bluuebunny/crossref_metadata_2025 huggingface dataset:
Cytoreductive surgery for advanced stage ovarian cancer in the second trimester of pregnancy—a case report and literature review
Authors: Bacalbaşa Nicolae , Bălescu Irina , Vîlcu Mihaela , Dima Simona , Iliescu Laura , Brezean Iulian
Published: July 2020

Rationale:

Advanced stage ovarian cancer is rarely encountered in pregnant women, due to the high number of ultrasound imagistic studies performed during this period. The clinical course of patients diagnosed with advanced stage ovarian cancer is similar in pregnant and nonpregnant women.

Patient concerns:

We present the case of a 27-year-old woman initially submitted to emergency surgery for ovarian cyst torsion in the ninth week of gestation, at that moment ovarian cystectomy being performed.

Diagnoses:

The histopathological studies demonstrated the presence of a moderately differentiated epithelial ovarian cancer.

Interventions:

Although the interdisciplinary team decided for staging surgery followed by platinum-based chemotherapy beginning from the second trimester of pregnancy, both the patient and her family refused this strategy and opined for total hysterectomy en bloc with bilateral adnexectomy. Surprisingly, intraoperatively both ovaries had a tumoral aspect, whereas peritoneal carcinomatosis nodules were found in the Douglas pouch. Therefore, the neoplastic process was staged as a IIIC epithelial ovarian cancer, a total hysterectomy with bilateral adnexectomy, Douglas pouch peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection being performed.

Outcomes:

The patient was discharged in the sixth postoperative day and was confined to the oncology service in order to be submitted to the standard taxanes and platinum based chemotherapy.

Lessons:

Although ovarian cancer has been rarely reported during pregnancy, this diagnostic should be taken in consideration whenever persistent adnexal masses are encountered.
Tianma Gouteng Decoction combined with Qiju Dihuang Pill for the treatment of essential hypertension
Authors: Chen Xuan , Li Lijuan , Xu Xiangmei , Yang Wenna , Wang Jie , Kong Yixuan , Zheng Jinghui
Published: July 2020

Background:

Essential hypertension is one of the risk factors of cardiovascular and cerebrovascular diseases, which can cause target organ damage such as heart, brain and kidney, and has extremely high disability rate and death rate. With the development of economy and society, the prevalence rate of hypertension in China has increased rapidly from 9.8% in the 1980s to over 30% in the 21st century. According to the data published in “China Cardiovascular Disease Report 2018,” China currently has 245 million hypertension patients. Comprehensive prevention and treatment of hypertension has become one of the major public health problems in China. The clinical practice and theoretical innovation of traditional Chinese medicine in the prevention and treatment of hypertension have been carried out for decades. Relevant literature points out that Tianma Gouteng Decoction combined with Qiju Dihuang Pill has ideal effect in the treatment of primary hypertension. However, most of the literatures are small sample studies, with uneven quality and clinical evidence, and lack of evidence-based medical evidence for clinical efficacy. Therefore, this study makes further meta-analysis of Tianma Gouteng Decoction combined with Qiju Dihuang Pill in the treatment of primary hypertension, with a view to providing evidence-based medical evidence for the treatment of primary hypertension.

Methods:

We will search 3 foreign electronic databases (Cochrane Library, Embase, PubMed) and 4 Chinese electronic databases (China National Knowledge Infrastructure, WangFang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database) to collect potential systematic reviews from their inceptions to February 2020. The language of publication is limited to Chinese or English. First, the quality of randomized controlled trials documents included in this study was evaluated by using the improved Jadad scoring scale. Then, the 2 researchers conducted the evaluation independently according to Cochrane bias risk tools. The evidence level of the results will be evaluated by using the recommended evaluation, development and evaluation grading of recommendations assessment, development, and evaluation method. Statistical analysis will be conducted using Revman 5.3.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusions:

The conclusion of this study will provide evidence for the efficacy of Tianma Gouteng Decoction combined with Qiju Dihuang Pills in the treatment of primary hypertension due to the efficacy of western medicine alone in treating primary hypertension.

Registration number PROSPERO:

INPLASY202050088.
Diagnostic value of rapid on-site evaluation in interventional pulmonology
Authors: Weng Xiangwen , Zhi Lijia , An Xing , Xu Meixin , Zhang Hua , Long Kunlan , Gao Peiyang
Published: July 2020

Background:

Rapid on-site evaluation (ROSE) is a kind of rapid evaluation of specimen satisfaction, preliminary diagnosis and priority strategy, the diagnostic accuracy of ROSE in the field of pulmonary intervention shows wide variation. The aim of the study was to further clarify the accuracy and diagnostic efficacy of ROSE in interventional pulmonology.

Methods:

This review summarizes and meta-analyzes studies of ROSE in interventional pulmonology, the ROSE diagnoses would be compared with the final pathologic diagnoses. The following electronic databases have been searched: PubMed, Cochrane Library, Embase, Web of science, CNKI, and WANFANG DATA. The methodologic quality of studies has been assessed using the Quality of Diagnostic Studies (QUADAS-2) instrument. This review is conducted using standard methods for systematic reviews of diagnostic accuracy studies. STATA SE 12.0 is used for data synthesis and analysis.

Results:

This review evaluates the accuracy and diagnostic efficacy of ROSE in interventional pulmonology, and the process factors that may influence the ROSE diagnosis are analyzed, such as Smear method, profession of smear technician, staining method, Profession of stain technician, Profession of reading slides, invasive procedure, Anesthesia method and etc.

Conclusion:

This review will stimulate proper evaluation of ROSE and provide assistance for clinical practice.
Virological activity in treatment-naïve HBeAg-negative HBV-infected adult patients
Authors: Zhai Xiangjun , Zhu Liguo , Jiang Jie , Song Ci , Peng Hong , Qian Jiao , Zhou MingHao , Zhou Yan , Wang Qungang , Xu Jianfang , Wang Zhijian , Liu Hongjian , Fan Min , Hu Zhibin , Shen Hongbin , Zhu Fengcai
Published: July 2020

Nowadays most of the hepatitis B virus (HBV) infected population are adults, among which hepatitis B e antigen (HBeAg) negative infection occupied the largest proportion of HBV infection in China. HBeAg-negative patients are heterogeneous, and the corresponding interventions are different. Therefore, it is worth researching the infection characteristics of HBeAg-negative patients to help guide the interventions.

A total of 11,738 treatment-naïve HBeAg-negative adult patients were randomly selected, and their demographic and medical history information were collected. The liver biochemistry, and HBV infection biomarkers including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), HBeAg, hepatitis B e antibody (anti-HBe), hepatitis B core antibody (anti-HBc), and hepatitis B virus deoxyribonucleic acid (HBV-DNA) levels were tested. The infection characteristics and their influencing factors were explored.

Sixty percent of the patients presented HBV-DNA-positive, of which 31.2% had HBV-DNA level higher than 2000 IU/mL, and 16.5% had HBV-DNA level higher than 20,000 IU/mL. HBV-DNA levels tended to increase along with the increasing of age, and the male patients had significant higher HBV-DNA levels than the female patients. Twenty-four percent of the patients had abnormal transaminase. The male patients were more vulnerable to abnormal transaminase (30.0%) than the female patients (18.4%). Fifty-five percent patients with HBV-DNA ≥20,000 IU/mL presented abnormal alanine aminotransferase (ALT) or aspartate transaminase (AST), which was significantly higher than that of patients with HBV-DNA levels below 20,000 IU/mL (19.0–21.7%). Multivariate logistic regression analyses revealed that the male patients and the patients with higher viral load had higher risk of having abnormal liver function.

A considerable number of HBeAg-negative patients were virological active and had liver damage. It is necessary and urgent to carry out regular active interventions for the chronic HBV-infected patients.
Therapeutic effects of regorafenib after sorafenib monotherapy with advanced hepatocellular carcinoma including Child–Pugh classification B
Authors: Komiyama Satoshi , Numata Kazushi , Ogushi Katsuaki , Moriya Satoshi , Fukuda Hiroyuki , Chuma Makoto , Maeda Shin
Published: July 2020

The therapeutic effect of regorafenib was previously demonstrated in patients with advanced hepatocellular carcinoma (HCC) and Child–Pugh classification A (CP-A) whose disease progressed during sorafenib treatment in a phase III trial. However, treatment options are limited for patients with advanced HCC other than CP-A. In this study, we aimed to evaluate the therapeutic effect of regorafenib on advanced HCC patients including those with Child–Pugh classification B (CP-B).

We retrospectively analyzed the medical records of 21 patients with advanced HCC who were treated with regorafenib after sorafenib monotherapy at our hospital from July 2017 to April 2018 and were followed up until September 2019. Patients were classified according to liver function and adverse events experienced during sorafenib treatment and were started on regorafenib with a pre-defined reduced starting dose along with a dose reduction and schedule change based on the judgement of the attending physician.

At regorafenib initiation, 13 and 8 patients were classified as CP-A and CP-B, respectively. In all patients with CP-B, the starting dose of regorafenib was reduced, and the pre-defined starting-dose sets were applied to 17 (81%) patients. The median duration of regorafenib treatment in patients with CP-A and CP-B were 4.1 months and 2.0 months, respectively, with no significant difference. The median overall survival from regorafenib initiation (OS-r) and sorafenib initiation (OS-s) was 13.2 months and 30.9 months, respectively. In subgroup analysis, OS-r was 16.3 months in patients with CP-A and 10.1 months with CP-B with no significant difference (P = .44), whereas OS-r was 16.3 months in patients with modified albumin-bilirubin Grade 1/2a and 13.2 months in patients with Grade 2b, with no significant difference. There was no clear difference in the incidence rate of ≥grade 3 adverse events between CP-A and CP-B. OS-r and OS-s were significantly correlated.

Even patients with impaired liver function achieved the desired therapeutic effects by safely reducing the starting dose of regorafenib according to both impaired liver function and adverse events during pretreatment. Regorafenib may be considered to be an effective treatment after sorafenib monotherapy in patients with impaired liver function.
The sensitivity and specificity of statistical rules for diagnosing delayed neurocognitive recovery with Montreal cognitive assessment in elderly surgical patients
Authors: Hu Jian , Li Chun-Jing , Wang Bo-Jie , Li Xue-Ying , Mu Dong-Liang , Wang Dong-Xin
Published: July 2020

Delayed neurocognitive recovery (DNR) is common in elderly patients after major noncardiac surgery. This study was designed to investigate the best statistical rule in diagnosing DNR with the Montreal cognitive assessment (MoCA) in elderly surgical patients.

This was a cohort study. One hundred seventy-five elderly (60 years or over) patients who were scheduled to undergo major noncardiac surgery were enrolled. A battery of neuropsychological tests and the MoCA were employed to test cognitive function at the day before and on fifth day after surgery. Fifty-three age- and education-matched nonsurgical control subjects completed cognitive assessment with the same instruments at the same time interval. The definition of the international study of postoperative cognitive dysfunction (ISPOCD 1) was adopted as the standard reference for diagnosing DNR. With the MoCA, the following rules were used to diagnose DNR: the cut-off point of ≤26; the 1 standard deviation decline from baseline; the 2 scores decline from baseline; and the Z score of ≥1.96. The sensitivity and specificity as well as the area under receiver operating characteristic curve for the above rules in diagnosis of DNR were calculated.

The incidence of DNR was 13.1% (23/175) according to the ISPOCD1 definition. When compared with the standard reference, the 2 scores rule showed the best combination of sensitivity (82.6%, 95% confidence interval [CI] 67.1%–98.1%) and specificity (82.2%, 95% CI 76.2%–88.3%); it also had the largest area under receiver operating characteristic curve (0.824, 95% CI 0.728–0.921, P < .001). The cut-off point rule showed high sensitivity (95.7%) and low specificity (37.5%), whereas the 1 standard deviation and the Z score rules showed low sensitivity (47.8% and 21.7%, respectively) and high specificity (93.4% and 97.3%, respectively).

Compared with the ISPOCD1 definition, the 2 scores rule with MoCA had the best combination of sensitivity and specificity to diagnose DNR.
The effectiveness and safety of acupuncture for allergic rhinitis
Authors: Yang Jun , Xiong Jun , Wang Xue , Yuan Ting , Fu Yong , Jiang Yunfeng , Zhou Xiaohong , Liao Kai , Xu Lingling
Published: July 2020

Background:

Allergic rhinitis (AR) is one of the most common allergic disorders globally. Several systematic reviews and meta-analyses have reported the effectiveness of acupuncture for patients with AR. However, the evidence has not been systematically synthesized. This overview aims to map, synthesize, and assess the reliability of evidence generated from these systematic reviews (SRs) and meta-analyses of acupuncture for AR.

Methods:

A Comprehensive literature search will be conducted through the PubMed, Embase, the Cochrane Library of Systematic Reviews, the China National Knowledge Infrastructure Database, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Scientific Journal Database from inception until January 2020. Additionally, the PROSPERO database and the reference list of included studies will be searched for unpublished, ongoing, or recently completed SRs and meta-analyses. The reviewers will identify reviews independently and extract data according to the methodological guidelines for overviews provided by the Cochrane Collaboration. The risk of bias will be assessed based on the Risk of Bias in Systematic Reviews. The methodological and reporting quality of the included reviews will be assessed using the Assessing the Methodological Quality of Systematic Reviews (V.2) tool and the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. The outcomes of interest include total nasal symptom score, rhinoconjunctivitis quality-of-life questionnaire, immunoglobulin E, visual analog scale, laboratory examination, and side effects. The quality of evidence of outcomes will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation. The evidence will be synthesized where appropriate based on patient subgroups and outcomes.

Ethics and dissemination:

Ethical approval is not required for overviews. We plan to publish results in peer-reviewed journals and present at international and national academic, clinical, and patient conferences.

Results:

The results will be published in a peer-reviewed journal.

Conclusion:

This overview will provide comprehensive evidence of acupuncture for patients with AR.

PROSPERO registration number:

CRD42019140756.
Evaluation of an artificial intelligent hydrocephalus diagnosis model based on transfer learning
Authors: Duan Weike , Zhang Jinsen , Zhang Liang , Lin Zongsong , Chen Yuhang , Hao Xiaowei , Wang Yixin , Zhang Hongri
Published: July 2020

To design and develop artificial intelligence (AI) hydrocephalus (HYC) imaging diagnostic model using a transfer learning algorithm and evaluate its application in the diagnosis of HYC by non-contrast material-enhanced head computed tomographic (CT) images.

A training and validation dataset of non-contrast material-enhanced head CT examinations that comprised of 1000 patients with HYC and 1000 normal people with no HYC accumulating to 28,500 images. Images were pre-processed, and the feature variables were labeled. The feature variables were extracted by the neural network for transfer learning. AI algorithm performance was tested on a separate dataset containing 250 examinations of HYC and 250 of normal. Resident, attending and consultant in the department of radiology were also tested with the test sets, their results were compared with the AI model.

Final model performance for HYC showed 93.6% sensitivity (95% confidence interval: 77%, 97%) and 94.4% specificity (95% confidence interval: 79%, 98%), with area under the characteristic curve of 0.93. Accuracy rate of model, resident, attending, and consultant were 94.0%, 93.4%, 95.6%, and 97.0%.

AI can effectively identify the characteristics of HYC from CT images of the brain and automatically analyze the images. In the future, AI can provide auxiliary diagnosis of image results and reduce the burden on junior doctors.
Combining the tumor abnormal protein test with tests for carcinoembryonic antigens, cancer antigen 15–3, and/or cancer antigen 125 significantly increased their diagnostic sensitivity for breast cancer
Authors: Chen Rui , Jiang Chaojun , Zhu Qiannan , You Sainan , Li Yan , Li Shuo , Ding Lei , Meng Haojie , Yang Yuxin , Zha Xiaoming , Wang Jue
Published: July 2020

Background:

The tumor abnormal protein (TAP) test is used to screen for many cancers, but its use for breast cancer has not been studied.

Methods:

Tests for carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 15-3 (CA15-3), and TAP were administered to 261 women with operable benign breast disease and 348 with breast cancer. The cutoff value used for TAP was the mean + 3 standard deviations for benign breast disease patients (275.64 μm2). Sensitivities and specificities of single biomarker tests and combined tests were compared. The combined tests were defined as positive if any single biomarker was positive, and negative otherwise.

Results:

The single biomarker test sensitivities were similar: CEA, 7.18%; CA125, 4.89%; CA15-3, 7.47%; and TAP, 4.89%. For the combinations TAP + CEA + CA125, TAP + CEA + CA15-3, TAP + CA125 + CA15-3, and TAP + CEA + CA125 + CA15-3, the sensitivities were 16.67%, 17.82%, 16.38%, and 21.84%, respectively, and the specificities were 93.49%, 97.70%, 93.87%, and 92.72%.

Conclusions:

The 4-test combination showed the highest sensitivity (21.84%) and may be auxiliary used in early screening. TAP + CEA + CA15-3 showed high specificity (97.70%) and so could be used for confirming breast cancer.
Diagnostic accuracy of contrast-enhanced ultrasound in the detection of small renal masses
Authors: Wu Jiang-feng , Wu Chao , Wang Yun-lai , Wang Zheng-ping
Published: July 2020

Background:

The small renal masses (SRMs) were defined that the diameter of renal masses measured by enhanced image was ≤4 cm. The diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for SRMs is apparently variable among previous studies. Hence, this study will evaluate the diagnostic accuracy of CEUS in the identification of benign and malignant SRMs.

Methods:

A comprehensive search using the databases of Cochrane Library, Embase, PubMed, WANGFANG, and China National Knowledge Infrastructure will be carried out to identify studies in which patients with SRMs are assessed by CEUS. Two investigators will independently screen the literature and extract the data. Any discrepancies will be resolved via discussion with the senior author. Study quality will be assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various CEUS findings for the diagnosis of SRMs will be determined. Summary receiver operating characteristic curve will be used to assess the overall performance of CEUS.

Results:

This study will evaluate the diagnostic accuracy of CEUS for the diagnosis of SRMs through sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio.

Conclusion:

This study will summarize the most recent evidence that focusing on the diagnosis of CEUS for SRMs.

Study registration:

INPLASY202060040.
Lymphocyte percentage and platelet count correlate with the treatment outcome to tyrosine kinase inhibitors in epidermal growth factor receptor–mutated lung adenocarcinoma
Authors: Li Chi-Cheng , Lin Chih-Bin , Chu Sung-Chao , Huang Wei-Han , Lee Jen-Jyh , Yang Gee-Gwo , Wang Tso-Fu , Wu Yi-Feng
Published: July 2020

This observational study evaluated the treatment outcomes of clinical factors on the patients with lung adenocarcinoma with epidermal growth factor receptor mutations who received tyrosine kinase inhibitors as first-line treatment.

Patients with stage IIIb or IV lung adenocarcinoma with mutated epidermal growth factor receptor were enrolled retrospectively between March 2010 and December 2017. The hematologic markers on progression-free survival (PFS) and overall survival (OS) were analyzed.

Totally 190 patients were enrolled. In univariate analysis by hematologic markers, lower lymphocyte percentage and higher platelet count were associated with significantly poor PFS and OS. Multivariate analysis showed lower lymphocyte percentage was independent poor prognostic factors for PFS and OS. Higher platelet count was an independent poor prognostic factor for OS only.

Patients with lung adenocarcinoma receiving tyrosine kinase inhibitors with lower lymphocyte percentage and higher platelet count had poorer prognoses compared with other patients.
Effect of early activity combined with early nutrition on acquired weakness in ICU patients
Authors: Zhou Wendie , Shi Baisheng , Fan Yuying , Zhu Jinsong
Published: July 2020

Introduction:

Intensive care unit-acquired weakness (ICU-AW) occurs in 25% to 100% of critically ill patients, and is associated with prolonged mechanical ventilation, extended ICU stay, and total hospital stay, increased hospital costs, higher risk of death, impaired physical function, and decreased quality of life. However, there are not any current guidelines that mention management of ICU-AW. The present study will evaluate the effects of a combination of early nutrition and early exercise compared to those of either early exercise alone or the standard care for patients in ICUs.

Methods:

This is a 3-arm, parallel, randomized controlled trial including an estimated 147 critically ill patients aged ≥18 years recruited from the ICUs of 2 hospitals in Heilongjiang, China. Patients will be prospectively randomized 1:1:1 to receive early mobilization, early nutrition combined with early mobilization, or standard care (minimal exercises, experience-based initiation and enrollment of nutrition support). Outcomes are assessed at ICU discharge after baseline. The primary outcome is occurrence of ICU-AW according to the Medical Research Council scale at the end of treatment. Muscle strength, organ failure, functional independence, self-care ability, time of ICU stay, duration of mechanical ventilation, and ICU mortality are secondary outcome measures.

Discussion:

This trial has the potential to identify a novel strategy for preventing or managing ICU-AW. The findings may increase the clinical knowledge about nutrition and mobilization interventions for people with ICU-AW, and contribute to the formation of practice guidelines for managing this condition.

Trial registration number:

ChiCTR2000033482
Effectiveness and outcomes of 2 therapeutic interventions for cardiac tamponade
Authors: Zgheib Hady , Wakil Cynthia , Shayya Sami , Bachir Rana , El Sayed Mazen
Published: July 2020

Pericardial effusions can either be drained by percutaneous pericardiocentesis (PCC) or by surgical pericardiotomy (SP), with limited evidence of superiority for the management of cardiac tamponade (CTa).

This study uses the US Nationwide Emergency Department Sample database to investigate the effectiveness of SP and PCC in patients with CTa in terms of clinical outcomes and healthcare costs.

Retrospective observational study conducted on the US Nationwide Emergency Department Sample 2014 dataset CTa patients. Descriptive and multivariate logistic regression analyses were done to assess the impact of different procedures (none, SP, PCC, SP, and PCC) on mortality.

A total of 10,410 CTa patients were included, of which 28.9% underwent no procedure, 32.9% underwent SP, 30.2% underwent PCC and 8.0% underwent SP and PCC. Mortality rates were highest in patients undergoing no procedure (22.3%) followed by PCC (15.0%), SP and PCC (11.5%), and then SP (9.6%) (P < .001). SP patients had longer length of stay (11.65 vs 8.16 days, P < .001) and higher total charges ($162,889.1 vs $100,802, P < .001) compared to PCC patients. Undergoing any procedure for CTa reduced the rate of mortality compared to no procedure with SP being the most effective (OR = 0.323, 95%CI 0.244-0.429), followed by SP & PCC (OR = 0.387, 95% CI 0.239–0.626), and then PCC (OR = 0.582, 95% CI 0.446–0.760).

Adult CTa patients treated with SP had lower mortality rates but longer length of stay and higher healthcare expenses. This SP associated benefit remained consistent across different subpopulations after stratifying by age and potential disease etiology.
Acute glans ischemia after circumcision successfully treated with low-molecular-weight heparin and topical dihydrotestosterone
Authors: Zvizdic Zlatan , Anic Dusko , Popovic Nusret , Vranic Semir
Published: July 2020

Rationale:

Circumcision like any other surgical procedure is not devoid of complications. Serious complications are rare and include iatrogenic hypospadias, glans ischemia/necrosis, and glans amputation, all of which require an emergent treatment.

Patient concerns:

We report here a case of 6 months-old-boy with a superficial glans ischemia following circumcision.

Diagnosis:

Physical examination revealed a severely cyanotic glans with the moderate edema of the dorsal penile skin. Plasma levels of D-dimer were 8.57 mg/L. Urine passage was unremarkable while color Doppler ultrasonography revealed a normal blood flow.

Interventions:

The patient was successfully treated with subcutaneous injection of enoxaparin (low-molecular-weight heparin) and topical 2.5% dihydrotestosterone.

Outcomes:

The appearance of the glans penis on the 5th day was close to normal while the control levels of D-dimer dropped to the reference range. The patient was discharged from the hospital on the 6th day. At 6-month follow-up, the appearance of the glans penis was normal.

Lessons:

Acute glans penis ischemia following circumcision is a rare complication. Its successful treatment with enoxaparin and topical dihydrotestosterone has not been previously reported in the literature.
Gray matter alterations in restless legs syndrome
Authors: Sheng LiQin , Zhao PanWen , Ma HaiRong , Qi Liang , Yi ZhongQuan , Shi YuanYuan , Zhong JianGuo , Shi HaiCun , Dai ZhenYu , Pan PingLei
Published: July 2020

Background:

Voxel-based morphometry (VBM) is an objective structural magnetic resonance imaging (MRI) technique which allows researchers to investigate group-level differences in regional gray matter (GM) volume or density over the whole brain. In the last decade, VBM studies in restless leg syndrome (RLS) have exhibited inconsistent and conflicting findings.

Methods:

Studies will be identified through a computerized literature search of the following databases: PubMed, Web of Science, and Embase until October 1, 2018 and updated on March 1, 2020. This protocol will be performed in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). In addition, we will follow the recent guidelines and recommendations for coordinate-based meta-analysis (CBMA). This CBMA will be performed with the seed-based d mapping with permutation of subject images (SDM-PSI) software.

Results:

This CBMA will offer the latest evidence of GM alterations in RLS.

Conclusions:

To our knowledge, this will be the first CBMA that pooled VBM findings in RLS. This quantitative evidence of GM alterations will characterize brain morphometry of RLS.

PROSPERO registration number:

CRD42018117014.
The impact of exercise intervention for patients undergoing hemodialysis on fatigue and quality of life
Authors: Zhang Fan , Bai Yan , Zhao Xing , Huang Liuyan , Zhang Ying , Zhang Huachun
Published: July 2020

Background:

This study aims to determine the therapeutic efficacy of exercise interventions for patients undergoing hemodialysis (HD) on fatigue and health-related quality of life (HRQoL).

Methods:

This review will only include randomized controlled trials (RCTs). The search strategy will be performed in 4 English databases, 4 Chinese databases, Clinical Trials.gov, and the Chinese Clinical Trial Registry. All English or Chinese RCTs, published from inception to May 31, 2020, will be sought. Two reviewers will screen, select studies, extract data, and assess quality independently. Primary outcome is fatigue assessed by questionnaire. The methodological quality including the risk of bias of the included studies will be evaluated using the Physiotherapy Evidence Database scale. Stata 12.0 software will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis.

Results:

We will provide some more practical and targeted results investigating the effect of exercise interventions for patients undergoing HD on fatigue and HRQoL in the current meta-analysis, and point out the main limitation of previous studies.

Conclusion:

The study will provide recent evidence for evaluating the therapeutic efficacy of exercise interventions for patients undergoing HD on fatigue and HRQoL.

Registration number:

INPLASY202050071 (DOI: 10.37766/inplasy2020.5.0071)
A mycobacterial DivIVA domain-containing protein involved in cell length and septation
Authors: Pickford Hayleah , Alcock Emily , Singh Albel , Kelemen Gabriella , Bhatt Apoorva
Published: July 2020

Mycobacterial cells elongate via polar deposition of cell wall material, similar to the filamentous

Streptomyces

species, which contain a tip-organizing centre. Coiled-coiled proteins such as DivIVA play an important role in this process. The genome of

Mycobacterium tuberculosis

, the causative agent of tuberculosis, encodes many coiled-coil proteins that are homologous to DivIVA with a potential role in mycobacterial cell elongation. Here we describe studies on Mycobacterium smegmatis MSMEG_2416, a homologue of M. tuberculosis Rv2927c. Two previous independent studies showed that MSMEG_2416 was involved in septation (subsequently referred to as sepIVA). Contrary to these previous reports, we found sepIVA to be dispensable for growth in laboratory media by generating a viable null mutant. The mutant strain did, however, show a number of differences, including a change in colony morphology and biofilm formation that could be reversed on complementation with sepIVA as well as Rv2927c, the sepIVA homologue from

M. tuberculosis

. However, analysis of cell wall lipids did not reveal any alterations in lipid profiles of the mutant strain. Microscopic examination of the mutant revealed longer cells with more septa, which occurred at irregular intervals, often generating mini-compartments, a profile similar to that observed in the previous studies following conditional depletion, highlighting a role for sepIVA in mycobacterial growth.
Interpreting the result of a diagnostic test: An experimental study in a social network
Authors: Sofi-Mahmudi Ahmad
Published: July 2020

Background

Statistical literacy is an important element in informing patients and planning treatments for both clinicians and policymakers. This study aim to investigate and compare the interpretation of a diagnostic test result in medical and non-medical professionals.

Methods

A diagnostic test question about positive predictive value was posted on the “Stories” section of five personal Instagram accounts. The collected information included the exact calculated number, educational status (undergraduate or graduated) and field of study (dentistry, medicine, other medical, non-medical). The results were analysed using R version 3.4.4 on Microsoft Windows 10 with the Pearson χ2 test.

Results

Of 121 participants, 63.6% did not provide a correct answer. The highest and the lowest correct answer ratios were seen in non-medical and dentistry groups, with 52.6% and 22.2%, respectively (P = 0.09, χ2 = 6.464, df = 3). Undergraduates showed a more favourable performance than graduates with 41.8% correct answers compared to 20.0% (P = 0.03, χ2 = 4.616, df = 1).

Conclusion

The statistical interpretation of the medical professionals is lower than the non-medical professionals and graduates showed less favourable results compared to undergraduates. There is a need for more beneficial and continuative statistical education for medical professionals.
Seroprevalence of Hospital Staff in Province with Zero COVID-19 Cases
Authors: Nopsopon Tanawin , Pongpirul Krit , Chotirosniramit Korn , Jakaew Wutichai , Kaewwijit Chuenkhwan , Kanchana Sawan , Hiransuthikul Narin
Published: July 2020

BACKGROUND

COVID-19 seroprevalence data has been scarce, especially in less developed countries with a relatively low infection rate.

METHODS

A locally developed rapid immunoglobulin M (IgM) / immunoglobulin G (IgG) test kit was used for screening hospital staff in Ranong hospital which located in a province with zero COVID-19 prevalence in Thailand from April 17 to May 17, 2020. A total of 844 participants were tested; 82 of which were tested twice with one month apart. (Thai Clinical Trials Registry: TCTR20200426002)

RESULTS

Overall, 0.8% of the participants (7 of 844) had positive IgM, none had positive IgG. Female staff seemed to have higher IgM seropositive than male staff (1.0% vs. 0.5%). None of the participants with a history of travel to the high-risk area or a history of close contact with PCR-confirmed COVID-19 case had developed antibodies against SARS-CoV-2. Among 844 staff, 811 had no symptom and six of them developed IgM seropositive (0.7%) while 33 had minor symptoms and only one of them developed IgM seropositive (3.0%). No association between IgM antibody against SARS-CoV-2 status and gender, history of travel to a high-risk area, history of close contact with PCR-confirmed COVID-19 case, history of close contact with suspected COVID-19 case, presence of symptoms within 14 days, or previous PCR status was found. None of the hospital staff developed IgG against SARS-CoV-2.

CONCLUSION

COVID-19 antibody test could detect a substantial number of hospital staffs who could be potential silent spreaders in a province with zero COVID-19 cases. Antibody testing should be encouraged for mass screening, especially in asymptomatic healthcare workers.

TRIAL REGISTRATION

This study was approved by the Institutional Review Board of Chulalongkorn University (IRB No.236/63) and the Institutional Review Board of Ranong Hospital. (Thai Clinical Trials Registry: TCTR20200426002)

FUNDING

None.
Efficacy of McKenzie Manipulative Therapy on Pain, Functional Activity and Disability for Lumbar Disc Herniation
Authors: Hossain Mohammad Anwar , Jahid Iqbal Kabir , Hossain Md. Forhad , Uddin Zakir , Kabir Md. Feroz , Hossain K M Amran , Hassan Md. Nazmul , Walton Lori Maria
Published: July 2020

Introduction

Lumbar disc herniation (LDH) is one of the common determinations for low back pain and disability. The objectives of the study were to explore the effectiveness of McKenzie exercises and Manipulative Therapy approaches for LDH.

Methodology

Assessor blinded RCT carried out for 36 months at CRP. 72 subjects aged 25-50 years, clinically and radiologically diagnosed with LDH were randomly recruited and 68 found eligible. The control group received stretching exercises and Maitland mobilization, and the experimental group received McKenzie therapy for 12 sessions in 4 weeks, both groups received conventional care in addition. Pain was the primary outcome and secondary outcome was participation in functional activities and disability.

Results

From day 1 to 4 weeks both groups had improvement in pain, fear avoidance and bothersome (p<.05). McKenzie found superior in disability (p<.001) from 4 weeks to 6 months, in pain and disability (p<.05) from day 1 to 6 months, and in fear avoidance belief total (p<.05).

Conclusion

The McKenzie manipulative therapy approach reported effective for pain, disability and participating in activities for single or multiple level LDH patients from day 1 to week 4 and the treatment effect extends after 6 months.
Implementation of Tuberculosis Infection Control Practices in Tuberculosis Diagnostic and Treatment Health Facilities in Kampala District, Uganda, August 2015
Authors: Tugumisirize Didas , Turyahabwe Stavia , Bulage Lilian , Muyanja Stella Zawedde , Majwala Robert Kaos , Kakinda Michael , Muchuro Simon , Nyombi Abdunoor , Nsawotebba Andrew , Mujuni Denis , Kabugo Joel , Katongole Simon Peter
Published: July 2020

Background

Effective implementation of Tuberculosis infection control (TB IC) measures in health facilities delivering TB care services is very critical in controlling nosocomial transmission of TB infections among health workers, patients and their attendants. The aim of the study was to assess and document the implementation of TB IC practices in TB diagnostic and treatment health facilities in Kampala District, which accounts for 15-20% of the total TB burden in Uganda.

Methods

In August 2015, we conducted a cross-sectional study in 25 health facilities including 07 Public and 18 Private healthcare facilities in Kampala. We used a modified checklist adopted from the national manual for implementing TB control measures in health care facilities. We reviewed health facility records and where necessary observed TB IC practices to triangulate our findings. We conducted univariate analysis and generated proportions in order to describe the extent of implementation of TB IC measures.

Results

On average, 73% of both administrative and managerial, 65% environmental, and 56% personal protective TB IC measures were complied with at the health facilities visited. Private health facilities implemented 71% of both administrative and managerial TBIC measures compared to public health facilities (31%). Thirty Six percent of health facilities reported that they were regularly screening health care workers for TB. By Observation, 28% had TB IC guideline, 36% had TB IC plan, 12% had a designated area for sputum collection, 56% were regularly opening windows, 40% had fans installed in the waiting areas and/or consultation rooms and 24% had bio-safety cabinets fitted with UV light. In addition, 60% had N95 respirators but only 32% of the facilities reported that their health workers routinely wore them.

Conclusion

Implementation of WHO recommended TB IC measures in health facilities delivering TB care services in Kampala was sub optimal. Routine involvement of health facility management as well as increasing human resources for health is critical in implementing easy to do TBIC measures like triaging, patients’ educating on coughing etiquette and respiratory hygiene and daily window opening particularly in public health care settings where implementation of administrative TB IC measures is wanting
Longitudinal dynamics of the neutralizing antibody response to SARS-CoV-2 infection
Authors: Wang Kai , Long Quan-Xin , Deng Hai-Jun , Hu Jie , Gao Qing-Zhu , Zhang Gui-Ji , He Chang-Long , Huang Lu-Yi , Hu Jie-Li , Chen Juan , Tang Ni , Huang Ai-Long
Published: July 2020

Background

Coronavirus disease 2019 (COVID-19) is a global pandemic with no licensed vaccine or specific antiviral agents for therapy. Little is known about the longitudinal dynamics of SARS-CoV-2-specific neutralizing antibodies (NAbs) in COVID-19 patients.

Methods

Blood samples (n=173) were collected from 30 COVID-19 patients over a 3-month period after symptom onset and analyzed for SARS-CoV-2-specific NAbs, using the lentiviral pseudotype assay, coincident with the levels of IgG and proinflammatory cytokines.

Results

SARS-CoV-2-specific NAb titers were low for the first 7-10 d after symtom onset and increased after 2-3 weeks. The median peak time for NAbs was 33 d (IQR 24-59 d) after symptom onset. NAb titers in 93.3% (28/30) of the patients declined gradually over the 3-month study period, with a median decrease of 34.8% (IQR 19.6-42.4%). NAb titers increased over time in parallel with the rise in IgG antibody levels, correlating well at week 3 (r = 0.41, p < 0.05). The NAb titers also demonstrated a significant positive correlation with levels of plasma proinflammatory cytokines, including SCF, TRAIL, and M-CSF.

Conclusions

These data provide useful information regarding dynamic changes in NAbs in COVID-19 patients during the acute and convalescent phases.
The Effect of the COVID-19 Pandemic on People with Parkinson’s Disease
Authors: Brown Ethan G. , Chahine Lana M. , Goldman Samuel M. , Korell Monica , Mann Emerald , Kinel Daniel R. , Arnedo Vanessa , Marek Kenneth L. , Tanner Caroline M.
Published: July 2020

Objective

To rapidly identify areas of need and improve care in people with Parkinson’s disease (PwPD) affected by the COVID-19 pandemic, we deployed a survey focusing on the presentation and complications of COVID-19 infection and the effect of the COVID-19 pandemic among those not infected.

Methods

Individuals with and without PD participating in the online study Fox Insight (FI) were invited to complete an online survey between April 23-May 23, 2020. Among people reporting COVID-19 diagnosis, we compared the frequency of symptoms and poor outcomes in people with and without PD. Among people not reporting COVID-19, we assessed the effects of the pandemic on access to medical care and other services, and in PwPD, its effects on PD symptoms.

Results

Among 5,429 PwPD and 1,452 without PD, 77 reported a COVID-19 diagnosis (51 PwPD, 26 without PD). Complications were more frequent in people with longer PD duration. PwPD and COVID-19 experienced new or worsening motor (63%) and nonmotor (75%) PD symptoms. PwPD not diagnosed with COVID-19 reported disrupted medical care (64%), exercise (21%), and social activities (57%), and worsened PD motor (43%) and non-motor (52%) symptoms. Disruptions were more common for PwPD living alone, and for those with lower income and non-white race.

Conclusions

The COVID-19 pandemic is associated with wide-ranging effects on people with PD, and certain groups may be at particular risk. FI provides a rapid, patient-centered means to assess these effects and identify needs that can be used to improve the health of PwPD.
Use of Powered Air-Purifying Respirator(PAPR) by healthcare workers for preventing highly infectious viral diseases -a systematic review of evidence
Authors: Licina Ana , Silvers Andrew , Stuart Rhonda L
Published: July 2020

Background

Healthcare workers (HCWs) are at particular risk during pandemics and epidemics of highly virulent diseases with significant morbidity and case fatality rate. These diseases include Severe Acute Respiratory Syndrome Coronaviruses, SARS-CoV-1 and SARS-CoV-2, Middle Eastern Respiratory Syndrome (MERS) and Ebola. With the current (SARS-CoV-2) global pandemic, it is critical to delineate appropriate contextual respiratory protection for HCWs. The aim of this systematic review was to evaluate the effect of Powered Air Purifying Respirators (PAPR’s) as part of respiratory protection versus another device (egN95/FFP2) on HCW infection rates and contamination.

Methods

Our primary outcomes included HCW infection rates with SARS-CoV-2, SARS-CoV-1, Ebola or MERS when utilizing PAPR. We included randomized controlled trials, non-randomized controlled trials, and observational studies. We searched the following databases: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. Due to clinical and methodological heterogeneity, we did not conduct a meta-analysis. Where applicable, we constructed Evidence Profile (EP) tables for each individual outcome. Confidence in cumulative evidence for each outcome was classified according to the GRADE system.

Results

We identified 689 studies during literature searches. We included 10 full text studies. A narrative synthesis was provided. Two on-field studies reported no difference in the rates of healthcare workers performing airway procedures during care of critical patients with SARS-CoV-2. A single simulation trial reported a lower level of cross-contamination of participants using PAPR compared to alternative respiratory protection. There is moderate quality evidence that PAPR use is associated with greater heat tolerance but lower scores for mobility and communication ability. We identified a trend toward greater self-reported wearer comfort with PAPR technology in low quality observational simulation studies.

Conclusion

Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment. Greater heat tolerance accompanied by lower scores of mobility and audibility in PAPR were identified. Further pragmatic studies are needed in order to delineate actual effectiveness and provider satisfaction with PAPR technology.

Please note: Protocol for this review was prospectively registered with the International Register of Systematic Reviews identification number CRD42020184724.