bluuebunny/crossref_metadata_2025 huggingface dataset:
EphA2, vascular endothelial growth factor, and vascular endothelial growth factor correlate with adverse outcomes and poor survival in patients with glioma
Authors: Shen Likui , Sun Ran , Kan Shifeng , Wang Zhimin , Yu Zhengquan
Published: January 2021

Purpose:

To assess expression levels of Ephrin type-A receptor 2 (EphA2), vascular endothelial growth factor (VEGF), and von Willebrand factor (vWF), and assess their potentials as prognostic biomarkers to predict the risk of poor survival in patients with primary lower grade glioma.

Method:

The study included75 patients with histopathologically confirmed primary glioma (World Health Organization Grade IV). All patients underwent combined surgery and postoperative radiotherapy for the management of primary glioma. Immuno-histochemical analysis was performed to evaluate expression levels ofEphA2 and VEGF. Evaluation of tumor microvessel density was also performed at angiogenesis hot spots due to tumor growth. Main outcomes of the study were the prognostic efficiencies of EphA2, VEGF, and vWF in primary low-grade glioma, as well as whether their expression levels were associated with cancer progression.

Results:

Of the patients with glioma, 67% had very strong expression of EphA2. Overall survival was inversely correlated with the expression of EphA2. Regarding VEGF expression, 38 patients (51%) had strong expression, 29 patients (39%) had weak expression, and 8 patients (11%) had no expression. Strong VEGF expression was associated with poor prognosis and poor survival.

Conclusion:

EphA2, VEGF, and vWF could be considered prognostic markers for assessment of primary glioma.
Biceps tenotomy versus tenodesis for lesions of the long head of the biceps tendon
Authors: Zhou Peng , Liu Juncai , Deng Xiangtian , Li Zhong
Published: January 2021

Background:

Biceps tenotomy and biceps tenodesis are 2 most common surgical procedures for long head of the biceps tendon (LHBT) pathology, but debate still exists regarding the choice of treatment. This meta-analysis was conducted to compare clinical results between tenotomy and tenodesis for the treatment of lesions of LHBT. It was hypothesized that there is no difference in outcomes of tenotomy and tenodesis for lesions of LHBT.

Methods:

A comprehensive search of literature published between 1980 and April 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. Randomized controlled trials (RCTs) comparing tenotomy and tenodesis for LHBT lesions were included. The primary outcomes were Constant score and Popeye deformity. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, muscle strength, cramping pain, and operative time. For primary outcomes, trial sequential analysis (TSA) was conducted to reduce the risk of random errors and the GRADE (grading of recommendations, assessment, development, and evaluations) approach was used to assess the quality of the body of evidence.

Results:

A total of 9 RCTs were included. In pooled analysis, statistical significance was observed in the Constant score (mean difference [MD], 1.59; 95% confidence interval [CI] 0.04–3.14; P = .04), Popeye deformity (risk ratio [RR], 0.33; 95% CI, 0.22–0.49; P < .00001) and operative time (MD, 9.94; 95% CI 8.39–11.50; P < .00001). However, there were no significant differences between the tenodesis and tenotomy in ASES score (P = .71), VAS for pain (P = .79), cumulative elbow flexion strength (P = .85), cumulative elbow supination strength (P = .23), and cramping pain (P = .61) TSA revealed that the results for Constant score was inconclusive.

Conclusion:

For the treatment of LHBT lesions, with the exception of constant score, there was no significant benefit of tenodesis over tenotomy. Although tenotomy is affected by a higher risk of Popeye sign, it is more timesaving.
Spontaneous unscarred uterine rupture in a twin pregnancy complicated by adenomyosis
Authors: Li Xuqing , Li Caihua , Sun Meiguo , Li Hongyan , Cao Yunxia , Wei Zhaolian
Published: January 2021

Introduction:

Uterine rupture during pregnancy is a serious obstetric complication accompanied by a high incidence of maternal morbidity and mortality, and the presence of uterine scars is the main risk factor. In the present case, uterine rupture occurred in an unscarred uterus in a nonlaboring primigravida woman with adenomyosis and twin pregnancy in the third trimester.

Patient concerns:

In this case, the patient suspected to have a history of endometriosis have got twin pregnancies following intracytoplasmic sperm injection, and complained of recurrent lower abdominal pain from 16 weeks to 29 weeks of gestation.

Diagnosis:

After exploratory laparotomy, the patient was diagnosed with uterine rupture and adenomyosis.

Interventions:

The patient was first administered expectant treatment such as antibiotics, tocolytics, and fluid replacement therapy. Symptoms then appeared repeatedly and worsened, followed by eventual peritoneal irritation, and exploratory laparotomy was performed.

Outcomes:

Two live female fetuses were extracted by cesarean section, and the uterine laceration was repaired. The mother recovered without any postoperative complications, and the babies were discharged after receiving one month of prematurity care without any postnatal complications.

Conclusion:

Adenomyosis and the conception of twins may lead to uterine rupture. For pregnant women with a history of adenomyosis with multiple gestations, close monitoring for signs of uterine rupture is necessary. Single-embryo transfer and multifetal pregnancy reduction should be recommended for infertile patients with adenomyosis.
Meta-analysis of FOLFIRINOX-based neoadjuvant therapy for locally advanced pancreatic cancer
Authors: Chen Zhiliang , Lv Yongshuang , Li He , Diao Rui , Zhou Jian , Yu Tianwu
Published: January 2021

Currently, the combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) is the standard therapy for metastatic pancreatic cancer. In recent years, FOLFIRINOX-based neoadjuvant therapy for locally advanced pancreatic cancer (LAPC) has been gaining an increasing amount of attention, owing to its ability to reduce disease stage and transform LAPC to borderline resectable or even resectable pancreatic cancer. Accordingly, we aimed to evaluate the efficacy of first-line FOLFIRINOX chemotherapy in patients with LAPC.

We searched PubMed, Embase, and Cochrane Library from the time of establishment till January 1, 2020 and included studies focusing on LAPC patients who received FOLFIRINOX as first-line neoadjuvant treatment. The primary outcomes were: resection rate and radical (R0) resection rate while the secondary outcomes were: objective response rate, overall survival, progression-free survival, and rate of grade 3 to 4 adverse events. The meta package for R 3.6.2 was used for heterogeneity and publication bias testing.

Twenty-one studies, including 653 patients with LAPC, were selected. After treatment with FOLFIRINOX, the resection rate was 26% (95% confidence interval [CI] = 20%–32%, I2 = 61%) and R0 resection rate was 88% (95% CI = 78%–95%, I2 = 62%). The response rate was 34% (95% CI = 25%–43%, I2 = 56%). The median overall survival and progression-free survival durations ranged from 10.0 to 32.7 months and 3.0 to 25.3 months, respectively. The observed grade 3 to 4 adverse events were neutropenia (20.0 per 100 patients, 95% CI = 14%–27%, I2 = 75%), febrile neutropenia (7.0 per 100 patients, 95% CI = 5%–9%, I2 = 42%), thrombocytopenia (6.0 per 100 patients, 95% CI = 5%–8%, I2 = 27%), nausea/vomiting (7.0 per 100 patients, 95% CI = 7%–12%, I2 = 76%), diarrhea (10.0 per 100 patients, 95% CI = 8%–12%, I2 = 38%), and fatigue (9.0 per 100 patients, 95% CI = 7%–11%, I2 = 43%).

FOLFIRINOX-based neoadjuvant chemotherapy has the potential to improve the rates of resection, R0 resection, and median OS in LAPC. Our results require further validation in large, high-quality randomized controlled trials.
Manual passive rehabilitation program for geriatric distal radius fractures
Authors: Zhang Wei , Wang Lei , Zhang Xiong , Zhang Qing , Liang Baoli , Zhang Bing
Published: January 2021

Limitation of wrist range of motion (ROM) is a common complication of distal radius fractures (DRFs) in geriatric patients. The present study aimed to evaluate the effectiveness of rehabilitation in the restoration of wrist ROM after geriatric DRF. Eighty-eight geriatric patients with DRF, 59 women and 29 men aged 71.69 ± 6.232 years participated in the study. The time from wrist immobilization to rehabilitation was 12.89 ± 5.318 weeks. Daily rehabilitation was performed 30 minutes a day for 8 weeks. Active wrist ROM was measured before and at 2, 4, and 8 weeks after rehabilitation. Data were analyzed by the repeated measures multivariate analysis of variance (MANOVA), one-way MANOVA, and analysis of variance (ANOVA). Repeated measures MANOVA suggested a significant time effect for ROM (Wilks Lambda = 0.002, F = 7500.795, P < .001). Compared with before rehabilitation, each wrist ROM was significantly improved at 2, 4, and 8 weeks after rehabilitation. The one-way MANOVA demonstrated that changes in ROM were significantly different between groups (Wilks Lambda = 0.007, F = 559.525, partial eta square = 0.993, P < .001), indicating that patients in the short-term stiffness group (≤3 months) had a significantly greater increase in ROM than patients in the long-term stiffness group (>3 months). The results of this study suggest an 8-week daily rehabilitation program for geriatric patients with limited ROM <3 months after DRF.
Acupuncture combined with moxibustion for insomnia after stroke
Authors: Sun Junjun , Zuo Zheng , Song Ran , Bao Xiongying , Zhu Miansheng
Published: January 2021

Background:

Stroke is the main cause of death and disability in the world and insomnia is a common complication of stroke patients. Insomnia will not only seriously affect the prognosis and quality of life of patients with stroke, but even cause the recurrence of stroke. Many studies have proved that acupuncture and moxibustion can effectively improve insomnia symptoms. This study will systematically evaluate the effectiveness and safety of acupuncture combined with moxibustion in treating insomnia after stroke.

Methods:

The following 8 databases will be searched from the inception to October 31, 2020, including China National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journal Database (VIP database), China Biomedical Literature Database (CBM), Wanfang Data Chinese Database, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Alternative Medicine Database (AMED), Excerpt Medica Database (Embase). We will also search for ongoing trials from the World Health Organization International Clinical Trial Registration Platform search portal, Chinese Clinical Trial Register, Clinical trials.gov. In addition, the reference lists of studies meeting the inclusion criteria will also be searched for achieving the comprehensive retrieval to the maximum. All randomized controlled trials of acupuncture and moxibustion in treating insomnia after stroke will be included. Two reviewers will conduct literature screening, data extraction, and quality evaluation respectively. The main outcome is the Pittsburgh sleep quality index (PSQI), and the secondary outcomes include clinical efficacy, quality of life, and safety. RevMan V.5.4.1 will be used for meta-analysis. We will express the results as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and mean difference (MD) or standard mean difference (SMD) 95% CIs for continuous data.

Results:

This study will provide a comprehensive review of the available evidence of acupuncture combined with moxibustion in treating insomnia after stroke.

Conclusion:

The conclusion of our study will provide the updated evidence to judge the effectiveness and safety of acupuncture combined with moxibustion for the treatment of insomnia after stroke.

Trial registration number:

PROSPERO CRD42020216720.
Effects of modified ultrafiltration and conventional ultrafiltration combination on perioperative clinical outcomes in pediatric cardiac surgery
Authors: Hu Jiajia , Li Ping , Chen Xuliang , Yan Jianqin , Zhang Junjie , Zhang Chengliang
Published: January 2021

Background:

This meta-analysis was performed to review the effects of the addition of modified ultrafiltration (MUF) and conventional ultrafiltration (CUF) to CUF alone on postoperative hemoglobin, surgical and ultrafiltration data, and postoperative clinical outcomes in pediatric patients undergoing cardiac surgery.

Methods:

A systematic search was performed to identify randomized controlled clinical trials that compared MUF and CUF combination with CUF alone in pediatric cardiac surgery undergoing cardiopulmonary bypass (CPB) in PubMed, Embase, Cochrane Library, and Web of Science without any language or date limitation in February 2020. For each included trial, the primary outcomes including post-CPB and postoperative hematocrit, surgical and ultrafiltration data, postoperative clinical outcomes including volume of chest tube drainage within 48 hours after surgery and perioperative blood requirement, ventilation support duration, and length of stay day in the intensive care unit (ICU) and hospital were collected and analyzed. The analysis was conducted using STATA version 12.0.

Results:

A total of 8 trials encompassing 405 patients were included in this analysis. Analysis indicated that MUF + CUF increased the post-CPB hematocrit (Standard mean difference, SMD = 1.85, 95% confidence interval, 95% CI 0.91–2.79). Meanwhile, ultrafiltration volume was higher in CUF+MUF infants than CUF-alone infants (SMD = 1.46, 95% CI 0.51–2.41, P = .003). The clinical outcomes, including postoperative hemodynamic changes, prime volume, blood requirement, chest tube drainage volume, mechanical ventilation duration, and ICU duration, were unclear because of the unstable sensitivity analyses.

Conclusions:

Beneficial effects of using MUF and CUF for pediatric cardiac surgery, including increase post-CPB hematocrit and ultrafiltration volume when compared with CUF alone. Meanwhile, MUF and CUF did not significantly influence the postoperative hospital stay duration, CPB, and aortic occlusion duration.
Comparative efficacy and safety of traditional Chinese patent medicine for NAFLD in childhood or adolescence
Authors: Sun Yuli , Tan Zhaofeng , Jiang Zhenyuan , Li Min , Wang Weiqin , Huang Yaoyao , Sun Jianguang
Published: January 2021

Background:

Nonalcoholic fatty liver disease is a common reason for chronic liver disease in children and adults. The increasing incidence of the disease has become one of the most critical public health problems in the 21st century, closely related to genetic and environmental factors. So far, apart from changing lifestyle and diet, modern medicine still lacks effective treatment measures. Chinese patent medicine has the advantages of apparent curative effect, overall regulation and fewer side effects. However, there is a lack of research on the simultaneous comparison of various Chinese patent medicines. Therefore, we used a reticular meta-analysis to indirectly compare the efficacy and safety of different oral Chinese patent medicines through standard reference.

Method:

We will conduct a comprehensive and systematic search of Chinese and English databases from the beginning to December 2020. All randomized controlled trials (RCTs) of oral Chinese patent medicine for NAFLD in children will be searched. The 2 researchers then independently filter the retrieved literature, extract the data according to the data extraction table and assess the risk of bias. We will perform a pair of meta-analyses and a Bayesian network meta-analysis. STATA and Win BUGS software will be used for data analysis.

Results:

This study will thoroughly compare and analyze the differences in the efficacy of all kinds of TCPM in NAFLD treatment in childhood or adolescence.

Conclusion:

This study will provide reference and evidence support for clinical drug selection optimization.

Ethics and dissemination:

This study does not require ethical approval.

INPLASY registration number:

2020120068.
Intraductal papillary mucinous neoplasm of the biliary tract with cardiac metastasis
Authors: Lee Joo Hyung , Kim Hyung Sun , Park Ji Hyun , Park Joon Seong
Published: January 2021

Introduction:

Intraductal papillary mucinous neoplasm of the biliary tract (IPNB) is a rare, low-grade neoplasm limited to the bile duct mucosa. The malignant transformation rate is low, and there have been limited reports of metastasis to other organs. Herein, we presented a rare case of a patient who was diagnosed with IPNB concurrent with invasive adenocarcinoma after surgery and was diagnosed with cardiac metastasis 6 months later.

Patient concerns:

A 61-year-old male patient presented with abdominal pain to a local clinic. He was diagnosed with intrahepatic cholangiocarcinoma with pancreatitis and transferred to our hospital.

Diagnosis:

Diagnostic testing (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, positron emission tomography-computed tomography) revealed a papillary neoplasm and invasive adenocarcinoma with papillary neoplasm in the periampullary lesion.

Interventions:

Pancreaticoduodenectomy, right hemihepatectomy, and left lateral sectionectomy of the liver were performed. After surgery, we planned gemcitabine-based adjuvant chemotherapy.

Outcomes:

Upon completion of the sixth gemcitabine chemotherapy cycle, a hyperechoic, oval-shaped mass (1.3 × 2.6 cm) was found on the outer wall of the right atrium. Resection of a cardiac tumor in the right atrium and patch repair were performed.

Conclusion:

To our knowledge, no other case of cardiac metastasis found during observation after surgery for an IPNB has been described. IPNBs are known to be less aggressive and to have a lower metastasis rate than intraductal papillary mucinous neoplasms; therefore, the number of case reports describing metastasis after surgery is relatively low. Our case suggests that close observation is necessary in patients diagnosed with an IPNB.
Atypical late-onset severe gastritis in immune dysregulation, polyendocrinopathy, enteropathy, and X-linked (IPEX) syndrome: 2 case reports
Authors: Fang Youhong , Luo Youyou , Lou Jingan , Chen Jie
Published: January 2021

Rationale:

The immune dysregulation, polyendocrinopathy, enteropathy, and X-linked (IPEX) syndrome is a rare disorder that most often manifests in the early stages of life. IPEX syndrome with a late onset, presenting with severe gastritis has rarely been reported.

Patient concerns:

Two male adolescents presented with recurrent vomiting, severe malnutrition, and growth retardation due to severe gastritis.

Diagnoses:

Esophagogastroduodenoscopy of the 2 patients revealed rare presentations of severe gastritis with multiple ulcers and stenosis of the pylorus. Next-generation sequencing revealed 2 novel variants in gene FOXP3 in the patients who were diagnosed with the IPEX syndrome.

Interventions:

Both patients were treated with a high calorie formular enteral nutritional therapy. In addition, the pylorus of patient 1 was enlarged by balloon dilation, while patient 2 was treated with mercaptopurine and low dose prednisone.

Outcomes:

Symptoms and nutritional status of the patients improved after treatment.

Lessons:

Chronic severe gastritis with stenosis of the pylorus could be an atypical manifestation of the IPEX syndrome. The use of next-generation sequencing is highly suitable for the diagnosis of atypical IPEX syndromes.
Prognostic impact of eosinophils in peripheral blood and tumor site in patients with esophageal squamous cell carcinoma treated with concurrent chemoradiotherapy
Authors: Yang Xiyue , Wang Lei , Du Huan , Lin Binwei , Yi Jie , Wen Xuemei , Geng Lidan , Du Xiaobo
Published: January 2021

To date, no effective biological markers have been identified for predicting the prognosis of esophageal cancer patients. Recent studies have shown that eosinophils are independent prognostic factors in some cancers. This study aimed to identify the prognostic impact of eosinophils in esophageal squamous cell carcinoma patients treated with concurrent chemoradiotherapy (CCRT).

This study enrolled 136 patients who received CCRT for locally advanced unresectable esophageal squamous cell carcinoma (ESCC). We evaluated the survival time and clinical pathological characteristics of eosinophils. The Kaplan–Meier method was used to estimate survival data. The log-rank test was used for univariate analysis and the Cox proportional hazards regression model was used to conduct a multivariate analysis.

Kaplan–Meier analysis revealed that high eosinophil infiltration correlated with better overall survival (OS) (P = .008) and better progression-free survival (PFS) (P = .015). The increase in absolute eosinophil count after CCRT also enhanced OS (P = .005) and PFS (P = .007). The PFS and OS in patients with high blood eosinophil count before CCRT (>2%) was better than those with low blood eosinophil count(<2%) (P = .006 and P = .001, respectively). Additionally, the multivariate analysis revealed that disease stage and high eosinophil infiltration, increased peripheral blood absolute eosinophil count after CCRT, and high peripheral blood eosinophil count before CCRT were independent prognostic indicators.

High eosinophil count of tumor site, increased peripheral blood absolute eosinophil count after CCRT, and high peripheral blood eosinophil count before CCRT are favorable prognostic factors for patients with ESCC treated with CCRT.
Determinants of anxiety and depression among pheochromocytoma patients
Authors: Jia Siming , Li Chengbai , Lei Zhuqing , Xia Qiang , Jiang Yuqing
Published: January 2021

Phaeochromocytomas are catecholamine-producing neuroendocrine tumors that may manifest in many ways, specifically as sustained or paroxysmal hypertension. Data, including data from mental status screening, were prospectively collected from suspected patients. The Hospital Anxiety and Depression Scale was used as a screening tool to identify abnormal mental status. Results showed phaeochromocytoma patients were more likely to experience anxiety and depression. For future phaeochromocytoma treatment, early screening for anxiety and depression should be recommended.
CONSORT the effect of a bolus dose of dexmedetomidine on postoperative pain, agitation, and quality of recovery after laparoscopic cholecystectomy
Authors: Choi Jung Ju , Kim Kyungmi , Park Hee Yeon , Chang Young Jin , Lee Kyung Cheon , Kim Kwan Yeong , Kwak Hyun Jeong
Published: January 2021

Background:

The perioperative administration of dexmedetomidine may improve the quality of recovery (QoR) after major abdominal and spinal surgeries. We evaluated the effect of an intraoperative bolus of dexmedetomidine on postoperative pain, emergence agitation, and the QoR after laparoscopic cholecystectomy.

Methods:

Patients undergoing elective laparoscopic cholecystectomy were randomized to receive dexmedetomidine 0.5 μg/kg 5 minutes after anesthesia induction (dexmedetomidine group, n = 45) or normal saline (control group, n = 45). The primary outcome was the QoR at the first postoperative day using a 40-item scoring system (QoR-40). Secondary outcomes included intraoperative hemodynamic parameters, postoperative agitation, pain, and nausea and vomiting.

Results:

The heart rate and the mean blood pressure were significantly lower in the dexmedetomidine group than in the control group (P < .001 and .007, respectively). During extubation, emergence agitation was significantly lower in the dexmedetomidine group than in the control group (23% vs 64%, P < .001). The median pain scores in the post-anesthetic care unit were significantly lower in the dexmedetomidine group than in the control group (4 [2–7] vs 5 [4–7], P = .034). The incidence of postoperative agitation, pain, and nausea and vomiting was not different between the groups. On the first postoperative day, recovery profile was similar between the groups. However, the scores on the emotional state and physical comfort dimensions were significantly higher in the dexmedetomidine group than in the control group (P = .038 and .040, respectively).

Conclusions:

A bolus dose of dexmedetomidine after anesthesia induction may improve intraoperative hemodynamics, emergence agitation, and immediate postoperative analgesia. However, it does not affect overall QoR-40 score after laparoscopic cholecystectomy.
Endoscopically assisted transoral resection of a Bailey type IV second branchial cleft cyst
Authors: Gao Shan , Xu Qin , Yi Qinchuan
Published: January 2021

Rationale:

The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes.

Patient concerns:

A 21-year-old man with a 1-year history of snoring complained about sore throat for 1 month and a fever that lasted for 3 days.

Diagnoses:

On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3 cm. Blood testing revealed 19.29 × 109 white blood cells (WBCs)/L and 14.94 × 109 neutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2 × 4.0 × 7.7 cm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC.

Interventions:

The patient was administered 1.5 g ceftazidime every 12 hours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery.

Outcomes:

After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1 cm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed.

Lessons:

Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.
Toxic epidermal necrolysis in a patient on atorvastatin therapy expressing human leukocyte antigen alleles
Authors: Lv Meina , Jiang Shaojun , Fu Jinglan , Liu Yuxin , Lian Siheng , Zhang Jinhua
Published: January 2021

Rationale:

Toxic epidermal necrolysis (TEN) is a rare, severe mucosal response of the skin associated with a high mortality rate. TEN is most commonly caused by drugs, and is characterized by extensive skin epidermal exfoliation.

Patient concerns:

A 68-year-old woman presented with a rash that had persisted for four days. The patient who had undergone a mitral valve replacement 1 month prior and was taking atorvastatin at the time of admission.

Diagnoses:

The patient exhibited more than 30% exfoliation surfaces and the severe drug eruption was considered to be TEN. According to human leukocyte antigen (HLA) allele detection and ALDEN score, HLA alleles which found in this case report may be an cause of TEN induced by atorvastatin.

Interventions:

All drugs used prior to admission were discontinued and the patient was given antiallergic drugs.

Outcomes:

After 3 weeks following Antiallergic treatment, the rash on patient's calf had subsided, the edema was relieved, and the patient was no longer experiencing pain. After 60 days following discharge, the patient's skin has regrown.

Lessons:

This is the first report describing the induction of TEN by atorvastatin in a HLA alleles carrier. For HLA alleles carrier, atorvastatin may need to be used with caution to avoid TEN. Future systematic research is also required to confirm this finding and avoid similar serious skin adverse reactions.
Diagnostic accuracy of ultrasound superb microvascular imaging for focal liver lesions
Authors: Sui Ping , Wang Xiaoyan , Sun Lipeng , Wang Hui
Published: January 2021

Background:

Superb microvascular imaging (SMI) is a new ultrasound vascular imaging technology, which uses a new Doppler algorithm, it has the characteristics of high sensitivity and high resolution to detect low velocity blood flow; it is easier to detect microvessels with low-velocity flow compared with color Doppler flow imaging in theory; and it can image the microvessels of the lesion without angiography.
[1]
Previous studies showed that SMI can detect tumor neovascularization to differentiate benign from malignant focal liver lessions (FLLs). However, the results of these studies have been contradictory with low sample sizes. This meta-analysis tested the hypothesis that SMI is accurate in distinguishing benign and malignant FLLs.

Methods:

We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the November 30, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.

Results:

This systematic review will determine the accuracy of SMI in the differential diagnosis between benign and malignant FLLs.

Conclusion:

Its findings will provide helpful evidence for the accuracy of SMI in the differential diagnosis between benign and malignant FLLs.

Systematic review registration:

INPLASY2020120081.
Immunohistochemical Staining With Neuroendocrine Markers is Essential in the Diagnosis of Neuroendocrine Neoplasms of the Esophagogastric Junction
Authors: Jepsen Dea N.M. , Fiehn Anne-Marie K. , Garbyal Rajendra S. , Engel Ulla , Holm Jakob , Federspiel Birgitte
Published: January 2021

Neuroendocrine neoplasms (NENs) of the esophagogastric junction (EGJ) are uncommon and the classification of these tumors has been revised several times. Since 2016, at the Department of Pathology, Rigshospitalet, Denmark, all adenocarcinomas and poorly differentiated carcinomas of the EGJ have been stained routinely with the neuroendocrine markers, synaptophysin and chromogranin A, to detect a possible neuroendocrine component. This study aimed to determine if routine immunohistochemical staining is necessary to detect neuroendocrine differentiation of the EGJ tumors by evaluating how often a neuroendocrine component of the tumors was correctly identified or missed on routine hematoxylin and eosin-stained slides, and by evaluating the interobserver agreement among several pathologists. Of 262 cases a NEN was identified in 24 (9.2%). Up to 22.7% of all EGJ NENs would have been missed without routinely performed neuroendocrine staining in all EGJ tumors. The interobserver agreement between 3 pathologists was slight to moderate. In conclusion, immunohistochemical staining with neuroendocrine markers is essential for the diagnosis of NENs, and to detect all NENs, we recommend to perform this routinely on all resected tumors of the EGJ.
Quantitative Ultrasound Texture Feature Changes With Conservative Treatment of the Trapezius Muscle in Female Patients With Myofascial Pain Syndrome
Authors: Sancar Mert , Keniş-Coşkun Özge , Gündüz Osman Hakan , Kumbhare Dinesh
Published: January 2021

Objective

We set out to assess whether quantitative ultrasound could be used to assess changes that occur after physical therapy in patients experiencing myofascial pain syndrome.

Methods

We consecutively recruited female subjects experiencing myofascial pain syndrome of the neck and shoulder region and provided 10 sessions of conservative physical therapy. A control group was recruited for textural analyses. We measured change in pain ratings, range of motion, and ultrasound texture features before and after the intervention and after 3 mos.

Results

We recruited 63 female myofascial pain syndrome subjects and 20 healthy controls. After treatment, the mean blob size (an ultrasound texture feature) value for each subject decreased from 30.84 ± 5.00 to 25.86 ± 5.67 on the right and decreased from 31.70 ± 5.51 to 28.08 ± 5.53 on the left (P < 0.0005). The blob count showed a significant increase only on the left side (P < 0.01). Corresponding to this were reductions in pain and disability scores after treatment and at 3 mos compared with retreatment (P < 0.0005 for all checkpoints). Cervical range of motion values were significantly increased only at 3 mos compared with pretreatment except for mean flexion range of motion.

Conclusions

Ultrasound texture feature of blob size and count changes correspond to routine clinical outcomes after conservative physical therapy of myofascial pain syndrome in female individuals.
Development and Validation of a Fall Prevention Efficiency Scale
Authors: Dykes Patricia C. , Khasnabish Srijesa , Burns Zoe , Adkison Lesley E. , Alfieri Lois , Bogaisky Michael , Carroll Diane L. , Carter Eileen J. , Hurley Ann C. , Jackson Emily , Kurian Susan , Lindros Mary Ellen , Ryan Virginia , Scanlan Maureen , Sessler Kelly , Shelley Alexandra , Spivack Linda B. , Walsh Mary-Ann , Bates David W. , Adelman Jason S.
Published: January 2021

Objectives

Fall TIPS (Tailoring Interventions for Patient Safety) is an evidence-based fall prevention program that led to a 25% reduction in falls in hospitalized adults. Because it would be helpful to assess nurses’ perceptions of burdens imposed on them by using Fall TIPS or other fall prevention program, we conducted a study to learn benefits and burdens.

Methods

A 3-phase mixed-method study was conducted at 3 hospitals in Massachusetts and 3 in New York: (1) initial qualitative, elicited and categorized nurses’ views of time spent implementing Fall TIPS; (2) second qualitative, used nurses’ quotes to develop items, research team inputs for refinement and organization, and clinical nurses’ evaluation and suggestions to develop the prototype scale; and (3) quantitative, evaluated psychometric properties.

Results

Four “time” themes emerged: (1) efficiency, (2) inefficiency, (3) balances out, and (4) valued. A 20-item prototype Fall Prevention Efficiency Scale was developed, administered to 383 clinical nurses, and reduced to 13 items. Individual items demonstrated robust stability with Pearson correlations of 0.349 to 0.550 and paired t tests of 0.155 to 1.636. Four factors explained 74.3% variance and provided empirical support for the scale’s conceptual basis. The scale achieved excellent internal consistency values (0.82–0.92) when examined with the test, validation, and paired (both test and retest) samples

Conclusions

This new scale assess nurses’ perceptions of how a fall prevention program affects their efficiency, which impacts the likelihood of use. Learning nurses’ beliefs about time wasted when implementing new programs allows hospitals to correct problems that squander time.
Health Care Professionals' Usage and Documentation of a Swedish Quality Registry Regarding Preventive Nutritional Care
Authors: Johansson Linda , Wijk Helle , Christensson Lennart
Published: January 2021

Objectives:

To describe health care staff members' usage and documentation in a Swedish quality registry focusing on a preventive care process regarding the risk area of malnutrition among persons with dementia. The preventive care process includes risk assessment, analysis of underlying causes, planning and performing interventions, as well as evaluating effects.

Methods:

Data were collected from 2 Swedish quality registries, Senior Alert and the Swedish Dementia Register (Svedem). In total, 1929 people with dementia were assessed and 1432 registered as being at risk of malnutrition or malnourished.

Results:

Performed nutritional interventions were registered in approximately 65% of cases. In more than 80% of registrations, the analyses of underlying causes were missing. Those who had registered underlying causes had significantly more interventions and the evaluation of the performed intervention was registered. The time between assessment and evaluation depended on care setting and ranged from 0 to 702 days.

Conclusions:

Limitations in registration were noted; however, the register allows staff to focus on nutritional care and has resulted in many risk assessments. Rarely people were registered in all steps of the preventive care process. Large variances in when the performed interventions were evaluated makes it difficult to measure improvements.
Reliability and Validity of the Spanish Version of the Medical Outcomes Study Pain Severity Scale in Mexican Patients With Rheumatic Diseases
Authors: Horta-Baas Gabriel
Published: January 2021

Objective

To evaluate the reliability and validity of the Spanish version of the Medical Outcomes Study Pain Severity Scale (MOS-PSS) in patients with rheumatic diseases.

Methods

A cross-sectional study was carried out from January 2019 to March 2020 using a nonprobabilistic sampling of consecutive cases. The internal consistency of the scale was evaluated through the Cronbach α coefficient and by the item response theory reliability coefficient. Construct validity was evaluated by factor analysis; relationships between MOS-PSS and visual numeric scale for pain, numeric rating scale for pain, and verbal rating scale for pain; and differences between relevant groups. Item response theory–based methods were used to assess item performance.

Results

A clinical sample of 796 outpatients was recruited. Most patients presented moderate to severe pain. Two subscale solutions showed a good model fit in confirmatory factor analysis. The overall model fit of multidimensional generalized partial credit model showed to be adequate. The most discriminating item was “average pain intensity.” Evidence revealed disordered thresholds in 2 items. Collapsing categories resulted in ordered thresholds for all items and significantly improving the overall model fit. The MOS-PSS and modified MOS-PSS yielded high reliability. Both scales were very strongly correlated with numeric rating scale for pain, visual numeric scale for pain, and verbal rating scale for pain (ρ ≥ 0.85). All hypotheses related to subgroups comparison were fulfilled.

Conclusions

Overall, the Spanish version of the MOS-PSS showed good reliability and construct validity. Nevertheless, the statistical evidence from this study would suggest the modified MOS-PSS should be the version of choice for measuring pain in Mexican patients with rheumatic diseases.
Long-term Survival in Esophageal Cancer After Minimally Invasive Esophagectomy Compared to Open Esophagectomy
Authors: Gottlieb-Vedi Eivind , Kauppila Joonas H. , Mattsson Fredrik , Lindblad Mats , Nilsson Magnus , Lagergren Pernilla , Rouvelas Ioannis , Lagergren Jesper ,   FINEGO group
Published: January 2021

Objective:

To examine 5-year survival in esophageal cancer after MIE compared to OE.

Summary Background Data:

MIE is becoming an increasingly common approach in the surgical treatment of esophageal cancer. A recent meta-analysis suggested 18% lower 5-year all-cause mortality after MIE compared to OE, but the quality of the included studies was limited.

Methods:

Population-based cohort study including almost all patients who underwent elective esophagectomy for esophageal cancer in Sweden or Finland in 2010 to 2016, with follow-up until end of 2019. Cox regression was used to provide hazard ratios (HRs) with 95% confidence intervals (CIs) of all-cause 5-year mortality (main outcome) after MIE (hybrid or total) versus OE. Adjustments were made for age, sex, comorbidity, pathological tumor stage, histological tumor type, neoadjuvant chemo(radio)therapy, country, and annual hospital volume of esophagectomy.

Results:

Among all 1264 patients, 470 (37.2%) underwent MIE and 794 (62.8%) underwent OE. MIE was associated with an 18% decreased risk of all-cause 5-year mortality, compared to OE [adjusted HR 0.82, 95% CI 0.67– 1.00 (P = 0.048)]. The HR of all-cause 5-year mortality was seemingly lower after total MIE compared to OE (adjusted HR 0.77, 95% CI 0.60–0.98) than after hybrid MIE compared to OE (adjusted HR 0.87, 95% CI 0.68–1.11).

Conclusions:

This bi-national study indicates that MIE is associated with a higher 5-year survival than OE in patients with esophageal cancer, and that the survival benefit is greater after total MIE than hybrid MIE.
Robotic Versus Open Liver Resection in Hepatocarcinoma: Surgical and Oncological Outcomes
Authors: Pesi Benedetta , Bencini Lapo , Moraldi Luca , Tofani Federica , Batignani Giacomo , Bechi Paolo , Farsi Marco , Annecchiarico Mario , Coratti Andrea
Published: January 2021

Background:

Minimally invasive approaches are spreading in every field of surgery, including liver surgery. However, studies comparing robotic hepatectomy with the conventional open approach regarding oncologic outcomes for hepatocellular carcinoma are limited.

Materials and Methods:

We retrospectively reviewed demographics characteristics, pathologic features, surgical, and oncological outcomes of patients who underwent robotic and conventional open liver resection for hepatocellular carcinoma.

Results:

No significant differences in demographics features, tumor size, tumor location, and type of liver resection were found. The morbidity rate was similar, 23% for the open group versus 17% of the robotic group (P=0.605). Perioperative data analysis showed a greater estimated blood loss in patients who underwent open resection, if compared with robotic group (P=0.003). R0 resection and disease-free resection margins showed no statistically significant differences. The 3-year disease-free survival of the robotic group was comparable with that of the open group (54% vs. 37%; P=0.592), as was the 3-year overall survival (87% vs. 78%; P=0.203).

Conclusions:

The surgical and the oncological outcomes seem to be comparable between minimally invasive and open hepatectomy. Robotic liver resections are effective, and do not compromise the oncological outcome, representing a reasonable alternative to the open approach.
Pilates for Conditioning of Equestrian Master Athletes
Authors: Romani-Ruby Christine
Published: January 2021

Introduction:

Master athletes performing in equestrian riding and jumping have specific needs that many typical conditioning programs do not address.

Case Presentation:

An equestrian master athlete with several comorbidities embraced Pilates as a method to maintain her fitness level and improved her performance at competition.

Management and Outcome:

The client was experiencing difficulty holding her position on the horse due to fatigue, lack of flexibility, and weakness. Through a year of Pilates conditioning, she improved her strength and flexibility and learned methods to delay the onset of fatigue and improve her posture for riding.

Discussion:

One of the most vital aspects of training for the equestrian master athlete is the ability to visualize and produce postures. The Pilates environment provides the simulated environment, the visual cues, and the appropriate physical overload.
Aging and the Cost of Inactivity
Authors: Puleo Joy
Published: January 2021

The world's population is living longer, due in large part to the post-World War II baby boom and medical advances. As our population ages, natural age–related physical decline coupled with chronic and/or degenerative diseases creates an increased demand on our health care system and drives up health care-related costs. Physical activity can mitigate health care costs by staving off morbidity and keeping our aging population physically independent longer. However, with only 20% of Americans meeting government activity recommendations and 6% to 10% of the deaths worldwide from noncommunicable diseases associated with lack of physical activity, it is clear that we can no longer afford to be inactive. Physical activity programs designed for an aging population need to meet the physical challenges of natural aging and provide a safe, effective, and appropriate environment designed to encourage program adherence. Mindfulness and mindful movement, specifically Pilates, may well prove to be an effective nonpharmacological answer to aging and activity. Pilates is not only safe, effective, and appropriate, but its inwardly directed design enhances efficacy and physical self-confidence.
Copresence of Osteophyte and Effusion as a Risk Factor for Knee Pain in the Community-Dwelling Elderly
Authors: Ogaya Shinya , Iwata Akira , Nonaka Koji , Higuchi Yumi , Fuchioka Satoshi
Published: January 2021

The aim of this study was to investigate the risk factors for knee pain in the elderly. Seventy-six community-dwelling elderly women underwent an ultrasound examination of their knees. We compared the results of knee pain among the groups allocated according to the presence of osteophyte and effusion. Our results showed that the group with a copresence of osteophyte and effusion had a significantly higher presence of knee pain than the other groups. A combination of osteophyte and effusion provides a better indication for the risk of knee pain.
Nursing Home Residents
Authors: Raposo Paula , Nogueira Dália , Reis Elizabeth , Serrasqueiro Rogério
Published: January 2021

Background:

Frailty is a state of increased vulnerability with multisystem loss of physiologic reserves and decreased response to stressors, predicting adverse health outcomes. The phenotype of frailty is characterized by unintentional weight loss, self-reported exhaustion, weakness (low grip strength), slow walking speed, and low physical activity. This study aimed at assessing the prevalence and characteristics of frailty in a sample of institutionalized older people to identify a target intervention group.

Methods:

This is a descriptive cross-sectional and correlational study. Participants were 226 men and women living in nursing home facilities. Frailty was assessed using the phenotype of frailty. Sociodemographic, health status, physical and cognitive function, and depression data were collected. Relations between variables were analyzed using parametric (t test, Pearson coefficient) and nonparametric (chi-square and Spearman coefficient) tests. A multiple linear regression model was applied to assess the relationship between the frailty criteria and a set of predictor variables.

Results:

Assessment of frailty was possible in 35.3% of the subjects and 41.5% were found frail, 52.1% prefrail, and 6.4% nonfrail. Three frailty criteria had higher prevalence: weakness (76.6%), low physical activity (61.7%), and low walking speed (52.1%). The number of frailty criteria per subject was significantly correlated with cognitive status and depressive symptoms, and there was weak, though significant, correlation with the Barthel Index. Participants in frailty tests had a better functional and cognitive state than those unable to participate. No significant difference in depressive symptoms was found between these 2 groups. The multiple regression model explained only 21.6% of the variation of frailty.

Conclusions:

Subjects revealed low social status, advanced age comorbidity, and multifactorial incapacity. In a nursing home setting, frail and prefrail elderly stand out as a subset in the sample with higher functional status, as opposed to the usual findings in community-dwelling older adults. These facts should help recognize them as a target intervention group, as frail elderly are vulnerable and their needs might be underestimated in a setting where highly dependent people represent a huge burden for caretakers. Targeted interventions may improve their condition, prevent adverse health events, and preserve quality of life.