bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental and numerical analysis of compression behaviour of 3D printed metal foams
Authors: Ramesh R , Prasanth A S , Krishna R , KoushikSundaram K , Arul MozhiSelvan R , Roy Abhishek
Published: December 2020

This article focuses on comparing the experimental and numerical compressive behaviour of metal foams. The metal foams were initially modelled in three configurations of pore sizes. Each configuration was 3D printed using a laser sintering metal additive manufacturing technique. Subsequently, quasi-static compression tests were conducted and their stress-strain curves were examined to ascertain the proof stress of the three configurations. A numerical simulation of the compressive behaviours of the three foams was then conducted and their results were correlated with those from experimentation to quantify the error in simulation. The compression tests revealed that, the compressive strength was a function of density and porosity of the metal foams. Further, the numerical results of compression behaviours were validated, with less than 5 % deviation from the experimental results for all three foam configurations.
Selfsimilarity of diffusions’ first passage times
Authors: Eliazar Iddo
Published: December 2020

Considering a general diffusion process that runs over the non-negative half-line, this paper addresses the first-passage time (FPT) to the origin: the time it takes the process to get from an arbitrary fixed positive level to the level zero. Inspired by the special features of Brownian motion, three types of FPT selfsimilarity are introduced: (i) stochastic, which holds in ‘real space’; (ii) Laplace, which holds in ‘Laplace space’; and (iii) joint, which is the combination of the stochastic and Laplace types. Analysis establishes that the three types of FPT selfsimilarity yield, respectively and universally, the following FPT distributions: inverse-gamma; inverse-Gauss; and Levy–Smirnov. Moreover, the analysis explicitly pinpoints the classes of diffusion processes that produce the three types of selfsimilar FPTs. Shifting from general diffusion dynamics to Langevin dynamics, it is shown that the three classes collapse, respectively, to the following specific processes: diffusion in a logarithmic potential; Brownian motion with drift; and Brownian motion. Also, the effect of the Girsanov transformation on the three types of selfsimilar FPTs is investigated, as well as the effect of initiating the diffusion process from its steady-state level (rather than from a fixed positive level). This paper presents a novel approach to the exploration of first-passage times.
Integrability and scattering of the boson field theory on a lattice
Authors: Campos Manuel , López Esperanza , Sierra Germán
Published: December 2020

A free boson on a lattice is the simplest field theory one can think of. Its partition function can be easily computed in momentum space. However, this straightforward solution hides its integrability properties. Here, we use the methods of exactly solvable models, that are currently applied to spin systems, to a massless and massive free boson on a 2D lattice. The Boltzmann weights of the model are shown to satisfy the Yang–Baxter equation with a uniformization given by trigonometric functions in the massless case, and Jacobi elliptic functions in the massive case. We diagonalize the row-to-row transfer matrix, derive the conserved quantities, and implement the quantum inverse scattering method. Finally, we construct two factorized scattering S matrix models for continuous degrees of freedom using trigonometric and elliptic functions. These results place the free boson model in 2D in the same position as the rest of the models that are exactly solvable à la Yang–Baxter, offering possible applications in quantum computation.
NO
x
storage and reduction assisted by non-thermal plasma over Co/Pt/Ba/γ-Al2O3 catalyst using CH4 as reductant
Authors: ZHU Tao , ZHANG Xing , YI Nengjing , LIU Haibing , LI Zhenguo
Published: December 2020

NO
x
storage and reduction (NSR) technology has been regarded as one of the most promising strategies for the removal of nitric oxides (NO
x
) from lean-burn engines, and the potential of the plasma catalysis method for NO
x
reduction has been confirmed in the past few decades. This work reports the NSR of nitric oxide (NO) by combining non-thermal plasma (NTP) and Co/Pt/Ba/γ-Al2O3 (Co/PBA) catalyst using methane as a reductant. The experimental results reveal that the NO
x
conversion of NSR assisted by NTP is notably enhanced compared to the catalytic efficiency obtained from NSR in the range of 150 °C–350 °C, and NO
x
conversion of the 8% Co/PBA catalyst reaches 96.8% at 350 °C. Oxygen (O2) has a significant effect on the removal of NO
x
, and the NO
x
conversion increases firstly and then decreases when the O2 concentration ranges from 2% to 10%. Water vapor reduces the NO
x
storage capacity of Co/PBA catalysts on account of the competition for adsorption sites on the surface of Co/PBA catalysts. There is a negative correlation between sulfur dioxide (SO2) and NO
x
conversion in the NTP system, and the 8% Co/PBA catalyst exhibits higher NO
x
conversion compared to other catalysts, which shows that Co has a certain SO2 resistance.
MXenes and the progress of Li–S battery development—a perspective
Authors: Balach Juan , Giebeler Lars
Published: December 2020

Lithium–sulfur (Li–S) battery has attracted tremendous interest owing to its high energy density at affordable costs. However, the irreversible active material loss and subsequent capacity fading caused by the uncontrollable shuttling of polysulfides have greatly hampered its commercial viability. MXenes, a novel class of 2D materials derived from nano-layered MAX phases, have been shown the potential to push the development of sulfur-based batteries to a next level owing to their high conductivity, strong polysulfide affinity and electrocatalytic properties. This perspective article focuses on the possible implications that MXene-based materials will have in the development of advanced sulfur-based batteries and their potential application in different upcoming technologies. In four sections possible developments are outlined which can be reached in the next 10 years, that enable a highly reliable, minimized Li–S battery finally combined with energy harvesters to fabricate autonomous power supplies for the next generation of microscaled devices like meteorological or geotechnical probes, wearable (medical) sensors or other suitable mobile devices. Finally, a flowchart illustrates the possible way to realize some important milestones for the certain possible steps with significant contributions of MXenes.
Pyometra and estrous cycle modulate the uterine expression of the kisspeptin system and angiogenic and immune factors in cats
Authors: Santos Luciano Cardoso , dos Anjos Cordeiro Jeane Martinha , da Silva Santana Larissa , Santana Larissa Rodrigues , Santos Bianca Reis , Barbosa Erikles Macêdo , da Silva Thayná Queiroz Menezes , Corrêa Janaina Maria Xavier , Lavor Mário Sergio Lima , da Silva Elisângela Barboza , de Melo Ocarino Natália , Serakides Rogéria , Silva Juneo Freitas
Published: December 2020

Failures in hypothalamic kisspeptin/Kiss1r signaling are associated with infertility, and in vitro studies have shown that kisspeptin can modulate angiogenesis and immune activity. Because there is no in vivo research on the functional relationship between these factors in the reproductive system, especially in domestic cats, we evaluated the expression profile of kisspeptin/Kiss1r and angiogenic and immunological mediators in the genital tract of cyclic cats and of those with pyometra. The uterus of cats in diestrus exhibited greater gene and protein expression of Kiss1, as well as Vegf, Pigf, Mif, and Il6. In contrast, Kiss1r presented greater expression in proestrus/estrus, similarly to that observed for the immunostaining of INFγ, MIF, TNFα, and IL10. These factors were positively correlated with Kiss1 and/or Kiss1r, and a positive correlation between Kiss1 and Kiss1r was also observed in the uterus of cats during the estrous cycle. Cats with pyometra showed greater immunostaining of Kiss1 and Kiss1r on the endometrial surface and reduced immunostaining of Kiss1 in deep glands, whereas there was a significant reduction in Vegf, Pigf, Mif, and Il6 mRNA, and an increase in Tnf mRNA. The findings reveal that there is a gene correlation between kisspeptin/Kiss1r and angiogenic and immune mediators in the uterus of the domestic cat, which is modulated by the estrous cycle, and that pyometra affects the expression of these mediators. This study suggests, for the first time, a functional relationship between the Kiss/Kiss1r system and angiogenic and immune mediators in the female genital tract.
Late adult presentation of ALCAPA syndrome: need for a new clinical classification? A case report and literature overview
Authors: Lotman Eno-Martin , Karu Külliki , Mikkel Mehis , Elmet Märt
Published: December 2020

Background

Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a very uncommon congenital coronary artery anomaly, most commonly presenting in early infancy. Late adult presentation of ALCAPA syndrome is extremely rare.

Case summary

We present a case of a 76-year-old patient with first presentation of ALCAPA. The coronary anomaly was first diagnosed during elective coronary angiography. The case was discussed at the Heart Team meeting and as the patient was asymptomatic, had good coronary collateral circulation, a medical treatment strategy was chosen and the patient was discharged in a good physical condition. During 3 years of follow-up, the patient has experienced no cardiovascular complications.

Discussion

We hereby also discuss briefly the clinical presentation, epidemiology, diagnostics and treatment options for adults with newly diagnosed ALCAPA and discuss the need for a new clinical classification. Only a few cases have been published of septuagenarians or octogenarians with first presentation of ALCAPA. To our knowledge, the patient presented in our case was one of the least symptomatic patients during her eight decades of life.
Postpartum multi-vessel spontaneous coronary artery dissection in the setting of cocaine and amphetamine use: a case report
Authors: McGovern Laurna , Coughlan J J , Murphy Ross , Edroos Sadat
Published: December 2020

Background 

Spontaneous coronary artery dissection (SCAD) is a recognized cause of acute coronary syndrome (ACS). Pregnancy, the postpartum period, and illicit drug use have all been reported as potential triggers.

Case summary 

We describe the case of a 41-year-old patient who presented to the emergency department with chest pain in the setting of recent cocaine and amphetamine use. The patient was 4 months postpartum following an uncomplicated pregnancy. Past medical history was non-contributory, with no known risk factors for ischaemic heart disease. Electrocardiogram was normal but high-sensitivity troponin T was significantly elevated. Coronary angiography revealed multi-vessel SCAD. This was managed conservatively as the patient remained clinically stable and pain free without high-risk anatomy (left main stem or proximal two-vessel coronary artery dissection).

Discussion 

Spontaneous coronary artery dissection must be considered in a postpartum patient presenting with ACS, particularly in the context of environmental stressors such as illicit drug use. Coronary angiography is key to determine diagnosis and guide management. Conservative therapy is favoured, except for patients with ongoing ischaemia, haemodynamic instability, and left main stem involvement. In this case, we suspect SCAD occurred due to the haemodynamic effects of cocaine and amphetamines in the context of structural arterial changes of the postpartum state.
Stroke and bleeding risk stratification in atrial fibrillation: a critical appraisal
Authors: Lane Deirdre A , Lip Gregory Y H
Published: December 2020

Atrial fibrillation (AF) significantly increases the risk of stroke and, therefore, stroke prevention is an essential component of the management for patients with AF. This requires formal assessment of the individual risk of stroke to determine if the patient is eligible for oral anticoagulation (OAC), and if so, their risk of bleeding on OAC, before a treatment decision regarding stroke prevention is made. Risk of stroke is not homogenous; it depends on the presence or absence of risk factors. A plethora of stroke and bleeding risk factors has been identified, including common and less-well established clinical risk factors, plus imaging, urine, and blood biomarkers. Consequently, there are several stroke and bleeding risk stratification scores available and this article provides an overview of them, the risk factors included and how they are scored, and provides a critical appraisal of them. The review also discusses the debate regarding whether female sex is a risk factor or a risk modifier, and highlights the dynamic nature of both stroke and bleeding risk and the need to re-assess these risks periodically to ensure treatment is optimal to reduce the risk of adverse outcomes. This review also summarizes the recommended stroke and bleeding risk stratification scores from all current major international guidelines.
What do we do about atrial high rate episodes?
Authors: Boriani Giuseppe , Vitolo Marco , Imberti Jacopo Francesco , Potpara Tatjana S , Lip Gregory Y H
Published: December 2020

Atrial high rate episodes (AHREs) are defined as asymptomatic atrial tachyarrhythmias detected by cardiac implantable electronic devices with atrial sensing, providing automated continuous monitoring and tracings storage, occurring in subjects with no previous clinical atrial fibrillation (AF) and with no AF detected at conventional electrocardiogram recordings. AHREs are associated with an increased thrombo-embolic risk, which is not negligible, although lower than that of clinical AF. The thrombo-embolic risk increases with increasing burden of AHREs, and moreover, AHREs burden shows a dynamic pattern, with tendency to progression along with time, with potential transition to clinical AF. The clinical management of AHREs, in particular with regard to prophylactic treatment with oral anticoagulants (OACs), remains uncertain and heterogeneous. At present, in patients with confirmed AHREs, as a result of device tracing analysis, an integrated, individual and clinically-guided assessment should be applied, taking into account the patients’ risk of stroke (to be reassessed regularly) and the AHREs burden. The use of OACs, preferentially non-vitamin K antagonists OACs, may be justified in selected patients, such as those with longer AHREs durations (in the range of several hours or ≥24 h), with no doubts on AF diagnosis after device tracing analysis and with an estimated high/very high individual risk of stroke, accounting for the anticipated net clinical benefit, and informed patient’s preferences. Two randomized clinical trials on this topic are currently ongoing and are likely to better define the role of anticoagulant therapy in patients with AHREs.
Incidence and real-world burden of brain metastases from solid tumors and hematologic malignancies in Ontario: a population-based study
Authors: Habbous Steven , Forster Katharina , Darling Gail , Jerzak Katarzyna , Holloway Claire M B , Sahgal Arjun , Das Sunit
Published: December 2020

Background

Although intracranial metastatic disease (IMD) is a frequent complication of cancer, most cancer registries do not capture these cases. Consequently, a data-gap exists, which thwarts system-level quality improvement efforts. The purpose of this investigation was to determine the real-world burden of IMD.

Methods

Patients diagnosed with a non-CNS cancer between 2010 and 2018 were identified from the Ontario Cancer Registry. IMD was identified by scanning hospital administrative databases for cranial irradiation or coding for a secondary brain malignancy (ICD-10 code C793).

Results

25,478 of 601,678 (4.2%) patients with a diagnosis of primary cancer were found to have IMD. The median time from primary cancer diagnosis to IMD was 5.2 (0.7, 15.4) months and varied across disease sites, for example, 2.1 months for lung, 7.3 months for kidney, and 22.8 months for breast. Median survival following diagnosis with IMD was 3.7 months. Lung cancer accounted for 60% of all brain metastases, followed by breast cancer (11%) and melanoma (6%). More advanced stage at diagnosis and younger age were associated with a higher likelihood of developing IMD (P < .0001). IMD was also associated with triple-negative breast cancers and ductal histology (P < .001), and with small-cell histology in patients with lung cancer (P < .0001). The annual incidence of IMD was 3,520, translating to 24.2 per 100,000 persons.

Conclusion

IMD represents a significant burden in patients with systemic cancers and is a significant cause of cancer mortality. Our findings support measures to actively capture incidents of brain metastasis in cancer registries.
Molecular characterisation of the first New Delhi metallo-β-lactamase 1-producing Acinetobacter baumannii from Tanzania
Authors: Moyo Sabrina J , Manyahi Joel , Hubbard Alasdair T M , Byrne Rachel L , Masoud Nahya Salim , Aboud Said , Manji Karim , Blomberg Bjørn , Langeland Nina , Roberts Adam P
Published: December 2020

Background

We aimed to characterise the genetic determinants and context of two meropenem-resistant clinical isolates of Acinetobacter baumannii isolated from children hospitalised with bloodstream infections in Dar es Salaam, Tanzania.

Methods

Antimicrobial susceptibility was determined by disc diffusion E-test and broth microdilution. Genomes were completed using a hybrid assembly of Illumina and Oxford Nanopore Technologies sequencing reads and characterisation of the genetic context of resistance genes, multi-locus sequence types (STs) and phylogenetic analysis was determined bioinformatically.

Results

Twelve A. baumannii were isolated from 2226 blood cultures, two of which were meropenem-resistant. The two meropenem-resistant isolates, belonging to distinct STs, ST374 and ST239, were found to harbour blaNDM-1, which was chromosomally located in isolate DT0544 and plasmid-located in isolate DT01139. The genetic environment of blaNDM-1 shows the association of insertion sequence ISAba125 with blaNDM-1 in both isolates. Both isolates also harboured genes conferring resistance to other β-lactams, aminoglycosides and cotrimoxazole.

Conclusions

This is the first report of New Delhi metallo-β-lactamase-producing isolates of A. baumannii from Tanzania. The genetic context of blaNDM-1 provides further evidence of the importance of ISAba125 in the spread of blaNDM-1 in A. baumannii. Local surveillance should be strengthened to keep clinicians updated on the incidence of these and other multidrug-resistant and difficult-to-treat bacteria.
General concepts on hemophilia A and on women carrying the disease
Authors: Mingot Castellano María E.
Published: December 2020

Hemophilia A affects one in every 5000 live male births. As the disorder follows a hereditary X-linked recessive pattern, women who inherit the mutation become carriers of the disease. The exact prevalence of carriers of hemophilia A or B is unknown. A search of the literature identified only one study that provides an approximation. According to its authors, for every 100 male with hemophilia there are 277 potential carriers. We will review through this supplement carrier condition from reproductive to care giver and individual point of view.
The association between coagulopathies such as thrombophilia or rare bleeding disorders with the development of gestational vascular complications
Authors: Santamaría Amparo
Published: December 2020

The association between coagulopathies, more specifically thrombophilia, and the development of gestational vascular complications was established in the 1990s. Ever since, huge efforts have been invested into gaining a better understanding of the role played by clotting factors, both prothrombotic and hemorrhagic, in those complications, not least because hypertensive disorders and venous thromboembolism are among the most common causes of maternal mortality in the Western world.
Efficacy and safety of montelukast sodium combined with fluticasone in the treatment of adult bronchial asthma
Authors: Luo Huiling , Han Hongmei , Liu Xiaoli , Liu Qin
Published: December 2020

Background:

Bronchial asthma (BA) is a chronic airway inflammatory disease with reversible airflow limitation as the main clinical manifestations, such as wheezing, cough, shortness of breath, chest tightness, etc, mediated by a variety of inflammatory cells, which can be recurrent. Clinical can improve symptoms, but cannot be cured; glucocorticoid is the most important first-line medication. Clinical practice has shown that montelukast sodium combined with fluticasone in the treatment of adult BA can improve clinical efficacy and reduce adverse reactions. The purpose of this study is to systematically study the efficacy and safety of montelukast sodium combined with fluticasone in the treatment of adult BA.

Methods:

The Chinese databases (CNKI, VIP, Wanfang, Chinese Biomedical Database) and English databases (PubMed, the Cochrane Library, Embase, Web of Science) were searched by computer, for the randomized controlled clinical studies of montelukast sodium combined with fluticasone in the treatment of adult BA from establishment of database to October 2020. Two researchers independently extracted the relevant data and evaluated the quality of the literatures, and used RevMan5.3 software to conduct meta-analyze of the included literatures.

Results:

This study assessed the efficacy and safety of montelukast sodium combined with fluticasone in the treatment of adult BA through total effective rate, pulmonary function (FEV1, FVC, PEF, FEV1/FVC), and adverse reactions.

Conclusion:

This study will provide reliable evidence-based evidence for the clinical application of montelukast sodium combined with fluticasone in the treatment of adult BA.

OSF Registration number:

DOI 10.17605/OSF.IO/CKQFM
A mobile delivered self-exercise program for female farmers
Authors: Baek Sora , Kim Gowun , Park Hee-won
Published: December 2020

Introduction:

Female farmers commonly experience musculoskeletal pain in the back, knee, and shoulder. Despite their obvious advantages in reducing musculoskeletal pain, face-to-face exercise programs are limited by geographical and physical barriers. Thus, we decided to introduce eHealth technology to farmers’ musculoskeletal health care. Using a mobile application (app), we aim to provide a tailored self-exercise program for shoulder, knee, and back pain in female farmers in rural areas after a musculoskeletal health check-up.

Methods:

This study is planned as 2 randomized control studies (MObile Delivered self-Exercise [MODE] phase I and phase II). We plan to recruit 200 female farmers aged 41 to 70 years. Initially, the shoulders, knees, and low back will be evaluated to provide individualized exercise programs. In MODE-I (single-blinded: evaluator), the subjects will be randomly allocated to experimental (n = 100) and control (n = 100) groups using a computer-generated sequence. Both groups will perform a 3-month self-exercise using a smartphone app or physical education data (booklets), respectively. Outcomes including exercise completion will be assessed at 3 months. In MODE-II, after subject random allocation, the experimental and control groups will perform exercise using a smartphone app with and without real-time feedback, respectively. Every 3 months, the level of the exercise program will be evaluated and the difficulty level will be adapted accordingly. After MODE-II is completed, all subjects will undergo close-out assessment.

Discussion:

This will be the first attempt to compare methods using booklets and apps to identify effective ways of providing personalized self-exercise programs according to musculoskeletal health stages by evaluating female farmers (MODE-I). This will help clarify whether the mobile app is effective for self-exercise compared to a conventional booklet. The MODE-II study will help to assess the effect of providing feedback through the mobile app. Finally, we will evaluate musculoskeletal health according to the degree of participation over 12 months to confirm the effect of self-exercise. Our study should aid in managing musculoskeletal health for farmers living in rural areas and help promote health in the “untact” era.

Trial registration:

Clinical Research Information Service of the Korean National Institutes of Health (KCT0005245). Registered July 17, 2020.
Long-term outcomes of single stenting compared with double stenting strategy for unprotected left main coronary artery disease
Authors: Wang Jia-jie , Li Xin , Yan Dong-dong , Zhang Zheng
Published: December 2020

Background:

The optimal interventions for unprotected left main coronary artery (ULMCA) disease have long been debated, and long-term clinical studies comparing single stenting to double stenting strategies for ULMCA are currently lacking.

Methods:

We plan to perform a systematic review and meta-analysis of clinical trials comparing single stenting with double stents strategy for ULMCA disease. We will search PubMed, EMBASE, Web of science and Cochrane Library using a comprehensive strategy. The related conference proceedings and reference lists of the included studies will also be checked to identify additional studies. Two reviewers will screen retrieved records, extract information and assess the risk of bias independently. STATA software will be used to conduct data synthesis. There is no requirement of ethical approval and informed consent.

Results:

This study will be submitted to a peer-reviewed journal for publication.

Conclusion:

We hope it will provide a relatively comprehensive reference for clinical practice and future relevant clinical trials.

Ethics and dissemination:

Ethics approval and patient consent are not required, as this study is a systematic review and meta-analysis.

INPLASY registration number:

INPLASY2020110030
Effects of age on the peak ratio of ophthalmic artery Doppler
Authors: Yang Xi-Yue , Xu Li-Fang , Luo Yuan , Li Na , Yang Jin-Pin , Zhu Lin-Ping , Li Zhi-Xian
Published: December 2020

This study aimed to investigate the effects of age on the peak ratio (PR) of ophthalmic artery (OA) Doppler.

The initial peak velocity (P1), second peak velocity (P2) and PR of OA were detected by color Doppler ultrasonography in 147 healthy subjects. All of the subjects were divided into 6 groups (G1-G6) according to the age. (G1, 20-29 years; G2, 30-39 years; G3, 40-49 years; G4, 50-59 years; G5, 60-69 years; and G6, 70 years or older). The blood pressure and heart rate were also examined before ultrasonography. The influences of age, blood pressure and heart rate on the P1, P2, and PR were further evaluated.

There were significant differences in the P2 and PR among different age groups except for P1. There were no significant differences in the P2 and PR between the first 2 groups, neither among the latter 4 groups. Nevertheless, P2 and PR in the first 2 groups were significantly different from those in the latter 4 groups. In addition, both P2 and PR (not P1) increased significantly with age, systolic and diastolic blood pressure. P1, P2 and PR were not related to heart rate. Both P2 and PR were closely related to the age. PR also had a weak relationship with systolic blood pressure.

Both P2 and PR of OA Doppler increase with age. Concern should be raised when P2 and PR are used to evaluate the hemodynamic change of OA.
The efficacy and safety of acupuncture for perimenopausal insomnia
Authors: Wang Zhao , Zhai Fengting , Zhao Xiaomin , Zhao Guizhi , Li Na , Zhang Fang , Liu Jinxing
Published: December 2020

Background:

As a common symptom of perimenopausal period, perimenopausal insomnia brings great pain to many women and families. Acupuncture has been accepted by people as the incidence rate of this disease increases. The purpose of this study is to systematically compare the safety and efficacy of various acupuncture treatments for perimenopausal insomnia through network meta-analysis.

Methods:

We will search Web of Science, PubMed, The Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Wan Fang Date, VIP database, conference papers and grey literature. All relevant Randomized controlled trial (RCT) using acupuncture for perimenopausal insomnia will be included. Two reviewers will independently search and screen date. Network meta-analysis will be completed by Stata and WinBUGS software.

Results:

This study will compare the efficacy and safety of different acupuncture treatments for perimenopausal insomnia.

Conclusion:

The result of this study will provide reliable evidence for evaluating the efficacy and safety of acupuncture in the treatment of perimenpausal insomnia.

INPLASY registration number:

INPLASY2020110047.
Primary care pathway- a novel way to reduce the burden on orthopaedic fracture clinics within the pediatric subgroup
Authors: Bussoletti Timothy , Quach Lucian , Fuschini Christian , Khire Pushkar , Cleary Aidan
Published: December 2020

Emergency departments receive an increasing amount of musculoskeletal injuries, with the majority referred to a fracture clinic (FCs). A literature review revealed certain orthopaedic injuries can be safely managed away from the FC pathway by general practitioners (GPs) or allied health professionals (AHPs). The present study aims to review all paediatric presentations to FCs at 2 Queensland hospitals, identifying low risk injuries that could potentially be managed by GPs or AHPs. This study is a continuation from Cleary et al in which a primary care pathway (PCP) was proposed for the management of low risk adult orthopaedic injuries. A PCP has the potential to have significant savings to the health system.

A retrospective study was conducted looking at paediatric patients (<16 years) referrals to 2 FCs over 8 weeks. Injuries were categorised into those requiring FC care supervised by an orthopaedic surgeon, and those that can be safely managed by GPs or AHPs via a PCP.

Four hundred ninety (57.7%) of the 849 patients referred to FC were assessed as suitable for PCP care. The most common upper limb injury deemed suitable was radius and ulna buckle fractures (18.4%), while the most common lower limb injury is ankle sprains (8%). Total failure to attend rate in the PCP group was 6.7%.

Adopting the PCP has the potential to significantly reduce FC referrals. With proven success of similar pathways abroad, the PCP may generate significant time and financial savings for both the health care system and patient.
Effectiveness of dose-escalated topiramate monotherapy and add-on therapy in neurosurgery-related epilepsy
Authors: Liu Yu-Tse , Chen Guo-Tai , Huang Yin-Cheng , Ho Jih-Tsun , Lee Cheng-Chi , Tsai Cheng-Chia , Chang Chen-Nen
Published: December 2020

Background:

Lesional and symptomatic causes of epilepsy are the most common neurological disorders of the brain. Topiramate effectively controls newly diagnosed epilepsy and refractory focal seizures, but high-dose topiramate does not improve seizure control. This study aimed to evaluate the clinical efficacy and safety of dose-escalated topiramate as first-line monotherapy and add-on therapy in patients with neurosurgery-related epilepsy.

Material and Methods:

A total of 55 neurosurgical patients with epilepsy were divided into monotherapy and add-on therapy groups and both groups received topiramate via the dose-escalation method. The primary efficacy outcomes were seizure-free rate and seizure response rate. Adverse events and seizure frequency were recorded.

Results:

The seizure response rate in the first month of monotherapy was significantly better than that of add-on therapy (89% vs 65%, P < .05), but no significant differences were found in seizure response rates between the 2 groups after 2 months of treatment. Both monotherapy and add-on therapy were effective in controlling seizures, with mean seizure frequency of 0.725 vs 0.536 and seizure-free rate of 88% vs 78.6%. Both treatments showed good improvement of seizure frequency in patients without tumor. The efficacy of monotherapy was better than that of add-on therapy (80% vs 29.2%) in patients with body mass index (BMI) ≤24. However, add-on therapy was better than monotherapy (76.7% vs 21.4%) in patients with BMI > 24. Dizziness (25.5%) and headache (16.4%) were the most common adverse events. No severe adverse event such as cognitive impairment was observed.

Conclusions:

Dose-escalated topiramate monotherapy and add-on therapy demonstrate good efficacy and safety, with fewer adverse events in seizure control in neurosurgical patients.
Incidence of nontuberculous mycobacterial disease and coinfection with tuberculosis in a tuberculosis-endemic region
Authors: Lin Chin-Kuo , Yang Yao-Hsu , Lu Mong-Liang , Tsai Ying-Huang , Hsieh Meng-Jer , Lee Yi-Chen , Wang Tsu-Nai , Chen Yi-Lung , Chen Vincent Chin-Hung
Published: December 2020

Nontuberculous mycobacteria (NTM) infection may interfere in the diagnosis and treatment of tuberculosis (TB) in TB-endemic regions. However, the population-based incidence of NTM disease and NTM–TB coinfection remains unclear.

We used Taiwan's National Health Insurance Research Database to identify new diagnoses of NTM disease and TB from 2005 to 2013 and calculated the incidence rate and the proportion of NTM–TB coinfection. The patients with NTM disease or TB were determined by the use of disease codes from International Classification of Diseases, Ninth Revision, Clinical Modification, laboratory mycobacterium examination codes, and antimycobacterial therapy receipts.

From 2005 to 2013, the age-adjusted incidence rate of NTM disease increased from 5.3 to 14.8 per 100,000 people per year and the age-adjusted incidence rate of NTM–TB coinfection was around 1.2 to 2.2 per 100,000 people per year. The proportion of NTM–TB coinfection among patients with confirmed TB was 2.8%. Male and older patients had a significantly higher incidence of NTM disease. The effects of urbanization and socioeconomic status (SES) on the incidences of TB and NTM disease were different. Rural living and lower SES were significantly associated with increasing the incidence of confirmed TB but not with that of NTM disease. For NTM disease, those living in the least urbanized area had significantly lower incidence rate ratio than in the highest urbanized area. The incidence of NTM–TB coinfection was higher in older patients and compared with patients aged < 45 years, the incidence rate ratio of the patients aged> 74 years was 12.5.

In TB-endemic Taiwan, the incidence of NTM disease increased from 2005 to 2013. Male gender and old age were risk factors for high incidence of NTM disease. SES did not have a significant effect on the incidence of NTM disease, but rural living was associated with lower incidence of NTM disease. In TB-endemic areas, NTM–TB coinfection could disturb the diagnosis of TB and treatment, especially in elderly patients.
Clinical therapeutic effects of lidocaine combination with flurbiprofen axetil for reducing propofol-induced pain in adults
Authors: Sun Weiqiang , Yu Jinfen , Lu Gang , Ye Xiaofeng , Fu Jun
Published: December 2020

Background:

Pain on injection is a well-recognized adverse event of propofol administration for the stimulation of general anesthesia. Pre-treatment with lidocaine or flurbiprofen axetil has proven to be effectual in the reduction propofol-induced pain in adults. Nonetheless, only few studies have evaluated the clinical therapeutic effects of lidocaine combination with flurbiprofen axetil to prevent pain on injection of propofol. The current study aims to evaluate the clinical therapeutic effects of lidocaine combination with flurbiprofen axetil to reduce pain on injection of propofol among adult patients.

Methods:

The literature search will be conducted from their inception to November 2020 from MEDLINE, EMBASE, Web of Science, and Cochrane Library databases without date or geographical restrictions. However, language will be restricted to publications in English and Chinese. Two authors will independently screen abstracts and titles of all papers to determine whether to include or exclude them. The authors will also study characteristic and outcomes of data extraction and carry out risk of bias assessment. We plan to use either a fixed-effects or random-effects model to estimate the risk ratios (RR) or mean difference (MD) or standardized mean difference (SMD) together with 95% confidence interval (CI).

Results:

This study will provide high-quality evidence for the clinical therapeutic effects of lidocaine combination with flurbiprofen axetil for reducing pain on injection of propofol in adult patients.

Conclusion:

This study will summarize current evidence for the management of pain on injection of propofol in adult patients and provide guidance for both intervention and future research.

Ethics and dissemination:

Since no data collection will be involved, there is no need for an ethics approval.

Registration number:

November 17, 2020.osf.io/72tpj/. (https://osf.io/72tpj/)
The association between age and adverse events due to biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis
Authors: Ikari Yuzo , Yajima Nobuyuki , Miwa Yusuke
Published: December 2020

We examined whether the age of patients with rheumatoid arthritis was associated with adverse events (AEs) caused by biologic disease-modifying antirheumatic drugs (bDMARDs).

Patients with rheumatoid arthritis using bDMARDs from Showa University Hospital, Showa University Northern Yokohama Hospital, and Showa University Koto Toyosu Hospital from January 2005 to December 2017 were eligible for this retrospective cohort study. The maximum observation period was determined to be 1 year. Outcomes in patients older and younger than 75 years were compared. The primary outcome was the rate of drug discontinuation because of AEs caused by bDMARDs. Univariate and multivariate analyses were performed using Pearson's chi-squared test and logistic regression analysis, respectively.

A total of 416 patients were enrolled; median (interquartile range [IQR]): 60.0 (44.3 - 71.0) years and 84.6% women; patients ≥ 75 years were 67/416 (16.1%). The rates of drug discontinuation because of AEs caused by bDMARDs were 10.5% (7/67) in patients 75 years and older and 10.9% (38/349) in those younger than 75 years (relative risk 0.95, 95% confidential interval 0.45-2.24). In logistic regression analysis adjusted for covariates, the rate of drug discontinuation showed no significant difference between the patients ≥ 75 years and the those < 75 years (adjusted odds ratio 0.70, 95% confidential interval 0.29-1.75, P = .45).

The rate of drug discontinuation because of AEs caused by bDMARDs was not significantly different between patients 75 years and older and patients younger than 75 years.
Effectiveness and safety of Yufengningxin for treating coronary heart disease angina
Authors: Liu Chao , Bai Jing , Liu Lanchun , Gao Jialiang , Wang Jie
Published: December 2020

Background:

More than 11 million people suffer from coronary heart disease (CHD) angina in China, showing high morbidity and mortality rates. Yufengingxin (YFNX) is a commonly used Chinese patent medicine in CHD angina treatment. The purpose of this protocol is to evaluate the effectiveness and safety of YFNX for the treatment of CHD angina.

Methods:

A systematic search of randomized controlled trials related to the effectiveness and safety of YFNX in the treatment of CHD angina will be performed from relevant databases, including PubMed, Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). We will screen all the literatures from the database inception to November 1, 2020. The data including study ID, study characteristics, methodological information, patients information, interventions, comparisons and outcomes will be extracted. The frequency and duration of angina attacks will be served as the primary outcome. Review Manager 5.3 and STATA 14.0 software will be used for data analysis.

Conclusion:

This systematic review will provide strong evidence for the effectiveness and safety of YFNX in the treatment of CHD angina.

Trial registration number:

INPLASY2020110040.
Herbal medicines for anorexia in lung cancer
Authors: Lee Ju Ah , Kim Kyun Ha , Ko Geum Young , Yoo Hwa-Seung , Choi Jun-Yong
Published: December 2020

Introduction:

Lung cancer is the leading cause of cancer-related death worldwide. Anorexia is the most common cause of malnutrition in lung cancer patients as well as an independent prognostic factor for cancer survival. This review will deal with the clinical evidence of herbal medicine use for reducing anorexia in lung cancer patients.

Methods and analysis:

Fourteen electronic databases will be searched from inception until October 2020. We will include randomized controlled trials (RCTs) assessing herbal medicines for anorexia in lung cancer patients. Interventions of any herbal medicines will be included. The methodological qualities of the included RCTs will be assessed via the Cochrane Collaboration tool for assessing the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument will be used to evaluate the confidence in the cumulative evidence.

Ethics and dissemination:

This systematic literature review does not require an ethics review. This review will be published in a peer-reviewed journal and disseminated electronically and in print. The review will be updated to inform and guide healthcare practices.

Registration number:

reviewregistry1038.
Reduced Myocardial Uptake of 123I-MIBG in Congenital Insensitivity to Pain With Anhidrosis
Authors: Sasahara Mihoko , Abe Takashi , Otomi Yoichi , Yamazaki Hiroki , Harada Masafumi
Published: December 2020

A 30-year-old man presented with repeated episodes of painless injuries in his feet and abnormally high body temperature. He was diagnosed with congenital insensitivity to pain with anhidrosis—a rare hereditary peripheral neuropathy characterized by decreased pain, reduced sweating, and autonomic neuropathy. Congenital insensitivity to pain with anhidrosis is also called hereditary sensory and autonomic neuropathy type IV. 123I-MIBG myocardial scintigraphy showed reduced myocardial uptake (heart-to-mediastinum ratio: 1.56 and 1.42 in the early and late phases, respectively; washout ratio, 49%), indicating autonomic dysfunction. This finding may contribute to the diagnosis of congenital insensitivity to pain with anhidrosis and the semiquantitative evaluation of an autonomic dysfunction.
FDG PET/CT of Benign Psammomatous Meningioma Effacing the Medulla
Authors: Chuang Tzyy-Ling , Chen Jin-Cherng , Chen Yu-Ruei , Wang Yuh-Feng
Published: December 2020

A 62-year-old woman had progressively developing throbbing right neck pain for 1 year. The pain radiated to the right suboccipital area, sometimes accompanied by breathlessness. To rule out cancer, patient received FDG PET/CT, which showed an intraspinal cord intense FDG-avid calcified mass at the level of the first cervical spine, mimicking malignancy. MRI showed it effacing the medulla; surgery is probably a challenge. She received laminectomy with tumor removal; pathology showed psammomatous meningioma, World Health Organization grade I. This case suggests that benign spinal cord psammomatous meningioma with calcification may show high FDG uptake, mimicking malignancy.
A Novel Approach to Coronoidectomy: the Modified Keen Technique
Authors: Roy Tulsi , Reid Russell
Published: December 2020

Introduction:

Coronoid fractures are relatively rare fractures of the craniofacial skeleton, but typically occur concomitantly with high-velocity craniofacial trauma to the midface and lateral mandible. Management of coronoid fractures may vary, but when surgical excision is indicated, treatment frequently involves an intraoral approach through a posterior intraoral incision along the mandibular ramus. Here, the authors present an alternative and novel approach to the coronoid process based on the Keen approach to the lateral midface.

Technical note:

The authors present a patient with a left zygomatico-maxillary complex fracture and left coronoid fracture. After disimpaction of the zygomatico-maxillary complex fracture, a maxillary vestibular incision in the gingivobuccal sulcus was made. After subperiosteal dissection, the maxillary fracture was exposed and fixated. A modified Keen approach was used to expose the coronoid process, perform temporalis myotomy, and excise the fracture fragment.

Discussion:

Compared to the classic intraoral approach to coronoidectomy, the modified Keen approach is a quick, versatile technique that allows for direct visualization of the coronoid process without the use of endoscopy, facilitates fixation of concurrent midfacial fractures, and utilizes an anterior intraoral incision that is easy to retract and close. For these reasons, the modified Keen technique for coronoidectomy should be considered in the treatment of trismus when an intraoral approach is indicated.
Yield of Adding chest CT to Abdominal CT to Detect COVID-19 in Patients Presenting With Acute Gastrointestinal Symptoms (SCOUT-3): Multicenter Study
Authors: Borgstein A.B.J. , Scheijmans J.C.G. , Puylaert C.A.J. , Keywani K. , Lobatto M.E. , Orsini R.G. , van Rees Veillinga T. , van Rossen J. , Scheerder M.J. , Voermans R.P. , Han A.X. , Russell C.A. , Prins J.M. , Gietema H.A. , Stoker J , Boermeester M.A. , Gisbertz S.S. , Besselink M.G. ,   on behalf of the SCOUT study group
Published: December 2020

Objective:

To determine the incremental yield of standardized addition of chest CT to abdominal CT to detect COVID-19 in patients presenting with primarily acute gastrointestinal symptoms requiring abdominal imaging. Summary Background Data: Around 20% of patients with COVID-19 present with gastrointestinal symptoms. COVID-19 might be neglected in these patients, as the focus could be on finding abdominal pathology. During the COVID-19 pandemic, several centers have routinely added chest CT to abdominal CT to detect possible COVID-19 in patients presenting with gastrointestinal symptoms. However, the incremental yield of this strategy is unknown.

Methods:

This multicenter study in 6 Dutch centers included consecutive adult patients presenting with acute nontraumatic gastrointestinal symptoms, who underwent standardized combined abdominal and chest CT between March 15, 2020 and April 30, 2020. All CT scans were read for signs of COVID-19 related pulmonary sequelae using the СО-RADS score. The primary outcome was the yield of high COVID-19 suspicion (СО-RADS 4-5) based on chest CT.

Results:

A total of 392 patients were included. Radiologic suspicion for COVID-19 (СО-RADS 4-5) was present in 17 (4.3%) patients, eleven of which were diagnosed with COVID-19. Only 5 patients with СО-RADS 4-5 presented without any respiratory symptoms and were diagnosed with COVID-19. No relation with community prevalence could be detected.

Conclusion:

The yield of adding chest CT to abdominal CT to detect COVID-19 in patients presenting with acute gastrointestinal symptoms is extremely low with an additional detection rate of around 1%.