bluuebunny/crossref_metadata_2025 huggingface dataset:
Carbetocin Reduces the Need for Additional Uterotonics in Elective Cesarean Delivery: A Systematic Review, Meta-analysis, and Trial Sequential Analysis of Randomized Controlled Trials
Authors: Onwochei D.N. , Van Ross J. , Singh P.M. , Salter A. , Monks D.T.
Published: November 2020

(Int J Obstet Anesth. 2019;40:4–23)

Uterine atony is the most common (70%) cause of postpartum hemorrhage (PPH). While oxytocin has been shown to effectively treat PPH, rescue uterotonics are needed in as many as 13% of women undergoing elective cesarean delivery (CD) to achieve adequate uterine tone. Some studies have suggested carbetocin is superior to oxytocin in minimizing blood loss and the need for additional uterotonics, although systematic reviews examining its ability to reduce the incidence of PPH have yielded varied results. These reviews have included both emergency and elective CDs, however, and have been limited by their traditional meta-analysis structure. This review used trial sequential analysis (TSA), which has been shown to prevent false-positive results, to compare carbetocin with oxytocin for its effectiveness in the prevention of uterine and PPH during elective CD.
Prevalence and Outcomes of Prenatal Recreational Cannabis Use in High-income Countries: A Scoping Review
Authors: Singh S. , Filion K.B. , Abenhaim H.A. , Eisenberg M.J.
Published: November 2020

(BJOG. 2020;127:8–16)

With the potency of recreational cannabis on the rise, there is a need for an updated review of recent studies on pregnancy outcomes. Thus far, only 2 review studies have assessed the use of cannabis on maternal and neonatal outcomes. However, these reviews provided conflicting results and included studies only from before 2000. This study aimed to assess the prevalence of recreational cannabis use in pregnant women, its association with maternal and neonatal outcomes, and the potential impact of its legalization.
Trials and Tribulations of Viscoelastic-based Determination of Fibrinogen Concentration
Authors: Ranucci M. , Di Dedda U. , Baryshnikova E.
Published: November 2020

(Anesth Analg. 2020;130:644–653)

One cause for severe bleeding in various clinical situations (such as cardiac surgery or trauma) is acquired fibrinogen deficiency. Current guidelines suggest both fibrinogen supplementation in patients who are bleeding with fibrinogen levels <1.5 g/L, as well as the application of viscoelastic tests (VETs) for a rapid determination of functional levels of fibrinogen. This procedure then entails translating values obtained with a VET into fibrinogen concentration correspondent values, a process that is far from perfect and includes many possible biases. The purpose of this review was to address issues with VET-based fibrinogen concentration measurement via different devices, along with their correlating Clauss-based measurement and the correlating values obtained via different devices.
Grandmultiparity, Maternal Age, and the Risk for Uterine Rupture—A Multicenter Cohort Study
Authors: Hochler H. , Wainstock T. , Lipschuetz M. , Sheiner E. , Ezra Y. , Yagel S. , Walfisch A.
Published: November 2020

(Acta Obstet Gynecol Scand. 2020;99:267–273)

The rare complication of uterine rupture can potentially result in catastrophic consequences for both mother and fetus. The most common risk factor for uterine rupture is previous cesarean delivery (CD), but few published studies exist addressing uterine rupture in women without a history of previous CD. Conflicting conclusions have been reported regarding any association between grandmultiparity and uterine rupture. In this population, obstetricians have been cautious due to a fear of increased risk for uterine rupture. This approach might trigger the performance of unnecessary CDs. Therefore, this study was undertaken to determine if grandmultiparity is an independent risk factor for intrapartum uterine rupture in women without a history of previous uterine surgery.
Patient-centred Perioperative Mobile Application in Cesarean Delivery: Needs Assessment and Development
Authors: Ke J.X.C. , George R.B. , Wozney L. , Chorney J.L.
Published: November 2020

(Can J Anesth/J Can Anesth. 2019;66:1194–1201)

There are multiple obstetric and anesthetic complications related to cesarean delivery (CD), including infection, postoperative pain, postdural puncture headache, and nerve injury. Because of the high prevalence of CDs in Canada, it is critical to ensure optimal preoperative preparation, provide relevant patient education, and monitor postoperative complications. The goal of this study was to design a mobile application to enhance the perioperative care of elective CD patients using input from both patients and anesthesiologists.
Maternal and Neonatal Characteristics in Obstetric Intensive Care Unit Admissions
Authors: Seppa¨nen P. , Sund R. , Uotila J. , Helminen M. , Suominen T.
Published: November 2020

(Int J Obstet Anesth. 2020;41:65–70)

The World Health Organization defines severe acute maternal morbidity as “a woman who nearly died, but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” Intensive care unit (ICU) admission resulting from maternal morbidity is most commonly associated with hemorrhage-related cardiovascular instability and severe preeclampsia. This retrospective register-based study from January 2007 to December 2011 held 3 objectives: (1) to evaluate the course of pregnancy and delivery for obstetric patients admitted to ICU, (2) discern the health status of infants born to those women, and (3) comparison of the results with reference data on Finnish parturients and infants.
Planned Vaginal Delivery and Cardiovascular Morbidity in Pregnant Women With Heart Disease
Authors: Easter S.R. , Rouse C.E. , Duarte V. , Hynes J.S. , Singh M.N. , Landzberg M.J. , Valente A.M. , Economy K.E.
Published: November 2020

(Am J Obstet Gynecol. 2020;222:77.e1–77.e11)

Pregnant women with cardiovascular disease (CVD) are at increased risk for adverse obstetric and cardiac events. The few prior studies that have examined this issue have focused on these risks for pregnant women with CVD compared with those without CVD. While this type of analysis helps to assess the overall risk, it does not provide guidance on the clinical management of this patient population. The aim of this study was to assess whether there is an association between CVD in pregnancy and the planned mode of delivery.
Comparison of Spontaneous Versus Operative Vaginal Delivery Using Obstetric Quality of Recovery-10 (ObsQoR-10): An Observational Cohort Study
Authors: Sultan P. , Kormendy F. , Nishimura S. , Carvalho B. , Guo N. , Papageorgiou C.
Published: November 2020

(J Clin Anesth. 2020;63:109781)

Within the UK, operative vaginal delivery rates are estimated at between 10% and 13% of deliveries, which accounts for an ∼85,000 births in 2018 within England and Wales. The US, by contrast, estimates a 3% rate, which is ∼115,000 births in 2018. The primary goal of this study was to investigate the patient recovery for both types of vaginal deliveries, to determine whether postpartum treatment of these patients ought to be individualized due to labor type or remain more universal for all deliveries as it currently exists. Authors hypothesized that a spontaneous vaginal delivery would yield a better recovery when compared with an operative vaginal delivery.
Outcomes Following a Clinical Algorithm Allowing for Delayed Hysterectomy in the Management of Severe Placenta Accreta Spectrum
Authors: Zuckerwise L.C. , Craig A.M. , Newton J.M. , Zhao S. , Bennett K.A. , Crispens M.A.
Published: November 2020

(Am J Obstet Gynecol. 2020;222:179.e1–179.e9)

Placenta accreta spectrum (PAS) is a major risk factor for maternal injury and death, with an estimated morbidity rate of 24% to 67% and an estimated mortality rate of up to 7%. The current recommendations for treatment of PAS focus on immediate cesarean hysterectomy, but given the significant morbidity of PAS, new treatment strategies are needed. This study assessed the outcomes of patients with an antenatal diagnosis of placenta percreta that was managed with delayed hysterectomy versus patients who had an immediate cesarean hysterectomy.
Impact of Intraoperative Dexamethasone After Scheduled Cesarean Delivery: A Retrospective Study
Authors: Nanji J. , Guo N. , Riley E. , Carvalho B.
Published: November 2020

(Int J Obstet Anesth. 2020;41:39–46)

In current anesthesia practice, a common preventative medication for postoperative nausea and/or vomiting (PONV) is dexamethasone. However, its efficacy when administered as a single intraoperative dose for procedures performed under spinal anesthesia is unclear. Analgesic effects of dexamethasone administered in the perioperative period have also been described in the literature. The investigators of this impact study aimed to determine the postoperative benefits from the administration of a single dose of intravenous (IV) dexamethasone during cesarean delivery (CD) performed under spinal or combined spinal epidural (CSE) anesthesia.
Intimate Partner Violence During Pregnancy and Risk of Fetal and Neonatal Death: A Meta-analysis With Socioeconomic Context Indicators
Authors: Pastor-Moreno G. , Ruiz-Pérez I. , Henares-Montiel J. , Petrova D.
Published: November 2020

(Am J Obstet Gynecol. 2020;222:123.e5–133.e5)

It is estimated that 30% of women have experienced intimate partner violence (IPV) during their lifetime. IPV in pregnancy can cause both immediate (uterine rupture, fetal and maternal death) and long-term sequelae (low birthweight and prematurity) that are associated with increased risk of fetal and neonatal death. While maternal conditions, such as psychosocial stressors, infectious diseases, and environmental exposures, have been shown to impact fetal and neonatal health, the association between IPV and fetal and neonatal mortality has not been studied comprehensively. This study aimed to summarize the results of observational studies investigating the risk of perinatal death as a direct function of IPV as well as examine how socioeconomic factors may influence this association.
Placental Growth Factor Predicts Time to Delivery in Women With Signs or Symptoms of Early Preterm Preeclampsia: A Prospective Multicenter Study
Authors: Barton J.R. , Woelkers D.A. , Newman R.B. , Combs C.A. , How H.Y. , Boggess K.A. , Martin J.N. , Kupfer K. , Sibai B.M.
Published: November 2020

(Am J Obstet Gynecol. 2020;222:259.e1–259.e11)

There is a clear need for quantitative testing methods to determine which patients with signs of preeclampsia may be at heightened risk for adverse pregnancy outcomes. The altered angiogenic factor concentrations including placental growth factor (PlGF) have been found to be associated with preeclampsia and precede the onset of preeclampsia by several weeks. While previous studies have found encouraging evidence that PlGF concentrations may predict adverse pregnancy outcomes, the association between angiogenic factors and time to delivery (TTD) is still unclear. This study aimed to examine the relationship between TTD and PlGF in pregnant women with gestational age <35 weeks with signs of preeclampsia and to evaluate the performance of PlGF as a predictor for TTD.
Gastric Emptying of Carbohydrate Drinks in Term Parturients Before Elective Cesarean Delivery: An Observational Study
Authors: Popivanov P. , Irwin R. , Walsh M. , Leonard M. , Tan T.
Published: November 2020

(Int J Obstet Anesth. 2020;41:29–34)

Most enhanced recovery after surgery programs now opt to use preoperative carbohydrate (CHO) drinks as a standard part of their protocol. Preoperative fasting guidelines set by the American Society of Anesthesiologists (ASA) state that moderate amounts of clear fluids up to 2 hours before anesthesia are allowed for uncomplicated patients undergoing elective surgery. Most research regarding clear liquid consumption before anesthesia has been performed in nonpregnant patients although recent data found gastric emptying of water was not delayed in nonlaboring parturients. The rate of gastric emptying of CHO drinks in a pregnant population has yet to be studied, however. The aim of this study was to investigate gastric emptying of 400 mL of a CHO drink up to 2 hours before elective cesarean delivery.
Association Between Early Amniotomy in Labor Induction and Severe Maternal and Neonatal Morbidity
Authors: Battarbee A. , Glover A. , Stamilio D.
Published: November 2020

(Aust N Z J Obstet Gynaecol. 2020;60:108–114)

Labor induction is a common obstetric procedure in the United States and is crucial in expediting delivery for women with fetal or maternal indications. However, the optimal method for induction of labor is highly debated and lacks consensus. Amniotomy is frequently a component of labor induction, but many providers have concerns that early amniotomy could increase a variety of delivery complications, such as umbilical cord prolapse, cesarean delivery, infection, and neonatal intensive care unit admission. The primary aim of this study was to assess whether early amniotomy [defined as artificial rupture of membranes (AROM) at <4 cm dilation] affected the duration of labor induction in both nulliparous and multiparous women, and whether it was associated with increases in cesarean delivery rate, severe maternal morbidity, or severe neonatal morbidity.
Oxycodone for Pain Management in the Latent Phase of Labour: A Pragmatic Trial
Authors: Kinnunen M. , Kokki H. , Hautajärvi H. , Tuovinen K. , Kokki M.
Published: November 2020

(Acta Anaesthesiol Scand. 2020;64:685–690)

While systemic opioids are effective for labor analgesia, there are concerns for adverse fetal and maternal effects, particularly at higher doses. However, there are limited data on the use of oxycodone during labor and on the use of any opioid during the latent phase of labor. This study aimed to evaluate the efficacy, fetal exposure, and safety of subcutaneous (SC) oxycodone used for labor analgesia during the latent phase.
Adverse Side Effects and Route of Administration of Opioids in Combined Spinal-epidural Analgesia for Labour: A Meta-analysis of Randomized Trials
Authors: Grangier L. , Martinez de Tejada B. , Savoldelli G.L. , Irion O. , Haller G.
Published: November 2020

(Int J Obstet Anesth. 2020;41:83–103)

Both epidural (EP) and combined spinal-epidural (CSE) techniques are used to establish effective labor analgesia. Over time, the latter has gained popularity due to faster onset of pain relief and superior sacral nerve coverage. The addition of opioids in neuraxial labor analgesia allows for lower concentrations of local anesthetic and a longer duration of the analgesic effect. However, opioids also impart risk for additional side effects including pruritus, sedation, nausea, vomiting, hypotension, and fetal heart rate pattern disturbances. This study was designed to analyze how individual and combined routes of neuraxial opioid administration impact the incidence of maternal and fetal side effects.
Prevention of Hypotension After Spinal Anaesthesia for Cesarean Section: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
Authors: Fitzgerald J.P. , Fedoruk K.A. , Jadin S.M. , Carvalho B. , Halpern S.H.
Published: November 2020

(Anaesthesia. 2020;75:109–121)

The potential for maternal hypotension is one key risk of spinal anesthesia for elective cesarean delivery (CD). A variety of methods to prevent postspinal hypotension during CD are recommended in the literature. While an international consensus statement published in 2018 recommended prophylactic vasopressors for all CDs it did not take into account the risks associated with these agents. Also, a recent meta-analysis comparing different methods to prevent hypotension was inadequate to determine treatment efficacy. The aim of this study was to determine the relative efficacy of interventions, including vasopressors, to prevent hypotension associated with spinal anesthesia during elective CD.
Risk Factors for Shivering During Cesarean Section Under Spinal Anesthesia: A Prospective Observational Study
Authors: Wódarski B. , Chutkowski R. , Banasiewicz J. , Moorthi K. , Wójtowicz S. , Malec-Milewska M. , Iohom G.
Published: November 2020

(Acta Anaesthesiol Scand. 2020;64:112–116)

Shivering during a cesarean section (CS) while under spinal anesthesia is a common problem, occurring in up to 50% of cases. However, the cause of shivering in this context is not completely understood. Evidence suggests that perioperative anxiety levels may impact the autonomic nervous system and potentially alter physiological behaviors. This study aimed to examine the relationship between potential risk factors and shivering during CS, specifically investigating preoperative anxiety levels.
Induction Opioids for Cesarean Section Under General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: White L.D. , Hodsdon A. , An G.H. , Thang C. , Melhuish T.M. , Vlok R.
Published: November 2020

(Int J Obstet Anesth. 2019;40:4–13)

Inducing general anesthesia (GA) for cesarean section (CS) can cause a significant sympathetic response that may then lead to serious adverse events, such as intracranial hemorrhage. Thus, administration of sympatholytic medications as part of the induction of GA would be desirable. While opioids are effective sympatholytic agents, older opioids may have adverse effects on the neonate. As a result their use has not been recommended during induction of GA for CS. Newer opioids are shorter-acting and it has been suggested they may have less adverse neonatal effects when used for GA induction for CS. However, more information is needed on their efficacy and potential adverse effects. This systematic review and meta-analysis was undertaken to evaluate the effects of shorter-acting induction opioids on Apgar scores, as well as other neonatal outcomes and their maternal sympatholytic efficacy.
Quadratus Lumborum Block for Analgesia After Cesarean Section: A Randomized Controlled Trial
Authors: Irwin R. , Stanescu S. , Buzaianu C. , Rademan M. , Roddy J. , Gormey C. , Tan T.
Published: November 2020

(Anaesthesia. 2020;75:89–95)

Effective pain management after cesarean delivery is crucial both for maternal satisfaction with their delivery experience and their ability to devote their care and attention to their newborns. Neuraxial opioids have been a mainstay of postcesarean pain management, but there are significant drawbacks with these medications, including the potential for misuse. Another analgesic option for postcesarean analgesia is the quadratus lumborum block (QLB). The literature has indicated that QLB is safe and easy to perform after cesarean delivery and has shown superiority over transversus abdominis plane block. Yet, adding QLB to a standard multimodal analgesic regimen that includes intrathecal morphine has not yet been evaluated. The aim of this study was to assess the efficacy of QLB when added to a standard protocol that includes intrathecal morphine for the management of postcesarean pain after cesarean delivery.
A Triple-blinded Randomized Trial Comparing Spinal Morphine With Posterior Quadratus Lumborum Block After Cesarean Section
Authors: Tamura T. , Yokota S. , Ando M. , Kubo Y. , Nishiwakia K.
Published: November 2020

(Int J Obstet Anesth. 2019;40:32–38)

Postoperative pain control is a crucial component in the management of women following cesarean section (CS). Spinal anesthesia is commonly used to provide surgical anesthesia during CS, and spinal opioids are a popular method for providing postcesarean analgesia. Intrathecal opioids, however, are associated with bothersome adverse effects such as nausea and pruritus. Posterior quadratus lumborum block (pQLB) is being used increasingly for postoperative analgesia after lower abdominal surgery and might be an appropriate pain management method following CS. The aim of this study was to compare the analgesic efficacy of ultrasound-guided pQLB plus spinal morphine after CS with spinal morphine alone. The investigators hypothesized that intrathecal morphine with pQLB would be more effective than spinal morphine alone.
Sebaceous Tumors of the Skin: A Study of 145 Lesions From 136 Patients Correlating Pathologic Features and DNA Mismatch Repair Staining Pattern
Authors: Konstantinova Anastasia M. , Kastnerova Liubov , Michal Michal , Kolm Isabel , Kazakov Dmitry V.
Published: November 2020

Sebaceous neoplasms occur sporadically or in the setting of Muir–Torre syndrome. The data regarding the correlation of pathologic features and DNA mismatch repair (MMR) staining pattern in sebaceous tumors of the skin are very scanty and based on relatively small series of patients. The goal of this study was to correlate MMR staining pattern with selected morphological features in a series of 145 sebaceous neoplasms (sebaceous adenoma, sebaceoma, and extraocular sebaceous carcinoma) from 136 patients. Cystic change, intratumoral mucin deposits, squamous metaplasia in the absence of keratoacanthoma-like changes, ulceration, intratumoral and peritumoral lymphocytes (in cases without epidermal ulceration), and intertumoral heterogeneity proved to be significantly associated with MMR deficiency. Identification of any of these changes, alone or in combination, should prompt further investigation of the patient to exclude Muir–Torre Syndrome. Our study also confirms the previously published observation that the diagnosis and tumor location are significantly associated with MMR deficiency.
A comparison of the efficacy and safety of combined aclidinium bromide and formoterol fumarate in the treatment of chronic obstructive pulmonary disease
Authors: Lu Hong , Huang Yi-Tong , Chen He-Jiang , Chen Pei-Feng
Published: November 2020

Background:

To systematically evaluate the efficacy and safety of combined aclidinium bromide and formoterol fumarate for chronic obstructive pulmonary disease (COPD).

Methods:

Electronic databases including PubMed, MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, WanFang, and China National Knowledge Infrastructure (CNKI) database were searched for studies on the use of combined aclidinium bromide and formoterol fumarate in the treatment of COPD. Two independent researchers performed literature screening, data extraction, and assessment of quality of studies. The strength of the association of the efficacy and safety of combined aclidinium bromide and formoterol fumarate in the treatment of COPD was evaluated according to the odds ratio (OR), mean differences (MDs), and 95% confidence interval (CI). Statistical analysis was carried out via using RevMan 5.3 software.

Results:

The results of the present study will be published in a peer-reviewed journal.

Conclusion:

The conclusion of the present study will provide evidence to judge whether combined aclidinium bromide and formoterol fumarate is an effective and safety intervention in the treatment of COPD.

Systematic review registration number:

INPLASY202070063.
Tumor Necrosis Factor-α 308 G/A polymorphism and psoriasis risk
Authors: Shen Cuicui , Wang Haiyan , Song Qunxian , Zhang Bing , Liu Xuewei , Li Jianwei
Published: November 2020

More and more researches have been carried out on the association between the tumor necrosis factor-α (TNF-α) 308 G/A polymorphism and psoriasis, however, controversial results have emerged in these studies. This meta-analysis was performed to quantitatively clarify the relationship between TNF-α 308 G/A polymorphism and the risk of psoriasis in different populations. Databases of PubMed, Springer Link, Ovid, Chinese Wanfang Data Bases, Chinese National Knowledge Infrastructure and Chinese Biology Medicine were investigated until June 2019. The association between the TNF-α 308 G/A polymorphism and psoriasis was evaluated by calculating the pooled odds ratio (OR) and 95% confidence intervals (CIs). A total of 26 studies including 3657 patients and 3197 controls were screened out. In the overall population, the pooled results showed a reduced psoriasis risk with the TNF-α 308 G/A polymorphism (A vs G: OR = 0.77, 95% CI = 0.67-0.89; AA+GA vs GG: OR = 0.72, 95% CI = 0.61–0.86). In the subgroup analysis stratified by geographic locations, the TNF-α 308 G/A polymorphism was significantly associated with a reduced risk of psoriasis in Germany (A vs G: OR = 0.67, 95% CI = 0.57–0.78; AA+GA vs GG: OR = 0.62, 95% CI = 0.52–0.75), as well as in China (AA+GA vs GG: OR = 0.71, 95% CI = 0.52–0.98) and Poland (A vs G: OR = 0.61, 95% CI = 0.38–0.97; AA+GA vs GG: OR = 0.59, 95% CI = 0.35–0.99). This study indicated a significantly reduced psoriasis risk associated with the TNF-α 308 G/A polymorphism in Germans, as well as in Chinese and Poles populations compared with other populations. Ethnicity and geographic locations probably play a pivotal role in the genetic association of psoriasis.
External beam radiation therapy in a centenarian with primary liver cancer
Authors: Meng Zhen , Gao Feifei , Liu Chang , Huang Shengcai , Hu Kai , Wang Rensheng
Published: November 2020

Rationale:

Due to unprecedented global aging, the number of elderly and super-elderly patients with cancer is increasing. However, restricted by comorbidities or fragility, many elderly patients are considered ineligible to receive invasive therapies. A centenarian with primary liver cancer (PLC) was treated by external beam radiation therapy (EBRT). This rare case deserves our attention.

Patient concerns:

We present a rare case of a centenarian with PLC. The super-elderly male patient complained that 2 liver lesions were found by abdominal ultrasonography in June 2016.

Diagnoses:

The Segment 7 (S7) lesion and the Segment 5/8 (S5/8) lesion were clinically diagnosed as PLC successively.

Interventions:

The S7 lesion was considered PLC initially and treated by EBRT in October 2016. In the 1-year follow-up after EBRT, the S7 lesion was well controlled. Unfortunately, the S5/8 lesion had increased in size, was diagnosed as PLC and subsequently treated by CyberKnife in another hospital. However, local failure of the S5/8 lesion was suggested 15 months after CyberKnife. At the age of 102 years, the patient received re-irradiation for the S5/8 lesion.

Outcomes:

Three months after re-irradiation, des-γ-carboxy-prothrombin decreased to normal; no significant change in the S5/8 lesion was found in Magnetic Resonance Imaging. No severe acute or late toxicities were reported after each course of EBRT. Unfortunately, the patient died of respiratory failure caused by severe pneumonia in mid-March 2020.

Conclusion:

Advanced age is not a contraindication for elderly patients with cancer to receive radiotherapy and even re-irradiation.
Transcatheter closure of patent ductus arteriosus in preterm ventilation-dependent neonates
Authors: Shi Xiaoqing , Hua Yimin , Li Yifei
Published: November 2020

Objective:

Surgical closure of patent ductus arteriosus (PDA) has been considered the only way to rescue preterm neonates following nonsteroidal anti-inflammatory drugs closure failure. However, PDA closure by catheter-based interventions has become another therapeutic choice. The aim of this report was to investigate the timing and treatment methods for hemodynamically significant PDA (hsPDA) in preterm neonates.

Methods:

We retrospectively studied 4 ventilator-dependent preterm neonate cases with hsPDA who had an urgent need of PDA closure and who attended our hospital between October 2016 and March 2018. We assessed the efficacy and safety of transcatheter closure of the hsPDA, and evaluated the dependence of the infants on mechanical ventilation.

Results:

The 4 infants with hsPDA underwent successful transcatheter closures. Two infants were weaned from the ventilatory support within 24 hours after the closure. Those 2 preterm neonates demonstrated normal growth and development during the postoperative follow-up. However, the other 2 infants still needed ventilatory support beyond 48  hours post procedure. One of them presented a bronchial stenosis, underwent a bronchial stent placement by bronchoscopy 10 days after the PDA closure, and was only then finally withdrawn from the ventilatory support. The other infant had a severe bronchomalacia and was only weaned from the ventilator 36 days post PDA closure.

Conclusion:

Transcatheter closure could be an acceptable alternative to surgical ligation when medication treatment fails to close hsPDAs in ventilator-dependent preterm neonates. This intervention should be considered to minimize mechanical ventilation duration, reduce the incidence of bronchopulmonary dysplasia, and improve the prognoses of these infants.
Prognostic value of the miR-200 family in bladder cancer
Authors: Mei Yanhui , Zheng Jianbo , Xiang Ping , Liu Cheng , Fan Yidong
Published: November 2020

Background:

We aimed to evaluate the prognostic significance of high expression of the miR-200 family of microRNAs in bladder cancer.

Methods:

Studies on the correlation between the miR-200 family and prognosis in patients with bladder cancer were searched in databases. Combined hazard ratios (HRs) were calculated based on HRs and 95% confidence intervals (CIs) for overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Cochranes Q test and the I
2 statistic were utilized to assess heterogeneity across the included studies. Potential publication bias was analyzed by Begg and Egger tests. The meta-analysis was conducted using RevMan 5.3 and Stata SE12.0.

Results:

Data from a total of 1150 patients from 8 studies were extracted. The meta-analysis revealed that high expression of the miR-200 family was correlated with better OS (pooled hazard ratio: 0.50, 95% confidence interval: 0.40–0.62), CSS (pooled hazard ratio: 0.36, 95% confidence interval: 0.22–0.59) and RFS (pooled hazard ratio: 0.48, 95% confidence interval: 0.36–0.65). Both Begg test and Egger test verified no publication bias within the included cohorts.

Conclusion:

The high expression of the miR-200 family is strongly associated with better prognosis in bladder cancer patients, which will improve bladder cancer management in clinical practice.
Comparison of surgical clipping and endovascular coiling in the treatment of oculomotor nerve palsy caused by posterior communicating artery aneurysm
Authors: Liu Jianwu , Peng Chengfu , Zhu Guofeng , Sheng Chunpeng , Song Shuxin , Cheng Zhihua , Zhu Jianming
Published: November 2020

Oculomotor nerve palsy (ONP) caused by posterior communicating aneurysm (PcomAA) is mainly treated by surgical clipping or endovascular coiling. However, there are still some controversies about which treatment method could provide the more beneficial prognosis. This study aimed to compare ONP recovery rate between surgical clipping and endovascular coiling in patients diagnosed as PcomAA combined with ONP, and explore the potential risk factors of ONP recovery.

The clinical data of 152 patients with ONP caused by PcomAA were retrospectively analyzed. Diameter of aneurysm, different treatment methods (surgical clipping or endovascular coiling), subarachnoid hemorrhage (SAH), degree of preoperative ONP, time from ONP onset to treatment, as well as degree of ONP symptom recovery were collected from medical records. All patients were followed up for at least 1 year.

One hundred twelve patients underwent surgical clipping and 40 patients received endovascular coiling. There were no significant differences in age, gender, aneurysm diameter, hypertension, dyslipidemia, time from ONP symptom onset to treatment, SAH, and preoperative ONP degree between the 2 groups (all P > .05). Time to complete or partial recovery was 86.7 ± 35.7 days for patients receiving surgical clipping and 132.6 ± 37.5 days for patients receiving endovascular coiling, respectively (Log rank test, P < .001). The recovery rate was 94.6% in the surgical clipping group and 65.0% in the endovascular coiling group. The difference between the two groups was statistically significant (P < .001). Postoperative ONP recovery in the surgical clipping group was significantly superior to that of patients in the endovascular coiling group (HR, 2.625; 95% CI: 1.423–4.841; P = .002). Time from ONP symptom onset to treatment exerted the obvious effect on the ONP prognosis (HR, 0.572; 95% CI: 0.384–0.852; P = .006). In addition, the ONP recovery in patients with SAH before surgery was also independently associated with ONP prognosis (HR, 1.276; 95% CI, 1.043–1.562; P = .018). There was no treatment-related death in either group, and postoperative complications were within the manageable range.

The recovery rate and recovery degree of ONP after surgical clipping was significantly better than that of endovascular coiling in PcomAA patients combined with ONP. The postoperative ONP recovery was associated with preoperative spontaneous SAH and time from ONP onset to treatment.
Morphological characteristics and clinical significance of the distal femur in patients with hemophilia-related knee arthritis
Authors: Gao Qiang , Yao Yunfeng , Jing Juehua
Published: November 2020

This retrospective study aimed to define the morphological characteristics of the distal femur in patients with hemophilia-related knee arthritis (HA) and develop precise femoral component installation during total knee arthroplasty (TKA) using a reference axis.

Computed tomography (CT) was performed in 75 patients [HA group: 34 patients, 48 knees; osteoarthritis (OA group): 41 patients, 48 knees] during 2017–2019. CT scans were constructed into three-dimensional models. We measured the medial (MPC) and lateral (LPC) posterior condyle widths, lateral anteroposterior (LAP) height, medial anteroposterior (MAP) height, mediolateral epicondyle (ML) width, and depths of the anterior patellar groove (X2) and the intercondylar notch (X4). Also, angles were measured between the posterior condylar line (PCL) and surgical transepicondylar axis (STEA) (PCA angle), anteroposterior axis (APA angle) and STEA (APSA angle), anterior condylar line (ACL) and STEA (ACA angle), and clinical transepicondylar axis (CTEA) and PCL (CTA angle). ML/MAP, ML/LAP, X4/LAP, X2/LAP, and LPC/ML ratios were calculated.

There were no significant differences in any angles between the HA and OA groups (P > .05). However, the HA group had a smaller MPC (P < .05) and larger X4 than the OA group (P < .05). ML, ML/LAP, X2, MAP, and LAP showed no significant differences between the 2 groups.

ML, ML/LAP, and PCA showed no significant differences between the 2 groups. During TKA in hemophilia-related knee arthritis patients, the femoral component can be installed with PCL as the reference axis, although individual differences should be considered.
The correlation between neck circumference and risk factors in patients with hypertension
Authors: Zhang Yudan , Wu Haixia , Xu Yilian , Qin Huang , Lan Cuizhen , Wang Wenzhen
Published: November 2020

It is necessary to identify the relationship between neck circumference and cardiovascular risk factors in patients with hypertension.

Patients with hypertension treated in our hospital were included. The height, weight, neck circumference, waist circumference, fasting blood glucose, 2 h blood glucose (2hPPG), density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and glycated hemoglobin (HbA1c) were analyzed and compared.

A total of 2860 patients with hypertension were included. There were significant differences between male and female patients in the neck circumference, waist circumference, fasting blood glucose, Total cholesterol, triacylglycerol, HDL-C, LDL-C, diabetes, metabolic syndrome, dyslipidemia, drinking and smoking (all P < .05); the neck circumference was positively correlated with waist circumference, body mass index (BMI), fasting blood glucose, 2hPPG, HbA1c, triacylglycerol and LDL-C (all P < .05), and negatively correlated with HDL-C (P = .014); as the neck circumference increases, the risk of hypertension, diabetes, metabolic syndrome, abdominal obesity, and dyslipidemia increases accordingly (all P < .05); the area under curve (AUC) was 0.827 and 0.812, and the neck circumference of 37.8 and 33.9 cm was the best cut-off point for male and female patients, respectively.

Neck circumference is closely related to cardiovascular risk factors in patients with hypertension, which should be promoted in the screening of cardiovascular diseases.
Comorbid irritable bowel syndrome symptoms and headache have greater association with anxiety than depression
Authors: Kawashima Kousaku , Fukuba Nobuhiko , Uemura Yusuke , Ota Kuniko , Kazumori Hideaki , Sonoyama Hiroki , Oka Akihiko , Tada Yasumasa , Mishima Yoshiyuki , Oshima Naoki , Yuki Takafumi , Katsube Tomoko , Kinoshita Yoshikazu , Ishihara Shunji
Published: November 2020

High rates of co-existing irritable bowel syndrome (IBS) and headache have been reported in western countries. We investigated that comorbidity in individuals in Japan, along with anxiety and depression in subjects with and without IBS symptoms and/or headache.

This cross-sectional study was performed from April 2012 to January 2013 at the Matsue Seikyo General Hospital Health Check Center. Questionnaires concerning symptoms related to IBS (Rome III) and headache, as well as anxiety/depression score were sent to individuals scheduled to undergo an annual health check-up, then returned during the visit and analyzed in a blinded manner.

A total of 2885 individuals returned completed questionnaires and were enrolled, of whom 218 (7.6%) met the IBS criteria. The rates of co-existing headache in subjects with and without IBS symptoms were 44.0% (96/218) and 22.9% (611/2667), respectively, indicating a significantly higher rate of co-existing headache in subjects with as compared to without IBS (odds ratio [OR] 2.65, P < .001). Furthermore, the percentage of subjects with anxiety along with comorbid IBS symptoms and headache was significantly greater as compared to those with IBS (OR 3.01, P = .001) or headache (OR 2.41, P < .001) alone. Unlike anxiety, the percentage of subjects with depression was not significantly different among the IBS/non-headache, non-IBS/headache, and IBS/headache groups.

Subjects with IBS symptoms had a higher rate of co-existing headache as compared to those without IBS. Furthermore, those with comorbid IBS symptoms and headache had a greater association with anxiety than with depression, as compared to those with only IBS or headache.
Isoniazid preventive therapy in HIV-infected pregnant and postpartum women in high prevalence of tuberculosis countries
Authors: Wang Xiaozhuan , Zhang Yun , Lin Xiaojuan , Fu Yu , Sun Qingmei , Li Jing , Liu Xiaoling , Bai Jing
Published: November 2020

Background:

Tuberculosis (TB) is the leading cause of health complications and death among human with immunodeficiency virus (HIV) infection. When TB develops during pregnancy or the early postpartum period, it is associated with negative maternal, pregnancy, and fetus and infant outcome, including premature birth, low birth weight, and congenital or neonatal TB infection or disease. The objective of this systematic review is to investigate the effective and safe of isoniazid for preventing TB for HIV-infected pregnant women in counties with high prevalence of TB.

Methods:

Pubmed, Embase, and Cochrane library will be searched to include randomized control trials which compared isoniazid preventive therapy with placebo for preventing TB in HIV-infected pregnant and postpartum women. RevMan version 5.3 will be used to perform all calculations related to the meta-analysis. Dichotomous data will be calculated in terms of a fixed or random effect model and expressed by the relative risk (RR) with 95% confidence interval (CI). The Cochrane collaboration's tool in the following aspects was used to assess the risk of bias (ROB) in included studies. The inconsistency index (I2) and Chi-squared will be applied for heterogeneity detection between clinical trials. A value of P < 0.05 will be considered statistically significant.

Results:

The main outcomes of pooled evidence synthesis will be presented including the incidence of TB and adverse events.

Conclusion:

This study will provide the evidence of whether isoniazid is an effective and safe intervention for preventing TB for HIV-infected pregnant women.

Registration number:

INPLASY202070011
Aberrant brain-expressed X-linked 4 (BEX4) expression is a novel prognostic biomarker in gastric cancer
Authors: Zhu Chenhong , Xiao Deshuang
Published: November 2020

Background:

This study aimed to investigate the expression level of X-linked 4 (BEX4) in patients with gastric cancer (GC) and to investigate the prognostic significance of BEX4.

Methods:

The mRNA expression of BEX4 was analyzed using the Cancer Genome Atlas (TCGA) datasets. The relationship between the expression of BEX4 and GC patient survival was assessed using a Kaplan-Meier plot and Log Rank test. Multivariate cox regression analysis was used to evaluate prognostic factor. The diagnostic value of BEX4 expression in GC tissue was determined through receiver operating characteristic (ROC) curve analysis. Gene set enrichment analysis (GSEA) was used to explore BEX-4 related signaling pathways in GC. Furthermore, the Human Protein Atlas (HPA) database and GSE62254 dataset were used for further validation.

Results:

BEX4 was expressed at lower level in GC tissues than normal gastric tissues. The lower expression of BEX4 was also validated at protein level in HPA database. The area under the ROC curve for BEX4 expression in normal gastric tissue and GC was 0.791, which presented modest diagnostic value. Kaplan-Meier survival analysis revealed that patients in low BEX4 expression group had a worse prognosis than those with high BEX4 expression (P = .009). Multivariate analysis showed that BEX4 is an independent risk factor for overall survival both in TCGA and GSE62254 (P = .0142, .013, respectively). GSEA identified that the expression of BEX4 was related to DNA replication, RNA polymerase, cell cycle, and P53 signaling pathway.

Conclusion:

BEX4 is expressed at low levels in GC. BEX4 expression independently predicted poor OS for GC. It is a promising independent molecular predictor for the diagnosis and prognosis of GC.
Topical clotrimazole cream for the treatment of tinea cruris
Authors: Zhao Dan , Chen Bing , Wang Ying-Ting , Jiao Chuan-Hua
Published: November 2020

This retrospective study assessed the efficacy and safety of 1% topical clotrimazole cream for the treatment of patients with tinea cruris (TC).

We included 86 patients with confirmed TC for the presence of fungal hyphae. Of those, 43 patients received 1% topical clotrimazole cream for a total of 4 consecutive weeks, and were assigned to an experimental group. The other 43 patients underwent 1% topical butenafine cream for a total of 2 consecutive weeks, and were allocated to a control group. The efficacy and safety were measured and analyzed after 4 weeks treatment.

After treatment, patients in both groups achieved better improvements in erythema (P < .01), scaling (P < .01), itching (P < .01), and KOH-negative results (P < .01), compared with those in patients before the treatment. However, there were not significant differences in erythema (P = .61), scaling (P = .57), itching (P = .47), and KOH-negative results (P = .67) between 2 groups. In addition, no treatment-related adverse events were recorded in both groups.

Both 1% topical clotrimazole and butenafine cream are found to be effective and safe for patients with TC. However, there is not significant difference in efficacy and safety between two groups.
Efficacy and safety of Brucea javanica oil emulsion for liver cancer
Authors: Luo Didi , Hou Daorui , Wen Tiancheng , Feng Meiling , Zhang Haiming
Published: November 2020

Background:

Brucea javanicaoil emulsion (BJOE), extracted from the Chinese herbBruceae Fructus (Yadanzi), is a broad-spectrum anti-tumor drug and has been widely used for the treatment of liver cancer in China. The aim of this study is to systematically investigate the efficacy and safety of BJOE for the treatment of liver cancer.

Methods:

Seven electronic databases including the Cochrane Library, PubMed, Excerpt Medica Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Scientific Journal Database, and Wanfang Database will be systematically retrieved for data extraction from their inceptions to September 2020. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. The RevMan 5.4 and Stata 16.0 software will be applied for statistical analyses. Statistical heterogeneity will be computed byI2tests. Sensitivity analysis will be conducted to evaluate the stability of the results. The publication bias will be evaluated by funnel plots and Egger test. The quality of evidence will be assessed by the GRADE system.

Results:

The results of our research will be published in a peer-reviewed journal or presenting the findings at a relevant conference.

Conclusion:

The conclusion of this study will provide helpful evidence of the effect and safety of BJOE for the treatment of liver cancer in clinical practice.

OSF registration number:

10.17605/OSF.IO/UC8XQ
Pregnancy outcome treated with stage-by-stage acupuncture and moxibustion therapy based on the chong channel being sea of blood theory in repeated IVF-ET failure patients
Authors: Xing Liwei , Xu Jinlong , Zhang Qiong , Li Li , Li Yunxiu , Zhuang Haina , Yuan Zhuojun , Zhao Rong , Ma Yanping
Published: November 2020

Introduction:

Acupuncture and moxibustion has become a commonly used adjuvant treatment method to improve the success rate of in vitro fertilization-embryo transfer (IVF-ET). However, There is still insufficient evidence that acupuncture treatment can improve the local microenvironment of endometrium, the endometrial receptivity, and the pregnancy outcome of patients, which is worthy of further study.

Method/Design:

To investigate the effect of Stage by Stage Acupuncture and Moxibustion Therapy on endometrial receptivity and Pregnancy Outcome based on the theory of “Chong channel being sea of blood,” we will conduct a multicenter randomized controlled trial. Inclusion criteria are as follows: infertile women under 45 years of age who received IVF-ET or Intracytoplasmic sperm injection cycles. The study will only be applied to women who have failed repeated implantation, that is, women who have failed 3 or more embryo transplants in the past (existing frozen embryos do not require the retrieval of eggs). Those who are not prepared to receive IVF-ET or are at risk of pregnancy, have a serious medical condition, or are egg donors will be excluded. Subjects will be randomly assigned to either the acupuncture group (IVF-ET plus stage-by-stage acupuncture and moxibustion therapy based on the “Chong channel being sea of blood” theory) or the control group (IVF-ET only). The trial required a total sample size of 246 women to compare endometrial receptivity between the 2 groups. The acupuncture group will receive acupuncture and moxibustion treatment 3 times a week starting from the third day of menstruation in the ovary stimulation cycle. One menstrual cycle was one course of treatment, and a total of 3 menstrual cycles were treated. The main outcome indicator was clinical pregnancy rate. Secondary outcome indicators were the three-dimensional volume blood flow parameters (vascularization index, flow index, and vascularization flow index) of the endometrium, endometrial thickness, endometrial volume, uterine artery PI, RI, and S/D during the “implantation window period” (20–24 days after menstruation in the ovary stimulation cycle).

Discussion:

This study will provide important evidence for the use of Stage by Stage Acupuncture and Moxibustion Therapy Based on the “Chong Channel Being Sea of Blood” Theory in IVF.

Trial registration:

http://www.chictr.org.cn/edit.aspx?pid=28811&htm=4 ID: ChiCTR1800017191 (07/17/2018).