bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of combined angiotensin II receptor blocker with tripterygium glycosides on diabetic nephropathy
Authors: Ma Chang-e , Yu Pei , Wei Wei , Chen Xiao-qin
Published: June 2021

Background:

Several studies have reported good results for angiotensin II receptor blockers (ARB) combined with tripterygium glycosides (TGs) in the treatment of diabetic nephropathy (DN). However, because a small number of cases were included in each study, the statistical power was limited. Therefore, we performed a protocol for meta-analysis to further evaluate the clinical efficacy and safety of combined ARB and TGs in treatment of DN.

Methods:

The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, Science Direct up to April 2021. Outcome measures were 24-h urinary total protein, urinary albumin excretion rate, serum creatinine, blood urea nitrogen, albumin, hemoglobin A1c, β2-microglobulin and serum glutamic pyruvic transaminase. The risk of bias assessment of the included studies was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). We performed meta-analysis using STATA 11.0.

Results:

The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

Conclusion:

The findings will provide helpful evidence for the application of combined ARB and TGs in the treatment of DN.

OSF registration number:

10.17605/OSF.IO/ARGE3
Estimation of renal function by three CKD-EPI equations in Chinese HIV/AIDS patients
Authors: Zhao Naxin , Zeng Zhili , Liang Hongyuan , Wang Fang , Yang Di , Xiao Jiang , Chen Meiling , Zhao Hongxin , Zhang Fujie , Gao Guiju
Published: June 2021

Assessing renal function accurately is important for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) recommended three equations to calculate estimated glomerular filtration rate (eGFR). There is evidence that eGFR based on the combination of serum creatinine and cystatin C is the most accurate of the three equations. But there is limited data on the comparison of three CKD-EPI equations in Chinese HIV/AIDS patients. The aim of our study was to compare the three CKD-EPI equations in Chinese HIV/AIDS population and assess renal function.

Cross-sectional, single center, prospective study.

One hundred seventy two Chinese adult HIV/AIDS patients were enrolled, including 145 (84.3%) males and 27 (15.7%) females. Mean age was 40(±12) years old. Overall mean eGFR based on serum creatinine, cystatin C and the combination of the 2 markers was 112.6(±19.0) mL/min/1.73 m2, 92.0(±24.2)mL/min/1.73 m2, and 101.7(±21.8)mL/min/1.73 m2, respectively (P = .000). The eGFR calculated by serum creatinine alone is higher than eGFR calculated by combination of serum creatinine and cystatin C, and eGFR calculated by cystatin C individual is lower than eGFR calculated by combination of the 2 markers.

Of the 3 CKD-EPI equations, the CKD-EPIscr-cys equation may have the most accuracy in evaluating renal function in Chinese HIV/AIDS patients while the CKD-EPIscr equation may overestimate renal function and the CKD-EPIcys equation may underestimate renal function.
Activities of daily living associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery
Authors: Kang Yu , Zhang Gui-Chen , Zhu Ji-Qiao , Fang Xiang-Yang , Niu Jing , Zhang Ying , Wang Xiao-Juan
Published: June 2021

Elderly patients who undergo major abdominal surgery are being in increasing numbers. Intensive care unit (ICU) survival is critical for surgical decision-making process. Activities of daily living (ADL) are associated with clinical outcomes in the elderly. We aimed to investigate the relationship between ADL and postoperative ICU survival in elderly patients following elective major abdominal surgery.

We conducted a retrospective cohort study involving patients aged ≥65 years admitted to the surgical intensive care unit (SICU) following elective major abdominal surgery. Data from all patients were extracted from the electronic medical records. The Barthel Index (BI) was used to assess the level of dependency in ADL at the time of hospital admission.

ICU survivors group had higher Barthel Index (BI) scores than non-survivors group (P < .001). With the increase of BI score, postoperative ICU survival rate gradually increased. The ICU survivals in patients with BI 0–20, BI 21–40, BI 41–60, BI 61–80 and BI 81–100 were 55.7%, 67.6%, 72.4%, 83.3% and 84.2%, respectively. In logistic regression, The Barthel Index (BI) was significantly correlated with the postoperative ICU survival in elderly patients following elective major abdominal surgery (OR = 1.33, 95% CI: 1.20–1.47, P = .02). The area under the receiver operating characteristic (ROC) curve of Barthel Index in predicting postoperative ICU survival was 0.704 (95% CI, 0.638–0.771). Kaplan–Meier survival curve in BI≥30 patients and BI < 30 patients showed significantly different.

Activity of daily living upon admission was associated with postoperative intensive care unit survival in elderly patients following elective major abdominal surgery. The Barthel Index(BI) ≥30 was associated with increased postoperative ICU survival. For the elderly with better functional status, they could be given more surgery opportunities. For those elderly patients BI < 30, these results provide useful information for clinicians, patients and their families to make palliative care decisions.
Knowledge about sexually transmitted infections among young men presenting to the Brazilian Army, 2016
Authors: Paganella Machline Paim , da Motta Leonardo Rapone , Adami Aline De Gregori , Sperhacke Rosa Dea , Kato Sérgio Kakuta , Pereira Gerson Fernando Mendes
Published: June 2021

Global burden of sexually transmitted infections (STIs) remains high and has a profound impact on health and lives of children, adolescents and adults worldwide. For over a decade, the Brazilian Department of Chronic Condition Diseases and Sexually Transmitted Infections and the Ministry of Defense have been conducting the Conscripts Survey aiming to assess the STI prevalence and obtain data on knowledge regarding STIs and risk factors among youth.

A cross-sectional study was conducted among conscripts across Brazil aged 17 to 22 years from August to December 2016. It included a self-reported questionnaire containing 74 questions, 25 questions related to awareness and knowledge of STIs and their associated symptoms, routes of transmission, complications and risk factors.

A total of 37,282 young men across Brazil were considered for the analysis. The majority resided in the Northeast and Southeast regions (38.9% and 30.0%, respectively), followed by the South (13.9%), North (9.7%), and Central-west (7.5%) regions. Of the conscripts, 97.2% have the knowledge they may be at risk if they do not use condoms during sex. Conscripts with a higher level of education have almost 2 times greater chance of having knowledge of having sex without a condom (OR 3.23 CI95% 2.82–3.70 P = .000) and sharing needles and syringes (OR 2.84 CI95% 2.62–3.07 P = .000) represents a risk. Those with higher education also have an almost 50% greater chance of having knowledge regarding STI transmission from mother to child (OR 1.54 CI95% 1.44–1.64 P = .000), and knowledge of no transmission by mosquito bite (OR 1.61 CI95%1.51–1.72 P = .000), by kissing (OR 1.45 CI95% 1.36–1.55 P = .000) or by using public toilets (OR 1.51 CI95% 1.41–1.61 P = .000). Television (71.8%) and internet (69.4%) are the preferred forms to obtain STIs information regardless of the level of education.

Conscripts with higher level of education have greater knowledge regarding transmission of STIs. However, there are gaps regarding their knowledge about HIV pre-exposure prophylaxis and the fact that other STIs can increase the chances of acquiring HIV.
Efficacy and safety of acupuncture for urinary retention after hysterectomy
Authors: Zhao Qinyu , Yan Chunchun , Dan Meng , Jia Hongling
Published: June 2021

Objective:

The aim of this study was to evaluate the efficacy and safety of acupuncture in the treatment of urinary retention after hysterectomy in women.

Methods:

This research searched for 6 database documents, and the deadline is July 23, 2020. This study included a randomized controlled trial of women with urinary retention after hysterectomy. These randomized controlled trials compare acupuncture with bladder function training or other nonacupuncture treatments, and measure urodynamics, effectiveness (BR), and urinary tract infection rates (UIR). Four independent reviewers participated in data extraction and evaluation. Assess the risk of bias in each article, and conduct a meta-analysis according to the type of acupuncture. The result is expressed as a mean difference (MD) or relative risk (RR) with a 95% confidence interval (CI).

Results:

The meta-analysis contains 12 studies. Most studies indicate low risk or unknown risk, but the GRADE scores of the combined results show low or moderate levels. After the combined analysis, we found that acupuncture versus bladder function exercise and other nonacupuncture therapies can significantly improve the values of post voided residual urine (PVR) (MD = −25.29; 95% CI [−30.45 to −20.73]), maximal cystometric capacity (MD = 39.54; 95% CI [10.30–68.78]), bladder capacity for first voiding desire (MD = −61.98; 95% CI [−90.69 to −33.26]) and maximal flow rate (MFR) (MD = 7.58; 95% CI [5.19–9.97]). And compared with the control group, acupuncture still has advantages in BR (RR = 1.36; 95% CI [1.18–1.56]) and UIR (RR = 0.22; 95% CI [0.08–0.82]). These heterogeneities have been resolved through subgroup analysis, and their main sources are related to different intervention times, the time to start the intervention, and different PVR requirements.

Conclusions:

There is insufficient evidence that acupuncture can increase the patient's MFR, BR, and UIR. However, acupuncture can effectively improve the PVR, maximal cystometric capacity, and bladder capacity for first voiding desire values of patients with urinary retention after hysterectomy. Although limited due to the quality and methodological limitations of the included studies, acupuncture can still be used as an effective and safe treatment for women with urinary retention after hysterectomy.

Registration:

The research has been registered and approved on the PROSPERO website. The registration number is CRD42019119238.
Effects of chromosomal abnormalities on pregnancy outcomes in female undergoing artificial insemination with donor's sperm
Authors: Liu Yu , Sun Tingting , Jiang Ronghua , Chen Ruiling , Liu Xiaoling , Chen Qiao , Song Ge
Published: June 2021

This study aimed to evaluate the clinical characteristics, pregnancy outcomes and prognostic factors for pregnancy of female with chromosomal abnormalities (CAs) after artificial insemination with donor's sperm (AID) treatment.

A retrospective case–control study was analyzed by using the data of 29 female patients with CA and 116 controlled patients with normal karyotype (1:4 ratio) who underwent AID cycles at Guangdong Family Planning Special Hospital from January 2011 to December 2017. In all cases, reproductive histories were collected, and the cytogenetic analysis was performed by Trypsin-Giemsa banding and karyotyping. The embryos were fertilized via intracervical or intrauterine insemination. Clinical characteristic variables were compared.

The prevalence of CA was found to be 0.29% in the whole AID population. The live birth rates of CA group and controlled group were 41.4% and 31.0% (P = .29) respectively. Compared to normal karyotype group, patients with CA showed higher rate of primary infertility (93.1% vs 75.9%, P = .049); Multivariate analysis demonstrated that ovarian stimulation (odds ratio, 3.055; 95% confidence interval, 1.421–6.568; P = .004) was associated with adverse pregnancy outcomes in female patients with AID treatment.

For the infertility CA patients who were phenotypically normal, AID was a suitable choice, whereas ovarian stimulation results in an improvement in the pregnancy rate.
Medial cortical positive support
Authors: Shi Xuchao , Han Mingyuan , Dai Bo
Published: June 2021

Treatments for proximal humerus fractures (PHFs) often fail to achieve anatomical reduction. The purpose of this study was to evaluate the role of positive medial cortical support (PMCS) in the nonanatomical reduction of PHFs.

A retrospective analysis was performed of 78 patients with PHFs who underwent surgery from August 2014 to September 2017 and whose treatments did not achieve anatomical reduction. Based on the results of standard AP radiographs of the shoulders 3, 6, and 12 months after surgery, the patients were divided into PMCS or negative medial cortical support (NMCS) groups. The postsurgical change in head-shaft angle (HSA) between the 2 groups was compared. Shoulder joint function and visual analog scale (VAS) scores of the 2 groups were also compared at the same time.

Of the 78 patients analyzed, 37 were in the PMCS group and, 41 in the NMCS group. There was no statistically significant difference in any of the characteristics of the 2 groups (P > .05), or in postsurgical HSA. However, the HSA of the 2 groups had become significantly different (P < .05) 3, 6, and 12 months following surgery. The changes in HSA of the 2 groups were different at various time points (P < .05). One year after surgery, the shoulder function score of the PMCS group was significantly better than that of the NMCS group, as was the VAS score (both P < .05).

Patients whose surgery for PHF does not achieve anatomical reduction during surgery can undergo PMCS to achieve improved results, postoperatively. NMCS should be avoided as far as possible.
A case report of CLIPPERS syndrome and literature review
Authors: Zhang Lei , Zhao Dan , Li Jia , Feng Jingqi , Zhang Qinghui , Liu Li , Liu Jingxin , Chen Jiajun
Published: June 2021

Rationale:

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a chronic inflammatory disorder of the central nervous system. It is characterized by the appearance on magnetic resonance imaging of punctate and curvilinear gadolinium enhancement in the pons and cerebellum, and is exquisitely responsive to steroid treatment. The etiology of CLIPPERS remains unclear, although its pathogenesis reflects immune-mediated processes. The accurate diagnosis of this disease is very important for both its management and prognosis.

Patient concerns:

A 43-year-old woman presented with clinical and radiological features suggestive of CLIPPERS. Whole-exome sequencing of the patient's DNA revealed 76 mutations.

Diagnoses:

The patient was clinically diagnosed with CLIPPERS.

Interventions:

Hormone therapy was administered intravenously upon hospitalization and then gradually reduced to an oral dose.

Outcomes:

The clinical symptoms and imaging manifestations of the patient improved rapidly. This patient was followed up for more than 1 year, and there has been no recurrence or aggravation.

Lessons:

A gene variation library of CLIPPERS syndrome was established, which lays the foundation for the further accumulation of data, and will allow the etiology and pathogenesis of the disease to be explored.
Primary biliary non-Hodgkin's lymphoma
Authors: Wu Jiamei , Zhou Yin , Li Qingshu , Zhang Jing , Mao Yun
Published: June 2021

Rationale:

Primary biliary non-Hodgkin's lymphoma (PBNHL) is a rare disease with only 41 cases reported since 1982. The incidence of PBNHL in patients with malignant cholangiocarcinoma was 0.6%, and PBNHL accounted for 0.4% of extranodal non-Hodgkin's lymphoma, and only 0.016% of all non-Hodgkin's lymphoma cases.

Patient concerns:

We present a rare case of PBNHL in a 59-year-old female who had jaundice for 3 days with weight loss and Epstein-Barr virus infection. Initial computed tomography and magnetic resonance imaging showed diffuse thickening wall of bile ducts with corresponding lumen stenosis, blurred fat space around the portal vein, lymphadenopathy, and a normal spleen. These manifestations and images were similar to hilar cholangiocarcinoma. So, the diagnosis of hilar cholangiocarcinoma was initially considered.

Diagnoses:

Postoperative pathology confirmed the final diagnosis was PBNHL.

Interventions:

The patient and her family requested to clarify the histologic diagnosis by laparotomy biopsy. Because the biopsy result could not be defined during operation, then right hemihepatectomy and choledochojejunostomy were performed. She did not receive any antitumor treatment.

Outcomes:

One month after the patient's first examination, both computed tomography and magnetic resonance images showed diminished stenosis of common bile duct and left hepatic duct, but a new mass in segment IV of liver was observed. Unfortunately, the patient died due to disease progression.

Lessons:

This case reminds us that although PBNHL is rare, making accurate diagnosis difficult preoperatively, PBNHL should be considered when encountering a case with Epstein-Barr virus infection and those typical imaging findings.
The effect of mind-body exercise on the cervical spine mobility of people with neck discomfort
Authors: Liao Xianhui , Ge Beihai , Chen Qiang
Published: June 2021

Background:

With the development of the economy and society, the pace of in-person work has gradually accelerated, resulting in longer and more intense work hours. Long-term and high-intensity work can lead to considerable discomfort in people's cervical spines.

Objectives:

This study aims to explore the effect of mind-body exercise intervention on the cervical spine mobility of people with neck discomfort through meta-analysis.

Methods:

This study's researchers will search a total of 5 research databases for data retrieval: China National Knowledge Infrastructure (from 1979), Web of Science (from 1950), PubMed (from 1965), Cochrane (from 1991), and EBSCO (from 1949) (Date of retrieval: March 10, 2021). Two authors will independently search literature records, scan titles, abstracts, and full texts, collect data, and assess materials for risk of bias. Stata14.0 software will be used for the data analysis.

Results:

The current study is a systematic review and meta-analysis program with no results. Data analysis will be completed after the program has been completed.

Discussion:

There is potential evidence that exercise can have a positive effect on the cervical spine mobility of people with cervical spine discomfort. In addition, direct evidence of the benefits of mind-body exercise intervention may be more important.

INPLASY Registration Number:

INPLASY202140126.
Effectiveness and safety of Liuhedan for treating cellulitis
Authors: Li Na , Zhang Li , Pan Pan , Cheng Tao , Xu Shu-Yun
Published: June 2021

Background:

Liuhedan is a famous traditional Chinese Medicine formula used to treat cellulitis in China. However, there are no systematic reviews for the evidence and the therapeutic effectiveness and safety of Liuhedan for treating cellulitis. The aim of this study is to summarize previous evidence, assessing the efficacy and safety of Liuhedan treating cellulitis.

Methods:

We will search the EMBASE, WANFANG DATA, Web of Knowledge, CNKI, PubMed, ClinicalTrials.gov, and Cochrane Library from inception to June 30, 2021 to retrieve relevant studies using the search strategy: (“Liuhedan” OR “Liuhe Pill” OR “Liu-He-Dan”) AND (“cellulitis” OR “phlegmon” OR “skin and soft tissue infection” OR “skin tissue infection” OR “soft tissue infection”). Two authors independently judged study eligibility and extracted data. Heterogeneity will be examined by computing the Q statistic and I
2 statistic.

Results:

This study assessed the efficiency and safety of Liuhedan for treating cellulitis.

Conclusions:

This study will provide reliable evidence-based evidence for the clinical application of Liuhedan for treating cellulitis.

Ethics and dissemination:

Ethical approval is unnecessary as this protocol is only for systematic review and does not involve privacy data. The findings of this study will be disseminated electronically through a peer-review publication or presented at a relevant conference.
Blood pressure measurement during cesarean delivery
Authors: Bobet Mathieu , Joachim Jona , Gayat Etienne , Bonnet Agnès , Sievert Kerstin , Barnichon Carole , Fischler Marc , Le Guen Morgan
Published: June 2021

Early detection of arterial hypotension during cesarean delivery under spinal anesthesia is important. This study aims to compare the validity of NexfinTM as beat-to-beat noninvasive blood pressure monitoring with conventional intermittent oscillometric measurement of blood pressure during elective cesarean delivery.

This open prospective observational bicentric study was performed between January 2013 and December 2015. We simultaneously recorded arterial blood pressure with both techniques in pregnant women undergoing elective cesarean delivery under spinal anesthesia. The primary outcome was a Bland–Altman analysis of systolic blood pressure measurement comparing NexfinTM and a conventional method. The secondary outcomes were the time to detect the first relevant hypotensive episode and the comparison of both devices using a four-quadrant graph.

One hundred and seventy-four parturients completed the study, and 2640 pairs of systolic blood pressure measurements were analyzed. Bias was -10 mmHg with upper and lower limits of agreement of -61 and +41 mmHg. In 73.9% of the cases, the two techniques provided the same information (normotension or hypotension), but the conventional method missed 20.8% of measurements, with NexfinTM detecting 16.2% more hypotensive measurements. The median [25–75 percentiles] duration to detect the first hypotensive measurement was 331 [206–480] seconds for NexfinTM and 440 [300–500] s for intermittent oscillometry (P < .001).

The agreement between NexfinTM and an intermittent method for the measurement of systolic blood pressure was not in an acceptable range during cesarean delivery, although NexfinTM may detect hypotension earlier than the standard method.

Trial registration: Clinicaltrials.gov identifier: NCT01732133; November 22, 2012
Acute pancreatitis associated with duodenal obstruction induced by groove pancreatitis
Authors: Li Jiayan , Liu Qianyi , Liu Zhishang , Cen Chuan , Yang Yuyu , Ye Jianming , Xu Li , Lu Xiji , Chen Dongfeng , Ruan Weishan
Published: June 2021

Rationale

Groove pancreatitis (GP) is a rare form of chronic pancreatitis. Since GP presents with nonspecific symptoms, it can be challenging to diagnose. Duodenal obstruction is often caused by malignant diseases; however, when associated with acute pancreatitis, it is rarely induced by groove pancreatitis.

Patient's concerns

A 56-year-old man who presented with acute pancreatitis complained of recurrent upper abdominal discomfort. His concomitant symptoms included abdominal pain, postprandial nausea, and vomiting. Contrast-enhanced computed tomography (CT) of the abdomen showed thickening of the duodenum wall. Gastrointestinal radiographs and upper gastrointestinal endoscopy showed an obstruction of the descending duodenum.

Diagnosis

The pathologic diagnosis was groove pancreatitis.

Interventions

The patient underwent gastrojejunostomy to relieve the obstruction.

Outcomes

The patient had an uneventful recovery with no complications.

Lessons

Groove pancreatitis should be considered in the differential diagnosis of patients presenting with acute pancreatitis and duodenal obstruction. These data can help to make a precise diagnosis and develop an appropriate treatment plan.
Successful treatment of acute promyelocytic leukemia in a 92-year-old man using all-trans retinoic acid combined with oral arsenic
Authors: Shi Xiaowei , Li Shuangyue , Tang Shanhao , Lu Ying
Published: June 2021

Rationale

Acute promyelocytic leukemia is a special subtype of acute myeloid leukemia. The incidence of early death and complications is high. An oral regimen of all-trans retinoic acid combined with the realgar-indigo naturalis formula (RIF) without chemotherapy has provided a new strategy for the treatment of these patients.

Patient concerns

A 92-year-old male patient was admitted to the hospital due to fatigue and oral bleeding. He had no fever or lung infection. Routine blood test showed white blood cell count 1.0 ×109/L, hemoglobin 100 g/L, and platelets 21 × 109/L. Coagulation function indicated fibrinogen 1.02 g/L and D-dimer 2360 ng/mL. And 28% abnormal promyelocytes were observed in peripheral blood.

Diagnosis

A bone marrow morphologic, immunophenotypic, cytogenetic, and molecular examination was performed. Routine bone marrow examination showed active proliferation of nucleated cells, with promyelocytes accounting for 91%; immunophenotyping revealed an early myeloid cell population, accounting for approximately 82.4% of all cells.

Interventions

From February 15, 2020, 25 mg/m2 all-trans retinoic acid was orally administered daily. After the fusion gene result was obtained, oral administration of 60 mg/kg RIF daily began since February 18, 2020. The combination of the 2 agents was given until March 16, 2020. Oral administration of 25 mg/m2 retinoic acid daily began from March 20, 2020 for 2 weeks, and oral administration of 60 mg/kg RIF daily lasted for 4 weeks as the consolidation therapy. During the treatment, the proportion of promyelocytes in peripheral blood, white blood cell count, platelets, coagulation function, liver function, and QT interval were monitored.

Outcomes

Oral retinoic acid and oral RIF were given without chemotherapy and the patient achieved bone marrow remission after 1 month, and molecular remission was achieved 2 months later. In the early stage of acute promyelocytic leukemia, combined thrombocytopenia and disseminated intravascular coagulation may develop. Platelet and fresh frozen plasma infusion were proactively given until platelets were stabilized above 30 × 109/L, and the coagulation function returned to normal.

Lessons

The regimen was safe and effective, and subsequent treatment did not require hospitalization, which helped to improve the patient's quality of life.
Thromboembolism after cardiac surgery in a patient with cancer-related thrombosis and severe thrombocytopenia
Authors: Kim Soo Yeon , Ro Soo Jin , Koh Su Rim , Lim Hyunyoung
Published: June 2021

Rationale:

Patients with cancer have elevated risk of both venous thromboembolism and bleeding compared with patients without cancer due to cancer- and patient-specific factors. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult because management of cancer-associated thrombosis requires anticoagulation despite its known increased risks for bleeding. The adjustment of blood transfusion or cessation of anticoagulants can be a challenge in surgical diagnosis or treatment of cancer patients with such an imbalanced coagulate status.

Patient concerns:

A 45-year-old woman with no underlying disease was suspected of ovarian cancer and was awaiting diagnostic laparoscopic exploration surgery.

Diagnoses:

While waiting for the surgery, the patient developed chest pain and underwent stent insertion under diagnosis of myocardial infarction. Two weeks later, endocarditis developed, and replacement of the aortic valve and mitral valve was planned. In addition, the patient developed multiple thromboembolisms and was administered anticoagulants to eliminate vegetation of valves and multiple thromboses. Her blood test showed anemia (7.4 g/dL) and severe thrombocytopenia (24 × 109/L).

Interventions:

The patient underwent double valve replacement.

Outcomes:

A color change of the left lower extremity was noted 5 hours after double valve replacement, and angiography was performed. Thrombectomy was performed under diagnosis of thrombosis in the left iliac artery. One month later, the patient underwent laparoscopic exploration surgery as scheduled.

Lessons:

This case will help establish the criteria of blood coagulation for surgical treatment of cancer patients with imbalanced clotting and bleeding.
The risk factors of postoperative delirium in general anesthesia patients with hip fracture
Authors: Chu Zhe , Wu Yixuan , Dai Xuanhui , Zhang Cuicui , He Qianfeng
Published: June 2021

Delirium is a common postoperative complication of patients with hip fracture, yet the risk factors for postoperative delirium in patients with hip fracture remain unclear. We aimed to evaluate the associated risk factors of postoperative delirium in patients with hip fracture, to provide evidence for formulating coping measures of postoperative delirium prevention and treatment in clinical practice.

Patients undergoing surgery for hip fracture from March 1, 2018 to September 30, 2020 in our hospital were included. The related characteristics and related lab examination results were reviewed and collected. The univariate and logistic regression analyses were performed to identify the potential risk factors.

A total of 462 patients were included, the incidence of postoperative delirium in patients with hip fracture was 16.02%. Logistic regression analyses indicated that history of delirium (OR = 4.38, 1.15–9.53), diabetes mellitus (OR = 5.31, 1.23–10.75), hypoalbuminemia (OR = 4.97, 1.37–9.86), postoperative hypoxemia (OR = 5.67, 2.24–13.42), and body mass index (BMI) (kg/m2) (OR = 3.03, 1.36–6.18) were the independent risk factors for the delirium in patients with hip fracture surgery (all P < 0.05). The cutoff value of postoperative blood sugar, albumin, and BMI for delirium prediction was 8.05 (mmol/L), 32.26 (g/L), and 19.35 (kg/m2), respectively, and the area under curve of postoperative blood sugar, albumin, and BMI was 0.792, 0.714, and 0.703, respectively.

Those patients with a history of delirium, postoperative hypoxemia, blood glucose ≥8.05 mmol/L, albumin ≤32.26 g/L, and BMI ≤19.35 kg/m2 particularly need the attention of healthcare providers for the prevention of delirium.
Differences in the clinicopathological features of pancreatic head carcinoma in dorsal and ventral pancreas
Authors: Wang Dasong , Zeng Qihui , Niu Xiaoya , Chen Xinghan , Ye Hui
Published: June 2021

The embryonic development of the pancreas originates from dorsal and ventral anlagen, and the pancreatic cancer arising from dorsal or ventral pancreas may have different clinical pathology features. This study aims to explore whether there are differences in clinicopathological features and prognosis of pancreatic head carcinoma arising from dorsal or ventral pancreas.

Between January 2014 and February 2018, 101 patients with resectable pancreatic head cancer who underwent pancreaticoduodenectomy in our institution were retrospectively reviewed. The patients were assigned into 2 groups according to tumor location on preoperative imaging materials (computed tomography/magnetic resonance imaging [CT/MRI]), and the clinicopathological features and prognosis were retrospectively analyzed in view of the embryonic development of the pancreas.

Among these patients with pancreatic head cancer, 42 patients had tumors arising from dorsal pancreas (D group) and 59 patients had tumors arising from ventral pancreas (V group). The frequency of lymph node (LN) metastasis around the common hepatic artery (CHA) and hepatoduodenal ligament lymph nodes in the D group was higher than that in the V group (45.2% vs 10.2%, P = .001). And the rate of LN metastasis in the superior mesenteric artery (SMA) region in the V group is higher than that in the D group (32.2% vs 4.8%, P = .002). The D group was more likely to invade the common bile duct (78.6% vs 59.3%, P = .042) and duodenum (71.4% vs 44.1%, P = .006) than the V group. In addition, the survival outcome of V group was better than D group (median overall survival [OS], 15.37 months vs 10.53 months, P = .048, median DFS 9.73 months vs 5.93 months, P = .046).

The clinicopathological features of pancreatic head carcinoma arising from dorsal or ventral pancreas are different, and the pancreatic head carcinoma arising from ventral pancreas has a better survival outcome.
Irrational career beliefs in agricultural education students, demographics, impacts, and rational career education intervention
Authors: Ifeanyieze Florence Obiageli , Ede Moses Onyemaechi , Ejiofor Tochukwu E. , Ekenta Lilian Ukamaka , Onah Ogechukwu , Okechukwu Favour C. , Isiwu Edward Chukwuka , Ogbonna Emeka , Azunku Francis , Nwankwo Clara Ukamaka , Ezebuiro Felicia , Onah Fredrick Chinedu , Mezieobi Daniel I. , Ede Kelechi R. , Onyeanusi Obiageli Calista , Asogwa Vincent O. , Omeje Benedicta , Abubakar Ibrahim , Samuel Mary
Published: June 2021

Background:

Studies have shown that a good number of students admitted into Agricultural Science Education program in Nigerian universities exhibit irrational career interest which affects their perceptions, feelings, and academic behaviors. This study, therefore, explored the effect of rational emotive career education on irrational career beliefs among students enrolled in agricultural education program in federal universities in Enugu state. Three null hypotheses guided the study.

Method:

Of the population (N = 79 students) targeted for the study and who underwent a screening exercise, 61 students were recruited as participants/sample size for the study. Sequence allocation software was used to assign 31 students into experimental groups and 30 into waitlisted control group. Participants in the intervention group received a rational emotive career education program that lasted for 12 sessions while those in waitlisted group did not receive the intervention. The participants in both groups were assessed at three points (Time 1, Time 2, and Time 3) using rational and irrational belief scale. A repeated measure (ANOVA) and partial eta square statistical tools were used to analyze the data collected.

Result:

This study result showed that rational emotive career education significantly reduced irrational career beliefs among students enrolled in Agricultural Science Education program exposed to intervention group compared to those in waitlisted control group. It also showed that there was time × group interaction for irrational career beliefs. The follow-up assessment indicated that the efficacy of rational emotive career education was sustained overtime.

Conclusion:

This study concluded that rational emotive career education is beneficial in reducing irrational career beliefs of university students enrolled in Agricultural Science Education program. Recommendations were also made in line with the results.
Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm
Authors: Celebi Ozlem Ozcan , Celebi Savas , Berkalp Berkten
Published: June 2021

Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.

A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.

The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.

Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.
Sagittal plane alignment affects the strength of pin fixation in supracondylar humerus fractures
Authors: Bitzer Alexander M. , Belkoff Stephen M. , LiBrizzi Christa L. , Chibututu Chimelie , Lee R. Jay
Published: June 2021

Closed reduction with percutaneous pin fixation is commonly used to treat pediatric supracondylar humerus fractures. Various pin configurations of varying biomechanical strength have been described. However, to our knowledge, no biomechanical study has focused on pin alignment in the sagittal plane. Our goal was to compare the stability of fixation using 3 different pin constructs: 3 lateral pins diverging in the coronal plane but parallel in the sagittal plane (3LDP), 3 lateral pins diverging in the coronal and sagittal planes (3LDD), and 2 crossed pins (1 medial and 1 lateral).

Transverse fractures were made through the olecranon fossa of 48 synthetic humeri, which were then reduced and pinned in the 3LDP, 3LDD, and crossed-pin configurations (16 specimens per group) using 1.6-mm Kirschner wires. The sagittal plane pin spread was significantly greater in the 3LDD group than in the 3LDP group, whereas we found no difference in the coronal plane. Sagittal extension testing was performed from 0° to 20° at 1°/s for 10 cycles using a mechanical torque stand. The torque required to extend the distal fragment 20° from neutral was compared between groups using one-way analysis of variance with multiple comparison post-hoc analysis. P values ≤.05 were considered significant.

The 3LDD configuration was more stable than the 3LDP and crossed-pin configurations. The mean torque required to displace the pinned fractures was 5.7 Nm in the 3LDD group versus 4.1 Nm in the 3LDP group and 3.7 Nm in the crossed-pin group (both, P < .01). We found no difference in stability between the 3LDP and crossed-pin groups (P = .45).

In a synthetic biomechanical model of supracondylar humerus fracture, sagittal alignment influenced pin construct stability, and greater pin spread in the sagittal plane increased construct stability when using 3 lateral pins. The lateral pin configurations were superior in stability to the crossed-pin configuration.

Level of Evidence: Level V.
The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
Authors: Ai Xiaolin , Xu Jianguo
Published: June 2021

The brainstem arteriovenous malformations (BS-AVMs) have a high morbidity and mortality and stereotactic radiosurgery (SRS) has been widely used to treat BS-AVMs. However, no consensus is reached in the explicit predictors of obliteration for BS-AVMs after SRS.

To identify the predictors of clinical outcomes for BS-AVMs treated by SRS, we performed a retrospective observational study of BS-AVMs patients treated by SRS at our institution from 2006 to 2016. The primary outcomes were obliteration of nidus and favorable outcomes (AVM nidus obliteration with mRS score ≤2). For getting the outcomes more accurate, we also pooled the results of previous studies as well as our study by meta-analysis.

A total of 26 patients diagnosed with BS-AVMs, with mean volume of 2.6 ml, were treated with SRS. Hemorrhage presentation accounted for 69% of these patients. Overall obliteration rate was 42% with mean follow-up of more than five years and two patients (8%) had a post-SRS hemorrhage. Favorable outcomes were observed in 8 patients (31%). Higher margin dose (>15Gy) was associated with higher obliteration (P = .042) and small volume of nidus was associated with favorable outcomes (P = .036). After pooling the results of 7 studies and present study, non-prior embolization (P = .049) and higher margin dose (P = .04) were associated with higher obliteration rate, in addition, the lower Virginia Radiosurgery AVM Scale (VRAS) was associated with favorable outcomes (P = .02) of BS-AVMs after SRS.

In the BS-AVMs patients treated by SRS, higher margin dose (19–24Gy) and non-prior embolization were the independent predictors of higher obliteration rate. In addition, smaller volume of nidus and lower VRAS were the potential predictors of long-term favorable outcomes for these patients.
The efficacy of acupuncture and moxibustion for early and middle-stage osteonecrosis of the femeral head
Authors: Jin Hongguang , Li Linhui , Yu Wen , Fu Yong
Published: June 2021

Background:

Osteonecrosis of the femeral head (ONFH) occurs predominantly in young- and middle-aged people, and the disability rate is high in the late stage of the disease and most patients have to undergo total hip replacement. Clinically, increasing attention is paid to intervening early and middle-stage ONFH so as to delay its progress. Acupuncture and moxibustion (AM) is a unique method for treating ONFH in China. This study aims to summarize the advantages of AM for the treatment of ONFH.

Methods:

A comprehensive literature search was conducted on the database with languages of English and Chinese. The medical subject titles used are “Osteonecrosis of the femoral head” and “acupuncture and moxibustion.” Related words in the title or abstract including but were not limited to “necrosis of the femoral head,” “avascular necrosis of the femoral head,” “ischemic necrosis of the femoral head,” “caput femoris necrosis,” “bone paralysis,” “bone erosion,” and “bone atrophy.”

Results:

Nine randomized controlled trials were identified in this meta-analysis that included 630 subjects. Meta-analysis showed that the trial group that treated with conventional therapy combined with AM had a higher effective rate (Z = 2.27 P = 0.02) and excellent and good rate (Z = 4.85 P < 0.00001) and Harris hip function score (HHS) (Z = 2.31 P = 0.02) and lower incidence of related adverse reactions during treatment (Z = 2.82 P = 0.005) compared with the control group that treated with conventional therapy alone.

Conclusions:

AM for early and middle-stage ONFH is an effective and relatively safe intervention, which can improve the effective rate and excellent and good rate and HHS, and reduce the adverse reaction rate. Clinically, early and middle-stage ONFH can be intervened by combining with AM while taking conventional therapy to improve the efficacy.
Laser photocoagulation for the treatment of bilateral late-onset retinopathy of prematurity-related retinal detachment in an adult male
Authors: Lin Ting Yi , Feng Kathy Ming , Chang Yun Hsiang , Liang I. Chia
Published: June 2021

Rationale:

Retinopathy of prematurity (ROP) is one of the major leading causes of childhood visual morbidity worldwide. Retinal break and traction develop in regressed ROP can further result in rhegmatogenous or tractional retinal detachment years or even decades later.

Patient concerns:

Here, we reported a case of bilateral ROP related late complication in a 36-year-old male with a chief complaint of increased floaters in his left eye.

Diagnoses:

The fundus examination showed demarcation lines over temporal side in both eyes with tractional retinal detachment and retinal breaks anterior to the lines. A diagnosis of ROP-related late complication of combined tractional and rhegmatogenous retinal detachment was made.

Interventions:

Peripheral laser photocoagulation along the demarcation lines for confining the detachment area in both eyes was performed with a stable condition during follow up.

Outcomes:

After laser retinopexy, the patient was followed up at one week and four months later with stable laser scars and without progression of the retinal detachments.

Conclusion:

Regressed ROP-associated retinal detachment can occur at any time during life. Special care and follow-up may be necessary for these patients.
Multiple endocrine neoplasia 2A with RET mutation p.Cys611Tyr
Authors: Li Yan , Tan Ya-qin , Tang Zhi-xiang , Liao Qing-hui , Guo Zhong-qiu , Lai Kang-bao , Wang Rong , Chen Yu-hua
Published: June 2021

Rationale:

Multiple endocrine neoplasia 2A (MEN2A) is a rare autosomal-dominant genetic syndrome, frequently misdiagnosed or neglected clinically, resulting in delayed therapy to patients.

Patient concerns:

A 47-year-old Chinese male patient underwent laparoscopic right adrenal tumorectomy, and postoperative pathology confirmed the tumor as pheochromocytoma (PHEO). He was readmitted to the department of endocrinology and metabolism due to constant increase in carcinoembryonic antigen (CEA) at 5 months after the operation.

Diagnosis:

The patient was confirmed with medullary thyroid carcinoma (MTC), multiple neck lymph node metastasis, and pituitary microadenoma. The p.Cys611Tyr (c.1832G>A, C611Y) mutation was detected. Therefore, he was diagnosed with MEN2A.

Interventions:

He underwent total thyroidectomy. The gene-sequencing analysis of his family was conducted, and the C611Y mutation was detected in his daughter.

Outcomes:

The level of carcinoembryonic antigen decreased significantly after thyroidectomy in this patient. Long-term follow-up management was conducted. Elevated serum calcitonin and bilateral thyroid nodules were found in his 13-year-old daughter. Thus, MEN2A was highly suspected and she was suggested to undergo total thyroidectomy.

Conclusion

Patients with MEN2A should be screened regularly and managed by a multidisciplinary team.
COVID-19 phobia in a boy with undiagnosed autism spectrum disorder
Authors: Sakamoto Shoko , Miyawaki Dai , Goto Ayako , Harima Yuji , Tokuhara Daisuke , Inoue Koki
Published: June 2021

Rationale:

Coronavirus disease 2019 (COVID-19) is affecting mental health profoundly. Previous studies have reported pandemic-related anxiety. Anxiety disorder and autism spectrum disorder (ASD) are common comorbidities. However, there has been no report of any patient with undiagnosed ASD who developed anxiety disorders caused by the COVID-19 pandemic. In this case report, we describe an 8-year-old Japanese boy with undiagnosed ASD who developed COVID-19 phobia, resulting in avoidant restrictive food intake disorder (ARFID).

Patient concerns:

As COVID-19 was highly publicized in the mass media and the risk of droplet infection was emphasized upon, the patient began to fear viral contamination from food, culminating in a refusal to eat or even swallow his saliva. He was admitted to a pediatric medical center in Osaka with life-threatening dehydration and was then referred to our child psychiatry department.

Diagnosis:

We diagnosed the patient with COVID-19 phobia resulting in ARFID. We identified ASD traits from his present social communication skills and developmental history.

Interventions:

We provided psychoeducation of ASD for the parents and administered supportive psychotherapy.

Outcomes:

Shortly after our intervention to relieve his ASD-related anxiety, his dysphagia improved.

Lessons:

Our findings suggest that children with undiagnosed ASD may develop COVID-19 phobia. In these cases, intervention for ASD may be more appropriate than starting treatment for anxiety disorders as the first-line option. COVID-19 is the biggest pandemic in the recent past, and more undiagnosed ASD patients who develop COVID-19 phobia may seek treatment. Clinicians should consider the underlying ASD in these patients and assess their developmental history and present social communication skills.