bluuebunny/crossref_metadata_2025 huggingface dataset:
ANTERIOR MIGRATION OF INTRAVITREAL FLUOCINOLONE ACETONIDE IMPLANTS: A CASE REPORT
Authors: Gunzenhauser Robert C. , Greven Margaret A. , John Vishak J.
Published: July 2019

Background/Purpose:

To describe management of anterior migration of a fluocinolone acetonide(FAc) intravitreal implant.

Methods:

A retrospective case report. A 61-year-old man with diabetic macular edema and prior vitrectomy had anterior migration of a FAc implant. Anterior segment photos and optical coherence tomography were performed.

Results:

Approximately 3 months after FAc implant was administered, it was noted to have migrated into the anterior chamber. Vision, intraocular pressure, and optical coherence tomography imaging initially remained stable, and no evidence of detectable corneal edema developed in 30 months of follow-up. However, at 36 months of follow-up, after second FAc implant injection, mild corneal edema developed,suspected to be related to the migrating implants.

Conclusion:

Anterior migration of a FAc implant may lead to less rapid and severe corneal decompensation compared with other steroid implants. Despite this, delayed corneal edema may occur. Careful monitoring of the cornea and intraocular pressure is recommended in cases of anterior FAc migration.
CYTOMEGALOVIRUS RETINITIS AFTER AN INTRAVITREAL DEXAMETHASONE IMPLANT IN AN IMMUNOCOMPETENT PATIENT
Authors: Witmer Matthew T. , Connolly Brian P.
Published: July 2019

Purpose:

To present the case of a 71-year-old woman who developed cytomegalovirus retinitis after the administration of an intravitreal dexamethasone implant in an immunocompetent patient.

Methods:

Retrospective case report.

Patients:

Single patient with a diagnosis of cytomegalovirus retinitis associated with the intravitreal dexamethasone implant.

Results:

The patient developed cytomegalovirus retinitis three months after an intravitreal injection of a dexamethasone implant for macular edema. The patient had no history of poor immune function and was not taking immunosuppressive medications.

Conclusion:

Cytomegalovirus retinitis has been associated with local steroid therapy. This has been described in both immunocompromised and immunocompetent patients. The intravitreal dexamethasone implant may cause local immunosuppression and result in cytomegalovirus retinitis in immunocompetent patients.
Comparison of Corneal Power and Corneal Astigmatism of Different Diameter Zones Centered on the Pupil and Corneal Apex Using Scheimpflug Tomography
Authors: Dong Jing , Zhang Yaqin , Zhou Jing , Zhang Suhua , Sun Bin , Tang Maolong , Wang Xiaogang
Published: July 2019

Purpose:

Using Scheimpflug tomography to investigate the difference in corneal power and corneal astigmatism between 3- and 4-mm diameter zones centered on the pupil and corneal apex.

Methods:

A total of 90 eyes were included in this study. Axial keratometry, total refractive power, and true net power centered on the pupil and corneal apex in 3- and 4-mm diameter zones were assessed. The paired sample t test and independent sample t test were used for data comparison.

Results:

For corneal power and corneal astigmatism for the 3- and 4-mm diameter zones, the flat K values of axial keratometry, total refractive power, and true net power centered on the pupil (3-mm: 43.99 ± 1.69 D, 43.12 ± 1.71 D, 42.53 ± 1.67 D; 4-mm: 44.04 ± 1.67 D, 43.38 ± 1.71 D, 42.61 ± 1.65 D) were significantly higher than those centered on the apex (3-mm: 43.93 ± 1.69 D, 43.05 ± 1.71 D, 42.46 ± 1.67 D; 4-mm: 44.01 ± 1.67 D, 43.34 ± 1.69 D, 42.58 ± 1.65 D; all P < 0.02). However, the steep K and astigmatism magnitude values centered on the pupil (3-mm: 45.71 ± 1.73 D, 45.01 ± 1.73 D, 44.38 ± 1.69 D; 1.72 ± 0.83 D, 1.89 ± 0.86 D, 1.85 ± 0.84 D; 4-mm: 45.78 ± 1.73 D, 45.28 ± 1.74 D, 44.45 ± 1.68 D; 1.73 ± 0.84 D, 1.90 ± 0.85 D, 1.84 ± 0.85 D) were lower than those centered on the apex (3-mm: 45.81 ± 1.74 D, 45.10 ± 1.72 D, 44.50 ± 1.70 D; 1.88 ± 0.90 D, 2.05 ± 0.90 D, 2.04 ± 0.90 D; 4-mm: 45.85 ± 1.73 D, 45.34 ± 1.73 D, 44.51 ± 1.69 D; 1.83 ± 0.88 D, 2.00 ± 0.90 D, 1.93 ± 0.86 D; all P < 0.01). Compared with the 3-mm diameter zone, the corresponding 4-mm diameter zone showed higher corneal power centered on both pupil and corneal apex.

Conclusions:

The difference in corneal power and corneal astigmatism, measured at 3 and 4 mm, centered on the pupil and the corneal apex should be noted in corneal refractive surgery and toric intraocular lens calculation.
Indications and Techniques of Pediatric Keratoplasty in Eastern China From 2008 to 2017
Authors: Zhao Songjiao , Le Qihua , Yao Wang , Xu Jianjiang
Published: July 2019

Purpose:

To explore the transition of indications and surgical techniques of pediatric keratoplasty in Eastern China in the past 10 years.

Methods:

Medical charts of 1026 pediatric patients (1059 eyes) who underwent keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2017 were retrospectively reviewed. The indications for keratoplasty and the surgical techniques were collected and analyzed.

Results:

A total of 634 infants (≤3 years) (661 eyes), 207 toddlers and older children (4–12 years) (211 eyes), and 185 adolescents (13–18 years) (187 eyes) were included. The median age at the time of surgery was 2 years. The surgical indications were composed of congenital abnormalities (74.6%), acquired nontraumatic diseases (16.5%), acquired traumatic diseases (3.6%), and regraft (5.3%). Only congenital abnormality had a significant growing trend during this decade (P = 0.023). Keratoconus (67.2%) exceeded infectious keratitis (14.9%) and was the most common acquired nontraumatic cause in our study. The annual number of pediatric keratoplasties increased significantly from 40 cases in 2008 to 190 cases in 2017 (P < 0.001). Although penetrating keratoplasty was performed in 414 eyes (39.1%), its application in the treatment of keratoconus decreased significantly during this decade (P = 0.04). By contrast, deep anterior lamellar keratoplasty showed an increasing trend because of its popularization in the treatment of keratoconus (P = 0.003).

Conclusions:

Congenital abnormalities have replaced infectious keratitis and have been the leading indications of pediatric keratoplasty in the past 10 years. Although the using of penetrating keratoplasty was still the predominant procedure to treat pediatric corneal pathologies, the adoption of deep anterior lamellar keratoplasty showed a significant increasing trend during the past decade.
Longitudinal Analysis of Bruch Membrane Opening Morphometry in Myopic Glaucoma
Authors: Bhalla Mahadev , Heisler Morgan , Han Sherry X. , Sarunic Marinko V. , Beg Mirza F. , Mackenzie Paul J. , Lee Sieun
Published: July 2019

Précis:

The Bruch membrane opening (BMO) was posteriorly bowed and the degree of nonplanarity increased in stable and progressive glaucoma subjects. BMO became more posterior relative to the Bruch membrane (BM) in control and both stable and progressive glaucoma subjects.

Purpose:

To investigate longitudinal changes in morphologic characteristics of the BMO in control and glaucomatous subjects.

Materials and Methods:

A total of 53 myopic eyes (17 control, 6 suspect, 20 stable glaucoma, and 10 progressing glaucoma) were followed for an average of 4.2±1.4 years and imaged at the baseline and 2 follow-up appointments using a 1060 nm swept-source optical coherence tomography system. BM and BMO were segmented, and 4 morphometric BMO parameters (area, ellipse ratio, nonplanarity, and depth) were measured.

Results:

There were no significant changes in BMO area or ellipse ratio for all groups. BMO nonplanarity was shown to increase in the glaucoma groups. BMO depth relative to BM increased in all groups except the suspects (control: 8.1 µm/y, P=0.0001; stable glaucoma: 3.5 µm/y, P=0.0001; progressing glaucoma: 14.0 µm/y, P=0.0026). In linear mixed-model analysis, axial length was positively associated with BMO area in all groups except for progressing glaucoma, and with BMO nonplanarity in stable glaucoma. It was not a significant factor to the slopes of the BMO parameters in the ANCOVA analysis of slopes.

Conclusions:

Longitudinally, BMO increased in nonplanarity in the glaucoma eyes, and its axial position relative to BM became more posterior in both control and glaucoma eyes.
Perceptual and motor responses directly and indirectly mediate the effects of noxious stimuli on autonomic responses
Authors: Tiemann Laura , Hohn Vanessa D. , Ta Dinh Son , May Elisabeth S. , Nickel Moritz M. , Heitmann Henrik , Ploner Markus
Published: July 2019

Autonomic responses are an essential component of pain. They serve its adaptive function by regulating homeostasis and providing resources for protective and recuperative responses to noxious stimuli. To be adaptive and flexible, autonomic responses are not only determined by noxious stimulus characteristics, but likely also shaped by perceptual and motor responses to noxious stimuli. However, it is not fully known how noxious stimulus characteristics, perceptual responses, and motor responses interact in shaping autonomic responses. To address this question, we collected perceptual, motor, and autonomic responses to brief noxious laser stimuli of different intensities in 47 healthy human participants. Multilevel 2-path mediation analyses revealed that perceptual, but not motor responses mediated the translation of noxious stimuli into autonomic responses. Multilevel 3-path mediation analyses further specified that motor responses indirectly related to autonomic responses through their close association with perceptual responses. These findings confirm that autonomic responses are not only a reflexive reaction to noxious stimuli, but directly and indirectly shaped by perceptual and motor responses, respectively. These effects of motor and perceptual processes on autonomic responses likely allow for the integration of contextual processes into protective and regulatory autonomic responses, aiding adaptive and flexible coping with threat.
Tailor-made iliac branched device for preserving the internal iliac artery in patients with common iliac artery aneurysm
Authors: Chen Po-Lin , Hsu Hung-Lung , Chen I-Ming , Kuo Tzu-Ting , Chen Yin-Yin , Shih Chun-Che
Published: July 2019

Background:

Endovascular repair with stent-graft is a treatment option for patient with common iliac artery aneurysm (CIAA). However, the preservation of the internal iliac artery (IIA) is a concern. The commercially available iliac branched device (IBD) requires a common iliac length of at least 5 cm, which is usually too long for Asian people. Here, we report our medium-term results of using tailor-made IBD for patients with short common iliac artery (CIA) with and without abdominal aortic aneurysm (AAA).

Methods:

A selected iliac limb of the AAA stent-graft was unloaded from the delivery system. A 6-mm fenestration hole was made at the length of the CIA from the proximal end. The edge of the hole was reinforced with the soft and radiopaque tip of a 0.014´´ wire. Then, the iliac limb was reloaded into the introduced sheath as the tailor-made IBD. It was inserted from the selected side of the femoral artery and deployed. The ipsilateral IIA was cannulated through the fenestration hole. Then, a balloon-expandable or self-expandable covered stent with an appropriate size was deployed as the bridging stent-graft.

Results:

Between March 2013 and March 2017, a total of 10 patients received the tailor-made IBDs. One patient died of systemic thromboembolism 2 days after the operation. The bridging stent-grafts remained patent in all patients, except one occluded at 1 year after operation.

Conclusion:

A tailor-made IBD is an easy-to-apply, alternative option for preserving the IIA perfusion in short CIAA patients with and without AAA.
Accuracy of Postoperative Risk Scores for Survival Prediction in Interagency Registry for Mechanically Assisted Circulatory Support Profile 1 Continuous-Flow Left Ventricular Assist Device Recipients
Authors: Critsinelis Andre C. , Lamba Harveen K. , Nguyen Michelle T. , Conroy Jacob R. , Cheema Faisal H. , Civitello Andrew B. , Delgado Reynolds M. , Nair Ajith P. , Oberton Selby B. , Rosengart Todd K. , Frazier O.H. , Morgan Jeffrey A. , Chatterjee Subhasis
Published: July 2019

In this study, we sought to determine the accuracy of several critical care risk scores for predicting survival of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1 patients after continuous-flow left ventricular assist device (CF-LVAD) placement. We retrospectively analyzed the records of 605 patients who underwent CF-LVAD implantation between 2003 and 2016. We calculated the preoperative HeartMate II Risk Score (HMRS) and preoperative Right Ventricular Failure Risk Score (RVFRS) and the following risk scores for postoperative days 1–5: HMRS, RVFRS, Model for End-stage Liver Disease (MELD), MELD-eXcluding International Normalized Ratio, Post Cardiac Surgery (POCAS) risk score, Sequential Organ Failure Assessment (SOFA) risk score, and Acute Physiology and Chronic Health Evaluation III. The preoperative scores and the postoperative day 1, 5-day mean, and 5-day maximum scores were entered into a receiver operating characteristic curve analysis to examine accuracy for predicting 30-day, 90-day, and 1-year survival. The mean POCAS score was the best predictor of 30-day and 90-day survival (area under the curve [AUC] = 0.869 and 0.816). The postoperative mean RVFRS was the best predictor of 1-year survival (AUC = 0.7908). The postoperative maximum and mean RVFRS and HMRS were more accurate than the preoperative scores. Both of these risk score measurements of acuity in the postoperative intensive care unit setting help predict early mortality after LVAD implantation.
Intravenous immunoglobulin for adjunctive treatment of severe infections in ICUs
Authors: Aubron Cécile , Berteau Florian , Sparrow Rosemary L.
Published: July 2019

Purpose of review

This review focuses on the emerging literature regarding the use of intravenous immunoglobulins (IVIg) in critically ill patients with severe infections. The aim is to provide an accessible summary of the most recent evidence of IVIg use in sepsis and septic shock and to help clinicians to understand why there is still equipoise regarding the potential benefit of this adjunctive therapy in this setting.

Recent findings

Observational studies with propensity score matching analyses and investigating the effect of IVIg in severe infections including necrotizing soft tissue infection have been recently published. These studies suffer important flaws precluding robust conclusion to be drawn. Some recent randomized controlled trials raised interesting findings supportive of personalized medicine but are likely to be underpowered or confounded.

Insufficient evidence is available to support IVIg use in sepsis and septic shock, apart from the specific case of streptococcal toxic shock syndrome. Current literature suggests that IVIg efficacy in sepsis or septic shock could depend on the IVIg preparation (IgM-enriched or minimal IgM), time of administration (<24 h), dose, and the inflammatory/immunomodulation profile of the patients. Investigator-initiated research, incorporating these parameters, is warranted to determine whether IVIg benefits critically ill patients with severe infection.
Diagnostic value of polymerase chain reaction/acid-fast bacilli in conjunction with computed tomography–guided pleural biopsy in tuberculous pleurisy
Authors: Li Lei , Wang Ye , Zhang Rui , Liu Dan , Li Yalun , Zhou Yongzhao , Song Juan , Li Weimin , Tian Panwen
Published: July 2019

Patients with tuberculous pleurisy often remain undiagnosed even after blind thoracentesis and closed pleural biopsy (PB). In this study, we assessed the value of computed tomography (CT)-guided core needle biopsy of pleural lesion and evaluated the diagnostic accuracy of polymerase chain reaction (PCR)/staining for acid-fast bacilli (AFB) in suspicious tuberculous pleurisy undiagnosed in blind thoracentesis.

Patients with exudative pleural effusion (PE) without specific etiology after blind thoracentesis and closed PB were enrolled in this study. PB specimens were obtained through CT-guided core needle biopsy of pleural lesion, then underwent PCR, AFB, histopathological examination, and some routine tests. Diagnostic values were evaluated through sensitivity, specificity, negative predictive value, positive predictive value, and accuracy.

A total of 261 participants (TB group: 241, non-TB group: 20) were recruited. In this cohort, the sensitivity, specificity, and accuracy were 56.0%, 95.0%, and 59.0%, respectively for PCR, whereas 57.3%, 95.0%, and 60.2%, respectively for AFB. Their parallel test achieved an improved sensitivity (76.8%) and accuracy (77.8%), with a slight decrease in specificity (90.0%). In histopathological examination, granuloma was the most common finding in TB group (88.4%, 213/241), but also observed in non-TB group (10.0%, 2/20). In addition, pleural lymphocyte percentage in TB group was significantly higher than that of non-TB group (92% vs 61%, respectively; P = .003). However, no significant differences were found for other biomarkers.

CT-guided core needle PB is essential for patients with exudative PE but undiagnosed after blind thoracentesis. Combining with PCR and AFB, it strongly improves the diagnosis of tuberculous pleurisy.
Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery
Authors: Su I-Li , Wu Victor Chien-Chia , Chou An-Hsun , Yang Chia-Hung , Chu Pao-Hsien , Liu Kuo-Sheng , Tsai Feng-Chun , Lin Pyng-Jing , Chang Chih-Hsiang , Chen Shao-Wei
Published: July 2019

To investigate the incidence, outcomes, and risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients undergoing surgical repair for acute type A aortic dissection.

This retrospective study involved 270 patients who underwent surgical repair for acute type A aortic dissection between January 2009 and December 2015. Data on clinical characteristics and outcomes were collected. Patients who immediately died after surgery and with preoperative myocardial dysfunction were excluded. The included patients were divided into the ARDS (ARDS patients who met the Berlin definition) and non-ARDS groups. Primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS and was reviewed by 2 qualified physicians with expertise in critical care and cardiac surgery. Outcomes of interest were the incidence and severity of risk factors for ARDS in this population, and perioperative outcomes and survival rates were compared with patients with or without ARDS.

A total of 233 adult patients were enrolled into this study; of these, 37 patients (15.9%) had ARDS. Three, 20, and 14 patients had mild, moderate, and severe ARDS, respectively, according to the Berlin definition, with no significant difference in age, sex, and underlying disease. The ARDS group had lower mean oxygenation index (OI) than the non-ARDS group in the first 3 days post-surgery and demonstrated an improvement in lung function after the fourth day. Postoperative complication risks were higher in the ARDS group than in the non-ARDS group. However, no significant difference was observed in in-hospital mortality between the 2 groups (10.8% vs 5.6%, P = .268). Additionally, there was also no significant difference in the 3-year mortality rate between the 2 groups (P of log-rank test = .274). Postoperative hemoglobin level (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.62–0.99) and perioperative blood transfusion volume (OR: 1.07; 95% CI: 1.03–1.12) were associated with ARDS risk.

Postoperative ARDS after type A aortic dissection repair surgery was associated with risks of postoperative complications but not with risk of in-hospital mortality or 3-year mortality. A higher perioperative blood transfusion volume and a lower postoperative hemoglobin level may be risk factors for ARDS.
Effects of long-term glycemic variability on incident cardiovascular disease and mortality in subjects without diabetes
Authors: Yu Ji Hee , Han Kyungdo , Park Sanghyun , Lee Da Young , Nam Ga Eun , Seo Ji A , Kim Sin Gon , Baik Sei Hyun , Park Yong Gyu , Kim Seon Mee , Kim Nan Hee , Choi Kyung Mook
Published: July 2019

Increased glycemic variability (GV) is an independent risk factor for cardiovascular complications in patients with diabetes. We evaluated the risk of future development of cardiovascular disease (CVD) and death according to GV in a general population without diabetes.

We used the National Health Insurance Service, providing a population-based, nationwide database of Koreans. We included individuals without diabetes who underwent glucose measurement at least 3 times during 2002 to 2006. GV was calculated as standard deviation (SD) of fasting plasma glucose (FPG) levels. We observed development of CVD or all-cause death from 2007 to 2015, and also evaluated the mortality within 1 year after CVD.

Among 3,211,319 people, we found 23,374 incident cases of myocardial infarction (MI), 27,705 cases of stroke, and 63,275 deaths during 8.3 years of follow-up. After multivariate adjustment, GV was found to be a significant predictor of MI, stroke and all-cause death for their highest quartile, with corresponding hazard ratios (HR) of 1.08 (95% confidence interval, CI 1.04–1.11), 1.09 (95% CI 1.06–1.13), and 1.12 (95% CI 1.10–1.15), respectively. The risk of death increased more in those who had both impaired fasting glucose and the highest quartile of GV (HR 1.24 [95% CI 1.21–1.28]). Moreover, early death rate after 1 year of CVD was higher in the highest quartile of GV compared to the lowest quartile (HR 1.21 [95% CI 1.03–1.41]).

Long-term FPG variation was independently associated with CVD and mortality in a general population without diabetes.
Computer-aided detection for prostate cancer diagnosis based on magnetic resonance imaging
Authors: Liang Fuxiang , Li Meixuan , Yao Liang , Wang Xiaoqin , Liu Jieting , Li Huijuan , Cao Liujiao , Liu Shidong , Song Yumeng , Song Bing
Published: July 2019

Background:

Prostate cancer (PCa) is one of the most common primary malignancies in humans and the second leading cause of cancer-specific mortality among Western males. Computer-aided detection (CAD) systems have been developed for accurate and automated PCa detection and diagnosis, but the diagnostic accuracy of different CAD systems based on magnetic resonance imaging (MRI) for PCa remains controversial. The aim of this study is to systematically review the published evidence to investigate diagnostic accuracy of different CAD systems based on MRI for PCa.

Methods:

We will conduct the systematic review and meta-analysis according to the Preferred Reporting Items for a systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA) guidelines. Cochrane library, PubMed, EMBASE and Chinese Biomedicine Literature Database will be systematically searched from inception for eligible articles, 2 independent reviewers will select studies on CAD-based MRI diagnosis of PCa and extract the requisite data. The quality of reporting evidence will be assessed using the quality assessment of diagnosis accuracy study (QUADAS-2) tool. Pooled sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curves will be calculated to estimate the diagnostic accuracy of CAD system. In addition, we will conduct subgroup analyses according to the type of classifier of CAD systems used and the different prostate zoon.

Results:

This study will conduct a meta-analysis of current evidence to investigate the diagnostic accuracy of CAD systems based on MRI for PCa by calculating sensitivity, specificity, and SROC curves.

Conclusion:

The conclusion of this study will provide evidence to judge whether CAD systems based on MRI have high diagnostic accuracy for PCa.

Ethics and dissemination:

Ethics approval is not required for this systematic review as it will involve the collection and analysis of secondary data. The results of the review will be reported in international peer-reviewed journals.

Prospero registration number:

CRD42019132543.
Cluster of differentiation 30 expression in lacrimal gland and conjunctival tissues in patients with Sjögren's syndrome
Authors: Ogawa Akiko , Ogawa Yoko , Mukai Shin , Shimizu Eisuke , Kuwana Masataka , Kawakami Yutaka , Tsubota Kazuo
Published: July 2019

Introduction:

Sjögren's syndrome (SS) often causes lymphoproliferative disorders such as malignant lymphoma and macroglobrinemia. Approximately 5% of long-term follow-up SS patients develop malignant lymphoma. Recently, the tumor necrosis factor receptor superfamily cluster of differentiation 30 (CD30) has been thought to be implicated in malignant cells in organs affected by Hodgikin lymphoma or in a prognostic marker of diffuse large B cell lymphoma. In this study, we investigated CD30 expression in lacrimal gland and conjunctiva in patients with SS.

Methods:

We examined lacrimal gland and conjunctival tissues for the diagnosis from 3 female SS patients with a median age of 51 and 3 female chronic graft-versus-host disease (cGVHD) patients with a median age of 41. Histological analysis of these tissues of the remaining samples was conducted by methods including immunohistochemistry and electron microscopy (#20090277). We analyzed the expression and localization of cluster of differentiation 4 (CD4), cluster of differentiation 8 (CD8), cluster of differentiation 20 (CD20), CD30, and Interferon-γ in tissue sections prepared from lacrimal glands and conjunctiva in 3 each of SS and cGVHD patients.

Results:

There were more B cells and plasma cells in lobules of SS-affected lacrimal glands than in those of their cGVHD-affected counterparts. Interferon-γ was expressed on endothelia of capillaries in SS-affected lacrimal gland and conjunctival tissues whereas it was expressed on fibroblasts in their GVHD-affected equivalents. Furthermore, lacrimal glands and conjunctiva disordered by SS had a greater number of CD30+ cells than those disordered by cGVHD.

Conclusion:

Our results suggest that CD30+ cells are increased in lacrimal glands and conjunctiva affected by SS and that a subset of SS patients are thereby at risk of development malignant lymphoma.
Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery
Authors: Yuan Tianyang , Zhang Jun , Yang Lili , Wu Jiuping , Tian Haiqing , Wan Teng , Xu Derui , Liu Qinyi
Published: July 2019

Rationale:

Cauda equina syndrome (CES) refers to a group of symptoms that occur when the nerves in the cauda equina become compressed or damaged. The most common etiology of CES is lumbar intervertebral disc herniation, but CES following lumbar spinal surgery is rare, especially without motor dysfunction. Herein, we illustrate a case of CES that developed as a complication of spinal surgery and to deduce its possible underlying cause.

Patient concerns:

A 46-year-old man experienced lumbago, bilateral shank pain, and numbness with neurogenic claudication for 3 years due to degenerative lumbar disc herniation and spinal cord stenosis. After a thorough examination to diagnose lumbar spinal stenosis, the patient underwent bilateral decompression and pedicle screw system internal fixation with bone graft. Postoperatively, the patient showed regained strength in his bilateral shanks, and he did not complain of lumbago and shank pain, but CES occurred, which manifested as underpants-type numbness in the perineum without bladder, anal, and motor dysfunction.

Diagnoses:

CES as a postoperative complication of lumbar stenosis.

Interventions:

The patient underwent bilateral laminectomies, partial facetectomies, and pedicle screw system internal fixation and fusion with bone graft. Postoperatively, the patient performed adequate rehabilitation exercises and was expected to recover spontaneously.

Outcomes:

The symptoms of pain and claudication resolved after 3 weeks in the hospital, but an underpants-type hypoesthesia in the perineum without motor dysfunction developed. The patient experienced full recovery from CES 6 months after surgery.

Lessons:

CES as a complication of lumbar spinal surgery is very rare. Excessive sensitivity to the traction of the dural sac was, in our opinion, the most possible cause of postoperative CES in this case. When the nerve root is pulled intraoperatively, it is best not to cross the central line of the spinous process. The plane of the nerve retractor needs to be parallel to the dural sac at the pulling point to reduce the formation of shear force. Most importantly, gentle maneuver is required because sensitivity to the traction of the dural sac varies individually.
Novel diagnosis of mesenteric endometrioma
Authors: Sima Romina-Marina , Radosa Julia Caroline , Zamfir Radu , Ionescu Cringu-Antoniu , Carp Delia , Iordache Ioan-Iulian , Stănescu Anca-Daniela , Pleş Liana
Published: July 2019

Rationale:

Mesenteric cysts are benign gastrointestinal cystic lesions, with an incidence of <1/100 000. They usually develop in the small bowel mesentery, mesocolon (24%), retroperitoneum (14.5%), and very rarely originate from the sigmoid mesentery. Endometriomas represent a localized type of endometriosis and are usually within the ovary. Our case is unique because there are no reports in the literature of endometrial mesenteric cysts.

Patient concerns:

We present a case of a 29-year-old woman who underwent a routine gynecologic control.

Diagnosis:

Clinical examination and imaging identified 2 endometriomas on the left and posterior to the uterus.

Interventions:

The patient underwent exploratory laparoscopy. Unexpectedly, a 10 cm mesenteric cyst was identified; this was associated with adhesions in the left adnexal area and a left ovarian endometrioma. The classic surgical approach which was necessary identified the mesenteric cyst with cranial mesosigmoid and ileal adhesions, as well as distal adhesions which included the uterus, ileum, left ovarian endometrioma, left hydrosalpinx, left ureter, and rectum. The cyst was removed completely and a left adnexectomy was performed because of the presence of the endometrioma and adhesions.

Outcomes:

The patient's outcome was favorable, with discharge at 72 hours after surgery. The histopathological report revealed that both the mesenteric and ovarian cysts were endometriomas.

Lessons:

Our case is unusual in that a mesenteric cyst was identified in a patient with no clinical symptoms. Furthermore, the histopathological examination revealed the endometriotic origin of the mesenteric cyst which has not previously been reported in the literature.
Mixed large and small cell neuroendocrine carcinoma of the endometrium with serous carcinoma
Authors: Hu Ruijiao , Jiang Jiyong , Song Guangyao , Zhu Chenggong , Chen Liyan , Wang Chenhui , Wang Xiuying
Published: July 2019

Rationale:

Endometrial neuroendocrine carcinoma is a rare histological subtype of endometrial cancer, divided into low-grade neuroendocrine carcinoma (carcinoid) and high-grade neuroendocrine carcinoma (small cell and large cell neuroendocrine carcinoma). It is characterized by high invasiveness and poor prognosis. L/SCNEC is an extremely rare pathological type of endometrial carcinoma, and the number of reports on this condition is few globally.

Patient concerns:

A 54-year-old Chinese female presented with vaginal bleeding.

Diagnoses:

Outpatient hysteroscopy and endometrial biopsy were performed, and the pathological examination revealed that cervix was invaded by endometrial malignancy. The patient underwent a laparoscopic radical hysterectomy was diagnosed with the mixed large and small cell neuroendocrine carcinoma (L/SCNEC) of the endometrium combined with serous carcinoma III C2 (FIGO2009).

Interventions:

Chemotherapy-radiotherapy-chemotherapy “sandwich” treatment was performed as postoperative therapy.

Outcomes:

After three chemotherapy circles, the patient showed no evidence of further disease progression.

Lessons:

L/SCNEC is a rare and invasive disease. Once diagnosed, comprehensive treatments including surgery, radiotherapy, and chemotherapy can prolong the survival of patients and improve the prognosis.
Clinical characteristics and treatment of thallium poisoning in patients with delayed admission in China
Authors: Lin Guodong , Yuan Luo , Peng Xiaobo , Long Jianhai , Wang Chunyan , Bai Lili , Lu Xiaoxia , Dong Jianguang , Liu Yanqing , Wang Yongan , Qiu Zewu
Published: July 2019

Thallium is highly toxic and its effects are cumulative. The clinical symptoms of thallium poisoning are non-specific, thereby delaying admission and treatment. This study aimed to summarize the clinical features and treatment experience of patients with delayed admission who experience thallium poisoning.

We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had thallium poisoning and experienced a delay in hospital admission. The time from symptom onset to admission was assessed. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory test results, examination findings, treatment methods, outcomes, and follow-up information, were conducted.

A total of 34 patients with thallium poisoning were included: 8 were admitted to the hospital early or with mild delay, 9 had a moderate delay, and 17 had a severely delayed admission. The time from illness onset to admission was 13 (interquartile range, 7.5–26) days. Some patients with delayed admission had significant symptoms associated with central nervous system damage, and changes in magnetic resonance images and electroencephalograms were also noted. After admission, all patients received Prussian blue treatment, and some patients with relatively high blood concentration received blood purification treatments. Following treatment, the blood and urine thallium concentrations of all patients decreased significantly, and their symptoms were alleviated.

Our results show that delayed patient admission in cases of thallium poisoning is associated with greater risk of central nervous system damage. Use of Prussian blue combined with blood purification treatments might improve patients’ conditions.
MR imaging to detect myelolipomas of the liver
Authors: Xin Huizhen , Li Haijun , Yu Honghui , Zhang Juan , Peng Weizhi , Peng Dechang
Published: July 2019

Rationale:

Primary hepatic myelolipoma is a rare benign neoplasm comprising mature adipose tissue and marrow components in various proportions. Chemical shift imaging (CSI) can distinguish the lipid within the tumor clearly; however, there have been no reports on the CSI of hepatic myelolipoma.

Patient concern:

A 20-year-old woman visited our hospital after discovering a space-occupying lesion in the liver with a history of more than 1 year. She felt distension pain and discomfort under the xiphoid process, accompanied by nausea, vomiting, and occasional chest oppression.

Diagnosis:

The tumor showed a well-defined mass with a pseudocapsule and a heterogeneous appearance on both T1- and T2-weighted magnetic resonance (MR) images. CSI analysis showed a signal decline within the tumor. Based on the histopathology, the tumor was diagnosed as hepatic myelolipoma.

Interventions and Outcomes:

The patient underwent a right hepatectomy, and the postoperative vital signs were stable. Two weeks later, the patient was discharged safely.

Lessons:

Although hepatic myelolipoma is extremely rare, this condition should be considered in differential diagnosis when CSI shows that hepatic lesions contain fatty.
Preventive infusion of donor-derived CAR-T cells after haploidentical transplantation
Authors: Zhang Cheng , Ma Ying-Ying , Liu Jun , Liu Yao , Gao Lei , Gao Li , Kong Pei-Yan , Xiong Qing-Hui , Mei Wei-Ling , Liu Jia , Jiang Peng-Fei , Ye Xun , Zhong Jiang F. , Cao Wei , Han De-Ping , Zhang Xi
Published: July 2019

Rationale:

Relapse is the main cause of death after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, there are no efficient methods to prevent relapse after allo-HSCT. Chimeric antigen receptor T (CAR-T) cells have achieved favorable outcomes in the treatment of refractory/relapsed acute lymphoblastic leukemia (ALL) because of their strong anti-leukemia activity. However, it is unclear whether the CAR-T cells constructed using viral systems can be used as preventive infusions to prevent relapse after haploidentical HSCT.

Patient concerns:

Two patients with ALL with high risk received haploidentical HSCT.

Diagnoses:

Two patients were diagnosed with ALL with high risk.

Interventions:

Patients received preventive infusion of donor-derived CAR-T cells constructed using viral systems on day 60 after haploidentical HSCT.

Outcomes:

The CAR-T cells were continually detected, and no graft versus host disease developed. The two patients survived with disease-free for 1 year and 6 months, respectively.

Lessons:

Preventive infusion of donor-derived CAR-T cells after haploidentical HSCT may be safe and that immunosuppressors may not affect the proliferation of CAR-T cells.
Impact of amyloid-PET in daily clinical management of patients with cognitive impairment fulfilling appropriate use criteria
Authors: Triviño-Ibáñez Eva María , Sánchez-Vañó Raquel , Sopena-Novales Pablo , Romero-Fábrega Juan Carlos , Rodríguez-Fernández Antonio , Carnero Pardo Cristóbal , Martínez Lozano María Dolores , Gómez-Río Manuel
Published: July 2019

To evaluate the use of amyloid-positron emission tomography (PET) in routine clinical practice, in a selected population with cognitive impairment that meets appropriate use criteria (AUC).

A multicenter, observational, prospective case-series study of 211patients from 2 level-3 hospitals who fulfilled clinical AUC for amyloid-PET scan in a naturalistic setting. Certainty degree was evaluated using a 5-point Likert scale: 0 (very low probability); 1 (low probability); 2 (intermediate probability); 3 (high probability); and 4 (practically sure), before and after amyloid PET. The treatment plan was considered as cognition-specific or noncognition-specific.

Amyloid-PET was positive in 118 patients (55.9%) and negative in 93 patients (44.1%). Diagnostic prescan confidence according amyloid-PET results showed that in both, negative and positive-PET subgroup, the most frequent category was intermediate probability (45.7% and 55.1%, respectively). After the amyloid-PET, the diagnostic confidence showed a very different distribution, that was, in the negative-PET group the most frequent categories are very unlikely (70.7%) and unlikely (29.3%), while in the positive-PET group were very probable (57.6%) and practically sure (39%). Only in 14/211 patients (6.6%) the result of the amyloid-PET did not influence the diagnostic confidence, while in 194 patients (93.4%), the diagnostic confidence improved significantly after amyloid-PET results. The therapeutic intention was modified in 93 patients (44.1%). Specific treatment for Alzheimer disease was started, before amyloid-PET, in 80 patients (37.9%).

This naturalistic study provides evidence that the implementation of amyloid-PET is associated with a significant improvement in diagnostic confidence and has a high impact on the therapeutic management of patients with mild cognitive impairment fulfilled clinical AUC.
Loss of guidewire and its sequelae after central venous catheterization
Authors: Zhao Shenyu , Wang Zhe , Zhao Yu
Published: July 2019

Rationale:

Central venous catheterization is a common tool used to monitor central venous pressure and administer fluid medications in patients undergoing surgery. The loss of a broken guide wire into the circulation is a rare and preventable complication. Here, we report a peculiar case of a missed guidewire puncturing the aortic arch and cerebrum.

Patient concerns:

A 53-year-old man with complaints of an intermittent headache and right swollen ankle following central venous catheterization.

Diagnoses:

Using computed tomography; the patient was diagnosed with the loss of a guide wire in his body. The guide wire had migrated to the brain and punctured the vascular wall of the aortic arch.

Interventions:

Due to the risks of surgery, the patient was advised to have a follow-up visit once every 3 months.

Outcomes:

At present, the patient could live like a normal person, although he suffers from intermittent headaches.

Lessons:

The loss of a guide wire is a completely preventable complication, provided that a hold on the tip of the wire is maintained during placement, and the correct safety measurements and protocols are followed.
High pretreatment plasma D-dimer levels predict poor prognosis in gastrointestinal cancers
Authors: Rong Guoyi , Fan Wenxin , Shen Jian
Published: July 2019

Background:

High pretreatment plasma D-dimer levels can predict poor prognosis in various types of gastrointestinal carcinomas. Our meta-analysis explored the correlation between plasma D-dimer levels and prognosis in gastrointestinal malignancies.

Methods:

Two independent reviewers conducted a comprehensive search from PubMed, ScienceDirect, Embase, Web of Science and the Cochrane Library. All articles evaluating the correlation between pretreatment plasma D-dimer levels and prognosis in gastrointestinal malignancies were searched. We chose overall survival (OS) as the primary survival outcome measure and progression-free survival (PFS), disease-free survival (DFS) and cancer-specific survival (CSS) as the secondary survival outcome measures. We extracted hazard ratios (HRs) and 95% confidence intervals (CIs) from the eligible publications.

Results:

We included 30 studies involving 5928 gastrointestinal cancer patients. There was an obvious correlation between high D-dimer levels and poor OS (HR = 2.01, 95% CI = 1.72–2.36, P < .01). High plasma D-dimer levels were correlated with shorter PFS (HR = 1.34, 95% CI = 1.05–1.70, P = .32), DFS (HR =  1.67, 95% CI = 1.12–2.50, P < .01) and CSS rates (HR = 1.93, 95% CI = 1.49–2.49, P = .66).

Conclusions:

Elevated pretreatment plasma D-dimer levels might help predict poor prognosis in patients with gastrointestinal malignancies.
Efficacy and safety of Hou Gu Mi Xi for peptic ulcer diseases
Authors: Chen Xiaofan , Yan Dongmei , Fang Jianhe , Liu Wenjun , Nie Heyun , Lv Nonghua , Fang Nian , Gong Jinhua , Yu Jianwei , Jiang Yiping , Liu Zhijun , Gan Huihu , Fu Ying , Yang Deping , Xiong Yan , Liu Dunju , Chen Ming , Wang Yanping , Wang Yang , Sun Xin , Zhou Xu , Zhu Weifeng
Published: July 2019

Background:

Peptic ulcer disease (PUD) is a major burden worldwide. Several challenges remain with standard Western treatment of PUD, such as persistent weakness, fatigue, and relapse. A dietary traditional Chinese medicine (TCM) formula, Hou Gu Mi Xi (HGMX), has been developed as a complementary treatment for PUD.

Aims:

This multicenter, double-blind, randomized controlled trial will assess efficacy and safety of HGMX in patients with PUD.

Methods:

Three hundred sixty eligible patients will be assigned to receive HGMX, placebo, HGMX + rabeprazole or placebo + rabeprazole for 4 weeks after 2 weeks of standard Western treatment. This first step, with a 2 × 2 factorial design, will focus on assessing the main and interaction effects of HGMX and rabeprazole on ulcer healing. Then, rabeprazole will be stopped, and HGMX will be continued for up to 1 year. The second step, with a placebo-controlled design, will compare the long-term effects of HGMX and placebo. Extended follow-up with no treatment will continue for up to 2 years. Independent and paired t tests, Pearson χ
2 test and the rank-sum test will be used to compare between-group differences. The P value will be adjusted using the O’Brien & Fleming method for multiple comparisons.

Expected outcomes:

The primary outcomes are total efficacy rate of PUD treatment, quality of ulcer healing, and changes in spleen qi deficiency symptoms. The secondary outcomes include ulcer area, PUD recurrence, Helicobacter pylori eradication rate, gastric function, body weight, and body mass index. Adverse events (AEs), severe AEs, treatment-related AEs, and withdrawal owing to AEs will be recorded to assess treatment safety.

Discussion:

The trial results will provide high-quality evidence for HGMX, as a complementary therapy, for the long-term management of PUD and will be valuable for the development of related guidelines and regulations.

Trial registration:

The protocol of this trial was approved in all research hospitals and was registered in ClinicalTrials.gov at October 25, 2017(No. NCT03320538).
Palliative care in pediatric heart failure and transplantation
Authors: Kaufman Beth D. , Cohen Harvey J.
Published: July 2019

Purpose of review

Advanced heart failure in children is characterized by dynamic clinical trajectories, uncertainty of prognosis, and intermittent need for difficult decision-making, often related to novel therapeutic interventions with uncertain impact on quality of life. This review will examine the current role of palliative care to support this unique population.

Recent findings

Pediatric heart failure patients commonly die in ICUs with high burden of invasive therapies together with end of life care needs. In addition, several studies advocate for integration of palliative care early in disease trajectory, not only focused on end of life care. Many advocate for the core tenets of palliative care (symptom management, communication of prognosis, and advanced care planning) to be provided by the primary cardiology team, with consultation by pediatric palliative care specialists. There is also a consensus that palliative care training should be incorporated into pediatric advanced heart disease training programs.

Palliative care is an important component of pediatric heart failure care. Research and quality improvement efforts are needed to determine the most effective palliative care interventions for children with advanced heart disease. Provision of palliative care is an essential component of training for pediatric heart failure and transplant specialists.
Shortened 8‐Week Course of Sofosbuvir/Ledipasvir Therapy in Adolescents With Chronic Hepatitis C Infection
Authors: Serranti Daniele , Dodi Icilio , Nicastro Emanuele , Cangelosi Antonina M. , Riva Silvia , Ricci Silvia , Bartolini Elisa , Trapani Sandra , Mastrangelo Greta , Vajro Pietro , D'Antiga Lorenzo , Resti Massimo , Indolfi Giuseppe
Published: July 2019

Treatment‐naïve, noncirrhotic adults with chronic hepatitis C virus genotype 1 infection and with viremia levels <6 million IU/mL could be effectively treated with sofosbuvir/ledipasvir for 8 weeks. The aim of this pilot, prospective, open‐label, multicenter study was to evaluate the efficacy and safety of this shortened treatment course in adolescents (≥12 years). The efficacy endpoint was sustained virological response 12 weeks after the end of treatment. Safety was assessed by adverse events and clinical/laboratory data. Fourteen consecutive adolescents (median age 16.5 years, Q1 14.1–Q3 17.4; female 57.1%), vertically infected, were enrolled and treated (June 2018–January 2019). Overall, the end of treatment response and sustained virological response 12 weeks after the end of treatment were 100%. No grade 3 to 4 adverse event or a serious adverse event was observed. Further studies are needed to confirm the optimal efficacy of the shortened 8‐week treatment with sofosbuvir/ledipasvir for treatment‐naïve, noncirrhotic adolescents with chronic hepatitis C virus genotype 1 infection and pretreatment viremia level < 6 million IU/mL.