bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of dermoscopic characteristic for the differential diagnosis of palmoplantar psoriasis and palmoplantar eczema
Authors: Yu Xiaoping , Wei Guo , Shao Chunchun , Zhu Mingjie , Sun Shuna , Zhang Xiaojie
Published: February 2021

Dermoscopy is a noninvasive diagnostic technique that is of great value for the differential diagnosis of palmoplantar psoriasis and palmoplantar eczema. Considering the particularity of palmoplantar anatomy, the dermoscopic features of psoriasis and eczema in palm region show fewer differences, compared with those in other parts of the body. Only a few studies have examined the palmoplantar region of psoriasis and eczema patients under a dermoscope.

A total of 26 patients with palmoplantar psoriasis and 31 patients with palmoplantar eczema were enrolled in our study. Target palmoplantar areas were observed through general observation and under dermoscope.

We found that the presence of white scales and a regular arrangement of dots and globular vessels were significantly indicative of palmoplantar psoriasis, while yellowish scales and an irregular arrangement of atypical vessels were significantly indicative of palmoplantar eczema.
The Effectiveness and safety of T-MSAT on inpatients with acute low back pain caused by traffic accidents
Authors: Han Jeong-Hun , Park Byung-Hak , Park Jin-Hun , Min Tae-Woon , Lee Hyun-Jun , Lee Yoon Jae , Lee Sook-Hyun , Park Kyong Sun , Ha In-Hyuk
Published: February 2021

Background:

Presentation of musculoskeletal symptoms, such as pain, discomfort, or disability, caused by a traffic accident (TA) is a common occurrence. However, studies on treatment and management of sudden low back pain (LBP) caused by a TA are very scarce, while studies on the effectiveness of motion style acupuncture therapy (MSAT) used on such patients are also rare. Accordingly, a randomized controlled trial (RCT) is planned to assess the effectiveness and safety of MSAT using traction (T-MSAT) for the treatment of pain and functional problems in patients with acute LBP caused by a TA.

Methods:

This study will be conducted at Jaseng Hospital of Korean Medicine in South Korea, using a two-armed, parallel, assessor-blinded RCT design. The study population will consist of 100 participants who will be randomly assigned in a 1:1 ratio to either the T-MSAT+integrative Korean medicine therapy (IKMT) group or IKMT control group. The treatment will be applied continuously for 3 days after admission. The primary outcome will be the difference between the numeric rating scale (NRS) scores at admission and immediately after treatment on the fourth day of admission. Secondary outcomes will include visual analogue scale (VAS) for LBP and radiating leg pain; NRS for radiating leg pain; lumbar active range of motion; Oswestry Disability Index (ODI); Patient Global Impression of Change (PGIC); the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5-K); and 12-item short-form health survey (SF-12).

Discussion:

This study is a RCT to assess the effectiveness and safety of T-MSAT for acute LBP caused by a TA. The findings could be used by healthcare-related policy makers and clinicians in primary care institutions, which are frequently visited by patients suffering from LBP caused by a TA.
Clinicopathological characteristics of young never smoker females with oral cavity squamous cell carcinoma
Authors: Kwon Minsu , Lee Dong Kyu , Choi Seung-Ho , Nam Soon Yuhl , Kim Sang Yoon , Lee Yoon Se
Published: February 2021

Although the incidence of oral cavity cancer (OCC) in young never smoker females is increasing worldwide, there has been little research on the etiologies and characteristics of these patients to date. In this study, we sought to evaluate the annual increase in OCC incidence in young never smoker females (YNSF) in our hospital as well as to investigate their clinicopathological characteristics and different disease courses compared with those of other OCC patients. We retrospectively reviewed the medical records of patients who were diagnosed and treated at our tertiary referral hospital from 2006 to 2016. The annual incidence of OCC and proportion of YNSF (never smoker females aged 45 years or younger at the time of diagnosis) among the enrolled OCC patients were evaluated. The characteristics and prognosis of the YNSF group were analyzed using their clinicopathological and survival data. Among the OCC patients primarily enrolled in this study, the proportion of YNSF did not show significant annual increase. There were 32 YNSF among 354 OCC patients (9%), who were ultimately included for the analyses of clinicopathological characteristics and survival. However, YNSF showed no significant differences compared with other OCC patients, even in subgroup analyses for overall survival. Our study did not demonstrate significant changes in the annual proportion of YNSF among OCC patients. In addition, differences in neither clinicopathological characteristics nor survival were noted between YNSF and other OCC patients.
A dynamic model of the Coronavirus Disease 2019 outbreak to analyze the effectiveness of control measures
Authors: Yang Shuhang , Liu Yu , Chen Ke , Li Tong , Huang Yi , Chen Xiaolei , Qi Pengfang , Xu Yazhi , Yu Feifei , Yang Yuling , Chen Youhua
Published: February 2021

The World Health Organization (WHO) classified the spread of COVID-19 (Coronavirus Disease 2019) as a global pandemic in March. Scholars predict that the pandemic will continue into the coming winter and will become a seasonal epidemic in the following year. Therefore, the identification of effective control measures becomes extremely important. Although many reports have been published since the COVID-19 outbreak, no studies have identified the relative effectiveness of a combination of control measures implemented in Wuhan and other areas in China. To this end, a retrospective analysis by the collection and modeling of an unprecedented number of epidemiology records in China of the early stage of the outbreaks can be valuable.

In this study, we developed a new dynamic model to describe the spread of COVID-19 and to quantify the effectiveness of control measures. The transmission rate, daily close contacts, and the average time from onset to isolation were identified as crucial factors in viral spreading. Moreover, the capacity of a local health-care system is identified as a threshold to control an outbreak in its early stage. We took these factors as controlling parameters in our model. The parameters are estimated based on epidemiological reports from national and local Center for Disease Control (CDCs).

A retrospective simulation showed the effectiveness of combinations of 4 major control measures implemented in Wuhan: hospital isolation, social distancing, self-protection by wearing masks, and extensive medical testing. Further analysis indicated critical intervention conditions and times required to control an outbreak in the early stage. Our simulations showed that South Korea has kept the spread of COVID-19 at a low level through extensive medical testing. Furthermore, a predictive simulation for Italy indicated that Italy would contain the outbreak in late May under strict social distancing.

In our general analysis, no single measure could contain a COVID-19 outbreak once a health-care system is overloaded. Extensive medical testing could keep viral spreading at a low level. Wearing masks functions as favorably as social distancing but with much lower socioeconomic costs.
Efficacy and safety of acupuncture on childhood attention deficit hyperactivity disorder
Authors: Lin Yong , Jin Hongjiao , Huang Bo , Zhao Ning , Li Zhu , Mao Jiao , Chen Changda , Xu Jie , Zhang Jun , Shuai Biqin
Published: February 2021

Introduction:

The purpose of this paper is to evaluate the efficacy and safety of acupuncture in the treatment of childhood attention deficit hyperactivity disorder (ADHD).

Methods and analysis:

We will electronically search PubMed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database from their inception. Also, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and grey literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating pediatric ADHD will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data were synthesized by using a fixed effect model or random effect model depend on the heterogeneity test. The scores of Revised Conners’ Parent Rating Scale (CPRS-R), Conners Teacher Rating Scale (CTRS-R), and Child Behavior Checklist (CBCL) will be the primary outcomes. Besides, the scores of the Conners Continuous Performance Test, Internal Restlessness Scale, and Behavior Assessment System for Children (BASC), and the possible adverse events will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals (CIs), while dichotomous data will be expressed in the form of relative risk with 95% CIs.

Ethics and dissemination:

The protocol of this systematic review (SR) does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences.

Systematic review registration:

OSF Registries, DOI: 10.17605/OSF.IO/XVYP9 (https://osf.io/xvyp9)
Efficacy and safety of blood purification in the treatment of deep burns
Authors: Zhang Gaofei , Liu Wenjun , Li Jiamei , Wang Di , Duan Jianxing , Luo Hanxiao
Published: February 2021

Introduction:

This meta-analysis aimed to systematically review and evaluate randomized controlled trials (RCTs) and cohort studies examining the efficacy and safety of blood purification in the treatment of patients with deep burns.

Methods:

The PubMed, Cochrane Library, and Embase databases and relevant references were systematically searched for RCTs and cohort studies published until the end of September 2020 to investigate the potential of blood purification in improving the prognosis of severely burned patients. The primary outcome of this systematic review was overall patient mortality; secondary outcomes included the incidence of sepsis and infection prevention (vital signs and routine blood tests).

Results:

A total of 6 RCTs and 1 cohort study were included, with a total of 538 burn patients (274 patients who received blood purification and 264 control patients). Compared with patients who received conventional treatment, those treated with blood purification displayed significant 2-day reduction in mortality and sepsis with relative risks of 0.62 and 0.41, respectively (95% confidence intervals [CIs], 0.74–0.82 and 0.25–0.67, respectively; P < .05). In terms of vital signs and blood biochemistry, the respiratory rates and blood urea nitrogen levels of patients in the blood purification group 3 days post-treatment were significantly higher than those in the control group (randomized standard deviations (SMDs), 0.78 and 0.77, respectively; 95% CIs, 0.33–1.23 and 1.22–0.31, respectively; P < .05). However, there were no significant differences between groups on day 3 with regard to temperature (P = .32), heart rate (P = .26), white blood cell count (P = .54), or neutrophil count (P = .74), potentially owing to the small sample size or the relatively short intervention time. Heterogeneous differences existed between the groups with respect to blood urea nitrogen (SMD = -1.22; 95% CI, -2.16 to -0.40; P < .00001) and Cr (SMD = -3.13; 95% CI, -4.92 to -1.33; P < .00001) on day 7. No systematic adverse events occurred.

Conclusions:

Blood purification treatment for deep burn patients can significantly reduce the mortality rate and the incidence of complications.
Evaluation of the association between extravascular lung water and prognosis of sepsis
Authors: Luo Peng , Song Cai-xia , Ai Ye-qing , Chen Zhe , Yan Sheng-nan , Liu Xia , Chen Ying , Sun Jia-bin
Published: February 2021

Background:

The purpose of this study is to explore the association between extravascular lung water (EVLW) and prognosis of sepsis (PS).

Methods:

We will carry out comprehensive literature search in electronic databases (PUBMED/MEDLINE, EMBASE, CENTRAL, WorldSciNet, PsycINFO, Allied and Complementary Medicine Database, CBM, and CNKI) and additional sources. All electronic databases will be searched from their initial to the present without language restrictions. Case-controlled studies reporting the association between EVLW and PS will be evaluated for inclusion. Outcomes of interest will include mortality rate, extravascular lung water index, pulmonary vascular permeability index, blood lactate clearance, oxygenation index, blood gas analysis, PaO2/FiO2, cardiac output index, global end diastolic volume index, intrathoracic blood volume index, systemic resistance index, acute physiology and chronic health scoring system II, and infection-related organ failure scoring system. Study quality will be evaluated using Newcastle-Ottawa Tool, and statistical analysis will be performed utilizing RevMan 5.4 software.

Results:

This study will summarize the most recent evidence to investigate the association between EVLW and PS.

Conclusions:

The results of this study will provide an exhaustive view of the association between EVLW and PS.

Study registration OSF:

osf.io/vhnxw.
The relationship of irisin with metabolic syndrome components and insulin secretion and resistance in schoolchildren
Authors: Wu Chung-Ze , Chu Nain-Feng , Chang Li-Chien , Cheng Chao-Wen , Lin Yuh-Feng , Pei Dee , Fang Te-Chao , Chen Jin-Shuen
Published: February 2021

Irisin, a novel myokine, is believed to be the crucial factor in converting white adipose tissue to beige adipose tissue. For this paper, we studied the relationship among irisin and components of metabolic syndrome (MetS), and insulin secretion and resistance in schoolchildren of Taiwan.

Subjects receiving routine annual health examination at elementary school were enrolled. Demographic data, anthropometry, MetS components, irisin, and insulin secretion and resistance were collected. Subjects were divided into normal, overweight, and obese groups for evaluation of irisin in obesity. Finally, the relationship between irisin and MetS was analyzed.

There were 376 children (179 boys and 197 girls), aged 10.3 ± 1.5 years, were enrolled. In boys, irisin levels were not associated with body mass index percentile, body fat, blood pressure, lipid profiles, insulin secretion or resistance. After adjusting for age, the irisin level in boys was negatively related to fasting plasma glucose (FPG) (r = –0.21, P = .006). In girls, after adjusting for age, the irisin levels were positively related only to FPG (r = 1.49, P = .038). In both genders, irisin levels were similar among normal, overweight, and obese groups, and between subjects with and without MetS.

The irisin levels were not associated with MetS in either boys or girls. In girls, circulating irisin levels have a nonsignificant declining trend in overweight and obese girls. However, irisin levels were negatively related to FPG in boys and positively related to FPG in girls. The contrary relationship between irisin and FPG in boys and girls needs further exploration.
Comparison of the antihypertensive efficacy of morning and bedtime dosing on reducing morning blood pressure surge
Authors: Zhang Peng , Jin Mei-Ying , Song Xu-Yu , Wang Zhao , Jiang Yue-Hua , Yang Chuan-Hua
Published: February 2021

Background:

It is well known that morning blood pressure surge increases the risk of myocardial events in the first several hours post-awakening. This meta-analysis was performed to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge.

Methods:

Articles in 4 databases about clinical trials of ingestion time of antihypertensive drugs were searched and performed a meta-analysis to evaluate the different effects on morning blood pressure and absolute blood pressure (BP) reduction from baseline of between bedtime administration (experimental group) and morning awaking administration (control group).

Results:

The aim of this study is to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge.

Conclusions:

The bedtime will provide evidence support for clinicians and patients for reducing morning blood pressure surge.

Ethics and dissemination:

This study does not require ethical approval.
Diagnostic value of diffusion-weighted imaging/magnetic resonance imaging for peritoneal metastasis from malignant tumor
Authors: Dong Li , Li Kuo , Peng Taisong
Published: February 2021

Background:

Previous meta-analyses examined either multiple tools for the diagnosis of peritoneal metastases (PMs), but not diffusion-weighted imaging (DWI), or included only 1 tumor type. This study aimed to determine the summary diagnostic value of DWI/magnetic resonance imaging in determining PMs originating from various tumors.

Methods:

PubMed, Embase, and Cochrane library were searched for available papers up to 2019/12. Pooled estimates for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and accuracy were calculated using random-effects models.

Results:

Ten studies were included and could be used to calculate the pooled sensitivity and specificity. The pooled sensitivity of DWI for PMs was 89% (95% confidence interval [CI]: 83%–93%). The pooled specificity was 86% (95% CI: 79%–91%). When considering only the retrospective studies, the pooled sensitivity of DWI for PMs was 85% (95% CI: 81%–89%). The pooled specificity was 84% (95% CI: 72%–92%). When considering only the studies about gastrointestinal tumors, the pooled sensitivity of DWI for PMs was 97% (95% CI: 68%–100%). The pooled specificity was 86% (95% CI: 69%–95%). No publication bias was observed (P = dd.27).

Conclusion:

DWI magnetic resonance imaging is highly sensitive and specific for the detection of PMs from various abdominal cancers.
Focusing on quality of life in the family caregivers of patients with schizophrenia from the perspective of family functioning
Authors: Meng Na , Chen Juan , Cao Bingrong , Wang Feng , Xie Xing , Li Xiaolin
Published: February 2021

The study aimed to explore the association between family functioning and quality of life (QOL) in family caregivers of patients with schizophrenia.

Totally 121 family caregivers were surveyed in the cross-sectional study by the self-administration questionnaires about sociodemographic characteristics, family functioning and QOL. Family functioning was evaluated in terms of the family assessment device and the Family Adaptability and Cohesion Evaluation Scale II China Version. QOL was evaluated in terms of TSDHE short-form 12-item health survey, version 2. Multiple regression models were built to explore the association between QOL and family functioning.

A regression analysis showed that poorer physical health of family caregivers was significantly associated with the lower educational level of caregivers, the closer kinship with patients and the multiple episodes schizophrenia. The other regression analysis showed that better family adaptability and affective responsiveness were significantly associated with the better mental health of family caregivers.

Family functioning is associated with mental health rather than the physical health of family caregivers. Psychoeducational intervention could focus on family caregivers with a lower educational level and closer kinship, and those who look after patients with multiple episodes schizophrenia. Further family intervention could focus on family adaptability and affective expression in family caregivers of patients with schizophrenia.
Acute complicated diverticulitis is associated with an increased advanced neoplasia diagnosis rate
Authors: Abu Baker Fadi , Ganayem Mohanad , Mari Amir , Taher Randa , Suki Mohamad , Kopelman Yael
Published: February 2021

Recent reports have documented an unchanged rate of occurrence of colorectal cancer (CRC) and have publicised doubts regarding the benefit of prompt colonoscopy procedures after an episode of acute diverticulitis (AD). These reports mandate further evaluation of colonoscopy yield and timing in this regard. The current study aims to determine whether the rate of advanced colonic neoplasia after AD differs from that of average-risk patients, and to identify risk factors that are associated with their development.

In this retrospective study, we included all patients who had been hospitalized to the surgery ward in the years 2008 to 2016 with radiographically confirmed AD, and had completed colonoscopies within one year of index hospitalization. Patients who were referred for screening colonoscopies during the same years were included as a control group. We compared the rates of diagnosis of CRC and advanced polyps for both groups before and after adjustment for multiple confounders. Moreover, we investigated risk factors that were associated with increased rate of advanced neoplasia diagnosis.

A total of 350 patients were included in the AD group and 1502 patients in the screening colonoscopy control group. The CRC diagnosis rates (1.7% vs 0.3%; P = .09) and overall diagnosis rates of advanced neoplasia (12.3% vs 9.6%; P = .19) were not significantly different when findings were compared between the AD and control groups, respectively. Cases of complicated diverticulitis, however, were associated with increased risk of advanced neoplasia diagnosis (odds ratio (OR) 3.729, 95% confidence interval (CI) 1.803–7.713; P = .01).

The diagnosis rate for advanced neoplasia after AD was not significantly different from that of average-risk populations. A course of complicated AD, however, was a potential risk factor.
Serum level of high mobility group box protein-1 and prognosis of patients with end-stage renal disease on hemodialysis and peritoneal dialysis
Authors: Chen Linyan , Chen Gaoping , Kong Xiangdong
Published: February 2021

To investigate serum level of high mobility group box protein-1 (HMGB1) and prognosis of patients with end-stage renal disease (ESRD) on hemodialysis (HD) and peritoneal dialysis (PD).

This prospective cohort observational study included a total of 253 ESRD patients who came to our hospital for HD or PD from February 2013 to February 2015. Enzyme linked immunosorbent assay (ELISA) method was used to detect the serum level of HMGB1, interleukin (IL-6), IL-8, and tumor necrosis factor-alpha (TNF-α). The kidney disease quality of life short form (KDQOL-SF) and kidney disease targeted area (KDTA) was applied for evaluating the quality of life. Kaplan–Meier (K–M) curve was performed for survival time.

Serum level of HMGB1 in patients on HD was higher than PD. HMGB1 levels were gradually decreased with the treatment of HD or PD. Furthermore, HMGB1 was positively correlated with IL-6 and TNF-α. Moreover, patients with higher HMGB1 had more complications than patients with lower HMGB1, but there was no difference for the survival rate. In addition, the quality of life was associated with different dialysis methods.

The serum level of HMGB1 and prognosis of ESRD patients was associated with different dialysis methods.
A case report of pneumonic-type adenocarcinoma diagnosed by transbronchial cryobiopsy after the patient's death
Authors: Zhao Qiquan , Han Xiaoli , Peng Li
Published: February 2021

Rationale:

Due to its nonspecific manifestations, pneumonic-type adenocarcinoma can be easily misdiagnosed as pneumonia, tuberculosis, or other diseases, especially in developing countries where many patients in the early stage refuse invasive examinations. Early recognition of pneumonic-type adenocarcinoma is essential.

Patient concerns:

We report a case of pneumonia lung adenocarcinoma diagnosed by frozen lung biopsy after death.

Diagnoses:

A 75-year-old male patient was admitted to the hospital on April 24, complaining of 5 months of recurrent coughing, expectoration, and panting, and his symptoms had been worsening over the past month.

Interventions:

After obtaining informed consent from the patient's family, transbronchial cryobiopsy was performed at the bedside.

Outcomes:

After a positive rescue, the patient died. Pathological examination indicated adenocarcinoma.

Lessons:

At present, surgery is still the first choice for the treatment of pneumonic lung cancer, and early diagnosis can remove the tumor as much as possible. Transbronchial cryobiopsy can be used for the collection of pathological samples, especially for the early diagnosis of pneumonic lung cancer.
Cardiac thrombus and stroke in a child with Mycoplasma pneumoniae pneumonia
Authors: Wang Yefeng , Xiao Yunbin , Deng Xicheng , Xu Ningan , Chen Zhi
Published: February 2021

Rationale:

Cardiac thrombus and stroke are rare complications in Mycoplasma pneumoniae infection, which is a common cause of community-acquired pneumonia in children. Early detection and prevention of thrombus in children with M pneumoniae pneumonia is relatively difficult.

Patient concerns:

A 5-year-old boy with severe M pneumoniae pneumonia was referred to our center. During the treatment with sufficient antibiotics, an echocardiography surprisingly revealed a thrombus in the left atrium, with significant changes in D-dimer level and anti-phospholipid antibodies. At day 12 after admission, the patient showed impaired consciousness, aphasia, and reduced limb muscle power. Magnetic resonance angiography (MRA) showed right middle cerebral artery infarction.

Diagnoses:

Cardiac thrombus and stroke associated with M pneumoniae pneumonia.

Interventions:

He was started on aggressive antibiotic therapy and urokinase thrombolytic therapy for 24 hours, continued with low molecular heparin calcium and aspirin along with rehabilitation training.

Outcomes:

On follow up, the D-dimer decreased slowly and echocardiograms showed a steadily decreasing size of thrombus with eventual disappearance at day 22 after admission. His left limb muscle power was improved after rehabilitation for 2 months.

Lessons:

Early diagnosis and treatment with multiple modalities maybe useful for improving prognosis of cardiac thrombus and stroke in M pneumoniae pneumonia. Changes in D-dimer level and anti-phospholipid antibodies should be routinely monitored in severe M pneumoniae pneumonia.
Efficacy and safety of acupuncture in postoperative ileus after gynecological surgery
Authors: Guo Yi , Kong Xianglu , Cao Qiuyu , Li Yin , Zhang Yuzhuo , Huang Jieming , Li Kunyin , Guan Yongge
Published: February 2021

Background:

Acupuncture is widely used in treatment of postoperative ileus (POI), but the safety and efficacy of acupuncture in POI after gynecological surgery still lack of evidence-based basis.

Methods:

PubMed, CINAHL, EMBASE, Web of science, Google Scholar, Wangfang database, Chinese Biomedical Literature Database (SinoMed), Chinese Science and Technology Periodical Database, and China National Knowledge Infrastructure database will be searched until December 31, 2020. Two independent investigators will screen the relevant randomized controlled trials from Data one by one by using prespecified criteria. The relevant data from included studies will be extracted and analyzed by using RevMan V.5.3 software. Quality of the included studies will be estimated by using the Cochrane Collaboration risk of bias tool, and publication bias will be assessed by using Egger test and Begg test. In addition, quality of evidence will be evaluated by using Grading of Recommendations Assessment, Development, and Evaluation.

Results:

We will analyze the effect of acupuncture on time to first flatus and time to bowel sound recovery as the primary outcomes of this review. Meanwhile, frequency of bowel sounds, time to defecation, time of hospital stay, biochemical indicators related to gastrointestinal motility, inflammation factors, responder rate, and adverse events for patients receiving gynecological surgery.

Conclusion:

Our findings will benefit researchers and provide reference for the treatment and prevention of POI for the patients undergoing gynecological surgery.
An incomplete form of anti-ganglioside antibody-positive Miller Fisher syndrome after an Epstein-Barr virus infection
Authors: Chang Le , Xiong Jing , Xue Yuying , Wang Jie , Zhu Xurong , Zheng Xuejiao , Gao Xiaoyu , Yan YuE , Hao Jiaduo , Zhao Hehuan , Di Zhengli
Published: February 2021

Rationale:

The Miller Fisher syndrome (MFS) is an acute polyradiculoneuritis regarded as an uncommon clinical variant of the Guillain-Barre syndrome (GBS). It is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. The diagnosis of MFS is based on clinical presentation, presence of albuminocytologic dissociation in the cerebrospinal fluid (CSF), and normal brain imaging results. The presence of anti-ganglioside antibodies (GQlb) in the serum is helpful for the diagnosis. A history of upper respiratory tract infection or diarrhea 3 days to 6 weeks before the onset of MFS is common. However, there are some patients with atypical manifestations who are difficult to diagnose. Here, we present an incomplete form of MFS where antibodies against GQ1b were detected in the serum following an Epstein Barr virus (EBV) infection.

Patient concerns:

A 77-year-old Chinese woman was admitted to the hospital with acute diplopia and right blepharoptosis. She had a history of mild upper respiratory tract infection 2 weeks ago. In 1 week, the symptoms rapidly progressed into bilateral ophthalmoplegia and hyporeflexia of the limbs without ataxia. CSF analysis on the third day after onset was normal, without albuminocytologic dissociation. EBV immunoglobulin G (IgG) antibodies were detected in the CSF. GQ1b and GD1b IgG antibodies were positive in the serum and negative in the CSF. No responsible lesion was found on brain imaging examination.

Diagnoses:

In accordance with the progressive bilateral ophthalmoplegia and hyporeflexia, the history of upper respiratory tract infection, the detection of EBV and GQ1b antibodies, and the negative brain imaging examination, the diagnosis of MFS was confirmed.

Interventions:

The patient was administered intravenous immunoglobulin for 5 days.

Outcomes:

She had a favorable outcome after treatment. At the 6-week follow-up, bilateral ocular movement limitation and tendon reflexes had recovered.

Lessons:

The diagnosis of MFS can be challenging, especially when encountered with incomplete symptoms and normal CSF results. Attention should be paid to the presence of anti-GQ1b IgG antibodies when the clinical manifestations are incomplete. Furthermore, EBV primary infection could be associated with MFS and considered a potential causative agent.
Intraductal papillary neoplasm of intrahepatic bile ducts complicated by chronic disseminated intravascular coagulation and thrombosis
Authors: Xiao Ming , Sun Aijun , Yu Fan , Xiao Ying , Li Lihong , Shen Dongyan , Xiang Canhong , Dong Jiahong
Published: February 2021

Rationale:

Intraductal papillary neoplasm of the bile ducts (IPNB) is a relatively rare tumor that is clinically characterized by digestive symptoms. The concurrent occurrence of chronic disseminated intravascular coagulation (DIC) with thrombosis is an extremely rare combination, reported in patients with IPNB. The clinical features of chronic DIC include microangiopathic hemolytic anemia, thrombocytopenia, and hypofibrinogenemia. Here, we report the case of a mucin-producing IPNB patient with hematological abnormalities.

Patient concerns:

A 58-year-old male patient suffered from abdominal distension for more than 2 months with obstructive jaundice appearance. Abdominal contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography showed a neoplasm in the right hepatic lobe. Multiple intravascular fillings were found in the inferior vena cava, pulmonary artery, and right atrium. Anemia and hypofibrinogenemia were discovered through routine laboratory tests. The count of platelets began to decline 25 days after admission, while 1 month after hospitalization, the patient developed abdominal pain, fever, and shock.

Diagnosis:

Pathological examination demonstrated IPNB with a part of high-grade intraepithelial neoplasia. Cardiac and inferior vena cava emboli were diagnosed as thrombi without neoplastic cells. Immunohistochemically, tumor cells were positive for Vimentin (mesenchyme), CK7, CK19, MUC-1, MUC-5AC, MUC-6, S-100p (focal), Ki-67 (12%), and negative for Inhibin-α, ER, CK20, CEA, and MUC-2. Additionally, immunohistochemistry indicated that IPNB was a mucus-secretion gastric type. The laboratory tests confirmed the presence of chronic DIC.

Interventions:

The patient was given anticoagulant therapy before hepatectomy and right atrium thrombectomy was performed under cardiopulmonary bypass.

Outcomes:

After anticoagulant therapy, the levels of hemoglobin, platelet, and fibrinogen of the patient returned to normal. Hepatectomy and thrombus removal was successfully performed. Then, the patient was discharged 12 days after the operation. After 12 months of follow-up, the patient recovered well without any hematologic abnormalities and no signs of tumor recurrence were observed.

Lessons:

IPNB may cause hematological complications, which can be easily misdiagnosed. It is essential to pay particular attention to the hematological abnormalities of patients with IPNB. Early detection and differential diagnosis of chronic DIC and thrombosis are necessary. We note that anticoagulant therapy coupled with surgery is an effective strategy to treat these complications.
A strengthening the reporting of observational studies in epidemiology (STROBE)
Authors: Dellino Miriam , Gargano Giulio , Tinelli Raffele , Carriero Carmine , Minoia Carla , Tetania Skrypets , Silvestris Erica , Loizzi Vera , Paradiso Angelo , Casamassima Porzia , Tufaro Antonio , Cormio Gennaro , Garrisi Vito Michele
Published: February 2021

Paget disease is a complex disorder that can be identified in the breast (mammary Paget disease) or in other locations (extramammary Paget's disease) such as ano-genital skin (Paget disease of the vulva -PVD). This condition is associated with low mortality, but a late diagnosis and recurrence can negatively impact the prognosis. Therefore, the main objective of this study is to evaluate if the human epididymis protein 4 (HE4) and cancer antigen125 (CA125) can promote recognition of PVD in early stages and during the relapses.

we have conducted a prospective, observational and laboratory-based study, that included 50 patients, whose 25 healthy women represented the control group and 25 PVD patients, which have been operated in our Oncology Institute, from May 2017 to September 2019. Both in the control group and in PVD patients, the CA-125 and HE4 were evaluated before surgery and after 6 months. Finally, a comparison of markers serum level, both between before/after surgery and with control group, and a ROC (Receiver Operating Characteristic) curve were performed.

Dosing the markers in PVD patients, 3/25 (12%) showed a higher value of CA125 and 11/25 (44%) an increased HE4. In addition, after surgical treatment there were no statistically significant difference between levels of CA-125 (P = .3) and HE4 (P = .19). On the other hand, comparing HE4 in PVD patients with the control group, a statistically significant difference was found (P-value = .0036). Contrary, comparing CA-125 in PVD patients with the control group (P-value= .1969), no statistically significant difference was evidenced. Moreover, ROC (Receiver Operating Characteristic) curve showed low sensitivity and specificity for CA125 with area under curve (AUC) = 0.5608. Instead, the ROC curve of HE4 revealed a sensitivity and specificity of 76% and 88% respectively (AUC = 0.7408) using a cut-off at 90 pmol/L.

Despite the limited cases, our data showed that CA125 is not a sensitive marker for PVD. On the other hand, in 44% of PVD we’ve seen an increase in HE4. So, this could be a starting point for further research that could confirm the possibility to use this marker in order to support PVD early identification.
SS-A52 antigen expression in thymic carcinoma accompanied with Sjögren syndrome
Authors: Isono Tomomi , Wakasa Tomoko , Kusumoto Hidenori , Shimada Keiji , Ogawa Takafumi , Shiono Hiroyuki
Published: February 2021

Rationale:

The relationship between thymic tumors and Sjögren syndrome (SjS) is unknown, and surgical resection has not been optimized. Especially, thymic carcinoma with autoimmune disease is rare. Analysis of SS-A52, germinal centers, plasma cells, and Foxp3+ Treg in thymic carcinoma has never been reported, and their pathological roles in causing SjS have not been studied.

Patient concerns:

A 78-year-old man presented with sputum production and xerostomia while asleep. Chest computed tomography showed a homogeneous and hypodense mass in the anterosuperior mediastinum. Serum levels of the antinuclear antibody, antibody to SS-A, and antibody to SS-B were positive.

Diagnoses:

Thymic carcinoma (squamous cell carcinoma) and SjS.

Interventions:

Video-assisted thoracoscopic resection of the mediastinal tumor and postoperative radiation therapy was performed.

Outcomes:

The histological diagnosis was thymic squamous cell carcinoma. Histologically, the squamous carcinomatous cells were arranged in nests and cords in the fibrohyaline stroma with capsular invasion. In the stroma, dense lymphoid tissues containing large reactive germinal centers and many plasma cells were also noted. In the involuted thymus, CD20-positive mature lymphocytes infiltrated, and germinal centers were noted. Double immunohistochemical staining revealed that SS-A52 antigen was positive in both the carcinoma component and CD20-positive mature B cells. Postoperatively, the xerostomia persisted, and serum SS-A and SS-B remained positive. No evidence of carcinoma recurrence with chest computed tomography scan was observed at 18-months follow-up.

Lessons:

In the surgical treatment of thymic tumors with SjS, extended thymectomy might be worth considering to stop the progressive destruction of the targets of SjS-specific autoantibodies. However, the postoperative symptoms may not dramatically improve because the target organs might have changed irreversibly, and memory B cells might persist. This is the first report that demonstrated the SS-A52 antigen presentation in a thymic tumor to the best of our knowledge.
Is Qi Fu Yin effective in clinical treatment of dementia?
Authors: Wang Lei , Qiao Pengli , Yue Lulu , Sun Rong
Published: February 2021

Background:

Dementia, a kind of acquired and progressive intelligence-damaging syndrome, is induced by cerebral dysfunction. Ancient records show that Qi Fu Yin (QFY) has the advantages in age-related dementia treatment. This study aims to evaluate therapeutic efficacy of QFY on dementia through meta-analysis.

Methods:

We comprehensively reviewed articles from various databases, including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Chinese Biomedical Literature (CBM), PubMed, and Web of Science published before June 2020, for all randomized controlled trials (RCTs) on dementia treatment with QFY. Then, we selected eligible literatures, extracted related data, and assessed risk of bias. Forest plots of total clinical effective rate, MMSE score, HDS score and ADL score illustrated the difference between the experimental group (treatment with QFY alone or combined with routine western medicine) and the control group (treatment with routine western medicine only). Random effects model and fixed effects model were adopted. Finally, publication bias was further analyzed using funnel plot, sensitivity analysis, Begg and Egger test.

Results:

Finally, 9 RCTs, involving 697 patients, were included in this study. The results revealed that the total clinical effective rate of the experimental group was obviously higher than that of the control group (OR = 0.33, 95% CI [0.22, 0.50], P < .001). In comparison with the control group, the experimental group showed higher MMSE score (WMD = 2.60, 95% CI [2.16, 3.03], P < .001) and HDS score (WMD = 1.51, 95%CI [1.10, 1.92], P < .001). Due to few included studies, there were no statistically significance between experimental and control groups (WMD = -9.90, 95%CI [−26.09, 6.30], P = .231) regarding ADL score. In addition, there is no publication bias towards clinical effective rate and MMDE score.

Conclusions:

QFY only or combined with western medicine therapy can significantly improve cognitive ability compared with only western medicine therapy in dementia. However, multiple samples, RCTs of high quality are still needed to verify our conclusions.
Exercise intervention for the risk of falls in older adults
Authors: Zhang Qin , Liu Yi , Li Dongze , Jia Yu , Zhang Wei , Chen Bowen , Wan Zhi
Published: February 2021

Background:

Falls can easily lead to serious injury and even death in the older adults. Many exercise interventions, such as balance, flexibility, and endurance training have been shown to reduce the incidence of falls in this population. However, which mode of exercise is most beneficial for them remains unanswered.

Methods:

We will search the following databases as data sources: PUBMED, EMBASE, Cochrane Library, Wanfang, China knowledge Network (CNKI), Clinical Trials Database, and Science Network. Data extraction will be performed by two independent reviewers, who will discuss and resolve any differences, with the consensus of a third author. The RCTs will be selected according to prespecified inclusion criteria. The main outcome is the occurrence of a fall, and the secondary outcomes are the adverse consequences of a fall and a fall risk assessment index. If the heterogeneity test shows slight or no statistical heterogeneity, a fixed effect model will be used for data synthesis; otherwise, a random effect model will be used. We will develop a unified data extraction table including a number of parameters. The Cochrane cooperative bias risk tool will be used to evaluate the methodological quality of the selected RCTs. RevMan Manager v5.3 software and STATA v16.0 software will be used for data analysis. If enough randomized controlled trials (more than 10) are identified and selected.

Conclusion:

This protocol will be applied to synthesize the existing evidence so as to identify the most effective exercise program to prevent falls in the elderly.

INPLASY registration number:

INPLASY2020110008.
Quality assessment of traditional and conventional medicine clinical practice guidelines for osteoporosis
Authors: Kim Jung-Hyun , Seo Byung-Kwan , Baek Yong-Hyeon
Published: February 2021

Numerous studies have reported the variable quality of clinical practice guidelines (CPGs) across various domains. The aim of this study was to systematically assess the quality, methodology, and consistency of recently developed traditional and conventional medicine CPGs that focus on the management of osteoporosis and provide helpful recommendations for patients with osteoporosis.

From June 2020 to July 2020, CPGs with osteoporosis targeting any age were systematically retrieved. All CPGs of traditional and conventional medicine related to the assessment and diagnosis, management, and clinical therapeutic and pharmacological recommendations with osteoporosis were eligible for inclusion in this study. The excluded documents included guidelines without recommendations, secondary publications derived from CPGs, consensus statements, or consensus conferences based on the opinion of panelists, systematic reviews, editorials, clinical trials, and single-author documents. The quality of CPGs was independently examined by three assessors using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. AGREE II consists of 6 domains; scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Consequently, selected CPGs were graded as recommended (A), recommended with modifications (B), or not recommended (C), and the specific treatments and preventive recommendations in the CPGs were summarized.

The quality of the 15 CPGs assessed varied across the AGREE II domains. The overall quality ranged from 3.0 to 6.0 out of 7. The domain that had the highest scores were “clarity of presentation,” with a mean value of 69.0% (range 46%–83%); “editorial independence” had the lowest score of 30.2% (range 0%–75%). The conventional CPGs focused on pharmacological treatments, calcium and vitamin D intake, and prevention, while the traditional CPGs consistently emphasized on herbal medicine and non-pharmaceutical treatment and management.

Further development of CPGs will require improvement in domains where low item scores have been obtained in the quality assessment in this present study. Further research is needed on alternative modalities for osteoporosis, especially complementary approaches, and higher quality CPGs are needed to facilitate evidence-based clinical practice.
COVID-19
Authors: Poncin Lisa , Bower Kathleen A.
Published: February 2021

The COVID-19 pandemic has affected millions of Americans, including health care staff. This article traces the experience of 1 nurse leader as she falls ill, only to learn that she has, indeed, been infected with the virus. She describes her 4-week quarantine, including the impact on her family and her attempts to continue to support her staff. As she recovers from the acute onslaught of COVID, the focus shifts back to her nurse leader role. In this role, she and her colleagues manage the logistics of caring for more than 150 COVID-positive patients a day in the 719-bed academic medical center. This included staffing the hospital, given the extreme challenges of staff availability limited by concerns such as school closings and at-risk family members. Now with the hospital's daily volume of COVID-positive patients greatly reduced, there is an opportunity to reflect on lessons learned, including what went well during the peak of the crisis and where there were opportunities. Leadership and staff are experiencing a sense of pride at their exceptional care of this complex population, even while exploring opportunities to be even better prepared should COVID erupt once again.
Implications and Experiences in Postacute Care—Rehabilitation, Long-Term Acute Care, and Skilled Nursing
Authors: Hatch Mary Ellen
Published: February 2021

Postacute care is a term used to describe a group of health care providers, caring for patients outside of traditional acute care. The populations served and measures of outcomes are similar, but the services provided may vary by type of setting and individual provider. Managing through the coronavirus disease-2019 (COVID-19) pandemic has been both a challenge and an opportunity to demonstrate the vital role of postacute providers in the health care continuum. National media outlets have highlighted emergency departments, critical care areas, and start-up COVID units in acute care hospitals treating critically ill patients battling COVID-19. Stories of nursing homes in crisis over the rapid spread of COVID-19 have saddened readers of newspapers and social media alike. Postacute providers have experienced the pandemic alongside the acute care hospitals in ways that have highlighted the flexibility of postacute care, challenged leaders to lead with intensity, and demonstrated their importance in the continuum of care. Through a series of interviews with postacute care leaders, this article explores the response to the pandemic from the perspective of providers in postacute care settings.