bluuebunny/crossref_metadata_2025 huggingface dataset:
Video Head Impulse Test Results in Patients With a Vestibular Schwannoma—Sensitivity and Correlation With Other Vestibular System Function Tests, Hearing Acuity, and Tumor Size
Authors: West Niels , Sass Hjalte , Klokker Mads , Cayé-Thomasen Per
Published: March 2020

Objective:

No previous studies have investigated a vestibular function test battery combining the Video Head Impulse Test (VHIT), the caloric test, and the cervical vestibular evoked myogenic potential (cVEMP) test. The objective was to investigate the sensitivity of the three vestibular tests to the presence of a vestibular schwannomas (VS), and possible correlations between test results, hearing acuity, and tumor size.

Study Design:

Retrospective cohort study.

Setting:

University hospital.

Patients:

Fifty-nine patients with a unilateral VS.

Intervention:

Audio-vestibular tests; the VHIT, cVEMP, caloric irrigation, pure-tone audiometry, and speech discrimination.

Main Outcome Measure:

Findings, sensitivity, and correlations between VHIT saccades and gain; cVEMP potentials, unilateral caloric weakness; hearing acuity.

Results:

The sensitivity for VS was 80% for the VHIT, 93% for the caloric test, and 73% for the cVEMP test. VHIT gain and saccades were associated, and both had a positive correlation to caloric function. Medium-sized tumors demonstrated the highest gain asymmetry while larger tumors were associated with saccades. There was a weak correlation between vestibular findings and hearing acuity.

Conclusion:

The VHIT is sensitive to the occurrence of a VS, but less so than the caloric test, and vestibular function deteriorates to some extent with increasing tumor size. VHIT outcomes are positively correlated to caloric function, but only vaguely to cVEMP and hearing acuity. The combined vestibular function test battery reached a sensitivity of 97% to the occurrence of a VS and could thus potentially substitute MRI for tumor screening upon the diagnosis of an asymmetrical hearing loss.
Validation of the Omron HBP-1320 for professional use according to the ANSI/AAMI/ISO 81060-2:2013 protocol and the 2010 revision of the European Society of Hypertension International Protocol
Authors: Saito Kanako , Hishiki Yukiko , Takahashi Hakuo
Published: March 2020

Objective

Performance of the Omron HBP-1320, designed for professional use by adding several features to the home blood pressure (BP) measuring device, was validated using two different protocols, specifically the ANSI/AAMI/ISO 81060-2:2013 (ANSI/AAMI/ISO) and the European Society of Hypertension International Protocol, 2010 Revision (ESH IP2), as a separate study.

Methods

Three trained medical technologists validated the performance of this device by comparing data obtained from the device with those obtained using a standard mercury sphygmomanometer throughout the study.

Results

Mean differences in mercury readings for systolic BP (SBP) and diastolic BP (DBP) between the devices were 1.6 ± 5.8 and −0.4 ± 5.3 mmHg, respectively, according to the ANSI/AAMI/ISO protocol, and mean device-observer measurement differences were −0.4 ± 4.9 and −0.2 ± 4.2 mmHg, respectively, satisfying Part 1 of ESH IP2. Differences in SBP and DBP both satisfied Part 2 of ESH IP2. The number of absolute differences in the values obtained using the device and those obtained by the observers fulfilled the requirements of the ANSI/AAMI/ISO protocol and ESH IP2.

Conclusion

Omron HBP-1320 met all requirements of the ANSI/AAMI/ISO protocol and ESH IP2.
A case report of sinusoidal diffuse large B-cell lymphoma in a STK4 deficient patient
Authors: Ashrafi Farzaneh , Klein Christoph , Poorpooneh Mohaddese , Sherkat Roya , Khoshnevisan Razieh
Published: March 2020

Introduction:

Primary immunodeficiency diseases (PIDs), a rare group of gene defects with different manifestations, are at great risk of malignancy. The incidence of diffuse large B-cell lymphoma in the sinusoidal tract is quite rare with nasal congestion, stuffiness, and pain in maxillary sinus manifestation. Human serine-threonine kinase 4 (STK4) deficiency affects the immune system with recurrent bacterial and viral infections, mucocutaneous candidiasis, cutaneous warts, skin abscesses, T- and B-cell lymphopenia, and neutropenia.

Patient concern:

In this study we describe the infrequent incidence and successful treatment of sinusoidal diffuse large B-cell lymphoma in a STK4 deficient patient with clinical manifestation of severe intractable headaches, unilateral swelling of her face, nasal congestion, stuffiness, and pain in maxillary.

Diagnosis:

Clinical data including headaches, unilateral swelling of face, nasal congestion, stuffiness and pain in maxillary sinus with confirmed histopathology and magnetic resonance imaging finding confirmed sinusoidal diffuse large B cell lymphoma in a STK4 deficient patient.

Intervention:

Six cycles of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone) were administered and after each cycle, G-CSF support was used. Chemotherapeutic drugs were administered with standard dose and no dose reduction was done during the treatment. IVIG treatment continued during the courses of chemotherapy.

Outcome:

The index patient achieved complete response at the end of chemotherapy courses and was in remission for about 8 months afterward, prior to the date of the present report.

Conclusion:

PID patient are often at increased risk of malignancies. Sinusoidal diffuse large B-cell lymphoma is quite rare and prognosis is variable. Early attention to patient's manifestation, suitable treatment, and monitoring manifestations caused by PID are critical.
Systematic evaluation and meta-analysis of quality and safety of life in patients with chronic rhinosinusitis treated by acupuncture
Authors: Li Lu , Hu Shouliang , Zhu Xin , Zhu Tianmin , Li Hui
Published: March 2020

Background:

This study aims to assess the quality and safety of life in patients with chronic rhinosinusitis (CRS) treated by acupuncture.

Methods:

An extensive database search was executed to find the randomized controlled trials on acupuncture vs. sham acupuncture, and any other treatments for patients with CRS. Review Manager 5 (RevMan) was used for the data analysis. A strict methodology was used when the meta-analysis was performed.

Results:

This study systematically assesses the effectiveness and safety of acupuncture in patients with CRS. The primary outcomes include health-related quality of life, disease severity, treatment-related adverse events. The secondary outcomes are comprised of recurrence rate, endoscopic score, computerized tomography (CT) scan score and objective physiological measures.

Conclusion:

This article summarizes the current evidence base for the quality of life and safety of acupuncture in patients with CRS.

Systematic review registration:

International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42018114432).
Whether statin use improves the survival of patients with glioblastoma?
Authors: Xie Yonglin , Lu Qin , Lenahan Cameron , Yang Shuxu , Zhou Daoyang , Qi Xuchen
Published: March 2020

Background:

Glioblastomas are malignant brain tumors associated with high mortality and poor prognosis. Evidence from preclinical studies suggests that statins have an antitumor role, but their effects on the survival of patients with glioblastoma remain controversial. This meta-analysis attempts to assess the association between statins and glioblastoma.

Methods:

We searched 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) for articles that evaluate the effect of statins on the survival of patients with glioblastoma. Two reviewers were asked to assess the quality of the studies and extract the data regarding progression-free survival (PFS) and overall survival (OS).

Result:

A total of 5 studies met the inclusion criteria with 430 statin users and 2089 nonstatin users. All 5 studies were retrospectively analyzed. The pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated. There was no benefit of statins found pertaining to the survival of glioblastoma patients in both PFS (HR, 0.97; CI, 0.84–1.13) and OS (HR, 0.98; CI, 0.87–1.11). In a subgroup defined by the patterns of statin use, it was determined that usage before glioblastoma diagnosis favored the OS of patients (HR, 0.85). The result, however, failed to demonstrate a statistically significant difference.

Conclusion:

Use of statins was not associated with prolonged survival of patients with glioblastoma. Further well-designed randomized controlled trials are needed to confirm.
Optimal timing for the resection of pulmonary metastases in patients with colorectal cancer
Authors: Yamada Kazunosuke , Ozawa Daigo , Onozato Ryouichi , Suzuki Masaki , Fujita Atsushi , Ojima Hitoshi
Published: March 2020

This study aims to clarify the surgical treatment time of pulmonary metastasis in patients with colorectal cancer.

Early relapse after resection of pulmonary metastasis is often encountered when the interval from the detection of pulmonary metastasis to pulmonary metastasectomy was short.

In this retrospective analysis, data of patients with colorectal cancer who underwent surgical treatment of pulmonary metastasis at the Gunma Prefectural Cancer Center, Gunma, from April 2001 through September 2018 were evaluated. The patients were divided into 2 groups. We examined the interval period from the diagnosis of pulmonary metastasis to pulmonary metastasectomy. This period was divided into every 3 months, and the prognosis of each group was compared with clarify the appropriate timing of pulmonary metastasectomy.

The primary endpoints were 5-year overall survival and recurrence-free survival rates.

The most significant difference was observed when the cutoff value was 9 months (5-year recurrence-free survival 45.8% vs 85.6%,P < .01). No significant difference was found in any background factors between the 2 groups. Twenty-five patients (34.7%) experienced recurrence after pulmonary metastasectomy. The most common site of recurrence was the lung (48%). Among the 12 cases of recurrence of pulmonary metastasis, 11 cases belonged to the <9 months group. A multivariable survival analysis found that the interval period of <9 months was a significant predictor of recurrence.

Our study suggests that clinical follow-up for 9 months prior pulmonary metastasectomy in colorectal patients would improve the prognosis.
Association between antibiotic use and the risk of rheumatoid arthritis
Authors: Meng Tingting , Zhang Shibin , Wang Dawei , Zhang Haijun , Song Zhongyang , Li Shengdong , Chen Min , Tang Chunzhi
Published: March 2020

Background:

The potential association between antibiotic use and the risk of rheumatoid arthritis (RA) has drawn significant attention from clinicians and researchers in recent years due to the wild usage of antibiotic. This study aimed to perform a systematic review and meta-analysis of the literature to determine if antibiotic use is associated with an increased risk of RA, so as to provide an important reference for clinical decision-making.

Methods:

Case-control and nest case-control studies of assessing whether antibiotic use is associated with the onset of RA will be identified in searches of 4 databases from their inception to August 2019. All data were assessed and extracted by 2 authors independently. The Newcastle–Ottawa scale was used to assess the quality of the selected studies. Manager Software 5.3 from Cochrane Collaboration (London, UK) and Stata 15.1 (Stata Corp, College Station, TX) will be used to conduct meta-analysis, determining pooled odds ratios and evaluating heterogeneity between studies.

Result:

The results of this systemic review and meta-analysis will be submitted to a recognized journal for publication.

Conclusion:

This systemic review and meta-analysis will determine if antibiotic use is associated with an increased risk of RA. We hope this study can make a definitive conclusion for the association.
The effectiveness and safety of plaster splint and splints for distal radius fractures
Authors: Cui Xin , Liang Long , Zhang Hongyan , Li Yongyao , Cheng Hao , Liu Guangwei , Cheng Yongzhong , Du Yachao , Liu Jiani , Wang Zhibo , Tian Yaliang
Published: March 2020

Background:

To assess the efficacy and safety of plaster splint vs splints in the treatment of distal radius fractures (DRFs).

Methods:

For a more comprehensive collection of original study, we mainly searched 9 electronic databases including the PubMed, Web of Science, EMBASE, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials.gov, the Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and VIP Database. The retrieval date of all databases is from the establishment to January 2019. In the aspect of assessing the quality of original research methodology, we mainly rely on the Cochrane risk bias assessment tool and GRADE assessment method. Revman 5.3 is used for statistical analysis.

Results:

A total of 8 studies involving 717 participants were included. The results showed that effective rate (RR = 0.99, 95%CI 0.91 to 1.07, P = .83), reduction rate (RR = 1.00, 95%CI 0.93 to 1.07, P = .98), and complication rate of the plaster splint had no significant difference with the splint. In addition, for the excellent rate of treatment, subgroup analysis based on the included studies found that when the intervention period was 4 weeks, the plaster splint was better than the splint, and when the intervention period was more than 4 weeks, there was no significant difference between them.

Conclusions:

There is no sufficient evidence that plaster splint is superior to splint. However, according to current evidence, plaster splint is more effective than splint when the intervention period is shorter (4 weeks), and its advantage disappears when the intervention period is longer (> 4 weeks). It should be noted that the results of this study were influenced by the sample size and the quality of the included studies. More high-quality and well-controlled RCTs are needed to draw better conclusions in further study.
Comprehensive evaluation of SPATS2 expression and its prognostic potential in liver cancer
Authors: Xing Jin , Tian Yijun , Ji Wu , Wang Xinying
Published: March 2020

Spermatogenesis associated serine rich 2 (SPATS2) has been reported to be dysregulated in few types of cancer; however, no reports have investigated SPATS2 in liver cancer. The aim of the present study was to investigate SPATS2 expression in liver cancer and to analyze its association with the prognosis of liver cancer patients.

We examined the differential expression of SPATS2 in liver cancer by exploring The Cancer Genome Atlas (TCGA) database. The diagnostic efficiency of SPATS2 was obtained by Receiver Operating Characteristic (ROC) curve. The Chi-Squared test was used to assess clinical relevance. Survival analysis and Cox regression model were used to detect the effect of SPATS2 on the survival of liver cancer patients. Gene Set Enrichment Analysis (GSEA) was used to identify signaling pathways related to SPATS2 expression.

SPATS2 is highly expressed in liver cancer (P < 2.2e-16) and has the high diagnostic ability (AUC = 0.964). Survival analysis showed that patients with high SPATS2 expression have an apparently shorter overall survival (OS, P < .0001) and relapse-free survival (RFS, P < .0001). Cox regression analysis showed that high SPATS2 expression might be an independent risk factor for liver cancer (OS, HR = 2.41, P = .000; RFS, HR = 1.90, P < .001). GSEA analysis identified 3 signaling pathways (Mitotic spindle, G2 M checkpoint, E2F targets) that were enriched in the presence of high SPATS2 expression.

SPATS2 expression could be a novel diagnostic and prognostic biomarker in liver cancer.
Prevalence and risk factors of diabetic retinopathy in diabetic patients
Authors: Yin Li , Zhang Delong , Ren Qian , Su Xian , Sun Zhaohui
Published: March 2020

In China, there is a significant lack of awareness of diabetes and its complications. Screening of diabetic retinopathy has important for early detection, prevention, and treatment. This large, cross-sectional study aimed to characterize the demographic, physical, serological, and ocular characteristics of subjects with diabetes mellitus in Shijiazhuang, China. It also aimed to associate these characteristics with the presence of diabetic retinopathy.

From May 2, 2018 to August 25, 2019, under diabetes care program, the diabetic patients (n = 1008) were subjected to standardized questionnaires to collect demographical characteristics. Also, telescreens and laboratory tests were performed for the enrolled patients. Multivariate logistic regression analysis was used to evaluate factors associated with diabetic retinopathy.

Forty percent of diabetics in its population had some form of diabetic retinopathy. Diabetic retinopathic patients were likely to be elder (P = .0003), men (P = .018), hypertensive (P < .0001), and had high body mass index (P < .0001), metabolic abnormalities, and longer duration of diabetes (P < .0001). Higher intraocular pressure (P = .0008), fasting blood glucose (P < .0001), serum total cholesterol (P < .0001), serum triglyceride (P = .0006), % glycated hemoglobin (HbA1c) (P < .0001), and disc asymmetry including cup–disc ratio (P = .041) reported in patients with diabetic retinopathy. Age (P = .049), male sex (P = .048), hypertension (P = .048), duration of diabetes (P = .012), diabetic neuropathy (P = .048), diabetic nephropathy (P = .048), diabetic foot ulcer (P = .041), foot amputation (P = .042), fasting blood glucose (P = .022), serum total cholesterol (P = .028), serum triglyceride (P = .035), and HbA1c (P = .042) were associated with diabetic retinopathy.

Diabetic retinopathy was the most common ocular fundus disease in diabetic patients. Also, aging, the other comorbidities, and metabolic syndrome are associated with diabetic retinopathy.

Level of Evidence: III.
Detection of extremity chronic traumatic osteomyelitis by machine learning based on computed-tomography images
Authors: Wu Yifan , Lu Xin , Hong Jianqiao , Lin Weijie , Chen Shiming , Mou Shenghong , Feng Gang , Yan Ruijian , Cheng Zhiyuan
Published: March 2020

Despite the availability of a series of tests, detection of chronic traumatic osteomyelitis is still exhausting in clinical practice. We hypothesized that machine learning based on computed-tomography (CT) images would provide better diagnostic performance for extremity traumatic chronic osteomyelitis than the serological biomarker alone. A retrospective study was carried out to collect medical data from patients with extremity traumatic osteomyelitis according to the criteria of musculoskeletal infection society. In each patient, serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer were measured and CT scan of the extremity was conducted 7 days after admission preoperatively. A deep residual network (ResNet) machine learning model was established for recognition of bone lesion on the CT image. A total of 28,718 CT images from 163 adult patients were included. Then, we randomly extracted 80% of all CT images from each patient for training, 10% for validation, and 10% for testing. Our results showed that machine learning (83.4%) outperformed CRP (53.2%), ESR (68.8%), and D-dimer (68.1%) separately in accuracy. Meanwhile, machine learning (88.0%) demonstrated highest sensitivity when compared with CRP (50.6%), ESR (73.0%), and D-dimer (51.7%). Considering the specificity, machine learning (77.0%) is better than CRP (59.4%) and ESR (62.2%), but not D-dimer (83.8%). Our findings indicated that machine learning based on CT images is an effective and promising avenue for detection of chronic traumatic osteomyelitis in the extremity.
The role of county-level socioeconomic status on brand-name prescriptions in Medicare part D
Authors: Volpi Connor , Shehadeh Fadi , Mylonakis Eleftherios
Published: March 2020

The objective of this study was to examine the association between county-level socioeconomic factors and brand-name drug prescription drug patterns among medical specialties with overall high brand-name outpatient prescription use.

This cross-sectional study used data from 2 publicly available datasets. The 2015 Medicare Part D PUF data quantifies the prescription rates at the county-level and data from the US Census Bureau provides information on socioeconomic status at the county-level.

We analyzed 3,821,523 brand-name claims and 14,088,613 generic claims reported by health providers from 40 specialties as provided by the 2015 Medicare Part D dataset. Internal Medicine, Family Practice, General Practice, Cardiology, and Ophthalmology accounted for 71% of the total amount of brand-name drugs filled under Medicare Part D in 2015. As the presence of individuals with an income ≥$100,000 increased in a given county, the likelihood of receiving a brand-name prescription claim increased.

A county-level association exists involving socioeconomic factors and outpatient brand-name drug prescription patterns. Future interventions should consider these factors in order to reduce percentage of brand-name drugs filled and decrease health care expenditures.
Physical symptoms and mental health status in deep underground miners
Authors: Xie Heping , Liu Jifeng , Gao Mingzhong , Liu Yilin , Ma Tengfei , Lu Yiqiang , Li Cong , Wang Mingyue , Zhang Ru , Wu Jiang , Zou Jian , Liu Shixi , Li Weimin
Published: March 2020

The aim of the present study was to reveal the physical symptom changes and their correlations with mental health status in deep underground miners.

A total of 286 deep underground miners completed a cross-sectional questionnaire study at China Pingmei Shenma mine complex. The questionnaire included sociodemographics, self-reported physical symptoms, underground adverse environmental factors, and the Symptom Checklist-90-Revised (SCL-90-R). Five environmental parameters of 1 deep mine were also measured.

Data from 266 valid questionnaires were analyzed. The 3 most frequent complaints about underground adverse conditions were moisture [62.03% (165/266)], dim light [45.86% (122/266)], and high temperature [42.11% (112/266)]. Fatigue [40.22% (107/266)], hearing loss [34.96% (93/266)], and tinnitus [31.58% (84/266)] were reported to be the three most common physical symptoms. Insomnia was reported in 204 participants (76.69%) mainly due to the difficulty of falling asleep [42.35% (84/204)] and dreams [39.70% (81/204)]. Mean scores of SCL-90-R subscales including somatization, anxiety, phobic anxiety, psychoticism, and paranoid ideation were elevated compared to Chinese norms, while there was diminished interpersonal sensitivity. Univariate analyses indicated that the 3 most common physical symptoms were associated with poorer SCL-90-R scores. With increasing depth below ground, air pressure, relative humidity, CO2 concentration and temperature rose, while total gamma radiation dose-rate decreased.

The physical and mental health status of deep underground miners was poorer than the general Chinese male population. Some adverse environmental factors were identified that may have influenced health status. Measures are suggested to improve the deep underground working environment.
A systematic review and meta-analysis of the association between psoriasis and hypertension with adjustment for covariates
Authors: Duan Xi , Liu Junbo , Mu Yunzhu , Liu Ting , Chen Yujuan , Yu Ruichao , Xiong Xincai , Wu Tao
Published: March 2020

Background:

Several studies have shown a relationship between psoriasis and hypertension, but no meta-analysis has been restricted to studies that adjusted for confounders. The aim of the study was to estimate the association between psoriasis and hypertension with adjustment for covariates.

Methods:

A systematic literature search in the MEDLINE, Embase, Cochrane databases, and Google Scholar was conducted to identify relevant studies which reported the association of psoriasis with the risk of hypertension published up to November 2018 in English. Data analysis was performed with Stata V.12, and Begg adjusted rank correlation test and Egger regression asymmetry test were used to detect publication bias.

Results:

A total of 16 adjusted-for-covariates studies, involving 50,291 cases with hypertension in 255,132 psoriasis patients and 76,547 cases with hypertension in 814,631 controls (no psoriasis), were included in this meta-analysis. The results indicated that psoriasis was associated with an increased risk of hypertension compared to those without psoriasis, and the prevalence of hypertension in severe psoriasis patients was higher than that in mild psoriasis patients, and the risk of hypertension in psoriasis patients was higher than that in nonpsoriasis patients in Europe and Asia.

Conclusion:

We conducted this meta-analysis using the adjusted-for-covariates odds ratio, demonstrating that psoriasis was associated with an increased risk of hypertension compared to those without psoriasis.
The impact of pain and opioids use on survival in cancer patients
Authors: Zheng Jungang , He Jing , Wang Weifei , Zhou Haidong , Cai Saihong , Zhu Linhai , Qian Xinger , Wang Jun , Lu Zihui , Huang Changshun
Published: March 2020

The study aimed to explore whether cancer-related pain and opioids use are associated with the survival of cancer patients, and perform a cohort study and a meta-analysis to quantify the magnitude of any association.

A retrospective cohort study was performed to analyze the impact of pain level, and opioids use on cancer-specific survival (CSS) in advanced cancer patients. Patients and relevant medical records were selected from the registry of the Radiation and chemotherapy division of Ningbo First Hospital between June 2013 and October 2017. Hazard ratios (HRs) and 95% confidential intervals (CIs) for CSS by opioids use were calculated by univariate and multivariate Cox regression analyses. The systematic review included relevant studies published before October 2018. The combined HRs and 95% CIs for overall survival (OS) and progression-free survival (PFS) were calculated using random-effect models.

A total of consecutive 203 cancer patients were included in the cohort study. Kaplan–Meier curves indicate a negative association between CSS and cancer-related pain or opioids requirement, but less evidence of an association with the dose of opioids use. Multivariate models revealed that the pain level and opioids requirement were associated with shorter CSS, after adjusting for significant covariates. The results of the meta-analysis indicated that postoperative opioids use had a poor effect on PFS, and opioids use for cancer-related pain was associated with poor OS in cancer patients, while intraoperative opioids use was not associated with cancer survival.

We concluded that cancer-related pain and opioids requirements are associated with poor survival in advanced cancer patients, and postoperative opioids use and opioids use for cancer-related pain may have an adverse effect on the survival of cancer patients.
Shi's Yi-Qi Bu-Shen Tong-Luo decoction combined with manipulation in the management of wrist stiffness after distal radius fracture
Authors: Wu Hai-Yang , Wang Yi-Ru , Gui Jing , Wen Guo-Wei , Tang Zhen-Yin , Liu Ping , Wu Jun-Hao
Published: March 2020

Introduction:

Wrist stiffness is a common sequela of distal radial fractures. Manipulation is generally used and effective, but problems exist, such as intense pain, swelling during the process of manipulation and long treatment period. Therefore, a combinative therapeutic strategy is necessary to benefit rehabilitation after distal radius fracture. Shi's Yi-Qi Bu-Shen Tong-Luo decoction (BTD) combined with wrist manipulation has been used in the Shanghai Ninth People's Hospital Huangpu Branch in last few decades. BTD has potential therapeutic effects on rehabilitation after distal radius fracture, which should be evaluated by rigorous clinical trial.

Methods/design:

A randomized, double-blind, placebo-controlled clinical trial will be conducted to determine the efficiency of BTD in relief of wrist stiffness and pain and function rehabilitation. A total of 80 wrist stiffness patients with or without pain and edema will be enrolled, and treated with wrist manipulation plus BTD or placebo for 4 weeks. The primary outcome measure is the Cooney wrist score. The second outcome measures include pain numerical rating scale, patient rated wrist evaluation, 36-item short form health survey questionnaire, and side effects.

Discussion:

Although BTD has shown effects on rehabilitation after distal radius fracture in the Shanghai Ninth People's Hospital Huangpu Branch for decades, the universality of this efficacy needs evaluated. The results of this trial will provide a convincing evidence.

Trial registration:

ChiCTR2000029260, January 19, 2020.
Electroacupuncture for post-thoracotomy pain
Authors: Park Sohyeon , Gu Ji-Hyang , Jang Hye-Kyoung , Oh Min-Seok , Lee Eun-Jung , Jung In Chul
Published: March 2020

Background:

Thoracotomy is a common surgical procedure used in cases such as trauma and cancer resection. It is an invasive procedure in which incisions are made in the chest wall to gain access to the chest. Therefore, it often produces intense postoperative pain. Electroacupuncture has been known for its analgesic effects in various conditions, including cases of postoperative pain. This protocol design is for a systematic review and meta-analysis to gather evidence and investigate the analgesic effects of electroacupuncture in pain after thoracotomy.

Methods:

The studies for the systematic review will be searched with keywords on the following 10 databases: PubMed, Cochrane Library (CENTRAL), EMBASE, MEDLINE, Google Scholar, CNKI, KoreaMed, KMBASE, KISS, and OASIS. The search will be done without language restrictions. Only the randomized controlled trials that meet the eligibility criteria will be finally included in the study. The quality of the study will be assessed using the Cochrane Collaborations’ risk-of-bias tool, and Cochrane's software RevMan 5.3 will be used for meta-analysis.

Results:

The designed study will provide a systematic review and meta-analysis of the searched and randomized controlled trials that meet the eligibility criteria. Meta-analysis will be performed with pain scores as the main outcome measure, and they may also be performed with additional outcomes. The qualitative and quantitative data synthesis is expected to provide high quality evidence to judge the pain management effect of electroacupuncture for patients who underwent thoracotomy.

Conclusion:

The conclusion of this systematic review and meta-analysis will provide evidence to judge whether electroacupuncture is an effective analgesic treatment option for patients suffering with post-thoracotomy pain.

PROSPERO registration number:

CRD42019142157.
High C-reactive protein to albumin ratio and the short-term survival prognosis within 30 days in terminal cancer patients receiving palliative care in a hospital setting
Authors: Ju Sang-Yhun , Ma Soo-Jin
Published: March 2020

Survival estimates are very important to patients with terminal cancer. The C-reactive protein (CRP)/albumin ratio is associated with cancer outcomes. However, few studies have investigated the dose-response association in terminal cancer patients. Therefore, we aimed to evaluate the association between the CRP/albumin ratio and mortality in terminal cancer patients using a longitudinal analysis. We retrospectively investigated the electronic medical records of 435 inpatients with terminal cancer admitted to the palliative care unit of Yeouido St. Mary's Hospital between October 8, 2015, and January 17, 2018. In total, 382 patients with terminal cancer were enrolled in the study. The serum CRP/albumin ratio measured at admission had a linear dose-response relationship with the risk of death among the terminal cancer patients (P for linearity = .011). The multivariate analyses showed that the CRP/albumin ratio was an independent prognostic factor (Model 1, CRP/albumin ratio >48.53 × 10−4: HR = 2.68, 95% CI = 1.82–3.93; Model 2, tertile 2: HR = 1.91, 95% CI = 1.31–2.82 and tertile 3: HR = 3.66, 95% CI = 2.24–5.97). The relationship between a high CRP/albumin ratio and poor survival was a flat L-shape for survival time with an inflection point at approximately 15 days, while the relationship was not significant in terminal cancer patients who survived beyond 30 days. This study demonstrated that high CRP/albumin ratios are significantly and independently associated with the short-term survival prognosis of terminal cancer patients within 30 days.
Vonoprazan vs proton pump inhibitors in treating post-endoscopic submucosal dissection ulcers and preventing bleeding
Authors: Martin  , Zhou Yi , Meng Chun-Xu , Takagi Tatsuya , Tian Yu-Shi
Published: March 2020

Background:

Vonoprazan is a potassium-competitive acid blocker (P-CAB) that is frequently used in Japan forHelicobacter pylori (H. pylori) eradication, treatment of gastroesophageal reflux disease, and treatment of post endoscopic submucosal dissection (ESD) complications. We sought to determine if vonoprazan was superior to proton pump inhibitors (PPIs) for treating ESD-induced ulcers (as assessed by ulcer healing and shrinkage ratios) and preventing delayed bleeding over various treatment durations (2, 4, and 8 weeks).

Methods:

We collected randomized controlled trials (RCTs) and observational studies that discussed the effectiveness of vonoprazan and PPIs on ESD-induced ulcers and bleeding from PubMed, Cochrane Library, ClinicalTrials.gov, and Google Scholar. Studies were selected according to pre-established eligibility criteria and data were extracted separately by 2 researchers with double-check. We used the Cochrane risk of bias tool to assess RCTs and the Newcastle–Ottawa Quality Assessment Scale to assess observational studies. Meta-analyses, based on the random-effects model, were conducted to compare differences in ulcer shrinkage ratios (%) and odds ratios (ORs) for ulcer healing and delayed bleeding. Publication bias was evaluated using funnel plots and Egger regression test. Heterogeneity was assessed usingI2statistics. A sensitivity analysis was conducted to check the robustness of results. The evidential quality of the findings was assessed using the GRADE profiler.

Results:

Thirteen studies were included in this meta-analysis. The OR effect sizes of vonoprazan relative to PPIs for ulcer healing were 1.33 (P = .13) with a 95% CI (0.33–3.21) at 4 weeks and 1.48 (P = .09) with a 95% CI (0.81–5.20) at 8 weeks. The overall effect size for the shrinkage ratio was 12.24% (P = .16) with a 95% CI (−4.96–29.44) at 2 weeks. The effect size of its subgroup ofH. pylori-positive patients was 19.51% (P < .001) with a 95% CI (11.91–27.12). The overall OR for the occurrence of delayed bleeding was 0.66 (P = .26) with a 95% CI (0.32–1.35). After excluding combination drug studies, the overall ORs between vonoprazan and PPIs on ulcer healing and delayed bleeding were 1.44 and 0.76, respectively.

Conclusion:

During the first 2 weeks of treatment, vonoprazan was more effective than PPIs for treatingH. pylori-positive patients with ESD-induced gastric ulcers.
Reproductive outcomes of 3 infertile males with XYY syndrome
Authors: Zhang Xinyue , Liu Xiangyin , Xi Qi , Zhu Haibo , Li Linlin , Liu Ruizhi , Yu Yang
Published: March 2020

The aim of this study is to evaluate the pregnancy outcomes of males with a 47, XYY karyotype following assisted reproductive treatment.

A retrospective study was performed using data from infertile men with 47, XYY at a center for reproductive medicine in 2004 to 2017. Of the 19,842 infertile males treated, a total of 21 showed the 47, XYY karyotype and were included in the present study. Clinical variables were collected. Three men were under treatment with their partner before either in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

The incidence of 47, XYY in infertile men is 1/945 (21/19842). Most men are azoospermic or severely oligospermic. Three men and their partners underwent IVF or ICSI treatment with fresh ejaculate samples. The fertilization rate was 52.94% to 83.33%. The embryo cleavage rate was 50% to 90%. One man had abnormal sex hormonal levels and his partner had no clinical pregnancy. The other 2 couples had healthy baby boys.

Live spermatozoa can be gathered and fertility is possible for infertile males with 47, XYY syndrome when IVF or ICSI treatment is used. It is recommended that genetic counseling is provided in such cases.
Immediate effects of noxious and innocuous thermal stimulation on brain activation in patients with stroke
Authors: Chen Sharon Chia-Ju , Hsu Miao-Ju , Kuo Yu-Ting , Lin Ruey-Tay , Lo Sing-Kai , Lin Jau-Hong
Published: March 2020

Case-control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However, the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46°C to 47°C, cold pain 7°C–8°C) or innocuous TS (n = 8; temperature combination: hot 40°C–41°C, cold 20°C–21°C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre-TS vs post-TS). Regions activated by noxious TS relative to innocuous TS (P < .05, adjusted for multiple comparisons) were related to motor performance and sensory function in the bilateral primary somatosensory cortices, anterior cingulate cortex, insula, thalamus, hippocampus and unilateral primary motor cortex, secondary somatosensory cortex at the contralateral side of lesion, and unilateral supplementary motor area at the ipsilateral side of lesion. Greater activation responses were observed in the side contralateral to the lesion, suggesting a significant intervention effect. Our preliminary findings suggest that noxious TS may induce neuroplastic changes unconstrained to the local area.

Trial registration: NCT01418404
Morbidity and mortality during hepatitis C treatment using sofosbuvir and daclatasvir with or without ribavirin, in a cohort of Egyptian patients
Authors: Elsadek Hany M. , Abdelbaser Elsayed S. , Emara Mohamed H. , Soliman Hanan H. , Farag Alaa A.
Published: March 2020

Background

Though direct-acting antiviral agents (DAAs) therapy is associated with a high cure rate of hepatitis C virus infection, a potential risk of serious adverse events (SAEs) exists. The aim of this study was to determine the incidence and predictors of morbidity and mortality related to DAAs therapy.

Methods

This prospective study was conducted on a real word cohort of 1562 treatment naïve chronic hepatitis C (CHC) Egyptian patients, who received 12-weeks therapy with sofosbuvir (SOF) plus daclatasvir (DCV) ± ribavirin (RBV). The incidence and predictors of SAEs and mortality during treatment course and over the following 12 weeks were recorded.

Results

The mean age of study participants was 51.38 ± 9.70 years (55.22%, males). Liver cirrhosis was defined in 72.4% of participants. SAEs were recorded in 120 participants (7.68%), including hepatic decompensation, gastrointestinal bleeding, anemia and hepatocellular carcinoma. Nine patients (0.58%) died and 69 patients (4.42%) discontinued therapy due to SAEs. Severity of cirrhosis was the significant predictor of morbidities and mortality. Hepatic decompensation was predicted by baseline serum albumin [cutoff value: 3.00 g/dL, area under the receiver operating characteristic curve (AUROC): 0.953] and serum bilirubin (cutoff value: 1.75 mg/dL, AUROC: 0.940).

Conclusion

The risk of morbidity and mortality related to SOF/DCV ± RBV therapy in CHC patients is small and is significantly linked to advanced cirrhosis.
Narrow band imaging characteristics of gastric polypoid lesions: a single-center prospective pilot study
Authors: Esposito Gianluca , Angeletti Stefano , Cazzato Maria , Galli Gloria , Conti Laura , Di Giulio Emilio , Annibale Bruno , Lahner Edith
Published: March 2020

Introduction:

Gastric polypoid lesions (GPL) are endoscopic findings whose histological nature is difficult to determine with white-light endoscopy. Hyperplastic polyps (HP), type-1 gastric carcinoids (T1-GC) and adenomas are the most frequent GPL needing different management. Narrow-band imaging (NBI) has high accuracy for gastric malignant lesions but few studies assessed whether GPL display specific NBI characteristics. We aimed to investigate the endoscopic NBI appearances of GPL.

Materials and methods:

During gastroscopies, images of GPL were recorded, and lesions were removed for histological evaluation. Two endoscopists blindly reviewed the digital images and registered the endoscopic NBI appearances on a specific check-list. GPL were categorized in HP, adenomas and T1-GC using histology as gold standard.

Results:

Overall 52 GPL, observed in 40 patients [F55%; age 63 (36–85) years], were included: 29 (55.8%) HP; 18 (34.6%) T1-GC; 5 (9.6%) adenomas. The median size was seven (2–35) mm. A regular circular mucosal pattern was more frequently observed in HP and T1-GC compared to adenomas (P < 0.001). T1-GC showed a central erosion in 77.8% (P < 0.001 versus HP) with a clear demarcation line in 33.3%. Adenomas had tubule-villous mucosal pattern in 80% (P = 0.01 versus other lesions).

Conclusion:

NBI analysis of the mucosal pattern seems to be effective to endoscopically discriminate between adenomas and HP while the main characteristic of T1-GC seems to be the presence of a central erosion, sometimes with demarcation line. The endoscopic NBI characterization of GPL may contribute to optimize the management of these lesions.
Management of Unresectable Metastatic Primitive Myxoid Mesenchymal Tumor of Infancy: A Case Report and Systematic Review of the Literature
Authors: Asaftei Sebastian D. , Campello Anna , Tirtei Elisa , Colombo Sara , Vallero Stefano , Boffano Michele , Fagioli Franca
Published: March 2020

Primitive myxoid mesenchymal tumor of infancy is a rare soft tissue tumor. The present case is one of the most invasive primitive myxoid mesenchymal tumor of infancy reported to date. To our knowledge, it is the first case described with extensive involvement of pelvis and the third described developing metastasis and with an invasion of the spinal canal without evidence of transformation into undifferentiated sarcoma. The patient failed to respond to chemotherapy (CHT). According to the few available data, CHT seems to be more effective in the presence of metastatic disease or increased cellularity. However, CHT, including high-dose ifosfamide, resulted ineffective even after lung metastasis development with pathologic evidence of increased mitotic rate. The management of this case and the data in the literature confirm surgery as the gold standard treatment in this pathology.
Participant-reported Warfarin Adherence in Community-based Pediatric Patients
Authors: Zhao Shali , Fanham Aaliya , Stewart Jemma , Franssen Eva , Newall Fiona
Published: March 2020

Warfarin is the most commonly prescribed anticoagulant for children in the outpatient setting in Australia. Pediatric patients likely have different challenges to warfarin adherence compared with their adult counterparts; however, little is known about warfarin adherence among this population. This study aimed to understand warfarin adherence among community-based pediatric patients by using an online survey design. The survey instrument incorporated parent or patient self-reported warfarin doses missed in the preceding month, a validated warfarin adherence assessment tool, the 13-item Self-Efficacy for Appropriate Medication use Scale (SEAMS-13), and an open-ended question asking about the challenges of warfarin adherence. The indication of warfarin administration and patient’s time in therapeutic range were obtained from medical records. The study recruited outpatients managed by a tertiary pediatric hospital who had previously consented to participate in warfarin research. In total, 53 families were contacted with 43 responses (81% response rate) and 41 completed surveys. The median age of the children from participating families was 10.6 years (range, 4.1 to 18.9 y). The majority of these children (n=42) used warfarin prophylactically and only 1 child used it to treat deep venous thrombosis. The time in therapeutic range achievement of this cohort was 64.4% (95% confidence interval, 58.7-70.2). The mean SEAMS-13 score was 33.5 (95% confidence interval, 31.75-35.37) and the total missed doses was 2.5%. Participants also identified barriers and enablers of warfarin adherence. This study was the first of its kind and thus it provides baseline data for future research. The warfarin adherence of this cohort was likely optimized because of frequent clinical contact and access to self-testing. Future studies are required to examine the different approaches aiming to improve the anticoagulant adherence after the emergence of direct oral anticoagulants with a wider therapeutic index and minimal monitoring that could contribute to less clinical contact.
Is CSF1R Expression Localization Crucial for its Prognostic Value in Colorectal Cancer?
Authors: Guan Huiyuan , Wang Xin , Song Yongxi , Gao Peng , Li Yuan , Wu Zhonghua , Zhu Jinliang , Wang Zhenning
Published: March 2020

The colony-stimulating factor 1 receptor (CSF1R) is commonly known as a transmembrane receptor on tumor-associated macrophages, which are essential in the tumor microenvironment. However, the expression pattern and prognosis of CSF1R are still unknown in colorectal cancer (CRC) and are still controversial among various cancers. To clarify the expression pattern and prognosis of CSF1R in CRC, we performed immunohistochemistry on 332 CRC tissue and 283 nontumorous adjacent tissues. We explored the expression pattern of CSF1R and analyzed its relationship with clinical characteristics and prognosis. The positive expression ratio of CSF1R was much higher in nontumorous adjacent tissues, while the positive cytomembrane ratio of CSF1R was much higher in cancer tissue. Furthermore, we found that CSF1R expression, especially in the cytoplasm, acted as a protective factor. However, our findings indicated that CSF1R expression on the cytomembrane decreased its prognostic predictive value. These results emphasize the important role of the localization of CSF1R and may also explain the contrasting effects seen between various cancers.