bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of glycated hemoglobin index and mean arterial pressure on acute ischemic stroke prognosis after intravenous thrombolysis with recombinant tissue plasminogen activator
Authors: Liu Shi-Ying , Cao Wen-Feng , Wu Ling-Feng , Xiang Zheng-Bing , Liu Shi-Min , Liu Hai-Yan , Pan Yang , Nie Feng , Wu Xiao-Mu , Xie Xu-Fang
Published: December 2018

To determine whether glycated hemoglobin and mean arterial pressure (MAP) during thrombolysis are prognostic factors of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke (AIS).

A total of 125 AIS patients, who received rt-PA intravenous thrombolysis in our hospital, were included into the present study, and divided into good prognosis group and poor prognosis group. Univariate and multivariate logistic regression analyses were used to determine the prognostic factors of AIS treated by rt-PA thrombolysis, Spearman correlation analysis was used to analyze the correlation of the accumulated cigarette consumption in the smoking subgroup and glycated hemoglobin in the diabetic subgroup with the prognosis after intravenous thrombolysis and the symptomatic intracranial hemorrhage (sICH).

Univariate analysis revealed that the interval from onset to thrombolysis, baseline National Institutes of Health Stroke Scale (NIHSS) score, MAP during thrombolysis and DRAGON score were prognostic factors. Multivariate logistic regression analysis revealed that baseline NIHSS score and MAP during thrombolysis were independent prognostic factors for rt-PA thrombolysis. Furthermore, the glycated hemoglobin index was positively correlated with the incidence of sICH.

The NIHSS score before thrombolysis and MAP during thrombolysis were independent factors for the prognosis of AIS treated by thrombolysis. The higher the glycated hemoglobin index of diabetic patients, the more likely they are to develop sICH, the glycated hemoglobin index was negatively correlated with the prognosis after intravenous thrombolysis. The accumulated cigarette consumption was negatively correlated with the prognosis after intravenous thrombolysis.
Targeted next-generation sequencing identifies a novel mutation of LAMB3 in a Chinese neonatal patient presented with junctional epidermolysis bullosa
Authors: Wang Hairong , Yang Yun , Zhou Jieqiong , Cao Jiangxia , He Xuelian , Li Long , Gao Shuyang , Mao Bing , Tian Ping , Zhou Aifen
Published: December 2018

Rationale:

Epidermolysis bullosa (EB) refers to a group of rare inherited mechanobullous disorders that present with great clinical and genetic heterogeneity. Its severity ranges from mild blistering to life-threatening. However, the clinical symptoms of different types of EB overlap significantly, especially at an early stage. Thus it is important to clarify the diagnosis for prognostic implications, patient management, and genetic counseling.

Patient concerns:

Here, we report a 10-day-old male neonate from a nonconsanguineous Chinese family. He showed a bulla on the left lower limb lasting for 3 days, erosions around fingertips and toe tips at birth (predominantly on fingers), with the progressive spread of generalized blisters over the body as well as the development of the illness.

Diagnosis:

The patient was diagnosed with suspected epidermolysis bullosa according to the blisters and erosions of the body as well as the pyogenic fingernails and toenails.

Interventions:

The patient was performed targeted next-generation sequencing (NGS) with 9 candidate known genes, subsequently, his parents were screened for the mutations identified in the patient by Sanger sequencing. Then, prenatal diagnosis with amniotic fluid was performed in the subsequent pregnancy by Sanger sequencing.

Outcomes:

Targeted NGS revealed a previously unreported splice site variant c.822+1G>A (IVS 8) and a known recurrent nonsense variant c.124C>T (p.Arg42Ter, exon 3) in LAMB3 gene. The patient's father possessed a heterozygous c.822+1G>A mutation, his mother possessed a heterozygous c.124C>T mutation. For the subsequent pregnancy, the analyses of amniotic fluid sample indicated that the fetus carried neither of the mutations.

Lessons:

Our finding will further enlarge LAMB3 genotype-phenotype correlations spectrum. Targeted capture sequencing is a valuable method to illustrate precise molecular pathology in patients with EB disorders, especially at an early stage of the clinical evaluation of complex disorders to avoid unnecessary and economically wasteful tests.
The impact of abdominal fat on abdominal aorta calcification measured on non-enhanced CT
Authors: Goldenberg Limor , Saliba Walid , Hayeq Hashem , Hasadia Rabea , Zeina Abdel-Rauf
Published: December 2018

Cardiovascular (CV) morbidity, atherosclerosis, and obesity are all targets of clinical concern and vast research, as is the association between them. Aim of this study is to assess the impact of adipose tissue (including visceral and subcutaneous fat) on abdominal aorta calcification measured on non-enhanced computed tomography (CT). We retrospectively included 492 patients who underwent non-enhanced CT scans during workup for clinically suspected renal colic. All scans were reviewed for abdominal aorta calcification, liver attenuation, and thickness of visceral and subcutaneous fat. Multivariate general linear regression models were used to assess the association between abdominal aorta calcium score and adiposity measures. In the model that included only adiposity measures; visceral fat thickness had statistically significant direct association with abdominal aorta calcium score (B = 67.1, P <.001), whereas subcutaneous pelvic fat thickness had a significant inverse association with abdominal aorta calcium score (B = −22.34, P <.001). Only the association of subcutaneous pelvic fat thickness with abdominal aorta calcium score remained statistically significant when controlling for age, sex, smoking, hypertension, diabetes mellitus, and hyperlipidemia (B = −21.23, P <.001). In this model, the association of visceral fat remained statistically significant in females (B = 84.28, P = .001) but not in males (B = 0.47, P = .973). Visceral fat thickness and subcutaneous pelvic fat thickness were found to have opposing associations with abdominal aorta calcium score. This suggests that while visceral fat may have a lipotoxic effect on aortic atherosclerotic processes, subcutaneous pelvic fat may have a protective role in these processes.
Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward
Authors: Kopczynska Maja , Sharif Ben , Cleaver Sian , Spencer Naomi , Kurani Amit , Lee Camilla , Davis Jessica , Durie Carys , Joseph-Gubral Jude , Sharma Angelica , Allen Lucy , Atkins Billie , Gordon Alex , Jones Llewelyn , Noble Amy , Bradley Matthew , Atkinson Henry , Inns Joy , Penney Harriet , Gilbert Carys , Walford Rebecca , Pike Louise , Edwards Ross , Howcroft Robyn , Preston Hazel , Gee Jennifer , Doyle Nicholas , Maden Charlotte , Smith Claire , Azis Nik Syakirah Nik , Vadivale Navrhinaa , Battle Ceri , Lyons Ronan , Morgan Paul , Pugh Richard , Szakmany Tamas
Published: December 2018

Controversy exists regarding the best diagnostic and screening tool for sepsis outside the intensive care unit (ICU). Sequential organ failure assessment (SOFA) score has been shown to be superior to systemic inflammatory response syndrome (SIRS) criteria, however, the performance of “Red Flag sepsis criteria” has not been tested formally.

The aim of the study was to investigate the ability of Red Flag sepsis criteria to identify the patients at high risk of sepsis-related death in comparison to SOFA based sepsis criteria. We also investigated the comparison of Red Flag sepsis to quick SOFA (qSOFA), SIRS, and national early warning score (NEWS) scores and factors influencing patient mortality.

Patients were recruited into a 24-hour point-prevalence study on the general wards and emergency departments across all Welsh acute hospitals. Inclusion criteria were: clinical suspicion of infection and NEWS 3 or above in-line with established escalation criteria in Wales. Data on Red Flag sepsis and SOFA criteria was collected together with qSOFA and SIRS scores and 90-day mortality.

459 patients were recruited over a 24-hour period. 246 were positive for Red Flag sepsis, mortality 33.7% (83/246); 241 for SOFA based sepsis criteria, mortality 39.4% (95/241); 54 for qSOFA, mortality 57.4% (31/54), and 268 for SIRS, mortality 33.6% (90/268). 55 patients were not picked up by any criteria. We found that older age was associated with death with OR (95% CI) of 1.03 (1.02–1.04); higher frailty score 1.24 (1.11–1.40); DNA-CPR order 1.74 (1.14–2.65); ceiling of care 1.55 (1.02–2.33); and SOFA score of 2 and above 1.69 (1.16–2.47).

The different clinical tools captured different subsets of the at-risk population, with similar sensitivity. SOFA score 2 or above was independently associated with increased risk of death at 90 days. The sequalae of infection-related organ dysfunction cannot be reliably captured based on routine clinical and physiological parameters alone.
Survival nomograms for stage III colorectal cancer
Authors: Li Chenglong , Pei Qian , Zhu Hong , Tan Fengbo , Zhou Zhongyi , Zhou Yuan , Li Yuqiang , Pei Haiping
Published: December 2018

The postoperative survival of patients with stage III colorectal cancer (CRC) various obviously. We sought to develop novel nomograms for predicting the survival of these patients after radical surgery and postoperative chemotherapy.

A total of 620 consecutive patients with stage III CRC who underwent curative resection and postoperative chemotherapy between January 2009 and December 2015 were retrospectively collected and randomly allocated to the training (n = 372) or validation cohort (n = 248). Clinicopathological factors were collected and analyzed. On the basis of data from 372 patients in the training set, predictive factors for overall survival (OS) and disease-free survival (DFS) were identified using multivariate Cox regression and used to construct nomograms. The predictive performance of the nomograms was assessed by concordance index (C-index) and calibration plots. An external cohort of 248 patients was used to validate the nomograms. Furthermore, nomogram performance was compared with the performance of T and N stage stratification.

Tumor differentiation grade, lymph node metastasis ratio, intravascular emboli (IVE), preoperative serum carcinoembryonic antigen (CEA) level, albumin to globulin ratio (AGR), T stage and N stage were significant prognostic factors for OS on multivariate analysis; whereas, Tumor differentiation grade, lymph node metastasis ratio, IVE, AGR and N stage were significant for DFS. Nomograms to predict 3- and 5-year OS and DFS were established that performed well (C-indexes of 0.734 [95% CI, 0.691–0.779] for OS and 0.699 [95% CI, 0.657–0.740] for DFS prediction), and nomogram accuracy was confirmed in the validation cohort. Furthermore, model comparison proved that the nomograms were superior to risk stratification by T and N stage for stage III CRC.

We propose 2 practical nomograms for stage III CRC patients that provide more accurate prognostic predictions and should be helpful for guiding individualized treatment and postoperative surveillance.
Association between MDM2 SNP309 and endometrial cancer risk
Authors: Zou Xinwei , Zhang Yi , Zhang Lin , Li Jiaxi , Zhu Chenjie , Cheng Qiuhong , Zhou Jinhua , Chen Youguo
Published: December 2018

Background:

Murine double minute 2 homolog (MDM2) plays an important role in the downregulation of P53 tumor suppressor gene. MDM2 inhibits P53 transcriptional activity and thereby results in accelerated tumor formation. Overexpression of MDM2 has been found in several cancer types including endometrial cancer. SNP309 is located in the promoter region of MDM2 and contributes to the overexpression of MDM2. The association between MDM2 SNP309 polymorphism and endometrial cancer risk has been investigated in several studies; however, the conclusion remains controversial.

Objectives:

We performed the present meta-analysis to give a comprehensive conclusion of the association between MDM2 SNP309 polymorphism and endometrial cancer susceptibility.

Methods:

We conducted a literature research on PubMed, Embase, Cochrane Library, OVID, Web of Science, Wan Fang, CNKI, and CQVIP databases up to July 31, 2018. Newcastle–Ottawa scale was used to assess the quality of studies. We evaluated the strength of association by combining odds ratios (ORs) and 95% confidence intervals (CIs) in 5 different genetic models under a fixed-effect model or random-effect model. We further conducted subgroup analysis by ethnicity, source of control, histological type, clinical type, grade, and stage of tumor. Sensitivity analysis and publication bias were also performed.

Results:

Nine eligible studies were finally included in our meta-analysis. We found MDM2 SNP309 polymorphism increased the risk of endometrial cancer under allele model (OR: 1.23, 95% CI: 1.06–1.41, P = .005), homozygote model (OR: 1.43, 95% CI: 1.13–1.81, P = .003) and recessive model (OR: 1.55, 95% CI: 1.17-2.04, P = .002). Subgroup analysis suggested a similar elevated risk in both Asians and Caucasians. We identified a strong association of enhanced susceptibility to endometrial cancer in endometrioid group (OR: 2.13, 95% CI: 1.28–3.54, P = .004) and Type I group (OR: 1.89, 95% CI: 1.25–2.86, P = .002) under dominant model. We identified no significant publication bias according to Egger's test.

Conclusions:

Our meta-analysis suggested that MDM2 SNP309 polymorphism increased the risk of endometrial cancer significantly, especially in endometrioid and Type I endometrial cancer, indicating MDM2 could serve as a potential diagnostic factor marker for endometrial cancer.
General hyperpigmentation induced by Grave's disease
Authors: Song Xiaoxiao , Shen Yimin , Zhou Ying , Lou Qinhua , Han Li , Ho Jon Kee , Ren Yuezhong
Published: December 2018

Rationale:

Hyperpigmentation is a common skin disease. However, there are few reported cases of Grave's disease with diffuse hyperpigmentation. We hereby described a rare case with diffuse hyperpigmentation induced by Grave's disease.

Patient concerns:

A 42-year-old Chinese woman with accumulated general pigmentation of skin was admitted to our hospital in October 2017. On examination, hyperpigmentation was observed throughout the whole body, especially on the extremities and the face.

Diagnoses:

The patient has elevated levels of serum free thyroxine (FT4), free triiodothyronine (FT3), reduced levels of thyroid-stimulating hormone (TSH) and positive anti-TSH receptor antibody (TRAb). She presented with grade I goiter and a diffusely increased thyroid uptake to 18.5% in thyroid scan. Histopathological examination demonstrated melanin pigmentation in the pigmented skin area. The patient was diagnosed with hyperpigmentation induced by Grave's disease.

Interventions:

The patient was treated with oral methimazole (15 mg/day) for thyroid dysfunction and beta blocker for symptom control.

Outcomes:

After a period of treatment with methimazole and beta blocker, symptoms of hyperthyroidism ameliorated and hyperpigmentation abated.

Lessons:

Our studies proposed that in this case the diffuse hyperpigmentation in Grave's disease was caused by elevated adrenocorticotropic hormone (ACTH) as well as anti- TSH receptor stimulating antibody instead of enhanced capillary fragility. Other potential mechanisms for skin pigmentation in hyperthyroidism still need further exploration.
Radiculoplasty with reconstruction using 3D-printed artificial dura mater for the treatment of symptomatic sacral canal cysts
Authors: Liu Bin , Wang Zhenyu , Lin Guozhong , Zhang Jia
Published: December 2018

Rationale:

Currently, interventional injection of albumin glue and nerve sleeve plasty by cyst excision is the main treatment for sacral cysts. However, albumin glue can only be used in patients with partial cystic neck stenosis, and surgical treatment may result in postoperative complications such as numbness and cyst recurrence. Here, a modified radiculoplasty is presented, in which the lamina is restored with the nerve root wrapped with 3-dimensional (3D)-printed artificial dura mater.

Patient concerns:

The first patient, a 28-year-old man, had been complaining of aggravated perineal pain for 8 months a visual analog scale (VAS) score of 7. Sacrococcygeal magnetic resonance imaging (MRI) revealed multiple sacral canal cysts. The second case, a 48-year-old woman, has been complaining of lumbosacral and left leg pain for 1 month (VAS score of 7). Physical examination showed hyperalgesia below the right sacrum 2 level. Sacrococcygeal MRI and computed tomography (CT) revealed multiple sacral canal cysts and a calcified lesion in the cyst.

Diagnoses and Intervention:

The first patient underwent radiculoplasty with reconstruction using 3D-printed artificial dura mater, with 3 cysts treated and the lamina restored. Four cysts of the second patients were treated, including 1 bone-occupying lesion. Radiculoplasty with reconstruction using 3D-printed artificial dura mater was used for the cysts and the lamina was restored

Outcomes:

The postoperative VAS score was 0 to 2 points in the 2 patients. No postoperative infection or new neurological dysfunction was observed. Postoperative MRI showed no cysts, with lamina restoration. After 6 months, the VAS score was 0, and MRI showed no recurrence.

Lessons:

Radiculoplasty with reconstruction using 3D-printed artificial dura mater and lamina restoration could be beneficial for the treatment of symptomatic sacral canal cysts.
The diagnostic accuracy of contrast-enhanced ultrasound for the differentiation of benign and malignant thyroid nodules
Authors: Liu Qinghua , Cheng Jian , Li Jingjing , Gao Xiang , Li Hongbo
Published: December 2018

Background:

Contrast-enhanced ultrasound (CEUS) is a non-invasive method that has been used in the diagnosis of several diseases. Recently, CEUS has been used in the differentiation of benign and malignant thyroid nodules. However, the performance of CEUS in thyroid nodules has not been studied clearly.

Methods:

The databases of Pubmed, Embase, Cochrane library and the unpublished studies were systematically searched for candidate inclusions, with the use of CEUS in differentiating the benign and malignant thyroid nodules. The quality of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) questionnaire. The pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratio (NLR) were calculated using STATA software version 14.0.

Results:

Totally 33 diagnostic studies were included for further analysis. The quality of included studies was relatively high using QUADAS method. The pooled estimates of sensitivity and specificity were 0.88 (95% CI 0.85, 0.91) and 0.88 (95% CI 0.83, 0.91), respectively. In addition, the DOR, the positive and NLRs were pooled positive LR and the negative LR were 54 (95% CI 33, 89), 7.1% (5.2%, 9.8%), and 0.13% (0.10%, 0.18%). No significant publication bias was observed.

Conclusions:

Our meta-analysis further indicated that CEUS is a useful tool in differentiating benign and malignant thyroid nodules, with high sensitivity and specificity.
Definition of a safe zone for screw fixation of posterior talar process fracture by 3-dimensional technology
Authors: Mao Haijiao , Wang Haiqing , Wang Linger , Yao Liwei
Published: December 2018

Background:

Percutaneous screw fixation can provide stable fixation with a minimally invasive surgical technique for posterior talar process fracture.

Objectives:

The purpose of this study was to investigate the optimal posterior screw placement and the geometry of safe zone for screw insertion in the posterior talar process by analyzing with 3-dimensional (3D) technology.

Methods:

100 adult feet computed tomography (CT) scans were evaluated. CT data were imported into Materiaise's interactive medical image control system (MIMICS) 18.01 software for 3-dimensional reconstruction. Two 3.0mm-diameter screws were simulated from the posterior to anterior position for posterior talar process. The morphology parameters of posterior talar process were also quantitatively measured. The safe zone and the length and entry point of screw were defined.

Results:

The optimal entry point of screw for posterior talar process fracture was lateral tubercle from the posterior to anterior position. The safe zone of medial tubercle entry point was smaller in lateral tubercle. These gender-specific measurements were all significant (P <.001).

Conclusions:

The predefined zone with computer-assisted 3D techniques for the most frequently positioned percutaneous screws may aid in preoperative planning, shorten the operation time and reduce the incidence of surgical complications.
Proposal of a new exercise protocol for idiopathic scoliosis
Authors: Ko Jin Young , Suh Jee Hyun , Kim Hayoung , Ryu Ju Seok
Published: December 2018

In clinical practice, we found a unilateral instability in patients with right thoracic scoliosis during asymmetric spinal stabilization exercise (ASSE), which can be an important clue to identify the pathophysiology of idiopathic scoliosis (IS).

We investigated the relationship between unilateral postural instability and weakness of paraspinal muscles according to curve pattern. And finally, we propose the new exercise method based on the curve pattern.

Combined use of prospective and retrospective clinical trials.

Fifteen participants without IS and 10 patients with IS in 1 tertiary referral hospital.

In 15 participants without IS, surface electromyography (sEMG) was used to evaluate the muscular activation patterns in the bilateral erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles during ASSE. In addition, to assess the clinical effect of ASSE, Cobb angle and rotation grade were measured from 10 patients with IS.

The most significant findings from the sEMG data were the increased activities of ipsilateral 7th thoracic ES during hand-up motion, ipsilateral 3rd lumbar ES during leg-up motion, and 12th thoracic and 3rd lumbar ES during side-bridging. In a radiographic analysis, specific components of ASSE that activates the concave side muscles were found to be effective for IS.

The paraspinal muscle strengthening of the concave side using ASSE can improve the severity of scoliosis. Based on this research, we could propose a new exercise protocol that can be personalized according to the curve pattern.
An in silico analysis of human sperm genes associated with asthenozoospermia and its implication in male infertility
Authors: Liu Xue Xia , Cai Li , Liu Fu Jun
Published: December 2018

Asthenozoospermia is the most common clinical symptom of male infertility. Molecular markers associated with asthenozoospermia spermatozoa are scarcely identified. The objective of this study was to screen the differentially expressed genes (DEGs) in asthenozoospermia spermatozoa and assess the underlying bioinformatics roles in regulation of sperm quality.

Based on gene expression omnibus (GEO) database, the GSE22331, GSE1133, and GSE4193 expression profile data were downloaded. The DEGs of asthenozoospermia spermatozoa were identified. Germ cell specific genes in DEGs were further screened. Then, gene ontology (GO) and over-representation analysis of DEGs were performed, followed by protein–protein interaction (PPI) network analysis. Expressions of selected genes of TEX11, ADAMTS5, ASRGL1, GMCL1, PGK2, KLHL10 in normozoospermia and asthenozoospermia spermatozoa were identified using real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR).

A total of 1323 DEGs were identified, including 1140 down-regulated genes. Twenty one and 96 down-regulated genes were especially expressed in spermatogonia and round spermatids, suggesting their testicular origins and influences on sperm quality. Bioinformatics analysis showed enriched functions of ubiquitin-like protein transferase or protein binding activities in down-regulated genes. Expressions of selected genes were validated by RT-PCR, which was consistent with bioinformatical results.

The present study provided a novel insight into the understanding of sperm quality, and a potential method and dataset for the diagnosis and assessment of sperm quality in the event of male infertility.
Comparative efficacy and safety of phosphodiesterase-5 inhibitors with selective serotonin reuptake inhibitors in men with premature ejaculation
Authors: Jin Kun , Deng Linghui , Qiu Shi , Tu Xiang , Li Jiakun , Bao Yige , Yang Lu , Wei Qiang
Published: December 2018

Background:

We performed the network meta-analysis (NMA) and systematic review involved all evidence from relevant trials to compare the efficiency and safety of various types of selective serotonin reuptake inhibitors (SSRI) and phosphodiesterase-5 inhibitors (PDE5i) in patients with premature ejaculation (PE).

Methods:

We conducted comprehensive searches of peer-reviewed and grey literature. PubMed, the Cochrane Library Central Register of Controlled Trials, Embase were searched for randomized controlled trials published up to June 1, 2017. The primary outcome was intravaginal ejaculation latency time (IVELT) and adverse effects (AEs). We performed pairwise meta-analyses by random effects model and network meta-analysis by Bayesian model. We used the GRADE framework to assess the quality of evidence contributing to each network estimate.

Results:

Of 3046 titles and abstracts initially identified, 17 trials reporting 5739 participants were included. Considering IVELT in the NMA, paroxetine plus sildenafil and sildenafil alone are both superior to placebo (MD: 1.75, 95% CrI: 0.05 to 3.78; MD 1.43, 95% CrI 0.003 to 2.81). Sildenafil is superior to sertraline (MD: 1.63, 95% CrI: 0.10 to 2.79). Considering AEs, placebo demonstrated obviously lower risk comparing to paroxetine, sildenafil and paroxetine plus sildenafil (OR 0.20, 95% CI: 0.05 to 0.52; OR 0.23, 95% CI: 0.04 to 0.80; OR 0.45, 95% CI: 0.01 to 0.92). Compared with tadalafil plus paroxetine, dapoxetine showed significantly less AEs (OR 0.23, 95% CI 0.02 to 0.96).

Conclusions:

Our study concluded that although paroxetine plus sildenafil and sildenafil alone both demonstrated significant IVELT benefit compared with placebo, significant increase of AEs risk was also observed. Furthermore, sildenafil alone was superior to sertraline in efficacy with comparable tolerability.
Complete clinical and functional recovery following low-dose methotrexate related paraparesis in a patient with compound c.1298A>C AND c.677C>T MTHFR polymorphism
Authors: Saviola Gianantonio , Abdi-Ali Lul , Sacco Silvano , Comini Laura , Plewnia Katrin , Rossi Maja , Orrico Alfredo
Published: December 2018

Rationale:

The mechanisms of action of MTX (methotrexate) in the treatment of RA (rheumatoid arthritis) and PsA (psoriatic arthritis) is related to its antifolic activity, due to the high affinity for enzymes that require folate cofactors as dihydrofolate reductase and to the anti-inflammatory activity derivated from the inhibition of thymidylate synthetase that leads to the over-production of adenosine.

Patient concerns:

Our patient was a 41-year-old female, affected by PsA in treatment since 2 years with low-dose methylprednisolone and low-dose subcutaneous MTX. The treatment was effective. The patient subacutely developed a severe paraparesis with impossibility of gait or standing without aid and was admitted to a Neurology Department where the cause of the paraparesis was not clear in spite of accurate radiological neurophysiologic and laboratory tests. Therefore, she was admitted in a rehabilitation unit.

Diagnosis and interventions:

Paraparesis in PsA patient in treatment with methotrexate. MTX toxicity was hypothesized; therefore the drug was discontinued while i.m. folic acid and cyanocobalamin were administered for 20 days. The diagnosis was clinical, based on neurological examination (paraparesis) and on the chronic use of MTX (hypothesis of toxicity).

Outcomes:

The patient obtained a complete resolution of paraparesis. Genetic analyses showed associated a compound heterozygosity for the c.1298A>C and c.677C>T variants of methylenetetrahydrofolate reductase (MTHFR) gene.

Lessons:

Neurological side effects of MTX are uncommon. In literature no previous case of MTX induced paraparesis in patients treated with low-dose MTX for chronic arthritis has been described. The association between the gene polymorphisms of MTHFR (c.1298A>C and c.677C>T) and MTX toxicity in arthritis patients is confirmed. The case also confirms that folates are a precious antidote of MTX toxicity.
Case report of dysregulation of primary bile acid synthesis in a family with X-linked adrenoleukodystrophy
Authors: Płatek Teresa , Orso Evelyn , Zapała Barbara , Polus Anna , Kieć-Wilk Beata , Piwowar Monika , Chojnacka Monika , Ciałowicz Urszula , Malczewska-Malec Małgorzata , Schmitz Gerd , Solnica Bogdan , Dembińska-Kieć Aldona
Published: December 2018

Rationale:

X-linked adrenoleukodystrophy (X-ALD) is a rare disorder caused by mutations in theABCD1gene, coding for peroxisomal membrane transporter adrenoleukodystrophy (ALD) protein. The disease is characterized by accumulation of very long chain fatty acids (VLCFAs) in tissues. Adult adrenomyeloneuropathy (AMN) and the cerebral inflammatory form of ALD are the main phenotypes presenting various symptoms.

Patient concerns:

We report a case of 37-year-old patient with diagnosis of X-ALD, confirmed based on elevated VLCFA concentrations and genetic testing ofABCD1gene. The complete clinical picture in the patient indicates AMN phenotype with cerebral involvement.

Diagnoses:

The reduced synthesis of unconjugated cholic and chenodeoxycholic acids, and the reduction to 28% to 29% of peroxisomal beta-oxidation of behenic acid and normal peroxisomal metabolism of pristanic and palmitic acid were observed in the X-ALD patient. Sanger sequencing of major genes involved in primary bile acid (BA) synthesis failed to identify pathogenic mutations of the investigated set of genes.

Interventions:

Plasma concentrations of BAs, VLCFAs, and beta-oxidation of C22:0, C16:0, and pristanic acid were studied in primary skin fibroblasts of the patient. In addition, we performed sequencing of theABCD1,ABCD3,CYP7A1,CYP7B1,CYP27A1,HSD3B7, AKR1D1, andSLC27A5genes in the X-ALD family.

Outcomes:

In the Polish family affected with AMN a dysregulation of the primary BA synthesis pathway was found.

Lessons:

We have demonstrated the coincidence of the adult form of X-ALD with abnormalities in BA synthesis. We suggest that decreased synthesis of BAs may be an additional dysfunction as a consequence of theABCD1c.659T>C, p.(Leu220Pro) mutation and may be further evidence that disturbed cholesterol metabolism is important in the pathology of ALD.
Relationship between mortality in people with mental disorders and suicide mortality in China during 2000 to 2014
Authors: Liang Yundan , Yang Mengchang , Zhao Gaofeng , Mao Yuanyi , Zhang Lushun , Hu Zeqing
Published: December 2018

Suicide is one of the top 10 causes of death in many countries. Although there are many studies on mental disorders, few studies have examined mortality in suicide population and mentally ill population. This study examined the association between mortality and mental disorders using data on suicides and mental disorders in China. Data from China's Health and Family Planning Statistical Yearbook for 2000 to 2014 were used to analyze the relationship between mortality associated with suicide and mental disorders. The analyses found that mortality among people with mental disorders dropped from 5.42/10 million in 2000 to 2.68/10 million in 2014, decreased more among females than males, and differed between urban and rural areas; that suicide mortality dropped from 10.79/10 million in 2000 to 6.79/10 million in 2014; the decrease was greater in women than in men, with suicide being highest among male residents of cities; and no significant correlation was found between mortality among persons with mental disorders and suicide mortality. There was no correlation between suicide mortality and mental-disorder mortality during 2000 to 2014; however, overall mortality decreased more among females than males during this period.
The relationship between job satisfaction, burnout syndrome and depressive symptoms
Authors: Oliveira Alan Maicon de , Silva Marcus Tolentino , Galvão Taís Freire , Lopes Luciane Cruz
Published: December 2018

Research shows an instability in the way workers in the healthcare field live, and a prevalence of an unhealthy lifestyle. Exhaustion, an overload of obligations and responsibilities and dissatisfaction are all factors that may result in both physical and mental disorders. The aim of our study is to analyze the association between individual and occupational aspects of hospital workers and their job satisfaction, burnout syndrome, and depressive symptoms, as well as the relationship between these 3 factors.

A transversal study was carried out from August to November 2016 in a teaching hospital that is a reference in healthcare to 13 cities in the State of São Paulo, Brazil. Workers with an employment relationship of a period of 3 months or longer were included in the study. Subjects for the study were recruited through random probability sampling. Data were collected using psychometric tools in order to analyze job satisfaction (Job Satisfaction Survey [JSS]), the presence of burnout syndrome (Maslach Burnout Inventory [MBI]) and depressive symptoms (Patient Health Questionnaire-9). Adjusted analyses were conducted and the prevalence ratio (PR) was calculated using Poisson regression. The partial least squares structural equation modeling (PLS-SEM) was used for the analyses.

The final sample of this study comprised 271 professionals. Administrative workers or technical support workers from the hospital showed to be more satisfied in their jobs compared to the healthcare professionals (P = .02). Time of professional activity was also associated with job satisfaction (P = .03). Men displayed burnout syndrome approximately twice as often as women (PR = 1.98; 95% CI: 1.03–3.79; P = .04). Workers who had a low household income presented a predominance twice as high of depressive symptoms (PR = 2.84; 95% CI: 1.24–6.51; P = .01). PLS-SEM confirmed the causal and inverse relationship between burnout syndrome and job satisfaction (P < .001). Depressive symptoms were considered predictors for professional exhaustion (P < .001).

Personal and occupational factors of hospital workers were associated with job satisfaction, burnout syndrome, and depressive symptoms. The absence of burnout was identified as a predictive aspect for job satisfaction, and depressive symptoms as a predictor for professional exhaustion.
Mesalazine treatment causing resolution of intracranial hypertension secondary to ulcerative colitis
Authors: Khanna Raoul Kanav , Hage Rabih , Hage Alexandre , Polin Vanessa , Sené Thomas , Vignal-Clermont Catherine
Published: December 2018

Rationale:

The association between intracranial hypertension (ICH) and ulcerative colitis (UC) is rare. We report the unusual case of a male patient with UC and ICH in whom both conditions resolved with mesalazine therapy.

Patient concerns:

A 48-year-old Caucasian man presented to our department in June 2016 for decreased vision, transient visual obscuration, pulsatile tinnitus and headaches of 7 months duration. Bilateral optic disc swelling was found at fundus examination. Brain MRI excluded any brain tumor and lumbar puncture showed cerebrospinal fluid (CSF) opening pressure of 26 cm of water with normal CSF contents.

Diagnoses:

Idiopathic ICH was suspected.

Interventions:

The patient was managed with oral acetazolamide. Headaches initially improved but the dosage could not be decreased under 750 mg a day without recurrence of the symptoms. Extensive review of systems showed that the patient had active UC. He was given oral mesalazine, 2000 mg a day.

Outcomes:

The symptoms of UC and ICH quickly resolved. Acetazolamide was progressively tapered over the course of the 9 subsequent months and the patient did not show any worsening of his symptoms or papilledema.

Lessons:

UC should be added to the list of disorders associated with ICH. In case of atypical ICH with drug dependency, investigations should seek for UC. Treating efficiently UC with mesalazine may improve ICH, suggesting an underlying inflammatory process.
Apatinib for treating advanced intrahepatic cholangiocarcinoma after failed chemotherapy
Authors: Wang Li-Ye , Gong Shuai , Gao Li-Ping , Hou Li-Xia , He Wei
Published: December 2018

Rationale:

Intrahepatic cholangiocarcinoma (ICC) originates from the secondary branch of the bile duct and the intrahepatic bile duct epithelial cells, and is a rare pathological type of primary liver cancer. Recently, apatinib has been successfully used for a variety of malignancies.

Patient concerns:

A 23-year-old female was noted with intermittent right upper abdominal distension, abdominal pain, and vomiting after eating for more than 1 month. The enhanced CT scan revealed multiple intrahepatic lesions, portal vein and right branch tumor emboli were present.

Diagnosis:

Combined with the patient's medical history and pathology and immunohistochemistry, the diagnosis was confirmed as locally advanced unresectable ICC (cT4N1M1, Stage IVB).

Interventions:

The disease progressed after six cycles of gemcitabine plus capecitabine chemotherapy. She received oral apatinib treatment since September 30, 2017. Due to related adverse reactions, the patient could not tolerate the treatment, and the subsequent reduction therapy was given.

Outcomes:

On April 11, 2018, the review of CT evaluation suggested that the disease was progressed. Hence, in this patient, apatinib as second-line treatment for advanced ICC showed a progression-free survival with 6 months.

Lessons:

Apatinib as second-line treatment for advanced ICC is effective, and the adverse effects are tolerable. However, the efficacy and safety of apatinib in the treatment of ICC need to be further confirmed by large sample of prospective randomized controlled trials.
Comparison of analgesic efficacy of oxycodone and fentanyl after total hip replacement surgery
Authors: Kim Mi Kyeong , Ahn Sang Eun , Shin Eunsil , Park Sung Wook , Choi Jeong-Hyun , Kang Hee Yong
Published: December 2018

Background:

Total hip replacement (THR) is often accompanied by severe postoperative pain. We aimed to study whether oxycodone can be an effective alternative for fentanyl in the management of early postoperative pain after total hip replacement.

Methods:

We conducted a randomized controlled trial on 46 patients scheduled to undergo THR. We followed a standard general anesthetic technique, with endotracheal intubation. Twenty minutes before the end of surgery, single bolus injection of fentanyl, 50 μg (fentanyl group [group F], n = 23) or oxycodone, 4 mg (oxycodone group [group O], n = 23) was administered intravenously. Numeric rating scale (NRS) was used to assess pain in the post-anesthesia care unit (PACU). All patients had intravenous patient-controlled analgesia (PCA) with 10 μg/kg of fentanyl for 48 hours. Intravenous boluses of 50 μg were administered for breakthrough pain. The cumulative opioid dose administered at 6, 12, 24, and 48 h after surgery were recorded. A P value of less than .05 was considered statistically significant.

Results:

The NRS of group O in the PACU was significantly lower (P <.05); fewer patients in group O required additional fentanyl boluses in the PACU (P <.05). The cumulative opioid requirement was significantly less in group O at 6, 12, 24, and 48 hours after surgery. (P <.05)

Conclusions:

A single bolus injection of oxycodone is more effective than that of fentanyl in the acute phase of postoperative pain after THR. It may be used as an alternative drug for fentanyl in pain control after orthopedic surgery.
Hyponatremia: Prevalence and characteristics in internal medicine patients in northeast of China
Authors: Gang Xiaokun , Zhang Yumin , Pan Xin , Guo Weiying , Li Zhuo , Wang Yao , Wang Guixia
Published: December 2018

To determine the incidence, clinical features, etiology, risk factors, and mortality in internal medicine patients with hyponatremia (P-Na).

A prospective survey was conducted in patients with P-Na, diagnosed at admission in an Internal Medicine Department. 692 patients were then selected and subsequently divided into 3 groups based on the severity of P-Na. Multivariate linear regression analysis was used to explore the factors associated with levels of P-Na.

The prevalence of P-Na was 3.37%. Euvolemia P-Na was the predominant subtype in 3 types of P-Na (49.42%). Gastrointestinal and neurological manifestations were common hyponatremic symptoms. The leading 5 underlying diagnoses were chest infection (31.94%), malignancy (10.84%), cardiac disease (6.36%), liver cirrhosis (6.07%), and neurological disease (5.20%). Moderate and severe P-Na had higher mortalities than mild P-Na (P <.05). For the levels of serum Na, Age, and serum Cl were positively correlated while serum K, blood urea nitrogen (BUN), and Glu were negatively correlated (P <.05).

P-Na is common in internal medicine and accompanied by other electrolyte disturbances, various symptoms/diagnoses, and increased mortalities with decreasing Na, which requires special attention in clinical practice.
Bee venom acupuncture for circumscribed morphea in a patient with systemic sclerosis
Authors: Hwang Ji Hye , Kim Kyung-Ho
Published: December 2018

Rationale:

Bee venom has been reported to demonstrate antinociceptive and anti-inflammatory effects in experimental studies, but there remain questions regarding the clinical use of bee venom, especially for scleroderma. This case report shows the successful outcome of bee venom acupuncture for circumscribed morphea in a patient with systemic sclerosis, which is considered to be a rare condition.

Patient concerns:

A 64-year-old Korean woman had circular white areas (3 and 1 cm diameter) with severe itch in the right lateral iliac crest. Based on an initial diagnosis of systemic sclerosis (1 year prior to presentation at our clinic), she had been treated with painkillers, steroids, antitussive expectorants, and aspirin, with minimal effect on her recent skin symptoms.

Diagnoses:

In this study, the diagnosis of circumscribed morphea was based on localized skin symptoms of the patient with systemic sclerosis.

Interventions:

The patient visited Gachon University Korean Medical Hospital for treatment of topical skin symptoms. After being evaluated for bee venom compatibility, she was administered subcutaneous bee venom acupuncture along the margins of the patches (superficial circumscribed lesions) using the shallow surround needling method twice per week for 1 week and then once per week for the following 3 weeks.

Outcomes:

Itch levels were evaluated before each treatment session: by her second visit, her itch had decreased from 8 to 3 on a 10-point numerical rating scale; by her sixth visit, her itch had decreased from 3 to 0. She did not experience adverse effects, and these improvements were maintained until the 2-month follow-up evaluation.

Lessons:

Bee venom treatment demonstrates the potential to serve as an effective localized therapy for circumscribed morphea.
Atrial fibrillation in athletes and general population
Authors: Li Xiangdan , Cui Songbiao , Xuan Dongchun , Xuan Chunhua , Xu Dongyuan
Published: December 2018

Background:

Atrial fibrillation (AF) is the most common type of heart arrhythmia, but the impact of long-term, high-intensity endurance exercise on the risk of AF remains uncertain.

Methods:

PubMed, EMBASE, and Cochrane library databases were searched till Nov 2017 to retrieve the articles. The included studies were summarized, pooled odds ratio (OR) and its 95% confidence interval (CI) were calculated. Both fixed and random effects models were used to combine the data. Stratified and logistic meta-regression analyses were performed to explore the sources of heterogeneity across studies.

Results:

Nine studies including 2308 athletes and 6593 controls were eligible. Our results showed that the risk of AF was significantly higher in athletes than in general population (OR = 2.34, 95% CI = 1.04–5.28, P
heterogeneity<.001, I

2
 = 92.3%). Subgroup analysis based on gender and mean age demonstrated a significantly increased risk in men (OR = 4.03, 95% CI = 1.73–9.42, P
heterogeneity<.001, I

2
 = 82.7%) and participants with mean age <60 (OR = 3.24, 95% CI = 1.23–8.55, P
heterogeneity<.001, I

2
 = 84.3%). Furthermore, subgroup analysis based on type of athletes demonstrated a significantly increased risk of AF in participants with single type of sport (OR = 3.97, 95% CI = 1.16–13.62, P
heterogeneity = .018, I

2
 = 70.4%). Results remained unchanged after performing sensitivity analysis. Meta-regression showed that gender, age, type of study, sample size, and sports mode were unrelated to heterogeneity.

Conclusion:

Our study confirmed that the risk of AF was significantly higher in athletes than in general population, especially among men and participants aged <60.
The higher serum endocan levels may be a risk factor for the onset of cardiovascular disease
Authors: Zhao Tianming , Kecheng Yao , Zhao Xuelei , Hu Xuehua , Zhu Jing , Wang Yingnan , Ni Jixiang
Published: December 2018

Objective:

Endothelial dysfunction was widely regarded as the initial lesion in the multifactorial pathogenesis of cardiovascular disease (CVD). Serum endocan, a novel endothelial dysfunction biochemical marker, is involved in the development of CVD. Here, we fulfilled a meta-analysis to evaluate the association between CVD and serum endocan levels.

Method:

The relevant published literature was searched through large literature databases, including PubMed, Embase, Cochrane Library, SinoMed, and Web of Science, up to June 1, 2018. The data were extracted from the studies. Stata software was used to perform a meta-analysis.

Result:

Fifteen original studies with a total of 1839 patients and 1258 controls fulfilled the inclusion criteria and were included in the study dataset. Meta-analysis showed that the levels of serum endocan in patients with hypertension, coronary artery disease, and coronary slow flow were higher than those in the control group. The pooled standardized mean differences and 95% confidence intervals of endocan concentrations in those 3 groups were 0.53 [0.19–0.86], P < .01; 0.99 [0.51–1.39], P < .01; and 0.62 [0.45–0.78], P < .01, respectively. Further analysis showed that the level of serum endocan in hypertension patients with coronary artery disease was higher than that in patients with hypertension (0.61 [0.30–0.92], P < .01). Sensitivity analysis and subgroup analysis were use to confirm the above results.

Conclusions:

In this meta-analysis, we further confirmed that serum endocan level was significantly increased in the CVD population. The high serum endocan level may be one of the risk factors for CVD.