bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of burnout in medical students in China
Authors: Li You , Cao Liang , Mo Chunbao , Tan Dechan , Mai Tingyu , Zhang Zhiyong
Published: June 2021

This meta-analysis aimed to estimate the prevalence of burnout among medical students in China.

A systematic search from the following electronic databases: China National Knowledge Infrastructure, Wangfang database, VIP database, Chinese biomedical literature database, PubMed, Embase, Web of Science, and Google Scholar was independently conducted by 2 reviewers from inception to September 2019. The data were analyzed using stata software Version 11. Heterogeneity was assessed using I
2 tests, and publication bias was evaluated using funnel plots and Egger's test. The source of heterogeneity among subgroups was determined by subgroup analysis of different parameters.

A total of 48 articles with a sample size of 29,020 met the inclusion criteria. The aggregate prevalence of learning burnout was 45.9% (95% confidence interval [CI] = 38.1%–53.8%). The prevalence rate of high emotional exhaustion was 37.5% (95% CI: 21.4%–53.7%). The percentage was 44.0% (95% CI: 29.2%–58.8%) for low personal accomplishment. The prevalence rate was 36.0% (95% CI: 23.0%–48.9%) in depersonalization dimension. In the subgroup analysis by specialty, the prevalence of burnout was 30.3% (95% CI: 28.6%–32.0%) for clinical medicine and 43.8% (95% CI: 41.8%–45.8%) for other medical specialties. The total prevalence of burnout between men and women was 46.4% (95% CI: 44.8%–47.9%) and 46.6% (95% CI: 45.5%–47.6%), respectively. The prevalence of burnout with Rong Lian's scale was 43.7% (42.1%–45.2%), and that with the other scales was 51.4% (50.4%–52.4%). The prevalence rates were 62.9% (61.3%–64.6%), 58.7% (56.3%–61.1%), 46.5% (42.9%–50.2%), and 56.0% (51.6%–60.4%) from Grades 1 to 4, respectively. There was a statistically significant difference among the different grades (P = .000).

Our findings suggest a high prevalence of burnout among medical students. Society, universities, and families should take appropriate measures and allot more care to prevent burnout among medical students.
STROBE-clinical characteristics and prognosis factors of gastric cancer in young patients aged ≤30 years
Authors: Zhou Liyun , Jiang Zhenhua , Gu Wenhui , Han Shuangyin
Published: June 2021

We aimed to determine the clinical characteristics and prognosis factors of young patients with gastric cancer (GC).

A total of 101 young patients with GC referred to Zhengzhou University People's Hospital, Henan province, China between January 1st, 2003 and June 1st, 2015 were retrospectively reviewed. The medical records included ages, genders, marital status, family history of tumors, comorbidity, Helicobacter pylori (H.pylori) infection, fibrinogen, prealbumin, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), tumor location, tumor size, TNM stage, differentiation of the tumor, WHO type, treatment method and prognostic factors effect were further assessed.

The mean age of GC patients in our group was 26.0 years. The incidence was slightly higher in females (female: male = 1.1:1). Some patients had the family history of tumor and H.pylori infection (2.0%, 6.9%). The tumor sizes were mainly under 5 cm (52.4%) and the most locations were in the antrum (43.5%) and body (42.5%). A large number of patients were diagnosed as adenocarcinomas (66.3%) and the main histological of GC was poor differentiated (72.3%). Moreover, a high proportion of patients were diagnosed at the stages III-IV (61.4%), and most patients received surgery combined chemotherapy (63.4%), however, the survival outcome was poor. In univariate Cox analysis, tumor sizes, TNM stage were significantly associated with overall survival (OS) and the multivariate Cox analysis demonstrated that TNM stage was significantly associated with OS.

GC in young patients has its unique biological and clinical features. A large majority of young patients were diagnosed at their advanced stages with poor prognostic. TNM stage was an independent prognostic factor for young patients with GC, early GC screening in young people should be actively promoted.
GDS score as screening tool to assess the risk of impact of chronic conditions and depression on quality of life in hospitalized elderly patients in internal medicine wards
Authors: Argano Christiano , Catalano Nicola , Natoli Giuseppe , Monaco Marika Lo , Corrao Salvatore
Published: June 2021

Aging of population is characterized by multiple chronic conditions in the same individual. Health-related quality of life (HR-QOL) reflects the multidimensional impact of chronic disease on population and it is increasingly analysed as outcomes.

The aim of this study was the evaluation of the predictors of quality of life among elderly patients hospitalized in internal medicine ward, investigating the effect of comorbidities on health-related quality of life.

Data collected in this cross-sectional study were analysed. Socio-demographic, clinical characteristics, disease distribution and quality of life by the 12-Item Short Form Health Survey (SF-12) were evaluated.

Of 240 inpatients, subjects with Barthel Index (BI)≤40 were 23.7%, 55% had a Geriatric Depression Scale (GDS)≥2. After categorizing mental component score (MCS) and physical component score (PCS) in five classes, we found that diabetics and patients with cancer were more frequent in the first class of MCS while patients with NYHA III-IV are significantly more frequent in the first class of PCS. When we classified patients according to GDS≥2 or < 2, subjects with GDS≥2 had BI and MCS significantly lower. In the multivariate analysis GDS score ≥2 was independently associated with first MCS class [16.32 (3.77–70.68)] while NYHA III-IV class and claudicatio intermittents were strong predictors of the worst PCS class [9.54 (1.97–47.40), 2.53 (1.16–5.49), respectively]. Liver disease was independently associated with GDS≥2 [5.26 (1.13–24.39)].

Our study highlighted the impact of chronic diseases on health-related quality of life in elderly subjects hospitalized in an internal medicine ward pointing out the importance of taking into account patient's needs and perception and the setting up of a personalised health-care. Patients with diabetes and liver disease along with persons affected by cancer need psychological support to improve their quality of life. A GDS score ≥ 2 is a strong predictor of poor quality of life and should trigger an in-depth assessment of mental health in this kind of patients.
Fixation options for reconstruction of the greater trochanter in unstable intertrochanteric fracture with arthroplasty
Authors: Huang Guanning , Zhang Mingran , Qu Zhiguo , Zhang Youjia , Wang Xukai , Kang Wenbo , Zhang Minglei
Published: June 2021

Introduction:

With the aggravation of population aging, the incidence of intertrochanteric fracture also increases dramatically. Patients are often elderly accompany with severe osteoporosis and various complications. Therefore, we should select an individualized treatment based on the each patient's state. Arthroplasty is recommended for unstable fractures with obvious osteoporosis, ipsilateral femoral head necrosis or arthritis. Rigid fixation of the greater trochanter with arthroplasty is challenging because of the powerful pulling forces created by multiple muscles being transmitted to the greater trochanter. Currently, there are few contemporary literatures on the evaluation of unstable intertrochanteric fracture with efficient fixation of the greater trochanter. Moreover, there is no consensus to choose which implant to immobilize the greater trochanter. The purpose of this study was to review previous literatures and provide a valuable guidance.

Conclusions:

The locking plate, which not only provides rigid fixation but also results in lower rate of postoperative complications. However, further prospective randomized and cohort studies are needed.
Effectiveness and safety of music therapy for insomnia disorder patients
Authors: Ding Jie , Huang Tianqi , Hu Jinyu , Yuan Fuqiang
Published: June 2021

Background:

Music therapy has been widely used clinically to relieve insomnia disorder patients. However, the efficacy of music therapy in the treatment of insomnia disorder patients is uncertain. The purpose of this study is to determine the effectiveness and safety of music therapy in the treatment of insomnia disorder patients.

Methods:

Search PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, China Biomedical Literature Database, and search-related randomized controlled trials. Two reviewers will independently select studies, collect data, and evaluate methodological quality through the Cochrane Deviation Risk Tool. Revman V.5.3 will be used for meta-analysis.

Results:

This study will evaluate the current status of music therapy treatment for insomnia disorder patients, aiming to illustrate the effectiveness and safety of music therapy treatment.

Conclusion:

This study will provide a basis for judging whether music therapy is effective in treating insomnia disorder patients.

INPLASY registration number:

INPLASY202150087.
Effects of music therapy on COVID-19 patients’ anxiety, depression, and life quality
Authors: Chen Xiaomei , Li Haiying , Zheng Xiaoying , Huang Jiaqi
Published: June 2021

Background:

Whether music therapy improves coronavirus disease 2019 (COVID-19) patients’ anxiety, depression, and life quality are still controversial. Therefore, to provide evidence-based medical evidence for clinical non-pharmacological interventions, we performed a meta-analysis of randomized controlled trials of music therapy for COVID-19 patients’ anxiety, depression, and life quality.

Methods:

Cochrane Central Register of Controlled Trials Repositories, PubMed, Embase, Web of Science and Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan-Fang database were searched to identify studies on the evaluation of the effectiveness of the music-based intervention on COVID-19 patients’ anxiety, depression, and life quality from inception to May 2021. Two researchers independently carried out data extraction and literature quality evaluation of the quality and the meta-analysis on the included literature was performed with Revman5.3 software.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study will provide reliable evidence-based evidence for the effects of music therapy on COVID-19 patients’ anxiety, depression, and life quality.
Efficacy and safety of dapagliflozin in the treatment of chronic heart failure
Authors: Dong Xueyan , Ren Lili , Liu Yueli , Yin Xuewei , Cui Siyuan , Gao Wulin , Yu Liming
Published: June 2021

Background:

As the last link in the chain of cardiovascular events, chronic heart failure (CHF) has high morbidity, high mortality, and poor prognosis. It is one of the main causes of death and disability worldwide. As a new drug for the treatment of chronic cardiovascular disease, dapagliflozin, the efficacy, and safety issues are still the focus of attention. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of dapagliflozin in the treatment of CHF.

Methods:

According to the search strategy, regardless of publication date or language, randomized controlled trials (RCTs) of dapagliflozin for CHF will be retrieved from 8 databases. First of all, the literature was screened according to the eligibility criteria, and use the Cochrane Collaboration's tool to assess the quality of the included literature. Then, using Rev Man 5.3 and STATA 14.2 software for traditional meta-analysis. Finally, the evaluation of the quality of the evidence and the strength of the recommendations will adopt the Grading of Recommendations, Assessment, Development and Evaluation method.

Results:

This study will evaluate the efficacy and safety of dapagliflozin for CHF, thereby providing more evidence support for clinical decision-making in CHF.

Conclusion:

Our research will provide more references for the clinical medication of patients with CHF.

Protocol registration number:

INPLASY202150046
Maternal exposure to pesticides during pregnancy and risk for attention-deficit/hyperactivity disorder in offspring
Authors: Zhu Zhixian , Wang Ying , Tang Shiming , Tan Huawei , Liu Cheng , Cheng Liwei
Published: June 2021

Background:

Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder in childhood. Studies explored the association of maternal exposure to pesticides during pregnancy with a risk of offspring developing ADHD, but have reported inconclusive results. Here, we will perform a systematic review and meta-analysis of observational studies to assess a possible association between them.

Methods:

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. PubMed, Embase, Web of Science, the Cochrane Library, and the PsycINFO will be searched from inception to May 2021. Observational studies investigating the association of maternal exposure to pesticides during pregnancy with a risk of offspring developing ADHD will be considered. The Newcastle-Ottawa Scales or the scale of the Agency for Healthcare Research and Quality will be used to assess the methodological quality of the included studies according to their study design. A fixed or random-effect model will be used to synthesize data depend on the heterogeneity test. STATA version 12.0 will be used to conduct the meta-analysis.

Results:

This study will provide a high-quality evaluation of association between maternal exposure to pesticides during pregnancy and risk for ADHD in offspring.

Conclusion:

This study will present evidence on whether maternal exposure to pesticides during pregnancy is a risk factor for ADHD in offspring.
Therapeutic effects of sleeve gastrectomy for non-alcoholic steatohepatitis estimated by paired liver biopsy in morbidly obese Japanese patients
Authors: Murakami Eisuke , Nakahara Takashi , Hiramatsu Akira , Morio Kei , Fujino Hatsue , Yamauchi Masami , Kawaoka Tomokazu , Tsuge Masataka , Imamura Michio , Aikata Hiroshi , Fudeyasu Kenichi , Nakashima Yuki , Iwaki Daisuke , Jodai Daichi , Ohigashi Toshikazu , Nishimura Yui , Minamoto Yusuke , Nagao Akiko , Yoneda Masayasu , Saeki Yoshihiro , Tanabe Kazuaki , Ohdan Hideki , Chayama Kazuaki
Published: June 2021

Bariatric surgery has been reported to improve non-alcoholic steatohepatitis (NASH), which is a frequent comorbidity in morbidly obese patients. We performed a retrospective cohort study to estimate the therapeutic effect of sleeve gastrectomy (SG), the most common bariatric surgery in Japan, on obese patients with NASH by comparing the findings of paired liver biopsies.

Eleven patients who underwent laparoscopic SG for the treatment of morbid obesity, defined as body mass index (BMI) > 35 kg/m2, from March 2015 to June 2019 at Hiroshima University Hospital, Japan, were enrolled. All patients were diagnosed with NASH by liver biopsy before or during SG and were re-examined with a second liver biopsy 1 year after SG. The clinical and histological characteristics were retrospectively analyzed.

One year after SG, body weight and BMI were significantly reduced, with median reductions in body weight and BMI of—22 kg and –7.9 kg/m2, respectively. Body fat was also significantly reduced at a median of 13.7%. Liver-related enzymes were also significantly improved. On re-examination by paired liver biopsy, liver steatosis improved in 9 of the 11 patients (81.8%), ruling out of the pathological diagnosis of NASH. However, fibrosis stage did not significantly improve 1 year after SG. The non-alcoholic fatty liver disease activity score was significantly reduced in 10 of 11 patients (90.9%).

Pathological improvement or remission of NASH could be achieved in most morbidly obese Japanese patients 1 year after SG.
Comparison of efficacy between palonosetron-midazolam combination and palonosetron alone for prevention of postoperative nausea and vomiting in patients undergoing breast surgery and patient controlled analgesia
Authors: Hong Jeong-Min , Han Yun-Hee , Lee Dowon , Hwang Boo Young , Baik Jiseok , Cho Ah Reum , Lee Hyeon Jeong , Kim Eunsoo
Published: June 2021

Background:

Postoperative nausea and vomiting (PONV) is a common complaint in patients following general anesthesia. Various antiemetics, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, are effective but still have limited efficacy. Therefore, combination therapy is preferable to using a single drug alone in high-risk patients. We performed a comparative study on the antiemetic effect of palonosetron, a 5-HT3 receptor antagonist, monotherapy vs palonosetron-midazolam combination therapy for the prevention of PONV.

Methods:

A total of 104 female patients scheduled for breast cancer surgery were enrolled. They were randomly divided into 2 groups, a palonosetron monotherapy group (group P) and palonosetron-midazolam combination therapy group (group PM). Both groups received 0.075 mg palonosetron intravenously after induction of anesthesia. Patient-controlled analgesia (PCA) was applied according to the allocated group. Intravenous (IV)-PCA in group P consisted of fentanyl 20 μg/kg plus normal saline (total volume: 100 ml); IV-PCA in group PM consisted of fentanyl 20 μg/kg plus midazolam 4 mg plus normal saline (total volume: 100 ml). Efficacy parameters were collected during 0 to 1, 1 to 6, 6 to 24, and 24 to 48 hours postoperative time intervals. These measures included complete response (defined as no PONV and no rescue anti-emetic use) rate, incidence of PONV, sedation score, rescue antiemetic use, rescue analgesic use, and numerical rating scale (NRS) for pain. The complete response rate during the 0 to 24 hours interval was analyzed as the primary outcome.

Results:

Although the complete response rate between 0 and 24 hours was higher in group PM (42.3% and 48.1% in group P and PM, respectively), there was no statistically significant difference (P = .55). The complete response rates in other time intervals were not different between the 2 groups as well. The sedation score and NRS score also showed no differences between the 2 groups.

Conclusions:

The combination therapy of palonosetron with midazolam did not lead to a greater reduction in the incidence of PONV than monotherapy in patients undergoing breast surgery and receiving IV-PCA containing fentanyl.
Effect of partial splenic embolization on transarterial chemoembolization for hepatocellular carcinoma with hypersplenism
Authors: Liu Jibing , Wu Zhijuan , Zhang Jianxin , Xie Yinfa , Sun Peng , Wu Huiyong , Chang Xu , Zhang Lin , Liu Fengyong
Published: June 2021

This study retrospectively studied transarterial chemoembolization (TACE) combined with partial splenic embolization (PSE) in the treatment of hepatocellular carcinoma (HCC) with severe hypersplenism.

Seventy patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stage B or C with hypersplenism were divided into non-partial splenic embolization group (N-PSE, n = 51) and partial splenic embolization group (PSE, n = 19). The N-PSE group was further divided into N-PSE with mild to moderate hypersplenism (N-PSE-M, 47 cases) and N-PSE with severe hypersplenism (N-PSE-S, 4 cases).

In the PSE group, leukocytes, neutrophils, lymphocytes, and platelets were significantly increased (P < .05) and were significantly different from that in the N-PSE group (P < .05). In the N-PSE group, except for a slight increase in neutrophils, other blood cells were decreased, including lymphocytes that were significantly decreased (P < .05). There was no significant difference in the changes of liver function between the 2 groups before and after surgery (P > .05). The analysis showed a significant increase in ascites after 6 months of TACE in the N-PSE group (P < .05). According to the follow-up results, the median overall survival (OS) in the PSE group was 24.47 ± 3.68 (months) and progression-free survival (PFS) was 12.63 ± 4.98 (months). Regardless of OS or PFS, the PSE group was superior to the N-PSE group and its subgroups, with a statistically significant difference in PFS between the N-PSE group and PSE group (P < .05). Moreover, the time of extrahepatic progression was significantly earlier in the N-PSE group than in the PSE group (P < .05). N-PSE-S group had the worst prognosis, and PFS and OS were worse than the other 2 groups, suggesting that PSE in severe hypersplenism may improve PFS and OS.

In patients with HCC and severe hypersplenism, TACE should be actively combined with PSE treatment.
Childhood dystonic reactions in the middle Black Sea region
Authors: Çirakli Sevgi
Published: June 2021

Acute dystonic reactions are a worrying reason for presentation to the pediatric emergency department and the pediatric neurology clinic in childhood. It must be diagnosed and treated quickly. The aim of this study was to examine the clinical presentations, etiological factors, and prognosis of patients presenting to our regional tertiary pediatric neurology clinic with a diagnosis of acute dystonic reactions in children.

Nine pediatric patients who were treated for acute dystonic reactions between May, 2018 and May, 2020 and had adequate follow-up were included in the study. Medical record data were reviewed age, gender, etiology, features of family, treatment, and results.

Three of the patients were female and 6 were male. Their average age was 11 years (4–17). All patients were evaluated as a drug-induced acute dystonic reaction. Of the 9 patients, 5 were due to metoclopramide, 3 were due to risperidone, and 1 was due to aripiprazole. It was learned that a similar situation against other drugs developed in the family history of 3 patients. As a treatment, all of them were intramuscularly applied biperiden suitable for their weight and 30 minutes dramatic improvement was observed. Additional dose had to be administered in only 1 case. All cases were discharged for 24 hours. No problem was observed in their follow-up.

Drug-induced acute dystonic reaction can be diagnosed and has a clinical picture that completely resolves when effective treatment is applied. However, it should not be forgotten that it can reach life-threatening dimensions clinically.
Analysis of perinatal coagulation function in preeclampsia
Authors: Xu Chang , Li YunHui , Zhang Wen , Wang QiuShi
Published: June 2021

To study the dynamic changes in perinatal coagulation function in patients with preeclampsia (PE).

The general data and coagulation indexes of 290 PE patients during the perinatal period (prenatal and 1 and 3 days postpartum) and 256 healthy pregnant women in the third trimester of pregnancy were investigated, and the data were analyzed.

Compared with healthy pregnant women, prothrombin time (PT), fibrinogen (FIB), platelet count (PLT), mean platelet volume (MPV), thrombocytocrit (PCT), maximum amplitude (MA), and coagulation index (CI) of PE patients decreased, and activated partial thrombin time (APTT), thrombin time (TT), D-dimer (DD), platelet distribution width (PDW) and K values increased before delivery (P < .05). APTT and FIB in PE patients were lower in the day 1 postpartum group than in the prenatal and postpartum day 3 groups, and TT, DD, and fibrin degradation products (FDP) were higher (P < .05). PCT and MPV were highest in the prenatal group (P < .05).

Compared with that of healthy pregnant women, the coagulation function of PE patients is in a relatively low-coagulation and high-fibrinolysis state on postpartum day 1, which increases the risk of postpartum hemorrhage and other adverse outcomes.
The ratio of preoperative alpha-fetoprotein level to total tumor volume as a prognostic factor of hepatocellular carcinoma after liver transplantation
Authors: Jiang Tao , Zhang Xiao-shi , Pan Fei , Lyu Shao-cheng , Wang Jing , Huang Meng-xiu , He Qiang , Lang Ren
Published: June 2021

To evaluate the effect of preoperative serum alpha-fetoprotein(AFP) level to total tumor volume (TTV) ratio as a prognostic marker on predicting the tumor recurrence and overall survival time of patients with hepatocellular carcinoma (HCC) after liver transplantation.

One-hundred eight patients with HCC who underwent liver transplantation in Beijing Chaoyang Hospital from April 2013 to October 2017 were studied. Divided into AFP/TTV≤2 group and AFP/TTV>2 group by the best cut-off score calculated by receiver operation characteristic curve, the clinical and pathological data of the patients in two groups were compared to explore the relationship between AFP/TTV and tumor recurrence together with the prognosis of HCC patients after liver transplantation. Risk factors of early tumor recurrence and poor prognosis of HCC in patients after liver transplantation were studied by multivariate regression analysis. Kaplan-Meier survival analysis was used to compare the tumor-free survival and overall survival between the two groups of patients.

In 108 patients, 47 patients have AFP/TTV≤2 while 61 patients have AFP/TTV>2. Patients in AFP/TTV≤2 group have longer tumor-free survival time and overall survival time compared with patients in AFP/TTV>2 group. The age, total bilirubin level, serum AFP level, TTV, portal vein tumor thrombus and AFP/TTV (all P < .05) of patient with HCC are closely related to poor prognosis after liver transplantation. Multivariate regression analysis showed that have portal vein tumor thrombus (hazard ratio [HR] = 2.345, P < .05), TTV≥65.5 cm3 (HR = 2.701, P < .05) and AFP/TTV > 2 (HR = 4.624, P < .05) are independent risk factors for poor prognosis of patients with HCC after liver transplantation while TTV≥65.5 cm3 (HR = 2.451, P < .05) and AFP/TTV > 2 (HR = 4.257, P < 0.05) were independent risk factors for tumor recurrence at the same time.

The tumor recurrence and the prognosis of patients with HCC after liver transplantation is affected by many factors. AFP/TTV ratio has important predictive value for the tumor recurrence and the prognosis of patients with HCC after liver transplantation. AFP/TTV>2 is an independent risk factor for both early tumor recurrence and poor prognosis of patients with HCC after liver transplantation.
Identification of key miRNAs and their targets in peripheral blood mononuclear cells of IgA nephropathy using bioinformatics analysis
Authors: Liu Ling , Yang YaZhen , Yu Dongrong
Published: June 2021

Background:

Currently, renal biopsy is the gold standard for clinical diagnosis and evaluation the degrees of IgA nephropathy. However, renal biopsy is an invasive examination and not suitable for long-term follow-up IgA nephropathy. The activation of peripheral blood mononuclear cells (PBMCs) are related to IgA nephropathy, but the key molecular marker and target of PBMCs for evaluating the progression and prognosis of IgA nephropathy is still unclear.

Methods:

We downloaded gene expression omnibus series 25590 (GSE25590) datasets, of which PBMCs from IgA nephrology (IgAN) and healthy patients, from the gene expression omnibus (GEO) database. Differentially expressed miRNAs (DEMs) between IgAN and healthy patients were identified. The Funrich software was used to predict the differentially expressed genes (DEGs). Gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) analyzes of overlapping genes were analyzed at the function level on DAVID 6.8. We used search Tool for the retrieval of interacting genes (STRING) online database constructed the protein–protein interaction (PPI) network. Then we further analyzed the hub genes by Cytoscape software and the hub miRNA by TargetScan.

Results:

We identified 418 DEMs from the GSE25590 datasets. The upstream transcription factors SP1 regulates most DEMs. According to the GO and KEGG results, the DEGs were enriched in the MAPK signaling pathway and small GTPase mediated signal transduction. SYN1, SYT4, RBFOX1, KCNC1, VAMP2, FBXO11, ASB9, SYT9, KLHL5, and KRAS were identified as hub genes. Hsa-miR-532-5p, hsa-miR-92a, hsa-miR-328, hsa-miR-137, hsa-miR-153, hsa-miR-9-5p, hsa-miR-140-5p, hsa-miR-217, hsa-miR-155, and hsa-miR-212 were predicted as hub miRNAs.

Conclusions:

The DEMs and DEGs re-analysis provided potential key genes and hub miRNA of PMBCs, which may help to monitor the happening and prognosis of IgAN.
Relationship of electrocardiographic changes and severity of acute cerebral ischemic stroke in old patients
Authors: Zhang Chao , Zhou Jidong , Zhou Ting
Published: June 2021

There was a controversy for the electrocardiogram (ECG) changes and their relationship with disease severity in old patients with acute cerebral ischemic stroke (CIS). This study was aim to provide referential data for this topic.

Totally 200 old patients with acute CIS in our hospital from January 2017 to December 2019 were included into this study. According to the ST-T segment changes in ECG, these patients were divided into 3 groups: persistent ischemic group (n = 38), transient ischemic group (n = 106) and non-ischemic group (n = 56). The characteristics and incidence of abnormal ECG and their relationship with disease severity, infarct size and prognosis were respectively analyzed under the severe, moderate and mild type of disease.

The ECG changes of patients were mainly characterized by myocardial ischemic ST-T segment changes with a abnormal ECG incidence of 72.00%, the arrhythmia with a abnormal ECG incidence of 9.50%, which were the second most common in clinical features. There were statistically significant differences of myocardial ischemic ST-T segment changes among different disease severity, infarct size and prognosis of acute CIS patients (P < .05). The ischemic ST-T segment changes of ECG reflected that the disease severity, and more ECG abnormalities indicated more severe pathological conditions in CIS patients.

The characteristics of ischemic ST-T segment changes have important reference value in the evaluation of severity and prognosis of acute CIS in old patients.
Efficacy and safety of ibuprofen in children with musculoskeletal injuries
Authors: Jin Jianping , Wang Xiaoqing , Wang Jingjing , Wan Zhanhai
Published: June 2021

Objective:

To evaluate the analgesic efficacy and safety of ibuprofen in children with musculoskeletal injuries.

Methods:

PubMed, EMBASE, Web of science, and the Cochrane Central register of Controlled Trials (CENTRAL) were systematically searched to identify eligible randomized controlled trials (RCTs) that compared ibuprofen with other analgesics for pain relief in children with musculoskeletal injuries. Primary outcomes included change of visual analog scale (VAS) scores from baseline to post-medication, the proportion of patients achieving adequate analgesia, and the proportion of patients requiring additional analgesia. Secondary outcome was the incidence of adverse effects. Data analysis was performed using RevMan 5.3 software.

Results:

Five RCTs involving 1034 patients were included in this meta-analysis. Compared to the control group, change of VAS scores was greater in ibuprofen group at 60 min (standardized mean difference [SMD] = 0.28; 95% confidence intervals [CI], 0 to 0.57; P = .05), 90 min (SMD = 0.38; 95% CI, 0.17 to 0.59; P = .0005), and 120 min (SMD = 0.4; 95% CI, 0.23 to 0.57; P < .00001) after treatment. No difference was found in the change of VAS scores at 30 min (SMD = 0.07; 95% CI, -0.08 to 0.22; P = .36) after treatment. The proportion of patients who received adequate analgesia was higher in the ibuprofen group (risk ratios [RR] = 1.36; 95% CI, 1.20 to 1.56; P < .00001). The proportion of patients that required additional analgesia was lower in the ibuprofen group (RR = 0.7; 95% CI, 0.53 to 0.92; P = .01). The incidence of total adverse effects was lower in the ibuprofen group (RR = 0.59; 95% CI, 0.45 to 0.79; P = .0002).

Conclusions:

Ibuprofen provides a better pain relief with a lower incidence of adverse effects in children with musculoskeletal injuries as compared to other analgesics.

PROSPERO registration number:

CRD42021231975.
The use of the posterior interosseous artery flap and anterolateral thigh flap for post-traumatic soft tissue reconstruction of the hand
Authors: Ren Jinyan , Lu Laijin , Gao Fei
Published: June 2021

The purpose of this study was to examine the differences between the use of a posterior interosseous artery (PIA) flap and an anterolateral thigh (ALT) flap for post-traumatic, medium-sized soft tissue reconstruction of the hand based on flap characteristics, postoperative complications, and aesthetic outcomes.

From October, 2010 to March, 2016, 62 patients undergoing soft tissue reconstruction of the hand with 30 PIA flaps and 32 ALT flaps were included in this study. The 62 patients were divided into the PIA flap group and the ALT flap group. The differences between the 2 groups were analyzed.

The 62 patients included 52 males and 10 females, and the mean age at the time of surgery was 41 years. The flap failure rate was 13.3% (4/30) in the PIA flap group and 9.4% (3/32) in the ALT flap group. No significant differences in flap failure rate, recipient site complication rate, or donor site complication rate were observed between the 2 groups. However, the operative time (136 min vs 229 min) and aesthetic outcomes (flap bulk swelling, 0 cases vs 31 cases) were statistically significantly different.

Both the pedicled PIA flap and the free ALT flap were comparable for the reconstruction of post-traumatic, medium-sized soft tissue defects of the hand according to the evaluated outcomes of postoperative complications. Based on the surgical characteristics of the flap and the evaluation of aesthetic outcomes, the pedicled PIA flap was significantly superior to the free ALT flap.
Bicuspid aortic valve disease is associated with abnormal wall shear stress, viscous energy loss, and pressure drop within the ascending thoracic aorta
Authors: Geeraert Patrick , Jamalidinan Fatemehsadat , Fatehi Hassanabad Ali , Sojoudi Alireza , Bristow Michael , Lydell Carmen , Fedak Paul W.M. , White James A. , Garcia Julio
Published: June 2021

Bicuspid aortic valve (BAV) disease has significant gaps in its clinical management practices. To highlight the potential utility of advanced hemodynamic biomarkers in strengthening BAV assessment, we used 4-dimentional flow magnetic resonance imaging to investigate altered hemodynamics in the ascending aorta (AAo).

A total of 32 healthy controls and 53 age-matched BAV patients underwent cardiac magnetic resonance imaging at 3T, with cine imaging and 4D-flow. Analysis planes were placed along 3D-segmented aortas at the left ventricular outflow tract (LVOT), sinuses of Valsalva, mid-ascending aorta (MAA), and proximal to the first aortic branch. Locations were analyzed for aortic diameter (normalized to body surface area), pressure drop (PD), viscous energy loss (EL), and wall shear stress (WSS) sub-vectors (axial wall shear stress, circumferential wall shear stress [WSSC], magnitude wall shear stress). Student's t tests, or non-parametric equivalents, compared parameters between cohorts. Univariable and multivariable analyses explored the associations of AAo diameter with hemodynamics within the BAV cohort.

Compared to control cohort, BAV patients showed significantly greater PD (MAA: 9.5 ± 8.0 vs 2.8 ± 2.4 mm Hg; P < .01), EL (from LVOT-AA1: 7.39 ± 4.57 mW vs 2.90 ± 1.07 mW; P < .01), and WSSC (MAA: 0.3 ± 0.1 vs 0.2 ± 0.06 Pa; P ≤ .01) throughout the AAo. Correlational analyses revealed an inverse association between AAo diameter and both magnitude wall shear stress and axial wall shear stress.

BAV patients exhibited increased PD, EL, and WSSC in the AAo, and an inverse association between AAo diameter and WSS sub-vectors. This demonstrated the impact of PD, EL, and WSS in BAV disease and the importance of altered hemodynamics in aortic remodelling.
Comparison of catheter-over-needle and catheter-through-needle methods in ultrasound-guided continuous femoral nerve block
Authors: Kim Hee Young , Ahn Ji-Soo , Park Seyeon , Choi Eun-Ji , Ri Hyun-Su , Yoon Ji-Uk , Byeon Gyeong-Jo
Published: June 2021

Background:

The catheter-through-needle (CTN) method involves the insertion of a catheter with an outer diameter smaller than the initial puncture hole. We investigated whether the catheter-over-needle (CON) method is more effective than the CTN method in local anesthetic leakage at the catheter insertion site and catheter dislodgement, and how it affects postoperative pain management.

Methods:

Seventy patients scheduled to undergo continuous femoral nerve block for pain control following total knee arthroplasty were enrolled and randomized to receive a perineural catheterization with either the CTN method (group CTN) or CON method (group CON). After ultrasound-guided catheterization, the transparent securement dressing was attached. The study compared the CON and CTN methods in terms of leakage at the catheter insertion site, catheter dislodgement, and postoperative analgesic efficacy for 48 hours postoperatively.

Results:

Leakage at the catheter insertion site was significantly lower in the group CON (P < .05), while catheter dislodgement was not significantly different between the groups. The other adverse events were not different between the groups. The procedure time was significantly shorter in group CON (P < .05). No significant intergroup differences were observed 48 hours postoperatively in the visual analog scales, the number of patients requiring additional analgesics, and the number of times a bolus dose was injected with an injection pump.

Conclusion:

The CON method was able to shorten the procedure time while reducing the incidence of leakage at the catheter insertion site than the CTN method, and showed similar effects in postoperative pain management.
Phase- and gender-specific, lifetime, and future costs of cancer
Authors: Bugge Christoffer , Brustugun Odd Terje , Sæther Erik Magnus , Kristiansen Ivar Sønbø
Published: June 2021

Valid estimates of cancer treatment costs are import for priority setting, but few studies have examined costs of multiple cancers in the same setting.

We performed a retrospective population-based registry study to evaluate phase-specific (initial, continuing, and terminal phase) direct medical costs and lifetime costs for 13 cancers and all cancers combined in Norway. Mean monthly cancer attributable costs were estimated using nationwide activity data from all Norwegian hospitals. Mean lifetime costs were estimated by combining phase-specific monthly costs and survival times from the national cancer registry. Scenarios for future costs were developed from the lifetime costs and the expected number of new cancer cases toward 2034 estimated by NORDCAN.

For all cancers combined, mean discounted per patient direct medical costs were Euros (EUR) 21,808 in the initial 12 months, EUR 4347 in the subsequent continuing phase, and EUR 12,085 in the terminal phase (last 12 months). Lifetime costs were higher for cancers with a 5-year relative survival between 50% and 70% (myeloma: EUR 89,686, mouth/pharynx: EUR 66,619, and non-Hodgkin lymphoma: EUR 65,528). The scenario analyses indicate that future cancer costs are highly dependent on future cancer incidence, changes in death risk, and cancer-specific unit costs.

Gender- and cancer-specific estimates of treatment costs are important for assessing equity of care and to better understand resource consumption associated with different cancers.

Cancers with an intermediate prognosis (50%–70% 5-year relative survival) are associated with higher direct medical costs than those with relatively good or poor prognosis.
Methodological considerations of evaluating the rate of presynaptic dopaminergic denervation in Parkinson disease with radiotracers
Authors: Lee Jeong Won , Song Yoo Sung , Kim Hyeyun , Ku Bon D. , Lee Won Woo
Published: June 2021

Many previous studies have estimated the rate of dopaminergic denervation in Parkinson disease (PD) via imaging studies. However, they lack the considerations of onset age, disease duration at onset, gender, and dopaminergic denervation due to normal aging. Herein, using a large prospective cohort, we estimated the rate of dopaminergic denervation in PD patients, compared with an age- and gender-matched normal control group.

One hundred forty-one normal controls and 301 PD patients were enrolled. Striatal specific binding ratios (SBRs) of I-123 FP-CIT single positron emission tomography images were analyzed according to the age of onset, gender, and the duration of motor symptoms.

In the PD group, symptom duration was significantly correlated with caudate SBRs, but with putamen SBRs (P 
< .05, R
2 = 0.02). Moreover, was significantly inversely related to caudate SBRs, but not with putamen SBRs (P 
< .05, R
2 = 0.02). Patients of different age onsets did not show any significant correlation between symptom durations and striatal SBRs. In the age-matched group, no significant relationship was observed between symptom duration and percent decrease of caudate SBRs, but there was a significant relationship between symptom duration and percent decrease of the putamen SBRs (P 
< .01, R
2 = 0.06). There was no significant relationship between the symptom duration and the percent decrease of striatal SBRs in the age- and gender-matched group.

The significance and R
2 values from the regression analysis between symptom duration, age, and dopaminergic denervation are low. This suggests that, contrary to previous knowledge, there is a relatively weak association between dopaminergic denervation and age or symptom duration.
Warning system improve the clinical outcomes in transfer patients with ST-segment elevation myocardial infarction
Authors: Fang Hsiu-Yu , Lee Wei-Chieh
Published: June 2021

A warning system included directly faxing electrocardiography information to the mobile phone immediately after an ST-segment elevation myocardial infarction (STEMI) diagnosis was made at a non-percutaneous coronary intervention (PCI) capable hospital. This study aimed to explore the outcomes after using a warning system in transfer STEMI patients.

From October 2013 to December 2016, 667 patients experienced a STEMI event and received primary PCI at our institution. 274 patients who were divided into transfer group were transferred from non-PCI capable hospitals and connected to a first-line cardiovascular doctor by the warning system. Other 393 patients were divided into the non-transfer group.

The transfer group still had a longer pain-to-reperfusion time and presented higher troponin-I level when compared with non-transfer group. There was no significant difference in the use of drug-eluting stent and procedural devices between non-transfer and transfer groups. The prevalence of different anti-platelet agents loading did not differ between non-transfer and transfer groups. Non-significant trend about higher prevalence of statin use was noted in transfer group (78.9% vs 86.1%, P = .058). The transfer group presented similar clinical short-term results regarding both cardiovascular and all-cause mortality when comparing with non-transfer group. The transfer group provided non-significant trend about lower one-year cardiovascular mortality (10.7% vs 6.2%, P = .052) and lower all-cause mortality (12.2% vs 6.9%, P = .026) when compared with non-transfer group. There was a significant difference in the Kaplan–Meier curve of 1-year cardiovascular mortality between the transfer group and the non-transfer group (P = .049).

After using the warning system, the inter-facility transfer group had comparable outcomes even though a longer pain-to-reperfusion time and a higher peak troponin-I level when comparing with non-transfer group.
Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty
Authors: Juraj Masaryk , Jaroslav Vidan , Gažová Andrea , Žufková Viera , Kyselovič Ján , Šteňo Boris
Published: June 2021

Background:

Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding in major surgical procedures. This study evaluates the efficacy and safety of the systemic and topical intra-articular administration of TXA in total hip arthroplasty (THA).

Methods:

Patients (N = 123) scheduled for primary unilateral THA were divided into 3 treatment groups: control group; TXA, systemic, repeated 1 g bolus; TXA, topically intra-articularly, 2 g in 50 mL saline. Primary readouts used were intra- and postoperative bleeding, transfusion requirement, postoperative hemoglobin levels and complications.

Results:

Both systemic and topical intra-articular TXA administrations decreased bleeding and transfusion requirements. Topical intra-articular use of TXA led to the reduction in intraoperative and postoperative bleeding and affected hemoglobin levels compared with control. Systemic administration of TXA led to a significant reduction of postoperative bleeding and transfusion rate compared with control and was not different in efficacy and complication incidence when compared to topical administration of TXA.

Conclusions:

The use of TXA to reduce blood loss and transfusion requirements in THA is an effective and safe concept in practice. The dose of 2 g TXA topically intra-articularly and a repeated bolus of 1 g TXA systematic led to lower intra- and postoperative bleeding and a significantly lower transfusion rate than the control group. Topical intra-articular TXA administration could be a reasonable alternative in high-risk patients.
Comparative analysis of the effects of AO mini-plate and Kirschner wire pinning in the metacarpal fractures
Authors: Lv Fuzhou , Nie Qiang , Guo Jing , Tang Meiyu
Published: June 2021

The aim of this study was to investigate the clinical effect of AO miniplate screw internal fixation and Kirschner wire (KW) in the treatment of metacarpal fractures.

We retrospectively analyzed the clinical data of 590 metacarpal fracture patients admitted to our hospital from March 2016 to March 2019. Among them, 290 patients were treated with KWs; 300 were treated with AO microplate internal fixation. The clinical, radiological results, time of surgery, and complications were observed and compared between the 2 groups.

The imaging characteristics and preoperative fracture types of the 2 groups were similar and comparable (P > .05). The operation time, length of hospital stay, and fracture healing time of AO group were shorter than those of KW group, and the differences were statistically significant (41.22 ± 7.23 vs 25.64 ± 6.29; 7.13 ± 2.38 vs 5.26 ± 1.71; 67.43 ± 22.01 vs 52.57 ± 17.46, P < .05). In addition, the incidence of postoperative complications in AO group was lower than that in KW group (8.3% vs 15.2%, P < .05). In terms of surgical knuckle extension, flexion, and total mobility (compared with the uninjured hand), patients in the AO plate group were significantly improved compared with patients in the KW group, and the difference was statistically significant (4 vs 10 degree; 19 vs 10 degree; 14 vs 29 degree, P < .05); The average degree of finger rotation deformity in AO plate group was significantly lower than that in KW group (1 vs 6 degree, P < .05). In terms of grip strength (compared with the healthy hand), the average grip strength of AO plate group was significantly higher than that of KW group (93% vs 83%, P < .05). Patients in the OA plate group had a lower Disabilities of the Arm, Shoulder and Hand score (P < .05).

Compared with KW fixation, AO mini-plate and screw fixation for the metacarpal fracture has a better effect, which can effectively shorten the operation time and reduce the trauma to patients. It can provide patients with better stability and realize the early movement of the palm, promote fracture healing and joint function recovery; it can reduce the incidence of postoperative complications, which has certain safety. In addition, it can effectively reduce the risk of poor finger rotation.