bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between inflammation factors and Mycoplasma pneumoniae in children
Authors: He Jin-e , Qu Hui , Gao Chun-Yan
Published: April 2019

Background:

Several clinical studies have reported that inflammation factors (IF) are associated with Mycoplasma pneumoniae in children. However, no study systematically investigated the association between IF and M pneumoniae in pediatric population. Thus, this study will explore the association between IF and pediatric M pneumoniae systematically.

Methods:

This study will search following databases of PUBMED, PsycINFO, Scopus, Cochrane Library, EMBASE, Web of Science, and Chinese Biomedical Literature Database from inception to the February 28, 2019 without any language limitations. We will cover clinical studies of M pneumoniae that report associations between IF and M pneumoniae. In addition, reference lists of relevant studies will also be identified to avoid missing any eligible studies. Two investigators will independently screen and select studies, and will assess the methodological quality for each study, which is evaluated by using Newcastle Ottawa Scale. Any disagreements will be settled down through discussion with a third investigator until consensus is reached.

Results:

This study will explore the associations between IF and M pneumoniae by assessing the changes of IF, such as interleukin (IL)-4, IL-5, IL-6, IL-10, IL-13, and IL-17 at different stages of M pneumoniae.

Conclusion:

The findings of this study may provide most recent evidence for the associations between IF and M pneumoniae in pediatric populations.

Ethics and dissemination:

Ethical approval is not needed in this study, because no individual patient data will be utilized in this study. The findings of this study are expected to be published at peer-reviewed journal or will be presented at professional conference.

PROSPERO registration number:

PROSPERO CRD42019125359.
Efficacy of laser acupuncture for patients with chronic Bell's palsy
Authors: Ton Gil , Lee Li-Wen , Ng Hui-Ping , Liao Hsien-Yin , Chen Yi- Hung , Tu Cheng-Hao , Tseng Chun-Hung , Ho Wen-Chao , Lee Yu-Chen
Published: April 2019

Background:

Bell's palsy is the most frequent cause of unilateral peripheral facial palsy, a common condition that third of patients can have inadequate recovery and subsequent physical and social impairments. The largely ineffective and even controversial nature of the various medical and surgical treatment options means that novel, alternative approaches are needed. In preclinical and clinical evidence, low-level laser therapy (LLLT) has demonstrated the ability to regenerate peripheral nerves. Laser acupuncture treatment (LAT), the stimulation of traditional acupoints with low-intensity, non-thermal laser irradiation, is a common treatment modality, but its efficacy in chronic Bell's palsy is undetermined. This study aims to evaluate the efficacy of LAT in patients experiencing inadequate recovery from Bell's palsy.

Methods:

This 2-armed, parallel, randomized, subject-assessor-blinded, single-center, sham-controlled pilot trial will randomly assign 32 eligible patients into either a real LAT group (n = 16) or a sham LAT group (n = 16). The real LAT group will receive 3 LAT sessions each week for 6 weeks (a total of 18 sessions), delivered to acupoints corresponding with the affected side of the face. The sham LAT group will receive the same treatment as the real LAT group, but with a sham laser device. The primary outcome measure will be the change from baseline at week 6 in the Facial Disability Index score. Secondary outcomes will monitor changes during treatment in the House-Brackmann and Sunnybrook facial nerve grading systems and stiffness scale, at weeks 1, 3, and 6.

Discussion:

To the best of our knowledge, this double-blind, randomized, sham-controlled trial is the first such investigation into the efficacy of LAT in chronic Bell's palsy. Clinical trials using LLLT have shown positive therapeutic effects in acute Bell's palsy, although as yet, the feasibility and efficacy of LAT remain unclear in patients experiencing inadequate recovery from Bell's palsy.

Trial registration:

This trial protocol has been approved by the Research Ethics Committee of the China Medical University Hospital, Taichung, Taiwan (Protocol ID: CMUH107-REC1-030) also registered at ClinicalTrials.gov (identifier no. NCT03592797).
Strain histograms used for differential diagnosis of breast masses according to hardness percentage
Authors: Xue Yan , Zou Hongsheng , Ou Yang , Li Sheng , Zhao Yuehuan , Li Yun , Li Yunling
Published: April 2019

To evaluate the diagnostic performance of percentage of hard component (PHC) versus strain ratio (SR) in focal breast lesion diagnosis.

Ultrasonography and elastography images of 245 malignant and 255 benign breast lesions were obtained and analyzed according to the Breast Imaging-Reporting and Data System of the American College of Radiology. PHC and SR were measured for each lesion and receiver operating characteristic (ROC) curve analysis was performed to evaluate and compare the diagnostic performance of conventional ultrasound (CU) only, PHC with CU, and SR with CU.

Mean PHC differed significantly between malignant (90.46 ± 13.29) and benign (62.03 ± 25.61) lesions. Mean SR differed significantly between malignant (4.61 ± 1.75) and benign (2.34 ± 1.80) lesions. ROC curve threshold values were 82.45 for PHC and 2.69 for SR. The area under the curve values for CU, SR with CU, and PHC with CU were 0.956, 0.960, and 0.956, respectively, with no significant differences among them (P < .05).

PHC was comparable to SR for differentiating malignant from benign breast masses and may be an auxiliary tool for breast lesion stiffness evaluation. ROC data for CU, SR with CU, and PHC with CU were statistically similar.
Treatment experience for full-thickness wound dehiscence with cerebrospinal fluid leakage following posterior primary spine surgery
Authors: Feng Chen , Qianqian Shao , Jianhua Hu , Yu Zhao , Yipeng Wang , Jianguo Zhang , Guixing Qiu
Published: April 2019

Rationale:

Full-thickness wound dehiscence with cerebrospinal fluid (CSF) leakage following posterior spine surgery is a rare but troublesome complication. In the present study, 3 clinical cases associated with this entity are reported.

Patient concerns:

The first case developed incision effusion 5 days after posterior decompression and internal fixation for lumbar spinal stenosis. The second case has the same diagnosis and treatment with the first case. She developed intraoperative CSF leak and incision effusion 7 days after the surgery. The third case developed incision effusion 6 days after posterior single door laminoplasty for cervical spondylosis.

Diagnosis:

All cases developed CSF leak, incision effusion and finally full-thickness wound dehiscence on the postoperative period.

Interventions:

Bed rest, drainage, vacuum sealing drainage (VSD), and reoperations were applied in all of the patients. Trapezius flap transfer was applied to the third case. One lumbar patient developed deep infection and meningitis; thus, the internal fixation and bone graft were removed.

Outcomes:

All of the patients received wound healing finally and were followed up for >6 months. No incision complications reoccurred, and preoperative symptoms significantly relieved.

Lessons:

Several techniques can be adopted to minimize the incidence of complications and proper surgical repair is the most important. Lumbar cistern drainage and VSD are recommended. Some other available options of management will also help.
Iatrogenic bile duct Injury with a retained T-tube in common bile duct for 10 years
Authors: Wang Li , Dong Ping , Zhang Yi , Liu Xubao , Tian Bole
Published: April 2019

Rationale:

Bile duct injury (BDI), a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over T-tube in severe cases. There were few cases about retained fragments of T-tube. Whereas, intact T-tube retained in common bile duct (CBD) for years after BDI was very rare.

Patient Concerns:

A 55-year-old female complaining of a retained T-tube in the right upper quadrant for 10 years with bilious exudation for 3 months.

Diagnosis:

Based on the medical history of reoperation after the initial laparoscopic cholecystectomy (LC), the retained T-tube, the bilious exudation, and the feature of image modalities, she was diagnosed with retained biliary T-tube, biliary leak, hepatolithiasis, and BDI.

Interventions:

After nonsurgical management at local hospitals, the patient had her indwelling T-tube removal during laparotomy in our center finally. During this procedure, bile duct exploration, hilar bile ducts reconstruction, and primary Roux-en-Y hepaticojejunostomy were performed.

Outcomes:

Unfortunately, bile leakage occurred postoperatively. After drainage of the peritoneal bilious fluid, the patient recovered gradually without further complication.

Lessons:

T-tube in CBD could act as nidus for stone formation after long-time placement. As a result of gradual stone formation on T-tube, severe hepatic ducts dilatation may occur without the presence of jaundice. Timely follow-up and proper surgical intervention should be suggested for patients with T-tube placement or iatrogenic BDI to avoid further impacts.
Assessing treatment and monitoring of musculoskeletal conditions using opioid versus nonopioid therapy
Authors: Pierce Derek P.R. , Pierce Brett , Cheng Chin-I , Perzhinsky Juliette
Published: April 2019

The purpose of this study is to examine the treatment of noncancer musculoskeletal pain in different clinical settings by assessing patient demographics, pain diagnoses, opioid analgesic monitoring, and alternative treatments.

Data was collected in a retrospective chart review involving 300 randomly selected charts with an active musculoskeletal diagnosis based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. The population consisted of primary care outpatient clinic and emergency department encounters during the timeframe of January 1, 2016 to March 31, 2016 in a predominantly rural community in Michigan. Variables included prescription medications, musculoskeletal conditions, and prescription drug monitoring modalities. Statistical analysis was accomplished using means, standard deviations, proportions, 2-sample proportional tests, multivariable logistic regression, and multinomial regression models.

Opioid prescribing was observed in 64% of outpatient and 68.9% of emergency department encounters. Back pain was the most common problem with 61.9% patients prescribed opioids having at least 1 diagnosis of back pain. Patients on opioids were older (mean age 58) than patients taking nonopioids (mean age 50). For every year of increasing age, there is a 3.1% increase in the odds of an opioid being prescribed (odds ratio 1.03, confidence interval 1.012–1.049, P = .001). Documentation was extremely low with only 15.2%, 1.5%, and 1.5% of patient charts prescribed opioids demonstrating documentation of urine drug screens, pain agreements, and review of a state prescription drug monitoring program, respectively.

Despite drug monitoring recommendations, low rates of monitoring were observed. Back pain was the largest contributing pain location and had higher opioid use compared to other sites. Many patients had additional pain medications being concurrently prescribed with opioids suggesting that musculoskeletal pain is not often controlled by a single medication type. Reported alcohol abuse, active tobacco use, and illicit substance use can serve as predictors when assessing patients for pain management options. The use of alternative measures and integrative treatment modalities (which saw low utilization in this study) should be implemented as either primary or supplementary therapy as a way to reduce the pharmacologic burden on the patient.
A prospective study of risk factors for in-hospital mortality in patients with malignant obstructive jaundice undergoing percutaneous biliary drainage
Authors: Sha Junfeng , Dong Yanchao , Niu Hongtao
Published: April 2019

Background:

The in-hospital mortality rate in patients undergoing percutaneous transhepatic biliary drainage (PTBD) for malignant obstructive jaundice (MOJ) is high. There are few reports on the risk factors associated with hospital death after MOJ, with most of them being retrospective analyses of single factors. Therefore, this study aimed to assess pre-, intra-, and post-procedure risk factors that were independently associated with increased in-hospital mortality in MOJ patients who underwent PTBD.

Methods:

One-hundred fifty-five patients with MOJ who underwent initial PTBD were included in this study. A total of 25 pre-, 4 intra-, and 6 post-procedure factors potentially related to in-hospital mortality were assessed by univariate and multivariate analyses.

Results:

The in-hospital mortality rate was 16.8% (26/155). Of 25 pre-procedure variables analyzed, Child-Pugh classification C, creatinine level ≥6.93 μmol/L, and quality-of-life score (≤30) were found to be significant in univariate and multivariate analyses. Increased mortality was observed in patients with 2 or more risk factors, which was significantly different from patients with no risk factors or one risk factor (P < .01). None of the intra-procedure factors were important in identifying patients at risk of death. Multivariate analysis indicated post-PTBD cholangitis and unsuccessful drainage as post-procedure risk factors that correlated with in-hospital death.

Conclusion:

It was identified that in-hospital mortality was associated with 3 pre-procedure and 2 post-procedure risk factors, such as the liver function classification, quality-of-life score of cancer patients, creatinine level, PTBD-associated biliary duct infection, and unsuccessful drainage.
Ultrasound image analysis using deep learning algorithm for the diagnosis of thyroid nodules
Authors: Song Junho , Chai Young Jun , Masuoka Hiroo , Park Sun-Won , Kim Su-jin , Choi June Young , Kong Hyoun-Joong , Lee Kyu Eun , Lee Joongseek , Kwak Nojun , Yi Ka Hee , Miyauchi Akira
Published: April 2019

Fine needle aspiration (FNA) is the procedure of choice for evaluating thyroid nodules. It is indicated for nodules >2 cm, even in cases of very low suspicion of malignancy. FNA has associated risks and expenses. In this study, we developed an image analysis model using a deep learning algorithm and evaluated if the algorithm could predict thyroid nodules with benign FNA results.

Ultrasonographic images of thyroid nodules with cytologic or histologic results were retrospectively collected. For algorithm training, 1358 (670 benign, 688 malignant) thyroid nodule images were input into the Inception-V3 network model. The model was pretrained to classify nodules as benign or malignant using the ImageNet database. The diagnostic performance of the algorithm was tested with the prospectively collected internal (n = 55) and external test sets (n = 100).

For the internal test set, 20 of the 21 FNA malignant nodules were correctly classified as malignant by the algorithm (sensitivity, 95.2%); and of the 22 nodules algorithm classified as benign, 21 were FNA benign (negative predictive value [NPV], 95.5%). For the external test set, 47 of the 50 FNA malignant nodules were correctly classified by the algorithm (sensitivity, 94.0%); and of the 31 nodules the algorithm classified as benign, 28 were FNA benign (NPV, 90.3%).

The sensitivity and NPV of the deep learning algorithm shown in this study are promising. Artificial intelligence may assist clinicians to recognize nodules that are likely to be benign and avoid unnecessary FNA.
A case report of intraventricular and intrathecal tigecycline infusions for an extensively drug-resistant intracranial Acinetobacter baumannii infection
Authors: Deng Zi-Wei , Wang Jin , Qiu Cheng-Feng , Yang Yi , Shi Zhi-Hua , Zhou Jian-Liang
Published: April 2019

Rationale:

The treatment of intracranial Acinetobacter baumannii infections is made difficult by multidrug-resistance poor drug penetration through the blood-brain barrier (BBB). Although tigecycline appears to be effective against A baumannii, it is only administered intravenously because it does not readily cross the BBB. The addition of intraventricular (IVT) or intrathecal infusions of tigecycline could revolutionize clinical therapy for intracranial A baumannii infections. However, there are few reports on the successful use of such treatments.

Patient concerns:

We report the case of a 17-year-old male who presented with high fever and neck rigidity after intracranial drainage.

Diagnosis:

Intracranial infection with extensively drug-resistant A baumannii after intracranial drainage.

Interventions:

On the advice of a clinical pharmacist, the patient was administered intrathecal infusions of tigecycline after treatment failure with IVT tigecycline.

Outcomes:

The patient's body temperature returned to normal. Thereafter, the patient was in good clinical condition without signs of cerebrospinal fluid infection and tuberculosis.

Lessons:

However, when central nervous system infections fail IVT tigecycline, clinicians should consider changing to intrathecal tigecycline infusions rather than raising the dose of IVT tigecycline. In addition, the co-administration of tigecycline with other drugs that can penetrate the BBB should not be ruled out.
End-stage renal disease in a Down syndrome patient caused by delayed diagnosis of nonneurogenic bladder
Authors: Kim Ga Eun , Sin Dal Sik , Kim Seung Soo , Lee Chang-Ho , Cho Nam-Jun , Lee Eun Young
Published: April 2019

Rationale:

Patients with Down syndrome (DS) have a higher incidence of nonneurogenic neurogenic bladder (NNB) than do normal subjects. Renal failure may occur frequently in NNB patients. Although most of the cases of NNB patients with DS reported to date have been acute renal injuries, we report a patient with DS who was diagnosed late with urinary tract obstruction due to NNB that finally proceeded to end-stage renal disease (ESRD). This case of terminal renal failure is the first such reported case in the world.

Patient concerns:

A 35-year-old female patient had visited another hospital for 1 month for abdominal discomfort, nausea, constipation, and palpable mass. Cystic mass in the pelvic cavity, increased BUN, and Cr findings were observed. Residual urine was 1.8 L. She had a history of DS.

Diagnoses:

Based on computed tomography and urodynamic study, ESRD due to NNB was diagnosed.

Interventions:

An emergency hemodialysis was performed and a catheter was inserted into the bladder. Transfusion and amlodipine were administered according to the patient's condition. There was no improvement in renal function seen, and so arteriovenous fistula surgery and regular hemodialysis were performed.

Outcomes:

The patient was discharged from the hospital with a bladder catheter. She was visited on a regular basis for catheter replacement and hemodialysis.

Lessons:

Patients with DS have lower intelligence than normal people and often do not recognize or complain about inconveniences, even in the presence of urinary symptom. NNB has good prognosis when treated early, but there is a risk of ESRD if the diagnosis and treatment are delayed, as was the case here. Considering that the prevalence of NNB and other urinary tract diseases is high in patients with DS, clinicians need to take careful histories and observe deeply, even if the patient does not mention certain issues.
Non-ST elevation myocardial infarction induced by carbon monoxide poisoning
Authors: Gao Yu , Yang Jing , Ma Linlin , Zhang Yi , Li Zhuo , Wu Lianhua , Yang Lin , Wang Hongshi
Published: April 2019

Rationale:

Acute myocardial infarction is a rare complication of carbon monoxide poisoning. there is often no chest pain and other typical manifestations. We report a patient with mild carbon monoxide poisoning who had acute dyspnea as the earliest symptom and was later diagnosed with non-ST elevation myocardial infarction (NSTEMI) and acute left heart failure.

Patient concerns:

A 73-year-old woman complained of dizziness and fatigue with shortness of breath after carbon monoxide intoxication.

Diagnoses:

This patient had a clear history of carbon monoxide poisoning, acute respiratory distress, bilateral lung dry and moist rale, chest X-ray showed bilateral pulmonary edema, Electrocardiograph indicated general depression of the ST segment of the leads in the chest, cardiac troponin I (CTNI) increased progressively, cardiac ultrasonography indicated abnormal ventricular wall movement, coronary angiography suggested left main trunk and 3-vessel lesions, suggesting diagnosis acute carbon monoxide poisoning, acute coronary syndrome, acute left heart failure.

Interventions:

She was treated with a high concentration of oxygen, an inhibitor of platelet aggregation (aspirin plus clopidogrel), an anticoagulant (low molecular weight heparin), an antimicrobial (ceftizoxime), an expectorant (mucosolvan), diuresis (furosemide and spironolactone), and myocardial support (Metoprolol). Coronary angiography and stent placement were performed 8 days later.

Outcome:

On the 10th day after onset of the condition, echocardiography was performed, which showed that cardiac function was improved. Mild segmental wall motion abnormality was observed on echocardiography. After 14 days, the patient had recovered well and was discharged without chest tightness, chest pain, dizziness, headache, or unresponsiveness.

Lessons:

This case suggests that the symptoms of carbon monoxide poisoning are complex and diverse. It can be manifested as a primary hypoxic symptom, or cause the exacerbation of underlying diseases due to hypoxia. Therefore, patients with carbon monoxide poisoning should actively seek comprehensive cardiac examination to ensure early diagnosis. Whenever necessary, coronary angiography and stent implantation should be performed to improve the likelihood of the patient's survival.
Efficacy of etoricoxib for ankylosing spondylitis
Authors: Tang Hua-yu , Zhao Yu , Li Yu-zhi , Wang Tian-shu
Published: April 2019

Background:

Previous clinical trials have reported that etoricoxib has been utilized to treat ankylosing spondylitis (AS) effectively. However, no study systematically investigated the efficacy and safety of etoricoxib for patients with AS. In this systematic review, we will assess the efficacy and safety of etoricoxib for AS.

Methods:

The following electronic databases will be searched from inception to the February 1, 2019: Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database. This study will include randomized controlled trials that explore the efficacy and safety of etoricoxib for AS. The primary outcome is pain intensity, as measured by any pain scales, such as Numerical Rating Scale. The secondary outcomes consist of AS function, as measured by Bath Ankylosing Spondylitis Functional Index, or other tools; quality of life, as assessed by Ankylosing Spondylitis Quality of Life questionnaire or any other relevant instruments; as well as adverse events. Two authors will independently carry out the study selection, data extraction, and risk of bias assessment. Statistical analysis will be performed by using RevMan 5.3 software.

Results:

This systematic review will provide a detailed summary of present evidence related to the efficacy and safety of etoricoxib for patients with AS.

Conclusion:

The results of this study may provide management guidance for AS treated by etoricoxib.

Dissemination and ethics:

This systematic review dose not needs ethical approval, because it will not analyze individual patient data. The findings of this study are expected to publish through a peer-reviewed journal.

Systematic review registration:

CRD42019124768.
MicroRNA-related transcription factor regulatory networks in human colorectal cancer
Authors: Hao Shuhong , Huo Sibo , Du Zhenwu , Yang Qiwei , Ren Ming , Liu Shui , Liu Tongjun , Zhang Guizhen
Published: April 2019

Objective

Colorectal cancer (CRC) is an extremely common gastrointestinal malignancy. The present study aimed to identify microRNAs (miRNAs) and transcription factors (TFs) associated with tumor development.

Methods

Three miRNA profile datasets were integrated and analyzed to elucidate the potential key candidate miRNAs in CRC. The starBase database was used to identify the potential targets of common differentially expressed miRNAs (DEMs). Transcriptional Regulatory Element Database and Transcriptional Regulatory Relationships Unraveled by Sentence-based Text databases were used to identify cancer-related TFs and the TF-regulated target genes. Functional and pathway enrichment analyses were performed using the Database for Annotation, Visualization and Integration Discovery (DAVID) database, and the miRNA–TF–gene networks were constructed by Cytoscape. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to detect the expression of genes and miRNAs.

Results

In total, 14 DEMs were found in CRC. By bioinformatics analysis, 5 DEMs (miR-145, miR-497, miR-30a, miR-31, and miR-20a) and 8 TFs (ELK4 (ETS-family transcription factor), myeloblastosis proto-oncogene like (MYBL)1, MYBL2, CEBPA, PPARA, PPARD, PPARG, and endothelial PAS domain protein (EPAS1)) appeared to be associated with CRC and were therefore used to construct miRNA–TF–gene networks. From the networks, we found that miR-20a might play the most important role as an miRNA in the networks. By qRT-PCR, we demonstrated that miR-20a was significantly upregulated in CRC tissues. We also performed qRT-PCR to identify the expression of miR-20a-related TFs (PPARA, PPARD, PPARG, EPAS1). Three of them, PPARA, PPARG, and EPAS1, were downregulated in CRC tissues, with statistically significant differences, while the downregulation of PPARD in CRC tissues was not significantly different. Pathway enrichment analyses indicated that the phosphoinositide 3-kinase (PI3K)-Akt signaling pathway was the most significantly enriched pathway. Two main elements of the PI3K-Akt signaling pathway, phosphatase and tensin homolog deleted on chromosome 10 and B-cell lymphoma 2-associated agonist of cell death, were demonstrated to be downregulated in CRC.

Conclusion

The present study identified hub miRNAs and miRNA-related TF regulatory networks in CRC, which might be potential targets for the diagnosis and treatment of CRC.
Analgesic effectiveness of rectus sheath block during open gastrectomy
Authors: Hong Seongwook , Kim Hyunjeong , Park Junmo
Published: April 2019

Background:

Despite recent advances in gastric cancer surgery, open gastrectomy is often needed to treat gastric cancer. Due to the large incision in the abdomen, the amount of opioid required during surgery increases and postoperative pain becomes worse. It is well known that postoperative pain has a negative impact on the patient's immune system. Herein, we performed an ultrasound-guided bilateral rectus sheath block (RSB) in patients undergoing open gastrectomy under general anesthesia and analyzed the analgesic effectiveness of RSB in open gastrectomy.

Methods:

A total of 46 patients scheduled for open gastrectomy were randomly divided into 2 groups: Group A (n = 21) consisted of patients who received an RSB using 40 mL of 0.375% ropivacaine under ultrasound guidance and Group B (n = 20) consisted of patients who received an RSB using 40 mL of normal saline. An electronic injection pump was connected to each patient for patient-controlled analgesia (PCA) immediately after the skin closure. The amount of remifentanil required during the surgery was analyzed. After using PCA, data on the use of PCA bolus dose were extracted and analyzed using Excel.

Results:

Group A used significantly less remifentanil (1021.4 ± 172.0 μg) than group B (1415.0 ± 330.6 μg; P = .03). The number of PCA bolus dose provided to the patients after surgery was significantly lower in group A (1 h: 1.14 ± 0.9, 2 h: 0.85 ± 0.7) than in group B (1 h: 1.85 ± 0.7, 2 h: 1.45 ± 1.0) until 2 hours after the surgery (1 h, P = .008; 2 h, P = .03), but after 3 hours, there were no significant differences between the 2 groups.

Conclusions:

If ultrasound-guided bilateral RSB with 40 mL of 0.35% ropivacaine is performed precisely in patients undergoing open gastrectomy, the requirement for remifentanil during surgery can be reduced. In addition, it significantly reduces the use of PCA bolus dose for acute postoperative pain within 2 hours after surgery.
Association between adolescent idiopathic scoliosis and sacroiliac joint dysfunction in young athletes
Authors: Šarčević Zoran , Tepavčević Andreja
Published: April 2019

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, a 3-dimensional deviation in the axis of the spine. Etiology of AIS is unclear and the general belief is that AIS is multifactorial disorder possibly caused by different factors. It would be worthwhile to reveal new factors associated with AIS. The present study aimed to investigate association between sacroiliac joint (SIJ) dysfunction and AIS in young athletes.

This case–control study included 196 children athletes (basketball, football, volleyball, handball, ballet, and others), 82 males and 114 females aged 8 to 17, 98 of them with the diagnosis of AIS. The case group consisted of young athletes examined at a regular checkup by a sport physician and diagnosed with AIS. The control group consisted of athletes matched to the case group according to sex, age, sports, number of training years and number of training hours per week, but without AIS.

The scoliosis was diagnosed with Adams’ forward bend test and the scoliometer measurement. The SIJ dysfunction was determined using the palpation meter (PALM) measuring the sagittal pelvic position in standing position and in standing position with the hip flexion angle of 90°. The data were analyzed using Student t test, Mann–Whitney U test, contingency coefficients, and logistic regression.

The average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was found to be statistically different in the case and the control groups (t = 13.88, P = .00). There was a strong positive association between variables representing presence of AIS and SIJ dysfunction (determined by contingency coefficient C = 0.62, coefficient Phi = 0.79 and tetrachoric correlation coefficient 0.95).

The logistic regression indicated that the average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was significantly associated with the probability of scoliosis in young athletes (P = .00, Wald test).

There was a strong positive association between SIJ dysfunction and AIS in young athletes.
Hypothyroidism is an independent risk factor for Menière's disease
Authors: Lin Wen-Ling , Chen Chih-Yu , Hsu Tai-Yi , Chen Wei-Kung , Lin Cheng-Li , Chen Hang-Cheng
Published: April 2019

The relationship of hypothyroidism and Menière's disease (MD) has been discussed before, yet not well documented. Our study aims to investigate the correlation of both diseases.

This is a retrospective cohort study based on data from the LHID2000 (Longitudinal Health Insurance Database 2000), a subset of the Taiwan National Research Health Insurance Database that contains claims data for the 2000 to 2011 period. A total of 27,050 patients were included in this study, 5410 of whom had received a hypothyroidism diagnosis. The prevalence of MD was high in patients with hypothyroidism (95% confidence interval [CI]: 1.14–1.51), especially in those older than 50 years old (P < .001). Although comorbidities such as hypertension or cirrhosis are significant risk factors for Menière's disease (P < .001, P < .05), the incidence rate of Menière's disease in patients with hypothyroidism differs significantly between groups without these comorbidities (95% CI: 1.14–1.95). Regarding the timing for the occurrence of Menière's disease in patients with hypothyroidism, there was a significant time interval of <5 years (P < .05). The risk of MD decreased after treatment with thyroxine and did not differ from that of the nonhypothyroidism cohort (adjusted HR [aHR] = 0.85, 95% CI: 0.66–1.11).

The study demonstrates a significant association between hypothyroidism and Menière's disease, especially in elderly female patients. Physicians should consider verifying the thyroid function when encountering these patients.
Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis
Authors: Yoo Yongjae , Moon Jee Youn , Yoon Sojeong , Kwon Seok Min , Sim Sung Eun
Published: April 2019

Lumbar foraminal spinal stenosis (LFSS) is defined as the narrowing of the nerve root exit associated with a herniated intervertebral disc, osteoarthritic changes in the facet joints, or a hypertrophied ligamentum flavum, which can provoke neurogenic claudication. To achieve effective and safe decompression of the lumbar spinal foramen, a specially designed instrument (Claudicare, SEAWON Meditech, Bucheon-si, Gyeonggi-do, Republic of Korea) for percutaneous lumbar foraminoplasty (PLF) was invented. The purpose of this study was to evaluate the clinical efficacy and safety of the newly devised instrument in patients with LFSS.

PLF was performed for LFSS by a single pain physician. For each patient, an 11-point numerical rating scale (NRS) pain score—the Oswestry Disability Index (ODI)—and the duration of walking without radicular pain were evaluated at the 3-month follow-up. The successful responder percentage was defined as ≥50% reduction from the baseline NRS score with improvement in ODI and duration of walking.

Among 24 patients who underwent PLF, 15 patients showed successful responses. The NRS pain score and duration of walking without radicular pain were improved significantly from baseline at the 3-month follow-up (P 
< .01). The ODI was also decreased, but the difference was not statistically significant (P = .09). The NRS pain score and walking duration without pain at 3 months were statistically significantly different between the groups (P 
< .001 and P 
= .01, respectively), whereas there was no statistically significant difference in improvement in ODI between the groups (P 
= .23). No serious adverse events occurred in the study.

In conclusion, PLF using the Claudicare device may be an optimal and safe option for managing intractable LFSS on an outpatient basis.
Correlation of left atrial wall thickness and atrial remodeling in atrial fibrillation
Authors: Zuo Kun , Li Kuibao , Liu Min , Li Jing , Liu Xiaoqing , Liu Xingpeng , Zhong Jiuchang , Yang Xinchun
Published: April 2019

Atrial remodeling plays a significant role during the progression of atrial fibrillation (AF). Left atrial wall thickness (LAT) is a subjective and easily acquirable indicator referring to structural remodeling. Therefore, we aimed to investigate the association between LAT and atrial remodeling substrate, and to explore the predictive role of LAT about strong maintenance substrate and poor response to catheter ablation.

LAT was measured by cardiac computed tomography in 2 selected locations (roof and floor) in 100 persistent AF patients. Then the low-dose-ibutilide-facilitated catheter ablation was performed and atrial maintenance substrate was categorized as weak, mild, and strong, based on the response to circumferential pulmonary vein isolation or complex fractionated atrial electrograms ablation. During follow-up, the success rate was evaluated. LAT showed a progressive thickening tendency from weak, mild, to strong maintenance substrate (roof: 2.2 mm vs. 2.6 mm vs. 3.9 mm, P < .0001; floor: 1.7 mm vs. 2.0 mm vs. 2.5 mm, P < .0001). During follow-up, the success rate of ablation was decreased with the maintenance substrate strengthening (weak 80%, mild 64.53%, strong 31.43%, P = .009). LA roof thickness >3.10 mm might be the predictor to strong atrial maintenance substrate and poor response to ablation.

LAT was associated with the remodeling extent of atrial maintenance substrate and might predict the response to catheter ablation. These findings could help the clinicians to select the appropriate ablative strategy and predict the complexity and prognosis before catheter ablation.
Serum vitamin D but not zinc levels are associated with different disease activity status in patients with inflammatory bowel disease
Authors: Mechie Nicolae-Catalin , Mavropoulou Eirini , Ellenrieder Volker , Petzold Golo , Kunsch Steffen , Neesse Albrecht , Amanzada Ahmad
Published: April 2019

The incidence of inflammatory bowel disease (IBD) is increasing and the pathogenesis is still not completely understood. Micronutrients like vitamin D [25 (OH)D] and zinc play an important role in enzyme activities and the immune system. As the 25 (OH)D-receptor has been shown to be downregulated in patients with IBD, 25 (OH)D may emerge as a predictive marker for disease improvement. Studies on relationship of both micronutrients in IBD patients are lacking.

We retrospectively evaluated serum levels of 25(OH)D and zinc together with baseline characteristics of 232 IBD patients. Uni- and multivariate analyses were performed for association between serum levels of 25(OH)D and zinc with clinical and deep remission (CR and DR).

155 Crohn's disease (CD) and 77 ulcerative colitis (UC) patients were included. 54% (n = 125) and 6% (n = 14) of IBD patients showed deficient serum 25(OH)D levels below 20 ng/mL and zinc levels below 7 μmol/L. Serum 25(OH)D levels were significantly higher in IBD patients with CR (P = .02) and DR (P < .001) but not serum zinc levels, respectively. Serum 25(OH)D levels (P = .008), anti-tumor-necrosis-factor-α-trough-concentration (anti-TNF-α-TC) (P = .02) and CRP level (P = .02) were independently associated with CR in CD patients. Serum 25(OH)D threshold of 19 ng/mL discriminated CD patients with or without CR, having an area under the receiver operating curve analysis (AUROC) of 0.77 [95%-confidence interval (CI): 0.68–0.85]. In multivariate analysis serum 25(OH)D levels (P = .04) and anti-TNF-α-TC (P = .04) were associated with DR in CD patients. Serum 25(OH)D threshold of 26 ng/mL discriminated CD patients with or without DR, having an AUROC of 0.75 (95%-CI: 0.68–0.83).

Serum 25(OH)D (P = .04) and fecal calprotectin levels (P = .04) were independently correlated with CR in UC patients. Serum 25(OH)D threshold of 32 ng/mL discriminated UC patients in CR with an AUROC of 0.83 (95%-CI: 0.71–0.95). Zinc levels did not correlate with disease activity status in CD or UC patients either.

In conclusion, beside CRP and fecal calprotectin, serum 25(OH)D levels, but not serum zinc levels, may be an additional useful and noninvasive marker for characterizing different disease activity status of IBD patients. Measurement of serum 25(OH)D in IBD patients may be warranted. 25(OH)D supplementation in deficient IBD patients is recommended.
Early intervention and perceived quality
Authors: Romero-Galisteo Rita Pilar , Blanco-Villaseñor Ángel , Moreno-Morales Noelia , Gálvez-Ruiz Pablo
Published: April 2019

The current perspective on early intervention revolves around consideration of the family as a cornerstone, its opinion being essential in providing a quality service. Early intervention centers require an evaluation of the services they perform. The aim of this study was to examine the psychometric properties of the short version of the Inventory of Quality for Early Intervention Centers (IQEIC) and to obtain evidence of its validity and reliability. The sample consisted of 887 families from 21 early intervention centers in Spain, which were randomly divided into 2 groups to conduct a cross-validity analysis: exploratory factor analysis with the first group (n1 = 440), and confirmatory factor analysis with the second group (n2 = 447). A 8 factor structure was obtained in the confirmatory factor analysis that showed a good fit. Both the internal consistency (composite reliability ranging from 0.84 to 0.90) and the convergent (AVE values ranged from 0.12 to 0.50) and discriminant validity were adequate. Lastly, a multigroup analysis (n1 and n2) showed the invariance factorial through the difference in the CFI index. The IQEIC showed satisfactory reliability and validity in this study confirming the proposed model is a valid tool to assess the quality of the service provided in early intervention centers, therefore recommending its application for both research and management.
The effectiveness and safety of moxibustion for dry eye
Authors: Zi Yingxin , Ji Meiqi , Deng Yu , Qin Yali , Wang Rui , Meng Huan , Jin Ming
Published: April 2019

Background:

Dry eye (DE) is a common type of ocular surface disease that affects many people. Moxibustion has been widely used in China to treat ocular surface diseases, especially DE. Many clinical trials have demonstrated that moxibustion can increase the tear secretion quantity and improve tear film stability. The purpose of this review is to provide an objective and normative systematic review to evaluate the effectiveness and safety of moxibustion treatment in patients with DE.

Methods:

The systematic review will include all of the randomized controlled trials on the effectiveness and safety of moxibustion for DE. Nine medical databases, namely PubMed, EMBASE, the Cochrane Library, Google Scholar, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal database (VIP), Wanfang Database, and CBM, will be searched from the date of the database inception to February 28, 2019. We will also search registers of clinical trials, potential gray literature, and conference abstracts. There are no restrictions on language and publication status. Two reviewers will independently select studies, and extract and manage data. The reporting quality and risk of bias will be assessed by other 2 review authors. The primary outcomes will include ocular surface disease index (OSDI) scores, Schirmer test (SIT) results, tear meniscus height (TMH), and tear break-up time (TBUT) values. Quality of life, the main symptom scores before and after treatment, meibomian gland (MG) morphology, total treatment efficacy, and safety will be evaluated as the secondary outcomes. We will use RevMan V.5.3 software to synthesize and analyze data.

Results:

This systematic review will provide a comprehensive review of current evidence of moxibustion for DE from the following aspects: the OSDI, SIT, TMH, BUT, quality of life, the main symptom scores, MG morphology, total treatment efficacy, and safety.

Conclusion:

The conclusion of our systematic review will provide evidence to determine whether moxibustion is an effective and safe intervention for patients with DE.

Ethics and dissemination:

Since patients will not be involved in this study, it is not necessary to obtain ethical approval. The protocol and results will be published in a peer-reviewed journal.

PROSPERO registration number:

PROSPERO CRD42018097399.
Evaluation of the adjunctive effect of Xing Nao Jing Injection for viral encephalitis
Authors: Cao Hui-Juan , Liang Shi-Bing , Zhou Wei , Wu Jia-Rui , Zhang Cheng-Liang
Published: April 2019

Background:

To systematically evaluate the effect and safety of Xing Nao Jing (XNJ) injection as an add-on treatment on the treatment for viral encephalitis (VE).

Methods:

Trials assessing the adjunctive effectiveness of XNJ injection for VE were searched from 4 electronic databases from inception to October 31, 2018. Two authors independently extracted data and assessed risk of bias. Statistical analyses were performed using RevMan 5.3 software. Meta-analysis and additional analysis were conducted if data permitted. Trial Sequential Analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were also performed.

Results:

This review involved 23 trials and 1757 participants, all trials were assessed as having unclear risk of bias. Results from 5 meta-analyses, 13 subgroup meta-analyses, and the single studies showed that based on conventional therapy XNJ injection (0.4–0.6 mL/kg daily for children, 20 mL/day for adults) may have better effect on increasing the numbers of cured patients and decreasing the time of recovery of main symptoms for patients with viral encephalitis. Patients used combination of XNJ injection and conventional therapy had higher cured rate (risk ratio 1.61, 95% confidence interval 1.45–1.80, 19 trials, 1456 participants) and less mortality rate (risk ratio 0.26, 95% confidence interval 0.10–0.71, 9 trials, 595 participants). The average difference of time for fever, conscious, or convulsive recovery was average 2 hours shorter in combination group than in control. No difference was found between children and adults according to the subgroup analysis. Safety of the XNJ injection was failed to evaluate due to the insufficient evidence in this review.

Conclusions:

This review found “very low” quality evidence which showed the potential effectiveness of combination of XNJ injection and conventional therapies for VE. Considering the TSA results, conclusion could only be draw on effectiveness of the XNJ injection as add-on treatment for VE patients on increasing the cured rate. Firm conclusion on other outcome measures for effectiveness assessment or safety of XNJ injection could not be draw according to this review due to the insufficient evidence.
Bilateral discoid medial Meniscus
Authors: Yang Xiaolong , Shao Decheng
Published: April 2019

Rationale:

Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and it is difficult to diagnose a bilateral discoid medial meniscus because not all the discoid medial menisci are symptomatic. Herein, we report 2 cases of bilateral discoid medial meniscus.

Patients concerns:

Case1: a 23-year-old man presented with complaints of pain and occasional clicking of the right knee for 6 years, the left knee was asymptomatic. Case 2: a 51-year-old woman had a 1-month history of pain and a feeling of “giving away” in both knees.

Diagnoses:

Based on physical examination and magnetic resonance imaging (MRI) findings, they were diagnosed with bilateral discoid medial meniscal tears.

Interventions:

Case 1: partial meniscectomy and reshaping were performed for the torn discoid medial meniscus of the right knee only. Case 2: partial medial meniscectomy and reshaping were performed for the torn discoid medial meniscus on both knees.

Outcomes:

The postoperative pain and the recovery of joint function were observed. The average follow-up time of 2 patients was 1 year. The Lysholm score of 2 patients was improved from 55 to 95 and 40 to 90 respectively. The pain of knee joint was relieved and the symptoms of disharmony were obviously improved.

Lessons:

We recommend preservation of the discoid medial meniscus in asymptomatic patients. Meniscectomy and reshaping for injured discoid medial meniscus produces promising short-term results.