bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaphylaxis-like reaction to anti-BRAF inhibitor dabrafenib confirmed by drug provocation test
Authors: Seremet Teofila , Haccuria Amaryllis , Lienard Danielle , del Marmol Véronique , Neyns Bart
Published: October 2018

The combination of BRAF and MEK inhibitors is a standard therapeutic option for patients with metastatic melanoma with BRAF-mutated tumors. This type of targeted therapy improved patient survival, having a manageable toxicity profile. Nevertheless, potentially life-threatening severe toxicity as anaphylaxis-like reactions was observed in two reported cases. No confirmatory testing was performed for these two patients. We report a case of anaphylactic reaction to the BRAF inhibitor dabrafenib administered as a first-line treatment. The clinical picture is different compared with the reported cases, with the main life-threatening symptom being severe hypotension. An important feature of our case report is the diagnostic assessment by drug provocation test, which is considered the ‘gold standard’ investigation for the diagnosis of drug hypersensitivity. Additionally, serum tryptase levels were assessed, and the basophil activation test has been performed as an in-vitro diagnostic test. Elements in favor of both IgE-mediated and non-IgE-mediated reaction were observed, which is suggestive of a complex pathomechanism. This can be evocative for the heterogenous clinical manifestation of the immediate hypersensitivity reactions to BRAF inhibitors. The mechanisms responsible for the reactions should be investigated in future molecular and cellular studies.
Regression rate of choroidal melanoma following iodine-125 brachytherapy is not associated with metastatic spread
Authors: Pépin François , Julien Anne-Sophie , Fugaru Ioana , Lihimdi Nadia , Thariat Juliette , Landreville Solange , Mouriaux Frédéric
Published: October 2018

Nearly half of choroidal melanomas progress to the metastatic stage at 15 years. The purpose of our study was to evaluate the prognostic value of tumour-height regression rate in medium-sized choroidal melanomas treated with iodine-125 brachytherapy. A retrospective cohort study was performed on 128 patients with medium-sized choroidal melanoma who were treated with iodine-125 brachytherapy. Tumour characteristics including tumour apical height at baseline and after irradiation, recurrence, metastasis and mortality were collected from patients’ records. Regression rate was defined in mm/month or in percentage of baseline apical height. Patients were statistically stratified in three groups of regression rate at 6 months using the Ward’s method and Euclidian distance (slow, medium and fast regression groups). Mean initial apical height was of 5.71±1.79 mm. At 6 months, the average regression rate was 0.02±0.12 mm/month in the slow group (n=60), 0.32±0.11 mm/month in the medium group (n=52) and 0.67±0.21 mm/month in the fast group (n=16). Cox regression analysis for the recurrence, metastasis and mortality rates according to the three groups did not show any statistically significant difference. Sensitivity analyses with the regression rates at 12 months showed similar associations. Exudative retinal detachment resolved with treatment at 5.9±4.0 months, and it was more common at presentation in the fast regression rate group. The regression rate at 6 and 12 months after iodine-125 brachytherapy is not associated with a higher metastatic rate in medium-sized choroidal melanoma.
Evaluation of the efficacy and safety of elemene in treating malignant pleural effusion caused by tumors
Authors: Wang Qing-tao , Zhang Ze-lin , Xiong Hui , Zhou Dong-sheng , Li Jun , Liang Jian , Wang Ya-fei
Published: October 2018

Objective:

Elemene is widely used to treat malignant pleural effusion in China. This meta-analysis aimed to evaluate the efficacy and safety of elemene in treating malignant pleural effusion.

Methods:

Electronic databases including Pubmed, the Cochrane Library, Embase and Chinese biomedical literature database were searched until March 2017. Clinical controlled trials (CCTs) assessing the efficacy and safety of elemene in the treatment of malignant pleural effusion were included. The quality of the included studies was evaluated using the quality evaluation criteria of the Cochrane Handbook version 5.1.0.

Results:

A total of 46 CCTs were included, with 2992 patients. Results of meta-analysis showed that elemene significantly improved the overall response rate (ORR) in controlling malignant pleural effusion (risk ratio [RR] = 1.16; 95% CI: 1.08–1.23; P < .05). Subgroup results showed that the ORR of elemene in the treatment of lung cancer patients with malignant pleural effusion (RR = 1.20, 95% CI: 1.07–1.34; P < .05) was higher than that of other cancers (RR = 1.14, 95% CI: 1.05–1.23; P < .05). Meanwhile, elemene did not significantly increase the incidences of chest pain and fever (P > .05).

Conclusion:

Elemene is suggested to have the ability of improving the treatment outcome of malignant pleural effusion with acceptable safety.
Predicting the graft diameter of the peroneus longus tendon for anterior cruciate ligament reconstruction
Authors: Song Xiaoxiao , Li Qiangqiang , Wu Zongfang , Xu Qian , Chen Dongyang , Jiang Qing
Published: October 2018

The aim of this study was to evaluate the correlation between various anthropometric parameters and the graft diameter of the peroneus longus tendon (PLT).

We retrospectively analyzed the data of 156 patients who underwent anterior cruciate ligament reconstruction (ACLR) with the PLT graft at our institution. Anthropometric parameters, including height, weight, gender, age, duration of injury, and preinjury activity levels, were recorded. t tests, correlation coefficients (Pearson r), and a multiple linear regression analysis were used to evaluate the influence of these anthropometric variables on the diameter of the graft obtained.

The mean PLT graft diameter was 8.3 mm, and 21 patients (13.5%) had a diameter less than 8 mm; 85 patients (54.5%) had a diameter between 8 and 9 mm, and 50 patients (32.0%) had a diameter greater than or equal to 9 mm. The correlation analysis showed that height (P < .001), weight (P < .001), and duration of injury (P = .012) were significantly related to graft diameter. On the basis of these 3 predictors, the following regression equation was obtained: Diameter = 2.28 + 0.028∗height (cm) + 0.013∗weight (kg) + 0.289∗duration of injury (0 or 1). Patients who were short and shin were more likely to own smaller graft diameters (<8 mm), especially the one ruptured his or her anterior cruciate ligament (ACL) over 3 months.

Height, weight, and duration of injury were associated with the diameter of PLT. They are important preoperative information for surgeon about the size of PLT and can be used for alternative graft source planning and patient counseling.

Level of evidence: IV
Cardiac tamponade induced by dabrafenib and trametinib combination therapy for melanoma
Authors: Sundaram Vinita Ruth , Abbas Tahir
Published: October 2018

Rationale:

BRAF and MEK inhibitors (BRAF/MEKi) are targeted therapy for proto-oncogene BRAF mutated metastatic unresectable melanoma. Compared to monotherapy, an increased cardiovascular toxicity is reported with the combination of Dabrafenib and Trametinib. This case report documents Grade 4 cardiac treatment emergent adverse effect of pericardial effusion and cardiac tamponade induced by this combination therapy.

Patient concerns:

A 52 year old man presented with clinical stage II unresectable melanoma with BRAF V600E mutation, was initiated on treatement with Dabrafenib and Trametinib. He complained of generalised edema and increased his weight by 27 kg. This progressed to shortness of breath and he underwent echocardiogram which revealed cardiac tamponade.

Diagnoses:

Emergent pericardiocentesis was performed. No definited pathology was demonstrated in laboratory analysis of pericardial fluid. Re- initiating treatment resulted in cardiac tamponade and pericardiotomy was performed by video-assisted thoracic surgical (VATS). Pericardial biopsy revealed nonspecific chronic inflammation.

Interventions:

Discontinuation of treatment with Dabrafenib and Trametinib and diuretics resolved peripheral edema. Cardiac function normalized after pericardiocentesis and pericardiotomy.

Outcomes:

Treatment with Dabrafenib and Trametinib caused significant peripheral edema and pericardial effusion resulting in cardiac tamponade. Naranjo score suggests probable association of treatment induced pericardial effusion and cardiac tamponade.

Lessons:

This is the first documented report of pericardial effusion and cardiac tamponade induced by Dabrafenib and Trametinib. Cardiac toxicity of BRAF/MEK inhibitors is rare but clinicans must monitor for treatment emergent adverse effects.
A new perspective on perioperative coagulation management in a patient with congenital factor VII deficiency
Authors: Sun Yongliang , Jia Lingling , Yang Zhiying , Chen Wenqian
Published: October 2018

Rationale:

Congenital factor VII (FVII) deficiency is a rare coagulopathy. There are little clinical data for congenital FVII deficiency and no evidence-based medicine guidelines for treatment.

Patient concerns:

A 48-year-old woman with gallbladder stones suffered from intermittent abdominal pain for 2 months that was accompanied by an abnormally prolonged prothrombin time.

Diagnoses:

The woman was diagnosed as having cholecystolithiasis with cholecystitis and congenital FVII deficiency.

Intervention:

Preoperative evaluation confirmed the necessity of recombinant activated factor VII (rFVIIa) replacement therapy. We monitored the plasma factor VII activity (FVII:C) and coagulation function, determined the half-life of rFVIIa in the patient, and administered personalized rFVIIa replacement therapy.

Outcomes:

Laparoscopic cholecystectomy was performed successfully, and the patient recovered well without any complications.

Lessons:

The clinical manifestations and severity of bleeding in patients with congenital FVII deficiency can vary widely. The history of massive bleeding and plasma FVII:C are the decisive factors when implementing a replacement therapy. The actual half-life of rFVIIa can be determined from intensive monitoring results of plasma FVII:C at the beginning of replacement therapy, which could further guide the personalization of rFVIIa replacement therapy.
The association between BMI and kidney cancer risk
Authors: Liu Xuezhen , Sun Qi , Hou Haifeng , Zhu Kai , Wang Qian , Liu Huamin , Zhang Qianqian , Ji Long , Li Dong
Published: October 2018

Objective:

Obesity is considered as one of the risk factors of kidney cancer. However, the results are not consistent in reported original studies, as well as in published meta-analysis. This study aims to clarify the relationship between overweight/obesity and kidney cancer by an updated overall and dose-response meta-analysis.

Methods:

This meta-analysis was conducted in accordance with PRISMA guideline. Relevant studies were searched using PubMed, Embase, and Web of Science databases. The studies were limited to human cohort studies in English and Chinese language. Random-effect models and dose-response meta-analysis were used to synthesize the results. Subgroup analyses were also conducted based on the characteristics of participants.

Results:

Twenty-four cohort studies with 8,953,478 participants were included in our meta-analysis. Compared to the normal weight, the pooled RRs of kidney cancer was 1.35 (1.27–1.43) in overweight and 1.76 (1.61–1.91) in obese participants. An increased kidney cancer risk of 1.06 (1.05–1.06) for each 1 kg/m2 increase in BMI was showed in dose-response meta-analysis. No significant heterogeneity was found across studies with I
2 = 39.4% for overweight, and I
2 = 43.3% for obesity.

Conclusion:

The overall and dose-response meta-analysis suggested that overweight/obesity increases the risk of kidney cancer both in men and women.
Compound heterozygous mutations in the TH gene in a Chinese family with autosomal-recessive dopa-responsive dystonia
Authors: Feng Bangzhe , Sun Guangfei , Kong Qingxia , Li Qiubo
Published: October 2018

Rationale:

Autosomal-recessive dopa-responsive dystonia (DRD) is a rare clinical disorder presenting as bradykinesia, dystonia, tremor and even severe encephalopathy, and caused by tyrosine hydroxylase deficiency (THD). We report a case of compound heterozygous mutations in the TH gene in a Chinese family with autosomal-recessive DRD herein.

Patient concerns:

A 16-month-old Chinese boy presented with symptoms of movement disorder and growth retardation in his infant period.

Diagnoses:

The genetic test revealed compound heterozygous mutations in the TH gene at c.457C>T and c.698G>A, which are pathogenic of DRD.

Interventions:

The patient was administrated low-dose levodopa.

Outcomes:

The treatment resulted in the substantial improvement of dystonia. His long-term neurological outcome need follow-up for years.

Lessons:

Gene mutation analysis is helpful and necessary to diagnose DRD and has important guiding significance for the subsequent treatment.
Primary Philadelphia chromosome positive acute myeloid leukemia
Authors: Shao Xiaoyan , Chen Dangui , Xu Peipei , Peng Miaoxin , Guan Chaoyang , Xie Pinhao , Yuan Cuiying , Chen Bing
Published: October 2018

Rationale:

Philadelphia chromosome positive acute myeloid leukemia (Ph+ AML) is a rare subtype of AML that is now included as a provisional entity in the 2016 revised WHO classification of myeloid malignancies. However, a clear distinction between de novo Ph+ AML and chronic myeloid leukemia blast crisis is challenging. It is still a matter of debate whether Ph+ AML patients should be treated with chemotherapy or tyrosine kinase inhibitors as first-line therapy.

Patient concerns:

We reported here a case of a 46-year-old man who was diagnosed as Ph+ AML. This diagnosis was confirmed by bone marrow pathology and karyotype analysis of 46, XY, t (9; 22). Further examination, molecular genetic analysis showed BCR/ABL1 (p190) without ABL1 kinase domain mutations, and direct evidence demonstrated in AML by flow cytometry.

Diagnosis:

The diagnosis of Ph+ AML was made on May 2016 according to morphology, immunology, cytogenetic, and molecular criteria, and multiple organ failure was also diagnosed.

Interventions:

The patient was treated with dasatinib as the only medication after experiencing multiple organ failure. Then, he received 2 cycles of chemotherapy with IA (idarubicin 8 mg/m2, day 1–3; cytarabine 100 mg/m2, day 1–7) in August, 2016.

Outcomes:

The patient finally achieved a complete molecular remission.

Lessons:

This case study suggests that dasatinib can be a safe and effective treatment for Ph+ AML patients with poor physical condition.
Value of electrocardiographic left ventricular hypertrophy as a predictor of poor blood pressure control
Authors: Wang Zhenzhen , Zhang Chunyan , Bao Huihui , Huang Xiao , Fan Fangfang , Zhao Yan , Li Juxiang , Chen Jing , Hong Kui , Li Ping , Wu Yanqing , Wu Qinghua , Wang Binyan , Xu Xiping , Li Yigang , Huo Yong , Cheng Xiaoshu
Published: October 2018

Recent studies have shown that hypertension is poorly controlled in many populations worldwide. Electrocardiographic left ventricular hypertrophy is a common manifestation of preclinical cardiovascular disease that strongly predicts cardiovascular disease morbidity and mortality. However, little information is available regarding the role of left ventricular hypertrophy in blood pressure (BP) control. We aimed to assess the relationship between electrocardiographic left ventricular hypertrophy and BP control in the China Stroke Primary Prevention Trial. The study population included 17,312 hypertensive patients who were selected from a group of 20,702 adults who had participated in the China Stroke Primary Prevention Trial and had undergone electrocardiography at baseline visit. Multivariate analysis identified left ventricular hypertrophy as a predictor of unsatisfactory BP control. The results revealed that 8.1% of hypertensive adults exhibit left ventricular hypertrophy and that the disease is more prevalent in males (12.8%) than in females. Multivariate regression analysis showed that the electrocardiographic left ventricular hypertrophy group had a significantly higher rate of unsatisfactory BP control [odds ratio (OR) 1.42, 95% confidence interval (95% CI) 1.26–1.61, P < .001) than the nonleft ventricular hypertrophy group.

Notable differences in BP control were also observed among males (OR 1.37, 95% CI 1.17–1.60, P < .001) and females (OR 1.45, 95% CI 1.18–1.77, P < .001) and especially among patients with comorbid diabetes (OR 2.32, 95% CI 1.31–4.12, P = .004). In conclusion, the results of this study indicate that electrocardiographic left ventricular hypertrophy appears to be an independent predictive factor for poor BP control, especially in females and patients with comorbid diabetes.
Effect of optimized collagenase digestion on isolated and cultured nucleus pulposus cells in degenerated intervertebral discs
Authors: Feng Xu , Liu Li , Yu Bao-Qing , Huang Jian-Ming , Gu Long-Dian , Xu Da-Feng
Published: October 2018

This study aims to explore the optimized digestive method of collagenase to nucleus pulposus (NP) cells by observing the digestive effects of type I and II collagenase in different concentrations to NP in degenerated intervetebral discs.

NP were collected from 18 human herniated intervertebral disc samples, and digested by type I and II collagenase, which were separated or combined in different concentrations. NP cells were counted using an inverted microscope, and the activities were determined by trypan blue staining at 4, 8, 16, and 24 hours after digestion. The growth of NP cells was also observed.

The amount of NP cells with combined collagenases was greater than that separated in an identical concentration. With the combined collagenases at 4 and 8 hours, the higher concentration, the greater the amount of NP cells became. The amount of cells in extremely low concentrations of collagenase increased after 16 and 24 hours, and its activities remained at a higher level.

The optimized digestion of extremely low concentrations of type I and II collagenase combined could save enzymes, was less harmful to NP cells, and was more adapted to separated and cultured NP cells.
Spontaneous resolution of isolated neurogenic blepharoptosis after blunt trauma
Authors: Kim Tae Gi , Shin Jae Ho
Published: October 2018

Rationale:

Complete isolated neurogenic blepharoptosis caused by blunt trauma is a sporadically reported rare entity and there is no consensus regarding the optimal treatment. We would like to report a rare case of isolated neurogenic blepharoptosis secondary to eyelid trauma with spontaneous recovery occurring within 4 weeks.

Patient concerns:

A previously healthy 47-year-old man presented with blepharoptosis in the right eye after eyelid trauma.

Diagnosis:

At presentation, visual acuity in both eyes was 20/20, and intraocular pressure was within the normal limits. Physical examination showed unilateral ptosis; magnetic resonance imaging (MRI) showed hematoma in the right frontal sinus. No intracranial lesions were observed and the pupillary reactions were normal. The remainder of the examination was unremarkable with full ocular motility. He was diagnosed with an isolated neurogenic blepharoptosis.

Intervention and outcomes:

He was managed conservatively without any specific treatment. Four weeks later, the patient had normal, symmetric lid height, and levator function was completely restored.

Lessons:

Isolated neurogenic blepharoptosis can be caused by blunt trauma, which might cause injury to the terminal branch of the oculomotor nerve. In this case, no special treatment was required, and complete resolution was achieved within 4 weeks.
Application of ultrasonography in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients
Authors: Ren Chong , Chen Jing , Wang Yong , Huang Bihong , Lu Wenwen , Cao Yanpei , Yang Xiaoli
Published: October 2018

This study aims to evaluate the application of color Doppler ultrasound in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients.

Patients with maintenance hemodialysis who underwent autologous arteriovenous fistula were enrolled in this cross-sectional study. Ultrasound was used to detect fistula complications (stenosis and thrombosis), brachial artery diameter, and hemodynamic parameters. The ultrasound parameters were analyzed and screened to identify the most important indicator for monitoring complications.

In all, 89 patients were included. Ultrasound showed 72 cases (80.90%) had normal fistula structure, and 17 cases (19.10%) had complications. The diameter, time-averaged mean velocity, flow volume, and diastolic peak velocity of brachial artery in complication group were significantly lower than those of noncomplication group (P < .05). The brachial artery pulsatility index and resistance index of complication group were significantly higher than those of noncomplication group (P < .05). There was no significant difference in peak flow velocity between complication and noncomplication group (P > .05). Indicators showed statistical significance were grouped based on quantiles. The incidence of complications was higher when the brachial artery diameter was ≤5.40 mm, or brachial artery flow was ≤460 mL/ min, or brachial artery pulsatility index was >1.04, or brachial artery resistance index was >0.60.

Ultrasound monitoring of brachial artery diameter and hemodynamic parameters can help early detection of fistula complications. When the brachial artery diameter was ≤5.40 mm, or brachial artery flow was ≤460 mL/min, or brachial artery pulsatility index was >1.04, or brachial artery resistance index >0.60, stenosis or thrombosis should be checked to prevent fistula failure.
Prevention of depression in first-year university students with high harm avoidance
Authors: Saigo Tatsuo , Hayashida Masaki , Tayama Jun , Ogawa Sayaka , Bernick Peter , Takeoka Atsushi , Shirabe Susumu
Published: October 2018

High harm avoidance (HA) scores on the temperament and character inventory appear to be a risk factor for depressive disorders and suicide. Since 2012, we have conducted group cognitive behavioral therapy (G-CBT) interventions for students at Nagasaki University with high HA and without depressive disorders, with the aim of preventing depression. Here, we report on the effects of the G-CBT at 1-year follow-up for the 2012 to 2015 period.

Forty-two participants with high HA were included in the final analysis. Outcomes were measured with the Beck Depression Inventory II, Manifest Anxiety Scale, 28-item General Health Questionnaire, and Brief Core Schema Scales at baseline, and at 6-month, and 1-year follow-ups.

Repeated-measures analyses of variance revealed a significant decrease in mean depressive symptom scores at the 6-month follow-up point; this decrease was maintained at 1 year. Improvements in cognitive schemas were also seen at 6 months and 1 year.

We observed improvements in cognitive schemas associated with depression as a result of the G-CBT intervention, with effects maintained at 1 year post-intervention. This intervention may be effective in positively modifying the cognitions of students with HA and preventing future depression.
Concurrent versus sequential whole brain radiotherapy and TKI in EGFR-mutated NSCLC patients with brain metastasis
Authors: Chen Hualin , Wu Aibing , Tao Hua , Yang Donghong , Luo Yiping , Li Shujun , Yang Zhixiong , Chen Ming
Published: October 2018

To examine the outcomes of concurrent versus sequential whole-brain radiotherapy (WBRT) and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in nonsmall cell lung cancer (NSCLC) patients with EGFR mutation.

Retrospectively 105 patients with NSCLC, brain metastasis, and EGFR mutation (Affiliated Hospital of Guangdong Medical University, 01/2011 to 12/2014) were grouped as: EGFR-TKIs alone (n = 39, group A), EGFR-TKIs + concurrent radiotherapy (n = 34, group B), and radiotherapy followed by EGFR-TKIs (n = 32, group C).

The intracranial objective response rates of groups A, B, and C were 66.7%, 85.3%, and 75%, respectively (P < .05). The median intracranial progression-free survival of groups A, B, and C were 6.8, 12.4, and 9.1 months, respectively (P < .05). The median extracranial progression-free survival of groups A, B, and C were 7.8, 9.4, and 8.3 months, respectively (P > .05).

EGFR-TKIs and WBRT by simultaneous application improved the short- and long-term benefits to patients with NSCLC brain metastasis carrying EGFR mutation compared to concurrent application or EGFR-TKIs alone without additional adverse events.
Association between the HLA-DQA1 rs2187668 polymorphism and risk of idiopathic membranous nephropathy
Authors: Bao Liping , Li Jushuang , Hu Shuang , Wu Xiaoyan
Published: October 2018

Objective:

Numerous studies have evaluated the association between the rs2187668 polymorphism in the human leucocyte antigen (HLA) complex class II HLA-DQ a-chain 1 (HLA-DQA1) gene and idiopathic membranous nephropathy (iMN) risk, which provided new insight into potential new targets for the treatment of iMN. However, this relationship remains inconclusive. Our aim was to evaluate the relationship between this polymorphism and iMN susceptibility by performing a meta-analysis.

Methods:

Articles were identified in the PubMed, Google Scholar, EMBASE, Cochran Library databases. Meta-analyses were performed for rs2187668 allele frequency, genotypes, and the association with iMN susceptibility. Subgroup analyses, publication bias and sensitivity analyses were also conducted.

Results:

11 eligible studies (3209 cases and 7358 controls) from 7 articles were included. Statistical analyses were carried out using Stata 12.0, combining data from all the relevant studies. The pooled odds ratios (ORs) regarding the association between the HLA-DQA1 rs2187668 polymorphism and iMN risk were statistically significant [A vs G: OR = 3.34, 95% confidence interval (CI) = 2.70–4.13; AA vs GA + GG: OR = 8.69, 95% CI = 6.64–11.36; GG vs GA + AA: OR = 0.25, 95% CI = 0.19–0.33;AA vs GG: OR = 12.61, 95% CI = 8.02–19.81; GA vs GG: OR = 3.45, 95% CI = 2.79–4.25].

Conclusions:

Our pooled analysis showed a significant association between rs2187668—(A) allele and iMN susceptibility, and the intervention of this mutation might bring new therapeutic strategy for iMN. However, further studies should be performed to confirm this finding.
A case report of recurrent Merkel cell carcinoma with synchronous metastases to the heart and stomach
Authors: Ha Joo Young , Park Song Ee , Kim Hee Sung , Won Hoyoun , Kim Beom Jin , Hwang In Gyu
Published: October 2018

Rationale:

Merkel cell carcinoma (MCC) is an aggressive, rare neuroendocrine skin cancer. MCC metastasis to the heart is exceedingly rare and gastric metastases from MCC have rarely been reported.

Patient concerns:

We described the case of an 82-year-old man diagnosed with recurrent MCC with cardiac and gastric metastasis who presented with poor oral intake and severe weight loss. The patient was diagnosed with MCC 3 years ago and treated with surgical resection and radiation.

Interventions:

We performed stomach biopsy in edematous lesion. And fluoroscopy and ultrasound guided biopsy of the cardiac mass was performed.

Diagnoses:

MCC with synchronous metastases to the heart and stomach.

Outcomes:

The primary lesion had complete resolution and the patient remained disease free on regular follow-up every 6 months for 2 and half years. After MCC recurred, palliative anti-cancer therapy was considered but could not be performed due to the patient's poor performance status involved elderly, combined recurrent pneumonia.

Lessons:

To our best knowledge, this is the first report of synchronous cardiac and gastric metastasis from cutaneous MCC worldwide. Although uncommon, MCC should be considered in clinical cases of synchronous metastasis.
Autopsy diagnosis of acupuncture-induced bilateral tension pneumothorax using whole-body postmortem computed tomography
Authors: Jian Junqi , Shao Yu , Wan Lei , Zhang Min , Liu Ningguo , Zhang Jianhua , Chen Yijiu
Published: October 2018

Rationale:

Acupuncture, a component of traditional Chinese medicine, is also a well-known form of complementary and alternative medicine. Serious adverse events of acupuncture have been reported, including the acupuncture-related pneumothorax which is a rare but fatal condition sometimes. The pneumothorax was related to needle insertion in the upper back or paraspinal area and the reported victims suffered from either unilateral or bilateral pneumothorax. Postmortem computed tomography has advantages in the detection of pathologic gas and is being considered as a useful visualization tool for diagnosing the cause of death.

Patient concerns:

A 52-year-old man underwent acupuncture and cupping treatment at an illegal Chinese medicine clinic for neck and back discomfort and was admitted to the hospital with severe gasp and dyspnea about 30 hours later. The patient suddenly became unconscious with heart rate and blood pressure lost and died after cardiopulmonary resuscitation. Diagnosis, interventions and outcomes: Whole-body postmortem computed tomography of the victim revealed collapse of the both lungs and mediastinal compression, which was also confirmed by autopsy. More than 20 pinprick injuries were found on the skin of the upper and lower back in which multiple pinpricks were located on the body surface projection of the lungs. The cause of death was concluded as acute respiratory and circulatory failure due to acupuncture-induced bilateral tension pneumothorax.

Lessons:

Acupuncture-induced tension pneumothorax is rare and should be recognized by forensic pathologists. Postmortem computed tomography can be used to detect and accurately evaluate the severity of pneumothorax before autopsy and can play a supporting role in determining the cause of death.
Difference of achievements between physicians from public hospitals and emergency medical center in prehospital emergency
Authors: Ni Tongtian , Chen Min , Zhou Weijun , Zhao Jiong , Jia Dan
Published: October 2018

The benefit gained by replacing physicians in the prehospital service is still controversial. The present study compared the difference of achievements of pre-hospital emergency between the physicians from public hospitals and those from the Emergency Medical Center.

We included prehospital emergency patients who were sent to the hospital by ambulance after emergency calls from February 1 to May 31, 2016, in Shanghai (24,250,000 inhabitants). Cohort characteristics and diagnoses were described, and the data were analyzed using the Shanghai Emergency Medical Center's database software. We determined whether the physicians from public hospitals were associated with greater success rate of cardiopulmonary resuscitation (CPR) and examined the diseases category and the number of patients with cardiac arrest in prehospital emergency patients.

During February 1, 2016, to May 31, 2016, the total turnout of ambulances in the urban area of Shanghai was 107,341 times, among which, first aid was 55,053 times. The number of patients with cardiac arrest was 3012, the 3 principal causes for cardiac arrest were Unknown diagnosis (45.19%), Cardiovascular disease (28.02%) and Respiratory diseases (11.09%), and the successful rate of CPR was 1.56%. The number of critically ill patients, encountered by the physicians from public hospitals, was 10.33% as compared to those from the Emergency Medical Center, which was 11.77% (P < .001). Although the success rate of CPR of the physicians from public hospitals was lower than that of the physicians from the Emergency Medical Center (1.22–1.58%), it did not achieve statistical significance (P > .05).

Transferring the physicians from public hospitals to work in Emergency Medical Center showed no improvement in the success rates of resuscitation.
A retrospective study of factors associated with the development of oral candidiasis in patients receiving radiotherapy for head and neck cancer
Authors: Kawashita Yumiko , Funahara Madoka , Yoshimatsu Masako , Nakao Noriko , Soutome Sakiko , Saito Toshiyuki , Umeda Masahiro
Published: October 2018

The aims of this study were to investigate the incidence and risk factors for oral candidiasis in patients receiving radiotherapy for head and neck cancer, and to determine the influence of topical steroid therapy on the development of oral candidiasis.

We conducted a retrospective study of 300 patients receiving radiotherapy to the head and neck region. The primary endpoint was the incidence of oral candidiasis during radiotherapy. Associations between the incidence of oral candidiasis and various clinical factors were investigated. The cumulative incidence rate of oral candidiasis was calculated using the Kaplan–Meier method and analyzed by the log-rank test and Cox regression. Propensity score-matched analysis was used to assess the influence of topical steroid therapy on the development of oral candidiasis.

Oral candidiasis occurred in 75 (25.0%) of the 300 patients. Multivariate analysis identified minimum lymphocyte count and severity of oral mucositis during radiotherapy as independent risk factors for the development of oral candidiasis. Topical steroid therapy for oral mucositis was not associated with the incidence of oral candidiasis according to multivariate and propensity score matching analyses.

Oral candidiasis was associated with the suppression of the host's immunity and severe oral mucositis, but not topical steroid therapy. Proper oral health care during radiotherapy and the prevention of severe oral mucositis may reduce the incidence of oral candidiasis.
Chinese herbal medicines compared with N-acetylcysteine for the treatment of idiopathic pulmonary fibrosis
Authors: Guo Jing , Li Bin , Li Wenyuan , Pan Yi , Wang Zhichao , Wu Yuxiao , Wang Fei
Published: October 2018

Background:

Idiopathic pulmonary fibrosis (IPF) is a major public health problem worldwide. There is no curative treatment for IPF except lung transplantation. Chinese herbal medicines (CHMs) are widely used in the treatment of IPF in China. However, their effectiveness and safety are still obscure and deserve further investigation. The aim of the study was to assess the efficacy and safety of CHMs in treating IPF compared with N-acetylcysteine (NAC).

Methods:

This review summarizes and meta-analyzes randomized controlled trials (RCTs) of CHMs for the treatment of IPF. RCTs compare either CHMs alone or in combination with NAC or conventional medicine treatment (CMT) vs NAC alone or in combination with CMT have been included. The following electronic databases have been searched: PubMed, Cochrane Library, Embase, CNKI, CBM, VIP, and WANFANG DATA. The methodologic quality of RCTs has been assessed using the Cochrane risk assessment tool. All trials included are analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software, and GRADE pro GDT web solution are used for data synthesis and analysis.

Results:

This review evaluates the effects of CHMs on acute exacerbation, mortality, the quality of life, 6-minute walking test distance, lung function (total lung capacity, diffusing capacity of the lungs for carbon monoxide, and forced vital capacity), partial pressure of oxygen in blood (PaO2), and safety in patients with IPF.

Conclusion:

This review provides clear evidence to assess the effectiveness and safety of CHMs for IPF.
Comparative study of the maximum Watts factor and Schafer contractility grade, bladder contractility index in male patients with lower urinary tract symptoms
Authors: Liu Dandan , Chen Min , Han Xiaomin , Li Ying
Published: October 2018

To investigate whether the maximum Watts factor (WF) is 1 parameter of describing detrusor contraction in male patients with lower urinary tract symptoms (LUTS).

We retrospectively reviewed urodynamic data of male subjects with LUTS. Data on age, maximum flow rate (Qmax), post-void residual (PVR), detrusor pressure at maximum flow rate (PdetQmax), maximum Watts factor (WFmax), and Schafer contractility grades were collected. First, all patients were divided into 6 groups according to Schafer contractility grade. The urodynamic parameters include WFmax and bladder contractility index (BCI) were compared and analyzed among the 6 groups by using Kruskal–Wallis test statistically. The box plot of Schafer contractility grade with WFmax or BCI were plotted and analyzed. Second, the correlation scatter diagram between WFmax and BCI was plotted and analyzed. Spearman's correlation test was performed. Third, we drew the Receiver Operating Characteristic (ROC) curve and confirmed the area under the curve, the Optimal Operating Point (OOP) and corresponding sensitivity and specificity for WFmax by the reference standard of Schafer contractility grade and BCI respectively.

A total of 455 men were included. The mean age of patients was 57 ± 17.9 years, ranging from 18 to 87 years. Median of WFmax increased from 5.8 W/m2 in very week (VW) group to 19.5 W/m2 in strong (ST) group, while BCI rose from 70 to 170. The box plot of Schafer contractility grade with WFmax or BCI showed that both WFmax and BCI were positively correlated with Schafer contractility grade. Kruskal-Wallis test among the 6 groups showed statistically significant difference (P <.001). The correlation scatter diagram showed that WFmax increased significantly with BCI (Fig. 3), the linear regression equation being Y = 3.33 + 0.07X, R2 = 0.298. Spearman's correlation test revealed that WFmax and BCI were positively correlated, with the correlation coefficient being 0.616 (P <.001). The WFmax area under ROC curve by Schafer contractility grade was 0.894 and WFmax OOP was interpreted at 11.1 W/m2. In addition, the area under ROC curve by BCI was 0.802 and WFmax OOP was interpreted at 9.8 W/m2.

Our findings suggestted that WFmax was a good parameter of evaluating detrusor contraction as well as Schafer contractility grade and BCI, which should be widely used in clinical.
Intracerebral hematoma after endoscopic fenestration of an arachnoid cyst
Authors: Qin Bing , Gao Liansheng , Hu Junwen , Wang Lin , Chen Gao
Published: October 2018

Rationale:

An intracranial arachnoid cyst is a relatively common congenital benign lesion. A small number of patients present with neurological symptoms. Endoscopic fenestration has become a common treatment for arachnoid cysts in recent years, but intracerebral hematoma after surgery is rarely reported.

Patient concerns:

A 60-year-old woman with an arachnoid cyst in the left parietal and occipital lobes showed obvious progressive neurological deficits. She had weakness in her right limbs for 2 years and a sudden convulsion in her left limbs.

Diagnosis:

An arachnoid cyst in the left parietal and occipital lobes was detected on magnetic resonance imaging.

Intervention:

Endoscopic fenestration was performed for the cyst. However, she developed an intracerebral hematoma after surgery, which was detected by computed tomography. Due to the exacerbation of the patient's condition in the early stage after surgery, reoperation was performed to remove the hematoma.

Outcomes:

The patient was finally cured with no serious neurological deficits.

Lessons:

The rare complication of intracerebral hematoma after surgery for an arachnoid cyst can lead to a rapid deterioration in the patient's condition. More-adequate preoperative examination and neuronavigation should be conducted during surgery. Appropriate enlargement of the bone hole may help protect against this complication. Moreover, prompt reoperation for the intracerebral hematoma may improve the prognosis.
A case report of remarkable response to association of radiofrequency ablation with subsequent Atezolizumab in stage IV nonsmall cell lung cancer
Authors: Yin Jie , Dong Jingyin , Gao Wei , Wang Yina
Published: October 2018

Rationale:

Programmed cell death-1 (PD-1) or programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors have demonstrated impressive efficacy in patients with nonsmall cell lung cancer (NSCLC). Radiofrequency ablation (RFA) is an alternative locoregional therapy for patients with inoperable NSCLC. We report the role of RFA in a patient with metastasis from advanced stage NSCLC that was managed with checkpoint inhibitors. Therefore, this combination of RFA with subsequent immunotherapy can control NSCLC better than RFA or immunotherapy on their own.

Patient concerns:

We report here a 61-year-old Chinese male who presented with postoperative recurrence squamous cell lung cancer following the left upper lobectomy and 4 cycles of postoperative adjuvant chemotherapy 6 months back.

Diagnosis:

A newly occurring lesion was detected in the left lower lung. Based on computed tomography (CT) and percutaneous lung biopsy enhancement, the patient was diagnosed with stage IV nonsmall cell lung cancer.

Interventions:

The patient refused systemic chemotherapy. And there was no basis for using tyrosine kinase inhibitors. RFA was performed for 3 times at the left lower lung lesion, which was under control. Afterward, an enlargement of the lesion at left lower lung with involvement to chest wall, and new nodules in both lungs were revealed. After that, the patient received intravenous PD-L1 immune checkpoint inhibitors Atezolizumab. Follow-up restaging CT scan showed disease progression in both lungs. However, by treated 4 months later, partial response was observed at the left lower lung lesion, and stable response was observed at the right upper lung lesion.

Outcomes:

The patient displayed a remarkable response to Atezolizumab in one lesion at left lower lung, where he received previous locoregional therapy of RFA. As a comparison, another lesion at right upper lung without RFA history showed little response to Atezolizumab.

Lessons:

Our case suggests a significantly synergistic effect of sequential association of RFA and subsequent immunotherapy. Integrating locoregional therapy such as RFA into anti-PD-1/PD-L1 agent regimens may help to release tumor-associated antigen and mediate T-cell immune enhancement, and on the long run improve the ongoing efficacy of checkpoint inhibitors. The combination of locoregional therapy and immunotherapy represents a potential new treatment option in the management of metastatic NSCLC.
Fetal closed head injuries following maternal motor vehicle accident
Authors: Nishida Naoki , Ina Shihomi , Hata Yukiko , Nakanishi Yuko , Ishizawa Shin , Futatani Takeshi
Published: October 2018

Rationale:

The clinicopathologic appearance of fetal closed head injury (FCHI) due to a maternal motor vehicle accident has not been fully investigated because of its extreme rarity.

Patients concern:

A 22-year-old woman at 31 weeks of gestation was riding in the front passenger seat of a car, and another rightward-turning car struck the right side of her vehicle.

Diagnosis:

Uterine injury with placental abruption was strongly suspected.

Intervention:

A live female infant in breech presentation was delivered by emergency caesarean section.

Outcomes:

Although the female infant was and showed no evidence of trauma on her body surface. She exhibited a convulsion on the day of birth, and subsequent ultrasonography revealed possible intracranial hemorrhage. Although laboratory parameters associated with circulatory and respiratory function suggested a good response to the intensive care administered during the treatment course, the infant died 6 days later despite intensive care. Autopsy showed severe brain softening, subarachnoid hemorrhage with cerebral and cerebellar contusion, and bilateral thalamic hemorrhage. No hypoxic/ischemic changes of the thoracoabdominal organs were evident at autopsy.

Lessons:

This was a clear case of FCHI by both shear and tensile forces. Multiple factors including the structural vulnerability of the fetal brain, the head posture of the fetus, the crash location and direction of force on the vehicle, and the employment of safety equipment may have contributed to the occurrence of FCHI in the present case.
PEG 3350 Versus Lactulose for Treatment of Functional Constipation in Children
Authors: Jarzebicka Dorota , Sieczkowska‐Golub Joanna , Kierkus Jaroslaw , Czubkowski Piotr , Kowalczuk‐Kryston Monika , Pelc Maciej , Lebensztejn Dariusz , Korczowski Bartosz , Socha Piotr , Oracz Grzegorz
Published: October 2018

Objectives:

The aim of this study was to compare the clinical efficacy and tolerance of polyethylene glycol 3350 (PEG) and lactulose for the treatment of functional constipation in infants and children.

Methods:

This randomized, multicenter study covered 12 weeks of treatment and 4 weeks of follow‐up of patients with functional constipation. Patients were randomized (central randomization) to receive either PEG or lactulose. The primary end points were the number of defecations per week after 12 weeks of treatment and improvement in stool consistency of at least 2 points in the Bristol scale. The secondary end point was the presence of adverse events. Bowel movements ≥3 per week and stool consistency ≥2 (Bristol scale) were considered as successful treatment.

Results:

We enrolled 102 patients (M 57, F 45) aged 3.62 ± 1.42 years and 88 completed the study. At week 12, good clinical outcome was achieved in 98% (PEG) and 90% (lactulose). The PEG group had more defecations per week compared with the lactulose group (7.9 ± 0.6 vs 5.7 ± 0.5, P = 0.008) and both groups had similar frequency of defecation with pain (5% vs 5%, P = 0.9), stool retention (7% vs 10%, P = 057), large volume of stools (30% vs 31%, P = 0.9) and hard stools (7% vs 13%, P = 0.58). There were more patients with side effects in the lactulose group (15 vs 23, P = 0.02), mostly bloating and abdominal pain.

Conclusions:

PEG 3350 is more effective and causes fewer side effects than lactulose in the treatment of constipation in infants and children.
Reducing Risks for Older Adults With an Interprofessional Community-Academic Partnership
Authors: Schain Alexandra , Rees Catherine , Medina Catherine , Eyler Rachel , Glenney Susan , Rodko Eric , Cassese Jason , Shellman Juliette , Malcolm Millicent
Published: October 2018

As the older adult population in the United States increases and diversifies, understanding and reducing risks for hospitalization and institutionalization can reduce burdens for this vulnerable population. Using evidence-based assessment tools to understand medical, psychosocial, pharmacologic, and functional status can aid an interprofessional team to best evaluate older adults at risk. By providing culturally competent care for a diversifying older adult demographic, attention to social determinants can improve health equity for this population. This article describes in a case study exemplar, how one such interprofessional collaborative practice program, Geriatric Outreach and Training with Care (GOT Care!) provides a comprehensive assessment for high-risk older adults, identifies and documents these risks, and shares recommendations and rationale with the primary care provider toward risk reduction and improvement of outcomes.