bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying the Microvascular Anastomotic Coupler Device to End-to-side Venous Anastomosis in Reconstructive Surgery
Authors: Umezawa Hiroki , Hokazono Yu , Taga Marie , Ogawa Rei 
Published: January 2022

Background:
Microsurgical vascular anastomosis plays an important role in successful free-tissue transfer. The Microvascular Anastomotic Coupler Device (MACD) aims to simplify anastomosis and decrease the time spent on this step, thereby reducing surgeon stress and improving the overall quality of the surgery, especially when venous end-to-side anastomosis is required. Our comparative retrospective cohort study aimed to determine the effect of this widely used device on anastomosis times and complications in head and neck/esophageal reconstruction cases involving venous end-to-side anastomosis using the internal jugular vein as the recipient vessel.

Methods:
All consecutive patients who underwent head and neck/esophageal reconstruction with hand-sewn or MACD-mediated venous end-to-side anastomosis using the internal jugular vein by three experienced microsurgeons in our tertiary-care hospital in 2012–2020 were identified. Venous anastomosis times and venous trouble cases were recorded.

Results:
Of the 191 cases, 44 and 147 underwent hand-sewn and MACD-mediated anastomosis respectively. The average venous anastomosis times of these groups were 31 and 11 minutes, respectively. Venous trouble was observed in two hand-sewn (4.5%) and four MACD (2.7%) cases, respectively. Vein twisting and improper coupler placement were the causes in the latter four cases.

Conclusions:
This study confirmed that MACD simplifies end-to-side venous anastomosis and reduces the time spent on this procedure. Also, for safer anastomosis, it is necessary to pay attention to preventing twisting and improper coupler placement when using MACD. We believe the MACD can improve the quality of reconstructive surgery.
Outcome measures in clinical trials of traditional Chinese medicine for stable angina pectoris
Authors: Xing Dongmei , Zhu Mingjun , Liu Chunxiang , Wang Hui 
Published: January 2022

Abstract

Objective:
This work aimed to present a descriptive analysis of the outcome measures used in clinical trials of traditional Chinese medicine (TCM) for patients with stable angina pectoris, and to provide baseline data for the development of core outcome sets (COSs) for relevant clinical trials.

Methods:
Medical databases were searched to identify randomized trials of the effects of TCM for the treatment of stable angina pectoris. Outcome measures of each trial were extracted. Descriptive statistics were used to analyze the baseline characteristics of outcomes in clinical trials of TCM.

Results:
94 randomized trials (with 9,111 participants) involving 79 different outcomes were identified. The mean number of outcomes was 5 (1–21 per trial). The 5 most commonly reported outcomes were efficacy rate of electrocardiogram, efficacy rate of angina pectoris, efficacy rate of TCM syndrome, fasting lipid indices, and withdrawal rate of nitroglycerin. Several challenges were identified: (1) significant heterogeneity of outcomes and differences in the technique and timing of the measurement of the same outcome; (2) transformation of continuous data into categorical data and presented as such in >90% of trials; (3) few trials on the outcomes associated with the advantages and characteristics of TCM; and (4) selective reporting of outcomes.

Conclusions:
The outcomes used are excessively heterogenous, and the choice of some outcomes (timing and techniques) for measurement is confusing or inappropriate. Hence, developing and implementing a COS is necessary for greater consistency.
The rationale behind the four major anti-COVID-19 principles of Chinese herbal medicine based on systems medicine
Authors: Jin Guanyuan , Jin Louis Lei , Jin Bonnie Xia 
Published: January 2022

Abstract
As the novel coronavirus disease 2019 (COVID-19) and its variants continue to rage into the second year of a global pandemic, many success stories of applying Chinese herbal medicine (CHM) to treat COVID-19 patients continue to emerge from China and other part of the world. Herewith, from a systems medicine perspective, the authors analyze those experiences and categorize them into four major treatment principles: (1) focusing on eliminating toxins in the early stage of the disease, (2) tonifying deficiency of the body throughout the entire disease course, (3) treating the affected lung and intestine simultaneously based on visceral interactions, (4) cooling blood and removing blood stasis at the later stage, as well as interpret the rationale of these principles. This is helpful not only in reducing the complexity of promoting the CHM applications to enhance anti-COVID-19 efficacy, but also in ramping out the process of integrating traditional Chinese medicine with modern medical practices.
Development and evaluation of Panax notoginseng saponins contained in an in situ pH-triggered gelling system for sustained ocular posterior segment drug delivery
Authors: Lu Peng , Wang Renxing , Xing Yue , Gao Yanquan , Zhang Qingqing , Xing Bin , Zhang Ying , Yu Changxiang , Cai Xinfu , Shang Qiang , Kebebe Dereje , Pi Jiaxin , Liu Zhidong 
Published: January 2022

Abstract

Objective:
This study aimed to lay the foundation for the research on Panax notoginseng saponins (PNS) in pH-sensitive in situ gel and the development and improvement of related preparations.

Methods:
We used Carbopol®940, a commonly used pH-sensitive polymer, and the thickener hydroxypropyl methylcellulose (HPMC E4M) as an ophthalmic gel matrix to prepare an ophthalmic in situ gel of PNS. In addition, formula optimization was performed by assessing gelling capability with the results of in vitro release studies. In vitro (corneal permeation, rheological, and stability) and in vivo (ocular irritation and preliminary pharmacokinetics in the vitreous) studies were also performed.

Results:
The results demonstrated that the in situ gelling systems containing PNS showed a sustained release of the drug, making it an ideal ocular delivery system for improving posterior ocular bioavailability.

Conclusions:
This study lays the foundation for the research of PNS contained in an in situ pH-triggered gel as well as the development and improvement of related preparations. It concurrently traditional Chinese medicine with a contemporary in situ gelling approach to provide new directions for the treatment of posterior ocular diseases such as diabetic retinopathy.
POLYPOIDAL CHOROIDAL VASCULOPATHY ASSOCIATED WITH SECTOR RETINITIS PIGMENTOSA
Authors: Appanraj Ramya , Manayath George J. , Verghese Shishir , Narendran Venkatapathy 
Published: January 2022

Purpose:
To report a case of polypoidal choroidal vasculopathy associated with sector retinitis pigmentosa.

Methods:
Case report.

Results:
A 63-years-old woman presented with complaints of having painless progressive reduction of vision in the left eye (LE) for the past 6 months. On examination, her best-corrected visual acuity was 20/20 in the right eye and 20/125 in the LE. Based on fundus examination and multimodal imaging findings, both eyes were diagnosed to have sector retinitis pigmentosa, and an associated active extramacular polypoidal choroidal vasculopathy was seen in the LE. Spectral-domain optical coherence tomography also revealed choroidal thinning in both eyes. Patient underwent bevacizumab injection in the LE. At 1-month posttreatment, her best-corrected visual acuity remained stable in the LE, and spectral-domain optical coherence tomography showed reduction in subretinal fluid and size of the polypoidal lesion.

Conclusion:
Polypoidal choroidal vasculopathy, a pachychoroid disease, could occur in association with retinitis pigmentosa, in the setting of thin choroids, and multimodal imaging is important to differentiate it from Type-1 macular neovascularization.
Risk Factors for Severity and Mortality in Adult Patients Confirmed with COVID-19 in Sierra Leone: A Retrospective Study
Authors: Tu Bo , Lakoh Sulaiman , Xu Biao , Lado Marta , Cole Reginald , Chu Fang , Hastings-Spaine Susan , Jalloh Mohamed Bole , Zheng Junjie , Chen Weiwei , Sevalie Stephen 
Published: January 2022

Abstract

Background:
The coronavirus disease 2019 (COVID-19) is a highly infectious respiratory disease. There is no recommended antiviral treatment approved for COVID-19 in Sierra Leone, and supportive care and protection of vital organ function are performed for the patients. This study summarized the clinical characteristics, drug treatments, and risk factors for the severity and prognosis of COVID-19 in Sierra Leone to provide evidence for the treatment of COVID-19.

Methods:
Data of 180 adult COVID-19 patients from the 34th Military Hospital in Freetown Sierra Leone between March 31, 2020 and August 11, 2020 were retrospectively collected. Patients with severe and critically ill are classified in the severe group, while patients that presented asymptomatic, mild, and moderate disease were grouped in the non-severe group. The clinical and laboratory information was retrospectively collected to assess the risk factors and treatment strategies for severe COVID-19. Demographic information, travel history, clinical symptoms and signs, laboratory detection results, chest examination findings, therapeutics, and clinical outcomes were collected from each case file. Multivariate logistic analysis was adopted to identify the risk factors for deaths. Additionally, the clinical efficacy of dexamethasone treatment was investigated.

Results:
Seventy-six (42.22%) cases were confirmed with severe COVID-19, while 104 patients (57.78%) were divided into the non-severe group. Fever (56.67%, 102/180) and cough (50.00%, 90/180) were the common symptoms of COVID-19. The death rate was 18.89% (34/180), and severe pneumonia (44.12%, 15/34) and septic shock (23.53%, 8/34) represented the leading reasons for deaths. The older age population, a combination of hypertension and diabetes, the presence of pneumonia, and high levels of inflammatory markers were significantly associated with severity of COVID-19 development (P < 0.05 for all). Altered level of consciousness [odds ratio (OR) = 56.574, 95% confidence interval (CI) 5.645–566.940, P = 0.001], high levels of neutrophils (OR = 1.341, 95%CI 1.109–1.621, P = 0.002) and C-reactive protein (CRP) (OR = 1.014, 95%CI 1.003–1.025, P = 0.016) might be indicators for COVID-19 deaths. Dexamethasone treatment could reduce mortality [30.36% (17/56) vs. 50.00% (10/20)] among severe COVID-19 cases, but the results were not statistically significant (P > 0.05).

Conclusions:
The development and prognosis of COVID-19 may be significantly correlated with consciousness status, and the levels of neutrophils and CRP.
Oculopharyngeal Muscular Dystrophy Ptosis, Mueller’s Muscle Involvement, and a Review of Management Over 34 Years
Authors: Jordan David R. , Klapper Stephen R. , Farmer James 
Published: January 2022

Purpose:
To review the management of the ptosis associated with oculopharyngeal muscular dystrophy (OPMD) from one author’s experience over 34 years, demonstrate Mueller’s muscle involvement in this disease, and how this impacts the preferred choice of surgery.

Methods:
Retrospective, nonrandomized comparative case series. Forty patients with OPMD who underwent primary bilateral ptosis surgery through an anterior eyelid incision and had their Mueller’s muscle biopsied (one side) and sent for histopathologic analysis were selected for chart review. The main outcome measure was the presence or absence of dystrophic changes in the biopsied Mueller’s muscle.

Results:
In 29/40 biopsies (72.5%), there were dystrophic changes and fatty infiltration of Mueller’s muscle identified histopathologically.

Conclusions:
Mueller’s muscle is involved in the dystrophic process more often than expected contributing to ptosis in the OPMD syndrome. A combined Mueller’s-aponeurotic advancement is more effective at elevating the eyelid than simply advancing the aponeurosis when Mueller’s is fatty infiltrated at the time of external levator advancement surgery in our experience. Management strategies for ptosis surgery in OPMD are reviewed. The age of onset, levator muscle function, previous ptosis repair, how debilitated the patient is with their disease process systemically, as well as the presence of other eye problems (e.g., dry eye, prior glaucoma filtering procedures, history of corneal surgery, laser refractive procedure) are important clinical considerations in patients with OPMD.
Peripheral Trigeminal Nerve Blocks for Chronic Orbital Pain: Clinical Features and Outcomes
Authors: Lee Grace , Pham Chau M. , Kardon Randy H. , Shriver Erin M. 
Published: January 2022

Purpose:
To characterize chronic orbital pain in patients who benefitted from peripheral trigeminal nerve blocks and to explore the relationship between pain etiologies and phenotypes, injection attributes, and positive response to treatment.

Methods:
In this single-center retrospective descriptive study, patients who underwent peripheral trigeminal nerve blocks for chronic orbital pain from November 2016 to May 2021 were selected. Data reviewed included inciting factors, neuropathic symptoms of orbital pain, injection composition (anesthetic alone versus anesthetic + dexamethasone), and corneal epitheliopathy grades. Primary outcomes assessed were response to injection, duration of injection effectiveness, and overall treatment efficacy. Associations between subgroups of chronic orbital pain, injection attributes, and treatment outcomes were examined.

Results:
Nineteen patients who underwent a total of 94 peripheral trigeminal nerve blocks for chronic orbital pain were included. During a mean follow-up period of 2.4 years after initial injection (range 7 days–4.6 years), 16 (84.2%) patients achieved either partial or complete improvement. Ocular versus nonocular origin of orbital pain or the presence of neuropathic sensory characteristics was not associated with a treatment outcome. Injections containing dexamethasone had a lower positive efficacy (relative risk, 0.88; 95% CI, 0.81–0.97) and no statistically significant association with prolonged effect. Twenty-nine (50.9%) of the 57 injections for which effect duration was recorded produced a response lasting greater than 6 weeks.

Conclusions:
Modulation of trigeminal afferent nerve activity with peripheral trigeminal nerve blocks containing anesthetic with or without dexamethasone may be a promising treatment strategy for chronic orbital pain of diverse etiologies and phenotypes.
Functional Improvement During Prolonged Hospitalization in a Patient With Acute Myeloid Leukemia Utilizing Physical and Occupational Therapy Comanagement
Authors: Strikwerda Jessica A. , Bodensteiner Schmitt Emily A. 
Published: January 2022

Background and Purpose:
Being physically active and mobile in the acute care setting has been shown to improve functional outcomes in individuals with cancer. Patient participation in occupational (OT) and physical therapy (PT) activities contributes to this; however, specific interventions and strategies are rarely described in the rehabilitation literature. Even more limited are descriptions of the purpose and implementation of OT and PT cotreatment therapy sessions. This case report describes OT and PT treatment interventions, including cotreatment therapy sessions, used in the management of a patient with prolonged hospitalization.

Case Description:
A 65-year-old man with a medical diagnosis of acute myeloid leukemia was admitted to the hospital for abdominal pain, dehydration, and poor appetite. His hospital course totaled 101 days and included 27 days in the intensive care unit (ICU). Medical complications included graft-versus-host disease and recurrent gastrointestinal bleeding. At therapy evaluation, voluntary motor activation was not visualized or felt during transfers. The patient had impaired balance and impaired cognition, and he needed total assistance to sit at the edge of the bed.

Intervention:
The patient received 13 weeks of OT and PT treatment in the ICU and continued until hospital discharge. OT and PT cotreatment therapy sessions were used throughout this period of patient care to maximize the patient's recovery of mobility and endurance.

Results:
At hospital discharge, the patient was independent in bed mobility and ambulation using a 4-wheeled walker. He was able to navigate 6 stair steps using handrails. For activities of daily living, he was independent in grooming, upper body dressing, toileting, lower body dressing, and showering from a seated position.

Discussion:
The use of both cotreatment and individual therapy sessions may be beneficial for individuals with cancer at different stages of functional recovery in the acute care setting. Cotreatment therapy sessions were used in this case when both OT and PT providers could address their different therapy goals during the same treatment session. The patient in this case report initially required total assistance for functional mobility and activity and achieved near-full independence at hospital discharge.
Epidemiological investigation and ultrasonic diagnosis of developmental dysplasia of the hip in Chinese infants
Authors: Xu Na , Xia Bei , Tao Hongwei , Sun Ke , Liu Qinghua , Chen Wenjuan , Wang Dan , Gao Hong , Guo Yan , Liu Yan , Gao Jun , Teng Jianbo , Li Tianzi , He Qiancheng , Wu Zhixia 
Published: January 2022

Abstract
Developmental dysplasia of the hip (DDH) is common among Chinese infants, but a lack of large-scale, multi-center epidemiological studies has made it difficult to characterize the risk factors associated with this disease.This multi-center cohort study included 19,833 Chinese infants aged 14 days to 6 months. A multi-center ultrasound protocol was used to diagnose hip abnormalities, and epidemiological data of the infants were collected through questionnaires. Categorical variables were expressed as percentages and compared using χ2 test. Multivariate analysis was performed through logistic regression.
Of 19,833 infants, 345 had DDH (1.7%). DDH incidence was higher in female infants (n = 279) than in male infants (n = 66) (χ2 = 95.89, P < .05), and there were more left hip cases (n = 149) than right hip cases (n = 79) (χ2 = 12.49, P < .05). DDH incidence was statistically different amongst different age groups in months (χ2 = 451.71, P < .05), and it gradually decreased with age (P < .05). The prevalence of a positive DDH family history, breech presentation, oligohydramnios, swaddling style, and other musculoskeletal deformities was higher in the positive group than in the negative group (all P < .05). No significant differences were found in terms of delivery by cesarean section, multiple births, or premature birth between both groups.
Family history, breech presentation, oligohydramnios, musculoskeletal deformities, and female sex are high-risk factors for DDH in Chinese infants. The incidence of DDH gradually decreases with age. The results of this study provide evidence for the epidemiology of infant DDH in China.
Early treatment of rituximab combined with eltrombopag for secondary thrombocytopenic purpura in rheumatoid arthritis
Authors: Zhang Naidan , Ji Chaixia , Bao Xiao , Yuan Chengliang 
Published: January 2022

Abstract

Rationale:
Secondary immune thrombocytopenic purpura (ITP) is also known as acquired thrombocytopenic purpura, autoimmune disease is usually one of the important causes. There are few reports about treatment of refractory thrombocytopenic purpura in rheumatoid arthritis (RA). We report a case of refractory ITP in which changes in platelet-related markers with therapeutic agents are worthy of the attention of clinicians.

Patient concerns:
A 69-year-old woman admitted for ecchymosis on the neck and arms for 15 days presented to our hospital. She was diagnosed with RA 5 years ago.

Diagnosis:
The diagnosis met the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria. The disease activity score 28 (DAS-28) was 4.6, indicating that the disease activity was moderate.

Interventions:
Treatment with first-line therapies and second-line treatment--eltrombopag (EPAG) were ineffective. Therefore, we performed rituximab combined with a low dose of EPAG.

Outcomes:
The patient received 2 cycles of rituximab combined with EPAG, and reported no new petechiae on her buccal mucosa and limbs during follow-up.

Lessons:
This case suggests that early treatment of rituximab combined with EPAG is beneficial to patients with refractory ITP in RA. In terms of disease dynamic monitoring, immature platelet fraction (IPF) may be an auxiliary indicator for predicting efficacy, but its significance needs further study.
Immune checkpoint inhibitor-induced refractory polyarthritis rapidly improved by sarilumab and monitoring with joint ultrasonography
Authors: Abe Kazuya , Ishikawa Yuichi , Fujiwara Michio , Yukawa Hiroko , Yanagihara Takeshi , Takei Saori , Arioka Hitoshi , Kita Yasuhiko 
Published: January 2022

Abstract

Rationale:
Immune checkpoint inhibitors (ICIs) have shown efficacy for the treatment of various kinds of malignant tumors. However, ICIs can cause immune-related adverse events, such as arthritis. Nevertheless, the treatment of ICI-induced arthritis has not been established yet. Here we report a case of ICI-induced polyarthritis successfully treated using sarilumab and monitored using joint ultrasonography.

Patient concerns:
A 61-year-old man presented with polyarthritis. He had been treated with nivolumab for recurrent renal cell carcinoma 11 months before. He developed ICI-induced nephritis (proteinuria and elevated serum creatinine) 3 months before, which resolved after discontinuing nivolumab for 1 month. Two months after resuming nivolumab, he developed polyarthralgia and joint swelling, which were suspected to be associated with nivolumab administration, and hence we discontinued nivolumab again. Laboratory tests revealed elevated C-reactive protein level and erythrocyte sedimentation rate, but were negative for rheumatoid factor and anti-cyclic citrullinated peptide antibody. Joint ultrasonography revealed active synovitis in several joints, but a joint X-ray revealed no bone erosion.

Diagnoses:
We diagnosed polyarthritis as ICI-induced arthritis because the findings were not typical of rheumatoid arthritis (no bone erosion and seronegativity) and the patient had already developed other immune-related adverse events (ICI-induced nephritis).

Interventions:
After discontinuation of nivolumab, we started treatment with 15 mg daily prednisolone and 1000 mg daily sulfasalazine, although it was ineffective. Hence, we initiated 200 mg biweekly sarilumab.

Outcomes:
Following sarilumab administration, polyarthritis improved rapidly, and joint ultrasonography confirmed the rapid improvement of synovitis. Hence, we tapered off the glucocorticoid treatment. No recurrence of renal cell carcinoma was noted for 2 years after the initiation of sarilumab despite no anti-tumor therapy.

Lessons:
Sarilumab may serve as a good treatment option for treating refractory ICI-induced polyarthritis. Joint ultrasonography may contribute to the evaluation of ICI-induced polyarthritis and monitoring the effects of treatments.