bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of Kanglaite injection combined with chemotherapy for colorectal cancer
Authors: Mao Weili , Fan Yihua , Cheng Chao , Yuan Xingyu , Lan Tian , Mao Kaili , Wang Jun 
Published: September 2020

Abstract

Background:
The incidence and mortality of colorectal cancer are high. Chemotherapy is currently the commonly used therapeutic scheme, but there are drug resistance and toxic and side effects. Kanglaite (KLT) injection is a broad-spectrum anticancer drug extracted from Semen Coicis (Yi Yi Ren), which has been widely used in the treatment of colorectal cancer. Clinical practice shows that KLT injection combined with chemotherapy has certain therapeutic advantages, but there is a lacking of evidence of evidence-based medicine. The purpose of this study is to systematically investigate the efficacy and safety of KLT injection combined with chemotherapy in the treatment of colorectal cancer.

Methods:
Randomized controlled trials of KLT injection combined with chemotherapy in the treatment of colorectal cancer were retrieved from English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, Wanfang, Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database), as well as searching Baidu academic and Google academic manually, and the retrieval time was from their establishment to August 2020. Two researchers independently conducted data extraction and literature quality evaluation on the quality of the included literatures, and meta-analysis was conducted on the included literatures using RevMan 5.3 (developed by the UK's International Cochrane Collaboration).

Results:
This study assessed the efficacy and safety of KLT injection combined with chemotherapy in the treatment of colorectal cancer by effective rate, Karnofsky Performance Status, Carcinoemybryonic Angtigen remission rate, pain remission rate, and incidence of adverse reactions etc.

Conclusions:
This study will provide reliable evidence-based evidence for the clinical application of KLT injection combined with chemotherapy in the treatment of colorectal cancer.

Ethics and dissemination:
The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.

OSF Registration number:
DOI 10.17605/OSF.IO/EKVAF
Herbal medicine Siho-sogan-san for functional dyspepsia
Authors: Ha Na-Yeon , Jeong Hae-in , Lee Ha-nul , Ko Seok-Jae , Park Jae-Woo , Kim Jinsung 
Published: September 2020

Abstract

Background:
Functional dyspepsia (FD) is characterized by persistent and recurrent dyspeptic symptoms, such as postprandial fullness and epigastric pain. Although it is rarely severe or life-threatening, it can degrade the quality of life and cause social and economic issues. As symptoms often persist despite the treatment with conventional Western medicine, herbal medicine can be considered as an alternative for treating FD. Siho-sogan-san (SHS) is a traditional herbal formula prescribed for dyspepsia for hundreds of years. This protocol for a systematic review was designed to evaluate the safety and efficacy of SHS for the treatment of FD through a meta-analysis.

Methods:
Studies will be searched from the following electronic databases up to March 2020: Embase, MEDLINE (via PubMED), Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Korean Medical Database, KoreaMed, Korean Studies Information Service System, National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, China National Knowledge Infrastructure Database, and Citation Information by Nii. Randomized controlled trials of SHS and herb-added SHS for treating FD will be selected in this review. The control groups of no-treatment, placebo, and conventional Western medicine will be compared with SHS for its efficacy. The synergetic effect of SHS with Western medicine will also be analyzed in comparison with conventional Western medicine alone. Two independent reviewers will collect the data and assess the risk of bias in individual studies. The total clinical effectiveness rate will be synthesized and evaluated as primary outcome.

Results:
This systematic review will present an adequate clinical evidence of SHS for the treatment of FD based on specific parameters, including dyspepsia-related symptoms, gastric emptying, and adverse events.

Conclusion:
This study will provide evidence for the safety and efficacy of SHS for the treatment of patients with FD.

Review Registry Unique Identifying Number:
reviewregistry952.
Acupuncture for mild cognitive impairment in elderly people
Authors: Li Weitong , Wang Qing , Du Shizheng , Pu Yalou , Xu Guihua 
Published: September 2020

Abstract

Background:
Acupuncture has an unique role in preventing and managing mild cognitive impairment (MCI) in nonpharmaceutical therapies because of its small wound, mild pain, and high security for many years. However, there is no systematic review evaluating safety and efficacy of acupuncture for MCI in elderly people. Therefore, this study will provide a protocol to explore the effectiveness and safety of acupuncture for MCI in the elderly.

Methods:
Retrieval from 8 electronic databases was conducted to determine eligible trials published until May, 2019. Homogeneity qualified studies were included for data were extracted such as study country location, demographic characteristics, and measure outcomes, and were analyzed by a random effect model and sensitivity analyses to identify heterogeneity. Review Manager (Revman Version 5.3) software will be used for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias.

Results:
A total of 15 randomized control trials involving 1051 subjects were included. The results were as follows: Compared with the control group, the clinical efficacy rates of acupuncture was better, odds ratio = 2.52, 95% confidence interval (CI) (1.86, 3.42), P < .00001, mini-mental state examination scores (mean difference [MD] = 1.53, 95% CI [1.04, 2.01], P < .00001), Montreal cognitive assessment scores (MD = 2.05, 95% CI [1.17, 1.92], P < .00001), activity of daily living scale (MD = 1.71, 95% CI [–1.38, 4.79], P > .05), and clock drawing task scores (MD = 1.91, 95% CI [1.74, 2.08], P < .00001).

Conclusion:
This study shows that acupuncture is beneficial for improving aspects of cognitive function in elderly people with MCI, which suggests that acupuncture may be an effective alternative and complementary approach to existing therapies for elderly people. More rigorous experimental studies and longer follow-up studies should be conducted in the future.
Relationship between hand and wrist bone age assessment methods
Authors: Bian Zhen , Guo Yuan , Lyu XueMin , Yang Zheng , Cheung Jason Pui Yin 
Published: September 2020

Abstract
Assessment of skeletal maturity is crucial for managing growth related problems. Tanner and Whitehouse (TW) hand and wrist bone age assessment is an accurate method; however, it is complex and labor-intensive. Several simplified methods derived from the TW method were proposed, and each had its own character. The purpose of this study is to explore the relationship between these methods for accurate usage.
Between 2018 and 2019, a cross-sectional study was performed with consecutive left hand and wrist x-rays obtained from a pediatric orthopedic clinic. Bone age assessments included the distal radius and ulna (DRU) classification, Sanders staging (S), thumb ossification composite index (T), and TW method. Somers delta correlation was conducted to determine the interchangeability of these stages. The mean bone age and standard deviation (SD) of each subgrade were compared and analyzed.
Totally 103 films (92 girls) were analyzed with mean age of 12.1 years (range: 8.0–17.9 years). The radius (R) stages had good correlation with S, T, and U stages with a very high Somers delta correlation (P < .05). R5 had relatively large SD (1.5) and referred to T2 and T3; R6 and R7 had the smallest SD (0.3) with reference to T4 or S2; R8 referred to T5 or S3, S4, S5; R9 referred to S6 and S7.
The internal relationship between the DRU and digital stages system was well proven. We also provided a simple and accurate way to assess the bone age by combination of some subgrades with smaller SD: 10y-proximal thumb covered without sesamoid (T2); 10.5y-sesamoid just appearing (T3); 11y-distal radial physis just covered (medial double joint line, R6); 11.5y-medial capping of distal radial physis (R7); 12y-bilateral capping of distal radial physis (R8) / phalangeal capping without fusion (S3); 12.5y-distal phalangeal physes start to fuse (S4); 13y-distal phalangeal physes fused (S5); 13.5y-proximal phalangeal physes start to fuse (S6); 14.5y-proximal phalangeal physes fused (S7); 15y-distal radial physis almost fused (R10).

Level of Evidence: Diagnostic study, level III.
Clinical warning signs of life-threatening hematochezia in neurosurgical patients with long-term bed rest
Authors: Jung Ji-Ho , Cho Yong-Hwan , Park Man-Seok , Joo Sung-Pil 
Published: September 2020

Abstract

Rationale:
Patients with long term bed rest in intensive care unit after neurosurgery could experience splanchnic hypoperfusion. These patients have several other medical conditions that exacerbate splanchnic hypoperfusion during treatment and the splanchnic hypoperfusion could result in “stress-induced intestinal necrosis”, which could cause massive hematochezia. We report here the experience of life-threatening hematochezia in 3 patients who underwent brain surgery in our institution.

Patients concerns:
One female patient (72-year-old) and 2 male patients (58- and 35-year-old) were admitted to our institution because of traumatic intracerebral hemorrhage, subarachnoid hemorrhage due to a ruptured anterior communicating artery, and subarachnoid hemorrhage with unknown cause respectively. All patients underwent emergency brain surgery for diagnosis and treatment. After surgery, they all experienced long-term bed rest in intensive care unit. Hematochezia occurred on postoperative day 15, 17, and 49, respectively.

Diagnoses:
All of the patients were assessed by abdomen/pelvis computed tomography and underwent a colonoscopy.

Interventions:
The female patient underwent embolization through pelvic arteriography and epinephrine injection through colonoscopy, but a total colectomy and ileostomy was performed due to refractory hematochezia. 58-year-old male patient had a laparoscopic ileostomy for the bowel rest. The other patient underwent nil per os and conservative treatment for 2 weeks.

Outcomes:
The female patient was discharged without further treatment plan, 58-year-old male patient survived after laparoscopic ileostomy, while the other patient survived after 2 weeks of nil per os.

Lesson:
Abdominal symptoms, such as hematochezia, should be actively managed in neurosurgical patients who are undergoing long-term bed rest in an intensive care unit under physiologically stressful medical conditions.
Sarcomatoid hepatocellular carcinoma mimicking hepatic abscess
Authors: Yang Zheng , Lv Kun , Zhao Yanan , Pan Minqiang , Zhang Chao , Wei Shumei 
Published: September 2020

Abstract

Rationale:
Primary sarcomatoid hepatocellular carcinoma (SHC) is a rare subtype of morphologic hepatocellular carcinoma reported on less than 1% of surgical pathology specimens. Herein, we report a rare case of SHC. The case in question was initially misdiagnosed as a liver abscess due to the clinical and radiological similarity between these 2 pathologies. Ultrasound(US)- and contrast-enhanced ultrasound (CEUS)- guided biopsies are helpful in making an accurate diagnosis under the appropriate biopsy area and angle of puncture.

Patient concerns:
A 56-year old male presented to our hospital with a 2-month history of dull, upper abdominal pain without radiation.

Diagnoses:
Upon initial investigation with computed tomography, a cystic mass was found in the hepatic V segment and an infectious etiology was presumed. Further diagnostic examination with CEUS and magnetic resonance imaging suggested a hepatic abscess. However, a diagnosis of atypical intrahepatic cholangiocarcinoma was not excluded. The patient received the standard antibiotic treatment without alleviation of his symptoms. Through 3 diagnostic US-and CEUS-guided biopsies over a 3-month period, the pathological diagnosis of SHC was finally confirmed.

Interventions:
The patient was diagnosed by 3 diagnostic US-and CEUS-guided biopsies, the pathological diagnosis of SHC was finally confirmed.

Outcomes:
Due to the delay in diagnosis, the patient was not a candidate for surgical resection, and showed dissemination of the lesion to the portal vein. Therefore, treatment with chemotherapy was initiated. After 4 courses of this regimen, tumor progression was found on enhanced magnetic resonance imaging. Therefore, the patient received immunotherapy and targeted therapy with limited response. The patient passed away 3 months later due to tumor progression.

Lessons:
A hepatic abscess should be considered as a malignant lesion when clinical symptoms do not resolve upon standard treatment. US- and CEUS- guided biopsies are helpful in making an accurate diagnosis under the appropriate biopsy area and angle of puncture.
A Blueprint for Streamlining Patient Pathways Using a Hybrid Lean Management Approach
Authors: Rizan Chantelle , Low Rob , Harden Saskia , Groves Nick , Flaherty Breda , Welland Trevor , Das Prodip , Bhutta Mahmood F. 
Published: September 2020

Background:
Streamlining patient pathways within health care systems is a complex and challenging process. While frontline clinicians often have an abundance of ideas, these rarely translate into real-world change due to nonadoption or early abandonment.

Objectives:
The aim of this article is to provide frontline clinicians with a blueprint for developing a business case for a streamlined pathway while guiding the practical implementation of this blueprint.

Methods:
The key steps outlined in streamlining a patient pathway are as follows: step 1—identify problems with the patient pathway; step 2—identify the potential to streamline; step 3—forecast the benefits of the streamlined pathway; step 4—gain approvals; step 5—plan the practicalities; step 6—implement and monitor the streamlined pathway; and step 7—monitor the streamlined pathway. Within these steps, Lean management techniques are introduced (including value stream mapping, Pareto charts, Ishikawa diagrams, demand and capacity calculations, role lane mapping) and strengthened by other methods (retrospective audit, systematic review, patient questionnaires, and cost analysis).

Results:
This roadmap is contextualized using a case study, demonstrating how streamlining pathways can result in statistically significant reductions in referral to treatment time, the number of steps in the pathway, lead time (pathway duration), and handoff (transfer of patients between health care professionals). This can be achieved while increasing patient contact time, improving patient satisfaction, and reducing costs.

Conclusion:
This blueprint demonstrates a comprehensive method for streamlining patient pathways, using Lean management techniques complemented by additional methods. This approach was developed by frontline clinicians and can be replicated by others, translating quality improvement ideas into sustainable change in practice. It enables the design of streamlined pathways that confer significant benefits to patients, health care service providers, and the health economy.
Constructing Causal Networks Through Regressions: A Tutorial
Authors: Alemi Farrokh 
Published: September 2020

Background:
Significant progress has been made in the practice of conducting causal analysis using network models. Despite this progress, there is limited evidence that hospital risk managers are using these analytical models.

Objective:
This article introduces the causal network, its related concepts, and methods of analysis. The article demonstrates how hospital risk managers can use existing regression software to construct a causal network and identify root causes of an adverse event.

Methods:
Causal networks depict cause and effect in a set of variables. In this context, causes are strong correlations that meet 3 additional criteria: (1) causes occur prior to effects, (2) there is an articulated mechanism for how causes lead to effects, and (3) the association between cause and effect is not spurious, meaning the association persists even after other variables are statistically controlled for (a method of analysis called counterfactual). A causal network can be constructed through repeated use of least absolute shrinkage and selection operator (LASSO) regression. In the proposed regressions, the response variable is any variable in the data. The independent variables are variables that occur prior to the response variable. By design, the statistically significant coefficients in the time-constrained LASSO regressions identify “direct” causes of the response variables. When direct causes of all variables are identified, then the entire network model, including root causes, has been specified. In the final step, the parameters of the network model (ie, strength of causal associations) are estimated by fitting the network structure to the available data. We demonstrate these concepts through fitting a network model to simulated data for causes of excessive boarding in emergency departments.

Results:
The network (involving 12 causes, over 4 periods, and 1 sentinel event) was accurately recovered from the simulated case reports. The recovered network did not differ from the original network used to simulate the data in any of the 156 possible links. The recovered network allowed the identification of root and direct causes. It showed that hospital occupancy rate, and not emergency department efficiency, was root cause of excessive emergency department boarding.

Discussion:
Causal networks can provide insights into root, and direct, causes of an adverse event. These models provide empirical tests of causes of adverse events. We encourage the use of these methods by hospital risk managers.
3D-Printing and upper-limb prosthetic sockets; promises and pitfalls
Authors: Olsen Jennifer , Day Sarah , Dupan Sigrid , Nazarpour Kianoush , Dyson Matthew 
Published: September 2020

AbstractModernising the way upper-limb prosthetic sockets are made has seen limited progress. The casting techniques that are employed in clinics today resemble those developed over 50 years ago and there is still a heavy reliance on manual labour. Modern manufacturing methods such as 3D scanning and printing are often presented as ready-to-use solutions for producing low-cost functional devices, with public perceptions being largely shaped by the superficial media representation and advertising. The promise is that modern socket manufacturing methods can improve patient satisfaction, decrease manufacturing times and reduce the workload in the clinic. However, the perception in the clinical community is that total conversion to digital methods in a clinical environment is not straightforward. Anecdotally, there is currently a disconnect between those developing technology to produce prosthetic devices and the actual needs of clinicians and people with limb difference. In this paper, we demonstrate strengths and drawbacks of a fully digitised, low-cost trans-radial diagnostic socket making process, informed by clinical expertise. We present volunteer feedback on the digitally created sockets and provide expert commentary on the use of digital tools in upper-limb socket manufacturing. We show that it is possible to utilise 3D scanning and printing, but only if the process is informed by expert knowledge. We bring examples to demonstrate how and why the process may go wrong. Finally, we provide discussion on why progress in modernising the manufacturing of upper-limb sockets has been slow yet it is still too early to rule out digital methods.
Type I interferon potentiates metabolic dysfunction, inflammation, and accelerated aging in mtDNA mutator mice
Authors: Lei Yuanjiu , Martinez Camila Guerra , Torres-Odio Sylvia , Bell Samantha L. , Birdwell Christine E. , Bryant Joshua D. , Tong Carl W. , Watson Robert O. , West Laura Ciaccia , West A. Phillip 
Published: September 2020

AbstractMitochondrial dysfunction is a key driver of inflammatory responses in human disease. However, it remains unclear whether alterations in mitochondria-innate immune crosstalk contribute to the pathobiology of mitochondrial disorders and aging. Using the polymerase gamma (POLG) mutator model of mitochondrial DNA (mtDNA) instability, we report that aberrant activation of the type I interferon (IFN-I) innate immune axis potentiates immunometabolic dysfunction, reduces healthspan, and accelerates aging in mutator mice. Mechanistically, elevated IFN-I signaling suppresses activation of nuclear factor erythroid 2-related factor 2 (Nrf2), which increases oxidative stress, enhances pro-inflammatory cytokine responses, and accelerates metabolic dysfunction. Ablation of IFN-I signaling attenuates hyper-inflammatory phenotypes by restoring Nrf2 activity and reducing aerobic glycolysis, which combine to lessen cardiovascular and myeloid dysfunction in aged mutator mice. These findings further advance our knowledge of how mitochondrial dysfunction shapes innate immune responses and provide a framework for understanding mitochondria-driven immunopathology in POLG-related diseases and aging.
Breast tumors escape endocrine therapy by ER-independent mechanisms triggered by the coordinated activities of HER2/HER3 and deacetylated FOXA1
Authors: Gilfillan Siv , Wang Shixiong , Katika Madhumohan R. , Norum Jens Henrik , Bergholtz Helga , Fiorito Elisa , Nordhagen Siri , Sharma Yogita , Singh Sachin , Somisety Venkata S. , Fosdahl Anne-Marthe , Nord Silje , Engebraaten Olav , Lingjaerde Ole Christian , Børresen-Dale Anne-Lise , Sahlberg Kristine Kleivi , Sørlie Therese , Bellet Meritxell , Lopez-Aviles Sandra , Hurtado Antoni 
Published: September 2020

ABSTRACTHormone-resistance in ER positive breast cancer is associated with high HER2 activity. Yet, the interplay between HER2 and FOXA1 in hormone resistant tumors is not elucidated. Now, we demonstrate that hormone resistant tumors have increased HER2 expression and that FOXA1 mediates the signals of HER2/3 in an Estrogen Receptor independent manner. Ourin vitroandin vivoexperiments reveal that HER2/HER3 triggers FOXA1 binding at chromatin regions of ER-regulated genes associated with poor prognosis, facilitating their expression and leading to ER-independent growth. Furthermore, our study supports that FOXA1 acetylated by the acetyltransferase EP300 is retained at ER chromatin regions, which enables ER function. By contrast, HER2/3 activation hinders FOXA1 acetylation and facilitates FOXA1 binding at non-ER interacting regions enriched towards poor prognosis genes. Moreover, FOXA1 deacetylation confers insensitivity to anti-ER drugs inhibitory effect in ER positive cells. These results elucidate how post-translational modifications of FOXA1 control transcription independently of ER in hormone-resistant tumors with enhanced HER2/3 signaling.