bluuebunny/crossref_metadata_2025 huggingface dataset:
Traditional Chinese medicine fumigation as auxiliary treatment of diabetic peripheral neuropathy
Authors: Kang Shixin , Zhong Yanmei , Liu Donghao , Li Weihong
Published: January 2021

Background:

Diabetic peripheral neuropathy (DPN) is 1 of the most common clinical complications of diabetes, which seriously affects the quality of life of patients and causes a substantial economic burden on diabetes care. The pathogenesis of DPN is complex. There is no targeted treatment method, and mainstream treatment methods have low efficacy and large side effects. Traditional Chinese medicine has rich clinical experience in the prevention and treatment of diabetic peripheral neuropathy, which has dramatically improved the quality of life of patients. It is clinically proven that traditional Chinese medicine fumigants (TCMF) have apparent effects in treating diabetic peripheral neuropathy. Therefore, we aim to systematically review the effectiveness and safety of TCMF for DPN.

Methods:

We will search the following databases: PubMed, Embase, Cochrane Library, MEDLINE, the China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Cqvip Database, and Wanfang Data. Besides, we will also search for clinical trial registrations, potential grey literature, relevant conference abstracts, and reference lists of established studies. The studies published from the inception of the database to November 2020 will be retrieved. The randomized controlled trials on TCMF for DPN will be included. Also, we will search for clinical trial registrations, potential grey literature, relevant conference abstracts, and reference lists of established studies. The main result is clinical efficacy and nerve conduction velocity. Fasting blood glucose, 2 hours postprandial blood glucose, blood lipid, glycosylated hemoglobin, and adverse events are secondary results. We will perform the analyses using RevMan V.5.3 software.

Results:

This study will provide a high-quality comprehensive evaluation of the efficacy and safety of TCMF in the treatment of DPN.

Conclusions:

This systematic review will evaluate the effectiveness and safety of TCMF in the treatment of DPN, and provide the latest evidence for clinical application.

INPLASY registration number:

INPLASY2020110137.
Diagnostic agreement between 3.0-T MRI sequences of nerve root and surgery in patients with cervical radiculopathy
Authors: Wang Qi , Li Huixia , Kong Jianjun , Li Xiaohui , Feng Lin , Wu Zhanyong
Published: January 2021

Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.

This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.

The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.

This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.
Krebs von den Lungen-6 and surfactant protein-A in interstitial pneumonia with autoimmune features
Authors: Xue Mingshan , Cai Chuanxu , Zeng Yifeng , Xu Yifan , Chen Huai , Hu Haisheng , Zhou Luqian , Sun Baoqing
Published: January 2021

Interstitial pneumonia with autoimmune features (IPAF) is a special subtype of interstitial lung disease that has received worldwide attention. Krebs von den Lungen-6 (KL-6) and surfactant protein-A (SP-A) can be used as an important biomarker of interstitial lung disease, but its exact relationship with IPAF is poorly understood.

A total of 65 IPAF patients were included in the study and were followed up for 52 weeks. The KL-6 and SP-A were evaluated by chemiluminescence enzyme immunoassay. The above indicators were tested at 2 time points, baseline (the first admission of patients) and 52 weeks. We also collected the indicators of antinuclear antibodies and rheumatoid factor. Based on high-resolution computed tomography evaluations, patients were divided into: aggravation, stable, and improvement group. At same time, 30 age-matched normal people as normal control were recruited, the same information was collected. Correlations among the groups were compared and analyzed.

The KL-6 and SP-A level in IPAF patients were significantly higher than normal controls (fold increase = 11.35 and 1.39, both P < .001) and differed significantly at baseline and 52 weeks in IPAF (difference ratio = 37.7% and 21.3%, P < .05, both). There were significant differences at baseline and 52 weeks (r values of aggravation, improvement, and stable groups for KL-6 were 0.705, 0.770, and 0.344, P = .001, .001, and .163, and for SP-A the r value were 0.672, 0.375, and 0.316, P = .001, .126, and .152). In aggravation group, KL-6 and SP-A were correlated with CT scores (both P < .05). Diffusing capacity of the lung for carbon monoxide (DLCO) and forced vital capacity (FVC), % predicted showed a progressive downward trend, with a significant difference at baseline and 52 weeks in IPAF patients (difference ratio = 23.8% and 20.6%, both P < .05). There was a significant correlation between KL-6 and FVC % predicted and DLCO (both P < .05), SP-A showed negatively correlated with DLCO, but not significantly correlated with FVC % predicted (P < .05 and .47).

This study demonstrated that KL-6 and SP-A can reflect disease progression, and both 2 play a key role at reflection of lung epithelial cell injury and fibrosis degree in IPAF.
The effectiveness and safety of lienal polypeptide combined with chemotherapy or chemoradiotherapy for non-small cell lung cancer patients in real world
Authors: Wang Zhe , Liu Junfeng
Published: January 2021

Chemotherapy/chemoradiotherapy are still the fundamental treatment for advanced lung cancers. To reduce side effects and improve life quality, lienal polypeptide (LP) could be used in combine with chemotherapy/chemoradiotherapy. Moreover, LP could regulate immune system and possibly reduce the side effects of chemotherapy drugs.

In our study, 1658 lung cancer patients from 10 hospitals were retrospectively analyzed and divided into LP group and non-LP group by whether using LP during their treatment. Kaplan-Meier curves and Log-rank test was used to detect the difference of progression-free survival and overall-survival between the 2 groups. Two-sided P-values of less than .05 indicated statistical significance. All analyses were performed with SAS software (version 9.4 SAS Institute, Cary, NC).

Results showed that the number of patients who had progressed diseases in LP group and control group were 532 (64.2%) and 507 (61.2%). Log Rank test showed that median progression-free survival for LP group was 12.1 months and 11.4 months for control group (P = .3478). Statistical analyses revealed significantly difference in overall-survival between LP group and control group (23.6 months vs 18.9 months, P = .0177). The overall adverse effect rates were non-significantly different with 9.9% in the LP group and 9.3% in the non-LP group (P = .6767).

In conclusion, our research results indicated that LP used in combination with chemotherapy/chemoradiotherapy was a safe and effective treatment for patients of advanced lung cancer. LP could also reduce the adverse effects of chemotherapy/chemoradiotherapy, thereby improving patients’ life qualities, and potentially improving prognosis.
Unexpected adrenal pheochromocytoma associated with a generalized tonic-clonic seizure in a prepubertal boy
Authors: Zvizdic Zlatan , Selimovic Mirsad , Mesic Amira , Anic Dusko , Misanovic Verica , Skenderi Faruk , Vranic Semir
Published: January 2021

Rationale:

Pheochromocytoma (PHEO) is a rare neuroendocrine tumor arising from chromaffin cells of the adrenal medulla. Most pediatric PHEOs are functional tumors, and clinical manifestations are related to catecholamine hypersecretion and/or tumor mass effects.

Patient concerns:

We report here a case of a 10-year-old boy with a highly functional adrenal PHEO detected after the evaluation of a generalized tonic-clonic seizure in the patient. His vital signs at admission were: blood pressure up to 220/135 mm Hg; pulse, 112 beats/min; temperature, 37.4°C; respiratory rate, 22 breaths/min.

Diagnosis:

A 24-hour urine collection for catecholamines test showed a marked increase in Vanillylmandelic acid levels (338.9 μmol/L). An abdominal magnetic resonance imaging revealed a well-defined left adrenal gland mass measuring ∼5 cm in its largest dimension.

Interventions:

The mass was surgically removed, and histopathological examination revealed PHEO with low malignant potential (Adrenal Gland Scaled Score/PASS/ < 4).

Outcomes:

The patient was discharged on the 10th postoperative day in good condition. At 24-month follow-up, the patient was doing well without complications such as tumor recurrence, elevated blood pressure, and seizure.

Lessons:

PHEO should be considered in the differential diagnosis of children with seizures presenting in the emergency department. A multidisciplinary approach to the evaluation and treatment of PHEO is also crucial for a successful outcome.
Social support, resilience, and self-esteem protect against common mental health problems in early adolescence
Authors: Liu Qiaolan , Jiang Min , Li Shiying , Yang Yang
Published: January 2021

The aim of this study is to examine the mutual effects of self-esteem and common mental health problems (CMHPs) as well as the mutual effects of self-esteem and resilience in early adolescence. The recruited participants were 1015 adolescents aged 12.7 years (SD = 0.5 years) from two junior high schools. Data were repeatedly collected at five time points at 6-month intervals over 2-year years. The Social Support Rating Scale (SSRS), Block and Kremen's Ego-Resiliency Scale (ER89), Rosenberg Self-esteem Scale (RSES), and Mental Health Inventory of Middle School Students (MMHI-60) were used to measure social support, resilience, self-esteem, and CMHPs, respectively. Nonrecursive structural equation modeling (SEM) was performed to analyze the data.

There were bivariate partial correlations among the five-time measurements for the SSRS, ER89, RSES, and MMHI-60 scores. Self-esteem negatively predicted CMHPs with a standardized direct effect of −0.276 (95% CI: −0.425 to −0.097), and the opposite effect was −0.227 (95% CI: −0.383 to −0.072). Self-esteem positively predicted resilience with the standardized direct effect of 0.279 (95% CI: 0.093–0.425), and the opposite effect was 0.221 (95% CI: 0.063–0.376). Social support was a protective factor for mental health status.

The findings of mutual effects of self-esteem and CMHPs as well as self-esteem and resilience can provide researchers and practitioners with a conceptual framework that can help them build effective intervention methods to promote adolescent mental health status.
Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission
Authors: Januszek Rafał , Bujak Kamil , Gąsior Mariusz , Legutko Jacek , Bartuś Stanisław
Published: January 2021

The relationship regarding time of percutaneous coronary intervention (PCI) and clinical outcomes in patients with acute myocardial infarction (AMI) treated within the left main coronary artery (LMCA) is less investigated compared to the overall group of patients with AMI.

Therefore, we aimed to assess the relationship between time of PCI (day- vs night-time) and overall mortality rate in patients treated due to AMI within the LMCA.

This cross-sectional study included 443,805 AMI patients hospitalized between 2006 and 2018 enrolled in the Polish Registry of Acute Coronary Syndromes. We extracted 5,404 patients treated within the LMCA. The number of patients were treated during daytime hours (7:00 am–10:59 pm) was 2809 while 473 patients underwent treatment during night-time hours (11:00 pm–6:59 am). Differences in cardiac mortality rates between night- and day-hours among patients treated with PCI during the follow-up period were assessed via the Kaplan–Meier method.

The 30-day (20.3% vs 14.9%, P = .003) and 12-month (31.7% vs 26.2%, P = .001) overall mortality rates were significantly greater among patients treated during night-time, which was confirmed by comparison using Kaplan–Maier survival curves (P = .001). The time of PCI was not found among predictors of survival in multiple regression analysis (hazard ratio: 1.22; 95% confidence interval: 0.96-1.55, P = .099).

Patients treated during night-time in comparison to the day-time are related to higher in-hospital, 30-day and 12-month mortality. This is probably largely a consequence that the night-time, in comparison to the day-time, of treatment of patients with AMI with PCI within the LMCA is and indicator of higher comorbidity and clinical acuity of patients undergoing therapy. Therefore, the night-time was not found to be an independent predictor of greater mortality rate during the 12-months follow-up period.
Methodological quality evaluation of systematic reviews or meta-analysis of trastuzumab-based therapy for breast cancer
Authors: Wei Hua , Zhang Yong-Jun , Yu Ting , Yan Xiao-Yan , Jiang Qian
Published: January 2021

Background:

To evaluate the methodological quality of systematic reviews (SRs) or meta-analysis of trastuzumab-based therapy for breast cancer.

Methods:

We searched the PubMed, EMBASE, Web of science, Cochrane library, international prospective register of systematic reviews, Chinese BioMedical Literature Database, Wan Fang, China National Knowledge Infrastructure and VIP database for SRs or meta-analysis. The methodological quality of included literatures was appraised by risk of bias in systematic review (ROBIS) tool.

Results:

Twenty three eligible systematic reviews or meta-analysis were included. Only 2 systematic reviews provided protocol. The most frequently searched databases were PubMed, MEDLINE, EMBASE, and the Cochrane. The two-reviewers model described in the screening for eligible original articles, data extraction, and methodological quality evaluation had 30%, 61%, and 26%, respectively. In methodological quality assessment, 52% SRs or meta-analysis used the Jadad scoring or Cochrane reviewer’ handbook. Research question were well matched to all SRs or meta-analysis in phase 1 and 35% of them evaluated “high” risk bias in study eligibility criteria. The “high” risk of bias in all non-Cochrane SRs or meta-analyses, which involve methods used to identify and/or select studies. And more than half SRs or meta-analysis had a high risk of bias in data collection and study appraisal. More than two-third of SRs or meta-analysis were accomplished with high risk of bias in the synthesis and findings.

Conclusions:

The study indicated poor methodological and reporting quality of SRs/meta-analysis assessing trastuzumab-based therapy for breast cancer. Registration or publishing the protocol and the reporting followed the PRISMA checklist are recommended in future research.
Screening and identification of potential biomarkers for obstructive sleep apnea via microarray analysis
Authors: Cao Yuanyuan , Cai Xintian , Zhu Qing , Li Nanfang
Published: January 2021

Obstructive sleep apnea (OSA) is a common chronic disease and increases the risk of cardiovascular disease, metabolic and neuropsychiatric disorders, resulting in a considerable socioeconomic burden. This study aimed to identify potential key genes influence the mechanisms and consequences of OSA.

Gene expression profiles related to OSA were obtained from Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) in subcutaneous adipose tissues from OSA compared with normal tissues were screened using R software, followed by gene ontology (GO) and pathway enrichment analyses. Subsequently, a protein-protein interaction (PPI) network for these DEGs was constructed by STRING, and key hub genes were extracted from the network with plugins in Cytoscape. The hub genes were further validated in another GEO dataset and assessed by receiver operating characteristic (ROC) analysis and Pearson correlation analysis.

There were 373 DEGs in OSA samples in relative to normal controls, which were mainly associated with olfactory receptor activity and olfactory transduction. Upon analyses of the PPI network, GDNF, SLC2A2, PRL, and SST were identified as key hub genes. Decreased expression of the hub genes was association with OSA occurrence, and exhibited good performance in distinguishing OSA from normal samples based on ROC analysis. Besides, the Pearson method revealed a strong correlation between hub genes, which indicates that they may act in synergy, contributing to OSA and related disorders.

This bioinformatics research identified 4 hub genes, including GDNF, SLC2A2, PRL, and SST which may be new potential biomarkers for OSA and related disorders.
The effectiveness of acupuncture at Yaotongdian (EX-UE 7) for acute lumbar sprain
Authors: Yue Pan , Zhong Juan , Huang Jiajun , Lan Zhaoxi , Zhong Sen
Published: January 2021

Background:

Acupuncture at Yaotongdian (EX-UE 7) is increasingly used in acute lumbar sprain (ALS), and many studies have published that it is effective in the treatment of ALS. However, it is controversy if acupuncture at (EX-UE 7) can provide an evidence-based clinical benefit in the ALS population.

Methods:

We will go through 8 databases, and conduct a systematic review of acupuncture on (EX-UE 7) and health-related outcomes in ALS patients according to the Preferred Reporting Items for Systematic Reviews. The primary objective is to assess the impact of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on clinical outcomes relevant to ALS patients, such as effective rate, life-quality evaluation, and adverse events. Cochrane Risk Assessment Tool will be used to assess the quality of eligible studies according to the Cochrane handbook.

Results:

The results of this systematic review will provide a synthesis of current evidence of Acupuncture at Yaotongdian (EX-UE 7) and we have a specific opportunity to determine the efficacy and safety of it.

Conclusion:

This study will explore whether or not acupuncture on (EX-UE 7) can be used as one of the non-drug therapies to prevent or treat ALS.

Registration number:

10.17605/OSF.IO/29QV7 (https://osf.io/29qv7/)
Comparison of the clinical outcomes of non-invasive ventilation by helmet vs facemask in patients with acute respiratory distress syndrome
Authors: Khatib Mohamad Y. , Peediyakkal Mohamed Z. , Elshafei Moustafa S. , Elzeer Hani S. , Ananthegowda Dore C. , Shahen Muhsen A. , Abdaljawad Wael I. , Shaik Karimulla S. , Kannappilly Nevin , Mohamed Ahmed S. , Soliman Ahmed A. , Nashwan Abdulqadir J.
Published: January 2021

The main aim of this study is to compare the use of non-invasive ventilation (NIV) via helmet versus face mask where different interfaces and masks can apply NIV. However, some of the limitations of the NIV face mask were air leak, face mask intolerance, and requirement of high positive end expiratory pressure, which could be resolved with the use of the helmet NIV. NIV facemask will be applied as per the facial contour of the patient. NIV helmet is a transparent hood and size will be measured as per the head size. Both groups will have a standard protocol for titration of NIV.

Patients aged more than 18 years old and diagnosed with acute respiratory distress syndrome as per Berlin definition will be enrolled in the study after signing the informed consent. Subjects who met the inclusion criteria will receive 1 of the 2 interventions; blood gases, oxygenation status [Po2/Fio2] will be monitored in both groups. The time of intubation will be the main comparison factor among the 2 groups. The primary and secondary outcomes will be measured by the number of patients requiring endotracheal intubation after application of helmet device, Improvement of oxygenation defined as PaO2/FiO2 ≥ 200 or increase from baseline by 100, duration of mechanical ventilation via an endotracheal tube, intensive care unit length of stay, death from any cause during hospitalization at the time of enrolment, need for proning during the hospital stay, intensive care unit mortality, and the degree to which overt adverse effects of a drug can be tolerated by a patient including feeding tolerance.

Trial registration number:

NCT04507802.

Protocol version:

May 2020
Esophageal peripheral T-cell lymphoma treated with radiotherapy
Authors: Zhang Qiujing , Liu Chengxiang , Liu Zining , Liu Menghan , Xie Chao , Zheng Jinsong , Han Congcong , Zhang Dexian , Zhang Jianjun , Fu Shuai , Liu Jie
Published: January 2021

Rationale:

The clinical prognosis of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) patients is poor. Therefore, effective treatment is still a challenge at present. Moreover, little is known about the value of radiotherapy in the treatment of PTCL-NOS.

Patient concerns:

A 55-year-old male patient with eating difficulties and progressive exacerbation for 3 months was diagnosed as non-Hodgkin's lymphoma. Airway compression occurred after 2 cycles of first line treatment with cyclophosphamide–Adriamycin–vincristine–prednisone regimen, radiotherapy (48Gy/24f) was given as the second line therapy.

Diagnosis:

After radiotherapy, the patient complained that mild intermittent dysphagia still existed. Endoscopic biopsy of the upper digestive tract confirmed necrotic material and superficial squamous epithelial mucosa, suggesting esophageal stricture after radiotherapy, which was indistinguishable from tumor residue.

Interventions:

The patient received anti-inflammatory treatment outside the hospital and did not receive any other special treatment.

Outcomes:

The symptoms of dysphagia disappeared and the focus showed complete response (CR). As of October 1, 2020, the patient has been diagnosed with PTCL-NOS for more than 57 months and the overall survival (OS) have not been achieved.

Lessons:

Radiotherapy has obvious and rapid anti-tumor effect on cyclophosphamide–Adriamycin–vincristine–prednisone refractory PTCL-NOS. At the same time, hollow organs after radiotherapy can lead to lumen stenosis and the symptoms of suspected recurrence which is difficult to distinguish only from the imaging findings.
Evaluation of the diagnostic utility of carbohydrate-deficient transferrin in chronic alcoholism
Authors: Liang Shan-Shan , He Ying , Huang Zhi-Gang , Jia Cheng-Yao , Gan Wei
Published: January 2021

Although recent gathered evidence indicates that obtaining the diagnostic value of serum carbohydrate-deficient transferrin might be more useful for identifying alcohol abuse than other widely available biochemical tests; however, its precise value as an indicator of chronic alcoholism is unclear. The main objective is to investigate the diagnostic significance of carbohydrate-deficient transferrin in chronic alcoholism in the Chinese population.

In this study, we enrolled (1) 52 physically healthy subjects, (2) 20 patients with nonalcoholic liver disease, and (3) 70 alcoholics. Patients with liver injuries and a history of liver surgery were excluded. Serum gamma-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, and mean corpuscular volume were determined by standard biochemical assays, and serum carbohydrate-deficient transferrin was estimated in each group using capillary electrophoresis. Subsequently, the diagnostic value of carbohydrate-deficient transferrin (CDT) in chronic alcoholism was determined based on differences between each indicator among the three groups.

The CDT level in the alcoholic group was significantly higher than that of the non-alcoholic liver disease and healthy control groups (P < .05). The area under the curve for alcoholism diagnosis was the highest for CDT, at 0.922, whereas those for gamma-glutamyltransferase, aspartate aminotransferase, alanine aminotransferase, and mean corpuscular volume were 0.860, 0.744, 0.615, and 0.754, respectively. When the cutoff value of CDT was set at 1.25%, the sensitivity and specificity were 85.5% and 89.6%, respectively. However, the correlation between CDT and daily alcohol consumption was weak (r = 0.175; P = .16).

Compared with the other parameters evaluated, CDT was a better indicator of alcoholism. It should, therefore, be actively promoted in clinical practice. However, the correlation between CDT and daily alcohol consumption needs further evaluation.
CCT6A, a novel prognostic biomarker for Ewing sarcoma
Authors: Jiang Jie , Liu Chong , Xu Guoyong , Liang Tuo , Yu Chaojie , Liao Shian , Zhang Zide , Lu Zhaojun , Wang Zequn , Chen Jiarui , Chen Tianyou , Li Hao , Zhan Xinli
Published: January 2021

Background:

Ewing sarcoma (ES), the second most prevalent bone malignant tumor has no widely known prognostic biomarker. Earlier studies have suggested that chaperonin containing TCP1 complex 6A (CCT6A), which encodes a molecular protein chaperone, is involved in the pathogenesis of many cancers. However, there are no known reports providing clear evidence of its role in ES pathogenesis.

Methods:

We performed a bioinformatic analysis of 32 ES specimens from the GSE17618 dataset concentrating on the differences in gene expression, OS, event-free survival (EFS) in the different subgroups. Immunohistochemical studies were also performed to identify the expression levels of selected genes in ES and immediate paracancerous tissues.

Results:

After 3 screenings, CCT6A was identified to be highly correlated with ES prognosis. Our survival analysis revealed a low overall survival (OS) for high CCT6A expression (P-value = .024). Our Cox regression analysis identified CCT6A expression, lEFS, and age were strongly associated with prognosis of ES. Our multivariate Cox regression analysis shows that CCT6A (P-value = .015), age (P-value = .026), and EFS (P-value = .002) were independent poor prognostic biomarkers. Our immunohistochemical analysis showed that the expression levels of CCT6A were significantly higher in ES tissues compared to the paracancerous tissues.

Conclusion:

From the results of our study, we identified the expression levels of CCT6A to be strongly associated with prognosis of ES. Thus, the expression levels of the CCT6A gene could serve as a biomarker for the prediction of ES prognosis.
Esophago-bronchial fistula treated by the Over-The-Scope-Clipping (OTSC) system with argon beam electrocoagulation
Authors: Sonomura Jun , Shimizu Tetsunosuke , Taniguchi Kohei , Lee Sang-Woong , Tanaka Ryo , Imai Yoshiro , Honda Kotaro , Kawai Masaru , Tashiro Keitaro , Uchiyama Kazuhisa
Published: January 2021

Rationale:

An esophago-bronchial fistula is one of the rare postoperative complications of esophageal cancer. There are various medical treatments, including suturing, endoscopic clip, and fibrin glue. However, these treatments often lead to unsatisfactory results, causing physicians to opt for surgical alternatives. The Over-The-Scope-Clipping (OTSC) system offers an alternative method for fistula closure. It can capture a large amount of tissue and is able to compress the lesion until it has fully healed. However, data indicating the efficacy of OTSC for esophago-bronchial fistula are limited.

Patient concerns:

A 64-year-old man presented with an esophago-bronchial fistula after surgery for esophageal cancer. We chose to use a stent as the first line of treatment, but the fistula did not close.

Diagnoses:

Intractable esophago-bronchial fistula associated with esophageal surgery.

Interventions and Outcomes:

On the 94th postoperative day, fistula closure with OTSC was performed, and no leakage of the contrast agent was observed during fluoroscopy. We also attempted to close the fistula by combining OTSC and argon plasma coagulation (APC) to burn off the scar tissue from around the fistula. The fistula gradually shrank after a total of 4 rounds of OTSC, and closure of the fistula was achieved on the 185th postoperative day. There were no adverse events during the treatment of this case.

Lessons:

We demonstrate that OTSC is useful in the management of esophago-bronchial fistulas, and may become a standard procedure for the endoscopic treatment of esophago-bronchial fistulas, replacing the use of stents, clips, or glue.
Seizure-like movements caused by residual sevoflurane inside the anesthesia machine
Authors: Zheng Jianqiao , Du Li , Zhang Lu
Published: January 2021

Rationale:

Sevoflurane-induced seizures are most often caused by high concentrations of sevoflurane during anesthesia induction. However, in this case, we found a rare case of seizure-like movements caused by residual sevoflurane inside the anesthesia machine. Therefore, we propose that the detection of residual anesthesia-inhaled drugs should be included in pre-anesthesia checkout procedures.

Patient concerns:

An 11-year-old girl with a history of epilepsy was scheduled for emergency appendectomy under general anesthesia. The patient presented with seizure-like movements caused by residual sevoflurane inside the anesthesia machine after pre-oxygenation during rapid sequence induction.

Diagnoses:

Based on the clinical presentation and previous history of seizures, sevoflurane-induced seizures were diagnosed.

Interventions:

A washout procedure was performed by turning the oxygen flow up to 10L/min to wash out the residual sevoflurane from the anesthesia machine.

Outcomes:

The seizures ceased spontaneously, and the vital signs of the patient were stable during the washout procedure. Rapid sequence anesthesia induction and total intravenous anesthesia maintenance were uneventful. Surgery was performed as planned, and there were no postoperative problems. The patient was discharged after 4 days without complications and was well on follow-up.

Lessons:

The check-up procedure of residual anesthesia-inhaled drugs inside the anesthesia machine should be included in the checkout design guidelines, or else the washout procedure should be performed in the pre-anesthesia checkout procedures.
Simultaneous cardio-cerebral infarction in the coronavirus disease pandemic era
Authors: Eskandarani Rawan , Sahli Seham , Sawan Shaima , Alsaeed Asim
Published: January 2021

Introduction:

Simultaneous occurrence of acute ischemic stroke and myocardial infarction is reported to have variable precipitating causes. This occurrence has been rarely reported in the literature and described only in very few case reports. During the surge of coronavirus disease (COVID-19) in our region, we noted an increase in the simultaneous occurrence of cardio-cerebral infarction. This led us to explore the possible mechanisms and pathophysiology that could contribute to this increase. The retrospective nature of the study limited us from drawing any conclusion about causation. Rather, we aimed to formulate a hypothesis for future, more rigorous studies.

Patient concerns:

We present an overview of 5 cases of simultaneous cardio-cerebral infarction that we encountered in our emergency department within 1 month.

Diagnosis:

In all cases, diagnosis was confirmed using an electrocardiogram, assessment of laboratory cardiac markers, and imaging.

Interventions:

In all cases, dual antiplatelet therapy was started and thrombolysis was held, as the condition was considered high risk in most of the patients. Cardiac catheterization lab was not activated either because the patient was unstable or the risk of COVID-19 in staff outweighed the benefit added in patient treatment.

Outcomes:

Two out of 5 patients died because of early complications that lasted for few days. The remaining 3 were discharged from the hospital in moderate functionality for extensive therapy and rehabilitation.

Conclusion:

Early recognition and immediate treatment is important in different scenarios leading to thrombosis as the outcome. Additionally, addressing the unknown risks that could contribute to our traditional understanding of these causative mechanisms is important. The hypothesis of exacerbated damage caused by inflammatory and immunological endothelial systemic damage should further be explored to be able to delineate new possibilities in managing these conditions.
Three novel ATG16L1 mutations in a patient with acute myocardial infarction and coronary artery ectasia
Authors: Han Falan , Yan Bo
Published: January 2021

Introduction:

Acute myocardial infarction (AMI) is a specific type of coronary artery disease (CAD) caused by the rupture of coronary atherosclerotic plaques. Coronary artery ectasia (CAE) is a rare phenotype of cardiovascular disease that may promote thrombosis and inflammatory responses leading to myocardial infarction due to abnormal dilatation of blood vessels and coronary blood flow disorders. It is a complicated disease and shows interaction between genetic and environmental factors.

Patient concerns:

A 34-year-old male patient was admitted to our hospital on May 12, 2016, with complaints of chest pain for 1 hour duration.

Diagnosis:

Coronary angiography through the emergency medical service (EMS) system showed 100% occlusion at the first turning point of the right coronary artery (RCA), along with tumor-like expansion of the proximal segment of the RCA and the end of the left main (LM) artery. The patient was diagnosed with AMI and CAE. Three-point mutations in the ATG16L1 gene were identified by direct sequencing.

Interventions:

After admission, the patient underwent emergency green channel coronary angiography and percutaneous coronary intervention (PCI) to assess and unblock the stenosis and occlusion of the RCA lumen, but no stenting was performed because the catheter could not pass the second inflection point of the RCA. Aspirin enteric-coated tablets, clopidogrel sulfate tablets, tirofiban hydrochloride, and low molecular weight heparin calcium were given as anticoagulant and antiplatelet therapy. Atorvastatin calcium tablets were used to regulate blood lipid levels. Perindopril and spironolactone were used to inhibit the renin-angiotensin-aldosterone system (RAAS) to reverse myocardial remodeling. Acetylcholinesterase inhibitors (ACEI) and beta blockers were administered to resist ventricular remodeling and improve cardiac function and prognosis after the patient's blood pressure and heart rhythm were stabilized.

Outcomes:

After active rescue treatment, the patient recovered and was discharged. A coronary angiogram performed 2 years later showed that the RCA blood flow was restored, and the patient had recovered well.

Conclusion:

Three-point mutations in the ATG16L1 gene were identified in a patient with AMI and CAE, which extended the mutation spectrum of the ATG16L1 gene. Hence, the etiology of coronary artery aneurysmal dilatation is worthy of further investigation.
Clinical features and outcome of pediatric acute lymphoblastic leukemia with low peripheral blood blast cell count at diagnosis
Authors: Dai Qingkai , Zhang Ge , Yang Hui , Wang Yuefang , Ye Lei , Peng Luyun , Shi Rui , Guo Siqi , He Jiajing , Jiang Yongmei
Published: January 2021

Peripheral blood (PB) blast cell count on day 8 of prednisone therapy has been considered one of the strongest predictors of outcome in children with acute lymphoblastic leukemia (ALL). However, little is known about the clinical features and prognostic impact of PB blast cell count at diagnosis in these patients. The aim of this study was to evaluate the relationship between initial PB blast cell count and clinical prognosis of pediatric ALL.

The study comprised 367 patients with ALL, aged 0 to 14 years, enrolled and treated using the Chinese Children's Leukemia Group-ALL 2008 protocol between 2011 and 2015. The majority (91.6%) of patients were B-cell precursor ALL (BCP ALL), and 8.4% were T-cell ALL (T-ALL).

Patients with BCP ALL in the low PB blast cell count group (<1 × 109/L) had significantly superior survival rates to those in the high count group (≥30 × 109/L). In T-ALL, the low count group showed significantly inferior survival rates compared to both the intermediate count group (1–29.9 × 109/L) and high count group. Multivariate analysis revealed that the initial white blood cell count and minimal residual disease at the end of induction therapy were independently predictive of BCP ALL outcome, while risk stratification was shown to be an independent prognostic factor for T-ALL outcome.

These results indicated that low blast cell count in PB at diagnosis was associated with different clinical outcomes in patients with BCP ALL and T-ALL, although it was not an independent outcome predictor by multivariate analysis.
The gap between overweight and obesity status in children - (STROBE-compliant article)
Authors: Mărginean Cristina Oana , Meliţ Lorena Elena , Huţanu Adina , Ghiga Dana Valentina , Săsăran Maria Oana
Published: January 2021

Overweight might represent only the early stage of obesity or it might act as a trigger of self-awareness turning into an ideal chance for preventing further obesity development.

The aim of this study was to assess the differences between overweight and obese children in terms of anthropometric, low-grade systemic inflammation, liver impairment and atherosclerotic risk.

We performed a study on 132 children aged between 5 and 18 years, divided according to the BMI into 2 groups: group 1 to 76 obese children, and group 2 to 56 overweight children, assessing anthropometric, laboratory and elastography parameters.

We obtained significantly higher values of anthropometric parameters in obese children versus overweight ones. We found higher levels of leukocytes, lymphocytes, AST, ALT, and E median (P = .0345, P = .0103, P < .0001, P = .0008 and P < .0001) in the obese group as compared to the overweight one. BMI was positively correlated with neutrophils, NLR, ESR, glycemia, anthropometric parameters, and E median (P = .0007/<.0001/.0018/.0044/<.0001/<.0001/<.0001/<.0001/<.0001/.0204); and negatively with lymphocytes and HDL-cholesterol (r = −0.2747/−0.2181, P = .0116/.0120).

Our study underlined significant differences between overweight and obese children in terms of inflammatory status and liver impairment suggesting that the risk is directly related to the increase in BMI.
Breast cancer survivors’ perceptions of their partners’ interest in cancer-focused psychosocial interventions
Authors: Cohee Andrea A. , Krueger Ellen F. , Vachon Eric A. , Cottingham Ann H. , Stutz Patrick V. , Alwine Jennifer S. , Johns Shelley A.
Published: January 2021

Background:

Despite that partners of breast cancer survivors (BCS) often experience long-term consequences from the cancer experience, including fear of recurrence and depression, there are rarely psychosocial interventions aimed at mitigating these consequences. Because partners are usually recruited to research studies through BCS, it is important to understand the views of BCS regarding their partners’ involvement in interventions. The aim of this study was to explore perceptions of BCS regarding the advisability of offering a psychosocial intervention to their partners.

Methods:

BCS (N = 22) enrolled in 1 of 3 interventions (acceptance and commitment therapy [ACT], survivorship education [SE], or enhanced usual care [EUC]) were queried about whether they believed their partner would be interested in a psychosocial intervention similar to what they had just completed and asked to provide their opinions about how a partner intervention should be structured and what it should address. Twenty-two BCS (ACT group [n = 5], SE [n = 11], and EUC [n = 6]) completed the interviews.

Results:

The participants identified 3 unmet partner needs that they thought could be addressed by a psychosocial intervention: problems with coping, communication breakdowns, and lack of information. They also provided 3 recommendations regarding the development of a partner intervention: the use of a group format, the provision of separate sessions for partners and BCS, and the inclusion of intervention components that provide practical or factual information related to breast cancer.

Conclusions:

BCS can provide valuable insights that can inform the development of psychosocial interventions for partners of survivors. The development of such partner interventions is critical to address the negative and often hidden health and social effects experienced by partners of BCS.
Current practices in clinical supervision in psychosocial oncology
Authors: Taylor-Irwin Nicole E. , Kracen Amanda
Published: January 2021

Purpose:

Clinical supervision is a common pedagogical practice, but one that has received little scrutiny. This descriptive study examined the state of supervision in psycho-oncology in the United States. We were interested in learning more about how supervision is being conducted to better understand how training and clinical supervision can be improved in psycho-oncology.

Design/Sample:

Fifty-three psychosocial oncology mental health professionals completed an electronic survey.

Methods:

Participants were asked about their training in supervision, how they practice, what is unique about supervising in an oncology setting, and whether participants viewed their training as sufficient.

Findings:

Most respondents (50; 94.3%) had received some training in supervision; however, about half (28, 52.8%) reported that they had not received enough training to be an effective supervisor of trainees working with cancer patients. The majority (49, 92.5%) believed it is necessary to gain specific training to be an effective supervisor in oncology settings. In open-ended responses, participants shared what they found unique about supervising in psychosocial oncology; 4 themes emerged. These were the considerations of working in a medical setting, differences in the process and structure of therapy, deeper relationships with colleagues and patients, and the effect of clinical work on the therapist/supervisee.

Conclusions/Implications:

More than half of our sample of psychosocial oncology practitioners in the United States felt that they were inadequately prepared to supervise and believed it is necessary to pursue specific training in this area. Enhanced training in supervision should be offered because of the specialized demands of practicing in oncology settings.
Invasive Mechanical Ventilation for Acute Viral Bronchiolitis: Retrospective Multicenter Cohort Study*
Authors: Mitting Rebecca B. , Peshimam Niha , Lillie Jon , Donnelly Peter , Ghazaly Marwa , Nadel Simon , Ray Samiran , Tibby Shane M.
Published: January 2021

Objectives:

Bronchiolitis is a leading cause of PICU admission and a major contributor to resource utilization during the winter season. Management in mechanically ventilated patients with bronchiolitis is not standardized. We aimed to assess whether variations exist in management between the centers and then to assess if differences in PICU outcomes are found.

Design:

Retrospective cohort study.

Setting:

Three tertiary PICUs (Centers A, B, and C) in London, United Kingdom.

PATIENTS:

Patients under 1 year of age (n = 462) who received invasive mechanical ventilation for acute viral bronchiolitis from 2012-2016.

INTERVENTIONS:

None.

Design:

Retrospective cohort study.

MEASUREMENTS AND MAIN RESULTS:

Data collected include all sedative agents administered, 48 hour cumulative fluid balance and location of endotracheal tube (oral or nasal). Primary outcome was duration of invasive mechanical ventilation. A generalized linear model was used to test for differences in duration of invasive mechanical ventilation between centers after adjustment for confounders: corrected gestational age, oxygen saturation index, bacterial coinfection, prematurity, respiratory syncytial virus status, risk of mortality score and comorbidity. Baseline characteristics were similar, other than a higher risk of mortality score at center A and higher admission oxygen saturation index at center C. Center A was associated with utilization of the most benzodiazepine and opiate sedation, the fewest nasal endotracheal tubes, and the highest mean cumulative fluid balance at 48 hours.

Center A had an adjusted mean duration of invasive mechanical ventilation that was 44% longer than center C (95% CI, 25–66%; p < 0.001).

The majority of confounders had an association with the duration of invasive mechanical ventilation; all were biologically plausible. Corrected gestational age was negatively associated with the duration of invasive mechanical ventilation for preterm infants less than 32 weeks, but not for term or 32–37 week infants (interaction effect). This meant that at a corrected age of 0 months, a less than 32-week infant had a mean duration that was 55% greater than a term infant: this effect had disappeared by 8 months old.

Conclusions:

Between-center variations exist in both practices and outcomes. The relationship between these two findings could be further tested through implementation science with “optimal care bundles.”
The Role of Health Informatics in Facilitating Communication Strategies for Community Health Workers in Clinical Settings: A Scoping Review
Authors: Kolla Avani , Lim Sahnah , Zanowiak Jennifer , Islam Nadia
Published: January 2021

Background:

Community health workers (CHWs) have been identified as effective members of health care teams in improving health outcomes and reducing health disparities, especially among racial and ethnic minorities. There is a growing interest in integrating CHWs into clinical settings using health informatics–based strategies to help provide coordinated patient care and foster health-promoting behaviors.

Objective:

In this scoping review, we outline health informatics–based strategies for CHW-provider communication that aim to improve integration of CHWs into clinical settings.

Design:

A scoping review was conducted.

Eligibility Criteria:

US-based sources between 2013 and 2018 were eligible.

Study Selection:

Literature was identified through PubMed and Google queries and hand searching key reference lists. Articles were screened by title, abstract, and then full-text.

Main Outcome Measures:

Health informatics–based strategies for CHW-provider communication and their impacts on patient care were documented and analyzed.

Results:

Thirty-one articles discussed health informatics–based strategies for CHW-provider communication and/or integration of CHWs into clinical settings. These strategies include direct CHW documentation of patient encounters in electronic health records (EHRs) and other Web-based applications. The technologies were used to document patient encounters and patient barriers to health care providers but were additionally used for secure messaging and referral systems. These strategies were found to meet the needs of providers and CHWs while facilitating CHW-provider communication, CHW integration, and coordinated care.

Conclusions:

Health informatics–based strategies for CHW-provider communication are important for facilitating CHW integration and potentially improving patient outcomes and improving disparities among minority populations. This integration can support the development of future disease prevention programs and health care policies in which CHWs are an established part of the public health workforce. However, further investigation must be done on overcoming implementation challenges (eg, lack of time or funding), especially in smaller resource-challenged community-based clinics that serve minority patients.