bluuebunny/crossref_metadata_2025 huggingface dataset:
A Two-Dimensional Mathematical Model to Simulate the Effects of Knee Center Misalignment in Lower-Limb Orthoses
Authors: Bapat Ganesh M. , Sujatha S.
Published: August 2020

Introduction

Pistoning is relative sliding motion between an affected limb and its corresponding externally fit assistive device (like an orthosis). Pistoning causes skin problems, pain, and discomfort to the orthosis user. Misalignment of an orthotic joint with respect to the anatomical joint is one of the causes of pistoning motion, and the current knowledge pertaining to the effects of orthotic knee center (OKC) misalignments in lower-limb orthoses is limited. This work quantifies the effects of OKC misalignment in terms of relative motion between the limb and the orthosis and predicts locations of resultant pressure point on the limb.

Method

A two-dimensional link segment model that simulates relative motion between the limb and orthosis was developed. The OKC was systematically misaligned in the anterior-posterior (A-P), proximal-distal (P-D) directions, and their combination to simulate orthosis/thigh strap sliding and identify pressure points on the thigh. Simulations were performed for stand-to-sit activity and walking with a knee-ankle-foot orthosis.

Results

It was found that OKC misalignment causes increased A-P and P-D relative motions with an increase in misalignment distance for the stand-to-sit activity. The A-P and P-D relative motions are of greater concern for activities involving increased knee flexion such as sitting, squatting, and kneeling as compared with walking with an orthosis. Although the A-P and P-D relative motions during walking are of small magnitude, they occur with reversals in the direction and are repetitive in nature, which may cause skin problems and discomfort due to recurring pressure points.

Conclusions

The model provides a means to study the consequences of misalignment and insights for orthosis modification for improved comfort. A software simulation tool based on the presented model can serve as an educational and training tool in prosthetics and orthotics courses for creating awareness about the importance of proper alignment of orthotic knee joints. Study of misalignments of this nature will also guide fabrication and fitting of lower-limb orthoses/exoskeletons.
Risk Factors Associated With Postendoscopic Mucosal Resection Bleeding in Patients With Cirrhosis
Authors: Hasan Badar , Colak Yasar , Rashid Mamoon Ur , Van Amy , Sarvepalli Deepika , Khalid Rumman A. , Yim Yunjoo , Rahman Asad Ur , Charles Giovanni , Castro Fernando J. , Zervos Xaralambos B. , AlKhalloufi Kawtar
Published: August 2020

Background and Aim:

There is limited data regarding the safety of endoscopic mucosal resection (EMR) in the cirrhotic population. Our study aimed to evaluate the safety of colonoscopic EMR in cirrhosis.

Materials and Methods:

This was a retrospective review of cirrhotics who underwent colonic EMR at 8 Cleveland Clinic Centers between January 1, 2006, and December 31, 2018. Patient data including polyp details and complications occurring within 30 days of the procedure were noted. Univariable and multivariable logistic regression analyses were conducted to find risk factors for post-EMR bleeding.

Results:

A total of 238 patients who underwent EMR were included. There were 145 males (60.9%) and the mean age was 61.9±8.6 years. Immediate and delayed bleeding, and postpolypectomy syndrome rates were 9.2%, 5.8%, and 1.3%, respectively. Significant risk factors for postpolypectomy bleeding were: increased age (P=0.001), procedure duration >37 minutes (P=0.001), antiplatelet use within 5 days (P=0.023), and lesion diameter >15 mm (P=0.004). Multivariable analysis revealed independent predictors of procedure-related bleeding: age above 65 years [odds ratio (OR) 2.14, P=0.044], antiplatelet use within 5 days (OR 2.42, P=0.047), right colon polyp (OR 3.51, P=0.001), and lesion diameter >15 mm (OR 3.22, P=0.003).

Conclusions:

EMR in cirrhotics has an acceptable bleeding risk. Age above 65 years, right colon polyp, polyp size >15 mm, and use of antiplatelets within 5 days are independent risk factors for bleeding.
Diagnostic performance of a whole-body dynamic 68GA-DOTATOC PET/CT acquisition to differentiate physiological uptake of pancreatic uncinate process from pancreatic neuroendocrine tumor
Authors: Thuillier Philippe , Bourhis David , Karakatsanis Nicolas , Schick Ulrike , Metges Jean Philippe , Salaun Pierre-Yves , Kerlan Véronique , Abgral Ronan
Published: August 2020

To evaluate the diagnostic performance of net influx rate (Ki) values from a whole-body dynamic (WBD) 68Ga-DOTATOC-PET/CT acquisition to differentiate pancreatic neuroendocrine tumors (pNETs) from physiological uptake of pancreatic uncinate process (UP).

Patients who were benefited from a WBD acquisition for the assessment of a known well-differentiated neuroendocrine tumor (NET)/suspicion of disease in the prospective GAPET-NET cohort were screened. Only patients with a confirmed pNET/UP as our gold standard were included. The positron emission tomography (PET) procedure consisted in a single-bed dynamic acquisition centered on the heart, followed by a whole-body dynamic acquisition and then a static acquisition. Dynamic (Ki calculated according to Patlak method), static (SUVmax, SUVmean, SUVpeak) parameters, and tumor-to-liver and tumor-to-spleen ratio (TLRKi and TSRKi (according to hepatic/splenic Ki)), tumor SUVmax to liver SUVmax (TM/LM), tumor SUVmax to liver SUVmean (TM/Lm), tumor SUVmax to spleen SUVmax (TM/SM), and tumor SUVmax to spleen SUVmean (TM/Sm) (according to hepatic/splenic SUVmax and SUVmean respectively) were calculated. A Receiver Operating Characteristic (ROC) analysis was performed to evaluate their diagnostic performance to distinguish UP from pNET.

One hundred five patients benefited from a WBD between July 2018 and July 2019. Eighteen (17.1%) had an UP and 26 (24.8%) a pNET. For parameters alone, the Ki and SUVpeak had the best sensitivity (88.5%) while the Ki, SUVmax, and SUVmean had the best specificity (94.4%). The best diagnostic accuracy was obtained with Ki (90.9%). For ratios, the TLRKi and the TSRKi had the best sensitivity (95.7%) while the TM/SM and TM/Sm the best specificity (100%). TLRKi had the best diagnostic accuracy (95.1%) and the best area under the curve (AUC) (0.990).

Our study is the first one to evaluate the interest of a WBD acquisition to differentiate UP from pNETs and shows excellent diagnostic performances of the Ki approach.
HER2-positive pure mucinous breast carcinoma
Authors: Zhao Xingjuan , Yang Xuan , Gao Runfang , Zhai Liqin , Yang Lizhu , Yu Keda
Published: August 2020

Introduction:

Pure mucinous carcinoma is a rare type of breast carcinoma, but it usually has a favorable prognosis. Tumors of pure mucinous carcinoma are typically positive for both estrogen receptor (ER) and progesterone receptor (PR), and they do not commonly overexpress human epidermal growth factor receptor 2 (HER2). However, when tumors have HER2 overexpression and are progesterone receptor negative, the prognosis is worse.

Patient concerns:

A 59-year-old female reported a slow growth mass of 3 years, which was radiologically diagnosed as fibroadenoma at another institution. The patient came to our institution for treatment and follow-up. She had no salient past history.

Diagnosis:

Excisional biopsy revealed a pure mucinous breast carcinoma that was ER (100%, moderate-strong intensity), PR(−), 5% Ki-67 (+), and HER2(3+) by immunohistochemistry. The HER2 gene was found to be amplified by fluorescence in situ hybridization (FISH). The clinical staging was T2N0M0, with pathological grade I, subtype luminal B.

Interventions:

After a modified radical mastectomy, she received four 21-day cycles of intravenous docetaxel (75 mg/m2), intravenous cyclophosphamide (600 mg/m2), and intravenous trastuzumab (8 mg/kg) (loading dose) on day 1 followed by 6 mg/kg every 3 weeks to complete a full year of treatment. She then received 2.5 mg of letrozole daily for 5 years.

Outcomes:

After following up for 2 years, the patient's outcome was survival without recurrence. Cardiac ultrasounds were performed every 3 months and there was no change in the left ventricular ejection fraction (LEVF).

Conclusion:

It is essential to correctly diagnose the ER(+), PR(−) HER2(+) subtype in mucinous carcinoma. This type should be treated with chemotherapy and anti-HER2 therapy, as well as aromatase inhibitor endocrine therapy.
Chinese medicine for coronavirus disease 2019 as complementary therapy
Authors: Zhou Min , Liang Qijun , Pei QiuLan , Xu Fan , Wen Hang
Published: August 2020

Background:

The aim of this systematic review and meta-analysis is to assess effectiveness and safety of Chinese medicine (CM) as complementary therapy in treating coronavirus disease 2019 (COVID-19).

Methods:

The following databases will be searched: PubMed, Cochrane, Embase, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang database from October 1, 2019 to March 1, 2020. Randomized trials and quasi-randomized or prospective controlled clinical trials of CM that reported data on COVID-19 patients will be included. Study selection, data extraction, quality assessment, and assessment of risk bias will be performed by 2 reviewers independently. Odds ratios and correlative 95% confidence intervals will be calculated to present the association between the CM and CWM using Review Manager version 5.3 when there is sufficient available data.

Results:

The results will be disseminated through a peer-reviewed journal publication.

Conclusion:

This systematic review findings will summarize up-to-date evidence for that CM is more effective and safe as adjunctive treatment for patients with COVID-19.

Ethics and dissemination:

Ethics approval and patient consent are not required as this study is a systematic review based on published articles.

PROSPERO registration number:

CRD42020185382.
Multi-center study for acupuncture combined with Chinese medicine in the treatment of chronic spontaneous urticaria based on the theory of taking shu-stream points when the disease is aggravated
Authors: Qin Yuesi , Guo Jing , Song Pan , Hou Tianshu , He Yan , Han Ming , Yu Qianying , Lin Wenxia , Chen Mingling , Su Hong
Published: August 2020

Chronic spontaneous urticaria (CSU) is a common dermatologic disease that seriously affects patient quality of life. The choice of therapy to control the disease and prevent its recurrence has always presented a difficult clinical issue. Previous studies have shown that traditional Chinese medicine is a safe and effective treatment for CSU. Recently, the temporal rhythms of CSU, a disease characterized by intermittent flares of active disease and periods of little or no disease, have attracted the attention of traditional Chinese medicine researchers. We designed a multicenter, randomized, controlled study to evaluate the efficacy and safety of combining a Chinese herbal formulation with acupuncture using shu-stream acupoints applied on the corresponding time meridians during disease exacerbations. We plan to recruit 111 outpatients with CSU aged 18 to 65 years. Participants will be randomized to 1 of the 3 groups: group A, which will be given basic acupuncture and the herbal formulation dangui yinzi; group B, which will be given danggui yinzi and shu-stream acupuncture; and a control group, which will be given danggui yinzi alone. Patients will be treated for 4 weeks and followed for 8 additional weeks. Investigators will evaluate the following parameters: the symptoms and side effects of treatment, quality of life (using the chronic urticaria quality of life questionnaire), and overall patient condition. Each week, patients will also complete the measurement of 7-day urticarial activity score. This is the first use of a combination of shu-stream acupoints and Chinese herbal medicine in the treatment of CSU. If successful, it will prove to be a simple, inexpensive, treatment strategy for solving a difficult clinical problem.
A protocol of systematic review and meta-analysis of narrow band imaging endoscopy in detection of early gastric cancer
Authors: Zhang Li , Liu Xiao-yu , Zhong Gang , Xin Zhi , Sun Xiang-Yu , Wang Zhen-Yu
Published: August 2020

Background:

Early gastric cancer is the fifth common malignancy and the third leading cause of cancer death throughout the world. However, it is not clear how endoscopic screening for early gastric cancer affects incidence or mortality. We performed a systematic review and meta-analysis to evaluate the relationship between endoscopic screening for the mortality and incidence of early gastric cancer.

Materials and methods:

This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Web of Science, PubMed, EMBASE, and the Cochrane Library were searched for cohort and case-control studies in cases without early gastric cancer until March 31, 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the Eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The relative risk and 95% confidence intervals were used as effect estimate. I-square test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review.

Results:

The results will be published in a peer-reviewed journal.

Conclusion:

The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence of whether endoscopic screening would reduce the mortality and incidence of early gastric cancer.

PROSPERO registration number:

CRD42020171053
Selective serotonin reuptake inhibitors-associated apathy syndrome
Authors: Padala Prasad R. , Padala Kalpana P. , Majagi Anusha S. , Garner Kimberly K. , Dennis Richard A. , Sullivan Dennis H.
Published: August 2020

Selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, are associated with loss of motivation, anergy, and lack of curiosity often referred collectively as apathy. However, this association has not been systematically assessed using a specific rating scale for measuring apathy syndrome. Our objective was to study the association between SSRI use and apathy syndrome.

We conducted a retrospective chart review of 125 patients enrolled in an outpatient psychiatry clinic. The prevalence of apathy syndrome and its clinical significance (based on standardized assessment) were compared between patients treated and not treated with SSRIs. Apathy was assessed using the Apathy Evaluation Scale-clinician version with a score ranging 18–72 with higher score for worse apathy. A score of greater than 30 is considered clinically significant apathy.

Among 119 patients, the mean apathy scores were significantly higher in those treated with SSRIs compared to those not treated with SSRIs (42.5 ± 9.2 vs 31.3 ± 6, P < .0001). The SSRI group also had a significantly higher percentage of patients with clinically significant apathy (92% vs 61%, P < .0001). Use of all SSRIs was associated with the presence of apathy. Apathy was seen in all mental health diagnostic categories with highest Apathy evaluation scale-clinician version scores in those with dementia.

SSRI use may be associated with higher rates of apathy syndrome. Clinicians should specifically inquire about iatrogenic apathy syndrome when evaluating patients on an SSRI if there is suspicion of loss of motivation. Limitations of this study included retrospective nature of this study, and that majority of the sample was males. Prospective studies are needed to elucidate information regarding the prevalence, etiology, and treatment response for SSRI-associated apathy syndrome.
Laparoscopic versus open herniorrhaphy for children with inguinal hernia
Authors: Liu Guoqing , Zhang Wenxian , Zhou Jianfeng , Sun Bin , Jiang Bin , Wang Hao
Published: August 2020

Purpose:

The aim of this study was to compare the effectiveness between laparoscopic herniorrhaphy (LH) and open herniorrhaphy (OH) in children with inguinal hernia.

Methods:

PubMed, EmBase, and the Cochrane library were searched to select trials from their inception till April 2019. The summary of relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were employed to evaluate the treatment effectiveness between LH and OH.

Results:

Six randomized controlled trials (RCTs) including a total of 594 children were selected. No significant differences were observed between LH and OH regarding the risk of postoperative complications. However, LH significantly reduced the risk of major postoperative complications when compared with OH. Moreover, LH showed association with a shorter operative time in bilateral inguinal hernia when compared with OH, whereas no significant difference between groups for unilateral inguinal hernia. Finally, children who received LH showed association with longer time to discharge than those who received OH, whereas no significant difference was observed between the groups for time to resume full activity.

Conclusions:

These findings suggested that children who received LH had protection against major postoperative complications than those who received OH. Moreover, children who received LH had shorter operative time, and longer time to discharge.
Analysis of the correlation between periodontal disease and metabolic syndrome among coal mine workers
Authors: Zhao Jian , Zhu Xiang-yu , Ren Yan , Li Jin-yuan
Published: August 2020

Metabolic syndrome (MetS) refers to the pathological state of metabolic disorders in the body's proteins, fats, carbohydrates and other substances. MetS is a systemic metabolic disease. Periodontal disease is also a part of systemic inflammatory diseases. Among Chinese patients with middle-aged and elderly MetS, the periodontal morbidity is very high, which is due to the involvement of inflammatory mediators in the pathogenesis of MetS and periodontal disease. The latter may also be a risk factor for the former's morbidity and promotion of disease progression. At present, there are not many investigations and studies on periodontal examination data and periodontal disease prevalence of patients with MetS. Coal mine workers, especially coal mine underground workers, have different work natures and different working environments. See related report.

We will collect the clinical diagnosis and treatment information of the enrolled patients. We will focus on checking the incidence of periodontal disease and recording. Establish a database, check every 10 medical records, and make corrections in time to ensure data accuracy. We will popularize oral hygiene knowledge for the included patients and guide them to brush their teeth correctly and how to use dental floss. We will perform periodontal examination on the patients’ teeth by site and record the plaque index, gingival sulcus bleeding index, periodontal pocket exploration depth and other indicators. We will repeat the above inspection items and record in the second and fourth weeks of the experiment.

This study will explore the correlation between periodontal disease and MetS of coal mine workers. We aim to clarify the role and mechanism of MetS in the occurrence and development of periodontal diseases, guide the prevention of periodontal diseases, and thus reduce the prevalence of periodontal diseases.

Trial registration:

ClinicalTrials.gov, ChiCTR2000034177, Registered on 27 June 2020
Ankylosing spondylitis complicating Turner syndrome
Authors: Chen Fang-Fei , Zhang Xue-Han , Jiao Yang
Published: August 2020

Rationale:

Turner syndrome (TS) is an anomaly caused by loss of part of or all the X chromosomes. Ankylosing spondylitis (AS) is an HLA-B27-associated autoimmune disease with a male predominance. It is widely accepted that TS patients are at higher risk of autoimmune diseases, but AS in TS patients has only rarely been reported.

Patient concerns:

A 13-year-old TS patient presented with intermittent pain in both hip joints, and a 27-year-old TS patient presented with thoracic kyphosis and a history of AS.

Diagnoses:

Both patients were diagnosed with AS according to their symptoms, laboratory results, and imaging.

Interventions:

The first patient was treated with tocilizumab for 8 months, whereas the second patient was treated with diclofenac initially with subsequent surgery for thoracic kyphosis.

Outcomes:

Treatment relieved the symptoms of both patients and laboratory parameters improved.

Lessons:

Even though AS has a male predominance, clinicians should be aware that AS and TS may co-exist and that the clinical features are atypical in TS patients with AS.
The efficacy and safety of the infiltration of the interspace between the popliteal artery and the capsule of the knee block in total knee arthroplasty
Authors: Cong Zhongxiao , Zhang Lejun , Ma Fengying
Published: August 2020

Background:

Total knee arthroplasty (TKA) is an established and successful surgical procedure which is the major treatment for degenerative knee joint diseases. A novel technique to address posterior knee joint pain is the infiltration of local anesthetic between the interspace between the popliteal artery and capsule of the knee (IPACK). The goal of this randomized clinical trial was to assess the efficacy and safety of adding IPACK to adductor canal block (ACB) after TKA.

Methods:

This was a prospectively randomized trial that investigated the effectiveness and safety of the IPACK after TKA. Approval from Clinical Studies Ethical Committee in Qilu Hospital of Shandong University was obtained. The inclusion criteria were adult patients undergoing primary unilateral TKA and American Society of Anesthesiologists grade 1 or 2 with normal cognitive function. The patients were randomized to 1 of 2 treatment options: ACB-alone group and ACB + IPACK group. The primary outcome was the total morphine consumption during postoperative 24 hours. Secondary outcomes included postoperative pain score, time to first and total dosage of rescue morphine in postoperative 48 hours, early and late postoperative period (from postoperative day 0–3 months follow-up) performance-based test (Timed-Up and Go test, and quadriceps strength). Postoperative nausea and vomiting, length of hospital stay, patient satisfaction, and other adverse events were also evaluated.

Results:

It was hypothesized that when combined with a control group, the IPACK block would result in a lower morphine consumption and pain score after TKA.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5765).
Effect of renal dialysis on mortality and complications following hip fracture surgery in elderly patients
Authors: Ahn Eun-Jin , Bang Si Ra
Published: August 2020

Hip fractures in older patients requiring dialysis are associated with high mortality. The primary aim of this study was to evaluate the specific burden of dialysis on 30-day mortality following hip fracture surgery. The secondary aim was to determine the burden of dialysis on overall survival as well as several postoperative complications.

A retrospective cohort study was conducted using data from the Korean National Health Insurance Research Database. Patients were aged ≥65 years and underwent hip fracture surgery during the period from 2009 to 2015. To construct a matched cohort, each dialysis patient was matched to 4 non-dialysis patients based on age, sex, hospital type, anesthesia type, and comorbidities. Survival status was determined 30 days after surgery and at the end of the study period.

In total, 96,289 patients were identified. Among them, 1614 dialysis patients were included and matched to 6198 non-dialysis patients. During the 30-day postoperative period, there were 102 mortality events in the dialysis group and 127 in the non-dialysis group, for an adjusted hazard ratio of 3.12 (95% confidence interval, 2.42–4.09). Overall, by the end of the study period, there were 1120 mortality events in the dialysis group and 2731 in the non-dialysis group, for an adjusted hazard ratio of 1.97 (95% confidence interval, 1.83–2.1). These findings may be limited by the characteristics of the administrative database.

The 30-day mortality rate was 3-fold higher in the dialysis group than in the non-dialysis group, while the overall mortality rate was approximately 2-fold higher in the dialysis group than in the non-dialysis group. These findings suggest that caution in the perioperative period is required in dialysis patients undergoing hip fracture surgery. The results of our study represent only an association between dialysis and mortality. Further studies are necessary to investigate the possible causal effect of dialysis on mortality and complications after hip fracture surgery.
The Risks of Exfoliative Esophagitis in Patients with Atrial Fibrillation
Authors: Tajima Hiroki , Narasaka Toshiaki , Akutsu Daisuke , Suzuki Hideo , Matsui Hirofumi , Maruo Kazushi , Yamasaki Hiro , Mizokami Yuji
Published: August 2020

The aging of the population has resulted in atrial fibrillation (AF) becoming increasingly prevalent. Treatment focuses on the prevention of thromboembolism through the use of catheter ablation or drug therapy with anticoagulants, such as warfarin or direct oral anticoagulants (DOACs). Dabigatran-induced exfoliative esophagitis has been reported as a rare side effect of DOACs. Although most cases are mild, some result in severe outcomes. However, the etiology of exfoliative esophagitis remains incompletely understood. The aim of this study is to investigate the etiology of exfoliative esophagitis and identify its risk factors by observational study.

The participants were 524 patients using anticoagulants who received catheter ablation for AF and subsequently underwent upper gastrointestinal endoscopy at University of Tsukuba Hospital. Exfoliative esophagitis was noted in 21 (4.0%) patients. Potential risk factors for exfoliative esophagitis were examined retrospectively by comparing patients with and without this condition across the following parameters that were extracted retrospectively from the electronic medical records: physical characteristics, comorbidities, blood-based cardiac markers, echocardiographic and endoscopic findings, and current medications.

Regarding physical characteristics, patients with exfoliative esophagitis had significantly higher body weight and BMI. No association was observed between exfoliative esophagitis and comorbidities. Associations were also not found for cardiac markers, echocardiographic findings, or endoscopic findings. In terms of current medications, patients receiving oral dabigatran showed the highest prevalence of exfoliative esophagitis at 8.8% (13/148). The adjusted odds ratio of dabigatran for exfoliative esophagitis was 10.3 by multivariable logistic regression analysis.

Obesity and oral dabigatran were found to be significant risk factors for exfoliative esophagitis.
Is biodegradable pin a good choice for lateral condylar fracture of humerus in children
Authors: Li Jin , Rai Saroj , Liu Yudong , Ze Renhao , Tang Xin , Liu Ruikang , Hong Pan
Published: August 2020

Introduction:

Lateral condylar fracture (LCF) of the humerus in children is one of the commonest elbow injuries in children. Early recognition of the problem and appropriate management usually yields satisfactory outcomes. Closed or open reduction with Kirschner-wire (KW) is a cost-effective choice of fixation method for displaced fracture. However, various other methods, including partially threaded cannulated cancellous screw and biodegradable pin (BP), have also been used. This study aimed to investigate the efficacy of BP and compare its clinical outcomes with KW.

Material and methods:

Patients with LCF admitted from January 2008 to January 2016 at our institute were reviewed retrospectively. Baseline information and clinical data were collected from Hospital Database. Patients were divided into the KW group and BP group.

Results:

In all, 85 patients (male 50, female 35) in the KW group and 76 patients (male 47, female 29) in the BP group were included in this study. The average age of patients in the KW group was 5.2 years, and that of BP was 5.9 years. No nonunion or malunion was observed in either group. At the last follow-up visit, there was no statistically significant difference between the 2 groups with regard to elbow function and appearance. The incidence of long-term complications, including avascular necrosis, fishtail deformity, and lateral prominence, showed no significant difference between both the groups. The incidence of hardware prominence was higher in the KW (13/85, 15.6%) than BP (2/76, 2.6%) group (P < .001).

Conclusions:

Both KW and BP are safe and effective choices for LCF of the humerus in children. Both the implant designs produce satisfactory and comparable clinical outcomes. However, BP has the advantage of less hardware prominence, no need for hardware removal, and fewer long-term complications.
Association between ABO blood groups and risk of coronavirus disease 2019
Authors: Liu Nanyang , Zhang Tingting , Ma Lina , Wang Huican , Li Hao
Published: August 2020

Background:

The 2019 Coronavirus Disease (COVID-19) pandemic has threatened millions of people worldwide. Growing evidence suggests that the ABO blood type contributed to the susceptibility of COVID-19, but the results are controversial. The major objective of this systematic review and meta-analysis study is to investigate the impact of ABO blood group on COVID-19 pneumonia.

Methods:

Two independent reviewers searches the databases of the China Biology Medicine disc, China National Knowledge Infrastructure, China Science and Technology Periodical Database, Wanfang Database, PubMed, Embase, and Web of Science from the date of conception to June 30, 2020. We will manually search for gray literature, such as meeting records and dissertations. Two independent reviewers will screen studies that meet the criteria, extract data, statistical data, and assess the risk of bias. The dichotomous variable will calculate the odds ratio and the corresponding 95% confidence interval. Heterogeneity between included studies will be assessed by heterogeneity χ
2 tests and I
2 index. The forest plots will be used to describe the pooled results. The Begg rank correlation test or Egger linear regression test will be performed to quantize the publication bias.

Discussion:

This study will provide high-quality evidence to evaluate the contribution of the ABO blood group in COVID-19 pneumonia infection.

PROSPERO registration number:

CRD42020195615
Towards a universal definition of postpartum hemorrhage: retrospective analysis of Chinese women after vaginal delivery or cesarean section
Authors: Wei Qiang , Xu Yi , Zhang Li
Published: August 2020

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, yet it is inconsistently defined, preventing accurate estimation of its incidence and identification of risk factors. Here we began to explore a unified definition of PPH that may be valid for vaginal delivery and cesarean section.

Medical records of women who underwent vaginal delivery or cesarean section at our tertiary medical center between January and December 2018 were retrospectively analyzed. Patients who delivered by each route were compared in terms of PPH incidence and risk factors depending on different blood loss cut-off values.

A total of 560 vaginal deliveries and 393 cesarean sections were analyzed. Vaginal deliveries were associated with significantly greater blood loss based on change of hemoglobin level, but significantly lower blood loss based on clinical estimation. When PPH was defined as blood loss ≥500 ml based on change of hemoglobin level, its incidence was 57.7% for vaginal deliveries and 28.2% for cesarean sections. The corresponding incidences were 15.4% and 3.3% when PPH was defined as blood loss ≥1000 ml based on change of hemoglobin levels. Independent risk factors for PPH in vaginal deliveries were lateral perineotomy (OR 2.835, 95%CI 1.694-4.743), suturing by a junior physician (OR 3.456, 95%CI 2.005-5.956), and long time from delivery of placenta to return to the recovery room (OR 1.013, 95%CI 1.003-1.022). A risk factor for PPH in cesarean sections was a long time from delivery of the fetus until the end of the operation.

PPH is a significantly underestimated obstetric problem, especially in vaginal deliveries. Regardless of delivery route, hemoglobin-based blood loss of 500 ml and 1000 ml may be useful, respectively, as early warning and diagnostic cut-off values.
Image quality and clinical usefulness of automatic tube current modulation technology in female chest computed tomography screening
Authors: Li Cheng , Qi Lin , Zhang Yusheng , Gao Feng , Jin Xiu , Zhang Lukai , Tang Huan , Li Ming
Published: August 2020

The study was aimed to evaluate the image quality and radiation dose during female chest computed tomography (CT) screening using organ-based tube current modulation technology X-ray combined applications to reduce exposure (XCARE).

Five hundred sixty female individuals undergoing chest CT scan were prospectively enrolled and divided into 4 groups based on body mass index (BMI). Then they were randomly and equally divided into control and experimental subgroup and respectively accepted conventional low-dose and XCARE technology spiral CT scan with same parameters. Signal-to-noise ratio and contrast-to-noise ratio were calculated. The quality of the images was evaluated by 2 radiologists using a 5-point scale.

Among experimental subgroups of the 4 BMI groups, Signal-to-noise ratios, CT dose index of volume, dose-length product, effective dose, and contrast-to-noise ratio all displayed significant differences, as well as in control subgroups (P < .001). Both the experimental and control subgroups showed an increasing trend in radiation dose with the increasing of BMI. Parameters of image quality and radiation dose displayed no significant differences between control and experimental subgroups in the 4 groups. In multiple linear regression analysis, age and scanning protocol were not associated with radiation dose (P > .05), while BMI was significantly associated with increased CT dose index of volume (P < .05). The display of the lesions for the patients in the control and experimental subgroups of the 4 groups with different BMIs exhibited no statistically significant difference.

The same image quality and radiation dose can be obtained using XCARE technology compared to conventional chest CT scans, which can be used regularly in female patients.

Advances in knowledge: Using automatic tube current modulation technology to reduce exposure in breast. In this study, we sought a radiation protection method for sensitive tissue in chest CT screening.
Intramuscular hemangioma with hemorrhagic transformation arising from paraspinal muscles of posterior neck
Authors: Yu Dongwoo , Choi Joon Hyuk , Jeon Ikchan
Published: August 2020

Rationale:

Hemangiomas are usually found in cutaneous or mucosal layers, less than 1% of hemangiomas develop in skeletal muscles. Intramuscular hemangioma (IH) in the head and neck areas is relatively infrequent, accounting for 15% of IH. Most of them are identified as a benign mass, and rapid changes in size or internal bleeding are rare.

Patient concerns:

A 60-year-old female patient presented with a 2-week history of sudden onset posterior neck pain. There was no neurological deficit except limited neck motion due to pain. The palpable mass was noted on the paraspinal muscles of cervicothoracic junction, which was located midline to left side portion with tenderness.

Diagnoses:

Magnetic resonance imaging demonstrated a round shaped, multi-lobulated, and well-defined mass lesion (4.1 × 2.6 × 0.9 cm) embedded from the inter-spinous space of T1-2 to the left paraspinal muscles. The lesion was iso-intense on T2-weighted images (WI), iso- to slightly low-intense on T1-WI, heterogeneous enhancement of intra- and peri-mass lesion on contrast-enhanced T1-WI. Vascular structures presented as signal voids were identified internally and around the mass lesion. Histological examination revealed a mixed-type hemangioma.

Interventions:

The mass was removed completely including some of the surrounding muscles where boundaries were unclear between the mass and surrounding muscles with ligation of peritumoral vessels. Dark-brown colored blood was drained from the ruptured tumor capsule during the dissection. There was no bony invasion.

Outcomes:

The preoperative symptoms improved immediately after the operation. There is no residual or recurrence lesion by the 15-months follow-up.

Lessons:

IH with hemorrhagic transformation in the head and neck is extremely rare. In the case of intramuscular tumors accompanied by a sudden onset of severe acute pain, we recommend considering a differential diagnosis of IH with hemorrhagic transformation. Complete resection of the tumor mass including surrounding muscles is required to prevent recurrence.
Laparoscopic appendectomy is safe and feasible in pregnant women during second trimester
Authors: Cai Yu-Long , Yang Si-Shu , Peng Ding-Zhong , Jia Qian-Bin , Li Fu-Yu , Ye Hui , Cheng Nan-Sheng
Published: August 2020

Acute appendicitis (AA) is the most common nonobstetric surgical emergency during pregnancy. According to the current guidelines and meta-analyses, traditional open appendectomy (OA) is still recommended for pregnant patients over laparoscopic appendectomy (LA), which might be associated with higher rates of fetal loss. Previous studies and experiences indicated that LA might be safe in the second trimester of pregnancy. The current study aimed to evaluate the safety and feasibility of LA in pregnant women during the second trimester.

At our institution, a retrospective study was conducted with pregnant patients who underwent LA or OA during the second trimester between January 2016 and August 2018.

A total of 48 patients were enrolled. Of them, 12 were managed with laparoscopy and 36 with the open approach. We found that the LA group had higher BMIs than the OA group (4.0 ± 4.3 vs 21.5 ± 2.9,P = .031). The financial results showed that the average daily medical costs for patients who underwent LA was higher than those who underwent OA (444 ± 107 US$ vs 340 ± 115 US$,P = .009), while the total cost of hospitalization was comparable between the 2 approaches. The perioperative and obstetric outcomes were comparable between LA and OA. In each group, only 1 patient had fetal loss. No “Yinao” was found in any of the patients in the LA group.

In this study, with the proven advantages of the laparoscopic techniques, LA was found to be safe and feasible for pregnant women during the second trimester.
The biochemistry of low-carbohydrate and ketogenic diets
Authors: Feinman Richard D.
Published: August 2020

Purpose of review

To summarize the underlying biochemical basis for low-carbohydrate and ketogenic diets (LC/KD) and provide mechanisms to account for demonstrated effectiveness.

Recent findings

LC/KD continue to have success, to outperform other diets as well as most drugs for weight loss and diabetes treatment. In many cases, LC/KD can effect remission (absence of drugs) or reversal (only metformin or nondiabetes drugs) of type 2 diabetes and can provide a significant adjunct to pharmacology in type 1. Medication is reduced or eliminated in most cases. The results are consistent with the biochemical rationale which stresses the global effects of the glucose–insulin axis.

Evidence for the superior effectiveness of LC/KD for metabolic disease is now overwhelming. At the same time, the approach has received only limited support, and in many cases, persistence of the traditional opposition. Clinical practice or research must confront this crisis in order to bring practice in line with current science and to avoid continued harm to medicine and ultimately, the patient.
Carbohydrate-induced gastrointestinal symptoms: development and validation of a test-specific symptom questionnaire for an adult population, the adult Carbohydrate Perception Questionnaire
Authors: Hammer Johann , Sonyi Marc , Engeßer Katrin M. , Riedl Guntram , Luong Stefan , Hammer Heinz F.
Published: August 2020

Objectives

Carbohydrate intolerances may affect a majority of the worlds-population but there is no validated, test-specific assessment of carbohydrate-induced symptoms during breath tests. We aimed to develop and validate a questionnaire for evaluation and quantification of carbohydrate intolerance.

Methods

A visual analog scale-questionnaire with five complaints (pain, nausea, bloating, flatulence, and diarrhea) was designed. The time frame of symptoms was ‘current’ (for baseline symptoms) and ‘since filling out the last questionnaire’. Validity was determined in focus-group style interviews and during breath tests in an original (n = 342) and follow-up patient groups (n = 338).

Results

The questionnaire had good face validity, content validity ratio according to Lawshe was 1. Intraclass correlation coefficients (n = 195; 30-min’ interval) demonstrated excellent reliability (P < 0.001), Cohen’s d (measure of effect size) was small (≤0.19 for each symptom). Convergent and discriminant validity were supported against patient interviews. Questionnaire-derived results highly correlated with a medical interview (P < 0.001; n = 338). Responsiveness to change was verified during breath tests despite small effect sizes (≤0.32). Additional cross-validation and external validation studies (follow-up in-house: n = 182; external: n = 156) demonstrated generalizability and identified relevant numbers of patients in whom there was no co-occurrence of carbohydrate malabsorption and intolerance.

Conclusions

The adult Carbohydrate Perception Questionnaire is a valid instrument for the assessment of gastrointestinal symptoms after carbohydrate ingestion with excellent psychometric properties. It allows standardized, test-specific diagnosis of carbohydrate intolerance and evaluation of the relation between malabsorption and intolerance. It shall be useful for future studies on treatment of carbohydrate intolerance.
RET gene mutation analysis and long-term clinical outcomes of medullary thyroid cancer patients
Authors: Prabhu Meghana , Shakya Sunil , Ballal Sanjana , Ahmed Shamim Shamim , Bal Chandrasekhar
Published: August 2020

Objective

Medullary thyroid carcinoma is a rare, potentially aggressive tumour, with relatively worse prognosis than well-differentiated thyroid cancer. We evaluated the long-term outcomes and prognosis of medullary thyroid carcinoma patients at a single institution in India and compared outcomes based on results of RET protooncogene mutation analysis.

Methods

Data were retrieved through a prospectively maintained thyroid cancer database from 1998 to June 2019, and medullary thyroid carcinoma patients were recruited. RET gene mutation status (exon 10–16) was assessed. Patient with a minimum follow-up of 12 months was eligible to be part of the long-term outcome analysis.

Results

Out of 149 peripheral blood samples, 42 were positive for RET gene mutation (prevalence of 28.1%). The median follow-up duration was 48 months, ranging from 12 to 240 months. Long-term clinical outcomes of 113 patients were assessed. Two deaths were noted in this series. Both 5- and 10-year survival was cent per cent. Overall survival was 98.2% (97.3% in RET positive and 98.7% in RET negative group). Progression-free survival was 55.4% in total (60% in RET positive and 53.3% in RET negative group). No statistically significant difference was found between RET positive and RET negative groups concerning overall survival (P = 0.6011) and progression-free survival (P = 0.5140). Univariate analysis revealed high calcitonin (>10 pg/mL), stage IV disease, and presence of lymph nodal metastasis to be significant predictors of disease recurrence, however, multivariate analysis demonstrated the presence of lymph node metastases as the only significant predictor of recurrence (P = 0.0005).

Conclusions

Medullary thyroid carcinoma patients had relatively favourable long-term outcomes. Long-term survival was similar irrespective of RET mutation status. Presence of lymph node metastases appeared to be the strongest predictor of overall and progression-free survival, followed by Calcitonin level and stage of the disease.
A Proposed Staging System for Improved Prognostication of MDM2-amplified Liposarcoma
Authors: Tucci Jonathan J. , Dashti Nooshin K. , Cates Justin M.M.
Published: August 2020

Despite the release of anatomic site-specific staging systems for soft tissue sarcomas in the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, the algorithms for sarcomas arising in the extremities/trunk and retroperitoneum differ only in the staging of lymph node metastasis. The retroperitoneum not only provides a larger potential space for tumor growth before the clinical presentation, but its anatomic complexities complicate surgical resection and adversely affect disease-free survival. Here, we propose a new staging system for MDM2-amplified liposarcomas (well-differentiated and dedifferentiated subtypes) that properly emphasizes retroperitoneal localization, degree of differentiation (histologic subtype), and presence of distant metastasis. A retrospective cohort of 4146 adult patients with surgically resected liposarcoma was extracted from the SEER database to compare the natural history of MDM2-amplified liposarcomas arising in the extremities/trunk or retroperitoneum. Separate training and validation datasets were created, and Cox proportional hazard regression, multivariable nonlinear regression, and nomographic analyses determined the most significant parameters in predicting sarcoma-specific death. A new staging system was derived and its predictive accuracy was compared with the AJCC, eighth edition system using areas under receiver operating characteristic curves and multiple concordance indices. Multivariable analysis showed that dedifferentiation (hazard ratio [HR]=3.7±0.5; P<0.0005), retroperitoneal location (HR=3.2±0.5; P<0.0005), and distant metastasis (HR=2.4±0.6; P=0.002), but not categorized tumor size (pT category), had the largest effects on sarcoma-specific survival. A new staging system based on these predictive factors demonstrated better discrimination between tumor stages, higher concordance with clinical outcomes, and greater predictive accuracy than the AJCC eighth edition staging system (86±1% vs. 83±2%; P=0.005). Statistical analysis of a large national cohort failed to confirm that categorized tumor size is a useful criterion by which to stage MDM2-amplified liposarcoma. A simplified staging system based on anatomic location and dedifferentiation outperforms the current AJCC staging system. Anatomic localization and histologic grade, and not tumor size, should be included in any future liposarcoma-specific staging system.