bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time-effective analgesic effect of acupressure ankle strip pressing wrist and ankle acupuncture point on primary dysmenorrhea
Authors: Zhai Shu-jie , Ruan Yi , Liu Yue , Lin Zhen , Xia Chen , Fang Fan-fu , Zhou Qing-hui 
Published: March 2020

Abstract

Background:
Dysmenorrhea seriously affects the ability of women to perform normal social activities and decreases their quality of life. Primary dysmenorrhea can be effectively treated with acupuncture. Based on the wrist-ankle acupuncture (WAA) theory, we designed a portable WAA point compression treatment strap that treats diseases by automatically applying pressure to acupuncture points. The proposed study aims to evaluate the immediate analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea.

Methods:
The study will be a randomized controlled trial conducted from May 1, 2019 to May 30, 2020 that includes 78 students from Shanghai University of Traditional Chinese Medicine who have primary dysmenorrhea and meet the eligibility criteria. Participants will be randomly divided into 2 groups in a 1:1 allocation ratio. The intervention group will use the acupressure wrist-ankle strap equipped with tip compression component parts on the internal side; the control group will use the nonacupressure wrist-ankle strap with the tip compression parts removed. All participants will be treated for 30 minutes on the 1st day of menstruation. The primary outcome is the pain intensity score measured by the visual analog scale. The secondary outcomes are the onset time of analgesia, the pain threshold at Yinlingquan (SP 9), skin temperature at Guanyuan (CV 4), and expectations and satisfaction of patients as investigated via the expectation and treatment credibility scale.

Discussion:
This trial will be the 1st study to evaluate the analgesic effect of the acupressure wrist-ankle strap in patients with primary dysmenorrhea. The quality of this study is ensured by the randomization, nonacupressure control, and blinded design. The results may provide evidence for a potential alternative treatment for primary dysmenorrhea and evidence-based proof of the analgesic effect of WAA.
Combined effect of laser acupuncture and electroacupuncture in knee osteoarthritis patients
Authors: Wu Szu-Ying , Lin Chien-Hung , Chang Nai-Jen , Hu Wen-Long , Hung Yu-Chiang , Tsao Yu , Kuo Chun-En Aurea 
Published: March 2020

Abstract

Background:
Knee osteoarthritis (KOA) is a common degenerative joint disorder that affects 250 million people globally. KOA can lead to disability and is often associated with cardiovascular disease, poor quality of life, and mortality. The most common treatment for KOA is non-steroidal anti-inflammatory drug administration. However, the analgesic effect is limited and often accompanied by multiple side effects. Hence, many KOA patients opt for complementary and alternative medicine. Acupuncture is one of the most popular complementary treatments with great analgesic effect and minimal side effect. Electroacupuncture (EA) and laser acupuncture (LA) have been known to reduce pain in KOA patients. However, to date, no study has assessed the benefits of combining these two therapies.

Methods:
Fifty participants diagnosed with KOA, aged 50 years or older, and with consistent knee pain for more than 3 months were recruited and randomly assigned to the treatment group (EA plus LA) or control group (EA plus sham LA without laser output). All subjects in the treatment group will undergo a combined EA and LA treatment thrice a week for 4 weeks. The acupuncture will be performed on GB33, GB34, SP9, SP10, and ST36 sites. The treatment group will receive acupuncture with a transcutaneous electrical nerve stimulator at GB33, GB34, SP9, and SP10 sites and with LA at EX-LE5, ST35, and BL40 sites. The subjects in the control group will undergo the same treatment modality as the treatment group, except these subjects will not be exposed to laser output. Outcome measurements will include visual analog scale, Western Ontario McMaster Universities Osteoarthritis Index, Knee injury and osteoarthritis outcome, body composition analysis, knee range of motion, quadriceps muscle stiffness, one-leg standing with eyes open test, and the 30-s chair stand test before and after 4 weeks of intervention.

Objectives:
This protocol aims to investigate the combined effect of EA and LA in KOA patients.
Photobiomodulation by low-level laser therapy in patients with obstructive sleep apnea
Authors: de Camargo Fernanda Cristina Ferreira , DeMoura José Roberto , Cepeda Felipe Xerez , de Almeida Correia Marilia , Nascimento Reginaldo Ceolin , Fortes-Queiroz Lucas , Ferreira Fabiana Gonçalves , Palma Renata Kelly da , Hussid Maria Fernanda , Chavantes Maria Cristina , Trombetta Ivani Credidio 
Published: March 2020

Abstract
Obstructive sleep apnea (OSA) increases morbidity and mortality and it is associated with an increased cardiovascular risk. The gold standard treatment for OSA is positive airway pressure therapy (CPAP). However, it is an expensive treatment and several patients do not adapt to CPAP.

Goal:
The researchers will verify the effects of low-level laser therapy (LLLT) on OSA, when applied to the soft palate and on the tongue base.

Methods:
The researchers will select individuals of both sexes aged 30 to 60 years old who are sedentary and that present a high risk of OSA by the Berlin questionnaire. The evaluations pre and post interventions will be polysomnography; anthropometric and body composition measurements (Bioimpedance); metabolic syndrome risk factors (International Diabetes Federation); physical capacity (VO2 peak at the cardiopulmonary exercise test, CPET); endothelial function (flow-mediated dilatation, FMD); autonomic control (heart rate variability and sympathovagal balance). Those diagnosed with moderate and severe OSA (apnea/hypopnea index, AHI ≥15 events/h) will be invited to participate in the study and they will be randomized into 2 groups: LLLT treatment or placebo (C). The LLLT group will receive applications at 8 points on the soft palate and on the base of the tongue for 8 seconds for each point. The applications of LLLT will occur twice a week, with a minimum interval of 2 days between the applications for 2 months, when using a Therapy Plus NS 13678 Laser. The C group will have similar applications, but with the device turned off.

Expected Results:
In the individuals with OSA, photobiomodulation through LLLT will decrease the AHI. Additionally, when LLLT is applied in the oral cavity, a highly vascularized region, this may cause improvements in the vascular function and in the autonomic and hemodynamic control.

Ethics and Dissemination:
This protocol was approved by the Research Ethics Committee of the Nove de Julho University, São Paulo, Brazil, on the date of March 11, 2019 (CAAE: 06025618.2.0000.5511 - Acceptance Number: 3.191.077). This trial has been registered with the Brazilian Registry of Clinical Trials (REBEC TRIAL RBR-42v548). This study is not yet recruiting. Issue date: November 4, 2019.
Risk factors of cage nonunion after anterior cervical discectomy and fusion
Authors: Ren Bao , Gao Wenshan , An Jilong , Wu Menghui , Shen Yong 
Published: March 2020

Abstract
The aim of our study was to explore risk factors of cage nonunion after anterior cervical discectomy and fusion (ACDF).
295 patients underwent ACDF in our hospital between Jan. 2014 and Jan. 2017. Of them, 277 patients suffered cage union (union group, UG) after 6-month follow-up and 18 did not (nonunion group, NG). We collected possible factors including gender, history of smoking, alcohol, hypertension, heart disease, diabetes, body mass index, diagnose, and preoperative visual analog scale -neck, visual analog scale-arm, neck disability index (NDI) and Japanese Orthorpaedic Association, surgical duration, blood loss, fusion levels, superior fusion segment, angle of C2–C7, range of motion for C2–C7, C2–C7 sagittal vertical axis and T1 slope. We performed univariable and multivariable analysis to compare data in 2 groups.
The rate of cage nonunion after ACDF was 6.1% (18 of 295) in our study. The outcome of univariable analysis showed that age (63.5 ± 10.1), angle of C2–C7 (18.0 ± 4.6), range of motion of C2–C7 (32.5 ± 7.7), C2–C7 sagittal vertical axis (17.9 ± 4.3) and T1 slope (22.1 ± 5.3) were higher in NG than these (59.4 ± 9.2, 16.2 ± 4.5, 30.2 ± 6.9,16.1 ± 4.0, 20.9 ± 4.9) in UG. Additionally, patients with osteoporosis had markedly higher rate of cage nonunion after ACDF than those without. What's more, the multivariable analysis implied the same results with univariable analysis.
Many factors could predict cage nonunion after ACDF. Cervical sagittal parameters play an important role in cage nonunion after ACDF. We hope that we can provide some guidance for spine surgeon before performing ACDF.
Long-term outcomes of patients with gastric adenoma in Korea
Authors: Park Tae Young , Jeong Su Jin , Kim Tae Hyung , Lee Jin , Park Jongha , Kim Tae Oh , Park Yong Eun 
Published: March 2020

Abstract
New endoscopic resection techniques are constantly being developed for gastric adenoma, which can be classified as low or high grade according to the Vienna classification. However, long-term data on gastric adenoma (e.g., removal or follow-up after resection via endoscopy) remain lacking.
We retrospectively analyzed 133 cases with gastric adenoma that underwent endoscopic resection from January 2010 to November 2018. We analyzed the risk factors and frequency of patients with synchronous and metachronous lesions after endoscopic resection for gastric adenoma and followed them for more than 2 years.
One hundred six (79.7%) and 27 patients (20.3%) received endoscopic resection (ER) once and more than twice, respectively. Compared with the initial endoscopic biopsy pathological results, the upgraded and downgraded histological discrepancy rates were 10.5% (n = 14) and 3.0% (n = 4) after resection, respectively. The mean time to synchronous/metachronous recurrence was 2.23 years. The average lesion size at first procedure was larger in the multiple ER group than in the single ER group (2.00 vs 1.10 cm; P = .040). Eleven (8.3%) and 16 patients (12.0%) had recurred synchronous and metachronous lesions, respectively. In the multivariate Cox analysis of the recurrence group, intestinal metaplasia (hazard ratio, 2.761; 95% confidence interval, 1.117–6.820; P = .028) and lesion size (hazard ratio, 1.607; 95% confidence interval, 1.082–2.385; P = .019) were independent factors for receiving endoscopic resection more than twice.
If patients have severe intestinal metaplasia or large size of lesion at endoscopic resection for gastric adenoma, periodic observation is necessary.
Combined mutations of NKX2-1 and surfactant protein C genes for refractory low oxyhemoglobin saturation and interstitial pneumonia
Authors: Gu Rui , Ye Guangyong , Zhou Yimin , Jiang Zhou 
Published: March 2020

Abstract

Rationale:
Mutations of the NKX2-1 gene are associated with brain-lung-thyroid syndrome, which is characterized by benign hereditary chorea, hypothyroidism, and pulmonary disease with variable presentation. Surfactant protein C (SFTPC) gene mutations result in chronic interstitial lung disease in adults or severe neonatal respiratory distress syndrome.

Patient concerns:
Recurrent hypoxemia was observed shortly after birth in a baby at a gestational age of 40 weeks and birth weight of 3150 g. The need for respiratory support gradually increased. He had hypothyroidism and experienced feeding difficulties and irritability.

Diagnosis:
Genetic examination of the peripheral blood revealed combined mutations of the NKX2-1 and SFTPC genes.

Interventions:
The patient was administered respiratory support, antibiotics, low-dose dexamethasone, supplementary thyroxine, venous nutrition, and other supportive measures.

Outcomes:
The patient's guardian stopped treatment 3 months after commencement of treatment, due to the seriousness of his condition and the patient died.

Lessons:
Combined mutations of NKX2-1 and SFTPC genes are very rare. Thus, idiopathic interstitial pneumonia with hypothyroidism and neurological disorders require special attention.
Automated Pupillary Measurements Inversely Correlate With Increased Intracranial Pressure in Pediatric Patients With Acute Brain Injury or Encephalopathy
Authors: Freeman Ashley D. , McCracken Courtney E. , Stockwell Jana A. 
Published: March 2020

Objectives:
The purpose of this study was to determine correlation and temporal association between automated pupillary measurements and intracranial pressure in pediatric patients with brain injury or encephalopathy requiring intracranial pressure monitoring. We hypothesized that abnormal pupillary measurements would precede increases in intracranial pressure.

Design:
A prospective cohort study was performed. Automated pupillometry measurements were obtained at the same frequency as the patients’ neurologic assessments with concurrent measurement of intracranial pressure, for up to 72 hours. Pupillary measurements and the Neurologic Pupil index, an algorithmic score that combines measures of pupillary reactivity, were assessed for correlation with concurrent and future intracranial pressure measurements.

Setting:
Single-center pediatric quaternary ICU, from July 2017 to October 2018.

Patients:
Pediatric patients 18 years or younger with a diagnosis of acute brain injury or encephalopathy requiring an intracranial pressure monitor.

Interventions:
None.

Measurements and Main Results:
Twenty-eight patients were analyzed with a total of 1,171 intracranial pressure measurements. When intracranial pressure was elevated, the Neurologic Pupil index, percent change in pupillary size, constriction velocity, and dilation velocity were significantly lower than when intracranial pressure was within normal range (p < 0.001 for all). There were mild to moderate negative correlations between concurrent intracranial pressure and pupillary measurements. However, there was an inconsistent pattern of abnormal pupillary measurements preceding increases in intracranial pressure; some patients had a negative association, while others had a positive relationship or no relationship between Neurologic Pupil index and intracranial pressure.

Conclusions:
Our data indicate automated assessments of pupillary reactivity inversely correlate with intracranial pressure, demonstrating that pupillary reactivity decreases as intracranial pressure increases. However, a temporal association in which abnormal pupillary measurements precede increases in intracranial pressure was not consistently observed. This work contributes to limited data available regarding automated pupillometry in neurocritically ill patients, and the even more restricted subset available in pediatrics.
Pediatric Critical Care Medicine Fellowship Simulation Use Survey*
Authors: Henricksen Jared W. , Troy Lindsey , Siefkes Heather 
Published: March 2020

Objectives:
Simulation-based education is used in the U.S. Pediatric Critical Care Medicine fellowship programs, yet the prevalence and types of simulation used is unknown. A survey was developed to determine the prevalence, the perceived importance, and barriers associated with simulation-based education in these programs.

Design:
A 43-item survey instrument was sent to all 66 U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs during the summer of 2018. We defined simulation broadly as “any type of simulation that involved mannequins, task trainers, standardized actors, team training, etc.”

Setting:
An online survey was used to obtain information regarding simulation used in Pediatric Critical Care Medicine fellowship programs.

Subjects:
All sixty-six U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs were sent a survey request.

Measurements and Main Results:
Forty-four of the 66 U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs (67%) responded to the survey. Ninety-eight percent of responding programs (n = 43) use simulation-based education in their Pediatric Critical Care Medicine fellowship curriculum. Most programs (56%) have incorporated simulation training into their Pediatric Critical Care Medicine fellowship curriculum in the last 4–10 years (range, <1 to >15 yr, median 4–6 yr). A variety of principles, concepts, and programs were reported as used in their simulation programs. The most commonly reported barriers to Pediatric Critical Care Medicine fellowship simulation-based education were lack of funding (56%) and lack of faculty with simulation experience (56%). The majority of programs (64%; N = 28) think simulation-based education is absolutely necessary to Pediatric Critical Care Medicine fellowship training.

Conclusions:
Nearly, all responding U.S. Accreditation Council for Graduate Medical Education–accredited Pediatric Critical Care Medicine fellowship programs use simulation-based education to train Pediatric Critical Care Medicine fellows with the majority perceiving simulation as absolutely necessary to Pediatric Critical Care Medicine fellow training. The reported types of simulation used in fellow training varied, as did training theories and concepts in the simulation programs. More research is needed to understand how to optimize and perhaps standardize parts of Pediatric Critical Care Medicine fellowship simulation training to improve the impact and outcomes of such training.
Repeatedly in Rhabdomyolysis
Authors: Gooch Catherine , Dean Sarah Joy , Marzullo Laurie 
Published: March 2020

Abstract
Repeated presentations of a rare symptom in a patient should make a physician stop and evaluate for rare conditions. This is a report of a teenager with multiple episodes of rhabdomyolysis and weakness. He was eventually diagnosed as having McArdle muscular dystrophy, or glycogen storage disease type V. His rhabdomyolysis has been severe, with a creatinine kinase level of >320,000 U/L, myoglobinuria, transaminitis, and elevated bilirubin. He has a low threshold for triggering rhabdomyolysis, such as doing an hour of aerobic exercise 2 days in a row. McArdle disease is a glycogen storage disorder in which the skeletal muscle cannot convert glycogen to glucose. Unlike other glycogen storage disorders, McArdle muscular dystrophy only affects the skeletal muscle, sparing the brain and visceral organs, leading to a vague phenotype. These patients have exercise intolerance, muscle cramps, and rhabdomyolysis. Many patients report loading with simple carbohydrates before exercise, as they have learned that this can increase their stamina. The vague symptoms can lead to decades of delay in diagnosis and significant mismanagement. Rhabdomyolysis is the most dangerous sign of McArdle disease, and it can lead to acute kidney injury, resulting in renal failure requiring dialysis in the severest cases.
Rhabdomyolysis has numerous causes, but when it is recurrent, especially with seemingly insignificant triggers, one needs to develop a broader differential and pursue advanced testing. This testing can include specific exercise tests, genetic sequencing, and muscle biopsy. This case report will guide the clinician through the process of evaluating recurrent rhabdomyolysis, working through the differential diagnosis and testing options.
1
Two Cases Illustrating the Diagnostic Challenge of Pediatric Blastomycosis Presenting as Osteomyelitis
Authors: Gusland Danièle Y. , Livermore Andrew T. , Sterkel Alana K. , Nguyen Jie C. , Conway James H. 
Published: March 2020

Abstract

Blastomyces dermatitidis is a dimorphic fungus endemic to the United States and Canada. Although both Histoplasma and Blastomyces are found in similar geographic regions, Blastomyces is many times more likely to cause dissemination in the immunocompetent host, frequently involving the bone. However, given the indolent nature of this fungal infection and more prevalent bacterial etiologies of osteomyelitis, diagnosis and treatment are often significantly delayed. We review 2 pediatric cases that initially presented with isolated orthopedic symptoms without documented fever or pulmonary complaints, although both had signs of pulmonary infection on imaging. These cases demonstrate the importance of a high level of suspicion as well as appropriate diagnostic workup, including surgical pathology with fungal stains, when evaluating osteomyelitis in patients exposed to a Blastomyces-endemic region.
Computed Tomography Scan Utilization in Pediatric Trauma
Authors: Edwards Mary J. , Jenkel Timothy , Weller Brandon , Weber Alexis , Zhu Karen , Parikh Raina , Ata Ashar , Danziger Carrie 
Published: March 2020

IntroductionComputerized tomography (CT) scans are the mainstay of diagnostic imaging in blunt trauma. Particularly in pediatric trauma, utilization of CT scans has increased exponentially in recent years. Concerns regarding radiation exposure to this vulnerable population have resulted in increased scrutiny of practice. What is not known is if liberal imaging practices decrease length of stay by eliminating the need for clinical observation, and the impact of false-positive rates from liberal use of CT scanning on clinical outcomes.MethodsMedical records from a nonaccredited pediatric trauma center with a practice of liberal imaging were reviewed over a 2-year period. Total CT scans obtained were recorded, in addition to length of stay, age, and Injury Severity Score (ISS). Rates of clinically significant imaging findings were recorded, as were false positive findings and complications of imaging.ResultsOut of 735 children, 58% underwent CT scanning, and if scanned, received an average of 2.4 studies. Clinically significant findings were documented in 20% of head CTs, 2% of cervical spine CTs, 3.5% of chest CTs, 24% of facial CTs, and 14.7% of abdominal CTs. False-positive findings were found in 1.5% of head CTs, 1.2% of cervical spine CTs, 2.4% of chest CTs, and 2.5% of abdominal CTs. Liberal CT scanning was not associated with decreased length of stay. In contrast, obtaining CT scans on more than 4 body regions was independently predictive of longer length of stay, independent of ISS.ConclusionsFalse-positive rates of CT scans for trauma were low in this cohort. However, when scanning the cervical spine or the chest, for every 2 clinically significant findings obtained, there was at least one false positive result, calling into question the practice of liberal imaging of these regions. Liberal utilization of CT scan did not allow for more rapid discharge home, and for more than 4 CTs was independently associated with longer hospital stay.
Injectable Biologics
Authors: Kubrova Eva , D’Souza Ryan S. , Hunt Christine L. , Wang Qian , van Wijnen Andre J. , Qu Wenchun 
Published: March 2020

Abstract
Injectable biologics have attracted considerable interest in the field of musculoskeletal medicine. Biologics encompass a broad and diverse group of human tissue–derived therapeutics. The most commonly reported biologics for use in musculoskeletal conditions include platelet-rich plasma, bone marrow aspirate concentrate, mesenchymal stem cells, microfragmented fat, stromal vascular fraction, amniotic membrane–based products, and autologous conditioned serum. The benefits of biologics in tissue healing and regeneration are thought to be derived from their trophic, paracrine, and immunomodulatory functions. The purpose of this review is to define commonly used injectable biologics and to appraise current evidence on its efficacy in the treatment of musculoskeletal disease.