bluuebunny/crossref_metadata_2025 huggingface dataset:
Old Poison, New Problem: Cyanide Fatal Intoxications Associated with Internet Shopping
Authors: Wachełko Olga , Chłopaś-Konowałek Agnieszka , Zawadzki Marcin , Szpot Paweł
Published: April 2021

Widespread access to the Internet has an increasing influence on how suicides are committed. On websites such as eBay® or Amazon.com®, highly toxic substances including cyanides are available for purchase. In the last 5 years, a few fatal intoxications associated with Internet shopping and buying “suicide kits” have been reported. The epidemiology of intoxications reported by the American Association of Poison Control Centers between 2000 and 2018 shows that about 10% of all exposures to cyanide were related to suicide attempts and intentional ingestion of this substance. In order to determine the cyanide concentration in four fatal intoxication cases associated with Internet shopping, a headspace gas chromatography with dual-column/dual-flame ionization detection method was validated and applied to casework. The method was linear in range, from 1 to 50 mg/L, with a coefficient of determination of 0.999 (R2). The limit of quantification was 1.0 mg/L; the detection limit was 0.5 mg/L. Intra- and interday validation precision and accuracy did not exceed 10% and 15%, respectively. Recovery and matrix effect values ranged from 94.8% to 103.8% and from −5.2% to 3.8%, respectively. The cyanide concentrations were determined in biological fluids (blood, urine, bile, vitreous humor and gastric content) and postmortem tissue samples (spleen, kidney, liver and brain). The headspace gas chromatographic method, which is routinely used in clinical and forensic toxicology to quantify ethanol with its congeners (methanol, acetone, isopropanol, n-propanol and n-butanol), can also be applied to determine the cyanide concentrations in intoxication cases. The global problem of a high number of suicides each year requires increasing and more restrictive control of highly toxic substances available online as well as careful monitoring of human exposure to cyanide. This old and well-known poison is being increasingly used nowadays for suicidal purposes; therefore, the determination of cyanide in biological samples is still important in terms of clinical and forensic toxicology.
Outcomes of femoral de-rotation osteotomy for treatment of femoroacetabular impingement in adults with decreased femoral anteversion
Authors: Mastel M S , El-Bakoury A , Parkar A , Sharma R , Johnston K D
Published: April 2021

Decreased femoral anteversion is an often overlooked factor in femoroacetabular impingement (FAI), with potential to exacerbate both cam and pincer type impingement, or itself be the primary cause. Femoral de-rotation osteotomy (FDO) is a surgical option for symptomatic patients with such underlying bony deformity. This study aimed to investigate outcomes of FDO for management of symptomatic FAI in the presence of decreased (<5°) femoral anteversion. Secondary aims were to describe the surgical technique and assess complications. This study included 33 cases (29 patients) with average pre-operative anteversion measuring –3.1° (true retroversion). At an average follow-up of 1.5 years (19.8 months), 97% reported significant improvement. The overall average post-operative International Hip Outcome Tool (iHOT-33) score of 70.6 points (r: 23–98) compared to the average pre-operative score of 42.8 points (r: 0–56) for the 11 patients with available pre-operative scores suggests an overall improvement. The minimal clinically important difference for the iHOT-33 is 6.1 points. Patients with both pre- and post-operative iHOT-33 scores available demonstrated a statistically and clinically significant improvement of 37.7 (r: 13–70) points. There were three cases (9%) of delayed union and two cases (6%) of non-union early in the series which prompted evolution of the technique. Locking screw removal was performed in 33% of patients for a resultant overall re-operation rate of 45%. The findings suggest improvement in patient-reported outcomes can be achieved with FDO for symptomatic FAI in the setting of decreased femoral anteversion (<5°).
A case at crossroads—urological presentation, cardiac complication and haematological diagnosis: should imaging be pursued prior to orchidectomy at all costs?
Authors: Yasen Zaid , Kazzazi Fawz , Ioannides Kyriacos , Velmurugan Shanti , Zegocki Kris , Li Chi
Published: April 2021

This case report explores the interesting case of a 71-year-old gentleman who presented with a testicular lump following trauma. Ultrasound imaging of the testicle demonstrated malignancy and subsequently orchidectomy was listed. Due to a scheduling difficulty, this was prioritized ahead of his whole-body computed tomography scan. Intraoperatively, he developed electrocardiogram changes suggestive of a non-ST elevated myocardial infarction. Post-operative imaging demonstrated a diffuse large B-cell lymphoma encroaching the heart and greater vessels. This case report highlights the importance of preoperative imaging, even where it may prove challenging. We assess the adequacy of current guidelines within the UK on imaging for new testicular malignancies.
Strategic coalitions in stochastic games
Authors: Naumov Pavel , Ros Kevin
Published: April 2021

The article compares two different approaches of incorporating probability into coalition logics. One is based on the semantics of games with stochastic transitions and the other on games with the stochastic failures. The work gives an example of a non-trivial property of coalition power for the first approach and a complete axiomatization for the second approach. It turns out that the logical properties of the coalition power modality under the second approach depend on whether the modal language allows the empty coalition. The main technical results for the games with stochastic failures are a strong completeness theorem for the logical system without the empty coalition and an incompleteness theorem which shows that there is no strongly complete logical system in the language with the empty coalition.
Incidence of Infections and Predictors of Mortality During Checkpoint Inhibitor Immunotherapy in Patients With Advanced Lung Cancer: A Retrospective Cohort Study
Authors: Bavaro Davide Fiore , Pizzutilo Pamela , Catino Annamaria , Signorile Fabio , Pesola Francesco , Di Gennaro Francesco , Cassiano Sandro , Marech Ilaria , Lamorgese Vito , Angarano Gioacchino , Monno Laura , Saracino Annalisa , Galetta Domenico
Published: April 2021

Background

Immune checkpoint inhibitors (ICIs) have revolutionized nonsmall cell lung cancer (NSCLC) treatment and significantly increased overall survival of patients. However, the incidence of concurrent infections and their management is still debated.

Methods

From August 2015 to October 2019, all consecutive patients with NSCLC who received nivolumab or pembrolizumab as first- or second-line therapy were retrospectively evaluated. At the time of analysis all patients had died. Clinical characteristics of patients, type of infections, and predictors of mortality were analyzed.

Results

A total of 118 patients were identified: 74 in the nivolumab group and 44 in the pembrolizumab group. At least 1 infection was recorded in 22% of the nivolumab-group versus 27% of the pembrolizumab-group (P = .178). In both groups, the main infection was pneumonia, followed by skin and soft tissue infections, urinary tract infections, and gastroenteritis. Crude mortality for first infection was 10.7%, followed by 25% and 40% for the second and third recurrence, respectively (p for trend = .146). No opportunistic infections were recorded. It is notable that, by Cox-regression model, the independent predictor of mortality was a higher Eastern Cooperative Oncology Group performance status at baseline (P < .001), whereas the multidisciplinary diagnosis and treatment of concurrent infections was associated with a reduced probability of mortality (adjusted hazard ratio = 0.50; 95% confidence interval = 0.30–0.83; P < .001).

Conclusions

In patients with NSCLC treated with ICIs, multidisciplinary management of concurrent infections may reduce the risk of mortality. Further studies to investigate risk factors for infections, as well as appropriate management strategies and preventive measures in this setting, are warranted.
Interactive effects between travel behaviour and COVID-19: a questionnaire study
Authors: Zhang Jinbao , Lee Jaeyoung
Published: April 2021

This study has two main objectives: (i) to analyse the effect of travel characteristics on the spreading of disease, and (ii) to determine the effect of COVID-19 on travel behaviour at the individual level. First, the study analyses the effect of passenger volume and the proportions of different modes of travel on the spread of COVID-19 in the early stage. The developed spatial autoregressive model shows that total passenger volume and proportions of air and railway passenger volumes are positively associated with the cumulative confirmed cases. Second, a questionnaire is analysed to determine changes in travel behaviour after COVID-19. The results indicate that the number of total trips considerably decreased. Public transport usage decreased by 20.5%, while private car usage increased by 6.4%. Then the factors affecting the changes in travel behaviour are analysed by logit models. The findings reveal significant factors, including gender, occupation and travel restriction. It is expected that the findings from this study would be helpful for management and control of traffic during a pandemic.
Analysis of the Fusarium graminearum Species Complex from Gramineous Weeds Near Wheat Fields in Jiangsu Province, China
Authors: Dong Fei , Li Yunpeng , Chen Xinyuan , Wu Jirong , Wang Shufang , Zhang Xiao , Ma Guizhen , Lee Yin-Won , Mokoena Mduduzi P. , Olaniran Ademola O. , Xu Jian Hong , Shi Jian Rong
Published: April 2021

Several weed species are known as alternative hosts of the Fusarium graminearum species complex (FGSC), and their epidemiological significance in Fusarium head blight (FHB) has been investigated; however, scant information is available regarding FGSC occurrence in weeds near Chinese wheat fields. To evaluate the potential role of gramineous weeds surrounding wheat fields in FHB, 306 FGSC isolates were obtained from 210 gramineous weed samples in 2018 in Jiangsu Province. Among them, 289 were Fusarium asiaticum, and the remainder were F. graminearum. Trichothecene genotype and mycotoxin analyses revealed that 74.3% of the F. asiaticum isolates were the 3-acetyldeoxynivalenol (3ADON) chemotype, and the remainder were the nivalenol (NIV) chemotype. Additionally, 82.4% of F. graminearum isolates were the 15-acetyldeoxynivalenol (15ADON) chemotype, and the remainder were the NIV chemotype. FHB severity and trichothecene analysis indicated that F. asiaticum isolates with the 3ADON chemotype were more aggressive than those with the NIV chemotype in wheat. 3ADON and NIV chemotypes of F. asiaticum isolated from weeds and wheat showed no significant differences in pathogenicity in wheat. All selected F. asiaticum isolates produced perithecia, with little difference between the 3ADON and NIV chemotypes. These results highlight the epidemiology of the FGSC isolated from weeds near wheat fields, with implications for reducing FHB inoculum in China.
Media Use Among Kindergarteners From Low-Income Households During the COVID-19 Shutdown
Authors: Dore Rebecca A. , Purtell Kelly M. , Justice Laura M.
Published: April 2021

Objective:

This study examines the media use of children from low-income homes during school closings during the COVID-19 pandemic.

Methods:

Caregivers of 151 kindergarteners from low-income homes completed questionnaires as part of a larger study. Caregivers reported how much time children spent watching television/videos and using apps on the most recent weekday and weekend days. Caregivers also reported how their child's current use of media for several different purposes compared with how much the child usually uses media for that purpose.

Results:

Weekly average media use was 46.3 hours or 6.6 hours per day. Counter to previous research, weekday media use was higher than weekend media use, suggesting that media was likely used as a replacement for time usually spent in school. Caregivers reported increased child media use for positive purposes, such as education and maintaining relationships with family and friends outside of the home, and potentially useful but less socially valued purposes, such as occupying the child's time while caregivers were completing other tasks. Having more children in the household was related to higher media use, and girls used media for maintaining remote relationships more than boys.

Conclusion:

These findings provide reason for both concern and optimism for the impacts of pandemic closures on low-income children. High levels of media use seem to be prevalent in this population. However, the diverse purposes for media use suggest that caregivers relied on media to supplement children's academic and social growth at a time when school and socializing were not safe in their typical forms.
Effects of SGLT2 Inhibitor on Ischemic Events Stemming From Atherosclerotic Coronary Diseases: A Systematic Review and Meta-analysis With Trial Sequential Analysis of Randomized Controlled Trials
Authors: Ye Gailin , Wang Shuai , Peng Daoquan
Published: April 2021

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce cardiovascular complications of type-2 diabetes mellitus. However, the beneficial effects of SGLT2 inhibition are mainly associated with decline in hospitalization and death of heart failure. This systematic review will focus on the effect of SGLT2 inhibitors on ischemic events stemming from atherosclerotic coronary diseases, including angina pectoris, angina unstable, and myocardial infarction. We searched PubMed, Scopus, Embase, and Web of Science for relevant publications before October 2020. Twenty-two clinical trials consisting of 56,064 participants were included in the analysis. Cardiovascular effects following treatment with SGLT2 inhibitors were observed for angina pectoris, angina unstable, and myocardial infarction. A random-effects model was chosen, and after analysis of the P values and I2 statistic indices, we concluded that SGLT2 inhibitor treatment did not result in any significant differences in the incidence rate of angina pectoris [relative risk (RR), 0.98; 95% confidence interval (CI), 0.83–1.14; P = 0.92], angina unstable (RR, 0.95; 95% CI, 0.84–1.07; P = 0.84), or myocardial infarction (RR, 0.94; 95% CI, 0.79–1.11; P = 0.98) between the experimental and control groups with firm evidence from sensitivity and trial sequential analyses. This meta-analysis provides evidence that SGLT2 inhibitors have no significant effects on ischemic events stemming from atherosclerotic coronary diseases in patients with type-2 diabetes mellitus.
Clozapine-Associated Leukopenia and Agranulocytosis in Western Cape, South Africa
Authors: Geldenhuys Christoff , Zunza Moleen , Tiffin Nicki , Koen Liezl , Decloedt Eric H.
Published: April 2021

Background

Clozapine may cause life-threatening hematological side effects (HSEs). Hematological side effect incidence data from Sub-Saharan Africa are lacking. Furthermore, clozapine reduces cellular immunity, and it is unknown whether clozapine is a risk factor for tuberculosis or whether HIV is a risk factor for developing HSEs. We assessed the incidence of HSEs in South Africans from the Western Cape Province on clozapine, and the secondary objective was to determine the association of HIV and tuberculosis with clozapine exposure.

Methods

We conducted a 24-week retrospective descriptive study of patients initiated on clozapine between January 2015 and December 2017 using anonymized data from the Provincial Health Data Centre. A control group of patients initiated on risperidone was selected.

Results

We identified 23,328 patients and included 5213 who had white blood cell monitoring (n = 1047 clozapine, n = 4166 risperidone). The incidence of leukopenia in patients on clozapine was 0.38% (95% confidence interval [CI], 0.01%–0.76%) measured over a 24-week period and was 0.41% in patients on risperidone (95% CI, 0.21%–0.6%) (P = 0.91). The incidence of agranulocytosis in patients on clozapine was 0.19% (95% CI, 0.00%–0.46%) measured over a 24-week period and was 0.24% in patients on risperidone (95% CI, 0.09%–0.39%) (P = 0.266). HIV-infected patients had a 7.46 times increased risk of developing leukopenia (95% CI, 3.37–16.48; P < 0.01). Patients who developed leukopenia had a 6.24 times increased risk of contracting tuberculosis (95% CI, 1.84–21.11; P < 0.01).

Conclusions

Our incidence of clozapine-induced HSEs was lower than previously reported and not significantly different compared with risperidone. HIV infection was associated with HSEs. Patients with HSEs had an increased risk of developing tuberculosis.
Shenfu injection alleviates the clinical symptoms of heart failure patients combined with conventional treatment
Authors: Luo Ziqing , Jiang Min , Liu Su , Duan Yunbiao , Huang Jianhui , Zeng Huizhen
Published: April 2021

Background:

Shenfu Injection (SFI) is a promising alternative treatment for heart failure (HF) in China. Many complete clinical trials have examined the efficacy of SFI combined use with conventional treatment (CT) vs CT alone. This study is to conduct a systematic review and meta-analysis of randomized clinical trials to evaluate the benefits and risks of using SFI in addition to CT for the treatment of HF.

Method:

All the trials will be searched through 4 English databases (MEDLINE via PubMed, the Cochrane Library, EMBASE, Web of Science) and 4 Chinese databases (the China Science and Technology Journal Database, Chinese Biomedical Literature Database, Wan-fang Database, the China National Knowledge Infrastructure.) from October 2005 to June 2019. Conference articles or articles with incomplete data will be removed. The primary outcome was the New York Heart Association, 6-minute walk test, hospitalization or rehospitalization. Left ventricular ejection fraction percentage, left ventricular end-diastolic dimension, Cardiac index, heart rate, N-terminal pronatriuretic peptide and other indicators were also assessed. RevMan V.5.3 Software and Stata 13.0 Statistics Software were used to calculate the data synthesis and conduct meta-analysis according to the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols 2015.

Results:

Mortality, New York Heart Association function classification, heart rate, 6-minute walk test, hospitalization or rehospitalization, Heart rate, systolic blood pressure, DBP, Cardiac minute volume, left ventricular ejection fractions percentage, left ventricular end-diastolic dimension (mm), N-terminal pronatriuretic peptide, etc. and adverse effects will be comprehensively assessed to evaluate the adjunctive effect of SFI through different aspects. We will perform a meta-analysis of each outcome with subgroup analysis based on the type of HF, treatment methods, and course of disease. Sensitivity analysis will be conducted with clinical factors, treatment methods, methodological characteristics, and statistical heterogeneity (if applicable).

Conclusion:

This study will assess the adjunctive effect of SFI and its safety on HF with clinical evidence.

PROSPERO registration number:

PROSPERO CRD42020151856
Efficacy and safety of Shenfuqiangxin pills in complementary treatment of chronic heart failure
Authors: Ren Lili , Guan Hui , Dai Guohua , Gao Wulin , Su Jing
Published: April 2021

Background:

As the last link in the chain of cardiovascular events, chronic heart failure (CHF) has high morbidity, high mortality, and poor prognosis. It is one of the main causes of death and disability worldwide. Shenfuqiangxin Pills (SFQX) is widely used as a Chinese herbal medicine (CHM) prescription for CHF, but there is still a lack of strict evidence-based medical evidence. Therefore, we make a protocol for evaluating the efficacy and safety of SFQX for CHF.

Methods:

According to the search strategy, randomized controlled trials (RCTs) of SFQX for CHF will be retrieved from 8 databases without limitation of publication date or language. First of all, the literature was screened according to the eligibility criteria, and use the Cochrane Collaboration's tool to assess the quality of the included literature. Then, using software for traditional meta-analysis. Finally, using GRADE method to assess the strength of recommendations.

Results:

This study will evaluate the efficacy and safety of SFQX for CHF, thereby providing more evidence support for clinical decision-making in CHF.

Conclusion:

Our research will provide more references for the clinical medication of patients with CHF.

Protocol registration number:

INPLASY202110019
Epidemiological characteristics of 561 cases of intracerebral hemorrhage in Chengdu, China
Authors: Yu Kai , Zhu Shu , He Mingjie , Li Zongxi , Zhang Lie , Sui Zhao , Li Yunming , Xia Xun
Published: April 2021

To explore the epidemiology of patients with spontaneous intracerebral hemorrhage (sICH) in Chengdu, China, we retrieved the data of patients with spontaneous cerebral hemorrhage admitted to the First Affiliated Hospital of Chengdu Medical College from January 2017 to December 2019. We performed a comprehensive analysis of the location of hemorrhage, demographics, factors of hemorrhage, condition of body, severity of disturbance of consciousness, treatment, length of stay (days), inpatient costs, prognosis, and mortality rate in patients with sICH. In total, data of 561 in patients with sICH were included. The hemorrhage site was primarily located in the basal ganglia and thalamus (64.71%). The mean patient age was 63.2 ± 12.4 years (64.17% men, 35.83% women). Male patients (mean age 62.3 ± 12.5 year) were younger than female patients (mean age 64.9 ± 12.1 year). The age of sICH onset in our sample was between 40 and 79 years; this occurred in 87.70% of the included cases. There were more males than females, which may be related to more daily smoking, longer drinking years, and overweight in males than in females. Cases occurred most frequently during the winter and spring months, and the relationship between sICH visits and hospitalizations appeared as a U-shape. The median time from illness onset to hospital admission was 3.0 hours. According to the Glasgow Coma Scale (GCS) score at admission, 20.50% of sICH cases were of mild intensity, 39.93% were moderate, and 39.57% were severe. Moderate disorder is the most common sICH severity. Factors influencing the disturbance of consciousness were blood glucose level at the time of admission as well as the number of years with hypertension. The lower the degree of disturbance of consciousness and the more they smoked per day indicated they had a higher likelihood of receiving surgical treatment while in hospital. The median hospital stay was 13.0 days, while the median inpatient cost was USD 3609. The 30-day mortality rate was 18.36%. sICH is an important public health problem in Chengdu, China. A governmental initiative is urgently needed to establish a sICH monitoring system that covers the Chengdu region to develop more effective and targeted measures for sICH prevention, treatment, and rehabilitation.
Performance evaluation of CA242 by flow fluorescence assay
Authors: Hou Yanyan , Chen Yongquan , Sun Jieli , Geng Jinting , Jin Hongwei , Zhang Zhongying
Published: April 2021

Carbohydrate antigen 24–2 (CA24–2) is usually used as a biomarker for the diagnosis of pancreatic cancer and colorectal cancer. Currentlly, a new quantitative assay kit for CA242 by flow fluorometry assay (FFA) was developed by Shanghai Tellgen Cooperation Co. Ltd. China. Therefore, we conducted the performance evaluation for it.

According to the “Guiding principles on performance analysis of diagnostic reagents in vitro” and “American association of clinical laboratory standardization guidelines EP15-A2”, the accuracy, precision, linear range, reportable range, biological reference interval verification, carry-over contamination rate, anti-interference capability and cross reaction of the assay kit used in TESMI F3999-Luminex200 automatic immunoassay system were evaluated. In addition, the assay kit was performed in parallel to CanAg kit (CanAg Diagnostics Products Beijing Co., Ltd.) to analyze the correlation between the 2 kits.

The bias of accuracy of the new assay kit was less than 12.5% and the coefficient of variations (CVs) of precision were all less than 10.0%. The linear range of CA242 concentration of the testing kit was between 3.46 U/ml and 434.76 U/ml and the reportable range was 6.00 to 535.13 U/ml. The CA242 reference interval 0.00 to 20.00 U/ml was suitable for use in laboratory. The carry-over contamination rate was −0.14%. Correlation analysis showed a satisfactory relevance and consistency (r = 0.982,P < .001) between the new assay kit and CanAg kit, with a regression equationY = 1.0012X to 0.878 (R2 = 0.9647,P < .001). No statistically significant difference between serum samples without interferences and samples containing lipemia, bilirubin and hemoglobin. And no cross reaction existed between the assay kit and the other tumor markers, such as carbohydrate antigen 125 (CA125), alpha-fetoprotein (AFP), and cytokeratin-19 soluble fragment (CYFRA21-1).

The new CA242 quantitative assay kit possesses good detection performance when it is used in TESMI F3999-Luminex200 automatic immunoassay system, which can be used for the examination of CA242 in clinical practice.
Predicting the developmental outcomes of very premature infants via ultrasound classification
Authors: Zhang Xue-hua , Chen Wen-juan , Gao Xi-rong , Li Ya , Cao Jing , Qiu Shi-jun
Published: April 2021

Objective:

This study aimed to assess the accuracy of ultrasonic grading in determining brain injury in very premature infants and analyze the affecting factors of these neonatal morbidity and mortality, and to investigate the relationship between serial cranial ultrasound (cUS) classification and Mental Developmental Index (MDI)/Psychomotor Developmental Index (PDI) in premature infants.

Methods:

A total of 129 very preterm infants (Gestational Age ≤ 28 weeks) were subjected to serial cUS until 6 months or older and classified into 3 degrees in accordance with classification standards. The MDI and PDI (Bayley test) of the infants were measured until the infants reached the age of 24 months or older. The consistency between Term Equivalent Age (TEA)-cUS and TEA- magnetic resonance imaging (MRI) was calculated. Ordinal regression was performed to analyze the relationship among severe disease, early cUS classifications, psychomotor and mental development, and death. Operating characteristic curve were used to analyze the relationship between serial cUS grades and MDI/PDI scores.

Results:

The mortality and survival rates of 129 very preterm infants were 32.8% and 67.3%, respectively. Among the 86 surviving infants, 20.9% developed mild cerebral palsy (CP) and 5.8% to 6.9% developed severe CP. The consistency between TEA-cUS and TEA-MRI was 88%. Grades 2 and 3 at first ultrasound were associated with adverse mental (OR = 3.2, OR = 3.78) and motor (OR = 2.25, OR = 2.59) development. cUS classification demonstrated high sensitivity (79%–96%). Among all cUS classifications, the specificity of the first cUS was the lowest and that of TEA-cUS was the highest (57% for PDI and 48% for MDI).

Conclusions:

Moderate and severe brain injury at first ultrasound is the most important factor affecting the survival rate and brain development of very premature infants. The cUS classification had high sensitivity and high specificity for the prediction of CP, especially in TEA-cUS.
The efficacy of reduced-visit prenatal care model during the coronavirus disease 2019 pandemic
Authors: Wang Xiaoli , Wang Ying , Liang Lin
Published: April 2021

Background:

While this reduced-visit prenatal care model during the COVID-19 pandemic is well-intentioned, there is still a lack of relevant evidence to prove its effectiveness. Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy of reduced-visit prenatal care model during the COVID-19 pandemic.

Methods:

The online literature will be searched using the following combination of medical subject heading terms: “prenatal care” OR “prenatal nursing” AND “reduced-visit” OR “reduce visit” OR “virtual visit.” MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science will be searched without any language restrictions. A standard data extraction form is used independently by 2 reviewers to retrieve the relevant data from the articles. The outcome measures are as following: pregnancy-related stress, satisfaction with care, quality of care. The present study will be performed by Review Manager Software (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark). P < .05 is set as the significance level.

Results:

It is hypothesized that reduced-visit prenatal care model will provide similar outcomes compared with traditional care model.

Conclusions:

The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

OSF registration number:

10.17605/OSF.IO/WYMB7.
Effects of continuous positive airway pressure treatment in obstructive sleep apnea patients with atrial fibrillation
Authors: Li Xinyao , Zhou Xinbin , Xu Xiaoming , Dai Jin , Chen Chen , Ma Lan , Li Jiaying , Mao Wei , Zhu Min
Published: April 2021

Background:

Obstructive sleep apnea (OSA) is correlated with atrial fibrillation (AF). Over the past decade, there has been an increasing interest in the relationship between OSA with continuous positive airway pressure (CPAP) and progression or recurrence of AF.

Methods:

This investigation was an analysis of studies searched in the Cochrane Library, PubMed, EMBASE, EBSCO, OVID, and Web of Science databases from inception to July 2020 to evaluate the recurrence or progression of AF in CPAP users, CPAP nonusers, and patients without OSA.

Results:

Nine studies with 14,812 patients were recruited. CPAP therapy reduced the risk of AF recurrence or progression by 63% in a random-effects model (24.8% vs 40.5%, risk ratio [RR] = 0.70, 95% confidence interval [CI] = 0.57–0.85, P = .035). Compared with non-OSA patients, AF recurrence or progression was much higher in CPAP nonusers (40.6% vs 21.1%, RR = 1.70, 95% CI = 1.19–2.43, P = .000). However, AF recurrence or progression in the CPAP group was similar to that in the non-OSA group (24.0% vs 21.1%, RR = 1.13, 95% CI = 0.87–1.47, P = .001). Begg correlation test and Egger regression test revealed no publication bias in this analysis.

Conclusions:

OSA is a salient factor in the progression or recurrence of AF. CPAP therapy for OSA may contribute to reduction of AF in patients for whom radiofrequency ablation or direct current cardioversion is not performed.

Trial Registration:

The protocol for this meta-analysis was registered on PROSPERO with a registration No. CRD42019135229.
Research on the economic loss of hospital-acquired pneumonia caused by Klebsiella pneumonia base on propensity score matching
Authors: Zhong Xiao , Wang Dong-Li , Xiao Li-Hua
Published: April 2021

Background:

Hospital-acquired pneumonia (HAP) caused by Klebsiella pneumonia (KP) is a common nosocomial infection (NI). However, the reports on the economic burden of hospital-acquired pneumonia caused by Klebsiella pneumonia (KP-HAP) were scarce. The study aims to study the direct economic loss caused by KP-HAP with the method of propensity score matching (PSM) to provide a basis for the cost accounting of NI and provide references for the formulation of infection control measures.

Methods:

A retrospective investigation was conducted on the hospitalization information of all patients discharged from a tertiary group hospital in Shenzhen, Guangdong province, China, from June 2016 to August 2019. According to the inclusion and exclusion criteria, patients were divided into the HAP group and noninfection group, the extended-spectrum beta-lactamases (ESBLs) positive KP infection group, and the ESBLs-negative KP infection group. After the baselines of each group were balanced with the PSM, length of stay (LOS) and hospital cost of each group were compared.

Results:

After the PSM, there were no differences in the baselines of each group. Compared with the noninfection group, the median LOS in the KP-HAP group increased by 15 days (2.14 times), and the median hospital costs increased by 7329 yuan (0.89 times). Compared with the ESBLs-negative KP-HAP group, the median LOS in the ESBLs-positive KP-HAP group increased by 7.5 days (0.39 times), and the median hospital costs increased by 22,424 yuan (1.90 times).

Conclusion:

KP-HAP prolonged LOS and increased hospital costs, and HAP caused by ESBLs-positive KP had more economic losses than ESBLs-negative, which deserves our attention and should be controlled by practical measures.
No linear correlation between pelvic incidence and acetabular orientation
Authors: Kim Jung-Taek , Shen Quan Hu , Jeon Chang-Hoon , Chung Nam-Su , Jeong Seungmin , Lee Han-Dong
Published: April 2021

Links between sagittal spinal alignment and acetabular orientation attract considerable research attention with the goal of understanding “hip-spine syndrome.” However, whether pelvic incidence (PI) is related to acetabular orientation remains debatable. The purpose of the present study was to determine

We analyzed 100 abdominopelvic computed tomography (CT) scans of skeletally healthy young adults. We measured PI and acetabular orientation with three-dimensional (3D) measurements. The orientation of 200 acetabula was measured using 3D reconstructed models of 100 pelvises in the coordinate system based on the anterior pelvic plane (APP). To quantify the acetabular orientation, the radiographic definitions of anteversion and inclination were used. To examine the correlation between acetabular orientation and PI, Pearson's correlation was used.

The mean PI was 46.9° ± 10.2°, and the mean acetabular orientation 15.3° ± 5.7° anteverted and 37.5° ± 3.9° inclined. While no significant difference in the PI was observed, the average acetabular orientation of female pelvises (anteversion, 17.5° ± 5.6°; inclination, 36.7° ± 3.7°) was more anteverted and less inclined compared to that of male pelvises (anteversion, 13.2° ± 4.9°; inclination, 38.3° ± 3.9°, respectively; P values < .05). The correlation between PI and acetabular orientation was statistically not significant. After division of study group by sex, the linear correlation between PI and acetabular orientation was not statistically supported. The asymmetry of the acetabular orientation between the left and right sides was not significant.

The linear relationship between anatomical acetabular orientation and PI was not evident in the normal population. Our finding thus proves the absence of a linear relationship between the upper and lower articular orientation of the pelvic segment and deepens the understanding of the characteristics of acetabular orientation and PI.
Comparison of nutrition and quality of life of esophagogastrostomy and the double-tract reconstruction after laparoscopic proximal gastrectomy
Authors: Eom Bang Wool , Park Ji Yeon , Park Ki Bum , Yoon Hong Man , Kwon Oh Kyoung , Ryu Keun Won , Kim Young-Woo
Published: April 2021

This study aims to compare the nutritional outcomes and quality of life between patients who underwent esophagogastrostomy (EG) and those who underwent the double-tract reconstruction (DTR) after laparoscopic proximal gastrectomy for early gastric cancer.

We retrospectively reviewed the prospectively established database of 45 patients who underwent EG with anti-reflux procedure and 58 patients who underwent the DTR after laparoscopic proximal gastrectomy between December 2013 and June 2017. Then, we compared the baseline characteristics, clinical outcomes, postoperative nutritional parameters, and quality of life (QOL) using European Organization for Research and Treatment of Cancer (EORTC) QLQ STO-22 between the EG and DTR groups.

In the postoperative 1-year endoscopic findings, the incidence of esophageal reflux was higher in the EG group (17.8% vs 3.4%, P = .041) and there was no significant difference in anastomotic stricture. Nutritional status was evaluated via body mass index, serum albumin, protein, hemoglobin, and ferritin; we found no significant differences. The incidences of iron deficiency anemia and vitamin B12 deficiency also showed no significant difference between the 2 groups. With regards to the quality of life, the difference values between preoperative and postoperative 1-year were evaluated; there was no significant difference between the EG with anti-reflux procedure and DTR groups.

EG had higher incidence of esophageal reflux and similar nutritional outcomes and QOL compared with the double-tract reconstruction after laparoscopic proximal gastrectomy. Additional large-scale research is needed to evaluate the long-term functional outcomes of EG and the double-tract reconstruction.
External treatment of traditional Chinese medicine for myasthenia gravis
Authors: Peng Yuxuan , Lu Bibo , Li Lu , Pan Yuting , Ye Qing , He Min , Chen Weiyin , Yang Xueping
Published: April 2021

Background:

Myasthenia gravis (MG) is an archetypal autoimmune disorder. The conventional treatments for this disease are drugs, plasma exchange, surgical, and so on. However, this disease is difficult to cure. A mass of studies revealed that the external treatment of traditional Chinese medicine (TCM) for MG is a safe and economical approach. The present study conducted a meta-analysis to compare TCM external treatment combined with modern medicine with modern medicine for MG, in order to determine which TCM external treatment intervention has the best relative efficacy, safety, and provide the best evidence for clinical practice.

Methods:

PubMed, Cochrane Library, EMBASE, Web of Science, Springer, China National Knowledge Infrastructure (CNKI), Wan-fang database, VIP Chinese Science and Technique Journals Database, the Chinese Bio Medical Database (CBM), and Baidu Scholar were searched. The time of publication was limited from inception to February 28, 2021. Two reviewers independently searched for the selected articles and extract the data. The RevMan V.5.3 statistical software (Cochrane Collaboration) and Stata V.16.0 software were used to conduct the meta-analysis.

Results:

The results of the systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

The present study provides a protocol that can be used in the systematic review and meta-analysis, with the intent to inform professionals on the external treatment of TCM for MG. These would lead to investigations on the use of the most external treatment of TCM for MG.

Trial registration number:

INPLASY202110083
Acupotomy for shoulder pain
Authors: Zhu Yongda , Zhu Yiwen , Ye Renying , Hua Danyun , Shen Cimin
Published: April 2021

Background:

Shoulder pain is a common musculoskeletal disorder prompting many patients to seek treatment. Acupotomy is a common treatment for shoulder which has been widely used in hospitals. But its efficiency has not been scientifically and methodically evaluated. This protocol aims to evaluate the efficacy and safety of acupotomy for treating shoulder pain.

Methods:

Relevant studies will be searched from the databases of PubMed, EMBASE, Cochrane Library, China Knowledge Resource Integrated Database, Weipu Database for Chinese Technical Periodicals, SinoMed, and Wanfang Database. Two researchers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool.

Results:

The systematic review will provide high-quality evidence to assess the efficacy and safety of acupotomy for shoulder pain as well as adverse events.

Conclusion:

The systematic review will provide evidence to assess the effectiveness and safety of acupotomy therapy for shoulder pain patients.

INPLASY registration number:

INPLASY 202130002.
Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT
Authors: Delabie Pierre , Evrard Diane , Zouhry Ilyass , Ou Phalla , Rouzet François , Benali Khadija , Piekarski Eve
Published: April 2021

Introduction:

The most common malignancies metastasizing to the heart are cancers of the lung, breast, mesothelioma, melanoma, leukemia, and lymphoma. Cardiac metastasis from a tongue cancer is a rare finding and only a few cases have been reported previously in the literature. In this case report and literature review, we discuss the main clinical features of patients with cardiac metastases secondary to a tongue cancer and imaging modalities performed, especially the 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT).

Patient concerns:

This is a case of a 39-year-old woman who in April 2018 was diagnosed with an invasive well differentiated squamous cell carcinoma of the movable tongue. She underwent a left hemiglossectomy followed by a revision of hemiglossectomy and ipsilateral selective neck lymph nodes dissection levels II to III because of pathological margins. An early inoperable clinical recurrence was diagnosed and she received radiochemotherapy with good clinical and metabolic response. She remained asymptomatic thereafter.

Diagnosis:

In January 2020, a pre-scheduled 18F-FDG PET/CT showed a diffuse cardiac involvement. In February 2020, a biopsy of the lesion revealed a metastatic squamous cell carcinoma.

Interventions:

She was deemed to not be a cardiac surgical candidate and treated by palliative chemotherapy: taxol-carboplatin associated with cetuximab then cetuximab alone because of adverse effects. A re-evaluation imaging performed in April 2020 evidenced a progression of the cardiac involvement, which led to switch chemotherapy by immunotherapy with nivolumab.

Outcomes:

This patient had a very poor prognosis and succumbed to major heart failure 4 months after the diagnosis of cardiac metastasis.

Conclusion:

In this case report, 18F-FDG PET/CT proved to be useful in detecting cardiac metastasis and changed the therapeutic management of the patient. It suggests that patients with tongue malignancies in a context of poor initial prognosis should be followed-up early by 18F-FDG PET/CT with HFLC diet to facilitate detection of recurrence.
ATP2B1 gene polymorphisms rs2681472 and rs17249754 are associated with susceptibility to hypertension and blood pressure levels
Authors: Xie Ming , Yuan Shuqian , Zeng Yuan , Zheng Chanjuan , Yang Yide , Dong Yanhui , He Quanyuan
Published: April 2021

Objective:

The present study aimed to conduct a systematic review and meta-analysis to evaluate the relationships between ATP2B1 gene polymorphisms with blood pressure (BP) level and susceptibility to hypertension.

Methods:

PubMed, Web of Science, Embase and China National Knowledge Infrastructure (CNKI) Databases were systematically searched by 2 independent researchers to screen studies on ATP2B1 gene polymorphisms and BP related phenotypes. The records retrieval period was limited from the formation of the database to March 4, 2021. Pooled odds rations (ORs) or β and their 95% confidence intervals (95%CI) were calculated to assess the association between ATP2B1 gene polymorphisms and the risk of hypertension or BP levels. Publication bias and sensitivity analysis were conducted to find potential bias. All the statistical analysis were conducted with Stata version 11.0 software.

Results:

A total of 15 articles were ultimately included in the present study, including 15 polymorphisms of ATP2B1 gene. Nine articles (N = 65,362) reported the polymorphism rs17249754, and 7 articles(N = 91,997) reported rs2681472 (both loci were reported in 1 article). Meta-analysis showed that rs17249754 (G/A) and rs2681472 (A/G) were associated with the susceptibility to hypertension (rs17249754: OR = 1.19, 95%CI: 1.10–1.28; rs2681472: OR = 1.15, 95%CI: 1.12–1.17), and were positively associated with systolic BP (SBP) and diastolic blood pressure (DBP) (rs17249754: SBP, β=1.01, 95%CI: 0.86–1.16, DBP, β=0.48, 95%CI: 0.30–0.66; rs2681472: SBP, β=0.92, 95%CI: 0.77–1.07, DBP, β=0.50, 95%CI: 0.42–0.58) in the additive genetic model. Subgroup analysis stratified by race, population, sample size, and BP measurement method revealed that the association between A allele in rs2681472 polymorphism and risk of hypertension was slightly stronger in European (EUR) populations (OR = 1.16, 95%CI: 1.13–1.20) than in East Asians (OR = 1.14, 95%CI: 1.10–1.17). While in East Asians, relation between rs17249754 with risk of hypertension (OR = 1.19, 95%CI: 1.10–1.28) is stronger than rs2681472 (OR = 1.14, 95%CI: 1.10–1.17).

Conclusions:

Our study demonstrated that ATP2B1 gene polymorphism rs2681472 and rs17249754 were associated with BP levels and the susceptibility to hypertension.
Effect of acupuncture on essential hypertension
Authors: Yu Jing , Wei Yi , Jing Yang , Gao Yongli
Published: April 2021

Background:

Essential hypertension is a risk factor for early cardiovascular disease and is a major preventable risk factor for premature death and disability worldwide. However, some antihypertensive drugs cannot be used for treatment because of their cost-effectiveness or side effects. Non-drug treatments for hypertension include weight loss, salt restriction, smoking cessation, alcohol withdrawal, and exercise, although these methods are difficult to maintain and to achieve. This study will investigate the efficacy and safety of acupuncture and moxibustion in the treatment of different grades of essential hypertension.

Methods and analysis:

A systematic search of the Cochrane, PubMed, EMBASE, CNKI, WanFang, VIP, and CBM databases will be performed, which will include randomized controlled trials on acupuncture for essential hypertension. The main results will include systolic and diastolic blood pressure before and after treatment, whereas the secondary outcomes will be efficacy rate and adverse events. The possible adverse reactions include dizziness, headache, edema, cough, nausea, electrolyte disorders, and hypotension. RevMan Manager 5.3 (Cochrane Collaboration) and STATA 16.0 software will be used to calculate mean deviation, standard deviation, confidence interval, and P values. For continuous variables, we will use the standardized mean difference of 95% confidence intervals as the summary statistics of the meta-analysis.

Results:

This study will assess the efficacy and safety of acupuncture for essential hypertension.

Conclusions:

Our study will determine the efficacy and safety of acupuncture in treating primary hypertension, and provide the basis for clinical decision-making.

INPLASY registration number:

INPLASY202130042.
COVID-19 and Suicide
Authors: Abi Zeid Daou Margarita , Rached Gaelle , Geller Jeffrey
Published: April 2021

COVID-19 hit the world amidst an unprecedented suicide epidemic in this century. As the world focuses on limiting the spread of the virus and prioritizing acutely medically ill patients, containment measures are not without mental health consequences. With rising anxiety and depression, risk of suicide—acutely and in the aftermath of the pandemic—also rises. This article aims to shed light on this major public health problem and better understand what factors may create or exacerbate psychiatric symptoms and suicide. We review suicide data predating the pandemic and examine impact of previous epidemics on suicide rates. We then focus on the current pandemic's impacts and the world's response to COVID-19. We examine how these may lead to increased suicide rates, focusing on the US population. Finally, we offer suggestions on mitigating interventions to curb the impending rise in suicide and the resultant increased burden on an already stretched health care system.