bluuebunny/crossref_metadata_2025 huggingface dataset:
Robotic bronchoscopy for peripheral pulmonary lesions: a convergence of technologies
Authors: Lin Julie , Ost David E.
Published: May 2021

Purpose of review

Robotic bronchoscopy is the newest advanced diagnostic bronchoscopy technology for biopsying peripheral pulmonary lesions; sensitivity for malignancy is currently suboptimal using modalities, such as radial endobronchial ultrasound or electromagnetic navigational bronchoscopy. We review the pitfalls of prior methods and the technological advancements with robotic bronchoscopy.

Recent findings

The contributors to reduced diagnostic sensitivity with current approaches include limitations in: navigation to the target, confirmation once the target is reached, and tissue acquisition. CT to body divergence with virtual reality methods, such as with electromagnetic navigation, potential false-positive confirmation with radial endobronchial ultrasound because of intraprocedural induced atelectasis, and lack of bronchoscopic and instrument maneuverability are all limitations to improving sensitivity. Robotic bronchoscopy enhances navigation through target pathway selection, allows for further reach in the distal airways, and improves tissue acquisition with more flexible and maneuverable biopsy instruments but lacks a high-fidelity target confirmation system.

Robotic bronchoscopy shows promise in biopsying peripheral lesions. Current published studies focus on diagnostic yield with robotic bronchoscopy. Future studies with long-term follow-up will be needed to assess diagnostic sensitivity for lung cancer and if robotic bronchoscopy is superior to other advanced diagnostic bronchoscopic techniques for peripheral pulmonary lesions.
Trans-esophageal echocardiography guided closure of ventricular septal defect with 2 occluders from different incisions simultaneously
Authors: Yang Hui , Mu Jie , Zhao Yuyi , Chen Zizhu , Song Haibo , Liu Jin
Published: May 2021

Introduction:

Ventricular septal defect (VSD) accounts for up to 40% of all congenital cardiac malformations. Transthoracic closure of VSDs has been well described in literature. In the current report, we described a procedure to successfully close a VSD with 2 occluders from different incisions simultaneously under the guidance of trans-esophageal echocardiography (TEE), to save the patient from undergoing another surgery.

Patient concerns:

A 52-year-old man was referred to our clinic for repeating palpitations for 6 months without chest pain and polypnea after activity.

Diagnosis:

The diagnosis of VSD was established due to the findings of a juxtatricuspid VSD with a left-to-right shunt at ventricular level and mild mitral regurgitation by TTE.

Interventions:

A transcatheter VSD closure was firstly performed but failed to repair the VSD. After the failure of transcatheter VSD closure, the patient received transthoracic closure of VSD operated by a cardiac surgeon. The VSD was closed with 2 occluders from different incisions (median thoracic skin incision and subxiphoid incision) simultaneously under the TEE guidance.

Outcomes:

The patient was extubated in intensive care unit and was discharged 4 days after the operation. During the follow up, there were no significant clinical nor laboratory side-effects of the procedure found as compared to the patient's condition before the procedure.

Conclusion:

VSD can be closed with 2 occluders from different incisions simultaneously under the TEE guidance to save the patient from undergoing repeated surgeries. Meanwhile, TEE plays a significant role in cardiac surgery.
The worldwide coronavirus disease 2019 outbreak
Authors: Mu Lin , Zhang Caijuan , Pei Yun , Wang Jingyu
Published: May 2021

To describe and advise on management protocols and infection-protection experience of the radiology department in makeshift hospitals in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.

Based on the literature review and the experience in the frontline, we retrospectively reviewed the configuration of the radiology department, human resource, personal protection, examination procedures for patients confirmed with COVID-19 in Wuhan fangcang shelter hospital.

From February 11, 2020 to March 10, 2020, 2730 and 510 CT examinations were performed in the Hanjiang shelter hospital and Hanyang Sports School shelter hospital, respectively, including initial examinations and re-examinations. The maximum number of daily CT examinations reached 289. The CT scanned a patient approximately once every 13 mins.

Fangcang shelter radiology department could be powerful components of both global and national responses to the COVID-19 pandemic.
Efficacy of Jihwangeumja (Dihuang Yinzi) on cognitive function and activities of daily living in patients with Alzheimer disease
Authors: Lee Jae Yeong , Kim Ju Yeon , Lee Ji-Yoon , Jung Jin-Hyeong , Jung In Chul
Published: May 2021

Background:

This systematic review protocol describes the methods proposed to evaluate the efficacy and safety of Jihwangeumja in patients with Alzheimer disease.

Methods:

The following databases, PubMed, EMBASE, CENTRAL, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, National Digital Science Library, Korean Information Service System, and Korean Medical Database will be searched for relevant publications without language or publication status restrictions. Search terms will be based on “Alzheimer” for participants and “Jihwangeumja” or “Dihuang Yinzi” for interventions. Two researchers will independently extract the study data from the included studies and only randomized controlled trials will be included. The risk of bias will also be assessed independently by 2 researchers using the Cochrane risk of bias tool. We will use RevMan software random-effects and fixed-effect models for the assessment of heterogeneity and data synthesis. Any changes in the plan for documenting significant protocol amendments will require the researchers to have a revision agreement and register the international prospective register of systematic review modification.

Results:

The treatment effect and safety will be measured by meta-analysis and the quality of the included studies will be reviewed.

Conclusion:

This systematic review will provide evidence regarding the efficacy and safety of Jihwangeumja.

Ethics and dissemination:

Ethical approval is not required because individual patient data will not be included in this paper. The study findings will be disseminated through conference presentations.

OSF Registration

DOI: 10.17605/OSF.IO/HXA58.
Nonpharmacological treatments for Tourette syndrome and tic disorders
Authors: Suh Hyo-Weon , Kwon Chan-Young , Hong Sunggyu , Lee Hyun Woo , Lee Misun , Kim Jong Woo , Chung Sun-Yong
Published: May 2021

Background:

A tic is a sudden, rapid, recurrent, nonrhythmic motor movement, or vocalization. Tic disorders are diagnosed based on the presence of motor or vocal tics, duration of tic symptoms, and age at onset. Current clinical practice guidelines strongly recommend behavioral therapies because they are more effective and safer than medications. To determine the most effective nonpharmacological intervention for tic disorders and Tourette syndrome, we will conduct a systematic review and network meta-analysis.

Methods:

We will search the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycARTICLES, AMED, 3 Chinese databases (China National Knowledge Infrastructure, Chongqing VIP, and Wanfang Data), 3 Korean databases (Korean Medical Database, Korean studies Information Service System, and ScienceON), and a Japanese database (CiNii). There will be no language or date restrictions. The primary outcome will be the tic severity scale, the Yale Global Tic Severity Scale. The secondary outcomes will include the effective rate defined by the trial authors, dropout rate, and adverse events. Methodological quality will be assessed using the Cochrane risk of bias tool.

Results:

Results of this review and network meta-analysis will be published in a peer-reviewed journal.

Conclusions:

This systematic review will assess the effectiveness of nonpharmacological interventions for treating tic disorders. A systematic review or meta-analysis will provide an unbiased overview of the existing evidence.
Clinical course of asymptomatic malignant pleural effusion in non-small cell lung cancer patients
Authors: Roh Jiyeon , Ahn Hyo Yeong , Kim Insu , Son Ju Hyeong , Seol Hee Yun , Kim Mi Hyun , Lee Min Ki , Eom Jung Seop
Published: May 2021

The British Thoracic Society guidelines recommend observation for patients with asymptomatic malignant pleural effusion (MPE). However, asymptomatic MPE can become symptomatic. This study examined the clinical course of asymptomatic MPE in patients with non-small cell lung cancer (NSCLC), including the incidence and timing of symptom development of asymptomatic MPE and the associated factors.

Retrospective data of 4822 NSCLC patients between January 2012 and December 2017 were reviewed. Symptom development of asymptomatic MPE was defined as the development of symptoms requiring additional treatment, such as insertion of a chest tube, within 1 year in patients who lacked MPE symptoms at the time of diagnosis. Clinical information, pathological parameters, and radiological characteristics were reviewed. Patient data up to 1 year from the initial diagnosis were reviewed.

Of 113 patients with asymptomatic MPE, 46 (41%) became symptomatic within 1 year despite appropriate anticancer treatment. The median time to symptom development was 4 months, and 38 patients (83%) developed symptoms within 6 months. Multivariate logistic regression showed that female sex (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.101–0.649; P = .004) and the depth of pleural effusion on initial computed tomography (CT) (OR, 0.957; 95% CI, 0.932–0.982; P = .001) were independently associated with symptom development of asymptomatic MPE.

A fraction of 41% of patients with asymptomatic MPE became symptomatic within 1 year. Female sex and larger MPE on initial CT were independently associated with symptom development of asymptomatic MPE.
Long-term outcomes of 170 brain arteriovenous malformations treated by frameless image-guided robotic stereotactic radiosurgery
Authors: Punyawai Pritsana , Radomsutthikul Nicha , Dhanachai Mantana , Kobkitsuksakul Chai , Hansasuta Ake
Published: May 2021

This study was conducted to report long-term outcomes of the frameless robotic stereotactic radiosurgery (SRS) for brain arteriovenous malformation (AVM) at Ramathibodi Hospital.

Retrospective data of patients with brain AVM (bAVM), who underwent CyberKnife SRS (CKSRS) at Ramathibodi Hospital from 2009 to 2014, were examined. Exclusion criteria were insufficient follow-up time (<36 months) or incomplete information. Patients’ demographics, clinical presentation, treatment parameters, and results were analyzed. Excellent outcome was defined as AVM obliteration without a new neurological deficit. Risk factors for achieving excellent outcome were assessed.

From a total of 277 CKSRS treatments for bAVM during the 6 years, 170 AVMs in 166 patients met the inclusion criteria. One hundred and thirty-nine cases (81.76%) presented with hemorrhages from ruptured bAVMs. Almost two-thirds underwent embolization before radiosurgery. With the median AVM volume of 4.17 mL, three-quarters of the cohort had single-fraction CKSRS, utilizing the median prescribed dose of 15 Gray (Gy). In the multisession group (25.29%), the median prescribed dose and the AVM volume were 27.5 Gy and 22.3 mL, respectively. An overall excellent outcome, at a median follow-up period of 72.45 months, was observed in 99 cases (58.24%). Seven AVMs (4.12%) ruptured after CKSRS but 1 patient suffered a new neurological deficit. Two patients (1.18%) were classified into the poor outcome category but there were no deaths. Negative factors for excellent outcome, by multivariate regression analysis, were the male sex and multisession SRS delivery, but not age, history of AVM rupture, previous embolization, or AVM volume.

Despite relatively larger bAVM and utilizing a lower prescribed radiation dose, the excellent outcome was within the reported range from previous literature. This study offers one of the longest follow-ups and the largest cohorts from the frameless image-guided robotic SRS community.
Five-year clinical outcomes of the first Korean-made sirolimus-eluting coronary stent with abluminal biodegradable polymer
Authors: Seo Kyoung-Woo , Yang Hyoung-Mo , Yoon Junghan , Kim Hyo-Soo , Chang Kiyuk , Lim Hong-Seok , Choi Byoung-Joo , Choi So-Yeon , Yoon Myeong-Ho , Lee Seung-Hwan , Ahn Sung Gyun , Youn Young Jin , Lee Jun-Won , Koo Bon-Kwon , Park Kyung Woo , Yang Han-Mo , Han Jung-Kyu , Chung Wook-Sung , Park Hun-Jun , Hwang Byung-Hee , Choo Eun-Ho , Oh Gyu-Chul , Tahk Seung-Jea
Published: May 2021

This study evaluated the 5-year clinical outcomes of the Genoss DES, the first Korean-made sirolimus-eluting coronary stent with abluminal biodegradable polymer.

We previously conducted the first-in-patient prospective, multicenter, randomized trial with a 1:1 ratio of patients using the Genoss DES and Promus Element stents; the angiographic and clinical outcomes of the Genoss DES stent were comparable to those of the Promus Element stent. The primary endpoint was major adverse cardiac events (MACE), which was a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years.

We enrolled 38 patients in the Genoss DES group and 39 in the Promus Element group. Thirty-eight patients (100%) from the Genoss DES group and 38 (97.4%) from the Promus Element group were followed up at 5 years. The rates of MACE (5.3% vs 12.8%, P = .431), death (5.3% vs 10.3%, P = .675), TLR (2.6% vs 2.6%, P = 1.000), and target vessel revascularization (TVR) (7.9% vs 2.6%, P = .358) at 5 years did not differ significantly between the groups. No TLR or target vessel revascularization was reported from years 1 to 5 after the index procedure, and no MI or stent thrombosis occurred in either group during 5 years.

The biodegradable polymer Genoss DES and durable polymer Promus Element stents showed comparable low rates of MACE at the 5-year clinical follow-up.
Sintilimab induced diabetic ketoacidosis in a patient with small cell lung cancer
Authors: Huang Xiaofei , Yang Mei , Wang Liu , Li Libo , Zhong Xiaowei
Published: May 2021

Rationale:

Sintilimab is a novel programmed cell death receptor-1 (PD-1) inhibitor approved in the treatment of classical Hodgkin's lymphoma and undergoing clinical trials for various malignancies. As a PD-1 inhibitor, sintilimab is known to cause autoimmune adverse events similar to other PD-1 inhibitors. Diabetic ketoacidosis (DKA) is a rare but severe adverse event of this therapy.

Patient concerns:

We report a case of a 59-year-old man who developed DKA after 5 doses of sintilimab for small cell lung cancer. His fasting glycemia level was 14.07 mmol/L, urine ketone bodies were 4+, arterial blood pH was 7.271, bicarbonate was 12.3 mmol/L, and glycated hemoglobin (HbA1c) was 7.4%. Extended investigations revealed that fasting C-peptide was undetectable (<0.003 nmol/L).

Diagnosis:

These laboratory investigations supported the diagnosis of fulminant type 1 diabetes mellitus, but no β-cell related antibodies were positive.

Interventions:

After remission of DKA, he was treated with insulin therapy to acquire a normalization of glycemia and the disappearance of symptoms.

Outcomes:

Sintilimab was withheld after 6 cycles and was converted to durvalumab to sustain the therapeutic effect.

Lessons:

This case and associated literature review illustrate the importance of educating and monitoring patients who start PD-1 inhibitor therapy regarding this potentially life-threatening complication.
Magnetic resonance radiomics signatures for predicting poorly differentiated hepatocellular carcinoma
Authors: Yang Xiaozhen , Yuan Chunwang , Zhang Yinghua , Wang Zhenchang
Published: May 2021

Radiomics contributes to the extraction of undetectable features with the naked eye from high-throughput quantitative images. In this study, 2 predictive models were constructed, which allowed recognition of poorly differentiated hepatocellular carcinoma (HCC). In addition, the effectiveness of the as-constructed signature was investigated in HCC patients.

A retrospective study involving 188 patients (age, 29–85 years) enrolled from November 2010 to April 2018 was carried out. All patients were divided randomly into 2 cohorts, namely, the training cohort (n = 141) and the validation cohort (n = 47). The MRI images (DICOM) were collected from PACS before ablation; in addition, the radiomics features were extracted from the 3D tumor area on T1-weighted imaging (T1WI) scans, T2-weighted imaging (T2WI) scans, arterial images, portal images and delayed phase images. In total, 200 radiomics features were extracted. t test and Mann–Whitney U test were performed to exclude some radiomics signatures. Afterwards, a radiomics signature model was built through LASSO regression by RStudio Software. We constructed 2 support vector machine (SVM)-based models: 1 with a radiomics signature only (model 1) and 1 that integrated clinical and radiomics signatures (model 2). Then, the diagnostic performance of the radiomics signature was evaluated through receiver operating characteristic (ROC) analysis.

The classification accuracy in the training and validation cohorts was 80.9% and 72.3%, respectively, for model 1. In the training cohort, the area under the ROC curve (AUC) was 0.623, while it was 0.576 in the validation cohort. The classification accuracy in the training and validation cohorts were 79.4% and 74.5%, respectively, for model 2. In the training cohort, the AUC was 0.721, while it was 0.681 in the validation cohort.

The MRI-based radiomics signature and clinical model can distinguish HCC patients that belong in a low differentiation group from other patients, which helps in the performance of personal medical protocols.
Combined therapy of hypertensive nephropathy with ginkgo leaf extract and dipyridamole injection and antihypertensive drugs
Authors: Jialiken Dinala , Qian Lichao , Ren Shuai , Wu Lihua , Xu Junyao , Zou Chong
Published: May 2021

Background:

In recent years, the incidence rate of hypertensive nephropathy has been increasing quickly, which has been a major threat to people's health. Renin-angiotensin-aldosterone system blockers have certain curative effects. However, there are some patients having serious adverse reactions, and the benefit population is limited, so the treatment of hypertensive renal damage is necessary to have beneficial supplement. More and more clinical studies have shown that ginkgo leaf extract and dipyridamole injection (GDI) combined with antihypertensive drugs has achieved good results in the treatment of hypertensive renal damage. It is supposed to be a supplementary treatment in hypertensive nephropathy.

Objectives:

To systematically assess the efficacy and safety of GDI combined with antihypertensive drugs on hypertensive renal injury.

Methods:

Seven databases including PubMed, Cochrane Library, Embase, Wanfang database, China biomedical literature service system (Sino Med), VIP Chinese Sci-tech journal database (VIP), and China national knowledge internet (CNKI) were retrieved to collect randomized controlled trials (RCTs) in the experimental group containing combined therapy of hypertensive nephropathy with GDI and antihypertensive drugs. The retrieval time was from the establishment of database to July 8, 2020. Two researchers independently selected literature, extracted data, and evaluated the risk of bias in the study. The methodological quality was evaluated with Cochrane handbook and meta-analysis was performed with Stata 14.0 software.

Results:

Eight studies were included in this study which involved 556 patients. The meta-analyses indicated that, compared with using antihypertensive drugs alone, combined treatment of GDI with antihypertensive drugs can decrease 24-hour urinary total protein (weighted mean difference [WMD] –0.61, 95% confidence interval [CI]: –0.82, –0.39; k = 6, P ≤ .001), blood urea nitrogen (WMD –1.27, 95% CI: –2.45, –0.10; k = 6, P = .033, serum creatinine (WMD –29.50, 95% CI: –56.44, –2.56; number of estimates [k] = 6, P = .032).

Conclusions:

Our meta-analyses showed that GDI combined with antihypertensive drugs can improve the renal function of hypertensive patients with renal injury.
Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis in a COVID-19 patient
Authors: Kogure Chio , Kikushima Wataru , Fukuda Yoshiko , Hasebe Yuka , Takahashi Toshiyuki , Shibuya Takashi , Sakurada Yoichi , Kashiwagi Kenji
Published: May 2021

Rationale:

Coronavirus disease 2019 (COVID-19) has spread worldwide. It involves multiple organs of infected individuals and encompasses diverse clinical manifestations. We report a case of acute optic neuritis (ON) associated with myelin oligodendrocyte glycoprotein (MOG) antibody possibly induced by COVID-19.

Patient concerns:

A 47-year-old man presented to our clinic with left eye pain and vision loss. Magnetic resonance imaging of the orbit revealed the bilateral high intensity of the optic nerve sheaths. He tested positive for COVID-19 by polymerase chain reaction (PCR) testing on the day of admission but he had no signs of respiratory illness. Laboratory testing revealed that MOG immunoglobulin G (MOG IgG) was positive, but other antibodies including aquaporin-4 were negative.

Diagnosis:

The patient was diagnosed with MOG antibody-positive acute ON possibly induced by COVID-19.

Interventions:

Steroid pulse therapy consisting of methylprednisolone 1 g/day for a total of 3 days, followed by an oral prednisolone taper was performed.

Outcomes:

His left eye pain was immediately relieved, and his decimal vision improved from 0.03 to 0.1 on the day of discharge. Outpatient follow-up 2 weeks later revealed left a decimal vision of 1.2, and a complete resolution of the left eye pain.

Lessons:

Our case indicated that COVID-19 might trigger an autoimmune response that leads to MOG antibody-associated ON, similar to other pathogens that were reported in the past. The treatment response to steroid pulse therapy was preferable following a typical course of MOG antibody-positive ON.
Efficacy and safety of massage therapy for autism spectrum disorders
Authors: Guo Sheng , Zhou Ke-Lin , Dong Shuo , Xue Xiao-Na , Wei Pei-Dong , Yang Jing-Yi , Fu Guo-Bing , Liu Zhen-Bo , Cui Xia
Published: May 2021

Background

Autism spectrum disorder is a neurodevelopmental disorder with increasing incidence. At present, the global incidence of the disease is on the rise, and the cause is unknown. There is no specific treatment for this disease at present, mainly education and training. Traditional Chinese medicine treatment has a certain effect on the improvement of the symptoms of the disease. The treatment methods are mainly oral Chinese medicine and acupuncture, but children are often not easy to cooperate. As a safe and effective green therapy, massage is easy to be accepted by children.

Methods

We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating autism spectrum disorders: Wanfang and PubMed Database, China National Knowledge Infrastructure Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, and Excerpta Medica database. Each database will be searched from inception to March 2021. The entire process will include study selection, data extraction, risk of bias assessment, and meta-analyses.

Results

This proposed study will evaluate the effectiveness and safety of massage therapy for patients with autism spectrum disorders. The outcomes will include changes in autism spectrum disorder relief and adverse effect.

Conclusion

This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for patients with autism spectrum disorders.

Dissemination and ethics

The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.
Relationship between ABO blood group and gestational diabetes mellitus
Authors: Chen Dongyun , Lin Lili , Hong Qiong , Li Xiaohong
Published: May 2021

Background:

Gestational diabetes mellitus (GDM) is a common metabolic disorder syndrome in women during pregnancy. If effective measures are not taken to intervene in the early stage of GDM, severe effects will damage maternal and infant health. ABO is the most important human blood group system. A large number of studies have displayed that ABO blood group is associated with many diseases. At present, the risk relationship between ABO blood group and GDM is controversial. The purpose of this study is to explore the risk relationship between ABO blood group and GDM by meta-analysis, thus providing basis for the prevention and treatment of GDM.

Methods:

An electronic database, including Embase, Cochrane Library, Pubmed, Chinese databases SinoMed, Chinese National Knowledge Infrastructure, Chinese Scientific Journals Database and Wanfang Data, will be used to search for studies of ABO blood group and GDM. The language will be limited to Chinese and English. The two reviewers will be responsible for the selection of the study, the extraction of data and the evaluation of the quality of the research. All statistical analyses will be carried out using Review Manager 5.3.

Results:

The results of this meta-analysis will be published in peer-reviewed journals.

Conclusion:

This study will provide evidence to support the relationship between ABO blood group and the risk of GDM

Ethics and dissemination:

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

OSF Registration number:

DOI 10.17605/OSF.IO/W6QSX.
Physical activity and risk of sudden cardiac death in individuals at high risk for cardiovascular disease
Authors: Wu Qinqin , Li Fanghui , Jia Yu , Liu Yi , Zeng Rui
Published: May 2021

Background:

Regular physical exercise is recommended for lowering the risk of coronary events and all-cause mortality. However, there is a variety of exercise options, and their relative effectiveness and hierarchy remain unclear. Herein, we present a systematic review and meta-analysis protocol that aims to compare the impact of different types of physical activity on the risk of sudden cardiac death.

Methods and analysis:

English language articles reporting on randomized controlled trials will be searched in MEDLINE, Cochrane Library, CINAHL, and PubMed databases by two reviewers. A snowball approach will be used for literature retrieval. Reviewers will independently screen the literature, extract data, evaluate study quality and risk of bias, and perform a meta-analysis. In the presence of heterogeneity, a random effects model will be used for meta-analysis; otherwise, a fixed effect model will be used.

Ethics and dissemination:

This study is a secondary analysis and does not require ethical review. The results of this study will be disseminated through peer-reviewed publications, journals, and academic conferences and other forms of exchange.

Systematic review registration number:

INPLASY202140033
National early warning score on admission as risk factor for invasive mechanical ventilation in COVID-19 patients
Authors: Chang Min Cheol , Kim Tae Uk , Park Donghwi
Published: May 2021

The coronavirus disease (COVID-19) has become a global pandemic. Invasive mechanical ventilation is recommended for the management of patients with COVID-19 who have severe respiratory symptoms. However, various complications can develop after its use. The efficient and appropriate management of patients requires the identification of factors associated with an aggravation of COVID-19 respiratory symptoms to a degree where invasive mechanical ventilation becomes necessary, thereby enabling clinicians to prevent such ventilation. This retrospective study included 138 inpatients with COVID-19 at a tertiary hospital. We evaluated the differences in the demographic and clinical data between 27 patients who required invasive mechanical ventilation and 111 patients who did not. Multivariate logistic regression analysis indicated that the duration of fever, national early warning score (NEWS), and lactate dehydrogenase (LDH) levels on admission were significantly associated with invasive mechanical ventilation in this cohort. The optimal cut-off values were: fever duration ≥1 day (sensitivity 100.0%, specificity 54.95%), NEWS ≥7 (sensitivity 72.73%, specificity 92.52%), and LDH >810 mg/dL (sensitivity 56.0%, specificity 90.29%). These findings can assist in the early identification of patients who will require invasive mechanical ventilation. Further studies in larger patient populations are recommended to validate our findings.
Survey and enlightenment on the wearing of protective equipment of nurses working on the front line against COVID-19
Authors: Wu Maojie , Zhang Lin , Ning Ning , Liu Li , Liu Xiaoyan
Published: May 2021

At present, coronavirus disease 2019 (COVID-19) remains a significant challenge for health workers around the world. This survey aims to highlight the status of the implementation of occupational protection measures for nurses working on the front line against COVID-19, and to analyze the problems in the process of wearing protective equipment.

This cross-sectional study was conducted among 165 nurses who worked in COVID-19-stricken areas in China in March 2020. The questionnaire covered 3 aspects, namely: general information, the current condition of protective equipment wearing, and the wearing experience of protective equipment.

A total of 160 (96.97%) valid questionnaires were collected. The average time of wearing protective equipment for the nurses surveyed was 6.38 ± 3.30 hours per working day. For first-line nurses with low risk of infection, repeated wear of protective equipment was as follows: medical protective mask 30.77%, double latex gloves 8.46%, goggles/protective mask 15.38%, protective suit 15.38%; less wear of protective equipment were as follows: work cap 7.69%, surgical mask 7.69%, single layer latex gloves 30.77%, goggles/protective mask 30.77%, and isolation gown 46.15%. For nurses who were at moderate risk of infection, repeated wear of protective equipment was as follows: surgical mask 62.22%, goggles/protective mask 68.89%, and isolation gown 65.56%; less wear: work cap 3.33%, medical protective mask 15.56%, latex gloves 15.56%, goggles/protective mask 5.56%, and protective suit 16.67%. For front-line nurses with high risk of infection, repeated wear of protective equipment was as follows: surgical mask 64.91%, more than double latex gloves 8.77%, goggles/protective mask 75.44%, isolation gown 75.44%; less wear: work cap 1.75%, medical protective mask 1.75%, latex gloves 26.32%, goggles/ protective mask 1.75%, protective suit 1.75%. The main discomforts of wearing protective equipment were poor vision due to fogging (81.88%), stuffiness (79.38%), poor mobility (74.38%), sweating (72.5%), and skin damage (61.25%).

More detailed personal protection standards should be developed, and the work load of nurses should be reduced. Actions should be taken to ensure the scientific implementation of personal protective measures. To solve practical clinical problems, future protective equipment may focus on the research and development of protective equipment applicable for different risk levels, as well as the research on integrated design, fabric innovation, and reusability.
Cecal intubation time in screening colonoscopy
Authors: Kim Hyun Young
Published: May 2021

The time required to intubate the cecum varies. The aim of this study was to determine whether demographic and anthropometric factors, such as body mass index (BMI), percent body fat, muscle mass, and fat mass, affect the cecal intubation time (CIT) during complete colonoscopy.

A retrospective chart review of 1229 patients (aged 40–80 years) was performed. These patients underwent average-risk screening colonoscopies performed by expert gastroenterologists at Health Check-up Center, Seoul National University Bundang Hospital, during a health check-up. We collected data on age, sex, BMI, percent body fat, muscle mass, fat mass, history of prior abdominal or pelvic surgery, CIT, and bowel preparation quality (Boston Bowel Preparation Scale [BBPS] score).

Of the 1229 patients, 62% were men. The mean age was 55 years, and the mean BMI was 24 kg/m2. The median CIT was 5 min. The patients were categorized into two groups according to CIT: easy colonoscopy (CIT ≤ 10 min) and difficult colonoscopy (CIT > 10 min). In univariate analysis, CIT was prolonged by the following factors: older age, poor bowel preparation, lower BMI, lower percent body fat, and less fat mass. Multivariate analysis showed that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass were not significant factors for CIT. Older age (≥ 70 years) (odds ratio [OR]: 2.272, 95% confidence interval [CI]: 1.056–4.890, P = .036) and poor bowel preparation (BBPS score ≤ 5) (OR: 3.817, 95% CI: 1.866–7.808, P = .000) were found to be correlated with difficult colonoscopy.

Our study suggests that anthropometric indices including BMI, percent body fat, muscle mass, and fat mass are not associated with significantly different CIT. Furthermore, sex and prior abdominal or pelvic surgery are not useful factors for a prolonged CIT. Older age (≥ 70 years) and poor bowel preparation (BBPS score ≤ 5) are significant variables predicting the CIT of expert gastroenterologists.
Patient activation level and its associated factors in adults with chronic pain
Authors: Yao Fengzhen , Zheng Man , Wang Xiaoqing , Ji Shujuan , Li Sha , Xu Gang , Zheng Zhen
Published: May 2021

Background:

Patients’ capacity to manage their own health can be graded by levels of activation. Highly activated patients tend to have better health outcomes. However, little is known about the activation levels of chronic pain patients in China. This study aimed to identify:

Methods:

In this cross-sectional survey, patients completed a sociodemographic questionnaire, Brief Pain Inventory and Patient Activation Measure (PAM) 13. Patient activation was measured and categorized into Levels 1–4. Its associations with sociodemographic, patient-reported diseases and pain variables were explored using Wilcoxon rank sum test and Kruskal-Wallis H test.

Results:

Of 338 patients, 84 were excluded. Of the 254 remaining, 51.6% of patients were at lower activation levels (PAM Levels 1 and 2). Higher activation levels (PAM Levels 3 and 4) were recorded in patients with younger age (P = .00005), higher education (P = .0018), non-laboring occupations (P = .0239), and fewer co-morbidities (P = .00615). Intensities of the worst pain (P = .000627), average pain (P = .0213), and current pain (P = .0353), as well as the impact of pain on relationships with others (P = 0.00529), mood (P = .00391), sleep (P = .0132), and interest in life (P = .0248), were negatively correlated with activation levels.

Conclusion:

Half of the chronic pain patients in this population displayed lower activation levels. Older age, less education, manual labor, more co-morbidities, more intense pain and greater impact of pain on life were associated with lower activation levels. Pain education programs need to target the individual's PAM level.

Registration:

This trial was registered in Chinese Clinical Trial Registry. Number: ChiECRCT-20180170
Preliminary screening for sarcopenia and related risk factors among the elderly
Authors: Wu Li-Chu , Kao Hsueh-Hui , Chen Hong-Jhe , Huang Pin-Fang
Published: May 2021

The aim of this study is to survey the prevalence of sarcopenia and the factors that influence its development in Southern Taiwan's community-dwelling aged people.

This is an observational cross-sectional study using the 6-meter walking test, body composition, handgrip strength, body measurements, and basic personal information to identify sarcopenia in the participants. This study included 200 participants aged 65 or over living in Taiwan, but excluded the following:

The prevalence of sarcopenia in the elderly community is approximately 6.0%. It is less prevalent in females (1.5%) than in males (14.3%). The incidence of sarcopenia increases with age. Significantly related risk factors for sarcopenia are gender, age, smoking, and body mass index (BMI) (P < .05). Further analysis of the risk factors for sarcopenia reveal that the odds ratios (ORs) of having low muscle mass increase with every 1 year in age by a factor of 1.19 (P < .05); those who smoke show a higher incidence than those who do not smoke (OR = 2.69, P < .05). For every 1 kg / m2 increase in BMI, the odds of sarcopenia decrease by a factor of 0.45.

For the elderly, the lower the BMI, the higher the risk of sarcopenia. Maintaining good exercise habits and keeping body weight in check might help to prevent sarcopenia by increasing functional ability and improving muscle strength.
Helicobacter pylori reinfection and its risk factors after initial eradication
Authors: Li Renliang , Zhang Ping , Hu Ziyi , Yi Ying , Chen Lisha , Zhang Hengyi
Published: May 2021

Background:

Helicobacter pylori (H pylori) infection is a common health problem, which is closely related to peptic ulcers, gastric cancer, and extragastric diseases. Drugs can successfully eradicate it. However, the recurrence of H pylori often occurs after initial eradication. To confirm the global incidence of H pylori reinfection and systematically evaluate its risk factors.

Methods:

We will search for the relevant literature through Chinese and English databases, with the retrieval deadline being November 2021. Databases include PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, the Chongqing VIP Chinese Science and Technology Periodical Database, Wanfang Database, and China Biomedical Literature Database. Stata14.0 will be used to conduct this systematic review. The preferred reporting items for systematic reviews and meta-analysis protocols statements are followed in this protocol, and the PRISMA statement will be followed in the completed systematic review.

Results:

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

Conclusions:

This systematic review will provide evidence regarding the rate of H pylori reinfection and its risk factors after successful eradication. It can guide the management of patients with H pylori infection.
Quality indicators for the management of high-risk upper tract urothelial carcinoma requiring radical nephroureterectomy
Authors: König Frederik , Shariat Shahrokh F. , Karakiewicz Pierre I. , Mun Dong-Ho , Rink Michael , Pradere Benjamin
Published: May 2021

Purpose of review

The purpose of this article was to identify quality indicators for an optimized management of high-risk upper tract urothelial carcinoma (UTUC) requiring radical nephroureterectomy (RNU).

Recent findings

RNU with bladder cuff resection is the standard treatment of high-risk UTUC. For the bladder cuff resection, two main approaches are accepted: transvesical and extravesical. Lymph node dissection following a dedicated template should be performed in all high-risk patients undergoing RNU as it improves tumour staging and possibly survival. Postoperative bladder instillation of single-dose chemotherapy should be administered after RNU to decrease the risk of intravesical tumour recurrence. Perioperative systemic chemotherapy should always be considered for advanced cancers. Although level-1 evidence is available for adjuvant platinum-based chemotherapy, neoadjuvant regimens are still being evaluated.

Optimal management of high-risk UTUC requires evidence-based reproducible quality indicators in order to allow guidance and frameworks for clinical practices. Adherence to quality indicators allows for the measurement and comparison of outcomes that are likely to improve prognosis. Based on the literature, we found four evidence-based accepted quality indicators that are easily implementable to improve the management of high-risk UTUC patients treated with RNU: adequate management of the distal ureter/ bladder cuff, template-based lymph node dissection, single-shot postoperative intravesical chemotherapy, and perioperative systemic treatment.
Revolution of Disturbed Bregs and Bmems Lymphocytes Homeostasis in Children With Chronic ITP After High-dose Dexamethasone Rescue Therapy
Authors: Youssef Mervat A.M. , Salah Eldin Eman M. , Osman Naglaa S.
Published: May 2021

Dexamethasone is approved as second-line therapy in pediatric chronic immune thrombocytopenic purpura (ITP). Several B-cell abnormalities have been described in ITP pathogenesis.

This study assessed the effects of high-dose dexamethasone (HD-DXM) on the percentages and absolute counts of CD19+CD24hiCD38hi regulatory (Bregs) and CD19+CD27+ memory B lymphocytes (Bmems) in children with chronic ITP during active bleeding.

The study was a prospective case-control, included 20 children with chronic ITP and uncontrolled bleeding. Children received a single daily dose of HD-DXM for 4 days. Blood samples were withdrawn from patients just before HD-DXM therapy and on day 5 to evaluate the platelet counts and flow cytometric analysis of Bregs and Bmem. The patients’ platelet counts significantly increased after 5 days of the initiation of therapy (P=0.0001). Bmems percentage and absolute counts were significantly higher in patients before treatment (P=0.0007), and decreased after HD-DXM therapy (P=0.97) compared with the controls. Bregs percentage and absolute counts were significantly lower before treatment (P=0.0003) and increased after HD-DXM (P=0.003). There is a negative correlation between platelet counts and Bregs percentage and absolute count Bmems percentage before and after HD-DXM, whereas a positive correlation between platelets and Bregs before and after dexamethasone has been reported.

Conclusions:

HD-DXM reestablishes the normal Bregs/Bmems balance. This finding discloses possible involvement of Bregs and Bmems in the pathogenesis of pediatric ITP and provides a novel vision for immune modulation and treatment perspectives.
Comparable Outcomes of Matched Sibling Donor and Matched Unrelated Donor Stem Cell Transplantation in Children With Acute Leukemia in Argentina
Authors: Gómez Sergio M. , Varela Marcela A. , Ruiz Claudia , Sung Lillian
Published: May 2021

Background:

Hematopoietic stem cell transplantation (HSCT) is an effective mode of consolidation therapy for children with high-risk acute leukemia. In high-income countries, match sibling donor (MSD) and match unrelated donor (MUD) HSCT have similar outcomes, but data are scarce in upper-middle-income countries. Our objective was to compare MSD and MUD HSCT outcomes for children with acute leukemia in Argentina.

Patients and Methods:

This was a single-institution retrospective cohort study. We included children with acute leukemia who underwent HSCT with either MSD or MUD between 2014 and 2019.

Results:

The study included 45 patients who received MSD (n=27) or MUD (n=18) for acute leukemia. Event-free survival was not significantly different between MSD (62.3±10.7%) versus MUD (54.2±15.0%; P=0.54) at 5 years. Similarly, there was no significant difference in 5-year overall survival between MSD (71.9±9.8%) versus MUD (65.1±13.5%; P=0.38). The cumulative incidence of treatment-related mortality (P=0.31), cumulative incidence of relapse (P=0.99), and proportion with acute-graft-versus-host disease (P=0.76) and chronic-graft-versus-host disease (P=0.68) were also not significantly different.

Conclusions:

In Argentina, we did not show significant differences in outcomes between MSD and MUD HSCT for children with high-risk leukemia. Future work should focus on strategies to reduce the relapse risk in children with high-risk leukemia in upper-middle-income countries.
Case Report: Atraumatic Orbital Emphysema after Bronchoscopy with Endobronchial Biopsy
Authors: Li Suzzane S. , Engelke Carla B.
Published: May 2021

SIGNIFICANCE

Orbital emphysema is a well-documented condition where air enters the orbital soft tissue typically because of direct or indirect trauma; however, atraumatic cases can be encountered. The following is a novel case report of acute unilateral atraumatic orbital emphysema 24 hours after bronchoscopy with endobronchial biopsy.

PURPOSE

To the best of the authors' knowledge, this is the first known case report of atraumatic orbital emphysema as a postprocedure complication of bronchoscopy with endobronchial biopsy in the literature.

CASE REPORT

A 74-year-old man presented with painless swelling of the left upper and lower eyelids upon awakening. The patient had a history of bronchoscopy and endobronchial biopsy with conscious sedation for a right upper lobe lung mass 24 hours before the visit. Slit-lamp examination revealed air entrapment in the left upper and lower lids with enlarged subconjunctival air pockets of the left eye. Head and maxillofacial computed tomography without contrast revealed extensive emphysema tracking and dissecting along the subcutaneous and deep soft tissue spaces of the neck and face that was more pronounced along the left side. The patient was admitted for overnight observation and prescribed a prophylactic oral course of 250 mg of azithromycin daily for 2 days by the attending hospitalist. The subsequent follow-up visit 3 days later revealed complete resolution of signs and symptoms.

CONCLUSIONS

This case report demonstrates the importance of considering orbital emphysema in patients with a history of recent bronchoscopy with endobronchial biopsy. Clinicians should be aware of this potential complication and refer for appropriate testing and comanagement.