bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic effects of puerarin on polycystic ovary syndrome
Authors: Li Wenjing , Hu Hongbo , Zou Guofang , Ma Zhanzhong , Liu Jing , Li Fanxiang
Published: May 2021

Background:

This study aims to assess the therapeutic effects of a well-known component (puerarin) obtained from a Chinese herb root in patients with polycystic ovary syndrome (PCOS).

Methods:

Women with premature ovarian failure (POF) were assigned to the obese group (body mass index [BMI] ≥24 kg/m2 and waist hip ratio [WHR] >0.85) or non-obese group (group 3, n = 21). Obese patients were further randomly assigned to the obese treatment group (group 1, n = 15) and obese control group (group 1, n = 15). All patients received standard treatment (Diane-35, 1 tablet/d, orally, plus metformin, 1.5 g/d, orally). In addition to the standard modality, patients in group 1 and group 3 also orally received 150 mg/d of puerarin tablets for 3 months. Venous blood was drawn before and after treatment. Then, the metabolic and antioxidant biomarkers were measured. The normality of distribution of the data was tested using the Kolmogorov–Smirnov method. The baseline characteristics were analyzed using one-factor analysis of variance (ANOVA), and post-hoc was performed using the least significance difference (LSD)-t test.

Results:

Significantly improved blood levels of sex hormone binding globulin (SHBG) and superoxide dismutase (SOD) were observed in patients who received the additional treatment of puerarin, regardless of their lean or obese status, while these were not observed in patients who did not receive puerarin. Furthermore, obese patients with PCOS had significantly lower systolic blood pressure, total cholesterol, and testosterone blood levels, when compared with before treatment.

Conclusion:

The addition of puerarin to the present treatment protocol can be considered for the management of metabolic disorders and hyperandrogenism in PCOS patients.
White matter integrity in alcohol-dependent patients with long-term abstinence
Authors: Lee Jeonghwan , Ju Gawon , Son Jung-Woo , Shin Chul-Jin , Lee Sang Ick , Park Hyemi , Kim Siekyeong
Published: May 2021

Based on association studies on amounts of alcohol consumed and cortical and subcortical structural shrinkage, we investigated the effect of chronic alcohol consumption on white matter pathways using probabilistic tractography.

Twenty-three alcohol-dependent men (with an average sobriety of 13.1 months) from a mental health hospital and 22 age-matched male healthy social drinkers underwent 3T magnetic resonance imaging. Eighteen major white matter pathways were reconstructed using the TRActs Constrained by UnderLying Anatomy tool (provided by the FreeSurfer). The hippocampal volumes were estimated using an automated procedure. The lifetime drinking history interview, Alcohol Use Disorder Identification Test, Brief Michigan Alcoholism Screening Test, and pack-years of smoking were also evaluated.

Analysis of covariance controlling for age, cigarette smoking, total motion index indicated that there was no definite difference of diffusion parameters between the 2 groups after multiple comparison correction. As hippocampal volume decreased, the fractional anisotropy of the right cingulum-angular bundle decreased. Additionally, the axial diffusivity of right cingulum-angular bundle was positively correlated with the alcohol abstinence period.

The results imply resilience of white matter in patients with alcohol dependence. Additional longitudinal studies with multimodal methods and neuropsychological tests may improve our findings of the changes in white matter pathways in patients with alcohol dependence.
Determining optimal gestational weight gain (GWG) in a northwest Chinese population
Authors: Bai Yang , Li Lanlan , Wang Baolin , Qiu Jie , Ren Yucheng , He Xiaochun , Li Yilin , Jia Yanfeng , He Chunxiao , Cui Hongmei , Lv Ling , Lin Xiaojuan , Zhang Chong , Zhang Honghong , Xu Ruifeng , Liu Qing , Luan Hua
Published: May 2021

To determine optimal gestational weight gain (GWG) for the Chinese population.

Live singleton deliveries at the largest maternal & childcare hospital in northwest China from 2010 to 2012 were analyzed retrospectively. Multivariable logistic regression analysis was conducted to determine the lowest aggregated risk of interested perinatal outcomes based on Chinese adult body mass index (BMI) categories.

Eight thousand eight hundred seventy enrolled parturients were divided into 4 groups according to their prepregnancy BMI: underweight (21.31%, BMI < 18.5 kg/m2), normal weight (67.81%, 18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (8.99%, 24 kg/m2 ≤ BMI < 28 kg/m2 and obese (1.89%, BMI ≥ 28 kg/m2). The optimal GWG values for the above 4 groups were 16.7 kg (GWG range, 12.0–21.5), 14.5 kg (9.5–19.5), 11.5 kg (7.0–16.5), and 8.0 kg (5.0–13.0). The rates of inadequate, optimal and excessive GWG in present study were 6.14% (545), 62.34% (5529), and 31.52% (2796) respectively, which were significantly different from those of the 2009 Institute of Medicine recommendation (χ2 = 1416.05, Pinteraction < 0.0001).

Wider optimal GWG ranges than those recommended by Institute of Medicine were found in our study, and our proposed criteria seems to be practical to the Chinese population.
Cerebral venous sinus thrombosis and aneurysm in a patient with double heterozygous beta-thalassemia major
Authors: Gu Rui , Xiong Yao , Li Li , Zhao Xiaoling , Liu Yan
Published: May 2021

Rationale:

Thalassemia is an inherited disease associated with thromboembolic events (TEE) and cerebral artery disease. Here, we report a patient with beta-thalassemia presenting with intracerebral hemorrhage due to cerebral venous sinus thrombosis (CVST), and intracranial aneurysms were found after examination. We believe that it is very rare for this patient to have two kinds of cerebrovascular diseases.

Patients’concern:

A 25-year-old woman suffered from headache for nine days. She had a history of thalassemia and splenectomy nine years prior.

Diagnosis:

Intracranial hemorrhage, Cerebral venous sinus thrombosis, Intracranial aneurysm and double heterozygous beta-thalassemia major.

Interventions:

The patient was treated with low-molecular-weight heparin sodium injection (4100IU sc q12 h) and then switched to warfarin after four days of overlap with low-molecular-weight heparin sodium injection. Oral hydroxyurea was prescribed before discharged from the hospital.

Outcomes:

The patient's headache was relieved significantly within 48 h, and re-examination of CT showed that the hemorrhage was completely absorbed one week later.

Lessons:

CVST and intracranial aneurysms are associated with the pathological mechanism of thalassemia, and patients with beta-thalassemia should be monitored and educated for long-term prevention, especially those with risk factors.
Clinical experience with near-infrared ray catheter, a fluorescent ureteral catheter, on laparoscopic surgery for colon diverticulitis
Authors: Osumi Wataru , Yamamoto Masashi , Taniguchi Kohei , Masubuchi Shinsuke , Hamamoto Hiroki , Ishi Masatsugu , Izuhara Keisuke , Tanaka Keitaro , Okuda Junji , Uchiyama Kazuhisa
Published: May 2021

Rationale:

As the world's population ages, the number of surgical cases of colovesical fistulas secondary to colon diverticulitis is also expected to increase. The key issue while performing laparoscopic surgery for these fistulas is the avoidance of iatrogenic ureteral injury. There are no reports of Near-infrared Ray Catheter being used in surgery for diverticulitis, which is one of the diseases with the highest risk of ureteral injury. We present a case of a male patient with colovesical fistulas secondary to sigmoid colon diverticulitis who underwent laparoscopic surgery with visualization of the ureter using a new surgical technique in laparoscopic surgery.

Patient's concern:

An 82-year-old man presented to our urological department with general fatigue and air and fecal matter in the urine.

Diagnoses:

Cystography showed delineation of the sigmoid colon. Abdominal computed tomography findings revealed multiple sigmoid colon diverticula with thickened walls as well as large stones and a small amount of air in the bladder. He was diagnosed with a urinary tract infection with colovesical fistulas and bladder stones due to sigmoid diverticulitis.

Interventions:

After the creation of a transverse colostomy, we scheduled a laparoscopic anterior resection and cystolith removal.

Outcomes:

Severe inflammatory adhesions around the sigmoid colon and a high risk of ureteral injury were expected preoperatively. After induction of anesthesia, we inserted a Near-infrared Ray Catheter, a fluorescent ureteral catheter, which allowed us to easily identify and visualize the ureter in real-time. This allowed bowel dissection without concerns of ureteral injury. The operative time for the gastrointestinal part of the procedure was 150 minutes, and the patient was in a good general condition after the operation and was discharged on postoperative day 7.

Lessons:

The course of the ureter was easily and quickly identified by the green fluorescence from the ureteral catheter during laparoscopic surgery for fistulas associated with diverticulitis, where severe inflammation and dense fibrosis were present. Our technique is an easy and feasible approach that provides real-time urethral navigation during surgery for colovesical fistulas secondary to colon diverticulitis.
Effectiveness of beinaglutide in a patient with late dumping syndrome after gastrectomy
Authors: Ding Bo , Hu Yun , Yuan Lu , Yan Reng-Na , Ma Jian-Hua
Published: May 2021

Rationale:

Dumping syndrome is a frequent and potentially severe complication after gastric surgery. Beinaglutide, a recombinant human glucagon-like peptide-1 (GLP-1) which shares 100% homology with human GLP-1(7-36), has never been reported in the treatment of dumping syndrome before.

Patient concerns:

The patient had undergone distal gastrectomy for gastric signet ring cell carcinoma 16 months ago. He presented with symptoms of paroxysmal palpitation, sweating, and dizziness for 4 months.

Diagnosis:

He was diagnosed with late dumping syndrome.

Interventions and outcomes:

The patient was treated with dietary changes and acarbose for 4 months before admitted to our hospital. The treatment with dietary changes and acarbose did not prevent postprandial hyperinsulinemia and hypoglycemia according to the 75 g oral glucose tolerance test (OGTT) and continuous glucose monitoring (CGM) on admission.

Therefore, the patient was treated with beinaglutide 0.1 mg before breakfast and lunch instead of acarbose. After the treatment of beinaglutide for 1 month, OGTT showed a reduction in postprandial hyperinsulinemia compared with before starting treatment, and the time in the range of 3.9 to 10 mmol/L became 100% in CGM. No side effect was observed in this patient during beinaglutide treatment.

Lessons:

These findings suggest that beinaglutide may be effective for treating post-gastrectomy late dumping syndrome.
Home-based versus outpatient pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease
Authors: Shi Guiyun , Chen Chuanjun
Published: May 2021

Background:

Although home-based pulmonary rehabilitation programs have been shown in some studies to be an alternative and effective model, there is a lack of consensus in the medical literature due to different study designs and lack of standardization among procedures. Therefore, the purpose of this study was to compare the efficacy of a home-based versus outpatient pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD).

Methods:

Five electronic databases including Embase, PubMed, Scopus, Science Direct, and Cochrane Library will be searched in May 2021 by 2 independent reviewers. The reference lists of the included studies will be also checked for additional studies that are not identified with the database search. There is no restriction on the dates of publication or language in the search. The randomized controlled trials focusing on comparing home-based and outpatient pulmonary rehabilitation for COPD patients will be included in our meta-analysis. The following outcomes should have been measured: functional exercise capacity, disease-specific health-related quality of life, and cost-effectiveness measures. Risk ratio with a 95% confidence interval or standardized mean difference with 95% CI is assessed for dichotomous outcomes or continuous outcomes, respectively.

Results:

It was hypothesized that these 2 methods would provide similar therapeutic benefits.

Registration number:

10.17605/OSF.IO/5CV48.
Awareness and knowledge of COVID-19 infection control precautions and waste management among healthcare workers
Authors: Aleanizy Fadilah Sfouq , Alqahtani Fulwah Yahya
Published: May 2021

Healthcare workers (HWs) perform a critical role not only in the clinical management of patients but also in providing adequate infection control and prevention measures and waste management procedures to be implemented in healthcare facilities. The aim of this study was to evaluate the awareness and knowledge of COVID-19 infection control precautions and waste management procedures among HWs in Saudi Arabian hospitals.

This was a descriptive, cross-sectional study. Information on knowledge, awareness, and practice of infection control and waste management procedures were obtained from the HWs using a structured questionnaire. A thematic analysis was used to analyze the data.

Our findings indicated that most of the study participants were knowledgeable, with a mean score of 78.3%. In total, 92.5%, 90.3%, and 91.7% of the participants were aware of the infection control precautions, COVID-19 waste management procedures, the availability of infection control supplies, respectively. HWs’ Knowledge regarding waste management and infection control procedures correlated significantly with sex (P ≤ .001 and <.001), education (P = .024 and .043), and working experience (P = .029 and .009), respectively.

Most participants appreciated the importance of their role in infection control, surveillance, and monitoring of the ongoing safety practices in their patients as well as their facilities and communities.
Effects of vitamin and omega-3 fatty acid co-supplementation on blood glucose in women with gestational diabetes mellitus
Authors: He Lei , Xue Zhiwei , Liu Yijun , Chen Ruixin , Zhou Shu
Published: May 2021

Background:

There is limited study that has conducted a review investigating the clinical effects of vitamin and omega-3 fatty acid co-supplementation on blood glucose in women with gestational diabetes mellitus (GDM). Therefore, in order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the effectiveness and safety of vitamin and omega-3 fatty acid co-supplementation on blood glucose in women with GDM.

Methods:

This protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. We will conduct systematic reviews and meta-analyses to identify relevant randomized controlled trials (RCTs) involving vitamin and omega-3 fatty acid co-supplementation on GDM in electronic databases including PubMed, Web of Science, Embase, and the Cochrane Library up to June 2021. Exclusion criteria include observational studies, non-RCTs, review articles, studies with a sample size <50, and studies with insufficient outcome data. The primary outcomes include fasting glucose and insulin. Secondary outcomes are evaluated in a homeostasis model of insulin resistance, total antioxidant capacity, triglycerides, total cholesterol, low-density lipoprotein cholesterol, preterm birth and macrosomia over 4 kg.

Results:

The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

Registration number:

10.17605/OSF.IO/NSW54.
Low urine pH associated with sarcopenia in the elderly
Authors: Saitsu Akihiro , Iwazu Yoshitaka , Matsushita Haruka , Hayashi Hirotaka , Mizuhashi Yumiko , Kotani Kazuhiko
Published: May 2021

The pathophysiology of sarcopenia is complex and must be further explored. While metabolic acidosis may be a risk factor for sarcopenia, it remains unclear whether acidic urine is related to sarcopenia. The purpose of the present study was to investigate the association between sarcopenia and urine pH in the elderly.

An elderly population (n = 123 [male = 46]; mean age = 81.7 years) was classified into 2 groups based on the sarcopenia status according to their strength, requirement of assistance in walking, their ability to rise from a chair their ability to climb stairs, and their history of falls. Urinalysis was measured using dipstick tests.

The sarcopenia group (n = 32) was significantly older, had less exercise habit and showed a lower urine pH (mean pH = 5.5) in comparison to the nonsarcopenia group (mean pH = 6.2, P < .01). A multivariate analysis that was adjusted for age, male sex, body mass index, uro-renal variables and exercise habit revealed that urine pH (odds ratio, 0.43; 95% confidence interval, 0.22–0.85, P = .02), age and less exercise habit were independently and significantly associated with sarcopenia.

The findings of the present study suggest a potential association between metabolic acidosis and the pathophysiology of sarcopenia in the elderly. As urine pH is a simple biomarker that can be obtained using dipstick tests, it is therefore expected to be helpful for detecting sarcopenia in the clinical setting.
Acupuncture therapy and cognitive dysfunction in patients with type 2 diabetes
Authors: Pan Ting , Zhou Xue , Li Xuefeng , Wang Heran , Meng Meng , Han Yiran , Qian Xin , Chen Chunhai , Chen Xinhua
Published: May 2021

Background:

With the aging of society, the incidence of type 2 diabetes (T2DM) is increasing every year, and there is a clear correlation between T2DM and cognitive dysfunction. Acupuncture therapy has been widely used in the treatment of T2DM, but there is no systematic review on the treatment of T2DM associated with cognitive impairment. Therefore, this study aimed to conduct a meta-analysis of acupuncture in the treatment of T2DM with cognitive impairment to clarify its efficacy.

Methods:

A structured and systematic literature search will be conducted in the following databases up to April 26, 2021: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific and Journal Database (VIP), and Wan Fang database (Wanfang). We will use the Review Manager 5.4 software provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures.

Results:

This meta-analysis further determined the beneficial effects of acupuncture on T2DM with cognitive impairment.

Conclusion:

The purpose of this meta-analysis was to explore the effect of acupuncture on patients T2DM with and cognitive impairment patients, and provide more options for clinicians and patients to treat T2DM with cognitive impairment.

Ethics and dissemination:

This systematics review will evaluate the efficacy and safety of acupuncture in the treatment of T2DM with cognitive impairment. Since all the data included were published, the systematic review did not require ethical approval.

Registration number:

CRD42021245681.
Laparoscopic treatment of a giant seminal vesicle cyst with hemorrhage
Authors: Hou Yuzhu , Hu Xuejiao , Duan Yixing , Tan Wubin , Guo Xi
Published: May 2021

Rationale:

A seminal vesicle cyst is a benign lesion of the seminal vesicle that is usually asymptomatic. However, when a giant seminal vesicle cyst ruptures and bleeds, it can cause obvious clinical symptoms. To our knowledge, no single giant seminal vesicle cyst with hemorrhage has been reported in current studies, and surgery is the primary method to treat seminal vesicle hemorrhage with obvious symptoms.

Patient concerns:

A 31-year-old man presented with urination pain but without obvious urination frequency and urgency, dysuria, and discomfort. Rectal palpation in the chest-knee position revealed a hard mass palpable in the upper right with a smooth surface and mild tenderness, and the upper edge of the mass could not be palpated.

Diagnosis:

The results of the B-mode ultrasound indicated a mixed echogenic lump between the bladder and prostate, with a size of 81 × 76 mm. The computer tomography scan showed an “S” tubular lump in the right side of the pelvic cavity. The mass has a computer tomography value of 58 to 70 HU, and uneven reinforcement can be observed. On the basis of the results of the magnetic resonance imaging of the urinary bladder, the lump has T1 and T2 signals of equal lengths.

Interventions:

The patient was diagnosed with a huge right seminal vesicle cyst with hemorrhage and was treated via laparoscopic surgery.

Outcomes:

The patient recovered quickly after the operation, and the symptoms of urination pain were significantly improved.

Lessons:

Seminal vesicle hemorrhage is clinically rare, and laparoscopic treatment is an effective and safe surgical method for the treatment of seminal vesicle cysts.
Acute kidney injury and acyclovir-associated encephalopathy after administration of valacyclovir in an elderly person with normal renal function
Authors: Kenzaka Tsuneaki , Sugimoto Kazuma , Goda Ken , Akita Hozuka
Published: May 2021

Introduction:

Acyclovir (ACV)-associated encephalopathy is related to an increase in plasma levels of 9-carboxymethoxymethylguanine, an ACV metabolite, and is often reported in patients with renal dysfunction. We report a case of ACV-associated encephalopathy with rapid progression of renal dysfunction after oral administration of valacyclovir (VACV) and review literature of previous ACV-associated encephalopathy cases.

Patient concerns:

An 88-year-old man was diagnosed with herpes zoster. VACV (3000 mg/day) treatment was initiated. Serum creatinine (Cr) level was 0.80 mg/dL. However, irritability, memory impairment, and decreased responsiveness occurred after 3 days. The Cr level was 6.76 mg/dL on admission.

Diagnosis:

He was diagnosed with ACV-associated encephalopathy with acute kidney injury.

Interventions:

VACV was discontinued, hemodialysis was initiated on the day of admission, and then the signs and symptoms improved approximately 72 hours after the admission.

Conclusion:

Worsening of renal function and encephalopathy should be a focus when using VACV or ACV, regardless of age and original renal function. Acute kidney injury and ACV-associated encephalopathy may particularly occur in the elderly even when renal function is normal. Therefore, regular monitoring of renal function and consciousness is necessary during VACV treatment.
The pathogenic characteristics and influencing factors of health care-associated infection in elderly care center under the mode of integration of medical care and elderly care service
Authors: Jiao Panpan , Jiang Yufen , Jiao Jianhong , Zhang Long
Published: May 2021

The aim of this study was to analyze the distribution of pathogenic bacteria in hospitalized patients in elderly care centers under the mode of integration of medical care and elderly care service, and explore the influencing factors to reduce the health care-associated infection rate of hospitalized patients.

A total of 2597 inpatients admitted to elderly care centers from April 2018 to December 2019 were included in the study. The etiology characteristics of health care-associated infections (HCAI) was statistically analyzed, univariate analysis, and multivariate logistic regression analysis method were used to analyze the influencing factors of HCAI.

A total of 98 of 2597 inpatients in the elderly care centers had HCAI, and the infection rate was 3.77%. The infection sites were mainly in the lower respiratory tract and urinary tract, accounting for 53.92% and 18.63%, respectively. A total of 53 pathogenic bacteria were isolated, 43 of which (81.13%) were Gram-negative, mainly Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae, which respectively accounted for 24.53, 16.98, and 13.21%. 9 (16.98%) strains were Gram-positive, mainly Staphylococcus aureus and Enterococcus faecium, respectively accounting for 7.55 and 5.66%. Only 1 patient (1.89%) had a fungal infection. Multivariate logistic regression analysis indicated that total hospitalization days, antibiotic agents used, days of central line catheter, use of urinary catheter and diabetes were independent risk factors of nosocomial infection in elderly care centers (P < .05).

Many factors can lead to nosocomial infections in elderly care centers. Medical staff should take effective intervention measures according to the influencing factors to reduce the risk of infection in elderly care facilities.
Protective and therapeutic experience of perioperative safety in extremely elderly patients with biliary diseases
Authors: Zhang Zongming , Zhao Yue , Lin Fangcai , Liu Limin , Zhang Chong , Liu Zhuo , Zhu Mingwen , Wan Baijiang , Deng Hai , Yang Haiyan , Jiao Lijun , Xie Xiyuan
Published: May 2021

To explore the protective and therapeutic measures of improving perioperative safety in extremely elderly patients with biliary diseases, so as to improve the therapeutic efficacy of surgery.

A retrospective case–control study of 412 elderly patients with biliary diseases was carried out from July 2013 to July 2019. Seventy eight cases were divided into the high age (HA) group (≥80 years) and 334 into the middle–low age (MLA) group (60–79 years).

In the HA compared with MLA group,

Although the surgical risk was significantly increased, there was no significant difference in the therapeutic efficacy in the HA compared with MLA group, suggesting that surgical treatment in extremely elderly patients with biliary diseases is safe and feasible. The key is to actively treat preoperative coexisting diseases, strictly adhere to surgical indications, reasonably select surgical procedures, precisely perform the operation, closely monitor and control intraoperative emergencies, timely prevent and treat postoperative complications, so as to improve the perioperative safety of extremely elderly patients with biliary diseases.
Long-term outcomes of individualized interventional treatment for primary Budd–Chiari syndrome complicated by inferior vena cava thrombosis
Authors: Sun Xuedong , Zhang Jinlong , Duan Feng , Wang Maoqiang
Published: May 2021

Background

Various endovascular treatments were used for Budd–Chiari syndrome (BCS) patients complicated by inferior vena cava (IVC) thrombosis. The best treatment for this disease remains unknown. To evaluate safety and efficacy of individualized interventional treatment for primary BCS with IVC thrombosis.

Methods

Forty-seven consecutive patients with IVC involvement BCS complicated by IVC thrombosis between June 2002 and August 2020 were analyzed retrospectively. They were treated with individualized interventional treatment based on thrombus type and size. Agitation thrombolysis, transcatheter thrombus aspiration, and catheter-directed thrombolysis were initially used for fresh and mixed thrombus (n = 20), then stent implantation for compressing thrombus and IVC recanalization were performed according to the size of the residual thrombus. Direct balloon angioplasty was used for old thrombus (n = 27).

Results

Median follow-up duration was 109 (5–223) months (average 114 ± 60 months). IVC recanalization were attempted in forty patients and failed in one. The technical successful rate of IVC recanalization was 97.5%. Thrombus was completely lysed in eight patients with fresh thrombus (40%, 8/20), partially lysed in 11 patients with mixed thrombus (55%, 11/20), and no response in one patient with mixed thrombus (5%, 1/20). Thrombolytic-related complications occurred in one patient (5%, 1/20). No symptomatic pulmonary embolism occurred. Among the 11 patients with thrombus partially lysed, five patients underwent stent implantation for compressing thrombus, six patients received conservative treatment. Old thrombus was completely lysed in 15 patients (55.6%, 15/27) during follow-up. Restenosis occurred in six patients (15.4%, 6/39). Primary patency rates at 1, 5, 10 and 15 years were 92, 92, 86 and 80%, respectively. Hepatocellular carcinoma (HCC) occurred in four patients (8.5%, 4/47). One patient died of HCC. The survival rate was 97.9%.

Conclusions

The individualized interventional treatment based on thrombus type and size for primary BCS complicated by IVC thrombosis patients is safe and effective with long-term patency and survival.
Computer-aided detection of colorectal polyps using a newly generated deep convolutional neural network: from development to first clinical experience
Authors: Pfeifer Lukas , Neufert Clemens , Leppkes Moritz , Waldner Maximilian J. , Häfner Michael , Beyer Albert , Hoffman Arthur , Siersema Peter D. , Neurath Markus F. , Rath Timo
Published: May 2021

Aim

The use of artificial intelligence represents an objective approach to increase endoscopist’s adenoma detection rate (ADR) and limit interoperator variability. In this study, we evaluated a newly developed deep convolutional neural network (DCNN) for automated detection of colorectal polyps ex vivo as well as in a first in-human trial.

Methods

For training of the DCNN, 116 529 colonoscopy images from 278 patients with 788 different polyps were collected. A subset of 10 467 images containing 504 different polyps were manually annotated and treated as the gold standard. An independent set of 45 videos consisting of 15 534 single frames was used for ex vivo performance testing. In vivo real-time detection of colorectal polyps during routine colonoscopy by the DCNN was tested in 42 patients in a back-to-back approach.

Results

When analyzing the test set of 15 534 single frames, the DCNN’s sensitivity and specificity for polyp detection and localization within the frame was 90% and 80%, respectively, with an area under the curve of 0.92. In vivo, baseline polyp detection rate and ADR were 38% and 26% and significantly increased to 50% (P = 0.023) and 36% (P = 0.044), respectively, with the use of the DCNN. Of the 13 additionally with the DCNN detected lesions, the majority were diminutive and flat, among them three sessile serrated adenomas.

Conclusion

This newly developed DCNN enables highly sensitive automated detection of colorectal polyps both ex vivo and during first in-human clinical testing and could potentially increase the detection of colorectal polyps during colonoscopy.
Single-session training on an ascending treadmill slope: effects on gait parameters in persons with stroke. A pilot study
Authors: Imandt Erica , Bonnyaud Céline , Bensmail Djamel , Zory Raphael , Pradon Didier , Roche Nicolas
Published: May 2021

Objective

Treadmill training with an upward incline could improve gait parameters altered in persons with stroke, especially lower limb flexion. This study aimed to determine the effects of a treadmill single-session training with a 10% upward incline on biomechanical gait parameters in persons with stroke.

Methods

Fifteen persons with stroke-related hemiparesis performed a 20-min treadmill training session with a 10% ascending incline in this interventional pilot study. Spatiotemporal, kinematic and kinetic parameters were evaluated, overground, with a tridimensional optoelectronic system, before the session, immediately after and after a 20-min rest period.

Results

The single-session training on a treadmill with a 10% incline has significantly increased hip flexion peak on the paretic side (39.8°± 8.1 in baseline to 42.7°± 8.6 after the session, P < 0.001, large effect size) and knee flexion peak on the paretic side (39.9°± 11.6 in baseline to 43.1°± 11.7 after the session, P = 0.004, large effect size). Gait speed, other spatiotemporal gait parameters and propulsion on the paretic side were also significantly increased (P < 0.05, all large effects size). These short-term changes were maintained after the break.

Conclusions

A treadmill single-session training with a 10% upward incline induces biomechanical changes in people with stroke. The environmental constraints of this training could explain these biomechanical adaptations, concerning especially paretic hip and knee flexion.
Application of the Threshold Concept Framework in Nursing
Authors: Kistler K. Brooke , Tyndall Deborah E.
Published: May 2021

Background:

The shift to concept-based curricula requires nurse educators to be selective with disciplinary content to avoid overburdening curricula. Although educators strive to make these concepts explicit, some learners find them troublesome. These troublesome concepts are often threshold concepts, which are critical to understanding disciplinary knowledge.

Purpose:

The purpose of this integrative review was to examine how the threshold concepts framework has been applied within nursing to facilitate student learning of troublesome knowledge.

Method:

Whittemore and Knafl's integrative literature review methodology was used.

Results:

Twenty articles were included representing a diverse selection of literature. Data analysis resulted in 3 themes: framing difficult knowledge, developing pedagogical strategies, and designing nursing curricula.

Conclusion:

The threshold concepts framework aids in redesigning pedagogy to engage students at critical points in the learning process, helping them successfully navigate encounters with troublesome knowledge. The framework also provides guidance for identifying and sequencing concepts critical to the discipline to avoid overcrowded curricula.
Using Free Arterialized Venous Flaps for Reconstructing Hand Defects
Authors: Alonso-Carpio Miriam , Pérez-García Alberto , Thione Alessandro , Salmerón-González Enrique , Condiño-Brito Eloy , Trapero Ana
Published: May 2021

Hand and digit soft tissue defects are quite common and frequently require specialized reconstruction. When local flaps cannot be used to reconstruct a soft tissue defect, free flaps must be utilized. To overcome tissue volume and discrepancies in vessel diameter, arterialized venous free flaps from the forearm may provide an acceptable alternative. When using arterialized venous free flaps, surgeons should implement shunt restriction procedures to enhance flap viability.
Satisfaction With Expectations-Based Education in Women Undergoing Breast Reconstruction
Authors: Tedesco Deborah , Makarem Gasan , Mayo James , Loerzel Victoria
Published: May 2021

Women undergoing breast reconstruction sometimes have unrealistic or unformed expectations regarding the reconstructive process and outcomes. The objectives of this study were to assess preoperative expectations in women undergoing mastectomy and initial breast reconstruction, provide expectations-based education, and evaluate satisfaction with education. Fifty-one women undergoing mastectomy and breast tissue expander placement participated in this study. At a preoperative education appointment, participants completed a questionnaire to determine whether their expectations were realistic, unrealistic, or unformed. A nurse practitioner reviewed the results and provided patient-centered, expectations-based education to modify expectations from unrealistic to realistic or to set expectations from unformed to realistic. Four to 6 weeks after surgery, a second questionnaire was provided to assess perceived satisfaction with education. Unrealistic and unformed expectations were identified related to complications, pain, scarring, sensation, symmetry, and aesthetic results. After receiving patient-centered, expectations-based preoperative education, participants agreed they had received the appropriate amount of information and felt well prepared for their surgery and recovery. Most participants reported they were aware of possible complications, had effective tools to manage their pain, and had received adequate information about scarring and sensation changes. Some participants continued to have unrealistic or unformed expectations related to aesthetic results. Women undergoing breast reconstruction often have unrealistic or unformed expectations before surgery. Identifying these expectations and proving expectations-based education resulted in satisfaction with information provided.
Monitoring Breast Reconstruction Flaps Using Near-Infrared Spectroscopy Tissue Oximetry
Authors: Kumbasar Duygu Ece , Hagiga Ahmed , Dawood Omar , Berner Juan Enrique , Blackburn Adam
Published: May 2021

Free flap reconstruction is a common procedure with success rates greater than 99%. However, vascular complications may occur, resulting in flap failure. For this reason, early detection of vascular compromise is crucial for flap salvage. Vascular complications may be detected early by monitoring tissue oximetry parameter changes using near-infrared spectroscopy (NIRS). This method of noninvasive monitoring can evaluate changes in flap oxygenation levels caused by arterial and venous thrombosis before surgical reexploration. The goal of this study was to assess the validity of using NIRS oximetry for monitoring free flaps. We conducted a prospective cohort observational study of 10 patients undergoing breast reconstruction. We used the INVOS 7100 cerebral oximetry monitoring system (Medtronic, Dublin, Ireland) to provide 24-hr continuous postoperative monitoring of flap perfusion and compared the data with clinical assessment findings. The median patient age was 57 years (range = 41–61 years). Patients underwent immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap surgery (n = 4), delayed reconstruction with DIEP flap surgery (n = 4), transverse upper gracilis flap surgery (n = 1), and latissimus dorsi flap with lipofilling (n = 1). We successfully monitored all 10 flaps for 24 hr postoperatively. The overall flap survival rate was 100%. Findings of clinical examination, Doppler studies, and surgical outcome were consistent with NIRS monitoring. In conclusion, NIRS tissue oximetry could potentially provide a noninvasive method for effective postoperative monitoring of free flaps.
Evaluation of Medication Therapy Issues, Resolutions, and Adherence Among Persons With HIV in the Pharmacist-Led Patient-Centered HIV Care Model
Authors: Hazen Ronald J. , Halbur Drew , Mills Brittany , Kirkham Heather S. , Hou John ,   for the Patient-Centered HIV Care Model Team
Published: May 2021

Objective:

To identify medication therapy issues and resolutions and assess their relationship to antiretroviral therapy (ART) adherence among participants of the Patient-Centered HIV Care Model demonstration project.

Methods:

Adult persons with HIV (PWH) in the United States were enrolled in the Patient-Centered HIV Care Model from August 2014 to September 2016. Pharmacists conducted regular medication therapy reviews and documented ART and non-ART issues and suggested resolutions. Adherence to ART was calculated using proportion of days covered (PDC), and the mean PDC by the number of ART issues was compared using a generalized linear model with linear trend estimation.

Results:

The most common ART issue was adherence (57%). Adherence ART issues were resolved by adherence management (48%) or patient education (36%). Participants had a mean of 4.2 ART issues and 6.4 non-ART issues. PDC was 89% for those with 0 ART issues and 73% for those with ≥3 ART issues. Persons with 0 ART issues had an increase in adherence (+8%) in the postperiod, whereas those with ≥3 ART issues had a decrease in adherence (−6%) (P = 0.02) in the postperiod.

Conclusions:

Identifying therapy issues could help pharmacists improve care for PWH. Because PWH are an aging population with an increased risk of comorbidities and polypharmacy, pharmacists and providers should collaborate to provide holistic, primary care solutions to address both the number and nature of therapy issues.
Extramedullary Relapsed Multiple Myeloma Treatment With 177Lu-Labeled CXCR4 Endoradiotherapy and Dosimetric Results
Authors: Demirkol Mehmet Onur , Özkan Ahu , Uçar Burcu , Wester Hans-Jürgen , Ferhanoğlu Burhan
Published: May 2021

We created our first national clinical protocol of 177Lu-CXCR4 therapy for patient who have failed to respond to current therapy options. We also calculated the kidney, liver, and tumor dosimetry. The kidney's mean absorbed dose was calculated to be 0.45 Gy/GBq, the calculated radiation absorbed dose of the liver was 0.63 Gy/GBq, and the radiation absorbed doses of the tumors vary between 9.2 and 82 Gy/GBq. 177Lu-CXCR4 therapy produced a promising clinical response in our patient in acceptable radiation dose limits as a treatment option in heavily pretreated patients with advanced multiple myeloma.
18F-FDG PET Uptake in the Scalp After Platelet-Rich Plasma Therapy
Authors: Usmani Sharjeel , Al-Turkait Dalal , Al-Kandari Fareeda , Ahmed Najeeb
Published: May 2021

18F-FDG PET/CT has been found useful for the detection of the source of infection/inflammation in the body. Platelet-rich plasma is a new treatment modality in which plasma is injected subdermally or intradermally for potential hair regrowth into the scalp. We report a case of 43-year-old woman with right breast cancer who underwent surgery, chemotherapy, and radiotherapy 2 years ago and is currently on hormonal therapy. 18F-FDG PET/CT demonstrate incidental findings of increased FDG avidity in the scalp after platelet-rich plasma therapy.
Detection of Chyle Leakage Site With Lymphoscintigraphy SPECT/CT in a Patient With Chylothorax Secondary to T-Cell Lymphoblastic Leukemia
Authors: Kesim Selin , Ozguven Salih , Oksuzoglu Kevser , Erdil Tanju Yusuf
Published: May 2021

We present a pediatric case with T-cell lymphoblastic leukemia and persistent chylothorax who was referred to lymphoscintigraphy to identify the site of leakage. Planar lymphoscintigraphy with SPECT/CT revealed hot spots at the left jugulovenous angle and the confluens of the vena brachiocephalica to vena cava, which were compatible with the sites of leakage. Hybrid imaging with SPECT/CT technique have great impact on accurate detection of the defects in the lymphatic system in patients with chylothorax.
Quality and Safety in Healthcare, Part LXXXVIII
Authors: Harolds Jay A.
Published: May 2021

The Toyota Production System (TPS) revolutionized automotive manufacturing and then spread more widely to other manufacturing and service industries, including healthcare. Many of the concepts in the TPS originated from ideas from the quality and production pioneers in the United States. Japanese experts built on these concepts and added many of their own to fashion them together into a comprehensive system. One of the key concepts in the TPS is to reduce waste without sacrificing quality.
Hepatobiliary Excretion PET/CT With 68Ga-TAoS-DAZA to Evaluate Bile Duct Patency
Authors: Freesmeyer Martin , Drescher Robert , Kühnel Christian , Gühne Falk , Greiser Julia
Published: May 2021

Tri-alkoxysalicyl-1,4-diazepan-6-amine (TAoS-DAZA) ligands, radiolabelled with 68Ga, have been proposed as PET/CT agents for depiction and quantification of hepatobiliary function and evaluation of bile excretion. In the presented case, a patient with hepatocellulary carcinoma underwent PET/CT with the TAoS-derivate 68Ga-tri-methoxysalicyl-(TMoS)-DAZA to determine the patency of intrahepatic and extrahepatic bile ducts, in particular of a stent in the common bile duct. The PET/CT was performed without complications. Evaluation of bile excretion over time was possible. 68Ga-TAoS-DAZA PET/CT may be an option for dynamic imaging of the excretory hepatic function to visualize the biliary tree and to rule out cholestasis.
68Ga-DOTATATE PET/CT Uptake in Prostate With an Incidental Finding of Prostatic Acinar Adenocarcinoma and Metastatic Neuroendocrine Cancer to the Liver
Authors: Nisar Muhammad Umer , Costa Daniel N. , Jia Liwei , Öz Orhan K. , de Blanche Lorraine
Published: May 2021

A 69-year-old man with history of metastatic neuroendocrine tumor presented for initial staging with 68Ga-DOTATE PET/CT. 68Ga-DOTATATE PET/CT showed incidental focal increased DOTATATE uptake in the left apical prostate tissue, which was thought to be of benign etiology. Digital rectal examination later was consistent with a palpable nodule along with elevated prostate-specific antigen of 7.0 ng/mL. MRI of prostate demonstrated a 3.8-cm lesion followed by a targeted biopsy that revealed prostatic acinar adenocarcinoma. Chronic inflammatory cell infiltrates were also noted on biopsy, and this may have been the cause of increased DOTATATE uptake seen on 68Ga-DOTATATE PET/CT study.
A Phase 0 Microdosing PET/CT Study Using O-[18F]Fluoromethyl-d-Tyrosine in Normal Human Brain and Brain Tumor
Authors: Moon Hansol , Byun Byung Hyun , Lim Ilhan , Kim Byung Il , Choi Chang Woon , Rhee Chang Hun , Lee Kyo Chul , Woo Sang-Keun , Park Chansoo , Kil Hee Seup , Chi Dae Yoon , Youn Sang Min , Lim Sang Moo
Published: May 2021

Purpose

The aim of the present study was to obtain information about distribution, radiation dosimetry, toxicity, and pharmacokinetics of O-[18F]fluoromethyl-d-tyrosine (d-18F-FMT), an amino acid PET tracer, in patients with brain tumors.

Patients and Methods

A total of 6 healthy controls (age = 19–25 years, 3 males and 3 females) with brain PET images and radiation dosimetry and 12 patients (median age = 60 years, 6 males and 6 females) with primary (n = 5) or metastatic brain tumor (n = 7) were enrolled. We acquired 60-minute dynamic brain PET images after injecting 370 MBq of d-18F-FMT. Time-activity curves of d-18F-FMT uptake in normal brain versus brain tumors and tumor-to-background ratio were analyzed for each PET data set.

Results

Normal cerebral uptake of d-18F-FMT decreased from 0 to 5 minutes after injection, but gradually increased from 10 to 60 minutes. Tumoral uptake of d-18F-FMT reached a peak before 30 minutes. Tumor-to-background ratio peaked at less than 15 minutes for 8 patients and more than 15 minutes for 4 patients. The mean effective dose was calculated to be 13.2 μSv/MBq.

Conclusions

Using d-18F-FMT as a PET radiotracer is safe. It can distinguish brain tumor from surrounding normal brain tissues with a high contrast. Early-time PET images of brain tumors should be acquired because the tumor-to-background ratio tended to reach a peak within 15 minutes after injection.
Prognostic Significance of Pretreatment Staging With 18F-FDG PET in Esophageal Cancer
Authors: Lu Hsi-Huei , Chiu Nan-Ching , Tsai Mu-Hung
Published: May 2021

Purpose of the Report

Without the routine use of 18F-FDG PET for initial staging of esophageal cancer, it may lead to inaccurate staging and suboptimal treatment. The purpose of this study was to evaluate the prognostic significance of pretreatment 18F-FDG PET in nonmetastatic esophageal cancer by comparing the survival between patients with and without pretreatment PET.

Materials and Methods

We selected newly diagnosed esophageal cancer patients without metastasis between 2009 and 2015 from Taiwan Cancer Registry and National Health Insurance Research Database. Pretreatment 18F-FDG PET staging was determined according to the implementation of PET within 90 days before starting treatment. Overall survival was calculated from the day of treatment initiation to the death from any cause. Survival curves were compared between patients with and without PET staging using the log-rank test.

Results

Of the 9078 patients included, 1765 (19.4%) and 7313 (80.6%) patients were staged with and without pretreatment PET, respectively. The median follow-up time for all patients and survivors was 1.29 years and 5.46 years, respectively. The pretreatment PET group had a lower risk of death than the no pretreatment PET group (hazards ratio, 0.74; 95% confidence interval, 0.70–0.79; P < 0.001). After adjusting for age, stage, histology, and tumor location, pretreatment PET remained significantly correlated with a lower risk of death (hazards ratio, 0.78; 95% confidence interval, 0.73–0.83; P < 0.001).

Conclusions

The utilization of pretreatment 18F-FDG PET for staging in nonmetastatic esophageal malignancy is associated with a lower risk of death even after adjusting for age, stage, histology, and tumor location.