bluuebunny/crossref_metadata_2025 huggingface dataset:
Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres
Authors: Basile Carlo , Combe Christian , Pizzarelli Francesco , Covic Adrian , Davenport Andrew , Kanbay Mehmet , Kirmizis Dimitrios , Schneditz Daniel , van der Sande Frank , Mitra Sandip
Published: March 2020

COVID-19, a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. This novel coronavirus has specifically high morbidity in the elderly and in comorbid populations. Uraemic patients on dialysis combine an intrinsic fragility and a very frequent burden of comorbidities with a specific setting in which many patients are repeatedly treated in the same area (haemodialysis centres). Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under exceptional additional strain. Therefore, all measures to slow if not to eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. The aim of the present review of the European Dialysis (EUDIAL) Working Group of ERA-EDTA is to provide recommendations for the prevention, mitigation and containment in haemodialysis centres of the emerging COVID-19 pandemic. The management of patients on dialysis affected by COVID-19 must be carried out according to strict protocols to minimize the risk for other patients and personnel taking care of these patients. Measures of prevention, protection, screening, isolation and distribution have been shown to be efficient in similar settings. They are essential in the management of the pandemic and should be taken in the early stages of the disease.
Gabriel–Roiter Measure, Representation Dimension and Rejective Chains
Authors: Conde Teresa
Published: March 2020

The Gabriel–Roiter measure is used to give an alternative proof of the finiteness of the representation dimension for Artin algebras, a result established by Iyama in 2002. The concept of Gabriel–Roiter measure can be extended to abelian length categories and every such category has multiple Gabriel–Roiter measures. Using this notion, we prove the following broader statement: given any object $X$ and any Gabriel–Roiter measure $\mu$ in an abelian length category $\mathcal{A}$, there exists an object $X^{\prime}$ that depends on $X$ and $\mu$, such that $\Gamma =\operatorname{End}_{\mathcal{A}}(X\oplus X^{\prime})$ has finite global dimension. Analogously to Iyama’s original results, our construction yields quasihereditary rings and fits into the theory of rejective chains.
Clinical and imaging characteristics of osteitis condensans ilii as compared with axial spondyloarthritis
Authors: Poddubnyy Denis , Weineck Henning , Diekhoff Torsten , Redeker Imke , Gobejishvili Nino , Llop Maria , Rodriguez Valeria Rios , Proft Fabian , Protopopov Mikhail , Haibel Hildrun , Sieper Joachim , Hermann Kay Geert A
Published: March 2020

Objectives

Osteitis condensans ilii (OCI) has become an important differential diagnosis for axial spondyloarthritis (axSpA). The objective of this matched case–control study was to investigate demographic, clinical, laboratory and MRI characteristics of OCI as compared with axial spondyloarthritis (axSpA).

Methods

A total of 60 patients diagnosed with OCI were included in the final analysis. From 27 of these patients, MRIs of the sacroiliac joints were available. OCI patients were matched with a 1:1 ratio by back pain duration to patients with definite axSpA in order to compare clinical, laboratory and MRI characteristics.

Results

The OCI patients were nearly all females (96.7 vs 46.7%), had a significantly lower prevalence of inflammatory back pain (39.5 vs 88.9%), a significantly lower percentage of HLA-B27 positives (35.2 vs 80.0%) and a lower prevalence of the majority of other SpA features as compared with axSpA patients. Interestingly, there was no difference in the prevalence of osteitis in the sacroiliac joints (92.6 vs 85.2% in OCI and axSpA, respectively, P = 0.44), but there was a difference in the prevalence of erosions (7.4 vs 66.7%, respectively, P = 0.0001). In addition, in OCI nearly all lesions were localized in the anterior part of the sacroiliac joints while in axSpA lesions were localized predominantly in the middle part of the joint (for osteitis: 96 vs 4% in OCI and 28.6 vs 71.4% in axSpA; P = 0.0002 for the inter-group difference).

Conclusion

Clinical and imaging features of OCI compared with axSpA are described that should help in differential diagnosis.
Interaction of Cannabis Use Disorder and Striatal Connectivity in Antipsychotic Treatment Response
Authors: Blair Thies Melanie , DeRosse Pamela , Sarpal Deepak K , Argyelan Miklos , Fales Christina L , Gallego Juan A , Robinson Delbert G , Lencz Todd , Homan Philipp , Malhotra Anil K
Published: March 2020

Antipsychotic (AP) medications are the mainstay for the treatment of schizophrenia spectrum disorders (SSD), but their efficacy is unpredictable and widely variable. Substantial efforts have been made to identify prognostic biomarkers that can be used to guide optimal prescription strategies for individual patients. Striatal regions involved in salience and reward processing are disrupted as a result of both SSD and cannabis use, and research demonstrates that striatal circuitry may be integral to response to AP drugs. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the relationship between a history of cannabis use disorder (CUD) and a striatal connectivity index (SCI), a previously developed neural biomarker for AP treatment response in SSD. Patients were part of a 12-week randomized, double-blind controlled treatment study of AP drugs. A sample of 48 first-episode SSD patients with no more than 2 weeks of lifetime exposure to AP medications, underwent a resting-state fMRI scan pretreatment. Treatment response was defined a priori as a binary (response/nonresponse) variable, and a SCI was calculated in each patient. We examined whether there was an interaction between lifetime CUD history and the SCI in relation to treatment response. We found that CUD history moderated the relationship between SCI and treatment response, such that it had little predictive value in SSD patients with a CUD history. In sum, our findings highlight that biomarker development can be critically impacted by patient behaviors that influence neurobiology, such as a history of CUD.
Psychosocial Intervention With or Without Antipsychotic Medication for First-Episode Psychosis: A Randomized Noninferiority Clinical Trial
Authors: Francey Shona M , O’Donoghue Brian , Nelson Barnaby , Graham Jessica , Baldwin Lara , Yuen Hok Pan , Kerr Melissa J , Ratheesh Aswin , Allott Kelly , Alvarez-Jimenez Mario , Fornito Alex , Harrigan Susy , Thompson Andrew D , Wood Stephen , Berk Michael , McGorry Patrick D
Published: March 2020

This triple-blind (participants, clinicians, and researchers) randomized controlled noninferiority trial examined whether intensive psychosocial intervention (cognitive-behavioral case management, CBCM) for first-episode psychosis (FEP) in 15–25 year-olds managed in a specialized early intervention for psychosis service was noninferior to usual treatment of antipsychotic medication plus CBCM delivered during the first 6 months of treatment. To maximize safety, participants were required to have low levels of suicidality and aggression, a duration of untreated psychosis (DUP) of less than 6 months, and be living in stable accommodation with social support. The primary outcome was level of functioning as assessed by the Social and Occupational Functioning Scale (SOFAS) at 6 months. Ninety young people were randomized by computer, 46 to placebo, and 44 antipsychotic medication and 33% of those who commenced trial medication completed the entire 6-month trial period. On the SOFAS, both groups improved, and group differences were small and clinically trivial, indicating that treatment with placebo medication was no less effective than conventional antipsychotic treatment (mean difference = −0.2, 2-sided 95% confidence interval = −7.5 to 7.0, t = 0.060, P = .95). Within the context of a specialized early intervention service, and with a short DUP, the immediate introduction of antipsychotic medication may not be required for all cases of FEP in order to see functional improvement. However, this finding can only be generalized to a very small proportion of FEP cases at this stage, and a larger trial is required to clarify whether antipsychotic-free treatment can be recommended for specific subgroups of those with FEP.

Trial Registration: ACTRN12607000608460 (www.anzctr.org.au).
In Utero and Lactational Exposure to Flame Retardants Disrupts Rat Ovarian Follicular Development and Advances Puberty
Authors: Allais Adélaïde , Albert Océane , Lefèvre Pavine L C , Wade Michael G , Hales Barbara F , Robaire Bernard
Published: March 2020

Brominated flame retardants (BFRs), including polybrominated diphenyl ethers and hexabromocyclododecane, leach out from consumer products into the environment. Exposure to BFRs has been associated with effects on endocrine homeostasis. To test the hypothesis that in utero and lactational exposure to BFRs may affect the reproductive system of female offspring, adult female Sprague Dawley rats were fed diets formulated to deliver nominal doses (0, 0.06, 20, or 60 mg/kg/day) of a BFR dietary mixture mimicking the relative congener levels in house dust from prior to mating until weaning. Vaginal opening and the day of first estrus occurred at a significantly earlier age among offspring from the 20 mg/kg/day BFR group, indicating that the onset of puberty was advanced. Histological analysis of ovaries from postnatal day 46 offspring revealed an increase in the incidence of abnormal follicles. A toxicogenomic analysis of ovarian gene expression identified upstream regulators, including HIF1A, CREB1, EGF, the β-estradiol, and PPARA pathways, predicted to be downregulated in the 20 or 60 mg/kg/day group and to contribute to the gene expression patterns observed. Thus, perinatal exposure to BFRs dysregulated ovarian folliculogenesis and signaling pathways that are fundamental for ovarian function in the adult.
Recommended Surgical Margins for Basal Cell Carcinoma: Is 3 mm Safe Enough?
Authors: Ünverdi Ömer Faruk , Yücel Sercan , Berk Osman Serdar
Published: March 2020

OBJECTIVE

The primary aim of treatment of basal cell carcinoma (BCC) is the complete excision of the tumor. Reconstruction of the defect after surgical excision varies, depending on the location and size of the defect and the skin to be used in the reconstruction. In this study, investigators compared the rates of tumor positivity at the edges of BCC specimens excised with 3- or 5-mm surgical margins.

METHODS

Researchers analyzed data related to 113 patients with a preliminary diagnosis of BCC between August 2016 and June 2018. In total, 99 lesions from 91 patients not exceeding 2 cm in size excised with 3-mm (n = 53) or 5-mm (n = 46) surgical margins were included. Statistical analysis was performed using the χ
2 test.

RESULTS

After histopathologic assessment, 3 of 53 lesions that were excised with 3-mm surgical margins had a positive surgical margin, whereas none of the 46 lesions excised with 5-mm margins indicated a positive tumor presence. However, there was no statistical difference between the groups.

CONCLUSIONS

A 3-mm surgical margin may be sufficient and safe for BCC excision.
Ensuring accurate BP measurements
Authors: Matheson Emily , Kremer Michael , Fogg Louis , Crisanti Gia
Published: March 2020

Accurate BP measurements are vital for determining appropriate medication and treatment regimens. This article describes a quality improvement project to increase compliance with the American Heart Association's guidelines for BP measurement.
Local anesthetic with sedation is a viable alternative to general anesthesia for lumbar spinal decompressions: A retrospective cohort feasibility study and short-term analysis of outcomes
Authors: Ziino Chason , Guzman Roberto A. , Koltsov Jayme , Montgomery Blake K. , McMains Craig , Alamin Todd
Published: March 2020

Background:

An increasing focus on value-based care in spine surgery has prompted interest in alternative anesthetics. Avoidance of general anesthesia (GA) has gained support due to reductions in postoperative symptoms. Little has been published on local anesthesia with sedation techniques.

Methods:

A retrospective chart review was performed to compare outcomes of lumbar decompression using local anesthesia with light intravenous sedative (LIS) and lumbar decompression using general anesthesia. Outcomes reported were 90-day adverse events, reoperations, and narcotic use.

Results:

A total of 65 patients who underwent lumbar decompression were identified. Patients receiving LIS were older and had more comorbidities compared with those receiving GA. Rates of peripheral vascular disease and peptic ulcer disease were higher in patients receiving LIS (P=0.004 and 0.012, respectively). The overall rate of postoperative adverse events was 30% lower in patients with LIS. There were no aborted procedures in the LIS cohort. Rates of reoperation trended towards being lower in LIS (14.3%) versus the GA group (37.8%). There was no difference in postoperative narcotic use (LIS 17.9%, GA 24.3%, P=0.530). After adjusting for age, gender, body mass index, Charlson Comorbidity Index, and peripheral vascular disease, the rate of adverse events remained lower in the LIS group (odds ratio: 0.166 [95% CI: 0.037, 0.617], P=0.011), and the trends towards lower rates of recurrent stenosis (P=0.082) and reoperation (P=0.082) remained. There was still no difference in the rate of postoperative narcotic use beyond the first follow-up (P=0.542).

Conclusions:

Lumbar spinal decompressions are commonly performed surgeries, and they are increasingly being performed in outpatient settings. We conclude that LIS is a safe alternative to GA. Further work is needed to identify cost savings in LIS spine surgery and define patient characteristics that identify appropriate candidates.

Level of Evidence:

Level III.
Cast application techniques for common pediatric injuries: A review
Authors: Sabeh Karim , Aiyer Amiethab , Summers Spencer , Hennrikus William
Published: March 2020

Casting has become a lost art. Cast immobilization remains the mainstay of fracture treatment in the pediatric population. The purpose of a cast is to immobilize and hold the fracture in proper alignment while minimizing the functional impairment of the limb. Basic understanding of multiple cast types is obligatory for practitioners with exposure to pediatric trauma. This article aims to update the readers and allow them to improve their cast application techniques for common pediatric fractures as well as cast removal skills, resulting in safe and satisfactory fracture outcomes with minimal complications.
Variations in arterial pedal circulation in idiopathic congenital talipes equinovarus: a systematic review
Authors: Puri Aiysha M.C. , Hughes Katie P. , Stenson Katherine M. , Gelfer Yael , Holt Peter J.E. , Patterson Benjamin O.
Published: March 2020

Variations in pedal circulation in congenital talipes equinovarus (CTEV) are well documented. There is a reported risk of vascular injury to the posterior tibial artery (PTA) during operative procedures for CTEV, potentially leading to necrosis and amputation. The aim of this systematic review was to identify the most common anomalies in arterial pedal circulation in CTEV and to determine the relevance of these to clinical practice. The systematic review was registered on PROSPERO and was carried out according to Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines by two independent reviewers. Studies that examined pedal circulation in idiopathic CTEV were included. Articles that studied nonidiopathic CTEV and those not published in English were excluded. Data extracted included patient demographics, imaging modalities, and findings. A total of 14 articles satisfied the inclusion criteria, including 192 patients (279 clubfeet), aged 0–13.5 years, at various stages in their treatment. Imaging modalities included arteriography (n = 5), duplex ultrasound (n = 5), magnetic resonance angiography (n = 2), and direct visualization intraoperatively (n = 2). The dorsalis pedis was most frequently reported as absent (21.5%), and the anterior tibial artery (ATA) was most frequently reported as hypoplastic (18.3%). Where reported (n = 36 feet), 61% of patients were noted to have a dominant supply from the PTA. The most common variation in pedal circulation in CTEV is diminished supply from ATA and dorsalis pedis, although there are documented anomalies in all of the vessels supplying the foot. We therefore recommend routine Doppler ultrasound imaging prior to operative intervention in CTEV.
Challenges and opportunities in the management of metastatic renal cell carcinoma: combination therapy and the role of cytoreductive surgery
Authors: Patel Hiren V. , Shinder Brian , Srinivasan Ramaprasad , Singer Eric A.
Published: March 2020

Purpose of review

As the biology of metastatic renal cell carcinoma (mRCC) continues to be elucidated, novel treatments focused around immunotherapies and targeted therapies will continue to emerge. In this review, we will highlight recent treatment advances and their implications for surgical and systemic therapy.

Recent findings

Several new treatments, including the tyrosine kinase inhibitor cabozantinib, the combination of a programmed cell death protein 1 antibody (nivolumab) with a cytotoxic T-lymphocyte-associated antigen 4 antibody (ipilimumab), and the combination of axitinib with pembrolizumab or avelumab have been approved by the US Food and Drug Administration as first-line therapy for the treatment of mRCC. Although promising survival benefits have been seen with these new therapies, careful patient selection is still critical.

The introduction of novel therapies and the investigation of combinatorial therapies have shifted the treatment paradigm for advanced RCC. Present trials have provided promising data that could lead to further therapeutic advances.
The mKATP Channels and protein-kinase C Are Involved in the Cardioprotective Effects of Genistein on Estrogen-Deficient Rat Hearts Exposed to Ischemia/Reperfusion: Energetic Study
Authors: Colareda Germán A. , Ragone María Inés , Bonazzola Patricia , Consolini Alicia E.
Published: March 2020

Estrogenic deficiency is considered a risk of coronary disease in women. The phytoestrogen genistein could be a safe preventive strategy. The first aim of this work was to validate a model of cardiac stunning in which natural estrogenic deficiency rats, ie, adult young male (YM) and aged female (AgF), are compared with young female rats (YF). The second aim was to study whether the in vivo administration of genistein prevents the stunning in estrogenic deficiency rats. The third aim was to evaluate whether in our estrogenic deficiency model exists a synergy between genistein and estradiol. The fourth aim was to characterize the underlying mechanisms of genistein. Stunning was induced by ischemia/reperfusion (I/R) in isolated hearts inside a calorimeter. The left ventricular pressure (P) and total heat rate (Ht) were simultaneously measured, while diastolic contracture and muscle economy (P/Ht) were calculated. During R, P/Ht and P recovered less in AgF and YM than in YF rat hearts. Genistein through i.p. (GST-ip) improved P and P/Ht in AgF and YM, but not in YF. In YM, the cardioprotections of GST-ip and estradiol were synergistic. After ischemia, GST-ip increased SR Ca2+ leak causing diastolic contracture. The GST-ip cardioprotection neither was affected by blockade of PI3K-Akt, NO synthases, or phosphatases, but it was sensitive to blockade of protein-kinase C and mKATP channels. Results suggest that (1) estrogenic deficiency worsens cardiac stunning, (2) GST-ip was more cardioprotective in estrogenic deficiency and synergistic with estradiol, and (3) cardioprotection of GST-ip depends on the protein-kinase C and mKATP channel pathway activation.
Adipose Tissue-preserved Skin Grafts for Lower Extremity Defects: Recommendations to Optimize Outcomes
Authors: Van Kouwenberg Emily A. , Chiu David T. W.
Published: March 2020

Background:

Adipose tissue-preserved skin grafts (ATPSGs) are full-thickness skin grafts with inclusion of a thin layer of adipose tissue. ATPSGs are recommended for reconstruction of anatomic areas that are cosmetically sensitive and for areas that functionally benefit from additional soft tissue thickness compared to traditional skin grafts. Careful intraoperative technique and postoperative care are mandatory for ATPSG success, given the expected higher metabolic demands compared to traditional grafts. A strict postoperative protocol is especially important after reconstruction of lower extremity defects.

Methods:

Detailed descriptions of intraoperative and postoperative care for ATPSG reconstructions are provided. A case is presented displaying lower extremity reconstruction with an ATPSG. The intraoperative technique includes meticulous hemostasis of the recipient site, atraumatic handling of recipient skin edges, anatomical epidermal-to-epidermal reapproximation, avoidance of tissue strangulation during inset, and careful bolster placement. The postoperative protocol after lower extremity reconstruction includes strict elevation, non-weight-bearing status, and eventual dangle protocol.

Results:

An 85-year-old woman was treated with an ATSG for a middle-third leg resection of squamous cell carcinoma resulting in a 9 × 5 cm defect. The strict postoperative protocol was initiated, but the patient was noncompliant with elevation and weight-bearing restrictions. She had postoperative congestion and epidermolysis that was treated with local wound care without need for additional surgery.

Conclusions:

There are many benefits to ATPSG reconstruction when chosen for the appropriate candidate. The meticulous technique and strict adherence to the postoperative protocol are crucial when these reconstructions are performed. Detailed descriptions of intraoperative and postoperative recommendations to optimize outcomes after ATPSG are presented.
Associations between ideal blood pressure based on different BMI categories and stroke incidence
Authors: Zheng Liqiang , Xie Yanxia , Zheng Jia , Guo Rongrong , Wang Yali , Dai Yue , Sun Zhaoqing , Xing Liying , Zhang Xingang , Sun Yingxian
Published: March 2020

Objectives:

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for high blood pressure (BP) in adults redefined hypertension as SBP at least 130 mmHg or DBP at least 80 mmHg. However, the optimal BP for different BMI population to reduce stroke incidence is uncertain.

Methods:

A prospective cohort study was designed by four examinations: baseline (2004–2006), 2008, 2010 and 2017 follow-up. The study group composed of 36 352 individuals, to determine the ideal BP range to reduce stroke incidence of two BMI level, adjusted Cox proportional hazards models were utilized to establish the associations between SBP/DBP and the risk of stroke incident. Then, the restricted cubic spline regression was applied to find the ideal range of SBP/DBP values for two kinds of BMI categories definitions.

Results:

During a median follow-up period of 12.5 years, 2548 (7.0%) nonstroke individuals at baseline developed incident stroke. After fully adjusting confounding factors, SBP (per 20 mmHg increase) and DBP (per 10 mmHg increase) are independently associated with the risk of stroke incidence [SBP, hazard ratio = 1.277, 95% confidence interval (95% CI), 1.217–1.340, P < 0.001; DBP, hazard ratio = 1.138, 95% CI, 1.090–1.189, P < 0.001].

Conclusion:

Our study revealed that the ideal BP for a population with BMI less than 24 kg/m2 was less than 130/80 mmHg, whereas the ideal BP for BMI at least 24 kg/m2 was less than 120/80 mmHg. The sensitivity analyses between BMI less than 25 kg/m2 and BMI at least 25 kg/m2 showed similar findings. This finding provides more accurate primary prevention strategies based on various BMI populations.
EPIRETINAL FIBROSIS REMOVAL IN AN ARGUS II–IMPLANTED EYE
Authors: Patelli Fabio , Falleni Monica , Colombo Leonardo , Martinelli Carla , Tosi Delfina , Bulfamante Gaetano , Rossetti Luca
Published: March 2020

Purpose:

1) To investigate morphologic and histochemical characteristics of an epiretinal fibrosis removed in an Argus II–implanted eye; 2) to evaluate the Argus II function before and after the fibrosis removal, and 3) to compare morphologic and functional data.

Methods:

Fibrosis, which developed between the Argus II prosthesis and the retina two years after implant, was surgically removed. Its morphologic and histochemical characteristics were evaluated both in light and transmission electron microscopy, with special stains and immunohistochemistry. The Argus II function was evaluated during the follow-up before surgical removal and 1 month later.

Results:

Fibrosis was successfully removed. It was composed of a fibrotic tissue with spindle cells arranged in nodular aggregates with a symmetric distribution, mixed with an inflammatory infiltrate. Extra- and intracellular, irregular, small iron particles were found and confirmed ultrastructural characterization with degenerative cellular changes. The repositioned Argus II restored, and its function was partially nearly to normal values 1 month after surgery.

Conclusion:

Fibrosis can develop between the Argus II and the retina with increasing reduced function. Morphologic characteristics of the removed fibrosis suggested a pathogenesis based on an inflammatory process involved in a foreign body reaction with progressing connective tissue deposition leading to sclerosis. Adequate clinical follow-up is critical to successful removal of the fibrosis with reactivation of the Argus II function.
Physical disuse contributes to widespread chronic mechanical hyperalgesia, tactile allodynia, and cold allodynia through neurogenic inflammation and spino-parabrachio-amygdaloid pathway activation
Authors: Ohmichi Yusuke , Ohmichi Mika , Tashima Ryoichi , Osuka Koji , Fukushige Kaori , Kanikowska Dominika , Fukazawa Yugo , Yawo Hiromu , Tsuda Makoto , Naito Munekazu , Nakano Takashi
Published: March 2020

Physical disuse could lead to a state of chronic pain typified by complex regional pain syndrome type I due to fear of pain through movement (kinesiophobia) or inappropriate resting procedures. However, the mechanisms by which physical disuse is associated with acute/chronic pain and other pathological signs remain unresolved. We have previously reported that inflammatory signs, contractures, disuse muscle atrophy, spontaneous pain-like behaviors, and chronic widespread mechanical hyperalgesia based on central plasticity occurred after 2 weeks of cast immobilization in chronic post-cast pain (CPCP) rat model. In this study, we also demonstrated dystrophy-like changes, both peripheral nociceptive signals and activation of the central pain pathway in CPCP rats. This was done by the following methods: (1) vascular permeability (Evans blue dye) and inflammatory- and oxidative stress-related messenger RNA changes (real-time quantitative polymerase chain reaction); (2) immunofluorescence of pERK and/or c-Fos expression in the spino-parabrachio-amygdaloid pathway; and (3) blockade of nociceptive-related signals using sciatic nerve block. Furthermore, we demonstrated tactile allodynia using an optogenetic method in a transgenic rat line (W-TChR2V4), cold allodynia using the acetone test, and activation of dorsal horn neurons in the chronic phase associated with chronic mechanical hyperalgesia using c-Fos immunofluorescence. In addition, we showed that nociceptive signals in the acute phase are involved in chronic pathological pain-like behaviors by studying the effects of sciatic nerve block. Thus, we conclude that physical disuse contributes to dystrophy-like changes, spontaneous pain-like behavior, and chronic widespread pathological pain-like behaviors in CPCP rats after 2 weeks of cast immobilization.
Increasing gender differences in the prevalence and chronification of orofacial pain in the population
Authors: Häggman-Henrikson Birgitta , Liv Per , Ilgunas Aurelia , Visscher Corine M. , Lobbezoo Frank , Durham Justin , Lövgren Anna
Published: March 2020

Although a fluctuating pattern of orofacial pain across the life span has been proposed, data on its natural course are lacking. The longitudinal course of orofacial pain in the general population was evaluated using data from routine dental check-ups at all Public Dental Health services in Västerbotten, Sweden. In a large population sample, 2 screening questions were used to identify individuals with pain once a week or more in the orofacial area. Incidence and longitudinal course of orofacial pain were evaluated using annual data for 2010 to 2017. To evaluate predictors for orofacial pain remaining over time, individuals who reported pain on at least 2 consecutive dental check-ups were considered persistent. A generalized estimating equation model was used to analyze the prevalence, accounting for repeated observations on the same individuals. In total, 180,308 individuals (equal gender distribution) were examined in 525,707 dental check-ups. More women than men reported orofacial pain (odds ratio 2.58, 95% confidence interval [CI] 2.48-2.68), and there was a significant increase in the prevalence of reported pain from 2010 to 2017 in both women and men. Longitudinal data for 135,800 individuals were available for incidence analysis. Women were at higher risk of both developing orofacial pain (incidence rate ratio 2.37; 95% CI 2.25-2.50) and reporting pain in consecutive check-ups (incidence rate ratio 2.56; 95% CI 2.29-2.87). In the northern Swedish population studied, the prevalence of orofacial pain increases over time and more so in women, thus indicating increasing differences in gender for orofacial pain.
A Dynamic System Based Model for Reducing Medical Laboratory Turnaround Time in Developing Countries
Authors: Bastawi Abeer M. H. , Sayed Ahmed M. , Eldosoky Mohamed A. A.
Published: March 2020

Medical laboratory turnaround time (TAT) is the total time consumed by the medical laboratory to complete a testing cycle and make the result available. Turnaround time is determined by 3 main stages: the preanalytical, analytical, and postanalytical times. The goal of this work is to analyze and reduce TAT in developing countries as a complete process starting from when the sample was drawn until delivery of the result to the requesting physician. This study covered healthcare facilities in Egypt as a sample of developing countries. A dynamic system simulation model was used in this work. This model was designed to reduce TAT by studying the 8 most critical parameters that affect TAT. A causal loop diagram was developed using real laboratory data collected from 15 different hospitals in Egypt. The 8 key parameters are number of samples, number of equipment, total staff count, staff performance, environmental conditions, preanalytical and postanalytical time, equipment defect increase rate, and number of rack samples. The results showed that TAT is directly proportional with number of samples, preanalytical and postanalytical time, and equipment defects. The results also showed that TAT is inversely proportional with the other key parameters. This study highlights the need for continuous improvement and focuses on the environment surrounding the analysis process in a medical laboratory where TAT was reduced by about 70% and patient satisfaction increased, which are less costly and an applicable solutions in developing countries.
Safety of Use of Clozapine in Patients With Schizophrenia With Comorbid Diabetes Mellitus
Authors: Grover Sandeep , Verma Meha , Chakrabarti Subho
Published: March 2020

Purpose/Background

To evaluate the outcome of diabetes mellitus among patients of schizophrenia who had diabetes mellitus before starting clozapine.

Methods

Clozapine data were screened to detect the patients who had diabetes mellitus before starting clozapine. Those who had diabetes mellitus before starting clozapine were taken up for the study.

Results

Of the 468 records screened, 28 patients (5.6%) had diabetes mellitus before starting clozapine. Among the 28 patients, 15 (53.6%) were females, and 13 (46.4%) were male. In three-fourths (75%) of the patients, clozapine was started while these patients were admitted to the inpatient unit. Twenty-six patients had type 2 diabetes mellitus and 2 patients had type 1 diabetes mellitus at the time of starting clozapine. Most patients also had deranged blood glucose levels at the time of starting clozapine and required close monitoring of blood glucose levels and also starting/continuation of antidiabetic medications. None of the patients developed diabetic ketoacidosis during the initial part of the treatment. At the mean follow-up duration of 16 months, most patients were on regular follow-up for more than 1 year, and their blood glucose levels were maintained close to the reference range. Majority of these patients showed good response to clozapine.

Conclusions

The present study suggests that presence of diabetes mellitus should not stop the clinicians to use clozapine among patients with schizophrenia. However, close monitoring of blood glucose levels must be done.
Effectiveness and safety of acupuncture in post-stroke depression (PSD)
Authors: Chen Baishu , Zhao Minhong , Chen Bin , Yang Zhaojun , Yu Xiaojiang , Lin Xueying , Fan Chun
Published: March 2020

Background:

Post-stroke depression (PSD) is the most common emotional problem after stroke. It can lower the quality of life and increase the recurrence and mortality. Pharmacological agents have been shown to treat PSD. However, the benefits of pharmacotherapy are debatable and the side-effects are significant. More and more clinical trials suggest that acupuncture plays an important role in patients with PSD. The primary purposes of the study are to conduct a Bayesian analysis of randomized trials to determine the effect of acupuncture and investigate the effect of several acupuncture therapies on PSD.

Methods:

We will retrieve articles from 5 English databases [PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, and WHO International Clinical Trials Registry (TCTRP)] and 4 Chinese databases [Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)]. The publication period will be from inception to January 2019. All randomized controlled trials that evaluate the safety and efficacy of acupuncture on PSD will be included. The primary outcomes will be the change in the degree of depression as measured by the Hamilton Depression Scale and Beck Depression Inventory. Two reviewers will separately extract the data and assess the risk of bias by using the Cochrane Collaboration's risk of bias tool. Bayesian analysis will be conducted to pool the effects of several acupunctures. The ranking probabilities for several acupunctures (simple acupuncture, fire needle, warm acupuncture, auriculo-acupuncture, or electroacupuncture) will be estimated by the surface under the cumulative ranking curve.

Result:

This study will provide reliable evidence for acupuncture on PSD.

Conclusion:

The results of this review will introduce a safe and effective treatment and provide reliable evidence to evaluate the effectiveness of several acupuncture therapies on PSD.

Trial registration number: CRD42019132725
Relationship of ankle-brachial index, vibration perception threshold, and current perception threshold to glycemic variability in type 2 diabetes
Authors: Zhang Chuangbiao , Tang Meili , Lu Xiaohua , Zhou Yan , Zhao Wane , Liu Yu , Liu Yan , Guo Xiujie
Published: March 2020

To explore the relationship of glycemic variability with lower extremity arterial disease (LEAD) and diabetic peripheral neuropathy (DPN).

Seventy-eight patients with type 2 diabetes were enrolled. All patients underwent 72-hour dynamic blood glucose monitoring and obtained mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), standard deviation of blood glucose (SD), largest amplitude of glycemic excursion (LAGE), mean blood glucose (MBG), T≥10.0 (percentage of time for blood glucose levels ≥10.0 mmol/L), T≤3.9 (percentage of time for blood glucose levels ≤3.9 mmol/L), and other glycemic variability parameters. In the meanwhile, in order to explore the correlation of glycemic variability parameters with ankle-brachial index (ABI), vibration perception threshold (VPT), and current perception threshold (CPT), all patients underwent quantitative diabetic foot screening, including ABI for quantitative assessment of lower extremity arterial lesions and VPT and CPT for quantitative assessment of peripheral neuropathy.

Patients were divided into abnormal CPT group (n = 21) and normal CPT group (n = 57) according to the CPT values. Compared with the normal CPT group, abnormal CPT group showed significantly higher levels of HbA1c, longer duration of diabetes, and higher levels of T≤3.9 (P < .05). However, there was no significant difference of MAGE, SD, LAGE, MODD, and other glycemic variability parameters between abnormal CPT group and normal CPT group (P > .05). Pearson correlation analysis or Spearman correlation analysis showed that ABI negatively correlated with MBG, T≥10.0, SD, LAGE, and MAGE (P < .05), but no correlation of ABI with T≤3.9 and MODD (P > .05) was shown. VPT showed a positive correlation with T≥10.0 (P < .05), but no correlation with other glycemic variability parameters (P > .05). There was no correlation between the other CPT values and the glycemic variability parameters (P > .05), except that the left and right 250 Hz CPT values were positively correlated with T≤3.9 (P > .05).

The higher the blood glucose levels, the severer the degree of LEAD and DPN lesions; the higher the incidence of hypoglycemia, the severer the degree of DPN lesions; the greater the fluctuation of blood glucose, the severer the degree of LEAD lesions. However, the glycemic variability was not significantly correlated with DPN.
Elevated platelet distribution width predicts poor prognosis in hilar cholangiocarcinoma
Authors: Li Bei , Lu Jiong , Peng Ding-Zhong , Zhang Xin-Yi , You Zhen
Published: March 2020

Although the platelet distribution width (PDW) has been reported as a reliable predictor of prognosis in several types of cancer, to our knowledge the prognostic value of PDW in hilar cholangiocarcinoma (HC) has not been studied. The aim of the study was to investigate the prognostic value of PDW in HC patients. A retrospective analysis of 292 consecutively recruited HC patients undergoing radical resection with at least a 5-year follow-up. The optimal cutoff value of PDW was determined by receiver operating characteristic (ROC) curve. Survival analysis by the Kaplan–Meier method and the difference between the clinico-pathologic variables and survival was evaluated by log-rank analysis. Multivariate analysis identified independent prognostic risk factors of overall survival (OS). ROC curve analysis suggested that the optimal cutoff value for the PDW was 16.55. There were significant associations of high PDW with high white blood cell (P < .001) and high neutril-to-lymph ratio (P < .001). In a multivariate analysis, the PDW was an independent prognostic factor for overall survival (HR = 2.521, 95% CI 1.832–3.470, P < .001). In conclusions, our findings indicate that PDW may have clinical significance in predicting OS after surgery in HC patients.
Novice training
Authors: Wu Ching Feng , Paradela Marina , Wu Ching Yang , Mercedes de la Torre , Fernandez Ricardo , Delgado Maria , Fieira Eva , Hsieh Ming Ju , Chao Yin Kai , Yang Lan Yan , Pan Yu Bin , Gonzalez-Rivas Diego
Published: March 2020

The competency in video-assisted thoracoscopic (VATS) lobectomy is expected to be achieved after surgeons practiced 30 to 50 cases according to previous reports. Does single port video-assisted thoracoscopic (SPVATS) lobectomy have a steeper learning curve and being harder to perform correctly, leading to long development times and high defect rates?

From January, 2014 to February, 2017, 8 individual surgeons (3 were novices, 5 were pioneers in SPVATS surgery) submitted their cases chronologically to evaluate the learning curve of SPVATS lobectomy. Operating time (OT) was set as a surrogate marker for surgical competency. Postoperative outcomes and OT between the 2 groups were compared using propensity score matching (1:1 nearest neighbor). The learning curve for OT was evaluated using the cumulative sum (CUSUM) method.

In the entire study cohort, a total of 356 cases were included (93 in junior consultant group [group A], 263 in senior consultant group [group B]). There were no significant differences between the 2 groups in operative time, conversion rate, postoperative complication rate, 30 and 90 days mortality rate. After propensity-score matching (86 pairs), operative time was longer in group A (214.33 ± 62.18 vs 183.62 ± 61.25 minutes, P = .001). Two-year overall survival rate was similar among 2 groups (P = .409). Competency was reached after junior surgeon completed 30th case of SPVATS lobectomy.

SPVATS lobectomy is safe for the novice surgeon who wants to adopt this new surgical approach under well-developed training program. The learning curves for competence in SPVATS lobectomy are similar to VATS lobectomy in our series.
Evaluation of plasma D-dimer for the diagnosis in Chinese patients with hepatocellular carcinoma
Authors: Fang Ping , Du Lijun , Cai Decheng
Published: March 2020

Background:

To evaluate the value of plasma D-dimer levels for the diagnosis of hepatocellular carcinoma (HCC).

Methods:

The following databases were searched for relevant studies published from 1990 to 2018: Wanfang Data, SinoMed, VIP Chinese Science and Technology Periodicals Database, China National Knowledge Infrastructure, Superstar Journals Database, Cochrane library, and PubMed. The studies were selected according to the diagnosis of HCC by plasma D-dimer levels. Quality assessment of the diagnostic accuracy of the studied items was conducted for rigorous quality evaluation of the studies that met the inclusion criteria. After extracting the relevant data, Stata 15.0 software was adopted for the analysis of the diagnostic odds ratio (DOR), sensitivity, specificity, and positive and negative likelihood ratios. A summary receiver operating characteristic (SROC) curve was constructed to comprehensively evaluate the value of plasma D-dimer levels for the diagnosis of HCC.

Results:

A total of 6 studies conducted in China with 475 cases in the patient groups and 727 in the control groups were included. The confidence level was expressed as the 95% confidence interval (CI). The pooled sensitivity, specificity, positive and negative likelihood ratios, and DOR of plasma D-dimer levels for the diagnosis of HCC were 0.75 (95% CI = 0.66–0.82), 0.93 (95% CI = 0.86–0.97), 11.4 (95% CI = 5.3–24.5), 0.27 (95% CI = 0.20–0.36), and 42 (95% CI = 19–93), respectively. The area under the SROC curve was 0.88 (95% CI = 0.85–0.91).

Conclusions:

Plasma D-dimer has high sensitivity and specificity, and is expected to be an important plasma marker for the clinical diagnosis of HCC. Due to the limited quality and quantity of the included studies, the above results should be further validated.
Selective nerve root block combined with posterior percutaneous cervical endoscopic discectomy for cervical spondylotic radiculopathy with double nerve root variation
Authors: Yu Tong , Zhang Jun , Wu Jiu-Ping , Yu Hai-Chi , Tian Hai-Qing , Luo Su-Li , Liu Qin-Yi
Published: March 2020

Rationale:

The aim of this report is to present the technique of selective nerve root blockage combined with posterior percutaneous cervical endoscopic discectomy (PPECD) for cervical spondylotic radiculopathy (CSR).

Patient concerns:

A 49-year-old female has pain in the skin area of the left scapular, pain in left elbow and limitation of left upper limb movement for 1.5 years.

Diagnosis:

She was diagnosed with CSR and C6-7 double nerve root variation.

Interventions:

We used selective nerve root block to determine the lesion segment and applied PPECD to relieve pressure on the patient's nerve roots.

Outcomes:

The pain symptoms disappeared after the patient was treated with C6-7 nerve root block. Endoscopic displayed C6-7 double nerve root variation on the left side of the spinal cord intraoperative. The neurological function was intact postoperatively and no recurrence of cervical disc herniation during the 5 months’ follow-up period. The hospitalization time was 5 days, the operation time was 68.2 minutes and the bleeding volume was 52.6 ml. There was no change in cervical curvature and cervical disc height postoperatively. Japanese Orthopaedic Association score, SF-36 score and Visual Analogue Scale score improved significantly postoperatively.

Lessons:

The application of selective nerve root blockage combined with PPECD for CSR could achieve satisfactory effect of position and decompression of the injured nerve root. Besides, we recommend that surgery be performed under general anesthesia to minimize patients’ emotional stress and discomfort.
Time-effective analgesic effect of acupressure ankle strip pressing wrist and ankle acupuncture point on primary dysmenorrhea
Authors: Zhai Shu-jie , Ruan Yi , Liu Yue , Lin Zhen , Xia Chen , Fang Fan-fu , Zhou Qing-hui
Published: March 2020

Background:

Dysmenorrhea seriously affects the ability of women to perform normal social activities and decreases their quality of life. Primary dysmenorrhea can be effectively treated with acupuncture. Based on the wrist-ankle acupuncture (WAA) theory, we designed a portable WAA point compression treatment strap that treats diseases by automatically applying pressure to acupuncture points. The proposed study aims to evaluate the immediate analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea.

Methods:

The study will be a randomized controlled trial conducted from May 1, 2019 to May 30, 2020 that includes 78 students from Shanghai University of Traditional Chinese Medicine who have primary dysmenorrhea and meet the eligibility criteria. Participants will be randomly divided into 2 groups in a 1:1 allocation ratio. The intervention group will use the acupressure wrist-ankle strap equipped with tip compression component parts on the internal side; the control group will use the nonacupressure wrist-ankle strap with the tip compression parts removed. All participants will be treated for 30 minutes on the 1st day of menstruation. The primary outcome is the pain intensity score measured by the visual analog scale. The secondary outcomes are the onset time of analgesia, the pain threshold at Yinlingquan (SP 9), skin temperature at Guanyuan (CV 4), and expectations and satisfaction of patients as investigated via the expectation and treatment credibility scale.

Discussion:

This trial will be the 1st study to evaluate the analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea. The quality of this study is ensured by the randomization, nonacupressure control, and blinded design. The results may provide evidence for a potential alternative treatment for primary dysmenorrhea and evidence-based proof of the analgesic effect of WAA.