bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacokinetics and Pharmacodynamics of Remimazolam (CNS 7056) after Continuous Infusion in Healthy Male Volunteers
Authors: Schüttler Jürgen , Eisenried Andreas , Lerch Marco , Fechner Jörg , Jeleazcov Christian , Ihmsen Harald
Published: January 2020

Background

Remimazolam (CNS 7056) is a new ultra–short-acting benzodiazepine for intravenous sedation and anesthesia. Its pharmacokinetics and pharmacodynamics have been reported for bolus administration. This study aimed to investigate the pharmacokinetics and pharmacodynamics of remimazolam after continuous infusion.

Methods

Twenty healthy male volunteers (20 to 38 yr, 64 to 99 kg) received remimazolam as continuous intravenous infusion of 5 mg/min for 5 min, 3 mg/min for the next 15 min, and 1 mg/min for further 15 min. Pharmacokinetics of remimazolam and its metabolite were determined from arterial plasma concentrations. Sedation was assessed using the Modified Observer’s Assessment of Alertness and Sedation scale. Pharmacokinetic-pharmacodynamic modeling was performed by population analysis. Hemodynamics and the electrocardiogram were also investigated.

Results

Pharmacokinetics was best described by a three-compartment model for remimazolam and a two-compartment model with transit compartment for the metabolite. Remimazolam showed a high clearance (1.15 ± 0.12 l/min, mean ± SD), a small steady-state volume of distribution (35.4 ± 4.2 l) and a short terminal half-life (70 ± 10 min). The simulated context-sensitive halftime after an infusion of 4 h was 6.8 ± 2.4 min. Loss of consciousness was observed 5 ± 1 min after start, and full alertness was regained 19 ± 7 min after stop of infusion. Pharmacodynamics of Modified Observer’s Assessment of Alertness and Sedation score was best described by a sigmoid probability model with effect site compartment. The half-maximum effect site concentration for a Modified Observer’s Assessment of Alertness and Sedation score less than or equal to 1 was 695 ± 239 ng/ml. The equilibration half-time between central and effect compartment was 2.7 ± 0.6 min. Mean arterial blood pressure decreased by 24 ± 6%, and heart rate increased by 28 ± 15%. Spontaneous breathing was maintained throughout the study. There was no significant prolongation of the QT interval of the electrocardiogram observed.

Conclusions

Remimazolam was characterized by a pharmacokinetic–pharmacodynamic profile with fast onset, fast recovery, and moderate hemodynamic side effects.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Management of Ankle Arthritis After Severe Ankle Trauma
Authors: Coetzee J. Chris , McGaver Rebecca S. , Seiffert Kayla J. , Giveans M. Russell
Published: January 2020

Objectives:

There are still unanswered questions about the best treatment options for ankle arthritis after severe lower leg trauma. This study compared results in outcomes and complications for 3 groups.

Design:

Retrospective cohort study case–control study.

Setting:

Single institution.

Patients:

Three groups of 100 surgeries.

Intervention:

Patients underwent an ankle fusion using anterior plate, total ankle arthroplasty (TAA) for primary osteoarthritis (OA), or a TAA for post-traumatic arthritis (PTA).

Main Outcome Measurements:

Veterans Rand 12-Item Health Survey (VR-12), Ankle Osteoarthritis Scale, Visual Analog Pain Scale, and the American Orthopaedic Foot and Ankle Society Hindfoot score were collected preoperatively and at subsequent postoperative appointments. A patient satisfaction survey was also distributed to each patient postoperatively.

Results:

Although all scores improved from preoperative to latest postoperative, the total ankle for PTA consistently resulted in the best postoperative outcomes. Patient satisfaction survey indicated 26% of fusion, 55% of TAA-OA, and 63% of TAA-PTA experienced very good to excellent pain relief. The overall satisfaction was found to be 92.5% for the TAA-PTA patients, 90.5% for the TAA-OA patients, and 84% for the fusion patients. Revision surgeries included 2 from the TAA-OA group, 2 from the TAA-PTA group, and 1 fusion patient.

Conclusions:

Results of comparing 3 groups who underwent an ankle fusion or a TAA demonstrate improvement in pain (P < 0.001), physical quality of life (P < 0.001), and activity (P < 0.001) and resulted in a high level of patient satisfaction.

Level of Evidence:

Level III. See Instructions for Authors for a complete description of levels of evidence.
The Critical Nature of Addressing Burnout Prevention: Results From the Critical Care Societies Collaborative's National Summit and Survey on Prevention and Management of Burnout in the ICU
Authors: Kleinpell Ruth , Moss Marc , Good Vicki S. , Gozal David , Sessler Curtis N.
Published: January 2020

Objectives:

To summarize the results of expert discussions and recommendations from a National Summit and survey on the promoting wellness and preventing and managing burnout in the ICU.

Data Sources:

Literature review; Critical Care Societies Collaborative (CCSC) Statement on Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action; CCSC's National Summit on Prevention and Management of Burnout in the ICU; and a descriptive survey on strategies for addressing burnout using Research Electronic Data Capture (REDCap) (project-redcap.org).

Data Synthesis:

Building on the CCSC call for action to address burnout among critical care professionals, the CCSC sponsored the National Summit on Prevention and Management of Burnout in the ICU with 55 invited experts in various fields including psychology, sociology, integrative medicine, psychiatry, suicide prevention, bereavement support, ethics, palliative care, meditation, mindfulness-based stress reduction, among others. Attendees joined breakout groups, to identify factors influencing burnout in ICU professionals and the value of organizational and individual interventions. As a follow-up to the Summit, a descriptive survey assessing strategies for addressing burnout was sent via email or newsletter blast with responses received from 680 CCSC members, including physicians, nurses, pharmacists, therapists, and others.

Conclusions:

The Summit attendees identified the importance of raising awareness among critical care clinicians and key stakeholders, advocating for workplace changes to promote healthy work environments, and promoting research to further explore practical strategies to address, mitigate, and prevent burnout. Critical care clinicians reported that a number of initiatives are being implemented both at their hospitals and at the unit level to build resilience and address burnout prevention. However, other respondents reported that no measures were being used within their organizations, and that colleagues were experiencing burnout. Dissemination and application of resiliency building measures and strategies to address burnout in critical care clinicians are needed.
Problem-solving in technology-rich environments and cancer screening in later life
Authors: Sahoo Shalini , Millar Roberto J. , Yamashita Takashi , Cummins Phyllis A.
Published: January 2020

Routine cancer screening is widely recognized as an effective preventive strategy to reduce cancer mortality – the second leading cause of death in the US. However, cancer screening requires a complex array of tasks such as seeking up-to-date guidelines, making appointments, planning hospital visits, and communicating with health care professionals. Importantly, modern health care largely relies on technology to disseminate the latest information and administer the system. Yet, little is known about the technology-related skills that are relevant to regular cancer screening. This study examined the association between problem-solving skills in the technology-rich environment and cancer screening in later life. Using 2012/2014 Program for International Assessment of Adult Competencies data, binary logistic regressions with survey weights were used to estimate the association between problem-solving skills in the technology-rich environment and four cancer screening behaviors among the corresponding target populations aged between 45 and 74 years old (n = 1374 for cervical screening; n = 1373 for breast screening; n = 1166 for prostate screening; n = 2563 for colon screening). Results showed that greater problem-solving skills in the technology-rich environment scores (0–500 points) were significantly and positively associated with prostate cancer screening (odds ratio = 1.005, P < 0.05) among men, but not with colon (men and women) or cervical or breast (women) cancer screenings. Improvement in problem-solving skills in the technology-rich environment may promote specific cancer screening behaviors. Our findings inform future policy discussions and interventions that seek to improve cancer screening among a vulnerable section of older populations.
NRAS Mutation Detected in a Melanoma With Chondroid Stroma: A Case Report With Molecular Evaluation and Literature Review of a Rare Form of Melanoma
Authors: Sweeney Shane P. , Royer Michael C.
Published: January 2020

Melanoma with cartilaginous differentiation is a rare histologic subtype that has been reported in the literature. It often presents clinically different than conventional melanomas and can be diagnostically challenging. Molecular alterations in previously reported cases have not been published. We present a case of melanoma with chondroid stroma from a 70-year-old man that was found to contain an NRAS mutation (c.182A>G (p.Q61R)) via Illumina TruSight Tumor 15 (TST15) next generation sequencing assay.
Clinical features and diagnosis of new malignancy in patients with acute pulmonary embolism and without a history of cancer
Authors: Lin Yen-Chung , Chen Su-Chan , Huang Chi-Ming , Hu Yu-Feng , Chen Yun-Yu , Chang Shih-Lin , Lo Li-Wei , Lin Yenn-Jiang , Chen Shih-Ann
Published: January 2020

Background:

Pulmonary embolism (PE) is frequently associated with cancer. This study aimed to assess patients with acute PE and identify diagnostic predictors of new cancer after 1 year of follow-up.

Methods:

One hundred and twenty-one patients with PE were enrolled consecutively from the emergency department of a single medical center in Taiwan. Data from computed tomography angiography, echocardiogram, electrocardiogram and for baseline comorbidities, clinical presentation, and laboratory parameters were recorded. The surviving discharged patients without a cancer diagnosis were followed-up for 1 year, and new malignancies were recorded.

Results:

Of 121 patients with acute PE, 44 (36%) had an underlying cancer history (cancer group), and 77 (64%) did not (noncancer group). Baseline demographic characteristics, comorbidities, clinical symptoms, biochemical parameters, echocardiogram data, and electrocardiogram data of the two groups were similar except for a higher hospital mortality rate (56.8% vs 9.1%; p < 0.001), lower body mass index (22.6 ± 4.1 vs 25.5 ± 4.9; p =0.02), higher systolic blood pressure (139.7 ± 33.7 vs 125.4 ± 24.1; p = 0.02), lower low-density lipoprotein level (67.4 ± 38.3 vs 90.4 ± 33.8; p = 0.04), lower creatinine kinase (CK; 43.0 ± 43.0 vs 83.5 ± 83.1; p = 0.01), higher myocardial band (MB) form of CK ratio (0.2 ± 0.2 vs 0.1 ± 0.1; p < 0.01), higher partial pressure of arterial oxygen (122.81 ± 81.2 vs 90.2 ± 59.4; p = 0.03), and less presentation of chest pain (15.9% vs 40.3%; p = 0.01) in the cancer group. Kaplan–Meier curve analysis revealed that the 30-day survival rate was higher in the noncancer group than in the cancer group (log-rank p = 0.04). After 1 year of follow-up, 6 of 59 (10.17%) initial non–cancer-related PE survivors were diagnosed with malignancies. After multivariate analysis, only the initial CK-MB level was associated with a diagnosis of new cancer (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.029–1.811; p = 0.03).

Conclusion:

This study suggests that the CK-MB level is associated with future malignancy in patients with PE. Patients with cancer-related PE had a worse 30-day survival rate.
Bone Pate Obliteration in Canal Wall Down Mastoidectomy: Modifications of an Established Technique
Authors: Fischer Jakob L. , Nesbitt Nicholas B. , Littlefield Philip D.
Published: January 2020

Objective:

To describe outcomes with obliteration of the mastoid and medial attic following canal wall down mastoidectomy for cholesteatoma. Our technique uses bone pate in the mastoid and cartilage in the epitympanum and supratubal recess.

Study Design:

Retrospective observational study.

Setting:

Tertiary medical center.

Patients:

Ten years of sequential canal wall down mastoidectomies with obliteration from one neurotologist were reviewed. This included primary and revision cases in adults and children.

Main Outcome Measures:

Complications, location and extent of cholesteatoma, the presence of a dry ear after surgery, cholesteatoma recidivism, revision procedures, and postoperative hearing.

Results:

Seventy-eight patients (79 ears) met inclusion criteria. There were few major complications. There was active follow-up of a year or more in 61. For these, the mean follow-up was 3.1 years, and approximately 90% had a dry cavity for the remainder of their follow-up. About half required minimal (if any) maintenance. There were five cases with residual disease, and no cases with recurrent disease. There were five cases that were considered failures, with three taking several years to manifest. There were no cases where cholesteatoma was buried in bone pate. A sizeable minority continued to have active tubotympanic disease despite successful treatment of the attic and mastoid.

Conclusions:

This seems to be a safe and reliable means to eradicate cholesteatoma and create a dry, low-maintenance cavity. It is not a cure for tubotympanic disease, and a small minority of initially stable cavities may fail several years following surgery.

Level of Evidence: 4.
Hepatitis C Virus Therapy for Decompensated and Posttransplant Patients
Authors: Dailey Francis , Ayoub Walid S.
Published: January 2020

Treatment of hepatitis C (HCV) has been revolutionized with the introduction of the direct-acting antivirals (DAA). The DAAs allowed patients to better tolerate HCV therapy with much lower side effects and better efficacy. The DAA also offered hope for a cure in HCV patients who cannot tolerate interferon-based therapy. Such populations include patients with decompensated cirrhosis and postliver transplantation. Despite DAA therapy showing cure rate of over 95% in the absence of cirrhosis, cure rate in the decompensated liver disease setting remains lower. In this paper, we aim to review the current recommendations for the treatment of HCV in patients with decompensated cirrhosis and postliver transplantation.
Rotational and translational osteotomy for treatment of severe deformity in hypophosphatemic rickets
Authors: Li Jin , Rai Saroj , Ze Renhao , Tang Xin , Liu Ruikang , Hong Pan
Published: January 2020

Rationale:

Hypophosphatemic rickets (HR) is a rare hereditary disease characterized by hypophosphatemia, defects in bone mineralization, and rickets, and surgical intervention is warranted for the patient of severe skeletal deformity.

Patient concerns:

Here we report a case of an 11-year-old boy who presented with severe varus deformities of the bilateral lower extremities and was associated with uncoordinated gait with multiple unintentional falls onto ground resulting in fractures of lower extremities.

Diagnoses:

He was diagnosed as HR caused by genetic mutations in the phosphate-regulating endopeptidase homologue. Based on his family history and laboratory tests, including high serum alkaline phosphatase, high urinary phosphorus, hypophosphatemia, and normal serum calcium level, the patient was diagnosed with this disorder.

Interventions:

Rotational and translational osteotomy was performed to redress the severe varus deformity and readjust the malalignment of the lower extremity.

Outcomes:

Right after the surgery, the alignment in the left lower extremity was readjusted, and his appearance seemed normal. Combined with rehabilitation and pharmacological intervention, including oral intake of phosphate and alphacalcidol, the bone healed uneventfully. After the second surgery of a similar procedure on the right femur, the patient was able to walk almost like a normal teenager.

Lessons:

This case proposed a novel technique to treat severe varus or valgus deformity of the lower extremity. HR is a rare disease, and it is important to stress its recognition to avoid delay of diagnosis and surgical intervention if necessary.
Fatal and extensive multiorgan hemorrhages in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis
Authors: Watanabe Tsuyoshi , Takizawa Naoho , Nagasaka Toru , Nakamura Yoshihiro , Ikai Hiroki , Yamamoto Mari , Murai Yukari , Takasugi Koji , Yokoyama-Kokuryo Waka , Fujita Yoshiro
Published: January 2020

Introduction:

Anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) is an autoantigen associated with dermatomyositis (DM). Anti-MDA5 Ab-positive DM patients frequently exhibit clinically amyopathic dermatomyositis (CADM), and develop rapidly progressive interstitial lung disease (RPILD). Even with early detection and potent combination immunosuppressive therapy, anti-MDA5 Ab-positive DM patients have a poor prognosis. In the present case report, we present a rare autopsy case of a patient with anti-MDA5 Ab+ DM with RPILD who exhibited diffuse alveolar damage (DAD) patterning in lung specimens, and extensive hemorrhages in multiple organs.

Patient concerns:

An 82-year-old Japanese man admitted with bacterial pneumonia was subsequently diagnosed with anti-MDA5 Ab-positive DM based on skin manifestations (mechanic's hand, ulcerated palmar papules, and flagellate erythema), myositis, interstitial pneumonia, and elevation of anti-MDA5 Ab titer.

Diagnosis:

The patient was diagnosed with anti-MDA5 Ab+ DM, complicated with RPILD.

Interventions:

The patient received potent immunosuppressive therapy consisting of pulse methylpredonisolone at a dose of 1000 mg for 3 days, followed by prednisolone at 60 mg/d, a 1000 mg pulse of intravenous cyclophosphamide (IVCY), and oral tacrolimus at 6 mg/d. Intravenous immunoglobulin (IVIG) at a dose of 400 mg/kg/d for 5 days was subsequently administered.

Outcomes:

Despite triple immunosuppressive therapy and IVIG, the patients’ respiratory status deteriorated, and the patient died of respiratory failure on the twelfth day after admission. An autopsy revealed pulmonary DAD and multiorgan hemorrhages, including the left iliopsoas muscle, gastric and bowl mucosa, spleen, and left adrenal gland.

Lessons:

Multiorgan hemorrhages may be a fatal complication in anti-MDA5 Ab+ DM patients.
The efficacy and safety of Health Qigong for ankylosing spondylitis
Authors: Liu Biyuan , Fan Zhu , Wang Zheyi , Li Man , Lu Tao
Published: January 2020

Background:

Non-pharmacological treatments (education, exercise, and physical therapy) are remain basic approaches to long-term management of ankylosing spondylitis (AS) patients. As an important part of non-pharmacological treatments, Health Qigong is widely used for AS treatment. We will perform the systematic review to confirm the safety and efficacy of Health Qigong for AS.

Methods:

Systematical search of 6 electronic databases will be done, including English and Chinese, until December 2019. All randomized controlled trials (RCTs) involving Health Qigong in combination with conventional therapy for AS will be included. Study selection, data extraction, and validation were performed independently by 2 reviewers. RevMan (V.5.3) will be used for mata-analysis.

Results:

This systematic review will identify the safety and efficacy of Health Qigong in the treatment of AS and update evidence summaries of Health Qigong. At the end of the treatment, the primary outcome is Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) with a range of 0 to 10,and the secondary outcomes will include functional ability that measured by Bath Ankylosing Spondylitis Functional Index (BASFI), mobility measured by Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion, night spinal pain, adverse reactions, laboratory measures such as erythrocyte sedimentation rate (ESR) and C protein response (CRP).

Conclusion:

This study will provide evidence that whether Health Qigong can benefit patients with ankylosing spondylitis by reducing disease activity, alleviating pain to support the application of Health Qigong in the AS treatment.

Registration number:

CRD42019159126
Risk factors for gallstone disease in Shanghai
Authors: Gu Qiyun , Zhou Guoqing , Xu Tao
Published: January 2020

The purpose of this study was to evaluate related risk factors for gallstone disease in Shanghai.

We analyzed successive physical examinations of 2288 adults who were recruited at the Jinshan Branch of the Sixth People's Hospital of Shanghai and Jinshan Hospital Affiliated to Fudan University Hospital from July 2010 to December 2012. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to measure the influence factors on the risks of gallstone development.

The incidence of gallstone disease was 4.11% (94/2,288). Older age (OR: 1.02; 95% CI: 1.00–1.03; P = .039), higher body weight (OR: 1.02; 95% CI: 1.00–1.04; P = .021), alanine transaminase activity (ALT) (OR: 1.02; 95% CI: 1.01–1.03; P = .001), total standard bicarbonate (SB) (OR: 1.04; 95% CI: 1.02–1.06; P < .001), free SB (OR: 1.17; 95% CI: 1.12–1.21; P < .001), and low density lipoprotein (LDL) levels (OR: 1.59; 95% CI: 1.32–1.91; P < .001) were associated with an increased risk of gallstone disease. Based on univariate logistic analysis, increased triglyceride (TG) levels were associated with a reduced risk of gallstone disease (OR: 0.76; 95% CI: 0.60–0.97; P = .024). The results of multivariable logistic regression analysis showed higher LDL levels correlated with an increased risk of gallstone disease (OR: 1.92; 95% CI: 1.31–2.81; P < .001), while age, weight, ALT, total SB, free SB, and TG levels did not affect the risk of gallstone disease.

The although unadjusted results showed age, weight, ALT, total SB, free SB, TG, and LDL levels to be associated with the risk of gallstone disease, adjusting for potential factors revealed only increased LDL levels to be associated with an increased risk of gallstone disease.
Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis in a small child
Authors: Mărginean Maria Oana , Molnar Eniko , Chinceşan Mihaela Ioana
Published: January 2020

Introduction:

Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially lethal disorder, characterized by a dysregulation of the immune response, leading to a severe inflammatory syndrome. Epstein–Barr virus (EBV)-associated HLH is a form of secondary HLH, a fulminant presentation of an otherwise benign viral infection.

Patient concerns:

We report the case of a 3-year-old girl who presented with fever, signs of accute upper respiratory tract infection and spontaneous, disseminated ecchymoses. Initial laboratory tests revealed pancytopenia. A bone marrow aspirate was performed, which revealed megaloblasts and numerous macrophages, with abundant foamy cytoplasm. Megaloblastic anemia was excluded, as the levels of vitamin B12 and folic acid were both within normal ranges.

Diagnosis.

Hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia, and splenomegaly were relevant criteria for the diagnosis of HLH, in accordance with the bone marrow specimen. Positive immunoglobulin M antibodies for EBV were supportive of an acute EBV infection, which was the most probable trigger of HLH. The patient's evolution was complicated by a massive epistaxis, in the context of thrombocytopenia which required plasma, thrombocyte, and erythrocyte substitutes.

Intervention.

The patient was started on a treatment regimen of 8 weeks with etoposide and dexamethasone.

Outcome:

Her evolution was favorable, the treatment being successful in remission induction.

Conclusion:

Our case emphasizes the diagnostic challenges of HLH, in a patient with EBV infection whose evolution was hindered by a severe epistaxis, with potentially fatal outcome.
Pyogenic tenosynovitis of the wrist due to Corynebacterium striatum in a patient with dermatomyositis
Authors: Kawaguchi Yohei , Okamoto Hideki , Endo Kojiro , Iwata Hidetoshi , Joyo Yuji , Nozaki Masahiro , Tamechika Shinya , Waguri-Nagaya Yuko , Murakami Hideki
Published: January 2020

Introduction:

Corynebacterium striatum is common contaminant in clinical specimens. Here, we report a rare case of pyogenic tenosynovitis of the wrist caused by C striatum in a dermatomyositis patient taking oral immunosuppressants.

Patient concerns:

A 67-year-old Japanese woman with dermatomyositis had a history of multiple intraarticular injections of corticosteroids to the right wrist joint for the treatment of osteoarthritis. She was admitted to our hospital with a painful lump on the right dorsal wrist lasting for three months. MRI revealed cellulitis of the dorsum of the right wrist and hand and fluid collection in the extensor tendon sheath. C striatum was detected in the cultures of three samples of synovial fluid taken from the dorsal hand.

Diagnosis:

Pyogenic tenosynovitis of the wrist due to C striatum.

Interventions:

The infection was successfully controlled with synovectomy and adjuvant antibiotic therapy.

Outcomes:

There has been no sign of recurrence for 12-months after the surgical treatment.

Lessons:

This is the first reported case of pyogenic tenosynovitis due to C striatum in a patient with dermatomyositis. Clinicians should be aware that patients undergoing immunosuppressive therapy have a risk of C striatum infection.
Idiopathic humeral head osteonecrosis mimicking rotator cuff disorders
Authors: Kuo Fang-Yu , Chen Kuan-Lin , Yen Chieh-Chi
Published: January 2020

Rationale:

Shoulder pain is a common complaint among patients, and rotator cuff disorders are the most common diagnoses. Humeral head osteonecrosis is easily masked by other more common diagnoses and concomitant conditions.

Patient concerns:

This challenging diagnostic report consists of 2 cases. Case 1 was that of a 59-year-old man who presented with right shoulder pain that had lasted for >1 year. Case 2 was that of a 52-year-old man who complained of right shoulder pain lasting for 6 months. They both presented with chronic right shoulder pain without relevant trauma history, and the physical examination showed a tenderness point over the right greater tuberosity.

Diagnosis:

These 2 patients were diagnosed with osteonecrosis involving the right greater tuberosity region via magnetic resonance imaging.

Interventions:

In case 1, the patient underwent cord decompression and artificial bone grafting with C-arm guidance. In case 2, the patient refused surgical intervention and decided to continue receiving physical therapy for symptom control.

Outcomes:

In case 1, the patient responded well to cord decompression and artificial bone grafting. After the surgery, the active range of motion was restored and the pain in the right shoulder diminished further. In case 2, conservative treatment helped alleviate the patient's shoulder pain but did not entirely eliminate it.

Lessons:

Physicians should always have a high index of suspicion for osteonecrosis, especially when treating chronic shoulder pain, regardless of whether there are typical symptoms/known risk factors or not.
Gene expression profile and bioinformatics analysis revealed key molecular characteristics of chordoma—before and after TNF- a treatment
Authors: Xu Guoyong , Liu Chong , Liang Tuo , Zhang Zide , Jiang Jie , Chen Jiarui , Xue Jiang , Zeng Haopeng , Lu Zhaojun , Zhan Xinli
Published: January 2020

Background:

Chordoma is a rare malignant tumor with limited treatment. Recent studies have shown that the proliferation and invasion ability of chordoma after Tumor necrosis factor alpha (TNF-α) treatment is enhanced, which may activate the gene pathway involved in the development of chordoma. This study tends to identify differentially expressed genes (DEGs) before and after treatment of TNF-α in chordoma cell line, providing a new target for future molecular therapy of chordoma.

Methods:

The gene expression profile of GSE101867 was downloaded from the Gene Expression Omnibus database, and the differentially expressed genes were obtained using GEO2R. Based on the CLUEGO plugin in Cytoscape, DEGs functionality and enrichment analysis. A protein-protein interaction (PPI) network was constructed using Cytoscape based on data collected from the STRING online dataset. The Hub genes are selected from the CytoHubba, the first 20 genes that coexist with the KEGG tumor-related pathway.

Results:

A total of 560 genes, including 304 up-regulated genes and 256 down-regulated genes, were selected as DEGs. Obviously, GO analysis shows that up-regulated and down-regulated DEGs are mainly enriched in biological processes such as synaptic tissue, cell adhesion, extracellular matrix organization and skeletal system development. DEGs are mainly enriched in tumor-associated pathways such as Pi3k-akt Signal path, Rap1 signal path. Three key genes were identified: PDGFRB, KDR, FGF2. All of these genes are involved in the tumor-associated pathways described previously.

Conclusion:

This study is helpful in understanding the molecular characteristics of chordoma development. Hub genes PDGFRB, KDR, FGF2 and pi3k-akt signaling pathway, Rap1 signaling pathway will become a new target for the future treatment of chordoma.
Pulmonary intimal sarcoma involving the pulmonary valve and right ventricular outflow tract
Authors: Xu Rui , Zhao Yixuan , Xu Xiaosen , Liu Shuang , Hu Chenyu , Lv Dongmei , Wu Huiying
Published: January 2020

Introduction:

Pulmonary artery intimal sarcoma (PAIS) is a rare and highly aggressive tumor, and approximately 80% of pulmonary cases occur in the pulmonary trunk. We report herein a case of retrograde extension of the sarcoma to the pulmonary valve and right ventricle, which is an uncommon manifestation of this lethal tumor.

Patient concerns:

A 41-year-old woman was initially diagnosed with pulmonary thromboembolism (PTE) and transferred to our hospital.

Diagnosis:

Computed tomographic pulmonary angiography (CTPA) showed that there are low-density filling defects in both pulmonary arteries, and the patient was diagnosed with PTE. However, the ultrasonographers considered that the lesion is a space-occupying type that involves the right ventricular outflow tract and pulmonary valve instead of PTE. Postoperative pathology confirmed the diagnosis of PAIS.

Interventions:

The patient underwent resection of pulmonary artery sarcoma and endarterectomy.

Outcomes:

During the follow-up via telephone 1 month after discharge, the patient reported to have been feeling well.

Conclusion:

Owing to the rarity of the disease and its non-specific clinical manifestations, approximately half of the PAIS cases are misdiagnosed or have a delayed diagnosis. Thus, improving our understanding of the disease and facilitating its early diagnosis are essential.
Efficacy and safety of dexmedetomidine combined with tramadol for patient-controlled intravenous analgesia in Chinese surgical patients
Authors: Chen Peng , Chen Fuchao , Lei Jiexin , Zhou Benhong
Published: January 2020

Background:

Patient-controlled intravenous analgesia (PCIA) has been suggested as an effective method of pain relief. There are several randomized controlled trials (RCTs) of dexmedetomidine (DEX) combined with tramadol for PCIA in Chinese surgical patients. The purpose of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of DEX combined with tramadol for PCIA in Chinese surgical patients from current data.

Methods:

The RCTs of DEX combined with tramadol for PCIA were gathered from the PubMed, Excerpta Medica Database, Cochrane Library, Cochrane Library, China National Knowledge Infrastructure database, and VIP databases. After data extraction and quality assessment of the included RCTs, RevMan 5.3 software was employed for the meta-analysis of visual analog scale (VAS) scores, Ramsay sedation scores, effective pressure times for PCIA, tramadol consumption, and safety.

Results:

Fourteen RCTs were included. Compared with tramadol alone, postoperative intravenous tramadol-DEX combination PCA led to lower VAS scores (weighted mean differences [WMD]12h = 0.14, 95% confidence interval [CI] v1.50 to 1.79; WMD24h = 0.78, 95% CI −0.92 to −0.62; WMD48h = 0.51, 95% CI −0.66 to −0.38; all P 
< .05), lower Ramsay sedation scores (WMD24h = 0.08, 95% CI −0.14 to −0.02; WMD48h = 0.09, 95% CI −0.11 to −0.07; all P 
< .05), and less postoperative tramadol consumption (WMD0–24h = −102.59 mg, 95% CI −149.68 to −55.49; WMD0–48h = −152.91 mg, 95% CI −259.93 to −45.89; all P < .05). With regard to safety, there was a significant difference between DEX-tramadol and tramadol for PCIA in terms of the incidence of postoperative nausea and vomiting, dizziness, chills, and restlessness (all P 
< .05).

Conclusion:

According to the domestic evidence, this systematic review and meta-analysis suggests that DEX-tramadol PCIA is superior to tramadol in terms of analgesic efficacy and safety for Chinese surgical patients. However, because of some clear limitations (sample size and heterogeneity), these results should be interpreted with caution. Further large-scale and well-designed studies are needed to summarize and analyze the data to draw a more convincing conclusion.
Prevention of chemotherapy-induced nausea and vomiting with acupuncture
Authors: Ma Ting-Ting , Zhang Tao , Zhang Gan-Lin , Dai Cun-Fang , Zhang Bo-Ran , Wang Xiao-Min , Wang Lin-Peng
Published: January 2020

Background:

Nausea and vomiting are the most common complications following chemotherapy and usually lead to decreased quality of life. Acupuncture therapy is an effective method for chemotherapy-induced nausea and vomiting (CINV), the effects and safety have been observed by many clinicians and demonstrated in a systematic review, which was included in the Cochrane Library in 2014. After several years, new studies have occurred and an updated systematic evaluation is needed. This protocol describes a method for performing a systematic review and meta-analysis to further evaluate the beneficial effects and safety of acupuncture for CINV.

Methods:

A searching strategy will be carried out mainly in eight databases in English and Chinese, Cochrane Central Register of Controlled Trials, PubMed, Embase, China National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Wanfang database, China Doctoral Dissertations Full-text Database, and China Master's Theses Full-text Database. Only randomized controlled trials related to acupuncture for CINV will be included to enhance the effectiveness. The effective percentage will be used as primary outcome. Changes in the symptoms of nausea and vomiting, like severity, duration, and frequency as well as quality of life will be assessed as secondary outcome. Side effects and adverse events will be used as safety evaluations. To ensure the quality of the systematic evaluation, study selection, data extraction, and quality assessment will be independently performed by 2 authors, and the third author will deal with any disagreement. The Review Manager V.5.3.3 s will be used to perform the data synthesis and subgroup analysis.

Results:

There are additional studies, further explanations and more subgroup analyses compared with the previous systematic analysis to determine the effects and safety of acupuncture for CINV.

Conclusion:

The result of this systematic review may offer clinicians stronger evidence to assist patient in relieving CINV.

Ethics and dissemination:

There is no need to acquire ethical approval for individuals come from literatures instead of recruiting directly. The findings of this review will be reported in peer-reviewed publications and/or presented at relevant conferences

Trial registration number:

CRD42016045223.
Clinical study on concurrent use of electro-acupuncture or Chuna manual therapy with pregabalin for chemotherapy-induced peripheral neuropathy: safety and effectiveness (open-labeled, parallel, randomized controlled trial, assessor-blinded)
Authors: Lee Jin-Hyun , Cho Tae jin , Park Min Geun , Kim Ji-Hoon , Song Sung Kyu , Park Shin-Young , Sunwoo Yun-Young , Lee Ilkyun , Park Tae-Yong
Published: January 2020

Introduction:

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the major side effects of chemotherapy. Its main symptoms are pain, paresthesia, and numbness. However, the mechanisms underlying the development of CIPN remain unclear and standard treatments have not been established. Recently, there has been a growing interest in various approaches to overcome the limitations of the existing treatments. This study aims to evaluate the efficacy and safety of the concurrent use of two complementary and alternative therapies: electroacupuncture (EA) and Chuna manual therapy (CMT), with pregabalin, which is the conventional pharmacotherapy for neuropathic pain.

Methods/design:

This is an open-label, parallel, assessor-blinded randomized controlled trial, which includes 90 patients with colorectal and breast cancer, who developed CIPN. After a 2-week preparation period, the patients are divided into three groups (pregabalin administration group, pregabalin + EA treatment group, and pregabalin + CMT treatment group), treated for approximately 5 weeks and followed-up 4 weeks after treatment. The primary outcome is assessed using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group Neurotoxicity subscale score (version 4.0) and the secondary outcome is measured using the Quality of Life Questionnaire-CIPN 20-Item Scale (version 3.0) and the quality of life questionnaire (version 3.0) developed by the European Organisation for Research and Treatment of Cancer. Moreover, exploratory efficacy and safety evaluations will be conducted based on the chemotherapy-completion rate and nerve conduction studies.
Possible increased risk of colonic diverticular disease from alcohol intoxication or abuse
Authors: Tseng Yun-Jung , Lai Ching-Yuan , Wang Yu-Chiao , Chen Wei-Kung , Kao Chia-Hung , Chen Chun-Hung
Published: January 2020

Alcohol consumption has been suggested as a potential risk factor for diverticular diseases. This study investigated the association between alcohol intoxication or abuse and colonic diverticular disease (CDD).

Using the National Health Insurance Research Database of Taiwan from January 1, 2000, to December 31, 2008, 51, 866 subjects newly diagnosed with alcohol intoxication were enrolled in this study as the alcohol intoxication cohort. The control (nonalcohol intoxication) cohort was frequency-matched 1:4 by age, sex and index year. Data were analyzed using a Cox proportional hazards model.

The overall incidence of CDD (per 10,000 person-years) for the alcohol intoxication and control cohorts was 16.4 and 3.46, respectively. Compared with patients in the control cohort (95% confidence interval [CI] = 2.76–3.74), those with alcohol intoxication exhibited a 3.21-fold risk of CDD; the risk was particularly higher in male patients (adjusted hazard ratio [aHR] = 3.19, 95% CI = 2.72–3.74) and in those aged <45 years (aHR = 4.95, 95% CI = 3.91–6.27). The alcohol intoxication still had higher risk of CDD than nonalcohol intoxication, regardless of subjects without comorbidity (aHR = 3.38, 95% CI = 2.77–4.11) or with (aHR = 2.85, 95% CI = 2.25–3.61).

There was a significant relationship between alcohol intoxication or abuse and CDD.
The relationship between low serum calcium level and intracerebral hemorrhage hematoma expansion
Authors: Sun Jian , Liu Wanjun , Zhu Rending , Wu Yao , Yang Liqi
Published: January 2020

Background:

To investigate the relationship between intracerebral hemorrhage hematoma expansion with low serum calcium level.

Methods:

We will search the following electronic bibliographic databases: MEDLINE, Embase, PubMed, The Cochrane Library, and Web of Science. All sources have to be searched from the earliest date until May 1, 2019. The quality of the included studies will assess by 2 evaluation members according to the Cochrane Collaboration network standard or the Newcastle–Ottawa Scale. The included studies will analysis by using RevMan 5.3 software.

Results and conclusion:

This will be the first systematic review and meta-analysis to evaluate the association of hematoma following intracerebral hemorrhage with hypocalcemia. The study will provide more reliable, evidence-based data for clinical decision making.

Prospero registration number:

CRD42019135956
Protocol of a meta-analysis
Authors: Liu Wanjun , Sun Jian , Wu Yao , Yang Liqi
Published: January 2020

Background:

The purpose of this study was to evaluate the effectiveness and safety of long fusion (LF) versus short fusion (SF) for the treatment of degenerative scoliosis (DS).

Methods:

We will search MEDLINE, EMBASE, PubMed, the Cochrane Library, and Web of Science to collect the randomized and non-randomized controlled studies that compared LF with SF in the treatment of DS from inception to June 1, 2019. The quality of the included studies will be assessed by 2 evaluation members according to the Cochrane collaboration network standard or the Newcastle–Ottawa Scale. The included studies will be analyzed using RevMan 5 (version 5.3.3).

Results and Conclusion:

The study will compare the efficacy and safety of LF and SF in the treatment of DS and provide more reliable, evidence-based data for clinical decision making.

PROSPERO registration number:

CRD42019137646.
Prolonged cholestasis following endoscopic retrograde cholangiopancreatography, a rare complication of contrast agent induced liver injury
Authors: Lin Cheng-Kuan , Huang Wen-Chih
Published: January 2020

Rationale:

Prolonged cholestasis is a rare complication associated with endoscopic retrograde cholangiopancreatography (ERCP).

Patient concerns:

A 68-year-old man who presented with worsening cholestasis after ERCP for the removal of a common bile duct stone.

Diagnosis:

Total bilirubin increased up to 35.2 mg/dL after the 21st day post-ERCP. A percutaneous liver biopsy was performed and drug-related cholestasis was suspected as occurring as a result of the contrast agent.

Interventions:

Oral ursodeoxycholic acid and cholestyramine were prescribed to the patient.

Outcomes:

By the 7th week post-ERCP, the patient's symptoms and markers of physiological health began to resolve. The bilirubin returned to normal levels on the 106th day post-ERCP. We reviewed the literature for studies of 9 patients with jaundice more than 30 days post-ERCP, the peak of total serum bilirubin occurred on 16th ± 7th days and the recovery followed after mean time of 54th ± 22th days.

Lessons:

Although the cholestasis was prolonged, the outcome was favorable after medical therapy. There were no long-term consequences for the patient.
A novel RNA sequencing-based prognostic nomogram to predict survival for patients with cutaneous melanoma
Authors: Tian Jun , Yang Ye , Li Meng-Yang , Zhang Yuan
Published: January 2020

Background:

Plenty of evidence has suggested that long non-coding RNAs (lncRNAs) have played a vital part may act as prognostic biomarkers in a variety of cancers. The aim of this study was to screen survival-related lncRNAs and to construct a lncRNA-based prognostic model in patients with cutaneous melanoma (CM).

Methods:

We obtained lncRNAs expression profiles and clinicopathological data from the Cancer Genome Atlas (TCGA) and the Genotype-Tissue Expression (GTEx) databases. A lncRNA-based prognostic model was established in training set. The established prognostic model was evaluated, and validated in the validation set. Then, a prognostic nomogram combining the lncRNA-based risk score and clinicopathological characteristics was developed in training set, and assessed in the validation set. The accuracy of the model was evaluated by the discrimination and calibration plots.

Results:

A total of 212 lncRNAs were identified to be differentially expressed in CM. After univariate analysis, LASSO penalized regression analysis, and multivariate analysis, 3 lncRNAs were used to construct risk score model. The proposed risk score model could divide patients into high-risk and low-risk groups with significantly different survival in both training set and validation set. The ROC curve showed good performance in survival prediction in both sets. Furthermore, the nomogram for predicting 3-, 5-, and 10-year OS was established based on lncRNA-based risk score and clinicopathologic factors. The prognostic accuracy of the risk model was confirmed by the discrimination and calibration plots in both training set and validation set.

Conclusions:

We established a novel three lncRNA-based risk score model and nomogram to predict overall survival of CM. The proposed nomogram may provide information for individualized treatment in CM patients.
Peripheral dentinogenic ghost cell tumor of the ethmoid sinus
Authors: Liu Guo , Li Jin-nan , Liu Feng
Published: January 2020

Rationale:

The dentinogenic ghost cell tumor (DGCT), a locally invasive benign neoplasm, is one of the rarest odontogenic tumors, usually developing in the maxilla or mandible. It can be classified into 2 types: intraosseous (central) and extraosseous (peripheral). Here, we describe the first case of a peripheral DGCT located in the ethmoid sinus.

Patient concerns:

An 8-year-old boy presented to our department with a longer than 7-month history of nasal obstruction, purulent secretion, and reduction in sense of smell in the right nasal cavity.

Diagnosis:

The patient was diagnosed with peripheral DGCT of the ethmoid sinus based on computed tomography scan and pathology.

Interventions:

Functional endoscopic sinus surgery was performed.

Outcomes:

With 2 years of follow-up, there was no evidence of recurrence.

Lessons:

Peripheral DGCT can occur in the paranasal sinus and the need to consider this entity as a possible diagnosis by the clinicians.
A nationwide peer-assisted learning program in disaster medicine for medical students
Authors: Ragazzoni Luca , Conti Andrea , Dell’Aringa Marcelo , Caviglia Marta , Maccapani Fabio , Della Corte Francesco
Published: January 2020

Objectives

The Sendai Framework advocates the importance of training in disaster medicine as a way to improve health system resilience. In Italy, despite the official recognition of disaster medicine as a mandatory discipline in the standard curriculum, most students are never exposed to its basic concepts. DisasterSISM is a nationwide educational program in disaster medicine developed in 2008. Given the scarcity of experienced instructors, in 2013, the course adopted a peer-assisted learning (PAL) approach to correct the omission identified in the national curriculum. The new approach involved a training of trainers (ToT) and a basic course organized and delivered by certified student teachers.

Methods

The authors gathered and analyzed data from demographic questionnaires, pretest and posttests, and satisfaction questionnaires.

Results

From 2013 to 2018, 42 medical students attended the ToT becoming student teachers. From 2014 to 2018, 2316 medical students attended the basic course delivered by the student teachers across Italy. Thirty-six out of 41 medical schools were reached. Participation in the program improved students’ knowledge in disaster medicine. Participants were satisfied with both the course structure and its PAL approach and considered disaster medicine to be highly relevant for their future professional career.

Conclusions

By presenting this nationwide program and its outcomes, the authors hope to strengthen the case for including disaster medicine education in the standard medical curriculum. Because the course relies on medical students and PAL, the authors trust that it could be adapted to other countries worldwide.