bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and Safety of Contact Lens–Assisted Corneal Crosslinking in the Treatment of Keratoconus With Thin Corneas
Authors: Nour Mostafa Mahmoud , El-Agha Mohamed-Sameh H. , Sherif Ahmed M. , Shousha Shireen Mostafa
Published: May 2021

Objective:

To evaluate the safety and efficacy of contact lens–assisted crosslinking (CA-CXL) in progressive keratoconus with thin corneas (350–400 µm).

Methods:

Forty eyes (30 patients) underwent epithelium-off CA-CXL with iso-osmolar riboflavin and ultraviolet-A irradiation for 30 min (fluence, 3 mW/cm2). A non–ultra-violet-absorbing soft contact lens (sCL) soaked in riboflavin was applied over the cornea during irradiation. Demarcation line (DL) depth was measured 1 month postoperatively. Endothelial cell count (ECC) was measured preoperatively and 3 months postoperatively. Distance uncorrected visual acuity (UDVA) and best spectacle–corrected visual acuity (BDVA), and maximum keratometric values (K max) were evaluated preoperatively and 9 months postoperatively.

Results:

The sCL added a mean thickness of 100.05±1.23 µm. The mean ECC was 2,982±165 cell/mm2 preoperatively and 2,955±125 cell/mm2 postoperatively (endothelial cell loss, 0.9%, P=0.21). The mean DL depth was 204.8±20.2 µm. There was significant improvement in UDVA (P<0.001) and BDVA (P=0.011) with a stable K max (P
=0.06).

Conclusion:

Contact lens–assisted crosslinking was safe and effective, with endothelial loss less than 1% after 3 months and stable corneal tomography over 9 months, with improved visual acuity. Demarcation line depth was found to be shallower than conventional CXL. Therefore, the long-term efficacy of CA-CXL requires further study.

Clinical Trial Registry Number:

NCT04504578 Clinical trials.gov.
Does Education in Oral Health Competencies in Physician Assistant Education Programs Translate to Delivery of Oral Health Services in Clinical Practice?
Authors: Langelier Margaret , Surdu Simona
Published: May 2021

Purpose

The purpose of this study was to determine the extent to which physician assistants (PAs) are educated in oral health competencies and the relationship of education to providing oral health services to patients.

Methods

The study was conducted in 2016 by administering an Internet-based survey to a nationwide sample of 2014 graduates of programs accredited by the Accreditation Review Commission on Education for the Physician Assistant. The survey response rate was 12.7% (N = 304).

Results

More than half of the PAs who received education in oral health in their professional education programs indicated that oral health curricula were either integrated into one or several topical areas in the base curriculum or delivered in stand-alone lectures. The majority of PA respondents rated their educational preparation as good or excellent in helping them provide oral health education to their patients (54.8%), make appropriate referrals to oral health providers (53.7%), and provide preventive oral health services (51.2%), while more than 40% rated their preparation as good or excellent in helping them identify oral diseases, conditions, and intervention strategies. More than one-third (35.7%) of all PA respondents reported that they provided oral health services in their clinical practices. PAs who received instruction in oral health competencies through the PA education curriculum or from other sources were 2.82 times more likely to provide oral health assessment and screening services to their patients (95% confidence interval, 1.19–6.67). The PA respondents' provision of oral health services was also significantly associated with working in primary medicine or urgent care practice specialties but not with the work setting.

Conclusions

PAs educated in oral health competencies are more likely to provide such services to patients, especially in primary medicine or urgent care settings.
Agreement between blood pressure from research study visits versus electronic medical records and associations with hypertensive disorder diagnoses in pregnant women with overweight/obesity
Authors: Lane-Cordova Abbi D , Wilcox Sara , Fernhall Bo , Liu Jihong
Published: May 2021

Objectives

Blood pressure (BP) abstracted from electronic medical records (EMR) is moderately correlated to BP in nonpregnant adults with limited agreement. Little is known about the agreement of research versus EMR BP measured during pregnancy or associations of EMR BP with hypertensive disorder of pregnancy (HDP) diagnoses.

Methods

BP was measured according to guidelines at in-person research study visits in 214 women with prepregnancy overweight or obesity (44.4% African American, mean age = 29.8 ± 4.8 years) at weeks 16 and 32 of pregnancy. Clinic BP readings that occurred within 1 week of the study visits were abstracted from the EMR. We assessed correlations between sources using Pearson’s coefficients; the agreement was evaluated with Bland–Altman plots. We compared differences in the proportion of women with an HDP diagnosis in the EMR between women with versus without a hypertensive EMR BP measurement.

Results

SBP and DBP from study visits and the EMR were modestly moderately correlated at both time points; 0.20 < r < 0.44; P < 0.05 for all. The average mean difference was 10.5 mmHg for SBP and <1 mmHg for DBP in early and 7.3 mmHg for SBP and −1.7 mmHg for DBP in late pregnancy. Women with at least one hypertensive BP reading in the EMR were more likely to have an HDP diagnosis recorded in the EMR; 43.5 versus 3.3%; P < 0.01.

Conclusion

EMR SBP was higher but moderately correlated with research quality BP in early and late pregnancy. Women with a hypertensive EMR BP measurement were more likely to have an HDP diagnosis in the EMR.
Comparison of invasive fungal diseases between patients with acute myeloid leukemia receiving posaconazole prophylaxis and those not receiving prophylaxis
Authors: Yang Eunmi , Choi Eun-Ji , Park Han-Seung , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Lee Jung-Hee , Lee Je-Hwan , Lee Kyoo-Hyung , Kim Sung-Han
Published: May 2021

Posaconazole prophylaxis is effective in decreasing the incidence of invasive fungal diseases (IFDs) in patients with acute myeloid leukemia (AML). However, the use of antifungal prophylaxis varies in real-life practice, and only a small number of studies have compared the incidence of IFDs between those receiving posaconazole prophylaxis and those without prophylaxis. We compared the clinical characteristics and outcomes of IFDs between patients with AML who received posaconazole prophylaxis and those without antifungal prophylaxis.

We reviewed the medical records of adult AML patients who underwent induction chemotherapy between June 2016 and October 2019 at Asan Medical Center (Seoul, South Korea), where posaconazole prophylaxis is not administered in patients with gastrointestinal symptoms that may hinder sufficient absorption of oral prophylactic agents, and in patients with abnormal liver functions considering the possible exacerbation of adverse events. Patients who received posaconazole prophylaxis for ≥7 days were included in the prophylaxis group. Clinical characteristics and outcomes including the incidence of IFDs were compared between the 2 groups.

Of the 247 patients with AML who underwent induction chemotherapy, 162 (66%) received posaconazole prophylaxis and 85 (34%) did not receive any prophylaxis. The incidence of proven/probable IFD was significantly higher in the no prophylaxis group than in the prophylaxis group (9.4% [8/85] vs 2.5% [4/162], P = .03). Of the 8 cases of IFDs in the no prophylaxis group, 7 were mold infections and 1 was invasive candidiasis. Of the 4 cases of IFDs in the prophylaxis group, 3 were mold infections and 1 was invasive candidiasis. Patients with posaconazole prophylaxis less frequently received therapeutic antifungal therapy (2.5% vs 9.4%, P = .03) and had a longer median, duration from chemotherapy to antifungal therapy compared with the no prophylaxis group (18 vs 11 days, P < .01). The rate of IFD-related mortality was similar between the 2 groups (0.6% vs 0%, P > .99).

Patients with AML who received posaconazole prophylaxis had a lower incidence of breakthrough IFDs compared with those who did not receive any prophylaxis. Invasive mold infection was the most common IFD regardless of antifungal prophylaxis.
The analgesic evaluation of gabapentin for arthroscopy
Authors: Huang Feiri , Yang Zhifang , Su Zhongliang , Gao Xiaosheng
Published: May 2021

Introduction:

The efficacy of gabapentin for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of gabapentin versus placebo on the postoperative pain intensity of arthroscopy.

Methods:

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials assessing the effect of gabapentin versus placebo on pain control of arthroscopy. This meta-analysis is performed using the random-effect model.

Results:

Five randomized controlled trials are included in the meta-analysis. Overall, compared with control group for arthroscopy, gabapentin remarkably decreases pain scores at 24 hour (standard mean difference [SMD]=-0.68; 95% confidence interval [CI]=-1.15 to -0.02; P = .21), analgesic consumption (SMD = -18.24; 95% CI=-24.61 to -11.88; P < .00001), nausea and vomiting (OR = 0.42; 95% CI = 0.21 to 0.84; P = .01), but has no obvious influence on pain scores at 6 h (SMD = −1.30; 95% CI = −2.92 to 0.31; P = .11) or dizziness (OR = 1.12; 95% CI = 0.56 to 2.24; P = .75).

Conclusions:

Gabapentin is effective for pain control after arthroscopy.
Thymosin alpha-1 therapy improves postoperative survival after curative resection for solitary hepatitis B virus-related hepatocellular carcinoma
Authors: Linye He , Zijing Xia , Wei Peng , Chao He , Chuan Li , Tianfu Wen
Published: May 2021

Thymosin alpha-1 (Tα1) is an immunomodulatory and antiviral agent with potential effects on chronic hepatitis B and liver cancer. Its impact on solitary hepatocellular carcinoma (HCC) remains controversial, so we aimed to investigate the efficacy of Tα1 in solitary HBV-related HCC patients after curative resection.

Between May 2010 and April 2016, 468 patients with solitary HBV-related HCC after curative resection were analyzed. Propensity score matching (PSM) was used to minimize confounding variables. Risk factors were identified by the Cox proportional hazards model. Recurrence-free survival (RFS) rates, overall survival (OS) rates, immunological, and virologic response were compared.

The median follow up was 60.0 months. Immunological response improved in the Tα1 group compared with the control group (P < .001) but the virologic response was similar between 2 groups after 24 months. Patients with Tα1 therapy had better RFS and OS before (P = .018 and P < .001) and after (P = .006 and P < .001) propensity matching. Multivariate analysis revealed that Tα1 therapy was an independent prognostic factor for both OS (P < .001, HR = 0.308, 95% CI: 0.175–0.541) and RFS (P < .001, HR = 0.381, 95% CI: 0.229–0.633).

Tα1 as an adjuvant therapy improves the prognosis of solitary HBV-related HCC patients after curative liver resection.
Association between gastroesophageal reflux disease and vocal fold polyps
Authors: Zou Yazhu , Deng Dan , Li Xia , Yang Zhaoxia
Published: May 2021

The aim of this study is to explore the relationship between gastroesophageal reflux disease (GERD) and vocal fold polyps (VFPs).

This is a Case-Control study and was performed with the help of The Second Affiliated Hospital of Chongqing Medical University.

Twenty-seven patients with VFP and 20 controls without VFP were recruited between May and October 2018. All the subjects underwent a saliva pepsin test, completed the GerdQ questionnaire and 24-hour multichannel intraluminal impedance with pH (24-h MII-pH) monitoring. Twenty-five resected VFP specimens were examined with immunohistochemical (IHC) and double immunofluorescence (IF) staining.

The incidence of GERD in the VFP group was significantly higher than that in the control group (P = .003). Patients with VFP had significantly higher GerdQ scores, pepsin concentrations, and pepsin-positive rates (P < .05). Moreover, the number of proximal and upright reflux events was significantly higher in the VFP group (P < .05). The pepsin concentration in saliva showed a significant positive correlation with the pepsin levels in tissues (r

2
 = 0.50, P = .011). Pepsin and TGF-β1-positive cells were colocalized with CD45RO-positive cells. IHC staining showed that the majority of VFP patients had a positive expression of pepsin (20/25, 80%) and pepsin-positive cells were found in both the squamous epithelium and mesenchymal tissues. IHC staining of TGF-β1 in VFP revealed findings similar to those of pepsin staining.

GERD is an important risk factor for VFP. Pepsin may promote the aggregation of immune cells, increase the local cytokines, and promote inflammatory reaction, suggesting a potential new pathogenesis for VFP. The saliva pepsin test is a reliable method for GERD diagnosis.
Risk factors of postpartum stress urinary incontinence in primiparas
Authors: Gao Jiejun , Liu Xinru , Zuo Yan , Li Xiaocui
Published: May 2021

Stress urinary incontinence (SUI) is a common clinical postpartum complication. It is necessary to explore the risk factors of postpartum SUI in primiparas to provide evidence support for preventing and reducing the occurrence of SUI.

Primiparas who were delivered in our hospital from March 2019 to October 2020 were identified, the personal information and related treatment details of SUI and no-SUI primiparas were collected and analyzed. Logistic regression analyses were conducted to identify the risk factors of postpartum SUI in primiparas.

A total of 612 primiparas were included, the incidence of SUI in primiparas was 32.03%. There were significant differences in the body mass index (BMI) before pregnancy, diabetes, abortion, delivery method, newborn's weight, epidural anesthesia, and duration of second stage of labor (all P < .05) between SUI and no-SUI group, and there were no significant differences in the age, BMI at admission, hypertension and hyperlipidemia SUI and no-SUI group (all P > .05). Logistic regression analyses indicated that BMI before pregnancy ≥24 kg/m2 (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.042–4.394), diabetes (OR: 2.250, 95% CI: 1.891–3.544), abortion history (OR: 3.909, 95% CI: 1.187–5.739), vaginal delivery (OR: 2.262, 95% CI: 1.042–4.011), newborn's weight ≥3 kg (OR: 1.613, 95% CI: 1.095–2.316), epidural anesthesia (OR: 2.015, 95% CI: 1.226–3.372), and duration of second stage of labor ≥90 minutes (OR: 1.726, 95% CI: 1.084–2.147) were the risk factors of postpartum SUI in primiparas (all P < .05).

The clinical incidence of SUI in primiparas is relatively high. In clinical practice, medical staff should conduct individualized early screening for those risk factors, and take prevention measures to reduce the occurrence of SUI.
The best thickness of cornea graft from SMILE surgery as patch graft in glaucoma drainage implant surgery
Authors: Wang Yuhong , Liu Jinkun , Huang Weiyi , Xu Yazhang , Cheng Meizhu , Shen Zhengwei
Published: May 2021

Objective:

The aim of this study was to determine the best thickness of corneal slices acquired from femtosecond laser surgery—small incision lenticule extraction (SMILE surgery) as patch graft in glaucoma drainage implantation surgery.

Methods:

This study is a prospective randomized study. Patients who received glaucoma drainage implantation from September 2016 to November 2018 were observed. The patients were randomly divided into 3 groups. Group A included 102 cases (104 eyes), receiving 1 layer (120–150 μm) of allogeneic lamellar corneal tissue as the graft. Group B included 117 cases (120 eyes), receiving 2 layers of lamellar corneal tissue from one donor. Group C included 109 cases (111 eyes), using 3 layers of lamellar corneal tissue from 2 donors. The intraocular pressure, corneal graft, conjunctiva stromalysis, drainage tube exposure, and drainage plate were observed.

Results:

Patients were followed up for 6 to 33 months. The intraocular pressure was significantly reduced after surgery in all three groups. Conjunctiva stromalysis and drainage tubes were exposed in 3 eyes (3%) in group A and 1 eye (0.8%, a special case which has nystagmus and the plate was placed infratemporally) in group B, whereas no conjunctiva stromalysis or tube exposure was reported in group C.

Conclusions:

The corneal graft acquired from SMILE surgery can effectively prevent drainage tube exposure and give patients a better cosmetic appearance. Two layers of lamellar corneal tissue (240–300 μm) may be the best suitable thickness because it can effectively reduce tube exposure and rejection. In some special cases, 3 layers of lamellar corneal tissue are needed.
Risk factors of infection after transarterial chemoembolization for hepatocellular carcinoma
Authors: Shi Zhipeng , Yang Wen , Tang Hao , Li Xiuhong
Published: May 2021

Background:

Transarterial chemoembolization (TACE) has the characteristics of minimally invasive, strong repeatability, and good curative effect, so it is commonly used in the nonoperative treatment of hepatocellular carcinoma (HCC). However, infection will occur after TACE, which not only increases the hospitalization time and medical expenses, but also affects the efficacy of TACE treatment. At present, there is a lack of analysis of the risk factors of infection after TACE of patients with HCC. In this study, meta-analysis was used to further explore the risk factors of postoperative infection in patients with HCC after TACE, and to provide strategies for infection prevention and intervention.

Methods:

To search the literatures about the influencing factors of post-TACE infection in patients with HCC published from the establishment of PubMed, Embase, The Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and WANFANG to April 2021. Screening was carried out according to inclusion criteria and exclusion criteria. A meta-analysis was performed using RevMan 5.3 software.

Results:

We disseminated the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.

Conclusion:

This study systematically reviewed the existing evidence and determined the incidence and predictors of infection after TACE of patients with HCC.

Ethics and dissemination:

The private information from individuals will not be published. This systematic review also should not damage participants’ rights. Approval from an ethics committee is not required for this study. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.

OSF Registration number:

DOI 10.17605/OSF.IO/26P5X
Quality of life in chronic pain treated through pulsed radiofrequency therapy
Authors: Lo Buono Viviana , De Cola Maria Cristina , Di Cara Marcella , Floridia Daniela , Bonanno Lilla , De Salvo Simona , Cerra Francesco , Cannistraci Cecilia , Maresca Giuseppa , Bramanti Placido , Marino Silvia , Corallo Francesco
Published: May 2021

Anxiety and depression are often symptoms present in people who suffer from chronic pain, compromising the quality of life of these individuals. The objective of this study was to assess whether a pulsed radiofrequency (PRF) treatment, in addition to psychological support intervention, can decrease chronic pain, thereby improving quality of life and restoring psychological well-being.

Fifty outpatients with a diagnosis of chronic pain, without any benefit from traditional drug therapies, were selected to perform a PRF treatment in combination with a psychological intervention. They were evaluated before and after the intervention through the Hamilton Anxiety Rating Scale and the Beck Depression Inventory-II for anxiety and depression symptomatology, respectively, the Short Form Health Survey 36 (SF-36) was used to assess the subject's quality of life, and the Numerical Rating Scale was used for pain assessment.

The Wilcoxon signed-rank test showed a significant difference in Beck Depression Inventory-II (P < .001), Hamilton Anxiety Rating Scale (P < .01), and Numerical Rating Scale (P = .004). In the SF-36 scores, we observed a significant difference between T0 and T1 in both mental (P < .001) and physical (P < .001) dimensions.

This study shows that a chronic pain reduction leads to a decrease of anxiety-depressive symptoms and an improvement in quality of life. PRF seems to be an appropriate method to reduce the chronic pain that influences psychological well-being and quality of life.
Exercise interventions for older people at risk for frailty
Authors: Zhang Jianna , Liu Zhixi , Liu Yi , Ye Lei
Published: May 2021

Background:

Frailty is a state of age-related reduced physiological reserve characterized by an increased risk of adverse clinical outcomes. Studies have shown that exercise can improve frailty in older people. However, it remains to be seen which exercises will most improve the fitness of older people with frailty or those at the risk for frailty.

Objective: This protocol aims to determine whether physical exercise can improve frailty in older people, and if which methods are most effective.

Methods:

We searched the following databases for relevant articles published between January 1, 2012 and January 1, 2021: PubMed, EMBASE, the Cochrane Library, Wanfang, the China National Knowledge Infrastructure, Clinical Trials Database, and the Science Network. Two independent reviewers will carry out data extraction, discuss and resolve differences, and obtain consensus from the third author. We will select randomized control trials (RCTs) according to the preformulated inclusion criteria. The main outcomes in this study are scores from Fried Frailty Phenotype Criteria; the Frailty Trait Scale–short form; the SHARE Frailty Instrument; the FRAIL scale; the Gérontopôle Frailty Screening Tool; the Clinical Frailty Scale, the Rockwood and Mitnitsky Frailty Index; the Study of Osteoporotic Fractures Index; the Edmonton Frailty Scale; the Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index; the Multidimensional Prognostic Index; the Tilburg Frailty Indicator; PRISMA-7; the Groningen Frailty Indicator; the Sherbrooke Postal Questionnaire; and the Kihon Checklist. Secondary outcomes are muscle strength, gait velocity, stair-climbing power, and level of spontaneous physical activity. If the heterogeneity test shows slight or no statistical heterogeneity, a fixed effects model will be used for data synthesis; otherwise, a random effects model will be used. We will develop a unified data extraction table that includes a number of parameters. The Cochrane Cooperative Bias Risk Tool will be used to evaluate the methodological quality of the selected RCTs. RevMan Manager 5.3 and STATA 14.0 will be used for data analysis if enough RCTs (more than 10) are identified and selected.

Result:

The final results will provide information on the effectiveness of intervention programs for frail older adul and further demonstrate which exercise programs are more effective and which methods can significantly improve frailty.

Conclusion:

This protocol will contribute to the development of more effective interventions for elderly individuals with frailty.

Ethics and dissemination:

This study applies existing literature references; therefore, ethical approval is not required.

INPLASY registration number:

INPLASY202130107
m6A regulators are associated with osteosarcoma metastasis and have prognostic significance
Authors: Zhang Wenpeng , Wang Lina , Zhang Ping , Zhang Quanbin
Published: May 2021

Background:

Osteosarcoma represents the most common malignant bone tumor with high metastatic potential and inferior prognosis. RNA methylation (N6-methyladenosine [m6A]) is a prevalent RNA modification that epigenetically influences numerous biological processes including tumorigenesis. This study aims to determine that m6A regulators are significant biomarkers for osteosarcoma, and establish a prognostic model to predict the survival of patients.

Methods:

In this study, we comprehensively analyzed the underlying associations between m6A regulators’ mRNA expressions and metastasis as well as prognosis of osteosarcoma patients in the Cancer Genome Atlas. Multivariate Cox-regression analysis was used to screen regulators that were significantly associated with overall survival of osteosarcoma patients. Least absolute shrinkage and selection operator (LASSO) Cox-regression analysis was used for constructing m6A regulator-based osteosarcoma prognostic signature.

Results:

Some of the regulators exhibited aberrant mRNA levels between osteosarcoma samples with and without metastasis. Multivariate Cox-regression analysis identified several regulators with potential prognostic significance. A risk score formula consisted of methyltransferase-like 3, YTH domains of Homo sapiens, and fat mass and obesity-associated protein was obtained through which patients could be prognostically stratified independently of potential confounding factors. The signature was also significantly associated with the metastatic potential of osteosarcoma. All the analyses could be well reproduced in another independent osteosarcoma cohort from the Gene Expression Omnibus.

Conclusions:

In conclusion, this study first revealed potential roles of m6A regulators in osteosarcoma metastasis and prognosis, which should be helpful for its clinical decision-making.
Mutation analysis of the TNFAIP3 in A20 haploinsufficiency
Authors: Yan Mei , Li Danlu , Aknai Shakan , Zhu Hongtao , Abudureyim Mayila
Published: May 2021

Introduction:

Haploinsufficiency of A20 (HA20) is a novel genetic disease presented by Zhou et al in 2016. A20 is a protein encoded by TNFAIP3. Loss-of-function mutation in TNFAIP3 will trigger a new autoinflammatory disease: HA20. HA20-affected patients may develop a wide range of clinical manifestations, such as Behcet disease, rheumatoid arthritis, rheumatic fever, juvenile idiopathic arthritis, and systemic lupus erythematosus. HA20 is rarely reported, thus remaining far from thoroughly understood. Sixty-one cases of HA20 have been reported worldwide, among which 29 cases were diagnosed with Behcet disease ultimately. Moreover, 3 cases have been reported in China, which was the first report of HA20 characterized by Behcet disease. A comprehensive understanding of the pathogenic genes of HA20 could help us apply targeted therapy as soon as possible to improve patients’ survival rates.

Patient concerns:

A 2-year-old 3-month-old child was presented to our hospital with recurrent infectious enteritis and stomatitis.

Diagnosis:

Genetic mutations were detected immediately, and a novel pathogenic mutation was found in TNFAIP3. A heterozygous mutation (c.436-437deTC) located at TNFAIP3 was confirmed. The present research indicated that the TNFAIP3 mutation of c.436-437deTC (p.L147Qfs∗7) accounted for familial Behcet-like autoinflammatory syndrome in the child suffering from HA20, while no variation in this locus was found in her parents.

Interventions:

Symptomatic treatments including oral administration of prednisone (12.5 mg/d) and iron supplement were performed, and repeated infection was no longer observed in the child. Pain and activity limitation was found in the knee joints. The treatment regimen was adjusted to oral prednisone (12.5 mg/dose, 2 doses/d) and subcutaneous injection of rhTNFR:Fc (12.5 mg/week).

Outcomes: At the last follow-up, the limbs’ activities were normal, the inflammatory indicators were reduced or within the normal range. The prednisone dose was reduced to 7.5 mg/d, while the dose of rhTNFR:Fc was not changed.

Conclusion:

We have identified a novel pathogenic HA20 mutation. In this article, 1 case was analyzed in-depth in terms of clinical manifestations of the patient and new sources of such a novel disease, which might improve our understanding of this disease.
Eccrine poroma presented as spindle-shaped plaque
Authors: Wang Yuqian , Liu Meng , Zheng Yan , Feng Yiguo
Published: May 2021

Rationale:

Eccrine poroma, a benign cutaneous neoplasm originating from the intraepidermal portion of the eccrine sweat duct, is relatively common in clinical practice. Nevertheless, the 1 presenting as spindle-shaped plaque is extremely rare and easily misdiagnosed as seborrheic keratosis or other dermatoses. Thus, the current study demonstrates a case of eccrine poroma with unique clinical manifestation.

Patients concerns:

A 47-year-old man presented with a spindle-shaped plaque on his left sole for 6 years.

Diagnoses:

Based on the clinical and histopathological manifestations, diagnosis of eccrine poroma was established.

Interventions:

Surgical excision under local anesthesia was performed.

Outcomes:

No recurrence or malignant transformation occurred within 6-month follow-up.

Lessons:

Eccrine poroma typically presents as a dome-shaped nodule on palm or sole. But this case reminded us the lesion presenting as a spindle-shaped plaque on sole can not rule out the possibility of eccrine poroma.
Correlation between serum levels of C-reactive protein and neonatal pneumonia
Authors: Li Xiaowen , Chen Zhong
Published: May 2021

Background:

Few studies have reported the correlation between serum levels of C-reactive protein (CRP) and neonatal pneumonia. The purpose of the present meta-analysis was to clarify whether an increased serum level of CRP accelerates the development of neonatal pneumonia.

Methods:

This protocol is conducted according to the preferred reporting items for systematic reviews and meta-analysis protocol (PRISMA-P) statement guidelines. Related articles were identified by searching PubMed, Embase, Cochrane Library, Web of Science, Science Direct, and CNKI databases. Two investigators extracted information according to the selection criteria and used a set of predefined criteria based on the Newcastle–Ottawa Scale (NOS) criteria to assess the studies. All calculations were carried out with Stata 12.0 (Stata Corp, College Station, TX).

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

We hypothesized that a higher serum CRP level is closely correlated with the progression of neonatal pneumonia. CRP as a general systemic inflammation biomarker may help clinicians to make difficult therapeutic decisions for neonatal pneumonia.

Open Science Framework registration number:

10.17605/OSF.IO/RGBMX.
Serum electrolytes and renal alterations in HIV-seropositive Mexican subjects
Authors: Garza Tovar Oscar Antonio , Pérez Alberto Alejandro Miranda , Pérez María Elena Gutiérrez , Robledo Ivonne Urraza , Galarza Faviel F. González , Márquez Francisco Carlos López
Published: May 2021

To examine potential risk factors associated with biochemical alterations in renal function in a population diagnosed with HIV/AIDS undergoing antiretroviral treatment.

This is an observational, transversal, and relational design study that included 179 HIV-seropositive subjects. Glucose serum, cholesterol, triglycerides, total proteins, albumin, creatine, urea, blood urea nitrogen (BUN), and electrolytes levels were determined for each individual. Renal function was evaluated through the glomerular filtration rate (GFR), using the CKD-EPI equation. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate  < 60 mL/min/1.73 m2. Univariate model significant variables, with a 95% confidence interval (CI), were included in a multivariate logistic regression analysis.

CKD prevalence in patients was 7.3%, with comorbidities of 7.8% for type 2 diabetes mellitus, 7.3% for arterial hypertension, and 35.2% for dyslipidemia. Additionally, both hypernatremia and hypophosphatemia were detected in 57% (n = 102) of the patients. Multivariate logistic regression suggested that CD4+ T cell count < 200 (P = .02; OR 0.2; CI 95% 0.08–0.8) was associated to hyponatremia; similarly, detectable viral load was associated to hypokalemia (P = .02; OR 5.1; CI 95% 1.2–21.3), hypocalcemia (P = .01; OR 4.1; CI 95% 1.3–12.3), and hypermagnesemia (OR 3.9; CI 95% 1.1–13.6). Patient age was associated to both hypophosphatemia (P = .01; OR 2.4; CI 95% 1.1–5.0) and hypermagnesemia (P = .01; OR 2.8; IC 95% 1.1–7.0), and high creatinine levels were associated to nucleoside reverse transcriptase inhibitor treatment (P = .001; OR 42.5; CI 95% 2.2–806.9). Lastly, high BUN levels were associated to age (P = .03; OR 3.8; CI 95% 1.0–14.4), while GFR 60 to 89 mL/min/1.73 m2 was associated to dyslipidemia (P = .02; OR 2.2; CI 95% 1.1–4.5).

CD4+ T cell and viral load were the main factors associated with renal biochemical alterations.
Outpatients’ perception of their preoperative information regarding their health literacy skills and their preoperative anxiety level
Authors: Stephanie Chandler-Jeanville , Mathieu Ahouah , Aurore Margat , Monique Monique Rothan-Tondeur
Published: May 2021

Despite the benefits related to ambulatory surgery such as cost reduction due to lack of accommodation and patient satisfaction due to early home return, it may not lead to these expected benefits. Indeed, this kind of practice can increase responsibility for the person being treated and his or her relatives. It is therefore essential to inform them as well as possible to obtain their adherence to the proposed care protocol. Nevertheless, patients’ failures to comply with preoperative instructions or the non-attendance of the patient may result in late cancellation of the scheduled surgery. In order to reduce this kind of dysfunction, the Assistance Publique-Hôpitaux de Paris (APHP) uses a reminder system by Short Message Service (SMS).

This study is a descriptive cross-sectional multicenter study that focuses on outpatients’ lived experiences of their preoperative preparation and information. It aims to collect patients’ perceptions of their ability to follow preoperative instructions received by SMS the day before an operation performed for ambulatory surgery, according to their level of health literacy (HL) and preoperative anxiety. Indeed, poor communication between patients and doctors can contribute to preoperative anxiety, while low health literacy (LHL) can lead to poor understanding of preoperative preparation instructions. Therefore, it seems important to take these 2 criteria into account in this study. This research is designed to interview outpatients undergoing ambulatory surgery in the establishments of APHP. A self-questionnaire will be used for this purpose. The choice of this institution is justified by its decision to use in all care units the reminder of preoperative instructions by SMS.

The main outcome is the perception of outpatients with LHL skills regarding preoperative information provided by doctors.

French ethics review committee (Comité d’Ethique de la Recherche) of the University of Paris has approved the study protocol (IRB 00012020-14). Results from this study will be disseminated through oral communications and a scientific article in an international peer-reviewed journal.

This protocol is registered on researchregistry.com (researchregistry5834). This version number is 1.1 Protocol dated July 22, 2020.
Efficacy and feasibility of deep brain stimulation for patients with depression
Authors: Zhang Hongli , Wang Na , Yu Liping , Zhao Min
Published: May 2021

Background:

Previous meta-analyses have examined the clinical efficacy and acceptability of deep brain stimulation (DBS) compared with sham therapy or paired active therapy. However, the absence of head-to-head clinical trials with some treatment comparisons creates uncertainty for decision makers. Thus, to provide new evidence-based medical evidence for clinical treatment, we undertook a meta-analysis to assess the efficacy and safety of DBS in patients with depression based on high-quality randomized controlled studies.

Methods:

The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. PubMed/Medline and EMBASE will be searched before May 2021 for all studies, using various combinations of the following free text and key terms: deep brain stimulation; depression; random. No language restrictions will be applied. The method of data extraction will follow the approach outlined by the Cochrane Handbook for Systematic Reviews of Interventions. Review Manager software 5.3 is used for the meta-analysis. The quality of randomized trials will be assessed by Cochrane risk of bias tool for randomized controlled trials.

Results:

The results of our review will be reported strictly following the PRISMA criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

OSF registration number:

10.17605/OSF.IO/Q5B3S.
Plasma D-dimer and FDP are promising biomarkers to predict perioperative fibrinolysis and bleeding following primary total joint arthroplasty
Authors: Wang Yan , Xie Jinwei , Pei Fuxing
Published: May 2021

Perioperative bleeding is associated with postoperative hyperfibrinolysis caused by surgical trauma in the setting of total hip and knee arthroplasty (THA/ TKA). The study aimed to clarify the dynamics of postoperative fibrinolytic activity and the values of fibrin degeneration products and thromboelastography (TEG) to guide precisive antifibrinolytic therapy.

Forty three patients undergoing primary unilateral THAs and 40 TKAs were included to the prospective observational cohort study. Venous blood sample at different time points (preoperative, intraoperative, postoperative 6 hours, 12 hours, 24 hours, 48 hours) were drawn to test D-dimer, fibrin (-ogen) degradation products (FDP) and TEG.

The TEG parameters associated with coagulation (R, K, α, MA, and CI) and fibrinolysis (estimate percent lysis and Ly30) were all in normal range although had a higher level than preoperative time (P < .05). The postoperative levels of D-dimer and FDP were higher than preoperative level (P < .05). The dynamics of D-dimer and FDP presented a bimodal pattern, which peaked at 6 hours postoperatively, then remained and decreased until 24 hours, but would rebound at 48 hours postoperatively with smaller amplitude. Moreover, FDP6h (P = .028), D-Dimer6h (P = .044), FDP12h (P = .009), D-dimer12h (P = .007), and FDP48h (P = .016) were all correlated with total blood loss on POD3.

FDP and D-dimer were effective and practical markers for prediction of acute postoperative fibrinolytic activity, which peaked at 6 hours after end of surgery and would maintain for at least 24 hours.
Alterations of bone markers in obese patients with type 2 diabetes after bariatric surgery
Authors: Huang Tzu-Wen , Chen Jing-Yi , Wu Yueh-Lin , Kao Chih-Chin , Yeh Shu-Ching , Lin Yen-Chung
Published: May 2021

Background:

The aim of this study is to evaluate the alterations in bone mineral density and other surrogate markers for osteoporosis in obese patients with type 2 diabetes mellitus (T2DM) who received Roux-en-Y gastric bypass (RYGB) versus medical treatment as control.

Methods:

We searched 4 electronic databases and reference lists of relevant studies for eligible research published before December, 2019. After quality assessment, eligible studies were synthesized for relevant outcomes, including lumbar spine bone mineral density (L-spine BMD) change, total hip BMD change, osteocalcin level, C-terminal telopeptide level, and parathyroid hormone level.

Results:

Three randomized clinical trials and 2 observational studies concerning 307 total obese T2DM patients were included. Follow-up ranged from 12 to 60 months. Patients underwent RYGB surgery were associated with both higher L-spine BMD loss (mean difference: −2.90, 95% CI: −2.99∼−2.81, P < .00001) and total hip BMD loss (mean difference: −5.81, 95% CI: −9.22∼−2.40, P = .0008). As to biochemical markers of bone metabolism, we found significantly higher osteocalcin level in medical treatment (control) group compared with RYGB group (mean difference: 11.16, 95% CI: 8.57–13.75, P < .00001). However, higher C-terminal telopeptide level and parathyroid hormone level were noted in medical treatment group (control) compared with RYGB group (mean difference: 0.29, 95% CI: 0.11–0.48, P = .002; mean difference: 1.56, 95% CI: 0.84–2.27, P < .0001).

Conclusions:

RYGB surgery is associated with negative impact on bone metabolism and increase the risk of osteoporosis in obese patients with T2DM. We suggest that clinicians acknowledge the adverse effects of surgery and keep monitoring bone mineral components in post-RYGB populations. Further studies regarding the optimal amount of perioperative and postsurgical supplementation should be evaluated.
An unusual case of familial Mediterranean fever complicated with protracted peritonitis
Authors: Matsumoto Haruki , Fujita Yuya , Asano Tomoyuki , Sato Shuzo , Temmoku Jumpei , Yashiro-Furuya Makiko , Matsuoka Naoki , Watanabe Hiroshi , Suzuki Eiji , Migita Kiyoshi
Published: May 2021

Introduction:

Familial Mediterranean fever (FMF) is a genetic autoinflammatory disease characterized by acute and recurrent attacks of fever and serosal inflammation. These attacks are usually of short duration (24–72 hours) and associated with acute serositis.

Patient concerns:

We describe the case of a 46-year-old male patient with FMF whose dominant clinical features were recurrent peritonitis and fever.

Diagnosis:

During the previous five years, he had intermittent peritoneal attacks with abdominal rigidity that persisted for > 1 week, even with colchicine treatment. Although a MEFV gene analysis revealed no MEFV mutation or polymorphisms, the diagnosis of incomplete FMF was confirmed using the criteria by Livneh et al.

Intervention:

Recurrent, prolonged, and unresolved abdominal pain was refractory to nonsteroidal anti-inflammatory drugs or opioids and occurred even with preventive colchicine treatment. We started the patient on subcutaneous injections of 150-mg canakinumab at 4-week intervals.

Outcomes:

Fever and protracted peritonitis were resolved promptly after the induction of canakinumab treatment. Febrile or peritoneal attacks did not occur during the 13 months of maintenance treatment with canakinumab (150 mg, every 4 weeks).

Conclusion:

We present an unusual case of protracted FMF-mediated peritonitis with excellent response to canakinumab but not to colchicine. Colchicine treatment is usually prescribed in FMF cases and can prevent recurrences of fever and abdominal attacks, including peritoneal inflammation. Recent clinical trials have shown that anti-interleukin-1 treatment is the best therapeutic option for patients with colchicine-resistant FMF. Clinicians should consider FMF in the differential diagnosis of prolonged peritonitis that is resistant to colchicine, even in the subgroup of FMF patients without MEFV mutations.
68Ga-PSMA-I&T-PET/CT interobserver and intraobserver agreement for prostate cancer: a lesion based and subregional comparison study among observers with different levels of experience
Authors: Soyluoglu Selin , Korkmaz Ulku , Ozdemir Busra , Ustun Funda , Durmus-Altun Gulay
Published: May 2021

Objective

68Ga-PSMA-PET/CT is a relatively new technique, that is rapidly becoming widespread. We aimed to contribute interobserver–intraobserver agreement of 68Ga-PSMA-PET/CT, among low/high-experienced interpreters.

Methods

68Ga-PSMA-PET/CT of 56 patients with prostate cancer were evaluated blindly by four observers. Visual interpretation of malignant disease and SUVmax for lymph node (LN) regions, local tumor, bones and visceral organs were recorded. Cohen’s Kappa and Fleiss’ Kappa analyses were used to measure agreement between low/high/all-experienced observers. Variations were compared for regions, and the effect of prostate-specific antigen or Gleason score on the results was investigated.

Results

Interobserver agreement was almost perfect for all LN regions (LN1 low-experienced κ: 0.84/0.84, high-experienced 0.89/0.96; LN2 low-experienced κ: 0.88/0.79, high-experienced 0.95/0.95; LN3 low-experienced κ: 0.84/0.89, high-experienced 0.87/0.94, first/second readings, respectively) and bone lesions (low-experienced κ: 0.88/0.88, high-experienced 0.92/0.92, first/second readings, respectively). For local tumor, interobserver agreement was substantially-almost perfect among a high-experienced group (κ: 0.74/0.89, first/second readings, respectively), and was moderate-substantial among a low-experienced group (κ: 0.62/0.56, first/second readings, respectively). Intraobserver agreement was almost perfect for three observers for all regions and substantial for the observer with the lowest experience in LN3, local and visceral lesions (κ: 0.74/0.79/0.62, respectively).

Conclusion

Interpretation of prostate-specific membrane antigen (PSMA) for prostate cancer is acceptably consistent among observers, but some details are noteworthy. The evaluation should be done more algorithmically for local tumors, since all observers showed relatively lower agreement. The agreement increased as prostate-specific antigen and Gleason score increased. The observer with PSMA experience <30 readings showed lower reliability, distinct from the others. This indicates that although a reader may be familiar with other PET agents, a more consistent interpretation of 68Ga-PSMA-PET/CT requires training with a small number of identified cases.
Bacteremia in Febrile, Non-neutropenic, and Well-appearing Children With Cancer
Authors: Beauchemin Melissa , Marshall Alison F. , Ricci Angela M. , Lopez Ibis D. , Yao Yujing , Lee Alice , Jin Zhezhen , Sulis Maria L.
Published: May 2021

Fever in a neutropenic pediatric oncology patient requires prompt assessment due to the risk of infectious complications. The appropriate management of fever in non-neutropenic patients, however, is not well-established. We describe the rate of bacteremia in a cohort of non-neutropenic pediatric oncology patients with fever at a large institution. Patients were included if they presented to the emergency department or outpatient clinic between 2009 and 2014 with fever, had a central venous catheter (CVC), and were not neutropenic. Three hundred eighty-six episodes of fever occurring in 159 patients were included in the data analysis. Fifty-nine percent of patients were male, 41% had a diagnosis of acute lymphoblastic leukemia, and 90% had a port-a-cath as CVC. The rate of bacteremia was 3.4%; presence of a port-a-cath was protective against bacteremia whereas a white blood cell count >20,000/mm3 was associated with a higher likelihood of bacteremia. Gram-positive microorganisms were most commonly isolated (64.3%) and frequently resistant to cephalosporins. In summary, in our study, the rate of bacteremia was low among non-neutropenic, well-appearing pediatric cancer patients with a CVC and was not associated with any serious medical complications. Prospective research is needed to determine the most appropriate management of these patients.
Sequential Therapy of Inotuzumab Ozogamicin and Blinatumomab as a Bridge-to Hematopoietic Stem Cell Transplantation in a Pediatric Patient With Primary Refractory Acute Lymphoblastic Leukemia: A Case Report
Authors: Uchida Eriko , Kurata Takashi , Komori Kazutoshi , Kobayashi Jun , Kubota Noriko , Sakashita Kazuo
Published: May 2021

For relapsed/refractory (r/r) acute lymphocytic leukemia (ALL), there is a clinical question on how to combine blinatumomab and inotuzumab ozogamicin (InO), which are newly emerging immunotherapeutic agents, with conventional treatment. We report the case of an 11-year-old boy with B-cell ALL, who had a failed primary treatment and achieved molecular complete remission treated with a sequence therapy of InO and blinatumomab. Later, hematopoietic stem cell transplantation could be performed without major complications. Our case may suggest that the sequence therapy of InO and blinatumomab as a bridge-to hematopoietic stem cell transplantation could be effective in the treatment of pediatric r/r ALL.