bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the efficacy and safety of acupuncture and acupotomy for patients with cervical spondylotic radiculopathy
Authors: Zhou Shiming , Liu Biao , Guo Jinwei 
Published: March 2021

AbstractBackground:There is no systematic review to compare the efficacy of acupuncture and acupotomy in patients with cervical spondylotic radiculopathy. It is worthy to critically review the evidence of the comparison of these 2 therapies to inform clinical practice. Therefore, the purpose of this study was to compare the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy and to provide evidence for clinical practice.Methods:Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library were searched in March 2021 by 2 independent reviewers. Data extraction was performed independently, and any conflict was resolved before final analysis. Only randomized clinical trials were included in this study. Outcomes included pain intensity, symptom score, neck disability index, total effective rate, and curative rate. The Cochrane risk of bias tool is used to evaluate the risk of bias of included randomized controlled trials by 2 independent reviewers.Results:We hypothesized that these 2 methods would provide similar therapeutic benefits. The results of this research will be delivered in a peer-reviewed journal.Conclusion:This study expects to provide credible and scientific clinical evidence for the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy.OSF registration number:10.17605/OSF.IO/U7T6A.
Disseminated gonococcal infection in a Japanese man with complement 7 deficiency with compound heterozygous variants
Authors: Kageyama Misaki , Hagiya Hideharu , Ueda Yasutaka , Ohtani Katsuki , Fukumori Yasuo , Inoue Norimitsu , Wakamiya Nobutaka , Yoneda Nanoka , Kimura Keigo , Nagasawa Motonori , Nakagami Futoshi , Nishi Isao , Sugimoto Ken , Rakugi Hiromi 
Published: March 2021

Abstract

Rationale:
Complement deficiency are known to be predisposed to disseminated gonococcal infection (DGI). We herein present a case of DGI involving a Japanese man who latently had a complement 7 deficiency with compound heterozygous variants.

Patient concerns:
A previously healthy 51-year-old Japanese man complained of sudden-onset high fever. Physical examination revealed various skin lesions including red papules on his trunk and extremities, an impetigo-like pustule on left forearm, and tendinitis of his right forefinger.

Diagnosis:
Blood culture testing detected gram-negative cocci, which was confirmed to be Neisseria gonorrhoeae based on mass spectrometry and a pathogen-specific PCR test.

Interventions:
Screening tests for underlying immunocompromised factors uncovered that complement activities (CH50) was undetectable. With a suspicion of a congenital complement deficiency, genetic analysis revealed rare single nucleotide variants in complement 7 (C7), including c.281-1G>T and a novel variant c.1454C>T (p.A485V). CH50 was normally recovered by adding purified human C7 to the patient's serum, supporting that the patient has C7 deficiency with compound heterozygous variants.

Outcomes:
Under a diagnosis of DGI, the patient underwent an antibiotic treatment with cefotaxime for a week and was discharged without any sequela.

Lessons:
DGI is a rare sexually-transmitted infection that potentially induces systemic complications. Complement immunity usually defeats N. gonorrhoeae and prevents the organism from causing DGI. This case highlighted the importance of suspecting a complement deficiency when a person develops DGI.
The relationship between mean platelet volume and metabolic syndrome in patients with type 2 diabetes mellitus
Authors: Ding Qinpei , Wang Fangwei , Guo Xintong , Liang Min 
Published: March 2021

Abstract
This study aimed to investigate the association between mean platelet volume (MPV) and metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM). Data for 1240 patients with T2DM admitted to the Department of Endocrinology at the First Affiliated Hospital of Guangxi Medical University between January 1, 2017 and June 1, 2020 were collected retrospectively via electronic medical records, including demographic information, complete blood count, lipid profile, and glucose metabolism indexes. MetS was defined according to the Chinese Diabetes Society. Among the 1240 patients enrolled, 873 (70.40%) had MetS. MPV was significantly higher in patients with MetS (P < .001). For individual MetS components, MPV was significantly higher in the presence of abdominal obesity (P = .013) and hypertriglyceridemia (P = .026), but did not differ in the presence of elevated blood pressure (P = .330) or low high-density lipoprotein cholesterol (P = .790). Moreover, MPV was independently associated with MetS after adjustment for sex, smoking, alcohol drinking, white blood cell count, fasting C-peptide, and body mass index (odds ratio 1.174, 95% confidence interval 1.059–1.302). The odds ratio for MetS in the highest tertile, compared with the lowest MPV tertile, was 1.724 (95% confidence interval 1.199–2.479, P for trend = .003) after multiple adjustment. In stratified analyses, the positive correlation of MPV with MetS was significant only in patients who were older, male, or overweight, or who had poor glycemic control. In conclusion, high MPV was positively associated with the presence of MetS in patients with T2DM, particularly older, male, or overweight patients, or those with poor glycemic control.
Glioblastoma in a female neurofibromatosis 1 patient without IDH1, BRAF V600E, and TERT promoter mutations
Authors: Cai Jia-Wei , Chen Xiao-Yong , Chen Jin-Yuan , Wu Zan-Yi , Wu Xi-Yue , Yu Liang-Hong , You Hong-Hai 
Published: March 2021

Abstract

Rationale:
Glioblastoma is the most lethal and common malignant brain tumor but rare in patients with neurofibromatosis type 1. The clinical findings and pathological findings with gene signatures in female patients have not been well clarified.

Patient concerns:
A 51-year-old female patient complained of headache and left limb weakness lasting for 20 days. The patient underwent a cesarean section 20 years ago and hysterectomy 1 year ago because of uterine leiomyomas. Multiple café-au-lait spots and neurofibromas were found over patient's chest, neck, back, and arms. The myodynamia of left distant and proximate epipodite were grade 0 and grade 1 respectively. The myodynamia of lower left limb was grade 3.

Diagnoses:
Magnetic resonance imaging revealed a malignant lesion which was most likely a glioblastoma in the right temporo-parietal lobe, approximately 5.6 × 5.9 × 6.9 cm in size with a rounded boundary.

Interventions:
A right temporo-parietal craniotomy was performed to resect the space-occupying lesion for gross total removal. Then, the patient received concurrent chemoradiotherapy. Histological examination confirmed a glioblastoma without v-RAF murine sarcoma viral oncogene homolog B1 gene, isocitrate dehydrogenase 1 gene, and telomerase reverse transcriptase gene promoter mutations.

Outcomes:
After surgery, the headache was relieved and the muscular strength of left limbs did improve. After receiving the standard treatment regimen, the patient was alive at 13 months follow-up.

Lessons:
This is the first reported glioblastoma in female neurofibromatosis type 1 patient without v-RAF murine sarcoma viral oncogene homolog B1 gene, isocitrate dehydrogenase 1 gene, and telomerase reverse transcriptase gene promoter mutations. Tumors in adult patients with these signatures were less aggressive with well-circumscribed border and had long-term survivals which strengthened the evidence that these patients may comprise a unique subset in glioblastoma.
Symptomatic bilateral massive pulmonary embolism and proximal and distal deep vein thrombosis following arthroscopic meniscus surgery
Authors: Jeon Sang Hyun , Kwon Geon Ho , Kim Man Soo 
Published: March 2021

Abstract

Rationale:
The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery.

Patient concerns:
The patient underwent arthroscopic meniscus repair with no intraoperative complication. There were no underlying diseases such as hypertension or diabetes. On day 5 postoperative, the patient complained of dyspnea, chest discomfort, and nausea after standing.

Diagnosis:
On DVT and PTE computed tomography, there were multifocal PTEs in the distal portion of the main and segmental branches of both pulmonary arteries. There was a focal thrombosis in the left deep femoral vein, as well as small DVTs in the left popliteal and calf veins.

Interventions:
After 3 days of low-molecular-weight heparin 1 mg/kg every 12 hours, treatment was changed to an oral drug, dabigatran, for 6 months.

Outcomes:
There were no PTE or DVT findings on computed tomography at 6 months postoperative. The patient did not complain of symptoms related to PTE or DVT at 6 months after the operation, has returned to work, and is living without discomfort.

Lessions:
The frequency of VTE is very low after arthroscopic meniscus surgery, but it represents a life-threatening event. Our patient had risk factors for VTE including obesity, surgery time of ∼60 minutes, and immobilization. Although arthroscopic meniscus surgery is relatively safe, evaluation of risk factors for VTE should be performed before and after surgery, and appropriate thromboprophylaxis should be provided when necessary.
Advancing African otolaryngology and head & neck surgery education and training through virtual academic platforms and multidisciplinary teams
Authors: Din Taseer F. , Macharia Chege , Harris Tashneem 
Published: March 2021

Purpose of review
To overview the rise of virtual tools to propagate academia and clinical service within Africa, in the field of otolaryngology, propelled by the coronavirus disease 2019 (COVID-19) pandemic.

Recent findings
The rise of the COVID-19 virus saw a dramatic reduction in elective surgery and outpatient services with a subsequent reduction in experiential learning for trainees. This has spurred the rising trend to maintain the mission of education and clinical service, virtually. There have been unprecedented levels of international collaboration in the ‘pandemic year of 2020’ that has seen various platforms conceived to harmonize varying practices from global experts towards the ultimate goal of education propagation and improved patient care. The continent of Africa, amidst its own unique challenges, has boldly stepped into the virtual realm in form of a resident-centred platform coined University Of Cape Town-Africa Virtual ENT, and two multidisciplinary team (MDT) meetings: the African Head and Neck Society Virtual Tumour Board and the African Virtual Cochlear Implant Meeting.

Summary
The COVID-19 pandemic will have long-lasting effects on clinical practice and training programs globally. This has demanded academicians to re-imagine novel ways to buoy academia and maintain international collaboration in an inexpensive and convenient way to nourish the sacred mission of education and clinical service within our spirited continent.
Tolerance, immunosuppression, and immune modulation: impacts on lung allograft survival
Authors: Shepherd Hailey M. , Gauthier Jason M. , Kreisel Daniel 
Published: March 2021

Purpose of review
Immune responses following lung transplantation continue to result in high rates of allograft failure and rejection, and current immunosuppression does not address the unique immunologic properties of the lung. Here, we review recent studies on lung allograft tolerance and alloimmunity and discuss implications for immunosuppression.

Recent findings
Processes governing tolerance and alloimmunity in lung allografts differ from other solid organs. Recent studies have suggested that allorecognition is regulated at the level of the lung graft. Furthermore, certain cell populations essential for lung allograft tolerance may facilitate rejection in other organs. Induction of lung allograft tolerance is associated with the formation of tertiary lymphoid organs, which are enriched in regulatory T cells and play an important role in preventing rejection.

Summary
Recent discoveries regarding alloactivation and the regulation of tolerance following lung transplantation have introduced exciting potential avenues for the development of lung-specific immunosuppression.
The evolving role of ECMO in liver transplantation
Authors: Hogen Rachel , Sedra Ashraf H. , Motamed Arash , Emamaullee Juliet 
Published: March 2021

Purpose of review
To review the indications for extra-corporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients and their optimal management on ECMO.

Recent findings
Recent studies have reported a 30–40% survival rate among LT recipients that receive ECMO. Increasingly, case reports have documented successful outcomes of LT performed for patients on preoperative ECMO. Outcomes appear to be superior with patients in the immediate peri-LT period with reversible causes of severe, acute respiratory, and/or cardiovascular collapse. Mortality is most commonly secondary to infection. Volume optimization with CRRT may improve outcomes and perfusion to the graft, especially for patients on veno-arterial ECMO. There is little consensus on management of anticoagulation in these patients, but it can likely be held temporarily when the patient is coagulopathic and/or experiencing bleeding complications.

Summary
ECMO should be considered in the peri-LT period for patients with severe, acute, and reversible causes of respiratory and/or cardiovascular collapse, with acceptable outcomes in patients that would otherwise not be expected to survive. Management of the post-LT patient on ECMO is challenging with a slowly enlarging body of literature to inform decision making.
Prevalence of Drinking Within Low-Risk Guidelines During the First 2 Years After Inpatient Rehabilitation for Moderate or Severe Traumatic Brain Injury
Authors: Adams Rachel Sayko , Ketchum Jessica M. , Nakase-Richardson Risa , Katz Douglas I. , Corrigan John D. 
Published: March 2021

Abstract
The objective of this retrospective, longitudinal study was to investigate the prevalence of drinking within the recommended limits (i.e., low-risk drinking) after moderate/severe traumatic brain injury (TBI). Data were drawn from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems National Database, a longitudinal dataset closely representative of the US adult population requiring inpatient rehabilitation for TBI. The sample included 6348 adults with moderate or severe TBI (injured October 2006–May 2016) who received inpatient rehabilitation at a civilian TBI Model Systems center and completed the alcohol consumption items preinjury and 1 and 2 yrs postinjury. National Institute on Alcohol Abuse and Alcoholism guidelines define low-risk drinking as no more than 4 drinks per day for men or 3 drinks per day for women and no more than 14 drinks per week for men or no more than 7 drinks per week for women. Low-risk drinking was common both before and after TBI, with more than 30% drinking in the low-risk level preinjury and more than 25% at 1 and 2 yrs postinjury. Postinjury, most drinkers consumed alcohol in the low-risk level regardless of preinjury drinking level. Definitive research on the long-term outcomes of low-risk alcohol consumption after more severe TBI should be a high priority.
Tensiomyographic changes of muscle contractile properties in individuals with lower-limb amputation: A pilot study
Authors: Fujishita Hironori , Maeda Noriaki , Urabe Yukio , Komiya Makoto , Sakai Shogo , Fukuhara Kouki , Kimura Hiroaki , Adachi Nobuo 
Published: March 2021

Background:
Individuals with a unilateral lower-limb amputation (LLA) rely heavily on their intact limb during daily physical activities. However, there is limited research on the resultant effects of this over-reliance on contractile properties of muscles in the intact limb.

Objective:
To compare the muscle contractile properties of the intact limb among individuals with a unilateral LLA to those of age-matched able-bodied individuals, using tensiomyography.

Study Design:
This is a cross-sectional, observational study.

Methods:
Nine men with a unilateral LLA and 10 able-bodied men (control) were included. Tensiomyography measures were obtained for 5 muscles: gastrocnemius lateralis (GL) and medialis (GM), rectus femoris, vastus lateralis (VL), and vastus medialis. Contraction time (Tc), delay time (Td), maximal displacement (Dm), and velocity of deformation (Vd) for each muscle were compared between groups.

Results:
Tc and Td for the GL and GM muscles were lower for the LLA than the control group (GL: P = .03, r = −0.51, P < .01, r = 0.67; GM: P = .02, r = 0.53, P = .07, r = 0.54, respectively). Dm and Vd of the VL were significantly smaller in the LLA than the control group (P < .01, r = 0.73, P < .01, r = 0.23, respectively).

Conclusions:
Men with a unilateral LLA seem to have slower deformation of the gastrocnemius muscles and higher stiffness of the VL than able-bodied controls. These findings may be indicative of an overuse of the intact limb as a compensation for the unilateral LLA. The confirmation of these findings in a larger sample size is required to translate these findings to practice.
Hepatic Radiofrequency Ablation
Authors: Collettini Federico , Brangsch Julia , Reimann Carolin , Chapiro Julius , Savic Lynn Jeanette , Buchholz Rebecca , Keller Sarah , Hamm Bernd , Goldberg S. Nahum , Makowski Marcus R. 
Published: March 2021

Objectives
Macrophages accumulating in the periablational rim play a pivotal role in initiating and sustaining the perifocal inflammatory reaction, which has been shown to be at least 1 of the mechanisms responsible for the systemic pro-oncogenic effects of focal hepatic radiofrequency ablation (RFA). Herein, we tested the hypothesis to use superparamagnetic iron oxide nanoparticle (SPION)–enhanced magnetic resonance imaging (MRI) for noninvasive quantification of iron-loaded macrophages in the periablational rim of VX2 tumor-bearing rabbits.

Materials and Methods
Twelve VX2 tumor-bearing rabbits underwent MRI immediately after and up to 3 weeks after focal hepatic RFA. For noninvasive quantification of macrophage accumulation in the periablational rim, animals were scanned before and 24 hours after SPION injection. T2*-weighted images were analyzed and correlated with histopathological and immunohistochemical findings. Furthermore, correlations with quantitative measurements (ICP-MS [inductively coupled plasma–mass spectrometry] and LA-ICP-MS [laser ablation–ICP-MS]) were performed.

Results
SPION-enhanced T2*-weighted MRI scans displayed a progressive increase in the areas of signal intensity (SI) loss within the periablational rim peaking 3 weeks after RFA. Accordingly, quantitative analysis of SI changes demonstrated a significant decline in the relative SI ratio reflecting a growing accumulation of iron-loaded macrophages in the rim. Histological analyses confirmed a progressive accumulation of iron-loaded macrophages in the periablational rim. The ICP-MS and LA-ICP-MS confirmed a progressive increase of iron concentration in the periablational rim.

Conclusions
SPION-enhanced MRI enables noninvasive monitoring and quantification of ablation-induced macrophage recruitment in the periablational rim. Given the close interplay between ablation-induced perifocal inflammation and potential unwanted tumorigenic effects of RFA, SPION-enhanced MRI may serve as a valuable tool to guide and modulate adjuvant therapies after hepatic RFA.
A Novel Deep Learning Based Computer-Aided Diagnosis System Improves the Accuracy and Efficiency of Radiologists in Reading Biparametric Magnetic Resonance Images of the Prostate
Authors: Winkel David J. , Tong Angela , Lou Bin , Kamen Ali , Comaniciu Dorin , Disselhorst Jonathan A. , Rodríguez-Ruiz Alejandro , Huisman Henkjan , Szolar Dieter , Shabunin Ivan , Choi Moon Hyung , Xing Pengyi , Penzkofer Tobias , Grimm Robert , von Busch Heinrich , Boll Daniel T. 
Published: March 2021

Objective
The aim of this study was to evaluate the effect of a deep learning based computer-aided diagnosis (DL-CAD) system on radiologists' interpretation accuracy and efficiency in reading biparametric prostate magnetic resonance imaging scans.

Materials and Methods
We selected 100 consecutive prostate magnetic resonance imaging cases from a publicly available data set (PROSTATEx Challenge) with and without histopathologically confirmed prostate cancer. Seven board-certified radiologists were tasked to read each case twice in 2 reading blocks (with and without the assistance of a DL-CAD), with a separation between the 2 reading sessions of at least 2 weeks. Reading tasks were to localize and classify lesions according to Prostate Imaging Reporting and Data System (PI-RADS) v2.0 and to assign a radiologist's level of suspicion score (scale from 1–5 in 0.5 increments; 1, benign; 5, malignant). Ground truth was established by consensus readings of 3 experienced radiologists. The detection performance (receiver operating characteristic curves), variability (Fleiss κ), and average reading time without DL-CAD assistance were evaluated.

Results
The average accuracy of radiologists in terms of area under the curve in detecting clinically significant cases (PI-RADS ≥4) was 0.84 (95% confidence interval [CI], 0.79–0.89), whereas the same using DL-CAD was 0.88 (95% CI, 0.83–0.94) with an improvement of 4.4% (95% CI, 1.1%–7.7%; P = 0.010). Interreader concordance (in terms of Fleiss κ) increased from 0.22 to 0.36 (P = 0.003). Accuracy of radiologists in detecting cases with PI-RADS ≥3 was improved by 2.9% (P = 0.10). The median reading time in the unaided/aided scenario was reduced by 21% from 103 to 81 seconds (P < 0.001).

Conclusions
Using a DL-CAD system increased the diagnostic accuracy in detecting highly suspicious prostate lesions and reduced both the interreader variability and the reading time.