bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupuncture methods for diabetic peripheral neuropathy
Authors: Jiang Hai Lun , Zhang Qiang , Du Yu Zheng , Meng Xiang Gang , Ban Hai Peng , Lu Yang Tao
Published: March 2021

Background:

Many clinical trials and systematic reviews have suggested that acupuncture (include moxibustion) could be effective in the treatment of diabetic peripheral neuropathy (DPN). However, clinical practices vary greatly leads to different choices which are mainly based on personal experience. The aim of this Bayesian network meta-analysis is to compare the efficacy of different acupuncture methods for DPN.

Methods:

Randomized controlled trials on acupuncture treatment of DPN published before January of 2021 will be searched in 9 databases including Medline, Web of Science, PubMed, Cochrane Library, Excerpta Medica Database, Sinomed, China National Knowledge Infrastructure, WanFang, and China Science and Technology Journal Database. The methodological assessment performed using the risk of bias assessment tool of Cochrane, and the level of evidence quality for the main results will be evaluated by a recommended grading, evaluation, formulation, and evaluation system approach. Bayesian network meta-analysis will be conducted using STATA V.14.0 and WinBUGS V.1.4.3.

Results:

The primary outcome involves: clinical efficacy. The secondary outcomes include: motor nerve conduction velocity, sensory nerve conduction velocity, Toronto clinical scoring system, Michigan neuropathy screening instrument, the modified Toronto Clinical Neuropathy Scale, the Utah early neuropathy scale, or the neuropathy disability score, and adverse reactions.

Conclusion:

To find the most effective acupuncture therapy for the treatment of DPN supported by evidence-based medicine.
Correlation between the sulfamethoxazole-trimethoprim resistance of Shigella flexneri and the sul genes
Authors: Ma Quanping , Zhu Chengbao , Yao Mingxiao , Yuan Guangying , Sun Yuguo
Published: March 2021

The aim of this study was to discuss the correlation between the sulfamethoxazole-trimethoprim resistance of Shigella flexneri (S. flexneri) and the antibiotic resistance genes sul1, sul2, and sul3 and SXT element.

From May 2013 to October 2018, 102 isolates of S. flexneri were collected from the clinical samples in Jinan. The Kirby–Bauer (K-B) test was employed to determine the antibiotic susceptibility of the S. flexneri isolates. The antibiotic resistance rate was analyzed with the WHONET5.4 software. The isolates were subject to the PCR amplification of the sul genes (sul1, sul2, and sul3) and the SXT element. On the basis of the sequencing results, the correlation between the sulfamethoxazole-trimethoprim resistance of the S. flexneri isolates and the sul genes was analyzed.

The antibiotic resistance rates of the 102 S. flexneri isolates to ampicillin, streptomycin, chloramphenicol, tetracycline, and sulfamethoxazole-trimethoprim were 90.2%, 90.2%, 88.2%, 88.2%, and 62.7%, respectively. The antibiotic resistance rates of these isolates to cefotaxime, ceftazidime, and ciprofloxacin varied between 20% and 35%. However, these isolates were 100% susceptible to cefoxitin. Positive fragments were amplified from 59.8% (61/102) of the 102 S. flexneri isolates, the sizes of the sul1 and sul2 genes being 338 bp and 286 bp, respectively. The sequence alignment revealed the presence of the sul1 and sul2 genes encoding for dihydrofolate synthase. The carrying rate of the sul1 gene was 13.7% (14/102), and that of the sul2 gene was 48.0% (49/102). No target gene fragments were amplified from the 3 isolates resistant to sulfamethoxazole-trimethoprim. The sul3 gene and SXT element were not amplified from any of the isolates. The testing and statistical analysis showed that the resistance of the S. flexneri isolates to sulfamethoxazole-trimethoprim correlated to the sul1 and sul2 genes.

The acquired antibiotic resistance genes sul1 and sul2 were closely associated with the resistance of the 102 S. flexneri isolates to sulfamethoxazole-trimethoprim.
Necrotizing fasciitis secondary to lake water inoculation with Aeromonas sobria
Authors: Hutchinson Lauren E. , Franke Jacob D. , Mailey Brian A.
Published: March 2021

Rationale:

Necrotizing fasciitis (NF) is a rapidly progressing bacterial soft tissue infection with a high mortality rate. It is characterized by significant soft tissue destruction with associated sepsis. The mainstay of treatment is coverage with appropriate broad-spectrum antibiotic therapy and emergent surgical debridement.

Patient concerns:

A previously healthy 66-year-old female presented with a deep laceration to her right, posterior calf with subsequent contamination with lake water. After the wound was irrigated and closed, the patient developed NF.

Diagnosis:

Laceration of the right lower extremity complicated by NF secondary to Aeromonas sobria.

Interventions:

The patient underwent emergent surgical debridements with intravenous broad-spectrum antibiotics and negative pressure wound therapy. The lower extremity was reconstructed with split-thickness skin grafts.

Outcomes:

The patient's initial penetrating trauma was closed in the emergency room, and the patient was discharged home with antibiotics. She returned the next day with unstable vitals and was admitted to the intensive care unit. Her condition continued to deteriorate, and she underwent serial surgical debridements. Her condition improved and was discharged home after 13 days in the hospital.

Lessons Learned:

Close monitoring for NF is important for tissue infections sustained in aquatic environments. Timely identification and surgical management of NF increases overall survival.
Dacryoendoscopy-guided re-canalization of canaliculops
Authors: Kitada Tomoko , Mimura Masashi , Takahashi Yasuhiro , Takagi Mai , Oku Hidehiro , Ikeda Tsunehiko
Published: March 2021

Rationale:

Canaliculops is a rare condition, and only 11 cases have been reported previously. We report 2 cases of canaliculops, which were successfully treated using the new recanalization technique under dacryoendoscopy followed by bicanalicular lacrimal intubation.

Patient concerns:

A 78-year-old man and a 76-year-old woman had 3- and 1-year histories of medial-upper eyelid swelling (left and right, respectively) without any inflammatory signs, history of periocular trauma, herpes infection, use of specific drugs, or ophthalmic diseases of note.

Diagnoses:

The cystic lesions were evaluated using ultrasound biometry or computed tomography to find the lumen of the horizontal canaliculus was exceedingly expanded, and to confirm the clinical diagnosis of canaliculops.

Interventions:

As the 2 cases of canaliculops were caused by upper puncta and common canaliculus obstructions, canaliculops of the upper eyelid were recanalized under dacryoendoscopic guidance, followed by bicanalicular intubation. The tubes were kept in situ involving bi-weekly irrigation and instillation of antibiotic and anti-inflammatory eye drops, and were removed after 2 to 3 months of follow-up.

Outcomes:

Epiphora, and eyelid swelling were completely resolved immediately after the procedure, and the lesions did not recur on follow-up after more than 6 months.

Lessons:

Eleven case series of canaliculops have been described previously, but this is the first report of this recanalization procedure offering a new, less invasive treatment option compared to complete or partial resection of the cystic lesion.
Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis
Authors: Bai Zixing , Yang Yanjun , Chen Si , Dong Yongli , Cao Xuhan , Qin Weikai , Sun Weidong
Published: March 2021

Background:

Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion.

Objective:

To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis.

Methods:

We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software.

Results:

A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = −2.31, 95% CI:−4.63, −2.21), intraoperative blood loss (MD = −43.37, 95%CI: −48.49, −38.25), hospital stay (MD = −1.80, 95%CI: −2.28, −1.33), and visual analog scale score (MD = −1.75, 95%CI: −2.04, −1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001).

Conclusion:

Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application.

PROSPERO registration number:

CRD42020195727.
Bivalirudin in patients undergoing percutaneous coronary intervention and independent predictors of postoperative adverse events in these patients
Authors: Hu Yue-cheng , Yao Wei-jie , Jin Dong-xia , Zhang Jing-xia , Wang Le , Zhang Rui , Xu Jing-han , Cong Hong-liang
Published: March 2021

The efficacy and safety of bivalirudin in percutaneous coronary intervention (PCI) has always been a hot topic in perioperative antithrombotic therapy, but there are still some controversies. So studies are needed to provide more evidence, especially the real world study which includes patients excluded from previous RCT studys. Our study aimed to investigate these information and analyze the independent predictors of postoperative adverse events.

A retrospective study enrolled 1416 patients underwent PCI in Tianjin Chest Hospital from May 2016 to October 2017. The incidence of stent-thrombosis and net clinical adverse events, including all-cause death, myocardial infarction, stroke, urgent target-vessel revascularization and bleeding, were followed up for 30 days and 1 year. Logistic regression and COX regression were respectively used to analyze independent predictors of bleeding events within 30-days, and independent predictors of Major adverse cardiovascular and cerebrovascular events (MACCE) in patients with stent implantation within 1-year.

Seven hundred six patients were treated with bivalirudin while 710 with unfractionated heparin (UFH). The proportions of diabetes, hypertension, anemia, myocardial-infarction history, PCI history, moderate-to-severe renal-impairment, gastrointestinal-bleeding history in the bivalirudin group were significantly higher (P < .05). Women, anemia were independent risk factors for bleeding within 30-days (P < .05). Among 682 patients with stent implantation in bivalirudin group, anemia, Body Mass Index (BMI) >25 kg/m2, KILLIP ≥2, ejection fraction (EF) <45%, eGFR <60 ml/minutes were independent risk factors for MACCE, while Statins, proton pump inhibitor (PPI) were independent protective factors for MACCE with-in 1-year (P < .05).

Bivalirudin have good anticoagulant effect and lower bleeding risk during PCI, especially in patients with higher bleeding risk. In patients treated with bivalirudin, female, anemia were independent predictors of bleeding within 30-days, BMI >25 kg/m2, anemia, KILLIP ≥2, EF <45%, eGFR <60 ml/minutes were independent risk factors and Statins, PPI were independent protective factors of MACCE within 1-year.
The value of repeated CT in monitoring the disease progression in moderate COVID-19 pneumonia
Authors: Gao Yang , Hu Yuxiong , Zhu Junteng , Liu Huan , Qiu Rongxian , Lin Qunying , He Xiongzhi , Lin Hai-Bin , Cheng Shiming , Li Guangxi
Published: March 2021

The role of thoracic CT (computerized tomography) in monitoring disease course of COVID-19 is controversial. The purpose of this study is to investigate the risk factors and predictive value of deterioration on repeatedly performed CT scan during hospitalization.

All COVID-19 patients treated in our isolation ward, from January 22, 2020 to February 7, 2020, were reviewed. Patients included were categorized into RD (Radiological Deterioration) group or NRD (No Radiological Deterioration) group according to the manifestation on the CT routinely performed during the hospitalization. All clinical data and CT images were analyzed.

Forty three patients were included in our study. All are moderate cases with at least 4 CT scans each. Eighteen (42.9%) patients had radiological deteriorations which were all identified in CT2 (the first CT after admission). Patients in RD group had lower leukocyte count (P = .003), lymphocyte count (P = .030), and higher prevalence (P = .012) of elevated C-reactive protein (CRP) at admission. NRD patients had a lower prevalence of reticulations (P = .034) on baseline CT (CT1, performed within 2 days before admission) and a longer duration between symptom onset and the time of CT2 (P < .01). There was no significant difference in hospital stay or fibrotic change on CT4 (follow-up CT scan performed 4 weeks after discharge) between 2 groups. Shorter duration between symptom onset and CT2 time (odds ratio [OR], 0.436; 95% confidence interval: 0.233–0.816; P < .01) and lower leukocyte count in baseline evaluation (OR, 0.316; 95% CI: 0.116–0.859; P < .05) were associated with increased odds of radiological deterioration on CT image during hospitalization.

For moderate COVID-19 patients, the value of routinely performed CT during the treatment is limited. We recommend avoiding using CT as a routine monitor in moderate COVID-19 patients.
The role of elevated red blood cell distribution width in the prognosis of AECOPD patients
Authors: Zhu Mengpei , Peng Hongxing , Wan Lei , Zhang Shuling , Zeng Yulan
Published: March 2021

Chronic obstructive pulmonary disease (COPD) is still a constant threat to people's health. We aimed to identify the relationship between increased red cell distribution width (RDW) on admission and length of hospitalization in acute exacerbation of chronic obstructive pulmonary disease patients (AECOPD).

Patients with AECOPD were recruited and divided into 3 groups based on RDW tertiles.

Two hundred eighty six patients with AECOPD admitted to our department during January 1, 2017 and June 30, 2019 were enrolled in the study. According to the RDW tertiles (≤12.8%, 12.9% to 13.6%, >13.6%), the patients were divided into 3 groups. Length of stay was significantly related to RDW (P < .001) in AECOPD patients. Correlation analysis indicated that RDW was negatively associated with FEV1% predicted (r = −0.142, P = .016). However, RDW was positively associated with prolonged of stay (r = 0.298, P < .001) in AECOPD patients. Multivariate regression analysis discovered that RDW was independently associated with the length of hospitalization (P = .001). Receiver operating characteristic (ROC) curve showed that RDW was a good predictor of prolonged hospital stay in AECOPD patients, and the area under the curve (AUC) was 0.818 (95% CI: 0.769–0.868). The highest sensitivity to predict prolonged hospital stay was 83.8% and the specificity was 71.6% with the cut-off 13.35%.

In conclusion, prolonged hospital stay in AECOPD patients was closely associated with increased RDW. Elevated RDW may be an independent predictor for prolonged hospitalization in AECOPD patients.
Suitability of h- and x-indices for evaluating authors’ individual research achievements in a given short period of years
Authors: Yie Kyent-Yon , Chien Tsair-Wei , Chen Chieh-Hsun , Yeh Yu-Tsen , Lin Jui-Chung John , Lai Feng-Jie
Published: March 2021

Background:

The h-index of a researcher refers to the maximum number h of his/her publications that has at least h citations via the concept of the square area. The x-index is determined by the maximum area of a rectangle under the curve to interpret authors’ individual research achievements (IRAs). However, the properties of both metrics have not been compared and discussed before. This study aimed to investigate whether both metrics of h- and x-index are suitable for evaluating IRAs in a short period of years.

Methods:

By searching the PubMed database (Pubmed.com), we used the keyword “PLoS One” (journal) and downloaded 50,000 articles published in 2015 and 2016. A total of 146,346 citations were listed in PubMed Central and 27,035 authors(with h-index ≥1) were divided into 3 parts. Correlation coefficients among metrics (ie, AIF, h, g, Ag, and x-index) were examined. The bootstrapping method used for estimating 95% confidence intervals was applied to compare differences in metrics among author groups. The most cited authors and topic burst were visualized by social network analysis. The most prominent countries/areas were highlighted by the x-index and displayed via choropleth maps.

Results:

Results demonstrated that, first, the h-index had the least relation to other metrics and failed to differentiate authors’ IRAs among groups, particularly in a short time period. Second, the top 3 highest x-index for countries were the United States, China, and the UK but with the productivity-oriented feature. Third, the most cited medical subject headings (ie, MeSH terms) were genome, metabolome, and microbiology, and the most cited author was Lori Newman (whose x-index = 13.52, and h = 2) from Switzerland with the article (PMID = 26646541) cited 291 times. The need for the x-index combined with a visual map for displaying authors’ IRAs was verified and recommended.

Conclusions:

We verified that the h-index failed to differentiate authors’ IRAs among author groups in a short time period. The x-index combined with the Kano map is recommended in research for a better understanding of the authors’ IRAs in other journals or disciplines, not just limited to the journal of PloS One as we did in this study.
Relationships between serum omentin-1 concentration, body composition and physical activity levels in older women
Authors: Li Shuo , Xue Jingjing , Hong Ping
Published: March 2021

This study aimed to investigate the relationships between omentin-1, body composition and physical activity (PA) levels in older women.

Eighty-one older women (age = 64 ± 6years; body mass index = 24.2 ± 3.2 kg/m2; body fat percentage = 36.1 ± 5.7%) participated in this study. We divided the subjects into overweight/obesity and normal weight group. Body composition was measured by dual energy X-ray absorptiometry. Serum omentin-1 concentration was measured using enzyme linked immunosorbent assay. PA levels were obtained by using accelerometers. In addition, anthropometric and insulin resistance values were determined.

Omentin-1 level in overweight/obesity group was significantly lower than in the normal weight group (P < .01). Analysis of all subjects showed that serum omentin-1 was negatively correlated with body weight, BMI (body mass index), waist circumference (WC), WHR (waist-to-hip ratio), percentage of body fat, total body fat mass (FM), fat-free mass (FFM) (r = −.571, −0.569, −0.546, −0.382, −0.394, −0.484, −0.524, all P < .01), respectively. We also found a negative correlation between moderate-to-vigorous physical activity (MVPA) and total body FM (r = −.233, P < .05). However, no significant correlation was found between omentin-1 and sedentary behavior and MVPA (both P > .05). Moreover, the relationship between omentin-1, body composition and PA was analyzed by using multiple linear stepwise regressions. The results showed that serum omentin-1 concentration was inversely correlated with total body FM (β = −0.334, P = .004) in multiple linear stepwise regression analysis.

We found that total body FM was inversely related to serum omentin-1 concentration and PA levels, but there was no correlation between omentin-1 and PA levels. These results showed that PA may participate in the regulation of body composition, which may be also affected by serum omentin-1. However, the mechanism by which PA affects body composition may not be through omentin-1 and was more likely through other metabolic pathways.
Transformation of NSCLC to SCLC after 1st- and 3rd-generation EGFR-TKI resistance and response to EP regimen and erlotinib
Authors: Lai Lin , Meng Wentao , Wei Jialiang , Zhang Xiaofei , Tan Zhiwei , Lu Yunxin , Hou Encun
Published: March 2021

Rationale:

Genotypic and histological evolution of non-small-cell lung cancer (NSCLC) into small-cell lung cancer (SCLC) has been described as a mechanism of acquired resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy. However, the number of clinical cases is rare.

Patient concerns:

Two lung adenocarcinoma patients with EGFR mutations who recurred after radical resection transformed into SCLC under treatment with the sequential first- and third-generation EGFR-TKIs.

Diagnosis:

The 2 cases were both confirmed as SCLC by pathological rebiopsy after EGFR-TKIs resistance.

Interventions:

Case 1 was treated with etoposide plus cisplatin (EP) regimen and erlotinib, while case 2 was treated with erlotinib and EP followed by oral etoposide.

Outcomes:

Case 1 treated with EP only achieved 3-month progression-free survival (PFS), which is the first case that reported T790 M/C797S cis-mutation for osimertinib resistance before the SCLC transformation. However, case 2 treated with erlotinib and EP followed by oral etoposide, PFS lasted for 8 months.

Lessons:

The cases highlighted the importance of rebiopsy that identified pathologically SCLC transformation after EGFR-TKI resistance, and suggested the treatment of erlotinib plus EP followed by etoposide, which could provide a reference for such phenotype.
A rare case of nevus sebaceous of the bilateral labia minora
Authors: Wen Qiao , Zhao Zhiwei , Yang Yanlin , Zhao Fengnian , Wang Ling , Cheng Juan , Wu Jiang , Miao Yali
Published: March 2021

Rationale:

Nevus sebaceous (NS) is a lesion caused by congenital hyperplastic disorder of the sebaceous glands. It commonly noted in the scalp and face and rarely in the trunk, neck, or oral mucosa. We present a rare case of a lesion arising in the genital region.

Patient concerns:

A 47-year-old woman complained of a gradual increase in the size of her bilateral labia minora over 2 years, which affected her sexual life and caused walking difficulty. She was admitted to the Department of Obstetrics and Gynecology. On physical examination, no ulcer, discharge, and vulval or vaginal bleeding were found. The bilateral inguinal lymph nodes were not palpable, bilateral labia minora were asymmetric, and the right side was evidently bigger than the left. The labia minora had serrated edges and numerous papillae with a maximum diameter of 0.5 cm. The vagina, cervix, and uterus with its attachments were normal. Blood samples tested negative for human immunodeficiency virus, human papilloma virus, hepatitis B virus, and hepatitis C virus.

Diagnosis:

A diagnosis of NS of the bilateral labia minora was made following histopathological examination of the resected specimen.

Intervention:

The bilateral labia minora lesions were resected general anesthesia on August 29, 2016. The operation was successful, and intraoperative blood loss was about 10 ml.

Outcomes:

After 40 months of postoperative follow-up, no recurrence or appearance of other tumors were noted.

Lessons:

We recommend surgical removal of lesions in the genital area during adolescence or before adulthood. Adolescence may be the best period for surgical intervention owing to a greater risk of malignant change in adulthood. On the other hand, surgical risk should be avoided in children considering the low incidence of malignant transformation.
Using human umbilical cord mesenchymal stem cells combined with allogenic platelet-rich fibrin membrane for the treatment of dual limb ischemia in an elderly patient
Authors: Ju Wendong , Fu Simao , Huang Jun , Li Bishuang , Wang Li , Zheng Minmin , Song Haojie , Li Quanyong , Zhou Qiaoyun , He Meixing
Published: March 2021

Rationale:

To describe the clinical effects of human umbilical cord mesenchymal stem cells (UCMSCs) combined with allogenic platelet-rich fibrin (PRF) for the treatment of lower limb ischemia in an elderly patient.

Patient concerns:

The patient was a 93-year-old Chinese woman with bilateral foot gangrene and ulcers lasting for 6 months. She had a prior history of Behcet's disease.

Diagnoses:

The admitting diagnosis for this episode was atherosclerosis bilateral limb ischemia.

Interventions:

First, treatment consisting of immunosuppressants, anticoagulation, antiplatelets, and anti-microbials were instituted. A UCMSC suspension was administered intravenously and injected into the lower limbs twice. An allogenic PRF membrane was externally applied 15 times over the lower limbs.

Outcomes:

The patient's pain improved and the 6 ulcers healed.

Lessons:

The combination of UCMSCs with a PRF membrane for the treatment of lower limb ischemia in an elderly patient is effective and safe. More and larger trials are needed before incorporating this therapy into mainstream treatment.
Randomized controlled trial comparing a conventional needle and a novel needle for endoscopic ultrasound (EUS)-guided histology of peripancreatic masses
Authors: Lee Hyoun Wook , Kim Kwang Min
Published: March 2021

Introduction:

Cytological study of samples obtained by Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) allows for recognition of clear signs of malignant transformation. However, certain neoplasms can be difficult to diagnose without histological analysis. Recently, a novel EUS-guided fine needle biopsy (EUS-FNB) needle was developed to increase tissue acquisition. This study set out to investigate the usefulness of this novel EUS-FNB needle (NEFN) in terms of obtaining a proper histology compared with a conventional EUS-FNA needle (CEFN).

Methods:

This investigation was a prospective, single-blind, randomized study in a single academic hospital. Primary outcome was the acquisition rate of an appropriate and sufficient specimen for histologic assessment. Secondary outcomes were diagnostic yield of peripancreatic masses using a CEFN and a NEFN. Furthermore, we assessed the feasibility of determining K-ras mutation status according to needle type.

Results:

The study enrolled 56 consecutive patients. Technical success rates were 96.6% (28/29) for the CEFN and 100% (27/27) for the NEFN (P = 1.000). No complications occurred during or after the procedure in either needle group. An adequate sample for cytologic diagnosis was obtained in 89.7% (26/29) of patients in the CEFN group vs 96.3% (26/27) of patients in the NEFN group (P = .612). For histologic diagnosis, a sample with a biopsy adequacy score of 2 or more was obtained in 41.4% (12/29) of CEFN-acquired samples vs 88.9% (24/27) of NEFN-acquired samples (P < .001). K-ras mutation analysis using histologic specimens was possible in 13 (44.8%) CEFN-acquired samples and 25 (92.6%) of NEFN-acquired samples. This difference was significant (P < .001).

Conclusions:

The present study suggests that the NEFN is an effective and reliable alternative compared to a CEFN in terms of tissue acquisition rate and quality of histologic sampling.
p-STAT3 expression in breast cancer correlates negatively with tumor size and HER2 status
Authors: Wang Yan , Wang Qian , Tang Chih-Hsin , Chen Hua-Dong , Hu Gui-Nv , Shao Jun-Kang , Dong Xiao-Fang , Jin Lu-Lu , Wang Chao-Qun
Published: March 2021

Although some studies have reported the expression and clinical significance of phosphorylated signal transducer and activator of transcription 3 (p-STAT3) in breast cancer tissues, it is still controversial whether p-STAT3 play a role in promoting or suppressing cancer. Here, we used immunohistochemistry analysis to explore expression of p-STAT3 in 407 cases of breast cancer, and analyzed the relationship between p-STAT3 expression and the clinicopathological characteristics and prognosis of breast cancer patients. Positive p-STAT3 expression was seen in 112 cases (27.5%) of breast cancer. p-STAT3 expression was negatively correlated with tumor size, tumor stage and human epidermal growth factor receptor 2 (HER2) status, and the positive rate of p-STAT3 was lowest in HER2-enriched subtype breast cancer (15.3%), while other subtypes were luminal B (23.0%), luminal A (30.2%), and triple-negative breast cancer (TNBC) (37.5%). Logistic regression model multivariate analysis showed that the independent correlation factor of p-STAT3 expression in breast cancer was tumor size (OR = 0.187, 95% CI = 0.042–0.839, P = .029) and HER2 status (OR = 0.392, 95% CI = 0.216–0.710, P = .002). In this study, no clear relationship was observed between patients’ prognosis and expression of p-STAT3. Therefore, we suggest that p-STAT3 expression in breast cancer is negatively correlated with tumor size and HER2 status, but appears to have no effect on survival.
Radiofrequency induced lesion characteristics according to force–time integral in experimental model
Authors: Hwang You Mi , Lee Woo Seok , Choi Kee-Joon , Kim Yoo Ri
Published: March 2021

Contact force (CF)-sensing technology has enabled accurate real-time CF measurement in tissue. Average CF, which is quantified by the force–time integral (FTI), correlates with lesion volume.

Little is known about which of the time and force factors that compose FTI plays a more important role and which is a better index for predicting lesion size, FTI, or force–power–time index (FPTI). Investigators sought to identify a better index for predicting radiofrequency ablation lesion formation with experimental model.

Radiofrequency current was delivered to the swine skeletal muscle at radiofrequency energy current was delivered at 4 fixed power settings (15, 25, 30, and 40 W) for 6 variable time durations (5, 10, 20, 30, 40, and 50 s) with 6 variable CF settings (5, 10, 20, 30, 40, and 50 g). At each setting, the following parameters were evaluated:

Between FTI factors, the time factor was more important than the force factor for lesion formation. The area under the curve was greater for FPTI (0.943) than for FTI (0.870). On univariate linear regression analysis, the explanatory power of the linear regression model was better explained by FPTI (56.4%) than FTI (32.1%).

Under the same FTI condition, the time factor had a greater effect on lesion formation. When power was included, the power factor had a greater effect on lesion formation and steam pop.
Short-term impact of the COVID-19 pandemic on patients with a chronic pain disorder
Authors: Lassen Christoph L. , Siam Laila , Degenhart Astrid , Klier Tobias W. , Bundscherer Anika , Lindenberg Nicole
Published: March 2021

The current Covid-19 pandemic has already had a definite impact on the daily life of many people worldwide. It has been proposed that people with preexisting medical conditions will be harder hit by the pandemic and the subsequent measures to contain the spread of the disease. In this questionnaire-based, observational study, we aimed to assess the impact of the pandemic on patients with a chronic pain disorder, who are treated at a tertiary multidisciplinary pain center.

Participants rated the impact of the pandemic on their chronic pain disorder using a self-designed questionnaire. Also, participants filled out the regular follow-up questionnaire to assess a chronic pain disorder measuring among other parameters pain intensity, symptoms of depression, anxiety, stress, and pain-related quality of life.

Of 136 eligible patients who presented to our pain center between May 5th and July 17th, 112 agreed to participate in the study (82.4%). Eighty two participants (73.2%) reported a deterioration of the pain disorder using the self-designed questionnaire. The more robust parameters of the regular follow-up questionnaire showed no relevant changes compared to data collected before the pandemic. We were not able to detect any demographic and medical parameters that were clinically relevantly associated with a higher impact of the pandemic.

We conclude that a chronic pain disorder is a relatively stable disease that does not change significantly due to external factors, like the Covid-19 pandemic, even if the subjective impact is perceived to be high.
Idiopathic hypereosinophilic syndrome in hemodialysis patients
Authors: Mutsuyoshi Yuko , Hirai Keiji , Morino Junki , Kaneko Shohei , Minato Saori , Yanai Katsunori , Ishii Hiroki , Matsuyama Momoko , Kitano Taisuke , Aomatsu Akinori , Miyazawa Haruhisa , Ito Kiyonori , Ueda Yuichiro , Ookawara Susumu , Morishita Yoshiyuki
Published: March 2021

Rationale:

Herein, we report 3 hemodialysis patients with idiopathic hypereosinophilic syndrome who were successfully treated using corticosteroid therapy.

Patient concerns:

Case 1 was a 63-year-old man who was undergoing hemodialysis because of bilateral nephrectomy and developed hypereosinophilia with digestive symptoms, myocardial injury, and intradialytic hypotension. Case 2 was an 83-year-old man who was undergoing hemodialysis because of nephrosclerosis and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension. Case 3 was a 59-year-old man who was undergoing hemodialysis because of diabetic nephropathy and developed hypereosinophilia with pruritus, myocardial injury, and intradialytic hypotension.

Diagnoses:

All 3 patients presented with hypereosinophilia (eosinophil count ≥1500 /μL for more than 1 month) and multiple-organ involvement (intradialytic hypotension, cardiac injury, digestive symptoms, and allergic dermatitis). A specific cause for the hypereosinophilia was not identified by systemic computed tomography, electrocardiography, echocardiography, bone marrow examination, or blood tests. Furthermore, Case 2 and 3 had not recently started taking any new drugs and drug-induced lymphocyte stimulation tests were negative in Case 1. Therefore, they were diagnosed with idiopathic hypereosinophilic syndrome.

Interventions:

All 3 patients received corticosteroid therapy with prednisolone at a dose of 40 mg/d, 30 mg/d, and 60 mg/d in Case 1, 2, and 3, respectively.

Outcomes:

Their digestive symptoms, pruritus, intradialytic hypotension, and serum troponin I concentrations were immediately improved alongside reductions in their eosinophil counts.

Lessons:

There have been few case reports of idiopathic hypereosinophilic syndrome in patients undergoing hemodialysis. We believe that recording of the clinical findings and treatments of such patients is mandatory to establish the optimal management of idiopathic hypereosinophilic syndrome.
Goal-directed ultrasound protocol in patients with nontraumatic undifferentiated shock in the emergency department: prospective dual centre study
Authors: Leroux Pierre , Javaudin François , Le Bastard Quentin , Lebret Yannick , Pes Philippe , Arnaudet Idriss , Vignaud Frédéric , Montassier Emmanuel , Le Conte Philippe
Published: March 2021

Background and Importance

Early identification of the cause of shock is associated with better prognosis.

Objective

The aim of this study was to explore the performances of an ultrasound protocol (echoSHOCK) to diagnose the cause of shock in the emergency department (ED).

Design, settings and participants

This was a prospective study performed in two EDs. Included patients were older than 18 years admitted with shock. After routine workup strategy, the suspected cause of shock and the planned treatment were reported. The echoSHOCK protocol, using only B mode, was then performed. After performing echoSHOCK, the investigator reported the same two items.

Intervention

echoSHOCK protocol that assessed: compressive pericardial effusion (tamponade), right ventricle dilatation and flattening of the septum, left ventricle dimension and systolic function, indices of hypovolemia.

Outcomes measure and analysis

We defined four different causes for shock (tamponade, acute cor pulmonale, cardiogenic and hypovolemia). The primary endpoint was the degree of agreement of the routine workup and echoSHOCK with an expert panel.

Main Results

85 patients [mean age of 73 (14) years] were included. Kappa coefficients between routine strategy and echoSHOCK for the cause of shock, with the expert panel were 0.33 (95% CI, 0.26-0.4) and 0.88 (95% CI, 0.83-0.93), respectively. Likewise, for the planned treatment, kappa were 0.21 (95% CI, 0.14-0.28) and 0.9 (95% CI, 0.85-0.94), respectively. The physician’s confidence increased from 3.9 (2.1) before echoSHOCK to 9.3 (1.1) after, (P < 0.001).

Conclusion

This study suggested that echoSHOCK significantly increased the ability to determine the cause of undifferentiated shock in the ED.
Assessment of diagnostic strategies based on risk stratification for aneurysmal subarachnoid hemorrhage: a retrospective chart review
Authors: Bianchi Christophe , Ageron François-Xavier , Carron Pierre-Nicolas
Published: March 2021

Background and importance

Current guidelines recommend noncontrast computed tomography (NCCT) followed by lumbar puncture for the diagnosis of subarachnoid hemorrhage (SAH). Alternative strategies, including clinical risk stratification and CT angiography (CTA), are emerging.

Objective

To evaluate alternative strategies to current guidelines through clinical risk stratification.

Design, setting and participants

Single-site, retrospective observational study of patients with SAH suspicion, from 2011 to 2016. We combined results of each investigation (NCCT, CTA and lumbar puncture) with a clinical risk assessment, including Ottawa score.

Exposure

Comparing the current strategy (NCCT ± lumbar puncture if negative CT) to alternative strategies (NCCT + CTA ± lumbar puncture if high clinical risk or negative CT and onset of headache ≥12 h o dds ratio ≥24 h).

Outcome measure and analysis

Main outcome was diagnosis of SAH at hospital discharge. Secondary outcomes were death from all causes and need for invasive procedures at 28 days. We used sensitivity, specificity, positive predictive value and negative predictive value (NPV) to evaluate the diagnostic performance of three strategies.

Main results

310 patients were included. SAH was diagnosed in 8 cases (2.6%), none died and 7 (2.2%) had a surgical procedure. Performances of different strategies were not statistically different. NPVs were 99.7% [95% Confidence interval (CI), 98.2–100%] for strategy 1 and 100% (95% CI, 98.8–100%) for strategies 2 and 3. More than 4000 lumbar punctures are needed to diagnose one SAH when CTA is performed within 24 h of symptoms’ onset and absence of high-risk criteria.

Conclusion

Clinical risk stratification and CTA strategy are well-tolerated and effective for diagnosis of SAH, avoiding systematic use of lumbar puncture.
Emergency Medical Services response levels and subsequent emergency contacts among patients with a history of mental illness in Denmark: a nationwide study
Authors: Mackenhauer Julie , Valentin Jan Brink , Mikkelsen Søren , Steinmetz Jacob , Væggemose Ulla , Christensen Helle Collatz , Mainz Jan , Johnsen Søren Paaske , Christensen Erika Frischknecht
Published: March 2021

Background and importance

People with mental illness have higher use of emergency services than the general population and may experience problems with navigating in complex healthcare systems. Poor physical health contributes to the excess mortality among the mentally ill.

Objective

To compare the level of Emergency Medical Services (EMS) response and subsequent contacts emergency between patients with and without a history of mental illness.

Design, setting, and participants

A nationwide cohort study was conducted in Denmark including medical 1-1-2 calls 2016 2017. The healthcare system is financed through taxation allowing free access to healthcare services including ambulance services.

Exposure

Exposed groups had a history of major, moderate, or minor mental illness.

Outcome measures and analysis

We studied seven national prehospital care Performance Indicators (PI 1–7). The selected PI concerned EMS response levels and subsequent contacts to prehospital and in-hospital services. Exposed groups were compared to nonexposed groups using regression analyses.

Results

We included 492 388 medical 1-1-2 calls: 8, 10, and 18% of calls concerned patients with a history of major, moderate, or minor mental illness, respectively.

There were no clinically relevant differences regarding response times (PI 1–2) or registration of symptoms (PI 3) between groups.

If only telephone advice was offered, patients with a history of major, moderate or minor mental illness were more likely to recall within 24 h (PI 4): adjusted risk ratio (RR) 2.11 (1.88–2.40), 1.96 (1.20–2.21), and 1.38 (1.20–1.60), but less or equally likely to have an unplanned hospital contact within 7 days (PI 6): adjusted RRs 1.05 (0.99–1.12), 1.04 (0.99–1.10), and 0.90 (0.85–0.94), respectively.

If released at the scene, the risk of recalling (PI 5) or having an unplanned hospital contact (PI 7) was higher among patients with a history of mental illness: adjusted RRs 2.86 (2.44–3.36), 2.41 (2.05–2.83), and 1.57 (1.35–1.84), and adjusted RRs 2.10 (1.94–2.28), 1.68 (1.55–1.81), and 1.25 (1.17–1.33), respectively.

Patients with a history of mental illness were more likely to receive telephone advice only adjusted RRs 1.61 (1.53–1.70), 1.30 (1.24–1.37), and 1.08 (1.04–1.13), and being released at scene adjusted RRs 1.11 (1.08–1.13), 1.03 (1.01–1.04), and 1.05 (1.03–1.07).

Conclusion

More than one-third of the study population had a history of mental illness. These patients received a significantly lighter EMS response than patients with no history of mental illness. They were significantly more likely to use the emergency care system again if released at scene. This risk increased with the increasing severity of the mental illness.
Thiamine combined with vitamin C in sepsis or septic shock: a systematic review and meta-analysis
Authors: Ge Zengzheng , Huang Jiewu , Liu Yawei , Xiang Jun , Gao Yanxia , Walline Joseph Harold , Lu Xin , Yu Shiyuan , Zhao Lina , Li Yi
Published: March 2021

Background

Thiamine and vitamin C have been increasingly used in patients with sepsis or septic shock because of their potential for improving metabolism and reducing mortality.

Objective

We aim to determine if thiamine combined vitamin C can reduce mortality in patients with sepsis or septic shock.

Evidence sources and study selection

We comprehensively searched the PubMed, Embase, Cochrane Library, and Web of Science databases from their inception dates through 1 January 2021. Literature works evaluating the efficacy of thiamine combined vitamin C in patients with sepsis or septic shock were considered.

Data extraction and outcome measurements

Two reviewers extracted data and assessed study quality. A meta-analysis was performed to calculate an odds ratio (OR), 95% confidence intervals (CIs), and P values for in-hospital mortality (primary outcome). Secondary outcomes included duration of ICU stay, duration of hospital stay, duration of vasopressor use, and change in sequential organ failure assessment (SOFA) scores.

Results

Seven randomized controlled trials were identified, encompassing a total of 868 patients. There was no statistical difference between groups for in-hospital mortality (OR: 1.11; 95% CI [0.79–1.56]; P = 0.55). Other than improving SOFA score during the first 72 h after enrollment and duration of vasopressor use, we found no other significant associations.

Conclusions:

Despite widespread enthusiasm for thiamine combined with vitamin C for sepsis and septic shock, we only found an association with reduced SOFA score and time of vasopressor use. There was no association with in-hospital mortality.
Multimorbidity and Social Drivers of Homelessness and Health
Authors: Tsai Jack , King Ben , Elder Jen
Published: March 2021

This introduction describes the impetus and context for this special issue on multimorbidity in homeless populations. The guest editors begin the introduction by describing the problem of homelessness which has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. The editors then describe the content of this special issue, which includes original research examining special populations such as homeless youth, aging populations, and Veterans as well as medical and behavioral health conditions such as tuberculosis, HIV, and opioid use disorder. Two editorials are also included in this special issue that comment on the history of homelessness and the link between homelessness and suicide. The editors acknowledge the different stakeholders that helped support this special issue and highlight the need for continued research and innovative solutions to improve the health, housing, and well-being of homeless populations.
Female Pattern Hair Loss: Why the Follicular Unit Transplantation Surgical Technique Remains a Good Option
Authors: Uebel Carlos O. , Piccinini Pedro S. , Spencer Leonardo S. B. , da Silveira Jorge A. M.
Published: March 2021

Background:

Female pattern hair loss is a common nonscarring alopecia that can present with several patterns of decreased hair density. The condition is very bothersome to affected women, and although there are multiple nonsurgical options, surgical follicular unit transplantation remains one of the most effective options.

Methods:

A retrospective chart review was performed of the senior author’s (C.O.U.) experience and technique of follicular unit transplantation for treatment of female pattern hair loss.

Results:

A total of 751 patients with female pattern hair loss underwent follicular unit transplantation over the past 31 years. Average patient age was 48 years. Patients with small areas of hair loss made up 40 percent of the group (Ludwig stage I), those with medium-sized areas constituted 45 percent (Ludwig stage II), and those with large areas constituted 15 percent (Ludwig stage III). The average operative time was 3 hours 21 minutes. One hundred thirty-five patients (18 percent) underwent a second replacement, at an average period of 4 years after the procedure, because of the progressive nature of female pattern hair loss. Complications included donor-site scar widening in six patients and folliculitis in 17 patients.

Conclusion:

Follicular unit transplantation is an excellent option for treatment of female pattern hair loss patients, as there is no need to shave the recipient sites, operative times are shorter than for follicular unit excision techniques, and the incidence of complications is very low.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.