bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Cochlear Implant Channels With Relatively Poor Electrode-Neuron Interfaces Using the Electrically Evoked Compound Action Potential
Authors: Jahn Kelly N. , Arenberg Julie G.
Published: January 2020

Objectives:

The primary objective of this study was to quantify local (within ear) and global (between ear) variation in the cochlear implant (CI) electrode-neuron interface (ENI) using the electrically evoked compound action potential (ECAP). We tested the hypothesis that, within an ear, ECAP measures can be used to identify channels with presumed good and poor ENIs, which may be influenced by a combination of spiral ganglion neuron (SGN) density, electrode position, and cochlear resistivity. We also hypothesized that ECAP responses would reflect age-related differences in the global quality of the ENI between younger and older listeners who theoretically differ in SGN density.

Design:

Data were obtained from 18 implanted ears (13 individuals) with Advanced Bionics HiRes 90K devices. Six participants (8 ears) were adolescents or young adults (age range: 14–32 years), and 7 participants (10 ears) were older adults (age range: 54–88 years). In each ear, single-channel auditory detection thresholds were measured on channels 2 through 15 in response to a spatially focused electrode configuration (steered quadrupolar; focusing coefficient = 0.9). ECAP amplitudes, amplitude growth function (AGF) slopes, and thresholds were assessed on a subset of channels in each ear in response to three interphase gaps (0, 7, and 30 µs). ECAP peak amplitudes were assessed on all channels between 2 and 15. AGFs and ECAP thresholds were measured on the two nonadjacent channels with the lowest and highest focused behavioral thresholds in each ear. ECAP responses were compared across low- and high-threshold channels and between younger and older CI listeners.

Results:

Channels that were estimated to interface poorly with the auditory nerve (i.e., high-focused-threshold channels) had steeper ECAP AGF slopes, smaller dynamic ranges, and higher ECAP thresholds than channels with low focused thresholds. Younger listeners had steeper ECAP AGF slopes and larger ECAP peak amplitudes than older listeners. Moreover, younger listeners showed greater interphase gap sensitivity for ECAP amplitude than older listeners.

Conclusions:

ECAP responses may be used to quantify both local (within ear) and global (between ear) variation in the quality of the ENI. Results of this study support future investigation into the use of ECAP responses in site-selection CI programming strategies. The present results also support a growing body of evidence suggesting that adolescents and young adults with CIs may have denser populations of functional SGNs relative to older adults. Potential differences in global SGN integrity between younger and older listeners warrant investigation of optimal CI programming interventions based on their divergent hearing histories.
Sagittal Plane Residual Deformity in Pediatric Type II Supracondylar Humerus Fractures
Authors: Silva Mauricio , Day Matthew J. , Aceves-Martin Bianka , Ebramzadeh Edward
Published: January 2020

Introduction:

The incidence of residual deformity in the sagittal plane of the humerus (RDSPH) after nonoperative management of type II supracondylar humerus fractures (SCHFs), and the effects of such deformity on the overall arc of motion (AOM) of the elbow, are unknown. Our purpose was to analyze data collected prospectively on a large cohort of type II SCHF’s to establish the incidence and extent of RDSPH, and the effects of the deformity on the elbow function, to further support our previously published recommendations on the treatment of type II SCHF.

Methods:

The clinical data and radiographs of 1107 pediatric type II SCHFs enrolled in a prospective registry, and followed for a minimum of 8 weeks, were retrospectively reviewed. The radiographs obtained during the latest follow-up appointment were examined for the presence of RDSPH, as demonstrated by the anterior humeral line falling anterior or posterior relative to the center of the capitellum. The amount of RDSPH in the sagittal plane was then calculated. We compared the treatment outcome of elbows with and without RDSPH by assessing the patients’ AOM, the arc of flexion (AOF), and relative arcs of motion (R-AOM) and relative arcs of flexion (R-AOF) (as compared with the unaffected, contralateral elbow).

Results:

Overall, 799 (72.2%) fractures were treated nonsurgically, and 308 (27.8%) fractures were treated surgically. The overall incidence of RDSPH was 10.2%. None of the fractures managed operatively demonstrated residual deformity. The RDSPH was classified as mild in 35 fractures (3.2%), moderate in 64 fractures (5.7%) and severe in 14 fractures (1.3%). Therefore, the incidence of RDSPH in fractures treated nonoperatively was 14.1%. In fractures treated nonoperatively, the difference in AOM between those without (n=686) and with (n=113) RDSPH was <4 degrees (149.1 vs. 145.8 degrees, P=0.02). Those with and without RDSPH had a clinically similar AOF, with a mean difference of<4 degrees (134.5 vs. 137.9 degrees, P<0.0001). The differences in R-AOM and R-AOF between those with and without RDSPH were minimal (97.3% vs. 95.6% and 96.6% vs. 95.3%, respectively). A satisfactory outcome, defined as an R-AOM of at least 85% when compared with the unaffected, contralateral side at the latest follow-up, was achieved in 91% of fractures with RDSPH, and 93% of fractures without RDSPH.

Discussion and Conclusion:

The incidence of RDSPH in type II SCHF treated nonoperatively was 14%. In our cohort, nearly 99% of all RDSPH were mild to moderate. On the basis of the data presented in the current study, nonsurgical treatment of type II SCHF can provide a satisfactory recovery of AOM, AOF, R-AOM, and R-AOF, and a high rate of satisfactory outcomes, even in the presence of RDSPH.
Does Pedicle Screw Fixation Assisted by O-Arm Navigation Perform Better Than Fluoroscopy-guided Technique in Thoracolumbar Fractures in Percutaneous Surgery?
Authors: Lu Jianhua , Chen Weikai , Liu Hao , Yang Huilin , Liu Tao
Published: January 2020

Study Design:

A retrospective cohort study.

Objective:

To evaluate the effect of O-arm navigation in percutaneous surgeries for thoracolumbar fracture in comparison to the use of conventional fluoroscopic technique.

Summary of Background Data:

O-arm navigation is a progressive surgical tool, with extensive research papers reporting its effects. Whereas, there were not many papers describing its accuracy and facet impingement rate when compared with fluoroscopy-guided technique in percutaneous surgeries, especially at varying fracture levels.

Materials and Methods:

We conducted a retrospective comparative study of 97 consecutive patients of single-level neurological intact thoracolumbar fractures from November 2015 to October 2017 and they were all treated with percutaneous pedicle screw implantation. Screws were classified as 4 grades of perforations and 3 grades of facet joint violation. The association between variables such as anatomic perforation, functional perforation, and facet impingement were investigated by χ2 test, Fisher exact test or t test. A P-value of <0.05 was considered statistically significant.

Results:

A total of 573 pedicle screws were implanted and graded. The overall anatomic perforation rate and functional perforation rate were lower in the O-arm group compared with the fluoroscopy group (8.3% vs. 15.0%, P=0.013, 1.1% vs. 4.2%, P=0.024). At fracture level, the rate of grade 2 perforation of the O-arm group was lower than that of the fluoroscopy group (0% vs. 6.1%, P=0.033). Furthermore, the O-arm group obviously reduced the facet impingement rate both at all levels and at fracture levels (P=0.002; 0.02).

Conclusions:

In percutaneous pedicle screw placement for neurological intact thoracolumbar fracture, the introduction of O-arm navigation improved accuracy, reduced functional perforations, and minimized serious perforations compared with conventional fluoroscopic technique. It also decreased facet joint violation observably and helped to prevent development of adjacent segment degeneration.
Differential Expression of Cancer Testis Antigens on Lentigo Maligna and Lentigo Maligna Melanoma
Authors: Tio Darryl , Willemsen Marcella , Krebbers Gabrielle , Kasiem Fazira R. , Hoekzema Rick , van Doorn Remco , Bekkenk Marcel W. , Luiten Rosalie M.
Published: January 2020

The cancer/testis antigens (CTA) are a group of antigens expressed on germ cells of healthy testis and malignant tumors. We studied whether CTA are present on lentigo maligna (LM) and LM melanoma (LMM) samples. Immunohistochemical expression of a panel of CTA (MAGE-A1, A2- A3, NY-ESO-1, PRAME, SSX-2, and a MAGE-A antibody reactive with -A1, -A2, -A3, -A4, -A6, -A10, and -A12) was investigated in formalin-fixed paraffin-embedded samples from LMM (n = 20), LM (n = 8), chronically sun-exposed skin (n = 7), and healthy skin (n = 7). In 4 LMM lesions, the MAGE-A marker was positive. Another 3 LMM lesions were positive for MAGE-A1, MAGE-A2, and MAGE-A3. PRAME was positive in 18/20 LMM and 6/8 LM. We did not find expression of MAGE, NY-ESO-1, or SSX-2 in LM, thereby excluding these CTA as diagnostic markers to discern malignant melanocytes in LM from normal melanocytes. LMM did express MAGE, NY-ESO-1, and SSX-2. If a biopsy from a lesion suspect for LM shows positivity for MAGE, NY-ESO-1, and SSX-2, the lesion may actually be LMM. In contrast, PRAME expression was found in LM at low levels and in LMM at much higher levels, and absent in normal melanocytes. PRAME can potentially be used to discern normal melanocytes from malignant melanocytes.
Therapeutic Drug Monitoring of Asparaginase: Intra-individual Variability and Predictivity in Children With Acute Lymphoblastic Leukemia Treated With PEG-Asparaginase in the AIEOP-BFM Acute Lymphoblastic Leukemia 2009 Study
Authors: Würthwein Gudrun , Lanvers-Kaminsky Claudia , Gerss Joachim , Möricke Anja , Zimmermann Martin , Stary Jan , Smisek Petr , Attarbaschi Andishe , Nath Christa , Zucchetti Massimo , Rizzari Carmelo , Schrappe Martin , Boos Joachim ,   on behalf of the AIEOP-BFM ALL 2009 Asparaginase Working Party
Published: January 2020

Background:

Therapeutic drug monitoring (TDM) can identify patients with subtherapeutic asparaginase (ASNase) activity [silent inactivation (SI)] and prospectively guide therapeutic adaptation. However, limited intra-individual variability is a precondition for targeted dosing and the diagnosis of SI.

Methods:

In the AIEOP-BFM acute lymphoblastic leukemia (ALL) 2009 trial, 2771 children with ALL were included and underwent ASNase-TDM in a central laboratory in Münster. Two biweekly administrations of pegylated ASNase during induction and a third dose during reinduction or the high-risk block, which was administered several weeks later, were monitored. We calculated (1) the incidence of SI; and (2) the predictivity of SI for SI after the subsequent administration. ASNase activities monitored during induction were categorized into percentiles at the respective sampling time points. These percentiles were used to calculate the intra-individual range of percentiles as a surrogate for intrapatient variability and to evaluate the predictivity of ASNase activity for the subsequent administration.

Results:

The overall incidence of SI was low (4.9%). The positive predictive value of SI identified by one sample was ≤21%. Confirmation of SI by a second sample indicated a high positive predictive value of 100% for biweekly administrations, but not for administration more than 17 weeks later. Sampling and/or documentation errors were risks for misdiagnosis of SI. High intra-individual variability in ASNase activities, with ranges of percentiles over more than 2 quartiles and low predictivity, was observed in approximately 25% of the patients. These patients were likely to fail dose individualization based on TDM data.

Conclusions:

To use TDM as a basis for clinical decisions, standardized clinical procedures are required and high intra-individual variability should be taken into account. Details of the treatment are available in the European Clinical Trials Database at https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-004270-43/DE.
High Submaximal Exercise Heart Rate Impacts Exercise Intolerance in the Postural Orthostatic Tachycardia Syndrome
Authors: Van Iterson Erik H. , Laffin Luke J. , Mayuga Kenneth A. , Hutt Centeno Erika , Ahmed Taha , Cho Leslie , Ahmed Haitham M.
Published: January 2020

Purpose:

Exercise intolerance is a hallmark of the postural orthostatic tachycardia syndrome (POTS). However, no data are available on the implications of an exaggerated submaximal heart rate (HR) on exercise intolerance in patients. We investigated whether exaggerated HR responses occurring early on during incremental stress testing relate with increased odds of POTS and exercise intolerance.

Methods:

Clinical characteristics and stress test HRs were compared between adults with POTS achieving ≥85% predicted metabolic equivalents (METs) (EX-TL, n = 101; body mass index [BMI] 24 ± 5 kg·m−2; 95% women) or <85% (EX-INTL, n = 71; BMI 28 ± 7 kg·m−2; 79% women) and sedentary controls (n = 30; BMI 36 ± 3 kg·m−2; 87% women). Multivariate logistic regressions were performed to estimate ORs and the probability of POTS and exercise intolerance associated with exercise HRs.

Results:

Exercise tolerance was increased in EX-TL, but not in EX-INTL (10.0 ± 1.3 and 8.3 ± 1.5 METs vs 8.0 ± 1.6 METs, respectively) versus controls. Absolute peak HR was increased in EX-TL and EX-INTL versus controls (P < .01), whereas percent predicted did not differ. Exercise within the first-to-second stress stages was performed at exaggerated HRs (122 ± 17 bpm vs 103 ± 15 and 113 ± 15 bpm, P < .001) and percent HR reserve in EX-INTL versus controls and EX-TL (49% ± 12% vs 34% ± 11% and 41% ± 11%, P < .001), respectively. In multivariate analyses, peak HR was not significant, whereas increased submaximal HR (either variable) was associated with increased odds of EX-TL or EX-INTL. Lastly, odds of EX-INTL increased as METs decreased, whereas METs was not a predictor of EX-TL.

Conclusions:

An exaggerated submaximal exercise HR is predictive of POTS and exercise intolerance, and this chronotropic phenotype is exacerbated in patients achieving <85% predicted METs.
Neutron and Photon Dose Rates in a D-T Neutron Generator Facility: MCNP Simulations and Experiments
Authors: Xu Xu , Yi Chang , Wanyue Tang , Yuanming Sun , Jingbin Lu , Yumin Liu , Long Zhao , Jiaxi Liu , Xiaoyi Li
Published: January 2020

The deuterium-tritium neutron generator is a common neutron source for fast neutron activation analysis. The 14.1 MeV neutrons emitted from a deuterium-tritium neutron generator are difficult to shield due to their strong penetrability and the induced secondary gamma rays in the shield. A rough calculation based on attenuation factors shows that when 14.1 MeV neutrons with a yield of 1 × 108 ns−1 penetrate the designed shielding layers, which consist of a 0.5-m-thick concrete layer and a 0.5-m-thick water layer, the neutron ambient dose equivalent rate is 2.48 μSv h−1. A geometric model of a neutron shielding room is constructed based on the calculation. Monte Carlo simulations indicate that the highest neutron ambient dose equivalent rate outside the neutron shielding room is 0.73 μSv h−1, and the neutron ambient dose equivalent rate at the detector position in the shielding room is 2.12 μSv h−1. The experimental results show that the highest neutron ambient dose equivalent rate outside the neutron shielding room is 1.43 μSv h−1, and the neutron ambient dose equivalent rate at the detector position inside the shielding corridor is 2.74 μSv h−1. Comparative investigations show that the experimental results are basically consistent with the results of the Monte Carlo simulations, except for some positions with large proportions of fast neutrons where it is too difficult for the neutron dose equivalent meter to provide reliable values. Moreover, the radiation dose rate outside the designed shielding room is lower than the occupational exposure dose limit, which is in line with the design expectations. Finally, the gamma spectrum at the position of the gamma detectors is measured by a high-purity germanium detector. The analyzed results show that many secondary gamma rays are generated by the interaction of neutrons with the shield materials and detector probe crystals, and some gamma rays are produced from natural background radionuclides such as 40K, 208Tl, 212Bi, 214Bi, 212Pb, 214Pb, and 228Ac.
MP3 Plus: A Modified Micropulse Transscleral Cyclophototherapy Technique for the Treatment of Refractory Glaucoma
Authors: Wong Kirsten Yue Ting , Aquino Cecilia Maria , Macasaet Anne Marie , Suwandono Maya Ekakristiani , Chew Paul Tec Kuan , Koh Victor Teck Chang
Published: January 2020

Précis:

In advanced refractory glaucoma which has failed prior MP3 laser, MP3 Plus is effective in reducing intraocular pressure (IOP) without significant complications. It is also useful as a temporizing procedure before incisional surgery.

Purpose:

To evaluate the efficacy and safety of MP3 Plus, a novel technique using modified micropulse transscleral cyclophototherapy (MPTCP) in eyes with refractory glaucoma or failed MPTCP treatment.

Methods:

This is a retrospective interventional case series. In total, 32 consecutive eyes from 29 patients with uncontrolled IOPs who had previous MPTCP or refractory glaucoma underwent MP3 Plus, a modified MPTCP where additional discrete pulses are applied. The main outcome measurement was IOP at 1, 3, 6, and 12 months postprocedure, with success defined as a 20% reduction in baseline IOP, an IOP of 25 mmHg or less, and no need for further reoperation. We collected and analyzed visual acuity, number of glaucoma medications, and complications.

Results:

The patients had an average of 1.4±0.9 glaucoma procedures before treatment, where 87.5% underwent one or more previous MPTCP with suboptimal response. Of the eyes presenting for follow-up, 51.6% (n=31), 37.0% (n=27), 35.7% (n=28), and 25.9% (n=27) achieved the primary outcome at 1, 3, 6, and 12 months, respectively. Baseline IOP was 33.7±11.6 mmHg (n=32 eyes) and posttreatment IOP at 1, 3, 6, and 12 months were 21.0±9.0 mmHg (n=31; P<0.0001), 26.2±10.8 mmHg (n=25; P<0.0001), 23.2±9.4 mmHg (n=20; P<0.05), and 24.6±9.8 mmHg (n=16; P<0.001), respectively. There was a reduction in glaucoma medications from 3.4±0.8 preoperatively to 2.8±1.2 (n=16; P<0.05) at 12 months. There were no cases of prolonged inflammation or hypotony.

Conclusions:

MP3 Plus is effective and safe in lowering IOP in eyes with refractory glaucoma after previous failed MPTCP.
Solitary Free-Floating Iris Cyst Associated With Bilateral Pigment Dispersion Syndrome: Report of a Case
Authors: Bruttini Carlo , Vulpetti Andrea , Riva Ivano , Katsanos Andreas , Oddone Francesco , Quaranta Luciano
Published: January 2020

Case Report:

A 27-year-old white man with a 5-year history of pigment dispersion syndrome presented for evaluation. His past ocular history was significant for bilateral intraocular pressure elevation that had required intraocular pressure -lowering medication (beta-blocker-prostaglandin analogue fixed combination). On ophthalmic examination, the visual acuity was 20/20 without correction in both eyes. Anterior chamber slit-lamp examination revealed a pigmented round mass with modest transillumination at 6-o’clock position of the right eye. When asked, the patient reported that he had first noticed a shadow in his right eye during childhood when he was flexing his neck and keeping a face-down position for a few seconds. During a head-flexing test, the mass freely floated in the anterior chamber. When the patient extended the neck, the round mass could be seen in front of the pupil. After a few moments, the mass would slowly fall to the iridocorneal angle at the 6-o’clock position. Ultrasound biomicroscopy and anterior-segment optical coherence tomography confirmed that the lesion was a pigmented cyst without internal reflectivity. Specular microscopy examinations, performed to exclude cyst-induced corneal endothelium compromise, revealed a cell-density of ~3000 cells/mm2 in both eyes. Gonioscopy showed an open angle with trabecular pigmentation and funduscopy a cup-to-disc ratio of 0.5 bilaterally. Visual fields and optical coherence tomography tests were within normal limits.

Conclusions:

The etiology of free-floating iris cysts is unclear, but it is generally agreed that these masses are usually dislodged pigment epithelial cysts. This is the first report of a unilateral free-floating iris cyst associated with bilateral pigment dispersion syndrome.
Middle- and long-term results after iris-fixated phakic intraocular lens implantation in myopic and hyperopic patients: a meta-analysis
Authors: van Rijn Gwyneth A. , Gaurisankar Zoraida S. , Ilgenfritz Antonio P. , Lima José Eduardo E. , Haasnoot Geert W. , Beenakker Jan-Willem M. , Cheng Yanny Y. Y. , Luyten Gregorius P. M.
Published: January 2020

The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects. The iris-fixated phakic intraocular lens (pIOL) has been available for over 25 years. To provide a clear picture of outcomes and risks, for this systematic review and meta-analysis, the literature was searched for reports on middle- and long-term effects of iris-fixated pIOLs on myopic and hyperopic eyes with a follow-up of at least 2 to 4 years. Visual and refractive results after implantation for correction of myopia are positive and the complication rate is low. Endothelial cell loss appears to be at an acceptable rate, although the range of endothelial cell change is too wide to draw firm conclusions. Care should be taken when considering an iris-fixated pIOL for hyperopic eyes because complication rates, particularly pigment dispersion, might be higher than those in myopic eyes. More well-designed, long-term studies are needed, especially in hyperopic eyes. The authors advocate for standardized reporting of refractive surgery data. Initiatives proposed by journal authors and editors to achieve uniformity should be supported.
Posterior chamber phakic intraocular lens for the correction of presbyopia in highly myopic patients
Authors: Stodulka Pavel , Slovak Martin , Sramka Martin , Polisensky Jaroslav , Liska Karel
Published: January 2020

Purpose:

To report the initial experience with a new presbyopic phakic intraocular lens (pIOL) in the correction of high myopia and presbyopia.

Setting:

Gemini Eye Clinic, Zlin, Czech Republic.

Design:

Prospective cohort study.

Methods:

Presbyopic eyes with moderate to high myopia were implanted with a presbyopic posterior chamber pIOL (IPCL). The visual acuities at near and distance, endothelial cell density, and ocular condition were examined 1 week, 3 months, 1 year and 2 years postoperatively.

Results:

The mean uncorrected distance visual acuity improved significantly from 1.25 logarithm of the minimum angle of resolution (logMAR) (1.15 to 1.35 95% confidence interval [CI]) to 0.11 logMAR (95% CI, 0.03 to 0.17) (P < .0001). No eye lost 1 or more lines of corrected distance visual acuity. The mean distance refraction improved significantly from −6.9 diopters (D) (range −8.6 to −5.3 D) preoperatively to −0.35 D (range −0.55 to −0.15 D, P < .0001) with less than −0.5 D residual refraction in 11 of 17 eyes. Fifteen of 17 eyes had improved uncorrected near visual acuity to J1 (Jaeger chart) at the 2-year follow-up. The near addition at the 2-year follow-up decreased from preoperatively +1.26 D (range 0.19 to 2.34 D) to +0.39 D (range 0.18 to 0.60 D). The mean endothelial cell density was reduced from 2552 cells/mm2 (range 2421 to 2682 cells/mm2) to 2299 cells/mm2 (range 2108 to 2490 cells/mm2) after 2 years. All patients were subjectively satisfied with the outcomes.

Conclusions:

The new pIOL provided good visual outcomes in near and far distances in an initial case series of patients.
Longxuetongluo capsule alleviates lipopolysaccharide-induced neuroinflammation by regulating multiple signaling pathways in BV2 microglia cells
Authors: Hong Qian , Yang Yang , Wang Zenghui , Xu Liuliu , Yan Zhao
Published: January 2020

Background:

Longxuetongluo capsule (LTC), derived from the total phenolic compounds of Chinese dragon’s blood, is now used in the treatment of ischemic stroke in convalescence. The aim of this study is to explore the neuroprotective effect of LTC from the perspective of neuroinflammation.

Methods:

Cell viability and lactate dehydrogenase (LDH) release were measured by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) and LDH assay kit. Proinflammatory mediators and cytokines production including Nitric Oxide (NO), prostaglandin E2, (PGE2), interleukin (IL-β), IL-6, and tumor necrosis factor-α (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA) assay. In addition, western blot was used to detect the expression of inflammatory proteins associated with the mitogen-activated protein kinases (MAPKs), janus kinase/signal transducer and activator of tranions (JAK/STAT), nuclear transcription factor κB (NF-κB), and nuclear factor erythroid-2-related actor 2/heme oxygenase 1 (Nrf2/HO-1) signaling pathways. Moreover, immunofluorescence assay and electrophoretic mobility shift assays (EMSA) were performed to determine the Nrf2 translocation and the binding-DNA activity of NF-κB, respectively.

Results:

LTC at 0.5 to 2 μg/mL significantly increased cell viability and decreased LDH, NO, PGE2, IL-1β, IL-6, and TNF-α production in oxygen-glucose deprivation/reoxygenation (OGD/R) and lipopolysaccharide (LPS)-induced BV2 microglia cells. Meanwhile, LTC not only decreased the protein expressions of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) but also down-regulated phosphorylation of extracellular signal-regulated kinase (ERK)1/2, p38, and up-regulated HO-1 expression via nuclear translocation of Nrf2. LTC can significantly inhibit the phosphorylation of JAK1/STAT3 and reduce the translocation of NF-κB from cytosol to nucleus as well as the binding-DNA activity. PC12 cell pretreated with LTC-condition medium (CM) significantly alleviated LPS-induced neurotoxicity and increased PC12 cell viability in a dose-dependent manner.

Conclusion:

The present study showed that LTC exhibited a strong antineuroinflammatory activity and neuroprotective effects on LPS-stimulated BV2 microglial cells and PC12 cells.
Erythematous Papules and Vesicles in the Diaper Region
Authors: Patel Dharmik , Martin Kari L.
Published: January 2020

This is a case of a 19-month-old girl with a vesicular diaper rash that was seen using telecommunication technology. Store-and-forward teledermatology increases overall access to dermatology care by sending protected medical information electronically to off-site medical providers (Roman & Jacob, 2014). The following case of vesicular diaper rash is presented in the standardized teledermatological reader format.
Well-Circumscribed Erythematous Plaque Behind the Ear
Authors: Raffi Jodie , Botto Nina
Published: January 2020

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of erythematous, fissured plaques in the retroauricular area.
Cost-effectiveness analysis of etanercept plus methotrexate vs triple therapy in treating Chinese rheumatoid arthritis patients
Authors: Shi Zhi-Chao , Fei Hong-Ping , Wang Zhi-Liang
Published: January 2020

Objective:

This study aimed to explore the cost-effectiveness of etanercept plus methotrexate (ETN+MTX) compared to triple disease-modifying anti-rheumatic drugs (DMARDs) in treating Chinese rheumatoid arthritis (RA) patients.

Methods:

The 134 Chinese RA patients who were about to initiate ETN+MTX or triple DMARDs therapy based on treat-to-target strategy were consecutively recruited and categorized into ETN+MTX group (N = 49) or triple DMARDs group (N = 85). Treatment efficacy was assessed at month 3 (M3)/M6/M9/M12 after initiation of treatment. Also, 1-year treatment cost was evaluated, and cost-effectiveness analysis and sensitivity analysis were conducted.

Results:

RA patients in ETN+MTX group exhibited similar disease activity and quality of life at each time point while elevated 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR) change (M0-M12) and low disease activity rate compared with triple DMARDs group. For 1-year treatment cost, ETN+MTX required increased drug cost, decreased other medical cost, and finally elevated total cost compared with triple DMARDs. Meanwhile, compared to triple DMARDs, ETN+MTX produced an additional quality-adjusted life year (QALY) of 0.015, resulting in an incremental cost-effectiveness ratio (ICER) of ¥2,939,506.7 per QALY that was 53.1 folds of gross domestic product (GDP) per capita in China. More interestingly, sensitivity analysis revealed that the ETN price had to be reduced at least by 71.3% before ETN+MTX became cost-effectiveness compared to triple DMARDs.

Conclusion:

ETN+MTX is less cost-effective in treating Chinese RA patients compared with triple DMARDs.
Effects of exercise therapy for pregnancy-related low back pain and pelvic pain
Authors: Hu Xiang , Ma Ming , Zhao Xianghu , Sun Wudong , Liu Yanli , Zheng Zengbin , Xu Liang
Published: January 2020

Background:

Pregnancy-related low back pain (PLPB) and pelvic pain (PP) are common in pregnancy. In spite of its high prevalence rate, treatment of the disorder is a challenging topic. Women commonly utilize complementary exercise therapies such as yoga, motor control exercises, breathing exercises, core stability exercise, pelvic stability exercise, and so on to manage their symptoms. However, it is currently unknown whether exercise produces more beneficial effects than other treatment in patients with PLPB and PP. The aim of this study is to explore the therapeutic effect of exercise for pregnancy-related low back pain and PP.

Methods:

This review will only include randomized controlled trials. Published articles from July 1999 to July 2019 will be identified using electronic searches. Search strategy will be performed in 3 English databases, 1 Chinese database, and the World Health Organization International Clinical Trials Registry Platform. Two reviewers will screen, select studies, extract data, and assess quality independently. The methodological quality including the risk of bias of the included studies will be evaluated using a modified assessment form, which is based on Cochrane assessment tool and Physiotherapy Evidence Database scale. Review Manager Software (Revman5.3) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. We will use GRADE system to evaluate the quality of our evidence.

Results:

We will provide some more practical and targeted results investigating the effect of exercise therapy (ET) for PLPB and PP in the current meta-analysis. Meanwhile, we will ascertain study progress of ET for PLPB and PP and find out defects or inadequacies of previous studies, so that future researchers could get beneficial guidance for more rigorous study.

Conclusion:

The stronger evidence about PLPB and PPs rehabilitative effect and safety will be provided for clinicians and policymakers.

Systematic review registration:

PROSPERO CRD 42017075099.
Distal radial artery access in the anatomical snuffbox for coronary angiography and intervention
Authors: Yu Weiwei , Hu Pengfei , Wang Shen , Yao Liping , Wang Hao , Dou Liping , Lu Ming , Bo Gang , Yu Xixia , Chen Jingwen , Chen Chao , Luo Ying , Yang Ming , Dong Zhuqin , Huang Shuwei
Published: January 2020

Background:

To explore the feasibility and safety of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via the distal radial artery in the anatomical snuffbox.

Methods:

Ninety two patients who underwent CAG or PCI through distal radial artery access at The Second Affiliated Hospital of Zhejiang Chinese Medical University from September 2017 to March 2018 were included in our study. We collected baseline characteristics, number, and duration of arterial punctures, procedural success rate, postoperative compression time, the numerical rating scale (NRS) scores at 3 hours after procedure, complications, hospitalization duration.

Results:

The mean age was 69 ± 11years (44–92 years), and there were 57 males (62.0%). The diameter of the right distal radial artery and the more proximal right radial artery were 0.171 ± 0.05 cm, 0.213 ± 0.06 cm, respectively. On average, the number of puncture attempts was 1.52 ± 0.81, access time was 2.3 ± 1.78 minutes (0.33 – 8.72 minutes), access success was 95.7%, the postoperative compression time was 3.41 ± 0.76 hours (2–6 hours), the NRS scores at 3 hours was 1.53 ± 0.72 (1–4), and the mean hospitalization duration was 7.13 ± 4.02 days. Four patients underwent left distal radial artery access and 88 patients underwent right distal radial artery access. There were 3 local hematomas after procedure and 2 patients had vasospasm. There were no cases of major bleeding, arteriovenous fistula, radial artery occlusion, or hand numbness.

Conclusion:

Cardiac catheterization through the distal radial artery in the snuffbox is safe and feasible. The right distal radial artery access can be routinely carried out.
Evaluating the association between avascular necrosis of femoral head and oral corticosteroids use in Taiwan
Authors: Lai Shih-Wei , Lin Cheng-Li , Liao Kuan-Fu
Published: January 2020

The aim of this study was to assess a correlation between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. A population-based case-control study was performed to analyze the database of Taiwan National Health Insurance Program. The study consisted of 3002 subjects aged 20 to 84 with newly diagnosed avascular necrosis of femoral head between 2000 and 2013 as the cases and 11279 sex-matched and age-matched subjects without avascular necrosis of femoral head as the matched controls. Use of oral corticosteroids was defined as subjects who had at least a prescription for oral corticosteroids before the index date. No use of oral corticosteroids was defined as subjects who did not have a prescription for oral corticosteroids before the index date. The logistic regression model revealed that subjects with avascular necrosis of femoral head were 1.65 times more likely to be exposed to oral corticosteroids than those subjects without avascular necrosis of femoral head (OR 1.65, 95% CI = 1.51–1.80). A sub-analysis revealed that there was a significant association between avascular necrosis of femoral head and increasing cumulative duration of oral corticosteroids for each additional month of use (OR 1.03, 95% CI = 1.02–1.03). A significant association is detected between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. There is a duration-dependent effect of oral corticosteroids use on the risk of avascular necrosis of femoral head. Clinicians should be aware of the risk of avascular necrosis of femoral head when oral corticosteroids are prescribed for a long time.
Endotracheal administration for intraoperative acute massive pulmonary embolism during laparoscopic hepatectomy: Retraction
Authors: Liu Yu , Zhao LianYing , Wang ShuQin , Wu Qi , Jin FeiHong , Liu GuangHeng , Qi Feng
Published: January 2020

Introduction:

Acute pulmonary embolism (APE) during an operation is a very urgent occurrence, especially when the patient with hemodynamic instability. Generally, drugs are administered intravenously; however, these drugs have little effects under most circumstances. We present a case of successful resuscitation in a patient with endotracheal administration.

Patient concerns:

A 67-year-old female presented for laparoscopic hepatectomy. Acute pulmonary gas embolism occurred during the operation with hemodynamic instability. The total amount of carbon dioxide and argon reached 300 mL. We used a novel way of administering drugs instead of intravenous administration for rescuing and the patient condition had improved greatly and was discharged from the hospital without any neurological deficits.

Diagnoses:

A diagnosis of APE was made because of a lot of gas was extracted out from central venous catheter and sudden observable decrease in end-tidal CO2.

Interventions:

These measures included endotracheal administration, position adjustment, manual ventilation, and gas extraction.

Outcomes:

The patient was discharged from the hospital and had no signs of neurological deficits.

Conclusion:

Intravenous administration may not the best appropriate way of administration when patients occurred APE. Endotracheal administration as a unique method may work wonders and has the value of research and application.
The efficacy and safety of Chinese herbal medicine Shen-Qi Hua-Yu formula in patients with diabetic lower extremity artery disease
Authors: Leng Yulin , Gao Hong , Fu Xiaoxu , Xie Hongyan , Hu Zhipeng , Zhu Jianwei , Liu Xiaoke , Zhou Xiujuan , Xie Ziyan , Xie Chunguang
Published: January 2020

Background:

Lower extremity artery disease (LEAD) is greatly harmful to Type 2 Diabetes Mellitus patients. Traditional Chinese Medicine (TCM) is an alternative therapy to delay the development of macrovascular diseases, but the existing evidence of its efficacy, safety and mechanism of action is insufficient. We report a study protocol of a multi-center, randomized, double-blind, placebo-controlled trial that aims to use well-designed clinical trial to evaluate the efficacy and safety of Chinese herbal medicine (CHM) Shen-Qi Hua-Yu formula, and to explore efficacy mechanism of the TCM granules and the biomarkers of TCM syndrome.

Methods:

This is a multi-center, double-blind, randomized, and placebo-controlled study that randomized 120 participants into 2 groups. The treatment group will receive TCM granules and conventional medicine, while the control group will receive placebo in addition to conventional medicine. Two groups will receive 12-week treatment and 48-week follow-up, with a total of 13 visits. Primary efficacy outcomes included ankle brachial index. Secondary efficacy outcomes included fasting plasma glucose, blood lipid, hemorheology indexes, advanced glycation end products, the inner diameter, peak systolic velocity, end diastolic velocity and mean average velocity of the anterior tibial artery, posterior tibial artery and dorsalis pedis artery, and TCM syndrome score. The safety and endpoint outcomes will be evaluated in this trial. The study will explain the biological therapeutic mechanism of Shen-Qi Hua-Yu formula for diabetic LEAD, and try to use Isobaric tags for Relative and Absolute Quantitation (iTRAQ) and Western blot to screen biomarkers of characteristic diagnosis and clinical efficiency evaluation of the TCM syndrome.

Discussion:

This study is a multi-center, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of CHM in patients with diabetic LEAD, and to interpret the therapeutic mechanism of Shen-Qi Hua-Yu formula in treatment of diabetic LEAD through proteomics technology, and to screen biomarkers with characteristics of TCM diagnosis and clinical efficacy evaluation. On the other hand, to our knowledge, this study may be the first trial of CHM formulas to observe cardiovascular outcomes through long-term follow-up for the treatment of diabetic LEAD, which is of great value.

Trial registration:

This study is registered on the Chinese Clinical Trial Registry: ChiCTR1900026372.
Efficacy and safety of programmed cell-death-protein-1 and its ligand inhibitors in pretreated patients with epidermal growth-factor receptor-mutated or anaplastic lymphoma kinase-translocated lung adenocarcinoma
Authors: Bylicki Olivier , Guisier Florian , Monnet Isabelle , Doubre Hélène , Gervais Radj , Janicot Henri , Perol Maurice , Fournel Pierre , Lamy Régine , Auliac Jean-Bernard , Chouaid Christos
Published: January 2020

Immune-checkpoint inhibitor (ICI) efficacy in patients with non-small cell lung cancer (NSCLC) harboring molecular alterations remains poorly elucidated. This study was undertaken to determine ICI efficacy against epidermal growth-factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)/c-ros oncogene 1 (ROS1)-mutated NSCLC patients in the real-world setting.

In this retrospective, multicenter study on adults with ICI-treated EGFR-mutated or ALK- or ROS1-translated NSCLCs, we analyzed clinical characteristics and outcomes: ICI-treatment duration, and progression-free survival (PFS), objective response rate, duration of response, and overall survival (OS) from immunotherapy initiation.

Fifty-one NSCLC patients (mean age, 58.0 years) were included from 20 French centers: 61% were never-smokers and 59% were women. Among them, 82% had EGFR-activating mutations, 16% ALK translocations, or 2% ROS1 translocations. Before ICI therapy, patients had received a median of 3 treatment lines (including tyrosine-kinase inhibitor). The median PFS was 2.1 (95% confidence interval [CI], 1.5–3.2) months for the entire cohort, 2.2 (95% CI, 1.4–3.2) for EGFR-mutated patients, and 2.4 (95% CI, 2.1–not reached) months for ALK-translocated patients. The median OS was 14.7 (95% CI, 12.1–19.2) months for the entire population and 13.9 (95% CI, 8.8–20.0) and 19.2 (95% CI, 13.1–not reached) months for EGFR-mutated and ALK-translocated patients, respectively. Seven (13.7%) patients were treated with ICI for >9 months. Toxicities were reported in 22% (11/51), including 8% (4/51) grade ≥3.

In this real-world setting, analysis of ICI PFS against EGFR-mutated or ALK-translocated NSCLC patients appeared close to that observed in pretreated unselected NSCLC patients. The more promising OS probably linked to post-ICI treatments. Large prospective studies on these patient subsets are needed.
Survivals of patients with pancreatic neuroendocrine carcinomas
Authors: Deng Ben-Yuan , Yang Min , Wen Jie-Yu , Hou Sheng-Zhong , Chen Yang , Tian Bo-Le , Liu Xu-Bao , Zhang Yi
Published: January 2020

Recently, the American Joint Committee on Cancer (AJCC) 8th staging manual stipulated the World Health Organization (WHO) G3 pancreatic neuroendocrine carcinomas (p-NECs) should all be classified by the system for pancreatic exocrine adenocarcinomas, which had ignored the heterogeneity of G3 p-NECs. We focused on demonstrating whether the heterogeneous subgroups of G3 p-NECs would influence the accurate application of AJCC 8th staging systems.

G3 p-NECs were divided into well-differentiated and poorly-differentiated subgroups, whose clinical features and overall survival (OS) were compared. Survival analysis by applying 2 new AJCC 8th staging systems to well-differentiated G3 p-NECs were performed to validate whether these subgroup patients should also be staged by the system proposed for all G3 p-NECs.

We enrolled 172 patients who were histopathologically diagnosed as G3 p-NECs, including 64 well-differentiated G3 p-NECs and 108 poorly-differentiated ones, whose patient demographics and tumor characteristics present no notably differences (P > .05), except their Ki-67 index and mitotic rate (P = .031, P = .025; respectively). The estimated OS of well-differentiated G3 p-NECs was significantly better than those of poorly-differentiated tumors (P < .001). When applying the new AJCC system for all G3 p-NECs to well-differentiated G3 tumors, 18, 22, 12, and 12 patients were respectively distributed in the new AJCC Stage I, Stage II, Stage III, and Stage IV. Using the AJCC 8th staging system for WHO G1/G2 pancreatic neuroendocrine tumors (p-NETs) to well-differentiated G3 p-NECs, there were 5, 25, 22, and 12 patients classified from the new AJCC Stage I to Stage IV, respectively. The system for G1/G2 p-NETs could significantly differentiate the survival differences between each new stage of well-differentiated G3 p-NECs (P < .05), while comparisons of survivals between Stage II with Stage III or Stage III with Stage IV by the system for G3 p-NECs were not statistically different (P = .334, P = .073; respectively).

G3 p-NECs were heterogeneous with well-differentiated and poorly-differentiated subgroups. Both AJCC 8th staging systems proposed for all G3 p-NECs and G1/G2 p-NETs were practical for well-differentiated G3 p-NECs, while the one originally applied to G1/G2 p-NETs appeared to be superior in performance due to its better prognostic stratification and more accurate predicting ability.
Circumferential penile defect reconstruction with pull-up double-opposing keystone-designed perforator island flaps
Authors: Lee Hyun Gun , Lim Soo Yeon , Yoon Chi Sun , Kim Kyu Nam
Published: January 2020

Rationale:

The challenges with reconstruction of penile defects are plenty. In addition, no single and universally accepted reconstructive method exists for penile defect repair. Herein, we present the application of a circumferential penile shaft defect reconstruction using pull-up double-opposing keystone-designed perforator island flaps (KDPIFs) in one patient. This is the first case report of a circumferential penile shaft defect reconstruction using KDPIFs.

Patient concerns:

A 43-year-old man who injected petroleum jelly into his penis 10 years ago presented with multiple firm nodular mass-like lesions adherent to the overlying skin along the penile shaft. Our urologic surgeon removed the foreign bodies and performed a primary closure with undermining. However, wound dehiscence developed, and skin necrosis was exacerbated 5 days postoperatively.

Diagnoses:

We performed debridement, and the final post-debridement defect was circumferential (5.5 × 12 cm) from the base of the glans to the midpoint of the penile shaft.

Interventions:

We covered the defect using pull-up double-opposing KDPIFs (10 × 13 cm each) based on the hot spots of the superficial external pudendal artery perforators on each side from the suprapubic area to the scrotum.

Outcomes:

The flaps survived perfectly, with no postoperative complications. The patient was satisfied with the final outcome and had no erectile dysfunction or shortening of penile length after a 6-month follow-up.

Lessons:

We successfully reconstructed a circumferential penile defect with pull-up double-opposing KDPIFs both esthetically and functionally. Our technique can be a good alternative modality for extensive penile defect reconstruction.