bluuebunny/crossref_metadata_2025 huggingface dataset:
Textural features on 18F-FDG PET/CT and dynamic contrast-enhanced MR imaging for predicting treatment response and survival of patients with hypopharyngeal carcinoma
Authors: Wong Chih-Kai , Chan Sheng-Chieh , Ng Shu-Hang , Hsieh Chia-Hsun , Cheng Nai-Ming , Yen Tzu-Chen , Liao Chun-Ta
Published: August 2019

The utility of multimodality molecular imaging for predicting treatment response and survival of patients with hypopharyngeal carcinoma remains unclear. Here, we sought to investigate whether the combination of different molecular imaging parameters may improve outcome prediction in this patient group.

Patients with pathologically proven hypopharyngeal carcinoma scheduled to undergo chemoradiotherapy (CRT) were deemed eligible. Besides clinical data, parameters obtained from pretreatment 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT), dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), and diffusion-weighted MRI were analyzed in relation to treatment response, recurrence-free survival (RFS), and overall survival (OS).

A total of 61 patients with advanced-stage disease were examined. After CRT, 36% of the patients did not achieve a complete response. Total lesion glycolysis (TLG) and texture feature entropy were found to predict treatment response. The transfer constant (K
trans
), TLG, and entropy were associated with RFS, whereas K
trans
, blood plasma volume (V
p
), standardized uptake value (SUV), and entropy were predictors of OS. Different scoring systems based on the sum of PET- or MRI-derived prognosticators enabled patient stratification into distinct prognostic groups (P <.0001). The complete response rate of patients with a score of 2 was significantly lower than those of patients with a score 1 or 0 (14.7% vs 58.9% vs 75.7%, respectively, P = .007, respectively). The combination of PET- and DCE-MRI-derived independent risk factors allowed a better survival stratification than the TNM staging system (P <.0001 vs .691, respectively).

Texture features on 18F-FDG PET/CT and DCE-MRI are clinically useful to predict treatment response and survival in patients with hypopharyngeal carcinoma. Their combined use in prognostic scoring systems may help these patients benefit from tailored treatment and obtain better oncological results.
Sporadic renal hybrid oncocytic/chromophobe tumor in a young man
Authors: Hou Bingbing , Liang Chaozhao
Published: August 2019

Rationale:

Hybrid oncocytic/chromophobe tumor (HOCT) is defined as tumor composed of renal oncocytoma (RO) and chromophobe renal cell carcinoma (CHRCC). Sporadic HOCT is extremely rare, the preoperative diagnosis is difficult, and no guidelines for clinical therapy. We report a case who is the youngest male patient of sporadic HOCT in the world, review the previously reported cases, and share the clinical features, diagnosis, treatment, and prognosis of HOCT.

Patient concerns:

A 30-year-old man was admitted with the complaints of incidental right renal tumor detected by abdominal ultrasound. He had no complaints of urological symptoms, abdominal pain, osphyalgia, and hematuria. Abdominal contrast-enhanced computed tomography revealed an 85 mm × 80 mm × 80 mm unilateral and solid renal mass, and no findings of metastases.

Diagnosis:

The preoperative diagnosis was right renal tumor.

Interventions:

Laparoscopic right radical nephrectomy was performed.

Outcomes:

Histopathology demonstrated a mixture of cells with the morphologic features of those seen in CHRCC and RO. The patient was final diagnosed as sporadic HOCT. After follow-up of 14 months, the patient had no complaints and evidence of disease recurrence.

Lessons:

Sporadic HOCT is extremely rare. It is possible that core biopsy could improve diagnostic accuracy. Laparoscopic radical nephrectomy or nephron sparing surgery should be considered the clinical therapy of the sporadic HOCT patients. The clinical behavior of HOCT is still entirely uncertain and should be proved by studies with available long follow-up.
Acute myocardial infarction in a Chinese patient with paroxysmal nocturnal hemoglobinuria
Authors: Li Gang , Hu Rui , Gao Yifang
Published: August 2019

Rationale:

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal hematopoietic stem cell disease. Patients with PNH often experience a high incidence (14%–40%) of thrombotic events, which are mainly venous and rarely arterial thrombotic events. Because it is very rare, delay in diagnosis is common in patients with PNH, imposing a remarkable impact on patient's management and prognosis.

Patient concerns:

We presented a 33-year-old female case with no medical history of any systemic illnesses who complained of approximately 1-month progressively worsening constant heartburn, and was also hospitalized twice due to acute myocardial infarction (AMI).

Diagnoses:

In our case, AMI occurred twice, whereas there were no cardiovascular risk factors and abnormalities based on the angiography of the coronary artery. Flow cytometry analysis showed that 25% of CD55 and CD59 were lost on the surface of neutrophils, and 30% of CD55 and CD59 were lost on the surface of the blood cells. Thus, our diagnosis of this patient was AMI secondary to PNH.

Interventions and outcomes:

For the first myocardial infarction, local hospitals used thrombolytic therapy to alleviate symptoms. After the patient's second myocardial infarction was treated in our hospital, we adopted coronary interventional therapy. Considering the patient's situation, eculizumab was given for treatment. The patient was gradually restored to achieve stability, and the follow-up observation showed that there was no arterial thrombosis.

Lessons:

This case report aimed to provide a reliable reference for the rare cause of AMI. In addition, PNH should be highly taken into consideration in young patients who have a rare cause of AMI.
Critical appraisal of clinical practice guidelines for treatment of urinary incontinence
Authors: Smiles Flavia Blaseck , Mazzei Lauren Giustti , Lopes Luciane Cruz , Barberato-Filho Silvio , Castro Juliana , Castro Analaura , Marengo Livia Luize , Bergamaschi Cristiane Cássia
Published: August 2019

Background:

Urinary incontinence is a common complaint in all parts of the world, cause of distress, as well as significant costs for both individuals and society. The aim of this study will be to evaluate the rigor of the development of clinical practice guidelines and to identify the recommendations of interventions for urinary incontinence in adult women.

Methods:

In this systematic review, clinical practice guidelines will be identified using a prospective protocol through a systematic search of: MEDLINE (via Ovid); EMBASE (Excerpt Medical Database, via Ovid); Web of Science and Virtual Health Library. Specific databases of guidelines for clinical practice will also be searched (National Institute for Health and Care Excellence, American Urological Association, and others). Reviewers, independently and in duplicate, will assess the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II). The results will be checked for discrepancies. Differences between the scores equal to or greater than 2 will be considered as discrepant and the final result will be decided by consensus. A comparison of the recommendations of interventions and information about the level of evidence, the degree of recommendation, the level of agreement and the level of acceptance will be described. This step will also be done independently and in duplicate, and the result will be decided by consensus. The results will be presented in tables and the descriptive statistics will be calculated for all domains of the AGREE II instrument as mean (standard deviation) and median (interquartile range).

Results:

The results derived from this study will increase the knowledge about the development of recommendations guidelines for urinary incontinence of high methodological rigor. This study may also identify key areas for future research.

Conclusion:

This study may guide health professionals, policy makers, and health policy managers in choosing the guidelines for recommendation in clinical practice.

Protocol Registration:

PROSPERO - CRD42018116517
MiRNAs with prognostic significance in multiple myeloma
Authors: Xu Peipei , Xia Tian , Ling Yipeng , Chen Bing
Published: August 2019

Background:

Multiple myeloma (MM) is a clonal plasma cell malignancy associated with hypercalcemia, bone lesions, and renal failure. The prognostic significance of the mutation of miRNAs, one kind of small noncoding RNA molecules that can modulate gene expression, should be confirmed in non-Hodgkin lymphomas (NHL). This study aimed to identify the prognostic value of miRNAs in patients with MM.

Methods:

A meta-analysis was performed to estimate the pooled hazard ratios and their corresponding 95% confidence intervals for the associations between levels of miRNA expression (predictive factors) and outcomes in patients with MM. We systematically searched the PubMed, Web of Science, and China National Knowledge Infrastructure databases (final search conducted January 1, 2018) to identify eligible studies. Eligible studies were included by certain inclusion and exclusion criteria, whose quality was assessed by Newcastle-Ottawa Scale.

Results:

After performing the literature search and review, 10 relevant studies, including 1214 cases, were identified. The results of our meta-analysis revealed that upregulated miR-92a level and downregulated miR-16, miR-25, miR-744, miR-15a, let-7e, and miR-19b expression were associated with poor prognosis in MM.

Conclusions:

This study identified miRNAs could serve as potential prognostic biomarkers in MM. Given the limited research available, the clinical application of these findings has yet to be verified.
Application of “parachute” technique for free flap reconstruction in advanced tongue cancer after ablation without lip-jaw splitting
Authors: Liu Chin-Jui , Fang Ku-Hao , Chang Chang-Cheng , Lin Erh-Ti , Chang Geng-He , Shen Jen-Hsiang , Chen Yu-Tsung , Tsai Yao-Te
Published: August 2019

The hemi or subtotal/total glossectomy is usually approached by lip-jaw splitting procedure for advanced tongue cancer ablation. This highly invasive procedure can cause facial disfiguration, bone malunion, and osteoradionecrosis. The aim of this study is to compare the surgical outcome in free flap tongue reconstruction between novel parachute technique in an intact jaw and the conventional lip-jaw splitting procedure after tongue cancer ablation.

In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy. We retrospectively reviewed patients who have received primary advanced tongue cancer resection and free flap reconstruction during April, 2008 to January, 2015. Patients were divided into 2 groups. Group A was undergoing parachute technique without lip-jaw splitting. We sutured all the strings through the edges of defect in the first step and through the matching points of flap margin in the second step from outside the oral cavity. Then, the strings were pulled and the flap was parachuted down on the defects after all the matching points were tied together. In group B, the patients received conventional lip-jaw splitting procedure. Student t test was used for results analysis.

There were 15 patients (n = 15) in group A and 15 patients (n = 15) in group B. In the patients receiving parachute technique, operation time showed 34 minutes (P = .49) shorter, hospital stay showed 4 days (P = .32) shorter, and the infection rate of surgical site showed 6.6% (P = .64) less than with conventional technique. The survival rates of the flaps were both 100% without revision.

The parachute technique is an effective and more accessible method for free flap setting in cases of tongue reconstruction without lip-jaw splitting, and provides patients with better aesthetic appearance.
Mini-incisional entropion repair for correcting involutional entropion
Authors: Han Jisang , Lee Shin-Hyo , Shin Hyun Jin
Published: August 2019

The aim of the study was to report the surgical outcome of mini-incisional correction method to treat involutional entropion.

This is a retrospective interventional case series of 46 eyelids in 31 patients with involutional entropion and significant ocular irritation. In this technique, after turning the lower eyelid inside out, threads are introduced into it through the conjunctiva close to the inferior fornix. The lower lid retractor and tarsus are then connected using threads. These threads are applied at 3 locations of the lower eyelid and tightening them results in the eyelid being everted and the correction of entropion. Surgical success was defined as no contact between the eyelashes and the globe during forced closure of the eyelids. Surgical failure was defined as persistence of the eyelashes remaining in contact with the globe or cosmetic dissatisfaction.

During the mean follow-up period of 22.1 months (range, 12–34 months), 43 of the eyelids (93.5%) were successfully corrected. Two patients (3 eyelids) experienced recurrence: 1 had involutional entropion combined with a cicatricial component, and the other had blepharospasm and apraxia of eyelid opening related to Parkinsonism. No postoperative complications such as overcorrection, suture-knot exposure, or ocular irritation were observed.

Our mini-incisional entropion repair is based on reinforcement of the lower eyelid retractors using transconjunctival buried sutures. This technique is a quick, simple, and predictive for involutional entropion repair, and has a high success rate.
Pediatric minimally invasive surgery for malignant abdominal tumor
Authors: Yang Hee-Beom , Kim Hyun-Young , Jung Sung Eun , Choi Young Hun , Lee Ji Won
Published: August 2019

This study examined the safety and usefulness of minimally invasive surgery (MIS) for malignant abdominal tumors in pediatric patients and analyzed the factors affecting the resection margin, operative time, and hospital stay of neuroblastoma (NBL) patients.

We retrospectively reviewed data of pediatric patients who underwent MIS for malignant abdominal tumors from January 2011 to June 2017 at the Seoul National University Children's Hospital. Sex; age at operation; diagnosis; tumor location; operation-related data, such as operation time and transfusion; and follow-up data were reviewed. We divided patients into an excision group and a biopsy group. Detailed pathologic data were reviewed to analyze factors affecting the resection margin of NBL. Median value and range were calculated for all continuous variables. Mann–Whitney test and χ
2 test were used as appropriate. P values of <.05 were considered significant.

Thirty-four pediatric patients were included; 21 were boys. The median age was 4 (0.2–18) years. The most common diagnosis was NBL (17 patients; 50.0%). Three patients each were diagnosed with lymphoma, solid pseudopapillary tumor of the pancreas, and teratoma. The median tumor size was 3.4 (0.5–10.2) cm. The median operation time was 108 (55–290) minutes, and the median hospital stay was 5 (2–11) days. The number of conversions to open surgery was 4. There were no postoperative complications or mortality. There were 18 patients in the excision group and 16 in the biopsy group. Diagnosis and the number of patients receiving preoperative chemotherapy differed between the 2 groups. R0 resection of NBL was significantly higher in patients with stage 1 disease and those aged >2 years. There were no clinical factors influencing operative time or hospital stay.

MIS was feasible and safe in pediatric patients with malignant abdominal tumors. R0 resection of NBL was related to age and stage.
The effectiveness and safety of electromyography biofeedback therapy for motor dysfunction of children with cerebral palsy
Authors: He Ming-Xing , Lei Cong-Jie , Zhong Dong-Ling , Liu Qi-Cen , Zhang Hong , Huang Yi-Jie , Li Yu-Xi , Liu Xiao-Bo , Li Juan , Jin Rong-Jiang , Wan Li
Published: August 2019

Introduction:

To investigate the effectiveness and safety of electromyography (EMG) biofeedback therapy in improving motor dysfunction among children with cerebral palsy (CP).

Methods and analysis:

The following databases will be searched: PubMed, EMBASE, ScienceDirect, the Cochrane Library, China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP), WanFang Data and China Biology Medicine (CBM) from inception to June 2019. All relevant randomized controlled trials (RCTs) utilizing EMG biofeedback therapy for CP will be included. The main outcome is the Gross Motor Function Measure (GMFM). Additional outcomes such as the Modified Ashworth Scale (MAS), Integral Electromyogram (iEMG), Composite Spasticity Scale (CSS), passive range of motion (PROM) or other related outcomes will be included, adverse effects of EMG biofeedback therapy and comparators will also be included. Two reviewers will screen studies, extract data and assess quality independently. Review Manager 5.3 will be used to assess the risk of bias, data synthesis, and subgroup analysis.

Ethics and dissemination:

This systematic review does not require formal ethical approval because all data will be analyzed anonymously. Results will provide a general overview and evidence concerning the effectiveness and safety of EMG biofeedback therapy for children with CP. The findings of this systematic review will be disseminated through peer-reviewed publications or conference presentations.
Timing of continuous renal replacement therapy in patients with septic AKI
Authors: Li Yuting , Li Hongxiang , Zhang Dong
Published: August 2019

Background:

The effects of early continuous renal replacement therapy (CRRT) on mortality in patients with septic acute kidney injury (AKI) remain controversial. A systematic review and meta-analysis was performed to investigate the impact of timing of CRRT on clinical outcomes in patients with septic AKI.

Methods:

The PubMed, Cochrane, and Embase databases were searched from inception to the 31st of March 2019, to identify trials that assessed the timing of initiation of CRRT in patients with septic AKI.

Results:

Five trials including 900 patients were included. The results of this meta-analysis showed that there was no significant difference between 28-day mortality (odds ratio = 0.76;95% CI, 0.58–1.00; P = .05) and 90-day mortality(odds ratio = 0.79;95% CI, 0.59–1.06; P = .12)of early and late initiation of CRRT group. In addition, compared with late initiation strategy, early initiation showed no significant advantage in length of stay in ICU (Mean difference = −0.9;95% CI, −2.37 to 0.57; P = .23) and length of stay in hospital (Mean difference = −1.43;95% CI, −5.28 to 2.41; P = .47).

Conclusion:

Our meta-analysis revealed that early initiation of CRRT could not reduce mortality in patients with septic AKI. The study also showed no significant difference in ICU length of stay or hospital length of stay between early and late CRRT group. To achieve optimal timing of CRRT for septic AKI, large multicenter randomized trials with better design are still needed.
Clinical and cranial MRI features of female patients with ornithine transcarbamylase deficiency
Authors: Yu Dan , Lu Guoyan , Mowshica Rajah , Cheng Yan , Zhao Fumin
Published: August 2019

Introduction:

Ornithine transcarbamylase deficiency (OTCD) is a common metabolic disease of urea circulation disorder. We reported the clinical, brain imaging and genetic characteristics of 2 cases with OTCD. The patients’ clinical features, novel gene mutations, cranial MR specific imaging changes and blood tandem mass spectrometry, and urine gas chromatography-mass spectrometry were, retrospectively, analyzed.

Patient concerns:

Patient 1 was a 1.6-year-old female. She was admitted to the hospital with 2-months history of general irritability and disturbance of consciousness for a day. Patient 2 was a 3.7-year-old female. She was admitted to the hospital due to decline of language ability and irritability for 5 days. Blood tandem mass spectrometry and urine gas chromatography-mass spectrometry showed uracil and orotate increased significantly in urine while amino acids in the urea cycle ring were in the normal range. The features of brain MRI are consistent with those of urea circulatory disorders. Gene detection showed 1 novel mutation in the OTC gene (c.658C>T) in patient 1 and, 1 novel mutation (c.298+2T>G) in the OTC gene in patient 2.

Diagnosis:

Combined with metabolic screening and gene detection, both patients were diagnosed with OTCD.

Interventions:

The patients’ condition improved after following a low protein diet and receiving treatments for decreasing blood ammonia, energy supplement, correcting acid-base imbalance, and other symptomatic treatments.

Outcomes:

After prompt symptomatic treatment, the consciousness and cognition of the children improved. Besides, liver function also improved significantly.

Conclusions:

For patients with neurological symptoms and unexplained increase in transaminase and ammonia, OTCD should be considered as a possible diagnosis. Brain MRI can help the diagnosis of genetic metabolic encephalopathy and reflect the level of brain injury. Metabolic screening and genetic detection are helpful to make a confirmed diagnosis.
Pneumothorax after minimally invasive plate osteosynthesis for midshaft clavicle fracture
Authors: Kim Mi Kyeong , Lee Hyun-Jung , You Ann Hee , Kang Hee Yong
Published: August 2019

Rationale:

Isolated fracture of clavicle is usually treated with nonoperative conservative treatment. However, surgical treatment, customized for individual patient's need, is increasingly done. With regard to the surgery of the clavicle fracture, pneumothorax is a possible, but rare complication.

Patient concerns:

We report the case of a 32-year-old healthy female patient who underwent minimally invasive plate osteosynthesis (MIPO) due to a clavicle fracture. To avoid direct exposure of fracture site, the pre-contoured plate was inserted through the lateral incisional port to reach the medial incisional port. There was no problem during the surgery, but the patient complained of dyspnea in the post-anesthesia care unit.

Diagnoses:

A chest radiograph was taken immediately, and a definitive finding of pneumothorax was revealed.

Interventions:

A tube was inserted at the right chest.

Outcomes:

The patient's dyspnea was resolved. On the 6th day after the surgery, the chest radiograph revealed that pneumothorax was nearly resolved, enabling to remove the chest tube. On the 9th day after the surgery, the patient was discharged without complication.

Lessons:

After clavicle surgery requiring strong dissection like MIPO, the possibility of pneumothorax is suspected and the patient should be carefully observed.
Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient
Authors: Jeong Hee Joon , Sim Woo Seog , Park Hue Jung , Lee Seung Hwan , Oh Min Seok , Cho Min Kyoung , Seon Heui Jin , Lee Jin Young
Published: August 2019

Introduction:

Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy.

Patient concerns:

Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy.

Diagnosis:

Enhanced lumbar magnetic resonance imaging revealed left sided L1–L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation.

Interventions:

A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day.

Outcomes:

The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction.

Conclusion:

An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.
Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male
Authors: Yang Lan , Jia Min , Han Ping
Published: August 2019

Rationale:

Primary epiploic appendagitis (PEA) is a rare cause of acute abdomen caused by spontaneous torsion or venous thrombosis of epiploic appendices, it commonly manifests with acute lower quadrant pain, thus may mimic acute diverticulitis, appendicitis, or mesenteric infarction.

Patient concerns:

In this case report, we report a 44 years old man who presented with persistent sharp pain in the left lower quadrant abdomen, Laboratory tests were mostly normal, contrast enhanced computed tomography (CECT) revealed a slightly high density shadow with fat foci in the middle was presented around the local descending colon, accompanied by the adjacent peritoneal thickening.

Diagnoses:

He was diagnosed with PEA as confirmed by an abdominal contrast enhanced computed tomography (CECT) scan.

Interventions:

He was followed up in the clinic without any dietary restrictions, antibiotic or analgesic drugs use.

Outcomes:

The abdominal pain gradually subsided a week later, and there were no recurrence of the symptoms during follow-up.

Lessons:

In our case, the diagnosis of PEA using CECT allows the patient to avoid surgery and other invasive treatment.
Behavior of self-inflicted violence in patients with bipolar disorder
Authors: de Cássia Hoffmann Leão Rita , Filho Frederik L. , Fiamoncini Carolina M. , Sousa Renata Alves de , Vasconcelos Selene Cordeiro , Sougey Everton Botelho , Silva Tatiana de Paula Santana da
Published: August 2019

Background:

Studies aimed at understanding the higher risk profiles for self-inflicted violence in individuals with BD become essential as a possible predictive risk measure for the presence of suicidal behavior, corroborating the expressive reduction of suicide deaths in young people who are in psychic suffering.

Methods:

The protocol was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA-P) and the research question was constructed using guidelines from the Population Intervention Comparator Outcome Setting (PICOS) strategy. A third reviewer will be contacted, and two studies will be included in the selection, analysis and inclusion phases of the articles, in case of divergence, a third reviewer will be contacted. (1) methodological design studies of cohorts, case-control and cross-sectional; (2) Diagnosis of Bipolar disorder according to Diagnostic and statistical Manual of mental disorders V; (3) Studies with adult population and (4) Studies that consider at least one type of self-inflicted violence as a variable. The articles considered eligible will be analyzed by New Castle - Ottawa quality assessment scale/cross section studies (NOS) to evaluate the quality of the studies.

Results:

The identification of the characteristics of self-harm may subsidize professionals who work in the treatment of bipolar disorder with greater attention to these practices and monitoring of possible suicidal behaviors.

Conclusion:

This study may represent one of the initial measures of evaluation on these correlations, which will allow to protocol the guidelines in the field of practice and contribute to improvements in public health indexes.
Effect of extracorporeal shockwave therapy on carpal tunnel syndrome
Authors: Kim Ju Chan , Jung Se Hee , Lee Shi-Uk , Lee Sang Yoon
Published: August 2019

Background:

Although several trials have reported the use of extracorporeal shock wave therapy (ESWT) for mild to moderate carpal tunnel syndrome (CTS), little is known about the efficacy of ESWT. Thus, we performed a meta-analysis to evaluate whether ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in CTS.

Methods:

Six randomized controlled trials investigating the effect of ESWT on CTS were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- or random-effects models.

Results:

ESWT showed significant overall effect size compared to the control (overall Hedge g pooled standardized mean difference (SMD) = 1.447; 95% confidence interval [CI], 0.439–2.456; P = .005). Symptoms, functional outcomes, and electrophysiologic parameters all improved with ESWT treatment. However, there was no obvious difference between the efficacy of ESWT and local corticosteroid injection (pooled SMD = 0.418; 95% CI, −0.131 to 0.968; P = .135). A publication bias was not evident in this study.

Conclusion:

Our meta-analysis revealed that ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in patients with CTS. Further research is needed to confirm the long-term effects and the optimal ESWT protocol for CTS.
Predictors of quality of care and survival in a three-state cohort of locally advanced cervical cancer patients and development of a predictive model to identify women at risk of incomplete treatment
Authors: Schad Michael D. , Moore Joanna , Camacho Fabian , Anderson Roger T. , Cantrell Leigh A. , Showalter Timothy N.
Published: August 2019

To expand our prior statewide analysis of care distribution for locally advanced cervical cancer in Virginia to include 2 more states and to develop a tool for predicting quality of care. Complete treatment was defined as receiving chemotherapy (CT), brachytherapy (BT), and external beam radiotherapy.

State cancer registry databases yielded a three-state cohort of 3197 women diagnosed with locally advanced cervical cancer from 2000 to 2013. A logistic regression evaluated predictors for receipt of BT, CT, and high (2–3 modalities received) versus low (0–1 modalities received) quality care. A Cox proportional hazards models determined predictors of survival. Finally, a predictive model was developed and preliminarily validated using our cohort.

Only 35.3% of the cohort received complete treatment and only 57.3% received BT. Significant predictors of lower odds of receiving high quality care varied by state but included: 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; public insurance with supplement as compared to private; treatment at a low volume facility; and closer distance quintiles to a high volume treatment center as compared to the furthest quintile. Significant predictors of worse survival varied by state but included: low quality score (0–1 modalities received); 2000 to 2004 or 2005 to 2009 year of diagnosis as compared to 2010 to 2013; 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; treatment at a low volume facility; and unmarried/unknown marital status as compared to married. Our treatment quality prediction tool included age, age2, treatment at high volume facility, and cancer stage and demonstrated 78.2% sensitivity and a 62.9% specificity.

Only 35.3% of patients received complete guidelines-concordant treatment. Additionally, in 2/3 states it appeared that BT usage may have decreased during the study period. Our predictive model may help identify patients/regions at risk of receiving low quality care to target interventions aimed at improving cervical cancer treatment quality and survival.
Add-on effect of Guizhi Fuling formula to mifepristone for endometriosis
Authors: Meng Wenbin , Ta Na , Wang Fei
Published: August 2019

Background:

Guizhi Fuling pill, a famous traditional Chinese herbal formula, has been widely used for treatment of gynecological diseases. This meta-analysis sought to evaluate the add-on effect of Guizhi Fuling capsule (GZFL) to mifepristone in women with endometriosis.

Methods:

A comprehensively literature search was conducted using Pubed, Embase, Cochrane Library, Wanfang, CNKI, VIP databases from their inceptions to January 25, 2019. Randomized controlled trials that compared GZFL plus mifepristone to mifepristone alone for treatment of endometriosis were eligible. Main outcomes were pregnancy, reduction of the recurrence, and serum level of follicle-stimulating hormone, luteinizing hormone, estradiol or progesterone.

Results:

A total of 1052 women with endometriosis from 10 trials were identified and analyzed. Meta-analyses showed that GZFL plus mifepristone was superior to mifepristone in reducing the recurrence of endometriosis (RR 0.40; 95% CI 0.27–0.59) and improving the pregnancy (risk ratio [RR] 1.74; 95% confidence intervals [CI] 1.40–2.17). Moreover, adjuvant treatment with GZFL also significantly reduced serum level of estradiol (mean difference [MD] −20.83 pmol/L; 95% CI −34.01 to −7.65) and progesterone (MD −0.18 mmol/L; 95% CI −0.23 to −0.12). However, there were no significant differences in serum level of follicle-stimulating hormone (MD −0.42 U/L; 95% CI −1.16 to 0.31) and luteinizing hormone (MD −0.04 U/L; 95% CI −0.43 to 0.34).

Conclusion:

GZFL as adjuvant therapy to mifepristone appears to have additional benefits in preventing recurrence of endometriosis and improving pregnancy among women with endometriosis. However, these conclusions should be interpreted with caution due to the methodological flaws of the included trials.
Traditional Chinese medicine for mild-to-moderate ulcerative colitis
Authors: Shen Zhaofeng , Zhou Qing , Ni Yingjun , He Weiming , Shen Hong , Zhu Lei
Published: August 2019

Background:

Ulcerative colitis (UC) is a universal chronic nonspecific intestinal inflammatory disease of unknown etiology. Although 5-aminosalicylic acid (5-ASA) is used as a first-line treatment for mild-to-moderate UC, some patients do not react well to it. Traditional Chinese medicine (TCM) plays a complementary role in the management of UC. A large number of randomized controlled trials (RCTs) have shown that TCM has a significant effect in the treatment of mild-to-moderate UC. However, due to the diversity of TCM treatments, its relative effectiveness and safety remains unclear. Therefore, we aim to compare the effectiveness and safety of TCM for mild-to-moderate UC by implementing a Bayesian network meta-analysis (NMA) and provide a reference for clinical treatment.

Methods:

According to the Cochrane Handbook, PubMed, MEDLINE, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CHKD-CNKI), Chinese Biomedical Literature database (CBM), and WANFANG database will be searched. Related randomized controlled trials (RCTs) that compared one TCM intervention with another or with 5-ASA (placebo) for mild-to-moderate UC from inceptions to February 2019 will be included. Two authors will screen the literature and extract data independently based on predesigned rules, and evaluate the risk of bias of included studies using the Cochrane Risk of Bias Tool. Both classical pair-wise meta-analysis and Bayesian NMA will be conducted using R-3.4.4 and WinBUGS-1.4.3 software. The ranking probabilities for all interventions will be estimated and the hierarchy of each intervention will be summarized as surface under the cumulative ranking curve. The consistency within network will be evaluated with Cochrane Q statistic and net-heat plot. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results:

The study results will be disseminated through a peer-reviewed journal publication or conference presentation.

Conclusions:

The findings will provide a systematic evidence-based medical evidence of TCM interventions in the treatment of UC and help clinical practitioners, UC patients, and policy-makers make more informed choices in the decision-making.

Ethics and dissemination:

Ethical approval and informed consent are not required since this is a protocol for a network meta-analysis based on published studies. The findings will be disseminated through a peer-reviewed journal publication or conference presentation.

Registration:

PROSPERO CRD42019133962.
Assessing the Relative Contribution of Resident Versus Facility Characteristics Associated With Antipsychotic Medication Receipt Among Nursing Facility Residents
Authors: Busch Susan H. , Cohen Michael S. , Konetzka R. Tamara
Published: August 2019

Objective:

In 2012 Centers for Medicare and Medicaid Services (CMS) launched a multifaceted initiative aimed at reducing the unnecessary use of antipsychotic medications in nursing facilities due to evidence these medications are associated with little or uncertain benefit and substantial risk. Yet, little is known about whether efforts to reduce antipsychotic medication should be focused on residents with targeted characteristics, or on nursing facility regulation (eg, staffing levels). Our objective was to identify the relative contribution of resident and facility characteristics to potentially inappropriate antipsychotic use.

Methods:

We examined 1,156,875 long stay residents in 14,699 US nursing facilities in 2014 and predicted resident antipsychotic use controlling sequentially for resident and facility characteristics and calculated the incremental variation explained.

Results:

We found significant variability in unadjusted rates of potentially inappropriate antipsychotic use among nursing facilities (mean=18.0%; interquartile range: 11.3%–23.7%; SD: 11.1). Regression results indicated that 93% of the explained variation in antipsychotic use was attributed to resident characteristics and 7% was attributed to facility-level factors. At the facility level, worker hours per resident day was not significantly associated with antipsychotic use. Simulations indicated that applying the effect sizes achieved by the best performing facilities to the existing case mix across all nursing facilities would result in no more than a 1 percentage point change in population-level antipsychotic use.

Conclusions:

Efforts to reduce antipsychotic use may have greater impact by developing new clinical strategies to address specific diagnoses rather than regulations related to facility-level attributes.
Comparative Responsiveness and Minimally Important Difference of Common Anxiety Measures
Authors: Kroenke Kurt , Baye Fitsum , Lourens Spencer G.
Published: August 2019

Background:

Anxiety is one of the most prevalent mental disorders and accounts for substantial disability as well as increased health care costs. This study examines the minimally important difference (MID) and responsiveness of 6 commonly used anxiety scales.

Methods:

The sample comprised 294 patients from 6 primary care clinics in a single VA medical center who were enrolled in a telecare trial for treatment of chronic musculoskeletal pain and comorbid depression and/or anxiety. The measures assessed were the Patient Reported Outcomes Measurement Information System (PROMIS) 4-item, 6-item, and 8-item anxiety scales; the Generalized Anxiety Disorder 7-item scale (GAD-7); the Symptom Checklist anxiety subscale (SCL); the Posttraumatic Stress Disorder Checklist (PCL); the Short Form (SF)-36 Mental Health subscale; and the SF-12 Mental Component Summary (MCS). Validity was assessed with correlations of these measures with one another and with measures of quality of life and disability. MID was estimated by triangulating several methods. Responsiveness was evaluated by comparing: (a) the standardized response means for patients who reported their mood as being better, the same, or worse at 3 months; (b) the area under the curve for patients who had improved (better) versus those who had not (same/worse).

Results:

Convergent and construct validity was supported by strong correlations of the anxiety measures with one another and moderate correlations with quality of life and disability measures, respectively. All measures differentiated patients who reported global improvement at 3 months from those who were unchanged, but were less able to distinguish worsening from no change. The area under the curves showed comparable responsiveness of the scales. The estimated MID was 4 for the PROMIS scales; 3 for the GAD-7; 6 for the PCL; 9 for the SF-36 mental health subscale; 5 for the MCS score, and 0.3 for the SCL anxiety scale.

Conclusions:

Six commonly used anxiety scales demonstrate similar responsiveness, and estimated MIDs can be used to gauge anxiety change in clinical research and practice.
Race, Poverty, and Mental Health Drive Colorectal Cancer Screening Disparities in the Veterans Health Administration
Authors: May Folasade P. , Yano Elizabeth M. , Provenzale Dawn , Steers William N. , Washington Donna L.
Published: August 2019

Introduction:

Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50–75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer.

Methods:

We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA.

Results:

The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65–0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61–0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72–0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10–1.31 for quintiles 2–5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake.

Conclusions:

Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.
Using Ancillary Sociodemographic Data to Identify Sexual Minority Adults Among Those Responding “Something Else” or “Don’t Know” to Sexual Orientation Questions
Authors: Elliott Marc N. , Dahlhamer James M. , MacCarthy Sarah , Beckett Megan K. , Orr Nate , Guerino Paul , Agniel Denis , Saunders Catherine L. , Schuster Mark A. , Ng Judy H. , Martino Steven C.
Published: August 2019

Background:

General population surveys are increasingly offering broader response options for questions on sexual orientation—for example, not only gay or lesbian, but also “something else” (SE) and “don’t know” (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers studying sexual orientation-based disparities face difficult methodological trade-offs regarding how best to classify respondents identifying with the SE and DK categories.

Objectives:

Develop respondent-level probabilities of sexual minority orientation without excluding or misclassifying the potentially ambiguous SE and DK responses. Compare 3 increasingly inclusive analytic approaches for estimating health disparities using a single item: (a) omitting SE and DK respondents; (b) classifying SE as sexual minority and omitting DK; and (c) a new approach classifying only SE and DK respondents with >50% predicted probabilities of being sexual minorities as sexual minority.

Materials and Methods:

We used the sociodemographic information and follow-up questions for SE and DK respondents in the 2013–2014 National Health Interview Survey to generate predicted probabilities of identifying as a sexual minority adult.

Results:

About 94% of the 144 SE respondents and 20% of the 310 DK respondents were predicted to identify as a sexual minority adult, with higher probabilities for younger, wealthier, non-Hispanic white, and urban-dwelling respondents. Using a more specific definition of sexual minority orientation improved the precision of health and health care disparity estimates.

Conclusions:

Predicted probabilities of sexual minority orientation may be used in this and other surveys to improve representation and categorization of those who identify as a sexual minority adult.
Pneumonia Readmissions in Older Adults With Dementia
Authors: Knox Sara
Published: August 2019

Background/Objectives:

Pneumonia readmissions have significant quality of care and policy implications for patients and health care providers. Research indicates that initiatives to decrease readmissions should target high-risk subgroups. Older adults with dementia have an increased risk of pneumonia and subsequent hospitalizations, suggesting that they may be at high-risk of pneumonia readmissions. The purpose of this study was to determine if associations between patient factors and readmission rates differ for older adults with and without dementia who were hospitalized for pneumonia.

Design:

This was a retrospective study of secondary data.

Participants:

A nationally representative sample of 389,198 discharge records was extracted from the 2013 Nationwide Readmission Database.

Measures:

Differences between groups were analyzed using χ2 and t tests. A generalized linear model was utilized to examine associations between patient factors and pneumonia readmissions.

Results:

Significant differences were found (P<0.001) when comparing patient characteristics of older adults with and without dementia who were readmitted. Older adults with dementia had a readmission rate of 23.5% and were 2.9 times more likely to be readmitted (odds ratio; 95% confidence interval, 1.93, 4.40) than older adults without dementia. Associations were calculated using a generalized linear model with dementia included as an interactive effect. Dementia significantly modified (P<0.05) the relationship between pneumonia readmissions and 4 factors; (a) discharge disposition, (b) chronic conditions, (c) risk of mortality, and (d) median household income.

Conclusions:

Classifying older adults with dementia as a high-risk subgroup for pneumonia readmissions is supported by the findings of this study. Development of strategies to reduce pneumonia readmissions that are tailored to individuals with dementia should be considered.
Using Data From the Healthcare Cost and Utilization Project for State Health Policy Research
Authors: Boudreaux Michel , Gangopadhyaya Anuj , Long Sharon K. , Karaca Zeynal
Published: August 2019

Background:

The Healthcare Cost and Utilization Project (HCUP), the nation’s most complete source of all-payer hospital care data, supports analyses at the national, regional, state and community levels. However, national HCUP data are often used in inappropriate ways in studies of state-specific issues.

Objective:

To describe the opportunities and challenges of using HCUP data to conduct state health policy research and to provide empirical examples of what can go wrong when using the national HCUP data inappropriately.

Research design:

Comparison of results from state-level analyses using national HCUP data and the state-specific HCUP data recommended by the Agency for Healthcare Research and Quality (AHRQ). Analyses included trends in state-specific rates of cesarean delivery and a difference-in-differences analysis of Connecticut’s Medicaid expansion.

Subjects:

Hospital discharges from the 2004 to 2011 HCUP Nationwide Inpatient Samples (NIS) and State Inpatient Databases (SID).

Measures:

Cesarean delivery rates, discharges per capita, and discharges by the payer.

Results:

State-level estimates derived from the NIS are volatile and often provide misleading policy conclusions relative to estimates from the SID.

Conclusions:

The NIS should not be used for state-level research. AHRQ provides resources to assist analysts with state-specific studies using SID files.