bluuebunny/crossref_metadata_2025 huggingface dataset:
Skewed Distribution of Medical Spas and Aesthetic Physician Practices: A Cross-Sectional Market Analysis
Authors: Wang Jordan V. , Albornoz Christian A. , Noell Claire , Friedman Paul M. , Zachary Christopher B. , Saedi Nazanin
Published: August 2020

BACKGROUND

Medical spas have experienced a recent rise in popularity by consumers. Their regulations vary from state to state, especially concerning oversight and credentialing. A majority of aesthetic physicians were shown to have a medical spa within 5 minutes of their workplace.

OBJECTIVE

Our study investigated the current market distribution of medical spas and physician practices in the aesthetic field.

MATERIALS AND METHODS

For the 30 most populous cities, data were collected for medical spas and aesthetic physicians. Descriptive ratios were calculated, and various local factors were examined.

RESULTS

The cities with the greatest number of medical spas were New York (374), Houston (297), and Los Angeles (227). The cities with the greatest number of aesthetic physicians were New York (365), Houston (135), and Chicago (122). Population size had significant relationships with number of medical spas (p < .000001) and aesthetic physicians (p < .000001). For ratio of medical spas to aesthetic physicians, the top cities were Las Vegas (9.17), Denver (3.86), and San Jose (3.65). In total, 73.3% of cities had more medical spas than aesthetic physicians.

CONCLUSION

Certain cities have experienced an unequal distribution of medical spas. Further research should examine how this affects consumer decision-making for the selection of practice settings.
AUTOFLUORESCENCE AND YELLOWING SUBHYALOID BLOOD WITH PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Bloom Steven M. , Spaide Richard F.
Published: August 2020

Purpose:

To present a patient with a subhyaloid hemorrhage from proliferative diabetic retinopathy who showed a unique contrast between the fundus autofluorescent patterns of yellow with red blood.

Methods:

Analysis of color and autofluorescence fundus photographs of a patient with an aging subhyaloid hemorrhage.

Results:

The remnants of a resorbing subhyaloid hemorrhage had two layers, a superior yellow portion that was intensely hyperautofluorescent and an inferior relatively hypoautofluorescent red portion. We argue that the yellow appearance of the devitalized blood and fluorophores imaged are related to free-base porphyrins.

Conclusion:

Fundus autofluorescence is a useful modality to image subhyaloid blood and may lend important insights into the fluorophores that hyperfluoresce. The blood breakdown products are potentially toxic and autofluorescence imaging may offer clues to their presence.
Efficacy and safety of sotagliflozin adjuvant therapy for type 1 diabetes mellitus
Authors: Chen Mao-Bing , Xu Rui-Jun , Zheng Qi-Han , Zheng Xu-Wen , Wang Hua
Published: August 2020

Background:

To systematically evaluate the efficacy and safety of sotagliflozin (SOTA) adjuvant therapy for type 1 diabetes mellitus (T1DM).

Methods:

Through April 2019, the Web of Science, PubMed, Cochrane Library, Embase, and China National Knowledge Infrastructure databases were electronically searched to identify randomized controlled trials exploring SOTA adjuvant therapy for T1DM. Strict screening and quality evaluations of the obtained literature were performed independently by 2 researchers. Outcome indexes were extracted, and a meta-analysis of the data was performed using Revman 5.3 software.

Results:

A total of 7 randomized controlled trials were included. The meta-analysis results showed that compared with the patients in the placebo group, the patients in the SOTA group had a lower hemoglobin A1c (mean difference [MD] = −0.28, 95% confidence interval [CI] [−0.34, −0.22], P < .01), lower total daily insulin use (MD = −8.89, 95% CI [−11.64, −6.13], P < .01), faster weight loss (MD = −3.03, 95% CI [−3.79, −2.26], P < .01), better fasting blood glucose and 2-hour postprandial blood glucose control (MD = −0.75, 95% CI [−1.04, −0.45], P < .01; MD = −2.42, 95% CI [−3.17, −1.67], P < .01), and a higher rate of well-controlled glucose levels (relative risk = 1.75, 95% CI [1.55, 1.99], P < .01), while no significant difference in the incidence of severe hypoglycemic events was found between the SOTA and placebo groups (risk difference [RD] = −0.01, 95% CI [−0.02, 0.00], P = .13). The incidence of diabetic ketoacidosis was higher in the SOTA group than in the placebo group (RD = 0.03, 95% CI [0.02, 0.04], P < .01). The incidence of genital mycotic infection was higher in the SOTA group than in the placebo group (RD = 0.06, 95% CI [0.05, 0.08], P < .01). No significant difference in the incidence of urinary tract infections was detected between the SOTA group and the placebo group (RD = 0.00, 95% CI [−0.01, 0.01], P = 0.97).

Conclusions:

SOTA is a potential drug for the treatment of T1DM and is effective for controlling blood sugar. The main adverse reactions to SOTA are genital mycotic infections and diabetic ketoacidosis. We must further assess the severity of diabetic ketoacidosis caused by SOTA.
Vitamin D supplementation in the treatment of type 2 diabetic microangiopathy
Authors: Chen Junmin , Gong Xiayu , Liu Jie , Wang Tingting , Shi Xiaoyan , Zhang Xiaoran , Chen Qiu
Published: August 2020

Background:

The number of people with diabetes is growing exponentially.Human studies have shown that vitamin D supplementation is beneficial for type 2 diabetic microangiopathy. However, owing to the low quality, small sample size, and methodological heterogeneity of these studies, this conclusion is not convincing. Consequently, in order to determine whether vitamin D supplementation is effective and safe in type 2 diabetic microangiopathy, it is necessary to conduct a meta-analysis of high-quality clinical trials.

Methods:

We will search each database from the built-in until March 2020. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science, while the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Simultaneously we will retrieval clinical registration tests and grey literatures. In this study, only the clinical randomized controlled trials were selected to evaluate the efficacy and safety of vitamin D in the treatment of type 2 diabetic microangiopathy. The two researchers independently conducted literature selection, data extraction and quality assessment. Statistical heterogeneity among studies will be evaluated using the Cochran Q test (x2) and the I2 statistical value. We will utilize the Review Manage software V5.3.0 (The Nordic Cochrane Center, The Cochrane Collaboration, 2014, Copenhagen, Denmark) to statistically analyze all data.

Ethics and dissemination:

Ethics and dissemination: This study is a systematic review of vitamin D supplementation as a treatment of type 2 diabetic microangiopathy.

Results:

This study will provide high-quality synthesis of effectiveness and safety of vitamin D supplementation for type 2 diabetic microangiopathy.

Conclusion:

This systematic review aims to provide new options for vitamin D treatment of type 2 diabetic microangiopathy in terms of its efficacy and safety.

Registration number:

LNPLASY202050055
The prophylactic effects of vitamin K supplementation on coagulopathies associated with type 2 diabetes mellitus
Authors: Mokgalaboni Kabelo , Dludla Phiwayinkosi V. , Nkambule Bongani B.
Published: August 2020

Background:

The impact of vitamin K in ameliorating diabetes-associated complications, especially those linked with platelet activation and coagulation remains unclear. The current study aims to systematically explore and discuss the available evidence on the impact of vitamin K on the diabetes-cardiovascular disease (CVD)-associated complications.

Methods:

A systematic review of studies published on the MEDLINE (PubMed), EMBASE, and Google Scholar electronic database will be conducted. The review will include studies published from inception until May 25, 2020, reporting on the effect of vitamin K on CVD-related markers, especially coagulation factors and platelet activation in type 2 diabetes mellitus. Before the full-text screening, all studies will be screened by title, abstract, and keywords. The Downs and Black checklist will be used to assess the quality of the studies. Additionally, the Cochrane collaboration tool will also be used to evaluate the risk of bias across the included studies. Kappa Cohen's calculator will be used to assess the level of agreement between the authors.

Discussions:

This systematic review will not require ethical approval, and the results will be distributed through conference and peer-reviewed publications. Our results will assist current and future research scientists on the potential use of vitamin K as a protective therapy against CVD-related complications.

Systematic review registration:

This protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42020151667.
Hypoplastic coronary arteries in a child with a mutation in Notch1
Authors: Shi Xiaoqing , Liu Jianxin , Wu Jinlin , Hua Yimin , Zhou Kaiyu , Li Yifei
Published: August 2020

Rationale:

Coronary artery abnormalities are usually of major significance in clinical cardiology and cardiac surgery departments due to associated myocardial ischemia, myocardial infarction, and sudden cardiac death. Among them, anatomical malformations account for most coronary artery abnormalities. However, hypoplasia of the coronary artery is a rare type of coronary artery without any genetic screening information.

Patient concerns:

A 10-year-old boy suffered severe chest pain, and a subsequent syncope occurred.

Diagnosis and intervention:

The boy complained of significant chest pain with syncope. Computerized tomography (CT) angiography scanning showed that the left coronary artery was dominated by abnormal origins and dramatically narrow artery lesions. Moreover, cardiac magnetic resonance imaging (MRI) confirmed myocardial ischemia. Cardiac catheterization confirmed that this was an extremely rare hypoplastic coronary case. Finally, a mutation was identified in NOTCH1 c.1023C>A for the first time.

Outcomes:

The boy was discharged after completing all examinations and was forbidden to play any kind of sport activity while waiting for heart transplantation.

Lessons:

Hypoplastic coronary artery diseases have only been reported within very limited cases. This is the only report that has identified hypoplasia in 3 epicardial major coronary arteries. In addition, this is the first case to provide evidence between NOTCH1 genetic disorder and hypoplastic coronary artery disease in the clinic.
Adjuvant chemotherapy-associated lipid changes in breast cancer patients
Authors: He Tao , Wang Chengshi , Tan Qiuwen , Wang Zhu , Li Jiayuan , Chen Tao , Cui Kaijun , Wu Yunhao , Sun Jiani , Zheng Danxi , Lv Qing , Chen Jie
Published: August 2020

Adjuvant chemotherapy may cause alterations in serum lipids in postoperative breast cancer (BC) patients, but the specific alterations caused by different chemotherapy regimens remain unclear. The aim of this study was to investigate the status of serum lipids pre- and post-chemotherapy and to compare the side effects of different chemotherapy regimens on serum lipid.

We retrospectively analysed the lipid profiles of 1934 consecutive postoperative BC patients who received one of the following chemotherapy regimens:

The levels of triglycerides (TG), total cholesterols (TC), and low-density lipoprotein (LDL-C) were significantly elevated in patients who received chemotherapy regimens above (P < .001). With respect to different chemotherapy regimens, FEC had less side effects on lipid profiles (TG (P 
= .006), high-density lipoprotein (HDL-C) (P < .001), and LDL-C (P < .001)) than TC regimen and AC-T and EC-T regimen. Also, the incidence of newly diagnosed dyslipidemia after chemotherapy was lower in FEC group than TC group and AC-T and EC-T group (P < .001). Additionally, the magnitude of the alterations in lipid profiles (TG, TC, HDL-C, and LDL-C) was greater in premenopausal patients than that of the postmenopausal patients (P 
= .004; P < .001; P 
= .002; P 
= .003, respectively). Moreover, after adjusting for multiple baseline covariates, anthracycline-plus-taxane-based regimens (AC-T and EC-T) were still statistically associated with a high level of TG (P 
= .004) and a low level of HDL-C (P 
= .033) after chemotherapy compared with FEC regimen. Also, body mass index (BMI) > 24 was associated with abnormal lipid profiles (TG, TC, HDL-C, LDL-C) post-chemotherapy compared with BMI ≤ 24 (P < .001; P 
= .036; P 
= .012; P 
= .048, respectively).

BC patients receiving chemotherapy may have elevated lipid profiles, and anthracycline-based regimen had less side effects on lipid profiles compared with regimens containing taxane. Therefore, it is necessary to take lipid metabolism into consideration when making chemotherapy decisions and dyslipidemia prevention and corresponding interventions are indispensable during the whole chemotherapy period.
Cytoreductive surgery and HIPEC for malignant ascites from colorectal cancer - a randomized study
Authors: Ba Mingchen , Chen Cheng , Long Hui , Gong Yuanfeng , Wu Yinbin , Lin Kunpeng , Tu Yinuo , Zhang Bohuo , Wu Wanbo
Published: August 2020

Introduction:

The efficacy of different timings of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in controlling malignant ascites caused by peritoneal carcinomatosis of colorectal cancer (CRC) is not well defined. The study aims to investigate the clinical efficacy and safety of different timings of CRS with HIPEC for malignant ascites caused by peritoneal carcinomatosis from CRC.

Materials and Methods:

This was a preliminary randomized controlled study performed at the Intracelom Hyperthermic Perfusion Therapy Center of the Cancer Hospital of Guangzhou Medical University (China) from December 2008 to December 2016. The patients were randomized to: CRS, followed by HIPEC (CRS+HIPEC; n = 14), and ultrasound-guided HIPEC, followed by CRS 1 to 2 weeks later (HIPEC+ delayed cytoreductive surgery (dCRS) group, n = 14). The endpoints were complete remission rate of ascites, successful complete CRS rate, and overall survival.

Results:

Malignant ascites in all patients showed complete remission; the total effective rate was 100%. Complete CRS was not feasible in any patient. The median follow-up of the 2 groups was 41.9 and 42.3 months in the CRS+HIPEC and HIPEC+dCRS groups, respectively. Overall survival was 14.5 (95%CI: 7–19 months) and 14.3 months (95%CI: 4–21 months) (P > .05). The adverse effects of HIPEC were manageable.

Conclusions:

CRS+HIPEC and HIPEC+dCRS have the same efficacy in controlling malignant ascites caused by CRC and peritoneal carcinomatosis. The timing of CRS and HIPEC does not prolong the survival of patients with peritoneal carcinomatosis from CRC, even when a complete CRS is not feasible.
Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma
Authors: Maocai Li , Fuxing Liu , Lianqing Li , Lili Gong , WenChao Duan , ShouZhou Liu
Published: August 2020

Introduction:

Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is a rare neoplasm characterized by morphological analogy to papillary thyroid carcinoma and the abnormal expression of thyroid transcription factor-1 (TTF-1). We herein report a rare case of TL-LGNPPA with a review of its clinical and morphological characteristics and the treatment provided.

Patient concerns and Diagnosis:

The patient was a 50-year-old Chinese woman with the complaint of a three-year history of phlegm with blood with pharyngeal discomfort. There were no remarkable physical findings, and the laboratory tests were normal. Laryngoscopy and nasal computed tomography identified a mass at the posterior end of the nasal septum. Histologically, the tumor exhibited an oval papillary growth. Immunohistochemically, the neoplastic cells were positive for TTF-1, vimentin, cytokeratin 7, and cytokeratin 19. Pathological examination indicated a thyroid-like low-grade nasopharyngeal papillary adenocarcinoma.

Intervention:

The neoplasm was completely resected without any complication.

Outcomes:

The patient had neither local recurrence nor distant metastasis 1 year after the removal of the tumor.

Conclusion:

Although TL-LGNPPA is a malignant tumor, complete surgical resection is an effective treatment.
Nonsurgical treatment of chronic subdural hematoma with Chinese herbal medicine
Authors: Tong Yanping , Liu Weiming , Xu Long , Ou Yunwei , Li Kangning , Yang Tao , Zhao Tianyou , Guan Ruixi , Fan Yongping
Published: August 2020

The aim of the study was to observe the efficacy of nonsurgical treatment with Chinese herbal medicine (CHM) for chronic subdural hematoma (CSDH). This study includes clinical results of a STROBE-compliant retrospective study.

Forty patients diagnosed with CSDH were recruited from outpatient. Different CHM prescriptions were dispensed for each patient based on syndrome differentiation until the patient had a stable neurologic condition for 2 weeks and/or CSDH completely resolved according to the computed tomography scan. Markwalder grading scale for neurologic symptoms and head computed tomography scan for hematoma volumes were performed before and after CHM treatment to evaluate efficacy.

Patients received uninterrupted CHM treatment for 2.81 ± 1.45 months (0.75–6 months). The hematoma volume significantly reduced from 73.49 ± 35.43 mL to 14.72 ± 15.94 mL (P < .001). The Markwalder grading scale scores of patients at the end of CHM treatment decreased significantly, from 1.3 ± 0.69 to 0.15 ± 0.36 (P < .001). Ninety percent of the patients showed >50% decrease in the hematoma volume and complete improvement in neurologic symptoms. The linear regression analysis suggested that change in hematoma was significantly related to the duration of CHM treatment (R
2 = 0.334; P < .001; Ŷ = 25.03 + 11.91X). Leonurus heterophyllus Sweet (Yi-Mu-Cao, 90.5%), Semen persicae (Tao-Ren, 88.8%), and Acorus tatarinowii Schott (Shi-Chang-Pu, 86.2%) were the top 3 single Chinese herbs prescribed in CHM treatment.

The CHM treatment for CSDH based on syndrome differentiation with appropriate duration relieved neurologic symptoms quickly and promoted hematoma absorption effectively. It could be an effective nonsurgical therapy for CSDH.
Identification of the key gene and pathways associated with osteoarthritis via single-cell RNA sequencing on synovial fibroblasts
Authors: Wu Zhen , Shou Lu , Wang Jian , Xu Xinwei
Published: August 2020

Osteoarthritis (OA) is a chronic degenerative joint disease with its onset closely related to the growth of synovial fibroblasts (SFs), yet the genes involved in are few reported. In our study, we aimed to identify the OA-associated key gene and pathways via the single-cell RNA sequencing (scRNA-seq) analysis on SFs.

scRNA-seq data of SFs from OA sufferers were accessed from GEO database, then the genes involved in were subjected to principal component analysis (PCA) and T-Stochastic Neighbor Embedding (TSNE) Analysis. GO and KEGG enrichment analyses were performed to find the most enriched functions and pathways associated with marker genes and a PPI network was constructed to identify the key gene associated with OA occurrence.

Findings revealed that marker genes in three cell types identified by TSNE were mainly activated in pathways firmly related to fibroblasts growth, such as extracellular matrix, immune and cell adhesion molecule binding-associated functions and pathways. Moreover, fibronectin1 (FN1) was validated as the key gene that was tightly related to the growth of SFs, as well as had the potential to play a key role in OA occurrence.

Our study explored the key gene and pathways associated with OA occurrence, which were of great value in further investigation of OA diagnosis as well as pathogenesis.
Effectiveness of nurse-led program on mental health status and quality of life in patients with chronic heart failure
Authors: Mo Yuzhu , Wang Haiyan , Huang Guoding , Chu Mingzi
Published: August 2020

Current study was to evaluate the effectiveness of nurse-led program in improving mental health status (MHS) and quality of life (QOL) in chronic heart failure (CHF) patients after an acute exacerbation. CHF patients were enrolled after informed consent was obtained and were assigned into the control and treatment group. Patients in the control group received standard care. In the treatment group, patients received standard care plus telehealth intervention including inquiring patients medical condition, providing feedbacks, counseling patients, and having positive and emotional talk with patients. At the third and sixth month after discharge, participants were called by registered nurses to assess Mental Health Inventory-5 (MHI-5) and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Compared to the treatment group, patients in the control group were less likely to have educational attainment ≥ high school degree and have a married status, but were more likely to have diabetes. No significant differences in MHI-5 (68.5 ± 12.7 vs 66.9 ± 10.4) and KCCQ (70.6 ± 12.2 vs 68.7 ± 10.9) scores at baseline between the control and treatment groups were observed. There were significantly differences in MHI-5 (72.7 ± 15.6 vs 65.2 ± 11.4) and KCCQ score (74.2 ± 14.9 vs 66.4 ± 12.1) at 3 months follow-up between control and treatment groups. Nonetheless, at 6 months follow-up, although MHI-5 and KCCQ scores remained higher in the treatment group, there were no statistically significant differences (MHI-5: 65.4 ± 12.8 vs 61.4 ± 10.0; KCCQ: 65.1 ± 12.3 vs 61.9 ± 10.3). After multivariate regression analysis, not receiving nurse-led program were significantly associated with reduced MHI-5 (odds ratio [OR] 1.25% and 95% confidence interval [CI]: 1.14–1.60) and KCCQ (OR: 1.20% and 95% CI:1.11–1.54) scores. Nurse-led program is helpful to improve MHS and QOL in CHF patients after an acute exacerbation. However, these achievements are attenuated quickly after the nurse-led intervention discontinuation.
Giardia lamblia mimicking acute graft versus host disease after allogeneic hematopoietic stem cell transplantation
Authors: Ma Shengling , Yan Han , Shi Wei , You Yong , Zhong Zhao-Dong , Hu Yu
Published: August 2020

Rationale:

As the major complications post allogeneic hematopoietic stem cell transplantation (allo-HSCT), gastrointestinal disorders were most commonly ascribed to acute graft-versus-host disease (aGVHD) and opportunistic infections. Though Giardia lamblia (G lamblia) is the most common waterborne parasite of intestinal infection worldwide, seldom has it been reported in a patient with acute severe aplastic anemia after allo-HSCT.

Patient concerns:

A 23-year-old male with severe aplastic anemia developed diarrhea, abdominal cramps, bloating, nausea, vomiting, fever, weight loss, and fatigue after allo-HSCT.

Diagnosis:

Stool examinations for ova and parasites showed Giardia trophozoites and cysts.

Interventions:

Methylprednisolone was stopped and the patient was intravenously treated with a 7-day course of metronidazole (500 mg, tid.). Simultaneously, cyclosporine (5 mg/kg) was continually utilized for suspicious gut GVHD.

Outcomes:

The Giardia lamblia in stool turned negative and his symptoms were resolved after the 7-day course.

Lessons:

Incorporating non-invasive monitoring of stool examination for ova and parasites in the follow-up algorithm for post-HSCT patients can expedite clinical decision-making in the differential diagnoses for aGVHD even in the non-endemic area. Metronidazole therapy can be well-tolerated in HSCT patients with giardiasis.
Prevalence and occult rates of uterine leiomyosarcoma
Authors: Wang Lingxiang , Li Shumei , Zhang Zhengmao , Jia Jingde , Shan Baoen
Published: August 2020

This study aimed to assess the prevalence and occult rates of uterine leiomyosarcoma (ULMS) in women with smooth-muscle tumors undergoing gynecological surgery. A retrospective study was performed at an academic cancer center from 2008 to 2015. Patients undergoing either hysterectomy or myomectomy via laparoscopic, abdominal, vaginal, and hysteroscopic approaches were identified with the validated pathology diagnosis of either ULMS or leiomyomas. All patients initially operated at our institute were included and reviewed. The prevalence and occult rates of ULMS were calculated and compared between different age groups.

Twenty-eight patients with original ULMS were identified in 9556 gynecological surgeries. The prevalence of overall and occult ULMS in our study was 0.25% (1 in 345 patients) and 0.07% (1 in 1429 patients). The proportion of occult in all ULMSs was 25%. The prevalence rates of overall ULMS were 0.21%, 0.13%, 0.52%, 2.12%, and 6.67% in the 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70-year age groups, respectively. There was a significantly increased risk of ULMS after 50 years of age. The prevalence rates of occult ULMS were 0.05%, 0.08%, and 0.12% for the 30 to 39, 40 to 49, and 50 to 59 year age groups, respectively. There was no statistically significant difference among age the groups. The prevalence of ULMS was 0.41% and 0.16% for solitary and multiple tumor masses, respectively. Patients with solitary uterine tumors were at a significantly increased risk of ULMS (OR = 2.601, 95% CI = 1.108–6.141).

Our retrospective data in part reflects the clinical characteristics of overall and occult ULMS and forms the basis for further prevention of occult ULMS.
Empathy and theory of mind in multiple sclerosis
Authors: Lin XiaoGuang , Zhang XueLing , Liu QinQin , Zhao PanWen , Zhong JianGuo , Pan PingLei , Wang GenDi , Yi ZhongQuan
Published: August 2020

Background:

Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system (CNS). Recently, numerous studies have shown that MS disrupts a number of social cognitive abilities, including empathy, theory of mind (ToM), and facial emotion recognition. In contrast to well-documented deficits in the core social cognitive domains of ToM and facial emotion recognition, it is not clear the broad and specific subcomponents of empathy processing affected. In addition, the specific subcomponents of ToM affected in MS are also unclear. The aim of this study is to conduct a systematic review and meta-analysis to characterize the performance of empathy and ToM in MS.

Methods:

A systematic literature search will be performed for eligible studies published up to July 1st, 2020 in 3 international databases (PubMed, Web of Science, and Embase). The work such as article retrieval, screen, quality evaluation, data collection will be conducted by 2 independent researchers. Meta-analysis will be performed using Stata 15.0 software.

Results:

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

Conclusions:

This meta-analysis will provide a high-quality synthesis from existing evidence for the performance of empathy and ToM in MS.

PROSPERO registration number:

INPLASY202070029.
A randomized, double-blind, placebo-controlled trial for Yi-Qi Hua-Yu tong-sui granule in the treatment of mild or moderate cervical spondylotic myelopathy
Authors: Xu Chongqing , Zhou Xiaoning , Tong Zhengyi , Ma Junming , Ye Jie , Xu Jinhai , Mo Wen
Published: August 2020

Background:

Neck pain, sensory disturbance and motor dysfunction in most patients suffered cervical spondylotic myelopathy (CSM). However, some conservative treatments are limited by their modest effectiveness. In the other hand, surgical treatment is necessary when symptoms are refractory to conservative treatments and neurological function of the patients has deteriorated. Many patients use complementary and alternative medicine, including traditional Chinese medicine, to address their symptoms. The purpose of the present study is to examine effectiveness and safety of Yiqi-Huayu-Tongsui (YQHYTS) granule, a compound traditional Chinese herbal medicine, on symptoms in patients with mild or moderate CSM.

Methods/Design:

A randomized, double blinded, placebo-controlled clinical trial to evaluate the efficacy and safety of YQHYTS granule is proposed. 72 patients in Longhua Hospital with the diagnosis of mild or moderate CSM will be randomly allocated into 2 groups, and treated with YQHYTS granule or placebo. The prescription of the trial drugs (YQHYTS granule/placebo) is 20 grams twice a day for 3 months. The primary outcome measurements include visual analog scale, Japanese Orthopedic Association, and Neck Disability Index score. The secondary outcome measurements are electromyogram and Pfirrmann classification.

Discussion:

YQHYTS granule has been established and applied in Longhua Hospital for many years. As it has a potential benefit in treating mild or moderate CSM, we designed a double-blind, prospective, randomized controlled trial and would like to publish the results and conclusions later. If YQHYTS granule can alleviate neck pain, sensory disturbance, and even motor dysfunction without adverse effects, it may be a unique strategy for the treatment of mild or moderate CSM.

Trial registration:

Chinese Clinical Trial Registry ID: ChiCTR1900028192. Registered 15 December 2019, Available at: http://www.chictr.org.cn/edit.aspx?pid=46913&htm=4
Predictive value of protein induced by absence of vitamin K absence or antagonist II, alpha-fetoprotein and gamma-glutamyltransferase/aspartate aminotransferase ratio for the diagnosis of hepatocellular carcinoma in transplantation candidates
Authors: Ekmen Nergis , Akalin Çağri , Akyildiz Murat
Published: August 2020

Objectives

Alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) are used as tumour markers for the diagnosis of hepatocellular carcinoma (HCC). We investigate whether combined liver function marker such as gamma-glutamyl transferase (GGT) and aspartate aminotransferase (AST) with alpha-fetoprotein (AFP) and PIVKA-II increase their diagnostic predictive value in diagnosis of HCC.

Methods

The serum levels of PIVKA-II, AFP and GGT/AST ratio were analysed in 112 transplant candidates. Of these patients, 66 (59%) had HCC and 46 (41%) patients did not.

Results

Histological grade was positively correlated with serum levels of PIVKA-II and AFP (r = 0.255, P < 0.039 and r = 0.284, P < 0.021, respectively) and only tumour size positively correlated with the serum level of PIVKA-II (r = 0.270, P < 0.028), but no correlation between the number of tumour, Milan criteria and PIVKA-II (r = −0.002, P = 0.984 and r = 0.154, P = 0.216, respectively) with AFP (r = −0.024, P = 0.851 and r = 0.080, P = 0.522, respectively). Sensitivity and specificity of AFP, PIVKA-II and GGT/AST ratio at cutoff values of 6.08, 2.63 and 0.89, respectively, were as follows: 77, 77 vs 71, 83 vs 60 and 53%. The combination of AFP and PIVKA-II and GGT/AST ratio in HCC diagnosis increased AUROC values as follows; 0.860 vs 0.882 and 0.823 vs 0.840, respectively.

Conclusions

This study showed that combined tumour markers such as AFP, PIVKA-II and GGT/AST ratio increase their sensitivity in HCC diagnosis.
Is there a utility of adding skeletal imaging to 68-Ga-prostate-specific membrane antigen-PET/computed tomography in initial staging of patients with high-risk prostate cancer?
Authors: Raju Shobhana , Sharma Anshul , Patel Chetan , Sahoo Ranjith , Das Chandan J. , Kumar Sanjay , Sharma Akshima , Kumar Rakesh
Published: August 2020

Purpose

Both bone-scan and cross-sectional imaging are indicated in the staging of high-risk prostate cancer (PCa). However, 68Ga-prostate-specific membrane antigen (PSMA)-PET/computed tomography (CT) has proven to be an excellent tracer for detection of skeletal metastases. The aim of this study was to assess if adding skeletal imaging (with 18F-Fluoride-PET/CT) to 68-Ga-PSMA-PET/CT had any impact on high-risk PCa staging.

Method

Fifty treatment-naive, histopathologically proven, high-risk (European Association of Urology) PCa patients underwent both 68-Ga-PSMA-PET/CT and 18F-Fluoride-PET/CT for staging.

Results

Fluoride-PET/CT detected significantly a higher number of skeletal metastases/patient than PSMA-PET/CT (median 4.5/patient vs 3.0; Wilcoxan-signed-rank-test, P = 0.060) and there was a significantly higher proportion of only Fluoride-avid than only PSMA-avid lesions (McNemar-test P < 0.001). No significant advantage was seen in patient-wise metrics. Most lesions missed by PSMA-PET/CT were in flat bones (25/33). serum prostate specific antigen (S.PSA) showed positive correlation with both, the number of lesions [r(PSMA)-0.555 (P = 0.006) and r(Fluoride)-0.622 (P = 0.001)] as well as tumor to background ratio (TBR) [[r-0.706 (P < 0.001) and 0.516 (P = 0.010)]. Median TBR was significantly higher in PSMA-PET/CT (22.77 vs 16.30; P < 0.001). All three patients with only Fluoride-avid lesions (also not identified in bone-scan) showed biochemical response with additional therapy.

Conclusion

Though, Fluoride-PET/CT detected a higher absolute number of lesions than PSMA-PET/CT, no significant advantage was seen in patient-wise metrics. Fluoride-PET/CT added second-line management in only 3/50 patients, which could have been reduced to 1/50, with more sensitive evaluation of flat bones in PSMA-PET-CT. Therefore, additional skeletal imaging is not needed with 68-Ga-PSMA-PET/CT in initial staging of high-risk PCa.
Pediatric Pseudo‐pseudoxanthoma Elasticum Resulting From D‐Penicillamine Treatment for Wilson Disease
Authors: Yu Zizi , Sheu Song Johanna , Schmidt Birgitta , Corey Kristen , Hawryluk Elena B.
Published: August 2020

We describe a 14‐year‐old boy with Wilson disease (WD) who first developed pseudo‐pseudoxanthoma elasticum (PPXE) after 4.5 years of treatment with D‐penicillamine. Although previously reported cases have occurred in adults following at least a decade of high‐dose D‐penicillamine use, this case demonstrates that D‐penicillamine‐induced PPXE can present in children with shorter treatment courses. Upon this diagnosis, the patient was switched from D‐penicillamine to trientine, with adequate cupriuresis and stabilization of the skin lesion. Prompt diagnosis and management of PPXE in children can limit systemic progression and prevent long‐term complications.
Higher Waitlist Mortality in Pediatric Acute‐on‐chronic Liver Failure in the UNOS Database
Authors: Godfrey Elizabeth , Desai Moreshwar , Lam Fong , Goss John , Rana Abbas , Miloh Tamir
Published: August 2020

Objectives:

Acute‐on‐chronic liver failure (ACLF), whereas increasingly well‐defined in adults, has been poorly characterized in pediatric patients other than having a poor prognosis. This study aimed to identify ACLF and evaluate prognosis in the American pediatric population.

Methods:

Modified ACLF definitions (p‐CLIF) were applied to 11,300 children listed for liver transplantation from March 2002 through 2017 in the Organ Procurement and Transplantation Network (OPTN) database.

Results:

Pediatric ACLF patients have greater mortality within 90 days from listing (46.6% by p‐CLIF) than other types of failure (<30%), including acute liver failure, as well as greater mortality within the first 30 and 90 days after transplantation than all other types of liver failure, but do not have increased mortality rates relative to other groups between 90 and 365 days from transplant. Although some ACLF listings also received 1B status, ACLF mortality at 90 days was greater than the general 1B population (50 vs 29.4%). Model for End‐Stage Liver Disease/Pediatric End‐Stage Liver Disease scores of ACLF patients are lower than 1B listings, and do not predict waitlist or posttransplant death. Greater number of organ failures does correlate with increased mortality. Biliary atresia is the leading etiology of pediatric chronic liver disease, accounting for over 30% of chronic and 45% of ACLF listings, yet is protective against mortality (hazard ratio [HR] = 0.142 for ACLF). Receiving exception approval is independently but similarly protective in ACLF (HR = 0.145).

Conclusions:

These findings pose a challenge for allocation decisions but indicate greater attention to ACLF is needed, as scoring systems may not capture these children's risk of early death, which appears to currently be mitigated by exceptions. Multicenter, clinical, preferably prospective study of ACLF is necessary to determine how to prioritize ACLF relative to other liver failure types to address its relatively higher early mortality.
Positivity of Stool Pathogen Sampling in Pediatric Inflammatory Bowel Disease Flares and Its Association With Disease Course
Authors: Melnik Pesah , Soffair Niv , Matar Manar , Shamir Raanan , Assa Amit
Published: August 2020

Objectives:

Acute exacerbations of inflammatory bowel disease (IBD) may involve enteric pathogen. We aimed to assess the frequency and outcomes of Clostridium difficille toxin (CDT) and non‐CDT enteric infections in symptomatic pediatric patients with IBD.

Methods:

Patients’ records were retrospectively searched for disease flares in which stool samples were collected for enteric pathogens. Each patient with a positive sample was matched with a patient with IBD flare and negative samples for analyzing 1‐year outcomes following sampling.

Results:

A total of 618 pediatric patients with IBD [Crohn's disease, n = 439 (71%), mean age at diagnosis 13.0 ± 3.4 years, girls, n = 264 (42.7%)] had 1048 stool samples during the study period (2001–2018). Of 914 bacterial cultures, 40 (4.3%) were positive, 30 (75%) of which, positive for Campylobacter jejuni. Of 393 samples for CDT, 28 (7.1%) were positive while parasitic infection rate was 21/529 (3.9%).

Overall, 19 positive C jejuni cases and 19 positive CDT cases with matching controls were examined. During 12 months of follow‐up, the mean number of disease flares and emergency room visits was higher among patients with positive CDT (1.5 ± 1.4 vs 0.5 ± 0.9, P = 0.019, 1.3 ± 1.5 vs 0.4 ± 0.8, P = 0.05, respectively) with a numeric increase of surgical interventions (3 vs 0, P = 0.08). There were no significant differences in disease outcomes between patients with C jejuni infections and matched controls.

Conclusions:

C difficile and C jejuni are the most common enteric infections among pediatric patients with IBD but only clostridial infection was associated with a more severe disease course within 12 months.
Impaired Bone Health in Children With Biliary Atresia
Authors: Ruuska Satu , Laakso Saila , Leskinen Outi , Hagfors Anna , Jalanko Hannu , Kolho Kaija‐Leena , Pakarinen Mikko P.
Published: August 2020

Objectives:

The aim of the study was to examine the frequency of rickets and bone fractures and to assess areal bone mineral density (aBMD) in childhood among patients with biliary atresia (BA).

Methods:

We gathered data on all patients diagnosed with BA in Finland that survived to ≥1 year of age between 1 January 2000 to 30 June 2018. Data on gestational age, birth weight, postsurgical medications, and history of rickets and bone fractures were collected retrospectively. Serum levels of 25‐hydroxyvitamin D [25(OH)D] postportoenterostomy (PE) were collected. Plain radiographs and dual energy X‐ray absorptiometry (DXA) measurements of study subjects were reviewed.

Results:

Out of 49 patients, 7 (14%) were diagnosed with rickets during infancy. Clearance of jaundice [odds ratio 0.055, 95% confidence interval [CI] 0.00266–0.393; P < 0.01] was a protective factor against rickets. Sufficient 25(OH)D levels were reached 3 months post‐PE. Eleven (22%) patients suffered at least one bone fracture (range 1–9) during childhood and adolescence. In DXA measurements, median lumbar spine aBMD anthropometrically adjusted z‐scores were as follows: in native liver survivors 0.8 (interquartile range [IQR] −1.9 to 1.4) at 5 and −0.3 (IQR −1.3 to 0.8) at 10 years and for liver transplanted patients 0.4 (IQR −0.2 to 1.1) at 5 and 0.6 (IQR −0.1 to 1.3) at 10 years.

Conclusions:

BA patients have an increased risk for rickets and bone fractures compared with the normal population. Most BA patients have aBMD within normal range between 5 and 10 years of age irrespective of liver transplantation status.
Factors associated with hospital admission for COVID-19 in HIV patients
Authors: Di Biagio Antonio , Ricci Elena , Calza Leonardo , Squillace Nicola , Menzaghi Barbara , Rusconi Stefano , Orofino Giancarlo , Bargiacchi Olivia , Molteni Chiara , Valsecchi Laura , Cenderello Giovanni , Ferrara Sergio , Saracino Annalisa , Maggi Paolo , Falasca Katia , Taramasso Lucia , Bonfanti Paolo
Published: August 2020

This study reports on hospital admission and outcomes of 69 HIV-infected individuals who were diagnosed with SARS-CoV-2 infection between February and May 2020, in a network of Italian centres. Patients’ characteristics and median days between symptoms and diagnosis were similar by hospital admission, whereas admitted patients had lower nadir CD4+ cells and current lymphocytes count. These values were also correlated to worse COVID-19 outcome. Antiretroviral drugs did not seem to be associated with disease severity.
The Umbrella Technique for the Closure of Cerebrospinal Fluid Fistula
Authors: Maggiore Giandomenico , Locatello Luca Giovanni , Cannavicci Angelo , Bruno Chiara , Gallo Oreste
Published: August 2020

The diagnosis and management of cerebrospinal fluid (CSF) rhinorrhea remains an important challenge in the field of rhinology. In this study, the authors want to propose a technique for transnasal endoscopic closure of CSF fistulas, tested for the first time on 2 adult fresh cadaveric specimens. The authors think that the use of a device similar to the umbrella device, used to close cardiac atrial defects, may also be valid for the closure of defects at the level of the anterior skull base.
Advanced Simultaneous Isolation, Culture, and Identification of Myoblasts and Fibroblasts From Sternocleidomastoid Muscle of Congenital Muscular Torticollis
Authors: Qiu Xin , Zeng Shuaidan , Xiong Zhu , Tang Shengping , Tang Gen , Li Shicheng
Published: August 2020

Background:

Congenital muscular torticollis (CMT) is a common pediatric disease caused by contracture of sternocleidomastoid muscle (SCM) that leads to neck stiffness and deformity. Based on the adhesion characteristics of different cells in affected SCM of CMT, myoblasts and fibroblasts can be isolated simultaneously by advanced culture conditions. Our study aimed to explore and optimize the isolation, culture, and identification of myoblasts and fibroblasts in SCM of CMT.

Methods:

Myoblasts and fibroblasts were separated by combined digestion with trypsin and collagenase. With this improved method, the morphology of isolated myoblasts and fibroblasts was observed under the microscope, the cell growth curve was drawn, and the purity of myoblasts and fibroblasts was determined by immunofluorescence.

Results:

The method allowed to satisfactorily culture myoblasts and fibroblasts. The cells could stably grow and be passaged, provided they were at least 80% confluent. Immunofluorescence of myoblasts and fibroblasts showed high rate of positive staining, and cell count showed excellent growth state. Moreover, according to the growth curve, fibroblasts grew at a higher rate than myoblasts.

Conclusions:

The isolated myoblasts and fibroblasts have high purity, intact structure, and relatively high vitality. This method can be used to establish a cell model with myoblasts and fibroblasts, which can be applied to investigate etiology of CMT or mechanisms of drug action.
Long-Term Outcomes of Zygomaticomaxillary Reconstruction With Autologous Bone Grafts Supported by Pedicled Buccal Fat Pad Flap
Authors: Chu Hanwen , Huang Linjian , Xu Feifei , Chen Guanfu , Xu Xin
Published: August 2020

Purpose:

The purpose of this study was to investigate the effectiveness of the pedicle buccal fat pad flap combined with autogenous bone grafts to reconstruct zygomaticomaxillary defects after tumor resection.

Materials and Methods:

A retrospective case series analysis of 11 patients that underwent zygomaticomaxillary reconstruction after tumor resection with autologous bone grafts supported by pedicle buccal fat pad flap as the lining of the maxillary sinus from January 2009 to December 2015 was performed. All the patients underwent computed tomography to measure the aesthetic appearance, bone graft formation, mucosa of the maxillary sinus, and their response to treatment, including complications.

Results:

With a mean follow-up period of 4.7 years, all patients were pleased with the symmetrical contours of zygomaticomaxillary and symptom improvements of the maxillary sinus except for one patient who complained of transient infraorbital numbness. Recurrence, bone infection or necrosis, and other complications were not observed in the follow-up period.

Conclusion:

Pedicled buccal fat pad flap promotes wound healing and prevents the exposure of bone grafts to the maxillary sinus. This technique may be a promising treatment option when reconstructing complicated zygomaticomaxillary defects.
First Report of Pai Syndrome With Upper Alveolar Cavernous Hemangioma: Diagnosis and Surgical Treatment
Authors: Demir Can Ilker , Yaşar Emrah Kağan , Bayrak Büşra Yaprak , Işik Halil , Alagöz Murat Şahin
Published: August 2020

This case describes the surgical methodology and the procedure for follow-up in a patient who had midline cleft of the upper lip, mid-alveolar cleft, double frenulum, and alveolar mass. Our patient is the first who meets the criteria for Pai syndrome with cavernous hemangioma and is also the fourth case with concomitant double frenulum.
Correction of Temporal Hollowing With the Superior Gluteal Artery Perforator Free Flap
Authors: Lee Yoon Jae , Lee Chae Rim , Moon Suk-Ho , Jun Young Joon , Oh Deuk Young
Published: August 2020

Temporal hollowing is most frequently an acquired deformity and can be caused by volume defects of bone, soft tissue, or both. Recently, surgical reconstruction with autogenous fat or allografts has been introduced, but these materials can be resorbed over time and may also lead to infection. Herein, the authors present 2 cases demonstrating the treatment of temporal hollowing with a superior gluteal artery perforator (SGAP) free flap. Both patients had a history of traffic accidents and subsequent craniectomy because of subdural hemorrhage, followed by cranioplasty. An SGAP free flap was selected to reconstruct the soft tissue temporal defect in both patients. Pre-operatively, computed tomography (CT) angiography was used to locate the superior temporal artery (STA). A preauricular incision provided surgical access to the STA, and a subcutaneous pocket was created. The STA and SGAP artery and vein anastomoses were performed. Before flap insetting, it was de-epithelized, and its volume and shape trimmed to fit into the temporal defect. The patients’ post-operative courses were without complications, and facial symmetry was achieved. This is the first case report describing the microvascular reconstruction of temporal hollowing with an SGAP free flap. The SGAP free flap is permanent and highly vascularized with no risk of infection. These case reports illustrate a unique reconstruction technique that resulted in a satisfactory outcome for the patients.