bluuebunny/crossref_metadata_2025 huggingface dataset:
Volar Neurovascular Advancement Flap With an All Neural Branch–preserving Technique
Authors: Liu Wen-Chih , Wen Chaoxi , Wang Zengtao
Published: July 2020

Several fingertip reconstruction options exist, among which, the use of a volar advancement flap or local transposition flap is a simple and effective technique for reconstructing the volar pulp with the same skin texture. To advance the flap, we have to release the tethering structure and sometimes include the neural branches. We describe a concept of an all neural branch–preserving technique to harvest a volar flap. We demonstrate this technique on an anatomic specimen and 1 case with delicate surgical tips. We performed this technique in 16 patients, and the mean follow-up period was 28.4 months. The mean range of motion of the distal interphalangeal joint was 70.3 degrees, and that of the proximal interphalangeal joint was 101.9 degrees. The mean static 2-point discrimination of the volar pulp was 4.8 mm. This technique could be applied on the volar advancement flap with a better sensation recovery.
Rosthorin A inhibits non-small cell lung cancer cell growth and metastasis through repressing epithelial-mesenchymal transition via downregulating Slug
Authors: Ni Lulu , Li Zhongjie , Shi Xuelin , Yao Chao , Sun Jiangnan , Ai Min , Li Shuangshuang , Liu Yixiao , Xu Fei , Zhou Yuetao , Li Jiangan , Qiu Liying
Published: July 2020

Lung cancer always ranks first in the number of cancer deaths every year, accounting for 18.4% of total cancer deaths in 2018. Metastasis is the main cause of death in lung cancer patients. The identification of bioactive components of traditional Chinese medicine is very important for the development of novel reagents against non-small cell lung cancer (NSCLC). Rosthorin A has originated from Rabdosia rosthornii (Diels) Hara which excerpts from ‘Chinese materia medica’, and is known to have ‘clear heat phlegm’ properties in the folk. Little is known about the biological functions and mechanisms of Rosthorin A in cancer cells at present. The role of EMT in metastasis of a tumor cell is self-evident. Slug is an important EMT inducer, which is related to the development of lung cancer. Cell growth, clone assay, cell migration, cell invasion, and protein expression, and NSCLC transplanted tumor growth were performed in A549, H1299, and H1975 cells. Rosthorin A significantly inhibited the growth of NSCLC cells, it could prolong the survival of nude mice. Rosthorin A inhibited the migration and invasion of A549, H1299, and H1975 cells. Rosthorin A up-regulated E-cadherin expression level and down-regulated the expression of β-catenin, N-cadherin, vimentin, Slug, and Twist. Rosthorin A could promote the expression of E-cadherin and inhibit the development of EMT by downregulating Slug, to inhibit the development and metastasis of NSCLC cells. In summary, Rosthorin A could be used as a promising candidate for the treatment of NSCLC patients with recurrence and metastasis.
Icaritin inhibits lung cancer-induced osteoclastogenesis by suppressing the expression of IL-6 and TNF-a and through AMPK/mTOR signaling pathway
Authors: Zhao Xueqiang , Lin Yun , Jiang Bijia , Yin Jianhua , Lu Chunlan , Wang Juan , Zeng Jinrong
Published: July 2020

Bone metastasis is one of the common phenomena in the late stage of lung cancer. Inhibition of bone metastasis can improve the survival of lung cancer patients. However, the current drugs for the treatment of bone metastasis have shown little effect on overall survival. Therefore, there is an urgent necessity to identify novel drugs capable of preventing and treating bone metastasis of lung cancer. Our study determined that icaritin (ICT) can inhibit lung cancer-mediated osteoclastogenesis and induce the apoptosis of osteoclasts. Exposure to ICT increased the activation of adenosine 5’-monophosphate-activated protein kinase (AMPK), reduced the activation of mammalian target of rapamycin (mTOR) and decreased the expression of bcl-2. The bioactivity of ICT on osteoclastogenesis was associated with the regulation of the AMPK/mTOR signaling pathway. Blocking AMPK significantly increased osteoclast differentiation, decreased osteoclast apoptosis and canceled the effects of ICT on the phosphorylation of AMPK as well as the inhibition of mTOR and bcl-2. Furthermore, ICT decreased the levels of IL-6 and TNF-α in osteoclasts, while the AMPK inhibitor compound C significantly abolished the inhibitory effects of ICT on IL-6 and TNF-α. Thus, the present study demonstrated that ICT may be a potential natural agent for the treatment of bone metastasis in patients with lung cancer.
The novel therapeutic potential of bovine α-lactalbumin made lethal to tumour cells (BALMET) and oleic acid in oral squamous cell carcinoma (OSCC)
Authors: Sinevici Nicoleta , Harte Níal , O’Grady Isabel , Xie Yongjing , Min Soyoung , Mok Ken Hun , O’Sullivan Jeff
Published: July 2020

Background

Since the serendipitous discovery of bovine α-lactalbumin made lethal to tumour cells (BAMLET)/human α-lactalbumin made lethal to tumour cells there has been an increased interest in the ability of the two components, oleic acid and α-lactalbumin, to form anti-cancer complexes. Here we have investigated the in-vitro efficacy of the BAMLET complex in killing oral cancer (OC) cells, determined the active component of the complex and investigated possible biological mechanisms.

Materials and methods

Two OC cell lines (±p53 mutation) and one dysplastic cell line were used as a model of progressive oral carcinogenesis. We performed cell viability assays with increasing BAMLET concentrations to determine the cytotoxic potential of the complex. We further analysed the individual components to determine their respective cytotoxicities. siRNA knockdown of p53 was used to determine its functional role in mediating sensitivity to BAMLET. Cell death mechanisms were investigated by flow cytometry, confocal microscopy and the lactate dehydrogenase assay.

Results

Our results show that BAMLET is cytotoxic to the OC and dysplastic cell lines in a time and dose-dependent manner. The cytotoxic component was found to be oleic acid, which, can induce cytotoxicity even when not in complex. Our results indicate that the mechanism of cytotoxicity occurs through multiple simultaneous events including cell cycle arrest, autophagy like processes with a minor involvement of necrosis.

Conclusion

Deciphering the mechanism of cytotoxicity will aid treatment modalities for OC. This study highlights the potential of BAMLET as a novel therapeutic strategy in oral dysplastic and cancerous cells.
Psychiatric Disturbance or Parkinsonism as a Presentation of CNS Lymphoma: Observational Retrospective Study and Review of Literature
Authors: Sharma Akanksha , Dube Sophia , Mountjoy Luke , Ertz-Archambault Natalie , Porter Alyx , Mrugala Maciej M.
Published: July 2020

Objective:

To evaluate the incidence of and characterize the presentation of neuropsychiatric symptoms and/or Parkinsonism as a presentation of central nervous system lymphoma (CNSL) in either its primary CNSL form or when it spreads to the brain in systemic diffuse large B-cell lymphoma (secondary CNSL).

Patients and Methods:

With Institutional Review Board approval we identified patients who had been treated at Mayo Clinic from 1998 to 2018 and were recorded to have a combination of ICD 9/10 codes for CNSL and various psychiatric diagnoses.

Results:

A total of 20 of the 232 patients (9%) were noted to have neuropsychiatric symptoms preceding diagnosis. The average age at diagnosis was 62, with even split for sex. The majority (85%) of patients had primary CNSL. The average duration of symptoms before the diagnosis was 4.8 months. Confusion (80%), depression (40%), apathy (30%), anxiety (30%), and agitation (30%) were the most common symptoms identified. The majority (65%) of patients had subcortical lesions followed by the frontal lobe (50%). Parkinsonism was identified in 5 of the 20 patients with 4 demonstrating resolution of symptoms with treatment of the lymphoma.

Conclusions:

Neuropsychiatric symptoms are a rare but notable symptom before the presentation of CNSL. There is an increasing awareness of neurological illness presenting as pure psychiatric disturbance, prompting the need to exclude organic and treatable diseases, particularly in elderly patients. Acknowledgment and diagnosis are important for an appropriate management as there is a significant impact on patient and caregiver quality of life.
Prevalence and determinants of blood pressure variability in pygmies of Southern region Cameroon
Authors: Bika Lele Elysée C. , Hermans Michel P. , Bovet Pascal , van de Borne Philippe , Donnen Philippe , Leeman Marc , Degaute Jean-Paul , M’Buyamba-Kabangu Jean-René , Hako Yves , Ndongo Amougou Sylvie , Doumbe Jacques N. , Mbango Edisari , Lemogoum Daniel
Published: July 2020

Introduction:

The impact of urbanization and living conditions on the prevalence of hypertension in the Cameroonian population is poorly known.

Aim:

To evaluate the prevalence and determinants of blood pressure (BP) in adult Pygmies and Bantus living in urban and rural areas of Southern Cameroon.

Participants and methods:

This was a cross-sectional comparative study of 406 adults (96 urban Bantus, 100 urban Pygmies, 111 rural Bantus and 99 tropical rainforest Pygmies with a traditional Pygmies way of life), recruited in Southern Cameroon (mean age 42 ± 17 years; 56.7% women). Sociodemographic, anthropometric and BP parameters were collected. Hypertension was defined as BP at least 140/90 mmHg and/or use of BP-lowering drug(s).

Results:

The age-standardized prevalence of hypertension in urban Bantus, rural Bantus, urban Pygmies and traditional Pygmies was 18.0, 13.5, 9.3 and 4.1%, respectively. Mean SBP and DBP differed significantly according to Bantu vs. Pygmy ethnicity, and urban vs. rural residency. After multiple adjustments, mean arterial pressure was significantly associated with age, BMI, Bantu ancestry and urban residency.

Conclusion:

Bantu ethnicity and urban residency are significantly associated with high-BP among people from Southern Cameroon.
MULTIPLE BILATERAL RETINAL BREAKS AS A LONG-TERM COMPLICATION OF RETINOPATHY OF PREMATURITY TREATED WITH INTRAVITREAL BEVACIZUMAB
Authors: Teixeira-Pinto Tomás , Paccola Maria L. , Scott Ingrid U. , Jorge Rodrigo
Published: July 2020

Purpose:

To report the occurrence of multiple bilateral retinal breaks 11 years after bevacizumab treatment for retinopathy of prematurity (ROP).

Methods:

A case report.

Results:

An 11-year-old girl developed multiple bilateral retinal breaks in areas of vitreous condensation 11 years after treatment for ROP with intravitreal bevacizumab at 4 months of age. The retinal breaks were treated with laser retinopexy as prophylaxis for retinal detachment.

Discussion:

Patients with a history of ROP have a lifelong increased risk of retinal tears, and the long-term effects of intravitreal anti–vascular endothelial growth factor therapy for ROP are not well understood or documented. It is unknown whether there are differences in the rates of long-term ocular complications of ROP after anti–vascular endothelial growth factor versus laser treatment of ROP. Studies are needed to compare the long-term benefits and risks associated with both approaches.
The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes
Authors: Funk Ian T. , Strelow Bryan A. , Klifto Meredith R. , Knight O’Rese J. , Van Buren Eric , Lin Feng-Chang , Fleischman David
Published: July 2020

Précis:

This study addresses the paucity of literature examining glaucoma patients’ distance from clinic on postoperative follow-up outcomes. Greater distance from clinic was associated with higher likelihood of loss to follow-up and missed appointments.

Purpose:

To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance.

Methods and Participants:

Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill’s Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson χ2, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up.

Results:

In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24–4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t
(150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t
(197)=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t
(144)=−2.193; P<0.05).

Conclusions:

Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.
Diagnosis and treatment of microspherophakia
Authors: Yu Xuewen , Chen Weijie , Xu Wen
Published: July 2020

As a rare congenital disease, microspherophakia (MSP) is characterized by small and spherically shaped crystalline lenses. The common complications of MSP include secondary glaucoma and crystalline lens dislocation or subluxation. Patients with MSP often show high lenticular myopia. The special morphological characteristics and complex complications bring challenges to the treatment of patients with MSP. Although there are some studies on MSP, most are case reports. In this article, the morphological characteristics, complications, genetic diagnosis, and treatment of MSP were systematically reviewed, providing valuable insight into the clinical diagnosis and treatment of this disease.
Management of small-incision lenticule extraction ectasia using tissue addition and pocket crosslinking
Authors: Ganesh Sri , Brar Sheetal , Bowry Rohan
Published: July 2020

The feasibility of managing ectasia after small-incision lenticule extraction (SMILE) using tissue addition and pocket corneal crosslinking (CXL) is described. Four eyes of 3 patients (mean age 25.7 years) developed features of keraectasia at a mean period of 3 years after SMILE for myopia. All cases were managed with insertion of heterologous SMILE lenticules in the previously created pocket, followed by simultaneous accelerated CXL. At a mean follow-up of 7.67 months, there was improvement in corrected distance visual acuity and reduction in keratometry and higher-order aberrations in all eyes. The visual, refractive, and topographic parameters remained stable at the last visit compared with the 2-week follow-up visit. No eye developed haze, infection, or rejection requiring tissue explantation. Early experience showed tissue addition with simultaneous pocket CXL to be a feasible approach for managing ectasia after SMILE. However, further follow-up is required to establish the long-term safety and effects on corneal stabilization.
Duloxetine improves cancer-associated pain in a mouse model of pancreatic cancer through stimulation of noradrenaline pathway and its antitumor effects
Authors: Kajiwara Ichie , Sano Makoto , Ichimaru Yoshimi , Oshima Yukino , Kitajima Osamu , Hao Hiroyuki , Masamune Atsushi , Kim Jinsuk , Ishii Yukimoto , Ijichi Hideaki , Suzuki Takahiro
Published: July 2020

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Patients with inoperative PDAC require effective chemotherapy and pain control to increase their quality of life. We investigated whether duloxetine, a serotonin–noradrenaline reuptake inhibitor, improves quality of life in a KPPC (LSL-Kras

G12D/+

;Trp53

flox/flox

;Pdx1-cre) mouse model of PDAC. Six-week-old KPPC mice were orally administered 4 mg/kg/d duloxetine (n = 12); 4 mg/kg/d duloxetine with 0.15 mg/kg/d atipamezole, a synthetic α2 adrenergic receptor antagonist (n = 9); or vehicle water (n = 11). Body weight and food intake were measured daily, and cancer pain was evaluated by the hunching score and mouse grimace scale. At the endpoint, the tumor status, angiogenesis, and immunoinflammatory condition were analyzed. The pain level using the hunching and mouse grimace scale scores improved by duloxetine in KPPC mice (P < 0.01), whereas the scores that had been reduced by duloxetine were elevated by administration of atipamezole. Kaplan–Meier analysis demonstrated that duloxetine-treated mice had significantly prolonged survival (P < 0.05) with delayed appetite loss, cachexia, and body weight loss. Duloxetine inhibited the proliferation of PDAC cells and cancer-associated fibroblasts in vivo with a shift into an antitumor immunoinflammatory condition and the corresponding plasma cytokine levels. The migrative/invasive potentials of PDAC were inhibited by duloxetine in vitro. Meanwhile, atipamezole did not inhibit the antitumor effects of duloxetine in vitro and in vivo. Therefore, our results indicate that duloxetine mainly improves cancer-associated pain by enhancement of the noradrenergic pathway rather than the serotonergic pathway, whereas duloxetine modulates antitumor effects on PDAC without involvement of the noradrenergic pathway.
Ventricular Assist Device Implantation and Bariatric Surgery: A Route to Transplantation in Morbidly Obese Patients with End-Stage Heart Failure
Authors: Jeng Eric I. , Miller Amber H. , Friedman Jeffrey , Tapia-Ruano Stephen A. , Reilly Kevin , Parker Alex , Vilaro Juan , Aranda Juan M. , Klodell Charles T. , Beaver Thomas M. , Arnaoutakis George J. , Ahmed Mustafa
Published: July 2020

We reviewed our experience of morbidly obese patients with end-stage heart failure that underwent left ventricular assist device (LVAD) implantation. From January 1, 2008 to January 1, 2018, 240 adult LVADs were implanted at our center. We reviewed the cases of patients presenting with end-stage heart failure and morbid obesity (preoperative body mass index [BMI] ≥ 35 kg/m2) who underwent LVAD-alone, and compared that to a group that underwent LVAD and bariatric surgery (laparoscopic sleeve gastrectomy [LSG]) as a means for weight reduction. Demographic characteristics, perioperative details, BMI, and status of transplant candidacy were recorded. Statistical analysis was performed (SPSS version 25) with χ2 analysis, Kaplan–Meier survival analysis, regression analysis, and Student’s t-test. Twenty-nine patients met criteria and underwent LVAD implantation. Fifteen patients underwent LVAD-alone. Fourteen patients underwent LVAD + LSG. Both groups showed good survival outcomes, LVAD-alone (88.9 ± 5.9 months) versus LVAD +LSG (96.1 ± 12.4 months) but were not significantly different. However, we did note that more patients in the LVAD + LSG group were bridged to heart transplantation (p < 0.001). LVAD-alone and/or LVAD + LSG are both technically feasible and effective treatment options for the long-term survival of morbidly obese patients with end-stage heart failure. Combining LVAD + LSG can help bridge patients to heart transplantation.
Artificial Intelligence Algorithm for Screening Heart Failure with Reduced Ejection Fraction Using Electrocardiography
Authors: Cho Jinwoo , Lee ByeongTak , Kwon Joon-Myoung , Lee Yeha , Park Hyunho , Oh Byung-Hee , Jeon Ki-Hyun , Park Jinsik , Kim Kyung-Hee
Published: July 2020

Although heart failure with reduced ejection fraction (HFrEF) is a common clinical syndrome and can be modified by the administration of appropriate medical therapy, there is no adequate tool available to perform reliable, economical, early-stage screening. To meet this need, we developed an interpretable artificial intelligence (AI) algorithm for HFrEF screening using electrocardiography (ECG) and validated its performance. This retrospective cohort study included two hospitals. An AI algorithm based on a convolutional neural network was developed using 39,371 ECG results from 17,127 patients. The internal validation included 3,470 ECGs from 2,908 patients. Furthermore, we conducted external validation using 4,362 ECGs from 4,176 patients from another hospital to verify the applicability of the algorithm across different centers. The end-point was to detect HFrEF, defined as an ejection fraction <40%. We also visualized the regions in 12 lead ECG that affected HFrEF detection in the AI algorithm and compared this to the previously documented literature. During the internal and external validation, the areas under the curves of the AI algorithm using a 12 lead ECG for detecting HFrEF were 0.913 (95% confidence interval, 0.902–0.925) and 0.961 (0.951–0.971), respectively, and the areas under the curves of the AI algorithm using a single-lead ECG were 0.874 (0.859–0.890) and 0.929 (0.911–0.946), respectively. The deep learning-based AI algorithm performed HFrEF detection well using not only a 12 lead but also a single-lead ECG. These results suggest that HFrEF can be screened not only using a 12 lead ECG, as is typical of a conventional ECG machine, but also with a single-lead ECG performed by a wearable device employing the AI algorithm, thereby preventing irreversible disease progression and mortality.
Specific Considerations for Venovenous Extracorporeal Membrane Oxygenation During Coronavirus Disease 2019 Pandemic
Authors: Guihaire Julien , Owyang Clark g. , Madhok Jai , Laverdure Florent , Gaillard Maïra , Girault Antoine , Lebreton Guillaume , Mercier Olaf
Published: July 2020

Extracorporeal membrane oxygenation (ECMO) is recognized as organ support for potentially reversible acute respiratory distress syndrome (ARDS). However, limited resource during the outbreak and the coagulopathy associated with coronavirus disease 2019 (COVID-19) make the utilization of venovenous (VV) ECMO highly challenging. We herein report specific considerations for cannulation configurations and ECMO management during the pandemic. High blood flow and anticoagulation at higher levels than usual practice for VV ECMO may be required because of thrombotic hematologic profile of COVID-19. Among our first 24 cases (48.8 ± 8.9 years), 17 patients were weaned from ECMO after a mean duration of 19.0 ± 10.1 days and 16 of them have been discharged from ICU.
Effect comparison of salpingectomy versus proximal tubal occlusion on ovarian reserve
Authors: Wu Shuxie , Zhang Qiong , Li Yanping
Published: July 2020

Introduction:

The women with hydrosalpinx have lower pregnancy rates in assisted reproductive technology, and only laparoscopic salpingectomy and tubal occlusion has proven to be effective to improve the outcome of in vitro fertilization. The main objective of the present meta-analysis was to assess and compare the ovarian reserve after salpingectomy or proximal tubal occlusion (PTO) in the published literature.

Material and methods:

We considered all published cohort (retrospective and prospective) and cross-sectional studies as well as randomized controlled trials that investigated changes in serum anti-Müllerian hormone (AMH), follicle-stimulating hormone levels or antral follicle count (AFC) following salpingectomy or PTO. Two investigators (SW, QZ) independently screened the full text of all identified articles to assess relevance to our meta-analysis.

Results:

In total, 648 patients were included in 5 studies. In the analysis of comparative studies. In the analysis of comparative studies, the follicle-stimulating hormone of salpingectomy had no significant difference with that of PTO (WMD 0.46IU/L, 95% CI[-0.14,1.05]). The AMH and AFC of salpingectomy were significantly higher than that of PTO (AFC: WMD -0.80IU/L, 95% CI [-1.46, -0.14]; AMH: WMD -1.01IU/L, 95% CI [-1.28, -0.74]).

Conclusions:

Salpingectomy did more harm to ovarian reserve than PTO in the short-term. However, the long-term effects on ovarian reserve remains uncertain.
Clinical research on minimally invasive internal fixation for the treatment of anterior ring injury in tile C pelvic fracture
Authors: Sun Xiaochen , Yan Huimin , Wang Jianmin , Liu Zhaojie , Tian Wei , Jia Jian
Published: July 2020

The aim of this study is to explore the clinical outcome and indications in treating anterior ring injury of Tile C pelvic fracture with minimally invasive internal fixation.

We retrospectively reviewed 18 patients (aged 25–62, 34.2 ± 7.4) with 26 pelvic anterior ring injuries of Tile C pelvic fracture treated with minimally invasive internal fixation in our hospital were from January 2012 to August 2016. Two cases were pubic symphysis diastasis, 15 were anterior ring fracture (7 were bilateral), and 1 was vertical displacement of pubic symphysis associated with pubic ramus fracture. According to Tile classification, 8, 4, and 6 cases were types C1, C2, and C3, respectively. All patients accepted the operation of pelvic fractures on both rings, while the anterior ring injuries were treated with minimally invasive internal fixation. The period from injury to operation was 5 to 32 days (11.2 ± 3.7). Four patients had pubic symphysis diastasis or pelvic anterior ring fracture medial obturator foramen reduced with modified Pfannenstiel incision and fixed with cannulated screws, 14 patients (22 fractures) had a fractured lateral obturator foramen reduced with modified Pfannenstiel incision associated with small iliac crest incision and fixed with locking reconstruction plates. Clinical data, such as operation time, intraoperative bleeding, Matta standard to assess the reduction quality of fracture, and complications, were collected and analyzed.

The operation time ranged from 30 to 65 minutes (42.8 ± 18.7), and the intraoperative bleeding volume was 30 to 150 mL (66.5 ± 22.8). All cases were continuously followed-up for 16 to 42 months (30.2 ± 4.6). All fractures were healed between 3 and 9 months postoperatively (4.9 ± 2.7 months). According to the Matta standard assessment, 18, 7, and 1 cases were excellent, good, and fair, respectively, with a 96.2% (25/26) rate of satisfaction. Neither reduction loss, fixation failure, nor infection occurred; complications included 1 patient with fatal liquefaction, 1 patient had lateral femoral cutaneous nerve injury, and 1 patient complained of discomfort in the inguinal area due to fixation stimulation.

Minimally invasive internal fixation for pelvic anterior ring injury in Tile C pelvic fracture has the advantages of less damage, safer manipulation, less complications, and good prognosis.
The effectiveness of thunder fire moxibustion for treating allergic rhinitis
Authors: Xiong Jun , Yuan Ting , Huang Qiaotong , Wang Xue , Yang Jun , Jiang Yunfeng , Zhou Xiaohong , Liao Kai , Xu Lingling
Published: July 2020

Background:

Allergic rhinitis (AR) is a chronic disease, resulting in severe syndromes such as sneezing, itching, nasal blockage, and rhinorrhea. The major medications treating AR cause side effects, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Thus, this systematic review and meta analysis aims to systematically evaluate the effectiveness and safety of TFM in the treatment of AR.

Methods:

Nine databases, including Medline, PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database (WF), Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) from inception to July 2020 will be searched. In addition, the grey literature and the references of all included literature will be retrieved manually. Reviewers will identify studies, extract data and assess the quality independently. The outcomes of interest include: total nasal symptom score, total non-nasal symptom score, rhinitis quality of life questionnaire, visual analog scale, Laboratory indicators: serum immunoglobulin E, immunoglobulin A, or immunoglobulin G level and adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis will be performed using RevMan5.3.0 software.

Results:

Because the review is ongoing, no results can be reported.

Conclusions:

The findings from this review will provide reliable evidence for effectiveness and safety of TFM for AR.

Ethics and dissemination:

Ethical approval requirements are not necessary for this review. This systematic review and meta analysis will be disseminated online and on paper to help guide the clinical practice better.

PROSPERO Registration number:

CRD42019141113
Clinical comparison between Er: YAG and CO2 laser in treatment of oral tumorous lesions
Authors: Liu Rui , Sun Kunjun , Wang Yuanda , Jiang Yunxian , Kang Jianyong , Ma Hong
Published: July 2020

Background:

To compare clinical effect between Er: YAG and CO2 laser in treatment of oral tumorous lesions.

Methods:

A comprehensive search was conducted from 2000 to 2019. The quality assessment was performed by the QUADAS-2 tool (The Cochrane Collaboration, 2011). The clinical value of comparison between Er: YAG and CO2 laser was evaluated by using the pooled estimate of sensitivity and specificity. In addition, sensitivity analysis and bias analysis were applied to ensure the accuracy of the results.

Results:

Finally, 268 patients were enrolled in 6 studies and ultimately met the eligibility criteria. The Er: YAG and CO2 groups were 141 and 127, respectively. The meta-analysis showed significant difference in success (risk ratio  = 21.29, 95% confidence interval [1.09, 1.52], P = .002; P for Heterogeneity = .99, I
2
 = 0%) and time of surgery ((P of heterogeneity = .29, I
2
 = 20%, Z = 25.69, P of over effect < .00001). The recurrence and complications of CO2

and Er: YAG groups had no difference.

Conclusion:

Er: YAG laser had better effects than CO2 laser in eliminating oral tumorous lesions while it needed longer operation time than CO2 laser.
Severe asymptomatic hypokalemia associated with prolonged licorice ingestion
Authors: Kwon Young Eun , Oh Dong-Jin , Choi Hye Min
Published: July 2020

Rationale:

Excessive ingestion of licorice can cause pseudohyperaldosteronism. A few case reports in the available literature have described significant hypokalemia secondary to licorice consumption with clinical manifestations of muscle weakness, paralysis, or severe hypertension. To our knowledge, no report has discussed severe asymptomatic hypokalemia associated with licorice consumption.

Patient Concerns:

A 79-year-old man presented to the urology clinic with a several-month history of urinary frequency and a weak stream. Routine laboratory investigations revealed serum potassium (K+) level of 1.8 mmol/L, and he was immediately admitted to the nephrology department.

Diagnoses:

He was in a good state of health, and systemic and neurological examinations were unremarkable. However, laboratory investigations revealed severe hypokalemia and metabolic alkalosis accompanied with renal K+ wasting and hypertension, suggesting a state of mineralocorticoid excess. Hormonal studies revealed low serum renin and aldosterone but normal serum cortisol levels. Detailed history taking revealed that he had used licorice tea daily during the preceding 18 months.

Interventions and outcome:

The patient's serum K+ returned to normal levels after vigorous K+ replacement and discontinuation of licorice intake. He was also diagnosed with benign prostatic hyperplasia during hospitalization and was treated.

Lessons:

Chronic licorice ingestion can precipitate severe hypokalemia, although patients may remain asymptomatic. This case report indicates that the severity of a patient's clinical presentation depends on individual susceptibility, as well as the dose and duration of licorice intake.
Bilateral brachial plexus block in a patient with cervical spinal cord injury
Authors: Kim Byung-Gun , Yang Chunwoo , Lee Kyungjoo , Choi Won Jun
Published: July 2020

Rationale:

Bilateral brachial plexus block (BPB) generally requires a relatively large dose of local anesthetic for a successful block, resulting in a high risk of local anesthetic systemic toxicity. It can also result in inadvertent bilateral phrenic nerve palsy, leading to respiratory failure. Hence, it has not been widely used. However, it can be performed in selected patients. In this report, we present a case of ultrasound-guided BPB for bilateral upper extremity surgery in a patient with cervical spinal cord injury (SCI).

Patient concerns:

A 25-year-old woman with SCI secondary to traumatic fifth cervical spine fracture scheduled for surgical treatment of bilateral elbow fracture received bilateral BPB.

Diagnoses:

Due to the complications of SCI, the patient had incomplete sensory loss, loss of motor function, and complete diaphragmatic paralysis on the right side.

Interventions:

Right infraclavicular and left axillary BPB was performed as the sole anesthetic procedure for bilateral upper extremity surgery.

Outcomes:

Bilateral BPB was successful for bilateral upper extremity surgery. The surgery was uneventful and without further complications.

Lessons:

Patients with cervical SCI have a high risk of respiratory complications. Bilateral BPB can be a suitable option for bilateral upper extremity surgery in selected patients. It is imperative to select an appropriate anesthetic technique that preserves respiratory function to minimize the potential risk of respiratory complications.
Efficacy of 25G vitrectomy combined with intrascleral intraocular lens implantation
Authors: Luo Shasha , Yu Jinjin , Ding Nannan , Chen Yanghao , Wu Zhifeng
Published: July 2020

We investigated the clinical efficacy and safety of 25-gauge (G) vitrectomy combined with intrascleral intraocular lens (IOL) implantation. A 25G vitrectomy combined with intrascleral IOL implantation was performed on 39 patients diagnosed with lens dislocation, IOL dislocation, or aphakia. Changes in visual acuity, intraocular pressure (IOP), number of corneal endothelial cells, location of IOL, anatomic success of IOL, recurrence rate of IOL dislocation, and complications were analyzed. One week postoperatively, the IOL was in the centered position in all patients (100%), and 1 month postoperatively, it was centered in 36 patients (92.3%). IOL haptics were exposed under the conjunctiva in one patient (2.6%). Reimplantation of IOL for IOL dislocation was required in two patients (5.1%). Three to six months postoperatively, the IOLs were in the optimum position in 36 patients (92.3%). There were significant differences between the average logarithm of minimal angle of resolution (logMAR) visual acuity at 1 week, 1 month, 3 months, and 6 months postoperatively and that before surgery (P < .05). The average IOP at 1 week, 1 month, 3 months, and 6 months postoperatively was significantly lower than the preoperative IOP (P < .05). A 25G vitrectomy combined with intrascleral IOL implantation is effective and safe for the treatment of eyes without capsular support.
Quick diagnosis units: predictors of time to diagnosis and costs
Authors: Montori-Palacín Elisabet , Ramon Jordi , Compta Yaroslau , Insa Monica , Prieto-González Sergio , Carrasco-Miserachs Ignasi , Vidal-Serra Rafel X. , Altes-Capella Jordi , López-Soto Alfons , Bosch Xavier
Published: July 2020

Financial crisis has forced health systems to seek alternatives to hospitalization-based healthcare. Quick diagnosis units (QDUs) are cost-effective compared to hospitalization, but the determinants of QDU costs have not been studied.

We aimed at assessing the predictors of costs of a district hospital QDU (Hospital Plató, Barcelona) between 2009 and 2016.

This study was a retrospective longitudinal single center study of 404 consecutive outpatients referred to the QDU of Hospital Plató. The referral reason was dichotomized into suggestive of malignancy vs other. The final diagnosis was dichotomized into organic vs nonorganic and malignancy vs nonmalignancy. All individual resource costs were obtained from the finance department to conduct a micro-costing analysis of the study period.

Mean age was 62 ± 20 years (women = 56%), and median time-to-diagnosis, 12 days. Total and partial costs were greater in cases with final diagnosis of organic vs nonorganic disorder, as it was in those with symptoms suggestive or a final diagnosis of cancer vs noncancer. Of all subcosts, imaging showed the stronger correlation with total cost. Time-to-diagnosis and imaging costs were significant predictors of total cost above the median in binary logistic regression, with imaging costs also being a significant predictor in multiple linear regression (with total cost as quantitative outcome).

Predictors of QDU costs are partly nonmodifiable (i.e., cancer suspicion, actually one of the goals of QDUs). Yet, improved primary-care-to-hospital referral circuits reducing time to diagnosis as well as optimized imaging protocols might further increase the QDU cost-effectiveness process. Prospective studies (ideally with direct comparison to conventional hospitalization costs) are needed to explore this possibility.
The effectiveness and safety of traditional Chinese medicine for the treatment of children with COVID-19
Authors: Li Yanqing , Bi Lin , Li Yulin , Hu Xiongxin , Wang Quanxi , Liang Xin , Yu Xujun , Dong Liang , Xie Quan
Published: July 2020

Introduction:

With the widespread spread of novel coronavirus pneumonia, more and more countries have been affected. Some research reports have shown that traditional Chinese medicine has a significant effect on COVID-19 infection, and the treatment of traditional Chinese medicine is used in some special people, such as children. At present, there is a lack of high-quality systematic reviews on the safety and efficacy of using Chinese medicine to treat children with novel coronavirus pneumonia.

Materials and methods:

We will search Cochran library, MEDLINE, EMBASE, China National Knowledge Infrastructure Database (CNKI), China Biomedical Database (CBM), VIP Database (VIP), and Wanfang database for research. This study includes randomized controlled trials (RCTs) and non-RCTs, and uses the Cochrane systematic review to review the safety and efficacy of traditional Chinese medicine in preventing and treating children with novel coronavirus pneumonia. RCT research tools and quantitative research quality assessment tools for non-randomized studies will be used to assess the risk of bias in studies included in the systematic review. We will use Revman 5.3 software for meta-analysis, the main result is odds ratio, and then a subgroup analysis will be performed based on the age, intervention degree, and disease severity of the patients reviewed.

Ethics and dissemination:

This systematic review protocol is designed to provide evidence regarding the effectiveness and safety of traditional Chinese medicine for the treatment of children with COVID-19, such evidence may be useful and important for clinical treatment decisions. The results should be disseminated through publication in a peer-reviewed journal. Since the data and results used in the systematic review will be extracted exclusively from published studies, approval from an ethics committee will not be required.

Registration information:

PROSPERO CRD42020179150.
Evaluation of titanium cranioplasty and polyetheretherketone cranioplasty after decompressive craniectomy for traumatic brain injury
Authors: Yang Jingguo , Sun Tong , Yuan Yikai , Li Xuepei , Yu Hang , Guan Junwen
Published: July 2020

Introduction:

Cranioplasty following decompressive craniectomy is routinely performed to restore integrity of skull and improve neurological function. However, reconstructing the cranial defect brings many challenges to neurosurgeons and search for ideal implant materials is one of the most controversial issues. Although many studies have compared the outcomes of titanium and polyetheretherketone (PEEK) cranioplasty, yet no prospective study exists to guide the choice of titanium and PEEK materials.

Methods/design:

A non-randomized, partially blinded, prospective cohort study is described that comprehensively compares the long-term outcomes of titanium cranioplasty versus PEEK cranioplasty. One hundred forty-five patients for each group will be recruited. Eligible patients are those with cranial defect due to traumatic brain injury (≥ 16 years), defect size is over 25 cm2 and they must agree to participate in the trial. Each participant is evaluated before surgery, on discharge, 3, 6, and 12 months after cranioplasty. The primary outcome is the infection, implant failure and implant deformation requiring revision surgery within 12 months. Secondary outcomes include postoperative complication rate, neurological outcomes, motor function, and cosmetic outcome over a 6-month period.

Discussion:

Search for ideal implant materials is throughout the history of cranioplasty. This study will provide robust evidence for the choice of cranioplasty materials.

Trial registration number:

ChiCTR2000033406
Evaluation of efficacy and safety of single and multiple therapy of herbal medicine/Chuna therapy on non-specific chronic low back pain
Authors: Ko Youme , Jang Bo-Hyoung , Oh Min-Seok , Kim Sun Joong , Ko Yeon-seok , Ha In-Hyuk , Lee Eun Jung , Kim Me-riong , Song Yun-Kyung , Ko Seong-Gyu
Published: July 2020

Introduction

Chronic non-specific low back pain is one of the common health issues which reduce the quality of life and in working population. While combined therapeutic treatment method is widely used for musculoskeletal related disorders in Korea, well-developed trials on the efficacy of single or combine therapy on herbal medicine and Chuna manual therapy (CMT) are scarce.

Objective

This study aims to evaluate the clinical efficacy and safety of herbal medicine, Sogyeonghwalhyeol-tang (SGHH) on work related chronic low back pain patients. The primary aim is to determine the efficacy of a combined multidisciplinary approach using SGHH with CMT compared to SGHH alone. The secondary aim is to examine the naïve direct comparison between SGHH and placebo.

Method

This trial is designed as a multicenter, randomized, controlled, clinical trial. A total of 150 participants who have with chief complaint of low back pain in Korean medicine rehabilitation center will be randomly assigned to 1 of 3 treatments with a ratio of 1:1:1. Eligible participant will be randomized to treatment arm A receive single treatment of Sogyeonghwalhyeol-tang, in treatment Arm B Sogyeonghwalhyeol-tang and Chuna manual therapy are administered concurrently, in treatment arm C, where individuals receive placebo with Chuna manual therapy. They will receive assigned treatment in 4 weeks and follow-up for 4 weeks. The primary endpoint is to assess the change in severity of low back pain from baseline. The secondary endpoints are the following: the changes in disability and health related quality of life. Adverse events will also be reported.

Discussion

The study result will provide the valuable information for efficacy and safety of monotherapy and multiple therapy of herbal medicinal extract and Chuna manual therapy on chronic non-specific low back pain.

Trial registration:

ClinicalTrials.gov Identifier: NCT03132974.
Comparison of clinicopathologic profiles and prognosis of gastric cancer in the upper, middle and lower third of the stomach
Authors: Ma Xiaoming , Zhang Chengwu , Wang Cheng , Miao Wei , Zhou Wei , An Juan , Qiao Wenjie , Li Mingzheng , Lai Minggui , Yu Pengjie
Published: July 2020

Gastric cancer (GC) is the fourth most common cancer in the world and the second most common cancer in China. The aim of this study was to investigate the clinicopathologic profiles and prognosis of GC in the upper third (UT), middle third (MT) and low third (LT) of the stomach.

Five hundred and forty-two patients with GC resected between January 2010 and January 2014 were retrospectively studied and divided in 3 groups according to cancer location: upper third gastric cancer (UTGC) (n = 62); MTGC (n = 131) and LTGC (n = 349). Clinical and pathological parameters including gender, age, tumor size, macroscopic types, histological types, depth of invasion, lymph node metastasis, venous infiltration and lymph embolism were compared among groups. Overall survival (OS) was calculated based on the aforementioned parameters. Univariate and multivariate survival was analyzed and Cox regression was conducted for each location. The prognostic accuracy was determined using receiver operating characteristic curve analysis.

Patients with UTGC was similar to those with MTGC and both were distinct from those with LTGC based on the tumor size, macroscopic types, depth of invasion and 5-year OS. Patients with MTGC were similar to those with LTGC and distinct from UTGC patients based on gender. 5-year OS were lower for patients with UTGC than those with LTGC (P = .001) and were comparable between MTGC and LTGC. No significant differences in 5-year OS were observed between UTGC and MTGC. Cox regression revealed that macroscopic types, depth of invasion and lymph node metastasis were the independent prognostic factors for GC patients regardless of locations. Receiver operating characteristic curve analysis revealed that macroscopic types, depth of invasion and lymph node metastasis were the significantly effective prognosis for the 5-year OS in GC patients regardless of locations.

Our results showed that UTGC is distinct from LTGC whereas MTGC shares some characteristics from both UTGC and LTGC.
Survival after in-hospital cardiopulmonary resuscitation from 2003 to 2013
Authors: Park In Young , Ju Young-Su , Lee Sung Yeon , Cho Hyun Sun , Hong Jeong-Im , Kim Hyun Ah
Published: July 2020

We analyzed cardiopulmonary resuscitation (CPR) rates, deaths preceded by CPR, and survival trends after in-hospital CPR, using a sample of nationwide Korean claims data for the period 2003 to 2013.

The Korean National Health Insurance Service–National Sample Cohort is a stratified random sample of 1,025,340 subjects selected from among approximately 46 million Koreans. We evaluated the annual incidence of CPR per 1000 admissions in various age groups, hospital deaths preceded by CPR, and survival rate following in-hospital CPR. Analyses of the relationships between survival and patient and hospital characteristics were performed using logistic regression analysis.

A total of 5918 in-hospital CPR cases from 2003 to 2013 were identified among eligible patients. The cumulative incidence of in-hospital CPR was 3.71 events per 1000 admissions (95% confidence interval 3.62–3.80). The CPR rate per 1000 admissions was highest among the oldest age group, and the rate decreased throughout the study period in all groups except the youngest age group. Hospital deaths were preceded by in-hospital CPR in 18.1% of cases, and the rate decreased in the oldest age group. The survival-to-discharge rate in all study subjects was 11.7% during study period, while the 6-month and 1-year survival rates were 8.0% and 7.2%, respectively. Survival tended to increase throughout the study period; however, this was not the case in the oldest age group. Age and malignancy were associated with lower survival rates, whereas myocardial infarction and diabetes mellitus were associated with higher survival rates.

Our result shows that hospital deaths were preceded by in-hospital CPR in 18.1% of case, and the survival-to-discharge rate in all study subjects was 11.7% during the study period. Survival tended to increase throughout the study period except for the oldest age group. Our results provide reliable data that can be used to inform judicious decisions on the implementation of CPR, with the ultimate goal of optimizing survival rates and resource utilization.