bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-related quality of life in patients with chronic wounds before and after treatment with medical ozone
Authors: Izadi Morteza , Bozorgi Majedeh , Hosseine Mahboobeh Sadat , Khalili Nahid , Jonaidi-Jafari Nematollah
Published: November 2018

Ozone therapy has been used to treat numerous diseases. Indications of its therapeutic application are increasing, and evidence for its usefulness is growing. Evidence of its antibacterial and proliferative activity suggests its efficacy in treating chronic wounds. The current study evaluated the effect of ozone therapy on the health-related quality of life of patients with chronic wounds.

In the present cross-sectional study, the health-related quality of life was evaluated in 86 patients with chronic wounds undergoing ozone therapy. To measure quality of life, 2 previously established questionnaires were used, the Cardiff wound impact questionnaire and the SF-36 questionnaire. Questionnaires were completed through interviews with the patients.

A total of 86 patients with chronic wounds undergoing ozone therapy participated in this study. The mean age of participants was 58.91 years; 69.8% of them were male, 91.9% had diabetes mellitus, and 50% were receiving insulin therapy. Patients were under local (26.7%), systemic (9.3%), and local plus systemic (64%) protocols of ozone therapy. Mean overall quality of life reported by the patients was 6.2, and mean overall quality of life satisfaction was 6.02 (measured by the Cardiff Wound Impact Questionnaire). Mean physical quality of life measured by the SF-36 questionnaire was 39.12, and mean mental quality of life was 44.37 (measured by the same questionnaire). Among the included variables, the number of ozone therapy sessions was the strongest predictor of quality of life in both questionnaires and remained significant after different levels of adjustment.

In addition to the significant improvement observed in the healing of chronic wounds, medical O3 therapy has also shown to effect a significant improvement in the health-related quality of life of patients and could be a valuable therapeutic option in chronic wound cases.
Comparison of the diagnostic efficiency for local recurrence of rectal cancer using CT, MRI, PET and PET-CT
Authors: Shao Hongsheng , Ma Xueni , Gao Ya , Wang Jiancheng , Wu Jiarui , Wang Bo , Li Jipin , Tian Jinhui
Published: November 2018

Background:

The risk of local recurrence (LR) continues to threat patients with rectal cancer after surgery or chemoradiotherapy. The main reason is that there is frequently extensive scarring and reactive changes after radiotherapy and resection. Thus, the diagnosis of LR can be challenging. There are different imaging modalities that have been used in the follow-up of rectal cancer, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and positron emission tomography-computed tomography (PET-CT) in clinical practice.

Methods:

We will systematically search PubMed, EMBASE, the Cochrane Library, and Chinese Biomedical Literature Database for diagnostic trials using CT, MRI, PET, and PET-CT to detect LR of rectal cancer in April, 2018. Two review authors will independently screen titles and abstracts for relevance, assess full texts for inclusion, and carry out data extraction and methodological quality assessment using the QUADAS-2 tool. We will use bivariate meta-analysis to estimate summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CT, MRI, PET, and PET-CT, as well as different sequences of MRI. For each index test, estimates of sensitivity and specificity from each study will be plotted in summary receive operating curve space and forest plots will be constructed for visual examination of variation in test accuracy. We will perform meta-analyses using the hierarchical summary receiver-operating characteristic model to produce summary estimates of sensitivity and specificity. Then, head-to-head and indirect comparison meta-analyses will be carried out.

Discussion:

This review will help determine the diagnostic accuracy of CT, MRI, PET, and PET-CT for the diagnosis of patients with LR of rectal cancer.

Ethics and dissemination:

Ethics approval and patient consent are not required, as this study is a systematic review.

PROSPERO registration number:

CRD42018104918.
STORE-gastrointestinal functions and gastrointestinal hormones in patients with liver failure
Authors: Wang Ping , Zhang Ying-Jian , Li Yi-Ran , Xia Xiao-Yan , Lv Shu-Yan
Published: November 2018

This study aims to investigate the gastrointestinal functions of patients with liver failure (LF) based on gastrointestinal dysfunction (GD) scores and serum gastrointestinal hormone levels.

The GD in LF patients was scored using the gastrointestinal dysfunction scoring criteria. Serum gastrin (GAS), cholecystokinin (CCK), and motilin (MTL) levels were determined in LF patients. In addition, liver function and prothrombin activity were detected, and ultrasonography was performed.

The GD score was significantly higher in the LF groups than in the control group. Compared with the control group, serum GAS, CCK, and MTL levels significantly increased in the LF groups, and was positively correlated with the severity of LF. Furthermore, in the LF groups, GD was positively correlated with the severity of LF. However, the GD score and serum GAS, CCK, and MTL levels in the acute LF group were not statistically different, when compared with those in the subacute LF group, acute-on-chronic LF group and chronic LF group.

LF plays a key role in the development of GD, and may be the main cause of obvious gastrointestinal symptoms, such as abdominal distension, nausea, vomiting and anorexia, in LF patients. The severity of GD is not associated with LF type, but is positively correlated with the severity of LF, suggesting that GD in LF patients may have complicated mechanisms.
Association of exposure level to passive smoking with hypertension among lifetime nonsmokers in Japan: a cross-sectional study
Authors: Tamura Takashi , Kadomatsu Yuka , Tsukamoto Mineko , Okada Rieko , Sasakabe Tae , Kawai Sayo , Hishida Asahi , Hara Megumi , Tanaka Keitaro , Shimoshikiryo Ippei , Takezaki Toshiro , Watanabe Isao , Matsui Daisuke , Nishiyama Takeshi , Suzuki Sadao , Endoh Kaori , Kuriki Kiyonori , Kita Yoshikuni , Katsuura-Kamano Sakurako , Arisawa Kokichi , Ikezaki Hiroaki , Furusyo Norihiro , Koyanagi Yuriko N. , Oze Isao , Nakamura Yohko , Mikami Haruo , Naito Mariko , Wakai Kenji
Published: November 2018

Brief exposure to passive smoking immediately elevates blood pressure. However, little is known about the association between exposure to passive smoking and chronic hypertension. We aimed to examine this association in a cross-sectional study, after controlling multiple potential confounders.

Participants included 32,098 lifetime nonsmokers (7,216 men and 24,882 women) enrolled in the Japan Multi-Institutional Collaborative Cohort Study. Passive smoking was assessed using a self-administered questionnaire. The single question about exposure to passive smoking had five response options: “sometimes or almost never,” “almost every day, 2 hours/day or less,” “almost every day, 2 to 4 hours/day,” “almost every day, 4 to 6 hours/day,” and “almost every day, 6 hours/day or longer.” Hypertension was defined as any of the following: systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medication. Multivariate-adjusted odds ratio (OR) and 95% confidence interval (CI) for hypertension were estimated by exposure level to passive smoking using unconditional logistic regression models.

The multivariate-adjusted OR for hypertension in those exposed almost every day was 1.11 (95% CI: 1.03–1.20) compared with those exposed sometimes or almost never. The OR for a 1-hour per day increase in exposure was 1.03 (95% CI: 1.01–1.06, P

for trend
 = .006). This association was stronger in men than in women; the ORs were 1.08 (95% CI: 1.01–1.15, P

for trend
 = .036) and 1.03 (95% CI: 1.00–1.05, P

for trend
 = .055), respectively.

Our findings suggest importance of tobacco smoke control for preventing hypertension.
Predictors of survival and neurologic outcome for adults with extracorporeal cardiopulmonary resuscitation
Authors: Wang Junhong , Ma Qingbian , Zhang Hua , Liu Shaoyu , Zheng Yaan
Published: November 2018

Background:

This systemic review aimed to explore the predictors of discharge and neurologic outcome of adult extracorporeal cardiopulmonary resuscitation (ECPR) to provide references for patient selection.

Methods:

Electronically searching of the Pubmed, Embase, Cochrane Library, and manual retrieval were done for clinical trials about predictors for adult ECPR which were published between January 2000 and January 2018 and included predictors for discharge and neurologic outcome. The literature was screened according to inclusion and exclusion criteria, the baseline information and interested outcomes were extracted. Two reviewers assessed the methodologic quality of the included studies and the quality of evidence for summary estimates independently. Pooled mean difference (MD) or odds ratio (OR) and 95% confidence interval (CI) were calculated by Review Manager Software 5.3. At last the quality of evidence for summary estimates was appraised according to Grading of Recommendations Assessment, Development, and Evaluation rating system.

Results:

In 16 studies, 1162 patients were enrolled. Out-of-hospital cardiac arrest (CA) (OR 0.58, 95% CI 0.36–0.93, P = .02), in-hospital CA (OR 1.73, 95% CI 1.08–2.77, P = .02), witnessed CA (OR 5.2, 95% CI 1.18–22.88, P = .01), bystander cardiopulmonary resuscitation (CPR) (OR 7.35, 95% CI 2.32–23.25, P < .01), initial shockable rhythm (OR 2.29, 95% CI 1.53–3.42, P < .01), 1st recorded nonshockable rhythm (OR 0.44, 95% CI 0.29–0.66, P < .01), CPR duration (MD −13.84 minutes, 95% CI −21 to −6.69, P < .0001), arrest-to-extracorporeal membrane oxygenation (ECMO) (MD −17.88 minutes, 95% CI −23.59 to −12.17, P < .01), PH (MD 0.14, 95% CI 0.08–0.21, P < .01), lactate (MD −3.66 mmol/L, 95% CI −7.15 to −0.17, P = .04), and percutaneous coronary intervention (PCI) (OR 1.63, 95% CI 1.02–2.58, P = .04)were identified as the survival predictors of ECPR. Shockable rhythm (OR 2.33, 95% CI 1.20–4.52, P = .01) and CPR duration (MD −9.85 minutes, 95% CI −15.71 to −3.99, P = .001) were identified as the neurologic outcome predictors of ECPR.

Conclusion:

Current evidence showed that in-hospital CA, witnessed CA, bystander CPR, initial shockable rhythm, shorter CPR duration and arrest-to-ECMO duration, higher baseline PH, lower baseline lactate and PCI were favourable survival predictors of adult ECPR, and shockable rhythm and shorter CPR duration were good neurological outcome predictors of adult ECPR.
Prophylaxis with oral zinc sulfate against radiation-induced oropharyngeal mucositis in patients with head and neck cancer
Authors: Shuai Ting , Yi Li-Juan , Tian Xu , Chen Wei-Qing , Chen Hui , Li Xiu-E
Published: November 2018

Background:

Oropharyngeal mucositis is considered to be an inevitable and the most troubling side effect of head and neck irradiation, which is caused by the direct toxic action of radiation on oral mucosa. Several randomized controlled trials (RCTs) have investigated the efficacy of zinc sulfate in prevention of radiation-induced oropharyngeal mucositis in patients with head and neck cancer. However, the definite conclusions have not been confirmed. The systematic review and meta-analysis will be performed to comprehensively evaluate whether zinc sulfate is effective in prevention of radiation-induced oropharyngeal mucositis in patients with head and neck cancer.

Methods:

Relevant information will be identified by a comprehensive search of the following electronic databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and EBSCO from their inception to October 2018. Only RCTs which evaluated whether zinc sulfate is effective in prevention of radiation-induced oropharyngeal mucositis in patients with head and neck cancer will be eligible. Two independent investigators will be assigned to search literature, screen information, extract data, and appraise the risk of bias. The primary investigator will use Revman 5.3 software to perform all statistical analyses. We designed this systematic review and meta-analysis on June 5. 2018, and expect to complete the full-text on December 20, 2018.

Results: This protocol has been registered with a unique identifier of CRD42018108533. We will submit this systematic review and meta-analysis to a peer-reviewed journal. Meanwhile, we also will dissemination the whole findings in topic-related conferences.

Conclusion: As the first systematic review and metaanalysis, the present study will elucidate current evidence of the role of oral zinc for the prevention and treatment of radiation-induced oropharyngeal mucositis in the head and neck cancer.
Central corneal thickness changes and horizontal corneal diameter in premature infants
Authors: Choo May May , Yeong Choo Mee , Grigg John R. , Khaliddin Nurliza , Kadir Azida Juana , Barnes Elizabeth H. , Kamalden Tengku Ain , Watson Stephanie L.
Published: November 2018

To report observations of horizontal corneal diameter (HCD) and central corneal thickness (CCT) changes in premature infants with stable optic disc cupping and intraocular pressures (IOPs). The HCD and CCT at term serve as a baseline for premature infants.

Sixty-three premature infants were enrolled in a prospective case series. HCD, CCT, and IOP were measured. RetCam images of the optic discs were used to evaluate the cup-disc ratio (CDR) and read by an independent masked observer. Data were collected at between preterm (32–36 weeks) and again at term (37–41 weeks) postconceptual age. Left eye measurements were used for statistical analysis. Left eye findings were combined to construct predictive models for HCD and CCT.

The mean HCD was 9.1 mm (standard deviation [SD] = 0.7 mm) at preterm and 10.0 mm (SD = 0.52 mm) at term. The mean CCT preterm was 618.8 (SD = 72.9) μm and at term 563.9 (SD = 50.7) μm, respectively. The average preterm CDR was 0.31 and at maturity was 0.33. Average IOP of preterm and term was 13.1 and 14.11 mm Hg, respectively. There was significant linear correlation between HCD with the postmenstrual age (r = 0.40, P < .01) and the head circumference (r = 0.33, P < .05). Predictive models were constructed for HCD (R
2 = 0.52, 0.2 mm/wk) and CCT (R
2 = 0.23, −11.4 μm/wk) with postconceptual ages.

The HCD and CCT variation did not affect IOP reading over time. CCT was not correlated with birth parameters and decreased as the infant reached term. Corneal diameter correlated with gestational age at birth and head circumference.
Successful treatment of drug-induced esophageal ulcer in a patient with chronic heart failure
Authors: Maesaka Kazuki , Tsujii Yoshiki , Shinzaki Shinichiro , Yoshii Shunsuke , Hayashi Yoshito , Iijima Hideki , Nakamoto Kei , Ohtani Tomohito , Sakata Yasushi , Takehara Tetsuo
Published: November 2018

Rationale:

Although esophageal compression due to cardiomegaly may be a risk factor of drug-induced esophageal injuries (DIEIs), the causal relationship between the two conditions has not been fully demonstrated.

Patient concerns:

We present a case of a drug-induced esophageal ulcer caused by left atrial enlargement in a 44-year-old woman with end-stage hypertrophic cardiomyopathy. Upper gastrointestinal endoscopy showed a deep, circumferential ulcer in the middle thoracic esophagus. CT revealed that the esophagus was compressed between the enlarged left atrium (LA) and the vertebral body. In the upper gastrointestinal series, retention of contrast media was observed in the esophagus near the LA.

Diagnosis:

The ulcer was a result of potassium chloride retention in the esophagus, which was compressed by the enlarged LA.

Intervention:

After cessation of potassium chloride administration for 2 months, the ulcer healed and a stricture developed. Two years after the ulcer development, the patient underwent heart transplantation, and subsequent endoscopic balloon dilation was performed for the esophageal stricture.

Outcomes:

The patient's oral intake recovered completely without any ulcer recurrence.

Lessons:

The case demonstrated that esophageal compression by the enlarged LA caused a drug-induced esophageal ulcer. Preventive care and treatment measures for DIEIs, including an anatomical approach, should be considered for patients with LA enlargement.
Protein-losing enteropathy secondary to nonocclusive mesenteric ischemia
Authors: Shima Takafumi , Ozeki Maiko , Kinoshita Takashi , Honda Kotaro , Inoue Hitoshi , Morita Shinsho
Published: November 2018

Rationale:

Nonocclusive mesenteric ischemia (NOMI) is a life-threatening disorder; prompt diagnosis is vital. Surgical treatment is often required, but some cases can be treated conservatively. We herein report an extremely rare case wherein protein-losing enteropathy (PLE) developed after conservative treatment of NOMI.

Patient concerns:

The patient was a 66-year-old man. He underwent laparoscopic super low anterior resection and temporary ileostomy for sigmoid colon cancer and rectum cancer. During the postoperative course, he developed ileus. Subsequently, he developed shock. On examination, the possibility of NOMI could not be denied, but intestinal necrosis was absent. Conservative treatment was initiated. His general condition improved, but the ileus persisted. Therefore, we performed a stoma closure. Ten days after stoma closure, he developed continuous unexplained diarrhea. The serum albumin and total protein levels were low. The symptoms improved after administration of an antidiarrheal drug, but the root cause was yet untreated.

Diagnosis:

The patient's alpha-1 antitrypsin clearance was increased. A CT scan revealed an enhanced hypertrophied wall of the short segment of the small intestine, and 99m Tc-labeled human serum albumin scintigraphy revealed protein leakage into the thickened wall of the small intestine. We arrived at a definitive diagnosis of PLE secondary to NOMI.

Interventions:

Partial resection of the affected small intestine was performed.

Outcomes:

The patient recovered uneventfully and was discharged on the 30th postoperative day.

Lessons:

NOMI has a high mortality rate, often requiring intestinal resection immediately after onset. To our knowledge, there is no report of PLE developing after conservative treatment, as in our case. Further study of cases is necessary to determine the reversibility of the condition, which will influence the therapeutic plan. We herein present an extremely rare case of PLE after conservative treatment for NOMI. The possibility of PLE also needs to be considered when hypoalbuminemia occurs after conservative treatment of NOMI.
Long term use of bevacizumab in the treatment of triple negative breast cancer with giant tumor in chest wall
Authors: Gui Xinyu , Li Huiping , Song Guohong , Shao Bin , Jiang Hanfang
Published: November 2018

Rationale:

Triple-negative breast cancer (TNBC) is associated with unfavorable prognosis due to lack of targeted agents. Bevacizumab, an anti-angiogenic monoclonal antibody against vascular endothelial growth factor A, has shown clinical effects in patients with TNBC.

Patient concerns:

We reported a 49-year-old woman presenting with a giant breast tumor.

Diagnoses:

Stage IV TNBC with chest wall metastasis.

Interventions:

The patient underwent long-term use of bevacizumab combined with chemotherapy.

Outcomes:

The patient was on follow-up for 46 months, a remarkable improvement of the chest wall cutaneous lesion was observed.

Lessons:

Bevacizumab may provide benefits for TNBC patients with chest wall metastasis.
Pyoderma gangrenosum around an ileostoma
Authors: Yu Yong-Ming , Lai Fu-Ji , Feng Chun , Chen Bei-Lei , Cao Yi-Sheng
Published: November 2018

Rationale:

Pyoderma gangrenosum (PG) is a rare postoperative complication of enterostomy, mostly developing from dermatitis, which may have serious consequence.

Patient concerns:

A patient with lower rectal cancer receiving low anterior resection (LAR) and protective ileostomy was initially diagnosed with dermatitis, which very quickly developed to PG, though no medical or familial history was found.

Diagnosis:

We diagnosed the patient with peristoaml dermatitis starting from a tiny skin ulceration, but corrected the diagnosis to PG because of the rapid development and severe consequences.

Interventions:

Routine stoma care did not improve the condition, so we performed 2 terms of debridement, the closure of the stoma and autologous skin transplantation before finally solving the problem.

Outcomes:

The patient was discharged 60 days after the first surgery and 5 days after the last one. After 18 months of follow-up, the patient kept in a stable condition.

Lessons:

Medical staff should not neglect peristoaml dermatitis because of its common occurrence. Once the situation develops beyond the doctors′ expectation, more efforts should be made to treat it, even expand debridement if possible.
Minimally invasive and open gastrectomy for gastric cancer
Authors: Wang Xixiong , Li Zhiqiang , Chen Meizhu , Wu Chenming , Fu Yexiang
Published: November 2018

Background:

The aim of this study is to find the better treatment for gastric cancer by comparing robotic gastrectomy, laparoscopic gastrectomy, and open gastrectomy using Bayesian network meta-analysis.

Methods:

We will search PubMed, Embase, and the Cochrane Library for eligible studies published before 1 September 2018. There will be no language restrictions. Randomized clinical trials that compare robotic gastrectomy, laparoscopic gastrectomy, or open gastrectomy for patients with gastric cancer will be included. The risk of bias of included studies will be assessed by the Cochrane Collaboration's tool for assessing risk of bias in randomized trial. The outcomes of the study include operation time, estimated blood loss, time of ambulation, times to first flatus, time of oral intake, hospitalization, and the occurrence of complication. If sufficient data is collected and adequate clinical homogeneity is established among studies, we will conduct pairwise meta-analyses and Bayesian network meta-analyses for all related outcome measures.

Ethics and dissemination:

The study does not involve human subjects and does not need ethical approval and patient consent. The results of the network meta-analysis will be disseminated in a peer-reviewed journal for publication.
Intralesional and subcutaneous application of Viscum album L. (European mistletoe) extract in cervical carcinoma in situ
Authors: Reynel María , Villegas Yván , Kiene Helmut , Werthmann Paul G. , Kienle Gunver S.
Published: November 2018

Rationale:

Carcinoma in situ (CIS) of the uterine cervix is a premalignant condition of squamous epithelium. The standard treatments are excision and ablation procedures; for women with positive margins, hysterectomy is recommended.

Patient concerns:

A 47-year-old Peruvian woman with recurrent candidal vaginitis had been diagnosed with colpocervicitis and squamous metaplasia 8 years ago, which were not treated.

Diagnoses:

The patient was diagnosed with CIS after cervical conization procedure. She refused radical hysterectomy and opted for integrative medicine treatment.

Interventions:

She was treated with intralesional and subcutaneous Viscum album L. extract (VAE) injections. VAE is a widely used herbal cancer treatment with cytotoxic, apoptogenic, and immunological effects, but it has not been investigated in cervical CIS.

Outcomes:

Ending month 5 of treatment, complete remission of cervical CIS was observed. The patient is still in remission after 30 months (until publication).

Lessons:

This is the first report on complete remission of cervical CIS after intralesional and subcutaneous injection with VAE. Prospective studies should evaluate to what degree the treatment effect is reproducible.
Telbivudine and adefovir dipivoxil combination therapy improves renal function in patients with chronic hepatitis B
Authors: Xu Yong , Nie Zhen-wang
Published: November 2018

Few studies have addressed the impact of adefovir dipivoxil (ADV)-based combination therapy on the renal function of patients with chronic hepatitis B (CHB). This study evaluated the effects of ADV combined with other antiviral nucleotide analogs (NAs) on renal function of patients with CHB, and analyzed the risk factors for more than 20% reduction of baseline estimated glomerular filtration rate (eGFR).

The data of 164 patients with CHB were retrospectively analyzed in this study. Of the 164 patients, 42 received entecavir (ETV) combined with ADV (ETV + ADV group), 68 lamivudine (LAM) combined with ADV (LAM + ADV group), and 54 telbivudine (LDT) combined with ADV (LDT + ADV group). Serum creatinine (SCr) level, eGFR, and proportion of patients with eGFR ≥ 90 mL/min/1.73 m2 were observed. Also, the independent risk factors for more than 20% reduction of baseline eGFR were analyzed.

After 104-week combination therapy, compared with the baseline level, SCr levels were significantly increased in the ETV + ADV group (67 μmol/L vs 73 μmol/L, P = .012) and LAM + ADV group (68 μmol/L vs 79 μmol/L, P = .008), but it was significantly decreased in the LDT + ADV group (69 μmol/L vs 64 μmol/L, P = .023). Compared with the baseline level, eGFR was significantly decreased in the ETV + ADV group (107.8 mL/min/1.73 m2 vs 96.1 mL/min 1.73/m2, P = .004), and LAM + ADV group (105.4 mL/min/1.73 m2 vs 87.3 mL/min/1.73 m2
, P = .000), but it was significantly increased in the LDT + ADV group (104.1 mL/min 1.73/m2 vs 116.2 mL/min/1.73 m2
,
P = .005). The proportion of patients with normal renal function (≥90 mL/min/1.73 m2) was significantly higher in the LDT + ADV group than in the ETV + ADV group (P = .002) and LAM + ADV group (P = .001). Multivariate analysis showed that age (P = .035), male (P = .005), baseline eGFR (P < .001), LAM combined with ADV (P < .008), and ETV combined with ADV (P = .03) were independent risk factors for 20% reduction of baseline eGFR.

As compared with ETV and ADV combination therapy as well as LAM and ADV combination therapy, LDT and ADV combination therapy can improve eGFR level, so LDT and ADV combination therapy is suitable for the patients with potential renal impairment.
Terlipressin for the treatment of acute variceal bleeding
Authors: Zhou Xinmiao , Tripathi Dhiraj , Song Tingxue , Shao Lichun , Han Bing , Zhu Jia , Han Dan , Liu Fufang , Qi Xingshun
Published: November 2018

Background and aim:

Acute variceal bleeding (AVB) is life-threatening. We aimed to systematically review the current evidence regarding the efficacy and safety of terlipressin for AVB in liver cirrhosis.

Methods:

We searched the PubMed, EMBASE, and Cochrane Library databases. The reference list was also hand-searched. Using a random-effect model, we combined the data obtained according to the different time points when the events developed. Odds ratio (OR) and weighted mean difference (WMD) were calculated. Quality of evidence was evaluated by the GRADE methodology.

Results:

Thirty randomized controlled trials with 3344 patients were included. Compared with no vasoactive drug, terlipressin significantly improved the control of bleeding within 48 hours (OR = 2.94, P = .0008) and decreased the in-hospital mortality (OR = 0.31, P = .008). Compared with somatostatin, terlipressin had a significantly higher risk of complications (OR = 2.44, P = .04). Compared with octreotide, terlipressin had a significantly inferior control of bleeding within 24 hours (OR = 0.37, P = .007). Compared with vasopressin, terlipressin had a significantly lower risk of complications (OR = 0.15, P = .02). Compared with terlipressin combined with endoscopic variceal ligation, terlipressin alone had significantly higher 5-day treatment failure (OR = 14.46, P = .01) and transfusion requirements within 49 to 120 hours (WMD = 1.20, P = .002). No outcome was significantly different between terlipressin and sclerotherapy. Compared with balloon tamponade, terlipressin significantly decreased the 30-day rebleeding (OR = 0.05, P = .001) and transfusion requirements (WMD = −2.70, P = .02). Quality of evidence was very low to moderate.

Conclusion:

Our findings were in accordance with the current recommendations regarding terlipressin for the treatment of AVB in cirrhosis. However, due to low quality of evidence, further studies are recommended.
Comparison of T2∗ mapping between regular echo time and ultrashort echo time with 3D cones at 3 tesla for knee meniscus
Authors: Yi Jisook , Lee Young Han , Song Ho-Taek , Suh Jin-Suck
Published: November 2018

The objectives of this study were to compare the ultrashort T2∗ relaxation time with the T2∗ relaxation time using the 3 dimensional (3D) cones sequence in 3 groups of patients with normal, degenerated, and torn knee menisci, and to demonstrate the additional effect of the ultrashort echo time (UTE) signal intensity.

Following institutional review board approval, 42 knee magnetic resonance imaging (MRI) scans of 42 patients who presented with knee pain and underwent knee MRIs, with the 3D Cones of UTE sequence (minimum TEs: 32 μs) and a 3T MRI scanner (Discovery 750, GE Healthcare, Waukesha, WI), were analyzed. The enrolled patients were classified into 3 subgroups:

normal meniscus on conventional MRI, with no positive meniscus-related physical examination in medical records;

meniscal degeneration with signal changes on conventional MRI; and

meniscal tear.

For the quantitative assessment, the mean values inside user-drawn regions of interest (ROIs) of the medial menisci were drawn on UTE T2∗ map and T2∗ map. For statistical analyses, 1-way analysis of variance (ANOVA) with post-hoc analysis using the Tukey HSD test was conducted to compare groups, and effect size was used to compare the discrimination power.

The ultrashort T2∗ relaxation times were higher in patients with meniscal tear than in those with normal and degeneration groups (P <.05, respectively) whereas T2∗ relaxation times were not statistically significantly different. The ultrashort T2∗ relaxation times showed higher effect sizes than the T2∗ times between tear and normal/degeneration.

The ultrashort T2∗ relaxation times showed better delineation of meniscal degeneration or tears than T2∗ relaxation times. The ultrashort T2∗ relaxation times could be more sensitive at differentiating between normal and pathologic meniscal conditions in patients.
Primary small bowel mesentery de-differentiated liposarcoma causing torsion with no recurrence for 5 years
Authors: Matsuo Kentaro , Inoue Masaya , Shirai Yasutsugu , Kataoka Tatsuki , Kagota Shuji , Taniguchi Kohei , Lee Sang-Woong , Uchiyama Kazuhisa
Published: November 2018

Rationale:

Liposarcoma (LPS) is a rare malignant soft-tissue tumor. Management of LPS is relatively difficult, because there are no characteristic symptoms, or biomarkers, nor any established effective treatment. Hence, the report of the accumulation of each LPS case is necessary. We experienced an extremely rare case of torsion caused by a primary small bowel mesentery LPS.

Patient's concern:

A 70-year-old male consulted our hospital with the complaints of abdominal pain and sudden vomiting.

Diagnosis:

No lump could be palpated, and tumor markers tested were within normal limits. However, computed tomography revealed an intestinal obstruction caused by torsion of the small bowel due to an LPS tumor.

Interventions:

After decompression of the intestinal obstruction by use of an ileus tube, surgical treatment was performed with rapidity.

Outcome:

The torsion was found to be caused by the tumor that originated from the small bowel mesentery. The tumor was resected along with a portion of the small bowel. The growth of adipose tissues of various sizes and containing atypical cells was detected by histopathological examination. Also, immunohistochemical examination resulted in positive immuno-reactions for MDM2, CDK4, and p16INK4, which indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 14 without any complications, and no recurrence of the tumor was observed at 5 years after the operation.

Lessons:

LPS should be considered in differential diagnosis of bowel torsion, and careful management is required because of the high possibility of recurrence. Patients should be followed carefully for at least 5 years, and further accumulation of data will be required in order to establish the appropriate management of LPS.
Pathologic and molecular studies of enterovirus 71 infection in a fatal case from a recent epidemic in China
Authors: Xing Jingjun , Wang Ke , Wei Hua , Wei Dengming
Published: November 2018

Rationale:

Enterovirus 71 (EV71) is identified as the primary cause of hand, foot, and mouth disease (HFMD) and mainly infects the young infants. Though some fatal cases have been reported, the underlying mechanisms of EV71 infection remain elusive and more further pathologic and molecular studies of EV71 infection are needed.

Patient concerns:

A 26-month-old girl with a history of fever and lethargy for 3 days and intermittent seizures for 2 hours associated with rash on 4 limbs was brought to a hospital.

Diagnoses:

The autopsy was performed to identify the cause of death for a medical dispute. The results of histologic examination, immunohistochemistry (IHC), nested reverse transcription polymerase chain reaction (RT-PCR), and viral isolation confirmed that this patient died of EV71 infection.

Interventions:

The patient was transferred to neonatal intensive care unit and was intubated and mechanically ventilated. The other treatment included cardiopulmonary resuscitation and intravenous injection of adrenaline.

Outcomes:

The patient presented persistent coma and intermittent seizures and suddenly developed respiratory arrest and died 16 hours after admission.

Lessons:

Our results suggest that EV71 might invade into the central nervous system (CNS) through peripheral nerves which control the digestive tract in the early stage of infection. In addition, we successfully isolated one EV71 strain. Phylogenetic analysis showed that the isolated strain clustered in the C4a of C4 subgenotype. This case also highlights that rapid deterioration in HFMD cases is still a challenge to physicians and they must pay special attention to the infants with HFMD symptoms, particularly in EV71 epidemic areas for early diagnosis and treatment.
Human deaths from drug overdoses with carfentanyl involvement—new rising problem in forensic medicine
Authors: Fomin Dmitrij , Baranauskaite Vilma , Usaviciene Emilija , Sumkovskaja Alina , Laima Sigitas , Jasulaitis Algimantas , Minkuviene Zita Nijole , Chmieliauskas Sigitas , Stasiuniene Jurgita
Published: November 2018

Carfentanyl, an ultra-potent synthetic opioid, is approved for use only in veterinary medicine as a tranquilizing agent. However, many cases of human poisoning with carfentanyl have recently appeared in the news with limited information given and scientific literature provides only 1 case of documented human exposure to carfentanyl.

Fifteen cases of death from drug overdoses with carfentanyl involvement are being presented. Fifteen blood and urine samples have been taken for alcohol and drug testing. Headspace gas chromatography was used for alcohol detection. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography–time-of-flight mass spectrometry (LC/MS TOF) system was used for drug detection.

Sixty-three cases of death from poisoning with drugs have been tested for carfentanyl in the State Forensic Medicine Service. Fifteen of them were positive for carfentanyl.

The cases mentioned above show that carfentanyl exposure causes signs and symptoms similar to other opioid toxicity. Carfentanyl intoxication may even be fatal if appropriate treatment is not available. Therefore, nowadays it is very important to draw forensic medicine expert's attention to new substances in drug trade.
Application of enamel matrix derivative and deproteinized bovine bone for the treatment of peri-implantitis after decontamination with an ultrasonic scaler
Authors: Park Jun-Beom
Published: November 2018

Rationale:

The purpose of this report is to present a case of peri-implantitis with successful regeneration. The surface of the affected dental implant was decontaminated with an ultrasonic scaler and treated with bovine-derived hydroxyapatite and enamel matrix derivative.

Patient concerns:

A 52-year-old male was referred for evaluation of a dental implant placed in the mandibular right second premolar area.

Diagnosis:

The radiographic evaluation showed the loss of supporting bone around the dental implant. Bleeding upon probing and suppuration were observed, with the deepest probing depth at 6 mm.

Interventions:

The area was firstly treated with a nonsurgical approach. After re-evaluation, a full-thickness flap was elevated. The area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area was grafted with bovine-derived hydroxyapatite and enamel matrix derivative.

Outcomes:

Histopathologic evaluation revealed chronic inflammation with fibrosis and calcification. The evaluation at 2 years and 3 months after surgery showed that the prosthesis was functioning well. Bleeding upon probing and suppuration was not noted, and reduction of probing depth was seen, with the deepest depth at 4 mm. The area showed maintenance of graft material with increased radiopacity around the dental implant.

Lessons:

In conclusion, a case of peri-implantitis can be successfully treated with bovine-derived hydroxyapatite and enamel matrix derivative after surface decontamination with an ultrasonic scaler.
Geographical variance in reporting of elective surgery for chronic pancreatitis
Authors: Baltatzis Minas , Jegatheeswaran Santhalingam , Siriwardena Ajith K.
Published: November 2018

The selection of optimum surgical procedure from the range of reported operations for chronic pancreatitis (CP) can be difficult. The aim of this study is to explore geographical variation in reporting of elective surgery for CP. A systematic search of the literature was performed using the Scopus database for reports of five selected procedures for CP: duodenum-preserving pancreatic head resection, total pancreatectomy with islet autotransplantation (TPIAT), Frey pancreaticojejunostomy, thoracoscopic splanchnotomy and the Izbicki V-shaped resection. The keyword and MESH heading ‘chronic pancreatitis’ was used. Overall, 144 papers met inclusion criteria and were utilized for data extraction. There were 33 reports of duodenum-preserving pancreatic head resection. Twenty-one (64%) were from Germany. There were 60 reports of TPIAT, 53 (88%) from the USA. There are only two reports of TPIAT from outwith the USA and UK. The 34 reports of the Frey pancreaticojejunostomy originate from 12 countries. There were 20 reports of thoracoscopic splanchnotomy originating from nine countries. All three reports of the Izbicki ‘V’ procedure are from Germany. There is geographical variation in reporting of surgery for CP. There is a need for greater standardization in the selection and reporting of surgery for patients with painful CP.
Diagnostic and Prognostic Impact of Neutrophil-to-Lymphocyte Ratio for Intraductal Papillary Mucinous Neoplasms of the Pancreas With High-Grade Dysplasia and Associated Invasive Carcinoma
Authors: Hata Tatsuo , Mizuma Masamichi , Motoi Fuyuhiko , Ishida Masaharu , Morikawa Takanori , Takadate Tatsuyuki , Nakagawa Kei , Hayashi Hiroki , Kanno Atsushi , Masamune Atsushi , Kamei Takashi , Furukawa Toru , Naitoh Takeshi , Unno Michiaki
Published: November 2018

Objectives

The aim of this study was to evaluate the diagnostic and prognostic impact of systemic inflammatory markers for IPMN with high-grade dysplasia (HGD)/invasive carcinoma.

Methods

Neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelet-to-lymphocyte ratio, and C-reactive protein–to–albumin ratio were compared across the different histological grades of 205 IPMN cases. We also tested the diagnostic performance for IPMN with HGD/invasive carcinoma.

Results

The median (interquartile range) preoperative NLR was higher in IPMN with HGD/invasive carcinoma (2.03 [1.48–2.93]) than IPMN with low-grade dysplasia (1.74 [1.42–2.24], P = 0.0137). The C-reactive protein–to–albumin ratio and derived NLR values were also significant higher in cases with HGD/invasive carcinoma. A combination assay of NLR, carcinoembryonic antigen, and carbohydrate antigen 19-9 revealed a 58.8% sensitivity and 76.8% specificity. Among the cases with worrisome features, the high NLR values increased the positive predictive value (68.8%) compared with low values (31.8%). In IPMN cases with the associated invasive carcinoma, high NLR values showed association with the deeper vertical invasion and shorter survival periods.

Conclusions

Preoperative NLR, combined with tumor markers and image findings, can be a useful predictive marker for the presence of HGD/invasive carcinoma in IPMNs. Preoperative NLR also predicts the long-term outcomes in IPMN cases with invasive carcinoma.
Asking for Feedback
Authors: Bowen-Brady Helene , Haag-Heitman Barbara , Hunt Valerie , Oot-Hayes Margaret
Published: November 2018

OBJECTIVE

The purpose of this study was to understand clinical nurses’ perceptions of their participation in a formal, annual peer review process at a metropolitan community hospital.

BACKGROUND

Peer review is an essential component of professional nursing practice for self-regulation of the practice and promotion of quality and safety. Robust empirical evidence of formalized and effective peer review nursing processes is not evident.

METHODS

A descriptive qualitative study with focus group interviews was used.

RESULTS

Study results validate that peer review is a meaningful and valuable process used by clinical nurses to support professional growth and development. Nurses reported using their specific peer feedback as part of their annual goal setting.

CONCLUSIONS

Results validate the importance of implementation of a structured, formal peer review process at the organizational level. The study findings identify that the essential components of an effective peer review process include education for peer facilitators and clinical nurses; dedicated time, space, and privacy to conduct peer reviews; and leadership support.
Utilization Rate of Helicobacter pylori Immunohistochemistry Is Not Associated With the Diagnostic Rate of Helicobacter pylori Infection
Authors: Son Jung H. , Lebwohl Benjamin , Sepulveda Antonia R. , Lagana Stephen M.
Published: November 2018

Background:

Utilization rates of immunohistochemistry (IHC) for the diagnosis of Helicobacter pylori infection may vary by laboratory and/or pathologists. IHC for H. pylori is not performed routinely in our practice. Instead, it is used in selected cases at the pathologists’ discretion (and according to their specific criteria). The purpose of this study was to determine if IHC utilization rates correlated with rates of detecting H. pylori infection.

Materials and Methods:

We searched our records and investigated all gastric biopsies for 1 calendar year. H. pylori diagnostic rate and IHC utilization rate was calculated for each pathologist.

Results:

Overall, the rate of diagnosis was 12.1% and the IHC utilization rate was 45.2%. Individual pathologists had H. pylori diagnostic rates ranging from 3.6% to 34.1% (median: 11.1%) and IHC utilization ranging from 17.1% to 95.2% (median: 42.2%). The rate of detection of H. pylori infection among pathologists showed no significant correlation with rates of IHC utilization (Pearson coefficient=0.121).

Conclusions:

Increasing use of IHC is not independently associated with the diagnostic rate of infection. Ultimately, if we assume that the case mix was similar for each pathologist, it suggests that more liberal criteria to order IHC does not result in more infections diagnosed.
NordiQC Assessments of CD117 Immunoassays
Authors: Røge Rasmus , Bzorek Michael , Nielsen Ole , Vyberg Mogens
Published: November 2018

This paper is the number 5 in a series developed through a partnership between ISIMM and NordiQC for the purpose of reporting research assessing the performance characteristics of immunoassays in an external proficiency-testing program.
Pleomorphic and Florid Lobular Carcinoma In Situ Variants of the Breast
Authors: Shamir Eliah R. , Chen Yunn-Yi , Chu Tianming , Pekmezci Melike , Rabban Joseph T. , Krings Gregor
Published: November 2018

The natural history and optimal treatment of pleomorphic (PLCIS) and florid (FLCIS) lobular carcinoma in situ variants remains uncertain. We reviewed the clinicopathologic features and management of LCIS variants at our institution over a 20-year period. Of 85 cases (61 PLCIS, 24 FLCIS), 77% were associated with invasive carcinoma (84% lobular, 13% ductal/lobular, 3% ductal) and only 17% (9 PLCIS, 5 FLCIS) were pure. Most (81%) invasive carcinomas were grade 2, with all grade 3/pleomorphic invasive lobular carcinomas (ILC) associated with PLCIS, and all grade 1 tumors associated with FLCIS. PLCIS-associated invasive carcinomas were more often ER− (21%) or HER2+ (14%) than FLCIS-associated tumors (100% ER+, 6% HER2+). LCIS variants were unifocal and co-localized with invasive carcinoma in 20/20 selected spatially mapped cases, whereas classic LCIS (CLCIS) was multifocal with wider distribution (10/17). Of 21 pure LCIS variants on core biopsy, all represented the radiographic (95%) or palpable (5%) target. The excisional upgrade rate was similar for PLCIS (38%) and FLCIS (33%). Pure LCIS variants on core biopsy were often (20%) HER2+ and had a higher Ki-67-index than synchronous CLCIS (P=0.002). Lower ER expression in LCIS variants versus CLCIS was due to ER− apocrine PLCIS. ER and HER2 were consistently concordant between LCIS variants and upgraded ILC but discordant between synchronous CLCIS and LCIS variants in 5/14 (36%). Pure LCIS variants were excised to negative margins and frequently (58%) treated with endocrine but not radiation therapy without recurrences. In summary, PLCIS and FLCIS demonstrate features of direct precursor lesions warranting surgical excision.