bluuebunny/crossref_metadata_2025 huggingface dataset:
Considering Breast Reconstruction after Mastectomy: A Patient Decision Aid Video and Workbook
Authors: Hoffman Aubri S. , Cantor Scott B. , Fingeret Michelle C. , Housten Ashley J. , Hanson Summer E. , McGee Jennifer H. , Pietz Jordan T. , Bennett Alina , Volk Robert J. , Reece Gregory P.
Published: November 2019

Background:

Women report difficulty understanding and personalizing breast reconstruction information during the complex and time-limited period of cancer treatment planning. Patient decision aids can help patients become well informed, form realistic expectations, prepare to communicate with the surgical team, and be more satisfied with their decision-making process.

Methods:

We engaged patients, providers, and stakeholders in a user-centered design process to develop an online patient decision aid video and interactive workbook for breast reconstruction after mastectomy. The video and workbook introduce breast reconstruction and compare the risks and benefits of 3 key decisions: reconstruction versus no reconstruction, immediate versus delayed, and tissue- versus implant based. Pilot testing using cognitive interviews and pre-/postdecision aid questionnaires assessed acceptability, knowledge, and decision-making values.

Results:

After viewing the decision aid, patients (n = 20) scored 97.5% correct on a knowledge test; however, the factors driving their decisions were varied. All (n = 40) patients and providers/stakeholders provided over 80% positive acceptability ratings. 97.5% said they would recommend the video and workbook to other women with breast cancer.

Conclusions:

The Considering Breast Reconstruction after Mastectomy patient decision aid video and workbook show potential for improving informed decision-making. Delivery before the initial plastic surgery consultation was well supported as a way to give women time to process the information and prepare to talk with the surgical team about their options. The Personal Decision Worksheet shows potential for assessing patients’ knowledge and the factors driving their personal decision-making process.
A Cost and Efficiency Analysis of the WALANT Technique for the Management of Trigger Finger in a Procedure Room of a Major City Hospital
Authors: Maliha Samantha G. , Cohen Oriana , Jacoby Adam , Sharma Sheel
Published: November 2019

Background:

The “Wide Awake Local Anesthesia No Tourniquet” (WALANT) technique is gaining popularity in hand surgery owing to its benefits of reduced cost, shorter hospital stay, improved safety, and the ability to perform active intraoperative examinations. The aim of this study is to analyze the cost savings and efficiency of performing A1 pulley release for treatment of trigger finger using the WALANT technique in a major city hospital procedure room (PR) as compared with the standard tourniquet, operating room (OR) approach.

Methods:

Patients who underwent trigger finger release between 2012 and 2017 were identified. Demographic and procedural information were obtained. Patients were followed for an average of 82 and 242 days in the PR and OR groups, respectively.

Results:

Thirty-nine PR and 37 OR patients were identified. Case length and turnover time were shorter in the PR group [21.4 ± 7 versus 23.5 ± 14.3 min (P = 0.942) and 31.1 ± 11.1 and 65.3 ± 17.7 min (P < 0.001), respectively). The cost of the instrument tray utilized was calculated as $3,304.25 in the main OR and $993.79 in the PR. Cost per minute for all personal services in the OR was calculated to be $44/min, a cost that was virtually absent in the PR. Complication rates did not differ between both groups.

Conclusion:

Performing A1 pulley release for treatment of trigger finger using the WALANT technique is both cost effective and time efficient compared to performing the same procedure in the main OR of a major city public hospital.
Cardiovascular, renal and liver protection with novel antidiabetic agents beyond blood glucose lowering in type 2 diabetes: consensus article from the European Society of Hypertension Working Group on Obesity, Diabetes and the High-risk Patient
Authors: Kotsis Vasilios , Jordan Jens , Stabouli Stella , Antza Christina , Micic Dragan , Jelaković Bojan , Schlaich Markus P. , Nilsson Peter M. , Kreutz Reinhold , Mancia Giuseppe , Tsioufis Kostas , Grassi Guido
Published: November 2019

The prevalence of type 2 diabetes (T2D) has increased over the past few decades. T2D has a strong genetic propensity that becomes overt when a patient is exposed to a typical Western lifestyle, gain weight and becomes obese, whereas weight loss protects from the development of T2D. Except of lifestyle modifications, the choice of the appropriate treatment is essential in the management of patients with T2D and appears critical for the obese population with T2D. The new pharmacological approach for the treatment of T2D, sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, seems to be effective not only in the management of T2D but also for weight loss, reduction of blood pressure and improvement of nonalcoholic fatty liver disease. Sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 analogues reduced cardiovascular risk, prevented cardiovascular disease and mortality, thereby playing an important role in the treatment of obese patients with hypertension and T2D.
Weight gain and blood pressure
Authors: Sundström Johan , Lind Lars , Lampa Erik , Angerås Oskar , Bachus Erasmus , Bergström Göran , Carlberg Bo , Engström Gunnar , Engvall Jan E. , Eriksson Mats , Gigante Bruna , Hagström Emil , Hjelmgren Ola , Jansson Jan-Håkan , Jernberg Tomas , Mannila Maria , Nyström Fredrik H. , Oldgren Jonas , Persson Margaretha , Sandström Anette , Swahn Eva , Söderberg Stefan , Torén Kjell , Östgren Carl Johan , Rosengren Annika
Published: November 2019

Objective:

Although the causality of the obesity--hypertension association is established, the potential for prevention is not. We hypothesized that weight gain between early adulthood and mid-life is associated with higher mid-life blood pressure.

Methods:

We investigated the hypothesis using a large contemporaneous population-based mid-life cohort of men and women aged 50–64 years. Recalled body weight at age 20 years was self-reported, and mid-life body weight and office blood pressures were measured in accordance with a detailed protocol.

Results:

On average, men had gained 14.9 (95% CI 14.6–15.2) kg of weight, and women 14.6 (95% CI 14.4–14.9) kg, between age 20 years and the mid-life examination, corresponding to 0.40 (95% CI 0.39–0.41) kg/year for men and women. Both weight at age 20 years and weight at the mid-life examination were associated with mid-life blood pressures. On average, a 10 kg weight increase between age 20 years and mid-life was associated with 2.2 (95% CI 0.9–3.5) mmHg higher systolic and 1.7 (95% CI 0.9–2.5) mmHg higher diastolic mid-life blood pressure in men, and 3.2 (2.5–4.0) mmHg higher systolic and 2.4 (1.9–2.9) mmHg higher diastolic mid-life blood pressure in women. Mid-life weight was more closely associated than weight at age 20 years with mid-life blood pressure. For a given mid-life weight, blood pressure was higher in persons with higher weight gain from age 20 years.

Conclusion:

In sum, weight gain between early adulthood and mid-life was associated with higher mid-life blood pressure. The magnitude of the association indicates a potentially great public health impact of strategies to prevent weight gain throughout adulthood.
Objectively measured physical activity relates to night-time blood pressure in older adults: cross-sectional analysis in the HEIJO-KYO cohort
Authors: Yamagami Yuki , Saeki Keigo , Tai Yoshiaki , Maegawa Taeko , Iwamoto Junko , Kataoka Hiroshi , Kurumatani Norio , Obayashi Kenji
Published: November 2019

Objectives:

Prognostically, night-time blood pressure (BP) is more important than other BP parameters. Previous physiological studies suggested physical exercise continuously decreases subsequent BP levels, although the association between daytime physical activity and night-time BP has not been evaluated in large populations.

Methods:

This cross-sectional study of 1111 older adults (mean age, 71.8 years) measured physical activity using actigraphy and ambulatory BP parameters.

Results:

The mean night-time SBP and DBP were 115.9 mmHg (SD, 16.2) and 67 mmHg (8.6), respectively, and the mean average daytime physical activity was 299.2 counts/min (104.3). A multivariable linear regression analysis, adjusted for potential confounders, suggested greater average daytime physical activity was significantly associated with lower night-time SBP (regression coefficient per 100 counts/min increment, −1.18; 95% CI −2.10 to −0.26), and DBP (−0.69; 95% CI −1.17 to −0.17). Significant associations between time above activity thresholds and night-time SBP were consistently observed (≥500 counts/min: regression coefficient per log min increment, −1.61, 95% CI −3.14 to −0.08; ≥1000 counts/min: −1.00, 95% CI −1.97 to −0.03; ≥1500 counts/min: −1.13, 95% CI −2.11 to −0.14). A subgroup analysis without antihypertensive medications (n = 619) strongly associated time above activity thresholds with night-time SBP (≥500 counts/min: −2.94; 95% CI −5.20 to −0.68). These results were consistent in the analysis using dipping as a dependent variable.

Conclusion:

Objectively measured daytime physical activity was significantly and inversely associated with night-time BP in older adults. Further longitudinal studies would ascertain effects of physical activity on night-time BP.
Moving organizational theory in health care forward: A discussion with suggestions for critical advancements
Authors: Nembhard Ingrid M. , Flood Ann Barry , Kimberly John R. , Kovner Anthony R. , Shortell Stephen M. , Zinn Jacqueline S.
Published: November 2019

In May 2019, scholars in management and organization of health care organizations and systems met. The opening plenary was a moderated discussion with five distinguished scholars who have exemplified pushing the frontier of organizational theory and practice throughout their careers: Ann Barry Flood of Dartmouth College, John Kimberly of the University of Pennsylvania, Anthony (Tony) Kovner of New York University, Stephen (Steve) Shortell of University of California at Berkeley, and Jacqueline (Jackie) Zinn of Temple University. The discussion was moderated by Ingrid Nembhard of the University of Pennsylvania. The goal of the plenary was to provide an opportunity to hear from senior members of the health care management community how they think about organizational behavior and theory, changes that they have observed, research gaps that they see, and lessons for research and practice that they have learned. This article is the transcript of that plenary discussion. It is shared to capture the intellectual history of the field and help surface the critical advancements still needed in organizational theory and practice in health care. The closing remarks of the panelists summarize recommendations for both practice and scholarship in health care organization management.
A 15-YEAR-OLD BOY WITH PROTRACTED VISION LOSS FROM ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY
Authors: Sulewski Michael E. , Kolomeyer Anton M. , Saran Bruce R. , Brucker Alexander J.
Published: November 2019

Purpose:

To present an atypical case of acute posterior multifocal placoid pigment epitheliopathy in a 15 year old treated with immunosuppressive therapy.

Methods:

Interventional case report.

Results:

On initial presentation, the vision was 20/200 in the right eye and 20/300 in the left eye. The posterior poles of both eyes showed numerous creamy-white placoid lesions. Fundus autofluorescence demonstrated hypoautofluorescence lesions with hyperautofluorescence rims, while fluorescein angiography showed early blockage followed by late staining. These findings were consistent with a diagnosis of acute posterior multifocal placoid pigment epitheliopathy. Optical coherence tomography demonstrated outer retinal disruptions and thinning. Due to the severity of his disease, the patient was treated first with oral prednisone and later transitioned to mycophenolate mofetil by 2 months. His poor vision persisted beyond a 5-month follow-up visit despite fading of the lesions and reconstitution of the outer retinal layers and thickness on optical coherence tomography. By 8 months of follow-up, the visual acuity returned to 20/20 bilaterally without any further recurrences.

Conclusion:

Although most patients with acute posterior multifocal placoid pigment epitheliopathy have a relatively short course and recover vision quickly, the use of steroids and immunosuppression may be of benefit for those patients with severe and prolonged visual loss.
CHORIORETINAL FOLDS IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY
Authors: Cohen Salomon Y. , Ducos de Lahitte Ghislaine , Gaudric Alain , Mrejen Sarah
Published: November 2019

Background and Purpose:

To the best of our knowledge, there is no study of patients with central serous chorioretinopathy associated with chorioretinal folds, since a short mention in Gass' stereoscopic atlas. We report here six cases with this association.

Methods:

Six patients with both conditions were examined in our institution and underwent fluorescein angiography and optical coherence tomography.

Results:

Patients were 3 men and 3 women, aged 44 years to 82 years. All patients were hyperopic and two received corticosteroids. Fluorescein angiography showed pigmentary changes, diffuse leakage areas typical of chronic central serous chorioretinopathy, and chorioretinal folds mainly located in the upper temporal part of the fundus. Enhanced depth imaging optical coherence tomography was performed in 5 cases and revealed a thick choroid in all cases (mean subfoveal choroidal thickness: 381 µm, range: 280–510 µm).

Conclusion:

Although possibly coincidental, the presence of chorioretinal folds in hyperopic central serous chorioretinopathy eyes could be due to the excessive thickness of the choroid in eyes with hyperopia related to short axial length.
LONG-TERM VISUAL ACUITY PRESERVATION IN SORSBY FUNDUS DYSTROPHY WITH CORTICOSTEROID TREATMENT
Authors: Spaide Richard F.
Published: November 2019

Purpose:

To describe the long-term findings of a patient with Sorsby fundus dystrophy treated with corticosteroids and propose a mechanism by which the results were obtained.

Methods:

Comprehensive ophthalmologic examination with multimodal imaging to include optical coherence tomography and optical coherence tomography angiography was used to evaluate a patient with Sorsby fundus dystrophy treated with intravitreal triamcinolone.

Results:

A 35-year-old woman presented in 2003 with aggressive macular neovascularization in both eyes; her visual acuity was 20/25 in the right and 20/400 in the left eye. She previously had photodynamic therapy without apparent benefit. She was then treated with photodynamic therapy and an intravitreal injection of 4 mg of triamcinolone, which caused the neovascularization to become inactive. She was eventually switched to an intravitreal injection of triamcinolone 4 mg every 3 to 4 months in the right eye. She had no further treatment in the left eye because of extensive scarring. After 15 1/2 years of treatment, her visual acuity in the right eye was 20/20. Optical coherence tomography showed a large, low-level, irregular elevation of the retinal pigment epithelium. optical coherence tomography angiography revealed widespread macular neovascularization, and the choriocapillaris showed extensive loss. The patient had a TIMP-3 mutation, c.610A>T (p.Ser204Cys).

Conclusion:

TIMP3 has numerous effects including controlling vascular endothelial growth factor signaling and tumor necrosis factor alpha production. Corticosteroids have the potential to modulate both cytokines. This is the longest reported treatment follow-up of Sorsby fundus dystrophy with macular neovascularization, and the patient retained excellent visual acuity.
An Unusual Cause of Recurrent Pleural Effusion
Authors: He Kevin , Priyank Kumar , Weber Devin
Published: November 2019

Cryptococcus neoformans is a yeast that can cause severe infection in the immunocompromised. It is commonly associated with meningitis in patients with underlying HIV infection; however, infections can occur in other immunosuppressed hosts as well as the immunocompetent. Pulmonary disease is well described, but recurrent pleural effusion and empyema are rare. We describe a case in a non–HIV-infected, nontransplant cirrhotic patient presenting with recurrent pleural effusions and cryptococcal empyema.

The patient is a 66-year-old man with cirrhosis, diabetes, and kidney disease who presented with 3 months of dyspnea complicated by recurrent pleural effusion and low protein ascites after treatment of hepatitis C virus. Routine cultures from multiple thoracenteses were unrevealing. Fungal culture ultimately grew C. neoformans/gattii. His serum cryptococcal antigen titer was 1:40, and chest imaging revealed several pulmonary nodules. He was admitted for evaluation of disseminated disease and central nervous system involvement, which was unremarkable. He was started on oral fluconazole 200 mg daily dosed for his renal function and was doing well in outpatient follow-up.

Patients with cirrhosis tend to have a higher incidence of cryptococcal disease and are more likely to have disseminated infection with higher mortality. It is possible that deficiencies in complement and cytokine levels as well as leukocyte function may contribute to this increased risk. Effusions are an uncommon manifestation of pulmonary cryptococcosis and, as with the case in our patient, may resemble hepatic hydrothorax, leading to a delay in antifungal therapy.

In conclusion, patients with liver disease have an increased risk of cryptococcosis. A high index of suspicion must be maintained for infection and should be considered in patients with recurrent effusions.
Ethnic disparities in pain processing among healthy adults: μ-opioid receptor binding potential as a putative mechanism
Authors: Letzen Janelle E. , Mun Chung Jung , Kuwabara Hiroto , Burton Emily F. , Boring Brandon L. , Walls Taylor , Speed Traci J. , Wong Dean F. , Campbell Claudia M.
Published: November 2019

Although ethnic differences in pain perception are well documented, the underlying mechanism for these outcomes has not been established. µ-opioid receptor (MOR) function might contribute to this disparity, given that MORs play a key role in pain sensitivity and modulation. However, no study has characterized ethnic differences in MOR physiology. This study sought to address this knowledge gap by examining differences in µ-selective agonist binding potential (BPND; [11C]-Carfentanil) between 27 non-Hispanic black (NHB) and 27 demographically similar, non-Hispanic white participants. Participants completed questionnaires and two 90-minute high-resolution research tomograph positron emission tomography (PET) imaging sessions. During PET imaging, a capsaicin or control cream was applied to individuals' arms, and pain ratings were collected. Bonferroni-corrected PET volumes of interest analyses revealed significantly greater [11C]-Carfentanil BPND among NHB participants in bilateral ventral striatum ([left]: F1,52 = 16.38, P < 0.001; [right]: F1,52 = 21.76, P < 0.001), bilateral dorsolateral prefrontal cortex ([left] F1,52 = 17.3, P < 0.001; [right]: F1,52 = 14.17, P < 0.001), bilateral subgenual anterior cingulate cortex ([left]: F1,52 = 10.4, P = 0.002; [right]: F1,52 = 12.91, P = 0.001), and right insula (F1,52 = 11.0, P = 0.002). However, there were no significant main effects of condition or ethnicity × condition interaction effects across models, likely attributable to individual variability in the direction of change within groups. BPND values were significantly correlated with pain ratings collected during the capsaicin condition (r range = 0.34-0.46, P range = 0.01-0.001). Results suggest that NHB individuals might have generally greater unoccupied MOR density than non-Hispanic white peers. Findings have implications for physiological differences underlying ethnicity-related pain disparities. If replicated, these results further emphasize the need for tailored treatments in historically underserved populations.
Forensic Nursing Response to Victim-Administered Evidence Kits
Authors: Pierce-Weeks Jennifer
Published: November 2019

The International Association of Forensic Nurses has issued guidance in response to victim- or self-administered evidence kits after sexual assault.
The Relationship Between Institution-Affiliated Childcare and Employee Stress
Authors: Apple Rachel , Samuels Lauren R. , McGee-Swope Kinyata , Alsup Christina , Dewey Charlene , Roumie Christianne L.
Published: November 2019

Objective:

To evaluate the relationship between utilization of institution-affiliated childcare and employee stress among parents working at a large, academic medical center.

Methods:

Cross-sectional analysis of the relationship between institution-affiliated childcare and employee stress. Survey questions asked about personal stress related to job, relationship with spouse, parental responsibilities, childcare, finances, and personal health.

Results:

558 (68%) respondents were predominantly women (76.9%). Fifty-four percent had non-institution-affiliated childcare and 45% had institution-affiliated childcare. Use of institution-affiliated childcare was associated with less overall stress (–4.86 [95% confidence interval –8.01, –1.72], P = 0.003), and less stress related to finances, childcare, and personal health. Differences between groups related to job, relationship with spouse, or parental responsibilities were not statistically significant.

Conclusions:

This study demonstrated an association between institution-affiliated childcare and lower stress, highlighting the centrality of employer-affiliated childcare to employees’ stress.
Design and analysis of high-risk medical device clinical trials for diabetes monitoring and treatment: a review
Authors: Zhang Bo , Shankara Sravya B. , Ye Shangyuan , Zhang Hui
Published: November 2019

Class III medical devices are those devices that support or sustain human life or prevent impairment of human health but, when used, pose high risks to the patients. There were 15 class III medical devices that were approved by the US Food and Drug Administration from September 1, 2005 to December 31, 2018 for glucose monitoring and diabetes treatment. In this article, we reviewed the study design and statistical analysis in clinical trials that were conducted to provide evidences for safety and effectiveness of these medical devices. Two exemplars of clinical trials for “Eversense continuous glucose monitoring system” and “t:slim X2 Insulin Pump with Basal-IQ Technology” are discussed in details.
Total parathyroidectomy plus multi-point subcutaneous transplantation in the forearm may be a reliable surgical approach for patients with end-stage renal disease
Authors: Lin Nan , Fang Yong Chao , Song Jun Chuan , Wang Yu
Published: November 2019

Rationale:

We studied the feasibility of total arathyroidectomy(tPTX)+multi-point transplantation in the forearm for treatment of secondary hyperparathyroidism. Considering the controversial nature of the appropriate timing for and location of this type of surgery, relevant research is relatively rare. Our experience may be a relatively successful one.

Patient concerns:

Our patient was a 28-year-old woman with end-stage renal disease (ESRD), who was on dialysis for 7 years, and a 2-year history of progressively aggravated bone pain. She also had hypercalcemia and hyperphosphatemia.

Diagnoses:

Given the patient's history of long-term dialysis, bone pain, high levels of intact parathyroid hormone(i-PTH) and hypercalcemia, we performed ultrasonography which showed solid nodules in the bilateral parathyroid glands. She was accordingly diagnosed with SHPT.

Interventions:

The patient underwent tPTX+multi-point subcutaneous transplantation in the forearm.

Outcomes:

Her i-PTH level dropped to < 300 pg/mL, and the symptoms of bone pain markedly reduced after surgery.

Lessons:

Total parathyroidectomy+multi-point subcutaneous transplantation in the forearm may be a reliable surgical approach for patients with ESRD.
Venous thoracic outlet syndrome secondary to arterial stent implantation
Authors: Liu Yang , Wu Zhoupeng , Huang Bin , Yang Yi , Zhao Jichun , Ma Yukui
Published: November 2019

Rationale:

Venous thoracic outlet syndrome (VTOS) secondary to subclavian arterial stent implantation is extremely rare. Here, we firstly report this disease and the endovascular intervention using covered-stents.

Patient concerns:

An 80-year-old man who had received an acceptable stent implantation for the treatment of a right subclavian arteriovenous malformation (AVM), presented with a gradually increasing swelling and pain in his right upper extremity.

Diagnosis:

The patient was diagnosed with right VTOS and recurrent subclavian AVM following ultrasonography and computed tomographic angiography.

Interventions:

We positioned a covered-stent in the subclavian artery to block the feeding arteries and successfully embolized the remaining branches with coils. Next, we performed successful dilation 3 times, followed by the positioning of another covered-stent in the right subclavian vein.

Outcomes:

The patient was free of all symptoms and the imaging procedures confirmed an acceptable thrombosis of the AVM with patent stents in the right subclavian artery and vein during the 6-month follow-up.

Lessons:

Venous stent implantation is an alternative to treat VTOS caused by subclavian arterial stents and it is essential to pay more attention to the incidence of VTOS following arterial stent implantation in the subclavian artery.
Perforation of inferior vena cava and duodenum by strut of inferior vena cava filter
Authors: Park Hyun Oh , Choi Jun Young , Jang In Seok , Kim Jong Duk , Kim Jong Woo , Byun Joung Hun , Kim Sung Hwan , Yang Jun Ho , Moon Seong Ho , Kim Ki Nyun , Kang Dong Hun , Jung Jae Jun , Choi See Min , Kim Ji Yoon , Lee Chung Eun
Published: November 2019

Introduction:

An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term.

Patient concerns and diagnosis:

A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts.

Interventions:

We performed a laparotomy to remove the IVC filter.

Outcomes:

Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge.

Lessons:

There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.
Traditional Chinese herb for low endometrial receptivity and its effect on pregnancy
Authors: Jiang Mei , Huang Ling , Gu Xiaohong , Liu Tiegang , Kang Jia , Wang Ting
Published: November 2019

Background:

Low endometrial receptivity is associated with infertility in women through multiple and complex mechanisms. Existing treatments are not always effective. Symptomatic drugs such as estradiol valerate and/or aspirin do not completely solve the problem. Traditional Chinese herbs have been widely used in infertility and uterine disease including low endometrial receptivity. However, their effectiveness and safety are still obscure and deserve further investigation.

Objective:

To assess the effect and safety of traditional Chinese herbs in treating low endometrial receptivity.

Methods:

We will summarize and meta-analyze randomized controlled trials (RCTs) of traditional Chinese herbs for the treatment of low endometrial receptivity. RCTs comparing traditional Chinese herbs with blank control, placebo, or conventional therapies will be included. RCTs comparing traditional Chinese herbs plus conventional therapies with conventional therapies alone will also be included. The following electronic databases will be searched: PubMed, Cochrane Library, EMBASE, CNKI, CBM, VIP, and WANFANG DATA. The methodological quality of RCTs will be assessed using the Cochrane risk assessment tool. All trials included will be analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software will be used for publication bias analysis. GRADE pro GDT web solution will be used for evidence evaluation.

Results:

This review will evaluate the effects of traditional Chinese herbs on estradiol, progesterone, thickness, volume, and perfusion index(PI) of the endometrium, pregnancy rate, and symptoms.

Conclusions:

This review will provide clear evidence to assess the effectiveness and safety of traditional Chinese herbs for low endometrial receptivity.

OSF registration number:

DOI 10.17605/OSF.IO/M85VT.
Case report: neonatal giant forehead hemangiopericytoma with a 5-year follow-up
Authors: Peng AiJun , Zhang LiBing , Zhao Hai , Zhou LiangXue
Published: November 2019

Rationale:

Hemangiopericytoma (HPC) is a rare pediatric neoplasm with a high risk of bleeding, aggressive growth and high early relapse rates. Surgical excision remains the mainstream treatment, while the functions of chemotherapy and radiotherapy remain controversial. In particular, an infantile giant extracranial HPC located in the forehead has never been reported.

Patient concerns:

A 3-day-old girl was delivered normally with a giant tumor localized mainly in the right frontal region. The surface of the mass was filled with vascularity.

Diagnosis:

According to the results of imaging and pathological examinations, the diagnosis was HPC grade II.

Interventions:

Gross total resection of the tumor and the invading partial frontal bone followed by skin scalp reconstruction was carried out without any blood transfusion.

Outcomes:

No recurrence was identified during 5 years of follow-up. And better outcomes can be achieved without adjuvant therapy.

Lessons:

Multimodality imaging and a collaborative multidisciplinary approach are indispensable for the successful surgical management of infantile HPC, especially for giant tumors and their potential risk of life-threatening bleeding. Gross total resection is the optimal option for infantile HPC, and even without adjuvant therapy, it achieves better outcomes.
Clinical efficacy of femtosecond laser for myopia
Authors: Wang Xiao-fang , Zhang Jun-xia
Published: November 2019

Background:

Femtosecond laser (FL) is an effective method to treat patients with myopia, but its relative efficacy and safety is still unclear. Thus, this study will be conducted to assess the efficacy and safety of FL for myopia systematically.

Methods:

This study will systematically retrieve the following electronic databases up to the present: Cochrane Library, PubMed, EMBASE, Web of Science, PsycINFO, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, Wanfang, VIP, and China National Knowledge Infrastructure. All electronic databases will be searched without any limitations of language and publication status. RevMan 5.3 software will be utilized for statistical analysis.

Results:

We will summarize the targeted results evaluating the efficacy and safety of FL for patients with myopia.

Conclusions:

This study will provide a comprehensive evidence summary on FL for patients with myopia.

PROSPERO registration number: PROSPERO CRD42019148659.
Modified two-flaps palatoplasty with lateral mucus relaxing incision in cleft repair
Authors: Gu Meizhen , Huang Xiuchang , Xu Hongming , Chen Fang , Jiang Yugang , Li Xiaoyan
Published: November 2019

Study Design:

clinical results of A STROBE-compliant retrospective study

Objective:

To achieving adequate pharyngeal closure and improve the pharyngeal function by a modified two-flap palatoplasty.

Summary of Background:

Excessive tension in soft palate is the main factor causing the dysphonia after cleft palate. The tension-free suture of the soft palate is the key to achieving adequate pharyngeal closure. In this paper, a modified two-flap palatoplasty improved the pharyngeal function

Methods:

From August 2016 to December 2017, 20 patients with cleft palate were treated with a modified two-flap palatoplasty of the posterolateral symmetrical mucosal relaxation incision. The mucosal relaxation incision was performed on both posterolateral sides of the soft palate.

Results:

All cases had good healing of mucosal flap and the palate. All patients underwent endoscopic examination at 6 months after operation. The postoperative results were satisfactory, with no complications. Twelve patients had bilateral exudative otitis media before operation, 4 patients returned to normal postoperatively, and 8 patients underwent bilateral tympanic membrane catheterization; 2 patients had abnormal function of bilateral eustachian tube before operation and returned to normal postoperatively; 3 patients had unilateral exudative otitis media before operation, and all of them returned to normal; the acoustic impedance test was normal in 3 children before operation. Most children begin to learn to speak, parents are satisfied with their pronunciation, and 3 children are in speech rehabilitation due to unclear pronunciation.

Conclusions:

We propose a technique to improve the function of the velopharyngeal closure which effectively reduces the incidence of pharyngeal insufficiency and occurrence of operative correction of pharyngeal closure dysfunction. The modifed two-flap palatoplasty with posterior lateral symmetric mucosal relaxation incision is beneficial for better velopharyngeal closure.
Predictor of sleep difficulty among community dwelling older populations in 2 African settings
Authors: Wang Chao , Liu Jiaxuan , Li Zhifei , Ji Lu , Wang Ruoxi , Song Hongxun , Mao Yiqing , Bishwajit Ghose , Zhang Baoming , Tang Shangfeng
Published: November 2019

Sleep deprivation is a common phenomenon among older population and is commonly linked to behavioral, physiological, and psychosocial factors. Not much is known about sleep deprivation among older population in Africa. Therefore, in this study we aimed to investigate the basic sociodemographic and psychosocial predictors of self-reported sleep deprivation among older population.

In this study we analyzed cross-sectional data on 1495 community dwelling men and women aged 50 years and above. Data were collected from the SAGE Well-Being of Older People Study conducted in South Africa and Uganda. Outcome variable was self-reported sleep difficulty last 30 days. Multivariable logistic regression models were used to identify the variables significantly associated with sleep difficulty.

The prevalence of mild-moderate sleep difficulty was 32.6% (27.9, 37.6) and severe/extreme 23.0% (20.3, 26.0) respectively. Multivariable analysis revealed that sleep difficulty was associated with several behavioral, environment, and illness conditions. In South Africa, those who reported dissatisfaction with living condition had 1.592 [1.087, 2.787] times higher odds of reporting mild/moderate sleep difficulty. Poor subjective quality of life (QoL) was associated with higher odds of severe/extreme sleep difficulties (odds ratios [OR] = 4.590, 95% confidence interval [CI] = 2.641, 7.977 for South Africa, and OR = 4.461, 95% CI = 2.048 and 9.716 for Uganda). In Uganda, perceived depression was associated with higher odds of severe/extreme (OR = 2.452, 95% CI = 1.073, 5.602) sleep difficulties among men, and both mild/moderate (OR = 1.717; 95% CI = 1.011, 2.914) and severe/extreme sleep difficulties among women (OR = 2.504, 95% CI = 1.408, 4.453).

More than half of the participants had sleep difficulty of certain degrees, emphasising an urgent need for intervention for sleep deprivation in the population. Interventions targeting to promote subjective health, quality of life, and living environment may prove beneficial for improving sleep health in this regard.
High internal radiation exposure associated with low socio-economic status six years after the Fukushima nuclear disaster
Authors: Sawano Toyoaki , Kambe Toshiyuki , Seno Yuki , Konoe Ran , Nishikawa Yoshitaka , Ozaki Akihiko , Shimada Yuki , Morita Tomohiro , Saito Hiroaki , Tsubokura Masaharu
Published: November 2019

Rationale:

Managing the health of vulnerable groups is an important component of health care. Given the long-term burden of radiation-release incidents among those exposed, managing the health of vulnerable groups following a nuclear disaster is very important. However, there is limited information available concerning the long-term management of the health effects of radiation exposure in vulnerable groups following nuclear disasters. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Minamisoma City launched internal radiation exposure monitoring program for local residents, using whole body counter (WBC) units. In 2017, a man of low socio-economic status (SES), was found to have the highest level of internal contamination detected in a person living in the Soma District in recent years. This report describes the case so that the lessons learned can be applied in future nuclear disaster settings.

Patient concerns:

A 77-year-old Japanese man, who had been homeless for 2 months and had been staying in the exclusion zone of Minamisoma City, was brought to our hospital. He had become homeless because a lack of communication between social support services had led to his eviction from leased housing after free housing support for evacuees was terminated.

Diagnoses:

He was admitted with a diagnosis of dehydration and malnutrition. A WBC unit was used to assess his body burden of radioactive cesium. This revealed levels of Cs-134 and Cs-137 of 538 Bq/body and 4,993 Bq/body, respectively.

Intervention:

He received intravenous fluid therapy and health monitoring. The paperwork required for him to receive public income support was processed during hospitalization.

Outcome:

He was discharged to public housing after 9 days, and municipal workers started visiting him regularly after his discharge.

Lessons:

A high level of internal radiation contamination may occur after a nuclear disaster. This may be associated with a decline in social support, poverty, and social isolation, and may have more impact on people in poor health than on the general population. It would be useful to strengthen linkages between local government and welfare service providers to increase social support for vulnerable groups requiring health care, not only following disasters, but also under normal circumstances.
A case report of several intraoperative convulsions while using the Narcotrend monitor
Authors: Berger-Estilita Joana , Steck Katharina , Vetter Christian , Seidel Kathleen , Krejci Vladimir , Hight Darren , Kaiser Heiko
Published: November 2019

Introduction:

Intraoperative seizures under general anesthesia are rare and our observation is the first to demonstrate a distinct electroencephalogram (EEG) pattern on the Narcotrend monitor.

Patient concerns:

We present the case of a 30-year-old man undergoing craniotomy for glioblastoma resection under general anesthesia who suffered tonic-clonic seizures captured in a specific pattern by the intraoperative EEG.

Diagnoses:

Our depth of anesthesia monitor recorded, before the seizure, a widening of the beta-wave performance in a distinct “triangular-shaped” pattern. This pattern was repeated before the second seizure. The patient had no previous history of seizures and following surgery no further seizures were recorded.

Interventions:

A spectrogram analysis showed a distinct increase in mean absolute beta power immediately prior to the first seizure. The EEG immediately prior to the second seizure was characterized by broadband noise. Both seizures were characterized by increased mean absolute delta, theta, and beta power.

Outcomes:

The increase in EEG beta activity seen before the tonic-clonic movements may represent cortical irritability secondary to surgical manipulation, induced by electrical stimulation, reflecting progressive brain over-arousal. The attentive analysis of the relative beta power may have helped forecast the occurrence of the second seizure.

Lessons:

We report the use of a simple, inexpensive, and portable EEG-based monitoring device to assist seizure detection and decision making.
Sixteen-and-a-half syndrome with metastatic pons tumor
Authors: Choi Shin-Myeong , Kim Tae Gi , Chung Junkyu , Joo Jin-Ho , Park In-Ki , Moon Sang Woong , Shin Jae-Ho
Published: November 2019

Rationale:

One-and-a-half syndrome (OAAH) is characterized as the combination of ipsilateral horizontal gaze palsy and internuclear ophthalmoplegia. OAAH syndrome accompanied with 7th and 8th cranial nerve palsy is called 16-and-a-half syndrome. We aimed to report the case of 16-and-a-half syndrome with metastatic pons tumor.

Patient concerns:

A 57-year-old male diagnosed with nonsmall-cell lung cancer (NSCLC) with brain metastasis occurring 15 months ago was referred to our clinic with the chief complaint of horizontal diplopia and right gaze palsy.

Diagnosis:

According to the patient symptom, ocular examination, and radiographic findings, he was diagnosed as 16-and-a-half syndrome which was caused by brain tumor metastasis from NSCLC.

Interventions:

We referred him to hemato-oncology department and he was treated with radiation and supportive therapy.

Outcomes:

Unfortunately, the patient passed away 1 month later without improvement of ophthalmoplegia.

Lessons:

The clinical findings of our case indicate 16-and-a-half syndrome caused by brain tumor metastasis from NSCLC, which to our knowledge has not been previously reported. The case highlights a rare cause of OAAH spectrum disease and the importance of a systemic work-up including associated neurologic symptoms and brain imaging in patients with horizontal gaze palsy.
The position of the spinal cord relative to the vertebrae in adolescent idiopathic scoliosis
Authors: Miyazaki Masashi , Ishihara Toshinobu , Abe Tetsutaro , Kanezaki Shozo , Notani Naoki , Kataoka Masashi , Tsumura Hiroshi
Published: November 2019

We aimed to clarify the position of the spinal cord relative to the vertebra in patients with Lenke type 1 adolescent idiopathic scoliosis (AIS). In all, 35 patients with Lenke type 1 AIS who underwent posterior spinal fusion using a pedicle screw construct and preoperative computed tomography (CT) after myelography were recruited. The following radiological parameters were measured on preoperative CT myelography: spinal cord–vertebral (SV) angle, entry–spinal cord distance (ESD), ESD-X, ESD-Y, spinal cord–pedicle (SP) angle, and rotation angle (RAsag). The SV and SP angles were the smallest at T9 level, followed by T8 and T7 levels, and tended to increase cranially and caudally. The ESD was the shortest at T9 level, followed by T8 and T10 levels. The ESD-X was the smallest at T9 level, followed by T8 level, while the ESD-Y was the smallest at T10 level, followed by T9 and T8 levels. Mean RAsag increased from T4 to T9 levels and decreased from T9 to T12 levels. The ESD was significantly negatively correlated to RAsag. Among all apical vertebrae, the SV and SP angles were negatively correlated to Cobb angle. The RAsag was positively correlated while the ESD was negatively correlated to the Cobb angle. The spinal cord is close to the vertebrae in the apical vertebral region and far from the vertebrae at the upper and lower thoracic vertebral levels in AIS. Therefore, the potential risk of spinal cord injury by pedicle screw is the highest in the apical vertebral region.
Efficacy of Raman spectroscopy in the diagnosis of bladder cancer
Authors: Jin Hongyu , Lin Tianhai , Han Ping , Yao Yijun , Zheng Danxi , Hao Jianqi , Hu Yiqing , Zeng Rui
Published: November 2019

Background:

Bladder cancer is one of the severest human malignancies which are hardly detected at an early stage. Raman spectroscopy is reported to maintain a high diagnostic accuracy, sensitivity and specificity in some tumors.

Methods:

We carried out a complete systematic review based on articles from PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, Cochrane Library and CNKI. We identified 2341 spectra with strict criteria in 9 individual studies between 2004 and 2018 in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We summarized the test performance using random effects models.

Results:

General pooled diagnostic sensitivity and specificity of RS to kidney cancer were 94% (95% CI 0.93-0.95) and 92% (95% CI 0.90-0.93). The pooled positive LR was 10.00 (95%CI 5.66-17.65) while the negative LR was 0.09 (95%CI 0.06-0.14). The pooled DOR was 139.53 (95% CI 54.60-356.58). The AUC of SROC was 0.9717.

Conclusion:

Through this meta-analysis, we found a promisingly high sensitivity and specificity of RS in the diagnosis of suspected bladder masses and tumors. Other parameters like positive, negative LR, DOR, and AUC of the SROC curve all helped to illustrate the high efficacy of RS in bladder cancer diagnosis.
Clinicopathological characteristics, treatment, and survival outcomes of retroperitoneal desmoid-type fibromatosis
Authors: Shen Chaoyong , Wang Chengshi , Yan Jiaqi , He Tao , Zhou Xiaoquan , Ma Wenjing , He Jialing , Yin Yuan , Yin Xiaonan , Cai Zhaolun , Chen Zhixin , Zhang Hongying , Zhang Bo
Published: November 2019

Retroperitoneal desmoid-type fibromatosis (RPDF) is a rare mesenchymal neoplasm, and it covers a broad spectrum of aggressive monoclonal, fibroblastic proliferation. There is no evidence-based or established optimal treatment available for this intriguing disease yet. Therefore, we here investigated the clinicopathological characteristics, surgical, and survival outcomes in RPDF among Chinese patients.

Patients with histologically confirmed RPDF were retrospectively studied from 2010 to 2018 within the West China Hospital of Sichuan University. Demographics, clinicopathological characteristics, treatment, and survival outcome data were collected.

Of the 29 cases of RPDF, 19 were females. Tumor diameter ranged from 4 to 40 cm, with a median of 10 cm. Of these patients, surgical resection was the primary treatment adopted for RPDF in 26 cases; while 3 patients underwent watchful waiting. In surgical group, complete and incomplete macroscopic resection was achieved in 21 (80.77%) and 6 (19.23%) cases, respectively. Totally, 21 (80.77%) cases underwent multi-visceral resection. With a median follow-up duration of 48 months, 11 patients experienced tumor progression for the entire cohort. Tumor progression was observed for those patients with incomplete and complete macroscopic resection in 2/5 (40.0%) and 6/21 (28.6%) cases, respectively. In the watchful waiting group, there were no documented cases of RPDF regression. The progression-free survival rate was 86.1%, 71.5%, and 62.3% at 1-, 2-, and 3-years, respectively.

RPDFs are rare types of tumor, which have characteristically varied natural histories. Surgical resection had a relative favorable outcome, but some patients were associated with burden of significant surgical complications.