bluuebunny/crossref_metadata_2025 huggingface dataset:
A Sustainable Approach to Prepectoral Breast Reconstruction Using Meshed Acellular Dermal Matrix
Authors: McCullough Meghan C. , Vartanian Emma , Andersen James , Tan Mark
Published: January 2021

Background:

Prepectoral implant-based breast reconstruction provides an alternative to submuscular reconstruction, but the increased acellular dermal matrix (ADM) required has the potential to lead to increased costs and decreased supply of this limited-resource material. We present a method for prepectoral reconstruction utilizing skin-graft meshing techniques to increase the surface area of usable ADM.

Methods:

Forty-four patients underwent this technique from February 2019 to February 2020. Patient characteristics, operative details, and outcomes, including complications and patient satisfaction utilizing the BREAST-Q, were analyzed. Cost analysis relative to projected cost of nonmeshed techniques was performed.

Results:

There were 20 unilateral and 24 bilateral procedures, for a total of 68 breast reconstructions. Mean age was 45.9 years (32–71). Mean implant volume was 485 cm3 (265–800), and one sheet of ADM was used for each breast with an average surface area of 161 cm2. Median follow-up was 350 days (212–576). Minor complications included an infection treated with oral antibiotics. Major complications included one axillary hematoma and one delayed implant loss. One patient underwent revision for asymmetry. Mean BREAST-Q score was 47.4/60. Cost ranged from $4113 to 5025 per breast, compared with the projected $9125–18250 per breast for other techniques in the literature.

Conclusions:

In contrast to previously described uses of ADM in prepectoral reconstruction, meshing maximizes resource utilization by expanding the coverage of a single sheet. Early findings demonstrate minimal complications and high patient satisfaction, suggesting the approach has potential to provide the benefits of prepectoral reconstruction while responsibly preserving product availability and tempering healthcare costs.
Congenital Insensitivity to Pain: A Case Report With Corneal Esthesiometry and In Vivo Confocal Microscopy
Authors: Keenan Jeremy D. , Gonzales John A. , Waxman Stephen G. , Delwig Anton
Published: January 2021

Purpose:

To report the findings of a comprehensive eye examination from an individual with congenital insensitivity to pain because of loss-of-function mutations in the SCN9A gene.

Methods:

Ophthalmologic examination and confocal microscopy were performed on a patient with congenital insensitivity to pain.

Results:

A 39-year-old man with compound heterozygous mutations in the SCN9A gene underwent examination. Cochet–Bonnet esthesiometry readings averaged 38 mm (SD 8 mm) in the right eye and 55 mm (SD 7 mm) in the left eye. Other corneal findings included mild conjunctival lissamine green staining, nonvisually significant corneal scars, mild anterior basement membrane dystrophy, and a tear breakup time of 3 seconds in each eye. In vivo confocal microscopy of the corneal subbasal nerve plexus revealed relatively normal corneal nerve morphology, but a reduction in corneal nerve fiber density.

Conclusions:

An individual with loss-of-function mutations in SCN9A had reduced corneal nerve fiber density but normal corneal mechanoreception.
Diffuse Lamellar Keratitis in a Patient Undergoing Collagen Corneal Cross-Linking 18 Years After Laser In Situ Keratomileusis Surgery
Authors: Grassmeyer Justin J. , Goertz John G. , Baartman Brandon J.
Published: January 2021

Purpose:

To report a case of diffuse lamellar keratitis (DLK) after corneal collagen cross-linking in an eye with a remote history of laser in situ keratomileusis (LASIK) surgery.

Methods:

This is a case report and literature review.

Results:

This report describes the development of unilateral stage IV DLK in a patient who underwent bilateral corneal cross-linking for corneal ectasia 18 years after LASIK surgery. The patient was treated with high-dose topical steroids that were tapered over 1 month and multiple flap lifts. The ultimate best-corrected visual outcome was 20/60.

Conclusions:

DLK is a potential sight-threatening complication of refractive surgery that can occur at any time in the postoperative period, even years after the procedure. Undergoing a subsequent corneal procedure that may disrupt or promote inflammation within the surgical flap–stromal interface, such as corneal collagen cross-linking, is a recognized risk factor for the development of DLK. This case suggests that patients with any history of LASIK surgery undergoing corneal cross-linking or other lamellar corneal surgeries may benefit from closer follow-up (eg, daily) than patients with no history of LASIK.
Preterm Birth and Antiretroviral Exposure in Infants HIV-exposed Uninfected
Authors: Piske Micah , Qiu Annie Q. , Maan Evelyn J. , Sauvé Laura J. , Forbes John C. , Alimenti Ariane , Janssen Patricia A. , Money Deborah M. , Côté Hélène C.F. ,   for the CIHR Team Grant on Cellular Aging and HIV Comorbidities in Women and Children
Published: January 2021

Background:

Infants HIV-exposed and uninfected (IHEU) who are born to women living with HIV are at an increased risk of preterm birth (PTB). Antenatal exposure to certain maternal antiretroviral therapy (ART) regimens has been associated with PTB, although existing studies in this domain are limited and report discordant findings. We determined odds of PTB among IHEU by antenatal ART regimens and timing of exposure, adjusting for maternal risk factors.

Methods:

We retrospectively studied IHEU born in British Columbia (BC), Canada between 1990 and 2012 utilizing provincial health administrative databases. We included data from a control group of infants HIV-unexposed and uninfected (IHUU) matched ~3:1 for each IHEU on age, sex and geocode.

Results:

A total of 411 IHEU and 1224 IHUU were included in univariable analysis. PTB was more frequent among IHEU (20%) compared with IHUU (7%). IHEU were more often antenatally exposed to alcohol, tobacco, as well as prescription, nonprescription, and illicit drugs (IHEU: 36%, 8% and 35%; vs. IHUU: 3%, 1% and 9%, respectively). After adjusting for maternal substance use and smoking exposure, IHEU remained at increased odds of PTB [adjusted odds ratio (aOR) (95% CI): 2.66; (1.73, 4.08)] compared with matched IHUU controls. ART-exposed IHEU (excluding those with NRTIs only ART) had lower adjusted odds of PTB compared with IHEU with no maternal ART exposure, regardless of regimen [aOR range: 0.16–0.29 (0.02–0.95)]. Odds of PTB between IHEU exposed to ART from conception compared with IHEU exposed to ART postconception did not differ [aOR: 0.91 (0.47, 1.76)]; however, both groups experienced lower odds of PTB compared with IHEU with no maternal ART [preconception: aOR: 0.28 (0.08, 0.89); postconception: aOR 0.30 (0.11, 0.83)].

Conclusions:

BC IHEU were over twice as likely to be born preterm compared with demographically matched controls. Maternal substance use in pregnancy modulated this risk; however, we found no adverse associations of PTB with exposure to antenatal ART.
Epidemiology of Human Metapneumovirus-associated Lower Respiratory Tract Infections in African Children: Systematic Review and Meta-analysis
Authors: Ramocha Lesego M. , Mutsaerts Eleonora A. M. L. , Verwey Charl , Madhi Shabir
Published: January 2021

Background:

Human metapneumovirus (hMPV) has been associated with upper and lower respiratory tract infections (LRTI) in children and adults. This systematic review evaluated the epidemiology of hMPV-associated LRTI, including severe acute respiratory infection (SARI) hospitalization or clinically diagnosed severe pneumonia, in African children under 5 years of age.

Methods:

We searched Science Direct, PubMed, Cochrane Central, Scopus, and WHO regional databases using the terms “(“Human metapneumovirus” AND “Africa”) OR (“hMPV” AND “Africa”)” up to September 17, 2020. Other sources included ClinicalTrials.gov to obtain unpublished data. Studies were included if children were less than 5 years of age and hospitalized with hMPV-associated LRTI, SARI or if clinically diagnosed with severe pneumonia in the community. The main outcomes were prevalence of hMPV identified among children with hospitalized LRTI or SARI. We further calculated odds ratios for hMPV in cases with LRTI compared with non-LRTI controls. Pooled results were calculated using a random-effects model.

Results:

Thirty studies were eligible for inclusion in the review. The prevalence of hMPV-LRTI/SARI among hospitalized and severe pneumonia cases was 4.7% [95% confidence interval (CI): 3.9–5.6, I2
 = 95.0]. The case-control studies indicated that hMPV was 2.0-fold (95% CI: 0.9–4.4) more likely to be identified in LRTI cases (10.3%) than controls (6.0%). Three of 5 studies reported hMPV-associated LRTI case fatality risk, with a pooled estimate of 1.3% (95% CI: 0.3–2.9; I2
 = 49).

Conclusions:

hMPV was associated with approximately 5% of LRTI/SARI hospitalizations or severe pneumonia cases in Africa.
Significance of Self-Care Management as Persons Prepare to Reintegrate Into the Community
Authors: Maruca Annette T. , Dion Kimberly , Zucker Donna , Kozuch Tammi
Published: January 2021

Introduction

Persons reentering the community after incarceration often confront a range of challenges that influence their ability to engage in self-care. This study sought to gain insight and understanding of how persons recently released from an incarceration experience perceive their preparedness for reentry and how this affects their ability to engage in self-care management.

Method

Using focus group methodology, four male, two female, and one mixed focus groups (N = 31) were held at a syringe access program, a medication-assisted recovery clinic, and a postincarceration support service. The Rediscovery of Self-Care (RSC) model served as the framework. The a priori RSC constructs guided data analysis.

Findings

Participants defined self-care as basic hygiene, eating well, engaging with family, and managing mental health and their substance use issues. Depending on the interview location, self-care also included using clean injection materials, taking prescribed medications, or adhering to treatment programs. Reported challenges to self-care included transportation, substance addiction, job and housing instability, and mental illness. Our results indicate that there is value in applying the RSC model to guide nursing interventions in promoting self-care for persons with an incarceration experience.

Conclusion

There is a need for reskilling, especially pertaining to sober environments, mental health services, syringe access programs, and continuity of care. Self-care ability, self-efficacy, motivation, sense of internal control, and social support were identified as critical to the successful transition to full reentry after incarceration.
Impact of Time Restricted Feeding on Fitness Variables in Professional Resistance Trained Firefighters
Authors: Gonzalez Andrew E. , Waldman Hunter S. , Abel Mark G. , McCurdy Kevin W. , McAllister Matthew J.
Published: January 2021

Firefighters are at an elevated risk for cardiometabolic disease and sudden cardiac death due to physiological and psychological stressors. Research suggests time restricted feeding (TRF) may improve health and performance variables.

Objective:

This study investigated the effects of a 7-week TRF (14-hour fasting:10-hour eating window) on fitness variables related to physical health and performance among professional, resistance-trained firefighters.

Methods:

Several fitness variables were assessed pre- and post-TRF intervention.

Results:

Relative and absolute ventilatory threshold (VT) increased (P < 0.05), relative and absolute

, decreased (P < 0.05), and muscular strength, endurance, and power were not affected pre- versus post-intervention.

Conclusion:

Although

, decreased, all other performance variables were not negatively impacted by TRF. Improvements in VT may be associated with improvements to markers of endurance exercise performance in firefighters, but more data are needed to confirm this hypothesis.
Prediction and analysis of hub genes between glioblastoma and low-grade glioma using bioinformatics analysis
Authors: Xu Baowei
Published: January 2021

Gliomas are an intractable tumor in the central nervous system. The present study aimed to identify the differentially expressed genes (DEGs) between glioblastoma multiforme (GBM) and low-grade gliomas (LGG) in order to investigate the mechanisms of different grades of gliomas. The Cancer Genome Atlas (TCGA) database was used to identify DEGs between GBM and LGG, and 2641 genes have been found differentially expressed. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to determine the related functions and pathways of DEGs. Protein–protein interaction (PPI) network extracted a total of 444 nodes and 1953 interactions, and identified the top 6 hub genes in gliomas. The microarray data of the datasets GSE52009 and GSE4412, which were obtained from Gene Expression Omnibus (GEO) database, were used to externally validate DEGs expression levels. Gene Expression Profiling Interactive Analysis (GEPIA) database which was based on TCGA was used to explore the survival of hub genes in LGG and GBM. Additionally, the Oncomine database and Chinese Glioma Genome Atlas (CGGA) database were used to validate the mRNA expression level and prognostic value of hub genes. Gene Set Enrichment Analysis (GSEA) identified further hub genes-related pathways. In summary, through biological information and survival analysis, 6 hub genes may be new biomarkers for diagnosis and for guiding the choice of treatment strategies for different grades of gliomas.
Comprehensive, multisystem, mechanical decolonization of Vancomycin-Resistant Enterococcus and Carbapenem-Resistant Enterobacteriacease without the use of antibiotics
Authors: Choi Eunseok , Lee Sook Joung , Lee Sangjee , Yi Jinseok , Lee Yeon Soo , Chang So-youn , Jeong Ho Young , Joo Yunwoo
Published: January 2021

Among multidrug-resistant organisms (MDROs), Vancomycin-resistant Enterococcus (VRE), and Carbapenem-resistant Enterobacteriaceae (CRE) have become major nosocomial pathogens that are endemic worldwide. If VRE/CRE are present as colonizing organisms but do not act as pathogens, these organisms do not cause symptoms and do not require antibiotic use. However, once gastrointestinal colonization with VRE/CRE occurs, it can persist for long periods and serve as a reservoir for transmission to other patients. Therefore, a breakthrough strategy to control the spread of MDRO colonization is needed. We herein introduce decolonization method, which is a comprehensive, multisystem, consecutive mechanical MDRO decolonization protocol that does not utilize antibiotics.

Our protocol included

These steps were repeated consecutively until the patient was released from quarantine. We conducted VRE/CRE tests every week. Because our protocol was a comprehensive and multisystem decolonization protocol, the cooperation of patients and/or caregivers was essential, and family support was important for patient care. Patients were divided into VRE and CRE groups and were subdivided into success and failure groups according to decolonization status.

Thirty-two patients with VRE or CRE colonization were enrolled, and our protocol was performed. A total of 20 patients (62.5%) were successfully decolonized after repeated protocols. Univariate analysis revealed that patients with younger age, higher body mass index (BMI), shorter period of MDRO isolation without trial, and higher functional status showed significantly enhanced success rates with our decolonization protocol.

This study presents the decolonization effects of a comprehensive, multisystem, mechanical decolonization protocol for VRE and CRE. Most importantly, our decolonization protocol does not use antibiotics and is thus not harmful. These results suggest an active decolonization trial to be performed as early as possible in patients with VRE or CRE colonization. This simple, easy-to-apply protocol can be used as 1 of the basic treatment options for MDROs infection or colonization, regardless of whether it requires antibiotic treatment.
Effectiveness of CO2 laser therapy in treating acne depressed scar
Authors: Zang Huan , Xu Ya-nan
Published: January 2021

Background:

This study is to assess the effectiveness of CO2 laser therapy (COLT) in treating patients with acne depressed scar (ADS).

Methods:

Relevant randomized controlled trials will be checked by search the electronic databases of Cochrane Library, PUBEMD, EMBASE, Web of Science, Allied and Complementary Medicine Database, VIP Database, CBM database, and China National Knowledge Infrastructure. All potential randomized controlled trials of COLT for patients with ADS will be identified by 2 independent authors by searching all sources from inception to present. Two authors will independently undertake literature selection, data collection and study quality assessment. Any divergences between 2 authors will be settled down by a third author through discussion. RevMan 5.3 software will be used for statistical analysis.

Results:

This study will assess the effectiveness of COLT for patients with ADS.

Conclusions:

This study may provide helpful evidence to determine whether COLT is an effective intervention for patients with ADS.

Study registration:

OSF (osf.io/m9ghv).
Clinical outcomes of multivessel coronary artery disease patients revascularized by robot-assisted vs conventional standard coronary artery bypass graft surgeries in real-world practice
Authors: Lin Tzu-Hsiang , Wang Chi-Wei , Shen Ching-Hui , Chang Keng-Hao , Lai Chih-Hung , Liu Tsun-Jui , Chen Kuan-Ju , Chen Yu-Wei , Lee Wen-Lieng , Su Chieh-Shou
Published: January 2021

The treatment of patients with multivessel coronary artery disease (MVD) by coronary stenting (PCI) and the “gold standard” conventional coronary-artery bypass grafting (C-CABG) has been well explored in the literature. However, the clinical outcomes of robot-assisted CABG (R-CABG) vs C-CABG in MVD patients in real-world practice were unknown. We aimed to study the clinical outcomes of MVD patients who underwent R-CABG (robotic MIDCAB) and C-CABG at our institution between January 2005 and December 2013.

A total of 516 MVD patients received CABG were recruited into this study. Among them, 281 patients received R-CABG and 235 patients underwent C-CABG. Patients in the R-CABG group were younger, and had fewer vessels with coronary artery disease (CAD), lower prevalence of chronic renal disease (CKD), higher left ventricular ejection fraction (LVEF), as well as lower Euro scores. The in-hospital and long-term mortalities were lower in the R-CABG group, but the incidences of target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI), and stroke were not significantly different between the two groups. The long-term mortality was related to age, lower LVEF, and CKD, but not residual SYNTAX score, or completeness of revascularization. The revascularization modality (R-CABG vs C-CABG) was a borderline significantly independent predictor of long-term mortality (OR 1.76 [0.99–3.14], P = .055).

Our study concluded that R-CABG, in comparison with C-CABG, for MVD carried out in younger patients involved fewer clinical complexities was associated with lower in-hospital and long-term mortalities in real-world practice. However, the long-term rates of TLR, TVR, MI, and stroke were similar. The long-term mortality was correlated with age, lower LVEF, and CKD, where R-CABG remained a borderline significant predictor after correcting for confounding factors. R-CABG could be an effective alternative to C-CABG for MVD patients with fewer clinical complexities in real-world practice.
Comparison of lung ultrasound and other volumetric methods in peritoneal dialysis patients
Authors: Sevinc Mustafa , Hasbal Nuri Baris , Basturk Taner , Ozcafer Perin Nazif , Kocas Betul Balaban , Kilickesmez Kadriye , Ozel Alper , Sakaci Tamer , Ahbap Elbis , Unsal Abdulkadir , Koc Yener
Published: January 2021

Although many alternative methods are present, maintaining ideal volume status in peritoneal dialysis (PD) patients still rely on clinical evaluation due to lack of an evidence-based method. Lung ultrasound (LUS) is a new method for evaluation of hidden congestion in this group.

LUS findings and its relationship with other volumetric methods are investigated in this observational cross-sectional study.

In this observational cross sectional study, LUS was performed to all PD patients and compared with symptoms of hypervolemia, physical examination, vascular endothelial growth factor-C (VEGF-C), and N-terminal pro-brain natriuretic peptide levels, chest radiography, echocardiography, bioelectrical impedance analysis.

Data of 21 PD patients were evaluated. There was correlation between number of B lines and VEGF-C levels (r = 0.447, P = .042), daily urine output (r = 0.582, P = .007) and left ventricle mass index (r = –0.456, P = .038). Correlations with all other parameters were not significant. Daily urine output and VEGF-C levels were significantly different when B lines were grouped into 2 according to the median level (P < .05 for all).

This is the widest spectrum study looking for LUS findings and other volumetric parameters in a small PD cohort. LUS might be useful to evaluate hidden hypervolemia. Its correlation with VEGF-C level is a novel finding.
Evaluation of the therapeutic effect of acoustic therapy combined with acupuncture on idiopathic tinnitus
Authors: Wang Siji , Chen Ziqi , Dai Jiaqiu , Yu Fenghui , Kang Houyong
Published: January 2021

Background:

There is no effective treatment for idiopathic tinnitus. Both acoustic therapy and acupuncture have been used in the treatment of idiopathic tinnitus, but the clinical efficacy is quite different. For there is no clinical study combining the 2, the purpose of this randomized controlled trial is to evaluate the effectiveness and safety of acoustic therapy combined with acupuncture in the treatment of idiopathic tinnitus.

Methods:

This is a prospective randomized controlled trial to study the effectiveness and safety of acoustic therapy combined with acupuncture in the treatment of idiopathic tinnitus, and is approved by the clinical research ethics committee of our hospital. The patients are randomly divided into one of 2 treatment options: (A) acoustic therapy combined with acupuncture group and (B) simple acupuncture group. Patients, doctors, nurses, and data collection assistants are blinded to group allocation. Observation indicators include:

Data is analyzed using the statistical software package SPSS version 25.0 (Chicago, IL).

Discussion:

This protocol will evaluate the efficacy and safety of acoustic therapy combined with acupuncture in the treatment of idiopathic tinnitus. The results of this experiment will provide clinical evidence for the use of acoustic therapy combined with acupuncture in the treatment of idiopathic tinnitus.

Trial registration:

This study protocol is registered in

Ethics and dissemination:

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval was not required.

OSF Registration number:

DOI 10.17605/OSF.IO/87VFB.
The efficacy and safety of local infiltration analgesia vs femoral nerve block after anterior cruciate ligament reconstruction
Authors: Chen Juan , Wang Xiaowei
Published: January 2021

Background:

Several previous trials have attempted to compare the efficacy of femoral nerve block (FNB) and local infiltrative analgesia (LIA) for patients received anterior cruciate ligament (ACL) reconstruction, but reached inconsistent conclusions. The primary purpose of this present research was to compare the FNB and LIA in the reconstruction of ACL.

Methods:

This investigation was conducted and then reported on the basis of Strengthening the Reporting of Observational studies in the Epidemiology checklist. From our registry database, we retrospectively determined 688 patients who received the primary reconstruction of ACL from 2016 to 2019 at our academic institutions. This current retrospective cohort study was approved through the institutional review committee at our hospital. Inclusion criteria contained the primary or autograft bone-patellar tendine-bone reconstruction of ACL in the patients over 16 years of age. Patients in the LIA group underwent intraoperative infiltration at the harvested site after tendon harvest, with use of 2 mg/mL of ropivacaine 20 mL and 5 mg/mL of epinephrine, respectively. After the reconstruction of ACL, 5 Lg/mL of epinephrine, and 20 mL of ropivacaine (2 mg/mL) were injected at the site of surgical trauma. The patient in FNB group was given 40 mL of ropivacaine (2 mg/mL), and the ropivacaine was injected into femoral nerve sheath at femoral triangle level. The primary outcome was the consumption of morphine 24 h after the operation. And the secondary results involved the complications, functional results, and the scores of pain.

Results:

It is assumed that the efficacy of LIA in the early postoperative pain is no less than that of FNB. For our study, the major limitation is the lack of randomization. Nevertheless, these data were prospectively harvested, with high response rate of patient.

Trial registration:

This study protocol was registered in Research Registry (researchregistry6277).
Clinical effect of vestibular rehabilitation on benign paroxysmal positional vertigo
Authors: Liu Wei , Pan Cheng-Li , Wang Xi-chun , Sun Shuang
Published: January 2021

Background:

This study will evaluate the clinical effect of vestibular rehabilitation (VR) on benign paroxysmal positional vertigo (BPPV).

Methods:

In this study, we will identify relevant trials on the topic published in MEDLINE, EBASE, Web of Science, Cochrane Library, Scopus, CINAHL, CBM, and CNKI from inception to the present. We will also search conference proceedings, thesis/dissertation, ongoing trials in clinical trial registry, and reference lists of included studies. Two researchers will independently carry out record selection, data extraction, and study quality assessment, respectively. Any disagreement will be arbitrated and solved with the help of a third researcher. If necessary, we will conduct random-effects meta-analysis to pool the effect estimates of included trials determined to be acceptable heterogeneity.

Results:

We will summarize the latest evidence to assess the effect of VR for the treatment of patients with BPPV.

Conclusion:

The findings of this study will help determine whether or not VR is effective in treating BPPV.

OSF registration:

osf.io/k83y5.
Tuina for diabetes with obesity
Authors: Peng Sihan , Xie Ziyan , Zhang Xiyu , Liu Ya , Zhang Xiangeng , Liang Xiaoli , Wang Hongyan , Xie Chunguang
Published: January 2021

Background:

Obesity is an independent risk factor for the occurrence and development of diabetes. Patients with diabetes combined with obesity will face serious burdens such as increase in insulin resistance and difficulty in blood glucose control. As a safe, effective, economical, and simple intervention, Tuina is more acceptable to the public than drugs. The objective of this systematic evaluation and meta-analysis is to evaluate the efficacy and safety of Tuina for diabetes with obesity.

Methods:

We will search the following electronic databases: PubMed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure (CNKI), Sino Med, Wanfang, Chinese Clinical Trial Registry System, China Biomedical Literature Database (CBM). The time limit for retrieving studies is from establishment to November 2020 for each database. Randomized controlled clinical trials related to Tuina intervention on diabetes with obesity will be included. Data synthesis, sensitivity analysis, subgroup analysis as well as the assessment of bias risk will be conducted by using Stata V.13.0 and Review manager 5.3 software.

Results:

This study will provide a quantitative and standardized evaluation for the efficacy of Tuina therapy on diabetes with obesity.

Conclusion:

This systematic review and meta-analysis will provide the high-quality evidence of whether Tuina is an effective intervention for diabetes with obesity.

Registration number:

INPLASY2020110106.
Stent insertion with high-intensity focused ultrasound ablation for malignant biliary obstruction
Authors: Cai Peng-Fei , Gu Hong , Zhu Lei-Juan , Xu Yuan-Shun , Deng Hong-Yan
Published: January 2021

Background:

This meta-analysis was conducted in order to understand the clinical efficacy of stent insertion with high-intensity focused ultrasound (HIFU) ablation for the treatment of malignant biliary obstruction (MBO).

Methods:

The Pubmed, Embase, and Cochrane Library databases were searched for all relevant studies published through July 2020. The meta-analysis was conducted using RevMan v5.3, with analyzed study endpoints including the rate of stent dysfunction, time to stent dysfunction, stent patency, complication rate, and overall survival (OS).

Results:

In total, 35 potentially relevant studies were initially identified, of which 6 were ultimately included in the present meta-analysis. These 6 studies included 429 MBO patients that were treated either only via stenting (n = 221) or via stenting in combination with HIFU ablation (n = 208). Pooled stent dysfunction rates in the stent and stent with HIFU groups were 25.9% and 18.0%, respectively (OR: 1.59; 95% CI: 0.88, 2.84, P = .12). The average time to stent dysfunction was significantly longer in the stent with HIFU group relative to the stent group (MD: −3.15; 95% CI: −3.53, −2.77, P < .0001). Pooled complication rates in the stent and stent with HIFU groups were 17.1% and 19.6%, respectively (OR: 0.88; 95% CI: 0.49, 1.58, P = .67). Stent patency and OS were both significantly longer in the stent with HIFU group relative to the stent group (P < .0001 and.0001, respectively). Funnel plot analyses did not reveal any significant evidence of publication bias linked to the selected study endpoints.

Conclusions:

This meta-analysis found that a combined stenting and HIFU ablation approach can achieve better stent patency and OS in MBO patients relative to stent insertion alone.
Covered vs bare stent for distal malignant biliary obstruction due to primary common biliary cancer
Authors: Tang Ling , Bao Kai-Hu , Xu Yuan-Shun , Liu Peng-Hui
Published: January 2021

This study was designed as a means of comparing the clinical efficacy and long-term outcomes of covered vs bare stent insertion as a treatment for distal malignant biliary obstruction (DMBO) caused by primary common biliary cancer (PCBC).

This retrospective study was designed using data collected between January 2012 and December 2019 to assess the short- and long-term outcomes in patients with DMBO caused by PCBC treated by inserting either bare or covered stents were compared.

Ninety two patients with DMBO caused by PCBC were divided between bare (n = 51) or covered (n = 41) stent groups. Technical success rates in both groups were 100%. Clinical success of bare vs covered stent use were 96.1% and 97.6% (P = 1.00). Stent dysfunction was seen in 17 and 6 patients in the bare and covered stent groups, respectively (P = .04). The median stent patency for bare and covered stents was 177 and 195 days, respectively (P = .51). The median survival was 188 and 200 days in the bare and covered stent groups, respectively (P = .85).

For patients with DMBO caused by PCBC, using bare vs covered stents yields similar clinical efficacy and long term outcomes.
Changes in fasting bile acid profiles after Roux-en-Y gastric bypass and sleeve gastrectomy
Authors: Zhang Chunlan , Zhang Jingjing , Zhou Zhiguang
Published: January 2021

Background:

Bile acid is an essential factor that plays a role in metabolic regulation, but how bile acid is regulated after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remains unclear. This meta-analysis aimed to investigate changes in the levels of fasting bile acids following RYGB and SG.

Methods:

A systematic literature search of the PubMed, EMBASE, Cochrane Library and Web of Science databases through July 2020 was performed in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The concentrations of bile acids were evaluated.

Results:

Thirteen studies with 289 patients were included. Our results showed that patients who underwent RYGB had increased levels of fasting total bile acids, primary bile acids, secondary bile acids, conjugated bile acids, and unconjugated bile acids, but no significant differences in all these bile acid levels were observed in patients who underwent SG. Furthermore, 12a-hydroxylated bile acid levels and the 12a-hydroxylated/non-12a-hydroxylated bile acid ratio also increased following RYGB.

Conclusion:

In this study, we found that fasting bile acid levels, especially 12a-hydroxylated bile acids levels, were increased after RYGB. However, no differences in fasting bile acid levels were observed following SG.
Impact of regulatory T cells on the prognosis of hepatocellular carcinoma
Authors: Shi Xinhui , Li Qisong , Wang Yungang
Published: January 2021

Background:

This meta-analysis aimed to systematically review current available literature to assess the impact of regulatory T cells (Tregs) on the prognosis of hepatocellular carcinoma (HCC).

Methods:

We will browse the online databases of PubMed and Cochrane Library. The summary hazard ratio (HR) and their 95% confidence intervals (CIs) will be combined to present the value reported in the study.

Conclusion:

Our meta-analysis will provide useful guidance in treatment of HCC based on the reported evidences regarding the impact of Tregs on the prognosis of HCC.

OSF registration number:

10.17605/OSF.IO/3Q8PW
Efficacy and safety of montelukast for pediatric obstructive sleep apnea syndrome
Authors: Bao Jun-Li , Xinyuan-Gao  , Han Yu-Bo , Zhang Ke , Liu Li
Published: January 2021

Background:

Pediatric obstructive sleep apnea syndrome (OSAS) is significant public concern. Clinical practice indicates that montelukast has certain therapeutic advantages, while there is a lack of evidence-based medicine support. The aim of this study is to synthesize related data to explore efficacy and safety of montelukast for pediatric OSAS.

Methods:

Data in Pubmed, EMBASE, CENTRAL, CBM, CNKI, WanFang, VIP databases were comprehensively searched. All the randomized controlled trials (RCTs) in OSAS children were identified, in which the effects of montelukast on a range of outcomes were compared. The search had a deadline of January 1, 2020. Two investigators independently conducted data extraction and assessed the literature quality of the included studies. The Revman5.3 software was used for meta-analysis of the included literature.

Results:

The efficacy and safety of montelukast in the treatment of pediatric OSAS were evaluated in terms of apnea hypopnea index (AHI), the Pittsburgh Sleep Quality Index, the Epworth Sleep Scale (ESS), neck circumference, important index in Polysomnography: sleep efficiency, desaturation index, total sleep time.

Conclusions:

This study provides reliable evidence-based support for the clinical application of montelukast in the treatment of pediatric OSAS.

PROSPERO registration number:

CRD42020146940.
Computed tomography-guided cutting needle biopsy for lung nodules
Authors: Zhang Hui-Mei , Huo Xiao-Bing , Wang Hua-Long , Zhang Xiao , Fu Yu-Fei
Published: January 2021

We aim to compare the diagnostic accuracy, safety, and radiation exposure between low-dose and standard-dose computed tomography (CT)-guided cutting needle biopsy (CNB) for lung nodules.

From January 2016 to August 2017, all consecutive patients admitted with lung nodule underwent low-dose or standard-dose CT-guided CNB procedure in our center. Diagnostic accuracy and radiation dose were compared.

A total of 67 and 69 patients who underwent low-dose and standard-dose CT-guided CNB procedure were included in this study. Each patient underwent CT-guided CNB for 1 nodule. The technical success rates were 100% in both groups. The sensitivity, specificity, and overall diagnostic accuracy were 97.7%, 100%, and 98.5% for low-dose group and 91.5%, 100%, and 94.2% for standard-dose group. There was no significant difference in diagnostic accuracy (P = .380) between 2 groups. Pneumothorax was found in 8 and 15 patients in the low-dose and standard-dose groups, respectively (11.9% vs 21.7%, P = .127). Hemoptysis was found in 10 and 10 patients in the low-dose and standard-dose groups, respectively (14.9% vs 14.5%, P = .943). The mean dose-length product was 38.2 ± 17.2 mGy-cm and 375.3 ± 115.7 mGy-cm in the low-dose and standard-dose groups (P < .001). The mean dose-length product was 38.2 ± 17.2 mGy-cm and 375.3 ± 115.7 mGy-cm in the low-dose and standard-dose groups, respectively (P < .001). The mean effective dose was 0.5 ± 0.2 mSv and 5.3 ± 1.6 mSv in the low-dose and standard-dose groups, respectively (P < .001).

Low-dose CT-guided CNB of lung nodules significantly decreased radiation dose compared with standard-dose CT. The low-dose protocol could provide similar diagnostic accuracy and safety as standard-dose CT-guided CNB for lung nodules.
Retinitis pigmentosa sine pigmento masqueraded as myopia
Authors: Lu Yi , Sun Xiaodong
Published: January 2021

Introduction:

Retinitis pigmentosa is a major cause of visual disability and blindness. Photopsia is usually presented in patients with retinal traction caused by posterior vitreous detachment in clinic, which would occur more commonly in those suffer from moderate or high myopia. We describe a patient with leopard-like retinopathy initially complaining of photopsia caused not by myopia but by retinitis pigmentosa.

Patient concerns:

A 39-year-old woman with a history of moderate myopia presented to us complaining of photopsia for several days.

Diagnosis:

Fundus examination revealed leopard-like retinopathy with normal optic disc and macula appearance in both eyes. The atrophy of retinal pigment epithelium was found in peripheral retina while no bone spicule was present. Retinal multimodal imaging helped in the correct diagnosis of retinitis pigmentosa (sine pigmento), later confirmed by genetic testing.

Interventions:

At current no specific treatment was applied, but the patient was required for follow-up observation every six months.

Outcomes:

Follow-up observation

Conclusion:

This case highlights the potential for retinitis pigmentosa sine pigmento to present with photopsia under cover of myopia and the importance of performing multimodal imaging including fundus autofluorescence for fundus disorders. Careful history review and multimodal imaging with genetic testing would help for the correct diagnosis of retinitis pigmentosa sine pigmento.
A case report of pulmonary artery sling and situs inversus incompletes
Authors: Xu Yingchun , Xu Dan , Cheng Beilei , Tang Lanfang , Chen Zhimin , Du Lizhong
Published: January 2021

Rationale:

Pulmonary artery sling (PAS) is a rare congenital anomaly. Associated airway anomalies and/or those of the cardiovascular system are present in about half the patients. Situs inversus is a rare disease in which organs of the chest and/or abdomen are arranged in a mirror image reversal of their normal position. Herein, we report a rare case of pulmonary artery sling and situs inversus incompletus, which has not yet been reported.

Patient concerns:

A 10-year-old girl was admitted because of heart murmur for more than 9 years. On physical examination, the second heart sound was prominent, and a grade 2/6 systolic murmur was heard at the left mid-sternal border. Echocardiography revealed PAS and atrial septal defect (8.6 mm). A chest computer tomography angiograph demonstrated that she had lung inversus, right aortic arch, and right lung hypoplasia in addition to PAS, with a normal positioning of the heart. The PAS intersected and twisted across the bronchus, which was obviously narrowed. The PAS was type II B, since the carina was at the T6 level without a separate right upper lobe bronchus.

Diagnoses:

Her final diagnosis was that of PAS, tracheal stenosis, situs inversus incompletus, right lung hypoplasia, right aortic arch, ASD and PDA.

Interventions:

She underwent one-stage total correction for her initial cardiovascular defects through median sternotomy under cardiopulmonary bypass support.

Outcomes:

She had an uneventful recovery and completely healthy following the procedure.

Lessons:

A thorough examination before PAS surgery was essential in discovering and carefully evaluating complicated heart and lung anomalies.
Life-threatening bleeding in a patient with pemphigoid-induced acquired hemophilia A and successfully treated with rituximab and rFVIIa
Authors: Ma Hongbing , Chang Hong
Published: January 2021

Rationale:

Acquired hemophilia A (AHA) is a rare bleeding disorder with prolonged activated partial thromboplastin time (aPTT). Severe hemorrhage may occur, especially in refractory AHA.

Patient concerns:

We reported a 63-year-old man who suffered from life-threatening bleeding after the onset in lower limbs.

Diagnoses:

The patient was diagnosed as AHA which was related to pemphigoid.

Interventions:

The patient had no response to the first-line treatment with corticosteroid and cyclophosphamide. Meanwhile, fatal hemorrhage occurred successively in thoracic cavity and right frontal lobe. rFVIIa and rituximab were administered.

Outcomes:

The patient survived from the life-threatening hemorrhage with a normal aPTT. His aPTT and FVIII:C level was normal during the follow-up of 6 months.

Lessons:

Rituximab and rFVIIa can play a critical role in rescuing AHA that is refractory to the first-line treatment.
Granulomatosis with polyangiitis with obstructive pneumonia progressing to hypertrophic pachymeningitis
Authors: Hayashi Keigo , Watanabe Haruki , Yamamura Yuriko , Asano Yosuke , Katayama Yu , Hiramatsu-Asano Sumie , Ohashi Keiji , Morishita Michiko , Narazaki Mariko , Matsumoto Yoshinori , Sada Ken-Ei , Wada Jun
Published: January 2021

Rationale:

Bronchial involvement alone is a rare initial manifestation of granulomatosis with polyangiitis (GPA). Herein, we report a case of refractory GPA with obstructive pneumonia caused by bronchial involvement.

Patient concerns:

A 65-year-old man complained of a 2-week cough and fever.

Diagnoses:

Considering the presence of opacities and multiple consolidations in both lungs due to obstruction or stenosis on the bronchus, which did not respond to antibiotics, and proteinase-3-antineutrophil cytoplasmic autoantibody positivity, he was diagnosed with GPA. Positron emission tomography- computed tomography scan revealed no abnormal findings in the upper respiratory tract.

Interventions:

He was treated with prednisolone (PSL, 50 mg/d) and intravenous cyclophosphamide.

Outcomes:

His general and respiratory symptoms improved. However, 8 weeks after PSL treatment at 20 mg/d, he developed a relapse of vasculitis along with sinusitis and hypertrophic pachymeningitis. Hence, PSL treatment was resumed to 50 mg/d, and weekly administration of rituximab was initiated. Consequently, the symptoms gradually mitigated.

Lessons:

GPA with bronchial involvement is often intractable and requires careful follow-up, which should include upper respiratory tract and hypertrophic pachymeningitis assessment.
Simultaneous ipsilateral distal radius and radial head fractures
Authors: Park Il-Jung , Sur Yoo Joon , Kim Jongmin , Jeon Jin Hwa , Park Ho Youn
Published: January 2021

Rationale:

Distal radius fracture with simultaneous ipsilateral radial head fracture is a very rare pattern of injury. This type of injury is referred to as ‘radius bipolar fracture’. Treatments for this injury pattern can be challenging because both the wrist and elbow need to be considered. There are currently no guidelines for the treatment of this specific type of injury. We report two cases of this unusual pattern of injury treated in our hospital.

Patient concerns:

Case 1 was a 78-year-old female patient and case 2 was a 19-year-old female patient who visited our emergency department with left elbow and wrist pain after slipping and falling.

Diagnosis:

Plain radiography and computed tomography revealed radius bipolar fracture. Case 1 had an AO type C3 distal radius fracture, a Mason type III radial head fracture. Case 2 had an AO type B2 undisplaced distal radius fracture and a Mason type III radial head fracture.

Interventions:

In case 1, open reduction and internal fixation (ORIF) was performed for the distal radius fracture and radial head replacement arthroplasty for the radial head fracture. In case 2, distal radius fracture was treated conservatively and ORIF was performed for the radial head fracture.

Outcomes:

Bony union as achieved in both cases. At 1-year follow-up, case 1 showed slight limited range of motion of the wrist. Case 2 showed no radius shortening and full range of motion of the wrist and elbow. The Quick disabilities of the arm, shoulder and hand score was 18 and 16, respectively.

Lessons:

After this type of injury, the radius length can be changed, and as a result, ulnar variance can be affected. When radial head replaced is considered, it would be better to operate on the wrist first, and then perform radial head replacement. In this way, radiocapitellar overstuffing or instability can be prevented. However, if ORIF is planned for proximal radius fracture, either the proximal or distal radius can be fixed first. Surgeons should try to preserve radial length during treatment to optimize patient outcomes.
Acupoint for angina pectoris
Authors: Jiang Li , Deng Zhaoxia , Zhang Hongcai , Li Yuan , Wang Tingting , Xie Wen
Published: January 2021

Introduction:

Patients with angina pectoris (AP) often experience heavy psychological distress, especially anxiety and depression, which results in poorer quality of life, shorter survival time. Acupoint therapies, including massage, acupuncture, acupoints injection, acupressure, and moxibustion, showed clinical and long-lasting benefits for AP, but the efficiency of acupoint therapies was poorly evaluated. The current review is attempted to evaluate the efficacy and safety of the different acupoint-based therapies for AP.

Methods and analysis:

A literature search will be conducted in MEDLINE, EMBASE, Web of Science, Cochrane Library, Web of Science, PubMed, Science Direct, Wan Fang Data Knowledge Service Platform, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), and China National Knowledge Infrastructure (CNKI). Observational studies regarding the association between liver cancer and depression and anxiety written in English or Chinese will be included. Study inclusion, data extraction, and quality assessment will be performed independently by 2 reviewers. We will use RevMan V.5.0 and STATA V.12.0 software for statistical analysis. The I
2 test will be used to identify the extent of heterogeneity. Publication bias will be assessed by generating a funnel plot and performing the Begg and Egger test. The quality of the systematic review will be evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. With the permitted numeric data, we will carry out a meta-analysis.

Results:

This study will provide a high-quality synthesis of pain VAS and functional disability or the quality of life, the success treatment rate, the recurrent rate and the complications rate to assess the effectiveness and safety of acupoint for AP patients. This systematic review will provide evidence to judge whether acupoint is an effective intervention for patients with AP.

Conclusion:

This systematic review and meta-analysis will provide evidence to judge whether acupoint is an effective intervention for patients with AP and provide evidence for designing early targeted interventions for high-risk survivors that can attenuate negative reactions.

PROSPERO registration number:

10.17605/OSF.IO/VNXWE.