فهرست مطالب

  • Volume:22 Issue: 7, 2020
  • تاریخ انتشار: 1399/05/19
  • تعداد عناوین: 21
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  • Evaluating the Effect of Planned Online Video Visitations on Anxiety and Depression of Patients at Open Heart Intensive Care Unit: A Randomized Controlled Trial
    Hossein Shahdosti, Seyed Reza Mazlom *, Saeed Vaghee, Shahram Amini Page 1
    Background

    Anxiety and depression are among the most important and common problems in patients admitted to the intensive care unit open-heart (ICU-OH). While the family plays a vital supportive role in decreasing these complications, patients are deprived of this supportive source during the important post-operative days due to visiting restrictions at these wards.

    Objectives

    Therefore, this study aimed to evaluate the role of online video visitations on the anxiety and depression of patients at ICU-OH.

    Methods

    This randomized clinical trial was carried out among 66 patients at ICU-OH of Imam Reza Hospital in Mashhad, Iran. The subjects were selected by the convenience sampling method and were randomly allocated to the intervention and control groups. Data were collected using a demographic characteristics checklist and HADS. In the intervention group, online video visitations with the family were carried out three times in the morning, evening and night on the second and third days of hospitalization in ICU-OH. In the control group, patients received the routine care of the ward and had no visitations with their families. Data were collected before the surgery, as well as 24 and 48 hours after admission to the ICU-OH. In addition, data analysis was performed in SPSS using independent t-test, Mann-Whitney U test, paired t-test, and Chi-square test.

    Results

    No significant difference was observed between the intervention (7.8 ± 2.2) and control (8.3 ± 2.3) groups regarding the mean anxiety score 24 hours after the intervention (P = 0.416). However, the mean anxiety scores 48 hours after the intervention were 6.1 ± 2.3 and 7.7 ± 2.6 in the intervention and control groups, respectively, showing a significant decrease in the intervention group, compared to the control group (P = 0.010). However, the mean depression scores 24 and 48 hours after the intervention were estimated at 8.0 ± 2.0 and 7.1 ± 2.0, respectively, demonstrating no significant difference from the control group (P = 0.933 and P = 0.269).

    Conclusions

    According to the study results, online video visitations decreased anxiety in patients at ICU-OH. Therefore, it is recommended that this method be used as an alternative to in-person meetings of patients at this ward.

    Keywords: Anxiety, Depression, Planned Online Video Visitations, ICU-OH
  • Engeng Chen, Zhiyao Xu, Gaoyang Cao, Li Chen * Page 2
    Introduction

    Primary colorectal angiosarcoma is a highly rare malignant tumor. There is no standard treatment method for this disease. No treatment of rectal angiosarcoma with apatinib has been reported so far.

    Case Presentation

    In the current study, an 87-year-old male presented with the symptoms of frequent defecation for more than one month in Hangzhou, China, in 2018. The patient was initially diagnosed with a rectal stromal tumor. The patient underwent ultrasound-guided transrectal mass puncture in the next treatment. However, immunohistochemical examinations confirmed the initial diagnosis of rectal angiosarcoma. The patient had advanced age and rectal angiosarcoma with metastasis; he had no surgical indications, and we tried to use apatinib 250 mg/d treatment to control the progression of the lesion. Then, he received apatinib, a novel tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2). The patient has been stable to apatinib with a dose of 250 mg daily by now.

    Conclusions

    Apatinib may play an important role in the treatment of unresectable angiosarcoma.

    Keywords: Case Report, Apatinib, Rectal Angiosarcoma
  • Samira Faraji, Rasoul Zarrin, Asma Zamanian, Reza Hajizadeh, Parvin Ayremlou, Behzad Rahimi * Page 3
    Background

    Hypertension is one of the most serious global concerns since it has affected over 1.2 billion people.

    Objectives

    The present study aimed to determine the effect of vitamin D supplementation on blood pressure, fasting blood sugar, and lipid profile in hypertensive patients with vitamin D deficiency.

    Methods

    In this double-blinded randomized placebo-controlled clinical trial study, 116 hypertensive patients (intervention and placebo groups, 58 each) with vitamin D deficiency (< 30 ng/mL with ECL) for 14 weeks, started from the beginning of autumn 2019 in Seyed-al-Shohada Educational Hospital in Urmia City. Fifty-five patients (49%) were male with the mean vitamin D 15.89 ± 5.09 ng/mL and 57 females with 17.29 ± 6.31 ng/mL. In a stratified blocked randomization scheme, the patients were randomly allocated into similar sized intervention and control groups based on body mass index (BMI), then the randomization with four block size was performed in each of strata by random allocation software. The intervention group received six doses of 50,000 IU vitamin D supplements for 6 weeks, then two supplements for two following months (one capsule per month). Blood pressure (24/h blood pressure measured by an ambulatory blood pressure monitoring device), vitamin D, FBS, and lipid profile (HDL, LDL, CL, and TG) were all measured at baseline and end of the study. Physical activity (measured by short IPAQ questionnaire), sun exposure using a questionnaire, dietary intake of vitamin D using three 24-hour recalls during the intervention, and anthropometric indices were measured at baseline, middle, and end of the study. Fifty-six patients in each group completed the study. The study was approved by the Ethics Committee of the Urmia University of Medical Sciences (ethics code: IR.UMSU.REC.1398.192).

    Results

    The office blood pressure, 24-h systolic blood pressure (SBP) and diastolic blood pressure (DBP), nighttime SBP and DBP were significantly reduced in the intervention group compared to the control group, whereas the reduction of daytime SBP and DBP was not statistically significant. Vitamin D supplementation significantly decreased serum triglyceride, cholesterol, and LDL levels.

    Conclusions

    Vitamin D supplementation had positive effects on blood pressure, triglyceride, cholesterol, and LDL levels in patients with low serum vitamin D.

    Keywords: Vitamin D, Hypertension, Vitamin D Deficiency, Ambulatory Blood Pressure Monitoring
  • Farzaneh Karami, Fateme Assarian *, Fatemeh Sadat Ghoreishi, Mojtaba Sehat Page 4
    Background

    Methamphetamine dependence is a growing global problem. Currently, there are no approved pharmacotherapy options for the management of methamphetamine dependence. One of the alternatives to manage this addiction is the use of N acetylcysteine (NAC) due to its capacity to restore homeostasis in the brain glutamate systems disrupted in addiction and its ability to reduce craving and the risk of relapse.

    Methods

    Methamphetamine‐dependent volunteers under methadone treatment (n = 38) were randomized to receive daily doses of 1200 mg of NAC, or placebo. The participants were followed for 12 weeks (two visits weekly). Craving and Beck Inventory Depression (BDI) was determined at the beginning of the study and also after one month, two months, and three months. Addiction severity index (ASI) was recorded at the beginning of the study and after three months. The data were analyzed via SPSS version 16.0 (SPSS Inc. Chicago, Illinios, USA)

    Results

    The mean score of craving and BDI reduced after two months with NAC treatment. ASI (e.g., substance, familial, and psychiatric categories) was significantly reduced at the end of the study in the NAC group compared to placebo (P < 0.001). The success of the treatment in groups of NAC and placebo were 84% and 73%, respectively (P = 0.001). 63.2% of the NAC group patients avoided substance use for more than a month, but this was 10.5% in the placebo group (P = 0.001).

    Conclusions

    The NAC showed good efficacy in suppressing methamphetamine craving, addiction severity index, and depression. It may be a useful pharmacological treatment for methamphetamine dependency.

    Keywords: Methadone, Craving, Methamphetamine, Dependency, N-acetylcysteine
  • Elham Shafiei, Arash Nademi, Ali Ashraf Mozafari, Elham Bastani, Taleb Kokhazadeh, Kosar Yousefi, Ali Sahebi * Page 5
    Background

    The incidence of limb fractures in children depends on environmental factors and socioeconomic backgrounds.

    Objectives

    This study aimed to evaluate the epidemiology of limb fractures in 1 to 15-year-old children in Ilam City, Iran.

    Methods

    This retrospective study enrolled all children aged 15 and below admitted to the Emam Khomeini Hospital of the Ilam University of Medical Sciences between July 2012 and March 2018. Data including age, sex, injury mechanism, and injured organs were recorded in SPSS software and analyzed using a chi-square test.

    Results

    Out of 4877 children, 74.3% were boys, and 25.7% were girls, with the men to women ratio of 2.87 and the mean age of 9.10 ± 4.3 years. Elbow and forearm with 39.35% and leg with 21.61% were the most common sites of fractures. Home, street, and sports fields were the commonplaces of injury with 50.7%, 28.3%, and 7.2%, respectively. The age range of 8 - 15 years, with 3693 cases (75.72%) was the most vulnerable age group. Fractures occurred mostly in spring and summer and less frequently in the other seasons.

    Conclusions

    Specific attention should be paid to the home environment and its safety for controlling injuries in preschool children. This includes increasing parents’ knowledge of preventive measures. Moreover, improving the physical condition of pavements and crosswalks in the streets is necessary for the prevention of injuries.

    Keywords: Pediatrics, Epidemiology, Fracture
  • Pir Hossein Kolivand, Hassanali Faraji Sabokbar, Peyman Saberian, Mahdi Bahmanabadi, Parisa Hasani-Sharamin, Alireza Baratloo * Page 6
    Objectives

    We intended to map the geographical distribution of patients with acute stroke who called the Tehran EMS center based on the geographic information of the incident location on a map. The distributions of these centers and patients’ access within a standard period were evaluated.

    Methods

    A cross-sectional study based on the registered data was conducted on suspected acute stroke patients > 18 years of age that were transferred by EMS. The analysis was performed based on pointing the patients’ locations and locating the hospitals in ArcGIS software plus a review of the polygons and focal points.

    Results

    Totally, 1,606 patients suspected to stroke with a mean age of 64.89 ± 17.48 years were evaluated, of whom 947 (58.6%) were male. The mean time of arrival of an ambulance in the patient’s location from the EMS station was 11.94 ± 6.67 minutes, and the longest time was 69.32 minutes. The mean time from the patient’s location to the stroke center was 17.79 ± 11.42 minutes (range 2.4 - 83.70 minutes). Stroke centers in Tehran are not distributed in a balanced manner, and they are concentrated on the central and northern parts of Tehran, limiting access to hospital services.

    Conclusions

    The multiplicity of hospitals in the west and center of Tehran led to an increase in access times in eastern Tehran. It emphasizes the necessity of revision of service locating, especially because the east of Tehran has a denser texture than the west.

    Keywords: Stroke, Geographic Information Systems, Emergency Medical Services, Health Services Accessibility
  • Paola Fugazzola *, Francesco Favi, Matteo Tomasoni, Claudia Zaghi, Chiara Casadei, Enrico Prosperi, Giacomo Sermonesi, Davide Corbella, Federico Coccolini, Beniamino Pratico', Vanni Agnoletti, Luca Ansaloni Page 7
    Background

    The Coronavirus Disease 2019 (COVID-19) pandemic has necessitated the alteration of the organization of entire hospitals to try to prevent them from becoming epidemiological clusters. The adopted diagnostic tools lack sensitivity or specificity.

    Objectives

    The aim of the study was to create an easy-to-get risk score (Ri.S.I.Co., risk score for infection with the new coronavirus) developed on the field to stratify patients admitted to hospitals according to their risk of COVID-19 infection.

    Methods

    In this prospective study, we included all patients who were consecutively admitted to the suspected COVID-19 department of the Bufalini Hospital, Cesena (Italy). All clinical, radiological, and laboratory predictors were included in the multivariate logistic regression model to create a risk model. A simplified model was internally and externally validated, and two score thresholds for stratifying the probability of COVID-19 infection were introduced.

    Results

    From 11th March to 5th April 2020, 200 patients were consecutively admitted. A Ri.S.I.Co lower than 2 showed a higher sensitivity than SARS-Cov-2 nucleic acid detection (96.2% vs. 65.4%; P < 0.001). The presence of ground-glass pattern on the lung-CT scan had a lower sensitivity than a Ri.S.I.Co lower than 2 (88.5% vs. 96.2%; P < 0.001) and a lower specificity than a Ri.S.I.Co higher than 6 (75.0% vs. 96.9%; P < 0.001).

    Conclusions

    We believe that the Ri.S.I.Co could allow to stratify admitted patients according to their risk, preventing hospitals from becoming the main COVID-19 carriers themselves. Furthermore, it could guide clinicians in starting therapies early in severe-onset cases with a high probability of COVID-19, before molecular SARS-CoV-2 infection is confirmed.

    Keywords: Early Diagnosis, Mass Casualty Incidents, Pandemic, Score
  • Yu Hu *, Xiao Ming Li, Yi Chao Zhang, Jian Xun Song Page 8
    Introduction

    Sertoli cell tumors (SCTs) of the testis are relatively rare neoplasms that originate from the sex cord and interstitial stromal cells of the testis. Magnetic resonance imaging (MRI) can be used for characterization, particularly recommended when clinical and ultrasonography (US) features are indeterminate for the staging of local lesions. Scrotal MRI may also help in the imaging-based differential diagnosis of a wide range of testicular neoplasms and prevents unessential radical orchiectomy in cases of benign lesions. Accurate and early diagnosis will play a key role in keeping the viability of testicle and fertility.

    Case Presentation

    We present the case of a 46-year-old male with a 1-year duration of a left painless testicular tumor that has had some recent enlargement. He has been admitted to the Department of Urological Surgery, Shenzhen Bao’an people’s hospital, Shenzhen, Guangdong Province, China, on Dec 2nd, 2018. Laboratory tests were within normal limits. A well-defined margin (pseudocapsule) can be found both on US and pre-contrast MRI, but organ-sparing surgery is not advocated for the suspicious malignant features, including recent enlargement, intratumoral hemorrhageand necrosis, and contrast-enhancing solid tissue with indistinct and irregular marginss on MRI. Finally, this patient proceeded with radical orchiectomy after a sufficient preoperative assessment.

    Conclusions

    The low incidence rate of SCTs and their similar clinical features to those of other testicular tumors make their preoperative diagnosis challenging, but the identification of the tumor’s extent, morphologic information, signal component, adjacent relationship, and distant metastasis on MRI images can be vital to make a differential diagnosis, establish reasonable intervention plans, and predict the prognosis.

    Keywords: Ultrasonography, Magnetic Resonance Imaging, Testis, Sertoli Cell Tumor
  • Maryam Seraji, Zaher Khazaei, Victoria Momenabadi, Reza Beiranvand, Ahmad Naghibzadeh Tahami, Elham Nejadsadeghi, Maryam Zahmatkeshan, Leili Moayed Elham Goodarzi * Page 9
    Background

    Exposure to radiation is a major risk factor for skin cancer so that 65 to 90% of skin cancers can be attributed to the exposure with sunlight.

    Objectives

    The current study aimed to investigate the association between the human development index and the incidence of UV-related melanoma.

    Methods

    This is an ecological study. Data on the incidence of UV-induced melanoma were extracted from the GLOBOCAN estimates (GLOBOCAN 2012), and data on the human development index were extracted from the World Health Organization (WHO) database. Data analysis was conducted by Stata software (Ver. 14). The descriptive analysis involved mean and standard deviation. The correlation method was used to evaluate the association between the population attributable fraction (PAF) of melanoma for ultraviolet (UV) and the HDI components. A P value < 0.005 was considered as statistically significant.

    Results

    The results revealed a significant positive association between UV-attributable melanoma cancer and HDI in women (r = 0.401, P < 0.0001), men (r = 0.488, P < 0.0001), and both sexes (r = 0.455, P < 0.0001). In Americas (r = 0.452, P < 0.05) and Europe (r = 0.740, P < 0.05), a significant positive correlation was observed between UV-induced melanoma and HDI, but this association was not significant in Asia (P > 0.05). In Africa, a negative correlation was observed, though it was not statistically significant (r = -0.301, P > 0.05). The results of the analysis of variance (ANOVA) showed a significant statistical relationship between the incidence of UV-related melanoma and the levels of development (F = 25.1, P < 0.0001) so that the higher the score of HDI, the higher the incidence of this cancer.

    Conclusions

    Since there is a positive correlation between UV-related melanoma and HDI, further attention should be paid to this risk factor, especially in countries with a high HDI to reduce the UV-induced melanoma cancer.

    Keywords: Human Development Index, UV Radiation, Melanoma Cancer, Population Attributable Fraction
  • Chinese Medicine Treatment of Cytokine Storm Caused by COVID-19
    Youfu Ke *, Jianli Cui Page 10
    Context

    COVID-19 has turned into a pandemic, threatening the lives of millions of people worldwide. Research has found that some COVID-19 patients will suddenly aggravate, resulting in a cytokine storm, respiratory distress syndrome, and death. It is necessary to articulate the mechanism of cytokine storm and propose a Chinese medicine treatment strategy for COVID-19.

    Evidence Acquisition

    A literature search was conducted using five databases on April 30, 2020, including PubMed, Google Scholar, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data with the keywords of “cytokine storm AND Chinese medicine AND COVID-19 “, “cytokine storm AND Chinese medicine AND SARS-CoV-2”. The outcome of interest was the concept and mechanism of cytokine storm, the characteristics, and the Chinese medicine treatment of COVID-19 cytokine storm, etc. A total of 43 articles were retrieved after removing duplicate articles.

    Results

    The cytokine storm is also called cytokine cascade. The body overreacts with positive feedback without negative feedback, making a variety of abnormal cytokines accumulations, triggering a cytokine storm. COVID-19 cytokine storm does not occur in the early stages, but only after a period of development, it attacks not only the lungs but also the heart, kidneys, and other organs. The key pathogenesis is “toxins and blood stasis, lung failure” in Chinese medicine. The treatment is detoxification, removing blood stasis, and nourishing the lung. Chinese medicine should comprehensively regulate multiple targets and multiple pathways to intervene in the immune regulation of the body to intercept the progress of inflammation and focus on the integration of Chinese medicine with Western medicine to combine anti-virus and anti-inflammatory therapy.

    Conclusions

    The immune response caused by cytokine storm is a complex signal network with multiple targets and pathways and various cytokines acting together. Immunomodulation can balance the excessive inflammatory response and effectively control the replication and spread of SARS-CoV-2. Returning the immune response to a balanced state is an ideal method for treating COVID-19 cytokine storm. Chinese medicine can achieve overall coordination and balance. Nevertheless, the pharmacology of Chinese medicine must be further studied, and the mechanism of cytokine storm treatment should be thoroughly clarified.

    Keywords: COVID-19, SARS-CoV-2, Cytokine Storm, Chinese Medicine Treatment
  • Incidence of Insufficient Physical Activity Among Adults and Its Relationship with the Human Development Index: A Global Study
    Victoria Momenabadi, Elham Goodarzi, Maryam Seraji, Ahmad Naghibzadeh Tahami, Reza Beiranvand, Elham Nejadsadeghi, Maryam Zahmatkeshan, Leili Moayed, Zaher Khazaei, * Page 11
    Background

    Insufficient physical activity, particularly in low- and middle-income countries, plays an important role in the spread of non-communicable diseases.

    Objectives

    The purpose of this study is to investigate the incidence of insufficient physical activity and its relationship with the human development index (HDI) in the world.

    Methods

    This is an ecological study, and the study data, including the human development index and the incidence of insufficient physical activity, were extracted from the World Bank’s database. The descriptive analysis included mean and standard deviation. The inferential analysis consisted of two-way correlation and ANOVA at a significance level of less than 0.05. The analyses were performed using Stata-14 software.

    Results

    The highest incidence of insufficient physical activity in both sexes (39.26 [37.42, 40.95]) was found in the Americas, especially in high-income regions. There was a significant positive correlation between the incidence of insufficient physical inactivity and HDI in the world (r = 0.446, P < 0.0001). This correlation was also significant in Asia and Africa (P < 0.05). The results showed a positive correlation between components of HDI (i.e., gross national income per 1000 capita, mean years of schooling, life expectancy at birth, and expected years of schooling) and insufficient activity (P < 0.0001). The results of ANOVA also exhibited a significant relationship between the mean prevalence of physical inactivity and the level of development (P < 0.0001).

    Conclusions

    Given the significant correlation between the incidence of insufficient physical inactivity and HDI, understanding this correlation and its components, especially in low- and middle-income countries can alleviate the impact of physical inactivity epidemics in the future, thereby contributing to the effective global prevention of non-communicable diseases.

    Keywords: Prevalence, Human Development Index, World, Insufficient Physical Activity
  • Laboratory Abnormalities in Patients with COVID-19 in Mazandaran Province, Iran
    Reza Alizadeh Navaei, Majid Saeedi, Reza Valadan, Fatemeh Roozbeh, Omolbanin Amjadi, Ehsan Zaboli, Mahmood Moosazadeh, Hossein Ranjbaran, Zinab Qazizadeh, Ali Akbari-Malekshah, Touraj Assadi, Versa Omrani Nava, Akbar Hedayatizadeh Omran, * Page 12
    Background

    Coronavirus is a single-stranded RNA virus, causing an epidemic of pneumonia and acute respiratory distress syndrome (ARDS) worldwide in late 2019.

    Objectives

    In addition to the clinical symptoms, laboratory diagnosis can greatly help diagnose the diseases; therefore, this study aimed to analyze laboratory parameters in patients with COVID-19.

    Methods

    In this cross-sectional study, the laboratory data of 2563 patients with COVID-19 admitted to hospitals affiliated with Mazandaran University of Medical Sciences were extracted from hospital information systems (HIS). The data were recorded on Excel and analyzed through t-test, chi-squared, and Fisher’s exact tests in SPSS 19 at the significance level of P < 0.05.

    Results

    Out of 2563 patients with a mean age of 55.1 ± 16.7 years, 1409 (55%) were male, and 1154 (45%) were female with a mean age of 55.7 ± 16.8, and 54.3 ± 16.6 years, respectively. As the most frequent clinical findings, ESR, CRP, and LDH were increased by 83.5%, 71%, and 69.3% of the patients, respectively. Other research findings included lymphopenia, disturbed INR, abnormal SGOT, abnormal alkaline phosphatase (ALP), and increased lactate dehydrogenase (LDH), which were significantly higher in men than in women and was different between age groups.

    Conclusions

    Conducting simple, convenient, and inexpensive laboratory tests can be helpful in the diagnosis of COVID-19.

    Keywords: ARDS, Coronavirus, COVID-19, Laboratory Test
  • Apatinib for Treatment of Locally Advanced Rectal Angiosarcoma: A Case Report
    Engeng Chen, Zhiyao Xu, Gaoyang Cao, Li Chen * Page 13
    Introduction

    Primary colorectal angiosarcoma is a highly rare malignant tumor. There is no standard treatment method for this disease. No treatment of rectal angiosarcoma with apatinib has been reported so far.

    Case Presentation

    In the current study, an 87-year-old male presented with the symptoms of frequent defecation for more than one month in Hangzhou, China, in 2018. The patient was initially diagnosed with a rectal stromal tumor. The patient underwent ultrasound-guided transrectal mass puncture in the next treatment. However, immunohistochemical examinations confirmed the initial diagnosis of rectal angiosarcoma. The patient had advanced age and rectal angiosarcoma with metastasis; he had no surgical indications, and we tried to use apatinib 250 mg/d treatment to control the progression of the lesion. Then, he received apatinib, a novel tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2). The patient has been stable to apatinib with a dose of 250 mg daily by now.

    Conclusions

    Apatinib may play an important role in the treatment of unresectable angiosarcoma.

    Keywords: Case Report, Apatinib, Rectal Angiosarcoma
  • Chronic Active Epstein-Barr Virus Infection in a Patient with Enteritis, Myositis, and Pericardial Effusion: A Case Report
    Jin Xian Huang*, Xiao Yan Huang, Li Jun Zhang, Ya Qin Wang Page 14
    Introduction

    Chronic active Epstein-Barr virus infection (CAEBV) is a rare, life-threatening disease entity involving multiple organs and systems. The disease could be presented in a single organ with atypical symptoms, be misdiagnosed at the early phase, and resolved without aggressive treatment. Previous studies reported favorable outcomes with early diagnosis and treatment, while in other cases, disease progression and presenting in other organs could result in a very poor outcome. Clinicians from any department should be aware of the CAEBV entity when an unresolved systemic inflammation presents.

    Case Presentation

    A 61-year-old female presented to the cardiology department due to edema and fatigue with the progression of symptoms, including fever, muscle weakness, and shortness of breath. MR images showed muscular edema, and ultrasound analysis revealed massive pericardial effusion. Results of laboratory tests indicated hematological involvement, liver damage, and positivity for EBV DNA, and EBER in muscle and intestine by staining. She was first misdiagnosed with ulcerative colitis, but the disease evolved to the muscles and cardiovascular system later on. Altogether, the CAEBV infection with enteritis, myositis, and pericardial effusion was confirmed in the case. Although diagnosed, the treatment of the elderly population remains rather challenging in severe cases. The patient died after disease onset for less than three years.

    Conclusions

    Elderly patients with CAEBV infection tend to have a poor prognosis. Early diagnosis would facilitate early treatment and the utilization of available options, which might reduce the disease mortality rate eventually. Individualized therapy and promising approaches should be further developed for CAEBV infection.

    Keywords: Epstein-Barr Virus Infections, Myositis, Pericardial Effusion, Enteritis
  • Analysis of the Risk Factors for the Recurrence of Ischemic Stroke with Diabetes Mellitus and Establishment of Cox’s Regression Model and the Personal Prognosis Index in Two Years of Follow-Up
    Ya Chen An, *, Yu Xun Wang, Yan Ru Jiang, Yan Zheng Li, Jing Yu Feng, Song Xin Shi, Jing Jun Chen Page 15
    Background

    Ischemic stroke is a major cause of disability and mortality in patients with type 2 diabetes mellitus (T2DM), and diabetic stroke has a high recurrence rate.

    Objectives

    This prospective cohort study aimed at investigating the risk factors and establishing Cox’s regression model and personal prognosis index for the recurrence of ischemic stroke at a two-year follow-up in T2DM patients.

    Methods

    T2DM patients with ischemic stroke, who were consecutively admitted to the Neurology Department of North China University of Science and Technology Affiliated Hospital between January 1, 2015, and December 31, 2015, were retrospectively reviewed. These cases were followed up since the onset of ischemic stroke for 2 years. Univariate and multivariate Cox’s proportional hazard regression model was used to analyze risk factors associated with the recurrence rate. Thus, a recurrence model and personal prognosis index were set up.

    Results

    During the follow-up period, 44 cases relapsed. Furthermore, the 1-year recurrence rate was 16.48%, while the 2-year recurrence rate was 24.18%. The univariate and multivariate Cox proportional hazard regression model revealed that the independent risk factors associated with recurrence were TOAST criteria (X1) (RR = 1.663; 95% CI = 1.015 - 2.760, P = 0.032), hypertension grade (X2) (RR = 1.897; 95% CI = 1.097 - 3.280, P = 0.022), duration of diabetes mellitus (X3) (RR = 1.151; 95% CI = 1.009 - 1.991, P = 0.039), total cholesterol (X4) (RR = 1.13; 95% CI = 1.006 - 1.876, P = 0.035), and Essen stroke risk score (ESRS) (X5) (RR = 2.055; 95% CI = 1.357 - 3.134, P = 0.001). The personal prognosis index of the recurrence model was as follows: PI = 0.504 X1 + 0.640 X2 + 0.345 X3 + 0.759 X4 + 0.823 X5.

    Conclusions

    TOAST criteria, hypertension grade, duration of diabetes mellitus, total cholesterol, and ESRS were the independent risk factors associated with the recurrence of ischemic stroke with diabetes mellitus. The recurrence model and personal prognosis index equation were successfully established.

    Keywords: Risk Factors, Recurrence Rate, Ischemic Stroke, Type 2 Diabetes Mellitus, Cox Proportional Hazard Regression Model
  • Risk of Hypertension Associated with Antivascular Endothelial Growth Factor Monoclonal Antibodies: A Meta-Analysis From 51088 Patients with Cancer
    Weilan Wang, Le Cai, Bingkun Xiao *, Rongqing Huang Page 16
    Context

     Hypertension events are the dominant adverse events observed in patients receiving the antivascular endothelial growth factor (anti-VEGF) monoclonal antibodies bevacizumab and ramucirumab treatment, which severe hypertension, particularly hypertensive emergencies, may cause acute target organ injury and major cardiovascular events, that has limited the administration of anti-VEGF monoclonal antibodies. The current meta-analysis aimed to examine the relative risk (RR) of hypertension associated with anti-VEGF monoclonal antibodies.

    Evidence Acquisition

    PubMed, EMBASE, ASCO Abstracts, ESMO Abstracts, Cochrane Library, and Clinical Trials.gov were searched until July 2019 for relevant phase II and III randomized controlled trials (RCTs). Statistical analyses were performed to examine the RR (with 95% confidence intervals (CIs)) of hypertension associated with the anti-VEGF monoclonal antibodies.

    Results

    Ninety four RCTs and 51088 patients were included in the current meta-analysis. According to the results, compared with the control arms, anti-VEGF monoclonal antibodies increased the risk of all-grade (RR: 3.45, 95% CI: 2.98 - 4.00) and high-grade (RR: 5.63, 95% CI: 5.05 - 6.26) hypertension. In the subgroup analyses, the risk of high-grade hypertension varied significantly with cancer type, so that the highest RR was for patients with ovarian cancer (17.27, 95% CI: 8.50 - 35.08), whereas the risk of all-grade hypertension did not vary significantly. When stratified based on drug types and drug dose, no significant difference was discovered.

    Conclusions

    Anti-VEGF monoclonal antibodies significantly increased the risk of hypertension. The risk may vary with tumor type. Clinicians should be aware of the adverse reaction and clinical monitoring as well as effective management of such situations, particularly for high-risk patients.

    Keywords: Meta-Analysis, Hypertension, Bevacizumab, Anti-VEGF Monoclonal Antibodies, Ramucirumab
  • Covered and Uncovered Self-Expandable Metallic Stents in the Treatment of Malignant Biliary Obstruction
    Lian-Biao Li *, Wen Yan Qin, Wen Ping Peng, Jin Zhen Li, Ming Ming Zhang, Bo Lao, Jie Ming Hong Page 17

    Context: Self-expandable metal stents (SEMSs) are commonly used in the treatment of malignant biliary obstruction. We performed a meta-analysis to compare the efficacy of covered self-expandable metallic stents (CSEMSs) and uncovered self-expandable metallic stents (UCSEMSs) for patients with malignant distal biliary obstruction.

    Methods

    A comprehensive search was conducted using PubMed, Embase, Cochrane, and CNKI databases from 2010 to 2019. All randomized controlled trials, which compared the use of the CSEMSs and UCSEMSs for the treatment of malignant distal biliary obstruction were included in this study.

    Results

    This meta-analysis included 1,539 patients enrolled in 13 trials. There was no difference between the two groups in terms of patients’ survival (hazard ratio (HR) 0.96, 95% confidence interval (CI): 0.87 - 1.07; I2 = 32.6%), stent patency (HR 0.92, 95% CI: 0.69 - 1.22; I2 = 56.3%), and the overall complication rate (relative risks (RR) 1.35, 95% CI: 0.82 - 2.23; I2 = 0%). In particular, the CSEMSs group presented a lower rate of tumor ingrowth (RR 0.30, 95% CI: 0.15 - 0.57; I2 = 58.5%) than the UCSEMSs group. However, the CSEMSs group exhibited a higher rate of tumor overgrowth (RR 1.63, 95% CI: 1.00 - 2.66; I2 = 0%), sludge formation (RR 2.28, 95% CI: 1.36 - 3.82; I2 = 0%), and migration (RR 5.14, 95% CI: 1.90 - 13.88; I2 = 0%).

    Conclusions

    Our meta-analysis indicated that there was no significant difference between the two stents, and each one had its advantages and disadvantages.

    Keywords: Covered Metallic Stent, Uncovered Metallic Stent, Self-Expandable Metallic Stent (SEMS), Malignant Biliary Obstruction, Biliary Stent
  • The Effects of Diaphragmatic Breathing and Omeprazole on Respiratory Indices and Diaphragmatic Excursion in Patients with Gastroesophageal Reflux Disease
    Mehdi Ahmadi, Mohsen Amiri, Tahere Rezaeian, Amir Mansour Rezadoost, Enayatollah Bakhshi, Iraj Abdollahi, * Page 18
    Background

    Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders that can disturb patients’ respiratory indices. Proton pump inhibitors (PPIs) such as omeprazole are currently the most common treatment in the patients. PPI-refractory GERD is a clinical problem constituting around 30% of patients with GERD.

    Objectives

    The aim of this study was to investigate the effects of diaphragmatic breathing (DB) and omeprazole on respiratory indices (RI) and diaphragmatic excursion (DEX) in patients with GERD.

    Methods

    This is a clinical trial conducted for eight weeks among 40 patients with severe GERD in Tehran in 2018. The block randomization method was designed to randomize 40 patients into two groups (DB and control) that resulted in equal sample sizes. The control group received omeprazole 20 mg once daily, and the DB group, in addition to omeprazole, performed DB. Respiratory indices, including (Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Peak Expiratory Flow (PEF)), and DEX were evaluated before, immediately, and six weeks after the end of intervention by spirometry and ultrasonography; respectively.

    Results

    There was no significant difference in the RI and DEX before the intervention between groups. FVC (P = 0.04) and PEF (P = 0.02) significantly changed in the control group, but FEV1 (P = 0.001), FVC (P = 0.002), PEF (P = 0.001) and DEX (0.001) significantly changed after DB. There was a significant difference in terms of RI between before and followed up in DB.

    Conclusions

    Diaphragmatic breathing with omeprazole had more effects on RI and DEX than omeprazole alone. The positive effects of DB remain at least six weeks after the end of the intervention.

    Keywords: Ultrasonography, Omeprazole, Spirometry, Reflux, Diaphragmatic Excursion, Respiratory Indices
  • Study of the Relationship Between Hearing Loss and Cognitive Performance at Chronic Exposure to Noise
    Iraj Alimohammadi, Fakhradin Ahmadi Kanrash *, Shahram Vosoughi, Jamileh Abolaghasemi, MohammadHossein Chalak, Kazem Rahmani Page 19
    Background

    Noise is considered as one of the most significant and dangerous physical factors in work environments, and due to the advancement of industries, it has become a threat to physical and psychological health in the current era. In addition to its undesirable effects on the hearing system, noise can have harmful non-auditory effects that may cause physiological disorders and cognitive impairment.

    Objectives

    This study aimed to investigate the relationship between hearing loss and workers’ cognitive performance in an industrial environment.

    Methods

    A total of 300 individuals were enrolled in this study after their informed consent was obtained, and their compliance with the inclusion and exclusion criteria was confirmed. Based on the sound intensity level, the individuals were classified into two groups of exposure to > 85 dB (n = 196) and ≤ 85 dB (n = 104). To measure the individuals’ occupational exposure at an 8-hour equivalent level based on the ISO 9612: 2009 standard, the Testo device (Model CEL-815) was used with the precision of 0.5 dB. The most common weighting that is used in noise measurement is A-weighting. Like the human ear, this effectively cuts off the lower and higher frequencies that the average person cannot hear. The DANPLEX-AS54 device was also used to check audiometry. To investigate the workers’ hearing performance, two psychological tests, namely Stroop and TOL, were used as well.

    Results

    Hearing loss was higher among workers exposed to a sound intensity level of > 85 dB than those exposed to a sound intensity level of ≤ 85 dB, and this difference was significant in all sound level frequencies (NIHL left ear: for ≤ 85 dB: 25.92 and for > 85 dB: 27.49) (NIHL right ear: for ≤ 85 dB: 27.62 and for > 85 dB: 29.50) (P value < 0.05). The results showed a significant positive relationship between cognitive indicators and hearing loss (P value < 0.05). Moreover, the study of cognitive indicators in the two groups revealed that the mean change of cognitive performance indicators was higher among subjects exposed to a higher sound intensity level (P value < 0.05).

    Conclusions

    The results of this study showed that noise-induced hearing loss in work environments had a significant positive relationship with cognitive indicators. In other words, an increase in the hearing loss level would result in changes in cognitive indicators such as number of errors and response time.

    Keywords: Hearing Loss, Occupational Exposure, Noise, Stroop Test, Cognitive Science, Industrial
  • The Long-Term Efficacy of Radiofrequency Ablation Versus Laparoscopic Hepatectomy for Small Hepatocellular Carcinoma in East Asia: A Systematic Review and Meta-Analysis
    Xiaozheng Lu, Zhijun Li, Yahui Liu, Zishuai Wang, Fenghui Peng, Qiong Yu, Xueqi Fu, Bai Ji* Page 20
    Context

    Hepatocellular carcinoma (HCC) is a common malignant cancer and the second leading cause of cancer-related deaths around the world. Radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) have been adopted for the treatment of HCC. The aim of the meta-analysis was to explore the long-term efficacy of RFA compared with LH for small HCC (sHCC) patients in the East Asian population.

    Evidence Acquisition

    We performed a systematic review and meta-analysis by the literature search on PubMed, Cochrane Library, EMBASE, Chinese Biological Medical Literature (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang from their inception until October 10, 2019, for comparing the long-term efficacy outcomes of RFA with LH.

    Results

    Fourteen retrospective studies with 1,390 subjects were included in the meta-analysis. Compared with the LH-treated group, RFA could raise the local recurrence rate under median follow-up duration and reduce disease-free survival (DFS) rates at 1 - 3 years. However, it failed to affect 5-year overall survival (OS) and DFS rates. In the subgroup analyses, different RFA approaches had significantly higher local recurrence rates than the LH group. A similar effect on OS and DFS rates within five years for single early (≤ 3 cm) HCCs and on the 1- and 5-year DFS rates for nodules ≤ 5 cm were observed between the two groups, but RFA approaches could reduce the 3-y OS and DFS rates for single nodules ≤ 5 cm. The percutaneous radiofrequency ablation (PRFA) group had significantly lower 3- and 5-year OS and the 1- and 3-year DFS rates than the LH group, while no significant difference in OS and DFS rates in the laparoscopic radiofrequency ablation (LRFA) approach. The RFA approach improved the 3-year OS compared with the LH group in Japan, but reduced the 3-year OS and DFS rates within 3 years in China.

    Conclusions

    Our results support that LH treating sHCC had a better long-term efficacy and a lower local recurrence rate than RFA in the East Asian population. Further high-quality prospective studies are required to confirm the long-term efficacy.

    Keywords: Meta-Analysis, Radiofrequency Ablation, Minimally Invasive Surgery, Laparoscopic Hepatectomy, Hepatocellular Carcinomas
  • Association Between SYNTAX Score and Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Graft (CABG)
    Ahmad Amouzeshi, Seyyed Ali Moezi Bady *, Vahid Nabati Bonyabadi Page 21
    Background

    Stroke as a complication of open-heart surgery can be a cause of death and widespread disability.

    Objectives

    This study aimed to determine the relationship between the SYNTAX Score and carotid artery stenosis and evaluate patients undergoing open-heart surgery in terms of postoperative complications and mortality in a six-month to two-year follow-up period.

    Methods

    A cross-sectional study was conducted on 113 patients with CAD who underwent open-heart surgery at our hospital from 2016 to 2017. After collecting demographic data, the SYNTAX score, and color Doppler sonography report, the data were recorded and analyzed by SPSS22.

    Results

    In our study, most patients were male and aged between 50 and 70 years. The mean SYNTAX score was 32.667 + 13.668 in the group with significant carotid stenosis, 33.926 + 9.387 in the group with no significant carotid stenosis, and 30.868 + 9.963 in the group without carotid stenosis. The results showed no significant relationship between carotid artery stenosis and the SYNTAX score (P = 0.512) and no significant relationship between the SYNTAX score and surgical complications (P = 0.666).

    Conclusions

    According to the results, there is no significant relationship between the SYNTAX score and various indices related to heart disease, carotid artery stenosis, and postoperative morbidity and mortality. Thus, this index cannot be used to check and follow patients. However, further studies are needed to reach a definitive conclusion.

    Keywords: Coronary Artery Bypass Graft, Carotid Artery Stenosis, SYNTAX Score