bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined administration of problem- and lecture-based learning teaching models in medical education in China
Authors: Jia Xue , Zeng Wen , Zhang Qin
Published: October 2018

Introduction:

The aim of this meta-analysis is to assess the effectiveness of the combined administration of problem-based learning (PBL) and lecture-based learning (LBL) teaching models in Chinese medical education.

Materials and methods:

We searched the following Chinese electronic databases: China National Knowledge Infrastructure, WanFang Data, China Science Periodical Database, and the Chinese BioMedical Literature Database. We also searched the following English electronic databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Search Engine. We searched for published studies involving the combined administration of PBL+LBL teaching models in Chinese medical education. All randomized controlled trials were included. The focus of the meta-analysis was on the outcomes of knowledge scores, skill scores, medical writing scores, comprehensive ability scores and teaching satisfaction. A subgroup analysis was also performed.

Results:

A total of 23 RCTs were included, with a total sample size of 2589 medical students. The PBL+LBL teaching model significantly increased knowledge scores (95% CI, 2.85–5.78; P < .00001), skill scores (95% CI, 0.51–3.71; P = .01), medical writing scores (95% CI, 1.04–4.04; P = .0009), comprehensive ability scores (95% CI, 2.04–8.71; P = .002) and teaching satisfaction (RR, 1.32; 95% CI, 1.10–1.59; P = .003) compared with the LBL teaching model alone. Additionally, a subgroup analysis showed significant differences in the effect of PBL+LBL on knowledge scores, medical writing scores, and comprehensive ability scores when comparing practical and theoretical courses. Another subgroup analysis that looked at the level of training showed that the PBL+LBL teaching model also significantly improved the knowledge scores of Freshman, Sophomore, Junior, Senior and Masters students.

Discussion and Conclusions:

Based on the current evidence, this meta-analysis showed that the PBL+LBL teaching model is an effective way to increase knowledge scores, skill scores, medical writing scores, and comprehensive ability scores and to improve teaching satisfaction.
Meditation-based clinical study to determine the correlation of quantitative electroencephalogram (qEEG) and 24-hour EEG activity
Authors: Cheong Moon Joo , Son Sung-Eun , Kang Hyung Won , Lee Youngseop , Bae Kwang-Ho , Kang Yeonseok , Lee Eun Mi , Lee Go-Eun , Seo Joo-Hee , Weon Hee-Wook , Lee Ji-Yoon , Lyu Yeoung-Su
Published: October 2018

Background:

The heart continuously transmits information to the cerebrum during each pulse, and influences information processing such as perception, cognition, and emotion, which are processed in the cerebrum. This is the basis for the theory of oriental medicine widely used in psychiatric medicine and clinical practice, so-called Simjushinji (heart and brain) theory, that the heart controls the mind. The present study aims to analyze the correlation between heart and brain function by 24-hour active electrocardiogram and quantitative electroencephalogram (EEG) measurement under meditation.

Methods:

This randomized, controlled, assessor-blinded, 2-armed, parallel, multicenter clinical trial will analyze a total of 50 subjects, including 25 each for the test group and the active control group. Subjects will be randomly allocated to the test group (performing resource mindfulness) and the control group (performing stress mindfulness) in a 1:1 ratio. The clinical trial consists of 3 stages. The first and third stages are stable states. The second stage is divided into the test and active comparator groups. Quantitative EEG (qEEG) measurements at stages 1 and 3 will be recorded for 10 minutes; measurements at stage 2 will be recorded for 20 minutes with the eyes closed. The 24-hour Holter Monitoring and heart rate variability will be evaluated at each stage. Before the beginning of stage 3, subjects will complete the questionnaires. The primary outcome will be analyzed by independent t tests of both groups.

Discussion:

Scientific studies based on clinical epistemology are expected to serve as a basis for sustainable medical services in the field of psychiatric medicine in Korea. HRV, blood pressure index, and biometric index in qEEG, as determined by 24-hour Holter monitoring, will complement quantitative biomarkers and be useful in various fields.
CARE—Placental site trophoblastic tumor presenting with thrombotic microangiopathy
Authors: Zhao Cai-Fu , Du Ze-Qing , Li Nan , Wang Yan , Zhao Su-Fen
Published: October 2018

Rationale:

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasm (GTN).

Patient concerns:

A 28-year-old Chinese female with initial presentation of thrombotic microangiopathy (TMA) with symptoms of edema of the lower extremities and eyelid, thrombocytopenia and anemia.

Diagnoses:

The primary diagnosis was chronic glomerulonephritis according to the related laboratory tests and clinical symptoms.

Interventions:

A total abdominal hysterectomy with a bilateral salpingectomy was performed.

Outcomes:

The PSTT patient was cured, which contributed to the symptom relief of TMA.

Lessons:

This case report aims to elucidate the relationship between TMA and PSTT, so as to achieve timely diagnosis and treatment and reduce misdiagnosis.
Comparative effectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis
Authors: Li Xian , Zhang Li , Gu Shuming , Sun Jianfeng , Qin Zongshi , Yue Jiaji , Zhong Yu , Ding Ning , Gao Rui
Published: October 2018

Background:

Plantar fasciitis is one of the most common causes of adult heel pain. The aim of this study is to comprehensively compare the effectiveness of various therapies for plantar fasciitis using network meta-analysis.

Methods:

Studies were comprehensively searched on Embase, MEDLINE via PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) up to December 4, 2017. Randomized controlled trials that used extracorporeal shock wave therapy, ultrasound, ultrasound-guided pulsed radiofrequency treatment (UG-PRF), intracorporeal pneumatic shock therapy (IPST), low-level laser therapy (LLLT), and noninvasive interactive neurostimulation (NIN) for the treatment of plantar fasciitis were included. The primary outcome is change in pain relief. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system.

Results:

Nineteen trials with 1676 patients with plantar fasciitis plantar fasciitis were included. In the pair-wise meta-analysis, radial extracorporeal shock wave therapy (RSW), LLLT, and IPST showed a significant pooled reduction in the visual analogue scale (VAS) compared with placebo at 0 to 6 weeks [mean difference (MD) = 6.60, 95% confidence interval (CI): (6.04, −7.16); MD = 2.34, 95% CI: (1.60, 3.08); MD = 2.24, 95% CI: (1.44, 3.04), respectively]. Compared with placebo, UG-PRF [MD = 2.31, 95% CI: (1.26, 3.36)] and high-intensity focused extracorporeal shock wave (H-FSW) [MD = 0.82, 95% CI: (0.20, 1.45)] showed superior pain-relieving effects at 2 to 4 months; UG-PRF [MD = 1.11, 95% CI: (0.07, 2.15)] and IPST [MD = 4.92, 95% CI: (4.11, 5.73)] showed superior effects at 6 to 12 months. In the network meta-analysis, only RSW induced significant pain reduction compared with placebo at 0 to 6 weeks [MD = 3.67, 95% CI: (0.31, 6.9)]. No significant differences were found for the 2 to 4-month and 6 to 12-month periods because of the wide 95% CIs.

Conclusions:

We recommend treating plantar fasciitis with RSW. The commonly used ultrasound and focused extracorporeal shock wave (FSW) therapies can be considered as alternative treatment candidates. IPST, NIN, and LLLT may potentially be better alternatives, although their superiority should be confirmed by additional comprehensive evidence.

PROSPERO registration number: PROSPERO (CRD42015017353).
Phlebosclerotic colitis
Authors: Chen Wenguo , Zhu Huatuo , Chen Hongtan , Shan Guodong , Xu Guoqiang , Chen Lihua , Dong Fei
Published: October 2018

The aim of the current study was to enhance the awareness of phlebosclerotic colitis (PC) through our clinical experience.

A retrospective review of 25 patients who were diagnosed as PC in our 2 affiliated hospitals from January 2013 to October 2017 was conducted.

The patients were found at a mean age of 63.5 years, range 47 to 87years. The majority of patients were male (23 cases). Only 4 patients (16%, 4/25) had the history about long-term use of Chinese herbs and medical liquor. The most common symptoms were abdominal pain (40%) and intestinal obstruction (16%), followed by diarrhea (12%), and gastrointestinal bleeding (12%), etc. Three cases (12%) had no symptoms. The varying degrees of calcifications along the colon and mesenteric venous were found in all of their computed tomography (CT) images. The lesions mainly located in transverse and ascending colon (60%, 15/25). The terminal ileum, the whole colon and rectum involvement were also been found. Fourteen patients had the examination of colonoscopy which all presented characteristic dark purple-colored endoscopic findings. Conservative treatment with close follow-up was preferred in our group. Three cases had the surgery of colectomy due to the repeatedly intestinal obstruction, perforation.

The PC was a very rare but characteristic entity with unclear etiopathogenesis. Examination of abdomen CT and colonoscopy could help you to make clinical diagnosis.
Cutaneous comorbidities in patients with multiple myeloma
Authors: Woo Yu Ri , Jung Yu Jin , Kim Jong Sic , Kim Miri , Park Young Min , Min Chang-Ki , Kim Dong-Wook , Park Hyun Jeong
Published: October 2018

Multiple myeloma (MM) is a common hematologic malignancy characterized by the presence of the clonal proliferation of tumor cells. Studies on cutaneous comorbidities in Asian patients with MM have yet to be conducted.

This study aimed to analyze the prevalences, characteristics, overall survivals, and risk factors of various cutaneous comorbidities in patients with MM.

A retrospective cohort study using medical records from January 1, 2008, to December 31, 2017, in patients with MM was conducted.

Of 1438 patients with MM, 354 patients (24.61%) had one or more cutaneous comorbidities. Among them, herpes zoster infection was found to be the most common cutaneous comorbidity. The development of herpes zoster was found to be a possible candidate for good prognostic factor for overall survival [hazard ratio, 0.62; 95% confidence interval (95% CI), 0.44–0.86], while the occurrence of cutaneous malignant tumor was found to be a possible candidate for poor prognostic factor for overall survival (hazard ratio, 3.13; 95% CI, 1.76–5.56).

The development of some cutaneous comorbidities heralds the prognostic importance in patients with MM. A better understanding of the prevalences, clinical characteristics, and risk factors of various cutaneous comorbidities in patients with MM may help clinicians identify the clinical course and prognosis of the disease.
The effect of dexmedetomidine on the perioperative hemodynamics and postoperative cognitive function of elderly patients with hypertension
Authors: Du Xuejiang , Yu Jianshe , Mi Weidong
Published: October 2018

Introduction:

Cognitive dysfunction after surgery, a common clinical manifestation of postoperative psychonosema. It usually occurs after heart surgery, hip replacement, mandibular fractures, and other major operations. Dexmedetomidine can exert sedative, analgesic, anxiolytic effect, inhibits the sympathetic activity, maintains hemodynamic balance, helps reduce the amount of anesthetic agents, and relatively slightly depresses respiration. Preoperative administration of dexmedetomidine for sedation has been reported to reduce the incidence of acute postoperative delirium. But currently there is no study on the effect of dexmedetomidine on the postoperative cognitive function of elderly patients with essential hypertension.

Methods/Design:

This study is a prospective, single-center, double-blind controlled clinical trial. Elderly patients aged between 60 and 80 years old, diagnosed with primary hypertension for 1 year or longer will be included, and randomized into 2 groups. Patients in observational group will be given a loading dose of dexmedetomidine at 0.8 μg/kg, pumped for over 10 minutes. Although patients in control group will be pumped of the same volume of normal saline within 10 minutes, before the induction of anesthesia. Minimental state examination and levels of interleukin-6, tumor necrosis factor alpha, and C-reactive protein will be set as primary endpoints. Baseline characteristics of patients will be summarized by groups and compared using Chi-square or Fisher exact tests for categorical variables and 2-sample t tests or Wilcoxon rank sum test for the continuous variables. Repeated measurement analysis of covariance model will also be used for the comparison of endpoints between 2 groups.

Conclusion:

The present study is designed to investigate the effect of the application of dexmedetomidine on postoperative myocardial injury and postoperative cognitive dysfunction, also to explore the association between inflammatory factors and postoperative cognitive function. With this study, we are expecting to find out an appropriate anesthesia method for elderly people with hypertension to alleviate the postoperative adverse effects caused by medical treatments.

Trials registration: This study was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/) with the ID ChiCTR-IPR-16009156.
Prognostic value of 18F-fluorodeoxyglucose bone marrow uptake in patients with solid tumors
Authors: Jeong Shin Young , Kim Seong-Jang , Pak Kyoungjune , Lee Sang-Woo , Ahn Byeong-Cheol , Lee Jaetae
Published: October 2018

Background:

Several studies have reported the prognostic value of 18F-fluorodeoxyglucose (18F-FDG) bone marrow uptake (BMU) measured by 18F-FDG positron emission tomography (18F-FDG PET) in various cancers. We performed a meta-analysis to evaluate the prognostic value of 18F-FDG BMU in patients with solid tumors.

Methods:

Systematic searches of MEDLINE and Embase databases were performed using the keywords “18F-FDG,” “bone marrow,” and “prognosis.” All published human studies of the prognostic value of 18F-FDG BMU in patients with solid tumors were searched. The primary outcome was event-free survival (EFS), and the secondary endpoint was overall survival (OS); both of these were extracted directly from each study. The effects of 18F-FDG BMU on survival were assessed by using hazard ratios (HRs).

Results:

Ten studies with 1197 patients (8 studies reporting EFS in 1096 patients and 7 studies reporting OS in 836 patients) were included. In the EFS analysis, the combined HR was 1.75 (95% confidence interval [CI]: 1.45–2.11, P < .00001) in the random effects model (I
2 = 51%, P 
= .05). The combined HR of OS was 1.40 (95% CI: 1.13–1.73, P = .002) in the random effects model (I
2 = 52%, P = .05).

Conclusion:

This meta-analysis has demonstrated that patients with a low level of 18F-FDG BMU have better EFS and OS than those with a high level of 18F-FDG BMU. Based on our results, we suggest that 18F-FDG BMU could be used as a biomarker for stratifying the risk of tumor progression in patients with solid tumors.
Choroidal thickness changes in non-treated acute and ranibizumab-treated chronic central serous chorioretinopathy
Authors: Yumusak Erhan , Gokcinar Nesrin Buyuktortop , Ornek Kemal
Published: October 2018

To evaluate the changes in subfoveal retinal, and choroidal thicknesses (CT) in the non-treated acute and the ranibizumab-treated chronic central serous chorioretinopathy (CSCR) patients.

This retrospective study included 32 eyes of 32 consecutive patients with CSCR. There were 12 patients who presented with a spontaneous resolution of CSCR (Group 1) and 20 patients who were treated with ranibizumab for persistent subretinal fluid (SRF) (Group 2). Optical coherence tomography (OCT) imaging of subfoveal retinal thickness and enhanced depth imaging OCT of CT at subfoveal; at nasal and temporal 500 μm (T500); at nasal and temporal 1500 μm (T1500) were analyzed. The Student t test and multivariate analysis were used to compare variables within and between groups, respectively and correlations were analyzed using Pearson correlation coefficient. A P value of P < .05 was accepted as significant.

The mean patient age was 38.94 ± 8.41 years (range, 20–53 years). Female/male ratio was 4/28. The mean duration of follow-up was 21.6 ± 8.2 months in the chronic CSCR group. Visual acuity improved and central foveal thickness (FT) decreased significantly in both groups. CT decreased significantly only at nasal 1500 μm (N1500) in the acute group and at all measured points in the chronic group compared with baseline, except at T500 (P 
= .07). No significant difference in central FT was detected between the 2 groups. Compared with the acute group, baseline subfoveal CT was significantly higher in chronic patients. There was a significant difference between the groups in baseline and final CT at T500. No significant difference was found at T1500. At nasal 500 μm and N1500, the difference between the groups was significant only for final CT values.

Chronic CSCR was associated with higher baseline CT values in the subfoveal region and at T500. CT significantly decreased at most of the measured points in ranibizumab-treated chronic CSCR patients, whereas it significantly decreased only at 1 point in spontaneously resolved acute CSCR patients.
Transesophageal echocardiography and fluoroscopy for percutaneous closure of atrial septal defects
Authors: Xu Weize , Li Jianhua , Ye Jingjing , Yu Jin , Yu Jiangen , Zhang Zewei
Published: October 2018

The aim of the study was to compare transesophageal echocardiography (TEE) and fluoroscopy for percutaneous atrial septal defect (ASD) closure.

This was a retrospective analysis of children who underwent percutaneous ASD closure. The procedure was guided by TEE without fluoroscopy in 130 patients (TEE group) and by fluoroscopy in 163 patients (fluoroscopy group). Baseline demographic/clinical characteristics were recorded. Patients were followed until hospital discharge. Outcomes were procedure duration, peri/postoperative complications, hospital stay, and costs.

The TEE and fluoroscopy groups showed no significant differences in age (71.7 ± 40.7 vs 62.5 ± 38.8 months), male/female ratio (54/76 vs 66/97), weight (22.0 ± 12.0 vs 20.1 ± 9.0 kg), ASD diameter (9.9 ± 4.2 vs 9.3 ± 3.9 cm), distances to the superior vena cava (13.4 ± 4.6 vs 13.3 ± 4.2 cm), inferior vena cava (13.4 ± 4.3 vs 13.9 ± 4.1 cm) and atrial septal roof (12.1 ± 4.0 vs 12.3 ± 3.2 cm), or atrial septal size (38.2 ± 6.2 vs 39.4 ± 26.6 cm); distance to the mitral valve was greater in the TEE group (13.2 ± 4.4 vs 11.3 ± 3.9 cm; P < .001). The TEE and fluoroscopy groups showed no significant differences in occlusion device size (14.3 ± 4.6 vs 13.8 ± 4.0 cm) or sheath size (8.7 ± 1.8 vs 8.7 ± 0.9 cm), but procedure duration was shorter in the TEE group (21.5 ± 14.6 vs 28.6 ± 10.9 minutes; P < .001). Postoperative fever (>38°C) occurred less frequently in the TEE group than in the fluoroscopy group (0.8% vs 9.2%; P < .001); there were no significant differences for the other complications. No patient had postoperative residual shunt, occlusion device shedding/displacement, or pericardial effusion. The TEE group had longer hospital stay (3.2 ± 0.6 vs 2.9 ± 0.6 days; P < .001) and higher procedure cost (29,687 ± 4218 vs 28,530 ± 1668 CNY (China Yuan); P = .002) than the fluoroscopy group.

TEE-guided percutaneous ASD closure can be used as an alternative to fluoroscopy-guided procedures and avoids the use of radiation or contrast agents.
Age-related variations in corneal geometry and their association with astigmatism
Authors: Namba Hiroyuki , Sugano Akira , Nishi Katsuhiro , Murakami Takanori , Nishitsuka Koichi , Konta Tsuneo , Ishizawa Kenichi , Kayama Takamasa , Yamashita Hidetoshi
Published: October 2018

To investigate how aging affects corneal geometry in Japanese adults, and the association between corneal geometry and astigmatism.

We included 421 participants who had undergone systemic and ophthalmological examinations in 2015 in Funagata town, Yamagata, Japan. Corneal topographic data were obtained using anterior-segment optical coherence tomography (CASIA SS-1000). Astigmatism was evaluated using power vector analyses where J0 represents the power of the orthogonal astigmatism. Positive values of J0 indicate with-the-rule astigmatism, while negative values indicate against-the-rule (ATR) astigmatism.

Regarding age-related variations in corneal geometry, the anterior elevations at axis 0° and 180° decreased, and those at axis 90° and 270° increased with increasing age in linear regression analyses, demonstrating horizontal steepening and vertical flattening of the corneal surface. There were no significant age-related variations in posterior elevations and pachymetry findings, including central corneal thickness. Regarding age-related variations in orthogonal astigmatism, the mean values of J0 and corneal J0 (cJ0) decreased by –0.014 and –0.015 per year of increase in age, indicating astigmatic shift toward ATR. Regarding the correlation between corneal geometry and astigmatism, the shift toward ATR was positively correlated with horizontal steepening and vertical flattening, in accordance with the age-related corneal variations. In addition, the posterior surface of the cornea also has an association with this shift to some extent.

The results of our population-based study demonstrated that the age-related variation in astigmatism is associated with geometrical changes in the cornea, especially those in the anterior surface of the cornea.
Recurrent, late-onset pleural effusions in elderly patients receiving pacemaker therapy
Authors: Xiong Mengqing , Zhang Zhan , Hu Ke , Dong Minglin , Hu Weihua
Published: October 2018

Late-onset pacemaker-related pleural effusions (PEs) are rare and are often misdiagnosed with other entities. Our study aimed to detail the clinical features and management of PEs long after pacemaker insertion.

We conducted a review of 6 consecutive elderly patients with PEs, who had undergone a new pacemaker insertion from September 2014 to January 2017. Also, the clinical characteristics and therapeutic courses of PEs were summarized.

Two cases involved fluids after the first implantations, with pacing durations of 3 and 7 months. Two other cases developed PEs 3 or 4 months after the first replacement, with pacing durations of 6 and 11 years. Another 2 cases developed PEs 3 or 5 months following the second replacement, with total pacing durations of 16 and 18 years, respectively. The average interval was 4.17 months for the 6 cases from the time of the new pacemaker insertion to the occurrence of PEs. During the course, they had to be hospitalized repeatedly for thoracenteses because conventional treatments had only short-term effects. After the pacing settings were adjusted, PEs in all cases disappeared gradually. No patients were readmitted for PEs during the median follow-up period of 13 months.

For elderly patients following implantation of a new pacemaker, PEs should be considered due to improper pacing settings, and corresponding adjustments to the device should be made.
The correlation between controlled attenuation parameter and metabolic syndrome and its components in middle-aged and elderly nonalcoholic fatty liver disease patients
Authors: Hu Yue-Yan , Dong Ning-Ling , Qu Qiu , Zhao Xu-Fan , Yang Hong-Ju
Published: October 2018

This study aims to investigate the correlation between controlled attenuation parameter (CAP) and metabolic syndrome (MetS) and its components in middle-aged and elderly nonalcoholic fatty liver disease (NAFLD) patients.

Middle-aged and elderly patients with NAFLD, who visited our hospital from June 2016 to May 2017, were enrolled as study subjects, whereas middle-aged and elderly patients without liver disease were enrolled as controls in the same period. The prevalence of MetS, MetS components, and the different numbers of MetS components were compared among patients with different CAP values.

As the CAP value increased, the prevalence of MetS, MetS components, and the different numbers of MetS components significantly increased. The CAP value was positively correlated with the prevalence of MetS, obesity, hypertriglyceridemia, hypertension, hyperglycemia, hyperuricemia, and the number of MetS components, and was negatively correlated with the prevalence of hypo–high-density-lipoprotein cholesterolemia.

CAP values are closely correlated to MetS and its components in middle-aged and elder NAFLD patients. CAP may be an indicator of risk of MetS and the severity of metabolic disorders in middle-aged and elderly NAFLD patients.
Postoperative morbidity and mortality in patients receiving neoadjuvant chemotherapy for locally advanced gastric cancers
Authors: Luo Huiyu , Wu Liucheng , Huang Mingwei , Jin Qinwen , Qin Yuzhou , Chen Jiansi
Published: October 2018

Aim:

To investigate the postoperative morbidity and mortality for neoadjuvant chemotherapy (NAC) plus surgery compared with surgery alone.

Methods:

PubMed and Embase were searched to capture the incidence of any postoperative complications, pulmonary complications, anastomotic leakage, surgical site infections, and postoperative mortality in randomized clinical trials comparing NAC plus surgery with surgery alone. The meta-analyses were performed with a random effects model.

Results:

Nine relevant studies were included. Comparing NAC with surgery alone, there were no increases in any postoperative complications, pulmonary complications, anastomotic leakage, surgical site infections, or postoperative mortality attributable to NAC. Sensitivity analysis suggested a possible increased risk of any postoperative complications compared with surgery alone: the risk difference 0.056 (95% confidence interval –0.032 to 0.145). Severe complications such as anastomotic leakage and pulmonary complications were similar in the 2 groups.

Conclusions:

NAC for gastric cancer does not increase the risk of postoperative morbidity and mortality compared with surgery alone.
Huge mucinous tubular and spindle cell carcinoma of kidney
Authors: Du Jun-Hua , Zhang Li , Liang Chao-Zhao
Published: October 2018

Rationale:

Mucinous tubular and spindle cell carcinoma (MTSCC) is a variant of renal cell carcinoma newly added to the WHO classification in 2004. It is a rare variant of renal cell carcinoma and sometimes it is not easy to distinguish MTSCC from papillary renal cell carcinoma, chromophobe renal cell cancer, etc. The prognosis of MTSCC is favorable after surgical resection.

Patient concerns:

A 45-year-old male patient presented with a right renal mass that was detected on ultrasonography incidentally. The computed tomography scan showed a huge homogenous mass with patchy calcification in the central area, and the lesion was slightly enhanced after contrast injection.

Diagnoses:

According to postoperative pathology, the patient was diagnosed with MTSCC.

Interventions:

The patient underwent an open transabdominal radical resection of right kidney and right retroperitoneal lymph node dissection.

Outcomes:

The surgical outcomes were good, and no recurrence or metastasis was observed during the follow-up.

Lessons:

MTSCC is a rare malignancy of the kidney and the prognosis is usually favorable. Preoperative enhanced CT and MRI can help differentiate MTSCC from other renal tumors, so as to provide a more suitable surgical approach for those who need to retain renal function as much as possible.
Immune checkpoint inhibitors of CTLA4 and PD-1 for malignant melanoma arising in ovarian cystic teratoma
Authors: Yano Mitsutake , Asami Yuri , Nishikawa Tadaaki , Yoshida Saori , Kamada Kouichi , Katoh Tomomi , Teramoto Yukiko , Nakamura Yasuhiro , Yasuda Masanori
Published: October 2018

Rationale:

Malignant melanoma (MM) arising in ovarian cystic teratoma (OCT) is a rare disease with poor prognosis. Recently, immune checkpoint inhibitors of cytotoxic T-lymphocyte-associated antigen 4 (CTLA4) and programmed death 1 (PD-1) have shown promising results in MM. Herein we report a case of MM arising in OCT.

Patient concerns:

A 63-year-old Japanese primigravida had lower abdominal pain. Magnetic resonance imaging revealed the presence of an 85-mm mass at the right ovary.

Diagnoses:

The patient underwent right salpingo-oophorectomy for right ovarian tumor, and histopathological examinations revealed MM arising in OCT. On immunohistochemical analysis, the tumor cells were positive for HMB-45, Melan A, and S-100 protein, and negative for programmed death-ligand 1 (PD-L1). BRAF gene mutations were not detected by the Real-Time PCR. Two months after surgery, liver metastasis was detected.

Interventions:

The patient underwent immune checkpoint inhibitors of CTLA4 (ipilimumab) and PD-1 (pembrolizumab and nivolumab). She had interstitial pneumonia associated with ipilimumab, but she safely underwent the immune checkpoint inhibitors therapy along with oral prednisolone. Pembrolizumab, ipilimumab, and nivolumab therapies had poor effect on the tumor.

Outcomes:

Now, the present case has had tumor-bearing survival for 14 months since the initial diagnosis and 12 months since the detection of liver metastasis.

Lessons:

This is the first case of MM arising in OCT treated by immune checkpoint inhibitors, with information of PD-L1 immunohistochemical expression and adverse events. The present case is the longest survivor following the detection of recurrence among all the previous reports. The long survival and slow-growing tumor in the present case may be associated with no PD-L1 expressions.
Excellent long-term outcomes of endovascular treatment in budd–chiari syndrome with hepatic veins involvement
Authors: Bi Yonghua , Chen Hongmei , Ding Pengxu , Zhou Pengli , Han Xinwei , Ren Jianzhuang
Published: October 2018

This study aimed to evaluate the long-term efficacy and safety of percutaneous transhepatic balloon angioplasty (PTBA) and transjugular intrahepatic portosystemic stent-shunt (TIPSS) in the treatment of Budd–Chiari syndrome (BCS) with hepatic veins involvement. Between June 2008 and August 2016, a total of 60 BCS patients with hepatic vein involvement in our department were enrolled in this study. Thirty-three cases underwent hepatic vein balloon angioplasty in PTBA Group and 27 cases underwent TIPSS. Data were retrospectively collected, and follow-up observations were performed. TIPSS Group showed significantly higher thrombotic/segmental obstruction and peripheral stenosis/obstruction compared with PTBA Group. The success rates were 93.9% and 100.0% in PTBA Group and TIPSS Group, respectively. The mean portal vein pressure decreased significantly after stenting. Except for 1 patient died from repeated hemorrhage, other sever complications had not been observed in both group. Twenty-six patients and 21 patients were clinically cured in PTBA Group and TIPSS Group, respectively. The primary patency rates were 89.7%, 79.3%, and 79.3% for short-term, mid-term and longterm in PTBA Group, which were significantly higher than TIPSS Group for long-term follow up. The second patency rates were 100.0%, 96.6% and 96.6% for short-term, mid-term and long-term in PTBA Group, which were similar to TIPSS Group (P = 1.0000). In conclusion, PTBA and TIPSS are safe and effective in the treatment of BCS with hepatic veins involvement, with an excellent long-term patency rate of hepatic vein and TIPSS shunt. TIPSS can be used to treat patients with all 3 hepatic veins lesion and failure PTBA.
Paths of femoral nerve catheters placed using ultrasound-guided in plane vs out of plane techniques
Authors: Büttner Benedikt , Dracklé Joschka , Kristof Katalin , Hinz José , Schwarz Alexander , Bauer Martin , Mansur Ashham , Bergmann Ingo
Published: October 2018

Background:

Continuous blockade of the femoral nerve is widely used for postoperative analgesia after hip surgery. It can be achieved by ultrasound-guided placement of a femoral nerve catheter via either the in plane (IP) or out of plane (OOP) technique. On the basis of postoperative radiographs, we evaluated the paths of femoral nerve catheters with respect to both techniques and its effect on postoperative analgesia.

Methods:

Thirty-four patients were randomized to receive a radiopaque femoral nerve catheter via either the IP or OOP technique. The paths and tip position of the catheters were evaluated in postoperative frontal radiographs of the operated hip joint concerning a predefined target region and four neighboring regions. Pain scores were assessed using a numeric rating scale (0–10).

Results:

Sixteen IP patients and 18 OOP patients were included in the study. The catheter path was radiographically evaluated in 13 IP patients and in 10 OOP patients. The catheter tips were located within the target region in 39% of the IP group and in 50% of the OOP group. The catheter tip was 0.00 cm [−3.80 to 3.84] and −1.19 cm [−12.27 to 0.00] (median [range]) from the target region in the OOP group and IP group, respectively (P = .045). Catheters flipped distally more often in the IP group (IP: 61.5%, OOP: 10.0%; P = .01). There were no marked differences in the pain scores of either group.

Conclusion:

Femoral nerve catheters inserted by the ultrasound-guided IP technique flip distally more frequently than catheters inserted by the OOP technique. Moreover, the distance between the catheter tip and the trunk of the femoral nerve is greater for IP catheters than for OOP catheters. Despite these findings, postoperative analgesia did not seem to differ between the 2 techniques.
Generalist versus specialist nurses’ knowledge, attitudes, and behavioral intentions toward promoting pulmonary rehabilitation for patients with chronic obstructive pulmonary disease
Authors: Guo Su-Er , Shen Hsueh-Chen , Okoli Chizimuzo , Liao Yen-Chi , Tsai Kuen-Daw , Lin Ming-Shian , Hsu Hsin-Tien
Published: October 2018

Pulmonary rehabilitation (PR) is an effective strategy to manage chronic obstructive pulmonary disease (COPD), though its utilization rate is low. One reason for this low utilization rate is that nurses do not provide COPD patients with enough health education to increase the patient's motivation for PR participation. This study examined knowledge, attitudes, and behavioral intention toward PR promotion. The study also investigated the correlates of behavioral intentions to promote PR among pulmonary nurses.

A cross-sectional correlational design was used. Overall, 284 nurses (all women) from chest medicine and general internal medicine wards in 3 hospitals within Midwest Taiwan were recruited. Data were collected by anonymous, self-administered questionnaires. We aimed to understand if there would be differences in the Chest Medicine and Generalist nurses on these outcomes, given the specialty versus generalist nature of their practice. Results were analyzed using multiple linear regressions.

Although the 2 groups of nurses (ie, Chest Medicine, General Medicine) showed no differences in PR knowledge, attitudes, or behavioral intentions, they lacked sufficient PR knowledge and skills. The accuracy rate of PR knowledge was approximately 12% and self-evaluated PR skills were less than 50%. Self-efficacy in promoting PR was above average (ie, 57%–60%), and the strength of attitudes and behavioral intentions was over 70%. A multiple linear regression revealed that behavioral intentions of nurses working in the chest medicine ward were influenced by behavioral attitudes, and also PR skills and self-efficacy (explanatory power 33.3%).

Attitudes, skills, and self-efficacy heavily affected pulmonary nurses’ ability to promote PR; however, PR knowledge and skills remain low. Therefore, future implementation of practical PR training courses is needed to strengthen nurses’ behavioral intentions toward PR promotion.

Improved pulmonary rehabilitation-related skill, attitudes, clinical experience of PR programs, and/or practical PR training are needed among both generalist and specialist nurses. Education courses and clinical practice training should be increased in the future to promote pulmonary rehabilitation of COPD patients.
A retrospective pilot study of high-quality nursing care for cervical cancer
Authors: Fu Ya-hui , Wang Zhao-rong
Published: October 2018

This retrospective pilot study investigated the feasible effect of high-quality nursing care (HQNC) for patients with cervical cancer (CC). A total of 58 patients with CC were included in this study. All patients were treated with routine care, and were divided into a treatment group and a control group, according to the different interventions they received. In addition, patients in the treatment group also received HQNC. The primary outcome of anxiety was measured by Beck Anxiety Inventory (BAI). The secondary outcomes were rumination, as measured by ruminative responses scale (RRS); and emotion, as measured by the Emotion Regulation Questionnaire (ERQ). All outcomes were measured before and after 4-week treatment. After treatment, patients in the treatment group showed better outcomes in anxiety, as evaluated by BAI scale (minimal, P = .04), rumination, as measured by RRS (P < .01), and emotion, as assessed by ERQ (P < .01), compared with patients in the control group. The results of this study demonstrated that HQNC might have positive effect in patients with CC after 4-week treatment.
Women were noninferior to men in cardiovascular outcomes among patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention from Taiwan acute coronary syndrome full-spectrum registry
Authors: Chou Li-Ping , Zhao Ping , Kao Chieh , Chen Yen-Hsun , Jong Gwo-Ping
Published: October 2018

This study was conducted to compare the survival rate and the influencing factors between women and men following ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

A national-wide Acute Coronary Syndrome Full Spectrum Registry conducted by the Taiwan Society of Cardiology was used for data collection between October 2008 and January 2010. Details of 1621 patients with STEMI treated with primary PCI, including 1350 (83%) men and 271 (17%) women, were collected. Composite outcomes included all-cause death, myocardial reinfarction, and an ischemic stroke. Demographic data, comorbidities, clinical presentations, details of treatment received, and outcomes were recorded at 3-month intervals for 1 year.

No significant difference was observed between men and women in the composite endpoints after STEMI during their hospital stay (5.5% vs 2.5%, P = .07). However, women showed significantly higher in-hospital and 1-year mortality rates than those of men (4.1% vs 1.8%, P = .008; 11.0% vs 4.1%, P = .000, respectively). Compared with men, women presented with higher age (mean age 68.9 vs 58.9 years, P = .001), less body weight (58.7 vs 70.9 kg, P < .001), more number of risk factors, delayed diagnosis, and more number of inadequate medical treatments. After adjusting for age and cardiovascular risk factors, the difference in mortality ceased to exist between men and women.

Although female patients with STEMI-treated primary PCI had higher in-hospital and 1-year mortality rates than those of males in Taiwan, there was no gender difference after adjusting for age and cardiovascular risk factors.
Association between years since manufacture and utilization of computed tomography scanner in South Korea
Authors: Hong Jae-Seok
Published: October 2018

Health care institutions that acquire an expensive, brand-new computed tomography (CT) scanner are likely to perform excessive scanning in an attempt to recover their investment as early as possible. We examined the association between the age of CT scanners and the number of CT scans at small-sized hospitals and clinics in Korea and assessed the notable increase in scanning quantity at health care institutions with a recently manufactured CT scanner.

A cross-sectional study designed to analyze whether the age of CT scanners was associated with the number of scans at small-sized hospitals and clinics that were operating a CT scanner for the full year 2008 (n = 703). Data were obtained by linking the National Health Insurance Claims Database and Health Care Institution Statistics.

A multiple regression analysis found that the older a CT scanner was, the fewer CT scans were performed in terms of annual total (β = −34.8; P < .001) and patient average (β = −0.0018; P = <.001).

Health care institutions with newer CT scanners administered more CT scans in terms of annual total and scans per patient. Because this may indicate the practice of excessive scanning with newly acquired equipment, it is necessary to have a system of regularly monitoring the quantity and retake rate of CT scanning in these health care institutions so as to prevent unnecessary use of CT.
Quantitative Analysis of Apparent Diffusion Coefficient for Disease Assessment in Paediatric Inflammatory Bowel Disease
Authors: Scionti Alessandra , Di Maurizio Marco , Basile Massimo , Bernardini Azzurra , Miccoli Mario , Lionetti Paolo , Defilippi Claudio , Caramella Davide
Published: October 2018

Objective:

The aim of the study was to establish an apparent diffusion coefficient (ADC) cut‐off value to classify active and non‐active lesions in inflammatory bowel disease.

Methods:

We reviewed 167 paediatric magnetic resonance enterographies executed for suspected inflammatory bowel disease by using a 1.5‐ and 3‐T scanner. We assessed the presence and activity of the disease by using morphologic and functional parameters such as the ADC. Each patient could have more than 1 examinations. Quantitative assessment of disease activity in the ADC map was measured placing 3 regions of interest in the areas of highest inflammation and the mean value was calculated, patients without sign of inflammation were assessed at 2 standardised site. Ileocolonoscopy, esophagogastroduodenoscopy, surgery, and video‐capsule endoscopy were used as standards of reference.

Results:

We enrolled 34 patients and 35 examinations: radiological findings of disease were identified in 29 examinations and 44 lesions were detected. Six patients had negative results and ADC assessment was taken at the terminal ileum and cecum. A total of 56 bowel segments were included in the study. Image analysis revealed 39 active lesions (69.6%) and their ADC values were lower compared to the ones of non‐active segments. For each scanner a cut‐off value was found (sensitivity: 0.91, specificity: 0.89 for 1.5 T and 0.81 for 3 T). Inter‐rater agreement on disease activity between ADC values and magnetic resonance enterography results and between ADC values and the standard of reference were very good.

Conclusions:

ADC can provide a scanner‐based quantitative measurement of disease activity.
Oral and Extraoral Intermediate Tumors: Are MMP-9 and Ki-67 Biomarkers Correlated to Their High Recurrence Rates?
Authors: Afifi Marwa M. , Elnouaem Manal I. , Omar Enas M. , El-Komary Ingy
Published: October 2018

Intermediate tumors of the head and neck fall in the borderline category. They are clinically aggressive tumors with no malignant phenotyping. They are locally infiltrative and have high recurrence rate with less chances to metastasize. The standard care is surgical excision with wide margins. However, surgeons are challenged with the anatomic complexity of the head and neck, increasing the susceptibly of satellite cells being left behind. Ki-67 and MMP-9 are proliferative index and extracellular matrix degradation biomarkers, respectively. They are directly correlated to malignant tumors, whereas less associated with the benign ones. Our main objective was to correlate between Ki-67 and MMP-9 expressions and the recurrence rates in these borderline tumors. We performed a retrospective immunohistochemical study comparing the immunoexpression of Ki-67 and MMP-9. Tumors of interest were aggressive fibromatosis (AF, n=70), epithelioid hemangioendothelioma (EHE, n=25), hemangiopericytoma (HP, n=25), benign fibrous histiocytoma (BFH, n=80) and juvenile ossifying fibroma (JOF, n= 40). Our results revealed that AF followed by HP showed significant high levels of MMP-9 expression, with an average positive area percentage of 40% and 37.4% respectively, compared with other tumors (P<0.05). Ki-67 immunoreaction was significantly the lowest in AF (2.3%, P<0.05) and the highest in JOF (24.7%). To conclude, MMP-9 can be used as a possible target in these tumors as an adjuvant therapy to minimize recurrence rates.
Condylar Resorption After Orthognathic Surgery
Authors: Politis Constantinus , Van De Vyvere Gaétan , Agbaje Jimoh Olubanwo
Published: October 2018

The aim was to postoperatively evaluate a conservative treatment approach to bilateral condylar resorption after orthognathic surgery. A retrospective study was carried out on 730 consecutive patients undergoing sagittal split osteotomy, 2013 to 2016. The mean follow-up period was 2.29 years. Clinical and radiographic findings of patients with postoperative bilateral condylar resorption were searched. Syndromic patients and patients with juvenile rheumatoid arthritis were excluded from this study. Of the 730 patients, 6 (0.82%) required treatments because of bilateral postoperative condylar resorption but had no surgery at the temporomandibular joint (TMJ). Five patients with TMJ symptoms because of postoperative condylar resorption were managed with conservative treatment. About 2 of the 6 patients were successfully retreated with orthognathic surgery in the upper jaw to close the open bite. The TMJ symptoms can successfully be managed with conservative therapy, whereas skeletal relapse can be retreated with orthognathic surgery in the upper jaw, depending on the amount of overjet. Patient undergoing orthognathic surgery may develop bilateral condylar resorption though the frequency is <1%, most of these patients can be managed conservatively.
In Vitro Effect of Bromelain on the Regenerative Properties of Mesenchymal Stem Cells
Authors: Ghensi Paolo , Cucchi Alessandro , Bonaccorso Antonio , Ferroni Letizia , Gardin Chiara , Mortellaro Carmen , Zavan Barbara
Published: October 2018

Background:

Bromelain belongs to a group of protein-digesting enzymes obtained commercially from the fruit or stem of pineapple. Several studies demonstrated that bromelain exhibits various fibrinolytic, anti-edematous, antithrombotic, and anti-inflammatory activities supporting its application for many therapeutic benefits. The aim of this study was to analyze the effects of bromelain on the pro-wound healing activities and the regenerative properties of mesenchymal stem cells.

Methods:

Mesenchymal stem cells were treated in vitro with bromelain alone or combined with dexamethasone sodium phosphate. Real-time polymerase chain reaction was performed to profile the expression of extracellular matrix components and remodeling enzymes, and cytokines.

Results:

The combination of bromelain and dexamethasone sodium phosphate induced a great activation of mesenchymal stem cells with an increase in hyaluronan and collagen production and anti-inflammatory cytokines release.

Conclusion:

Based on the results of this in vitro study, the combined use of bromelain and dexamethasone sodium phosphate stimulated the pro-wound healing activities and the regenerative properties of mesenchymal stem cells better than bromelain and dexamethasone alone.