bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of DMEK and DSAEK in Eyes With Endothelial Decompensation After Previous Penetrating Keratoplasty
Authors: Kiel Marian , Bu Julia Bing , Gericke Adrian , Vossmerbaeumer Urs , Schuster Alexander K. , Pfeiffer Norbert , Wasielica-Poslednik Joanna
Published: June 2021

Purpose:

Posterior lamellar keratoplasty is increasingly applied in patients with endothelial decompensation after penetrating keratoplasty (PK). The aim of this study was to compare the results of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) after PK.

Methods:

In this retrospective study, clinical data of 30 patients who received DMEK (n = 19) or DSAEK (n = 11) for endothelial decompensation after PK were evaluated. All lamellar keratoplasties were performed at the Department of Ophthalmology at University Hospital Mainz, Germany. Primary end point included best-corrected visual acuity, and secondary end points included endothelial cell density, rebubbling, and rejection rates, all at 6 and 12 months.

Results:

After 6 months and 12 months, 89% of DMEK and 73% of DSAEK grafts and 63% of DMEK and 64% of DSAEK grafts provided sufficient corneal deturgescence, respectively, represented by improvement in best-corrected visual acuity. DMEK group median preoperative Logarithm of the Minimum Angle of Resolution visual acuity of 1 increased to 0.5 after 6 and 12 months. DSAEK group median Logarithm of the Minimum Angle of Resolution visual acuity increased from 3 to 2 and 1.3 after 6 and 12 months. After 12 months, graft endothelial cell density had decreased by 58% in the DMEK group and by 59% in the DSAEK group. The proportion of patients requiring a rebubbling were 63% in the DMEK and 64% in the DSAEK group. No lamellar graft rejection occurred in either trial arm.

Conclusions:

Both DMEK and DSAEK significantly improved visual acuity in patients after PK. Lamellar graft survival, loss of endothelial cells, and mean rebubbling rates were similar in both groups.
Old drugs for a new indication: a review of chloroquine and analogue in COVID-19 treatment
Authors: Ehianeta Teddy S. , Akinyeye Richard O. , Orege Joshua I. , Ejeromedoghene Onome , Adebule Adeniyi P. , Okonkwo Bright O.
Published: June 2021

As an innovative therapeutic strategy, drug repurposing affords old, approved, and already established drugs a chance at new indications. In the wake of the COVID-19 pandemic and the accompanied urgency for a lasting treatment, drug repurposing has come in handy to stem the debilitating effects of the disease. Among other therapeutic options currently in clinical trials, chloroquine (CQ) and the hydroxylated analogue, hydroxychloroquine (HCQ) have been frontline therapeutic options in most formal and informal clinical settings with varying degrees of efficacy against this life-threatening disease. Their status in randomized clinical trials is related to the biochemical and pharmacological profiles as validated by in vitro, in vivo and case studies. With the aim to bear a balance for their use in the long run, this review not only synopsizes findings from recent studies on the degrees of efficacy and roles of CQ/HCQ as potential anti-COVID-19 agents but also highlights our perspectives for their consideration in rational drug repositioning and use.
Beliefs and Experience of Journaling in Mothers of Adult Children With Substance Use Problems
Authors: Kim-Godwin Yeoun Soo
Published: June 2021

Background

The challenges experienced by mothers supporting an adult child with substance use problems suggest intervention is needed to improve such mothers' psychosocial well-being through adaptive coping.

Aims

This study examined beliefs about journaling as well as changes in stress, cortisol levels, and mental health after a 6-week intervention by mothers whose adult children had substance use problems. In addition, the study explored coping methods used and the experience of writing among these mothers.

Methods

A purposeful sample of 17 mothers completed the pretest and posttest. Participating mothers were asked to make journal entries at least 3 times per week for 6 weeks.

Results

The mothers used diverse adaptive coping methods to manage stress. In particular, they frequently used religious and meaning-focused coping. The mothers perceived journaling as a highly valuable coping method for daily stress. The findings of paired t tests indicated no statistically significant differences in the stress, mental health variables, and cortisol levels between pretest and posttest. However, participants shared the positive experiences of journaling: emotional well-being, stress management, perspective changes, focus, self-regulation, clarity, and gratitude.

Conclusion

The present finding suggests journaling is a practical means to promoting adaptive coping in mothers with adult children who have substance use problems.
Attitudes Scale on Alcohol, Alcoholism, and Persons With Alcohol Use Disorders
Authors: de Vargas Divane , Naegle Madeline A.
Published: June 2021

Background

The Attitudes Scale on Alcohol, Alcoholism, and Persons with alcohol use disorders (“Escala de Atitudes Frente ao Álcool, ao Alcoolismo e ao Persons with alcohol use disorders” [EAFAA]) is an instrument designed to measure attitudes toward alcohol, alcoholism, and persons with alcohol use disorders. It has been validated in Portuguese and Spanish.

Objective

The purpose of this study was to examine the psychometric properties and factor structure of the American English version of the EAFAA (EAFAA-AEV).

Methods

One hundred eighty-seven participants (nurses = 101 and nursing students = 86) completed the EAFAA-AEV.

Results

Confirmatory factor analysis resulted in a four-factor solution, supporting the original factor structure of the EAFAA. The scale has shown good internal consistency and reliability for the four factors. The total scale had a Cronbach's alpha of .85 and a McDonald's omega of .87.

Conclusion

The EAFAA-AEV has similarly strong psychometric properties as the original version, suggesting that it is a reliable tool to identify attitudes toward alcohol and related issues among American-English-speaking nurses and nursing students.
Men and suicide: Primary care prevention in the era of COVID-19 and beyond
Authors: Adler Rachel H.
Published: June 2021

The COVID-19 pandemic has had detrimental effects on mental health, including a predicted increase in suicidality, making suicide prevention a high priority. The rate of men's suicide in the United States is significantly higher than that of women's suicide. This case study considers the role of primary care advanced practice nurses in addressing the risks of suicide in their practice with male patients. It is argued that a gender-sensitive approach is necessary to be effective in male suicide prevention efforts.
Comparison of hepatitis C treatment outcomes between primary care and specialty care
Authors: Stanley Kate , Bowie Bonnie H.
Published: June 2021

Background:

Hepatitis C virus (HCV) infections have increased significantly in the United States recently, having tripled by 2014. Seventy-five percent of those with HCV are aging baby boomers, which places increased pressure on the medical system to provide treatment. There are not enough specialists available to treat everyone infected with HCV.

Purpose:

The aim of this research was to determine whether treatment of hepatitis C with new direct-acting antivirals in primary care settings resulted in equivalent cure rates when compared with those patients treated by specialists.

Methodology:

A retrospective cohort design was used. Participants were those treated for hepatitis C in specialty care at large public hospitals by gastroenterologists and/or hepatologists and those treated in two primary care community health centers in Seattle. Multivariate logistic regression was used to determine differences of sustained virologic response between those treated in primary care and those treated in specialty care. Treatment failure and those lost to follow-up were combined into one category.

Results:

Failure rates were only 4% in primary care and 1.1% in specialty care. After adjustment, patients treated in primary care were statistically significantly less likely to have failure/lost to follow-up than those treated in specialty care. Hepatitis C treatment can be successfully provided in primary care with equivalent treatment outcomes.

Implications for practice:

Primary care advanced practice nurses are in a good position to identify and treat hepatitis C. In addition, as patients are typically more engaged with their primary care provider, follow-up rates may be better versus referring these patients to a specialty provider.
A case report on severe nivolumab-induced adverse events similar to primary sclerosing cholangitis refractory to immunosuppressive therapy
Authors: Hirasawa Yuya , Yoshimura Kiyoshi , Matsui Hiroto , Kubota Yutaro , Ishida Hiroo , Arai Jun , Sakaki Masashi , Oguro Nao , Shida Midori , Taniguchi Makoto , Hamada Kazuyuki , Ariizumi Hirotsugu , Ishiguro Tomoyuki , Ohkuma Ryotaro , Sambe Takehiko , Horiike Atsushi , Imamura Chiyo K. , Shiozawa Eisuke , Wada Satoshi , Tsurutani Junji , Iwamoto Sanju , Uchida Naoki , Kiuchi Yuji , Tate Genshu , Kobayashi Shinichi , Tsunoda Takuya
Published: June 2021

Introduction:

Immune checkpoint inhibitors (ICIs), particularly anti-PD-1 antibody, have dramatically changed cancer treatment; however, fatal immune-related adverse events (irAEs) can develop. Here, we describe a severe case of sclerosing cholangitis-like irAE. We report the use of 3 immunosuppressive agents that resulted in the death of the patient due to treatment inefficacy. According to a postmarketing study of nivolumab, the frequency of ICI-related sclerosing cholangitis is 0.27% and that of ICI-related cholangitis is 0.20%. There have been 4 case reports of sclerosing cholangitis-like irAE, with imaging findings, including typical intrahepatic bile duct beaded constriction in primary sclerosing cholangitis. Treatment starts with prednisolone and is combined with an immunosuppressant in refractory cases. There are no reports of severe cases that ultimately led to death.

Patients concerns:

The patient is a 64-year-old male with Stage IV squamous cell lung carcinoma; he was hospitalized with abdominal pain and elevation of aspartate transaminase and alanine transaminase, approximately 4 months after ICI administration was suspended. This occurred because the patient treated with nivolumab as the second-line chemotherapy and developed type 1 diabetes mellitus after 11 courses.

Diagnosis:

A grade 3 increase in bilirubin was observed and he was diagnosed with sclerosing cholangitis, based on magnetic resonance cholangiopancreatography imaging and pathological findings of the liver and bile duct.

Interventions:

Prednisolone, mycophenolate mofetil, and tacrolimus combination therapy was administered.

Outcomes:

The treatment was difficult and failed. He died from liver failure 8 months after diagnosis. In this case, hepatitis and cholangitis, mainly alanine transaminase-dominant liver disorder, developed in the early stages of irAEs. Although he showed some improvement after prednisolone administration, bilirubin levels began rising again, and sclerosing cholangitis did not improve even with the use of 3 immunosuppressive agents recommended by the ESMO Clinical Practice Guidelines for immune-related hepatotoxicity management. Although the antitumor effect showed a complete response, liver failure led to death.

Conclusion:

This is the first case report on the ineffectiveness of triple immunosuppressant combination therapy recommended by the guidelines for immune-related hepatotoxicity. It is necessary to develop more appropriate treatment for severe sclerosing cholangitis-like irAE based on the robust evidence.
Comparative analysis of vascular bulldog clamps used in laparoscopic liver resection
Authors: He Liang , Li Weixiang , Zhou Dachen , Wang Lei , Hou Hui , Geng Xiaoping
Published: June 2021

To compare the clinical effect of Bulldog clamps with traditional Pringle for vascular occlusion during laparoscopic hepatectomy.

One hundred ten patients were retrospectively investigated in this research from December 2014 to January 2019 in the second hospital of Anhui Medical University, who underwent laparoscopic liver resection using Bulldog (modified group, n = 54) and cotton tourniquet (traditional group, n = 56) for blocking the liver inflow-blood. Intraoperative blood loss, duration of the operation time, clamping time, postoperative outcomes were analyzed.

All the operations were accomplished successfully without conversion to laparotomy, perioperative period clinical date was calculated. Intraoperative operative time, blood loss and resection sections had no statistical significance, but the clamping time (36.2 ± 5.6 vs 277.3 ± 88.4 s, P < .001) was significantly shorter in the bulldog group. Albumin, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin had no statistical differences in postoperative day (POD) 1and 3, but POD 5 alanine aminotransferase (71.0 ± 46.8vs 105.8 ± 61.7IU/L P = .018) and aspartate aminotransferase (72.8 ± 39.7 vs 100.2 ± 16.7 IU/L P = .028). The postoperative hospital stays (7.02 ± 1.56 vs 8.50 ± 2.35 days P = .026) in bulldog group were lower than cotton group and differences had statistical significance. The C-reactive protein levels were significantly higher in the traditional group than in the modified group on POD 3 (46.3 ± 19.2 vs 57.7 ± 23.9 mg/L P = .019), and POD5 (13.3 ± 4.2 vs 17.5 ± 7.3 mg/L P = .001). There were 8 postoperative complications occurred in cotton group, while there was 5 in Bulldog group, all patients with complications were discharged after adequate drainage and symptomatic treatment.

Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle maneuver.
A double-closed wedge broken-line osteotomy for cubitus varus deformity
Authors: You Chao , Zhou Yibiao , Han Jingming
Published: June 2021

Various osteotomy methods have been proposed in the treatment of cubitus varus. We designed an improved stepped osteotomy to achieve improved deformity correction. We refer to this new approach as double-closed wedge broken-line osteotomy and report a series of clinical and imaging results (deformity correction, range of motion [ROM], function, osteotomy healing, and complications) of patients with cubitus varus treated with this technique.

Between July 2014 and July 2019, we treated 9 cases of cubitus varus using the new technique. The study was conducted in accordance with the principles of the Declaration of Helsinki, and the study protocol was approved by the ethics committee of Shenzhen Children's Hospital. We obtained written parental consent for the minors before the study was begun. We compared preoperative and postoperative clinical and imaging parameters (humeral elbow-wrist angle, elbow ROM) in all patients. Postoperative evaluation was performed by telephone interview and outpatient review. The median follow-up was 23.2 months (range, 3–63 months).

The median humeral elbow-wrist angle modified from −14.27 to 15.15. The median clinical and imaging parameters after correction of deformity were not different from that of the normal side. Using our rehabilitation program, all patients recovered preoperative elbow ROM at the last follow-up.

Our double-closed wedge broken-line osteotomy has a larger cancellous bone contact surface. The deformity correction is satisfactory, the osteotomy healing is reliable, and the incidence of complications is low.

Level of Evidence: Level IV.
Identification of potential diagnostic biomarkers in MMPs for pancreatic carcinoma
Authors: Xie Junhao , Zhou Xianzhu , Wang Rui , Zhao Jiulong , Tang Jian , Zhang Qichen , Du Yiqi , Pang Yanan
Published: June 2021

Pancreatic cancer (PC) is a malignant tumor which ranks fourth in cancer-related death. However, the specificity and sensitivity of traditional biomarkers such as carbohydrate antigen 19-9 no longer meet the clinical requirements.

Tools as ONCOMINE and Gene Expression Profiling Interactive Analysis (GEPIA) were used to analyze the differential expression of matrix metalloproteinases (MMPs) in PC and adjacent tissues. For further analysis, we adopted database for annotation, visualization and integrated discovery (DAVID 6.8), transcriptional regulatory relationships unraveled by sentence-based text (TRRUST) and other tools. We also identified drugs targeted the selected MMPs.

Eight MMPs (MMP1, MMP2, MMP7, MMP9, MMP11, MMP12, MMP14, and MMP28) were differentially expressed in PC and adjacent tissue. MMP1 (P = .0189), MMP7 (P = .000216), MMP11 (P = .0209), MMP14 (P = .00611) were correlated with the pathological stages of PC. Patients with higher expression of MMP1 (P = .0011), MMP2 (P = .011), MMP7 (P = .0081), MMP9 (P = .046), MMP11 (P = .0019), MMP12 (P = .0011), MMP14 (P = .0011), and MMP28 (P = 6.3e-06) showed poor prognosis. Ten transcription factors were associated with the up-regulation of selected MMPs. Marimastat (DB00786) was found to target selected MMPs.

Our research revealed that selected MMPs played an important role in the early diagnosis and prognosis of PC.
Intracardiac thrombus in a patient with mitral bioprosthesis and atrial fibrillation treated with direct oral anticoaugulant
Authors: D’Angelo Myriam , Manganaro Roberta , Boretti Ilaria , Giacopelli Daniele , Cannavà Gaetano , Corallo Francesco , Bramanti Placido , Duca Antonio
Published: June 2021

Rationale:

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity, especially stroke and heart failure. There is also increasing awareness that atrial fibrillation is a major cause of embolic events which in 75% of cases are complicated by cerebrovascular accidents.

Patient concerns:

A 50-year-old woman with mitral bioprosthesis under warfarin for nonvalvular atrial fibrillation was referred to our Coronary Intensive Care Unit due to acute myocardial infarction without evidence of significant coronary artery stenosis.

Diagnoses:

Cardiovascular examination showed an irregular pulse and a grade II diastolic murmur was audible at the apical area. The patient underwent coronary angiography showing absence of obstructive coronary artery disease. We decided to replace Warfarin with direct oral anticoagulants as anticoagulant therapy.

Interventions:

Transoesophageal echocardiography revealed a thrombus in left atrial appendage that was treated by replacing warfarin with an oral direct thrombin inhibitor.

Outcomes:

At 2-month follow-up, the therapy showed to be effective for thrombus resolution.

Lessons:

Our case demonstrated how AF has high risk of thromboembolic complications, not only in terms of stroke but also of myocardial infarction and death.

The use of direct oral anticoagulants in AF patients with bioprosthetic heart valves is still debated due to an unclear definition of “nonvalvular” AF.
Rational emotive education for reducing stress of undergraduate students of religious education program
Authors: Ilechukwu Leonard Chidi , Egenti Nkechi Theresa , Aloh Henry Egi , Uwakwe Rowland C. , Obande-Ogbuinya Nkiru , Eke Chinyere Lambert , Kalu Ijeoma Awa , Ejionueme Lambert Kenechukwu , Iremeka Felicia Ukamaka
Published: June 2021

Background:

Rational emotive education (REE) program aims to improve the behavioral and mental health of students. This study objective was to evaluate the effect of an REE program on stress among undergraduate students of religious education program in Nigerian Universities.

Method:

One hundred and fifty (150) religious education undergraduates who had high level of stress participated in the study. Participants were assigned to 2 different groups. The treatment group had 75 participants and while control group also had 75 participants. Data collection was done using the Perceived Stress Scale (PSS-10) while data analysis was done using independent sample t test and paired t test statistics at .05 probability level.

Results:

The REE program resulted in a significant decrease in level of stress among undergraduate students of religious education program in the treatment group compared with those students in the control group. Also, the effect of the REE program was maintained during the follow-up among undergraduate students of religious education program exposed to it.

Conclusion:

The REE program can be used to assist undergraduate students of religious education program to manage their stress.
Using vibration controlled transient elastography and FIB-4 to assess liver cirrhosis in a hepatitis C virus infected population
Authors: Saleem Nabil , Miller Lesley S. , Dadabhai Alia S. , Cartwright Emily J.
Published: June 2021

We assessed the performance characteristics of the Fibrosis-4 (FIB-4) score in a veteran population with chronic hepatitis C virus (HCV) infection and used vibration controlled transient elastography (VCTE) as the gold standard.

All VCTE studies were performed by a single operator on United States veterans with HCV infection presenting for care at the Atlanta VA Medical Center (AVAMC) over a 2 year period. VCTE liver stiffness measurements (LSM) were categorized as cirrhotic if LSM was >12.5 kPa and non-cirrhotic if LSM was ≤12.5 kPa. FIB-4 scores ≤3.25 were considered non-cirrhotic and scores >3.25 were considered cirrhotic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the FIB-4 score. A second analysis was done which identified and excluded indeterminate FIB-4 scores, defined as any value between 1.45 and 3.25.

When FIB-4 was used to screen for liver cirrhosis using VCTE as the gold standard, sensitivity was 42%, specificity was 88%, PPV was 62%, and NPV was 76%. When indeterminate FIB-4 scores were excluded from the analysis, sensitivity was 95%, specificity was 61%, PPV was 62%, and NPV was 94.4%. In a veteran population with chronic HCV infection, we found the sensitivity of the FIB-4 score to be unacceptably low for ruling out liver cirrhosis when using a binary cutoff at 3.25. Using a second staging method like VCTE may be an effective way to screen for liver cirrhosis in persons with chronic HCV, especially when the FIB-4 score is in the indeterminate range.
Assessment of the viability and treatment response of bone metastases in patients with metastatic castration-resistant prostate cancer using choline PET/CT
Authors: Kitajima Kazuhiro , Yamamoto Shingo , Kawanaka Yusuke , Komoto Hisashi , Shimatani Kimihiro , Hanasaki Takeshi , Taguchi Motohiro , Nagasawa Seiji , Yamada Yusuke , Kanematsu Akihiro , Yamakado Koichiro
Published: June 2021

This study aimed to evaluate the clinical use of choline-PET/CT for discriminating viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and evaluating the response of bone metastasis to treatment in metastatic castration-resistant prostate cancer (mCRPC) patients. Thirty patients with mCRPC underwent a total of 56 11C-choline-PET/CT scans for restaging, because 4 patients received 1 scan and 26 had 2 scans. Using 2 (pre- and post-treatment) 11C-choline-PET/CT examinations per patient, treatment response was assessed according to European Organization for Research and Treatment of Cancer (EORTC) criteria in 20 situations, in which only bony metastases were observed on 11C-choline-PET/CT scans. Viable bone metastases and osteoblastic change induced by the treatment effect were identified in 53 (94.6%) and 29 (51.8%) of 56 11C-choline-PET/CT scans, respectively. In 27 cases (48.2%), 11C-choline-PET/CT scans could discriminate the 2 entities. The mean SUVmax of the metastatic bony lesions was 5.82 ± 3.21, 5.95 ± 3.96, 6.73 ± 5.04, and 7.91 ± 3.25 for the osteoblastic, osteolytic, mixed, and invisible types, respectively. Of the 20 situations analyzed, CMR, PMR, SMD, and PMD, as determined by the EORTC, were seen in 1, 2, 3, and 14 cases, respectively. Of the 13 patients with increasing PSA trend, all 13 showed PMD. Of the 2 patients with PSA response of <50%, both 2 showed SMD. Of the 5 patients with PSA response of ≥50%, 1 showed CMR, 2 showed PMR, 1 showed SMD, and 1 showed PMD. Choline-PET/CT is very useful to discriminate viable progressive osteoblastic bone metastasis from osteoblastic change, and assess treatment response of bone metastases in mCRPC.
Variants translating reduced expression of the beta estrogen receptor gene were associated with increased carotid intima media thickness
Authors: Cano-Marquina Antonio-Jorge , García-Pérez Miguel-Ángel , Tarín Juan J. , Maceira Alicia M. , Cosín-Sales Juan , Cano Antonio
Published: June 2021

There is debate on the role of estrogens in modulating the risk for atherosclerosis in women. Our purpose was to investigate whether the size of the estrogenic impact was independently associated with variation of carotid intima-media thickness (IMT) in healthy late postmenopausal women. The levels of circulating estrogens have been used in previous studies but the influence of SNPs of the estrogen receptors (ER) α and β have not been investigated.

We performed a crossed-sectional study of 91 women in a university hospital. We used a double approach in which, in addition to the measurement of estradiol levels by ultrasensitive methods, genetic variants (SNPs) associated with differing expression of the ER α and β genes were assessed. Multivariable analysis was used to examine the association of candidate factors with the value of IMT and plaque detection at both the carotid wall and the sinus.

A genotype combination translating reduced gene expression of the ERβ was directly associated with IMT at both the carotid wall (P = .001) and the sinus (P = .002). Other predictors of IMT were the levels of glucose, positively associated with IMT at both the carotid wall (P < .001) and the sinus (P = .001), age positively associated with IMT at the sinus (P = .003), and levels of vitamin D, positively associated with IMT at the carotid wall (P = .04).

Poorer estrogenic impact, as concordant with a SNP variant imposing reduced expression of the ERβ, was directly associated with IMT at both the carotid wall and the sinus. Glucose level, vitamin D only for the carotid wall, and age only for the sinus, also emerged as independent factors in the IMT variance.
Prospective evaluation of the efficacy of peroral endoscopic myotomy in patients with achalasia
Authors: Gong Eun Jeong , Na Hee Kyong , Ahn Ji Yong , Jung Kee Wook , Kim Do Hoon , Choi Kee Don , Song Ho June , Jung Hwoon-Yong
Published: June 2021

Peroral endoscopic myotomy (POEM) is an endoscopic alternative to surgical myotomy in patients with achalasia. This study aimed to evaluate the efficacy and clinical outcomes of POEM.

A total of 20 patients with achalasia who underwent POEM between October 2016 and November 2017 were prospectively recruited. The intraoperative esophagogastric junction distensibility index (mm2/mm Hg) was measured pre- and post-myotomy using an endoluminal functional lumen imaging probe. Clinical response was defined as Eckardt score ≤3. Health-related quality of life was measured by the 36-item short-form health survey score.

POEM was successfully completed in all cases. The median procedure time was 68.5 minutes (range 50.0–120.0), and the median myotomy length was 13 cm (range 11–18). Major adverse events were encountered in 2 cases. Overall, clinical responses were observed in all patients during a median follow-up of 11.9 months (range 1.2–26.2). Postoperative esophagogastric junction distensibility index was significantly higher than baseline (from 1.3 [range 0.8–6.9] to 6.3 [range 25–19.2], P < .001). The median Eckardt scores were decreased after POEM (5 [range 2–11] to 1 [range 0–3], P < .001), and the 36-item short-form health survey score was also improved significantly after POEM (67.5 [range 34.5–93.9] to 85.7 [range 53.4–93.3], P = .004).

POEM is an effective treatment for achalasia, based on the improvement of both symptoms and objective measures.

Clinicaltrial.gov NCT 02989883
Effects of brain-computer interface training on upper limb function recovery in stroke patients
Authors: Xue Xiali , Tu Huan , Deng Zhongyi , Zhou Ling , Li Ning , Wang Xiaokun
Published: June 2021

Background:

In recent years, with the development of medical technology and the increase of inter-disciplinary cooperation technology, new methods in the field of artificial intelligence medicine emerge in an endless stream. Brain-computer interface (BCI), as a frontier technology of multidisciplinary integration, has been widely used in various fields. Studies have shown that BCI-assisted training can improve upper limb function in stroke patients, but its effect is still controversial and lacks evidence-based evidence, which requires further exploration and confirmation. Therefore, the main purpose of this paper is to systematically evaluate the efficacy of different BCI-assisted training on upper limb function recovery in stroke patients, to provide a reference for the application of BCI-assisted technology in stroke rehabilitation.

Methods:

We will search PubMed, Web of Science, The Cochrane Library, Chinese National Knowledge Infrastructure Database, Wanfang Data, Weipu Electronics, and other databases (from the establishment to February 2021) for full text in Chinese and English. Randomized controlled trials were collected to examine the effect of BCI-assisted training on upper limb functional recovery in stroke patients. We will consider inclusion, select high-quality articles for data extraction and analysis, and summarize the intervention effect of BCI-assisted training on the upper limb function of stroke patients. Two reviewers will screen titles, abstracts, and full texts independently according to inclusion criteria; Data extraction and risk of bias assessment were performed in the included studies. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X8 will be applied in selecting the study, Review Manager 5.3 will be applied in analyzing and synthesizing.

Results:

The results will provide evidence for judging whether BCI is effective and safe in improving upper limb function in patients with stroke.

Conclusion:

Our study will provide reliable evidence for the effect of BCI technology on the improvement of upper limb function in stroke patients.

PROSPERO registration number:

CRD42021250378.
Effectiveness and safety of moxibustion for Parkinson disease
Authors: Hou Yonghui , Ning Baile , Liu Yamin , Liu Ying , Fu Wenbin , Wen Zehuai
Published: June 2021

Background:

Parkinson disease (PD) is a common neurodegenerative disease among middle-aged and elderly people. Clinically, it is a movement disorder characterized mainly by static tremors, kinesia, myotonia, and postural balance disorder. In recent years, an increasing number of clinical reports on moxibustion therapy for PD have been published. Despite this, no systematic review of moxibustion therapy for PD has been undertaken.

Methods:

Two reviewers will search the following 7 English and Chinese databases online: the Cochrane Library; PubMed; EMBASE; the China National Knowledge Infrastructure; the Wan Fang databases; the China Science and Technology Journal Database; and the Chinese Biomedical Literature Database. Reviewers will search each electronic database for studies published from journal inception to May 2021. Two reviewers will independently conduct clinical study inclusion, data extraction, and risk bias assessment. Any differences in the above process will be resolved through discussion with a third reviewer. If the data are sufficient, RevMan software 5.3 (Cochrane Community, London, UK) will be used for the meta-analysis of the extracted data.

Results:

In this systematic review, the effectiveness and safety of moxibustion therapy in PD treatment will be evaluated.

Conclusion:

This systematic review may provide further evidence to encourage clinicians to use moxibustion in the treatment of PD.

INPLASY registration number:

INPLASY202140097
Blood pressure-lowering effect of repeated Waon therapy in non-smokers with hypertension
Authors: Kominami Kazuyuki , Takahiza Etsuko , Tabuchi Mineko , Akino Masatoshi
Published: June 2021

Waon therapy (WT) has been used as a thermal therapy in chronic heart failure patients. However, its effect in patients with hypertension is unclear. This study aimed to reveal the hypotensive effect of WT in patients with hypertension. WT was performed on 31 patients with hypertension (63.9 ± 11.9 years, male: 17) on standard hypertension treatment focusing on lifestyle modification and medication. Systolic and diastolic blood pressures were measured before and after WT using an upper arm automated sphygmomanometer. We investigated the effect of single and repeated (1 time/d, >5 times) WT sessions on blood pressure and further compared its effect between current smoking (n = 11, 55.4 ± 6.4 years, 8.5 ± 2.4 times) and non-smoking (n = 11, 66.9 ± 8.5 years, 12.2 ± 5.9 times) groups. A total of 370 sessions of WT were conducted. Systolic and diastolic blood pressures significantly decreased after a single WT session (systolic blood pressure: 118.5 ± 10.1 to 115.1 ± 9.0 mm Hg, P < .001; diastolic blood pressure: 70.5 ± 6.4 to 65.9 ± 5.3 mm Hg, P < .001). The blood pressure decrease following repeated WT was not significant when all participants were considered (systolic blood pressure: 122.3 ± 15.2 to 116.9 ± 19.6 mm Hg; diastolic blood pressure: 73.8 ± 16.7 to 68.2 ± 13.2 mm Hg); however, it was significant in the non-smoking group (systolic blood pressure: 124.2 ± 11.3 to 108.8 ± 13.4 mm Hg, P < .001; diastolic blood pressure: 73.6 ± 4.9 to 62.1 ± 7.6 mm Hg, P < .001). Repeated WT (at least 5 sessions) decreased blood pressure in patients with hypertension, especially in non-smokers. WT is a simple method to reduce blood pressure in non-smoking patients with hypertension.
Low recurrence rate after endoscopic resection in non-ampullary duodenal lesions
Authors: Oh Gyu Man , Je Hyun Seung , Jung Kyoungwon , Kim Jae Hyun , Kim Sung Eun , Moon Won , Park Moo In , Park Seun Ja
Published: June 2021

Endoscopic resection (ER) for non-ampullary duodenal lesions (NADLs) is technically more difficult than lesions of the stomach. However, endoscopic treatment of duodenal lesions has been increasingly performed in recent years. This study aimed to evaluate the efficacy and safety of ER for NADLs.

Patients who underwent ER for NADLs between 2004 and 2019 were retrospectively reviewed. Clinical and pathologic features of the lesions including the clinical outcomes and adverse events were analyzed.

The study included 80 patients with NADLs. The mean age of patients was 59.3 years (22–80 years), the mean size of the lesion was 8.8 ± 7.0 mm, and the mean procedure time was 13.2 ± 11.2 min. Half (40/80) of the lesions were in the duodenal bulb including the superior duodenal angle. Final histological data showed 56 adenomas (70.5%), 13 Brunner gland tumors (16.2%), and 4 pyloric gland tumors (5.0%). The final diagnoses of 5 lesions after ER showed higher-grade dysplasia compared to pre-ER biopsy findings. The en bloc resection rate was 93.8% (75/80), and the complete resection rate with clear margins was 90.0% (72/80). Micro-perforation occurred in 2 of 80 patients and was successfully treated with conservative treatment. There were no cases of delayed bleeding. The mean follow-up period was 27.0 months (2–119 months) with no cases of recurrence.

ER may be an effective treatment for NADLs with favorable long-term outcomes. However, the possibility of perforation complications should always be considered during ER.
Associations and interaction effects of maternal smoking and genetic polymorphisms of cytochrome P450 genes with risk of congenital heart disease in offspring
Authors: Diao Jingyi , Zhao Lijuan , Luo Liu , Li Jinqi , Li Yihuan , Zhang Senmao , Wang Tingting , Chen Letao , Huang Peng , Qin Jiabi
Published: June 2021

To assess associations and interactions of maternal smoking and cytochrome P450 (CYP450) genetic variants with the developments of congenital heart disease (CHD) and specific subtypes.

A case–control study of 654 cases and 666 controls was conducted from November 2017 to March 2020. The exposures of interest were maternal active and passive smoking before/in the early pregnancy and CYP450 genetic polymorphisms. Data were analyzed using the Chi-square test and logistic regression analysis.

After adjusting for the potential confounding factors, our study showed maternal active (ORadj = 2.34, 95%CI: 1.19–4.60) or passive (ORadj = 1.76, 95%CI: 1.34–2.31) smoking before pregnancy, passive smoking in the early pregnancy (ORadj = 3.05, 95%CI: 2.26–4.12), as well as polymorphisms of CYP450 at rs1065852 (G/A vs G/G: ORadj = 1.46, 95%CI: 1.07–1.99; A/A vs G/G: ORadj = 1.63, 95%CI: 1.15–2.33) and rs16947 (A/A vs G/G: ORadj = 3.61, 95%CI: 2.09–6.23), were significantly associated with risk of total CHD in offspring. Similar results were also found for some subtypes of CHD. Additionally, significant interactions between maternal smoking and CYP450 genes on the risk of CHD were observed.

Maternal smoking and CYP450 genetic variants were associated with increased risk of CHD and specific subtypes in offspring. And the effects of CYP450 genes on CHD may be modified by maternal smoking.
Analysis of sagittal curvature and its influencing factors in adolescent idiopathic scoliosis
Authors: Zhang Cong , Wang Yidan , Yu Jinghong , Jin Feng , Zhang Yunfeng , Zhao Yan , Fu Yu , Zhang Kai , Wang Jianzhong , Dai Lina , Gao Mingjie , Li Zhijun , Wang Lidong , Li Xiaohe , Wang Haiyan
Published: June 2021

This study aimed to explore the characteristics of changes in the sagittal arrangement of the spine between adolescent patients with idiopathic scoliosis (AIS) and normal adolescents, the risk factors for AIS and the factors affecting the progress of AIS.

X-ray images of the full length of the spine in standing position were taken in AIS patients and normal adolescents. Radiographic measurements made at intermediate follow-up included the following:C1 and C2 cervical lordosis and C2 - C7 curvature of cervical lordosis, C2-C7sagittal horizontal distance (C2-C7SagittalVerticalAxis, C2-C7SVA), TS-CL, after thoracic lobe (Thoracic Kyphosis, TK), thoracic lumbar segment Angle (thoracolumbar kyphosis, [TLK]), lumbar lordosis Angle (Lumbar Lordosis, LL), sacral slope Angle (Sacrum Slope, SS), pelvic tilt Angle (Pelvic Tilt, PT), pelvic incidence (PI), L5 Incidence (Lumbar5 Slope (L5S), L5 incidence (Lumbar5 Incidence (L5I), sagittal horizontal distance (CSVA), lower depression Angle of the 2nd cervical spine. The difference of sagittal plane parameters between AIS group and normal adolescent group was compared. To evaluate the progress of AIS, correlation analysis was conducted between diagonal 2 and other parameters. The main risk factors of AIS were determined by binary Logistic analysis.

The CSVA of AIS patients was higher than that of healthy adolescents (AIS: 27.64 ± 19.56) mm. Healthy adolescents: (17.74 ± 12.8) mm), L5S (AIS: 19.93°= 7.07° and healthy adolescents: 15.38°= 7.78°, P = .024 < .05), C2 downward sag Angle (AIS: 15.12°= 2.7°;Healthy adolescents: 12.97°= 4.56°); AIS patients had lower TS-CL (AIS: 22.48 ± 6.09 and healthy adolescents: 28.26°= 10.32°), PT (AIS: 10.42°= 4.53° and healthy adolescents: 15.80°=7.68°), (AIS: 41.87°=9.72° and healthy adolescents: 48.75°= 8.22°). The main risk factor for idiopathic scoliosis in adolescents was L5 (OR = 1.239, 95%CI = 1.049–1.463, P = .012 < .05).

L5S is a major risk factor for idiopathic scoliosis in adolescents. The larger PI is, the higher the risk of scoliosis progression is. In AIS patients, lumbar lordosis is increased, cervical lordosis is reduced, and even cervical kyphosis occurs.
Efficacy of thromboelastography in the management of anticoagulation for veno-venous extracorporeal membrane oxygenation in a coronavirus disease 2019 patient
Authors: Nakashima Ryosuke , Nishihara Masaaki , Iyonaga Takeshi , Iwasaka Sho , Yamamoto Yuzo , Shono Yuji , Maki Jun , Tokuda Kentaro , Akahoshi Tomohiko , Higo Taiki , Kitazono Takanari , Tsutsui Hiroyuki
Published: June 2021

Rationale:

In coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome refractory to optimal conventional management, we should consider the indication for veno-venous extracorporeal membrane oxygenation (V-V ECMO). Growing evidence indicates that COVID-19 frequently causes coagulopathy, presenting as hypercoagulation and incidental thrombosis. For these reasons, a multifactorial approach with several anticoagulant markers should be considered in the management of anticoagulation using heparin in COVID-19 patients on V-V ECMO.

Patient concerns:

A 48-year-old man was infected with COVID-19 with a worsening condition manifesting as acute respiratory distress syndrome.

Diagnoses:

He was refractory to conventional therapy, thus we decided to introduce V-V ECMO. We used heparin as an anticoagulant therapy for V-V ECMO and adjusted the doses of heparin by careful monitoring of the activated clotting time (ACT) and activated partial thromboplastin time (APTT) to avoid both hemorrhagic and thrombotic complications. We controlled the doses of heparin in the therapeutic ranges of ACT and APTT, but clinical hemorrhaging and profound elevation of coagulant marker became apparent.

Interventions:

Using thromboelastography (TEG; Haemonetics) in addition to ACT and APTT, we were able to clearly detect not only sufficient coagulability of COVID19 on V-V ECMO (citrated rapid thromboelastography-R 0.5 min, angle 75.5°, MA 64.0 mm, citrated functional fibrinogen-MA 20.7 mm) but also an excessive effect of heparin (citrated kaolin -R 42.7 min, citrated kaolin with heparinase 11.7 min).

Outcomes:

Given the TEG findings indicating an excessive heparin effect, the early withdrawal of ECMO was considered. After an evaluation of the patient's respiratory capacity, withdrawal from V-V ECMO was achieved and then anticoagulation was stopped. The hemorrhagic complications and elevated thrombotic marker levels dramatically decreased.

Lessons:

TEG monitoring might be a useful option for managing anticoagulation in COVID-19 patients on V-V ECMO frequently showing a hypercoagulative state and requiring massive doses of heparin, to reduce both hemorrhagic and thrombotic complications.
Step-by-step inpatient rehabilitation for critical illness after coronavirus disease 2019
Authors: Gwak Dae-Won , Hwang Jong-Moon
Published: June 2021

Introduction:

Since the coronavirus disease (COVID-19) outbreak in Wuhan, China, in December 2019, COVID-19 has become a worldwide pandemic. Muscle weakness and deconditioning caused by COVID-19-induced critical illness requires rehabilitation.

Patient concerns:

A 74-year-old male patient complained of general weakness after COVID-19, requiring ventilator treatment.

Diagnosis:

He was confirmed as having COVID-19 using a polymerase chain reaction test.

Interventions:

During admission in the intensive care unit, medical staff wearing level D protective equipment performed the bedside manual range of motion exercise. After a negative COVID-19 test, the patient was transferred to a general ward, where sitting balance training and pulmonary rehabilitation were additionally performed by rehabilitation therapists wearing protective gear. When the patient was able to stand up with support, standing balance training and sit-to-stand training were performed.

Outcomes:

After a month of rehabilitation, the patient could sit alone, but he needed help with standing balance. The Berg Balance Scale score improved from 0 to 4, and the Modified Barthel Index score improved from 8 to 18. He was able to breathe in room air without an oxygen supply.

Lessons:

This case report shows an example of how safe and effective rehabilitation can be provided to COVID-19 patients.
Philadelphia chromosome-positive B-lymphoblastic lymphoma successfully treated with chemotherapy regimen containing imatinib
Authors: Li Xiaoning , Cao Weijie , Zhang Suping , Li Li , Li Yingmei , Jiang Zhongxing , Wan Dingming , Yu Jifeng
Published: June 2021

Rationale:

B-lymphoblastic lymphoma (B-LBL) with BCR/ABL mutation (Ph+ B-LBL) is a rare type of cancer in both childhood and adults. Its clinical manifestations are similar to those of other types lymphoma. However, the targeted therapy can substantially improve the outcome of Ph+ B-LBL.

Patient concerns:

A 19-year-old male with blood type O, Rh+ was admitted into our hospital on August 14, 2018, due to a recurrent fever and hypocytosis for 6 months.

Diagnoses:

Routine blood exam showed pancytopenia. Bone marrow sample flow cytometry (FCM) exam showed abnormal cells were 2.27% of the nucleated cells, and was classified as the abnormal early B-lineage lymphoblastic cells. FISH testing showed the BCR/ABL positive cells were 13.6%. Karyotype analysis showed the 46, XY, t(9;22)(q34;q11). Molecular analysis of BCR/ABL mutation on ABL kinase showed that BCR/ABL T315I mutation. Patient was diagnosed with B-LBL with BCR/ABL mutation (Ph+ B-LBL).

Interventions:

The patient was given chemotherapy with VDPI regimen (Vinorelbine, daunorubicin, prednisone, imatinib).

Outcomes:

The patient achieved complete remission after 2 courses’ treatment, followed by one course of clarithromycin regimen and another two courses of VDPI regimen. Patient remains in complete remission as of March 10, 2021.

Lessons:

In B-LBL, a BCR/ABL mutation can happen in some of these patients. It is important to guide the pathologist to perform appropriate gene mutation detection, in addition to routine Immunohistochemistry test, to ensure an accurate diagnosis and use the targeted agent for treatment. According to the literature and our results, it seems that intensive chemotherapy plus TKI regimen is effective in inducing complete remission, and allo-SCT should be used as a long-term strategy.