bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of mindfulness-based stress reduction therapy on maternal anxiety, depression, and sleep quality
Authors: Chen Zhongrong , Jiang Jianmei , Hu Tingting , Luo Lan , Chen Cheng , Xiang Wei
Published: February 2022

Background:

Depression and anxiety are common in the prenatal and postnatal periods, which significantly influence pregnant women and their unborn babies. Pharmacological interventions can negatively affect maternal and infant health outcomes, while psychotherapy can avoid adverse events of medication and improve maternal depression and anxiety. Whether mindfulness-based stress reduction (MBSR) can alleviate maternal anxiety and depression and improve sleep quality is still controversial. Therefore, we aim to conduct a meta-analysis by collecting randomized controlled trials (RCTs) reporting the effects of MBSR on maternal anxiety, depression, and sleep quality, thus providing evidence-based medical evidence for non-pharmacological interventions.

Methods:

RCTs reporting the effect of MBSR on maternal anxiety, depression, and sleep quality versus conventional obstetric care will be searched in online databases, including the Cochrane Central Register of Controlled Trials Repositories, PubMed, Embase, Web of Science, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan Fang Database. Literature selection, data extraction, risk of bias assessment, and meta-analyses will be independently completed by 2 researchers. Meta-analysis will be performed by using RevMan5.4.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This study will provide reliable evidence-based evidences for the effects of MBSR on improving maternal anxiety, depression, and sleep quality.
Do synbiotics really enhance beneficial synbiotics effect on defecation symptoms in healthy adults?
Authors: Ito Daisaku , Yamamoto Yuta , Maekita Takao , Yamagishi Naoko , Kawashima Shuji , Yoshikawa Takanori , Tanioka Kensuke , Yoshida Takeichi , Iguchi Mikitaka , Kunitatsu Kosei , Kanai Yoshimitsu , Kato Seiya , Kitano Masayuki
Published: February 2022

Goals:

We examined whether synbiotics enhance improvement by probiotics.

Background:

Probiotics, which are beneficial microbacteria, are a nutritional intervention for treatment of functional constipation or its tendency. Prebiotics, meanwhile, can promote the proliferation of probiotics in the gastrointestinal tract and enhance their beneficial effects. Synbiotics, a combination of probiotics and prebiotics, may be superior to probiotics in the treatment of defecation-related symptoms, but this requires elucidation.

Study:

This randomized, double-blind, placebo-controlled study enrolled 69 healthy adults with constipation tendency. Participants were allocated to either control, probiotics, or synbiotics groups and they recorded details of their defecations and their condition. The first 2 weeks were the observation period and the latter 2 weeks were the intervention period, in which participants took test foods. Probiotic foods included Bifidobacterium longum NT strain (1010 CFU/day), synbiotic foods included the NT strain (1010 CFU/day) and galactooligosaccharide (1 g/day). Placebo foods contained the vehicle only. Participants answered questionnaires (Patient Assessment on Constipation Symptoms [PAC-SYM], and one on dietary history) on the last day of each period.

Results:

Nine participants withdrew consent, and 2 of the remaining 60 had missing data. Age, body mass index, and sex were not significantly different between the 3 groups. Frequency of bowel movements in the fourth week, the primary endpoint, was not increased in the probiotics or synbiotics groups compared with the control group, and the frequency of bowel movements and days with defecation were not changed by probiotics or synbiotics during the intervention period. Probiotics and synbiotics did not improve stool conditions, although incomplete defecation was improved by probiotics but not by synbiotics compared with placebo. PAC-SYM indicated that stool condition and total scores were improved by probiotics but not by synbiotics during the intervention compared with placebo.

Conclusion:

The probiotic strain Bifidobacterium longum NT can improve constipation symptoms, especially stool condition, but it does not increase bowel movement frequency in healthy adults with constipation tendency. Synbiotics treatment seemed to diminish this improvement of constipation induced by probiotics. This study indicates the possibility of attenuation of beneficial effects from probiotics by the use of synbiotics, contrary to synbiotics theory.
The impact of the COVID-19 pandemic on outpatients of internal medicine and pediatrics
Authors: Byun Hayoung , Kang Dawon , Go Se-Il , Kim Hye In , Hahm Jong Ryeal , Kim Rock Bum
Published: February 2022

This study analyzed the changes in the number of outpatients and disease presentation during the entirety of 2020, the period of COVID-19 pandemic.

The average annual number of outpatient visits between 2017 and 2019 (before COVID-19) and the total number of outpatient visits in 2020 (COVID-19 period) were compared. Diagnostic codes were identified during 2 periods to analyze changes in the number of outpatient visits according to disease and month.

The average annual number of outpatient visits was 47,105 before, and 40,786 during the COVID-19 pandemic, with a decrease of 13.4%. The number of outpatient visits in internal medicine decreased by 10.2% during the COVID-19 pandemic and tended to rebound during the second half of the year. However, the number of outpatient visits in the pediatric department decreased by 37.5% overall throughout the COVID-19 period and continued to decline in the second half of the year. The number of outpatients with infectious diseases decreased significantly (35.9%) compared to noninfectious diseases (cancer, 5.0%; circulatory disease, 4.1%). In addition, the number of outpatient visits due to viral diseases continued to decline, while the incidence of bacterial diseases increased rapidly in the second half of the year.

This study confirmed that the number of outpatient visits due to bacterial or viral infections decreased throughout the COVID-19 crisis. Therefore, expanding public health and telemedicine services is necessary to prevent secondary health problems caused by essential medical use restrictions.
Newly diagnosed multiple sclerosis in a patient with ocular myasthenia gravis
Authors: Bong Jeong Bin , Lee Min A. , Kang Hyun Goo
Published: February 2022

Rationale:

Patients with myasthenia gravis may also have comorbid autoimmune diseases. Since both myasthenia gravis and neuromyelitis optica spectrum disease are mediated by antibodies, they are likely to occur together. However, since multiple sclerosis is an autoimmune disease that is not mediated by a specific antibody, it has fewer immune mechanisms in common with myasthenia gravis than neuromyelitis optica spectrum disease. We encountered a case of newly developed multiple sclerosis in a patient with myasthenia gravis.

Patient concerns:

A 46-year-old man was diagnosed with ocular myasthenia gravis 6 years ago and had been taking pyridostigmine to control his symptoms.

Diagnosis:

The patient developed right optic neuritis, and multiple sclerosis was suspected based on the brain magnetic resonance imaging findings. However, the required diagnostic criteria were not met.

Interventions:

Disease-modifying therapy was not initiated, and clinical progression of the disease was monitored.

Outcomes:

One year after the onset of optic neuritis, the patient developed myelitis and was diagnosed with multiple sclerosis, prompting treatment with disease-modifying therapy.

Lessons:

When optic neuritis occurs in patients with myasthenia gravis, careful evaluation is necessary while considering the possibility that it may be the first symptom of a demyelinating central nervous system disease. Therefore, it is important to conduct shorter-interval monitoring and symptom screening for patients with neurological autoimmune diseases, such as myasthenia gravis, even if multiple sclerosis is not initially suspected, to achieve early detection of multiple sclerosis.
Efficacy and safety of tuina for senile insomnia
Authors: Liu Yangshengjie , Bai Xuejiao , Zhang Hongshi , Zhi Xiaoyu , Jiao Jundong , Wang Quanwu , Ji Yuanyuan , Zheng Xu , Zhang Xinlu , Tong Xue , Liu Jiayi , Sun Yahui , Liu Peng
Published: February 2022

Background:

Insomnia is a common diseases of the elderly, tuina is a widely used treatment. At present, there is a lack of supportive evidence on efficacy and safety of tuina for senile insomnia. The purpose of this systematic review is to assess the effectiveness and safety of tuina therapy in the treatment of senile insomnia.

Methods:

Literature on tuina for senile insomnia in the PubMed, EMBASE, Web of Science, Cochrane, China National Knowledge Infrastructure Database, Wanfang, Chinese Scientific and Journal Database, Japanese medical database, Korean Robotics Institute Summer Scholars, and Thai-Journal Citation Index Center will be conducted to search from the creation of these databases. We will search the databases from the beginning to January 2022. The primary outcome was the Pittsburgh Sleep Quality Index score, and the secondary outcomes included clinical efficacy and safety. RevMan 5.4.1 will be used for the meta-analysis.

Results:

This study aimed to will prove the effectiveness and safety of tuina therapy for the treatment of insomnia in the elderly.

Conclusion:

This study provides up-to-date evidence of the effectiveness and safety of tuina for the treatment of senile insomnia.

INPLASY registration number:

INPLASY2021110063.

Ethics and Communication:

This systematic review will evaluate the effectiveness and safety of massage therapy for insomnia in the elderly population. As all the included data have been published, systematic reviews do not require ethical approval.
Identification of a new RNA-binding proteins-based signature for prognostic prediction in gastric cancer
Authors: Wang Yuzhi , Ye Weixia , Tian Gang , Zhang Yi
Published: February 2022

Gastric cancer (GC) is one of the most common cancers with high incidence and mortality worldwide. Recently, RNA-binding proteins (RBPs) have drawn more and more attention for its role in cancer pathophysiology. However, the function and clinical implication of RBPs in GC have not been fully elucidated. RNA sequencing data along with the corresponding clinical information of GC patients were downloaded from The Cancer Genome Atlas (TCGA) database. Differentially expressed RNA-binding proteins (DERBPs) between tumor and normal tissues were identified by “limma” package. Functional enrichment analysis and the protein-protein interaction (PPI) network were harnessed to explore the function and interaction of DERBPs. Next, univariate and multiple Cox regression were applied to screen prognosis-related hub RBPs and to construct a signature for GC. Meanwhile, a nomogram was built on the basis of the independent factors. A total of 296 DERBPs were found, and most of them mainly related to post-transcriptional regulation of RNA and ribonucleoprotein. A PPI network of DERBPs was constructed, consisting of 262 nodes and 2567 edges. A prognostic signature was built depending on 7 prognosis-related hub RBPs that could divide GC patients into high-risk and low-risk groups. Survival analysis showed that high-risk group had a worse prognosis compared with the low-risk group and the time-dependent receiver operating characteristic (ROC) curves suggested that signature existed moderate predictive capacities of survival for GC patients. Similar results were obtained from another independent set GSE62254, confirming the robustness of signature. Besides, the genetic variation and immune heterogeneity differences were identified between the high-risk and low-risk groups by bioinformatics methods. These findings would provide evidence of the effect of RBPs and offer a novel potential biomarker in prognostic prediction and clinical decision for GC.
Laparotomic radical hysterectomy versus minimally invasive radical hysterectomy using vaginal colpotomy for the management of stage IB1 to IIA2 cervical cancer
Authors: Yang Eun Jung , Kim Nae Ry , Lee A. Jin , Shim Seung-Hyuk , Lee Sun Joo
Published: February 2022

This study compared survival outcomes for patients with stage IB1 to IIA2 (International Federation of Gynecology and Obstetrics stage 2009) cervical cancer who underwent open radical hysterectomy (ORH) versus those who underwent minimally invasive radical hysterectomy (MIRH) using vaginal colpotomy (VC).

Data for 550 patients who were diagnosed with cervical cancer at our institution during the period August 2005 to September 2018 was retrospectively reviewed. Of these, 116 patients who underwent radical hysterectomy (RH) were selected after applying the exclusion criteria. All MIRH patients underwent VC. Clinicopathological characteristics and survival outcomes between the ORH and MIRH groups were compared using appropriate statistical testing.

Ninety one patients were treated with ORH and 25 with MIRH during the study period. Among the MIRH patients, 18 underwent laparoscopy-assisted radical vaginal hysterectomy and 7 underwent laparoscopic RH. Preoperative conization was performed more frequently in MIRH patients than in ORH patients (44% vs 22%, respectively, P = .028). The incidence of lymph node invasion was higher in the ORH group than in MIRH group (37.4% vs 12.0% respectively; P = .016). Following RH, ORH patients underwent adjuvant treatment more frequently than MIRH patients (71.4% vs 56.0%, respectively, P = .002). There were no significant differences between ORH and MIRH patients for either progression-free survival (PFS) (91.3% vs 78.7%, respectively; P = .220) or 5-year overall survival (OS) (96.6% vs 94.7%, respectively, P = .929). In univariate analysis, lympho-vascular space invasion was the only clinicopathological feature associated with decreased PFS. No other clinicopathological factors was significantly associated with PFS or OS in univariate and multivariate analyses.

Despite a higher incidence of unfavorable prognostic factors in ORH patients, their survival outcomes were not different to those of MIRH patients with VC.
Trends and age-related characteristics of substance use in the hospitalized homeless population
Authors: Chun Sung-youn , Yoo Ji W. , Park Hyeki , Hwang Jinwook , Kim Pearl C. , Park Seong , Shen Jay J.
Published: February 2022

We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.

This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.

Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20–1.26], cocaine 2.55 [2.50–2.60], marijuana 1.43 [1.40–1.46], and heroin 1.57 [1.29–1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55–0.58] for other patients and 0.60 [0.50–0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81–6.90] and heroin 5.86 [2.08–16.52] in comparison with other hospitalized patients.

Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.
Chinese herbal injections for radiation pneumonitis
Authors: Gui Yuerong , Pang Qing , Wang Shuo , Dong Jun , Wang Dandan , Ma Xiumei , Wang Xinyan , Hu Shuaihang , Hou Wei
Published: February 2022

Background:

Radiation pneumonitis is a common dose-limiting factor in radiotherapy for thoracic malignancies, and its treatment encounters a bottleneck. As an essential adjuvant treatment method, Chinese herbal injections (CHIs) have been used to treat radiation pneumonitis (RP), and clinical studies have appeared potentially beneficial and nontoxic. However, the efficacy and safety of CHIs for RP have not been evaluated comprehensively.

Methods:

The systematic review and meta-analysis will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) statement guidelines. The Cochrane Library, PubMed, EMBASE, SinoMed, CNKI, VIP, and Wan Fang Databases were systematically searched from inception until January 20, 2022. The selection of studies, data extraction, and assessment of the risk of bias will be performed by 2 reviewers independently. The total effective rate was used as a primary outcome measure; the secondary outcomes are quality of life, clinical symptoms and signs, inflammatory cytokines, and adverse effects. Cochrane Review Manager (RevMan5.3) software will be used for data synthesis and analysis.

Results and conclusion:

This systematic review will evaluate the efficacy and safety of CHIs in treating radiation pneumonitis to provide more comprehensive evidence for the treatment of clinical RP.

INPLASY registration number:

INPLASY202210106.
Successful treatment with tocilizumab for refractory anemia and slowly progressive renal glomerulosclerosis in multicentric Castleman disease
Authors: Sugawara Eri , Sato Taiki , Amasaki Yoshiharu , Katsumata Kazuaki
Published: February 2022

Rationale:

Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder accompanied by systemic symptoms characterized by polyclonal hypergammaglobulinemia and chronic inflammation due to overexpression of interleukin-6. Histological heterogeneity of renal involvement in MCD has been described, although the number of reports is limited. Tocilizumab, a humanized anti-interleukin-6 receptor antibody, has been reported to be effective for MCD.

Patent concerns:

A 64-year-old man experienced refractory anemia and slowly progressive renal dysfunction with proteinuria, accompanied by persistent inflammation for 11 years.

Diagnosis:

Two renal biopsies were obtained. The first biopsy performed 7 years before admission revealed non-specific interstitial inflammation, whereas the second biopsy demonstrated global sclerosis in most glomeruli and interstitial fibrosis. The patient had multiple lymphadenopathies. Cervical lymph node biopsy histological findings were compatible with plasma cell type Castleman disease. The patient had no evidence of human hepatitis virus-8 infection.

Intervention:

The patient was treated with 60 mg/d prednisolone followed by 8 mg/kg intravenous tocilizumab every 2 weeks.

Outcome:

His anemia significantly improved, as well as a marked reduction in proteinuria and stabilization of renal function. He did not experience renal function during the 2-years follow-up period.

Lessons:

The heterogeneity of the renal manifestations of MCD sometimes makes early diagnosis difficult. We need to interpret the histological findings of the renal biopsy carefully. For advanced-stage renal diseases, tocilizumab might be an effective treatment strategy for MCD.
Hybrid operation for arteriovenous malformations with associated multiple intracranial aneurysms and subarachnoid hemorrhage
Authors: Xie Fei , Huang Lin , Ye Yongqiang , Hao Jianqiang , Lv Janwei , Richard Seidu A.
Published: February 2022

Rationale:

The hybrid surgical concept for the treatment of brain arteriovenous malformations (AVMs) with associated intracranial aneurysms (IAs) is still not widely practiced. Concomitant occurrence of AVMs with IAs is common. Subarachnoid hemorrhage (SAH) as a result of AVM or IA rupture is often associated with these dual pathological phenomena. We present a case of concomitant occurrence of AVMs and IAs that was successfully treated using the hybrid operation concept.

Patient concerns:

A 62-year-old man presented with sudden onset of severe headache, dizziness, nausea, and vomiting for 4 hours.

Diagnosis:

Computed tomography revealed SAH and a hematoma in the right frontal lobe. A computed tomographic angiogram also revealed a right frontal AVM with 3 IAs.

Interventions:

We used a hybrid operating room to successfully treat both AVMs and IAs.

Outcomes:

Two years of follow-up showed that the patients were well and performed their daily duties.

Lessons:

The hybrid operating room is an innovative, safe, and effective method for the treatment of AVMs with associated IAs, particularly high-grade AVMs and IAs with hemorrhage or SAH. Patients with concomitant AVMs and IAs have the highest chance of hemorrhage compared with those with AVM or IAs alone.
Treatment of acute hypernatremia caused by sodium overload in adults
Authors: Goshima Takahiro , Terasawa Teruhiko , Iwata Mitsunaga , Matsushima Asako , Hattori Tomonori , Sasano Hiroshi
Published: February 2022

Background:

Rapid-onset, acute hypernatremia caused by sodium overload is a rare, life-threatening condition. Although experts recommend rapid correction of sodium concentration [Na] based on pathophysiological theories, only a few reports have documented the specific details of sodium correction methods. The objective of this study was to systematically review the reported treatment regimens, achieved [Na] correction rates, and treatment outcomes.

Methods:

PubMed, Ichushi-database, and references without language restrictions, from inception to January 2021, were searched for studies that described ≥1 adult (aged ≥18 years) patients with rapid-onset hypernatremia caused by sodium overload, whose treatment was initiated ≤12 hours from the onset. The primary outcome of interest was the [Na] correction rate associated with mortality.

Results:

Eighteen case reports (18 patients; median [Na], 180.5 mEq/L) were included. The cause of sodium overload was self-ingestion in 8 patients and iatrogenic sodium gain in 10 patients; baseline [Na] and symptoms at presentation were comparable for both groups. Individualized rapid infusion of dextrose-based solutions was the most commonly adopted fluid therapy, whereas hemodialysis was also used for patients already treated with hemodialysis. The correction rates were more rapid in 13 successfully treated patients than in 5 fatal patients. The successfully treated patients typically achieved [Na] ≤160 within 8 hours, [Na] ≤150 within 24 hours, and [Na] ≤145 within 48 hours. Hyperglycemia was a commonly observed treatment-related adverse event.

Conclusion:

The limited empirical evidence derived from case reports appears to endorse the recommended, rapid, and aggressive sodium correction using dextrose-based hypotonic solutions.
Changes in bone marrow and peripheral blood lymphocyte subset findings with onset of hepatitis-associated aplastic anemia
Authors: Kakiuchi Toshihiko , Eguchi Katsuhide , Koga Daisuke , Eguchi Hiroi , Nishi Masanori , Sonoda Motoshi , Ishimura Masataka , Matsuo Muneaki
Published: February 2022

Rationale:

Hepatitis-associated aplastic anemia (HAAA) is a rare illness that results in bone marrow failure following hepatitis development. The etiological agent remains unknown in most HAAA cases. However, clinical features of the disease and immunotherapy response indicate that immune-mediated factors play a central role in the pathogenesis of HAAA. Activation of cytotoxic T cells and increase in CD8 cells could exert cytotoxic effects on the myelopoietic cells in the bone marrow.

Patient concerns:

A 15-month-old boy was brought to our hospital with complaints of generalized petechiae and purpura observed a week prior to hospitalization. His liver was palpated 3 cm below the costal margin, platelet count was 0 × 104/μL, and alanine aminotransferase level was 1346 IU/L. A blood test indicated cytomegalovirus infection, and 3 bone marrow examinations revealed progressive HAAA. As the disease progressed to the 3rd, 6th, and 9th week after onset, CD4+ T cells were markedly decreased, CD8+ T cells were markedly increased, and the CD4/CD8 ratio was significantly decreased. The number of B cells and natural killer cells decreased with time, eventually reaching 0.0%.

Diagnosis:

HAAA.

Interventions:

Rabbit antithymocyte globulin and eltrombopag olamine (a thrombopoietin receptor agonist) were administered.

Outcomes:

The patient's platelet count returned to normal, and bone marrow transplantation was avoided. The peripheral blood lymphocytes (PBLs) improved as the patient's general condition recovered.

Lessons:

This case demonstrates that HAAA induced by cytomegalovirus infection features decreasing CD4+ and increasing CD8+ PBLs as the bone marrow hypoplasia progresses. The PBLs return to their normal levels with the recovery from the disease. Our case findings thus support the involvement of immunological abnormality in HAAA.
The effect of acupuncture used for cervical spondylosis of vertebral artery type
Authors: Lu Jinxian , Song Quanmei , Zhu Yongzheng , Jia Hongling , Zhang Yongchen
Published: February 2022

Background:

Cervical spondylosis of vertebral artery type is a common clinical disease. With the change of people's lifestyle and the improvement of people who work at desks, its incidence is also increasing, which can seriously affect people's normal life and work. Acupuncture has been gradually accepted and recognized by the public for its green, simple and safe characteristics. In this systematic review, we aimed to evaluate the effect and safety for patients with cervical spondylosis of vertebral artery type to provide evidence for clinical decision making.

Methods:

We will search the following 8 databases from their inception to November 2021: Web of Science, the Cochrane Library, PubMed, Embase, Chinese Biomedicine, China National Knowledge Infrastructure, Chinese Scientific Journals Database, and the WanFang Database. All relevant randomized controlled trials (RCTs) that meet the inclusion criteria will be included in our analysis. Literature screening, data extraction and literature quality assessment will be carried out in a step. Data analysis will be performed using RevMan 5.4 software.

Results:

Based on the results of this study, we will evaluate the safety and effectiveness of acupuncture in the treatment of vertebral artery type cervical spondylosis.

Conclusion:

This study will provide strong evidence-based medical evidence for acupuncture in treating cervical spondylosis of vertebral artery type.

PROSPERO registration number:

CRD42021293053.
Early complementary acupuncture improves the clinical prognosis of traumatic brain edema
Authors: Guo Zi-Quan , Jiang Hua , Huang Yong , Gu Hong-Mei , Wang Wen-Bin , Chen Tai-Dong
Published: February 2022

Background:

Traumatic brain edema occurs commonly brain injury, and most manifests as pericontusional edema of brain contusions. On the basis of evidence-based medicine, apart from recommending craniotomy and mannitol, there are few particularly effective measures to prevent and treat traumatic brain edema. It is uncertain whether an early complementary acupuncture treatment would improve long-term outcomes of patients with traumatic brain edema. The aim of this study is to assess the efficacy and the safety of early complementary acupuncture for patients with traumatic brain edema.

Methods:

This study is an actively accruing, single-center, single-blinded, 2-arm, randomized controlled trial. Patients with traumatic brain injury, a Glasgow Coma Scale score of 6∼12, and brain edema on computed tomography scan will be divided into 2 groups on the basis of stratified block randomization. All patients will receive conventional treatment, and the study group will undergo additional acupuncture therapy (start within 72 hours after the injury) once a day for 28 days. The primary outcome is the dichotomized Glasgow Outcome Score at 6 months and 12 months after injury, and the secondary outcomes are the Glasgow Coma Scale, the volume of traumatic brain edema, the serum levels of C-reactive protein and interleukin-6, and the Modified Barthel Index.

Discussion:

This study will provide data regarding the efficacy of early complementary acupuncture for traumatic brain edema. If the study yields positive results, its findings may offer insights into a valuable complementary option of acupuncture for traumatic brain edema that could provide pilot evidence for large, randomized, controlled trials.

Trial registration: This trial has been published in the Chinese Clinical Trial Register, http://www.chictr.org.cn/edit.aspx?pid=141208&htm=4 (Identifier: ChiCTR2100053794, registered on December 3, 2021).
Low tricuspid annular plane systolic excursion is associated with a poor outcome in patients with COVID-19
Authors: Tian Ye , Lu Huaihai , Liu Xuefang , Zhao Yinlong , Zhang Pei
Published: February 2022

Background: This systematic review and meta-analysis aimed to assess whether tricuspid annular plane systolic excursion (TAPSE) could be used as a prognostic tool in patients with coronavirus disease 19 (COVID-19).

Methods:

Studies on the relationship between TAPSE and COVID-19 since February 2021. Standardized mean difference (SMD) and 95% confidence intervals were used to assess the effect size. The potential for publication bias was assessed using a contour-enhanced funnel plot and Egger test. A meta-regression was performed to assess if the difference in TAPSE between survivors and nonsurvivors was affected by age, sex, hypertension or diabetes.

Results:

Sixteen studies comprising 1579 patients were included in this meta-analysis. TAPSE was lower in nonsurvivors (SMD −3.24 (−4.23, −2.26), P < .00001; I2 = 71%), and a subgroup analysis indicated that TAPSE was also lower in critically ill patients (SMD −3.85 (−5.31, −2.38,), P < .00001; I2 = 46%). Heterogeneity was also significantly reduced, I2 < 50%. Pooled results showed that patients who developed right ventricular dysfunction had lower TAPSE (SMD −5.87 (−7.81, −3.92), P = .004; I2 = 82%). There was no statistically significant difference in the TAPSE of patients who sustained a cardiac injury vs those who did not (SMD −1.36 (−3.98, 1.26), P = .31; I2 = 88%). No significant publication bias was detected (P = .8147) but the heterogeneity of the included studies was significant. A meta-regression showed that heterogeneity was significantly greater when the incidence of hypertension was <50% (I2 = 91%) and that of diabetes was <30% (I2 = 85%).

Conclusion:

Low TAPSE levels are associated with poor COVID-19 disease outcomes. TAPSE levels are modulated by disease severity, and their prognostic utility may be skewed by pre-existing patient comorbidities.

Trial retrospectively registered (February 12, 2021):

PROSPERO CRD42021236731
Impact of the COVID-19 pandemic on emergency department utilization patterns in South Korea
Authors: Chang Hyunglan , Kang Min Woo , Paek So Hyun
Published: February 2022

The purpose of analyzing changes in the use of emergency departments (EDs) was to better understand how to use ED resources efficiently during infectious disease outbreaks.

Our study was a retrospective observational study. We analyzed the patterns of visits of adult and pediatric patients to separate EDs during 2020 coronavirus disease 2019 (COVID-19) outbreak to know the changes in the ED utilization. We collected the patient's demographics and time of visit, patients’ acuity level at triage, cause of visit, transportation used, disposition, symptom to visit time, length of stay, and top 10 most common complaints. We compared pediatric and adult EDs before and after COVID-19.

The total number of patients who visited the EDs was 197,152 over 3 years. During the COVID-19 outbreak in 2020, the number of visits decreased significantly, especially the number of pediatric patients. The number of ED visits decreased in correlation with a surge in the number of confirmed COVID patients. The proportion of severe cases in pediatric emergency department (PED) visits increased, but there was no difference in adult emergency department. The number of hospitalized PED patients increased, and the number of hospitalized adult emergency department patients decreased. However, both types of ED patients increased in intensive care unit hospitalizations, proportion of deaths, and use of ambulances. The proportion of trauma patients in the PED increased significantly (P 
< .001). The time from symptom onset to ED visit time was reduced for patients. The ED length of stay increased in adults, and decreased for pediatric patients.

COVID-19 brought about many changes to ED utilization. A greater reduction in ED utilization occurred in pediatric patients compared to adult patients. Our study showed changes in the number and characteristics of patients visiting the ED during the COVID-19 period compared to 2018 and 2019.
Excessive sacral sweating caused by autonomic dysreflexia after traumatic brainstem injury
Authors: Saito Hiroshi
Published: February 2022

Rationale:

Autonomic dysreflexia is a release phenomenon of spinal sympathetic preganglionic neurons from supraspinal inhibition, possibly of the lower brainstem origin. It is most frequently observed in patients with severe spinal lesions above the mid-thoracic cord. Theoretically, brainstem lesions may cause autonomic dysreflexia; however, such reports are rare. The author reports a case of autonomic dysreflexia restricted to the sacral area that appeared after brainstem lesions due to a traffic accident.

Patient concerns:

A 36-year-old man suffered from traumatic subarachnoid hemorrhage and hematomas in the lower brainstem. After he became alert and ambulant, he presented with neurological deficits suggestive of right-sided brainstem lesions, which were visualized on magnetic resonance images. He also complained of excessive sweating in the sacral area whenever he had a desire to void.

Diagnoses:

On the basis of neurological and radiological findings, and results of the thermal sweating test and sweating induced by bladder or rectal distension, his sacral hyperhidrosis was attributed to autonomic dysreflexia.

Interventions:

Baclofen (15 mg per day) was administered for more than three months, and the sacral hyperhidrosis gradually subsided.

Outcomes:

After three months, the patient returned home with minor gait disturbances and sacral sweating.

Lessons:

This may be the first report of excessive sweating due to autonomic dysreflexia caused by traumatic brainstem lesions restricted to the sacral territory. These observations suggest possible somatotopic arrangements, even in the supraspinal inhibitory pathways. Baclofen may be one of the choices for similar cases.
Open-label, single-dosing, the safety and pharmacokinetics of HAD-B1 in healthy male volunteers
Authors: Kim Soo-Dam , Kwag Eun-Bin , Chae Jung-Woo , Yang Sung-Yoon , Park Ji-Hye , Yoo Hwa-Seung , Park So-Jung
Published: February 2022

Background:

Previous studies have proven that Korean Traditional Medical substance HangAmDan-B1 (HAD-B1) is safe and effective in treating lung cancer. According to those research, long term and high dosage administration of HAD-B1 (13 week, higher than 2000 mg/kg), and its combined administration with Afatinib did not affect the therapeutic effect of Afatinib, and showed no drug tolerance. In vivo and in vitro studies also showed that HAD-B1 was found to be safe as it did not affect normal cells. Based on those results, this clinical trial aims to evaluate the safety and pharmacokinetics by oral administration of HAD-B1 in healthy male volunteers.

Methods:

Fifteen healthy male volunteers will be recruited for the study. Sample size for this phase 1 clinical trial. Subjects will be pre-examined within 4 weeks prior to the first dosing day to evaluate the compatibility. On day 0, participants will be admitted around 4 PM and will be fasting from 10 PM except for the water intake. On the dosing day, participants will take HAD-B1 at 8 AM on an empty stomach (1.944 g/day). Blood sample will be drawn at pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 8, 12, 24, and 48 hours. Area under the curve will be expressed in linear and log/linear graphs. Pharmacokinetic analysis will be non-compartment analysis using Phoenix WinNonlin (Pharsight, CA) software package.

Discussion:

This study investigates the safety and pharmacokinetics of HAD-B1 as it is already proven to be safe and effective according to the previous studies. The results from this clinical trial are expected to provide strict and objective evidences of the efficacy and safety of the formula HAD-B1 for patients with lung cancer.
Examining the Relationship Between Mild Traumatic Brain Injuries and Development of Mental Illness Disorders in a Mid-Term Follow-up Period
Authors: Wilder J. Heath , Gupta Sanchita S. , Kelly Grace C. , Logarbo J. Nicholas , Sanchez Santiago L. , Williams Garrett H. , Sherman William F.
Published: February 2022

Objective

The sequalae of mild concussions continue to emerge with increased awareness in sports-related injuries. This study aimed to quantify the number of patients who are affected by a mental illness within 3 yrs of a concussion and identify whether demographic differences exist that may influence a mental illness diagnosis.

Design

Using a nationwide database, data were queried for a diagnosis of concussion, capturing patients aged 18–45 yrs with no previous mental illness, and then identified if these patients were diagnosed with a mental illness within 3 yrs of their concussion. The mental illnesses specifically chosen for this study included depression, anxiety, panic disorder, posttraumatic stress disorder, bipolar, and schizophrenia.

Results

Within 3 yrs after a concussion, 48% of patients were later diagnosed with a mental illness. All of the mental illnesses this study chose to evaluate were present in a higher proportion of patients after a concussion than the general population.

Conclusions

The mechanism between concussions and mental illness remains unclear. A large proportion of patients who experience a concussion are later diagnosed with a mental illness within 3 yrs. Patients with a history of a previous concussion may benefit from screening for the development of a mental illness.
Acute postoperative pain after orthognathic surgery can be predicted by the preoperative evaluation of conditioned pain modulation and pain catastrophizing
Authors: Takashima Keiko , Oono Yuka , Takagi Saori , Wang Kelun , Arendt-Nielsen Lars , Kohase Hikaru
Published: February 2022

Introduction:

The incidence and severity of chronic postoperative pain (POP) are major clinical challenges, and presurgical conditioned pain modulation (CPM) and pain catastrophizing scale (PCS) assessments have exhibited predictive values for POP. However, whether CPM and PCS assessments are also predictive of acute POP is unknown.

Objectives:

We aimed to investigate the relationship between preoperative CPM and PCS and acute POP severity after orthognathic surgery by assessing preoperative CPM and PCS in 43 patients.

Methods:

The pressure pain threshold and tonic painful cold–heat pulse stimulation (applied with a pain intensity score of 70 on a visual analogue scale [VAS 0–100]) were used as the test and conditioning stimuli, respectively. The pain area under the postoperative VAS area under the curve (VASAUC) was estimated. The associations between CPM, PCS, and VASAUC were also analyzed.

Results:

No patient experienced chronic POP after 1 month. Negative and positive CPM effects (test stimulus threshold was 0% > and 0% ≤ during conditioning stimulation, respectively) were detected in 36 and 7 patients, respectively. For patients with negative CPM effects (CPM responders), multiple regression analysis revealed a prediction formula of log (VASAUC) = (−0.02 × CPM effect) + (0.13 × PCS-magnification) + 5.10 (adjusted R
2 = 0.4578, P = 0.00002, CPM effect; P = 0.002, PCS-magnification; P = 0.0004), indicating that a weaker CPM and higher PCS scores were associated with more acute POP after surgery.

Conclusion:

CPM and PCS can predict acute POP after orthognathic surgery.
The impact of syringe services program closure on the risk of rebound HIV outbreaks among people who inject drugs: a modeling study
Authors: Zang Xiao , Goedel Williams C. , Bessey Sam E. , Lurie Mark N. , Galea Sandro , Galvani Alison P. , Friedman Samuel R. , Nosyk Bohdan , Marshall Brandon D.L.
Published: February 2022

Objective:

Despite their effectiveness in preventing the transmission of HIV among people who inject drugs (PWID), syringe services programs (SSPs) in many settings are hampered by social and political opposition. We aimed to estimate the impact of closure and temporary interruption of SSP on the HIV epidemic in a rural United States setting.

Methods:

Using an agent-based model (ABM) calibrated to observed surveillance data, we simulated HIV risk behaviors and transmission in adult populations who inject and do not inject drugs in Scott County, Indiana. We projected HIV incidence and prevalence between 2020 and 2025 for scenarios with permanent closure, delayed closure (one additional renewal for 24 months before closure), and temporary closure (lasting 12 months) of an SSP in comparison to persistent SSP operation.

Results:

With sustained SSP operation, we projected an incidence rate of 0.15 per 100 person-years among the overall population (95% simulation interval: 0.06–0.28). Permanently closing the SSP would cause an average of 58.4% increase in the overall incidence rate during 2021–2025, resulting in a higher prevalence of 60.8% (50.9–70.6%) (18.7% increase) among PWID by 2025. A delayed closure would increase the incidence rate by 38.9%. A temporary closure would cause 12 (35.3%) more infections during 2020–2021.

Conclusion:

Our analysis suggests that temporary interruption and permanent closure of existing SSPs operating in rural United States may lead to ‘rebound’ HIV outbreaks among PWID. To reach and sustain HIV epidemic control, it will be necessary to maintain existing and implement new SSPs in combination with other prevention interventions.
CoviVac vaccination induces production of neutralizing antibodies against Delta and Omicron variants of SARS-CoV-2
Authors: Kozlovskaya Liubov , Gordeychuk Ilya , Piniaeva Anastasia , Kovpak Anastasia , Shishova Anna , Lunin Aleksandr , Shustova Elena , Apolokhov Vasiliy , Fominykh Ksenia , Ivin Yuri , Kondrashova Alla , Volok Viktor , Tcelykh Irina , Siniugina Aleksandra , Ishmukhametov Aydar
Published: February 2022

Vaccines are proven to be an effective tool in prophylaxis of severe COVID-19, but emerging mutated SARS-CoV-2 variants constantly challenge vaccines’ protectivity. We have evaluated the ability of the sera from individuals vaccinated with two variants of inactivated vaccine CoviVac and COVID-19 convalescents (May-December 2020) to neutralize SARS-CoV-2 variants Delta and Omicron. Four groups of serum samples (CoviVac vaccinees; COVID-19 convalescents; mice immunized with CoviVac preparations based on prototype B.1.1 strain and Delta variant) were evaluated in virus neutralization test against SARS-CoV-2 heterologous B.1.1 virus, Delta and Omicron variants. CoviVac preparations based on B.1.1 and Delta induced neutralizing antibodies against SARS-CoV-2 B.1.1 and two variants of concern. We observed a decrease in neutralization capacity in the sera from CoviVac (based on B.1.1 strain) vaccinees: 57.1% samples had detectable neutralizing antibodies against Delta and 61.9% against Omicron variants. Sera samples of all (100%) mice immunized with a candidate vaccine based on the SARS-CoV-2 Delta variant strain had neutralizing antibodies against all tested strains.
Presence of Symptoms 6 Weeks After COVID-19 Among Vaccinated and Unvaccinated U.S. Healthcare Personnel
Authors: Mohr Nicholas M. , Plumb Ian D. , Harland Karisa K. , Pilishvili Tamara , Fleming-Dutra Katherine E. , Krishnadasan Anusha , Hoth Karin F. , Saydah Sharon H. , Mankoff Zachary , Haran John P. , Briggs-Hagen Melissa , León Eliezer Santos , Talan David A. ,   the Project PREVENT Network
Published: February 2022

Abstract

Importance

Although COVID-19 vaccines protect against infection and severe disease, the role of vaccination in preventing prolonged symptoms in those with subsequent infection is unclear.

Objective

To determine differences in symptoms stratified by prior vaccination reported by healthcare personnel (HCP) 6 weeks after onset of COVID-19, and whether there were differences in timing of return to work.

Design

Nested cohort study within a multicenter vaccine effectiveness study. HCP with COVID-19 between December 2020 and August 2021 were followed up 6 weeks after illness onset.

Setting

Health systems in 12 U.S. states.

Participants

HCP participating in a vaccine effectiveness study were eligible for inclusion if they had confirmed COVID-19 with either verified mRNA vaccination (symptom onset ≥14 days after two doses) or no prior COVID-19 vaccination. Among 681 eligible participants, 419 (61%) completed a follow-up survey approximately 6 weeks after illness onset.

Exposures

Two doses of a COVID-19 mRNA vaccine compared with no COVID-19 vaccine.

Main outcomes and measures

Presence of symptoms 6 weeks after onset of COVID-19 illness and days to return to work after COVID-19 illness.

Results

Among 419 HCP with confirmed COVID-19, 298 (71%) reported one or more COVID-like symptoms 6 weeks after illness onset, with a lower prevalence among vaccinated participants (60.6%) compared with unvaccinated participants (60.6% vs. 79.1%; aRR 0.70, 95% CI 0.58-0.84). Vaccinated HCP returned to work a median 2.0 days (95% CI 1.0–3.0) sooner than unvaccinated HCP (aHR 1.37; 95% CI, 1.04–1.79).

Conclusions

A history of two doses of COVID-19 mRNA vaccine among HCP with COVID-19 illness was associated with decreased risk of COVID-like symptoms at 6 weeks and earlier to return to work. Vaccination is associated with improved recovery from COVID-19, in addition to preventing symptomatic infection.

KEY POINTS

Question

Does vaccination lead to improved recovery of symptoms and return to work following COVID-19?

Findings

In this nested cohort study of healthcare personnel, participants with COVID-19 who had received two doses of a COVID-19 mRNA vaccine were less likely to report symptoms 6 weeks after illness onset than participants with COVID-19 who were unvaccinated. Return to work was sooner if previously vaccinated.

Meaning

Vaccination is associated with improved recovery from COVID-19, in addition to prevention of infection and disease.