bluuebunny/crossref_metadata_2025 huggingface dataset:
The effectiveness of dextrose prolotherapy in plantar fasciitis
Authors: Lai Wei-Fu , Yoon Chang Ho , Chiang Meng Ting , Hong Ying-Han , Chen Hui-Chuan , Song Wenyu , Chin Yen Po (Harvey)
Published: December 2021

Background:

Dextrose prolotherapy (DPT) is considered to be a type of regenerative therapy and is widely used in various musculoskeletal disorders. Plantar fasciitis is a common cause of heel pain that affects the quality of life of many people. We aimed to evaluate the effectiveness and safety of DPT for plantar fasciitis.

Methods:

PubMed, Embase, and the Cochrane Library were searched from their respective inception dates to June 2021. Only randomized controlled trials comparing DPT and other interventions for plantar fasciitis were included in this review. Standardized mean differences (SMDs) with 95% confidence intervals were calculated for comparison. The outcome measurements included visual analog score, numeric rating scale, Foot Function index, Revised Foot Function index, American Orthopedic Foot and Ankle Score, and plantar fascia thickness. Post-treatment duration was classified as short-term (1–2 months), medium-term (3 months), or long-term (6 months).

Results:

Six studies with 388 adult patients diagnosed with plantar fasciitis were included for the meta-analysis. In terms of pain scores improvement, DPT was superior to placebo or exercise in the short-term (SMD: −1.163, 95%CI: −2.17 to −0.156) and the medium-term (SMD: −1.394, 95%CI: −2.702 to −0.085). DPT was inferior to corticosteroid injection in the short-term (SMD: 0.781, 95%CI: 0.41 to 1.152). For functional improvement, DPT was superior to placebo or exercise in the short-term (SMD: −1.51, 95%CI: −2.96 to −0.059), but inferior to corticosteroid injection (SMD: 0.526, 95%CI: 0.161 to 0.89) and extracorporeal shock wave therapy in the short-term (SMD: 0.484, 95%CI: 0.145 to 0.822). Randomized controlled trials showed a better pain improvement in the long-term for patients treated with DPT compared to corticosteroid (P = .002) and exercise control (P < .05). No significant differences were found between patients treated with DPT and patients treated with platelet-rich plasma.

Conclusion:

Dextrose prolotherapy was a safe and effective treatment option for plantar fasciitis that may have long-term benefits for patients. The effects were comparable to extracorporeal shock wave therapy or platelet-rich plasma injection. Further studies with standardized protocols and long-term follow-up are needed to address potential biases.
Novel clinical risk scoring model for predicting mortality in patients with necrotizing fasciitis
Authors: Khamnuan Patcharin , Chuayunan Nipaporn , Duangjai Acharaporn , Saokaew Surasak , Chaomuang Natthaya , Phisalprapa Pochamana
Published: December 2021

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection that rapidly progresses and requires urgent surgery and medical therapy. If treatment is delayed, the likelihood of an unfavorable outcome, including death, is significantly increased. The goal of this study was to develop and validate a novel scoring model for predicting mortality in patients with NF. The proposed system is hereafter referred to as the Mortality in Necrotizing Fasciitis (MNF) scoring system. A total of 1503 patients with NF were recruited from 3 provincial hospitals in Thailand during January 2009 to December 2012. Patients were randomly allocated into either the derivation cohort (n = 1192) or the validation cohort (n = 311). Clinical risk factors used to develop the MNF scoring system were determined by logistic regression. Regression coefficients were transformed into item scores, the sum of which reflected the total MNF score. The following 6 clinical predictors were included: female gender; age > 60 years; white blood cell (WBC) ≤5000/mm3; WBC ≥ 35,000/mm3; creatinine ≥ 1.6 mg/dL, and pulse rate > 130/min. Area under the receiver operating characteristic curve (AuROC) analysis showed the MNF scoring system to have moderate power for predicting mortality in patients with NF (AuROC: 76.18%) with good calibration (Hosmer-Lemeshow χ2: 1.01; P = .798). The positive likelihood ratios of mortality in patients with low-risk scores (≤2.5) and high-risk scores (≥7) were 11.30 (95% confidence interval [CI]: 6.16–20.71) and 14.71 (95%CI: 7.39–29.28), sequentially. When used to the validation cohort, the MNF scoring system presented good performance with an AuROC of 74.25%. The proposed MNF scoring system, which includes 6 commonly available and easy-to-use parameters, was shown to be an effective tool for predicting mortality in patients with NF. This validated instrument will help clinicians identify at-risk patients so that early investigations and interventions can be performed that will reduce the mortality rate among patients with NF.
Growth trends analysis of unilateral condylar hyperplasia followed up with planar scintigraphy
Authors: Liu Pingan , Shi Jun
Published: December 2021

The current research aimed to retrospectively investigate the trends of the growth of condylar hyperplasia with serial planar scintigraphs.

Patients of unilateral condylar hyperplasia with at least one follow-up planar scintigraph were retrospectively included in the study. Patients’ age, gender at the initial scan, durations of following scans, and ratios between condylar activities were recorded.

The study retrospectively included 111 patients of unilateral condylar hyperplasia. Patients were divided into 3 groups (progressive, relatively stable, regressive) according to ratio variation between initial and last scans. There were 23 (21%) patients fell into the progressive group, 40 (36%) patients into the relatively stable group, and 48 (43%) patients into the regressive group. More female patients were in the progressive group than those in the other groups (P < .01). There were no significant differences among the 3 groups in terms of age or durations of follow-up (P > .05). There were no strong relations between ratio differences and ages. However, a weak relation seems to exist in the regressive group with r = −0.240, (P = .10).

Our investigation showed that more than a half of patients with condylar hyperplasia remain constantly or progressively active growth in patients in the follow-up scans. Roughly less than a half of patients showed regressive trends toward normal growth. Patients’ age seemly does not play a role in the growth trend pattern, although there are no optimum follow-up periods, regularly follow-up scans are needed to determine the growth status of condylar hyperplasia.
Is rifaximin better than nonabsorbable disaccharides in hepatic encephalopathy?
Authors: Cheng Junxiong , Chen Yafang , Cao Wenfu , Zuo Guoqing
Published: December 2021

Background:

The purpose of the present meta-analysis was to compare the efficacy of rifaximin and nonabsorbable disaccharides (NADs) in hepatic encephalopathy (HE).

Methods:

After the registration of the present meta-analysis on INPLASY, all procedures were performed according to PRISMA 2020. Relevant literature was retrieved on PubMed, Embase, and the Cochrane Library up to September 5, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the enrolled studies, and Review Manager software (version 5.3) was used to analyze the clinical efficacy, blood ammonia and adverse effects.

Results:

Six studies with 559 patients were included in the present meta-analysis. There were no significant differences in the basic characteristics of the included studies. Analysis of the complete resolution of HE showed that rifaximin was better than NADs (risk ratio [RR] = 1.87, 95% confidence interval [CI] = 1.03–3.39, P = .04). However, there were no significant differences in mental status (RR = 1.04, 95% CI = 0.92–1.18, P = .53), blood ammonia level (standard mean difference = −0.02, 95% CI = −0.40–0.02, P = .08), or drug adverse drug effects (OR = 0.43, 95% CI = 0.10–1.77, I
2 = 56%, P = .24) between the rifaximin and NADs treatment groups.

Conclusion:

Rifaximin is not superior to NADs in the treatment of HE.
Transposition and fixation of lower pole crossing vessel in children with ureteropelvic junction obstruction
Authors: Sizonov Vladimir V. , Shidaev Askhab H.-A. , Mayr Johannes M. , Kogan Mikhail I. , Kagantsov Ilya M. , Rostovskaya Vera V.
Published: December 2021

Chapman and Hellstrom techniques are typically employed to transpose renal lower pole crossing vessels (LPCVs). Both procedures have certain limitations. We investigated the midterm outcomes in pediatric patients in whom LPCV-induced ureteropelvic junction obstruction was treated with either dismembered Anderson-Hynes pyeloplasty or upward transposition coupled with a new technique to fix the LPCV.

We retrospectively compared Anderson-Hynes pyeloplasty to the new technique in terms of outcome. LPCV transposition was considered feasible in patients in whom the diuretic loading test revealed a decrease in the pelvic volume after correction of vascular compression as well as absence of structural changes in the ureteropelvic junction (UPJ) and hemodynamic compromise of the lower renal pole. The fascial flap was passed below the LPCV to form a “hammock”. The free edge of the flap was sutured to its base.

Group 1 consisted of 102 (69.9%) patients (median age: 7.9 years) undergoing dismembered Anderson-Hynes pyeloplasty, while group 2 included 44 (30.1%) patients (median age: 8.4 years) treated with upward transposition and the new technique to fix the LPCV. No intra-operative complications or conversions occurred in either group. Redo-pyeloplasty was performed in 3 (2.9%) children of group 1 and 1 (2.3%) child of group 2. Renal ultrasonography conducted 12 months after surgery revealed similar anteroposterior diameters of the renal pelvis in groups 1 (7.9 ± 8.1 mm) and 2 (6.0 ± 2.9 mm). Patients in both groups showed a non-significant median increase in differential renal function at follow-up after at least 1 year after surgery (group 1: 36% [33.3; 40.5] vs 36.5% [35.3; 41.0]; group 2: 41% [37.5; 46.0] vs 43% [39; 46]).

In our patients, the new technique for laparoscopic or open fixation of the obstructing vessel after transposition was effective, reproducible, and devoid of limitations typical for the Chapman and Hellstrom techniques. We recommend Anderson-Hynes pyeloplasty in children with a history of hydronephrosis diagnosed antenatally, recurrent abdominal pain, intra-operative absence of peristalsis across the UPJ, high location of the UPJ at the renal pelvis, or intra-operative absence of volume reduction of the renal pelvis upon furosemide testing.
Acute pancreatitis caused by tigecycline
Authors: Wang Peng-fei , Zou Hong , Zhu Ji-hong , Shi Fang-e
Published: December 2021

Rationale:

There is evidence that tigecycline has broad-spectrum antibiotic activity against a variety of complicated infections. However, adverse effects are inevitable, including gastrointestinal side effects such as nausea, vomiting, and diarrhea; in 2006, acute pancreatitis was also brought into the side-effect list after postmarketing surveillance. Here, we present a case of tigecycline-induced acute pancreatitis.

Patient concerns:

An 87-year-old female patient with urinary tract infection received an intravenous drip of tigecycline for 6 days, after which she developed abdominal distension, vomiting, abdominal pain, and abdominal rigidity.

Diagnosis:

The patient was suspected to have tigecycline-induced acute pancreatitis.

Interventions:

Tigecycline was discontinued immediately, and the patient received a series of immediate treatments including an indwelling gastric tube for continuous gastrointestinal decompression and inhibition of gastric acid and pancreatic enzyme secretion.

Outcomes:

Following initial interventions, we observed that the patient's symptoms improved significantly, and abdominal distension, vomiting, abdominal pain, and abdominal rigidity were slightly relieved. After 5 days of follow-up, blood lipase and amylase levels decreased to normal levels. Unfortunately, the patient developed convulsions during the use of multiple antibiotics after 1 week and then died of septic shock and acute liver failure.

Lessons:

Acute pancreatitis caused by tigecycline is rare. However, in the application of antibiotics, the possibility of adverse effects must be considered, and antibiotics should be used reasonably. If the patient has relevant symptoms, it is necessary to stop using tigecycline immediately, carry out symptomatic treatment, and change to other types of antibiotics for antibacterial treatment.
Hepatotoxicity associated with the use of teriflunomide in a patient with multiple sclerosis
Authors: Ferreira Cristiane Munaretto , Vasconcelos-Pereira Erica Freire de , Oliveira Vanessa Marcon de , Salgado Pedro Rippel , Domingos João Américo , Monreal Maria Tereza Ferreira Duenhas , Guerra-Shinohara Elvira Maria , Gubert Vanessa Terezinha
Published: December 2021

Rationale:

Teriflunomide is an inhibitor of pyrimidine synthesis available as a first-line treatment for relapsing-remitting multiple sclerosis. Drug-induced liver damage is a relevant problem in clinical practice, representing a frequent cause of treatment discontinuation. This case report describes the occurrence of liver injury, with a 33.7-fold increase in the upper limit of normality of the liver enzyme alanine aminotransferase during treatment with teriflunomide 14 mg.

Patient concern:

A 44-year-old woman receiving teriflunomide 14 mg for the treatment of multiple sclerosis presented symptoms suggestive of liver dysfunction 54 days after starting treatment. The patient had no history of using disease-modifying therapy, neither previous liver disease nor other comorbidities.

Diagnostics:

The suggested diagnosis was drug-induced liver injury, classified as hepatocellular. Other possible hepatic and autoimmune etiologies were ruled out.

Interventions:

Replacement of teriflunomide treatment with glatiramer acetate and follow-up of the disease.

Outcomes:

Signs and symptoms regressed after treatment with teriflunomide 14 mg was discontinued, with normalization of liver enzyme activity in ∼5 months. The causality assessment of the adverse drug reaction was determined by the Naranjo scaling system, resulting in probable, with a final score of 7.

Conclusions:

Teriflunomide-induced liver injury in patients with multiple sclerosis is a serious adverse reaction. The report of this case contributes to updating knowledge about the safety aspects of treatment with teriflunomide and planning of monitoring strategies and patient risk management.
Muscle involvement with pseudohypertrophy in systemic light chain amyloidosis
Authors: Draghici Mirela , Jercan Andreea , Badelita Sorina Nicoleta , Irimia Ruxandra Maria , Bastian Alexandra Eugenia , Dobrea Camelia , Popescu Monica , Coriu Daniel
Published: December 2021

Rationale:

Muscle pseudohypertrophy is a rare manifestation of light chain amyloidosis (AL) amyloidosis.

Patient concerns:

A 63-year-old woman presented with a 2-year history of progressive asthenia, macroglossia, dysphonia, cachexia, hypotension, paresthesia, and lower limb muscle hypertrophy.

Diagnosis:

Free serum lambda light chains were increased, and fat pad biopsy demonstrated Congo red-positive deposits. Additionally, electromyography showed a myopathic pattern, whereas muscle biopsy revealed amyloid deposits. A diagnosis of λAL with cardiac, renal, nervous system, and skeletal muscle involvement was established.

Interventions and outcomes:

The patient received 3 subsequent lines of therapy over the following 23 months, with very slow hematological remission followed by resolution of organ dysfunction.

Lessons:

Despite its rarity, muscle involvement should be considered in patients diagnosed with AL amyloidosis associated with unexplained muscle hypertrophy or weakness associated with macroglossia or elevated troponin T levels in the absence of clear cardiac involvement.
Postoperative hypoalbuminemia is an independent predictor of 1-year mortality after surgery for geriatric intertrochanteric femoral fracture
Authors: Choi Sung Uk , Rho Jeong Ho , Choi Yoon Ji , Jun Seung Woo , Shin Young Jae , Lee Yoon Sook , Shin Hyeon Ju , Lim Choon Hak , Shin Hye Won , Kim Jae Hwan , Lee Hye Won , Lim Hye Ja
Published: December 2021

Preoperative hypoalbuminemia from malnutrition is associated with increased morbidity and mortality after geriatric hip fracture surgery. However, little is known regarding the correlation between postoperative hypoalbuminemia and mortality. This study aimed to evaluate whether postoperative hypoalbuminemia could predict 1-year mortality after intertrochanteric femoral fracture surgery in elderly patients.

The medical records of 263 geriatric patients (age ≥65 years) who underwent intertrochanteric femoral fracture surgery between January 2013 and January 2016 in a single hospital were reviewed retrospectively. The patients were allocated to 2 groups based on lowest serum albumin levels within 2 postoperative days (≥3.0 g/dL [group 1, n = 46] and <3.0 g/dL [group 2, n = 217]. Data between the non-survival and survival groups were compared. Multivariable logistic regression analysis was conducted to identify the independent predictor for 1-year mortality.

The 1-year mortality rate was 16.3% after intertrochanteric femoral fracture surgery. Multivariable logistic regression analysis revealed that postoperative hypoalbuminemia was significantly associated with 1-year mortality (adjusted odds ratio, 8.03; 95% confidence interval, 1.37-47.09; P = .021). The non-survival group showed a significantly increased incidence of postoperative hypoalbuminemia (95.4% vs 80.0%, P = .015) and intensive care unit admission (11.6% vs 2.7%, P = .020), older age (82.5 ± 5.8 years vs 80.0 ± 7.2 years, P = .032), lower body mass index (20.1 ± 3.2 kg/m2 vs 22.4 ± 3.8 kg/m2, P < .001), and increased amount of transfusion of perioperative red blood cells (1.79 ± 1.47 units vs 1.43 ± 2.08 units, P = .032), compared to the survival group.

This study demonstrated that postoperative hypoalbuminemia is a potent predictor of 1-year mortality in geriatric patients undergoing intertrochanteric femoral fracture surgery. Therefore, exogenous albumin administration can be considered to improve postoperative outcomes and reduce the risk of mortality after surgery for geriatric hip fracture.
Effect of amlodipine versus bisoprolol in hypertensive patients on maintenance hemodialysis
Authors: Youssef Ahmed Mohamed , Elghoneimy Hesham Abdallah , Helmy Maged Wasfy , Abdelazeem Ahmed Mokhtar , El-Khodary Noha Mahmoud
Published: December 2021

Background:

Left ventricular hypertrophy and asymmetric dimethylarginine (ADMA) are surrogate markers of cardiovascular disease (CVD) in the dialysis population. This study aimed to evaluate the effect of a calcium channel blocker-based antihypertensive regimen compared to a beta-blocker-based antihypertensive regimen on left ventricular mass index (LVMI) and ADMA levels in hypertensive patients on hemodialysis (HD).

Methods:

This was a parallel-design, open-label, single-center randomized controlled trial on 46 hypertensive patients on maintenance HD, with no history of CVD. Patients were randomly assigned to receive amlodipine 10 mg/d (n = 23) or bisoprolol 10 mg/d (n = 23). Office-based blood pressure (BP) was targeted to ≤ 140/ 90 mm Hg. The outcome was the change in LVMI and ADMA from baseline to 6 months.

Results:

Baseline demographic and clinical characteristics did not vary between groups. After 6 months of treatment, amlodipine-based therapy induced a greater reduction in LVMI from baseline than bisoprolol-based treatment (35 ± 34.2 vs 9.8 ± 35.9 gm/m2; P = .017). A similar reduction in the mean BP occurred with treatment in both groups. ADMA concentration decreased significantly from baseline in the amlodipine group (0.75 ± 0.73 to 0.65 ± 0.67 nmol/mL; P = .001), but increased nonsignificantly in the bisoprolol group (0.64 ± 0.61 to 0.78 ± 0.64 nmol/mL; P = .052).

Conclusion:

This study showed that compared to a bisoprolol-based regimen, an amlodipine-based antihypertensive regimen resulted in a significantly greater reduction in LVMI and ADMA levels from baseline in hypertensive patients on HD despite similar BP reduction in both groups. These findings support the re-evaluation of amlodipine as a potential first-line antihypertensive treatment in patients on HD without previous CVD.

Trial Registration:

Clinicaltrials.gov Identifier: NCT04085562, registered September 2019.
Efficacy and safety of bismuth quadruple regimens containing tetracycline or furazolidone for initial eradication of Helicobacter pylori
Authors: Wang Junxian , Cao Yuping , He Wei , Li Xiaoping
Published: December 2021

Helicobacter pylori (H pylori) infection can cause chronic gastritis, peptic ulcer, and even gastric cancer, so effective eradication is critical.

This study compared the efficacy and safety of bismuth quadruple regimens including either tetracycline or furazolidone for initial eradication.

Patients newly diagnosed with H pylori infection from January 2020 to January 2021 were randomly assigned to receive either the tetracycline-containing regimen (n = 116) or furazolidone-containing regimen (n = 168). Both regimens included 1 proton pump inhibitor (rabeprazole 20 mg, or esomeprazole 20 mg, or eprazole 5 mg), colloidal pectin bismuth 300 mg, and amoxicillin 1000 mg in addition to tetracycline 1.0 g or furazolidone 0.1 g. All drugs were administered twice daily for 12 consecutive days. The 14C urea breath test was used for diagnosis, and re-test negativity at one-month follow-up was considered successful eradication. Adverse events were recorded during follow-up by telephone interview.

In total, 109 patients in the tetracycline group and 157 in the furazolidone group were re-examined at 1 month. In the tetracycline group, 101 patients tested negative at follow-up, yielding an eradication rate of 92.7% according to per-protocol analysis and 87.1% by intention-to-treat analysis. In the furazolidone group, 141 patients tested negative, yielding eradication rates of 89.8% by PP and 83.9% by ITT. Eradication rates did not differ significantly between regimens (per-protocol: χ

2
 = 0.637, P = .517; intention-to-treat: χ

2
 = 0.537, P = .501). However, total adverse events incidence was significantly lower in the tetracycline group (20.2% vs 37.6%; χ

2
 = 9.193, P = .003).

Both bismuth quadruple regimens produce high initial eradication, but the tetracycline regimen appears safer.
Life-threatening Mycobacterium intracellulare pleuritis in an immunocompetent host
Authors: Kho Bo-Gun , Na Young-Ok , Park Hwa Kyung , Lee Jae-Kyeong , Oh Hyung-Joo , Park Ha-Young , Kim Tae-Ok , Shin Hong-Joon , Kwon Yong-Soo , Kim Yu-Il , Lim Sung-Chul
Published: December 2021

Rationale:

Nontuberculous mycobacteria (NTM)–associated pleuritis is a very rare disease. Here, we describe 2 cases of life-threatening Mycobacterium intracellulare-associated pleuritis in immunocompetent hosts.

Patient concerns:

A 78-year-old man with sudden onset-onset dyspnea (case 1) and an 80-year-old man with cough, sputum and fever (case 2) presented to our emergency room.

Diagnoses:

Both the patients were diagnosed with Mycobacterium intracellulare-associated pleuritis.

Intervention:

In case 1, the patient underwent intubation with mechanical ventilation due to hypoxemic respiratory failure. Daily azithromycin, rifampin and ethambutol, and intravenous amikacin 3 times a week was administered. In case 2, the patient received daily azithromycin, rifampin and ethambutol, and intravenous amikacin 3 times a week.

Outcomes:

In case 1, after receiving NTM treatment for 14 months, NTM-associated pleuritis was cured, with radiologic improvement. In case 2, however, bronchopleural fistula was developed. Despite tube drainage, air leak continued. The patient refused surgical management and eventually died of respiratory failure.

Lessons:

Pleural effusion arising from NTM lung disease located in the subpleural area should be considered a possible cause of NTM-associated pleuritis. Drainage and a multidrug regimen are required to treat NTM, and surgical treatment should be considered when complications occur.
Emergent versus planned delivery in patients with placenta accreta spectrum disorders
Authors: Thang Nguyen Manh , Anh Nguyen Thi Huyen , Thanh Pham Hai , Linh Pham Thi , Cuong Tran Danh
Published: December 2021

The aim of this study is to compare the clinical outcomes and to identify risk factors for emergent cesarean delivery and planned cesarean delivery in patients with placenta accreta spectrum (PAS) disorders in Vietnam.

The medical records of patients admitted to our hospital with a diagnosis of PAS disorders >5 years were retrospectively reviewed.

A total of 255 patients with PAS disorders were identified, including 95 cases in the emergent delivery group and 160 cases in the planned delivery group. The percentage of complete/partial placenta previa in the planned delivery group was significantly higher than that in the emergent delivery group (59.22% vs 32.16%, P = .027). Fewer patients in the planned group had vaginal bleeding compared with those in the emergent group (29 vs 36 cases, P < .001). The percentage of blood transfusion was similar between the 2 groups; however, the transfused units of pack red blood cells were greater in the emergent delivery group (5.3 ± 0.33 vs 4.5 ± 0.25 U, P = .036). When considering the neonatal outcomes, the data demonstrated that the planned delivery group had a significantly higher birth weight and a lower rate of preterm delivery than the emergent group (P < .001). The mean gestational age at delivery for the emergent group was 35.1 ± 0.27 weeks compared with 38.0 ± 0.10 weeks for the planned group (P < .001). The increased risk factors for emergent delivery were vaginal bleeding (odds ratio 2.86, 95% confidence interval 1.59–5.26) and preterm delivery (odds ratio 5.26, 95% confidence interval 2.13–14.29).

Planned delivery is strongly associated with a lower need for blood transfusion and better neonatal outcomes compared with emergent delivery. Antenatal vaginal bleeding and preterm labor are risk factors for emergent delivery among patients with PAS disorders. Based on the results of this study, we recommend that the management strategies for patients with PAS disorders should be individualized to determine the optimal timing of delivery and to decrease the rate of emergent cesarean delivery.
Retinopathy in Egyptian patients with sickle cell disease
Authors: Hassan Tamer , Badr Mohamed , Hanna Diana , Arafa Mohamed , Elhewala Ahmed , Dabour Sherief , Shehata Saad , Rahman Doaa Abdel
Published: December 2021

Sickle cell disease (SCD) is a disorder that causes red blood cells to become sticky and rigid. Sickle cells can block blood flow in small blood vessels depriving the eye of oxygen and cause damage. This is called sickle retinopathy that can progress to severe proliferative sickle cell retinopathy, bleeding into the eye, detachment of the retina or even loss of vision.

To assess ocular manifestations and detect frequency of retinopathy in patients with SCD.

Cross-sectional study was conducted on 32 patients with SCD. They were 22 males and 10 females with mean age of 12 years. Routine investigations as well as ophthalmological examination including visual acuity, fluorescein angiography and optical coherence tomography were done.

We found that 8 patients (25%) suffered from proliferative retinopathy, 10 patients (31%) showed tortuous retinal veins, while 14 patients (44%) were normal. All patients showed macular thinning on optical coherence tomography examination.

We concluded that frequency of retinopathy in patients with SCD is more than expected and it was higher in patients who started transfusion at a later age. More attention should be paid for this problem and close observations and follow up is strongly needed.
Changing patterns of use of implantable cardiac monitors from 2011 to 2018 for a large commercially-insured U.S. population
Authors: Ellenbogen Michael I. , Andersen Kathleen M. , Marine Joseph E. , Wang Nae-Yuh , Segal Jodi B.
Published: December 2021

Implantable cardiac monitors (ICMs) provide long-term electrocardiographic monitoring for a number of indications. However, frequencies of use by indication and temporal changes have not been characterized on a national scale. We sought to characterize overall use and changes between 2011 and 2018. We used generalized linear models to characterize the incidence rate per 1,000,000 patient-quarters at risk and an autoregressive integrated moving average model to account for autocorrelation in this time series data. We studied commercially-insured patients and their insured dependents in the IBM MarketScan Commercial Database who had an ICM placed. We described the characteristics of individuals who received ICMs and the frequency of placements into 3 guideline concordance groups. We estimated the mean change per quarter in ICM placements (mean quarterly change in incidence rate per 1,000,000 patient-quarters at risk) for quarter (Q)1 2011 through Q1 2014, Q1 2014 to Q2 2014, and Q2 2014 through Q4 2018 for each guideline concordance group. The most common indications for categorizable ICM placement were syncope (24%), atrial fibrillation (11%), and stroke (11%). For each of the 3 guideline concordance groups except guideline unaddressed inpatient ICM placements, there was a significant increase in use either during the Q1 2014 to Q2 2014 or the Q2 2014 through Q4 2018 periods. A significant portion of ICM placements were for indications that lack strong evidence, such as established atrial fibrillation. The incidence of ICM placement for most of the indications and settings increased after miniaturization and technical improvements.
Transcutaneous electrical stimulation therapy and genetic analysis in Dercum's disease
Authors: Caretto Amelia , Errichiello Edoardo , Patricelli Maria Grazia , Zuffardi Orsetta , Cristel Giulia , Ravelli Silvia , Sirtori Marcella , Scavini Marina , Bosi Emanuele , Martinenghi Sabina
Published: December 2021

Dercum's disease (DD), or adiposis dolorosa, is a rare condition of unknown etiology characterized by growth of painful subcutaneous adipose tissue. No specific treatment exists. Pain is often invalidating and resistant to analgesic drugs. We tested the efficacy of Frequency Rhythmic Electrical Modulation System (FREMS) therapy on pain relief. Subcutaneous biopsies were performed for genetic analysis.

Nine DD patients were enrolled. Five cycles of FREMS at 3-month intervals during 1 year were administered. Visual analogue scale (VAS), Bartel Index Questionnaire and Short Form 36 questionnaire were used to measure pain and general health status at baseline, 6 and 12 months. Dual-energy X-ray absorptiometry (DEXA) quantified fat mass. Next-Generation Sequencing (NGS) was performed on adipose tissue biopsies and peripheral blood sample to search for somatic variants and specific protein pathway mutation.

Seven patients were included in the final analysis. FREMS induced a reduction in VAS score (from 92 to 52.5, P = .0597) and a significant improvement in SF-36 domains (Physical functioning, Role limitation due to physical health, Body pain, Vitality, Social functioning, P < .05). No modification in anthropometrics and DEXA values was observed. The analysis of the mitochondrial Displacement loop (D-loop) region confirmed the clonality of all lipomatous lesions. The presence of the mitochondrially encoded tRNA-Lysine (MT-TK) m.8344A>G variant, occasionally identified in patients with multiple symmetric lipomatosis, was excluded in all subjects. On the other hand, we observed variants in genes belonging to signaling pathways involved in cell cycle and proliferation (Phosphoinositide 3-kinase/AKT/mTOR, MAPK/ERK, and Hippo).

FREMS can be a useful tool to alleviate pain and improve overall quality of life in patients with DD. Genetic analysis highlighted the molecular heterogeneity of lipomas.
Effect and safety of traditional Chinese exercises for patients with type 2 diabetes
Authors: Zou Lijuan , Lei Linfeng , Kong Chuifeng , Yu Peiying , Li Jiazhou , Pan Hua-shan
Published: December 2021

Background:

Traditional Chinese exercises are more and more popular for type 2 diabetes patients for the treatment and rehabilitation; however, the comparative effectiveness and safety remains unclear. Our study aims to compare the pros and cons of these exercise interventions for type 2 diabetes by implementing a network meta-analysis.

Methods:

Eight databases will be searched for relevant systematic reviews including SinoMed, VIP, CNKI, Wanfang, PubMed, Embase, Web of Science and the Cochrane Library from inception to Oct 2021. Randomized controlled trials that meeting eligibility in published systematic reviews will be identified. Randomized controlled trial related to Traditional Chinese Exercises or Qigong therapy in the treatment of type 2 diabetes will be included. Two researchers conducted literature screening, data extraction and risk of bias assessment independently. Network meta-analysis of the data was performed by Stata 14.0. The Grades of Recommendations Assessment, Development and Evaluation system will be used to evaluate the rank of evidence.

Results:

The findings will be reported according to the preferred reporting items for systematic reviews and meta-analyses- network meta-analysis statement. This systematic review and network meta-analysis will summarize the direct and indirect evidence for different kinds of traditional Chinese exercises therapies and to rank these interventions. The results will be submitted to a peer-reviewed journal once completed.

Conclusion:

The network meta-analysis was designed to update and expand on previous research results of clinical trials to better evaluate the effectiveness and safety of different interventions of traditional Chinese exercises for type 2 diabetes patients.

OSF Registration DOI:

10.17605/OSF.IO/MNJD6.
Effectiveness of non-pharmacological interventions for treating post-stroke depression
Authors: Zhang Chengcheng , He Lianyi , Li Zhendong , Qiu Hangjian , Wang Xiaoqian , Zhang Yuejuan
Published: December 2021

Background:

Many systematic reviews and meta-analyses have evaluated the effectiveness of non-pharmacological therapies to improve symptoms of post-stroke depression (PSD) and reduce disability and mortality in patients with PSD. However, no research has appraised the credibility of the evidence. This study aims to summarize and evaluate the current evidence for non-pharmacological treatment of PSD and to seek effective treatment with reference to reliable evidence.

Methods:

We searched the electronic databases EMBASE, MEDLINE, Cochrane Central, PubMed, PROSPERO, Web of Science, and CINAHL. We will search articles from the above database for all published meta-analyses to December 2021 to evaluate the effect of non-pharmacological treatment of PSD. Two reviewers will extract the general characteristics of the included articles, as well as participants, interventions, outcome measures, and conclusions. The quality evaluation of each systematic review will be conducted with reference to the AMSTAR 2 tool. The effect size of each review will be recalculated using either a fixed-effects or a random-effects model. Cochrane's Q test and I
2 statistics will be used to evaluate the heterogeneity between studies. To determine whether a systematic review had small study effects, we will use the Egger test. We expect to extract valid evidence and classify it from strong to weak.

Results:

The findings of this umbrella review will provide effective evidence for the non-pharmacological treatment of PSD.

Conclusion:

Our research conclusion will provide clinical staff and PSD patients with appropriate treatment recommendations.

Ethics and dissemination:

As the data were obtained from published materials, there is no need for ethical approval for this umbrella review. The findings of this umbrella review will be published in a peer-reviewed journal.

INPLASY registration number:

INPLASY2021100083.
Moxibustion for diarrhea-predominant irritable bowel syndrome
Authors: Dong Tiantian , Li Xuhao , Ma Xin , Xue Xiqing , Hou Yi , Liu Yuanxiang , Yang Jiguo
Published: December 2021

Background:

Irritable bowel syndrome (IBS) is commonly accompanied by intestinal dysfunction, and diarrhea-predominant irritable bowel syndrome accounts for approximately 23.4% of all cases of IBS. The purpose of this study was to evaluate the efficacy and safety of moxibustion in the treatment of diarrhea-predominant irritable bowel syndrome.

Methods:

According to the retrieval strategies, randomized controlled trials (RCTs) on moxibustion therapies for IBS-D will be obtained from the China National Knowledge Infrastructure, WanFang Data, Chinese Scientific Journals Database, PubMed, Embase, and Cochrane Library, regardless of publication date or language. Studies will be screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed with the Markov chain Monte Carlo method and carried out with Stata 14.2 and WinBUGS 1.4.3 software. Ultimately, the quality of the evidence obtained from the results will be evaluated.

Results:

This study will evaluate whether moxibustion therapy can effectively treat diarrhea-predominant irritable bowel syndrome.

Conclusion:

This study will provide evidence for whether moxibustion therapy is beneficial to the treatment of human diarrhea-predominant irritable bowel syndrome.

INPLASY registration number:

INPLASY202180003.
Selection of different surgical methods for uterine fibroids
Authors: Liu Ya-Hong , Qiu Yu-Hong , Ru Ya , Liu Yan-Qing , Wang Dan , Zhang Ping-An
Published: December 2021

Introduction:

Uterine fibroids is a common benign tumor disease of the female reproductive system. The main methods of current clinical treatment of uterine fibroids are conservative treatment and surgical treatment. With the rise of the concept of minimally invasive surgery in gynecology, laparoscopic myomectomy, and vaginal myomectomy have been widely used.

Methods/design:

This study plans to retrospectively analyze 150 patients with uterine fibroids. They will be divided into laparoscopic myomectomy, vaginal myomectomy group, and open hysteromyoma resection group. This study will compare the intraoperative blood loss, operation time, postoperative exhaust time, postoperative hospital stay and postoperative complications of different surgical methods.

Discussion:

This study will compare the clinical efficacy of these 3 common surgical methods through retrospective medical record analysis, and provide more reliable evidence-based medical evidence for clinical treatment choices.
Post-traumatic severe ankle valgus and forefoot supination deformities treated by staged surgery using ilizarov technique and limited osteotomy
Authors: Zhang Jie , Li Yongmei , Liu Luping , Chen Leijie , Liu Zhou , Duan Qihui , Pu Bo
Published: December 2021

Rationale:

Post-traumatic ankle valgus deformities are relatively rare. Old post-traumatic ankle deformity compounded by abundant scar contracture tissue formation around the joint is a big challenge for orthopedics. Conventional one-stage corrective osteotomy with internal fixation always results in many knotty postoperative complications, such as soft tissue avascular necrosis, implant-related infections, and distinct lower limb discrepancy. Here, we describe a patient with old post-traumatic severe ankle valgus and forefoot supination deformities and obtained satisfactory clinical results following multi-stage surgery using the Ilizarov technique and limited osteotomy. Even more encouraging, any complications of conventional one-stage surgery were successfully avoided through our treatment regimen.

Patient concerns:

A 24-year-old healthy man had post-traumatic 90-degree hindfoot valgus and forefoot supination deformities of the right foot for more than 10 years. The complicated issue was the vast, poorly vascularized scar contracture tissues tightly adhered to the bones of the lateral malleolus and dorsum pedis.

Diagnoses:

Old post-traumatic severe ankle valgus and forefoot supination deformities and scar contracture of soft tissues of the foot and ankle joint.

Interventions:

In the first stage, Ilizarov external fixation was used to stretch the scar contracture tissue of the lateral malleolus. In the second stage, limited osteotomy of the tibiotalar joint and progressive closure of the osteotomy site were performed. In the third stage, Chopart joint osteotomy and slow forefoot pronation by external frame were performed.

Outcomes:

Our treatment regimen not only guaranteed soft tissue safety, but also avoided infection and obvious lower limb discrepancy. At the 1-year follow-up, the patient acquired aesthetic and functional right foot.

Lessons:

Although relatively rare, old post-traumatic severe ankle valgus and forefoot supination deformities can be corrected using Ilizarov external fixation technology combined with limited osteotomy. With a well-designed staged operation scheme, soft tissue avascular necrosis, infection of the wound, obvious lower limb discrepancy, and flap grafting can be avoided.
Diagnosis and treatment of secretory carcinoma arising from the oral minor salivary gland
Authors: Ogawa Masaru , Yokoo Satoshi , Yamaguchi Takahiro , Suzuki Keisuke , Seki-Soda Mai , Shimizu Takahiro , Kurihara Jun , Makiguchi Takaya
Published: December 2021

Introduction:

Secretory carcinoma (SC) is a malignancy of the salivary glands, which is similar to SC of the breast regarding its association with neurotrophic tyrosine receptor kinase fusion-positive gene. SC is a recently described salivary gland tumor, and there are a few reports describing oral minor salivary gland-derived SC. We reported two cases of SC in the oral cavity and reviewed the literature.

Patient concerns:

The patients included a 65-year-old Japanese woman who presented with a mass of the upper lip and an 84-year-old Japanese man who presented with a mass on the buccal mucosa.

Diagnosis:

Diagnosis was based on histomorphological and immunohistochemical findings and identification of a specific translocation of the ETS variant 6-neurotrophic receptor tyrosine kinase 3 gene fusion. Case 1 was finally diagnosed using reverse transcription-polymerase chain reaction with formalin-fixed paraffin-embedded tissue samples, while case 2 was diagnosed using fluorescence in situ hybridization analysis.

Interventions and outcomes:

In case 1, excisional biopsy was done and there was no recurrence observed in five-year follow-up. In case 2, tumor resection was done and there was no recurrence observed in two-year follow-up.

Conclusion:

It is highly likely for many cases of SC to be initially diagnosed as acinic cell carcinoma (AciCC) owing to their similar histological findings. The treatment strategy for minor salivary gland-originated SC is similar to that of AciCC; however, SC is often highly malignant and involves a high risk of cervical lymph node metastasis. Thus, establishing an accurate diagnosis together with pathologists and confirming the presence of the ETS variant 6-neurotrophic receptor tyrosine kinase 3 fusion gene using genetic analysis is important.
Bilateral nephromegaly due to direct leukemic cell invasion in the initial and relapse phases of T-cell acute lymphoblastic leukaemia
Authors: Tamura Yoshifuru , Sumiyoshi Ritsu , Yamamoto Tadashi , Hayama Yuto , Fujigaki Yoshihide , Shibata Shigeru , Sasajima Yuko , Tashiro Haruko
Published: December 2021

Rationale:

T-cell acute lymphoblastic leukemia is a relatively uncommon disorder in adults. Kidneys are not frequently invaded by leukemic cells, and patients with adult ALL showing nephromegaly as an initial presentation are rare.

Patient concerns:

A 54-year-old man was referred to our institution for mild anemia and thrombocytopenia. Laboratory tests showed bicytopenia with abnormal lymphoid cells in the peripheral blood and mild renal dysfunction.

Diagnosis:

Ultrasonography and computed tomography (CT) revealed bilateral enlargement of the kidneys. [18F]-fluorodeoxyglucose positron emission tomography/CT demonstrated a strong increase in metabolic uptake in the bilateral kidneys. A kidney biopsy revealed a leukemia invasion into the parenchyma. Based on the lymphocytic repertoire, the patient's condition was diagnosed as T-cell acute lymphoblastic leukaemia.

Interventions:

The patient received hyper-cyclophosphamide, vincristine, adriamycin, and dexamethasone and high-dose methotrexate and cytarabine as induction chemotherapy. After his leukemia relapsed, he received nelarabine as a second induction therapy and underwent haploidentical peripheral blood stem cell transplantation.

Outcomes:

Complete remission (CR) was achieved after chemotherapy. Chemotherapy also improved renal function associated with the normalization of bilateral nephromegaly. Repeated [18F]-fluorodeoxyglucose - positron emission tomography/CT posttreatment showedregression of metabolic uptake in the bilateral kidneys. The patient underwent cord blood transplantation at the first CR, but his leukemia relapsed 9 months later. At relapse, bilateral nephromegaly reappeared. Then, the second induction therapy induced CR for at least 10 months after induction therapy.

Lessons:

Although rare, ALL in the initial and relapsed phases can be associated with bilateral nephromegaly and renal impairment due to the invasion of leukemic cells into the parenchyma with or without abnormal leukemic cells in circulation. Leukemia is an important differential diagnosis of renal impairment with bilateral nephromegaly.
Analysis of COVID-19 pandemic impact on the presenting complaints of the emergency department visits
Authors: Lai Yen-Wen , Hsu Ching-Tang , Lee Yu-Ting , Chen Wei-Lung , Chen Jiann-Hwa , Huang Chien-Cheng , Chung Jui-Yuan
Published: December 2021

The impact of coronavirus disease 2019 (COVID-19) on economic and medical systems is significant, especially in the emergency department (ED). The patterns of ED visits have also changed significantly and may play a crucial role in rearranging medical resources to the most needed departments during the pandemic.

This was a retrospective study conducted in hospitals of the Cathay Health System. All patients presented to the EDs between January 21, 2020 to April 30, 2020 (pandemic stage) and January 21, 2019 to April 30, 2019 (before the pandemic stage). Basic demographics, including visit characteristics, disposition, and chief complaints, of the patients visiting the ED between these 2 periods of time will be compared and analyzed.

A total of 71,739 patients were included in the study. A reduction in ED visits was noted in 15.1% (32,950 ED visits) during the pandemic stage. ED visiting patients with the chief complaints of upper respiratory infection and social problems increased by 14.23% and 1.86%, respectively, during the pandemic period. Critical chief complaints such as cardiac arrest, chest pain and altered mental status decreased to less than the ED visits difference (−15.1%) between the pandemic and prepandemic stages, for 0%, −7.67%, and −13.8% respectively.

Rearrangement of the ED pediatric staff to the COVID-19 special units and recruiting more social workers to the ED should be performed to respond to the COVID-19 pandemic.