bluuebunny/crossref_metadata_2025 huggingface dataset:
Qingfei Paidu decoction for treating COVID-19
Authors: Zhang Yuan , Xie Hongyan , Li Yan , Li Tianhao , Yuan Haipo , Fu Xiaoxu , Xie Chunguang
Published: September 2020

Background:

Coronavirus disease 2019 (COVID-19) is one of the infectious diseases that have seriously threatened global public health since its outbreak in 2019. Due to the complicated Pathogenesis, high infectivity and high fatality rate of COVID-19, there is currently no effective treatment for such epidemic disease. Traditional Chinese medicine has a long clinical history for the prevention and treatment of this kind of acute infectious disease. Qingfei Paidu Decoction (QFPD) is widely used in treating COVID-19 in China. However, there is still a lack of comprehensive and systematic evidence on the effectiveness and safety of Qingfei Paidu Decoction.

Methods:

We will search each database from the built-in until May 2020. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science, while the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Simultaneously we will retrieval clinical registration tests and grey literatures. This study only screen the clinical randomized controlled trials (RCTs) about QFPD for COVID-19 to assess its efficacy and safety. The two researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is represented by relative risk (RR), and the continuous is expressed by mean difference (MD) or standard mean difference (SMD), eventually the data is synthesized using a fixed effect model (FEM) or a random effect model (REM) depending on whether or not heterogeneity exists. Total clinical effective rate, improvement rate of lung CT, adverse events were evaluated as the main outcomes. Effective rate of clinical symptoms, treatment time were secondary outcomes. Finally, meta-analysis was conducted by RevMan software version 5.3.

Results:

The results of our research will be published in a peer-reviewed journal.

Conclusion:

This systematic review aims to provide new evidence of QFPD for COVID-19 in terms of its efficacy and safety.

PROSPERO registration number:

CRD42020200894.
A protocol for systematic review and meta-analysis of optimizing treatment for malaria
Authors: Zhang Renyan , Dong Xing , Wang Junyao , Guo Ying , Dai Yong
Published: September 2020

Background:

Malaria remains a global health threat for centuries. In recent years, a rising resistance of Plasmodium falciparum to current standard artemisinin-based combination therapies (ACTs) leads to increasing treatment failures and requires for optimized treatment. Here, we intend to make a systematic review and meta-analysis of optimizing treatment for malaria, so as to find a potential optimal treatment.

Methods:

We will search electronic databases: the Cochrane Infectious Diseases Group (CIDG) Specialized Register, the Cochrane Central Register of Controlled Trials (CEN-TRAL), PubMed, Embase, Web of Science from their inception to 1 July, 2020. We will also search International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, and contact with authors when necessary. Two authors will independently collect and select data, and the statistical analyses will be conducted by Revman V.5.3 software.

Results:

We will evaluate efficacy and safety of modified ACTs for uncomplicate malaria, comparing with standard ACTs in all eligible clinical studies.

Conclusion:

In this study, we will offer clinical evidence for optimizing treatment for malaria.

Registration number:

INPLASY202070115
Comparative effectiveness of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for resected low-grade appendiceal mucinous neoplasm (LAMN)
Authors: Yang Wenming , Nie Pan , Liu Xueting , Peng Jikui
Published: September 2020

Background:

Whether prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) offers long-term survival benefit to patients with low-grade appendiceal mucinous neoplasms (LAMNs) after resection surgery is still under heated debate. The aim of the present meta-analysis is to investigate the comparative effectiveness and safety of prophylactic HIPEC regimens in LAMNs

Methods:

A systematic search of MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and controlledtrials.com will be performed. All published RCTs and quasi-RCTs through July 20, 2020 with language restricted in English will be included in this review study. Two reviewers will independently conduct the procedures of study identification, data collection, and methodological quality assessment. The primary outcomes are overall survival (OS) and disease-free survival (DFS). The secondary outcomes consist of peritonitis and sepsis, colonic fistula, chemotherapy-associated adverse events, and adhesive intestinal obstruction. The pooled odds ratios (ORs) or hazard ratios (HRs) and relative 95% confident intervals (CIs) of each outcome measurement will be calculated. EndNote X9 software will be applied to manage all citations. The Stata software version 14.0 and R x64 software version 3.5.1 will be employed for main statistical analyses.

Discussion:

This study will employ a network meta-analysis to summarize direct and indirect evidence in the specific area to provide detailed individualized guidance on surgical management for LAMNs.

Registration:

This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 25 July 2020 (registration number INPLASY202070112).
Immunoglobulin G4-related disease in the stomach presenting as a gastric subepithelial tumor
Authors: Cho Min Ji , Moon Hee Seok , Lee Hyeon Seok , Park Jae Ho , Kim Ju Seok , Kang Sun Hyung , Lee Eaum Seok , Kim Seok Hyun , Sung Jae Kyu , Lee Byung Seok , Jeong Hyun Yong
Published: September 2020

Introduction:

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disorder characterized by specific pathologic findings and often, but not in all cases, elevated serum IgG4 concentration. Although it can virtually involve every organ system, cases involving the gastrointestinal tract and especially gastric mass lesions have rarely been reported.

Patient concerns:

A 45-year-old man, who was incidentally discovered asymptomatic subepithelial tumor (SET), by endoscopy, on the greater curvature of the upper gastric body, was referred to our hospital for further evaluation.

Diagnosis:

The patient was postoperatively diagnosed with IgG4-RD by histopathologic results.

Interventions:

The patient underwent laparoscopic wedge resection.

Outcomes:

The patient is presently followed up annually in our clinic and had no problems and showed no signs of recurrence in examination.

Conclusion:

We reported a rare case of IgG4-RD presenting as a gastric SET. The first line treatment of IgG4-RD is glucocorticoid administration. However, because pathologic examination is challenging owing to the lesion location, preoperative diagnosis is difficult and may lead to unnecessary gastric resection. Thus, using alternative preoperative diagnostic methods such as endoscopic ultrasound-guided fine-needle biopsy or the biopsy unroofing technique could spare the patient from unnecessary surgical treatment.
Leydig cell tumor of a testis with azoospermia
Authors: Kong Qingkuo , Yu Yang , Tian Tian , Zhang Hongguo , Sun Meiling , Liu Ruizhi , Liu Yanhong
Published: September 2020

Rationale:

Testicular tumors represent 1% to 1.5% of all tumors in men. Those derived from Leydig cells are rare and account for 1% of testicular tumors. Leydig tumor cells can produce steroid hormones such as estrogen, progesterone and testosterone. The amount and type of hormones secreted by these tumors may produce complicated clinical characteristics in these patients.

Patient concerns:

Here, we report a patient with azoospermia, a testicular Leydig cell tumor (LCT), and elevated plasma testosterone levels. We describe the diagnostic and therapeutic experience of this case, and our follow-up of the patient's clinical indicators and fertility status.

Diagnosis:

The patient was diagnosed with azoospermia and a testicular LCT.

Interventions:

The patient underwent testicular tumor removal and long-term follow-up.

Outcomes:

After 4 months of follow-up, the patient's semen examination index significantly improved and his wife became naturally pregnant. At 4 months of gestation, the fetus was delivered because of a ruptured amniotic cavity. Twenty-six months after tumor removal, the patient's sex hormone levels had completely returned to normal and spermatogenic function had partially recovered, but there was no natural pregnancy with his partner.

Conclusion:

For LCTs, testis sparing surgery may provide a safe and feasible option to restore spermatogenic function, although longer-term follow-up is required. Drug assistance may be required to maintain spermatogenic function and achieve fertility, and further research is required.
Chinese herbal fumigant and lotion for postoperative complication in surgical wound of anal fistula
Authors: Zhu Liying , Ma Sisi , Jia Chunhua , Zhang Bei , Ma Zimi , Park EunHee
Published: September 2020

Background:

Surgery is the most common and effective therapy for anal fistula, while the postoperative complication, such as pain, edema, pruritus, turgescence, and exudation in surgical wound, can have serious impact on wound healing and patients’ quality of life. Chinese herbal fumigant and lotion have been commonly used in postoperative treatment and achieved satisfied effect in China. However, clinical evidence-based literature of Chinese herbal fumigant and lotion for postoperative anal fistula is not sufficient. This protocol is described for a systematic review to investigate the beneficial effects.

Methods:

A systematic search will be conducted in database involving PubMed, the Cochrane library, Embase, Web of Science, Google Scholar, SinoMed, China National Knowledge Infrastructure(CNKI), VIP, Wanfang Database, CiNii(National Institute of Informatics), and KISS(Koreanstudies Information Service System) from inceptions to December 31, 2019. We will include randomized controlled trials (RCT) regarding Chinese herbal fumigant and lotion in the treatment of complication in surgical wound of anal fistula. Quality of included RCTs will be assessed according to the Cochrane Handbook 5.1.0. GRADE will be used to assess the quality of evidence. The summary results will be pooled using the random-effects model or fixed-effects model according to the heterogeneity of included studies.

Results:

After peer-review, the study will be disseminated in scientific journals and conferences.

Conclusion:

This systematic review will provide evidence for the efficacy of Chinese herbal fumigant and lotion for curing postoperative complication of anal fistula. In addition, it might provide suggestions for Chinese medicine clinical practice or guideline.

PROSPERO registration:

CRD42020164975.
Short-term clinical efficacy of the pulsed Nd:YAG laser therapy on chronic nonspecific low back pain
Authors: Abdelbasset Walid Kamal , Nambi Gopal , Elsayed Shereen H. , Alrawaili Saud M. , Ataalla Nahla N. , Abodonya Ahmed M. , Saleh Ayman K. , Moawd Samah A.
Published: September 2020

Background:

Chronic non-specific low back pain (LBP) is gradually increasing among populations worldwide and affects their activities. Recently, the Nd:YAG laser has been presented in the rehabilitation field.

Objectives:

This study aims to explore the short-term effects of the Nd:YAG laser on chronic non-specific LBP individuals.

Methods:

Thirty-five individuals with chronic nonspecific LBP were included in the study from December 2019 to March 2020. Randomly, they were categorized to Nd:YAG group (n = 18) and sham laser as a control (n = 17) thrice weekly for a 6-week intervention. Modified Oswestry disability index (MODI), pain disability index (PDI), visual analogue scale (VAS), and lumbar flexion range of motion (ROM) have been assessed pre and post-6 weeks of the intervention.

Results:

Significant improvements were observed in the Nd:YAG group (MODI, P < .001; PDI, P = .007; VAS, P < .001; lumbar ROM, P = .002), whereas the sham group showed no significant changes (MODI, P = .451; PDI, P = .339; VAS, P = .107; lumbar ROM, P = .296) after 6-week intervention. Between-group comparisons showed significant differences in tending toward the Nd:YAG group (MODI, P < .001; PDI, P = .046; VAS, P < .001; lumbar ROM, P = .003).

Conclusions:

Regarding the present study outcomes, short-term pulsed Nd:YAG laser (6 weeks) may reduce functional disabilities and pain intensity, and improve the lumbar flexion ROM in patients with chronic nonspecific LBP. Further well-designed randomized controlled studies with large sample sizes should be conducted regarding laser treatment.
Primary gastric squamous cell carcinoma presenting as a large submucosal mass
Authors: Gao Lei , Tang Xiaolong , Qu Hui , He Qingsi , Sun Guorui , Shi Jingbo , Ye Jianhong , Liang Yahang
Published: September 2020

Rationale:

Primary gastric squamous cell carcinoma (SCC) is rarely encountered clinically. SCC, which presents as a submucosal tumor, is even rarer. Without the support of pathological evidence, it is difficult to make a correct preoperative diagnosis. Due to limited clinical data, the pathogenesis and treatment of gastric SCC remain unclear.

Patient concerns:

A 69-year-old man was admitted to our hospital with unexplained weight loss. Endoscopy revealed a submucosal mass without any ulcer on its surface located on the body of the stomach. The results of 2 gastroscopic mucosal biopsies were chronic inflammation.

Diagnoses:

The clinical diagnosis by computed tomography (CT) and gastroscopy was gastrointestinal stromal tumor (GIST) preoperatively. The postoperative pathological examination demonstrated this tumor as moderately differentiated SCC.

Interventions:

Total gastrectomy, distal pancreatectomy, and splenectomy were performed.

Outcomes:

The patient was discharged 7 days after the surgery without any complications. The follow-up CT scan showed no evidence of metastatic disease 6 months after surgery.

Lessons:

Large primary gastric SCC could present as a submucosal mass. Gastroscopic mucosal biopsy may not be able to get tumor tissue due to inflammatory reaction.
First-line pemetrexed and carboplatin plus anlotinib for epidermal growth factor receptor wild-type and anaplastic lymphoma kinase-negative lung adenocarcinoma with brain metastasis
Authors: Zhang Chu , Kong Feng-Wei , Wu Wen-Bin , Zhang Miao , Yu Guang-Mao , Wang Xiang , Liu Yuan-Yuan
Published: September 2020

Rationale:

Brain metastasis (BM) is a serious complication in non-small cell lung cancer (NSCLC) patients. Pemetrexed is one of the preferred agents in nonsquamous NSCLC with BM; however, the traditional chemotherapy demonstrated limited efficacy partly due to drug resistance and the blood-brain barrier.

Patient concerns:

A 52-year-old male non-smoker was admitted for irritating cough, chest distress, and back pain.

Diagnoses:

Epidermal growth factor receptor wild-type, anaplastic lymphoma kinase-negative primary lung adenocarcinoma with an asymptomatic solitary BM (cTxNxM1b, IVA).

Interventions:

Pemetrexed (500 mg/m2 of body surface area) and carboplatin (area under the curve of 5) were firstly administered every 3 weeks for 3 cycles, followed by pemetrexed/carboplatin plus anlotinib (12 mg daily; 2 weeks on and 1 week off) for another 3 cycles. Then maintenance anlotinib monotherapy was continued for a year, without unacceptable adverse events.

Outcomes:

The BM was slightly enlarged after 3 cycles of pemetrexed/carboplatin; however, a complete remission was achieved after the combination therapy. His intracranial progression-free survival was more than 2 years.

Lessons:

Pemetrexed/carboplatin plus anlotinib could be considered for the treatment of epidermal growth factor receptor wild-type, anaplastic lymphoma kinase-negative lung adenocarcinoma with BM. Further well-designed trials are warranted to verify this occasional finding.
Impact of bedside assistant on outcomes of robotic thyroid surgery
Authors: Kwon Hyungju
Published: September 2020

The importance of bedside assistants has been well established in various robotic procedures. However, the effect of assistants on the surgical outcomes of thyroid surgery remains unclear. We investigated the effects of a dedicated robot assistant (DRA) in robotic thyroidectomy. We also evaluated the learning curve of the DRA.

Between January 2016 and December 2019, 191 patients underwent robotic total thyroidectomy, all of which were performed by a single surgeon. The DRA participated in 93 cases, while non-dedicated assistants (NRAs) helped with 98 cases. Demographic data, pathologic data, operative times, and postoperative complications were recorded and analyzed.

Robotic thyroidectomy was successful in all 191 patients, and none required conversion to the conventional open procedure. Mean operative time was shorter in the DRA group than in the NRA group (183.2 ± 33.6 minutes vs 203.1 ± 37.9 minutes; P < .001). There were no significant differences in terms of sex distribution, age, preoperative serum thyroid stimulating hormone level, or pathologic characteristics between the groups. Cumulative summation analysis showed that it took 36 cases for the DRA to significantly reduce operative time. Mean operative time decreased significantly in the subgroup including the 37th to the 93rd DRA cases compared with the subgroup including only the first 36 DRA cases (199.7 ± 37.3 minutes vs 172.8 ± 26.4 minutes; P < .001). NRA group showed no definite decrease of operation time, which indicated that the NRAs did not significantly deviate from the mean performance.

Increased experience of the bedside assistant reduced operative times in the robotic thyroidectomy. Assistant training should be considered as a component of robotic surgery training programs.
Immune benefit of combined heart and liver transplantation
Authors: Ortega-Legaspi Juan M. , Hoteit Maarouf , Wald Joyce
Published: September 2020

Purpose of review

Understanding the mechanisms involved in immune protection provided by a hepatic allograft is imperative as further therapies for highly sensitized patients could be developed and thus expanding the donor pool and improving outcomes.

Recent findings

The clinical data from immune protection comes mainly from combined liver and kidney transplants with excellent results in overall survival and also that of the allograft. This phenomenon has also been observed in dual liver transplants with heart, lung, skin and intestines, albeit with less data. In heart transplant recipients, the liver allograft has proven to be protective even in cases of highly sensitized patients with at least equal survival and rejection outcomes to recipients of heart alone. Although not fully understood, the mechanisms for immune benefit proposed are extensive at different levels of the hepatic immune system. Some of these mechanisms include chimerism, T-cell deletion, the presence of peripheral regulatory T cells and donor-specific antibody neutralization.

Combined heart and liver transplantation is an infrequent but growing procedure due to increasing need in the adult congenital heart disease and cardiac amyloid populations. Given the ever expanding need for heart transplantation, understanding immunological phenomena that could expand the donor pool could, subsequently, increase the number of transplants.
Pathomics in urology
Authors: Schuettfort Victor M. , Pradere Benjamin , Rink Michael , Comperat Eva , Shariat Shahrokh F.
Published: September 2020

Purpose of review

Pathomics, the fusion of digitalized pathology and artificial intelligence, is currently changing the landscape of medical pathology and biologic disease classification. In this review, we give an overview of Pathomics and summarize its most relevant applications in urology.

Recent findings

There is a steady rise in the number of studies employing Pathomics, and especially deep learning, in urology. In prostate cancer, several algorithms have been developed for the automatic differentiation between benign and malignant lesions and to differentiate Gleason scores. Furthermore, several applications have been developed for the automatic cancer cell detection in urine and for tumor assessment in renal cancer. Despite the explosion in research, Pathomics is not fully ready yet for widespread clinical application.

In prostate cancer and other urologic pathologies, Pathomics is avidly being researched with commercial applications on the close horizon. Pathomics is set to improve the accuracy, speed, reliability, cost-effectiveness and generalizability of pathology, especially in uro-oncology.
Applications of neural networks in urology: a systematic review
Authors: Checcucci Enrico , De Cillis Sabrina , Granato Stefano , Chang Peter , Afyouni Andrew Shea , Okhunov Zhamshid
Published: September 2020

Purpose of review

Over the last decade, major advancements in artificial intelligence technology have emerged and revolutionized the extent to which physicians are able to personalize treatment modalities and care for their patients. Artificial intelligence technology aimed at mimicking/simulating human mental processes, such as deep learning artificial neural networks (ANNs), are composed of a collection of individual units known as ‘artificial neurons’. These ‘neurons’, when arranged and interconnected in complex architectural layers, are capable of analyzing the most complex patterns. The aim of this systematic review is to give a comprehensive summary of the contemporary applications of deep learning ANNs in urological medicine.

Recent findings

Fifty-five articles were included in this systematic review and each article was assigned an ‘intermediate’ score based on its overall quality. Of these 55 articles, nine studies were prospective, but no nonrandomized control trials were identified.

In urological medicine, the application of novel artificial intelligence technologies, particularly ANNs, have been considered to be a promising step in improving physicians’ diagnostic capabilities, especially with regards to predicting the aggressiveness and recurrence of various disorders. For benign urological disorders, for example, the use of highly predictive and reliable algorithms could be helpful for the improving diagnoses of male infertility, urinary tract infections, and pediatric malformations. In addition, articles with anecdotal experiences shed light on the potential of artificial intelligence-assisted surgeries, such as with the aid of virtual reality or augmented reality.
The best rules for antimicrobial stewardship in urogenital tract infections
Authors: Kulchavenya Ekaterina
Published: September 2020

Purpose of review

Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections, but therapy of UTIs is limited by resistance of pathogens and nonoptimal using of antibacterials. Narrative review of recent (2020–2018) literature dedicated to antimicrobial stewardship (AMS) in urological infections has been done.

Recent findings

Analysis of recent 64 articles has shown following principles of AMS for UTIs: selecting the correct drug, correct dose, and shortest clinically effective duration of therapy whenever possible, is a base for optimal antimicrobial stewardship; symptomatic UTIs should be treated with antimicrobials to alleviate symptoms, and in the case of more serious infection, to prevent complications; in both symptomatic and asymptomatic infection, quantitative culture is the gold standard for diagnosis; we have to avoid prescriptions of antibiotics when possible; we have to follow European and National Guidelines; we must avoid prescription of fluoroquinolones as empiric therapy for UTIs by many reasons, one of these is urogenital tuberculosis; the choice of antibiotic for UTI should be based on local level of resistance of uropathogens.

Studies of antimicrobial stewardship in urology are limited. Nevertheless, there are some golden rules, which may help to reduce inappropriate use of antimicrobials, improve patient outcomes, reduce side effects of antibiotic therapy, decrease the emergence and spread of multidrug-resistant infections, as well as decrease total costs of the therapy.
Chryseobacterium indologenes bacteremia in a healthy 2-month-old baby
Authors: Caballero Mora Francisco J. , Malgorzata Dyląg Margarita , Ariza Jimenez Ana B. , Jimenez Alvarez Silvia M.
Published: September 2020

Chryseobacterium indologenes is a Gram-negative bacteria rarely pathogenic in humans that can produce serious infections, especially, in children with comorbidities. Only a few cases of bacteremia have been published by C. indologenes, the majority in Taiwan. We show a Spanish healthy 2-month-old baby, who was diagnosed with this germ at our hospital, to report on the serious infections that it can cause and the multiple drug resistance to antibiotics that it shows.
Pain Assessment Clinical Practice Improvement
Authors: Chimenti Chris , McIntyre John , Noonan Brigid , Woerner Louise , Bell Marie , Marchetti Carol
Published: September 2020

In the 2 decades since The Joint Commission on Accreditation of Healthcare Organizations designated pain as the fifth vital sign, practitioners have become increasingly aware of the numerous challenges associated with the assessment and management of pain in older adults. Comprehensive pain assessment relies not only on the availability of assessment tools, but also on a clinician's knowledge, training, prior experience, and keen awareness of their own implicit bias and how it may influence their assessment and decisions. The purpose of this project was to develop, implement, and evaluate outcomes of a two-part online learning module on home healthcare clinicians' knowledge of pain. A quasi-experimental, one-group pretest posttest design was used. Of the 94 clinicians who volunteered, 54 participants completed all modules and surveys. Mean posttest scores (58.7%) were significantly higher than pretest scores (50.7%; n = 54, T = 3.08, p-value = 0.003). The strongest gains in learning occurred for those with lower pretest scores. The mean difference between posttest and pretest scores did not vary among job titles. There was no significant difference in posttest scores among job titles. A higher mean pretest score was associated with greater years of clinical experience, but did not significantly affect mean posttest scores. These findings suggest elearning is an effective educational approach to improve home healthcare clinicians' pain knowledge, particularly those who lack a sufficient knowledge base at the outset.
Home-Based Palliative Care and Its Influence on Quality of Life in Patients With a Life-Limiting Condition
Authors: Mendez Jessica L. , Yinger Kimberly , Bhatia Vipul
Published: September 2020

The need for comprehensive palliative care is inevitable with the aging population. Incorporating home-based palliative care is a new frontier within healthcare. The purpose of this study was to embed home-based palliative care services within the visiting nursing association (VNA) at a health system in Pennsylvania, examining effect on quality of life and symptom control, and average number of hospital admission days. A convenience sample of patients with one or more chronic conditions was selected from the existing VNA census (n = 22). A series of topics were outlined for discussion at each weekly visit for the pilot length of up to 6 months, scripted by evidence-based guidelines from the ENABLE II: Charting Your Course booklet (National Cancer Institute, 2004). A pretest/posttest survey method was conducted by utilizing results of the Edmonton Symptom Assessment System (ESAS) and the National Comprehensive Cancer Network Distress Thermometer. The effectiveness of the program was assessed using Spearman correlation to compare the difference in scores to the number of weeks in the program. The average number of hospital admission days during the pilot period was compared with admission days 6 months before enrollment in the pilot using the Wilcoxon signed-rank test. A significant relationship was found between the number of weeks in the program and reduction in the total ESAS symptom scores (rho = -0.484, p = .022), indicating that a reduction in symptoms was significantly more likely the longer a patient was in the program. Percentage of patients hospitalized decreased from 86% during preintervention period to 32% while enrolled. There was a noted reduction in the average number of days patients spent in the hospital while enrolled in the pilot (z = -2.24, p = 0.025).
The Effects of Sensory Enrichment After a Laboratory Stressor on Human Skin Barrier Recovery in a Randomized Trial
Authors: Law Mikaela , Jarrett Paul , Nater Urs M. , Skoluda Nadine , Broadbent Elizabeth
Published: September 2020

Objective

Environmental enrichment (EE) can reduce stress, alter immunity, and speed wound healing in animals. However, it is not known whether these effects translate to humans. This study aimed to investigate whether sensory EE could improve wound healing after a stressor in humans.

Methods

A total of 105 participants underwent a tape-stripping procedure and were then stressed using a laboratory stress paradigm. After this, they were randomized to interact for 30 minutes with one of two possible sensory EE interventions (music as auditory enrichment or a Paro robot as multisensory enrichment) or to a control condition. Skin barrier recovery was measured using transepidermal water loss at baseline, after the stressor, and after the intervention. Stress was measured using self-report, heart rate, blood pressure, and salivary stress-related biological measures. Enjoyment during the intervention was measured by self-report as a possible mediator.

Results

The Paro condition had significantly improved skin barrier recovery (mean [M] = 44%, standard error [SE] = 1.92) compared with the control condition (M = 37% SE = 2.01, F
(2,88) = 3.25, p = .043), both with and without controlling for covariates. The music condition did not significantly differ from the other conditions (M = 42%, SE = 1.95, p values > .05). Both objective and subjective stress measures did not significantly differ between conditions. Mediational analysis showed that enjoyment levels during the intervention period significantly mediated the relationship between condition and skin barrier recovery (z = 2.00, p = .046).

Conclusions

Paro, or other companion robots, may be an effective form of enrichment to improve skin barrier recovery in humans after a laboratory stressor, and this effect may be due to enjoyment. Further research with patient groups is required to investigate whether Paro can help heal clinical wounds.

Trial Registration: ACTRN12618000953235, registered at https://anzctr.org.au.
Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa
Authors: Marchesi Andrea , Amendola Francesco , Garieri Pietro , Steinberger Zvi , Vaienti Luca
Published: September 2020

Background

Hidradenitis suppurativa (HS) is a chronic skin pathology characterized by the occurrence of inflamed and swollen lesions, with a devastating impact of the disease on patient's quality of life. Wide local excision (WLE) of the affected tissue is the criterion-standard treatment, but there is no general consensus on the best reconstructive technique. The aim of this article is to evaluate the quality of life before and after WLE combined with pedicled perforator flap reconstruction, in patients suffering from HS.

Methods

We analyzed 26 consecutive patients suffering from Hurley stage III HS. Every patient underwent WLE, followed by reconstruction with pedicled perforator flap. Dermatology Quality of Life Index (DLQI) tests were administered to every patient preoperatively and 6 months after surgery, when the clinical condition was considered stable. Dermatology Quality of Life Index scores were compared in terms of means with Student t test. Linear regression studies were used to compare the changes in DLQI score with the surgical and clinical variables.

Results

Axillary area involvement was found in 21 of 27 patients; 6 patients had more than 1 body region involved. Thirty-two pedicled perforator flaps were performed, and 22 were thoracodorsal artery perforator flaps. Mean DLQI test score before the first operation was 21.31 ± 4.79; the average DLQI score after the last follow-up was 5 ± 2.95 (P < 0.0001). Dermatology Quality of Life Index scores were not influenced by complications including reoperation. There were also no correlations found between DLQI score delta and number of reoperation (−0.18) or days of hospital stay (−0.13).

Conclusions

Wide local excision followed by pedicled perforator flap reconstruction allows a radical excision of HS areas with short postoperative healing periods. Dermatology Quality of Life Index scores confirmed high levels of patients' satisfaction. Disadvantages of this technique include difficult learning curve, long operating time, and a nonnegligible complications rate.
Role of Orbicular Oculi Muscle Resection in Double Eyelid Surgery to Correct Ptosis of Young Adults
Authors: Li Tian , Liu Hai-peng , Wang Jia-qi , Zhang Duo
Published: September 2020

Background

A plump single eyelid with ptosis is the morphological feature of Asians. Orbicularis oculi muscle (OOM) technique can correct ptosis and get a good appearance.

Methods

A retrospective study was conducted in 121 Chinese patients who underwent double eyelid surgery with medial epicanthoplasty using OOM resection technique from December 2016 to December 2019. Preoperatively, all the patients had good or excellent levator function while skin fold overlapping the upper eyelid margin was found. Palpebral fissure height, upper eyelid margin reflex distance, complications, and cosmetic results were evaluated. Comparisons were performed preoperatively and postoperatively.

Results

The study included 121 patients. Mean follow-up time was 12.8 months (range, 6–32 months). Mean margin reflex distance increased from 1.96 ± 0.60 mm preoperatively to 3.74 ± 0.50 mm postoperatively (P < 0.001), mean palpebral fissure height increased from 6.31 ± 0.51 mm preoperatively to 8.33 ± 0.52 mm postoperatively (P < 0.001). Most patients obtained satisfactory results. Only 1 patient was under correction, 2 patients were with mild asymmetry 6 months postoperatively.

Conclusions

Ptosis of the upper eyelid can be corrected by the OOM resection technique without any procedure on levator muscle. This technique can be an alternative method for the correction of ptosis of the upper eyelid.
Estimation of Health Utility and Quality Adjusted Life Years in Bilateral Hand Transplantation
Authors: Harijee Ankita , Thankappan Krishnakumar , Sharma Mohit , NageswaraRao Nagesh Noothanapati , Patel Tejal , Bhaskaran Renjitha , Raj Manu , Sundaram Karimassery Ramaiyer , Iyer Subramania
Published: September 2020

Background

Hand transplantation and advances in the field of prostheses have opened new frontiers in the restoration of hand function among bilateral hand amputees (BHA). There is only scarce literature evaluating the health utility (HU) and quality adjusted life years (QALY) gained by bilateral hand composite tissue allotransplantation (CTA) or prosthesis over amputation. The study was focused on BHA restored with prosthesis or CTA.

Methods

The HU of three different health states (HS) namely, BHA, using prosthesis or with CTA and net QALYs gained by hand transplantation or prosthesis over amputation were computed by time trade-off (TTO) method among 236 study participants.

Results

Among 236 study participants, medical professional (120), general public (89), BHA (23), and bilateral hand transplant recipients (4) were included. The mean HU by TTO method among the study participants (n = 232) as BHA, using prosthesis or CTA was 0.34 (±0.24), 0.50 (±0.26) and 0.69 (±0.26) respectively. Bilateral hand CTA imparted an expected gain of 12.57 (±11.43) mean QALYs over amputation among the study participants. The subgroup analysis displayed higher mean HU in hand CTA recipient HS along with maximum QALY gained by CTA over amputation.

Conclusions

Bilateral hand CTA HS stands above the other 2 HSs, namely BHA and prosthesis, in terms of the health utility. As demonstrated by QALY gain of 12.57, participants' valuation of health utility is notably higher for CTA with acceptance of lifelong immunosuppressant rather than for a state of uncompromised physical health with a bilateral hand amputation.
Ear Deformations in Preterm Newborns: Non-Surgical Treatment
Authors: Olshinka Asaf , Ad-El Dean D. , Yaacobi Dafna (Shilo) , Ashkenazi Moshe
Published: September 2020

Approximately 30% of newborns have some degree of congenital ear anomalies, the minority will resolve spontaneously. Deformations can be treated non-surgically, when diagnosed early, whereas malformations surgically only. The authors use the EarWell system proven to achieve excellent results in treating deformations. Although prematurity might raise the risk of ear-deformations compared to term infants, in our experience, there is a longer time frame until effective treatment is initiated due to the cartilage malleability.

Treatment included splinting with retractors and taping or a custom-made silicone ear-mold if necessary. Patients were examined weekly, and treatment continued until appropriate ear shape was achieved (6–14 weeks).

The authors treated 8 preterm infants during 2018 to 2020 with the above method. Average age of application was 9.25 weeks; treatment was initiated in all patients before the age of 12 weeks. 5/8 had a right-side, 2/8 a left-side, and one a bilateral deformation. Average treatment duration was 10 ± 2.9 weeks. Assessment of satisfaction was made by parents via phone questionnaires; most were pleased with the overall result, while 62% were extremely satisfied.

The authors observed higher compliance and longer-lasting malleability of the cartilage in preterm compared to term-infants. They also had fewer complications than in the term group, maybe due to their older (actual age), and more resistant and durable skin compared to a term-infant of the same age. The authors recommend initiating treatment in preterm infants later than accepted practice as results were excellent, and despite the longer treatment duration, this is a better treatment option than surgery.
Propane-2-sulfonic acid octadec-9-enyl-amide, a novel PPARα/γ dual agonist, reverses neuroinflammation in lipopolysaccharide-induced mice
Authors: Lu Huahui , Zhang Huijun , Cong Ying , Li Wenjun , Zhou Juan , Wu Chuang , Liang Fulong , Li Ying
Published: September 2020

Our previous study showed that propane-2-sulfonic acid octadec-9-enyl-amide (N15), a novel peroxisome proliferator-activated receptor α and γ (PPARα/γ) dual agonist, inhibits inflammatory responses in tumor necrosis factor alpha (TNFα)-induced vascular endothelial cells or lipopolysaccharide (LPS)-induced human myeloid leukemia mononuclear cells-1. However, little is known about whether N15 applies to other pathological or neuroinflammatory conditions. In the present study, we detected the effect of N15 on the LPS-induced neuroinflammatory response in mice and further investigated whether the effect of N15 on neuroinflammation and neuronal cells survival was related to PPARα/γ dual pathways. We found that N15 decreased the mRNA expression of the proinflammatory cytokines IL-1β, IL-6, TNFα, inducible nitric oxide synthase and cyclooxygenase-2; inhibited microglial activation; and ameliorated neuronal apoptosis in the hippocampus and cortex of LPS-induced mice. In addition, PPARα antagonist MK886 or PPARγ antagonist T0070907 partially eliminated the effect of N15. These results demonstrate that N15 exerts an anti-inflammatory effect, at least in part, by enhancing PPARα/γ dual signaling. Our study reveals that N15 may be a promising neuronal protective drug for the treatment of neuroinflammatory diseases.
Salinity tolerance and geographical origin predict global alien amphipod invasions
Authors: Cuthbert Ross N. , Kotronaki Syrmalenia G. , Dick Jaimie T. A. , Briski Elizabeta
Published: September 2020

Invasive alien species are driving global biodiversity loss, compromising ecosystem function and service provision, and human, animal and plant health. Habitat characteristics and geographical origin may predict invasion success, and in aquatic environments could be mediated principally by salinity tolerance. Crustacean invaders are causing global problems and we urgently require better predictive power of their invasiveness. Here, we compiled global aquatic gammarid (Crustacea: Amphipoda: Gammaroidea) diversity and examined their salinity tolerances and regions of origin to test whether these factors predict invasion success. Across 918 aquatic species within this superfamily, relatively few gammarids (
n
= 27, 3%) were reported as aliens, despite extensive invasion opportunities and high numbers of published studies on amphipod invasions. However, reported alien species were disproportionately salt-tolerant (i.e. 32% of brackish-water species), with significantly lower proportions of aliens originating from freshwater and marine environments (both 1%). Alien gammarids also significantly disproportionally originated from the Ponto-Caspian (20% of these taxa) when compared with all ‘other' grouped regions (1%), and principally invaded Eurasian waters, with translocations of salt-tolerant taxa to freshwaters being pervasive. This suggests habitat characteristics, alongside regional contexts, help predict invasibility. In particular, broad environmental tolerances to harsh environments and associated evolutionary history probably promote success of aliens globally.
Dysregulation of tryptophan catabolism at the host-skin microbiota interface in Hidradenitis Suppurativa
Authors: Guenin-Macé Laure , Morel Jean-David , Doisne Jean-Marc , Schiavo Angèle , Boulet Lysiane , Mayau Véronique , Goncalves Pedro , Duchatelet Sabine , Hovnanian Alain , Bondet Vincent , Duffy Darragh , Ungeheuer Marie-Noëlle , Delage Maïa , Nassif Aude , Di Santo James P , Demangel Caroline
Published: September 2020

Hidradenitis Suppurativa (HS) is a chronic skin disorder of unknown etiology that manifests as recurrent, painful lesions. Cutaneous dysbiosis and unresolved inflammation are hallmarks of active HS, but their origin and interplay remain unclear. Our metabolomic profiling of HS skin revealed an abnormal induction of the kynurenine pathway (KP) of tryptophan catabolism in dermal fibroblasts correlating with the release of KP-inducing cytokines by inflammatory cell infiltrates. Notably, over-activation of the KP in lesional skin was associated with local and systemic depletion in tryptophan. Yet the skin microbiota normally degrades host tryptophan into indoles regulating tissue inflammation via engagement of the Aryl Hydrocarbon Receptor (AHR). In HS skin lesions, we detected contextual defects in AHR activation coinciding with impaired production of bacteria-derived AHR agonists and decreased incidence of AHR ligand-producing bacteria in the resident flora. Dysregulation of tryptophan catabolism at the skin-microbiota interface thus provides a mechanism linking the immunological and microbiological features of HS lesions. In addition to revealing metabolic alterations in HS patients, our study suggests that correcting AHR signaling would help restore immune homeostasis in HS skin.
Survival and 30-days hospital outcome in hospitalized COVID-19 patients in Upper Egypt: Multi-center study
Authors: Hussein Aliae AR Mohamed , Galal Islam , Mohamed Mohammed Mustafa Abdel Rasik , Eltaher AA Ibrahim Mohamed , Ahmed Shazly B
Published: September 2020

Background

Defining the clinical features and associated outcomes of patients diagnosed with corona virus disease (COVID-19) is fundamental to improving our understanding and adequate management of this illness. The aim of this study was to identify the demographic data, underlying comorbidities and the mortality related factors of hospitalized patients with COVID-19 in Upper Egypt.

Patients and methods

1064 cases consecutively admitted to isolation hospitals in Upper Egypt. All cases had confirmed COVID-19 infection. The electronic records of the patients were retrospectively revised and the demographic data, clinical manifestations, qSOFA score on admission and 30 days-outcome (ICU admission, death, recovery, referral or still in hospital) were analyzed. Overall cumulative survival in all patients and those > or < 50 years were calculated.

Results

49.2% of the study population were males and 50.8% were females with mean age 49.4±17.8 years-old. On admission, 83.9% were stable with qSOFA score <1, 3% required non-invasive mechanical ventilation, and 2.1% required O2 therapy. Within 30 days, 203 cases (19.1%) required admission to ICU. Death was recorded in 11.7% of cases, 28.7% recovered, 40.5% referred and 19.2% were still under treatment. Determinants of ICU admission and survival in the current study were age > 50, respiratory rate > 24/minute, SaO2 < 89%, qSOFA >1 and need for O2 therapy or NIV. The cumulative survival was 75.3% with the mean survival was 28.1, and 95.2% overall survival was recorded in those aged ≤50 years.

Conclusions

Age older than 50 years old, those with pre-existing DM, initial qSOFA score, requirement for O2 therapy and NIV from the first day of hospital admission may be associated with unfavorable 30 days- in hospital outcome of COVID-19.
Genomic epidemiology of COVID-19 in care homes in the East of England
Authors: Hamilton William L. , Tonkin-Hill Gerry , Smith Emily , Aggarwal Dinesh , Houldcroft Charlotte J. , Warne Ben , Brown Colin S. , Meredith Luke W. , Hosmillo Myra , Jahun Aminu S. , Curran Martin D. , Parmar Surendra , Caller Laura G. , Caddy Sarah L. , Khokhar Fahad A. , Yakovleva Anna , Hall Grant , Feltwell Theresa , Pinckert Malte L. , Georgana Iliana , Chaudhry Yasmin , Brown Nicholas M. , Gonçalves Sónia , Amato Roberto , Harrison Ewan M. , Beale Mathew A. , Chapman Michael Spencer , Jackson David K. , Johnston Ian , Alderton Alex , Sillitoe John , Langford Cordelia , Dougan Gordon , Peacock Sharon J. , Kwiatkowski Dominic P. , Goodfellow Ian , Török M. Estée ,   COVID-19 Genomics Consortium UK
Published: September 2020

COVID-19 poses a major challenge to care homes, as SARS-CoV-2 is readily transmitted and causes disproportionately severe disease in older people. Here, 1,167 residents from 337 care homes were identified from a dataset of 6,600 COVID-19 cases from the East of England. Older age and being a care home resident were associated with increased mortality. SARS-CoV-2 genomes were available for 700 residents from 292 care homes. By integrating genomic and temporal data, 409 viral clusters within the 292 homes were identified, indicating two different patterns - outbreaks among care home residents and independent introductions with limited onward transmission. Approximately 70% of residents in the genomic analysis were admitted to hospital during the study, providing extensive opportunities for transmission between care homes and hospitals. Limiting viral transmission within care homes should be a key target for infection control to reduce COVID-19 mortality in this population.

Impact statement

SARS-CoV-2 can spread efficiently within care homes causing COVID-19 outbreaks among residents, who are at increased risk of severe disease, emphasising the importance of stringent infection control in this population.