bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of physical therapy on the suboccipital area of patients with tension-type headache
Authors: Jiang Wenbin , Li Zhe , Wei Ning , Chang Wenli , Chen Wei , Sui Hong-Jin
Published: May 2019

Background:

There has been a lot of research on physical therapy for tension-type headaches. However, the efficacy of physical therapy on the suboccipital region remains unclear.

Objective:

To establish the effectiveness of physical therapy on the suboccipital area of patients with tension-type headache.

Methods:

Databases including Cochrane Library, Medline/Pubmed, CNKI, Embase, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently. On 1 hand, authors compared the treatment of the suboccipital area with control group. On the other hand, the efficacy of several physical therapy techniques on the suboccipital region was compared. The quality of the included studies was assessed using the Cochrane Handbook. RevMan 5.3 software was used for data analysis. The primary outcome measures were the cervical range of motion, the visual analog scale, and headache disability inventory.

Results:

Six randomized controlled trials with a total of 505 participants were included. Suboccipital soft-tissue inhibition technique (SIT) + occiput-atlas-axis global manipulation (OAA) was more effective than SIT in increasing craniocervical extension at 4 weeks post-treatment, the overall mean differences (MD) was 3.61, 95% confidence interval (CI) (0.89–6.34). There was no difference at 8 weeks post-treatment (MD 2.38, 95% CI −1.02 to 5.78, P = .17). SIT was more effective than SIT + OAA in increasing cervical flexion at 4-week post-treatment (MD −3.36, 95% CI −6.65 to −0.05). SIT + OAA was more effective than SIT on decreasing intensity of pain at 4-week post-treatment (MD −0.91, 95% CI −1.78 to −0.04), but no difference at 8-week (MD −0.43, 95% CI −1.18 to 0.33, P = .27). SIT + OAA was more effective than SIT in reducing the functional score of the headache disability inventory at 4-week post-treatment (MD −4.47, 95% CI −8.44 to −0.50). These results may indicate that the SIT + OAA combined therapy is more effective in short term (4-week), no major difference in longer term (8-week).

Conclusion:

Combined therapy may be more suitable for the treatment of tension-type headache.
Salvage therapy for subclavian artery perforation resulting in mediastinal hematoma during percutaneous coronary intervention
Authors: Li Wenhua , Shi Hongjian , Li Yong
Published: May 2019

Rationale:

Transradial access (TRA) is a widely used technique during percutaneous coronary intervention (PCI). However, mediastinal and cervical hematomas, the rare and severe complications of transradial approach, have extremely high mortality rates. To the best of our knowledge, there were no medical literatures about the successful anticoagulation reversal procedure of mediastinal hematoma in PCI till now.

Patient concerns:

We here present a 54-year-old male Han patient who underwent PCI. Immediately after PCI, he reported an episode of neck and chest discomfort, dyspnea, cough recurrence, and cold sweats. Emergency chest computed tomography (CT) revealed a perforation of the subclavian artery resulting in a large mediastinal hematoma with potentially lethal tracheal compression.

Diagnosis:

A diagnosis of the large mediastinal hematoma was made based on the enhanced computed tomography.

Interventions:

The patient was successfully managed with palliative therapy of anticoagulation reversal instead of a covered stent graft and surgical operation.

Outcomes:

Angiography confirmed the absence of leakage after anticoagulation reversal. The patient had an apparent remission of clinical dyspnea. Follow-up CT confirmed an almost entire absorption of the mediastinal hematoma 35 days postdischarge.

Lessons:

The current case highlights the importance of anticoagulation reversal as well as careful guidewire and guide catheter manipulation by the radial approach. Early evaluation, prompt identification, appropriate treatment, and close monitoring are all essential for invasive cardiology.
Compare the efficacy of acupuncture with drugs in the treatment of Bell's palsy
Authors: Zhang Rongchao , Wu Tao , Wang Ruihui , Wang Dong , Liu Qi
Published: May 2019

Background:

Bell's palsy or idiopathic facial paralysis is an acute facial paralysis caused by the inflammation of facial nerve. Several previous studies showed that acupuncture was beneficial in the treatment of facial paralysis. However, its effectiveness is still controversial compared with drug therapy. Therefore, this systematic review and meta-analysis was performed to assess the efficacy of acupuncture for Bell's palsy.

Methods:

This is a systematic review and meta-analysis of clinical studies among patients with Bell's palsy. We did a systematic literature search in PubMed, Embase, and the Cochrane Register of Controlled Trials to identify studies comparing the efficacy of acupuncture and drug treatment in treating facial paralysis. The search was last updated on July 2018.

Results:

The study included 11 randomized controlled trials with an overall sample of 1258 individuals. Acupuncture treatment was associated with an increased cure rate [relative risk (RR) = 1.77, 95% confidence interval (CI): 1.41–2.21], with significant heterogeneity in the pooled results (I2 = 67%, P = .0008). There was a significant difference in total effective rate in acupuncture and drug treatment for Bell's palsy (RR = 1.18,95% CI: 1.07–1.31), with substantial heterogeneity (I2 = 90%, P < .00001).

Conclusion:

Although there was not enough evidence to prove its safety, acupuncture seems to be an effective therapy for Bell's palsy. Results of the present meta-analysis showed that acupuncture was associated with increased cure rate and total effective rate of the treatment of Bell's palsy in comparison with drugs. However, the results should be interpreted cautiously, because of the poor quality and heterogeneity of the included studies. In the future, more and more high quality randomized controlled trials (RCT) are needed to prove the safety and effectiveness of acupuncture.
Magnetic stimulation for female patients with stress urinary incontinence, a meta-analysis of studies with short-term follow-up
Authors: Peng Liao , Zeng Xiao , Shen Hong , Luo De-yi
Published: May 2019

Background:

To determine the efficacy of magnetic stimulation (MS) in female patients with stress urinary incontinence (SUI) by performing a meta-analysis on peer-reviewed randomized controlled trails (RCTs).

Methods:

PubMed, Embase, and Cochrane library were retrieved for any peer-reviewed original articles in English. Databases were searched up to July 2018. Included studies investigated effects of MS on SUI. The data were analyzed by review manager 5.3 software (Cochrane Collaboration, Oxford, UK).

Results:

A total of 4 studies involving 232 patients were identified and included in present meta-analysis. Compared with the sham stimulation, the MS group had statistically significantly fewer leaks/3 days (MD = −1.42; 95%CI: −2.42 to −0.59; P = .007), less urine loss on pad test (g.)/24 h (MD = −4.99; 95%CI: −8.46 to −1.53; P = .005), higher QoL scores (MD = 0.42; 95%CI: 0.02–0.82; P = .009), and lower ICIQ scores (MD = −4.60; 95%CI: −5.02 to −4.19; P < .001). MS presented higher cure or improvement rate, with a statistically significant improvement in UDI and IIQ-SF scores compared to sham stimulation. No MS-related adverse effects were reported in study.

Conclusion:

MS leads to an improvement in SUI without any reported safety concerns and an improvement in patient quality of life. The long-term outcome of this technique remains unclear and is the subject of ongoing research.
Brain education-based meditation for patients with hypertension and/or type 2 diabetes
Authors: Lee Seung-Ho , Hwang Sun-Mi , Kang Do-Hyung , Yang Hyun-Jeong
Published: May 2019

Background:

Hypertension and type 2 diabetes are chronic diseases, which generally require lifetime care. Meditation and yoga can be complementary to pharmacological therapies according to the scientific evidences so far. Brain education-based meditation (BEM) is a technique, which has been known to change brain structure, psychology, and physiology of healthy adult participants. This randomized, nonblinded pilot trial aimed to examine whether BEM affects the conditions of patients with hypertension and/or type 2 diabetes compared with health education classes.

Methods:

We randomly allocated 48 patients with hypertension and/or type 2 diabetes to BEM (n = 24) or health education (n = 24) classes in the Ulsan Junggu Public Health Center in Korea, where the classes were run during the same period and explored the impact of 8-week practice on the serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, gamma glutamyl transpeptidase, creatinine, high-density lipoprotein cholesterol, and low-density lipoprotein (LDL) cholesterol. Total RNA was extracted to examine inflammatory gene expressions from the whole blood using PAXgene blood RNA System. In addition, self-reports on mental/physical health were evaluated. The Student'sttest, chi-squared test, and analysis of covariance were used for statistical analysis.

Results:

The number of people who participated until the completion of the study was 14 in the control and 21 in the BEM group. After 8 weeks, LDL cholesterol level was significantly decreased in the BEM group after the intervention (13.82 mg/dL reduction,P < .05), while it was not significantly altered in the control group. The expression of inflammatory genes was significantly reduced after 8 weeks of the BEM training (0.3-, 0.5-, and 0.2-fold change forNFKB2,RELA, andIL1B, respectively, allP < .05). In the item analysis of mental/physical health self-reports, a significant improvement was confirmed as follows: increases in focus, confidence, relaxation, and happiness; decreases in fatigue, anger, and loneliness (allP < .05). There were no important adverse events or side-effects by BEM intervention.

Conclusion:

Compared to health education, BEM helps lower LDL cholesterol level and the inflammatory gene expression in the patients with hypertension and/or type 2 diabetes. Moreover, BEM induces positive effects on the self-reported mental/physical states, warranting further study.
Diagnostic efficacy of smear plus liquid-based cytology for EUS-FNA of solid pancreatic lesions
Authors: Itonaga Masahiro , Murata Shin-Ichi , Hatamaru Keiichi , Tamura Takashi , Nuta Junya , Kawaji Yuki , Maekita Takao , Iguchi Mikitaka , Kato Jun , Kojima Fumiyoshi , Yamaue Hiroki , Kawai Manabu , Okada Ken-Ichi , Hirono Seiko , Shimokawa Toshio , Tanioka Kensuke , Kitano Masayuki
Published: May 2019

Liquid-based cytology (LBC) is a thin-layer slide preparation procedure that was developed to overcome the cell crowding and contamination associated with smear cytology (SC). The present study compared diagnostic efficacy between SC alone and SC combined with LBC (SLBC) using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of pancreatic lesions.

We retrospectively analyzed data derived from 311 consecutive patients. Specimens obtained via EUS-FNA from 179 patients between December 2011 and May 2016 were analyzed by SC, and those obtained from 132 patients between June 2016 and October 2017 were analyzed by SLBC. The 2 groups were compared in terms of adequate sample rate, diagnostic accuracy, sensitivity, and specificity using propensity score matching.

SC and SLBC were compared using propensity score-matching in 204 patients (n = 102 per group). The adequate sample rate did not differ significantly between SLBC (100%) and SC (99.0%, P = 1). Diagnostic sensitivity, negative predictive value and accuracy were better for SLBC than for SC in terms of cytological (93.2% vs 67.4%, 68.4% vs 23.1%, and 94.1% vs 69.6%, P < .01 each, respectively) and cytohistological (95.5% vs 81.5%, 76.5% vs 34.6%, and 96.1% vs 82.4%, P < .01, P = .02, and P < .01, respectively) analyses.

SLBC improves the diagnostic efficacy of EUS-FNA for pancreatic lesions compared to LBC.
Increased risk of appendectomy due to appendicitis after tonsillectomy in women
Authors: Kim So Young , Min Chanyang , Oh Dong Jun , Choi Hyo Geun
Published: May 2019

The purpose of this study was to evaluate the risk of appendectomy due to appendicitis after tonsillectomy in Koreans using national cohort data. Using the national cohort study from the Korean Health Insurance Review and Assessment Service, 1:4 matched tonsillectomy participants (9015) and control participants (36,060) were selected. The Cox-proportional hazard model was used. In this analysis, a crude and adjusted model for age, sex, income, region of residence, and the past medical histories of hypertension, diabetes mellitus, and dyslipidemia were used. For the subgroup analyses, the participants were divided as follows: children (≤14 years old) vs adolescents and adults (≥15 years old) and men vs women. The adjusted hazard ratio (HR) of tonsillectomy for appendectomy was 1.06 (95% confidence interval, CI = 0.89–1.27, P = .517). In the subgroup analysis, the HR was 1.03 (95% CI = 0.82–1.30, P = .804) in children and 1.10 (95% CI = 0.84–1.47, P = .468) in adolescents and adults. In another subgroup analysis, the HR was 0.89 (95% CI = 0.70–1.12, P = .314) in men and 1.39 (95% CI = 1.06–1.83, P = .018) in women. The risk of appendectomy was higher in the tonsillectomy group but only in women.
Outcomes of patients with non-diagnostic bronchoscopy
Authors: Venkatram Sindhaghatta , Pena Damaris , Bajantri Bharat , Diaz-Fuentes Gilda
Published: May 2019

Bronchoscopy is one of the most common diagnostic procedures in pulmonary practice. Data on the outcome of patients following a non-diagnostic bronchoscopy are sparse. Diagnostic yield depends on indication, the characteristics of patients, and the chest imaging. The aim of this study was to evaluate the outcomes of patients with a non-diagnostic bronchoscopy and to compare patients who had a diagnostic with those that had a non-diagnostic bronchoscopy.

Retrospective, single-center study of adult patients who underwent bronchoscopy with transbronchial biopsy (TBBX) and/or endobronchial biopsy (EBBX), endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), or brushing. A strict definition for a “diagnostic” bronchoscopy was used. Univariate and multivariate analyses were performed.

A total of 684 patients were identified, 350 (51%) had a diagnostic procedure. Of the 334 patients with a non-diagnostic bronchoscopy, 196 (58.6%) were followed, but only 172 (88%) completed 1 year of follow-up. Most of the patients (57.8%) had resolution or stabilization of the condition; in the remaining patients, malignancy was most commonly diagnosed after further investigation followed by diffuse lung diseases and infections. Pulmonary tuberculosis was diagnosed in 8 patients. EBUS-TBNA and EBBX were the procedures associated with a diagnostic bronchoscopy. Presence of bilateral interstitial infiltrates predicted a non-diagnostic bronchoscopy.

A significant number of patients with non-diagnostic bronchoscopy may have serious treatable disease that is identified upon further investigation. Close follow up of patients with a non-diagnostic procedure is warranted. Our study found no clear clinical or radiological predictors of diagnostic bronchoscopy.
Herpes zoster involving the abducens and vagus nerves without typical skin rash
Authors: Joo Taesung , Lee Young Chan , Kim Tae Gi
Published: May 2019

Rationale:

Herpes zoster is characterized by unilateral vesicular eruption and it most often affects the trigeminal nerve. We would like to report a rare case of abducens and vagus nerves palsy caused by varicella zoster virus (VZV) without the typical vesicular rash.

Patient concerns:

A 71-year-old woman presented with diplopia. Three days previously, she had experienced sore throat and hoarseness.

Diagnosis:

At presentation, the prism cover test revealed esotropia of 10 prism diopters at primary gaze, and abduction was restricted in the right eye. No vesicular rash was observed on the patient's face, and magnetic resonance imaging of the brain showed no pathology. Flexible fiberoptic laryngoscopy revealed multiple ulcerations on the right side of the larynx—from the epiglottis to the arytenoid. After 1 day of hospitalization, a diffuse skin rash occurred on the patient's trunk, and polymerase chain reaction for VZV DNA was positive at the skin lesion. The patient was diagnosed as having herpes zoster associated with vagus and sixth nerve palsy.

Intervention and outcomes:

She received famciclovir at a dose of 500 mg 3 times daily for 7 days and coadministered methylprednisolone. At the 4-month follow-up, her diplopia and eye movement had resolved completely.

Lessons:

In patients with abducens nerve palsy without typical vesicular lesion, herpes zoster may not be detected early. In that case, systemic examination is very important for diagnosing herpes zoster.
Structural and functional connectivity of ascending reticular activating system in a patient with impaired consciousness after a cardiac arrest
Authors: Parra-Morales Alejandra M. , Rudas Jorge , Vargas Jorge A. , Gómez Francisco , Enciso-Olivera Cesar O. , Trujillo-Rodriguez Diana , Martínez Darwin , Hernandez José , Ordóñez-Rubiano Edgar G. , Marín-Muñoz Jorge H.
Published: May 2019

Rationale:

Diffusion tensor imaging (DTI), diffusion tensor tractography (DTT), as well as resting-state-functional magnetic resonance imaging (rsfMRI) are promising methods for assessing patients with disorders of consciousness (DOCs).

Patient concerns:

This work describes the main findings using DTI, DTT, and rsfMRI in a patient with a DOC secondary to an anoxic encephalopathy who had a fatal outcome. She was an 85-year-old woman who presented a cardiac arrest and underwent cardiopulmonary resuscitation for 20 minutes then returning to spontaneous circulation. After sedation withdrawal, 2 days after the event, she remained with a Glasgow Coma Scale score of 3/15 and with an absence of brainstem reflexes.

Diagnoses:

DOC secondary to an anoxic encephalopathy after cardiovascular resuscitation.

Interventions:

A complete brain MRI scan was performed 72 hours after the initial event, including DTI, DTT, and rsfMRI. DTT demonstrated disruption of both ventral and dorsal tegmental tracts bilaterally. DTI showed a reduction of fractional anisotropic level in the mesencephalic nuclei. Moreover, changes in the number of fiber tracts were not evidenced in any portions of the ascending reticular activating system (ARAS). Finally, an increase in the anticorrelated and correlated association among the nuclei in the ARAS and the cortex was evidenced.

Outcomes:

Patient deceased.

Lessons:

Neuroimaging demonstrated low FA values in the ARAS, destruction of dorsal and ventral tegmental tracts, as well as hyper-connective (highly correlated or anti-correlated) association among ARAS and cortical nuclei compared with 3 healthy control subjects.
The effect of meditative movement for glucose control in patients with type 2 diabetes
Authors: Xia Tingwei , Yang Yue , Li Weihong , Tang Zhaohui , Li Zongrun , Guo Yongsong
Published: May 2019

Background:

Type 2 diabetes is one of the most common and complex chronic disease. A lot of clinical researches have focused on meditative movement for type 2 diabetes. However, there is no systematic review and meta-analysis has been conducted. We aim to systematically review the effect of meditative movement on the type 2 diabetes care.

Methods:

The databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Ovid LWW, EMBASE will be searched. Studies published from the time when the database establishment to December 2018 will be retrieved. RCTs study on meditative movement for glucose control in patients with type 2 diabetes will be included. The primary outcomes are HbA1c, fasting blood glucose, and postprandial blood glucose (PPBG). RevMan V.5.3 software will be used to perform the analyses.

Results:

This study will provide high-quality synthesis of effectiveness and safety of meditation movement for type 2 diabetes.

Conclusion:

This systematic review will provide high-quality evidence to judge whether the meditative movement is beneficial to glucose control in patients with type 2 diabetes.

PROSPERO registration number: CRD42019128495
Low serum bilirubin, albumin, and uric acid levels in patients with Crohn's disease
Authors: Su Qisheng , Li Xiaohong , Mo Wuning , Yang Zheng
Published: May 2019

Serum concentrations of bilirubin, albumin, and uric acid (UA) play important roles in controlling oxidative stress. Until now, there are few researches related to the relationship between oxidative stress and Crohn's disease (CD); furthermore, no such study has been reported from China. Our aim was to evaluate serum bilirubin, albumin, and UA levels in CD patients and relate them to disease activity.

Seventy-one patients diagnosed with CD and 125 sex- and age-matched healthy individuals were retrospectively analyzed during the same period. Clinical characteristics and laboratory parameters were analyzed in CD patients and healthy control groups.

Serum levels of bilirubin, albumin, and UA in patients with CD were significantly lower than those in the healthy control group. Correlation analysis demonstrated that serum concentrations of total bilirubin, direct bilirubin, indirect bilirubin, albumin, and UA were negatively related to disease activity in patients with CD (r = −0.620,P < .001;r = −0.304,P < .05;r = −0.623,P < .001;r = −0.408,P < .01; andr = −0.296,P < .05; respectively).

Serum bilirubin, albumin and UA levels were significantly lower in CD patients, suggesting potential correlations between serum bilirubin, albumin, and UA levels and disease activity in CD patients. In addition, the noninvasive biochemical index may be potential markers for assessing the disease activity of patients with CD.
Anesthetic management for a patient with bronchobiliary fistula after pancreaticoduodenectomy
Authors: Lee Jungwon , Jung Sung Mee , Lee Yongbae , Kim Sae-Yeon
Published: May 2019

Rationale:

Perioperative management of patients with bronchobiliary fistula (BBF) is an anesthetic challenge because they typically exhibit poor lung function preoperatively, require meticulous lung isolation intraoperatively and need postoperative respiratory support.

Patient concerns:

A 44-year-old man with a past surgical history of pancreaticoduodenectomy presented fluctuating fever, jaundice, dyspnea and yellowish sputum. Despite intravenous antibiotic treatment and repeated percutaneous drainage, patient showed gradual deterioration with hypoxemia, and uncontrolled pneumonia.

Diagnoses:

The patient was diagnosed with BBF based on the clinical manifestation such as biloptysis with pneumonia, and imaging studies.

Interventions:

Resection of the fistula and bilobectomy was performed under general anesthesia. Avoidance of positive pressure ventilation before lung isolation and precise lung isolation are essential for patients with BBF to protect the unaffected lung. Therefore, rapid sequence induction was performed. Left-sided double-lumen tube was inserted for lung isolation and position of the tube was confirmed by visualization with fiberoptic bronchoscopy. Bile-stained secretion was repeatedly suctioned in trachea and both bronchi during surgery.

Outcomes:

In spite of decrease in SpO2 with institution of one-lung ventilation, the patient's oxygenation was gradually improved as surgery progressed without hemodynamic instability. At the end of surgery, the double-lumen tube was replaced with a single-lumen endotracheal tube for postoperative mechanical ventilation.

Lessons:

Absolute lung isolation using double-lumen tube for one-lung ventilation and bronchial toilet during surgery and replacement of single-lumen tube for postoperative respiratory support at the end of surgery are effective to improve oxygenation in patients with BBF.
Rib cartilage in Asian rhinoplasty: new trends
Authors: Yoo Shin Hyuk , Jang Yong Ju
Published: May 2019

Purpose of review

Costal cartilage has many advantages over other grafting materials because of its large quantity and high biocompatibility. As a result, it has been considered as a good option for Asian rhinoplasty. However, costal cartilage is difficult to use and is associated with a high complication rate. To avoid the disadvantages and complications of costal cartilage graft, several techniques have been proposed in the literature. This review addresses the conventional uses of costal cartilage in Asian rhinoplasty and recent updates.

Recent findings

Different techniques have been reported for Asian rhinoplasty using costal cartilage. Solid-block costal cartilage and diced cartilage with or without wrapping materials are widely used for dorsal augmentation. Many different grafting techniques for the tip and septal reconstruction have been reported by numerous surgeons. When using costal cartilage graft, surgeons should pay attention to both graft complications, such as warping or infection, and donor-site morbidity. Several strategies have recently been developed to avoid these complications.

This article summarises grafting options for Asian rhinoplasty using costal cartilage and possible complications. This information may assist with proper selection of appropriate techniques for harvesting, carving and grafting costal cartilage.
Diagnosis and management of hypopituitarism
Authors: Yeliosof Olga , Gangat Mariam
Published: May 2019

Purpose of review

This review summarizes pituitary function, and the clinical presentation and treatment of hypopituitarism.

Recent findings

Updates in the field include new guidelines and meta-analyses on the diagnosis and treatment of select hormone deficiencies, novel treatment options, and advances in next generation sequencing technology.

Hypopituitarism is defined as partial or complete loss of a single or multiple pituitary hormones. The clinical presentation of hypopituitarism varies depending on the number and severity of hormone deficiencies. Treatment involves the physiologic replacement of the individual end-organ hormone deficiencies and requires close lifelong monitoring.
The Gray Degeneration of the Brain and Spinal Cord
Authors: Ganesh Aravind , Stahnisch Frank W.
Published: May 2019

In 1857, French-Austrian psychiatrist Bénédict Augustin Morel (1809–1873) published his infamous though highly successful Traité des dégénérescences physiques, intellectuelles et morales de l'espèce humaine, which was fully dedicated to the social problem of “degeneration” and its psychiatric and neurological underpinnings. European psychiatrists, neurologists, and pathologists integrated Morel's approach into their neuropsychiatric theories and searched for the somatic and morphological alterations in the human brain, as did the versatile pupil of Rudolph Virchow (1821–1902), Georg Eduard von Rindfleisch (1836–1908), in his Lehrbuch der pathologischen Gewebelehre (1867). This can be seen as a starting point of research into the vascular genesis of “multiple sclerosis” by observing that the changes of blood vessels and nerve elements could be the result of inflammation and increased blood flow. We examine the waxing and waning of a 19th century diagnostic condition, which fell out of favor and resurfaced during the 20th century.
Surgical Excision Versus Ablation for Superficial Endometriosis-Associated Pain: A Randomized Controlled Trial
Authors: Riley Kristin A. , Benton Andrea S. , Deimling Timothy A. , Kunselman Allen R. , Harkins Gerald J.
Published: May 2019

(Abstracted from J Minim Invasive Gynecol 2019;26:71–77)

The primary sequelae of endometriosis are infertility and chronic pelvic pain (CPP). Nearly 40% of women with endometriosis are infertile, and 71% to 87% have CPP.
The Effectiveness of Regular Exercise Programs in the Prevention of Gestational Diabetes Mellitus—A Systematic Review
Authors: Makaruk Beata , Galczak-Kondraciuk Anna , Forczek Wanda , Grantham Weronika , Charmas Małgorzata
Published: May 2019

Importance

Physical activity is recognized as one of the most important tools in the management of gestational diabetes mellitus (GDM).

Objective

The aim of this review was to compare and analyze regular prenatal exercise programs and examine their effectiveness in the prevention of GDM.

Evidence Acquisition

The following databases were used: Academic Search Complete, Health Source–Consumer Edition, Health Source–Nursing/Academic Edition, Master File Premier, MEDLINE, and SportDiscus with full text. The inclusion criteria were as follows: a randomized study, regular training program throughout pregnancy, and supervised by a prenatal activity specialist.

Results

The 10 articles selected for the review were divided into 2 groups. The first group comprised 2 studies presenting successful interventions in the prevention of GDM, whereas the second group included 8 articles with no statistically significant effects of the training programs in GDM prevention. Beginning an exercise program at early stages of the pregnancy and high adherence were common features of the effective programs.

Conclusions

When designing and carrying out the program, the beginning of the intervention and adherence should be considered. To increase adherence, the program should be attractive and it should meet the participants' needs.

Relevance

This review might be used for identifying factors deciding whether an exercise program is an effective intervention to prevent the development of GDM. Moreover, it might also prove useful in the preparation of future guidelines for designing and implementing regular exercise programs effective in preventing GDM in pregnant women by gynecologists, obstetricians, midwives, trainers, and prenatal specialists.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, physicians should be better able to compare and analyze regular prenatal exercise programs; identify the most effective exercise programs in the prevention of GDM; distinguish factors decisive in gravid participants' involvement in regular physical activity sessions; and prepare for preparation of the future guidelines regarding regular exercise programs effective in preventing GDM.
Intravaginal Diazepam for the Treatment of Pelvic Floor Hypertonic Disorder: A Double-blind, Randomized, Placebo-Controlled Trial
Authors: Holland Michael A. , Joyce John S. , Brennaman Lisa M. , Drobnis Erma Z. , Starr Julie A. , Foster Raymond T.
Published: May 2019

(Abstracted from Female Pelvic Med Reconstr Surg 2019;25:76–81)

Pelvic floor hypertonic disorder is a neuromuscular condition that causes involuntary spasms of the levator ani muscles, resulting in reproducible pelvic pain during vaginal intercourse or internal pelvic examination. It may act as a primary pain generator, a singular component of pelvic pain, or cause bladder or bowel dysfunction.
Clinical Practice Guidelines for the Rehabilitation of Lower Limb Amputation
Authors: Webster Joseph B. , Crunkhorn Andrea , Sall James , Highsmith M. Jason , Pruziner Alison , Randolph Billie J.
Published: May 2019

Between 2015 and 2017, the US Department of Veterans Affairs and the US Department of Defense developed a clinical practice guideline for rehabilitation of lower limb amputation to address key clinical questions. A multidisciplinary workgroup of US Department of Veterans Affairs and US Department of Defense amputation care subject matter experts was formed, and an extensive literature search was performed which identified 3685 citations published from January 2007 to July 2016. Articles were excluded based on established review criteria resulting in 74 studies being considered as evidence addressing one or more of the identified key issues. The identified literature was evaluated and graded using the National Academies of Science GRADE criteria. Recommendations were formulated after extensive review. Eighteen recommendations were confirmed with four having strong evidence and workgroup confidence in the recommendation. Key recommendations address patient and caregiver education, consideration for the use of rigid and semirigid dressings, consideration for the use of microprocessor knees, and managed lifetime care that includes annual transdisciplinary assessments. In conclusion, this clinical practice guideline used the best available evidence from the past 10 yrs to provide key management recommendations to enhance the quality and consistency of rehabilitation care for persons with lower limb amputation.
Blended Collaborative Care to Treat Heart Failure and Comorbid Depression: Rationale and Study Design of the Hopeful Heart Trial
Authors: Herbeck Belnap Bea , Anderson Amy , Abebe Kaleab Z. , Ramani Ravi , Muldoon Matthew F. , Karp Jordan F. , Rollman Bruce L.
Published: May 2019

Objective

Despite numerous improvements in care, morbidity from heart failure (HF) has remained essentially unchanged in recent years. One potential reason is that depression, which is comorbid in approximately 40% of hospitalized HF patients and associated with adverse HF outcomes, often goes unrecognized and untreated. The Hopeful Heart Trial is the first study to evaluate whether a widely generalizable telephone-delivered collaborative care program for treating depression in HF patients improves clinical outcomes.

Methods

The Hopeful Heart Trial aimed to enroll 750 patients with reduced ejection fraction (HFrEF) (ejection fraction ≤ 45%) including the following: (A) 625 patients who screened positive for depression both during their hospitalization (Patient Health Questionnaire [PHQ-2]) and two weeks following discharge (PHQ-9 ≥ 10); and (B) 125 non-depressed control patients (PHQ-2(−)/PHQ-9 < 5). We randomized depressed patients to either their primary care physician's “usual care” (UC) or to one of two nurse-delivered 12-month collaborative care programs for (a) depression and HFrEF (“blended”) or (b) HrEFF alone (enhanced UC). Our co-primary hypotheses will test whether “blended” care can improve mental health–related quality of life versus UC and versus enhanced UC, respectively, on the Mental Component Summary of the Short-Form 12 Health Survey. Secondary hypotheses will evaluate the effectiveness of our interventions on mood, functional status, hospital readmissions, deaths, provision of evidence-based care for HFrEF, and treatment costs.

Results

Not applicable.

Conclusions

The Hopeful Heart Trial will determine whether “blended” collaborative care for depression and HFrEF is more effective at improving patient-relevant outcomes than collaborative care for HFrEF alone or doctors' UC for HFrEF.

Trial registration:
ClinicalTrials.gov identifier NCT02044211.
Utilization of a Role-Based Head Covering System to Decrease Misidentification in the Operating Room
Authors: Rosen David A. , Criser Andrew L. , Petrone Ashley B. , Jackson Eugenie , Bowers Jay
Published: May 2019

Objectives

In a typical operating room (OR), there are many individuals who present all dressed in similar attire, making it extremely difficult to distinguish a person's role in the OR. Misidentification of an individual in the OR can make effective communication difficult, which could adversely impact patient safety. Furthermore, an inability to identify graduate medical students or distinguish students from OR faculty may hinder student learning opportunities within the OR. The purpose of this study was to determine whether implementation of a role-based, colored head covering requirement would improve identification in the OR and ultimately patient safety.

Methods

Operating room faculty and graduate medical students completed a four-question survey to assess opinions on misidentification in the OR, 1 month before and 2 months after a role-based head covering requirement was instituted in the OR. We analyzed the data from a total of 28 preintervention responses.

Results

Before intervention, students and OR faculty reported that it was difficult to distinguish students from OR faculty in the OR. After intervention, there was a significant decrease in the proportion of respondents who felt that it was difficult to distinguish students in training from trained OR personnel from 79% to 42% (P = 0.007)

Conclusions

Implementation of a role-based head covering system in the OR significantly increased the ability to determine a person's role in the OR. This study provides evocative support for a simple, inexpensive solution able to improve patient safety and learning opportunities for graduate medical students.
Styloid Process Osteoradionecrosis: Report of 3 Cases
Authors: Elakkad Ahmed , Romero-Sanchez Griselda Teresa , Forghani Reza , Ginsberg Lawrence E.
Published: May 2019

We report the imaging and clinical findings in 3 patients with osteoradionecrosis of the styloid process, an uncommon consequence of radiation therapy for head and neck malignancy.
Ultrasound Visualization of Torsional Anatomic Changes From External Rotation of the Anterior Shoulder
Authors: Strakowski Jeffrey A. , Chiou-Tan Faye Y. , Forrest Elizabeth G. , Ughwanogho Uvieoghene O. , Taber Katherine H.
Published: May 2019

The sonographic appearance of soft tissue can be altered with movement. This can be related to both position change as well as torsional stress. The objective of this article is to demonstrate sonographic anatomy of the anterior shoulder as it moves into full external rotation.

Methods

Ultrasound images were obtained in a healthy human subject. Conventional imaging locations were selected that are typically utilized to assess musculoskeletal and peripheral nerve anatomy as well as perform therapeutic injections. The transducer was centered over each region to obtain both short- and long-axis views. A pair of sonographic images was recorded for both imaging planes at each site: the first in anatomic neutral and second in full external rotation. In addition, a video recording was made at each site to track the movement of the muscles and nerves during external rotation.

Results

The rotator interval including the intertubercular groove and biceps brachii long head moves far laterally when viewed in short axis, and it becomes out of plane when viewed in long axis. The subscapularis is relatively poorly visualized with the shoulder in neutral position, but the tendon and more distal aspect of the muscle are well visualized in full external rotation. The pectoralis major tendon insertion is well visualized in long axis with the shoulder in both neutral position and full external rotation. Movement of the humerus and the pectoralis major insertion are seen with shoulder rotation. The muscle appears to tighten and lengthen. The pectoralis major muscle is also seen in greater detail in external rotation. The cord level of the brachial plexus is also visualized at the infraclavicular portion of the anterior shoulder. The medial, posterior, and lateral cords are visualized in relation to the axillary artery. The relative position of the cords is only minimally altered with external rotation; however, the overlying pectoralis minor is tightened, and its influence can be visualized.

Discussion

External rotation has a considerable effect on the sonographic appearance of the anterior shoulder. Targets used for therapeutic injections, such as the bicipital groove, rotate out of clear view. Some chemodenervation targets, such as the muscle of the subscapularis, can only be accessed with the shoulder in full external rotation. Full external rotation of the shoulder also places torsional stress on some of the anterior shoulder structures, such as the pectorals, which can provide diagnostic clues in certain pathologic conditions.

Conclusion

Movement into external rotation changes the sonographic appearance of the anatomic relationships of the anterior shoulder. Knowledge of these torsional changes can have both diagnostic and therapeutic implications.
Dual-Energy Computed Tomography for Evaluating Acute Brain Infarction of Middle Cerebral Artery Territories: Optimization of Voltage Settings in Virtual Monoenergetic Imaging
Authors: Yoshida Morikatsu , Nakaura Takeshi , Tanoue Shota , Takada Sentaro , Inoue Taihei , Uetani Hiroyuki , Harada Kazunori , Yamashita Yasuyuki
Published: May 2019

Objective

To evaluate the optimal virtual monochromatic energy in dual-energy computed tomography for differentiating between infarcted areas and normal brain parenchyma.

Methods

We enrolled 29 patients with middle cerebral artery acute brain infarction of who underwent examination by dual-energy computed tomography. We calculated the contrast-to-noise ratio (CNR) between white or gray matter and the infarcted area (CNR(W-I) and CNR(G-I), respectively) and normalized CNRs. From the normalized CNRs, we assessed which monochromatic energy gave the best balance between the infarcted area and normal brain parenchyma. The 70-keV images were used for comparison.

Results

The 99-keV images demonstrated the best balance between the infarction and normal brain parenchyma. In quantitative analysis, the 99-keV images were not inferior to the 70-keV images. (CNR(G-I), 1.92 ± 0.80 vs 2.00 ± 0.70, respectively [P = 0.16]; CNR(W-I), 0.52 ± 0.72 vs 0.40 ± 0.64, P < 0.01, respectively).

Conclusions

Monochromatic 99-keV energy images may be optimal for evaluating middle cerebral artery acute brain infarction.
Female-to-Male Transgender Chest Contouring
Authors: Cohen Wess A. , Shah Nikhil R. , Iwanicki Margaret , Therattil Paul J. , Keith Jonathan D.
Published: May 2019

Purpose

The number of gender affirmation surgeries performed in the United States is increasing. Frequently, chest contouring is the first surgery for female-to-male transgender patients; it fosters assimilation into the new gender role with a desired sense of masculinity. Creating an aesthetic male chest requires adjustment of breast tissue volume, proper nipple-areolar complex placement, and abolishment of the inframammary fold. Although much has been published on various techniques and outcomes, there is no consensus on how to approach transmale top surgery. We have reviewed the most up-to-date literature and in so doing have uncovered significant knowledge gaps.

Methods

An electronic literature review was performed. PubMed search keywords included combinations of “female-to-male,” “transgender surgery,” “chest contour,” and “nipple-areolar complex.” Articles were included if the patients were transgender female to male.

Results

Our literature search yielded 67 unique articles, 22 of which met our inclusion criteria. A total of 2447 unique patients were analyzed. The articles discussed aspects of chest surgery in female-to-male transsexuals including mastectomy and nipple aesthetics. Relevant data trends were extracted and subsequently investigated.

Discussion

Female-to-male transgender patients often undergo chest contouring as their initial gender affirmation surgery. As the surgical treatment of gender dysphoria continues to grow, it is imperative for plastic surgeons to understand the surgical options and associated outcomes for transmasculine top surgery. Future research is needed to improve patient selection, surgical decision making, and patient-reported outcomes for different chest contouring techniques. In addition, there is a significant knowledge gap for the ideal nipple-areolar complex shape, size, and location.
Histone Deacetylase 7 Inhibition in a Murine Model of Gram-Negative Pneumonia-Induced Acute Lung Injury
Authors: Kasotakis George , Kintsurashvili Ekaterina , Galvan Manuel D. , Graham Christopher , Purves J. Todd , Agarwal Suresh , Corcoran David L. , Sullenger Bruce A. , Palmer Scott M. , Remick Daniel G.
Published: May 2019

Background:

Pulmonary infections remain the most common cause of Acute Respiratory Distress Syndrome (ARDS), a pulmonary inflammatory disease with high mortality, for which no targeted therapy currently exists. We have previously demonstrated an ameliorated syndrome with early, broad spectrum Histone Deacetylase (HDAC) inhibition in a murine model of gram-negative pneumonia-induced Acute Lung Injury (ALI), the underlying pulmonary pathologic phenotype leading to ARDS. With the current project we aim to determine if selective inhibition of a specific HDAC leads to a similar pro-survival phenotype, potentially pointing to a future therapeutic target.

Methods:

C57Bl/6 mice underwent endotracheal instillation of 30×106
Escherichia coli (strain 19138) versus saline (n = 24). Half the infected mice were administered Trichostatin A (TSA) 30 min later. All animals were sacrificed 6 h later for tissue sampling and HDAC quantification, while another set of animals (n = 24) was followed to determine survival. Experiments were repeated with selective siRNA inhibition of the HDAC demonstrating the greatest inhibition versus scrambled siRNA (n = 24).

Results:

TSA significantly ameliorated the inflammatory phenotype and improved survival in infected-ALI mice, and HDAC7 was the HDAC with the greatest transcription and protein translation suppression. Similar results were obtained with selective HDAC7 siRNA inhibition compared with scrambled siRNA.

Conclusion:

HDAC7 appears to play a key role in the inflammatory response that leads to ALI after gram-negative pneumonia in mice.
Treating the primary in metastatic prostate cancer: where do we stand?
Authors: Nason Gregory J. , Hamilton Robert J.
Published: May 2019

Purpose of review

Traditionally, local treatment was reserved for palliative control of symptoms in men with metastatic prostate cancer. In the past few years there have been many advances in the systemic options available. The aim of this review is to explore the evidence in support of treating the primary tumor despite the presence of metastatic disease.

Recent findings

There is a wealth of retrospective studies demonstrating advantages of local treatment [radical prostatectomy or radiation therapy (RT)] in metastatic disease. As these studies are prone to bias, treatment of the primary in the metastatic setting has not been adopted. However, two recent prospective randomized trials (HORRAD and STAMPEDE) have addressed the role of RT to the prostate in metastatic disease. The STAMPEDE sub-group analysis of low-volume metastatic disease demonstrated a survival advantage in favor of the RT arm (hazard ratio 0.68; 95% CI 0.52–0.90). The HORRAD trial showed a similar but nonsignificant trend towards RT (hazard ratio 0.68; 95% CI 0.42–1.10). As a result, the 2019 European Association of Urology and National Comprehensive Cancer Network guidelines now include RT to the prostate as an option in the setting of low-volume metastatic disease.

Although systemic treatment remains standard of care for men with metastatic prostate cancer, there is recent compelling evidence from two prospective randomized trials supporting treatment of the prostate in oligometastatic disease.