bluuebunny/crossref_metadata_2025 huggingface dataset:
Downregulation of serum survivin correlates with increased inflammation, enhanced disease severity and worse prognosis in sepsis patients
Authors: Zhang Yanmin , Feng Qiang , Zhou Shaoying , Chen Huimin
Published: July 2020

This study aimed to determine the role of survivin in sepsis patients.

Serum samples of 288 sepsis patients and 290 healthy individuals (as healthy controls) were collected 24 hours within enrollment. Serum survivin and inflammatory cytokines were detected by enzyme-linked immunosorbent assay, and biochemical indexes were recorded. In sepsis patients, acute pathologic and chronic health evaluation II score and sequential organ failure assessment score were evaluated, and 28-day mortality was recorded.

Survivin was greatly decreased in sepsis patients compared to healthy controls (P < .001) and it predicted decreased sepsis risk (area under curve (AUC): 0.921, 95% confidence interval (CI): 0.900–0.942). For clinical characteristics of sepsis patients, survivin was negatively correlated with acute pathologic and chronic health evaluation II score (P < .001), score and sequential organ failure assessment score (P < .001), serum creatinine (P < .001), white blood cell (P = .037), C-reactive protein (P < .001), tumor necrosis factor-α (P < .001), interleukin (IL)-1β (P < .001), IL-6 (P < .001), and IL-8 (P < .001), while positively correlated with albumin (P < .001). For prognosis of sepsis patients, survivin was decreased in deaths compared to survivors (P < .001), and it predicted decreased death risk (AUC: 0.625, 95% CI: 0.558–0.692). Meanwhile, accumulating mortality was decreased in survivin high patients compared to survivin low patients (P = .006). However, multivariate logistic regression revealed survivin was not an independent predictive factor for 28-day mortality, indicating it might interact with other independent factors to affect prognosis of sepsis patients.

Survivin was decreased in sepsis patients and predicted decreased sepsis risk. Meanwhile, survivin was correlated with declined inflammation, reduced disease severity, and favorable prognosis in sepsis patients.
Segmental zoster paresis of unilateral upper extremity
Authors: Chen Guan-Bo , Tuan Sheng-Hui , Liou I-Hsiu , Huang Hung-Ya , Hu Ya-Chun , Wu Shin-Yi
Published: July 2020

Rationale:

Segmental zoster paresis (SZP) is a relatively rare neurologic complication of herpes zoster (HZ), and is characterized by focal asymmetric motor weakness in the myotome that corresponds to skin lesions of the dermatome. The upper extremities are the second most commonly involved regions after the face, and predominantly involve proximal muscles. The pathogenesis of SZP remains unclear; however, most of the reports indicate that it is the inflammation because of the spread of the herpes virus.

Patient concerns:

A 72-year-old man without trauma history of the left shoulder joint developed weakness of the left proximal upper extremity 10 days after vesicular eruption of HZ.

Diagnoses:

His left shoulder girdle paresis was diagnosed with the upper truncus of the brachial plexus as a HZ complication according to a series of tests, including cervical magnetic resonance imaging (MRI), cerebral fluid analysis, sonography, and electrophysiological studies.

Interventions:

Acyclovir and prednisolone were administered during hospitalization to treat SZP. Meanwhile, analgesics and gabapentin were administered to control the patient's neuralgic pain. He also received inpatient (daily) and outpatient (3 times per week) physical therapy along with range of motion and strengthening exercises.

Outcomes:

Partial improvement of the strength of the left shoulder girdle, and no improvement of the left deltoid muscle was observed 2 months after the interventions.

Lessons:

This case emphasizes that HZ infections may be complicated by segmental paresis and they should be considered in the differential diagnosis of acute paresis in the upper limb. Awareness of this disorder is important because it avoids unnecessary invasive investigations and interventions, leading to suitable treatments with favorable prognosis.
A meta-analysis: Internet mindfulness-based interventions for stress management in the general population
Authors: Zhang Yun , Xue Jiaming , Huang Ying
Published: July 2020

Background:

Psychological stress was an important mental health problem among the general population and warrant research to inform strategies for effective prevention. iMBIs provide a possibility to offer easily accessible, efficacious, convenient, and low-cost interventions on a wide scale. However, the efficacy of iMBIs in the general population remains unclear. The aim of this meta-analysis is to evaluate the effects of iMBIs for stress reduction in the general population.

Methods:

A systematic search in PubMed, Embase, Web of Science, Medline, Cochrane Library, CNKI, and Wanfang Data databases was performed up to April 10, 2019. The overall effect sizes of the iMBIs on stress, depression, anxiety, and mindfulness were recorded by the metric of Hedges’ g with 95% confidence interval (CI), Z-value, and P value.

Results:

Sixteen eligible studies were included in the meta-analysis. The overall results indicated that iMBIs had small to moderate effects on stress (Hedges’ g = −0.393) and mindfulness (Hedges’ g = −0.316) compared with the control group. Results from subgroup analyses revealed that the type of sample and delivery mode had a greater impact on heterogeneity across the studies. Meta-regression found that the overall effect might be moderated by guidance for iMBIs.

Conclusion:

The present meta-analysis suggested that iMBIs had small to moderate effects in reducing stress and improving mindfulness of the general population in comparison with the control group. Future research is needed to explore how iMBIs are remolded to improve adherence and suit specific individuals.
Prospective study to optimize the health of patients with TIAS (transient ischemic attack) and stroke admitted to the Hamad General Hospital
Authors: Imam Yahia Z. , Mohamed Mouhand F.H. , Abdelmoneim Mohamed S. , Santos Mark , Alkhawad Nima , Salam Abdul , Amir Numan , Saqqur Maher , Muhammad Ahmad , Elsoutohy Ahmed , Kamran Saadat , Akhtar Naveed , Kiliyanni Abdul Salim , Own Ahmed , Deleu Dirk , Shuaib Ashfaq
Published: July 2020

Introduction:

Recurrent ischemic strokes (IS) make up to one-third of all strokes. Nine out of 10 strokes are due to modifiable risk factors. Thus, it seems that standard management strategies of modifiable risk factors are yet to improve. Hence, we planned a randomized controlled trial assessing nurses or pharmacists-led aggressive control of comorbidities and their prognostic impact on IS and transient ischemic attacks (TIA).

Methods/design:

Prospective study to optimize the health of patients with TIAs and stroke admitted to the Hamad General Hospital (PROMOTE HEALTH) is an assessor-blinded, open-label, randomized, two-arm, controlled trial. Eligible patients have IS or TIA, and an additional modifiable risk factor (Hypertension or dyslipidemia) attending the stroke ward or clinic at the Weill Cornell-affiliated Hamad General Hospital. Stroke specialists will offer the control group the currently practiced best risk factor management strategies. Whereas, in the intervention arm, with the assistance of a nurse and a pharmacist, we will make aggressive attempts to meet targets of defined risk factors. The primary outcomes are the mean difference in blood pressure (BP) and low-density lipoprotein. Whereas myocardial infarction, recurrent stroke events, and mortality serve as the study's secondary outcomes. We require 200 patients per study arm to achieve a power of 80% and an alpha level of <0.05. The Medical Research Center and the Institutional Review Board have approved the study, and it was prospectively registered in a trial registry.

Discussion:

A significant proportion of strokes are due to modifiable preventable risk factors. Despite having the right preventive strategies aimed at mitigating these risk factors, a sizeable proportion of strokes are due to recurring events. This prompted the medical community to evaluate aggressive means of addressing these risk factors. The nurse or pharmacist-led management of comorbidities has been proven to be of value in the management of diabetes and hypertension. It will be of value to demonstrate the effectiveness of utilizing this additional task force in aggressively managing IS or TIA patients with an overarching goal of improving their prognosis. If our intervention proves to be efficacious, this would have a substantial impact on the current stroke practices and guidelines. Additionally, it will invite further research in the area.

Clinical trial registration:

Clinicaltrials.gov NCT02868723, last updated on September 2018
Femoral nerve block vs adductor canal block after anterior cruciate ligament reconstruction under general anesthesia
Authors: Xue Qingpei , Jiang Wei , Wang Meng , Sui Jinkui , Wang Yiping
Published: July 2020

Background:

Femoral nerve block (FNB) is considered the preferred analgesia after anterior cruciate ligament reconstruction (ACLR), but leads to weakness in the quadriceps muscles. Adductor canal block (ACB) is a new sensory block technique that effectively relieves postoperative pain while preserving quadriceps strength. The purpose of our study was to compare the efficacy of FNB vs ACB for pain control after ACLR.

Methods:

This prospective, randomized, double-blind, controlled, superiority clinical trial was approved by the institutional review board in our university hospital. We enrolled 120 patients set to undergo ACLR in this randomized therapeutic trial. Sixty patients received FNB and the other 60 received ACB for postoperative pain control. All ACB and FNB were performed using ultrasound-guided single-shot procedures. The primary outcomes included maximum voluntary isovolumetric contraction and postoperative pain score. Secondary outcomes included total opioid consumption, length of hospital stay, complication, and satisfaction score.

Results:

This clinical trial might provide some insights to estimate and compare the safety and efficacy of ACB vs FNB following ACLR.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5569).
Neiguan (PC6)-based acupuncture pretreatment for myocardial ischemia reperfusion injury
Authors: Yang Qiqi , Mao Huifang , Chen Xia , Zhang Yanji , Zhang Xiaolei , Liu Zhenzhen , Jiang Gongdao , Huang Wei
Published: July 2020

Background:

Myocardial ischemia reperfusion injury (MIRI) is 1 of the leading causes of disability and mortality worldwide in the cardiovascular diseases. Acupuncture has been widely applied in the treatment and prevention of cardiovascular diseases in recent years. This systematic review protocol aims to provide the methods for evaluating the efficacy of Neiguan (PC6)-based acupuncture pretreatment in animal models of MIRI.

Methods and analysis:

The electronic databases of PubMed, Embase, Cochrane Library, as well as the Chinese databases such as China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, China Biology Medicine Database and WanFang Database will be searched from inception to November 2019. The outcome measures were myocardial infarct size, the level of ST-segment elevation, left ventricular ejection fraction, shortening fraction, arrhythmia score, cardiac enzymes, and cardiac troponin. Study inclusion, data extraction and quality assessment will be performed independently by 2 reviewers. RevMan 5.3 software will be used for the data synthesis and the quality of each study will be assessed independently by using the Collaborative Approach To Meta-Analysis And Review Of Animal Data From Experimental Studies checklist with minor modification.

Results:

This review will provide a high-quality synthesis of Neiguan (PC6)-based acupuncture pretreatment for MIRI in animal models

Conclusions:

This systematic review will provide conclusive evidence for whether Neiguan (PC6)-based acupuncture pretreatment is an effective intervention in animal models of MIRI.

Trial registration number:

PROSPERO CRD42020175144.
Genetically confirmed limb-girdle muscular dystrophy type 2B with DYSF mutation using gene panel sequencing
Authors: Lee Sook Joung , Choi Eunseok , Shin Soyoung , Park Joonhong
Published: July 2020

Rationale:

The limb-girdle muscular dystrophies (LGMDs) are a heterogeneous group of disorders characterized by progressive proximal muscle weakness and have more than 30 different subtypes linked to specific gene loci, which manifest as highly overlapping and heterogeneous phenotypes.

Patient concerns:

A 59-year-old male presented for evaluation of progressive muscle weakness since his late twenties. When he was 38 years old, he had muscle weakness in the upper extremities and had a waddling gait, hyper lordosis of lower back, and anterior pelvic tilt. His gait disturbance and muscle weakness slowly progressed. When he was 55 years old, he could not walk at all and had to use a wheelchair for ambulation.

Diagnosis:

Next-generation sequencing using a custom target capture-based gene panel including specific genes responsible for muscular dystrophy was performed. As a result, the proband was genetically diagnosed as LGMD type 2B, carrying 2 compound heterozygous mutations (NM_003494.3:c.1663C>T, p.Arg555Trp; rs377735262 and NM_003494.3:c.2997G>T, p.Trp999Cys; rs28937581) of the DYSF gene.

Interventions:

Physical and occupational therapy were prescribed properly for the first time Bracing and assistive devices were adapted specifically to the patient's deficiencies to preserve mobility and function and prevent contractures.

Outcomes:

The patient with LGMD has periodic assessments of physical and occupational therapy for the prevention and management of comorbidities. However, in the 3 years after the gene panel sequencing diagnoses, his weakness was slowly progress and the patient still could not walk.

Lessons:

Gene panel sequencing allows for the correct recognition of different LGMD subtypes, improving timely treatment, management, and enrolment of molecularly diagnosed individuals in clinical trials.
Promoting breastfeeding in Chinese women undergoing cesarean section based on the health belief model
Authors: Hu Lei , Ding Tingting , Hu Juan , Luo Biru
Published: July 2020

Background:

The high rate of cesarean section is an important factor affecting breastfeeding in China. To improve the nation's current situation of breastfeeding, promoting breastfeeding in women undergoing cesarean section is essential.

Objective:

To explore the effects of health belief model-based interventions on breastfeeding knowledge, breastfeeding behaviors, and breastfeeding satisfaction of Chinese cesarean women.

Methods:

A total of 346 cesarean section women were enrolled in the randomized controlled trial conducted at a center in Chengdu, China, between July 1, 2018 and August 31, 2018. While the control group (n = 173) received conventional breastfeeding guidance only, the intervention group (n = 173) received additional interventions based on the health belief model. Questionnaires were distributed to assess breastfeeding knowledge, breastfeeding behavior, and breastfeeding satisfaction at discharge, 42 days postpartum, and 4 months postpartum, respectively.

Results:

At discharge from hospital, the breastfeeding knowledge score of the intervention group was higher than that of the control group (Z = −11.753, P < .001). The exclusive breastfeeding rates in the intervention group at the time of discharge, 42 days postpartum, and 4 months postpartum were 67.3%, 60.7%, and 52.9%, respectively, while those of the control group were 41.2%, 41.6%, and 40.4%, respectively. The differences were statistically significant (χ

2
 = 23.353, P < .001; χ

2
 
= 11.853, P < .001; χ

2
 = 4.805, P = .03). The breastfeeding satisfaction of the intervention group was also higher than the control group at the time of discharge, 42 days postpartum and 4 months postpartum (t = 4.955, P < .001; t = 3.051, P = .002; Z = −3.801, P < .001).

Conclusion:

The health belief model-based interventions can effectively increase breastfeeding knowledge for Chinese cesarean women and improve their breastfeeding behaviors and breastfeeding satisfaction within 4 months after delivery.

Clinical Trial Registration:

ChiCTR1900026006 
Multiple hepatocellular adenomas associated with long-term administration of androgenic steroids for aplastic anemia
Authors: Wang Lixia , Wang Cong , Li Wei , Meng Fanyang , Li Yuying , Fan Hongqiong , Zhou Yanhua , Bharathi Gnana , Gao Sujun , Yang Yan
Published: July 2020

Introduction:

Anabolic steroids are widely administered to patients with aplastic anemia (AA) and are associated with numerous medical complications. To assist with future diagnoses, we report about a young boy with multiple hepatocellular adenomas (HAs) induced by long-term use of anabolic androgenic steroids (AAS) for AA and present a related literature review.

Patient concern:

A 15-year-old boy who was diagnosed with AA in 2011 had been treated with stanozolol (6 mg per day) and ciclosporin A (120–150 mg per day) for almost 4 years. He presented with epigastric pain and fever, and abdominal computed tomography showed a lesion of heterogenous density measuring 13.5 × 13.0 × 8.0 cm in the left hepatic lobe, which was initially misdiagnosed as a liver abscess.

Diagnosis:

The patient went into hemorrhagic shock twice after invasive manipulation that aimed at diagnosis and was finally diagnosed with HA using fine needle aspiration.

Interventions:

The patient discontinued AAS and only reserved ciclosporin A for AA treatment.

Outcomes:

Follow-up abdominal computed tomography performed 4 years after AAS discontinuation showed obvious regression of the hepatic lesions.

Conclusion:

It is of great importance for hematologists to completely understand that the long-term use of AAS may cause HA, which carries a great risk of hemorrhage and malignant transformation.
Relationship between the self-concept and physical activity towards the prevention of chronic illnesses
Authors: Duarte-Clíments Gonzalo , Sánchez-Gómez María Begoña , Palenzuela-Luis Natacha , González-Abreu Javier , Guzmán-Fernández Cristo Jesús , Ramos-Santana Sara , Gómez-Salgado Juan , Rodríguez-Gómez José Ángel , Romero-Martín Macarena
Published: July 2020

The objective of this work is to verify the relationship between the self-perception of health and the self-concept of physical appearance in adolescents, in order to check their influence on the physical activity they perform with the aim of preventing chronic illnesses. To this end, an observational, cross-sectional descriptive study with analytical components was carried out. Opportunistic activity, in which young people, between the ages of 16 and 22, were recruited from 5 secondary schools of the municipality of San Cristóbal de La Laguna, on the island of Tenerife (Spain). Data were collected through the General Health Questionnaire, the Rosemberg Self-esteem Scale, and the physical exercise habits test physical activity questionnaire for adolescents-A, revealing the first 2 that most percentage of responses were grouped on the positive side. The physical exercise habits test physical activity questionnaire for adolescents-A described that the most commonly performed physical activity was walking (75%).
Association of bone mineral density with peripheral blood cell counts and hemoglobin in Chinese postmenopausal women
Authors: Li Li , Ge Ji-Rong , Chen Juan , Ye Yun-Jin , Xu Peng-Chao , Li Jian-Yang
Published: July 2020

Osteoporosis (OP) is a metabolic bone disease that can cause structural changes in bone marrow cavity. Bone marrow is the hematopoietic organ of adults. Accumulating evidence has shown a close connection between bone marrow hematopoietic function and bone formation. Some studies have revealed that OP is associated with hematopoiesis. However, the relationship is not definite.

This study aimed to evaluate the association between peripheral blood cell counts (white blood cells [WBC], red blood cells [RBC], platelets [PLT]), hemoglobin [HGB], and bone mineral density [BMD]) in a sample of Chinese postmenopausal women. This is a retrospective study involving 673 postmenopausal women cases. The BMD of lumbar spine and left hip joint were measured by dual-energy X-ray absorptiometry. The levels of blood cell counts and HGB were measured and analyzed.

The study results showed the WBC, RBC, PLT, and HGB levels of postmenopausal women in the OP group were all higher than those in the non-osteoporosis group. Spearman linear trend analysis and partial correlation analysis demonstrated that BMD was negatively correlated with WBC, RBC, PLT, and HGB in postmenopausal women.

Due to the differences between different countries and races, and there are few studies on the association of BMD with peripheral blood cell counts and HGB in Chinese Postmenopausal Women. Therefore, more large sample studies are needed.
Reversible posterior leukoencephalopathy syndrome due to adrenal pheochromocytoma
Authors: Han Bo , Li Yi , Tang Maozhi , Wu Shun , Xu Xiaosong
Published: July 2020

Rationale:

Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare neuropathic syndrome with typical clinical and radiological features. There are large amounts of risk factors resulting in RPLS, those including hypertension, eclampsia, neoplasia treatment, renal failure, systemic infections, chemotherapy, and immunosuppressive therapy after organ transplantation.

Patient Concerns:

A 27-year-old male patient was admitted for a 2-week history of paroxysmal tic of limbs along with consciousness disorder. Blood pressure elevation was discovered for the first time on admission, and the highest record was 210/150 mmHg during hospitalization. Neurological examinations were positive among mental state, speech, reaction and pathological reflex. The computed tomography scan of the abdomen demonstrated a mass derived from right adrenal gland. The magnetic resonance imaging of the brain showed reversible lesions in the centrum ovale, paraventricular, area and corpus callosum.

Diagnoses:

After control of blood pressure and rationally preoperative preparation, the mass was radically resected and verified to be pheochromocytoma by postoperative pathologic findings. He was diagnosed as having RPLS due to adrenal pheochromocytoma.

Interventions:

The right adrenal gland mass was completely removed after 2 weeks of α-blockers and β-blockers to treat hypertension.

Outcomes:

One week after surgery, the cerebral lesions of RPLS gradually faded and the blood pressure was easy to control well.

Lessons:

A few case reports of RPLS related to pheochromocytomas had been documented in the literature. Therefore, we believe that pheochromocytomas may be a potential risk factor of RPLS. If patients receive timely diagnosis and treatment, it can often lead to a favorable prognosis.
The significance of multidisciplinary classifications based on transbronchial pathology in possible idiopathic interstitial pneumonias
Authors: Wang Weixue , Xu Jian , Liu Chunfang , Feng Ruie , Zhao Junjun , Gao Na , Jiang Ling , Zhang Xiaolin , Han Xue , Ren Lina , Zhao Xiaohui , Liu Yuan
Published: July 2020

Surgical lung biopsy is regarded as the golden standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). Here, we attempted to show the diagnostic accuracy of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC) , bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA).

Patients with suspected interstitial lung diseases admitted from June 1, 2016 to December 31, 2018 were involved. Patients with known causes of interstitial lung diseases and typical idiopathic pulmonary fibrosis diagnosed through clinical, radiological information were excluded. Patients with atypical idiopathic pulmonary fibrosis and possible IIPs accepted transbronchial pathological evaluation. Initial multidisciplinary diagnosis (MDD) classifications were made depending on clinical, radiological and transbronchial pathological information by a multidisciplinary team (MDT). The final MDD classifications were confirmed by subsequent therapeutic effects. All patients were followed up for at least 6 months.

A total of 70 patients were finally involved. The samples of lung parenchyma extracted through TBLC were enough for confirmation of pathological diagnoses in 68.6% (48/70) cases. Samples of 6 cases were extracted by EBUS-TBNA. Bacteriological diagnoses were positive in 1 case by BALF. Pathological diagnoses of 77.1% (54/70) cases were achieved through TBLC, EBUS-TBNA and BALF. During the follow up study, the pulmonary lesions of 60% patients were improved, 11.43% were relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% were leveled off and 8.57% were progressed. The diagnoses of 4 patients with progressed clinical feature were revised. As a result, 94.3% initial MDD classifications based on transbronchial pathology were consistent with the final MDD, and the difference of diagnostic yield wasn’t significant between initial and final MDD (Z = −1.414, P = .157).

Classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.
A case report of primary adrenal lymphoma
Authors: Yang Yunyun , Xie Wei , Ren Yan , Tian Haoming , Chen Tao
Published: July 2020

Rationale:

Primary adrenal lymphoma (PAL) is an extremely rare and highly invasive malignant disease. Imaging examination usually shows bilateral adrenal involvement with large tumor masses and local infiltration. However, it is unclear how lymphoma dynamically develops into huge tumor masses in the adrenal glands. The overall survival rate of PAL is generally poor, and the underlying mechanism might be related to prooncogenic mutation but not fully elucidated.

Patient concerns:

A 52-year-old woman complaining of a large mass in the left adrenal region for 1 month was admitted to our department.

Diagnosis:

Computed tomography firstly showed a huge mass (8.9 × 7.5 cm) in the left adrenal gland and diffusely enlarged right adrenal gland. A month later, the mass in the left adrenal gland further enlarged (9.5x7.5 cm) with infiltration of the left renal artery and retroperitoneal lymphadenopathy, and the right adrenal gland rapidly progressed into a huge mass (8.0x4.7 cm). Additionally, her chest computed tomography revealed mediastinal and bilateral hilar lymphadenopathy. Then an adrenal biopsy confirmed the diagnosis of diffuse large B-cell lymphoma, nongerminal center B-cell type, stage IV by Ann Arbor staging system. Immunohistochemistry showed positivity for Ki-67 (approximately 90%), BCL2 (approximately 80%) and MYC (approximately 70%) double-expressor lymphoma.

Interventions:

The patient's condition progressed rapidly, there was no opportunity to use pathology-based chemotherapy. Dexamethasone was given intravenously by thoracic and intraperitoneal injection; antibiotics and supporting treatment were also given.

Outcomes:

The patient's condition progressed rapidly, with the development of malignant chest and abdominal cavity fluid and lung infection, and eventually developed septic shock and respiratory failure. She responded poorly to treatment regimens, and eventually died 8 days after the diagnosis of PAL.

Lessons:

PAL grows progressively throughout the adrenal glands, high Ki-67 positivity and BCL2/ MYC co-expression predict rapid progress and poor prognosis.
Effect of phenylephrine infusion on hypotension induced by the beach chair position
Authors: Ko Myoung Jin , Kim Hyojoong , Lee Hyun-seong , Lee Soo Jee , Park Yei Heum , Bang Jin-Young , Lee Ki Hwa
Published: July 2020

Background:

The beach chair position (BCP), used during shoulder surgery, is associated with hypotension, bradycardia, and risk of cerebral hypoperfusion. Phenylephrine is commonly used as a first treatment of choice of intraoperative hypotension during surgery. We evaluated the hemodynamic effects of 2 doses of intravenous phenylephrine infusion administered before being placed in BCP for arthroscopic shoulder surgery. The primary endpoint was the incidence of hypotension after positional change.

Methods:

Sixty-six patients were randomized to receive either intravenous normal saline (group NS) or intravenous phenylephrine infusion (0.5 μg/kg/min, group LP or 1.0 μg/kg/min, group HP) for 5 minutes before being placed in the BCP. Mean arterial pressure(MAP), heart rate, stroke volume variation, and cardiac index were measured before and after positional change.

Results:

The total incidence of hypotension after the BCP was 93.65%, but was not significantly different among the 3 groups. However, there was a significant difference in trends between the groups for MAP for 5 minutes after BCP (P = .028). Comparison of changes in MAP at 1 minute compared to post-induction MAP was significantly different between group HP and group NS (P = .014).

Conclusion:

Infusion of 0.5 and 1.0 μg/kg/min of phenylephrine for 5 minutes before the BCP has no preventive effect for incidence of hypotension. However, this study showed that 1.0 μg/kg/min of phenylephrine infusion for 5 minutes can attenuate the severity of hypotension.
Efficacy and safety of dual filtration plasmapheresis combined with biological agents in active refractory rheumatod arthritis
Authors: Xing Yida , Wang Shouquan , Liu Changyan , Wang Hongjiang , Zhao Mingli , Jin Bo , Kong Xiaodan
Published: July 2020

To investigate the effectiveness of dual filtration plasmapheresis (DFPP), a novel blood purification treatment, as a rapid and sustained disease-modifying therapy for active refractory rheumatoid arthritis (RA).

A retrospective cohort study had been conducted. One hundred fifty three patients aged 18 years or older with active refractory RA were treated with DFPP combined with infliximab (IFX), IFX, or glucocorticoid (GC), all the above treatments were combined with methotrexate (MTX).

Baseline characteristic of the 153 patients (DFPP: n = 53; IFX: n = 51; GC: n = 49) were similar across groups. The remission rate of CDAI (SDAI) in the DFPP treatment group was significantly higher than that of the IFX and GC group after 3 months of treatment. The remission rate of DFPP treatment group was above 50%, while in IFX and GC group, the rate of CDAI (SDAI) remission was 41.2% (37.3%) and 22.4% (14.2%) after 3 months of treatment.

A combination of DFPP and biological agents can quickly induce remission or low disease activity of active refractory RA.
Randomized trial protocol of interscalene nerve block vs liposomal bupivacaine injection after total shoulder arthroplasty
Authors: He Jianbin , Li Yalan
Published: July 2020

Background:

The possibility of local infiltration analgesia (LIA) replacing interscalene blockade (ISB) as an integral component of a multimodal clinical pathway for total shoulder arthroplasty (TSA) needs to be further investigated. We thus further designed a randomized controlled study to compare LIA with ISB in the treatment of TSA.

Methods:

This blinded and randomised study was performed after approval of the institutional review board in the first affiliated hospital of Jinan University. The included patients were all aged over 18 years and underwent shoulder arthroplasty because of osteoarthritis of the shoulder. Subjects were randomized into 2 groups as follows: LIA or ISB. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. Secondary outcomes included pain scores, length of hospital stay, complication, and satisfaction score. P value < .05 was considered statistically significant.

Results:

For the present trial, we hypothesized that there would be no difference in pain score levels and opioid medication use throughout admission.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5640).
Case report: narcolepsy type 2 due to temporal lobe glioma
Authors: Liao Yuangao , He Yan , Yang You , Li Xiaojie , Huang Fengzhen
Published: July 2020

Rationale:

The orexin projection system includes the lateral hypothalamus, reticular activating structure, and ventrolateral preoptic nucleus, and this system is related to the pathogenesis of narcolepsy. Here, we report a case of narcolepsy type 2 caused by hippocampal glioma of the right temporal lobe.

Patient concerns:

A 44-year-old male farmer complained of excessive daytime sleepiness (EDS) over the past 3 months and more.

Interventions:

The lesion of the right anteromedial temporal lobe was removed and its pathological examination was carried out.

Outcomes:

General examination showed no abnormalities of his heart, lungs, or abdomen. Neurological examination showed no positive sign. The blood routine and biochemical examination were normal. He scored 7 on the Pittsburg sleep quality index, 16 on the Epworth sleepiness scale, 52 on the self-rating anxiety scale, and 48 on the self-rating depression scale. The multiple sleep latency test data showed 2 periods of sleep-onset rapid eyes movement period across 4 successive tests; the average sleep latency was under 8 minutes, and the rapid eyes movement latency was under 7 minutes. Lesion of glioma in hippocampus area of the right anteromedial temporal lobe was confirmed through magnetic resonance imaging, magnetic resonance spectroscopy, and histological examination. After surgical removal of the glioma from the hippocampus area of the right anteromedial temporal lobe, the patient's EDS symptoms disappeared immediately. He scored 3 on the Epworth sleepiness scale. During our follow-up three months later, he remained well with no complications.

Diagnosis:

We diagnosed the patient with narcolepsy type 2 according to the 3rd Edition of International Classification of Sleep Disorders (ICSD-3).

Conclusion:

The patient suffered from EDS and was diagnosed with narcolepsy type 2. The narcolepsy type 2 was linked to glioma of the hippocampus area. The hippocampus might be another part of regulating the sleep-arousal pathway, and the glioma secretion might interact with the orexin projection system.
Feasibility of customizing titanium implant with three-dimensional CT imaging of low dose in skull
Authors: Yang Min-xia , Chen Bing , Zhang Ya-ping , Zhao Zhen-hua
Published: July 2020

Object:

To explore the feasibility and practicability of making virtual three-dimensional model of skull defect and customizing titanium implant by skull three-dimensional CT examination of low dose.

Methods:

Sixty patients with skull defects who underwent skull three-dimensional CT before cranioplasty were randomly divided into 4 groups: group A (conventional dose 120 peak Kilovoltage (kVp), 150 tube current time product (mAs)), low dose group B (120 kVp, 50 mAs), low dose group C (100 kVp, 50 mAs), low dose group D (100 kVp, 30 mAs). After the scanning, we compared radiation doses and image quality among the groups. The CT data were sent to the reconstruction company to produce accurate titanium implants, and neurosurgeons performed cranioplasty. After the operation, patients immediately underwent head CT scans to confirm the accuracy of the implantation position, and a series of clinical functions were evaluated.

Results:

There were significant differences in dose length product (DLP) and effective dose (ED) among the 4 groups (P < .001). The volume CT dose index (CDTIvol), DLP, and ED in group D were, respectively, 87.1%, 86.9%, and 87.3% lower than those in group A (P < .001). All images quality were at or above the general level, and there was no statistical difference (P > .05). Titanium implants were successfully manufactured, every cranioplasty was carried out smoothly, and the clinical function of patients recovered well.

Conclusion:

Customizing titanium implant with three-dimensional CT imaging of low dose in skull not only met the clinical requirements, but also significantly reduced the radiation dose and hazard.
Acupuncture and related therapies for stress urinary incontinence
Authors: Yang Jiao , Cheng Ying , Zhao Ling , Chen Jiao , Zheng Qianhua , Guo Yaoguang , Liang Fanrong
Published: July 2020

Background:

Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting patients’ quality of life and sexual function. Lots of Clinical trials suggested that acupuncture is beneficial for SUI and various acupuncture methods have been widely used in clinic. However, the comparative efficacy and safety of these acupuncture methods remains unclear. Clinicians are confused to select the optimal way to treat SUI. This review aims to gather solid evidence in order to provide reliable reference in establishing guidelines for acupuncture treatment of SUI.

Methods:

Relevant databases including MEDLINE, Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, the Chongqing VIP Chinese Science and Technology Periodical Database will be retrieved from their inception to April 2020. The quality of the included studies will be evaluated by the risk of bias tool and the evidence will be evaluated by Grading of Recommendations Assessment, Development and Evaluation System. Network meta-analysis will be conducted by using software R3.5.1. The primary outcome is the number of patients with self-reported continence and number of patients with self-reported improvement in SUI.

Results:

The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:

the results may be useful for patients, clinicians, and guideline-makers to choose the optimal acupuncture method for SUI treatment.
Variant facial artery anatomy revisited
Authors: Hong Seok Jin , Park Sung Eun , Jo Jeong Won , Jeong Do Seon , Choi Dae Seob , Won Jung Ho , Hwang Minhee , Kim Chi Yeon
Published: July 2020

A number of studies have evaluated the variable courses of facial artery. However, the results of these differed substantially from each other so not consistent relationships have yet been established. There has also yet to be a relevant study using conventional angiography.

We assessed the variant branching pattern of the facial artery and its branches using conventional angiography.

Two radiologists retrospectively reviewed 284 cases of angiographies of the external carotid artery in 198 patients. The courses of the facial artery and infraorbital branch of the maxillary artery were classified into 4 types and 2 types, according to the end branch.

Among 284 cases of facial artery, type 1 (angular branch) made up 104 cases (36.6%), type 2 (lateral nasal branch) made up 138 cases (48.6%), type 3 (superior labial branch) made up 24 cases (8.5%), and type 4 (inferior labial branch) made up 18 cases (6.3%).

Regarding the 284 total cases of maxillary artery, 163 cases (57.4%) had anastomosis with the angular artery or extended to the territory of the angular artery. In addition, 121 cases (42.6%) had nothing done in regard to the angular artery.

The results may be helpful for avoiding complications related to facial and maxillary arteries during facial surgeries and cosmetic procedures.
Upregulation of lncRNA plasmacytoma variant translocation 1 predicts poor prognosis in patients with muscle-invasive bladder cancer
Authors: Li Bin , Guo Li-hua , Ban Zi-qin , Liu Lu , Luo Lei , Cui Tong-yue
Published: July 2020

LncRNA plasmacytoma variant translocation 1 (PVT1) has been recognized as an oncogenic lncRNA, which participates in the migration and invasion of many kinds of cancer cells and the development of cancers. In the present study, we explored its clinical significance and prognostic value in muscle invasive bladder cancer (MIBC).

A total of 98 MIBC patients’ samples were collected, who had undergone radical cystectomy from the March 2013 to December 2018. The associations between PVT1 expression and clinical data were calculated using the Chi2-test. Overall survival curves were determined by the Kaplan–Meier technique and contrasted via log-rank test. We utilized univariate and multivariate Cox proportional hazard models to examine the HR and 95% CI.

The expression levels of PVT1 were significantly higher in MIBC tissues than that in normal bladder tissues (P < .001). PVT1 expression was significantly correlated with tumor grade (P = .009), margin (P = .002), T stage (P = .02), and lymph node metastasis (P < .001). MIBC patients with high PVT1 expression level had shorter overall survival than those with low PVT1 expression level (log-rank test, P = .004). Multivariate Cox regression analysis showed that PVT1 expression level (HR = 2.381, 95% CI: 1.821–7.012, P = .014) was an independent factor in predicting the overall survival of MIBC patients.

In summary, increased PVT1 expression in MIBC patients is correlated with a higher MIBC stage and is significantly associated with poor prognosis for MIBC patients, which may provide new insights into new therapeutic strategy and postoperative intervention against bladder cancer.
Skeletal muscle volume loss among liver cirrhosis patients receiving levocarnitine predicts poor prognosis
Authors: Fujita Masashi , Abe Kazumichi , Hayashi Manabu , Takahashi Atsushi , Ohira Hiromasa
Published: July 2020

Sarcopenia has a negative impact on the prognosis of patients with liver cirrhosis (LC). We investigated the significance of skeletal muscle volume and its changes in LC patients taking levocarnitine (L-carnitine).

We retrospectively analyzed 51 LC patients taking L-carnitine from December 2012 to March 2019. Skeletal mass index was calculated as the left-right sum of the major × minor axis of psoas muscle at the third lumbar vertebra, divided by height squared (psoas muscle index [PMI]). Patients were classified into 2 groups (low and normal PMI) depending on PMI < 6.0 and < 3.4 cm2/m2 for men and women, respectively. Changes in PMI per month during L-carnitine administration (ΔPMI/m) were calculated, and we classified the patients into 2 groups (severe and mild muscle atrophy) depending on ΔPMI/m below the lower quartile. We assessed overall survival (OS).

At the start of L-carnitine administration, there were no significant differences in OS between groups with low and normal PMI. Multivariate analysis showed that ΔPMI/m (hazard ratio [HR], 0.007; P = .005) and L-carnitine administration period (HR, 0.956; P = .021) were significantly associated with OS. Patients with severe muscle atrophy had a significantly lower OS than those with mild muscle atrophy. There was the positive correlation relationship between ΔPMI/m and L-carnitine administration period.

Among LC patients taking L-carnitine, progressive muscle volume loss was a predictor of poor prognosis. L-carnitine administration for longer may be able to prevent muscle volume loss and lead to a better prognosis in LC patients.
Tigecycline in the treatment of fulminant Mycoplasma pneumoniae pneumonia non-responsive to azithromycin and fluoroquinolone
Authors: Yuan Xin , Liu Jie , Bai Changqing , Niu Wenkai , Wang Jingjing , Li Puyuan , Liu Huiying , Luo Yuan
Published: July 2020

Rationale:

Fulminant macrolide-resistant Mycoplasma pneumoniae pneumonia (MPP) has seldom been reported, and cases of MPP usually show rapid improvement after fluoroquinolones or tetracyclines addition. The purpose of this case report is to highlight the importance of proper selection of antibiotics for treatment of severe MPP and increase awareness concerning the emergence of fluoroquinolone-resistant MPP.

Patient concerns:

A case of severe life-threatening pneumonia in a 26-year-old man with high fever and cough was non-responsive to azithromycin and fluoroquinolones.

Diagnoses:

The patient was diagnosed with MPP based on the test results of bronchoalveolar lavage using real-time quantitative PCR method.

Interventions:

Tigecycline was given to the patient after azithromycin and fluoroquinolones failed.

Outcomes:

The patients fever subsided within the first day of tigecycline therapy. He showed rapid symptom resolution and improvement in lung infiltration after 4 days of tigecycline therapy.

Lessons:

The case suggests that fulminant MPP should be timely treated with proper antibiotics, and the possible emergence of fluoroquinolone-resistant MPP should be of concern.
Increased repeat syphilis among HIV-infected patients
Authors: Lee Nan-Yao , Chen Yen-Chin , Liu Hsiao-Ying , Li Chung-Yi , Li Chia-Wen , Ko Wen-Chien , Ko Nai-Ying
Published: July 2020

Among human immunodeficiency virus (HIV)–infected individuals, syphilis is an important sexually transmitted infection (STI), and repeat infections are common. Identifying risk factors for delineating the trends in repeat syphilis are essential for STI and HIV prevention.

This study is to investigate the dynamic of the syphilis epidemic among HIV-infected patients and to identify the risk factors associated with repeat syphilis.

A population-based cohort design was used to analyze claim data between January 2000 and December 2010 using the Taiwan National Health Insurance Research Database. The Poisson regression test was used to identify risk factors for repeat syphilis.

Of 13,239 HIV-infected patients, annual syphilis screen tests have been performed in 4,907 (37.1%) of these patients. Syphilis has been diagnosed in 956 (19.5%) patients, and 524 (10.7%) had repeat syphilis. The annual trend in repeat syphilis showed a significant increase in the study period (β = 0.23, P < .001). Younger age (adjusted incidence rate ratio [aIRR] 1.43; 95% CI 1.11–1.86), male gender (aIRR 11.14, 95% CI 4.16–29.79), a history of STIs (aIRR 1.39, 95% CI 1.21–1.59) were independently associated with repeat syphilis. The retention in HIV care and adherence to antiretroviral therapy ≥85% ([aIRR] 0.77, 95% CI 0.61–0.98; P < .001) were associated with a reduced risk of repeat syphilis.

The incidence of repeat syphilis increased during 11 years of follow-up. The screening of syphilis for early diagnosis and retention in HIV care with medication adherence should be encouraged to minimize the risk of repeat syphilis in the targeted population.
Complementary and alternative therapies for post-traumatic stress disorder
Authors: Song Kai , Xiong Fanjie , Ding Ning , Huang Ailing , Zhang Hong
Published: July 2020

Background:

Post-traumatic stress disorder (PTSD) is a psychiatric disorder. While bringing psychologic pain to patients, it also damages their social function, which is a great threat to people's life and health. Complementary and alternative medicine (CAM) therapies have been used clinically to treat PTSD; however, the selection strategies of different CAM interventions in clinical practice is still uncertain, and the purpose of this study is to evaluate the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis.

Methods:

According to the strategy, the authors will retrieve a total of 7 electronic databases by June 2020. After a series of screening, the 2 researchers will use Aggregate Data Drug Information System and Stata software to analyze the data extracted from randomized controlled trials of CAM therapies for the PTSD. Finally, the evidence grade of the results will be evaluated.

Results:

This study will provide a reliable evidence for the selection of CAM therapies for PTSD.

Conclusion:

The results of this study will provide references for evaluating the influence of different CAM therapies for PTSD, and provide decision-making references for clinical research.