bluuebunny/crossref_metadata_2025 huggingface dataset:
An osteoclast-like giant cell tumor embedded in the mural nodule of a pancreatic mucinous cystic neoplasm
Authors: Fan XiaoYu , Wang WenYue , Li ChaoFeng , Tang Tao , Han YongXin , An Ke
Published: April 2019

Rationale:

Mucinous cystic neoplasms (MCNs) are relatively rare lesions, accounting for 2%–5% of all exocrine pancreatic neoplasms. MCNs mainly occur in women (female:male ratio = 20:1), with a peak incidence in the 5th decade of life. Osteoclast-like giant cell tumors (OGCTs) are rare and relatively aggressive neoplasms, comprising <1% of all pancreatic carcinomas. Herein, we present a rare “combination tumor” case and discuss the impact of mural nodules in pancreatic MCNs considering malignant transformation.

Patient concerns:

A 54-year-old Mongolian man, without vomiting, nausea or jaundice, presented with abdominal distention since 3 months. He had a 7-year history of diabetes. Physical examinations indicated slight middle abdominal tenderness without rebound tenderness or rigidity. Laboratory results revealed that the level of carcinoembryonic antigen (CEA) was 1.16 ng/ml (normal: <5 ng/ml); CA-199: 30.02 U/ml (normal: <27 U/ml); hemoglobin: 143 g/L; fasting glucose: 7.71 mmol/L; and albumin: 43 g/L. Abdominal enhanced computed tomography revealed a 7 × 6 cm solid neoplasm in the pancreatic body with partial enhancement and heterogeneity. Endoscopic ultrasound revealed a solid-cystic space-occupying lesion in the pancreatic body.

Diagnosis:

The preoperative preliminary diagnosis was pancreatic solid-cystic tumor, possibly a solid pseudopapillary tumor. Postoperative pathological findings revealed a pancreatic borderline MCN with an OGCT embedded in a mural nodule of the capsule. Immunohistochemical results indicated a simultaneous dual origin from the epithelium and stroma.

Interventions:

The patient underwent open distal pancreatectomy and splenectomy. Postoperative blood glucose levels were closely monitored and regulated. We intravenously administered single-agent gemcitabine (1400 mg on day 1) as the first-time chemotherapy, 1 month after surgery. After the first chemotherapy, the patient refused to receive further treatment owing to personal reasons.

Outcomes:

The patient showed uneventful recovery and was discharged 13 days after the initial surgery. Follow-up was performed 1, 3 and 6 months after surgery. At 6 months, abdominal computed tomography scan showed no signs of recurrence, regional lymphadenopathy, or other abnormalities. And laboratory tests showed a platelet count of 301 × 109/L, postprandial blood glucose of 12.9 mmol/L and CA-199 level of 20 U/ml. The patient had no obvious discomfort.

Lessons:

Although pancreatic MCNs are widely accepted as borderline tumors, malignant transformations may occur due to various risk factors (cyst size, mural nodules, septations, and tumor location). The combination tumor in this case was more likely to increase the possibility of malignant biological behavior, thereby worsening overall prognosis. Therefore, long-term follow-up must be maintained with strict monitoring.
Effect of electrical stimulation for chemotherapy-induced nausea and vomiting in patients with liver cancer
Authors: Li Wei-hong , Li Dong
Published: April 2019

Background:

This study will be proposed for assessing the effects of electrical stimulation (ES) for chemotherapy-induced nausea and vomiting (CINV) in patients with liver cancer (LC).

Methods:

We will identify the relevant literatures of ES for CINV in patients with LC from following databases: Cochrane Library, PUBMED, EMBASE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the date of literature searched without any language restrictions. Randomized controlled trials and case–control studies on assessing of effects and safety of ES for CINV in patients with LC will be included. Methodological quality for all included studies will be assessed by using Cochrane risk of bias tool. RevMan 5.3 software (Cochrane Community, London, UK) will be used to analyze the data.

Results:

This study will summarize current evidence for ES on CINV in patients with LC. Primary outcome includes symptoms severity. Secondary outcomes consist of appetite, performance status, health-related quality of life, and adverse events.

Conclusion:

The results of this study will provide latest evidence to judge the effects and safety for ES on CINV in patients with LC.

PROSPERO registration number:

PROSPERO CRD42019126379.
The clinical efficacy and safety of the Chinese herbal medicine Astragalus (Huangqi) preparation for the treatment of acute myocardial infarction
Authors: Zhang Yuqin , Wu Jiani , Guo Shuwen , Lin Wangou , Zhang Binyue , Chen Xi , Mo Hanrong , Zhan Tianwei
Published: April 2019

Background:

In recent years, with the enormous advances in the field of cardiac intervention technology, the survival rate of patients with acute myocardial infarction (AMI) has been improved significantly. However, the risk of arrhythmias and heart failure remains very high in AMI patients for long-term prognosis. Chinese herbal medicine (CHM) is more and more used in the treatment of AMI because of its good curative effect and less side effects. The target of this research is to analyze the efficacy and safety of Astragalus (Huangqi) preparation in the treatment of AMI by meta-analysis and also to provide a better evidence for clinical practice.

Methods:

Seven databases will be searched in this study: The Cochrane Library, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (CSJD), the Chinese Biomedical Literature Database (CBM), and Wanfang DATA. The following search terms will be used: (Huangqi OR Huang Qi OR Astragalus OR radix astragali) AND (acute myocardial infaction OR myocardial infaction OR AMI) AND (randomized controlled trial OR RCT OR randomized). No language limitations and the searches will be conducted up to March, 2019. Inclusion criteria: randomized controlled trial (RCT) of Astragalus (Huangqi) preparation in patients with AMI. Main outcome measures will be left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), recanalization rate, mortality rate, incidence of reperfusion arrhythmias, postinfarction angina pectoris, and re-infarction rate. Secondary outcome indicators were the incidence of adverse reactions and the effective rate of traditional Chinese medicine (TCM) treatment. Two independent reviewers will filter the literature and extract data which based to the Cochrane manual. The relevant data, including bias risk assessment, data synthesis, subgroup analysis, meta-analysis, and final meta-analysis, will be analyzed with RevMan 5.3 software. The funnel diagram will be used to evaluate the reported deviation, and the Egger test will be used to evaluate the symmetry of the funnel graph.

Results:

This systematic review study will provide a clear basis for evaluating the efficacy and safety of Astragalus (Huangqi) preparation with the treatment of AMI.

Conclusion:

This study will provide an up-to-date evidence for evaluating the efficacy and safety of Astragalus (Huangqi) preparation.

PROSPERO registration number:

CRD42019124843.
Fibroma of tendon sheath embedded in carpal bones mimicking carpal enchondroma
Authors: Fu Zhuo , Liu Jianfeng , Huang Dongxu , Jia Xiaoyan , Liu Zhigang , Liu Bin
Published: April 2019

Rationale:

Fibroma of tendon sheath is a rare entity that is typically attached to the tendon sheath.

Patient concerns:

A 43-year-old man presented with a painful mass in his right wrist, which was initially misdiagnosed as an enchondroma.

Diagnosis:

Fibroma embedded into carpal bones, which exhibited lytic radiographic features similar to those of enchondroma. Excisional biopsy demonstrated spindle-shaped cells and collagen-like stroma.

Interventions:

The patient underwent lesion resection surgery.

Outcomes:

The patient recovered well and showed no signs of recurrence at 6-month follow-up.

Lessons:

This case provides valuable insights for hand surgeons. While radiograph is helpful in multiple diseases, histological examination is indispensable for establishment of final diagnosis.
Scrotal elephantiasis associated with follicular occlusion triad
Authors: Liu Jing-Chao , Liu Xi-Gao , Xu Chao , Zhao Hai-Feng , Jiang Xian-Zhou
Published: April 2019

Rationale:

Follicular occlusion triad (FOT) is an autosomal recessive inherited disease and no more than 3 variants of the triad have been reported. We give a report in which scrotal elephantiasis is a variant of FOT and further perform a literature review.

Patient concerns:

A 41-year-old man came to us because of a large scrotal cyst and generalized skin lesions that had occurred over the past 10 years. The generalized skin lesions consisted of hidradenitis suppurativa on the perineum and back, acne conglobata in the armpit, and dissecting cellulitis of the scalp. He took antibiotics for a long time but achieved poor effect. Furthermore, he told his father and elder brother also manifested such skin lesions.

Diagnoses:

Magnetic resonance showed a mass in the left scrotum with clear boundaries. A routine blood test showed a high leukocyte level of 12 × 109/L and a hemoglobin content of 78 g/L. C-reactive-protein increased. Series of autoimmune antibody tests were negative. The postoperative pathologic findings showed that the mass was an epidermoid cyst, and hematoxylin and eosin staining showed hyperkeratosis of the skin as well as inflammatory and edematous changes. A diagnosis of a variant of FOT was made.

Interventions:

We removed skin abscesses and lesioned the inner part with hydrogen peroxide. Then we performed an excision of the scrotal lesion.

Outcome:

The patient recovered well and had no evidence of recurrence at a 16-month follow-up.

Lessons:

We reported a case in which scrotal elephantiasis was a variant of FOT and surgical intervention played an important role in secondary urologic diseases.
Echinococcosis in left ventricle: a case report
Authors: Su Li , Yu Jianqun , Dai Chengzhong , Liu Yin , Peng Liqing
Published: April 2019

Introduction:

Echinococcosis, also called hydatid disease, is a common parasitic infection of the liver. However, echinococcus lesions rarely involve the heart, especially in children.

Patient concerns:

An 8-year-old child from grazing areas of northwest China was referred to our hospital for the complaint of inpersistent precordial chest pain and left upper quadrant pain for 3 years. Palpation showed hepatomegaly, abdominal palpable mass while inspection abdominal distension. Routine blood tests were within the normal ranges.

Diagnosis:

Combining the life history in pasture area, imaging features and serology results, it was consistent with the diagnosis of cardiac echinococcosis.

Interventions:

Surgery was performed to evacuate cyst liquid and remove the internal capsule of the cyst.

Outcomes:

There was no cystic lesion in heart on ultrasound and her physical condition improved significantly after the surgery. The patient died of hepatic hydatid cyst rupture due to refusing high-risk surgical treatment and other treatment.

Lessons:

We presented a rare case of cystic echinococcosis involving left ventricle in a child, and surgery is an alternative and effective therapy for this lesion due to the cyst rupture or leakage that can result in anaphylaxis. The typical imaging features of the cardiac echinococcosis on cardiac magnetic resonance are presented. Patient prognosis relies on proper treatment of all lesions.
Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase
Authors: Zhou Haijiang , Mei Xue , He Xinhua , Lan Tianfei , Guo Shubin
Published: April 2019

Severity stratification and prognostic prediction at early stage is crucial for reducing the rates of mortality of patients with acute pancreatitis (AP). We aim to investigate the predicting performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red-cell distribution width (RDW) combined with severity scores (sequential organ failure assessment [SOFA], bed-side index for severity of AP [BISAP], Ranson criteria, and acute physiology and chronic health evaluation II [APACHE II]) for severe AP (SAP) and mortality.

A total of 406 patients diagnosed with AP admitted in a tertiary teaching hospital were enrolled. Demographic information and clinical parameters were retrospectively collected and analyzed. NLR, PLR, RDW, blood urea nitrogen (BUN), and AP severity scores (SOFA, BISAP, Ranson, and APACHE II) were compared between different severity groups and the survival and death group. Receiver-operating characteristic (ROC) curves for SAP and 28-day mortality were calculated for each predictor using cut-off values. Area under the curve (AUC) analysis and logistic regression models were performed to compare the performance of laboratory biomarkers and severity scores.

Our results showed that NLR, PLR, RDW, glucose, and BUN level of the SAP group were significantly increased compared to the mild acute pancreatitis (MAP) group on admission (P < .001). The severity of AP increased as the NLR, SOFA, BISAP, and Ranson increased (P < .01). The AUC values of NLR, PLR, RDW, BUN, SOFA, BISAP, Ranson, and APACHE II to predict SAP were 0.722, 0.621, 0.787, 0.677, 0.806, 0.841, 0.806, and 0.752, respectively, while their AUC values to predict 28-day mortality were 0.851, 0.693, 0.885, 0.765, 0.968, 0.929, 0.812, and 0.867, respectively. BISAP achieved the highest AUC, sensitivity and NPV in predicting SAP, while SOFA is the most superior in predicting mortality. The combination of BISAP + RDW achieved the highest AUC (0.872) in predicting SAP and the combination of SOFA + RDW achieved the highest AUC (0.976) in predicting mortality. RDW (OR = 1.739), SOFA (OR = 1.554), BISAP (OR = 2.145), and Ranson (OR = 1.434) were all independent risk factors for predicting SAP, while RDW (OR = 7.361) and hematocrit (OR = 0.329) were independent risk factors for predicting mortality by logistic regression model.

NLR, PLR, RDW, and BUN indicated good predictive value for SAP and mortality, while RDW had the highest discriminatory capacity. RDW is a convenient and reliable indicator for prediction not only SAP, but also mortality.
Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy
Authors: Liu Chun-jie , Yu Kun-lun , Bai Jiang-bo , Tian De-hu , Liu Guo-li
Published: April 2019

Background:

Platelet-rich plasma (PRP) is used as an alternative therapy to reduce pain and improve functional restoration in patients with Achilles tendinopathy (AT). We evaluated the current evidence for the efficacy of PRP as a treatment for chronic AT.

Methods:

The PubMed, Embase, Web of Science, and The Cochrane Library databases were searched for articles on randomized controlled trials (RCTs) that compared the efficacy of PRP with that of with placebo injections plus eccentric training as treatment for AT. The articles were uploaded over the establishment of the databases to May 01, 2018. The Cochrane risk of bias (ROB) tool was used to assess methodological quality. Outcome measurements included the Victorian Institute of Sports Assessment-Achilles (VISA-A), visual analog scale (VAS) and Achilles tendon thickness. Statistical analysis was performed with RevMan 5.3.5 software.

Results:

Five RCTs (n = 189) were included in this meta-analysis. Significant differences in the VISA-A were not observed between the PRP and placebo groups after 12 weeks [standardized mean difference (SMD) = 0.2, 95% confidence interval (95% CI): 0.36 to 0.76, I
2 = 71%], 24 weeks (SMD = 0.77, 95% CI: −0.10–1.65, I
2 = 85%) and 1 year (SMD = 0.83, 95% CI: −0.76–2.42, I
2 = 72%) of treatment. However, PRP exhibited better efficacy than the placebo treatment after 6 weeks (SMD = 0.46, 95% CI: 0.15–0.77, I
2 = 34%). Two studies included VAS scores and tendon thickness. VAS scores after 6 weeks (SMD = 1.35, 95% CI: −0.1.04–3.74, I
2 = 93%) and 24 weeks (SMD = 1.48, 95% CI: −0.1.59–4.55, I
2 = 95%) were not significantly different. However, VAS scores at the 12th week (SMD = 1.10, 95% CI: 0.53–1.68, I
2 = 83%) and tendon thickness (SMD = 1.51, 95% CI: 0.39–2.63, I
2 = 53%) were significantly different.

Conclusion:

PRP injection around the Achilles tendon is an option for the treatment of chronic AT. Limited evidence supports the conclusion that PRP is not superior to placebo treatment. These results still require verification by a large number of well designed, heterogeneous RCT studies.
The effectiveness and safety of pertussis booster vaccination for adolescents and adults
Authors: Xu Jiawei , Liu Shudan , Liu Qin , Rong Rong , Tang Wenge , Wang Qing , Kuang Shanshan , Zhou Chunbei
Published: April 2019

Background:

Due to the resurgence of pertussis, many countries have revised the pertussis immunization schedules and recommended booster doses of pertussis component vaccine for adolescents and adults. Here we aim to investigate the effectiveness and safety of pertussis component vaccines in adolescents and adults.

Methods:

Based on a prospectively registered protocol, we reviewed the literature and selected trials in adolescents and adults using pertussis component vaccine. We followed Cochrane and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidance to assess risk of bias, quality of evidence and to perform meta-analyses.

Results:

A total of 17 clinical trials were included. At post-vaccination with pertussis component vaccine, the vaccine protective rate of pertussis reached 88.89%, the vaccine response rate of pertussis antibodies in most trials were above 85%, and the antibody titers at post-vaccination were higher than at pre-vaccination. Reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine was associated with significantly higher incidences of nausea [RR = 1.26, 95%CI:1.01, 1.57] and vomiting [RR = 2.08, 95%CI:1.21, 3.58] in acellular pertussis vaccines combined with tetanus and diphtheria (Tdap) group than diphtheria tetanus-toxoid vaccines (Td) group. Higher dose of diphtheria toxoid and adjuvant in dTap might cause higher incidence of fever.

Conclusions:

Except for significant difference in gastrointestinal reaction (nausea, vomiting), acellular pertussis component vaccines are quite safe and has short-term effectiveness for the adolescents and adults. The adverse event of acellular pertussis component vaccine is similar to or safer than that of placebo or other vaccines without pertussis component.
Effect of timing of umbilical cord clamping on maternal and neonatal outcomes
Authors: Yu Liping , Sun Yue , Shang Yi , Yin Min
Published: April 2019

Background:

Umbilical cord clamping is one of the most commonly used medical or complementary medical interventions. The different timing of cord clamping may have any significant impact on public health. However, the results remain controversial. The aim of the study was to evaluate and compare the effect of different timing of umbilical cord clamping on maternal and neonatal outcomes.

Methods:

A systematic literature search for relevant articles will be conducted in the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Chinese Biomedical Literature Database from their inception to December 2018. Any randomized controlled trial (RCT), case-control study, observational study, that reported the effect of different timing of cord clamping will be included regardless of sample size. There are no language restrictions. Mortality and risk of iron-deficiency anemia will be used to assess the clinical effect. Risk of bias assessment of the included RCTs will be conducted by the Cochrane risk of bias tool and the Newcastle–Ottawa Scale is used to assess observational studies. All statistical analyses will be performed using Stata V.15.0. A modified version of Grades of Recommendation, Assessment, Development, and Evaluation will be used to assess the quality of evidence in network meta-analysis (NMA).

Results:

The results will be published in a peer-reviewed journal.

Conclusion:

This will be the first NMA to evaluate and compare the effect of different timing of umbilical cord clamping. We hope that the results of this NMA will help clinicians and caregivers make more appropriate choices when clamping umbilical cord.
Schizoaffective disorder comorbid with type 2 diabetes mellitus accompanied by frontotemporal atrophy and impaired cognition
Authors: Bai Yuanhan , Yin Mengdong , Zeng Zhiqiang , Liang Jie , Yang Haichen
Published: April 2019

Rationale:

Brain atrophy coupled with impaired cognition may be a sign of dementia. However, growing evidence indicates that schizoaffective disorder (SAD) and type 2 diabetes mellitus (T2DM) play roles in the processes of frontotemporal atrophy and cognitive decline. Few cases of frontotemporal atrophy and impaired cognition have been reported in young adult patients with SAD and T2DM.

Patient concerns:

A 34-year-old man was admitted for his 19th rehospitalization due to auditory verbal hallucinations (AVHs), delusions of persecution, mania, and fluctuating blood sugar levels. After admission, a brain computed tomography (CT) scan revealed that the patient's frontotemporal atrophy, which was first found in 2014, had gradually degenerated over time. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) revealed cognitive impairments. Based on the clinical assessment, his cognition and social function impairments were determined to mainly result from SAD and T2DM because the clinical characteristics and course of the disease did not coincide with the features of progressive aggravation of dementia.

Diagnoses:

Diagnoses include the following: SAD-mania and T2DM.

Interventions:

Paliperidone and sodium valproate coupled with quetiapine add-on treatment were prescribed for the patient.

Outcomes:

The therapeutic strategy had a limited effect on the patient.

Lessons:

Early onset of SAD and T2DM, as well as irregular treatment, resulting in brain atrophy coupled with cognitive impairments, may be the main causes of the patient's treatment resistance and poor outcome. The risks and benefits of treatment strategies should be individually assessed. Further neuroimaging, pertinent biomarkers, and genetic tests along with long-term follow-up are needed for precise evaluation of the patient's condition.
Damage control orthopedics applied in an 8-year-old child with life-threatening multiple injuries
Authors: Pfeifle Viktoria Amanda , Schreiner Simone , Trachsel Daniel , Holland-Cunz Stefan Gerhard , Mayr Johannes
Published: April 2019

Rationale:

Damage control is a staged surgical approach to manage polytraumatized patients. The damage control approach comprises three steps. First, bleeding is controlled and fractures are stabilized temporarily; second, vital parameters are stabilized and the child is rewarmed in the intensive care unit; and third, the child is reoperated for definitive repair of injuries. We aimed to describe the feasibility of the damage control orthopedic approach in a child.

Patient concerns:

An 8-year-old girl fell from the balcony of the 5th floor onto concrete pavement and was admitted to our accident and emergency ward in a stable cardiorespiratory state, but with gross deformity of the lower limbs, left thigh, and forearm.

Diagnoses:

The child had sustained multiple injuries with severe bilateral lung contusion, pneumothorax, fracture of first rib, liver laceration, stable spine fractures, transforaminal fracture of sacrum, pelvic ring fracture, displaced baso-cervical femoral neck fracture, displaced bilateral multifragmental growth plate fractures of both tibiae, fractures of both fibulae, displaced fracture of left forearm, and displaced supracondylar fracture of the humerus.

Intervention:

In the initial operation, we performed closed reduction and K-wire fixation of the right tibia, closed reduction and external fixation of the left tibia, open reduction and screw osteosynthesis of the femoral neck fracture, closed reduction and K-wire fixation of the radius, and closed reduction of the supracondylar fracture. Subsequently, we transferred the girl to the pediatric intensive care unit for hemodynamic stabilization, respiratory therapy, rewarming, and treatment of crush syndrome. In a third step, 10 days after the injury, we managed the supracondylar fracture of the humerus by closed reduction and K-wire fixation.

Outcomes:

Growth arrest of the left distal tibial growth plate and osteonecrosis of the femoral head and neck, slipped capital femoris epiphysis (SCFE), and coxa vara of the right femur led to balanced leg length inequality 2 years after the injury. The lesion of the left sciatic nerve improved over time and the girl walked without walking aids and took part in school sports but avoided jumping exercises.

Lessons:

We emphasize the importance of damage control principles when managing polytraumatized children.
Efficacy of sertraline for post-stroke depression
Authors: Bai Zheng-fa , Wang Liu-yi
Published: April 2019

Background:

Depression is a prevalent disorder for patients with stroke. Clinical researches indicate that sertraline is utilized to treat post-stroke depression (PSD) effectively. However, no systematic review has investigated this issue yet presently. Thus, this study aims to systematically assess the efficacy and safety of sertraline for patients with PSD.

Methods:

Literature sources will be divided into 2 sections: electronic sources and manual sources. We will search electronic literature sources as follows: EMBASE, MEDICINE, Web of Science, Cochrane Library, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from their inceptions to the February 28, 2019. Manual sources include dissertations, ongoing trials, and conference abstracts. Two reviewers will select the literatures, extract and collect data information, and evaluate the risk of bias independently. Statistical analysis will be carried out by using RevMan 5.3 software.

Results:

Primary outcome is depression. It can be measured by Hamilton depression scale, Beck Depression Inventory, or any other scales. Secondary outcome are anxiety (as assessed by Hamilton anxiety scale, or other tools) response rate, activities of daily living (as measured by Barthel Index, or other scales), quality of life (as measured by 36-Item Short Form Health Survey), and safety.

Conclusions:

The results of this systematic review may summarize the up-to-date evidence on the efficacy and safety of sertraline for patients with PSD.

Ethics and dissemination:

This systematic review will not need any ethical approval, because it will not analyze any individual patient data. The findings of this study are expected to disseminate at peer-reviewed journals.
Efficacy of furosemide for treatment of liver cirrhosis
Authors: Zhu Zheng-Ri , Liu Wan-Lu , Ding Zhao-Min , Li Yue
Published: April 2019

Background:

Previous clinical studies have reported that furosemide can be used to treat liver cirrhosis (LC) effectively. However, no study systematically explored this issue. This systematic review aims to investigate the efficacy and safety of furosemide for treatment of LC.

Methods:

This study will be conducted through searching the following literature sources from their inception to February 28, 2019 without any language limitations: PUBMED, EMBASE, PsycINFO, Web of Science, Scopus, OpenGrey, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. In addition, reference lists of relevant reviews and websites of clinical trial registry will also be searched. Only randomized controlled trials of furosemide for treatment of LC will be included in this study. Two reviewers will independently select studies, collect data, and determine risk of bias. RevMan 5.3 software will be used to pool the data and to conduct meta-analysis if sufficient studies will be included with acceptable heterogeneity.

Results:

This study will investigate the efficacy and safety of furosemide for LC by the assessment of primary and secondary outcomes. The primary outcome includes mortality rate. The secondary outcomes consist of response rate, overall survival, body weight, urinary volume, quality of life, as measured by any relevant scales, and adverse events.

Conclusion:

The results of this study may provide summarized evidence of furosemide for the treatment of LC.

Ethics and dissemination:

No individual patient data will be used in this study, thus no ethics approval is needed. The findings of this study will be published in peer-reviewed journals.
Depression involved in self-reported prospective memory problems in survivors of breast cancer who have received chemotherapy
Authors: Huang Zhonglian , Zhao Jingjing , Ding Ke , Lv Yue , Zhang Congjun , Chao Herta H. , Li Chiang-Shan , Cheng Huaidong
Published: April 2019

To investigate the relationship between depression and the self-reported prospective memory (SPM) problems in breast cancer survivors who have received chemotherapy.

Sixty-three breast cancer patients were administered with self-rating depression scale (SDS) and the prospective memory questionnaire as part of extensive neuropsychological assessments before and after chemotherapy. The performance of SDS and SPM were compared, with the level of significance set at P < .05.

Compared with the group before chemotherapy, there is a significant difference on the SPM score (t = 6.069, P = .000) in breast cancer patients after chemotherapy. Further, there is also a significant difference on the SPM score (t = −4.348, P = .000) between the patients with and without depression group after chemotherapy.

The present result indicated that the depression in breast cancer survivors after chemotherapy may be involved in their chemotherapy-induced SPM impairment.
Endovascular treatment of a ruptured thoracic aortic pseudoaneurysm secondary to Pott disease during a spine surgery
Authors: Li Weichao , Sun Xianrun , Li Hongrong , Meng Zengdong , Yang Yong , Yao Shaoping
Published: April 2019

Rationale:

The coexistence of a tuberculous aortic pseudoaneurysm and Pott disease in patients with a history of tuberculosis (TB) is relatively rare, and the treatment strategies remain still controversial.

Patient concerns:

A 57-year-old female patient with a history of primary pulmonary TB presented with symptoms of breathlessness, chest pain, weight loss, and fever. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a thoracic aortic pseudoaneurysm secondary to Pott disease at T11/12 level.

Diagnoses:

Tuberculous pseudoaneurysm at the descending thoracic aorta associated with tuberculous vertebral osteomyelitis.

Interventions:

We originally planned a combined surgery consisting of posterior spine stabilization, anterior excision of the infected field, and aortic reconstruction. When we surgically stabilized the posterior spine, unexpectedly, the pseudoaneurysm ruptured. Immediately, we terminated the surgery and appropriately placed an endovascular stent graft, which successfully rescued the patient.

Outcomes:

When the patient's conditions were stable, we anteriorly debrided all infected tissues and then performed a spinal fusion by grafting autologous iliac bone. After the debridement and spinal fusion, we arranged a 1-year anti-tuberculous chemotherapy for this patient and performed a 24-month follow-up. This patient had no signs of recurrent infection during the follow-up.

Lessons:

For the patients with tuberculous aortic aneurysm(s) complicated with vertebral osteomyelitis, the endovascular repair of an aneurysm(s) should be considered a conventional therapy before the spine surgery, lowering the risk of aortic aneurysm rupture. Meanwhile, minimally invasive endovascular stent graft combined with anti-tuberculosis drugs may be considered one of the therapeutic regimens for the patients whose conditions are not suitable for open surgery, such as age, weakness, or severe organ failure.
Prognostic impact of preoperative neutrophil–lymphocyte ratio for surgically resected gastrointestinal stromal tumors
Authors: Yang Jing , Gu YuanHui , Huang XianBin , Xu JiaYu , Zhang Yan , Yang XiaoJun , Tian HongWei , Zhan WeiPeng
Published: April 2019

Neutrophil–lymphocyte ratio (NLR) was shown to be prognostic value in various malignancies. There are limited data about predictive or prognostic role of NLR during gastrointestinal stromal tumors (GISTs) patients. This study evaluated the prognostic significance of preoperative NLR in patients with GIST.

We retrospectively enrolled 72 primary GIST patients who received initial curative surgical resection with or without adjuvant imatinib therapy. The preoperative NLR in the peripheral blood was calculated. Univariate and multivariate Cox proportional hazard regression models were used to identify potential predictors of tumor outcomes.

The NLR cut-off value of 4.18 was selected. Multivariate analysis revealed that high NLR was associated with a unfavorable prognosis of GISTs (P < .05). Tumor size, tumor location, and age were significantly correlated with the NLR (P < .05).

High NLR was an unfavorable prognostic factor of overall survival in GISTs and may be a useful preoperative biomarker of the prognosis of GISTs.
Maternal lipid profiles in women with and without gestational diabetes mellitus
Authors: Wang Jing , Li Zhi , Lin Li
Published: April 2019

To determine the longitude lipid profiles in women with and without gestational diabetes mellitus (GDM), and to investigate the relationship between lipid disturbances in the 1st trimester and GDM.

Blood samples were collected from 1283 normal pregnant women and 300 women with GDM. Serum lipids which include total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured and the TG/HDL-C ratio was calculated in the 1st, 2nd, and 3rd trimesters of pregnancy and then we got the longitudinal lipid profiles. We compared the differences of lipid profiles between patients with GDM and normal pregnant women using 2-way repeated measures analysis of variance. Also additional propensity-based subgroup analyses were performed. The logistic regression analysis was used to determine the relationship between the lipid disturbances in the 1st trimester and GDM.

TG, TC, LDL-C concentrations, and TG/HDL-C ratio increased progressively throughout pregnancy; while HDL-C amounts increased from the 1st to the 2nd trimester with a slight decrease in the 3rd trimester. The GDM group showed higher TG concentrations, higher TG/HDL-C ratio, and lower HDL-C concentrations throughout pregnancy. There were no significant differences in TC and LDL-C concentrations in the 1st, 2nd, and 3rd trimesters (P > .05), between the GDM group and the control group. Logistic regression analysis showed that maternal age, prepregnancy body mass index (BMI), and TG/HDL ratio in the 1st trimester were associated with an increased risk of GDM.

The lipid profile alters significantly in patients with GDM, and maternal age, prepregnancy BMI, and TG/HDL ratio in the 1st trimester were associated with an increased risk of GDM.
Subcutaneous tissue-sparing dorsal slit with new marking technique
Authors: Jiang Zhao-Long , Sun Cheng-Wen , Sun Jian , Shi Gao-Feng , Li Hu
Published: April 2019

Circumcision is a very common surgical procedure that is performed for medical and traditional purposes in the world. However, many technical of circumcision is needed to improve. Thus, this study introduced a novel method of circumcision that is a refined version of the sleeve technique, termed subcutaneous tissue sparing dorsal slit with new marking, and evaluated the safety and efficacy of this novel method of circumcision.

The randomized clinical trial included 93 adult patients with redundant foreskin or phimosis treated from May 2015 to March 2017. Patients were randomly divided into the novel circumcision method (n = 45) or conventional dissection (n = 48). The groups were compared regarding rates of intraoperative hemorrhage, operative time, pain, healing, satisfaction with penis appearance, and relevant adverse events.

No patient suffered any obvious complication. Compared with the patients given conventional dissection, the patients who underwent the new surgical device experienced significantly less wound healing time, scar width, and recovery time (P <.05). The new method resulted in greater intraoperative bleeding volume and surgical time (P <.05). The rate of satisfaction with appearance of the penis was significantly higher in the group treated with the novel technique. In addition, the cost of surgery of these 2 methods was similar.

Based on the above research, we found that subcutaneous tissue-sparing dorsal slit with new marking technique was an effective and safe procedure for circumcision, and deserved further application in clinical practice.
Successful conservative treatment of primary endometrial marginal zone lymphoma (MALT type)
Authors: Zhang Xiuming , Zhou Feng
Published: April 2019

Rationale:

Primary endometrial marginal zone lymphoma (mucosa-associated lymphoid tissue [MALT] type) is a rare histological type of non-Hodgkin lymphoma (NHL); therefore, this disease is challenging to diagnosis and treatment.

Patient concerns:

A 61-year-old (gravidity 2, parity 2) female was admitted complaining of postmenopausal vaginal bleeding for 2 months.

Diagnoses:

An ultrasound revealed a slightly thickened endometrium. Histology revealed a dense lymphoid infiltrate in the endometrium, which was suggestive of an NHL. The atypical lymphocytes were positive for CD20 and BCL-2. Moreover, the PCR demonstrated monoclonal heavy chain gene rearrangement. Taken together, the diagnosis of primary endometrial marginal zone lymphoma (MALT type) was established. According to Ann Arbor criteria, the disease was staged IEA.

Interventions:

Dilatation and curettage was performed, and no additional surgery or radiotherapy and chemotherapy was administered.

Outcomes:

The patient was alive with no evidence of cancer for ≥41 months.

Lessons:

Primary endometrial marginal zone lymphoma (MALT Type) is a very rare indolent tumor, and its prognosis seems to be good. Thus, conservative treatment and no further therapy were suggested based on the tumor biology.
Anti-angiogenesis treatment in a patient with appendix metastasis of small cell lung cancer
Authors: Xue Peng , Wang NingJun , Mao Yun , Zhu Shijie
Published: April 2019

Rationale:

Small-cell lung cancer (SCLC) is a common pathological type of lung cancer, but appendiceal metastasis of SCLC was rare. At present, clinical studies on the maintenance therapy of SCLC have not reached a significant conclusion.

Patient concerns:

We reported on a 52-year-old man who diagnosed as extensive stage SCLC with abdominal pain for 2 months, aggravated for 2 days.

Diagnoses:

The patient was diagnosed with extensive-stage SCLC, relapsed with appendix metastasis after treatment by emergency abdominal surgery.

Interventions:

The patient received systemic treatments, including surgery, bevacizumab in combination with chemotherapy and bevacizumab alone was continued as maintenance therapy.

Outcomes:

The patient had an overall survival would more than 23 months, and he gained another 8 months of progression-free survival after first-line radiochemotherapy.

Lessons:

Although SCLC appendix metastasis is rare, continuous anti-angiogenic therapy combined with bevacizumab maintenance therapy after surgical treatment can prolong survival.
Patient-tailored FOLFIRINOX as first line treatment of patients with advanced pancreatic adenocarcinoma
Authors: Ulusakarya Ayhan , Teyar Nahla , Karaboué Abdoulaye , Haydar Mazen , Krimi Sarra , Biondani Pamela , Gumus Yusuf , Chebib Amale , Almohamad Wathek , Morère Jean-François
Published: April 2019

FOLFIRINOX is one of the most effective reference regimens in the 1st line treatment of locally advanced (LA) and metastatic pancreatic cancer (mPC), despite its high toxicity. We evaluated our real-life experience with “patient-tailored intent to treat FOLFIRINOX” in patients with LA or mPC compared to other reports along with the pivotal phase III trial.

We analyzed data from all consecutive patients with pancreatic ductal adenocarcinoma treated with dose-modified FOLFIRINOX in 2016 at Paul Brousse University Hospital. Irinotecan was administered whenever initial serum bilirubin was <1.5 × upper limit of normal. Oxaliplatin was stopped for severe sensory neuropathy. Initial dose reductions were made according to patient profile (eg, age, comorbidities) and later due to toxicity. The treatment was continued until surgery or disease progression. Endpoints were time to progression (TTP), overall survival (OS), objective response rate (ORR), and secondary complete resection (R0R1).

Thirty-seven patients with unresectable LA or mPC received patient-tailored FOLFIRINOX as 1st line chemotherapy. There were 22 male (59%) and 15 female patients (41%) aged 44 to 81 years with LA (18 patients, 49%) and mPC (19 patients, 51%). They had World Health Organization-performance status of 0 (59%) or 1 (41%). A total of 384 cycles were administered. Median dose intensities (mg/m2/w) were 28.9 for oxaliplatin, 56.8 for irinotecan, and 886.2 for 5-fluorouracil. Thirty-four patients were assessed for response; ORR and disease control rates were 47% and 85%, respectively. R0R1 rate was 30%. Median TTP and OS were 9.6 and 14.6 months. LA disease was associated with significantly longer TTP and OS (P < .001).

FOLFIRINOX with patient-tailored dose adaptations seems to offer better results in patients with advanced PC. This approach in the neoadjuvant setting results in a macroscopic R0R1 in 61% of patients with initially unresectable disease. It deserves prospective evaluation to further improve outcomes in the management of advanced PC.
Anaphylaxis after wheat ingestion in a patient with coeliac disease: two kinds of reactions and the same culprit food
Authors: Mennini Maurizio , Fiocchi Alessandro , Trovato Chiara M. , Ferrari Federica , Iorfida Donatella , Cucchiara Salvatore , Montuori Monica
Published: April 2019

In recent years, the role of atopic dermatitis epidermal skin barrier defects in inducing a transcutaneous allergic sensitization is highly debated, possibly explaining why some children with eczema are sensitized to foods they have never eaten. In our specific situation, the association between coeliac disease and wheat allergy might be particularly harmful owing to unavoidable strict food avoidance. We describe the case of a young boy affected by coeliac disease who, after an occasional unexpected ingestion of gluten, experienced a complete anaphylactic reaction characterized by urticarial, labial angioedema, wheezing, and hypotension. To better investigate the state of allergic sensitization to wheat in our patient, we then performed the component resolved diagnosis, which showed Tri a19 2 kU/l and Tri a14 0.3 kU/l. These results demonstrated the association of IgE-mediated allergy to wheat and coeliac disease. The natural course of specific IgE in allergic patients who are on a food-free diet needs further investigation, such as the possible influence that the increasing popularity of gluten-free diets may have on the epidemiology of wheat allergy in westernized societies. National and International registers of cases of anaphylaxis may improve the still limited knowledge in this field. The final message of our contribution is that the decision to eliminate a food should to take into account a patient’s awareness of possible consequences.
Laparoscopic-assisted colorectal surgery benefits visceral obesity patients: a propensity-matched analysis
Authors: Ye Xing-Zhao , Chen Xi-Yi , Ruan Xiao-Jiao , Chen Wei-Zhe , Ma Liang-Liang , Dong Qian-Tong , Cai Hui-Yang , Yu Zhen , Chen Xiao-Lie
Published: April 2019

Background

We aimed to determine the safety and effectiveness of laparoscopic-assisted surgery (LAS) in visceral obesity patients with colorectal cancer (CRC).

Patients and methods

We retrospectively collected the clinical data of consecutive patients who underwent colorectal surgery for CRC between August 2014 and July 2018. The third lumbar vertebra visceral fat area was measured to diagnose visceral obesity. One-to-one propensity score matching was performed to compare the short-term outcomes between the open surgery (OS) and LAS in visceral obesity patients. Univariate and multivariate analyses were performed to evaluate the risk factors of postoperative complications.

Results

A total of 280 visceral obesity patients were included in this study with 140 patients for each group. Compared with the OS group, the LAS group had more lymph nodes harvested, longer surgical duration, and shorter postoperative hospital stay. The overall incidence of complications in OS was significantly higher than LAS (32.1 vs. 20.0%, P=0.021). Multivariate analysis revealed that age of at least 65 years (odds ratio: 1.950, 95% confidence interval: 1.118–3.403; P=0.019) was an independent risk factor for postoperative complications, whereas LAS (odds ratio: 0.523, 95% confidence interval: 0.302–0.908; P=0.021) was a protective factor.

Conclusion

LAS in visceral obesity patients with CRC was a safer and less invasive alternative than open surgery, with fewer complications within the first 30 days postoperatively.
Immune Checkpoint Inhibitors–Related Cardiotoxicity
Authors: Konala Venu Madhav , Adapa Sreedhar , Aronow Wilbert S.
Published: April 2019

Background:

Immunotherapy is a significant breakthrough in cancer therapy in the last decade. Immunotherapy is better tolerated compared with chemotherapy. However, it does have side effects, and one of the rare and serious side effects of immunotherapy is cardiotoxicity. Cardiotoxicity has been described with other cancer-related treatments such as chemotherapy and targeted therapy. A high index of suspicion is required, and prompt management with immunosuppression needs to be instituted as soon as possible to prevent fatal outcomes.

Areas of Uncertainty:

Research is still ongoing to identify biomarkers that will help us to choose the patients, who will respond well to immunotherapy. Tumor-infiltrating lymphocytes, tumor PD-L1 expression, and tumor mutational burden explored as potential biomarkers. There are no predictive biomarkers to identify patients who are at higher risk of severe cardiotoxicity. Both cardiologists and oncologists should be aware of cardiac toxicity from immune checkpoint inhibitors.

Conclusion:

All patients who are starting immune checkpoint inhibitors should undergo baseline cardiac risk factor assessment with referral to a cardiologist in a patient with multiple risk factors or previous history of cardiovascular disease. Cardiac immune-related adverse events are higher in patients taking combination therapy with anti–CTLA-4/anti–PD-1 agents compared with monotherapy. Patients with known cardiac comorbidities require a higher level of vigilance to monitor for cardiac toxicity because nonspecific symptoms can lead to rapid clinical deterioration and a higher rate of mortality when treated with checkpoint inhibitors.