bluuebunny/crossref_metadata_2025 huggingface dataset:
Rate of Spiral Ganglion Cell Loss in Idiopathic Sudden Sensorineural Hearing Loss
Authors: Ungar Omer J. , Handzel Ophir , Santos Felipe
Published: October 2018

Objective:

To calculate the spiral ganglion neural decay rate among patients diagnosed with idiopathic sudden sensorineural hearing loss (ISSNHL).

Study Design:

Retrospective.

Setting:

Temporal bone histopathology bank.

Patients:

Subjects diagnosed during life with unrecovered unilateral ISSNHL.

Intervention(s):

Spiral ganglion cell count in the bilateral reconstructed Rosenthal canal.

Main Outcome Measure(s):

Decay rate of spiral ganglion cells.

Results:

Nine patients were enrolled. The average age of ISSNHL diagnosis and death was 52 and 63 years, respectively. The total and segmental SGCC decay shows a temporal dependency. The time lag between the ISSNHL event and death was linearly proportional to the SGCC decay. Subjects who died less than 5 years from diagnosis of ISSNHL had no more than 13% loss of their total SGCC, and no more than 14% of SGCC per Rosenthal canal segment. When a longer period passed from ISSNHL diagnosis to death (19–20 yr), a loss of 16% and 13 to 18% of total and segmental SGCC occurred, respectively.

Conclusions:

SGCC decline from ISSNHL diagnosis through life.
Significance of Endolymphatic Hydrops Herniation Into the Semicircular Canals Detected on MRI
Authors: Sugimoto Satofumi , Yoshida Tadao , Teranishi Masaaki , Kobayashi Masumi , Shimono Mariko , Naganawa Shinji , Sone Michihiko
Published: October 2018

Objective:

The objective of this study was to investigate the relationship between endolymphatic hydrops (EH) and hearing level or vestibular symptoms by focusing on EH herniation into the semicircular canal (SCC).

Study Design:

Retrospective study.

Setting:

University hospital.

Methods:

The study included 1,548 ears of 775 patients who underwent magnetic resonance imaging (MRI) examination in our university hospital to investigate possible EH. MRI was performed 4 hours after intravenous injection of a standard dose of gadodiamide hydrate and/or 24 hours after intratympanic injection of gadopentetate dimeglumine diluted eightfold. The hearing threshold and vestibular symptoms were compared between ears with unilateral and bilateral EH herniation into the SCC and between ears having vestibular EH adjacent to the stapes footplate with or without EH herniation.

Results:

Forty-four ears (19 men and 25 women, mean age 53.6 yr) showed EH herniation into the SCC. The average hearing thresholds at 500 to 4000 Hz and presence of vestibular EH adjacent to the stapes footplate were significantly higher in ears with unilateral herniation than in those with bilateral herniation. The average hearing thresholds at 500 and 1000 Hz were significantly higher in the group of ears having adjacency with herniation than in those without herniation. Vestibular symptoms did not differ significantly between groups.

Conclusion:

Unilateral herniation occurs with EH progression. Bilateral herniation may occur regardless of EH progression and might be influenced by other factors that alter the membranous labyrinth.
Retrospective clinical analysis of 320 cases of microvascular decompression for hemifacial spasm
Authors: Li Zhimin , Gao Jun , Wang Tianyu , Li Yongning
Published: October 2018

To investigate effects of microvascular decompression (MVD) surgical treatment on hemifacial spasm.

A retrospective analysis of 320 adult patients (95 male cases, 29.7% and 225 female cases, 70.3%) with hemifacial spasm treated by surgery was conducted between February 2007 to June 2016, with an average age of 49.3 years and average disease course of 4.9 years. All the 320 cases of patients received MVD. After surgery, all patients were followed up for an average of 2.3 years. Surgical effects were evaluated based on the patients’ symptoms and signs. As this is just a retrospective study that does not involve any interventions, ethical approval was not necessary according to the rules of the hospital.

All patients were followed up, no death occurred. Symptom was completely disappeared in 241 cases (75.3%), 50 cases (15.6%) improved; the total effective rate of surgery was 90.9%. No obvious changes of hemifacial spasm were happened in 29 cases (9.1%). There was no deteriorated case.

MVD is one of the preferred treatments of hemifacial spasm, the intraoperative electrophysiological monitoring of abnormal muscle response signals contributes to the determination of responsible vessels and fully understanding of delayed resolution is helpful to the accuracy of surgical evaluation.
Primary squamous cell carcinoma of the pancreas with effective comprehensive treatment
Authors: Zhang Ge , Cheng Zhu-zhong , Xu Guo-hui , Jiang Xiao , Wang Xiao-xiong , Wang Qi-feng
Published: October 2018

Rationale:

Primary squamous cell carcinoma (SCC) of the pancreas is a rare entity since the pancreas lacks squamous cells. This condition is associated with a poor prognosis, and there is currently no optimal treatment strategy for it.

Patient concerns:

A 64-year-old female patient with a complaint of epigastric pain for 3 months was referred to our hospital.

Diagnoses:

She was finally diagnosed with primary SCC of the pancreas with lymph node metastasis on the basis of radiological and pathological findings.

Interventions:

She received chemoradiation along with targeted therapy and was provided with treatment response evaluation through PET/CT.

Outcomes:

She eventually died of tumor progression after 8 months.

Lessons:

Primary SCC of the pancreas is associated with a poor prognosis. Comprehensive therapy and proper radiologic evaluation may facilitate prolonged survival of these patients.
The effectiveness of anticancer traditional Korean medicine treatment on the survival in patients with lung, breast, gastric, colorectal, hepatic, uterine, or ovarian cancer
Authors: Bae Kyeore , Kim Eunseok , Choi Jeong June , Kim Mi Kyung , Yoo Hwa-Seung
Published: October 2018

Although anticancer traditional Korean medicine treatment (ACTKMT) is widely applied to patients with cancer together with, or in place of, conventional cancer treatment in Korea, the cohort evidence on its clinical effects is lacking. Therefore, this prospective cohort study is designed to evaluate the effect of ACTKMT on the survival and the clinical outcomes for patients being treated at an integrative oncology clinic.

This is a single center, prospective cohort study of patients within 1 year after the diagnosis of primary lung, breast, gastric, colorectal, hepatic, uterine, or ovarian cancer. The event-free survival, disease-free survival/progression-free survival, the overall survival, the results of blood tests, and telomere-length information will be compared between patients receiving and patients not receiving a key ACTKMT (HangAmDan-B1, Geonchil-jung, and/or cultivated wild ginseng pharmacopuncture), and the correlation between the use of the key ACTKMT and the prognosis will be identified considering other risk factors.

This study has received ethical approval from the Institutional Review Board, Dunsan Korean Medicine Hospital of Daejeon University (No. DJDSKH-16-BM-09). The results of this study will be published in a peer-reviewed journal.

Clinical Research Information Service: KCT0002160.
Levodopa-induced respiratory dysfunction confirmed by levodopa challenge test
Authors: Ko Pan-Woo , Kang Kyunghun , Lee Ho-Won
Published: October 2018

Introduction:

Parkinson disease is associated with various nonmotor symptoms, including rare respiratory dysfunction events. However, patients with Parkinson disease often have comorbid medical problems, such as respiratory distress, and differentiating nonmotor symptoms can be difficult.

Case presentation:

A 78-year-old male presented with repetitive shortness of breath. He was diagnosed with Parkinson disease and chronic obstructive pulmonary disease (COPD) several years prior. His symptoms were ambiguous between acute COPD exacerbation and levodopa-related nonmotor symptoms of Parkinson disease. To clarify the underlying cause, we performed the levodopa challenge test. After the patient complained of dyspnea following levodopa administration, levodopa-induced respiratory dysfunction was diagnosed. After adjusting antiparkinson medication, the patient's respiratory symptoms gradually improved.

Conclusion:

Respiratory dysfunction as a nonmotor symptom of Parkinson disease can be caused by levodopa medication. To determine whether the symptoms are induced by levodopa, the levodopa challenge test may be useful in clarifying symptoms related to antiparkinson medication.
The relationship between adenoid hypertrophy and gastroesophageal reflux disease
Authors: Niu Xun , Wu Zeng-Hong , Xiao Xi-Yue , Chen Xiong
Published: October 2018

Background:

Gastroesophageal reflux disease (GERD) is believed to be associated with various manifestations in the otorhinolaryngology and has been found to be an additional risk factor for adenoid hypertrophy, but the causal relation between them is under controversial. We thus performed a meta-analysis to grade the strength of evidence and systematically explore whether adenoid hypertrophy correlates with GERD in the literature.

Methods:

A systematic literature search was performed using Medline via PubMed, Embase, CNKI, and Web of Science. Studies reporting the adenoid hypertrophy and GERD were identified for inclusion.

Results:

There were 6 studies that matched the selection criteria, and the total sample size of these studies was 548 cases. We identified a significant relationship between adenoid hypertrophy and GERD, with a pooled odds ratio of 4.12 (95% confidence interval [CI]: 1.32–12.93; P < .001). The results was significant in 24-hour pH monitoring subgroup analysis, with a corresponding value of 8.62 (95% CI: 4.06–18.27, P > .05) under the fixed-effects model. And the results was significant in Helicobacter pylori subgroup analysis, with a corresponding value of 2.39 (95% CI: 0.39–14.55, P < .05) under the random-effects model. Begg tests (P = .73) and Egger tests (P = .76) showed there were no obvious evidence to support publication bias in our study.

Conclusion:

This meta-analysis provided a strong correlation between adenoid hypertrophy and GERD, the children with adenoid hypertrophy had a higher incidence of GERD than healthy children, but the pathogenesis of GERD in adenoid hypertrophy awaits more investigations and suggests that we should not overlook GERD in clinical practice and an appropriate evaluation for GERD may be needed.
The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block
Authors: Dai Wei , Tang Maocai , He Kaihua
Published: October 2018

Background:

Dexmedetomidine has been used as an adjuvanty added to local anesthetics to prolong analgesia following peripheral nerve blockade. The aim of this meta-analysis was to investigate the effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block (BPB).

Methods:

A search strategy was created to identify eligible randomized clinical trial (RCT) in PubMed, Embase, and The Cochrane Library (updated May, 2018). The methodologic quality for each included study was evaluated using the Cochrane Tool for Risk of Bias by 2 independent researchers.

Results:

Twelve RCTs were included in the meta-analysis (n = 671). As an adjuvant to ropivacaine, dexmedetomidine significantly reduced the onset time of sensory (mean difference [MD], −3.86 minutes, 95% CI −5.45 to −2.27 minutes; I
2 = 85%) and motor (MD, −5.21 minutes; 95% CI −7.48 to −2.94 minutes; I
2 = 94%). In addition, it increased the blockade duration of sensory (MD, 228.70 minutes; 95% CI 187.87–269.52 minutes; I
2 = 93%) and motor (MD, 191.70 minutes; 95% CI 152.48–230.91 minutes; I
2 = 92%). Moreover, the combination prolonged the duration of analgesia (MD, 303.04 minutes; 95% CI 228.84–377.24 minutes; I
2 = 86%). There was no difference of the incidence of bradycardia (risk difference [RD], 0.01, 95% CI −0.02 to 0.05, I
2 = 45%; P = .45) and hypotension (RD, 0.01, 95% CI −0.01 to 0.03, I
2 = 0%; P = .57) between 2 groups.

Conclusion:

Dexmedetomidine added to ropivacaine in BPB has a better analgesia effect (shorter onset time and longer duration) compared to ropivacaine alone. At the same time, there was no difference in the incidence of bradycardia and hypotension.
Acupuncture for treating whiplash-associated disorder
Authors: Lee Seunghoon , Jo Dae-Hyun , Kim Kun Hyung
Published: October 2018

Background:

This review aims to evaluate the effectiveness and safety of acupuncture treatment for patients with whiplash-associated disorder (WAD).

Methods:

We will search the following databases from their inception to October 2018: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, 1 Chinese database (China National Knowledge Infrastructure), 1 Japanese database (Japan Science and Technology Information Aggregator, Electronic), and 5 Korean databases (KoreaMed, Research Information Service System, Korean Studies Information Service System, Database Periodical Information Academic, and Oriental Medicine Advanced Searching Integrated System). All randomized controlled trials of acupuncture for WAD will be considered for inclusion without language restrictions. The risk of bias will be assessed using the Cochrane risk of bias tool. The mean difference or standard mean difference for continuous data and risk ratio for dichotomous data will be calculated with 95% confidence intervals.

Dissemination:

The results of this review will be disseminated through peer-reviewed journal articles or conference presentations, and may provide important guidance for clinicians and patients regarding the use of acupuncture treatment for treating WAD.

Trial registration number: PROSPERO 2018: CRD42018106964.
Use of steroid and nonsteroidal anti-inflammatories in the treatment of rheumatoid arthritis
Authors: Del Grossi Moura Mariana , Cruz Lopes Luciane , Silva Marcus Tolentino , Barberato-Filho Sílvio , Motta Rogério Heládio Lopes , Bergamaschi Cristiane de Cássia
Published: October 2018

Background

Rheumatoid arthritis affects 1% of the world's population and its current treatment options are costly. There are not enough studies that evaluated the efficacy and safety of anti-inflammatory drugs medications used to reduce rheumatoid arthritis's symptoms. This study will evaluate the effectiveness and the safety of steroid and nonsteroidal anti-inflammatory drugs for the treatment of patients with rheumatoid arthritis.

Methods

Randomized clinical trials eligible for our systematic review will enroll adults with rheumatoid arthritis treated with anti-inflammatory drugs compared with a control group (placebo or active control) at any dose, duration, and route of administration and double blind studies. In order to include all forms of rheumatoid arthritis and anti-inflammatory drugs, we will search the following electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE (via Ovid); ExcerptaMedica Database (via Ovid); Cumulative Index to Nursing and Allied Health Literature (via Ovid); Web of Science; ClinicalTrial.gov; and WHO International Clinical Trials Registry Platform. We will not impose any language restrictions or publication status. Outcomes of interest include are pain, physical function, swelling, stiffness, grip force, radiological image of the joint, quality of life, adverse events, discontinuation due to adverse events, satisfaction with the treatment, and rescue medication for pain. A team of reviewers will independently screen search results, extract data from eligible trials, and assess risk of bias. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence by outcome. Dichotomous data will be summarized as risk ratios; continuous data will be given as standard average differences with 95% confidence intervals.

Results

The evidence derived by this study will increase awareness of the effectiveness and safety of steroid and nonsteroidal anti-inflammatory drugs for the treatment of rheumatoid arthritis.

Conclusion

The results could guide patients and healthcare practitioners and help facilitate evidence-based shared care decision making.
Core decompression, lesion clearance and bone graft in combination with Tongluo Shenggu decoction for the treatment of osteonecrosis of the femoral head
Authors: Hao Yang-Quan , Guo Hao , Zhu Tian , Xu Zhao-Chen , Qi Han-Deng , Lu Chao , Yuan Pu-Wei
Published: October 2018

The aim of this study was to evaluate the clinical effect of core decompression (CD), lesion clearance, and bone graft in combination with Tongluo Shenggu decoction for the treatment of osteonecrosis of the femoral head (ONFH).

A total of 75 patients (92 hips), with ONFH at Association Research Circulation Osseous (ARCO) stages II to IIIA, were studied and divided into treatment group and control group. In control group, patients were treated with the CD in combination with autologous or artificial ceramic bone graft. In treatment group, patients were treated with the above method combined with Tongluo Shenggu decoction. Patients were followed-up at 1 month, 6 months, and 24 months after surgery. The visual analogue scale (VAS) scores, Harris Hip Score (HSS), and total effective rates were measured and recorded.

The total effective rate of the treatment group was significantly higher than that of the control group (97.2% vs. 89.9%, P < .05). Compared with preoperative, the VAS and HSS scores were both improved at final follow-up, and there was significant difference between 2 groups (P < .01).

The combination of CD, lesion clearance, and the bone graft with Tongluo Shenggu decoction is safe and effective for the treatment of ONFH, owing to which it can provide higher postoperative functional outcomes, reduce pain, and achieve smaller osteonecrosis area and better bone changes.
Prognostic value of neutrophil to lymphocyte ratio and clinicopathological characteristics for multiple myeloma
Authors: Zeng Qiang , Liu Zhigang , Li Qiuyang , Liu Ting
Published: October 2018

Background:

Neutrophil to lymphocyte ratio (NLR) was reported to be an effective parameter in carcinoma prognosis. Many studies were already performed to investigate the prognostic value of NLR in patients with multiple myeloma (MM). The results, however, were still debatable.

Methods:

Databases of Pubmed, Cochrane library and Embase were examined. Hazard ratio (HR) with 95% confidence interval (CI) was used to assess the results. In addition, odds ratios (ORs) with 95% CIs were used to evaluate the association of NLR with clinicopathological factors. Meta-regression, sensitivity analysis, and subgroup analysis were also performed.

Results:

The results showed poor OS (HR: 1.73, 95% CI: 1.23-2.44; P = .002) and progression-free survival (PFS) (HR: 1.74, 95% CI: 1.11-2.73; P = .015) when pretreatment NLR elevated. Our pooled ORs suggested that NLR had association with International Staging System (ISS), isotype and response to treatment.

Conclusion:

The meta-analysis results demonstrated that NLR could predict prognosis in MM patients.
Phantom limb syndrome induced by combined spinal and epidural anesthesia in patients undergoing elective open gynecological surgery
Authors: Wang Huan , Geng Yingjie , Zheng Weijian , Fang Weiping , Gu Erwei , Liu Xuesheng , Li Wenzhi
Published: October 2018

Background:

During regional anesthesia, including combined spinal and epidural anesthesia (CSEA), patients may develop a perceptual alteration of limb position known as phantom limb syndrome (PLS). We aimed to identify factors that influence the PLS onset, to explore whether PLS predisposes to other postoperative symptoms, and to document the relationship between PLS and sensorimotor impairment during recovery.

Methods:

Psychological questionnaires for anxiety and depression were completed beforehand, then multimodal tests of sensory and motor function, especially tests of proprioception, were performed regularly afterward. Two hundred participants undergoing elective gynecological surgery under CSEA reported their experiences of PLS and other symptoms using Likert rating scales.

Results:

Prolonged preoperative fasting (odds ratio (OR) 2.34; 95% confidence intervals (CI) 1.21–4.52), and surgical history (OR 2.56; 95% CI 1.16–5.62) predisposed to PLS, but patients with more extensive anesthetic histories may be at lower risk (OR 0.57; 95% CI 0.31–1.08). Furthermore, significant correlations were observed between the recovery from PLS and the perception of joint movement within the deafferented area (R = 0.82, P < .01) and motor functions (R = 0.68). PLS increases the chance of experiencing postoperative fatigue, physical discomfort, and emotional upset.

Conclusion:

This study is the first to have identified the risk factors for PLS, assessed the relationship between PLS and postoperative sensorimotor impairment, and its influence on postoperative complications.
The efficacy and safety of soluble guanylate cyclase stimulators in patients with heart failure
Authors: Zheng Xiaoyu , Zheng Weijin , Xiong Bo , Huang Jing
Published: October 2018

Background:

Several randomized controlled trials (RCTs) have been investigated the benefits of soluble guanylate cyclase (sGC) stimulators in the treatment of heart failure, but a comprehensive evaluation is lacking. We performed a meta-analysis to evaluate the efficacy and safety of oral sGC stimulators (vericiguat and riociguat) in patients with heart failure.

Methods:

Studies were searched and screened in PubMed, Embase, and Cochrane Library. Eligible RCTs were included that reported mortality, the change of EuroQol Group 5-Dmensional Self-report Questionnaire (EQ-5D) US index, N-terminal pro-B-type natriuretic peptide (NT-proBNP), or serious adverse events (SAEs). Relative risk or weight mean difference (WMD) was estimated using fixed effect model or random effect model. Analysis of sensitivity and publication bias was conducted.

Results:

Five trials with a total of 1200 patients were included. sGC stimulators had no impact on the mortality (1.25; 95% confidence interval 0.50–3.11) and significantly improved EQ-5D US index (0.04; 95% confidence interval 0.020–0.05). Furthermore, in comparison with control group, NT-proBNP was statistically decreased in riociguat group (−0.78; 95% confidence interval −1.01 to −0.47), but not in vericiguat group (0.04, 95% confidence interval −0.18 to 0.25). There were not obverse differences in SAEs between sGC stimulators and control groups (0.90; 95% confidence interval 0.72–1.12).

Conclusion:

Our meta-analysis suggests that sGC stimulators could improve the quality of life in patients with heart failure with good tolerance and safety, but their long-term benefits need to be observed in the future. sGC stimulators are likely to be promising add-on strategies for the treatment of heart failure.
Efficacy and safety of nicotinamide on phosphorus metabolism in hemodialysis patients
Authors: Zhang Yong , Ma Tean , Zhang Pan
Published: October 2018

Background:

Recent evidence has shown that nicotinamide treatment may have an impact on phosphorus metabolism in hemodialysis patients. Nevertheless, the treatment remains controversial. This study aimed to precisely estimate the efficacy and safety of nicotinamide on phosphorus, calcium and iPTH in hemodialysis patients.

Methods:

We searched numerous information sources regarding randomized controlled trials (RCTs) of nicotinamide treatment in hemodialysis patients, including PubMed, EMBASE, and the Cochrane Library.

Results:

Nine relevant studies (n = 428) were included in the meta-analysis. Meta-analysis showed that levels of serum phosphorus (SMD −1.06; 95% CI, −1.27 to −0.85, P < .001), parathyroid hormone (SMD −1.09; 95% CI, −1.49 to −0.70, P < .001), and calcium–phosphorus (SMD −0.65; 95% CI, −0.97 to −0.34, P < .001) in the nicotinamide group were significantly lower than those of the control group. There was no significant difference in the levels of serum calcium (SMD 0.08; 95% CI, −0.15 to 0.30, P = .51) between the groups. The meta-analysis showed that the nicotinamide group had a significantly higher risk of adverse events (OR 3.99; 95% CI, 1.94–8.23, P < .001) than did the control group, especially for thrombocytopenia (OR 49.00; 95% CI, 2.68–897.36, P = .009). However, no serious adverse reactions were observed. There was no significant difference in the incidence of withdrawal (OR 3.51; 95% CI, 0.49–25.00, P = .21) between the groups.

Conclusion:

Evidence to date clearly indicates that nicotinamide is safe and effective for improving phosphorus metabolism in hemodialysis patients. However, nicotinamide probably causes thrombocytopenia. Further large-sample size, high-quality RCTs are needed.
Impact of the pay-for-performance program on lower extremity amputations in patients with diabetes in Taiwan
Authors: Sheen Yi-Jing , Kung Pei-Tseng , Kuo Wei-Yin , Chiu Li-Ting , Tsai Wen-Chen
Published: October 2018

Patients with diabetes are at a high risk of lower extremity amputations and may have a reduced life expectancy. Taiwan has implemented a diabetes pay-for-performance (P4P) program providing team care to improve the control of disease and avoid subsequent complications. Few studies investigated the effects of adopting a nationalized policy to decrease amputation risk in diabetes previously. Our study aimed to analyze the impact of the P4P programs on the incidence of lower extremity amputations in Taiwanese patients with diabetes.

This was a population-based cohort study using the Taiwan National Health Insurance Research Database (which provided coverage for 98% of the total population in Taiwan) from 1998 to 2007. Patients with diabetes were identified based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes. We linked procedure codes to inpatient claims to identify patients hospitalized for nontraumatic lower extremity amputations.

A total of 9738 patients with diabetes with amputations were enrolled (mean age ± standard deviation: 64.4 ± 14.5 years; men: 63.9%). The incidence of nontraumatic diabetic lower extremity amputations decreased over the time period studied (3.79–2.27 per 1000 persons with diabetes). Based on the Cox proportional hazard regression model, male sex (hazard ratio: 1.83, 95% confidence interval [CI] 1.76–1.92), older age, and low socioeconomic status significantly interact with diabetes with respect to the risks of amputation. Patients who did not join the P4P program for diabetes care had a 3.46-fold higher risk of amputation compared with those who joined (95% CI 3.19–3.76).

The amputation rate in Taiwanese diabetic patients decreased over the time period observed. Diabetes in patients with low socioeconomic status is associated with an increased risk of amputations. Our findings suggested that in addition to medical interventions and self-management educations, formulate and implement of medical policies, such as P4P program, might have a significant effect on decreasing the diabetes-related amputation rate.
Efficacy and safety of direct aspiration versus stent-retriever for recanalization in acute cerebral infarction
Authors: Qin Chuan , Shang Ke , Xu Sha-Bei , Wang Wei , Zhang Qiang , Tian Dai-Shi
Published: October 2018

Background and purpose:

Whether the direct aspiration approach of thrombectomy for recanalization in patients with acute ischemic stroke has a similar efficacy and safety compared to the stent-retriever remains uncertain.

Methods:

We conducted a meta-analysis of 9 studies obtained through PubMed and Embase database searches to determine whether successful recanalization rate, good functional outcome at 3 months (modified Rankin score, mRS≤2), procedure time from groin puncture to maximal revascularization and procedure-related adverse events differed between patients who underwent the direct aspiration and those receiving stent-retriever for recanalization in acute cerebral infarction.

Results:

There was no significant difference between the direct aspiration group and the stent-retriever group in rate of successful recanalization (summary odds ratio [OR], 0.86 [95% confidence interval (CI), 0.45–1.52]; P = .60), but a better functional outcomes in the direct aspiration group at 3 months defined as a mRS score of 0 to 2 (OR, 0.77; 95% CI, 0.66–0.97; P = .03). Furthermore, the direct aspiration patients compared with the stent-retriever patients had a tendency of shorter procedural time (Mean difference [MD], -8.77 [95% CI, from-18.90 to 1.37]; P = .09). Finally, there were less adverse events especially in symptomatic intracerebral hemorrhage (sICH) (OR, 0.56; 95% CI, 0.33–0.98; P = .04) and embolization to a new territory (ENT) (OR, 0.49; 95% CI, 0.28–0.84; P = .01) in the direct aspiration group when compared with the stent-retriever group, although no difference between them in the rate of any ICH (OR, 0.81; 95% CI, 0.41–1.60; P = .54).

Conclusions:

The results support that the direct aspiration technique for those acute ischemic stroke patients may have better functional outcomes, less procedure related-adverse events and a tendency of faster revascularization time as compared to the stent-retriever thrombectomy, with a similar successful recanalization rate. However, major limitations of current evidence (mainly from retrospective and observational studies and a small number of patients population) indicate a need for adequately powered, multicenter randomized controlled trials (RCT) to answer this question.
A systematic review of clinical studies on electrical stimulation therapy for patients with neurogenic bowel dysfunction after spinal cord injury
Authors: Deng Yuling , Dong Yonghai , Liu Yun , Zhang Qiong , Guan Xihong , Chen Xiaodan , Li Meng , Xu Lei , Yang Cheng
Published: October 2018

Background:

This study aimed to perform a systematic literature review of the clinical trial evidence on electrical stimulation for the treatment of neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI).

Methods:

Systematic electronic searches were carried out in the PubMed/Medline, EMBASE, Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure databases, along with the reference lists in the include studies. Studies were eligible for inclusion if they adopted a controlled clinical design based on human population, the patients suffered from spinal cord injury, the main outcomes were the disorders of bowel function and the intervention was electrical stimulation. Also, the language was limited to English and Chinese.

Results:

Eleven studies were included in this systematic review, comprising transcutaneous electrical stimulation, transrectal bowel stimulation, sacral nerve stimulation, intravesical electrical stimulation, etc. Of the 11 studies, 3 were randomized controlled trials, 8 were controlled before-and-after trials. The quality of the included studies was moderate bias risk. Most studies revealed that the electrical stimulation was beneficial for the patient with NBD after SCI.

Conclusions:

Only 11 small clinical studies with 298 participants have evaluated the efficacy of electrical stimulation for NBD after SCI. Although some studies showed electrical stimulation was benefit for the patient with NBD after SCI, there was currently not enough evidence to support the use of electrical stimulation could improve the clinical symptoms of those patients. Thus, well-designed randomized controlled trials with larger patient population are warranted to establish its benefit in clinical practice in the future.
Damage-associated molecular patterns in intensive care unit patients with acute liver injuries
Authors: Hayase Naoki , Doi Kent , Hiruma Takahiro , Inokuchi Ryota , Hamasaki Yoshifumi , Noiri Eisei , Nangaku Masaomi , Morimura Naoto
Published: October 2018

Acute liver injury (ALI) is frequently detected in an intensive care unit (ICU) and reportedly affects prognosis. Experimental animal studies suggested that increased extracellular histone and high morbidity group box-1 (HMGB1) levels might contribute to ALI development. Whether these damage-associated molecular patterns (DAMPs) play a crucial role in ALI remains unclear in the human clinical setting.

We consecutively enrolled the patients admitted to our ICU. The patients with ALI were included in the analysis together with those without ALI by using frequency matching. Extracellular histone, HMGB1, soluble thrombomodulin (sTM), and interleukin-6 (IL-6) levels were measured in plasma collected at ICU admission. ALI was defined as an acute elevation in serum aminotransferase levels to >200 IU/L.

A total of 805 patients were enrolled. Twenty ALI and forty non-ALI patients were analyzed. Plasma histone levels were significantly higher in the ALI group than in the non-ALI group, whereas HMGB1 levels were significantly lower in the ALI group. Furthermore, sTM was significantly increased in the ALI patients, whereas IL-6 levels were comparable between the groups. Multivariate logistic regression analysis demonstrated that histones were independently associated with ALI. There was no significant impact of ALI on in-hospital mortality.

Extracellular histones showed an independent association with ALI. Histone elevation might be one of the possible pathogenic mechanisms in the development of ALI of ICU patients.
Effect of high-flow nasal cannula oxygen therapy vs conventional oxygen therapy on adult postcardiothoracic operation
Authors: Wu Xiu , Cao Wei , Zhang Bin , Wang Shengyu
Published: October 2018

Introduction:

The effect of high-flow nasal cannula (HFNC) on adult post cardiothoracic operation remains controversial. We conducted a meta-analysis of randomized controlled trials to evaluate the effect of HFNC and conventional oxygen therapy (COT) on postcardiothoracic surgery.

Methods:

A search was conducted in Embase, MEDLINE, Ovid, and Cochrane databases until December, 2017 for all the controlled study to compare HFNC with COT in adult postcardiothoracic surgery. Two authors extracted data and assessed the quality of each study independently. The meta-analysis was performed by using RevMan 5.3. The primary outcome was the rate of escalation of respiratory support rate and pulmonary complications; secondary outcome included the length of intensive care unit (ICU) stay and length of hospital stay and the rate of intubation.

Results:

Four studies that involved 649 patients were included in the analysis. No significant heterogeneity was found in outcome measures. Compared with COT, HFNC were associated with a significant reduction in the escalation of respiratory support (odds ratio [OR] = 0.44, 95% confidence interval [CI] = 0.29−0.66, P < .001) and pulmonary complications (OR = 0.28, 95% CI = 0.13−0.6, P = .001). There were no significant differences in the reintubation rate (OR = 0.33, 95% CI = 0.02−5.39, P = .43), length of ICU stay (weighted mean difference = 0.11; 95% CI = −0.44 −0.26, P = .14) or length of hospital stay (weighted mean difference = −0.15, 95% CI = −0.46 −0.17, P = .36) between the 2 groups. No severe complications were reported in either group.

Conclusion:

The HFNC could reduce respiratory support and pulmonary complications, and it could be safely administered for adult postcardiothoracic surgery. Further large-scale, randomized, and controlled trials are needed to update this finding.
Analysis of caudal epidurogram in single center
Authors: Koo Bon Sung , Kang Woo Bin , Park Jun Woo , Lee So Jeong , Lee Mi Soon , Cho A Na , Chung Yang Hoon , Lee Joon Ho , Kim Yong Ik , Chae Won Seok
Published: October 2018

A caudal epidural block involves placing a needle through the sacral hiatus and delivering medication into the epidural space. The procedure is safe and simple, but failure rates can be as high as 25%. The purpose of this study was to investigate the success rate of caudal epidural block by analyzing needle placement and dye flow pattern.

We retrospectively analyzed the medical records of patients who underwent caudal epidural block under spinal stenosis. A case was defined as a failure if it met at least one of the following four criteria: the epidural needle was not placed correctly inside the caudal canal; blood regurgitation or aspiration in the needle was observed; the contrast dye was injected into a blood vessel; or a large amount of the dye leaked into the sacral foramen or did not reach the L5-S1 level.

At least 1 failure criterion was observed in 14 cases (17.7%), while none of the failure criteria were satisfied in 65 successful cases (82.3%).

No matter how experienced the anesthesiologist may be, delivery of adequate therapeutic agent is not achieved in approximately 20% of cases. Therefore, we recommend fluoroscopy-guided needle placement and confirmation by radio-contrast epidurograpy as the best choice.
Giant gastric stromal tumor mimicking as a posterior mediastinal mass
Authors: Yin Xiaonan , Shen Chaoyong , Yin Yuan , Cai Zhaolun , Chen Zhixin , Zhang Bo
Published: October 2018

Rationale:

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Mediastinal GISTs are rare and mostly arise from the esophagus.

Patient concerns:

A 68-year-old woman with dysphagia who presented with a huge posterior mediastinal mass.

Diagnoses:

The patient was diagnosed with a GIST through chest computed tomography (CT)-guided core biopsy of the mass.

Interventions:

Complete excision including the tumor, lower part of the esophagus and fundus of the stomach were performed.

Outcomes:

On follow-up after 48 months, the patient is currently alive without any evidence of tumor recurrence.

Lessons:

The case highlights GISTs are taken into consideration in the differential diagnosis of posterior mediastinal masses.
The Levels of Tumor Markers in Pancreatic Neuroendocrine Carcinoma and Their Values in Differentiation Between Pancreatic Neuroendocrine Carcinoma and Pancreatic Ductal Adenocarcinoma
Authors: Zhuge Xiaoling , Guo Chuangen , Chen Yu , Feng Limin , Jia Rongfei , Zhao Ying , Sun Ke , Wang Zhongqiu , Chen Xiao
Published: October 2018

Objectives

The levels of tumor markers in pancreatic neuroendocrine carcinoma (PNEC) are unknown, and imaging findings of PNEC and pancreatic ductal adenocarcinoma (PDAC) have overlaps. In this study, we show the tumor markers in PNEC and evaluate their values for distinguishing PNEC from PDAC.

Methods

Thirty-three cases of PDAC and 21 cases of PNEC were retrospectively evaluated. The demographic information and clinical data were reviewed.

Results

Pancreatic neuroendocrine carcinoma was usually misdiagnosed (57.1%) as PDAC based on imaging findings. Abnormal carbohydrate antigen (CA) 19-9, carcinoembryonic antigen (CEA), and α-fetoprotein (AFP) were observed in 19.0% to 28.6% of PNECs. Abnormal CA 19-9 and CA 125 levels were more common in PDAC than in PNEC (P< 0.05). Higher level of AFP was more common in PNEC than in PDAC (33.3% vs 3.0%,P< 0.05). The cutoff value of CA 19-9 for detecting PNEC was calculated as 38.5 U/mL or less with 0.788 sensitivity and 0.800 specificity. Carbohydrate antigen 19-9 (odds ratio [OR], 22.9; 95% confidence interval [CI], 2.94–179.3), AFP (OR, 0.08; 95% CI, 0.012–0.564), and CA 125 (OR, 17.4; 95% CI, 1.13–267.3) were predictors in differentiating PDAC from PNEC.

Conclusions

Carbohydrate antigen 19-9, AFP, and CA 125 have potential for distinguishing hypovascularized PNEC from PDAC.
Limping on split-belt treadmills implies opposite kinematic and dynamic lower limb asymmetries
Authors: Tesio Luigi , Malloggi Chiara , Malfitano Calogero , Coccetta Carlo A. , Catino Luigi , Rota Viviana
Published: October 2018

Walking on a split-belt treadmill (each of the two belts running at a different speed) has been proposed as an experimental paradigm to investigate the flexibility of the neural control of gait and as a form of therapeutic exercise. However, the scarcity of dynamic investigations challenges the validity of the available findings. The aim of the present study was to investigate the dynamic asymmetries of lower limbs of healthy adults during adaptation to gait on a split-belt treadmill. Ten healthy adults walked on a split-belt treadmill mounted on force sensors, with belts running either at the same speed (‘tied’ condition) or at different speeds (‘split’ condition, 0.4 vs. 0.8 or 0.8 vs. 1.2 m/s). The sagittal power and work provided by ankle, knee and hip joints, joint rotations, muscle lengthening, and surface electromyography were recorded simultaneously. Various tied/split walking sequences were requested. In the split condition a marked asymmetry between the parameters recorded from each of the two lower limbs, in particular from the ankle joint, was recorded. The work provided by the ankle (the main engine of body propulsion) was 4.8 and 2.2 times higher (in the 0.4 vs. 0.8, and 0.8 vs. 1.2 m/s conditions, respectively) compared with the slower side, and 1.2 and 1.1 times higher compared with the same speed in the tied condition. Compared with overground gait in hemiplegia, split gait entails an opposite spatial and dynamic asymmetry. The faster leg mimics the paretic limb temporally, but the unimpaired limb from the spatial and dynamic point of view. These differences challenge the proposed protocols of split gait as forms of therapeutic exercise.
The Masseter Muscle and Its Role in Facial Contouring, Aging, and Quality of Life: A Literature Review
Authors: Almukhtar Rawaa M. , Fabi Sabrina G.
Published: October 2018

Background:

Masseter muscle hypertrophy manifests itself as enlargement of the masseter muscle. It can be associated with a square-angled lower face, pain, dental attrition, maxillary and mandibular bone resorption, and accelerated aging process of the lower face. The objective of this study was to assess the efficacy and safety of botulinum toxin type A in contouring the masseter and its impact on quality of life and the aging process of the lower face, and its role in full face rejuvenation.

Methods:

A PubMed search was conducted for articles on masseter treatment with botulinum toxin type A, masseter muscle hypertrophy, and the aging process of the lower face. Key studies are reviewed and findings are summarized.

Results:

Botulinum toxin type A can be injected into the lower posterior aspect of the masseter muscle. Treatment decreases muscle bulk and reshapes the lower face. Furthermore, patient quality-of-life measures, including pain and symptoms of grinding and clenching, are improved. Treatment can decrease shear stress on maxillary and mandibular bones and can possibly prevent tooth loss and progressive bone resorption of the lower face. Adverse effects are minimal and short lasting.

Conclusions:

Botulinum toxin type A is a safe and effective treatment of masseter hypertrophy. The treatment results in improvement of functionality and cosmesis, and restoration of facial harmony.
Nighttime Sleep and Daytime Sleepiness Improved With Pimavanserin During Treatment of Parkinson’s Disease Psychosis
Authors: Patel Neepa , LeWitt Peter , Neikrug Ariel B. , Kesslak Patrick , Coate Bruce , Ancoli-Israel Sonia
Published: October 2018

Introduction

Impaired nocturnal sleep and excessive daytime sleepiness are common problems for patients with Parkinson’s disease, and patients with Parkinson’s disease with sleep dysfunction are 5 times more likely to experience psychotic symptoms. Pimavanserin, a 5-HT2A inverse agonist approved to treat Parkinson’s disease psychosis, may improve sleep quality in patients with Parkinson’s disease experiencing sleep disturbances.

Methods

Scales for Outcomes in Parkinson’s Disease nighttime sleep (SCOPA-NS) and SCOPA–daytime sleepiness (DS) data obtained during 2 double-blind placebo-controlled studies of pimavanserin in persons with Parkinson’s disease psychosis were evaluated. Data from the placebo and pimavanserin 34 mg groups in the 2 studies were pooled to provide further information on the effect of pimavanserin 34 mg on sleep. Additional analyses on the pooled study data were performed on participants with significantly impaired nighttime sleep and daytime sleepiness, defined as SCOPA-NS ≥7 and SCOPA-DS ≥5, respectively.

Results

In the pooled analysis, treatment effects, expressed as least squares mean reductions in SCOPA-NS at week 6, were −1.4 for pimavanserin 34 mg and −0.5 for placebo. At week 6, the decrease from baseline in SCOPA-DS for the pimavanserin 34 mg group was −1.7 and −1.2 for the placebo group (P = 0.108). When evaluating participants with impaired nighttime sleep and daytime sleepiness at baseline, the SCOPA-NS score change was −4.4 for the pimavanserin 34 mg group and −2.3 for the placebo group (P = 0.002), whereas the SCOPA-DS change was −2.9 and −1.9 for the pimavanserin 34 mg and placebo groups (P = 0.120), respectively.

Conclusion

The data from the trials suggest that nighttime sleep improved with administration of pimavanserin, a novel 5-HT2A receptor inverse agonist/antagonist.
Segment-specific associations between local haemodynamic and imaging markers of early atherosclerosis at the carotid artery: an
in vivo
human study
Authors: Gallo Diego , Bijari Payam B. , Morbiducci Umberto , Qiao Ye , Xie Yuanyuan (Joyce) , Etesami Maryam , Habets Damiaan , Lakatta Edward G. , Wasserman Bruce A. , Steinman David A.
Published: October 2018

Low and oscillatory wall shear stress (WSS) has long been hypothesized as a risk factor for atherosclerosis; however, evidence has been inferred primarily from model and post-mortem studies, or clinical studies of patients with already-developed plaques. This study aimed to identify associations between local haemodynamic and imaging markers of early atherosclerosis. Comprehensive magnetic resonance imaging allowed quantification of contrast enhancement (CE) (a marker of endothelial dysfunction) and vessel wall thickness at two distinct segments: the internal carotid artery bulb and the common carotid artery (CCA). Strict criteria were applied to a large dataset to exclude inward remodelling, resulting in 41 cases for which personalized computational fluid dynamic simulations were performed. After controlling for cardiovascular risk factors, bulb wall thickening was found to be weakly, but not significantly, associated with oscillatory WSS. CE at the bulb was significantly associated with low WSS (
p
< 0.001) and low flow helicity (
p
< 0.05). No significant associations were found for the CCA segment. Local haemodynamics at the bulb were significantly correlated with blood flow rates and heart rates, but not carotid bifurcation geometry (flare and curvature). Therefore low, but not oscillatory, WSS is an early independent marker of atherosclerotic changes preceding intimal thickening at the carotid bulb.