bluuebunny/crossref_metadata_2025 huggingface dataset:
Is pre-operative axillary ultrasound alone sufficient to determine need for axillary dissection in early breast cancer patients?
Authors: Jamaris Suniza , Jamaluddin Jazree , Islam Tania , See Mee Hoong , Fadzli Farhana , Rahmat Kartini , Bhoo-Pathy Nirmala , Taib Nur Aishah Mohd
Published: May 2021

Pre-operative status of axillary lymph node (ALN) in early breast cancer is usually initially assessed by pre-operative ultrasound, followed by ultrasound-guided needle biopsy (UNB) confirmation. Patients with positive nodal status will undergo axillary lymph node dissection (ALND), while those with negative nodal status will have sentinel lymph node biopsy. ALND is associated with higher morbidity than Sentinel lymph node biopsy. The objective of this study is to determine if axillary ultrasound alone without UNB is predictive enough to assign patients to ALND and to identify ultrasound features that are significantly associated with pathologically positive ALN.

383 newly diagnosed primary breast cancer patients between 2012 and 2014, and who had undergone pre-operative axillary ultrasound in University Malaya Medical Centre with a complete histopathology report of the axillary surgery were retrospectively reviewed. ALN was considered positive if it had any of these features: cortical thickening > 3 mm, loss of fatty hilum, hypoechoic solid node, mass-like appearance, round shape and lymph node size > 5 mm. Post-operative histopathological reports were then analyzed for nodal involvement.

The overall sensitivity, specificity, and accuracy of pre-operative axillary ultrasound in detecting diseased nodes were 45.5%, 80.7%, and 60.3% respectively. The positive (PPV) and negative predictive values were 76.5% and 51.8%. Round shape, loss of fatty hilum and mass-like appearance had the highest PPVs of 87%, 83% and 81.6% respectively and significant odds ratios (ORs) of 5.22 (95% confidence interval [CI]: 1.52 - 17.86), ORs of 4.77 (95% CI: 2.62 - 8.70) and ORs of 4.26 (95% CI: 2.37 - 7.67) respectively (P-value < .05). Cortical thickness of > 3 mm was identified to have low PPV at 69.1%, ORs of 1.71 (95% CI: 0.86 - 3.41, P = .126).

There are features on axillary ultrasound that confer high PPV for axillary involvement i.e. round shape, loss of fatty hilum, and mass-like appearance. In a low resource setting, these features may benefit from ALND without further pre-operative biopsies. However, pre-operative UNB for features with low PPV that is, cortical thickness > 3 mm should be considered to obviate the unnecessary morbidity associated with ALND.
The efficacy and safety of combined methotrexate with anti-vascular endothelial growth factor therapy in treatment of diabetic macular edema
Authors: Bao Yuzhi , Lu Xiaolei , Zhou Yuwei
Published: May 2021

Objective:

There is no review or meta-analysis to compare the efficacy and safety of methotrexate plus anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with diabetic macular edema (DME). It is worthy to critically review the evidence of the assessment of combined therapies to inform clinical practice. Therefore, the purpose of this study was to compare the efficacy and safety of methotrexate plus anti-VEGF therapy in the treatment of DME and to provide evidence for clinical practice.

Methods:

The electronic databases of EMBASE, PubMed, Cochrane Library, and Web of Science were searched from the inception to April 2021 using the following key terms: “diabetic macular edema,” “methotrexate,” and “anti-vascular endothelial growth factor,” for all relevant studies. Additionally, the reference lists from published original articles and relevant reviews were assessed to identify more relevant studies. Only English publications were included. Data were extracted by review of each study for population, mean age, gender, follow-up duration, study design, publishing date, characteristics, and outcomes assessment. The present study was performed using Review Manager (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark).

Results:

We hypothesized that combined therapies would provide better therapeutic benefits compared to single method.

OSF registration number:

10.17605/OSF.IO/APD6 V.
Blastic plasmacytoid dendritic cell neoplasm of the breast
Authors: Lee Hyo-jae , Park Hye Mi , Ki So Yeon , Choi Yoo-Duk , Yun Sook Jung , Lim Hyo Soon
Published: May 2021

Rationale:

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon and aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions with or without involvement of lymph nodes, peripheral blood, or bone marrow. However, breast involvement of BPDCN is rare and there has been no report describing the radiologic features of BPDCN within breast parenchyma.

Patient concerns:

We report a case of a 47-year-old woman who presented with an incidentally detected hypermetabolic breast lesion on PET/CT with concurrent right cheek plaque.

Diagnoses:

Skin biopsy was performed for the right cheek plaque. Mammography and breast ultrasonography were performed to evaluate the breast lesion. The lesion was depicted as a 2.5 cm sized focal asymmetry on mammogram and an irregular heterogeneous echoic mass within the mammary zone of the right upper outer breast. Core needle biopsy was performed for the breast lesion. Histologic diagnosis of the two lesions was BPDCN.

Interventions:

The patient was treated with induction and consolidation chemotherapy and received allogenic peripheral blood stem cell transplantation.

Outcomes:

The patient remains in complete remission state without relapse at 34 months since initial diagnosis.

Lessons:

This is the first case of BPDCN manifested as a breast parenchymal mass and assessed by diagnostic breast imaging tools (mammography and ultrasonography). This case report is significant for BPDCN within the breast parenchyma and presenting rare radiologic description of BPDCN.
Efficacy and safety of Xihuang pill for gastric cancer
Authors: Wang Junwei , Hou Daorui , Peng Yahui , Xiong Jian , Xiong Lu , Tan Xin
Published: May 2021

Background:

Xihuang pill has been widely applied as a promising adjunctive drug for gastric cance. However, the exact effects and safety of Xihuang pill have yet to be systematically investigated. We aimed to summarize the effificacy and safety of Xihuang pill for the treatment of advanced GC through the meta-analysis, in order to provide scientific reference for the design of future clinical trials.

Methods:

The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant randomized controlled trials were searched from PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and echnology Periodical Database, and Chinese Biomedical Literature Database. Papers in English or Chinese published from their inception to October 2020 will be included without any restrictions. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. The RevMan 5.4 and Stata 16.0 software will be applied for statistical analyses. Statistical heterogeneity will be computed by I
2 tests. Sensitivity analysis will be conducted to evaluate the stability of the results. The publication bias will be evaluated by funnel plots and Egger test. The quality of evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluate system.

Results:

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

Conclusion:

The conclusion of this study will provide helpful evidence of the effect and safety of Xihuang pill for the treatment of GC in clinical practice.

OSF registration number:

10.17605/OSF.IO/VFJAK.
Durability of non-nucleotide reverse transcriptase inhibitor-based first-line ART regimens after 7 years of treatment in rural Uganda
Authors: Nanfuka Mastula , Forrest Jamie I. , Zhang Wendy , Okoboi Stephen , Birungi Josephine , Kaleebu Pontiano , Zhu Julia , Tibenganas Samuel , Moore David M.
Published: May 2021

Most antiretroviral therapy (ART) programs in resource-limited settings have historically used non-nucleotide reverse transcriptase inhibitor (NNRTI)-based regimens with limited access to routine viral load (VL) testing. We examined the long-term success of these regimens in rural Uganda among participants with 1 measured suppressed VL.

We conducted a prospective cohort study of participants who had been on NNRTI-based first-line regimens for ≥4 years and had a VL <1000 copies/mL at enrollment in Jinja, Uganda. We collected clinical and behavioral data every 6 months and measured VL again after 3 years. We quantified factors associated with virologic failure (VF) (VL ≥ 1000 copies/mL) using Wilcoxon Rank Sum, chi-square, and Fisher's Exact Tests.

We enrolled 503 participants; 75.9% were female, the median age was 45 years, and the median duration of time on ART was 6.8 years (IQR = 6.0–7.6 years). Sixty-nine percent of participants were receiving nevirapine, lamivudine, and zidovudine regimens; 22.5% were receiving efavirenz, lamivudine, and zidovudine; and 8.6% were receiving other regimens. Of the 479 with complete follow-up data, 12 (2.5%) had VL ≥ 1000 copies/mL. VF was inversely associated with reporting never missing pills (41.7% of VFs vs 72.8% non-VFs, P = .034). There were differences in distribution of the previous ART regimens (P = .005), but no clear associations with specific regimens. There was no association between having a VL of 50 to 999 copies/mL at enrollment and later VF (P = .160).

Incidence of VF among individuals receiving ART for nearly 7 years was very low in the subsequent 3 years. NNRTI-based regimens appear to be very durable among those with good initial adherence.
Gastrointestinal perforation secondary to COVID-19
Authors: Al Argan Reem J. , Alqatari Safi G. , Al Said Abir H. , Alsulaiman Raed M. , Noor Abdulsalam , Al Sheekh Lameyaa A. , Al Beladi Feda’a H.
Published: May 2021

Introduction:

Corona virus disease-2019 (COVID-19) presents primarily with respiratory symptoms. However, extra respiratory manifestations are being frequently recognized including gastrointestinal involvement. The most common gastrointestinal symptoms are nausea, vomiting, diarrhoea and abdominal pain. Gastrointestinal perforation in association with COVID-19 is rarely reported in the literature.

Patient concerns and diagnosis:

In this series, we are reporting 3 cases with different presentations of gastrointestinal perforation in the setting of COVID-19. Two patients were admitted with critical COVID-19 pneumonia, both required intensive care, intubation and mechanical ventilation. The first one was an elderly gentleman who had difficult weaning from mechanical ventilation and required tracheostomy. During his stay in intensive care unit, he developed Candidemia without clear source. After transfer to the ward, he developed lower gastrointestinal bleeding and found by imaging to have sealed perforated cecal mass with radiological signs of peritonitis. The second one was an obese young gentleman who was found incidentally to have air under diaphragm. Computed tomography showed severe pneumoperitoneum with cecal and gastric wall perforation. The third case was an elderly gentleman who presented with severe COVID-19 pneumonia along with symptoms and signs of acute abdomen who was confirmed by imaging to have sigmoid diverticulitis with perforation and abscess collection.

Interventions:

The first 2 cases were treated conservatively. The third one was treated surgically.

Outcome:

Our cases had a variable hospital course but fortunately all were discharged in a good clinical condition.

Conclusion:

Our aim from this series is to highlight this fatal complication to clinicians in order to enrich our understanding of this pandemic and as a result improve patients’ outcome.
Prominent PD-L1-positive M2 macrophage infiltration in gastric cancer with hyper-progression after anti-PD-1 therapy
Authors: Yamaguchi Kyoko , Tsuchihashi Kenji , Tsuji Kunihiro , Kito Yosuke , Tanoue Kenro , Ohmura Hirofumi , Ito Mamoru , Isobe Taichi , Ariyama Hiroshi , Kusaba Hitoshi , Akashi Koichi , Baba Eishi
Published: May 2021

Rationale:

Anti-PD-1 antibody is the standard therapy for treatment-resistant gastric cancer, but only a limited number of patients respond. Additionally, cases of hyper-progressive disease (HPD) in which tumor growth accelerates after anti-PD-1 antibody administration have been reported; however, the biological mechanism has not been elucidated.

Patient concerns:

In the present case, metastatic gastric cancer was treated with the anti-PD-1 antibody, nivolumab, as third-line treatment.

Diagnosis:

After the initiation of nivolumab therapy, a rapidly enlarging para-aortic lymph nodes were observed leading to the diagnosis of HPD.

Interventions:

Multiplex immunohistochemistry was used to examine immune cells infiltrating in the primary tumor and in liver metastasis which were obtained before nivolumab treatment, and in lymph node metastasis which presented with HPD after nivolumab therapy.

Outcomes:

In the primary tumor, helper T (Th) cells, cytotoxic T lymphocytes (CTLs), regulatory T (Treg) cells, and PD-L1-negative macrophages were observed. On the other hand, in metastatic lymph nodes presenting with HPD, PD-L1-positive macrophages prominently increased, while Treg cells, CTLs, and Th cells decreased. PD-L1 expression was not observed in gastric cancer cells among the three specimens.

Lessons:

The findings suggest the possibility that PD-L1-positive M2 macrophage might contribute to acceleration of tumor growth with anti-PD-1 therapy in the present case.
Atrial reconstruction, distal gastrectomy with Ante-situm liver resection and autotransplantation for hepatocellular carcinoma with atrial tumor thrombus
Authors: Tuxun Tuerhongjiang , Apaer Shadike , Yao Gang , Wang Zhipeng , Gu Shensen , Zeng Qi , Aizezijiang Aidan , Wu Jing , Anweier Nuerzhatijiang , Zhao Jinming , Li Tao
Published: May 2021

Rationale:

Hepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures.

Patient concerns:

We present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities.

Diagnoses:

Preoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium.

Interventions:

Distal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed.

Outcomes:

The operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence.

Lessons:

This case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.
Rescue balloon-assisted remodeling technique for protrusion of coil loop
Authors: Ko Hak Cheol
Published: May 2021

Rationale:

Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop.

Patient concerns:

A 53-year-old man was admitted to our hospital with severe bursting headache, nausea, and vomiting. Computed tomography showed subarachnoid hemorrhage and digital subtraction angiography revealed an anterior communicating artery aneurysm. We decided to obliterate the aneurysm with endovascular embolization using detachable coils

Diagnosis:

A small loop protruded into the parent artery during the removal of the microcatheter.

Interventions:

We performed successful repositioning of the protruded coil loop using balloon inflation.

Conclusion:

The rescue balloon-assisted remodeling technique was useful in the management of protrusion of a small coil loop into the parent artery during endovascular coil embolization of an intracranial aneurysm. The procedure was associated with minimal complications.
Using JAK inhibitor to treat cytokine release syndrome developed after chimeric antigen receptor T cell therapy for patients with refractory acute lymphoblastic leukemia
Authors: Zi Fu Ming , Ye Long Long , Zheng Ji Fu , Cheng Jing , Wang Qing Ming
Published: May 2021

Rationale:

Significant concerns about the adverse effects following chimeric antigen receptor T cell (CAR-T) therapy are still remained including cytokine release syndrome (CRS). In rare circumstances, CRS may be refractory to tocilizumab and/or corticosteroids, a new treatment is needed for the management of CRS.

Patient concerns:

We present a case of a 20-year-old male patient with acute lymphoblastic leukemia developed CRS after CD19/CD22 bispecific CAR-T treatment.

Diagnosis:

The patient was diagnosed with BCR-ABL(P210) positive B-ALL and developed CRS after CD19/CD22 bispecific CAR-T treatment.

Interventions:

Tocilizumab and methylprednisolone were administered, unfortunately the patient's symptoms of CRS were still not resolved. Another methylprednisolone and ruxolitinib were administered.

Outcomes:

The persistent fever and hypotension of this patient achieved a rapid clinical remission within hours after ruxolitinib administration.

Lessons:

Ruxolitinib can be used as an alternative therapeutic approach for severe and refractory CRS without impairing CAR-T amplification and anti-tumor effect.
Gait retraining for runners with patellofemoral pain
Authors: Xiao Huan , Li Zeng , Lei Shoubin
Published: May 2021

Introduction:

Patellofemoral pain (PFP) is highly prevalent in runners. Physical therapies were proved to be effective in the treatment of PFP. Gait retraining is an important method of physical therapy, but its effectiveness and safety for PFP remained controversial. Previous review suggests gait retraining in the treatment of PFP warrants consideration. However, recent publications of randomized controlled studies and case series studies indicated the positive effect of gait retraining in clinical and functional outcomes, which re-raise the focus of gait retraining. This paper will systematically review the available evidence, assessing the safety and effectiveness for the use of gait retraining for runners with PEP.

Method and analysis:

A systematic review of relevant studies in Pubmed, Embase, SCOPUS, and Cochrane Library were synthesized. Inclusion criteria are studies evaluating clinical outcomes (i.e., changes to pain and/or function) following running retraining interventions in symptomatic running populations; Studies with less than 10 participants in total or in the running retraining intervention group were excluded. The primary outcomes measured will be pain score, Lower extremity functional scale and training related injuries or complications. Review Manager (Revman Version 5.3) software will be used for data synthesis, sensitivity analysis, meta regression, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Begg and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence.

Ethics and dissemination:

Our aim is to publish this systematic review in a peer-reviewed journal. Our findings will provide information about the safety of gait retraining and their effect on reliving pain and improving function of lower limb on runners with PEP. This review will not require ethical approval as there are no issues about participant privacy.
Predicting in-hospital mortality in ICU patients with sepsis using gradient boosting decision tree
Authors: Li Ke , Shi Qinwen , Liu Siru , Xie Yilin , Liu Jialin
Published: May 2021

Sepsis is a leading cause of mortality in the intensive care unit. Early prediction of sepsis can reduce the overall mortality rate and cost of sepsis treatment. Some studies have predicted mortality and development of sepsis using machine learning models. However, there is a gap between the creation of different machine learning algorithms and their implementation in clinical practice.

This study utilized data from the Medical Information Mart for Intensive Care III. We established and compared the gradient boosting decision tree (GBDT), logistic regression (LR), k-nearest neighbor (KNN), random forest (RF), and support vector machine (SVM).

A total of 3937 sepsis patients were included, with 34.3% mortality in the Medical Information Mart for Intensive Care III group. In our comparison of 5 machine learning models (GBDT, LR, KNN, RF, and SVM), the GBDT model showed the best performance with the highest area under the receiver operating characteristic curve (0.992), recall (94.8%), accuracy (95.4%), and F1 score (0.933). The RF, SVM, and KNN models showed better performance (area under the receiver operating characteristic curve: 0.980, 0.898, and 0.877, respectively) than the LR (0.876).

The GBDT model showed better performance than other machine learning models (LR, KNN, RF, and SVM) in predicting the mortality of patients with sepsis in the intensive care unit. This could be used to develop a clinical decision support system in the future.
Stature estimation for Saudi men based on different combinations of upper limb part dimensions
Authors: Ahmed Altayeb Abdalla
Published: May 2021

Estimating stature based on body/limb parts can help define the characteristics of unidentified bodies. The most studied upper limb part is the hand, although few studies have examined whether stature can be estimated using fingers plus other hand dimensions. Moreover, there is paucity in anthropometric studies that determined whether bilateral whole limb parts (e.g., arms, forearms, and hands) are related to stature among the living subjects.

This prospective cross-sectional study aimed to evaluate the relationship between different upper limb measurements and the stature of Saudi men. Furthermore, I assessed whether upper limb asymmetry was present, and developed regression models to estimate stature based on different available measurements. Stature and 13 upper limb parameters were measured for 100 right-handed Saudi men who were 18 to 24 years old.

All measurements were positively correlated with stature (P < .001), and the best single predictor was the bilateral ulnar length. Asymmetry was more pronounced in the hand measurements. A multiparameter model provided reasonable predictive accuracy (±3.77–5.68 cm) and was more accurate than single-parameter models. Inclusion of the right-side fingers improved the model's accuracy.

This study developed potential models for estimating stature during the identification of bodies of Saudi men.
Effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery
Authors: Du Hong , Zhang Dong , Song Guodong , Zong Xianlei , Jin Xiaolei
Published: May 2021

Background:

In facial contour surgery, due to the narrow field of vision in the oral approach and the abundant blood supply to the maxillofacial area, hemostasis is not easy. The purpose of this study was to evaluate the hemostatic effect of soluble hemostatic gauze.

Methods:

We organized a prospective randomized study of 282 patients receiving facial contouring surgery (4 types of procedures in total) during 2016.1.1 to 2018.12.30. For each type of procedure, patients were randomly divided into study group (received hemostatic gauze) and control group (received sterile gauze). Two groups were compared for each type of procedure regarding 5 major perioperative variables: intraoperative blood loss, operation time, 24-hour postoperative drainage volume, total postoperative drainage volume, and postoperative drainage time. Correlation between variables was analyzed.

Results:

Compared with control group, the study group had higher amount of intraoperative blood loss in mandibular angle ostectomy (MAO) (P < .01) and mandibular angle-body-chin curved ostectomy procedures (P < .05), less total postoperative drainage volume in MAO (P < .01) but not in malarplasty with MAO and partial masseter muscle resection along with MAO procedures. No significant difference was observed between respective study and control groups regarding operation time, 24-hour postoperative drainage volume, and postoperative drainage time in any of the 4 types of surgery. In all 4 types of procedures, a strongly positive correlation was observed between total drainage volume and 24-hour drainage volume in both the study and control groups (r: 0.88–0.97, P < .01).

Conclusion:

The effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery is associated with the type of surgery, which can reduce the risk of postoperative bleeding in MAO. However, for surgery with relatively large amount of intraoperative and postoperative bleeding, the hemostatic gauze had a limited postoperative hemostasis efficacy, which needs further evaluation.
Predictors of bleeding event among elderly patients with mechanical valve replacement using random forest model
Authors: Kim Jisu , Jang InSil
Published: May 2021

Available classification tools and risk factors predicting bleeding events in elderly patients after mechanical valve replacement may not be suitable in Asian populations. Thus, we aimed to identify an accurate model for predicting bleeding in elderly patients receiving warfarin after mechanical valve replacement in a Korean population. In this retrospective cohort study, a random forest model was used to determine factors predicting bleeding events among 598 participants. Twenty-two descriptors were selected as predictors for bleeding. Steroid use was the most important predictor of bleeding events, followed by labile international normalized ratio, history of stroke, history of myocardial infarction, and cancer. The random forest model was sensitive (80.77%), specific (87.67%), and accurate (85.86%), with an area under the curve of 0.87, suggesting fair prediction. In the elderly, drug interactions with steroids and overall physical condition had a significant effect on bleeding. Elderly patients taking warfarin for life require lifelong management.
High-dose vitamin C intravenous infusion in the treatment of patients with COVID-19
Authors: Huang Lifang , Wang Lang , Tan Jianghong , Liu Hong , Ni Yanhui
Published: May 2021

Background:

Patients infected with a virus usually lack vitamin C. High-dose vitamin C has an antiviral effect, and has been used by several researchers to treat COVID-19 by intravenous infusion, achieving good results. However, the efficacy and safety of vitamin C in the treatment of patients with COVID-19 remain unclear. Thus, the aim of the present study was to investigate the efficacy of high-dose vitamin C infusion in the treatment of patients with COVID-19.

Methods:

Electronic databases were searched, including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure database, Chinese Wanfang database, and Chinese Biomedical Literature database. The aim was to collect randomized controlled trials of high-dose vitamin C infusion in the treatment of patients with COVID-19, with the retrieval time being from the establishment of the database to March 2021. In accordance with the pre-designed inclusion/exclusion criteria, all data were extracted independently by 2 researchers. To assess the risk bias in the studies, the Cochrane collaboration's tool for assessing risk of bias was used to assess the risk bias in the studies, while meta-analysis was performed using Revman 5.3 software.

Results:

In the present study, a high-quality comprehensive evaluation is provided of high-dose vitamin C infusion in the treatment of patients with COVID-19.

Conclusion:

Further convincing evidence for the clinical treatment of COVID-19 is provided, in addition to evidence-based guidance for clinical practice.

PROSPERO Registration Number:

CRD42021246342.
Diagnostic value of ultrasound combined with MRI in cholecystolithiasis
Authors: Yang Mingfang , Shi Yu
Published: May 2021

Background:

Early diagnosis of cholecystolithiasis is significant for prevention of further development of situation. Ultrasound is the best choice for the diagnosis of cholecystolithiasis with a sensitivity of >95% and specificity of practically 100%. However, ultrasound is not perfect for it is not so clear sometimes. So, MRI is needed to assist the diagnosing of cholecystolithiasis. Some studies have been conducted to investigate the diagnostic value of ultrasound combined with MRI in cholecystolithiasis, however, the evidence was not enough.

Methods:

We will search the following sources for the identification of trials: The Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science and Technique Journals Database (VIP), and the Wanfang Database. The searches were limited to articles published before 1st, April, 2021, and the language were limited to Chinese and English. Statistical analyses will be conducted with Sata 14.0 software and the evaluation of the quality of the included studies will be performed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

Results:

This study will provide a rational synthesis of current evidences for MRI combined with ultrasound for cholecystolithiasis.

Conclusion:

The conclusion of this study will provide evidence for the diagnostic value of MRI combined with ultrasound for cholecystolithiasis.

Ethics and dissemination:

This protocol will not evaluate individual patient information or affect patient rights and therefore does not require ethical approval. Results from this review will be disseminated through peer-reviewed journals and conference reports.

PROSPERO registration number:

INPLASY202130003
Effects of 45° prone position ventilation in the treatment of acute respiratory distress syndrome
Authors: Zhan Zhenye , Cai Hairong , Cai Huiling , Liang Xingmin , Lai Shikeng , Luo Yajie
Published: May 2021

Background:

Acute respiratory distress syndrome (ARDS) is an increasingly common acute respiratory failure that seriously threaten people's health. ARDS has a case fatality rate of up to 40%. ARDS is a serious threat to the life safety of patients and the quality of life, causing a huge economic burden to individuals, families and society. ARDS has become a large worldwide public health problem. Prone position ventilation (PPV) is an important auxiliary treatment for ARDS, which could improve oxygenation. However, PPV could cause Pressure injuries (PI) and other complications easily. We found that 45° PPV could reduce the incidence of PI, but lack of robust Evidence-based medicine evidence proving its efficacy. Therefore, we designed a randomized controlled trial to evaluate the efficacy of 45° PPV in the treatment of ARDS.

Methods:

A total of 268 patients will be randomly assigned to the control group and the test group (n = 134 each) in a ratio of 1:1. The treatment period is 7 days. The primary outcome measure will be the incidence of PI. The secondary outcomes will include APACHE II score, Braden Scale score, heart rate, systolic blood pressure, diastolic blood pressure, central venous pressure, mean arterial pressure, pH of arterial blood, oxygenation index, oxygen partial pressure, and carbon dioxide partial pressure. The evaluation will be performed at baseline, 1 hour, 12 hour, 48 hour, 5days, 7days after PPPV.

Results:

This study is helpful to evaluate the efficacy of 45° PPV in the treatment of ARDS.

Conclusion:

45° PPV may reduce the incidence of PI and improve oxygenation in patients with ARDS, which has important value in practical application

Trial registration:

ChiCTR2000040436, registration time: November 28, 2020.
The correlation between intimate relationship, self-disclosure, and adaptability among colorectal cancer enterostomy patients
Authors: Du Xixi , Wang Dongyang , Du Huiyong , Zou Qiyun , Jin Yan
Published: May 2021

The postoperative physiological changes and psychological pressure of cancer patients affect the patient's adaptability to the disease, and thus affect the spousal intimate relationship. This study aimed to evaluate the correlation between spousal intimate relationship, self-disclosure, and adaptability among colorectal cancer (CCI) patients with enteric stoma.

This cross-sectional study selected patients with CCI in Henan Province from February 2018 to October 2020. The Marital Adjustment Test (MAT), the Distress Disclosure Index scale, and the Ostomy adjustment inventory-20 scale were used to collect relevant data of the participants. A Pearson correlation analysis was used to test the correlation between variables, and multiple stepwise regression analysis was used to test the influence of general information on the intimate relationship, self-disclosure, and adaptability.

Among the respondents, 42.6% had a spousal intimate relationship problem, 58.4% had a low or moderate level of self-disclosure, and 90.8% were at a low or moderate level of adaptation. Education background, self-care ability, and postoperative time were associated with a couple's intimate relationship. Average monthly household income, gender, and place of residence were associated with self-disclosure. Self-care ability, average monthly household income, postoperative time, and educational background were associated with adaptation.

Healthcare workers should provide more health education training to guide CCI enterostomy patients to express their thoughts and feelings with each other increase self-disclosure, so as to enhance their intimate relationship then improve their adoption to ostomy, finally elevate their quality of life.
Salt intake causes B-type natriuretic peptide elevation independently of blood pressure elevation in the general population without hypertension and heart disease
Authors: Ohashi Naro , Takase Hiroyuki , Aoki Taro , Matsuyama Takashi , Ishigaki Sayaka , Isobe Shinsuke , Fujikura Tomoyuki , Kato Akihiko , Yasuda Hideo
Published: May 2021

Excessive salt intake causes hypertension and cardiovascular diseases (CVDs). B-type natriuretic peptide (BNP) is synthesized and released from the ventricle, and is a surrogate marker reflecting various CVDs. Moreover, when a slight BNP elevation is shown, it leads to a poor prognosis in the general population. However, the relationship between salt intake and BNP levels in the general population remains unclear, especially in those without hypertension and heart diseases.

In this study, we recruited 1404 participants without hypertension and electrocardiogram abnormalities, who received regular annual health check-ups in Japan. Plasma BNP levels were measured, and daily salt intake levels were evaluated using urinary samples. In addition, some clinical parameters were obtained, and the data were cross-sectionally analyzed.

The median of plasma BNP levels was 10.50 pg/mL, and daily salt intake was 8.50 ± 1.85 g. When dividing participants into quartiles according to daily salt intake, those with the highest daily salt intake revealed the highest plasma BNP levels. Plasma BNP levels were significantly and positively associated with daily salt intake. Moreover, multiple linear regression analyses revealed that plasma BNP levels showed a significant positive association with daily salt intake levels after adjustments.

Plasma BNP levels were significantly and positively associated with daily salt intake after adjustment in the general population. Plasma BNP levels may be a surrogate marker reflecting salt-induced heart diseases.
A Comprehensive Review of State Vision Screening Mandates for Schoolchildren in the United States
Authors: Wahl Madison D. , Fishman Donna , Block Sandra S. , Baldonado Kira N. , Friedman David S. , Repka Michael X. , Collins Megan E.
Published: May 2021

SIGNIFICANCE

Methods and frequency of vision screenings for school-aged children vary widely by state, and there has been no recent comparative analysis of state requirements. This analysis underscores the need for developing evidence-based criteria for vision screening in school-aged children across the United States.

PURPOSE

The purpose of this study was to conduct an updated comprehensive analysis of vision screening requirements for school-aged children in the United States.

METHODS

State laws pertaining to school-aged vision screening were obtained for each state. Additional information was obtained from each state's Department of Health and Education, through their websites or departmental representatives. A descriptive analysis was performed for states with data available.

RESULTS

Forty-one states require vision screening for school-aged children to be conducted directly in schools or in the community. Screening is more commonly required in elementary school (n = 41) than in middle (n = 30) or high school (n = 19). Distance acuity is the most commonly required test (n = 41), followed by color vision (n = 11) and near vision (n = 10). Six states require a vision screening annually or every 2 years.

CONCLUSIONS

Although most states require vision screening for some school-aged children, there is marked variation in screening methods and criteria, where the screening occurs, and grade levels that are screened. This lack of standardization and wide variation in state regulations point to a need for the development of evidence-based criteria for vision screening programs for school-aged children.
Interpreting Retinal Nerve Fiber Layer Reflectance Defects Based on Presence of Retinal Nerve Fiber Bundles
Authors: Swanson William H. , King Brett J. , Burns Stephen A.
Published: May 2021

SIGNIFICANCE

Adaptive-optics scanning-laser-ophthalmoscopy (AOSLO) retinal imaging of the retinal nerve fiber layer (RNFL) helps predict the severity of perimetric damage based on absence of fibers and projection of the defects in en face images of the RNFL from spectral-domain optical coherence tomography (SD-OCT).

PURPOSE

En face images of the RNFL reveal reflectance defects in patients with glaucoma and predict locations of perimetric defects. These defects could arise from either loss of retinal nerve fiber bundles or reduced bundle reflectance. This study used AOSLO to assess presence of bundles in areas with RNFL reflectance defects on SD-OCT.

METHODS

Adaptive-optics scanning laser ophthalmoscopy was used to image a vertical strip of RNFL measuring approximately 30 × 3° between the optic disc and the fovea. Fifteen patients with glaucoma who had SD-OCT reflectance defects that passed through this region were chosen. Four patients had reflectance defects in both superior and inferior hemifields, so presence of bundles on AOSLO was assessed for 19 hemifields. Where bundles were present, the hemifield was scored for whether bundles seemed unusual (low contrast and/or low density). Perimetric defects were considered deep when sensitivity was below 15 dB.

RESULTS

Ten hemifields had a region with no fibers present on AOSLO; all had a corresponding deep perimetric defect. The other nine hemifields had no region in the AOSLO image without fibers: four with normal fibers and five with unusual fibers. The only one of these nine hemifields with a deep perimetric defect was one with low-contrast fibers and overall thin RNFL.

CONCLUSIONS

Retinal nerve fiber layer reflectance defects, which were associated with deep perimetric defects, usually had a region with absence of fibers on AOSLO images of RNFL. Ability to predict severity of perimetric damage from en face SD-OCT RNFL reflectance images could benefit from quantification that differentiated between absence of fibers and unusual fibers.
Success of Masking 5% Povidone-Iodine Treatment: The Reducing Adenoviral Patient Infected Days Study
Authors: Whiteside Meredith M. , Shorter Ellen S. , Margolis Mathew S. , Alvi Fatima , Huecker Julia B. , Than Tammy P. , Migneco Mary K. , Harthan Jennifer S. , Morettin Christina E. , Hartwick Andrew T. E. , Johnson Spencer D. , Perera Chamila D. , Gordon Mae O.
Published: May 2021

SIGNIFICANCE

The effectiveness of masking is rarely evaluated or reported in single- or double-masked clinical trials. Knowledge of treatment assignment by participants and clinicians can bias the assessment of treatment efficacy.

PURPOSE

This study aimed to evaluate the effectiveness of masking in a double-masked trial of 5% povidone-iodine for the treatment of adenoviral conjunctivitis.

METHODS

The Reducing Adenoviral Patient Infected Days study is a double-masked, randomized trial comparing a one-time, in-office administration of 5% povidone-iodine with artificial tears for the treatment of adenoviral conjunctivitis. Masking was assessed by asking participants and masked clinicians at designated time points if they believed the treatment administered was povidone-iodine or artificial tears, or if they were unsure. Adequacy of masking was quantified using a modified Bang Blinding Index.

RESULTS

Immediately after treatment, 34% of participants who received povidone-iodine and 69% of those who received artificial tears guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.31 and −0.38, respectively). On day 4, 38% of the povidone-iodine participants and 52% of the artificial tear participants guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.24 and −0.05, respectively), indicating adequate and ideal masking. On days 1, 4, 7, 14, and 21, masked clinicians guessed incorrectly or were unsure of treatment in 53%, 50%, 40%, 39%, and 42% among povidone-iodine participants compared with 44%, 35%, 38%, 35%, and 39% among artificial tears participants, respectively. The modified Bang Indices for clinician masking in the povidone-iodine group ranged from −0.05 to 0.25 and from 0.13 to 0.29 in the artificial tears group.

CONCLUSIONS

Masking of participants and clinicians was adequate. Successful masking increases confidence that subjective measurements are not biased. We recommend quantitative assessment and reporting the effectiveness of masking in ophthalmic clinical trials.
Median Nerve’s Microcirculation in Carpal Tunnel Syndrome: Superb Microvascular Imaging
Authors: Yildiran Gokce , Seher Nusret , Sutcu Mustafa , Nayman Alaaddin , Akdag Osman , Tosun Zekeriya
Published: May 2021

Background:

The objectivity of physical and electrodiagnostic tests is limited in detecting carpal tunnel syndrome and its recurrence. Predicting the median nerve blood supply using superb microvascular imaging will allow exact diagnosis and a good follow-up system. The aims of this study include using superb microvascular imaging to correlate with electromyographic diagnosis, and to determine the impact of surgery on improvement in superb microvascular imaging.

Methods:

Between July of 2019 and January of 2020, 32 wrists of 21 patients were evaluated prospectively. After preoperative electrodiagnostic studies and vascular index measurement with superb microvascular imaging, open carpal tunnel release was performed by a single surgeon, and 3 months later standardized superb microvascular imaging was performed. Preoperative vascular indexes were compared with the mild, moderate, and severe electrodiagnostic study results. Preoperative and postoperative vascular index results were compared.

Results:

The average of the preoperative and postoperative imaging groups was 2.77 and 1.48, respectively, and there was a statistically significant difference between the two groups (p < 0.05). Although no significant difference was found between preoperative and postoperative vascular index values in patients presenting with mild carpal tunnel syndrome (p > 0.05), there was a significant decrease in vascular index values in patients presenting with moderate and severe carpal tunnel syndrome after surgical decompression.

Conclusions:

Superb microvascular imaging is emerging as a groundbreaking, new, and reliable technique. Evaluation of the median nerve blood supply is a reliable method that would be helpful for early diagnosis, planning treatment, determining the severity of carpal tunnel syndrome, and postoperative follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Incidence, Impact, and Management of Incidentalomas on Preoperative Computed Tomographic Angiograms for Breast Cancer Patients with and without Genetic Mutations
Authors: Lu Stephen M. , Waldman Leah E. , Boudiab Elizabeth M. , Lopez Christopher D. , Bassiri-Tehrani Brian , DelMauro Matthew A. , Israeli Ron , Bank Jonathan , Machnicki Stephen C. , Lerman Oren Z.
Published: May 2021

Background:

Preoperative abdominal computed tomographic angiograms for free flap breast reconstruction improve operative safety and efficiency, but incidental findings are common and potentially affect management. In addition, the authors hypothesized that patients with genetic mutations might have a higher rate of significant findings. The authors present the largest series of computed tomographic angiogram “incidentalomas” in these two populations and an evidence-based algorithm for managing common findings.

Methods:

All patients undergoing free flap breast reconstruction at Northwell Health between 2009 and 2017 were eligible. Medical history, perioperative details, and radiology reports were examined with abnormal findings recorded. Published literature was reviewed with radiologists to develop standardized guidelines for incidentaloma management.

Results:

Of 805 patients included, 733 patients had abdominal imaging. One hundred ninety-five (27 percent) had a completely negative examination. In the remaining 538 patients, benign hepatic (22 percent) and renal (17 percent) findings were most common. Sixteen patients (2.2 percent) required additional imaging (n = 15) or procedures (n = 5). One finding was concerning for malignancy—renal cell carcinoma—which interventional radiology ablated postoperatively. Seventy-nine patients (10.8 percent) had a genetic mutation but were not found to have a statistically significant higher rate of incidentalomas.

Conclusions:

The authors’ rate of computed tomographic angiography incidental findings (73 percent) is consistent with previous studies, but the rate requiring further intervention (2.2 percent) is lower. Incidental findings were no more common or pathologic among genetic mutation carriers. The authors also introduce an evidence-based algorithm for the management of common incidentalomas. Using these guidelines, plastic surgeons can reassure patients, regardless of mutation status, that incidentalomas are most commonly benign and have minimal impact on their surgical plan.