bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Regional Blocks or Local Anaesthetic Infiltration for Analgesia After Caesarean Delivery: A Network Meta-Analysis of Randomized Controlled Trials
Authors: Singh N.P. , Monks D. , Makkar J.K. , Palanisamy A. , Sultan P. , Singh P.M.
Published: November 2022

(Anaesthesia. 2022;77:463–474. doi: 10.1111/anae.15645)

With cesarean delivery (CD) rates on the rise globally, it is important to understand the most effective methods of managing postoperative pain, which can be moderate to severe. Effective analgesia following CS has the long-term benefits such as decreasing opioid consumption, postpartum depression, and the likelihood of chronic pain. While long-acting neuraxial opioids reduce opioid requirements, breakthrough pain is not uncommon and neuraxial interventions may be contraindicated for some women. Local anesthetic infiltration has been increasingly used to reduce pain without significant adverse effects and may add the benefit of visceral analgesia. With many approach sites for treatment (direct wound infiltration, ilio-inguinal nerve, transversus abdominis plane, erector spinae plane, transverse fascia plane, and quadratus lumborum plane), it has not yet been studied if certain sites offer greater benefit over others. This network meta-analysis compares and ranks injection sites for efficacy of pain relief following CD.
Addressing Peer-to-Peer Resident Mistreatment Through the Use of Forum Theatre: A Pilot Intervention
Authors: Botros-Brey Sylvia , Dyurich Adriana , Pfeiffer Alixandria , Prestigiacomo Roberto , Wang Hanzhang , Page-Ramsey Sarah M. , Basler Joseph W. , Berggren Ruth
Published: November 2022

Problem

Residents may experience mistreatment by faculty, peers, nurses, or patients. While faculty are reportedly the primary contributors to mistreatment, residents can also be offenders, which merits study. Forum theatre (FT) is an experiential learning modality requiring a peer group to develop problem-solving strategies. FT was piloted to address mistreatment among residents. The objective was to determine whether FT was feasible, acceptable to resident learners, and could lead to self-reported changes in perceptions or behaviors, providing program directors a focused option to address professionalism as a competency.

Approach

This initiative was conducted from September 2019 through February 2021 in obstetrics–gynecology and urology residencies at UT Health San Antonio and consisted of 3 phases: a focus group to identify mistreatment experienced by residents, resident volunteers to create and act out the FT scenario, and enactment of the FT scenario during didactic time. Residents completed anonymous retrospective pre- and postsurveys, as well as at 6–8 months after, to assess knowledge, attitudes, and self-reported and observed behaviors. Wilcoxon rank-sum tests and 2-sample t tests for proportions were used to compare variables between groups.

Outcomes

The FT was completed successfully in both departments during didactic time. Twenty-six residents participated, 24 (92%) responded. Most respondents (23, 96%) would recommend FT to colleagues for teaching professionalism. Behavior changes were reported by 15 (63%) participants after the program. After 6–8 months, self-reported mistreatment behaviors had decreased, including “making fun of others” (15 (63%) to 10 (38%), P = .04) and sending “disparaging texts” (13 (54%) to 7 (27%), P =.02).

Next Steps

The use of FT during regularly scheduled didactic times was feasible and well received among residents. The evaluation demonstrated sustained self-reported behavior changes. Plans are ongoing to expand this approach to other medical specialties and professions institutionally.
Prognostic Factors Impacting Surgical Outcomes in Patients With Cervical Spondylotic Myelopathy
Authors: Su Brian W. , Tadepalli Vaib , Kamalapathy Pramod N. , Shimer Adam
Published: November 2022

The purpose of surgical decompression in patients who have CSM is to stop the progression of symptoms and hopefully improve function. It is critical to understand prognostic factors that affect the outcome. Factors intrinsic to the patient that can adversely affect outcomes include diabetes, older age, tobacco use, the presence of mental health disease, and obesity. MRI imaging findings of T2 hyperintensity and clinical duration and severity of symptoms is also associated with poorer outcomes. Patients should be counseled regarding the efficacy of decompressive procedures for CSM and given realistic expectations based on their unique biophysical profiles.
New Imaging Modalities for Degenerative Cervical Myelopathy
Authors: Rajan Prashant V. , Pelle Dominic W. , Savage Jason W.
Published: November 2022

Introduction:

Degenerative cervical myelopathy (DCM) is defined as dysfunction of the spinal cord as a result of compression from degenerative changes to surrounding joints, intervertebral disks, or ligaments. Symptoms can include upper extremity numbness and diminished dexterity, difficulty with fine manipulation of objects, gait imbalance, and incoordination, and compromised bowel and bladder function. Accurate diagnosis and evaluation of the degree of impairment due to degenerative cervical myelopathy remain a challenging clinical endeavor requiring a thorough and accurate history, physical examination, and assessment of imaging findings.

Methods:

A narrative review is presented summarizing the current landscape of imaging modalities utilized in DCM diagnostics and the future direction of research for spinal cord imaging.

Results and Discussion:

Current imaging modalities, particularly magnetic resonance imaging and, to a lesser extent, radiographs/CT, offer important information to aid in decision making but are not ideal as stand-alone tools. Newer imaging modalities currently being studied in the literature include diffusion tensor imaging, MR spectroscopy, functional magnetic resonance imaging, perfusion imaging, and positron emission tomography. These newer imaging modalities attempt to more accurately evaluate the physical structure, intrinsic connectivity, biochemical and metabolic function, and perfusion of the spinal cord in DCM. Although there are still substantial limitations to implementation, future clinical practice will likely be revolutionized by these new imaging modalities to diagnose, localize, surgically plan and manage, and follow patients with DCM.
Radiofrequency Microneedling for Skin Tightening of the Lower Face, Jawline, and Neck Region
Authors: Nguyen Lynhda , Blessmann Marco , Schneider Stefan W. , Herberger Katharina
Published: November 2022

BACKGROUND

Radiofrequency microneedling (RFMN) treatment is the latest generation of fractional skin rejuvenation methods.

OBJECTIVE

To evaluate the efficacy, safety, tolerability and patient satisfaction of RFMN treatment for skin rejuvenation of the lower face and neck area.

MATERIALS AND METHODS

A prospective, intraindividual, controlled study. Subjects were treated with a fractional insulated RFMN system with 1 to 3 sessions at intervals of 4 to 12 weeks. Follow-up visits were scheduled on Day 90 and 180 posttreatment. Outcome was assessed by volume analysis of standardized 3-dimensional imaging, and validated clinical scales were rated by the physician, a blinded investigator, and patients.

RESULTS

Thirty patients (mean age 55.5 years, Fitzpatrick skin type I–IV) were included. Mean submental volume difference was −4.72 cm3 (±10.07 cm3; range −26.65 cm3 to +16.01 cm3). Physician, blinded investigator, and subjects rated the clinical outcome as highly improved. Mean pain intensity was 5.61/10 on Numeric Rating Scale. Beside slight swelling and redness, no relevant downtime has been observed.

CONCLUSION

Fractional RFMN treatment is a safe and effective technique for rejuvenation of the lower face, jawline, and neck region. Sufficient pain management should be provided. Data indicated low to no downtime and high patient satisfaction.
Intradermal Injection of Poly-d, l-Lactic Acid Using Microneedle Fractional Radiofrequency for Acne Scars: An Open-Label Prospective Trial
Authors: Hyeong Jin Hyeok , Jung Joon Woo , Seo Suk Bae , Kim Hong Seok , Kim Kwang Ho
Published: November 2022

BACKGROUND

Treatment with filler injections using a microneedle fractional radiofrequency (MFRF) device is a promising modality with proven efficacy for acne scar treatment.

OBJECTIVE

To investigate the efficacy and histologic differences of intradermal injection of a filler (poly-d, l-lactic acid, PDLA) using an MFRF device for the treatment of acne scars.

METHODS

Patients with acne scars on both cheeks were included. Poly-d, l-lactic acid was injected via the MFRF device every 4 weeks for a total of 4 sessions. Patients were evaluated using the grading system for acne scars before each session, as well as personal satisfaction. For histologic evaluation, 2 patients (who consented) underwent a skin biopsy from the upper arm before and after the same single session.

RESULTS

After the final session, the acne scar grading (échelle d'évaluation clinique des cicatrices d'acné) scale and visual analog scale for evaluation of satisfaction showed improvement compared with initial assessment (36.99% and 79.65% respectively [p < .001, respectively]). For histologic evaluation, biodegradation of PDLA materials and increase in collagen and elastic fibers were observed after 5 months of treatment.

CONCLUSION

Intradermal injection of PDLA using the MFRF device could be used as an effective treatment with fewer side effects in acne scar patients with Fitzpatrick skin type III-IV.
The association between incidentally found breast arterial calcification on routine screening mammography and the development of coronary artery disease and stroke: results of a 10-year prospective study
Authors: Nudy Matthew , Asmaro Ragad , Jiang Xuezhi , Schnatz Peter F.
Published: November 2022

Objective

The objective of this study is to assess whether the presence of breast arterial calcifications (BACs) found on routine mammography is prospectively associated with the development of cardiovascular disease (CVD) events after 10 years of follow-up.

Methods

Women presenting for screening mammography were enrolled in this prospective cohort. Baseline data were collected including history of CVD and CVD risk factors. Mammograms were assessed for the presence or absence of BAC. Participants completed questionnaires 10 years after baseline that assessed the development of CVD (coronary artery disease [CAD] and stroke) and CVD risk factors.

Results

Of the 1,995 participants who enrolled at baseline, complete 10-year follow-up data were available for 1,039; of those, 114 (11.0%) were BAC-positive and 925 (89.0%) were BAC-negative at baseline. After controlling for age, BAC-positive women were more likely to develop CAD (odds ratio, 3.14; 95% confidence interval, 1.86-5.27; P < 0.001) compared with BAC-negative women after 10 years of follow-up. After controlling for age, BAC-positive women were more likely to have had a stroke (odds ratio, 5.10; 95% CI, 1.82-14.30) compared with BAC-negative women after 10 years.

Conclusions

The presence of BAC on routine screening mammography was associated with a significantly increased risk of developing CAD and stroke after 10 years of follow-up. Additional large prospective, population-based studies are needed to confirm BAC as a predictor of future CVD events and its utility in stratifying a woman's risk of CVD.
Monoaminergic mediation of hyperalgesic and analgesic descending control of nociception in mice
Authors: Nemoto Wataru , Kozak Dalia , Sotocinal Susana G. , Tansley Shannon , Bannister Kirsty , Mogil Jeffrey S.
Published: November 2022

Descending control of nociception (DCN; also known as conditioned pain modulation [CPM], the behavioral correlate of diffuse noxious inhibitory controls) is the phenomenon whereby pain inhibits pain in another part of the body and is the subject of increasing study because it may represent a biomarker of chronic pain. We recently discovered that pain modulation on the application of a DCN paradigm involving low-intensity test stimuli occurs in the direction of hyperalgesia in healthy mice and rats, whereas the use of high-intensity stimuli produces analgesia. To elucidate the physiological mechanisms underlying hyperalgesic DCN, we administered agonists and antagonists of norepinephrine (NE) and serotonin (5-HT) receptors, key neurochemical players in the production of analgesic DCN. We find that 3 different monoamine reuptake inhibitors—the NE-selective reboxetine, the 5-HT-selective fluoxetine, and the dual NE/5-HT agonist duloxetine—all abolish hyperalgesic DCN when administered into the spinal cord (but not systemically), with no effect on heat or mechanical pain sensitivity. The reversal by reboxetine of hyperalgesic DCN is mediated by α2-adrenergic receptors (ie, blocked by atipamezole), and the fluoxetine reversal is mediated by 5-HT7 receptors (ie, blocked by SB269970). By contrast, analgesic DCN was found to be reversed by atipamezole and SB269970 themselves, with no effect of reboxetine or fluoxetine. Thus, hyperalgesic DCN seems to be the neurochemical opposite to analgesic DCN. These data further validate and help elucidate a preclinical paradigm that mimics dysfunctional CPM and thus may form the basis of translational experiments that aim to reveal preventative pharmacological strategies for individuals predisposed to persistent pain.
Evaluation of autonomic cardiac modulation and body composition in elderly submitted to the protocol of exercise and the gametherapy: A clinical trial protocol (SPIRIT compliant)
Authors: Thoma Sáskia Fürstenberg , Pérez-Riera Andrés Ricardo , Silva Eduardo Antônio Costa , Costa Ester Laura Cordeiro Oliveira , Ferreira Airlon Nery , Belfort Emanuel Ewald Thoma , Leite Jéssica Costa , Zangirolami-Raimundo Juliana , Raimundo Rodrigo Daminello
Published: November 2022

Introduction:

Aging affects the cardiovascular system by impairing the amount and strength of cardiac pumping. Heart rate variability (HRV) is a safe parameter to assess variations in the cardiovascular system, providing data on sympathetic and parasympathetic activations.

Objectives:

Our primary aim is to investigate the cardiac autonomic modulation and body composition of active older adults participating in a physical exercise protocol and gametherapy. Our secondary aim is to assess their functional capacity, cognitive function, balance, respiratory pressures, and functional autonomy.

Method:

This randomized clinical trial will include 100 active older adults aged 60 to 80 years. The exercise group (EG) will perform 24 supervised training sessions (strength and aerobic) for 12 weeks (2 60-minutes sessions per week). The gametherapy group (GG) will exercise using gametherapy. Assessments will occur on the first week, after the 12th week, after wash out and in the end of cross over. The primary outcome will be HRV and body composition (bioimpedance). Secondary outcomes will be functional capacity (6-minute walk test), cognitive function (mini-mental state examination), risk of falls and balance (berg balance scale and timed up and go test), inspiratory and expiratory pressures (manovacuometry) and functional autonomy (functional reach test and group of Latin American development to maturity [GDLAM] protocol).

Discussion:

This study will provide relevant information about the effects of physical training (physical exercises and gametherapy) on HRV and other variables in active older adults.
The role of tonifying kidney decoction and acupuncture in the treatment of Alzheimer’s disease: A network meta-analysis
Authors: Wang Xin-Chen , Chu Chen-Liang , Lu Kuan , Chen Xi , Jin Xiao-Qian , Quan Shi-Jian
Published: November 2022

Importance:

As one of the chronic neurological degenerative diseases with the highest incidence of amnesia and dementia, Alzheimer’s disease (AD) carried out the clinical treatment based on the 2 traditional Chinese medicine (TCM) of Chinese herbal compound and acupuncture (AP). With the vigorous development of TCM, doctors are facing the problem of choosing TCM or western medicine in clinical work. Hence there is an urge to make pairwise comparisons among these interventions to provide evidence for clinical practice.

Objective:

The used efficacy of the 2 TCM methods and combined with donepeziline were compared to compile the best treatment through network meta-analysis.

Methods:

Patients diagnosed with AD were included in the randomized clinical trial, who were treated with tonifying kidney decoction (TKD) or AP combined with donepezil hydrochloride (DH) as an intervention measure, while the control group was treated with DH. The total effective rate was the primary outcome, and mini-mental state examination (MMSE) score and activities of daily living (ADCS-ADL) scores were the secondary indicators.

Results:

Eventually 30 studies reporting 2236 patients underwent TKD or AP combined with DH were enrolled. In terms of total efficiency, compared with TKD and DH, TKD + DH was significantly preferable. In addition, TKD were classified into 2 categories, namely tonifying kidney with reducing phlegm formulas (TKRP) and tonifying kidney with filling lean marrow (TKFLM). Regarding to MMSE score of TKD, of the 3 interventions, only TKRP + DH (standard mean difference [SMD] = 4.84, 95% confidence interval [CI]: 0.86–8.82) and TKFLM + DH (SMD = 3.93, 95% CI: 1.06–6.80) had significant efficacy over TKFLM (SMD = 4.25, 95%CI: −2.58 to 11.08). Although no difference between TKRP and other groups, its effectiveness was higher than TKFLM + DH and TKFLM (surface under the cumulative ranking curve (SUCRA) = 61.5%). For the ADL score, compared with TKFLM + DH and DH, TKRP + DH had more effective (SUCRA = 70.2%). Regarding to the total effective rates, AP + DH was more statistically better than AP, and AP was statistically better than DH.

Conclusion:

TKD or AP in combination with DH are significantly superior in treating AD.
Tongue features of patients with granulomatous lobular mastitis
Authors: Chen Jiajing , Yang Jiyong , Qin Yuenong , Sun Chenping , Xu Jiatuo , Zhou Xiqiu , Wu Chunyu , Xu Yiyun , Liu Sheng
Published: November 2022

Traditional Chinese tongue diagnosis plays an irreplaceable role in disease diagnosis. This study aimed to describe the tongue characteristics of patients with granulomatous lobular mastitis (GLM). Forty GLM patients and 40 non-GLM controls were evaluated using the Traditional Chinese Medicine subjective clinical interpretation and a TDA-1 Tongue Diagnostic and Analysis system. The associations between the image features of the tongue body and coating and the profiling of immune-inflammatory parameters were analyzed. GLM patients were prone to a reddish tongue bodies with thick, white, and greasy coatings. Thick and greasy tongue coating features are risk factors for GLM. GLM patients had higher levels of white blood cells (WBC), platelets, C-reactive protein, interleukin-2, and transforming growth factor-β (TGF-β) than non-GLM controls (P < .05). Also, tongue coating contrast and entropy values were significantly correlated with WBC or TGF-β levels in GLM patients (r < −0.310 andP < .05). We demonstrated that the hot evil and phlegm-dampness constitutions are the main characteristics of GLM. This might provide a reference for GLM diagnosis.
A case report of small cell ovarian neuroendocrine carcinoma combined with immunochemotherapy
Authors: Zhu Yuan-Xue , Gao Xiang-Peng , Xin Lei , Jia You-Chao
Published: November 2022

Background:

Small cell ovarian neuroendocrine (NE) carcinoma is a rare NE tumor with a low incidence, poor prognosis, and no standardized treatment. To date, there have been no clear reports on the efficacy or prognosis of combined immunological and chemotherapy-based approaches in patients with this type of tumor.

Methods:

We administered the immune checkpoint inhibitor tirelizumab (PD-1 mab), in combination with etoposide and cisplatin chemotherapy (EP), to a patient with small cell ovarian NE carcinoma to examine its efficacy and safety.

Results:

The evaluation of efficacy was PR for every 2 courses of application, and immunomaintenance therapy was administered after 6 courses of treatment.

Conclusion:

Our studies indicate that tirelizumab combined with EP, may be an effective treatment for small cell ovarian NE carcinoma.
The efficacy and safety of acupuncture in the treatment of taste disorders after rehabilitation from COVID-19: A protocol for systematic review and meta-analysis
Authors: Chao Yuqiao , Zhang Lili , Chen Qiaobin , Chen Biwei , Yu Yannan , Chen Shaozong
Published: November 2022

Background:

Since the outbreak of the new crown pneumonia epidemic, although it has had a serious impact on people’s lives and health in itself, the sequelae that accompany coronavirus disease 2019 (COVID-19) have also had a serious impact on people’s mental health and quality of life. Taste disorder (TD) is one of the sequelae of COVID-19. Patients may experience reduced or even absent taste sensation, which seriously affects their real life. The efficacy of acupuncture in the treatment of taste disorders has been well reported, but there is a lack of evidence-based medical evidence. Therefore, this study set out to systematically evaluate the efficacy and safety of acupuncture in the treatment of post-COVID-19 taste disorder.

Methods:

According to the retrieval strategies, randomized controlled trials on the acupuncture for COVID-19 TD were obtained from Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database and the Wanfang Database, regardless of publication date, or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool was used to evaluate the quality of the studies. The meta-analysis was performed using Review Manager (RevMan 5.4) and StataSE 15.0 software. Ultimately, the evidentiary grade for the results will be evaluated. This systematic evaluation protocol is registered in PROSPERO under the registration ID CRD42022364653.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

This meta-analysis will evaluate the effect of acupuncture and moxibustion on TD caused by sequelae of COVID-19, providing evidence as to the treatment in these patients.
Effectiveness of massage therapy on anxiety and depression of COVID-19 convalescent: A protocol for systematic review and meta-analysis
Authors: Huichai Pan , Kelin Zhou , Shuo Dong , Ting Liu , Jing Wang , Zhongchen He , Fang Pan
Published: November 2022

Background:

Novel coronavirus pneumonia was first detected in Wuhan, China, in late December 2019. Its widespread infectivity and strong pathogenicity has posed a great threat to public health, seriously affecting social production and life. The disease caused by this virus has been officially named COVID-19 (coronavirus disease 2019) by the World Health Organization (WHO). Tuina (massage) therapy is 1 of the widely employed complementary and alternative medicine interventions in the world. As a useful therapy implemented on human’s skin, muscles and joints, tuina (massage) has unique advantages in the field of medicine. This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for COVID-19.

Methods:

We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating all patients recovering from COVID-19: Wanfang and Pubmed Database, china national knowledge infrastructure database, cochrane central register of controlled trials, cumulative index of nursing and allied health literature and excerpta medica database. Each database will be searched from inception to October 2022. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses.

Results:

This proposed study will evaluate the effectiveness and safety of massage therapy for patients recovering from COVID-19.

Conclusions:

This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for patients recovering from COVID-19.
Association of hypertension, hyperlipidemia, obesity, and demographic risk factors with breast cancer in Bangladeshi women
Authors: Islam Diganta , Islam Md. Shihabul , Jesmin
Published: November 2022

In recent years, breast cancer incidences and related deaths have been rising among Bangladeshi women and will be a major threat by 2040. So, conducting more population-based studies is crucial. This case-control study was designed to quantitatively evaluate potential risk factors for breast cancer. In this population-based case-control study, 52 random breast cancer cases and 59 matched healthy controls, aged between 25 and 70 years, were included. The breast cancer patient samples were collected from the National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh, from December 2021 to February 2022. The study was conducted fully following the Declaration of Helsinki guidelines. The collected socio-demographic data and blood samples of the study participants were analyzed. Chi-square analysis was used to compare study characteristics between cases and controls, Odds ratios (ORs) with 95% confidence intervals (CIs) were derived by univariate-logistic regression, and models were adjusted where necessary for study characteristics. Summary demographic characteristics of the 111 study participants suggested that higher age: (≥45): [OR 4.38, 95% CI (1.94–9.89), P value <.001], height: (<1.5 m): [OR 3.01, 95% CI (1.12–8.12), P value .029], low-incomes: [OR 6.83, 95% CI (2.11–22.05), P value .001], and illiteracy: [OR 12.65, 95% CI (3.49–45.79), P value .0001] showed significant correlations with breast cancer. The patient’s body mass index (BMI) (≥30) indicated an association with breast cancer: [OR 3.91, 95% CI (1.00–15.31), P value .05]. The lipid profile: [triglycerides (TG): OR = 3.20, 95% CI (1.36–7.53), P value .008; TG/high-density lipid (HDL): OR = 8.82, 95% CI (2.81–27.68), P value <.001; and a lowered HDL: OR = 3.32, 95% CI (1.38–7.98), P value .007], hypertension: [systolic: OR 4.32, 95% CI (1.71–10.93), P value .002; and diastolic: OR 7.32, 95% CI (2.51–21.34), P value <.001], and gastric issues: [OR 6.07, 95% CI (2.00–18.37), P value .001], all showed significant association with breast cancer. The ER- breast cancer subtype was significantly associated with the overweight (OW) group (P value .046) whereas the PR-patients were significantly higher in the normal BMI group (P value .013). Results from this study might aid in the prevention, management, and raising of awareness against the specific risk factors among Bangladeshi women in near future.
Autologous platelet-rich gel in the treatment of diabetic foot ulcers: A retrospective study
Authors: Li Wei , Wang Qiao-Yun , Bai Xiao-Gang , Xu Jie
Published: November 2022

This study retrospectively investigated the effectiveness and safety of autologous platelet-rich gel (APRG) for the treatment of diabetic foot ulcers (DFU). In this retrospective study, we reviewed the electronic medical records (EMR) of 72 patients with DFU. The patients were allocated to a treatment group (n = 36) or a control group (n = 36). The patients in both groups received standard care (SC) and dressing change. In addition, patients in the treatment group also received APRG. Patients in both groups were treated for 12 weeks. The outcomes were DFU healing time (days), length of hospital stay (days), healing rate of DFU, DFU surface area reduction (cm2), and adverse events. We assessed and analyzed the outcomes before and after the 12-week treatment period. After treatment, there were significant differences in DFU healing time (P = .04), length of hospital stay (P = .04), DFU healing rate, and DFU surface area reduction (P < .01). Regarding safety, no EMR reported adverse events in this study. The results of this study showed that the APRG may benefit patients with DFU. However, high-quality prospective randomized controlled trials are required to verify these findings.
General anesthesia, using remimazolam, for the patient with myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD): A case report
Authors: Hong Seung-Wan , Kim Byung-Soo , Park Sang-Tae , Jeong Hae-Chang , Hwang Min-Sik , Kim Seong-Hyop
Published: November 2022

Rationale:

Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is one of auto-immune demyelinating diseases of nervous system. Although both regional anesthesia and general anesthesia has been successfully performed in the patient with demyelinating diseases of nervous system, it has been controversial which one is better.

Patient concerns:

Forty-four male patient was admitted for arthroscopic elbow surgery due to limitation of range of motion. The patient was diagnosed as MOGAD with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, and steroid was used to prevent and treat symptoms and signs.

Diagnosis:

He was diagnosed as MOGAD with anti-NMDA receptor encephalitis, 1 year ago. The patient complaint of dizziness, diplopia, nausea, vomiting, seizure, general weakness and so on when he was confirmed as MOGAD with anti-NMDA receptor encephalitis. The diagnosis of MOGAD was confirmed with positive anti-myelin oligodendrocyte glycoprotein (MOG) Immunoglobulin (Ig)G and negative anti-aquaporin 4 (AQP4) IgG in the blood.

Interventions and outcomes:

After steroid cover, total intravenous anesthesia (TIVA) with remimazolam and remifentanil was established for the patients. Rocuronium was administered under monitoring of neuromuscular blockade, using train of 4 (TOF). The operation was performed without any event under right lateral decubitus position. The patient was uneventfully recovered from anesthesia.

Lessons:

The case report showed total intravenous anesthesia with remimazolam and remifentanil under proper monitoring was successfully performed in the patient with MOGAD.
Effects of epidural anesthesia in pheochromocytoma and paraganglioma surgeries: A protocol for systematic review and meta-analysis
Authors: Yang Min , Kang Chao , Zhu Shuai
Published: November 2022

Objective:

Anesthetic management is a great challenge during the surgical resection of pheochromocytomas and paragangliomas (PPGLs) due to potential hemodynamic fluctuations and/or postoperative complications. Although combined epidural-general anesthesia is commonly used in PPGLs surgeries, there is still no consensus whether combined epidural-general anesthesia was superior than general anesthesia alone for these populations. For the first time, we conducted this systematic review and meta-analysis to summarize the effects of combined epidural-general anesthesia versus general anesthesia alone on hemodynamic fluctuations as well as postoperative complications in patients undergone PPGLs surgeries.

Methods:

This systematic review and meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses statement. The primary outcome were hemodynamic fluctuations, including intraoperative hypotension, postoperative hypotension, and hypertensive crisis. Secondary outcome was the incidence of postoperative complications during hospital stay.

Results:

Finally, three retrospective cohort studies involving 347 patients met the inclusion criteria. A meta-analysis was not performed since outcomes from included studies were not available to be pooled. On the basis of the findings of non-randomized controlled trials (RCTs) literature, 2 studies suggested that combined epidural-general anesthesia was associated with intraoperative and postoperative hypotension, although one study reported that epidural anesthesia use reduced the incidence of postoperative complications in patients undergone surgical resection of PPGLs.

Conclusions:

Currently, no published RCTs have yet assessed clinically relevant outcomes with respect to the application of epidural anesthesia during PPGLs surgeries. Well-designed RCTs should nonetheless be encouraged to properly assess the efficacy and safety of epidural anesthesia for PPGLs surgeries.
Diagnostic test accuracy of PCR by saliva specimen for cytomegalovirus infection in newborn: A protocol for systematic review and meta-analysis
Authors: Zheng Bo , Wu Fang Fang , Li Xiao Xiao , Shen Ren , Zheng Zong , Liu Hong Yan
Published: November 2022

Background:

This study aimed to assess the diagnostic accuracy of polymerase-chain-reaction by saliva.

Method:

We searched Pubmed, EMBASE, Cochrane Library and Web of Science. A case–control or cohort study designed to explore the saliva specimens for diagnosing the cytomegalovirus infection was eligible for this study. Sensitivity (SEN), specificity (SPE), diagnostic odds ratio (DOR), and summary receiver operating characteristic curves were calculated.

Results:

Nine articles were selected for the meta-analysis. For assessing saliva PCR with urine culture, the SEN, SPE, and DOR were 0.97 [95% confidential interval (CI):0.61,1.00] 1.00 [95%CI:0.99, 1.00] 15672 [95%CI:558, 440325], respectively; for assessing saliva PCR with urine PCR, the SEN, SPE, and DOR were 0.87 [95%CI:0.79, 0.92] 1.00 [95%CI:1.00, 1.00] 15637 [95%CI:5946, 41126], respectively; for total assessment, the SEN, SPE, and DOR were0.91 [95%CI:0.70, 0.98] 1.00 [95%CI:1.00, 1.00] 8493 [95%CI:1429, 50487], respectively.

Conclusion:

We reported that saliva PCR performed well in the diagnosis of cytomegalovirus infection.
Monitoring of blood immunosuppressant concentrations and lymphocyte activation for predicting viral infections following kidney transplantation: A pilot study
Authors: Iwamoto Takuya , Nishikawa Kohei
Published: November 2022

The current standard pharmacokinetic monitoring of immunosuppressive therapy does not consider inter- and intra-individual differences in the biological response to multidrug immunosuppressive therapy. The authors evaluated the blood levels of the immunosuppressive drugs IL-2 and IFN-γ in circulating lymphocytes as surrogate indicators of the development of viral infections after living kidney transplantation. This single-center prospective study included 20 kidney transplant recipients who underwent living-donor transplantation at the Mie University Hospital. All the study participants received tacrolimus, mycophenolic acid, methylprednisolone, and basiliximab. The area under the concentration curves (AUCs) of blood tacrolimus and serum mycophenolic acid were measured 1 day prior to transplantation and on post-transplantation days (PTD) for up to 5 months. IL-2 and IFN-γ levels in circulating lymphocytes were measured simultaneously. One recipient experienced an acute graft rejection. Although the AUC of tacrolimus at PTD 7 was significantly higher in the virus-infected group than that in the non-infected group, the AUC of mycophenolic acid did not differ significantly between the 2 groups. The expression levels of IFN-γ+ NK, IFN-γ+ CD4+ T, and CD8+ T cells in the infected group also tended to be higher than those in the noninfected group. During the study period, there was a clear difference in the expression of IFN-γ+ CD8+ T cells, which increased significantly during or after infection. Circulating IFN-γ+ CD8+ T cell counts may serve as promising biomarkers for predicting opportunistic viral infections early after kidney transplantation.
Pilot study on the effect of grape seed proanthocyanidin extract on inferior vene cava blood flow in patients with chronic venous insufficiency using 4D flow MRI
Authors: Jung Hyuk Jae , Choo Ki Seok
Published: November 2022

Background:

Four-dimensional (4D) flow magnetic resonance imaging (MRI) was used to objectively assess changes in blood flow velocity in patients with chronic venous insufficiency (CVI) who underwent stocking treatment alone and stocking combined with Grape seed proanthocyanidin extract (GSPE) treatment.

Methods:

Patients diagnosed with CVI were recruited from August 31, 2018 to December 31, 2020. A total of 23 participants were selected, with 10 and 13 patients in the stocking treatment and stocking + GSPE treatment groups, respectively. The blood flow velocity (Th-plane peak and average velocities) was calculated using 4D flow MRI. A paired t test was used to evaluate the differences in blood flow velocity before and after treatment.

Results:

In the stocking treatment group, The Th-Plane peak velocity increased by 2.48 ± 5.05 cm/s after treatment (P = .16). In the stocking + GSPE treatment group, the Th-Plane peak velocity increased by 4.85 ± 5.57 cm/s after treatment (P < .001).

Conclusion:

The blood flow velocity on 4D flow MRI was significantly increased in participants who underwent GSPE, highlighting the potential of GSPE for CVI treatment.
Efficacy and safety of abdominal acupuncture in Parkinson’s disease: A protocol for systematic review and meta-analysis
Authors: Fang Yuehong , Xu Yilian , Liu Zhengzhong , Dong Sihan , Su Ying
Published: November 2022

Background:

Parkinson disease (PD) is a worldwide spread neurodegenerative disorder. Dopamine replacement therapy is currently the mainstream treatment, which can alleviate the symptoms but induces motor complications. Acupuncture therapy is effective for PD. As a form of acupuncture, the abdominal acupuncture has been used to relieve symptoms in patients with PD, but its effectiveness and safety have not yet reached a definitive conclusion. Therefore, this systematic review and meta-analysis protocol is planned to evaluate the efficacy and safety of abdominal acupuncture for PD patients.

Methods:

Six English databases (PubMed, Web of Science, MEDLINE, EMBASE, Springer Cochrane Library, and WHO International Clinical Trials Registry Platform) and 4 Chinese databases (Wan Fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, and Chinese Biomedical Literature Database) will be searched normatively according to the rule of each database from the inception to August 20, 2022. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Any disagreement will be resolved by discussion with the third reviewer. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. Either the fixed-effects or random-effects model will be used for data synthesis based on the heterogeneity test. The analysis will be conducted by RevMan 5.3 software according to Cochrane Handbook.

Results:

The aim of this systematic review is to provide high-quality evidence to assess the efficacy and safety of abdominal acupuncture for patients in Parkinson’s disease. The efficacy and safety of abdominal acupuncture for PD will be comprehensively assessed from the outcomes, including the effectiveness rate. The Unified Parkinson Disease Rating Scale (UPDRS) and Webster scale, Motor symptom scores utilizing UPDRS III scale, Dopamine (DA) content, and Nonmotor symptom scores employing UPDRS I scale, Activities of daily living using UDPRS II; Complications of treatment applying UPDRS IV, antioxidant ability: super oxide dismutase activity and Lipide Peroxide (LPO) content, Content of inflammatory cytokines, tumor necrosis factor-α and interleukin-1β, and adverse events as the secondary outcome.

Conclusion:

This systematic review will explore whether abdominal acupuncture is an effective and safe intervention for patients in Parkinson’s disease.
Increase of burnout among emergency department professionals due to emotional exhaustion during the SARS-Cov2 pandemic: Evolution from 2016 to 2021
Authors: Yuguero Oriol , Rius Nuria , Soler-González Jorge , Esquerda Montserrat
Published: November 2022

The objective is to establish there have been any significant changes in the evolution of levels of burnout and empathy at the different Emergency Department in our region, bearing the severe acute respiratory syndrome coronavirus 2 pandemic. This cross-sectional observational study was conducted in a healthy region between November 2020 and January 2021. Lleida emergency care centers. All the doctors and nurses of the health were contacted by email. Empathy was measured using the Spanish version of the Jefferson scale of physician empathy. Burnout was measured using the Maslach Burnout Inventory (MBI) in the version validated in Spanish. Sociodemographic data were also recorded. We compared the data with 2016 results. A total of 159 professionals agreed to participate in this study. A significant increase in the MBI score was observed in the 2020 to 2021 sample (39.5 vs 49.7), mostly due to an increase in the MBI-EE (21.5 vs 28.5), as well as an increase in the Jefferson scale of physician empathy score (112 vs 116). (P = .039). There were no differences when analyzing the association between professions (nurses or doctors) or years worked, burnout, and empathy. For 2020 to 2021, the 41 to 50 years age group showed the highest burnout (MBI score). Emergency department practitioners suffered more burnout compared to 2016, especially due to emotional exhaustion (P < .001). Despite practitioners’ improved degree of empathy, which had been described as being preventative against burnout, during the COVID-19 pandemic, over-involvement may have led to empathic stress and emotional exhaustion, giving rise to greater burnout.
Sonographic imaging features of alveolar soft part sarcoma: Case series and literature review
Authors: Li Wenxue , Zhang Shanshan , Fan Wenting , Li Diancheng , Tian Hui , Che Dongdong , Yu Lei , Gao Shuang , Liu Yiqun
Published: November 2022

Background:

Alveolar soft part sarcoma (ASPS) is a rare tumor but potentially fatal condition. Understanding the imaging and clinical features of ASPS is of certain value for preoperative qualitative diagnosis and clinical treatment of tumors. Nevertheless, there have been only 11 documented case reports describing the sonographic features in the English literature.

Methods:

Three patients with confirmed ASPS occurring primarily in the limbs were enrolled in this study. Complete surgical excision was performed with conservative limb function. We pay particular attention to the ultrasonographic features and performed a literature review of ASPS cases.

Results:

With regular surveillance, one patient had no symptom recurrence and two developed lung and/or breast metastasis later. The specific sonographic findings were heterogeneous hypoechoic, well-circumscribed, and lobulated or round contours on grayscale images, abundant flow signals of intratumoral and extratumoral tubular structures on color Doppler images.

Conclusion subsections:

Its low incidence rate and lack of characteristic clinical manifestations often result in misdiagnosis of ASPS. The specific sonographic findings may add useful diagnostic information.
Factors associated with nonadherence to surveillance for hepatocellular carcinoma among patients with hepatic C virus cirrhosis, 2000–2015
Authors: Chang Shen-Shong , Hu Hsiao-Yun , Cheng Feng-Shiang , Chen Yu-Chin , Yen Yung-Feng , Huang Nicole
Published: November 2022

Hepatocellular carcinoma (HCC) surveillance can detect the early stage of tumors and lead to improved survival. Adherence to guideline-concordant HCC surveillance is crucial in at-risk populations, including patients with hepatic C virus (HCV) cirrhosis. This study was conducted to identify patient and provider factors associated with nonadherence to HCC surveillance in patients with HCV cirrhosis. Data were primarily obtained from the Taiwan National Health Insurance Research Database for the 2000 to 2015 period. Adult patients newly diagnosed as having HCV cirrhosis between 2003 and 2012 were enrolled. Each patient was followed up for 3 years and until the end of 2015. Annual HCC surveillance was defined as the uptake of an abdominal ultrasound and alpha-fetoprotein (AFP) test annually during the 3-years follow-up. Nonannual surveillance was defined as the lack of an annual abdominal ultrasound and AFP test during the same 3-years period. Multinomial logistic regression models were applied to determine factors influencing adherence or nonadherence to annual HCC surveillance. We included a total of 4641 patients with HCV cirrhosis for analysis. Of these patients, only 14% adhered to annual HCC surveillance. HCC surveillance improved in later years, compared with the earlier phases of the study period. Patients with HCV cirrhosis comorbid with coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) or those with a relatively high number of comorbidities had a significantly higher likelihood of nonadherence. Patients who primarily received care from internists were significantly less likely to exhibit nonadherence to annual HCC surveillance compared with patients receiving care from physicians of other specialties. Patients who primarily received care from physicians practicing in larger hospitals were significantly less likely to exhibit nonadherence. HCC surveillance rates remain unacceptably low among high-risk patients, and our findings may be helpful in the development of effective interventions to increase HCC surveillance. The effective incorporation of HCC surveillance into routine visits for other chronic comorbidities, particularly for CAD or COPD, may be crucial for increasing HCC surveillance.
Effect of educational music intervention on emotion regulation skills of first-year university music education students
Authors: Nwokenna Edith N. , Sewagegn Abatihun Alehegn , Falade Temitope Ayodeji
Published: November 2022

Background:

Making music and listening to music have been found to contribute to positive mental health. In this study, we examined whether educational music intervention improved emotion regulation skills among first-year university music education students.

Methods:

The design of the study consisted of a randomized controlled trial with a treatment group as well as a control group. Students were randomly distributed to an intervention group and a control group. Students in the intervention group participated in twice-weekly group sessions for 8 weeks that discussed problem-solving skills, calming techniques, and retraining attributions. Instruments for data collection were; the Emotion Regulation Skills Scale and the Emotion Regulation Questionnaire.

Results:

Results demonstrate that educational music intervention can facilitate the development of emotional regulation skills in undergraduate students majoring in music education.

Conclusion:

Based on the results of this study, educational music intervention is effective in enhancing emotional regulation among first-year undergraduate music education students. The educational music program provides participants with the opportunity to enhance their ability to regulate their emotions.