bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Approach to Radiographic Evaluation of Arthritis of the Hand and Wrist
Authors: Kluckman Matthew L. , Bernard Stephanie , Bui-Mansfield Liem T.
Published: April 2021

More than 92 million adults in the United States have arthritis.1 Initial imaging evaluation of arthritis begins with radiography. Having a systematic approach to the interpretation of the radiographs for arthritis is essential to recognize subtle features and to correctly identify similar appearing diseases. The “ABCs” approach to the radiographic evaluation of arthritis has been a standard for decades. The goal of this article is to review the “ABCs” approach, to discuss how the radiographic features reflect the underlying pathology of common arthropathies, and to provide differential diagnostic considerations for conditions in one of three categories: aggressive erosive, osteoarthritis-like, or mass-like depositional patterns of arthritis.
The Midlife Transition and the Risk of Cardiovascular Disease and Cancer Part II: Strategies to Maximize Quality of Life and Limit Dysfunction and Disease
Authors: Kase Nathan G. , Friedman Elissa Gretz , Brodman Michael
Published: April 2021

(Abstracted from Am J Obstet Gynecol 2020;223:834–847.e2)

The leading causes of death in the United States are heart disease and cancer. Among women, the clinical appearance of heart disease and cancer (breast, endometrium, and ovary) escalates during the decades of the midlife transition during and after menopause.
Medication-Assisted Treatment vs. Detoxification for Women Who Misuse Opioids in Pregnancy: Associations With Dropout, Relapse, Neonatal Opioid Withdrawal Syndrome (NOWS), and Childhood Sexual Abuse
Authors: Macfie Jenny , Towers Craig V. , Fortner Kimberly B. , Stuart Gregory L. , Zvara Bharathi J. , Kurdziel-Adams Gretchen , Kors Stephanie B. , Noose Samantha K. , Gorrondona Andrea M. , Cohen Chloe T.
Published: April 2021

(Abstracted from Addict Behav Rep 2020;12:100315)

The American College of Obstetrics and Gynecology recommends medically assisted treatment (MAT) for the management of women who misuse opioids during pregnancy. Medically assisted treatment allows pregnant women to use opioids at doses that lessen the euphoric effect, minimize withdrawal symptoms, and curb cravings.
Maternal Perceived Discrimination and Association With Gestational Diabetes
Authors: MacGregor Caitlin , Freedman Alexa , Keenan-Devlin Lauren , Grobman William , Wadhwa Pathik , Simhan Hyagriv N. , Buss Claudia , Borders Ann
Published: April 2021

(Abstracted from Am J Obstet Gynecol MFM 2020;2:100222)

Up to 7% of pregnancies are complicated by gestational diabetes mellitus (GDM), disproportionately affecting women of color and lower socioeconomic status. These disparities in GDM have been associated with risk factors such as obesity and chronic stress.
Clinical Outcomes of a Genomic Screening Program for Actionable Genetic Conditions
Authors: Buchanan Adam H. , Kirchner H. Lester , Schwartz Marci L. B. , Kelly Melissa A. , Schmidlen Tara , Jones Laney K. , Hallquist Miranda L. G. , Rocha Heather , Betts Megan , Schwiter Rachel , Butry Loren , Lazzeri Amanda L. , Frisbie Lauren R. , Rahm Alanna Kulchak , Hao Jing , Willard Huntington F. , Martin Christa L. , Ledbetter David H. , Williams Marc S. , Sturm Amy C.
Published: April 2021

(Abstracted from Genet Med 2020;22:1874–1882)

Hereditary breast and ovarian cancer (HBOC), Lynch syndrome, and familial hypercholesterolemia (FH) are recognized by the Centers of Disease Control and Prevention as tier-1 genetic conditions for which early identification and management could decrease morbidity and mortality. Yet few patients with a personal or familial history of these conditions are screened for genetic risk.
Functional Outcomes for Meniscal Allograft Interposition Arthroplasty of the Hand
Authors: McCullough Meghan C. , Minasian Raquel , Tanabe Kylie , Rodriguez Sandra , Kulber David
Published: April 2021

Background:

Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate arthrodesis or arthroplasty. Meniscal allograft has been used for large joint resurfacing, but its application to smaller joints is less well understood. We propose its use for hand joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore articular function.

Methods:

Thirty-one patients with osteoarthritis of the CMC, MCP, or PIP joints underwent arthroplasty with meniscal allograft. Patient demographics and operative information were recorded. Preoperative Disability of the Shoulder, Arm, and Hand, Wong Baker pain, grip and pinch strength, and range of motion were compared to postoperative scores at 6 weeks, 6 months, and 1 year.

Results:

Twenty-three women and 8 men, mean age 62.8 years, underwent 39 joint reconstructions, including CMC (n = 26), thumb MP (n = 2), thumb IP (n = 2), digit MP (n = 2), and digit PIP (n = 7). At 1 year, mean Disability of the Shoulder, Arm, and Hand scores decreased from 41.3 to 15.6 (P < 0.001) and pain scores from 6.9 to 1.0 (P < 0.001). Grip strength increased from 38.1 to 42.9 (P = 0.017) and radial and palmar abduction from 43.1 to 49.2 (P = 0.039) and 43.7 to 51.6 (P = 0.098), respectively. There were no complications related to the meniscus.

Conclusions:

Meniscal allograft represents an alternative to arthrodesis which obviates the need for a donor site and avoids many of the complications inherent to synthetic alternatives. Our early results demonstrate its successful use to reduce subjective pain and disability scores, improve objective strength measures, and maintain range of motion.
Bilateral Pseudomonas aeruginosa Keratitis in 7 Patients
Authors: Perzia Brittany , Enzor Rikki , Kowalski Regis P. , Jhanji Vishal
Published: April 2021

Purpose:

To report 7 patients (14 eyes) with bilateral Pseudomonas aeruginosa keratitis (PAK).

Methods:

Case records of patients with bilateral PAK were reviewed at a single academic medical center from April 2009 to December 2020.

Results:

Seven patients aged 29 to 94 years presented with bilateral P. aeruginosa corneal ulcers. All patients were soft contact lens wearers except one elderly patient with a complex ocular history. Three patients wore specialty contact lens, including one cosmetic contact lens wearer, one multifocal contact lens wearer, and one extended-wear contact lens wearer. The remaining three patients were not overnight contact lens wearer but regularly showered in contact lens or used tap water for contact lens case cleaning. All patients presented with asymmetric disease, with visual acuity ranging from 20/20 to light perception. Ulcers were located centrally in 5 eyes (35.7%), diffusely over the entire cornea in 5 eyes (35.7%), temporally in 2 eyes (14.2%), and nasally in 1 eye (7.14%), and in 1 eye (8.3%), the ulcer location was not recorded. Corneal thinning was noted in 7 eyes (50%). Hypopyon was also noted in 7 eyes (50%). Two patients required procedures because of progressive stromal necrosis. All other patients were treated nonsurgically, with antibiotic drops, which resulted in ulcer resolution. Final visual acuity on last recorded follow-up ranged from 20/20 to no light perception.

Conclusions:

This is the largest case series of bilateral PAK, which occurred primarily in contact lens wearer. This case series reiterates the risk of contact lens infection related to poor hygiene.
A meta-analysis of optimal medical therapy with or without percutaneous coronary intervention in patients with stable coronary artery disease
Authors: Shah Rahman , Nayyar Mannu , Le Francis K , Labroo Ajay , Nasr Abrar , Rashid Abdul , Davis Donnie A , Weintraub William S. , Boden William E.
Published: April 2021

Background

Whether percutaneous coronary intervention (PCI) improves clinical outcomes in patients with chronic angina and stable coronary artery disease (CAD) has been a continuing area of investigation for more than two decades. The recently reported results of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, the largest prospective trial of optimal medical therapy (OMT) with or without myocardial revascularization, provides a unique opportunity to determine whether there is an incremental benefit of revascularization in stable CAD patients.

Methods

Scientific databases and websites were searched to find randomized clinical trials (RCTs). Pooled risk ratios were calculated using the random-effects model.

Results

Data from 10 RCTs comprising 12 125 patients showed that PCI, when added to OMT, were not associated with lower all-cause mortality (risk ratios, 0.96; 95% CI, 0.87–1.08), cardiovascular mortality (risk ratios, 0.91; 95% CI, 0.79–1.05) or myocardial infarction (MI) (risk ratios, 0.90; 95% CI, 0.78–1.04) as compared with OMT alone. However, OMT+PCI was associated with improved anginal symptoms and a lower risk for revascularization (risk ratios, 0.52; 95% CI, 0.37–0.75).

Conclusions

In patient with chronic stable CAD (without left main disease or reduced ejection fraction), PCI in addition to OMT did not improve mortality or MI compared to OMT alone. However, this strategy is associated with a lower rate of revascularization and improved anginal symptoms.
Development of delayed neurologic sequelae in acute carbon monoxide poisoning cases caused by briquette-based kotatsu
Authors: Onodera Makoto , Tsukada Yasuhiko , Suzuki Tsuyoshi , Sorimachi Kotaro , Ebihara Kenichi , Sato Lubna , Zenda Rie , Ueno Satoshi , Sugaya Kazuki , Iseki Ken
Published: April 2021

Briquette-based kotatsu, a traditional Japanese heating system, is still used in rural areas and has been linked to the development of acute carbon monoxide (CO) poisoning. This study aimed to investigate the occurrence of delayed neurologic sequelae (DNS) in patients with acute CO poisoning caused by briquette-based kotatsu.

This retrospective study included 17 patients treated for acute CO poisoning due to briquette-based kotatsu, between April 2017 and March 2020. Patients were divided into either a sequelae group (3 patients) or a non-sequelae group (14 patients) based on the presence or absence, respectively, of DNS. Demographic data, kotatsu characteristics, clinical findings, and therapies were compared between the 2 groups.

Significant differences were noted in patient posture during their initial discovery. Specifically, all non-sequelae patients only had their legs under the kotatsu quilt and all sequelae patients had their entire bodies under the kotatsu quilt (P = .001). There were no statistically significant differences in carbon monoxide levels in hemoglobin (CO-Hb) or the creatine-kinase myocardial band (CK-MB), between the 2 groups; however, troponin-I levels were significantly higher in the sequelae group (P = .026). Abnormal head imaging findings were noted in 2 sequelae-group patients, with a significant difference between the groups (P = .025).

We speculate that acute CO poisoning, caused by briquette-based kotatsu, may lead to DNS more frequently in patients in who cover their entire body with the kotatsu quilt and are found in this position. Patients should be warned about the dangers of acute CO poisoning when using briquette-based kotatsu.
Primary varicella-zoster virus infection of the immunocompromised associated with acute pancreatitis and hemophagocytic lymphohistiocytosis
Authors: Bérar Antoine , Ardois Samuel , Walter-Moraux Patricia , Jegonday Marc-Antoine , Henriot Basile
Published: April 2021

Rationale:

Primary varicella-zoster virus (VZV) infection may be associated with hemophagocytic lymphohistiocytosis (HLH), as well as with acute pancreatitis. However, there is few data concerning the evolution and the optimal treatment of these rare associations.

Patient concerns:

A 57-year-old immunocompromised woman, who was treated for chronic lymphocytic leukemia 3 years prior to admission, was hospitalized with abdominal pain revealing severe acute pancreatitis. The day after admission, a pruritic rash appeared on her face, trunk, and limbs, sparing the palmoplantar regions. At the same time, fever, thrombocytopenia (27 × 109/L), major hyperferritinemia (11,063 μg/mL), hypertriglyceridemia (2.56 mmol/L) and elevated lactate dehydrogenase levels (1441 IU/L) suggested HLH.

Diagnosis:

The diagnosis of chickenpox (varicella) was established. Primary VZV infection was then confirmed: cutaneous and plasma VZV polymerase chain reactions were positives, VZV serology was negative for IgG.

Interventions:

Treatment with aciclovir was started intravenously after the onset of the rash, for a total of 10 days. A 48-h surveillance in intensive care was carried out.

Outcomes:

Acute pancreatitis and biological abnormalities evolved favorably under aciclovir. Platelet count was normalized 6 days after admission to hospital.

Lessons:

A favorable outcome of primary VZV infection associated with severe acute pancreatitis and probable HLH in an immunocompromised patient is possible with aciclovir alone.
The efficacy and safety of cupping therapy for treating of intractable peripheral facial paralysis
Authors: Cao Zhiwen , Jiao Lin , Wang Hongyu , Li Jun , Zhong Genping , Zhu Daocheng , Xu Wei , Jin MengKe
Published: April 2021

Background:

Peripheral facial paralysis (PFP) is a common clinical neurological disease and the incidence of intractable peripheral facial paralysis is on the rise. Symptoms include crooked mouth and eyes, tearing and shallow nasolabial folds. The disease seriously affects the physical and mental health of patients. At present, a large number of clinical studies have shown that cupping is effective in treating intractable peripheral facial paralysis (IPFP). Therefore, the purpose of this review is to evaluate the effectiveness and safety of cupping in the treatment of refractory peripheral facial paralysis.

Methods:

We will conduct a comprehensive and systematic search of relevant documents in the following databases: Medline, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure (CNKI), Wang Fang Database, Chinese Scientific Journal Database from inception to February 2021 without any language restriction. The 2 reviewers will be independently completed select research, extract data, evaluate research quality and use the Cochrane risk of bias tool to assess methodological quality. Using revman5.4 software for statistical analysis. The degree of heterogeneity will be Determined through heterogeneity test, to definite whether to adopt a random effects model or a fixed-effects model.

Results:

The protocol for the meta-analysis will systematically evaluate the efficacy and safety of cupping therapy for intractable peripheral facial paralysis patients.

Conclusion:

This study will explore whether or not cupping therapy can be used as one of the non-drug therapies to prevent or treat intractable peripheral facial paralysis
A meta-analysis of the secondary fractures for osteoporotic vertebral compression fractures after percutaneous vertebroplasty
Authors: Zhai Gongwei , Li Ang , Liu Binfeng , Lv Dongbo , Zhang Jingyi , Sheng Weichao , Yang Guang , Gao YanZheng
Published: April 2021

To identify the risk factors of the secondary fractures for osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).

We conducted a search of relevant articles using Cochrane Library, PubMed, Medline, Science Direct, Embase, the Web of Science and other databases. The time range we retrieved from establishment of the electronic database to November 2017. Gray studies were found in the references of included literature reports. STATA version 11.0 (Stata Corporation, College Station, Texas) was used to analyze the pooled data.

Fourteen studies involving 1910 patients, 395 of whom had fracture secondary to the surgery were included in this meta-analysis. The result of meta-analyses showed the risk factors of the secondary fractures for OVCFs after PVP was related to bone mineral density (BMD) [95%CI (−0.650, −0.164), SMD=−0.407, P=.001], cement leakage ((RR=0.596, 95%CI (0.444,0.798), P = .001)), and kyphosis after primary operation ((SMD=0.741, 95%CI (0.449,1.032), P = .000)), but not to gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.

Bone mineral density, cement leakage, and kyphosis after primary operation are the risk factors closely correlative to the secondary fracture after PVP. There have not been enough evidences to support the association between the secondary fracture and gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.
Correlation between real-time heart rate and fatigue in chest compression providers during cardiopulmonary resuscitation
Authors: Bae Go Eun , Choi Arom , Beom Jin Ho , Kim Min Joung , Chung Hyun Soo , Min In Kyung , Chung Sung Phil , Kim Ji Hoon
Published: April 2021

Background:

The American Heart Association guidelines recommend switching chest compression providers at least every 2 min depending on their fatigue during cardiopulmonary resuscitation (CPR). Although the provider's heart rate is widely used as an objective indicator for detecting fatigue, the accuracy of this measure is debatable.

Objectives:

This study was designed to determine whether real-time heart rate is a measure of fatigue in compression providers.

Study design:

A simulation-based prospective interventional study including 110 participants.

Methods:

Participants performed chest compressions in pairs for four cycles using advanced cardiovascular life support simulation. Each participant's heart rate was measured using wearable healthcare devices, and qualitative variables regarding individual compressions were obtained from computerized devices. The primary outcome was correct depth of chest compressions. The main exposure was the change in heart rate, defined as the difference between the participant's heart rate during individual compressions and that before the simulation was initiated.

Results:

With a constant compression duration for one cycle, the overall accuracy of compression depth significantly decreased with increasing heart rate. Female participants displayed significantly decreased accuracy of compression depth with increasing heart rate (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95–0.98; P < .001). Conversely, male participants displayed significantly improved accuracy with increasing heart rate (OR: 1.03; 95% CI: 1.02–1.04; P < .001).

Conclusion:

Increasing heart rate could reflect fatigue in providers performing chest compressions with a constant duration for one cycle. Thus, provider rotation should be considered according to objectively measured fatigue during CPR.
Efficacy and safety of Biqi capsule in the treatment of knee osteoarthritis
Authors: Zhou YaZhou , Wang WenGang , Tian Ke , Huang Hui , Jia Mengrui
Published: April 2021

Background:

Knee osteoarthritis (KOA) is a chronic and degenerative bone and joint disease, with KOA, cartilage degeneration, destruction and subchondral bone remodeling as the main pathological features. Its clinical symptoms are knee pain, swelling, limited activity, and long course of disease can cause joint deformities. At present, the early treatment of Western medicine is mainly the use of nonsteroidal drugs for anti-inflammation and removing pain, but because the efficacy of these drugs is unstable, the disease is easy to repeat after treatment, and the clinical effect is not good. Although Biqi capsule has advantages in the treatment of KOA, there is a lack of standard clinical studies to verify it, so the purpose of this randomized controlled study is to evaluate the efficacy and safety of Biqi capsule in the treatment of KOA.

Methods:

This is a prospective randomized controlled trial to study the efficacy and safety of Biqi capsule in the treatment of KOA. The patients were randomly divided into a treatment group and a control group according to 1:1. Among them, treatment group: Biqi capsule combined with diclofenac sodium sustained release tablets; Control group: Diclofenac sodium sustained-release tablets alone. Both groups were treated with standard treatment for 2 weeks and were followed up for 30 days to pay attention to the efficacy and safety indexes. Observation indicators included: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital for Special Surgery Knee Score (HSS), liver and kidney function, adverse reactions, and so on. SPSS 25.0 software is used for data analysis.

Discussion:

This study will evaluate the efficacy and safety of Biqi capsule in the treatment of KOA, and the results of this experiment will provide a clinical basis for Biqi capsule in the treatment of KOA.

Trial registration:

OSF Registration number: DOI 10.17605/OSF.IO/6HB9D
Characteristics and forecasting of respiratory viral epidemics among children in west China
Authors: Duan Yifei , He Jinlan , Cui Yali , Li Wensheng , Jiang Yongmei
Published: April 2021

We aimed to assess the respiratory virus characteristics and forecasts among young children with acute respiratory tract infection (ARTI) in west China.

This retrospective study investigated the epidemic characteristics of respiratory viruses among 11,813 paediatric ARTI patient samples (mean age, 2.25 years) between March 2018 and March 2020.

The ratio of boys to girls was 1.36. The 2 predominant viruses were influenza (Flu) A and respiratory syncytial virus (RSV) in both years, with Flu A accounting for 47.3% and 47.5% in the first and second years and RSV accounting for 32.7% and 24.7% of the positive samples in the first and second years, respectively. The Flu B positive rates were 10.9% and 13.1%, and those of the other 4 viruses were <7%. The most common virus was RSV in children below 5 years and Flu A in those between 5 and 10 years. Flu A and RSV demonstrated pronounced seasonality, and their infection rates increased from October. During the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, isolation measures led to a decline in the number of ARTI cases.

This study provides surveillance data of the respiratory viruses in west China. It could guide medical staff in implementing necessary prevention and management strategies before future viral outbreaks.
Traditional Chinese medicine injection for the treatment of viral pneumonia in children
Authors: Fang Li , Pei Jiaoru , Mao Song , Wu Liangxia , Jiang Siqiong
Published: April 2021

Background:

In recent years, more and more reports are focused on the application of traditional Chinese medicine injection (TCMJ) for the treatment of viral pneumonia. There are about 200 million cases of viral pneumonia worldwide every year, half of which are children. At present, many kinds of TCMJ are created for the treatment of viral pneumonia in children, with good therapeutic effects. However, there are many kinds of TCMJ, and the treatment advantages are different, thus bringing difficulties to the selection of clinical drugs. In order to provide evidence-based evidence support for the clinical selection of TCMJ for the treatment of viral pneumonia in children, this study selected the commonly used TCMJ for clinical treatment of viral pneumonia for meta-analysis to evaluate its efficacy.

Methods:

The Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data, Viper information databases, Cochran library Web of Science, PubMed, MEDLINE and EMBASE will be searched. The literature will be searched, with language restriction in English and Chinese. The related reference will be retrieved as well. Two reviewers will independently extract data and perform quality assessment of included studies. Review Manager 5.3 will be applied to conduct this meta-analysis.

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal once we finish this study.

Conclusions:

This study provides reliable evidence-based evidence for the efficacy of TCMJ in the treatment of viral pneumonia in children.

Ethics and dissemination:

We will not be allowed to publish private information from individuals. This kind of systematic review should not harm the rights of participants. No ethical approval was required. The results can be published in peer-reviewed journals or at relevant conferences.

OSF Registration number:

DOI 10.17605/OSF.IO/795MB.
Effects of long noncoding RNA on prognosis of oral squamous cell carcinoma
Authors: Lin Qingjie , Zhang Yong , Liu Yanguo , Xu Xin
Published: April 2021

Background:

Long noncoding RNA (lncRNA) is reported to be upregulated in many tumors. Although the expression of lncRNA in oral squamous cell carcinoma has been assessed, the association between lncRNA expression and prognosis or clinicopathological feature still remains controversial. Therefore, we conducted a meta-analysis to verify whether lncRNA expression was related to prognosis or clinicopathological features in patients with oral squamous cell carcinoma.

Methods:

We searched Embase, PubMed, Web of Science, Cochrane library, Chinese National Knowledge Infrastructure, and Wanfang databases from inception to February 2021. The language included Chinese and English. The published literature on lncRNA expression and prognosis or clinicopathological characteristics of patients with oral squamous cell carcinoma was statistically analyzed. The combination of hazard ratios (HRs), odds ratios (OR), and 95% confidence intervals (95% CIs) were applied to evaluate the effects of lncRNA on the prognosis and clinicopathological features of oral squamous cell carcinoma.

Results:

This study could provide a comprehensive review of the available evidence of lncRNA on the prognosis and clinicopathological features of oral squamous cell carcinoma.

Conclusion:

The conclusion of our study will provide the updated evidence to judge the lncRNA on the prognosis and clinicopathological features of oral squamous cell carcinoma.
Association between vitamin D receptor polymorphisms and acute pancreatitis
Authors: Li Xiaofeng , Gan Xianghai , Gong Junzuo , Mou Tianyi , Zhou Hua , Li Mengqin
Published: April 2021

Background:

Several studies have been performed to investigate the association between vitamin D receptor (VDR) gene polymorphism and acute pancreatitis, but the results are inconclusive. We conducted this meta-analysis for a precise estimation of the association between BsmI (rs1544410), ApaI (rs7975232), TaqI (rs731236), and FokI (rs2228570) polymorphisms and acute pancreatitis.

Methods:

Appropriate studies were retrieved by searching Web of Science, PubMed, Scopus, and Google scholar databases, until January 31, 2021. Two reviewers independently conducted data extraction and literature quality evaluation. Odds ratios and 95% confidence intervals were calculated to evaluate the strength of the association.

All of the data were analyzed with Stata 16.0.

Results:

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

Conclusions:

This meta-analysis will summarize the association between BsmI, ApaI, TaqI, and FokI polymorphisms and the risk of acute pancreatitis.

Ethics and dissemination:

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

OSF REGISTRATION NUMBER:

DOI 10.17605/OSF.IO/83W7R.
Generalized morphoea in the setting of combined immune checkpoint inhibitor therapy for metastatic melanoma
Authors: Langan Ewan A. , Budner Kaja , Zillikens Detlef , Terheyden Patrick
Published: April 2021

Rationale:

Immune checkpoint inhibition has dramatically altered the therapeutic landscape in the treatment of a range of locally advanced and metastatic skin cancers. In particular, the treatment of metastatic melanoma with combined anti-programmed cell death protein 1 (anti-PD1) and anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA4) antagonists has resulted in median 5-year survival rates of over 50%. However, combined immune checkpoint inhibitor therapy frequently results in the development of immune-related adverse events (irAE) which can be severe and life-threatening. While the typical irAEs, namely colitis, thyroiditis, and hepatitis are well recognized, cutaneous irAEs are varied and can be difficult to accurately diagnose.

Patient concerns:

A 61-year-old female with metastatic melanoma presented with widespread indurated, waxy skin changes, and weight loss following combined anti-PD1 and anti-CTLA4 immunotherapy.

Diagnoses:

Generalized morphea in the setting of combined immunotherapy.

Interventions:

Dexamethasone pulse therapy (100 mg i.v. over 3 days) was combined with topical therapy (clobetasone propionate ointment) and physiotherapy. Four cycles of dexamethasone pulse therapy, at 4 weekly intervals, led to an improvement in the skin changes, accompanied by increased mobility. However, the changes did not resolve completely.

Outcome:

Staging examinations revealed progressive melanoma brain metastases and despite 2 further cycles of combined anti-PD1 and anti-CTLA4 immunotherapy followed by 1.5 cycles of Fotemustine, the patient died 22 months after the development of the scleroderma-like skin changes.

Lessons:

Cutaneous irAEs are varied in nature and severity. Sclerotic skin changes are rare, but unlike cutaneous irAEs related to immune checkpoint inhibitor therapy, they are often refractory to standard treatment with systemic corticosteroids. Clinicians should be aware of immunotherapy-related scleroderma to prompt dermatological evaluation to facilitate early recognition and initiate treatment. Administration of systemic immunosuppression should be carefully balanced against the risk of promoting melanoma progression.
Acquired hemophilia A associated with Epstein–Barr-virus-associated T/natural killer-cell lymphoproliferative disease
Authors: Yamamoto Masayo , Shindo Motohiro , Sumi Chihiro , Igarashi Sho , Saito Takeshi , Tsukada Nodoka , Toki Yasumichi , Hatayama Mayumi , Inamura Junki , Sato Kazuya , Mizukami Yusuke , Torimoto Yoshihiro , Okumura Toshikatsu
Published: April 2021

Introduction:

Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies against factor VIII (FVIII). Hematological malignancies, especially lymphoid malignancies, are known to be underlying causes of AHA; however, thus far, there is no report of AHA associated with Epstein–Barr-virus-associated T/natural killer-cell lymphoproliferative disease (EBV-T/NK-LPD). Here, we present a case of AHA that developed during treatment for EBV-T/NK-LPD.

History:

A 69-year-old man visited our hospital because of general fatigue. Blood examination showed pancytopenia, and computed tomography revealed whole-body lymphadenopathy, but there were no findings indicating hematological malignancy from bone marrow aspiration and cervical lymph node biopsy. The level of EBV DNA in peripheral blood was extremely high, and he was diagnosed with EBV-T/NK-LPD. EBV-T/NK-LPD improved with prednisolone (PSL) administration. Seventeen months after starting treatment, the patient complained of back and right leg pain. At that time, he had been treated with low-dose PSL, and EBV-T/NK-LPD was well controlled. Imaging revealed hematoma of the right iliopsoas muscle. Prolonged activated partial thromboplastin time (APTT) was the only abnormal finding in a screening coagulation test. FVIII coagulant activity was below detection limit, and FVIII inhibitor level was increased. From these results, he was diagnosed with AHA.

A higher dose of PSL was administered, and, after 1 month of treatment, FVIII activity gradually increased, and FVIII inhibitor level became undetectable. APTT also normalized, and complete remission was achieved and maintained for 13 months with low-dose PSL. During treatment, EBV-T/NK-LPD was well controlled.

Conclusion:

It is speculated that proliferating lymphocytes interfere with normal immune functions and that abnormal autoantibodies are produced from those lymphocytes in patients with LPD. Therefore, we speculate that EBV-infected and proliferating monoclonal NK cells might have modulated the immune system and produced autoantibodies against FVIII, thus causing AHA in this patient with EBV-T/NK-LPD.
Acute fatty liver of pregnancy causes severe acute pancreatitis and stillborn fetus
Authors: Ye Rongzong , Mai Zhenhua , Pan Xiaoyan , Cai Shuting , Deng Liehua
Published: April 2021

Rationale:

Acute

fatty liver of pregnancy (AFLP) is a potentially fatal obstetric emergency characterized by acute hepatic failure secondary to fatty infiltration. The resultant effects include coagulopathy, electrolyte abnormalities, and multisystem organ dysfunction. Pancreatitis typically develops after the onset of renal and hepatic dysfunction. Pancreatitis has been suggested as a poor prognostic indicator because it is associated with more adverse outcomes.

Patient concerns:

A 29-year-old Chinese woman at 34.7 weeks pregnancy was admitted to hospital due to paroxysmal hypogastric pain and massive colporrhagia for 1 day.

Diagnosis:

Laboratory tests revealed hepatic and renal impairment, coagulopathy. Thoracoabdominal computed tomography (CT) scanning showed pleural and peritoneal effusion, fatty liver, and pancreatitis. She was diagnosed with AFLP, severe acute pancreatitis (SAP), multiple organ dysfunction syndrome (MODS), and intrauterine fetal death.

Interventions:

The patient was treated with blood component transfusions, plasma exchange combined with renal replacement therapy, antibiotic de-escalation, gastric and pancreatic secretion inhibitor, and enteral nutrition.

Outcomes:

After successful management, the patient was discharged without any complications on day 35 of admission. At 10 months follow-up, thoracoabdominal enhanced CT revealed was normal and laboratory tests revealed normal liver and kidney function.

Lessons:

Once AFLP is highly suspected or confirmed, the pregnancy should be terminated in time and active symptomatic management should be given.
The effect of traditional Chinese medicine treatment for post-viral olfactory dysfunction
Authors: Ma Fangfang , Zhang Hewei , Li Bingxue , Cheng Peiyu , Ma Yunfei , Yu Mingwei , Wang Xiaomin
Published: April 2021

Background:

Post-viral olfactory dysfunction (PVOD) have been reported in infections caused by several respiratory viruses, especially in COVID-19 which influence severely the quality of life of affected subjects. Few study has been published on the treatment of PVOD. Traditional Chinese medicine (TCM) is an effective method for PVOD which effects and safety have been confirmed. Therefore, this study is aim to evaluate the effects of TCM on PVOD.

Methods:

A searching strategy will be carried out mainly in the following databases in English and Chinese, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical and Medical Database (CBM), and Wanfang Database. Only randomized controlled trials related to TCM for PVOD will be included to enhance effectiveness. The primary outcome is the effective rate of PVOD. The secondary outcomes are included olfactory domain value examination, visual analogue scale (VAS), questionnaires of olfactory disorders (QOD), T&T olfactometer test, Sniffin ticks test, and any other clinical assessments. Two authors will independently perform study selection, data extraction, and quality assessment to ensure the quality of the systematic evaluation. Every disagreement will be deal with by the third author. Data synthesis and subgroup analysis will be performed in the Review Manager V 5.3.3.

Results:

This study is aim to evaluate the efficacy and safety of TCM in PVOD.

Conclusion

: This meta-analysis may provide more reliable evidence-based medical evidence for clinical practice to assist patient in relieving PVOD.

Ethics and dissemination:

There is no need to acquire ethical approval for individuals come from literatures instead of recruiting directly. The findings of this review will be reported in peer-reviewed publications and/or presented at relevant conferences.

Prospero registration number:

CRD42021238977.
Self-monitored versus supervised walking programs for older adults
Authors: Hsu Ching-Yi , Wu Hsin-Hsien , Liao Hung-En , Liao Tai-Hsiang , Su Shin-Chang , Lin Pay-Shin
Published: April 2021

Walking is an effective, well accepted, inexpensive, and functional intervention. This study compared the outcomes and changes in walking behavior of self-monitored (SM) and supervised (SU) walking interventions for older adults.

Participants were assigned to SM (n = 21) and SU (n = 21) walking groups according to their place of residence. Both groups exercised and wore a pedometer for 3 months.

The outcome measures were step count, body mass index (BMI), and physical function. Two-way repeated-measure ANOVA and independent t tests were used to compare the intervention effects. We also plotted the trends and analyzed the walking steps weekly.

Only BMI exhibited a group × time interaction. The pre-posttest differences showed knee extension muscle strength (KEMS) and Timed Up and Go test were significantly improved in the SM group, whereas BMI, KEMS, 30-s sit-to-stand, functional reach were significantly improved, but 5-m gait speed significantly slower in the SU group. For participants attending ≥50% of the sessions, those in the SM and SU groups had similar results for all variables, except for 2-min step (2MS) and daily walking step counts.

Both self-monitored and supervised walking benefit older adults in most physical functions, especially lower-extremity performance, such as muscle strength, balance, and mobility. The effects of both programs do not differ significantly, except for BMI and 2MS (ie cardiopulmonary endurance). We recommend pedometer-assisted self-monitored walking for older adults because of its ability to cultivate exercise habits over the long term, whereas supervised walking to establish effective exercise intensity.
The value of automated breast volume scanner combined with virtual touch tissue quantification in the differential diagnosis of benign and malignant breast lesions
Authors: Wang Junli , Fan Hongjie , Zhu Yuting , Shen Chunyun , Qiang Banghong
Published: April 2021

This study aimed to evaluate the diagnostic value of automated breast volume scanner (ABVS) combined with virtual touch tissue quantification (VTQ) in the differential diagnosis of breast lesions.

In this retrospective study, 183 patients (mean age, 49.8 ± 8.2 years) with 218 breast lesions underwent ABVS, VTQ, and mammography (MG). All lesions were confirmed by postoperative histopathology. A logistic regression model was constructed to generate a receiver operating characteristic (ROC) curve, calculate the area under the ROC curve (AUC), and compare and evaluate the diagnostic performance of ABVS, VTQ, MG, and ABVS combined with VTQ (ABVS-VTQ).

The sensitivity, specificity, and accuracy of ABVS, VTQ, MG, and ABVS-VTQ in diagnosing breast lesions were 94.01% (110/117), 96.03% (97/101), and 94.95% (207/218); 80.34% (94/117), 94.05% (95/101), and 86.69% (189/218); 70.08% (82/117), 68.31% (69/101), and 69.26% (151/218); and 96.58% (113/117), 96.03% (97/101), and 96.33% (210/218), respectively. The AUC of ABVS-VTQ was higher than that of the other examinations alone. The detection rate of ABVS (100%, 218/218) was higher than that of MG (78.89%, 172/218), and the difference was statistically significant (χ
2 = 51.426, P < .001).

The combined application of ABVS and VTQ can improve the accuracy and specificity of the diagnosis and is a promising ultrasound method for the differential diagnosis of breast lesions.
SORL1 mutations are associated with parkinsonian and psychiatric features in Alzheimer disease
Authors: Qiu Guozhen , Xu Chunyan , Guo Qiwen , Zhu Fei-Qi
Published: April 2021

Rationale:

The sortilin-related receptor 1 gene (SORL1) encodes a key protein (SORLA) involved in the pathophysiology of Alzheimer disease (AD). SORLA also mediates a trophic pathway that acts through glial cell line-derived neurotrophic factor (GDNF), a critical survival factor for the midbrain dopaminergic (DA) neurons.

Patient concerns:

Four patients presented to our hospital with complaints of progressive memory decline, who developed extrapyramidal signs (EPS) and psychiatric symptoms.

Diagnoses:

All 4 patients were diagnosed with AD based on their symptoms, findings from cranial magnetic resonance imaging, and cerebrospinal fluid analysis.

Interventions:

We also performed whole-exome sequencing (WES) and found 4 novel mutations in SORL1. Donepezil, rivastigmine, memantine, madopar, quetiapine, and risperidone were administrated as therapy.

Outcomes:

The four mutations would change the thermal stability of SORLA domain. This could be associated with parkinsonian and psychiatric features in AD. These patients showed improvements in parkinsonian and psychiatric features.

Lessons:

These cases suggest that SORL1 mutations might result in aggregation of a-synuclein through altered function of GDNF and further lead to appearance of core dementia with Lewy bodies features.
Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome
Authors: Kim Sung-Kyu , Chang Dong-Gune , Park Jong-Beom , Seo Hyoung-Yeon , Kim Yun Hwan
Published: April 2021

Rationale:

A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child.

Patient concerns:

A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome.

Diagnosis:

Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3–4.

Interventions:

The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia.

Outcomes:

At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity.

Lessons:

To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.
Obstructive ureteric calculus with superimposed infections causing reversible posterior leukoencephalopathy syndrome
Authors: Xie Fei , Cai Yanli , Huang Lin , Hao Jianqiang , Ling Tianjin , Richard Seidu A.
Published: April 2021

Rationale:

Reversible posterior leukoencephalopathy syndrome (RPLS) is a clinicoradiological phenomenon first observed 2 decades ago. Reversibility is the hallmark of this rare clinical phenomenon once the triggering pathology is aptly and adequately treated. Tinnitus preceding bilateral hearing loss as a symptomatology of RPLS has not been reported in the literature. Furthermore, chronic obstructive ureteric calculus with superimposed infections as a cause of RPLS has not been reported in the literature.

Patient concerns:

A 57-year-old female was admitted at our facility because of 2 days history of hearing loss in both ears. She experienced tinnitus in both ears 2 weeks prior to the hearing loss. She is a known hypertensive. She has also undergone multiple surgical treatments for urinary calculi.

Diagnosis:

Computed tomography (CT) scan of the urinary system revealed a calculus at the right ureter. Magnetic resonance imaging (MRI) showed abnormal signals at both temporo-parieto-occipital (TPO) cortices, the subcortical area, as well as the left hippocampus which was consistent with the diagnosis of RPLS.

Interventions:

While on antibiotics for treatment of infections, the patient went into hypertensive encephalopathy and pneumonia was also established necessitating intensive care.

Outcomes:

We observed a resolution of the patient's temperature and hypertension when the right ureteric stone finally descended into the bladder. Also, we observed disappearance of the abnormal signals at both TPO cortices, the subcortical area, as well as the left hippocampus. Two years follow-up revealed no recurrence of her symptomatology.

Lesions:

Patients who present with hypertensive encephalopathy maybe more prone to developing RPLS. Renal insufficiency alone or hypertension alone may not be single predisposing entities to RPLS but rather multiple predisposing factors.
Analysis of individualized antiplatelet therapy for patients of acute coronary syndrome after percutaneous coronary intervention under the guidance of platelet function
Authors: Dang Wenxi , Wang Jiajia , Zhang Qing , Liu Nairong , Li Wenting , Yao Zhuhua
Published: April 2021

There is controversy in clinical application of antiplatelet drugs by monitoring platelet function. Therefore, we explored whether early and dynamic medication could bring better clinical outcomes for patients under the guidance of platelet function tests (PFT).

In this retrospective cohort study, we analyzed the prognostic events of 1550 patients with acute coronary syndrome (ACS) at Tianjin People's Hospital in China. They received dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) from January 2017 to December 2018. The primary endpoint was based on the Bleeding Academic Research Consortium (BARC) 3 or 5 major bleeding. Secondary endpoints included MACCE (all-cause death, nonfatal myocardial infarction, stroke, stent thrombosis, and unplanned target vessel reconstruction) and BARC 1 to 2 minor bleeding. The endpoint events within 1 year after PCI were recorded. Patients were divided into a guided group and a control group according to the drug adjustment by PFT results. After the propensity scores matched, the end points of 2 groups were compared, and subgroup analysis was performed on major bleeding events.

After propensity score matching, there were 511 cases in the guided group and the control group, respectively. The primary endpoint events occurred in 10 patients (1.96%) in the guided group and 23 patients (4.5%) in the control group (HR: 0.45; 95% CI, 0.21–0.95; P = .037). After the guided group adjusted drug doses, the risk of major bleeding was lower than standard DAPT of the control group. Although some patients in the guided group reduced doses earlier, the incidence of MACCE events did not increase in the guided group compared with the control group (4.89% vs 6.07%; P = .41). There was no statistical difference in BARC 1 to 2 minor bleeding (P = .22). Subgroup analysis showed that PFT was more effective in patients with diabetes and multivessel disease.

Early observation of dynamic PFT in ACS patients after PCI can guide individualized antiplatelet therapy to reduce the risk of major bleeding without increasing the risk of ischemia.