Health Sciences

"PhysioLego:" Learning concepts, building, and applying physiology knowledge Hwee-Ming Cheng, See-Ziau Hoe BLDE University Journal of Health Sciences 2020 5(2):97-101 When we talk about conceptual learning, we also think about certain principles in physiology that recur in various organ systems in the body. These global underlying themes are like the Lego building blocks when we look at the mechanics of physiological processes. One main?” PhysioLego” concept of building brick is the relationship between membrane selective permeability and effective osmotic pressure. This is expressed in laboratory class demonstration by saying that the tonicity of a solution is dependent on not just the osmotic concentration but also importantly on the membrane penetrability of the solute in solution. The “PhysioLego” osmotic bricks and its construction to build an integrated understanding of physiology and pathophysiology will be described in this article.

The International Yoga Day, political discourse, and soft power game in India Janmejaya Samal BLDE University Journal of Health Sciences 2020 5(2):102-105 The International Day of Yoga is being celebrated every year on 21st June since 2015, throughout the globe. The United Nations (UN) General Assembly on December 11, 2014, declared that 21st June would be celebrated as the International Day of Yoga or World Yoga Day following lobbying by the Prime Minister of India, Mr Narendra Modi. One hundred and seventy countries around the globe supported the resolution which even did not require vote. Mr Narendra Modi, in his address to the UN in September 2014, stated that it is not about the exercises rather the way of discovering oneself. Furthermore, he stated that it is the longest day of the Northern Hemisphere and has special significance in many parts of the world. It is the day of summer solstice. It is now being celebrated beyond religion, region, and culture, however, it has been politicized since its first day of observation. It is neither an innocent event nor dissociated from politics and soft power game in India. Despite all these, many believe that it would live up to its lofty ideals and that these become its eternal legacy.

Evidence that does not lie - Implementation of raped victims and treatment algorithm within the oral surgery department: From ashes to truth Shubha Ranjan Dutta, Purnima Singh, Deepak Passi, Jwala Nepal, Kusal Kumar Das BLDE University Journal of Health Sciences 2020 5(2):106-113 Odontologists play a primary duty in the identification of individuals or missing persons in a scenario of a mass disaster, violent crime, child abuse, and elder abuse. When it comes to the identification of the victim or the suspect, their dental traits could turn out to a compelling proof and can help in slimming down the result of the investigating welfare work. Typically, it becomes necessary to use some least known and fewer widespread techniques in identification procedure such as lip prints, rugae patterns, and willing odontometrics can provide relatively valid conclusions referring to a person's identification. This review elucidates the importance of cheiloscopy, palatoscopy, and canine odontometry in a person's identification in relation to sex prediction and discrimination. This review article provides the newest information about the recent major advances and discoveries related to the classical and modern developed methods of dental identification that would enhance the knowledge and awareness among the professionals examining the youth victims of sex trafficking in urban and rural communities or identification of the rape or sexual abuse victims and the convicts, particularly in the Indian subcontinent when the rate of raped or sexually abused victims has risen. Various search engines such as Medline, PubMed, PsycINFO, EMBASE, and Web of Science were explored for scientific articles (original clinical research findings, case reports, and review articles) in the present subject area. A manual search strategy was adopted to obtain relevant literature on human trafficking, sexual violence, dental identification, and forensic odontology. There were no fixed inclusion and exclusion criteria before and after the literature search. Thus, the articles and items reviewed in this article were picked based on their relevance to the present topic, and an attempt was made to understand the application of various available methods of dental identification all over the world and its applicability to the forensic odontologists in the Indian subcontinent. The dental professionals who operate on the potential victims of human trafficking in secondary care units usually lack data and confidence. Coaching is required significantly for the dental employees who are involved in the identification of the victims and answering their demands, along with creating safe referrals.

A systematic review on the effect of high.intensity training on heart rate variability in sports professionals and healthy young adults Shweta Shenoy, Prachi Khandekar BLDE University Journal of Health Sciences 2020 5(2):114-126 BACKGROUND: Exercise plays an essential role in managing cardiovascular disorders, and high-intensity training (HIT) exercise is a potential, time-effective alternative to traditional aerobic exercise. OBJECTIVES: The objective of this study was to evaluate the effect of HIT program on the time and frequency domains of heart rate variability (HRV) in sports professionals and healthy young adults (18–30 years of age) through a systematic review. METHODS: Physiotherapy Evidence Database (PEDro), PubMed, ScienceDirect, Taylor and Francis Online, and Google Scholar were searched for relevant studies. PEDro scale was used to assess internal validity, exclude risk bias, and assess the methodological quality of studies. RESULTS: A total of 4430 search results were obtained by searching for specific keywords, out of which, only 7 studies met the inclusion criteria after removing all the duplicate articles. Our results showed that HIT programs have significant effect on HRV (root mean square of successive difference [RMSSD], mean difference [MD] =13.35, 95% confidence interval [CI] =1.73, 24.97), high-frequency (HF, MD = 381.7, 95% CI = 321.54, 441.86) power, and low- to high-frequency power (MD = -0.10, CI = -0.73, 0.53) ratio in young adult athletes and healthy young adults. No significant difference was found in other HRV variables. CONCLUSION: HIT is an effective exercise program that can cause improvement in parasympathetic and sympathetic cardiac modulation depending on the duration of the HIT program. HIT program can be given for 2–4 weeks to improve HRV in young adults.

Concept of cumulative dose in Ayurveda with special reference to metallic Bhasma Pravin Jawanjal, Bishwajyoti Patgiri, SS Savrikar BLDE University Journal of Health Sciences 2020 5(2):127-131 BACKGROUND: Metals and minerals are an integral part of Ayurvedic therapeutics. Many cases of metal toxicity caused by the administration of Ayurvedic drugs are being reported every now and then. It has been observed that in most of these reported cases, the Ayurvedic drugs were used in inappropriate dose and duration. In view of this observation, an attempt has been made in this article to bring forth the appropriate therapeutic and cumulative dose of metallic Bhasmas as described by Ayurvedic classics. The concept of the cumulative dose appears to be the most ignored part by Ayurvedic practitioners. AIMS AND OBJECTIVES: To search and find out the references of cumulative dose with special reference to metallic Bhasma and to explore the concept of cumulative dose in Ayurveda. METHODS: Ancient Ayurvedic classics and other available translations in various languages, published books, and other topic-related material available online were viewed and compiled references to elaborate on the concept of cumulative dose with special reference to metallic Bhasma. STATISTICAL ANALYSIS: The cumulative frequency method is used to determine the cumulative dose. RESULTS: Total 2 references found out of the one reference in Ayurved Prakasha and one in Sharangadhara Samhita with the commentary of adhamallas dipika. DISCUSSION: According to Sharangadhara Samhita, with the commentary of Adhamallas Dipika therapeutics dose of metallic Bhasma for Swarna 2 Yava (62.5 mg), whereas 1 Yava according to Ayurveda prakasha but the cumulative dose is same. CONCLUSION: As per Sharangadhara Samhita, with the commentary of Adhamallas metallic Bhasma can be used for 16 days and as per Ayurveda Prakasha 32 days. It needs to be determined in accordance with the status of Agni, Dosha, Desha, Kaala, Prakruti, and other factors.

Shelf-life evalution of Agastyharitaki Avaleha and its granule: A preliminary study Vasundhara Jaluthriya, Pravin Jawanjal, Prem Kumar Goud, BJ Patgiri, P Bedarkar BLDE University Journal of Health Sciences 2020 5(2):132-139 BACKGROUND: Shelf life is the indication of best before use duration, the importance of quality of package and storage condition is also emphasized in classics. Nowadays, due to the development and adaptation of packaging and storage technology by Ayurvedic industries, a need arise to restudy and re-establish the newer ones criteria. AIM AND OBJECTIVES: The aim and objectives of the study were to evaluate the shelf life of Agastyaharitaki Avaleha (AHA) and its granule prepared with Khanda Sharkara through accelerated stability study. SUBJECTS AND METHODS: Physicochemical parameters were measured at 40°C ± 2°C temperature and 75% ± 5% relative humidity. The analysis was repeated at intervals of 1, 3, and 6 months, and average 10% degradation of both the test drug samples was calculated and extrapolated to find the shelf life. RESULTS: Agastyaharitaki granule (AHG) prepared with Khanda Sharkara showed more extractive values and sugar contents and found to have a longer shelf life (5.28 years) than AHA?(1.57 years). AHG is comparatively more stable than AHA.

Impact of structured training of basic surgical skills in controlled environment for first.year postgraduate students of surgical specialties K Tejaswini Vallabha, Girish K Kullolli, Vikram Sindgikar, Basavaraj S Narasanagi, Deepak Chavan, Hemant Kumar, Dayanand Biradar, Ramakant Baloorkar BLDE University Journal of Health Sciences 2020 5(2):140-144 BACKGROUND: Appropriate training and obtaining adequate competency in basic surgical skills is very essential for a fresh postgraduate in surgical specialties to deliver effectively various responsibilities. Due to absence of any methodology to assess these skills before entry into the surgical residency program, anxiety and low confidence regarding the skills, there is delay in allotting graded responsibilities by the faculty and seniors. Hence a short structured training program to address these skills was planned and implemented. MATERIALS AND METHODS: One hundred and forty two trainees underwent this course in last five years. The training included very basic surgical skills demonstrated and hands on training in controlled environment of clinical skills laboratory. Secondary outcome was assessed for available forty three trainees. RESULTS: The immediate feedback suggested that the training was necessary, very useful and perception wise the trainees felt their competencies improved significantly from 60 -80%. They also opined that these facilities should be allowed to use regularly and all of them opined that they wish to be assessed after three months to assess internalization of skills obtained. Retention test was conducted for 43 available postgraduates in the form of OSCE .Their scores revealed good improvement in the skills by 60-80% suggesting the utility of the training and improvement in the competencies. CONCLUSION: Training of various basic surgical skills in a controlled environment improves competencies of fresh postgraduates, improves their confidence and reduces time for allotting graded responsibilities

Adherence to iron/folic acid supplementation and associated factors among pregnant women attending governmental health center in Yeka Sub City, Addis Ababa, Ethiopia Birhanu Tadesse Urgessa, Ziyad Ahmed Abdo BLDE University Journal of Health Sciences 2020 5(2):145-153 CONTEXT: Iron-folic acid deficiency is the leading nutritional deficiency globally, affecting the lives of >2 billion people, accounting over 30% of the world's population. Provision of iron-folic acid supplement to all pregnant women, is among the very critical interventions to reduce the burden of anemia. Even though the service is free in Ethiopia, the prevalence of anemia is slowly increased in the country. AIM: The aim is to assess adherence to iron-folic acid supplementation and associated factors among pregnant women attending governmental health center in Yeka sub city, Addis Ababa, Ethiopia, from November 1 to 30, 2019. METHODOLOGY: An institutional-based quantitative cross-sectional study was used to conduct the study. Systematic sampling system was used to select 408 study populations. Data were collected through interview using structured questionnaire. Bivariate and multivariable logistic regressions were employed to identify the predictor variables. Statistical significance was considered at P < 0.05 with adjusted odds ratio (AOR) calculated at 95% confidence interval (CI). RESULTS: A total of 408 pregnant women attending anti-natal care (ANC) were participated in this study, with response rate of 100%. The overall adherence rate was found to be 71.3%. Women whose family income >1500 Ethiopian Birr (ETB) (AOR [95% of CI]) = 3.77 (0.58–24.38)], having secondary or higher educational level (AOR [95% of CI]) = 1.48 (0.90–2.43), having history abortion (AOR [95% of CI] = 6.99 (1.11–44.19), starting ANC visit in first trimester (AOR [95% of CI] = 3.0 (0.24–37.18) were significantly associated with iron-folic acid supplementation. CONCLUSION: According to this study, adherence to iron-folic acid supplementation was relatively high. Empowering women in economy and education are very important. Proper counseling and health promotion about iron-folic acid supplementation, promoting the benefits of early and frequent ANC visit are very important to increase adhere to iron-folic acid supplementation.

Truncal growth pattern of Yogasana-practising children and adolescents Debjani Mandal, Uday Sankar Ray, Pratiti Ghosh BLDE University Journal of Health Sciences 2020 5(2):154-159 BACKGROUND: Truncal growth forms a robust skeletal frame which determines athletic execution. At present, yogasana practice is in high demand. AIM: Thus, the evaluation of effect of yogasana on growth pattern during childhood and adolescence (aged 4–15 years) is required. MATERIALS AND METHODS: A cross-sectional study was conducted on Bengalee children of similar socioeconomic status. Anthropometric measurements, namely height (stature), biacromial breadth, and bicristal breadth were analyzed from 864 yogasana-practitioners (YPs) and 738 untrained control participants (CPs), subgrouped into yogasana-practising boys (YBs), yogasana-practising girls (YGs), control boys (CBs), and control girls (CGs). Unpaired t-test was performed to assess the level of significance between the anthropometric parameters of different groups. Correlation of breadth ratio and stature with biacromial and bicristal breadth was determined by Pearson's correlation coefficient. RESULTS: YP had significantly greater biacromial breadth (P < 0.05) and bicristal breadth (P < 0.05) than CP. The mean biacromial breadth decreased, especially in YG. The shoulder and pelvis size were significantly different between YB and CB but not so among females. Growth in breadth ratio was also strongly correlated with bicristal breadth growth. CONCLUSION: Medium-sized shoulder and pelvis in YB and medium-sized shoulder relative to narrow-sized pelvis in YG nullifies the effect of yogasana training on specific bodily growth of YP. Hence, in contrast with high-demand sports, yogasana practice is not reflected on truncal growth.

Chemical cautery versus anterior inferior turbinectomy: Which is the better modality of treatment in nasal allergy? KS Gangadhara Somayaji, Tom Koshy Jones, S Saimanohar BLDE University Journal of Health Sciences 2020 5(2):160-164 INTRODUCTION: Nasal allergy is one of the most common forms of allergy seen in practice. Although medical treatment is the most commonly accepted modality of treatment, surgery also has a role. This study was aimed at the assessment of nasal symptoms and mucociliary clearance in patients with nasal allergy, before and following chemical cautery with trichloroacetic acid (TCA) in one group and anterior–inferior turbinectomy in another group and to study advantages and disadvantages of each procedure. MATERIALS AND METHODS: This was a prospective, randomized, single-blind, controlled clinical trial conducted at a tertiary care hospital on a sample of fifty patients with a history of allergic rhinitis without a satisfactory response to medical line of treatment. Preoperative nasal airflow was assessed both subjectively and objectively using the nasal symptom score and the mucociliary clearance, respectively. One group was subjected to undergo anterior–inferior turbinectomy and the other group chemical cautery with 50% TCA. Postoperative nasal airflow was also assessed by similar methods after a duration of 1 month. RESULTS: All the patients had significant relief from their symptoms at the end of 1 month postprocedure, irrespective of the procedure done. However, patients who underwent anterior–inferior turbinectomy had more symptomatic relief compared to the other group. DISCUSSION: Debulking the inferior turbinate either with surgery or with cautery relives the nasal obstruction in patients with allergic rhinitis. The other symptoms of nasal allergy are also found to be less severe in these cases. CONCLUSION: Surgical line of treatment can be used as an effective intervention to satisfactorily alleviate patient's allergic symptoms. Anterior–inferior turbinectomy is preferred for the longer symptom-free life of the patients.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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Otolaryngology & Head and Neck Surgery

Are opioids necessary in post sinus surgery care? Purpose of review The aim of the review is to review the recent literature on the use of opioids in post sinus surgery care. Recent findings Research regarding the use of opioids in post sinus surgery over the past two years support previous thinking that there is an overprescription of opioids for an operation which is not particularly painful, resulting in the potential for narcotic abuse and misuse. Summary Large randomized controlled trials with detailed pain recording scoring systems are needed to assess the opioid requirements – if any – after sinus surgery. Correspondence to Jannis Constantinidis, MD, PhD, Department of Otolaryngology, AHEPA University Hospital, Kiriakidi 1 Str, 54621, Thessaloniki, Greece. Tel: +30 2310994761; e-mail: janconst@otenet.gr Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

How close are we to anterior robotic skull base surgery? Purpose of review The application of robotic surgery to anterior skull base disease has yet to be defined despite the potential for improved tumour resection with less morbidity in this region. Complex anatomy and restricted access have limited the development of robotic anterior skull base surgery. Recent findings A limited number of transoral robotic surgical anterior skull base procedures have been undertaken; however, there are significant limitations to the utilization of this technology in the anterior skull base. In this article, the advantages, disadvantages and limitations of robotic anterior skull base surgery are discussed. Currently, the major limitation is the size of the robotic endoscope and of the available instrumentation. Technological advancements that provide promise for the future development of robotic anterior skull base surgery are in development, such as single-port robots, flexible instrument systems and miniaturization and growth of minimally invasive platforms. Summary Although transnasal access to the skull base is not possible with the currently available robotic systems, promising technology does exist and is in development. Robotic anterior skull base surgery promises to provide greater access to skull base disease, improve oncologic results, reduce morbidity and to reduce the ergonomic burden on the surgeon. Correspondence to Raewyn G. Campbell, MD FRACS GradDip BAppSc (Physio), Department of Otolaryngology – Head and Neck Surgery, The ENT Centre, 12/25-29 Hunter St., Hornsby, NSW 2077, Australia. Tel: +61 294773717; e-mail: raewyn.campbell@gmail.com Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Updates in the cause of sinonasal inverted papilloma and malignant transformation to squamous cell carcinoma Purpose of review The purpose of this study was to give an overview of recently published articles investigating the cause of inverted papilloma and possible mechanisms mediating malignant transformation into squamous cell carcinoma (SCCa). Recent findings Inverted papilloma is a sinonasal tumour that is benign in nature, but has a tendency for local invasion, recurrence and malignant degeneration. Its pathogenesis has not been elucidated and the etiological role for human papillomavirus virus (HPV) has been controversial. Recent reports have varied in detection method (mRNA ISH, DNA ISH and PCR amplification of highly conserved regions of the viral genome), ranging from 0 to 100%. Advances in meta-genomics have permitted detection of HPV viral signatures that were previously cost-prohibitive, and there appears to be a potential role for both low-risk and high-risk in the cause of the disease. Activating EGFR mutations have also been identified to be correlated with malignant transformation, which may be exclusive of HPV infection. Furthermore, more comprehensive approaches in detecting genomic markers have been reported, with HOX-related genes and epithelial-mesenchymal-transition-related gene sets appear to be differentially upregulated. Summary Sinonasal inverted papilloma is a diverse disease that is predominantly benign, but it harbours the potential for malignant degeneration in the SCCa with cause yet to be elucidated. Current evidence supports a potential role for high-risk HPV in a subset of SCCa, with the role of low-risk HPV yet to be defined. Historic studies of individual and small groups of molecular markers have not consistently adequate characterize signalling pathways underpinning the oncogenesis, and comprehensive genomic studies are needed to better understand the disease. Correspondence to Charles C.L. Tong, MD, Department of Otorhinolaryngology- Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, 5 Ravdin, Philadelphia, PA 19104, USA. E-mail: chinglick.tong@pennmedicine.upenn.edu Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

A roadmap of six different pathways to improve survival in laryngeal cancer patients Purpose of review Laryngeal cancer continues to require improvement in earlier stage diagnosis and better imaging delineation of disease, and hence 'more evidence-based' selection of treatment, as recent evidence suggests that related mortality, in the last decades, has not significantly decreased worldwide. Even though the reasons are not fully understood, there persists an urgency for a review and development of future strategies to embrace such clinical and diagnostic challenges from a political, societal, as well as scientific and clinical points of view. Recent findings This review of the published literature suggests that survival improvement in laryngeal cancer may be achieved by fuelling and combining at least some or all of six targeted agendas: documentation of disease global incidence and national burden monitoring; development and implementation of high-quality cancer registries; education on risk factors and hazardous habits associated with laryngeal cancer for the general population; active modification of proven at-risk population lifestyles; centralization of treatment; and use of machine learning of gathered 'big data' and their integration into approaches for the optimization of prevention and treatments strategies. Summary Laryngeal cancer should be tackled on several fronts, commencing with disease monitoring and prevention, up to treatment optimisation. Available modern resources offer the possibility to generate significant advances in laryngeal cancer management. However, each nation needs to develop a comprehensive approach, which is an essential prerequisite to obtain meaningful improvement on results. Correspondence to Patrick J. Bradley, 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5RD, UK. E-mail: pjbradley@zoo.co.uk Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Can computational fluid dynamic models help us in the treatment of chronic rhinosinusitis Purpose of review The aim of this study was to review the recent literature (January 2017–July 2020) on computational fluid dynamics (CFD) studies relating to chronic rhinosinusitis (CRS), including airflow within the pre and postoperative sinonasal cavity, virtual surgery, topical drug and saline delivery (sprays, nebulizers and rinses) and olfaction. Recent findings Novel CFD-specific parameters (heat flux and wall shear stress) are highly correlated with patient perception of nasal patency. Increased ostial size markedly improves sinus ventilation and drug delivery. New virtual surgery tools allow surgeons to optimize interventions. Sinus deposition of nasal sprays is more effective with smaller, low-inertia particles, outside of the range produced by many commercially available products. Saline irrigation effectiveness is improved using greater volume, with liquid entering sinuses via 'flooding' of ostia rather than direct jet entry. Summary CFD has provided new insights into sinonasal airflow, air-conditioning function, the nasal cycle, novel measures of nasal patency and the impact of polyps and sinus surgery on olfaction. The deposition efficiency of topical medications on sinus mucosa can be markedly improved through parametric CFD experiments by optimising nasal spray particle size and velocity, nozzle angle and insertion location, while saline irrigation effectiveness can be optimized by modelling squeeze bottle volume and head position. More sophisticated CFD models (inhalation and exhalation, spray particle and saline irrigation) will increasingly provide translational benefits in the clinical management of CRS. Correspondence to Narinder Pal Singh, Department of Surgery, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia. Tel: +61 2 9680 8800; e-mail: narinder.singh@sydney.edu.au Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Updates in techniques for improved visualization in sinus surgery Purpose of review Adequate visualization during endoscopic sinus surgery (ESS) is one of the most critical aspects of performing well tolerated and successful surgery. The topic of visualization encompasses a broad spectrum of preoperative and intraoperative manoeuvres the surgeon can perform that aid in the understanding of the patient's anatomy and in the delivery of efficient surgical care. Recent findings Preoperative considerations to improve visualization include optimization of haemostasis through management of comorbidities (e.g. hypertension, coagulopathies), medication management (e.g. blood thinners) and systemic versus topical corticosteroids. New technologies allow preoperative visual mapping of surgical plans. Advances in knowledge of intraoperative anaesthesia have encouraged a move toward noninhaled anaesthetics to reduce bleeding. High definition cameras, angled endoscopes, 3D endoscopes and more recently augmented reality, image-guided surgery, and robotic surgery, represent the state of the art for high-quality visualization. Topical interventions, such as epinephrine, tranexamic acid and warm isotonic saline, can help to reduce bleeding and improve the operative field. Surgical manoeuvres, such as polyp debulking, septoplasty, carefully controlled tissue manipulation and a consistent repeatable approach remain fundamental to appropriate intraoperative surgical visualization. Summary This chapter delineates medical, technical and technological means – preoperatively and intraoperatively – to achieve optimized visualization of the surgical field in ESS. Correspondence to Kevin C. Welch, 676 N St Clair Suite 1325, Chicago, IL 60614, USA. Tel: +1 312 695 8182; fax: +1 312 695 4303; e-mail: Kevin.Welch@nm.org Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Is there still a role for cranialization in modern sinus surgery? Purpose of review To give an overview of recently published literature on the indications and use of cranialization of the frontal sinuses. Recent findings Recent studies on cranialization have evaluated its role in frontal sinus fractures, inflammatory disease, and tumors involving both the frontal sinus and anterior cranial fossa. Currently, a more conservative approach is favored with traumatic injury to the frontal sinus outflow tract, with multiple studies demonstrating outflow recanalization with observation alone. Similarly, advancements in endoscopic sinus surgical approaches allow the many posterior table fractures to be managed without cranialization. Severe inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression have successfully been managed without cranialization in multiple studies suggesting an endoscopic surgical approach can be favored in these settings. Both benign and malignant tumors of the frontal sinus are managed without cranialization with select cases favoring an open approach with cranialization depending on tumor location. Malignant tumors of the frontal sinus are more likely to require cranialization as oncologic resection including margins can lead to large dural defects with significant tissue loss, which is unfavorable for more conservative reconstructive options. Summary Cranialization remains a necessary and indicated procedure in the appropriate clinical circumstances. A more conservative approach to frontal sinus fractures is warranted, with recent literature supporting similar outcomes and less morbidity. Inflammatory disease of the frontal sinus including giant mucoceles with frontal lobe compression can be managed without cranialization. Although most benign tumors can be resected via endoscopic approaches, cranialization remains a mainstay as part of the reconstructive plan after oncologic resection of malignant tumors involving the frontal sinus. Correspondence to Rakesh K. Chandra, MD, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 7209, Nashville, TN 37232-8605, USA. E-mail: rakesh.chandra@vumc.org Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Immediate dental implant placement and restoration in the edentulous mandible in head and neck cancer patients: a systematic review and meta-analysis Purpose of review Oral rehabilitation with dental implants in head and neck cancer (HNC) patients is challenging. After tooth removal prior to radiotherapy, immediate placement of dental implants during panendoscopy or surgery is thought to reduce the oral rehabilitation time improving patients' quality of life. Recent findings There is lack of consensus on the timing of dental implant placement and loading protocols. The aim of this study was to perform a systematic review of the literature regarding the performance and survival rate of immediately inserted dental implants placed prior to radiotherapy. Of 1003 articles, 10 were finally included comparing immediate vs. delayed placement of implants and comparing the effect of radiotherapy on immediately placed implants. Meta-analysis demonstrated a slightly higher survival of immediately placed implants compared with postponed placed implants [risk ratio: 0.92, 95% confidence interval (95% CI): 0.48–1.78, P = 0.81, I2 = 0%]. The other meta-analysis comparing radiotherapy vs. nonradiotherapy showed a clearly better survival of immediately placed implants not having received radiotherapy (risk ratio: 5.02, 95% CI: 0.92–27.38, P = 0.10, I2  = 56%). Summary Guidelines are recommended for immediate dental implant placement in the edentulous mandible in HNC patients prior to radiotherapy to allow homogeneity regarding the treatment protocols and thus comparison of treatment outcomes. Correspondence to Frank K.J. Leusink, MD, PhD, Amsterdam UMC, location VUmc, Department of Oral and Maxillofacial Surgery, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands. Tel: +31 20 444 1023; fax: +31 20 444 1005; e-mail: f.leusink@amsterdamumc.nl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-otolaryngology.com). This is an-open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Treatment of persistent/recurrent nodal disease in nasopharyngeal cancer Purpose of review Persistent or recurrent disease in the neck lymphatics is an unusual pattern of failure in nasopharyngeal carcinoma (NPC) after definitive radiotherapy or chemoradiotherapy. The purpose of this review is to critically synthesize the current knowledge regarding salvage treatment of this unique form of failure in NPC. Recent findings Surgery in the form of radical neck dissection has been established as the standard salvage treatment with 5-year regional control of 60--86%. Recent shift in paradigm has resulted in the use of modified or selective neck dissection as salvage surgery in some centers. Risk factors for poor survival outcome include recurrent nodal disease, number of involved lymph nodes, extracapsular extension, high lymph node ratio, and positive resection margin. There are no well controlled studies on the role of additional radiotherapy or chemotherapy to improve local control or survival after salvage neck dissection in this group of patients with regional failure. Summary There is limited literature regarding the extent of surgical dissection in treating nodal persistent or recurrent disease. Prospective studies are also needed to determine whether adjuvant therapy improves treatment outcomes. Correspondence to Wai-Tong Ng, Department of Clinical Oncology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China. Tel: +852 2255 4352; fax: +852 2872 6426; e-mail: ngwt1@hku.hk Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

The role of endoscopic medial maxillectomy in sinus disease Purpose of review The endoscopic medial maxillectomy (EMM) has remained a relevant procedure for certain sinus diseases and at the same time reemerged as a salvage technique or even as a primary procedure for other diseases. Several mucosal-sparing techniques have also been described and the outcome of the surgeries is available for review. Recent findings Modifications of the EMM technique in the last two decades, aimed at mucosal preservation of the inferior turbinate, nasolacrimal duct, and medial maxillary wall have been successful in addressing a multitude of diseases. There are also evidences to support adjunct procedures/methods to improve access, healing, and to address associated dysfunction such as impaired mucociliary clearance. Tailored approaches have shown favourable outcomes with a low rate of adverse effects. Summary The EMM is appropriate for selected indications, in particular lesions causing medial wall destruction or extensive tumour involving the anterior wall or the prelacrimal recess. As for other maxillary sinus diseases including those identified to a limited site, a modified EMM is a reasonable consideration. The choice is appropriate provided instrument access, visualization, the ability for complete resection, postoperative care, and the requirement for surveillance is not compromised. A tailored approach with or without adjunct procedures is recommended. Correspondence to Narayanan Prepageran, Department of Otorhinolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel: +60379492062; e-mail: prepageran@yahoo.com Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,

Fwd: PAMJ Clinical Medicine - Recently Published

Clinical Medicine 

Authors are invited to submit original articles for consideration. The special issue will run for a period of one year and articles will be published continuously. The PAMJ will expedite the publication and PubMed Central indexation of accepted articles. Article Processing Charges will be waived for accepted submissions. Submit Now!                               Recently Published in PAMJ CM, 1-18 June 2020 CASE REPORTS Unusual metastatic tumor in the heart: report of an exceptional case with review of the literature Mustapha Azzakhmam, Ouadie Elmenaoui, Mohamed Allaoui, Hafsa Chahdi, Abderrahmane Albouzidi, Mohamed Oukabli Osteosarcoma is the most common malignant bone tumor. Osteosarcomemetastatic with an exceptional heart; only 63 cases have been reported in the medical literature in English up to 2017 during the previous 123 years. In addition, the precise incidence remains poorly understood, estimated at <2% of metastatic osteosarcomas. We report here a rare case of humeral osteosarcoma treated with surgery and chemotherapy, with metachronous cardiac metastasis extending to the superior vena cava (SVC), right atrium (RA) and right ventricle (RV). The patient was operated on with resection of the tumor. The anatomic pathological study had confirmed the same histological nature as the primary humeral tumor, consolidated by molecular biology: intracardiac metastasis of a mixed osteoblastic and chondroblastic osteosarcoma. READ MORE Scoliosis in an identical twin: a case report with literature review Serdar Toy, Sinan Yilar Scoliosis is a 3-dimensional deformity that occurs when the lateral angulation of the vertebra is more than 10 degrees. Scoliosis is divided into two different groups. These are Congenital scoliosis (CS) and Idiopathic scoliosis (IS). Congenital scoliosis occurs at a rate of 0.5-1 per 1000 live births. The role of genetic factors and environmental factors in its etiology has not been fully explained yet. Studies suggested that the spine is challenged due to developmental disorders in the fifth and eighth weeks of pregnancy. These studies emphasized the developmental defects of the spine may occur as a result of segmentation and formation anomalies or a combination of both. READ MORE RESEARCH Risk factors of mortality among patients with stroke in eastern region of the democratic republic of Congo: a retrospective cohort study Larrey Kasereka Kamabu, Hervé Monka Lekuya, Bienvenu Muhindo Kasusula, Moise Muhindo Valimungighe, Nicole Kavugho Mutimani, Louange Maha Kathaka, Eric Sadiki Butala, Adelard Kalima Nzanzu, Zacharie Tsongo Kibendelwa Stroke is the leading cause of acquired disability in the world, the second cause of dementia after Alzheimer's disease, and the third cause of death after ischemic cardiomyopathy, making it a public health concern. In terms of public health, it constitutes one of the major and challenging problems in critical care medicine. Between 1990 and 2017, an increased number of stroke patients was observed worldwide. However, this increase was largely linked to population growth and aging. In developing countries, the incidence of stroke is estimated at 18,875 cases per year, one-third of which recur with a death rate twice as high as the initial stroke. The prevalence of stroke in Black Africans is 5 to 24%. Out of 434 autopsies performed on hypertensive patients in South Africa, 51% was due to stroke. The proportion of deaths caused by stroke is 10 to 12% affecting patients under the age of 65. READ MORE CASE SERIES Neurological manifestations of cytomegalovirus infection with immune reconstitution syndrome in patients with poorly-controlled HIV Karishma Sharma, Felix Riunga, Dilraj Singh Sokhi Cytomegalovirus (CMV) is a ubiquitous herpes virus with an estimated global seroprevalence of greater than 80%. Humans are the only reservoir, with transmission occurring through direct contact with saliva, blood, semen or vaginal secretions. Viral reactivation is seen in immunocompromised patients including those with HIV/AIDS, especially with a CD4 count of less than 100 cells/mm3. The most common manifestations are retinitis and gastrointestinal disease. Neurological manifestations are rare, with the most common being painful polyradiculopathy/radiculomyelitis. CMV immune reconstitution inflammatory syndrome (IRIS) is even rarer and is mainly described as a uveitis.   READ MORE IMAGES IN CLINICAL MEDICINE Giant vulvar condyloma acuminata during pregnancy Hadiza Moutari Soulé, Fatima Zohra Fdili Alaoui External anogenital condylomata acuminata associated with papillomavirus infection are common during pregnancy with a low risk of transmission during childbirth. We report a case of a giant condyloma acuminata infected during pregnancy. This was a 28-year-old primigravidae patient at 36 weeks of gestation, with no previous pathological history, who consulted for vulvar swelling with smelly leucorrhoea and tension type pain rated at 4 on the visual analogue scale. On examination, a huge mass was found on the entire vulva, not allowing individualizing the large as the small lips as well as the clitoris. The vagina was accessible and the vaginal walls were without any particularity at the vaginal touch. The speculum examination was difficult. The patient was placed under parenteral antibiotics, palliative analgesics and local care. The evolution was favorable after antibiotic treatment with a slight regression in the size of the mass. The biopsy had returned in favor of a condyloma acuminata. READ MORE Trying to submit for The Pan African Medical Journal Special issue on COVID-19? Submit your manuscript through the PAMJ Manuscript Hut (https://www.manuscript-hut.panafrican-med-journal.com) Select Supplement - PAMJ COVID 19 Series as manuscript type and follow the instructions to upload your submission The submissions should comply to the PAMJ Instructions for Authors (http://www.panafrican-med-journal.com/instruction.php)   We look forward to receiving your submission.   Submit Manuscript Copyright © -2018- PAMJ-CEPHRI/ThePAMJ.org. Kenya: 3rd Floor, Park Suite Building, Parkland Road, Nairobi. 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Medicine

Study Protocol Titles: Erratum No abstract available

Huanglian Jiedu Decoction for treatment of multiple myeloma: A protocol for a systematic review and meta-analysis Background: Multiple myeloma can lead to lots of clinical problems including pain, fatigue, anemia, infections, renal failure, and so on. Huanglian Jiedu Decoction is a common conservative treatment for this disease in China. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy of Huanglian Jiedu Decoction in the treatment of multiple myeloma. Methods: A systematic literature search for studies will be performed in 8 databases, including PubMed, Web of Science, Embase, the Cochrane library, ClinicalTrials.gov databases, Chinese National Knowledge Infrastructure Database, Wanfang database, and VIP database. The methodological quality of the included studies using the risk bias assessment tool of Cochrane. And the level of evidence for results is assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Statistical analysis is conducted with Revman 5.3. Results: This systematic review and meta-analysis will provide a synthesis of existed evidences for Huanglian Jiedu Decoction on multiple myeloma. Conclusion: The conclusion of this study will provide evidence to assess effectiveness of Huanglian Jiedu Decoction on multiple myeloma, which can further guide clinical decision-making. INPLASY registration number: INPLASY202060094

Three metachronous primary lung cancers in a chronic smoker: A case report and review of the literature Rationale: Lung cancer is a leading cause of cancer-related deaths. Smoking is major risk factor for initial and subsequent lung cancer especially in active smokers. Treatment of subsequent lung cancer depends on whether it is synchronous or metachronous. We report a rare case of triple metachronous lung cancer and review of literature of patients with triple metachronous cancers. This will be the second case reported of triple metachronous lung cancer. Patient concerns: A 60-year-old male, active smoker with diabetes mellitus, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease presented with cough and hemoptysis. Initial computed tomography (CT) scan showed right upper lobe spiculated mass. Diagnosis: He underwent transthoracic needle biopsy for right upper lobe mass, showing primary lung adenocarcinoma (ADC)-Stage-IIIA. He continued to smoke and 9-years later had new left upper lobe spiculated nodule, which on surgical resection showed squamous cell carcinoma (SCC)-Stage-IA1. Despite counselling on smoking cessation, he was unable to quit. Six months later, he presented with shortness of breath and CT chest showing right hilar adenopathy in right upper and lower lobes. He underwent transbronchial biopsies of lesion which showed small cell lung carcinoma (SCLC). Interventions: His initial lung ADC-Stage-IIIA, was treated with chemotherapy, weekly thoracic radiation and additional chemotherapy cycles. Nine years later, his left upper lobe mass showing SCC-Stage-IA1 was deemed curative after apical resection and he was kept on surveillance. Six months later, after diagnosis of SCLC in right upper and lower lobe, patient was not a candidate for systemic chemotherapy due to poor performance status and opted for hospice care. Outcomes: His initial lung ADC-Stage-IIIA showed complete radiological response with chemotherapy and radiation. Subsequent SCC-Stage-IA1 was deemed curative after resection. Due to his poor performance status, he was not a candidate for chemotherapy for SCLC and patient opted for hospice care. Lessons: Smoking is a major risk factor for developing lung cancer and with continued smoking, patients are at higher risk for developing subsequent primary lung cancers. We recommend, patients with lung cancer must quit smoking, and those who do not, should remain on long-term surveillance.

Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: A pilot randomized controlled trial Background: Brain-computer interface-controlled functional electrical stimulation (BCI-FES) approaches as new feedback training is increasingly being investigated for its usefulness in improving the health of adults or partially impaired upper extremity function in individuals with stroke. Objective: To evaluate the effects of BCI-FES on postural control and gait performance in individuals with chronic hemiparetic stroke. Methods: A total of 25 individuals with chronic hemiparetic stroke (13 individuals received BCI-FES and 12 individuals received functional electrical stimulation [FES]). The BCI-FES group received BCI-FES on the tibialis anterior muscle on the more-affected side for 30 minutes per session, 3 times per week for 5 weeks. The FES group received FES using the same methodology for the same periods. This study used the Mann-Whitney test to compare the two groups before and after training. Results: After training, gait velocity (mean value, 29.0 to 42.0 cm/s) (P = .002) and cadence (mean value, 65.2 to 78.9 steps/min) (P = .020) were significantly improved after BCI-FES training compared to those (mean value, 23.6 to 27.7 cm/s, and mean value, 59.4 to 65.5 steps/min, respectively) after FES approach. In the less-affected side, step length was significantly increased after BCI-FES (mean value, from 28.0 cm to 34.7 cm) more than that on FES approach (mean value, from 23.4 to 25.4 cm) (P = .031). Conclusion: The results of the BCI-FES training shows potential advantages on walking abilities in individuals with chronic hemiparetic stroke.

Mediating effect of social support on the association between life events and depression: A cross-sectional study of adolescents in Chongqing China Depression is one of the most common mental health problems in adolescents. The link between negative life events and depression has been well established. However, our understanding about the role of social support in the link, which is likely culture-dependent, is quite limited. This study aimed to determine the mediating effect of social support on the association between life events and depression in adolescents in Chongqing China. A total of 1512 adolescents aged 12 to 17 years old in Chongqing of China were selected using a stratified cluster sampling strategy. Depression symptoms, negative life events, and perceived social support of the participants were measured using the Children's Depression Inventory, Adolescent Life Event Scale, and Child and Adolescent Social Support Scale, respectively. Pearson correlation analyses were performed to detect their associations. A multivariate linear regression model was established to determine the association between life events and depression after adjustment for variations in socio-demographic variables. The mediating effect of social support on the association between negative life events and depression was tested using the structural equation model. About 16.8% of the participants were detected with depression. Depression was associated with negative life events and low levels of social support (P < .05). Both frequency and perceived importance of social support showed a mediating effect on the association between life events and depression. Social support has a mediating effect on the association between life events and depression. Strengthening social support may be considered as an effective interventional strategy on depression in adolescents.

Comparison of empirical high-dose and low-dose of meropenem in critically ill patients with sepsis and septic shock: A randomized controlled study protocol Background: Sepsis and septic shock syndrome are the main problems in modern medicine. Current treatment guidelines for the sepsis recommend an appropriate and timely antibiotic treatment. Meropenem has activity against a wide variety of Gramnegative and Gram-positive bacteria. At present, there are few studies on the application of high-does meropenem in the patients with sepsis and septic shock. We therefore carry out the randomized controlled research to compare the low-dose and high-dose meropenem in the critically ill sepsis and septic shock patients, and to assess the safety of the two regimens. Method: This is a prospective, single-center, and randomized research authorized through the local research ethics committee of Zhejiang Chinese Medical University (No.32198276). Sixty-four participants with a diagnosis of sepsis and septic shock are analyzed. Patients who meet the following conditions will be included: (1)patients older than 18 years old,(2)patients diagnosed with the sepsis and septic shock, and(3)patients (or their relatives) who have signed a consent. Patients with the following conditions will be excluded (1)patients with infective endocarditis and central nervous system infection;(2)Within 24 hours after the randomization of patients needing surgery;(3)Within 24 hours after the randomization, patients who received extracorporeal membrane oxygenation (ECMO);(4)Patients with known meropenem allergy. They are assigned to 2 groups, namely, the standard-does group and high-dose group, in the standard-does group, they receive low-dose meropenem (intravenous injection of 1 g meropenem for more than 30 minutes, followed by intravenous injection of 1 g meropenem for more than three hours every 8 hours), and in the high-dose group, patients receive high-does meropenem (intravenous injection of 2 g meropenem for more than 30 minutes, and then intravenous injection of 2 grams of meropenem for more than three hours every 8 hours). The main outcomes are the modified Acute Physiology and Chronic Health Evaluation II (APACHE II) and scores of Sequential Organ Failure Assessment (SOFA). And the secondary outcomes are the 14-day mortality and 28-day mortality, the rate of microbiological cure and clinical cure, ventilator-free days, vasopressor-free days, hospital-free days and the ICU-free days, as well as safety in the two regimen groups. All analysis in our work is carried out via utilizing the software of IBM SPSS Statistics for Windows, version 20. Results: Figure 1 reveal the primary outcomes and the secondary outcomes. Conclusion: This protocol can provide a reliable evidence for the safety and effectiveness of the high-dose meropenem in the critically ill sepsis and septic shock patients. Trial registration number: researchregistry6023

Effectiveness and safety of different medicines for Uremia pruritus: A protocol for systematic review and network meta analysis Introduction: A large number of patients will experience pruritus after uremia. Medicine is the preferred treatment for many doctors, but the effectiveness and safety of different medicines for uremia pruritus has not yet been comprehensively compared, based on network meta-analysis. Methods and analysis: According to the retrieval strategy, two team members independently searched the literature in 7 databases, and imported the retrieval results into the EndNote Software AQ8 (V.X9). After deleting repeated articles, they read the abstract and the full text, selected the articles that met the inclusion criteria and extracted valid information. The main results were visual analogue scale (VAS) and the secondary results were verbal rating scale (VRS), Dirk R Kuypers score, and adverse event incidence. The methodological quality evaluation was conducted from 7 aspects, according to The Cochrane Collaborative Tool, Stata Statistical Software (Version 14.0, Stata Corporation, College Station, TX) was used for data analysis. The level of evidence will be assessed by the Grading of Recommendations, Development and Evaluation (GRADE) instrument). Results: The results will rank the efficacy of drugs used to treat uremic pruritus and assess their safety. Conclusion: This study is the first to compare the efficacy and safety of medicines for uremic pruritus based on network analysis and will provide evidence and ideas for the treatment of uremic pruritus. INPLASY registration number: No. INPLASY202090103.

Different acupuncture therapies combined with rehabilitation in the treatment of scapulohumeral periarthritis: A protocol for systematic review and network meta-analysis Background: Scapulohumeral periarthritis is a disease that seriously affects human daily work and life, and greatly reduces peoples quality of life and affects human health all over the world. Now, many studies have shown that acupuncture and rehabilitation have a significant effect on scapulohumeral periarthritis. In this study, network meta-analysis was used to analyze and compare the clinical efficacy and difference of different acupuncture treatments on scapulohumeral periarthritis. Methods: All patients were diagnosed as scapulohumeral periarthritis by randomized controlled trial. Computer searches will be conducted on CNKI, Wan-Fang databases, VIP, CBM, Pubmed, Cochrane library, Embase, Web of Science. The retrieval period is from the date of database establishment to September 8, 2020. To avoid omissions, we will manually retrieve relevant references and conference papers. Finally, the risk of bias included in the study will be assessed according to the guidelines of the Cochrane Handbook for systematic review of interventions. All data analysis will be performed by Revman 5.3, WinBUGS1.4.3 and Stata14.2. Results: The effectiveness of each intervention was quantified. The main results included cure rate, total effective rate, VAS score and shoulder function score. Conclusion: Objective to provide evidence-based medicine basis for clinicians to choose more effective acupuncture therapy for scapulohumeral periarthritis. INPLASY Registration number: 202090035.

Clinical features of velamentous umbilical cord insertion and vasa previa: A retrospective analysis based on 501 cases To identify the risk factors associated with velamentous cord insertion (VCI) and investigate the association between adverse pregnancy outcomes and VCI in singleton pregnancies and those with vasa previa. A total of 59,976 single cases admitted from Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014 were included in this study. We retrospectively analyzed the perinatal complications, neonatal complications, and the clinical features, as well as the Color Doppler ultrasonography findings of the velamentous placenta and placenta previa. We reviewed the clinical data of 59,976 women with singleton pregnancies delivered in Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014. Risk factors and the risks of adverse pregnancy outcomes including admission to a neonatal unit, fetal death, preterm delivery, low birth weight of <2500 g, the infant being small for its gestation age, low Apgar scores (<7) at 1 and 5 minute were evaluated separately among women with and without VCI by means of logistic regression analyses. The prevalence of velamentous umbilical cord insertion was 0.84%, and the prevalence of vasa previa was 0.0017%. The independent risk factors for VCI were nulliparity, obesity, fertility problems, placenta previa, and maternal smoking. VCI was associated with a 1.83-, 2.58-, 3.62-, and 1.41-fold increase in the risk of retention in the neonatal unit, preterm delivery (<37 gestation weeks), low birth weight, and small-for-gestational age, compared to pregnancies involving normal cord insertion. Of the women with VCI, 16.1% underwent emergency cesarean section compared to 8.9% (P < .001) of women without VCI. The prevalence of VCI was 0.84% in singletons. The results suggest that VCI is a moderate risk condition resulted in increased risks of prematurity and impairment of fetal growth.

The efficacy of Chinese herbal medicine as an adjunctive therapy for colorectal cancer: A protocol for systematic review of randomized controlled trials Background: Colorectal cancer (CRC) is a public health problem and the world's leading cancer killer. It is a disease with high incidence and mortality. Although chemotherapy has achieved some success in the treatment of CRC, drug resistance and tumor metastasis caused by chemotherapy are still the main causes of death in patients with CRC. Notably, many side effects associated with chemotherapy, such as nausea, vomiting, and peripheral neurotoxicity, are major challenges in the treatment of patients with CRC. Chinese herbal medicine (CHM) has been widely used as an adjunctive therapy for CRC, but its efficacy and safety are still uncertain. The aim of this systematic review is to assess the efficacy and safety of CHM for the treatment of CRC. Methods: A comprehensive retrieval will be performed in the following electronic databases: PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, SinoMed, VIP, and Wan Fang Data. The methodologic quality of randomized controlled trials will be assessed using the Cochrane risk assessment tool. Review Manager 5.3 software will be used for data synthesis and analysis. Funnel plot analysis and Egger test will be used to assess publication bias. The Grading of Recommendations Assessment, Development and Evaluation standard will be used to generate summary of finding table. Results: The results of this systematic review will be used to summarize and evaluate the evidence from randomized controlled clinical trials of CHM as adjuvant therapy for CRC. Conclusion: This review will provide a detailed summary of the evidence to assess the efficacy and safety of CHM for CRC. OSF Registration: DOI 10.17605/OSF.IO/X2SKJ

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