bluuebunny/crossref_metadata_2025 huggingface dataset:
Beneficial effect of polaprezinc on cardiac function post-myocardial infarction
Authors: Yoshikawa Fumitsugu , Nakajima Tetsu , Hanada Masaharu , Hirata Kazuo , Masuyama Tohru , Aikawa Ryuichi
Published: March 2019

Background:

Polaprezinc is clinically used for the treatment of gastric ulcers. It induces the mobilization of mesenchymal stem cells and the mRNA expression of insulin-like growth factor-1 in vascular endothelial cells in order to protect injured gastric tissue or skin.

Methods:

The current study population included 50 patients with primary acute myocardial infarction (AMI). After percutaneous coronary intervention, the subjects were randomly divided into 2 groups, namely, the nonpolaprezinc and polaprezinc groups. Peripheral blood and urinary samples were collected in a specific time to analyze zinc concentration, cardiac enzymes, and the levels of the inflammation marker interleukin-6. To evaluate the cardiac function, echocardiography was performed upon admission to the hospital and at 9 months post-AMI.

Results:

The urine and blood zinc levels of the polaprezinc group were higher compared with those of the non-polaprezinc group at 8 days after percutaneous coronary intervention. The mean interleukin-6/maximal creatine phosphokinase level was significantly reduced in the polaprezinc group (0.024 [0.003–0.066] vs. 0.076 [0.015–0.212], respectively; P = .045). In addition, echocardiography revealed that the ejection fraction of the nonpolaprezinc group was not significantly increased between day 3 and 9 months post-AMI (53 [49–60.8] vs. 59.5 [52–69.3], respectively; P = .015). However, a significant increase was detected in the ejection fraction of the polaprezinc group at the 2 time points (54 [51–57] vs. 62 [55–71], respectively; P < .01).

Conclusions:

The results of the present study suggest that polaprezinc has an anti-inflammatory effect and improves cardiac function after AMI.
Protocol of global incidence and progression of age-related macular degeneration
Authors: Zhao Shan , Lan Xiaowen , Wu Jingyang , Yue Song , Zhang Han , Wu Qiang , Zhang Guisen , Liu Lei
Published: March 2019

Background:

There have been many reports on the prevalence and incidence of age-related macular degeneration (AMD), and there are some systematic reviews reporting on the pooled prevalence of AMD. However, there is no systematic review of incidence or progression of AMD worldwide. Given the few evidences regarding the pooled incidence or progression of AMD, we performed this meta-analysis protocol to investigate the global incidence or progression of AMD. In addition, we will investigate the risk factors for AMD incidence or progression using meta-analysis.

Methods:

Four English databases (PubMed, EMBASE, Cochrane Library, and Web of Science) and four Chinese databases (CMB, CNKI, VIP, and Wanfang database) will be searched to identify relevant studies. The primary outcome of this meta-analysis is the incidence or progression of AMD. The second outcome of this meta-analysis is risk factors for the incidence or progression of AMD. Meta-analysis was performed to calculate the pooled incidence or progression rate and 95% confidence interval of AMD. Pooled risk ratios of risk factors (age, gender, smoking, and hypertension) for AMD incidence or progression were computed as the Mantel–Haenszel-weighted average of the risk ratios for all included studies. Sensitivity analysis, subgroup analysis, quality assessment, and publication bias analysis will be performed to ensure the reliability of our findings.

Results:

This study will provide a current evidence of global pooled incidence or progression of AMD. Further, current study will provide evidence-based risk factors for AMD incidence or progression. Moreover, our study will project the incident number of people with AMD from 2030 to 2050.

Conclusion:

This systematic review and meta-analysis will provide evidence to develop major public health strategies for preventing AMD. Ethics and dissemination: ethical approval is not required because our systematic review and meta-analysis will be based on published data without interventions on patients. The findings of this study will be published in a peer-reviewed journal.
Thoracotomy versus video-assisted thoracoscopic resection of lung cancer
Authors: Chai Tianci , Lin Yuhan , Kang Mingqiang , Lin Jiangbo
Published: March 2019

Background:

Video-assisted thoracoscopic surgery (VATS) is a kind of minimally invasive surgery with the advantages of small surgical incision, less surgical bleeding, and fewer hospitalization days. However, traditional thoracotomy has advantages in lymph node dissection and radical resection of tumors and the benefits of VATS compared with thoracotomy for lung cancer are controversial. This systematic review and meta-analysis will be conducted to evaluate the advantages and disadvantages of the 2 different surgical methods.

Methods and Analysis:

PubMed (Medline), Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomized controlled trials (RCTs), quasi-RCTs, and Hi-Q (high quality) prospective cohort trials published or unpublished in any language before March 1, 2019. Subgroup analysis will be performed in type of operation, tumor pathological stage, and ethnicity.

Results:

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

Conclusion:

As far as we know, this study will be the first time to compare and meta-analyze the efficacy of thoracoscopic lung cancer resection and thoracotomy. This study will provide high-quality and reliable evidence for clinicians’ decision-making by comparing published or completed but unpublished trials data. Because of the characteristics of disease and intervention methods, large sample size and RCTs may be insufficient. We will carefully consider the inclusion of small sample RCTs, but this may lead to high heterogeneity and affect the reliability of research results.

PROSPERO registration number:

CRD42018118427
A technique to establish fistuloclysis for high-output jejunocutaneous fistula through percutaneous enterostomy
Authors: Niu Dong-Guang , Yang Fan , Tian Wei-Liang , Zhao Yun-Zhao , Li Chen , Ding Lian-An , Fang Hong-Chun , Huang Qian
Published: March 2019

Rationale:

Currently, fistucolysis helps to establish intestinal nutrition and succus entericus reinfusion in the case of controllable mature high-output enterocutaneous fistula. However, if the tube cannot reach the distal limb of a fistula, fistuloclysis is not achieved. We proposed a strategy to establish succus entericus reinfusion for intractable intestinal fistula through percutaneous enterostomy.

Patient concerns:

A 43-year-old man was transferred to our facility for postoperative enterocutaneous fistulae, sepsis, malnutrition, and electrolyte and fluid imbalance. The contrast X-ray demonstrated the breakdown of the primary anastomosis, with fistula output ranging from 1500 to 2000 mL/d, despite the administration of medications to reduce gastrointestinal secretions.

Diagnoses:

The patient was diagnosed with high-output anastomosis fistula by gastrointestinal radiography.

Interventions:

We used percutaneous enterostomy to establish fistuloclysis.

Outcomes:

Fistuloclysis was established by percutaneous enterostomy successfully. No complications were found during the past 4-month follow-up after percutaneous enterostomy. He is waiting for reconstruction surgery after 6 months’ enteral nutrition (EN).

Lessons:

Fistuloclysis-assisted EN, if used appropriately, avoids the complications of long-term parenteral nutrition (PN) and may promote faster fistula healing.
Risk factors for lower respiratory tract infection in children with tracheobronchial foreign body aspiration
Authors: Zhong Bing , Sun Si-Lu , Du Jin-Tao , Deng Di , Liu Feng , Liu Ya-Feng , Shi-Xi Liu , Chen Fei
Published: March 2019

The aim of this study was to determine the risk factors for lower respiratory tract infection (LRTI) in children caused by tracheobronchial foreign body aspiration (TFBA).

A total of 351 patients were retrospectively reviewed; all patients were diagnosed with TFBA at West China Hospital of Sichuan University from 2015 to 2017. Univariate analyses and multivariate analysis were used.

Age (<2 years) (P < .001), type of foreign body (plant) (P < .001), shape of foreign body (nonsmooth) (P < .001), and residence time of foreign body (>7 days) (P = .001) were risk factors for LRTI on univariate analysis. Multivariate analysis showed age (<2 years) (hazard ratio [HR] = 4.457; 95% confidence interval [CI] = 2.031–6.884; P < .001), type of foreign body (plant) (HR = 2.686; 95% CI = 1.577–3.452; P < .001), shape of foreign body (nonsmooth) (HR = 1.649; 95% CI = 1.437–3.663; P < .008), and residence time of foreign body (>7 days) (HR = 1.751; 95% CI = 1.329–3.554; P = .004) were independent risk factors for LRTI. Furthermore, children with LRTI also had longer lengths of hospital stays and antibiotic use than did children without LRTI.

Age, plant foreign body, nonsmooth foreign body, and long-term incarceration were all independent risk factors for LRTI in children. These results can help us to select more appropriate intervention times and stratified treatment for children with TFBA.
Learning curve and short-term outcomes of modularized LADG for advanced gastric cancer
Authors: Liao Gang , Wang Ziwei , Li Hui , Min Jiang , Zhong Jinkun , Mariella Sandrie , Qian Kun , Zhang Wei
Published: March 2019

Laparoscopy-assisted distal gastrectomy (LADG) is a complicated procedure. To reduce the difficulty of the operation and standardize the surgical procedure, we explored a new operation mode, which we termed modularized LADG (MLADG). To further extend the new operation mode, we conducted this study to evaluate the short-term outcomes of MLADG for advanced gastric cancer, and determine the learning curve.

Data from 100 consecutive patients who received LADG between October 2016 and October 2017 were retrospectively analyzed. Short-term outcomes, such as operation time and intraoperative blood loss, were evaluated, and the learning curve was calculated.

For MLADG, the mean operation time was 168.2 ± 13.0 minutes, the mean intraoperative blood loss was 93.6 ± 29.1 ml, the mean number of harvested lymph nodes was 28.6 ± 4.2, and conversion to open surgery occurred in only 1 case. In addition, MLADG had an acceptable postoperative complication incidence and fast postoperative recovery. After the first 20 cases, the operation skill reached a mature and stable level.

Our results indicate that MLADG is an oncologically feasible and technically safe surgical procedure. For the trainees with rich experience in open distal gastrectomy, the learning curve is considered to be completed after 20 MLADG cases.
Computed tomography-guided navigation assisted drainage for inaccessible deep neck abscess
Authors: Han Sung Min , Chae Hee Sung , Lee Ha Neul , Jeon Hyun Jong , Bong Jeong Pyo , Kim Ji Hoon
Published: March 2019

Rationale:

Deep neck infections (DNIs) in the head and neck area are difficult to treat due to the anatomical complexity of the cervical region. Since inflammation causes changes in anatomy, it is often difficult to find the exact location of the abscess, which leads to failed surgical drainage.

Patient concern:

A 76-year-old female patient was referred to our clinic with trismus and right-side facial swelling. After extraction of her lower third molar 2 weeks ago, due to chronic periodontitis, her trismus had aggravated and her maximal mouth opening was 20 mm.

Diagnoses:

Computed tomography (CT) revealed an approximately 2.5 cm-sized abscess pocket with cellulitis in the right pterygomandibular space.

Interventions:

Since the first surgical drainage attempt using the intraoral approach under general anesthesia had failed and conservative antibiotic treatment was also ineffective, a second surgical procedure with a CT-guided navigation system was performed and the pus was successfully evacuated.

Outcomes:

After drainage with CT-guided navigation, the clinical symptoms and septic conditions of the patient showed remarkable improvement, and there was no recurrence of infection within a year after the procedure.

Lessons:

Drainage with CT-guided navigation can be used as a successful surgical tool to aid in the surgery of patients with DNI when it is difficult to accurately target the abscess due to inflammation.
Health outcomes in offspring of mother with breast implants
Authors: Song Ailin , Dang Jie , He Zhiyun , Zhang Youcheng , Liu Xiaokang , Zhao Lei , Lv Xi , Li Yumin
Published: March 2019

Background:

An increasing number of women undergo breast augmentation at their reproductive age. The most existing evidence focuses on the impact of breast implant on the index women's health and breastfeeding after they give birth to a child. No previous systematic review has investigated the association between breast implant in mother and health outcomes in offspring. In this study, we aimed to conduct a systematic review and meta-analysis to evaluate the influence of breast implant on offspring's health outcomes.

Methods:

A comprehensive search strategy will be conducted including the following databases: MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Data. The World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) will be searched as well for retrieving the ongoing studies. The cohort study and case–control study will be considered as eligible study if investigating the impact of breast implant in mother on health outcomes in offspring. The risk of bias of included studies will be appraised by the Newcastle–Ottawa scale.

Results:

The results of this study will be presented in the full-text of the systematic review.

Conclusion:

This systematic review and meta-analysis will infer a conclusion on the association between breast implant in mother and health outcomes in offspring, and the quality of existing evidence.

PROSPERO registration number: CRD42019121221
The burden of air pollution and weather condition on daily respiratory deaths among older adults in China, Jinan from 2011 to 2017
Authors: Song Wan-Mei , Liu Yi , Liu Jin-Yue , Tao Ning-Ning , Li Yi-Fan , Liu Yao , Wang Liu-Xin , Li Huai-Chen
Published: March 2019

The health effects of short-term exposure to air pollutants on respiratory deaths and its modifiers such as meteorological indexes have been widely investigated. However, most of the previous studies are limited to single pollutants or total respiratory deaths, and their findings are inconsistent.

To comprehensively examine the short-term effects of air pollutants on daily respiratory mortality.

Our analysis included 16,931 nonaccidental respiratory deaths (except lung cancer and tuberculosis) among older adults (>65 years) from 2011 to 2017 in Jinan, China. We used a generalized additive Poisson models adjusted for meteorology and population dynamics to examine the associations between air pollutants (particulate matter with an aerodynamic diameter of b2.5μm [PM2.5], particulate matter with an aerodynamic diameter of b10μm [PM10], SO2, NO2, O3) and daily mortality for the total patients, males, females, chronic airway diseases, pneumonia patients, and rest patients in Jinan.

Outdoor air pollution was significantly related to mortality from all respiratory diseases especially from chronic airway disease in Jinan, China. The effects of air pollutants had lag effects and harvesting effects, and the effects estimates usually reached a peak at lag 1 or 2 day. An increase of 10 μg/m3 or 10 ppb of PM2.5, PM10, SO2, NO2, and O3 corresponds to increments in mortality caused by chronic airway disease of 0.243% (95% confidence interval [CI]: −0.172–0.659) at lag 1 day, 0.127% (95% CI: −0.161–0.415) at lag 1 day, 0.603% (95% CI: 0.069–1.139) at lag 3 day, 0.649% (95% CI: −0.808–2.128) at lag 0 day and 0.944% (95% CI: 0.156–0.1598) at lag 1 day, respectively. The effects of air pollutants were usually greater in females and varied by respiratory subgroups. Spearman correlation analysis suggested that there was a significant association between meteorological indexes and air pollutants.

Sex, age, temperature, humidity, pressure, and wind speed may modify the short-term effects of outdoor air pollution on mortality in Jinan. Compared with the other pollutants, O3 had a stronger effect on respiratory deaths among the elderly. Moreover, chronic airway diseases were more susceptible to air pollution. Our findings provided new evidence for new local environmental and health policies making.
Allergic reaction to platelet-rich plasma (PRP)
Authors: Latalski Michal , Walczyk Alicja , Fatyga Marek , Rutz Erich , Szponder Tomasz , Bielecki Tomasz , Danielewicz Anna
Published: March 2019

Rationale:

In the recent years, growing interest is focused on the use of platelet-rich plasma (PRP) in wound healing and tissue regeneration. There are a number of papers regarding the usefulness of PRP in the healing of ulcerations, skin injures, bone loss or distraction osteogenesis. Most authors emphasize the safety of PRP usage due to its authogenic nature.

Patient concerns:

We present a case of a 14 -year-old boy admitted to our department due to simple bone cyst of the distal tibia, qualified for injection of PRP into the cyst. PRP was separated with the use of Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems Hopkington, MA) according to the manufacturers’ manual. Immediately after separation during short-term IV anaesthesia, 3 mL of PRP was installed to the bone cyst under image intensifier control.

Diagnoses:

Within the first 24 hours after exposure to PRP, the skin rash appeared. Physical examination revealed the small red papular, regionally purpuric eruptions, mainly concentrated on the upper extremities and on more warmed regions of skin, in association with pharyngitis, tonsillar enlargement, mucopurulent discharge in the posterior pharynx and swelling of the eyelids.

Interventions:

As the patient received calcium citrate with the PRP injection additional calcium citrate test were performed. Skin prick testing (negative) was and an intradermal test was positive (10×13 mm). Treatment included Claritine (Loratidinum) and Clemastin (Clemastinum)—both antihistaminic drugs.

Outcomes:

All symptoms withdrew and the patient was released home after 4 days. The patient is in 6 years follow-up without any symptoms of allergic disease.

Lessons:

Our case shows that safety of use of PRP is not absolutely sure. The pure autologous tissue is safe, but preparation for its use can substantially decrease this safety. In our patient, only limited skin reaction to calcium citrate was observed, but general reaction leading to anaphylactic shock cannot be excluded. In order to reduce the risk of side effects skin test should be performed but as there were no records of allergic diseases on family and patients medical history this should apply to all patients.
Comparative efficacy and safety of analgesics for acute renal colic
Authors: Fu Shimin , Zhang Kebiao , Gu Manping , Liu Zhiping , Sun Wenzhuo , Xiao Mingzhao
Published: March 2019

Introduction:

Acute renal colic is one of the most common urological emergencies. While previous randomized controlled trials (RCTs) and pairwise meta-analyses only looked at the efficacy of 1 or 2 analgesics. It is not fully understood that the comprehensive ranking of the effectiveness and safeness of analgesics from these published articles. Therefore, this network meta-analysis (NMA) aims to compare and rank the different analgesics for treatment of acute renal colic.

Methods and analysis:

We will perform a systematic literature search in PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library to identify RCTs of different analgesics for acute renal colic. RCTs assessing active analgesics intervention against active comparator or placebo controls for acute renal colic will be included. We will also screen the reference lists of included studies, previous reviews and meta-analyses to identify other relevant trials. The primary outcomes will be pain variance at 30 minutes, need rescue medicine, complete pain relief or at least 50% pain relief at 30 minutes, and pain relapse within 24 hours. We will also assess secondary outcomes for safeness (side effects: dizziness, vomit, allergic, hypotension, cardiac toxicity, and drug dependence). The risk of bias of included RCTs will be assessed by using the Cochrane Collaboration's tool, and the quality of evidence will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. We will perform pairwise meta-analysis and Bayesian NMA to compare the effectiveness and safeness of different analgesic interventions.

Results:

This NMA will compare and rank the different analgesics for treatment of acute renal colic.

Conclusion:

This is the first systematic review to use the NMA to comprehensively compare and rank analgesics for relieving pain of acute renal colic in adults based on most important factors deciding the choice of initial analgesia, and the results can provide implications for clinical practice and further research.
Non-needle acupoint stimulation for prevention of nausea and vomiting after breast surgery
Authors: Sun Ran , Dai Wei , Liu Yang , Liu Changli , Liu Yongning , Gong Ying , Sun Xiaohong , Shi Tieying , Song Mingzhi
Published: March 2019

Background:

Breast disease has been a global serious health problem, among women. Surgery is the main treatment for the patients suffering from breast disease. Postoperative nausea and vomiting are still disturbing. Acupoint stimulation, an effective treatment of traditional Chinese medicine, has been used to reduce postoperative nausea and vomiting. Recently, non-needle acupoint stimulation becomes a new intervention. Though several clinical trials have been done, there is still no final conclusion on the efficacy. This Meta-Analysis aims at evaluating the efficacy of non-needle acupoint stimulation for prevention of nausea and vomiting after breast surgery.

Methods:

Systematic searches were conducted in PubMed, Embase, Cochrane, and Wanfang Med Online databases for studies. The review period covered from the inception of databases to December 31, 2017. The outcome measures of interest were frequency of nausea, frequency of vomiting, frequency of PONV, verbal rating scale of nausea, and use of rescue antiemetic. Data extraction and risks of bias evaluation were accomplished by 2 independent reviewers using the Cochrane Collaboration Review Manager software (RevMan 5.3.5).

Results:

Fourteen randomized controlled trials with a total of 1009 female participants in the non-needle acupoint stimulation group and control group met the inclusion criteria. Although the therapeutically effect on vomiting within postoperative 2 hours was not obvious, non-needle acupoint stimulation still had an important role in reducing nausea and vomiting within postoperative 48 hours. According to Jadad scale, there was moderate quality evidence for the pooled analysis results in this study. In addition, stimulating acupoint by wristband acupressure was more likely to cause adverse reactions.

Conclusion:

Non-needle acupoint stimulation can be used for female patients undergoing breast surgery to reduce postoperative nausea and vomiting. Into consideration, we recommend transcutaneous acupoint electrical stimulation on PC6 from 30 minutes before induction of anesthesia to the end of surgery for application. This non-pharmaceutical approach may be promising to promote the recovery of patients after breast surgery.
Cryopreserved amniotic membrane and umbilical cord particulate for managing pain caused by facet joint syndrome
Authors: Bennett Daniel S.
Published: March 2019

Treatment of back pain due to facet joint syndrome has been a challenge for physicians since its recognition ∼80 years ago. Intra-articular injections of steroids, local anesthetics, and phenol have been widely adopted despite their known shortcomings. Recently, intra-articular injection of amniotic membrane-umbilical cord (AMUC) has been utilized in various orthopedic indications, including those involving synovial joints, due to its reported anti-inflammatory properties. Herein, use of AMUC for facet joint syndrome was evaluated.

A single-center case series was conducted on patients presenting with pain caused by facet joint syndrome, confirmed by single blocking anesthetic injection and treated using a single intra-articular injection of 50 mg particulate AMUC (CLARIX FLO) suspended in preservative-free saline. Patient reported back pain severity (numerical scale 0–10) and opioid use were compared between baseline and 6 months following treatment.

A total of 9 patients (7 males, 2 females), average age 52.1 ± 15.9 years, were included. Five patients with cervical pain had a history of trauma, 1 patient had suffered lumbar facet injury and 3 had degenerative lumbar facet osteoarthritis. All patients had severe pain prior to injection (8.2 ± 0.8) and 4 (44%) were taking opioids (>100 morphine milligram equivalents). Six-month post-treatment, average pain had decreased to 0.4 ± 0.7 (P <.05). All patients had ceased use of prescription pain medications, including opioids. No adverse events, repeat procedures, or complications were reported.

Intra-articular injection of AMUC appears to be promising for managing facet pain and mitigating opioid use. Further investigation with larger sample size is warranted.
Acupuncture combined Bobath approach for limbs paralysis after hypertensive intracerebral hemorrhage
Authors: Song Guang-fu , Li Xin , Feng Yao , Yu Chang-hong , Lian Xiao-yu
Published: March 2019

Background:

Previous studies have reported that acupuncture combined Bobath approach (BA) can be used to treat limbs paralysis (LP) after hypertensive intracerebral hemorrhage (HICH) effectively. However, no systematic review has explored its effectiveness and safety for LP following HICH. In this systematic review, we aim to assess the effectiveness and safety of acupuncture plus BA for the treatment of LP following HICH.

Methods:

The following 7 databases will be searched from their inception to the February 1, 2019: Cochrane Central Register of Controlled Trials, EMBASE, PUBMED, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure without any language restrictions. The randomized controlled trials (RCTs) of acupuncture plus BA that evaluate the effectiveness and safety for LP after HICH will be included. The methodological quality of all included studies will be assessed by using Cochrane risk of bias tool. Two authors will independently perform study selection, data extraction, and methodological quality evaluation. Any disagreements occurred between 2 authors will be resolved by a third author involved through discussion. Data will be pooled and analyzed by using RevMan 5.3 Software.

Results:

This review will evaluate the effectiveness and safety of acupuncture combined BA for LP following HICH. The primary outcome is limbs function. The secondary outcomes are muscle strength, muscle tone, and quality of life, as well as the adverse events.

Conclusion:

The results of this study will summarize the latest evidence of acupuncture combined BA for LP following HICH.
A comparison of 2 intravenous patient-controlled analgesia modes after spinal fusion surgery
Authors: Lee Seung Hyuk , Baek Chong Wha , Kang Hyun , Park Yong-Hee , Choi Geun Joo , Jung Yong Hun , Woo Young Cheol
Published: March 2019

Background:

Conventional intravenous patient-controlled analgesia (PCA), which usually involves constant-rate background infusion plus demand dosing, may cause adverse effects or insufficient analgesia. When variable-rate feedback infusion plus demand dosing mode is used, the infusion rate can be changed according to the patient's needs.

Methods:

In this prospective randomized double-blind study, 78 adults who were undergoing spinal fusion surgery were randomly allocated to either the constant-rate background infusion plus demand dosing group (group C) or the variable-rate feedback infusion plus demand dosing group (group V). The number of demands, volume delivered, numerical rating scale (NRS) score, adverse effects and the use of rescue analgesics were examined at 30 minutes after the operation in the post-anesthesia care unit, and at 6, 12, 24, and 48 hours.

Results:

The number of demands was significantly lower in group V than in group C at 12-24 hours (4.59 ± 4.31 vs 9.21 ± 6.79 times, P = .001) and over the total period. The volume delivered via PCA was significantly lower in group V than in group C at 12 to 24 hours (13.96 ± 13.45 vs 21.19 ± 8.66 mL, P = .006), 24 to 48 hours (13.39 ± 12.44 vs 33.6 ± 12.49 mL, P = .000), and over the total period. NRS scores, administration of rescue analgesics, and postoperative nausea and vomiting showed no between-group differences.

Conclusions:

Variable-rate feedback infusion plus the demand dosing mode can control postoperative pain more efficiently, with lower dosages of analgesics, than constant-rate background infusion plus demand dosing in patients who undergo spinal fusion surgery.
Three-dimensional printing of surgical guides for mandibular distraction osteogenesis in infancy
Authors: Mao Zhe , Zhang Na , Cui Yingqiu
Published: March 2019

Pierre Robin sequence (PRS) is a congenital malformation characterized by micrognathia, glossocoma, and mechanical obstruction of the upper respiratory tract. These deformities impair respiration, sleep, feeding, and swallowing, and can lead to malnutrition, stunted development, and death. Bilateral mandibular distraction osteogenesis, whereby the mandible and tongue root are extended outward, is the standard treatment to relieve upper airway obstruction in severe PRS. Accurate placement of the distraction device is essential but challenging, especially in infants, and requires the pre-operative fabrication of surgical guides based on CT images. Three-dimensional (3D) printing allows for the accurate recreation of objects from digitized models. We compared surgical efficacy and safety of bilateral mandibular distraction osteogenesis using 3D printed or traditionally fabricated surgery guides for treatment of infants with severe PRS.

During the period from 2014 to 2016, 22 patients with severe PRS were treated using either traditional or 3D printed surgery guides. We compared outcome measures of operations, including intraoperative bleeding, operation time, and postoperative complications.

The 3D printed surgery guide group demonstrated significantly shorter operation time (P <.05) as well as moderately shorter hospital stay and artificial ventilation time (∼1 day less). Furthermore, despite markedly younger average age of the 3D printed group (1.3 vs 3.5 months), there was no increase in postoperative complications using the 3D printed guides.

Three-dimensional printed surgery guides were used successfully for bilateral mandibular traction osteogenesis, and according to several outcome, parameters demonstrated superior efficacy and safety compared to traditional guides. Further research is warranted to extend the applications of 3D printed surgical guides for craniofacial surgery.
Elevated serum IL-37 concentrations in patients with sepsis
Authors: Wang Yong-Chun , Weng Guo-Peng , Liu Jian-Ping , Li Lei , Cheng Qing-Hong
Published: March 2019

To investigate the changes and significance of IL-37 in patients with sepsis.

A total of 50 patients with sepsis between September 2016 and October 2017 at the intensive care unit (ICU) of the First Affiliated Hospital of Shihezi University School of Medicine were selected as the sepsis group, 30 age and sex-matched healthy controls were selected as the control group. The levels of IL-37 in serum were measured by enzyme-linked immunosorbent assay (ELISA) on day 1 and day 7 of the sepsis patients.

The levels of serum IL-37 in the sepsis group on day 1 [(39.13 ± 34.35)pg/mL] were significantly higher than that in the control group [(23.75 ± 2.52)pg/mL] with significant difference (P <.05). The levels of IL-37 in the sepsis group after treatment [(30.57 ± 11.01)pg/mL] on day 7 were obviously lower than that before treatment without statisticaly difference (P >.05). A correlation analysis showed that the levels of serum IL-37 and IL-1β were positively correlated.

The level of IL-37 observed in sepsis was found to correlate with the severity of the inflammatory reaction. IL-37 could be an important cytokine in the control of sepsis by suppressing the production of pro-inflammatory cytokines.
Aberrant alteration of follicular T helper cells in ulcerative colitis patients and its correlations with interleukin-21 and B cell subsets
Authors: Xue Guohui , Zhong Yao , Hua Lin , Zhong Meijun , Liu Xiaofeng , Chen Xueli , Gao Dian , Zhou Nanjin
Published: March 2019

Patients with ulcerative colitis (UC) are at increased risk of developing colitis-associated colon cancer. Accumulating evidence suggests that follicular T helper (TFH) cells play a crucial role in the pathogenic process of autoimmune diseases. However, little is known about the role of TFH cells in the development of UC. To investigate the role of TFH cells in the development of UC, the number of TFH cells, the level of interleukin-21 (IL-21), the numbers of B cell subsets, and clinical parameters were detected in peripheral blood from 31 UC patients and 29 healthy controls. TFH cells and the level of IL-21 were significantly higher in UC patients than in the healthy controls. A positive correlation between TFH and IL-21 cells was found in UC patients. Moreover, aberrant frequencies of different subsets of B cells were observed in UC patients, and a positive correlation was found between CD38+CD19+ B cells and TFH cells and between CD86+CD19+ B cells and TFH cells. A high number of TFH cells were positively associated with Mayo score, serum C-reaction protein (CRP) and serum IgG in UC patients. Our data indicate that TFH cells and IL-21 are involved in the pathogenesis of UC.
Comparison of mid-term outcomes of posterior or postero-anterior approach using different bone grafting in children with lumbar tuberculosis
Authors: Zhang Hongqi , Guo Qiang , Liu Shaohua , Guo Chaofeng , Gao Qile , Tang Mingxing
Published: March 2019

The anterior and middle columns instead of the posterior column of spine are usually destroyed by tuberculosis which could aggravate the kyphosis accompanying the growth imbalance of spine in children. The surgical method needs to be selected cautiously for effective treatment. To our knowledge, few studies have evaluated mid-term outcomes of 2 surgeries (posterior-only approach and combined posterior and anterior approaches) with allograft or shaped titanium mesh cages for the treatment of lumbar tuberculosis in children. The study aims to compare the surgical mid-term outcomes of the posterior-only approach and the combined approaches using different bone grafting for the treatment of pediatric lumbar tuberculosis.

Between January 2007 and June 2013 at our spine center, 51 consecutive pediatric lumbar tuberculosis with an average age of 7.3 ± 3.93 years treated with combined posterior and anterior approaches (PA, 22 cases) or posterior-only approach (PO, 29 cases) were enrolled. Two types of interbody bone graft were applied in this study: fresh-frozen tricortical iliac-bone allograft (AG, 21 cases) and shaped titanium mesh cages (TM, 30 cases). All medical records and radiographs were retrospectively reviewed. The Japanese Orthopaedic Association (JOA) is applied to evaluate the neurological function. The average visual analogue (VAS) and Oswestry Disability Index (ODI) were used to evaluate the quality of life.

The average follow-up was 6.7 ± 1.9 years. The mean operation time, average blood loss, complication rate, and lengths of hospital stay of PO were less than those of the PA. The postoperative VAS (1 day after surgery) of PA was significantly higher than that of PO. The ODI, VAS and JOA scores at the final follow-up had been improved significantly compared with preoperative scores. The ODI, VAS and JOA scores at the final follow-up were similar between PA and PO as well as between AG and TM. There was no statistically significant difference about the fusion times between PO and PA groups. The final follow-up kyphosis correction rate and the correction loss at the final follow-up between the PO and PA groups showed no statistically significant difference. However, the final follow-up correction rate of the AG group was lower than that of TM group. The correction loss of the AG group was higher than that of TM group.

The posterior only approach in experienced hands provides satisfying treatment for the children lumbar tuberculosis with less invasive, much safer, and more effective compared with combined posterior and anterior approach. The shaped titanium mesh cages are noted to be a valuable tool in surgical decision making.
Effectiveness of electrical stimulation combined with pelvic floor muscle training on postpartum urinary incontinence
Authors: Ma Xiao-xing , Liu An
Published: March 2019

Background:

Previous clinical trials have reported that electrical stimulation (ES) combined with pelvic floor muscle training (PFMT) can be used to treat postpartum urinary incontinence (PPUI) effectively. However, no systematic review has investigated the effectiveness and safety of ES plus PFMT for the treatment of patients with PPUI. In this systematic review, we will firstly assess the effectiveness and safety of ES and PFMT for treating PPUI.

Methods:

In this study, we will search the following electronic databases: Cochrane Library, Web of Science, Springer, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inceptions to the present without language restrictions. All eligible randomized controlled trials (RCTs) on the effectiveness of ES plus PFMT for PPUI will be included. We will also search grey literature to avoid missing any other potential qualified studies. Two authors will independently conduct the study selection, data extraction, and risk of bias assessment. A third author will be consulted to solve any disagreements between 2 authors. RevMan 5.3 Software will be used to pool the data and to carry out the meta-analysis.

Results:

This study will provide high quality evidence of ES and PFMT for PPUI. The primary outcome includes symptoms improvement. The secondary outcomes consist of incontinence-specific quality of life, clinician's observations, and adverse effects.

Conclusion:

The findings of this study will summary up-to-dated evidence for judging whether ES combined PFMT is an effective intervention for PPUI or not.

Ethics and Dissemination:

This study does not needs ethical approval, because it will not involve individual patient data. Its findings will be disseminated through peer-reviewed journals.

Systematic review registration:

CRD42019122540.
PBK/TOPK overexpression and survival in solid tumors
Authors: Xu Ming , Xu Song
Published: March 2019

Background:

The prognostic significance of PBK/TOPK overexpression in solid tumors remains controversial. Therefore, we carried out a meta-analysis to evaluate the impact of PBK/TOPK overexpression in solid tumors on patients’ overall survival (OS) and disease-free survival (DFS).

Methods:

Relevant articles were identified through searching the PubMed, Embase and Web of Science up to May 2017. The pooled hazard ratio (HR) with 95% confidence interval (CI) was used to estimate the effects.

Results:

In this meta-analysis, 12 studies involving 1571 participants were included, PBK/TOPK overexpression was significantly associated with poor OS (pooled HR = 1.91, 95%CI = 1.22-3.00, P = .005) and short DFS (pooled HR = 1.95, 95%CI = 1.46-2.58, P < .001).

Conclusions:

PBK/TOPK overexpression was associated with poor survival in human solid tumors which may be a valuable prognosis biomarker and a potential therapeutic target of solid tumors.
Tuina for functional constipation
Authors: Wang Congan , Zhang Xinghe , Wang Dandan , Shi Bin , Sun Guodong , Zhang Bo , Zou Liang
Published: March 2019

Background:

Functional constipation (FC) is one of the most common functional gastrointestinal disorders, which brings many negative impacts to the patient's daily life. In the treatment of FC, Tuina (Chinese massage) is often performed as complementary and alternative medicine and shows a good effect in many clinical trials. However, no high-quality systematic review was taken to show the efficacy and safety of Tuina for FC.

Methods:

The electronic databases of Cochrane Library, Web of Science (WOS), MEDLINE, Wiley, Springer, EMBASE, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Wan-fang database, and other databases will be searched from the establishment to February 1, 2019. Randomized controlled trials about this theme will be retrieved. Independent reviewers will operate literature retrieval, duplication removing, screening, quality evaluation, data analyses by EndNote (X9) and Review Manager (5.3.5). Meta-analysis, subgroup analysis and/or descriptive analysis will be performed based on the included data form.

Results:

Evidenced outcome will be provided from defecation frequency, stool consistency (Bistol stool scale), success rates, quality of life, proportion of patients using laxatives, and adverse effects.

Conclusion:

This review will provide evidence of whether Tuina is an effective and safe intervention for FC.

Trail registration number:

This protocol of systematic review has been registered on PROSPERO website (No. CRD42019119722).
Case report: a novel mutation in ZIC2 in an infant with microcephaly, holoprosencephaly, and arachnoid cyst
Authors: Xiong Jianjun , Xiang Bingwu , Chen Xiang , Cai Tao
Published: March 2019

Rationale:

Holoprosencephaly (HPE) is a severe congenital brain malformation resulting from failed or incomplete forebrain division in early pregnancy.

Patient concerns:

In this study, we reported a 9-month old infant girl with mild microcephaly, semilobor HPE, and arachnoid cyst.

Diagnoses:

Potential genetic defects were screened directly using trio-case whole exome sequencing (WES) rather than traditional karyotype, microarray, and Sanger sequencing of select genes.

Outcomes:

A previous unpublished de novo missense mutation (c.1069C >G, p.H357D) in the 3rd zinc finger domain (ZFD3) of the ZIC2 gene was identified in the affected individual, but not in the parents. Sanger sequencing using specific primers verified the mutation. Extensive bioinformatics analysis confirmed the pathogenicity of this extremely rare mutation. Phenotype-genotype analysis revealed significant correlation between the 3rd zinc-finger domain with semilobor HPE.

Lessons:

These findings expanded the spectrum of the ZIC2 gene mutations and associated clinical manifestations, which is the first identification of a mutated ZIC2 gene in a Han infant girl with mild microcephaly, semilobor HPE, and arachnoid cyst.
Expanding the clinical and mutational spectrum of germline ABL1 mutations-associated syndrome
Authors: Bravo-Gil Nereida , Marcos Irene , González-Meneses Antonio , Antiñolo Guillermo , Borrego Salud
Published: March 2019

Rationale:

Clinical and genetic management of patients with rare syndromes is often a difficult, confusing, and slow task.

Patient concerns:

Male child patient with a multisystemic disease showing congenital heart defects, facial dysmorphism, skeletal malformations, and eye anomalies.

Diagnosis:

The patient remained clinically undiagnosed until the genetic results were conclusive and allowed to associate its clinical features with the germline ABL1 mutations-associated syndrome.

Interventions:

We performed whole-exome sequencing to uncover the underlying genetic defect in this patient. Subsequently, family segregation of identified mutations was performed by Sanger sequencing in all available family members.

Outcomes:

The only detected variant compatible with the disease was a novel heterozygous nonframeshift de novo deletion in ABL1 (c.434_436del; p.Ser145del). The affected residue lays in a functional domain of the protein, it is highly conserved among distinct species, and its loss is predicted as pathogenic by in silico studies.

Lessons:

Our results reinforce the involvement of ABL1 in clinically undiagnosed cases with developmental defects and expand the clinical and genetic spectrum of the recently reported ABL1-associated syndrome. In this sense, we described the third germline ABL1 causative mutation and linked, for the first time, ocular anterior chamber anomalies to this pathology. Thus, we suggest that this disorder may be more heterogeneous than is currently believed and may be overlapping with other multisystemic diseases, hence genetic and clinical reassessment of this type of cases should be considered to ensure proper diagnosis.
Efficacy of erlotinib and celecoxib for patients with advanced non-small cell lung cancer
Authors: Jin Yi-Hua , Li Wei-Hong , Bai Yan , Ni Lei
Published: March 2019

This study evaluated the efficacy and toxicity of erlotinib and celecoxib (EC) for treating Chinese patients with advanced non-small cell lung cancer (ANSCLC) and epidermal growth factor receptor (EGFR) wild type.

Totally, 75 subjects with ANSCLC and EGFR wild type were included. They all underwent EC treatment. The outcome measurements consisted of progression-free survival (PFS), overall survival (OS), complete response (CR), partial response (PR), stable disease (SD), progress disease (PD), and disease control rate (DCR). Additionally, adverse events were also documented.

Two-year CR, PR, SD, PD, and DCR were 4.0%, 6.7%, 42.6%, 46.7%, and 53.3% respectively. The median PFS was 3.4 months, the median OS was 10.0 months. Additionally, acceptable toxicities were recorded in this study.

The results showed that EC may be efficacious for patients with ANSCLC and EGFR wild type only, and acceptable toxicity among the Chinese Han population.
Occurrence of acute pulmonary embolism induced by recombinant erythropoietin during treatment of pure red cell aplasia associated with thymoma
Authors: Cui Xiangli , Wan Zirui , Ma Zhuo , Liu Lihong , Yang Yuanhua
Published: March 2019

Rationale:

Thymoma is a type of rare tumor in the thymus gland, and among patients with thymoma, less than 10% will develop pure red cell aplasia (PRCA), whereas less than 5% of patients with PRCA have a thymoma. The optimal approach for PRCA in thymoma is immunosuppressive therapy, such as steroids, cyclosporine, and human antithymocyte globulin.

Patient concerns:

A sixty-one-year-old male was diagnosed with thymoma with PRCA after he complained fatigue, tinnitus, and weakness for 1 month, he received therapy with recombinant erythropoietin (rhEPO) for 1 month after the tumor was totally resected and readmitted with pulmonary embolism and received anticoagulation therapy with enoxaparin for 3 months.

Diagnoses:

Thymoma, pure red cell aplasia, pulmonary embolism.

Intervention:

He received cyclosporine A, prednisone and rhEPO treatment. Two months after the thymectomy and postoperative radiation, he was readmitted with pulmonary embolism.

Outcomes:

Thymoma and pulmonary embolism become complete response (CR), PRCA become partial response (PR).

Lessons:

Clinicians should be alert to the possibility of the increased risk of thrombosis induced by rhEPO when it used to treat PRCA associated with thymoma. If other medication is effective for managing PRCA, rhEPO should be avoided.