bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishment and clinical application value of an automatic diagnosis platform for rectal cancer T-staging based on a deep neural network
Authors: Wu Qing-Yao , Liu Shang-Long , Sun Pin , Li Ying , Liu Guang-Wei , Liu Shi-Song , Hu Ji-Lin , Niu Tian-Ye , Lu Yun
Published: March 2021

Background:

Colorectal cancer is harmful to the patient's life. The treatment of patients is determined by accurate preoperative staging. Magnetic resonance imaging (MRI) played an important role in the preoperative examination of patients with rectal cancer, and artificial intelligence (AI) in the learning of images made significant achievements in recent years. Introducing AI into MRI recognition, a stable platform for image recognition and judgment can be established in a short period. This study aimed to establish an automatic diagnostic platform for predicting preoperative T staging of rectal cancer through a deep neural network.

Methods:

A total of 183 rectal cancer patients’ data were collected retrospectively as research objects. Faster region-based convolutional neural networks (Faster R-CNN) were used to build the platform. And the platform was evaluated according to the receiver operating characteristic (ROC) curve.

Results:

An automatic diagnosis platform for T staging of rectal cancer was established through the study of MRI. The areas under the ROC curve (AUC) were 0.99 in the horizontal plane, 0.97 in the sagittal plane, and 0.98 in the coronal plane. In the horizontal plane, the AUC of T1 stage was 1, AUC of T2 stage was 1, AUC of T3 stage was 1, AUC of T4 stage was 1. In the coronal plane, AUC of T1 stage was 0.96, AUC of T2 stage was 0.97, AUC of T3 stage was 0.97, AUC of T4 stage was 0.97. In the sagittal plane, AUC of T1 stage was 0.95, AUC of T2 stage was 0.99, AUC of T3 stage was 0.96, and AUC of T4 stage was 1.00.

Conclusion:

Faster R-CNN AI might be an effective and objective method to build the platform for predicting rectal cancer T-staging.

Trial registration:

chictr.org.cn: ChiCTR1900023575; http://www.chictr.org.cn/showproj.aspx?proj=39665.
Aldosterone and cortisol synthesis regulation by angiotensin-(1-7) and angiotensin-converting enzyme 2 in the human adrenal cortex
Authors: Caroccia Brasilina , Vanderriele Paul-Emmanuel , Seccia Teresa Maria , Piazza Maria , Lenzini Livia , Prisco Selene , Torresan Francesca , Domenig Oliver , Iacobone Maurizio , Poglitsch Marko , Rossi Gian Paolo
Published: March 2021

Objective:

The branch of the renin--angiotensin system constituting angiotensin-(1–7) [Ang-(1–7)], the Ang II type 2 receptor, the Mas receptors and the Ang-(1–7)-forming enzyme ACE-2, by counteracting the Ang II type 1 receptor (AT1R)-mediated effects, are held to be cardiovascular protective in several conditions. However, whether Ang-(1–7) and ACE-2 are detectable in human adrenocortical tissues and whether they affect aldosterone and cortisol biosynthesis was unknown.

Methods:

We measured angiotensin peptides with liquid chromatography tandem-mass spectrometry and ACE-2 mRNA with digital droplet (dd)PCR in human aldosterone-producing adenoma (APA) and APA-adjacent tissue obtained from patients with primary aldosteronism. We also investigated the effects of Ang-(1–7) and the ACE-2 activator diminazene aceturate (DIZE) on aldosterone synthase (CYP11B2) and 11β-hydroxylase (CYP11B1) gene expression, in the absence or presence of the AT1R antagonist irbesartan, or of the MasR antagonist A779.

Results:

APA and APA-adjacent adrenocortical tissues express ACE-2 mRNA and contain detectable amounts of Ang II and Ang-(2–8), but not of Ang I, Ang-(1–5), Ang (3–8) and Ang-(1–7). Under unstimulated and Ang II- stimulated conditions Ang-(1–7) did not blunt CYP11B1 and CYP11B2 mRNA. At supraphysiological concentrations (10−4 mol/l), Ang-(1–7) stimulated both CYP11B1 and CYP11B2 mRNA via the AT1R. The ACE-2 activator DIZE increased by 1.5-fold ACE-2 mRNA but did not blunt Ang II- upregulated CYP11B1 and CYP11B2 expression.

Conclusion:

These results do not support the hypothesis that the ACE-2/Ang-(1–7)/MasR axis play a protective role by counteracting enhanced aldosterone secretion in humans.
Research Letter: Performance of the Brief Test of Adult Cognition by Telephone in a National Sample
Authors: DiBlasio Christina A. , Sima Adam , Kumar Raj G. , Kennedy Richard E. , Retnam Reuben , Lachman Margie E. , Novack Thomas A. , Dams-O'Connor Kristen
Published: March 2021

Objective:

To create a larger, more representative community comparison sample of the Brief Test of Adult Cognition by Telephone (BTACT) data to facilitate assessment of cognitive function in research studies.

Setting:

National US community-based survey.

Participants:

In total, 6747 healthy adults aged 23 to 84 years (53% female; mean age = 55 years, SD = 13).

Design:

Secondary data analysis of BTACT data collected from the National Survey of Midlife Development in the United States (MIDUS) II and MIDUS Refresher cohorts.

Main Measures:

The BTACT, a brief (15-20 minute) measure of global cognitive function validated for telephone administration.

Results:

This article provides BTACT community comparison sample data based on age, sex, and education from a national sample. Similar to other cognitive measures, BTACT scores decreased with age and increased with education.

Conclusions:

The BTACT community comparison sample will facilitate investigation of cognitive functioning in large-scale traumatic brain injury research studies and will support secondary analysis of existing BTACT data gathered through the MIDUS study.
Convergent Validity of In-Person Assessment of Inpatients With Traumatic Brain Injury Using the Brief Test of Adult Cognition by Telephone (BTACT)
Authors: DiBlasio Christina A. , Novack Thomas A. , Cook Edwin W. , Dams-O'Connor Kristen , Kennedy Richard E.
Published: March 2021

Objective:

To examine convergent validity of the Brief Test of Adult Cognition by Telephone (BTACT) by determining correlation with established neuropsychological tests, administered an average of 4.4 days apart, in an inpatient traumatic brain injury (TBI) population.

Setting:

Acute inpatient rehabilitation hospital.

Participants:

Fifty-five patients receiving inpatient rehabilitation for new-onset TBI (69.1% male; mean age = 37 years, SD = 14 years).

Design:

Cross-sectional, secondary data analysis.

Main Measures:

BTACT; California Verbal Learning Test—second edition (CVLT-2); Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span; Trail Making Test; semantic fluency; phonemic fluency; Symbol Digit Modalities Test; Wisconsin Card Sorting Test.

Results:

The BTACT was significantly associated with established neuropsychological tests across composite scores of overall cognition (r = 0.64, P < .001), episodic verbal memory (r = 0.66, P < .001), and executive function (r = 0.56, P < .001). For BTACT subtests, Word List Immediate Recall and Word List Delayed Recall were correlated with CVLT-2 learning trials total score (r = 0.57, P < .01) and long delay free recall (r = 0.60, P < .001), respectively. BTACT Digits Backward correlated with WAIS-IV Digit Span (r = 0.51, P < .01). BTACT Animal Fluency was associated with semantic fluency (r = 0.65, P < .01), phonemic fluency (r = 0.60, P < .01), and Trail Making Test Part B (r = 0.39, P < .01).

Conclusion:

BTACT composite scores of overall cognition, verbal memory, and executive function demonstrate initial convergent validity in a TBI inpatient population. Future research should examine validity in a larger sample of individuals with TBI.
Stargardt disease masquerades
Authors: Ricca Aaron M. , Han Ian C. , Sohn Elliott H.
Published: March 2021

Purpose of review

Stargardt disease is the most common inherited macular dystrophy but has a wide clinical spectrum, and several inherited macular dystrophies have phenotypic similarities that can make clinical diagnosis challenging. This review seeks to highlight key clinical and multimodal imaging features to aid clinicians in accurate diagnosis.

Recent findings

Multimodal imaging has provided additional information to aid in the diagnosis of Stargardt disease and its masquerades. These data from multimodal imaging are important to correlate with findings from clinical examination to help support the clinical diagnosis or guide molecular investigations.

This review highlights the key similarities and differences, in history, clinical examination and multimodal imaging, to help distinguish between Stargardt disease and other macular dystrophies. These findings can help direct a focused molecular analysis for accurate diagnosis, which is critical in the era of gene and stem cell therapies.
Device Adjustment and Recovery in Patients With Heart Failure Undergoing a Cardiac Resynchronization Therapy Implantation
Authors: Thylén Ingela , Jaarsma Tiny , Ingadottir Brynja
Published: March 2021

Background

Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure.

Purpose

The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation.

Methods

In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions.

Results

A total of 133 patients, 79% male, with a mean age of 70 ± 10 years, were included. Patients adjusted to the device over time (P < .001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P < .001. Patients' recovery improved over time (P < .001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P < .001) and wound healing (9% vs 2%, P < .05) improved.

Conclusions

Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact.
The Association of Spirituality with Anxiety and Depression in Stroke Survivor–Caregiver Dyads
Authors: Bolgeo Tatiana , De Maria Maddalena , Vellone Ercole , Ambrosca Rossella , Simeone Silvio , Alvaro Rosaria , Pucciarelli Gianluca
Published: March 2021

Background

Although several authors have analyzed the effects of spirituality on stroke survivors' physical functioning and on their own caregiver's outcomes, such as quality of life, only few authors have explored the interaction between spirituality and anxiety and depression using a dyadic approach.

Objectives

The aim of this study was to analyze the influence of spirituality in the stroke survivor–caregiver dyad and specifically on anxiety and depression in both parties.

Methods

A total of 217 stroke survivor–caregiver dyads were enrolled at discharge from several rehabilitation hospitals in central and southern Italy. The actor-partner interdependence model was used to analyze the dyadic data. To verify the differences in the effects between survivors and caregivers, comparisons were made between the χ2 values of the model in which actor and partner effects were constrained to be equal.

Results

The average age of stroke survivors and their caregivers at baseline was 71.2 and 52.7 years, respectively. Among the stroke survivors, there were slightly more men than women, whereas 65% of the caregivers were women. Most stroke survivors had had an ischemic stroke. Four statistically significant actor effects were identified. Higher survivors' and caregivers' spirituality was associated with higher survivor and caregiver anxiety. The only significant partner effect that was identified was the association between stroke survivor spirituality and caregiver depression.

Conclusions

This study highlights the importance of studying spirituality in the population with stroke. Spirituality seems to play an important protective role in both stroke survivors' and caregivers' depression but not in anxiety.
Continuation of Treatment With Clozapine After an Episode of Neutropenia
Authors: Tirupati Srinivasan , Gordon Tracy
Published: March 2021

Background

Clozapine is the most effective in treatment-resistant schizophrenia. Neutropenia is an adverse effect of the drug requiring treatment discontinuation. This study related treatment continuation with little or no interruption after a neutropenia episode. The study contrasted from rechallenge studies after an extended treatment interruption.

Methods

This retrospective chart audit examined 37 patients with an episode of neutropenia. It described characteristics of patients continuing treatment with minimal interruption.

Findings

Thirty-one patients continued treatment after an initial treatment interruption for less than 3 days. A probable cause for neutropenia other than clozapine was identified in 14 patients. Twelve patients continued treatment with a change in the absolute neutrophil counts threshold to 1000/μL to determine treatment cessation. Most patients recovered from the index episode of neutropenia within 2 days. They also frequently presented with recurring benign episodes of low neutrophil cell counts during treatment than a comparative group.

Implications

The study recommends modifying clozapine treatment protocol absolute neutrophil count thresholds to less than 1000/μL to determine treatment cessation. Consideration of other probable causes for neutropenia, diurnal variations in cell counts, and laboratory errors reduced preemptive discontinuation of treatment. A risk-benefit approach supports continuing clozapine treatment after an episode of neutropenia.
Shades of Frustration
Authors: Hoff Mary
Published: March 2021

Postinflammatory hyperpigmentation (PIH) is a distressing condition associated with a number of inflammatory etiologies, with acne vulgaris being one of the most common. Even when resolution of inflammatory papules is achieved through treatment, patients are often dissatisfied with their overall appearance if their PIH is not addressed and treated appropriately. Because PIH can be associated with pigment deposition that extends beyond the epidermis, a number of topical therapies available to treat epidermal PIH often fail to provide meaningful improvement when deeper tissue is involved. A review of PIH as a disease process will be explored, and the mechanisms and limitations of first-line topical therapies will be discussed.
Evaluation and Modification of the Physical Therapist Clinical Performance Instrument
Authors: Wolden Mitch , Drevyn Elsa , Flom-Meland Cindy , Gusman Lori N.
Published: March 2021

Introduction.

Doctor of Physical Therapy (DPT) programs and clinical instructors (CIs) must have a reliable and valid instrument to assess the clinical competence of each DPT student. The Physical Therapist Clinical Performance Instrument (PT CPI) is the most commonly used instrument to assess DPT students' clinical competence. Validation studies of the PT CPI: Version 1997 and Version 2006 have identified 3 factors that account for students' clinical performance. Given the widespread use of the PT CPI and CIs and DPT programs concerns, evaluation of the current PT CPI (PT CPI: Web) as a three-factor model is warranted. The purpose of our investigation was to evaluate the three-factor model, suggest model modifications, and then analyze the modified PT CPI model.

Methods.

PT CPI data were analyzed from 703 DPT students' clinical experiences from 3 institutions. Data analyses were conducted in 2 phases. Phase 1: Confirmatory factor analysis (CFA) was conducted for the three-factor PT CPI (model I). Phase 2: CFA was performed on the modified PT CPI (model II). The 2 models were then compared to determine the preferred model.

Results.

The proposed 2-factor PT CPI (model II) with 15 performance criteria was found to be the preferred model over the current three-factor PT CPI (model I) for measuring DPT students learning and performance during clinical experiences.

Discussion and Conclusion.

Modifying the current three-factor PT CPI (model I) to the proposed 2-factor model (model II) may better support DPT students, CIs, and DPT programs in the assessment of DPT students' clinical learning and performance. Our findings also provide preliminary evidence to decrease the length of the PT CPI while maintaining instrument integrity.
Professionalism development of undergraduate medical students
Authors: Sattar Kamran , Akram Ashfaq , Ahmad Tauseef , Bashir Ulfat
Published: March 2021

Changeover phases are essential and inevitable times in professional life, which let the learners adapt and grasp emerging opportunities for learning based on the past experiences with the catering of novel creativity as required in the present as well as emerging time. This study was carried out to examine the effectiveness of a professionalism course, during the transition from a non-clinical to clinical setting, within the context of undergraduate medical education.

This observational study was conducted during 2019 to 2020, with pre- and post-professionalism course evaluation. We used the Dundee Poly-professionalism inventory-1: Academic Integrity, among the undergraduate medical students.

Our results are based on the medical student's professional progress with the transition from 2nd year to 3rd year. During the 1st phase of the study, the participants at their Pre-Professionalism Course (PrPC) level in their 2nd medical year (only attended the introductory lectures for professionalism), showed a good understanding of professionalism. For the 2nd phase, when the same students, at their Post-Professionalism Course (PoPC) level, in their 3rd year (completed professionalism course) filled the same survey and it was found that there was no decline in their understanding of the topic, even after more than a year. They were even more aware of the significance of professionalism in their clinical settings.

Despite a year gap, the understanding of professionalism among students was stable. Results helped us infer that time laps did not affect the professionalism concept learned earlier; rather during clinical settings, students become more aware of professionalism.
Improving the discomfort and satisfaction of colonoscopy by distraction with smartphones
Authors: Han Chaoqun , Xu Tao , Sheng Liping , Nie Chi , Liu Jun , Ding Zhen , Hou Xiaohua
Published: March 2021

Background:

Colonoscopy is an uncomfortable procedure. Distraction is thought to reduce pain by decreasing the amount of attention a person spends on a painful stimulus. We aimed to assess the usefulness of smartphones on discomfort associated with the colonoscopy.

Methods:

We designated 360 enrolled patients according to prospective randomized controlled study into two groups, including smartphone (SP) group (Relaxation by smartphones) and Control group (No relaxation). Measured outcomes included the discomfort, satisfaction, polyp detection rate and the willingness to repeat colonoscopy were analyzed between groups.

Results:

The pain and distension scores of SP group patients were significantly lower than those of the Control group (2.18 ± 2.80 vs 3.55 ± 3.07, P < .001; 4.15 ± 2.35 vs 4.79 ± 2.36, P = .011, respectively). Importantly, patient-reported satisfaction scores of the SP group were significantly higher than those of the Control group (96.45 ± 7.17 vs 91.12 ± 10.49, respectively; P < .001). Moreover, although there were no statistical differences, patients using smartphones were more likely to have shorter reach cecum times (09m:11 s vs 07m:37 s, P = .116) and more polyp detection rate (13.3% vs 9.4%, P = .246). In addition, more patients using smartphones were willing to repeat colonoscopy but no statistical difference (85.0% vs 81.7%, P = .396).

Conclusion:

Patient using smartphone is a special manner to increase satisfaction during colonoscopy with a less discomfort and is more likely to be polyp detection rate.
National level data analysis of facial lacerations in Korea using the National Health Insurance Service (NHIS) database
Authors: Mo Young Woong , Cho Gyo-Young , Mo Young Taek , Lee Dong Lark
Published: March 2021

No national epidemiological investigations have been conducted recently regarding facial lacerations. The study was performed using the data of 3,634,229 people during the 5-year period from 2014 to 2018 archived by the National Health Information Database (NHID) of the Health Insurance Review and Assessment Service. Preschool and children under 10 years old accounted for about one-third of patients. Facial lacerations were concentrated in the “T-shaped” area, which comprised forehead, nose, lips, and the perioral area. The male to female ratio for all study subjects was 2.16:1. Age and gender are significantly related with each other (P < .001). Mean hospital stays decreased, and numbers of outpatient department visits per patient were highest for hospitals and lowest for health agencies. Over the study period, hospital costs per patient in tertiary and general hospitals increased gradually. Preschool and school-aged children are vulnerable to trauma. Male patients outnumbered female patients by a factor of more than 2. The “T-shaped’” area around forehead is vulnerable to injury. Total cost of medical care benefits per patient in tertiary hospitals was about 7 times on average than in health agencies. Regarding functional, behavioral, and aesthetic outcomes, more attention should be paid to epidemiologic data and hospital costs for facial lacerations.
Genetic analysis of rapidly progressing esophageal squamous cell carcinoma
Authors: Zhao Shuang , Sun Ni , Yuan Xi , Shen Zetian , Zhu Xixu , Li Jing
Published: March 2021

Introduction:

Numerous investigations have been performed to explore candidate biomarker proteins in esophageal squamous cell carcinoma (ESCC) patients, which could predict the response to chemoradiotherapy (CRT). Here we report a patient with unresectable ESCC who had unsatisfactory effects with radiotherapy, chemotherapy and immunotherapy. We performed genetic analysis in this patient to gain insights about the cause of the rapid progression.

Patient concerns:

A 65-year-old man presented with food obstruction, hoarse voice and choking on drinking water for 2 months, and pain behind the breastbone for 1 month.

Diagnosis:

The patient was clinically diagnosed with ESCC and staged as T4N1M1 Stage IV

Interventions:

The patient was treated with CRT and immunotherapy. Mutational analyses through high throughput DNA sequencing methodology (next generation sequencing; NGS) was performed on the patient's blood sample.

Outcomes:

The tumor progressed rapidly during the treatment period, and the patient passed away only 3 months from the onset of symptoms.

Conclusion:

Although the role of TP53 gene and PIK3CA gene in the progression, treatment and sensitivity of esophageal cancer has been studied, the mechanism of their simultaneous appearance has not been demonstrated in relevant studies. We speculate that the reason for the rapid progression in this patient during active treatment might be related to this. Further studies are needed to validate our observations.
The effectiveness of problem-based learning in gynecology and obstetrics education in China
Authors: Bi Siwei , Liu Ruiqi , Li Jingyi , Gu Jun
Published: March 2021

Background:

A meta-analysis was conducted to assess the effectiveness of problem-based learning (PBL) in gynecology and obstetrics education in China.

Methods:

English and Chinese databases were systematically searched for eligible studies that compared the effects of PBL and traditional teaching methods measuring theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores in gynecology and obstetrics education in China. The authors restricted included studies to randomized controlled trials and performed a meta-analysis. Standardized mean difference (SMD) and risk ratio with 95% confidence interval (CI) were estimated

Results:

A total of 38 randomized controlled trials with 3005 participants were included. Compared with traditional teaching group, the PBL group significantly increased theoretical knowledge scores (SMD: 3.17, 95% CI: 2.28, 4.07), student satisfaction (risk ratio: 1.29, 95% CI: 1.16, 1.43), clinical operations (SMD: 1.15, 95% CI: 0.93, 1.37) and clinical practice (SMD: 2.17, 95% CI: 3.63, 2.71).

Conclusion:

The current research shows that PBL in gynecology and obstetrics education in China is more effective than the traditional teaching in enhancing theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores. However, more delicate-designed studies on this topic are needed in the future to validate these results.
Unintentional exposure and incidental findings during conventional chest radiography in the pediatric intensive care unit
Authors: Temsah Mohamad-Hani , Al-Eyadhy Ayman , Alsohime Fahad , Nassar Saeed Majed , AlHoshan Talal Nabil , Alebdi Hatim Abdullah , Almojel Faisal , AlBattah Muath Abdullah , Narayan Omendra , Alhaboob Ali , Hasan Gamal Mohamad , Abujamea Abdullah
Published: March 2021

Radiation overexposure is common in chest X-ray (CXRs) of pediatric patients. However, overexposure may reveal incidental findings that can help to guide patient management or warrant quality improvement.

To assess the prevalence of overexposure in CXRs in pediatric intensive care unit (PICU); and identify the incidental findings within overexposed areas, we conducted a retrospective cohort study of children who were admitted to PICU. Two independent evaluators reviewed patient's charts and digital CXRs according to the American College of Radiology standards; to evaluate overexposure of the anatomical parameters and incidental findings.

A total of 400 CXRs of 85 patients were reviewed. The mean number of CXRs per patient was 4.7. Almost all (99.75%) CXRs met the criteria for overexposure, with the most common being upper abdomen (99.2%), upper limbs (97%) and neck (95.7%). In addition, 43% of these X-rays were cropped by the radiology technician to appear within the requested perimeter. There was a significant association between field cropping and overexposure (t-test: t = 9.8, P < .001). Incidental findings were seen in 41.5% of the radiographs; with the most common being gaseous abdominal distension (73.1%), low-positioned nasogastric tube (24.6%), and constipation (10.3%).

Anatomical overexposure in routine CXRs remains high and raises a concern in PICU practice. Appropriate collimation of the X-ray beam, rather than electronically cropping the image, is highly recommended to minimize hiding incidental findings in the cropped-out areas. Redefining the anatomic boundaries of CXR in critically ill infants and children may need further studies and consideration. Quality improvement initiatives to minimize radiation overexposure in PICU are recommended, especially in younger children and those with more severe illness upon PICU admission.
The effects of robot-assisted left-hand training on hemispatial neglect in older patients with chronic stroke
Authors: Park Jin-Hyuck
Published: March 2021

Background:

Even though a variety of rehabilitative technique have been implemented to ameliorate neglect symptoms of patients with stoke, the effects of limb activation using a robotic device are still unknown. The purpose of this study was to investigate the effects of the robot-assisted hand training on hemispatial neglect of older patients with chronic stroke.

Methods:

The participants were randomly allocated to the experimental group (EG) receiving robot-assisted left-hand training (n = 12) or the control group (CG) receiving conventional treatments for neglect symptoms (n = 12). All participants received 20 sessions for 4-week. To examine the effects on hemispatial neglect, the line bisection test (LBT), the Albert test, and the Catherine Bergego Scale (CBS) were utilized. The outcome measures were analyzed before and after the 20 training sessions.

Results:

After the intervention, improvements in the LBT, the Albert test, and the CBS were found in the EG whereas there were significant improvements in the LBT and the CBS but not the Albert test in the CG. In addition, the EG showed a significantly greater gain in all outcome measures compared to the CG (p < .05).

Conclusions:

These results indicate that robot-assisted hand training was beneficial to improving the hemispatial neglect of elderly person with chronic stroke compared to the conventional treatments. Robot-assisted limb activation might be useful to ameliorate hemispatial neglect of the elderly with chronic stroke.
Massive Open Online Courses-based blended versus face-to-face classroom teaching methods for fundamental nursing course
Authors: Cao Wenjing , Hu Lin , Li Xiaoying , Li Xiaoling , Chen Chuan , Zhang Qianqian , Cao Shunwang
Published: March 2021

An increasing number of studies focus on the effectiveness of Massive Open Online Courses (MOOC)-based blended learning, whereas none have yet studied using it for teaching fundamental nursing skills at an undergraduate level.

To evaluate the effectiveness of MOOC-based blended learning versus face-to-face classroom teaching techniques within the fundamental nursing course at the Faculty of Nursing, University of Xiang Nan, China.

This cluster randomized controlled trial enrolled 181 students and assigned them into either an MOOC-based blended or a face-to-face classroom teaching group, both involving the Fundamental Nursing course for undergraduate nursing students. The analyzed outcomes included test scores, critical thinking ability, and feedback received from the students on the Fundamental Nursing course.

MOOC-based blended techniques versus face-to-face classroom teaching methods demonstrated higher daily performance (P = .014), operational performance (P = .001), theoretical achievements (P < .001), and final grades (P < .001) in Fundamental Nursing.

Moreover, the mean change in the participants’ critical thinking ability items between groups were, mostly, statistically significant. The items focusing on the feedback from the students demonstrated significant differences between the groups in terms of their satisfaction with the teaching they received (P < .001) and the overall learning effects (P = .030).

This study confirmed that receiving MOOC-based blended learning was superior when compared against face-to-face classroom teaching techniques for learning within the Fundamental Nursing course.
Efficacy and safety of moxibustion in the treatment of cancer-related fatigue
Authors: Deng Gen , Huang Xianbao , Tu Minfang , Cheng Qinghong , Qiu Qi , Li Peiling , Pan Zefeng
Published: March 2021

Background:

Cancer-related fatigue, a common symptom of cancer patients caused by the interaction of multiple factors, runs through the whole process of tumorigenesis, development, treatment, and prognosis. The main clinical manifestations are weakness, tiredness, exhaustion, fatigue, or slow movement, heavy limbs, low mood or irritability, sleep disturbance or lethargy, lack of attention, etc. CRF is different from the fatigue after daily body fatigue. It has no obvious relief or relief after rest or sleep, and exists for a long time in the relevant treatment and rehabilitation process. It seriously affects the physiological, psychological and social functions of patients, and reduces the quality of life of patients. Moxibustion therapy has shown strong advantages in the treatment of CRF, and the curative effect is accurate. Therefore, this paper will carry out a systematic evaluation and meta analysis of the efficacy and safety of moxibustion in the treatment of CRF.

Methods:

we will searching 8 electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, the China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wanfang Database, and Chinese Biomedical Literature Database. We will search above electronic databases from the beginning to January 2021, without any language restriction. Clinical efficacy, including total effective rate or cure rate, clinical symptom integral, and recurrence rate will be accepted as the primary outcomes. The fatigue scale score, quality of life improvement rate will be used as secondary outcomes. RevMan 5.3 software will be used for statistical analysis. The result about the curative effect and safety of moxibustion for cancer-related fatigue will be presented as risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data.

Results:

When this research program is completed, the relevant results can be obtained.

Conclusions:

The results of this study will provide reliable evidence for the efficacy and safety of moxibustion in the treatment of cancer-related fatigue.

Ethics and dissemination:

This article does not need to pass the ethics committee review, because this article does not involve the ethics question, only collates the related literature research.

INPLASY Registration number:

INPLASY202110072.
Treatment of exostosin 1-associated membranous lupus nephritis with multiple low doses of rituximab
Authors: Li Ling , Yang Zhi , Tao Tian , Yang Mei , Hu Zhang-Xue
Published: March 2021

Rationale:

Membranous glomerulonephritis (MN) is the leading cause of nephrotic syndrome in adults and is classified as primary or secondary. Secondary MN accounts for 20% to 30% of all MN cases and can arise from a number of conditions, including autoimmune diseases. Recently exostosin 1/exostosin 2 (EXT1/EXT2) have been identified as the common antigens in secondary autoimmune MN and are present in cases of pure membranous lupus nephritis (LN). The treatment of EXT1/EXT2-associated MN remains elusive.

Patient concerns:

We present the case of a 15-year-old female who presented with nephrotic syndrome, positive ANA and dsDNA, and low serum complements. A renal biopsy revealed pure membranous nephritis with IgG and C3 deposition. EXT1 was found along the glomerular capillary walls and stained positive, while phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A) were negative.

Diagnosis:

The patient was diagnosed with ETX1-associated membranous LN.

Interventions:

She was treated with prednisone and multiple low-dose rituximab (4 200 mg doses, approximately every 2 months, based on CD19+ cells counts).

Outcomes:

The patient had complete remission within 8 months later, and she remained in remission for the 16-month period of follow-up.

Lessons:

To our knowledge, this is the first case of EXT1-associated MN that has been successfully treated by multiple low-dose rituximab. Further studies can investigate the optimal dosage and treatment protocol.
The effectiveness and safety of traditional Chinese herbal medicine for the treatment of male infertility associated with sperm DNA fragmentation
Authors: Li Qingrui , Zhang Chao , Li Chenxi , Lin Xuyao , Wang Mingkai , Wu Lin , Li Hua , Ye Pule , Qin Guozheng
Published: March 2021

Background:

Sperm DNA fragmentation (SDF) may hinder embryonic development and growth, increasing the risk of spontaneous miscarriage, and is considered an important factor affecting male infertility (MI). Traditional Chinese herbal medicine is considered effective in the treatment of MI due to SDF by nourishing kidney essence or promoting blood circulation for removing blood stasis. The objective of this systematic review protocol is to evaluate the effectiveness and safety of traditional Chinese herbal medicine on the treatment of MI associated with SDF.

Methods:

We searched the PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP Chinese Science, Technology Journal Database, and Wanfang Database until the end of 2020 for English and Chinese published literature. Randomized controlled trials (RCTs) to evaluate the effectiveness and safety of traditional Chinese herbal medicine for the treatment of MI associated with SDF will be included. Study selection and data extraction were performed independently by 2 reviewers, and the quality evaluation and risk assessment were assessed by the Cochrane collaboration's tool, and use the RevMan 5.3 software for meta-analysis.

Conclusion:

This study will evaluate the efficacy and safety of traditional Chinese herbal medicine for the treatment of MI due to SDF, which may provide some help for the clinician's decision.

Prospero registration number:

CRD42020221053.
Epidural analgesia during labor and its optimal initiation time-points
Authors: Zha Ying , Gong Xun , Yang Chengwu , Deng Dongrui , Feng Ling , Luo Ailin , Wan Li , Qiao Fuyuan , Zeng Wanjiang , Chen Suhua , Wu Yuanyuan , Han Dongji , Liu Haiyi
Published: March 2021

Recent research has suggested that 6 cm of cervical dilation should be the threshold for the active labor phase, and it has confirmed that epidural analgesia (EA) is a safe method of pain relief during labor. However, the evidence provided for these findings comes mainly from randomized controlled clinical trials (RCTs), which suffer from the limitation of real-world generalizability.

To test the generalizability of the conclusions from these previous RCTs, we conducted a prospective cohort, real-world study (RWS) on 400 Chinese term nulliparas. A total of 200 of the participants (the EA group) received EA upon request. The participants in the EA group were further subdivided as follows according to their cervical dilation when the EA administration was initiated (CDE): [EA1 group (CDE < 3 cm), EA2 group (3 cm ≤ CDE < 6 cm), and EA3 group (CDE ≥ 6 cm)]. We compared the labor duration of the EA group versus the non-EA (NEA) group, and the NEA group versus the 3 EA subgroups. We also compared delivery outcomes between the EA and NEA groups.

The median total labor duration for the EA group [676 (511–923) minutes] was significantly longer than that of the NEA group [514 (373–721) minutes] (P < 0.001). The median durations of both the first- and second-stages of labor for the EA group [600 (405–855) minutes, 68 (49–97) minutes] were longer than those of the NEA group [420 (300–630) minutes, 50 (32–85) minutes] (P < .001, P < .001)]. In addition, the median total labor durations in both the EA1 [720 (548–958) minutes] and EA2 groups [688 (534–926) minutes] were longer than in the NEA group (P < .001 and P < .001, respectively), and the first- and second-stage labor durations of these subgroups were similar to their total labor durations. A Cox regression analysis showed that EA was associated with longer first-stage labor [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.42–0.71, P < .001] and longer second-stage labor (HR 0.66, 95% CI 0.51–0.85, P = .001). The delivery modes and neonatal outcomes between the EA and NEA groups were not statistically different, however.

Our findings suggest that EA administered before a cervical dilation of 6 cm may be associated with longer total, first-, and second-stage labor durations compared with no EA, while later EA administration is not. In addition, though EA prolongs labor duration, it does not impact delivery outcomes. These results confirm the significance of a 6 cm cervical dilation threshold in real-world labor settings.
Evaluation of medication error rates in Saudi Arabia
Authors: Almalki Ziyad S. , Alqahtani Nasser , Salway Najwa Tayeb , Alharbi Mona Marzoq , Alqahtani Abdulhadi , Alotaibi Nawaf , Alotaibi Tahani M. , Alshammari Tahani
Published: March 2021

Introduction:

Due to the diversity of reports and on the rates of medications errors (MEs) in Saudi Arabia, we performed the first meta-analysis to determine the rate of medications errors in Saudi Arabia using meta-analysis in the hospital settings.

Methods:

We conducted a systematic literature search through August 2019 using PubMed, EMBASE, CINAHL, PsycINFO, and Google Scholar to identify all observational studies conducted in hospital settings in Saudi Arabia that reported the rate of MEs. A random-effects models were used to calculate overall MEs, as well as prescribing, dispensing, and administration error rates. The I
2 statistics were used to analyze heterogeneity.

Results:

Sixteen articles were included in this search. The total incidence of MEs in Saudi Arabia hospitals was estimated at 44.4%. Prescribing errors, dispensing errors, and adminstration errors incidents represent 40.2%, 28.2%, and 34.5% out of the total number of reported MEs, respectively. However, between-study heterogeneity was also generally found to be >90% (I-squared statistic).

Conclusions:

This study demonstrates the MEs common in health facilities. Additional efforts in the field are needed to improve medication management systems in order to prevent patient harm incidents.
Ectopic variceal bleeding after hepatobiliary surgery
Authors: Tai Yang , Tong Huan , Wei Bo , Wu Hao
Published: March 2021

Rationale:

Jejunal varices are rare in portal hypertension and are often difficult to diagnose and treat. Herein, we present a case of gastrointestinal bleeding due to jejunal varices after hepatobiliary surgery.

Patient concerns:

A 69-year-old man presented with recurrent massive gastrointestinal bleeding. He underwent partial right hepatectomy and cholangiojejunostomy 2 years prior to the first onset of bleeding. Two sessions of endoscopic vessel ligation for esophageal varices were performed afterwards, and hematemesis resolved completely, but massive melena still recurred during the following 5 years.

Diagnosis:

The patient was diagnosed with jejunal varices caused by portal venous stenosis after hepatobiliary surgery.

Intervention:

Portal venous angioplasty using balloon dilation and stent implantation was performed.

Outcomes:

After the intervention procedure, the patient did not experience any onset of gastrointestinal bleeding during follow-up.

Lessons:

Hepatopancreatobiliary could lead to the formation of jejunal varices. The combined use of capsule endoscopy, contrast-enhanced computed tomography, and sometimes portal venography is a promising strategy to search for jejunal varices. Transcatheter angioplasty appears to be a safe and effective method for treatment of jejunal varices in certain appropriate cases.
Veno-arterial extracorporeal membrane oxygenation and targeted temperature management in tricyclic antidepressant-induced cardiac arrest
Authors: Ikejiri Kaoru , Akama Yuichi , Ieki Yohei , Kawamoto Eiji , Suzuki Kei , Yokoyama Kazuto , Ishikura Ken , Imai Hiroshi
Published: March 2021

Rationale:

Cardiotoxicity is a common cause of death in tricyclic antidepressant (TCA) intoxication. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is effective in critically ill poisoned patients who do not respond to conventional therapies, and targeted temperature management (TTM) is associated with improved neurological outcomes and mortality in comatose out-of-hospital cardiac arrest survivors. However, few reports have documented cases of TCA intoxication that required intensive care, including VA-ECMO or TTM.

Patient concerns:

A 19-year-old Japanese man with a history of depression was brought to our hospital because he was in a comatose state with a generalized seizure. Before admission, he had taken an unknown amount of amitriptyline.

Diagnosis:

After intubation, the electrocardiogram (ECG) displayed a wide QRS complex tachycardia, and the patient suffered from cardiovascular instability despite intravenous bolus of sodium bicarbonate. At 200 minutes after ingestion, he experienced a TCA-induced cardiac arrest.

Interventions:

We initiated VA-ECMO 240 minutes after ingestion. The hemodynamic status stabilized, and the ECG abnormality improved gradually. In addition, we initiated targeted temperature management (TTM) with a target temperature of 34°C.

Outcomes:

Twenty seven hours after starting the pump, the patient was weaned off the VA-ECMO. After completing the TTM, his mental status improved, and he was extubated on day 5. He was discharged on day 15 without neurological impairment, and the post-discharge course was uneventful.

Lessons:

First, VA-ECMO is effective in patients with TCA-induced cardiac arrest. Second, routine ECG screening during VA-ECMO support is useful for assessing the timing to wean off the VA-ECMO, as well as the degree of cardiotoxicity. Third, TTM is safe in comatose survivors of cardiac arrest caused by severe TCA intoxication.
Tacrolimus-induced epilepsy with primary membranous nephropathy
Authors: Yang Yan , Zhang Lei , Mo Ying , Ren Rong , Wang Fengmei
Published: March 2021

Rationale:

Tacrolimus-associated neurologic disorders can be found in some cases, mainly in organ transplantation patients. However, epilepsy induced by tacrolimus in primary membranous nephropathy (PMN) patient is scare.

Patient concerns:

A 63-year-old man experienced 1-year history of foamy urine, and edema of lower extremity.

Diagnosis:

The patient had proteinuria, hypoalbuminemia, which indicated nephrotic syndrome. Further, we performed renal biopsy for this patient. Combined with the renal biopsy result, the diagnosis of primary membranous nephropathy was established.

Intervention:

At first, irbesartan was administrated for 6 months. However, the proteinuria had no obvious improvement. Tacrolimus was administrated afterwards.

Outcomes:

Twenty-two days after tacrolimus treatment, epilepsy occurred. Sodium valproate and carbamazepine were successively given to control epilepsy. However, the epileptic symptoms were not effectively controlled. During the treatment, the concentration of tacrolimus fluctuated greatly. At last, levetiracetam was given to maintain the curative effect. Fortunately, the patient did not suffer from epilepsy again. The concentration of temporary tacrolimus was stable, whereas proteinuria gradually decreased.

Lessons:

Tacrolimus-induced epilepsy should be considered in patients exhibiting acute neurological symptoms. Early diagnosis and effective treatment play a vital role for favorable prognosis.
Association between triglyceride glucose index and coronary artery disease with type 2 diabetes mellitus in middle-aged and elderly people
Authors: Si Yueqiao , Fan Wenjun , Shan Weichao , Zhang Ying , Liu Jingyi , Han Chao , Sun Lixian
Published: March 2021

This study aimed to investigate the correlation between triglyceride glucose (TyG) index and coronary artery disease (CAD) with type 2 diabetes mellitus (T2DM) and identify the risk associated TyG index in different subgroups.

A total of 1665 eligible inpatients (CAD with T2DM group [n = 680], non-coronary artery disease without T2DM [n = 985]) were consecutively enrolled in this study. They were assigned into 4 subgroups: middle-aged, elderly, male, and female subgroups. Receiver operating characteristic curve diagnostic test and a logistic regression model was established to analyze the risk factors for CAD with T2DM.

TyG index is an independent risk factor for patients with CAD with T2DM. The risk of increased TyG index is greater in the middle-aged and male subgroups than in the elderly and female subgroups, respectively (all P < .05). The specificity and the positive predictive value of the TyG index is greater than the sensitivity and the negative predictive value, respectively (all P < .05).

Increased TyG index is a new independent risk factor for CAD with T2DM, and its risk is higher in the middle-aged and male subgroups than in the elderly and female subgroups, respectively. TyG index may be used as a clinical predictor of CAD with T2DM.