bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel vertebroplasty technique using a larger-diameter needle for thoracolumbar osteoporotic vertebral compression fracture
Authors: Park Eugene J. , Lee Ho-Jin , Jang Min-Gu , Ahn Jae-Sung , Kim Sang Bum
Published: June 2021

Percutaneous vertebroplasty (VP) and kyphoplasty (KP) are well-established minimally invasive surgical procedures for the treatment of osteoporotic vertebral compression fractures (OVCF). However, some drawbacks have been reported regarding these procedures, including height loss, cement leakage, and loss of the restored height after balloon deflation. We performed a novel VP technique to minimize these limitations of conventional procedures. This study aimed to compare radiological and clinical outcomes of our method using a larger-diameter needle versus conventional VP (using a smaller needle) for thoracolumbar OVCF.

From April 2016 to May 2017, 107 consecutive patients diagnosed with thoracolumbar OVCF were enrolled. Patients were divided into two groups: group 1 underwent conventional VP, i.e., using a smaller diameter needle, and group 2 underwent VP through a modified method with a larger-diameter needle. For radiological evaluation, parameters related to anterior vertebral height (AVH) and segmental angle were assessed using plain standing radiographs, and patient-reported outcomes were evaluated using the visual analog scale. Cement injection amount and leakage pattern were also analyzed. Group 2 showed a larger anterior vertebral height change than group 1 immediately postoperatively and one year postoperatively. The 1-year postoperatively-AVH maintained better in group 2 than in group 1. Group 2 showed more significant improvement of segmental angle immediately postoperatively than group 1 (3.15° in group 1 vs 9.36° in group 2). IYPo-visual analog scale significantly improved in both groups, with greater improvement in group 2 (3.69 in group 1 vs 5.63 in group 2). A substantially larger amount of cement was injected, with a lower leakage rate in group 2 than in group 1.

A novel VP technique using a larger-diameter needle showed superior radiological and clinical outcomes than conventional VP. Therefore, it can be considered a useful treatment option for OVCF.
Prognostic value of serum bilirubin in patients with heart failure
Authors: Wang Huan , Jia Qiulei , Shi Jingjing , Hu Yuanhui
Published: June 2021

Background:

Heart failure (HF) is one of the common and critical disease, and often accompanied by increased level of serum bilirubin, but the role of an indicator of bilirubin to monitor the prognosis of patients with heart failure is still unclear, so we implemented the study to systematically evaluate the predictive value of bilirubin in HF.

Methods:

A comprehensive search and systematic review will be conducted on electronic databases such as Medline, Cochrane Library, Embase, Web of Science, Cochrane Clinical Trials Database of study on the relationship between bilirubin and prognosis of HF patients. Review Manager software (version 5.3.5) and STATA 14 software (version 14.0) will be used for data analysis and synthesis.

Results:

The results will systematically and comprehensively reveal the evidence on the predictive value of bilirubin in HF.

Conclusion:

The study will display the effect of bilirubin level on the prognosis of patients with heart failure, and help clinicians to pay more attention to the level of bilirubin in patients with HF, and can take certain treatment measures as earlier as possible.

Inplasy registration number:

INPLASY202140116.
Physical activity in health care professionals as a means of primary prevention of cardiovascular disease
Authors: Marques-Sule Elena , Miró-Ferrer Silvia , Muñoz-Gómez Elena , Bermejo-Fernández Antonio , Juárez-Vela Raúl , Gea-Caballero Vicente , Martínez-Muñoz María del Carmen , Espí-López Gemma Victoria
Published: June 2021

The aim of this study was to assess the physical activity level of health care professionals, as well as the differences by sex, age, academic background, and among different health care professions.

This is an cross-sectional study.

Health care settings in the Valencian Community, Spain.

A total of 647 health care professionals.

Physical activity was assessed with the European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ) that includes the assessment of work-related physical activity, transport-related physical activity, health-enhancing physical activity, muscle-strengthening physical activity, and total physical activity.

93.51% of all health care professionals were physically active at work. Transport-related physical activity and health-enhancing physical activity were significantly lower in women (21.62% vs 41.86%, P < .001; and 50.19% vs 68.99%, P < .001, respectively). In addition, compliance with health-enhancing and muscle-strengthening physical activity guidelines were lower in older professionals (42.7% vs 61.84%, P < .001; and 47.57% vs 61.84%, P < .001, respectively). Those with higher education were more compliant with health-enhancing and muscle-strengthening physical activity guidelines (58.55% vs 45.69%, P = .002; and 60.24% vs 48.28%, P = .003, respectively). Moreover, 67.98% of physiotherapists performed health-enhancing physical activity and 67.54% muscle-strengthening physical activity regularly, and significant differences in all outcomes were observed compared to the rest of health care professionals (P < .05). Technicians showed lower work-related and total physical activity than nurses and nursing assistants (74.55% vs 90.37%, P = .002; and 83.64% vs 95.72%, P < .001, respectively). Additionally, nursing assistants showed higher work-related physical activity compared to nurses (97.18% vs 90.37%, P = .008).

Most health care professionals showed an appropriate level of physical activity. Men performed more transport-related and health-enhancing physical activity than women. Younger professionals and those with higher education were more compliant with health-enhancing and muscle-strengthening physical activity guidelines. Physiotherapists were more physically active when compared to the rest of health care professionals.
EFNA1 is a potential key gene that correlates with immune infiltration in low-grade glioma
Authors: Hao Yong-Ping , Wang Wen-Yi , Qiao Qiao , Li Guang
Published: June 2021

EFNA1 is a key gene that is associated with the pathogenesis of several human cancers. However, the prognostic role of EFNA1 in many cancers and the relationship between EFNA1 and tumor-infiltrating lymphocytes in different cancers remain unclear.

The expression levels of EFNA1 in 33 types of cancer in the TCGA (The Cancer Genome Atlas) database were collected via the UCSC Xena browser. The clinical data of LGG (low grade glioma) patients were downloaded from the TCGA database. The glioma data from the CGGA (Chinese Glioma Genome Atlas) database were also downloaded to verify the results. Kaplan–Meier and Cox regression analyses were used to investigate the prognostic value of EFNA1 in different cancers using R software. We verified the differential expression of EFNA1 in glioma and normal brain tissue via gene expression profiling interactive analysis. We evaluated the relationship between the expression level of EFNA1 and the clinicopathological features of LGG patients via the Wilcoxon signed-rank test. The immune infiltration levels were evaluated via tumor immune estimation resource (TIMER) and CIBERSORT, and the correlations between EFNA1 and immune cell levels were investigated via TIMER. Finally, we conducted gene set enrichment analysis (GSEA) to explore the potential mechanisms.

Data from the TCGA database showed that EFNA1 was differentially expressed in many kinds of cancers when compared with normal tissues. Upregulated EFNA1 expression in esophageal carcinoma (ESCA), cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC), and LGG correlated with shorter patient overall survival (OS) times. The Cox regression analysis revealed that the expression of EFNA1 was also a risk factor for the disease-specific survival (DSS) and progression-free interval (PFI) of LGG patients. The multiple Cox regression analysis revealed that EFNA1 was an independent prognostic factor for LGG patients. In addition, EFNA1 expression was increased in the WHO grade III group and the 1p19q non-codeletion group. Moreover, EFNA1 expression was positively correlated with the levels of infiltrating CD4+ T cells, myeloid dendritic cells and neutrophils in LGG. GSEA suggested that several GO and kyoto encyclopedia of genes and genomes (KEGG) items associated with nervous system function and apoptotic pathway were significantly enriched in the EFNA1-low and EFNA1-high expression phenotypes.

EFNA1 may play a pivotal role in the development of LGG and may serve as a potential marker for LGG prognosis and therapy.
Correlation between high hair cortisol level and intracranial aneurysm rupture
Authors: Kim You-Sub , Joo Sung-Pil , Song Dong-Jun , Lee Tae-kyu , Kim Tae-Sun
Published: June 2021

Measurement of cortisol in hair is a reliable method for determining long-term cortisol exposure reflecting chronic stress. Research using hair cortisol concentration has been limited to mainly cardiometabolic diseases. The association between hair cortisol concentration and aneurysmal rupture has not yet been studied. We aimed to investigate the relationship between the degree of chronic stress as measured by hair cortisol concentration and aneurysmal rupture.

Sixty-eight patients diagnosed with intracranial aneurysms were included in this study (ruptured group, 30; unruptured group, 38). Hair cortisol was measured in 3-cm hair segments, reflecting roughly 3 months of hair growth. For a risk factor analysis, patient-specific factors and aneurysm-specific factors as well as hair cortisol concentration were investigated.

Hair cortisol concentrations were significantly higher in the ruptured group than in the unruptured group (55.8 ± 22.0 ng/dL vs. 19.1 ± 6.4 ng/dL; P < .001). High hair cortisol concentration was found to be an independent risk factor for aneurysmal rupture (odds ratio [OR]: 2.245, 95% confidence interval [CI]: 1.825–2.753; P = .013). Additionally, a history of cerebrovascular disease was significantly associated with an increased risk of aneurysmal rupture (OR: 1.577, 95% CI: 1.099–2.262; P = .040).

Based on our results, we suggest that chronic stress as measured by hair cortisol concentration could be an independent risk factor for intracranial aneurysmal rupture.
Integrated analysis of ceRNA network in hepatocellular carcinoma using bioinformatics analysis
Authors: Luo Yu , Li Hongjuan , Huang Hongli , Xue Lian , Li Haiwen , Liu Li , Fu Haiyan
Published: June 2021

Background:

Long noncoding RNAs (lncRNAs) can work as microRNA (miRNA) sponges through a competitive endogenous RNA (ceRNA) mechanism. LncRNAs and miRNAs are important components of competitive endogenous binding, and their expression imbalance in hepatocellular carcinoma (HCC) is closely related to tumor development, diagnosis, and prognosis. This study explored the potential impact of the ceRNA regulatory network in HCC on the prognosis of HCC patients.

Methods:

We thoroughly researched the differential expression profiles of lncRNAs, miRNAs, and mRNAs from 2 HCC Gene Expression Omnibus datasets (GSE98269 and GSE60502). Then, a dysregulated ceRNA network was constructed by bioinformatics. In addition, hub genes in the ceRNA network were screened by Cytoscape, these hub genes functional analysis was performed by gene set enrichment analysis, and the expression of these hub genes in tumors and their correlation with patient prognosis were verified with Gene Expression Profiling Interactive Analysis.

Results:

A ceRNA network was successfully constructed in this study including 4 differentially expressed (DE) lncRNAs, 7 DEmiRNAs, and 166 DEmRNAs. Importantly, 4 core genes (CCNA2, CHEK1, FOXM1, and MCM2) that were significantly associated with HCC prognosis were identified.

Conclusions:

Our study provides comprehensive and meaningful insights into HCC tumorigenesis and the underlying molecular mechanisms of ceRNA. Furthermore, the specific ceRNAs can be further used as potential therapeutic targets and prognostic biomarkers for HCC.
Early prediction of anastomotic leakage after laparoscopic rectal surgery using creactive protein
Authors: Jin Dongai , Chen Li
Published: June 2021

At present, anterior resection of the rectum or transabdominal rectal resection is the most common surgical technique for rectal cancer. Laparoscopic techniques are popular, and the efficacy and safety of laparoscopic rectal surgery have been confirmed. However, postoperative anastomotic leakage is a common, severe complication that leads to high mortality. Thus, early diagnosis of anastomotic leakage is important for reducing clinical consequences.

The aim of this study was to determine whether C-reactive protein (CRP) is a good predictor of anastomotic leakage in laparoscopic transabdominal rectal resection.

Our retrospective study involved a series of 196 rectal cancer patients who underwent laparoscopic transabdominal rectal resection without ileostomy between May 2013 and April 2015 at the Sir Run Run Shaw Hospital, Zhejiang University College of Medicine. The following patient data were collected: demographic data, manifestations of the complication, CRP levels and neutrophil percentage during the first 7 postoperative days.

Anastomotic leakage was detected in 11 patients (5.6%). Each group showed significant differences (P < .05) in CRP levels on postoperative days 3 to 7; compared with other groups, the anastomotic leakage group showed significant differences in CRP levels (P < .05) on postoperative day 6. When patients were divided into groups with or without anastomotic leakage, CRP was a reliable predictor on postoperative days 4 to 7 (P < .05, area under the curve > 0.800). The best combination was CRP on postoperative day 6 (area under the curve = 0.932) with a cut-off of 76.6 mg/L, resulting in a sensitivity of 83.3%, a specificity of 94.6% and a negative predictive value of 99%.

CRP is a reliable predictor of anastomotic leakage after laparoscopic transabdominal rectal resection surgery. High CRP levels on postoperative days 4 to 7 indicate the need for a more careful patient evaluation.
A comparative study of propofol alone and propofol combined with midazolam for dental treatments in special needs patients
Authors: Lin I-Hsin , Huang Mao-Suan , Wang Pei-Yu , Huang Ta-Sen , Chong See-Yen , Chen Sam Li-Sheng , Tsai Hung-Huey
Published: June 2021

Although dental treatment with sedation is performed increasingly in special needs patients, data on adding midazolam to intravenous propofol sedation are very limited for this group. The purpose of this study was to identify the factors and procedure time associated with the use of intravenous sedation with propofol alone or propofol combined with midazolam in dental patients with special needs.

This was a retrospective data analysis. The sedation medications and relevant covariates, including demographic parameters, disability levels, oral health conditions, dental procedures, treatment time, and side effects, of 718 patients with special needs were collected between April 2013 and September 2014. The unfavorable side effects by sedation types were reported. Factors associated with procedure time and the sedation medications were assessed with multiple logistic regression analyses.

Of 718 patients, 8 patients experienced unfavorable side effects (vomiting, sleepiness, or emotional disturbance) after the dental procedures; the rate was 0.6% in the 509 patients who received propofol only. In 209 patients who received propofol and midazolam, 2.4% experienced the side effects. Sedation time was associated with body mass index (BMI) < 25 (adjusted odds ratio [aOR] = 1.45, 95% confidence interval [CI]: 1.04–2.04) and the performance of multiple dental procedures (aOR = 1.44, 95% CI: 1.06–1.97) but not associated with the sedation types. A significant odds ratio for the combined use of propofol and midazolam was shown for adolescents (aOR = 2.22, 95% CI: 1.28–3.86), men (aOR = 2.05, 95% CI: 1.41–2.98), patients with cognitive impairment (aOR = 1.99, 95% CI: 1.21–3.29), and patients undergoing scaling procedures (aOR = 1.64, 95% CI: 1.13–2.39).

With the acceptable side effects of the use of propofol alone and propofol combined with midazolam, multiple dental procedures increase the sedation time and the factors associated with the combined use of propofol and midazolam are younger age, male sex, recognition problems, and the type dental procedure in the dental treatment of patients with special needs.
Clinical and capillaroscopic findings in patients with liver disease and proximal apparent leukonychia (Terry nails and its variants)
Authors: Fernandez-Somoza Juan-Manuel , Ginarte Manuel , Otero Esteban , Tomé Santiago , Soutullo Carlos , Martínez-Ulloa Aarón , Gonzalez-Quintela Arturo
Published: June 2021

Terry nails and Lindsay nails are similar forms of proximal apparent leukonychia (PAL). A change in nail bed vascularity is thought to be responsible for PAL. The study was aimed at investigating the frequency of PAL in patients attending a liver disease clinic, the factors associated with its presence, its value for detecting cirrhosis, its prognostic value for mortality, and associated capillaroscopic findings.

A total of 521 patients were included (age range, 18–94 years; 69% men). Systematic nail photographs were evaluated by 2 independent investigators. Disease-related data were obtained from the medical records. Mortality was evaluated after 7 years of follow-up. Nailfold capillaroscopy was performed on a subset of 80 patients.

PAL was present in 228 patients (43.8%; Terry nails in 205, Lindsay nails in 20, and both in 3). The kappa-coefficient of interobserver agreement was 0.82. The presence of PAL was associated with cirrhosis and, accordingly, with portal hypertension and hepatocellular dysfunction. The positive likelihood ratio of PAL for the diagnosis of cirrhosis was 1.6 (95% CI 1.3–1.92). PAL was independently associated with chronic alcohol abuse and was not a significant predictor of mortality. Venous loop dilatation and prominence of the venous plexus were observed on capillaroscopy in patients with cirrhosis but were not significantly associated with PAL.

In summary, PAL is a common finding in patients from a liver clinic; it is associated with liver cirrhosis and with alcohol abuse. PAL is not associated with specific capillaroscopic findings. We propose the generic term proximal apparent leukonychia instead of classic eponymous titles to avoid confusion in the literature.
Kinematic analysis of the human body during sit-to-stand in healthy young adults
Authors: Li Jin , Xue Qiang , Yang Shuo , Han Xiaolong , Zhang Shouwei , Li Min , Guo Jingchen
Published: June 2021

Sit-to-stand (STS) motion is one of the most important and energy-consuming basic motions in everyday life. Kinematic analysis provides information regarding what strategy or motion pattern is used by the healthy people, and through which, we can understand and obtain the law of the STS motion. The objective of this article is to study the law of STS motion through the experiment to determine a suitable description of STS motion in healthy adults, so as to provide a starting point and bases for future design and control of STS assistive devices.

Thirty healthy adult subjects participated in this study and carried out STS motion experiment of standing up naturally. The STS motions were recorded using a high-definition camera. The experimentally collected kinematic data and a link segment model of the human body were used to obtain the coordinates of joints and to calculate the coordinates, velocity, and momentum of center of gravity; the postures of human body during STS are also obtained. The relationship between human body parameters and motion parameters is analyzed by using Pearson correlation method.

The STS motion is divided into 4 phases; the phases are differentiated in terms of STS motion characteristics and postures, and momentum of center of gravity of human body. The main factors determining the differences in STS motion among individuals are horizontal distance between hip joint and ankle joint, lower leg length, thigh length, and the length of the transition period. The horizontal distance between hip joint and ankle joint is positively correlated with the duration from motion begin to trunk stops flexing forward (P = .021 < .05), but not so with the duration from motion begin to the end of phase 2 (P = .15 > .05).

The results suggest that when designing the sit-to-stand assistive devices, one should pay attention to the whole-body posture control in STS motion, such as the posture guidance of trunk and lower leg, and should carry out specific training according to different STS phases. Sit-to-stand assistive devices should provide the same horizontal distance between hip joint and ankle joint for different individuals during the STS motion. Transition period should be properly controlled, and the degree of freedom of the lower leg should not be limited.
Efficacy and safety of riociguat in the treatment of chronic thromboembolic pulmonary arterial hypertension
Authors: Ying Miaofa , Song Jin , Gu Shenglong , Zhao Rui , Li Mingxing
Published: June 2021

Background:

Riociguat is a novel soluble guanylate cyclase stimulator, and has been widely used for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH). Some studies found that riociguat had better effects on CTEPH and proved to be safe, but the results were not utterly consistent. Therefore, the purpose of this study was to comprehensively evaluate the efficacy and safety of riociguat in the treatment of CTEPH.

Methods:

Randomized controlled trials on riociguat for the treatment of CTEPH were searched through such electronic databases as PubMed, Embase, Cochrane Library, Web of Science, China national knowledge internet, and Wanfang. The outcomes included exercise capacity, pulmonary hemodynamics, and side effects. The fixed-effects or random-effects models were used to analyze the pooled data, and heterogeneity was assessed by the I
2 test.

Results:

Four studies involving 520 patients were included in this meta-analysis. Compared with the placebo group, riociguat significantly improved the hemodynamic indexes and increased 6-min walking distance (P < .0001, standardized mean difference (SMD) = −0.24, 95%CI −0.35 to −0.12; P < .00001, SMD = 0.52, 95%CI 0.33 to 0.71), and decreased the Borg dyspnea score (P = .002, SMD = −0.31, 95%CI −0.51 to −0.12). In addition, riociguat could also significantly reduce the living with pulmonary hypertension scores and increase the EQ-5D scores (P = .01, SMD=−0.23, 95%CI −0.42 to −0.05; P < .00001, SMD = 0.47, 95%CI 0.27 to 0.66), but there was no significant difference in the change level of N-terminal pro-hormone B-type natriuretic peptide in patients with riociguat (P = .20, SMD = −0.24, 95%CI −0.61 to −0.13). The common adverse events of riociguat were dyspepsia and peripheral edema, and no other serious adverse reactions were observed.

Conclusions:

We confirmed that riociguat had better therapeutic effects in improving the hemodynamic parameters and exercise capacity in patients with CTEPH without inducing serious adverse events. This will provide a reasonable medication regimen for the treatment of CTEPH.
The diagnostic value of a non-contrast computed tomography scan-based radiomics model for acute aortic dissection
Authors: Zhou Zewang , Yang Jinquan , Wang Shuntao , Li Weihao , Xie Lei , Li Yifan , Zhang Changzheng
Published: June 2021

To investigate the diagnostic value of a computed tomography (CT) scan-based radiomics model for acute aortic dissection.

For the dissection group, we retrospectively selected 50 patients clinically diagnosed with acute aortic dissection between October 2018 and November 2019, for whom non-contrast CT and CT angiography images were available. Fifty individuals with available non-contrast CT and CT angiography images for other causes were selected for inclusion in the non-dissection group. Based on the aortic dissection locations on the CT angiography images, we marked the corresponding regions-of-interest on the non-contrast CT images of both groups. We collected 1203 characteristic parameters from these regions by extracting radiomics features. Subsequently, we used a random number table to include 70 individuals in the training group and 30 in the validation group. Finally, we used the Lasso regression for dimension reduction and predictive model construction. The diagnostic performance of the model was evaluated by a receiver operating characteristic (ROC) curve.

Fourteen characteristic parameters with non-zero coefficients were selected after dimension reduction. The accuracy, sensitivity, specificity, and area under the ROC curve of the prediction model for the training group were 94.3% (66/70), 91.2% (31/34), 97.2% (35/36), and 0.988 (95% confidence interval [CI]: 0.970–0.998), respectively. The respective values for the validation group were 90.0% (27/30), 94.1% (16/17), 84.6% (11/13), and 0.952 (95% CI: 0.883–0.986).

Our non-contrast CT scan-based radiomics model accurately facilitated acute aortic dissection diagnosis.
Diagnostic yield of CT pulmonary angiography for pulmonary embolism in clinically suspected patients
Authors: Alshumrani Ghazi , Al bshabshe Ali , Mousa Wesam Faried
Published: June 2021

Pulmonary embolism (PE) is a common medical problem. Its diagnostic criteria must be reviewed to determine the need for confirmatory testing. Computed tomography pulmonary angiography (CTPA) is the current standard of care, which provides accurate diagnosis with rapid turnaround. This study aimed to estimate the diagnostic yield of CTPA in clinically suspected PE patients in a tertiary care hospital in Saudi Arabia.

Radiology records of all patients with clinically suspected PE who underwent CTPA between January 1, 2012 and September 30, 2018 were reviewed retrospectively. A radiologist with 10 years of professional experience interpreted and reported all cases. The Wells score with 2 tiers (likely and unlikely) was used to raise the clinical suspicion of PE.

Positive results for PE were reported in 177 out of 534 clinically suspected cases (33%). Among the positive PE cases, 143 were acute (81%) and 34 (19%) were chronic. Bilateral, right-sided, and left-sided PE were found in 115 (65%), 37 (21%), and 25 (14%) cases, respectively. Involvement of the segmental branches, subsegmental branches, and the pulmonary trunk were noted in 152 (86%), 70 (40%), and 9 cases (5%), respectively. Saddle PE was found in (4%) of the cases. The lower lobe branches (right 55%, left 53%) and the upper lobe branches (right 47%, left 41%) were the most common sites of involvement.

CTPA had a higher positive detection rate for PE among clinically suspected cases than its published diagnostic yield. Adequate clinical evaluation when selecting patients for CTPA is emphasized to minimize unjustified exposure of the patients to radiation and intravenous contrast administration. It is crucial for radiologists to provide detailed reports commenting on all relevant findings, including pertinent negatives. A template for reporting radiological findings for CTPA can be recommended for this purpose.
Hepatitis C virus and hepatitis B virus in patients with schizophrenia
Authors: Chang Chun-Hung , Liu Chieh-Yu , Chen Shaw-Ji , Tsai Hsin-Chi
Published: June 2021

This study evaluated the severe hepatic outcome (SHO) in patients with schizophrenia and viral hepatitis who received antipsychotics.

Using the nationwide Taiwan National Health Insurance Research Database, patients first diagnosed with schizophrenia between 2002 and 2013 were identified. Patients diagnosed with schizophrenia who had viral hepatitis, including hepatitis B virus (HBV) or hepatitis C virus (HCV), were designated as the viral hepatitis group. A control group without viral hepatitis was matched for age, sex, and index year in a 2:1 ratio. Patients with severe hepatic outcomes before enrollment were excluded. The 2 cohorts were observed until December 31, 2013. The primary endpoint was occurrence of a SHO, including liver cancer, liver failure, liver decompensation, or transplantation.

Among the 16,365 patients newly diagnosed with schizophrenia between January 2002 and December 2013, we identified 614 patients with viral hepatitis and 1228 matched patients without viral hepatitis. Of these 1842 patients, 41 (2.22%) developed SHOs, including 26 (4.23%) in the viral hepatitis group and 15 (1.22%) in the control group, during the mean follow-up period of 3.71 ± 2.49 years. Cox proportional hazard analysis indicated that the SHO risk increased by 3.58 (95% confidence interval [CI]: 1.859–6.754; P < .001) in patients with schizophrenia and viral hepatitis. Moreover, patients with schizophrenia having HCV had a higher SHO risk than those without viral hepatitis (hazard ratio: 5.07, 95% CI: 1.612–15.956; P < .0001). Patients having both schizophrenia and viral hepatitis, especially HCV, had a higher risk of SHOs.
Construction of autophagy prognostic signature and analysis of prospective molecular mechanisms in skin cutaneous melanoma patients
Authors: Liao Shian , He Juliang , Liu Chong , Zhang Zide , Liao Hongyu , Liao Zuowei , Yu Chaojie , Guan Jian , Mo Hao , Yuan Zhenchao , Liang Tuo , Lu Zhaojun , Xu Guoyong , Wang Zequn , Chen Jiarui , Jiang Jie , Zhan Xinli
Published: June 2021

Background:

Autophagy is closely related to skin cutaneous melanoma (SKCM), but the mechanism involved is unclear. Therefore, exploration of the role of autophagy-related genes (ARGs) in SKCM is necessary.

Materials and methods:

Differential expression autophagy-related genes (DEARGs) were first analysed. Univariate and multivariate Cox regression analyses were used to evaluate the expression of DEARGs and prognosis of SKCM. Further, the expression levels of prognosis-related DEARGs were verified by immunohistochemical (IHC) staining. Finally, gene set enrichment analysis (GSEA) was used to explore the underlying molecular mechanisms of SKCM.

Results:

Five ARGs (APOL1, BIRC5, EGFR, TP63, and SPNS1) were positively correlated with the prognosis of SKCM. IHC verified the results of the differential expression of these 5 ARGs in the bioinformatics analysis. According to the receiver operating characteristic curve, the signature had a good performance at predicting overall survival in SKCM. The signature could classify SKCM patients into high-risk or low-risk groups according to distinct overall survival. The nomogram confirmed that the risk score has a particularly large impact on the prognosis of SKCM. Calibration plot displayed excellent agreement between nomogram predictions and actual observations. Principal component analysis indicated that patients in the high-risk group could be distinguished from those in low-risk group. Results of GSEA indicated that the low-risk group is enriched with aggressiveness-related pathways such as phosphatidylinositol-3-kinase/protein kinase B and mitogen-activated protein kinase signalling pathways.

Conclusion:

Our study identified a 5-gene signature. It revealed the mechanisms of autophagy that lead to the progression of SKCM and established a prognostic nomogram that can predict overall survival of patients with SKCM. The findings of this study provide novel insights into the relationship between ARGs and prognosis of SKCM.
Herbal medicine for post-stroke insomnia
Authors: Kim Sang-Ho , Lim Jung-Hwa
Published: June 2021

Background:

Post-stroke insomnia (PSI) is a highly prevalent complication in patients with stroke. However, there has been no comprehensive systematic review assessing the efficacy and safety of herbal medicine (HM) on PSI. This protocol was developed to conduct a systematic review and meta-analysis to evaluate the evidence related to the efficacy and safety of HM on PSI.

Methods:

We will perform a comprehensive electronic search, including Medline, EMBASE, CENTRAL, AMED, CINAHL, PsycARTICLES, and Chinese, Korean, and Japanese databases from their inception to November 2020. This systemic review will include only randomized controlled clinical trials of HM on PSI. The main outcome is the Pittsburgh Sleep Quality Index score. Two researchers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. A meta-analysis will be conducted using Review Manager 5.4. The evidence quality of each outcome will be appraised according to Grades of Recommendation, Assessment, Development, and Evaluation.

Results:

This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P (PRISMA-P) guidelines to ensure clarity and completeness of reporting in all phases of the systematic review.

Conclusion:

This study will provide evidence regarding the efficacy and safety of HM for the treatment of PSI.

Ethics and dissemination:

No ethical approval will be needed because data from previously published studies in which informed consent was obtained by primary investigators will be retrieved and analyzed. We will publish this systematic review in a peer-reviewed journal.

OSF registration DOI:

10.17605/OSF.IO/PEHQZ.
Assessment of the efficacy of tuina on treating cervicogenic headache
Authors: Qian Xin , Ma Dongyang , Liu Jiayi , Pan Ting , Wang Haili , Hu Zhe , Wang Zhaohui , Qi Wei
Published: June 2021

Background:

Cervicogenic headache is a secondary headache characterized by unilateral headache, symptoms, and signs of neck involvement. It is often worsened by neck movement, sustained awkward head position, or external pressure over the upper cervical or occipital region on the symptomatic side. In this systematic review, we aimed to evaluate the efficacy and safety of massage therapy for the treatment of cervicogenic headache.

Methods:

We searched the China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, China Doctoral Dissertations Full-Text Database, China Master's Theses Full-Text Database, Cochrane Central Register of Controlled Trials, PubMed, and Embase. We will select all eligible studies published on or before April 1, 2021. We will use Review Manager 5.4, provided by the Cochrane Collaborative Network for statistical analysis. We then assessed the quality and risk of the included studies and observed the outcome measures.

Results:

This meta-analysis further confirmed the benefits of tuina in the treatment of cervicogenic headache.

Conclusion:

The purpose of this meta-analysis was to explore the effect of tuina on patients with cervicogenic headache and to provide more options for clinicians and patients to treat cervicogenic headache.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of tuina in the treatment of cervicogenic headache. Since all the data included were published, the systematic review did not require ethical approval.

Registration number:

INPLASY202150053.
Delayed transient obstructive hydrocephalus after cerebral aneurysm rupture
Authors: Ge Yuanhong , Lai Qingjia , Wang Wenyu , Xu Xuejun
Published: June 2021

Rationale:

Obstructive hydrocephalus (OH) frequently occurs in patients with a ruptured cerebral aneurysm (CA), and it may lead to severe neurological deficits, including life-threatening brain herniation. OH generally occurs in the early stage of CA rupture, rather than in the late stage, and rarely resolves without therapy.

Patient concerns:

A 64-year-old woman with a ruptured anterior communicating artery aneurysm was treated with coil embolization. Nineteen days after her CA rupture, because of the delayed transient OH, she experienced a dramatic cycle in consciousness over 9 hours: wakefulness–drowsiness–coma–drowsiness–wakefulness.

Diagnosis:

The patient was diagnosed with delayed transient obstructive hydrocephalus, which is a very rare condition.

Interventions:

Mannitol was administered to reduce intracranial pressure.

Outcomes:

The patient was discharged from the hospital 30 days after admission, with a final GCS score of 15 and without weaknesses. At follow-up 2 months after discharge, brain CT revealed non-recurrence of hydrocephalus.

Lessons:

A blood clot of any size in the ventricle is likely to lead to obstructive hydrocephalus. Prolonged bed rest for IVH patients may help to reduce the incidence of delayed OH.
Iris metastasis as the initial presentation of metastatic esophageal cancer diagnosed by fine needle aspiration biopsy
Authors: Ozawa Hiroko , Usui Yoshihiko , Takano Yoji , Horiuchi Naoki , Kuribayashi Tohru , Kurihara Toshihide , Smith Lois E.H. , Tsubota Kazuo , Tomita Yohei
Published: June 2021

Rationale:

Metastasis of neoplasms to the eye is quite uncommon. In this case report, we describe a patient where primary esophageal cancer was diagnosed by fine needle aspiration biopsy (FNAB) of an iris tumor.

Patient concerns:

A 70-year-old male complained of redness and discomfort in the right eye.

Diagnosis and interventions:

The patient's right eye was diagnosed as idiopathic uveitis, and a topical steroid was administered. As vitreous opacities were observed even after topical therapy, oral prednisolone was administered. On slit-lamp examination of the right eye, an iris mass with neovascularization was seen in the anterior chamber. A metastatic tumor was suspected, and FNAB was performed. Histology revealed squamous cell carcinoma. Systemic workup revealed esophageal cancer with several metastases. Best-corrected visual acuity decreased to 20/400, and intraocular pressure was 40 mmHg in the right eye. Two iris tumors with neovascularization were present extending into the anterior chamber with posterior iris synechiae and 360 degree peripheral anterior synechiae. Intraocular pressure in the right eye was medically managed with hypotensive eye drops and oral acetazolamide. Iris metastases were treated with 40 Gray of radiation therapy and concurrent chemotherapy.

Outcomes:

The tumor regressed, but intraocular pressure was refractory to treatment because of 360 degree goniosynechial closure. The right eye lost light perception six months after treatment commenced, and the patient died 9 months after the onset of therapy due to multiple systemic metastases.

Lessons:

This is a rare case of masquerade syndrome without systemic symptoms in which FNAB of an iris tumor led to a diagnosis of metastatic esophageal squamous cell carcinoma. Although the patient lost his sight due to uncontrollable ocular hypertension, systemic chemotherapy, and radiation therapy were initially effective in the treatment of the metastatic iris tumor. As the prognosis of patients with metastatic iris tumors is poor, it is important for ophthalmologists to consider such diagnoses and conduct systemic investigations when necessary.
Acute acalculous cholecystitis as the initial manifestation of systemic lupus erythematous
Authors: Lee Jeonghun , Lee Young Joo , Kim Youngsun
Published: June 2021

Rationale:

Acute acalculous cholecystitis (AAC) is an extremely rare manifestation of systemic lupus erythematous (SLE). In previous reports, most of the patients were already diagnosed cases of SLE upon confirmation of AAC.

Patient concerns:

A 24-year-old female who initially presented with fever and acute right upper quadrant abdominal pain. She had no medical history.

Diagnoses:

Abdominal ultrasonography and computed tomography (CT) showed gallbladder thickening with pericholecystic edema without gallstones or sludge, demonstrating acalculous cholecystitis. She revealed discoid rash on the both shin. Laboratory tests revealed pancytopenia. The titer of antinuclear antibody (ANA) was 1:1280. Anti-dsDNA antibody, anti-phospholipid antibody, anti-Sm antibody test, and proteinuria in 24 hours were positive. Both C3 and C4 were low. Echocardiography and chest CT showed pericardial effusion and pleural effusion. Using the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria, the score was 31. We thought AAC of this case that was one of the initial manifestations of SLE.

Interventions:

The patient was treated with high-dose prednisolone (1 mg/kg) and hydroxychloroquine 400 mg.

Outcomes:

After 4 days of administration of high-dose corticosteroid therapy, symptoms rapidly improved. After 35 days of the treatment, her symptoms and disease activity of SLE were markedly improved.

Lessons:

Although AAC being the initial manifestation of SLE is very rare, prompt diagnosis and management with corticosteroids precluded surgical intervention. Physicians need to be cognizant of AAC as a disease flare and as a rare initial manifestation of SLE.
Efficacy and safety of Kanglaite injection combined with chemotherapy for women breast cancer
Authors: Cheng Shengli , Qu Biao , Qiu Xiaoxia , Li Nannan , Wang Xiaoli , Hao Jiahu
Published: June 2021

Background:

Breast cancer was the second cause of cancer death and approximately accounted for 30% of all newly diagnosed cancer in American women. Adjuvant chemotherapy is the preferred treatment approach for breast patients. Kanglaite injection (KI) was commonly used as adjuvant chemotherapy combined with chemotherapy for women breast cancer which could increase chemotherapy efficacy and alleviate chemotherapy drugs induced adverse events, however, the efficacy and safety for KI combined western medicine remains controversial. Thus, we conducted this protocol of systematic review and meta-analysis to estimate the efficacy and safety of KI combined with western medicine for women breast cancer.

Methods:

This study will search electronic database included English medicals databases and Chinese databased up to May 2021. The main outcomes of this study include clinical efficacy rate. Adverse reaction rate, Karnofsky Performance Status and immune function were defined as the secondary outcomes.

Results:

This protocol study will comprehensively evaluate the efficacy and safety of KI combined with chemotherapy for women breast cancer.

Conclusion:

This protocol for systematic review and meta-analysis will evaluate the efficacy and safety of KI combined with chemotherapy for women breast cancer, aiming to provide optimal therapy for women breast cancer patients.
Impact of closure of the in-house psychiatric care unit on prehospital and emergency ward length of stay and disposition locations in patients who attempted suicide
Authors: Ono Yuko , Ono Nozomi , Kakamu Takeyasu , Ishida Tokiya , Inoue Shigeaki , Kotani Joji , Shinohara Kazuaki
Published: June 2021

Suicide is an increasingly serious public health care concern worldwide. The impact of decreased in-house psychiatric resources on emergency care for suicidal patients has not been thoroughly examined. We evaluated the effects of closing an in-hospital psychiatric ward on the prehospital and emergency ward length of stay (LOS) and disposition location in patients who attempted suicide.

This was a retrospective before-and-after study at a community emergency department (ED) in Japan. On March 31, 2014, the hospital closed its 50 psychiatric ward beds and outpatient consultation days were decreased from 5 to 2 days per week. Electronic health record data of suicidal patients who were brought to the ED were collected for 5 years before the decrease in in-hospital psychiatric services (April 1, 2009–March 31, 2014) and 5 years after the decrease (April 1, 2014–March 31, 2019). One-to-one propensity score matching was performed to compare prehospital and emergency ward LOS, and discharge location between the 2 groups.

Of the 1083 eligible patients, 449 (41.5%) were brought to the ED after the closure of the psychiatric ward. Patients with older age, burns, and higher comorbidity index values, and those requiring endotracheal intubation, surgery, and emergency ward admission, were more likely to receive ED care after the psychiatric ward closure. In the propensity matched analysis with 418 pairs, the after-closure group showed a significant increase in median prehospital LOS (44.0 minutes vs 51.0 minutes, P < .001) and emergency ward LOS (3.0 days vs 4.0 days, P = .014) compared with the before-closure group. The rate of direct home return was significantly lower in the after-closure group compared with the before-closure group (87.1% vs 81.6%, odds ratio: 0.66; 95% confidence interval: 0.45–0.96).

The prehospital and emergency ward LOS for patients who attempted suicide in the study site increased significantly after a decrease in hospital-based mental health services. Conversely, there was significant reduction in direct home discharge after the decrease in in-house psychiatric care. These results have important implications for future policy to address the increasing care needs of patients who attempt suicide.
Epidemiological changes of geriatric trauma in the United Arab Emirates
Authors: Alao David O. , Cevik Arif Alper , Grivna Michal , Eid Hani O. , Abu-Zidan Fikri M.
Published: June 2021

We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.

Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.

There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%–77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%–78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%–16.5%, P = 0.07, Fisher Exact test).

Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.