bluuebunny/crossref_metadata_2025 huggingface dataset:
An online time-to-event dashboard comparing the effective control of COVID-19 among continents using the inflection point on an ogive curve
Authors: Lee Keng-Wei , Chien Tsair-Wei , Yeh Yu-Tsen , Chou Willy , Wang Hsien-Yi
Published: March 2021

Background:

During the COVID-19 pandemic, one of the frequently asked questions is which countries (or continents) are severely hit. Aside from using the number of confirmed cases and the fatality to measure the impact caused by COVID-19, few adopted the inflection point (IP) to represent the control capability of COVID-19. How to determine the IP days related to the capability is still unclear. This study aims to (i) build a predictive model based on item response theory (IRT) to determine the IP for countries, and (ii) compare which countries (or continents) are hit most.

Methods:

We downloaded COVID-19 outbreak data of the number of confirmed cases in all countries as of October 19, 2020. The IRT-based predictive model was built to determine the pandemic IP for each country. A model building scheme was demonstrated to fit the number of cumulative infected cases. Model parameters were estimated using the Solver add-in tool in Microsoft Excel. The absolute advantage coefficient (AAC) was computed to track the IP at the minimum of incremental points on a given ogive curve. The time-to-event analysis (a.k.a. survival analysis) was performed to compare the difference in IPs among continents using the area under the curve (AUC) and the respective 95% confidence intervals (CIs). An online comparative dashboard was created on Google Maps to present the epidemic prediction for each country.

Results:

The top 3 countries that were hit severely by COVID-19 were France, Malaysia, and Nepal, with IP days at 263, 262, and 262, respectively. The top 3 continents that were hit most based on IP days were Europe, South America, and North America, with their AUCs and 95% CIs at 0.73 (0.61–0.86), 0.58 (0.31–0.84), and 0.54 (0.44–0.64), respectively. An online time–event result was demonstrated and shown on Google Maps, comparing the IP probabilities across continents.

Conclusion:

An IRT modeling scheme fitting the epidemic data was used to predict the length of IP days. Europe, particularly France, was hit seriously by COVID-19 based on the IP days. The IRT model incorporated with AAC is recommended to determine the pandemic IP.
Prevalence and risk factor analysis for the nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus
Authors: Zhou Qiumei , Wang Yulong , Wang Jiajia , Liu Yating , Qi Dehui , Yao Wei , Jiang Hui , Li Tingting , Huang Kaiquan , Zhang Wancun , Huo Xingxing
Published: March 2021

Although non-alcoholic fatty liver disease (NAFLD) is strongly associated with type 2 diabetes mellitus (T2DM), the diagnosis of NAFLD for T2DM patients remains a challenge.

This study aimed to investigate the prevalence and risk factors for the NAFLD in T2DM outpatients.

This is a retrospective, cross-sectional study that included 2405 T2DM patients treated and admitted for glucose control into the Endocrinology Department of our hospital from April 2017 to March 2019. Using strict exclusion criteria, the target patients were screened and divided into two groups: NAFLD patients (study group) and non-NAFLD patients (control group). Subsequently, 34 factors were compared between the two groups. Furthermore, multivariate analysis of the NAFLD risk factors was performed using logistic regression. Finally, the diagnostic significance of individual biochemical predictors, as well as the combined predictive indicator (CPI), for NAFLD was estimated using receiver operating characteristic (ROC) curve analysis.

In this study, the overall prevalence of NAFLD in T2DM patients was 58.67%. Of the target patients, 17 factors were identified by univariate analysis to be associated with NAFLD, and 8 factors were found to be significant predictors for NAFLD using binary logistic regression modeling. Furthermore, the CPI and C-Peptide represent high diagnostic value for NAFLD in T2DM patients.

This study provides a more comprehensive risk factor analysis for NAFLD in T2DM patients. These data can be used to provide timely diagnosis and effective management of NAFLD.
NK cells adjuvant therapy shows survival benefits in a gastric mixed signet ring cell carcinoma patient
Authors: Jin Yuan-Yuan , Yang Wen-Zhuo , Sun Zheng-Yang , Wang Zhong-Bo , Chen Jian , Wu Chun-Tao , Yang Zhao-Yong
Published: March 2021

Rationale:

Advanced signet ring cell (SRC) carcinoma has a worse prognosis. Therefore, early diagnosis and prevention is particularly important; SRC tumors have lower R0 resection rate and are thought to be less chemosensitive than non-SRCC. Consequently, a novel postoperative adjuvant treatment is urgently needed to improve clinical outcomes.

Patient concerns:

A 41-year-old female with advanced gastric SRC carcinoma was treated with radical gastrectomy and oxaliplatin-based regimen for 6 cycles after surgery. She was suspected of recurrence with the high level of carbohydrate antigen (CA) 72-4.

Diagnoses:

The gastroscopy revealed SRC carcinoma of gastric antrum and poorly differentiated adenocarcinoma in some areas. The diagnosis of postoperative pathology report was gastric cancer with stage III C (T4a, N3a, M0).

Interventions:

The level of CA72-4 rapidly increased during the 2 follow-up after the completion of conventional treatment, ex vivo-cultured allogeneic natural killer (NK) cell infusion was offered to prevent recurrence.

Outcomes:

Intravenous injections of NK cells combination with surgical treatment and chemotherapy showed therapeutic effects in this patient with possible relapse. The patient remained disease-free 46 months after the infusion of NK cells until the latest follow-up.

Lessons:

CA72-4 appeared to be the most sensitive and specific marker in the gastric cancer patient, and the high level of CA72-4 may indicate the risk of recurrence. This case report provide rationale for NK cell infusion following the rapid increase of CA72-4 to prevent recurrence.
Repeated rotation of a toric implantable collamer lens
Authors: Zhang Haorun , Fu Mengjun , Wang Jiahao
Published: March 2021

Introduction:

Implantable collamer lens have been used widely worldwide, and have been accepted by more and more doctors and patients due to good safety, stability, and effectiveness. However, there is still a problem of crystal rotation. The large angle rotation (over 10°) would weaken the original astigmatism correction effect and even induce irregular astigmatism, seriously affecting the visual quality of patients. Herein, we reported a case who had 2 times of crystal rotations after toric implantable collamer lens (TICL) implantation.

Patient concerns:

The patient was a 38-year-old man who underwent TICL implantation for the correction of high myopic astigmatism in eyes. He presented a sudden decrease in the visual acuity (VA) of the left eye 4 months after the TICL implantation. The uncorrected visual acuity (UCVA) was 8/20 (refraction, +2.25 −5.25 × 68).

Diagnosis:

Rotation of TICL was diagnosed. The toric marks with a rotation of 75° counter-clockwise from the original position were observed.

Interventions:

The TICL was re-set to the original position, leading to the UCVA of 12/20 in the left eye (refraction, −0.00 −0.75 × 131), with the vaulting of 589 μm. Ten months after the TICL relocation, the patient again presented a sudden decrease in the VA of the left eye, with the UCVA of 2/20 (refraction, +2.25 −5.00 × 66). Again, the toric marks with a rotation of 75° counter-clockwise from the original position was observed, just at the same position as the last rotation. This time, the TICL was removed. The axis and power were recalculated, and a new TICL was implanted, with the rotation of 73° counter-clockwise from the horizontal line of the temporal side.

Outcomes:

The patient obtained a final UCVA of 12/20 in the left eye (refraction, +0.50 −0.50 × 26), which remained stable in the 6-month follow-up period, with the vaulting of 602 μm.

Lessons:

Rotation is a common complication after TICL surgery. Relocation or replacement of TICL are safe and efficient ways to recover VA due to TICL rotation.
Acupotomy treatment for finger joint contracture after immobilization
Authors: Yoon Sang-Hoon , Cha Jiyun , Lee Eunji , Kwon Byeongjo , Cho Kyongha , Kim Sungha
Published: March 2021

Introduction:

Contractures frequently occur in the finger joints after immobilization. This report describes the effect of acupotomy treatment in patients with joint contracture due to immobilization of the finger joints.

Patient concerns and clinical findings:

Case 1 was of a 39-year-old male patient who had flexion limitation of the left thumb and difficulty in grasping. Case 2 was of a 41-year-old female patient who had flexion limitation of the right index finger and difficulty in typing. Stiffness occurred after tendon repair surgery and cast immobilization in both cases. In Case 1, the patient had limited flexion movement of the first metacarpophalangeal and interphalangeal joints after 5 weeks of immobilization of the left thumb in a cast. In Case 2, the patient had limited flexion movement after 3 weeks of immobilization of the second proximal interphalangeal joint of the left hand in a cast.

Diagnosis, interventions, and outcomes:

We diagnosed both patients with finger joint contracture due to immobilization. Conservative treatment for approximately 4 weeks did not lead to improvement in either patient. Acupotomy is the key treatment for improving movement in Korean Medicine. Therefore, acupotomy was performed, and joint stiffness markedly improved without adverse events. Both patients reported that the daily use of the damaged fingers became comfortable.

Conclusion:

We found that acupotomy may be effective for finger joint contracture due to improper immobilization. We suggest it as a simple and safe treatment for joint contracture.
Successful defibrillation using double sequence defibrillation
Authors: Choi Hyo Jeong , Noh Hyun
Published: March 2021

Introduction:

Defibrillation is effective and the most common treatment for ventricular fibrillation (VF) and pulseless ventricular tachycardia in patients with cardiac arrest.

Patient concerns:

Recently we experienced 3 cases refractory ventricular fibrillation (RVF) which was successfully terminated with double sequence defibrillation (DSD) in our emergency department, so we’d like to report and discuss it.

Diagnosis:

Cardiac arrest

Interventions:

A single defibrillation 200J was performed twice for patients with ventricular fibrillation in the initial rhythm of the emergency room. At the same time, intubation and intravenous access were achieved and epinephrine and amiodarone were administered. The 400J DSD was performed on RVF patients with sustained VFs, despite several trials of 150-200J defibrillation and adherence to advanced cardiac life support.

Outcomes:

All three RVF patients recovered spontaneous circulation after DSD.

Conclusion:

The three cases we have shown are small, but DSD improves the chance of spontaneous circulation. Therefore it is suggested that attempts of DSD to patients with RVF, especially in the prehospital stages as a way to improve the return of spontaneous circulation.
Meta-analysis of procalcitonin as a predictor for acute kidney injury
Authors: Feng Yunxia , He Haiyan , Jia Chao , Xu Zhihua , Li Yuan , Liao Dan
Published: March 2021

Background:

Procalcitonin (PCT) was used for predicting the development of acute kidney injury (AKI) in several studies recently. We aimed to investigate the accuracy of PCT for predicting AKI in this study.

Methods:

Studies that assessed the predictive performance of PCT for the development of AKI in adult patients were searched from Medline, Embase, and the Cochrane Library from inception to June 2020. We calculated the pooled sensitivities and specificities and the area under the summary receiver-operating characteristic (SROC) curves. I
2 was used to test the heterogeneity and the potential heterogeneity was investigated by meta-regression.

Results:

In total, 9 of 119 studies with 4852 patients were included, 1272 were diagnosed with AKI. In the overall analysis, the area under the SROC curve was 0.82 (95% CI, 0.79–0.85) and the pooled sensitivity and specificity were 0.76 (95% confidence interval [CI], 0.64–0.85) and 0.75 (95% CI, 0.61–0.86), respectively. In the subgroup analysis among septic patients, the pooled sensitivity and specificity were 0.59 (95% CI, 0.29–0.84) and 0.53 (95% CI, 0.31–0.74), and the area under the SROC was 0.57 (95% CI, 0.53–0.62).

Conclusion:

PCT may be a potential predictor for the development of AKI.
Chinese herbal injections combined with rt-PA intravenous thrombolysis for acute ischemic stroke
Authors: Wu Jing , Wang Le , Dong Xiaoke , Li Zhonghao , Wang Kaiyue , Li Lili , Liu Jinmin
Published: March 2021

Background:

Acute ischemic stroke (AIS) is an important factor leading to adult death and disability globally. For AIS patients who meet certain conditions, recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis is an important method recommended by national guidelines to achieve vascular recanalization. However, complications such as hemorrhagic transformation and vascular reocclusion after thrombolysis are still unsolved problems in clinical. Several systematic reviews of clinical randomized controlled trials (RCTs) in the past have shown that Chinese herbal injections (CHIs) can improve the neurological function of patients, increase the tolerance of ischemic tissues to hypoxia, and inhibit platelet aggregation. Therefore, this study conducted a meta-analysis of AIS treatment with intravenous thrombolysis alone and compared it with the combined application of CHIs. To evaluate whether CHIs have a synergistic effect on thrombolytic therapy and provide a basis for clinical application.

Methods:

The following databases will be searched until September 2020: ①English databases: PubMed, Cochrane Library, Embase; ②Chinese databases: CNKI, Wanfang database, Weipu database, SinoMed. RCTs will be included to compare the efficacy of thrombolysis combined with CHIs and thrombolysis alone in the treatment of AIS. Data extraction and risk of bias assessments will be carried out by 2 verifiers independently. The risk of bias will be evaluated through the Cochrane risk of bias tool. Review Manager software 5.3 will be used for statistical analysis.

Results:

This study will provide comprehensive evidence for the treatment of AIS by CHIs combined with intravenous thrombolysis from multiple aspects.

Conclusion:

The conclusion of the meta-analysis will provide a basis for judging whether CHIs combined with intravenous thrombolysis is an effective measure for the treatment of AIS.

Ethics and dissemination:

Ethical approval is not needed because this study will be based on data that already published. We will publish the findings of this study in a peer-reviewed journal and related conferences.

PROSPERO registration number:

CRD42020215546.
Waterproofing spray-associated pneumonitis review
Authors: Shimoda Masafumi , Tanaka Yoshiaki , Fujiwara Keiji , Furuuchi Koji , Osawa Takeshi , Morimoto Kozo , Yano Ryozo , Kokutou Hiroyuki , Yoshimori Kozo , Ohta Ken
Published: March 2021

Waterproofing spray-associated pneumonitis (WAP) proceeds to acute respiratory failure and is characterized by diffuse bilateral ground-glass opacities on computed tomography; however, the detailed characteristics of WAP are unknown. Therefore, this study identified the characteristics of WAP from comparisons with those of acute eosinophilic pneumonia (AEP) and hypersensitivity pneumonitis (HP), which show similar features to WAP.

Adult patients with WAP, AEP, and HP treated in Fukujuji Hospital from 1990 to 2018 were retrospectively enrolled. Furthermore, data from patients with WAP were collected from publications in PubMed and the Japan Medical Abstracts Society and combined with data from our patients.

Thirty-three patients with WAP, eleven patients with AEP, and thirty patients with HP were reviewed. Regarding age, sex, smoking habit, and laboratory findings (white blood cell count, C-reactive protein level, and serum Krebs von den Lungen-6 level), WAP and AEP were not significantly different, while WAP and HP were significantly different. The duration from symptom appearance to hospital visit was shorter in patients with WAP (median 1 day) than in patients with AEP (median 3 days, P = .006) or HP (median 30 days, P < .001). The dominant cells in the bronchoalveolar lavage fluid of patients with WAP, AEP, and HP were different (macrophages, eosinophils, and lymphocytes, respectively).

The characteristic features of WAP were rapid disease progression and macrophage dominance in the bronchoalveolar lavage fluid, and these characteristics can be used to distinguish among WAP, AEP, and HP.
The fibrinogen levels on admission is a predictive marker of the contrast extravasation on enhanced computed tomography in sacral fracture
Authors: Notani Naoki , Miyazaki Masashi , Kanezaki Shozo , Ishihara Toshibobu , Sakamoto Tomonori , Abe Tetsutaro , Kataoka Masashi , Tsumura Hiroshi
Published: March 2021

Sacral fracture is the most frequent posterior injury among unstable pelvic ring fractures and is prone to massive hemorrhage and hemodynamic instability. Contrast extravasation (CE) on computed tomography (CT) is widely used as an indicator of significant arterial bleeding. However, while CE is effective to detect significant arterial bleeding but negative result cannot completely rule out massive bleeding. Therefore, additional factors help to compensate CE for the prediction of early hemodynamically unstable condition.

We evaluated the risk factors that predict CE on enhanced computed CT in patients with sacral fractures. Patients were classified into 2 groups: CE positive on enhanced CT of the pelvis [CE(+)] and CE negative [CE(−)]. We compared age, sex, injury severity score (ISS), systolic blood pressure (sBP), type of sacral fracture based on Denis classification, platelet (PLT), base excess, lactate, prothrombin time-international normalized ratio, hemoglobin (Hb), activated partial thromboplastin time, D-dimer, and fibrinogen between the 2 groups.

A total of 82 patients were treated for sacral fracture, of whom 69 patients were enrolled. There were 17 patients (10 men and 7 women) in CE(+) and 52 patients (28 men and 24 women) in CE(−). Age, ISS, and blood transfusion within 24 hours were significantly higher in the CE(+) group than in the CE(−) group (P = .023, P < .001, P < .001). sBP, Hb, PLT, fibrinogen were significantly lower in the CE(+) group than in the CE(−) group (P < .001, P < .001, P < .001, P < .001). D-dimer and lactate were higher in the CE(+) group than in the CE(−) group (P = .036, P < .001) with significant differences. On multivariate analysis, the level of fibrinogen was an independent predictor of CE(+). The area under the curve value for fibrinogen was 0.88, and the optimal cut-off value for prediction was 199 mg/dL.

The fibrinogen levels on admission can predict contrast extravasation on enhanced CT in patients with sacral fractures. The optimal cut-off value of fibrinogen for CE(+) prediction in sacral fracture was 199 mg/dL. The use of fibrinogen to predict CE(+) could lead to prompt and effective treatment of active arterial hemorrhage in sacral fracture.
Impact of time factor and patient characteristics on the efficacy of PCI vs CABG for left main coronary disease
Authors: Qiu Mei , Ding Liangliang , Zhan Zelin , Zhou Hairong
Published: March 2021

Background:

The impact of time factor and patient characteristics on the efficacy of percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary-artery bypass grafting (CABG) for left main coronary disease is unclear.

Methods:

We searched PubMed and Embase for related trials. Two outcomes of interest were major adverse cardiac or cerebrovascular events (MACCE, defined as a composite of all-cause mortality, myocardial infarction, stroke, or unplanned revascularization) and a composite of all-cause mortality, myocardial infarction, or stroke. We conducted random-effects meta-analysis stratified by follow-up duration and 7 factors of interest related to patient characteristics. Random-effects meta-regression was performed to calculate P values for trend and those for subgroup differences.

Results:

We included 11 articles from 5 trials. Compared with CABG, PCI increased MACCE at the end of 3-year (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.04-1.40, I
2 = 0) and 5-year (HR 1.33, 95% CI 1.20–1.48, I
2 = 0) follow-up, but did not increase all-cause mortality, myocardial infarction, or stroke. The logarithm of HR of PCI vs CABG for MACCE increased as follow-up duration increased (β = 0.057, P = .025). PCI vs CABG consistently increased 5-year MACCE across various subgroups defined by 7 factors of interest (P
subgroup ranged from .156 to .830).

Conclusions:

The long-term benefit of CABG vs PCI on MACCE in patients with left main coronary disease is consistent across patients with different clinical characteristics. The relative benefit of CABG on MACCE is driven by that of CABG on unplanned revascularization, and becomes greater as time goes on.
Multiple neurological manifestations in a patient with systemic lupus erythematosus and anti-NXP2-positive myositis
Authors: Cao Xiaojie , Zhang Mingjie , Lu Zhijie , Li Congyang , Zeng Yanping , Fan Jin , Yu Ke
Published: March 2021

Rationale:

Systemic lupus erythematosus (SLE) is a complex autoimmune inflammatory disease that frequently affects various organs. Neuropsychiatric manifestations in SLE patients, known as neuropsychiatric SLE, are clinically common. However, the principal manifestation of cranial neuropathy in patients with SLE and comorbidities is relatively rare.

Patient concerns:

In this report, we describe a 51-year-old Chinese woman who was admitted with a chief complaint of chronic-onset facial paresthesia, dysphagia, and choking cough when drinking water, accompanied by slurred speech, salivation, and limb weakness. The blood autoantibody test results showed that many SLE-associated antibodies were positive. Meanwhile, anti-nuclear matrix protein 2 (NXP2) antibody was strongly positive in the idiopathic inflammatory myopathy (IIM) spectrum test from the serum. Muscle biopsy indicated inflammatory infiltration of the muscle fiber stroma.

Diagnoses:

Taking into account the clinical manifestations and laboratory tests of the present case, the diagnosis of SLE and probable IIM was established.

Interventions:

Corticosteroids and additional gamma globulin were administered and the clinical symptoms were relieved during the treatment process.

Outcomes:

Unfortunately, the patient experienced sudden cardiac and respiratory arrest. Multiple system dysfunctions exacerbated disease progression, but in the present case, we speculated that myocardial damage resulting from SLE could explain why she suddenly died.

Lessons:

To our knowledge, multiple neurological manifestations in patients with SLE and anti-NXP2-positive myositis are rare. Note that SLE is still a life-threatening disease that causes multiple system dysfunctions, which requires increasing attention.
Clinical features and treatment of inflammatory bowel disease in a low-incidence area
Authors: Yen Hsu-Heng , Hsu Tsui-Chun , Chen Mei-Wen , Su Pei-Yuan , Chen Yang-Yuan
Published: March 2021

Inflammatory bowel disease (IBD) has emerged in the Asia–Pacific area over the past 2 decades. There is a paucity of clinical data regarding real-world experience of patients with IBD from low endemic area such as Taiwan. Therefore, the present study aimed to review the clinical features of patients with IBD form a tertiary center from Taiwan.

A total of 163 patients with IBD were identified from the electronic clinical database of Changhua Christian Hospital. Demographic data of the patients and clinical features of the disease pattern were retrospectively reviewed.

There was a higher proportion (62.6%) of patients diagnosed with ulcerative colitis (UC). Patients with Crohn disease (CD) and UC had male predominance. The median age of diagnosis was younger in patients with CD than in patients with UC (CD vs UC: 31 vs 40 years, P = .0423). The disease distribution of UC was as follows: E1 (15.7%), E2 (47.1%), and E3 (37.3%). The disease distribution of CD was as follows: L1 (36.1%), L2 (14.8%), L3 (42.6%), and L4 (6.5%). The majority of patients with CD had a complicated presentation with B2 (32.8%) and B3 (32.8%). Patients with CD had a higher bowel resection rate than patients with UC. Patients with CD were more likely to be treated with immunomodulator and biologics and those with UC were more likely to be treated with 5-aminosalicylic acid (5-ASA). A trend of decreased bowel resection for patients with IBD and less severe phenotype of patients with CD were observed after 2015.

UC with male predominance was the predominant type of IBD in the study. Patients with CD are likely to have a complicated disease course, requiring a higher demand of biologic therapy than patients with UC.
Emergency administration of fibrinogen concentrate for hemorrhage
Authors: Itagaki Yuki , Hayakawa Mineji , Takahashi Yuki , Yamakawa Kazuma
Published: March 2021

Introduction:

The occurrence of massive hemorrhages in various emergency situations increases the need for blood transfusions and the risk of mortality. Use of fibrinogen concentrate (FC) may increase plasma fibrinogen levels more rapidly than the use of fresh-frozen product or cryoprecipitate. However, thus far, the efficacy of FC in significantly improving the risk of mortality and significantly reducing transfusion requirements has not been effectively demonstrated in several systematic reviews and meta-analyses.

Methods and analysis:

We will conduct a systematic review and meta-analysis of FC for hemorrhages in emergency situations. We will include controlled trials, but will exclude randomized controlled trials in elective surgeries. We will include patients with hemorrhages in emergency situations. Intervention will be emergency supplementation of FC. The control group will be administered with ordinal transfusion or placebo. The primary outcome of the study is in-hospital mortality.

We will search in electronic databases such as MEDLINE (PubMed), Web of Science, and the Cochrane Central Register of Controlled Trials. Two reviewers will independently screen the title and abstract, retrieve the full text of the selected articles, and extract the essential data. We will apply uniform criteria for evaluating the risk of bias associated with individual randomized controlled trial based on the Cochrane risk of bias tool. Values of the risk ratio will be expressed as a point estimate with 95% confidence intervals (CIs). Data of continuous variables will be expressed as the mean difference along with their 95% CIs and P values. We will assess the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics and dissemination:

This systematic review will provide physicians with updated information on the efficacy and safety of using FC for hemorrhage in emergency settings. Approval from the ethics board and patient consent were not required in our study.

This study protocol has been funded through a protocol registry. The registry number is UMIN000041598.
Two-stage strategy for neglected Monteggia fracture in children
Authors: Li Jin , Zhao Xiaolong , Rai Saroj , Ding Yuhong , Zhang Qi , Ze Renhao , Tang Xin , Liu Ruikang , Hong Pan
Published: March 2021

A neglected Monteggia fracture is defined as the fracture of the proximal ulna associated with radial head dislocation (RHD) without undergoing any treatment for 4 weeks or more after injury. One-stage operation of ulnar corrective osteotomy and open reduction of RHD might result in many complications. Therefore, a two-stage strategy, including ulnar osteotomy (UO) with or without annular ligament reconstruction (ALR), was adopted at our institute since 2010.

We performed a retrospective review of 51 patients with neglected Monteggia fracture between January 2010 and January 2018. Patients with bilateral problems or concomitant injuries in the ipsilateral extremity were excluded. Radiological and clinical data were collected from Hospital Database and clinical visits. All patients were divided into 2 groups based on the status of the ALR: the UO alone (UO) group and the ALR group.

There were 15 patients in the UO group and 36 patients in the ALR group. The age in the UO group (6.1 ± 2.3, year) was significantly younger than the ALR group (9.8 ± 2.8, year) (P < .001). Concerning the duration from initial injury to surgery, there was a significant difference between the UO group (8.6 ± 3.2 months) and the ALR group (23.3 ± 12.6 months, P < .001). Concerning the preoperative elbow function, there was no significant difference between the UO group (67.6 ± 5.0) and the ALR group (66.6 ± 4.4) according to the Mayo elbow performance score (MEPS) (P = .51). Concerning the postoperative parameters, including postoperative ROM of the joint, removal of external fixator (6.7 ± 0.8, 6.9 ± 0.9 weeks) (P = .55), lengthening (8.9 ± 2.5, 10.3 ± 2.5 mm) (P = .10) and MEPS (92.7 ± 2.1, 91.6 ± 2.1) (P = .08), there was no significant difference between the UO group and ALR group.

Two-stage strategy is a reasonable choice for selected patients with long-lasting RHD with ulnar deformity.
Acupuncture for HIV-associated distal symmetric peripheral neuropathy
Authors: Gao Ning , Guo Yufeng , Wang Weiming
Published: March 2021

Background:

Human immunodeficiency virus (HIV)-associated distal symmetric peripheral neuropathy (DSPN) is one of the most frequent neurological complications of HIV infection, and causes pain and dysaesthesias in millions globally. Many individuals with this infection report using acupuncture to manage their symptoms, but evidence supporting the use of acupuncture is limited. This systematic review will assess the effectiveness and safety of acupuncture for patients with HIV-associated DSPN.

Methods:

Databases including MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Scopus, Web of science, AMED (Allied and Complementary Medicine), the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, Wanfang Database, VIP Database and clinical trials registers (the WHO International Clinical Trials Registry Platform portal and www.ClinicalTrials.gov) will be electronically searched from inception to December 1, 2020. All randomized controlled trials in English or Chinese without restriction on publication status will be included. Selection of studies, extraction of data, and assessment of studies quality will be independently performed by 2 reviewers. The primary outcome measure will be the change in pain intensity assessed by validated scales. Secondary outcomes include change in neurologic summary scores, quality of life, physical function evaluated by admitted tools, and adverse events related to acupuncture reported in the included trials. If possible, a meta-analysis will be conducted to provide an estimate of the pooled treatment effect using Review Manager 5.3 statistical software. Otherwise, qualitative descriptive analysis will be given. The results will be presented as the risk ratio for binary data and the mean difference (MD) or standardized MD for continuous data.

Results:

The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference.

Conclusion:

This review will be the first review entirely focused on assessing the effectiveness and safety of acupuncture for HIV-associated DSPN.

PROSPERO registration number:

CRD42020210994.
Emergency Department Utilization by Adolescents Experiencing Homelessness in Massachusetts
Authors: Giannouchos Theodoros V. , Gary Jodie C. , Anyatonwu Sophia , Kum Hye-Chung
Published: March 2021

Background:

Adolescents who experience homelessness rely heavily on emergency departments (EDs) for their health care.

Objectives:

This study estimates the relationship between homelessness and ED use and identifies the sociodemographic, clinical, visit-level, and contextual factors associated with multiple ED visits among adolescents experiencing homelessness in Massachusetts.

Research Design:

We used the Healthcare Cost and Utilization Project State Emergency Department Databases on all outpatient ED visits in Massachusetts from 2011 to 2016. We included all adolescents who were 11–21 years old. We estimated the association between homelessness and ED utilization and investigated predictors of multiple ED visits among adolescents who experience homelessness using multivariate logistic and negative binomial regressions.

Results:

Our study included 1,196,036 adolescents, of whom about 0.8% experienced homelessness and this subset of adolescents accounted for 2.2% of all ED visits. Compared with those with stable housing, adolescents who were homeless were mostly covered through Medicaid (P<0.001), diagnosed with 1 or more comorbidities (P<0.001), and visited the ED at least once for reasons related to mental health; substance and alcohol use; pregnancy; respiratory distress; urinary and sexually transmitted infections; and skin and subcutaneous tissue diseases (P<0.001). Homeless experience was associated with multiple ED visits (incidence rate ratio=1.18; 95% confidence intervals, 1.16–1.19) and frequent ED use (4 or more ED visits) (adjusted odds ratio=2.21; 95% confidence interval, 2.06–2.37). Factors related to clinical complexity and Medicaid compared with lack of coverage were also significant predictors of elevated ED utilization within the cohort experiencing homelessness.

Conclusions:

Adolescents who experience homelessness exhibit higher ED use compared with those with stable housing, particularly those with aggravated comorbidities and chronic conditions. Health policy interventions to integrate health care, housing, and social services are essential to transition adolescents experiencing homelessness to more appropriate community-based care.
Mechanisms of residual immune activation in HIV-1-infected human lymphoid tissue ex vivo
Authors: Mercurio Vincenzo , Fitzgerald Wendy , Vanpouille Christophe , Molodtsov Ivan , Margolis Leonid
Published: March 2021

Objective:

HIV-1 infection triggers immune activation, as reflected by the upregulation of various cytokines. This immune activation remains elevated despite antiretroviral therapy (ART) and leads to early age-related diseases. Here, we addressed the mechanisms of sustained immune activation in HIV-1-infected human lymphoid tissues ex vivo.

Design/method:

We investigated several potential causes of immunoactivation, including: a proinflammatory effect of ART drugs themselves; an early HIV-1-triggered cytokine storm, which could in turn trigger a sustained cytokine dysregulation; herpesvirus reactivation; HIV-1 protein release; and production of defective virions and extracellular vesicles. Tissue immune activation was evaluated from measurements of cytokines in culture medium using multiplexed immunoassays.

Results:

Neither ART itself nor simulated cytokine storms nor exogenously added HIV-1 proteins triggered a sustained cytokine upregulation. In contrast, defective (replicative-incompetent) virions and extracellular vesicles induced sustained cytokine upregulation, as did infectious virus. Tissue immune activation was accompanied by reactivation of cytomegalovirus.

Conclusion:

The system of ex-vivo human lymphoid tissue allowed investigation, under laboratory-controlled conditions, of possible mechanisms involved in persistent immune activation in HIV-1 patients under ART. Mechanisms of this immunoactivation identified in ex-vivo tissues may indicate potential therapeutic targets for restoration of immune system homeostasis in HIV-1-infected patients.
Three-Dimensional Measurement of Oropharynx and Laryngopharynx in Children With Hemifacial Microsomia
Authors: Peng Qi-Li , Zhang Zhi-Yong , Tang Xiao-Jun , Yin Lin , Xu Xi , Liu Wei
Published: March 2021

Objective:

This study focused on evaluating different parts of the airway in patients with hemifacial microsomia classified by the Pruzansky-Kaban classification system.

Methods:

Volumetric and morphologic airway parameters of 66 children with hemifacial microsomia were measured on 3D models. Using the Pruzansky-Kaban system, the patient cohort was composed of seven I-type, 14 IIa type, 27 IIb type, and 18 III type patients.

Results:

The total airway volume was not statistically different among groups. In the 3D oropharynx models, volume and surface area of the oropharynx decreased from the type I group to the type IIb group. However, no statistically significant difference was found for length (P = 0.965) or minimum cross-sectional area (mini-CSA, P = 0.550) of the oropharynx in the type III group compared to the other groups. In the 3D laryngopharynx models, the mean-CSA (P = 0.413) and mini-CSA (P = 0.378) were not statistically different among groups. In contrast, volume (P = 0.014), length (P = 0.005), and surface area (P = 0.032) of the laryngopharynx were reduced from type I to type III. Kruskal–Wallis analysis indicated statistically significant differences of volume (P = 0.004), length (P = 0.017), and surface area (P = 0.010) of the laryngopharynx among groups I, IIa, and IIb. The mean-CSA (P = 0.247) and mini-CSA (P = 0.206) of the laryngopharynx were not correlated with the different clinical types.

Conclusion:

The mean-CSA varied significantly from type I to IIb at the level of oropharynx. In addition, the volume of the laryngopharynx decreased from type I to type III. However, type III was unique in this study with nonseverely airway measurement results.
Endoscopic Endonasal Transsphenoidal Approach for Third Ventriculostomy in the Management of Obstructive Hydrocephalus
Authors: Liu Bolin , Zheng Tao , Lv Wenhai , Huang Yuanzhi , Li Baofu , Chen Baoying , Wang Binrong , He Shiming
Published: March 2021

Endoscopic third ventriculostomy (ETV) is a safe and effective method for the management of obstructive hydrocephalus. Traditional approach is a transfrontal trajectory through the foramen of Monro to access and open the third ventricle floor. Though endoscopic endonasal transsphenoidal approach (EETA) for pituitary and skull base tumors has become increasingly popular, no published literature has explored its utility in performing an ETV. Here, the authors reported a successful ETV for obstructive hydrocephalus through the EETA. A 57-year-old male presenting with progressive headache and gait disturbance for 3 months was diagnosed with obstructive hydrocephalus. Brain MRI revealed an obstruction of cerebrospinal fluid (CSF) flow at the cerebral aqueduct and supratentorial hydrocephalus, accompanied with dilatation and downward herniation of the third ventricle floor. Considering the displacement of the third ventricle floor and the indication for surgery, an ETV was successfully performed through the EETA. No postoperative complication was observed. Both radiological and clinical evaluation postoperatively confirmed ETV success with decreased ventricular size, increased CSF flow across the floor of the third ventricle, and improved clinical signs. EETA is a feasible approach for ETV in selected cases of obstructive hydrocephalus. This approach provides a short trajectory to directly visualize and open the Liliequist's membrane and the displaced floor of the third ventricle, while minimizes damage to normal brain tissue. Skull base repair with nasoseptal flap ensures the success rate by preventing postoperative CSF leak and infection.
Cost-effectiveness of Erenumab Versus Surgical Trigger Site Deactivation for the Treatment of Migraine Headaches: A Systematic Review
Authors: Shah Nikhil , Castro Ruben , Attaripour Isfahani Sanaz N. , Vyas Raj M.
Published: March 2021

Background:

Migraine headache is a common, debilitating condition responsible for astronomical societal burden. The chronicity of migraine headaches necessitates the use of many healthcare services. Preventative treatment remains the desirable option for this patient population. Pharmacologic advances have led to the development of erenumab, a monoclonal antibody calcitonin gene-related peptide receptor antagonist that directly interferes with the known biochemical pathway of migraine initiation. Alternatively, surgical decompression of migraine trigger sites is a historically effective preventative option for certain patients experiencing migraine headaches. As new treatments emerge, the large economic burden of migraine headaches requires cost evaluation against already available preventative modalities.

Methods:

Studies evaluating the cost-effectiveness of both erenumab and surgical trigger site deactivation were found using EMBASE and MedLine. Relevant economic data was extracted from this literature and the cost of treatment with erenumab was compared with surgical decompression.

Results:

The market price of erenumab is $6900/yr. Speculative models predicted a direct annual healthcare cost ranging from $11,404 to $12,988 for patients experiencing episodic migraine. For chronic migraine patients, this range extended to $25,604. Annual indirect costs ranged from $7601 to $19,377. Prospective and model-based studies evaluating surgical trigger site deactivation reported an average 1 time surgical cost between $6956 and $10,303. In episodic migraine, subsequent annual healthcare costs were $900.

Conclusions:

Erenumab has potential to be a revolutionary noninvasive preventative treatment for migraine headache. With that said, the cost-conscious option for patients receiving more than 1 year of treatment remains surgical trigger site deactivation.
Totally Laparoscopic Ileocolic Resection for Complex Enterovisceral Fistulas in Crohn’s Disease: A Comparative Study
Authors: Nevo Yehonatan , Zippel Douglas , Segev Lior , Ben Yaacov Almog , Meron Eldar Shai , Hazzan David
Published: March 2021

Introduction:

In primary Crohn’s disease (CD), laparoscopic ileocolic resection has been shown to be both feasible and safe, and is associated with improved outcomes in terms of postoperative morbidity and length of hospital stay. However, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with complex enterovisceral fistulas.

The aim of this study is to assess the feasibility and safety of laparoscopic surgery for complex enterovisceral fistulas, and compare it with CD patients who underwent primary laparoscopic ileocolic resection.

Patients and Methods:

All patients who underwent laparoscopic primary ileocolic resection (LICR) for complex enterovisceral fistulas between July 2006 and July 2017 were included. They were compared with all consecutive patients who underwent LICR for nonfistulizing CD in the same period of time. Patients with previous bowel resections or recurrent disease were excluded.

Results:

Nineteen patients with 20 enterovisceral fistulas (group I) were compared with 61 patients who underwent LICR for nonfistulizing disease (group II). There were no differences between the groups in age, sex, preoperative body mass index, nutritional status, and American Society of Anesthesiology score. There was no conversion to open surgery in both groups.

There were no significant differences between groups in terms of operative time [120 (range: 65 to 232) vs. 117 (range: 62 to 217) min, P=0.7], hospital stay [6 (5 to 8) vs. 7 (5 to 65) days, P=0.56], overall morbidity 26.3% versus 16.4% (P=0.33), major morbidity (Clavien-Dindo >3) 15.7% versus 10% (P=0.66) and reoperation rates 5.3% versus 4.9% (P=0.9). There was no mortality in both groups.

Conclusions:

Our experience shows that the laparoscopic approach for complex enterovisceral fistulas in selected CD patients is both feasible and safe in the hands of experienced inflammatory bowel disease surgeons with extensive expertise in laparoscopic surgery. Larger study cohorts are needed to confirm these findings.
Gordonia asplenii sp. nov., isolated from humic soil on bird’s nest fern (Asplenium nidus L.)
Authors: Suriyachadkun Chanwit , Ngaemthao Wipaporn , Pujchakarn Tawanmol , Chunhametha Suwanee
Published: March 2021

A novel member of the actinobacteria, designated strain A-T 0013T, was isolated from humic soil on a bird’s nest fern (Asplenium nidus L.) collected from Khao Yai National Park in Thailand. According the results of a polyphasic taxonomic study, A-T 0013T had characteristics typical of members of the genus

Gordonia

. The 16S rRNA gene sequence indicated that A-T 0013T shared ≤98 % sequence similarity with all members of the genus

Gordonia

. The most closely related species was

Gordonia effusa

IFM 10200T (97.92 % sequence similarity). The average nucleotide identity based on blast (ANIb) value with

G. effusa

IFM 10200T was 76.81 %. The cell-wall peptidoglycan contained meso-diaminopimelic acid. The whole-cell sugars contained ribose, arabinose and galactose. The predominant menaquinone was MK-9(H2). The predominant fatty acids were C16 : 0, C18 : 1ω9c, summed feature 3 (C16 : 1ω7c/C16 : 1ω6c), and C18 : 0 10-methyl. Mycolic acid was present. The polar lipid profile for this strain ncluded diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylinositol and phosphatidylinositol mannosides. The G+C content of the genomic DNA was 66.1 mol%. Differentiation of A-T 0013T from the most closely related species,

Gordonia effusa

IFM 10200T, was evident from digital DNA–DNA hybridization values of 21.8 %. On the basis of the results of comparative analysis of phenotypic, chemotaxonomic and genotypic data, strain A-T 0013T is concluded to represent a novel species of the genus

Gordonia

, for which the name Gordonia asplenii sp. nov. is proposed. The type strain is A-T 0013T (=TBRC 11910T=NBRC 114549T).