bluuebunny/crossref_metadata_2025 huggingface dataset:
The effectiveness of moxibustion for treating of low back pain
Authors: Zhu Siyuan , Xiong Jun , Chen Jun , Tang Genhua , Zhong Zhiying , Lu LunBin , Zhou Xingchen , Guo Han , Fan Hao
Published: October 2020

Background:

Low back pain is a common clinical chronic disease with symptoms of back soreness, numbness, and pain. The incidence of low back pain is high, and gradually increases with age. It is mainly middle-aged and has a high recurrence rate. It is considered to be one of the common diseases with the highest disability rate. The aim of this systematic review is to assess the effectiveness and safety of moxibustion therapy for low back pain.

Methods:

Two reviewers will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL);PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIP database); and Wan–Fang Database from the inception, without restriction of publication status and languages. Additional searching including researches in progress, the reference lists and the citation lists of identified publications. Study selection, data extraction, and assessment of study quality will be performed independently by 2 reviewers. If it is appropriate for a meta-analysis, RevMan 5.4 statistical software will be used; otherwise, a descriptive analysis will be conducted. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data.

Results:

This study will provide a comprehensive review of the available evidence for the treatment of moxibustion with low back pain.

Conclusions:

The conclusions of our study will provide an evidence to judge whether moxibustion is an effective and safe intervention for patients with low back pain.

Trial registration number:

INPLASY202080027.
Evolution of an obstetrics and gynecology interprofessional simulation-based education session for medical and nursing students
Authors: Ogunyemi Dotun , Haltigin Christopher , Vallie Stephanie , Ferrari Thomas M.
Published: October 2020

Simulation and Objective Structured Clinical Examination assessment of learners can teach clinical skills proficiency in a safe environment without risk to patients. Interprofessional simulation-based education (IPSE) contributes to a transformation in students’ understanding of teamwork and professional roles. Long term outcomes for stimulation and IPSE sessions, are less well studied. We hypothesized that a progressive interprofessional education simulation program incorporating both faculty and interprofessional student collaboration would improve medical students’ knowledge retention, comfort with procedural skills, positive teamwork and respectful interaction between students.

An Obstetrics and Gynecology IPSE for medical and nursing students (NS) was developed in collaboration between a school of medicine and a school of nursing from 2014 to 2017. By 2017, content included

From 2014 to 2016, medical students completed attitude, knowledge, and perception surveys both pre and immediately post simulation, at 4 months, and 8 months. In 2017; all students completed self-assessments and received faculty-assessments.

The program trained 443 medical and 136 NS. Medical students’ knowledge, comfort, and interest increased significantly post simulation. Outcome scores decreased but were still significantly improved at 4 months but nearly dissipated by 8 months. There were no significant differences between medical and NS self-assessment or faculty-assessment scores regarding IUD insertion, cervical examination, or contraception quiz scores. Medical students’ birth simulation self-assessment versus faculty-assessment scores were 8.6 vs 8.9, P < .001.

Simulation improved students’ short-term medical knowledge, comfort, and perception with some long-term persistence at 4–8 months. Medical and NS learned obstetrics and gynecology skills in a collaborative environment and in role-specific situations. Medical students had the opportunity to learn from NS. Positive teamwork and respectful interaction occurred between the students.
Nutrition screening tools for risk of malnutrition among hospitalized patients
Authors: Cortes Regina , Bennasar-Veny Miquel , Castro-Sanchez Enrique , Fresneda Sergio , de Pedro-Gomez Joan , Yañez Aina
Published: October 2020

Background:

Malnutrition is a clinical problem with a high prevalence in hospitalized adult patients. Many nutritional screening tools have been developed but there is no consensus on which 1 is more useful. The purpose of this review protocol is to provide an overview of which nutritional screening tool is most valid to identify malnutritional risk in hospitalized adult patients and to analyze the sensitivity and specificity of the different tools.

Methods:

The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/inplasy-2020-9-0028/) and INPLASY registration number is INPLASY202090028. We will perform a systematic literature search of main databases: PubMed, EMBASE, CINAHL and Web of Science and the Cochrane database. Also, grey literature will be search. Peer-reviewed studies published in English, Portuguese or Spanish language will be selected. Screening of titles, abstract and full text will be assessed for eligibility by 2 independent blinded reviewers and any discrepancies will be resolved via consensus. After screening the studies, a meta-analysis will be conducted, if it is possible.

Results:

Results from this systematic review will help health professionals to identify malnutrition in hospitalized patients and to make decisions to prevent or treat it as well as provide new clues to researchers.

Conclusion:

Our systematic review will provide aknowledge about the most valid malnutrition risk screening tool in hospitalized adult patients.
The epidemiological characteristics and profile of drug-resistant tuberculosis among children with tuberculosis in Sichuan, China, 2015–2018
Authors: Xu Yuanhong , Li Qingfeng , Zhu Ma , Wu Xueqi , Wang Dongmei , Luo Jia , Li Yingjie , Zhong Jing , Zeng Peibin
Published: October 2020

The aim of this study was to investigate the epidemiological characteristics and profile of drug-resistant tuberculosis (DR-TB) among children with TB in Sichuan province of China.

From January 2015 to December 2018, microbiological culture-confirmed child TB cases (aged <15 years old) were enrolled retrospectively. Epidemiological and clinical information from these cases, and the drug susceptibility testing results of the isolates were collected and analyzed.

Of 317 culture-confirmed child TB cases, 16.7% (53/317) were aged under 5 years old. 54.9% were Tibetans, and 31.9% had clear history of contact with TB patients. More than half (53.9%) were not vaccinated by Calmette–Guérin bacillus (BCG). Thirty percent (n = 95) were diagnosed as severe TB, and 92.4% (n = 293) were new cases. The ratio of severe TB in BCG vaccinated group was significant lower than that observed in unvaccinated group (P < .01). Significantly higher proportion of severe TB among Tibetans than Han child TB cases was observed in BCG unvaccinated group (P < .01). The overall rate of DR-TB in this study was 24.3% (77/317) and 17 multidrug-resistant tuberculosis (MDR-TB) cases were identified with rate of MDR-TB at 5.4% (17/317). No extensively drug-resistant case was found. Thirteen out of 17 MDR-TB cases (76.4%) were Tibetan children. The ratio of any resistance to 4 first-line drugs identified were: isoniazid (INH), 15.5%; rifampicin (RIF), 9.1%; ethambutol, 0.6% and streptomycin, 6.0%, respectively. More than half of MDR patterns were resistant to INH + RIF (9/17), followed by at least resistance to INH + RIF + streptomycin (n = 7).

This was the first investigation on the epidemiological characteristics and profiles of DR-TB among child TB cases in Southwest of China. Our findings indicated a potentially high risk of TB infection to Tibetan children in the concentrated Tibetan communities of Sichuan.
Tumor necrosis factor antagonists for paradoxical inflammatory reactions in the central nervous system tuberculosis
Authors: Santin Miguel , Escrich Cristina , Majòs Carles , Llaberia Mariona , Grijota Maria D. , Grau Imma
Published: October 2020

Rationale:

Paradoxical reaction/immune reconstitution inflammatory syndrome is common in patients with central nervous system tuberculosis. Management relies on high-dose corticosteroids and surgery when feasible.

Patient concern:

We describe 2 cases of HIV-negative patients with corticosteroid-refractory paradoxical reactions of central nervous system tuberculosis.

Diagnoses:

The 2 patients experienced clinical impairment shortly after starting therapy for TB, and magnetic resonance imaging showed the presence of tuberculomas, leading to the diagnosis of a paradoxical reaction.

Interventions:

We added infliximab, an anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, to the dexamethasone.

Outcomes:

Both patients had favorable outcomes, 1 achieving full recovery but 1 suffering neurologic sequelae.

Lessons:

Clinicians should be aware of the risk of paradoxical reactions/immune reconstitution inflammatory syndrome when treating patients with tuberculosis of the central nervous system and should consider the prompt anti-TNF-α agents in cases not responding to corticosteroids.
Clinical study on acupuncture acupoints around the eyes in treating myopia in children and adolescents
Authors: Huang Qun , Yang Yang , Huang Hui , Zheng Yanlin , Wang Wanjie , Liao Tingting , Xiao Xili , Wang Jing , Zou Weiwen , Wang Juan
Published: October 2020

Introduction:

Myopia is the most common cause of avoidable visual impairment worldwide, which causes huge economic burden and social burden. There are several ways to treat and reduce myopia, but all have drawbacks; this reality drives us to search for additional effective and low-risk interventions of treatment for myopia. Acupuncture is an ancient therapy with a history of thousands of years and is now widely used in the medical system. Some randomized controlled trials have reported that acupuncture, as an adjuvant therapy, can effectively improve the diopter and vision in the sense of myopic children. Deqi is a long-standing belief to ensure the efficacy of acupuncture in the treatment of myopia, but this belief has not been confirmed by sufficient evidence of randomized controlled trials.

Methods:

This clinical study is a parallel-group, randomized controlled, and single blind study. Three hundred eligible adolescents will randomly be divided into acupuncture Deqi group, acupuncture without Deqi group, and waiting list group. All groups will be given frame glasses for corrective treatment; patients in the acupuncture Deqi group will be treated with acupuncture at acupoints around the eyes and flat puncture to Deqi, while acupuncture without Deqi group will not flat puncture to Deqi. The waiting list group will not receive acupuncture treatment. The primary outcome will be diopter measurement. Adverse events and safety indexes will be recorded throughout the study.

Discussion:

Our study will compare acupuncture Deqi with acupuncture without Deqi, and place it in a control group for the treatment of myopia. The results of this trial are expected to provide solid evidence for the effectiveness and safety of acupuncture combined with Deqi in the treatment of myopia, and hope to provide a reference for clinical practice. The primary outcome will be diopter measurement of the patients before treatment.

Trial registration:

ChiCTR2000037874, registered September 3, 2020.
Yishentongluo decoction in treatment of idiopathic asthenozoospermia infertility
Authors: Zhang Qi , Fan Lipeng , Li Fangyuan , Sun Zixue , Zhang Chenming , Chen Rubing
Published: October 2020

Background:

The reproductive dilemma faced by men has always been the focus of the whole society. Idiopathic asthenozoospermia (AZS), as one of the common causes of male infertility, lack of specific treatment. Traditional Chinese medicine has shown potential benefits in the management of male infertility. Yishentongluo decoction (YSTL) is a representative Chinese herbal formula; however, there is still no rigorous clinical trial supporting its application. Therefore, we designed a randomized controlled trial to evaluate the efficacy and safety of YSTL for patients with idiopathic AZS and explain the possible action mechanisms of YSTL in improving sperm motility.

Methods:

In this randomized controlled study, a total of 160 eligible patients will be assigned to YSTL group or the Levocarnitine oral solution group in a 1:1 ratio. The treatment period will be 12 weeks and the follow-up period will last 4 weeks. The primary outcome will be the the progressive (motility), sperm rate (%). Secondary outcomes will include the progressive (motility) + non-progressive (motility) sperm rate(%), total effective sperm count, inner mitochondrial membrane potential (MMP) in spermatozoa, and spouse pregnancy rate (%). Safety outcomes will cover electrocardiogram , blood tests (including blood routine test, hepatic function, and renal function), urine routine test, and stool routine test. The semen parameters, sperm MMP test, and all the safety outcomes will be performed at the baseline, 4th, 8th and 12th week. The pregnancy outcome will be evaluated at 4 weeks after treatment.

Discussion:

This study will provide initial evidence regarding the efficacy and safety of YSTL in the treatment of idiopathic AZS with kidney deficiency and blood stasis pattern. In addition, potential mechanisms of YSTL in improving sperm motility will be explored based on sperm MMP test.

Trial registration:

Chinese Clinical Trials Register identifier, ChiCTR2000033290, registered on 26 May 2020.
The relationship between gestational diabetes mellitus and interleukin 1beta gene polymorphisms in southwest of China
Authors: Liu Ting , Deng Jia-min , Liu Yan-ling , Chang Li , Jiang Yong-mei
Published: October 2020

Gestational diabetes mellitus (GDM) is a kind of chronic inflammatory condition with carbohydrate metabolism disorder. Interleukin-1beta (IL-1β) plays an important role in inflammatory response, but its role in GDM development remains unknown. The aim of this study was to analyze the association between Interleukin 1beta (IL1B) rs1143623 and rs16944 polymorphisms and susceptibility to GDM.

In total, 300 pregnant women with GDM and 261 healthy pregnant women were included in the study. In both groups, single nucleotide polymorphism (SNP) rs1143623 and rs16944 were analyzed by using snapshot technology. IL-1β serum values were determined by ELISA.

Serum IL-1β levels involvement in GDM development. According to the results, we found the association between the IL1B rs1143623 polymorphism and susceptibility to GDM. In further analysis, IL1B rs1143623 GG genotype had a higher level of total cholesterol (TCHO) and lower level of high density lipoprotein (HDL) in GDM patients compared with the CC/GC genotypes. However, there were no statistically significant difference between the GDM and healthy control groups in terms of rs16944 polymorphism.

Our results indicated that rs1143623 in IL1B gene may lead to GDM in the southwest of china. However, no significant difference was found between GDM and rs16944. The rs1143623 genotype may significantly impact the fat metabolism, especially the levels of TCHO and HDL. We believe that our findings will contribute to understanding of the etiology and possible novel prognostic markers for GDM.
A randomized controlled trial for the effect of Modified Shenling Baizhu Powder on delaying the illness progress of COPD stable phase patients (GOLD 1–2 stages)
Authors: Liu Yufei , Xie Xiaohong , Wang Wujun , Zhao Keni , Xiao Wei , Xiao Jing , Chen Jianqin , Zeng Jurong , Chen Keling
Published: October 2020

Introduction:

As one of the most prominent public health and medical problems, Chronic Obstructive Pulmonary Disease (COPD) has a serious impact on the quality of life of participants and may even be life-threatening. While modern medicine has worked well to alleviate the symptoms of COPD, the current situation with this chronic disease is not encouraging. Lung-spleen qi deficiency syndrome is one of the common forms of COPD and the traditional Chinese medicine formula Modified Shenling Baizhu Powder is very frequently used in the treatment of this syndrome. However, no direct evidence is available to support the efficacy and safety of Modified Shenling Baizhu Powder for COPD treatment.

Methods:

The study is a prospective, randomized, placebo-controlled, double-blind trial in which 270 eligible participants will be randomly assigned to either the experimental or control group in a 1:1 ratio. Both groups will receive the standard Western medication. Meanwhile, participants in the experimental group will undergo Modified Shenling Baizhu Powder, while those in the control group will undergo a matched placebo. The course of treatment is 6 months with 12 months of follow-up. Primary outcome is the forced expiratory volume in 1 second (FEV1) after bronchodi-lator use. The secondary outcomes include the declines and the between-group difference in the change from baseline to 18 months in FEV1 before bronchodilator use; the forced vital capacity (FVC), FEV1/FVC, FEV1%pred after bronchodilator use, modified British medical research council, COPD Assessment Test, St George's Respiratory Questionnaire (SGRQ); frequency, interval, duration and severity of COPD exacerbations; time to first COPD exacerbation; administration of rescue medication and a cost-effectiveness analysis; Smoking status. A safety assessment will also be performed during the trial.

Discussion:

The results of this trial will provide comprehensive evidence of the efficacy of Modified Shenling Baizhu Powder for early-stage COPD and the potential mechanism by which Modified Shenling Baizhu Powder acts, which may provide reference for the treatment plan of COPD participants.

Trial registration:

ChiCTR2000037873, Registered 2 September 2020
Danhong injection for the treatment of early diabetic nephropathy
Authors: Huang Caixia , Huang Cuiling , Zhou Guomin
Published: October 2020

Background:

Diabetic nephropathy (DN) is the one that of the most common complications of diabetes mellitus (DM). Diabetic patients will experience a high mortality rate when DN progress to end-stage. So, it is extremely important to early treat DN. Although several interventions have been used to treat DN, a conclusive finding has not already been achieved. As one of the most common Chinese medicines, danhong injection (DHI) which has been shown to have various functions has also been prescribed to be as the alternative treatment option. However, no systematic review and meta-analysis has been conducted to objectively and comprehensively investigate its effectiveness and safety. Thus, we designed the current systematic review and meta-analysis to answer whether DHI can be preferably used to timely treat DN.

Methods:

We will perform a systematic search to capture any potentially eligible studies in several electronic databases including PubMed, Cochrane library, Embase, China National Knowledgement Infrastructure (CNKI), Wanfang database, and Chinese sci-tech periodical full-text database (VIP) from their inception to August 31, 2020. We will assign 2 independent reviewers to select eligible studies, and assess the quality of included studies with Cochrane risk of bias assessment tool. We will perform all statistical analyses using RevMan 5.3 software.

Ethics and dissemination:

We will submit our findings to be taken into consideration for publication in a peer-reviewed academic journal. Meanwhile, we will also communicate our findings in important conferences.

Protocol registry:

The protocol of this systematic review and meta-analysis has been registered at the International Plateform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) platform (https://inplasy.com/inplasy-2020-9-0005/, registry number: INPLASY202090005) and this protocol was funded through a protocol registry.
Carbapenems versus alternative β-lactams monotherapy or in combination for febrile neutropenia
Authors: Tang Xiuge , Chen Lingyuan , Li Yan , Jiang Junsong , Li Xianshu , Liang Xueyan
Published: October 2020

Background:

Febrile neutropenia (FN) in cancer patients can be life threatening and require the timely antimicrobial agents treatment.

Methods:

To compare the effectiveness and safety of carbapenems versus β-lactams for FN. PubMed, Medline (Ovid SP), Cochrane CENTRAL, and Embase were searched up to March 2019. FN in patients due to undergoing chemotherapy and treated with carbapenems and β-lactams were included. Odds ratio (OR) and 95% confidence interval (CI) were estimated.

Results:

Fifty randomized controlled trials (RCTs) studies involving 10,995 participants were included. Carbapenems were more likely to experience treatment success without modification (OR = 1.34, 95% CI = 1.24–1.46) compared with β-lactams. Meropenem (OR = 1.36, 95% CI = 1.18–1.56; OR = 1.24, 95% CI = 1.01–1.53), imipenem/cilastatin (OR = 1.40, 95% CI = 1.19–1.65; OR = 1.31, 95% CI = 1.04–1.67) showed higher effectiveness from that by β-lactams monotherapy or in combination with aminoglycoside, respectively. Carbapenems–aminoglycoside combination therapy does not provide an advantage over carbapenems alone. Meropenem showed similar risk of adverse events (AEs) versus β-lactams. Imipenem/cilastatin was related to higher risk of AEs compared with β-lactams. There was no significant difference between carbapenems and β-lactams monotherapy or in combination.

Conclusion:

Meropenem and imipenem/cilastatin monotherapy appears to be available treatment for FN compared with β-lactams. Imipenem/cilastatin was related to higher risk of AEs. Balancing the evidence for drug efficacy and side effects, meropenem monotherapy appears to be available treatment for FN. Individual centers should select the best matching therapy regimens according to local epidemiology and susceptibility patterns.
Efficacy of a single injection compared with triple injections using a costoclavicular approach for infraclavicular brachial plexus block during forearm and hand surgery
Authors: Lee Mi Geum , Jung Wol Seon , Go Doo Yeon , Choi Sung Uk , Shin Hye Won , Choi Yun Suk , Shin Hyeon Ju
Published: October 2020

Objectives:

It was recently proposed that a costoclavicular (CC) approach can be used in ultrasound (US)-guided infraclavicular brachial plexus block (BPB). In this study, we hypothesized that triple injections in each of the 3 cords in the CC space would result in a greater spread in the 4 major terminal nerves of the brachial plexus than a single injection in the CC space without increasing the local anesthetic (LA) volume.

Methods:

Sixty-eight patients who underwent upper extremity surgery randomly received either a single injection (SI group, n = 34) or a triple injection (TI group, n = 34) using the CC approach. Ten milliliters of 2% lidocaine, 10 mL of 0.75% ropivacaine, and 5 mL of normal saline were used for BPB in each group (total 25 mL). Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at 5 minutes intervals for 30 minutes immediately after LA administration.

Results:

Thirty minutes after the block, the blockage rate of all 4 nerves was significantly higher in the TI group than in the SI group (52.9% in the SI group vs 85.3% in the TI group, P = .004). But there was no significant difference in the anesthesia grade between the 2 groups (P = .262). The performance time was similar in the 2 groups (3.0 ± 0.9 minutes in the SI group vs 3.2 ± 1.2 minutes in the TI group, respectively; P = .54).

Discussion:

The TI of CC approach increased the consistency of US-guided infraclavicular BPB in terms of the rate of blocking all 4 nerves without increasing the procedure time despite administering the same volume of the LA.
Comparative efficacy of bariatric surgery for type 2 diabetes mellitus
Authors: Wang Xixiong , Chen Cunren , Zheng Buping , Yang Xiaolong , Zhang Xiaoxin , Yang Chenchen
Published: October 2020

Background:

The comparative efficacy of bariatric surgical procedures for type 2 diabetes mellitus (T2DM) has not been completely elucidated. To investigate this question, we conduct a systematic review and network meta-analysis.

Methods:

The protocol followed preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) checklist. Two review authors will independently search the PubMed, Embase (Ovid), and the Cochrane Central Register of Controlled Trials databases. The primary outcome is T2DM remission. The secondary outcomes include BMI, HbA1c (%), and percentage excess weight loss (% EWL). Results from the network meta-analysis will be presented as summary relative effect sizes (WMD or RR) and relative 95% CIs for each possible pair of treatments. Outcomes will be combined based on different periods of follow-up (12 months, 36 months, and 60 months).

Results:

The results will provide useful information about the efficacy of bariatric surgical procedures in patients with T2DM.

Conclusion:

The findings of the study will be disseminated through peer-reviewed journal.

INPLASY registration number:

INPLASY202050053.
The efficacy of a phone assistance nursing program for functional outcomes in patients after shoulder instability surgery
Authors: Zheng Yongling , Wang Hongli , Wang Huali , Xu Junchang , Chen Ping
Published: October 2020

Objective:

We conduct this research protocol for the assessment of the effect of phone-assisted care programs on functional outcomes in patients receiving shoulder instability surgery.

Methods:

This is a randomized controlled, single center trial which will be implemented from October 2020 to December 2021. This trial is conducted according to the SPIRIT Checklist of randomized researches. It was authorized via the Ethics Committee of the First People's Hospital of Xiangyang city affiliated to Hubei Medical College (XY234-026). Ninety participants who undergo shoulder instability surgery are analyzed. Patients are randomly divided into control group (standard management group, with 45 patients) and study group (the phone program group, with 45 patients). In control group, the exercises at home are not monitored. Whereas in study group, patients are asked about their at-home activities, and the extra coaching sessions are provided to patients on self-care, exercise guidance, and the importance of exercise at home, and then answers to their questions. The primary outcome is the range of motion of the shoulder joint, and the pain arcs are determined through the range of motion. The extra assessments include the shoulder functional outcome, pain, and the quality of life. All the analysis needed in this study is implemented with SPSS (IBM, Chicago, USA) for Windows Version 19.0.

Results:

The clinical outcome variables between groups are shown in Table.

Conclusion:

This investigation can offer a reliable basis for the effectiveness of phone assistance nursing program in patients after shoulder instability surgery.

Trial registration number:

researchregistry6010
Quality of life among patients with autoimmune hepatitis in remission
Authors: Takahashi Atsushi , Abe Masanori , Yasunaka Tetsuya , Arinaga-Hino Teruko , Abe Kazumichi , Takaki Akinobu , Torimura Takuji , Zeniya Mikio , Yoshizawea Kaname , Kang Jong-Hon , Suzuki Yoshiyuki , Nakamoto Nobuhiro , Inui Ayano , Tanaka Atsushi , Takikawa Hajime , Ohira Hiromasa
Published: October 2020

Health-related quality of life (HRQOL) is lower in individuals with autoimmune hepatitis (AIH) than in the general population. However, previous evaluations of HRQOL for AIH have included a broad range of disease activities. The aim of this study was to clarify HRQOL among patients with AIH in remission.

We assessed HRQOL in patients with AIH in remission, patients with chronic hepatitis C (CHC) with eradicated hepatitis C virus (HCV) and patients with primary biliary cholangitis (PBC) using the Japanese version of the Chronic Liver Disease Questionnaire (CLDQ).

Participants comprised 62 patients with AIH in remission, 39 patients with CHC with eradicated HCV and 66 patients with PBC. Median ages of patients were 63, 69, and 64 years, respectively. Overall score (5.6 vs 5.9, P = .02) and fatigue (5.2 vs 5.6, P = .01) and worry (5.6 vs 6.0, P = .01) domain scores of the CLDQ were significantly lower in patients with AIH in remission than in CHC with eradicated HCV, and similar to scores except for the systemic symptoms domain in patients with PBC. Disease duration was associated with lower scores on systemic symptoms and activity domains of the CLDQ in patients with AIH in remission.

Patients with AIH in remission show impaired HRQOL associated with disease duration.
The importance of overweight in COVID-19
Authors: Rao Xinrui , Wu Chuangyan , Wang Sihua , Tong Song , Wang Geng , Wu Gang , Zhou Rui
Published: October 2020

The aim of this study was to evaluate the association between overweight and severity, drug response, and clinical outcomes of novel coronavirus disease 2019 (COVID-19).

In this retrospective cohort study, we reviewed medical records of 240 COVID-19 patients admitted to Union Hospital in Wuhan, China, between December 24, 2019, and March 25, 2020. Physical, clinical, laboratory, radiological characteristics, treatment, and outcome data were abstracted. Patients who were obese [body mass index (BMI) ≥28 kg/m2], underweight (BMI < 18.5 kg/m2), under 18 years old, pregnant, or still in hospital were excluded. Disease severity was classified as moderate or severe pneumonia based on the World Health Organization interim guidance. Overweight was defined as BMI ≥24 kg/m2 and <28 kg/m2. Patients were followed for discharge or death through April 10, 2020. We used logistic regression models to identify risk factors for severe disease, Cox proportional hazard models to explore associations between medications and patient outcomes (discharge or in-hospital death), and Kaplan–Meier survival curves and Cox regression models to evaluate risk factors for in-hospital death.

One-half of patients (120, 50.0%) had severe pneumonia, while nearly one-half (114, 47.5%) were overweight. Among patients over 45 years old, overweight patients had significantly lower rates of fatigue, higher rates of headache, and higher median C-reactive protein levels. Patients under 45 years old had higher rates of cough and myalgia and higher proportions of increased alanine aminotransferase and lactic dehydrogenase, as well as more pulmonary lobes involved in the pneumonia revealed by chest computed tomography scans. Overweight patients were at higher risk of developing severe pneumonia. Although weight was not a risk factor for in-hospital death, overweight patients showed different responses to medications compared with normal weight patients. Intravenous interferon-α, intravenous glucocorticoids, and antifungal drugs were associated with reduced mortality in overweight patients. Intravenous immunoglobulin, oseltamivir, and ribavirin were associated with reduced mortality in normal weight patients.

Overweight is a worldwide health problem. We found overweight to be related to the COVID-19 severity but not to in-hospital death. Clinicians should be aware that overweight COVID-19 patients require increased attention for different clinical features and treatment response.
Morphological study of safe fixation region of temporomandibular joint prosthesis in Chinese northeast population with 3-dimensional computed tomographic image
Authors: Zhong Zhuan , Sun Jialiang , Yu Zhentao , Han Yingying , Kang Chunyang
Published: October 2020

This study aimed to measure temporomandibular joint (TMJ) with 3-dimensional (3D) reconstruction technique in Chinese northeast population, and to clarify the region for fixation and to provide morphological basis for the application of TMJ prosthesis in Chinese setting.

Computed tomography (CT) scan and 3D reconstruction were performed with 132 individuals. Structural markers and measurements were further performed with a 3D model of the total TMJ, including the width, thickness and angle of zygomatic arch, the width and height of articular fossa, as well as the area, width, thickness and angle of mandible in the fixation region of the TMJ prosthesis. All the measured indicators values were compared between bilateral sides and gender groups.

There was no statistical difference in the measured indicators between the left side and the right side (P > .05). However, certain parameters, including S, L5, L7, P4, and P5, were significantly different among males and females (P < .05).

In this study, 3D CT image was used to obtain the measurement data of TMJ, which provided data support for the clinical application of TMJ prosthesis in Chinese population.
In situ buccal carcinoma in a teenager after hematopoietic stem cell transplantation
Authors: Liu Yanbin , Yuan Wei , Li Man , Cheng Long , Yang Jinsuo , Yin Boya , Huang Xin
Published: October 2020

Rationale:

Hematopoietic stem cell transplantation (HSCT) is the most effective treatment for the majority of patients who have malignant haemolytic disease. Although the success rate of HSCT has increased, the increasing number of cases suffering from secondary solid malignancies after HSCT has attracted more interest recently.

Patient concerns:

A 16-year-old female patient from China presented with a crusty and painful lesion on the left buccal mucosa with a history of chronic graft-versus-host disease following allogeneic HSCT for acute myeloid leukaemia.

Diagnosis:

An incisional biopsy of the lesion showed stratified squamous epithelium mucosa with severe dysplasia (carcinoma in situ). Subsequently, a wide local excision was performed and histological examination revealed early infiltrating squamous epithelial mucosa (carcinoma in situ).

Interventions:

She was being treated in the oral and maxillofacial surgery clinic with an incisional biopsy of the left buccal mucosa. She also received a wide local excision.

Outcomes:

Follow-up for 4 years showed no recurrence.

Lessons:

This case helps raise awareness of the diagnosis of oral symptoms in young patients after HSCT. Due to the increasing application of HSCT, raising awareness in oral and dental physicians may be required to improve long-term clinical outcome of patients who underwent HSCT.
Chemoradiotherapy combined with NK cell transfer in a patient with recurrent and metastatic nasopharyngeal carcinoma inducing long-term tumor control
Authors: Jin Yuan-yuan , Yang Wen-zhuo , Zou Sen , Sun Zheng-yang , Wu Chun-tao , Yang Zhao-yong
Published: October 2020

Rationale:

Nasopharyngeal carcinoma (NPC) is one of the most common malignancies in Southern China. Although combined chemotherapy with radiotherapy has been widely used in treating locally advanced lesions, relapse and metastases remain the primary cause of treatment failure, and are associated with an extremely poor prognosis. Therefore, more efficient and milder therapies are needed.

Patient concerns:

Herein, we report a patient with advanced NPC with intracranial metastases who showed progression during conventional treatment.

Diagnoses:

Nonkeratinizing undifferentiated nasopharyngeal carcinoma (stage IV).

Interventions:

After the completion of initial chemoradiotherapy and targeted therapy, metastases to brain occurred during follow-up. Ex vivo-cultured allogeneic NK cell infusion was offered.

Outcomes:

Although the intracranial metastases did not decrease 10 months after the NK cell treatment, they decreased significantly at 31 months after the treatment and partially disappeared. The tumor response indicated partial response. Furthermore, all of the intracranial metastases continued to decrease at about 42 months after treatment.

Lessons:

The brain metastases of NPC are rare with poor prognosis. Radiotherapy in NPC can disrupt the blood–brain barrier, which may contribute to the metastases of brain. This case report will provide rationale for NK cell infusion following regular chemoradiotherapy.
Rapid-onset acute respiratory distress syndrome after mastectomy in a breast cancer patient
Authors: Chien Shih-Chao , Chien Shih-Chun , Hu Ting-Yu
Published: October 2020

Rationale:

Postoperative acute respiratory distress syndrome (ARDS) often results in severe morbidity and mortality in surgical patients. The etiology of this condition is complex, especially in cancer patients.

Patient concerns:

We encountered a 53-year-old woman with left breast cancer, cT1cN2M0, stage IIIA with left axillary lymph node metastasis. She had received chemotherapy with 4 cycles of doxorubicin plus cyclophosphamide, and 4 cycles of trastuzumab plus docetaxel within a span of 6 months. Subsequently, she underwent left simple mastectomy and axillary lymph node dissection, shortly after which she developed respiratory distress with progressive desaturation and hemoptysis.

Diagnosis:

ARDS was diagnosed using the Berlin criteria. Her arterial blood gas analysis revealed profound hypoxemia and her chest imaging was suggestive of pulmonary edema. She developed diffuse alveolar hemorrhage (DAH) that was confirmed with bronchoscopy and hemorrhagic samples on bronchoalveolar lavage.

Interventions:

She was mechanically ventilated with lung protective measures for management of ARDS. In addition to antibiotic cover with amoxicillin sodium-potassium clavulanate for occult infections during her stay in the intensive care unit, we administered epinephrine inhalations, intravenous treatment with tranexamic acid, and methylprednisolone for DAH.

Outcomes:

Her clinical course improved; she was extubated successfully on day 7 and discharged home on day 11.

Lessons subsections:

Chemotherapeutic agents may cause pulmonary toxicity through a direct cytotoxic effect or immune-mediated reactions and result in an increased risk of development of ARDS. Furthermore, surgery may trigger a systemic inflammatory response syndrome that can also induce ARDS. In our patient, the development of ARDS was attributed to the combined effects of surgery and chemotherapeutic agents (trastuzumab or docetaxel). When patients undergo major surgery after receiving chemotherapeutic agents, careful consideration is necessary to prevent the development of ARDS.
Soothing liver-qi stagnation method for cancer-related depression
Authors: Zhang Jianfeng , Liu Yunxia , Xu Yefeng
Published: October 2020

Background:

Cancer-related depression (CRD) is the most common mood disorder in patients with malignant tumors, negatively influencing the patient's daily life. Traditional Chinese medicine, as an alternative CRD therapy, has shown good treatment performance in recently years. Soothing liver-qi stagnation, as a classic therapy for depression, is based on traditional Chinese medicine theory. However, there is no evidence-based medical confirmation for the soothing liver-qi stagnation method for CRD treatment.

Methods:

We will systematically search relevant articles from their inception to July 1, 2019 in the following electronic databases: the Cochrane Library, PubMed, EMBASE, Chinese National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, Chinese Science and Technique Journals Database, and the Wan-fang Database. The primary outcome is the total scores of the Hamilton rating scale for depression and, the efficacy rate of reducing Hamilton rating scale for depression scores. The secondary outcomes are adverse reactions and quality of life as assessed by standard instruments. Two researchers will independently perform study selection, data extraction, and quality assessment. If there is any disagreement, it will be settled through third-party negotiations. We will assess the risk of bias and data synthesis using Review Manager (the Cochrane Collaboration) software, Version 5.3.0.

Results:

This work will evaluate the clinical effectiveness and safety of the soothing liver-qi stagnation method for CRD.

Conclusion:

This study may provide evidence-based medical corroboration for clinical application of the soothing liver-qi stagnation method for CRD treatment.

PROSPERO registration number:

CRD42019145678.
A nomogram for determining the disease-specific survival in invasive lobular carcinoma of the breast
Authors: Fu Rong , Yang Jin , Wang Hui , Li Lin , Kang Yuzhi , Kaaya Rahel Elishilia , Wang ShengPeng , Lyu Jun
Published: October 2020

We aimed to establish and validate a nomogram for predicting the disease-specific survival of invasive lobular carcinoma (ILC) patients.

The Surveillance, Epidemiology, and End Results program database was used to identify ILC from 2010 to 2015, in which the data was extracted from 18 registries in the US. Multivariate Cox regression analysis was performed to identify independent prognostic factors and a nomogram was constructed to predict the 3-year and 5-year survival rates of ILC patients based on Cox regression. Predictive values were compared between the new model and the American Joint Committee on Cancer staging system using the concordance index, calibration plots, integrated discrimination improvement, net reclassification improvement, and decision-curve analyses.

In total, 4155 patients were identified. After multivariate Cox regression analysis, nomogram was established based on a new model containing the predictive variables of age, the primary tumor site, histology grade, American Joint Committee on Cancer TNM (tumor node metastasis) stages II, III, and IV, breast cancer subtype, therapy modality (surgery and chemotherapy). The concordance index for the training and validation cohorts were higher for the new model (0.781 and 0.832, respectively) than for the old model (0.733 and 0.779). The new model had good performance in the calibration plots. Net reclassification improvement and integrated discrimination improvement were also improved. Finally, decision-curve analyses demonstrated that the nomogram was clinically useful.

We have developed a reliable nomogram for determining the prognosis and treatment outcomes of ILC. The new model facilitates the choosing of superior medical examinations and the optimizing of therapeutic regimens with cooperation among oncologists.
Case report: fatal pneumonia caused by new sequence type Legionella pneumophilia serogroup 1
Authors: Jiang Luxi , Tao Sixu , Mu Deguang , Zhang Naxin , Zhao Li , Chen Yu
Published: October 2020

Introduction:

Legionnaires’ disease is caused by Legionella bacteria, and commonly manifests as pneumonia and has a high fatality rate.

Patient concerns:

This case study reports on the fatal incident of a patient, initially diagnosed with pneumonia, and subsequently diagnosed with Legionnaires’ disease caused by a new sequence type (ST) of Legionella.

Diagnosis:

It is speculated that the patient acquired Legionnaires’ disease from a contaminated water source. Legionnaires’ disease was diagnosed using the Legionella urinary antigen assay and bacterial cultures of respiratory secretions; Legionella pneumophilia Type 1 was also identified through serological testing. Sequence-based typing of the cultured bacterium revealed it to be a previously unidentified species, and it was named ST2345 new-type.

Interventions:

In addition to the treatment of Legionnaires’ disease, blood samples taken on the second day of admission showed a co-infection of Candida tropicalis, which was treated with anti-fungal treatment. The patient improved after a week, however, on the seventh day of administration lower respiratory secretions showed the growth of Klebsiella pneumonia, indicative of ventilator-associated pneumonia.

Outcomes:

Despite active treatment, the patient passed away due to multiple organ failure. As this was a fatal case, further research is needed to determine whether the critical condition of this case was related to the virulence of the novel Legionella strain.

Conclusion:

A key finding of this study is that treatment for suspected Legionnaires’ disease must be administered rapidly, as infection with Legionella may give rise to secondary pathogenic infections.
Successful en bloc resection of large esophageal hemangioma by endoscopic submucosal dissection
Authors: Yu Yan , Shen Bingzheng , Zhang Chao , Zhang Jiqiao , Cao Li , Lu Panpan , Liu Mei
Published: October 2020

Rationale:

With the development of endoscopic techniques, endoscopic therapy began to play an important role in the management of esophageal hemangiomas.

Patients concerns:

A large esophageal submucosal tumor (2.5 cm), which was suspected to be an esophageal hemangioma, was diagnosed in a 50-year-old woman.

Diagnosis:

Esophageal hemangioma

Interventions:

Endoscopic submucosal dissection was performed for tumor removal.

Outcomes:

Histopathological results revealed hemangioma. No complication or recurrence was observed in the 17-month follow-up period.

Lessons:

Our successful experience showed that endoscopic submucosal dissection is an effective and a safe approach to treat large esophageal hemangiomas (2.5 cm).
Efficacy and tolerability of combination therapy with alpha-blockers and phosphodiesterase-5 inhibitors compared with monotherapy for lower urinary tract symptoms
Authors: Qiangzhao Liu , Xiaofeng Zhang , Fenghai Zhou , Qiong Lian , Fa Zhang , Bohong Guo , Xinsheng Xi
Published: October 2020

Purpose:

This study aimed to compare the efficacy and safety of combination therapy consisting of α-blockers and different phosphodiesterase type 5 inhibitors for lower urinary tract symptoms (LUTS) by performing a network meta-analysis.

Method:

Relevant articles were retrieved from the Cochrane Library, PubMed, and EMBASE databases. Bayesian network meta-analyses were performed with a random-effect model to compare the efficacy and safety of combination therapy with α-blockers and phosphodiesterase-5 inhibitors for LUTS. The odds ratio (OR), mean difference (MD) and surface under the cumulative ranking curve (SUCRA) were calculated with the GeMTC R package.

Results:

Twenty randomized trials with 4131 patients were included in this network meta-analysis. Based on the SUCRA values, vardenafil (10 mg) combined with α-blockers ranked first, first and sixth; sildenafil (25 mg) combined with α-blockers ranked second, third and first; and tadalafil (20 mg) combined with α-blockers ranked third, second and fourth in IPSS, post void residual, and maximum flow rate, respectively.

Conclusions:

Combination therapy with α-blockers and phosphodiesterase-5 inhibitors was effective and well tolerated for LUTS. For men who prioritize high efficacy, vardenafil (10 mg) combined with α-blockers seems to be the treatment of choice. For men wishing to optimize minimally invasive treatment, sildenafil (25 mg) and tadalafil (20 mg) combined with α-blockers appears to have a possible advantage in terms of avoiding adverse effects.