bluuebunny/crossref_metadata_2025 huggingface dataset:
Venoarterial Extracorporeal Membrane Oxygenation Support for Ventricular Tachycardia Ablation: A Systematic Review
Authors: Vallabhajosyula Saraschandra , Vallabhajosyula Saarwaani , Vaidya Vaibhav R. , Patlolla Sri Harsha , Desai Viral , Mulpuru Siva K. , Noseworthy Peter A. , Kapa Suraj , Egbe Alexander C. , Gersh Bernard J. , Deshmukh Abhishek J.
Published: January 2020

Refractory ventricular tachycardia (VT) and electrical storm are frequently associated with hemodynamic compromise requiring mechanical support. This study sought to review the current literature on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for hemodynamic support during VT ablation. This was a systematic review of all published literature from 2000 to 2019 evaluating patients with VT undergoing ablation with VA-ECMO support. Studies that reported mortality, safety, and efficacy outcomes in adult (>18 years) patients were included. The primary outcome was short-term mortality (intensive care unit stay, hospital stay, or ≤30 days). The literature search identified 4,802 citations during the study period, of which seven studies comprising 867 patients met the inclusion criteria. Periprocedural VA-ECMO was used in 129 (15%) patients and all were placed peripherally. Average inducible VTs were 2–3 per procedure and ablation time varied between 34 mins and 4.7 hours. Median ages were between 61 and 68 years with 93% males. Median duration of VA-ECMO varied between 140 minutes and 6 days. Short-term mortality was 15% (19 patients), with the most frequent causes being refractory VT, cardiac arrest, and acute heart failure. All-cause mortality at the longest follow-up was 25%. Major bleeding, vascular/access complications, limb ischemia, stroke, and acute kidney injury were reported with varying frequency of 1–6%. In conclusion, VA-ECMO is used infrequently for hemodynamic support for VT ablation. Further data on patient selection, procedural optimization, and clinical outcomes are needed to evaluate the efficacy of this strategy.
Thromboelastography-targeted management of severe coagulopathy and off-label use of four-factor prothrombin complex concentrate in an infant with massive bleeding
Authors: Efune Proshad N. , Alex Gijo , Journeycake Janna , Mehta Sonia D.
Published: January 2020

A 4-month-old girl initially presented to the pediatric ICU at 9 days old with multiorgan failure and cerebellar hemorrhage secondary to disseminated enteroviral infection and was eventually listed for liver transplant. Due to severe coagulopathy, she developed a hemothorax after line placement. Despite operative exploration and multiple recombinant factor VIIa doses, massive bleeding continued. The bleeding was finally controlled with thromboelastography-targeted platelet and cryoprecipitate transfusion in addition to four-factor prothrombin complex concentrate administration. This management strategy was invaluable in controlling bleeding from an iatrogenic cause.
Psychological effects of cognitive behavioral therapy on internet addiction in adolescents
Authors: Zhang Ying-ying , Chen Jian-ji , Ye Hai , Volantin Lupe
Published: January 2020

Background:

In this study, we aim to assess the psychological effects of cognitive behavioral therapy (CBT) on internet addiction (IA) in adolescents.

Methods:

This study will search the following databases of Cochrane Library, PUBMED, EMBASE, Scopus, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these electronic databases will be searched from inception to the September 30, 2019 without any language limitation. Two authors will conduct study selection, data extraction, and study quality assessment, respectively. Any disagreements between 2 authors will be solved by a third author through discussion. Statistical analysis will be performed using RevMan 5.3 software.

Results:

This study will investigate the psychological effects of CBT on IA in adolescents by measuring psychopathological symptoms, depression, anxiety, time spent on the internet (hours/day), and health-related quality of life.

Conclusion:

This study summarizes current evidence of CBT on IA in adolescents and may provide guidance for both intervention and future researches.

PROSPERO registration number: PROSPERO CRD42019153290.
Danggui-Shaoyao-San for dementia
Authors: Kim Yunna , Cho Seung-Hun
Published: January 2020

Background:

Although memory loss and other symptoms of dementia pose tremendous burdens on patients and societies, there is currently no cure for dementia.

Methods:

We conducted a systematic review and meta-analysis of the anti-dementia effects of Danggui-Shaoyao-San (DSS), which is derived from natural resources. We searched for randomized controlled trials (RCTs) from inception to June 2019. We searched PubMed, Embase, Korean databases (Research Information Service System and Oriental Medicine Advanced Searching Integrated System), Chinese databases (China Knowledge Resource Integrated Database and Wanfang Database), and Japanese databases (CiNii and J-STAGE). Studies were included if they were a RCT, investigated the efficacy of DSS or its modified form, and included participants with dementia. Use of DSS with other treatment (eg, acupuncture, anti-dementia drugs, etc) was included. Items of each trial were evaluated by 2 independent reviewers. Data were pooled by using random-effect models.

Results:

A total of 482 studies were identified, and 5 eligible studies for Alzheimer disease (AD) and 4 studies for vascular dementia (VD) were included in the final analysis, representing a total of 567 participants. As for AD, pooled results of the Mini-Mental State Examination (MMSE) (mean differences [MD] 4.60; 95% confidence interval [CI] 4.29, 4.91) and activities of daily living (MD 11.40; 95% CI 10.94, 11.86) favored DSS. DSS had synergistic effect with acupuncture over acupuncture alone in MMSE (MD 1.69; 95% CI 1.05, 2.34), Hasegawa Dementia Scale (MD.62; 95% CI –0.20, 1.44), and activities of daily living (MD 2.38; 95% CI 1.92, 2.85). In VD, pooled results showed a significant difference in the score of dementia scales such as MMSE and Hasegawa Dementia Scale compared with nootropic drugs. DSS significantly reduced symptoms (odds ratio 5.02, 95%, CI 2.76–9.11) in patients with VD. The respective size of each RCTs was small and some included studies were of low quality due to their limited description on methodological issues.

Conclusion:

These estimates suggest that DSS provides clinically important reductions in symptoms of AD and VD and can be a promising anti-dementia drug candidate.
Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases
Authors: Hernandez-Gonzalez Fernanda , Prieto-González Sergio , Brito-Zeron Pilar , Cuerpo Sandra , Sanchez Marcelo , Ramirez Jose , Agustí Carlos , Lucena Carmen María , Paradela Marina , Grafia Ignacio , Espinosa Gerard , Sellares Jacobo
Published: January 2020

To date, there is no clear agreement regarding which is the best method to detect a connective tissue disease (CTD) during the initial diagnosis of interstitial lung diseases (ILD). The aim of our study was to explore the impact of a systematic diagnostic strategy to detect CTD-associated ILD (CTD-ILD) in clinical practice, and to clarify the significance of interstitial pneumonia with autoimmune features (IPAF) diagnosis in ILD patients.

Consecutive patients evaluated in an ILD Diagnostic Program were divided in 3 groups: IPAF, CTD-ILD, and other ILD forms. Clinical characteristics, exhaustive serologic testing, high resolution computed tomography (HRCT) images, lung biopsy specimens, and follow-up were prospectively collected and analyzed.

Among 139 patients with ILD, CTD was present in 21 (15.1%), 24 (17.3%) fulfilled IPAF criteria, and 94 (67.6%) were classified as other ILD forms. Specific systemic autoimmune symptoms such as Raynaud phenomenon (19%), inflammatory arthropathy (66.7%), and skin manifestations (38.1%) were more frequent in CTD-ILD patients than in the other groups (all P < .001). Among autoantibodies, antinuclear antibody was the most frequently found in IPAF (42%), and CTD-ILD (40%) (P = .04). Nonspecific interstitial pneumonia, detected by HRCT scan, was the most frequently seen pattern in patients with IPAF (63.5%), or CTD-ILD (57.1%) (P < .001). In multivariate analysis, a suggestive radiological pattern by HRCT scan (odds ratio [OR] 15.1, 95% confidence interval [CI] 4.7–48.3, P < .001) was the strongest independent predictor of CTD-ILD or IPAF, followed by the presence of clinical features (OR 14.6, 95% CI 4.3–49.5, P < .001), and serological features (OR 12.4, 95% CI 3.5–44.0, P < .001).

This systematic diagnostic strategy was useful in discriminating an underlying CTD in patients with ILD. The defined criteria for IPAF are fulfilled by a considerable proportion of patients referred for ILD.
Association of rs2230806 in ABCA1 with coronary artery disease
Authors: Fan Qian , Zhu Yanfang , Zhao Fang
Published: January 2020

Background:

As a key gene in the reverse transport pathway of cholesterol, ABCA1 (ATP-binding cassette transporter A1) plays an important role in the pathogenesis of coronary artery disease (CAD). In the ABCA1, rs2230806 is the most widely studied polymorphism and its role has been controversial.

Methods:

We performed an updated meta-analysis by searching online electronic databases using the PubMed, Web of Science, Embase, Cochrane Library, EMBASE, Google Scholar, China National Knowledge Infrastructure, and Wan Fang databases before June 28, 2019. STATA12.0 software was used to perform a series of analyses on the data, including genetic effect model, heterogeneity, sensitivity, and publication bias analysis.

Results:

Based on our inclusion and exclusion criteria, finally 43 articles including a total of 34,348 subjects (14,085 CAD cases and 20,263 healthy controls) were investigated. Results showed that carrying the K allele in rs223086 in the overall population significantly reduced the risk of CAD (OR = 0.745, 95% CI = 0.687–0.809, P < .001). After the ethnicity stratification analysis, the above phenomenon was found to be significant in Asian populations (OR = 0.686, 95% CI = 0.633–0.744, P < .001), marginally significant in Caucasians (OR = 0.887, 95% CI = 0.786–1.001, P = .051), and not significant in other populations (OR = 0.851, 95% CI = 0.558–1.297, P = .452). Further stratified according to the sample size in the Asian and Caucasian populations, in the Asian the K allele is more protective in small samples than large samples; however, in the Caucasian small samples carrying the K allele play a protective role while large samples are negative. In addition, according to the source of the control population and the geographical location in China, the results showed that rs2230806 was significantly associated with CAD in any group. Five genetic models (allelic, recessive, dominant, homozygote, and heterozygote) were analyzed in the above analysis.

Conclusion:

The K allele of rs2230806 was significantly associated with decreased risk of CAD, especially in Asian populations and small sample Caucasians.
Ecchymosis combined with postinflammatory hyperpigmentation associated with acupuncture therapy
Authors: Zhao Yuwei , Yu Jinna , Liu Sixing , Zhou Jing , Wang Jing , Wang ZhaoBo , Liu Zhishun
Published: January 2020

To evaluate the incidence of ecchymosis combined with postinflammatory hyperpigmentation (ECPH) over the course of 10 sessions of acupuncture therapy and to examine associated factors.

An observational study was conducted from March 7, 2017 through March 6, 2018. This study included a total of 167 subjects and 326 bodily locations where acupuncture needles had been inserted. A 1-page questionnaire that included 14 items was used to collect patient data. The information collected was used to determine the incidence of ECPH. Chi-square tests were used to observe the associations between ECPH and demographic characteristics, dermatologic features, acupuncture-related factors, and other associated factors. Cox proportional hazards regression models were applied to calculate hazard ratios for ECPH among subjects treated with various frequencies of acupuncture and needles that differed in diameter.

Although 186 subjects were initially enrolled, the study ultimately included 167 subjects and 326 bodily locations at which acupuncture needles were inserted. Over 10 sessions of acupuncture, ECPH was observed in 117 (70.06%, 117/167) subjects and 221 (67.79%, 221/326) bodily locations. Factors found to be associated with ECPH included: frequency of acupuncture, diameter of acupuncture needle, total number of acupuncture sessions, and bodily location at which acupuncture was administered (P < .05). Among subjects who received >2 acupuncture sessions per week, a higher frequency of acupuncture was associated with increased incidence of ECPH. Thicker acupuncture needle diameter was associated with a higher incidence of ECPH.

The incidence of acupuncture-associated ECPH among the subjects included in the study was high. There were significant associations between ECPH and higher frequency of acupuncture as well as thicker diameter of acupuncture needles. Additional studies are required to confirm the findings.

Trial registration number: AMCTR-OOC-17000109.
d-dimer and diffusion-weighted imaging pattern as two diagnostic indicators for cancer-related stroke
Authors: Shen Yijun , Li Yuxia , Chen Chengming , Wang Wenan , Li Tian
Published: January 2020

The aim of this study was to evaluate the risk factors and elucidate the clinical characteristics of cancer-associated ischemic stroke to differentiate it from conventional ischemic stroke in China and East Asia. Between June 2012 and June 2016, a retrospective analysis was performed on 609 stroke patients with cancer. They were divided into 3 groups: cancer-stroke group (CSG, 203 cases), stroke group (SG, 203 cases), and cancer group (CG, 203 cases). The d-dimer levels and diffusion-weighted imaging lesion (DWI) pattern were compared to an age- and sex-matched control group. The most common cancer types were colorectal cancer (20.2%) and lung cancer (18.72%). The average d-dimer level in stroke patients and cancer patients were 0.34 and 1.50 mg/L, respectively. The descending levels of d-dimer from cancer types were lung cancer (2.06 mg/L), pancreas (1.74 mg/L), gastric (1.61 mg/L), among others. Univariate analysis of the CSG and the others shows there were significant differences in the prevalence of the levels of d-dimer and DWI pattern, hypertension, diabetes mellitus, and thrombus. CSG has a unique pathological characteristic including high plasma d-dimer levels and multiple vascular lesions. The results show that d-dimer and DWI can be used as diagnostic index in clinical practice.
Effect of alkaline phosphatase on sepsis-associated acute kidney injury patients
Authors: Tang Wenting , Huang Junlin , Huang Xiaowen , Han Xiao , Tang Wenyi , Ke Guibao , Xu Qingqing
Published: January 2020

Background:

This systematic review and meta-analysis were performed to evaluate kidney function in patients with sepsis-associated acute kidney injury (SA-AKI) on alkaline phosphatase (AP) therapy.

Methods:

PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched electronically from inception until May 4, 2019 and randomized controlled studies assessing AP treatment in patients with SA-AKI were included. Pool analyses with fixed effects or random effects models calculated pooled mean, standard deviation, and odds ratio (OR) with 95% confidence interval (CI).

Results:

Four randomized controlled trials involving AP therapy for 392 patients with SA-AKI were included. AP had a positive effect on endogenous creatinine clearance (ECC) in patients with SA-AKI at day 14 (random effects: mean difference = 10.56, 95% CI = 2.27–18.84, P = .01) and day 28 (random effects: mean difference = 14.30, 95% CI = 6.27–22.33, P = .0005). All-cause mortality at day 28 (fixed effects: OR = 0.62, 95% CI = 0.40–0.97, P = .04) and day 90 (fixed effects: OR = 0.61, 95% CI = 0.39–0.96, P = .03) improved. Plasma creatinine level (fixed effects: mean difference = −76.83, 95% CI = −146.92 to −6.74, P = .03) and biomarkers level (random effects: mean difference = −6.57, 95% CI = −10.74 to −2.40, P < .00001) also improved in the therapy group compared with placebo.

Conclusion:

In patients with SA-AKI, AP showed a relatively late protective effect by improving ECC at days 7, 14, and 28. ECC level improved when patients received AP dose of 0.212 mg/kg. Mortality improved at days 28 and 90, respectively, when patients received AP dose of 1.6 mg/kg. Levels of overall AKI biomarkers were improved in short term.
Anti-GQ1b antibody syndrome presenting with visual deterioration as the initial symptom
Authors: Zhao Teng , Deng Yuyan , Ding Ying , Zhang Rensheng , Zhou Chunkui , Lin Weihong
Published: January 2020

Rationale:

Anti-GQ1b antibody syndrome refers to a distinct variant of Guillain– Barré syndrome. Involvement of the optic nerve in anti-GQ1b antibody syndrome is extremely rare.

Patient concerns:

Here, we report a case of anti-GQ1b antibody syndrome presenting with visual deterioration as the initial symptom. A 73-year-old man presented with a 5-day history of bilateral blurred vision and ptosis. He had a previous history of diarrhea starting 10 days before admission. Physical examination showed visual deterioration, ophthalmoplegia, and peripheral facial paralysis. Testing of both serum and cerebrospinal fluid was positive for anti-GQ1b immunoglobulin G antibodies and negative for anti-aquaporin 4antibodies.

Diagnosis:

Anti-GQ1b antibody syndrome.

Interventions:

The patient was treated with intravenous methylprednisolone and human immunoglobulin.

Outcomes:

After a 20-day follow-up, the patient's condition took a favorable turn.

Lessons:

This case reminds us that anti-GQ1b antibody syndrome should be suspected in patients with visual deterioration and preceding infection.
Adjuvant chemotherapy for locally advanced rectal cancer in elderly patients after neoadjuvant chemoradiotherapy and surgery
Authors: Sun Quanquan , Liu Tongxin , Liu Peng , Lu Ke , Zhang Na , Liu Luying , Zhu Yuan
Published: January 2020

The treatment strategy for elderly patients with locally advanced rectal cancer (LARC) remains controversial. The aim of this study was to identify the significance of adjuvant chemotherapy (AC) for elderly patients with LARC after neoadjuvant chemoradiotherapy (nCRT) and surgical resection. Between February 2002 and December 2012, a total of 43 patients aged ≥70 years with LARC following nCRT and surgery were retrospectively reviewed. The median follow-up time was 51 months (range 15–161 months). All patients completed the programmed chemoradiotherapy, of which 20 patients (46.5%) received 5-fluorouracil-based AC, and other 23 patients (53.5%) received no adjuvant chemotherapy. The 5-year overall survival and disease-free survival rates for AC group and non-adjuvant chemotherapy (NAC) group were 74.7% vs 63.4% (P = .562) and 73.4% vs 66.3% (P = .445), respectively. More patients in AC group suffered from severe leucopenia than that in NAC group (60% vs 17.4%, P = .004). For elderly patients with LARC following nCRT and surgery, AC may not benefit for survival, but increase treatment related leucopenia.
Effectiveness of supervised early exercise program in patients with arthroscopic rotator cuff repair
Authors: Gutiérrez-Espinoza Héctor , Araya-Quintanilla Felipe , Pinto-Concha Sebastian , Zavala-González Jonathan , Gana-Hervias Gonzalo , Cavero-Redondo Iván , Álvarez-Bueno Celia
Published: January 2020

Background:

Based on the available evidence, it is difficult to make a clinical decision about the best exercise program and to establish the most favorable time to start postoperative treatment after rotator cuff (RC) repair. The aim of this trial is to evaluate the effects of adding a supervised early exercise program to standard treatment for functional improvement and pain relief compared with standard treatment alone in patients with arthroscopic RC repair.

Method/design:

A total of 118 patients between the ages of 18 and 50 years with arthroscopic RC repair will be randomized to 2 treatment arms. The control group will receive a standard exercise program based on a consensus statement on shoulder rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The intervention group will receive a supervised early exercise program in combination with standard treatment. This supervised exercise program will be based on electromyographic evidence. Three evaluations will be performed: before surgery, at 6 weeks, and at 12 weeks. The primary outcome measure will be the shoulder function by the Constant–Murley questionnaire, and the secondary outcome measures will be the upper limb function by the disabilities of the arm, shoulder, and hand questionnaire; pain by the visual analog scale; and the shoulder range of motion by a goniometer.

Discussion:

We hypothesize that patients who receive a supervised early exercise program in combination with standard treatment will benefit more in respect to shoulder function, pain reduction, and range of motion than those who receive a standard exercise program. If this is confirmed, our study can be used clinically to enhance the recovery of patients with arthroscopic RC repair.

Trial registration:

Brazilian registry of clinical trials UTN number U1111-1224-4143. Registered December 18, 2018.
The prevalence of stroke according to indoor radon concentration in South Koreans
Authors: Kim Soo Han , Park Jeong Mee , Kim Hee
Published: January 2020

To investigate the relationship between indoor radon level and stroke, which is a major factor for background radiation.

This study combines 2 nationwide studies. Demographic characteristics and medical history of participants were obtained from Korean National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2012. Participants over 40 years old and who completed the questionnaire were included in the study. Indoor radon concentration was analyzed using the mean value of winter housing radon concentration from 2012 to 2016 published by the National Institute of Environmental Research. The average values of each metropolitan city and province were assigned to the residence of the participant. To eliminate the potential confounding factors, participants’ age, sex, hypertension, diabetes, dyslipidemia, ischemic heart disease, education level, occupation, smoking, drinking, exercise, and dietary intake were adjusted in multivariable logistic regression.

Total of 28,557 participants were included in this study. Indoor radon levels were significantly higher in the participants with stroke, and the prevalence of stroke increased as indoor radon levels increased (P < .001, P for linear trend <.001). Indoor radon level was associated with stroke even after adjusting potential confounding factors (OR: 1.004 [95CI: 1.001–1.007], P = .010) and high radon exposure (indoor radon over 100Bq/m3) was also associated with stroke (OR: 1.242 [95CI: 1.069–1.444], P = .005). Trend analysis showed linear correlation of increased odds between radon quartile and stroke (P for linear trend < .001). In subgroup analysis, elevated indoor radon was most strongly associated in participants with age over 76(OR: 1.872[95%CI:1.320–2.654], P < .001).

High indoor radon concentration may be associated with stroke. Specifically, elevated radon was associated with stroke in participants over 76 years old. In high-risk population, home modification to reduce indoor radon may help decreasing the risk of stroke.
The study on analysis of risk factors for severity of white matter lesions and its correlation with cerebral microbleeds in the elderly with lacunar infarction
Authors: Zhou Yu-Ni , Gao Hao-Yuan , Zhao Fang-Fang , Liang Ying-Chun , Gao Yuan , Liu Xin-Hong , Wang Tao , Wang Zhi-Gao , Wu Qing-Jian
Published: January 2020

This study aimed to explore the risk factors for severity of white matter lesions and its correlation with in the elderly with lacunar infarction.

Patients (range, 70–85 years) with lacunar infarction treated in a hospital in China from 2016 to 2017were enrolled. Fazekas rating scale (0–6 points) was used to assess severity of white matter lesions. Risk factors for the severity of white matter lesions and correlation between cerebral microbleeds and white matter lesions in the elderly with lacunar infarction were studied.

The elderly (81–85 years’ old, odds ratio [OR]: 2.423, 95% confidence interval [CI]: 1.795–3.271, P = .018; 76∼80 years’ old, OR: 3.113, 95% CI: 1.723–5.625, P = .043), carotid atherosclerosis (OR: 3.062, 95% CI:1.715–5.468, P < .001), history of hypertension (OR: 3.694, 95% CI: 2.031–6.717, P < .001) were risk factors for the severity of white matter lesions. The white matter lesions score increased corresponding to increase in the cerebral microbleeds grade (P < .001). The white matter lesions score was higher in the cerebral microbleeds combined with the white matter lesions group than in the white matter lesions group (P < .01). After correcting the effects of age, there was a correlation between white matter lesions and cerebral microbleeds (P < .001). Logistic analysis revealed that the patients’ age (81–85 years’ old, OR: 2.722, 95% CI: 1.985–3.734, P = .019; 76∼80 years’ old, OR: 1.857, 95% CI: 1.075–3.207, P = .031), history of hypertension (OR: 2.931, 95% CI: 1.136–7.567, P = 0.0.036), systolic blood pressure (OR: 1.049, 95% CI: 1.015–1.084, P = .007), high-sensitivity C-reactive protein (OR: 1.504, 95% CI: 1.254–1.803, P < .001), homocysteine (OR: 1.076, 95% CI: 1.020–1.136, P = .009), and carotid atherosclerosis (OR: 1.389, 95% CI: 1.103–1.748, P = .010) were significant risk factors for combined cerebral microbleeds with white matter lesions in patients with lacunar infarction.

The elderly, carotid atherosclerosis, history of hypertension were risk factors for the severity of white matter lesions. Cerebral microbleeds were positively correlated with the severity of white matter lesions.
Clinical outcomes of nonsurgical treatment for Preiser disease
Authors: Tomori Yuji , Nanno Mitsuhiko , Takai Shinro
Published: January 2020

To elucidate whether nonsurgical treatment for Preiser disease is effective.

Eight patients with Preiser disease (median age 59 [47–69] years

) underwent nonsurgical treatment (median symptom-onset-to-treatment interval 8 [9–180] months). At presentation, 7 patients complained of constant pain and 1 of motion-related pain. Pain restricted wrist range of motion (median modified Mayo wrist score [MMWS] 17.5 [range 10–30]). Radiography revealed stages 1 to 3 disease (Herbert–Lanzetta classification). Median scapholunate angle was 62° (54°–75°), with 3 wrists suffering dorsal intercalated segment instability (DISI). Magnetic resonance imaging showed (Kalainov criteria) 4 stage 1 wrists (complete necrosis) and 4 stage 2 (incomplete necrosis). Two had concomitant Kienböck disease. All patients underwent nonsurgical treatment (ie, oral pain killer, immobilization, rest) and were monitored via radiographic and clinical evaluations. Scapholunate angles and the scaphoid area reduction ratio were calculated using radiography. Response criteria were the patients’ subjective and objective status. Endpoint was the time from start of non-surgical to surgical treatment.

Immobilization lasting 0 to 24 months (median 1.8 months) did not relieve their symptoms. Follow-up radiography showed that the disease stage had progressed in 5 of 8 wrists, with 5 wrists having DISI. The median area reduction ratio of the scaphoid was 11% (4%–52%) on anteroposterior views and 4% (−23% to 17%) on lateral views. Compared with the contralateral wrist, the median wrist flexion-extension arc was 61% (50%–79%) and the median grip strength 39%. Median MMWS score was 17.5 (10–25) – poor in 6 of 8 patients. Surgery was thus necessary in all patients.

Nonsurgical treatment for Preiser disease did not improve subjective or objective outcomes and did not prevent deterioration of radiographic findings.

Type of study/level of evidence: Therapeutic, Level V.
Comparisons of periventricular device closure, conventional surgical repair, and transcatheter device closure in patients with congenital ventricular septal defects
Authors: Li Dongxu , Zhang Zhao , Li Mengsi
Published: January 2020

Background:

Surgical treatments for ventricular septal defects (VSDs) mainly include 3 approaches: conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricualr device closure (PDC). PDC has been introduced in over 10 years, although there remain concerns about adverse events. This network meta-analysis is to compare PDC, CSR, and TDC in the treatment of congenital VSD.

Methods:

We will search MEDLINE, EMBASE, Clinical Trials, Cochrane Library, and China National Knowledge Infrastructure databases for comparative studies on device closure and conventional repair for congenital VSDs to August 2019. A network meta-analysis with frequentist frame will be performed to compare the 3 approaches involving the success rate, in-hospital indexes, and incidences of complications, using risk ratio with 95% confidence intervals.

Results:

This study will be submitted to a peer-reviewed journal for publication.

Conclusion:

This network meta-analysis will assess the safety and efficacy of PDC, CSR, and TDC in the treatment of congenital VSDs, and provide more evidence-based guidance in clinical practice.

PROSPERO registration number:

CRD42019125257.
99mTc-DPD scintigraphy and SPECT/CT in patients with AL and ATTR type amyloidosis
Authors: Lee Joohee , Kim Kihyun , Choi Jin-Oh , Kim Seok Jin , Jeon Eun-Seok , Choi Joon Young
Published: January 2020

Although pathological confirmation is the gold standard for diagnosis of amyloidosis, there is a need for a relevant imaging modality to identify involved organs and evaluate disease extent. Thus, we prospectively investigated imaging findings of 99mTc-DPD scintigraphy in AL and ATTR amyloidosis.

A total of 21 subjects with pathologically confirmed AL or ATTR amyloidosis were included. Pretreatment whole body 99mTc-DPD planar scanning and regional SPECT/CT were performed in all subjects. For allegedly involved organs, 99mTc-DPD uptake was visually and semi-quantitatively evaluated on a 4-point scale (grade 0: no uptake, 1: uptake less than spine, 2: uptake similar to spine, and 3: uptake greater than spine).

There were 29 organs involved in AL and 12 in ATTR. Significant 99mTc-DPD uptake was found in 24 organs (sensitivity = 82.8%) in AL and 9 organs (sensitivity = 75.0%) in ATTR. Additional SPECT/CT was helpful to ensure abnormal DPD uptake in the involved organs, which was uncertain by attenuation in planar imaging. Degree of 99mTc-DPD uptake was significantly higher in ATTR compared with AL amyloidosis (P = .017). Diffuse soft tissue uptake with photon defects in the liver area was found only in ATTR amyloidosis.

This study showed that 99mTc-DPD scintigraphy might have capacity to differentiate between AL and ATTR subtypes with good sensitivity in various organs involving primary systemic AL and ATTR amyloidosis. Additional SPECT/CT significantly improved the diagnostic efficacy of 99mTc-DPD scintigraphy.
Feasibility of using two-dimensional axial computed tomography in pretreatment decision making for patients with early gastric cancer
Authors: Kim Duk Ki , Kang Sun Hyung , Kim Ju Seok , Rou Woo Sun , Joo Jong Seok , Kim Myung Hee , Eun Hyuk Soo , Moon Hee Seok , Lee Eaum Seok , Kim Seok Hyun , Sung Jae Kyu , Lee Byung Seok , Jeong Hyun Yong
Published: January 2020

Computed tomography (CT) is widely used in the pretreatment period of early gastric cancer (EGC). Only few studies have reported low accuracy of CT imaging for T and N staging in patients with EGC. However, owing to the limited number of studies, the value of CT imaging for EGC staging is not well known. Thus, we conducted a retrospective cross-sectional study regarding the associations among submucosal invasion, lymph node metastasis, and CT findings.

The medical records of patients with EGC who had surgery or endoscopic resection were reviewed in a single center from January 2011 to December 2016. We evaluated the histological type, invasion depth, and lymph node (LN) metastasis on the basis of two-dimensional CT findings.

We enrolled 1544 patients. Submucosal (SM) invasion was related to tumor size, histological type, and wall thickening or enhancement on CT images. Deep SM invasion (>500 μm) was also related to tumor size, poorly differentiated type, and abnormal CT findings (wall thickening, enhancement, and central depression). Among the patients with LN reactive positivity (0.5–1 cm), those who were female and had a tumor invasion of >1000 μm showed a higher prevalence of LN metastasis. The false-negative LN group had a higher prevalence of large tumors (>3 cm), poor differentiation, and SM invasion than the true-negative group.

Wall thickening, enhancement, and central depression on CT images might be related to SM invasion. Patients with any positive CT findings needs more attention when performing ESD
Acupoint catgut embedding for asthma in adults
Authors: Lu Xiaoxiao , Wu Xianming , Wu Xingrong , Chen Panbi , Cui Jin
Published: January 2020

Background:

Asthma exacerbations can do a lot of harm to the patients and consume large amounts of medical resources. Although some studies have evaluated acupuncture for asthma in children, few studies have estimated acupoint catgut embedding therapy. We aim to assess the efficacy and safety of acupoint catgut embedding for asthma in adults.

Methods:

The following databases will be searched from inception to December, 2019: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the China National Knowledge Infrastructure Database (CNKI), the Chinese Scientific Journal Database (VIP database), and the Wan-fang database. We will also search relevant conference abstracts, and registers of clinical trials. Two reviewers will independently undertake study selection, data extraction, and quality assessment. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The Revman V5.3 software will be used to conduct meta-analysis.

Results:

The primary outcome was lung function, forced expiratory volume in one second and forced vital capacity (FVC) were the most commonly used parameters to evaluate lung function. The safety assessment includes the incidence of adverse events.

Conclusion:

This systematic review will retrieve clinical randomized controlled trials (RCT) on acupoint catgut embedding for asthma in 7 databases, aiming to describe and update existing evidence on the efficacy and safety of acupoint catgut embedding for asthma in adults.

PROSPERO registration number: CRD42019148401.
Robot-assisted direct repair of spondylolysis
Authors: Tian Wei , Zhang Qi , Han Xiao-Guang , Yuan Qiang , He Da , Liu Ya-Jun
Published: January 2020

Introduction:

Direct repair of the pars defect in lumbar spondylolysis is an effective surgical procedure, but it is technically challenging. We assessed the feasibility of a new robotic system for intralaminar screw fixation of spondylolysis.

Patient concerns:

A 26-year-old man complained about frequent low back pain after failed conservative treatments.

Diagnosis:

The lumbar computed tomography images demonstrated the presence of bilateral spondylolysis at the L5 level, with no spondylolisthesis.

Interventions:

We performed one surgery of direct intralaminar screw fixation under the guidance of the TiRobot system. The trajectory of the screw was planned based on intraoperative 3-dimensional radiographic images. Then, the robotic arm spontaneously moved to guide the guide wires and screw insertion.

Outcomes:

Bilateral L5 intralaminar screws were safely and accurately placed. No intraoperative complications occurred. Postoperative computed tomography showed good radiological results, without cortical perforation.

Conclusion:

We report the first case of robot-assisted direct intralaminar screw fixation for spondylolysis using the TiRobot system. Robotic guidance for direct repair of spondylolysis could be feasible.
Development and validation of a nomogram for predicting long-term overall survival in nasopharyngeal carcinoma
Authors: Wu Jiayuan , Zhou Quan , Pan Zhenyu , Wang Yufeng , Hu Liren , Chen Guanghua , Wang Shengpeng , Lyu Jun
Published: January 2020

We aimed to develop a nomogram based on a population-based cohort to estimate the individualized overall survival (OS) for patients with nasopharyngeal carcinoma (NPC) and compare its predictive value with that of the traditional staging system.

Data for 3693 patients with NPC were extracted from the Surveillance, Epidemiology, and End Results dataset and randomly divided into two sets: training (n = 2585) and validation (n = 1108). On the basis of multivariate Cox regression analysis, a nomogram was constructed to predict the 3-, 5-, and 10-year survival probability for a patient. The performance of the nomogram was quantified with respect to discrimination, calibration, and clinical utility.

In the training set, age, sex, race, marital status, histological type, T stage, N stage, M stage, radiotherapy, and chemotherapy were selected to develop a nomogram for predicting the OS probability based on the multivariate Cox regression model. The nomogram was generally more discriminative compared with the American Joint Committee on Cancer 7th staging system. Calibration plots exhibited an excellent consistency between the observed probability and the nomogram's prediction. Categorical net classification improvement and integrated discrimination improvement suggested that the predictive accuracy of the nomogram exceeded that of the classic staging system. With respect to decision curve analyses, the nomogram exhibited preferable net benefit gains than the staging system across a wide range of threshold probabilities.

This proposed nomogram exhibits an excellent performance with regard to its predictive accuracy, discrimination capability, and clinical utility, and thus can be used as a convenient and reliable tool for prognosis prediction in patients with NPC.
Carotid artery plaques and unilateral spatial neglect in the elderly
Authors: Wu Yixiao , Dai Yue , Jia Yanli , Yu Shuhang , Xu Siyuan , Wang Wei
Published: January 2020

The causes for falls in the elderly are varied, and visual spatial neglect could be 1 contributing factor. Further, the presence of a carotid artery plaque, especially on the right side, might influence the visual spatial attention of the elderly.

Our aim was to identify the intrinsic association between carotid plaques and lateralization of spatial attention in the elderly. Further, we sought to understand and potentially prevent the consequences of unilateral spatial neglect such as injury from falls.

Participants aged 64 to 93 years were divided into a group with carotid artery plaque(s) of the right side or both sides (BOTH, n = 38; and 9/ 38 were right side only) and a group without right-side carotid artery plaque(s) (LEFT, n = 53). Participants were asked to perform a line bisection task and undergo doppler ultrasonography examinations.

Contrary to expectations, compared to LEFT, the mean index and net scores of the line bisection errors in BOTH were significantly less leftward, but the mean diameter of the right-side common carotid artery in BOTH was significantly larger.

Our results indicate that the presence of carotid plaque(s) might be linked to increased risk of falls in the elderly. The attenuated spatial neglect in participants with right-side carotid artery plaque(s) might be due to compensatory carotid artery dilatation.
Preliminary study on the clinical significance of kinesin Kif18a in nonsmall cell lung cancer
Authors: Guo Weifeng , Zeng Huiqing , Zheng Jinyang , He Yueming , Zhuang Xibin , Cai Jinghuang , Huang Hong , Huang Hongbo , Xu Meng
Published: January 2020

The aim of this study was to investigate the expression of Kif18A in cancerous and paracancerous tissues from 100 patients with nonsmall cell lung cancer (NSCLC).

This was a prospective study of 100 patients with pathologically confirmed NSCLC (adenocarcinoma and squamous cell carcinoma [SCC], n = 50/group) that were operated at the Quanzhou First Hospital Affiliated to Fujian Medical University between June 2015 and December 2016. Kif18A protein expression in cancerous and paracancerous normal tissues was detected by western blot and immunohistochemistry.

The expression of the Kif18A protein was higher in adenocarcinoma and SCC tissues than in the corresponding paracancerous normal tissues. The expression of the Kif18A protein was higher in highly differentiated tumors, in patients with lymph node metastasis (vs no lymph node metastasis), adenocarcinoma, and in stage III NSCLC. There were no associations between Kif18A expression and age, gender, and pathologic type.

The expression of the Kif18A protein by immunohistochemistry was higher in NSCLC tissues than in normal tissues, and was associated with tumor differentiation, lymph node metastasis, and TNM staging. These results could provide a theoretical basis for novel molecular targeted therapies against NSCLC.
Textural analysis of hybrid DOTATOC-PET/MRI and its association with histological grading in patients with liver metastases from neuroendocrine tumors
Authors: Weber Manuel , Kessler Lukas , Schaarschmidt Benedikt , Fendler Wolfgang Peter , Lahner Harald , Antoch Gerald , Umutlu Lale , Herrmann Ken , Rischpler Christoph
Published: January 2020

Aims

Neuroendocrine tumors (NETs) are known to overexpress somatostatin receptors (SSTR), which can be visualized by DOTATOC-PET. Reduced SSTR expression on the other hand may indicate dedifferentiation. The aim of this retrospective study was to assess, if conventional PET parameters and textural features (TF) derived from simultaneous PET and MRI including apparent diffusion coefficient (ADC) are associated with the proliferative activity of NETs, potentially allowing non-invasive tumor grading.

Methods

Our institutional database was screened for patients with NET and liver metastases >1 cm. We assessed conventional PET parameters, such as maximum and mean standardized uptake value and more elaborate TF parameters from PET and ADC-MRI (including entropy and homogeneity) from up to the five largest liver lesions per patient. The association of proliferative activity as measured by Ki67-/MIB1-index with the aforementioned parameters was analyzed.

Results

One hundred patients with NET/NECs were eligible with a Ki67-index ranging from <1% to 30%. Overall, 304 liver lesions were analyzed. Conventional PET parameters, entropy, homogeneity of PET and ADC maps differed significantly between G1 and G2 NETs. However, Spearman’s test showed a weak association (r = −0.23 to 0.31).

Discussion

In our study cohort, conventional PET parameters and TF of PET and ADC-MRI showed only a weak correlation with Ki67. This indicates that in patients with a Ki67-index of up to 30% TF analysis of combined PET/MRI may not be reliably used for accurate non-invasive tumor grading. On the other hand, DOTATOC-PET might be a suitable staging tool in some higher grade NET/NECs.
The significance of serum thyroglobulin measurement before and after the treatment of toxic nodular goiter with 131I
Authors: Bonefačić Boris , Crnčić Tatjana Bogović , Tomaš Maja Ilić , Girotto Neva , Ivanković Svjetlana Grbac
Published: January 2020

Objectives

Thyroglobulin is routinely used as a tumor marker in follow up of patients with thyroid carcinoma, but is also elevated in patients with toxic nodular goiter. The aim of this study was to evaluate the role of thyroglobulin measurement prior to and after the radioiodine therapy (RIT) in patients with toxic nodular goiter and to compare the results with the therapy outcome.

Patients and methods

In 109 patients with toxic nodular goiter (102 females, 7 males, aged 45–85 years), 61 with multinodular toxic goiter and 48 with toxic adenoma, thyroglobulin level was measured before RIT and during the first 12 months after the treatment and compared to therapy outcome, defined as euthyroid, hypothyroid and persistent hyperthyroidism.

Results

In patients with euthyroid and hypothyroid outcome, a significant fall of thyroglobulin level was noted during the first 12 months after RIT, more prominent in the latter group. In patients with persistent hyperthyroidism, the initial thyroglobulin level was higher than in other two groups and no significant decrease was noted by the end of the first year after therapy, especially in patients with multinodular toxic goiter.

Conclusions

The significant fall of thyroglobulin after RIT observed in patients in whom euthyroidism and hypothyroidism was achieved indicates that thyroglobulin values can be related to the treatment outcome. In patients with high initial thyroglobulin levels (above 400 ng/l), and possible unfavorable RIT outcome, higher radioiodine activities or other treatment options might be considered.

Video abstract: http:/links.lww.com/NMC/A163
Eosinophilic Esophagitis Histology Remission Score
Authors: Collins Margaret H. , Martin Lisa J. , Wen Ting , Abonia Juan Pablo , Putnam Philip E. , Mukkada Vincent A. , Rothenberg Marc E.
Published: January 2020

Objectives:

Eosinophilic esophagitis (EoE) is characterized by remissions and relapses. Guidelines defining remission do not exist and therefore remission is inconsistently identified. We sought to define histology remission in EoE.

Methods:

Esophageal biopsies, obtained at the time the validated pediatric EoE symptoms scores v2.0 (PEESS v2.0) questionnaire was completed (N = 42), were scored using the validated EoE Histology Scoring System. An EoE Histology Remission Score (EoEHRS) was constructed and specified that in all esophageal sites sampled the peak eosinophil count was <15 per high power field (HPF); in addition, neither the total grade (severity of pathology) nor stage (extent of pathology) scores could exceed 3 (possible total maximum score for each was 24). Spearman correlation coefficients were generated for histology/symptom correlations; coefficient range 0.31 to 0.50 was considered moderate.

Results:

EoE Histology Scoring System composite and individual feature scores from proximal and distal esophageal biopsies correlated moderately with PEESS v2.0 mean scores (0.48–0.36, P < 0.01), and with scores in the dysphagia (0.39–0.30, P ≤ 0.01), pain (0.48–0.34, P ≤ 0.01), and gastroesophageal reflux disease (0.51–0.32, P ≤ 0.01) domains. Biopsies that met full EoEHRS criteria had reduced biomarkers, specifically expression of the mast cell markers CPA3 and tryptase mRNA, and reduced eosinophil peroxidase deposition (P < 0.03), compared to those with nonremission scores. Subjects whose biopsies met EoEHRS remission criteria reported reduced symptoms for all domains except nausea and vomiting (P ≤ 0.01).

Conclusions:

The EoEHRS correlated with reduced biomarkers of disease activity and reduced symptoms, and therefore may be useful to inform clinical care and interstudy comparisons.
Acute Care Nurses' Experiences of Basic Palliative Care
Authors: Neiman Tammy
Published: January 2020

As the population of chronically ill, older adults increases, there is a growing need for palliative care. The Institute of Medicine recommends that health care providers have a basic competency in palliative care. However, the definition of basic palliative care in practice and providers' understanding of basic palliative care lack clarity. The purpose of this study was to describe nurses' perceptions of basic palliative care in the acute care setting. This was accomplished by conducting focus group and individual interviews. The major themes of helping families navigate chronic illness and empowering families and subthemes of being present, giving options, and advocating emerged from the analysis. Through education and role modeling, nurses helped families navigate illness and end-of-life experiences. Study findings describe acute care nurses' perceptions of basic palliative care and may help to identify the educational needs of nurses in order to provide basic palliative care for patients and their families in acute care settings.