bluuebunny/crossref_metadata_2025 huggingface dataset:
The Utility of In-Hospital Postoperative Radiographs Following Surgical Treatment of Traumatic Thoracolumbar Injuries
Authors: Pyun Joseph , Camacho Jael E. , Usmani M. Farooq , Weir Tristan B. , Yousaf Omer , Sood Ashum , Vishwanath Vijay , Jolissaint Josef , Shasti Mark , Koh Eugene Y. , Banagan Kelley E. , Gelb Daniel E. , Ludwig Steven C.
Published: May 2019

Study Design:

A retrospective cohort study.

Objective:

The objective of this study was to assess the utility of routine in-hospital postoperative radiographs for identifying hardware failure following surgical treatment of traumatic thoracolumbar (TL) injuries.

Background:

Postoperative radiographs following spine surgery are considered standard of care despite a lack of evidence supporting their utility. Previous studies have concluded that postoperative radiographs following lumbar fusion for degenerative conditions have limited clinical value.

Materials and Methods:

A retrospective chart review was performed on patients who underwent surgical treatment of traumatic TL injuries between December 2006 and October 2015 at a level I trauma center. Before discharge, postoperative upright anteroposterior and lateral radiographs were obtained and reviewed by 1 surgeon and 1 radiologist as per protocol. Patients who subsequently underwent revision surgery during their initial hospital stay were identified. These patients were further analyzed to identify the indications for surgery and determine if the results of the radiographs obtained led to the subsequent revision surgery.

Results:

A total of 463 patients were identified who underwent surgical treatment following TL trauma. The rate of revision surgery during the initial hospitalization was 1.3% (6/463). Three patients underwent revision surgery due to worsening neurological status. One patient underwent reoperation because of advance imaging obtained for abdominal trauma. Two patients underwent revision surgery due to abnormal findings on postoperative radiographs. The overall sensitivity and specificity of routine postoperative radiographs was 33.3% and 100%, respectively.

Conclusions:

In the absence of new clinical signs and symptoms, obtaining routine in-hospital postoperative radiographs following surgical treatment of TL injuries provides minimal value. Clinical assessment should help determine if additional imaging is indicated for the patient. Avoiding unnecessary inpatient tests such as routine postoperative radiograph may offer multitude of benefits including lowering patient radiation exposure, reducing health care costs and better allocation of hospital resources.

Level of Evidence:

Level III.
Treatment of Endoprosthetic Knee Joint Infection in the Setting of Massive Bone Loss With Fusion of Femoral and Tibial Antibiotic Rods
Authors: Kellish Alec S. , Luciani Michael A. , Legato Joseph , Gutowski Christina J.
Published: May 2019

Chronic periprosthetic joint infection of the knee often requires staged surgical treatment combined with several weeks of intravenous antibiotic treatment. The first stage involves resection arthroplasty and placement of an antibiotic-cement spacer. A massive bone defect results from removal of a tumor-style prosthesis, introducing challenges to spacer creation and placement. This article describes a 27-year-old man who was treated 12 years prior for stage IIB osteosarcoma of the right proximal tibia with wide resection and alloprosthetic composite reconstruction. He developed chronic periprosthetic infection of the construct. Three surgical washouts and intravenous antibiotics failed to eradicate the infection, therefore 2-stage exchange arthroplasty was initiated. The first stage involved resection of all implants and allograft, and placement of a novel antibiotic-impregnated spacer. The spacer was created by locking a retrograde femoral nail and an antegrade tibial nail together at the knee joint level. This construct was then encased in antibiotic-impregnated cement to achieve fill of the massive tibial defect. After 6 weeks of intravenous antibiotic infusion, the infection was successfully eradicated and he was indicated for reimplantation arthroplasty with custom hinged knee components. Utilization of interlocked femoral and tibial nails in this manner has not been described for creating an antibiotic-laden temporary knee arthrodesis spacer as the first stage in treatment of periprosthetic joint infection. This strategy achieves stable knee fusion although avoiding violation of the hip and the complications of external fixation. Application of this technique may be particularly beneficial in the setting of massive bone loss.
Surgical management and gynecologic care of the transgender patient
Authors: Schmidt Megan , Ditrio Lauren , Shute Britta , Luciano Danielle
Published: May 2019

Purpose of review

Over 1.4 million adults are identified as transgender in 2014. Many of these individuals have undergone, or plan to undergo, gender-affirming surgery. This review summarizes the medical and surgical options available for the transgender population and reviews screening guidelines and fertility preservation options. In addition, it highlights the role gynecologists have in caring for this population.

Recent findings

Gynecologists perform certain gender-affirming surgeries, such as hysterectomies and bilateral salpingooophorectomies. They also can play an important role in providing hormone therapy, anatomy specific cancer screening, and discussion of and/or referral for fertility preservation.

Gynecologists are skilled to perform certain gender-affirming surgeries and play an important role in gender-affirming care.
Effects of Virtual Reality in Patients Undergoing Dialysis
Authors: Burrai Francesco , Othman Shokri , Brioni Elena , Micheluzzi Valentina , Luppi Marco , Apuzzo Luigi , Delli Zotti Giulia Bruna , La Manna Gaetano
Published: May 2019

Dialysis is often considered slow, repetitive, and with programmed intervals. Patients often perceive it as time taken from their lives with a sense of ineluctability and emptiness, engendering a negative emotional and cognitive perception of the world and one's place in it. Today, it is possible to improve the quality of life of patients during hemodialysis using virtual reality (VR). This creation of a true multisensory experience may absorb the patient's perceptions during hemodialysis, improving his/her quality of life. An Italian multicenter, longitudinal experimental study will be conducted with a randomized, pre-post test design, with balanced allocation 1:1, in parallel groups with a control group in the standard care of patients diagnosed with chronic renal failure who are, undergoing hemodialysis treatment. A sample of 186 patients calculated with sample size (power = 80%, β = 0.2, α = 0.05) will be randomized into an experimental group exposed to VR, and a control group in standard care. The 2 groups will be studied over a period of 1 month, with 12 applications of VR and with measurements of the following outcomes: anxiety, fatigue, pruritus, arterial pressure, heart rate, respiration rate, and duration of the session at each hemodialysis session. This is the first international experimental protocol that examines the application of VR in patients undergoing hemodialysis. If the results show statistically and clinically significant differences, the VR could be an additional holistic intervention, which is evidence based, linked to the humanization of chronic, repetitive interventions, complementary to and synergistic with standard of care.
Epithelial Ingrowth After Descemet Membrane Endothelial Keratoplasty
Authors: Álvarez de Toledo Clara , Salvador-Culla Borja , López José Carlos , De la Paz María Fideliz , Barraquer Rafael I. , Álvarez de Toledo Juan
Published: May 2019

Purpose:

To report the diagnosis, histological findings, and treatment of a patient who developed epithelial ingrowth after Descemet membrane endothelial keratoplasty (DMEK).

Methods:

We present the case of a type 2 diabetic 60-year-old man who underwent DMEK for Fuchs dystrophy. Two months after surgery, an epithelial ingrowth in the graft–host interface was suspected. After a 3-month follow-up period in which progressive and centrifugal growth of the epithelial cells in the interface was documented, penetrating keratoplasty (PK) was performed to remove all areas of epithelial ingrowth. No evidence of recurrence was observed 1 year later.

Results:

Histopathologic evaluation of the corneal button obtained in the PK procedure confirmed the epithelial ingrowth in the interface between the Descemet membrane graft and the host cornea.

Conclusions:

Epithelial ingrowth may occur after a corneal endothelium transplant. There have been multiple reports of epithelial ingrowth after Descemet stripping automated endothelial keratoplasty, but this particular case report suggests that epithelial ingrowth may also occur after DMEK. In this case, PK solved the complication.
“We Weren't Prepared for This”
Authors: Blackburn Carolyn , Harvey Merryl
Published: May 2019

Having a child born prematurely can plunge parents into an unknown and sometimes frightening situation, where they experience a loss of control over events and reduced decision-making capacity. Preterm birth sometimes results in posttraumatic stress disorder for parents and negatively impacts on parent–child interactional patterns, especially if parents were unprepared for this eventuality. The role of information, support, and early intervention in parents' coping capacity in this situation has been noted in developmental systems theory to contribute to family interactional patterns. This article reports on a mixed-methods study that explored the information and support needed by and available to parents following preterm birth in England and the effect of this on their emotional well-being. The findings suggest that support systems do not always provide timely or helpful emotional or practical support to parents, and this has the potential to place additional stress on family interactional patterns, especially where parents were unprepared for the possibility of preterm birth.
Construct, Convergent, and Discriminant Validity of the Beach Center Family Quality of Life Scale for Singapore
Authors: Waschl Nicolette , Xie Huichao , Chen Mo , Poon Kenneth K.
Published: May 2019

Family quality of life (FQoL) constitutes an important aspect of early intervention. However, the culture bound nature of this construct necessitates validation of FQoL measures when being used in a culture different from the one in which they were developed. This study sought to understand the psychometric properties and construct validity of the Beach Center FQoL (BCFQoL) scale in Singapore. Data from 307 caregivers of children in an early intervention program were used. These caregivers completed the BCFQoL scale and external validity measures of family outcomes, psychological distress, and life situation. Confirmatory factor analysis and correlations were used to examine the factor structure and convergent and discriminant validity of the BCFQoL scale. Results indicated support for 5 FQoL dimensions and a higher-order FQoL factor. External convergent and discriminant validity, as well as internal statistical discriminant validity of the individual BCFQoL dimensions were supported. Despite evidence of internal statistical discriminant validity, there was little variation in the strength of the relationships between individual BCFQoL dimensions and the various external validity measures. Overall, the results of this study support the use of the BCFQoL scale as a valid measure of FQoL in Singapore.
The Use of Peer Mediation and Educator Facilitation to Promote Turn Taking in Young Children With Autism Spectrum Disorder in Inclusive Childcare
Authors: Kemp Coral , Stephenson Jennifer , Cooper Megan , Hodge Kerry
Published: May 2019

A multiple-probe design across participants was used to investigate the effect of a peer-mediated intervention on the turn-taking behavior of 3 children with autism spectrum disorder (ASD) attending inclusive childcare centers. An educator trained peers to support the child with a disability to take turns playing a game on an iPad. The educator was also available to provide coaching for the peer when needed. An intervention effect was demonstrated for each of the children, and 2 were able to demonstrate maintenance of the skill when the training and coaching procedures were not implemented by the educator. Although some elements of the treatment procedures were not consistently applied by the educators or typical peers, the intervention was sufficiently robust to enable the children with ASD to improve their turn-taking skills.
Antibodies binding the head domain of P2X4 inhibit channel function and reverse neuropathic pain
Authors: Williams Wendy A. , Linley John E. , Jones Clare A. , Shibata Yoko , Snijder Arjan , Button James , Hatcher Jon P. , Huang Ling , Taddese Bruck , Thornton Peter , Schofield Darren J. , Thom George , Popovic Bojana , Dosanjh Bhupinder , Wilkinson Trevor , Hughes Jane , Dobson Claire L. , Groves Maria A. , Webster Carl I. , Billinton Andy , Vaughan Tristan J. , Chessell Iain
Published: May 2019

P2X4 is a ligand-gated ion channel implicated in neuropathic pain. Drug discovery efforts targeting P2X4 have been unsuccessful largely because of the difficulty in engineering specificity and selectivity. Here, we describe for the first time the generation of a panel of diverse monoclonal antibodies (mAbs) to human and mouse P2X4, capable of both positive and negative modulation of channel function. The affinity-optimised anti-P2X4 mAb IgG#151-LO showed exquisite selectivity for human P2X4 and induced potent and complete block of P2X4 currents. Site-directed mutagenesis of P2X4 revealed the head domain as a key interaction site for inhibitory mAbs. Inhibition of spinal P2X4 either by intrathecal delivery of an anti-P2X4 mAb or by systemic delivery of an anti-P2X4 bispecific mAb with enhanced blood–spinal cord barrier permeability produced long-lasting (>7 days) analgesia in a mouse model of neuropathic pain. We therefore propose that inhibitory mAbs binding the head domain of P2X4 have therapeutic potential for the treatment of neuropathic pain.
Continuous Renal Replacement Therapy in Venovenous Extracorporeal Membrane Oxygenation: A Retrospective Study on Regional Citrate Anticoagulation
Authors: Giani Marco , Scaravilli Vittorio , Stefanini Flavia , Valsecchi Gabriele , Rona Roberto , Grasselli Giacomo , Bellani Giacomo , Pesenti Antonio M. , Foti Giuseppe
Published: May 2019

Systemic infusion of unfractionated heparin (UFH) is the standard anticoagulation technique for continuous renal replacement therapy (CRRT) during extracorporeal membrane oxygenation (ECMO), but often fails to avoid CRRT circuit clotting. The aim of this study was to assess, in patients undergoing CRRT during venovenous ECMO (vv-ECMO), the efficacy and safety of adding regional citrate anticoagulation (RCA) for CRRT circuit anticoagulation (RCA + UFH group) compared with the sole systemic heparin anticoagulation (UFH group). We performed a retrospective chart review (2009–2018) of patients treated with CRRT during ECMO. We evaluated filter life span, rate of CRRT circuit clotting, and coagulation parameters. The incidence of citrate anticoagulation-related complications was recorded. Forty-eight consecutive adult patients underwent CRRT during vv-ECMO in the study period. The incidence of CRRT circuit clotting was lower in the RCA + UFH group (11% vs. 38% in the UFH group, p < 0.001). Log-rank survival analysis demonstrated longer circuit lifetime for RCA + UFH group. No complication ascribable to citrate anticoagulation was recorded. Regional citrate anticoagulation resulted a feasible, safe, and effective technique as additional anticoagulation for CRRT circuits during ECMO. Compared with systemic heparinization only, this technique allowed to reduce the rate of CRRT circuit clotting.
Zygomatic bone metastasis from hepatocellular carcinoma and the therapeutic efficacy of apatinib
Authors: Lei Qiucheng , Chen Huanwei , Zheng Huazhen , Deng Feiwen , Wang Fengjie , Li Jieyuan , Hu Jianyuan , Fu Rongdang , Zhen Zuojun
Published: May 2019

Rationale:

Hepatocellular carcinoma (HCC) metastases to the zygomatic bone are extremely uncommon, and the treatment of target drugs against such case is unknown.

Patient concerns:

A 48-year-old male patient was admitted to our hospital under suspicion of an advanced liver tumor due to an increase in levels of alpha-fetoprotein (AFP) after radiofrequency ablation for independent nodule in his liver 1 month before. He had a hepatitis B virus (HBV) history for 20 years without treatment.

Diagnosis and interventions:

A diagnosis of primary HCC was made based on pathological examination following right hepatectomy. Seven months after the surgery, a mass in S8 was identified and treated by ARF. Twenty days later, a right zygomatic mass was observed and the incisional biopsy revealed metastasis from HCC. Due to side effects of chemotherapy, the metastatic zygomatic mass was treated with radioactive seed implantation. Despite these interventions, there was steady increase in AFP values as well as increase in size of the zygomatic mass. Hence, the patient was started on apatinib with a dose of 500 mg/day from 1 to 28 days per cycle for a duration of 10 months.

Outcomes:

The AFP values were significantly decreased but the size of the zygomatic mass continued to increase indicating progression of disease. But the progression-free survival was more than 10 months. The patient exhibited adverse reactions which were controllable by symptomatic treatments. As of last follow-up, the patient is unwell with pain in the face, blurred vision in the right eye, dyscrasia, and exhibited difficulty in opening his mouth.

Lessons:

HCC metastases to the zygomatic bone are very aggressive with a very low incidence and immunohistochemistry is useful diagnostic indicators. Still now, there is no optimal treatment strategy for these patients. Apatinib may be a promising drug in the treatment of HCC metastases to the zygomatic bone.
Efficacy of TCM therapy of tonifying lung–kidney's Qi-deficiency in a case of idiopathic pulmonary fibrosis
Authors: Chen Ming-Jun , Yang Ge-Lliang , Ding Yu-Xuan , Tong Zhan-Qi
Published: May 2019

Rationale:

Idiopathic pulmonary fibrosis (IPF) is a special form of spontaneous, chronic, progressive interstitial fibrotic pneumonia of unknown cause, and treatments for IPF have shown a poor prognosis. This study reports a new treatment, traditional Chinese medicine (TCM) therapy, for tonifying Qi-deficiency of lung–kidney in a 64-year-old patient with IPF.

Patient concerns:

A 64-year-old man, who complained of cough and asthma, was diagnosed as IPF with mild impairment in lung function by thoracic high-resolution computed tomography and pulmonary function test. He received an 18-month N-acetylcysteine monotherapy but had no improvement in lung function.

Diagnoses:

IPF with mild impairment in lung function was diagnosed.

Interventions:

The Chinese herbal medicine composition was decocted in 300 ml water for oral administration with 150 ml decoction twice daily in June 2017.

Outcomes:

The pulmonary function test showed that diffusing capacity for carbon monoxide had increased to 81% of predicted back to normal after 2-month TCM monotherapy. And diffusing capacity for carbon monoxide had increased to 89% of predicted, and forced expiratory volume in 1 s/forced vital capacity ratio increased to 92% at 14-month follow-up. No adverse events occurred during the 14 months of therapy and observation.

Lessons:

The treatment by TCM therapy of tonifying lung–kidney's Qi-deficiency for IPF can improve the pulmonary function and reverse disease progression; it may be considered as a complementary treatment for IPF with mild-to-moderate impairment. However, the insights provided in this case report require further exploration and verification.
Repeat microvascular decompression for patients with persistent or recurrent trigeminal neuralgia
Authors: Cheng Jian , Meng Jinli , Lei Ding , Hui Xuhui
Published: May 2019

Patients with persistent or recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD) are frequently difficult to manage. This study aimed to analyze the safety and efficiency of repeat MVD, with the main focus on prognostic factors and long-term outcomes.

We performed a retrospective study of 41 TN patients (19 men, 22 women) who underwent repeat MVD due to persistent or recurrent pain from January 2008 to January 2016. These patients were followed up from 12 to 96 months (mean, 42 ± 17.3 months). Univariate analysis by Spearman's rank correlation coefficient was used for analysis of prognostic factors.

During the repeat MVD, compression of the trigeminal nerve was noted by an artery in 15 patients (36.6%), vein in 6 patients (14.6%), Teflon in 8 patients (19.5%), and no compression in 12 patients (29.3%). Twenty-one patients (51.2%) had already undergone 1 or more previous ablative procedures, either before the first MVD or between the surgeries. The complete pain relief rates of repeat MVD were 87.8% immediately after surgery and 75% at last follow-up. Thirteen patients (31.7%) had new or increased facial numbness after repeat surgery. Univariate analysis revealed 2 prognostic factors, negative finding during reoperation (P = .021) and no pain relief after the initial surgery (P = .038), that showed a negative influence on success rates after repeat MVD.

Repeat MVD can still achieve an excellent outcome in patients with persistent or recurrent pain. However, the risk of facial numbness is increased. Surgeons should be selective in performing repeat MVD, priority should be given to patients who have a pain-free interval after initial MVD or show demonstrable compression on imaging studies.
Rheumatoid arthritis-like active synovitis with T-cell activation in a case of idiopathic multicentric Castleman disease
Authors: Otsuka Mizuna , Koga Tomohiro , Sumiyoshi Remi , Okamoto Momoko , Endo Yushiro , Tsuji Sosuke , Takatani Ayuko , Shimizu Toshimasa , Igawa Takashi , Kawashiri Shin-ya , Iwamoto Naoki , Ichinose Kunihiro , Tamai Mami , Nakamura Hideki , Origuchi Tomoki , Daisuke Niino , Kawakami Atsushi
Published: May 2019

Rationale:

Idiopathic multicentric Castleman disease (iMCD) is a systemic disease with multiple regions of lymphadenopathy and systemic symptoms and associated with rheumatoid arthritis (RA) and collagen diseases. However, few reported have described the coexistence of iMCD and RA and the mechanisms by which iMCD induces arthritis remain elusive. We experienced a rare case of iMCD, wherein the patient exhibited symptoms of polyarthritis with high-grade fever.

Patient concerns:

A 34-year-old woman was admitted to our hospital for further evaluation of a high fever with polyarthritis. The levels of both rheumatoid factor and anticitrullinated protein antibody were negative. 18F-fluorodeoxyglucose/positron emission tomography-computed tomography showed lymphadenopathy with increased fluoro-2-deoxy-d-glucose uptake. Magnetic resonance imaging and musculoskeletal ultrasonography revealed active synovitis in the hands which was consistent with RA.

Diagnoses:

We diagnosed iMCD based on human herpesvirus 8 negativity, HIV negativity, systemic lymphadenopathy, and pathologic findings of the lymph nodes. The patient did not satisfy the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for RA. Cytokine assay showed elevated serum levels of interleukin-17 and CXCL10, comparable to those in patients with RA.

Interventions:

We administered 15 mg/d of predonisolone.

Outcomes:

After this treatment, the patient's symptoms showed improvement. As of this writing, we tapered the prednisolone to 7.5 mg/d, and the patient's remission has been maintained for >4 months.

Lessons:

The present case suggests that RA-like active synovitis may coexist in iMCD, resulting from aberrant T-cell activation and histologic examination using lymph node biopsy may help enable early diagnosis of iMCD.
Plasma exchange and rituximab treatments in primary membranous nephropathy combined with crescentic glomerulonephritis
Authors: Lu Hui , Cui Zhao , Zhou Xu-jie , Jin Qi-zhuang , Yu Xiao-juan , Wang Su-xia , Wang Yu , Zhou Fu-de , Zhao Ming-hui
Published: May 2019

Rationale:

Crescent formation is rare in primary membranous nephropathy (MN). Anti-phospholipase A2 receptor (PLA2R) antibodies are detectable in these patients. The mechanism and treatments are unknown.

Patient concerns:

A 72-year-old female patient who presented with nephrotic syndrome, hematuria, and rapidly progressive kidney dysfunction.

Diagnoses:

Kidney biopsy was performed and the diagnosis was MN in combination with crescentic glomerulonephritis. Circulating anti-PLA2R IgG3 and IgG4 were detected of high level.

Interventions:

The patient received plasma exchange and rituximab besides corticosteroids.

Outcomes:

The patient achieved complete remission of proteinuria and recovery of kidney function after the clearance of anti-PLA2R antibodies.

Lesson:

This case suggests a pathogenic role of anti-PLA2R antibodies in the mechanism of crescent formation in MN, which may need intensive therapy to eliminate the antibodies quickly.
Sanao decoction for asthma
Authors: Chen Guoming , Chen Yijun , Chen Ziyin , Gao Shuai , Zhang Peng , Zhang Honghui , Huang Yanfen , Lin Yingtong , Wei Li
Published: May 2019

Background:

Asthma is a chronic inflammatory disease characterized by recurrent attacks of breathlessness and wheezing, which often worsen at night or in the early morning and vary from person to person in severity and frequency. Sanao decoction (SAD), as a traditional Chinese medicine compound, has a long history of clinical application in the treatment of respiratory diseases. Whereas neither systematic nor meta-analysis of randomized controlled articles explain the efficacy of SAD in treating asthma. Therefore, we provide a protocol to evaluate the efficacy and safety of SAD for asthma.

Methods:

From the beginning to December 2018, the following electronic databases will be searched for studies in English or Chinese: the Cochrane Library, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, and the Wanfang Database. Total effective rate, peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC will be measured as primary outcomes. Meta-analysis will be performed using the Stata 15.

Results:

This study will provide the current evidence of asthma treated with SAD from the several points including PEF, FEV1, FVC, and FEV1/FVC.

Conclusion:

The consequence of this summary will furnish proof to evaluate if SAD is effective in the treatment of asthma.

PROSPERO registration number:

PROSPERO CRD42018117923.
Effects of photobiomodulation therapy in aerobic endurance training and detraining in humans
Authors: de Paiva Paulo Roberto Vicente , Casalechi Heliodora Leão , Tomazoni Shaiane Silva , Machado Caroline dos Santos Monteiro , Miranda Eduardo Foschini , Ribeiro Neide Firmo , Pereira Amanda Lima , da Costa Amanda Sampaio , Dias Luana Barbosa , Souza Bianca Cristina Gomes , Aguiar Lino Matheus Marinho , de Carvalho Paulo de Tarso Camillo , Leal-Junior Ernesto Cesar Pinto
Published: May 2019

Introduction:

Over the last 10 years, it has been demonstrated that photobiomodulation therapy (PBMT), also known as phototherapy, using low-level laser therapy (LLLT) and/or light-emitting diode therapy (LEDT) has ergogenic effects, improving athletic performance and also accelerating post-exercise recovery. However, many aspects related to these effects and its clinical applicability remain unknown. Therefore, the aim of this project is to evaluate the ergogenic effects of PBMT in detraining after an aerobic endurance training protocol.

Methods and analyzes:

A randomized, triple-blind, placebo-controlled clinical trial will be carried out. Healthy male volunteers will be randomly distributed into 4 experimental groups: PBMT before and after training sessions + PBMT during detraining, PBMT before and after training sessions + placebo during detraining, placebo before and after training sessions + PBMT during detraining, and placebo before and after training sessions + placebo during detraining. The aerobic endurance training sessions will be carried out using motorized treadmills during 12 weeks, and the detraining period will consist in the next 4 weeks after that. It will be analyzed the time until exhaustion, maximal oxygen uptake (VO2max), and fat percentage of volunteers.

Discussion:

Despite the increasing body of evidence for the use of PBMT as an ergogenic agent, several aspects remain unknown. The findings of this study will contribute to the advance of knowledge in this field regarding clinical applications.

Ethics and dissemination:

This study was approved by the Research Ethics Committee of Nove de Julho University. The results from this study will be further disseminated through scientific publications in international peer-reviewed journals and presentations at national and international scientific meetings.

Trial registration number:

NCT03879226.
Prevalence of mental health problems among medical students in China
Authors: Zeng Wen , Chen Ruiqi , Wang Xingyue , Zhang Qin , Deng Wei
Published: May 2019

Background:

The prevalence of mental health problems in medical students has continuously increased and is higher than the prevalence of mental health problems in students with other majors, which could lead to undesirable consequences for the students and their future patients. In China, the current states of medical education and healthcare workplaces differ in certain areas from those in Western or other Asian countries. However, the mental health status of Chinese medical students has not been systematically analyzed.

Objectives:

The purpose of this meta-analysis was to summarize the prevalence of mental health problems in Chinese medical students.

Methods:

All cross-sectional studies that investigated the prevalence of any mental health problem among Chinese medical students were retrieved from the following databases: EMBASE, PubMed, PsycINFO, OVID, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. We accepted each individual trial's inclusion and exclusion criteria for participants. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was adopted to appraise the methodological quality of each study. RevMan (version 5.3) was used to analyze the data.

Results:

Ten cross-sectional studies involving a total of 30,817 Chinese medical students were included. The prevalence of depression, anxiety, suicidal ideation, and eating disorders were 29%, 21%, 11%, and 2%, respectively. Subgroup analysis revealed no significant differences in the prevalence of depression and suicidal ideation between genders and no significant difference in the prevalence of depression between individuals of different ages (20 years and older or younger than 20 years).

Conclusions and implications of key findings:

Chinese medical students have relatively high prevalence of depression, anxiety, and suicidal ideation but a low prevalence of eating disorders. Mental health problems in Chinese medical students should be taken seriously, and timely screening of and proper intervention in these mental health problems are highly recommended.
Relationships among stress, emotional intelligence, cognitive intelligence, and cytokines
Authors: Jung Ye-Ha , Shin Na Young , Jang Joon Hwan , Lee Won Joon , Lee Dasom , Choi Yoobin , Choi Soo-Hee , Kang Do-Hyung
Published: May 2019

The brain has multiple functions, and its structures are very closely related to one another. Thus, the brain areas associated with stress, emotion, and intelligence are closely connected. The purpose of this study was to investigate the multiple associations between stress and emotional intelligence (EI), between EI and intelligence quotient (IQ), between cytokines and stress, and between cytokines and IQ. We measured the stress, EI, cognitive intelligence using IQ, and cytokine levels of 70 healthy subjects. We also analyzed the association of cytokines with IQ according to hemispheric dominance using the brain preference indicator (BPI). We found significant negative correlations between stress and the components of EI, such as emotional awareness and expression, emotional thinking, and emotional regulation. High levels of anger, which is a component of stress, were significantly related to poor emotional regulation. Additionally, emotional application was positively correlated with full-scale IQ scores and scores on the vocabulary, picture arrangement, and block design subtests of the IQ test. High IL-10 levels were significantly associated with low stress levels only in the right-brain-dominant group. High IL-10 and IFN-gamma levels have been associated with high scores of arithmetic intelligence. TNF-alpha and IL-6 were negatively associated with vocabulary scores and full-scale IQ, but IL-10 and IFN-gamma were positively associated with scores on the arithmetic subtest in left-brain-dominant subjects. On the other hand, IL-10 showed positive correlations with scores for vocabulary and for vocabulary and arithmetic in right-brain-dominant subjects. Furthermore, we found significant linear regression models which can show integrative associations and contribution on emotional and cognitive intelligence. Thus, we demonstrated that cytokines, stress, and emotional and cognitive intelligence are closely connected one another related to brain structure and functions. Also, the pro-inflammatory cytokines TNF-alpha and IL-6 had negative effects, whereas the anti-inflammatory cytokines (e.g., IL-10 and IFN-gamma) showed beneficial effects, on stress levels, and multiple dimensions of emotional and cognitive intelligence. Additionally, these relationships among cytokines, stress, and emotional and cognitive intelligence differed depending on right and left hemispheric dominance.
Metal nickel exposure increase the risk of congenital heart defects occurrence in offspring
Authors: Zhang Nannan , Chen Ming , Li Jun , Deng Ying , Li Sheng-li , Guo Yi-xiong , Li Nana , Lin Yuan , Yu Ping , Liu Zhen , Zhu Jun
Published: May 2019

Background:

Previous studies have investigated heavy metal exposure could increase the occurrence of congenital heart defects (CHDs). However, there are limited data regarding the relationship between exposure to nickel and CHDs occurrence in offspring. The aim of this study was to analyze the association between nickel exposure in mothers and the risk of CHDs in offspring.

Materials and methods:

To explore the association of nickel exposure and occurrence of CHD, a case-control study with 490 controls and 399 cases with CHDs in China were developed. The concentrations of nickel in hair of pregnant woman and fetal placental tissue were measured and used a logistic regression analysis to explore the relationship between nickel exposure and risk of CHD.

Results:

The median concentrations of nickel were 0.629 ng/mg, P < .05 (adjusted odds ratio [aOR], 1.326; 95% CI, 1.003–1.757) and 0.178 ng/mg, P < .05 (aOR, 2.204; 95% CI, 0.783–6.206), in maternal hair and in fetal placental tissue in the CHD group, respectively. Significant differences in the level of nickel in hair were also found in the different CHD subtypes including septal defects (P < .05), conotruncal defects (P < .05), right ventricular outflow tract obstruction (P < .01), and left ventricular outflow tract obstruction (P < .05). Dramatically different nickel concentrations in fetal placenta tissue were found in cases with other heart defects (P < .05).

Conclusions:

The finding suggested that the occurrence of CHDs may be associated with nickel exposure.
A meta-analysis of the impact of neutrophil-to-lymphocyte ratio on treatment outcomes after radiotherapy for solid tumors
Authors: Choi Noorie , Kim Jin Ho , Chie Eui Kyu , Gim Jungsoo , Kang Hyun-Cheol
Published: May 2019

Background:

To evaluate the impact of neutrophil-to-lymphocyte ratios (NLR) as a prognostic factor in predicting treatment outcomes after radiotherapy (RT) for solid tumors.

Methods:

PubMed and Embase databases were used to search for articles published by February 2019 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Hazard ratios (HR) with 95% confidence intervals (CI) were used to evaluate the association between NLR levels and treatment outcomes after RT. The primary endpoint was overall survival (OS) rates. Secondary endpoints included progression-free survival, disease-free survival, and disease-specific survival rates.

Results:

Thirty-eight datasets with a total of 7065 patients were included in the meta-analysis. Patients with high pretreatment NLR demonstrated significantly worse OS with a pooled HR of 1.90 (95% CI 1.66–2.17, P < .001). In patients receiving RT alone, the pooled HR for OS was 1.71 (95% CI 1.44–2.04, P < .001) with no between-study heterogeneity (I

2
 = 0%, P = .46).

Conclusion:

Elevated pretreatment NLR is associated with poorer survival in cancer patients undergoing RT. Elevated pretreatment NLR prior to RT initiation may be a useful biomarker to predict treatment outcomes and select a subgroup of patients in need of a more aggressive treatment approach.
Safety and feasibility of in-hospital early chemotherapy initiation after surgery in patients with stage II–IV colon cancer
Authors: Kang Jeonghyun , Chong Su-Weon , Park Eun Jung , Baik Seung Hyuk , Lee Kang Young
Published: May 2019

Although it is recommended to initiate postoperative chemotherapy for colon cancer within 8 weeks after surgery, the feasibility and impact of initiating chemotherapy before discharge after surgical resection has not been investigated.

Patients with stage II–IV colon cancer who received postoperative chemotherapy were dichotomized into early (chemotherapy initiation before discharge) and control (chemotherapy initiation after discharge) groups. A multivariable logistic regression model was used to determine factors associated with delayed chemotherapy, defined as more than 6 or 8 weeks after surgery.

From January 2004 to December 2012, of 729 patients with stage II–IV colon adenocarcinoma, 555 patients (76.1%) underwent postoperative chemotherapy. Of them, 181 (32.6%) patients were included in the early group. Time to initiation of chemotherapy was significantly shorter in the early group than in the control group (14.9 days vs 31.5 days, P < . 001). Multivariate analysis revealed that tumor stage and chemotherapy initiation strategy (odds ratio 8.4; 95% confidence interval, 1–66, P = .041) were independent predictors of delayed initiation of chemotherapy at more than 8 weeks. There was no difference in the completion rate of planned chemotherapy cycles between the 2 groups (P > .05).

The strategy of initiating chemotherapy before discharge after surgery is safe and feasible and might reduce the potential delay in chemotherapy initiation in patients with colon cancer.
Excessive physical activity duration may be a risk factor for hypertension in young and middle-aged populations
Authors: Zhu Zhongkai , Feng Tianyu , Huang Yi , Liu Xinglan , Lei Han , Li Ge , Deng Dan , Zhang Nan , Huang Wei
Published: May 2019

Physical inactivity is known to cause many health problems globally each year. However, evidence regarding the interaction between excessive physical activity (PA) and blood pressure in young and middle-aged populations is limited.

A multistage, stratified, random cluster sampling design was adopted to recruit representative samples. Participants were asked to complete a questionnaire and undergo physical examinations. Associations between prehypertension, hypertension and PA durations were examined by multivariable logistic regression.

Overall, 8206 subjects (4110 men, 50.1%) aged 15 to 45 years were enrolled. The prevalence rates of prehypertension and hypertension were 45.7% and 5.0%, respectively. Among the 1913 participants who performed moderate-intensity PA for more than 700 min/wk, 118 had hypertension (6.2%) and 845 had prehypertension (44.2%). Among the 1003 participants who performed vigorous-intensity PA for more than 450 min/wk, 82 had hypertension (8.2%) and 479 had prehypertension (47.8%).

Long-term and sustained PA may increase the risk for hypertension in young and middle-aged subjects. An appropriate recommendation of PA duration should be encouraged in this cohort.
Traditional Chinese medicine on treating premature ejaculation
Authors: Li Yongqiang , Duan Yunyun , Yu Xudong , Wang Jisheng , Yao Zeyu , Gong Xihao , Gong Xiaoyong , Zheng Wei , Xue Yahui , Guo Jianen
Published: May 2019

Background:

Premature ejaculation is a form of male sexual dysfunction. As people's lifestyle changes and the population ages, the incidence of premature ejaculation continues to increase. Many clinical trials have proven that Chinese medicine has a significant effect in the treatment of premature ejaculation. In this systematic review, we aim to evaluate the effectiveness and safety of Traditional Chinese medicine for premature ejaculation.

Methods:

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 April 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 premature ejaculation.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for treating premature ejaculation. 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.

Trial registration number:

PROSPERO CRD42017065316
Application of a real-time 3-dimensional navigation system for treatment of synovial chondromatosis of the temporomandibular joint
Authors: Matsuda Shinpei , Yoshimura Hitoshi , Sano Kazuo
Published: May 2019

Rationale:

Real-time three-dimensional navigation systems can provide useful information for operators during surgery. The authors report a case of synovial chondromatosis of the temporomandibular joint treated by open surgery under the guidance of a real-time 3-dimensional navigation system with a 3-point rigid cranial fixation device.

Patient concerns:

A 73-year-old woman presented with swelling in the left preauricular region and left temporomandibular joint pain.

Diagnoses:

The patient was diagnosed with synovial chondromatosis of the temporomandibular joint by imaging examinations.

Interventions:

The patient was treated by open surgery under the guidance of a real-time 3-dimensional navigation system with a 3-point rigid cranial fixation device.

Outcomes:

The patient was diagnosed with synovial chondromatosis by histopathological examination. There were no complications. The real-time 3-dimensional navigation system with a 3-point rigid cranial fixation device provided an accurate and useful navigation image and clear surgical field during the surgical procedure. Thirty months have passed since the operation without clinical findings associated with recurrence.

Lessons:

The guidance provided by a real-time 3-dimensional navigation system with a 3-point rigid cranial fixation device is useful in open surgery for the treatment of synovial chondromatosis of the temporomandibular joint.
The effects of ultrasound-guided serratus plane block, in combination with general anesthesia, on intraoperative opioid consumption, emergence time, and hemodynamic stability during video-assisted thoracoscopic lobectomy
Authors: Lee Jungwon , Kim Saeyoung
Published: May 2019

Background:

Thoracotomy is one of the most painful surgeries; therefore, video-assisted thoracoscopic surgery (VATS) was developed to reduce the surgical stress of thoracotomy. Although VATS results in reduced postoperative pain compared with thoracotomy, it is still painful. Serratus plane block (SPB) is a novel technique that provides lateral chest wall analgesia by blocking the lateral branch of the intercostal nerve.

Methods:

We conducted a prospective study in 50 patients, aged 20 to 75 years, undergoing three-port VATS lobectomy. Group G (n = 25) received conventional general anesthesia and Group S (n = 25) received SPB before induction of general anesthesia. In Group S, 20 ml of 0.375% ropivacaine was injected between the serratus anterior and latissimus dorsi muscles. During surgery, anesthesia was maintained by adjusting the propofol dose to maintain a bispectral index of 40 to 60 and the remifentanil dose to maintain blood pressure and heart rate within 70 to 130% of baseline.

Results:

Intraoperative remifentanil consumption was significantly lower in Group S compared to that in Group G (519.9 μg vs 1047.7 μg, P < .001). Moreover, emergence time was significantly shorter in Group S compared to Group G (10.8 minutes vs 14.9 minutes, P = .01). However, there were no significant differences in systolic blood pressure and heart rate (HR) between the groups at each time point. The doses of rescue drugs for the control of blood pressure and HR were not significantly different between the 2 groups.

Conclusions:

Ultrasound-guided SPB could be a safe and effective regional anesthesia technique for VATS
The effect of anti-gravity treadmill training for knee osteoarthritis rehabilitation on joint pain, gait, and EMG
Authors: Liang Junjie , Lang Shijuan , Zheng Yuxin , Wang Yujue , Chen Hongxin , Yang Jinyu , Luo Zhiwei , Lin Qiang , Ou Haining
Published: May 2019

Introduction:

To date, the anti-gravity treadmill (AlterG), as a representative method of Lower body positive pressure (LBPP) treadmills, has been rarely reported for knee osteoarthritis (KOA) rehabilitation. The purpose of this case study was to setup the clinical protocol example for AlterG intervention on KOA and evaluate treatment effectiveness by 3D gait analysis combined with free EMG to explore the kinematic gait parameter changes.

Patient concerns:

A 65-year-old female patient (BMI = 26, mild obesity) undergoing “more than 7 years of KOA.” The activity of the right knee joint was obviously limited and she suffered from severe pain over the past month.

Diagnosis:

Due to the patient's symptoms and radiographic findings, she was diagnosed with acute attack of KOA.

Interventions:

The patient has performed clinical function evaluation and gait analysis combined at pretreatment, post-treatment, and 4 months follow-up assessment. AlterG training was performed 6 days/week for 2 weeks, with up to 30 min of training per session. The training protocol included two major parts, walking and squatting in AlterG.

Outcomes:

After 2 weeks of AlterG intervention, the 10-m walking test (10 MWT) and Timed-up-and-go (TUG) test improved significantly post-treatment, whereas the Visual Analog Scale (VAS) score decreased post-treatment. The Modified Barthel Index improved post-treatment and the patient restored basic community walk after treatment. The temporal parameter results showed that stride length (%height), mean velocity (%height), and cadence gradually increased before treatment, after treatment, and at 4-month follow-up. The right range of motion (ROM) of knee flexion-extension were gradually increased. Meanwhile, the synchronized EMG data showed that the RMS (root means square) values of the rectus femoris, semitendinosus, and biceps femoris at post-treatment were improved to different degrees than at pretreatment.

Conclusion:

We found that for this patient with KOA, AlterG relieved pain, and was also effective at improving spatio-temporal parameters, knee flexion/extension gait pattern, and corresponding muscle strength, thereby restoring certain community activities.