bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous Ultrasound for Tumor Thickness Measurement in Squamous Cell Carcinoma: The Effect of Neoadjuvant Intralesional Methotrexate in 40 Patients
Authors: Bergón-Sendín Marta , Pulido-Pérez Ana , Carretero López Fernando , Díez-Sebastián Jesús , Suárez-Fernández Ricardo
Published: September 2019

BACKGROUND

Intralesional methotrexate (il-MTX) has been used as neoadjuvant therapy for cutaneous squamous cell carcinoma (cSCC) but studies on its effects on tumor thickness are lacking.

OBJECTIVE

The objective of this study was to evaluate il-MTX response with ultrasound examination.

METHODS

The authors conducted a prospective study in 40 patients with histologically confirmed cSCC. Neodjuvant il-MTX therapy was administered before surgery. Ultrasound evaluation was performed before the first infiltration and before surgical treatment.

RESULTS

Response to neoadjuvant treatment was observed in 92.5% of patients, both clinically and sonographically. There was a good correlation between both types of measurements, with r = 0.892 for the minor diameter and r = 0.944 for the major diameter (p < .001). The authors found an ultrasound overestimation compared to the clinical measurements in 92.5% of patients (mean overestimation: 1.08 mm). There was a good correlation between ultrasound and histological measurements in tumor thickness with r = 0.932 (p < .01), with an ultrasound overestimation in 97.5% of cases (mean overestimation: 0.90 mm).

CONCLUSION

Neoadjuvant il-MTX can reduce not only surface tumor dimensions but also tumor thickness. Ultrasound improves treatment response control with greater accuracy than clinical assessment alone.
On the Relation Between G-formula and Inverse Probability Weighting Estimators for Generalizing Trial Results
Authors: Dahabreh Issa J. , Robertson Sarah E. , Hernán Miguel A.
Published: September 2019

When generalizing inferences from a randomized trial to a target population, two classes of estimators are used: g-formula estimators that depend on modeling the conditional outcome mean among trial participants and inverse probability (IP) weighting estimators that depend on modeling the probability of participation in the trial. In this article, we take a closer look at the relation between these two classes of estimators. We propose IP weighting estimators that combine models for the probability of trial participation and the probability of treatment among trial participants. We show that, when all models are estimated using nonparametric frequency methods, these estimators are finite-sample equivalent to the g-formula estimator. We argue for the use of augmented IP weighting (doubly robust) generalizability estimators when nonparametric estimation is infeasible due to the curse of dimensionality, and examine the finite-sample behavior of different estimators using parametric models in a simulation study.
PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER AORTIC ANEURYSM REPAIR
Authors: Lando Leonardo , Isaac David Leonardo C. , Avila Marcos P.
Published: September 2019

Purpose:

We report a case of paracentral acute middle maculopathy secondary to cholesterol embolization syndrome after an endovascular aortic aneurism repair (EVAR).

Methods:

Functional and anatomical damage was assessed by Snellen visual acuity, fundoscopy, and optical coherence tomography.

Results:

A 67-year-old man presented with sudden vision loss in the right eye for one day with concomitant livedo reticularis in both feet. His medical history included an abdominal EVAR repair three days before the symptoms. The best-corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Fundoscopy showed intraarteriolar cholesterol plaques (Hollenhorst) bilaterally, and a localized retinal whitening in the right eye. Optical coherence tomography at the lesion site revealed a hyperreflective band on the level of inner nuclear layer. The patient was referred for imaging and complete systemic evaluation. He was then closely followed up by a vascular team, without additional intervention. Retinal stigma partially regressed at six months with visual improvement.

Conclusion:

This case describes paracentral acute middle maculopathy as a rare ocular sign of cholesterol embolization in postoperative intraaortic operations. The diagnosis of this complication led to prompt clinical care with a multidisciplinary approach.
Clinical Outcomes and Endothelial Cell Density After Descemet Membrane Endothelial Keratoplasty Using Peripherally-trephinated Donor Tissue (DMEK-pD) in Fuchs Endothelial Corneal Dystrophy
Authors: Basak Samar K. , Basak Soham
Published: September 2019

Purpose:

To evaluate the clinical outcomes and endothelial cell density (ECD) after Descemet membrane endothelial keratoplasty using peripherally trephinated donor tissue (DMEK-pD) and compare with DMEK using centrally trephinated donor tissue (DMEK-cD) in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods:

This was a prospective comparative interventional case series. One hundred twenty-five eyes of 110 patients with FECD and cataract who underwent either DMEK-pD (n = 60) or DMEK-cD (n = 65) combined with phacoemulsification, between June 2016 and November 2018, were included. Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA) and ECD were recorded at 6 months and 1 year.

Results:

All eyes had visually symptomatic FECD and cataract with a preoperative mean BSCVA of 1.03 logarithm of the minimum angle of resolution in both groups. Baseline donor mean ECD was 2944 ± 201 and 2907 ± 173 cells/mm2 in the DMEK-pD and DMEK-cD groups, respectively (P = 0.12). BSCVA improvement was comparable at 6 months and 1 year (P = 0.23 and P = 0.34). Mean ECD recorded after 6 months and 1 year was significantly higher in the DMEK-pD group than in the DMEK-cD group: 2508 ± 201 versus 2084 ± 298 cells/mm2 (P < 0.01) and 2338 ± 256 versus 1907 ± 339 cells/mm2 (P < 0.01), respectively. Complication rates were similar in both groups.

Conclusions:

DMEK-pD exhibited similar clinical outcomes with higher ECD compared with conventional DMEK-cD after 6 months and 1 year. The possibility of transplanting peripherally trephinated donor tissue in DMEK with more endothelial cells needs to be explored further in the future.
Downsizing a Baerveldt Glaucoma Implant For the Management of Persistent Postoperative Hypotony: A Case Series
Authors: Mavrommatis Maria A. , Dangda Sonal , Sidoti Paul A. , Panarelli Joseph F.
Published: September 2019

Purpose:

The purpose of this study was to describe a surgical technique for treating persistent hypotony after Baerveldt glaucoma implant (BGI) surgery.

Materials and Methods:

The medical records of 10 patients with persistent postoperative hypotony who underwent truncation of one or both wings of a previously placed BGI, combined with external ligation of the tube using a polypropylene suture, were retrospectively reviewed.

Results:

All 10 eyes that underwent BGI truncation and placement of a single, external, nonabsorbable (polypropylene) tube ligature exhibited resolution of hypotony within 24 hours and resolution of choroidal effusions within the first 2 postoperative weeks. The median time interval between primary BGI surgery and truncation was 5 months (range, 1.5 mo to 8 y). Median postrevision follow-up time was 12 months (range, 5 mo to 16.2 y). The mean preoperative intraocular pressure (IOP) was 2.1±1.0 mm Hg, and the mean IOP rose to 29.2±13.9 mm Hg on postoperative day 1. Mean IOP at week 1, month 1, and month 3 was 20.5±10.4, 19.7±11.8, and 18.0±8.2 mm Hg, respectively, using an average of 1.4±1.4 glaucoma medications at postoperative month 3. Ligature release after BGI revision was performed in 9 (90%) of the 10 patients. The median time to ligature release was 1.5 months (range, 3 wk to 4 y). There was no recurrence of hypotony in any of these patients. At most recent follow-up, the mean IOP was 12.9±6.0 mm Hg on an average of 1.5±1.3 glaucoma medications. Five patients demonstrated improvement in visual acuity from their prerevision best-corrected visual acuity.

Conclusions:

Truncation of one or both wings of a BGI and complete closure of the tube with nonabsorbable, but releasable, suture ligature is an effective and safe method for reversing persistent postoperative hypotony while maintaining IOP control.
Impact of rational emotive occupational health coaching on work-related stress management among staff of Nigeria police force
Authors: Nwokeoma Bonaventure N. , Ede Moses O. , Nwosu Nneka , Ikechukwu-Illomuanya Amaka , Ogba Francisca N. , Ugwoezuonu Amanda U. , Offordile Edmund E. , Agu Patricia U. , Amoke Chijioke , Eze Celestine O. , Nnamani Ogechi , Nwafor Bernedeth , Omeke Faith C. , Omeje Grace N. , Vita-Agundu Uche C. , Onuh Eucharia A. , Okorie Cornelius O. , Ede Kelechi R. , Nwadike Ngozi
Published: September 2019

Background:

Empirical studies indicated that job-related stress is threatening the well-being of Nigerian public workers. The objective of this investigation was to examine the impact of REOHC for improving work-stress management among Staff of Nigeria Police Force in southeast Nigeria.

Method:

This is a pretest-posttest control group design study with follow-up. A total of 63 Nigerian police officers (randomized into one of 2 groups: n = 32 for treatment group, n = 31 for waitlist control group) completed the study. Two self-report questionnaire measuring organizational and operational stressors associated with police general well-being were used as outcome measures. The intervention group received a 12-week REBC manual intervention. The intervention and waitlisted groups were evaluated at 3-time points: Time1, Time2, and Time3. Statistical analyses were achieved using repeated-measures ANOVA.

Results:

Results showed that there was no significant difference between the REOHC group and waiting-list control group in initial work-related stress management among staff of Nigerian Police Force. REOHC program had a significant effect on work-related stress management among staff of Nigerian Police Force when compared to their counterparts in the waiting-list control group.

Conclusion:

Therefore, REOHC program is a time-effective treatment approach for improving work-stress management among Staff of Nigeria Police Force in southeast Nigeria.
A protocol for developing, disseminating, and implementing a core outcome set for stress urinary incontinence
Authors: Rada Maria-Patricia , Pergialiotis Vasilios , Betschart Cornelia , Falconi Gabriele , Haddad Jorge Milhem , Doumouchtsis Stergios K.
Published: September 2019

Introduction:

Randomized trials evaluating interventions for stress urinary incontinence (SUI) have been using variable outcome measures, reporting a variety of outcomes. Alongside this variation across studies, outcome-reporting flaws contribute to a limited use of research to inform clinical practice. The development and use of core outcome sets (COSs) in future trials would ensure that outcomes important to different stakeholders and primarily women with SUI are reported more consistently and comprehensively.

Methods:

An international steering group including healthcare professionals, researchers, and women with urinary incontinence will guide the development of this COS. Potential outcomes will be identified through comprehensive literature reviews. These outcomes will be entered into an international, multiperspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and women with urinary incontinence, will be invited to participate. The modified Delphi method encourages stakeholder group convergence toward collective agreement, also referred as consensus, core outcomes.

Discussion:

Dissemination and implementation of the resulting COS within an international context will be promoted and reviewed. Embedding the COS for SUI within future clinical trials, systematic reviews and clinical practice guidelines could make a significant contribution to advancing the value of research in informing clinical practice, enhancing patient care and improving outcomes. The infrastructure created by developing a COS for SUI could be leveraged in other settings, for example, selecting research priorities and clinical practice guideline development.
Effects of the ratios of marrow cavity diameter to intramedullary nail diameter from different layers on blood loss during perioperative period for femoral intertrochanteric fractures
Authors: Yu Xiao , Zhang Hong , Zhang Xiangxin , Xu Renjie , She Yuanshi , Yu Zhaohen , Chen Guangxiang
Published: September 2019

The study aimed to investigate the effect of ratios of marrow cavity diameter to intramedullary nail diameter from different layers on hidden blood loss (HBL), overt blood loss (OBL) and total blood loss (TBL) during using proximal femoral nail antirotation-Asian version (PFNA)-II for femoral intertrochanteric fractures.

We retrospectively studied 70 patients treated in our hospital recently. We recorded postoperative hematocrit (Hct) and OBL during operation. TBL and HBL were calculated using CROSS equation. The ratios of marrow cavity diameter to intramedullary nail diameter from different layers, including start of funnel, end of funnel and femoral isthmus, were measured. The mean of the ratio from frontal and lateral X-ray were designated as R. We classified all included participants into a high and a low matching group according to z-score of R within each layer. TBL, HBL, and OBL were compared between the 2 groups. We applied multiple linear regression analysis between the HBL as a dependent variable and gender, age, body mass index, fracture type, and R as independent variables.

The present study indicated a significant reduction in the HBL and TBL in the high matching group compared to low matching group on three layers, whereas it showed no significant difference in OBL between the 2 groups on three layers. It showed that R values from start of funnel and end of funnel were significantly associated with HBL.

Matching rate of PFNA II at the funnel might be an important factor for HBL and TBL postoperatively.
Efficacy and safety of traditional Chinese medicine yangxin anshen therapy for insomnia
Authors: Li Feizhou , Wang Xuanxuan , Song Ziyu , Liu Ling , Zhang Tong , Chen Yanhua , Wang Ping
Published: September 2019

Background:

Traditional Chinese medicine (TCM) has gradually drawn the attention of clinicians as an alternative choice for insomniacs and TCM yangxin anshen therapy (TYAT), as a crucial therapy of treating insomniacs, is based on the theory of syndrome differentiation. However, owing to the lack of evidence-based medical evidence, the authors intend to carry out this study to evaluate TYAT's effectiveness and safety.

Methods:

Seven electronic databases will be searched from inception to July 2019. Two authors will independently identify randomized controlled trials, fetch data and assess the risk of bias with tools provided by Cochrane. A comprehensive meta-analysis will be conducted with the Cochrane Collaboration software (Review Manager 5.3) for eligible and appropriate studies. Further, the evidence will be assessed with the grading of recommendations assessment, development, and evaluation approach.

Results:

This article will be dedicated to assessing TYAT's efficacy and safety for insomniacs.

Conclusion:

This systematic review and meta-analysis may provide persuasive evidence for the clinical application of TYAT in treating insomnia.

Trial registration number:

PROSPERO CRD 42019135115.
Intralesional injection of triamcinolone acetonide for cavernous hemangiomas
Authors: Wang Wen-yan , Wang Luan-hong , Huang Guang , Lin Zhen-ying , Lin Han
Published: September 2019

Rationale:

Cavernous hemangiomas referred to as venous malformations (VMs), are not true vascular tumors. The treatment of cavernous hemangiomas is controversial.

Patient concerns:

A five-year-old girl with a cavernous hemangioma on her right buttock had undergone surgery but recurred 1 month after the operation.

Diagnoses:

Cavernous hemangioma was diagnosed on the basis of physical examination, magnetic resonance imaging (MRI) and postoperative pathologic examination.

Interventions:

We treated her with intralesional injection of triamcinolone acetonide (TCA) for 8 times.

Outcomes:

She was cured and had no recurrence during the 3-month follow-up.

Lessons:

This prompts that TCA may provide a more effective and safer choice for the treatment of cavernous hemangiomas.
Effects and safety of herbal medicines on patients with overactive bladder
Authors: Zhou Jin , Jiang Chenglong , Wang Peng , He Shen , Qi Zirong , Shao Shujun , Tang Yinshan
Published: September 2019

Background:

Overactive bladder (OAB) is a common disease in the urinary system. The morbidity is increasing annually. Herbal medicines have been pervasively used in the therapy of OAB. However, systematic review or meta-analysis has not been found to assess the effects and safety of herbal medicines in curing OAB at present. Hence, the systematic review is conducted to scientifically and methodically evaluate the value of its effectiveness and safety of herbal medicines on OAB.

Methods:

We will collect all randomized controlled trials (RCTs) to assess the effectiveness and safety of herbal medicines on OAB. The RCTs will be searched from the electronic databases, including 7 English databases, consisting of PubMed, Excerpta Medica Database (EMBASE), MEDLINE, Web of Science, Cochrane Library, SpringerLink, and WHO International Clinical Trials Registry Platform (ICTRP), and 4 Chinese databases, namely Wanfang Chinese database, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP), others valid search strategy will be adopted. All the RCTs will be assessed from the databases establishment to July 2019. We will perform the meta-analysis of RCTs when the dissertation is appropriate. We will conduct an assessment including data synthesis, bias risk, and subgroup analysis by means of Review Manager software (RevMan) V.5.3.5 software while the setting condition is met.

Results:

This systematic view and meta-analysis will generate a summary based on the current relevant research to calculate the effects and safety of herbal medicines in promoting the therapy of OAB. Furthermore, it will provide a high-quality synthesis for participants who use herbal medicine to cure OAB.

Conclusion:

The summary of our systematic view will verify whether herbal medicines intervention could be an effective and safety approach in curing OAB.
Chinese patent medicine Bailing capsule for treating lupus nephritis
Authors: Ren Hui-Jie , Sun Ya-Lei , Yuan Bin
Published: September 2019

Background:

Treatment of lupus nephritis (LN) remains challenging. LN remains the primary source of morbidity and mortality in patients with systemic lupus erythematosus. Chinese patent medicine Bailing capsule is commonly used for the treatment of LN. However, there is no consensus on the difference in clinical efficacy compared with routine treatment. Therefore, we plan to perform a systematic review and meta-analysis to review the clinical efficacy and safety of Bailing capsule for LN.

Methods:

Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang database, and VIP information database will be searched from their inception until January 2019. The meta-analysis will be conducted with Review Manager 5.3 software to systematically review the clinical efficacy and safety of Bailing capsule for LN. The primary outcome will include clinical effective rate, and the secondary outcomes will include Systemic Lupus Erythematosus Disease Activity Index, serum creatinine, 24-hour urine protein quantity, complement 3, and adverse effects.

Results:

This analysis will provide useful information about clinical efficacy and safety of Bailing capsule for LN.

Conclusions:

Our study will generate strong evidence of Bailing capsule for patients with LN and provide suggestions for clinical practice.
Efficacy of metoclopramide for the treatment of acute migraine
Authors: Jiang Chao , Wang Ting , Qiu Zheng-guo , Chen Bo , Fang Bang-jiang
Published: September 2019

Background:

In this study, we will assess the efficacy and safety of metoclopramide for the treatment of acute migraine (AM).

Methods:

We will comprehensively search Cochrane Library, PUMBED, EMBASE, Google Scholar, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the inception to July 1, 2019 to identify any eligible studies. Only randomized controlled trials will be considered for inclusion. The study selection, data collection, and management will be completed by two authors independently. The risk of bias will be assessed using Cochrane risk of bias tool. RevMan 5.3 software will be used for statistical analysis.

Results:

The primary outcome includes pain intensity, as measured by visual analogue scale or others. The secondary outcomes are success rate, requirement of rescue medicine, quality of life, relapse, and adverse events.

Conclusions:

This study will summarize the latest evidence for the clinical efficacy and safety of metoclopramide for the treatment of AM.

PROSPERO registration number:

PROSPERO CRD42019142795.
Effectiveness of spa therapy for patients with chronic low back pain
Authors: Bai Ruixue , Li Chihua , Xiao Yangxue , Sharma Manoj , Zhang Fan , Zhao Yong
Published: September 2019

Background:

Low back pain (LBP) is a major health problem around the world. Two previous meta-analyses showed that the spa therapy has a positive effect on reducing pain among patients with LBP based on studies published before 2006 and studies published between 2006 and 2013. In recent years, more studies reported the effect of spa therapy on treating chronic low back pain (CLBP). Our study aimed to update the meta-analysis of randomized controlled trials (RCTs) about the effect of spa therapy on treating CLBP and to examine the effect of spa therapy based on different interventions.

Methods:

PubMed, Embase, Web of Science, and Cochrane Library were searched until May 2018 to identify RCTs about spa therapy among patients with CLBP. Summary effect estimates were calculated by using a random-effects model. The quality of each eligible study was evaluated by Jadad checklist.

Results:

Twelve studies met the inclusion criteria for the systematic review and were included in meta-analysis. There was a significant decrease in pain based on visual analogue scale (VAS) (mean difference [MD] 16.07, 95% confidence interval [CI] [9.57, 22.57], P < .00001, I

2
 = 88%, n = 966), and lumbar spine function in Oswestry disability index (ODI) (MD 7.12, 95% CI [3.77, 10.47], P < .00001, I

2
 = 87%, n = 468) comparing spa therapy group to control group. Methodological assessment for included studies showed that the study's quality is associated with lacking blinding.

Conclusion:

This updated meta-analysis confirmed that spa therapy can benefit pain reliving and improve lumbar spine function among patients with CLBP. Physiotherapy of subgroup analysis indicated that it can improve lumbar spine function. However, these conclusions should be treated with caution due to limited studies. More high-quality RCTs with double-blind design, larger sample size, and longer follow-up should be employed to improve the validity of study results.
Obesity and nonalcoholic fatty liver disease associated with adenocarcinoma in patients with lung cancer
Authors: Zhu Chan-Yan , Qu Ji-Chen , Cao Hai-Xia , Chen Guang-Yu , Shi Yi-Hai , Fan Jian-Gao
Published: September 2019

Lung cancer has become the leading cause of cancer-related deaths around the world. In addition to genetic risk factors and smoking, the metabolic risk factors remain to be elusive.

To evaluate the associations between obesity, nonalcoholic fatty liver disease (NAFLD) and pulmonary adenocarcinoma in patients with lung cancer.

Consecutive operation-proven lung cancer patients with assessment of metabolic disorders and liver ultrasound in 2009 and 2013 were retrospectively enrolled. T-test and multivariate logistic regression were applied to evaluate the contribution of individual factors to lung adenocarcinoma, as well as the synergistic effects between these factors.

Among 3664 lung cancer patients with ultrasound examination, 2844 cases were enrolled for further analysis. Of them, 1053 (37.0%) were females, 1242 (43.7%) were cigarette smokers, 1658 (58.3%) were diagnosed as lung adenocarcinoma, 744 (26.2%) had obesity, and 614 (21.6%) had NAFLD. Proportion of female gender, nonsmoker, obesity, NAFLD, and serum lipid levels in patients with adenocarcinoma were significantly higher than those in other subtypes of lung cancer, and in 2013 than in 2009 (all P < .01). NAFLD and obesity were shown as independent factors and positively associated with pulmonary adenocarcinoma, along with female gender and nonsmoking, higher serum levels of cholesterol. NAFLD and other contributing factors exhibited no synergistic effects on adenocarcinoma.

Obesity and NAFLD might increase the risk for pulmonary adenocarcinoma, especially in nonsmoking females, and underscore the need for further study into carcinogenic mechanisms and preventive interventions.
Unmet challenges in treating hypertension in patients with borderline personality disorder
Authors: Roininen Saara M. , Cheetham Marcus , Mueller Beatrice U. , Battegay Edouard
Published: September 2019

Background:

Caregivers encounter serious and substantial challenges in managing hypertension in patients with subclinical or clinical borderline personality disorder (BPD). These challenges include therapeutic conflicts resulting from harmful drug–drug, and drug–disease interactions. Current guidelines provide no recommendations for concurrent psychotropic and antihypertensive treatment of hypertensive BPD patients who are at even greater cardiovascular risk.

Methods:

We conducted a systematic literature review to assess the extent of available evidence on prevalence rates, cardiovascular risk factors, therapeutic conflicts, and evidence-based treatment recommendations for patients with co-occurring hypertension and BPD. Search terms were combined for hypertension and BPD in PubMed, MEDLINE, EMBASE, Cochrane, and PsycINFO databases.

Results:

We included 11 articles for full-text evaluation and found a very high prevalence of hypertension and substantial cardiovascular risk in studies on co-occurring BPD and hypertension. However, we identified neither studies on harmful drug–drug and drug–disease interactions nor studies with treatment recommendations for co-occurring hypertension and BPD.

Conclusions:

Increased prevalence of hypertension in BPD patients, and therapeutic conflicts of psychotropic agents strongly suggest careful evaluation of treatment strategies in this patient group. However, no studies or guidelines recommend specific therapies or strategies to resolve therapeutic conflicts in patients with hypertension and BPD. This evidence gap needs attention in this population at high risk for cardiovascular disease.
Percutaneous mechanical circulatory support devices in high-risk patients undergoing percutaneous coronary intervention
Authors: Shi Wenhai , Wang Wuwan , Wang Kechun , Huang Wei
Published: September 2019

Background:

Percutaneous mechanical circulatory support devices (pMCSDs) are increasingly used on the assumption (but without solid proof) that their use will improve prognosis. A meta-analysis was undertaken according to the PRISMA guidelines to evaluate the benefits of pMCSDs in patients undergoing high-risk percutaneous coronary intervention (hr-PCI).

Methods:

We searched PubMed, EMbase, Cochrane Library, Clinical Trial.gov, and other databases to identify eligible studies. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for 30-day and 6-month all-cause mortality rates, reinfarction, and other adverse events using a random effect model.

Results:

Sixteen randomized controlled trials (RCTs) were included in this study. In the pooled analysis, intra-aortic balloon pump (IABP) was not associated with a decrease in 30-day and 6-month all-cause mortality (RR 1.01 95% CI 0.61–1.66; RR 0.88 95% CI 0.66–1.17), reinfarction (RR 0.89 95% CI 0.69–1.14), stroke/transient ischemic attack (TIA) (RR 1.75 95% CI 0.47–6.42), heart failure (HF) (RR 0.54 95% CI 0.11–2.66), repeat revascularization (RR 0.73 95% CI 0.25–2.10), embolization (RR 3.00 95% CI 0.13–71.61), or arrhythmia (RR 2.81 95% CI 0.30–26.11). Compared with IABP, left ventricular assist devices (LVADs) were not associated with a decrease in 30-day and 6-month all-cause mortality (RR 0.96 95% CI 0.71–1.29; RR 1.23 95% CI 0.88–1.72), reinfarction (RR 0.98 95% CI 0.68–1.42), stroke/TIA (RR 0.45 95% CI 0.1–1.95), acute kidney injury (AKI) (RR 0.83 95% CI 0.38–1.80), or arrhythmia (RR 1.52 95% CI 0.71–3.27), but LVADs were associated with a decrease in repeat revascularization (RR 0.26 95% CI 0.08–0.83). However, LVADs significantly increased the risk of bleeding compared with IABP (RR 2.85 95% CI 1.72–4.73).

Conclusions:

Neither LVADs nor IABP improves short or long-term survival in hr-PCI patients. LVADs are more likely to reduce repeat revascularization after PCI, but to increase the risk of bleeding events than IABP.
Obturator dislocation of the femoral head combined with ipsilateral femoral neck and pubic fractures
Authors: Hu Yu-chen , Gao Feng , Liu He , Chen Liang-shi , Li Yun-long , Li Zheng-wei , Huang Chao , Wang Yang , Piao Cheng-dong
Published: September 2019

Rationale:

Obturator dislocation of the femoral head combined with ipsilateral femoral neck and pubic fracture is a rare injury. We used cannulated screws combined with a femoral neck medial plate for the first time to treat this type of injury and achieved good follow-up results.

Patient concerns:

The patient was hospitalized due to an accident resulting in swelling and deformity accompanied by limited mobility of the right hip and left knee.

Diagnoses:

X-ray examination and computed tomography confirmed that the patient suffered from right hip obturator dislocation, femoral head and neck fracture, pubic fracture, as well as open fracture of the left femoral shaft.

Interventions:

Open reduction and internal fixation with cannulated screws and a medial support plate of the femoral neck were performed for the right hip obturator dislocation, femoral head and neck fracture, and the pubic fracture. Artificial bone grafting was performed to support the femoral head defect. Debridement and the second phase of internal fixation were executed to cure the open fracture of the left femoral shaft.

Outcomes:

The patient was followed-up for 6 months and showed good hip function. X-ray examination and computed tomography indicated that the fractures healed well without fracture displacement or loosening of the implants. Meanwhile, there were no signs of femoral neck valgus and femoral head necrosis observed.

Lessons:

The combination of cannulated screws and medial support plate was suggested for the treatment of hip obturator dislocation and femoral head and neck fracture. Furthermore, partial weight loading exercise should be performed promptly to reduce the risk of muscular atrophy and myasthenia.
Effective treatment using itraconazole combined with terbinafine in the treatment of nasal sporotrichosis
Authors: Guo Keying , Wang Shenghua , Wang Zhenying , Zhang Li
Published: September 2019

Rationale:

Sporotrichosis is a subacute or chronic infection caused by sporothrix schenckii complex. The misdiagnosis rate of sporotrichosis is very high. Fungal microscopic examination and timely culture help us make an accurate diagnosis and treatment. We observed that combined treatments are more effective than monotherapy in treatment of sporotrichosis.

Patient concerns:

A 47-year-old female complained of pustules and scabs on her nose tip that lasted for 1 month at our hospital. She was diagnosed with skin infection and treated with antibiotics for 20 days. Nonetheless, the treatment did not result in any improvement with the lesion.

Diagnoses:

The results on bacterial culture, sensitive test, special stains, and multiple acid-fast cultures were negative. Finally, fungi were observed by KOH. Finally, fungal hyphae were observed by KOH and by fluorescent staining. Taupe filamentous colonies of sporothrix-like species appeared by fungal culture. The diagnosis of sporotrichosis was finally confirmed based on the lesion characteristics and the results of laboratory examination.

Interventions:

The lesions did not alleviate with Itraconazole oral administration for 1 month. Then we treated the patient with the combination therapy of itraconazole (ITR) and terbinafine. At the same time, the compound glycyrrhizin tablet was used for liver protection.

Outcomes:

The patient was free of clinical symptoms of sporotrichosis following the treatment and did not have complications during an 8-month follow-up.

Lessons:

We should always be alert to sporotrichosis although it is not a very common disease. It is important to adapt fungi microscopic analysis and culture for an accurate diagnosis. ITR is the first choice for sporotrichosis. However, combination treatment is more effective for stubborn cases.
Screening for microRNA-based diagnostic markers in hepatic alveolar echinococcosis
Authors: Ren Bin , Wang Haijiu , Ren Li , Yangdan Cairang , Zhou Ying , Fan Haining , Lv Yi
Published: September 2019

This study aims to screen differentially expressed host miRNAs that could be used as diagnostic markers for liver alveolar echinococcosis (LAE).

Differentially expressed miRNAs were first screened by miRNA microarray in liver tissues from2 LAE patients and normal liver tissues from 3 LAE patients, followed by qRT-PCR validation in 15 LAE tissues and 15 normal tissues. Target genes of differentially expressed miRNAs were predicted using Targetscan, PITA and microRNAorg database, and the overlapped predicted target genes were analyzed by GO and KEGG.

The hsa-miR-1237-3p, hsa-miR-33b-3p, and hsa-miR-483-3p were up-regulated whereas the hsa-miR-4306 was down-regulated in LAE tissues compared with normal controls (P < .05). The expression change of miR-483-3p was further confirmed in both liver tissues and plasma. Several predicted targets of miR-1237-3p, miR-4306, and miR-483-3p were related to DNA-dependent transcriptional regulation, developmental regulation of multicellular organisms, and biological functions such as cellular immune responses (T cell proliferation). The overlapped predicted target genes of the 4 differentially expressed miRNAs were enriched in mRNA surveillance, cancer signaling pathway, intestinal immune network, and other signal pathways.

Our results indicate that miR-483-3p is a potential marker for the diagnosis of LAE, and targets of this miRNA could be the focus of further studies.
Association between the detection rate of thyroid cancer and the external radiation dose-rate after the nuclear power plant accidents in Fukushima, Japan
Authors: Yamamoto Hidehiko , Hayashi Keiji , Scherb Hagen
Published: September 2019

A thyroid cancer ultrasonography screening for all residents 18 years old or younger living in the Fukushima prefecture started in October 2011 to investigate the possible effect of the radiological contamination after the Fukushima Daiichi Nuclear Power Plant accidents as of March 12 to 15, 2011. Thyroid cancer in 184 cases was reported by February 2017. The question arises to which extent those cancer cases are a biological consequence of the radiation exposure or an artefactual result of the intense screening of a large population.

Experiences with the Chernobyl accident suggest that the external dose may be considered a valid surrogate for the internal dose of the thyroid gland. We, therefore, calculated the average external effective dose-rate (μSv/h) for the 59 municipalities of the Fukushima prefecture based on published data of air and soil radiation. We further determined the municipality-specific absolute numbers of thyroid cancers found by each of the two screening rounds in the corresponding municipality-specific exposed person-time observed. A possible association between the radiation exposure and the thyroid cancer detection rate was analyzed with Poisson regression assuming Poisson distributed thyroid cancer cases in the exposed person-time observed per municipality.

The target populations consisted of 367,674 and 381,286 children and adolescents for the 1st and the 2nd screening rounds, respectively. In the 1st screening, 300,476 persons participated and 270,489 in the 2nd round. From October 2011 to March 2016, a total of 184 cancer cases were found in 1,079,786 person-years counted from the onset of the exposure to the corresponding examination periods in the municipalities. A significant association between the external effective dose-rate and the thyroid cancer detection rate exists: detection rate ratio (DRR) per μSv/h 1.065 (1.013, 1.119). Restricting the analysis to the 53 municipalities that received less than 2 μSv/h, and which represent 176 of the total 184 cancer cases, the association appears to be considerably stronger: DRR per μSv/h 1.555 (1.096, 2.206).

The average radiation dose-rates in the 59 municipalities of the Fukushima prefecture in June 2011 and the corresponding thyroid cancer detection rates in the period October 2011 to March 2016 show statistically significant relationships.
The wedge insole for the treatment of knee osteoarthritis
Authors: Chen Shuling , Sun Yicheng , Ma Guanhua , Yin Xunlu , Liang Long
Published: September 2019

Background:

Functional limitations and pain are common presenting complaints for people suffering from knee osteoarthritis. Wedge insole can be sued for treatment of knee osteoarthritis. Hence, we conducted a systematic review and meta-analysis to explicit the efficacy of wedge insole in the treatment of knee osteoarthritis.

Methods:

A systematic literature search for studies will be performed in MEDLINE, Embase, the Chinese National Knowledge Infrastructure Database (CNKI), Cochrane Library, Web of Science. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. Funnel plot will be used to assess the reporting bias. And the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3.

Results:

This systematic review and meta-analysis will provide a synthesis of evidences for wedge insole on knee osteoarthritis.

Conclusion:

The conclusion of this study will provide recommendations to assess effectiveness of exercise on knee osteoarthritis, which may further guide clinical practice.

PROSPERO registration number:

CRD42018096804
Surgical treatment for Xp11.2 translocation renal cell carcinoma with venous thrombus
Authors: Ge Liyuan , Tian Xiaojun , Ma Jing , Zhao Guojiang , Song Yimeng , Zhang Shudong , Ma Lulin
Published: September 2019

The aim of the study was to report the experience and outcomes of Xp11.2 translocation renal cell carcinoma (tRCC) patients with tumor thrombus undergoing radical nephrectomy and thrombectomy.

Between January 2017 and December 2017, 66 consecutive patients with RCC and venous thrombus involvement received surgical treatment at Peking University Third Hospital. Of which, 5 patients were confirmed of Xp11.2 tRCC, 61 patients were diagnosed of non-tRCC subtypes including 45 ccRCCs, 10 pRCCs, and 6 other subtypes. Demographic, clinical, operation, pathological and follow-up data were extracted for analysis. Prognostic factors were identified by Cox regression analysis.

All the patients received radical nephrectomy and thrombectomy successfully. During a median follow-up of 18 months, 5 patients in non-tRCC group and 1 patient in tRCC group died of disease progression. Survival analysis revealed that Xp11.2 tRCC patients experienced shorter DFS than non-tRCC patients, however, there is no significant difference in OS between two groups. Xp11.2 tRCC histological subtype and presence of metastasis at diagnosis were identified as independent negative factors of DFS by multivariate analysis.

Radical nephrectomy with thrombectomy provides an acceptable efficacy for tRCC patients with tumor thrombus extending into the venous system. In addition, multimodality treatment should be considered for advanced Xp11.2 RCCs as this subtype was a negative prognostic factor of DFS.
Sera total oxidant/antioxidant status in lung cancer patients
Authors: Xiang Miao , Feng Jiafu , Geng Lidan , Yang Yuwei , Dai Chunmei , Li Jie , Liao Yao , Wang Dong , Du Xiao-Bo
Published: September 2019

We investigated oxidative stress parameters in the sera of patients with lung cancer and healthy individuals to evaluate their correlations with lung cancer.

Ninety-four lung cancer patients and 64 healthy controls were enrolled after obtaining informed consent. Their sera oxidative stress parameters were measured.

Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were significantly different between patients and healthy groups (all P < .001). TAS gradually decreased and TOS and OSI gradually increased from stage I to III, but it did not reach statistical significance (all P > .05). TAS and OSI were significantly different between the nonsmoking and smoking groups, radiotherapy and without radiotherapy groups, chemotherapy and without chemotherapy groups (P < .05), but not TOS (P > .05). In a receiver operating characteristic curve analysis comparing patients with lung cancer with healthy controls, the Youden indices of TOS, TAS, and OSI were 0.541, 0.532, and 1, respectively.

The oxidative stress may be correlation with lung cancer staging. Smoking, surgery, radiotherapy, and chemotherapy showed correlation with parts oxidative stress parameters.
Neutrophil–lymphocyte ratio as an early predictor for patients with acute paraquat poisoning
Authors: Cao Zong Xun , Song Ya Qi , Bai Wen Jing , Wang Wen Jie , Zhao Yong , Zhang Su Li , Feng Shun Yi
Published: September 2019

This retrospective study aimed to investigate whether the neutrophil–lymphocyte ratio (NLR) can be used as an early predictor of 90-day survival in patients with acute paraquat (PQ) poisoning.

This study enrolled 105 patients with acute PQ poisoning admitted from May 2012 to May 2018. Kaplan–Meier curve, receiver operating characteristic curve, and Cox proportional hazards regression analyses were used to investigate the predictive value of NLR for 90–day survival of patients with acute PQ poisoning.

The 90-day survival rate was 40.95% (43/105). Survivors had lower NLR (P <.001), which was an independent predictor of 90-day survival according to the Cox proportional hazard regression analyses. The area under the NLR curve was 0.842 (95% CI: 0.767–0.917, P <.001) in predicting 90-day survival.

Our findings showed that low NLR was a valuable early predictor of 90-day survival in patients with acute PQ poisoning.
Sequelae of an Evidence-based Approach to Management for Access to Care in the Veterans Health Administration
Authors: Kaboli Peter J. , Miake-Lye Isomi M. , Ruser Christopher , Yano Elizabeth M. , Orshansky Greg , Rubenstein Lisa , Curtis Idamay , Kirsh Susan , Hempel Susanne
Published: September 2019

Background:

Access to health care is a critical concept in the design, delivery, and evaluation of high quality care. Meaningful evaluation of access requires research evidence and the integration of perspectives of patients, providers, and administrators.

Objective:

Because of high-profile access challenges, the Department of Veterans Affairs (VA) invested in research and implemented initiatives to address access management. We describe a 2-year evidence-based approach to improving access in primary care.

Methods:

The approach included an Evidence Synthesis Program (ESP) report, a 22-site in-person qualitative evaluation of VA initiatives, and in-person and online stakeholder panel meetings facilitated by the RAND corporation. Subsequent work products were disseminated in a targeted strategy to increase impact on policy and practice.

Results:

The ESP report summarized existing research evidence in primary care management and an evaluation of ongoing initiatives provided organizational data and novel metrics. The stakeholder panel served as a source of insights and information, as well as a knowledge dissemination vector. Work products included the ESP report, a RAND report, peer-reviewed manuscripts, presentations at key conferences, and training materials for VA Group Practice Managers. Resulting policy and practice implications are discussed.

Conclusions:

The commissioning of an evidence report was the beginning of a cascade of work including exploration of unanswered questions, novel research and measurement discoveries, and policy changes and innovation. These results demonstrate what can be achieved in a learning health care system that employs evidence and expertise to address complex issues such as access management.
E-SCOPE
Authors: Henry Shayna L. , Mohan Yasmina , Whittaker Joel L. , Koster Marguerite A. , Schottinger Joanne E. , Kanter Michael H.
Published: September 2019

Background:

More than 50,000 randomized controlled trials and 8000 systematic reviews are anticipated to be published annually in the coming years. This huge volume of published findings makes it challenging for health care delivery systems to review new evidence, prioritize health care practices that warrant implementation, and implement best practices.

Objective:

The objective of this study was to describe the Kaiser Permanente Southern California E-SCOPE (Evidence Scanning for Clinical, Operational, and Practice Efficiencies) program, a systematic method to accelerate the implementation of evidence-based practices in clinical care settings.

Methods:

E-SCOPE uses a strategic evidence search algorithm to conduct proactive literature searches to identify high-quality studies of interventions that yield improved health outcomes, quality and/or efficiency of care delivery, or cost savings. Each quarterly search yields 500–1000 abstracts; about 5%–10% of studies are selected each quarter for consideration for implementation. These studies are presented to clinical and operational leaders and other stakeholders to make the final determination regarding the implementation of the practice; E-SCOPE staff work closely with stakeholders to develop an implementation plan, identify practice owners, and ensure sustainability.

Results:

The time from study publication to implementation using the E-SCOPE process ranges from 4 to 36 months, with an average of ∼16 months. Four examples of E-SCOPE implementation efforts, including new deployment, scale-up/spread, deimplementation, and operational efforts, are described.

Conclusion:

A single, centralized program for the proactive identification of the most up-to-date, evidence-based best practices and facilitated implementation can efficiently and effectively promote continuous learning and implementation in a learning health care system.