bluuebunny/crossref_metadata_2025 huggingface dataset:
Cochlear Implant Outcomes in Patients With Severe Compared With Profound Hearing Loss
Authors: Birman Catherine S. , Sanli Halit
Published: March 2020

Objective:

To compare the speech perception outcomes for patients with preoperative severe versus profound hearing loss with a cochlear implant (CI).

Study Design:

Retrospective patient review.

Setting:

Cochlear implant program.

Patients:

Cochlear implant adult recipients (16 yr and above) having surgery between 2008 and 2015 with speech perception results and four frequency averaged severe (70–89 dBHL) or profound (90 dBHL and above) hearing loss. Prelingual deaf adults were included in the data.

Intervention:

Cochlear implant.

Main Outcome Measures:

Speech perception scores with CUNY sentences and monosyllabic (CNC/CVC) word scores at preoperative and 3, 6, and 12 months postoperatively testing. Mann–Whitney U test was performed to compare outcomes of the two groups. Interquartile comparisons were also made.

Results:

The severe group had significantly better speech perception than the profound hearing loss group for CUNY sentences and CNC/CVC word scores preoperatively (p < 0.001) (p < 0.001), at 6 months (p < 0.001) (p < 0.001), and at 12 months (p < 0.01) (p < 0.001), respectively. At 3 months there was no significant difference. The number of patients in each severe or profound group at the different time points ranged from 92 to 367 patients for CUNY sentences and from 52 to 216 patients for the word scores. The 12 months’ lower quartile score for CUNY sentences for severe and profound groups was 83% and 75% respectively. The lower quartile score for words was 32% and 26% respectively.

Conclusion:

Adult CI recipients showed marked improvements in speech perception with a CI. Those with severe hearing loss have significantly better outcomes compared with profound hearing loss patients. These outcomes can inform CI candidacy evaluation criteria.
20 Year Review of Three-dimensional Tools in Otology: Challenges of Translation and Innovation
Authors: Mukherjee Payal , Cheng Kai , Wallace Gordon , Chiaravano Elodie , Macdougall Hamish , O’Leary Stephen , Solomon Michael
Published: March 2020

Introduction:

Three-dimensional (3D) tools have played a significant role in advancing anatomical knowledge, in simulation and clinical practice in Otology. Technology is evolving at a rapid rate with new applications being reported at an overwhelming pace. It is important to continuously review new applications, assess emerging trends, and identify challenges to innovation so clinical translation progresses in an efficient and evidenced-based manner.

Methods:

A review of 20 years of literature in 3D technology specific to Otology was undertaken using Medline, Embase, PubMed, and Google Scholar search engines. Trends in the literature were analyzed as applications are evaluated and adopted into clinical practice. A literature review was conducted to identify barriers to translation.

Results:

There was increasing volume of literature reporting innovations in 3D technology in Otology with a more recent increase in reviews and meta-analysis. The most marked trend was in literature regarding clinical applications of such technology and in 3D printing. Where this may indicate that translation of these technologies is adequate, this is not reflected in routine clinical practice or even in education and training platforms.

Conclusion:

Barriers to translation of 3D tools specific to Otology include ongoing challenges in attaining high-resolution data, rendering parameters and with the advent of 3D printing a multitude of new variables in software, printers, and materials adding complexity to selecting most appropriate options. These need methodical evaluation to selectively customize solutions to clinical challenges so effective translation, scale, and adoption can occur without causing confusion about choices.
Diabetes distress, happiness, and its associated factors among type 2 diabetes mellitus patients with different therapies
Authors: Liu Shun-Ying , Huang Jin , Dong Qiao-Liang , Li Bei , Zhao Xue , Xu Rong , Yin Hong-Fang
Published: March 2020

This study aimed to investigate diabetes distress, happiness, and its associated factors of patients with type 2 diabetes mellitus (T2DM) treated by different therapies, and to analyze the related impact factors. A total of 1512 patients with T2DM were randomly selected from 18 tertiary hospitals in Hunan province from January 2016 to April 2016 who has been treated with oral antidiabetics monotherapy, insulin monotherapy, and combination therapy. Use the general information questionnaire, WHO-5 (the World Health Organization 5 well-being index) and PAID (the problem areas in diabetes scale) to collect the data. There are 846 (55.95%) patients that have serious emotional disorders, and the diabetes related distress in insulin treatment group was higher than that in combination treatment group (P < .05). Happiness of T2DM patients in combination therapy was higher than oral antidiabetic drug monotherapy and insulin monotherapy (P < .05). There was a negative correlation between diabetic suffering and happiness in patients with different treatments (R ranged from –0.335 to –0.436, P < .001). Age and happiness experience could explain 14.8% of the variance. Acute and chronic complications, controlled blood glucose level, lifestyle, therapies, and school education can explain 18.3% variance. Under different therapies, the suffering and happiness of T2DM patients differed from each other. The suffering and happiness of T2DM were related to different therapies, age, complications, glycaemic control, lifestyle, school education, and so on.
Does well-functioning hand constraint induce stress in forced-use therapy for children with unilateral cerebral palsy?
Authors: Ko Eun Jae , Sung In Young , Yuk Jin Sook
Published: March 2020

This study investigated the stress induced by well-functioning hand constraint in forced-use therapy (FUT) for children with unilateral spastic cerebral palsy (CP).

Seventeen children with unilateral spastic CP (mean age 5.8 years) received FUT: 4-week unaffected upper limb immobilization with a short-arm Scotchcast and were encouraged to incorporate it to their daily routines and plays. They were evaluated at pretreatment, immediate post-treatment, and 6 months post-treatment. The Korea-Child Behavior Checklist (K-CBCL) was used to assess the stress degree; box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), Quality of Upper Extremity Skill Test (QUEST), and Pediatric Motor Activity Log (PMAL), upper limb function; and Pediatric Evaluation of Disability Inventory (PEDI), daily living activities.

In the preschoolers, most scores of K-CBCL tended to increase after FUT; however, there was no significant change in all scale findings after FUT. In the school-aged children, most scores of K-CBCL tended to decrease after FUT; however, there was no significant change in all scale findings after FUT. The findings of the BBT, QUEST, PMAL how often and well subscales significantly improved post-treatment (P < .05).

The 4-week FUT with well-functioning hand constraint significantly improved the UL function and did not induce emotional and behavioral problems in children with unilateral spastic CP.
No difference in clinical outcome and survivorship after total knee arthroplasty with patellar resurfacing and nonresurfacing after minimum 10-year follow-up
Authors: Feng Bin , Ren Yi , Lin Jin , Jin Jin , Qian Wenwei , Weng Xisheng
Published: March 2020

The study aims to evaluate the clinical outcomes and surgery survivorship for over 10 years following patellar resurfacing or nonresurfacing in total knee arthroplasty (TKA) in a cohort of Chinese patients.

From 1998 to 2003, 355 patients underwent primary TKA in our institute. The survivorship of TKA between the patellar resurfacing and nonresurfacing groups and the clinical outcome of Hospital for Special Surgery knee score, Western Ontario and McMaster Universities index score, patellar score, patellar related complications, and radiological results were studied at latest follow-up.

There was no statistically significant difference for the Hospital for Special Surgery score, Western Ontario and McMaster Universities score, and the patellar score between the 2 groups after an average 12.4-year follow-up. Nonresurfacing group had higher anterior knee pain than the resurfacing group (13.2% vs 5.6%). The patients with rheumatoid arthritis had a 2.9-fold higher rate of patellar-related complications than did the patients with osteoarthritis. The 10-year survival rate was not significantly different between the 2 groups both for revision surgery (P = .505) and for patellar-related complication (P = .194).

There was no significant difference in the long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing. Patellar nonresurfacing could be advisable during primary TKA for osteoarthritis patients. Selective patellar resurfacing for RA patients could achieve lower patellar-related complications.
Incidence of contralateral neurosensitive changes and persistent postoperative pain 6 months after mastectomy
Authors: Masgoret Paula , de Soto Inés , Caballero Ángel , Ríos José , Gomar Carmen
Published: March 2020

Mirror image sensory dysfunction (MISD) after breast surgery has not yet been studied. This prospective observational study aimed to determine the incidence of MISD, persistent postoperative pain (PPP) and mirror image pain (MIP) during 6 months after total unilateral mastectomy.

Visual analogue scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Life orientation test (LOT) and Quantitative Sensory Testing (QST) (in ipsi and contralateral breast, axilla and thigh) were recorded. VAS > 3 at 1, 3, and 6 postoperative months was considered PPP. Contralateral changes of QST at any time was considered indicative of MISD and spontaneous contralateral VAS ≥ 1 as MIP.

Sixty-four patients were included. PPP at 1, 3 and 6 months was 18.8%, 56.2%, and 21.3%, respectively Ten patients presented MIP. MISD was detected in 79.7% patients in contralateral breast and 62.5% in contralateral axilla. Furthermore, changes in QST were present in 39.1% of patients in thigh. Electronic Von Frey (EVF) changes in both contralateral breast and axilla, and in thigh significantly diminished at all postoperative times. Changes of postoperative EVF ≥ 20% in contralateral breast were associated to higher VAS values. NPSI scores were significantly higher at all postoperative times. At 1 month, PCS, depression HADS subscale and LOT scores were significantly worse than all the other periods.

MISD incidence was almost 80%, and 15.6% of patients showed spontaneous contralateral VAS ≥ 1. At 6 months 21.3% of patients manifested PPP. The worst alteration of factors related to PPP occurred at 1 postoperative month. Most consistent QST was EVF.
Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) with sarcomatous features without recurrence after extended radical surgery
Authors: Sato Miho , Yano Mitsutake , Sato Shimpei , Aoyagi Yoko , Aso Saki , Matsumoto Harunobu , Yamamoto Ichiro , Nasu Kaei
Published: March 2020

Rationale:

The malignant potential and the appropriate treatment of uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is controversial. Although these tumors generally have benign outcomes, several reports have described recurrences, metastases, and deaths associated with this disease.

Patient concerns:

A 57-year-old Japanese woman (gravida 2, para 2) was referred to our hospital for the evaluation and treatment of uterine fibroids. Magnetic resonance imaging revealed a right ovarian mass and multiple fibroids in the uterine myometrium.

Diagnoses:

The patient was diagnosed with UTROSCT with sarcomatous features.

Interventions:

She initially underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by second-stage surgery comprising pelvic and para-aortic lymphadenectomy and subtotal omentectomy.

Outcomes:

No postoperative recurrence was observed in the patient in 36 months.

Lessons:

In this case, extended radical surgery prevented the development of recurrent disease in a patient with UTROSCT with sarcomatous features. These clinicopathological findings suggest that UTROSCT is associated with several risk factors, including older age, presence of necrosis, lymphovascular invasion, significant nuclear atypia, and significant mitotic activity. This lesion type should be considered malignant and treated with curative intent.
Obesity is a risk factor for preoperative hypoxemia in Stanford A acute aortic dissection
Authors: Wu Zhiyong , Wang Zhiwei , Wu Hongbing , Hu Rui , Ren Wei , Hu Zhipeng , Chang Jinxing
Published: March 2020

Obese individuals are apt to develop Stanford A acute aortic dissection (AAD) complicated with acute lung injury (ALI), but the mechanism is still not well defined. We aim to investigate whether oxidative stress and inflammatory are involved in the aortic dissection lung injury caused by obesity.

Seventy-nine patients were categorized into AAD with obesity group (n = 17) and AAD without obesity group (n = 62) according to body mass index (BMI). Inflammatory reactions including interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α), IL-6, C-reactive protein (CRP) and white blood cell (WBC) count, and oxidative stress including malondialdehyde (MDA), superoxide dismutase were determined using enzyme-linked immunosorbent assays and chemiluminescence. All the patients received ascending aorta replacement combined with total arch replacement and stented elephant trunk. The postoperative complications were recorded.

The incidence of preoperative hypoxemia (94.1% vs 35.5%, P < .01) and postoperative ALI (88.2% vs 40.3%, P < .01) in obese patients was significantly higher than that in non-obese patients. Besides, the ICU stay (119.2 ± 59.2 vs 87.8 ± 31.2 h, P < .01) and hospitalization duration (18.8 ± 8.5 vs 14.3 ± 8.1d, P = .048) were increased in the obese patients with AAD. The expression of IL-1β, TNF-α, IL-6, CRP, and WBC was remarkably increased (P < .01) in obese group compared with non-obese group.

Oxidative stress and inflammatory response may be involved in the process of ALI of aortic dissection caused by obesity, which provides new ideas for the treatment of ALI of the aortic dissection.
The efficacy and safety of panitumumab supplementation for colorectal cancer
Authors: Wang Chengchen , Tan Chunyan , Chen Xiaopin , Chen Shuangdong
Published: March 2020

Background:

The efficacy of panitumumab supplementation for colorectal cancer remains controversial. We conduct a systematic review and meta-analysis to explore the influence of panitumumab supplementation on treatment efficacy of colorectal cancer.

Methods:

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2019 for randomized controlled trials (RCTs) assessing the efficacy of panitumumab supplementation for colorectal cancer. This meta-analysis is performed using the random-effect model.

Results:

Five RCTs are included in the meta-analysis. Overall, compared with control group for colorectal cancer, panitumumab supplementation is associated with the increase in objective response for wild-type (WT) KRAS (RR = 1.70; 95% CI = 1.07–2.69; P = .03), but has no remarkable influence on objective response for mutant KRAS (RR = 0.92; 95% CI = 0.79–1.08; P = .32), objective response (RR = 1.35; 95% CI = 1.00–1.83; P = 0.05), progressive disease for WT KRAS (RR = 0.94; 95% CI = 0.85–1.02; P = .15), mortality (RR = 0.86; 95% CI = 0.69–1.08; P = .20), or mortality for WT KRAS (RR = 0.94; 95% CI = 0.84–1.05; P = .28). In addition, grade 3 and 4 adverse events are found to be higher in panitumumab group than those in control group (RR = 1.17; 95% CI = 1.08–1.27; P = .0001; Fig. 8).

Conclusions:

Panitumumab supplementation can provide some improvement in objective response for colorectal cancer patients with WT KRAS, but results in the increase in grade 3 and 4 adverse events.
A novel EDA1 missense mutation in X-linked hypohidrotic ectodermal dysplasia
Authors: Wang Xu , Zhang Zhiyu , Yuan Shuo , Ren Jiabao , Qu Hong , Zhang Guozhong , Chen Wenjing , Zheng Shushen , Meng Lingqiang , Bai Jiuping , Du Qingqing , Yang Dongru , Shen Wenjing
Published: March 2020

A mutation in the epithelial morphogen gene ectodysplasin-A1 (EDA1) is responsible for the disorder X-linked hypohidrotic ectodermal dysplasia (XLHED), the most common form of ectodermal dysplasia. XLHED is characterized by impaired development of hair, eccrine sweat glands, and teeth. This study aimed to identify potentially pathogenic mutations in four Chinese XLHED families.

Genomic DNA was extracted from the peripheral blood and sequenced. Sanger sequencing was used to carry out mutational analysis of the EDA1 gene, and the three-dimensional structure of the novel mutant residues in the EDA trimer was determined. Transcriptional activity of NF-κB was tested by Dual luciferin assay.

We identified a novel EDA1 mutation (c.1046C>T) and detected 3 other previously-reported mutations (c.146T>A; c.457C>T; c.467G>A). Our findings demonstrated that novel mutation c.1046C>T (p.A349 V) resulted in XLHED. The novel mutation could cause volume repulsion in the protein due to enlargement of the amino acid side chain. Dual luciferase assay revealed that transcriptional NF-κB activation induced by XLHED EDA1 protein was significantly reduced compared with wild-type EDA1.

These results extend the spectrum of EDA1 mutations in XLHED patients and suggest a functional role of the novel mutation in XLHED.
A study of radiomics parameters from dual-energy computed tomography images for lymph node metastasis evaluation in colorectal mucinous adenocarcinoma
Authors: Liu Yingying , Dou Yafang , Lu Fang , Liu Lei
Published: March 2020

Lymph nodes (LN) metastasis differentiation from computed tomography (CT) images is a challenging problem. This study aims to investigate the association between radiomics image parameters and LN metastasis in colorectal mucinous adenocarcinoma (MAC).

Clinical records and CT images of 15 patients were included in this study. Among them, 1 patient was confirmed with all metastatic LNs, the other 14 were confirmed with all non-metastatic LNs. The regions of the LNs were manually labeled on each slice by experienced radiologists. A total of 1054 LN regions were obtained. Among them, 164 were from metastatic LNs. One hundred nine image parameters were computed and analyzed using 2-sample t test method and logistic regression classifier.

Based on 2 sample t test, image parameters between the metastatic group and the non-metastatic group were compared. A total of 73 parameters were found to be significant (P < .01). The selected shape parameters demonstrate that non-metastatic LNs tend to have smaller sizes and more circle-like shapes than metastatic LNs, which validates the common agreement of LN diagnosis using computational method. Besides, several high order parameters were selected as well, which indicates that the textures vary between non-metastatic LNs and metastatic LNs. The selected parameters of significance were further used to train logistic regression classifier with L1 penalty. Based on receiver operating characteristic (ROC) analysis, large area under curve (AUC) values were achieved over 5-fold cross validation (0.88 ± 0.06). Moreover, high accuracy, specificity, and sensitivity values were observed as well.

The results of the study demonstrate that some quantitative image parameters are of significance in differentiating LN metastasis. Logistic regression classifiers showed that the parameters are with predictive values in LN metastasis, which may be used to assist preoperative diagnosis.
Removal of intracardiac bone cement embolism after percutaneous kyphoplasty
Authors: Song Yu , Huang Xiaofan , Wu Long
Published: March 2020

Rationale:

Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart.

Patient concerns:

A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty.

Diagnoses:

Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found.

Interventions:

The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve.

Outcomes:

The postoperative course was uneventful and the patient was discharged on the 13th day after surgery.

Lessons:

If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.
Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis
Authors: Chen Zehan , Wang Chang , You Di , Zhao Shishun , Zhu Zhe , Xu Meng
Published: March 2020

Background:

This meta-analysis focuses on the controversial efficacy and safety of platelet-rich plasma (PRP) as compared with hyaluronic acid (HA) in the clinical treatment of knee osteoarthritis. We have attempted to provide an evidence-based medicine protocol for the conservative treatment of knee osteoarthritis. In addition, we included the latest relevant literature in this meta-analysis, and a staging study was conducted to compare the therapeutic effects of PRP and HA for knee osteoarthritis over different time periods.

Methods:

An online computer search with “platelet-rich plasma” and “knee osteoarthritis” as search terms was conducted in the PubMed, EMBASE, and Cochrane Library databases. We conducted a quality assessment of the retrieved literature and extracted the following indicators: visual analog scale (VAS) score, subjective International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and adverse events. RevMan5.3 software was used to determine the effect sizes, and indicators were compared across studies at three different time points from the administration of treatment.

Results:

A total of 14 randomized controlled trials (RCTs) involving 1350 patients were included. Long-term VAS, IKDC, WOMAC-Pain, WOMAC-Stiffness, WOMAC-Physical Function, and WOMAC-Total scores at each time point were higher in the PRP group than in the HA group. There were no significant differences in the remaining indicators between the two groups.

Conclusion:

Compared with HA, PRP offers obvious advantages in the conservative treatment of knee osteoarthritis. Treatment with PRP can reduce long-term pain and improve knee joint function with no additional risks. Therefore, PRP can be widely used for the conservative treatment of knee osteoarthritis.
Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
Authors: Yamazaki Haruhiko , Sugino Kiminori , Matsuzu Kenichi , Masaki Chie , Akaishi Junko , Hames Kiyomi , Tomoda Chisato , Suzuki Akifumi , Uruno Takashi , Ohkuwa Keiko , Kitagawa Wataru , Nagahama Mitsuji , Masuda Munetaka , Ito Koichi
Published: March 2020

Some thyroid cancer patients experience a rapid disease progression after the discontinuation of tyrosine kinase inhibitors (TKIs), which is called flare phenomenon. The incidence of the flare phenomenon of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) ranged from 4% to 11.1% and the median time to occurrence of the flare phenomenon ranged from 7 to 12 days in previous reports. In this study, we investigate the timing and incidence of the flare phenomenon in thyroid cancer patients treated with lenvatinib.

The records of patients treated with lenvatinib were retrospectively reviewed. The primary outcomes were the incidence rate and timing of the flare phenomenon after the discontinuation of lenvatinib. The flare phenomenon was defined as death, hospitalization attributable to tumor progression, or unexpected event (e.g., pleural drainage) within 1 month of lenvatinib cessation. We excluded patients with progression of underlying diseases other than thyroid cancer or infection, those in whom the disease progressed, or those who died without achieving a clinical response (stable disease, partial response, or complete response).

In total, 8 (14.3%) of the 56 patients experienced the flare phenomenon. The median time from lenvatinib cessation to the flare phenomenon was 9 (range, 4–30) days. Three patients in the flare group died within 1 month of lenvatinib cessation without an imaging evaluation. The remaining 5 patients had dyspnea and pleural effusion, and pleural drainage was performed in 3 of the 5 patients. Lenvatinib was resumed in 4 of the 8 patients in the flare group. Median overall survival (OS) was 15.1 months in the flare group and 41.9 months in the non-flare group. The OS tended to be poor in the flare group than in the non-flare group; however, this difference was not statistically significant (P = .051).

In lenvatinib treatment for thyroid cancer, the incidence and timing of the flare phenomenon were similar to those observed with other TKIs. OS tended to be poor in the flare group than in the non-flare group. Further studies are needed to determine the mechanism of the flare phenomenon and establish measures and treatment policies.
CTLA-4 rs5742909 polymorphism and cervical cancer risk
Authors: Hu ShiWan , Pu Dan , Xia XueYi , Guo BeiXi , Zhang ChuanLi
Published: March 2020

Background:

Number of studies have been performed to evaluate the relationship between the cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) gene variant rs5742909 polymorphism and cervical cancer risk, but the sample size was small and the results were conflicting. This meta-analysis was conducted to comprehensively evaluate the overall association.

Methods:

PubMed, Web of Science, Embase, China Biology Medical Literature database, China National Knowledge Infrastructure, WanFang, and Weipu databases were searched before July 31, 2018. The strength of associations was assessed using odds ratios (ORs) and 95% confidence intervals (CIs). All of the statistical analyses were conducted using Review Manager 5.3 and Stata 14.0.

Results:

Eleven studies involved 3899 cases and 4608 controls. Overall, significant association was observed between the CTLA-4 gene variant rs5742909 polymorphism and cervical cancer (T vs C: OR = 1.40, 95% CI = 1.12–1.76; TT vs CC: OR = 2.22, 95% CI = 1.13–4.37; TT vs CT+CC: OR = 1.96, 95% CI = 1.03–3.74; TT+CT vs CC: OR = 1.47, 95% CI = 1.14–1.90). In subgroup analysis by ethnic group, a statistically significant association was observed in Asians (T vs C: OR = 1.56, 95% CI = 1.22–1.99), but not in Caucasians (T vs C: OR = 1.19, 95% CI = 0.87–1.62). The sensitivity analysis confirmed the reliability and stability of the meta-analysis.

Conclusion:

our meta-analysis supports that the CTLA-4 gene variant rs5742909 polymorphism might contribute to individual susceptibility to cervical cancer in Asians.
Is it necessary to remove syndesmotic screw before weight-bearing ambulation?
Authors: Moon Young Jae , Kim Dong Hee , Lee Kwang-Bok
Published: March 2020

In syndesmosis injury, whether the syndesmosis screw should be removed prior to weight-bearing remains controversial. The aim of this study was to compare the functional outcome between removed screw and retained groups and between recurrence of diastasis and no diastasis groups.

Fifty-six patients who had undergone open reduction and internal fixation due to syndesmosis injury were retrospectively evaluated and divided into four groups: (A) removed syndesmotic screw before weight-bearing (postoperative 3 months, n = 28), (B)retained (n = 28), (C) recurrence of diastasis (n = 9), and (D) no diastasis (n = 47). Radiological diastasis, American Orthopedic Foot Ankle Society Score (AOFAS), Short Form Health Survey-12 (SF-12), and complications (screw loosening and breakage) were evaluated between groups.

AOFAS ankle-hindfoot score was 75.10 ± 10.40 in group A, 77.07 ± 10.60 in group B. SF-12 was 45.78 ± 5.68 in group A and 47.33 ± 5.83 in group B, showing no significant difference in AOFAS ankle-hindfoot score or SF-12 (P = .487, P = .319, respectively) between groups A and B. Radiological diastasis developed significantly (P = .025) more in group A (8/28) compared to that in group B (1/28). However, screw loosening or breakage developed significantly (P = .001) more in group B (4/28) compared to that in group A (0/28). AOFAS ankle-hindfoot score was 70.33 ± 6.22 in group C and 76.50 ± 10.26 in group D. SF-12 was 49.85 ± 3.83 in group C and 47.40 ± 8.01 in group D, showing no significant difference between groups C and D in AOFAS ankle-hindfoot score or SF-12 (P = .808, P = .948, respectively).

Removal of syndesmotic screw before weight-bearing does not influence clinical outcomes. Although unrelated to clinical progress, recurrence of diastasis significantly increased in screw removed group. Therefore, removal of syndesmotic screw is unnecessary before weight-bearing.
The association between pretreatment serum alkaline phosphatase and prognosis in hepatocellular carcinoma
Authors: Sun Ping , Chen Shihai , Li Yanlong
Published: March 2020

Background:

Numerous studies have investigated the association between pretreatment serum alkaline phosphatase (ALP) and prognosis in hepatocellular carcinoma (HCC), but conclusions remain controversial. Thus, we performed a meta-analysis to assess systematically the relationship between ALP and prognosis in HCC.

Methods:

We searched the PubMed, EMBASE, and Web of Science databases for eligible studies up to October. A combined hazard ratio (HR) was determined to describe the correlation between pretreatment serum ALP level and prognosis in HCC patients. Overall survival (OS) was calculated from the date of treatment either to the end point of the follow-up period or to the date of death by any cause. Disease-free survival (DFS) and recurrence-free survival (RFS) were defined as the period from the date of treatment to the date of last follow-up or to the date of recurrence. OS was regarded as the major outcome.

Results:

Altogether, 21 studies about OS and 6 studies about DFS/RFS were included in this meta-analysis. Our combined results showed that there was an inverse association of pretreatment serum ALP level with OS (HR=1.15, 95% CI: 1.12–1.19) and RFS (HR=1.78, 95% CI: 1.37–2.31).

Conclusion:

There was a close association between high pretreatment ALP level and poor survival in HCC patients, indicating that ALP may be used as a biomarker for prognosis. More high-quality studies are required to validate our findings further, considering the limitations of our meta-analysis.
Extrapyramidal side effect of donepezil hydrochloride in an elderly patient
Authors: Li Hong-Chun , Luo Ke-Xue , Wang Jie-Sheng , Wang Qin-Xian
Published: March 2020

Introduction:

Alzheimer disease (AD) is a neurodegenerative disease characterized by progressive cognitive dysfunction, which is mainly manifested as memory impairment and a reduced ability to self-care, often accompanied by neuropsychiatric and behavioral disorders. Donepezil is the second drug to be approved by the US FDA for the treatment of AD. Of the five FDA-approved drugs for AD treatment, donepezil is currently the most widely used. Here, we report an extrapyramidal adverse reaction to donepezil in an elderly patient with AD.

Patient concerns:

An 87-year-old woman presented with a 1-year history of forgetfulness that was aggravated since the past 2 months. She had a long-term history of multiple major conditions, including hypertension, diabetes, osteoporosis, and arterial plaques. Brain imaging showed age-related changes, and her Mini Mental State Examination score was 20. Other tests revealed no abnormalities apart from multiple thyroid nodules on ultrasonography.

Diagnosis:

She was diagnosed with AD, hypertension, type 2 diabetes mellitus, diabetic neuropathy, osteoporosis, carotid and lower-extremity arterial plaques, thyroid nodules.

Interventions:

She was treated with donepezil (5 mg/day), amlodipine besylate (5 mg/day), glimepiride (4 mg/day), methylcobalamin (1.5 mg/day), calcium carbonate D3 (600 mg/day), simvastatin (20 mg/day) and enteric-coated aspirin (100 mg/day).

Outcomes:

Four days later, she experienced fatigue, panic, sweating, and one episode of vomiting. On the 5th day, she developed increased muscle tension, speech difficulty, and involuntary tremors. Imaging and blood tests revealed no obvious abnormality, and the patient was not receiving psychotropic drugs. An extrapyramidal adverse reaction to donepezil was considered, and the drug was discontinued, after which the symptoms gradually disappeared.

Conclusion:

Serious adverse reactions to donepezil can occur in elderly patients, who typically require multiple medications for a variety of comorbidities. In particular, extrapyramidal reactions have occurred when donepezil is administered in combination with psychotropic drugs. However, in our patient, an extrapyramidal adverse reaction occurred in the absence of psychotropic drugs. Thus, clinicians must be aware of inter-individual differences in drug actions and possible serious adverse reactions, and carefully monitor these patients to ensure the timely detection of adverse events and their safe treatment.
The correlation between UDP-glucuronosyltransferase polymorphisms and environmental endocrine disruptors levels in polycystic ovary syndrome patients
Authors: Luo Yunyao , Nie Ying , Tang Lu , Xu Charles C. , Xu Liangzhi
Published: March 2020

Background:

In recent years, there has been an interest in whether environmental endocrine disruptors (EEDs) may contribute to the endocrine disorders in patients with polycystic ovary syndrome (PCOS). The clearance of EEDs from the human body is regulated by the glucuronidation of UDP-glucuronosyltransferases (UGT). This study aimed to analyze the relationship of UGT1A1, UGT2B7, and UGT2B15 polymorphisms with the metabolism of EEDs in patients with PCOS.

Methods:

A total of 357 Chinese women (119 PCOS cases and 238 controls) were genotyped for polymorphisms of UGT1A1

G71R
, UGT2B7

H268Y
, and UGT2B15

D85Y
. The plasma concentrations of EEDs were measured by the gas chromatography-mass spectrometry method. The association between UGT polymorphisms and the serum level of EEDs in patients with PCOS was analyzed.

Results:

The UGT2B7

H268Y
single nucleotide polymorphism was associated with an increased risk of PCOS. The homozygous polymorphism (TT) of UGT2B7

H268Y
showed higher bisphenol A and PAEs concentrations in serum. However, a single nucleotide polymorphism on UGT2B15

D85Y
expression was associated with a decreased risk of PCOS. Subjects homozygous for the T allele of UGT2B15

D85Y
had a significant effect on phthalates in the blood. In addition, our results also showed that the homozygous polymorphism (TT) of UGT2B7

H268Y
and UGT2B15

D85Y
was associated with the capacity of the excretion of androgen in patients with PCOS.

Conclusions:

Our study reported the novel associations between the UGT polymorphisms and EEDs concentrations in patients with PCOS, supporting the relevance of genetic differences in EEDs metabolism, which might be considered as an etiology of PCOS.
Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway
Authors: Yu Wei , Zhou Pengcheng , Chen Keling , Tang Wenjun , Xia Qianming , Ma Junmei
Published: March 2020

Introduction:

Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy.

Patient concerns:

The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress.

Diagnosis:

A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular.

Interventions:

To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support.

Outcomes:

We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged.

Conclusion:

ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.
Giant fibrous hamartoma of infancy
Authors: Wang Sun , Ma Qichao , Ying Hao , Jiao Qin , Yang Dan , Zhang Bin , Zhao Lihua
Published: March 2020

Rationale:

Fibrous hamartoma of infancy (FHI) is a rare benign soft-tissue tumor in children with a triphasic organoid histologic appearance.

Patient concerns:

We here report a case with the largest FHI published so far. A 13-month-old boy with a rapidly growing tumor 45 cm in length and 69.3 cm in circumference of the left lower extremity was identified immediately at birth.

Diagnoses:

The diagnosis was uncertain before the operation, although biopsy was conducted. The postoperation histological examination showed arranged spindle cells, adipose tissue, and nests of immature small cells embedded in a myxoid background, which is the characteristic triphasic histology of FHI.

Interventions:

Under general anesthesia, hip and lower extremity amputation was performed.

Outcomes:

The patient was followed-up for 6 years and no signs of recurrence were found, suggesting a favorable prognosis, although a part of the residual tumor was present after the surgery.

Lessons:

FHI exhibits pathological and clinical characteristics. However, differential diagnosis of FHI from other soft-tissue tumors before operation remains a challenge. Thus, sometimes, aggressive therapy for the treatment of FHI might be a good choice to get a satisfactory.
Protocol for a prospective multicenter cross-sectional observational study to investigate the role of air pollution on allergic rhinitis prevalence
Authors: Liu Jianmin , Wang Yongkuan , Liu Sisi , Cao Shuwei , Xu Chunyan , Zhang Meng , Liu Shixi
Published: March 2020

Introduction:

Allergic rhinitis (AR) is a major chronic inflammatory disease of the respiratory tract. A large number of epidemiological investigations have shown that the prevalence of AR is increasing, resulting in a large social burden. Importantly, the impact of air pollution on health is a widespread concern. We aim to evaluate association of air pollution and AR risk.

Methods and analysis:

This prospective study includes patients undergoing AR. The exclusion criteria will be as follows: Patients with nasal infection, nasal polyps, nasal tumors, mental disorders, and immunodeficiency will be excluded. Air pollution levels of ambient air pollutants including PM2.5, PM10, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon dioxide (CO), and O3, and patient data will be collected. The correlation analysis will be performed in air pollutants and AR risk.

Discussion:

This study will provide correlation of NO2, SO2, PM10, and PM2.5 for AR in several aspects, including symptom score, drug score, quality of life score, asthma control score, side effects, and laboratory examination such as nasal function test, serum total immunoglobulin E, and nasal secretion smear.
What is the optimal duration of the TILT after administration of 0.4 mg nitroglycerin spray?
Authors: Glockler Antonia , Cismaru Gabriel , Istratoaie Sabina , Gusetu Gabriel , Zdrenghea Dumitru , Pop Dana , Rosu Radu
Published: March 2020

Performing a head-up tilt test can be of great value for the diagnosis of vasovagal syncope. The European Society of Cardiology recommends a drug challenge phase duration of 15 to 20 minutes, with either Isoprenaline or Nitroglycerin administration.

We sought to investigate the outcome of a ten-minute active phase with Nitroglycerin in patients suspected of vasovagal syncope and determine the percentage of loss in the positivity rate, using this short duration approach.

We consecutively enrolled patients presenting with syncope undergoing the head-up tilt test (HUTT), with a clinical suspicion of vasovagal syncope between the years 2009 to 2019. The HUTT consisted of 2 successive phases: passive and active. During the passive phase, the patients were tilted at 70° for 20 minutes. If negative, the test was continued after administration of 0.4 mg sublingual Nitroglycerin. Applying the (VASIS) Vasovagal Syncope International Study classification of the vasovagal syncope international study and comparing for age and gender, positive responses were categorized into 3 types.

A number of 306 patients (age = 43.5 +/−20.3; male = 140 [45.7%]) with suspected vasovagal syncope, undergoing HUTT, were enrolled in the years of 2009 to 2019. Of those, 245 (80.2%) presented a positive test, with 200 patients (82.0%) during the being positive during the active phase of the test. The results were as follows: 116 subjects (47.2%) presented with a mixed response (VASIS I), 52 (21.3%) showed a cardio inhibitory response (VASIS II), and 77 (31.5%) displayed a vasodepressor response (VASIS III). We found no relationship between the type of syncope with neither gender, nor age of the patient. Three minutes represented the median time to positivity, after Nitroglycerine administration. The time distribution showed a peak incidence appearing between minutes 3 and 5, ranging from 1 to 20 minutes. Only 3 patients tested positive after minute 10.

Shortening the active phase to 10 minutes would result in a positivity rate loss of 1.5%.
Influence of hand and smartphone anthropometric measurements on hand pain and discomfort
Authors: Kamel Dalia M. , Hakeem Christine Al , Tantawy Sayed A.
Published: March 2020

A good mobile phone design may increase the productivity of users, as well as their comfort. To achieve mobile users’ satisfaction, there is a need to come up with an ideal measurement that would not strain the human's body parts used to control the devices.

To investigate the correlation between smartphone and hand anthropometry measurements and the development of hand discomfort and pain.

89 Ahlia University students between the ages of 17- and 30-year-old participated in this study. Participants completed a demographic data sheet and had both of their hand dimensions and grip strength measured.

A total number of 89 participants were recruited in this study with (57.3%) females and (42.7%) males. 38% have had hand pain recently while 61.8% did not experience any hand pain. There was weak negative correlation between the phone size (r = −0.04, P = .7), hand size (r = −0.08, P = .5), and the hand grip strength (r = −0.03, P = .7) all with the reporting of hand pain. For the phone screen size and the hand lengths (r = 0.22, P = .13) there was weak positive correlation.

Mobile phone manufacturers should take into account the users’ comfort when designing their phones as this could lead to hand pain and other musculoskeletal problems. Furthermore, hand pain is multifactorial so hand size; phone size and grip strength may be taken into account.
Clinical case report
Authors: Zhang Hongmin , Zhang Xingyu , Yang Mei
Published: March 2020

Introduction:

The incidence of Hashimoto's thyroiditis among patients who have Turner syndrome (TS) has increased, but Graves’ disease (GD) in patients with TS is rarely reported. Here we report a rare case of TS with GD accompanied by hypogonadotropic hypogonadism.

Patient concerns:

We report the case of a 16-year-old girl who complained nervousness, fatigue, marasmus, heat intolerance, sweating, palpitation, and tremor lasting for more than a month. She had no medical history.

Diagnosis:

TS was diagnosed of the results of karyotyping demonstrated a gene karyotype of 46, X, i (X)(q10). GD was also diagnosed in this patient following the detection of thyroid function analysis.

Interventions:

Methimazole was administered after identification of GD. Due to the absence of secondary sex characteristics, the patient was given a conjugated estrogen preparation for 1 year, followed by the addition of estradiol cyproterone tablets for the onset of menstruation.

Outcomes:

The hyperthyroidism symptoms of the patient had improved both clinically and laboratory tests after methimazole therapy. She was treated with estrogen and estradiol cyproterone, and the uterus and secondary sexual characteristics of the patient developed during 1 year follow-up.

Conclusion:

TS generally presents as hypergonadotropic hypogonadism. However, hypogonadotropic hypogonadism cannot completely exclude TS. The diagnosis of this disease depends on chromosomal examination. The disease should be detected and treated as early as possible to improve life quality of the patient.