bluuebunny/crossref_metadata_2025 huggingface dataset:
Flexion-Relaxation Ratio Asymmetry and Its Relation With Trunk Lateral ROM in Individuals With and Without Chronic Nonspecific Low Back Pain
Authors: Rose-Dulcina Kevin , Genevay Stéphane , Dominguez Dennis , Armand Stéphane , Vuillerme Nicolas
Published: August 2019

Study Design.

A cross-sectional comparative study.

Objective.

The present study aimed to investigate the relationship between the FR phenomenon asymmetry of lumbar muscles and trunk lateral range of motion (ROM) asymmetry in nonspecific chronic low back pain (NSCLBP) patients.

Summary of Background Data.

Imbalance in trunk muscle activation between right and left sides can induce pain by loading the spine incorrectly, especially in patients with NSCLBP. A previous study reported a greater asymmetry in the FR phenomenon of the erector spinae in NSCLBP patients than in asymptomatic participants (APs). Imbalance of muscle properties, such as trunk ROM, has been suggested as a possible cause of this observed asymmetry.

Methods.

Twenty-eight NSCLBP patients and 22 AP performed 3 standing maximal trunk flexions. Surface electromyography was recorded bilaterally for erector spinae longissimus and lumbar multifidus. A FR ratio was calculated for each muscle. The fingertip-to-thigh test was performed to assess trunk lateral ROM. Each parameter's asymmetry was calculated as the absolute difference between right and left sides.

Results.

NSCLBP patients present a significantly lower trunk lateral ROM than AP. FR ratio asymmetry of the erector spinae was significantly greater in NSCLBP patients than in AP (P < 0.05). FR ratio asymmetry of the multifidus and trunk lateral ROM asymmetry were not significantly different between groups. Significant correlation (r = 0.49) between FR ratio asymmetry of erector spinae and trunk lateral ROM asymmetry was observed only for patients with NSCLBP.

Conclusion.

The present findings showed that FR ratio asymmetry of erector spinae longissimus is moderately correlated with trunk lateral ROM asymmetry. In addition, the results confirmed that patients with NSCLBP present a reduced trunk lateral ROM, a FR ratio asymmetry of the erector spinae which is correlated with trunk rotation. These findings suggested an imbalance spine loading which can contribute to the persistence of pain.

Level of Evidence: 3
Comparison of Hip and Lumbopelvic Performance Between Chronic Low Back Pain Patients Suited for the Functional Optimization Approach and Healthy Controls
Authors: Pilz Bruna , Vasconcelos Rodrigo A. , Teixeira Paulo P. , Mello Wilson , Oliveira Isadora O. , Ananias Juliana , Timko Michael , Grossi Débora B.
Published: August 2019

Study Design.

Cross-sectional study.

Objective.

We explored the differences between chronic low back pain (CLBP) patients suited for the functional optimization approach and healthy controls in isometric hip-strength and lumbar-endurance tests and determined classificatory cutoff values for strength and endurance tests and ratios.

Summary of Background Data.

To optimize the treatment effect for CLBP, some approaches have classified patients into homogeneous subgroups matched to specific treatments. We evaluated CLBP patients suited for the functional optimization approach, who seek care because they experience symptoms during activities with high physical demands, although they are relatively asymptomatic.

Methods.

Three hundred fifty subjects (healthy controls, 170; CLBP patients, 180) were stratified by age (18–40 and 41–65 yrs), sex, and physical activity level. The CLBP patients had an Oswestry Disability Index score < 20% and a Numeric Pain Rating Scale score < 3. The subjects underwent hip abductor, extensor, and flexor isometric strength tests; a deep abdominal function test; and lateral/frontal bridge and lumbar flexor/extensor endurance tests.

Results.

Relative to the healthy controls, the CLBP patients showed significantly (P > 0.05) higher strength scores in the hip flexor and deep abdominal function tests but lower endurance in the lateral and frontal bridge and lumbar flexor and extensor tests. The cutoff values of the lumbar flexor test and the lumbar flexor/extensor, lateral bridge/lumbar flexor, frontal bridge/lumbar flexor, and hip extensor/flexor test ratios showed acceptable accuracy (AUC = 0.84, 0.82, 0.79, 0.75, and 0.73, respectively).

Conclusion.

In lumbopelvic and hip-performance tests, CLBP patients suited for the functional optimization approach showed differences from healthy controls. These patients could be discriminated from healthy controls on the basis of accurate cutoff values for strength and endurance tests and ratios, which should be considered in treatment decision-making when patients need to return to activities with higher physical demands.

Level of Evidence: 2
Outcomes of Surgery for Thoracic Myelopathy Owing to Thoracic Ossification of The Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients
Authors: Ando Kei , Imagama Shiro , Kaito Takashi , Takenaka Shota , Sakai Kenichiro , Egawa Satoru , Shindo Shigeo , Watanabe Kota , Fujita Nobuyuki , Matsumoto Morio , Nakashima Hideaki , Wada Kanichiro , Kimura Atsushi , Takeshita Katsushi , Kato Satoshi , Murakami Hideki , Takeuchi Kazuhiro , Takahata Masahiko , Koda Masao , Yamazaki Masashi , Watanabe Masahiko , Fujibayashi Shunsuke , Furuya Takeo , Kawaguchi Yoshiharu , Matsuyama Yukihiro , Yoshii Toshitaka , Okawa Atsushi
Published: August 2019

Study Design.

Prospectively collected, multicenter, nationwide study.

Objective.

The aim of this study was to investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF).

Summary of Background Data.

A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items.

Methods.

Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopedic Association [JOA] score), symptoms, and intraoperative neurophysiological monitoring were investigated prospectively in 223 cases. Differences in these factors between fusion and nonfusion procedures for T-OLF were examined. The minimum follow-up period was 2 years after surgery

Results.

The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at computed tomography, and intramedullary high intensity area at magnetic resonance imaging (P < 0.01). The preoperative JOA score was lower (P < 0.05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, P < 0.05).

Conclusion.

The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.

Level of Evidence: 3
Emergency Department Visits for Acute Gastrointestinal Illness After a Major Water Pipe Break in 2010
Authors: Lin Cynthia J. , Richardson David B. , Hilborn Elizabeth D. , Weinberg Howard , Engel Larry S. , Wade Timothy J.
Published: August 2019

Background:

When a water pipe breaks, contaminants can enter the drinking water system and cause waterborne illnesses such as acute gastrointestinal illness. In May 2010, a major water pipe broke near Boston, MA, and a boil water order was issued to nearly two million residents.

Methods:

Using a case-crossover study design, we examined the association between the water pipe break and subsequent emergency department visits for acute gastrointestinal illness. We identified cases of illness according to ICD-9-CM diagnosis codes and selected control dates 2 weeks before and after each case. We estimated the risk of visiting the emergency department during the 0–3 and 4–7 days after the water pipe break using conditional logistic regression models.

Results:

Our analysis included 5,726 emergency department visits for acute gastrointestinal illness from 3 April 2010 to 5 June 2010. Overall, there was a 1.3-fold increased odds for visiting the emergency department for acute gastrointestinal illness during the 0–3 days after the water pipe break (odds ratio [OR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) compared with referent dates selected 2 weeks before and after. During the 4–7 days after the break, the association diminished overall (OR = 1.1; 95% CI = 0.96, 1.2). However, in communities over 12 miles from the break, the 4- to 7-day association was elevated (OR = 1.4; 95% CI = 1.1, 1.8).

Conclusions:

This study suggests that a major water pipe break was associated with emergency department visits for acute gastrointestinal illness, particularly during the 0–3 days after the break, when a boil water order was in effect.
Diversity and inclusion: the role of unconscious bias on patient care, health outcomes and the workforce in obstetrics and gynaecology
Authors: Arvizo Cynthia , Garrison Etoi
Published: August 2019

Purpose of review

Although the business world has long recognized the benefits of diversity and inclusion and the effects of unconscious bias, the discourse is just now gaining traction in the medical field. In addition, many businesses have developed key initiatives to address unconscious bias in the workplace.

Recent findings

In the medical field, diversity leads to improved health outcomes, increased access to healthcare by the underserved and more innovation. However, unconscious bias may inadvertently propagate health disparities, affect trainee evaluations, hinder faculty satisfaction and exclude populations from meaningful research.

In this review, we discuss diversity, inclusion and unconscious bias in obstetrics and gynaecology, as it relates to patient care, health outcomes, medical faculty and trainees. We also discuss potential interventions that mitigate these issues.
SPATIAL DISTRIBUTION OF CHORIOCAPILLARIS IMPAIRMENT IN EYES WITH CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION
Authors: Moult Eric M. , Alibhai Agha Yasin , Rebhun Carl , Lee ByungKun , Ploner Stefan , Schottenhamml Julia , Husvogt Lennart , Baumal Caroline R. , Witkin Andre J. , Maier Andreas , Duker Jay S. , Rosenfeld Phillip J. , Waheed Nadia K. , Fujimoto James G.
Published: August 2019

Purpose:

To develop an optical coherence tomography angiography (OCTA)-based framework for quantitatively analyzing the spatial distribution of choriocapillaris (CC) impairment around choroidal neovascularization (CNV) secondary to age-related macular degeneration.

Methods:

In a retrospective, cross-sectional study, 400-kHz swept-source OCTA images from 7 eyes of 6 patients with CNV secondary to age-related macular degeneration were quantitatively analyzed using custom software. A lesion-centered zonal OCTA analysis technique—which portioned the field-of-view into zones relative to CNV boundaries—was developed to quantify the spatial dependence of CC flow deficits.

Results:

Quantitative, lesion-centered zonal analysis of CC OCTA images revealed highest flow-deficit percentages near CNV boundaries, decreasing in zones farther from the boundaries. Optical coherence tomography angiography using shorter (1.5 ms) interscan times revealed more severe flow deficits than OCTA using longer (3.0 ms) interscan times; however, spatial trends were similar for both interscan times. A detailed description of the OCTA processing steps and parameters was provided so as to elucidate their influence on quantitative measurements.

Conclusion:

Impairment of the CC, assessed by flow-deficit percentages, was most prominent closest to CNV boundaries. The lesion-centered zonal analysis technique enabled quantitative CC measurements relative to focal lesions. Understanding how processing steps, imaging/processing parameters, and artifacts can affect quantitative CC measurements is important for longitudinal, OCTA-based studies of disease progression, and treatment response.
BASELINE CHARACTERISTICS OF VITREOMACULAR TRACTION PROGRESSING TO FULL-THICKNESS MACULAR OR LAMELLAR HOLES IN THE PHASE III TRIALS OF ENZYMATIC VITREOLYSIS
Authors: Schneider Eric W. , Jaffe Glenn J.
Published: August 2019

Purpose:

To identify characteristics associated with progression from vitreomacular traction (VMT) to a full-thickness macular hole (FTMH) or lamellar hole (LH).

Methods:

Post-hoc analysis of the Phase III clinical trial comparing ocriplasmin with placebo for treatment of vitreomacular adhesion (MIVI-TRUST). Exact logistic regression analyses were used to identify baseline characteristics significantly associated with progression from vitreomacular traction to FTMH or LH over the 6-month study period.

Results:

Twenty eyes (4.5%) developed an FTMH and 38 (9.7%) developed an LH during the study period. The rate of progression to FTMH or LH did not differ significantly between ocriplasmin- and saline-treated eyes (P = 0.090 for FTMH, P = 0.369 for LH). On univariate analysis, the presence of subretinal fluid (adjusted odds ratio 5.64, 95% confidence interval 2.02–17.17, P < 0.001) and mean subretinal fluid thickness (adjusted odds ratio 1.10, 95% confidence interval 1.04–1.16, P = 0.003) were associated with FTMH development. Both remained significantly associated with FTMH development on multivariate testing. On univariate analysis, the presence of macular schisis (adjusted odds ratio 2.26, 95% confidence interval 1.30–3.82, P = 0.004) and mean retinal thickness (adjusted odds ratio 1.06, 95% confidence interval 1.01–1.10, P = 0.010) were associated with LH development. Schisis remained a significant predictor of LH formation on multivariate testing.

Conclusion:

Vitreomacular traction is more likely to progress to FTMH when associated with subretinal fluid, but when associated with intraretinal changes (such as schisis), vitreomacular traction appears more likely to progress to a LH after a single intravitreal injection of ocriplasmin or saline.
Comparison of Musculoskeletal Infections due to Nontyphoidal Salmonella Species and Staphylococcus aureus in Immunocompetent Children
Authors: Boguniewicz Juri , Rubiano Landinez Andrea , Kaplan Sheldon L. , Lamb Gabriella S.
Published: August 2019

Background:

Nontyphoidal Salmonella species (NTS) rarely cause musculoskeletal infections in healthy children. Data on NTS musculoskeletal infections in healthy children are limited. No previous studies have directly compared children with NTS musculoskeletal infections with those with Staphylococcus aureus.

Methods:

This was a case-control study of children 30 days–18 years old seen at Texas Children’s Hospital between 2010 and 2017 with NTS musculoskeletal infections. Controls were children with S. aureus musculoskeletal infections matched on date of infection. Patients with known predisposing conditions were excluded. Demographic and clinical risk factors between the 2 groups were compared.

Results:

From 2010 to 2017, 27 cases of NTS musculoskeletal infections were identified, 12 (46.0%) of which occurred in healthy children. The control group had 53 patients. Predictors of NTS musculoskeletal infections included exposure to reptiles [odds ratio (OR) 8.50, 95% confidence interval (CI): 11.24–58.23] and preceding gastrointestinal symptoms (OR 5.63, 95% CI: 1.45–21.89). Children with NTS musculoskeletal infections had greater odds of pelvic and/or spinal involvement than S. aureus controls (OR 5.32, 95% CI: 1.42–20.13). Complications occurred in 16.7% of NTS cases versus 32% of S. aureus controls.

Conclusions:

Healthy children with NTS musculoskeletal infections more frequently report reptile exposure and preceding gastrointestinal symptoms and have pelvic and spinal involvement compared with children with musculoskeletal infections due to S. aureus. NTS should be considered as a potential cause of musculoskeletal infections in children with these risk factors. In contrast to previous case reports and case series, children with NTS musculoskeletal infections had a low rate of complications.
The Use of Antidepressant Medications During Pregnancy and the Risk of Neonatal Seizures
Authors: Uguz Faruk
Published: August 2019

Purpose

This review examined the current literature about the potential relationship between the use of antidepressants during pregnancy and neonatal seizures.

Methods

PubMed was searched for English language reports published between January 1, 1996, and October 31, 2018, by using combinations of the following key words:pregnancy,neonatal outcome,neonatal convulsion,neonatal seizure,SSRI,selective serotonin norepinephrine reuptake inhibitor (SNRI),tricyclic antidepressant (TCA),antidepressants,sertraline,fluoxetine,paroxetine,citalopram,escitalopram,fluvoxamine,venlafaxine,mirtazapine,duloxetine,bupropion,amitriptyline,imipramine,and clomipramine.

Findings

A total of 9 relevant studies that met the review criteria were examined. The prevalence rates of neonatal seizures in the antidepressant groups and control groups were 0.30% to 0.91% and 0.10% to 0.30%, respectively. The use of selective serotonin reuptake inhibitors was associated with up to 5-fold increase in the risk of neonatal seizures. Compared with the controls, higher risks were reported in newborns of pregnant women using any antidepressant or tricyclic antidepressants albeit in a limited number of studies. Exposure to antidepressants in the third trimester of pregnancy appeared to be associated more with neonatal seizures compared with earlier exposure.

Implicatons

Although an increased risk of neonatal seizures in newborns antenatally exposed to antidepressants especially selective serotonin reuptake inhibitors may be suggested, the available studies have severe methodological limitations to enable any firm conclusion.
An Educational Intervention for Acute Dizziness Care: A Randomized, Vignette-based Study
Authors: Meurer William J. , Johnson Patricia , Brown Devin , Tsodikov Alexander , Rowell Brigid , Fagerlin Angela , Telian Steven A. , Damschroder Laura , An Lawrence C. , Morgenstern Lewis B. , Kerber Kevin A.
Published: August 2019

Importance:

Benign paroxysmal positional vertigo (BPPV) is a common cause of acute dizziness. Strong evidence exists for diagnosing BPPV using the Dix-Hallpike Test (DHT) and treating it with the canalith repositioning maneuver (CRM). Despite this, both are infrequently used in the emergency department (ED).

Objective:

As an early method to evaluate a BPPV-focused educational intervention, we evaluated whether an educational intervention improved ED provider performance on hypothetical stroke and BPPV cases delivered by vignette.

Design:

A randomized, controlled, educational intervention study in ED physicians. The intervention aimed to promote the appropriate use of the DHT and CRM. A BPPV vignette, a stroke-dizziness (safety) vignette, and vignette scoring schemes (higher scores indicating more optimal care) used previously established vignette methodology.

Setting:

We recruited participants at the exhibitor hall of an emergency medicine annual meeting.

Participants:

We recruited 48 emergency physicians. All were board certified or residency trained and board eligible. All were engaged in the active practice of emergency medicine. None were trainees.

Interventions:

Intervention group: a narrated, educational presentation by computer followed by the clinical vignettes. Control group: Received no educational intervention and completed the clinical vignettes—intended to mirror current clinician practice.

Main Outcome Measure:

Primary endpoint: total score (out of 200 points) on a vignette-based scoring instrument assessing the performance of history, physical, and diagnostic testing on hypothetical stroke and BPPV cases.

Results:

The efficacy threshold was crossed at the interim analysis. The intervention group had higher performance scores compared with controls (113.2 versus 68.6, p < 0.00001). BPPV and safety subscores were both significantly higher in the intervention group. Sixty-two percent of the intervention group planned to use the DHT versus 29% of controls. After the vignette described characteristic BPPV nystagmus, 100% of the intervention group planned to use the CRM versus 17% of controls.

Conclusions and Relevance:

The educational intervention increased provider performance in dizziness vignettes, including more frequent appropriate use of the DHT/CRM. These findings indicate the intervention positively influenced planned behavior. Future work is needed to implement and evaluate this intervention in clinical practice.
Hepatitis E infection in a patient with rheumatoid arthritis treated with leflunomide
Authors: Carubbi Francesco , Picchi Giovanna , Di Bartolomeo Salvatore , Ricciardi Alessandra , Cipriani Paola , Marola Laura , Grimaldi Alessandro , Giacomelli Roberto
Published: August 2019

Rationale:

Hepatitis E is an infectious disease due to inflammation of the liver caused by hepatitis E virus (HEV) and represents one of the most common causes of acute hepatitis and jaundice in the world. Although data of hepatitis E infection in patients with rheumatoid arthritis (RA) are accumulating, little is known on the course of HEV infection. We reported, for the 1st time, a case of patient with RA with hepatitis E that developed during leflunomide therapy in combination with low-dose steroids.

Patient concerns:

We present a 39-year-old woman, affected by RA and treated with leflunomide, reported diffuse itching and persistent fatigue laboratory data revealed elevated liver enzyme levels.

Diagnosis:

Positivity for anti-HEV IgM and IgG was observed. HEV-RNA of the genotype 3 was detected, indicating acute E hepatitis.

Interventions and outcomes:

Leflunomide was stopped and restarted 5 months after the initial diagnosis at the same dosage, with a close clinical and laboratory follow-up. The virus was eradicated from the serum without chronic transformation. The patient is alive and well 7 months after the initial diagnosis.

Lessons:

To our knowledge, this report is the 1st case of acute E hepatitis in a patient with RA developed during leflunomide therapy in combination with low-dose steroids. Moreover, geoepidemiology of infection is important, due to the fact that Abruzzo, a central region of Italy, has the highest HEV seroprevalence in general population, related to the zoonotic transmission of the infection from domestic and wild animals. Our case highlighted that immunosuppressive therapy, and in particular leflunomide, could be safely reintroduced after the resolution of the infection and the clearance of the virus. Further studies are needed to evaluate potential advantages in serologic testing for HEV infection as a part of the routine workup done to patients with rheumatic diseases and selected for immunosuppressive therapy.
A national center for persistent severe pain after groin hernia repair
Authors: Jensen Elisabeth Kjær , Ringsted Thomas K. , Bischoff Joakim M. , Petersen Morten A. , Rosenberg Jacob , Kehlet Henrik , Werner Mads U.
Published: August 2019

Severe persistent pain after groin hernia repair impairs quality-of-life. Prospective, consecutive cohort study including patients with pain-related impairment of physical and social life. Relevant surgical records were obtained, and examinations were by standardized clinical and neurophysiological tests. Patients demonstrating pain sensitivity to pressure algometry in the operated groin underwent re-surgery, while patients with neuropathic pain received pharmacotherapy. Questionnaires at baseline (Q0) and at the 5-year time point (Q5Y) were used in outcome analyses of pain intensity (numeric rating scale [NRS] 0–10) and pain-related effect on the activity-of-daily-living (Activities Assessment Scale [AAS]). Data are mean (95% CI).

Analyses were made in 172/204 (84%) eligible patients. In 54/172 (31%) patients re-surgery (meshectomy/selective neurectomy) was performed, while the remaining 118/172 (69%) patients received pharmacotherapy. In the re-surgery group, activity-related, and average NRS-scores at Q0 were 6.6 (5.6–7.9) and 5.9 (5.6–5.9), respectively. Correspondingly, NRS-scores at Q5Y was 4.1 (3.3–5.1) and 3.1 (2.3–4.0; Q0 vs. Q5Y: P < .0005), respectively. Although both groups experienced a significant improvement in AAS-scores comparing Q0 vs. Q5Y (re-surgery group: 28% (4–43%; P < .0001); pharmacotherapy group: 5% (0–11%; P = .005)) the improvement was significantly larger in the re-surgery group (P = .02).

This 5-year cohort study in patients with severe persistent pain after groin hernia repair signals that selection to re-surgery or pharmacotherapy, based on examination of pain sensitivity, is associated with significant improvement in outcome. Analyzing composite endpoints, combining pain and physical function, are novel in exploring interventional effects.

ClinicalTrials.gov Identifier NCT03713047
Computed tomography pulmonary angiograms using a novel dual-layer spectral detector
Authors: Iuga Andra-Iza , Doerner Jonas , Siedek Florian , Haneder Stefan , Byrtus Jonathan , Luetkens Julian A. , Maintz David , Hickethier Tilman
Published: August 2019

Objective:

The aim of this study was to determine optimal window settings for conventional polyenergetic and virtual monoenergetic images derived from computed tomography pulmonary angiogram (CTPA) examinations of a novel dual-layer spectral detector computed tomography system (DLCT).

Methods:

Monoenergetic (40 keV) and polyenergetic images of 50 CTPA examinations were calculated and the best individual window width and level (W/L) values were manually assessed. Optimized values were obtained afterwards based on regression analysis. Diameters of standardized pulmonary artery segments and subjective image quality parameters were evaluated and compared.

Results:

Attenuation and contrast-to-noise values were higher in monoenergetic than in polyenergetic images (P≤.001). Averaged best individual W/L for polyenergetic and monoenergetic were 1020/170 and 2070/480 HU, respectively.

All adjusted W/L-settings varied significantly compared to standard settings (700/100 HU) and obtained higher subjective image quality scores. A systematic overestimation of artery diameters for standard window settings in monoenergetic images was observed.

Conclusions:

Appropriate W/L-settings are required to assess polyenergetic and monoenergetic CTPA images of a novel DLCT. W/L-settings of 1020/170 HU and 2070/480 HU were found to be the best averaged values for polyenergetic and monoenergetic CTPA images, respectively.
Efficacy of Jianpi Liqi therapy for functional dyspepsia
Authors: Ye Jin-Tong , Dai Yun-Kai , Li Dan-Yan , Zhang Yun-Zhan , Huang Meng-Xin , Chen Wei-Jing , Li Ru-Liu , Hu Ling
Published: August 2019

Background:

We performed this meta-analysis to assess the efficacy and safety of Jianpi Liqi therapy (JLT), a traditional Chinese medicine therapy, in treating functional dyspepsia (FD).

Methods:

We systematically searched 13 databases from their inception to 15th, May 2019. Eligible studies were randomized controlled trials (RCTs) that compared JLT medicine with conventional pharmacotherapy (CP) in treating patients with FD. Cochrane Collaboration tool, Review Manager 5.3 and STATA 11.0, GRADE profiler 3.6 were used for evaluating risk of bias, analyzing, and assessing quality of evidence respectively.

Results:

After exclusions, 15 RCTs including a total of 1451 participants were included for analysis. We found evidence that JLT had better efficacy than CP (domperidone, omeprazole, esomeprazole, mosapride, lansoprazole, compound digestive enzymes, lactasin tablets) for FD (OR 0.34; 95% CI 0.26, 0.45; P < .00001). Moreover, JLT had more improvement on symptoms including abdominal pain, abdominal distention, early satiety, belching, poor appetite, and fatigue compared with CP. In addition, serious adverse events were not observed in treatment courses.

Conclusion:

This meta-analysis suggested that JLT appears to have better efficacy in treating FD compared with CP. It may be an effective and safe therapy option for patients with FD. Though, more large-sample and strictly designed RCTs are needed to confirm our findings.

PROSPERO registration number: CRD42019133241.
Efficacy of tiotropium in treating patients with moderate-to-severe asthma
Authors: Meng Jian-Feng , Li Hua , Luo Ming-Jie , Li Hai-Bin
Published: August 2019

Background:

The goal of the current meta-analysis and systematic review was to explore the efficacy of tiotropium in treating patients with moderate-to-severe asthma on the basis of qualified randomized controlled trials (RCTs).

Methods:

The following online electronic databases, such as Cochrane, PubMed, and Embase database were screened to identify qualified studies updated to January 2019 through the use of index words. Several literatures that were relevant to the present analysis were also included. To further analyze the main outcomes, we utilized the odds rations (OR), and mean difference (MD) along with its 95% confidence interval (95% CI).

Results:

A total of 14 RCTs with 4998 patients in the tiotropium group and 5074 patients in the control group were included in the present study. On the basis of the pooled results, tiotropium was significantly associated with improved morning PEF (SMD: 3.29, 95%CI: 2.03–4.55), evening PEF (SMD: 3.36, 95%CI: 2.24–4.48), peak FEV (SMD: 2.67, 95%CI: 1.47–3.88), and trough FEV (SMD: 1.90, 95%CI: 0.87–2.92) vs the control group. Nevertheless, no significant difference was observed in peak FVC (SMD: 0.77, 95%CI: −0.21–1.76), trough FVC (SMD: 0.67, 95%CI: −0.18–1.53), AE (RR: 0.98, 95%CI: 0.94–1.02) and serious AE (RR: 1.08, 95%CI: 0.77–1.52) between the 2 groups.

Conclusions:

In this review, we summarized the significant effect of tiotropium for the treatment of moderate-to-severe asthma, mainly in increasing morning PEF, evening PEF, peak FEV and trough FEV based on high-quality RCTs. Nevertheless, no significant difference in peak FVC, trough FVC, AE and serious AE was found between the 2 groups. A close comparison of the 2 groups revealed that more high-quality larger-sample RCTs are needed to gather more strong evidence on the therapeutic efficacy and safety of tiotropium for clinical practice.
Nomogram predicting long-term overall survival and cancer-specific survival of lip carcinoma patients based on the SEER database
Authors: Zhao Rui , Jia Tingting , Qiao Bo , Liang Jiawu , Qu Shuang , Zhu Liang , Feng Hang , Xing Lejun , Ren Yipeng , Wang Fengze , Zhang Haizhong
Published: August 2019

Our study was designed to construct nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of lip carcinoma patients.

A search of the Surveillance, Epidemiology, and End Results (SEER) database provided us with detailed clinical data of the 1780 lip carcinoma patients. On the basis of the credible random split-sample method, the 1780 patients were placed into 2 groups, with 890 patients in the modeling group and 890 patients in the counterpart's group (proportion = 1:1). By employing Kaplan–Meier univariate and Cox multivariate survival analyses based on the modeling cohort, the nomograms were developed and then used to divide the modeling cohort into low-risk cohort and high-risk cohort. The survival rates of the 2 groups were calculated. Internal and external evaluation of nomogram accuracy was performed by the concordance index (C-index) and calibration curves.

With regard to 5- and 8-year OS and CSS, the C-indexes of internal validation were 0.762 and 0.787, whereas those of external validation reached 0.772 and 0.818, respectively. All the C-indexes were higher than 0.7. The survival curves of the low-risk cohort were obviously better than those of the high-risk cohort.

Credible nomograms have been established based on the SEER large-sample population research. We believe these nomograms can contribute to the design of treatment plans and evaluations of individual prognosis.
Whole genome sequencing analysis of a dexamethasone-degrading Burkholderia strain CQ001
Authors: Si Dan , Xiong Yuxia , Yang Zhibang , Zhang Jin , Ma Lianju , Li Jinyang , Wang Yi
Published: August 2019

This study is to analyze the functional genes and metabolic pathways of dexamethasone degradation in Burkholderia through genome sequencing.

A new Burkholderia sp. CQQ001 (B. CQ001) with dexamethasone degrading activity was isolated from the hospital wastewater and sequenced using Illumina Hiseq4000 combined with the third-generation sequencing technology. The genomes were assembled, annotated, and genomically mapped. Compared with six Burkholderia strains with typical features and four Burkholderia strains with special metabolic ability, the functional genes and metabolic pathways of dexamethasone degradation were analyzed and confirmed by RT-qPCR.

Genome of B. CQ001 was 7,660,596 bp long with 6 ring chromosomes. The genes related to material metabolism accounted for 80.15%. These metabolism related genes could participate in 117 metabolic pathways and cover various microbial metabolic pathways in different environments and decomposition pathways of secondary metabolites, especially the degradation of aromatic compounds. The steroidal metabolic pathway containing 1 ABC transporter and 9 key metabolic enzymes related genes were scattered in the genome. Among them, the ABC transporter, KshA, and KshB increased significantly under the culture conditions of dexamethasone sodium phosphate as carbon source.

B. CQ001 is a bacterium with strong metabolic function and rich metabolic pathways. It has the potential to degrade aromatics and other exogenous chemicals and contains genes for steroid metabolism. Our study enriches the genetic information of Burkholderia and provides information for the application of Burkholderia in bioremediation and steroid medicine production.
Comparison of cortical bone trajectory versus pedicle screw techniques in lumbar fusion surgery
Authors: Hu Jing-Nan , Yang Xiao-Feng , Li Chuan-Ming , Li Xin-Xin , Ding Yun-Zhi
Published: August 2019

Background:

Biomechanical studies have demonstrated that cortical bone trajectory (CBT) screw can provide a 30% increase in uniaxial yield pullout load than pedicle screw (PS). In addition, the insertion torque of CBT screw is 1.71 times higher than that of PS. A meta-analysis was conducted to evaluate clinical results between CBT screw technique and PS technique in lumbar fusion surgery.

Methods:

An extensive search of literature was performed in PubMed, Embase, the Cochrane library. The following outcomes were extracted: visual analog scale (VAS), Oswestry disabilities index (ODI), Japanese Orthopaedic Association (JOA) score, complications, fusion rates, hospital stay, incision length, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0.

Results:

A total of 12 studies were included in the final analysis. The results indicated that CBT group with less blood loss [P < .01], less hospital stay [P < .01], and less incision length [P < .01] than PS group. There were no significant differences between 2 groups in other clinical parameters and outcomes.

Conclusion:

CBT technique provided similar clinical outcomes and fusion rates compared to PS technique in lumbar fusion surgery. However, CBT technique provided additional benefits of less blood loss, less hospital stay, and less incision length.
Comparative effectiveness of conservative and pharmacological interventions for chronic non-specific neck pain
Authors: Pillastrini Paolo , Castellini Greta , Chiarotto Alessandro , Fasciani Francesco , Marzioni Francesco , Vanti Carla , Bertozzi Lucia , Gianola Silvia
Published: August 2019

Background:

Neck Pain (NP) has been ranked as one of the top chronic pain conditions in terms of prevalence and years lived with disability in the latest Global Burden of Disease. NP has remarkable socio-economic consequences however, research efforts are limited. Discrepancies among guidelines recommendations on management of chronic neck pain exist. The purpose of this study protocol is to provide the methods for a review with network meta-analysis to identify the most effective interventions for chronic neck pain.

Methods:

The following databases will be searched from their inception to February 2019: Cochrane Controlled Trials Register (CENTRAL), PubMed, CINAHL, Scopus, ISI Web of Science and PEDro.

Randomized controlled trials (RCTs) on pharmacological and not pharmacological interventions will be included and their risk of bias will be evaluated using the Cochrane Risk of bias tool. Primary outcomes will be reduction in pain and disability. A network meta-analysis will be carried out and pairwise meta-analysis will be conducted using Stata 15 software. Grading of recommendations assessment, development, and evaluation (GRADE) will be applied to assess quality of the body of the evidence.

Results:

The results of this review will be submitted to a peer-review journal for publication.

Conclusion:

This network meta-analysis will provide a comprehensive review on the most effective treatments for the management of chronic neck pain providing key evidence-based information to patients, clinicians and other relevant stakeholders.
Registration: PROSPERO (registration number CRD42019124501).
Brain MRI imaging characteristics predict treatment response and outcome in patients with de novo brain metastasis of EGFR-mutated NSCLC
Authors: Lin Chia-Ying , Chang Chao-Chun , Su Po-Lan , Lin Chien-Chung , Tseng Yau-Lin , Su Wu-Chou , Yen Yi-Ting
Published: August 2019

Patients with non-small cell lung cancer (NSCLC) and de novo brain metastasis (BM) have poor prognosis. We aim to investigate the characteristic of brain magnetic resonance (MR) imaging and the association with the treatment response of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) for lung cancer with BM.

EGFR-mutated NSCLC patients with BM from October 2013 to December 2017 in a tertiary referral center were retrospectively analyzed. Patient's age, sex, cell type, EGFR mutation status, treatment, and characteristics of BM were collected. Survival analysis was performed using Kaplan–Meier method. The efficacy of different EGFR-TKIs were also analyzed.

Among the 257 eligible patients, 144 patients with Exon 19 deletion or Exon 21 L858R were included for analysis. The erlotinib group had the best progression free survival (PFS) (median PFS 13 months, P = .04). The overall survival (OS) revealed no significant difference between three EGFR-TKI groups. Brain MR imaging features including tumor necrosis, rim enhancement and specific tumor locations (frontal lobe, putamen or cerebellum) were factors associated with poor prognosis. Patients with poor prognostic imaging features, the high-risk group, who received erlotinib had the best PFS (median PFS 12 months, P < .001). However, the OS revealed no significant difference between 3 EGFR-TKI groups. The low risk group patients had similar PFS and OS treated with three different EGFR-TKIs.

In NSCLC patients with common EGFR mutation and de novo BM, those with poor prognostic brain MR characteristics, erlotinib provided better PFS than afatinib or gefitinib.
Dexmedetomidine attenuates the increase of ultrasonographic optic nerve sheath diameter as a surrogate for intracranial pressure in patients undergoing robot-assisted laparoscopic prostatectomy
Authors: Yu Jihion , Park Jun-Young , Kim Doo-Hwan , Koh Gi-Ho , Jeong Wonyeong , Kim Eunkyul , Hong Jun Hyuk , Hwang Jai-Hyun , Kim Young-Kug
Published: August 2019

Background:

Pneumoperitoneum and steep Trendelenburg position during robot-assisted laparoscopic prostatectomy (RALP) can increase intracranial pressure (ICP). Dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist, can cause cerebral vasoconstriction and decrease cerebral blood flow by stimulating the postsynaptic alpha-2 adrenergic receptors on cerebral blood vessels. However, the effects of dexmedetomidine on ICP are controversial and have not been evaluated during RALP under the establishment of pneumoperitoneum in the steep Trendelenburg position. Therefore, we evaluated the effect of dexmedetomidine on optic nerve sheath diameter (ONSD) as a surrogate for assessing ICP during RALP.

Methods:

Patients were randomly allocated to receive dexmedetomidine (n = 63) (loading dose, 1 μg/kg for 10 minutes and continuous infusion, 0.4 μg/kg/hr) or normal saline (n = 63). The ONSD was measured at 10 minutes after induction of anesthesia in the supine position (T1), 30 minutes (T2) and 60 minutes (T3) after establishment of pneumoperitoneum in the steep Trendelenburg position, and at closing the skin in the supine position (T4). Hemodynamic and respiratory variables were measured at every time point.

Results:

ONSDs at T2, T3, and T4 were significantly smaller in the dexmedetomidine group than in the control group (5.26 ± 0.25 mm vs 5.71 ± 0.26 mm, 5.29 ± 0.24 mm vs 5.81 ± 0.23 mm, and 4.97 ± 0.24 mm vs 5.15 ± 0.28 mm, all P <.001). ONSDs at T2, T3, and T4 were significantly increased compared to T1 in both groups. Hemodynamic and respiratory variables, except heart rate, did not significantly differ between the 2 groups. The bradycardia and atropine administration were not significantly different between the 2 groups.

Conclusion:

Dexmedetomidine attenuates the increase of ONSD during RALP, suggesting that intraoperative dexmedetomidine administration may effectively attenuate the ICP increase during pneumoperitoneum in the Trendelenburg position.
A randomized, double-blind, double-dummy, controlled, multicenter study of Qingzhong (tenofovir disoproxil fumarate) versus Viread for the treatment of chronic hepatitis B
Authors: Liang Rong-Yue , Xu Jing-Hang , Si Chong-Wen , Wang Sa , Shang Jia , Yu Zu-Jiang , Mao Qing , Xie Qing , Zhao Wei , Li Jun , Gao Zhi-Liang , Wu Shan-Ming , Tang Hong , Cheng Jun , Chen Xin-Yue , Zhang Wen-Hong , Wang Hao , Xu Zhong-Nan , Wang Ling , Dai Jun , Yu Yan-Yan
Published: August 2019

Background:

Tenofovir disoproxil fumarate (TDF) has been widely recommended as a first-line antiviral agent to treat chronic hepatitis B (CHB). Qingzhong and Viread, formulations of TDF commercialized by Jiangsu Chia-tai Tianqing Pharmaceutical Co Ltd and GlaxoSmithKline, respectively, have both been approved by the State Food and Drug Administration, China. This study analyzed the efficacy and safety of these 2 TDF agents in Chinese patients with CHB.

Methods:

In this multicenter, randomized, double-blind, double-dummy, noninferiority phase 3 clinical trial (ClinicalTrials.gov identifier: NCT02287857), 330 Chinese patients with CHB [hepatitis B envelope antigen-positive (HBeAg) (+): 232] were randomly assigned to receive Qingzhong (group A: 161 patients) or Viread (group B: 169 patients) 300 mg once daily for 48 weeks. Subsequently, all patients were administered Qingzhong 300 mg once daily from week 49 to week 240. The primary end point was the degree of decline of plasma hepatitis B virus (HBV) DNA levels at week 48 and the secondary endpoints were viral suppression, normalization of alanine aminotransferase (ALT) levels, hepatitis B surface antigen (HBsAg)/HBeAg loss or seroconversion, and virological breakthrough.

Results:

Among patients with CHB who were HBeAg (+), the mean HBV DNA titer decreased similarly between the groups at week 48. The percentages of patients who achieved undetectable HBV DNA were similar between the groups (85.11% and 82.35% in groups A and B, respectively) and similar losses of HBeAg and HBeAg seroconversion rates were achieved. Moreover, for patients with CHB who were HBeAg (−), reductions in HBV DNA were similar. Among all patients with CHB, the rates of normalization of ALT and the loss of HBsAg were similar. The overall incidence of adverse events was comparable between the groups.

Conclusion:

In conclusion, the 48-week administration of Qingzhong showed noninferior efficacy and safety profiles compared to Viread in Chinese patients with CHB.
Outcomes of volar locking plate (VLP) fixation for treatment of die-punch fracture of the distal radius
Authors: Yu Lili , Zhang Xiong , Zhang Bing , Hu Chunhe , Yu Kunlun , Tian Dehu , Bai Yanbin
Published: August 2019

Distal radius fracture involving the lunate facet is a tough issue for surgeons, but currently there is scarcity of data on these injuries. This study aims to evaluate results of volar locking plate (VLP) for treatment of die-punch fractures of the distal radius.

Between January 2013 and June 2017, a total of 37 patients with die-punch fractures of the distal radius were admitted and underwent VLP fixation. Clinical and radiographic data on these patients were extracted from their electronic medical records. Preoperative radiographs, CT scanning and 3D reconstruction were used to definitely diagnose this injury. Radiographs taken at immediate postoperation and at last follow-up were analyzed. Data on radial subsidence, articular step-off status, volar tilt, radial inclination, wrist motion range, grip strength and related complications at the final follow-up were documented for analysis. The overall outcomes of the injured limb were evaluated, based on the Gartland and Werley scoring system.

The mean radial subsidence was 0.8 mm (0–3.3 mm), and articular step-off finally occurred in 4 patients (10.8%). The mean volar tilt was 9.5° (6°–15°), radial inclination 21° (12°–27°). The mean wrist was 84.2% in flexion of the contralateral uninjured wrist, 87.0% in extension, 92.2% in pronation and 94.5% in supination, respectively. The mean grip strength was 86% (range 56%–108%) of the contralateral un-injured upper limb. Gartland and Werley score demonstrated the excellent and good rate of 83.8%, with excellent result in 21 patients, good in 10, fair in 4 and poor in 2. Incidence of overall complications was 27.0% (10/37), with one requiring surgical intervention.

VLP demonstrated its efficacy and safety for treatment of die-punch fractures. Prospective comparative studies with larger sample are required to compare the outcomes among different fixation methods, with expectation of precise and individualized treatment for every patient.

Type of study/level of evidence: Therapeutic III.