bluuebunny/crossref_metadata_2025 huggingface dataset:
The association of polymorphisms in promoter region of MMP2 and MMP9 with recurrent spontaneous abortion risk in Chinese population
Authors: Li Li , Liu Jia , Qin Shuang , Li Ruiman
Published: October 2018

This study aimed to reveal the genetic association between polymorphisms in promoter region of matrix metalloproteinase 2 (MMP2) and matrix metalloproteinase 9 (MMP9) and the risk of recurrent spontaneous abortion (RSA) in Chinese population.

A total of 129 RSA patients and 116 relative controls were selected and the genotyping of polymorphism was conducted by polymerase chain reaction with sequencing. Genotype distribution of polymorphism in the control group was tested the status of Hardy–Weinberg equilibrium and then, genotype frequencies were compared between the case and control groups by chi-squared test. Odds ratio (OR) with the corresponding 95% confidence interval (95% CI) was computed to express the risk of RSA caused by polymorphism. Moreover, the linkage disequilibrium of polymorphisms in MMP2 was analyzed by Haploview software.

CT genotype and T allele of rs243865 in MMP2 were significantly associated with the increased susceptibility to RSA in Chinese population (CT vs. CC: OR = 1.926, 95% CI = 1.101–3.368; T vs. C: OR = 1.751, 95% CI = 1.146–2.676). Similarly, CT genotype carriers of rs3918242 in MMP9 were obviously more in RSA patients than that of the controls (P = .037), which indicated it was associated with the risk of RSA occurrence (OR = 1.760, 95% CI = 1.034–2.995). So was T allele in RSA development (OR = 1.595, 95% CI = 1.061–2.398). Haplotypes C-T and T-C were also the risk factors of RSA (OR = 1.673, 95% CI = 1.103–2.536; OR = 2.171, 95% CI = 1.372–2.436).

MMP2 rs243865 and MMP9 rs3918242 polymorphisms are significantly associated with the risk of RSA in Chinese population.
Comparison of transcatheter closure, mini-invasive closure, and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children
Authors: Yi Kang , You Tao , Ding Zhao-hong , Hou Xiao-dong , Liu Xing-Guang , Wang Xin-Kuan , Tian Jin-hui
Published: October 2018

Objective:

Our study was aimed to comprehensively compare the relative efficacy, safety, and the cost of transcatheter closure, mini-invasive closure, and open-heart surgical repair to treat perimembranous ventricular septal defects (pmVSDs) in children using network meta-analysis method.

Methods:

Five databases were systematically searched including Chinese Biomedical Literature Database, China National Knowledge Infrastructure, PubMed, EMBASE.com, and the Cochrane Central Register of Controlled Trials from the starting date of each database to February 2017. Tools for assessing the risk of bias in nonrandomized studies of interventions (ROBINS-I) were used to evaluate the risk of bias in observational studies and Cochrane Handbook version 5.1.0 was used for randomized controlled trials (RCTs). Data were analyzed using R-3.4.0 software and Review Manager 5.2.

Results:

Three RCTs and 24 observational studies were included in our study. Network meta-analysis result demonstrated that transcatheter closure was the most effective treatment in terms of operative time [standardized mean difference (SMD) = −2.02, 95% confidence interval (CI): −3.92 to −0.12], major complications [odds ratio (OR) = 0.52, 95% CI = 0.30–0.91], ICU stay (SMD = −1.11, 95% CI = −2.13 to −0.08), and hospital stay (SMD = −1.81, 95% CI = −2.24 to −1.39). However, open-heart surgical repair showed a higher success rate of the procedure than transcatheter closure (OR = 0.36, 95% CI = 0.17–0.77).Statistical analysis result demonstrated that transcatheter closure had the best potential to lessen major complications, ICU stay, hospital stay, operative time, and significant residual shunt.

Conclusions:

Transcatheter closure has more benefit than mini-invasive closure and open-heart surgical repair to treat pmVSDs.
Eculizumab in a pregnant patient with laboratory onset of catastrophic antiphospholipid syndrome
Authors: Rovere-Querini Patrizia , Canti Valentina , Erra Roberta , Bianchi Esperia , Slaviero Giorgio , D’Angelo Armando , Rosa Susanna , Candiani Massimo , Castiglioni Maria Teresa
Published: October 2018

Rationale:

Hypercoagulability and pregnancy morbidity are hallmarks of the antiphospholipid syndrome (APS). Catastrophic antiphospholipid syndrome (CAPS) is a potentially life-threatening omplication of APS, with widespread acute thrombotic microangiopathy (TMA) that can be precipitated by pregnancy and delivery and result in multiorgan damage. Unrestrained activation of the complement cascade is involved, favoring endothelial activation, tissue factor expression by leukocytes, and platelet aggregation. The complement block, which interrupts this amplification cycle, could prevent CAPS in patients with early TMA who face precipitating events.

Patient concerns:

We present a nulliparous pregnant woman with APS at the 30+6 week of gestation who has developed thrombocytopenia, intravascular hemolysis, elevated creatinine, proteinuria, and hematuria.

Diagnoses:

These featurs were compatible with the diagnosis of CAPS. Consensually, serum C3 protein levels were rapidly decreasing, reflecting complement consumption.

Interventions:

She was treated with eculizumab, a humanized monoclonal antibody against C5 that prevents the formation of the complement membrane attack complex.

Outcomes:

Laboratory parameters improved and the patient did not develop thrombosis or detectable organ/tissue damage. The patient safely delivered by cesarean section at week 32 of gestation a healthy 1640 g male infant. After 5 days, she received additional eculizumab, with complete resolution of the clinical condition. Low complement activity was detectable in the infant blood for a week after delivery. No infectious complication occurred.

Lessons:

Inhibition of the terminal complement activation is safe and might be effective in patients with APS developing early TMA, enabling safe delivery and preventing thrombotic events both in the mother and in the newborn.
Musculoskeletal complaints in healthcare personnel in hospital
Authors: Koyuncu Nazmiye , Karcioglu Özgür
Published: October 2018

The objective of this study is to investigate musculoskeletal complaints (MSCs) in healthcare workers (HCWs) in 3 community hospital–based departments [internal medicine (IM), general surgery (GS), and emergency department (ED)] and its effects on the quality of work life (QWL) of hospital HCW.

This prospective cross-sectional study was performed in the 700-bed community training hospital. All HCW staffed in 3 departments (IM, GS, ED) of the hospital were asked to respond to items in the study data sheet. Enrolled personnel were inquired about their demographic data, work history and schedule, and medical history. The 16-item Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) Turkish version was applied to evaluate MSC. A total of 216 HCW constituted the study sample and demographic characteristics, history, and clinical findings were analyzed.

Among all, 103 personnel (47.7%) were women (n = 42, 41.1% in physicians, n = 57, 87.6% in nurses and n = 4, 8% in other HCW) (P = .000). A total of 173 personnel (79.7%) reported MSC in some part of their bodies. Female personnel had MSC significantly more commonly than males (chi-square = 40.7, P = .000). Numbers and percentages of the personnel with MSC in 3 departments (IM, GS, ED) were 51/61, 52/65, and 70/90, respectively (P = .67). Total QWL score of those without MSC was significantly higher than others (74.7 + −12 vs 63.2 + −15, respectively; t test, P = .000). Total frequency score of MSC as elicited via CMDQ was significantly higher in those without MSC compared to the others (8.1 + −7.6 vs 0.1 + −0.6, respectively, t test, P = .000).

Female sex, high-income, university graduation, being a nurse or a physician, and older age impose risk for HCW in hospital with respect to having MSC. Presence of MSC affects QWL negatively.
Acupotomy therapy for lumbar disc herniation
Authors: Jiang Cai , Li Yinyan , Guo Miaomiao , Li Xiaomei , Guo Jinhua , Yu Shengxian , Lin Zhonghua
Published: October 2018

Background:

Lumbar disc herniation (LDH) is a clinically common degenerative spinal disease that adversely affects patients’ quality of life and work ability. Although several articles have reported that acupotomy can improve the clinical symptoms of LDH, the efficiency of acupotomy has not been scientifically or methodically evaluated. The primary objective of this study is to evaluate and synthesize evidence on the effectiveness and safety of acupotomy therapy in patients with LDH.

Method:

We plan to search eight English and Chinese electronic databases, including the Web of Science, Cochrane Library, PubMed, EMBASE, SinoMed, Wanfang, China Science and Technology Journal (VIP), and China National Knowledge Infrastructure (CNKI) databases, for potentially eligible studies. Randomized controlled trials (RCTs) on acupotomy treatment in LDH patients will be searched for independently by 2 reviewers in the databases from their inception to August 2018. We will combine data from clinically homogenous studies in a fixed effect meta-analysis using RevManV.5.3.5, and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

Results:

This systematic review and meta-analysis will use high-quality evidence-based medicine to assess the efficacy and safety of acupotomy therapy in LDH.

Conclusion:

This study protocol will provide strong evidence to determine whether acupotomy therapy is an effective and safe intervention for patients with LDH.
A meta-analysis of safety and efficacy of regorafenib for refractory metastatic colorectal cancer
Authors: Xue Wu-Song , Men Si-Ye , Liu Wei , Liu Reng-Hai
Published: October 2018

Background:

Patients with metastatic colorectal cancer (mCRC) often suffer from progressive disease despite previous therapy. It has been a great challenge for those patients. In 2012, regorafenib was approved for mCRC. In this meta-analysis, we aimed to collect and present existing data to explorethe clinical use of regorafenib.

Methods:

The online electronic databases, such as PubMed, Embase, and the Cochrane library, updated to November 2017 were systematically searched. Trials on the effectiveness of regorafenib in patients who suffer from treatment-refractory metastatic colorectal cancer were included, of which the main outcomes included 3 parameters: overall survival (OS), progression-free survival (PFS), and grade 3/4 AE.

Results:

Totally, 4 trials were included in this meta-analysis. The OD was significantly better with the use of regorafenib (OR = 0.78, 95%CI = 0.65–0.94, I
2 = 69%, P = .008), and PFS (OR = 0.52, 95%CI = 0.34–0.79, I
2 = 97%, P = .002). However, the most common toxicities occurred more frequently in the regorafenib group than the control group (OR = 3.73, 95%CI = 1.68–8.28, I
2 = 79%, P = .001).

Conclusion:

Regorafenib demonstrates better efficacy and has manageable adverse-event profile for treatment-refractory mCRC. Considering the safety feature of regorafenib, further studies and clinical trials are warranted to investigate the dosing of regorafenib and alternative approaches are needed to explore predictive biomarker fortherapy selection.
A case report of Legionella and Mycoplasma pneumonia
Authors: Saladi Lakshmi , Zaidi Bushra , Toolsie Omesh , Vakde Trupti , Adrish Muhammad
Published: October 2018

Rationale:

Concurrent or sequential coinfections of Legionella pneumophila and Mycoplasma pneumoniae have been reported in the past though infrequently. Distinguishing a true co-infection from cross reactivity is often challenging as the diagnosis is mostly dependent on serological testing.

Patient concerns:

A 77-year-old male presented with worsening dyspnea, cough with yellow sputum, diarrhea and fever of 2-days duration. Patient had history of chronic obstructive pulmonary disease (COPD) on home oxygen, bronchiectasis, rheumatoid arthritis (on methotrexate and leflunomide), treated pulmonary tuberculosis and 30-pack-year smoking. Chest X-ray showed bilateral interstitial changes with left lower lobe infiltrate. On day 5, his urine antigen for L pneumophila serogroup 1 was reported positive. The following day his serum M pneumoniae IgM antibody titers were reported elevated at 6647 U/mL. Patient was started on antibiotics and placed on non-invasive positive pressure ventilation.

Diagnosis:

The patient was diagnosed with possible Legionella and Mycoplasma co-infection.

Outcomes:

Sputum Mycoplasma polymerase chain reaction (PCR) and serum cold agglutinins were obtained on day 6 and later reported negative. He was treated with azithromycin for 10 days with clinical improvement.

Lessons:

Serological testing alone is an indirect measure with poor sensitivity and specificity and has its own limitations. Urine antigen detection confirms L pneumophila serogroup 1 infection in a patient with suggestive symptoms. However, diagnosis of M pneumonia should be based on combination of tests including serology and PCR to confirm true co-infection.
Effect of Liuzijue Qigong on patients with chronic obstructive pulmonary disease
Authors: Guo Yu , Xu Mingmin , Ji Meiqi , Zhang Jialei , Hu Qingchuan , Wei Zeren , Yan Jian , Chen Yue , Lyu Jiaxuan , Shao Xiaoqian , Wang Ying , Guo Jiamei , Wei Yulong
Published: October 2018

Background:

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide with a substantial and increasing social and economic burden. Liuzijue Qigong is a kind of traditional Chinese Qigong exercises that Traditional Chinese Medicine practitioners prescribe to individuals with COPD to strengthen the internal organs’ function. Liuzijue Qigong was recommended for use in COPD rehabilitation, and some clinical trials indicate that Liuzijue Qigong would produce better functional capacity and quality of life of individuals with COPD. The objective of this study is to conduct a systematic review of the existing studies to assess effectiveness and safety of Liuzijue Qigong for the prevention or treatment of COPD in patients.

Methods:

We will perform the comprehensive literature search in English and Chinese electronic database. The publication period will be from inception to the search date. In addition, the clinical trial registries, dissertations, informal publication, grey literature, reference lists of studies, systematic reviews, and conference abstracts will also be collected. Two reviewers will identify relevant studies, extract data information, and then assess the methodical quality by the Cochrane risk of bias assessment tool. Only randomized controlled trials comparing Liuzijue Qigong against other intervention or nonintervention will be included. Data will be synthesized by either fixed-effect or random-effect model regarding to a heterogeneity test. The routine lung function, arterial blood gas tensions, partial pressure of carbon dioxide, functional capacity, 30 seconds sit-to-stand test, respiratory function, maximal inspiration pressure, maximal expiratory pressure, airway resistance, and specific airway conductance will be assessed as primary outcomes. The secondary outcomes involved dyspnea, and fatigue levels, respiratory muscle strength, upper and lower limb muscle strength, handgrip strength test, and health-related quality of life and safety. Meta-analysis will be performed by using Cochrane's Review Manager software (version 5.3.5).

Results:

This systematic review and meta-analysis will provide a high-quality synthesis and evaluate the efficacy and safety based on current relevant literature evidence of Liuzijue Qigong intervention for COPD patient.

Conclusion:

Our systematic review will provide evidence to determine whether Liuzijue Qigong is an effective and safe approach to prevention and treatment of COPD patients.
Fecal microbiota transplantation for patients with irritable bowel syndrome
Authors: Wen Wenting , Zhang Haibo , Shen Junlong , Wei Luxia , Shen Shunong
Published: October 2018

Irritable bowel syndrome (IBS) is a common functional bowel disease characterized by chronic or recurrent abdominal pain, bloating, constipation, and diarrhea. Many patients with IBS have a poor quality of life due to abdominal discomfort, diarrhea, constipation, and the presence of other diseases. At present, intestinal motility inhibitors, adsorbents, astringents, intestinal mucosal protective agents, and antidepressants have been combined to treat IBS, but the treatment process is long, which results in a large economic burden to patients. Fecal microbiota transplantation (FMT) is a treatment involving the transplantation of functional bacteria from healthy human feces into the gastrointestinal tract of patients; thus, replacing the intestinal flora and modulating intestinal and extra-intestinal diseases. In recent years, the efficacy and economic benefits of FMT in the treatment of IBS have received increasing attention from researchers.

A search for randomized controlled trials (RCTs) on treating IBS with FMT will be performed using 9 databases, including PubMed, the Cochrane Library, Embase, ClinicalTrails, China National Knowledge Infrastructure, Sino Med, ScienceDirect, VIP, and Wanfang Data. Two reviewers will independently screen data extraction studies and assess study quality and risk of bias. The risk of bias for each RCT will be assessed against the Cochrane Handbook standards to assess methodological quality. RevMan V.5.3 software will be used to calculate data synthesis when meta-analysis is allowed.

This study will provide a high-quality synthesis of existing evidence on the effectiveness and safety of FMT in the treatment of IBS.

This study will determine if FMT is an effective and safe intervention for IBS.

PROSPERO registration number is PROSPERO CRD42018108080.
Bystander cardiopulmonary resuscitation training in primary and secondary school children in China and the impact of neighborhood socioeconomic status
Authors: Li Hui , Shen Xu , Xu Xia , Wang Yan , Chu Lihua , Zhao Jialian , Wang Ya , Wang Haihong , Xie Guohao , Cheng Baoli , Ye Hui , Sun Yaqi , Fang Xiangming
Published: October 2018

Background:

The World Health Organization (WHO) has endorsed school bystander cardiopulmonary resuscitation (CPR) training programs. But related researches in China are limited. Therefore, we conducted this study to assess bystander CPR training in school children in China and the impact of neighborhood socio-economic status (SES) on.

Methods:

A total of 1,093 students from seven schools in Zhejiang province participated in this study. Theoretical and practical bystander CPR training were conducted in instructor-led classes. Students completed a 10-statement questionnaire before and after training, and then underwent a skills assessment during a simulated basic life support (BLS) scenario. Subgroup analyses were stratified according to neighborhood SES.

Results:

Before training, most students (72.83%) had a strong desire to learn bystander CPR and share with others. After training, bystander CPR theory was significantly improved (P < .01), and 92.64% students reached an 85-100% performance rate in a simulated BLS scenario. Students from low-SES neighborhoods had less pre-training knowledge of bystander CPR (P < .01). However, their performance was similar with students from higher-SES neighborhoods on the post-training questionnaire and the skills assessment, and better among students aged 13–14 years.

Conclusion:

School children in China have a poor pre-training knowledge of bystander CPR. However, with training, there was a significant improvement in the basic theory and skills of CPR. Bystander CPR training efforts should be targeted to Chinese primary and secondary school children, especially in low-SES neighborhoods.
Factors influencing class agreement and medical expenditure by age in South Korea
Authors: Choi Ryoung , Kang Hyun Goo
Published: October 2018

Background:

There are not many studies evaluating the factors affecting medical expenditure for different age groups, income classes, and subjective social classes. Therefore, this study evaluates the agreement between income class, objective class, and subjective social class and analyzes the factors that affect medical expenditure by age group.

Methods:

Multiple regression analysis and χ
2 test were conducted to evaluate the compatibility between income quintiles and subjective social classes and to identify the factors influencing medical expenditure by subjective social class and age using raw data from the 2013 Korea Health Panel (n = 9,385) of the Korea Institute for Health and Social Affairs and the National Health Insurance Service.

Results:

When the class compatibility between income quintiles and subjective social classes was analyzed by age group, young people in the first, second, and third income quintiles considered themselves to be in the second subjective social class while and those in the fourth and fifth income quintiles considered themselves to be in the third subjective social class. Moreover, middle-aged and old people in the first, second, third, and fourth income quintile considered themselves to be in the second subjective social class while those in the fifth income quintile considered themselves to be in the third subjective social class.

Conclusion:

Social support, public health approaches, and medical treatment service models are needed to eliminate comparative deprivation among individuals.
Young male breast cancer, a small crowd, the survival, and prognosis?
Authors: Li Naikun , Wang Xiaohui , Zhang Hongju , Wang Haiyong
Published: October 2018

Women diagnosed with breast cancer at young age often have poorprognoses. Yet, few studies have focused on the prognoses of young men with breast cancer. We therefore used Surveillance, Epidemiology, and End Results (SEER) population-based data and identified 151 male patients with breast cancer aged <40 years between 1988 and 2012. Propensity score matching analysis was used to balance the clinical variables among different groups. Kaplan–Meier curves were applied to compare the survival differences. The subgroup variables on cancer-specific survival (CSS) and overall survival (OS) were analyzed by the Cox proportional hazard model. Results showed that male patients with breast cancer aged <40 had a significant OS benefit compared with those aged ≥40 years (P < .001). The significant difference of the CSS was not found (P > .05). Compared with the male patients with breast cancer aged ≥40, those aged <40 had significant OS benefit in most subgroups (P < .05). Compared with the female patients with breast cancer aged <40, the male patients with breast cancer aged <40 had worse OS and CSS benefit only in the subgroup with progesterone receptor and estrogen receptor positive (P < .05). In conclusion, we demonstrated that young male patients with breast cancer had better OS compared with elder male patients with breast cancer. However, the survival benefit was not found compared with young female patients with breast cancer.
Retrospective analysis of concurrent docetaxel and epirubicin neoadjuvant versus adjuvant chemotherapy
Authors: Yang Houpu , Zhou Lixin , Wang Shu , Cao Yingming , Tong Fuzhong , Liu Peng , Zhou Bo , Cheng Lin , Liu Miao , Liu Hongjun , Xie Fei , Guo Jiajia , Wang Siyuan , Peng Yuan
Published: October 2018

Different biological subtype breast cancers respond differently to neoadjuvant chemotherapy, but it is unknown whether neoadjuvant or adjuvant chemotherapy leads to different long-term survival in each specific subtype although equal outcomes have been reported in general population. This study sought to clarify whether the selection of either neoadjuvant or adjuvant chemotherapy was linked to a differential survival benefit based on breast cancer subtypes.

A prospectively maintained breast cancer database was queried from 2000 to 2008. All patients with a diagnosis of stage II and III breast cancer who received neoadjuvant or adjuvant chemotherapy were identified, only patients receiving docetaxel and epirubicin (TA) regimen were included. Patients were divided according to the administration of neoadjuvant or adjuvant chemotherapy. The biological subtypes were determined by immunohistochemical tests. The outcomes between neoadjuvant and adjuvant chemotherapy were compared in each different subtype. Kaplan–Meier curves were generated, and the Cox model was used to estimate the association between death risk and chemotherapy timing while adjusting for potentially confounding factors. P values < .05 were considered statistically significant.

Of the 406 patients included, 201 (49.5%) received neoadjuvant chemotherapy, and 205 (50.5%) received an adjuvant TA regimen. Patients with the HER2+ and TNBC subtypes showed significantly higher pCR rates than patients with luminal types (P < .05). In general population, the neoadjuvant and adjuvant chemotherapy groups showed little survival variance (HR=1.15, 95% confidence interval (CI) .69–1.91, P=.60). In luminal B-like patients, neoadjuvant chemotherapy led to worse overall survival (OS) than adjuvant therapy (HR=2.92, 95%CI 1.20 to 8.31, P 
= .02). In patients with the HER2+ subtype, neoadjuvant treatment corresponded to better OS (HR = .10, 95%CI .02–.58, P 
= .01). In contrast, patients with luminal A-like (HR = 1.14, 95%CI .53–2.43, P = .74) and TNBC disease (HR = 1.00, 95%CI .27–3.73, P = >.99) who underwent neoadjuvant chemotherapy showed equivalent OS when compared to patients undergoing adjuvant therapy.

Neoadjuvant versus adjuvant chemotherapy results in a disparate impact on overall survival among patients with variant subtype breast cancer. When neoadjuvant chemotherapy was given, luminal B-like patients showed worse outcome, while patients with HER2+ disease had better OS. Prospective studies are necessary to determine and optimize the timing of chemotherapy for breast cancers with different molecular backgrounds.
A novel fibrinogen variant in a Chinese pedigree with congenital dysfibrinogenemia caused by FGA P. Arg38Thr mutation
Authors: Cai Ruimin , Li Yi , Wang Wenyang , Gao Xue , Liu Meirong , Diao Youxiang , Tang Yi , Feng Qiang
Published: October 2018

Rationale:

Congenital dysfibrinogenemia (CD) is characterized by altered functional properties of the fibrinogen; people who suffer from CD often have a low activity of fibrinogen and the mutation in the genomic DNA.

Patient concerns:

A 6-year-old child was examined with a low activity of fibrinogen measured by Von Clauss method and PT-derived method which indicated a normal level of fibrinogen; this abnormality was also detected in her mother. The genomic DNA of all the family members was extracted, and all exons of 3 fibrinogen genes which encode fibrinogen alpha chain (FGA), fibrinogen beta chain (FGB), and fibrinogen gamma chain (FGG) were amplified by polymerase chain reaction (PCR), in addition, sanger sequencing, homologous sequence alignment and bioinformatics software were performed for the further analysis.

Diagnoses:

CD in this pedigree is associated with c.113G>C in the exon 2 of FGA which caused Arg38Thr mutation.

Outcomes:

The child and her mother showed a low plasma concentration of fibrinogen measured by Von Clauss method, whereas a normal result measured by PT-derived method; finally, c.113G>C in the exon 2 of FGA was detected in the pedigree which caused Arg38Thr mutation and it is the first report on a pedigree with CD caused by AαArg38Thr.

Lessons:

This case gives us the lesson that not all patients with CD showed typical symptoms and laboratory test results; the result of fibrinogen concentration and antigen which is tested by Von Clauss method and immunoturbidimetric assay is various according to the condition of each CD patient.
Pleural effusion resulting from bronchial tuberculosis
Authors: Liu Xuchun , Xu Litao , Jiang Guohua , Huang Shubin
Published: October 2018

Rationale:

The clinical manifestations in patients with bronchial tuberculosis (BTB) are nonspecific and may pose a great diagnostic challenge.

Patient concerns:

Here we describe the case of a 57-year-old man presented with right chest pain, chest tightness, and discomfort for 2 days.

Diagnosis:

Bronchoscopic biopsy was performed which revealed subepithelial and epithelioid cell granuloma of Langerhans cell structure. The definitive diagnosis was BTB with pleural effusion.

Interventions:

Treatment with a quadruple combinational antituberculous therapy was initiated.

Outcomes:

Two months later, the patient's chest distress and discomfort significantly decreased. Repeat chest radiograph revealed that the pleural fluid had been absorbed. The patient recovered after 15 months of antituberculosis treatment.

Lessons:

The patient exemplifies the difficulty of diagnosing BTB, particularly the low reliability of imaging modalities. The diagnosis of BTB currently relies on bronchoscopy as well as bacteriological or pathological evidence. This report will help to lower the incidences of misdiagnosis of this disease.
Analysis of the risk factor for the poor prognosis of localized neuroblastoma after the surgical
Authors: Zhou Kai , Li Xiao-lu , Pan Jian , Xu Jian-zhong , Wang Jian
Published: October 2018

Neuroblastoma is a unique malignancy in infants often presenting with either localized or metastatic disease. The study was carried out to explore the risk stratification of the poor prognosis for patients underwent surgical treatment.

60 patients diagnosed with neuroblastoma were primarily enrolled in the study from April 2008 to April 2016. All the patients underwent surgical treatment and received 5-year follow-up. Clinical variables, including age, International Neuroblastoma Staging System (INSS) stage, tumor size and site, histology, and MYCN status were retrospectively analyzed, and EFS was chosen as the endpoint.

The median age of patients was 8.2 months and average follow-up period was 40.2 ± 8.6 months. Among 60 patients, complete remission was achieved in 35 patients and partial remission in 14 subjects. Poor prognosis including patient death and tumor progression were overserved in 11 patients. Cox multifactor regression analysis revealed that age, histology and MYCN status had significant prognostic effect on event-free survival (EFS) rate for neuroblastoma patients underwent surgical treatment.

In our study, we identified a series of prognostic factors including age, histology, and MYCN status predicting the prognosis of neuroblastoma patients after surgical treatment.
Rationale and design of a randomized trial of early intensive blood pressure lowering on cerebral perfusion parameters in thrombolysed acute ischemic stroke patients
Authors: Sharma Vijay K. , Tan Benjamin Y.Q. , Sim M. Ying , Kulkarni Amit , Seow Philip A. , Hong Chiew S. , Du Zhengdao , Wong Lily Y.H. , Chen Jintao , Chee Elaine Y.H. , Ng Bridget S.M. , Low Yingliang , Ngiam Nicholas J.H. , Yeo Leonard L.L. , Teoh Hock L. , Paliwal Prakash R. , Rathakrishnan Rahul , Sinha Arvind K. , Chan Bernard P.L. , Butcher Kenneth , Anderson Craig S.
Published: October 2018

Background and Rationale:

Uncertainty persists over the optimal management of blood pressure (BP) in the early phase of acute ischemic stroke (AIS). This study aims to determine the safety and effects of intensive BP lowering on cerebral blood flow (CBF) and functional in AIS patients treated with intravenous thrombolysis.

Methods:

In a randomized controlled trial, 54 thrombolysed AIS patients with a systolic BP of 160 to 180 mm Hg will be randomized to early intensive BP lowering (systolic target range 140–160 mm Hg) or guideline-based BP management (systolic range 160–180 mm Hg) during first 72-hours using primarily intravenous labetalol. We hypothesize that early intensive BP lowering will not reduce CBF by 20% and/or increase the volume of hypoperfused tissue by >20% on computed tomographic perfusion. Clinical outcome will be assessed using a dichotomized modified Rankin scale (scores 0–1 as excellent outcome vs scores 2–6 as dead or dependent) at 90 days. Other outcome would be symptomatic intracerebral hemorrhage. The trial is registered at ClinicalTrials.gov, NCT03443596.

Conclusion:

This randomized study will provide important information about the physiological effects of BP reduction on cerebral perfusion after intravenous thrombolysis in AIS.
Progression of aggressive vertebral hemangiomas during pregnancy
Authors: Wang Ben , Jiang Liang , Wei Feng , Liu Xiao Guang , Liu Zhong Jun
Published: October 2018

Rationale:

Vertebral hemangiomas (VHs), one of the most common benign tumors of the spine, can be aggressive, which is a rare condition and causes neurological deficits. Pregnancy is related to the worsening of aggressive VHs. The diagnosis and treatment of aggressive VHs remain challenging, especially for pregnant cases.

Patient concerns:

We report 3 cases of aggressive VH in women who developed progressive neurological deficits during pregnancy among 95 patients treated for aggressive VH in our hospital in the past 15 years.

Diagnoses and Interventions:

All 3 patients experienced progressive deterioration of neurological function and pain at 13, 28, and 41 weeks’ gestation. On radiological examination, VHs were the suspected radiological diagnoses in 2 patients; 1 patient was preoperatively misdiagnosed with a spinal metastatic tumor. All 3 patients underwent decompression surgery with intraoperative vertebroplasty and/or postoperative radiotherapy. The pathological diagnosis after surgery was all hemangiomas.

Outcomes:

In all 3 patients, there were no tumor recurrences, and neurological functions remained normal at the last follow-up of 75, 38, and 15 months after the treatment, respectively.

Lessons:

Pregnancy might lead to the onset of aggressive VHs. The diagnosis and treatment of VHs during pregnancy remain controversial due to concern for both maternal and fetal safety. Timely surgery could preserve neurological function. Decompression surgery by laminectomy followed by adjuvant therapies require less skill and have a shorter surgery time, and can be considered more appropriate for aggressive VHs with pregnancy.
Regaining body weight after weight reduction further increases pulse wave velocity in obese men with metabolic syndrome
Authors: Liang Kae-Woei , Lee Wen-Jane , Lee I-Te , Lin Shih-Yi , Wang Jun-Sing , Lee Wen-Lieng , Sheu Wayne H-H
Published: October 2018

Subjects with metabolic syndrome (MetS) or obesity have worse arterial stiffness. However, there have been no studies addressing time-sequential changes in pulse wave velocity (PWV) after weight loss and then regaining weight in obese non-diabetic men with MetS.

We prospectively enrolled 40 obese, non-diabetic men with MetS undergoing a 3-month weight reduction program. Another 26 lean and healthy men were recruited for comparisons. Oral glucose tolerance test and brachial ankle (ba) PWV were assessed in study subjects. Eighteen obese non-diabetic MetS and 15 lean control subjects had follow-ups at the 60th month.

The body weight of obese MetS decreased from 94.8 ± 7.6 to 86.1 ± 9.0 (N = 18, P < .001) after a 3-month weight reduction program but regained gradually thereafter to 93.6 ± 11.6 kg at the 60th month (P < .001 versus 3rd month). baPWV decreased after weight loss slightly (P = .240) while weight regain significantly increased the baPWV (from 3rd month, 1358 ± 168 to 60th month 1539 ± 264 cm/sec, P < .001). Systolic and diastolic blood pressure increments correlated with the increment of baPWV after weight regain. At the 60th month, lean controls (N = 15) had increases in body weight while their baPWV increased non-significantly. The increments of baPWV after weight regain in obese MetS were significantly higher than the increment of baPWV in lean controls after weight gain.

In conclusion, regaining body weight after weight reduction worsened arterial stiffness with significant increase of baPWV in obese non-diabetic MetS.
Progression of Structural Brain Changes in Patients With Chronic Pancreatitis and Its Association to Chronic Pain
Authors: Muthulingam Janusiya , Olesen Søren Schou , Hansen Tine Maria , Seminowicz David A. , Burrowes Shana , Drewes Asbjørn Mohr , Frøkjær Jens Brøndum
Published: October 2018

Objectives

Temporal information about the structural brain changes in chronic pancreatitis (CP) and its relation to the clinical manifestations is lacking. This study investigated changes in morphological brain parameters over 7 years in painful CP patients, compared with controls.

Methods

In this 7-year longitudinal magnetic resonance imaging study, we included 23 CP patients and 14 controls. Gray matter volume (GMV) and cortical thickness were examined using voxel-based and surface-based morphometry. In addition, patients completed pain questionnaires and diary.

Results

At baseline, patients had reduced GMV and cortical thickness in widespread brain areas compared with controls. After 7 years of follow-up, the GMV loss was more pronounced in patients compared with controls, particularly in precentral gyrus and putamen. Moreover, an increase in pain scores was associated with a less reduction of thalamic GMV (P = 0.046), whereas an increase in brief pain inventory score was associated with more reduction in cortical thickness of precentral (P = 0.005) and superior temporal gyri (P = 0.019), indicating that brain morphological alterations are associated with the pain.

Conclusions

Chronic pancreatitis pain is associated with morphological brain changes over time in several areas, reflecting that brain plasticity may be a consequence of repeated long-term nociceptive signaling.
Turkish adaptation of Parkinson fatigue scale and investigating its psychometric properties
Authors: Çilga Göksel , Genç Arzu , Çolakoğlu Berril Dönmez , Kahraman Turhan
Published: October 2018

Parkinson’s disease (PD) is one of the most common chronic degenerative diseases of the nervous system. In PD, nonmotor symptoms are seen as frequently as motor symptoms. Fatigue can occur in all stages of PD and leads to significant disabilities. The aim of this study was to investigate the psychometric properties of the Turkish version of Parkinson fatigue scale (PFS). Ninety-six patients with idiopathic PD were included in this study with a cross-sectional and test–retest design. Structural validity, internal consistency and test–retest reliability of PFS were analyzed. For convergent validity, fatigue severity scale and modified fatigue impact scale were used. Internal consistency was determined by the Cronbach’s α coefficient. For test–retest reliability, PFS was repeated after a 7–14-day period. Significant strong correlations were found between the PFS and the fatigue severity scale (r
s=0.844) and the modified fatigue impact scale (r
s=0.764), which indicate a high convergent validity. The Cronbach’s α coefficient, which indicates the internal consistency of the scale, was calculated as 0.947. The test–retest reliability was found to be high (intraclass correlation coefficient=0.928). This study suggests that the Turkish version of PFS is valid and reliable. PFS is suitable for use by researchers and healthcare professionals to assess fatigue in Turkish-speaking patients with PD.
Reliability and validity of the shortened Singapore versions of the Chedoke Arm and Hand Activity Inventory
Authors: Choo Silvana X. , Bosch Jackie , Richardson Julie , Stratford Paul , Harris Jocelyn E.
Published: October 2018

Upper limb deficits are common sequelae after a stroke and negatively affect daily living and quality of life. The use of outcome measures to evaluate upper limb function is essential to assess sensorimotor recovery and to determine the effectiveness of rehabilitation. The aim of this study was to estimate the construct validity and inter-rater reliability of three shortened versions of the Singapore version of the Chedoke Arm and Hand Activity Inventory (CAHAI-SG) comprising seven, eight, and nine test items. The sample consisted of 55 inpatients with acute/subacute stroke to whom the CAHAI-SG, Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT) were administered. To estimate convergent and discriminative construct validity, Spearman’s rank correlation coefficient and 95% confidence intervals were computed for CAHAI-SG scores with FMA-UE and ARAT scores. Reliability was estimated using intraclass correlation coefficient (relative reliability) and the standard error of measurement (absolute reliability). Convergent validity with the FMA-UE was 0.79, 0.80, and 0.81 for seven-item, eight-item, and nine-item versions of the CAHAI-SG, respectively, and 0.81 with the ARAT for all shortened versions. Discriminative validity with the FMA-UE pain subscale was between 0.37 and 0.38. The absolute reliability was 3.09, 3.65, and 3.98, and relative reliability was 0.96, 0.95, and 0.96 for the seven-item, eight-item, and nine-item versions, respectively. All shortened versions of the CAHAI-SG demonstrated similar psychometric properties to the full (13 item) version, meaning clinicians may use these shorter versions that require less time to administer and score.
Tobacco Use, Tobacco Cessation, and Musculoskeletal Health
Authors: Smith Mary Atkinson , Jackson Andrea
Published: October 2018

It is widely known that the physiological impacts of nicotine from cigarette smoking are harmful to almost every organ of the body, cause various diseases, and negatively impact the overall health of individuals. When it comes to musculoskeletal health and the specialty of orthopaedics, cigarette smoking has a significant influence on negative outcomes. This article discusses the impact of cigarette smoking and nicotine on the musculoskeletal system and the role of the orthopaedic nurse in educating patients on the importance of smoking cessation to improve musculoskeletal health and meet quality measures that serve to improve patient outcomes and lower healthcare costs.
Causal Relationships Between Modifiable Risk Factors of Cognitive Impairment, Cognitive Function, Self-Management, and Quality of Life in Patients With Rheumatic Diseases
Authors: Park JiSuk , Oh HyunSoo , Park Won , Kwon SeongRyul , Ham OkKyung , Suh YeonOk , Jeong HyeSun , Seo WhaSook
Published: October 2018

BACKGROUND:

Rheumatic diseases are one of the most common types of chronic conditions that affect cognitive functions.

PURPOSE:

To develop and verify a hypothetical model of causal relationships between modifiable risk factors for cognitive impairment, cognitive function, self-management, and quality of life in patients with rheumatic diseases.

METHODS:

A hypothetical model was developed on the basis of empirical evidence. The fitness of the model was verified on 210 patients with rheumatic diseases.

RESULTS:

The prevalence of cognitive impairment was 49.0%. Smoking, underlying diseases, pain, and fatigue had a significant direct effect on cognitive impairment. Only cognitive impairment had a significant direct effect on self-management. Fatigue, anxiety, depression, and cognitive function had a significant direct effect on quality of life.

CONCLUSIONS:

The importance of proper management of symptoms and health habits should be emphasized to prevent and delay the progression of cognitive impairment and improve adherence to self-management regimens and quality of life.
Literature Review on Brachymetatarsia
Authors: Córdoba-Fernández Antonio , Vera-Gómez Maria Luisa
Published: October 2018

Brachymetatarsia is a malformation characterized by an abnormal reduction in the length of 1 or more metatarsal bones. It occurs because of early closure of the growth plate of the affected metatarsal. Generally, it is caused by a congenital disorder and it usually occurs bilaterally. With a greater prevalence in females, it most often affects the fourth metatarsal, followed by the first metatarsal. Surgical treatments proposed include using external mini-fixators or bone grafts in a single step to lengthen the metatarsal. In this review, 62 scientific articles about brachymetatarsia were analyzed with key demographic and epidemiological aspects of this pathology. The prevalence of bilateral brachymetatarsia was 47%, and the female to male ratio was 10.53:1. Both these findings appear to contradict the usual data reported for brachymetatarsia. A better understanding of this disorder will enable an appropriate therapeutic approach according to the psychological and social profile of affected individuals.
The Use of Electronic Cigarettes in Pregnancy: A Review of the Literature
Authors: Whittington Julie R. , Simmons Pamela M. , Phillips Amy M. , Gammill Sarah K. , Cen Ruiqi , Magann Everett F. , Cardenas Victor M.
Published: October 2018

Importance

Electronic cigarette (e-cigarette) use in pregnancy has been steadily increasing and has been hyped as being a safe alternative to cigarette smoking during pregnancy. This review discloses what is currently known about e-cigarette use in pregnancy and the effects of its use on pregnancy outcomes.

Objective

To determine what is currently known about the prevalence of e-cigarette use in pregnancy and the effects of e-cigarette use on pregnancy and perinatal/neonatal outcomes.

Evidence Acquisition

A PubMed, CINAHL, and EMBASE search was undertaken using the search terms “pregnancy” OR “pregnancy complications” OR “pregnancy outcome” OR “newborn” OR “neonate” OR “birth” AND “electronic cigarettes” OR “e-cigarettes” OR “ecigarettes” OR “vaping” OR “vape.” The search was limited to the English language and between 2007 and October 12, 2017.

Results

The search identified 91 articles, 40 of which are the basis for this review. The prevalence of e-cigarette use is 0.6% to 15%. The amount of nicotine consumed by e-cigarette users is comparable to that consumed by cigarette smokers. Most of the animal model studies suggest a potential danger to the developing fetus primarily because of the nicotine consumed and that consumption has multiple effects on the immune system, neural development, lung function, and cardiac function. There is a widespread flawed perception that e-cigarettes are safe to use during pregnancy.

Conclusions

The marketing of e-cigarette use as a safer alternative to cigarette smoking has led to an increasing use even in pregnancy. The nicotine consumed by e-cigarettes is similar to that consumed by cigarette smoking. Animal studies confirm the dangers of nicotine to the developing fetus. More research needs to be done specifically assessing e-cigarette use, pregnancy, and pregnancy outcomes.

Relevance

The amount of nicotine consumed in cigarette smoking is similar to the amount of nicotine consumed with e-cigarettes. The effects of nicotine exposure during fetal development are well known and include effects on multiple organ systems.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to determine the prevalence of e-cigarette use in pregnancy, analyze and compare the nicotine consumed with cigarette smoking versus the nicotine consumed with e-cigarette smoking, and evaluate the risk in animal studies of the consumption of nicotine on the developing fetus.