bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid Retooling, Acquiring New Skills, and Competencies in the Pandemic Era: Implications and Expectations for Physician Continuing Professional Development
Authors: Price David W. , Campbell Craig M.
Published: May 2020

The SARS-CoV-2 (COVID 19) pandemic has necessitated changes in health care delivery, including increases in delivery of care through asynchronous or virtual means, and deployment of clinicians in different teams and settings. Physical distancing and redeployment of clinicians has also necessitated changes in health care continuing professional development (CPD). Health care delivery and CPD is unlikely to fully return (in the near term, if at all) to pre-pandemic status. The authors raise questions and opportunities for development and provision of CPD during and after the pandemic
Comparing the performance of air pollution models for nitrogen dioxide and ozone in the context of a multilevel epidemiological analysis
Authors: Butland Barbara K. , Samoli Evangelia , Atkinson Richard W. , Barratt Benjamin , Beevers Sean D. , Kitwiroon Nutthida , Dimakopoulou Konstantina , Rodopoulou Sophia , Schwartz Joel D. , Katsouyanni Klea
Published: May 2020

Background:

Using modeled air pollutant predictions as exposure variables in epidemiological analyses can produce bias in health effect estimation. We used statistical simulation to estimate these biases and compare different air pollution models for London.

Methods:

Our simulations were based on a sample of 1,000 small geographical areas within London, United Kingdom. “True” pollutant data (daily mean nitrogen dioxide [NO2] and ozone [O3]) were simulated to include spatio-temporal variation and spatial covariance. All-cause mortality and cardiovascular hospital admissions were simulated from “true” pollution data using prespecified effect parameters for short and long-term exposure within a multilevel Poisson model. We compared: land use regression (LUR) models, dispersion models, LUR models including dispersion output as a spline (hybrid1), and generalized additive models combining splines in LUR and dispersion outputs (hybrid2). Validation datasets (model versus fixed-site monitor) were used to define simulation scenarios.

Results:

For the LUR models, bias estimates ranged from −56% to +7% for short-term exposure and −98% to −68% for long-term exposure and for the dispersion models from −33% to −15% and −52% to +0.5%, respectively. Hybrid1 provided little if any additional benefit, but hybrid2 appeared optimal in terms of bias estimates for short-term (−17% to +11%) and long-term (−28% to +11%) exposure and in preserving coverage probability and statistical power.

Conclusions:

Although exposure error can produce substantial negative bias (i.e., towards the null), combining outputs from different air pollution modeling approaches may reduce bias in health effect estimation leading to improved impact evaluation of abatement policies.
Model-Informed Bayesian Estimation Improves the Prediction of Morphine Exposure in Neonates and Infants
Authors: Euteneuer Joshua C. , Mizuno Tomoyuki , Fukuda Tsuyoshi , Zhao Junfang , Setchell Kenneth D. R. , Muglia Louis J. , Vinks Alexander A.
Published: May 2020

Background:

Pain control in infants is an important clinical concern, with potential long-term adverse neurodevelopmental effects. Intravenous morphine is routinely administered for postoperative pain management; however, its dose–concentration–response relationship in neonates and infants has not been well characterized. Although the current literature provides dosing guidelines for the average infant, it fails to control for the large unexplained variability in morphine clearance and response in individual patients. Bayesian estimation can be used to control for some of this variability. The authors aimed to evaluate morphine pharmacokinetics (PKs) and exposure in critically ill neonates and infants receiving standard-of-care morphine therapy and compare a population-based approach to the model-informed Bayesian techniques.

Methods:

The PKs and exposure of morphine and its active metabolites were evaluated in a prospective opportunistic PK study using 221 discarded blood samples from 57 critically ill neonates and infants in the neonatal intensive care unit. Thereafter, a population-based PK model was compared with a Bayesian adaptive control strategy to predict an individual's PK profile and morphine exposure over time.

Results:

Among the critically ill neonates and infants, morphine clearance showed substantial variability with a 40-fold range (ie, 2.2 to 87.1, mean 23.7 L/h/70 kg). Compared with the observed morphine concentrations, the population-model based predictions had an R2 of 0.13, whereas the model-based Bayesian predictions had an R2 of 0.61.

Conclusions:

Model-informed Bayesian estimation is a better predictor of morphine exposure than PK models alone in critically ill neonates and infants. A large variability was also identified in morphine clearance. A further study is warranted to elucidate the predictive covariates and precision dosing strategies that use morphine concentration and pain scores as feedbacks.
Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery
Authors: Frey Jordan D. , Zide Barry M.
Published: May 2020

Background:

Any face/neck lift operation has a natural flow of slower and speedier portions; slower when dissecting under the superficial musculoaponeurotic system and around nerves while faster during opening, undermining, defatting, and closing. Surgeons can maximize efficiency with these simple maneuvers.

Methods:

We introduce and demonstrate ten reproducible surgical techniques based on anatomy, which span aspects of the entire face and neck lift procedure including markings, skin flap elevation, sub-superficial musculoaponeurotic system manipulation, preplatysmal fat management, skin re-draping, and post-operative dressings.

Results:

As examples, altered scissors facilitate “push” undermining, scoops reduce time for fat removal in the neck, a non-inset method for lobule creation, and digital measurements for certain technical maneuvers are discussed. Moreover, a block and tackle method of facial nerve blocks is reviewed which permits local-only face and neck lifting as well as hematoma drainage without patient intolerance.

Conclusions:

Implementation of these surgical techniques in face and neck lift procedures allows the surgeon to potentially decrease operative time and work towards minimizing post-operative edema while attaining aesthetic and natural results.
Establishing Photographic Standards for Facial Transplantation: A Systematic Review of the Literature
Authors: Wolfe Erin M. , Najera-Sweeney Guillermo , Berman Zoe P. , Alfonso Allyson R. , Diep Gustave K. , Ramly Elie P. , Rodriguez Eduardo D.
Published: May 2020

Background:

Photography provides a means for objective assessment and dissemination of clinical information. The American Society of Plastic Surgeons (ASPS) and Plastic Surgery Foundation (PSF) published photography guidelines in 2006 to optimize its clinical use. However, photographic documentation of outcomes in facial transplantation (FT) continues to lack standardization. We therefore appraised the current state of FT photography in the peer-reviewed literature.

Methods:

A PubMed search was conducted from July 2005 to July 2019. Studies containing photographs of partial or full FT recipients were included. Non-English language articles, cadaveric and animal studies, technique papers, and case reports were excluded. Data were extracted from 91 articles. Adherence rates were calculated to determine whether published FT photographs followed ASPS/PSF guidelines. Proposed photographic standards particular to FT were then formulated to guide standardization of practice.

Results:

Only 28.6% (26/91) of articles adhered to the photographic conventions of preparation, positioning, and views. Of 162 patient appearances in the 91 articles, 95% (154/162) met the criteria for preparation, 98.8% (160/162) met the criteria for positioning, but only 24.7% (40/162) met the criteria for views.

Conclusions:

Photographic documentation of FT outcomes in the peer-reviewed literature is limited, with inconsistent adherence to ASPS/PSF guidelines. There is substantial deficiency in provision of alternative views, with the majority of publications only depicting the frontal view. FT photography standards should specifically incorporate alternative views, proper lighting and framing, and elimination of distractions, and accommodate for remote patient self-photography. This will promote a transparent and consistent longitudinal evaluation of the surgical results.
A Systematic Review of Autologous Fat Grafting in the Treatment of Acute and Chronic Cutaneous Wounds
Authors: Malik Dean , Luck Joshua , Smith Oliver J. , Mosahebi Afshin
Published: May 2020

Background:

There is a growing interest in the regenerative potential of autologous fat. Adipose-derived stem cells, within the stromal vascular fraction of lipoaspirate samples, demonstrate anti-inflammatory, immunomodulatory, and angiogenic properties. This systematic review aimed to determine the efficacy and safety of autologous fat therapies for wound healing, with an evaluation of the quality of evidence provided by the literature.

Methods:

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Ovid Medline, Embase, and Cochrane Library databases from inception to November 2018. We included all human studies where wounds were treated with lipotransfer, cell-assisted lipotransfer, stromal vascular fraction products, or isolated adipose-derived stem cells. Study screening and data extraction were performed by 2 authors. The quality of evidence was evaluated using the GRADE approach.

Results:

The search strategy returned 5027 citations. From these, 10 observational case series were included in the qualitative synthesis; there were no randomized controlled trials. Patient characteristics, wound etiology, and intervention type differed markedly between studies, precluding formal meta-analysis. Autologous fat grafting was associated with satisfactory wound healing in all studies with low complication rates. However, the quality of evidence was consistently very low.

Conclusions:

Autologous fat grafting is an emerging therapeutic option for challenging wounds, although there is insufficient evidence to conclusively demonstrate its effectiveness and adverse event profile. Based on the literature to date, it is unclear whether one type of autologous fat therapy is superior. Well-designed, blinded, prospective randomized controlled trials with adequate methodologic details and objective outcome measure reporting are essential.

PROSPERO ID:

CRD42017081499.
Radiation-Induced Hyalinizing Clear Cell Carcinoma of the Orbit
Authors: Topping Katie L. , Ortiz Angelica , Lin Jonathan H. , Kossler Andrea L.
Published: May 2020

Radiation-induced malignancy is rare, occurring in approximately 0.4%–1.0% of patients receiving external beam radiation therapy. Sarcomas and squamous cell carcinomas are among the most common types of cancers to occur. A 74-year-old woman presented with redness and swelling in the right periorbital region. She had history of multiple recurrent ameloblastoma of the right maxilla, invading the right orbital floor status post 4 surgical resections and 66 Gray external beam radiotherapy 5 years prior. MRI showed a poorly circumscribed mass involving the inferior and lateral orbit. Orbital biopsy revealed clear cell carcinoma with hyalinizing sclerosis and Ewing sarcoma breakpoint region 1 gene arrangement. Due to the extent of orbital disease and presence of perineural invasion, she underwent orbital exenteration. Hyalinizing clear cell carcinoma, a rare cancer, has not been reported to occur in the orbit following radiation. This case highlights the importance of lifetime monitoring in patients who have undergone radiation therapy.
Direct Injection of 5-Fluorouracil Improves Outcomes in Cicatrizing Conjunctival Disorders Secondary to Systemic Disease
Authors: Jovanovic Nina , Russell William W. , Heisel Curtis J. , Hood Christopher T. , Kahana Alon
Published: May 2020

Purpose:

Conjunctival cicatrizing conditions are vision threatening, with poor outcomes despite aggressive systemic therapy. This study tests the utility of serial injections of 5-fluorouracil (5-FU) into the fornices to treat conjunctival scarring in patients with ocular cicatricial pemphigoid or Stevens–Johnson syndrome/toxic epidermal necrolysis.

Methods:

Retrospective cohort study. Fisher exact test and multivariable logistic regression analyses were used to compare clinical outcomes of patients who were administered 5-FU injections versus patients who were not injected. Model fit was examined for multivariable regression.

Results:

One hundred twelve eyes (56 patients) met the inclusion criteria. Thirty-eight eyes (34%) had Stevens–Johnson syndrome/toxic epidermal necrolysis, and 74 eyes (66%) were diagnosed with ocular cicatricial pemphigoid. Twenty-five eyes received ≥1 injection of 5-FU. Sixteen eyes received 1–4 injections, while 9 received ≥5. Median follow-up until last encounter was 18 months. Analysis of each disease entity alone and in combination revealed that 5-FU injections were associated with improvement in final visual acuity, corneal scarring, trichiasis, need for/number of mucous membrane graft surgeries, and severity of symblephara.

Conclusions:

Serial injection of 5-FU in the affected fornices is a promising treatment for severe vision-threatening conjunctival scarring from ocular cicatricial pemphigoid and Stevens–Johnson syndrome/toxic epidermal necrolysis. Given the excellent safety profile of 5-FU around the eye, the solid biologic foundation for using 5-FU in this setting, and the severe risk of vision loss from these disorders, the authors suggest that serial 5-FU injections be adopted as therapy for conjunctival scarring from ocular cicatricial pemphigoid or Stevens–Johnson syndrome/toxic epidermal necrolysis despite the limitations of this retrospective study.
Attentional biases in pediatric chronic pain: an eye-tracking study assessing the nature of the bias and its relation to attentional control
Authors: Soltani Sabine , van Ryckeghem Dimitri M.L. , Vervoort Tine , Heathcote Lauren C. , Yeates Keith , Sears Christopher , Noel Melanie
Published: May 2020

Attentional biases are posited to play a key role in the development and maintenance of chronic pain in adults and youth. However, research to date has yielded mixed findings, and few studies have examined attentional biases in pediatric samples. This study used eye-gaze tracking to examine attentional biases to pain-related stimuli in a clinical sample of youth with chronic pain and pain-free controls. The moderating role of attentional control was also examined. Youth with chronic pain (n = 102) and pain-free controls (n = 53) viewed images of children depicting varying levels of pain expressiveness paired with neutral faces while their eye gaze was recorded. Attentional control was assessed using both a questionnaire and a behavioural task. Both groups were more likely to first fixate on high pain faces but showed no such orienting bias for moderate or low pain faces. Youth with chronic pain fixated longer on all pain faces than neutral faces, whereas youth in the control group exhibited a total fixation bias only for high and moderate pain faces. Attentional control did not moderate attentional biases between or within groups. The results lend support to theoretical models positing the presence of attentional biases in youth with chronic pain. Further research is required to clarify the nature of attentional biases and their relationship to clinical outcomes.
Daily intermittent fasting in mice enhances morphine-induced antinociception while mitigating reward, tolerance, and constipation
Authors: Duron David I. , Hanak Filip , Streicher John M.
Published: May 2020

The opioid epidemic has plagued the United States with high levels of abuse and poor quality of life for chronic pain patients requiring continuous use of opioids. New drug discovery efforts have been implemented to mitigate this epidemic; however, new medications are still limited by low efficacy and/or high side effect and abuse potential. Intermittent fasting (IF) has recently been shown to improve a variety of pathological states, including stroke and neuroinflammation. Numerous animal and human studies have shown the benefits of IF in these disease states, but not in pain and opioid treatment. We thus subjected male and female CD-1 mice to 18-hour fasting intervals followed by 6-hour feed periods with standard chow for 1 week. Mice that underwent this diet displayed an enhanced antinociceptive response to morphine both in efficacy and duration using thermal tail-flick and postoperative paw incision pain models. While showing enhanced antinociception, IF mice also demonstrated no morphine reward and reduced tolerance and constipation. Seeking a mechanism for these improvements, we found that the mu-opioid receptor showed enhanced efficacy and reduced tolerance in the spinal cord and periaqueductal gray, respectively, from IF mice using a 35S-GTPγS coupling assay. These improvements in receptor function were not due to changes in mu-opioid receptor protein expression. These data suggest that a daily IF diet may improve the therapeutic index of acute and chronic opioid therapies for pain patients in the clinic, providing a novel tool to improve patient therapy and reduce potential abuse.
Feasibility Study of the Health Empowerment Intervention in Older Adults With Heart Failure
Authors: Thakur Ramesh Devi , Fleury Julie D. , Crawford Shearer Nelma B. , Belyea Michael
Published: May 2020

Background

Of almost 5.7 million Americans with heart failure, 80% are 65 years and older. Empowerment approaches facilitating recognition of personal and social contextual resources may improve well-being in this vulnerable population.

Objective

This research evaluated the feasibility of the Health Empowerment Intervention (HEI) in older adults with heart failure, including effects on health empowerment, purposeful participation, self-management, functional health, and well-being.

Methods

Twenty older adults with heart failure were randomly assigned to HEI or Attention Control conditions. The HEI consisted of 6 weekly sessions based on the Health Empowerment Theory. Outcomes were measured at baseline and at 6 weeks.

Results

Feasibility of the HEI was supported; participants realized significant improvement in health empowerment and purposeful participation in goal attainment.

Conclusions

This research supports the feasibility of the HEI and provides a basis for continued evaluation.
Implementation and Evaluation of a Platelet-Rich Plasma Multimedia Patient Education Tool for Patients With Androgenetic Alopecia
Authors: Givans Sharna
Published: May 2020

Androgenetic alopecia (AGA) is a chronic, progressive hair loss disorder affecting both men and women. It is the most common form of alopecia. Platelet-rich plasma (PRP) is an alternative treatment modality that provides individuals with AGA with a safe and effective treatment option. A practice improvement needs assessment was conducted within a private dermatology practice in South Florida to evaluate the need for a patient education tool for patients with AGA. Upon the completion of this needs assessment, dermatology providers discovered that there is a need for a PRP education tool to aid in patient comprehension of the PRP procedure. This clinical practice improvement study examined the impact of a brief multimedia educational intervention on patient comprehension of PRP for the treatment of AGA. A commercially produced PRP patient education video was viewed by 10 patients with AGA within this practice. Postintervention, the teach-back method was utilized to measure patient comprehension of the PRP procedure. On the basis of the study results, it can be concluded that the utilization of a PRP multimedia patient education tool may provide dermatology providers with a standardized patient education method for patients with AGA and improve patient comprehension of PRP for the treatment of AGA.
Outcomes From an Urgent Care Pre-exposure Prophylaxis Protocol for the Prevention of HIV
Authors: Mayeux Jack J. , Ng Yeow Chye , Bice Matthew M.
Published: May 2020

Pre-exposure prophylaxis (PrEP) and urgent care medical providers can be powerful allies when combined in the fight against HIV infection. Unfortunately, PrEP use in the urgent care setting is underused due to a lack of resources, provider staff knowledge, and comfort on the part of providers. An urgent care–specific PrEP protocol was developed, and 29 providers from six different urgent care facilities in Louisiana participated in a 20-week quality improvement project. The developed urgent care–specific PrEP protocol resulted in an increase in knowledge and comfort and a reduction in barriers associated with PrEP use. Overall, the urgent care PrEP protocol showed the ability to assist the urgent care clinician in many areas previously noted in research as reasons for reduced PrEP use. The urgent care PrEP protocol serves as an additional tool for the urgent care providers in HIV biomedical preventative care. The results of this project are reported using the Standards of Quality Improvement Reporting Excellence.
Hematogenous osteomyelitis in childhood can relapse many years later into adulthood
Authors: Clerc Axelle , Zeller Valerie , Marmor Simon , Senneville Eric , Marchou Bruno , Laurent Frederic , Lucht Frederic , Desplaces Nicole , Lustig Sebastien , Chidiac Christian , Ferry Tristan
Published: May 2020

To describe the epidemiological, clinical, laboratory, and radiological features and the management of adult patients who experienced a relapse between 2003 and 2015 of an acute hematogenous osteomyelitis acquired in childhood.

A retrospective multicentric cohort study was conducted in 5 centers in France.

Thirty-seven patients were included. The median age was 40 years (28–56), and 26 (70%) were male. The first site of infection was the distal femur (n = 23, 62%). The median time between the osteomyelitis in childhood and the relapse in adulthood was 26 years (13–45). Thirty-four (92%) patients reported inflammatory local clinical manifestations, 17 (46%) draining fistula, 10 (27%) fever. Most patients had intramedullary gadolinium deposition (with or without abscess) on magnetic resonance imaging. Most relapses were monomicrobial infections (82%). Staphylococcus aureus was the most commonly found microorganism (82%), expressing a small colony variant phenotype in 3 cases. Most patients (97%) had a surgical treatment, and the median duration of antibiotics for the relapse was 12 weeks. All patients had a favorable outcome, no patient died and no further relapse occurred. We count 2 femoral fractures on osteotomy site.

Osteomyelitis in childhood can relapse later in adulthood, especially in patients with lack of care during the initial episode. Osteotomy and prolonged antimicrobial therapy are required for clinical remission.
A case report of pyopneumopericardium following bungee jumping in a patient with tuberculosis
Authors: Guo Yong Zheng , Li Xiao Feng , Bao Qiong Ling , Song Qun , Yu Hai Ying , Zhu Ming Jian , Su Jun Wei , Zhu Biao , Xu Kai Jin , Li Lan Juan
Published: May 2020

Rationale:

Pyopneumopericardium related to bungee jumping is a rare occurrence in the current antibiotic era. We present a case of esophagus-seeded Streptococcus sanguinis pyopneumopericardium in a young man with tuberculosis who had just completed bungee jumping.

Patient concern:

A 27-year-old man was hospitalized with a 1-day history of fever, chest tightness, and intermittent sharp chest pain after bungee jumping for the first time.

Diagnoses:

Clinical examinations, thoracentesis, and pericardiocentesis revealed pyopneumopericardium, pyopneumomediastinum, and suppurative pleurisy secondary to bungee-jumping-related traumas. Pericardial fluid cultures were positive for S sanguinis, and Mycobacterium tuberculosis complex genetic test was positive in both sputum and pleural effusion.

Interventions:

The patient improved with drainage and comprehensive antimicrobial therapy.

Outcomes:

The patient developed constrictive pericarditis and underwent pericardiectomy after 6 months of anti-tuberculosis treatment. During the 6-month follow-up after surgery, he recovered uneventfully.

Lessons:

This case adds to the long list of bungee-jumping complications. Early diagnosis to initiate appropriate therapy is critical for pyopneumopericardium patients to achieve good outcomes.
Clinical and imaging characteristics of hematologic disease complicated by air leak syndrome
Authors: Zhang Kemin , Shi Bing , Zhai Qiang , Jiang Lihui , Wang Xiaoxue , Jiang Shan , Sun Hongyan
Published: May 2020

There are limited systematic studies on hematologic disease complicated by air leak syndrome (ALS). Physicians in radiology departments and hematology departments have a limited awareness of ALS.

The aim of this study was to explore the similarities and differences in clinical data between the clinical group and imaging group in patients with hematologic disease complicated by ALS.

Clinical and CT data for 59 patients with hematologic disease complicated by ALS in our hospital were retrospectively reviewed. Patients were assessed by clinical grouping and image grouping. Data were compared between groups, and P < .05 was considered statistically significant.

Dyspnea occurred more often in the allo-HSCT (allogeneic hematopoietic stem cell transplantation) group than that in the non–allo-HSCT group (68.8% vs 4.7%, P < .001), there were statistically significant differences in inducing factors between groups, and differences in other aspects were not statistically significant. Chest tightness and dyspnea occurred more often in the allo-HSCT with BO/BOOP (bronchiolitis Obliteran/bronchiolitis obliterans organizing pneumonia) group than those in the allo-HSCT without BO/BOOP group (80.0% vs 9.1%, P = .013), and differences in other aspects were not statistically significant. Chest pain occurred more often in the HPT (hydropneumothorax) group than that in the other 3 groups (pure pneumothorax [PT], pulmonary interstitial emphysema [PIE], complex ALS) (71.4% vs 11.1%, 0.0%, and 26.5%, P = .005); ALS thickness in the HPT group was greater than that in the other 2 groups (PIE and complex ALS) (19.7 vs 3.5 cm and 9.5 cm, P = .001); catheter drainage occurred more often in the HPT group than that in the other three groups (PT, PIE, complexALS) (64.3% vs 22.2%, 0.0%, and 2.9%, P = .001).

ALS is a high risk in male patients who have a low BMI, have leukemia as a basic disease, and have basic lung diseases (eg, BO/BOOP). CT types are mainly complex ALS, HPT, and pure PT. In addition, clinical symptoms for patients in the HPT group are severe, and there is a high prevalence of catheter drainage.
Screening and identification of key biomarkers for retinoblastoma
Authors: Huang Jing , Zhang Lingrui , Li Zimeng , Lu Xuejing
Published: May 2020

Background:

Retinoblastoma (RB) is one of the most common malignant tumors in pediatrics; to clarify the cause of RB, a lot of manpower and material resources have been invested but have not been well explained.

Methods:

To identify the candidate genes in the occurrence and development of the disease, we downloaded the microarray datasets GSE97508, GSE92987, and GSE24673 from the gene expression database (GEO). The differentially expressed gene (DEG) was identified and functional enrichment analysis was performed. The protein–protein interaction network was constructed and analyzed by String and Cytoscape.

Results:

A total of 74 DEGs were identified, including 40 up-regulated genes and 34 down-regulated genes. The rich functions and pathways of DEG include regulating mitosis, cell cycle, DNA transcription process, promoting protein phosphorylation, regulating energy metabolism in vivo, promoting the binding of some macromolecular complexes, and regulating the cell cycle. Twenty-four HUB genes were identified. Biological process analysis showed that these genes were mainly enriched in regulating energy metabolism in vivo, promoting the binding of some small molecules and regulating the cell cycle. Survival analysis showed that DGPDC1, NDC80, SHCBP, TOP2A, and DLGAP5 may be involved in the occurrence, invasion, or recurrence of RB.

Conclusion:

In conclusion, screening DEGs and HUB genes in RB can help us to better understand the mechanism of the occurrence and development of RB at the molecular level, and provide candidate targets for the diagnosis and treatment of RB.
Universal antibiotic prophylaxis may no longer be necessary for patients with acute variceal bleeding
Authors: Ueno Masayuki , Kayahara Takahisa , Sunami Tomohiko , Takayama Hiroshi , Takabatake Hiroyuki , Morimoto Youichi , Yamamoto Hiroshi , Mizuno Motowo
Published: May 2020

A few decades ago, antibiotic prophylaxis for patients with acute variceal bleeding was reported beneficial. However, endoscopic and systemic therapy for variceal bleeding has dramatically improved since then, so the necessity of prophylactic antibiotics can be questioned. In this study, we reevaluated the efficacy of antibiotic prophylaxis in acute variceal bleeding, using the most recent data in our hospital.

We retrospectively analyzed the medical records of 150 patients with acute variceal bleeding who were admitted to Kurashiki Central Hospital between January 2012 and December 2016. We compared the rates of bacterial infection, in-hospital mortality, 5-day rebleeding rate, and 30-day emergency readmission between patients treated or not treated with antibiotic prophylaxis.

Forty-six patients (30.7%) received antibiotic prophylaxis; 104 (69.3%) did not. The rates of the outcomes in patients with antibiotic prophylaxis were 6.5% (bacterial infection), 4.3% (in-hospital mortality), 2.2% (5-day rebleeding), and 10.9% (30-day emergency readmission) and were not significantly different form the corresponding figures in those without antibiotic prophylaxis (1.9%, 7.7%, 1.9%, and 10.6%, respectively). Moreover, these rates in our patients, even without antibiotic prophylaxis, were much lower than rates reported in past years, perhaps because of improvements in care of patients with variceal hemorrhage.

Antibiotic prophylaxis was not associated with significantly better outcomes of bacterial infection, mortality, rebleeding or readmission rate in patients with acute variceal bleeding. Universal antibiotic prophylaxis for patients with acute variceal bleeding should be reconsidered.
Gap balancing versus measured resection in primary total knee arthroplasty
Authors: She Guo-rong , Zha Zhen-gang
Published: May 2020

Background:

Recently, controversy still exists regarding the clinical effects of measured resection or gap-balancing technique in total knee arthroplasty (TKA). The objective of this retrospective study was to compare the clinical outcomes of conventional measured resection technique and computer-assisted gap-balancing technique in TKA.

Methods:

Strengthening the Reporting of Observational studies in Epidemiology checklist. Patients underwent primary TKA by a single surgeon between 2014 and 2016 were reviewed. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included surgical time, intraoperative complications, patient satisfaction, Oxford Knee Score, range of motion, postoperative complications, and revision.

Results:

This study had limited inclusion and exclusion criteria and a well-controlled intervention.

Conclusion:

We were able to directly compare the outcomes of measured resection versus gap-balancing techniques and might reveal a better technique in TKA.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5441).
Essential tremor vs idiopathic Parkinson disease
Authors: Tao Anyu , Chen Guangzhi , Mao Zhijuan , Gao Hongling , Deng Youbin , Xu Renfan
Published: May 2020

Substantia nigra (SN) hyperechogenicity measured by transcranial sonography (TCS) is a promising biomarker for Parkinson disease (PD). The aim of this study was to explore the diagnostic accuracy of SN hyperechogenicity (SN+) for differentiating PD from essential tremor (ET). A total of 119 patients with PD, 106 ET patients and 112 healthy controls that underwent TCS from November 2016 to February 2019 were included in this single-center retrospective case–control study. Two reviewers who were blinded to clinical information independently measured the SN+ by TCS imaging. The diagnostic sensitivity, specificity, and accuracy of TCS imaging were evaluated between the PD and healthy controls and between patients with PD and ET. Interrater agreement was assessed with the Cohen κ statistic. TCS imaging of the SN+ allowed to differentiate between patients with PD and ET with a sensitivity (91.6% and 90.8%) and specificity (91.5% and 89.6%) for readers 1 and 2, respectively. Interobserver agreement was excellent (к = 0.87). In addition, measurement of the SN+ allowed to differentiate between patients with PD and healthy subjects with a sensitivity (91.6% and 90.8%) and specificity (88.4% and 89.3%) for readers 1 and 2, respectively. Interobserver agreement was excellent (к = 0.91). Measurement of SN+ on TCS images could be a useful tool to distinguishing patients with PD from those with ET.
Neonatal pulmonary sequestration (PS) with rhabdomyomas-like hyperplasia
Authors: Liu Xiu-mei , Yuan Li-mei , Wu Yu-rui , Zhou Chun-ju
Published: May 2020

Introduction:

Pulmonary sequestration (PS) is a rare pulmonary congenital malformation characterized by disconnection with the tracheobronchial tree or the pulmonary arterial blood supply thus impeding the connection to the arterial blood supply from systemic circulation, ultimately resulting in a non-functional lung.

Patient concerns:

A 73-day-old boy with rhabdomyomatoid hyperplasia was hospitalized for cough and fever 2 months after birth.

Diagnoses:

Routine B-ultrasound revealed a cystic malformation in the right lung. CT showed increased volume of the right lung accompanied with cystic low-density shadows of different sizes and a blood vessel leading from the abdominal aorta into the lesion lung. Thus, he was diagnosed with PS.

Interventions:

The boy underwent an entire lobectomy of the lower lobe of the right lung. The operation field revealed several malformed blood vessels from the apposition to the right lower lobe. Most of the lung had cystic adenomatoid malformations. Other parts consisted of well-differentiated cystic dilated bronchus and striated muscles. Histopathological examination revealed rhabdomyus fibroblasts distributed throughout the bronchi. Nuclei were located at the margins of the cells. Striated muscle fibers observed as immunological markers (myogenin and desmin) of striated muscles were positively detected.

Outcomes:

The boy recovered uneventfully after his operation and no abnormal clinical findings were found at the 10-month follow-up.

Conclusion:

PS can not only accompany other developmental abnormalities, but can also associate with rhabdomyomatoid hyperplasia. This lesion is not a fatal congenital malformation and instead is a benign lesion affecting only a single lobe. It has a relatively good prognosis.
Trihexyphenidyl induced malignant hyperthermia in a patient with Parkinson's disease complicated with pneumonia
Authors: Zhao Jun , Xu Gang , Feng Congrui , Chen Yuluo , Kang Yanhong , Liu Feng , Ma Wei
Published: May 2020

Introduction:

Drug-induced fever is easy to overlook in respiratory departments. High fever is a rare side effect of trihexyphenidyl, which can be used clinically to treat Parkinson's disease. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a group of clinical syndromes caused by various diseases, resulting in water retention and refractory hyponatremia. However, pneumonia combined with malignant hyperthermia and SIADH has rarely been reported. We describe an unusual case of malignant hyperthermia and refractory hyponatremia due to trihexyphenidyl adverse reaction.

Patient concerns:

Fifty-five-year-old male with pneumonia presented with malignant hyperthermia and refractory hyponatremia has a history of Parkinson's disease.

Diagnosis:

Early considerations related the described hyperthermia findings to the manifestations of pneumonia. However, the last findings were due to trihexyphenidyl adverse reaction.

Interventions:

Broad-spectrum antibiotics, oral and intravenous supplement of concentrated sodium chloride, drug, and physical cooling.

Outcomes:

The patient survived. During the 3-month follow up, the patient was no recurrence of fever or hyponatremia.

Conclusion:

High fever and SIADH can be a rare adverse reaction to trihexyphenidyl. Therefore, possible drug factors should be considered in the case. Consideration of other possible causes can improve early diagnosis and treatment of patients with fever of unknown origins.
Cardioprotective effect of acupuncture for percutaneous coronary intervention-related myocardial injury in patients with coronary artery disease
Authors: Chen Cong , Zhu Xue-ying , Zhou Kun , Li Dong , Lin Qian
Published: May 2020

Background:

Although patients with coronary artery disease (CAD) rely increasingly upon percutaneous coronary intervention (PCI), this therapy causes subsequent the complications of myocardial injury. Acupuncture safely protects the heart from ischemic injury; however, the efficacy of acupuncture for periprocedural myocardial injury after PCI remains unclear.

Methods:

Seven databases in English and Chinese including PubMed, Web of Science, Cochrane Library, Embase, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, and Wanfang Database will be searched. Randomized controlled trials (RCTs) that use acupuncture to treat PCI-related myocardial injury in patients with CAD, regardless of blinding. The crossover randomized trials will be included, but only the pre-crossover data will be analyzed to avoid carryover effects. We will exclude non-RCTs, qualitative studies, uncontrolled clinical trials, and laboratory studies. The measurement of concentration of cardiac troponin (T or I) and MB isoenzyme of creatine kinase will be used as primary outcome. Postprocedural cardiac function and the major adverse cardiac/cerebrovascular event rate will be assessed as secondary outcome. Relevant data were collected independently by 2 reviewers and the third reviewer was responsible for resolving discrepancies through discussion. The Review Manager V.5.3.3 s will be used to perform the data synthesis and subgroup analysis.

Discussion:

This systematic review and meta-analysis would provide convincing evidence of various types of acupuncture that specifically focuses on cardioprotective effect of acupuncture on PCI-related myocardial injury.

Registration:

Open Science Framework (OSF) registries (osf.io/n2e6t) with the registration DOI: 10.17605/OSF.IO/79H2E.
Clinicopathological significance of Ki67 expression in colorectal cancer
Authors: Li Jing , Liu Zhi-ye , Yu Hai-bo , Xue Qing , He Wen-jie , Yu Hai-tao
Published: May 2020

Background:

This study will investigate the diagnostic accuracy of Ki67 expression in colorectal cancer (CC).

Methods:

A comprehensive search in electronic bibliographic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure) will be performed from inception to the February 29, 2020 with no restrictions to the language and publication status. Two authors will examine the collected studies, extract essential data, and appraise study quality separately. If possible, we will estimate receiver operating characteristic (ROC), sensitivity and specificity by utilizing bivariate random effects and hierarchical summary ROC models.

Results:

This study will summarize present evidence to explore the diagnostic accuracy of Ki67 expression in CC.

Conclusion:

The findings of this study will clarify the diagnostic accuracy of Ki67 expression in CC.

Systematic review registration:

INPLASY202030009.
Clinicopathological characteristics of primary central nervous system lymphoma with low 18F-fludeoxyglucose uptake on brain positron emission tomography
Authors: Kim Hye Ok , Kim Jae Seung , Kim Seon-Ok , Chae Sun Young , Oh Seung Jun , Seo Minjung , Lee Suk Hyun , Oh Jungsu S. , Ryu Jin-Sook , Huh Joo-ryung , Kim Jeong Hoon
Published: May 2020

Primary central nervous system lymphoma (PCNSL) typically shows a strong uptake of 18F-fludeoxyglucose (FDG) imaged by positron emission tomography (PET). Uncommonly, PCNSL demonstrates a low uptake on FDG PET. We investigated the clinicopathological characteristics of the unusual cases of PCNSL with low FDG uptake.

We retrospectively enrolled 104 consecutive patients with newly diagnosed PCNSL who underwent baseline brain FDG PET. The degree of FDG uptake of PCNSL was visually scored by 4 grades (0, ≤contralateral white matter; 1, >contralateral white matter and contralateral gray matter). Grades 0–2 were considered as PCNSL with low uptake. We investigated association of low uptake of PCNSL with the following clinicopathological factors: age, sex, steroid treatment, lactate dehydrogenase level, cerebrospinal fluid protein level, condition of PET scanning, immunohistochemical markers (cluster of differentiation 10 [CD10], B-cell lymphoma 6 [BCL-6], B-cell lymphoma 2 [BCL-2], multiple myeloma oncogene 1 [MUM1], Epstein-Barr virus [EBV] protein, and Ki67), location of lesions, tumor size, multiplicity of lesions, involvement of deep brain structures, and cystic or necrotic appearance of lesions.

Of the 104 patients with PCNSL, 14 patients (13.5%) showed PCNSL with low FDG uptake on PET. Among various clinicopathological factors, MUM1 negativity was the only factor associated with low FDG uptake PCNSL by univariate (P = .002) and multivariate analysis (P = .007).

This study suggests that the different clinicopathological characteristics between patients with high uptake and low uptake of PCNSL on FDG PET is closely associated with lack of MUM1, a protein known to be a crucial regulator of B-cell development and tumorigenesis.
Effects of dexmedetomidine on cognitive function in elderly patients after laparoscopic cholecystectomy
Authors: Li Na , Xiong Lu , Wu Ye-Hua , Chen Xiao-Jian , Meng Ya-Zhen , Li Shuang-Feng , Xiong Ya-Qin
Published: May 2020

Background:

Although many studies have reported the effects of dexmedetomidine on cognitive function (CF) in elderly patients after laparoscopic cholecystectomy (LCT), to this date, its effects are still not well understood. The aim of this study is to produce a qualitative synthesis of assessing the effects of dexmedetomidine on CF in elderly patients after LCT.

Methods:

We will conduct a comprehensive search in Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, VIP Database, WANGFANG Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the commencement to March 31, 2020 without restrictions of language and publication status. In addition, we will also search grey literature, including conference abstracts, dissertations, reference lists of included studies and relevant reviews. All potential studies will be identified independently by 2 authors to determine their inclusion against previously defined eligibility criteria. The quality of selected papers will be assessed using Cochrane risk of bias tool. All statistical analysis will be performed using RevMan 5.3 software.

Results:

This study will provide a synthesis of the current available data on assessing the effects of dexmedetomidine on CF in elderly patients after LCT.

Conclusions:

Its findings will provide qualitative evidence to better understand the effects of dexmedetomidine on CF in elderly patients after LCT.

INPLASY Registration Number: INPLASY202040030.
Association between serum lipoprotein levels and cognitive impairment in acute cerebral infarction
Authors: Wei Chun-Jie , Zou Chun-Ying , Wang Zeng-Mian , Jiang Yao-Jia
Published: May 2020

Background:

The objective of this study is to examine the association between serum lipoprotein levels (SLL) and cognitive impairment (CI) in patients with acute cerebral infarction (ACI).

Methods:

All published studies will be searched from the following electronic databases: PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, WANGFANG, and China National Knowledge Infrastructure from inauguration of each electronic database up to March 1, 2020. In addition, we will also search other sources, such as dissertations, Google scholar, conference proceedings, and reference lists of relevant reviews. We will not apply any language restrictions to the electronic databases. Two researchers will independently carry out literature selection, data collection, and methodological quality. A third researcher will help to solve any divergences by discussion. The RevMan 5.3 software will be employed to pool the collected data and to analyze the outcome data.

Results:

This study will scrutinize the association between SLL and CI in patients with ACI.

Conclusions:

The results of this study will present helpful evidence of the association between SLL and CI in patients with ACI.

Registration number: INPLASY202040018.
Risk factors for recurrent autoimmune liver diseases after liver transplantation
Authors: Chen Chongfa , Ke Ruisheng , Yang Fang , Cai Qiucheng , Liu Jianyong , Huang Xinghua , Chen Jianwei , Xu Fengfeng , Jiang Yi
Published: May 2020

Background:

Autoimmune liver disease (ALD) is a chronic liver disease caused by immune dysfunction in the body. However, no causative or curative medical treatment with proven efficacy exists to cure ALDs, and liver transplantation (LT) remains the only effective treatment available. However, the problem of recurrence of ALDs (rALDs) still remains after LT, which seriously affects the survival rate of the patients. Therefore, clinicians need to be aware of the risk factors affecting rALDs after LT. Therefore, this meta-analysis aims to define the risk factors for rALDs, which include the recurrence of primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis.

Methods:

A systematic search in Pubmed, Embase, Cochrane library and Web of Science databases was performed from 1980 to 2019. The inclusion criteria were risk factors for developing rALDs after LT. However, case series, case reports, reviews, meta-analysis and studies only including human immunodeficiency virus cases, children, and pregnant patients were excluded.

Results:

The electronic database search yielded 1728 results. Sixty-three retrospective cohort studies met the inclusion criteria and 13 were included in the meta-analysis. The final cohort included 5077 patients, and among them, 21.96% developed rALDs. Colectomy before LT, HR 0.59 (95% confidence interval [CI]: 0.37-0.96), cholangiocarcinoma, HR 3.42 (95% CI: 1.88–6.21), multiple episodes of acute cellular rejection, HR 2.07 (95% CI: 1.27–3.37), model for end-stage liver disease score, HR 1.05 (95% CI: 1.02–1.08), use of mycophenolate mofetil, HR 1.46 (95% CI: 1.00–2.12) and the use of cyclosporin A, HR 0.69 (95% CI: 0.49–0.97) were associated with the risk of rprimary sclerosing cholangitis. In addition, the use of tacrolimus, HR 1.73 (95% CI: 1.00–2.99) and cyclosporin A, HR 0.59 (95% CI: 0.39–0.88) were associated with the risk of rALD.

Conclusions:

Multiple risk factors for rALDs were identified, such as colectomy before LT, cholangiocacinoma, multiple episodes of acute cellular rejection, model for end-stage liver disease score, and especially the use of mycophenolate mofetil, cyclosporin A and tacrolimus.