bluuebunny/crossref_metadata_2025 huggingface dataset:
Uterine wall rupture in a primigravid patient with oligohydramnios as the first manifestation
Authors: Yang Lingyun , Zhang Bo , Zhao Yifan , Xie Chuan
Published: January 2021

Rationale:

Spontaneous uterine rupture during pregnancy, occurring most often during labor in the context of a scarred uterus, is a serious obstetric complication. Perhaps even more serious because of its extreme rarity, spontaneous uterine rupture in a primigravid patient with an unscarred gravid uterus would be essentially unexpected. Clinical manifestations of unscarred uterine ruptures are nonspecific and can be confusing, making a correct early diagnosis very difficult.

Patient concerns:

A primigravid woman at 27 weeks of gestation presented to our hospital with acute oligohydramnios. Ultrasound examination at her local hospital revealed oligohydramnios that had not been present 1 week previously. A specific cause of the acute oligohydramnios, however, was not established.

Diagnosis:

Upon transfer to our hospital, the patient was hemodynamically stable without abdominal tenderness or peritoneal signs. Transabdominal ultrasound was repeated and confirmed oligohydramnios and seroperitoneum. The fetal heart rate was in the normal range, and blood tests revealed a low hemoglobin level of 91 g/L, which had been normal recently. A repeat sonogram after admission found that there was almost no amniotic fluid within the uterine cavity, and there was increased peritoneal fluid. Repeat hemoglobin showed a further decrease to 84 g/L. The combination of increased free abdominal fluid, lack of intrauterine fluid, and acutely decreasing hemoglobin strongly suggested uterine rupture with active intraperitoneal bleeding.

Interventions:

Emergent laparotomy was performed, and a male infant was delivered. Comprehensive abdominal exploration revealed a rupture in the right uterine cornua with ongoing slow bleeding, through which a portion of the amniotic sac protruded into the abdominal cavity.

Outcomes:

The laceration was repaired, the patient and neonate recovered without complications, and were discharged 5 days postoperatively.

Lessons:

An increased awareness of the rare but real possibility of spontaneous uterine rupture in a primigravid patient with no prior uterine scarring helped to establish an earlier diagnosis. Obstetricians should consider this possibility in pregnant females, even in the absence of risk factors and in early gestational age, when sudden unexplained clinical manifestations, such as acute oligohydramnios, are encountered.
Successful transcatheter arterial embolization for massive hemorrhage from acquired uterine arteriovenous malformation which occurred as a complication of hysterectomy
Authors: Oh Chang Hoon , Kim Yook , Cho Bum Sang , Yi Kyung Sik
Published: January 2021

Rationale:

Uterine arteriovenous malformation (UVM), which can be congenital or acquired, is a relatively rare disorder that can cause life-threatening hemorrhage. Acquired UVM occurs predominantly after previous uterine procedures; rarely, it may occur after a hysterectomy. Although the best treatment option for UVM remains controversial, transcatheter arterial embolization (TAE) has recently been introduced as a safe and effective treatment.

Patient concerns:

A 34-year-old woman who underwent hysterectomy for uncontrolled postpartum bleeding continued to have hemoperitoneum.

Diagnosis:

Two days after surgery, massive hemoperitoneum was identified on computed tomography scan, and acquired UVM was diagnosed by angiography.

Interventions:

The patient was successfully treated using TAE with an n-Butyl cyanoacrylate.

Outcomes:

After embolization, hemodynamic stability was achieved. A day after embolization, hemoglobin was 10.2 g/dL, and the patient was discharged from the hospital 4 days thereafter.

Lessons:

Although the overall incidence of acquired UVM after hysterectomy is low, bleeding from acquired UVM should be considered as one of the differential diagnoses in the immediate postpartum period, especially when the clinical symptoms do not correlate with the amount of blood loss. A high index of suspicion, prompt diagnosis and intervention, and a multidisciplinary approach in the management were the elements of a successful outcome in this case.
Evaluating the predictive power of circulating tumor cells for the prognosis of transarterial chemoembolization treatment on patients with advanced hepatocellular carcinoma
Authors: Deng Jun , Chen Wei , Wu Xiaoxia , Zhou Yan , Li Jun
Published: January 2021

Explore the predictive power of Circulating Tumor Cells (CTCs) for evaluating the prognosis of transarterial chemoembolization (TACE) treatment on advanced hepatocellular carcinoma (HCC) patients, and use it to construct a prediction model.

We retrospectively analyzed 43 patients with Barcelona Clinic Liver Cancer stage C HCC who underwent TACE treatment.

The survival time of 43 advanced HCC patients were 2 to 60 months, with the median survival time of 12 months, 1-, 3-, and 5-year survival rates were 42.9%, 9.0%, and 3.6%, respectively. The OS of patients with high level of CTCs before TACE (CTC1 > 2) was significantly lower than that of patients with low level of CTCs (8 vs 12 months, P = .040), but there was no significant difference in PFS between the 2 groups (P = .926). Meanwhile, there was no significant difference in OS and PFS between patients with high level CTCs and those with low level CTCs at 1 week and 4 weeks after TACE (P all > .05). In univariate and multivariate Cox regression analysis, the number of lesions and CTC before TACE were the independent influencing factors for prognosis in these patients, and the HR was 3.01 and 1.20, respectively (all P < .05). The area under curve of COX regression model to predict OS increased with the increase of follow-up time, ranging from 0.56 to 0.85.

The CTCs number before TACE is an effective biomarker for predicting the OS of advanced HCC patients. The joint prediction model based on CTCs and tumor number can effectively predict the prognosis of patients with advanced HCC.
Treatment of vitiligo with fire needle
Authors: Mingqiang Liu , Guirong Qiu , Yunbo Wu , Hongrong Lan , Xiaoyan Du
Published: January 2021

Background:

We aim to study the treatment of vitiligo with fire needle.

Methods:

We will search PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wanfang Database, and Chinese Biomedical Literature Database of randomized controlled trials beginning from their inception to August 2020. The primary outcomes is that Complex area of white spot and Percentage of Clinical Effectiveness will be accepted as the primary outcomes. Additional outcome is the safety assessment will be considered a secondary outcome. Two independent authors will based on the Cochrane system evaluation manual 5.1.0 version of randomized controlled trial bias risk assessment tool to evaluate the risk of bias among the final included studies. And we will use the RevMan 5.3 software to analysis data.

Conclusion:

This study will provide evidence to judge whether fire needle is an effective therapy for vitiligo.

Inplasy registration number:

INPLASY2020120012.
Effects of platelet-rich plasma injection for pain control and cartilage repair in knee osteoarthritis
Authors: Bocun Li , Jing Li , Jia Li , Tan Qian , Chen Jianyi , Huang Zhongsheng , Guowei Cai
Published: January 2021

Background:

Knee osteoarthritis (KOA) is a common disabling condition and a heavy financial burden to the society. Platelet-rich plasma (PRP) is considered to be an effective method in the repair and regeneration of cartilage and alleviate pain in KOA. But the utilising of PRP to treat KOA in clinical has shown variable results from many studies. The objective of this protocol is to determine the efficacy of PRP in pain control and cartilage repair in KOA animal models.

Method:

We will search the following three electronic databases: MEDLINE, EMBASE and Web of Science. The primary outcome will include the histological score of cartilage and pain score. The secondary outcomes will be the behavioural assessments and cartilage thickness. SYRCLE's risk of bias tool will be used to assessment the risk of bias of including studies. The standardized mean difference and 95% confidence interval will be used to calculate the effect of PRP treatment. The I2 inconsistency values will be used to calculated the heterogeneity between studies.

Results:

The results of this paper will be submitted to a peer-reviewed journal for publication.

Conclusion:

This research will determine the efficacy of PRP of the treatment of knee osteoarthritis model.

PROSPERO registration number:

CRD42020181589.
Efficacy and safety of warm acupuncture in the treatment of ankylosing spondylitis
Authors: Dang Sha , Ren YuanYuan , Zhao BoYi , Meng XiangWei , Wang Cong , Han Xin , Liu Yang , Zhang ChaoYang
Published: January 2021

Background:

Ankylosing spondylitis refers to a type of autoimmune disease, which is commonly characterized by joint pain and stiffness, since the disease progression can exhibit joint deformity and other activities limited symptoms. Has significantly impacts on people's work and life. Warm acupuncture as a traditional Chinese therapy, showing several advantages (eg, safety, economy, and less side effects), has been extensively used to treat ankylosing spondylitis. However, its curative effect is supported by limited evidence. Accordingly, the present study aims to comprehensively assess the reliability of warm acupuncture in ankylosing spondylitis treatment.

Methods:

Randomized controlled trials were searched from the Chinese Biomedical Literature Database, Chongqing VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, Wanfang, Web of Science, Cochrane Library, PubMed, and EMBASE, regardless of their publication status. The deadline was November 6th, 2020. Two experienced researchers adopted RevMan V.5.3 software for literature selection, data collection, data analysis, and synthesis, respectively. In addition, the quality of the trials involved in this study was measured with the Cochrane Bias risk assessment tool, regardless of language or publication status.

Results:

The protocol will be used to assess the efficacy and safety of warm acupuncture in ankylosing spondylitis treatment.

Conclusion:

This review reliably evidences whether warm acupuncture is a reliable method for the intervention of ankylosing spondylitis.

INPLASY registration number:

INPLASY2020110096.
Effectiveness and safety of warm needle acupuncture for sciatica
Authors: Zhang Jing , Xie Yujia , Li Jia , Yuan Mingxing , Yu Zongming , Su Yue , Dai Qianxiang , Liu Yuan
Published: January 2021

Background:

Sciatica is a syndrome characterized by sciatic nerve path and distribution area pain. Many kinds of literature reported the definite effect of warm needle acupuncture (WNA) on sciatica. However, there is no systematic review or meta-analysis on WNA for sciatica. Therefore, this study will design a protocol to comprehensively and systematically evaluate the effectiveness and safety of WNA on sciatica.

Methods:

The two researchers in this study will search the electronic database for randomized controlled trials, (RCTs) of WNA on sciatica, The databases we will search include PubMed, EMBASE, Cochrane Library, Web of Science, Chinese national knowledge infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Chinese biomedical literature database (CBM). Review Manager 5.4 software and Cochrane risk bias tool will be us used for data analysis and to evaluate research quality. The main clinical indicators will include visual analogue scale (VAS) and Oswestry Disability Index (ODI).

Results:

This study will evaluate the efficacy and safety of WNA for sciatica.

Conclusion:

This study will provide a reliable scheme for objectively and comprehensively evaluating the efficacy and safety of WNA on sciatica.

Trial registration number:

INPLASY2020110074
High aneurysm wall enhancement values are associated with late sac shrinkage after endovascular repair of abdominal aortic aneurysms
Authors: Okata Shinya , Hoshina Katsuyuki , Miyahara Kazuhiro , Matsukura Mitsuru , Akai Takafumi , Isaji Toshihiko , Takayama Toshio
Published: January 2021

To analyze the correlation between aneurysm wall enhancement (AWE) values and early and late sac shrinkage after endovascular aneurysm repair (EVAR).

We retrospectively analyzed 28 patients who underwent EVAR for abdominal aortic aneurysms (AAA) using a bifurcated main body stent graft. The value of AWE in the slice of the maximum AAA diameter was measured using a volumetric analysis of computed tomography images. Sac measurements before EVAR and more than 10 months after EVAR were compared, and the maximum sac shrinkage rate was calculated.

The AWE value immediately after (4 to 7 days) EVAR correlated positively with the sac shrinkage rate (R2 = 0.0139). The AWE value at 6 months after EVAR was also strongly correlated with the sac shrinkage rate (R2 = 0.4982).

Higher AWE values at 6 months after EVAR were strongly associated with the sac volume shrinkage rate. High AWE values may be a predictive factor for sac shrinkage and may aid in the selection of the appropriate clinical strategy after EVAR.
Psychometric validation of a patient-reported outcome questionnaire (Qualipsosex) assessing the impact of psoriasis and psoriatic arthritis on patient perception of sexuality
Authors: Lespessailles Eric , Mahé Emmanuel , Reguiai Ziad , Begon Edouard , Maccari François , Beneton Nathalie , Chaby Guillaume , Rosenberg Carole , Dernis Emmanuelle , Roux Fabienne , Henry-Desailly Isabelle , Charles Bénédicte , Ferdynus Cyril , Marty Marc , Esteve Eric
Published: January 2021

Psoriasis (Pso) and psoriatic arthritis (PsA) frequently have a negative impact on patients’ sexual health. We have developed a specific questionnaire assessing the impact of Pso and PsA on patient perception of sexuality: the QualipsoSex Questionnaire (QSQ). The aim of the present study was to further validate this questionnaire by checking its psychometric properties including validity, reliability, and responsiveness.

A cross sectional observational study with a longitudinal component for responsiveness and test–retest reliability was performed in 12 centers in France including 7 dermatologists and 5 rheumatologists. Psychometric properties were examined according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) check-list.

At baseline, 114 patients had Pso and 35 patients had PsA including 17 peripheral arthritis, 4 axial disease, 13 patients with both axial disease and peripheral arthritis and one patient with an undifferentiated phenotype. The mean Pso Area and Severity Index score was 12.5. Genital organs were involved in 44.7% of Pso cases. Internal consistency, construct validity, and reliability were good with Cronbach's α coefficient, measure of sampling adequacy and intraclass correlation coefficient respectively at 0.87, 0.84, and 0.93. The QSQ also demonstrated acceptable sensitivity to change.

The QSQ has demonstrated good psychometric properties fulfilling the validation process relative to the recommendations of the COSMIN check list. The QSQ is simple to score and may hopefully be valuable in clinical practice and in clinical trials.
An update of fire needle acupuncture for acute herpes zoster and prevention of postherpetic neuralgia in adults
Authors: Wang Jiaxuan , Wang Xindong , Xia Hongyan , Zhang Na , Lin Shiyu , Zeng Jingchun , Lin Guohua
Published: January 2021

Background:

Herpes zoster, is one of the most familiar skin diseases in conducted a systematic review and meta-analysis in 2018 showed that fire needle acupuncture can relieve the pain caused by herpes zoster quickly and prevent the outcome of postherpetic neuralgia (PHN), with little side effects. The purpose of this study is to update the systematic review with the latest evidence.

Methods:

Four English (PubMed, Embase, the Cochrane Library, the Web of Science) and 4 Chinese databases (CNKI, Wanfang, VIP, and CBM) will be searched dating until 30 June 2020 for randomized controlled trials with no language restrictions. In addition, a hand search of the reference lists of included studies will also be done. Adults (aged 18–70) with acute herpes zoster (less than 7 days) using fire needle acupuncture will be included. Pairs of researchers will independently conduct the search, screen titles and abstracts, retrieve full texts of potentially eligible studies, assess the risk of bias, and conduct date extraction and synthesis. If there is any discrepancy in the whole process, consult a third researcher. For meta-analysis, the primary outcome is the pain intensity (visual analogue scale [VAS] pain scale; pain relieve of 30%, duration of pain), and the second outcome is incidence of PHN. A sequential analysis will be done to test the robustness of results of meta-analysis. The quality of evidence will be assessed using GRADE system.

Results:

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

Conclusion:

This study will provide the latest systematic review and meta-analysis of fire needle acupuncture for acute herpes zoster and prevention of PHN.
Assessment of extravascular lung water by measuring the number of pulmonary ultrasound B-lines before and after CBP in patients with MODS
Authors: Cao Guangke , Wu Yu , Zhao Yuliang , Wang Ling , Zhang Yang
Published: January 2021

To determine whether the change in the number of pulmonary ultrasound B-line can accurately assess the extravascular lung water (EVLW) before and after continuous bedside blood purification (CBP) in patients with multiple organ dysfunction syndrome (MODS).

Seventy-six patients with MODS who underwent CBP were examined within 24 hours before and after CBP using pulmonary ultrasound to detect the number of ultrasound B-line or using pulse indicator continuous cardiac output method to examine extravascular lung water, blood oxygenation index, and B-type natriuretic peptide (BNP) content. The correlation of the change in the number of B lines before and after CBP treatment with the negative balance of 24 hours liquid, the change of oxygenation index, and BNP content were analyzed.

In the 76 patients, CBP treatment significantly decreased EVLW, the number of B-line, and BNP (P < .05 for all), while it significantly increased the oxygenation index (P < .05). Correlation analysis showed that the decrease in B-line number after CBP treatment was positively correlated with the 24 hours negative lung fluid balance, decrease of EVLW, oxygenation index improvement, and decreased BNP content. The change in the numbers of pulmonary ultrasound B-line can accurately assess the change of EVLW before and after CBP treatment and reflect the efficiency of ventilation in the lungs and the risk of heart failure.

Thus, it can replace pulse indicator continuous cardiac output as an indicator for evaluating EVLW in patients with MODS treated with CBP.
Traditional Chinese medicine Lianhua Qingwen for treating COVID-19
Authors: Li Shasha , Zhang Jingxia , Li Fan , Mao Ajuan , Li Yajuan , Zhao Chongbo , Hu Xiaowei , Li Fang , Wang Weifeng
Published: January 2021

Background:

Since the outbreak of coronavirus disease 2019 (COVID-19) in 2019, it has swept the world with rapid development and is one of the infectious diseases that seriously threatened global public health. Because of the complex pathogenesis, high infectivity, and high fatality rate of COVID-19, there are no effective treatments for this epidemic at present. Traditional Chinese Medicine (TCM) has a long clinical history in the prevention and treatment of such acute infectious diseases. The therapeutic effect of Lianhua Qingwen (LHQW) on this new coronary pneumonia has attracted the attention of all walks of life, and relevant research reports continue to appear. Here, we intend to conduct a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of LHQW in COVID-19 patients.

Methods:

We will search each database from the built-in until Dec 2020. The English literature mainly search the Cochrane Library, EMBASE, PubMed, and Web of Science, while the Chinese literature come from CNKI, VIP, Chinese Biomedical Database (CBM), Chinese Science Citation Database (CSCD), and Wan Fang database. Simultaneously, we will retrieve clinical registration tests. This study only screens the RCT of LHQW against COVID-19 and evaluates its efficacy and safety. We will use the Cochrane Handbook to systematically review interventions to assess the risk of bias. The protocol will be reported according to the approach and preferred report items for systematic review and meta-analysis protocols (PRISMA - P). Finally, RevMan software version 5.3 will be used for meta-analysis.

Results:

The systematic review and meta-analysis aim to review and pool current clinical outcomes of LHQW for treating COVID-19.

Conclusion:

This study will provide further evidence for the efficacy and safety of LHQW in the treatment of COVID-19.

INPLASY Registration number:

INPLASY2020120043.
Comparison of efficacy and safety of complementary and alternative therapies for primary trigeminal neuralgia
Authors: Zhang Tianqi , Zhang Tiefeng , Li Chuancheng , Zhai Xixi , Huo Qing
Published: January 2021

Background:

Primary trigeminal neuralgia (PTN) is a type of peripheral neuralgia that seriously affects people's lives. In recent years, complementary therapies and alternative therapies have played a significant role in treating PTN. However, there is a lack of comparison among all the complementary and alternative therapies at present. Thus, the aim of this study is to discuss the efficacy and safety of diverse complementary and alternative therapies by Bayesian network meta-analysis (NMA).

Methods:

We will retrieve the Chinese and English databases to gather related randomized controlled trials (RCTs) of complementary and alternative therapies for treating PTN. The deadline is November 2020. Two independent researchers will be in charge of screening qualified literature, extracting data, and independently evaluating bias risks involved in the research. Pairwise meta-analysis and Bayesian network meta-analysis will be performed to assess all evidence. Then, we will use STATA16.0 as well as WinBUGS1.4.3 software for data analysis. Besides, the quality of NMA evidence will be classified by grading of recommendations assessment development and evaluation (GRADE).

Results:

This study will compare and rank the efficacy and safety of different complementary and alternative therapies in treating primary trigeminal neuralgia.

Conclusion:

Complementary and alternative therapies play an essential role in treating primary trigeminal neuralgia. We expect our study will furnish meaningful evidence support for clinicians and patients.

Protocol registration number:

INPLASY2020120026.

Ethical approval:

Since the study is based on published or registered RCTs, ethical approval and patient informed consent are abandoned.
Prenatal detection of a 3q29 microdeletion in a fetus with ventricular septum defect
Authors: Yue Fagui , Deng Shu , Xi Qi , Jiang Yuting , He Jing , Zhang Hongguo , Liu Ruizhi
Published: January 2021

Rationale:

Chromosomal 3q deletion is a recurrent genomic alternation, which is rarely reported in clinic.

Patient concerns:

A 27-year-old woman underwent amniocentesis for cytogenetic analysis and single nucleotide polymorphism (SNP) array analysis at 27 weeks of gestation, due to ventricular septum defect in prenatal ultrasound findings.

Diagnoses:

G-banding analysis showed the karyotype of the fetus was normal and the couple also had normal karyotypes. However, SNP array detected a 1.71 Mb microdelection in 3q29, which was described as arr[hg19]3q29(194184392–195887205) × 1. There are 12 genes located in this locus.

Interventions:

The couple refused SNP array to testify the 3q29 microdeletion was inherited or de novo and they chose termination of pregnancy.

Outcomes:

The deleted region in the fetus overlapped with part 3q29 microdeletion syndrome, which was characterized by learning disability, speech delay, mental deficiency, ocular abnormalities and craniofacial features. In addition, no similar/overlapping 3q29 microdeletion cases were reported according to the published literature and database.

Lessons:

For the chromosomal microscopic imbalances partially overlapping with the defined pathogenic syndrome, deleted/duplicated size, genetic materials and phenotypic diversity should be taken into consideration when genetic counseling is offered by the clinicians.
Effect of Nusinersen in a late onset spinal muscular atrophy patient for 14 months
Authors: Park Jin-Mo , Min Yu-Sun , Park Donghwi , Park Jin-Sung
Published: January 2021

Rationale:

Spinal muscular atrophy (SMA) is a genetic disorder caused by genetic defect of SMN1 gene. SMA was an untreatable disease until 2016, when Nusinersen an antisense oligonucleotide therapy was approved for treatment. We report the effect of Nusinersen in a late onset SMA for 14 months.

Patient concerns:

A 13-year-old boy who was diagnosed as SMA with progressive proximal limb weakness was treated with intrathecal injection of Nusinersen.

Diagnosis:

The patient had progressive proximal limb weakness after 2 years of age. The patient had elevated creatine kinase level and shoed neurogenic changes in the needle electromyography study. After genetic analysis, homozygous deletion in Exon 7 and 8 of SMN1 protein was found and he was diagnosed as late onset SMA.

Interventions:

Intrathecal Nusinersen was administered per protocol.

Outcomes:

After 14 months of treatment, the patient showed significant clinical improvement in the revised Hammersmith functional rating scale and 6-minute walk test.

Lessons:

Although there is limited data on the effect of Nusinersen in late onset SMA patients, our case adds on the effectiveness even in late onset SMA. More studies are needed to consolidate the effects and adverse events of Nusinersen in late onset SMA.
Awake endovascular coiling of a dissected intracranial aneurysm in a third-trimester twin pregnancy
Authors: Xie Fei , Hao Jianqiang , Richard Seidu A. , Yang Yuanli , Zou Wuchun , Liu Hong-Bin , Deng Min , Zhang Changwei
Published: January 2021

Rationale:

Subarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy.

Patient concerns:

A 28 years’ old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting.

Diagnosis:

Emergency obstetric ultrasound scan done confirmed 32 weeks’ twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery.

Interventions:

Awake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks’ gestation.

Outcomes:

Two years’ follow-up indicated no complications and children as well as their mother are healthy.

Lesions:

Awake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.
Pneumocystis jiroveci pneumonia, Nocardia brasiliensis, and Mycobacterium tuberculosis co-infection in a myasthenia gravis patient
Authors: Hou Jiahui , Cao Junmin , Tan Panli , Yu Ying
Published: January 2021

Rationale:

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junctions that leads to fluctuating weakness and disabling fatigability. Due to difficulty in breathing caused by weakness of the respiratory muscles, patients with MG are more susceptible to pneumonia and other respiratory infections. As many patients with MG are given immunosuppressive therapy, this makes them more prone to infections. However, coinfection with 3 pathogens is very rare.

Patient concerns:

Here, we report the case of a 41-year-old gentleman with MG who was receiving long-term steroid therapy. He presented with a cough with pale brown expectoration that occurred without obvious inducement, severe pain in the scapula, as well as swelling and weakness of both legs. Despite undergoing treatment, but his symptoms did not improve, prompting two additional hospital admissions over a period of several months.

Diagnosis:

Bronchoscopy and bronchoalveolar lavage (BAL) were performed, revealing the presence of Pneumocystis jirovecii , Nocardia brasiliensis, and Mycobacterium tuberculosis (MTB). N brasiliensis was identified by positive modified acid-fast Kinyoun staining as well as a positive colony culture identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry from the BAL sample. MTB was confirmed using GeneXpert, and due to the limitations of the culture conditions, methenamine silver stain was used to confirm Pneumocystis jirovecii. Next-generation sequencing (NGS) assay of the BAL samples also confirmed these pathogens.

Interventions:

The patient was transferred to a designated tuberculosis hospital and received anti-infective and anti-TB treatment.

Outcomes:

During treatment at the designated hospital, the patient developed gastrointestinal bleeding and impaired liver function. One month later, he developed multiple organ failure, consolidation of the left lower lung, and pan-drug resistant bacteremia. He refused further treatment and was discharged

Conclusion:

In conclusion, physicians should be aware of the predisposition of MG patients to co-infections, especially patients with metabolic disorders, to avoid inadequate treatment and poor patient outcomes. Due to the limitations of culture conditions, NGS should be considered as a new technique for identifying pathogens.
Complementary and alternative therapies for precancerous lesions of gastric cancer
Authors: Zhang Tianqi , Zhang Tiefeng , Li Chuancheng , Zhai Xixi , Huo Qing
Published: January 2021

Background:

Gastric cancer is one of the most common malignant tumors, which seriously affect peoples quality of life and threaten people's health. Precancerous lesions of gastric cancer (PLGC) are a critical stage in the occurrence and development of gastric cancer. Early effective intervention is an important means to prevent and control gastric cancer. In this study, we will evaluate the efficacy and safety of complementary and alternative therapies in the treatment of PLGC by Bayesian network meta-analysis (NMA).

Methods:

We will search PubMed, Cochrane Library, CNKI and other databases to gather randomized controlled trials (RCTs) on the treatment of PLGC with complementary and alternative therapies. Two reviewers will screen the literature and extract the data according to the inclusion and exclusion criteria, and then assess the quality and bias risk according to Cochrane's Risk of Bias Assessment Tool. Bayesian network meta-analysis will be conducted by Stata16.0 and WinBUGS1.4.3.

Results:

This study will compare and rank the efficacy and safety of different complementary and alternative therapies for PLGC.

Conclusion:

This study can provide reliable evidence for the efficacy and safety of complementary and alternative therapies in treatment of PLGC. We expect to provide scientific and rigorous evidence support for clinicians and patients, and then assist them to choose the optimum treatment.

Protocol registration number:

INPLASY2020120077.
Applicability of ultrasonography for detection of marginal sinus placenta previa
Authors: Ishibashi Hiroki , Miyamoto Morikazu , Shinmoto Hiroshi , Soga Shigeyoshi , Iwahashi Hideki , Kakimoto Soichiro , Matsuura Hiroko , Sakamoto Takahiro , Hada Taira , Suzuki Rie , Takano Masashi
Published: January 2021

This study aimed to examine whether marginal sinus placenta previa, defined as when the marginal sinus just reaches the internal cervical os and placental parenchyma might be >2 cm from the internal cervical os, can be diagnosed using ultrasonography (US). We identified the placenta previa cases that underwent both US and magnetic resonance imaging (MRI) between April 2010 and December 2018 at our institution. The diagnostic discrepancies for marginal sinus placenta previa between US and MRI were examined retrospectively. Of the 183 cases of placenta previa, 28 (15.3%) cases were diagnosed as marginal sinus placenta previa using MRI. Among them, 18 cases (64.3%) could also be diagnosed using US. The sensitivity and specificity of the diagnosis of marginal sinus placenta previa using US were 64.3% and 92.9%, respectively. A change in US diagnosis occurred in 10 (35.7%) cases, all of which were diagnosed with low-lying placenta previa or marginal placenta previa and did not develop any serious miserable obstetrical outcomes. In conclusion, the diagnostic accuracy of US for detecting marginal sinus placenta previa was not significant. MRI examination may be required to accurately categorize the types of placenta previa.
Efficacy and safety of mechanical thrombectomy for cardioembolic stroke
Authors: Zhang Ziqu , Wang Chenjin , Xia Wengang , Li Jingwei , Wang Yali , Liu Yong
Published: January 2021

Background:

Several randomized clinical trials have demonstrated the safety and efficiency of mechanical thrombectomy in the management of acute ischaemic stroke caused by larger vessel occlusion. According to the trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, acute ischaemic stroke can be divided into cardioembolic stroke and non-cardioembolic stroke. Previous studies have shown that mechanical thrombectomy in cardioembolic stroke with intracranial large artery occlusion has a poor prognosis. The reason may be that the old emboli are hard, making it difficult to remove. However, recent evidence shows that mechanical thrombectomy is also effective and safe in patients with cardioembolic stroke. Therefore, the aim of this study is to evaluate the efficacy and safety of mechanical thrombectomy for cardioembolic stroke.

Methods:

The electronic database, including PubMed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), VIP database, and Wan-fang database, were thoroughly retrieved from inception to December 1, 2021, without language restrictions. All randomized controlled trials that evaluated the efficacy and safety of mechanical thrombectomy in the treatment of cardioembolic stroke will be included. Primary outcomes will include vascular recanalization rate and score scale. Two authors will independently scan the articles searched, extract the data from articles included, and assess the risk of bias by Cochrane tool of risk of bias. Disagreements will be resolved by discussion among authors. All analysis will be performed based on the Cochrane Handbook for Systematic Reviews of Interventions. Dichotomous variables will be reported as risk ratio or odds ratio with 95% confidence intervals and continuous variables will be summarized as mean difference or standard mean difference with 95% confidence intervals.

Results:

This review will be to assess the efficacy and safety of mechanical thrombectomy for cardioembolic stroke.

Conclusions:

The results of our findings may be helpful for clinicians and health professionals to re-examine the clinical decision-making in the treatment of cardioembolic stroke, promising way for treatment of patients with cardioembolic stroke.

Systematic review registration number:

INPLASY2020120035
Gender Differences in Recovery Needs After a Suicide Attempt
Authors: Denneson Lauren M. , Tompkins Kyla J. , McDonald Katie L. , Britton Peter C. , Hoffmire Claire A. , Smolenski Derek J. , Carlson Kathleen F. , Dobscha Steven K.
Published: January 2021

Background:

Appropriate after-care for the estimated 1.4 million people with nonfatal suicide attempts each year in the United States is critical, yet little research has focused on recovery needs after an attempt and whether important gender differences in those needs may exist. In this study, we examined gender differences in recovery needs after a suicide attempt among a national sample of women and men veterans.

Methods:

We interviewed 25 women and 25 men veterans from Veterans Health Administration health care systems across the country. Purposive sampling was used to obtain a demographically and clinically diverse sample. Transcripts were analyzed using thematic analysis.

Results:

Although some recovery topics were similar between genders, the participants’ primary recovery needs, or goals, differed by gender. Women focused on developing connections with others and wanted to increase their self-knowledge and self-worth. Men were focused on trying to live up to their ideal selves by living and doing “right.” Men also wanted to feel like they were needed by others. Both women and men also wanted to feel a stronger sense of purpose in their lives.

Conclusions:

Findings suggest that recovery needs among veterans after a nonfatal suicide attempt vary by gender: women may benefit more from psychoeducational approaches in group settings with other women, whereas men may benefit more from approaches that help them focus on making changes in their lives towards becoming their ideal selves.
Machine Learning to Differentiate Risk of Suicide Attempt and Self-harm After General Medical Hospitalization of Women With Mental Illness
Authors: Edgcomb Juliet B. , Thiruvalluru Rohith , Pathak Jyotishman , Brooks John O.
Published: January 2021

Background:

Suicide prevention is a public health priority, but risk factors for suicide after medical hospitalization remain understudied. This problem is critical for women, for whom suicide rates in the United States are disproportionately increasing.

Objective:

To differentiate the risk of suicide attempt and self-harm following general medical hospitalization among women with depression, bipolar disorder, and chronic psychosis.

Methods:

We developed a machine learning algorithm that identified risk factors of suicide attempt and self-harm after general hospitalization using electronic health record data from 1628 women in the University of California Los Angeles Integrated Clinical and Research Data Repository. To assess replicability, we applied the algorithm to a larger sample of 140,848 women in the New York City Clinical Data Research Network.

Results:

The classification tree algorithm identified risk groups in University of California Los Angeles Integrated Clinical and Research Data Repository (area under the curve 0.73, sensitivity 73.4, specificity 84.1, accuracy 0.84), and predictor combinations characterizing key risk groups were replicated in New York City Clinical Data Research Network (area under the curve 0.71, sensitivity 83.3, specificity 82.2, and accuracy 0.84). Predictors included medical comorbidity, history of pregnancy-related mental illness, age, and history of suicide-related behavior. Women with antecedent medical illness and history of pregnancy-related mental illness were at high risk (6.9%–17.2% readmitted for suicide-related behavior), as were women below 55 years old without antecedent medical illness (4.0%–7.5% readmitted).

Conclusions:

Prevention of suicide attempt and self-harm among women following acute medical illness may be improved by screening for sex-specific predictors including perinatal mental health history.
Cerebral hemodynamic response to a therapeutic bed for procedural pain management in preterm infants in the NICU: a randomized controlled trial
Authors: Ranger Manon , Albert Arianne , MacLean Karon , Holsti Liisa
Published: January 2021

Introduction:

We developed a novel device, Calmer, that mimics key components of skin-to-skin holding to reduce stress in preterm infants. Our feasibility trial showed that Calmer worked 50% better than no treatment and no differently from our standard of care, facilitated tucking (FT), for reducing pain scores during a heel lance in preterm infants in the neonatal intensive care unit.

Objective:

We compared the effects of Calmer on regional cerebral hemodynamic activity during a noxious stimulation to FT.

Methods:

During a clinically required heel lance, we measured frontal cortex tissue oxygenation in a subsample of 29 preterm infants (27–33 weeks gestational age) from our larger randomized controlled trial. Infants were randomized to either FT (n = 16) or Calmer treatment (n = 12). The outcome measure, obtained using near-infrared spectroscopy, was a change in the tissue oxygenation index (TSI) across study phases (Baseline, Heel Lance, Recovery; median duration 517 seconds [421–906 seconds]).

Results:

No statistically significant differences were found between groups in the median TSI during any of the study phases. In response to the heel lance, 7 infants (27.6%) had a TSI that dipped below the 60% threshold (3 in the Calmer group 25% and 4 in the FT group 25%); none below 50%.

Conclusions:

Infants on Calmer maintained normal regional cerebral oxygen levels (55%–85%) no differently from infants receiving a human touch intervention during blood collection. Parental skin-to-skin holding is one of the most effective strategies to relieve procedural pain in preterm infants. When parents or FT are not available, Calmer shows potential for filling this gap in care.
Incidence of dyslipidemia in people with HIV who are treated with integrase inhibitors versus other antiretroviral agents
Authors:   The RESPOND Study Group∗
Published: January 2021

Objective:

To compare the incidence of dyslipidemia in people with HIV receiving integrase inhibitors (INSTI) versus boosted protease inhibitors (PI/b) and nonnucleoside reverse transcriptase inhibitors (NNRTI) within RESPOND consortium of prospective cohorts.

Methods:

Participants were eligible if they were at least 18 years, without dyslipidemia and initiated or switched to a three-drug antiretroviral therapy (ART)-regimen consisting of either INSTI, NNRTI, or PI/b for the first time, between 1 January 2012 and 31 December 2018. Dyslipidemia was defined as random total cholesterol more than 240 mg/dl, HDL less than 35 mg/dl, triglyceride more than 200 mg/dl, or initiation of lipid-lowering therapy. Poisson regression was used to determine the adjusted incidence rate ratios. Follow-up was censored after 3 years or upon ART-regimen discontinuation or last lipid measurement or 31 December 2019, whichever occurred first.

Results:

Overall, 4577 people with HIV were eligible (INSTI = 66.9%, PI/b = 12.5%, and NNRTI = 20.6%), 1938 (42.3%) of whom were ART-naive. During 1.7 (interquartile range, 0.6–3.0) median years of follow-up, 1460 participants developed dyslipidemia [incidence rate: 191.6 per 1000 person-years, 95% confidence interval (CI) 182.0–201.7]. Participants taking INSTI had a lower incidence of dyslipidemia compared with those on PI/b (adjusted incidence rate ratio 0.71; CI 0.59–0.85), but higher rate compared with those on NNRTI (1.35; CI 1.15–1.58). Compared with dolutegravir, the incidence of dyslipidemia was higher with elvitegravir/cobicistat (1.20; CI 1.00–1.43) and raltegravir (1.24; CI 1.02–1.51), but lower with rilpivirine (0.77; CI 0.63–0.94).

Conclusion:

In this large consortium of heterogeneous cohorts, dyslipidemia was less common with INSTI than with PI/b. Compared with dolutegravir, dyslipidemia was more common with elvitegravir/cobicistat and raltegravir, but less common with rilpivirine.
Brief Report: Differences in Types of Myocardial Infarctions Among People Aging With HIV
Authors: Crane Heidi M. , Nance Robin M. , Whitney Bridget M. , Heckbert Susan R. , Budoff Matthew , High Kevin , Landay Alan , Feinstein Matthew , Moore Richard D. , Mathews William Christopher , Christopoulos Katerina , Saag Michael S. , Willig Amanda , Eron Joseph J. , Kitahata Mari M. , Delaney Joseph A. C. ,   for the Centers for AIDS Research Network of Clinical Information Systems
Published: January 2021

Background:

Type 1 myocardial infarctions (T1MIs) result from atherosclerotic plaque instability, rupture, and/or erosion. Type 2 MIs (T2MIs) are secondary to causes such as sepsis and cocaine-induced vasospasm resulting in an oxygen demand–supply mismatch and are associated with higher mortality than T1MIs. T2MIs account for a higher proportion of MIs among people living with HIV (PLWH) compared with the general population. We compared MI rates by type among aging PLWH. We hypothesized that increases in MI rates with older age would differ by MI types, and T2MIs would be more common than T1MIs in younger individuals.

Methods:

Potential MIs from 6 sites were centrally adjudicated using physician notes, electrocardiograms, procedure results, and laboratory results. Reviewers categorized MIs by type and identified causes of T2MIs. We calculated T1MI and T2MI incidence rates. Incidence rate ratios were calculated for T2MI vs. T1MI rates per decade of age.

Results:

We included 462 T1MIs (52%) and 413 T2MIs (48%). T1MI rates increased with older age, although T1MIs occurred in all age decades including young adults. T2MI rates were significantly higher than T1MI rates for PLWH younger than 40 years. T1MI rates were similar or higher than T2MI rates among those older than 40 years (significantly higher for those aged 50–59 and 60–69 years).

Conclusions:

Rates of T2MIs were higher than T1MIs until age 40 years among PLWH, differing from the general population, but rates of both were high among older PLWH. Given prognostic differences between MI types, these results highlight the importance of differentiating MI types among PLWH.
Brief Report: Youth Living With Perinatally Acquired HIV Have Lower Physical Activity Levels as They Age Compared With HIV-Exposed Uninfected Youth
Authors: Dirajlal-Fargo Sahera , Williams Paige L. , Broadwell Carly , McFarland Elizabeth J. , Powis Kathleen M. , Jacobson Denise L. , Jao Jennifer ,   for the Pediatric HIV/AIDS Cohort Study (PHACS)
Published: January 2021

Background:

Few studies have evaluated physical activity patterns or their association with vascular inflammation among youth living with perinatally acquired HIV (YPHIV).

Methods:

We assessed YPHIV and youth perinatally HIV-exposed but uninfected (YPHEU) in the PHACS Adolescent Master Protocol with at least one Block physical activity questionnaire (PAQ) completed between ages 7–19 years. Physical activity metrics were as follows: (1) daily total energy expenditure (TEE) and (2) physical activity duration (PAD) defined as the minutes of daily moderate and vigorous activities. In a subgroup, we measured serum biomarkers of coagulation (fibrinogen and P-selectin) and endothelial dysfunction (soluble intracellular cell adhesion molecule-1, soluble vascular cell adhesion molecule-1, and E-selectin) obtained within 3 months of a single PAQ. Repeated measures linear regression models were used to compare the trajectories of log-transformed TEE and PAD by HIV status, adjusting for confounders. Spearman correlations were calculated to assess the relationship of TEE and PAD with vascular biomarkers.

Results:

Five hundred ninety-six youth (387 YPHIV and 209 YPHEU) completed 1552 PAQs (median PAQs completed = 3). The median age at enrollment (Q1, Q3) was 11 (9, 13) years. TEE and PAD increased with age in both YPHIV and YPHEU. However, even after adjusting for confounders, YPHIV had significantly less increase per year than YPHEU for TEE (5.7% [95% confidence interval (CI): −9.9% to −1.4%, P = 0.010] less) and PAD (5.2% [95% CI: −9.2% to −1.1%, P = 0.016] less). Among 302 youth with biomarker measures (187 YPHIV and 114 YPHEU), we observed little correlation with TEE or PAD.

Conclusions:

Both groups had increases in physical activity levels as they aged, but YPHIV had smaller increases throughout adolescence compared with YPHEU, which may impact long-term health.