bluuebunny/crossref_metadata_2025 huggingface dataset:
A preliminary study of the combination of ultrafast and abbreviated dynamic contrast
Authors: Jeong Seok-min , Ha Su Min , Ahn Hye Shin , Woo SeungTae , Sung Jae Kon , Shin Hee-Chul
Published: December 2020

We combined the abbreviated and ultrafast magnetic resonance imaging (MRI) technique with the standard MRI protocol and compared lesion characterization quantitatively and qualitatively to the standard MRI protocol.

Fifty-six patients with breast cancer who underwent MRI from June 2017 to May 2018 and fulfilled our inclusion criteria were included. Three radiologists measured the lesion sizes, described the MRI findings using BI-RADS lexicon, and demarcated the regions of interest to extract the volumetric quantitative and semi-quantitative parameters. We used Pearson's correlation analysis comparing the quantitative and semi-quantitative parameters. To evaluate the inter-observer variability, we calculated the intra-correlation coefficient (ICC). We also analysed the correlation in BI-RADS lexicon.

There were 45 (80.4%) luminal and 11 (19.6%) non-luminal breast cancers, and the most common tumour subtype was invasive carcinoma (n = 48, 85.7%), followed by ductal carcinoma in situ (n = 8, 14.3%). Regarding correlation between the quantitative and semi-quantitative parameters, Ktrans significantly correlated with the wash-in factor (r, 0.862; P < .001) and AUC value (r, 0.951; P < .001). The lesion size measured by standard and combined abbreviated-ultrafast phases and that from the surgical pathological specimens showed moderate agreement (ICC range, 0.516−0.578). The ICCs among the 3 readers were excellent for lesion size measurement, BI-RADS lexicon regarding lesion type, mass shape, margin, internal enhancement, non-mass enhancement distribution, and internal enhancement by the standard and combined abbreviated-ultrafast protocols.

The use of the modified and combined abbreviated-ultrafast MRI protocol provides a reliable measurement of the quantitative parameters and may aid in the screening of breast cancer.
PERCEPTION Trial protocol
Authors: Lusho Sejdi , Durando Xavier , Bidet Yannick , Molnar Ioana , Kossai Myriam , Bernadach Maureen , Lacrampe Nathalie , Veyssiere Hugo , Cavaille Mathias , Gay-Bellile Mathilde , Radosevic-Robin Nina , Abrial Catherine
Published: December 2020

Background:

Triple negative breast cancer affects 10% to 20% of all women diagnosed with breast cancer. Due to its characteristics, treatment strategies are limited and metastatic recurrences are common in the first 5 years after treatment. However, not all patients affected by this disease develop metastases. Tumor-infiltrating lymphocytes have shown to be reliable predictive biomarkers of treatment response and metastatic recurrences. However, we need to develop simpler and faster ways to predict response to cytotoxic treatment and the possibility of eventual cancer relapse by identifying new biomarkers. Recently, new studies are emerging, suggesting a predictive role of circulating blood cells in different types of cancer. In this study, we will assess the correlation between tumor-infiltrating lymphocytes and different elements of the blood count in patients diagnosed with triple negative breast cancer.

Methods:

The main objective of this study is to evaluate the correlation between the peripheral neutrophil-to-lymphocyte ratio and the amount of tumor-infiltrating lymphocytes, assessed in triple negative breast cancer patients at diagnosis. Secondary objectives include evaluation of the correlation between tumor-infiltrating lymphocytes at diagnosis and the baseline absolute neutrophil, lymphocyte, and platelet counts, as well as the platelet-to-lymphocyte ratio. The triple negative breast cancer patients will be enrolled in the PERCEPTION trial during the first year after the treatment completion. Two supplementary blood tests, at 12 months after the end of treatment and at the time of the first metastatic recurrence, will be performed.

Discussion:

The discovery of new prognostic and predictive biomarkers is crucial for triple negative breast cancer. We set up the PERCEPTION clinical trial in order to evaluate certain blood counts as early biomarkers and to assess their correlation with tumor-infiltrating lymphocytes. Demonstration of comparative predictive and/or prognostic capacities of peripheral blood counts and tumor-infiltrating lymphocytes would allow introduction of the former as simple and cheap biomarkers in triple negative breast cancer patient management.

Trial registration:

The PERCEPTION study has been registered in the French National Agency of Medical Security registry on the 2nd of July 2019 under the number 2019-A01861-56 and in the ClinicalTrials.org registry under the number NCT04068623.
Magnetic resonance imaging for evaluating tumor resectability in advanced ovarian cancer
Authors: Liu Ping , Deng Lingli , Yang Lijun , Yuan Xianhong , Xia Wei , Su Yongxue
Published: December 2020

Background:

This study will evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) to investigate tumor resectability at primary debulking surgery among women experiencing advanced-stage ovarian cancer.

Methods:

We will systematically search the randomized controlled trials (RCTs) for potentially eligible studies from electronic databases, including 4 English databases (PubMed, EMBASE, Web of Science, and Cochrane Library) and 3 Chinese databases (China National Knowledge Infrastructure, WanFang, and China Biomedical Database). The study language will be restricted to English and Chinese. Also, 2 independent authors will collect and carry out data extraction as well as quality assessment. Data will be synthesized using appropriate statistical methods.

Results:

We will summarize present study's evidence to assess the diagnostic accuracy of MRI for evaluating tumor resectability at primary debulking surgery in women experiencing advanced-stage ovarian cancer.

Conclusion:

The present study will put forward the latest high-quality evidence for MRI's clinical application for evaluating tumor resectability in women experiencing advanced ovarian cancer.

Ethics and dissemination:

Since the present study is a systematic review and meta-analysis based on the published literature, ethical approval will not be necessary.

Protocol registration number:

DOI 10.17605/OSF.IO/UWDRF (https://osf.io/uwdrf/)
Clinic image surveillance reduces mortality in patients with primary hepato-gastrointestinal cancer who develop second primary lung cancer
Authors: Huang Hung-Yu , Lu Min-Wei , Chen Mei-Chi , Chang Hsiu-Mei , Kuo Chih-Hsi , Lin Shu-Min , Wang Chun-Hua , Chung Fu-Tsai
Published: December 2020

Second primary cancer is prevalent in patients with gastrointestinal (GI) cancer, for which lung cancer is the most common and associated with high lethality. Image screening for lung cancer was proved to be effective in early diagnosis and lower mortality. However, trials of screen for lung cancer generally excluded patients with a previous diagnosis of malignancy. The study aimed to investigate the outcome of second primary lung cancer and the factor that improve survival in patients with hepato-GI cancer.

A total of 276 patients with secondary lung cancer were found among 3723 newly-diagnosed lung cancer patients diagnosed in Chang Gung Memorial Hospital, between 2010 and 2014. Patients’ clinical characteristics, stages and survival were recorded and analyzed. The patients were separated into 2 groups: Group I was defined as lung cancer detected in original primary cancer clinic and group II patients defined as lung cancer detected in other medical places.

Sixty-nine cases with primary GI-hepatic and secondary lung cancer were diagnosed (42 (60.8%) in Group I and 27 (39.1%) in Group II). Although both groups had comparable primary cancer stages and treatment, more patients in Group I than Group II were diagnosed as early stage lung cancer (stage I-II: 40.5% vs 11.1%; P = .023). Group II had larger lung tumor sizes than Group I (4.7 vs 3.5 cm; P = .025). Group I showed better 5-year overall survival than Group II (P = .014, median survival: 27 vs 10 months). Among Group II, only 37% had received image follow up in clinic compared with 67% of Group I cases (P = .025). Patients with chest image follow up in clinics also had better 5-year overall survival (P = .043).

GI-hepatic cancer was the most common primary malignancy in the lung cancer cohort. Patients had better survival outcome when secondary lung cancer was diagnosed in original primary cancer clinic. Chest image screening strategy may contribute better survival in secondary lung cancer due to detection at an earlier stage.
A comparative study of the efficacy of Chinese herbal medicine Duhuo Jisheng decoction combined with DMARDs vs isolated DMARDs for rheumatoid arthritis
Authors: Zhou Xing , Xiang Kemeng , Lu Minyuan , Xia Hanting , Zhou Xingchen , Yuan Xiangyao , Wang Zhenping , Li Kuanglin
Published: December 2020

Background:

Rheumatoid arthritis (RA) is a chronic autoimmune system disease that mainly affects joints throughout the body, causing joint pain, deformity, and even disability. The use of Chinese herbal medicine (CHM) to treat RA has achieved certain effects, and Duohuo Jisheng decoction (DHJSD) is one of them. But there is no high-level evidence to support this result. The purpose of this work is to evaluate the effectiveness of DHJSD combined with DMARDs compared with isolated DMARDs for RA.

Methods:

We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (WF), Chinese Scientific Journals Database (VIP), Chinese databases SinoMed (CBM), PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to October 2020. Two reviewers will independently assess the quality of the selected studies, NoteExpress and Excel software will be used to extract data, and the content will be stored in an electronic chart. Different researchers will separately screen the titles and abstracts of records acquired potential eligibility which comes from the electronic databases. Full-text screening and data extraction will be conducted afterward independently. Statistical analysis will be conducted using RevMan 5.4 software.

Results:

This study will evaluate the efficacy and safety of DHJSD combined with DMARDs compared with isolated DMARDs in the treatment of Rheumatoid arthritis, to provide high-quality, evidence-based clinical recommendations.

Conclusion:

This study will provide reliable evidence on whether Duhuo Jisheng decoction combined with DMARDs compared with isolated DMARDs is more effective in treating RA.

Trial registration number:

INPLASY2020100089.
Iliopsoas hematoma presenting with sudden knee extensor weakness
Authors: Kim Jae Hoon , Yoo Seung Don , Kim Dong Hwan , Han Young Rok , Lee Seung Ah
Published: December 2020

Rationale:

Hematoma of the iliopsoas muscle is a rare condition. Prolonged pressure conditions due to hematoma of the femoral nerve can cause severe pain in the affected groin, hip, and thigh, and quadriceps weakness. We report a rare case of a spontaneous iliopsoas muscle hematoma that caused sudden femoral neuropathy.

Patient concerns:

A 71-year-old woman presented sudden left hip pain and knee extensor weakness. The pain was aggravated with left hip extension. She had a bilateral total hip replacement surgery due to avascular necrosis. She was diagnosed as mild stenosis of the cerebral artery and took aspirin to prevent cerebral artery atherosclerosis.

Diagnosis:

A hip computed tomography scan demonstrated a suspicious fluid collection at the left iliopsoas bursa. We considered the possibility of lower limb weakness due to neuralgic amyotrophy and performed electromyography and enhanced lumbosacral magnetic resonance imaging (MRI). Electromyography finding showed left femoral neuropathy of moderate severity around the inguinal area was diagnosed. On MRI, left iliopsoas bursitis or hematoma, and displacement of the left femoral nerve due to the iliopsoas bursitis/hematoma were observed.

Intervention:

Ultrasonography (US)-guided aspiration of the left iliopsoas hematoma was performed. We started steroid pulse therapy for 8 days.

Outcomes:

After US-guided aspiration and steroid pulse therapy, the patient's knee extension motor grade improved from grade 1 to 2, and the pain was slightly reduced. At 3 weeks after the aspiration procedure, her hip flexion motor grade had improved from grade 3+ to 4 at follow-up.

Lessons:

Imaging studies are fundamental to diagnose of iliopsoas hematoma. Electromyography examination plays an important role in determining the prognosis of patients and lesion site. Despite the negligible change in sitting position, hematoma can develop. Physicians should consider hematoma that cause femoral neuropathy.
Disease severity predicts higher healthcare costs among hospitalized nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) patients in Spain
Authors: Romero-Gomez Manuel , Kachru Nandita , Zamorano Meritxell Ascanio , Darba Josep , Shreay Sanatan
Published: December 2020

The rising prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) presents many public health challenges, including a substantial impact on healthcare resource utilization and costs. There are important regional differences in the burden of NAFLD/NASH, and Spain-specific data are lacking. This retrospective, observational study examined the impact of liver disease severity, comorbidities, and demographics on healthcare resource utilization and costs in Spain.

NAFLD/NASH patients in the Spanish National Health System's Hospital Discharge Records Database (1/1/2006 to 4/30/2017) were categorized into disease severity cohorts as NAFLD/NASH overall, NAFLD/NASH non-progressors, compensated cirrhosis (CC), decompensated cirrhosis (DCC), liver transplant (LT), or hepatocellular carcinoma (HCC). Patients were followed from index date until the earliest of 6 months, disease progression, end of coverage, death, or end of study. Within each cohort, pre- and post-index healthcare resource utilization and costs per patient per month (PPPM) were calculated.

A total of 8,205 patients (mean age 58.4; 54% male) were identified; 5,984 (72.9%) were non-progressors, 139 (1.7%) progressed to CC, 2,028 (24.7%) to DCC, 115 (1.4%) to LT, and 61 (0.7%) to HCC. Pre-index comorbidity burden was high across disease cohorts, and the frequency of comorbidities increased with disease severity. From pre- to post-index, average length of stay (LOS) increased significantly (23%–41%) as did all-cause PPPM costs (44%–46%), with significantly longer LOS and costs in patients with increasing disease severity.

Progression of NAFLD/NASH was associated with significantly higher costs and longer LOS. A coordinated approach is needed to manage resources and costs in Spain.
Copeptin levels predict left ventricular systolic function in STEMI patients
Authors: Pamukcu Hilal Erken , Felekoğlu Mehmet Ali , Algül Engin , Şahan Haluk Furkan , Aydinyilmaz Faruk , Guliyev İlkin , İnci Saadet Demirtaş , Özbeyaz Nail Burak , Nallbani Ali
Published: December 2020

In the present study, we aimed to investigate whether copeptin values on admission are related to left ventricle (LV) systolic function and its improvement at 6 months in ST-segment elevation myocardial infarction (STEMI) patients.

In this single-center, prospective observational study, we included 122 STEMI patients from January 2016 to November 2016. LV systolic functions in the form of global longitudinal strain (GLS) in addition to conventional echocardiography parameters were evaluated on admission and at 6-month. Serum copeptin levels were determined using an ultrasensitive immunofluorescence assay.

The study population was divided into 2 groups according to median values of copeptin. GLS was significantly lower in patients with high copeptin levels compared to those with low copeptin levels at early stage and 6-month (−16% (16–16.5) vs −15% (15–15.5), P < .001 and −18% (18–19) vs −16% (16–16.25), P < .001, respectively). Copeptin values were negatively correlated with an early and 6-month GLS (r = –0.459 at early stage and r = –0.662 at 6-month). In addition, we observed that copeptin values were negatively correlated with the improvement of GLS at 6-month follow-up (r = −0.458, P < .001 and r = −0.357, P = .005, respectively).

Serum copeptin levels in STEMI patients at the time of admission may predict early and 6-month LV systolic function assessed by two-dimensional GLS. To the best of our knowledge, this study is the first to specifically address the relationship between copeptin values and GLS in STEMI patients.
Efficacy of hydroxychloroquine in hand osteoarthritis
Authors: Li Qiang-Qiang , Xie Ya-Dong , Liang Wen-Qiang , Yang Guo-Qing , Zhang Huai-Bin , Wang Yong-Ping
Published: December 2020

Background:

Symptoms of hand osteoarthritis result in activity limitations and lower quality of life. Hydroxychloroquine, which has been used successfully in the treatment of many autoimmune diseases, can suppress inflammation and might also be beneficial in hand osteoarthritis.

Methods:

We plan to perform a systematic review and meta-analysis of randomized clinical trial to determine the symptom-modifying effect of hydroxychloroquine in hand osteoarthritis. We will search PubMed, EMBASE, Cochrane Library, and Web of Science using a comprehensive strategy. The related conference proceedings and reference lists of the included studies will also be checked to identify additional studies. Two reviewers will screen retrieved records, extract information and assess the risk of bias independently. Stata v15.1 software will be used to conduct data synthesis.

Results:

This study will be submitted to a peer-reviewed journal for publication.

Conclusion:

We hope it will provide a relatively comprehensive reference for clinical practice and future relevant clinical trials.

INPLASY registration number:

INPLASY2020110005
Effects of intermittent feeding versus continuous feeding on enteral nutrition tolerance in critically ill patients
Authors: Li Yuanli , Yang Jin , Sun Shunxia , Huang Juan , Zhang Aiguo , Tang Xiaoling
Published: December 2020

Background:

Nutritional support is an indispensable treatment for critically ill patients. Enteral nutrition intolerance is one of the obstacles to the smooth progress of enteral nutrition.

Enteral nutrition can be divided into continuous feeding and intermittent feeding. However, the effectiveness and safety of the 2 ways of nutrition infusion are controversial clinically. Therefore, this meta-analysis further evaluated the effect of intermittent feeding versus continuous feeding on enteral nutrition tolerance in critically ill patients.

Methods:

Cochrane Library, PubMed, Web of Science, EMbase, China Biology Medicine disc (CBM), China Science and Technology Journal Database (VIP), China Journal full-text Database (CNKI), and Wanfang Database were searched for all randomized controlled trials (RCTs) on the effects of intermittent and continuous feeding on enteral nutrition tolerance in critically ill patients. The quality of literatures was strictly evaluated and the data were extracted by 2 investigators. Meta-analysis was carried out by applying RevMan 5.5 software.

Results:

The results of this meta-analysis are published in peer-reviewed journals.

Conclusions:

This study provides reliable evidence-based support for the effects of intermittent and continuous feeding on enteral nutrition tolerance in critically ill patients.

OSF Registration number:

DOI 10.17605/OSF.IO/4BP5X
Reconstruction of skull and dural defects using anterolateral thigh flaps
Authors: Zhang Wan-feng , Gao Qiu-fang , Li Zi-biao , Ma Ya-jun , Niu Xue-tao , Ma Bin , Ren Ke-yi , Huang Ren-chun
Published: December 2020

It is difficult to repair large skull and dural defects. We observed the therapeutic effects of anterolateral thigh flaps with vascular fascia lata for repairing large skull and dural defects.

From December 2008 to June 2019, we repaired large skull and dural defects for 28 cases including 12 cases with scalp malignant tumor and 16 cases requiring removal of titanium mesh which had been once placed due to craniocerebral trauma. The scalp malignant tumor invaded full-thickness skull in 12 cases; and invaded cervical lymph nodes, dura mater or brain tissue in 3 cases. In the 12 cases with scalp malignant tumor, the scalp defects of 12 cm × 9 cm to 22 cm × 18 cm and skull defects of 9 cm × 7 cm to 15 cm × 12 cm after radical tumor resection were repaired using anterolateral thigh flaps of 14 cm × 11 cm to 23 cm × 19 cm with fascia lata of 10 cm × 8 cm to 16 cm × 12 cm. Postoperative radiotherapy and chemotherapy were also performed in the 3 cases with tumor metastasis. In the 16 cases requiring removal of titanium mesh, the skull and dural defects of 8 cm × 7 cm to 15 cm × 11 cm after removal of titanium mesh were repaired using anterolateral thigh flaps of 10 cm × 8 cm to 16 cm × 12 cm.

In all cases, the transplanted anterolateral thigh flap with fascia lata survived after surgery and no vascular crisis occurred. During the followup of 8 months to 9 years, the flap appearance in the head-repaired area was fine, no external hernia of brain tissue occurred, the appearance of the femoral donor site was acceptable, and femoral muscle strength and movements were normal in all cases. The 12 cases with scalp malignant tumor had no local recurrence or distant metastasis.

Repairing the skull and dural defects caused by radical surgery for scalp malignant tumor or removal of titanium mesh using anterolateral thigh flaps with vascular fascia lata, is effective. The appearance in the head-repaired area is fine without external hernia of brain tissue.
Effectiveness of different types of ultrasonography screening for developmental dysplasia of the hip
Authors: Jung Hae Woon , Jang Woo Young
Published: December 2020

Background:

Infant hip screening for early detection of developmental dysplasia of the hip (DDH) is essential as early detection can enable less invasive treatments and achieve better long-term results. A previous meta-analysis assessed about 10,000 infants per group, which is insufficient for evaluating the effect of different infant hip screening strategies on early detection and treatment of DDH. Therefore, we conducted a systematic review and meta-analysis using both randomized controlled trials and cohort studies to determine the effects of universal hip ultrasonography screening (UHUS) and selective hip ultrasonography screening (SHUS) on the incidence of late-diagnosed DDH.

Methods:

A literature search of PubMed, EMBASE, and Cochrane databases was performed. The summary odds ratio (OR) with 95% confidence interval (CI) was calculated using fixed-effects models.

Results:

Meta-analysis of five studies that met the eligibility criteria revealed a significant difference in late-diagnosed DDH (OR 0.44, 95% CI 0.23–0.83) between infants screened using UHUS (n = 29,070) and those screened using SHUS (n = 30,442) in a fixed-effects model without heterogeneity among studies. In the subgroup analysis, meta-analysis of the randomized controlled trials showed no significant difference in late-diagnosed DDH (OR 0.52, 95% CI 0.20–1.39) between infants screened using UHUS (n = 11,453) and those screened using SHUS (n = 12,077) in a fixed-effects model with low heterogeneity among studies (I2 = 0.9%). However, meta-analysis of the cohort studies showed a significant difference in late-diagnosed DDH (OR 0.38, 95% CI 0.17–0.89) between infants screened using UHUS (n = 17,617) and those screened using SHUS (n = 18,345) in a fixed-effects model with low heterogeneity among studies. Sensitivity analysis revealed that the impact of each study on the summary results was not significant. There was no publication bias in our meta-analysis.

Conclusions:

Our meta-analysis suggests that a statistically significant decrease in the incidence of late-diagnosed DDH is possible when UHUS is adopted compared with SHUS. Our study provides information about the effects of different infant hip screening strategies on the incidence of late-diagnosed DDH, which can help decide upon which strategy to apply.
Effects of atorvastatin and aspirin on post-stroke epilepsy and usage of levetiracetam
Authors: Zhao Teng , Ding Ying , Feng Xuemin , Zhou Chunkui , Lin Weihong
Published: December 2020

Objective:

Atorvastatin and aspirin have been used in treating different forms of epilepsy. However, their effect on post-stroke epilepsy (PSE) still needs to be validated by large-scale clinical studies. In addition, their impact on the use of the antiepileptic drug levetiracetam for post-stroke epilepsy remains to be explored. Thus, the aim of this study was to further evaluate the effect of atorvastatin and aspirin on PSE and their effect on the usage of the antiepileptic drug levetiracetam in PSE patients.

Methods:

Patients, aged 65 to 85 years, with newly diagnosed post-ischemic stroke epilepsy from August 30, 2014 to August 30, 2018 were included in the study, with the exclusion of those with coexisting conditions.

Results:

Initially, 1321 patients were included, and 780 remained in the study at the 1-year follow-up. During the study, atorvastatin treatment with or without aspirin reduced the number of clinical epileptic episodes in PSE patients. It also reduced the dosage of levetiracetam and achieved better control of epilepsy compared to levetiracetam mono-treatment. Aspirin co-treatment with levetiracetam did not result in a significant improvement. However, the combination of aspirin with atorvastatin significantly reduced the number of seizures compared to atorvastatin treatment alone.

Conclusion:

Atorvastatin and aspirin co-treatment with levetiracetam can reduce epilepsy in PSE patients and reduce the dosage of levetiracetam required for effective control of PSE.
Arthroscopic treatment of a lipoma arborescens of the elbow
Authors: Paccaud Joris , Cunningham Gregory
Published: December 2020

Introduction:

Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa.

Case's description:

We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension.

Diagnosis:

The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy.

Interventions:

After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis.

Outcome:

At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores.

Conclusion:

This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.
Comparison of noninvasive scoring systems for the prediction of nonalcoholic fatty liver disease in metabolic syndrome patients
Authors: Saokaew Surasak , Kositamongkol Chayanis , Charatcharoenwitthaya Phunchai , Srivanichakorn Weerachai , Washirasaksiri Chaiwat , Chaiyakunapruk Nathorn , Phisalprapa Pochamana
Published: December 2020

Over half of metabolic syndrome (MetS) patients have nonalcoholic fatty liver disease (NAFLD). To prevent its complications, standard routine screening is required, but the human-resource and budgetary implications need to be taken into consideration. This study compared the performances of 4 noninvasive scoring systems in predicting NAFLD in MetS patients. They were the fatty liver index, hepatic steatosis index, lipid accumulation product index, and nonalcoholic fatty liver disease in metabolic syndrome patients scoring system (NAFLD-MS).

Scores were determined for 499 MetS patients, including 249 patients in a type 2 diabetes mellitus (T2DM) subgroup. Ultrasonography was used to diagnose NAFLD. The accuracies and performance of the scoring systems were analyzed using published cutoff values, and comparisons were made of their areas under receiver operating characteristic curves, sensitivities, specificities, positive and negative predictive values, and likelihood ratios.

NAFLD was detected in 68% of the MetS patients and 77% of the MetS patients with T2DM. According to the areas under receiver operating characteristic curves, fatty liver index and hepatic steatosis index provided better performances in predicting NAFLD. NAFLD-MS provided the highest specificity of 99% among the MetS patients as a whole, and it provided even better accuracy with similar performance when applied to the subgroup of MetS patients with T2DM. The maximum cost avoidance from unnecessary ultrasonography was also reported by using NAFLD-MS. In terms of simplicity and ease of calculation, the lipid accumulation product index and NAFLD-MS are preferred.

All 4 scoring systems proved to be acceptable for predicting NAFLD among MetS and T2DM patients in settings where the availability of ultrasonography is limited. NAFLD-MS provided the highest specificity and cost avoidance, and it is simple to use. All 4 systems can help clinicians decide further investigations.
The efficacy of 5-element therapy for senile diabetes with depression
Authors: Peng Sihan , Zhang Xiyu , Liu Ya , Fu Xiaoxu , Zhou Mingyang , Xu Gang , Xie Chunguang
Published: December 2020

Background:

Senile diabetes with depression is a common and frequently-occurring disease, and it is also a difficult and hot point in domestic and international research. However, the efficiency of combination hypoglycemic agents and antidepressants in the treatment of senile diabetes with depression is poor, and new intervention methods are urgently needed. Research shows the 5-element therapy, as a Chinese traditional non-drug intervention, has definite curative effect on the prevention and treatment of various physical and mental diseases. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of 5-element therapy on senile diabetes with depression.

Methods:

The electronic databases including Pubmed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure, Wanfang Database, Sino Med,China Biomedical Literature Database will be searched. The time limit for retrieving studies is from establishment to October 2020 for each database. Randomized controlled clinical trials related to 5-element therapy intervention on senile diabetes with depression will be included. Stata V.13.0 and Review manager 5.3 software will be implemented for data synthesis, sensitivity analysis, subgroup analysis, and the assessment of bias risk. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence.

Results:

This study will provide a quantitative and standardized evaluation for the efficacy of 5-element therapy on senile diabetes with depression.

Conclusion:

This systematic review and meta-analysis will provide the high-quality evidence to assess whether the 5-element therapy has a positive treatment effect for senile diabetes with depression.

Registration number:

INPLASY2020100081.
Efficacy of individualized education in patients with type 2 diabetes mellitus
Authors: Huang Li , Guo Hongyan , Xiu Lihua , Wang Haowen
Published: December 2020

Objective:

To assess the effect of the program of individualized diabetes education on type 2 diabetes mellitus (DM) patients.

Methods:

This is a single-center randomized controlled trial that will be implemented from December 2020 to April 2021. The experiment was granted through the Research Ethics Committee of People's Hospital of Chengyang District (03982765). Patients are randomly assigned to the study group and control group with 50 cases in each group. Patients who meet the following criteria will be included in our study: patients diagnosed with type 2 DM based on the World Health Organization diagnostic criteria in 1999; patients who can take part in the follow-up researches after discharge; patients who can provide the written informed consent. And the exclusion criteria include: the known mental or psychological disorders, for instance, severe anxiety disorders or depression; severe comorbidities, e.g. liver dysfunction, kidney failure, stroke, and cancer; Uncontrolled diabetes complications, for instance, infection, acidosis, as well as peripheral vascular disease. The clinical examination shall be conducted during each follow-up period, and the laboratory examination is implemented as necessary in the process of each hospital visit. At the end of the 6-month study, each patient's blood pressure, waist circumference, body mass index, blood lipids, as well as fasting blood glucose are evaluated.

Results:

Table 1 reveals the comparison of biochemical results and clinical results between the control group and the study group.

Conclusion:

Individualized diabetes education may improve the clinical outcomes in patients with type 2 DM.

Trial registration:

The protocol was registered in Research Registry (researchregistry6232).
Effect of electroacupuncture on restless legs syndrome (RLS) in hemodialysis patients
Authors: Chen Jia-Ming , Chiu Ping-Fang , Chang Yu-Jun , Hsu Po-Chi , Chang Chia-Chu , Lo Lun-Chien
Published: December 2020

Background:

Restless legs syndrome (RLS) is frequent in dialysis patients and occurs predominantly in its most severe forms. The aim of the present study was to evaluate the effects of electroacupuncture (EA) in hemodialysis patients with RLS by heart rate variability (HRV) monitor.

Methods:

One hundred twelve subjects who were hemodialysis patients with RLS will be divided into 2 groups: experimental and control. Each subject will receive the treatment relevant to their group 2 times a week for 4 weeks. After 4 weeks of treatment the subject will enter a 2-week washout period, after which the subjects will switch groups. Measurements will include HRV recordings, International Restless Legs Syndrome Rating Scale (IRLSRS) and Insomnia Severity Index (ISI).

Result:

The results of this study will systematically evaluate the effectiveness and safety of electoracupuncture intervention for hemodialysis patients with RLS.

Discussion:

This study is the first investigation to analyze the relationship between EA and the change of HRV by an objective monitor. If the findings of the current trial are positive, this study will also help support an effective, safe and cheap approach to clinical treatment of this challenging disorder, help foster improved understanding the relationship between autonomic nervous system and RLS, and ultimately contribute to elucidate the mechanisms of EA.

Trial registration:

ClinicalTrials.gov Identifier: NCT04356794; registration date: April 22, 2020.
Measurement of body mass by bioelectrical impedance analysis and computed tomography in cancer patients with malnutrition – a cross-sectional observational study
Authors: Mueller Tara Catharina , Reik Lilly , Prokopchuk Olga , Friess Helmut , Martignoni Marc Eric
Published: December 2020

Malnutrition and cachexia affects the majority of cancer patients and significantly worsens their quality of life and prognosis. However, the diagnostic criteria of malnutrition and cachexia remain a topic under constant debate. To overcome this hurdle, diagnostic tools to objectively detect and quantify the loss of muscle and fat mass are needed. Computed tomography (CT)-based measurement is currently considered the golden standard. Bioelectrical impedance analysis (BIA) is an economical, non-invasive tool but it is seen controversial in patients with cancer and malnutrition because of possible estimation errors.

BIA and CT-based analysis of body mass compartments were performed 172 times in 118 cancer patients, within the nutrition program of our institution. Prevalence of malnutrition was determined according to the global leadership initiative on malnutrition criteria. Data obtained for muscle and fat mass from both BIA and CT were correlated using Pearson's ρ. All analyses were performed with an explorative significance level of 5%.

45.7% of the cohort were classified as “malnourished.” No significant differences were observed between the 2 groups regarding demographic data. Median body mass index, Karnofsky performance status, and nutritional risk score were lower in the malnourished group. Values for muscle and fat mass by BIA and CT were significantly lower in malnourished patients. Correlation of the measured parameters were highly significant between CT-based and BIA measurement. In the overall cohort, correlation of measured muscle mass values by CT and BIA was significant with Pearson's ρ = 0.794 (P < .01). Looking at patients without malnutrition only, Pearson's ρ was 0.754 (P < .01). The correlation of measured fat mass values was equally significant, with Pearson's ρ of 0.748 (P < .01) in the overall cohort and 0.771 (P < .01) in patients with malnutrition.

To our knowledge, this is the first study comparing BIA to CT-based body mass analysis in a large cohort of cancer patients with malnutrition. The results suggest that BIA is a valid diagnostic tool for the assessment of muscle and fat mass, even in patients with malnutrition, and could be implemented for the early detection and short-term follow-up of malnutrition and cachexia.
Sports injury type and psychological factors affect treatment period and willingness-to-pay
Authors: Lee Ye-Seul , Park Deuk Su , Oh Jae Keun , Kim Song-Yi
Published: December 2020

This study aimed to describe the sport injuries of elite collegiate athletes, and to examine the influence of career length, past injuries, and psychological factors on the treatment period and willingness to pay (WTP) for treatment.

A survey was conducted among students of the Department of Physical Education, Korea National Sport University. Results were interpreted through frequency analysis and multiple linear regression analysis.

All students currently in training (n = 624, mean age 21 ± 2 years) participated in this study. 12-month prevalence of sports injuries was 56%. The locations of the most common and severe injuries were the knee, ankle, and back. The most frequent types of common injury were sprain, ruptured ligament, and bruising. The location of injuries varied according to the sports discipline. The treatment period was influenced by sports discipline, career length, location, and type of injury, and fear of further injuries. Treatment period was associated with the reason for fear of injuries, and WTP was influenced by fear of further injuries.

Our study suggests that specific management plans for athletes based on disciplines, past injuries, and their emotional responses to previous injuries are required for rehabilitation and return to sports following treatment.
Assessment of the content, usability, and benefits of the WeChat-based programme for dog bite victims in China
Authors: Du Zhe , Huang Wei , Zhang Yajun , Zhang Peng , Liu Zhongdi , Chen Qingjun , Wang Chuanlin
Published: December 2020

WeChat in China has been used for public health education and the prevention of diseases. This study introduced a WeChat-based program for rabies prevention and evaluated the users’ satisfaction with the program using the technology acceptance model.

An online satisfaction questionnaire was used to survey 315 users who had followed the WeChat official account in China, and their satisfaction scores were assessed and analyzed.

The users were generally satisfied with the WeChat-based program as an educational and instructional tool with the mean satisfaction score for each item ranging from 3.9 to 4.6 out of a maximum of 5.0 and the total mean satisfaction score of 41.5 out of a maximum of 50.0 (SD = 4.3). Urban users showed more satisfaction than rural users (P = .03). Users who were satisfied also reported that they intended to recommend WeChat to others (P = .00).

Findings from the present study indicated that WeChat was considered a useful educational and instructional tool for dog-bite victims among young and urban population. This model of a WeChat-based program for rabies prevention should be expanded to other areas in China.
Investigation of the interaction between proton pump inhibitors and clopidogrel using VerifyNow P2Y12 assay
Authors: Lin Sheng-Feng , Lin Pei-Chin , Chang Chih-Chun , Chang Wei-Lun , Chu Fang-Yeh
Published: December 2020

Background: Randomized trials and observation studies have revealed conflicting results regarding the interaction between clopidogrel and proton pump inhibitors (PPIs). The aim of our study was to provide laboratory evidence regarding whether PPIs blunt the antiplatelet reactivity of clopidogrel.

Methods: We included records of Asian patients who received clopidogrel treatment for cardiovascular or cerebrovascular events and the VerifyNow P2Y12 assay for platelet reactivity monitoring. The responsiveness of antiplatelet effect to clopidogrel was analyzed according to 3 criteria:

Results: Patients treated without PPIs did not differ significantly from those concomitantly treated with PPIs in terms of levels of PI (25.7% ± 24.3% vs 23.0 ± 25.3%, P = .4315), PRU (187.3 ± 74.0 vs 197.4 ± 77.3, P = .3373), or responsiveness to antiplatelet (adjusted absolute risk, 3.5%; 95% confidence interval, − 10.7 to 17.7%; P = .6297). Patients treated with lansoprazole, esomeprazole, pantoprazole, and rabeprazole exhibited no significant differences in PRU or PI levels compared with those treated without PPIs. By contrast, patients treated with dexlansoprazole exhibited a significantly decreased level of PI (25.7% ± 24.3% vs 14.0% ± 21.6%, P = .0297) and responsiveness to clopidogrel under the criterion PI > 20% (adjusted absolute risk: 10.5%; 95% confidence interval: 2.6% to 43.6%; P = .0274).

Conclusion: No robust interaction between clopidogrel and PPIs was found, but caution should be exercised in the concomitant use of dexlansoprazole and clopidogrel in Asians.
Prognostic value of imaging markers from 18FDG-PET/CT in paediatric patients with Hodgkin lymphoma
Authors: Rodríguez Taroco Mónica G. , Cuña Enrique G. , Pages Carolina , Schelotto Magdalena , González-Sprinberg Gabriel A. , Castillo Luis A. , Alonso Omar
Published: December 2020

Objective

Identification of imaging prognostic parameters for early therapy personalisation to reduce treatment-related morbidity in paediatric Hodgkin lymphoma (HL). Our aim was to evaluate quantitative markers from baseline 2-[18F]fluoro-2-deoxy-d-glucose PET/CT as prognostic factors for treatment outcomes. Another goal was assessing the prognostic value of Deauville score at interim PET/CT.

Methods

Twenty-one patients were prospectively enrolled. Median age was 12 years (range 6–17); 13 were female. Patients underwent PET/CT for disease staging (bPET), at the end of two cycles of chemotherapy (iPET) and after chemotherapy. A total of 173 lesions were segmented from bPET. We calculated 51 texture features for each lesion. Total metabolic tumour volume and total lesion glycolysis from bPET were calculated for response prediction at iPET. Univariate and multivariate analyses were used for optimal cut-off values to separate responders at iPET according to the Deauville score.

Results

We identified four texture features as possible independent predictors of treatment outcomes at iPET. The areas under the ROC for univariate analysis were 0.89 (95% CI, 0.75–1), 0.82 (95% CI, 0.64–1), 0.79 (95% CI, 0.59–0.99) and 0.89 (95% CI, 0.75–1). The survival curves for patients assigned Deauville scores 1, 2, 3 and X were different from those assigned a score 4, with 4-year progression free-survival (PFS) rates of 85 versus 29%, respectively (P = 0.05).

Conclusions

We found four textural features as candidates for predicting early response to chemotherapy in paediatric patients with HL. The Deauville score at iPET was useful for differentiating PFS rates.
Clinical association of CXCR4 in primary tumor of papillary thyroid cancer and response to iodine-131 treatment
Authors: Sirakriengkrai Korrakode , Tepmongkol Supatporn , Keelawat Somboon , Techavijit Usanee
Published: December 2020

Object

Papillary thyroid cancer (PTC) has an excellent prognosis. However, patients with such, if refract to radioiodine treatment, increase recurrent and mortality rates. Tumor aggressiveness in primary tumor of PTC expresses CXCR4 chemokine receptor. Thus, CXCR4 expression of the tumor may predict response to radioiodine treatment.

Materials and methods

Retrospective review of seventy-four PTC patients, treated with total/near-total thyroidectomy and radioiodine treatment at King Chulalongkorn Memorial Hospital from January 2007 to 2013, were classified as non-radioiodine-refractory (non-RAIR) or RAIR treatment response. All histopathologic diagnoses were reviewed and paraffin blocks were retrieved for CXCR4 immunostaining, determined by automated digital imaging analysis for intensity and extension. The scores were compared between primary tumour and adjacent normal thyroid tissue as well as between the tissue of non-RAIR and that of RAIR. Factors determining type of RAI response were analyzed.

Results

CXCR4 immunostaining scores of PTC is significantly higher than normal thyroid [2.03 (0.52) and 1.48 (0.75)] [mean (SD)] (P = 0.0001). CXCR4 immunostaining scores in RAIR are potentially higher than non-RAIR [1.95 (0.54) and 2.13 (0.47) (P = 0.149)]. Odds ratio of CXCR4 immunostaining score for predicting RAIR treatment is 1.99 (P = 0.150). CXCR4 immunostaining scores positively associate with tumor size (R = 0.298, P = 0.01); whereas no significant association with other clinicopathologic factors.

Conclusion

Our data support the notion that CXCR4 are significantly expressed in PTC tumor over normal thyroid tissues. However, there is no clinical association with radioiodine treatment response.
Case Report: Acute Abdominal Pain as Presentation of Pneumonia and Acute Pancreatitis in a Pediatric Patient With COVID-19
Authors: Sanchez Raul E. , Flahive Colleen B. , Mezoff Ethan A. , Gariepy Cheryl , Hunt W. Garrett , Vaz Karla K.H.
Published: December 2020

Abdominal pain, nausea, and vomiting are known gastrointestinal symptoms of symptomatic SARS-CoV-2 infection (COVID-19 disease) in pediatric patients.
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There is little literature regarding pancreatitis in COVID-19. We describe a 16-year-old male diagnosed with acute pancreatitis in the setting of a SARS-COV-2 infection and associated fluid balance considerations.
Assessment of Community Pediatric Providers’ Approach to Children With Helicobacter pylori
Authors: Du Nan , Scherer Corey , Porto Anthony
Published: December 2020

In 2016, the European and North American Societies for Pediatric Gastroenterology, Hepatology, and Nutrition updated guidelines for management of Helicobacter pylori in children, adjusting the previous diagnostic and therapeutic approaches in response to changing epidemiology and antibiotic resistance patterns. In this study, we assessed knowledge, practice habits of H. pylori management, and adherence to new guideline recommendations among one state’s community pediatric providers. The majority of the surveyed community pediatric providers are not following the new pediatric guidelines for H. pylori management. An evidence-practice gap for diagnosis and treatment of H. pylori disease can lead to poor resource utilization, inadequate antibiotic usage, increased antibiotic resistance, and prolonged symptoms in patients. By understanding pediatric provider practices, pediatric gastroenterologists can assist in addressing the gap through development of educational interventions for community pediatric providers.