bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of Lianhua Qingwen in the treatment of patients with moderate COVID-19 infection
Authors: Liu Nanyang , Zhang Tingting , Ma Lina , Wang Huican , Cao Yu , Yang Yang , Pei Hui , Li Hao
Published: August 2020

Background

: As of June 2020, more than 7 million cases of coronavirus disease (COVID-2019) have been reported worldwide. At present, there is no vaccine or antiviral for the novel coronavirus pneumonia. Lianhua Qingwen (LQ), a Chinese medicine formula, has been authorized by the Chinese government for treating COVID-2019. This systematic review and meta-analysis will evaluate the efficacy and safety of LQ on patients with COVID-19.

Methods

: Two independent reviewers will search the following databases of the China Biology Medicine disc, China National Knowledge Infrastructure, China Science and Technology Periodical Database, Wanfang database, Embase, PubMed, and Cochrane Library from the date of conception to June 1, 2020. We will use the MeSH/Emtree terms, combining free-text words that were properly adjusted for the different databases in all of the search strategies. We will take primary clinical symptoms, total efficacy, and adverse event into consideration for our primary outcomes. As secondary outcomes, we will estimate the chest computed tomography manifestations, the rate of conversion to severe cases, and secondary clinical symptoms. We will evaluate the quality of including studies through the risk of bias assessment tool provided by the Cochrane Collaboration. Fixed-or random-effect model will be utilized to calculate the overall pooled risk estimates. Forest plots will be generated to prove the pooled results. Sensitivity analysis will be carried out to identify sources of heterogeneity. The Begg rank correlation test and Egger linear regression test will be used to explore publication bias.

Results

: This systematic review and meta-analysis will compare the primary and secondary outcomes at baseline and endpoint in the treatment and control groups to investigate the efficacy and safety of LQ for treatment COVID-2019.

Discussion:

Data from this study will provide strong evidence for clinical decision if the findings are positive.

PROSPERO registration number: CRD42020190757.
A multicenter randomized controlled trial to assess the efficacy of cancer green therapy in treatment of stage IIIb/IV non-small cell lung cancer
Authors: Sun Manqiang , Zhou Tian , Fang Xueni , Wang Dan , Pang Haoyue , Chen Yu , Hu Kaiwen
Published: August 2020

Background:

Chemotherapy is the main therapy for stage IIIB/IV non-small cell lung cancer (NSCLC). However, the 5-year survival rate is 6%. Cancer Green Therapy is a novel therapy in China, which refers to cryoablation combined with traditional Chinese medicine (TCM) formula. Our previous retrospective analysis showed that patients with NSCLC had longer survival time and better quality of life after receiving cryoablation combined with TCM formula, compared with patients who received chemotherapy alone.

Methods:

This study is a multicenter, randomized, controlled clinical study. The experiment will be carried out in 6 hospitals at the same time, and a total of 450 cases of participants will be randomly assigned to the experimental group and the control group (n = 225). The experimental group will be given cryoablation and 28-days TCM formula, and the control group will be given 4 cycles chemotherapy. After 30 months of follow-up, the efficacy and safety of cryoablation combines with TCM formula in patients with stage IIIB/IV NSCLC will be observed. The primary outcome is overall survival. The secondary outcomes include progression-free survival, objective response rate, and quality of life. We will also conduct a safety evaluation of the treatment at the end of the trial.

Discussion:

This multicenter, randomized, controlled clinical study not only provides data on the efficacy and safety of cryoablation combined with TCM formula, but also provides a novel treatment strategy for clinicians and advanced NSCLC patients.
Nutritional assessments in pregnancy and the risk of postpartum depression in Chinese women
Authors: Shi Dan , Wang Guo-hua , Feng Wen
Published: August 2020

Prevalence of postpartum depression (PD) in Chinese women is rising and its associated factors are not well known. In this study we aim to explore the associations between nutritional factors in pregnancy and the risk of PD in Chinese women.

A case-control study was performed in our hospital during January 2016 to June 2019. A food frequency questionnaire was designed to collect food consumption before the childbirth preceding month. Nutrition related biochemical indicators including fasting blood-glucose (GLU), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), and uric acid in the third trimester of pregnancy were detected. Logistic regression model was applied to compute odds ratio (OR) and its corresponding 95% confidence interval (CI).

There were 565 participants in this study, which comprised 182 individuals with PD and 383 individuals without. Patients with PD had higher odds of increased GLU (OR=2.62, 95%CI = 1.67–4.11), TC (OR = 1.73 95%CI = 1.22–2.46), TG (OR = 2.43, 95%CI = 1.55–3.81), and LDL (OR = 3.41, 95%CI = 2.09–5.57), but decreased HDL (OR = 3.41, 95%CI = 2.09–5.57) during pregnancy. With respect to uric acid, there was lack of no statistical association (OR = 2.23, 95%CI = 0.82–6.26). Food frequency questionnaire indicated a higher meat intake, but a lower vegetable, fruit, fish, and poultry intake in patients with PD during pregnancy.

Increased GLU, TC, TG, and LDL, but decreased HDL in later stages of pregnancy might be associated with PD.
Effect of Ganduqing on common cold
Authors: Wang Xiaomin , Liao Tingting , Wu Yongcan , Huang Demei , Pei Caixia , Wang Zhenxing , Wang Fei
Published: August 2020

Background:

The common cold is an infectious viral disease of the upper respiratory tract that has become the most frequent infectious disease in humans. Currently there is no cure for the common cold, and treatment typically focuses on alleviating symptoms. Although antiviral treatment is an important focus of current research, more than 200 viral strains have been associated with the common cold, making antiviral drug interventions difficult. Ganduqing is a Chinese medicinal preparation composed of Astragalus and Shegan. Several randomized controlled trials have been conducted to evaluate treatment of the common cold, but their effectiveness and safety have not been scientifically evaluated. In this study, we will systematically examine the efficacy and safety of Ganduqing in patients with common cold.

Methods:

The following electronic databases will be systematically and comprehensively searched: Cochrane Library, EMBASE, PubMed, Science Network, China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database and Chinese Journal Database, for randomized controlled trials that used Ganduqing for treating the common cold through June 2020. The primary outcomes were signs and symptoms of the common cold, including cough, sore throat, fever, nasal congestion and runny nose. Secondary outcomes included changes in the percentage of neutrophils and lymphocytes, and recurrence. Study selection, data extraction and quality assessment will be independently conducted by 2 researchers. Meta-analyses incorporating data derived from the literature will conduct using Review Manager (RevMan) v.5.3 and Stata 14 software. The Grading of Recommendations, Assessment, Development and Evaluations framework will be used to assess the quality of evidence derived from the meta-analyses.

Results:

This systematic review and meta-analysis aims to provide an evidence of Ganduqing for the common cold and will be disseminated through publications in peer-reviewed journals and/or presentations at scientific conferences.

Conclusions:

This systematic review will provide evidence for the efficacy and safety of Ganduqing in treating common colds.

Trial registration number:

INPLASY202060073
Effectiveness of percutaneous lumbar foraminoplasty in patients with lumbar foraminal spinal stenosis accompanying redundant nerve root syndrome
Authors: Jeong Ki-Soon , Cho Sung-Ae , Chung Woo-Suk , In Chi-Bum
Published: August 2020

The clinical outcomes of redundant nerve root syndrome (RNRS) in patients with lumbar foraminal spinal stenosis (LFSS) are currently unknown. The purpose of this study was to evaluate the postprocedural outcomes of RNRS in LFSS after percutaneous lumbar foraminoplasty (PLF) and identify the factors associated with RNRS by comparative analysis between patients with and without RNRS.

Patients with LFSS who underwent PLF were retrospectively analyzed. RNRS is defined as the presence of thick, elongated, and tortuous structures in the cauda equine associated with lumbar spinal stenosis. Based on the sagittal or transverse magnetic resonance imaging scans obtained before the PLF, the patients were stratified into 2 groups. Comparative analysis was performed between patients with RNRS (group R) and those without RNRS (group C).

From March 2016 to January 2019, 8 of the 21 (38.1%) patients undergoing PLF showed signs of RNRS on magnetic resonance imaging images. PLF showed a tendency for less therapeutic effect with respect to changes in pain intensity in group R as compared to group C, but there were no statistically significant differences between the 2 groups. RNRS correlated with the cross-sectional area (CSA) of the dural sac and LFSS grade (P < .05). The CSA of the dural sac was smaller and the grade of LFSS was higher in group R than in group C.

RNRS is commonly associated with lumbar spinal stenosis and could affect the treatment outcomes. Clinical outcomes in group R were not statistically different from those in group C, although group R showed slightly worse outcomes. The independent factors associated with RNRS were CSA of the dural sac and the LFSS grade.
Bioinformatics analysis of microRNA linked to ubiquitin proteasome system in traumatic osteonecrosis of the femoral head
Authors: Chen Ning , Xiao Bolian , Wang Shiying , Wei Biaofang
Published: August 2020

MicroRNAs (miRNAs) have been suggested to act critical roles in the pathophysiology of traumatic osteonecrosis of the femoral head (TONFH). Unfortunately, their roles in the development of TONFH are still ambiguous. The purpose of this study is to identify promising miRNA biomarkers in traumatic osteonecrosis development.

We conducted a comprehensive bioinformatics analysis using microarray datasets downloaded from the Gene Expression Omnibus database, and compared the expression of miRNAs in the serum of TONFH patients with controls. Next, we performed target prediction, function enrichment analysis, and protein-protein interaction network analysis based on differentially expressed (DE) miRNAs.

We identified 26 DE miRNAs that may contribute to the pathophysiology of TONFH. The miRNAs were linked to ubiquitin proteasome system including conjugating protein ligase activity, ubiquitin-protein ligase activity and ubiquitin mediated proteolysis 5 pathway, and we exposed miR-181a-5p and miR-140-5p as promising biomarkers in TONFH.

A predicting model consisting of 5 miRNAs may help discriminating high-risk patients who might develop TONFH after femur neck fracture. Among DE miRNAs, MiR-181a-5p and miR-140-5p may contribute to the development femoral head osteonecrosis after femur neck fracture via ubiquitin proteasome system.
Usefulness of intraductal RFA in patients with malignant biliary obstruction
Authors: Han Sung Yong , Kim Dong Uk , Kang Dae Hwan , Baek Dong Hoon , Lee Tae Hoon , Cho Jae Hee
Published: August 2020

Background/Aims:

Intraductal radiofrequency ablation (ID-RFA) is a novel therapy for unresectable malignant biliary obstructions. ID-RFA for perihilar lesions is associated with a high risk of adverse events. We aimed to evaluate the feasibility and efficacy of temperature-controlled ID-RFA for perihilar malignant biliary obstruction.

Methods:

Sixteen patients with pathologically proven perihilar cholangiocarcinoma were prospectively enrolled to evaluate the feasibility of hilar ID-RFA. Clinical efficacy and outcomes were subsequently evaluated in a multicenter retrospective cohort.

Results:

Nine of the 16 patients in the prospective cohort had Bismuth type IV and 7 had type IIIA perihilar cholangiocarcinoma. The median length of stricture was 34.5 mm. The median number of ID-RFA sessions was three, and all sessions were technically and functionally successful without severe adverse events. Clinical outcomes were assessed using a multicenter hilar ID-RFA cohort of 21 patients; the median stent patency and overall survival were 90 days (range: 35–483 days) and 147 days (range: 92–487 days), respectively. An approximate 16-month patency of the bile duct was maintained in one patient who had an intraductal growth pattern. In a comparison of the self-expandable metallic stent (SEMS) and plastic stent (PS) after hilar ID-RFA, no differences in stent patency (89 vs 90.5 days, respectively; P = .912) and adverse events (20.0% vs 10%, respectively; P = .739) were observed.

Conclusions:

ID-RFA at 7 W for 120 seconds is safe and feasible in patients with advanced perihilar cholangiocarcinoma. After ID-RFA, SEMS and PS placement showed comparable patency and survival rates.

Trial registration number:

KCT0003223
Complete ureteral necrosis after injury sustained during lumbar disc surgery
Authors: Fuquan Jiang , Gang Zhang , Jianlin Xiao , Yin Ruofeng
Published: August 2020

Introduction:

Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection.

Patient concerns:

We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery.

Diagnosis:

The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods.

Intervention

: We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect.

Outcomes:

Post-operative period was uneventful and the patient showed good recovery.

Conclusion:

Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.
Proportion of time spent in blood glucose range 70 to 140 mg/dL is associated with increased survival in patients admitted to ICU after cardiac arrest
Authors: Zhou Dawei , Li Zhimin , Shi Guangzhi , Zhou Jianxin
Published: August 2020

The benefit of any specific target range of blood glucose (BG) for post-cardiac arrest (PCA) care remains unknown.

We conducted a multicenter retrospective study of prospectively collected data of all cardiac arrest patients admitted to the ICUs between 2014 and 2015. The main exposure was BG metrics during the first 24 hours, including time-weighted mean (TWM) BG, mean BG, admission BG and proportion of time spent in 4 BG ranges (<= 70 mg/dL, 70–140 mg/dL, 140–180 mg/dL and > 180 mg/dL). The primary outcome was hospital mortality. Multivariable logistic regression, Cox proportion hazard models and generalized estimating equation (GEE) models were built to evaluate the association between the different kinds of BG and hospital mortality.

2,028 PCA patients from 144 ICUs were included. 14,118 BG measurements during the first 24 hours were extracted. According to TWM-BG, 9 (0%) were classified into the <= 70 mg/dL range, 693 (34%) into the 70 to 140 mg/dL range, 603 (30%) into the 140 to 180 mg/dL range, and 723 (36%) into the > 180 mg/dL range. Compared with BG 70 to 140 mg/dL range, BG 140 to 180 mg/dL range and > 180 mg/dL range were associated with higher hospital mortality probability. Proportion of time spent in the 70 to 140 mg/dL range was associated with good outcome (odds ratio 0.984, CI [0.970, 0.998], P = .022, for per 5% increase in time), and > 180 mg/dL range with poor outcome (odds ratio 1.019, CI [1.009, 1.028], P< .001, for per 5% increase in time). Results of the 3 kinds of statistical models were consistent.

The proportion of time spent in BG range 70 to 140 mg/dL is strongly associated with increased hospital survival in PCA patients. Hyperglycemia (> 180 mg/dL) is common in PCA patients and is associated with increased hospital mortality.
Clinical outcomes of trabecular microbypass stent (iStent) implantation in medically controlled open-angle glaucoma in the Korean population
Authors: Kim Hee Jun , Lim Su-Ho
Published: August 2020

To evaluate the safety and efficacy [intraocular pressure (IOP)-lowering effect and medication use] of a single trabecular microbypass stent (iStent; Glaukos Corp, San Clemente, CA) for medically controlled open-angle glaucoma.

This retrospective case series included 42 eyes of 34 patients with medically controlled open-angle glaucoma with IOP less than 21 mm Hg. Clinical outcomes analyzed were IOP, medication use, corrected distance visual acuity (CDVA), and surgical complications. Surgical success was defined according to 4 criteria: IOP < 21 mm Hg without medication; IOP < 18 mm Hg without medication; IOP < 15 mm Hg without medications; and IOP < 18 mm Hg with or without medication. Patients were followed for a minimum of 6 months postoperatively.

Mean IOP was reduced from 15.8 ± 2.8 mm Hg to 14.5 ± 2.8 mm Hg (P < .001), while mean number of medications decreased from 2.2 ± 1.2 to 0.8 ± 1.1 at final visit (P < .001). Surgical success rates were 78.6%, 61.9%, 57.1%, and 97.6% at 6 months and 78.6%, 59.5%, 52.4%, and 95.2% at final visits according to criteria A, B, C, and D. Meanwhile, 59.5% of patients were medication-free at their final visit. The relative risk of surgical failure by Criteria B and C was 4.337 (95% confidence interval: 1.799–10.454) and 3.717 (95% confidence interval: 1.516–9.116) times greater in the higher-medication group (3 or more preoperative medications), respectively. CDVA was significantly improved from 0.41 ± 0.10 to 0.09 ± 0.07 LogMAR in the combined phacoemulsification and iStent implantation group (P < .001). There was no case whose vision was threatened (vision loss of 2 or more lines) or who showed severe complications after surgery.

Single trabecular microbypass stent implantation was effective in reducing IOP and medication usage in patients with open-angle glaucoma with a low preoperative IOP. Our results imply that it is more difficult to achieve low target IOP control in eyes with higher numbers of preoperative medications.
Herbal medicine treatment for Alzheimer disease
Authors: Lee JiEun , Jin Chul , Cho Seung-Yeon , Park Seong-Uk , Jung Woo-Sang , Moon Sang-Kwan , Park Jung-Mi , Ko Chang-Nam , Cho Ki-Ho , Kwon Seungwon
Published: August 2020

Background:

Alzheimer disease (AD) is a leading progressive neurodegenerative disease worldwide, but treating it is challenging in clinical practice. This review is aimed at evaluating the efficacy and safety of herbal medicine for treating AD.

Methods and analysis:

We will search for randomized controlled trials related to the effect and safety of herbal medicine for AD in the following databases: PubMed, Cochrane Central Register of Controlled Trials, Excerpta Medica Database, China National Knowledge Infrastructure database, Oriental Medicine Advanced Searching Integrated system, Korean Traditional Knowledge Portal, and Citation Information by National Institute for Informatics. The risk of bias will be evaluated using the Cochrane risk-of-bias assessment tool. After screening the studies, a meta-analysis will be performed. The primary outcome will be the Mini-Mental State Examination score. Secondary outcomes will consist of other scales for cognitive function and other aspects, such as behavioral and psychological symptoms and plasma levels of amyloid-β.

Results:

This study will provide the current status of evidence for herbal medicine to treat AD.

Conclusion:

The results of this review will determine the efficacy and safety of herbal medicine for AD.

Ethics and dissemination:

Ethical approval is not required, as this study is based on a review of published research. This review will be published in a peer-reviewed journal and disseminated both electronically and in print.

Trial registration number:

Research Registry reviewregistry933.
Spontaneous regeneration of the mandible following hemimandibulectomy for medication-related osteonecrosis of the jaw
Authors: Matsuda Shinpei , Yoshida Hisato , Shimada Minako , Yoshimura Hitoshi
Published: August 2020

Rationale:

Medication-related osteonecrosis of the jaw decreases quality of life of patients with cancer. The debate about it continues regarding the risk factors, etiology, and treatment methods, and so on. Also, spontaneous regeneration of the mandible is clinically rare.

Patient concerns:

A 67-year-old woman presented to the authors’ department complaining of pain, swelling, and pus discharge from a fistula. She previously had breast cancer bone metastases and had received antiresorptive intravenous bisphosphonate.

Diagnosis:

The patient was diagnosed with medication-related osteonecrosis of the jaw.

Interventions:

She received conservative therapy with antibiotics and surgical therapy as sequestrectomy under general anesthesia; however, the lesion did not heal. Thirty months after the MRONJ diagnosis, when she was 70 years’ old, she underwent a left hemimandibulectomy without reconstruction under general anesthesia.

Outcomes:

Spontaneous regeneration of the mandible was observed by follow-up imaging examinations. The patient has no current subjective or objective symptoms.

Lessons:

This is the first case report of the spontaneous mandibular regeneration after surgery for medication-related osteonecrosis of the jaw. Additionally, this case was the oldest patient among the published mandibular regeneration cases.
Plasma exchange for treating anti-Yo-associated paraneoplastic cerebellar degeneration
Authors: Hu Feng-Qi , Shang Fu-Rong , Liu Jing-Jing , Yuan Hai
Published: August 2020

Rationale:

Paraneoplastic cerebellar degeneration (PCD) is a rare neurodegenerative syndrome associated with antibodies targeting the Purkinje cells of the cerebellum. Most cases of anti-Yo-associated PCD occur in females, with <20 cases reported in males. Herein, we report a male patient with anti-Yo-associated PCD who was treated with plasma exchange and achieved a favorable outcome.

Patient concerns:

A 64-year-old man presented with progressive ataxia, gait instability, and dysuria. Electroencephalography, electromyography, brain and spinal neuroimaging, and routine laboratory examinations were all normal. The anti-neuronal antibody Anti-Yo was detected in the serum but not in the cerebrospinal fluid (CSF).

Diagnosis:

The patient was diagnosed with definite anti-Yo-associated PCD based on the clinical manifestations, anti-Yo was detected in the serum and response to treatment.

Interventions:

At beginning, the patient was treated with dexamethasone (10 mg/day for 10 days). Then, plasma exchange was performed.

Outcomes:

After treated with dexamethasone, no clinical improvement was noted in this patient. In the following month, his condition deteriorated. However, after two courses of plasma exchange, neurological examination showed marked improvement in gait. After four courses of plasma exchange, the patient could walk independently, the Romberg test was negative, and anti-Yo antibodies were undetectable. At the 6-month follow-up, the patients’ symptoms were relieved, and tests for anti-Yo antibodies remained negative.

Lessons subsections:

Treatment with plasma exchange for anti-Yo-associated male PCD patients without a concomitant tumor are recommend and need more studies.
A network meta-analysis protocol of conservative interventions for urinary incontinence in postpartum women
Authors: Wang Yang , Li Hui , Wang Jun , Hao Qinghong , Tu Yang , Chen Yalin , Qiu Mimi , Peng Wei , Liu Yunlu , Zhu Tianmin
Published: August 2020

Background:

Postpartum urinary incontinence (PPUI) is a common urological condition in women after childbirth. Due to the side effects of surgical and pharmacological therapies, the patients and physicians alike express a strong preference for conservative approaches on PPUI, such as pelvic floor muscle training, biofeedback, electrical stimulation, bladder training, vaginal cones and acupuncture. Application of these conservative approaches should be guided by high quality evidence, yet their comparative effectiveness has not been well documented. Therefore, the network meta-analysis aims to compare, rank and summarize all available studies to determine which conservative intervention is more effective for PPUI.

Methods:

In this present study, qualified English and Chinese studies will be searched in PubMed, Scopus, EMBASE, The Cochrane Library, Web of Science, VIP Database, Wanfang Database, Chinese Biomedical Literature Database and China National Knowledge Infrastructure. All eligible randomized controlled trails (RCTs) of conservative interventions for PPUI will be included. R software 3.61 (R Foundation for Statistical Computing, Vienna, Austria) will be applied to synthesize data and conduct network meta-analysis. I
2 statistic and Z test will be used to assess heterogeneity and inconsistency, respectively.

Results:

Ethical approval is not required for this existed literature based meta-analysis. The findings of this research will be disseminated through a recognized journal.

Conclusion:

The findings of this study will provide ranking evidence for clinicians and patients to choose a more appropriate conservative therapy on PPUI.

Trial registration number:

PROSPERO CRD42020168042
Persistent vegetative state after severe cerebral hemorrhage treated with amantadine
Authors: Gao Yu , Zhang Yi , Li Zhuo , Ma Linlin , Yang Jing
Published: August 2020

Amantadine is currently recommended for use in patients of posttraumatic brain injury with unconsciousness. However, the application of amantadine in consciousness disturbance after cerebral hemorrhage has only been rarely reported. This allows for a further exploration of the role of amantadine in the treatment of PVS resulting from severe cerebral hemorrhage.

Retrospective cohort study from 1/2015 to 7/2019 in Beijing Chaoyang hospital. We included adult patients treated with amantadine after severe cerebral hemorrhage in PVS. Primary outcome was time of consciousness recovery and Glasgow Out Scale scores after 5 months from onset. We compared characteristics and outcomes to a control cohort. matched on age, Coma Recovery Scale-Revised score, volume and location of hemorrhage.

Among the 12 patients who received amantadine treatment, 6 patients regained consciousness (50%) after 5 months of disease onset, but were still severely disabled. Besides, the time for regaining consciousness was within 3 months of disease onset. The remaining 6 patients were still in a PVS. Compared with the amantadine group, the consciousness recovery rate (50% vs 33.3%, P = .68) after 5 months in the nested control group was not significantly different. The awakening time for patients in the amantadine group was earlier than the control group (100% vs 25%, P = .03).

In this study, amantadine can accelerate the recovery of consciousness in patients following severe cerebral hemorrhage. We recommend further randomized controlled studies to determine the efficacy of amantadine.
Liver injury in patients with severe acute respiratory syndrome coronavirus-2 infection: a systematic review and meta-analysis
Authors: Labenz Christian , Toenges Gerrit , Wörns Marcus-Alexander , Sprinzl Martin F. , Galle Peter R. , Schattenberg Jörn M.
Published: August 2020

Objective

Coronavirus disease-19 (COVID-19) infection is a global health threat. To inform the liver community on the potential relevance of COVID-19, we performed a systematic review and meta-analysis of published data on liver injury in patients with COVID-19 infection.

Methods

We searched PubMed and Google Scholar through 22 March according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled data were analyzed by using random-effects meta-analyses.

Results

A total of 14 studies combining data from 2.871 patients were identified. The prevalence of pre-existing liver disease was reported at 3.1%. The pooled prevalence of elevated aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were 26% [95% confidence interval (CI), 20–32%] and 19% (95% CI, 14–26%), respectively. Only two studies reported the prevalence of elevated liver function tests according to normal ward versus ICU and here the frequency of elevated levels of AST was 50% and 62% versus ALT 40.8% and thus quantitatively higher in ICU-treated patients. Mean levels of absolute AST levels were 33 U/L (95% CI, 30.21–36.09), while mean ALT levels were 31 U/L (95% CI, 27.52–34.57). Cholestatic liver function tests were only incompletely reported in 510 patients. Here, mean levels of alkaline phosphatase were 71 U/L across three studies, and mean levels of gamma-glutamyl transferase were 40.6 U/L across four studies.

Conclusions

Emerging data on LFTs in COVID-19 are heterogeneous indicating mild LFTs involvement in every fourth to fifth patients with numerical more prevalent AST over ALT elevations. Prospective studies are needed to define the clinical relevance of liver injury in COVID-19.
Serial measurements of faecal calprotectin may discriminate intestinal tuberculosis and Crohn’s disease in patients started on antitubercular therapy
Authors: Sharma Vishal , Verma Suhang , Kumar-M Praveen , Mandavdhare Harshal S. , Singh Harjeet , Shah Jimil , Kalsi Dimple , Dutta Amitava , Mishra Shubhra , Prasad Kaushal K. , Sharma Arun K. , Dutta Usha
Published: August 2020

Background

Response to antitubercular therapy (ATT) is often used to differentiate intestinal tuberculosis (ITB) from Crohn’s disease. Role of non-invasive biomarkers to predict mucosal response to ATT is unclear.

Materials and methods

A prospective study to compare faecal calprotectin and serum C-reactive protein (CRP) levels at diagnosis, 2 and 6 months of ATT in patients with suspected ITB started on ATT was done. The patients were eventually divided into two groups: ITB or alternative diagnosis (OTH). Decline of calprotectin and CRP levels was used to compute area under the receiver operating characteristic (AUROC) to predict mucosal healing at 2 months.

Results

Thirty-seven patients (mean age: 34.95 ± 16.35 years, 23 males) were included and 28 (75.67%) were diagnosed as ITB while nine (24.32%) had alternative diagnosis (OTH). The median faecal calprotectin values of ITB and OTH groups at baseline, 2 months and 6 months were 216 and 282 µg/g (P = 0.466), 43 and 216 µg/g (P = 0.003), and 26 and 213 µg/g (P < 0.001), respectively. The median CRP values at baseline, 2 months and 6 months were 18 and 30 mg/L (P = 0.767), 4.7 and 15 mg/L (P = 0.025), and 3 and 10.85 mg/L (P = 0.068), respectively. The AUROC of percent decline in faecal calprotectin and serum CRP at 2 months for mucosal healing were 0.8287 [95% confidence inteval (CI) 0.6472–1] and 0.6018 (95% CI 0.4079–0.7957), respectively.

Conclusion

Faecal calprotectin can help in assessing response to therapy in suspected ITB patients started on empirical ATT.
The effects of diabetes mellitus on clinical outcomes of hospitalized patients with acute diverticulitis
Authors: Jiang Yi , Rodgers Brandon , Damiris Konstantinos , Choi Catherine , Ahlawat Sushil
Published: August 2020

Objectives

Acute diverticulitis is a common gastrointestinal illness due to diverticular inflammation and focal necrosis. Diabetes mellitus has been reported to influence the outcomes of patients with diverticular disease. Our study aimed to examine the inpatient outcomes and complications of patients with acute diverticulitis and coexisting diabetes mellitus.

Methods

The Nationwide Inpatient Sample was used to identify adult patients in 2014 admitted for acute diverticulitis. Primary outcomes were mortality, length of stay (LOS), and total hospitalization charges. Secondary outcomes were complications of acute diverticulitis and interventions.

Results

In total, 44 330 of patients with acute diverticulitis and diabetes mellitus were included in the analysis. Acute diverticulitis patients with diabetes mellitus had a higher rate of diverticular bleeding (P < 0.0001), but lower rates of abscess (P < 0.0001), obstruction (P < 0.0001) and colectomy (P < 0.0001) when compared to acute diverticulitis patients without diabetes mellitus. Complicated diabetes mellitus was associated with a longer LOS (P = 0.00003) and greater total hospitalization charges (P = 0.0021) compared to uncomplicated diabetes mellitus when coexisting with acute diverticulitis.

Conclusions

Acute diverticulitis with diabetes mellitus is associated with a higher rate of diverticular bleeding, lower rates of abscess, obstruction, and colectomy compared to acute diverticulitis without diabetes mellitus. When coexisting with acute diverticulitis, complicated diabetes mellitus is not associated with higher rates of mortality or diverticulitis-related complications compared to uncomplicated diabetes mellitus.
99mTc-dimercaptosuccinic acid scan versus MRI in pyelonephritis: a meta-analysis
Authors: Sarikaya Ismet , Albatineh Ahmed N. , Sarikaya Ali
Published: August 2020

Purpose

99mTc-dimercaptosuccinic acid (DMSA) scan is the current gold standard in detecting parenchymal changes, particularly scarring, in pyelonephritis. Recently, magnetic resonance imaging (MRI) is gaining popularity in the diagnosis of pyelonephritis. The aim of this study is to perform a meta-analysis on studies directly comparing MRI to DMSA scan in patients with pyelonephritis.

Materials

Systematic searches of PUBMED and EMBASE databases were performed to extract studies comparing MRI and DMSA scan in patients with pyelonephritis. The relevance of articles was assessed by two authors according to predefined inclusion and exclusion criteria. The pooled estimates of the sensitivities of MRI and DMSA scan were computed using random-effects meta-analysis model following DerSimonian and Laird’s method. Subgroup analysis and publication bias were performed.

Results

Seven studies were included (164 patients). Using random effect model, the pooled estimate of the sensitivities of MRI and DMSA scan were 0.62 (95%CI: 0.44 – 0.77) and 0.59 (95%CI: 0.48 – 0.70), respectively. The pooled estimates of sensitivities of MRI and DMSA scan for acute pyelonephritis were 0.73 (95%CI: 0.49- 0.89) and 0.66 (95%CI: 0.56 – 0.75), respectively, and for scar detection were 0.48 (95%CI: 0.31- 0.66), and 0.50 (95%CI: 0.30 – 0.71), respectively.

Conclusion

The overall sensitivities of MRI and DMSA scan were equivalent in detecting parenchymal changes in pyelonephritis. MRI and DMSA scan appeared to be equivalent to scar detection. In a small number of studies, MRI appeared to be better than the DMSA scan in acute pyelonephritis but this should be further studied in a larger number of patients.
Universal Trauma Screening in an Adult Behavioral Health Setting
Authors: Streb Stephanie , Burda Charon
Published: August 2020

Purpose/Objectives

The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) with Criterion A was universally used in admission screening to pilot a trauma-informed care process for quality improvement.

Description of the Project

All adult inpatient behavioral health patients at a Mid-Atlantic county hospital were screened for trauma exposure on admission. Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with Criterion A was provided to all adults admitted to a 27-bed inpatient behavioral health unit for 8 weeks. Quantitative descriptive statistics were calculated based on self-report PCL-5 scores; qualitative data were gathered from staff and stakeholders.

Outcome

During the pilot period, there was a 49.2% response rate. Fifty respondents (53.8%) screened positive for trauma as recorded on the Criterion A portion. Seventeen (18.3%) were negative for trauma self-report, and 26 (30.0%) did not complete this portion. Fifty-six (60.2%) completed screens scored 33 or greater on the PCL-5 portion. Staff found the timing of administration convenient but expressed concern over emotional cost to patient.

Conclusions

Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with Criterion A served as guidepost for trauma-informed assessment, treatment, and referrals. Future considerations may include timing of presentation to patient, electronic translation of the tool to facilitate interdisciplinary collaboration, and tracking of screening completion.
Building Evidence-Based Practice Competency Through Interactive Workshops
Authors: O'Shea Debra , Fischer-Cartlidge Erica
Published: August 2020

Background

Consistent implementation of evidence-based practice (EBP) leads to high-quality care, improved patient outcomes, and reduced costs. Increased job satisfaction, decreased turnover, and increased autonomy are reported when nurses use evidence for practice decisions. It is essential that clinical nurse specialists have strong EBP skills and enculturate these skills into bedside staff.

Project Design and Implementation

Interactive 90-minute workshops were developed to review the steps of EBP. The participants were nurses at the bedside and were encouraged to cultivate a spirit of inquiry.

Outcome Evaluation

Twenty-three workshops were held with 349 participants. Pre and post surveys were used to assess changes in knowledge and self-perceived confidence. A moderate to large effect size was noted in all areas measured. The largest change in knowledge was in correct identification of use of Boolean operators, which showed a 71% improvement. Overall mean knowledge improved by 29%, which was statistically significant (P < .0001).

Implications for Practice

Clinical nurse specialists can enact culture change by understanding the needs of their stakeholders and applying concepts to find creative ways to bring change to staff. This workshop successfully taught EBP concepts and implemented culture change in a way that was low cost and easy to replicate.
The 2020 WHO Classification
Authors: Kallen Michael E. , Hornick Jason L.
Published: August 2020

The fifth edition of the World Health Organization Classification of Tumors of Soft Tissue and Bone was published in early 2020. The revisions reflect a consensus among an international expert editorial board composed of soft tissue and bone pathologists, geneticists, a medical oncologist, surgeon, and radiologist. The changes in the soft tissue tumor chapter notably include diverse, recently described tumor types (eg, atypical spindle cell/pleomorphic lipomatous tumor, angiofibroma of soft tissue, and CIC-rearranged sarcoma), new clinically significant prognostic information for a variety of existing entities (eg, dedifferentiated liposarcoma and solitary fibrous tumor), and a plethora of novel genetic alterations, some of practical diagnostic relevance (eg, NAB2-STAT6 in solitary fibrous tumor, FOSB rearrangements in epithelioid hemangioma and pseudomyogenic hemangioendothelioma, and SUZ12 or EED mutations in malignant peripheral nerve sheath tumor, leading to loss of H3K27 trimethylation). In this review, we highlight the major changes to the soft tissue chapter in the 2020 World Health Organization Classification, as well as the new chapter on undifferentiated small round cell sarcomas, with a focus on updates in diagnostic categories, prognostication, and novel markers. Recent discoveries in molecular genetics are also discussed, particularly those of immediate utility in differential diagnosis, including protein correlates detectable using immunohistochemistry.
Association of chronic spinal pain with diet quality
Authors: Zick Suzanna Maria , Murphy Susan Lynn , Colacino Justin
Published: August 2020

Introduction:

Chronic spinal pain is disabling and has high personal and societal costs. Risk factors include behavioral factors; however, little is known about the role of diet quality and its association with spinal pain. Higher diet quality and consumption of macronutrients that drive higher diet quality were hypothesized to be associated with lower odds of having spinal pain.

Methods:

An analysis of a population-based data set (NHANES cycle 2009–2010) was conducted. Diet quality was calculated using the Healthy Eating Index 2015 (score 0–100). To examine odds of pain related to dietary intake, generalized linear regressions were used adjusting for relevant covariates.

Results:

Of 4123 participants (mean age 43.5 ± 0.44 [SD], 2167 [52.6%] female), 800 (19.4%) reported chronic spinal pain. People with chronic spinal pain consumed similar amounts of calories to those with no spinal pain (2137 ± 44.5 vs 2159.9 ± 27.7), but had significantly poorer diet quality compared to people without spinal pain (51.97 ± 0.65 vs 54.31 ± 0.39, P = 0.007). From multivariate analyses, individuals with diet quality in the highest tertile on Healthy Eating Index-2015 were 24% less likely to report chronic spinal pain relative to those in the lowest tertile. Higher fruit, whole grain, and dairy intake were associated with 20% to 26% lower likelihood (all P for trend <0.028) of chronic spinal pain. Added sugars were associated with 49% increased odds of chronic spinal pain (P for trend = 0.002).

Conclusion:

Although causality cannot be assumed, this study supports continued investigation into the role of nutritional quality as a factor that may impact pain.
Using HIV self-testing to increase the affordability of community-based HIV testing services
Authors: d’Elbée Marc , Makhetha Molemo Charles , Jubilee Makhahliso , Taole Matee , Nkomo Cyril , Machinda Albert , Tlhomola Mphotleng , Sande Linda A. , Gomez Guillen Gabriela B. , Corbett Elizabeth L. , Johnson Cheryl C. , Hatzold Karin , Meyer-Rath Gesine , Terris-Prestholt Fern
Published: August 2020

Objectives:

This study estimates the costs of community-based HIV testing services (HTS) in Lesotho and assesses the potential efficiency gains achieved by adding HIV self-testing (HIVST) and then self-testing booths.

Design:

Micro-costing analysis using longitudinal data from a real-world intervention.

Methods:

We collected data prospectively on provider's costs and programmatic outcomes over three time periods of approximately 8 months each, between May 2017 and April 2019. The scope of services was extended during each period as follows: HTS only, HTS and HIVST, HTS and HIVST with individual HIVST booths wherein clients were encouraged to self-test on-site followed by on-site confirmative testing for those with reactive self-test. For each implementation period, we estimated the full financial and economic implementation costs, the incremental costs of adding HIVST onto conventional HTS and the cost per HIV positive case identified.

Results:

Costs per HIV-positive case identified increased between period 1 (US$956) and period 2 (US$1249) then dropped in period 3 (US$813). Full versus incremental cost analyses resulted in large differences in the magnitude of costs, attributable to methods rather than resource use: for example, in period 3, the average full and incremental cost estimates for HTS were US$34.3 and US$23.5 per person tested, and for HIVST were US$37.7 and US$14.0 per kit provided, respectively.

Conclusion:

In Lesotho, adding HIVST to community-based HTS improves its overall affordability for HIV-positive case finding. The reporting of both full and incremental cost estimates increase transparency for use in priority setting, budgeting and financial planning for scale-up.
Philtrum Reconstruction Using a Triangular-Frame Conchae Cartilage Graft in Secondary Cleft Lip Deformities
Authors: Wei Jiao , Zhang Jinsong , Herrler Tanja , Zhang Yi , Li Qingfeng , Hua Chenqing , Dai Chuanchang
Published: August 2020

Background:

The philtrum represents an essential feature in the architecture of the upper lip and over all facial appearance. A missing philtral ridge and dimple after cleft lip repair is associated with aesthetic impairment. The authors therefore developed a novel strategy for philtrum reconstruction using a triangular-frame conchae cartilage. The authors herein describe the surgical procedure and evaluate the postoperative outcomes.

Method:

In this study, 32 patients with a deficiency of the philtrum due to unilateral or bilateral cleft lip underwent reconstructive surgery based on a triangular-frame conchae cartilage graft. Preoperative and postoperative assessment of the convexity of the philtral ridge and dimpling was performed at rest and while puckering by standard patient photography and video technology. Postoperative outcome and complications were recorded during follow-up including a patient satisfaction survey.

Results:

The follow-up period after philtrum reconstruction ranged from 6 months to 5.3 years. Postoperative evaluation showed satisfactory and stable results with an aesthetic philtral ridge and dimpling, even in the long term. The vast majority (31 patients) were satisfied with the postoperative outcome. Complications included acute infection (1 case), temporary stiffness of smile (1 case), and reddening of the scar (1 case). No systemic complications occurred.

Conclusion:

The authors here propose a simple, effective, and reliable surgical technique for secondary philtrum reconstruction in cleft lip deformity patients using a triangular-frame auricular cartilage graft.

Level of Evidence:

4
Anti-pig IgE and IgA Antibodies in Naive Primates and Nonhuman Primates With Pig Xenografts
Authors: Li Qi , Iwase Hayato , Yamamoto Takayuki , Nguyen Huy Quoc , Ayares David , Wang Yi , Cooper David K.C. , Hara Hidetaka
Published: August 2020

Background.

Natural preformed anti-pig IgM/IgG antibodies in primates play an important role in xenograft rejection. As it is not clear how IgE and IgA engage in the immune system in xenotransplantation, we investigated natural preformed and elicited anti-pig IgE/IgA in naive primates and after xenotransplantation in nonhuman primates.

Methods.

The binding of IgM/IgG/IgE/IgA antibodies to red blood cells (RBCs) from wild-type (WT), α1,3-galactosyltransferase gene-knockout (GTKO), and GTKO/cytidine monophospho-N-acetylneuraminic acid hydroxylase gene-knockout/β-1,4 N-acetylgalactosaminyltransferase 2 gene-knockout (ie, triple-knockout pigs) pigs were measured by flow cytometry in naive human (n = 50) and baboon (n = 14) sera. Antibody binding to WT and GTKO pig RBCs (pRBCs) was also measured in the sera of baboons (nonsensitized n = 7, sensitized n = 2) and rhesus monkeys (nonsensitized n = 2, sensitized n = 11) following WT or GTKO pig organ/tissue xenotransplantation. Deposition of IgM/IgG/IgE/IgA in the grafts was detected by immunohistochemistry.

Results.

The majority of humans had natural preformed IgM/IgG/IgE/IgA to WT and GTKO pRBCs. In contrast, IgM/IgG/IgE/IgA to triple-knockout pRBCs were present at lower levels and frequency (P < 0.01). Baboons also had IgM/IgG/IgE/IgA antibodies against WT pRBCs, but fewer to GTKO and triple-knockout (P < 0.01). After xenotransplantation into nonhuman primates, when IgM/IgG increased, IgE/IgA also increased, but to a lesser extent. In addition to IgM/IgG, IgE or IgA deposition was observed in rejected pig xenografts.

Conclusions.

Primates develop serum anti-pig IgE/IgA antibodies both naturally and during xenograft rejection. The pathophysiological role, if any, of anti-pig IgE/IgA antibodies remains unknown.