bluuebunny/crossref_metadata_2025 huggingface dataset:
A retrospective study of drug utilization and hospital readmissions among Medicare patients with hepatic encephalopathy
Authors: Vadhariya Aisha , Chen Hua , Serna Omar , Zamil Hani , Abughosh Susan M.
Published: April 2020

Hepatic encephalopathy (HE) is a complication occurring in patients with cirrhosis and is associated with neuropsychiatric and motor abnormalities. Symptomatic HE episodes almost always require hospitalization and the frequent recurrence of episodes is associated with poor prognosis and increased medical costs. The utilization of existing therapies for management of HE and adherence to them has yet to be evaluated using real-world claims data.

The aim of this study was to evaluate HE drug regimens and adherence and their association with hospital readmissions in Medicare Advantage plan patients.

This was a retrospective cohort study of patients discharged from a HE-related hospitalization or emergency room visit. Based on subsequent enrollment in the plan they were categorized into cohorts of 1 month, 3, and 6 months follow-up, and medication regimen was evaluated within the first month. The drugs evaluated included lactulose, rifaximin, and neomycin. Multivariable logistic regression was conducted to evaluate the association of drug regimen and medication adherence measured as proportion of days covered with HE readmissions.

There were 347 patients hospitalized for HE with 184 patients having 30-day enrollment and either a drug refill or an outpatient visit in this duration. Medications were not refilled by 67 (36.4%) patients. Various drug regimens had different adherence with mean (standard deviation) proportion of days covered ranging from 0.56 (0.29) to 0.82 (0.16) at 3 months and 0.48 (0.3) to 0.77 (0.15) at 6 months. The results of logistic regression at 3 and 6 months did not show a significant association of medication use or medication adherence with hospital readmissions.

Despite availability of therapy, medication utilization was alarmingly low after discharge of patients from HE-related hospitalization. Medication adherence was also low, which may affect the rate of recurrence and costs associated with readmissions. Efforts are needed in both care coordination of these patients to ensure they are prescribed appropriate medications and to enhance adherence to them.
The correlation of neuropsychological evaluation with 11C-PiB and 18F-FC119S amyloid PET in mild cognitive impairment and Alzheimer disease
Authors: Park Su Yeon , Byun Byung Hyun , Kim Byung Il , Lim Sang Moo , Ko In Ok , Lee Kyo Chul , Kim Kyeong Min , Kim Yu Kyeong , Lee Jun-Young , Bu Seon Hee , Kim Jung Hwa , Chi Dae Yoon , Ha Jeong Ho
Published: April 2020

For the diagnosis of mild cognitive impairment (MCI) and Alzheimer disease (AD), variable neuroimaging and neuropsychological tests have been used. We aimed to evaluate the correlation of neuropsychological domain with new amyloid positron emission tomography (PET) study and to validate the availability of new PET tracer.

We enrolled 20 patients who underwent 11C-PiB-PET/CT, new PET tracer 18F-FC119S PET/CT from November, 2014 to July, 2015. Among them, 10 patients were diagnosed with AD and 10 patients with MCI. The current version of Seoul Neuropsychological Screening Battery (SNSB) II was performed for cognitive evaluation. Each parameter of SNSB was compared between 2 patient groups. Spearman correlation analysis between value of SNSB domain and standardized uptake value ratio (SUVR) of PET was also performed.

The AD group presented significant poor z-score in Korean-Boston Naming Test(K-BNT) (P = .01),copy score of Rey Complex Figure Test (RCFT) (P = .049), immediate (P = .028)and delayed memory of Seoul Verbal Learning Test (SVLT) (P = .028), recognition of RCFT (P = .004), “animal” of Controlled Oral Word Association Test (COWAT) (P = .041), color reading of Korean-Color Word Stroop test (K-CWST) (P = .014), and Digit Symbol Coding (DSC) (P = .007) compared with MCI group. That means, except attention domain, all other cognitive domains were relatively impaired in AD compared with MCI. In correlation analysis, we found that poor performances on copy score of RCFT in MCI groups were associated with great beta amyloid burden in frontal area in both 11C-PiB-PET/CT and 18F-FC119S PET/CT. In AD group, 18F-FC119S PET presented more extensive correlation in each cognitive domain with multiple cortical areas compared with 11C-PiB-PET.

The degree of amyloid burden assessed on 18F-FC119S PET was significantly correlated with neuropsychological test in AD, and also MCI patients. The combination of neuropsychological evaluation with novel 18F-FC119S PET/CT can be used for valid biomarker for MCI and AD.
Attitude adjustments after global health inter-professional student team experiences
Authors: Skolka Michael , Hennrikus William L. , Khalid Muhammad , Hennrikus Eileen F.
Published: April 2020

How medical inter-professional (IP) education should be introduced to students is still a matter of research. We evaluated IP student attitudes before and after a busy “hands-on” clinical experience.

During 3 separate trips, first/second year medical and physician assistant students and third/fourth year nursing students traveled to Central America to work together for 1 week in an underserved clinical setting. Student opinions on inter-professional education were obtained before and after Brigade-1 using the Readiness for Inter-professional Learning Scale validated questionnaire. From these results, a modified version of the survey was developed that included quantitative and qualitative responses. For brigades-2 and -3, students received this modified version of the survey pre and post brigade. Quantitative data was analyzed via paired student t test, and qualitative data was analyzed to identify emerging themes using constant comparative methodology by three separate investigators.

No significant quantitative differences between IP student groups were observed in their evaluation of the importance of inter-professional education either before or after the brigades. Qualitative data noted pre-brigade expectations of positive IP, experiential and patient-centered cultural learning. Pre- and post-brigade student perspectives maintained a strong belief that high functioning IP care benefited the patient. Post-brigade perspectives revealed a shift in attitude from purely positive expectations to more practical aspects of teamwork, respect, and interpersonal relationships.

Students believe that patient care benefits from IP collaboration. After a busy clinical experience requiring collaboration, students realized that functional teams require appropriate skills, roles, and respectful interpersonal relationships.
Balance training can enhance hip fracture patients’ independence in activities of daily living
Authors: Chen Xinxin , Yang Wenhui , Wang Xiao
Published: April 2020

Background:

We conducted this meta-analysis to analyze the effectiveness of balance training in improving postoperative rehabilitation outcomes in hip fracture surgery patients.

Methods:

The Cochrane Library, Web of Science, Embase, and PubMed electronic databases were searched from their inception to December 2018. We selected prospective clinical control analyses and high-quality randomized controlled trials (RCTs) following the inclusion standards. We used Stata 12.0 to perform the meta-analysis. Where possible, the standard mean difference (SMD) with the 95% confidence interval (CI) was determined using a random effects model.

Results:

Ten RCTs involving 955 hips (balance training = 487, control = 468) published between 2002 and 2019 were assessed for eligibility of inclusion in the meta-analysis. Balance training was shown to remarkably improve the aspects of quality of life associated with physical health (standard mean difference [SMD], 2.20; 95% CI, 1.63–2.78, P = .000), a fast gait speed (SMD, 1.01; 95% CI, 0.25–1.77, P = .009), and balance (SMD = 0.26, 95% CI: [0.12, 0.41], P = .000). Moreover, the balance training group showed increases in independence in activities of daily living (ADLs), performance task scores, and health-related quality of life (HRQoL) scores compared with the control group (P < .05).

Conclusion:

According to the present meta-analysis, balance training improves one's independence in activities of daily living, performance tasks, lower limb strength, gait, and total physical function compared with no balance training. More high-quality RCTs with large sample sizes are required for the identification of the best balance training program after hip fracture.
Comparing hybrid problem-based and lecture learning (PBL + LBL) with LBL pedagogy on clinical curriculum learning for medical students in China: a meta-analysis of randomized controlled trials
Authors: Liu Chun-Xiao , Ouyang Wei-Wei , Wang Xiao-Wen , Chen Dan , Jiang Zhao-Lei
Published: April 2020

Background:

Problem-based learning (PBL) combined lecture based learning (LBL) has been a trend adopted as a new medical pedagogical approach in Chinese medical teaching. This study aims to evaluate the impacts of hybrid PBL and LBL pedagogy compared with LBL teaching method on the learning achievements of clinical curriculum for Chinese medicine students.

Methods:

Randomized controlled trials (RCTs) were identified through a systematic literature search of electronic databases and article references up to June 2019. PubMed, EBSCO, Web of Science, Cochrane Library, Wanfang Database, CNKI, and China Biology Medicine database (CBM) were searched. End points included knowledge scores, skill scores, medical writing scores, comprehensive ability scores and teaching satisfaction.

Results:

Totally 20 randomized controlled studies were finally included and all Chinese literatures, involving 1817 patients. Compared with traditional LBL pedagogy, hybrid PBL and LBL pedagogy significantly increased the clinical theoretical knowledge assessment score (RR = 4.84, 95% CI: 2.92∼6.76, P < .00001), clinical skills assessment score (RR = 1.60, 95% CI: 1.39∼1.81, P < .00001), comprehensive ability score (RR = 9.13, 95% CI: 8.42∼9.84, P < .00001) and teaching satisfaction (RR = 2.58, 95% CI: 1.84∼3.62, P < .00001), The meta-regression results showed that expertise-level of students and course type were the factors that caused heterogeneity.

Conclusions:

Hybrid PBL and LBL pedagogy integrates the advantages of conventional teaching methods and novel teaching methods, remarkably improves the teaching efficacy, demonstrates easy acceptance by students, and meets the demand of modern medical education, so it is an effective approach to cultivate the medical talents with an ability of innovative thinking and can be advocated and popularized as a teaching means.
The population attributable risk and clustering of stroke risk factors in different economical regions of China
Authors: Dong Shuju , Fang Jinghuan , Li Yanbo , Ma Mengmeng , Hong Ye , He Li
Published: April 2020

The greatest regional variation in stroke prevalence exists in China. However, whether there are differences in population attributable risk (PAR) and clustering of stroke risk factors among regions resulting in stroke geographic variation is unclear.

We conducted face-to-face surveys of residents of 14 provinces from September 2016 to May 2017 who participated in the Chinese Stroke Screening and Prevention Project. We compared the specific PAR values of eight risk factors and the different cluster rates and patterns in China.

A total of 84,751partipants were included. Eight factors accounted for 70% to 80% of the PAR of overall stroke in China. Not only did the PAR of the total risk factors differ among the 3 regions, but the PAR of the same risk factor also varied among different regions. The top 3 factors with the greatest PAR variations among the 3 regions were dyslipidemia, physical inactivity and family history of stroke. The clustering rates and patterns varied by regions. The overall proportion of participants with 0, 1, 2, 3, and ≥4 risk factors were 34.4%, 28.0%, 17.4%, 9.2%, and 10.3% in eastern China; 31.0%, 27.9%, 19.8%, 10.8%, and 9.9% in Central China and 28.2%, 29.5%, 19.9%, 10.8%, and 11.0% in western China, respectively. On basis of hypertension, the most common risk cluster patterns were overweight or smoking, dyslipidemia and physical inactivity, with other risk factors in the eastern, central and western regions, respectively.

The rates and patterns of clustering and the potential importance of stroke risk factors in different regions may together contribute to the geographical variation in stroke prevalence in China.
Comparison of acoustic radiation force impulse imaging with the convex probe 6C1 and linear probe 9L4
Authors: Wegner Mirja , Iskender Erol , Azzarok Ahmed , Sagir Abdurrahman
Published: April 2020

Background:

Acoustic radiation force impulse imaging (ARFI) is a noninvasive method to detect liver fibrosis. The aims of the study were to evaluate the difference between 2 different probes, 6 C1 and 9 L4, and to study inter- and intraobserver reproducibility for the probes.

Methods:

We enrolled 100 patients in this cross-sectional comparative study. All patients underwent liver stiffness measurement with both probes. Intraobserver, interobserver, intralobe, and interlobe agreement was analyzed using the intraclass correlation coefficient.

Results:

A significant difference in success rates was observed for both probes between the right and left liver lobes. A success rate of 91% was observed in the right liver lobe compared with 77% in the left liver for the convex probe (P = .007), and 91% vs 68% for the linear probe (P < .001). There was a significant correlation in ARFI-shear wave velocity (ARFI-SWV) between both probes in the right liver lobe (P = .01; r = .508) and in the left liver lobe (P = .05; r = .278); however, there was no significant correlation in ARFI-SWV between the liver lobes for both probes (convex probe r = .19 P = .112; linear probe r = .144 P = .23). Good or excellent inter- and intraobserver was detected for both probes. Poor agreement was found only for the interobserver agreement in the left lobe with the convex probe (ICC = .320).

Conclusion:

ARFI can be performed successfully with both probes in both liver lobes. There was no significant correlation in ARFI between the liver lobes for both probes; however, the right liver lobe should be favored. Standardization of the procedure is needed for the comparability of different studies.
The efficacy of extracorporeal shock wave for chronic musculoskeletal pain conditions
Authors: Qin Jiawei , Jin Tong , He Zexiang , Wu Lijian , Lin Qiuxiang , Lin Yiheng , Zhang Yi
Published: April 2020

Background:

This systematic review is the first one to assess the effectiveness and safety of extracorporeal shock-wave therapy (ESWT) for patients with chronic musculoskeletal pain conditions (CMPC).

Methods:

Seven electronic databases were searched for all relevant literature from inception to December 2019, including PubMed, the Web of Science, EMBASE, Cochrane library, China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang database. Only randomized controlled trials (RCTs) of ESWT for chronic musculoskeletal pain will be included. Two reviewers will independently select eligible studies and collected the detailed information, assessed the methodological quality. A third reviewer will join in discussion to solve disagreements. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) will be presented to demonstrate the effectiveness of ESWT for patients with chronic MSK pain conditions. RevMan 5.4 software will be used for statistical analysis.

Results:

This systematic review will explore the effectiveness and safety of ESWT for patients with CMPC. The primary outcome includes pain level, and secondary outcome includes function limitation and adverse events.

Conclusion:

It can provide the updated evidence which is of great importance for patients, clinical practice and health related policy maker in ESWT treating CMPC.
Electroacupuncture therapy for change of pain in classical trigeminal neuralgia
Authors: Sun Jing , Li Rongrong , Li Xiaoyu , Chen Lifang , Liang Yi , Zhang Qifei , Sun Ruohan , Hu Hantong , Shao Xiaomei , Fang Jianqiao
Published: April 2020

Introduction:

Classical trigeminal neuralgia (CTN) is a kind of trigeminal neuralgia which is due to neurovascular compression. The common neurological treatment CTN drug called carbamazepine is the main measure, although it usually has side effects and a high-rate of relapse. As a critical alternative therapy, electroacupuncture (EA) has been shown to benefit for neuropathic pain. The aims of this study are to observe the therapeutic effect and safety of EA for CTN, to evaluate whether EA has the advantage over carbamazepine in the analgesia of CTN. Furthermore, we would to establish a standardized, effective, and convenient therapy program of EA.

Methods and analysis:

One hundred twenty patients diagnosed with CTN will be randomized for a 4-week intervention. The interventions will be different according to the four groups (EA + carbamazepine group, sham EA + carbamazepine group, EA + placebo group and sham EA + placebo group). EA therapy will be performed in specific acupoints with a dilute wave (2/100 Hz) for 60 minutes. Carbamazepine tablets will be taken orally with 0.1 g each time, thrice daily. Sham EA and placebo intervention will not receive EA and drug treatment. The main outcomes are the change from baseline intensity of pain at 6 months (pain evaluation by visual analogue score) and the change from baseline brief introduction of 2-week pain to evaluate pain comprehensively. The data management and statistical analysis will be conducted by third party statisticians. Incidence of adverse events will be investigated.

Ethics and dissemination:

Ethics approval was obtained from the Clinical Trial Ethics Committee of The Third Affiliated Hospital of Zhejiang Chinese Medical University (NO. ZSLL-KY-2017-033) and Jiaxing Hospital of Traditional Chinese Medicine (NO. 2018-JZLK-002). The results will be disseminated by presentation at peer-reviewed journals.
Mobile health applications for the management of primary hypertension
Authors: Gong Ke , Yan Yu-Ling , Li Yu , Du Jun , Wang Jing , Han Yue , Zou Ya , Zou Xin-yu , Huang Hong , She Qiang
Published: April 2020

Background:

Hypertension is 1 of the major global public health challenges, which means that patients with hypertension need more measures to control their blood pressure. Currently, smart phones and applications are developing rapidly, and mobile health applications are used to manage hypertension, but evidences related to effectiveness are limited.

Objective:

The purpose was to assess the impact of m-Health apps on blood pressure control, medication adherence.

Methods:

480 participants were randomly assigned to the intervention and control groups. The intervention group used the “Yan Fu” app to manage their blood pressure, and the control group did not use any m-Health apps. The outcomes were changes in blood pressure, the percentage of participants with their blood pressure under control and medication adherence.

Results:

At the end of the study, the baseline characteristics between the 2 groups had no statistically differences (P > .05). Participants in the 2 groups all had lower systolic blood pressure and diastolic blood pressure than they did at baseline, and the intervention group demonstrated a significantly greater systolic blood pressure and diastolic blood pressure reduction than the control group (P < .05). Additionally, the percentage of participants with controlled blood pressure was higher in the intervention group (P < .05). The medication adherence of the intervention group was much higher than that of the control group (P < .05).

Conclusion:

M-Health apps are effective for hypertension management, it can favor the medication adherence and blood pressure control. Perhaps m-Health apps can be promoted in the blood pressure control.

Trial Registration: This study was registered in the Chinese Clinical Trial Registry under the number ChiCTR-IOR-17012069.
Chinese herbal medicine combination therapy for patients with steroid-dependent ulcerative colitis
Authors: Ye Qiaobo , Hu Zhipeng , Yang Maoyi , Qin Kaihua , Zhou Yingguang
Published: April 2020

Background:

Ulcerative colitis (UC) is a chronic non-specific intestinal inflammatory disease characterized by continuous and diffuse inflammatory response of colonic mucosa. Steroid-dependent UC is an important type of UC. Chinese herbal medicine is widely used in treating steroid-dependent UC in China. However, there is no systematic review and meta-analysis to collate and evaluate the evidence of these studies. The purpose of this research is to provide evidence of the efficacy and safety of Chinese herbal medicine in treating steroid-dependent UC.

Methods and analysis:

Six databases, including 3 English databases and 3 Chinese databases will be searched. In addition, other grey literatures and ongoing studies will also be searched. Two researchers will independently select eligible studies by reading titles, abstracts and full texts according to the inclusion and exclusion criteria. Risk of bias assessment will be conducted by 2 independent reviewers using Cochrane risk-of-bias tool. The outcomes include steroid-free remission rate, Total clinical effective rate, Incidence of adverse events, Disease activity index (modified Mayo score), Results of enteroscopy (Baron score) and mucosa (geboes index score). Heterogeneity between studies will be assessed by Cochrane X
2 and I

2
tests. We will conduct subgroup analysis and meta-regression to explore the source of heterogeneity. We will also evaluate the stability of the results through sensitivity analysis and publication bias through funnel plot and Egger test.

Results:

The results will be published in peer-reviewed journals.

Conclusion:

Our meta-analysis and systematic evaluation results will confirm whether Chinese herbal medicine is effective in the treatment of steroid-dependent UC. It will provide more ideas for future research.

OSF registration number:

DOI: 10.17605/OSF.IO/YP79Z
Laparoscopic gynecological surgery in an adult woman with Becker muscular dystrophy performed with sevoflurane with cisatracurium anesthesia
Authors: Zhou Shi-Yao , Wang Dan , Liu Chang , Zhang Shi , Shan Bao-Lei , Ma Hai-Chun
Published: April 2020

Rationale:

Becker muscular dystrophy (BMD) and Duchenne muscular dystrophy (DMD) are progressive neuromuscular disorders caused by mutations in the dystrophin gene. The management of anesthesia in patients with BMD is complicated because they are highly sensitive to the conventional anesthetics such as volatile anesthetics and muscle relaxants. It is reported that anesthesia in patients with DMD is associated with several complications. However, a few case reports have been published on adult patients with BMD undergoing surgery with general anesthesia. Reports indicate that children with BMD may experience some serious complications with flurane-inhaled anesthesia. However, no study has yet shown that the use of flurane-induced anesthesia in adults with DMD carries high risks.

Patient concerns:

We describe a 56-year-old woman with BMD who was scheduled for laparoscopic hysterectomy and bilateral adnexectomy under general anesthesia due to a mass in the uterus. The patient was diagnosed with BMD 20 years back and reported that during this period, she was able to walk slowly with help during her daily life. Additionally, she also had a history of hypertension since 4 years and type 2 diabetes mellitus since 2 years.

Diagnosis:

The patient was postmenopausal and presented with abnormal uterine bleeding and elevated CA125. Abdominal ultrasonography revealed diffuse enlargement of the uterus and hypoechoic internal echoes. These findings were suggestive of diffuse adenomyosis with multiple uterine leiomyomas, which would have adverse effects later in her life. Therefore, the patient required surgery to address the symptoms and further confirm the diagnosis. The final diagnosis was confirmed by histopathological analysis.

Interventions:

The patient was scheduled for laparoscopic hysterectomy and bilateral adnexectomy. Anesthesia was induced and maintained by a combination of intravenous and inhalation anesthetic agents, particularly cisatracurium besilate and inhaled. sevoflurane.

Outcomes:

The duration of anesthesia and postoperative period were uneventful. At the end of the operation, the patient had normal vital signs and was fully conscious. The patient was followed up for 8 months and no complications were noted during this period.

Lessons:

The combination of sevoflurane and cisatracurium besilate is a safe and effective method for the anesthetic management of adult patients with BMD scheduled for laparoscopic gynecological surgery. On the other hand, it is important to be aware of even rare complications of procedures, so that necessary precautions can be undertaken. Further investigations are necessary to determine the safe dosage of volatile anesthetics specifically for this clinical scenario so that anesthesiologists can use this combination method more accurately and precisely.
Airway obstruction during pneumonectomy using a single lumen tube
Authors: Son Shill Lee , Kim Woo-Shik , Kwon Miyoung , Moon Yeon-Jin
Published: April 2020

Rationale:

Endotracheal intubation is an essential step for airway management during general anesthesia. When surgeons carry out thoracic surgery such as pneumonectomy, they usually request lung isolation to secure a clear surgical view. A double lumen endotracheal tube is used for lung isolation in routine thoracic surgeries.

Patient Concerns:

A 56-year-old man was previously diagnosed with left Aspergilloma, a tuberculosis destroyed lung, and diabetes mellitus. According to his chest x-ray and chest computed tomography, his left lung was nearly collapsed, and the result of a pulmonary function test was severely restricted. The patient's diffusing capacity for carbon monoxide was 63% and predicted postoperative forced expiratory volume in 1 second was 23.5%

Diagnoses:

Due to his previous history, radiologic findings and laboratory test results, he was diagnosed with left Aspergilloma and tuberculosis destroyed lung.

Interventions:

Due to recurrence of Aspergilloma in his left lung, the patient was scheduled for a left pneumonectomy. Since the patient's partial oxygen concentration was adequate despite his left lung being nearly totally collapsed, we thought that we would be capable of performing the pneumonectomy using a single lumen tube (SLT). For a better surgical view, we planned lung isolation via insertion of a SLT deep into the bronchus.

Outcomes:

During pneumonectomy, after tracheal suction was performed, we tried a lung recruitment maneuver. Suddenly end-tidal carbon dioxide did not show on the monitor. The patient's blood pressure dropped and heart rate was decreasing. We thought that cardiopulmonary resuscitation was needed and an approximately 2 cm sized hematoma was removed from the endotracheal tube after vigorous suctioning. After getting rid of the hematoma, we changed the single tube to a double lumen tube (DLT).

Lessons:

This case led us to the conclusion that a DLT should be used for safety when carrying out thoracic surgery. We report a rare case of an airway obstruction using a SLT during pneumonectomy.
Case report: simultaneous occurrence of multiple myeloma and non-Hodgkin lymphoma treated by CAR T therapy
Authors: Li Tongjuan , Tan Jiaqi , Chen Liting , Kuang Dong , Mao Xia , Lou Yaoyao , Zhou Jianfeng , Zhou Xiaoxi
Published: April 2020

Rationale:

B cell lymphoma can co-occur with multiple myeloma (MM), and the prognosis in this case is usually poor. We propose the combination of CD19-chimeric antigen receptor (CAR) T cells and BCMA-CAR T cells for the treatment of such patients to obtain a superior prognosis.

Patient concerns:

We present a 50-year-old patient with previous B cell lymphoma and subsequent multiple myeloma (MM).

Diagnosis:

A diagnosis of B cell lymphoma and MM was made.

Interventions:

The patient was treated with a combination of haploidentical CD19-chimeric antigen receptor (CAR) T cells and BCMA-CAR T cells.

Outcomes:

After CAR T cell therapy, the monoclonal plasma cells in the bone marrow and M protein disappeared.

Lessons:

The combination therapy of CD19- and BCMA-CAR T cells is an effective measure to treat patients with concomitant or borderline cases of B cell lymphoma and MM.
High-energy focused extracorporeal shock wave therapy for bone marrow edema syndrome of the hip
Authors: Zhang Leilei , Cui Yuzhi , Liang Dawei , Guan Jie , Liu Youwen , Chen Xiantao
Published: April 2020

The objective of this retrospective study was to evaluate the efficacy of high-energy focused extracorporeal shock wave therapy (HF-ESWT) on painful bone marrow edema syndrome (BMES) of the hip and shorten the natural course of disease.

Thirty-four consecutive patients with BMES of the hip were treated with HF-ESWT in our department between August 2017and July 2018. The progression and treatment results of BMES were evaluated by imaging examination and clinical outcomes. The clinical outcomes include hip pain and function which were measured using the visual analog scale (VAS) and Harris hip score (HHS), respectively, and the VAS and HHS of all patients were calculated and evaluated before treatment (s0), at 1 month (s1), 3 months (s2), 6 months (s3)post-treatment. Imaging examination including Pelvic radiographs and frog views and double hip magnetic resonance imaging (MRI) were also obtained and scheduled before treatment, at 1, 3, 6, and the final follow-up post-treatment to exclude avascular necrosis and other pathology.

All patients successfully completed the treatment and follow-up. Compared with pretherapy, the pain was alleviated to varying degrees and the HHS was significantly improved, and the VAS was significantly reduced at S1–2 (1- and 3-months post-treatment) after therapeutic intervention (P < .05). The mean improvements were strongly statistically significant between S0 and S1 and between S1 andS2 (P < .0001) and less significant between S2 and S3 (P < .01). The mean improvement between 6 months (S3) and final follow-up (more than 12 months) was not statistically significant. The MRI findings demonstrated that the diffuse BMES in the femoral head and neck disappeared completely.

HF-ESWT is a safe, effective, reliable, and noninvasive treatment in patients with painful BMES of the hip, and it can accelerate the recovery of BMES of the hip, shorten the treatment time and course of disease, improve hip joint function and the quality of life of patients.
Early malfunction of a biliary self-expandable metal stent with an antireflux valve
Authors: Kim Sang Hoon , Oh Chi Hyuk , Lee Jae Min , Choi Seong Ji , Choi Hyuk Soon , Kim Eun Sun , Keum Bora , Jeen Yoon Tae , Chun Hoon Jai , Lee Hong Sik , Kim Chang Duck
Published: April 2020

Rationale:

Biliary drainage is essential to resolve jaundice in patients with malignant biliary obstruction. Recently, a biliary self-expandable metal stent (SEMS) with an antireflux valve was developed to prevent enteric-biliary reflux. Its antireflux valve was made of expanded polytetrafluoroethylene (ePTFE), a biostable and biocompatible material. Changes of the ePTFE membrane of medical devices are rarely reported in clinical practice.

Patient concerns:

A 59-year-old woman was admitted with a complaint of jaundice. Around 1 month before, she underwent endoscopic biliary stenting using a SEMS with an antireflux valve.

Diagnosis:

Acute cholangitis due to stent clogging was detected on abdominal computed tomography.

Interventions:

Endoscopic retrograde cholangiopancreatography and removal of the SEMS with deformity were performed.

Outcomes:

The obstructive jaundice was rapidly resolved after the removal of the clogged stent.

Lessons:

Although the ePTFE membrane is widely used to make medical devices, unexpected changes could occur after the membrane is exposed to bile juice in the duodenum. When performing biliary stenting using a SEMS with an antireflux valve, both the risk of early malfunction and the benefit of the antireflux effect should be considered.
Egg consumption and risk of type 2 diabetes mellitus in middle and elderly Chinese population
Authors: Ni Li-Ping , Du Li-Yun , Huang Yi-Qian , Zhou Jian-Ying
Published: April 2020

Data on the association between egg consumption and the risk of type 2 diabetes mellitus (T2DM) in the Chinese population are scarce. In the present study, we aimed to examine the association between egg consumption and the risk of T2DM in a middle and elderly Chinese population. A total of 3298 subjects (1645 men and 1653 women) from the Nutrition and Health Survey (2015–2017) in Hangzhou city were selected for the final analysis. Egg consumption was assessed using a validated food frequency questionnaire. All biochemical data and anthropometric measurements were collected following standardized procedures. Multivariable logistic regression analyses were used to assess the association between egg consumption and the risk of T2DM and the results were presented as odds ratios and 95% confidence interval (CI). Restricted cubic spline combined with logistic regression was used to explore the dose-response relationship between egg consumption and T2DM. Among 3298 subjects, 693 (21.0%) people had T2DM. Compared with participants who did not consume egg per week, the multivariable-adjusted odds ratios were 0.97 (95%CI : 0.78–1.21), 1.08 (95%CI : 0.91–1.06), 1.20 (95%CI : 0.94–1.55), 1.27 (95%CI : 0.99–1.68) in men (P > .05); 1.06 (95%CI : 0.81–1.37), 0.97 (95%CI : 0.78–1.21), 1.26 (95%CI : 0.99–1.59), 1.19 (0.92–1.54) in women (P > .05); 0.89 (95%CI : 0.79–1.04), 0.98 (95%CI : 0.91–1.06), 1.06 (95%CI : 0.87–1.30), 1.09 (95%CI : 0.88–1.34) in both men and women for egg consumption 0∼7, 7, 7∼14, and ≥14 eggs/week, respectively (P > .05). The dose-response curve showed that, with the increase of egg consumption, the risk of T2DM first increased and then decreased (P = .027).

We found that the association between egg consumption and T2DM was nonlinear, and higher egg consumption was not associated with an elevated risk for T2DM in middle-aged and elderly Chinese. However, future prospective studies are needed to confirm these findings.
Clinical significance of high expression of proliferating cell nuclear antigen in non-small cell lung cancer
Authors: Ye Xiaolan , Ling Bai , Xu Hanrong , Li Gongqi , Zhao Xinguo , Xu Jiangyan , Liu Jun , Liu Liangeng
Published: April 2020

Although proliferating cell nuclear antigen (PCNA) plays an important role in tumor proliferation and its expression level is closely related to the biological activity of tumor cells, PCNA expression in non-small cell lung cancer (NSCLC) has been seldom reported. In this study, we aimed to investigate the significance of PCNA expression in NSCLC tissues. PCNA expression in NSCLC and adjacent tissues were assessed by immunohistochemistry (IHC), western blotting, and reverse transcription polymerase chain reaction. Single factor analysis was used to study the relationship between the expression of PCNA and clinicopathological features of NSCLC. Multi-factor Cox survival analysis was used to evaluate the relationship between the expression of PCNA and overall survival of postoperative NSCLC patients. The areas under the receiver operating characteristics were calculated to evaluate the value of PCNA expression level in predicting the 3-year survival of NSCLC patients. IHC analysis showed that the positive expression rates of PCNA protein in NSCLC and adjacent tissues were 91.79% (257/280) and 25.83% (31/120), respectively. Western blotting confirmed that PCNA protein level was significantly higher in NSCLC tissues than in the adjacent tissues (P < .05). Reverse transcription polymerase chain reaction showed that the positive rate of PCNA mRNA in NSCLC was 88.93% (249/280), which was significantly higher than that in adjacent tissues 29.17% (35/120) (P < .05). Both PCNA mRNA and protein levels were correlated with tumor differentiation, size, metastasis, and stage in NSCLC. Patients exhibiting higher PCNA protein expression had a significantly shorter disease-specific survival rate than the other patients. PCNA protein level and tumor pathological type, metastasis, differentiation degree, and stage were independent factors affecting the overall survival of postoperative patients. The areas under the receiver operating characteristics of PCNA mRNA for predicting the 3-year survival of NSCLC patients was 0.89 (0.79–0.98), with a sensitivity and specificity of 0.84 and 0.76, respectively. In conclusion, high PCNA protein and mRNA levels may be associated with the occurrence, development, and prognosis of NSCLC.
Effects and mechanisms of Chinese herbal medicine for ulcerative colitis
Authors: Ye Qiaobo , Hu Zhipeng , Yang Maoyi , Qin Kaihua , Zhou Yingguang
Published: April 2020

Background:

Ulcerative colitis (UC), an important type of inflammatory bowel disease, is mainly characterized by persistent and diffuse inflammatory response of colonic mucosa. Many studies have explored the effects and mechanisms of Chinese herbal medicine (CHM) in UC animal models. However, there is no systematic review and meta-analysis to evaluate and summarize these studies. The purpose of this study is to provide precise evidence of the effects and mechanisms of CHM in treating UC.

Methods:

Six databases, including 3 English databases and 3 Chinese databases will be searched. Two researchers will independently select eligible studies by reading titles, abstracts, and full texts according to the inclusion and exclusion criteria. Risk of bias assessment will be conducted by 2 independent reviewers using SYRCLE's risk of bias tool. The outcomes include total clinical effective rate, adverse events, disease activity index, interleukin-1β (IL-1β), IL-4, IL-6, IL-17; colombosa damage index, colonic mucosa damage index; myeloperoxidase; epidermal growth factor; transforming growth factor-β1; and histopathological score. Heterogeneity between studies will be assessed by Cochrane X
2 and I

2
tests. We will conduct subgroup analysis to explore the subgroup effects. We will also evaluate the stability of the results through sensitivity analysis and publication bias through funnel plot and Egger test.

Results:

The results will be published in peer-reviewed journals.

Conclusion:

This study can help us to understand the effects and possible mechanisms of CHM for UC. For further clinical researches, this study can help us to better look for possible effective medicines for clinical use.

OSF registration number:

DOI 10.17605/OSF.IO/YU5FN.
Effect of pueraria, scutellaria, and coptis decoction for type 2 diabetes
Authors: Yang Maoyi , Hu Zhipeng , Yue Rensong
Published: April 2020

Background:

Type 2 diabetes mellitus is a common health problem in the world. The overall goal of diabetes management is to control blood glucose and lipids, so as to reduce the incidence of complications. Pueraria, scutellaria, and coptis decoction (PSCD) is 1 of the representative Traditional Chinese medicine formula in the treatment of diabetes, which is widely used in clinical practice in China. At present, there are many clinical reports about this formula, but these reports have their own defects.

Therefore, there is an urgent need for a systematic review and meta-analysis to synthesize the current clinical evidence.

Methods and analysis:

A comprehensive literature search will be conducted and randomized controlled trials will be selected according to inclusion and exclusion criteria. Fasting blood glucose and 2 hours postprandial blood glucose will be selected as the main outcomes. The secondary outcomes are glycated hemoglobin, fasting insulin, total cholesterol, glycerol, low-density cholesterol, high-density cholesterol and adverse effects. Chi-square and I
2 test will be used to test the heterogeneity of the study. Subgroup analysis will be conducted to explore the source of heterogeneity and sensitivity will be conducted to test the stability of the results. Funnel plot will be used to evaluate publication bias. Finally, the Grading of Recommendations Assessment, Development and Evaluate system will be used to summarize the quality of evidence.

Results:

The results will be published in peer-reviewed journals.

Conclusion:

This research will evaluate the efficacy of Pueraria, scutellaria, and coptis decoction in the treatment of type 2 diabetes mellitus patients. It will provide strong evidence-based support for clinical practice.

OSF registration number:

DOI 10.17605/OSF.IO/WVDE5
Long-term follow-up results in patients with thoracolumbar unstable burst fracture treated with temporary posterior instrumentation without fusion and implant removal surgery
Authors: Ko Sangbong , Jung Sukhan , Song Sukkyoon , Kim Jun-Young , Kwon Jaibum
Published: April 2020

Segmental fusion is not necessarily needed in treatment of thoracolumbar unstable burst fracture requiring surgery. Our objective was to report the results of follow-up for at least 10 years in patients with thoracolumbar unstable burst fracture requiring surgery in which fractured segment was healed following temporary posterior instrumentation without fusion, and in whom implants were subsequently removed.

Retrospective Cohort Study.

Nineteen patients in whom union of fractured vertebra was observed following surgery and in whom implants were removed within an average 12.2 months, and who could be followed up for at least 10 years, were enrolled.

At the last follow-up, we evaluated the segmental motions, anterior body height ratio, progress of further kyphotic deformity, Oswestry Disability Index, Rolland Morris Disability Questionnaire and Short Form 36.

Results: The follow-up period after implant removal surgery was 151 months on average. The local kyphotic angle was 26.89 ± 6.08 degrees at the time of injury and 10.11 ± 2.22 degrees at the last follow-up. The anterior body height ratio was 0.54 ± 0.16 at the time of injury and 0.89 ± 0.05 at the last follow-up. Thus, the fractured vertebra was significantly reduced after surgery and maintained till last follow-up. The segmental motion was 9.84 ± 3.03, Oswestry Disability Index was 7.95 ± 7.38, Rolland Morris Disability Questionnaire was 2.17 ± 2.67, short form 36 Physical Component Score was 77.50 ± 16.61, and short form 36 Mental Component Score was 79.21 ± 13.32 at last follow-up.

We conducted at least 10-year follow-up and found that temporary posterior instrumentation without fusion should be considered one of the useful alternative treatments for thoracolumbar unstable burst fracture in place of the traditional posterior instrumentation and fusion.
Correlation study between serum neuro-specific enolase and gastric and colorectal cancers
Authors: Luo Hai , Shen Kexin , Sun Hongyan , Li Ruiqi , Wang Zeming , Xie Zhongshi
Published: April 2020

This study investigated the diagnostic value of preoperative serum neuro-specific enolase (NSE) in gastric cancer (GC) and colorectal cancer (CRC), and the diagnostic viability of combined serum NSE, carcinoembryonic antigen (CEA), cancer antigen (CA)19-9, and CA242.

Patients with GC and CRC, and a healthy control group (n = 666 and 266, respectively) were compared with regard to NSE, CEA, CA19-9, and CA242 serum levels. NSE was analyzed for associations with clinicopathological parameters. To estimate the diagnostic potential of NSE, a receiver operating characteristic curve was constructed and the area under the curve (AUCs) was calculated for different patient subgroups.

The median serum NSE level of the tumor group (20.925 ng/mL) was significantly higher than that of the control (15.190 ng/mL). Serum NSE was associated with pathological tumor-node-metastasis staging, lymph node metastasis, distant metastasis, vascular invasion, and nerve infiltration. The area under the receiver operating characteristic curve (AUC) for NSE in GC and CRC (0.769) was higher than for the other 3 markers (0.571–0.680). The AUC of the combined markers was higher than for any of the markers individually (0.778–0.810).

The AUC for NSE alone suggests it may be an independent tumor marker, and useful for diagnosis of GC and CRC. However, the AUC for combined NSE, CEA, CA19-9, and CA242 was higher and thus potentially more diagnostic value.
Effects of hypertension in patients receiving mechanical thrombectomy
Authors: Yuan Zhengzhou , Chen Ning , Zhou Muke , Guo Jian , Zhang Yanan , Li Yanbo , He Li
Published: April 2020

Background:

Available evidence shows conflicting results with regard to a potential detrimental effect of hypertension on clinical outcomes in patients who undergo mechanical thrombectomy (MT). We performed a meta-analysis to evaluate the impact of hypertension on the prognosis of patients with acute ischaemic stroke (AIS) treated by MT.

Methods:

We systematically reviewed previous studies in the PubMed, EMBASE, and Cochrane library databases that reported MT outcomes in AIS patients and their relationships with hypertension or blood pressure. We used a poor outcome (modified Rankin score >2 at 3 months) as the primary end point. Mortality and symptomatic intracranial hemorrhage were the secondary end points. We incorporated a random effect for trials in all models.

Results:

Data from 6650 patients in 31 articles that evaluated the effect of hypertension or blood pressure on outcomes after MT were included. Compared with patients without hypertension, patients with hypertension had significantly higher odds of a poor outcome (odds ratio 0.70; 95% confidence interval 0.57–0.85; I
2 = 43%) and higher mortality (odds ratio 1.70; 95% confidence interval 1.26–2.29; I
2 = 33%). Symptomatic intracranial hemorrhage did not differ by patient hypertension status.

Conclusions:

The present study confirms that hypertension and high blood pressure are associated with a poor outcome at 3 months after MT in AIS patients. However, the causal relationship between hypertension and a poor outcome remains undetermined, and further investigations are required to ascertain whether AIS patients receiving MT could benefit from intensive blood pressure control.