bluuebunny/crossref_metadata_2025 huggingface dataset:
Aloe Vera–Derived Gel-Blended PHBV Nanofibrous Scaffold for Bone Tissue Engineering
Authors: Tahmasebi Aylin , Shapouri Moghadam Abbas , Enderami Seyed Ehsan , Islami Maryam , Kaabi Mohamad , Saburi Ehsan , Daei Farshchi Amir , Soleimanifar Fatemeh , Mansouri Vahid
Published: January 2020

Today, composite scaffolds fabricated by natural and synthetic polymers have attracted a lot of attention among researchers in the field of tissue engineering, and given their combined properties that can play a very useful role in repairing damaged tissues. In the current study, aloe vera–derived gel-blended poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanofibrous scaffold was fabricated by electrospinning, and then, PHBV and PHBV gel fabricated scaffolds characterized by scanning electron microscope, protein adsorption, cell attachment, tensile and cell’s viability tests. After that, osteogenic supportive property of the scaffolds was studied by culturing of human-induced pluripotent stem cells on the scaffolds under osteogenic medium and evaluating of the common bone-related markers. The results showed that biocompatibility of the PHBV nanofibrous scaffold significantly improved when combined with the aloe vera gel. In addition, higher amounts of alkaline phosphatase activity, mineralization, and bone-related gene and protein expression were detected in stem cells when grown on PHBV-gel scaffold in comparison with those stem cells grown on the PHBV and culture plate. Taken together, it can be concluded that aloe vera gel–blended PHBV scaffold has a great promising osteoinductive potential that can be used as a suitable bioimplant for bone tissue engineering applications to accelerate bone regeneration and also degraded completely along with tissue regeneration.
Effect of flexible patterns of health education on enhancing the compliance of pregnant women from Tibet, China
Authors: Chen Jiebing , Huang Jiaming , Ooi Shiyin , Lin Li , Chen Chun , Liu Yanwu , Yao Shuzhong
Published: January 2020

Prenatal examination is a pivotal measure to prevent high-risk pregnancy and to ensure the safety of both mother and infant. However, pregnant women in Linzhi Prefecture in the Tibet Autonomous Region (TAR) often cannot obtain regular prenatal examinations due to limited accessibility of healthcare facilities, shortage of medical staff, and lack of medical equipment. Health education is an important approach to solve this ever-growing issue of pregnant women in rural Tibet.

To evaluate the efficacy of flexible methods of health education programs on improving compliance among pregnant women from Tibet, China.

In May to November of 2018, a total of 168 pregnant women receiving prenatal examination in a tertiary referral hospital in Linzhi Prefecture were recruited and randomly assigned to a control (n = 85) and intervention group (n = 83). All pregnant women were followed up until delivery. The pregnant women in the control group received regular prenatal examination and health education programs. Other than receiving routine prenatal care, participants of the interventional group also voluntarily joined the WeChat Social Messaging platform. Online resources posted by the maternity schools provided convenience and flexibility for the pregnant woman. The number of prenatal examinations was statistically significant between the 2 groups. The effect of flexible patterns of health education programs on improving the compliance of pregnant women in Tibet was assessed.

The number of prenatal examinations in the intervention group was 2.646 times, which was higher than that in the control group (P < .01). Multivariate analysis demonstrated that interventional measures and ethnicity were the influencing factors of the number of prenatal examinations for pregnant women in Linzhi after the adjustment of age, history of adverse pregnancy, education level, ethnicity, multiparity, gestational complications, and medical history. The number of prenatal examinations for the pregnant Tibetan women was 0.535 times lower compared with that of the pregnant Han women (95% CI: –0.089, 1.157, P = .091).

Flexible forms of health education during the antenatal period can effectively increase the compliance of pregnant women in Tibet.
Acupuncture on treating asthma
Authors: Chen Yan-Ming , Xie Xiao-Lei , Xiao Peng-Yun , Wang Qiu-Hong , Wang Ji-Sheng , Yu Xu-Dong , Deng Sheng
Published: January 2020

Background:

Asthma is one of the most common chronic diseases in the world, with approximately 300 million asthma patients worldwide. The mortality rate of asthma is 1.6 to 36.7 / 100,000 people, and China has become one of the countries with the highest asthma death rate in the world. Asthma is a chronic allergic airway inflammatory disease. Patients with this disease may have symptoms such as cough, wheezing, and difficulty breathing. For many years, Western medicine has mainly used anti-inflammatory, anti-bronchial spasm, asthma, cough and oxygen to treat this disease, but the effect is not good. Clinical studies in recent years have found that the use of acupuncture in the treatment of bronchial asthma has a good clinical application prospect. This study was conducted to study the effect of using acupuncture to treat asthma.

Methods and analysis:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of asthma.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of acupuncture for asthma. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.
Gender related changes of empathy level among Polish dental students over the course of training
Authors: Mocny-Pachońska Katarzyna , Łanowy Patrycja , Trzcionka Agata , Skaba Dariusz , Tanasiewicz Marta
Published: January 2020

The appropriate approach to dental patients, developed during the course of dentists’ training, is a prerequisite for the holistic treatment of patients. Empathy is an important component of such an approach. This study aimed to determine the levels of empathy among students of dentistry at different stages in their training.

The Jefferson Scale of Empathy – Health Profession Students Version was used to conduct the research, and 100 dental students (66 female and 34 male) ranging from first to fifth year participated in the survey. The scale contained 20 questions, with a possible score interval between 20 and 140. A higher score indicates increased ability to express empathy.

The level of empathy among dentistry students increased from the first and second to fourth years, where it reached its maximum. During the fifth year, a decrease in levels of empathy was observed.

The increase in empathy during the dental course may be correlated with the growth of clinical practice during the subsequent years of study. A slight decrease in empathy in the fifth-year students may be due to the curricular focus on performing procedures, with students having to meet a set target in order to finish the course.
Case report of periorbital metastasis from rectal cancer
Authors: Paik Jin-Hee , Shin Hyun Jin , Lee Hye Seung , Han Hye Seung , Ryu Chun-Geun , Hwang Dae-Yong
Published: January 2020

Introduction:

Periorbital metastasis of colorectal cancer is rare. Therefore, herein, we report a patient with rectal cancer who presented with periorbital metastasis without any systemic metastasis.

Patient concerns:

The patient was a 57-year-old man who had a painless nodule on his left eyelid.

Diagnosis:

The patient presented with loose and frequent stools and was diagnosed with rectal adenocarcinoma via colonoscopic biopsy at the local clinic. Curative resection (low anterior resection with temporary ileostomy formation) was performed 4 weeks after completing chemoradiotherapy. The final TNM stage was yp stage T2N0M0. Eight months after the diagnosis of rectal cancer, a protruding lesion was noticed on the patient's left eyelid. Histologic evaluation of the nodule revealed metastatic adenocarcinoma of rectal cancer.

Interventions:

The patient received neoadjuvant chemoradiotherapy and curative resection for rectal cancer. After excision of the periorbital nodule, he received 5 cycles of chemotherapy.

Outcomes:

The patient underwent regular follow-up because he was not able to endure chemotherapy; no recurrence has been observed 21 months after the diagnosis of rectal cancer. Histologic examination revealed metastatic adenocarcinoma of rectal cancer on the patient's left eyelid. However, consecutive imaging studies revealed no other metastatic lesions. Finally, the patient was diagnosed with a solitary periorbital metastasis of rectal cancer.

Conclusion:

This case report helps in understanding the course of progression from rectal cancer to periorbital metastasis.
Relation of Chlamydia trachomatis infections to ectopic pregnancy
Authors: Xia Qingchang , Wang Tianqi , Xian Jin , Song Jingyan , Qiao Yan , Mu Zhenni , Liu Honggen , Sun Zhengao
Published: January 2020

Background:

In a multitude of previous studies, Chlamydia trachomatis (CT) plays an important role in the occurrence of ectopic pregnancy (EP). However, the predictive value of CT infections in the occurrence of EP has not been estimated worldwide. We thus evaluated, by means of a meta-analysis, the current status of the association between CT infections with EP and the potential predictive value of CT infections in EP.

Methods:

We evaluated studies performed between the database construction time and August 2018 published in PubMed, the Cochrane Library, EMBASE, and the Web of Science (SCI). The relationship between CT and EP was calculated based upon the predetermined entry criteria for control group selection and the original data. The related articles were analyzed using a random-effects model, and the heterogeneity of the studies was assessed using the I2 index. Data were analyzed with the STATA 12.0 software.

Results:

Twenty-five studies that recruited 11960 patients were included in the present meta-analysis, and the relation of CT infections with EP were assessed. The association between CT infections and EP risk showed an odds ratio (OR) of 3.03, with a 95% confidence interval (CI) of 2.37 to 3.89. Our results showed that there was a statistically significant difference between the intervention and control groups. The prevalence of CT infections in EP was then calculated by a subgroup analysis: African (OR, 2.22; 95% CI, 1.14–4.31), European (OR, 3.16; 95% CI, 2.10–4.47), North American (OR, 3.07; 95% CI, 1.78–5.31), and Asian (OR, 3.39; 95% CI, 1.95–5.90).

Conclusions:

From the results of numerous studies conducted on different continents, this meta-analysis showed a clear association between EP and prior CT infections, that is, CT infections increase the risk of EP occurrence.
Clevidipine use after first-line treatment failure for perioperative hypertension in neurosurgical patients
Authors: Borrell-Vega Jaume , Uribe Alberto A. , Palettas Marilly , Bergese Sergio D.
Published: January 2020

Perioperative hypertension is a common occurrence in the neurosurgical population, where 60% to 90% of the patients require treatment for blood pressure (BP) control. Nicardipine and clevidipine have been commonly used in neurocritical settings. This retrospective, observational study assessed the effectivity of the administration of clevidipine after nicardipine treatment failure in neurosurgical patients.

We retrospectively reviewed the medical charts of adult patients who were admitted to our neurosurgical department and received clevidipine after nicardipine treatment failure for the control of BP. The primary effectivity outcome was the comparison of the percentage of time spent at targeted SBP goals during nicardipine and clevidipine administration, respectively.

A total of 12 adult patients treated with clevidipine after nicardipine treatment failure and were included for data analysis. The median number of events that required dose-titration was 20.5 vs 17 during the administration of nicardipine and clevidipine, respectively (P = .534). The median percentage of time spent at targeted SBP goal was 76.2% during the administration of nicardipine and 93.4% during the administration of clevidipine (P = .123).

Our study suggests that clevidipine could be an alternative effective drug with an acceptable benefit/risk ratio in the neurosurgical population that fails to achieve BP control with nicardipine treatment.
Efficacy and safety of Yu-Ping-Feng powder for asthma in children: a protocol of systematic review and meta-analysis of randomized controlled trials
Authors: Wang Ruiyin , Wang Jianxin , Shu Jun , Gu Xianmin , Li Hongwen , Zi Yingxin , Liu Shufang , Lin Jiangtao
Published: January 2020

Background:

Asthma has become the most common chronic disease in children, which seriously affects children's health and growth. Yu-Ping-Feng powder (YPFP) is widely used for the treatment of asthma in children, but there are few meta-analyses to assess the add-on effects of YPFP in children with asthma. Therefore, it is necessary to conduct a systematic review to evaluate the efficacy and safety of YPFP in the management of asthma in children.

Methods:

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Web of Science and the Chinese electronic databases including China Network Knowledge Infrastructure (CNKI), Chinese Biomedicine (CBM), Chinese Scientific Journals Database (VIP), and Wan Fang Database were searched for the randomized controlled trials (RCTs) of YPFP in children with asthma based on the eligibility criteria from the date of the database inception to 28 November 2018. Two reviewers assessed the articles and extracted data from the included RCTs independently. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. We will assess the risk of bias with the Cochrane Collaboration Tool and overall quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation system (GRADE). Primary outcomes include the improvement of symptoms including breathlessness, coughing, wheezing and the frequency of asthma exacerbations. Lung function, serum IgE level, blood eosinophil count, phlegm eosinophil count and adverse events will be assessed as the secondary outcomes. We will perform the data synthesis, sensitivity analyses, and subgroup analyses in the Rev-Man version 5.3 software. A funnel plot will be established to evaluate reporting bias.

Results:

This systematic review and meta-analysis will review and synthesis current clinical evidence of YPFP for the treatment of asthma in children.

Conclusion:

This analysis will provide high quality evidence of YPFP for the treatment of asthma in children.

PROSPERO registration number:

CRD42018111223.
Garlic intake and the risk of colorectal cancer
Authors: Zhou Xi , Qian Haihua , Zhang Dan , Zeng Li
Published: January 2020

This was a meta-analysis of epidemiological articles that aimed to estimate the association of garlic intake with the risk of colorectal cancer (CRC).

Electronic databases, including the Cochrane Database of Systematic Reviews, PubMed, and EMBASE, were systemically searched from inception to May 2019 to identify related articles. In addition, a random model was used to pool the included evidence based on heterogeneity. Additionally, subgroup analyses were carried out to examine the differences between different groups. The stability of our findings was tested through sensitivity analyses. Publication bias was also assessed by Egger and Begg tests. Moreover, all enrolled studies were ordered according to the publication year for a cumulative meta-analysis.

A total of 11 studies (involving 12,558 cases) were included in the current meta-analysis. Our integrated relative risk (RR) of CRC was 0.80 (95% confidence interval [CI], 0.69–0.91) for the highest versus the lowest garlic consumption categories (RR: 0.71 [95% CI, 0.60–0.84] for controls and RR: 0.99 [95% CI, 0.80–1.23] for cohorts). There was significant heterogeneity across all enrolled studies (I
2 = 68.3%, P 
< .01). The sensitivity analysis revealed no notable alterations of the integrated results. According to the funnel plot regarding garlic intake and the risk of CRC, together with the Egger test (P = .1) and Begg test (P = .064) results, there was no notable evidence of publication bias. The cumulative meta-analysis suggested that the 95% CIs became narrower with the increase in sample size.

Based on the existing evidence, garlic intake could reduce the risk of CRC.
Influence of cephalic vein dilation on arteriovenous fistula maturation in patients with small cephalic veins
Authors: Zhang Fan , Li Yunming , Wang Tao , Tao Jie , Zhu Jun , Wei Meng , Mo Liweng , Li Xianglian , Wang Ying , Cheng Yue
Published: January 2020

A substantial limitation of dialysis fistulas is their high primary failure rate due to nonmaturation. Various studies have documented that patients with larger vein diameters exhibit reduced risks for nonmaturation. Nevertheless, some patients have small veins. Few studies have focused on patients with small veins. We hypothesize that sufficient venous dilation contributes to fistula maturation. Therefore, we studied the influence of cephalic vein dilation on fistula maturation in patients with small veins.

Patients with small cephalic veins (diameter <2 mm) undergoing initial arteriovenous fistulae (AVF) operation were included. A total of 72 patients were enrolled in this study. A prospective study was performed, and the patients were followed for 6 weeks after surgery. Preoperative and postoperative duplex ultrasound mapping of veins was performed, and dilation of the cephalic vein was evaluated.

The fistula maturation rate was 44.44%. Multivariate logistic regression analysis revealed a significant relationship between fistula maturation and preoperative cephalic vein dilation. Based on the results of ROC analysis, the fistula maturation rate in patients with vein dilation greater than or equal to the cut-off was 57.14% in the training data set and 54.55% in the testing data set. The independent influencing factors for fistula maturation were used to establish a combined index with logistic regression analysis. The fistula maturation rate in patients with combined indexes greater than or equal to the cut-off was 80.95% in the training data set and 77.78% in the testing data set.

Our results demonstrated that preoperative venous dilation was associated with AVF maturation. For patients with small veins, venous distensibility needs to be carefully assessed before surgery, as it may be a better predictor of AVF maturation than venous diameter.
The safety and efficacy of airway pressure release ventilation in acute respiratory distress syndrome patients
Authors: Sun Xuri , Liu Yuqi , Li Neng , You Deyuan , Zhao Yanping
Published: January 2020

Background:

The acute respiratory distress syndrome (ARDS) is a critical illness with high mortality and a worse prognosis. Mechanical ventilation (MV) is currently considered to be one of the most effective methods of treating ARDS. In this meta-analysis, we discussed the efficacy of airway pressure release ventilation (APRV) in treating ARDS.

Methods:

Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), Ovid Medline, Embase, and PubMed were systematically searched with the keywords of “ARDS” and “APRV”. The studies containing the treatment of APRV in ARDS were included. According to the MV protocol used in the studies, the comparison was undertaken between the APRV group vs low tidal volume (LTV) group and synchronized intermittent mandatory ventilation (SIMV) group. The relative risk (RR) and the standard mean difference with 95% confidence intervals (CI) were used for the comparison between groups.

Results:

Fourteen studies with 2096 patients were included in the meta-analysis. The average increasing rate of PaO2/FiO2 was 75.4% in the APRV group vs 44.1% in the non-APRV group. No significant differences were found in mortality and duration of ICU stay between APRV vs LTV (P = .073 and P = .404) and APRV vs SIMV (P = .370 and P = .894).

Conclusion:

The APRV protocol would have a higher increase in the PaO2/FiO2 ratio, which was a safe protocol with a compatible effect comparing to LTV and SIMV.
Age-related changes in serum reproductive hormone levels and prevalence of androgen deficiency in Chinese community-dwelling middle-aged and aging men
Authors: Zhou Shan-Jie , Zhao Ming-Jia , Yang Yi-Hong , Guan Di , Li Zhi-Guang , Ji Yu-Dang , Zhang Bao-Long , Shang Xue-Jun , Xiong Cheng-Liang , Gu Yi-Qun
Published: January 2020

To investigate the age-related nomograms and change trends of reproductive hormones, and prevalence of androgen deficiency (AD) in middle-aged and aging men from 2 studies.

Two cross-sectional studies were conducted at 5-year intervals in Chinese community-dwelling men living in the same area. A total of 434 (Study 1, S1) and 944 (Study 2, S2) men aged 40 to 69 years were recruited as subjects and 59 (S1) and 98 (S2) men aged 20 to 39 years as controls to measure serum reproductive hormone levels.

Serum total testosterone (TT) levels did not change significantly in S1, whereas TT levels increased in S2 with aging. Serum calculated free testosterone (cFT) levels gradually decreased with aging; however, only men aged 40 to 69 years showed this trend in S2. Serum luteinizing hormone (LH) and sex hormone binding globulin (SHBG) levels gradually increased, and serum testosterone secretion index (TSI) and free testosterone index (FTI) levels gradually decreased with male aging. The mean annual decrease values of serum cFT were 2.705 pmol/l in S1 and 1.060 pmol/l in S2. The cut-off values for AD in S1 and S2 were 9.13 nmol/l and 9.35 nmol/l for TT, and 169.00 pmol/l and 213.90 pmol/l for cFT. Using TT or cFT cut-off values, mean AD prevalence was 14.52% or 44.70% in S1, and 6.36% or 16.53% in S2. Based on cFT cut-off values, prevalence of AD increased gradually with male aging in a range of 25.30% to 61.63% in S1 and 1.20% to 23.03% in S2.

The change patterns of serum LH, SHBG, TSI and FTI levels in middle-aged and aging males were consistent; however, there were differences in serum TT and cFT change patterns in S1 and S2 with male aging. cFT cut-off values were the optimal metric to evaluate AD, which can be present a ladder-like change in prevalence of different age groups.
Risk factors of myasthenia crisis after thymectomy among myasthenia gravis patients
Authors: Geng Yingcai , Zhang Hanlu , Wang Yun
Published: January 2020

Background:

The purpose of the study was to determine the risk factors of post-surgery myasthenia crisis (PMC) among myasthenia gravis (MG) patients.

Methods:

A meta-analysis to synthesize all eligible literatures was conducted to analyze PMC predictors among MG patients.

Results:

A total of 15 trials with 2626 patients were included for the meta-analysis. As a result, patients with history of MC (RR = 3.36, 95%CI: 2.46–4.59, P < .001), generalized MG (RR = 0.39, 95%CI: 0.26–0.59, P < .001), bulbar symptom (RR = 3.59,95%CI:2.53–5.09, P < .001), thymoma (RR = 2.10, 95%CI:1.37–3.21, P = .001), post-surgery morbidity presence(RR = 2.59, 95%CI:1.90–3.54, P < .001), high-dose pyridostigmine usage (SMD = 0.480, 95%CI: 0.35–0.61 P < .001) tended to develop PMC. Large dose of steroid may reduce the incidence of PMC (RR = 0.41 95%CI: 0.18–0.94, P = .036). Regular steroid use (P = .066), immunosuppressive therapy (P = .179), gender (P = .774), and age at thymectomy (P = .212) had no impact upon PMC development.

Conclusion:

History of PMC, thymoma, generalized MG, bulbar symptom, and concomitant complication are the risk factors of PMC.
Neutropenia following intravenous immunoglobulin therapy in adult patients with immune thrombocytopenic purpura
Authors: Oh Sang-Bo , Shin Ho-Jin
Published: January 2020

The purpose of this study was to evaluate neutropenia following intravenous immunoglobulin (IVIG) therapy in adults with immune thrombocytopenic purpura (ITP).

Our analysis included 88 patients with ITP, who received IVIG from January 2006 to March 2016, at Pusan National University Hospital in Korea. Their white blood cell (WBC) count and absolute neutrophil count (ANC) before and after IVIG treatment were analyzed.

Of 88 patients, 24 patients (27.3%) were male, and 64 patients (72.7%) were female. Neutropenia developed in 8 patients (18.7%) after IVIG treatment. In patients with a decrease in WBC count and ANC compared to baseline, median WBC count decreased from 6280/μL to 4530/μL after IVIG therapy, and median ANC decreased from 3840/μL to 2840/μL after IVIG therapy. The neutropenia induced by IVIG had resolved spontaneously after several days, and the mean recovery time was 8.72 days after the completion of the IVIG treatment. During the neutropenic episodes, only one patient developed neutropenic fever, which subsided soon without any treatment.

The results of this study suggest that IVIG may cause neutropenia commonly in adults with ITP, and it seems to be transient and self-limited. This study is meaningful as the first report that not only pediatric ITP patients may develop neutropenia post IVIG administration, but also adult patients suffering ITP.
Fluoroscopic removal of self-expandable metallic airway stent in patients with airway stenosis
Authors: Bi Yonghua , Wu Gang , Yu Zepeng , Han Xinwei , Ren Jianzhuang
Published: January 2020

To study the safety and efficacy of fluoroscopic removal of self-expandable metallic stent for airway stenosis.

We conducted a retrospective analysis of 67 consecutive patients, 39 male and 28 female, who underwent fluoroscopic stent removal from March 2011 to April 2017. The patients ranged in age from 12 to 85 years. Seventy-six airway stents were implanted, 70 covered stents and 6 bare stents, including 9 stents for second stent implantation after removal. All patients underwent chest computed tomography scans with/without bronchoscopy before stent removal. The indication of stent removal and postinterventional complications were analyzed retrospectively.

Seventy-four of 76 airway stents were successfully removed, only 2 stent showed retained struts after removal, for a technical success rate of 97.4%. Two patients died of complications (1 hemorrhage and 1 respiratory failure), resulting in a clinical success rate of 94.7%. Five stents showed strut fracture and the remaining 71 stents were removed in 1 piece. Indications for stent removal include planned removal (n = 40), excessive granulation tissue (n = 15), intolerance of stenting (n = 6), inadequate expansion and deformation (n = 5), stent migration (n = 5), replacement of bare stent (n = 4), and strut fracture (n = 1). There were 17 complications of stent removal: death from massive bleeding (n = 1), restenosis requires stenting (n = 9), strut fracture or residue (n = 5), dyspnea requires mechanical ventilation (n = 2). The survival rates were 83.8%, 82.1%, and 82.1% for 0.5, 3, and 6 years.

Fluoroscopic removal of airway stent is technically feasible and effective. Stents are recommended for removal within 3 months for treating airway stenosis.
Enabling patients to cope with psychotropic medication in mental health care
Authors: Drivenes Karin , Vederhus John-Kåre , Haaland Vegard Øksendal , Ruud Torleif , Hauge Yina Luk , Regevik Hilde , Falk Ragnhild Sørum , Tanum Lars
Published: January 2020

This cross sectional study examined patients’ perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.

A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records.

Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86–89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.

The MedSupport inventory was suitable for assessing the patients’ perceived support from health care service regarding their medication. Awareness of differences in patients’ perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.
Recurrence of nasal type NK/T cell lymphoma presenting as neurolymphomatosis on 18F-FDG PET/CT
Authors: Pan Qingqing , Luo Yaping
Published: January 2020

Introduction:

NK/T cell lymphomas seldom involve the peripheral nervous system. We report a case of recurrent nasal type NK/T cell lymphoma presenting as neurolymphomatosis and its manifestation on 18F-FDG PET/CT.

Patient concerns:

A 55-year old man presented with a mass in the right nasal cavity was diagnosed with extranodal NK/T cell lymphoma, nasal type. 18F-FDG PET/CT showed intense FDG uptake within the mass. After radiotherapy the nasal tumor was completely relieved, but the patient experienced numbness and amyosthenia in the right upper extremity one week after completion of radiotherapy.

Diagnosis:

PET/CT showed intense FDG uptake in the brachial plexus, axillary, suprascapular and median nerves, suggestive of recurrence of lymphoma presenting as neurolymphomatosis.

Interventions:

After 1 cycle of chemotherapy, the follow-up PET/CT showed markedly reduced FDG uptake in the previous involved nerves, demonstrating a very good response of neurolymphomatosis to chemotherapy.

Outcomes:

The patient finally had a progression free survival of 8 months after completion of 4 cycles of chemotherapy and autologous stem cell transplantation.

Lessons:

As neurolymphomatosis is a rare neurologic manifestation in recurrence of NK/T cell lymphoma, recognition of its presentation is important for prompt diagnosis and initiating treatment approach.
Weekly versus triweekly cisplatin-based concurrent chemoradiotherapy in the treatment of locally advanced cervical carcinoma
Authors: Zhu Jiahao , Zhang Zheng , Bian Dongyan , Chen Qingqing , Hu Qunchao , Ji Shengjun , Gu Ke
Published: January 2020

Background:

Radiotherapy concurrent with cisplatin is the standard regimen used for treatment of locally advanced cervical carcinoma. In this meta-analysis, survival, recurrence, compliance, and acute adverse effects were compared between weekly and triweekly cisplatin-based concurrent chemoradiotherapy regimens for treatment of cervical cancer.

Methods:

A systematic search for relevant studies was conducted using PubMed, Cochrane Library, EMBASE, and Medline databases. Fixed- or random-effects models were used for pooled analysis. The endpoints were overall survival, recurrence, compliance, and acute adverse effects reported as odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

Eight randomized controlled trials met the inclusion criteria. No significant differences were observed between the 2 arms with respect to recurrence, survival, and acute adverse effects (all P > .05). However, the triweekly cisplatin regimen was associated with significantly lower incidence of local recurrence (OR, 1.72; 95% CI, 1.07–2.78; P = .03), radiotherapy completion (OR, 2.08; 95% CI, 0.99–4.38; P = .05), and anemia (OR, 2.10; 95% CI, 1.01–4.37; P = .05), while a weekly cisplatin regimen was associated with a lower risk of leukopenia (OR, 0.57; 95% CI, 0.42–0.92; P = .00) and thrombocytopenia (OR, 0.55; 95% CI, 0.31–0.97; P = .04).

Conclusions:

Triweekly cisplatin-based chemotherapy significantly reduced local recurrence with tolerable toxicity and might be the optimal regimen in concurrent chemoradiotherapy for locally advanced cervical carcinoma.
Optimal effect-site concentration of propofol for tracheal suctioning during emergence from ophthalmic surgery
Authors: Hung Nan-Kai , Lee Meei-Shyuan , Lai Hou-Chuan , Huang Yi-Hsuan , Lin Bo-Feng , Chan Shun-Ming , Wu Zhi-Fu
Published: January 2020

In ophthalmic surgery, coughing during emergence from general anesthesia may have a detrimental effect on intraocular pressure. Tracheal suction during emergence may elicit this reflex. The optimal effect-site concentration (EC) of propofol to prevent triggering of the cough reflex during tracheal suctioning is unknown. The aim of this study is to assess the optimal EC of propofol for tracheal suctioning during emergence in patients undergoing ophthalmic surgery.

Twenty-one patients were enrolled, all of them American Society of Anesthesiologists (ASA) physical status I or II non-smokers undergoing ophthalmic surgery. Anesthesia was induced and maintained under total intravenous anesthesia using target-controlled infusion. During emergence from general anesthesia, tracheal suction was performed at different propofol concentrations as required for Dixon's up-and-down method with a step size of 0.2 μg/ml. A propofol concentration at which the cough reflex was not triggered during tracheal suctioning was considered successful.

The EC50 of propofol for tracheal suction without cough was 1.4 μg/ml and the EC95 was 1.6 μg/ml.

Tracheal suction may be accomplished without triggering the cough reflex when the propofol effect-site concentration is higher than 1.6 μg/ml.
Ultrasonographic findings and prenatal diagnosis of Jacobsen syndrome
Authors: Chen Shuang , Wang Ruixue , Zhang Xinyue , Li Leilei , Jiang Yuting , Liu Ruizhi , Zhang Hongguo
Published: January 2020

Rationale:

Jacobsen syndrome (JBS) is a rare chromosomal disorder with variable phenotypic expressivity, which is usually diagnosed in infancy and childhood based on clinical examination and hematological and cytogenetic findings. Prenatal diagnosis and fetal ultrasonographic findings of JBS are rare.

Patient concerns:

A 38-year-old, gravida 3, para 1, pregnant woman underwent clinical ultrasound examination at 22 weeks of gestation.

Diagnoses:

Ultrasonographic findings indicated an interventricular septal defect, the presence of septal blood flow, dilation of the left renal pelvis, and a single umbilical artery. Amniocentesis was performed to evaluate possible genetic causes of this diagnosis by cytogenetic and single nucleotide polymorphism (SNP) array analysis.

Interventions:

After genetic counseling and informed consent, the couple elected to terminate the pregnancy.

Outcomes:

Karyotype analysis showed that the fetal karyotype was 46,XX,del(11)(q23). The SNP array revealed a 6.118 Mb duplication of 11q23.2q23.3 and a 15.03 Mb deletion of 11q23.3q25.

Lessons:

Ultrasonographic findings of fetal JBS, including an interventricular septal defect, dilation of the left renal pelvis, and a single umbilical artery, may be associated with a 15.03 Mb deletion of 11q23.3q25. Further cases correlating phenotype and genotype are required to predict the postnatal phenotype.
Is insertion of a plastic stent better and safer than epinephrine injection in post sphincterotomy bleeding?
Authors: Schmitz Daniel , Weller Niels , Doll Matthias , Werle Stephan , Mees Claus , Prinz Peter , John Barbara , Schmidt Dorothea , Günther Andreas , Weiß Christel , Rudi Jochen
Published: January 2020

Objectives

Epinephrine injection is the therapy of first choice in post sphincterotomy bleeding (PSB), but may not be efficient in all cases and can cause postprocedural myocardial infarction. Plastic stent insertion (PSI) may be a better treatment. The aim of this retrospective study was to compare epinephrine injection with PSI with respect to efficacy and safety.

Methods

Clinical success, number of reinterventions and hospital stays after therapy, postprocedural myocardial infarction, bilirubin increase, and pancreatitis as well as factors influencing PSB were analyzed.

Results

Seventy-nine PSBs in 5798 endoscopic retrograde cholangiopancreaticographies (ERCPs) from August 2002 through October 2018 were treated by epinephrine injection, PSI or both (n = 34, 30, 15). Clinical success of PSB therapy showed no difference: 33/34 (97%), 30/30 (100%), 14/15 (93%). Reinterventions were more frequent (n = 30 versus n = 1; P ≤ 0.0001) and hospital stay was longer [median: 3 (2–10) versus 2 (1–3) days; P = 0.0357] in patients who received PSI (versus epinephrine injection). Postprocedural adverse events were very rare: bilirubin increase (1/2/0) and pancreatitis (0/2/1). Intraprocedural episodes of hypertension (≥180 mmHg) were documented in 45–54%.

Conclusions

Epinephrine injection is better than PSI in PSB. PSI may be an adequate treatment in patients with otherwise indicated stent insertion. Intraprocedural episodes of hypertension may be a risk factor for PSB.
Detection of hepatitis C virus core antigen as an alternative method for diagnosis of hepatitis C virus infection in blood donors negative for hepatitis C virus antibody
Authors: Hassanin Taha M. , Abdelraheem Ehab M. , Abdelhameed Saad , Abdelrazik Mohamed , Fouad Yasser M.
Published: January 2020

Background

Screening of blood donors in many countries is based on the use of serologic assays to detect specific anti-HCV antibodies (HCV Ab), but it lacks detection sensitivity. So, HCV RNA detection using the current gold standard real-time PCR is a must to rule out HCV infection with the main disadvantage being of high cost. HCV core antigen (HCV-c-Ag) immunoassay is proposed as a more cost efficient alternative to HCV RNA detection with PCR.

Aim

To evaluate the effectiveness of HCV-c-Ag detection as a cheap alternative to HCV RNA (PCR) in diagnosis of HCV infection in blood donors who are HCV Ab negative.

Methods and results

One hundred eighty-six volunteer blood donors who tested negative for HCV Ab were examined for HCV-c-Ag. Seven cases out of these 186 cases were HCV-c-Ag positive (4%). HCV RNA detection (PCR technique) was done to 30 cases (seven cases who test positive for HCV-c-Ag and 23 cases who test negative). Six out of the seven cases who were HCV-c-Ag positive (86%) were HCV RNA positive. Twenty-two cases out of the 23 cases who were HCV-c-Ag negative (96%) were HCV RNA negative.

Conclusion

HCV-c-Ag detection is an efficient method for diagnosis of HCV infection during screening of blood donors with high specificity (95.6%) and high negative predictive value (95.6%).
The success rate of radioactive iodine therapy for Graves’ disease in iodine-replete area and affecting factors: a single-center study
Authors: Park Hyunju , Kim Hye In , Park Jun , Park So Young , Kim Tae Hyuk , Chung Jae Hoon , Choi Joon Young , Kim Sun Wook
Published: January 2020

Objective

Initial treatment options for Graves’ disease include antithyroid drugs, radioactive iodine (RAI), and surgery. Because of similar effects of three modalities, initial treatment preferences differ by country to country. In Korea, iodine-replete area, RAI was used as a second-line option. For these reasons, the RAI success rate in Korea might differ from other countries.

Methods

A total of 247 patients were enrolled. The primary outcome was cumulative success rate in the first year, and the secondary outcome was factors that affected the success. Delayed response, which included patients who attained successful RAI during the follow-up, after the first year without further RAI, and factors that affected the delayed response were reviewed.

Results

The cumulative success rate in the first year was 62.8%. Higher RAI activity [odds ratio (OR) 2.56, P = 0.02], longer disease duration (OR 0.43, P = 0.01), larger goiter (OR 0.31, P = 0.01), and higher post-RAI fT4 (fT4 between upper normal limit (UNL) to 1.5 × UNL; OR 0.24; P < 0.01, 1.5 × UNL<; OR 0.08; P < 0.01) were associated with RAI success. Twenty-seven patients showed delayed response, and goiter size (P < 0.05), pre-RAI TSH receptor Ab (TRAb) level (P < 0.01) and post-RAI fT4 (P < 0.01) were associated.

Conclusion

The success rate of the first RAI in Korea was lower than that in other countries. Delayed response was observed in patients with smaller goiter, low pre-RAI TRAb, and low post-RAI fT4. In these patients, clinical follow-up with monitoring could be an option, and decision of optimal timing of first RAI is crucial.
Diagnostic performance of 18F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography in identifying bone marrow infiltration in new patients with diffuse large B-cell lymphoma and Hodgkin lymphoma
Authors: Kandeel Ahmed A. , Hussein Mai , Zidan Lamia , Younis Jehan , Edesa Wael , Alsayed Yasser
Published: January 2020

Objective

To compare between 18F-2-fluoro-2-deoxy-D-glucose PET/computerized tomography (18F-FDG PET/CT) and routine iliac bone marrow biopsy (BMB) in assessment of bone marrow infiltration (BMI) in Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL) patients at initial presentation.

Patients and methods

A retrospective analysis of 138 patients (50 Hodgkin lymphomas, 88 DLBCLs). The study included 70 males and 68 females with median age of 43 years. All patients underwent 18F-FDG PET/CT and iliac crest BMB before treatment. Any focal or patchy FDG uptake in the bone marrow, superior-to hepatic uptake was interpreted as abnormal with or without corresponding CT changes. Treatment response was evaluated clinically with each cycle of chemotherapy, radiologically after three cycles and at the end of treatment.

Results

The overall diagnostic performance showed significant higher sensitivity of 18F-FDG PET/CT than that of BMB (73.9 versus 62.5%, P = 0.046), while the specificity was higher in BMB than in 18F-FDG PET/CT (100% in BMB versus 93.5% in 18F-FDG PET/CT). In Hodgkin lymphoma, sensitivity, negative predictive value (NPV) and accuracy were significantly higher in 18F-FDG PET/CT compared with BMB, being 87.5, 94.4 and 96% versus 50, 81 and 84% (P = 0.02, 0.03, 0.04, respectively). However, for DLBCL patients, almost comparable results were found between both tests in terms of sensitivity, NPV and accuracy (66.7, 83.9 and 81.8% versus 68.8, 84.9 and 88.6%, respectively). After PET/CT scan, 12 patients (8.6%) were upstaged to stage IV, eight of them were negative by BMB.

Conclusion

18F-FDG PET/CT seemed to be an excellent diagnostic test in assessment of BMI at initial assessment and staging of Hodgkin lymphoma and DLBCL patients.
Future treatments for hyperoxaluria
Authors: Burns Zachary , Knight John , Fargue Sonia , Holmes Ross , Assimos Dean , Wood Kyle
Published: January 2020

Purpose of review

The review of potential therapies in the treatment of hyperoxaluria is timely, given the current excitement with clinical trials and the mounting evidence of the importance of oxalate in both kidney stone and chronic kidney disease.

Recent findings

Given the significant contribution of both endogenous and dietary oxalate to urinary oxalate excretions, it is not surprising therapeutic targets are being studied in both pathways. This article covers the existing data on endogenous and dietary oxalate and the current targets in these pathways.

In the near future, there will likely be therapies targeting both endogenous and dietary oxalate, especially in subsets of kidney stone formers.
New devices for kidney stone management
Authors: Terry Russell S. , Whelan Patrick S. , Lipkin Michael E.
Published: January 2020

Purpose of review

The purpose of this review is to summarize recent developments in the array of devices which are commonly used by urologists in the surgical management of kidney stones. To accomplish this goal, an extensive review of recent endourology literature, conference abstracts, and publicly available documents from manufacturers and the United States Food and Drug Administration was collected and reviewed.

Recent findings

Recent developments in the holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy include the introduction of pulse modulation. This technique delivers the laser energy in an asymmetric manner such that an initial bubble is created (the ‘Moses effect’) through which the remainder of the energy can then travel through without being absorbed by surrounding water. Even more novel is the thulium fiber laser, which is produced in a fundamentally different way than traditional Ho:YAG lasers and is not yet available for clinical use. Finally, novel mechanical lithotrites which effectively combine ultrasonic energy, ballistic energy, and suction capability appear to be highly effective for stone clearance in recent benchtop and clinical studies.

With the introduction of both new modifications of time-tested technologies as well as completely novel modalities, the practicing urologist's armamentarium of devices for the surgical management of kidney stones continues to grow. As the popularity of ‘mini’ procedures continues to grow, the adaptability of these technologies to these procedures will be critical to maintain maximum relevance.
Medication Discrepancies in Older Veterans Receiving Home Healthcare
Authors: Mixon Amanda S. , Poppendeck Heidi , Kripalani Sunil , Speroff Theodore , Schnelle John , Dittus Robert , Roumie Christianne
Published: January 2020

In a prospective cohort study of Veterans and community health nurses, we enrolled hospitalized older Veterans referred to home care for skilled nursing and/or physical or occupational therapy for posthospitalization care. We assessed preadmission activities of daily living and instrumental activities of daily living, health literacy, numeracy, and cognition. Postdischarge phone calls identified medication errors and medication reconciliation efforts by home healthcare clinicians. Veterans Administration-based community health nurses completed surveys about content and timing of postdischarge interactions with home healthcare clinicians. We determined the types and frequency of medication errors among older Veterans receiving home healthcare, patient–provider communication patterns in this setting, and patient characteristics affecting medication error rates. Most Veterans (24/30, 80%) had at least one discordant medication, and only one noted that errors were identified and resolved. Veterans were asked about medications in the home healthcare setting, but far fewer were questioned about medication-taking details, adherence, and as-needed or nonoral medications. Higher numeracy was associated with fewer errors. Veterans Administration community health nurses reported contact by home healthcare clinicians in 41% of cases (7/17). Given the high rate of medication errors discovered, future work should focus on implementing best practices for medication review in this setting, as well as documenting barriers/facilitators of patient–provider communication.