bluuebunny/crossref_metadata_2025 huggingface dataset:
Thrombosis risk of Alport syndrome patients: evaluation of cardiological, clinical, biochemical, genetic and possible causes of inherited thrombophilia and identification of a novel COL4A3 variant
Authors: Eroz Recep , Damar İbrahim H. , Kılıçaslan Onder
Published: April 2020

To evaluate cases with Alport syndrome for laboratory, radiological, ophthalmological, auditory tests, cardiological and inherited thrombophilia risk. Laboratory findings, abdominal and urinary ultrasonography, ophthalmological and auditory tests and cardiological examination of 21 Alport syndrome suspicious cases were performed. Also, collagen type IV alpha three chain (COL4A3) gene, four chain (COL4A4) gene and five chain (COL4A5) genes were sequenced by next-generation sequencing system. In addition, possible causes of inherited thrombophilia were evaluated. A novel (c.2806C>T/p.Gln936Ter) variation in COL4A3 gene was detected in three cases. Also c.221G>A/p.Arg74Gln variation in COL4A5 gene of two cases, c.4421C>T/p.Thr1474Met variation in COL4A4 gene of one case, c.665C>T/p.Pro222Leu variation in COL4A4 gene of one case and compound heterozygous c.4421C>T/(p.Thr1474Met) and c.665C>T/p.Pro222Leu variation in COL4A4 gene of one case were detected. Although 10 (47.6%) cases had microscopic hematuria, six (28.6%) cases had macroscopic hematuria, but there were not hematuria in five (23.8%) of cases. Three cases with variation carrier in COL4A genes and one case without variation carrier had vision problem. Also, one case with variation carrier in COL4A gene had hearing loss. All cases with variation carrier in COL4A genes exclude one had at least one cardiac problems. Also, all cases with variation carrier in COL4A genes had possible causes of inherited thrombophilia risk. In addition to developing risk of progressive kidney failure, sensorineural hearing loss and ocular abnormalities, Alport syndrome cases may have increasing cardiac problems and possible causes of inherited thrombophilia risk. Therefore, these cases should be regularly evaluated and followed for cardiac problems and inherited thrombophilia risk.
Caesalpinia crista coat extract protects red blood cell from sodium nitrite-induced oxidative stress and exhibits antiplatelet activity
Authors: Srinivasa Chandramma , Kengaiah Jayanna , Nandish Sharath Kumar M. , Ramachandraiah Chethana , Hanumegowda Sujatha M. , Shivaiah Ashwini , Santhosh Sebestian , Sannaningaiah Devaraja
Published: April 2020

To understand the RBC protecting efficiency and antiplatelet activity of methanolic extract of Caesalpinia crista coat (MECCC). RBC-protecting activity of MECCC was evaluated using assays, such as DPPH, level of lipid peroxidation, protein carbonyl content, superoxide dismutase and catalase as a marker of oxidative stress whereas, platelet aggregation inhibition was performed using human platelet-rich plasma (PRP). MECCC showed about 76% of DPPH-scavenging activity, with an IC50 value of 71.89 μg/ml. The MECCC reduced the level of lipid peroxidation and protein carboxylation in RBC caused by NaNO2 in a dose-dependent manner. In addition, MECCC normalized the levels of superoxide dismutase (SOD) and catalase (CAT) in oxidative stress-induced RBC in a dose-dependent manner. This suggested the protective effect of MECCC on RBC against oxidative stress. Furthermore, MECCC also exhibited mild antiplatelet activity by inhibiting both ADP and epinephrine agonists that induced platelet aggregation. The noticed inhibition percentage was found to be 28 and 23%, respectively at the concentration of 150 μg. Interestingly, MECCC did not hydrolyse the RBC suggesting its nontoxic properties. MECCC possesses protective effect of RBC against NaNO2 (10 mmol/l) induce oxidative stress and inhibits platelet aggregation.
Coronary bifurcations treated with thin-strut drug-eluting stents: a prespecified analysis of the randomized BIO-RESORT trial
Authors: Buiten Rosaly A. , Warta Sanne , Ploumen Eline H. , Doggen Carine J.M. , van der Heijden Liefke C. , Hartmann Marc , Danse Peter W. , Schotborgh Carl E. , Scholte Martijn , Linssen Gerard C.M. , Zocca Paolo , von Birgelen Clemens
Published: April 2020

Background

Treatment of a coronary bifurcation lesion is often required in routine clinical practice, but data on the performance of very thin-strut biodegradable polymer drug-eluting stents are scarce.

Methods

Comparison of biodegradable polymer and durable polymer drug-eluting stents in an all comers population (BIO-RESORT) is a prospective, multicenter randomized clinical trial that included 3514 all-comer patients, who were randomized to very thin-strut biodegradable polymer-coated sirolimus- or everolimus-eluting stents, versus thin-strut durable polymer-coated zotarolimus-eluting stents. The approach of bifurcation stenting was left at the operator’s discretion, and provisional stenting was generally preferred. This prespecified analysis assessed 3-year clinical outcome of all patients in whom treatment involved at least one bifurcation with a side-branch diameter ≥1.5 mm.

Results

Of all BIO-RESORT trial participants, 1236 patients were treated in bifurcation lesions and analyzed. Single- and two-stent techniques were used in 85.8% and 14.2%, respectively. ‘True’ bifurcation lesions (main vessel and side-branch obstructed) were treated in 31.1%. Three-year follow-up was available in 1200/1236 (97.1%) patients. The main endpoint target vessel failure (composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization) occurred in sirolimus-eluting stents in 42/412 (10.3%) and in zotarolimus-eluting stents in 49/409 (12.1%) patients (P-logrank = 0.40). In everolimus-eluting stents, target vessel failure occurred in 40/415 (9.8%) patients (vs. zotarolimus-eluting stents: P-logrank = 0.26). There was no between-stent difference in individual components of target vessel failure. Findings were consistent in patients with single-vessel treatment and patients treated with a single-stent technique.

Conclusions

Three years after stenting all-comers with bifurcation lesions, clinical outcome was similar with the sirolimus-eluting and everolimus-eluting stents versus the zotarolimus-eluting stent.
Parameters of fluid responsiveness
Authors: Shi Rui , Monnet Xavier , Teboul Jean-Louis
Published: April 2020

Purpose of review

On the basis of recent literature, we summarized the new advances on the use of available dynamic indices of fluid responsiveness.

Recent findings

Reliability of passive leg raising to assess fluid responsiveness is well established provided that a real-time haemodynamic assessment is available. Recent studies have focused on totally noninvasive techniques to assess its haemodynamic effects with promising results. Presence of intra-abdominal hypertension is associated with false-negative cases of passive leg raising. Use of pulse pressure and stroke volume variations is limited and other heart–lung interaction tests have been developed. The tidal volume challenge may overcome the limitation of low tidal volume ventilation. Preliminary data suggest that changes in pulse pressure variation during this test well predict fluid responsiveness. Growing evidence confirms the good predictive performance of the end-expiratory occlusion test. All these dynamic tests allow selecting appropriate fluid responders and preventing excessive fluid administration. Performance of a mini-fluid challenge may help for the decision-making process of fluid management if other tests are not available.

Several new dynamic variables and monitoring techniques to predict fluid responsiveness were investigated in the past years. Nevertheless, further research investigating their reliability and feasibility in larger cohorts is warranted.

Video abstract

http://links.lww.com/COCC/A32
This is your toolkit in hemodynamic monitoring
Authors: Kaufmann Thomas , van der Horst Iwan C.C. , Scheeren Thomas W.L.
Published: April 2020

Purpose of review

To appraise the basic and more advanced methods available for hemodynamic monitoring, and describe the definitions and criteria for the use of hemodynamic variables.

Recent findings

The hemodynamic assessment in critically ill patients suspected of circulatory shock follows a step-by-step algorithm to help determine diagnosis and prognosis. Determination of accurate diagnosis and prognosis in turn is crucial for clinical decision-making. Basic monitoring involving clinical examination in combination with hemodynamic variables obtained with an arterial catheter and a central venous catheter may be sufficient for the majority of patients with circulatory shock. In case of uncertainty of the underlying cause or to guide treatment in severe shock may require additional advanced hemodynamic technologies, and each is utilized for different indications and has specific limitations. Future developments include refining the clinical examination and performing studies that demonstrate better patient outcomes by targeting hemodynamic variables using advanced hemodynamic monitoring.

Determination of accurate diagnosis and prognosis for patients suspected of circulatory shock is essential for optimal decision-making. Numerous techniques are available, and each has its specific indications and value.
Monitoring coherence between the macro and microcirculation in septic shock
Authors: Bakker Jan , Ince Can
Published: April 2020

Purpose of review

Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation.

Recent findings

Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the deterioration of microcirculatory perfusion. However, in many cases the restoration of adequate macrocirculatory parameters is frequently not associated with improvement in microcirculatory perfusion. This relates not only to the cause of shock, where there are some differences between different forms of shock, but also to the type of treatment.

The improvement in macrohemodynamics during the resuscitation is not consistently followed by subsequent changes in the microcirculation. This may result in both over-resuscitation and under-resuscitation leading to increased morbidity and mortality. In this article the principles of coherence and the monitoring of the microcirculation are reviewed.
Effect of cognitive-behavioral therapy with music therapy in reducing physics test anxiety among students as measured by generalized test anxiety scale
Authors: Ugwuanyi Christian S. , Ede Moses O. , Onyishi Charity N. , Ossai Osita V. , Nwokenna Edith N. , Obikwelu Lauretta C. , Ikechukwu-Ilomuanya Amaka , Amoke Chijioke V. , Okeke Agnes O. , Ene Catherine U. , Offordile Edmund E. , Ozoemena Lilian C. , Nweke Maduka L.
Published: April 2020

Background:

The study determined the effect of cognitive-behavioral therapy (CBT) with music in reducing physics test anxiety among secondary school students as measured by generalized test anxiety scale.

Methods:

Pre-test post-test randomized control trial experimental design was adopted in this study. A total of 83 senior secondary students including male (n = 46) and female (n = 37) from sampled secondary schools in Enugu State, Nigeria, who met the inclusion criteria constituted participants for the study. A demographic questionnaire and a 48-item generalized test anxiety scale were used for data collection for the study. Subjects were randomized into treatment and control groups. The treatment group was exposed to a 12-week CBT-music program. Thereafter, the participants in the treatment group were evaluated at 3 time points. Data collected were analyzed using repeated measures analysis of variance.

Results:

The participants who were exposed to CBT-music intervention program significantly had lower test anxiety scores at the post-treatment than the participants in the control group. Furthermore, the test anxiety scores of the participants in the CBT-music group were significantly lower than those in the control group at the follow-up measure. Thus, the results showed a significant effect of CBT with music in reducing physics test anxiety among secondary school students.

Conclusion:

We concluded that CBT-music program has a significant benefit in improving the management of physics test anxiety among secondary school students.
Topiramate for hypoxic ischemic encephalopathy
Authors: Chen Guoming , Chen Yijun , Xie Yaying , Huang Ruilan , Chen Tengyu , Shi Peiyu , Zhang Zhaoping , Hou Yingyue , Xing Wanli , Wei Li
Published: April 2020

Background:

Hypoxic ischemic encephalopathy (HIE) is brain injury caused by different reasons and the most common diagnosed is neonatal HIE. Most of the existing treatments have their own shortcomings or there are still some unexplained mechanisms in it. Topiramate (TPM) is a new drug for the treatment for seizures in neonates with HIE, but is currently used off-label. Our protocol aims to access the efficiency and safety of TPM for HIE.

Methods and analysis:

Eight databases will be searched by 2 independent researchers for the article on the topic of using TPM as treatment for HIE, including PubMed, the Cochrane Central Register of Controlled Trials (Cochrane Library), Embase, and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wang Fang Database and Chinese Science and Technology Periodical database (VIP). The included papers are those published from the established date of the databases to 2019. The therapeutic effects based on the grade of neonatal behavioral neurological assessment will be regarded as the primary outcomes. RevMan V5.3 will be used to compute the data synthesis and carry out meta-analysis. The risk of bias will be appraised by the Cochrane risk of bias tool. Rare ratio for dichotomous outcomes and mean different for continuous data will be expressed with 95% confidence intervals (CI) for analysis. A random effects model or a fixed effects model will be employed, when heterogeneity is found or not. Subgroup analysis and sensitivity analysis will be applied if the heterogeneity is obvious.

Results:

This study will provide the recent evidence of TPM for HIE from reducing seizure acticity.

Conclusion:

The conclusion of this study will provide proof to evaluate if TPM is effective and safe in the treatment of HIE.

PROSPERO registration number: PROSPERO CRD42018117981
Kanglaite injection plus fluorouracil-based chemotherapy on the reduction of adverse effects and improvement of clinical effectiveness in patients with advanced malignant tumors of the digestive tract
Authors: Song Qi , Zhang Jie , Wu Qibiao , Li Guoping , Leung Elaine Lai-Han
Published: April 2020

Background:

The digestive tract malignancies are a series of malignant tumor with high morbidity and mortality. Traditional Chinese medicine (TCM) combined with chemotherapy drugs interventions have been applied for the treatment of malignant tumors in Asian countries for dacades. This study aimed to assess the effectiveness and safety on the combination of Kanglaite injection and fluorouracil-based chemotherapy for treating digestive tract malignancies.

Purpose:

To assess the effectiveness and safety on the combination of Kanglaite injection and fluorouracil-based chemotherapy for digestive tract malignancies.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed when conducting the meta-analysis. Randomized controlled trials (RCTs) of Kanglaite injection combined with fluorouracil-based chemotherapy in the treatment of digestive tract malignant tumors were selected and assessed for inclusion. RevMan 5.3 software (Cochrane Collaboration, Oxford, UK) was used for meta-analysis. The objective response rate (ORR) was defined as the primary endpoint, and the disease control rate (DCR), quality of life (QoL), and toxicities were the secondary outcomes.

Results:

20 RCTs enrolling 1339 patients with advanced digestive tract malignancies were included. The methodological quality of most included trials was low to moderate. Compared with fluorouracil-based chemotherapy alone, Kanglaite injection plus fluorouracil-based chemotherapy can improve DCR (risk ratio (RR) = 1.18, 95% confidence interval (CI) 1.11–1.25, P < .00001), ORR (RR = 1.35, 95% CI 1.18–1.54, P < .00001), QoL (RR = 1.58, 95% CI 1.35–1.85, P < .00001), and can reduce adverse drug reactions (ADRs) such as myelosuppression (RR = 0.33, 95% CI 0.25–0.43, P < .00001), leukopenia (RR = 0.31, 95% CI 0.22–0.43, P < .00001), thrombocytopenia (RR = 0.6, 95% CI 0.38–0.49, P = .03), neutropenia (RR = 0.26, 95% CI 0.12–0.55, P = .0005), anemia (RR = 0.41, 95% CI 0.23–0.75, P = .004), gastrointestinal reaction (RR = 0.35, 95% CI 0.27–0.46, P < .00001), nausea/vomiting (RR = 0.41, 95% CI 0.28–0.61, P < .00001), diarrhea (RR = 0.34, 95% CI 0.18–0.62, P = .0004), hepatotoxicity (RR = 0.28, 95% CI 0.17–0.47, P < .00001), neurotoxicity (RR = 0.58, 95% CI 0.41–0.82, P = .002), mucositis (RR = 0.59, 95% CI 0.29–1.21, P = .15).

Conclusion:

Kanglaite injection combined with fluorouracil-based chemotherapy could remarkably improve the clinical effectiveness and reduce the adverse effects in patients with advanced malignant tumors of the digestive tract which may provide evidence to judge whether TCM is an effective and safe intervention for the digestive tract malignancies.
Surgical treatment for type II macular hole retinal detachment in pathologic myopia
Authors: Xin Wenjian , Cai Xuehong , Xiao Yun , Ji Leibing , Gu Yongxin , Lv Wenjuan , Jiang Jize
Published: April 2020

To observe the effectiveness and complications of inverted internal limiting membrane insertion through 25-G minimally invasive vitrectomy assisted with autologous blood adhesion fixation and combined with gas tamponade type-II macular hole retinal detachment in pathologic myopia.

This was a retrospective study. The best-corrected visual acuity, intraocular pressure, macular hole closure, retinal reattachment, and systemic and ocular adverse events were observed.

Twenty-three eyes were operated. Best-corrected visual acuity before surgery and at 3 and 6 months were 2.25 ± 0.47, 1.85 ± 0.32, and 1.32 ± 0.36 LogMAR (P < .001). On days 2 to 5, all the retinas reattached, and the macular holes closed. On days 5 to 9, 5 eyes showed increased intraocular pressure. At 2 and 4 months, 2 eyes showed retinal detachment recurrence. No serious systemic or ocular adverse events were observed.

This surgical technique showed clinical benefits and no significant complications. Clinical trials are necessary to confirm efficacy and safety.
Carotid intima media thickness in older children and adolescents with HIV taking antiretroviral therapy
Authors: Majonga Edith D. , Chiesa Scott T. , McHugh Grace , Mujuru Hilda , Nathoo Kusum , Odland Jon Oyvind , Kaski Juan Pablo , Ferrand Rashida A.
Published: April 2020

Increased carotid intima-media thickness (cIMT) is reported in both adults and children with human immunodeficiency virus (HIV) in high income settings and is associated with an increased risk of cardiovascular disease, but data from sub-Saharan Africa is lacking.

We assessed cIMT using ultrasound in perinatally HIV-infected children aged 6 to 16 years taking antiretroviral therapy (ART) for ≥6 months compared with HIV-uninfected controls in Harare, Zimbabwe. Groups were compared using unpaired t test and potential predictors of cIMT were assessed using multiple linear regression.

A total of 117 participants with HIV, of whom 55 (45%) were female and 75 healthy uninfected controls were included. Participants with HIV were younger than uninfected controls, 10.7 (2.4) years versus 11.9 (2.6) years (P = .001). Mean cIMT was 0.40 (0.05) mm in those with HIV versus 0.40 (0.04) mm in healthy controls (P = .377). There was no association between cluster of differentiation 4 count, HIV viral load, and duration on ART and cIMT.

Children with HIV taking ART have similar cIMT to uninfected children. Increasing numbers of children with HIV are reaching adulthood and longitudinal studies to assess the effect of long-term HIV and ART on vascular changes are required.
Cerebral oxygen desaturation in patients with totally thoracoscopic ablation for atrial fibrillation
Authors: Li Guohui , Yang Liqiao , Sun Yuan , Shen Sai’e
Published: April 2020

Background:

Epicardial radiofrequency ablation for stand-alone atrial fibrillation under total video-assisted thoracoscopy has gained popularity in recent years. However, severe cardiopulmonary disturbances during the surgery may affect cerebral perfusion and oxygenation. We therefore hypothesized that regional cerebral oxygen saturation (rSO2) would decrease significantly during the surgery. In addition, the influencing factors of rSO2 would be investigated.

Methods:

A total of 60 patients scheduled for selective totally thoracoscopic ablation for stand-alone atrial fibrillation were enrolled in this prospective observational study. The rSO2 was monitored at baseline (T0), 15 min after anesthesia induction (T1), 15 minute after 1-lung ventilation (T2), after right pulmonary vein ablation (T3), after left pulmonary vein ablation (T4) and 15 minute after 2-lung ventilation (T5) using a near-infrared reflectance spectroscopy -based cerebral oximeter. Arterial blood gas was analyzed using an ABL 825 hemoximeter. Associations between rSO2 and hemodynamic or blood gas parameters were determined with univariate and multivariate linear regression analyses.

Results:

The rSO2 decreased greatly from baseline 65.4% to 56.5% at T3 (P < .001). Univariate analyses showed that rSO2 correlated significantly with heart rate (r = -0.173, P = .186), mean arterial pressure (MAP, r = 0.306, P = .018), central venous pressure (r = 0.261, P = .044), arterial carbon dioxide tension (r = -0.336, P = .009), arterial oxygen pressure (PaO2, r = 0.522, P < .001), and base excess (BE, r = 0.316, P = .014). Multivariate linear regression analyses further showed that it correlated positively with PaO2 (β = 0.456, P < .001), MAP (β = 0.251, P = .020), and BE (β = 0.332, P = .003).

Conclusion:

Totally thoracoscopic ablation for atrial fibrillation caused a significant decrease in rSO2. There were positive correlations between rSO2 and PaO2, MAP, and BE.
Successful treatment of a huge hepatic carcinoma with right portal vein thrombosis
Authors: Tang Kezhong , Zhang Bo , Dong Linping , Wang Lantian , Jin Yecheng , Tang Zhe
Published: April 2020

Introduction:

Unlike the traditional associating liver partition and portal vein ligation for staged hepatectomy, it is still controversial whether patients with portal vein thrombosis can receive benefits from liver partition.

Patient concerns:

Right upper abdominal distension for 2 months.

Diagnosis:

Hepatocellular carcinoma with portal vein invasion

Intervention:

Radiofrequency-assisted liver partition with portal vein ligation (RALPP)

Outcomes:

Disease-free survival: 3 months, overall survival: 7 months

Conclusion:

Our results advocate this variation of RALPP for use in patients with huge HCC with portal vein invasion, without enough future liver remnant. Patients can receive benefits from the operation, including a shorter operation time, better recovery, and lower overall costs of the 2-stage procedure.
Hot topics in global perianal fistula research
Authors: Chen Qin , Li Yufei , Wang Xiaofeng , Li Huashan
Published: April 2020

Background:

The number of citations a scientific paper has received indicates its impact within any medical field. We performed a bibliometric analysis to highlight the key topics of the most frequently cited 100 articles on perianal fistula to determine the advances in this field.

Methods:

The Scopus database was searched from 1960 to 2018 using the search terms “perianal fistula” or “anal fistula” or “fistula in ano” or “anal fistulae” or “anorectal fistulae” including full articles. The topic, year of publication, publishing journal, country of origin, institution, and department of the first author were analyzed.

Results:

The median number of citations for the top 100 of 3431 eligible papers, ranked in order of the number of citations, was 100 (range: 65–811), and the number of citations per year was 7.5 (range: 3.8–40.1). The most-cited paper (by Parks et al in 1976; 811citations) focused on the classification of perianal fistula. The institution with the highest number of publications was St Mark's Hospital, London, UK. The most-studied topic was surgical management (n = 47). The country and the decade with the greatest number of publications in this field were the USA (n = 34) and the 2000s (n = 50), respectively.

Conclusion:

The 100 most frequently cited manuscripts showed that surgical management had the greatest impact on the study of perianal fistula. This citation analysis provides a reference of what could be considered the most classic papers on perianal fistula, and may serve as a reference for researchers and clinicians as to what constitutes a citable paper in this field.
Associations of maternal hyperglycemia in the second and third trimesters of pregnancy with prematurity
Authors: Zhao Dong , Yuan ShaSha , Ma Yan , An Ya Xin , Yang Yu Xian , Yang Jin Kui
Published: April 2020

Hyperglycemia in pregnancy (HIP) is related to adverse pregnancy outcomes. However, women with hyperglycemia in the second and third trimester of pregnancy (HISTTP) were not been observed. We aim to reveal associations between HISTTP and prematurity. To confirm which risk factor is better in predicting preterm delivery.

This retrospective study included 660 patients, of which 132 have HISTTP and 528 have euglycemia. Univariate analysis was used to extract risk factors and multivariates logistic regression analysis to obtain odds ratio (OR) for prematurity. Mean decrease gini (MDG) in random forest algorithm was used to rank the risk factors.

HISTTP women have higher prepregnancy BMI and a higher percentage of family history of hypertension, maternal adiposity, maternal anemia, gestational diabetes mellitus (GDM), prematurity, neonatal asphyxia in 1-minute (P < .05). Univariate analysis of prematurity showed that preterm women had higher rate of HISTTP (P < .01), second births, elderly pregnancy, hypertention, family history of hypertention and multiple perinatal infant (P < .05). Multivariate logistic regression analysis indicates that HISTTP (OR = 2.984, P = .0017), maternal hypertension (OR = 5.208, P = .001) and multiple perinatal infants (OR = 59.815, P < .0001) are independent risk factors for prematurity. After ranked the MDG, the top 3 risk factors were multiple perinatal infants, maternal hypertension, HISTTP. MDG of HISTTP is higher than that of GDM.

Women with HISTTP deserve to be concerned, whose prematurity rate are increased. HISTTP is an independent risk factor and a better predictor of prematurity.
The short-term efficacy of mud therapy for knee osteoarthritis
Authors: Hou Chengzhi , Liang Long , Chu Xuelei , Qin Weikai , Li Yongyao , Zhao Yong
Published: April 2020

The objective of this review is to systematically evaluate the short-term efficacy of mud therapy in the treatment of knee osteoarthritis (KOA).

Randomized controlled trials, in which treatment of KOA is mud therapy, were included by systematically searching the PubMed, Embase, and the Cochrane Library databases.

According to inclusion criteria and searching method, 11 articles, containing a total of 1106 patients, were included in the study. Our results showed significant differences in visual analog scale pain score and Western Ontario and McMaster Universities Osteoarthritis Index (pain, stiffness, function). In addition, the heterogeneity of study included is lower (I2 < 25%).

According to the results of this meta-analysis, mud therapy can effectively alleviate the pain and improve joint function for KOA.
Effectiveness of a multifactorial intervention, consisting of self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise, in patients with uncontrolled hypertension taking 2 or more antihypertensive drugs
Authors: Unda Villafuerte Fabián , Llobera Cànaves Joan , Lorente Montalvo Patricia , Moreno Sancho María Lucía , Oliver Oliver Bartolomé , Bassante Flores Patricia , Estela Mantolan Andreu , Pou Bordoy Joan , Rodríguez Ruiz Tomás , Requena Hernández Ana , Leiva Alfonso , Torrent Quetglas Matíes , Coll Benejam José María , D’Agosto Forteza Pilar , Rigo Carratalà Fernando
Published: April 2020

Introduction:

High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure.

Methods/Design:

This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales).

Discussion:

This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).
Quantitative assessments of static and dynamic balance performance in patients with chronic ankle instability
Authors: Zhang Ling , Lu Junlan , Cai Bin , Fan Shuai , Jiang Xin
Published: April 2020

Patients with chronic ankle instability (CAI) have postural-control deficits during center-of-pressure excursions than do healthy individuals. While an external analysis of center-of-pressure excursions in CAI has been performed, a quantitative analysis of center-of-gravity movements, to detect the balance deficits associated with CAI, has yet to be performed. Therefore, the aim of the study is to quantify the balance deficits in patients with unilateral CAI.

Forty-four patients with unilateral CAI (24 men; age, 31.7 ± 5.5 years) and 26 uninjured volunteers (12 men; age, 28.6 ± 5.9 years) underwent Neurocom Balance Manager assessments of dynamic and static balance responses in limits of stability, unilateral stance, and forward lunge tests.

In the limits of stability test, there were no significant group differences in the forward direction; however, reaction times were longer in the CAI group than in the control group in the backward (P = .037, effect size [ES] = 0.49) and rightward directions (P = .032, ES  = 0.47). Furthermore, the CAI group showed more excursions in the rightward (P = .046, ES = 0.50) and leftward directions (P = .002, ES = 0.80), and less directional control in the leftward direction (P = .036, ES = 0.59). In the unilateral stance test, the center of gravity sway velocity was faster in the CAI group than in the control group, whether eyes were opened or closed (P < .05). There were no significant group differences in forward lunge-test outcomes.

Patients with CAI have poor static and dynamic balance performance compared to that in healthy counterparts. Thus, balance retraining should be an essential component of rehabilitation programs for patients with CAI.
Atypical/malignant solitary fibrous tumor of the pancreas with spleen vein invasion
Authors: Li Jingdong , Li Jiangpeng , Xiong Yongfu , Xu Ting , Xu Jian , Li Qiang , Yang Gang
Published: April 2020

Introduction:

Solitary fibrous tumor (SFT) is an uncommon mesenchymal tumor that is most common in the pleura. However, according to previous studies, the SFT of the pancreas is extremely rare; only 20 cases have been reported so far. Here, we conduct a literature review and report the first case of atypical/malignant SFT of the pancreas with spleen vein invasion.

Patient concerns:

The patient is a 61-year-old Chinese male who presented with 1 week of upper abdominal pain. Abdominal magnetic resonance imaging showed a huge mass (>10 cm) at the distal end of the pancreas, and the mass obstructing the splenic vein.

Diagnosis:

Atypical/malignant SFT of the pancreas with splenic vein tumor thrombus.

Interventions:

The patient underwent laparoscopic distal pancreatectomy with splenectomy procedure to achieve a radical resection, and did not undergo chemotherapy or radiotherapy.

Outcomes:

Abdominal computed tomography scans were performed at 1 and 4 months after resection, and no signs of recurrence or metastasis were found (Fig. 1 JOURNAL/medi/04.03/00005792-202004240-00032/figure1/v/2023-09-15T184447Z/r/image-tiff . B).

Conclusion:

The clinical symptoms of atypical/malignant SFT of the pancreas with spleen vein invasion are not atypical, and imaging feature is lack of specificity. Preoperative diagnosis is difficult, and there is a potential for malignancy. However, due to the paucity of randomized control trials, there is no established, globally accepted treatment strategy, radiation therapy and chemotherapy regimens have not demonstrated global effectiveness, and no standardized treatments have been identified. Therefore, we recommend complete surgical resection and close clinical follow-up.
Risk factors for pneumonia in patients with anti-NMDA receptor encephalitis
Authors: Miao Xiaohui , Yuan Pingqiao , Zhao Lihong , Zhang Le , Jiang Xinyue , Cao Hanyu , Shi Hongrui , Li Jinmei , Yang Rong
Published: April 2020

To identify the risk factors of pneumonia in patients with Anti-N-methyl-D-aspartate (Anti-NMDA) receptor encephalitis.

This is a retrospective study.

Department of Neurology in West China Hospital of Sichuan University.

Patients with a definitive diagnosis of anti-NMDA receptor encephalitis.

Risk factors associated with pneumonia were examined by bivariate analysis and multivariate logistic regression model.

A total of 104 patients were included in this study, of which 41% patients (n = 43) were diagnosed with pneumonia at 7 days (range: 4–40 days) after admission. The occurrence of pneumonia was associated with prolonged hospital stays, a higher rate of poor outcome, and extra healthcare costs. Risk factors associated with pneumonia included Glasgow coma scale score (GCS), abnormal movements and hypokalemia.

Pneumonia is a common complication in anti-NMDA receptor encephalitis. In the present study, we found that disorders of consciousness, abnormal movements, and hypokalemia were independent risk factors for pneumonia in inpatients with anti-NMDA receptor encephalitis. Pneumonia prolongs the patients’ hospital stay, hospitalization expenditures, and affects the patients’ prognosis.
Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients
Authors: Wang Minjia , Song Jia , Gong Shijin , Yu Yihua , Hu Weihang , Wang Yueben
Published: April 2020

Introduction:

Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia.

Patient concerns:

In case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI.

Diagnoses:

The patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests.

Interventions:

Fluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given.

Outcomes:

Despite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter.

Conclusion:

Mesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis.
Association of hepatocellular carcinoma with thiazolidinediones use
Authors: Lai Shih-Wei , Lin Cheng-Li , Liao Kuan-Fu
Published: April 2020

The study aimed to investigate the association between the risk of hepatocellular carcinoma and thiazolidinediones use among type 2 diabetic patients who had risk factors for hepatocellular carcinoma.

A population-based case-control study was performed using the database of the Taiwan National Health Insurance Program. The cases consisted of 23580 type 2 diabetic subjects aged 20 to 84 years with newly diagnosed hepatocellular carcinoma between 2000 and 2011. The sex- and age-matched controls consisted of 23580 randomly selected type 2 diabetic subjects without hepatocellular carcinoma between 2000 and 2011. Ever use of thiazolidinediones was defined as subjects who had at least 1 prescription of thiazolidinediones before the index date. Never use of thiazolidinediones was defined as subjects who did not have a prescription of thiazolidinediones before the index date. The odds ratio and 95% confidence interval for the association between hepatocellular carcinoma and cumulative duration of thiazolidinediones use was measured by a multivariable logistic regression model.

Among subjects with any 1 of the comorbidities including alcohol-related disease, cirrhosis, hepatitis B infection, hepatitis C infection, and other chronic hepatitis, a multivariable logistic regression model demonstrated that there was a negative association between hepatocellular carcinoma and every 1-year increase of cumulative duration of thiazolidinediones use (adjusted odds ratio 0.94, 95% confidence interval 0.92–0.97).

There was a negative association in a duration-dependent manner between the risk of hepatocellular carcinoma and thiazolidinediones use among type 2 diabetic patients who had risk factors for hepatocellular carcinoma.
A systematic review and meta-analysis of the efficacy of acupuncture and electroacupuncture against chemotherapy-induced peripheral neuropathy
Authors: Hwang Man-Suk , Lee Hye-Yoon , Choi Tae-Young , Lee Jung-Han , Ko Youn-Seok , Jo Dong Chan , Do Kwangsun , Lee Jin-Hyun , Park Tae-Yong
Published: April 2020

Background:

Chemotherapy-induced peripheral neuropathy (CIPN) occurs in 68.1% of patients within the first month of undergoing chemotherapy; however, standardized treatment for CIPN has not been established yet. The efficacy of acupuncture, a widely used treatment for CIPN in South Korea, has not been studied sufficiently. This study aimed to review the studies that evaluated the efficacy of acupuncture or electroacupuncture (EA) in treating CIPN.

Methods:

A literature search was performed on relevant international databases — MEDLINE, Embase, the Allied and Complementary Medicine Databases, and China National Knowledge Infrastructure — as well as Korean databases — the National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, DBpia, and Korean Studies Information Service System. Randomized controlled trials (RCTs) that aimed to treat CIPN symptoms with acupuncture or EA and set not only a control group with a conventional pharmacological treatment or injection, but also a placebo control or sham-acupuncture group, were included. Meta-analysis was conducted to elucidate the efficacy of acupuncture/EA on the basis of symptom score.

Results:

Of the 13 studies included in the literature review, 12 RCTs compared acupuncture and pharmacological treatments. There were 3 EA RCTs, but only 1 RCT compared EA and sham-EA. A total of 832 participants were included in these studies. Five RCTs showed that acupuncture was more effective than pharmacological treatment in terms of efficacy rate. Regarding the risk of bias summary, the quality of included studies was poor. Only 1 study compared the efficacy of EA and sham EA; therefore, the specific efficacy of acupuncture could not be elucidated.

Conclusion:

Acupuncture is safe, but the symptom-alleviating effect on CIPN can hardly be determined because of methodological deficiencies of the included studies. In terms of the clinical efficacy rate, acupuncture was more effective than conventional pharmacological treatments.

PROSPERO registration number:

CRD42018111509.
Observation of tumor-associated macrophages expression in gastric cancer and its clinical pathological relationship
Authors: Zhu Qing , Wu Xia , Tang Mingyang , Wu Ligao
Published: April 2020

The present study was designed to investigate the expression of tumor-associated macrophages (TAMs) in gastric cancer and its clinicopathological relationship. In addition, we also aimed to analyze the relationship between helicobacter pylori (HP) infection and TAMs in gastric cancer.

The protein expression of CD16 and CD163 in 90 gastric cancer tissues and 30 margin tissues was detected by immunohistochemistry. HP infection was detected in 90 gastric cancer tissues and 30 margin tissues by gram staining and immunohistochemistry.

There was no clear correlation between CD16 macrophages and gastric cancer. The density of CD163 macrophages was not correlated with the general condition of tumor patients, but with tumor size, tumor differentiation, lymphatic metastasis, depth of invasion and TNM stage. Additionally, the infection rate of HP in gastric cancer tissues was significantly higher.

In summary, TAMs are associated with tumor size, degree of differentiation, depth of invasion, lymph node metastasis and TNM stage, suggesting their critical role in the invasion and metastasis of gastric cancer.
Effect of electroacupuncture on diabetic neurogenic bladder
Authors: Han Xuke , Gao Yang , Wang Shengju , Chen Qiu
Published: April 2020

Background:

The most common and bothersome lower urinary tract complication of diabetes mellitus is diabetic neurogenic bladder (DNB). Acupuncture has certain advantages in treating bladder dysfunction including urinary retention and incontinence. Therefore, we think that electroacupuncture (EA) may be beneficial to DNB patients. However, it is not clear whether EA combined with basic western medicine could optimize the therapeutic effect for DNB.

Method/design:

This is a sham-controlled, patient-blinded, pioneer randomized controlled trial (RCT). One hundred fifty eligible patients will be randomly divided into 3 groups: A. basic western medicine (BWC), B. EA with BWC, C. sham EA with BWC. EA treatment will be given twice a week for 12 weeks at bilateral BL23, BL32, BL33, and BL35. The BWC group will received Alpha-lipoic acid (ALA) and methylcobalamin (MC) treatment for 12 weeks, 2 treatment sessions per week. The primary outcome is scored by the 72-hour bladder diary (72h-BD). The secondary outcomes will be scored by the American Urological Association symptom index (AUA-SI), Post-void residual urine volume (PVR) and urodynamic tests. All the assessments will be conducted at baseline and the 12th weeks after the intervention starts. The follow-up assessments will be performed with 72h-BD and AUA-SI in the 4th, 12th, and 24th weeks after intervention ends.

Discussion:

This trial protocol provides an example of the clinical application acupuncture treatment in the management of DNB. This RCT will provide us information on the effect of treating DNB patients with only acupuncture, western medicine therapy (ALA + MC) as well as the combination of both. The additive effect or synergistic effect of acupuncture and basic western medicine will then be analyzed.

Trial registration:

Chinese Clinical Trial Registry, ChiCTR2000030421.
The biomechanical effects of foraminoplasty of different areas under lumbar percutaneous endoscopy on intervertebral discs
Authors: Xie YiZhou , Zhou Qun , Wang Xinling , Jian Qiang , Fan Xiaohong , Yu Yang , Gu Dangwei , Wu WeiDong
Published: April 2020

Background:

We set out to evaluate the biomechanical influence of foraminoplasty on intervertebral discs in different areas under lumber percutaneous endoscopy through the use of a three-dimensional finite element.

Methods:

We established a normal 3D finite element mode of L3–5, using simulate lumbar percutaneous endoscopy by carrying out cylindrical excision of a bone whose diameter was 7.5 mm on the L5 superior articular process and the L4 inferior articular process, respectively. We therefore obtained 3 models. The first was the normal lumbar model, the second the L4 inferior articular process shaped model, while the third was the L5 superior articular process shaped model. We compared the biomechanics of discs of L3/4 and L4/5 in states of forward flexion, backward extension, left and right flexion as well as left and right rotation.

Results:

When the L4 inferior articular process shaped model was in backward extension, left rotation, and right rotation, the stress of the L4/5 disc was greater than in the normal model, especially in the state of extension. When the L5 superior articular process shaped model was in left and right rotation, the biggest stress of the L4/5 disc increased slightly. However, no matter which way the L5 superior articular process or the L4 inferior articular process of model was shaped, the stress impact of the L3/4 disc was small.

Conclusions:

There is more biomechanical influence on the L4/5 disc when carrying out a foraminoplasty on L4 inferior articular process under a lumber percutaneous endoscopy. In addition, the influence of both types of surgery on the stress of L3/4 disc is small.