bluuebunny/crossref_metadata_2025 huggingface dataset:
Interleukin-10 resolves pain hypersensitivity induced by cisplatin by reversing sensory neuron hyperexcitability
Authors: Laumet Geoffroy , Bavencoffe Alexis , Edralin Jules D. , Huo Xiao-Jiao , Walters Edgar T. , Dantzer Robert , Heijnen Cobi J. , Kavelaars Annemieke
Published: May 2020

Understanding the mechanisms that drive transition from acute to chronic pain is essential to identify new therapeutic targets. The importance of endogenous resolution pathways acting as a “brake” to prevent development of chronic pain has been largely ignored. We examined the role of interleukin-10 (IL-10) in resolution of neuropathic pain induced by cisplatin. In search of an underlying mechanism, we studied the effect of cisplatin and IL-10 on spontaneous activity (SA) in dorsal root ganglia neurons. Cisplatin (2 mg/kg daily for 3 days) induced mechanical hypersensitivity that resolved within 3 weeks. In both sexes, resolution of mechanical hypersensitivity was delayed in Il10
−/− mice, in WT mice treated intrathecally with neutralizing anti-IL-10 antibody, and in mice with cell-targeted deletion of IL-10R1 on advillin-positive sensory neurons. Electrophysiologically, small- to medium-sized dorsal root ganglia neurons from cisplatin-treated mice displayed an increase in the incidence of SA. Cisplatin treatment also depolarized the resting membrane potential, and decreased action potential voltage threshold and rheobase, while increasing ongoing activity at −45 mV and the amplitude of depolarizing spontaneous fluctuations. In vitro addition of IL-10 (10 ng/mL) reversed the effect of cisplatin on SA and on the depolarizing spontaneous fluctuation amplitudes, but unexpectedly had little effect on the other electrophysiological parameters affected by cisplatin. Collectively, our findings challenge the prevailing concept that IL-10 resolves pain solely by dampening neuroinflammation and demonstrate in a model of chemotherapy-induced neuropathic pain that endogenous IL-10 prevents transition to chronic pain by binding to IL-10 receptors on sensory neurons to regulate their activity.
Applying Telehealth Technologies and Strategies to Provide Acute Care Consultation and Treatment of Patients With Confirmed or Possible COVID-19
Authors: Exum Emelia , Hull Brian L. , Lee Alan Chong W. , Gumieny Annie , Villarreal Christopher , Longnecker Diane
Published: May 2020

Background and Purpose:

The COVID-19 pandemic continues to grow, with 19% of total confirmed patients classified as severe or critical experiencing complications such as dyspnea, hypoxia, acute respiratory distress syndrome, or multiorgan failure. These complications require rehabilitative care. Considering the contagious nature of COVID-19 and the necessity to decrease the volume of health care professionals entering confirmed COVID-19 patient rooms and becoming a potential disease vector, can audiovisual technologies employed by telehealth and telerehabilitation help?

Case Description:

This case discusses the Baylor Scott and White Institute for Rehab (BSWIR) Physical Medicine and Rehabilitation (PMR) department COVID-19 acute care therapy team's creation of a telehealth strategy to provide early rehabilitative intervention without increasing the odds of disease transmission.

Outcomes:

The COVID-19 therapy team created a simple process for identifying and triaging care for patients with possible or confirmed COVID-19. These patients were evaluated and treated by the dedicated team using telehealth strategies. A structured risk-benefit analysis was used to determine when in-room care was indicated.

Discussion:

Acute care physical therapy, occupational therapy, and speech-language pathology telehealth strategies can add value by mitigating COVID-19–related harm and influencing recovery, while not unnecessarily becoming additional disease vectors consuming personal protective equipment. COVID-19 is not only an aggressive respiratory illness similar to acute respiratory distress syndrome but also highly contagious and a risk for health care providers. Telehealth strategies allow therapists to intervene early, opening the possibility to maximize recovery and prevent harm or decompensation. Telehealth strategies can be more prevention-focused while the patient is experiencing relatively good health with goals to maximize strength and endurance before the disease process evolves to critical illness. As COVID-19 progresses, therapy can help mitigate potential complications associated with prolonged intensive care unit stay and ventilator management.
Molluscum Contagiosum
Authors: Coyner Theresa
Published: May 2020

Molluscum contagiosum (MC) is a common dermatology condition affecting the worldwide population. MC is caused by the MC virus, a member of the Poxviridae family. The virus predominantly affects children, sexually active adolescents and young adults, individuals involved in contact sports, and immunocompromised individuals. The condition is self-limited and will eventually clear spontaneously without treatment. Many individuals do elect treatment, and management strategies are discussed along with potential side effects. Selected treatment outcomes printed in a recent Cochrane systematic review are summarized.
Paget's Disease of the Breast Presenting as Nipple Ulceration With Normal Mammogram
Authors: Brickley Sylvana A. , Mercurio Mary Gail
Published: May 2020

Paget's disease of the breast (PDB) is a rare disorder of the nipple–areola complex that may present clinically as a unilateral, eczematous, or ulcerated papule or plaque. This case highlights the importance of either punch or incisional wedge biopsy to establish a diagnosis of PDB for patients who present with chronic cutaneous changes of the nipple, areola, or skin of the breast, regardless of any previous normal mammogram or breast ultrasound. Mammography alone cannot rule out a diagnosis of PDB in a patient with cutaneous changes of the breast.
Clinical and prognostic value of neutrophil-lymphocyte ratio for patients with thyroid cancer
Authors: Feng Jidong , Wang Yanyan , Shan Guohui , Gao Lei
Published: May 2020

Background:

Although the malignant degree is relatively low and overall prognosis is excellent, some patients with thyroid cancer still experience metastasis during the follow-up, which leads to their possible death. Pretreatment neutrophil-to-lymphocyte ratio (NLR) has been recommended as a biomarker for the prediction of metastasis and prognosis in patients with cancers. However, its value in thyroid cancer remains inconclusive. This study aimed to comprehensively evaluate the prognostic and clinicopathological significance of NLR for thyroid cancer by a meta-analysis.

Methods:

Eligible studies were identified by searching PubMed, EMBASE, and Cochrane Library databases. The associations between NLR level and disease-free survival (DFS) or clinicopathological parameters were estimated by calculating hazard ratio (HR) or effect size with 95% confidence interval (CI).

Results:

Nine studies consisting of 3081 patients were enrolled. Results of meta-analysis showed that elevated NLR was not significantly associated with unfavorable DFS overall, but subgroup analysis of multivariate-adjusted studies demonstrated an elevation in pretreatment NLR predicted poor DFS (HR = 3.51, 95%CI = 1.42–8.70). Overall, a high level of NLR was significantly correlated with larger tumor size (standardized mean difference [SMD] = 0.49, 95%CI = 0.33–0.64), and metastasis status (risk ratio [RR] = 1.70, 95%CI = 1.10–2.64). The association with tumor size was still significant in the stratified analyses by country and histology type (Asian: SMD = 0.719, 95%CI = 0.44–0.98; non-Asian: SMD = 0.36, 95%CI = 0.17–0.56; medullary thyroid carcinoma: SMD = 0.57, 95%CI = 0.09–1.05; papillary thyroid carcinoma: SMD = 0.48, 95%CI = 0.31–0.64). The association between NLR and metastasis was only significant for papillary thyroid carcinoma subtype (RR = 1.82, 95%CI = 1.04–3.20).

Conclusion:

Pretreatment NLR may serve as an excellent biomarker for prediction of tumor growth, metastasis, and prognosis in patients with thyroid cancer.
NAD(P)H: quinone oxidoreductase 1 gene rs1800566 polymorphism increases the risk of cervical cancer in a Chinese Han sample
Authors: Yang Shanshan , Zhao Jiannan , Li Li
Published: May 2020

Recently, 2 studies from Thai and American investigated the relationship between NAD(P)H: quinone oxidoreductase 1(NQO1) gene rs1800566 polymorphism and cervical cancer risk and generated contrary results. However, no Chinese reports have addressed this relationship until now. To explore the association between NQO1 gene rs1800566 polymorphism with cervical cancer, we performed a study in a Chinese Han sample.

Using a unmatched case-control design, we enrolled 450 cervical cancer patients and 568 controls in the Central Hospital of Wuhan from January 2010 to December 2016. The genotypes were determined by sequencing polymerase chain reaction product. Hardy-Weinberg equilibrium was assessed using the Chi-square test. The univariate and multi-variate logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the association between the NQO1 gene rs1800566 polymorphism and cervical cancer susceptibility.

The Chi-square test indicated that significant allele and genotype distributions differences were observed between case group and control group (P 
< 
.001). The logistic regression indicated that TT genotype was associated with higher risk of cervical cancer compare with those with the CT or CC genotype (TT vs CC: OR = 2.82, 95%CI: 1.91–4.17, P < .001; TT vs CT: OR = 2.02, 95%CI: 1.36–3.01, P < .001). The effects of NQO1 show dominant model (TT/CT vs CC: OR = 1.67, 95%CI: 1.30–2.15, P < .001) and recessive model (TT vs. CT/CC: OR = 2.43, 95%CI: 1.68–3.52, P < .001). The significant relationship between NQO1 rs1800566 polymorphism and cervical cancer risk was also found in stratified analyses. The cross-over analysis indicated that there are potential interactions between genetic factors and human papillomavirus infection/ contraceptive oral use for the risk of cervical cancer.

NQO1 gene rs1800566 polymorphism is associated with elevated risk of cervical cancer in Chinese Han women. The interactions between rs1800566 polymorphism and human papillomavirus infection/ contraceptive oral use further reinforce this association.
Prognostic value of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of 18F-FDG PET/CT in patients with renal carcinoma
Authors: Xuan Dongchun , Wen Weibo , Tian Shengri , Piao Minhu , Xu Dongyuan , Liu Lan
Published: May 2020

Purpose:

We present a comprehensive systematic review of the documented literature on parameters derived from 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and meta-analysis of the prognostic value of maximal standard uptake value (SUVmax), metabolic tumor volume (MTV) and total lesional glycolysis (TLG) in patients with renal carcinoma (RCC).

Patients and methods:

Relevant articles in English from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratio (HR) values were used to assess the prognostic value of SUVmax, MTV, and TLG.

Results:

A total of 10 primary studies involving 780 patients with RCC were included. The combined HRs for event-free survival were 1.32 (95% CI 1.10–1.58) for SUVmax, 2.40 (95% CI 1.20–4.79) for MTV, and 3.31 (95% CI 1.68–6.50) for TLG. Pooled HRs for overall survival were 1.264 (95% CI 1.124–1.421) for SUVmax, 3.52 (95% CI 1.451–8.536) for MTV, and 6.33 (95% CI 1.32–30.30) for TLG. Subgroup analysis revealed SUVmax as an independent risk factor for patients with recurrence or metastasis.

Conclusion:

The present meta-analysis confirmed that despite the clinical heterogeneity of RCC and adoption of various methods between studies, high SUVmax is a significant prognostic factor, especially in patients with recurrence or metastasis. MTV and TLG were associated with prediction of higher risk of adverse events or death in patients with RCC.
A comparison of the clinical effects of arthroscopic treatment for popliteal cyst between techniques using one posteromedial portal and two posteromedial portals
Authors: Guo Dongsheng , Cheng Liang , Chen Guangxiang , Yu Xiao , Zhang Hong , She Yuanshi
Published: May 2020

There is a lack of research comparing the clinical effects of arthroscopic treatment of popliteal cysts between the one posteromedial portal (OPP) technique and the two posteromedial portals (TPP) technique. The aim of this study was to evaluate and compare the clinical efficacy of arthroscopic treatment for popliteal cysts between the 2 techniques.

Patients with symptomatic popliteal cysts after surgery were retrospectively invited to participate in this study. They received arthroscopy treatment via the OPP technique or the TPP technique. At the final follow-up, the Rauschning and Lindgren criteria and the Lysholm score were used for clinical evaluation. Moreover, magnetic resonance imaging was performed to detect the recurrence of cysts postoperatively.

Finally, 53 patients with symptomatic popliteal cysts were included in this study, including 25 in the OPP group and 28 in the TPP group. The operation time of the TPP group was significantly longer than that of the OPP group (P < .001). In the OPP group, the cysts disappeared in 17 patients and reduced in size in 8 patients. In the TPP group, the cysts disappeared in 23 patients and reduced in size in 5 patients. According to the Rauschning and Lindgren classification, the recurrence rate was significantly lower in the TPP group (0%) than in the OPP group (4%) (P = .03). In addition, there was no significant difference in the Lysholm score between the OPP group and the TPP group (P = .77).

TPP technique is more effective and superior than OPP technique for the treatment of popliteal cysts.
Prospective randomized controlled trial study of Luofengning granule in the treatment of unstable angina
Authors: Wang Kai , Cai Jun-Jun , Wu Yang , Wang Yu , Liu Lei-Lei , Shi Lei , Wang Xian
Published: May 2020

Introduction:

Although the current western treatment plans for unstable angina (UA) has been optimized in past decades, UA still is a common phenotype of acute coronary syndrome and significantly influence the quality of life and endanger lives. In China, the clinical application of Chinese herb medicine is considered as an effective approach to treating UA and widely recognized by patients. In clinical practices, we found Luofengning granule (LFN-G) could improve clinical manifestations of patients with UA, but there is lack of rigorous proof of evidence-based medicine. This trial aims to further evaluate the efficacy of LFN-G in the treatment of UA.

Methods:

A prospective, open-label, randomized, placebo-controlled clinical will be performed. A total of 60 patients diagnosed with UA will be randomly allocated to either the treatment group or the control group with a 1:1 ratio. The participants in the treatment group will receive LFN-G treatment and the participants in the control group will receive placebo. Meanwhile, both groups continue to undergo standard western medicine treatments. The duration of interventions is 4 weeks. The primary endpoint is the incidence of major cardiac adverse events, defined as a composite of recurrent angina, acute myocardial infarction (AMI), severe arrhythmia, heart failure, and cardiac death. Secondary outcomes include Seattle angina scale score, Chinese medicine syndromes and electrocardiograph (at weeks 0, 1, 2, 4), myocardial nuclides perfusion, measurement of wall motion score index and left ventricular ejection fraction, serum inflammation factors such as C-reactive protein, high sensitive-C-reactive protein, interleukin-6, matrix metalloproteinase-9, and so on (at weeks 0, 4). In addition, some biochemical indexes of blood and hematological indexes will be used to assess the safety of treatments. Any adverse effects of the treatment will be recorded.

Discussion:

The results of this trial will provide compelling evidence of the efficacy and safety of LFN-G for treatment of UA and preliminarily reveal the potential mechanism of how LFN-G acts. Finally, it will widen treatment options for patients with UA.
Evaluation and ultrastructural changes of amniotic membrane fragility after UVA/riboflavin cross-linking and its effects on biodegradation
Authors: Zhang Chenming , Du Tingting , Mu Guoying , Wang Jia , Gao Xin , Long Fumin , Wang Qiaoling
Published: May 2020

This study aims to evaluate the changes of fragility and ultrastructure of amniotic membrane after cross-linking by UVA/riboflavin.

Forty-nine fresh amniotic membranes were randomly divided into 3 groups. Eighteen were in group A (CX group) and immersed in 0.1% riboflavin solution for 10 min for UVA/riboflavin cross-linking. Sixteen were in group B (B2 group), soaked for 10 min with 0.1% riboflavin. After soaking, membranes in group A and B were transferred into corneal preservation solution. Fifteen pieces were in group C, directly into corneal preservation solution. The biomechanical and ultrastructural changes of the amniotic tissue before and after cross-linking were examined (CX group = 13, B2 group = 11, C group = 15). The amniotic membrane tissue of group A (n = 5) and B (n = 5) was transplanted into 16 eyes of the rabbits, respectively, and the dissolution time of the amniotic membrane tissue was investigated.

After cross-linking, compared with the control group, the elastic modulus of the low-stress area of the amniotic membrane (E
low) was higher, while the elastic modulus of the high-stress area of the amniotic membrane (E
high) was lower, with no significant difference in the tensile strength. Also, the collagen fibers showed coarse and bamboo-like changes. In group A, amniotic membranes began to dissolve 4 weeks after conjunctiva transplantation, and all amniotic membranes were dissolved and absorbed 6 weeks after conjunctiva transplantation. In group B, some amniotic membrane tissues were still visible 6 weeks after conjunctiva transplantation.

This study suggested that after amniotic membrane cross-linking, the brittleness was increased, the hardness was enhanced, and the morphology of the collagen fiber was changed. The cross-linked amniotic membrane showed resistance to tissue dissolution.
Prevalence and causes of visual impairment in population more than 50 years old
Authors: He Yuan , Nie Aiping , Pei Jinzhi , Ji Zhi , Jia Jun , Liu Huifeng , Wan Pengfei , Ji Mingli , Zhang Chuntao , Zhu Yanni , Wang Xia
Published: May 2020

To assess the prevalence and causes of visual impairment (VI) in the elderly Chinese rural population in Shaanxi Province.

A population-based, cross-sectional study design was used to determine the extent of VI in Chinese people over the age of 50 years in Shaanxi Province. Visual acuity and best-corrected visual acuity were measured using the logarithm of minimum angle of resolution chart. Blindness and low vision were defined according to WHO criteria. The major cause of VI was identified for all participants who were visually impaired.

A total of 1912 residents completed a standard questionnaire and underwent a detailed eye examination, and the response rate was 90%. The overall prevalence of blindness and low vision were 1.5% and 8.2%. There was no statistically significant differences between genders in the prevalence of blindness and low vision (P > .05). The prevalence of blindness and low vision was higher among older individuals (P < .05) and lower (P < .05) among those with the highest education level. Cataract, corneal opacity, and glaucoma were considered as the main causes of blindness, which accounted for 67.9%, 10.7%, and 7.1%, respectively. Cataract, refractive error, and age-related macular degeneration were always considered as the leading causes of low vision, which accounted for 66%, 14.7%, and 5.8%, respectively.

Cataract, corneal opacity, and glaucoma were the main causes of blindness and low vision in the population aged 50 years or more. The prevalence of these diseases that causes blindness and low vision was higher than that reported in other studies.
A study for precision diagnosing and treatment strategies in difficult-to-treat AIDS cases and HIV-infected patients with highly fatal or highly disabling opportunistic infections
Authors: Li Yao , Zeng Yan-Ming , Lu Yan-Qiu , Qin Yuan-Yuan , Chen Yao-Kai
Published: May 2020

Background:

An increased frequency of toxoplasma encephalitis, caused by Toxoplasma gondii, has been reported in AIDS patients, especially in those with CD4+ T cell counts <100 cells/μL. Several guidelines recommend the combination of pyrimethamine, sulfadiazine, and leucovorin as the preferred regimen for AIDS-associated toxoplasma encephalitis. However, it is not commonly used in China due to limited access to pyrimethamine and sulfadiazine. The synergistic sulfonamides tablet formulation is a combination of trimethoprim (TMP), sulfadiazine and sulfamethoxazole (SMX), and is readily available in China. Considering its constituent components, we hypothesize that this drug may be used as a substitute for sulfadiazine and TMP-SMX. We have therefore designed the present trial, and propose to investigate the efficacy and safety of synergistic sulfonamides combined with clindamycin for the treatment of toxoplasma encephalitis.

Methods/Design:

This study will be an open-labeled, multi-center, prospective, randomized, and controlled trial. A total of 200 patients will be randomized into TMP-SMX plus azithromycin group, and synergistic sulfonamides plus clindamycin group at a ratio of 1:1. All participants will be invited to participate in a 48-week follow-up schedule once enrolled. The primary outcomes will be clinical response rate and all-cause mortality at 12 weeks. The secondary outcomes will be clinical response rate and all-cause mortality at 48 weeks, and adverse events at each visit during the follow-up period.

Discussion:

We hope that the results of this study will be able to provide reliable evidence for the efficacy and safety of synergistic sulfonamides for its use in AIDS patients with toxoplasma encephalitis.

Trial registration:

This study was registered as one of 12 clinical trials under the name of a general project at chictr.gov on February 1, 2019, and the registration number of the general project is ChiCTR1900021195. This study is still recruiting now, and the first patient was screened on March 22, 2019.
Research “recover from illness defense complex” helper T cell immune mechanisms based on the “Fuxie” theory clearing away heat evil thoroughly nourishing kidney treatment of recurrent blood-heat syndrome Psoriasis
Authors: Li Mao , Hu Xia , Hao Ping-Sheng
Published: May 2020

Introduction:

Psoriasis vulgaris (PV) is a chronic, painful, disfiguring, and disabling dermatological disease, which affects the physical and mental health of patients and impacts their quality of life. Current conventional systemic therapies can be costly, present risks of side effects, have limited efficacy and commonly recur following treatment cessation. Some Chinese herbal medicine therapies have shown therapeutic benefits for psoriasis vulgaris, including relieving symptoms and improving quality of life, and a potential of reducing relapse rate. However, explicit evidence has not yet been obtained.

Methods and analysis:

This is a pilot randomized controlled trial with the objective of investigating the effect of Jia Wei Liang Xue Xiao Feng San granules on relapse rate of recurrent PV and the correlation between Psoriasis area severity index (PASI) and key psoriasis-related cytokine changes and the number of cells. A total of 102 participants were recruited for this study, including 72 patients with recurrent PV, 15 healthy volunteers and 15 patients with psoriasis vulgaris who have recovered for more than 1 year. A total of 72 patients, with recurrent PV, will be randomized (1:1) to receive the oral Chinese herbal medicine Jia Wei Liang Xue Xiao Feng San or the oral Acitretin Capsule treatments for a period of 8 weeks. After this period, participants whose PASI scores improvement reached more than 75%, will undergo a 52-week follow-up phase.

The primary outcome measures are as follows:

The secondary study outcomes will include:

This trial may provide a novel regimen for recurrent PV patients if the granules decrease recurrence rate without further adverse effects.

Ethics and dissemination:

The ethics approval was provided by the Sichuan Traditional Chinese medicine regional ethics review committee. The ethics approval number is 2018KL-055. The design and the results of the study will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number:

Chinese Clinical Trial Registry (ChiCTR1900022766).
A scoring system based on clinical features for the prediction of sporadic renal angiomyolipoma rupture and hemorrhage
Authors: Xu Xiao-feng , Hu Xian-hui , Zuo Qi-ming , Zhang Jiao , Xu Hao-yu , Zhang Yao
Published: May 2020

The purpose of this study is to analyze the risk factors of sporadic renal hamartoma and establish a risk scoring system, and to intervene in patients with high-risk sporadic renal hamartoma who are prone to rupture and bleeding as soon as possible.

Retrospective univariate and multivariate logistic analyzes were conducted for clinical data of 332 sporadic renal hamartoma patients to screen out independent risk factors of tumor rupture. Score of each independent risk factor was calculated. (Calculation formula: the risk coefficient of each factor = the beta regression coefficient of each factor/the minimum value of the beta regression coefficient of all factors, the value of the smallest beta regression coefficient corresponding to all the factors was assigned 1 point. The score of each factor was equal to the risk coefficient of each variable was taken as an integer value by rounding.) The total score was equal to the sum of all factors. Then the area under the receiver operating characteristics (AUC) curve was compared between high risk factors and scoring system. Finally, the scoring system was evaluated by the area under the curve (AUC) and the Hosmer–Lemeshow method in an independent cohort of 130 patients.Factors such as symptoms at presentation, tumor size, tumor blood supply, and tumor growth pattern were significant predictors of sporadic renal angiomyolipoma rupture in both the univariate and multivariate analyses; these predictors were included in the scoring system to predict sporadic renal angiomyolipoma rupture. There were no significant differences in AUCs between high risk factors and scoring system (z = 0.6434, P = .583, AUC = 0.913, and 0.903 for high risk factors and scoring system, respectively). The sporadic renal angiomyolipoma patients who scored >6 points were prone to rupture. AUROC of the scoring system in the validation set was 0.854(95%CI:0.779, 0.928). Using the Hosmer–Lemeshow method, the value of X2 was 2.916, P = .893, suggesting the scoring system fitted well.

A scoring system based on clinical features is simple and effective in predicting sporadic angiolipoma rupture and hemorrhage. When the score is higher than 6 points, the probability of hamartoma rupture and hemorrhage is significantly increased and early intervention is needed.
Isolated involvement of corpus callosum in metronidazole-induced encephalopathy with concomitant peripheral neuropathy
Authors: Peng Qing , You Qian , Zhang Jing , Liu Shui
Published: May 2020

Rationale:

Metronidazole is widely used for treating infection of anaerobic bacteria and protozoa. Metronidazole is generally well tolerated, although metronidazole-associated peripheral neuropathy (PN) and metronidazole-induced encephalopathy (MIE) have been reported as rare side effects. The most common sites of MIE involve the bilateral dentate nucleus of the cerebellum. Herein, we present a rare case of MIE with isolated corpus callosum involvement, with concomitant metronidazole-associated PN.

Patient concerns:

A middle-aged man with ulcerative colitis was diagnosed with amoebic dysentery because of unhygienic eating. After receiving metronidazole (1.8 g/d, cumulative dose 61.2 g) for >1 month, he started to complain of continuous paresthesia of the limbs, and intermittent speech problems. Magnetic resonance imaging demonstrated an isolated lesion in the splenium of the corpus callosum.

Diagnosis:

A diagnosis of reversible splenial lesion syndrome and PN was made. Given the patient's medical history, MIE and metronidazole-associated PN were considered.

Interventions:

Metronidazole was stopped. Mecobalamine and vitamin B1 were used for adjuvant treatment.

Outcomes:

At 1.5 months after stopping metronidazole, his symptoms of numbness and hyperesthesia had not improved, although he felt less ill. The isolated lesion disappeared on follow-up magnetic resonance imaging. At 6 months later, the hyperesthesia symptoms remained, and he was unable to resume his previous work.

Conclusions:

Physicians should consider MIE in their differentials for reversible splenial lesion syndrome when encountering a patient with a history of metronidazole medication and symptoms of encephalopathy, especially with concomitant PN. Early identification of this metronidazole-related complication and early cessation of the drug are essential for treatment.
Successful live birth in a woman with resistant ovary syndrome treated with letrozole and HMG
Authors: Mu Zhenni , Song Jingyan , Yu Yi , Sun Zhengao
Published: May 2020

Introduction:

Resistance ovary syndrome (ROS) is a disease characterized by hypergonadotropic amenorrhea but with normal ovarian reserve. Currently, its pathogenesis is still unclear and the treatment methods are complex. Nevertheless, there are evident negative effects of this disease on females’ physical and mental health such as gonadal dysplasia, infertility, anxiety, and depression. This article reports a case of successful ovulation induction and pregnancy with letrozole combined with HMG. This can provide clinical treatment guidelines for the disease.

Patient concerns:

The patient underwent several hormone replacement cycles and ovulation induction cycles. But the dominant follicles were not extracted even after using large doses of gonadotropin.

Diagnosis:

Resistant ovary syndrome; Primary infertility

Interventions:

Larger doses of letrozole combined with HMG were injected to stimulate ovulation and sensitize the ovaries during menstruation. This helped to examine the peripheral effects of letrozole in relation to gonadotropin.

Outcomes:

The patient displayed a dominant follicular growth and notable ovulation which resulted in a full-term pregnancy and successful delivery.

Conclusions:

The resistance ovary syndrome (ROS) can be treated and the findings from this case provides a possible treatment for ROS patients with infertility.
SARS-CoV-2 pneumonia with subcutaneous emphysema, mediastinal emphysema, and pneumothorax
Authors: Xiang Chunlin , Wu Gang
Published: May 2020

Introduction:

Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax.

Patient concerns:

Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%.

Diagnosis:

This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography.

Interventions:

He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given.

Outcomes:

He died on the twelfth day after admission.

Conclusions:

Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.
Neonatal effect of remifentanil in cesarean section with general anesthesia
Authors: Zhang Qi , Kan Hong-Li , Wang Dong-Xin , Fu Dong-Mei
Published: May 2020

Background:

Although several previous studies have reported the efficacy of remifentanil in cesarean section (CS) under general anesthesia, no study has specifically addressed its neonatal effect (NE) in CS under general anesthesia systematically. Thus, this study will systematically investigate the NE of remifentanil in CS under general anesthesia.

Methods:

Electronic databases including MEDLINE, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be systematically retrieved with the assistance of a specialist librarian to check randomized controlled trials reporting NE in CS under general anesthesia. We will retrieve all electronic databases from their initial time to March 20, 2020 without restrictions of language. All process of study selection, data extraction, and risk of bias evaluation will be carried out by 2 independent authors. We will invite another senior expert to solve the problems that arise between 2 authors. Data will be pooled and analyzed using RevMan V.5.3 software.

Results:

Outcomes consist of assessment of neonatal adaptation, requirements for postoperative respiratory support of neonates, systolic and diastolic noninvasive blood pressure, mean blood pressure, heart rate, electrocardiography, umbilical cord blood gas analysis, and adverse events.

Conclusion:

This study will present evidence of the NE of remifentanil in CS under general anesthesia. This information may inform benefits of intervention to guide the usage of remifentanil in CS under general anesthesia.

Study registration:

INPLASY202040028.
Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy
Authors: Yao Shudan , Ouyang Beiping , Lu Tingsheng , Chen Qiling , Luo Chunshan
Published: May 2020

To determine the short-term clinical outcomes of single-segment cervical spondylotic radiculopathy treated with posterior percutaneous endoscopic cervical discectomy (PPECD).

Data of a total of 24 patients who underwent PPECD and local anesthesia for single-level segmental cervical spondylotic radiculopathy between March 2016 and December 2017 were reviewed. The Japanese Orthopaedic Association, visual analog scale (VAS), and neck disability index scores at preoperative 1 day, postoperative 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year were recorded. The modified MacNab criteria at the last follow-up were re-recorded for the evaluation of clinical effectiveness.

All operations were successfully completed under endoscopic guidance. No patient showed spinal cord, nerve root, vascular injuries, dural tears or other complications. The postoperative VAS scores of the arm and neck were significantly reduced compared with the preoperative VAS scores (P < .05), while postoperative the Japanese Orthopaedic Association scores were significantly increased (P < .05). The postoperative neck disability index scores were significantly reduced compared with preoperative scores (P < .05). The modified MacNab criteria at the last follow-up showed 16 excellent cases, 8 good cases, 0 fine cases, and 0 poor cases. Postoperative magnetic resonance imaging and cervical 3-dimensional computed tomography reconstruction showed that the intervertebral disc was adequately resected and the nerve root was not under compression.

PPECD is safe and effective for the treatment of single-segment cervical spondylotic radiculopathy.
Refractory adult Coats disease treated with dexamethasone intravitreal implant
Authors: Ding Yu-hua , Yao Bang-tao , Zhao Xiao-gui , Yu Hao , Liu Gang , Wang Xiu-ying
Published: May 2020

Introduction:

Coats disease is a sporadic, retinal vascular abnormality, causing blindness. Several interventional methods, including laser photocoagulation, have been proposed; however, the use of intravitreal dexamethasone in refractory Coats disease is not well described.

Patient concerns:

A 38-year-old man presented with a painless reduction in visual acuity in his right eye, commencing 15 days prior to initial assessment.

Diagnosis:

Clinical manifestations and multimodal imaging indicated Coats disease.

Interventions:

Retinal laser photocoagulation was performed in the nonperfused areas, 15 months later, the exudative retinal detachment, and macular edema remained, the patient was then treated with an intravitreal slow-release dexamethasone implant.

Outcomes:

The exudative retinal detachment and macular edema had resolved, and the BCVA had also improved.

Conclusion:

Dexamethasone intravitreal implantation was effective in treating refractory Coats disease.
Effect of intraoperative pressure ulcer preventive nursing on inflammatory markers in patients with high-risk pressure ulcers
Authors: Jin Feng , Fu Yan-jun , Zhang Yang , Yan Jing-ling , Zhou Kui-chen , Liu Hong-wei
Published: May 2020

Background:

This study will be designed to appraise the effects of intraoperative pressure ulcer preventive nursing (IPUPN) on inflammatory markers (IMs) in patients with high-risk pressure ulcers (HRPU) based on high quality randomized controlled trials (RCTs).

Methods:

In this study, we will perform a rigorous literature search from the following electronic databases: Cochrane Library, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. All electronic databases will be retrieved from their initial time to March 1, 2020 without limitations of language and publication status. We will only consider high quality RCTs that explored the effects of IPUPN on IMs in patients with HRPU. Two investigators will identify relevant trials, extract data, and appraise risk of bias in each eligible trial. Data will be pooled by either a fixed-effects model or a random-effects model according to the results of heterogeneity identification. The primary outcomes include IMs, and incidence of new pressure ulcers. The secondary outcomes are time to ulcer development, quality of life, length of hospital stay, and adverse events. Statistical analysis will be undertaken using RevMan 5.3 software.

Results:

This study will summarize high quality clinical evidence of RCTs to evaluate the effects of IPUPN on IMs in patients with HRPU.

Conclusion:

The expected findings may provide helpful evidence to determine whether IPUPN is an effective intervention on IMs in patients with HRPU.

INPLASY Registration Number:

INPLASY202040029.
Clinical efficacy and safety of somatostatin in the treatment of early postoperative inflammatory small bowel obstruction
Authors: Wu Zhongyong , Wang Suibiao , Yuan Shaofei , Lin Ming
Published: May 2020

Background:

As one of the complications after abdominal operation, early postoperative inflammatory small bowel obstruction (EPISBO) is a great trouble for many patients. The use of somatostatin in treating this disease had been widely reported, but its efficacy and safety were controversial. Therefore, the present research carried out a systematic review of the clinical efficacy and safety of somatostatin in treating EPISBO.

Methods:

Computer retrieval was conducted in foreign databases (including PubMed, The Cochrane Library, and Embase) and Chinese database (including Sino Med, CNKI, VIP, and WangFang Data), supplementary search for the literatures included was performed, and manual retrieval was performed in abstracts, books, and non-electronic magazines related to the present research to ensure the recall rate. Among all republished relevant experimental studies in Chinese and English from January 1, 1996 to February 1, 2020, randomized controlled trials on the curative efficacy of somatostatin for EPISBO were collected. The evaluation measures included patients’ total effective rate, peristaltic sound recovery time, time of disappearance of abdominal pain, time of first defecation after operation, drainage of gastrointestinal decompression and length of stay after treatment. The literatures were selected by two investigators independently to extract data according to the inclusion and exclusion criteria, Bias Risk Assessment Tool recommended by Cochrane Review Hand book 5.2 was used to assess literature quality, and meta-analysis was carried out by using soft Stata 12.0.

Results:

This study will scientifically and effectively analyze the clinical efficacy and safety of somatostatin in the treatment of EPISBO through systematic review and meta-analysis.

Ethics and dissemination:

The results of this study will be published in a peer-reviewed SCI journal to provide evidence-based medical evidence for the clinical treatment of early postoperative inflammatory bowel obstruction.

Protocol and registration:

Open Science Framework (https://osf.io, OSF), registration number: ryd2g.
Effectiveness of respiratory muscle training for patients with obstructive sleep apnea
Authors: Xue Shi-Min , Jia Juan , Fan Ping , He Shi-Wei
Published: May 2020

Background:

This study will evaluate the effectiveness and safety of respiratory muscle training (RMT) for patients with obstructive sleep apnea (OSA).

Methods:

Randomized controlled trials will be retrieved through electronic database searches from MEDLINE, EMBASE, Cochrane Library, CINAHL, Scopus, CBM, and CNKI from the beginning to the present. All electronic databases will be searched without any language limitation. Two researchers will independently select studies, collect data, and assess study quality, respectively. RevMan 5.3 software will be used for statistical analysis.

Results:

The primary outcome is severity of OSA, as measured by polysomnography or any relevant tools. The secondary outcomes are hypopnea index, apnea index, respiratory event index, respiratory disturbance index, sleep-related quality of life, and any expected or unexpected adverse events.

Conclusion:

The results of this study will summarize current evidence of RMT for the treatment of patients with OSA.

Systematic review registration:

INPLASY202040051.
Risk of carpal tunnel syndrome after parathyroidectomy in patients with end-stage renal disease
Authors: Wang Jie-Sian , Chen Wei-Shan , Lin Cheng-Li , Wang I-Kuan , Shen Ming-Yi
Published: May 2020

Carpal tunnel syndrome (CTS) is the most common mononeuropathy in clinical practice. Some patients with end-stage renal disease (ESRD) often associate with tertiary hyperparathyroidism, and ultimately need parathyroidectomy (PTX). However, no studies have definitively demonstrated an effect of PTX on ESRD patients’ quality of life. We selected 1686 patients who underwent PTX and 1686 patients who did not receive PTX between 2000 and 2010. These patients were propensity-matched with others by age, sex, and comorbidities at a ratio of 1:1. We used single and multivariable cox proportional hazard models to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). In this study, 116 ESRD patients developed CTS, and the CTS incidences were 7.33 and 12.5 per 1000 person-years for the non-PTX and PTX group. The results reveal that the incidence curve for the PTX group was significantly higher than that for the non-PTX group (log-rank test, P = .004). After adjustments were made for sex, age, and baseline comorbidities, the PTX group had a 1.70-fold higher risk of CTS (hazard ratio (HR) = 1.70, 95% confidence intervals (CI) = 1.17–2.47) than the non-PTX group. The results also demonstrated that female patients (HR = 1.60, 95% CI = 1.06–2.42) and patients with one or more comorbidities (HR = 1.79, 95% CI = 1.23–2.60) might have an increased risk of CTS. The subhazard ratio for CTS risk was 1.62 (95% CI = 1.12–2.36) for the PTX group compared with the non-PTX group in the competing risk of death. In conclusion, we revealed that ESRD patients who had undergone PTX may have an increased risk of CTS.
Is septal deviation associated with headache?
Authors: Kwon Sam Hyun , Lee Eun Jung , Yeo Cha Dong , Kim Min Gul , Kim Jong Seung , Noh Sang Jae , Kim Eun Ji , Kim Su Geun , Lee Jong-Hwan , Yoo Ji Seob , Koh Ji hoon , Kim Byeong Jin
Published: May 2020

To investigate the potential relationship between septal deviation (SD) and headache using nationwide representative cohort sample data.

This study used a nationwide cohort sample from the Korean National Health Insurance Service database. The cohort sample was composed of 1 million patients, which is obtained by propensity score matching from 2002 to 2013. There were 9171 individuals in the SD group and 28243 in the control or no SD group. The Kaplan–Meier survival analysis, the log-rank test, and Cox proportional hazard regression analysis were used to calculate the incidence, survival curve, and hazard ratio of headache for each group.

There were no statistically significant differences in sex (P = .7708), age (P = .991), residential area (P = .9626), or socioeconomic status (P = .9982) between the 2 groups. The survival curve between SD and control or no SD showed a statistically significant difference. The adjusted hazard ratio for headache incidence during the 10-year follow-up period of the SD group was 1.37 (95% CI: 1.31-1.43).

This cohort study suggests that SD is associated with headache. Therefore, these findings suggest that septoplasty can be considered as 1 of the treatment option in SD patients with headache.
Genetic variants of mineral metabolism in health and disease
Authors: Robinson-Cohen Cassianne
Published: May 2020

Purpose of review

Disturbances in mineral metabolism are common among individuals with chronic kidney disease and have consistently been associated with cardiovascular and bone disease. The current review aims to describe the current knowledge of the genetic aspects of mineral metabolism disturbances and to suggest directions for future studies to uncover the cause and pathogenesis of chronic kidney disease – mineral bone disorder.

Recent findings

The most severe disorders of mineral metabolism are caused by highly penetrant, rare, single-gene disruptive mutations. More recently, genome-wide association studies (GWAS) have made an important contribution to our understanding of the genetic determinants of circulating levels of 25-hydroxyvitamin D, calcium, phosphorus, fibroblast growth factor-23, parathyroid hormone, fetuin-A and osteoprotegerin. Although the majority of these genes are known members of mineral homeostasis pathways, GWAS with larger sample sizes have enabled the discovery of many genes not known to be involved in the regulation of mineral metabolism.

GWAS have enabled remarkable developments in our ability to discover the genetic basis of mineral metabolism disturbances. Although we are far from using these findings to inform clinical practice, we are gaining understanding of novel biological mechanisms and providing insight into ethnic variation in these traits.