bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical treatment of 55 patients with COVID-19 from seven cities in northeast China who fully recovered
Authors: Fan Lichao , Liu Huan , Li Na , Liu Chang , Gu Ye , Liu Yongyu , Chen Yu
Published: January 2021

Coronavirus disease 2019 (COVID-19) is an emerging disease caused by severe acute respiratory syndrome coronavirus 2; no specific effective medication to treat the disease has been identified to date. We aimed to investigate the administered medications and intervention times for patients who completely recovered from COVID-19.

This single-center, retrospective, observational study included 55 patients with COVID-19 who were transferred to Shenyang Sixth People's Hospital between January 20 and March 15, 2020. Data on demographics, symptoms, laboratory indicators, treatment processes, and clinical outcomes were collected. Administered drugs and intervention times were compared in 47 and 8 patients with mild and severe symptoms, respectively.

All 55 patients recovered. Fifty-three patients (96.36%) received antiviral therapy, including 45 in the mild group (median treatment: 14 days; 17 received umifenovir) and all 8 severe-group patients (median treatment: 17.5 days; 4 received lopinavir/ritonavir). Twenty-nine patients (52.72%) were administered antibiotics, including 21 in the mild group (median treatment: 13.5 days; 15 received moxifloxacin) and all 8 in the severe group (median treatment: 9 days; 2 received linezolid). Moreover, 7 patients (12.72%) were treated with glucocorticoids and 9 (16.36%) with immunomodulators.

Given the 100% recovery rate, early administration of antiviral drugs can be considered. Umifenovir may benefit patients with mild symptoms, while lopinavir/ritonavir may benefit those with severe symptoms. Prophylactic administration of common antibiotics may reduce the risk of co-infection. The use of glucocorticoids is usually not necessary. Randomized, double-blind, and controlled trials remain necessary for more accurate conclusions.
Whether cognitive behavioral therapy is effective for Alzheimer's disease
Authors: Chen Wan-Qiang , Wu Fang-Fang , Lv Hong-Bo , Xing Wen-Ting , Liu Qi , Liu Jun-Ping , Ge Yong-Gui , Lu Ya-Qin
Published: January 2021

Background:

Alzheimer disease (AD) is a progressive neurodegenerative disease characterized by impaired memory and cognitive judgment. It is the leading cause of dementia in the elderly, and its high morbidity and mortality have also brought a significant social burden. So far, there is no method can completely cure Alzheimer's dementia, but there are many non-drug treatments that have been praised by people, especially the cognitive behavioral therapy proposed in recent years. The main purpose of this article is to evaluate the effect of cognitive behavioral therapy on the cognitive function improvement of patients with Alzheimer's dementia.

Methods:

We did a network meta-analysis to identify both direct and indirect evidence in relevant studies. A systematic literature search will be performed in the Cochrane Library, PubMed, and EMBASE from inception to October 2020. We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool.

The outcomes investigated were Mini–Mental State Examination and AD Assessment Scale-Cognitive section scores. We did a pair-wise meta-analysis using the fixed-effects model and then did a random-effects network meta-analysis within a Bayesian framework. The = the Assessment of Multiple Systematic Reviews-2 scale, Preferred Reporting Items for Systematic Reviews and Meta-Analyses scale and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality and evidence grade of the literature. General characteristics of the eligible randomized controlled trials will be summarized and described. Meanwhile, The ADDIS software will be used to perform the network meta-analysis, and the result figures will be generated by STATA 15.0 software.

Results:

Using the draft search strategy of databases and after screening,7 randomized controlled trials met the a priori criteria and were included. This network mate-analysis will be published in a peer-reviewed journal.

Conclusion:

Our study will provide evidence for cognitive behavioral intervention in AD patients. And provide recommendations and guidelines for the clinic.

Protocol Registration:

INPLASY2020110052.
Application of biomimetic double-layer biofilm stent in arthroscopic rotator cuff repair
Authors: Ma Liang , Xu Yongtao , Xu Xiaolong , Pan Qin , Xu Yongtao
Published: January 2021

Background:

Rotator cuff injury is the most common cause of shoulder dysfunction. Despite the continuous advancement of surgical techniques, the incidence of re-tearing after rotator cuff repair is still high. The main reason is that it is difficult to reconstruct the normal tendon bone interface and the process is slow, and the application of tissue engineering technology can promote tendon and bone healing. This study will evaluate the effect of the bionic double membrane stent on the rotator cuff healing after arthroscopic rotator cuff repair.

Methods:

This is a prospective randomized controlled trial to study the effect of biomimetic double-layer biofilm stent on rotator cuff healing. Approved by the clinical research ethics committee of our hospital. The patients were randomly divided into 1 of 2 treatment options: (A) a biomimetic double-layer biofilm stent group and (B) a non-bionic dual-layer biofilm stent group. Observation indicators include: visual analog scale score, University of California Los Angeles score, American Shoulder & Elbow Surgeons score and Constant-Murley score. Data were analyzed using the statistical software package SPSS version 16.0 (Chicago, IL).

Discussion:

This study will evaluate and evaluate the effect of the bionic double-layer membrane stent on the rotator cuff healing after arthroscopic rotator cuff repair. The results of this experiment will provide new treatment ideas for promoting rotator cuff tendon bone healing.

OSF Registration number:

DOI 10.17605/OSF.IO/FWKD6
Chronic kidney disease and cardiovascular mortality in patients with atrial fibrillation
Authors: Premužić Vedran , Stevanović Ranko , Radić Petra , Salvetti Massimo , Lovrić-Benčić Martina , Jelaković Ana , Miličić Davor , Capak Krunoslav , Agabiti-Rosei Enrico , Jelaković Bojan
Published: January 2021

Our aim was to analyze characteristics of atrial fibrillation (AF) patients with chronic kidney disease (CKD) from the Croatian cohort of the ESH A Fib survey and to determine the association of estimated glomerular filtration rate (eGFR) with cardiovascular (CV) mortality after 24 months of follow-up.

Consecutive sample of 301 patients with AF were enrolled in the period 2014 to 2018. Hypertension was defined as BP > 140/90 mm Hg and/or antihypertensive drugs treatment, CKD was defined as eGFR (CKD Epi) < 60 ml/min/1.73 m2 which was confirmed after 3 months.

CKD was diagnosed in 45.2% of patients (13.3% in CKD stage > 3b). CKD patients were older than non-CKD and had significantly more frequent coronary heart disease, heart failure and valvular disease. CKD patients had significantly higher CHA2DS2-VASc score and more CKD than non-CKD patients had CHA2DS2-VASc > 2. Crude CV mortality rate per 1000 population at the end of the first year of the follow-up was significantly higher in CKD vs non-CKD group who had shorter mean survival time. CV mortality was independently associated with eGFR, male gender, CHA2DS2VASc and R2CHA2DS2VASc scores.

Prevalence of CKD, particularly more advanced stages of CKD, is very high in patients with AF. Observed higher CV mortality and shorter mean survival time in CKD patients could be explained with higher CHA2DS2VASc score which is a consequence of clustering of all score components in CKD patients. However, eGFR was independently associated with CV mortality. In our cohort, R2CHA2DS2VASc score was not associated significantly more with CV mortality than CHA2DS2VASc score.
Corneal complication after femtosecond laser-assisted cataract surgery
Authors: Chlasta-Twardzik Edyta , Nowińska Anna , Wylęgała Edward
Published: January 2021

Rationale:

The femtosecond laser LDV Z 8 is unique, and the only femtosecond laser used in ophthalmic microsurgery, which is characterized by low-energy near-infrared (1030 nm) femtosecond single pulses in the nano-Joule range and a very high repetition rate in the MHz range. To the best of our knowledge, this is the first description of unintentional partial corneal incision in the anterior part of a stroma by the femtosecond laser.

Patient concerns:

A 79-year-old patient was referred to our clinic for cataract surgery. On admission, we diagnosed mature cataract of the left eye and pseudophakic of the right eye. The patient was qualified for the Femtosecond Laser-Assisted Cataract Surgery (FLACS). Unexpectedly during FLACS procedure after lens fragmentation the surgeon observed unexpected paracentral incision in the cornea.

Diagnosis:

The corneal incision line between 4 to 8 o’clock was observed. In vivo confocal microscopy was performed to assess the morphology and depth of the corneal wound. The corneal incision covered the epithelium, Bowman's membrane and stroma of the cornea reached a depth of 336 um.

Interventions:

The patient was under increased ophthalmologic controls; follow up with typical ophthalmic examinations and confocal microscopy was performed.

Outcomes:

In 2-year follow-up period, this complication had no effect on postoperative visual function, the patient had no visual problems and obtained the final BCVA 5/5. There is no dislocation of the lens in 2 years follow-up.

Lessons:

Low pulse energy and high pulse frequency in the LDV Z8 causes a low traumatization of tissues. In a 2-year follow-up, the corneal incision line could be observed on the slit lamp examination without long-term visual consequences of this complication. In our opinion, the most likely cause of this complication was human error and lack of communication between medical personnel. The operation team should be alert and great caution must be exercised during the procedure and check the laser settings parameters carefully each time.
Genomic analysis of mutations in platelet mitochondria in a case of benzene-induced leukaemia
Authors: Wang Dianpeng , Yang Xiangli , Cai Diya , Li Peimao , Zhang Zhimin , Lin Dafeng , Zhang Yanfang
Published: January 2021

Introduction:

As a hematopoietic carcinogen, benzene induces human leukemia through its active metabolites such as benzoquinone, which may cause oxidative damage to cancer-related nuclear genes by increasing reactive oxygen species (ROS). Mitochondrion is the main regulatory organelle of ROS, genetic abnormality of mitochondrion can impede its regulation of ROS, leading to more severe oxidative damage. Mutations have been related to certain types of cancer in several mitochondrial genes, but they have never been completely analyzed genome-wide in leukemia.

Patient concerns:

The patient was a 52-year-old female who had chronic exposure to benzene for several years. Her symptoms mainly included recurrent dizziness, fatigue, and they had lasted for nearly 8 years and exacerbated in recent weeks before diagnosis.

Diagnosis:

Samples of peripheral blood were taken from the patient using evacuated tubes with EDTA anticoagulant on the second day of her hospitalization. At the same time blood routine and BCR/ABL genes of leukemic phenotype were tested. Platelets were isolated for mitochondrial DNA (mtDNA) extraction. The genetic analysis of ATP synthase Fo subunit 8 (complex V), ATP synthase Fo subunit 6 (complex V), cytochrome c oxidase subunit 1 (complex IV), cytochrome c oxidase subunit 2 (complex IV), cytochrome c oxidase subunit 3, Cytb, NADH dehydrogenase subunit 1 (complex I) (ND) 1, ND2, ND3, ND4, ND5, ND6, 12S-RNA, 16S-RNA, tRNA-Cysteine, A, N, tRNA-Leucine, E, displacement loop in platelet mtDNA were performed. All the detected gene mutations were validated using the conventional Sanger sequencing method.

Interventions:

The patient received imatinib, a small molecule kinase inhibitor, and symptomatic treatments.

Outcomes:

After 3 months treatment her blood routine test indicators were restored to normal.

Conclusion:

A total of 98 mutations were found, and 25 mutations were frame shift. The ND6 gene mutation rate was the highest among all mutation points. Frame shifts were identified in benzene-induced leukemia for the first time. Many mutations in the platelet mitochondrial genome were identified and considered to be potentially pathogenic in the female patient with benzene-induced leukemia. The mutation rate of platelet mitochondrial genome in the benzene-induced leukemia patient is relatively high, and the complete genome analysis is helpful to fully comprehend the disease characteristics.
A rare case report of an solitary neurofibroma in postcricoid region of hypopharynx
Authors: Li Dongjie , Niu Kai , Yuan Tingting , Zhu Wei , Wang Xin , Yin Wanzhong
Published: January 2021

Rationale:

Postcricoid neurofibroma is an extremely rare hypopharynx tumor that can be challenging in both diagnosis and treatment. This case sheds light on the possibility of treatment with transoral microsurgery before pursuing open cervical incisions.

Patient concerns

: A 43-year-old man presented with a four months history of a persistent foreign body sensation and mild dysphagia. Indirect and direct laryngoscopy at admission revealed a round and smooth submucosal mass in the postcricoid region.

Diagnosis:

A laryngeal enhanced computed tomography and laryngoscopy suggested that the tumor located in hypopharynx, with clear boundary and slightly strengthened edge. A supporting laryngoscopy surgery was performed under general anesthesia and a biopsy confirmed solitary neurofibroma of the postcricoid region.

Interventions:

The tumor was successfully resected en bloc transorally through supporting laryngoscope, and obviated the need for open cervical surgery and tracheostomy.

Outcomes:

The patient recovered well without any intraoperative or postoperative complication and was discharged from hospital 2 days after surgery. There was no recurrence after 6 months follow-up.

Lessons:

Postcricoid neurofibroma is an extremely rare hypopharynx tumor that can be diagnostically challenging. To the best of our knowledge, this is the first case reported of solitary neurofibroma originating from the postcricoid region of the hypopharynx and was surgically removed with transoral surgery through supporting laryngoscope.
Immunotherapy-related pneumonitis and bacterial pneumonia after the successful treatment of metastatic malignant melanoma with pembrolizumab
Authors: Ma Qin , Yang Lei , Gu Feng
Published: January 2021

Introduction:

Pembrolizumab, a monoclonal antibody targeting programmed cell death-1 (PD-1), is approved as a therapy for unresectable or metastatic melanoma. Immunotherapy-associated pneumonitis is an uncommon event.

Patient concerns:

A 73-year-old man was admitted to our hospital with a history of melanoma on the left side of the face (resected in December 2012) and metastasis to the left lung upper lobe (resected in November 2016). Recurrence of metastasis to the bilateral lungs and left pleura was detected in April 2018. A complete response was achieved following treatment with pembrolizumab, with lower limb rashes the only adverse events occurring during therapy. The patient was readmitted in March 2019 with a productive cough, shortness of breath, and mild fever, and sputum culture identified Escherichia coli.

Diagnosis:

A diagnosis of pneumonia was made, and although cough and shortness of breath responded to ceftazidime and levofloxacin, but fever and poor appetite persisted. Computed tomography showed no improvement in the bilateral lower lobe lesions. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis. The response to prednisone confirmed the diagnosis.

Interventions:

The patient first received ceftazidime and levofloxacin, but the symptoms persisted. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis.

Outcome:

Complete resolution of the bilateral lung lesions occurred after 45 days of prednisone therapy.

Conclusion:

This case report highlights that both pneumonitis and bacterial pneumonia can occur as complications of anti-PD-1 immunotherapy.
Juvenile-onset multifocal osteonecrosis in systemic lupus erythematosus
Authors: Jin Wenyuan , Yang Xinghui , Lu Meiping
Published: January 2021

Rationale:

Osteonecrosis (ON) is a devastating illness that leads to bone ischemia and potential joint destruction. Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease, with multi-system involvement which is closely associated with occurrence of ON. Multifocal ON, with an estimated morbidity of 3% in SLE patients, is extremely rare in juvenile subjects.

Patient concerns:

A 13.3-year-old female SLE patient was admitted to hospital 20 months following the SLE diagnosis because of a sudden aggravation of sore knees. She suffered from double knee joint pain and her left knee joint showed typical signs of inflammation including redness, swelling, heat, and pain.

Diagnoses:

The SLE patient was diagnosed with multifocal ON of her knee joint based on magnetic resonance imaging findings of bone destruction and osteoproliferation at the bilateral distal femur and proximal tibia.

Interventions:

The patient received high-dose methylprednisolone and intravenous cyclophosphamide pulse therapies for controlling active lupus and nephritis. Oral calcitriol and dipyridamole were administered to alleviate knee pain and inhibit thrombi formation, thereby suppressing ON progress.

Outcomes:

Three weeks following the treatment, the swelling in patient's left knee subsided. Her self-reporting pain score decreased from 9 to 4 and walking time increased from 45minutes to 90minutes per day. Nearly 5 weeks later, the pain in bilateral knee joints disappeared and the patient could walk without difficulties.

Lessons:

This patient is the youngest SLE patient who developed multifocal ON based on the reported literature. It suggests that ON can occur in young SLE patients. A combination of internal and external risk factors can promote the development of ON. The balanced approach to the application of corticosteroids and immunosuppressors in the treatment of SLE and prevention of ON is a challenging problem that deserves further exploration.
Left atrial spindle cell sarcoma
Authors: Qin Jin , Li Rui , Ma Fei , Li Haojie , Fang Zemin , Fei Yujie
Published: January 2021

Rationale:

Cardiac primary spindle cell sarcoma is 1 of the rarest cardiac malignancies, with only a few cases reported so far. Herein, we reported a case of left atrial spindle cell sarcoma diagnosed and treated by a multidisciplinary approach, and retrospectively reviewed other reported cases.

Patient concerns:

A 49-year-old woman presented to our hospital with 2 weeks of gradual onset of dyspnea on exertion, dry cough and subacute fever.

Diagnosis:

The patient was initially revealed a left atrium mass by 2-dimensional transthoracic echocardiography. Based on the contrast-enhanced echocardiography and cardiac magnetic resonance imaging, she was subsequently suggested to have a cardiac malignant tumor. And the post-operative histopathology confirmed the tumor to be a cardiac primary spindle cell sarcoma.

Interventions:

The tumor was completely resected using autotransplantation. The patient was referred for polychemotherapy afterwards.

Outcomes:

Our patient underwent the tumor resection, with subsequent adjuvant polychemotherapy, and the tumor has not recurred during 12 months of follow-up.

Lessons:

Due to the rarity of these tumors and nonspecific symptoms, they are often difficult to diagnose preoperatively and missed occasionally. Thus, improving our understanding of the disease and facilitating its early diagnosis are essential.
Shear wave elastography of the ulnar nerve at the forearm
Authors: Bedewi Mohamed Abdelmohsen , Kotb Mamdouh A. , Aldossary Nasser M. , Abodonya Ahmed M. , Alhariqi Bader A. , Swify Sherine Mohamed
Published: January 2021

The study included 38 ulnar nerves in 20 healthy subjects. High-resolution ultrasound and Shear wave elastography were used to evaluate the ulnar nerve at the mid forearm. The mean cross-sectional area of the ulnar nerve was 7.1 mm2. The mean shear elastic modulus of the nerve in the short axis was 27.4 kPa. The mean shear elastic modulus of the nerve in long axis was 24.7 kPa. No statistical relation could be noted between elasticity measurements in long and short axes. The ulnar nerve elastic modulus also showed no correlation with CSA neither in the long axis nor short axis. Age, height, weight, and body mass index showed no correlation with the ulnar elastic modulus in short or long axes. The elastic modulus of the ulnar nerve has been determined in healthy subjects and can serve as a reference for future assessment of compressive neuropathies of the ulnar nerve.
Analysis of antibiotic sensitivity and resistance genes of Bordetella pertussis in Chinese children
Authors: Lin XiaoJuan , Zou Jun , Yao Kaihu , Li Lijun , Zhong Lili
Published: January 2021

Objective:

To understood the pathogen detection status and clinical characteristics of suspected pertussis in children and to observe the drug sensitivity and drug resistance genes of Bordetella pertussis (B. pertussis).

Methods:

Three hundred fifty-one cases were collected and their nasopharyngeal swab samples were analyzed by culture and fluorescent quantitative polymerase chain reaction. The susceptibility to erythromycin, clindamycin, ampicillin, levofloxacin, and sulfamethoxazole-trimethoprim were tested by E-test for the positive strains, and the susceptibility to erythromycin was also tested for the KB disk diffusion method. The 23S rRNA gene of the positive strains was amplified and sequenced, and statistical analysis was performed in conjunction with clinical data.

Results:

The positive rate of bacterial culture was 16.8% (59/351), and the positive rate of PCR was 62.4% (219/351). Two cases were positive about bacterial culture and negative for PCR. There were 221 confirmed cases of pertussis. The E-test results showed that the rate of the sensitivity of the 55 strains of pertussis to erythromycin and clindamycin was 50.9% (28/55), the minimum antibiotic concentration50 (MIC50) and MIC90 values were 0.094/>256 and 0.75/>256 mg/L, respectively, and the MIC50/MIC90 to ampicillin, levofloxacin, and sulfamethoxazole were 0.125/0.19, 0.38/0.5, and 0.125/0.25 mg/L, respectively. The KB disk diffusion method showed 27 of the 55 strains 49.1% (27/55) was resistant to erythromycin; all of the resistant strains had the 23S rRNA gene A2047G mutation, and their MIC of erythromycin was >256 mg/L.

Conclusion:

The diagnosis of pertussis by a fluorescent quantitative polymerase chain reaction method is more sensitive than that of bacterial culture. The resistance of B. pertussis to erythromycin was prominent. All of the strains of B. pertussis resistant to erythromycin in our center had the A2047G mutation of the 23S rRNA gene.
Music-based interventions for pain relief in patients undergoing hemodialysis
Authors: Cheng Jingru , Zhang Hui , Bao Hong , Hong Hanxia
Published: January 2021

Background:

Music therapy and music-based interventions have been used widely in numerous medical procedures to reduce the physical and psychological disorders. However, the effect of music therapy on pain relief in hemodialysis patients still remains unclear.

Methods:

Electronic databases were comprehensively searched through MEDLINE, Web of Science, EMBASE, Cochrane, and WANFANG. All studies met inclusion criteria were eligible for systematic review and meta-analysis. Clinical variables were extracted and pooled results were obtained using STATA software.

Results:

A total of 10 studies with 722 participants were included for systematic review. Overall, music therapy showed a significantly favorable effect on reducing pain for patients undergoing hemodialysis (SMD: −0.90, 95%CIs: −1.25 to −0.55, P < .001). No publication bias was observed.

Conclusions:

Music-based interventions could significantly relieve pain for patients undergoing hemodialysis, which should be promoted as an effective and safe complementary method.
The effect of trifluridine/tipiracil for patients with heavily pretreated metastatic gastric cancer
Authors: He Xiaoyan , Zhang Tianyao , Wu Lijuan , Wu Yongcan , Zhou Xin
Published: January 2021

Background:

Gastric cancer is a global health problem with high incidence rate and mortality rate. Due to the limitations of traditional chemotherapy drugs, such as patient intolerance, low efficacies and serious adverse effects, trifluridine/tipiracil has been considered to be a promising treatment for patients with heavily pretreated metastatic gastric cancer. However, the relevant systematic review has not been occurring. The presentation of this protocol is to scientifically evaluate the efficacy and safety of trifluridine/tipiracil in patients with highly pretreated metastatic gastric cancer.

Methods:

The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. We will systematically search MEDLINE, PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database (CNKI), VIP Chinese Science and Technology Periodical Database (VIP), Wan Fang Database up to November 1, 2020 to identify published articles. Using the Cochrane risk assessment tool to assess the methodological quality of the RCTs, and all included studies will be analyzed according to the criteria in the Cochrane Handbook. Review Manager 5.3 software will be used for literature quality evaluation and data analysis.

Results:

Objective to evaluate the efficacy and safety of trifluridine/tipiracil in patients with heavily pretreated metastatic gastric cancer by analyzing the eligible data extracted under limited conditions.

Conclusion:

This study provides clear evidence to evaluate the effectiveness and safety of trifluridine/tipiracil for patients with highly pretreated metastatic gastric cancer, and the findings will also be published in a peer-reviewed journal.

Ethics and dissemination:

No ethical statement will be required for this study because there is no direct involvement of human. This review will be published in a peer-reviewed journal as a conference report or an article.

Registration:

OSF registration number: DOI 10.17605/OSF.IO/6MF5U.
A comparison of the efficacy and safety of traditional Chinese medicine external treatment for the knee osteoarthritis
Authors: Song Xuyu , Wang Zhao , Zhang Peng , Zhao Min , Yang Lingsen , Zhang Wei
Published: January 2021

Background:

Knee osteoarthritis (KOA), also known as degenerative osteoarthritis, is a common and frequently occurring disease in orthopedics with cartilage degeneration as the pathogenic cause and articular bone hyperplasia as the sign. Many studies have confirmed that KOA can be effectively treated by traditional Chinese medicine (TCM) external treatment. So we take advantage of the method of network meta-analysis to systematically compare the efficacy and safety of different types of TCM external treatment for the KOA.

Methods:

We will research on external treatment of KOA by traditional Chinese medicine using randomized controlled trials (RCTs) in search database (EMBASE, PubMed, Web of Science, Chinese National Knowledge Infrastructure [CNKI], Weipu database [VIP], Wanfang, and China BioMedical Literature [CBM]). The data and evidence obtained will be processed using Stata 15.0 and WinBUGS 1.4.3.

Results:

We will evaluate the efficacy and safety of traditional Chinese medicine external treatment for the knee osteoarthritis in this study.

Conclusion:

This study will provide a new regimen for KOA treatment. It has extremely high reference value.

INPLASY registration number:

INPLASY2020120001.

DOI number

: 10.37766/inplasy2020.12.0001.
Dexamethasone and post-adenotonsillectomy pain in children
Authors: Kang Young , Ku Eu Jeong , Jung Il Gu , Kang Min Hyuck , Choi Young-Seok , Jung Hahn Jin
Published: January 2021

Objective:

To assess the impact of intraoperative intravenous dexamethasone on the reduction of postoperative morbidity in children undergoing adenotonsillectomy.

Methods:

A double blind randomized controlled trial conducted among children undergoing adenotonsillectomy at a tertiary hospital in Korea from November 2018 to June 2019. Children were randomly assigned to receive dexamethasone (0.5 mg/kg, maximum dose 24 mg) or placebo intravenously after induction of anesthesia. The primary endpoint was the reduction of postoperative pain and postoperative nausea and vomiting (PONV); secondary endpoints were adverse effects like postoperative hemorrhage.

Results:

The study included 105 children, and 67 were male. Their mean age was 6.2 ± 2.1 years. There was no significant difference between the groups in terms of demographic data or the operation time. The pain scores of the dexamethasone group were lower than those of the control group, but no significant difference was found (all P > .05). The average pain visual analog scale (VAS) during the study period (day 0–7) was 3.67 ± 1.59 and 4.40 ± 2.01 in the dexamethasone group and control group, respectively (P-value = .107). When we compared early pain VAS (day 0–2) and late pain VAS (day 5–7), the dexamethasone group showed significantly lower early mean VAS compared to the control group (4.55 ± 1.78 vs 5.40 ± 2.05, P-value = .046). The mean VAS for PONV was significantly lower in the dexamethasone group than in the control group (1.89 ± 2.22 vs 3.00 ± 2.37, P value = .044).

Conclusion:

In children undergoing adenotonsillectomy, dexamethasone decreased the early postoperative pain and PONV without increasing postoperative hemorrhage.
Effectiveness and safety of traditional Chinese medicines for pulmonary heart disease
Authors: Hu Xinyu , Li Lulu , Song Yuanying , Lu Yun
Published: January 2021

Background:

Previous review indicate that the effect of traditional Chinese medicines (TCM) on pulmonary heart disease (PHD) remains uncertainty. Therefore, we designed this study to systematically evaluate the effectiveness and safety of TCM in the treatment of PHD.

Methods:

Nine online databases will be searched from inception to October 01, 2021, and we will not restrict the language on included trials. Randomized controlled trials that included patients with PHD receiving TCM therapy vs a control group will be included. Two of us will perform independently the selection of studies, risk of bias assessment, and data extraction. The RevMan V.5.2 software with fixed effects model or random effects model will be used to syntheses the data, according to the heterogeneity test to conduct the data synthesis. The dichotomous data and the continuous data will be presented with risk ratios with 95% confidence intervals and weighted mean differences or standardized mean differences with 95% confidence intervals. And we will use the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate the evidence quality.

Result:

This study will assess effects and safety for TCM on PHD.

Conclusion:

The conclusion of this study will provide evidence to prove the safety and effectiveness of TCM on PHD.

Trial registration number:

INPLASY2020120024.
Natural changes of traumatic vertebral compression fractures during the first 6 months in patients visiting for disability certificates
Authors: Bae Jin Seok , Suh InHyuk , Kim Jong Keun , Jeong Yong Sung , Lim Jong Youb
Published: January 2021

To identify the natural changes of traumatic vertebral compression fractures during the first six months in patients visiting for disability certificates after conservative treatment.

Data of patients who visited the rehabilitation medicine department of a university hospital for disability certificates concerning traumatic vertebral compression fractures from 2015 to 2018 were reviewed. Those who visited 180 to 210 days after injuries were included, and those who received invasive procedures for compression fractures were excluded. The anterior and posterior heights, local kyphotic angle of compression fractures, and upper and lower vertebrae on initial and follow-up images were measured and compared. Compression ratio was calculated by vertebral body compression ratio and anterior vertebral body compression percentage. Thoracic and lumbar traumatic fractures were also compared.

Among 110 patients, 61 patients met the criteria. After six months, the anterior height of compression fractures decreased more than 4 mm, which implies the development of new compression fractures. The compression ratio and local kyphotic angle increased significantly without affecting the upper and lower vertebrae. Thoracic and lumbar compression fractures showed similar changes.

Traumatic vertebral compression fractures change significantly during the first six months. This study could warrant 6 months of waiting for issuance of disability certificates for patients with traumatic vertebral compression fractures.
Defensive medicine and cesarean sections in Brazil
Authors: Rudey Edson Luciano , Leal Maria do Carmo , Rego Guilhermina
Published: January 2021

Brazil has a high rate of cesarean sections (CS) that cannot be solely justified by women's clinical conditions; thus, other causes, for example, CS on maternal request and physicians’ fear of litigation as possible influencing factors, cannot be overlooked.

This study aimed to identify through a survey whether Brazilian gynecologists and obstetricians (GOs) perform defensive CS.

In this cross-sectional, descriptive study, a questionnaire was administered. The target population comprised of GOs who were members of premier Brazilian professional associations of gynecology and obstetrics. A total of 403 GOs participated in the survey using an obstetrics questionnaire about litigation and defensive medicine (DM). Statistical analyses were performed on pairs of variables to determine the risk factors of performing CS due to concerns of complications during vaginal delivery and to avoid lawsuits.

The mean age of the GOs was 47.7 years who were mostly female (58.3%) and having worked professionally in both public and private sectors (71.7%). Of all participants, 80.6% had been sued or knew an obstetrician who had been sued. The obstetricians who had been sued or who knew a colleague that had been sued exhibited a significantly higher likelihood of performing defensive CS than physicians who had not been sued or did not know physicians who had been sued. The perception of a higher risk of lawsuits against obstetricians influenced the practice of DM and led to a more than six-fold increase in CSs in specialists with this perception compared to specialists who did not believe the presence of an increased risk of litigation in obstetrics existed.

The majority of Brazilian GOs perform defensive CS. It is important to consider DM as one of the causes of high CS rates in Brazil and include it in the development of public policies to reduce these CS rates.
Clinical features and outcomes of hypocellular acute myeloid leukemia in adults
Authors: Song Ik-Chan , Jo Deog-Yeon , Kim Hyeoung-Joon , Min Yoo-Hong , Hong Dae Sik , Lee Won-Sik , Shin Ho-Jin , Lee Je-Hwan , Park Jinny , Kim Hee-Je
Published: January 2021

The hypocellular variant of acute myeloid leukemia (AML) is defined as bone marrow cellularity of <20% in a biopsy specimen at presentation. We performed a retrospective analysis of the clinical features and survival outcomes of hypocellular AML in a Korean population. We reviewed the medical records of all patients diagnosed with AML at nine hospitals participating in the Korean AML registry from 2006 to 2012. Overall survival (OS) and event-free survival (EFS) rates were calculated from the time of diagnosis until death or an event, respectively. In total, 2110 patients were enrolled and 102 (4.8%) were identified as having hypocellular AML. Patients with hypocellular AML were older than those with non-hypocellular AML (median age: 59 vs 49 years; P < .001) and presented with leukopenia more frequently (mean white blood cell count: 5810/μL vs 40549/μL; P < .001). There was no difference between patients with and without hypocellular AML in terms of the presence of antecedent hematologic disorders (5.9% vs 5.3%; P 
= .809). FLT3-ITD and NPM1 mutations were less common in hypocellular than non-hypocellular AML (FLT3-ITD mutations: 1.2% vs 14.3%, P < .001; NPM1 mutations: 0% vs 9.5%, P = .019). No differences were seen between the hypocellular and non-hypocellular AML groups in the complete remission rate (53.9% vs 61.3%, P = .139) or early death rate (defined as any death before 8 weeks; 14.7% vs 13.0%, P = .629). The OS and EFS did not differ between the hypocellular and non-hypocellular AML groups (median OS: 16 vs 23 months, P = .169; median EFS: 6 vs 9 months, P = .215). Hypocellular AML is more frequently observed in older-aged patients and have fewer FLT3-ITD and NPM1 mutation, but the clinical outcomes of hypocellular AML do not differ from those of non-hypocellular AML.
Efficacy and safety of Shufeng Jiedu Capsule in the treatment of acute exacerbations of chronic obstructive pulmonary disease
Authors: Ren Huijun , Jiang Yuhao , Wang Shiyu , Wang Yirong , Wang Jingying
Published: January 2021

Background:

With the outbreak of novel coronavirus, the treatment of respiratory diseases has been promoted. In particular, many traditional Chinese medicines, including Chinese patent medicines, have been found to be effective in the treatment of respiratory illness in China. chronic obstructive pulmonary disease (COPD) is one of most common respiratory condition. It is predicted that COPD will be become the third frequent cause of death by 2030. The aim of this study is to assess the efficacy and safety of Shufeng Jiedu Capsule in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Methods:

According to the search strategy, randomized controlled trials (RCTs) of Shufeng Jiedu Capsule in the treatment of AECOPD were obtained from Cochrane Library, MEDLINE, Embase, CNKI, VIP, CBM, and WANGFANG. Studies were screened according to inclusion and exclusion criteria, and the Cochrane risk bias assessment tool was used to assess the quality of the study. Meta-analysis was performed using Revman 5.4 software. Finally, the evidence level of the results will be evaluated.

Results:

The purpose of this study was to evaluate the efficacy and safety of Shufeng Jiedu Capsule in the treatment of AECOPD, and to provide basis for clinical rational drug use.

Conclusion:

Our research results of this study could provide reference for clinical decision-making and guiding development in the future COPD patient.

INPLASY registration number:

INPLASY2020120062
Tuina for lumbar disc herniation
Authors: Miao Zuoxiong , Tong Zhenglan , Ye Jinfei , Leng Shihan , Wang Min , Hu Anli , Zhang Jingyu , Dai Xingze , Liang Jiarong , Geng Yunlong , Chen Liang , Ye Bin , Dong Youkang
Published: January 2021

Background:

Lumbar disc herniation (LDH) is an important factor of causing leg pain and numbness. As a secondary discipline of Traditional Chinese Medicine, tuina is widely used for the treatment of LDH in China even in other nations while its clinical value is not acknowledged universally. So, we focus on this article aims to evaluate its efficacy and safety of LDH.

Methods:

Electronic databases involving Cochrane Library, PubMed, Web of Science, EMBASE, China Science and Technology Journal, China National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Database will be pertained with appropriate search strategy. And RevMan V.5.3.5 software will be conducted as the assessment tool for bias risk, data synthesis, subgroup analysis as well as meta-analyses.

Results:

This systematic review will provide a high-quality synthesis of current evidence of tuina for LDH.

Conclusion:

This protocol will determine whether Tuina is an effective and safe treatment method for LDH.
Diagnostic accuracy, yield, and comparative effectiveness of whole-body computed tomography in blunt trauma
Authors: Nagasawa Kyohei , Iwata Mitsunaga , Nihashi Takashi , Terasawa Teruhiko
Published: January 2021

Objectives:

Controversies emerge over routine performances of whole-body computed tomography (WBCT) in patients with blunt polytrauma. The existing randomized and non-randomized evidence is inconclusive, and during observations of non-trauma, incidental findings, detected by WBCT, have left uncertainty regarding their consequences and optimal management. Additionally, previous meta-analyses have failed to address the limitations of primary studies and issues associated with incidental findings. Therefore, we planned a new systematic review to address these points.

Methods:

We will search the PubMed, EMBASE, and Cochrane Central databases from inception to December 31, 2020, with no language restriction and perform full-text evaluation of potentially relevant articles. We will include prospective and retrospective studies with a single-gate design that assessed diagnostic accuracy and/or yield of WBCT to detect traumatic injuries, and studies that assessed incidental findings detected by WBCT. Additionally, we will include randomized controlled trials and non-randomized comparative studies that assessed the effectiveness of WBCT against conventional care, including selective computed tomography (CT). Studies of patients of all ages with blunt traumatic injuries, assessed at an emergency department, will be included. Two reviewers will extract data and rate the study validity via standard quality assessment tools. The primary outcome of interest will be reduction in mortality. Our secondary outcomes will include diagnostic accuracy and yield, detection of incidental findings and clinical outcomes associated with these detections, and improvement in other non-mortality clinical outcomes. We will qualitatively assess study, patient, and intervention characteristics and clinical outcomes. If appropriate, we will perform random-effects model meta-analyses to obtain summary estimates. Finally, we will assess the certainty of evidence by the grading the quality of evidence and strength of recommendations.

Ethics and dissemination:

Ethics approval is not applicable, as this is a secondary analysis of publicly available data. The review results will be submitted for publication in peer-reviewed journals.

Prospero registration:

CRD42020187852.
Epidemiological profile of female firearm-related mortality
Authors: Justino Dayane Caroliny Pereira , Costa Ketyllem Tayanne da Silva , de Andrade Fábia Barbosa
Published: January 2021

The mortality rate of women due to firearms increases every day in Brazil and globally. This study aimed to evaluate the trends of firearm-related mortality in women from the years 2007 to 2016 in order to determine their profile and to associate these indicators with public policy and strategies to reduce mortality.

This is an ecological time-series study using secondary data of women aged 10 to 49 years old collected through the mortality information system (SIM) in Brazil. Furthermore, independent characteristics such as education, color, race and civil status were also collected from SIM. Data was analyzed using the Join Point open source software version.

There was an increase in the mortality rate of women who received 4 to the 7 years of education, were single, and brown-skinned. There was a significantly increased rate of mortality in women whose ages ranged from 20 to 29 years followed by 30 to 39 years; the rate was also significantly higher in the northeast region followed by the southeast region.

There is a need for professional training to assist women in vulnerable situations.
Development and validation of a nomogram for predicting the overall survival of patients with gastroenteropancreatic neuroendocrine neoplasms
Authors: Xie Si , Li Lei , Wang Xiaotong , Li Lequn
Published: January 2021

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are increasing in incidence. Clinicians urgently need a method that can effectively predict the prognosis of GEP-NENs.

A total of 14770 GEP-NENs patients with pathologically confirmed between 1975 and 2016 were obtained from the surveillance, epidemiology, and end results database. All the patients were divided into primary (n = 10377) and validation (n = 4393) cohorts based on the principle of random grouping. Multivariate Cox proportional hazards proportional hazards regression analysis was performed to evaluate predictors associated with overall survival, and a nomogram was constructed based on the primary cohort. An independent external validation cohort and comparison with the eighth edition American Joint Committee on Cancer TNM staging system were subsequently used to assess the predictive performance of the nomogram.

The multivariate Cox model indicated that age, tumour differentiation, and distant metastases were independent predictors associated with overall survival. With respect to the primary cohort, the nomogram exhibited better discriminatory power than the TNM classification (C-index: 0.821 vs 0.738). Discrimination was also superior to that of TNM classification for the validation cohort (C-index: 0.823 vs 0.738). The calibrated nomogram predicted 3- and 5-years survival rate that closely corresponded to the actual survival rate.

This study developed and validated a prognostic nomogram applied to patients with GEP-NENs, which may help clinicians make reasonable prognostic judgments and treatment plans to a certain extent.
Prenatal detection of distal 1q21.1q21.2 microduplication with abnormal ultrasound findings
Authors: Zhang Hongguo , Yue Fagui , Zhang Xinyue , He Jing , Jiang Yuting , Liu Ruizhi , Yu Yang
Published: January 2021

Rationale:

1q21.1 duplication is an uncommon chromosomal submicroscopic imbalance which is associated with growth/mental retardation, dysmorphic features, autism, multiple congenital and neuropsychiatric disorders.

Patient concerns:

Two pregnant women underwent amniocentesis for cytogenetic analysis and chromosomal microarray analysis (CMA) following abnormal ultrasound findings. Case 1 presented short nasal bone and case 2 showed absent nasal bone, ventricular septal defect and umbilical cord circling in ultrasonic examination.

Diagnoses:

G-banding analysis showed that the two fetuses presented normal karyotypic results while CMA detected 1.796 Mb (case 1) and 1.242 Mb (case 2) microduplications in the region of 1q21.1q21.2 separately. Furthermore, the CMA also revealed a 1.2 Mb microdeletion of 8p23.3 in case 1.

Interventions:

The couple in case 1 chose to terminate the pregnancy, while the couple in case 2 continued the pregnancy and finally delivered a male infant who presented low nasal bridge and ventricular septal defect.

Outcomes:

The 1q21.1q21.2 duplications in our report were located in the distal 1q21.1 region, overlapping with 1q21.1 duplication syndrome. Case 2 was the first reported live birth with 1q21.1 duplication according to prenatal CMA detection in China.

Lessons:

The genotype-phenotype of 1q21.1 duplication is complicated due to the phenotypic diversity, incomplete penetrance, and lack of obvious characteristics. So it is difficult to predict the postnatal development and health conditions clinically. Hence, long term follow up is necessary for newborn infants with 1q21.1 duplication, irrespective of whether the duplication is de novo or inherited.