bluuebunny/crossref_metadata_2025 huggingface dataset:
Oncological and Functional Outcomes in Joint-sparing Resections of the Proximal Femur for Malignant Primary Bone Tumors
Authors: Ramkumar Dipak B. , Kelly Sean P. , Ramkumar Niveditta , Ercolano Lisa B. , Lozano-Calderon Santiago , Gebhardt Mark C. , Anderson Megan E.
Published: June 2021

Background

Joint-sparing resections (JSR) of the proximal femur allow for preservation of the proximal femoral growth plate and native hip joint, but whether this offers fewer complications or better function and longevity of the reconstruction remains unknown. In this study, we compared the functional outcomes of pediatric patients with bone sarcomas undergoing JSR of the proximal femur with intercalary allograft (ICA) reconstruction to those undergoing proximal femoral resections (PFR) with allograft-prosthetic composite (APC) reconstructions.

Methods:

We retrospectively reviewed all patients undergoing JSR with ICA reconstruction and PFR with APC reconstructions between 1995 and 2013 at a tertiary pediatric referral center. Primary outcomes included major and minor complications and secondary outcomes included the need for a secondary procedure, presence of local or distant relapse, survival status, and the presence of pain and ambulatory status (limp, assistive device, highest level of function). We assessed differences in outcomes using the Fisher exact and Wilcoxon rank-sum tests.

Results:

Eight patients underwent a JSR and ICA reconstruction, while 7 patients underwent a PFR with APC reconstruction. Median patient follow-up was 60.4 months (interquartile range: 36.8 to 112.9) Patients undergoing JSR and ICA reconstruction were younger than patients undergoing PFR with APC reconstruction (7.7 vs. 11.7 y, P=0.043); however, we found no other statistically significant differences in patient demographics. There were no statistically significant differences in primary or secondary outcomes between the study groups; however, patients who underwent JSR with ICA had more major complications (62.5% vs. 42.9%, P=0.29) and a lower rate of minor complications (25% vs. 28.6%, P=0.22).

Conclusion:

Treatment of proximal femoral bone sarcomas in pediatric and adolescent patients remains a challenging enterprise. JSR with ICA reconstruction in the proximal femur, when feasible, may provide a similar function and risk of intermediate-term major and minor complications when compared with PFR with APC reconstruction. Further long-term studies are required to determine the impact of the native femoral head retention with respect to revision rates.

Level of Evidence:

Level III, retrospective comparative study.
Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation
Authors: Chiapparelli Erika , Bowen Edward , Okano Ichiro , Salzmann Stephan N. , Reisener Marie-Jacqueline , Shue Jennifer , Sama Andrew A. , Cammisa Frank P. , Girardi Federico P. , Hughes Alexander P.
Published: June 2021

Study Design.

Retrospective observational study.

Objective.

The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation.

Summary of Background Data.

Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially life-threatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins.

Methods.

We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation.

Result.

A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances <2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances <4 mm.

Conclusion.

We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recommended for C2 pedicle instrumentation with consideration of these safety margins.

Level of Evidence: 3
Cardiovascular and renal burdens of metabolic associated fatty liver disease from serial US national surveys, 1999–2016
Authors: Zhang Hao-Jie , Wang Yu-Ying , Chen Chi , Lu Ying-Li , Wang Ning-Jian
Published: June 2021

Background:

Non-communicable chronic diseases have become the leading causes of disease burden worldwide. The trends and burden of “metabolic associated fatty liver disease” (MAFLD) are unknown. We aimed to investigate the cardiovascular and renal burdens in adults with MAFLD and non-alcoholic fatty liver disease (NAFLD).

Methods:

Nationally representative data were analyzed including data from 19,617 non-pregnant adults aged ≥20 years from the cross-sectional US National Health and Nutrition Examination Survey periods, 1999 to 2002, 2003 to 2006, 2007 to 2010, and 2011 to 2016. MAFLD was defined by the presence of hepatic steatosis plus general overweight/obesity, type 2 diabetes mellitus, or evidence of metabolic dysregulation.

Results:

The prevalence of MAFLD increased from 28.4% (95% confidence interval 26.3–30.6) in 1999 to 2002 to 35.8% (33.8–37.9) in 2011 to 2016. In 2011 to 2016, among adults with MAFLD, 49.0% (45.8–52.2) had hypertension, 57.8% (55.2–60.4) had dyslipidemia, 26.4% (23.9–28.9) had diabetes mellitus, 88.7% (87.0–80.1) had central obesity, and 18.5% (16.3–20.8) were current smokers. The 10-year cardiovascular risk ranged from 10.5% to 13.1%; 19.7% (17.6–21.9) had chronic kidney diseases (CKDs). Through the four periods, adults with MAFLD showed an increase in obesity; increase in treatment to lower blood pressure (BP), lipids, and hemoglobin A1c; and increase in goal achievements for BP and lipids but not in goal achievement for glycemic control in diabetes mellitus. Patients showed a decreasing 10-year cardiovascular risk over time but no change in the prevalence of CKDs, myocardial infarction, or stroke. Generally, although participants with NAFLD and those with MAFLD had a comparable prevalence of cardiovascular disease and CKD, the prevalence of MAFLD was significantly higher than that of NAFLD.

Conclusions:

From 1999 to 2016, cardiovascular and renal risks and diseases have become highly prevalent in adults with MAFLD. The absolute cardiorenal burden may be greater for MAFLD than for NAFLD. These data call for early identification and risk stratification of MAFLD and close collaboration between endocrinologists and hepatologists.
Occult Andersson lesions in patients with ankylosing spondylitis: undetectable destructive lesions on plain radiographs
Authors: Huang Ji-Chen , Qian Bang-Ping , Qiu Yong , Wang Bin , Yu Yang , Zhao Shi-Zhou
Published: June 2021

Background:

Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.

Methods:

A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate.

Results:

Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ
2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ
2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ
2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ
2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ
2 = 60.41, P < 0.001).

Conclusions:

Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.
Analysis of related factors affecting cumulative live birth rates of the first ovarian hyperstimulation in vitro fertilization or intracytoplasmic sperm injection cycle: a population-based study from 17,978 women in China
Authors: Yang Rui , Niu Zi-Ru , Chen Li-Xue , Liu Ping , Li Rong , Qiao Jie
Published: June 2021

Background:

More and more scholars have called for the cumulative live birth rate (CLBR) of a complete ovarian stimulation cycle as a key indicator for assisted reproductive technology. This research aims to study the CLBR of the first ovarian hyperstimulation cycles and analyze the related prognosis factors that might affect the CLBR.

Methods:

Our retrospective study included first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles performed between January 2013 to December 2014. A total of 17,978 couples of first ovarian hyperstimulation IVF/ICSI cycles were included. The study was followed up for 4 years to observe the CLBR. The multivariable logistic regression model was used to analyze the prognosis factor, P value of <0.05 was considered statistically significant.

Results:

The cumulative pregnancy rate was 58.14% (10,452/17,978), and the CLBR was 49.66% (8928/17,978). The female age was younger in the live birth group when compared with the non-live birth group (30.81 ± 4.05 vs. 33.09 ± 5.13, P < 0.001). The average duration of infertility was shorter than the non-live birth cohort (4.22 ± 3.11 vs. 5.06 ± 4.08, P < 0.001). The preliminary gonadotropin used and the total number of gonadotropin used were lower in the live birth group when compared with the non-live birth group (both P < 0.001). Meanwhile, the number of oocytes retrieved and transferrable embryos were both significantly higher in the live birth group (15.35 ± 7.98 vs. 11.35 ± 7.60, P < 0.001; 6.66 ± 5.19 vs. 3.62 ± 3.51, P < 0.001, respectively).

Conclusions:

The women's age, body mass index, duration of infertility years, infertility factors, controlled ovarian hyperstimulation protocol, the number of acquired oocytes, and number of transferrable embryos are the prognosis factors that significantly affected the CLBR.
Clinical Characteristics and Outcomes of Eosinophilic Colitis in Patients With Cancer
Authors: Khurana Shruti , Abu-Sbeih Hamzah , Ma Weijie , Qiao Wei , Foo Wai Chin , Richards David M. , Thomas Anusha S. , Khan Anam , Zhang Hao Chi , Wang Yinghong
Published: June 2021

Background:

Eosinophilic colitis (EoC) is a rare form of eosinophilic gastrointestinal disease characterized by diffuse eosinophilic infiltration in the deep lamina propria of colonic mucosa. The pathophysiology is unclear, but EoC has been associated with multiple known risk factors.

Aim:

The aim of this study was to characterize the clinical characteristics and disease course of patients with EoC at a major cancer center.

Material and Methods:

We retrospectively reviewed colonic samples obtained between January 2000 and December 2018 from our institutional database and included cases with significant colonic eosinophilia. Baseline clinical data and EoC-related clinical course and outcomes were documented.

Results:

Forty-one patients were included. One fourth had coexisting autoimmune conditions. Seventy-eight percent had a cancer diagnosis. Half the patients received chemotherapy, with a median duration of 180 days between chemotherapy and EoC onset. Symptoms were present in 76% of patients. Diarrhea was more prevalent in patients who received chemotherapy (85% vs. 42%). Median duration of EoC symptoms was 30 days in patients with cancer and 240 days in those without cancer (P=0.03). Most patients (88%) had normal colonoscopy findings. Fifteen percent of patients required hospitalization. All-cause mortality was 37%, mostly related to underlying malignancy and organ failure.

Conclusions:

EoC in cancer patients appears to have more diarrhea-predominant symptoms, particularly in patients receiving chemotherapy, but a shorter disease duration compared with patients without cancer. Hospitalization can be required for serious cases. Treatment may be reserved for patients requiring symptom management, as most patients with EoC have good clinical outcomes regardless of treatment.
Small-incision lenticule extraction in the U.S. military: prospective study of visual and military task performance
Authors: Sia Rose K. , Ryan Denise S. , Beydoun Hind , Eaddy Jennifer B. , Logan Lorie A. , Rodgers Samantha B. , Rivers Bruce A.
Published: June 2021

Purpose:

To assess early visual outcomes and military task performance after small-incision lenticule extraction (SMILE) among U.S. military service members.

Setting:

Warfighter Refractive Eye Surgery Program and Research Center and Night Vision and Electronic Sensors Directorate, Fort Belvoir, Virginia.

Design:

Single-center, prospective, observational study.

Methods:

The study was composed of active duty service members (n = 37) electing to undergo SMILE for myopia or myopic astigmatism. Testing performed preoperatively and at 1 month and 3 months postoperatively included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, wavefront aberrometry, low-contrast visual acuity (LCVA), contrast sensitivity, and vision-related questionnaire. 14 participants underwent rifle marksmanship with spectacle correction before and without correction at 6 to 8 weeks postoperatively.

Results:

At 3 months postoperatively, the efficacy index was 0.96 and the safety index was 1.03. UDVA was ≥20/20 in 69 (96%) of eyes. LCVA change from baseline was significant under night vision condition. Eye problems contributed to 10% work and 20% activity impairments, both of which decreased to 0% (P = .001). The overall satisfaction rating for SMILE was high at 90.9 (95% CI, 85.3 to 96.5), and 95% of participants would be willing to undergo the procedure again. The median scores between preoperative and 6 to 8 weeks postoperative firing performance were comparable (34 vs 35, with and without correction, respectively; P = .247).

Conclusions:

After the early recovery period, SMILE seems to preserve quality of vision, which appears to facilitate the accomplishment of tasks related to their work as military service members as well as performing activities outside of work.
Prevalence of Adult Female Genital Trauma After Acute Sexual Assault
Authors: McNair Susan M. , Boisvert Leslie
Published: June 2021

Background

Examination of the adult female genitalia after an acute sexual assault may reveal findings interpreted by the examiner as injuries, which may be linked to later legal outcomes. There is no consistent definition in the literature regarding what findings constitute genital trauma after sexual assault. We studied how the prevalence of genital trauma is impacted by the inclusion/exclusion of various genital findings reported in the literature.

Methods

A retrospective descriptive chart review of the sexual assault forensic records from a provincial regional sexual assault treatment center was conducted over a 4-year period and included 67 female patients, 12 years old and over, who reported being sexually assaulted in the previous 72 hours and received a complete forensic examination. We studied the prevalence of genital trauma, using eight definitions of trauma, as well as the percentage of each type of genital finding within this population.

Results

The prevalence of genital trauma in this population ranged from 52%, the majority, to 31% of women, depending on the definition of trauma utilized. Forty-one percent of the findings, the greatest number overall, were redness. Bruises, abrasions, and tears (lacerations), the components of blunt force trauma, accounted for 4%, 15%, and 14% of the findings, respectively.

Interpretation

A universal definition of what findings constitute genital trauma after acute sexual assault is required if the examiner, as expert witness, is to compare findings in a given case with the broader literature and assist the court in ensuring an informed process of decision making.
Workshift Changes in Hydration Status During Wildfire Suppression
Authors: Rosales Alejandro M. , Dodds Patrick S. , Sol Joseph A. , Marks Alexander N. , Domitrovich Joseph W. , Ruby Brent C.
Published: June 2021

Objective:

Document wildland firefighters (WLFFs) hydration status during a singular workshift (13.7 ± 1.4 hours).

Methods:

WLFF researchers documented real-time WLFF (n = 71) urine metrics and fluid consumption. Body weight and blood samples (n = 25) were also collected. Two-tailed dependent t tests determined statistical significance (P < 0.05).

Results:

Body weight significantly decreased (−0.3 ± 1.1%, P > 0.05). Fluid consumption totaled 6.2 ± 2.3 L including food and 5.0 ± 2.1 L without food. Morning versus afternoon urine frequency (2.6 ± 1.3, 3.1 ± 1.9 voids), urine volume (1.2 ± 0.7, 1.3 ± 0.8 L), urine volume per void (440 ± 157, 397 ± 142 mL), and urine specific gravity (1.010 ± 0.007, 1.010 ± 0.007) were not significantly different (P > 0.05). Pre- to post-workshift serum chloride (103.2 ± 1.9, 101.4 ± 1.7 mM) and blood glucose (5.2 ± 0.4, 4.5 ± 0.7 mM) significantly decreased (P < 0.05), while serum sodium (141.5 ± 2.4, 140.8 ± 2.0 mM) and serum potassium (4.3 ± 0.3, 4.2 ± 0.3 mM) remained stable (P > 0.05).

Conclusions:

WLFFs can ingest fluid and food amounts that maintain workshift euhydration and electrolyte status.
How Managers Find Out About Common Mental Disorders Among Their Employees
Authors: Bertilsson Monica , Klinkhammer Stephanie , Staland-Nyman Carin , de Rijk Angelique
Published: June 2021

Objective:

To explore how managers find out about common mental disorders (CMDs) among employees and associations with managers’ work- and knowledge-related characteristics and attitude to CMDs.

Methods:

Data from an online survey in 2017 with Swedish managers (n = 1810) were used. Different ways managers find out about CMDs were measured, and multivariate logistic regression analysis was conducted for associations with manager characteristics.

Results:

Few managers found out about CMDs themselves; another source was more common, for example, employees’ self-disclosure. Managers’ overseeing fewer subordinates and those with a negative attitude to depression were more likely to find out about CMDs themselves. The significance of mental health training and education could not be established.

Conclusion:

Managers’ awareness about employees’ CMDs mainly came about through employees’ self-disclosure. Managers’ attitudes and work conditions were related to the way of finding out.
Increasing Family Education and Support Opportunities
Authors: Tvedte Matthew J. , Henaghan Amelia S. , Nandivada Prathima , Dickie Belinda Hsi
Published: June 2021

Introduction

The medical and surgical care of individuals diagnosed with an anorectal malformation (ARM) has become increasingly standardized with greater attention to the importance of holistic and long-term treatment approaches. Development of opportunities for social connection and peer support among individuals diagnosed with an ARM and their families is a valuable contribution to care for this population. The desire to increase these types of opportunities in our center led to the development of a family education and peer support day for individuals with ARM and their families.

Methods

We identify and describe five priorities for event development: (a) securing hospital and center-based leadership support, (b) maximizing family input, (c) limiting financial burden, (d) maintaining an interdisciplinary approach, and (e) building on existing connections.

Results

A 1-day event was developed, which included educational presentations, Question and Answer with an expert panel, group discussion, and group activities. The event was attended by 42 participants including 28 caregivers, 12 patients, and two siblings, representing 18 distinct family groups. Overall feedback for the event (response rate: 50%) was positive.

Discussion

The development of a family education and support event was found to be a valuable experience for providers, patients, and families. Families appeared to benefit from both the education provided and the opportunity to engage with others with similar lived experiences. Implications for future events include greater emphasis on opportunities for peer connections, greater emphasis on the adolescent experience, and expansion of included diagnoses.
The Effect of Ostomy on Pediatric Patient and Family in Nursing
Authors: Uzsen Hatice , Yaz Seyda Binay , Gumus Merve
Published: June 2021

Aim

This study aimed to examine the studies on children with stoma/ostomy in the field of nursing in terms of nursing science.

Method

This was a qualitative research based on a document analysis of the studies, and it was designed as a systematic review. It was carried out in accordance with the Centre for Reviews and Dissemination guide. The databases of EBSCOhost, PubMed, Science Direct, Google Scholar, and Web of Science were searched between January 2010 and October 2020, and the studies on ostomy in pediatric patients were examined. The search was conducted by using the English keywords including “ostomy/stoma, children, nursing care.” Inclusion and exclusion criteria to select studies were determined based on the PICOS method (P = populations, I = interventions, C = comparison, O = outcomes, and S = study type). Data were extracted by two researchers independently. All studies were examined in full text, and it was decided which studies to include in the systematic review.

Results

In this study, 9,857 studies were found by entering the keywords in the first search. Among these, 87 studies were selected when their titles, abstracts, and keywords were examined. By the inclusion criteria, 20 studies from the EBSCOhost, PubMed, Scopus, Google Scholar, and Science Direct databases were included in the study.

Conclusion

It was observed that the most common studies were the ones that were investigating the problems experienced by the children with an ostomy and their parents and its effects on them. It has been suggested that this systematic review will form a base for the experimental or randomized controlled studies that are needed in the field of ostomy and make a contribution to the literature.
Measuring Recovery With Ecological Momentary Assessment in a Randomized Trial of Exercise After Sport-Related Concussion
Authors: Wiebe Douglas J. , Storey Eileen P. , Orchinik Julia E. , Grady Matthew F. , Leddy John J. , Willer Barry S. , Haider Mohammad Nadir , Mannix Rebekah , Meehan William P. , Vernau Brian T. , Master Christina L.
Published: June 2021

Objective:

Investigate the reliability of concussion symptoms captured through ecological momentary assessment (EMA) and compare time with recovery based on 3 definitions of symptomatic recovery and the date of clinical clearance to begin the return-to-play (RTP) process.

Design:

We used a mobile app with EMA to monitor concussion symptoms as part of a multicenter randomized controlled trial.

Setting:

Three sports medicine practices.

Participants:

Patients between 13 and 18 years old with sport-related concussion were prompted to complete the Post-Concussion Symptom Inventory daily over 4 weeks.

Interventions:

None.

Main Outcome Measures:

We compared the elapsed days to reaching the 4 outcomes using scatterplots and Kaplan–Meier curves.

Results:

Among 118 participants, symptoms reported into the app had excellent agreement with symptoms reported at a clinical visit on the same day (intraclass correlation coefficient = 0.97). Most (>50%) participants reached “specific symptom return to preinjury levels,” “overall symptom return to preinjury levels,” and “current symptom resolution” based on EMA symptom reports between several days and 1 week before achieving “clinical clearance to RTP” determined at a clinical visit, which had 100% sensitivity, but between 56.3% and 78.1% specificity, relative to the app-measured symptom outcomes.

Conclusions:

Time until symptom recovery varies based on the chosen definition of symptomatic recovery but is a more precise correlate with clinical clearance to begin the RTP process when defining symptom recovery as a return to a preinjury baseline level of symptomatology. Real-time symptom monitoring may be beneficial clinically, allowing providers to assess patients' recovery status and make more timely and remote treatment recommendations.
Psychological effects of traditional Chinese mind-body exercises for low back pain
Authors: Huang Qian , Lu Xiaonian , He Tianxiang , Du Juan , Zhang Peiguo
Published: June 2021

Introduction:

Several studies reported that traditional Chinese mind-body exercises showed beneficial effects on improving anxiety and depression of patients with low back pain (LBP) in recent years. However, the effects of traditional Chinese mind-body exercises on improving psychological disorders of patients with LBP remain controversial. Most previous reviews only focused on the effects of traditional Chinese mind-body exercises for LBP on pain and dysfunction. Therefore, the present systematic review and meta-analysis will be conducted to evaluate the evidence on psychological effects of traditional Chinese mind-body exercises for LBP.

Methods and analysis:

The electronic databases (PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, China Knowledge Resource Integrated Database, and Wanfang Data) will be searched. The search will include all documents from their inception to February 2021. The Physiotherapy Evidence Database scale will be used for quality assessment of eligible studies. Risk of bias of eligible studies will also be assessed by Cochrane tool. The meta-analysis will be conducted using the Review Manager Version 5.3 software. The Higgins I

2
statistic will be performed to examine for heterogeneity. The subgroup analysis will be conducted based on different types of traditional Chinese mind-body exercises, different intervention time, and different outcomes. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation.

Ethics and dissemination:

No ethical statement will be required for the performance of this review and meta-analysis. The results of this review will be published in an international peer-reviewed journal.

INPLASY registration number:

INPLASY202130075.
Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement
Authors: Wang Feng , Ma Wenming , Huang Zhihui
Published: June 2021

Background:

Currently, no meta-analysis exists elucidate the analgesic effect of adding IPACK block to our current multimodal analgesia regimen after total knee replacement (TKR). The purpose of this study is to systematically review the level I evidence in the literature to ascertain whether IPACK block can bring additional analgesic benefits to existing multimodal analgesia regimens.

Methods:

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Only level I randomized controlled trials (RCTs) were included in our study. The primary outcome was the pain scores with rest and activity. Secondary outcomes included cumulative opioid consumption, cumulative distance ambulated, and length of stay (LOS).

Results:

Five RCTs with a total of 467 patients were included. The most important finding in our study was that although IPACK block supplementation improved pain scores at 12 hours with rest or activity after surgery, no such benefit was observed at subsequent time points during the postoperative period. Interestingly, IPACK supplementation did not reduce opioid consumption, especially in the first 24 hours after surgery. Furthermore, other postoperative outcomes, including cumulative distance ambulated and LOS, were also not improved by the addition of an IPACK.

Conclusions:

The addition of an IPACK block to multimodal analgesia regiments does not reduce the postoperative opioid consumption nor improve functional performance. However, it may be an appropriate method to improve immediate analgesic effects after TKR.
Multi-system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia
Authors: Asseri Ali A. , AlHelali Ibrahim , Elbastawisi Emad , Ali Abdelwahid S. , Al-Qahtani Saleh M. , Shati Ayed A. , Awadalla Nabil J.
Published: June 2021

Most of the reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children reported mild-to-moderate disease manifestations. However, recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS-CoV-2 infection termed multisystem inflammatory syndrome in children (MIS-C).

The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS-C associated with SARS-CoV-2 infection. They were admitted to the pediatric intensive care unit (PICU). Their clinical presentation, laboratory, and outcome were described.

All patients shared similar clinical presentations such as persistent documented fever for more than 3 days, respiratory symptoms, gastrointestinal involvement, and increased inflammatory markers (CRP, ESR, and ferritin). Three patients had concurrent positive coronavirus disease 2019 (COVID-19) infection, and the other 2 patients had contact with suspected COVID-19 positive patients. They were all managed in the PICU and received intravenous immunoglobulin, systemic steroid, and hydroxychloroquine. The hospital stays ranged between 3 and 21 days. One patient died due to severe multiorgan failures and shock, and the other 4 patients were discharged with good conditions.

Pediatric patients with SARS–CoV-2 are at risk for MIS-C. MIS-C has a spectrum of clinical and laboratory presentations, and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes. Long-term follow-up studies will be required to explore any sequelae of MIS-C, precisely the cardiovascular complications.
Persistent anterior tunica vasculosa lentis in multisystemic smooth muscle dysfunction syndrome
Authors: She Kaiqin , Liang Licong , Lu Fang
Published: June 2021

Rationale:

Multisystemic smooth muscle dysfunction syndrome (MSMDS) is a genetic disease that affects multiple organs. The report here concerns a patient with MSMDS, who is known so far as the youngest among all the reported patients. In addition to the typical manifestations, we observed previously unreported ocular abnormalities, including persistent anterior tunica vasculosa lentis (TVL) and early-onset retinal arteriolar tortuosity, by the fluorescein angiography (FA).

Patient concerns:

The patient was admitted to the neonatal intensive care unit immediately after birth for a diagnosis of urinary system dysplasia during fetal life. After a thorough examination, the patient was found with patent ductus arteriosus, pulmonary hypertension, cerebrovascular disease, hypotonic bladder, intestinal malrotation, and congenital mydriasis. The FA of the eyes undertaken in her 6-week demonstrated perfused vasculature in the persistent anterior TVL and prominent retinal arteriolar tortuosity. The whole exome sequencing revealed a de novo heterozygous ACTA2 gene missense mutation p.R179H.

Diagnoses:

The patient was diagnosed with MSMDS.

Interventions:

Follow-up observation.

Outcomes:

At the 3-month follow-up, no change of the ocular disease was observed.

Lessons:

The persistent anterior TVL in this case implies that ACTA2 p.R179H mutation affects not only the smooth muscle cells but also the pericytes, and further affects the TVL regression. The prominent retinal arteriolar tortuosity in this 6-week-old infant indicates that the retinal arteriolar tortuosity can present early in MSMDS.
Gender difference in metabolic syndrome and incident colorectal adenoma
Authors: Ku Mei-Sheng , Chiu Sherry Yueh-Hsia , Chien Kuo-Liong , Lee Yi-Chia , Chen Sam Li-Sheng , Chen Chih-Dao
Published: June 2021

This community-based study aimed to elucidate whether there is a gender difference in the effect of metabolic syndrome (MetS) and its individual components on an elevated risk for incident colorectal adenoma.

A prospective cohort study was conducted by enrolling 59,767 subjects aged 40 years or older between 2001 and 2009 in Keelung, Taiwan, to test this hypothesis, excluding those with a prior history of colorectal cancer and those with colorectal cancer diagnosed at the first screening. Cox proportional hazards regression models were used to assess the effect of MetS in terms of a dichotomous classification, each individual component and the number of components for males and females.

Colorectal adenoma was present in 2.7% (n = 652) of male participants and 1.1% (n = 403) of female participants. The prevalence rate of MetS was 26.7% and 23.3% for males and females, respectively. The effect of MetS on colorectal adenoma was statistically significant and similar for the 2 genders, with an adjusted hazard ratio (aHR) of 1.33 (95% CI: 1.13–1.58) in males and 1.33 (95% CI: 1.06–1.66) in females after adjustment for confounders. However, MetS led to higher risk of advanced colorectal adenoma in men than in women. Regarding the effect of each component of MetS on colorectal adenoma, abnormal waist circumference and hypertriglyceridemia led to an elevated risk of colorectal adenoma in both genders. A rising risk of colorectal adenoma among females was noted in those with a moderately higher level of glycemia (100–125 mg/dL, aHR = 1.44, 95% CI: 1.12–1.85). Hypertriglyceridemia and high blood pressure were associated with an increased risk of advance colorectal adenoma in males.

Both male and female subjects with MetS had a higher risk of colorectal adenoma. The contributions from individual components of MetS varied by gender. These findings suggest that the possible risk reduction of colorectal adenoma through metabolic syndrome-based lifestyle modifications may differ between genders.
Serum IL-6 and procalcitonin are two promising novel biomarkers for evaluating the severity of COVID-19 patients
Authors: Tang Jinsong , Lin Jingtao , Zhang Erying , Zhong Mengru , Luo Yong , Fu Yong , Yang Yewei
Published: June 2021

To evaluate the development of coronavirus disease 2019 (COVID-19), the roles of interleukin 6 (IL-6) and procalcitonin (PCT) were assessed to diagnose severe COVID-19.

Between January and February 2020, 100 consecutive patients with confirmed COVID-19 were included and divided into common (n = 56), severe (n = 28), and critical (n = 16) groups.

IL-6 and PCT levels were assayed and compared among groups. IL-6 levels were significantly different among groups (common, 23.93±9.64 pg/mL; severe, 69.22 ± 22.98 pg/mL; critical, 160.34 ± 26.15 pg/mL; P < .05), and there was also a significant difference in the levels of PCT among groups (common, 0.23 ± 0.13 ng/mL; severe, 0.38 ± 0.16 ng/mL; critical, 0.73 ± 0.36 ng/mL; P < .05). Further analysis showed that patients in the critical group had the highest levels of IL-6 and PCT, and those in the common group had the lowest levels (all P < .05).

IL-6 and PCT are associated with the severity of COVID-19, and thus have potential value in the diagnosis of COVID-19.
Admixed phenotype of NEDD4L associated periventricular nodular heterotopia
Authors: Pecimonova Martina , Radvanszky Jan , Smolak David , Budis Jaroslav , Lichvar Michal , Kristinova Diana , Rozova Ivica , Turna Jan , Szemes Tomas
Published: June 2021

Rationale:

Periventricular nodular heterotopia-7 (PVNH7) is a neurodevelopmental disorder associated with improper neuronal migration during neurogenesis in cortex development caused by pathogenic variants in the NEDD4L gene.

Patient concerns:

We report the case of a polystigmatized 2-year-old boy having significant symptomatologic overlap with PVNH7, such as delayed psychomotor and mental development, seizures and infantile spasms, periventricular nodular heterotopia, polymicrogyria, cleft palate, 2 to 3 toe syndactyly, hypotonia, microretrognathia, strabismus, and absent speech and walking. The patient showed also distinct symptoms falling outside PVNH7 symptomatology, also present in the proband's older brother, such as blue sclerae, hydronephrosis, transversal palmar crease (found also in their father), and bilateral talipes equinovarus. In addition, the patient suffered from many other symptoms.

Diagnoses:

The boy, his brother and their parents were subjected to whole-exome sequencing. Because of uncertainties in symptomatology and inheritance pattern, the top-down approach was hard to apply. Using the bottom-up approach, we identified a known pathogenic variant, NM_001144967.2(NEDD4L):c.2677G>A:p.Glu893Lys, in the proband's genome that absented in any other analyzed family member, suggesting its de novo origin.

Interventions and outcomes:

The patient was treated with Convulex 300 mg/mL for the successful seizure control and Euthyrox 25mg for the treatment of thyroid malfunction. He also took various supplements for the metabolism support and digestion regulation. Moreover, the patient underwent the corrective surgeries of cleft palate and talipes equinovarus.

Lessons:

We successfully identified the causative mutation NM_001144967.2(NEDD4L):c.2677G>A:p.Glu893Lys explaining symptoms overlapping those reported for PVNH7. Symptoms shared with the brother were not explained by this variant, since he was not a carrier of the pathogenic NEDD4L variant. These are most likely not extended phenotypes of PVNH7, rather an independent clinical entity caused by a yet unidentified genetic factor in the family, highlighting thus the importance of thorough evaluation of symptomatology and genomic findings in affected and unaffected family members, when such data are available.
Efficacy and safety of adalimumab in hidradenitis suppurativa
Authors: Lu Jing-Wun , Huang Yu-Wen , Chen Tai-Li
Published: June 2021

Background:

Adalimumab is used as a first-line biologic agent in the management of moderate-to-severe hidradenitis suppurativa (HS). The objective of the present study was to evaluate the efficacy and safety of adalimumab in patients with moderate-to-severe HS.

Methods:

We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Pooled estimates, namely standardized mean difference (SMD) and relative risk (RR), were calculated using random-effect model with trial sequential analysis. Small study effects were examined using the Doi plot. Certainty of evidence (CoE) was assessed using “The Grading of Recommendations Assessment, Development, and Evaluation” approach, and number-needed-to-treat (NNT) was calculated.

Results:

Five randomized controlled trials, involving 1014 patients, were included. We performed subgroup analysis of adalimumab administered subcutaneously both weekly and every other week. Adalimumab administered weekly was associated with better clinical response achievement (RR 1.76, 95% confidence interval [95% CI] 1.35–2.29; trial sequential analysis TSA-adjusted CI 1.01–3.08; CoE: low; NNT = 5) and a significant improvement in modified Sartorius score (SMD = −0.45, 95% CI = −0.76 to −0.13; CoE: very low; NNT = 10) and dermatology life quality index (DLQI) (SMD −0.47, 95% CI −0.61 to −0.32; CoE: low; NNT = 10). Nevertheless, adalimumab administered every other week showed an improvement only in modified Sartorius score. The pooled RRs of adverse events in both groups revealed no statistical significance when compared with the placebo.

Conclusions:

Adalimumab administered weekly resulted in not only better clinical responses than placebo but also significantly improved disease severity and quality of life of patients with moderate-to-severe HS. Our study provides supporting evidence to the current guidelines and aids decision-making in the application of adalimumab in HS management.
The new imaging findings
Authors: Kasai Yuichi , Mizuno Tetsutaro , Paholpak Permsak , Sirichativapee Winai , Fukui Mitsuru
Published: June 2021

Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes.

“Passing spine” was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. Therefore, we compared the passing spine group and the kissing spine group to investigate whether the 2 groups belong to a similar disease group; this would help explain the clinical and imaging characteristics of patients with passing spine.

Previous studies have described the gradual increase in the height and thickness of the lumbar vertebral spinous processes that can occur in individuals aged >40 years, and reported that this progressive degeneration can lead to a condition termed “kissing spine.”

We examined the CT imaging of 373 patients with lumbar spinal disease and divided patients into 2 groups, the kissing spine (K) group and the passing spine (P) group, and compared the clinical (age, sex, presence/absence of lower extremity pain) and imaging data (localization of kissing or passing spine, intervertebral disc height at the level of kissing or passing spine, lumbar lordosis (LL) angle, presence/absence of vacuum phenomenon (VP) in the intervertebral discs and spondylolisthesis at the level of kissing or passing spine between the 2 groups.

Compared with patients with kissing spine, patients with passing spine had an increased incidence of lower extremity pain, lower intervertebral disc height at the level of passing spine, relatively static LL, and VP commonly observed in the intervertebral discs at the level of passing spine.

Because the clinical and imaging characteristics of patients with passing spine are different from those of patients with kissing spine, passing spine might be a pathological condition distinct from kissing spine.
The effects of dialysis modality choice on cognitive functions in patients with end-stage renal failure
Authors: Gao Tongbin , Ji Yongjian , Wang Yinghui
Published: June 2021

Background:

There is no published meta-analysis comparing the effects of dialysis modality choice on cognitive functions in patients with end-stage renal disease . Therefore, we perform a protocol for systematic review and meta-analysis to evaluate cognitive function in peritoneal dialysis versus hemodialysis patients.

Methods:

This protocol is conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) statement guidelines. Related articles were identified by searching Web of Science, Embase, PubMed, Wanfang Data, Medline, Science Direct, and Cochrane Library. The risk of bias assessment of the included articles was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. All calculations were carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom).

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

We hypothesized that patients on peritoneal dialysis demonstrated a lower odd of cognitive dysfunction compared to those on hemodialysis.

Open Science Framework registration number:

10.17605/OSF.IO/NWCZK
Feasibility of sit training for patients with severe COVID-19 pneumonia during deep sedation
Authors: Kinoshita Tokio , Umemoto Yasunori , Yasuoka Yoshinori , Yoshikawa Tatsuya , Kouda Ken , Hori Shinnosuke , Mikami Yukio , Nishimura Yukihide , Miyamoto Kyohei , Kato Seiya , Tajima Fumihiro
Published: June 2021

Rationale:

There have been a few reports on the early rehabilitation of patients with coronavirus disease (COVID-19), and none on the effectiveness and adverse events of early mobilization for mechanical ventilation patients (other than COVID-19) during deep sedation. This report indicates that sitting without adverse events is possible in patients with severe COVID-19 pneumonia during deep sedation with muscle relaxation.

Patient concerns:

A 65-year-old man with a history of diabetes mellitus, lacunar infarction, and Parkinson's disease was admitted to a local hospital for pneumonia due to COVID-19. After admission, the patient was managed on a ventilator under deep sedation with muscle relaxants and sedatives. Twelve days after admission, the patient was transferred to our hospital due to his worsening respiratory status.

Diagnosis:

Pneumonia due to COVID-19 was diagnosed using a polymerase chain reaction–dependent method.

Interventions:

The day following transfer, a physical therapist started passive range of motion training and sitting.

Outcomes:

The period spanning his initial rehabilitation to muscle relaxant medication interruption was 9 days, and he underwent 7 rehabilitation sessions. The patient was unable to sit during only one of the 7 sessions due to pre-rehabilitation hypoxemia. In 5 of the 6 sitting sessions, PaO2/FiO2 transiently decreased but recovered by the time of subsequent blood sampling. The patient's PaCO2 decreased during all sessions. His blood pressure did not drastically decrease in any sitting session, except the first. Sputum excretion via sputum suction increased during sitting, and peak inspiratory pressure did not change.

Lessons:

The patient eventually died of pneumonia due to COVID-19. However, sitting during deep sedation with muscle relaxants did not cause any serious adverse events nor did it appear to cause obvious negative respiratory effects.