bluuebunny/crossref_metadata_2025 huggingface dataset:
MTX intolerance in children and adolescents with juvenile idiopathic arthritis
Authors: Hügle Boris , van Dijkhuizen E H Pieter
Published: March 2020

MTX is the medication most commonly used for antirheumatic treatment in juvenile idiopathic arthritis. It has high efficacy, is usually well tolerated and has an excellent safety profile. However, frequently intolerance symptoms develop that manifest as nausea, feelings of disgust or abdominal complaints prior to or directly after administration of the medication. No obvious toxicity is causing these intolerance symptoms, but symptoms are strictly limited to MTX and not transferred to other medications. MTX intolerance causes a significant reduction of quality of life in affected patients, frequently puts the treating physician in difficult situations regarding treatment choice, and may lead to uncomfortable decisions whether or not to stop an otherwise effective drug. Conventional countermeasures such as antiemetics, change of route from subcutaneous to oral or vice versa, or taste masking usually have only a limited effect. In this review, we present the current knowledge on MTX intolerance, its clinical picture and commonly employed strategies. We also consider newer behavioural treatment strategies that may offer a more effective symptom control.
Economization of Expert Knowledge about Gender Equality in the European Union
Authors: Elomäki Anna
Published: March 2020

The article analyzes (i) how the increasing demand for empirical evidence about the economic impacts of gender equality transforms expert knowledge about gender equality in the European Union (EU) and (ii) the implications of these transformations. The article argues that the much-debated discursive economization of gender equality in the EU context is underpinned by the economization of expert knowledge about gender equality—the increasing reliance on mainstream economics to support gender equality claims. This has increased the influence of gender-biased economics knowledge and its modes of knowledge production in EU gender equality policy.
State laws matter when it comes to school provisions for structured PE and daily PE participation
Authors: Piekarz-Porter Elizabeth , Lin Wanting , Leider Julien , Turner Lindsey , Perna Frank , Chriqui Jamie F
Published: March 2020

The physical and mental benefits children receive from physical activity have been well documented, and physical education is a key way to ensure that physical activity opportunities are available during the school day. This study evaluates whether state PE laws are associated with school-level practices of requiring structured PE classes and whether students take PE classes daily. State laws were obtained as part of the National Cancer Institute’s Classification of Laws Associated with School Students (CLASS) and were compiled for all 50 states and District of Columbia using Boolean keyword searches in LexisAdvance and WestlawNext. PE time requirements and state daily PE requirements in the laws were subsequently linked to school-required structured PE classes and daily PE in the School Nutrition and Meal Cost Study (SNMCS) Principal Survey. Logistic regression analyses were conducted while controlling for grade level, district child poverty rate, district race/ethnicity, school urbanicity, and school size. The state daily PE analysis also controlled for region. Schools located in a state that required at least 90 min of PE per week at the elementary level or 150 min of PE per week at the middle or high school levels had almost seven times higher odds of requiring structured PE. Schools located in a state that required daily participation of PE had almost five times higher odds of at least some students taking PE daily. State policymakers can utilize these findings to promote laws that require time for PE every week, daily if possible.
Variation in the access to deep soil water pools explains tree-to-tree differences in drought-triggered dieback of Mediterranean oaks
Authors: Ripullone Francesco , Camarero J Julio , Colangelo Michele , Voltas Jordi
Published: March 2020

Individual differences in the access to deep soil water pools may explain the differential damage among coexisting, conspecific trees as a consequence of drought-induced dieback. We addressed this issue by comparing the responses to a severe drought of three Mediterranean oak species with different drought tolerance, Quercus pubescens L. and Quercus frainetto Ten., mainly thriving at xeric and mesic sites, respectively, and Quercus cerris L., which dominates at intermediate sites. For each species, we compared coexisting declining (D) and non-declining (ND) trees. The stable isotope composition (δ2H, δ18O) of xylem and soil water was used to infer a differential use of soil water sources. We also measured tree size and radial growth to quantify the long-term divergence of wood production between D and ND trees and non-structural carbohydrates (NSCs) in sapwood to evaluate if D trees presented lower NSC values. The ND trees had access to deeper soil water than D trees except in Q. frainetto, as indicated by significantly more depleted xylem water values. However, a strong δ2H offset between soil and xylem water isotopes observed in peak summer could suggest that both tree types were not physiologically active under extreme drought conditions. Alternative processes causing deuterium fractionation, however, could not be ruled out. Tree height and recent (last 15–25 years) growth rates in all species studied were lower in D than in ND trees by 22 and 44%, respectively. Lastly, there was not a consistent pattern of NSC sapwood concentration; in Q. pubescens, it was higher in ND trees while in Q. frainetto, the D trees were the ones exhibiting the higher NSC concentration. We conclude that the vulnerability to drought among conspecific Mediterranean oaks depends on the differential access to deep soil water pools, which may be related to differences in rooting depth, tree size and growth rate.
Taxonomic reassessment ofParasesarma(Crustacea: Brachyura: Decapoda: Sesarmidae) based on genetic and morphological comparisons, with the description of a new genus
Authors: Shahdadi Adnan , Fratini Sara , Schubart Christoph D
Published: March 2020

Parasesarma is a species-rich genus whose representatives are common in wetlands and mangroves of the Indo-Pacific. Morphologically, the genus is heterogeneous and has been postulated to constitute a polyphyletic taxon. In the present study, most species of Parasesarma are re-evaluated phylogenetically, using mitochondrial and nuclear molecular markers. The results show that the majority of the examined species cluster consistently with the type species Parasesarma plicatum. However, some species, among them the tree-climbing Parasesarma leptosoma, are clearly separated from this main clade of Parasesarma, forming a second stable monophyletic group, distinct from other known genera. Based on these results, and with additional support by morphological diagnoses highlighting consistent differences between the two species groups, we propose a new genus for the species clustering around P. leptosoma, proposing the new name Leptarma gen. nov.
Intrapopulation Antagonism Can Reduce the Growth and Aggressiveness of the Wheat Head Blight Pathogen Fusarium graminearum
Authors: Vaughan Martha M. , Ward Todd J. , McCormick Susan P. , Orwig Nathane , Hay William T. , Proctor Robert , Palmquist Debra
Published: March 2020

Fusarium graminearum is a causal agent of Fusarium head blight (FHB), a disease that reduces yield and quality of cereal crops and contaminates grain with mycotoxins that pose health risks to humans and livestock. Interpopulation antagonistic interactions between isolates that produce different trichothecene mycotoxins can reduce FHB in wheat, but it is not known if interactions between isolates with a shared population identity that produce the same trichothecenes have a similar effect. Using isolates from the predominant F. graminearum populations in North America (NA1 and NA2), we examined intrapopulation interactions by comparing growth, disease progression, and toxin production of individual isolates with multi-isolate mixes. In vitro, mycelial growth was significantly greater when most NA1 and NA2 isolates were cultured individually versus when cultured as a mixture of isolates from the same population. In susceptible wheat Norm, FHB generally progressed faster in heads inoculated with an individual isolate versus a multi-isolate mixture, but the antagonistic effect of intrapopulation interactions was more pronounced for NA1 than NA2 isolates. By contrast, in moderately resistant wheat Alsen, mixtures of isolates from either population caused obvious reductions in FHB development. Mycotoxin contamination was not consistently affected by intrapopulation interactions and varied depending on the interacting isolates from either population. Our results indicate that antagonistic intrapopulation interactions can influence FHB in controlled environmental conditions. Understanding if the regional composition of pathogen populations similarly influences FHB in the field could improve disease forecasting and management practices.
Reliable Method of Radial and Ulnar Nerve Identification During the Posterior Approach to the Humerus: A Clinical and Cadaveric Correlation Study
Authors: Yingling John M. , Yoon Richard S. , Liporace Frank A.
Published: March 2020

Objective:

To determine the reliability of using “fingerbreadths” and anatomic landmarks as reference points for predictable identification of the radial and ulnar nerves when using the posterior approach to the humerus.

Methods:

A systematic approach using “fingerbreadths” to mark and measure the skin before incision. Two markings were made: the first 4 fingerbreadths proximal to the lateral epicondyle (radial nerve location) and the second 2 fingerbreadths proximal to the medial epicondyle (ulnar nerve location). Once the posterior approach was made, the same fingerbreadths were used on the radial and ulnar sides to identify the radial and ulnar nerves within the deep interval. Measurements were taken at each stage in cadaveric specimens. Clinical correlations followed. Statistical analysis was performed comparing measurements (outer vs. inner) in both cadaveric and clinical specimens.

Results:

Thirty-two elbows evaluated in this study, 20 patients and 12 cadaveric specimens. In the cadaveric specimens, the mean distance of the radial nerve was 7.59 cm from the lateral epicondyle, SD ± 0.17 cm (P= 0.55), and the ulnar 3.68 cm from medial epicondyle, SD ± 0.63 cm (P= 0.302). In the clinical measurements, the radial nerve was 7.46 cm, SD ± 0.48 cm, never within 7.0 cm (P= 0.425), and the ulnar nerve was 3.14 cm, SD ± 0.31 cm (P= 0.051). Statistical analysis yielded no difference between skin marking and actual location in the deep interval, between cadaveric and clinical specimens, observer fingerbreadth widths, or between left or right arms.

Conclusions:

Use of “fingerbreadths” is a reliable, efficient, and reproducible method of identifying both the radial and ulnar nerves during the posterior approach to the humerus.
What Is the Cost of a “Cast Holiday” in Treating Children With Early Onset Scoliosis (EOS) With Elongation Derotation Flexion (EDF, “Mehta”) Casting?
Authors: Fedorak Graham T. , Dreksler Hannah , MacWilliams Bruce A. , D’Astous Jacques L.
Published: March 2020

Introduction:

Serial casting of children with early onset scoliosis (EOS) is an established treatment option. A break from cast treatment often called a “cast holiday,” (CH) is often allowed by some centers, particularly over the summer months. The impact of CHs on treatment duration or outcome has not been examined.

Methods:

Institution review board approved retrospective review of children treated for EOS with elongation derotation flexion (“Mehta”) casting at a children’s hospital between 2001 and 2016 with a minimum of 2 years’ follow-up. A CH was defined as a minimum of 4 weeks out of the cast, braced, or unbraced.

The analysis was performed to determine the impact of a CH within the first 18 months of treatment. Separate analyses were performed for the entire cohort of children castedduring the study period, and then separately looking at idiopathic EOS in isolation. The impact of a CH was assessed in terms of the likelihood of achieving scoliosis <15 degrees at the final follow-up (“success”). Odds ratios were used to assess group differences between “success” ratios, and Student t tests assessed group differences for parametric data.

Results:

Ninety children met inclusion and exclusion criteria, 31 of whom took a CH during the first 18 months of treatment (34%). This included 59 patients with idiopathic EOS (66%), 18 with syndromic EOS, 5 congenital, and 1 neuromuscular. There were no statistically significant differences between CH and no CH groups.

Forty-four percent of the no CH group achieved scoliosis <15 degrees at final follow-up, as opposed to 13% of the CH group, an odds ratio of 5.3 for success without a CH. When limited to children with idiopathic EOS, 56% achieved success in the no CH, versus only 22% in the group that took a CH, an odds ratio of 4.4 for success with no CH.

Conclusion:

This study demonstrates that children treated for EOS with serial casting who take a CH within the first 18 months of treatment are less likely to achieve scoliosis <15 degrees than those who persist with treatment.

Level of Evidence:

Level III.
Distribution of the COVID-19 epidemic and correlation with population emigration from Wuhan, China
Authors: Chen Ze-Liang , Zhang Qi , Lu Yi , Guo Zhong-Min , Zhang Xi , Zhang Wen-Jun , Guo Cheng , Liao Cong-Hui , Li Qian-Lin , Han Xiao-Hu , Lu Jia-Hai
Published: March 2020

Background

The ongoing new coronavirus pneumonia (Corona Virus Disease 2019, COVID-19) outbreak is spreading in China, but it has not yet reached its peak. Five million people emigrated from Wuhan before lockdown, potentially representing a source of virus infection. Determining case distribution and its correlation with population emigration from Wuhan in the early stage of the epidemic is of great importance for early warning and for the prevention of future outbreaks.

Methods

The official case report on the COVID-19 epidemic was collected as of January 30, 2020. Time and location information on COVID-19 cases was extracted and analyzed using ArcGIS and WinBUGS software. Data on population migration from Wuhan city and Hubei province were extracted from Baidu Qianxi, and their correlation with the number of cases was analyzed.

Results

The COVID-19 confirmed and death cases in Hubei province accounted for 59.91% (5806/9692) and 95.77% (204/213) of the total cases in China, respectively. Hot spot provinces included Sichuan and Yunnan, which are adjacent to Hubei. The time risk of Hubei province on the following day was 1.960 times that on the previous day. The number of cases in some cities was relatively low, but the time risk appeared to be continuously rising. The correlation coefficient between the provincial number of cases and emigration from Wuhan was up to 0.943. The lockdown of 17 cities in Hubei province and the implementation of nationwide control measures efficiently prevented an exponential growth in the number of cases.

Conclusions

The population that emigrated from Wuhan was the main infection source in other cities and provinces. Some cities with a low number of cases showed a rapid increase in case load. Owing to the upcoming Spring Festival return wave, understanding the risk trends in different regions is crucial to ensure preparedness at both the individual and organization levels and to prevent new outbreaks.
Evaluation of Assays to Measure Aminoglycosides in Serum: Comparison of Accuracy and Precision Based on External Quality Assessment
Authors: Li Mengya , Ma Lingyun , Chen Chaoyang , Lei Lili , Zhai Xingyu , Luo Daohuang , Zhou Ying , Cui Yimin
Published: March 2020

Background:

Aminoglycosides require highly accurate therapeutic drug monitoring owing to their narrow therapeutic windows and toxic side effects. Therapeutic drug monitoring varies in different laboratories, and this difference is mainly due to the use of different analytical techniques. This study aimed to compare the accuracy and precision of immunoassays for the measurement of gentamicin, tobramycin, and amikacin in serum.

Methods:

Human plasma samples were spiked with known concentrations of amikacin, gentamicin, and tobramycin and dispatched to laboratories worldwide. The percentage deviation and coefficient of variation were calculated to compare the accuracy and precision among immunoassays and among antibiotics.

Results:

We analyzed 273, 534, and 207 amikacin, gentamicin, and tobramycin measurement results, obtained satisfactory rates of 83.9%, 86.3%, and 93.7%, and coefficients of variation ranging from 1.1% to 15.6%, 2.9% to 25.2%, and 1.8% to 27.0%, respectively. The percentage deviation ranged from −7.5% to 6.6%, −20.8% to 18.7%, and −33.2% to 41.5% for amikacin, gentamicin, and tobramycin, respectively. Significant differences were observed in accuracy and precision among assays for all antibiotics.

Conclusions:

This study demonstrated high variations in results obtained from antibiotic assays conducted at different laboratories worldwide.
Summary of NCRP 2019 Annual Meeting, NCRP Meeting the Challenge at 90: Providing Best Answers to Your Most Pressing Questions About Radiation
Authors: Vetter Richard J. , Bushberg Jerrold T. , Mettler Fred A.
Published: March 2020

The National Council on Radiation Protection and Measurements (NCRP) held its 55th Annual Meeting 1-2 April 2019 in Bethesda, Maryland. The 2019 meeting was a special year for NCRP as it marked the 90th Anniversary of the founding of the predecessor organization, US Advisory Committee on X-Ray and Radium Protection. Leaders for the scientific portion of the meeting were Fred A. Mettler, Jr., M.D. (Chair), University of New Mexico School of Medicine; Jerrold T. Bushberg, Ph.D. (Co-Chair), University of California Davis; and Richard J. Vetter, Ph.D. (Co-Chair), Mayo Clinic. The meeting was designed to explore important areas of inquiry associated with use of ionizing radiation relevant to radiation protection, addressing frequently asked questions and concerns from both members of the public and radiation professionals. The meeting was organized into six sessions plus three honorary lectures and a special presentation. This paper summarizes the scientific content of the six sessions and is based on the notes of the co-chairs and the slides of the speakers. The three honorary lectures are included as other papers in this issue.
CASE OF IDIOPATHIC UVEAL EFFUSION THAT DEVELOPED PROLIFERATIVE DIABETIC RETINOPATHY AFTER SCLERAL RESECTION SURGERY
Authors: Baba Takayuki , Yamamoto Shuichi
Published: March 2020

Background/Purpose:

To report a diabetic patient with uveal effusion that developed proliferative diabetic retinopathy after unsuccessful scleral resection for the uveal effusion.

Case Report:

A 50-year-old Japanese man with nonproliferative diabetic retinopathy and uveal effusion in his right eye underwent partial thickness sclerectomies at the four quadrants to treat the uveal effusion. These procedures reduced the amount of subretinal fluid and thus the choroidal and retinal detachment. However, the retinal detachment recurred and proliferative diabetic retinopathy developed with pre- and subretinal proliferation at 5 months after the surgery. The patient then underwent pars plana vitrectomy combined with phacoemulsification and implantation of an intraocular lens. During the surgery, the vasoproliferative membrane was removed, panretinal photocoagulation was performed, and intraocular tamponade with silicone oil was performed. After the removal of the silicone oil, the retina remained attached but the visual acuity was 2/20 because of macular atrophy.

Conclusion:

Clinicians should be aware that treatment of a uveal effusion by scleral resection can lead to a progression of nonproliferative diabetic retinopathy to proliferative diabetic retinopathy.
Epidemic and Inter-epidemic Burden of Pediatric Human Parechovirus Infection in New South Wales, Australia, 2017–2018
Authors: Khatami Ameneh , Burrell Rebecca , McMullan Brendan J. , Rawlinson William , Givney Rodney C. , Kok Jen , Alexandersen Soren , Jones Cheryl A. , Macartney Kristine K. , Britton Philip N.
Published: March 2020

Background:

Human parechovirus (HPeV) typically infects young children, and although infection is often asymptomatic, some types (eg, HPeV3) are associated with severe clinical manifestations, including central nervous system infection or sepsis-like syndrome, particularly affecting young infants. The third documented national epidemic of HPeV occurred in Australia in 2017–2018.

Methods:

Four public laboratories that perform almost all of the HPeV PCR testing in New South Wales provided data regarding HPeV tests performed from July 1, 2017 to June 30, 2018. Limited demographic and clinical data were obtained from electronic medical records for laboratory test-positive cases that presented to each of the 3 pediatric hospitals in New South Wales.

Results:

Five hundred eighty-one HPeV-positive samples obtained from 395 cases were included in the analysis. The peak of the outbreak occurred in late November 2017 (approximately 35 new cases each week), with the main HPeV epidemic occurring between the spring and summer months of September 2017 to January 2018; although this seasonality was observed primarily in infants less than 12 months of age. Among the 388 pediatric cases, almost half were younger than 2 months (188; 47%) and only 10 were children older than 2 years. The annualized estimated incidence of laboratory confirmed HPeV infection in children was approximately 142.4 cases per 100,000 children younger than 5 years in New South Wales during the epidemic season.

Conclusions:

The large burden of HPeV infection and disease identified in young infants in this and previous Australian studies highlight the need for more comprehensive national surveillance of HPeV infections and improved prevention strategies.
Prevalence and Risk Factor for Antibiotic-resistant Escherichia coli Colonization at Birth in Premature Infants
Authors: Koizumi Aya , Maruyama Kenichi , Ohki Yasushi , Nakayama Akifumi , Yamada Yoshiyuki , Kurosawa Hajime , Tsukagoshi Hiroyuki , Fujiu Toru , Takahashi Miki , Kimura Takao , Saruki Nobuhiro , Murakami Masami , Arakawa Hirokazu
Published: March 2020

Background:

Escherichia coli causes neonatal early-onset sepsis (EOS) that is associated with high mortality and increasing antibiotic resistance. Thus, we estimated the prevalence, antibiotic susceptibility and risk factors for colonization of E. coli in premature infants at birth and characterized the pathogenicity of the isolates.

Methods:

A prospective surveillance study was conducted at three Japanese perinatal centers between August 2014 and February 2017. Infants weighing <2 kg and/or at gestational age <35 weeks at birth were enrolled. We screened the mothers and neonates for E. coli colonization. Pulsed-field gel electrophoresis was used to analyze the relatedness between the maternal and neonatal isolates. Virulence factors for the isolates were determined using polymerase chain reaction.

Results:

We enrolled 421 premature infants born to 382 mothers. The rate of colonization in mothers was 47.6%, comprising 5.9% extended-spectrum beta-lactamase-producing E. coli (ESBL-E) and 20.0% ampicillin-resistant strains. Ten (2.4%) infants exhibited colonization; ESBL-E and ampicillin-resistant strains colonized three and four infants, respectively. Three antibiotic-resistant, strain-positive infants developed EOS. Pulsed-field gel electrophoresis revealed vertical transmission of bacteria in four infants. Multivariate logistic regression analysis revealed that ESBL-E-positive mothers [odds ratio (OR), 19.2; 95% confidence interval (CI), 2.5–145.7)] and vaginal delivery (OR, 9.4; 95% CI, 1.7–50.7) were risk factors for neonatal colonization. The infant isolates possessed numerous virulence factors.

Conclusions:

Although the prevalence of E. coli-colonized premature infants at birth was low, the rate of antibiotic resistance and the attack rate for EOS were high. Infants with ESBL-E positive mothers should be closely monitored for EOS.
Hearing Preservation Outcomes and Prognostic Factors in Acoustic Neuroma Surgery: Predicting Cutoffs
Authors: Zanoletti Elisabetta , Mazzoni Antonio , Frigo Anna Chiara , Borsetto Daniele , Cazzador Diego
Published: March 2020

Objective:

To investigate the outcomes of hearing preservation surgery (HPS) for acoustic neuroma and quantify tumor and patient characteristics predictive of hearing preservation after surgery.

Study Design:

Retrospective study.

Setting:

Tertiary referral center.

Patients:

A total of 100 consecutive patients diagnosed with acoustic neuroma from 2000 to 2012.

Intervention:

Hearing preservation surgery through microscopic retrosigmoid approach combined with a retrolabyrinthine meatotomy.

Main Outcome Measure:

Pre- and postoperative hearing stratified according to the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) and the Tokyo classifications. The most accurate cutoff was identified for each tumor and patients’ variable affecting the outcome by calculating the Youden index. A multivariable analysis was undertaken at these cutoffs to identify prognostic factors for hearing preservation.

Results:

Preoperative hearing class was preserved after surgery in 31% (AAO-HNS), and 39% (Tokyo classification) of patients. According to the AAO-HNS classification, the tumor size in the cerebello-pontine angle, pure-tone average (PTA), and speech discrimination score cutoffs for predicting good postoperative hearing function were 7 mm, 21 dB, and 90%, respectively. With the Tokyo classification, only the PTA cutoff differed, with 27 dB. On multivariable analysis, tumor size and PTA were independent prognostic factors for postoperative hearing with high model's goodness of fit (area under the curve  = 0.784; 95% CI = 0.68–0.88 and area under the curve  = 0.813; 95% CI = 0.72–0.90), according to both the hearing classifications.

Conclusions:

The estimated cutoffs for tumor size and PTA were independently associated with HPS. These factors should be prospectively investigated before they are adopted as selection criteria for HPS.
The efficacy of manual therapy (Chuna) for chronic obstructive pulmonary disease
Authors: Roh Ji-Ae , Kim Kwan-Il , Park Jihye , Lee Beom-Joon , Jung Hee-Jae
Published: March 2020

Background:

Chronic obstructive pulmonary disease (COPD) is a challenging disease whose prevalence has increased over the last decades. Non-pharmacological therapies such as pulmonary rehabilitation occupy a core position in patient management. Among these therapies, manual therapy reduces symptoms and increases exercise capacity targeting musculoskeletal problems. Chuna, a traditional Korean manual therapy, has improved pulmonary disorders in clinical practice but unfortunately has not had its effects reported. This systematic review aims to evaluate the effectiveness and safety of manual therapy, focused on the use of Chuna in the management of COPD patients.

Methods:

The following databases will be used in this study: MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Database (CNKI), KoreaMed, Korean Medical Database (KMbase), and Oriental Medicine Advanced Searching Integrated System (OASIS). The primary outcome comprises lung function and exercise capacity. Secondary outcomes included symptoms, quality of life, and adverse events. We will include randomized controlled trials (RCTs) and crossover studies. Two independent reviewers will screen the searched studies, determine if they are suitable for inclusion, and perform data extraction. The risk of bias will be assessed using the Cochrane risk of bias tool. When appropriate, data will be pooled across studies for meta-analysis using a fixed or random effects model. When quantitative synthesis is not appropriate, the evidence will be summarized qualitatively.

Results:

This study will provide a comprehensive review of the available evidence to assess the efficacy of Chuna for COPD patients. Results will be published in a peer-reviewed journal and disseminated electronically and in print.

Conclusions:

This study will provide high-quality current evidence for evaluation the efficacy of Chuna for patients with COPD. Clinicians, patients and policy makers may find this review useful in making decisions regarding the use of Chuna for patients with COPD.

PROSPERO registration number:

CRD42019141150
Percutaneous sclerotherapy with polidocanol under the guidance of ultrasound for venous malformations in children – A retrospective cohort study from a single tertiary medical center
Authors: Hou Fang , Chen Jidong , Xia Meng , Ding Ke , Zeng Qiang , Liu Wenying
Published: March 2020

This study reports our experience, the therapeutic outcomes and complications of percutaneous sclerotherapy (PS) with polidocanol to treat venous malformations (VMs) in children.

A retrospective analysis was conducted of pediatric patients with VMs who underwent PS using polidocanol under continuous ultrasound (US) guidance between January 2015 and January 2018 at our department. Medical records were reviewed to record demographic information, lesion characteristics, treatment sessions, therapeutic outcomes and complications. χ2analysis was employed to evaluate the effects of these characteristics on outcomes.

Hundred treatment sessions were performed for lesions in 47 patients. The mean age of the patients was 4.1 ± 3.6 years (mean ± SD). The female to male ratio was almost 2:1 (female 32, male 15). The location of the VMs included the head and neck in 16 cases (34.0%), upper extremity in 11 cases (23.4%), lower extremity in 10 cases (21.3%), and trunk and perineum in 10 cases (21.3%). The majority of the lesions were focal in 36 cases (76.6%), while 11 (23.4%) were diffuse. Seventeen patients (36.2%) underwent single PS session, 14 patients (29.8%) underwent 2 sessions, 10 patients (21.3%) underwent 3 sessions and 6 patients (12.7%) underwent ≧4 sessions. The mean PS session per patient was 2.1 ± 1.1. The mean follow-up duration was 11.4 ± 7.6 months. After the last PS session, 8 patients (17.0%) had excellent outcomes, 27 (57.4%) had good outcomes, 10 (21.3%) had fair outcomes, and 2 (4.3%) had poor outcomes. Focal lesions were more likely to have good or excellent outcomes than diffuse lesions (χ2 = 4.522,P = .033). No other lesion characteristic significantly affected the outcomes (good or excellent outcomes), including lesion location (χ2 = 2.011,P = .570) or lesion size (χ2 = 1.045,P = .307). After the PS procedure, temporary local swelling occurred in 81 sessions (81.0%), local pain occurred in 15 sessions (15.0%), fever occurred in 27 (27.0%) sessions, and transient local numbness occurred in four sessions (4.0%).

PS with polidocanol under the guidance of US appears to be safe and effective for the treatment of VMs in children, especially for focal lesions.
Effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome in premature infants aged 32 to 36 weeks
Authors: Yang Guang , Hei Mingyan , Xue Zhimin , Zhao Yuan , Zhang Xinhua , Wang Chenghu
Published: March 2020

To explore the clinical effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome (RDS) in premature infants aged 32 to 36 weeks.

A total of 97 premature infants with RDS admitted to the Children's Hospital of Shanxi from February 2017 to January 2018 were randomly divided into LISA (47 cases) and (intubation-surfactant-extubation,) INSURE groups (50 cases). In the LISA group, 6F gastric tubes were inserted into the trachea through direct laryngoscopy under nasal continuous positive airway pressure (NCPAP), and pulmonary surfactant (PS) was injected. In the INSURE group, PS was injected via tracheal intubation and NCPAP was performed after extubation. The incidence of technical-related adverse events and various complications in the two groups were observed.

PS was successfully injected through gastric tube in the LISA group. There were no significant differences in reflux, asphyxia, bradycardia (<100 beats/min), apnea, FiO2, changes in PaO2 and PaCO2 at 1 hour post-treatment between the groups. During the course of administration, blood pressure and SpO2 in the LISA group were more stable, and significant differences between the 2 groups were observed. However, no significant differences in the complications and outcomes between the 2 groups occurred.

The LISA technique can be used to treat premature infants with RDS aged 32 to 36 weeks with stronger spontaneous breathing ability. Further clinical studies are required to determine the optimal strategy of LISA administration and the most profitable patient population.
Age, absolute CD4 count, and CD4 percentage in relation to HPV infection and the stage of cervical disease in HIV-1-positive women
Authors: Chambuso Ramadhani , Ramesar Raj , Kaambo Evelyn , Murahwa Alltalents T. , Abdallah Mohammed O.E. , De Sousa Michelle , Denny Lynette , Williamson Anna-Lise , Gray Clive M.
Published: March 2020

A subgroup of women who are co-infected with human immunodeficiency virus type 1 (HIV-1) and human papillomavirus (HPV), progress rapidly to cervical disease. We characterized HPV genotypes within cervical tumor biopsies, assessed the relationships of cervical disease stage with age, HIV-1 status, absolute CD4 count, and CD4 percentage, and identified the predictive power of these variables for cervical disease stage in a cohort of South African women.

We recruited 181 women who were histologically diagnosed with cervical disease; 87 were HIV-1-positive and 94 were HIV-1-seronegative. Colposcopy-directed tumor biopsies were confirmed by histology and used for genomic DNA extraction. The Roche Linear Array HPV genotyping test was used for HPV genotyping. Peripheral whole blood was used for HIV-1 rapid testing. Fully automated FC500MPL/CellMek with PanLeucogate (PLG) was used to determine absolute CD4 count, CD4 percentage, and CD45 count. Chi-squared test, a logistic regression model, parametric Pearson correlation, and ROC curves were used for statistical analyses. We used the Benjamini-Horchberg test to control for false discovery rate (FDR, q-value). All tests were significant when bothPand q were <.05.

Age was a significant predictor for invasive cervical cancer (ICC) in both HIV-1-seronegative (P < .0001, q < 0.0001) and HIV-1-positive women (P= .0003, q = 0.0003). Sixty eight percent (59/87) of HIV-1-positive women with different stages of cervical disease presented with a CD4 percentage equal or less than 28%, and a median absolute CD4 count of 400 cells/μl (IQR 300–500 cells/μl). Of the HIV-1-positive women, 75% (30/40) with ICC, possessed ≤28% CD4 cells vs 25% (10/40) who possessed >28% CD4 cells (bothP < .001, q < 0.001). Furthermore, 70% (28/40) of women with ICC possessed CD4 count >350 compared to 30% (12/40) who possessed CD4 count ≤ 350 (bothP < .001, q < 0.001).

Age is an independent predictor for ICC. In turn, development of ICC in HIV-1-positive women is independent of the host CD4 cells and associates with low CD4 percentage regardless of absolute CD4 count that falls within the normal range. Thus, using CD4 percentage may add a better prognostic indicator of cervical disease stage than absolute CD4 count alone.
The aura of malignant tumor
Authors: Li Weizheng , Wu Changliang , Qin Mengbin , Cai Fuqing , Huang Jiean
Published: March 2020

The global incidence of pyogenic liver abscess (PLA) is increasing, but related reports of malignant tumor-related PLA are infrequent. Potential malignant tumors of PLA have been reported, but there is no relevant predictive model for this subsection of patients.

To explore the risk factors of malignant tumor-related PLA.

A retrospective analysis about a total of 881 patients who had been diagnosed with PLA from January 2005 to May 2018 was performed. The incidence of malignant tumor-related PLA in the study was 9.99% (88/881) out of all PLA cases. And that of potential malignant tumors with PLA was 4.65% (41/881). There were 62 patients with malignant tumor-related PLA in the observation group, while 146 cases without malignant tumor-related PLA were considered as control group. The data from 52 cases of malignant tumor and nonmalignant tumor-related PLA was verified.

The malignant tumor type was mainly hepatobiliary malignant tumor, which occupies 72.3% (45/62) in all malignant tumor related PLA cases used to the model. Compared with nonmalignant tumor group, the rate of ineffective and mortality was higher in the malignant tumor group [19.4%(12/62) vs 7.5%(11/148),P = .01]. Multivariate analysis suggested that hepatobiliary interventional therapy or surgery, hepatitis B virus infection, multiple abscesses, portal embolism, and bile duct dilatation were independent risk factors for potential malignant tumors within the patients who combined with PLA.

PLA could be considered as an early warning sign of potential malignant tumors. Malignant tumor-related PLA had a poor prognosis. Patients with PLA who have more than one independent risk factor or logit(P) > −1.694 may be considered as the high risk group for potential hepatobiliary or colorectal malignant tumors.
Taxane-based or platinum-based combination chemotherapy given concurrently with radiation followed by surgery resulting in high cure rates in esophageal cancer patients
Authors: Lopez Anthony , Harada Kazuto , Chen Hsiang-Chun , Bhutani Manoop S. , Weston Brian , Lee Jeffrey H. , Maru Dipen M. , Chin Foo Wai , Rogers Jane E. , Thomas Irene , Amlashi Fatemeh G. , Blum-Murphy Mariela A. , Rice David C. , Zhao Meina , Hofstetter Wayne L. , Nguyen Quynh , Ajani Jaffer A.
Published: March 2020

Background:

Preoperative chemoradiotherapy (CRT) is one standard option for localized esophageal or gastroesophageal junction (GEJ) cancer patients but an optimal concurrent chemotherapy combination is not established.

Methods:

412 patients with resectable (cT1N1M0 or cT2-4N0-3M0) esophageal or GEJ cancer treated at the MDACC between October 2002 and June 2016 were analyzed. Exposures: CRT with DF or FOX followed by surgery (trimodality; TMT). Main outcomes and measures: Primary endpoints were overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox analyses were performed.

Results:

Of the 412 patients analyzed, 264 (64%) received DF and 148 (36%) FOX. The median age was 60 years, and 95% had adenocarcinoma. The clinical complete response, positron-emission tomography response, and pathologic complete response rates were 73%, 73%, and 30%, respectively. Median follow-up was 60.4 months. Median OS for the entire cohort was 81.6 months (95% confidence interval [CI], 56.3–122.0); 81.6 months (95% CI, 55.9–not estimable) for the DF group and 67.7 months (95% CI, 41.6–not estimable) for the FOX group (P = .24). The median DFS was 45.6 months (95% CI, 33.1–61.7) for the entire cohort; 49.5 months (95% CI, 38.6–70.3) for DF and 33.0 months (95% CI, 18.1–70.4;P = .38) for FOX. Higher tumor location (unfavorable) and clinical complete response (favorable) were prognostic for both OS and DFS in the multivariate analysis.

Conclusion:

At our high-volume center, the outcome of 412 TMT esophageal cancer patients was excellent. Taxane-based chemotherapy produces nonsignificant favorable trend.
Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery
Authors: Sigdel Shailendra , Ozaki Akihiko , Basnet Madindra , Kobashi Yurie , Pradhan Bishwas , Higuchi Asaka , Uprety Anup
Published: March 2020

Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients’ desire to obtain information related to their heart surgery.

This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.

In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15–0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01–5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67–0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01–1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21–1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.

The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.
A systematic review and meta-analysis for Chinese herbal medicine Duhuo Jisheng decoction in treatment of lumbar disc herniation
Authors: Sun Kai , Huang Fasen , Qi Baoyu , Yin He , Tang Bin , Yang Bowen , Chen Lin , Zhuang Minghui , Wei Xu , Zhu Liguo
Published: March 2020

Background:

Lumbar disc herniation (LDH) is 1 of the most common diseases in orthopedics, which seriously affects people's daily life and brings a heavy burden on society and families. Chinese herbal medicine has been used in clinical practice for a long time and Duhuo Jisheng Decoction (DHJSD) is believed to help alleviate the symptoms of LDH. This systematic review aims to collect evidences from randomized clinical trials and evaluate the efficacy of DHJSD on LDH in order to provide a reference for clinicians and researchers.

Methods:

We will comprehensively search the 8 electronic databases until December 2019 to identify related randomized controlled trials, including 4 foreign databases (PubMed, MEDLINE, EMBASE, Cochrane Library) and 4 Chinese databases (China National Knowledge Infrastructure Database, VIP Database, Wanfang Database and China Biology Medicine disc). The data of the World Health Organization International Clinical Trial Registry Platform and the Chinese Clinical Trial Registry also will be searched. The primary outcomes are Japanese Orthopaedic Association scores and visual analog scale scores. The risk of bias will be assessed using the Cochrane Collaboration tool. RevMan (V.5.3) software will be used for meta-analysis.

Results:

This study will report the results of DHJSD for the treatment of LDH from the literature screening, the basic information of the included studies, the risk of bias of the included studies, treatment effects, safety, and so on.

Conclusion:

This systematic review will evaluate the effectiveness and safety of DHJSD for the treatment of LDH and provide the latest evidence for its clinical application.

Ethics and dissemination:

This is a literature-based study, therefore it does not require ethical approval.

PROSPERO registration number:

CRD42019147302.
Randomized controlled trial for the efficacy of electroacupuncture in the treatment of urge urinary incontinence
Authors: Huang Yu , Qi Shuangjin , Wu Xianming , Zhi Na , He Ting , Shen Miaoxian , Yang Shuo , Mo Qian
Published: March 2020

Background:

Despite that the urge urinary incontinence (UUI) is a nonfatal disease, it can lead to anxiety, embarrassment and depression to the patient. UUI is a common public health problem that can significantly affect the quality of life of the patient. Several conservative treatments have been recommended for the treatment of UUI; however, their efficiency remains unclear, leaving the disease without a real effective treatment. The clinical application of acupuncture to treat UUI is currently considered an effective approach despite the limited evidence that support its efficiency. The aim of this study is to assess the efficacy and safety of electroacupuncture therapy in the treatment of UUI.

Methods and analysis:

A randomized, parallel, controlled study will be performed. Patients with UUI treated with electroacupuncture group (EA) will compare with the sham-treated sham EA (SA) patients. A total of 100 participants with UUI will be randomly allocated to either the EA or the SA group with a 1:1 ratio. The treatment of UUI patients will performed 3 times per week, for 8 weeks in 30-minute sessions. At the end of the treatment the patients will be followed-up until week 32. The primary outcomes include scores of incontinence questionnaire-short form, the average 24-hour urgency incontinence episodes, and the average 24-hour urge episodes responses from baseline until the 4th, 8th , 24th, and 32nd week. The secondary outcomes included the average 24-hour urine volume and the average 24-hour micturition frequency responses from baseline until the 8th and 32nd week, as well as the change in incontinence quality of life scores from baseline at the 8th and 32nd week. In addition, the degree of satisfaction of the participants undergoing acupuncture treatment will be measured at the 4th and 8th week. The participants’ clinical acupuncture expectations were evaluated at baseline, and the questionnaire for urinary incontinence diagnosis was used to identify stress incontinence, mixed urinary incontinence, and urge incontinence at baseline.

Discussion:

This is a randomized, controlled, observer-blinded trial of electroacupuncture treatment for UUI. The results of this trial will provide more evidence on whether electroacupuncture is efficacious for treating UUI.
Increased risk of herpes zoster in patients with peptic ulcers
Authors: Jin Young Ju , Park Bumjung , Park Il-Seok , Choi Hyo Geun
Published: March 2020

The purpose of this study was to investigate the association of herpes zoster infection with peptic ulcer disease in a Korean population.

The Korean National Health Insurance Service selects samples directly from the entire Korean population database, and 1,125,691 participants with 114,369,638 medical claim codes were selected from the entire Korean population (50 million). A total of 127,802 peptic ulcer disease participants were matched with 127,802 control participants at a ratio of 1:1, considering age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia. We analyzed stratified Cox proportional hazard models to calculate the hazard ratios of peptic ulcer with respect to herpes zoster. For subgroup analyses, we divided the participants by age, sex, and time periods after the index date.

The rate of herpes zoster was higher in the peptic ulcer group (9.1% [11,669/127,802]) than in the control group (7.4% [9,397/127,802], P < .001). The adjusted hazard ratio of herpes zoster was 1.24 (95% CI = 1.21–1.28, P < .001). In subgroup analyses performed according to age and sex, all crude and adjusted hazard ratios of herpes zoster were higher in the peptic ulcer disease group than in the control group (each P < .05). In another subgroup analysis according to follow-up periods, the crude and adjusted hazard ratios of herpes zoster were higher in the peptic ulcer disease group than in the control group except for < 1 year periods after the index dates (each P < .001).

The hazard ratios of herpes zoster were significantly increased in the peptic ulcer group compared with those in the control group in all age and sex groups.