bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of non-morphometric morphological characters used in the taxonomy of the genus Pseudechiniscus (Tardigrada: Echiniscidae)
Authors: Tumanov Denis V
Published: August 2019

Pseudechiniscus, the second-largest genus of the family Echiniscidae (Tardigrada: Heterotardigrada: Echiniscoidea), is notoriously difficult for taxonomic studies. In this study, I performed a morphological analysis of a new species from Croatia, based on a light microscopic and scanning electron microscopic examination of 45 specimens from the same sample. Furthermore, I have summarized all available data on Pseudechiniscus species, including their original descriptions, and have analysed the following complexes of morphological characters: (1) arrangement and morphology of dorsal cuticular plates, (2) ventral sculpture, (3) morphology of cephalic, trunk and leg sensory organs and (4) claw morphology. The applicability of these characters in the taxonomy and their distribution in the genus are discussed. Some of the characters traditionally used for species delimitation were shown to be unsuitable and others in need of a thorough reinvestigation. The meaning of the old term ‘faceted’, commonly used but often misapplied, has been clarified, based on the initial definition. Several characters of the claw structure were suggested as potentially useful for species delimitation. The taxonomic status of several old forms and species was discussed.
The homologies and evolutionary reduction of the pelvis and hindlimbs in snakes, with the first report of ossified pelvic vestiges in an anomalepidid (Liotyphlops beui)
Authors: Palci Alessandro , Hutchinson Mark N , Caldwell Michael W , Smith Krister T , Lee Michael S Y
Published: August 2019

We report the first example of ossified pelvic vestiges in an anomalepidid snake, Liotyplophs beui, and provide a review of the diversity of limb and pelvic elements within Serpentes. We trace the evolution, homology and reduction of the pelvic elements and hindlimbs from the oldest known snakes through to living forms. Evolutionary analysis of the pelvic and limb data shows that the most recent common ancestor of all living snakes (Serpentes) most probably retained all three pelvic elements and rudimentary hindlimbs (femoral spurs). Subsequently, there have been multiple losses of ossified pelvic and hindlimb elements and regaining of ossified pelvic elements. Reduction of the pelvis has followed different routes in the two primary groups of living snakes (scolecophidians and alethinophidians). The single remaining rod-like element in some scolecophidians is the ischium, whereas the single remaining rod-like element in many basal alethinophidians is the pubis. Notably, many basal alethinophidians share a distinctive configuration of cloacal spur (claw), femur and a sizeable pubis, which is likely to be related functionally to the widespread use of the hindlimbs in mating and courtship, rather than the usual representation of the bones as non-functional vestiges.
One-Stage Posterior Multiple-Level Asymmetrical Ponte Osteotomies Versus Single-Level Posterior Vertebral Column Resection for Severe and Rigid Adult Idiopathic Scoliosis
Authors: Zhang Yangpu , Tao Luming , Hai Yong , Yang Jincai , Zhou Lijin , Yin Peng , Pan Aixing , Liu Chang
Published: August 2019

Study Design.

Retrospective comparative study.

Objective.

To compare the efficacy and safety of one-stage posterior multiple-level asymmetrical Ponte osteotomies (MAPOs) and single-level posterior vertebral column resection (VCR) for severe and rigid adult idiopathic scoliosis (ADIS).

Summary of Background Data.

The surgical treatment of severe and rigid ADIS is a demanding and difficult challenge due to its complicated characteristics. Spine surgeons have often pursued advanced correction techniques such as VCR for such patients, which reported to present excellent correction outcomes. But this attractive procedure brought the greatest risk to both surgeons and patients.

Methods.

A total of 48 patients who underwent MAPO or VCR and fusion surgery with minimum 2-year follow-up between February 2009 and November 2015 were enrolled. Twenty-six patients were included in MAPO group and 12 patients in VCR group with an average age of 26.65 ± 8.40 and 27.92 ± 7.50 years, respectively. The average follow-up was 30.24 ± 10.55 months. The surgical details and complications were recorded. The radiological parameters and clinical outcome including Oswestry Disability Index and Scoliosis Research Society-22 questionnaire scores were collected and analyzed.

Results.

The main curve in MAPO and VCR group were corrected from an average of 98.52° ± 16.50° to 44.11° ± 17.72° and 108.91° ± 16.56° to 56.49° ± 18.82° with no significant difference. The postoperative coronal and sagittal parameters of the two groups were all improved and it showed no significant differences between the two groups. The mean operative time and blood loss of VCR group were significantly greater than those of MAPO group. All the clinical scores were significantly improved at final follow-up, with no significant difference. The incidence of complications in MAPO group was 3.85%, which was significantly lower than that of VCR group.

Conclusion.

The surgical procedure of multiple asymmetrical Ponte osteotomy is a safe, easy-to-operate, and effective technique that can correct scoliosis and restore the sagittal alignment. It can gain similar correction outcome to VCR, offering the advantages of reduced operation time, blood loss, and greatly reduced the complication.

Level of Evidence: 3
2020 Young Investigator Award Winner: Age- and Sex-related Normative Value of Whole-body Sagittal Alignment Based on 584 Asymptomatic Chinese Adult Population From Age 20 to 89
Authors: Hu Zongshan , Man Gene Chi Wai , Yeung Kwong Hang , Cheung Wing Hoi , Chu Winnie Chiu Wing , Law Sheung Wai , Lam Tsz Ping , Zhu Zezhang , Qiu Yong , Cheng Jack Chun Yiu
Published: August 2019

Study Design.

A cross-sectional radiographic study.

Objective.

The aim of this study was to establish the age- and sex-related normative values of whole-body sagittal alignment in asymptomatic Chinese adult population, and to investigate the changes and possible associated compensation mechanisms across age groups.

Summary of Background Data.

Previous studies have reported normative data for sagittal spinal alignment in asymptomatic adults. However, there was a lack of comprehensive investigation on age- and sex-related normative values of whole-body sagittal alignment.

Methods.

A total of 584 asymptomatic Chinese adults aged 20 to 89 years were recruited. Subjects were grouped according to age and sex. Whole-body standing radiographs were acquired for evaluating sagittal alignment from spine to lower limb. Comparisons of sagittal parameters between sex in different age groups were performed by independent t test. Pearson correlation analysis was used to determine relationships between each parameter.

Results.

Mean values of each sagittal parameter were presented based on age and sex. Thoracic kyphosis showed steady increasing trend while lumbar lordosis gradual decrease in both sexes. Pelvic tilt (PT) in males is greater than in females across all age groups with age-related gradual increase. There were significant differences between males and females from 20 to 60 years in terms of KneeFlex angle (KA) and AnkleFlex angle, but the differences were not significant after 60s. T1 pelvic angle (TPA) was significantly correlated with spinal, pelvic and lower-limb alignment. The older group (≥50 years) had a stronger correlation of TPA with PT and KA, whereas the younger (<50 years) had stronger correlation with TK.

Conclusion.

This study presented a comprehensive study of whole-body sagittal alignment based on a large asymptomatic population, which could serve as an age- and sex-specific reference value for spine surgeons when planning for correction surgery. Age can influence the recruitment of compensation mechanism that involves more pelvic and lower limb mechanisms for elderly people.

Level of Evidence: 3
The Fear Avoidance Beliefs Questionnaire (FABQ) Does it Really Measure Fear Beliefs?
Authors: Aasdahl Lene , Marchand Gunn Hege , Gismervik Sigmund Østgård , Myhre Kjersti , Fimland Marius Steiro , Røe Cecilie
Published: August 2019

Study Design.

A cohort study with 12 months of follow-up.

Objective.

To assess (1) the unidimensionality of the Fear-Avoidance Beliefs Questionnaire (FABQ) and (2) whether single questions in the FABQ predict future sickness absence as well as the whole scale.

Summary of Background Data.

The fear-avoidance model is a leading model in describing the link between musculoskeletal pain and chronic disability. However, reported measurement properties have been inconsistent regarding the FABQ.

Methods.

Individuals (n = 722) sick listed due to musculoskeletal, unspecified or common mental health disorders undergoing rehabilitation was included. A Rasch analysis was applied to evaluate the measurement properties of FABQ and its two subscales (physical activity and work). Linear regression was used to assess how well single items predicted future sickness absence.

Results.

The Rasch analysis did not support the FABQ or its two subscales representing a unidimensional construct. The 7-point scoring of the items was far too fine meshed and in the present population the data only supported a yes or no or a 3-point response option. The items were invariant to age, whereas two of the items revealed sex differences. The item “I do not think that I will be back to my normal work within 3 months” was the best predictor of future sickness absence. Adding the item “I should not do my regular work with my present pain” improved the prediction model slightly.

Conclusion.

The FABQ is not a good measure of fear-avoidance beliefs about work or physical activity, and the predictive property of the FABQ questionnaire is most likely related to expectations rather than fear. Based on these results we do not recommend using the FABQ to measure fear-avoidance beliefs.

Level of Evidence: 1
Trends and Characteristics of Spine Research From 2006 to 2015
Authors: Hollenberg Alex M. , Bernstein David N. , Baldwin Avionna L. , Beltejar Michael-John , Rubery Paul T. , Mesfin Addisu
Published: August 2019

Study Design.

Literature review.

Objective.

To determine characteristics and trends in published spine research over a recent decade in a high impact, general orthopedic surgery journal.

Summary of Background Data.

Recent trends in published spine research in a high-impact orthopedic surgery journal are unknown. Such knowledge could guide future research in the field.

Methods.

A comprehensive literature review of clinical and basic science spine articles published in The Journal of Bone & Joint Surgery from 2006 to 2015 was conducted. Articles were assessed for: title, year of publication, authorship, academic degrees of the authors, number of citations, institution of origin, and spine topic. Clinical articles were evaluated for: sex and race/ethnicity of the human subjects, level of evidence, and inclusion of patient-reported outcome measures (PROMs). Basic science articles were evaluated for: type of study (animal, cadaver, cell-based), sex of the animals, cadavers or cells studied (male, female, or male and female), and presence of sex-based reporting (defined as reporting of results by sex).

Results.

A total of 203 spine articles were evaluated from the 10-year study period. At least 35 validated or nonvalidated patient-reported outcome measures were utilized in clinical spine research. The most commonly reported PROMs were the Oswestry Disability Index (24.4%), Short Form-36 Health Survey (23.7%), and Visual Analog Scale for Pain (19.3%). The average level of evidence improved from 3.25 in 2006 to 2.60 in 2015. Only 13.2% of clinical spine articles reported the race/ethnicity of the subjects.

Conclusion.

A consensus regarding validated PROMs in spine research would be valuable. From 2006 to 2015, the level of evidence of spine articles in The Journal of Bone & Joint Surgery improved. Accurate and complete reporting of patient demographics is an area for improvement in spine research in light of studies demonstrating sex and race/ethnicity-related differences in clinical outcome after spine surgery.

Level of Evidence: 5
Augmented Reality Surgical Navigation in Spine Surgery to Minimize Staff Radiation Exposure
Authors: Edström Erik , Burström Gustav , Omar Artur , Nachabe Rami , Söderman Michael , Persson Oscar , Gerdhem Paul , Elmi-Terander Adrian
Published: August 2019

Study Design.

Prospective observational study.

Objective.

To assess staff and patient radiation exposure during augmented reality surgical navigation in spine surgery.

Summary of Background Data.

Surgical navigation in combination with intraoperative three-dimensional imaging has been shown to significantly increase the clinical accuracy of pedicle screw placement. Although this technique may increase the total radiation exposure compared with fluoroscopy, the occupational exposure can be minimized, as navigation is radiation free and staff can be positioned behind protective shielding during three-dimensional imaging. The patient radiation exposure during treatment and verification of pedicle screw positions can also be reduced.

Methods.

Twenty patients undergoing spine surgery with pedicle screw placement were included in the study. The staff radiation exposure was measured using real-time active personnel dosimeters and was further compared with measurements using a reference dosimeter attached to the C-arm (i.e., a worst-case staff exposure situation). The patient radiation exposures were recorded, and effective doses (ED) were determined.

Results.

The average staff exposure per procedure was 0.21 ± 0.06 μSv. The average staff-to-reference dose ratio per procedure was 0.05% and decreased to less than 0.01% after a few procedures had been performed. The average patient ED was 15.8 ± 1.8 mSv which mainly correlated with the number of vertebrae treated and the number of cone-beam computed tomography acquisitions performed. A low-dose protocol used for the final 10 procedures yielded a 32% ED reduction per spinal level treated.

Conclusion.

This study demonstrated significantly lower occupational doses compared with values reported in the literature. Real-time active personnel dosimeters contributed to a fast optimization and adoption of protective measures throughout the study. Even though our data include both cone-beam computed tomography for navigation planning and intraoperative screw placement verification, we find low patient radiation exposure levels compared with published data.

Level of Evidence: 3
Do We Have Adequate Flexion-extension Radiographs for Evaluating Instability in Patients With Lumbar Spondylolisthesis?
Authors: Morita Tomonori , Yoshimoto Mitsunori , Terashima Yoshinori , Tanimoto Katsumasa , Iesato Noriyuki , Ogon Izaya , Oshigiri Tsutomu , Teramoto Atsushi , Emori Makoto , Takashima Hiroyuki , Hirota Ryosuke , Fujimoto Shutaro , Yamashita Toshihiko
Published: August 2019

Study Design.

A retrospective cohort study of consecutive patients.

Objective.

To investigate whether adequate flexion-extension was acquired in standard functional radiographs in lumbar spondylolisthesis.

Summary of Background Data.

In lumbar spondylolisthesis, flexion-extension radiographs taken in the standing position are most commonly used to evaluate spinal instability. However, these functional radiographs occasionally depend on the patient's effort and cooperation, they can provide different results.

Methods.

This study included 92 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis. We analyzed the flexion-extension radiographs taken with the patient being led by the hand (LH) and those taken without LH (NLH). Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), and lumbar lordosis (LL) were measured on functional radiographs taken in both tests. Then, ST, SA, PO, detection rate of instability, and LL observed in LH were compared with those observed in NLH. Furthermore, the correlation of the difference was evaluated between ST, lumbar angulation, and LL.

Results.

A relative value of ST was 9.5% ± 4.3% in LH and 5.6% ± 3.3% in NLH, which differed significantly (P < 0.001). SA and PO were also significantly greater in LH than in NLH. The detection rate of instability was 71.7% in LH and 30.4% in NLH (P < 0.001). LL measurement on flexion showed 17.6° ± 13.5° in LH and 28.2° ± 12.2° in NLH, which differed significantly (P < 0.001). However, no significant difference was found in LL on extension between LH and NLH. There was a moderate correlation between the difference of ST, SA, PO, and LL on flexion.

Conclusion.

Flexion with physical assistance was useful for the detection of abnormal lumbar mobility. Taking radiation exposure into consideration, physical assistance such as using a table in front of a patient could lead the similar evaluation of the segmental instability.

Level of Evidence: 2
Right- Versus Left-sided Exposures of the Recurrent Laryngeal Nerve and Considerations of Cervical Spinal Surgical Corridor
Authors: Rajabian Ali , Walsh Michael , Quraishi Nasir A.
Published: August 2019

Study Design.

Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens which have not previously been reported.

Objective.

We aimed to perform surgically relevant exposures of the anterior cervical spine with particular attention to observing the potential vulnerabilities of the RLN on right and left.

Summary of Background Data.

Vulnerability of the RLN in the anterior cervical spine approach on the right versus left is the subject of ongoing debate. Although most cadaveric studies focus on course variations, structural relations of RLN, they have been done in preserved (fixed) cadavers without relevance to the needs of spinal exposure.

Methods.

Twelve fresh undyed cadavers had extensive layer by layer dissections by 2 surgeons (one with extensive experience as anatomy dissector). Both sides were explored for vulnerability during cervical spinal procedures. Each dissection was carried out in a phased approach and deliberately explored beyond what can be afforded in live surgery to allow the reader to conceptualize a better view of the structures.

Results.

In all specimens, we consistently demonstrated that the right surgical corridor involved manipulation of the nerve and its branches especially below C5 to achieve optimum midline access: in the right corridor, the RLN is on its oblique course to the tracheoesophageal groove. On the left, RLN is already in the tracheoesophageal groove and out of the surgical field involving minimal direct mobilization of the nerve.

Conclusion.

RLN surgical anatomy photographed here is novel in using fresh unprocessed cadaveric specimens which has previously not been reported.

Right surgical corridor, below C5, involves retraction/manipulation of RLN for achieving optimum spinal midline access, highlighting potential surgical vulnerability of right RLN.

Level of Evidence: 3
Synthetic Human Angiotensin II in Pediatric Patients With Vasodilatory Shock: A Report on Two Patients
Authors: Bailey Dwight M. , Chima Ranjit S. , Tidmarsh George F. , Williams Mark D.
Published: August 2019

Background:

Severe sepsis and septic shock continue to be an important problem in children, with hospital mortality rates for pediatric severe sepsis as high as 25%.

Case Summary:

Two pediatric patients with septic shock requiring high dose vasopressors, who were treated with angiotensin II as part of an open-label study. Both patients had a significant increase in mean arterial pressure shortly after initiation of angiotensin II, with a reduction of the dose of catecholamines and vasopressin infusions. Serious adverse events reported were not attributable to angiotensin II by investigators. One patient survived, and one died related to progressive cerebral edema.

Conclusions:

Angiotensin II may represent another therapeutic option for pediatric patients who remain hypotensive despite receiving fluids and standard vasopressor therapy and deserves further study.
Comparison of Self-controlled Designs for Evaluating Outcomes of Drug–Drug Interactions
Authors: Bykov Katsiaryna , Franklin Jessica M. , Li Hu , Gagne Joshua J.
Published: August 2019

Background:

Self-controlled designs, both case–crossover and self-controlled case series, are well suited for evaluating outcomes of drug–drug interactions in electronic healthcare data. Their comparative performance in this context, however, is unknown.

Methods:

We simulated cohorts of patients exposed to two drugs: a chronic drug (object) and a short-term drug (precipitant) with an associated interaction of 2.0 on the odds ratio scale. We analyzed cohorts using case–crossover and self-controlled case series designs evaluating exposure to the precipitant drug within person-time exposed to the object drug. Scenarios evaluated violations of key design assumptions: (1) time-varying, within-person confounding; (2) time trend in precipitant drug exposure prevalence; (3) nontransient precipitant exposure; and (4) event-dependent object drug discontinuation.

Results:

Case–crossover analysis produced biased estimates when 30% of patients persisted on the precipitant drug (estimated OR 2.85) and when the use of the precipitant drug was increasing in simulated cohorts (estimated OR 2.56). Self-controlled case series produced biased estimates when patients discontinued the object drug following the occurrence of an outcome (estimated incidence ratio [IR] of 2.09 [50% of patients stopping therapy] and 2.22 [90%]). Both designs yielded similarly biased estimates in the presence of time-varying, within-person confounding.

Conclusion:

In settings with independent or rare outcomes and no substantial event-dependent censoring (<50%), self-controlled case series may be preferable to case–crossover design for evaluating outcomes of drug–drug interactions. With frequent event-dependent drug discontinuation, a case–crossover design may be preferable provided there are no time-related trends in drug exposure.
RELATIONSHIP BETWEEN CHOROIDAL VASCULAR HYPERPERMEABILITY, CHORIOCAPILLARIS FLOW DENSITY, AND CHOROIDAL THICKNESS IN EYES WITH PACHYCHOROID PIGMENT EPITHELIOPATHY
Authors: Sakurada Yoichi , Fragiotta Serena , Leong Belinda C.S. , Parikh Ravi , Hussnain S. Amal , Freund K. Bailey
Published: August 2019

Purpose:

To use swept-source optical coherence tomography and swept-source optical coherence tomography angiography to investigate potential relationships between choroidal vascular hyperpermeability (CVH) seen with indocyanine green angiography (ICGA), choriocapillaris flow density, and choroidal thickness in eyes with pachychoroid pigment epitheliopathy.

Methods:

Patients with pachychoroid pigment epitheliopathy were prospectively imaged with 12-mm × 12-mm swept-source optical coherence tomography, 12-mm × 12-mm swept-source optical coherence tomography angiographyA, and ICGA. Binarized choriocapillaris OCTA images were superimposed with ICGA images in which CVH area had been isolated. Choriocapillaris flow density within or outside the quadrants of CVH was calculated and the ratio of these two values was determined. The presence of CVH and choroidal thickness was evaluated at 9 locations within a central 3-mm × 3-mm area to explore the relationship between these 2 factors.

Results:

Ten eyes from 10 patients were enrolled in the present study. Choriocapillaris flow density within quadrants of CVH area was significantly lower compared with quadrants without CVH (P < 0.001). The mean choriocapillaris flow density ratio was 0.86 ± 0.10 (range: 0.65–0.99). From among the 90 locations in 10 study eyes, 48 were within areas of CVH. Choroidal thickness was greater in quadrants of CVH compared with areas without CVH (P < 0.001, 455 ± 122 µm vs. 297 ± 93 µm).

Conclusion:

Reduced choriocapillaris flow density, increased choroidal thickness, and CVH appear to co-localize in eyes with pachychoroid pigment epitheliopathy.
A case report of oral contraceptive misuse induced cerebral venous sinus thrombosis and dural arteriovenous fistula
Authors: Huang Qingling , Chai Xue , Xiao Chaoyong , Cao Xuan
Published: August 2019

Rationale:

Consumption of oral contraceptive pills (OCP) is a known risk factor for cerebral venous sinus thrombosis (CVST) among women. Development of dural arteriovenous fistula (dAVF) afterwards was very uncommon. We present a rare chronic complication of development of dAVF after CVST.

Patient concerns:

A 22-year-old woman suffered headache for a week. She was then admitted into our hospital.

Diagnosis:

Contrast enhanced magnetic resonance venography (MRV) demonstrated the thrombosis of the left transverse-sigmoid sinus the second day.

Interventions:

The intravenous thrombolysis was carried out. As the symptoms improved, the patient was discharged, while the treatment with oral dabigatran continued. However, 3 months after the onset, magnetic resonance imaging (MRI) showed swelling brainstem, and digital subtraction angiography (DSA) confirmed a dAVF. Clipping of the fistula was conducted, and her clinical symptoms improved gradually.

Outcomes:

The patient was transferred to rehabilitation center later, and received follow-up care.

Lessons:

When a patient taking OCP and suffering from a sudden headache, a clinical suspicion of possible CVST should always arise to avoid the onset of dAVF as soon as possible.
Ossifying fibroma in the mandibular angle mimicking metastatic clear cell renal cell carcinoma
Authors: Matsuda Shinpei , Yoshimura Hitoshi , Yoshida Hisato , Taga Minekatsu , Imamura Yoshiaki , Kiyoshima Tamotsu , Sano Kazuo
Published: August 2019

Rationale:

Ossifying fibroma is benign fibro-osseous neoplasm. The authors report a case of ossifying fibroma in the mandibular angle suspected as metastasis of clear cell renal cell carcinoma.

Patient concerns:

A 74-year-old man presented to the primary hospital complaining of frequent urination. A tumor in the left kidney was detected via an abdominal computed tomography scan. The patient then visited the Department of Urology at our hospital.

Diagnoses:

According to whole-body imaging examinations, the patient was suspected of having renal cancer with mandibular metastasis. Also, a cystic lesion of the maxilla was revealed.

Interventions:

Left nephrectomy was performed by urologists, and the patient was diagnosed with clear cell renal cell carcinoma of the left kidney. Approximately 1 month later, resection with a safety margin of the mandibular lesion and removal of the maxillary lesion were performed by oral and maxillofacial surgeons.

Outcomes:

The patient was diagnosed with ossifying fibroma of the mandible and an odontogenic keratocyst of the maxilla via a histopathological examination. Eighteen months have passed since the operation without clinical and imaging findings associated with recurrence.

Lessons:

Ossifying fibroma in the mandibular angle of elderly patients is extremely rare. Surgeons should consider the possibility of metastasis when osteolytic lesions of the jaw are found in patients with cancer.
Circulating JNK pathway-associated phosphatase level correlates with decreased risk, activity, inflammation level and reduced clinical response to tumor necrosis factor-α inhibitor in Crohn disease patients
Authors: Shi Xue , Yang Wei , Wang Nian , Zhu Junyi
Published: August 2019

Objective:

This study aimed to investigate the correlation of serum Jun-amino-terminal kinase (JNK) pathway-associated phosphatase (JKAP) level with disease risk, severity, inflammation, and treatment response to tumor necrosis factor (TNF)-α inhibitor in Crohn disease (CD) patients.

Method:

Ninety-six active CD patients and 90 healthy controls (HCs) were consecutively enrolled. Serum JKAP level of participants was determined via enzyme-linked immunosorbent assay (ELISA). In CD patients, C-reactive protein (CRP), erythrocyte sedimentation rate, Crohn disease activity index (CDAI), and inflammatory cytokine levels (determined by ELISA) were recorded. All CD patients underwent infliximab (IFX) treatment for 12 weeks, then treatment response (defined as decrement of CDAI ≥70) was assessed at week 12 (W12).

Results:

Serum JKAP level in CD patients was lower compared to HCs, and it disclosed a good predictive value for decreased CD risk; meanwhile, it was negatively correlated with CRP level, CDAI score, TNF-α, interleukin (IL)-6, and IL-17 levels in CD patients. Sixty-eight (70.8%) patients achieved treatment response to IFX at W12, and JKAP level was increased at W12 compared to baseline. Interestingly, baseline JKAP level in response patients was decreased compared to nonresponse patients, and it exhibited a good predictive value for decreased treatment response to IFX, multivariate logistic regression revealed that JKAP was an independent factor for predicting reduced IFX response.

Conclusion:

Circulating JKAP expression correlates with decreased disease risk, activity, and inflammation level, and it could be served as a novel biomarker for predicting reduced clinical response to TNF-α inhibitor in CD patients.
Chuankezhi injection for asthma
Authors: Li Meichen , Zheng Wenjiang , Zhang Chaoyuan , Yan Qian , Peng Zijing , Xie Fuqi , Hong Yu , Liu Xiaohong
Published: August 2019

Background:

Asthma is a chronic inflammatory disease characterized by recurrent attacks of breathlessness and wheezing, which often worsen at night or in the early morning and vary from person to person in severity and frequency. Chuankezhi injection (CKZ), as a new Chinese medicine, was recently found to have a good clinical effect on asthma. Whereas neither systematic nor meta-analysis of randomized controlled trials (RCTs) explain the efficacy of CKZ in treating asthma. Therefore, we provide a protocol to evaluate the efficacy and safety of CKZ for asthma.

Methods:

From inception until April 2019, a systematic and comprehensive literature search will be conducted in both 4 Chinese databases and 3 English databases. RCTs will be included related to CKZ for asthma. We will assess the quality of the included trials in accordance with the risk of bias tools in Cochrane manual 5.1.0. We will use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method to assess the certainty of the estimated evidence. Data analysis will be performed using the STATA 15.0.

Results:

This systematic review aims to assess the effectiveness and safety of CKZ for the treatment of asthma, in order to provide evidence for the clinical practice of Chinese medicine. This protocol will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. The results of this meta-analysis will be submitted to a peer-reviewed journal once it is completed.

Conclusion:

The consequence of this study will furnish proof to evaluate if CKZ is effective in the treatment of asthma.

PROSPERO registration number:

ROSPERO CRD42019134458.
A case-control study on the relationship between miRNAs single nucleotide polymorphisms and sepsis risk
Authors: Zhang Yan , Li Min , Bao Lanying , Hu Pengfei
Published: August 2019

MicroRNAs (miRNAs) play an important role in the pathogenesis of sepsis, but the association of miRNAs single nucleotide polymorphisms (SNPs) and sepsis risk is not clear. We analyzed plasma levels of miR-187, miR-21, and miR-145 in 180 patients with sepsis and 180 healthy controls were analyzed, and the SNPs: rs12605436, rs13137, and rs353291 were detected by sequencing. Plasma levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 were measured in all subjects by enzyme-linked immunosorbent assay (ELISA). The results showed that the levels of TNF-α and IL-6 in the plasma of patients with sepsis were significantly higher than those in patients of the control group (P < .0001). Plasma levels of miR-187 in patients with sepsis were significantly lower than those in the control group, while those of miR-21 and miR-145 were significantly higher than those in the control group (P < .0001). Plasma levels of miR-187 in sepsis patients were inversely correlated with those of TNF-α and IL-6 (r = −0.2841, −0.2163), and plasma levels of miR-21 and miR-145 were positively correlated with those of TNF-α and IL-6 (r = 0.615, 0.3057, 0.4465, 0.2734). The T allele of the miR-187 SNP rs12605436 was found to be a risk factor for sepsis (OR = 1.403, 95% CI = 1.205–1.612, P < .001). The T allele of the miR-21 SNP rs13137 and the T allele of the miR-145 SNP rs353291 (OR = 0.685, 95% CI = 0.566–0.820, P < .001) were found to be a protective factor for sepsis (OR = 0.755, 95% CI = 0.632–0.896, P < .001). From our results, we can see that the plasma levels of miRNAs containing the SNPs rs12605436, rs13137, and rs353291 are associated with the occurrence of sepsis.
Long term follow-up in a patient with prune-belly syndrome – a care compliant case report
Authors: Cornel Aldea , Duicu Carmen , Delean Dan , Bulata Bogdan , Starcea Magdalena
Published: August 2019

Rationale:

Malformative uropathies represent a major cause of Chronic Kidney Disease (CKD) in children. Genitourinary system is the most frequent and sever affected in Prune-Belly syndrome cases. That is why the findings of early diagnosis and vigilant monitoring for these situations remain a major challenge for the medical team.

Patient concerns:

We present the clinical course of a 10 years old child with diagnosis of Prune-Belly syndrome. A urinary tract abnormality was suspected starting 25 weeks of gestation, when a routine ultrasound showed oligohydramnios, increased size urinary bladder, bilateral hydronephrosis and megaureters, thin abdominal wall.

Diagnosis:

Prenatal suspicion of Prune-Belly syndrome plays a deciding role in renal disease progression. A detailed clinical exam at birth established the diagnosis of Prune-Belly syndrome. Renal ultrasound confirmed bilateral grade III hydronephrosis and megaureters, with empty bladder, suggesting an obstruction at this level. A persistent urachus was confirmed by catheterization. Later it was used for imaging study that showed bilateral high grade reflux.

Interventions:

The main goal of any treatment is to preserve kidney function. Treatment options depend on the clinical picture. The pregnancy was closely monitorized, but fetal distress appeared so early labor was induced at 32 weeks. At beginning a temporary catheter was placed into the urachus which expressed urine. The urachus drain was left in place until the age of 6 weeks, when a bilateral ureterostomy was performed. Skeletal and genital malformations were present too; the child has undergone several surgeries to solve these abnormalities.

Outcomes:

At the age of 10 years, he is a well-adapted child. He has had fewer than 3 urinary tract infections per year. Long term follow-up showed a relatively slow decline in the estimated Glomerular Filtration Rate in our child (62 ml/1.73m2/min).

Lessons:

This case suggests that induced early labor could prove beneficial for early upper urinary tract decompression through earlier access to surgery. This is an option especially in situations or region where vesicoureteric or vesicoamniotic shunt placement is not available.
Fatal contrast medium-induced adverse response to iohexol in carotid artery angioplasty
Authors: Yang Zhiqi , Li Rong , Yue Jinbin , Wei Yaxuan , Zhang Xiaoyan , Yin Rong
Published: August 2019

Rationale:

Adverse drug reactions (ADRs) to iohexol occur infrequently and generally result in good outcomes. This report describes a 51-year-old man suffering from an ADR to iohexol (Omnipaque 300), which proved fatal.

Patient concerns:

The patient was admitted to hospital due to intermittent dizziness over 2 years and transient numbness and weakness of the right limbs for 1 week. The patient was investigated using carotid artery angioplasty (CAA), during which the patient suffered a sudden disorder of consciousness and a tonic-clonic seizure leading to status epilepticus. After the CAA, the patient suffered from increasing cerebral edema volume.

Diagnoses:

Results of digital subtraction angiography and computed tomography angiography performed at another hospital before the CAA suggested severe stenosis of the left internal carotid artery at the spinal C1 level. In the processes of intraoperative and postoperative CAA, the patient developed severe allergic reactions to the contrast agent including epilepsy, brain tissue edema, and renal failure, which were typical according to the 10th edition of the American College of Radiology Manual on Contrast Media (ACR Manual on Contrast Media, Version 10.3, 2017).

Interventions:

The patient was treated with antiepileptic, antianaphylactic therapy, and control of blood pressure. Due to rapid and severe brain edema, a decompressive craniectomy was performed on the left side, but it was unsuccessful in reducing brain edema. Subsequently, the patient was started on continuous renal replacement therapy for progressive renal dysfunction.

Outcomes:

Despite the use of a variety of medical and surgical interventions, it was not possible to control the patient's condition, which gradually declined leading to death, 7 days post-CAA.

Lessons:

To the authors’ knowledge, this represents the 1st case of fatal contrast-induced ADR to iohexol during CAA. Although a variety of preoperative tests for iohexol allergy were performed according to recommendations from the ACR Manual on Contrast Media (Version 10.3, 2017), severe complications related to iodized contrast agent still occurred. If the ADR had been recognized sooner and decompressive craniectomy and continuous renal replacement therapy were applied earlier, it would have improved the patients’ prognosis.
Primary tumor resection for initially staged IV breast cancer
Authors: Erol Timuçin , İmamoğlu Nazli Eylem , Aydin Büşra , Taşkiran Z. Ekim , Esendağli Güneş , Kösemehmetoğlu Kemal , Baykal Ataç
Published: August 2019

Conventional therapy modalities for advanced breast cancer are problematic, whereas checkpoint blockade immunotherapy has been considered as a promising approach. This study aims to determine programmed death-ligand 1 (PD-L1) expression and methylation status of PD-L1 promoter in primary tumor tissue and metastatic foci of patients with stage IV breast cancer.

Clinicopathological data and survival rates of 57 breast cancer patients, who were initially staged IV, and operated for intact tumors, were retrospectively analyzed. Immunohistochemical analysis of PD-L1 using 57 primary tumors, 33 paired metastatic lymph nodes, and 14 paired distant metastases was performed. Additionally, the methylation rate of the PD-L1 gene promoter region was determined with real-time polymerase chain reaction (PCR) analysis in 38 samples.

Overall PD-L1 expression in primary tumors was 23.1% (12/52). PD-L1 positivity was reduced in lymph nodes by 15.2% (5/33) and in distant metastases by 21.4% (3/14). PD-L1 expression diverged between primary and metastatic foci in a subset of cases (18.2% for lymph node and 33.3% for distant metastasis). In general, the PD-L1 promoter was not methylated, and mean methylation rates were low (min. 0%–max. 21%). We observed no correlation between PD-L1 expression, promoter methylation, and survival.

Neither the expression nor the methylation status of PD-L1 in patients, who were presented with stage IV breast cancer and operated for an intact primary tumor, had a statistically significant relation with survival. Discordance in PD-L1 expression between primary tumor and metastasis should be considered during pathological and clinical management of patients who would undergo checkpoint blockade therapy.
Pattern of adverse events induced by aflibercept and ranibizumab
Authors: Ha Dongmun , Choi So-Ra , Kwon Yongmin , Park Han-Heui , Shin Ju-Young
Published: August 2019

Data regarding the safety of anti-vascular endothelial growth factor (anti-VEGF) treatment is limited.

To compare the adverse events (AEs) induced by aflibercept and ranibizumab using a spontaneous reporting system and determine the signals.

We used data from the Korea Institute of Drug Safety & Risk Management-Korea Adverse Event Reporting System Database (KIDS-KD), collected between 2007 and 2016. Differences in patient demographics, report type, reporter, causality, and serious-AEs between aflibercept and ranibizumab were compared. Metrics including proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC), were used to compare signals with the AEs on the drug labels in the United States of America and Korea. Logistic regression analysis was performed to identify AEs that are more likely to occur with drug use.

A total of 32 aflibercept and 103 ranibizumab cases of AEs were identified. The proportion of AEs that were reported voluntarily was higher with aflibercept (50.5%) use than ranibizumab (4.9%), whereas the AEs reported by post-marketing surveillance were higher with ranibizumab (46.6%) use than aflibercept (31.3%). The percentage of AEs in patients >60 years old, reports by consumers, and the ratio of SAEs to AEs associated with aflibercept (84. %, 9.4%, and 75.0%, respectively) were higher than those of ranibizumab (77.7%, 1.9%, and 19.4%, respectively). The number of newly detected AEs after aflibercept and ranibizumab treatment was 3 and 8, respectively. Among these, conjunctivitis and medicine ineffective were not included on the aflibercept and ranibizumab labels, respectively. Endophthalmitis (OR 6.96, 95% CI 2.74–17.73) was more likely to be reported in patients with aflibercept than in patients without aflibercept, whereas medicine ineffective (OR 18.49, 95% CI 2.39–143.29) and retinal disorder (OR 7.03, 95% CI 1.60–30.96) were more likely to be reported in patients with ranibizumab than in patients without ranibizumab.

New signals have been identified for aflibercept and ranibizumab. Further research is necessary to evaluate the causality of AEs that were detected as signals in this study.
Application of lacrimal endoscopy in the diagnosis and treatment of primary canaliculitis
Authors: Zheng Qingqing , Shen Ting , Luo Hongbo , Hong Chaoyang , He JinJing , Gong Jingwen , Jiang Jin
Published: August 2019

To investigate the efficacy of lacrimal endoscopy in the diagnosis and treatment of primary canaliculitis.

This is a retrospective, interventional study. Fifteen patients diagnosed as primary canaliculitis were investigated, who underwent surgery with lacrimal endoscopy from January 2015 to December 2017 at Zhejiang Provincial People's Hospital. Patients were subsequently followed post-operatively for at least 6 months. Pre- and post-operative main measurement included ocular surface symptoms, signs of canaliculitis, intraoperative images, treatment response and complications.

Twelve patients (12 eyes) were enrolled. Endoscopy was successful in revealing the residual concretion and pathological change of lacrimal duct. With its unique direct vision and micro drill, all concretions got removed and lacrimal ducts got patent. On postoperative month 6, all of the patients got cured with no signs of redness, swelling of the punctum and eyelid, epiphora with discharge and pain. None serious complications such as false canalicular passage were observed.

Lacrimal endoscopy is indispensable in diagnosis, treatment and follows up of primary canaliculitis. With less iatrogenic injury, higher resolution rate and direct observation of canalicular mucosa, lacrimal endoscopy should be widely applied in the management of lacrimal diseases.
A study on the puncture method of extrapedicular infiltration anesthesia applied during lumbar percutaneous vertebroplasty or percutaneous kyphoplasty
Authors: Liu Liehua , Wang Haoming , Wang Jiangang , Wang Qian , Pu Yu , Wang Zili , Wu Yuexiang , Xu Yuan , Jin Weidong
Published: August 2019

Extrapedicular infiltration anesthesia (EPIA) was reported for percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) and provided good local anesthetic effects. Because of differences in anatomical morphology at each lumbar level, the puncture method of EPIA is not uniform in each lumbar vertebrae. To accurately insert the anesthetic needle into the extrapedicular region, we researched the puncture method of EPIA at each lumbar level.

We retrospectively analyzed computed tomography (CT) images in 230 patients with lumbar osteoporotic fractures, including 59 L1 fractures, 54 L2 fractures, 50 L3 fractures, 36 L4 fractures, and 31 L5 fractures. The puncture of EPIA was simulated in every fractured vertebrae through CT, and the skin puncture point, puncture direction, and puncture depth of the anesthetic needle were observed. These specific parameters were the distance from the skin puncture point to the superior border of the pedicle projection on the skin (distance AD), distance from the skin puncture point to the lateral border of the pedicle projection on the skin (distance BC), sagittal section angle (SSA), transverse section angle (TSA), and depth of EPIA.

As the lumbar ordinal number increased, the SSA, distance AD, TSA, and distance BC for each lumbar level gradually increased, and the puncture depth gradually decreased, all these parameters showed significant differences among the 5 lumbar levels (P < .001). The recommended puncture methods for EPIA at each lumbar level, including distance AD, distance BC, SSA, and TSA, were as follows: in L1, 4 mm, 8 mm, 9° and 8°; in L2, 6 mm, 10 mm, 11° and 10°; in L3, 9 mm, 13 mm, 12° and 12°; in L4, 12 mm, 18 mm, 16° and 18°; and in L5, 20 mm, 26 mm, 24° and 24°. The depth of EPIA was 13 mm in L1-L3 and 11 mm in L4-L5.

By confirming the skin puncture point and puncture direction of the anesthetic needle, from an anatomical perspective, EPIA is feasible for lumbar PVP (PKP).
Association of arterial stiffness with aortic calcification and tortuosity
Authors: Moon Inki , Jin Kwang Nam , Kim Hack-Lyoung , Suh Hyeon Jeong , Lim Woo-Hyun , Seo Jae-Bin , Kim Sang-Hyun , Zo Joo-Hee , Kim Myung-A
Published: August 2019

Impact of arterial stiffness on aortic morphology has not been well evaluated. We sought to investigate the association of brachial-ankle pulse wave velocity (baPWV) with aortic calcification and tortuosity.

A total of 181 patients (65.4 ± 10.4 years, males 59.7%) who underwent computed tomographic angiography and baPWV measurement within 1 month of study entry were retrospectively reviewed. Aortic calcification was quantified by the calcium scoring software system. Aortic tortuosity was defined as the length of the midline in the aorta divided by the length of linear line from the aortic root to the distal end of the thoraco-abdominal aorta. In simple correlation analyses, baPWV was correlated with aortic calcification (r = 0.36, P < .001) and tortuosity (r = 0.16, P = .030). However, these significances disappeared after controlling for confounders in multivariate analyses. Factors showing an independent association with aortic calcification were age (β = 0.37, P < .001), hypertension (β = 0.19, P = .003), diabetes mellitus (β = 0.12, P = .045), smoking (β = 0.17, P = .016), and estimated glomerular filtration rate (β = –0.25, P = .002). Factors showing an independent association with aortic tortuosity were age (β = 0.34, P < .001), body mass index (β = –0.19, P = .018), and diabetes mellitus (β = –0.21, P = .003).

In conclusion, baPWV reflecting arterial stiffness was not associated with aortic calcification and tortuosity. Traditional cardiovascular risk factors were more influential to aortic geometry. Further studies with a larger sample size are needed to confirm our results.