bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Detection of Patients at Risk of Developing a Post-Traumatic Stress Disorder After an ICU Stay*
Authors: Wawer Emilie , Viprey Marie , Floccard Bernard , Saoud Mohamed , Subtil Fabien , Wafa Hashim , Rheims Elodie , Rimmelé Thomas , Poulet Emmanuel
Published: August 2020

Objectives:

To evaluate the diagnostic accuracy of the Impact Event Scale-Revisited assessed following ICU discharge to predict the emergence of post-traumatic stress disorder symptoms at 3 months.

Design:

Prospective cohort study.

Setting:

Three medical or surgical ICU of a French university hospital (Lyon, France).

Patients:

Patients greater than or equal to 18 years old, leaving ICU after greater than or equal to 2 nights of stay, between September 2017 and April 2018.

Interventions:

Patients completed the Impact Event Scale-Revisited and the Peritraumatic Dissociative Experiences Questionnaire within 8 days after ICU discharge and the Impact Event Scale-Revisited again at 3 months by phone. Patients having an Impact Event Scale-Revisited greater than or equal to 35 at 3 months were considered as having post-traumatic stress disorder symptoms.

Measurements and Main Results:

Among the 208 patients screened, 174 were included and 145 reassessed by phone at 3 months. Among the patients included at baseline, 43% presented symptoms of acute stress. At 3 months, 13% had an Impact Event Scale-Revisited greater than or equal to 35 and 17% had a score between 12 and 34. Regarding the performance of the Impact Event Scale-Revisited performed within 8 days after the ICU discharge to predict post-traumatic stress disorder symptoms at 3 months, the area under the curve was 0.90 (95% CI, 0.80–0.99), and an Impact Event Scale-Revisited greater than or equal to 12 had a sensitivity of 90%, a specificity of 71%, a positive predictive value of 32%, and a negative predictive value of 98%. History of anxiety disorder odds ratio = 3.7 (95% CI, 1.24–11.05; p = 0.02) and Impact Event Scale-Revisited greater than or equal to 12 odds ratio = 16.57 (95% CI, 3.59–76.46; p < 0.001) were identified as risk factors for post-traumatic stress disorder symptoms.

Conclusions:

Impact Event Scale-Revisited assessed at ICU discharge has a good ability for the detection of patients at risk of developing post-traumatic stress disorder symptoms. Patients with history of anxiety disorder and those presenting acute stress symptoms at ICU discharge are more at risk to develop post-traumatic stress disorder symptoms.
Obesity and the Risk of Intubation or Death in Patients With Coronavirus Disease 2019
Authors: Frank Rachel C. , Mendez Sean R. , Stevenson Elizabeth K. , Guseh James S. , Chung Mabel , Silverman Michael G.
Published: August 2020

Objectives:

To characterize the impact of obesity on disease severity in patients with coronavirus disease 2019.

Design:

This was a retrospective cohort study designed to evaluate the association between body mass index and risk of severe disease in patients with coronavirus disease 2019. Data were abstracted from the electronic health record. The primary endpoint was a composite of intubation or death.

Setting:

Two hospitals in Massachusetts (one quaternary referral center and one affiliated community hospital).

Patients:

Consecutive patients hospitalized with confirmed coronavirus disease 2019 admitted between March 13, 2020, and April 3, 2020.

Interventions:

None.

Measurements and Main Results:

A total of 305 patients were included in this study. We stratified patients by body mass index category: < 25 kg/m2 (54 patients, 18%), ≥ 25 kg/m2 to < 30 kg/m2 (124 patients, 41%), ≥ 30 kg/m2 to < 35 kg/m2 (58 patients, 19%), and ≥ 35 kg/m2 (69 patients, 23%). In total, 128 patients (42%) had a primary endpoint (119 patients [39%] were intubated and nine died [3%] without intubation). Sixty-five patients (51%) with body mass index greater than or equal to 30 kg/m2 were intubated or died. Adjusted Cox models demonstrated that body mass index greater than or equal to 30 kg/m2 was associated with a 2.3-fold increased risk of intubation or death (95% CI, 1.2–4.3) compared with individuals with body mass index less than 25 kg/m2. Diabetes was also independently associated with risk of intubation or death (hazard ratio, 1.8; 95% CI, 1.2–2.7). Fifty-six out of 127 patients (44%) with body mass index greater than or equal to 30 kg/m2 had diabetes, and the combination of both diabetes and body mass index greater than or equal to 30 kg/m2 was associated with a 4.5-fold increased risk of intubation or death (95% CI, 2.0–10.2) compared with patients without diabetes and body mass index less than 25 kg/m2.

Conclusions:

Among consecutive patients hospitalized with coronavirus disease 2019, obesity was an independent risk factor for intubation or death.
Opening the HIV envelope: potential of CD4 mimics as multifunctional HIV entry inhibitors
Authors: Laumaea Annemarie , Smith Amos B. , Sodroski Joseph , Finzi Andrés
Published: August 2020

Purpose of review

Close to 2 million individuals globally become infected with HIV-1 each year and just over two-thirds will have access to life-prolonging antivirals. However, the rapid development of drug resistance creates challenges, such that generation of more effective therapies is not only warranted but a necessary endeavour. This review discusses a group of HIV-1 entry inhibitors known as CD4 mimics which exploit the highly conserved relationship between the HIV-1 envelope glycoprotein and the receptor, CD4.

Recent findings

We review the structure/function guided evolution of these inhibitors, vital mechanistic insights that underpin broad and potent functional antagonism, recent evidence of utility demonstrated in animal and physiologically relevant in-vitro models, and current progress towards effective new-generation inhibitors.

The current review highlights the promising potential of CD4 mimetics as multifunctional therapeutics.
Combination of traditional Chinese medicine and epidermal growth factor receptor tyrosine kinase inhibitors in the treatment of non-small cell lung cancer
Authors: Sui Xinbing , Zhang Mingming , Han Xuemeng , Zhang Ruonan , Chen Liuxi , Liu Ying , Xiang Yu , Xie Tian
Published: August 2020

Background:

In China, traditional Chinese medicine (TCM) is an increasingly important part of the treatment of non-small cell lung cancer (NSCLC), which usually includes a combination of prescription and syndrome differentiation. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have been proven to be the first-line drugs for the treatment of advanced EGFR mutation-positive NSCLC. In China, EGFR-TKIs are used in combination with traditional Chinese medicines to reduce side effects and/or enhance effectiveness. Nevertheless, the relationship between TCMs and EGFR-TKIs remain unclear. This meta-review aimed to explore the clinical evidence of TCMs combined with EGFR-TKIs in the treatment of NSCLC.

Methods:

Related studies were found by searching the databases of EMBASE, PubMed, Web of Science, MEDLINE, Cochrane library database, China Academic Journals (CNKI), Wanfang and Weipu. This study included 57 randomized controlled trials, all of these were processed by Stata software (version 12.0). In the study, all the materials are published articles, patient anonymity and informed consent and ethics Approval/Institutional review board are not necessary.

Results:

This study demonstrated that the objective response rate was higher in the group of TCMs plus EGFR-TKIs than in the group of EGFR-TKIs alone (risk ratios 1.39, 95% confidence intervals [1.29, 1.50]). Further research of specific herbal medicines showed that Huangqi, Baishu, Fuling, Gancao, Maidong, Baihuashecao, Shashen, Dangshen and Renshen, had significant higher contributions to results.

Conclusion:

TCMs may improve the efficacy of EGFR-TKIs in the treatment of NSCLC.
Using next-generation sequencing to analyze Helicobacter pylori clones with different levofloxacin resistances from a patient with eradication failure
Authors: Ye Liping , Meng Fei , Mao Xinli , Zhang Yu , Wang Jun , Liu Yunhui , Zhu Wei , Gu Binbin , Huang Qin
Published: August 2020

The regimens containing levofloxacin (LVX) have been recommended as an alternate to standard triple therapy to treat Helicobacter pylori infections and H pylori mixed infection always lead to H pylori chronic infection. Although the molecular mechanism of LVX resistance with gyrA gene mutation has been clearly understood in H pylori, other genes involved in antibiotic resistance remain unclear. Efflux pump plays an important role in clinically relevant multidrug resistance. Furthermore, the relationship between the strains with different LVX level-resistances from individuals is also unknown.

Helicobacter pylori monoclonal strains were isolated from patients with eradication failure. E test was used to detect the minimal inhibitory concentration of LVX. One lower-level LVX-resistant clone and 2 higher-level LVX-resistant clones from the same patient were selected to sequence the complete genomes. Single-nucleotide variants (SNVs) and mutations were extracted and analyzed from gryA and resistance-nodulation-division family efflux genes.

Two clones with higher-level resistance had the mutation pattern of Asn87Lys and one lower-level LVX-resistant clone had an Asp91Asn mutation. Compared to clones with higher-level resistance, the higher genetic variations were found in genes belonging to the resistance-nodulation-division family in H pylori strains with lower-level resistance to LVX. There were significantly more SNVs of Hp0970 (hefE) and Hp1329 (hefI) in the lower-level LVX-resistant clone than those in the higher-level LVX-resistant clones (P = .044).

The mutation pattern of the Asn87Lys of the gyrA gene confers a higher resistance to LVX than that of the Asp91Asn in H pylori. Increase in the number of SNVs of the Hp0970 (hefE) and Hp1329 (hefI) genes change the resistance to LVX. Twelve mutations verified by Sanger sequencing in Hp0970 (hefE) and Hp1329 (hefI) may decrease resistant levels to LVX.
Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care
Authors: Coronado-Vázquez Valle , Canet-Fajas Carlota , Delgado-Marroquín Maria Teresa , Magallón-Botaya Rosa , Romero-Martín Macarena , Gómez-Salgado Juan
Published: August 2020

Background:

Shared decision making (SDM) is a process within the physician–patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients’ and health professionals’ satisfaction with the intervention.

Methods:

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration's tool.

Results:

Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias.

Conclusions:

DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care.
The correlation between atmospheric visibility and influenza in Wuxi city, China
Authors: Liu Juan , Chen Enpin , Zhang Qi , Shi Ping , Gao Yumeng , Chen Yujun , Liu Wendong , Qin Yiran , Shen Yuan , Shi Chao
Published: August 2020

Influenza is an acute respiratory infectious disease that poses a threat to public health. We assessed the association between atmospheric visibility and influenza and influenza-like illness (ILI) in Wuxi city, China.

Daily meteorological data, ILI activity, and influenza virus infection rates were collected between 31 December 2012 and 31 December 2017. A distributed lag non-linear model (DLNM) was used to analyze the exposure-lag-response of ILI and influenza activity and daily average visibility.

A total of 12,800 cases were detected; 1046 cases (8.17%) were of Flu-A and 527 (4.12%) were of Flu-B infection. Our analysis suggested a non-linear relationship between atmospheric visibility and influenza: U-shaped for ILI, and L-shaped for Flu-A and Flu-B. Comparing low visibility (2.5 km) to ILI cases, the risk appeared between day 1 and day 2. For Flu-A, the risk appeared between days 5 and 9, whereas for Flu-B, the risk effect was much stronger and had a longer reaction delay, staying above zero until day 9. The protective effects of high visibility (14 km) on ILI and Flu-B occurred the same day or one day later. However, we found no association between high visibility and Flu-A.

In conclusion, our study contributes novel evidence for the effects of atmospheric visibility on influenza. These findings are important for the development of influenza surveillance and early warning systems in Wuxi city.
Weighted gene coexpression network analysis identifies hub genes related to KRAS mutant lung adenocarcinoma
Authors: Dai Dongjun , Shi Rongkai , Han Shuting , Jin Hongchuan , Wang Xian
Published: August 2020

The aim of current study was to use Weighted Gene Coexpression Network Analysis (WGCNA) to identify hub genes related to the incidence and prognosis of KRAS mutant (MT) lung adenocarcinoma (LUAD).

We involved 184 stage IIB to IV LUAD samples and 59 normal lung tissue samples from The Cancer Genome Atlas (TCGA) database. The R package “limma” was used to identify differentially expressed genes (DEGs). WGCNA and survival analyses were performed by R packages “WGCNA” and “survival,” respectively. The functional analyses were performed by R package “clusterProfiler” and GSEA software. Network construction and MCODE analysis were performed by Cytoscape_v3.6.1.

Totally 2590 KRAS MT specific DEGs were found between LUAD and normal lung tissues, and 10 WGCNA modules were identified. Functional analysis of the key module showed the ribosome biogenesis related terms were enriched. We observed the expression of 8 genes were positively correlated to the worse survival of KRAS MT LUAD patients, the 7 of them were validated by Kaplan–Meier plotter database (kmplot.com/) (thymosin Beta 10 [TMSB10], ribosomal Protein S16 [RPS16], mitochondrial ribosomal protein L27 [MRPL27], cytochrome c oxidase subunit 6A1 [COX6A1], HCLS1-associated protein X-1 [HAX1], ribosomal protein L38 [RPL38], and ATP Synthase Membrane Subunit DAPIT [ATP5MD]). The GSEA analysis found mTOR and STK33 pathways were upregulated in KRAS MT LUAD (P < .05, false discovery rate [FDR] < 0.25).

In summary, our study firstly used WGCNA to identify hub genes in the development of KRAS MT LUAD. The identified prognostic factors would be potential biomarkers in clinical use. Further molecular studies are required to confirm the mechanism of those genes in KRAS MT LUAD.
Discontinuation of biosimilar infliximab in Japanese patients with rheumatoid arthritis achieving sustained clinical remission or low disease activity during the IFX-SIRIUS STUDY I (the IFX-SIRIUS STUDY II)
Authors: Shimizu Toshimasa , Kawashiri Shin-Ya , Sato Shuntaro , Morimoto Shimpei , Minoda Shuri , Kawazoe Yurika , Kuroda Shohei , Tashiro Shigeki , Sumiyoshi Remi , Hosogaya Naoki , Yamamoto Hiroshi , Kawakami Atsushi
Published: August 2020

Background:

The introduction of biological disease-modifying anti-rheumatic drugs into clinical practice has dramatically improved the clinical outcomes of individuals with rheumatoid arthritis (RA). We are conducting the IFX-SIRIUS STUDY I that evaluates whether switching from originator infliximab (IFX) to its biosimilar, CT-P13, is not inferior in maintaining nonclinical relapse to continue treatment with originator IFX in patients with RA achieving clinical remission. It is the next great issue whether disease activity can be maintained in good condition after discontinuation of CT-P13 because no evidence is available regarding the clinical value of discontinuing biosimilars in patients with RA. Thus, we will evaluate whether a condition without clinical relapse will be maintained after discontinuation of CT-P13 in patients with RA, achieving clinical remission or low disease activity during the IFX-SIRIUS STUDY I.

Methods/design:

This study is an interventional, multicenter, open-label, single-arm clinical trial with a 48-week follow-up. Patients with RA who are treated with CT-P13 and sustained nonclinical relapse during the IFX-SIRIUS STUDY I will be included. Patients will discontinue CT-P13 after the study period of the IFX-SIRIUS STUDY I. We will evaluate disease activity by clinical disease activity indices and musculoskeletal ultrasound (MSUS). The primary endpoint is the proportion of patients who do not have clinical relapse during the study period. Important secondary endpoints are the changes from the baseline of the MSUS scores. We will also comprehensively analyze the serum levels of multiple biomarkers, such as cytokines and chemokines. In addition, if a clinical relapse occurs in patients after the discontinuation of CT-P13, we will evaluate the effectiveness and safety of restarting CT-P13.

Discussion:

The study results are expected to show the clinical benefit of the discontinuation of CT-P13 and effectiveness and safety of restarting CT-P13 after clinical relapse. The strength of this study is to prospectively evaluate the therapeutic effectiveness by not only clinical disease activity indices but also standardized MSUS findings in multiple centers. We will explore whether parameters at baseline can predict a nonclinical relapse after the discontinuation of CT-P13 by integrating multilateral assessments, that is, patient's characteristics, clinical disease activity indices, MSUS findings, and serum biomarkers.

Trial registration:

This study was registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp) on April 20, 2020 as jRCTs071200007.
Impacts of doctor-shopping behavior on diabetic patients’ health
Authors: Lin Chin-Shien , Khan Haider , Chang Ruei-Yuan , Liao Wei-Chih , Chen Yi-Hsin , Huang Bo-Lin , Hsieh Teng-Fu
Published: August 2020

The aim of this study was to clarify the relationship between doctor-shopping behavior and clinical conditions, and to clearly outline the effects of both the number of clinic visits and the number of doctor changes on patients’ health conditions. Data from January 1, 2000 to December 31, 2004 was collected from the National Health Insurance Research Database in Taiwan. After randomly selecting one million people, we extracted 5-year longitudinal data, about the number of clinic visits, number of doctor changes, and changes in self-health status for each patient with diabetes over the age of 18. We developed a relationship among the variables by using the generalized estimating equation. The results revealed that the number of clinic visits on the change of health status is a U curve, suggesting that health condition could be optimal with an appropriate number of clinic visits. The effect of the number of doctor changes is linearly correlated with health deterioration. The results suggest that disease conditions can only be controlled with an adequate number of clinic visits. Excessively frequent clinic visits are not only unfavorable to patients’ health status but are also wasteful of limited medical resources. For diabetic mellitus patients, the more they change doctors, the worse their health status. All of these results are important for patients to stay healthy and to save medical resources.
Bilateral pontine infarction with basilar artery fenestration
Authors: Ha Sang Hee , Kim Hyug-Gi , Kim Bum Joon
Published: August 2020

Rationale:

Basilar artery (BA) fenestration is a congenital anomaly with duplicated BA, which can cause ischemic stroke. However, the stroke mechanism is not clearly verified in patients with BA fenestration.

Patient concerns:

Here, we report a case of 64-year-old man with well-controlled hypertension admitted with dysarthria, only.

Diagnoses:

Diffusion weighted image showed a bilateral symmetric pontine infarction sparing the midline. BA fenestration was observed from magnetic resonance angiography.

Intervention:

High-resolution magnetic resonance image (MRI) and 4D flow MRI was performed to verify the mechanism of stroke associated with BA fenestration.

Outcomes:

No plaque was observed at the area of BA fenestration from high-resolution MRI. 4D flow MRI showed bifurcated flow with high flow velocity and low shear stress at the area of BA fenestration.

Lessons:

A turbulent flow with high flow velocity and low shear stress at the BA fenestration area may have influenced the flow through the bilateral perforating arteries resulting in a bilateral symmetric pontine infarction with sparing the midline where the septa of BA is located. 4D flow dynamic studies may be beneficial for verifying the mechanism of stroke.
Clinical characteristics and survival outcomes of patients with both primary breast cancer and primary ovarian cancer
Authors: Chen Chang , Xu Yali , Huang Xin , Mao Feng , Shen Songjie , Xu Ying , Sun Qiang
Published: August 2020

Breast cancer and ovarian cancer are closely related. The major common risk factors of these 2 types of cancer are likely genetic factors. However, few studies have shown any common characteristics in patients who have both types of these 2 cancers. The purpose of this retrospective study is to explore the clinical characteristics and survival outcomes of patients with both primary breast cancer and primary ovarian cancer.

A cohort of patients who had a history of both primary breast cancer and primary ovarian cancer were enrolled, and they received treatment in the Peking Union Medical College Hospital between January 1, 2010, and December 31, 2018. Both descriptive statistics analysis and survival analysis were performed for analysis.

A total of 114 patients with both primary breast cancer and primary ovarian cancer were included in the study. The median (range) follow-up was 129.5 (20–492) months. The average interval time between the diagnosis of 2 types of cancer was 79.4 months in patients having ovarian cancer firstly and was 115.9 months in patients having breast cancer firstly. The 5- and 10-year overall survival (OS) rates were 91.5% and 81.7% for patients with ovarian cancer following breast cancer, respectively, and 90.6% and 87.5% for patients with breast cancer following ovarian cancer, respectively. Multivariate analysis revealed that independent predictors of OS were the age of diagnosis of the first tumor and the time interval between two types of tumor in patients with ovarian cancer following breast cancer.

Most breast cancer or ovarian cancer occurred within 5 years after being diagnosed with the first tumor, and the interval time was significantly shorter in patients with previous ovarian cancer. The prognosis is likely positively correlated to the interval time between the occurrences of two types of cancer.
Macrophage activation syndrome as an unusual presentation of paucisymptomatic severe acute respiratory syndrome coronavirus 2 infection
Authors: Lolachi Sanaz , Morin Sarah , Coen Matteo , Samii Kaveh , Calmy Alexandra , Serratrice Jacques
Published: August 2020

Rationale:

Macrophage activation syndrome (MAS) is a rare life-threatening condition characterized by cytokine-mediated tissue injury and multiorgan dysfunction.

Patient Concerns:

We describe the unique case of young man who developed MAS as the sole manifestation of an otherwise paucisymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Diagnoses:

Clinical and biological criteria led to the diagnosis of MAS; cytokine profile was highly suggestive reverse transcription polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swabs was negative, but serum anti-SARS-CoV-2 immunoglobulin A and immunoglobulin G resulted positive leading to the diagnosis of SARS-CoV-2 infection.

Interventions:

The patient was treated with empiric antibiotic and hydroxychloroquine.

Outcomes:

Clinical improvement ensued. At follow-up, the patient is well.

Lesson:

SARS-CoV-2 infection may trigger develop life-threatening complications, like MAS. This can be independent from coronavirus disease 2019 gravity.
Prognostic significance of macrophage migration inhibitory factor expression in cancer patients
Authors: Koh Hyun Min , Kim Dong Chul
Published: August 2020

Background:

Recent studies showed that Macrophage migration inhibitory factor (MIF) is overexpressed and closely associated with prognosis in cancer patients. The present study was systematically evaluated the prognostic significance of MIF expression in cancer patients.

Methods:

PubMed, Cochrane library and Scopus were searched for eligible studies up to January 2020. Pooled hazard ratio with confidence interval (CI) was determined to assess the relationship between MIF expression and survival in cancer patients.

Results:

A total of 8 studies comprising 847 cancer patients were included in this meta-analysis. For overall survival, the pooled hazard ratio was 2.23 (95% CI 1.67–2.99, P < .001). For disease-free survival, the pooled hazard ratio was 2.24 (95% CI 1.69–2.96, P < .001). The results suggested that high expression of MIF was significantly related to poor overall survival and disease-free survival in cancer patients.

Conclusion:

MIF expression could be a valuable prognostic factor in cancer patients.
A preliminary study of spinal cord blood flow during PVCR with spinal column shortening
Authors: Li Tao , Zhao Zhi , Wang Yingsong , Xie Jingming , Zhang Ying , Bi Ni , Shi Zhiyue , Lu Qiuan , Li Quan
Published: August 2020

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.

The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.

Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.

There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ± 86 perfusion unite (PU), and the SCBF decreased to 228 ± 68 PU after VCR (P = .008). The SCBF increased to 296 ± 102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ± 65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.

These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.
Impact of pelvic floor ultrasound in diagnosis of postpartum pelvic floor dysfunction
Authors: Wang Fan-bo , Rong Rong , Xu Jing-jun , Yang Guang , Xin Tian-you , Wang Xiao-hui , Tang Hai-bo
Published: August 2020

Background:

This study will appraise the impact of pelvic floor ultrasound (PFU) in diagnosis of postpartum pelvic floor dysfunction (PPPFD).

Methods:

Studies that report the impact of PFU in diagnosis of PPPFD will be examined in Cochrane Library, MEDLINE, EMBASE, PSYCINFO, Scopus, Web of Science, Allied and Complementary Medicine Database, CNKI, and WANGFANG up to June 1, 2020. Grey literature sources will also be searched. All potential case-controlled studies (CCSs) exploring the impact of PFU in diagnosis of PPPFD will be considered for inclusion in this study. Data will be extracted from eligible CCSs for data pooling and meta-analysis. Whenever necessary, we will also perform summary effect size, heterogeneity across studies, study quality assessment, and reporting bias.

Results:

The present study will estimate pooled outcome effects regarding the impact of PFU in diagnosis of PPPFD.

Conclusion:

This study may provide robust evidence to judge the impact of PFU on PPPFD

Systematic review registration:

PROSPERO CRD42020187623.
Efficacy and safety of traditional Chinese medicine injections in the treatment of acute myocardial infarction
Authors: Zhao Wei , Li Jun , Chen Hengwen , Wu Qingjuan , Deng Yawen , Tan Yuqing
Published: August 2020

Background:

As one of the common cardiovascular diseases, acute myocardial infarction (AMI) is characterized by a high mortality rate, frequent complications, and a serious threat to human health and quality of life. Traditional Chinese medicine injection (TCMI) has been used clinically to treat AMI; however, there is no uniform standard for clinical treatment of AMI. The purpose of this study is to evaluate the efficacy and safety of different TCMI by using systematic review and network meta-analysis.

Methods:

According to the strategy, the authors will retrieve both 4 Chinese databases and 3 English databases by June 30, 2020. After a series of screening, randomized controlled trials will be included related to TCMI for AMI. Two researchers will use Aggregate Data Drug Information System and STATA 15.0 to analyze the data. Finally, the evidence grade of the results will be evaluated.

Results:

This study will provide a reliable evidence for the selection of TCMI therapies for AMI.

Conclusion:

The results of this study will provide references for evaluating the influence of different TCMI therapies for AMI, and provide decision-making references for clinical research.

OSF registration number:

DOI 10.17605/OSF.IO/FYGBT.
The efficacy and safety of acupoint application combined with western medicine for allergic rhinitis
Authors: Huang Yao , Fan Yihua , Tian Chunying , Zhang Mengni , Yang Shasha , Ji Yue , Zhang Qinxiu
Published: August 2020

Background:

Acupoint application combined with western medicine has been used for treating allergic rhinitis widely. However, the efficacy and safety of acupoint application combined with western medicine for allergic rhinitis are unclear. This study aims to evaluate the efficacy and safety of acupoint application combined with western medicine for allergic rhinitis.

Methods:

Randomized controlled trials of acupoint application combined with western medicine for allergic rhinitis will be searched in PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database, and China biomedical literature database from inception to July, 2020. And Baidu Scholar, Google Scholar, International Clinical Trials Registry Platform, and Chinese Clinical Trials Registry will be searched to obtain more relevant studies comprehensively. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3.

Results:

This study will summarize the present evidence by exploring the efficacy and safety of acupoint application combined with western medicine for the treatment of allergic rhinitis.

Conclusions:

The findings of the study will provide helpful evidence for the efficacy and safety of acupoint application combined with western medicine in the treatment of allergic rhinitis, facilitating clinical practice and further scientific studies.

Ethics and dissemination:

The private information from individuals will not publish. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.

OSF Registration number:

DOI 10.17605/OSF.IO/NSGJH
Surgical treatment of a rare case of hepatocellular carcinoma with right atrial metastasis
Authors: Qiu Wei , Wang Chuanlei , Zhang Ruoyan , Wei Feng , Shi Xiaoju , Sun Xiaodong , Ma Dashi , Lv Guoyue , Wang Guangyi
Published: August 2020

Rationale:

Hepatocellular carcinoma (HCC) with intracavitary metastasis extending to the heart, also known as inferior vena cava (IVC) tumor thrombus, is an extremely rare late-stage disease with no effective treatment. In fact, the median survival is reportedly less than 2 months; thus, there is an urgent need for better treatment.

Patient concerns:

In this study, a 48-year-old patient was admitted to our hospital to seek medical treatment for advanced primary HCC with right atrial metastasis.

Diagnosis:

The patient was diagnosed as primary HCC with a large mass in the right lobe of the liver and intracavitary metastasis to the right atrium.

Interventions:

A new surgical treatment of right hemihepatectomy, complete resection of the involved IVC and the right atrium thrombus, plus reconstruction of the resected IVC using autologous pericardial tube graft were undertaken and successfully performed.

Outcomes:

The patient recovered rapidly, and 14 days after the surgical procedures, he was discharged from the hospital. Notably, serum levels of alpha-fetoprotein dropped to normal range and no clinical signs of recurrence were observed during follow-up.

Lessons:

This report highlights an unusual case of right atrial metastasis from HCC. The surgical treatment appeared to be suitable and effective, together with postoperative administration of lenvatinib, a tyrosine kinase multitarget inhibitor selected by performing whole-exome sequencing. These therapies have offered favorable clinical outcomes such as prevention of recurrence and prolongation of patient survival. In addition, clinicians may benefit from our experience for their future treatment of patients with similar clinical conditions.
A novel compound heterozygous mutation in the arginase-1 gene identified in a Chinese patient with argininemia
Authors: Cui Dongqing , Liu Yanxia , Jin Liang , Hu Liping , Cao Lili
Published: August 2020

Introduction:

Arginineemia, also known as arginase deficiency, is a rare autosomal recessive metabolic disease. The diagnosis sometimes may be delayed due to atypical clinical manifestations. Confirmation of arginineemia depends on genetic testing.

Patient concerns:

We reported a Chinese male child presenting with hyperargininemia and progressive spastic diplegia, who has a novel compound heterozygous mutation in the arginase-1 (ARG1) gene (c.263-266delAGAA, p.K88Rfs∗45;c.674T>C,p.L216P), respectively, coming from his mother and father.

Diagnosis:

The patient was diagnosed with argininemia with a novel compound homozygous mutation of the ARG1 gene at the age of 12 years.

Interventions:

The patient had a low-protein diet (0.8 g/kg/day). Baclofen, eperisone hydrochloride, botulinum toxin, and rehabilitation training were used to improve his spastic diplegia symptoms for 3 months.

Outcomes:

The patient's blood arginine was still high after 3 months’ low-protein diet. His spastic diplegia symptoms had not aggravated after 3 months’ treatment.

Conclusions:

Argininemia should be considered in a patient with slowly progressive neurologic manifestations, especially spastic diplegia. This case also suggests that tandem mass spectrometry should be used as an effective tool in the validity of neonatal screening for early diagnosis.
Comparison of suture-button and screw fixation in the treatment of ankle syndesmotic injuries
Authors: Liu Xiaoning , Jin Guang , Piao Chengdong , Zhong Zhuan , Chang Fei , Huang Bingzhe
Published: August 2020

Background:

Syndesmotic injuries account for a significant number of ankle injuries. There is no consensus regarding the recommended method of treatment. The purpose of this study was to evaluate:

Methods:

This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. The records of 200 patients with ankle fractures who had undergone surgical treatment in our clinics between January 2014 and January 2018 were retrospectively investigated. This retrospective cohort study was approved by the institutional review board in the 2nd Hospital of Jilin University. The primary outcome measure was the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the Foot Function Index. Secondary outcome measures included visual analog scale score, complications, range of movement of ankle, reoperations, and radiologic outcomes. For statistical comparison of the clinical and radiologic findings between the 2 groups, we used SPSS, version 21.0 (SPSS, Chicago, IL), statistical software. P Values of < .05 were considered statistically significant.

Conclusion:

The hypothesis was that the SB technique would achieve better functional outcomes as compared to the syndesmotic screw technique after surgery.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5793).
Vitamin D status is associated with hepcidin and hemoglobin concentrations in patients with severe traumatic injury
Authors: Apple Camille G. , Miller Elizabeth S. , Kannan Kolenkode B. , Stortz Julie A. , Cox Michael , Loftus Tyler J. , Parvataneni Hari K. , Patrick Matthew , Hagen Jennifer E. , Brakenridge Scott , Efron Philip A. , Mohr Alicia M.
Published: August 2020

BACKGROUND

Severe traumatic injury leads to persistent injury-associated anemia that is associated with hypercatecholaminemia, systemic inflammation, increased hepcidin, and a functional iron deficiency. Vitamin D has been shown to reduce proinflammatory cytokines and hepcidin concentrations. This study aimed to investigate the association of vitamin D status with inflammation, iron biomarkers, and anemia following blunt trauma.

METHODS

A prospective observational cohort study comparing blunt trauma patients (n = 45) with elective hip replacement patients (n = 22) and healthy controls (n = 8) was performed. Bone marrow ferroportin, transferrin receptor, and erythroferrone expression was measured using quantitative polymerase chain reaction (qPCR). Plasma was assessed for systemic inflammation, erythropoietin (EPO), iron regulation, and vitamin D (25-OH) concentrations using enzyme-linked immunosorbent assay. Hemoglobin was measured on the day of discharge.

RESULTS

Compared with hip replacement, trauma patients had higher plasma interleukin-6 (90.1 vs. 3.8 pg/mL), C-reactive protein (6,223 vs. 2,612 ng/mL), and hepcidin (79.3 vs. 21.2 ng/mL) concentrations. Trauma patients had lower vitamin D (25-OH) (12.8 vs. 18.1 ng/mL) and iron (23.5 vs. 59.9 μg/mL) levels compared with hip replacement patients. Despite the higher hepcidin EPO levels, bone marrow erythroferrone expression was increased 69% following trauma.

CONCLUSION

Following elective hip replacement, patients did have anemia and impaired iron homeostasis without a significant change in inflammatory biomarkers, EPO, and vitamin D status. Vitamin D status did correlate with systemic inflammation, iron dysfunction, and persistent injury-associated anemia following severe blunt trauma. Further research is needed to determine whether supplementation with vitamin D in the trauma population could improve the persistent injury-associated anemia.

LEVEL OF EVIDENCE

Prospective study, prognostic, level III.
The role of mesenteric lymph exosomal lipid mediators following intestinal ischemia-reperfusion injury on activation of inflammation
Authors: Senda Atsushi , Morishita Koji , Kojima Mitsuaki , Doki Sanae , Taylor Beth , Yagi Masayuki , Watanabe Arisa , Kobayashi Tetsuyuki , Aiboshi Junichi , Coimbra Raul , Otomo Yasuhiro
Published: August 2020

BACKGROUND

Intestinal ischemia caused by hemorrhagic shock is known to induce systemic inflammatory responses. Previous studies have shown that mesenteric lymph (ML) plays a crucial role in gut-mediated inflammation. Lipid mediators, such as lysophosphatidylcholines (LPCs), which contain polyunsaturated fatty acids (PUFAs), are present in the postshock ML. Exosomes are also present in the ML and act as transcellular carriers of lipids; however, their role in postshock systemic inflammation has not been revealed. Here, we aimed to identify changes in lipid mediators in ML exosomes after intestinal ischemia.

METHODS

Male Sprague-Dawley rats underwent laparotomy, followed by ML duct cannulation. Animals were subjected to 60 minutes of intestinal ischemia by superior mesenteric artery clamping, followed by 120 minutes of reperfusion. Mesenteric lymph was obtained before and after intestinal ischemia, and exosomes were isolated from ML by ultracentrifugation. The biological activity of ML exosomes was determined using the monocyte nuclear factor κB (NF-κB) activation assay. Lipids of ML exosomes were extracted and quantified by liquid chromatography/electrospray ionization mass spectrometry.

RESULTS

Mesenteric lymph exosome–induced NF-κB activation significantly increased after intestinal ischemia, and lipid analysis revealed a significant increase in the concentration of PUFA-containing LPCs. In addition, PUFA-containing LPCs also induced NF-κB activation.

CONCLUSION

Our results suggest that biologically active lipid mediators in ML exosomes may be involved in the inflammatory response after intestinal ischemia.
Isolated low-grade solid organ injuries in children following blunt abdominal trauma: Is it time to consider discharge from the emergency department?
Authors: Plumblee Leah , Williams Regan , Vane Dennis , Zhang Jingwen , Jensen Aaron , Naik-Mathuria Bindi , Evans Lauren , Streck Christian J.
Published: August 2020

INTRODUCTION

Acute intervention (AI) for solid organ injury (SOI) is rare in hemodynamically stable children. Pediatric guidelines recommend admission with follow-up laboratories, even for low-grade injuries.

METHODS

Data sets from two large multicenter prospective observational studies were used to analyze a cohort of children (age, <17 years) with grade I to III SOI following blunt abdominal trauma. Children with hollow viscus injuries were excluded. Patients were divided into (a) those with or without other major injuries (OMIs) (traumatic brain injury, hemothorax or pneumothorax, pelvic fracture, urgent orthopedic or neurosurgical operations) and (b) with grade I or II versus grade III injuries. Outcomes included AIs (transfusion, angiography, abdominal operation) and disposition (admission unit and length of stay).

RESULTS

There were 14,232 children enrolled in the two studies, and 791 patients had a SOI (5.6%). After excluding patients with hollow viscus injuries and higher-grade SOIs, 517 patients with a grade I to III SOI were included, and 262 of these had no OMI. Among patients with no OMI, none of 148 patients with grade I or II SOI underwent AI, while only 3 of 114 patients with grade III injuries underwent AI (3 transfusions/1 angioembolization). All three had hemoperitoneum; two of three had an additional organ with a grade II injury. Among grade I and II SOIs with no OMI, 28 (18.9%) of 148 were admitted to an intensive care unit, 110 (74.3%) of 148 to floor, and 7 (4.7%) of 148 discharged home from emergency department; median length of stay 2 days. Among grade III SOIs with no OMI, 38 (33.3%) of 114 were admitted to an intensive care unit and 61.4% to the floor; median length of stay was 4 days. Among 255 patients with a grade I to III SOI and other major organ system injuries, 31 (12.2%) underwent AI.

CONCLUSION

No patient with a grade I and II SOI and no OMI following blunt abdominal trauma received intervention, suggesting that patients with low-grade SOI without OMIs could be safely observed and discharged from the emergency department.

LEVEL OF EVIDENCE

Therapeutic study, level IV.
Gender Disparity and Potential Strategies for Improvement in Neurology and Clinical Neurophysiology
Authors: Galloway Gloria , Schmitt Sarah , Herman Susan T. , La Roche Suzette
Published: August 2020

Discrimination in the workplace when documented is illegal but is seen to still exist in some forms whether based on culture, race, or gender. Each of these disparities warrants further discussion and study because of their significant impacts on hiring decisions, career advancement, and compensation. In this article, the authors have focused their attention on gender disparity in the fields of neurology and clinical neurophysiology and shared the data currently available to them. At a time when the field of clinical neurophysiology has seen enormous growth, gender disparity in leadership and compensation remain. Despite the increasing number of women entering the fields of neurology and clinical neurophysiology, women remain underrepresented in national leadership positions. Many women physicians report experiencing gender discrimination despite increasing efforts by universities and medical centers to improve inclusivity and diversity. Equity and inclusivity are not the same and there is a disconnect between the increased numbers of women and their shared experiences in the workplace. Implicit bias undermines the ability of women to advance in their careers. For neurologists, data indicate that the latest gender pay gap is $56,000 (24%), increased from $37,000 in 2015, and is one of the largest pay gaps in any medical specialty. One third of the top 12 medical schools in the United States require that maternity leave be taken through disability coverage and/or sick benefits, and most family leave policies constrain benefits to the discretion of departmental leadership. The authors recommend strategies to improve gender disparity include institutional training to Identify and overcome biases, changes to professional organizations and national scientific meeting structure, transparency in academic hiring, promotion and compensation, and mentorship and sponsorship programs.