bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Person-centered Language in Medical Research Articles Focusing on Hearing Loss or Deafness
Authors: Nicks Savannah , Johnson Austin L. , Traxler Brett , Bush Matthew L. , Brame Lacy , Hamilton Tom , Hartwell Micah
Published: January 2022

Background:

Hearing loss represents one of the most common disabilities worldwide. Despite its prevalence, there is a degree of stigmatization within the public’s perception of, or attitude toward, individuals diagnosed with hearing loss or deafness. This stigmatization is propagated by the way hearing loss is referenced, especially in writing. Although the medical community is familiar with hearing loss, medical research is not consistently compliant with nonstigmatizing terminology, like person-centered language (PCL). This study aims to quantify the use of PCL in medical research related to hearing loss.

Methods:

A cross-sectional analysis of articles related to hearing loss was performed using PubMed as the primary search engine. The search encompassed articles from January 1, 2016, to November 17, 2020. Journals had to have at least 20 search returns to be included in this study. The primary search resulted in 2392 articles from 31 journals. The sample was then randomized and the first 500 articles were chosen for data extraction. Article screening was performed systematically. Each article was evaluated for predetermined non-PCL terminology to determine adherence to the American Medical Association Manual of Style (AMAMS) guidelines. Articles were included if they involved research with human participants and were available in English. Commentaries and editorials were excluded.

Results:

Four hundred eighty-two articles were included in this study. Results from this study indicate that 326 articles were not adherent to AMAMS guidelines for PCL (326/482; 68%). Emotional language (i.e., burden, suffer, afflicted) was employed to reference hearing loss in 114 articles (114/482; 24%). Non-PCL adherent labels (i.e., impaired and handicapped) were identified in 46% (221/482) of articles related to hearing loss or deafness. Sixty-seven articles (67/482; 14%) used person-first language in reference to the word “deaf” and 15 articles (15/482; 3%) used “deaf” as a label.

Conclusions:

Based on the findings from this cross-sectional analysis, the majority of medical research articles that address hearing loss contain terminology that does not conform to PCL guidelines, as established by AMAMS. Many respected organizations, like the American Medical Association, have encouraged the use of PCL in interactions between patient and medical provider. This encompasses communication in person and in writing. This recommendation stems from the understood role that language plays in how we build impressions of others, especially in a medical context. Implementing PCL to destigmatize language used in reference to deafness or hearing loss is essential to increase advocacy and protect the autonomy of these individuals.
More Than Words: the Relative Roles of Prosody and Semantics in the Perception of Emotions in Spoken Language by Postlingual Cochlear Implant Users
Authors: Taitelbaum-Swead Riki , Icht Michal , Ben-David Boaz M.
Published: January 2022

Objectives:

The processing of emotional speech calls for the perception and integration of semantic and prosodic cues. Although cochlear implants allow for significant auditory improvements, they are limited in the transmission of spectro-temporal fine-structure information that may not support the processing of voice pitch cues. The goal of the current study is to compare the performance of postlingual cochlear implant (CI) users and a matched control group on perception, selective attention, and integration of emotional semantics and prosody.

Design:

Fifteen CI users and 15 normal hearing (NH) peers (age range, 18–65 years) 1istened to spoken sentences composed of different combinations of four discrete emotions (anger, happiness, sadness, and neutrality) presented in prosodic and semantic channels—T-RES: Test for Rating Emotions in Speech. In three separate tasks, listeners were asked to attend to the sentence as a whole, thus integrating both speech channels (integration), or to focus on one channel only (rating of target emotion) and ignore the other (selective attention). Their task was to rate how much they agreed that the sentence conveyed each of the predefined emotions. In addition, all participants performed standard tests of speech perception.

Results:

When asked to focus on one channel, semantics or prosody, both groups rated emotions similarly with comparable levels of selective attention. When the task was called for channel integration, group differences were found. CI users appeared to use semantic emotional information more than did their NH peers. CI users assigned higher ratings than did their NH peers to sentences that did not present the target emotion, indicating some degree of confusion. In addition, for CI users, individual differences in speech comprehension over the phone and identification of intonation were significantly related to emotional semantic and prosodic ratings, respectively.

Conclusions:

CI users and NH controls did not differ in perception of prosodic and semantic emotions and in auditory selective attention. However, when the task called for integration of prosody and semantics, CI users overused the semantic information (as compared with NH). We suggest that as CI users adopt diverse cue weighting strategies with device experience, their weighting of prosody and semantics differs from those used by NH. Finally, CI users may benefit from rehabilitation strategies that strengthen perception of prosodic information to better understand emotional speech.
Ecological Validity, External Validity, and Mundane Realism in Hearing Science
Authors: Beechey Timothy
Published: January 2022

Tests of hearing function are typically conducted in conditions very different from those in which people need to hear and communicate. Even when test conditions are more similar, they cannot represent the diversity of situations that may be encountered by individuals in daily life. As a consequence, it is necessary to consider external validity: the extent to which findings are likely to generalize to conditions beyond those in which data are collected. External validity has long been a concern in many fields and has led to the development of theories and methods aimed at improving generalizability of laboratory findings. Within hearing science, along with related fields, efforts to address generalizability have come to focus heavily on realism: the extent to which laboratory conditions are similar to conditions found in everyday settings of interest. In fact, it seems that realism is now tacitly equated with generalizability. The term that has recently been applied to this approach by many researchers is ecological validity. Recent usage of the term ecological validity within hearing science, as well as other fields, is problematic for three related reasons: (i) it encourages the conflation of the separate concepts of realism and validity; (ii) it diverts attention from the need for methods of quantifying generalization directly; and (iii) it masks a useful longstanding definition of ecological validity within the field of ecological psychology. The definition of ecological validity first used within ecological psychology—the correlation between cues received at the peripheral nervous system and the identity of distant objects or events in the environment—is entirely different from its current usage in hearing science and many related fields. However, as part of an experimental approach known as representative design, the original concept of ecological validity can play a valuable role in facilitating generalizability. This paper will argue that separate existing terms should be used when referring to realism and generalizability, and that the definition of ecological validity provided by the Lens Model may be a valuable conceptual tool within hearing science.
Applying the Microvascular Anastomotic Coupler Device to End-to-side Venous Anastomosis in Reconstructive Surgery
Authors: Umezawa Hiroki , Hokazono Yu , Taga Marie , Ogawa Rei
Published: January 2022

Background:

Microsurgical vascular anastomosis plays an important role in successful free-tissue transfer. The Microvascular Anastomotic Coupler Device (MACD) aims to simplify anastomosis and decrease the time spent on this step, thereby reducing surgeon stress and improving the overall quality of the surgery, especially when venous end-to-side anastomosis is required. Our comparative retrospective cohort study aimed to determine the effect of this widely used device on anastomosis times and complications in head and neck/esophageal reconstruction cases involving venous end-to-side anastomosis using the internal jugular vein as the recipient vessel.

Methods:

All consecutive patients who underwent head and neck/esophageal reconstruction with hand-sewn or MACD-mediated venous end-to-side anastomosis using the internal jugular vein by three experienced microsurgeons in our tertiary-care hospital in 2012–2020 were identified. Venous anastomosis times and venous trouble cases were recorded.

Results:

Of the 191 cases, 44 and 147 underwent hand-sewn and MACD-mediated anastomosis respectively. The average venous anastomosis times of these groups were 31 and 11 minutes, respectively. Venous trouble was observed in two hand-sewn (4.5%) and four MACD (2.7%) cases, respectively. Vein twisting and improper coupler placement were the causes in the latter four cases.

Conclusions:

This study confirmed that MACD simplifies end-to-side venous anastomosis and reduces the time spent on this procedure. Also, for safer anastomosis, it is necessary to pay attention to preventing twisting and improper coupler placement when using MACD. We believe the MACD can improve the quality of reconstructive surgery.
Outcome measures in clinical trials of traditional Chinese medicine for stable angina pectoris
Authors: Xing Dongmei , Zhu Mingjun , Liu Chunxiang , Wang Hui
Published: January 2022

Objective:

This work aimed to present a descriptive analysis of the outcome measures used in clinical trials of traditional Chinese medicine (TCM) for patients with stable angina pectoris, and to provide baseline data for the development of core outcome sets (COSs) for relevant clinical trials.

Methods:

Medical databases were searched to identify randomized trials of the effects of TCM for the treatment of stable angina pectoris. Outcome measures of each trial were extracted. Descriptive statistics were used to analyze the baseline characteristics of outcomes in clinical trials of TCM.

Results:

94 randomized trials (with 9,111 participants) involving 79 different outcomes were identified. The mean number of outcomes was 5 (1–21 per trial). The 5 most commonly reported outcomes were efficacy rate of electrocardiogram, efficacy rate of angina pectoris, efficacy rate of TCM syndrome, fasting lipid indices, and withdrawal rate of nitroglycerin. Several challenges were identified: (1) significant heterogeneity of outcomes and differences in the technique and timing of the measurement of the same outcome; (2) transformation of continuous data into categorical data and presented as such in >90% of trials; (3) few trials on the outcomes associated with the advantages and characteristics of TCM; and (4) selective reporting of outcomes.

Conclusions:

The outcomes used are excessively heterogenous, and the choice of some outcomes (timing and techniques) for measurement is confusing or inappropriate. Hence, developing and implementing a COS is necessary for greater consistency.
The rationale behind the four major anti-COVID-19 principles of Chinese herbal medicine based on systems medicine
Authors: Jin Guanyuan , Jin Louis Lei , Jin Bonnie Xia
Published: January 2022

As the novel coronavirus disease 2019 (COVID-19) and its variants continue to rage into the second year of a global pandemic, many success stories of applying Chinese herbal medicine (CHM) to treat COVID-19 patients continue to emerge from China and other part of the world. Herewith, from a systems medicine perspective, the authors analyze those experiences and categorize them into four major treatment principles: (1) focusing on eliminating toxins in the early stage of the disease, (2) tonifying deficiency of the body throughout the entire disease course, (3) treating the affected lung and intestine simultaneously based on visceral interactions, (4) cooling blood and removing blood stasis at the later stage, as well as interpret the rationale of these principles. This is helpful not only in reducing the complexity of promoting the CHM applications to enhance anti-COVID-19 efficacy, but also in ramping out the process of integrating traditional Chinese medicine with modern medical practices.
Development and evaluation of Panax notoginseng saponins contained in an in situ pH-triggered gelling system for sustained ocular posterior segment drug delivery
Authors: Lu Peng , Wang Renxing , Xing Yue , Gao Yanquan , Zhang Qingqing , Xing Bin , Zhang Ying , Yu Changxiang , Cai Xinfu , Shang Qiang , Kebebe Dereje , Pi Jiaxin , Liu Zhidong
Published: January 2022

Objective:

This study aimed to lay the foundation for the research on Panax notoginseng saponins (PNS) in pH-sensitive in situ gel and the development and improvement of related preparations.

Methods:

We used Carbopol®940, a commonly used pH-sensitive polymer, and the thickener hydroxypropyl methylcellulose (HPMC E4M) as an ophthalmic gel matrix to prepare an ophthalmic in situ gel of PNS. In addition, formula optimization was performed by assessing gelling capability with the results of in vitro release studies. In vitro (corneal permeation, rheological, and stability) and in vivo (ocular irritation and preliminary pharmacokinetics in the vitreous) studies were also performed.

Results:

The results demonstrated that the in situ gelling systems containing PNS showed a sustained release of the drug, making it an ideal ocular delivery system for improving posterior ocular bioavailability.

Conclusions:

This study lays the foundation for the research of PNS contained in an in situ pH-triggered gel as well as the development and improvement of related preparations. It concurrently traditional Chinese medicine with a contemporary in situ gelling approach to provide new directions for the treatment of posterior ocular diseases such as diabetic retinopathy.
POLYPOIDAL CHOROIDAL VASCULOPATHY ASSOCIATED WITH SECTOR RETINITIS PIGMENTOSA
Authors: Appanraj Ramya , Manayath George J. , Verghese Shishir , Narendran Venkatapathy
Published: January 2022

Purpose:

To report a case of polypoidal choroidal vasculopathy associated with sector retinitis pigmentosa.

Methods:

Case report.

Results:

A 63-years-old woman presented with complaints of having painless progressive reduction of vision in the left eye (LE) for the past 6 months. On examination, her best-corrected visual acuity was 20/20 in the right eye and 20/125 in the LE. Based on fundus examination and multimodal imaging findings, both eyes were diagnosed to have sector retinitis pigmentosa, and an associated active extramacular polypoidal choroidal vasculopathy was seen in the LE. Spectral-domain optical coherence tomography also revealed choroidal thinning in both eyes. Patient underwent bevacizumab injection in the LE. At 1-month posttreatment, her best-corrected visual acuity remained stable in the LE, and spectral-domain optical coherence tomography showed reduction in subretinal fluid and size of the polypoidal lesion.

Conclusion:

Polypoidal choroidal vasculopathy, a pachychoroid disease, could occur in association with retinitis pigmentosa, in the setting of thin choroids, and multimodal imaging is important to differentiate it from Type-1 macular neovascularization.
Risk Factors for Severity and Mortality in Adult Patients Confirmed with COVID-19 in Sierra Leone: A Retrospective Study
Authors: Tu Bo , Lakoh Sulaiman , Xu Biao , Lado Marta , Cole Reginald , Chu Fang , Hastings-Spaine Susan , Jalloh Mohamed Bole , Zheng Junjie , Chen Weiwei , Sevalie Stephen
Published: January 2022

Background:

The coronavirus disease 2019 (COVID-19) is a highly infectious respiratory disease. There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone, and supportive care and protection of vital organ function are performed for the patients. This study summarized the clinical characteristics, drug treatments, and risk factors for the severity and prognosis of COVID-19 in Sierra Leone to provide evidence for the treatment of COVID-19.

Methods:

Data of 180 adult COVID-19 patients from the 34th Military Hospital in Freetown Sierra Leone between March 31, 2020 and August 11, 2020 were retrospectively collected. Patients with severe and critically ill are classified in the severe group, while patients that presented asymptomatic, mild, and moderate disease were grouped in the non-severe group. The clinical and laboratory information was retrospectively collected to assess the risk factors and treatment strategies for severe COVID-19. Demographic information, travel history, clinical symptoms and signs, laboratory detection results, chest examination findings, therapeutics, and clinical outcomes were collected from each case file. Multivariate logistic analysis was adopted to identify the risk factors for deaths. Additionally, the clinical efficacy of dexamethasone treatment was investigated.

Results:

Seventy-six (42.22%) cases were confirmed with severe COVID-19, while 104 patients (57.78%) were divided into the non-severe group. Fever (56.67%, 102/180) and cough (50.00%, 90/180) were the common symptoms of COVID-19. The death rate was 18.89% (34/180), and severe pneumonia (44.12%, 15/34) and septic shock (23.53%, 8/34) represented the leading reasons for deaths. The older age population, a combination of hypertension and diabetes, the presence of pneumonia, and high levels of inflammatory markers were significantly associated with severity of COVID-19 development (P < 0.05 for all). Altered level of consciousness [odds ratio (OR) = 56.574, 95% confidence interval (CI) 5.645–566.940, P = 0.001], high levels of neutrophils (OR = 1.341, 95%CI 1.109–1.621, P = 0.002) and C-reactive protein (CRP) (OR = 1.014, 95%CI 1.003–1.025, P = 0.016) might be indicators for COVID-19 deaths. Dexamethasone treatment could reduce mortality [30.36% (17/56) vs. 50.00% (10/20)] among severe COVID-19 cases, but the results were not statistically significant (P > 0.05).

Conclusions:

The development and prognosis of COVID-19 may be significantly correlated with consciousness status, and the levels of neutrophils and CRP.
Cranial Base Pachymeningitis in Children
Authors: Mesquita Alice Leite , Coutinho João Victor Soares Coriolano , Filho Luiz Alves Ferreira , Marques Solomar Martins , Borges Moara Alves Santa Bárbara
Published: January 2022

Cryptococcal meningitis has clinical and radiologic manifestations similar to tuberculosis. A 12-year-old immunocompetent male developed cranial base pachymeningitis caused by Cryptococcus gattii infection. Although tuberculosis is the main cause of chronic meningitis in children, in regions with endemic cryptococcosis, high clinical suspicion and sensitive tests are essential for changing the high morbidity rate associated with cryptococcal infection.
Oculopharyngeal Muscular Dystrophy Ptosis, Mueller’s Muscle Involvement, and a Review of Management Over 34 Years
Authors: Jordan David R. , Klapper Stephen R. , Farmer James
Published: January 2022

Purpose:

To review the management of the ptosis associated with oculopharyngeal muscular dystrophy (OPMD) from one author’s experience over 34 years, demonstrate Mueller’s muscle involvement in this disease, and how this impacts the preferred choice of surgery.

Methods:

Retrospective, nonrandomized comparative case series. Forty patients with OPMD who underwent primary bilateral ptosis surgery through an anterior eyelid incision and had their Mueller’s muscle biopsied (one side) and sent for histopathologic analysis were selected for chart review. The main outcome measure was the presence or absence of dystrophic changes in the biopsied Mueller’s muscle.

Results:

In 29/40 biopsies (72.5%), there were dystrophic changes and fatty infiltration of Mueller’s muscle identified histopathologically.

Conclusions:

Mueller’s muscle is involved in the dystrophic process more often than expected contributing to ptosis in the OPMD syndrome. A combined Mueller’s-aponeurotic advancement is more effective at elevating the eyelid than simply advancing the aponeurosis when Mueller’s is fatty infiltrated at the time of external levator advancement surgery in our experience. Management strategies for ptosis surgery in OPMD are reviewed. The age of onset, levator muscle function, previous ptosis repair, how debilitated the patient is with their disease process systemically, as well as the presence of other eye problems (e.g., dry eye, prior glaucoma filtering procedures, history of corneal surgery, laser refractive procedure) are important clinical considerations in patients with OPMD.
Peripheral Trigeminal Nerve Blocks for Chronic Orbital Pain: Clinical Features and Outcomes
Authors: Lee Grace , Pham Chau M. , Kardon Randy H. , Shriver Erin M.
Published: January 2022

Purpose:

To characterize chronic orbital pain in patients who benefitted from peripheral trigeminal nerve blocks and to explore the relationship between pain etiologies and phenotypes, injection attributes, and positive response to treatment.

Methods:

In this single-center retrospective descriptive study, patients who underwent peripheral trigeminal nerve blocks for chronic orbital pain from November 2016 to May 2021 were selected. Data reviewed included inciting factors, neuropathic symptoms of orbital pain, injection composition (anesthetic alone versus anesthetic + dexamethasone), and corneal epitheliopathy grades. Primary outcomes assessed were response to injection, duration of injection effectiveness, and overall treatment efficacy. Associations between subgroups of chronic orbital pain, injection attributes, and treatment outcomes were examined.

Results:

Nineteen patients who underwent a total of 94 peripheral trigeminal nerve blocks for chronic orbital pain were included. During a mean follow-up period of 2.4 years after initial injection (range 7 days–4.6 years), 16 (84.2%) patients achieved either partial or complete improvement. Ocular versus nonocular origin of orbital pain or the presence of neuropathic sensory characteristics was not associated with a treatment outcome. Injections containing dexamethasone had a lower positive efficacy (relative risk, 0.88; 95% CI, 0.81–0.97) and no statistically significant association with prolonged effect. Twenty-nine (50.9%) of the 57 injections for which effect duration was recorded produced a response lasting greater than 6 weeks.

Conclusions:

Modulation of trigeminal afferent nerve activity with peripheral trigeminal nerve blocks containing anesthetic with or without dexamethasone may be a promising treatment strategy for chronic orbital pain of diverse etiologies and phenotypes.
Surgical Treatment of Proptosis due to High-axial Myopia During Lower Eyelid Blepharoplasty in Identical Twins
Authors: Scofield-Kaplan Stacy M. , Young William , Mancini Ronald
Published: January 2022

Unilateral high-axial myopia can be associated with amblyopia and relative proptosis due to elongation of the eye and staphyloma formation. It is important to consider addressing any relative proptosis at the time of a lower eyelid blepharoplasty as the proptotic eye often creates a significant negative vector and increases the likelihood of postoperative retraction and scleral show. We present twin sisters who presented for a lower eyelid blepharoplasty evaluation; each sister had unilateral proptosis with high-axial myopia. Both underwent bilateral lower eyelid blepharoplasty and unilateral fat decompression in the proptotic eye. One sister required additional medial wall bony decompression to resolve the proptosis at the time of the aforementioned surgery. Therefore, it is important to consider globe position and degree of proptosis at the time of lower eyelid blepharoplasty surgery to optimize surgical results.
Functional Improvement During Prolonged Hospitalization in a Patient With Acute Myeloid Leukemia Utilizing Physical and Occupational Therapy Comanagement
Authors: Strikwerda Jessica A. , Bodensteiner Schmitt Emily A.
Published: January 2022

Background and Purpose:

Being physically active and mobile in the acute care setting has been shown to improve functional outcomes in individuals with cancer. Patient participation in occupational (OT) and physical therapy (PT) activities contributes to this; however, specific interventions and strategies are rarely described in the rehabilitation literature. Even more limited are descriptions of the purpose and implementation of OT and PT cotreatment therapy sessions. This case report describes OT and PT treatment interventions, including cotreatment therapy sessions, used in the management of a patient with prolonged hospitalization.

Case Description:

A 65-year-old man with a medical diagnosis of acute myeloid leukemia was admitted to the hospital for abdominal pain, dehydration, and poor appetite. His hospital course totaled 101 days and included 27 days in the intensive care unit (ICU). Medical complications included graft-versus-host disease and recurrent gastrointestinal bleeding. At therapy evaluation, voluntary motor activation was not visualized or felt during transfers. The patient had impaired balance and impaired cognition, and he needed total assistance to sit at the edge of the bed.

Intervention:

The patient received 13 weeks of OT and PT treatment in the ICU and continued until hospital discharge. OT and PT cotreatment therapy sessions were used throughout this period of patient care to maximize the patient's recovery of mobility and endurance.

Results:

At hospital discharge, the patient was independent in bed mobility and ambulation using a 4-wheeled walker. He was able to navigate 6 stair steps using handrails. For activities of daily living, he was independent in grooming, upper body dressing, toileting, lower body dressing, and showering from a seated position.

Discussion:

The use of both cotreatment and individual therapy sessions may be beneficial for individuals with cancer at different stages of functional recovery in the acute care setting. Cotreatment therapy sessions were used in this case when both OT and PT providers could address their different therapy goals during the same treatment session. The patient in this case report initially required total assistance for functional mobility and activity and achieved near-full independence at hospital discharge.
The Impact of Principal Diagnosis on Readmission Risk among Patients Hospitalized for Community-Acquired Pneumonia
Authors: Ruhnke Gregory W. , Lindenauer Peter K. , Lyttle Christopher S. , Meltzer David O.
Published: January 2022

Coding variation distorts performance/outcome statistics not eliminated by risk adjustment. Among 1596 community-acquired pneumonia patients hospitalized from 1998 to 2012 identified using an evidence-based algorithm, the authors measured the association of principal diagnosis (PD) with 30-day readmission, stratified by Pneumonia Severity Index risk class. The 152 readmitted patients were more ill (Pneumonia Severity Index class V 38.8% versus 25.8%) and less likely to have a pneumonia PD (52.6% versus 69.9%). Among patients with PDs of pneumonia, respiratory failure, sepsis, and aspiration, mortality/readmission rates were 3.9/8.5%, 28.8/14.0%, 24.7/19.6%, and 9.0/15.0%, respectively. The nonpneumonia PDs were associated with a greater risk of adjusted 30-day readmission: respiratory failure odds ratio (OR) 1.89 (95% confidence interval [CI], 1.13-3.15), sepsis OR 2.54 (95% CI, 1.52-4.26), and possibly aspiration OR 1.73 (95% CI, 0.88-3.41). With increasing use of alternative PDs among pneumonia patients, quality reporting must account for variations in condition coding practices. Rigorous risk adjustment does not eliminate the need for accurate, consistent case definition in producing valid quality measures.
Extracorporeal Membrane Oxygenation in Pregnant Women With COVID-19
Authors: Mohammed Bamasood Omar , Shamsah Mohammed , Alfoudri Huda , Bitar Zouheir , Al Shammari Farah R. , Jagadeesan Jayakumar , Raj Pandian Vimal , Elkenany Yasser , Alsarraf Abdalaziz H , Almutawa Abdullatif , KH Abdullah Turki , Mahmoud Ibrahim Mahmoud Mohamed
Published: January 2022

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and lung involvement is common. Patients with COVID-19 may progress to acute respiratory distress syndrome (ARDS) for which they may require mechanical ventilation. When conventional ventilation strategies are unable to achieve the desired oxygenation and gas exchange, extracorporeal membrane oxygenation (ECMO) might be an option in selected patients. The literature on the use of ECMO in peripartum women with COVID-19 is limited. We present a series of ten cases involving pregnant and recently pregnant women who rapidly developed ARDS after the onset of COVID-19 for which they received ECMO. Nine of the 10 patients survived intensive care unit discharge after a gradual recovery of their pulmonary function and weaning from mechanical ventilation and ECMO. In addition, 9 out of the 10 delivered neonates survived neonatal intensive care unit discharge.
Hemostatic parameters predict 90-day mortality in hospitalized cirrhotic patients with acute decompensation: a prospective cohort study
Authors: Sivapornpan Nakarin , Ratana-Amornpin Sarita , Siramolpiwat Sith
Published: January 2022

Hemostatic disturbances are common in patients with cirrhosis. Few studies have evaluated the prognostic role of hemostatic parameters in cirrhosis with acute decompensation. This study aims to determine the prognostic ability of standard hemostatic parameters in hospitalized cirrhotic patients with acute decompensation. Cirrhotic patients admitted with acute decompensation were prospectively enrolled. Hemostatic parameters were determined within 24 h, and the DIC (disseminated intravascular coagulation) score was calculated based on platelet count, prothrombin time (PT), fibrinogen, and D- dimer. New onset of in-hospital major bleeding and 90-day mortality were assessed. Eighty-nine patients were included (MELD 13.6 ± 5.7). The indications of admission were infection (38.2%), and portal hypertension-related bleeding (31.5%). 14.6% developed in-hospital major bleeding, and 90-day mortality rate was 21.3%. Major bleeding group and 90-day nonsurvivors had significantly higher activated partial thromboplastin time (aPTT), PT, and DIC score. The 90-day mortality rate was higher in major bleeding group (46.2 vs. 17.1%, P = 0.029). By multivariate logistic regression analysis, DIC score was associated with 90-day mortality. The AUROC of DIC score for 90-day mortality prediction was significantly higher than of MELD score (0.78 vs. 0.59, P = 0.04). DIC score at least 4 predicted 90-day mortality with a sensitivity of 88.9%. The cumulative 90-day survival was significantly lower in patients with DIC score at least 4 (57.2 vs. 93.6%, P = 0.0003). The development of in-hospital major bleeding significantly increases mortality in cirrhotic patients with acute decompensation. The DIC score within 24 h can be used as a simple and reliable predictor for 90-day mortality in these patients.
Epidemiological investigation and ultrasonic diagnosis of developmental dysplasia of the hip in Chinese infants
Authors: Xu Na , Xia Bei , Tao Hongwei , Sun Ke , Liu Qinghua , Chen Wenjuan , Wang Dan , Gao Hong , Guo Yan , Liu Yan , Gao Jun , Teng Jianbo , Li Tianzi , He Qiancheng , Wu Zhixia
Published: January 2022

Developmental dysplasia of the hip (DDH) is common among Chinese infants, but a lack of large-scale, multi-center epidemiological studies has made it difficult to characterize the risk factors associated with this disease.This multi-center cohort study included 19,833 Chinese infants aged 14 days to 6 months. A multi-center ultrasound protocol was used to diagnose hip abnormalities, and epidemiological data of the infants were collected through questionnaires. Categorical variables were expressed as percentages and compared using χ2 test. Multivariate analysis was performed through logistic regression.

Of 19,833 infants, 345 had DDH (1.7%). DDH incidence was higher in female infants (n = 279) than in male infants (n = 66) (χ2 = 95.89, P < .05), and there were more left hip cases (n = 149) than right hip cases (n = 79) (χ2 = 12.49, P < .05). DDH incidence was statistically different amongst different age groups in months (χ2 = 451.71, P < .05), and it gradually decreased with age (P < .05). The prevalence of a positive DDH family history, breech presentation, oligohydramnios, swaddling style, and other musculoskeletal deformities was higher in the positive group than in the negative group (all P < .05). No significant differences were found in terms of delivery by cesarean section, multiple births, or premature birth between both groups.

Family history, breech presentation, oligohydramnios, musculoskeletal deformities, and female sex are high-risk factors for DDH in Chinese infants. The incidence of DDH gradually decreases with age. The results of this study provide evidence for the epidemiology of infant DDH in China.
Early treatment of rituximab combined with eltrombopag for secondary thrombocytopenic purpura in rheumatoid arthritis
Authors: Zhang Naidan , Ji Chaixia , Bao Xiao , Yuan Chengliang
Published: January 2022

Rationale:

Secondary immune thrombocytopenic purpura (ITP) is also known as acquired thrombocytopenic purpura, autoimmune disease is usually one of the important causes. There are few reports about treatment of refractory thrombocytopenic purpura in rheumatoid arthritis (RA). We report a case of refractory ITP in which changes in platelet-related markers with therapeutic agents are worthy of the attention of clinicians.

Patient concerns:

A 69-year-old woman admitted for ecchymosis on the neck and arms for 15 days presented to our hospital. She was diagnosed with RA 5 years ago.

Diagnosis:

The diagnosis met the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria. The disease activity score 28 (DAS-28) was 4.6, indicating that the disease activity was moderate.

Interventions:

Treatment with first-line therapies and second-line treatment--eltrombopag (EPAG) were ineffective. Therefore, we performed rituximab combined with a low dose of EPAG.

Outcomes:

The patient received 2 cycles of rituximab combined with EPAG, and reported no new petechiae on her buccal mucosa and limbs during follow-up.

Lessons:

This case suggests that early treatment of rituximab combined with EPAG is beneficial to patients with refractory ITP in RA. In terms of disease dynamic monitoring, immature platelet fraction (IPF) may be an auxiliary indicator for predicting efficacy, but its significance needs further study.
Immune checkpoint inhibitor-induced refractory polyarthritis rapidly improved by sarilumab and monitoring with joint ultrasonography
Authors: Abe Kazuya , Ishikawa Yuichi , Fujiwara Michio , Yukawa Hiroko , Yanagihara Takeshi , Takei Saori , Arioka Hitoshi , Kita Yasuhiko
Published: January 2022

Rationale:

Immune checkpoint inhibitors (ICIs) have shown efficacy for the treatment of various kinds of malignant tumors. However, ICIs can cause immune-related adverse events, such as arthritis. Nevertheless, the treatment of ICI-induced arthritis has not been established yet. Here we report a case of ICI-induced polyarthritis successfully treated using sarilumab and monitored using joint ultrasonography.

Patient concerns:

A 61-year-old man presented with polyarthritis. He had been treated with nivolumab for recurrent renal cell carcinoma 11 months before. He developed ICI-induced nephritis (proteinuria and elevated serum creatinine) 3 months before, which resolved after discontinuing nivolumab for 1 month. Two months after resuming nivolumab, he developed polyarthralgia and joint swelling, which were suspected to be associated with nivolumab administration, and hence we discontinued nivolumab again. Laboratory tests revealed elevated C-reactive protein level and erythrocyte sedimentation rate, but were negative for rheumatoid factor and anti-cyclic citrullinated peptide antibody. Joint ultrasonography revealed active synovitis in several joints, but a joint X-ray revealed no bone erosion.

Diagnoses:

We diagnosed polyarthritis as ICI-induced arthritis because the findings were not typical of rheumatoid arthritis (no bone erosion and seronegativity) and the patient had already developed other immune-related adverse events (ICI-induced nephritis).

Interventions:

After discontinuation of nivolumab, we started treatment with 15 mg daily prednisolone and 1000 mg daily sulfasalazine, although it was ineffective. Hence, we initiated 200 mg biweekly sarilumab.

Outcomes:

Following sarilumab administration, polyarthritis improved rapidly, and joint ultrasonography confirmed the rapid improvement of synovitis. Hence, we tapered off the glucocorticoid treatment. No recurrence of renal cell carcinoma was noted for 2 years after the initiation of sarilumab despite no anti-tumor therapy.

Lessons:

Sarilumab may serve as a good treatment option for treating refractory ICI-induced polyarthritis. Joint ultrasonography may contribute to the evaluation of ICI-induced polyarthritis and monitoring the effects of treatments.
Clinicopathological features of early stage gastric adenocarcinoma of fundic gland type
Authors: Zhang Huan , Wang Shuyan , Zhang Yongping , Ye Fusang , Wang Chunnian
Published: January 2022

Introduction:

Gastric adenocarcinoma of the fundic gland type (GA-FG) is characterized by a well-differentiated neoplasm. More than 100 cases have been reported, but only a few cases have been described in China. Therefore, its clinicopathological characteristics need to be investigated further. Herein, we report five cases and briefly review the relevant literature.

Patient concerns:

Five patients, including three women and two men, were identified in the Ningbo Clinical Pathological Diagnosis Center between March 2017 and July 2020. Patients (case 1, case 2, and case 5) underwent gastroscopy due to epigastric pain. Apart from the lesion, others were occasionally discovered on physical examination.

Diagnosis:

Gastric adenocarcinoma of the fundic gland type (GA-FG).

Intervention:

Five patients were treated with endoscopic submucosal dissection.

Outcomes:

Surgical outcomes were good. Esophagogastroduodenoscopy showed a scar with no recurrence, and no postoperative symptoms were observed from 3 to 43 months during the follow-up.

Conclusion:

We present five cases of well-differentiated tubular adenocarcinoma that mimicked the fundic glands. Cell differentiation by MUC2, MUC5AC, MUC6, pepsinogen-I, and H+/K+-ATPase. Immunohistochemical findings in GA-FG suggested differentiation of the fundic glands. In addition, it has a low proliferation. p53 and Her-2 were negative, and β-catenin was positive in the cytoplasm, indicating that the pathogenesis of this tumor was different from that of traditional intestinal and diffuse gastric carcinomas. In summary, this neoplasm is rare and unusual. To better understand this issue, similar cases should be monitored in the future.
Efficacy and safety of Shengmai injection as an adjunctive therapy on sepsis
Authors: Han Yue , Zhong Guofu , Chang Xiao , Xu Mujuan , Chen Mingtai , Zeng Linsheng , Wang Ling
Published: January 2022

Introduction:

Sepsis is a common life-threatening, acute and severe disease with high morbidity and mortality, which seriously endangers patient health. Shengmai injection (SMI) is typically used as an alternative treatment for sepsis patients. This investigation aimed at designing a comprehensive recollection and meta-analytical exercise for evaluating efficacy and safety-profile for employing SMI against sepsis.

Methods:

Multiple research literature repositories, both localized and global, were examined for randomized controlled trials of sepsis treated by SMI - from repository inception to December 2021 as a timeframe. Primary outcome measures contained 28-day all-cause mortality, while secondary outcome measures consisted of Sequential Organ Failure Assessment scorings, acute Physiology and Chronic Health Evaluation II scorings, ICU-based hospitalization length, mechanical ventilation timespan, ICU mortality rate, and adverse effects/events. RevMan V.5.3 was employed for data analyses. Two reviewers evaluated bias risks/investigation quality through Cochrane Collaboration risk of bias tool / Grades of Recommendations Assessment Development and Evaluation, separately.

Results:

Such a comprehensive reviewing protocol review protocol systematically and objectively analyzes the effectiveness and safety-profile of SMI for therapy against sepsis, together with providing scientific grounds for clinic-based employment for SMI.

PROSPERO registration number:

CRD42021245247.
Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient
Authors: Lang Jiaxin , Cui Xulei , Zhang Jia , Huang Yuguang
Published: January 2022

Rationale:

Hemidiaphragmatic paralysis (HDP) is a frequent complication of the brachial plexus block, caused by unintentional blockade of ipsilateral phrenic nerve. HDP did not rise enough alarm and attention to most anesthesiologists, because most patients with no coexisting comorbid diseases are asymptomatic and able to tolerate it. However, it may cause severe respiratory complication for patients with preexisting compromised cardiorespiratory function.

Patient concerns:

A 67-year-old woman with morbidly obesity was planned to receive opening reduction and internal fixation of right humeral shaft fracture under regional anesthesia considering less respiratory and cardiovascular system interference compared with general anesthesia.

Diagnoses:

After ultrasound guided supraclavicular brachial plexus block, the patient developed severe hypoxia and hypercapnia.Unintentional block of phrenic nerve and diaphragm paralysis was diagnosed by diaphragm ultrasound, which was considered as the main reason of severe hypoxia.

Interventions:

It led to a conversion from regional anesthesia to general anesthesia with endotracheal intubation for patient's safety and smooth operation.

Outcomes:

The unintentional phrenic nerve block leads to a prolonged ventilation time, length of stay in intensive care unit and length of stay in hospital.

Lessons:

This case report highlights the risk of diaphragm paralysis in morbidly obese patients. Though new diaphragm sparing brachial plexus block (BPB) methods were developed intended to reduce the risk of HDP, no approaches could absolutely spare phrenic nerve involvement. Therefore, clinicians should always consider the risk of HDP associated with BPBs. For each individual, a detailed preoperative evaluation and sufficient preparation are paramount to avoid serious complications.
Identification of a novel missense mutation in the TPM1 gene via exome sequencing in a Chinese family with dilated cardiomyopathy
Authors: Man Yilong , Yi Changying , Fan Meili , Yang Tianyu , Liu Peng , Liu Shiguang , Wang Guangxin
Published: January 2022

Rationale:

Dilated cardiomyopathy (DCM) is a cardiovascular disorder characterized by consecutive ventricular dilation and contractile dysfunction, often leading to congestive heart failure. DCM type 1Y (DCM1Y) is caused by a mutation in the TPM1 (tropomyosin 1) gene. To date, about thirty TPM1 gene mutations have been reported to be related to DCM1Y. However, mutational screening of the TPM1 gene is still far from being complete. Identification of TPM1 mutation is particularly important in the diagnosis of DCM1Y and will give more insights into the molecular pathogenesis of DCM1Y.

Patient concerns:

A Chinese Han family with DCM phenotypes was examined.

Diagnosis:

A novel missense mutation, c.340G > C in exon 3 of the TPM1 gene, was identified.

Interventions:

Next-generation sequencing (NGS) of DNA samples was performed to detect the gene mutation in the proband, which was confirmed by Sanger sequencing.

Outcomes:

This novel heterozygous mutation results in the substitution of glutamic acid with glutamine (p.E114Q). Based on this finding and clinical manifestations, a final diagnosis of DCM1Y was made.

Lessons:

We present evidence that p.E114Q mutation represents a novel TPM1 mutation in a Chinese Han family with DCM. Our data expand the mutation spectrum of the TPM1 gene and may facilitate the clinical diagnosis of DCM1Y.
Comparative clinical outcomes of different therapies for traumatic meniscal tears in adults
Authors: Hou Jun-Hu , Gong Yan-Long , Ma Ping , Chen Xin , Dong Wan-Tao , Liu Jian-Jun , Liu Bao-Jian , Zhang Chun-Mu
Published: January 2022

Background:

Meniscus tears are usually classified as degenerative or traumatic tears according to their pathogenesis. At present, traumatic meniscal tears are generally believed to have high healing potential. In recent years, multiple treatments have been described for traumatic meniscal tears, such as the inside-out technique, outside-in technique, all-inside technique, biological augmentation of meniscal repair, meniscectomy, and non-surgical treatment. However, the functional recovery of the knee joint and healing of the meniscus after treatment are quite different from the results reported in the literature, which requires more reliable evidence-based medical findings. This study will evaluate evidence from multiple types of research comparing different therapies for traumatic meniscal tears in adults.

Methods

We will search the EMBASE, Cochrane Library (the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials [CENTRAL], Cochrane Methodology Register), PubMed, Web of Science (Science and Social Science Citation Index), China Knowledge Network, CBM, Wanfang data, and VIP electronic databases from their inception to August 10, 2021, with no language restrictions. We will also manually search Baidu and Google Scholar to identify randomized controlled studies, non-randomized controlled studies, and cohort studies on the treatment of traumatic meniscal tears. Two researchers will independently screen the literature, extract the data, and evaluate the quality of the studies. Software programs, including Microsoft Access, Excel, Stata (Version 15), WinBUGS (Version 1.4.3), and ADDIS (Version 1.16.8), were used to analyze and manipulate the data.

Results

In this study, the main outcomes were physical function and healing rate, based on the Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm Knee Scoring Scale, Knee Injury and Osteoarthritis Outcome Score, Functional Recovery Scale, and clinical healing rate. The secondary indexes included total cost, cost-effectiveness ratio, incremental cost-effectiveness ratio, Tegner activity scale score, visual analogue scale, numerical rating scale, and meniscal tear complications.

Conclusions:

This systematic review will provide reliable evidence-based findings for the clinical application of different therapies for traumatic meniscal tears in adults.