bluuebunny/crossref_metadata_2025 huggingface dataset:
The efficacy and safety of Lianhua Qingwen (LHQW) for coronavirus disease 2019 (COVID-19)
Authors: Zhang Qiongshuai , Cao Fang , Ji Guangcheng , Xu Xiaohong , Sun Yihan , Li Jiannan , Qi Xun , Sun Shaoqian , Wang Yufeng , Song Bailin
Published: July 2020

Background:

Since the outbreak of Novel Coronavirus Pneumonia (NCP), it has swept the world with rapid development. Up to now, there is no effective drug to treat it. Lianhua Qingwen has been used in the treatment of COVID-19 in China, but there is no systematic review about it. This study will systematically evaluate its efficacy and safety in the treatment of COVID-19.

Methods:

We will search electronic database of PubMed, EMBASE, Cochrane library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific and Journal Database (VIP) and Wan Fang database (Wanfang) for the literature of RCTs of Lianhua Qingwen capsule for coronavirus disease 2019 (COVID-19). We will also search the Chinese Clinical Trial Registry (ChiCTR) and ClinicalTrials.gov (www.ClinicalTrials.gov) for ongoing trials with unpublished data, and the Conference abstracts will be searched manually. We will use the Cochrane Handbook for Systematic Reviews of Interventions to assess the risk of bias. The protocol will be conducted according to the approach and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P).

Results:

The study results will provide evidence of the efficacy and safety of Lianhua Qingwen (LHQW) for coronavirus disease 2019 (COVID-19).

Conclusion:

The result of the study will be published in a peer-reviewed journal.

PROSPERO registration number:

CRD42020180877.
Current trends in health coaching for chronic conditions
Authors: Yang Juan , Bauer Brent A. , Lindeen Stephanie A. , Perlman Adam I. , Abu Dabrh Abd Moain , Boehmer Kasey R. , Salinas Manisha , Cutshall Susanne M.
Published: July 2020

Background:

Chronic conditions are placing a serious burden on individuals as well as the health care system. Health coaching (HC) has emerged as a promising approach that can support effective lifestyle interventions for chronic conditions. However, until now there is no particularly comprehensive systematic review of HC impact on a chronic condition from the angle of patient improvement and detail coaching characteristics reported.

Objective:

To synthesize available studies on the efficacy and current status of HC interventions on the health of chronically ill adult patients.

Methods:

The literature search will be conducted for trials published in English within the past four years. Electronic databases CINAHL, Cochrane Library, Embase, MEDLINE, and Scopus will be searched with keywords describing HC for chronic diseases. Randomized controlled trials that compare HC interventions to conventional care or other alternative therapies will be included. Data extraction will be conducted by two reviewers independently, and enrolled trials will be evaluated for quality and bias assessment. If appropriate, meta-analysis will be conducted on the last stage of the review; otherwise, the study findings will be described narratively. The software Review Manager (Revman version 5.3.5.) provided by the Cochrane Collaboration will be applied for the meta-analysis.

Results:

This is the first study to comprehensively explore the effectiveness and current status of HC intervention for patients with chronic conditions.

Discussion:

Study findings from this review will advance the appropriate utilization of coaching practice by determining whether HC is effective and feasible among patients with chronic disease. If proven effective, this approach may be applied more broadly through public health interventions. The current status findings will also provide evidence to inform decisions for integrating HC interventions into the current management pathway for individuals with chronic conditions.

Systematic review registration:

PROSPERO CRD42020153280.
Diagnostic challenges and potential early indicators of breast periprosthetic anaplastic large cell lymphoma
Authors: La Forgia Daniele , Catino Annamaria , Fausto Alfonso , Cutrignelli Daniela , Fanizzi Annarita , Gatta Gianluca , Losurdo Liliana , Maiorella Arianna , Moschetta Marco , Ressa Cosmo , Scattone Anna , Portincasa Aurelio
Published: July 2020

Rationale:

Anaplastic large T-cell lymphoma (BI-ALCL) is a rare primitive lymphoma described in women with breast implant prostheses, which has been arousing interest in recent years due to its potentially high social impact. The difficult diagnosis associated with the high and increasing number of prosthetic implants worldwide has led to hypothesize an underestimation of the real impact of the disease among prosthesis-bearing women. The aim of this work is to search for specific radiological signs of disease linked to the chronic inflammatory pathogenetic mechanism.

Patient concerns:

This work describes a case of BI-ALCL in an American woman with no personal or family history of cancer, who underwent breast augmentation for esthetic purposes at our Institute. After about 10 years of relative well-being, the patient returned to our Institute with clear evidence of breast asymmetry due to the increase in volume of the right breast which had progressively become larger over a period of 6 months. There was no evidence of palpable axillary lymph nodes or other noteworthy signs.

Diagnosis:

The ultrasound and magnetic resonance (MR) tests indicated the presence of seroma with amorphous material in the exudate which was confirmed by indirect signs, visible in right breast mammography. Due to suspected cold seroma, an ultrasound-guided needle aspiration was performed for the cytological analysis of the effusion which highlighted the presence of a number of large-sized atypical cells with an irregular nucleus with CD30 immunoreactivity, leucocyte common antigen (CD45) compatible with the BI-ALCL diagnosis.

Interventions:

In our case, a capsulectomy was performed because the disease was limited inside the capsule and periprosthetic seroma. The final histological examination confirmed the stage.

Lessons:

The patient is being monitored and shows no signs of recurrence of disease >24 months after surgery.

Conclusion:

A diagnosis of BI-ALCL can be reached using new radiological indicators, such as fibrin, which is clearly visible by MR in the form of nonvascularized debris of amorphous material hypointense in all sequences, free flowing or adhered to the external surface of the prosthesis.
Effect of digital storytelling intervention on burnout thoughts of adolescent
Authors: Ofoegbu Theresa Onyema , Asogwa Uche D. , Ogbonna Chimaobi Samuel , Aloh Henry E. , Eseadi Chiedu , Eskay Michael , Nji Godfrey C. , Ngwoke Oliver Rotachukwu , Agboti Christian Iheanacho , Nnachi Robert Azu , Nnachi Oluomachi Charity , Otu Mkpoikanke S.
Published: July 2020

Background/Objective:

Both athletes with and without disabilities can develop burnout symptoms. However, athletes with disabilities may face different or more challenges compared to their counterparts without disabilities. The present study aimed at ascertaining the effect of digital storytelling intervention on burnout thoughts of adolescent-athletes with disabilities.

Method:

This study is a randomized controlled trial involving a total of 171 adolescent-athletes with disabilities who showed a high degree of burnout symptoms. These adolescent-athletes were randomly assigned to either an intervention group (n = 85) or a waitlisted control group (n = 86). The treatment intervention for the adolescent-athletes was digital stories which were created based on the framework of rational emotive behaviour therapy (REBT). The Athlete Burnout Questionnaire was used for gathering of data at three different times (baseline, post-test and follow up). Data were analyzed using repeated measure analysis of variance at a significant level of 0.05.

Results:

Results showed that the digital storytelling intervention based on REBT significantly reduced burnout thoughts among disabled adolescent-athletes in the intervention group compared to athletes in the waitlisted control group as measured by the Athlete Burnout Questionnaire. Additionally, at follow-up evaluation, it was observed that the decrease in burnout scores was maintained by those athletes in the digital storytelling intervention.

Conclusion:

Digital storytelling intervention based on rational emotive behaviour therapy shows great potentials in addressing burnout among adolescent-athletes with disabilities.
Effects and safety of intranasal phototherapy for allergic rhinitis
Authors: Kang Jeongin , Lee Goeun , Son Miju , Kim Youngeun , Heo Namhun , Lee Donghyo
Published: July 2020

Introduction:

Allergic rhinitis (AR) is an immunoglobulin E (Ig E)-mediated inflammatory disease. Intranasal phototherapy is a promising treatment modality because it has a profound immunosuppressive effect, but the evidence of its use for AR is insufficient. Therefore, rigorously designed randomized controlled trials (RCTs) are needed. Our objective is to describe the protocol for an RCT to assess the effects and safety of intranasal phototherapy for the treatment of AR.

Methods and analysis:

This is a study protocol for a single-center, randomized, parallel (acupuncture-controlled), open-label, investigator-initiated, pilot study. A total of 80 patients with AR will be randomly assigned to the intranasal phototherapy or acupuncture group at a 1:1 ratio. The participants will receive intranasal phototherapy with medical or acupuncture treatment for 20 minutes, 3 times a week for 4 weeks. The primary outcome will be the mean change in the total nasal symptom score (TNSS) from baseline to 4 weeks. The secondary outcomes will include the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, Nasal Endoscopy Index, total serum immunoglobulin E (Ig E) level and eosinophil count.

Discussion:

The findings of this study will provide the basis for the design and implementation of RCTs investigating the effects and safety of intranasal phototherapy for AR. Additionally, it will provide preliminary evidence of intranasal phototherapy for use in AR.

Trial registration:

This study was registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0004079).
Plasma vascular adhesion protein-1 levels correlate positively with frailty severity in older adults
Authors: Huang Hsien-Liang , Chang Chin-Hao , Chen Chin-Ying , Peng Jen-Kuei , Wang Yu-Ting , Chen Ching-Yu , Hsu Chih-Cheng , Lee Chung-Sheng , Tsai Jaw-Shiun
Published: July 2020

Geriatric frailty is associated with increased mortality and links to increased inflammatory activity. Vascular adhesion protein-1 (VAP-1) is important in inflammatory process. This study investigates the relationship between plasma VAP-1 level and frailty in older adults.

The cross-sectional study recruited community dwelling older adults from a hospital-based comprehensive geriatric assessment program. The demographic data, Fried Frailty Index, metabolic and inflammatory parameters were assessed.

A total of 151 participants (76 women, 50.3%) were included in the analysis, and the age (mean ±  standard deviation) was 77.1 ± 6.1 years. The mean plasma VAP-1 level (ng/mL) was significantly different (P = .029) among different frailty groups (346.3 ± 86.5 in the robust older adults, 371.6 ± 107.9 in the pre-frail older adults, and 416.6 ± 141.1 in the frail older adults). Multivariate ordered logistic regression analysis also demonstrated that plasma VAP-1 levels were positively associated with frailty severity (P = .039). Analysis of the frailty components with plasma VAP-1 levels showed that the elderly who had “exhaustion” (P = .016) or “weakness” (P = .025) tended to have higher plasma VAP-1 levels.

The data support that VAP-1 might represent a potential plasma biomarker of frailty.
Comparision of biportal endoscopic and microscopic decompression in treatment of lumbar spinal stenosis
Authors: Wu Jun , Guan Tao , Tian Feng , Liu Xueqi
Published: July 2020

Background:

Microscopic bilateral decompression (MBD) has been suggested as an alternative to open laminectomy and fusion. Recently, percutaneous biportal endoscopic decompression (PBED) has begun to attract attention. The purpose of this retrospective study was to evaluate postoperative pain, functional disability, symptom reduction and satisfaction, and specific surgical parameters between the MBD and PBED techniques in patients with lumbar spinal stenosis (LSS).

Methods:

A retrospective review of LSS patients performed with MBD or PBED technique between May 2015 and June 2018 was conducted. Institutional review board approval in People's Hospital of Ningxia Hui Nationality Autonomous Region was obtained prior to conducting chart review and analysis. We received informed consent from all patients before surgery. The primary outcomes assessed were the preoperative to postoperative changes in leg/back pain and disability/function, patient satisfaction with the procedure, and postoperative quality of life. The secondary outcomes including duration of postoperative hospital stay, time to mobilization, postoperative analgesic use, complication rates, and baseline patient characteristics were prospectively collected.

Results:

The hypothesis was that the PBED technique would achieve better clinical outcomes as compared to the MBD technique in LSS.
Neuromuscular electrical stimulation for cancer pain in children with osteosarcoma
Authors: Wang Tian-Shu , Wang Shou-Feng , Song Wei-dong , Tang Zhao-chen , Wei Wei , Wang Guan-kai
Published: July 2020

Background:

This systematic review will assess the effectiveness and safety neuromuscular electrical stimulation (NMES) for cancer pain (CP) in children with osteosarcoma.

Methods:

This systematic review protocol will retrieve the following electronic databases from inception to June 1 in Cochrane Library, MEDLINE, EMBASE, Web of Science, Scopus, CNKI, and VIP database. Manual head-searching of reference lists and conference proceedings will be performed to further examine the articles of interest. No restrictions will be applied to language and publication status. We will utilize a 3-stage approach to scan titles, abstracts, and full-text studies against all eligibility criteria, and collect data from included trials. Study quality will be evaluated by the Cochrane Risk of Bias Tool. If possible, we will narratively summarize study results and carry out meta-analysis.

Results:

This study will recapitulate the present high quality trials to appraise the effectiveness and safety of NMES for CP in children with osteosarcoma.

Conclusion:

The findings of this study will present evidence to determine whether NMES is effective and safe for CP in children with osteosarcoma.
Maternal bacteria to correct abnormal gut microbiota in babies born by C-section
Authors: Butler Éadaoin M. , Chiavaroli Valentina , Derraik José G.B. , Grigg Celia P. , Wilson Brooke C. , Walker Nicholas , O'Sullivan Justin M. , Cutfield Wayne S.
Published: July 2020

Introduction:

There is evidence that caesarean section (CS) is associated with increased risk of childhood obesity, asthma, and coeliac disease. The gut microbiota of CS-born babies differs to those born vaginally, possibly due to reduced exposure to maternal vaginal bacteria during birth. Vaginal seeding is a currently unproven practice intended to reduce such differences, so that the gut microbiota of CS-born babies is similar to that of babies born vaginally. Our pilot study, which uses oral administration as a novel form of vaginal seeding, will assess the degree of maternal strain transfer and overall efficacy of the procedure for establishing normal gut microbiota development.

Methods and analysis:

Protocol for a single-blinded, randomized, placebo-controlled pilot study of a previously untested method of vaginal seeding (oral administration) in 30 CS-born babies. A sample of maternal vaginal bacteria is obtained prior to CS, and mixed with 5 ml sterile water to obtain a supernatant. Healthy babies are randomized at 1:1 to receive active treatment (3 ml supernatant) or placebo (3 ml sterile water). A reference group of 15 non-randomized vaginal-born babies are also being recruited. Babies’ stool samples will undergo whole metagenomic shotgun sequencing to identify potential differences in community structure between CS babies receiving active treatment compared to those receiving placebo at age 1 month (primary outcome). Secondary outcomes include differences in overall gut community between CS groups (24 hours, 3 months); similarity of CS-seeded and placebo gut profiles to vaginally-born babies (24 hours, 1 and 3 months); degree of maternal vaginal strain transfer in CS-born babies (24 hours, 1 and 3 months); anthropometry (1 and 3 months) and body composition (3 months).

Ethics and dissemination:

Ethics approval by the Northern A Health and Disability Ethics Committee (18/NTA/49). Results will be published in peer-reviewed journals and presented at international conferences.

Registration:

Australian New Zealand Clinical Trials Registry (ACTRN12618000339257).
A comparison of the efficacy and safety of complementary and alternative therapies for gastroesophageal reflux disease
Authors: Zhang Shixiong , Jiang Qian , Mu Xiyan , Wang Zehou , Liu Shaowei , Yang Zeqi , Xu Miaochan , Ren Xuetong , Wang Yangang
Published: July 2020

Background:

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the world and is showing increasing prevalence in some countries. The disease has a chronic course that leads to a significant decline in the quality of life of patients and is associated with a high economic burden worldwide. And complementary and alternative medicine is used to treat the disease. Over the past few decades, a number of randomized controlled trials and systematic evaluations have been conducted to evaluate the effectiveness and safety of different types of complementary and alternative medicine methods, so there is an urgent need to summarize and further evaluate these studies.

Methods:

We will search the following sources without restrictions for date, language, or publication status: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Library, and EMBASE, China National Knowledge Infrastructure, Chinese Bio-medicine Database, VIP Chinese Periodical Database, Wan Fang Database. We will apply a combination of Medical Subject Heading and free-text terms incorporating database-specific controlled vocabularies and text words to implement search strategies. We will also search the ongoing trials registered in the World Health Organization's International Clinical Trials Registry Platform. Besides, the previous relevant reviews conducted on complementary and alternative therapies for GERD and reference lists of included studies will also be searched.

Results:

This study will provide a reliable basis for the treatment of GERD with complementary and alternative therapies.

Conclusions:

The findings will be an available reference to evaluate the efficacy and safety of complementary and alternative therapies on GERD and may provide decision-making reference on which method to choose for clinicians.

PROSPERO registration number:

PROSPERO CRD42020169332.
Papillary thyroid carcinoma with hyperthyroidism and multiple metastases
Authors: Zhang Li-li , Liu Bin , Sun Fang-fang , Li Hong-yu , Li Shuang , Zhao Li-rong
Published: July 2020

Rationale:

Papillary thyroid carcinoma (PTC) is the most common type of primary thyroid cancer with a low incidence of distant metastases. PTC represents more than 70% to –90% of thyroid malignancies. Distant metastases have only been observed in only 1% to 15% of patients with PTC. In this article, we reported the case of a patient with PTC and hyperthyroidism as well as simultaneous multiple metastases.

Patient concerns:

A 47-year-old man was admitted to our hospital on February 22, 2019, with several neck masses that had been present for 12 months, low back pain for 9 months, and lower limb paraplegia for 3 months.

Diagnoses:

According to the patient physical examination, adjuvant examination (e.g., ultrasound, computed tomography, magnetic resonance imaging, blood test, and biopsy) and medical history, the clinical diagnosis was as follows: thyroid papillary carcinoma; cervical lymph node metastasis; multisite bone metastasis (6th and 7th cervical vertebrae, left clavicle proximal, right scapula bone, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, bilateral ilium, and left pubic bone); muscular metastasis (the right medial femoral muscle, the vastus lateralis muscle, left thigh muscle, and the flexor superficialis of the left forearm); possible mediastinal lymph node metastasis; and paraplegia due to the soft-tissue metastasis around the 9th thoracic vertebral spine; and hyperthyroidism (free thyroxine: 36.59 pmol/L, free triiodothyronine: 9.58 pmol/L, thyroid-stimulating hormone: 0.005 μIU/mL, thyroid autoantibody: 2.53 IU/L).

Interventions and outcomes:

The patient refused to undergo further intervention or follow-up.

Lessons:

In summary, this is the 1st case of in which a patient with PTC and hyperthyroidism, as well as simultaneous multiple skeletal muscles and bone metastases, lymph node metastasis, and paraplegia was observed. In practice, in cases where patients have PTC and hyperthyroidism, practitioners should perform further examinations to rule out the presence of distant metastases. We believe that the use of ultrasound has a unique advantage in the diagnosis of PTC and skeletal muscle metastasis.
Concurrent ductal adenocarcinoma, pseudocyst, and neuroendocrine tumor of the pancreas
Authors: Liu Yu , Wang Changxin , Hu Xiaofeng , Wang Minrui , Wang Ying , Ye Mingshan , Liu Ying
Published: July 2020

Introduction:

Pancreatic pseudocyst is one of the most common cystic lesions. It always occurs following pancreatitis and is rarely found in combination with pancreatic adenocarcinoma. The coexistence of exocrine and neuroendocrine tumors of the pancreas is also infrequent. We herein report a case of simultaneous occurrence of a pancreatic ductal adenocarcinoma (PDAC), pseudocyst, and neuroendocrine tumor (NET), showing a “side-by-side pattern.”

Patient concern:

A 74-year-old man was hospitalized for epigastric pain and poor appetite. He had no history of pancreatitis, alcohol consumption, or smoking.

Diagnosis and intervention:

Abdominal enhanced computed tomography and magnetic resonance imaging revealed a 15 × 8 cm cystic lesion with poor enhancement located in the tail of the pancreas. The distal aspect of the main pancreatic duct was dilated. The pancreatic parenchyma adjacent to the cystic lesion showed slightly heterogeneous enhancement on computed tomography and magnetic resonance imaging. Laboratory examination showed an elevated carbohydrate antigen 19–9 serum level. The patient was preoperatively diagnosed with intraductal papillary mucinous neoplasm and subsequently underwent laparotomy. During the operation, a hard white tumor measuring about 4 × 3 cm was palpated adjacent to the cystic lesion on the duodenal side, and a 0.6-cm nodule was simultaneously found in the pancreatic tail. Therefore, total pancreatectomy and splenectomy were performed. Histopathological examination showed that the tumor was PDAC with an adjacent pseudocyst, and the small nodule was suggestive of a NET.

Outcomes:

The patient survived without recurrence or metastasis in the follow-up visit 10 months after the operation and adjuvant chemotherapy.

Conclusions:

The concomitant occurrence of a PDAC, pseudocyst, and NET has not been previously reported. We suggest that if a pancreatic cyst is found, the coincidental occurrence of a malignant tumor should be considered, especially if the carbohydrate antigen 19–9 level is increased. Additionally, dilation of the pancreatic duct may be a diagnostic clue. Furthermore, the simultaneous occurrence of pancreatic endocrine and exocrine tumors is very uncommon. Preoperative diagnosis becomes difficult because of the lack of specific symptoms and radiological features.
Identification of key genes and pathways in IgA nephropathy using bioinformatics analysis
Authors: Hu Shou-Liang , Wang Dan , Yuan Fan-Li , Lei Qing-Feng , Zhang Yong , Cheng Jun-Zhang
Published: July 2020

Background:

IgA nephropathy (IgAN) is the most frequent type of primary glomerulonephritis globally and the leading cause of end-stage renal disease in young adults. Its pathogenesis is not fully known, but is largely attributed to genetic factors. This study was aimed to explore the prognostic values of key genes in IgAN.

Methods:

The gene expression profile GSE93798 of 20 IgAN samples and 22 normal samples using glomeruli from kidney biopsy was adopted. Totally 447 upregulated and 719 downregulated differentially expressed genes were found in IgAN patients on the R software. The Gene Ontology enrichment and the Kyoto Encyclopedia of Gene and Genomes pathway were investigated on DAVID, and the protein-protein interaction network and the top 13 hub genes of the differentially expressed genes were built via the plug-in molecular complex detection and cytoHubba of Cytoscape.

Results:

From the protein-protein interaction network, of the top 13 hub genes, FOS, EGFR, SIRT1, ALB, TFRC, JUN, IGF1, HIF1A, and SOCS3 were upregulated, while CTTN, ACTR2, CREB1, and CTNNB1 were downregulated. The upregulated genes took part in the HIF-1 signaling pathway, Choline metabolism in cancer, Pathways in cancer, Amphetamine addiction, Estrogen, TNF, and FoxO signaling pathways, and Osteoclast differentiation, while the downregulated genes were involved in Pathogenic Escherichia coli infection, Bacterial invasion of epithelial cells, prostate cancer, and melanogenesis.

Conclusion:

This study based on the Gene Expression Omnibus database updates the knowledge about the mechanism of IgAN and may offer new treatment targets.
Unexpected SARS-CoV-2 cardiorespiratory arrest in a myopathy patient undergoing immunosuppressive treatment
Authors: DePace Nicholas L. , Soloway Stephen , Roshal David , Soloway Alyxandra Morgan , Colombo Joe
Published: July 2020

Rationale:

It is recommended that patients with Rheumatic diseases that are at high risk of developing active infections be screened for Tuberculosis, Hepatitis B, and Hepatitis C before receiving second-line immunosuppressive therapies. With the emergence 2019 novel coronavirus (SARS-CoV-2), expanded guidelines have not been proposed for screening in these patients before starting advanced therapy.

Patient concerns:

We present an unique circumstance whereas a patient with a 5 year history of inflammatory muscle disease, diagnosed by clinical history and muscle biopsy with elevated creatine kinase levels, suffered a hypoxemic cardiopulmonary arrest due to asymptomatic SARS-CoV-2 after receiving advanced immunosuppressive therapy.

Diagnoses:

The patient presented with an acute exacerbation of inflammatory muscle disease with dysphagia, muscle weakness, and elevated creatine kinase.

Interventions:

After no improvement with intravenous immunoglobulin the patient received mycophenolate and plasma exchange therapy.

Outcomes:

Subsequently the patient suffered a fatal hypoxemic cardiopulmonary arrest. Polymerase chain reaction test was positive for SARS-CoV-2 RNA.

Lessons:

We conclude that rheumatic patients, asymptomatic for SARS-CoV-2 infection, be screened and tested before initiating second-line immunosuppressive treatment.
Clinical and CT characteristics of healthcare workers with COVID-19
Authors: Xiong Ying , Zhang Qiang , Sun Dong , Zhu Wenzhen
Published: July 2020

A large number of healthcare workers have been infected with coronavirus disease-2019 (COVID-19). We aimed to investigate their clinical and chest computed tomography (CT) characteristics.

The clinical, laboratory test and CT features of 43 medical and hospital staff with confirmed COVID-19 (MP group, 26–70 years old) were retrospectively analyzed, and compared to 43 non-medical related patients (non-MP group, 26–71 years old). Follow-up CT characteristics were analyzed to assess the disease progression in the period of hospitalization.

At admission, the main complaints of the MP group, including fever (81.4%), fatigue (48.8%) and cough (41.9%), were similar to the non-MP group. The C-reactive protein, erythrocyte sedimentation rate, and lactate dehydrogenase levels were higher in the non-MP group than the MP group (17.5 ± 22.4 mg/L, 20.2 ± 23.4 mm/H and 219 ± 66U/L, respectively, P < .05). Ground-grass opacities, consolidation, interstitial thickening were common CT features of both groups. The severity of opacities on initial CT were less in the MP group (5.3 ± 3.9 scores) than in the non-MP group (9.1 ± 4.8 scores, P < .05). Before regular treatments, the sum score of the opacities showed weak to moderate correlations with duration, C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase levels (R ranged from 0.341–0.651, P < .05). In the study time window, the duration from illness onset to when the most obvious pulmonary opacities were observed, according to CT findings, were similar in the MP group (13.3 ± 6.6 days) and the non-MP group (13.8 ± 5.1 days, P = .69). Mild to moderate anxiety and depression were observed in both groups.

Despite greater knowledge of how to protect themselves than the general population, healthcare workers are also susceptible to COVID-19 infection. Occupational exposure is a very important factor. Healthcare workers have a higher vigilance about the infection in the early stage of the disease.
A systematic review and meta-analysis of the efficacy and safety of arbidol in the treatment of coronavirus disease 2019
Authors: Wang Xuemei , Xie Ping , Sun Guojuan , Zhao Min , Deng Zhumei , Zhou Yunxia , Bao Shuting
Published: July 2020

Background:

Coronavirus disease 2019 (COVID-19) is highly contagious, and the epidemic has spread to hundreds of countries around the world, and seriously threatens the life safety of people around the world. Arbidol is an antiviral drug with high potential against COVID-19, but evidence of effectiveness and safety is lacking. The systematic review protocol aims to formulate a research plan that can evaluate the efficacy and safety of arbidol for COVID-19.

Methods:

The retrieval time will be from the database establishment to June 2020. The retrieval database will include the Cochrane Library, PubMed, Embase, OVID, CNKI, Wanfang, VIP, CBM, etc. The primary outcome will be clinical efficacy, and the secondary results will be accompanying symptoms, time for the temperature to return to normal, time of novel coronavirus nucleic acid turning negative, blood sample test, Computed Tomography examination, length of hospitalization, adverse reactions, and adverse events. RevManV.5.3 software will be used for meta-analysis, and fixed effects model, random-effects model, subgroup analysis, and descriptive analysis will be adopted according to the heterogeneity of the research results.

Results:

To provide the latest evidence of clinical efficacy and safety of arbidol in the treatment of COVID-19.

Conclusion:

Our study will provide the latest evidence analysis of the efficacy and safety of arbidol for COVID-19, to provide evidence-based medicine for the prevention and control of this epidemic.

Registration details:

PROSPERO CRD42020189203.
Efficacy and safety of dapagliflozin plus saxagliptin vs monotherapy as added to metformin in patients with type 2 diabetes
Authors: Zhuang Yan , Song Jin , Ying Miaofa , Li Mingxing
Published: July 2020

Background:

This study aim at evaluating the efficacy and safety of dapagliflozin plus saxagliptin vs monotherapy as added to metformin in patients with type 2 diabetes mellitus (T2DM).

Method:

PubMed, Cochrane library, Embase, CNKI and Wanfang databases were searched up to 31 December 2019. Randomized controlled trials (RCTs) applicable in dapagliflozin plus saxagliptin vs monotherapy as added to metformin in the treatment of T2DM were included. The outcomes included changes in HbA1c, FPG, body weight, SBP, DBP and adverse reactions. Fixed or random effects model were used to assess these outcomes.

Results:

In this study, 8 RCTs involved 7346 patients were included. Compared with dapagliflozin plus metformin(DM) group, patients treated with dapagliflozin plus saxagliptin add on to metformin(DSM) could significantly increase the adjusted mean change levels of HbA1c, FPG, SBP and DBP(P < .00001, SMD = −4.88, 95%CI = −6.93∼−2.83; P < .00001, SMD = −6.50, 95%CI = −8.55∼−4.45; P < .00001, SMD = −0.97, 95%CI = −1.15∼−0.78; P < .00001, SMD = −2.00, 95%CI = −2.20∼−1.80), but no major difference in body weight loss showed(P = .12, SMD = 0.92, 95%CI = −0.22∼2.06). Furthermore, DSM therapy displayed better effects than saxagliptin plus metformin(SM) in the adjusted mean change levels of HbA1c, FPG, body weight and SBP(P < .00001, SMD = −7.75, 95%CI = −8.84∼−6.66; P < .00001, SMD = −7.75, 95%CI = −8.84∼−6.66; P = .04, SMD = −3.40, 95%CI = −6.64∼−0.17; P = .04, SMD = −7.75, 95%CI = −8.84∼−6.66), whereas no obvious difference in lowering DBP(P = .18, SMD = −16.35, 95%CI = −40.12∼7.41). Additionally, compared with DM and SM groups, there were no remarkable difference in the incidence of nausea, influenza, headache, diarrhea, urinary tract infection and renal failure for patients taking DSM, but the incidence of genital infection and hypoglycemia were higher in DSM group.

Conclusions:

Patients taking the DSM therapy had better effects in reducing the level of HbA1c, FPG, body weight, SBP and DBP than the DM and SM therapy. However, patients treated with DSM therapy are more likely to have hypoglycemia and genital infection. Dapagliflozin plus saxagliptin may be a suitable therapy strategy for patients with T2DM inadequately controlled with metformin, and this will provide a clinical reference for the treatment of T2DM.
Variable Mechanisms of Sudden and Unexpected Death in Cases of Occult Carcinoma of the Larynx
Authors: Byard Roger W. , Heath Karen
Published: July 2020

Two cases of clinically undiagnosed laryngeal squamous cell carcinomas in men aged 57 and 66 years, respectively, are reported that resulted in sudden death from upper airway occlusion. The cause of the terminal event differed between the 2 cases with acute airway narrowing being precipitated by tenacious mucopurulent secretions in case 1 and hemorrhage from surface ulceration with glottic occlusion by blood clot in case 2. At autopsy, the immediate cause of acute airway compromise in cases of space-occupying laryngeal lesions may, therefore, be due to the synergistic effects of different factors.
Developments in X-Ray Contrast Media and the Potential Impact on Computed Tomography
Authors: Schöckel Laura , Jost Gregor , Seidensticker Peter , Lengsfeld Philipp , Palkowitsch Petra , Pietsch Hubertus
Published: July 2020

Over the past 120 years, continuous developments in medical imaging has improved diagnosis and treatment for many diseases and has thereby improved treatment outcome and quality of life of many patients. The number of computed tomography (CT) examinations is today increasing by 4% per year worldwide, for a total of approximately 300 million CT scans per year. About 40% of CT scans are contrast enhanced. Intravenous iodinated contrast media are commonly used for contrast enhancement in CT scans to evaluate diseases and determine treatment response. The current gold standards for intravenous x-ray contrast media in CT or interventional angiography are iodinated low- and iso-osmolar compounds such as iopromide, iohexol, or iodixanol. Both classes have similar and favorable efficacy and safety profiles. Although iodine is biologically inert, iodinated contrast media can cause adverse reactions. In the future, one possibility would be to develop iodine-free contrast media that are better suited to higher x-ray tube voltage ranges, allowing greater flexibility for scanning protocols and thus leading to techniques that can provide equivalent diagnostic value at lower doses of radiation. Iodine-free contrast media would in addition provide an alternative to the market standard that could offer benefits for patients with known reactions to low-osmolality contrast media or thyroid disorders. The development of a new contrast medium, however, needs to be put in context with all upcoming technological advances in x-ray and CT. New detector technologies and artificial intelligence algorithms will in the future also improve the CT image reconstruction enabling the reduction of contrast media and radiation doses.
Impact of Confounding Thoracic Tubes and Pleural Dehiscence Extent on Artificial Intelligence Pneumothorax Detection in Chest Radiographs
Authors: Rueckel Johannes , Trappmann Lena , Schachtner Balthasar , Wesp Philipp , Hoppe Boj Friedrich , Fink Nicola , Ricke Jens , Dinkel Julien , Ingrisch Michael , Sabel Bastian Oliver
Published: July 2020

Objectives

We hypothesized that published performances of algorithms for artificial intelligence (AI) pneumothorax (PTX) detection in chest radiographs (CXRs) do not sufficiently consider the influence of PTX size and confounding effects caused by thoracic tubes (TTs). Therefore, we established a radiologically annotated benchmarking cohort (n = 6446) allowing for a detailed subgroup analysis.

Materials and Methods

We retrospectively identified 6434 supine CXRs, among them 1652 PTX-positive cases and 4782 PTX-negative cases. Supine CXRs were radiologically annotated for PTX size, PTX location, and inserted TTs. The diagnostic performances of 2 AI algorithms (“AI_CheXNet” [Rajpurkar et al], “AI_1.5” [Guendel et al]), both trained on publicly available datasets with labels obtained from automatic report interpretation, were quantified. The algorithms' discriminative power for PTX detection was quantified by the area under the receiver operating characteristics (AUROC), and significance analysis was based on the corresponding 95% confidence interval. A detailed subgroup analysis was performed to quantify the influence of PTX size and the confounding effects caused by inserted TTs.

Results

Algorithm performance was quantified as follows: overall performance with AUROCs of 0.704 (AI_1.5) / 0.765 (AI_CheXNet) for unilateral PTXs, AUROCs of 0.666 (AI_1.5) / 0.722 (AI_CheXNet) for unilateral PTXs smaller than 1 cm, and AUROCs of 0.735 (AI_1.5) / 0.818 (AI_CheXNet) for unilateral PTXs larger than 2 cm. Subgroup analysis identified TTs to be strong confounders that significantly influence algorithm performance: Discriminative power is completely eliminated by analyzing PTX-positive cases without TTs referenced to control PTX-negative cases with inserted TTs. Contrarily, AUROCs increased up to 0.875 (AI_CheXNet) for large PTX-positive cases with inserted TTs referenced to control cases without TTs.

Conclusions

Our detailed subgroup analysis demonstrated that the performance of established AI algorithms for PTX detection trained on public datasets strongly depends on PTX size and is significantly biased by confounding image features, such as inserted TTS. Our established, clinically relevant and radiologically annotated benchmarking cohort might be of great benefit for ongoing algorithm development.
Management of Mid-Vault Asymmetry in Secondary Unilateral Cleft Lip-Nose Deformity
Authors: Park Joo Seok , Jeong Hyung Hwa , Koh Kyung S.
Published: July 2020

The focus of secondary rhinoplasty for patients with a cleft lip after facial growth has been on correcting nasal tip asymmetry and distorted cleft-side lower lateral cartilage. However, some patients present with mid-vault asymmetry even after secondary rhinoplasty. The authors propose camouflage procedures for patients with a unilateral cleft lip and without symptoms of nasal airway obstruction. In camouflage procedures, autologous cartilage or acellular dermal matrix was used for onlay grafting and placed on the upper lateral cartilage. In this report, case examples are described to illustrate the surgical techniques and results. This method enables the correction of mid-vault asymmetry without the use of an additional septal spreader graft.
The Pericranial Flap as a Salvage Procedure in Pediatric Neurosurgical Complications
Authors: Karami Reem A. , Atallah Georgio M. , Ghanem Odette Abou , Abu Sittah Ghassan , Ibrahim Amir E.
Published: July 2020

The pericranium is a vascularized structure that can be used for the treatment of complex scalp and skull defects. It is also utilized as a prophylactic measure to prevent wound complications in high-risk patients. In this study, we looked at the use of the pericranial flap in pediatric patients. A retrospective chart review was done in the American University of Beirut Medical Center from February 2010 to 2020. Ten pediatric patients were identified who required either prophylactic pericranial flap (n 
= 
3) or for treatment of a chronic draining sinus (n = 
7). Patients were followed up for an average of 23 days. There were no cases of infection, hematoma, seroma, or meningitis. Only 1 case developed dehiscence of the skin. It was managed conservatively and healed within 2 weeks. The pericranial flap is a workhorse flap for scalp and skull reconstruction, with no donor site morbidity and thus should always be considered.
Early Screening of Risk for Multidrug-Resistant Organisms in the Emergency Department in Patients With Pneumonia and Early Septic Shock: Single-Center, Retrospective Cohort Study
Authors: Yiang Giou-Teng , Tzeng I-Shiang , Shui Hao-Ai , Wu Meng-Yu , Peng Ming-Yieh , Chan Chih-Yu , Chan Edward D. , Wu Yao-Kuang , Lan Chou-Chin , Yang Mei-Chen , Huang Kuo-Liang , Wu Chih-Wei , Chang Chia-Hui , Su Wen-Lin
Published: July 2020

Objectives:

Pneumonia is the fourth leading cause of death globally, with rapid progression during sepsis. Multidrug-resistant organisms (MDROs) are becoming more common with some healthcare-associated pneumonia events. Early detection of MDRO risk improves the outcomes; however, MDROs risk in pneumonia with sepsis is unknown. This study investigated the disease outcomes of pneumonia with septic shock in patients admitted in the emergency department (ED) intensive care unit (ICU), a population with a high prevalence of MDROs, after early screening of MDROs risk.

Methods:

In this retrospective cohort study, patients with pneumonia and early septic shock (n = 533) admitted to the ED at the Taipei Tzu Chi Hospital from 2013 to 2019 were selected. The study population was divided into four subgroups after the MDROs risk and screening procedure were completed within 1 or 6 h of admission. ICU mortality and multidrug antibiotic therapy were compared.

Results:

The high-risk MDROs groups had higher percentage of P aeruginosa than the low-risk group. Furthermore, the appropriate ED first antibiotics were higher in the 1-h subgroup than in the 6-h subgroup of the high-risk MDROs group. In multivariate analysis, the 6-h high-risk MDROs group had an adjusted odds ratio of 7.191 (95% CI: 2.911–17.767, P < 0.001) and 2.917 (95% CI: 1.456–5.847, P = 0.003) for ICU mortality and multidrug therapy in the ICU, respectively, after adjusting for other confounding factors.

Conclusions:

MDRO screening within 1 h is recommended following admission of patients with pneumonia and early septic shock in the ED, especially in areas with a high prevalence of MDROs.
Quantification of Intraoperative Blood Loss in a Simulated Scenario Using a Novel Device
Authors: Piekarski Florian , Gerdessen Lara , Schmitt Elke , Friedrichson Benjamin , Neef Vanessa , Meybohm Patrick , Zacharowski Kai , Raimann Florian J. , Wunderer Florian
Published: July 2020

Background:

Particularly for protracted bleeding situations, the realization of a relevant blood loss is necessary for early initiation of therapy to avoid hemodynamic instability and shock. The frequently used visual assessment of blood loss is known to be incorrect. An innovative option to address this problem is a mobile application using colorimetric image correction and analysis.

Methods:

The objective of this study was to evaluate the clinical applicability and accuracy of a novel mobile device application using colorimetric image correction and analysis for blood loss estimation. Scenarios of blood-filled surgical sponges were created to evaluate the accuracy of colorimetric-based blood loss estimation and visual and gravimetric blood loss estimation.

Results:

Fifty-three anesthesiologists ran through the scenarios. The estimated blood loss correlated the least with the reference blood loss in the visual technique (Rho: 0.52; P < 3.7×10−16), followed by the gravimetric technique (Rho: 0.73; P = 2.8×10−05). The best correlation was found in the colorimetric blood loss measurement (Rho: 0.77; P = 3.53×10−06). A median overestimation per scenario of 133.0 mL (interquartile range [IQR] 33.0 mL–283.0 mL) was observed when using the visual method, whereas 32.5 mL (IQR 10.8 mL–44.0 mL) was overestimated with the gravimetric method and 31 mL (IQR 17.0 mL–42.8 mL) with the colorimetric method. Especially in the case of blood loss underestimation, the application has the least deviation from the reference.

Conclusion:

The blood loss measured in the sponges correlated strong with the reference blood loss, showing the smallest median overestimation and the smallest deviation in underestimation. The visual estimation shows serious errors, where the gravimetric method is prone to errors, especially in dilution. The colorimetric method offers an easily implementable possibility to monitor blood loss in real time and to initiate early diagnostic and therapeutic measures in case of persistent blood loss. The influence of real-time estimation of colorimetric blood loss on transfusion decisions should be the subject of future studies.
Effects of Systemic Hypothermia on Microcirculation in Conditions of Hemodynamic Stability and in Hemorrhagic Shock
Authors: Caminos Eguillor Juan Francisco , Ferrara Gonzalo , Kanoore Edul Vanina Siham , Buscetti María Guillermina , Canales Héctor Saúl , Lattanzio Bernardo , Gatti Luis , Gutierrez Facundo Javier , Dubin Arnaldo
Published: July 2020

Introduction:

Although hypothermia is independently associated with an increased mortality in trauma patients, it might be an effective therapeutic approach for otherwise lethal hemorrhage. The effect of hypothermia on microcirculation, however, has been poorly studied in this setting. Our goal was to characterize the effects of hypothermia on microcirculation in normal conditions and in severe hemorrhagic shock.

Methods:

In anesthetized and mechanically ventilated sheep, we measured cardiac output (CO), renal blood flow (RBF), and systemic and renal O2 consumption (VO2). Cortical renal, intestinal villi, and sublingual microcirculation was assessed by IDF-videomicroscopy. After basal measurements, sheep were assigned to hypothermia (n = 12) and normothermia (n = 12) groups. Central temperature was reduced to ∼34°C and maintained at baseline in each group, respectively. Measurements were repeated after 1 h of hemodynamic stable conditions and 1 h of severe hemorrhagic shock.

Results:

In conditions of hemodynamic stability, the hypothermia group showed lower CO, RBF, and systemic and renal VO2 than the normothermia group. Red blood cell velocity was also lower in renal, villi, and sublingual microvascular beds (836 ± 195 vs. 1,066 ± 162, 916 ± 105 vs. 1051 ± 41, and 970 ± 182 vs. 1,102 ± 49 μm/s, respectively; P < 0.0001 for all). In hemorrhagic shock, most of the microvascular variables were similarly compromised in both the groups. In hypo- and normothermia groups, the percentage of reduction in perfused vascular density was higher in renal than in intestinal and sublingual microcirculation (66 ± 31 vs. 31 ± 23 and 15 ± 15%, and 78 ± 26 vs. 32 ± 37 and 18 ± 21%, P < 0.01 for both).

Conclusions:

This is the first experimental study assessing the effect of systemic hypothermia on microcirculation in severe hemorrhagic shock. The main finding was that hypothermia did not hamper additionally the microcirculatory derangements induced by hemorrhagic shock. In addition, renal microcirculation was more susceptible to hemorrhagic shock than villi and sublingual microcirculation.