bluuebunny/crossref_metadata_2025 huggingface dataset:
Initial Implementation of Resident-Sensitive Quality Measures in the Pediatric Emergency Department: A Wide Range of Performance
Authors: Schumacher Daniel J. , Martini Abigail , Holmboe Eric , Carraccio Carol , van der Vleuten Cees , Sobolewski Brad , Busari Jamiu , Byczkowski Terri L.
Published: January 2020

Purpose

A lack of quality measures aligned with residents’ work led to the development of resident-sensitive quality measures (RSQMs). This study sought to describe how often residents complete RSQMs, both individually and collectively, when they are implemented in the clinical environment.

Method

During academic year 2017–2018, categorical pediatric residents in the Cincinnati Children’s Hospital Medical Center pediatric emergency department were assessed using RSQMs for acute asthma exacerbation (21 RSQMs), bronchiolitis (23 RSQMs), and closed head injury (19 RSQMs). Following eligible patient encounters, all individual RSQMs for the illnesses of interest were extracted from the health record. Frequencies of 3 performance classifications (opportunity and met, opportunity and not met, or no opportunity) were detailed for each RSQM. A composite score for each encounter was calculated by determining the proportion of individual RSQMs performed out of the total possible RSQMs that could have been performed.

Results

Eighty-three residents cared for 110 patients with asthma, 112 with bronchiolitis, and 77 with closed head injury during the study period. Residents had the opportunity to meet the RSQMs in most encounters, but exceptions existed. There was a wide range in the frequency of residents meeting RSQMs in encounters in which the opportunity existed. One closed head injury measure was met in all encounters in which the opportunity existed. Across illnesses, some RSQMs were met in almost all encounters, while others were met in far fewer encounters. RSQM composite scores demonstrated significant range and variation as well—asthma: mean = 0.81 (standard deviation [SD] = 0.11) and range = 0.47–1.00, bronchiolitis: mean = 0.62 (SD = 0.12) and range = 0.35–0.91, and closed head injury: mean = 0.63 (SD = 0.10) and range = 0.44–0.89.

Conclusions

Individually and collectively, RSQMs can distinguish variations in the tasks residents perform across patient encounters.
pathCast: An Interactive Medical Education Curriculum That Leverages Livestreaming on Facebook and YouTube
Authors: Madrigal Emilio , Mannan Rifat
Published: January 2020

Problem

Global connectivity and awareness have significantly increased over the past 3 decades, yet medical education remains mostly unchanged in its delivery—local didactic teaching, supplemented with hands-on clinical experiences.

Approach

Beginning in 2016, the authors leveraged the livestreaming capabilities of Facebook and YouTube to create a platform called pathCast to broadcast pathology lectures to an international community of medical professionals. An interactive pathology curriculum was designed to address challenging topics across various subspecialties. Expert pathologists were invited to deliver 60-minute lectures using digital or glass slides or traditional slide decks. Remote (online) attendees interacted with lecturers in real time using the broadcasts’ chat interface. Facebook’s and YouTube’s analytics were evaluated to assess the performance of all lectures.

Outcomes

From June 2016 to December 4, 2019, 53 speakers delivered 87 lectures representing 18 pathology subspecialties in 9 different languages (with 78 [89.7%] in English only) and from various geographic regions. The lectures hosted on the Facebook channel have garnered 8,333 followers and 52,171 views for a total of 386,200 minutes of watch time, and the lectures hosted on the YouTube channel have accumulated 5,891 subscribers and 292,735 views for a total of 50,674 hours of watch time. The lectures have been viewed by users from 1,093 unique cities across 124 countries.

Next Steps

The authors will continue to develop the curriculum to further disseminate pathology education on a global scale.
Morphological characteristics of Malaysian Malay shoulders for the Latarjet procedure: A cross-sectional CT scan based study
Authors: Lakha Singh Sarbhjit Singh , Tengku Md. Shihabudin Tengku Muzaffar , Pall Singh Taran Singh , Bin Musa Ahmad Tarmizi , Mohd Daud Norfataha binti
Published: January 2020

Background:

The Latarjet procedure requires a 2.5-cm to 3-cm coracoid graft. The coracoid dimensions as they relate to coracoid transfer procedures have been studied in Caucasian, Chinese, and Mongolian populations. Data on coracoid dimensions as they relate to coracoid transfer procedures among other Asian populations are lacking. The objective of this study was to define the morphological characteristics of Malaysian Malay shoulders for the Laterjet procedure.

Methods:

CT with three-dimensional reconstruction of shoulders in 40 Malaysian Malay patients who had undergone CT to the thorax and neck were analyzed. The orientation of the images with regards to the axial, sagittal, and coronal planes was kept constant using tilt and spin function. Intraclass correlations were calculated to assess the agreement between measurements collected by the researcher and an independent radiologist.

Results:

The mean maximum length of the coracoid available for transfer was 19.6 mm. The mean coracoid midpoint height and width were 12.4 mm and 13.5 mm, respectively. The mean radii of curvature of the coracoid undersurface and the anterior lower half of the glenoid was 28.4 degrees and 68.8 degrees, respectively. Intraclass correlation agreement ranged from 0.85 to 0.96, which translated to good and excellent interrater agreement.

Conclusions:

The maximum length of the coracoid available for transfer in Malasian Malay patients was less than what has been recommended in the literature for the Latarjet procedure. The surface area that would be increased after a coracoid graft is placed on the glenoid would be 12.4±1.8 mm. Knowledge obtained from this study may help us further optimize osseous considerations for the Latarjet procedure in the Malaysian Malay population.

Level of Evidence:

Level III.
Postoperative Outcomes Based on American Society of Anesthesiologists Score After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Yoo Joon S. , Parrish James M. , Jenkins Nathaniel W. , Khechen Benjamin , Haws Brittany E. , Narain Ankur S. , Hrynewycz Nadia M. , Brundage Thomas S. , Singh Kern
Published: January 2020

Study Design:

A retrospective cohort study.

Objective:

To examine the association between the American Society of Anesthesiologists (ASA) score and patient-reported outcomes (PROs) after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:

Few studies have investigated the correlation between ASA score and PROs after MIS TLIF.

Methods:

Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed and placed into 3 cohorts: ASA score ≤2 and outpatient status, ASA score ≤2 and inpatient status, and ASA score >2. Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain, and Short Form-12 Physical Component Score (SF-12 PCS) were administered preoperatively and at 6-week, 12-week, and 6-month time points. ASA scores were tested for association with improvements in PROs using linear regression.

Results:

A total of 187 patients had an ASA score ≤2 and 41 patients had an ASA score >2. Higher ASA scores were associated with older age, obesity, higher comorbidity burden, and an increased length of stay. ASA subgroups demonstrated a significant difference in preoperative ODI and VAS back pain scores and improvement in VAS back pain scores at the 12-week and 6-month time points; however, there was no discernible pattern of improvement amongst cohorts. No statistically significant differences were observed with improvements in PROs.

Conclusions:

The study suggests ASA scores are not associated with postoperative recovery in pain and disability after MIS TLIF. Our results indicate that regardless of the preoperative ASA score, patients are likely to achieve similar improvements in PROs through 6 months follow-up. Although using ASA as a risk stratification tool to predict perioperative complications, its utility in predicting improvement in PROs is still uncertain at this time.
Sagittal Balance in Adult Idiopathic Scoliosis
Authors: Nolte Michael T. , Louie Philip K. , Harada Garrett K. , Khan Jannat M. , Ferguson Joseph , Dewald Christopher J. , An Howard S.
Published: January 2020

Study Design:

A narrative review article study.

Objective:

The objective of this study was to highlight guiding principles and challenges faced with addressing sagittal alignment in patients with adult idiopathic scoliosis (AIS) and to discuss effective surgical strategies based upon our clinical experience.

Summary of Background Data:

Previous research and guidelines for the treatment of AIS have focused on the correction of spinal deformity in the coronal and axial planes. Failure to address sagittal deformity has been associated with numerous adverse clinical outcomes.

Methods:

This is a review of the current body of literature and a description of the rod derotation surgical technique for correction in the sagittal plane.

Results:

Several studies have offered general goals for postoperative radiographic measures in the sagittal plane for patients with AIS. However, these guidelines are evolving as diagnostic and therapeutic modalities continue to improve. The rod derotation surgical technique through differential metal rods is one method to potentially address sagittal balance in AIS.

Conclusions:

Alignment in the sagittal plane is a unique challenge facing surgeons for patients with AIS. Further research with an assessment of functional outcomes and longer follow-up is needed to more precisely guide treatment principles.

Level of Evidence:

Level IV.
Modification in Unicompartmental Knee Replacement Technique: Saving the Tibial Bone
Authors: Kulshrestha Vikas , Kharat Kiran , Sood Munish , Mittal Gaurav
Published: January 2020

Rapid rehabilitation, better functional outcome, and decreased perioperative morbidity have been a driving factor for the resurgence of unicompartmental knee replacement (UKR) surgery. Modern implants, improved instrumentation, and refined surgical techniques have ensured reproducible results of UKR. One such implant design is mobile-bearing UKR (Oxford knee), and its usage has seen an increase in various parts of the world. The designer team success and implant survival of 95% at 15 years are similar to those of total knee replacement, but there remains a variable success rate for the nondesigner surgeons varying from 84% to 92%. Progression of arthritis to the lateral compartment remains the predominant cause of revision of UKR at long-term follow-up. However, one of the common reasons for midterm failure is aseptic loosening of the tibial component. To prevent tibial component failures, the Oxford group has emphasized the need for saving the tibial bone stock when the procedure is performed in patients with smaller morphology with compromised bone stock. However, they have still not advocated any modification of technique or instrumentation to execute the surgery in a manner to minimize tibial resection. This article describes a technique of performing conservative tibial cut with commensurate adjustments on the femoral side while performing Oxford UKR, which is in variation to what has been described by the designer group. This may prevent early to midterm failures seen owing to tibial loosening.
Combination treatment of bicalutamide and curcumin has a strong therapeutic effect on androgen receptor-positive triple-negative breast cancers
Authors: Dong Shengli , Alahari Suresh K.
Published: January 2020

Triple-negative breast cancers account for approximately 15–20% of breast cancer patients. Due to lack of expression of estrogen receptor, PR and human epidermal growth factor receptor 2 in triple-negative breast cancers, there are no targeted therapies available for these cancers. Therefore, a major research priority is to find potential therapeutic targets. Androgen receptor is present in 80–90% of all breast cancers, including 55% of estrogen receptor-α–negative cancers and 12%–35% of triple-negative breast cancers. Androgen receptor stimulates growth and survival in triple-negative breast cancer cells. Treatment with bicalutamide, an androgen receptor antagonist, has a good benefit for AR+ triple-negative breast cancer patients. AR+ triple-negative breast cancer cells were treated with curcumin or bicalutamide alone or in combination of both together. Cell growth, apoptosis and Wnt signaling pathways were examined. We found that curcumin dramatically suppressed Wnt signaling pathway in AR+ triple-negative breast cancer cells. Curcumin treatment inhibited androgen receptor protein expression in AR+ triple-negative breast cancer cells. Combination treatment of curcumin and bicalutamide has a robust increase in apoptosis. Furthermore, the combination treatment suppressed the growth of AR+ triple-negative breast cancer cells more effectively than with the single drug alone. Our data indicate that androgen receptor inhibition is a potential therapeutic approach for AR+ triple-negative breast cancers. In summary, our study for the first time shows that the combination treatment of curcumin and bicalutamide is effective in AR+ triple-negative breast cancer cells.
Assessing How Well Electronic Nursing Records Reflect Changes in the Nursing Profession's Scope of Practice in Korea
Authors: Lee Seungshin , Yu Soyoung , Park Hyunbong , Kim Tae Gon
Published: January 2020

Electronic health records, a source of key administrative data for patient care, have been used in Korea for the past 13 years. In recent years, there have been significant changes in the Korean hospital nursing care delivery system. “Comprehensive nursing service,” in which nurses provide direct care to patients, including activities of daily living without a family member, is one of the changes in the nursing profession's scope of practice. Accordingly, this study attempts to determine how well the electronic nursing record reveals nursing services that are being used differently. This study analyzed 19 372 nursing records of a total of 200 patients using the random sampling method in two comprehensive nursing service wards and two noncomprehensive nursing service wards. The number of nursing activity records for all items in the comprehensive nursing service ward was higher; only three items showed significant differences. Five nursing diagnoses including “anxiety” and “pain” were more significantly used in the records of the comprehensive nursing service ward. This study found that there were significant differences in nursing records based on the nursing services provided and that the current electronic nursing recording system adequately reflects changes in nursing practice.
A Case of Response to Immunotherapy in a Patient With MSI Metastatic Colorectal Cancer and Autoimmune Disease Receiving Steroid Therapy
Authors: Massucci Maria , Di Fabio Francesca , Rojas Llimpe Fabiola L. , Ardizzoni Andrea
Published: January 2020

Colorectal cancer is one of the most commonly diagnosed tumors worldwide and a leading cause of cancer-related death. Although the majority of gastrointestinal cancers are generally considered poorly immunogenic, recent data from clinical trials have demonstrated that the subgroup of patients with DNA mismatch repair system is highly responsive to immune checkpoint inhibitor–based therapy. We present the case of a 74-year-old man with pulmonary autoimmune intersitiopathy and microsatellite instability metastatic colorectal cancer who responded to nivolumab despite the concomitant steroid therapy. Furthermore, his autoimmune disease did not worsen during immunotherapy.
Penile Ulcer due to Leukemia Cutis—A Rare Diagnosis Not to Be Missed
Authors: Toh Joseph J.H. , Chia Hui Yi , Heng Yee Kiat
Published: January 2020

We present a rare case of leukemia cutis presenting with an ulcer on the ventral penis. A 60-year-old Chinese man was referred for a penile ulcer of 10 days. He was diagnosed with acute myelomonocytic leukemia 6 months earlier and had received 2 cycles of venetoclax with azacitidine. He developed a spontaneous penile blister. It ulcerated after the patient pricked it with a needle. This enlarged after traditional medicated ointment was applied. He denied pain, itch, urethral discharge, systemic symptoms, or rashes elsewhere.
PREDICTORS OF RECURRENT EXUDATION IN CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION DURING A TREATMENT-FREE PERIOD
Authors: Hikichi Taiichi , Agarie Mitsuko , Kubo Natsuki , Yamauchi Moe
Published: January 2020

Purpose:

To investigate predictors of recurrent exudation in choroidal neovascularization (CNV) of age-related macular degeneration on optical coherence tomography angiography (OCTA) images during an anti–vascular endothelium growth factor therapy-free period.

Methods:

Optical coherence tomography angiography images of 41 eyes of 41 patients with more than a 3-year history of anti–vascular endothelial growth factor therapy for neovascular age-related macular degeneration at the study baseline were evaluated retrospectively. The patients thereafter had a treatment-free period exceeding 6 months under an as-needed regimen and could be followed for an additional 6 months.

Results:

The square root of the CNV area in 19 eyes with recurrence during the second 6-month period enlarged significantly (P = 0.036) from 2.31 ± 0.81 (mean ± SD) to 2.86 ± 0.87 mm during the treatment-free period but not in the 22 eyes without a recurrence. The percentages of branching with tiny vessels (42%) and peripheral arcades at the CNV termini (42%) were significantly (P < 0.001, respectively) higher in the recurrence group compared with the group in which the CNV was no longer active (14% and 5%, respectively).

Conclusion:

Choroidal neovascularization enlargement and features may guide treatment timing in eyes with exudative-free periods.
Spontaneous Resolution of a Rapidly Formed Dense Cataract Following Nd: YAG Laser Peripheral Iridotomy in a Case of Pigmentary Glaucoma
Authors: Bansal Atul , Fenerty Cecilia H.
Published: January 2020

A 54-year-old man was referred for a senior opinion. His vision had acutely dropped in his right eye from 6/6 to hand movements following Nd:YAG laser peripheral iridotomy for treatment of pigmentary glaucoma. A dense rosette posterior subcapsular cataract had formed in his right eye rapidly after surgery. Within 4 weeks the cataract resolved spontaneously and his vision returned to 6/6. It is hypothesized that a dual mechanism caused the rapidly formed cataract. Shockwaves stemming from Nd:YAG laser resulted in a reversible misalignment of the lenticular fibers, and localized direct damage to capsule caused osmotic imbalance and fluid collection between lamellae. Restoration of the osmotic balance, repair, and formation of lens fibers and clearing of vacuoles led to the resolution of the cataract. The proximity of the concave iris to the lens equator in pigmentary glaucoma was a predisposing factor. This highlights the importance of exercising great caution in using laser peripheral iridotomy in cases of pigmentary glaucoma, particularly if a higher laser power is used and considering initial conservative management of this complication.
The First Case Report of Septic Arthritis and Osteomyelitis of the Knee Caused by Candida viswanathii
Authors: Wong Hei Man , Sim James Heng Chiak , Zhou Yvonne Peijun , Chien Jaime Mei Fong
Published: January 2020

An elderly lady was diagnosed in 2015 with septic arthritis and osteomyelitis of the knee caused by Candida viswanathii. This is the first report of a nonmeningitic, noncandidemic osteoarticular infection due to this rare Candida since the first 2 isolations in cerebrospinal fluid in 1959 and 1976, respectively. She was successfully treated with 2 repeat arthroscopic washouts and 16 months of susceptible antifungal therapy with full recovery. The contributing factors of this successful treatment include prompt molecular identification of this rare Candida species, adequate source control with arthrotomies, susceptibility directed antifungal therapy, therapeutic drug monitoring of voriconazole, and close follow-up of our patient. To our understanding, this is also the first reported case of invasive C. viswanathii infection with detailed clinical presentation, treatment method, and treatment response described.
Noninvasive optical coherence tomography imaging correlates with anatomic and physiologic end-organ changes in healthy normotensives with systemic blood pressure variability
Authors: Dagel Tuncay , Afsar Baris , Sag Alan A. , Derin Gozde , Kesim Cem , Tas Ayse Y. , Sahin Afsun , Dincer Neris , Kanbay Mehmet
Published: January 2020

Objective

Blood pressure variability (BPV) is considered as a novel risk factor for cardiovascular disease including left ventricular hypertrophy, vascular stiffness, and renal dysfunction. In this study, we aimed to determine the relationship between ambulatory BPV with subclinical organ damage and vascular stiffness parameters in normotensive healthy subjects.

Methods

A total of 100 healthy subjects over 18 years of age were included in this cross-sectional study. We divided the participants into two groups according to the median value of the SD of mean 24-h blood pressure (BP) (Group 1: SD of mean 24-h BP <10.15 and Group 2: SD of mean 24-h BP >10.15). BPs of these subjects were recorded over a 24-h period using ambulatory BP monitoring. Mobil-O-Graph device was used to estimate the augmentation index (AIx), pulse wave velocity (PWV), and ambulatory BP measurement. The choroidal thickness was measured by using optical coherence tomography device.

Results

The mean age of the patients was 25.4 ± 5.0 years. Choroidal thickness was correlated with PWV, AIx, protein excretion, and SD of systolic and diastolic BP (P < 0.05). Additionally, participants with higher BP variability have lower choroidal thickness and higher AIx.

Conclusion

We showed that even in normotensive subjects, BPV correlates with choroid thickness. Thus, BPV can be an early prognostic parameter for pathologic vascular changes.
Kinetic magnetic resonance imaging analysis of thoracolumbar segmental mobility in patients without significant spondylosis
Authors: Yao Xingwang , Chen Fei , Dong Chuning , Wang Jeffrey , Tan Yanlin
Published: January 2020

To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions.

Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10–L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10–T11 to L1–L2 were included for further analysis.

The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10–T11, 1.20 mm at T11–T12, 1.23 mm at T12–L1, and 1.34 mm at L1–L2 (P < .05 for L1–L2 vs T10–T11). The mean angular motion measurements at each level were 3.26° at T10–T11, 3.92° at T11–T12, 4.95° at T12–L1, and 6.85° at L1–L2. The L1–L2 segment had significantly more angular motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1–L2 (36.1%) and least at T10–T11 (17.1%; P < .01).

Segmental motion was greatest in the proximal lumbar levels, and angular motion showed a gradually increasing trend from T10 to L2.
Congenital adrenal hyperplasia presenting as pelvic inflammatory disease in a phenotypic male
Authors: Lim Eunsoo , Jeon Ja Young
Published: January 2020

Rationale:

Congenital adrenal hyperplasia (CAH) is caused by various enzyme deficiencies, among which 21-hydroxylase (21-OH) deficiency accounts for more than 90% of cases. Neonatal screening became mandatory only a few decades ago. Many patients who were born before this went undiagnosed and some of the severely virilized females were raised as men.

Patient concerns:

A 58-year old man with a history of excisional surgery in the external genitalia when he was a toddler presented with three days of dysuria and low abdominal pain.

Diagnosis:

The patient's laboratory results showed leukocytosis and elevated C-reactive protein (CRP); thus, the physicians decided to perform a computed tomography (CT) scan. The CT demonstrated pelvic inflammatory disease (PID), left adrenal gland myelolipoma, and a mesenteric mass. Meanwhile, we suspected CAH based on the clinical history and assessed the patient's hormone levels. Seventeen-hydroxyprogesterone (17-OH-PG) was markedly elevated and the patient was diagnosed with classic simple virilizing CAH.

Interventions:

Intravenous antibiotics were administered, and positron emission tomography-CT (PET-CT) was performed to evaluate any metastases.

Outcomes:

After 2 weeks of antibiotic treatment, CRP decreased to 0.12 mg/dL and PID was resolved. The patient opted for resection of the female genitalia along with the mesenteric and adrenal gland tumors in the near future, and was safely discharged.

Lessons:

The adrenal gland myelolipoma was thought to have developed as a result of a longstanding exposure to adrenocorticotropic hormone. There are controversies regarding the management of female genitalia in CAH patients who identify themselves as men. In this case, the physician and patient decided to remove the female genitalia because the surgery for the mesenteric mass was inevitable and there was a possibility of recurrent PID. To our knowledge, this is the first article to report primary mesenteric tumor in a CAH patient to date. In conclusion, patients who were born before neonatal screening for CAH became the mainstay, who are suspected to have CAH from their history, and present with abdominal pain must be diagnosed by performing an imaging study, testing levels of serum 17-OH-PG, and screening for female genitalia and adrenal gland myelolipoma.
Clinical significance of viral–bacterial codetection among young children with respiratory tract infections
Authors: Jung Jiwon , Seo Euri , Yoo Ree Nar , Sung Hungseop , Lee Jina
Published: January 2020

We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.

A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral–bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07–0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13–0.98), respectively.

We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral–bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.
Psychological effects of project-based learning in participants receiving clinical oncology teaching
Authors: Song Ling-Qin , Han Jun-Li , Liu Di , Dai Zhi-Jun , Zhang Shu-Qun , Braun Thomas
Published: January 2020

Background:

This study will assess the effects of the project-based learning (PBL) for participants undergoing clinical oncology teaching (COT).

Methods:

A systematic and comprehensive literature records will be identified from the electronic databases of PUBMED, EMBASE, Cochrane Library, Web of Science, Springer, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched from their inceptions up to the present. Any relevant randomized controlled trials on the effects of PBL in participants receiving COT will be considered for inclusion. Study quality will be assessed using the Cochrane risk of bias tool. RevMan 5.3 software will be utilized for statistical analysis.

Results:

This study will assess the effects of PBL in participants receiving COT through assessing the primary outcomes of psychological disorders, student satisfaction, and student feedback, and secondary outcomes of examination scores, excellence rates, course examination pass rates, and clinical knowledge or skills.

Conclusion:

The findings of this study will summarize the latest evidence on the effects of PBL in participants receiving in COT.

PROSPERO registration number:

PROSPERO CRD42019150433.
Statins reduce new-onset atrial fibrillation after acute myocardial infarction
Authors: Tseng Chien-Hao , Chung Wen-Jung , Li Chen-Yu , Tsai Tzu-Hsien , Lee Chien-Ho , Hsueh Shu-Kai , Wu Chia-Chen , Cheng Cheng-I
Published: January 2020

Atrial fibrillation (AF) is an important complication of acute myocardial infarction (AMI). The association between AF and serum lipid profile is unclear and statin use for lowering the incidence of new-onset AF remains controversial. The objective of this study was to investigate whether statins confer a beneficial effect on AF after AMI.

Data available in the Taiwan National Health Insurance Research Database on 32886 AMI patients between 2008 and 2011 were retrospectively analyzed. Total 27553 (83.8%) had complete 1-yr follow-up data. Cardiovascular outcomes were analyzed based on the baseline characteristics and AF type (existing, new-onset, or non-AF). AF groups had significantly higher incidence of heart failure (HF), stroke, all-cause death, and major adverse cardiac and cerebrovascular event (MACCE) after index AMI (all P < .05). In contrast, myocardial re-infarction (re-MI) was not significantly different among the three groups (P = .95). Statin use tended to be associated with lower risk of new-onset AF after AMI (HR: 0.935; 95% confidence interval (CI): 0.877–0.998; P = .0427).

Existing AF and new-onset AF subgroups had similar cardiovascular outcomes after AMI and were both inferior to the non-AF group. Statin tended to reduce new-onset AF after AMI.
Use of preoperative erythropoietin therapy to facilitate autologous blood donation in orthopedic surgery
Authors: Chang Xiao , Li Qiyi , Tang Huang
Published: January 2020

Background:

Autologous blood transfusion helps to avoid or reduce the need for allogenic blood transfusion in patients undergoing major surgery. We examined the value of erythropoietin therapy to support preoperative autologous blood donation (PABD) in patients undergoing orthopedic surgery.

Methods:

For this systematic review and meta-analysis, Medline, Cochrane, EMBASE, and Google Scholar databases were searched from October 26th, 1989 until September 30th, 2017. Primary outcomes were percentages of patients able to donate ≥4 units of blood for autologous transfusion, amount of allogeneic blood transfused, changes in hematocrit and hemoglobin levels from before PABD to immediately before surgery, and adverse events.

Results:

Of 256 studies identified, 18 studies met the inclusion criteria with a total of 1914 patients (mean age 51–69 years), of whom 1153 were treated with erythropoietin. Erythropoietin was associated with a greater percentage of patients able to donate ≥4 units of blood for autologous use compared to controls (OR = 6.00, 95% CI = 3.97 to 9.09, P < .001). Patients receiving preoperative erythropoietin had significantly less of a reduction in hematocrit and hemoglobin levels from before PABD to immediately before surgery compared with controls (hematocrit: mean differences = −1.438, 95% CI = −2.14 to −0.73, P < .001; hemoglobin: mean differences = −1.426, 95% CI = −1.78 to −1.07, P < .001). No significant differences were observed in the amount of allogenic blood transfused between patients receiving erythropoietin and controls (difference in means = −0.220, 95% CI = −0.536 to 0.097, P = .174). Patients who received erythropoietin were less likely to experience dizziness than controls, but the incidence of nausea or fatigue were similar between groups.

Conclusion:

Erythropoietin therapy during the PABD period results in less of a reduction in hematocrit and hemoglobin levels and an increase in the percentage of patients able to donate blood preoperatively.
Research trends and characteristics of oral lichen planus
Authors: Liu Wei , Ma Liwei , Song Chencheng , Li Chenxi , Shen Zhengyu , Shi Linjun
Published: January 2020

Background:

Bibliometric analysis highlights the key topics and research trends which have shaped the understanding and management of a concerned disease. The objective of this study was to identify and characterize the most-cited articles on oral lichen planus (OLP), and highlight the analysis of key topics and research trends.

Methods:

A comprehensive search was performed and identified in the Scopus database from 1907 to 5 March 2019 for the top-100 most-cited articles on OLP.

Results:

The number of citations of the 100 selected articles varied from 101 to 570, with a mean of 178.7 citations per article. Malignant potential, immunopathogenesis, and topical drug therapy were the top-3 study topics, and the majority of high-quality articles were the research of the 3 topics. Journal of Oral Pathology and Medicine (n = 19) and Oral Surgery Oral Medicine Oral Pathology Oral Radiology (n = 14) were 2 journals with the most articles published. Both van der Waal I. and Scully C. were the most frequently contributing authors (n = 9). United States (n = 27) and Academic Centre for Dentistry Amsterdam (n = 7) was the most contributing country and institution, respectively. Systematic reviews (n = 2), randomized controlled trial (n = 1), cohort studies (n = 17) were study designs with higher evidence level, but the large majority (n = 80) were considered lower level.

Conclusions:

The results of this first citation analysis of the 100 most cited articles on OLP provide a historical perspective on scientific evolution, and suggest further research trends and clinical practice in the field of OLP.
Survival analysis of patients with glioblastoma treated by long-term administration of temozolomide
Authors: Quan Rencui , Zhang Huaqing , Li Zihuang , Li Xianming
Published: January 2020

This analysis aimed to investigate whether the long-term administration of temozolomide (TMZ) claimed a survival advantage for patients with glioblastoma in China.

A total of 75 patients with newly diagnosed glioblastoma at the Department of Radiation Oncology, Shenzhen People's Hospital between August 2008 and August 2016 were retrospectively evaluated during analysis. A propensity-matched analysis was performed to balance the basic characteristics of patients between compared groups. Kaplan–Meier method and Cox proportional hazards model were used to assess progression-free survival (PFS) and overall survival (OS) of patients receiving 6 adjuvant TMZ cycles compared with patients treated with more than 6 cycles.

Twenty of 75 patients received more than 6 cycles of TMZ, and the other 55 patients were treated with a median of 6 cycles ranging from 1 to 6. The patients with long-term administration of TMZ had better OS (47.0 months, 95% CI 20.0–73.9 vs 20.6 months, 95% CI 17.9–23.2, P = .014) but not PFS (17.0 months, 95% CI 10.1–24.5 vs 14.2 months, 95% CI 11.8–16.6, P = .133). Balancing the clinical factors with a propensity-matched analysis also showed the significant advantage of prolonged TMZ application in terms of OS but not PFS.

Prolonged administration of TMZ beyond 6 cycles did demonstrate survival benefits for patients with initially diagnosed glioblastoma.
Efficacy and safety of Chuankezhi injection in patients with chronic obstructive pulmonary disease
Authors: Zhou Zhihui , Zheng Wenjiang , Liang Ting , Yan Qian , Zhang Chaoyuan , Huang Huiting , Liu Xiaohong , Ye Xiaohan
Published: January 2020

Background:

Chuankezhi injection (CKZ) is gaining increasing popularity for chronic obstructive pulmonary disease (COPD) treatment, yet their comparative effectiveness and safety remain unclear. Therefore, we will provide a protocol to assess the efficacy and safety of CKZ for COPD.

Methods:

From now until June 2020, we will conduct a comprehensive and systematic literature search in 4 Chinese and 4 English databases, and the use of CKZ in the treatment of COPD will be included in randomized controlled trials, as well as all the treatment of stable COPD during the treatment of all CKZ. The risk assessment of the bias tool in Cochrane 5.1.0 will be combined with the quality of the trial. The 2 investigators will independently perform quality assessments and data extractions for the included studies in strict accordance with inclusion and exclusion criteria and perform the meta-analysis with Stata 15 software (version 15.0, StataCorp, College Station, TX).

Results:

Further evidence of CKZ treatment for COPD will be provided by this study.

Conclusion:

The efficacy and safety assessment of CKZ for COPD will be supported by this protocol.

PROSPERO registration number:

ROSPERO CRD 42019134133.
Transanal drainage tubes vs metallic stents for acute malignant left-sided bowel obstruction
Authors: Xu Jing , Zhang Shuai , Jiang Tao , Zhao Yong-Jie
Published: January 2020

Background:

The surgical management of acute malignant left-sided bowel obstruction is associated with high morbidity and mortality. Recently, transanal drainage tubes (DTs) and metallic stents (MSs) used as a “bridge to surgery” have become widely used decompression methods compared with emergency surgery. This study aims to evaluate the efficacy and safety of DTs and MSs for the decompression of acute left-sided malignant colorectal obstruction.

Methods:

All studies were acquired from PubMed, Medline, Embase, CNKI and the Cochrane Library. The data were extracted by two of the coauthors independently and were analyzed with RevMan5.3. Mean differences (MDs), odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the risk of bias.

Results:

Eleven studies, which included three randomized controlled trials (RCTs) and 8 observational studies, were assessed. The methodological quality of the trials ranged from low to moderate. The pooled results of the technical success rate showed that the difference was not statistically significant between the2 devises. The differences in clinical success rate, operative time and complications were statistically significant between MSs and DTs, and MSs were associated with a better clinical success rate, increased operative time and fewer complications. Sensitivity analysis proved the stability of the pooled results, and the publication bias was low.

Conclusion:

MS insertion for acute left-sided malignant bowel obstruction is effective and safe with a better technical success rate and with fewer complications than decompression using a DT, and MS insertion can avoid stoma formation. Moreover, MS insertion appears to be a useful treatment strategy for malignant colonic obstruction even if the lesion is located in the right colon. More large-sample, multicenter, high-quality RCTs are needed to verify the outcomes of this meta-analysis.
Inequality in the health services utilization in rural and urban china
Authors: Guo Bin , Xie Xin , Wu Qunhong , Zhang Xin , Cheng Huaizhi , Tao Sihai , Quan Hude
Published: January 2020

Background:

Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality.

Methods:

This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method.

Results:

Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area.

Conclusion:

The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.
Cerebral sinovenous thrombosis in a child with ulcerative colitis
Authors: Liu Yue , Ren Dongmei , Zhou Qiaoyu , Gao Lin
Published: January 2020

Rationale:

Cerebral sinovenous thrombosis (CVT) associated with inflammatory bowel disease (IBD) is infrequent, but clinically nonnegligible due to its high disability and fatality rates.

Patient concerns:

A 12-year-old child with newly developed ulcerative colitis (UC) suffered from a sudden left-sided hemiparesis and numbness.

Diagnoses:

Cerebral sinovenous thrombosis due to ulcerative colitis was diagnosed in this girl.

Interventions:

The patient was treated with blood transfusion and anticoagulation therapy. Digital subtraction angiography (DSA) and urokinase thrombolysis were implemented followed.

Outcomes:

The patient achieved a complete recovery of limb functions and did not present any other stroke recurrences at follow-up a year later.

Lessons:

CVT in UC is a serious condition and can occur in the children and adolescents. Rapidly diagnosis of this complication of IBD and apply anticoagulant therapy early can contribute to avoiding a potentially fatal outcome.
Gene-based anticoagulation regimens for an infant after mitral-valve replacement
Authors: Cao Hua , Xia Xiaotong , Fu Jinglan , Wu Tingting , Chen Wenjun , Dai Ying , Xia Xuan , Zhang Jinhua
Published: January 2020

Rationale:

Heart-valve replacement is one of the main surgical methods for various heart-valve diseases. Warfarin is the only oral anticoagulant used for thrombosis prevention after heart-valve replacement. However, warfarin has a narrow therapeutic window, large differences in efficacy between individuals, and can be affected by drugs, food and disease status.

Patient concerns:

We used the Hamberg model to develop an anticoagulation regimen for a 10-month-old Chinese male after mitral-valve replacement.

Diagnoses:

Echocardiography revealed mitral malformation with severe regurgitation, patent foramen ovale, thickening of the left ventricular wall, enlargement of the left atrium, and the overall systolic function of the left ventricle was lower than normal.

Interventions:

First, the patient was treated with Mitral valvuloplasty plus temporary implantation of a pacing wire. Since this was inadequate, he underwent mitral-valve replacement. Then, we used the Hamberg model to develop an anticoagulation regimen.

Outcomes:

After discharge from hospital, the pharmacist provided anticoagulation management for this pediatric patient using an “Online Anticoagulation Clinic” (OAC). Point-of-care testing could be employed by the boy's mother at home to obtain the International Normalized Ratio. His time to response was 89.6% during the 6 months after hospital discharge, and adverse reactions such as bleeding or thrombosis did not occur.

Lessons:

This is the first time the Hamberg model has been employed to design anticoagulation therapy for an Asian infant. His anticoagulation therapy may be managed using the OAC.
Cardiopulmonary resuscitation of a cardiac arrest patient with left ventricular assist device in an out-of-hospital setting
Authors: Iwashita Yoshiaki , Ito Asami , Sasaki Ken , Suzuki Kei , Fujioka Masaki , Maruyama Kazuo , Imai Hiroshi
Published: January 2020

Rationale:

Despite increasing number of left ventricular assist device (LVAD) implantation, standardized cardiopulmonary resuscitation (CPR) protocol for patients with LVAD, especially in out-of-hospital settings are not well known.

Patient concerns:

A 41-year-old LVAD implanted man became cardiac arrest in an out-of-hospital setting. Bystander CPR was started and the patient was brought to our hospital without noticing LVAD. Upon arrival, the medical staff noted the LVAD and that the battery of the LVAD was exhausted.

Diagnosis:

Cardiac arrest on LVAD.

Interventions:

It took 50 minutes to change the battery, then the patient has become ventricular fibrillation; hence, we introduced extracorporeal membranous oxygenation and defibrillated the patient. After the sinus rhythm was restored, the LVAD started working uneventfully.

Outcomes:

The patient became brain dead.

Lessons:

There are several difficulties in treating these patients. First, hemodynamic collapse is difficult to diagnose. Second, chest compression for LVAD implanted patients remains controversial. Third, education to first responders who are not familiar with LVAD are not enough. Appropriate education for those issues is needed.