bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing Your Substance Use Disorder
Authors: Daley Dennis C. , Douaihy Antoine B.
Published: August 2019

This is a recovery workbook that provides clients with practical information and skills to help them understand and change their problems with alcohol, tobacco, or other drugs, such as marijuana, cocaine or methamphetamine, heroin or fentanyl, or nonprescribed addictive medications. The workbook is designed to be used in therapy or counseling and will help to focus on specific issues involved in stopping substance use and in changing behaviors that keep substance use problems active. The information presented is derived from research, clinical and recovery literature, and the authors’ many years of experience working with clients who have alcohol, tobacco, and other drug problems. It discusses the most effective and helpful recovery issues and change strategies from studies of cognitive-behavioral treatment, coping skills training, 12-step counseling, and relapse prevention. These treatment approaches focus on the importance of changing beliefs, thinking, relationships, and behaviors and learning skills to help clients stay sober and change their lives. The goals of this workbook are to help clients reach maximum treatment benefit by motivating them to develop and implement a personal change plan and to provide them with practical strategies and skills to cope with the most common problems and challenges encountered when substance use is stopped.
Horner’s Syndrome with Unilateral Brachial Plexus Blockade Mimicking Cerebrovascular Accident Following Lumbar Combined Spinal Epidural Analgesia for Labor
Authors: Bennett Richard J , Wooten Amy , Babbel Lee , Reel Bradley A
Published: August 2019

Horner’s Syndrome (HS) with brachial plexus involvement following lumbar epidural anesthesia may be a startling event for the patient and providers. We present a case of Horner’s Syndrome and complete brachial plexus blockade following epidural bolus of lidocaine for labor analgesia that was initially misdiagnosed as a cerebrovascular accident. Use of the catheter was discontinued and the episode resolved with expectant management. This complication is otherwise benign and resolves without sequelae.
Impact of various finishing and polishing techniques and composite materials on Candida albicans biofilm formation
Authors: Oktay Elif Aybala , Ersahan Seyda , Sabuncuoglu Fidan Alakus , Tort Huseyin , Karaoglanoglu Serpil
Published: August 2019

Candida albicans biofilms are commonly associated with severe oral infections. In dentistry, prosthetic and restorative materials are potential structures for the adhesion of C. albicans facilitating the formation of Candida biofilm and infection. Three composite resins (Charisma Classic, Sonic Fill, Estelite ∑ Quick) and two finishing-polishing systems (Biscover LV, Dental Finishing Disc) were evaluated for Candida biofilm formation. A Candida biofilm assay showed that both the resin and the finishing/polishing procedures affect Candida biofilm formation. Specifically, Candida biofilm formation was significantly lower in Sonic Fill resin than both Charisma Classic and Estelite ∑ Quick (P = .021). The type of finishing and polishing procedure also significantly affected the Candida biofilm formation to composite material (P < .001). Candida biofilm formation was more advanced after Biscover LV procedure than Dental Finishing Disc procedure.
Particle re-acceleration and Faraday-complex structures in the RXC J1314.4-2515 galaxy cluster
Authors: Stuardi C , Bonafede A , Wittor D , Vazza F , Botteon A , Locatelli N , Dallacasa D , Golovich N , Hoeft M , van Weeren R J , Brüggen M , de Gasperin F
Published: August 2019

Radio relics are sites of electron (re)acceleration in merging galaxy clusters but the mechanism of acceleration and the topology of the magnetic field in and near relics are yet to be understood. We are carrying out an observational campaign on double relic galaxy clusters starting with RXC J1314.4-2515. With Jansky Very Large Array multi-configuration observations in the frequency range 1-4 GHz, we perform both spectral and polarization analyses, using the Rotation Measure synthesis technique. We use archival XMM-Newton observations to constrain the properties of the shocked region. We discover a possible connection between the activity of a radio galaxy and the emission of the eastern radio relic. In the northern elongated arc of the western radio relic, we detect polarized emission with an average polarization fraction of 31 % at 3 GHz and we derive the Mach number of the underlying X-ray shock. Our observations reveal low levels of fractional polarization and Faraday-complex structures in the southern region of the relic, which point to the presence of thermal gas and filamentary magnetic field morphology inside the radio emitting volume. We measured largely different Rotation Measure dispersion from the two relics. Finally, we use cosmological magneto-hydrodynamical simulations to constrain the magnetic field, viewing angle, and to derive the acceleration efficiency of the shock. We find that the polarization properties of RXC J1314.4-2515 are consistent with a radio relic observed at 70○ with respect to the line of sight and that efficient re-acceleration of fossil electrons has taken place.
regBase: whole genome base-wise aggregation and functional prediction for human non-coding regulatory variants
Authors: Zhang Shijie , He Yukun , Liu Huanhuan , Zhai Haoyu , Huang Dandan , Yi Xianfu , Dong Xiaobao , Wang Zhao , Zhao Ke , Zhou Yao , Wang Jianhua , Yao Hongcheng , Xu Hang , Yang Zhenglu , Sham Pak Chung , Chen Kexin , Li Mulin Jun
Published: August 2019

Predicting the functional or pathogenic regulatory variants in the human non-coding genome facilitates the interpretation of disease causation. While numerous prediction methods are available, their performance is inconsistent or restricted to specific tasks, which raises the demand of developing comprehensive integration for those methods. Here, we compile whole genome base-wise aggregations, regBase, that incorporate largest prediction scores. Building on different assumptions of causality, we train three composite models to score functional, pathogenic and cancer driver non-coding regulatory variants respectively. We demonstrate the superior and stable performance of our models using independent benchmarks and show great success to fine-map causal regulatory variants on specific locus or at base-wise resolution. We believe that regBase database together with three composite models will be useful in different areas of human genetic studies, such as annotation-based casual variant fine-mapping, pathogenic variant discovery as well as cancer driver mutation identification. regBase is freely available at https://github.com/mulinlab/regBase.
VARIDT 1.0: variability of drug transporter database
Authors: Yin Jiayi , Sun Wen , Li Fengcheng , Hong Jiajun , Li Xiaoxu , Zhou Ying , Lu Yinjing , Liu Mengzhi , Zhang Xue , Chen Na , Jin Xiuping , Xue Jia , Zeng Su , Yu Lushan , Zhu Feng
Published: August 2019

The absorption, distribution and excretion of drugs are largely determined by their transporters (DTs), the variability of which has thus attracted considerable attention. There are three aspects of variability: epigenetic regulation and genetic polymorphism, species/tissue/disease-specific DT abundances, and exogenous factors modulating DT activity. The variability data of each aspect are essential for clinical study, and a collective consideration among multiple aspects becomes crucial in precision medicine. However, no database is constructed to provide the comprehensive data of all aspects of DT variability. Herein, the Variability of Drug Transporter Database (VARIDT) was introduced to provide such data. First, 177 and 146 DTs were confirmed, for the first time, by the transporting drugs approved and in clinical/preclinical, respectively. Second, for the confirmed DTs, VARIDT comprehensively collected all aspects of their variability (23 947 DNA methylations, 7317 noncoding RNA/histone regulations, 1278 genetic polymorphisms, differential abundance profiles of 257 DTs in 21 781 patients/healthy individuals, expression of 245 DTs in 67 tissues of human/model organism, 1225 exogenous factors altering the activity of 148 DTs), which allowed mutual connection between any aspects. Due to huge amount of accumulated data, VARIDT made it possible to generalize characteristics to reveal disease etiology and optimize clinical treatment, and is freely accessible at: https://db.idrblab.org/varidt/ and http://varidt.idrblab.net/.
Toxicities associated with checkpoint inhibitors—an overview
Authors: Spiers Laura , Coupe Nicholas , Payne Miranda
Published: August 2019

Immunotherapy has an increasing role in the management of cancer, both in metastatic disease and as an adjuvant therapy. However, sensitization of the immune system with checkpoint inhibitors comes with a unique side effect profile. Full appreciation of this can take some time to emerge as some adverse events are rare, or can be subtle and potentially overlooked. Clinician awareness of these side effects can be particularly important in patients with pre-existing autoimmune conditions. Here we describe common symptoms and diagnostic strategies for organ-specific side effects of anti-CTLA-4 and anti-PD-1/PD-L1 immunotherapy agents.
Conceptualizations of Domestic Violence–Related Needs among Women Who Resettled to the United States as Refugees
Authors: Wachter Karin , Dalpe Jessica , Heffron Laurie Cook
Published: August 2019

Despite robust evidence of the myriad consequences associated with intimate partner violence (IPV), social services in the United States may not adequately account for and respond to variations in how women resettling as refugees conceptualize service and support needs. With this study, the authors sought to develop a more nuanced understanding of needs as expressed by women resettling to the United States as refugees. Researchers conducted in-depth interviews and focus groups with refugee women who resettled to the United States (n = 35) and social services providers (n = 53), including those working in refugee resettlement or domestic violence agencies or community-based organizations. The research team used structural coding and thematic analysis to examine the data, through which they identified four themes: (1) living with enduring consequences of IPV, (2) “I just want them to help me,” (3) “I need you to talk to my husband,” and (4) “How will I pay the rent?” The study findings point to broader structural concerns shaping women’s resettlement experiences, as well as areas of incongruence between women’s conceptualizations of needs and established practice approaches. Implications for culturally competent and survivor-centered practice are discussed.
#Shemergency: Use of a Professional Development Group to Promote Female Resident Recruitment and Retention
Authors: Khatri Utsha G. , Love Jennifer , Zeidan Amy , Hsu Cindy H. , Mills Angela M.
Published: August 2019

Problem

Gender inequity in academic medicine is a pervasive challenge. Recommendations have been implemented to reduce inequities for female faculty. However, there are no well-established guidelines for the recruitment and retention of female residents.

Approach

To address challenges faced by female physicians and support the recruitment and retention of female residents, female emergency medicine residents and attending physicians at the Hospital of the University of Pennsylvania formed a professional development group (PDG), #Shemergency, in July 2017. From July 2017 to July 2018, this PDG developed events and initiatives for female residents that addressed methods to improve awareness of and develop skills relevant to well-described gender disparities in mentorship, speakership and conference representation, compensation, evaluations, wellness and service, and award recognition.

Outcomes

Over its first year (July 2017–July 2018), the PDG created a professional community and enhanced mentorship through a number of events and initiatives. The PDG secured funding for 5 residents to attend a national conference and nominated 5 residents and 2 attending physicians for professional organization awards (4 nominees won).

Next Steps

After the first year, the PDG expanded the number of joint activities with both male and female colleagues and organized a citywide event for female residents and faculty representing 5 different residency programs. Future work will focus on sustainability (e.g., holding fundraising events), generalizability (e.g., expanding the gender-disparity areas addressed as well as spreading the model to other programs), developing additional events and initiatives (e.g., expanding the number of joint activities with male colleagues), and outcome assessments (e.g., distributing pre- and postevent surveys).
Effect of Nail Size, Insertion, and Δ Canal-Nail on the Development of a Nonunion After Intramedullary Nailing of Femoral Shaft Fractures
Authors: Serrano Rafael , Mir Hassan R. , Gorman R. Allen , Karsch Jordan , Kim Ryan , Shah Anjan , Maxson Benjamin , Infante Anthony , Watson David , Downes Katheryne , Sanders Roy W.
Published: August 2019

Objective:

To determine whether intramedullary nail (IMN) diameter, antegrade versus retrograde insertion, or the difference between the canal and IMN diameter affect femoral shaft fracture healing.

Design:

Retrospective analysis of a prospective database.

Setting:

Level One Regional Trauma Center.

Patients/Participants:

Seven hundred thirty-three femoral shaft fractures (OTA/AO 32) treated with an IMN between 1999 and 2017. After exclusion criteria, 484 fractures remained in the final analysis.

Intervention:

Closed section, cannulated, interlocked, titanium alloy IMN using a reamed insertion technique.

Main Outcome Measurements:

Nonunion, IMN size (10, 11.5, and 13 mm), antegrade versus retrograde insertion, Δ canal-nail diameter (ΔD) after reaming (<1, 1–2, or >2 mm).

Results:

IMN diameters used were as follows: 314/10 mm (64%), 137/11.5 mm (28%), and 33/13 mm (8%). Forty-five percent were placed in antegrade versus 55% retrograde. Four hundred fifty-six fractures (94.2%) healed uneventfully. There were no IMN failures. 10/484 IMNs (2%) had broken interlocking screws; only 4 were associated with a NU. Average time to union was 23 weeks (12–119). Twenty-eight (5.8%) developed NU. There was no statistical correlation between (1) the NU rate and IMN diameter: 10 mm, 6.3%; 11.5 mm, 5.1%; 13 mm, 3% (P = 0.8, power = 0.85), (2) the NU rate and ΔD: 7.1% <1 mm, 5.6% 1–2 mm, 20% >2 mm (P = 0.36), (3) the NU rate and fracture location: Prox = 11%, Mid = 5%, Dist = 3% (P = 0.13), or (4) the NU rate and antegrade (7.2%) versus retrograde (4.2%) insertion (P = 0.24).

Conclusion:

Similar healing rates occurred regardless of IMN diameter, Δ canal-nail diameter after reaming, or insertion site. This indicates that a closed section, cannulated, interlocked, titanium alloy IMN with a diameter of 10 mm can be considered the standard diameter for the treatment of acute femoral shaft fractures, regardless of entry point. This should be associated with less reaming and therefore shorter operative times, and possibly less hospital implant inventories as well. Larger diameter IMN should be reserved for revision surgery.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Rib Regeneration Morphology After Thoracoplasty in Adolescent Idiopathic Scoliosis
Authors: Yang Jae Hyuk , Suh Seung-Woo , Chang Dong-Gune
Published: August 2019

Study Design.

A retrospective study.

Objective.

The purpose of this study was to evaluate the morphology of rib regeneration and to analyze the influence of demographics and curve characteristics on regeneration potential after thoracoplasty in the treatment of adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

Studies on the physiological effects after thoracoplasty have been performed for several decades. However, rib cage anatomical regeneration patterns and reformation have been rarely studied.

Methods.

A total of 120 AIS patients who underwent thoracoplasty with deformity correction were included. Patients were followed for >12 months and radiographic assessment was done at 3, 6, and 12 months. Conventional or short apical rib resection thoracoplasty was performed and 543 ribs were resected. Demographic and curve parameters were recorded and a rib regeneration classification was used to analyze regeneration. Computed tomography (CT) scan was performed only in selected patients (n = 74).

Results.

At end of 3, 6, and 12 months, 23%, 45%, and 60% of the ribs had fused respectively. On multiple logistic regression analysis, age <10 years (odds ratio [OR]: 3.5, 95% confidence interval [CI]: 0.754–16.982), age 11 to 12 years (OR: 2.7, 95% CI: 2.709–31.595), age 13 to 14 years (OR: 6.2, 95% CI: 2.504–15.391), age 15 to 16 years (OR: 4.8, 95% CI: 2.064–11.571), five or more ribs excision (OR: 2.0, 95% CI: 1.294–3.108) enhance regeneration. Lenke type 2 (OR: 0.5, 95% CI: 0.305–0.898) Lenke type 4 (OR: 2.3, 95% CI: 1.033–5.144), and Risser grade (OR: 0.8, 95% CI: 0.694–0.967) had a negative influence on regeneration.

Conclusion.

The regeneration potential of the resected ribs after thoracoplasty in AIS patients depends on age, Risser grade, Lenke classification, and number of ribs resected. Age was the single most important factor affecting regeneration.

Level of Evidence: 4
Palliative care in glioma management
Authors: Oberndorfer Stefan , Hutterer Markus
Published: August 2019

Purpose of review

The concept of palliative care is becoming increasingly important in the management of glioma patients. However, the right time for implementation, as well as the individual degree of integration of palliative care aspects, are still a matter of debate. This review updates recent evidence of palliative care in glioma and raises questions for future developments.

Recent findings

According to the disease-specific aspects of palliative care in glioma management, there is an increasing need for a specialized ‘neurooncological’ palliative care approach.

The implementation of palliative care for glioma patients and caregivers avoids unnecessary hospitalization and reduces health-related costs. Moreover, palliative care may be offered in different settings (inpatient/outpatient) according to local health structures, but definitely improves the QOL of glioma patients and their caregivers.

There are considerable differences between countries with respect to palliative care in glioma. Major aspects of good-quality care throughout the countries are optimized symptom control, support for patients and proxies by an interdisciplinary team and to provide realistic information to patients and caregivers. The availability of neurooncological palliative teams and multidisciplinary support programs increases well being of glioma patients and caregivers as well as releases pressure on healthcare systems.
Role of YAP/TAZ in Energy Metabolism in the Heart
Authors: Kashihara Toshihide , Sadoshima Junichi
Published: August 2019

The heart requires a high amount of energy, in the form of adenosine triphosphate, to maintain its viability and pump function. Anaerobic glycolysis and mitochondrial oxidative phosphorylation are the two main metabolic pathways by which adenosine triphosphate is generated, using fatty acids, glucose, lactate, and ketone bodies as primary substrates. Previous studies have demonstrated that, in response to stress, the heart undergoes alterations in metabolism, ranging from changes in substrate utilization to mitochondrial function, collectively called metabolic remodeling. However, the molecular mechanism mediating metabolic remodeling in the heart remains unclear. Yes-associated protein 1 (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ), which are major downstream effectors of the Hippo signaling pathway, play an important role in the regulation of heart size and cellular homeostasis of cardiomyocytes through the regulation of various transcriptional factors under both physiological and pathophysiological conditions. Recent findings in various organs and cell types have revealed that YAP and TAZ play an important role in energy metabolism. Here, we summarize what is currently known about YAP/TAZ in the regulation of metabolism of various substrates and mitochondrial function in various organs and cell types and discuss the potential role of YAP/TAZ in mediating metabolic remodeling of the heart during stress and heart failure.
Translation and Psychometric Evaluation of the Chinese Version of the Information Needs in Cardiac Rehabilitation Tool
Authors: Ma Chunhua , Yang Qinqin , Huang Shuling
Published: August 2019

Purpose:

To translate the Information Needs in Cardiac Rehabilitation (INCR) tool into Chinese and evaluate its cultural adaptation and psychometric properties of this Chinese version. The INCR uses a Likert-type scale that aims to assess information needs in cardiac rehabilitation (CR) patients.

Methods:

The initial Chinese INCR tool was generated by forward/backward translation and evaluation of face and content validity. The internal consistency was assessed by Cronbach α, item-to-total correlations, interitem correlations, and test-retest reliability using intraclass correlation coefficient. The construct validity was tested by principal component analysis and known-group validity by t test. A total of 296 CR patients were recruited from 2 university-affiliated hospitals in Guangzhou, China, using a convenience sample.

Results:

The Chinese INCR tool included 10 subscales with 55 items. Cronbach α of 10 subscales ranged from 0.68 to 0.90. Intraclass correlation coefficients of 55 items were between 0.62 and 0.89. The item-to-total correlations for all items were between 0.23 and 0.73 and interitem correlations of 80% items ranged from 0.30 to 0.70. The content validity index was 0.91. Ten factors were extracted by principal component analysis, which together accounted for 66.74% of total variance. The mean total scores of Chinese INCR tool in CR patients with less than high school education were higher than scores in those with high school education and above, and there was a statistically significant difference (t = 2.95, P = .021).

Conclusions:

The Chinese version of INCR tool has strong psychometric properties, providing preliminary evidence of the reliability and validity of INCR tool to assess information needs in Chinese CR patients.
CLOSURE OF SMALL MACULAR HOLES USING VITRECTOMY SURGERY WITH INTERNAL LIMITING MEMBRANE PEELING WITHOUT THE USE OF INTRAOCULAR GAS TAMPONADE: BROADENING THE UNDERSTANDING OF THE MACULAR HOLE PATHOPHYSIOLOGY
Authors: Lally David R. , Kasetty Megan A.
Published: August 2019

Purpose:

To determine whether small macular hole closure can be achieved with 25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or facedown positioning.

Methods:

25-G vitrectomy surgery with internal limiting membrane peeling without the use of intraocular gas tamponade or positioning was performed on 20 eyes with a small (<400-µm diameter), full-thickness macular hole.

Results:

In 17 of 20 eyes (85%), the hole had closed. Three holes had closed by Postoperative Day 1, 13 holes by Postoperative Week 1, 16 holes by Postoperative Week 2, and 17 holes by Postoperative Week 6. At Postoperative Month 1, vision improved in 16 of 17 eyes in which the macular hole had closed. One hole that had not closed at the first postoperative week and two holes that had not closed at the third postoperative week required follow-up surgery with intraocular gas tamponade and facedown positioning, after which the hole closed. The mean preoperative visual acuity was 0.626 logMAR (20/85), and the mean postoperative visual acuity after 1 month was 0.392 logMAR (20/50) (P < 0.001).

Conclusion:

Vitrectomy surgery with internal limiting membrane peeling without the use of gas tamponade or positioning can achieve closure of small macular holes.
Facial nerve schwannoma mimicking chronic suppurative otitis media
Authors: Gao Yueqiu , Shi Ziguang , Wang Chengkai , Yu Zhengzheng
Published: August 2019

Rationale:

Facial nerve schwannoma (FNS) is a rare slow-growing nerve sheath tumor derived from Schwann cells. FNS with normal facial nerve function may sometimes be misdiagnosed as otitis media because of similar ontological symptoms such as purulence, tympanic membrane damage, and hearing loss.

Patient concerns:

A 68-year-old woman was referred to our department because of otorrhea and hearing loss in the right ear for 20 years. Otoscopy revealed abundant purulent secretions deep in the right external auditory canal, and granulation proliferation in the posterior part of membranae tensa. Audiogram showed a right mixed hearing loss with an 85-dB pure-tone average and 35-dB air-bone gap.

Diagnosis:

This patient was misdiagnosed as chronic suppurative otitis media before surgery. During surgery, a mass was found, and intraoperative frozen section histopathology confirmed an FNS.

Interventions:

This patient was subjected to mastoidectomy for curing chronic suppurative otitis media initially. During surgery, a mass was found attached and widely extended into the tympanic and mastoid segments. We removed most part of the mass, however found the mass deriving from the vertical part of the facial nerve. Intraoperative frozen section histopathology confirmed an FNS. So we removed the incurs and malleus, and searched for the edge of the mass. The mass involved multisegments of facial nerve including the tympanic, vertical and pyramidal segments. The tumor was removed completely, and nerves were repaired using greater auricular nerves.

Outcomes:

After surgery, the patient had facial nerve paralysis of House-Brackmann (HB) Grade VI. Facial function recovered to HB Grade III at 30 months after surgery. The patient was followed up for 5 years. She had a facial function of HB grade III at the most recent follow-up.

Lessons:

FNS is rare and tend to be misdiagnosed. It is important to combine the imaging modalities of computed tomography and magnetic resonance imaging to evaluate FNS before surgery. The primary goal of managing FNS is to maintain normal facial function as long as possible; therefore, tailored strategy should be taken for managing FNS.
Efficacy and safety of oral SOCG in treatment of major depressive disorder
Authors: Kim Ju Yeon , Seo Young Kyung , Lee Ji-Yoon , Kang Weechang , Chee Ik-Seung , Choi Kwang-Yeon , Jung In Chul
Published: August 2019

Introduction:

Major depressive disorder (MDD) is a common condition worldwide, and leads to degradation in quality of life and large socioeconomic costs. There has been increasing demand for new therapies with fewer side effects. SOCG (SOCG tablet) is a modified prescription of So-ochim-tang, which is widely used in Traditional Korean Medicine to treat MDD. We aim to evaluate the efficacy of SOCG in treating MDD, and identify the optimum dose.

Design:

The protocol we are following is that of a Phase II clinical trial with a randomized, double blinded, placebo controlled, and parallel design. One hundred forty-eight participants will be randomly divided into 4 groups and treated for 8 weeks.

Outcome measures:

The primary outcome will be the score in the Korean Version of the Hamilton Depression Rating Scale. Scores in the Korean version of the Beck Depression Inventory-II Korean Symptom Check List-95 (KSCL-95), State Trait Anxiety Inventory-Korean version, State- Trait Anger Expression Inventory- Korean version (STAXI-K), Insomnia Severity Index (ISI), and the EuroQol-5 Dimension (EQ-5D) will be considered as secondary outcomes.

Discussion and Conclusions:

Demonstration of human safety and efficacy of SOCG in the present trial and identification of the appropriate dose will justify a New Drug Application and a phase III clinical trial. Further, we expect that this new antidepressant will be able to increase cure rates, and alleviate the burden of medical expenses.

Trial registration number:

Clinical Research Information Service, Republic of Korea (KCT0002763).
Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease
Authors: Winder Ophir , Fliss-Isakov Naomi , Winder Gilad , Scapa Erez , Yanai Henit , Barnes Sophie , Dekel Roy , Dotan Iris , Maharshak Nitsan
Published: August 2019

Intestinal strictures are common complications of Crohn's disease (CD). Endoscopic balloon dilatation (EBD) constitutes an alternative therapy to surgery, but associated factors of procedure success are inconclusive. Therefore, we aimed to evaluate the EBD success rate and its associated factors in CD patients.

This is a retrospective cohort study of consecutive EBDs that were conducted between 2006 and 2014 among patients with CD with lower gastrointestinal tract strictures. Patients’ and stricture characteristics, short term procedure success and related complications at 1 week follow-up, and long-term clinical endpoints were documented.

A total of 138 dilatations were performed on 64 CD patients. The overall dilatation success rate was 84.8%, with no difference between primary or anastomotic strictures, or between first or recurrent dilatation procedures. Long strictures (≥4 cm) were negatively associated with successful EBDs, but not with perforations. A multivariate analysis adjusting for age, sex, smoking, and disease duration revealed that a maximal dilatation diameter of ≥15 mm was positively associated with a successful EBD, while an inflamed stricture was negatively associated with procedure success. Strictures which were both long and inflamed were associated with the lowest EBD success rates compared with other strictures. Only 32.8% of patients required surgery during the follow-up period. Long-term prevention of surgery was negatively associated with stricture length and with a successful EBD.

EBD is highly successful in treating intestinal strictures and in prevention of surgery in CD patients. Although EBD of long strictures is safe, it will not prevent surgery in the majority of cases.
An unusual case of Behcet disease with posterior scleritis
Authors: Yanagida Chihiro , Usui Yoshihiko , Sakai Jun-Ichi , Goto Hiroshi
Published: August 2019

Rationale:

Posterior scleritis is an ocular inflammatory disorder that can be associated with both infectious and non-infectious immune reactions. Behcet disease is a chronic, relapsing, multisystemic inflammatory disorder with uveitis. There are no reported cases of posterior scleritis with Bechet disease.

Patient concerns:

A 50-year-old man previously diagnosed with systemic Behcet disease presented with ocular pain and decreased vision in the left eye.

Diagnosis:

Posterior scleritis associated with Behcet disease was diagnosed based on optical coherence tomography showing choroidal folds, as well as contrast computed tomography and ultrasound sonography demonstrating thickening of the posterior sclera.

Interventions:

Treatment with systemic corticosteroids was initiated. Since inflammation relapsed during steroid tapering, anti-tumor necrosis factor-alpha (TNF-α) therapy was used in combination, and tapering of steroids was possible without recurrence of inflammation for 12 months.

Outcomes:

Posterior scleritis was resolved and visual acuity improved. With the continuation of TNF-α therapy, oral prednisolone was successfully tapered and discontinued. No relapse of inflammation was observed at follow-up 1 year after discontinuation of prednisolone.

Lessons:

Ophthalmologists should be aware of the possibility of rare manifestation of posterior scleritis in patients with Behcet disease, and that combined use of systemic steroids and anti-TNF-α therapy may resolve the scleritis without recurrence of inflammation.
Effects of inferior alveolar nerve rupture on bone remodeling of the mandible
Authors: Shen Hongzhou , Wang Shuze , Zhi Yin , Si Jiawen , Shi Jun
Published: August 2019

Although various animal studies have indicated that sensory nerves played an important role in bone metabolism and nerve injury could impair the process of bone remodeling, the actual effect of sensory nerve rupture on human bones remains unclear. The aim of this preliminary study was to investigate the effect of inferior alveolar nerve (IAN) rupture on mandibular bone remodeling of patients underwent bilateral sagittal split ramus osteotomy (BSSRO).

Ten patients with unilateral IAN rupture during BSSRO were involved in this study. Neurosensory examinations were employed to assess the sensory function of bilateral IAN. The remodeling process of the post-operational mandible was evaluated by panoramic radiographs and computed tomography (CT) scans.

Neurosensory examinations indicated that nerve rupture resulted in significant hypoesthesia at the IAN-rupture side. Assessment of panoramic radiographs showed no evident alterations of bone structure at the IAN-rupture side of mandible. Evaluation of CT images also indicated no statistical difference in bone density and thickness between IAN-rupture side and contralateral side.

Accordingly, our study indicated that IAN rupture may not significantly impair the short-term bone remodeling process of human mandible.
Lung abscess by Actinomyces odontolyticus and Parvimonas micra co-infection presenting as acute respiratory failure
Authors: Yun Sang Suk , Cho Hyun Seop , Heo Manbong , Jeong Jong Hwan , Lee Hyang Rae , Ju Sunmi , Kim Ju-Young , You Jung Wan , Cho Yu Ji , Jeong Yi Yeong , Kim Ho Cheol , Lee Jong Deog , Lee Seung Jun
Published: August 2019

Rationale:

Actinomyces odontolyticus and Parvimonas micra are very rare causative organisms of lung abscess and acute respiratory failure.

Patient concerns:

A 49-year-old male patient visited the emergency room with a complaint of sudden onset of shortness of breath, and he developed acute respiratory failure rapidly.

Diagnosis:

An abscess in the left lower lung field was diagnosed on the computed tomography scan of chest.

Interventions:

Immediate treatment with intravenous antibiotics was initiated along with a pigtail catheter insertion for pus drainage.

Outcomes:

A odontolyticus was cultured on the drained pus and P micra was identified by a blood culture. The patient was successfully weaned from the mechanical ventilator and the lung abscess was completely resolved.

Lessons:

To the best of our knowledge, this is the first case report of mixed infection with A odontolyticus and P micra, which caused acute respiratory failure in an immune-competent patient. Therefore, physicians should consider the possibility of these organisms as causative pathogens of a fulminant pulmonary infection even in an immune-competent patient.
Galectin-9 in autoimmune hepatitis
Authors: Matsuoka Naoki , Kozuru Hideko , Koga Tomohiro , Abiru Seigo , Yamasaki Kazumi , Komori Atsumasa , Fujita Yuya , Tenmoku Junpei , Asano Tomoyuki , Sato Shuzo , Suzuki Eiji , Furuya Makiko , Kobayashi Hiroko , Watanabe Hiroshi , Naganuma Atsushi , Yoshizawa Kaname , Shimada Masaaki , Ario Keisuke , Yamashita Haruhiro , Kohno Hiroshi , Kaneyoshi Toshihiko , Nakamura Minoru , Furukawa Hiroshi , Takahashi Atsushi , Kawakami Atsushi , Ohira Hiromasa , Yatsuhashi Hiroshi , Migita Kiyoshi
Published: August 2019

Autoimmune hepatitis (AIH) is a disorder of unknown etiology in which immune-mediated liver damage progresses to cirrhosis or hepatocellular carcinoma (HCC). The mainstay therapy for AIH is steroids and other immunosuppressive treatments. Currently, there are no validated markers for monitoring immune-mediated hepatic inflammation. Galectin-9 has recently been identified as a potential biomarker in patients with chronic liver disease. The objective of this study was to determine whether Galectin-9 and other serum proteins are associated with active disease in AIH patients.

We enrolled 77 Japanese patients with well-documented AIH who were identified from the National Hospital Organization-AIH-liver-network database, as well as 32 patients with chronic hepatitis C (CHC), 27 patients with SLE, and 17 healthy control subjects. Serum levels of galectin-9, and markers of liver injury were measured and compared between groups.

Serum levels of galectin-9 were significantly higher in AIH patients than in CHC patients (13.8 ± 4.9 ng/mL vs 8.9 ± 3.0 ng/mL, P < .001) or healthy controls (13.8 ± 4.9 ng/mL vs 5.0 ± 1.3 ng/mL, P < .001). In AIH group, serum galectin-9 levels weakly correlated with alanine aminotransferase levels or total bilirubin (TB) and strongly correlated with C–X–C motif chemokine 10 (CXCL10) and Mac-2 binding protein glycosylation isomer (M2BPGi) levels, but did not correlate with the histological grade of liver fibrosis. Steroid treatment of AIH patients significantly reduced serum galectin-9 levels (14.1 ± 4.9 ng/mL vs 8.3 ± 3.8 ng/mL, P < .001). SLE patients exhibited higher galectin-9 levels, whereas the galectin-9 levels did not correlate with liver function tests such as alanine aminotransferase levels.

Serum galectin-9 correlated with disease status in AIH patients and could thus be useful biomarkers to detect hepatic autoimmunity. Because circulating galectin-9 reflects autoimmune-mediated inflammation, it may have additional utility as a biomarker for other autoimmune disorders.
The effect of tracheostomy delay time on outcome of patients with prolonged mechanical ventilation
Authors: Tai Hsueh-Ping , Lee David Lin , Chen Chiu-Fan , Huang Yuh-Chin Tony
Published: August 2019

The tracheostomy timing for patients with prolonged mechanical ventilation (PMV) was usually delayed in our country. Both physician decision time and tracheostomy delay time (time from physician's suggestion of tracheostomy to procedure day) affect tracheostomy timing. The effect of tracheostomy delay time on outcome has not yet been evaluated before.

Patients older than 18 years who underwent tracheostomy for PMV were retrospectively collected. The outcomes between different timing of tracheostomy (early: ≤14 days; late: >14 days of intubation) were compared. We also analyzed the effect of physician decision time, tracheostomy delay time, and procedure type on clinical outcomes.

A total of 134 patients were included. There were 57 subjects in the early tracheostomy group and 77 in the late group. The early group had significantly shorter mechanical ventilation duration, shorter intensive care unit stays, and shorter hospital stays than late group. There was no difference in weaning rate, ventilator-associated pneumonia, and in-hospital mortality. The physician decision time (8.1 ± 3.4 vs 18.2 ± 8.1 days, P < .001) and tracheostomy delay time (2.1 ± 1.9 vs 6.1 ± 6.8 days, P < .001) were shorter in the early group than in the late group. The tracheostomy delay time [odds ratio (OR) = 0.908, 95% confidence interval (CI) = 0.832–0.991, P = .031) and procedure type (percutaneous dilatation, OR = 2.489, 95% CI = 1.057–5.864, P = .037) affected successful weaning. Platelet count of >150 × 103/μL (OR = 0.217, 95% CI = 0.051–0.933, P = .043) and procedure type (percutaneous dilatation, OR = 0.252, 95% CI = 0.069–0.912, P = .036) were associated with in-hospital mortality.

Shorter tracheostomy delay time is associated with higher weaning success. Percutaneous dilatation tracheostomy is associated with both higher weaning success and lower in-hospital mortality.
Cinobufotalin injection combined with chemotherapy for the treatment of advanced NSCLC in China
Authors: Zhang Fan , Yin Yantong , Xu Tiantian
Published: August 2019

Background and objective:

Cinobufotalin injection (CFI), a kind of Chinese medicine, has been considered as a promising complementary therapy option for advanced non-small cell lung cancer (NSCLC), but their efficacy and safety remain controversial. This study aimed to systematically evaluate the efficacy and safety of CFI and chemotherapy-combined therapy for advanced NSCLC.

Methods:

Clinical trials were searched from Web of Science, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biological Medicine Database (CBM), Chinese Medical Citation Index (CMCI), Wanfang database and Chinese Scientific Journal Database (VIP). Main measurements, including therapeutic efficacy, quality of life (QoL) and adverse events, were extracted from the retrieved publications and were systematically evaluated.

Results:

The 29 trials including 2300 advanced NSCLC patients were involved in this study. Compared with chemotherapy alone, its combination with CFI significantly prolonged the patients’ 1-, 2- and 3-year overall survival rate (OS) (1-year OS, OR = 1.94, 95% CI = 1.42–2.65, P < .0001; 2-year OS, OR = 2.31, 95% CI = 1.55–3.45, P < .0001; 3-year OS, OR = 4.69, 95% CI = 1.78–12.39, P = .002) and improved patients’ overall response (ORR, OR = 1.84, CI = 1.54–2.18, P < .00001), disease control rate (DCR, OR = 2.09, 95% CI = 1.68–2.60, P < .00001) and QoL (quality of life improved rate, QIR, OR = 2.64, 95% CI = 1.98–3.52, P < .00001; karnofsky performance score, KPS, OR = 10.97, 95% CI = 5.48–16.47, P < .0001). Most adverse events caused by chemotherapy were obviously alleviated (P < .05) when CFI was also applied to patients.

Conclusion:

The combination of CFI and chemotherapy is safe, and is more effective in treating NSCLC than chemotherapy alone. Therefore, CFI mediated therapy could be recommended as an adjuvant treatment method for NSCLC.
HPV testing on vaginal/cervical nurse-assisted self-samples versus clinician-taken specimens and the HPV prevalence, in Adama Town, Ethiopia
Authors: Haile Eshetu Lemma , Cindy Simoens , Ina Benoy , Belay Gurja , Jean-Pierre Van geertruyden , Sharon Ransom , Lisbeth Lebelo Ramokone , Paul Bogers Johannes
Published: August 2019

This study aimed to determine the feasibility of vaginal/cervical nurse-assisted self-sampling (NASS) and the agreement between human papilloma virus (HPV) tests on self-samples versus clinician-taken (CT) specimens.

Women participated voluntarily for cervical cancer screening at St. Aklesia Memorial Hospital. Eighty-three women provided a total of 166 coupled self-taken and CT specimens collected. Specimens were stored at room temperature for a maximum of 10 months and analyzed using validated the RIATOL qPCR HPV genotyping test, a quantitative polymerase chain reaction (qPCR) high-throughput HPV E6, E7 assay. The average age of the participating women was 32 years. Seventy-three women (87.9%) felt that NASS was easy to use. An overall HPV, high-risk (HR) HPV, and low-risk HPV prevalence was 22.7% (15/66), 18.2% (12/66), and 6.1% (4/66), respectively. The overall HR HPV prevalence was 17.2% (NASS) and 15.5% (CT). The most prevalent HPV type was HPV51; HPV 16 was only detected in 1 woman (CT+NASS) and HPV18 only in 1 woman (CT). The overall measurement agreement between self-taken and CT samples was moderate with a kappa value of 0.576 (P < .001). Lifetime partnered with >2 men were associated with HR HPV positivity (P < .001). There was a strong statistical association between HR HPV positivity and visual inspection with acetic acid- positive (P < .001). The NASS for HPV testing could be seen as an alternative option and might be acceptable to Ethiopian women. The overall HR HPV prevalence was comparable with Sub-Saharan countries in the general population.
Identifying characteristics of drug-related problems in critically ill patients with decompensated liver cirrhosis
Authors: Aghili Mina , Neelathahalli Kasturirangan Meera
Published: August 2019

Objectives

Characteristics of drug-related problems and related patient harm has not been evaluated in critically ill patients with decompensated cirrhosis. Our objectives were to identify characteristics and incidence rate of drug-related problems and related preventable harm in critically ill patients with decompensated liver cirrhosis.

Patients and methods

A prospective observational study was conducted from February 2018 to January 2019 in 10-bed medical intensive care unit of a tertiary care hospital. Medication charts of 78 patients diagnosed with decompensated cirrhosis were reviewed by the clinical pharmacist. Pharmaceutical care-related standard tools were applied for classification of drug-related problems and their severity of outcomes.

Results

A total of 394 drug-related problems with an incidence rate of 298.48 per 1000 patient medical intensive care unit-day were identified. Most common drug-related problems were drug-drug interaction (48.7%) followed by guideline nonconformity (15.5%), inappropriate drug form (11.9%), and contraindication (9.6%). Approximately 27% of drug-related problems induced preventable harm, which included temporary harm (19.8%), permanent harm (5.8%), and death (0.8%). The incidence rate of preventable harm was found to be 78.78 per 1000 patient medical intensive care unit-day. Nonsteroidal anti-inflammatory drugs were the most common medications involved in drug-drug interaction, guideline nonconformity, and contraindication which led to gastrointestinal bleeding (24%) and worsening of renal function (11.5%).

Conclusion

Drug-related problems occurred commonly in critically ill patients with decompensated liver cirrhosis and induced preventable harm which jeopardized the safety of these vulnerable patients. Clinical pharmacist’s intervention is essential for identification of drug-related problems and related preventable harm among these patients.
Severe pancytopenia and aspergillosis caused by thioguanine in a thiopurine S-methyltransferase deficient patient: a case report
Authors: de Hoogd Sjoerd , Wong Dennis R. , de Vries Durk R. , Harmsze Ankie M.
Published: August 2019

Azathioprine and mercaptopurine are widely used in the treatment of inflammatory bowel disease. However, its use is limited by adverse drug event related to the relatively narrow therapeutic index of the active metabolites. Several patients discontinue treatment because of intolerable adverse events or toxicity such as leucopenia and hepatotoxicity. High 6-thioguanine nucleotides and 6-methylmercaptopurine ribonucleotides levels are associated with toxicity. Variations in the thiopurine S-methyltransferase (TPMT) gene can lead to diminished TPMT enzyme activity and to an increased incidence of myelotoxicity due to high 6-methylmercaptopurine ribonucleotides levels after treatment with azathioprine and mercaptopurine. Unlike azathioprine and mercaptopurine, thioguanine is more directly metabolized to the active metabolites without formation of the toxic 6-methylmercaptopurine ribonucleotides. Taking this into account, it seems likely that thioguanine is less associated with myelotoxicity due to TPMT deficiency. However, we report the case of a Crohn’s disease patient with life-threatening complications on 6TG treatment due to TPMT deficiency. Our patient developed a severe pancytopenia on thioguanine therapy, with 6-thioguanine nucleotides levels more than 10 times higher than the upper limit of the therapeutic window and was found to be a TPMT poor metabolizer (TPMT *3A/*3A). This case strongly illustrates that knowledge of TPMT enzyme activity is very important in the use of all thiopurines, including thioguanine. In conclusion, clinicians should be aware of the impact of TPMT deficiency on the metabolism of thioguanine and should consider performing preemptive TPMT genotyping in combination with frequent blood test monitoring when using thiopurines in general.