bluuebunny/crossref_metadata_2025 huggingface dataset:
Involvement of hydrogen sulfide in the progression of renal fibrosis
Authors: Wang Yu , Xing Qi-Qi , Tu Jing-Ke , Tang Wen-Bin , Yuan Xiang-Ning , Xie Yan-Yun , Wang Wei , Peng Zhang-Zhe , Huang Ling , Xu Hui , Qin Jiao , Xiao Xiang-Cheng , Tao Li-Jian , Yuan Qiong-Jing
Published: November 2019

Objective

Renal fibrosis is the most common manifestation of chronic kidney disease (CKD). Noting that existing treatments of renal fibrosis only slow disease progression but do not cure it, there is an urgent need to identify novel therapies. Hydrogen sulfide (H2S) is a newly discovered endogenous small gas signaling molecule exerting a wide range of biologic actions in our body. This review illustrates recent experimental findings on the mechanisms underlying the therapeutic effects of H2S against renal fibrosis and highlights its potential in future clinical application.

Data sources

Literature was collected from PubMed until February 2019, using the search terms including “Hydrogen sulfide,” “Chronic kidney disease,” “Renal interstitial fibrosis,” “Kidney disease,” “Inflammation factor,” “Oxidative stress,” “Epithelial-to-mesenchymal transition,” “H2S donor,” “Hypertensive kidney dysfunction,” “Myofibroblasts,” “Vascular remodeling,” “transforming growth factor (TGF)-beta/Smads signaling,” and “Sulfate potassium channels.”

Study selection

Literature was mainly derived from English articles or articles that could be obtained with English abstracts. Article type was not limited. References were also identified from the bibliographies of identified articles and the authors’ files.

Results

The experimental data confirmed that H2S is widely involved in various renal pathologies by suppressing inflammation and oxidative stress, inhibiting the activation of fibrosis-related cells and their cytokine expression, ameliorating vascular remodeling and high blood pressure, stimulating tubular cell regeneration, as well as reducing apoptosis, autophagy, and hypertrophy. Therefore, H2S represents an alternative or additional therapeutic approach for renal fibrosis.

Conclusions

We postulate that H2S may delay the occurrence and progress of renal fibrosis, thus protecting renal function. Further experiments are required to explore the precise role of H2S in renal fibrosis and its application in clinical treatment.
Pathogenesis, disease course, and prognosis of adult-onset Still's disease: an update and review
Authors: Wang Meng-Yan , Jia Jin-Chao , Yang Cheng-De , Hu Qiong-Yi
Published: November 2019

Objective:

Adult-onset Still's disease (AOSD) is a rare but clinically well-known polygenic systemic autoinflammatory disease. In this review, we aim to present frontiers in the pathogenesis, clinical features, diagnosis, biomarkers, disease course, prognosis, and treatment in AOSD.

Data sources:

We retrieved information from the PubMed database up to July 2019, using various search terms and relevant words, including AOSD and Still's disease.

Study selection:

We included data from peer-reviewed journals. Both basic and clinical studies were selected.

Results:

Pathogenesis of AOSD involves genetic background, infectious triggers, and immunopathogenesis, mainly the activation of macrophages and neutrophils followed by a cytokine storm. Diagnosis and prognosis evaluation of AOSD is still challenging; therefore, there is an urgent need to identify better biomarkers. Biologic agents, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-α antagonists in the treatment of AOSD, have good prospect.

Conclusion:

This review highlights the advances in pathogenesis, potential biomarkers, disease course, and treatment in AOSD.
The Reliability of Intraoperative Assessment on Predicting Tumor Size, Myometrial Invasion, and Cervical Involvement in Patients With a Preoperative Diagnosis of Complex Atypical Hyperplasia or (Clinical Stage I) Endometrial Cancer
Authors: Smith Brentley Q. , Boone Jonathan D. , Thomas Eric D. , Turner Taylor B. , McGwin Gerald , Stisher Amanda M. , Leath Charles A. , Novak Lea , Huh Warner K.
Published: November 2019

Objectives:

The objective of this study is to assess the reliability of intraoperative uterine assessment compared with the final pathologic evaluation in patients with endometrial cancer (EC) and whether assessment improves with experience.

Methods:

After Institutional Review Board approval, a prospective cohort study of women surgically managed with biopsy-proven complex atypical hyperplasia (CAH) or EC between March 2015 and December 2016 was performed. Demographics, preoperative biopsy results, procedure, intraoperative and final pathologic evaluation of lesion size, myometrial invasion, and lower uterine segment/cervical involvement were abstracted. The agreement between the intraoperative and final pathologic evaluation of tumor involvement of the uterus was determined using the kappa statistic and the intraclass correlation coefficient.

Results:

A total of 264 patients with a preoperative diagnosis of CAH or EC were included—71 (26.9%) with CAH and 193 (73.1%) with EC. The mean age was 62.6±11.5, and mean body mass index was 37.2±10.1. The majority of women were white (67%). A total of 227 (85.9%) patients underwent a laparoscopic or robotic hysterectomy, whereas 36 (13.6%) underwent an abdominal hysterectomy. 233 (88.3%) patients had EC and 21 (7.9%) patients had CAH on final pathology. There was a fair agreement between the intraoperative estimation of myometrial invasion (κ=0.37). A moderate agreement exists between the intraoperative estimation of lower uterine segment/cervical involvement (κ=0.57). There was a strong agreement between intraoperative tumor size assessment and the final path (intraclass correlation coefficient=0.74). The intraoperative correlation of tumor size was similar for the first half of the cohort (κ=0.50) and the second half (κ=0.46) chronologically.

Conclusions:

Despite only a fair correlation in the myometrial invasion, intraoperative assessment of cervical involvement and especially tumor size is more readily identified and overall accurate. Therefore, intraoperative evaluation is an additional tool to use when making the decision to proceed with surgical staging.
Mohs Micrographic Surgery at Challenging Anatomical Sites
Authors: Mori Westley S. , Demer Addison M. , Mattox Adam R. , Maher Ian A.
Published: November 2019

BACKGROUND

Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon.

OBJECTIVE

To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites.

METHODS

A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms.

CONCLUSION

These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.
Approaches to Perineural, Lymphovascular, and Single-Cell Disease
Authors: Collins Mary-Katharine , Behshad Ramona , Maloney Mary , Pugliano-Mauro Melissa
Published: November 2019

BACKGROUND

Mohs micrographic surgeons should be adept in identifying and managing perineural invasion (PNI), lymphovascular invasion (LVI), and single-cell spread (SCS), features denoting high-risk behavior of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and microcystic adnexal carcinoma (MAC).

OBJECTIVE

The purpose of this article is to review the literature and guidelines regarding the diagnosis of PNI, LVI, and SCS in BCC, cSCC, and MAC and examine the role of advanced diagnostic studies, adjuvant therapy, and reconstructive techniques of these high-risk tumors.

MATERIALS AND METHODS

We performed a literature search including the following terms: PNI, LVI, SCS, BCC, cSCC, keratinocyte carcinoma, MAC, sentinel lymph node biopsy, radiation, chemotherapy, and staging. Relevant studies, case reports, and review articles were included, as well as National Comprehensive Cancer Network guidelines.

RESULTS

Pancytokeratin immunohistochemistry may aid in the diagnosis of high-risk features of BCC and cSCC. Reconstruction of the Mohs defect should be carefully considered to allow for thorough inspection. Radiation therapy should be considered as an adjuvant treatment option for high-risk cSCC and BCC. Close surveillance for recurrence is warranted.

CONCLUSION

The Mohs surgeon should be competent in identification of high-risk tumors and to understand how best to manage, further treat, and follow these tumors.
“HIDE AND SEEK” NEUROSENSORY RETINAL DETACHMENTS IN PERIPAPILLARY PACHYCHOROID SYNDROME ASSOCIATED WITH PULMONARY ARTERIAL HYPERTENSION
Authors: Govetto Andrea , Sarraf David , Scialdone Antonio
Published: November 2019

Purpose:

To report the case of a patient with peripapillary pachychoroid syndrome and recurrent and spontaneous resolving peripapillary neurosensory retinal detachments associated with pulmonary arterial hypertension.

Methods:

Case report imaged with spectral-domain optical coherence tomography, swept-source optical coherence tomography angiography, fundus autofluorescence, and fluorescein and indocyanine green angiography.

Results:

A 47-year-old woman presented with unilateral blurred vision and metamorphopsia in her left eye and was diagnosed with peripapillary serous retinal detachments associated with peripapillary pachychoroid syndrome. Cardiologic examination was remarkable for heart failure secondary to severe pulmonary arterial hypertension. Neurosensory detachments spontaneously resolved after 1 day but recurred again three days from baseline. Fluorescein and indocyanine green angiography illustrated choroidal hyperpermeability associated with pachyvessels, whereas optical coherence tomography angiography displayed numerous areas of choriocapillaris nonperfusion, more severe in the left eye of the patient.

Conclusion:

In pulmonary arterial hypertension, hemodynamic changes caused by increased central venous pressure and endothelin-1 may explain the development of exudative retinal detachment and choroidal ischemia. The pathophysiological mechanisms explaining the peripapilary location of the fluid and the thick choroid, as with the peripapillary pachychoroid syndrome, are explored and discussed.
Factors Associated With Intensive Care Attention of Dengue Patients
Authors: Chieng Jin Yu , Aravan Logaruban , Arimuthu Durga A. , Tan Wendy Ai Ying , Naidu Tharani , Pan Yan
Published: November 2019

Background

Dengue is caused by dengue virus infection, and it is widespread globally. This study aimed to identify indicative markers for intensive care unit admission.

Methods

A retrospective study was conducted via recruiting dengue patients (≥15 years) admitted to Hospital Serdang, Malaysia, from January to April 2017.

Results

In total, 455 patients were included in this study. Among the factors considered, older age (P = 0.0226), Chinese (P = 0.0297), dengue with comorbidity (P = 0.0039), severe dengue (P < 0.0001), acute kidney injury (P < 0.0001), lower platelet level (P < 0.0001), higher bilirubin level (at admission, P = 0.0089; at highest concentrations, P = 0.0479), and prolonged activated partial thromboplastin time (P = 0.0144) were associated with intensive care unit admission.

Conclusions

Demographic characteristics (older and Chinese), clinical presentations (dengue with comorbidity, severe dengue, acute kidney injury), and laboratory findings (lower platelet, higher bilirubin, and prolonged activated partial thromboplastin time) could be used as suggestive indicators for dengue patients requiring intensive care to minimize mortality and to improve prognosis.
Nicotinamide adenine dinucleotide phosphate oxidase 2–derived reactive oxygen species contribute to long-term potentiation of C-fiber-evoked field potentials in spinal dorsal horn and persistent mirror-image pain following high-frequency stimulus of the sciatic nerve
Authors: Xu Jing , Wei Xuxia , Gao Feng , Zhong Xiongxiong , Guo Ruixian , Ji Yun , Zhou Xin , Chen Jialiang , Yao Peiwen , Liu Xianguo , Wei Xuhong
Published: November 2019

High-frequency stimulation (HFS) of the sciatic nerve has been reported to produce long-term potentiation (LTP) and long-lasting pain hypersensitivity in rats. However, the central underlying mechanism remains unclear. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) belongs to a group of electron-transporting transmembrane enzymes that produce reactive oxygen species (ROS). Here, we found that NOX2 was upregulated in the lumbar spinal dorsal horn after HFS of the left sciatic nerve, which induced bilateral pain and spinal LTP in both male and female rats. Blocking NOX2 with blocking peptide or shRNA prevented the development of bilateral mechanical allodynia, the induction of spinal LTP, and the phosphorylation of N-methyl-d-aspartate (NMDA) receptor 2B (GluN2B) and nuclear factor kappa-B (NF-κB) p65 after HFS. Moreover, NOX2 shRNA reduced the frequency and amplitude of both spontaneous excitatory postsynaptic currents and miniature excitatory postsynaptic currents in laminar II neurons. Furthermore, 8-hydroxyguanine (8-OHG), an oxidative stress marker, was increased in the spinal dorsal horn. Spinal application of ROS scavenger, Phenyl-N-tert-butylnitrone (PBN), depressed the already established spinal LTP. Spinal application of H2O2, one ROS, induced LTP and bilateral mechanical allodynia, increased the frequency and amplitude of spontaneous excitatory postsynaptic currents in laminar II neurons, and phosphorylated GluN2B and p65 in the dorsal horn. This study provided electrophysiological and behavioral evidence that NOX2-derived ROS in the spinal cord contributed to persistent mirror-image pain by enhancing the synaptic transmission, which was mediated by increasing presynaptic glutamate release and activation of NMDA receptor and NF-κB in the spinal dorsal horn.
Advancing Health Equity and Social Justice in Forensic Nursing Research, Education, Practice, and Policy: Introducing Structural Violence and Trauma- and Violence-Informed Care
Authors: Befus Deanna R. , Kumodzi Trina , Schminkey Donna , St. Ivany Amanda
Published: November 2019

Initial conceptualizations of violence and trauma in forensic nursing have remained relatively narrowly defined since the specialty's inception. The advent of trauma-informed care has been important but has limitations that obfuscate social and structural determinants of health, equity, and social justice. As forensic nursing practice becomes more complex, narrow definitions of violence and trauma limit the effectiveness of trauma-informed care in its current incarnation. In keeping with the nursing model of holistic care, we need ways to teach, practice, and conduct research that can accommodate these increasing levels of complexity, including expanding our conceptualizations of violence and trauma to advance health equity and social justice. The objective of this article is to introduce the concepts of structural violence and trauma- and violence-informed care as equity-oriented critical paradigms to embrace the increasing complexity and health inequities facing forensic nursing practice.
Firefighter's Acute Inflammatory Response to Wildfire Suppression
Authors: Main Luana C. , Wolkow Alexander P. , Tait Jamie L. , Della Gatta Paul , Raines Jenni , Snow Rodney , Aisbett Brad
Published: November 2019

Objectives:

The purpose of this study was to determine the inflammatory response to a 12-hour wildfire suppression shift, in firefighters attending the “Black Saturday” natural disaster.

Methods:

Thirty-eight male volunteer firefighters provided venous blood samples before and after a 12-hour firefighting shift. Pre- to post-shift changes in pro-inflammatory (Interleukin [IL]-1β, IL-2, IL-6, IL-8, IL-12P70, granulocyte macrophage-colony stimulating factor [GM-CSF], tumor necrosis factor-alpha [TNF-α], interferon-gamma [IFNγ]), and anti-inflammatory (IL-4, IL-5, IL-7, IL-10, IL-13) cytokines were measured with paired samplettests, or Wilcoxonttests for non-parametric data.

Results:

Interleukin (IL)-6 (P = 0.003) and IL-8 (P = 0.017) were significantly increased following 12-hours of wildfire suppression. There was also a significant decrease in IL-10 (P = 0.021).

Conclusions:

The observed acute inflammatory response may have resulted from multiple stressors including physical exertion, thermal strain, or smoke inhalation experienced during the shift, and may be a necessary response for the body to adapt to stressor exposure.
An innovative technique to promote understanding of anatomy for nurse practitioner students
Authors: Whited Teresa M. , DeClerk Leonie , Berber Albrey , Phelan Kevin D.
Published: November 2019

Nurse practitioner (NP) students are required to have a clear understanding of the complexities of the human body. Students enter graduate studies with varying experiences and backgrounds in anatomy and physiology. Evidence suggests that human anatomy laboratories increase learning outcomes when compared with comparative anatomy modalities. The purpose of this evaluation was to determine if teaching with a computed tomography (CT)-based three-dimensional (3D) anatomy table and cadaveric specimens improves Doctor of Nursing Practice (DNP) and NP students' understanding of anatomy in health assessment. Students participated in a hands-on anatomy review using a 3D anatomy table and human cadavers to master the five included body systems. Presurveys and postsurveys were administered to determine how much time had lapsed since our students' most recent anatomy class and the type of dissection laboratory provided within that class; to assess knowledge confidence in pediatric Head, Eyes, Ears, Nose and Throat (HEENT) anatomy; and to assess students' confidence in pediatric anatomical knowledge for all five body systems. Data were analyzed using a Mann–Whitney U test with independent samples. All areas with the exception of HEENT showed clinically significant improvement, including overall scores. Many positive themes were identified using qualitative thematic analysis. Teaching with a CT-based, 3D anatomy table with cadaveric specimens improved DNP and NP students' confidence levels in pediatric anatomy knowledge for all five systems. This innovative combination of human cadavers and virtual technology has the potential to produce advanced anatomical understanding for prospective health care professionals and to validate their capacity to conduct complex health assessments and procedures.
Identifying essential clinical skills and procedures for FNP students using an electronic clinical documentation system
Authors: Rivera Lara , Stevens Crystal , Waugh Shirley , Dinkel Shirley
Published: November 2019

Nurse practitioner (NP) education is designed to prepare graduates for competent entry-level practice. However, many new family NPs (FNPs) report a lack of preparation in performing clinical skills and procedures (CSPs). There is no approved list of CSPs for FNP students. Further, there is a dearth of literature reporting CSPs frequently performed by NPs to guide NP curricula development. The purpose of this investigation was to summarize frequently encountered CSPs reported by students enrolled in an FNP program from August 2012 through December 2018 at a Midwest university and to compare results with those found in the literature. After a comprehensive review of literature, a retrospective, longitudinal assessment of CSPs identified by FNP students and extracted from a proprietary, electronic clinical documentation system (eLOGS) was conducted. Comparison was made with current literature on CSPs used by practicing FNPs. Overall, there was consistency between CSPs documented by students in eLOGS and those found in the literature. Unique to this investigation was the frequent reporting of behavioral health assessments by students. Because behavioral health conditions are often first diagnosed and treated in the primary care setting, competency in care of behavioral health conditions is clearly a necessary CSP. Educators have a responsibility to prepare graduates for the skill set needed in the workplace. This includes a standardized set of CSPs essential to FNP practice. Development of a universally accepted list of CSPs will be instrumental in refining evidence-based NP curricula that best prepares graduates with the experience and confidence necessary to enter practice.
Implementation of home-based international normalized ratio testing in adult patients treated with warfarin
Authors: Van Beek Andrea , Bowers Margaret , Hall Bruce , Meyer Barry
Published: November 2019

Background and local problem:

Patients who take warfarin require frequent testing of their international normalized ratio (INR) level to ensure accurate dosage. Frequent testing can be inconvenient for patients in rural settings, the workforce, the homebound, or those who travel. Patients who have a home INR monitor can test their blood remotely.

Methods:

To circumvent barriers to INR testing, a quality improvement project was designed to implement home INR testing in an anticoagulation clinic setting.

Interventions:

Patients who received a home INR monitor were compared against two usual care testing arms (laboratory and clinic testing patients) in the outcomes of time in therapeutic range (TTR), adverse events, and patient satisfaction using the Duke Anticoagulation Satisfaction Scale (DASS).

Results:

The DASS survey demonstrated the home testing patients had a statistically significant advantage over the clinic testing group in the subdomain of hassles and burdens (p = .048), as well as the lowest overall scores (indicating highest satisfaction) over the clinic testing group (p = .041). No patients in the home testing group had clotting or bleeding issues necessitating hospital admission. There were no significant differences between groups in the TTR analysis (laboratory 70.8%, home 68.9%, and clinic 64.5%) (p = .683).

Conclusions:

Home INR testing provides convenience for patients and reduces the hassles and burdens of warfarin management, leading to improved satisfaction. This engagement in self-care translates to reduced adverse events. Home INR testing can be used in warfarin patients who are highly motivated and willing to engage in their care.
Purification and characterization of a thrombin-like enzyme isolated from Vipera lebetina venom: its interaction with platelet receptor
Authors: Kadi-Saci Amel , Laraba-Djebari Fatima
Published: November 2019

Snake venoms contain various molecules that can be used as tools in the diagnosis and in the treatment of hemostatic disorders. This study reports the isolation and functional characterization of a new thrombin-like enzyme and its role in the modulation of platelet aggregation and coagulation. The molecule was purified by gel filtration, anion exchange chromatography and reverse-phase-HPLC on C8 column; its molecular weight was determined. Natural and synthetic substrates were used to evaluate its enzymatic activities. The fibrinogenolytic activity was tested electrophoretically and by reverse-phase-HPLC on C18 column. Otherwise, the effect on blood coagulation and deficient plasma factors were also evaluated. The mechanism by which a thrombin-like enzyme VLCV (thrombin-like enzyme)-induced platelet aggregation was explored in presence of ticlopidin, clopidogrel and aspirin. VLCV (45 kDa) isolated from Vipera lebetina as a thrombin-like enzyme seems to be able to modulate platelet function. This enzyme showed an amidolytic activity by hydrolyzing the chromogenic-specific substrate of thrombin and the α-chain of fibrinogen. It is also able to clot human plasma and the deficient human plasma in factor X, suggesting that it is involved in the intrinsic and common pathways. The aggregating effect of VLCV is more sensitive to ticlopidine than to the clopidogrel suggesting the involvement of ADP/P2Y12/PI3K pathway. VLCV seems to be able to promote human platelet aggregation suggesting an interaction between P2Y12 and PAR1. Due to its ability to replace the missing factor X and its proaggregating activity, VLCV could be used as molecular tool to better understand the hemostasis mechanism.
Characteristics and related factors of bronchiectasis in chronic obstructive pulmonary disease
Authors: Yu Qihong , Peng Haiying , Li Bo , Qian Hongyu , Zhang Hong
Published: November 2019

The purpose of this study was to understand the incidence, clinical characteristics and related factors of bronchiectasis in chronic obstructive pulmonary disease (COPD) patients.

From January 2015 to January 2017, 133 patients with moderate to severe COPD admitted to our hospital were enrolled in the study. Bronchiectasis analysis was performed by high resolution CT of the chest, the clinical data of all patients were collected including increasing state of COPD, peripheral blood samples, pulmonary function, blood gas. And sputum samples were collected for detection of microorganisms.

the patients were aged 70.18 ± 8.31 years, and 62.4% of the patients were male. FEV1 accounted for an estimated value of 37.91 ± 10.68%, and 104 (78.2%) were severe COPD, and 43 (32.3%) had bronchiectasis. Bronchiectasis is mainly bilateral, multiple and columnar bronchiectasis. The most easily involved sites are the left lower lobe, left lingual lobe and right middle lobe. Bronchiectasis is associated with history of disease (P = .027), at least one hospitalization exacerbated by COPD in the past year (P = .025), and the separation of potential pathogenic microorganisms from sputum (P = .022). The most commonly isolated pathogen was Pseudomonas aeruginosa (P < .001).

Bronchiectasis should be noted in patients with COPD who often suffer from exacerbation or repeated respiratory infections, especially in those who isolate P aeruginosa from respiratory specimens.
The effect of salpingectomy on the ovarian reserve and ovarian response in ectopic pregnancy
Authors: Luo Jiaqi , Shi Yu , Liu Dan , Yang Danni , Wu Jiahui , Cao Lijuan , Geng Lan , Hou Zhenhui , Lin Hongbo , Zhang Qiuju , Jiang Xuefeng , Qian Weiping , Yu Zhiying , Xia Xi
Published: November 2019

Background:

Salpingectomy is routinely performed in ectopic pregnancy (EP). However, the effect of the surgery on the ovarian reserve and ovarian response in EP patients is still uncertain and has not been systematically evaluated. Therefore, we conducted this meta-analysis to provide a comparison of the ovarian reserve and ovarian response between the pre-salpingectomy and post-salpingectomy in EP patients.

Methods:

Pubmed, Embase, and Cochrane Library were searched for all relevant articles published up to December 2018. We retrieved the basic information and data of the included studies. The data was analyzed by Review Manager 5.3 software (Cochrane Collaboration, Oxford, UK).

Results:

A total of 243 articles were extracted from the databases, and 7 studies were included in the meta-analysis. The ovarian reserve including anti-Mullerian hormone (inverse variance [IV] −0.7 [95% confidence interval [CI] −0.63, 0.49]), antral follicle count (IV 1.7 [95% CI −2.02, 5.42]) and basal follicle stimulating hormone (IV 0.02 [95% CI −0.63, 0.68]) was comparable between the pre-salpingectomy group and the post-salpingectomy group. The amount of gonadotropin was significantly higher in the post-salpingectomy group when compared with that in the pre-salpingectomy group (IV −212.65 [95% CI −383.59, −41.71]). There was no significant difference in the left parameters of the ovarian response including the duration of gonadotropin stimulation (IV −0.32 [95% CI −0.76, 0.12]), the estrogen level on the human chorionic gonadotropin triggering day (IV −4.12 [95% CI −236.27, −228.04]) and the number of retrieved oocytes (IV 0.35 [95% CI −0.76, 1.46]) between 2 groups.

Conclusions:

The current results suggest that salpingectomy has no negative effect on the ovarian reserve and ovarian response.
Carbetocin vs oxytocin for prevention of postpartum hemorrhage after vaginal delivery
Authors: Jin Xin-Hang , Li Dan , Li Xia
Published: November 2019

Objective:

To evaluate the efficacy and safety of carbetocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery compared with oxytocin.

Methods:

We conducted a systemic literature search in PubMed, the Cochrane Library, and Embase without language restrictions from inception of each of database to November 18th, 2018. Randomized controlled trials with outcome measure of blood loss ≥500 ml were eligible if they compared carbetocin with oxytocin to prevent postpartum hemorrhage during the third stage of labor in women undergoing vaginal delivery.

Results:

This meta-analysis of 5 randomized controlled trials (30,314 women) indicated that there was no significant difference between carbetocin and oxytocin in blood loss ≥500 ml in women undergoing vaginal delivery (relative risks (RRs), 0.52; 95% confidence intervals (CIs), 0.24 to 1.15; P = .11; I
2 = 69%). Sensitivity analyses showed the same results. No significant differences were found in blood loss ≥1000 ml, use of additional uterotonic agents, blood transfusion, uterine massage, flushing, vomiting, abdominal pain, nausea, dizziness, headache, palpitation, itching, and shivering.

Conclusions:

This meta-analysis showed that carbetocin was as effective and safe as oxytocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery, and the choice of carbetocin for routine prophylaxis will depend on cost-effectiveness.
Serum YKL-40 positively correlates with MMP-9 and CRP in patients with acute ST segment elevation myocardial infarction following emergency treatment
Authors: Tan Yuanfei , Ji Xiaoying , Mo Zhifeng , Zhou Yaoliang
Published: November 2019

Objective:

To investigate the role of YKL-40 in ST segment elevation myocardial infarction (STEMI) and its relationship to C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9).

Methods:

This prospective study included 358 STEMI patients who were sent to the Emergency Department of our hospital from April 2014 to December 2017. Serum levels of YKL-40, CRP and MMP-9 were determined using commercially available Enzyme linked immunosorbent assay (ELISA) kits. Major adverse cardiovascular events (MACE) and overall survival time were analyzed.

Results:

GRACE scores (P < .001) and the levels of YKL-40 (P < .001), MMP-9 (P < .001), and CRP (P < .001) were significantly higher in deceased patients compared to those that survived. The levels of CRP (P = .007) and MMP-9 (P = .022) were significantly higher in the high YKL-40 group. The GRACE scores were also significantly elevated (P = .011, 95% CI 2.1 (−9.7 to −1.3)). Cumulative MACE rates and cardiac death rates were significantly higher in the high YKL-40 group (P < .001, 95% CI 3.9 (1.9–8.2)). Overall survival times were significantly longer in patients with lower YKL-40 levels (P < .0001).

Conclusion:

Elevated YKL-40 levels positively correlate with CRP and MMP-9 levels and are associated with clinical outcomes including MACE and 6-month survival in STEMI patients.
Severe hyperammonemia from intense skeletal muscle activity
Authors: Taneja Vikas , Jasuja Haneesh
Published: November 2019

Rationale:

Adult hyperammonemia is most often the result of hepatic dysfunction. Hyperammonemia in the setting of normal hepatic function is a much less common phenomenon and has usually been associated with medications and certain disease states. Here, we present an unusual case of severe hyperammonemia caused physiologically by intense muscle activity in a patient lacking any evidence of liver disease.

Patient concerns:

A 36-year-old woman was brought to the emergency department for a suicide attempt after being found covered in Lysol and Clorox germicidal bleach. She was noted to be in a state of violent psychosis with extreme agitation and had to be sedated and intubated for airway protection.

Diagnosis and interventions:

Initial labs revealed hyperammonemia, lactic acidosis, and anion gap metabolic acidosis. Aminotransferases, bilirubin, and creatine kinase (CK) were normal. Renal function, prothrombin time, activated partial thromboplastin time, and international normalized ratio were also unremarkable and remained so at 24 hours. Ethyl alcohol, acetaminophen, salicylate, and valproic acid were all undetectable in blood. She received 2 doses of lactulose overnight, with a subsequent bowel movement. Next day, her mentation, serum ammonia level, and lactic acid level were back to normal, and she was extubated. Aminotransferases and CK levels were elevated but improved with supportive care. A detailed history and relevant biochemical investigations were unremarkable for any other etiology of hyperammonemia including the common inborn errors of metabolism (IEM). The combination of clinical findings of extreme skeletal muscle activity along with hyperammonemia and lactic acidosis, and subsequently rhabdomyolysis in the setting of unremarkable history and otherwise normal hepatic function strongly suggest the myokinetic origin of hyperammonemia in the patient.

Outcome:

The patient recovered well with supportive care and was discharged on day 5.

Lessons:

This unique case illustrates the important role of skeletal muscle in the human metabolism of ammonia. In our discussion, we also elucidate the underlying pathophysiology, with the objective of improving clinician understanding of various differential diagnoses.
Atrophic gastritis and chronic diarrhea due to Helicobacter pylori infection in early infancy
Authors: Kakiuchi Toshihiko , Nakayama Aiko , Shimoda Ryo , Matsuo Muneaki
Published: November 2019

Rationale:

Helicobacter pylori infection causes atrophic gastritis in childhood, but atrophic gastritis due to H pylori infection is extremely rare in infancy. The relationship between H pylori infection and chronic diarrhea without protein leakage remains controversial.

Patient concerns:

An 8-month-old male infant presented to our hospital with severe watery diarrhea, erythema, and failure to thrive from approximately 1 month after birth. Blood, stool, esophagogastroduodenoscopy, total colonoscopy, and H pylori urease analysis results were positive, thereby suggesting atrophic gastritis.

Diagnoses:

Atrophic gastritis and chronic diarrhea due to H pylori infection.

Interventions:

We performed H pylori eradication therapy using triple therapy with vonoprazan (6 mg/kg), amoxicillin (300 mg/d), and clarithromycin (120 mg/kg) for 7 days.

Outcomes:

From approximately 1 week after the H pylori eradication therapy, the frequency of defecation had decreased, stool shape had improved, and body weight had gradually increased.

Lessons:

H pylori infection can cause atrophic gastritis and chronic diarrhea even in infancy. Early eradication therapy for H pylori infection may be useful for prevention of gastric cancer and improvement in growth disorders.
Skin-stretching device promotes the treatment effect of vacuum sealing drainage technique on phases III and IV stress-induced injuries in aged patients with chronic critical illness
Authors: Zhang Fulian , Gu Yuecheng , Wu Linjun
Published: November 2019

Stress-induced injury is a common complication associated with patients with chronic critical illness (CCI). Skin-stretching device (SSD) and vacuum sealing drainage (VSD) technique are 2 approaches that can facilitate wound healing.

In the present study, the effect of the concatenated application of the 2 techniques on the phases III and IV stress-induced injuries in aged patients with CCI was assessed. About 70 patients with CCI with stress-induced injuries were selected from February 2015 to October 2017. The treatment outcomes of the combined method and VSD method were assessed by comparing their clinicopathologic parameters.

The results showed that the combined treatment shortened the average healing duration of wounds. Moreover, the total area of pressure sores, incidence of bleeding, bacteria amount, 28-day cure rate, peripheral C-reactive protein (CRP) level, and the hospitalization duration were all significantly improved in patients treated with SSD and VSD. The overall effective rate (97.14%) of patients treated with VSD and SSD was significantly higher than that (77.14%) in patients treated with VSD.

The present study showed that the combined application of VSD and SSD improved the treatment outcomes of phases III and IV stress-induced injuries in aged patients with CCI.
Is ablation to atrial fibrillation termination of persistent atrial fibrillation the end point?
Authors: Li Fanghui , Tu Xiang , Li Dongze , Jiang Ying , Cheng Yisong , Jia Yu , Zhang Xinyu , Fu Hua , Hu Hongde , Jiang Jian , Zeng Rui
Published: November 2019

Background:

The ideal ablation strategy and end point for persistent atrial fibrillation (AF) have not been well founded. Defining periprocedural AF termination as the end point of catheter ablation is still controversial. This meta-analysis aimed to analyze the differences between periprocedural AF termination and non-termination in the long-term AF recurrence rate and postoperative complications.

Methods:

Randomized controlled trials (RCTs) were identified by a systematic search of electronic databases including PubMed, EMBASE, and Cochrane library from January 2008 to August 2019. The primary outcome was freedom from AF or any atrial arrhythmia without antiarrhythmic drugs at the long-term (≥12 months) follow-up. The secondary outcome was overall postoperative complication rates. The risk ratio (RR) with 95% confidence interval (CI) was pooled for these outcomes. A forest plot, fixed-effects model or random-effect model, Q test, I2 statistic, and Egger funnel plot were used in the statistical analysis.

Results:

Fourteen RCTs were included in this meta-analysis. Overall, no significant difference was found in freedom from AF at the long-term follow-up between patients in whom AF termination was achieved and not achieved (RR = 0.93, 95% CI = 0.78-1.09, P = .36, I2 = 69%). Patients with AF non-termination had a lower complication occurrence rate than those with AF termination (RR = 1.74, 95% CI = 1.11-2.73, P = .02, I2 = 0%).

Conclusion:

Our meta-analysis suggests that AF termination is not a reliable procedural end point during ablation of persistent AF.
Efficacy and safety of anti-PD-1/PD-L1 agents vs chemotherapy in patients with gastric or gastroesophageal junction cancer: a systematic review and meta-analysis
Authors: Wang Bi-Cheng , Zhang Zhan-Jie , Fu Chen , Wang Chang
Published: November 2019

Background:

Current therapeutic options have limited efficacy for patients with advanced gastric or gastroesophageal junction cancer. Immune checkpoint inhibition now has been increasingly used in advanced gastric or gastroesophageal junction cancer therapy. To further understand the efficacy and safety of anti-programmed cell death 1 (PD-1) and its ligand 1 (PD-L1) agents is critical for clinical practice. We conducted this systematic review and meta-analysis to assess the benefit and risk of PD-1 and PD-L1 inhibitors.

Methods:

The PubMed, EMBASE, Cochrane Library, and Web of Science online databases were searched up to Jun 16, 2019. Primary outcomes were overall survival (OS), progression-free survival (PFS). Second outcomes were objective response rate (ORR), disease control rate (DCR) and adverse events.

Results:

Six studies were assessed for inclusion in the final synthesis, of which 5 were eligible for meta-analysis. Compared with chemotherapy, the pooled hazard ratio (HR) for OS and PFS was, respectively, 1.01 (95% confidence interval [CI]: 0.88–1.15, P = .93) and 1.58 (95% CI: 1.38–1.81, P < .001) after treatment with PD-1/PD-L1 inhibitors. In patients treated with anti-PD-1/PD-L1 agents, the pooled ORR was 9.9% (95% CI: 4.4%–15.5%) and the pooled DCR was 30.8% (95% CI: 21.8%–39.9%). Sub-analysis for treatment related adverse events indicated that fatigue was the most common toxicity in anti-PD-1/PD-L1 therapy (incidence 10.6%, 95% CI: 5.6%–15.6%).

Conclusion:

PD-1/PD-L1 inhibitors appear to improve the antitumor activity in advanced gastric or gastroesophageal junction cancer patients. However, single-agent PD-1/PD-L1 inhibitor did not result in a relative improvement in OS and PFS compared with chemotherapy in the treatment of patients with advanced gastric or gastroesophageal junction cancer. Further randomized clinical trials are warranted to confirm our findings.
Laparoscopic management for stump appendicitis
Authors: Choi Hanlim , Choi Young Jin , Lee Taek-Gu , Kim Dae Hoon , Choi Jae-Woon , Ryu Dong Hee
Published: November 2019

Introduction:

Appendectomy is one of the most common emergency surgical operations. Stump appendicitis is a rare complication after appendectomy and is caused by acute inflammation of the remnant part of the appendix. Because of the low index of suspicion owing to a previous history of appendectomy, the diagnosis of stump appendicitis is often delayed.

Methods:

Between January 2008 and December 2017, 6 patients were diagnosed with stump appendicitis with or without perforation at a single institution. They had undergone operative management with laparoscopic approach. The clinical data of these patients were retrospectively analyzed by reviewing the medical records and pathologic reports.

Results:

Five patients were male, with a mean age of 42.4 years (range 11–77 years). The time interval after initial appendectomy ranged from 2 weeks to 30 years. Three patients underwent laparoscopic completion appendectomy, and the others underwent laparoscopic ileocecectomy. The mean hospital stay was 9 days (range 5–13 days). There were no cases of open conversion.

Conclusions:

Stump appendicitis is a rare complication after appendectomy. A laparoscopic procedure can be performed for management of stump appendicitis with or without perforation.
The Epidemiology and Etiology of Cholangitis After Kasai Portoenterostomy in Patients With Biliary Atresia
Authors: Baek Seung Hwan , Kang Ji‐Man , Ihn Kyong , Han Seok Joo , Koh Hong , Ahn Jong Gyun
Published: November 2019

Objectives:

We investigated the incidence and characteristics of cholangitis after Kasai portoenterostomy (KPE) in patients with biliary atresia. We also examined the distribution and antimicrobial susceptibility patterns of the causative pathogens, which were isolated in sterile specimens, such as blood and ascites.

Methods:

A retrospective chart review was performed in patients with biliary atresia who underwent KPE at Severance Children's Hospital in Korea from 2006 to 2015. The Kaplan‐Meier method was used to assess the cumulative incidence of cholangitis.

Results:

Among the 160 included patients, there were 494 episodes of cholangitis in 126 patients (78.8%) during the study period. The cumulative incidence of cholangitis at 1 and 5 years after KPE was 75.5% and 84.2%, respectively, and cholangitis recurred in most cases (76.2%). The cumulative incidence of culture‐proven cholangitis at 1 and 5 years after KPE was 22.1% and 23.9%, respectively. Enterococcus faecium (27.7%) was the most prevalent pathogen, followed by Escherichia coli (14.9%), Enterobacter cloacae (10.6%), and Klebsiella pneumoniae (8.5%). Gram‐positive isolates (n = 19) showed low susceptibility to ampicillin (42.1%) and gentamicin (66.7%), and only 38.1% of Gram‐negative isolates (n = 21) were susceptible to cefotaxime.

Conclusions:

The present study is the largest to show the high incidence and characteristics of cholangitis after KPE in patients with biliary atresia. Enterococcus is a common pathogen of cholangitis after KPE and should be considered when choosing empiric antimicrobial therapy.
Rumination Syndrome in Children Presenting With Refractory Gastroesophageal Reflux Symptoms
Authors: Nikaki Kornilia , Rybak Anna , Nakagawa Kenichiro , Rawat David , Yazaki Etsuro , Woodland Philip , Borrelli Osvaldo , Sifrim Daniel
Published: November 2019

Objectives:

Up to 40% of children presenting with reflux symptoms do not respond to standard medical interventions. In adults, 20% of patients presenting with Proton Pump Inhibitors refractory Gastro‐Esophageal Reflux Disease (GERD) have rumination syndrome. The management of GERD and rumination differ significantly. Our study aimed to identify rumination syndrome amongst children presenting with persistent GERD symptoms based on a distinct pattern on impedance‐pH monitoring.

Methods:

The parameters of impedance‐pH monitoring were compared between children with rumination syndrome (n = 12), diagnosed on high‐resolution manometry impedance (HRM/Z), children with GERD (n = 18), children with an alternative diagnosis (non‐GERD, n = 12) and children negative for rumination based on HRM/Z (n = 14). The parameters that distinguish the rumination group were identified and incorporated into a scoring system, which was blindly applied on a separate group of children with refractory GERD (n = 18) to define its sensitivity and specificity.

Results:

Rumination syndrome presents in 44% of children with refractory GERD. Children with rumination syndrome present with a large number of proximal reflux episodes (>57.5 episodes/24 hours); a high frequency of nonacid reflux events in the postprandial period (>2/hour); and a highly positive symptom‐reflux association analysis (SAP ≥ 95%). A score of ≥2 out of the 3 points distinguishes children with rumination syndrome with 75% sensitivity and 80% specificity.

Conclusions:

Children with rumination syndrome have a distinct pattern of impedance‐pH monitoring and can be distinguished amongst children presenting with refractory GERD. Applying a simple scoring system during impedance‐pH analysis could lead to early diagnosis of children with rumination syndrome.
Deep Vein Thrombosis Due to Fecal Impaction
Authors: Culler Kasen , Eiswirth Preston , Donaldson James , Green Jared , Rajeswaran Shankar
Published: November 2019

Background:

Deep vein thrombosis (DVT) can occasionally be secondary to mechanical compressions, such as in May-Thurner syndrome. To our knowledge, no cases of DVT associated with mechanical compression by fecal impaction in a pediatric patient have been previously reported.

Case Presentation:

An 18-year-old developmentally delayed female presented to the emergency department with swelling involving her left lower extremity. Cross-sectional imaging revealed a significant stool burden in the rectosigmoid colon compressing the left external iliac vein and causing secondary thrombosis. Thrombectomy successfully alleviated the clot burden.

Conclusion:

This case underscores the potentially serious implications of severe fecal impaction in the pediatric and adolescent populations.
The Journey Toward Taking the Day for Granted Again
Authors: Segevall Cecilia , Söderberg Siv , Björkman Randström Kerstin
Published: November 2019

BACKGROUND:

A hip fracture is an unexpected, subjective, traumatic experience that affects the person in both physical and emotional ways.

PURPOSE:

The purpose of this study was to describe rural older people's experiences of recovering after hip fracture surgery.

METHODS:

Thirteen individual interviews were conducted with older people. The interview texts were analyzed with qualitative content analysis.

RESULTS:

Patients described finding themselves in a new and vulnerable situation, dependent on others for simple everyday chores. They struggled to regain independence while staying positive, convinced that they would recover. Fear of another fall, as well as lack of information, made recovery at home difficult.

CONCLUSION:

Older people who experience hip fractures need support during the recovery process. Because recovery begins at the hospital, this study highlight patients' need to participate in recovery planning, as well as the need to have information about what it means to be affected by a hip fracture and how to prevent it from happening again. This study emphasizes that nurses' awareness of patients' need to participate in planning the recovery process is crucial for enabling patients' return to a daily life that is similar to their prefracture life.