bluuebunny/crossref_metadata_2025 huggingface dataset:
What Influences the Decision to Interview a Candidate for Medical School?
Authors: Dong Ting , Hutchinson Jeffrey , Torre Dario , Durning Steven J , Artino Anthony R , Schreiber-Gregory Deanna , Landoll Jennifer , Pflipsen Matthew , Anderson Denise , Saguil Aaron
Published: September 2020

Introduction

Holistic review, in which medical schools seek to balance applicant attributes and experiences alongside traditional academic metrics in making admissions decisions, has been in place for over a decade. Medical school applicants and the admissions’ community are still trying to understand the impact of holistic review on the composition of those medical schools choose to interview and accept.

Materials and Method

The study cohort included all candidates who applied to Uniformed Services University of the Health Sciences (USU) in 2014, 2015, and 2016 (N = 8,920). We conducted logistic regression analysis to examine the associations between the sociodemographic, academic, and military service variables of applicants applying to the School of Medicine and offers for interview.

Results

Medical College Admission Test scores and undergraduate grade point averages were important in predicting who would receive an interview. Having military experience, being a woman, and being self-reported African American race also predicted a higher likelihood of receiving an interview invitation. For example, controlling for all other variables in the model, if an applicant had previous military experience, the odds of being invited for interview was about 4 times that of an applicant who had no previous military experience. Leave this for the text and discussion. The resulting pool of interviewed and accepted students more increasingly represented the Military Health Service population served.

Conclusions

The use of holistic review generated a class with a composition different from that which would be predicted by Medical College Admission Test and grade point average alone. Further, holistic review produced an interview pool and class more representative of the wider Military Health Service beneficiary population. In the case of USU, holistic review allowed the school to better meet its mission to create a representative class able to “care for those in harm’s way.”
Atraumatic Splenic Rupture After Weight Lifting in a Patient Presenting With Left Shoulder Pain
Authors: Halliday Megan , Ingersoll Jared , Alex John
Published: September 2020

We discuss a 23-year-old active duty male who presented to the emergency department with left shoulder pain after deadlifting heavy weights the day prior. His physical examination revealed a nontender and otherwise unremarkable left shoulder with full range of motion and mild tenderness to palpation in the left upper quadrant of the abdomen. A bedside focused assessment with sonography for trauma (FAST) examination showed free fluid in the abdomen and a computed tomography scan showed a splenic laceration and splenomegaly. He later tested positive for infectious mononucleosis. This is the first case report of atraumatic splenic laceration after heavy weight lifting. This case illustrates the importance of a broad differential and high index of suspicion in the patient with undifferentiated abdominal pain in order to diagnose a potentially fatal disease.
The Association With Physical Fitness and Academic Performance at America’s Military Medical School
Authors: Macky Dillon , Dong Ting , Torre Dario , Schreiber-Gregory Deanna , Singaraju Raj , Durning Steven J
Published: September 2020

Introduction

Undergraduate and graduate medical education both have been reported to have high rates of depression, anxiety, and burnout as a result of the rigors of their educational curricula. Wellness, including physical fitness, is important to the profession because it may help mitigate these increased rates of depression and anxiety. While several studies examine physical fitness and academic performance in primary and secondary education, few studies have examined the association between fitness and performance in health professions education. Given the demands of medical school, this investigation aimed to investigate the possibility of an association between physical fitness and body mass index (BMI) with academic performance. Another goal was to examine the change in physical fitness and BMI throughout medical school.

Materials and Methods

Standardized measures of physical fitness were examined in 192 Army students from the Uniformed Services University of Health Sciences over 4 years from the classes of 2017–2019. Measurements include (1) body composition (BMI); (2) muscular endurance (timed push-ups); (3) aerobic endurance (timed run), and (4) total fitness defined as total points from sit-ups, run, and push-ups (everything but BMI). Pearson correlation analysis was conducted between physical fitness and academic performance measures such as United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 Clinical Knowledge (CK), and average core clerkship National Board of Medical Examiners (NBME) exam scores. A repeated measures analysis of variance was conducted to examine the differences of students’ fitness total points and BMI over 4 fitness measurements spanning approximately 1.7 years.

Results

There were weak positive correlations, 0.20 and 0.22, between USMLE Step 2 CK exam scores and push-up points and total fitness points, respectively. There also were weak positive correlations, 0.21 and 0.24, between core clerkship average NBME exam scores and push-up points and total fitness points, respectively. No statistically significant change of individual students’ fitness total point change was observed (F(2.52, 334.93 = 1.37, P = 0.26)). There was also no individual BMI change (F(2.36, 274.21 = 2.78, P = .06)) over the first four assessment measurements (about 1.7 years lapse). However, the class means over the four measurements showed a decrease of fitness total points and an increase of BMI.

Conclusions

Our investigation suggests that there may be correlations between physical fitness and clinical exam performance such as USMLE Step 2 CK and average core clerkship NBME exams. Although there is no statistically significant change in individual fitness total points or BMI, the study suggests that physical fitness and BMI may decline during medical school. This may be as a result of increasing academic demands while balancing clinical duties from clerkship rotations.
Constraining the entropy of formation from young transiting planet
Authors: Owen James E
Published: September 2020

Recently, K2 and TESS have discovered transiting planets with radii between ∼5 and 10 R⊕ around stars with ages <100 Myr. These young planets are likely to be the progenitors of the ubiquitous super-Earths/sub-Neptunes, which are well studied around stars with ages ≳1 Gyr. The formation and early evolution of super-Earths/sub-Neptunes are poorly understood. Various planetary origin scenarios predict a wide range of possible formation entropies. We show how the formation entropies of young (∼20–60 Myr), highly irradiated planets can be constrained if their mass, radius, and age are measured. This method works by determining how low-mass an H/He envelope a planet can retain against mass-loss, this lower bound on the H/He envelope mass can then be converted into an upper bound on the entropy. If planet mass measurements with errors ≲20 per cent can be achieved for the discovered young planets around DS Tuc A and V1298 Tau, then insights into their origins can be obtained. For these planets, higher measured planet masses would be consistent with the standard core-accretion theory. In contrast, lower planet masses (≲6–7 M⊕) would require a ‘boil-off’ phase during protoplanetary disc dispersal to explain.
Jeans modelling of the Milky Way’s nuclear stellar disc
Authors: Sormani Mattia C , Magorrian John , Nogueras-Lara Francisco , Neumayer Nadine , Schönrich Ralph , Klessen Ralf S , Mastrobuono-Battisti Alessandra
Published: September 2020

The nuclear stellar disc (NSD) is a flattened stellar structure that dominates the gravitational potential of the Milky Way at Galactocentric radii $30 \lesssim R \lesssim 300\, {\rm pc}$. In this paper, we construct axisymmetric Jeans dynamical models of the NSD based on previous photometric studies and we fit them to line-of-sight kinematic data of the Apache Point Observatory Galactic Evolution Experiment (APOGEE) and silicon monoxide (SiO) maser stars. We find that (i) the NSD mass is lower but consistent with the mass independently determined from photometry by Launhardt et al. Our fiducial model has a mass contained within spherical radius $r=100\, {\rm pc}$ of $M(r\lt 100\, {\rm pc}) = 3.9 \pm 1 \times 10^8 \, \rm M_\odot$ and a total mass of $M_{\rm NSD} = 6.9 \pm 2 \times 10^8 \, \rm M_\odot$. (ii) The NSD might be the first example of a vertically biased disc, i.e. with ratio between the vertical and radial velocity dispersion σz/σR > 1. Observations and theoretical models of the star-forming molecular gas in the central molecular zone suggest that large vertical oscillations may be already imprinted at stellar birth. However, the finding σz/σR > 1 depends on a drop in the velocity dispersion in the innermost few tens of parsecs, on our assumption that the NSD is axisymmetric, and that the available (extinction corrected) stellar samples broadly trace the underlying light and mass distributions, all of which need to be established by future observations and/or modelling. (iii) We provide the most accurate rotation curve to date for the innermost $500\, {\rm pc}$ of our Galaxy.
The consequences of gamma-ray burst jet opening angle evolution on the inferred star formation rate
Authors: Lloyd-Ronning Nicole M , Johnson Jarrett L , Aykutalp Aycin
Published: September 2020

Gamma-ray burst (GRB) data suggest that the jets from GRBs in the high redshift universe are more narrowly collimated than those at lower redshifts. This implies that we detect relatively fewer long GRB progenitor systems (i.e. massive stars) at high redshifts, because a greater fraction of GRBs have their jets pointed away from us. As a result, estimates of the star formation rate (SFR; from the GRB rate) at high redshifts may be diminished if this effect is not taken into account. In this paper, we estimate the SFR using the observed GRB rate, accounting for an evolving jet opening angle. We find that the SFR in the early universe (z > 3) can be up to an order of magnitude higher than the canonical estimates, depending on the severity of beaming angle evolution and the fraction of stars that make long GRBs. Additionally, we find an excess in the SFR at low redshifts, although this lessens when accounting for evolution of the beaming angle. Finally, under the assumption that GRBs do, in fact, trace canonical forms of the cosmic SFR, we constrain the resulting fraction of stars that must produce GRBs, again accounting for jet beaming-angle evolution. We find this assumption suggests a high fraction of stars in the early universe producing GRBs – a result that may, in fact, support our initial assertion that GRBs do not trace canonical estimates of the SFR.
An event excess observed in the deeply bound region of the 12C (K−, p) missing-mass spectrum
Authors: Ichikawa Yudai , Yamagata-Sekihara Junko , Ahn Jung Keun , Akazawa Yuya , Aoki Kanae , Botta Elena , Ekawa Hiroyuki , Evtoukhovitch Petr , Feliciello Alessandro , Fujita Manami , Gogami Toshiyuki , Hasegawa Shoichi , Hasegawa Tomoyuki , Hayakawa Shuhei , Hayakawa Tomonori , Hirenzaki Satoru , Honda Ryotaro , Hosomi Kenji , Imai Ken’ichi , Jung Wooseung , Kanatsuki Shunsuke , Kim Shin Hyung , Kinbara Shinji , Kobayashi Kazuya , Lee Jaeyong , Marcello Simonetta , Miwa Koji , Moon Taejin , Nagae Tomofumi , Nakada Yoshiyuki , Nakagawa Manami , Nanamura Takuya , Naruki Megumi , Sakaguchi Atsushi , Sako Hiroyuki , Sato Susumu , Sasaki Yuki , Shirotori Kotaro , Sugimura Hitoshi , Takahashi Toshiyuki , Tamura Hirokazu , Tanida Kiyoshi , Tsamalaidze Zviadi , Ukai Mifuyu , Yamamoto Takeshi O
Published: September 2020

We have measured, for the first time, the inclusive missing-mass spectrum of the $^{12}$C$(K^-, p)$ reaction at an incident kaon momentum of 1.8 GeV/$c$ at the J-PARC K1.8 beamline. We observed a prominent quasi-elastic peak ($K^-p \rightarrow K^-p$) in this spectrum. In the quasi-elastic peak region, the effect of secondary interaction is apparently observed as a peak shift, and the peak exhibits a tail in the bound region. We compared the spectrum with a theoretical calculation based on the Green’s function method by assuming different values of the parameters for the $\bar{K}$–nucleus optical potential. We found that the spectrum shape in the binding-energy region $-300 \, \text{MeV} < B_{K} < 40$ MeV is best reproduced with the potential depths $V_0 = -80$ MeV (real part) and $W_0 = -40$ MeV (imaginary part). On the other hand, we observed a significant event excess in the deeply bound region around $B_{K} \sim 100$ MeV, where the major decay channel of $K^- NN \to \pi\Sigma N$ is energetically closed, and the non-mesonic decay modes ($K^- NN \to \Lambda N$ and $\Sigma N$) should mainly contribute. The enhancement is fitted well by a Breit–Wigner function with a kaon-binding energy of 90 MeV and width 100 MeV. A possible interpretation is a deeply bound state of a $Y^{*}$-nucleus system.
Thousands of Alpha Tests
Authors: Giglio Stefano , Liao Yuan , Xiu Dacheng
Published: September 2020

Data snooping is a major concern in empirical asset pricing. We develop a new framework to rigorously perform multiple hypothesis testing in linear asset pricing models, while limiting the occurrence of false positive results typically associated with data snooping. By exploiting a variety of machine learning techniques, our multiple-testing procedure is robust to omitted factors and missing data. We also prove its asymptotic validity when the number of tests is large relative to the sample size, as in many finance applications. To improve the finite sample performance, we also provide a wild-bootstrap procedure for inference and prove its validity in this setting. Finally, we illustrate the empirical relevance in the context of hedge fund performance evaluation.
Neural dynamics of monetary and social reward processing in social anhedonia
Authors: Wang Zhao , Li Qi , Nie Lu , Zheng Ya
Published: September 2020

Being characterized by reduced pleasure from social interaction, social anhedonia constitutes a transdiagnostic marker for various psychiatric disorders. However, the neural portrait of social anhedonia remains elusive because of heterogeneities of reward type and reward dynamics in previous studies. The present event-related potential study investigated neural dynamics in response to monetary and social rewards in social anhedonia. Event-related potential responses were examined when a high social anhedonia (HSA, N = 23) group and a low social anhedonia (LSA, N = 26) group were anticipating and consuming social and monetary rewards. LSA but not HSA participants showed an increased stimulus-preceding negativity (anticipatory phase) and and increased reward positivity (consummatory phase) for monetary as compared with social rewards. This group difference could spring from an increased relevance of social rewards or a general decline in affective responding due to a potential association between social anhedonia and depression. Our findings provide preliminary evidence for neural aberrations of the reward system in social anhedonia, which is contingent upon reward type and reward dynamics.
Molecular Characterization of an Emerging Root-Knot Nematode Meloidogyne enterolobii in North Carolina, USA
Authors: Ye Weimin , Koenning Steve R. , Zeng Yongsan , Zhuo Kan , Liao Jinling
Published: September 2020

An emerging threat to agriculture, Meloidogyne enterolobii Yang & Eisenback, 1983, is a tropical species and considered to be the most damaging root-knot nematode (RKN) in the world because of its wide host range, aggressiveness, and ability to overcome resistance to RKN in many crops. It was first detected in the United States on ornamental plants in Florida in 2001 but has since been identified in North Carolina, South Carolina, and Louisiana. Several thousand RKN populations were collected from North Carolina field crops, ornamental plants, and turfgrasses for species identification in the Nematode Assay Laboratory in the North Carolina Department of Agriculture & Consumer Services. From 2006 to 2019, root systems showing galling symptoms were dissected under the microscope, and females were obtained for DNA analysis. When only soil samples were submitted, the second-stage juveniles or males were used instead. Molecular characterization was performed via polymerase chain reaction with species-specific primers and DNA sequencing on the ribosomal DNA 18S-ITS1-5.8S and 28S D2/D3 and mitochondrial DNA CoxII-16S. One hundred thirty-five representative RKN populations from North Carolina were characterized and identified as M. enterolobii. Six populations from China where the species was originally described were included in this study for identity confirmation and comparison. As of December 2019, M. enterolobii has been confirmed from a limited number of fields in 11 North Carolina counties: Columbus, Craven, Greene, Harnett, Johnston, Lenoir, Nash, Pitt, Sampson, Wayne, and Wilson. Currently, M. enterolobii is the most important emerging RKN species in the United States and causes severe damage to agronomic and horticultural crops, especially sweetpotato in North Carolina.
Substance Use Disorders in Global Mental Health Delivery: Epidemiology, Treatment Gap, and Implementation of Evidence-Based Treatments
Authors: Connery Hilary S. , McHugh R. Kathryn , Reilly Meghan , Shin Sonya , Greenfield Shelly F.
Published: September 2020

Learning objectives

After participating in this activity, learners should be better able to:

• Assess the treatment gap for patients with substance use disorders

• Evaluate treatments and models of implementation for substance use disorders

Substance use disorders (SUDs) account for substantial global morbidity, mortality, and financial and social burden, yet the majority of those suffering with SUDs in both low- and middle-income (LMICs) and high-income countries (HICs) never receive SUD treatment. Evidence-based SUD treatments are available, but access to treatment is severely limited. Stigma and legal discrimination against persons with SUDs continue to hinder public understanding of SUDs as treatable health conditions, and to impede global health efforts to improve treatment access and to reduce SUD prevalence and costs. Implementing SUD treatment in LMICs and HICs requires developing workforce capacity for treatment delivery. Capacity building is optimized when clinical expertise is partnered with regional community stakeholders and government in the context of a unified strategy to expand SUD treatment services. Workforce expansion for SUD treatment delivery harnesses community stakeholders to participate actively as family and peer supports, and as trained lay health workers. Longitudinal supervision of the workforce and appropriate incentives for service are required components of a sustainable, community-based model for SUD treatment. Implementation would benefit from research investigating the most effective and culturally adaptable models that can be delivered in diverse settings.
A Review of Behavioral Therapies in Adolescents with Opioid Use Disorder
Authors: Welsh Justine W. , Mataczynski Maggie J. , Nguyen Minh D. , McHugh R. Kathryn
Published: September 2020

A growing evidence base supports the use of medication to treat opioid use disorder (OUD) in adolescents, but little is known about behavioral therapies for adolescents with OUD. A systematic review using PRISMA methodology was conducted on behavioral therapy for adolescent OUD. Only three studies were identified. Combined evidence from two studies indicates initial efficacy of the Adolescent–Community Reinforcement Approach, motivational enhancement therapy, and cognitive-behavioral therapy for reducing opioid use. The only group therapy identified, which involved adolescents and their parents, demonstrated improvement in participants’ knowledge of relapse-prevention strategies, drug-refusal skills, and overall psychosocial functioning. Additional studies that included behavioral therapy but that did not specifically test its efficacy are also highlighted to expand the understanding of the small literature base. This review highlights the sparse evidence base for these therapies in this population. In addition, we highlight promising areas for future research and include evidence from the adult literature that may inform that research. Studies on behavioral therapies that utilize randomized, controlled trials for this population are imperative.
Cervical foraminal stenosis causing unilateral diaphragmatic paralysis without neurologic manifestation
Authors: Park Hyung-Youl , Kim Ki-Won , Ryu Ji-Hyun , Lim Chang-Rack , Han Sung-Bin , Lee Jun-Seok
Published: September 2020

Rationale:

Unilateral diaphragmatic paralysis due to cervical spondylosis has rarely been reported. We present the first case of unilateral diaphragmatic paralysis without radicular pain or motor weakness due to cervical foraminal stenosis and a review of the related literature.

Patient concerns:

A 59-year-old man presented with dyspnea and fever. His chest radiograph revealed right hemidiaphragmatic paralysis.

Diagnoses:

The differential diagnosis of phrenic nerve palsy excluded mediastinal and neurodegenerative diseases. Imaging studies showed right foraminal stenosis caused by cervical spondylosis at C3–4 and C4–5.

Interventions:

The patient underwent foraminotomy at C3–4 and C4–5 on the right side. The operative findings revealed a severe compression of the C4 root.

Outcomes:

At 3 months postoperatively, the unilateral diaphragmatic paralysis and dyspnea were recovered.

Lessons:

Hemidiaphragmatic paralysis deserves careful evaluation for the presence of cervical spondylosis, even without concomitant neurologic manifestations.
High levels of HIV drug resistance among adults failing second-line antiretroviral therapy in Namibia
Authors: Jordan Michael R. , Hamunime Ndapewa , Bikinesi Leonard , Sawadogo Souleymane , Agolory Simon , Shiningavamwe Andreas N. , Negussie Taffa , Fisher-Walker Christa L. , Raizes Elliot G. , Mutenda Nicholus , Hunter Christian J. , Dean Natalie , Steegen Kim , Kana Vibha , Carmona Sergio , Yang Chunfu , Tang Alice M. , Parkin Neil , Hong Steven Y.
Published: September 2020

To support optimal third-line antiretroviral therapy (ART) selection in Namibia, we investigated the prevalence of HIV drug resistance (HIVDR) at time of failure of second-line ART. A cross-sectional study was conducted between August 2016 and February 2017. HIV-infected people ≥15 years of age with confirmed virological failure while receiving ritonavir-boosted protease inhibitor (PI/r)-based second-line ART were identified at 15 high-volume ART clinics representing over >70% of the total population receiving second-line ART. HIVDR genotyping of dried blood spots obtained from these individuals was performed using standard population sequencing methods. The Stanford HIVDR algorithm was used to identify sequences with predicted resistance; genotypic susceptibility scores for potential third-line regimens were calculated. Two hundred thirty-eight individuals were enrolled; 57.6% were female. The median age and duration on PI/r-based ART at time of enrolment were 37 years and 3.46 years, respectively. 97.5% received lopinavir/ritonavir-based regimens. The prevalence of nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside reverse transcriptase inhibitor (NNRTI), and PI/r resistance was 50.6%, 63.1%, and 13.1%, respectively. No significant association was observed between HIVDR prevalence and age or sex. This study demonstrates high levels of NRTI and NNRTI resistance and moderate levels of PI resistance in people receiving PI/r-based second-line ART in Namibia. Findings underscore the need for objective and inexpensive measures of adherence to identify those in need of intensive adherence counselling, routine viral load monitoring to promptly detect virological failure, and HIVDR genotyping to optimize selection of third-line drugs in Namibia.
Abdominal aorta calcification predicts cardiovascular but not non-cardiovascular outcome in patients receiving peritoneal dialysis
Authors: Tsai Cheng-Hsuan , Lin Lian-Yu , Lin Yen-Hung , Tsai I-Jung , Huang Jenq-Wen
Published: September 2020

Abdominal aorta calcification (AAC) is associated with worse clinical outcomes in dialysis patients. However, the long-term prognostic values of AAC to cardiovascular (CV) and non-CV mortality in patients starting peritoneal dialysis (PD) remain unknown. This study is aimed to the analyze the predictive power of AAC to CV and non-CV mortality in PD patients. We prospectively enrolled 123 patients undergoing PD. All patients received quantitative analysis of AAC via abdominal computer tomography at enrollment. The AAC ratio was measured by the area of the whole aorta affected by aortic calcification above the iliac bifurcation. The CV mortality and non-CV mortality during the follow-up period were investigated using the Cox proportional hazard model and time-dependent receiver operating characteristic (ROC) analysis. After median 6.8 (interquartile range, 3.6–9.2) years of follow-up, there were 18 CV mortality, 24 non-CV mortality and 42 total mortality. The age and AAC ratio were significantly higher in CV mortality group compared with others without CV mortality. In time-dependent ROC analysis, AAC had excellent predictive power of CV mortality (AUC:0.787) but not non-CV mortality (AUC:0.537). The best cutoff value of AAC ratio to predict CV mortality was 39%. In addition, AAC was not associated with non-CV mortality but remained to be a significantly predictor of CV mortality after adjusted with clinical covariates in different Cox proportional hazard models. AAC has excellent prognostic value of CV mortality but is unable to predict non-CV morality in patients undergoing PD.
Tofacitinib for recurrence of antimelanoma differentiation-associated gene 5 antibody-positive clinically amyopathic dermatomyositis after remission
Authors: Ishikawa Yuichi , Kasuya Tadamichi , Fujiwara Michio , Kita Yasuhiko
Published: September 2020

Rationale:

Antimelanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab)-positive clinically amyopathic dermatomyositis (cADM) is frequently complicated with interstitial lung disease (ILD) and has a poor prognosis. Although the short-term prognosis of anti-MDA5 Ab-positive cADM is poor, it has been suggested that the recurrence rate is not higher than that of anti-MDA5 Ab-negative dermatomyositis. Combination therapy with corticosteroids, calcineurin inhibitors, and cyclophosphamide is the gold standard for the remission induction therapy at the onset. Recently, it has been reported that tofacitinib (TOF) could be effective for refractory anti-MDA5 Ab-positive cADM with ILD. Although initial remission induction therapy has been established, therapeutic strategies for relapse cases have not yet been established.

Patient concerns:

A 57-year-old woman who was diagnosed with anti-MDA5 Ab-positive cADM complicated with ILD. In October 2016, she was treated with prednisolone (PSL), tacrolimus (TAC), and cyclophosphamide (CY). These treatments were successful, and PSL could be tapered. However, she developed strong nausea and general fatigue as adverse events of CY. In April 2018, PSL was discontinued, and maintenance therapy was given with TAC. In July 2018, Gottron's sign and ILD recurred. Skin lesions on the finger were partially ulcerated and ILD was also worsening. We proposed a remission reinduction therapy including CY. However, she was rejected CY from experience with past adverse event of CY.

Diagnosis:

Based on skin lesions and chest computed tomography (CT) findings, the diagnosis was a recurrence of anti-MDA5 Ab-positive cADM with ILD.

Interventions:

Treatment by TOF 10 mg and PSL 22.5 mg (0.5 mg/kg equivalent) was introduced in November 2018.

Outcomes:

After introducing TOF and PSL, her skin lesions and chest CT findings of ILD gradually improved. Six months after the induction of TOF, the skin ulcer was epithelialized. One year after the introduction of TOF, PSL was decreased to 9 mg, and the disease activity did not re-exacerbate.

Lessons:

This case report is the first report suggesting the effectiveness of TOF for recurrent case of anti-MDA5 Ab-positive cADM with ILD. TOF might be an effective therapeutic option for treating recurrent case of anti-MDA5 Ab-positive cADM.
Effects of social stories intervention for children and adolescents with autism spectrum disorders
Authors: Chen Tingting , Yang Wenxu , Wang Qiu , Zhang Ying , Ma Zhigui
Published: September 2020

Background:

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder, which lacks specific medical treatment. Intervention is the key point of rehabilitation training for ASD. Social stories (SS) are a commonly used intervention practice in individuals with ASD. However, there is mixed evidence on the effectiveness of SS. Thus, the objective of this systematic review and meta-analysis is to assess studies of the effects of SS for children and adolescents with ASD.

Methods:

To identify relevant studies, we will search PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar and trials registers (the World Health Organization International Clinical Trial Registration Platform, ClinicalTrials.gov, and Chinese Clinical Trial Register) from inception to May 2020. In addition, we will also perform handsearching of grey literature, such as conference proceedings and academic degree dissertations. Only the randomized control trials will be accepted, no matter what the languages they were reported. We will first focus on the effectiveness of the intervention on the behavior of the targets. Then we will do further analysis of the study design, including the length and intensity of intervention, the characteristics of participants and interveners, the methods of assessment, the place, the medium, and the economic feasibility. Two independent reviewers will carry out literature identification, data collection, and study quality assessment. Discrepancies will be resolved by a third reviewer. The Cochrane Risk of Bias Tool will be used to evaluate the risk of bias of the randomized controlled trials. Data analysis will be calculated using the STATA 13.0 software.

Result:

This study will offer new evidence whether the SS is an appropriate intervention of benefiting the children and adolescents with ASD, and to determine which factors affect the effectiveness of SS.

Conclusion:

The conclusion drawn from this systematic review will benefit the children and adolescents with ASD.
Health status, healthcare utilisation, and quality of life among the coastal communities in Sabah
Authors: Dahlui Maznah , Azzeri Amirah , Zain Mohd Aizat , Mohd Noor Mohd Iqbal , Jaafar Hafiz , Then Amy Yee Hui , Suhaimi Julia , Kari Fatimah , Creencia Lota A. , Madarcos John Roderick , Jose Edgar , Fleming Lora E. , White Mathew P. , Morrissey Karyn , Fadzil Kamal Solhaimi , Goh Hong Ching
Published: September 2020

Introduction:

Coastal areas in Malaysia can have important impacts on the livelihoods and health of local communities. Efforts by Malaysian government to develop and improve the landscape and ecosystem have been planned; however, the progress has been relatively slow because some of the coastal areas are remote and relatively inaccessible. Thus, these coastal communities face various challenges in health, healthcare and quality of life. This paper presents a study protocol to examine the health status, healthcare utilisation, and quality of life among the coastal communities. In addition, the relationship between the community and their coastal environment is examined.

Methodology and analysis:

The population of interest is the coastal communities residing within the Tun Mustapha Park in Sabah, Malaysia. The data collection is planned for a duration of 6 months and the findings are expected by December 2020. A random cluster sampling will be conducted at three districts of Sabah. This study will collect 600 adult respondents (300 households are estimated to be collected) at age of 18 and above. The project is a cross sectional study via face-to-face interview with administered questionnaires, anthropometrics measurements and observation of the living condition performed by trained interviewers.
Posterior wall penetration of the internal jugular vein during central venous catheter insertion using real-time ultrasound
Authors: Lee Jeong Eun , Kim Myeong Jin , Kwak Kyung-Hwa
Published: September 2020

Rationale:

Because central venous catheters (CVCs) are placed at the great vessels, mechanical complications can be fatal. Using the landmark method alone can make CVC difficult to access, depending on the skill of the operator and various patient conditions, such as anatomical variations of the vessels, young age, hypovolemic state, obesity, and short neck. Therefore, ultrasound (US)-guided techniques, including visualization of the vein and needle in the lumen of the vessel, are recommended. Nevertheless, our experience demonstrated that CVC malposition or vascular penetration cannot be prevented completely, even with real-time US guidance.

Patient concerns:

The first patient was a 19-year-old woman (weight = 58 kg, height = 155 cm) who underwent CVC cannulation in the right internal jugular vein (IJV) under general anesthesia using real-time US. The second patient, a 50-year-old woman (weight = 51.6 kg, height = 155.7 cm), underwent CVC insertion in the right IJV using real-time US.

Diagnoses:

During guidewire insertion in the first case, the posterior wall of IJV was penetrated, and a break in the core body of the guidewire was detected. In the case of second patient, CVC was embedded in the posterior wall of IJV and misplaced in the interpleural space in the right thorax. In both cases, an out-of-plane US approach was used.

Interventions:

In the first case, the broken guidewire was completely removed with real-time US guidance. In the second case, all fluid injected through CVC was aspirated, and then CVC was removed.

Outcomes:

In both cases, surgeries were completed successfully and all the patients were discharged without any complications.

Lessons:

Even if the needle tip is located in the lumen of IJV and blood aspiration is confirmed on real-time US, vascular penetration or CVC malposition during the procedure cannot be completely prevented because of the limitation of the US imaging field. These results suggest that care must be exercised even during US-guided CVC placement and that alternative US-guided techniques or supplementary monitoring should be considered to confirm proper CVC position.
Influence of Baduanjin on lung function, exercise capacity, and quality of life in patients with mild chronic obstructive pulmonary disease
Authors: Yang Yang , Chen Keling , Tang Wenjun , Xie Xiaohong , Xiao Wei , Xiao Jing , Luo Xialing , Wang Wujun
Published: September 2020

Introduction:

Chronic obstructive pulmonary disease (COPD) is an illness characterized by progressive aggravation of airflow limitation, which seriously affects patients’ quality of life, and even life-threatening. The lung function of COPD patients is chronically and progressively deteriorated. Among them, the lung function of early COPD patients deteriorates rapidly, and forced expiratory volume in 1 second (FEV1) declines faster than other stages. If diagnosed early and effectively treated in time, it can greatly affect the prognosis. As a traditional exercise regimen, Baduanjin can improve lung function, exercise capacity, and quality of life of COPD patients. However, high-quality evidence-based medical evidence is so far be lacking to confirm the effectiveness of Baduanjin in reducing or preventing mild COPD lung function decline.

Methods:

This study is a randomized controlled trial, 192 patients with mild COPD were randomly divided into experimental group and control group. Both of them will receive basic treatment (health education and Tiotropium bromide), the experimental group will receive Baduanjin exercise training, and the control group will be told to maintain the original lifestyle and control the exercise. The Baduanjin exercise will last for 24 weeks and will be followed up for 72 weeks. The primary outcome is the change in lung function, including FEV1, FEV1/forced vital capacity (FVC), and FEV1/predicted. The secondary results included COPD assessment test, 6-minute walk test, St. George Respiratory Questionnaire, and Dyspnea Scale. Safety will also serve as assessing during the test.

Discussion:

The results of this trial will provide that traditional Baduanjin exercises can prevent COPD lung function deterioration, and provide a simple, inexpensive, and daily pulmonary rehabilitation measure for the patients with mild COPD.
Baseline SUVmax of 18F-FDG PET-CT indicates prognosis of extranodal natural killer/T-cell lymphoma
Authors: Xia Xianwu , Wang Yaqi , Yuan Jianjun , Sun Wenjie , Jiang Jinjin , Liu Chang , Zhang Qunling , Ma Xuejun
Published: September 2020

To evaluate the prognostic value of the baseline SUVmax of 18F-FDG PET-CT in extranodal natural killer/T-cell lymphoma (NKTCL) patients.

From January 2010 to December 2015, 141 extranodal NKTCL patients with staging 18F-FDG PET-CT scan were divided into two group based on SUVmax cutoff value obtained from operating characteristic (ROC) curves. All the patients received radiotherapy, chemotherapy or chemoradiation. Survival analysis was performed on the basis of SUVmax.

The median baseline SUVmax of the tumors was 11.67 (range 2.6–34.6). The ROC curves showed that the optimal cutoff of the baseline SUVmax was 9.65. The patients were divided into two groups: low SUV group (SUVmax < 9.65) and high SUV group (SUVmax ≥ 9.65). Patients in high SUV group were more likely to have invasive disease outside the nasal cavity (P < .001), poorer ECOG scores (P = .012) and higher LDH levels (P = .034). The univariate survival analyses indicated that high SUVmax was a poor prognostic factor for overall survival (OS, P = .038), progression free survival (PFS, P = .006) and distant relapse free survival (DRFS, P = .001), but not for local recurrence free survival (LRFS, P > .05). These results were consistent with that of the survival analyses using the Kaplan–Meier method. The multivariate survival analyses showed that the baseline SUVmax was no longer a prognostic factor for OS (HR 1.99, 95% CI 0.81–4.88, P = .135), but it still indicated worse PFS (HR 2.6, 95% CI 1.24–5.46, P = .012) and DRFS (HR 4.58, 95% CI 1.83–11.46, P = .001) independent of other variables.

For extranodal NKTCL patients, a higher baseline SUVmax of 18F-FDG PET-CT was associated with more aggressive clinical features. An SUVmax ≥ 9.65 was an independent poor prognostic factor for DRFS and PFS. Thus, the baseline SUVmax may be a valuable tool to help identify patients with a high risk of disease progression.
Silver dressings for the healing of venous leg ulcer
Authors: Zhao Minyan , Zhang Dongting , Tan Liping , Huang Hui
Published: September 2020

This study was aimed to evaluate whether silver-containing dressings were superior to other types of dressings in the treatment of venous leg ulcers (VLU) and their specific advantages.

Eight databases (Cochrane Library, PubMed, Web of Science, Ovid-Medline, Wanfang, VIP, China Biology Medicine, and China National Knowledge Infrastructure) were systematically reviewed from inception to May 2019 for randomized controlled trials (RCTs). The primary outcome was complete wound healing, and the secondary outcomes included absolute wound size changes (change of cm2 area since baseline), relative changes (percentage change of area relative to baseline), and healing rate. Two reviewers independently evaluated the risk of bias using the Cochrane Collaboration assessment tool and extracted the data according to the predesigned table. All analyses were performed using the latest Review Manager Software (version 5.3).

A total of 8 studies qualified and were included in the meta-analysis, including 1057 patients (experiment: 526, control: 531). Both complete wound healing and wound healing rates were reported in 5 studies. Two and 3 studies reported the effect of silver dressings on absolute and relative wound size changes, respectively. Most of the studies used intention-to-treat analysis.

There was sufficient evidence that silver-containing dressings can accelerate the healing rate of chronic VLU and improve their healing in a short duration of time. However, compared with other dressings, clinical trials with long-term follow-up data are needed to confirm whether silver dressings have advantages regarding complete wound healing.
The effect of nicorandil in patients with cardiac syndrome X
Authors: Jia Qiulei , Shi Shuqing , Yuan Guozhen , Shi Jingjing , Shi Shuai , Wei Yi , Hu Yuanhui
Published: September 2020

Background:

The prevalence of cardiac syndrome X (CSX) is considerable. Some patients show recurrent angina attacks and have a poor prognosis. However, the knowledge of CSX pathophysiological mechanism is still limited, and the treatment fails to achieve a satisfactory suppression of symptoms. Nicorandil has a beneficial effect on improving coronary microvascular dysfunction (CMD). This study aims to evaluate the clinical effects and safety of nicorandil on CSX patients.

Methods:

The Cochrane Library, Pubmed, EMBASE, ClinicalTrials.gov and 4 Chinese databases were searched to identify relevant studies. The Cochrane “Risk of bias” tool was used to assess the methodological quality of eligible studies. Meta-analysis was performed by RevMan 5.3 software. The Eggers test and meta-regression were performed by software Stata 14.0. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results:

Twenty four randomized controlled trials (RCTs) involving 2323 patients were included. Most of the included studies were classified as having an unclear risk of bias because of poor reported methodology. The main outcomes are angina symptoms improvement, resting electrocardiogram (ECG) improvement, treadmill test result, and endothelial function. Meta-analysis showed that nicorandil had some benefit on improving angina symptoms (RR 1.24, 95% CI 1.19 to 1.29, I
2 = 20%, P < .00001), resting ECG (RR = 1.24, 95% IC: 1.15 to 1.33, I
2 = 0%, P < .00001), and prolonged the time to 1 mm ST-segment depression in treadmill test result (WMD = 38.41, 95% IC: 18.46 to 58.36, I
2 = 0%, P = .0002). Besides nicorandil could reduce the level of endothelin-1 (ET-1) (SMD = −2.22, 95% IC: −2.61 to −1.83, I
2 = 77%, P < .00001) and increase the level of nitric oxide (NO) (WMD = 27.45, 95% IC: 125.65 to 29.24, I
2 = 81%, P < .00001). No serious adverse drug event was reported. The Eggers test showed that significant statistical publication bias was detected (Eggers test P = .000). The quality of evidence ranged from very low to low.

Conclusions:

Nicorandil shows the potential of improving angina symptoms, ECG, and endothelial dysfunction in patients with CSX. However, there is insufficient evidence for the clinical benefits of nicorandil due to the very low-quality evidence.
The prognostic value of tumor architecture in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy
Authors: Zhao Hu , Zhang Lijin , Wu Bin , Zha Zhenlei , Yuan Jun , Jiang Yuefang , Feng Yejun
Published: September 2020

Background and purpose:

There is a lack of consensus regarding the prognostic value of tumor architecture (sessile vs. papillary) in upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). The aim of the present study was to analyze the current evidence regarding the prognostic role of tumor architecture in patients undergoing RNU for UTUC through a systematic review and meta-analysis.

Methods:

According to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a literature search in PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI) databases was performed for citations published prior to February 2020. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (95% CIs) were conducted for the survival outcomes by Stata 12.0 software.

Results:

We retrieved 17 studies (including 8,146 patients) evaluating the effect of tumor architecture on oncologic outcomes in patients treated with RNU. According to our final results, sessile tumor architecture had a significant correlation with worse cancer-specific survival (CSS) (HR = 1.43, 95% CI: 1.31–1.55, P < .001), overall survival (OS) (HR = 1.40, 95% CI: 1.24–1.58, P < .001), recurrence-free survival (RFS) (HR = 1.43, 95% CI: 1.35–1.53, P < .001), and progression-free survival (PFS) (HR = 1.27, 95% CI: 1.11–1.45, P = 0.001). The funnel plot test indicated that there was no significant publication bias in the meta-analysis. Besides, the findings of this study were found to be reliable by our sensitivity and subgroup analysis.

Conclusions:

Sessile tumor architecture correlates with a significantly worse survival outcome compared with papillary tumor architecture, and it can be used as a valuable biomarker for monitoring prognoses of UTUC patients.
Stepwise local stitching ultrasound image algorithms based on adaptive iterative threshold Harris corner features
Authors: Sun Hongfei , Yang Jianhua , Fan Rongbo , Xie Kai , Wang Conghui , Ni Xinye
Published: September 2020

Herein, a Harris corner detection algorithm is proposed based on the concepts of iterated threshold segmentation and adaptive iterative threshold (AIT–Harris), and a stepwise local stitching algorithm is used to obtain wide-field ultrasound (US) images.

Cone-beam computer tomography (CBCT) and US images from 9 cervical cancer patients and 1 prostate cancer patient were examined. In the experiment, corner features were extracted based on the AIT–Harris, Harris, and Morave algorithms. Accordingly, wide-field ultrasonic images were obtained based on the extracted features after local stitching, and the corner matching rates of all tested algorithms were compared. The accuracies of the drawn contours of organs at risk (OARs) were compared based on the stitched ultrasonic images and CBCT.

The corner matching rate of the Morave algorithm was compared with those obtained by the Harris and AIT–Harris algorithms, and paired sample t tests were conducted (t = 6.142, t = 31.859, P < .05). The results showed that the differences were statistically significant. The average Dice similarity coefficient between the automatically delineated bladder region based on wide-field US images and the manually delineated bladder region based on ground truth CBCT images was 0.924, and the average Jaccard coefficient was 0.894.

The proposed algorithm improved the accuracy of corner detection, and the stitched wide-field US image could modify the delineation range of OARs in the pelvic cavity.