bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of transcutaneous electrical acupuncture point stimulation on expression of p-JNK in the dorsal root ganglion in a rat model of myofascial pain syndrome
Authors: Yu Xiangdi , Zhang Fangxiang , Zhang Jingchao 
Published: March 2021

Background: Acupuncture has been used to treat myofascial pain syndrome (MPS) for 2000 years in China, but its mechanisms are still not entirely clear. In the present study, we explored the effects of transcutaneous electrical acupuncture point stimulation (TEAS) at an Ashi acupuncture point on expression of phosphorylated c-Jun N-terminal kinase (p-JNK) in the dorsal root ganglion (DRG) using a rat model of MPS. Methods: 32 rats were divided into four groups: normal, MPS, MPS+TEAS and MPS+sham- TEAS. MPS was produced by a blunt strike to the left vastus medialis combined with eccentric exercise for 8 weeks. Rats in the MPS+TEAS group received TEAS (6–9 mA, 2 Hz, 30 min) treatment at the Ashi acupuncture point for 2 weeks; rats in the MPS+sham -TEAS group had the same electrodes applied but received no stimulation. Paw withdrawal thermal latency (PWTL) was studied at baseline and on days 3, 7, 11 and 15 after treatment. Haematoxylin and eosin staining was used to examine for morphological changes in the left vastus medialis muscles; expression of p-JNK in the L3–L5 DRG was determined by immunofluorescence staining and western blotting after treatment. Results: Compared with the normal group, PWTL decreased significantly (P<0.01) and the expression of p-JNK in the DRG increased in the MPS and MPS-sham-TEAS groups (P<0.01); compared with the MPS group, PWTL was increased significantly (P<0.01) and expression of p-JNK in the DRG was decreased in the MPS+TEAS group. However, when compared with the normal group, PWTL did not recover to baseline and expression of p-JNK was still higher. Conclusion: TEAS treatment may produce an analgesic effect, probably by inhibiting the expression of p-JNK in the DRG of rats with MPS.
Acupuncture and clomiphene citrate for anovulatory infertility: a systematic review and meta-analysis
Authors: Gao Ranran , Guo Baojun , Bai Jun , Wu Yeke , Wu Keming 
Published: March 2021

Objective: To evaluate the comparative effectiveness of acupuncture or acupuncture combined with clomiphene citrate (CC) versus CC alone on the outcomes of anovulatory infertility. Methods: A literature search in eight databases yielded nine randomised controlled trials (RCTs) that evaluated the comparative effectiveness of acupuncture and CC in anovulatory infertility. Subsequently, data were extracted and the studies were assessed for the quality of their methodological designs and risk of bias. Meta-analyses of the RCT data were conducted. Results: Nine trials including 1441 women were included in the meta-analysis. There were no significant differences in the rates of pregnancy (odds ratio (OR) 1.18, 95% CI 0.83 to 1.69), ovulation (OR 2.57, 95% CI 0.59 to 11.29) or pregnancy loss (OR 0.98, 95% CI 0.59 to 1.63) when acupuncture was used as an adjuvant therapy alongside CC. Although acupuncture alone did not increase the ovulation rate (OR 0.41, 95% CI 0.11 to 1.49), our review demonstrated superior effects in patients who received acupuncture as a separate treatment modality with respect to both the pregnancy rate (OR 2.34, 95% CI 1.76 to 3.10) and the maximum follicular diameter (mean difference 0.50 mm, 95% CI 0.44 to 0.56 mm) when compared with CC alone. Statistical analysis also showed a reduction in the rate of pregnancy loss when acupuncture was used as a separate treatment compared with CC alone (OR 0.19, 95% CI 0.08 to 0.45). Conclusions: Based on the above pooled results of the studies, the use of acupuncture as a monotherapy significantly improved the rate of pregnancy among the study participants compared with the use of CC alone. However, any results drawn from these studies should be interpreted with caution when considering the context of clinical practice.
Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials
Authors: Zhang Xinyan , Wang Xiuli , Zhang Bingyan , Yang Sa , Liu Dongling 
Published: March 2021

Objective: Breast cancer-related lymphoedema (BCRL) is a common complication after breast cancer treatment. We investigated whether acupuncture could be used to manage limb oedema in women after breast cancer surgery. Methods: The Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and four Chinese databases were electronically searched for papers published through November 2017. Randomised controlled trials (RCTs) of acupuncture for BCRL were included. Results: In total, six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. Two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001). Two other studies used the effectiveness index to assess the arm and found a significant difference between the acupuncture and control groups (WMD 23.34, 95% CI 10.74 to 35.94; P<0.001). The fifth study used bioelectrical impedance spectroscopy to assess lymphoedema at several points on the arm before and after acupuncture; this study also reported a significant reduction in lymphoedema. The sixth study reported no significant difference in bioimpedance between the groups. Conclusions: The present meta-analysis and systematic review suggests that acupuncture is effective at reducing BCRL in patients after breast cancer treatment.
Improving estimates of the burden of severe wasting: analysis of secondary prevalence and incidence data from 352 sites
Authors: Isanaka Sheila , Andersen Christopher T , Cousens Simon , Myatt Mark , Briend André , Krasevec Julia , Hayashi Chika , Mayberry Amy , Mwirigi Louise , Guerrero Saul 
Published: March 2021

IntroductionEstimates of incident cases of severe wasting among young children are not available for most settings but are needed for optimal planning of treatment programmes and burden estimation. To improve programme planning, global guidance recommends a single ‘incidence correction factor’ of 1.6 be applied to available prevalence estimates to account for incident cases. This study aimed to update estimates of the incidence correction factor to improve programme planning and inform the approach to burden estimation for severe wasting.MethodsA global call was issued for secondary data from severe wasting treatment programmes including prevalence, population size, programme admission and programme coverage through a UNICEF-led effort. Site-specific incidence correction factors were calculated as the number of incident cases (annual programme admissions/programme coverage) divided by the number of prevalent cases (prevalence*population size). Estimates were aggregated by country, region and overall using inverse-variance weighted random-effects meta-analysis.ResultsWe estimated incidence correction factors from 352 sites in 20 countries. Estimates aggregated by country ranged from 1.3 (Nigeria) to 30.1 (Burundi). Excluding implausible values, the overall incidence correction factor was 3.6 (95% CI 3.4 to 3.9).ConclusionOur results suggest that incidence correction factors vary between sites and that the burden of severe wasting will often be underestimated using the currently recommended incidence correction factor of 1.6. Application of updated incidence correction factors represents a simple way to improve programme planning when incidence data are not available and could inform the approach to burden estimation.
Applying natural language processing and machine learning techniques to patient experience feedback: a systematic review
Authors: Khanbhai Mustafa , Anyadi Patrick , Symons Joshua , Flott Kelsey , Darzi Ara , Mayer Erik 
Published: March 2021

ObjectivesUnstructured free-text patient feedback contains rich information, and analysing these data manually would require a lot of personnel resources which are not available in most healthcare organisations.To undertake a systematic review of the literature on the use of natural language processing (NLP) and machine learning (ML) to process and analyse free-text patient experience data.MethodsDatabases were systematically searched to identify articles published between January 2000 and December 2019 examining NLP to analyse free-text patient feedback. Due to the heterogeneous nature of the studies, a narrative synthesis was deemed most appropriate. Data related to the study purpose, corpus, methodology, performance metrics and indicators of quality were recorded.ResultsNineteen articles were included. The majority (80%) of studies applied language analysis techniques on patient feedback from social media sites (unsolicited) followed by structured surveys (solicited). Supervised learning was frequently used (n=9), followed by unsupervised (n=6) and semisupervised (n=3). Comments extracted from social media were analysed using an unsupervised approach, and free-text comments held within structured surveys were analysed using a supervised approach. Reported performance metrics included the precision, recall and F-measure, with support vector machine and Naïve Bayes being the best performing ML classifiers.ConclusionNLP and ML have emerged as an important tool for processing unstructured free text. Both supervised and unsupervised approaches have their role depending on the data source. With the advancement of data analysis tools, these techniques may be useful to healthcare organisations to generate insight from the volumes of unstructured free-text data.
Google translate in healthcare: preliminary evaluation of transcription, translation and speech synthesis accuracy
Authors: Birkenbeuel Jack , Joyce Helen , Sahyouni Ronald , Cheung Dillon , Maducdoc Marlon , Mostaghni Navid , Sahyouni Sammy , Djalilian Hamid , Chen Jefferson , Lin Harrison 
Published: March 2021

ObjectiveTo assess the ability of Google Translate (GT) to accurately interpret single sentences and series of sentences commonly used in healthcare encounters from English to Spanish.DesignEnglish-speaking volunteers used GT to interpret a list of 83 commonly used sentences and series of sentences of different lengths containing both medical and non-medical terminology. A certified medical interpreter evaluated whether the meaning of these sentences was preserved.ParticipantsEighteen English-speaking subjects (nine males and nine females), with a mean age of 36 years, volunteered for this study to read sentences.Main outcome measuresThe accuracy of GTs (1) real-time voice recognition (ie, transcription) of English sentences, (2) real-time translation of these transcribed English sentences to Spanish, and (3) GTs speech synthesis ability to preserve the meaning of spoken English sentences after translation to Spanish.ResultsSpeech synthesis accuracy, with preservation of the original English-spoken sentence(s), was 89.4% for single sentences with ≤8 words; 90.6% for single sentences with >8 words; 52.2% for two sentences and 26.6% for three sentences. Furthermore, the number of transcription and translation errors per sentence(s) significantly increased with the number of sentences (p<0.05).ConclusionsDespite the fact that GTs accuracy was widely variable and dependent on the length of the spoken sentence(s), GT is readily accessible, has no associated monetary costs, and offers nearly immediate interpretation services. As such, it has the potential to routinely facilitate effective one-way oral communication between English-speaking physicians and Spanish-speaking patients with limited English proficiency.
Deep learning model to predict the need for mechanical ventilation using chest X-ray images in hospitalised patients with COVID-19
Authors: Kulkarni Anoop R , Athavale Ambarish M , Sahni Ashima , Sukhal Shashvat , Saini Abhimanyu , Itteera Mathew , Zhukovsky Sara , Vernik Jane , Abraham Mohan , Joshi Amit , Amarah Amatur , Ruiz Juan , Hart Peter D , Kulkarni Hemant 
Published: March 2021

ObjectivesThere exists a wide gap in the availability of mechanical ventilator devices and their acute need in the context of the COVID-19 pandemic. An initial triaging method that accurately identifies the need for mechanical ventilation in hospitalised patients with COVID-19 is needed. We aimed to investigate if a potentially deteriorating clinical course in hospitalised patients with COVID-19 can be detected using all X-ray images taken during hospitalisation.MethodsWe exploited the well-established DenseNet121 deep learning architecture for this purpose on 663 X-ray images acquired from 528 hospitalised patients with COVID-19. Two Pulmonary and Critical Care experts blindly and independently evaluated the same X-ray images for the purpose of validation.ResultsWe found that our deep learning model predicted the need for mechanical ventilation with a high accuracy, sensitivity and specificity (90.06%, 86.34% and 84.38%, respectively). This prediction was done approximately 3 days ahead of the actual intubation event. Our model also outperformed two Pulmonary and Critical Care experts who evaluated the same X-ray images and provided an incremental accuracy of 7.24%–13.25%.ConclusionsOur deep learning model accurately predicted the need for mechanical ventilation early during hospitalisation of patients with COVID-19. Until effective preventive or treatment measures become widely available for patients with COVID-19, prognostic stratification as provided by our model is likely to be highly valuable.
Risk of active tuberculosis in migrants diagnosed with cancer: a retrospective cohort study in British Columbia, Canada
Authors: Kumar Divjot S , Ronald Lisa A , Romanowski Kamila , Rose Caren , Shulha Hennady P , Cook Victoria J , Johnston James C 
Published: March 2021

ObjectivesTo describe the association between types of cancer and active tuberculosis (TB) risk in migrants. Additionally, in order to better inform latent TB infection (LTBI) screening protocols, we assessed proportion of active TB cases potentially preventable through LTBI screening and treatment in migrants with cancer.DesignPopulation-based, retrospective cohort study.SettingBritish Columbia (BC), Canada.Participants1 000 764 individuals who immigrated to Canada from 1985 to 2012 and established residency in BC at any point up to 2015.Primary and secondary outcome measuresUsing linked health administrative databases and disease registries, data on demographics, comorbidities, cancer type, TB exposure and active TB diagnosis were extracted. Primary outcomes included: time to first active TB diagnoses, and risks of active TB following cancer diagnoses which were estimated using Cox extended hazard regression models. Potentially preventable TB was defined as active TB diagnosed >6 months postcancer diagnoses.ResultsActive TB risk was increased in migrants with cancer ((HR (95% CI)) 2.5 (2.0 to 3.1)), after adjustment for age, sex, TB incidence in country of origin, immigration classification, contact status and comorbidities. Highest risk was observed with lung cancer (HR 11.2 (7.4 to 16.9)) and sarcoma (HR 8.1 (3.3 to 19.5)), followed by leukaemia (HR 5.6 (3.1 to 10.2)), lymphoma (HR 4.9 (2.7 to 8.7)) and gastrointestinal cancers (HR 2.7 (1.7 to 4.4)). The majority (65.9%) of active TB cases were diagnosed >6 months postcancer diagnosis.ConclusionSpecific cancers increase active TB risk to varying degrees in the migrant population of BC, with approximately two-thirds of active TB cases identified as potentially preventable.
Real-world challenges for patients with breast cancer in sub-Saharan Africa: a retrospective observational study of access to care in Ghana, Kenya and Nigeria
Authors: Twahir Majid , Oyesegun Razaq , Yarney Joel , Gachii Andrew , Edusa Clement , Nwogu Chukwumere , Mangutha Gitangu , Anderson Philip , Benjamin Emmanuel , Müller Borna , Ngoh Charles 
Published: March 2021

ObjectiveTo evaluate medical resource utilisation and timeliness of access to specific aspects of a standard care pathway for breast cancer at tertiary centres in sub-Saharan Africa.DesignData were retrospectively abstracted from records of patients with breast cancer treated within a prespecified 2-year period between 2014 and 2017. The study protocol was approved by local institutional review boards.SettingSix tertiary care institutions in Ghana, Kenya and Nigeria were included.ParticipantsHealth records of 862 patients with breast cancer were analysed: 299 in Ghana; 314 in Kenya; and 249 in Nigeria.InterventionsAs directed by the treating physician.Outcome measuresParameters selected for evaluation included healthcare resource and use, medical procedure turnaround times and out-of-pocket (OOP) payment patterns.ResultsUse of mammography or breast ultrasonography was <45% in all three countries. Across the three countries, 78%–88% of patients completed tests for hormone receptors and human epidermal growth factor receptor 2 (HER2). Most patients underwent mastectomy (64%–67%) or breast-conserving surgery (15%–26%). Turnaround times for key procedures, such as pathology, surgery and systemic therapy, ranged from 1 to 5 months. In Ghana and Nigeria, most patients (87%–93%) paid for diagnostic tests entirely OOP versus 30%–32% in Kenya. Similarly, proportions of patients paying OOP only for treatments were high: 45%–79% in Ghana, 8%–20% in Kenya and 72%–89% in Nigeria. Among patients receiving HER2-targeted therapy, the average number of cycles was five for those paying OOP only versus 14 for those with some insurance coverage.ConclusionsPatients with breast cancer treated in tertiary facilities in sub-Saharan Africa lack access to timely diagnosis and modern systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their healthcare and were more likely to be employed and have secondary or postsecondary education. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.
Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study
Authors: Shetty Siddesh Sitaram , Moray Kusum Venkobrao , Chaurasia Himanshu , Joshi Beena Nitin 
Published: March 2021

ObjectivePostpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon tamponade (UBT) is recommended for refractory atonic PPH cases. As part of health technology assessment to determine the most cost-effective UBT device, this study estimated costs of atonic PPH management with condom-UBT, Every Second Matters (ESM) UBT and Bakri balloon UBT in public health system of Maharashtra, India.DesignHealth system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities.SettingsFour public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing.Outcome measuresUnit, package and annual cost of atonic PPH management with three UBT devices were measured. This included cost of medical treatment, UBT intervention and PPH related surgeries undertaken in public health system of Maharashtra for year 2017–2018.ResultsMedical management of atonic PPH cost the health system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53) with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to 73) per case. Overall annual cost of managing 27 915 atonic PPH cases with condom-UBT intervention in Maharashtra was US$1 226 610 (95% CI 870 250 to 1 581 596).ConclusionsAtonic PPH management in public health facilities of Maharashtra with condom-UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the state’s annual spending on reproductive and child health services. These findings can guide policy-makers to include PPH complication management in publicly financed health schemes. Economic evaluation studies can use this evidence to determine cost effectiveness of UBT in Indian settings.
WeChat-based vestibular rehabilitation for patients with chronic vestibular syndrome: protocol for a randomised controlled trial
Authors: Wu Peixia , Wan Yafang , Zhuang Yu , Wang Chennan , Xi Shuxin , Zhu Hui 
Published: March 2021

IntroductionDizziness is one of the most common symptoms seen in chronic vestibular syndrome, which has been linked to an increased risk of falls, substantial disability and negative psychological consequences. Recent evidence demonstrated that vestibular rehabilitation therapy (VRT) is effective for treating chronic vestibular symptoms. However, the delivery of VRT remains challenging because of lack of facility, insufficient qualified physiotherapist resources, as well as being in the actual situation of the pandemic. WeChat, the most widely used mobile app in China, offers a more viable way of delivering VRT than traditional office-based approaches do. This study aimed to evaluate the effectiveness of the WeChat-VRT programme for patients with chronic vestibular syndrome.Methods and analysisThis is a parallel-group, assessor-blinded randomised controlled trial. Fifty patients who experienced chronic vestibular symptoms longer than 3 months will be randomised into either the WeChat-VRT group or the usual care (UC) group. Participants in the WeChat-VRT group will receive 8-week VRT mainly through the WeChat app. Participants in the UC group will receive once-weekly VRT in the clinic for 8 weeks and remaining time home-based exercise. Outcome assessments will take place at baseline and at the 8th, 12th and 24th weeks after randomisation. The primary outcome will be the change from baseline to the eighth week on the patients’ functional improvements quantified by the Functional Gait Assessment (FGA). The secondary outcomes will include dynamic balance function, emotional well-being, and vestibular activity and participation level. Intention-to-treat analysis will be performed using generalised estimation equation modelling.Ethics and disseminationThe trial has been reviewed and approved by the Institutional Review Board of Eye and Ear Nose Throat Hospital of Fudan University (reference number 2017047/1). The study findings will be disseminated via peer-reviewed journals and conferences.Trial registration numberChiCTR2000029457; Pre-results.