bluuebunny/crossref_metadata_2025 huggingface dataset:
Health-Related Quality of Life in Nonoperated Patients With Adolescent Idiopathic Scoliosis in the Middle Years
Authors: Watanabe Kei , Ohashi Masayuki , Hirano Toru , Katsumi Keiichi , Mizouchi Tatsuki , Tashi Hideki , Minato Keitaro , Hasegawa Kazuhiro , Endo Naoto
Published: August 2019

Study Design.

A retrospective long-term follow-up study.

Objective.

To investigate the health-related quality of life (HRQOL) status in middle-aged patients with adolescent idiopathic scoliosis (AIS) treated non-surgically.

Summary of Background Data.

The HRQOL status using various established questionnaires for non-operated AIS patients has not been fully investigated in long-term follow-up surveys.

Methods.

Inclusion criteria were non-surgical treatment for AIS, more than or equl to 30° major scoliosis at skeletal maturity (Risser grade ≥4), and age more than or equl to 30 years at the time of the survey. A total of 107 AIS patients were included and divided into three groups (single main thoracic [MT] curve group; n = 50, single thoracolumbar/lumbar [TL/L] curve group; n = 19, and double-major [DM] curve group; n = 38) based on curve location at skeletal maturity. Age- and sex-matched volunteers were selected as the control group.

Results.

There were no significant differences in age at survey, body mass index, bone mineral density of the femoral neck, and skeletal muscle mass index among the groups. In all groups, major scoliosis progressed by approximately 0.5°/yr from the time of skeletal maturity to the survey. The thoracolumbar (TL/L) and double-major (DM) groups showed significantly worse visual analog scale scores for low back pain compared with the main thoracice (MT) group (P < 0.05). The all-scoliosis groups showed significantly worse scores for self-image domain of the Scoliosis Research Society Outcome Instrument-22 (SRS-22) than the control group (P < 0.0001). The TL/L group showed significantly worse scores for walking ability and social function domains of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) (P < 0.05). There were no significant differences in Oswestory Disability Index and Short-Form-12 among the four groups.

Conclusion.

AIS patients with single MT curve maintain equal HRQOL status compared with healthy controls. Patients with structural TL/L curves are likely to experience greater annual TL/L curve progression and have substantial low back pain or worse low back pain-specific HRQOL status during middle age.

Level of Evidence: 4
Incidence of Surgical Site Infection After Spine Surgery
Authors: Zhou Jiaming , Wang Rui , Huo Xiaoyang , Xiong Wuyi , Kang Liang , Xue Yuan
Published: August 2019

Study Design.

A systematic review and meta-analysis.

Objective.

The objective of this study was to investigate the incidence of surgical site infection (SSI) in patients following spine surgery and the rate of microorganisms in these cases.

Summary of Background Data.

Many studies have investigated the incidence and risk factors of SSI following spinal surgery, whereas no meta-analysis studies have been conducted regarding the comprehensive epidemiological incidence of SSI after spine surgery.

Methods.

We searched the PubMed, Embase, and Cochrane Library databases for relevant studies that reported the incidence of SSI after spine surgery, and manually screened reference lists for additional studies. Relevant incidence estimates were calculated. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed.

Results.

Our meta-analysis included 27 studies, with 603 SSI cases in 22,475 patients. The pooled SSI incidence was 3.1%. Subgroup analysis revealed that the incidence of superficial SSI was 1.4% and the incidence of deep SSI was 1.7%. Highest incidence (13.0%) was found in patients with neuromuscular scoliosis among the different indications. The incidences of SSI in cervical, thoracic, and lumbar spine were 3.4%, 3.7%, and 2.7%, respectively. Compared with posterior approach surgery (5.0%), anterior approach showed a lower incidence (2.3%) of SSI. Instrumented surgery had a higher incidence of SSI than noninstrumented surgery (4.4% vs. 1.4%). Patients with minimally invasive surgery (1.5%) had a lower SSI incidence than open surgery (3.8%). Lower incidence of SSI was found when vancomycin powder was applied locally during the surgery (1.9%) compared with those not used (4.8%). In addition, the rates of Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant Staphylococci in microbiological culture results were 37.9%, 22.7%, and 23.1%, respectively.

Conclusion.

The pooled incidence of SSI following spine surgery was 3.1%. These figures may be useful in the estimation of the probability of SSI following spine surgery.

Level of Evidence: 3
Odontoid Fractures
Authors: Carvalho André D. , Figueiredo José , Schroeder Gregory D. , Vaccaro Alexander R. , Rodrigues-Pinto Ricardo
Published: August 2019

Odontoid fractures represent one of the most common and controversial injury types affecting the cervical spine, being associated with a high incidence of nonunion, morbidity, and mortality. These complications are especially common and important in elderly patients, for which ideal treatment options are still under debate. Stable fractures in young patients maybe treated conservatively, with immobilization. Although halo-vest has been widely used for their conservative management, studies have shown high rates of complications in the elderly, and therefore current evidence suggests that the conservative management of these fractures should be carried out with a hard cervical collar or cervicothoracic orthosis. Elderly patients with stable fractures have been reported to have better clinical results with surgical treatment. For these and for all patients with unstable fractures, several surgical techniques have been proposed. Anterior odontoid fixation can be used in reducible fractures with ideal fracture patterns, with older patients requiring fixation with 2 screws. In other cases, C1–C2 posterior fixation maybe needed with the best surgical option depending on the reducibility of the fracture and vertebral artery anatomy. In this paper, current evidence on the management of odontoid fractures is discussed, and an algorithm for treatment is proposed.
Nonpharmacologic Interventions to Prevent or Mitigate Adverse Long-Term Outcomes Among ICU Survivors: A Systematic Review and Meta-Analysis*
Authors: Geense Wytske W. , van den Boogaard Mark , van der Hoeven Johannes G. , Vermeulen Hester , Hannink Gerjon , Zegers Marieke
Published: August 2019

Objective:

ICU survivors suffer from long-lasting physical, mental, and cognitive health impairments, also called “postintensive care syndrome”. However, an overview of the effectiveness of interventions to prevent or mitigate these impairments is lacking. The aim of this study is to assess the effectiveness of nonpharmacologic interventions.

Data Sources:

PubMed, CINAHL, PsycINFO, Embase, and Cochrane Library were systematically searched from inception until July 19, 2018.

Study Selection:

(Non)randomized clinical trials, controlled before-after studies, and interrupted time series were included. Outcomes of interest included patients physical, mental and cognitive outcomes, quality of life, and outcomes such as social functioning and functional status, measured after hospital discharge.

Data Extraction:

Two independent reviewers selected studies, extracted data, and assessed the risk of bias. Pooled mean differences and standardized mean differences were calculated using random-effect meta-analyses.

Data Synthesis:

After screening 17,008 articles, 36 studies, including 10 pilot studies, were included (n = 5,165 ICU patients). Interventions were subdivided into six categories: 1) exercise and physical rehabilitation programs; 2) follow-up services; 3) psychosocial programs; 4) diaries; 5) information and education; and 6) other interventions. Many outcomes favored the interventions, but significant differences were only found for diaries in reducing depression (two studies, n = 88; standardized mean difference, 0.68; 95% CI, 0.14–1.21) and anxiety (two studies, n = 88; standardized mean difference, 0.44; 95% CI, 0.01–0.87) and exercise programs in improving the Short Form Health Survey-36 Mental Component Score (seven studies, n = 664; mean difference, 2.62; 95% CI, 0.92–4.32).

Conclusions:

There is thin evidence that diaries and exercise programs have a positive effective on mental outcomes. Despite outcomes favoring the intervention group, other commonly used nonpharmacologic interventions in daily ICU practice are not supported by conclusive evidence from this meta-analysis. To improve recovery programs for ICU survivors, more evidence is needed from robust intervention studies using standardized outcomes.
Diffuse intrinsic pontine glioma: molecular landscape and emerging therapeutic targets
Authors: Aziz-Bose Razina , Monje Michelle
Published: August 2019

Purpose of review

Diffuse intrinsic pontine glioma (DIPG) is a fatal childhood brainstem malignancy. Despite advances in understanding of the molecular underpinnings of the tumor in the past decade, the dismal prognosis of DIPG has thus far remained unchanged. This review seeks to highlight promising therapeutic targets within three arenas: DIPG cell-intrinsic vulnerabilities, immunotherapeutic approaches to tumor clearance, and microenvironmental dependencies that promote tumor growth.

Recent findings

Promising therapeutic strategies from recent studies include epigenetic modifying agents such as histone deacetylase inhibitors, bromodomain and extra-terminal motif (BET) protein inhibitors, and CDK7 inhibitors. Tumor-specific immunotherapies are emerging. Key interactions between DIPG and normal brain cells are coming to light, and targeting critical microenvironmental mechanisms driving DIPG growth in the developing childhood brain represents a new direction for therapy.

Several DIPG treatment strategies are being evaluated in early clinical trials. Ultimately, we suspect that a multifaceted therapeutic approach utilizing cell-intrinsic, microenvironmental, and immunotherapeutic targets will be necessary for eradicating DIPG.
Nurses' Lived Experiences of Faith-Based Short-Term Medical Mission Trips
Authors: Harner Faith , Mann Jeremy , Whitten Carrissa , Abraham Samuel P. , Gillum Deborah R.
Published: August 2019

To date, little has been shared of nurses' perception of their experiences after participating in faith-based, short-term medical mission trips. This qualitative research study, guided by Leininger's transcultural nursing theory and the Sunrise Model, explored this topic. The results illuminated seven themes and pointed to the importance of pretrip planning. The value for Christian nurses in engaging in international medical missions encompasses reflection and growth of one's worldview and experience in providing spiritual care cross-culturally.
Using Laser Range-finding to Measure Bore Depth in Surgical Drilling of Bone
Authors: Demsey Daniel , Gomez Arrunategui Juan Pablo , Carr Nicholas J. , Guy Pierre , Hodgson Antony J.
Published: August 2019

Background

Measuring drilled bore depth in bone is an important part of osteosynthesis surgery. Current methods have substantial limitations in terms of reliability, leading to placement of incorrectly sized screws and unsatisfactory user experience.

Questions/purposes

(1) Can a prototype laser range-finder measure bore depth in bone as well as or better than a conventional depth gauge in terms of accuracy and precision (that is, variability)?

Methods

A conventional analog orthopaedic surgical depth gauge was compared with a laser range-finder-based prototype. Experiments were conducted on four pig hind limbs, with bicortical holes drilled in the femur and the tibia. Two surgeons alternated drilling bores in three different clinically relevant conditions: straight drilling through the diaphysis, angled drilling through the diaphysis, and straight drilling through the metaphysis. Depth measurements were taken with the laser range-finder-based prototype, and the conventional depth gauge and compared against depth measurements obtained from a CT image that served as the reference measurement.

Results

In straight diaphyseal drilling the laser range-finder-based prototype had a larger mean error of 1.34 mm (± 0.7 mm) compared with a mean error of -0.06 mm (± 1.38 mm) using the conventional gauge (95% CI 0.824 to 1.976; p < 0.001). In angled diaphyseal drilling, there was no difference in mean error between the laser range-finder-based prototype (1.66 ± 0.86 mm) and the conventional gauge (2.36 ± 3.79 mm [95% CI -2.338 to 0.938]; p = 0.393). In straight metaphyseal drilling, there was no difference in mean error between the laser range-finder-based prototype (2.11 ± 0.8 mm) and the conventional gauge (1.51 ± 3.19 mm [95% CI -0.500 to 1.700]; p = 0.280). The laser range-finder-based prototype had greater precision (smaller variance) than the conventional depth gauge in straight diaphyseal drilling (p < 0.001), angled diaphyseal drilling (p < 0.001), and straight metaphyseal drilling (p < 0.001).

Conclusions

A laser range-finder-based prototype mounted on a conventional surgical drill demonstrated overall similar accuracy and better precision in measuring drilled bore depth in bone compared with the conventional depth gauge.

Clinical Relevance

A device based on this concept could improve the reliability of bore depth measurement in surgical practice and could therefore reduce the frequency of screw replacement and associated complications.
Measurement of Tumor Thickness in Cutaneous Squamous Cell Carcinomas: Do the Different Methods Provide Better Prognostic Data?
Authors: Yildiz Pelin , Aung Phyu P. , Milton Denái R. , Hruska Chad , Ivan Doina , Nagarajan Priyadharsini , Tetzlaff Michael T. , Curry Jonathan L. , Torres-Cabala Carlos , Prieto Victor G.
Published: August 2019

Cutaneous squamous cell carcinoma (cSCC) is the second most common cause of nonmelanoma skin cancers. Although it has a relatively low mortality rate, it may be locally destructive and potentially metastasize. Tumor thickness of the primary lesion is one important parameter associated with biologic behavior. Such measurement is currently performed in different ways depending on the anatomic location and subspecialty (eg, skin vs. head and neck vs. gynecologic pathology). Furthermore, the new The American Joint Committee on Cancer eighth edition has changed the previously recommended method of measurement of cSCC of head and neck from a modified Breslow thickness to measuring from the granular layer of adjacent, normal-appearing skin to the deepest invasive tumor cell. This study evaluated the clinical significance on patient outcome by measuring tumor thickness using 4 common, currently available methods (measurement from: A. uninvolved dermoepidermal junction; B. top of granular cell layer of the epidermis overlying the tumor, that is, similar to Breslow thickness; C. dermoepidermal junction with in situ cSCC; D. top of granular layer of uninvolved skin) in 85 specimens from nongenital areas of 78 patients with cSCC. Thirty-five percent of them were from the head and neck area. Measurements were performed in millimeters using the digital ruler of image analysis software (Olympus cellSens Standard) on whole-slide scanned images. Associations between recurrence-free survival (RFS) and each method were assessed. When thickness was considered as a continuous measure, there was no statistically significant association between any of the 4 measurement techniques and RFS. When using the currently recommended 6.0-mm cutoff, methods B and C were significantly associated with RFS. Similarly, when optimal cutoff values were selected, all 4 methods were significantly associated with RFS in univariable analysis. However, in a multivariable model that included the techniques and location of lesion, only method B, using the optimal cutoff value of 8.7 mm, was independently associated with RFS. In summary, in our series of cSCC, measurement of thickness using a Breslow method (method B) was significantly associated with RFS using the optimal cutoff and the currently recommended 6.0 mm in univariable analyses and the optimal cutoff in a multivariable assessment. Therefore, our data indicate that measurement of tumor thickness in a manner similar to Breslow thickness may be used to help predict recurrence in patients with cSCC.
Associations Between Family and Community Protective Factors and Attention-Deficit/Hyperactivity Disorder Outcomes Among US Children
Authors: Duh-Leong Carol , Fuller Anne , Brown Nicole M.
Published: August 2019

Background:

Evidence has established the association between risk factors and attention-deficit/hyperactivity disorder (ADHD) severity, but less is known about factors that may have protective effects on clinical, academic, and social outcomes among children with ADHD.

Objective:

To examine associations between family cohesion, caregiver social support, community support, and (1) ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends.

Methods:

Cross-sectional study of school-aged and adolescent children with ADHD using data from the 2016 National Survey of Children's Health. Our outcomes were (1) parent-rated ADHD severity, (2) school engagement, and (3) difficulty making or keeping friends. Our independent variables were (1) family cohesion, (2) caregiver social support, and (3) community support. We used logistic regression models to examine associations between our independent variables and each of our outcome variables, adjusting for child and parent sociodemographic characteristics.

Results:

In our sample (N = 4,122, weighted N = 4,734,322), children exposed to family cohesion and community support had lower odds of moderate to severe ADHD [adjusted OR (aOR): 0.73 (0.55–0.97); aOR: 0.73 (0.56–0.95), respectively], higher odds of school engagement [aOR: 1.72, (1.25–2.37); aOR: 1.38, (1.04–1.84), respectively], and lower odds of difficulty making or keeping friends [aOR: 0.64, (0.48–0.85); aOR: 0.52, (0.40–0.67), respectively].

Conclusion:

Among children with ADHD, family cohesion and community support show protective effects in clinical, academic, and social outcomes. Systematically identifying family- and community-level strengths may be important components of multimodal treatment strategies in children with ADHD.
Research Progress of Mechanisms and Drug Therapy For Atherosclerosis on Toll-Like Receptor Pathway
Authors: Yin Qi-Yang , Zhao Bo , Qiu Yan-Ying , Fei Yu-Xiang , Hu Ya-Hui , Li Yun-Man
Published: August 2019

Recent reports have established atherosclerosis (AS) as a major factor in the pathogenetic process of cardiovascular diseases such as ischemic stroke and coronary heart disease. Although the possible pathogenesis of AS remains to be elucidated, a large number of investigations strongly suggest that the inhibition of toll-like receptors (TLRs) alleviates the severity of AS to some extent by suppressing vascular inflammation and the formation of atherosclerotic plaques. As pattern recognition receptors, TLRs occupy a vital position in innate immunity, mediating various signaling pathways in infective and sterile inflammation. This review summarizes the available data on the research progress of AS and the latest antiatherosclerotic drugs associated with TLR pathway.
FSTL3 Induces Lipid Accumulation and Inflammatory Response in Macrophages and Associates With Atherosclerosis
Authors: Runhua Ma , Qiang Ji , Yunqing Shi , Wenjun Ding , Chunsheng Wang
Published: August 2019

FSTL3 as adipokine takes part in dyslipidemia and inflammatory response, but the association of FSTL3 with atherosclerosis is unclear. This study indicated that FSTL3 showed significantly higher level (control: 7.68 ± 3.10 vs. AS: 9.29 ± 2.37 ng/mL; P < 0.001) in atherosclerosis, and FSTL3 expressed higher in plaque of ApoE knockout mice and located in macrophages. Oxidized low-density lipoproteins induced expression and secretion of FSTL3, meanwhile FSTL3 promoted lipid accumulation in macrophages. The advanced study found that FSTL3 upregulated CD36 and LOX-1 expression in a dose-dependent manner; however, FSTL3 also evoked interleukin 1-β (IL1-β), monocyte chemoattractant protein 1 (MCP-1), tumor necrosis factor-α, and matrix metalloproteinase-9 (MMP-9) secretion in macrophages. On the contrary, that downregulated FSTL3 attenuated expression of oxidized low-density lipoproteins induced CD36, LOX-1, and inflammatory cytokines expressing. All of these results demonstrated that FSTL3 as a novelty cytokine takes part in the process of atherosclerosis through increasing lipid accumulation and inflammation through regulating CD36 and LOX-1 expression.
Acupoint-tuina therapy promotes lactation in postpartum women with insufficient milk production who underwent caesarean sections
Authors: Lu Ping , Ye Zhi-qi , Qiu Jin , Wang Xiao-yu , Zheng Juan-juan
Published: August 2019

Breast milk is recognized and strongly recommended by the World Health Organization (WHO) as the optimal feeding for all babies. Breastfeeding is associated with better nutritional and non-nutritional outcomes when compared to formula feeding, and has proven health benefits to both infants and their mothers. This clinical research is to examine the feasibility and efficacy of Acupoint-Tuina therapy in treating postpartum women who underwent C-sections and suffered from insufficient milk production.

The patients in the control group received standard medical care, while the patients in the Tuina group received Tuina therapy during the next 48 hours in addition to standard care, given once daily for 2 days. To evaluate the efficacy of Tuina therapy, patients of both groups were assessed for surface temperature of breasts, volume of breasts, volume of breast milk production, serum PRL level, and uterus recovery at various time points.

Tuina therapy significantly increased the milk production when compared to the control group, for as much as 13-fold and 10-fold of that in the control group on the third and fourth postpartum days. In addition, Tuina therapy also significantly increased the full breast enlargement and the serum PRL level change, and decreased the breast surface temperature rise. Last but not the least, Tuina therapy also accelerated the post-surgery recovery of uterus.

During the early postpartum days, Tuina therapy increases the milk production and promotes other physiological changes supporting lactation for postpartum women with C-section delivery and insufficient breast milk production. The novel intervention is warranted for further investigation and validation.
Gastroenteritis during infancy is a novel risk factor for allergic disease
Authors: Pan Hui-Hsien , Lue Ko-Huang , Sun Hai-Lun , Ku Min-Sho
Published: August 2019

Antibiotics during infancy, delivery, and breastfeeding affect the intestinal microbiota in early life and is associated with allergic disease. Gastroenteritis (GE) during infancy also affects intestinal microbiota in early life, however, its relationship to allergic disease has not been investigated.

Data of 45,499 males and 49,430 females, from birth to 5 years of age, were collected from a national database in Taiwan. Subjects were categorized into early GE (GE within 0–6 months) and non-early GE group (no GE within 0–6 months). The rates of asthma (AS), allergic rhinitis (AR), and atopic dermatitis (AD) over 5 years were evaluated and compared between the groups. In patients with AS, AR, and AD, the number of clinical visits and drug prescriptions for the allergic disease was also evaluated to assess the effect of early GE on allergic disease.

After adjusting for the effect of GE in later life and other factors, the rates of AS [OR (odds ratio) 1.54, 95% confidence interval (CI) 1.48–1.60], AR [OR 1.49, 95% CI 1.45–1.54], and AD [OR 1.40, 95% CI 1.33–1.47] were higher in the early GE group than in the non-early GE group. The magnitude of the increase was higher in females than in males. In those with AS, AR, and AD, the number of clinical visits and drug prescriptions was not different between the early GE and non-early GE groups. In children with early GE, good control of GE in the following years lowered the rate of allergic disease.

Early-life GE was associated with increased rates of AS, AR, and AD in later life and this was trend more prominent in females.
GPR137 is a promising novel bio-marker for the prognosis of bladder cancer patients
Authors: Lu Jianlei , Zhong Feng , Sun Beibei , Wang Chao
Published: August 2019

Objectives:

G protein-coupled receptor 137 (GPR137) was reported to be associated with several cancers, but its role in bladder cancer has not been reported. The purpose of this study was to evaluate clinical significance of GPR137 in bladder cancer.

Methods:

The expressions of GPR137 in pathological tissues and corresponding normal tissues from bladder cancer patients were detected via quantitative real time polymerase chain reaction (qRT-PCR). Western blot was performed to detect GPR137 expression in bladder cancer tissues and adjacent normal tissues. Chi-Squared test analyzed the relationship between GPR137 expression and clinical features of bladder cancer patients. Additionally, Kaplan–Meier method was adopted in estimating overall survival of bladder cancer patients. Prognostic value of GPR137 was evaluated through Cox regression analysis.

Results:

The expression of GPR137 mRNA and protein in pathological tissues was significantly higher than that in adjacent normal tissues (P < .001). Moreover, similar result was found for bladder cancer patients and healthy controls (P < .001). And GPR137 expression was associated with tumor size (P = .006) and TNM stage (P = .012). The results of Kaplan–Meier analysis suggested that patients with high expression of GPR137 had shorter overall survival time than those with low expression (Log rank test, P = .001). Cox regression analysis indicated that GPR137 could act as an independent biomarker for bladder cancer prognosis (HR = 1.850, 95% CI = 1.272–2.689, P = .001).

Conclusion:

Abnormal expression of GPR137 is associated with bladder cancer and GPR137 is a potential biomarker for the therapy and prognosis of bladder cancer.
Fermented milk containing Lactobacillus paracasei and Glycyrrhiza glabra has a beneficial effect in patients with Helicobacter pylori infection
Authors: Yoon Jin Young , Cha Jae Myung , Hong Seong Soo , Kim Hyung Kyung , Kwak Min Seob , Jeon Jung Won , Shin Hyun Phil
Published: August 2019

Background:

Lactobacillus paracasei and Glycyrrhiza glabra have been reported as having beneficial effects on Helicobacter pylori infection. We aimed to assess the efficacy and safety of fermented milk containing L paracasei HP7 and G glabra in patients with H pylori infection.

Methods:

This multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial was conducted in 2 hospitals from April to December 2017. Patients with H pylori infection were randomized into either the treatment group (fermented milk with L paracasei HP7 and G glabra) or placebo group (fermented milk only) once daily for 8 weeks. The primary endpoint was the gastric load of H pylori measured by 13C-urea breath test (UBT). Secondary endpoints were histologic and clinical improvement.

Results:

A total of 142 patients were randomly allocated to the treatment (n = 71) or placebo groups (n = 71). Compared to baseline data, the quantitative value of 13C-UBT at 8 weeks was significantly reduced in the treatment group (from 20.8 ± 13.2% to 16.9 ± 10.8%, P = .035), but not in the placebo group (P = .130). Chronic inflammation improved significantly only in the treatment group (P = .013), whereas the neutrophil activity deteriorated significantly only in the placebo group (P = .003). Moreover, the treatment group had significant improvement in gastrointestinal symptoms (P = .049) and quality of life (P = .029). No serious adverse events were observed.

Conclusion:

The combination of fermented milk containing L paracasei and G glabra reduced H pylori density and improved histologic inflammation. However, their mechanisms of action should be elucidated in further studies.
A case report of spontaneous coronary artery dissection complicated by stent fracture
Authors: Gao Hanxiang , Hu Ye , Li Qi , Yao Suyu , Zhang Zheng , Bai Ming
Published: August 2019

Rationale:

Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, and nowadays poorly understood. The overall incidence of SCAD ranges from 0.28% to 1.1% in angiographic studies. Therefore, the true incidence of SCAD is most likely underestimated due to asymptomatic or sudden cardiac death before diagnosis. Stent fracture (SF) is a multifactorial issue. Longer vessel remodeled by 2 stents can be more prone to have SF due to higher radial force.

Patient concerns:

In this paper we report a 48-year-old man with chest pain for 2 years.

Diagnoses:

Elective coronary angiography revealed a linear dissection in obtuse marginal branch (OM).

Interventions:

He underwent percutaneous coronary intervention (PCI) with the guidance of intravascular ultrasound (IVUS).

Outcomes:

Then SF was revealed 9 months later.

Lessons:

This is the first case report of SF after coronary intervention therapy in SCAD patients.
Endoscopy and magnetic resonance imaging-based prediction of ypT stage in patients with rectal cancer who received chemoradiotherapy
Authors: Cho Min Soo , Kim HonSoul , Han Yoon Dae , Hur Hyuk , Min Byung Soh , Baik Seung Hyuk , Cheon Jae Hee , Lim Joon Seok , Lee Kang Young , Kim Nam Kyu
Published: August 2019

Accurate tumor response determination remains inconclusive after preoperative chemoradiation therapy (CRT) for rectal cancer. This study aimed to investigate whether clinical assessment, such as endoscopy and magnetic resonance imaging (MRI), can accurately predict ypT stage and select candidates for pelvic organ-preserving surgery in rectal cancer after preoperative CRT. A total of 110 patients who underwent preoperative CRT followed by curative resection for rectal cancer were prospectively enrolled. Magnetic resonance tumor regression grade (mrTRG) using T2-MRI, endoscopic evaluation, and combination modality (combination of endoscopy and mrTRG) were used to analyze tumor response after preoperative CRT. Endoscopic findings were categorized as 3 grades and the mrTRG was assessed into 5 grades. Twenty-nine patients (26.4%) had achieved pathologic complete response. When predicting ypT0, endoscopy showed significantly higher area under the curve (AUC 0.818) than did mrTRG (AUC 0.568) and combination modality (AUC 0.768) in differentiating good response from poor response (P < .001). Both endoscopy and combination modality showed significantly higher diagnostic performance in sensitivity (79.31%), positive predictive value (PPV 67.65%), negative predictive value (NPV 92.11%), and accuracy (84.55%) than those of MR tumor response (sensitivity 37.93%, PPV 36.67%, NPV 77.50%, and accuracy 66.36%) for the prediction of ypT0 (P < .001). Combination modality showed significantly higher diagnostic performance in sensitivity (56.92%), NPV (56.92%), and accuracy (67.27%) compared with those of mrTRG. Neither endoscopy, nor mrTRG, nor the combination modality had adequate diagnostic performances to be clinically acceptable in selecting candidates for nonoperative treatment strategies. However, endoscopy may be incorporated in clinical restaging strategy in planning the extent of surgical resection in patients with rectal cancer.
Ultrasound-guided percutaneous microwave ablation of parotid gland adenolymphoma
Authors: Jin Mingyue , Fu Jili , Lu Jianbo , Xu Wanying , Chi Hui , Wang Xue , Cong Zhibin
Published: August 2019

Rationale:

Parotid gland adenolymphoma is one of the most common benign tumors in parotid gland, and mainly treated by surgery. Despite the widespread of ultrasound-guided percutaneous microwave ablation, there is no report concerning its application in parotid gland adenolymphoma. Herein, we reported a 2-year follow-up result of a male patient underwent ultrasound-guided percutaneous microwave ablation for parotid gland adenolymphoma.

Patient concerns:

A 73-year-old man was admitted due to a hypoechoic nodule measuring 2.67 × 1.42 × 1.35 cm in posterior-inferior area of parotid gland with a high flow velocity in color Doppler flow imaging.

Diagnose:

The lesion was pathologically diagnosed as parotid gland adenolymphoma.

Interventions:

Ultrasound-guided percutaneous microwave ablation was performed to the tumor due to the fact that the patient refused to receive an open surgery in consideration of older age.

Outcomes:

The ablation procedure lasted about 2 minutes and 15 seconds, without significant adverse effect. The reduction ratios of tumor at postoperative 1 and 3-month were 53% and 82%, respectively. The tumor was fully absent at postoperative 8-month evaluation. Finally, there was no evident recurrence at postoperative 24-month evaluation.

Lessons:

Ultrasound-guided percutaneous microwave ablation is a safe and effective treatment for parotid gland adenolymphoma, which may serve as a novel alternative approach for patients unsuitable for open surgery.
Survey of job burnout and depression in standardized residency training programs in China
Authors: Zhang Yun , Chu Xiaotian , Sha Yue , Zeng Xuejun , Shen Ti
Published: August 2019

To evaluate job burnout and its impacts on mental health among clinical residents in a 3-year standardized residency training program in China.

This cross-sectional study was conducted among all residents in the Department of Internal Medicine of the Peking Union Medical College Hospital in August 2017. Job burnout and depressive symptoms were assessed using the Maslach Burnout Inventory-General Survey and the Center for Epidemiological Survey, Depression, respectively.

Among the 159 residents who completed the survey, comprising 69 who had graduated from 8-year medical schools and 90 from 5-year schools, the rate of job burnout was 62.2% (100/159) and the rate of depression was 28.3% (45/159). Rates of job burnout and depression in residents completed different years of training showed no significant difference. Rate of job burnout was significantly higher among graduates of 5-year medical schools (76.7%) than among those of 8-year schools (44.9%, P < .001). Pearson chi-squared test revealed a significant correlation between depression and job burnout (P < .001). Multiple logistic regression revealed a significant correlation between job burnout and attendance at 5- or 8-year medical schools (P = .044).

Job burnout may be more frequent among graduates from 5-year medical schools than among those from 8-year schools.
Ultrasound appearance of intravenous leiomyomatosis
Authors: Ge Zhitong , Wang Yahong , Qi Zhenhong , Zhang Qing , Jin Jin , Li Jianchu
Published: August 2019

Rationale:

Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign.

Patient concerns:

A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy.

Diagnoses:

Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made.

Interventions:

The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully.

Outcomes:

Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence.

Lessons:

The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.
Differentiating pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas by the “Duct-Road Sign”
Authors: Xiao Bo , Jiang Zhi-Qiong , Hu Jin-Xiang , Zhang Xiao-Ming , Xu Hai-Bo
Published: August 2019

To assess the duct-road sign and tumor-to-duct ratio (TDR) in MRI for differentiating pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal-adenocarcinomas (PDACs).

Retrospectively reviewed MRI characteristics of 78 pancreatic masses (histopathology-proven 25 PNETs and 53 PDACs). Receiver operating characteristics with TDR and diagnostic performance of the duct-road sign for differential diagnosis were performed.

The prevalence of duct-road sign in PNETs was higher than that for PDACs (84% vs 0%; P < .001). A strong correlation (r = 0.884, P < .001) was observed between MRI for PNETs and the frequency of this sign. Performance characteristics of the duct-road sign in MRI for PNET diagnosis were sensitivity (84%, [21 of 25]), specificity (100%, [53 of 53]), positive predictive value (100%, [21 of 21]), negative predictive value (92.9%, [53 of 57]), and accuracy (94.8%, [74 of 78]). In the intention-to-diagnose analysis, the corresponding values were 67.7% (21 of 31), 100% (53 of 53), 100% (21 of 21), 84.1% (53 of 63), and 88.1% (74 of 84). The TDR in PNETs was observed to be greater than that in PDACs (14.6 ± 9.3 vs 6.9 ± 3.8, P = .001). TDR with a cut-off value of 7.7 had high sensitivity (84%) and specificity (66%) with area under curve (0.802, 95% CI: 0.699, 0.904; P < .001) for distinguishing PNETs from PDACs.

The presence of duct-road sign and TDR > 7.7 on MRI may assist in diagnosis for PNET instead of PDAC.
Surgical treatment of giant chordoma in the thoracic spine combining thoracoscopic and posterior spinal surgery
Authors: Liu Shuzhong , Zhou Xi , Song An , Huo Zhen , Yao Siyuan , Wang Yipeng , Liu Yong
Published: August 2019

Rationale:

Giant thoracic chordoma is a highly unusual disease with no standard curative managements yet. The objective of this study is to report a very rare case of giant thoracic chordoma successfully operated by combination of thoracoscopic surgery together with posterior spinal surgery. The management of these unique cases has yet to be well-documented.

Patient concerns:

A 64-year-old man presented with a 4-month history of continuous and progressive back pain. The patient, who had been diagnosed of sacral chordoma for 2 years, received surgical treatment of posterior sacral tumor resection and instrumentation. A lytic, expanding lesion of the T5 and T6 vertebral and paraspinal region with mild epidural spinal cord compression was identified.

Diagnosis:

MRI of spine and PET/CT showed spinal cord compression secondary to the epidural component of the T5 and T6 mass, with increased metastatic marrow infiltration of the left T5 and T6 vertebral and paravertebral region, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic chordoma.

Interventions:

The patient underwent 1-stage thoracoscopic release of vertebral and paravertebral tumors, posterior resection of T5-T6 vertebral and paravertebral tumors, T4-T7 spinal canal decompression, and T2-T9 pedicle screw fixation procedure via a posterior approach.

Outcomes:

The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 3-month and 6-month follow-up visit. There were no other complications associated with the operation during the follow-up period.

Lessons:

Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, and medical oncology led to the successful diagnosis and management of this patient. Giant thoracic chordoma, although rare, should be part of the differential diagnosis when the patient has a history of sacral chordoma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the giant thoracic chordoma when the tumor has caused neurological deficits. One-stage thoracoscopic release or resection of vertebral and paravertebral tumor is also a good choice for surgical treatment.
Effects of dexmedetomidine vs sufentanil during percutaneous tracheostomy for traumatic brain injury patients
Authors: Gao Jian , Wei Limin , Xu Guangjun , Ren Chunguang , Zhang Zongwang , Liu Yanchao
Published: August 2019

Background:

Percutaneous tracheostomy, almost associated with cough reflex and hemodynamic fluctuations, is a common procedure for traumatic brain injury (TBI) patients, especially those in neurosurgery intensive care units (NICUs). However, there are currently a lack of effective preventive measures to reduce the risk of secondary brain injury. The aim of this study was to compare the effect of dexmedetomidine (DEX) vs sufentanil during percutaneous tracheostomy in TBI patients.

Methods:

The 196 TBI patients who underwent percutaneous tracheostomy were randomized divided into 3 groups: group D1 (n = 62, DEX infusion at 0.5 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), group D2 (n = 68, DEX infusion at 1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), and group S (n = 66, sufentanil infusion 0.3 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.4 μg·kg–1·hour–1). The bispectral index (BIS) of all patients was maintained at 50 to 70 during surgery. Anesthesia onset time, hemodynamic variables, total cumulative dose of DEX/sufentanil, total doses of rescue propofol and fentanyl, time to first dose of rescue propofol and fentanyl, number of intraoperative patient movements and cough reflexes, adverse events, and surgeon satisfaction score were recorded.

Results:

Anesthesia onset time was significantly lower in group D2 than in both other groups (14.35 ± 3.23 vs 12.42 ± 2.12 vs 13.88 ± 3.51 minutes in groups D1, D2, and S, respectively; P < .001). Both heart rate and mean arterial pressure during percutaneous tracheostomy were more stable in group D2. Total doses of rescue propofol and fentanyl were significantly lower in group D2 than in group D1 (P < .001). The time to first dose of rescue propofol and fentanyl were significantly longer in group D2 than in both other groups (P < .001). The number of patient movements and cough reflexes during percutaneous tracheostomy were lower in group D2 than in both other groups (P < .001). The overall incidences of tachycardia and hypertension (which required higher doses of esmolol and urapidil, respectively) were also lower in group D2 than in both other groups (P < .05). Three patients in group S had respiratory depression compared to X in the D1 group and X in the D2 group. The surgeon satisfaction score was significantly higher in group D2 than in both other groups (P < .05).

Conclusions:

During percutaneous tracheostomy, compared with sufentanil, DEX (1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1) can provide the desired attenuation of the hemodynamic response without increased adverse events. Consequently, DEX could be used safely and effectively during percutaneous tracheostomy in TBI patients.
Neoadjuvant chemotherapy before radical prostatectomy for locally advanced prostate cancer
Authors: Lin Tianhai , Yang Xiong , Gong Lina , Xu Hang , Qiu Shi , Yu Ruichao , Sun Sheng , Liu Liangren , Zhang Peng , Han Ping , Cheng Jingqiu , Yang Lu , Wei Qiang
Published: August 2019

Background:

To evaluate the effectiveness and safety of neoadjuvant chemotherapy (NAC) for locally advance prostate patients undergoing radical prostatectomy.

Methods:

PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, and Cochrane Library will be searched for studies related to the topic. The identification, inclusion and exclusion flow charts will be conducted according to PRISMA guidelines. The identified reports will be critically appraised using GRADE approach. Bias and heterogeneity of included studies will be assessed, and outcome measurements from individual studies will be combined with 95% confidence interval using a fixed- or random-effects model if qualified.

Results:

This study will provide evidence and data on the tolerance and efficacy of NAC followed by radical prostatectomy (RP).

Conclusion:

The application of taxanes-based chemotherapy has been widened to metastatic hormone sensitive prostate cancer in recent years. To be more vigorous, whether neoadjuvant administration of these cytotoxic agents can improve the outcome of RP in locally advance prostate cancer patients has been explored. This study aims to synthesis data regarding the adverse effect, response rate, recurrence, and survival from multiple trials, and to guide the healthcare practitioners using an evidence-based approach.
Trends in survival based on treatment modality for esophageal cancer: a population-based study
Authors: Akhtar-Danesh Noori , Shakeel Saad , Seow Hsien , Akhtar-Danseh Gileh-Gol , Finley Christian
Published: August 2019

Objectives

The primary objective was to examine the trends in treatment modalities and the respective survival rates for esophageal cancer in the province of Ontario, Canada.

Methods

This is a population-based study of all esophageal cancer cases diagnosed in Ontario between 2007 and 2015, including squamous cell carcinoma and adenocarcinoma, with known disease stage. Other characteristics include sex, age, date of diagnosis, and treatment modalities. Treatment modalities were classified as no-treatment, radiation only or chemotherapy only, chemoradiation, and surgical resection.

Results

In total, 2572 patients were identified with esophageal cancer from 2007 to 2015, of which 2014 (78.3%) were male. The mean age at diagnosis was 66.6 (SD = 11.7) years. Survival rate increased over time in patients who underwent chemoradiation or surgical resection but remained unchanged for the radiation-only or chemotherapy-only group and decreased for the no-treatment group. Survival considerably improved (15–20%) for patients with stages I–III disease.

Conclusions

The positive trends in the survival rate for esophageal patients could be due to adoption of multimodal therapy. Despite a lower proportion of advanced disease among patients over 80, they received less curative treatments compared with other age groups. Further studies are required to identify strategies to maximize survival for patients with stage IV disease, and patients 80 years and older.