bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated With Nonadherence to Cardiovascular Medications
Authors: van der Laan Danielle M. , Elders Petra J. M. , Boons Christel C. L. M. , Nijpels Giel , Hugtenburg Jacqueline G.
Published: May 2019

Background

Cardiovascular medications have well-established benefits in the primary and secondary prevention of cardiovascular diseases. Unfortunately, adherence to these medicines is often suboptimal. To develop interventions intended to enhance adherence to cardiovascular medications, more insight is needed into the complex character of medication nonadherence.

Objective

The aim of the present study was to identify which factors are associated with nonadherence to cardiovascular medications in a sample of patients from Dutch community pharmacies.

Methods

In this cross-sectional study, patients using cardiovascular medications from 23 community pharmacies were included. Patient demographics, medication and disease characteristics, knowledge, quality of life, attitude toward medicines, and satisfaction with information were assessed. Both an adherent sample (n = 146) and a sample of patients nonadherent to prescribed medications (n = 109) during the last 6 months as assessed with pharmacy refill data (proportion of days covered <80%) were selected. Associations with refill nonadherence were assessed using univariate and multivariate logistic regression analyses.

Results

In total, 255 patients participated (53.3% men, 71.6 ± 10.9 years). Factors associated with cardiovascular medication nonadherence in multivariate analyses included experiencing difficulties with medication use due to forgetting, having insufficient knowledge on what to do when a dose is forgotten, and having an ambivalent attitude toward medicines (beliefs of high necessity and high concerns).

Conclusions

Intervention strategies to enhance cardiovascular medication nonadherence should be targeted mainly to the unintentional dimension of nonadherence and include information and tools to prevent forgetting. Conversely, the influence of factors that underlie intentional nonadherence, particularly patients' beliefs about medicines, should also be addressed.
Evaluation of Anti-Xa and Activated Partial Thromboplastin Time Monitoring of Heparin in Adult Patients Receiving Extracorporeal Membrane Oxygenation Support
Authors: Arnouk Serena , Altshuler Diana , Lewis Tyler C. , Merchan Cristian , Smith Deane E. , Toy Bridget , Zakhary Bishoy , Papadopoulos John
Published: May 2019

The approach to monitoring anticoagulation in adult patients receiving heparin on extracorporeal membrane oxygenation (ECMO) support is controversial. The objective of this study was to compare the correlation between anti-Xa and activated partial thromboplastin time (aPTT) with heparin dose and to describe their association with clinical events in adult ECMO patients. We conducted a retrospective single-center study of 34 adult ECMO patients whose heparin was monitored by anti-Xa and/or aPTT. The heparin dose-to-assay correlation coefficient was 0.106 for aPTT and 0.414 for anti-Xa (p < 0.001). Major thrombotic and hemorrhagic events occurred in 14.7% and 26.5% of patients, respectively. The median anti-Xa in patients who experienced a major thrombotic event was 0.09 (0.06–0.25) IU/mL compared with 0.36 (0.26–0.44) IU/mL in patients who did not (p = 0.031), whereas the median aPTT did not differ between these groups. The maximum aPTT in patients who experienced a major bleed was 96.9 (76.0–200) seconds compared with 63.5 (44.4–98.6) seconds in patients who did not (p = 0.049), whereas the maximum anti-Xa did not differ between these groups. Monitoring both anti-Xa and aPTT may be warranted to safely provide understanding of pure heparin activity as well as underlying bleeding diatheses in adult ECMO patients.
Responding to Ventricular Assist Device Recalls: An Ethical Guide for Mechanical Circulatory Support Programs
Authors: Kirkpatrick James N. , Mahr Claudius , Beckman Jennifer , Bjelkengren Jason , Dudzinski Denise M.
Published: May 2019

We discuss the ethical responsibilities of mechanical circulatory support (MCS) programs in the context of cardiac device recalls, particularly the near-simultaneous recalls of Abbott HeartMate 3 left ventricular assist device (VAD) and Medtronic HVAD devices in 2018. We consider MCS programs’ ethical responsibilities toward patients who already have VADs and their caregivers, as well as the impact of recalls on informed consent and shared decision-making in patients under consideration for new VADs. Timely communication to affected patients is imperative throughout the recall process. MCS programs are required to notify existing VAD patients about the nature and likelihood of risk. A press release from the device manufacturer or other press reports may occur before MCS teams learn about the recall. This leads to a disclosure gap, where the programs are actively deciding on an appropriate action plan while simultaneously fielding patient concerns. From an ethics standpoint, if all device users are owed the recall information from the manufacturer, all patients are owed the information from their treating team. The question is what to disclose specifically, and how.
Prognostic Value of Sarcopenia for Long-Term Mortality in Extracorporeal Membrane Oxygenation for Acute Respiratory Failure
Authors: Cho Woo Hyun , Choi Yoon Young , Byun Ki Sup , Lee Seung Eun , Jeon Doosoo , Kim Yun Seong , Han Junhee , Yeo Hye Ju
Published: May 2019

It is unclear whether sarcopenia is responsible for long-term mortality in patients who require extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. We retrospectively reviewed 127 patients who underwent computed tomography imaging before initiating ECMO from June 2014 to November 2017. The patients were divided into two groups according to the skeletal muscle index (SMI): low SMI (n = 47) and high SMI (n = 80). Mean age was lower in the high SMI group than in the low SMI group (60.2 vs. 53.9 years, p = 0.002). Mean body mass index was higher in the high SMI group than in the low SMI group (21.6 vs. 24.1 kg/m2, p = 0.001). The mean Charlson comorbidity index (CCI) was lower in the high SMI group than in the low SMI group (3.0 vs. 2.2, p = 0.024). After propensity score matching for age and CCI score, no differences were observed in ECMO weaning success rate or hospital mortality between the two groups. However, the 1 year mortality rate was higher in the low SMI group than in the high SMI group (70.2% vs. 46.8%, p = 0.021). Multivariate analyses showed that renal replacement therapy (odds ratio [OR] 3.99, 95% confidence interval [CI] 1.74–9.13, p = 0.001) and low SMI (OR 5.47, 95% CI 2.31–12.98, p < 0.001) were associated with 1 year mortality. Kaplan–Meier analyses revealed that a low SMI predicted mortality (χ2 = 13.20, p < 0.001). Sarcopenia predicted worse 1 year mortality in patients who underwent respiratory ECMO.
A Minimally Invasive Approach to HeartMate 3 Implantation for Systemic Ventricular Failure Following the Mustard Procedure for Transposition of the Great Arteries
Authors: White Christopher W. , Ganapathi Asvin , Schroder Jacob
Published: May 2019

Late systemic (right) ventricular failure is common after the Mustard procedure for transposition of the great arteries (TGA), and mechanical circulatory support may be required for patients presenting with refractory heart failure; however, clinical experience with this approach is limited. We describe the use of the Impella 5.0 (Abiomed Inc., Danvers, Massachusetts) as a bridge to HeartMate 3 implantation in a highly sensitized patient with severe pulmonary hypertension following the Mustard procedure for TGA.
Chromosome 1q31.2q32.1 deletion in an adult male with intellectual disability, dysmorphic features and obesity
Authors: Hyder Zerin , Fairclough Adele , Douzgou Sofia
Published: May 2019

Intermediate interstitial deletions of the long arm of chromosome 1 are typically associated with developmental delay and dysmorphic features. We describe the case of a 31-year-old male with intellectual disability, obesity and dysmorphic features, in whom array–comparative genomic hybridization identified a de novo 9.55 Mb deletion at 1q31.2q32.1. We discuss the genes encompassed within the deleted region; in particular, the implications of the deleted cancer-predisposing gene, CDC-73, and compare our clinical findings to other cases with similar deletions. The absence of microcephaly and growth retardation appears to differentiate more proximal interstitial 1q deletions from intermediate 1q deletions, and the presence of obesity is a newly reported phenotype within the 1q deletion spectrum. It is imperative that surveillance for CDC-73 related disorders, including parathyroid carcinoma, is considered in the management of interstitial intermediate 1q deletions.
Deep benign fibrous histiocytoma occurring in the kidney
Authors: Du Jiang , Zhang Xue-Ting , Yang Man , Liu Xiao-Fang , Lin Xu-Yong
Published: May 2019

Rationale:

Deep benign fibrous histiocytoma (BFH) is relatively rare in contrast to superficial BFH involving the skin. Moreover, it was extremely rare for deep BFH occurring in the solid organ. To our knowledge, so far, only one case of deep BFH of the kidney was reported in English literature.

Patient concerns:

Herein, we report another case of deep BFH located in the kidney in a 88-year-old female. She was referred to our hospital for a severe pain in the right upper abdomen. Computed tomography revealed a round low-density shadow measuring 6 cm in the kidney.

Diagnosis:

The lesion was diagnosed as a deep BFH of the kidney, as the tumor was histologically predominately composed of bland ovoid cells arranged in a storiform pattern.

Intervention:

The patient underwent the total resection of the right kidney with the tumor in our hospital.

Outcomes:

The postoperative course was uneventful. The patient was alive with no tumor recurrence or metastasis within 6 months of follow-up.

Lessons:

We present another case of deep BFH of the kidney. Because of the rarity, the tumor may be poorly recognized. The typical storiform pattern in histology may be helpful for diagnosis. This report serves to remind that deep BFH is also a differential diagnosis for a tumor with storiform pattern in the kidney.
Comparisons of cancer-associated fibroblasts in the intratumoral stroma and invasive front in colorectal cancer
Authors: Son Gyung Mo , Kwon Myeong-Sook , Shin Dong-Hoon , Shin Nari , Ryu Dongryeol , Kang Chi-Dug
Published: May 2019

The aim of this study was to evaluate the cytomorphologic maturity and molecular activation of cancer-associated fibroblasts (CAFs) in the intratumoral stroma and invasive front in colorectal cancer and understand how they affect cancer invasion and long-term oncological outcomes.

The cytomorphologic maturity of and α-smooth muscle actin (α-SMA), fibroblast activation protein α (FAPα), and fibroblast-specific protein 1 (FSP-1) expression in CAFs in the intratumoral stroma (CAFIT) and the invasive front (CAFIF) of colorectal cancer tissues were compared (n = 147). The correlations between CAF maturation, molecular activity markers, and cancer invasion were evaluated by network analysis. Overall survival and systemic recurrence were analyzed to assess the oncological effects of CAF properties.

The cytomorphologic maturation rate was comparable between CAFIT and CAFIF. The presence of mature CAFs was related to epidermal growth factor receptor overexpression in cancer cells. Expression rates of α-SMA (96.6%–98.0%) and FAPα (18.6%–22.9%) were similar between CAFIT and CAFIF. FSP-1 expression was more frequent in CAFIT than in CAFIF (66.4% vs 58.2%, P = .038). There was a significant decrease in FSP-1 expression in CAFIT and CAFIF in higher stages. The infiltrating growth pattern of the tumor was more frequent in the immature CAFIT. In colorectal cancer with perineural invasion and lymph node metastasis, FSP-1 expression in CAFIF was significantly lower. On multivariate analysis using the Cox proportional hazards model, immature CAFIF was found to be an independent prognostic factor of overall survival. In non-metastatic (stage I-III) colorectal cancer patients, CAF maturity was not a prognostic factor for systemic recurrence.

Cytomorphologic maturity and molecular activation markers were similar between CAFs in the intratumoral stroma and invasive front of colorectal cancer.
Efficacy of cognitive behavior language therapy for aphasia following stroke: Implications for language education research
Authors: Akabogu Josephine , Nnamani Amuche , Otu Mkpoikanke Sunday , Ukoha Evelyn , Uloh-Bethels Annah C. , Obiezu Maureen Nnenna , Ike Chioma Vivian , Iyekekpolor Olayinka M. , Omile Jacinta Chinwe , Dike Anastasia E.
Published: May 2019

Background/Objective:

Evidence from previous research has shown that the incidence of aphasia following a stroke is high in Nigeria and other countries, and there is a call for intervention programs. The objective of the current study was to investigate the efficacy of cognitive behavior language therapy (CBLT) on aphasia following a stroke.

Methods:

The study was designed as a group randomized trial, which involved treatment and no-treatment control procedures. The participants of the study were 86 patients who had experienced aphasia following a stroke. The Porch Index of Communicative Ability (PICA) and Speech-Language Unhelpful Thoughts and Beliefs Scale (SLUTBS) were the measures used in the study. The repeated measures analysis of variance procedure, with Partial eta squared

JOURNAL/medi/04.03/00005792-201905030-00010/inline-graphic1/v/2023-09-14T035738Z/r/image-tiff

, adjusted R
2, mean, standard deviation, and upper/lower limit was followed in analyzing the data collected in the study.

Results:

The CBLT intervention significantly reduced aphasia following a stroke and significantly reduced speech-language and unhelpful thought and beliefs among aphasic stroke patients exposed to the treatment intervention when compared with the no-treatment control group.

Conclusion:

Based on the findings of the study, language educators, speech and language pathologists and therapists in education institutions, hospitals, and rehabilitation centers should adopt the principles of CBLT used in the current study to help them improve communication ability among aphasia stroke patients.
Intrathecal morphine combined with ropivacaine induces spinal myoclonus in cancer patients with an implanted intrathecal drug delivery system
Authors: Guo Xuejiao , Li Yunze , Yang Yixin , Zhao Yimin , Guo Jianguo , Zhang Yanfeng , Peng Zhiyou , Feng Zhiying
Published: May 2019

Rationale:

Although intrathecal opioid infusion has been used for decades for the treatment of severe pain, myoclonus as one of the complications of this therapeutic modality is now beginning to be recognized more.

Patients concerns:

Here, we report three patients who developed myoclonus after dose adjustment in intrathecal drug delivery system for the treatment of refractory cancer pain.

Diagnosis:

Spinal myoclonus is a sudden, brief, shock-like muscle contractions originating from the central nervous system.
[1]
In our cases, it occurred after opioid administration via intrathecal delivery system with no abnormality found in laboratory or imaging examinations.

Interventions:

Spinal myoclonus can be treated effectively by reducing the dose or infusion rate as described in case 1, or changing from an intrathecal to systemic administration in case 2, or correcting infusion and bolus parameters mistakes in case 3.

Outcomes:

All patients recovered quickly after stopping or decreasing the intrathecal drug infusion.

Lessons:

Prevention is more important than treatment as for spinal myoclonus. Pain management teams should be aware of this distressing complication. Dose of intrathecal drugs should not exceed the recommended maximal daily doses by guidelines and patient education is important for successful intrathecal analgesic therapy.
Malignant jejunal gastrointestinal stromal tumor with history of prostate cancer
Authors: Wei Sheng-cai , Li Wan-hu , Xu Liang , Li Wen-wu
Published: May 2019

Rationale:

The problem of the coexistence of gastrointestinal stromal tumor (GIST) with other neoplasms is complex, and carcinomas of prostate is one of the common types of GIST-associated cancers. Doubling time of GIST is about 3.9 months for high-risk GIST, and the treatment paradigm for GIST has required the integration of surgery and molecular therapy.

Patient concerns:

A 70-year-old man with postoperative history of prostate cancer experienced fast-growing malignant jejunal GIST with multiple peritoneal metastases within 1 year.

Diagnoses:

Enhanced computed tomography (CT) detected a neoplasm of small intestine with multiple peritoneal nodules and postoperative pathology confirmed GIST.

Interventions:

Oral imatinib after surgery, at 400 mg per day, was used for 4 years.

Outcomes:

The patient remains well, and the peritoneal nodules located in front of the rectum disappeared gradually.

Lessons:

Physicians should be aware of possibility of GIST in patients with prostate cancer and can perform abdominal examination in these patients. For postoperative patients with prostate cancer, an yearly or half-yearly abdominal and pelvic cavity examination can be performed. Suspicion and timely work-up is necessary in these postoperative prostate cancer patients, especially when they have abdominopelvic pain.
Pregabalin in the reduction of pain and opioid consumption after burn injuries
Authors: Jones Larry M. , Uribe Alberto A. , Coffey Rebecca , Puente Erika G. , Abdel-Rasoul Mahmoud , Murphy Claire V. , Bergese Sergio D.
Published: May 2019

Background:

The primary objective of the study was to evaluate the efficacy of 300 milligrams (mg) and 600 mg of pregabalin compared to placebo in the reduction of pain in patients with noncritical partial and full thickness burn injuries.

Methods:

A prospective, randomized, double-blinded, single center, placebo-controlled trial was conducted. Simple randomization method was used in this trial. After subjects met all the inclusion and none of the exclusion criteria, they were randomized and assigned to 1 of the 3 18-day treatments groups: Pregabalin 300 group, Pregabalin 600 group, or Placebo group. Demographics and clinical characteristics were recorded. The severity of pain was assessed by using the visual analog scale for pain intensity at baseline on day 3, day 9 ± 3, day 25 ± 7, day 90 ± 6, and day 180 ± 12.

Results:

A total of 54 subjects were randomly assigned, and 51 were included in the data analysis. Demographics and clinical characteristics did not differ significantly between the 3 groups. There was a statistically significant difference in pain between the Pregabalin 300 and Pregabalin 600 groups (P-value = .0260). The Pregabalin 300 group had 17.93 units (95% confidence interval: 1.83–34.04) higher pain scores on average than the Pregabalin 600 group, regardless of time. The adjusted P-value comparing 0 to 300 was .1618, while the adjusted P-value for 0 versus 600 was .5304. There was an overall difference in pain across time regardless of study group (P-value = <.0001). An overall difference in opioid consumption (P-value = .0003) and BSHS (P-value = .0013) across time regardless of study group was noted.

Conclusions:

Pregabalin could be part of a promising multimodal analgesic regimen in noncritical burn population. Future placebo-controlled studies assessing the use of pregabalin in burn victim patients may further endorse our findings.
Effective dose of dobutamine in augmenting free flap blood flow during reconstructive surgery of the lower extremity
Authors: Kim Sung-Hoon , Moon Young-Jin , Kim Jae-Won , Hong Jeong-Yeon , Kim Wook-Jong , Hwang Jai-Hyun
Published: May 2019

Success of surgical free flap transfer depends on achieving and maintaining adequate perfusion across the microvascular anastomosis. The purpose of this prospective study was to determine the optimal infusion rate of dobutamine to augment duplex ultrasound measured blood flow to the tissue flap during surgery.

Twenty-one patients undergoing general anesthesia for lower limb reconstructive surgery were recruited. The optimal dobutamine dose was evaluated using the modified Dixon's up-and-down method, starting at 6 μg·kg−1·min−1, and then titrated in increments of 1 μg·kg−1·min−1.

The optimal dose of dobutamine for improving blood flow to the tissue flap was 3.50 ± 0.57 μg·kg−1·min−1 in 50% of patients. The 95% effective dose of dobutamine calculated by probit analysis was 4.46 μg·kg−1·min−1 (95% confidence interval: 3.99–7.00 μg·kg−1·min−1).

The results of our study suggest that a dobutamine infusion rate less than 5 μg·kg−1·min−1provides significant improvement of blood flow to the tissue flap, while minimizing cardiovascular side effects.
The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome
Authors: Li Gaocen , Kong Lingde , Kou Ningzhao , Wang Yanxue , Yu Kunlun , Bai Jiangbo , Tian Dehu
Published: May 2019

Background:

Carpal tunnel syndrome is a common compressive neuropathy of the median nerve. Compared with standard release, the efficacy, safety, and postoperative complications of limited carpal tunnel release remain controversial. The purpose of this study was to compare the effects of the 2 treatments.

Methods:

The English-language literature was searched using MEDLINE, Web of Science, and Embase. Randomized controlled trials that compared standard and limited incision for carpal tunnel release were included in the meta-analysis. Strength, interval to return to activities, the rate of adverse events, effectiveness, and operative time were compared.

Results:

Thirteen randomized controlled trials (RCTs) containing 1020 patients were included. Limited incision treated patients showed better early recovery of grip strength (mean difference [MD], 4.25 [0.86–7.65];P = .01) and pinch strength (MD, 1.37 [0.24–2.51];P = .02) but no advantage after more than 6 months. Patients treated with limited incision showed an earlier return to activities (MD,−8.80 [−9.21 to −8.39];P < .01) and reduced operative time (standardized mean difference [SMD], −1.68 [−3.24 to−0.12];P = .04). The rate of adverse event was significantly higher in standard group compared with that in limited group (risk ratio [RR] 0.61, 95% CI 0.38–0.96,P = .03).

Conclusions:

Limited incision release allows us to return to activities early, reduces operative time, decreases rate of adverse events, and improves strength during the early postoperative period. Results at 6 months or longer are similar according to current data. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.
Pyoderma gangrenosum after cesarean section treated with skin graft
Authors: Shen Jinjing , Zhang Weishe , Jiang Xiaoe
Published: May 2019

Rationale:

Pyoderma gangrenosum (PG) is a rare skin disease. Pregnancy is a unique physiological condition. Here we report a rare case of PG after cesarean section.

Patient concerns:

A 32-year-old female presented with wound breakdown 1 day after cesarean section, with progression to a skin ulcer and no response to antibiotic therapy.

Diagnoses:

We experienced a case of PG after cesarean section. This was initially misdiagnosed as a wound infection, with fever and wound redness as clinical manifestations.

Interventions:

The patient was initially treated with antibiotics, followed by glucocorticoid and human immunoglobulin therapy. Wound debridement, vacuum sealing negative pressure drainage, skin grafting, and hyperbaric oxygen therapy were also performed.

Outcomes:

The wound healed without adverse reactions.

Lessons:

When a surgical incision infection does not respond to antibiotic treatment and the culture is negative, PG should be considered.
Effect of dexmedetomidine on postoperative cognitive dysfunction and inflammation in patients after general anaesthesia
Authors: Yang Wan , Kong Ling-Suo , Zhu Xing-Xing , Wang Rui-Xiang , Liu Ying , Chen Lan-Ren
Published: May 2019

Background:

Neuroprotective effects of dexmedetomidine are reported in preclinical and clinical studies but evidence regarding the postoperative neurocognitive function is still unclear. This study performed a meta-analysis on outcomes of studies which examined neurocognitive performance and inflammatory factors to investigate the effects of dexmedetomidine on postoperative cognitive dysfunction (POCD) and inflammation in patients after general anaesthesia.

Methods:

Literatures were searched in several electronic databases and studies were selected by following precise inclusion criteria. We searched PubMed, EMBASE, the Cochrane Library, China Academic Journals full-text database (CNKI), and Google Scholar to find randomized controlled trials (RCTs) of the influence of dexmedetomidine on POCD and inflammation in patients who had undergone general anaesthesia. Two researchers independently screened the literature, extracted data, and evaluated quality of methodology against inclusion and exclusion criteria. Meta-analyses of pooled ORs of POCD incidences and mean differences in neurocognitive assessment scores and inflammation levels were carried out and subgroup analyses were performed. Stata 12.0 was used to conduct our meta-analysis.

Results:

Twenty-six RCTs were included. Compared with controls, perioperative dexmedetomidine treatment significantly reduced the incidence of POCD (pooled ORs = 0.59, 95% confidence interval (CI) 0.45–2.95) and improved Mini-Mental State Examination (MMSE) score (standardized mean difference (SMD) = 1.74, 95% CI 0.43–3.05) on the first postoperative day. Furthermore, perioperative dexmedetomidine treatment significantly decreased IL-6 (SMD = −1.31, 95% CI −1.87–0.75, P < .001) and TNF-α (SMD = −2.14, 95% CI −3.14–1.14, P < .001) compared to saline/comparators treatment. In the stratified analysis by surgical type, age, type of control, and study region, the differences were also significant between dexmedetomidine- and saline-treated patients.

Conclusion:

Perioperative dexmedetomidine treatment is associated with significantly reduced incidence of POCD and inflammation and better neurocognitive function postoperatively in comparison with both saline controls and comparator anaesthetics.
Clinical efficacy of carvedilol treatment for dilated cardiomyopathy
Authors: Li Tao , Yuan Guoliang , Ma Chengbin , Jin Peng , Zhou Changgao , Li Wei
Published: May 2019

Background:

Clinical trials examining the therapeutic benefit of carvedilol on patients with dilated cardiomyopathy have reported inconsistent results. The aim of this study was to evaluate the clinical efficacy of carvedilol on patients with dilated cardiomyopathy.

Methods:

PubMed, Embase, Cochrane Library, web of science, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific and Technological Journal (VIP) databases were searched for randomized controlled trials (RCTs) before March 2018. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used to evaluate the effects of carvedilol on patients with dilated cardiomyopathy.

Results:

Twenty one studies including 1146 participants were included. There were significant improvements on heart rate (HR) (WMD = –14.18, 95% CI: –17.72 to –10.63, P < .001), LVEF (WMD = 7.28, 95% CI: 6.53–8.03, P < .001), SBP (WMD = –10.74, 95% CI: –12.78 to –8.70, P < .001), DBP (WMD = –4.61, 95% CI: –7.32 to –1.90, P = .001), LVEDD (WMD = –2.76, 95% CI: −4.89 to −0.62, P = .011), LVESD (WMD = –3.63, 95% CI: –6.55 to –0.71, P = .015), LVEDV (WMD = –9.30, 95% CI: –11.89 to –6.71, P < .001), LVESV (WMD = –12.28, 95% CI: –14.86 to –9.70, P < .001) under carvedilol treatment compared with control.

Conclusion:

This meta-analysis demonstrates that carvedilol significantly improves cardiac function on patients with dilated cardiomyopathy. Further large scale, high-quality and multicenter RCTs are still required to confirm the impacts of carvedilol on patients with dilated cardiomyopathy.
Diagnosis and treatment of traumatic vascular injury of limbs in military and emergency medicine
Authors: Xu Yichi , Xu Wenjing , Wang Aiyuan , Meng Haoye , Wang Yu , Liu Shuyun , Li Rui , Lu Shibi , Peng Jiang
Published: May 2019

Background:

Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries.

Methods:

To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes.

Results:

Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc).

Conclusion:

We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military (“3 districts and 7 grades” model). Many issues remain to be resolved by further experience and investigation.
Carotid plaque magnetic resonance imaging and recurrent stroke risk
Authors: Deng Fengbin , Hao Xinyu , Tang Zhuoran , Mu Changping , Li Kang , Li Huaqiang
Published: May 2019

Background & Aims:

Carotid atherosclerotic plaque is an important cause of carotid artery stenosis. The features of carotid atherosclerotic plaque detected by relevant magnetic resonance imaging (MRI), such as lipid core, plaque hemorrhage, and fibrous cap rupture, have been confirmed to be associated with the occurrence of the first cerebral ischemic event. Meanwhile, the features of carotid atherosclerotic plaque can be used as biomarkers to predict the occurrence of cerebral ischemic event. However, the mechanism of recurrent stroke is still unclear. A systematic review and meta-analysis will be performed to summarize the association between features of carotid artery plaque detected by MRI and recurrent stroke, so as to find biomarkers that can predict recurrent stroke.

Methods:

Electronic search will be performed in PUBMED, EMBASE, Cochrane Controlled Register of Trials (CENTRAL) from inception to October 30, 2018. We will include cohort studies with an average follow-up time of >1 month in which lipid-rich/necrotic cores (LRNC), intraplaque hemorrhage (IPH), and thinned or ruptured fibrous caps (TRFC) are associated with recurrent ipsilateral stroke or ischemic events. We will perform heterogeneity assessment before carrying out meta-analysis. According to the heterogeneity, we select random effect model or fixed effect model for meta-analysis of the included cohort studies.

Results:

Review Manager 5.3 software will be used to calculate the combined hazard ratio value and 95% confidence interval (CI). This meta-analysis will provide high-quality data analysis of LRNC, IPH, and TRFC and ipsilateral recurrent stroke or ischemic events, including biomarkers as major predictors.

Conclusion:

The systematic review will provide evidence to assess the association between features of carotid plaque and ipsilateral recurrent stroke or ischemic events.

PROSPERO registration number:

PROSPERO CRD42019124043.
Evaluation of changes in choroidal thickness and the choroidal vascularity index after hemodialysis in patients with end-stage renal disease by using swept-source optical coherence tomography
Authors: Shin Yong Un , Lee Sang Eun , Kang Min Ho , Han Sang-Woong , Yi Joo-Hark , Cho Heeyoon
Published: May 2019

To evaluate the effect of hemodialysis on choroidal thickness and the choroidal vascularity index (CVI) in patients with end-stage renal disease (ESRD) by using swept-source optical coherence tomography.

Thirty-two eyes of 32 patients with ESRD undergoing hemodialysis were recruited prospectively. Detailed ophthalmologic examinations and swept-source optical coherence tomography were performed immediately before and after hemodialysis. Choroidal thickness maps were generated automatically by using built-in software. The CVI was calculated using binarized choroidal optical coherence tomography images. Systemic parameters such as body weight and blood pressure were also measured. The changes in systemic and ocular parameters during hemodialysis were evaluated. Subjects were divided into 2 groups (diabetes mellitus [DM] vs non-diabetes mellitus) for subgroup analysis.

Total choroidal thickness showed a significant overall decrease after hemodialysis (−10.9 ± 14.0, P <.001). In the subgroup analysis, total choroidal thickness significantly decreased in both patients with DM (−11.3 ± 13.6, P = .004) and those without (−10.6 ± 14.9, P = .020), but the reduction of choroidal thickness was observed in more subfields in patients with DM than in those without. The CVI did not significantly change after hemodialysis (P = .717). No significant systemic and ocular factors affected the changes in total choroidal thicknesses.

Choroidal thickness significantly decreased after hemodialysis in most subfields regardless of the presence of DM. Peri-hemodialysis choroidal changes could be considered in the management of patients with ESRD. Swept-source optical coherence tomography can provide ample and reliable quantitative data for monitoring ocular hemodynamic changes.
Treatment of myoclonic-atonic epilepsy caused by SLC2A1 de novo mutation with ketogenic diet
Authors: Wei Zihan , Wang Luojun , Deng Yanchun
Published: May 2019

Rationale:

The SLC2A1 gene encodes glucose transporter 1 on blood–brain barrier, which plays an important role in the energy supply for neurons. Mutations in SLC2A1 gene can cause many clinical syndromes, including glucose transporter type 1 deficiency syndrome and many types of epilepsy syndromes such as childhood absence epilepsy and myoclonic-atonic epilepsy, etc. Ketogenic diet has been proved to be very effective on those cases. Clinically, SLC2A1 gene mutations are quite rare.

Patient concerns:

Repeated unconsciousness and bilateral limb weakness lasted for 3 years.

Diagnoses:

Myoclonic-atonic epilepsy.

Lessons:

After taking whole exome sequencing, we found out that there is a de novo insertion mutation in the patient's SLC2A1 gene, leading to frameshift. As a result, ketogenic diet (2:1, 4 times a day) was used as the treatment. As for the patient, total calories intake per day was controlled at 1190 kcal. The calories per kg per day were 66.11 kcal/kg. The amount of ketone bodies was controlled at 2 to 3 mmol/L and the concentration of plasma glucose was controlled at 4 to 5 mmol/L.

Outcomes:

After the launch of ketogenic diet, the patient has been seizure free for nearly a year and stopped all his antiepileptic drugs.

Conclusion:

Our case suggests that gene examination is very important part of the diagnosis of epilepsy etiology and epilepsy syndromes. Ketogenic diet should be considered as the first line therapy with SLC2A1 gene mutations.
Foveal choroidal neovascularization secondary to accidental laser exposure in a dermatologist
Authors: Lee You Hyun , Kim Yu Cheol
Published: May 2019

Rationale:

Most laser-induced retinal injuries are caused by accidental laser discharge during the preparation of laser devices without protective goggles, laser injury during the cosmetic procedure in a dermatologist, is very rare, with no prior case reports.

Patient concerns:

A 55-year-old Asian male dermatologist visited our hospital with a 2-week history of visual disturbance in his right eye. He had experienced sudden central scotoma in the right eye while using a Q-switched Nd:YAG laser (1064 nm, 2 J/cm2, 6-mm spot size, 750 ps) 2 to 3 cm from the target without proper eye protection. He had applied a glass slide firmly onto the treatment area prior to commencing the procedure. The choroidal neovascularization (CNV) was detected via optical coherence tomography angiography (OCTA) 2 weeks after the laser injury.

Diagnosis:

Foveal CNV secondary to laser energy reflected from the glass slide.

Intervention:

Intravitreal bevacizumab (1.25 mg/0.05 mL) injection was performed.

Outcomes:

Regression of CNV was observed.

Lessons:

Retinal injury can occur not only by direct laser beam exposure but also by way of a beam reflected from a glass slide. Operators should always use laser safety eyewear during cosmetic procedures involving laser devices, so as to prevent the occurrence of ocular complications. Thorough short-term follow-up with OCTA is recommended for the prompt detection of CNV in cases of retinal laser injury.
Parallel transverse uterine incisions combined with cell salvage minimized bleeding in a patient with pernicious placenta previa and an unexplained decrease in hemoglobin after transfusion of allogeneic red blood cells
Authors: Ma Yushan , You Yong , Jiang Xiaoqin , Lin Xuemei , Chen Yan
Published: May 2019

Rationale:

The incidence of pernicious placenta previa (PPP) and placenta accreta (PA) is increasing in China. Excessive blood loss in these women is an important cause of maternal death and emergency hysterectomy. Performing a traditional cesarean section (CS) in women with PPP is stressful for obstetricians because avoiding cutting the placenta is difficult. As a result, sudden life-threatening bleeding may be encountered. Therefore, there is an urgent need to establish a novel operative method for PPP and PA that is safe for both the mother and neonate, and less stressful for the surgeon.

Patient concerns:

We report an extremely rare case of PPP and PA complicated with anemia and an unexplained decrease in the hemoglobin (Hb) levels after transfusion of 3 units of allogeneic red blood cells.

Diagnoses:

The patient was diagnosed with unexplained anemia, and hemolysis resulting from donor red blood cell transfusion was suspected preoperatively.

Interventions:

To minimize blood loss for safety, a new operative technique, parallel transverse uterine incisions (PTUI) in CS (PTUI CS), was used under general anesthesia in this case. Inhaled volatile sevoflurane was used for uterine relaxation during PTUI. Cell salvage was also used.

Outcomes:

PTUI CS combined with cell salvage effectively reduced bleeding and preserved the uterus in our patient. Sevoflurane was effective for uterine relaxation during PTUI CS.

Lessons:

If PPP and PA are suspected, placental magnetic resonance imaging is recommended for definitively determining whether a transverse fundal incision can be made. If feasible, we strongly recommend that PTUI CS combined with cell salvage are used to minimize bleeding for high-risk patients with PPP and PA complicated with anemia and an unexplained decrease in Hb levels after transfusion of 3 units of allogeneic red blood cells. Anesthesiologists should be vigilant to maintain uterine relaxation from the time of delivery of the neonate to a second transverse incision in the lower segment of the uterus. This is a key element of successful PTUI CS. Additionally, the use of intraoperative cell salvage is recommended when it can be expected to reduce the likelihood of donor red cell transfusion.
Atypical and delayed de Winter electrocardiograph pattern
Authors: Yang Yingchao , Ma Yeshuo , Yin Da , Zhang Ying , Song Wei , Cheng Yunpeng , Fu Tingting , Zhang Ri , Liu Yue , Kang Kai , Wang Lixin , Jiang Yinong , Lu Yan
Published: May 2019

Rationale:

de Winter electrocardiograph (ECG) pattern signifies proximal left anterior descending coronary artery (LAD) occlusion and extensive anterior myocardial infarction, and it is found in about 2% of patients with proximal LAD occlusion. However, it is often unrecognized by physicians. In this case report, we present a patient with chest pain but showing an atypical and delayed de Winter ECG pattern.

Patient concerns:

A previously healthy 61-year-old man attended our emergency department with chest pain radiating to the left arm and back for 4 hours, who was without serious cardiovascular risk factors. ECG at emergency department showed no significant changes. High-sensitivity cardiac troponin I (hs-cTnI) was within normal limit.

Diagnosis:

At 5 hours after onset, ECG showed significant upsloping ST depression at J point in precordial leads V3 to V6, slight ST elevation in aVR and depression in inferior leads, and hs-cTnI peaked at 2.610 μg/L. The diagnosis of de Winter ECG pattern was confirmed by coronary angiography with an occlusion of the proximal LAD.

Interventions:

A stent was implanted through percutaneous coronary intervention.

Outcomes:

The patient's chest pain was relieved without further increase of hs-cTnI. ECG after procedure showed ST segment back to baseline in leads V4 to V6, but persistent ST elevation in V1 to V3 with QS or Q wave.

Lessons:

Timely diagnosis of de Winter ECG pattern is very important, especially the atypical and delayed ECG changes. It should be treated as ST elevation myocardial infarction equivalent and deserves emergent revascularization therapy.
Does postoperative morphine consumption for acute surgical pain impact oncologic outcomes after colorectal cancer resection?
Authors: Wu Hsiang-Ling , Tai Ying-Hsuan , Chang Wen-Kuei , Chang Kuang-Yi , Tsou Mei-Yung , Cherng Yih-Giun , Lin Shih-Pin
Published: May 2019

Whether morphine used in human cancer surgery would exert tumor-promoting effects is unclear. This study aimed to investigate the effects of morphine dose on cancer prognosis after colorectal cancer (CRC) resection.

In a retrospective study, 1248 patients with stage I through IV CRC undergoing primary tumor resections and using intravenous patient-controlled analgesia for acute surgical pain at a tertiary center between October 2005 and December 2014 were evaluated through August 2016. Progression-free survival (PFS) and overall survival (OS) were analyzed using proportional hazards regression models.

Multivariable analysis demonstrated no dose-dependent association between the amount of morphine dose and PFS (adjusted hazard ratio, HR = 1.31, 95% confidence interval, CI = 0.85–2.03) or OS (adjusted HR = 0.86, 95% CI = 0.47–1.55). Patients were further classified into the high-dose and low-dose groups by the median of morphine consumption (49.7 mg), and the morphine doses were mean 75.5 ± standard deviation 28.8 mg and 30.1 ± 12.4 mg in high-dose and low-dose groups, respectively. Multivariable models showed no significant difference in PFS or OS between groups, either (adjusted HR = 1.24, 95% CI = 0.97–1.58 for PFS; adjusted HR = 1.01, 95% CI = 0.71–1.43 for OS).

Our results did not support a definite association between postoperative morphine consumption and cancer progression or all-cause mortality in patients following CRC resection.
Is biportal technique/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients?
Authors: Kang Taewook , Park Si Young , Kang Chun Hyung , Lee Soon Hyuck , Park Jong Hoon , Suh Seung Woo
Published: May 2019

Background:

Lumbar decompressive surgery is a standard surgical technique for lumbar spinal stenosis. Many new surgical techniques have been introduced, ranging from open surgery to minimally invasive procedures. Minimally invasive surgical techniques are preferred because patients experience less postoperative pain and shorter hospital stays. However, the success rate of minimally invasive techniques have been controversial. The object of this study was to assess the feasibility of spinal decompression using biportal technique/endoscopic surgery compared with microscopic surgery.

Methods:

Seventy lumbar spinal stenosis patients undergoing laminectomy were included in this study. A number table was used to randomize the patients into two groups: a biportal technique/endoscopic surgery group (BG-36) and a microscopic surgery group (OG-34). One surgeon performed either biportal technique/endoscopic decompression or microscopic decompression using a tubular retractor, depending on the group to which the patient was randomized. Perioperative data and clinical outcomes at postoperative 6 months were collected and analyzed.

Results:

The demographic data and level of surgery were comparable between the two groups. A shorter operation time (36 ± 11 vs 54 ± 9 min), less hemovac drain output (25.5 ± 15.8 vs 53.2 ± 32.1 ml), less opioid usage (2.3 ± 0.6 vs 6.5 ± 2.5 T) and shorter hospital stay (1.2 ± 0.3 vs 3.5 ± 0.8 days) were shown in BG. The BG experienced no significant differences in clinical outcomes compared with OG. Favorable clinical outcomes were shown at 6 months after surgery in both groups.

Conclusion:

Lumbar decompressive surgery using biportal technique/endoscopy showed favorable clinical outcomes, less pain and a shorter hospital stay compared to microscopic surgery in patients with lumbar spinal stenosis.
Good hemostatic effect of platelets stored at 4°C in an in vitro model of massive blood loss and thrombocytopenia
Authors: Yang Jiang-Cun , Liu Feng-Hua , Sun Yang , Ma Ting , Xu Cui-Xiang , Wang Wen-Hua , Chen Ping , Xie Xin-Xin , Song Yao-Jun , Yin Wen
Published: May 2019

This study compared the corrective effects of storage of platelets at 4°C and at 22°C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications.

In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4°C (1, 3, 5, 7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices.

①Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 × 109/L to greater than 120 × 109/L for 4°C storage, and 20 to 27 × 109/L to greater than 120 × 109/L for 22°C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4 mm to greater than 43 mm for 4°C storage, and 12.2 to 14.4 mm to greater than 44.8 mm for 22°C storage. Thromboelastography reaction time values decreased from 9.9–24.9 minutes to 3.8–5.5 minutes for 4°C storage, and 9.9–22.7 minutes to 4.3–4.5 minutes for 22°C storage. ②Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 × 109/L to greater than 99 × 109/L for 4°C storage, and 12 to 34 × 109/L to greater than 120 × 109/L for 22°C storage. TEG-MA results improved from 21.4 to 32.1 mm to greater than 49.1 mm for 4°C storage, and 21.4 to 31.6 mm to greater than 50.5 mm for 22°C storage.

Platelets stored at 4°C and 22°C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4°C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.