bluuebunny/crossref_metadata_2025 huggingface dataset:
An Economic Analysis of Direct Costs of Distal Radius Fixation and the Implications of a Disposable Distal Radius Kit
Authors: Lans Jonathan , Westenberg Ritsaart F. , Verhiel Svenna H.W.L. , Garg Rohit , Jupiter Jesse B. , Chen Neal C.
Published: January 2021

Objective:

To assess the direct costs of distal radius fracture volar plate (VP) fixation and to create a model to examine the effect of these cost drivers.

Materials and Methods:

Retrospectively, 744 distal radius fractures treated with open reduction and internal fixation (ORIF) were identified. The outcomes assessed included (1) the direct costs related to distal radius ORIF and (2) if a VP alone was amenable. Costs were represented as a cost ratio relative to the average cost of distal radius ORIF, where the average value is set as 1.0. Simulation models were run with all cost drivers (sex, age, open fracture, intra-articular fracture, and ancillary fixation) and with only ancillary fixation as a cost driver.

Results:

The cost ratio ranged from 0.61 to 1.81 and ancillary fixation was associated with increased implant costs in multivariable analysis. In the simulations, the cost ratio ranged from 0.96 to 1.23 when all cost drivers were included and from 0.99 to 1.20 if only ancillary fixation was included as a cost driver, a reduction of the range by 22.2%. Older patients, females, closed fractures, and extra-articular fractures were more amenable to VP fixation alone.

Conclusions:

Eighty-three percent of the surgically treated distal radius fractures were treated with VP fixation alone. A disposable kit could help limit cost variance per case by roughly 22%, as only ancillary fixation varies these costs. Closed fractures and extra-articular fractures in older patients or female patients are more amenable to VP fixation alone.

Level of Evidence:

Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
Severe Acute Respiratory Syndrome Coronavirus-2 Infections in Critical Care Staff: Beware the Risks Beyond the Bedside
Authors: El Bouzidi Kate , Pirani Tasneem , Rosadas Carolina , Ijaz Samreen , Pearn Matthew , Chaudhry Shehnila , Patel Sameer , Sureda-Vives Macià , Fernandez Natalia , Khan Maryam , Cherepanov Peter , McClure Myra O. , Tedder Richard S. , Zuckerman Mark
Published: January 2021

OBJECTIVES:

Critical care workers were considered to be at high risk of severe acute respiratory syndrome coronavirus-2 infection from patients during the first wave of the pandemic. Staff symptoms, previous swab testing, and antibody prevalence were correlated with patient admissions to investigate this assumption.

DESIGN:

Cross-sectional study.

SETTING:

A large critical care department in a tertiary-care teaching hospital in London, United Kingdom.

SUBJECTS:

Staff working in critical care.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Participants completed a questionnaire and provided a serum sample for severe acute respiratory syndrome coronavirus-2 antibody testing over a 3-day period in April 2020. We compared the timing of symptoms in staff to the coronavirus disease 2019 patient admissions to critical care. We also identified factors associated with antibody detection. Of 625 staff 384 (61.4%) reported previous symptoms and 124 (19.8%) had sent a swab for testing. Severe acute respiratory syndrome coronavirus-2 infection had been confirmed in 37 of those swabbed (29.8%). Overall, 21% (131/625) had detectable severe acute respiratory syndrome coronavirus-2 antibody, of whom 9.9% (13/131) had been asymptomatic. The peak onset of symptoms among staff occurred 2 weeks before the peak in coronavirus disease 2019 patient admissions. Staff who worked in multiple departments across the hospital were more likely to be seropositive. Staff with a symptomatic household contact were also more likely to be seropositive at 31.3%, compared with 16.2% in those without (p < 0.0001).

CONCLUSIONS:

Staff who developed coronavirus disease 2019 were less likely to have caught it from their patients in critical care. Other staff, other areas of the hospital, and the wider community are more likely sources of infection. These findings indicate that personal protective equipment was effective at preventing transmission from patients. However, staff also need to maintain protective measures away from the bedside.
Testosterone for Managing Treatment-related Fatigue in Patients With Metastatic Renal Cell Carcinoma
Authors: Tsimafeyeu Ilya , Tishova Yulia , Zukov Ruslan , Borisov Pavel , Bondarenko Anastasia , Zakurdaeva Kristina
Published: January 2021

Background:

Fatigue is one of the most common adverse events of systemic therapy in patients with metastatic renal cell carcinoma (RCC). The aim of multicenter randomized phase 2 study was to determine the efficacy and safety of testosterone in patients with fatigue developed during targeted therapy.

Patients and Methods:

Male patients with metastatic clear-cell RCC, normal prostate-specific antigen level, low testosterone level, and no evidence of hypothyroidism receiving first-line sunitinib or pazopanib with fatigue were randomly assigned (1:1) to either testosterone undecanoate (1000 mg) and targeted therapy or targeted therapy alone. The primary endpoint was the mean change of fatigue from baseline to 28 days according to the Functional Assessment of Chronic Illness Therapy—Fatigue scale. Secondary endpoints were safety, Functional Assessment of Cancer Therapy—Kidney Symptom Index 19, testosterone serum concentrations, red blood cell count, and hemoglobin level.

Results:

Sixty patients were assigned to receive testosterone and targeted therapy (N=30) or targeted therapy alone (N=30). As of the data cutoff on December 30, 2019, median follow-up was 18.2 months. The study achieved its primary endpoint based on the significant differences at day 28 favoring testosterone over targeted therapy alone regarding the decreased level of fatigue (difference between groups, 22.5 points; 95% confidence interval, 18.4-26.6; P=0.012). Significant changes in scores demonstrating the enhanced quality of life with testosterone compared with targeted therapy were also observed for Functional Assessment of Cancer Therapy—Kidney Symptom Index 19 disease-related symptoms (P=0.01). There were nonsignificant differences in red blood cell count and hemoglobin level between the 2 groups (all P>0.05).

Conclusion:

Male patients with metastatic RCC and hypogonadism receiving testosterone had less fatigue and better symptom control during targeted therapy.
The Direct Observation of Lymphaticovenular Anastomosis Patency with Photoacoustic Lymphangiography
Authors: Suzuki Yushi , Kajita Hiroki , Kono Hikaru , Okabe Keisuke , Sakuma Hisashi , Imanishi Nobuaki , Aiso Sadakazu , Kishi Kazuo
Published: January 2021

It is difficult to evaluate the postoperative patency of lymphaticovenular anastomosis, but this evaluation is essential for determining surgical results. When using the current standard modality, near-infrared fluorescent lymphography, it is difficult to observe patency if the anastomotic point is veiled by dermal backflow. In this study, we used a new photoacoustic imaging device, PAI-05, to check the patency of anastomosis. We performed photoacoustic lymphangiography after lymphaticovenular anastomosis surgery. By digitally subtracting the superficial area, we can examine an area deeper than the dermal backflow, which is not visible by near-infrared fluorescent lymphography. The connection between the lymphatic vessel and the venule observed in the image is an indication of the patency of anastomosis. However, in a non-patent anastomosed site, the lymphatic vessel has a gap that separates it from the venule at the anastomosed site. Although photoacoustic lymphangiography cannot be used to visualize the lymphatic vessels that are not contrasted by indocyanine green, the resulting high-resolution images and clear anastomosis evaluation afforded by it will contribute to the development of future lymphedema treatments.
SIMPLE REFIXATION OF A DISLOCATED HAPTIC OF FLANGED INTRAOCULAR LENS USING A 25-GAUGE NEEDLE
Authors: Silpa-archa Sukhum
Published: January 2021

Purpose:

To report the development of a novel, simple-to-use technique for the salvage of a haptic of dislocated flanged intraocular lens during a retinal detachment surgery.

Methods:

A 25-gauge regular-wall needle was prepared and threaded by the dislocated flanged haptic before the flanged haptic was heated and enlarged by low-temperature cautery.

Results:

The dislocated flanged haptic was probably the result of too small of a diameter of the previously flanged haptic and was triggered by scleral indentation. The rescue technique required only a 25-gauge regular-wall needle to conduct the conventional procedure of flanged haptic intraocular lens fixation before being enlarged by low-temperature cautery. The intraocular lens remained centered and stable at a 3-month postoperative follow-up examination.

Conclusion:

The application of a 25-gauge needle in the salvage of a haptic of dislocated flanged intraocular lens is simple and effective without the need for trimming the flanged tip.
Demise of nociceptive Schwann cells causes nerve retraction and pain hyperalgesia
Authors: Rinwa Puneet , Calvo-Enrique Laura , Zhang Ming-Dong , Nyengaard Jens Randel , Karlsson Páll , Ernfors Patrik
Published: January 2021

Recent findings indicate that nociceptive nerves are not “free”, but similar to touch and pressure sensitive nerves, terminate in an end-organ in mice. This sensory structure consists of the nociceptive nerves and specialized nociceptive Schwann cells forming a mesh-like organ in subepidermis with pain transduction initiated at both these cellular constituents. The intimate relation of nociceptive nerves with nociceptive Schwann cells in mice raises the question whether defects in nociceptive Schwann cells can by itself contribute to pain hyperalgesia, nerve retraction, and peripheral neuropathy. We therefore examined the existence of nociceptive Schwann cells in human skin and their possible contribution to neuropathy and pain hyperalgesia in mouse models. Similar to mouse, human skin contains SOX10+/S100B+/AQP1+ Schwann cells in the subepidermal border that have extensive processes, which are intimately associated with nociceptive nerves projecting into epidermis. The ablation of nociceptive Schwann cells in mice resulted in nerve retraction and mechanical, cold, and heat hyperalgesia. Conversely, ablating the nociceptive nerves led to a retraction of epidermal Schwann cell processes, changes in nociceptive Schwann cell soma morphology, heat analgesia, and mechanical hyperalgesia. Our results provide evidence for a nociceptive sensory end-organ in the human skin and using animal models highlight the interdependence of the nerve and the nociceptive Schwann cell. Finally, we show that demise of nociceptive Schwann cells is sufficient to cause neuropathic-like pain in the mouse.
Order does matter: the combined effects of classical conditioning and verbal suggestions on placebo hypoalgesia and nocebo hyperalgesia
Authors: Bajcar Elżbieta A. , Wiercioch-Kuzianik Karolina , Farley Dominika , Buglewicz Ewa , Paulewicz Borysław , Bąbel Przemysław
Published: January 2021

In most experimental studies in which verbal suggestion and classical conditioning are implemented together to induce placebo effects, the former precedes the latter. In naturally occurring situations, however, the information concerning pain does not always precede but often follows the pain experience. Moreover, this information is not always congruent with experience. This study investigates whether the chronology of verbal suggestion and conditioning, as well as their congruence, affects placebo hypoalgesia and nocebo hyperalgesia. The effects induced in 15 groups were compared. The participants in 8 experimental groups were presented with verbal suggestions that were either congruent or incongruent with classical conditioning. The verbal suggestions were provided either before or after conditioning. In 2 other experimental groups, placebo conditioning or nocebo conditioning was implemented without any verbal suggestion; in 2 groups, verbal suggestion of hypoalgesia or hyperalgesia without conditioning was applied. The control groups without any suggestions or conditioning were also included. Placebo hypoalgesia induced by congruent procedures was significantly stronger when the suggestion of hypoalgesia preceded rather than followed conditioning. The order of the congruent procedures did not affect the magnitude of nocebo hyperalgesia. In the groups in which incongruent procedures were implemented, placebo hypoalgesia or nocebo hyperalgesia was in line with the direction of the last-used procedure, regardless of whether it was conditioning or verbal suggestion. The results show that not the type of the procedure (verbal suggestion or conditioning), but the direction of the last-used procedure shapes pain-related expectancies and determines placebo effects.
Sex differences in neuroimmune and glial mechanisms of pain
Authors: Gregus Ann M. , Levine Ian S. , Eddinger Kelly A. , Yaksh Tony L. , Buczynski Matthew W.
Published: January 2021

Pain is the primary motivation for seeking medical care. Although pain may subside as inflammation resolves or an injury heals, it is increasingly evident that persistency of the pain state can occur with significant regularity. Chronic pain requires aggressive management to minimize its physiological consequences and diminish its impact on quality of life. Although opioids commonly are prescribed for intractable pain, concerns regarding reduced efficacy, as well as risks of tolerance and dependence, misuse, diversion, and overdose mortality rates limit their utility. Advances in development of nonopioid interventions hinge on our appreciation of underlying mechanisms of pain hypersensitivity. For instance, the contributory role of immunity and the associated presence of autoimmune syndromes has become of particular interest. Males and females exhibit fundamental differences in innate and adaptive immune responses, some of which are present throughout life, whereas others manifest with reproductive maturation. In general, the incidence of chronic pain conditions, particularly those with likely autoimmune covariates, is significantly higher in women. Accordingly, evidence is now accruing in support of neuroimmune interactions driving sex differences in the development and maintenance of pain hypersensitivity and chronicity. This review highlights known sexual dimorphisms of neuroimmune signaling in pain states modeled in rodents, which may yield potential high-value sex-specific targets to inform future analgesic drug discovery efforts.
Targeting novel human transient receptor potential ankyrin 1 splice variation with splice-switching antisense oligonucleotides
Authors: Huang Hua , Tay Shermaine Huiping , Ng Winanto , Ng Shi Yan , Soong Tuck Wah
Published: January 2021

Activation of transient receptor potential ankyrin 1 (TRPA1) channels by both environmental irritants and endogenous inflammatory mediators leads to excitation of the nerve endings, resulting in acute sensation of pain, itch, or chronic neurogenic inflammation. As such, TRPA1 channels are actively pursued as therapeutic targets for various pathological nociception and pain disorders. We uncovered that exon 27 of human TRPA1 (hTRPA1) could be alternatively spliced into hTRPA1_27A and hTRPA1_27B splice variants. The resulting channel variants displayed reduced expression, weakened affinity to interact with WT, and suffered from complete loss of function because of disruption of the C-terminal coiled-coil domain. Using a human minigene construct, we revealed that binding of splicing factor serine/arginine-rich splicing factor 1 (SRSF1) to the exonic splicing enhancer was critical for the inclusion of intact exon 27. Knockdown of SRSF1, mutation within exonic splicing enhancer, or masking SRSF1 binding with antisense oligonucleotides promoted alternative splicing within exon 27. Finally, antisense oligonucleotides-induced alternative splicing produced transcript and protein variants that could be functionally determined as diminished endogenous TRPA1 activity in human Schwann cell-line SNF96.2 and hiPSCs-derived sensory neurons. The outcome of the work could potentially offer a novel therapeutic strategy for treating pain by targeting alternative splicing of hTRPA1.
Mechanisms of Acid-Base Kinetics During Hemodialysis: a Mathematical-Model Study
Authors: Wolf Matthew B.
Published: January 2021

This study contrasts the abilities and mechanisms of two physicochemical, mathematical models to predict experimental bicarbonate kinetics, hence, buffer transport, during a hemodialysis (HD) treatment in chronic renal failure patients. The existing Sargent model assumes that the body fluids can be described as a single, homogeneous extracellular fluid (EC) compartment whose volume decreases because of a constant ultrafiltration rate during HD. Bicarbonate and acetate transport between HD fluid and the EC compartment are by convection and diffusion with acetate metabolized in that compartment. The new model formulated in this study assumes the same conditions as Sargent et al., but constrains ion concentrations in the EC to be electrically neutral at all times. This constraint requires inclusion in the EC of other transportable small ions, Na+, K+, Cl− and unidentified, anionic organic acids in addition to an electrical charge on impermeable albumin. The findings are that the new electroneutrality model predicts plasma bicarbonate-concentration kinetics as closely as the Sargent model, but bicarbonate transport is an unlikely mechanism. Rather, the findings are better explained by rapid interconversion of CO2 and bicarbonate in this simplified EC compartment model. The results of this study bring into question the ability of the Sargent et al. hypothesized H+-mobilization model to explain buffer-transport kinetics during HD.
A-kinase interacting protein 1 is sufficiently expressed and positively associates with WHO grade, meanwhile predicts unfavorable overall survival independently in glioma patients
Authors: Shen Songbo , Yao Yiqun
Published: January 2021

The present study aimed to investigate the association of A-kinase interacting protein 1 (AKIP1) with clinical characteristics, and further explore the prognostic value of AKIP1 in glioma patients.

Totally 168 glioma patients who underwent tumor resection were analyzed, and their tumor tissue specimens were acquired for the detection of AKIP1 expression by immunohistochemistry (IHC), which was scored by a semi-quantitative method considering staining intensity and staining density.

According to AKIP1 expression in tumor tissues of glioma patients, there were 65 (38.7%) patients with AKIP1 low expression (IHC score 0–3), 48 (28.6%) patients with AKIP1 high + expression (IHC score 4–6), 42 (25.0%) patients with AKIP1 high++ expression (IHC score 7–9) and 13 (7.7%) patients with AKIP1 high+++ expression (IHC score 10–12), respectively. AKIP1 expression was positively associated with World Health Organization grade. Overall survival (OS) was the lowest in the patients with AKIP1 high+++ expression, followed by those with AKIP1 high++ expression and those with AKIP1 high+ expression, and highest in those with AKIP1 low expression. Further subgroup analysis exhibited that AKIP1 expression was negatively associated with OS especially in high-grade glioma patients. In addition, AKIP1 expression was negatively associated with OS in all subgroups of patients with/without adjuvant radiotherapy, with/without adjuvant chemotherapy. Further multivariate Cox's regression exhibited that AKIP1 high expression was an independent predictive factor for worse OS.

AKIP1 presents with the potential to be a novel biomarker for tumor management and prognosis surveillance in glioma patients.
The exosome of platelet endothelial cell adhesion molecule-1 (PECAM1) protein
Authors: Zhu Zhidong , Shen Yanyun , Chen Yunfeng , Shi Haiming , Shi Yun
Published: January 2021

A number of studies have demonstrated that exosomes were involved in important physiological and pathological processes through cell-to-cell communication in cardiovascular disease, which contained nucleic acids, proteins, and lipid contents. In our study, we found that the protein platelet endothelial cell adhesion molecule-1 (PECAM1) was an extracellular vesicle in the blood of high blood pressure patients (HBPP).

Isolated the vesicles from the blood of HBPP and health examiners and detected its size and morphology with nanoparticle tracking analysis, then we identified its surface protein CD63, CD81, and the protein expression of PECAM1 in the exosome with western blot. Furthermore, we analyzed the correlation between the expression of PECAM1 and the high blood degree with linear regression analysis.

Our results showed that the morphology of extracellular vesicles was more evident in high blood pressure groups than healthy controls, and the protein expression of PECAM1 was also abundant in the vesicles of HBPP, however, there were no extracellular vesicles in the blood samples of healthy controls. Besides, linear regression showed the linear correlation coefficient R = 0.901, P < .01 between the expression of PECAM1 and the systolic blood pressure of the high blood patients. Therefore, the exosome of protein of PECAM1 was a potential risking star in HBPP.
Pattern of antibiotic use for acute respiratory infections among out-patients in South Asian Region
Authors: Al-Amin Saif , Hassan Md Zakiul , Saif-Ur-Rahman K.M. , Chowdhury Muhammad Abdul Baker , Morrison Sharon D. , Donevant Sara B. , Chowdhury Fahmida
Published: January 2021

Background:

South Asian region has been experiencing the increasing burden of antimicrobial resistance (AMR) primarily due to over and irrational prescribing of antibiotics. Acute respiratory infections (ARIs) are the leading cause of out-patients’ visits in the region. Despite commonly known viral aetiology, ARI is the single largest reason for antibiotic prescriptions contributing the exponential growth of AMR in the region. Collated data on antibiotic consumption for ARI at outpatients and resistance pattern of respiratory pathogen are lacking in the region.

Methods:

MEDLINE, Cochrane, CINAHL Plus (EBSCO), and Web of Science will be searched for eligible papers. Titles and abstracts, and full texts of the relevant studies will be screened by 2 independent reviewers against the inclusion criteria. Data extraction and quality of the studies will be assessed by 2 reviewers independently using the JBI Critical Appraisal Tools. A third reviewer will resolve any disagreement at any point between 2 reviewers.

Results:

The review will assess proportions of ARI patients receiving antibiotic therapy and types of antibiotics prescribed among outpatients of all ages in South Asia. This review will also assess the pattern of antimicrobial resistance among respiratory pathogens causing ARI in the region.

Conclusions:

This systematic review will evaluate published literature, summarize the existing data on the antibiotic prescribing patterns for outpatients with ARI in South Asia. The holistic finding of the proportion of patients receiving antibiotic therapy for ARI, proportion of different types of antibiotic received, and resistance against respiratory pathogen might guide future research. This underscores a need for formulating regional and national policy for AMR mitigation strategy, and revising clinical practice guidelines for the clinician to ensure rational use of antibiotics for ARI.

PROSPERO

registration no: CRD42018116658
Massive venous air embolism with bleeding caused by femoral vein injury during total hip arthroplasty
Authors: Min Ji Young , Roh Kyungmoon , Cho Seunghee , Hong Sanghyun , Chung Mee Young
Published: January 2021

Introduction:

Venous air embolism (VAE) from vascular injuries, is of rare occurrence but can result in catastrophic complications during total hip arthroplasty (THA). Early recognition and prompt management of vascular injury are required to avoid severe complications. Especially, bleeding is generally associated with profound hypotension in venous injury. We report an unusual complication of venous air embolism induced by femoral vein rupture during THA.

Patient concerns:

A 54-year-old male patient with a history of old left acetabular fracture was scheduled for THA. We experienced massive bleeding and VAE induced by femoral vein rupture during total hip arthroplasty. The BP suddenly dropped from 100/70 mm Hg to 80/50 mm Hg with massive bleeding. ETCO2 and SaO2 decreased profoundly.

Diagnosis:

The VAE was diagnosed by the change in end- tidal CO2 (ETCO2) and change of vital signs, so we performed ABGA and inserted TEE for confirmination.

Interventions:

For treatment, patient was managed by oxygen therapy, inotropics, vasopressor, transfusion and surgical repair.

Outcomes:

Upon consulting with a cardiologist, the patient was extubated the next day and was transferred to the general ward and recovered without serious complications. He stayed for 17 days until finally discharged without complications

Conclusion:

Preoperative vascular imaging may be recommended in the revisional case of THA or in patients with the history of hip trauma. The monitoring of ETCO2 and TEE might be helpful to recognize VAE earlier and therefore to avoid catastrophic complications through adequate treatment.
Ipsilateral femoral neck and shaft fracture in children
Authors: Xing Hailin , Wu Quanzhou , Lan Shuhua , Wang Chong , Ye Jifei , Ye Fang , Huang Shuming
Published: January 2021

Rationale:

Pediatric femoral shaft combined with ipsilateral femoral neck fractures are very rare but challenging injuries fraught with the development of avascular necrosis, coxa vara, and leg length discrepancy. Majority of the previous reports indicated the neck femur fracture was fixed with cannulated screws or/and pins, femoral shaft fracture was stabilized with a plate and screws. However, we used cannulated screws combined with elastic stable intramedullary nails to minimally invasive procedures treat this type of injury and achieved good follow-up results.

Patient concerns:

A 7-year-old boy (Case 1) was hospitalized due to a traffic accident resulting in swelling and deformity of the right thigh accompanied by limited mobility of hip and knee. A 5-year-old male child (Case 2) presented with pain and swelling in the bilateral lower limb after fall from approximately 12 feet.

Diagnoses:

Physical examination, X-ray film, and computed tomography were performed. Both patients were diagnosed with ipsilateral femoral neck and shaft fracture.

Interventions:

The fractures were reduced closed by image-intensifier imaging. Two partially threaded cancellous screws were used to fix femoral neck fracture, and elastic intramedullary nails were performed to stable the femoral shaft fracture. Postoperatively, the patients were immobilized in a one-and-a-half hip spica cast for six weeks. The internal fixations were removed after one year.

Outcomes:

Case one was follow-up at 14 months and the other one was followed up for 3 years. And at the last follow-up showed a normal and painless hip function. No clinical complications were found during follow-up visit, including head penetration, implant failure, fracture nonunion, avascular necrosis and hip varus deformity.

Lessons:

Clinician should carefully check and read relevant imaging data to avoid missed diagnosis. And the internal fixation method described in this paper may be more minimally invasive.
The laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion
Authors: Chen Guang , Chen Peng , Chen Xiaoping , Wang Jing , Peng Xinming
Published: January 2021

Background:

At present, laser is regarded as an effective treatment for macular edema secondary to branch retinal vein occlusion. With the breakthrough of anti-vascular endothelial growth factor drugs in ophthalmology clinical research, the intravitreal injection of ranibizumab is widely applied, but both methods have their limitations, so some clinical studies have combined and applied them together. However, the clinical results are inconsistent and controversial, and there is no relevant system evaluation for the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion now.

Objective:

Meta analysis is used to analyze and evaluate the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion.

Method:

CNKI, VIP, WANFANG, China Biology Medicine disc, Web of Science, PubMed, Embase, Cochrane Library have used random controlled clinical trial of laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion from the establishment of the database to October 2020. Two researchers conducted independent screening, quality assessment and data extraction for the literatures, and used RevMan5.3 to conduct Meta analysis for the included literatures.

Result:

The research has evaluated the effectiveness and safety of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion through the aspects of the best corrected visual acuity 6 months after operation, macular center thickness and the incidence of adverse reactions such as elevated intraocular pressure, endophthalmitis, vitreous hemorrhage and cataract.

Conclusion:

Laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion has good effect, and the research has provided reliable evidence for the use of clinical treatment of the laser combined with intravitreal injection of ranibizumab for treatment of macular edema secondary to branch retinal vein occlusion.
Impact of music on anxiety and pain control during extracorporeal shockwave lithotripsy
Authors: Wang Zhenghao , Feng Dechao , Wei Wuran
Published: January 2021

Background:

The present evidence is insufficient for evaluating the impact of exclusive music therapy on anxiety and pain control in extracorporeal shock wave lithotripsy (ESWL).

Methods:

A systematic review and meta-analysis was conducted to explore the efficacy of music therapy in reducing pain and anxiety in patients undergoing ESWL. PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomized controlled trials assessing music therapy in reducing pain and anxiety in patients undergoing ESWL. The search strategy and study selection process were managed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.

Results:

Five randomized controlled trials were included in the meta-analysis. Overall, music intervention groups experienced significant reductions in pain (risk ratios = –1.20, 95% confidence intervals = –1.95 to –0.45, P = .002) and anxiety (risk ratios = –3.31, 95% confidence intervals = –4.97 to –1.84, P < .0001) compared with control groups during ESWL. Music therapy gave patient more satisfaction with the treatment and a willingness to repeat the therapy was reported. However, there was no significant difference in the stone clearance rate.

Conclusions:

Listening to music can reduce patient's pain and anxiety significantly with increased therapy satisfaction and willingness to repeat.
Correlation between serum 25-hydroxyvitamin D level and diabetic retinopathy
Authors: Chi Lin , Li Shuang , Shang Xinrong , Jiang Bo
Published: January 2021

Background:

Diabetic retinopathy is a common complication of diabetes with a high incidence, and vitamin D deficiency is associated with diabetic retinopathy. Serum 25-hydroxy vitamin D [25-hydroxy-vitamind, 25 (OH) D], a product of vitamin D in the body, is considered the best indicator of a person's vitamin D nutritional status, and can be determined by measuring the concentration of 25 (OH) D. The purpose of this study is to systematically evaluate the correlation between serum 25-hydroxy vitamin D levels and diabetic retinopathy.

Methods:

To search English databases (PubMed, Excerpta Medical Database (Embase), Web of Science, the Cochrane Library) and Chinese databases (Chinese National Knowledge Internet, Development, and Evaluation (CNKI), WanFang, Viper, Chinese Biomedical Literature Database) by computer about Clinical study on the correlation between serum 25-hydroxyvitamin D level and diabetic retinopathy from the establishment of the database to November 2020. Two researchers independently conducted data extraction and literature quality evaluation on the quality of the included studies, and meta-analysis is conducted on the included literatures using Stata12.0 and RevMan5.3 software.

Conclusion:

In this study, the correlation between serum 25-hydroxyvitamin D level and diabetic retinopathy was systematically evaluated to provide an evidence-based basis for clinicians.

Ethics and dissemination:

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF Registration number:

DOI 10.17605/OSF.IO/CQY94.
Efficacy and safety of ligation of intersphincteric fistula tract in the treatment of anal fistula
Authors: Zhang Jiaji , Hao Xilu , Zhu Yican , Luan Ronggang
Published: January 2021

Background:

Anal fistula is characterized with perianal cellulitis, anorectal pain, smelly or bloody drainage of pus, and difficulty in controlling bowel movements. Ligation of intersphincteric fistula tract (LIFT) technique is a recently developed approach against anal fistula, and it could alleviate the pain of the patient, with little postoperative trauma, which can greatly shorten the wound healing time and hospitalization stay. We conduct the meta-analysis and systematic review to systematically evaluate the clinical efficacy and safety of LIFT in the treatment of anal fistula.

Methods:

Randomized controlled trials of LIFT against anal fistula will be searched in several Chinese and English databases. Two reviewers will independently conduct the literature extraction and risk of bias assessment. Statistical analysis will be conducted in RevMan 5.3.

Results and conclusions:

The study will help to systematically evaluate the clinical efficacy and safety of LIFT in the treatment of anal fistula.

OSF Registration number:

DOI 10.17605/OSF.IO/T4FUH
Expression and clinical significance of SYNE1 and MAGI2 gene promoter methylation in gastric cancer
Authors: Qu Yanjun , Gao Na , Wu Tao
Published: January 2021

Gastric cancer is the fifth most common cancer and the third leading cause of cancer-related mortality globally. Abnormal DNA methylation is closely related to gastric cancer. The purpose of the study was to investigate the methylation of the SYNE1 and MAGI2 gene promoter and its relationship with the clinical-pathological factors, chemotherapy efficacy, and survival, thus providing a new biomarker for the prognosis and chemotherapy efficacy in gastric cancer.

The methylation status of SYNE1 and MAGI2 in gastric cancer and adjacent tissues was detected by MSP method in 70 cases of advanced gastric cancer paraffin specimens.

The methylation rate of the SYNE1 and MAGI2 gene promoter region was higher in gastric cancer tissues compared with adjacent tissues. The methylation status of SYNE1 was associated with the age at diagnosis and the size of the primary tumors, but no clinical or pathological factors have been found to be related with the methylation status of MAGI2 promoter. A high level of SYNE1 promoter methylation was associated with poorer chemotherapy efficacy in recurrent patients with gastric cancer. Thirty-three percent of the 70 patients exhibited highly methylated MAGI2; in this group, the median progression-free survival time was 4.1 months, shorter than those with negative methylated MAGI2 whose PFS was 5.1 months.

MAGI2 is more methylated in gastric cancer than in adjacent tissues suggesting that hypermethylation changes in MAGI2 may be one of the mechanisms of tumorigenesis in gastric cancer. The methylation status of the SYNE1 and MAGI2 promoter regions may affect the chemotherapy efficacy of advanced gastric cancer. The prognosis of MAGI2-negative patients was better than that of positive ones, suggesting that MAGI2 may be an independent prognostic factor for PFS in patients with advanced gastric cancer.
Clinical features of asthma with comorbid bronchiectasis
Authors: Zhang Shi-Qi , Xiong Xiao-Feng , Wu Zuo-Hong , Huang Ting-Ting , Cheng De-Yun
Published: January 2021

Background:

This meta-analysis aimed to systematically estimate the prevalence of comorbid bronchiectasis in patients with asthma and to summarize its clinical impact.

Methods:

Embase, PubMed, and Cochrane Library electronic databases were searched to identify relevant studies published from inception until March 2020.

Study Selection:

Studies were included if bronchiectasis was identified by high-resolution computed tomography. Outcomes included the prevalence of bronchiectasis and its association with demographic characteristics and indicators of asthma severity, including results of lung function tests and the number of exacerbations.

Results:

Five observational studies with 839 patients were included. Overall, the mean prevalence of bronchiectasis in patients with asthma was 36.6% (307/839). Patients with comorbid bronchiectasis had lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (MD: −2.71; 95% CI: −3.72 to −1.69) and more frequent exacerbations (MD: 0.68; 95% CI: 0.03 to 1.33) than those with asthma alone, and there was no significant difference of sex, duration of asthma and serum levels of immunoglobulin(Ig)Es between asthmatic patients with or without bronchiectasis.

Conclusion:

The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.
Effects of autophagy inhibitor 3-Methyladenine on ischemic stroke
Authors: Zhang Ao , Song Yangyang , Zhang Zhihui , Jiang Siyuan , Chang Siqi , Cai Zhengyun , Liu Furong , Zhang Xinchang , Ni Guangxia
Published: January 2021

Background:

Ischemic stroke is a huge threat to human health globally. Rescuing neurons in the ischemic penumbra (IP) is pivotal after the onset of ischemic stroke, and autophagy is essential to the survival of IP neurons and the development of related pathological processes. As the most common autophagy inhibitor, 3-Methyladenine (3-MA) is widely used in studies related to the mechanism of neuronal autophagy in ischemic stroke; however, there is no consensus has been reached on its effects of neuroprotection or neurodamage, which hinders the development and clinical application of autophagy-targeted therapy strategies for the treatment of ischemic stroke.

Methods:

We will search the following electronic bibliographic databases: PubMed, EMBASE, Scopus, Science Direct, and Web of Science. Participant intervention comparator outcomes of this study are as flowing: P, animal models of ischemic stroke; I, received 3-MA treatment merely; C, received only vehicle or sham treatment, or no treatment; O, Primary outcomes are infarct volume; neuro-behavioral scores. Secondary outcomes are cerebral blood flow, blood–brain barrier permeability, cerebral hemorrhage, brain water content. Review Manager 5.3 and Stata 15.1 will be used in data analysis. The characteristics of the studies, the experimental model, and the main results will be described, the quality assessment and the risk of bias assessment will be conducted. A narrative synthesis will be made for the included studies. Besides, if sufficient qualitative data is available, a meta-analysis will be conducted. I
2 statistics will be used to assess heterogeneity.

Discussion:

This systematic review and meta-analysis of the autophagy inhibitor 3-MAs effects on animal models of ischemic stroke can help us to understand whether inhibiting autophagy brings protection or damage to IP neurons; in addition, it also helps to clarify the specific role of autophagy in cerebral infarction. Therefore, this study can provide evidence for the future development of therapy strategies targeting autophagy and bring more hope to patients with ischemic stroke.

PROSPERO registration number:

CRD42020194262.
Three-day tracheal intubation manikin training for novice doctors using Macintosh laryngoscope, McGRATH MAC videolaryngoscope and Pentax AirwayScope
Authors: Murakami Yuryo , Ueki Ryusuke , Niki Miyuki , Hirose Munetaka , Shimode Noriko
Published: January 2021

Background:

We compared the intubation skills obtained by novice doctors following training using 3 instruments, the conventional Macintosh laryngoscope (Mac) and 2 types of indirect video-laryngoscopes (McGrathTM-MAC: McGrath (McG) and AirwayScope (AWS)), to determine the most appropriate instrument for novice doctors to acquire intubation skills, especially focusing on visual confirmation of vocal cords, during a 3-day intensive manikin training program.

Methods:

Fifteen novice doctors who did not have sufficient experience in endotracheal intubation (ETI) and consented to participate in this study were included. We used AirSim and AMT (Airway management Trainer) manikins. First, an experienced anesthesiologist instructed the trainees on using the 3 instruments for a few minutes. Then, after familiarizing themselves with each device for 10 minutes, the participants attempted ETI on the 2 manikins with the 3 devices used in random order. Intubations with each device were practiced and performed for 3 successive days. We assessed the percentage of glottic opening (POGO) score, successful intubation rate and tracheal intubation time for each participant, with each device, and on each day.

Results:

In the first manikin, AirSim, POGO scores in the McG and AWS groups were significantly higher than those in the Mac group on all 3 days (P < .0001). The number of intubation failures in the Mac group decreased from 2 cases on day 1, to 1 case on day 2 and zero cases on day 3. There were no failures in the McG and AWS groups on any of the days. With the second manikin, AMT, POGO scores in the Mac group were significantly lower than those in the McG and AWS groups on all 3 days. There were no intubation failures in the AWS group on all 3 days. In the Mac group, the number of intubation failures decreased from 3 on day 1, to 2 on day 2 and zero failures on day 3. In the McG group, there were only 3 failures on day 1.

Conclusion:

The 2 types of indirect video-laryngoscopes (McGRATH and AirwayScope) were demonstrated to be suitable instruments for novice doctors to achieve higher POGO scores in a 3-day intensive ETI training.
Effect of electroacupuncture on postoperative cognitive dysfunction for patients undergoing total knee arthroplasty
Authors: Ye Zixuan , Ke Mingjing , Wang Tao , Guan Yingxin , Ou Liang , Zheng Linbiao , Chen Zehua , Shen Zhen , Zheng Liuyi , Yuan Changfei , Li Wenyao , Liu Jinqing , Li Yuheng , Zhang Shaodan , Wu Huai , Liu Wengang , Xu Xuemeng
Published: January 2021

Background:

Electroacupuncture is increasingly used in rehabilitation for postoperative cognitive dysfunction (POCD), but relevant evidence remains unclear for patients receiving total knee arthroplasty (TKA).

Methods:

The databases research of PubMed, EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI) will be conducted from inception to December 31, 2020. The relevant randomized controlled trials (RCTs) from data will be screened one by one. The remaining studies that meet the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software. Paired 2 reviewers will assess quality of the included studies and publication bias by using the Cochrane Collaboration risk of bias tool, and Egger test and Begg test respectively. And grading of recommendations assessment, development and evaluation (GRADE) will be used to estimate the quality of evidence.

Results:

In this study, we will analyze the effect of electroacupuncture on Mini-Mental State Examination (MMSE), interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α), S100-β protein, and adverse events for patients with TKA.

Conclusion:

Our findings will provide evidence for the effectiveness of electroacupuncture on the treatment and prevention of POCD for TKA patients.

Registration number:

Available at: https://osf.io/azyt9 (DOI number: 10.17605/OSF.IO/AZYT9).
Open reduction and plate fixation versus sling in treatment of mid-shaft fractures of clavicle
Authors: Li Guanggao , Liao Junjie , Su Wencai
Published: January 2021

Background:

For this prospective randomized clinical trial, it is implemented for the comparison of the outcomes of open reduction and internal fixation versus the sling treatment for mid-shaft clavicle fractures.

Methods:

We will evaluate the eligible patients diagnosed with the mid-shaft clavicle fractures in our hospital from December 2020 to December 2021. The outcomes acquired were reported in accordance with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). Approval for this prospective randomized clinical trial was obtained from the institution alethics review committee of Wuzhong People's Hospital. The criteria for inclusion included: one third of clavicle fracture with at least 1 axial width displacement (Robinson type 2B2 or 2B1); agreed to take part in our research; over 18 years of age; patients with isolated clavicle fracture. While the criteria for exclusion contained: the medial or lateral segment clavicle fracture; open fracture; injuries related to neurovascular; over 21 days of changes from accident. The primary outcome was described as the evidence of nonunion at 1 year, which was defined as the intact bone bridge without X-ray fracture after more than 6 months. The secondary outcomes included the function of arm, overall health, adverse events, the satisfaction related to appearance, and pain.

Conclusions:

It was hypothesized that in the case of clavicular comminuted mid-shaft fracture, for the open reduction and internal fixation, its nonunion rate was lower and satisfaction rate was higher, although there were a variety of complications.

Trial registration:

This study protocol was registered in Research Registry (researchregistry6295).
The PITX gene family as potential biomarkers and therapeutic targets in lung adenocarcinoma
Authors: Zhang Chunyi , Chen Xing , Chen Yefeng , Cao Miaoying , Tang Jixian , Zhong Bo , He Meng
Published: January 2021

The PITX gene family of transcription factors have been reported to regulate the development of multiple organs. This study was designed to investigate the role of PITXs in lung adenocarcinoma (LUAD).

In this study, the transcriptional levels of the 3 identified PITXs in patients with LUAD were examined using the gene expression profiling interactive analysis interactive web server. Meanwhile, the immunohistochemical data of the 3 PITXs were obtained in the Human Protein Atlas website, and western blotting was additionally conducted for further verification. Moreover, the association between the levels of PITXs and the stage plot as well as overall survival of patients with LUAD was analyzed.

We found that the mRNA and protein levels of PITX1 and PITX2 were higher in LUAD tissues than those in normal lung tissues, while those of PITX3 displayed no significant differences. Additionally, PITX1 and PITX3 were found to be significantly associated with the stage of LUAD. The Kaplan-Meier Plot showed that the high level of PITX1 conferred a better overall survival of patients with LUAD while the high level of PITX3 was associated with poor prognosis.

Our study implied that PITX1 and PITX3 are potential targets of precision therapy for patients with LUAD while PITX1 and PITX2 are regarded as novel biomarkers for the diagnosis of LUAD.