bluuebunny/crossref_metadata_2025 huggingface dataset:
Turkish Version of the Motivation for Changing Lifestyle and Health Behavior for Reducing the Risk of Dementia Scale
Authors: Zehirlioglu Lemye , Erunal Merve , Akyol Merve Aliye , Mert Hatice , Hatipoglu Nur Sehnaz , Kucukguclu Ozlem
Published: February 2019

Objective: This methodological study evaluates the validity and reliability of the Motivation for Changing Life Style and Health Behavior for Reducing the Risk of Dementia scale in Turkish. Methods: The study enrolled 220 individuals aged 40 years and older between September 2017 and June 2018. The Kendall W analysis and content validity index were used for validity; test-retest and confirmatory factor analyses were used for the reliability analysis. Results: The Turkish version of the Motivation for Changing Life Style and Health Behavior for Reducing the Risk of Dementia scale has valid content. The Cronbach α coefficient of the scale was .809, and the subscales were in the ranges of .781 to .609. A statistically significant, positive correlation was found between the test and retest scores. Conclusions: These results show that the scale has validity and reliability for use in the Turkish population.
Physician Assistant Educator Competencies
Authors: Zaweski Joseph , Melcher Betsy Quick , Sedrak Mona , Von Mary , Fletcher Sara
Published: February 2019

The rapid expansion of physician assistant (PA) programs over the past decade has led to a shortage of experienced PA faculty. This has prompted many faculty development initiatives to help provide the skills needed by new faculty making the jump from clinical practice to academia. Faculty development is a key necessity in health professions education because many of the professionals attracted to the educator role are primarily trained as clinicians. Although this issue has been extensively evaluated by our colleagues in medical, nursing, and health education and various faculty development interventions have been implemented, this has not been done in the PA profession. In an effort to correct this, the Physician Assistant Education Association assembled a task force of experienced PA educators and charged them to evaluate the literature on faculty competencies in health professions education and to develop a set of PA educator competencies to help codify the essential knowledge, skills, attitudes, and behaviors that faculty need to be successful in their academic roles.

The task force met its charge by engaging in an extensive review of the literature, developing a competency framework and proposed competencies, and soliciting the input of a diverse panel of experts in PA education to vet the proposed competencies. Using the insights and recommendations from the expert panel, the task force refined the competencies—resulting in the framework of PA educator competencies presented in this document.
Fallback technique with circular stapler prevents anastomotic obstruction after esophagectomy
Authors: Zhou Peng , Wang Ya-Li , Liu Quan , Li Jin-Song
Published: February 2019

Rationale:

While performing esophago-ileal anastomosis after esophagectomy with circular staplers, the mucosal folds of the ileum can complicate stapling and lead to obstruction, especially when the diameter of the circular stapler is equal or greater than that of the small bowel lumen.

Patient concerns:

A 53-year-old man, presented with complaints of difficulty in swallowing for 2 weeks. Fifteen years previously, he had undergone partial gastrectomy for gastric ulcers.

Diagnosis:

The endoscopy showed that there was a large ulcer in the middle-third of the esophagus, about 28 to 32 cm from the incisors. Biopsy of the ulcer confirmed esophageal squamous cell carcinoma.

Interventions:

We performed an esophageal replacement using the right colon with circular staplers, but anastomotic site occurred due to stacking of the mucosa ahead of the stapler. To revise the anastomosis, we inserted the stapler 2 to 3 cm farther into the lumen than the intended site of anastomosis, and then pulled it back and rotated the stapler to complete the anastomosis. Consequently, the obstruction was corrected.

Outcomes:

With nearly 16 months’ follow-up duration until now, the patient has no difficulty swallowing and has twice received chemotherapy, and returned to his normal life relatively.

Lessons:

In the event of potential anastomotic obstruction due to accumulated mucosa, the stapler fallback technique can be successfully used achieve patent anastomosis.
Efficacy and safety of Zuogui Pill in treating osteoporosis
Authors: Chen Guoming , Zhang Zhaoping , Liu Yunyun , Lu Jiaxin , Qi Xiangjun , Fang Caishan , Zhou Chi
Published: February 2019

Background:

Osteoporosis (OP) is a common skeletal disorder worldwide, resulting in increased bone fragility and high risk of fractures. The Zuogui Pill (ZGP), a classic Chinese herbal formulation, has played a vital role in the clinical practice of OP in China for centuries. Increasing studies have been performed for clarifying its anti-osteoporotic mechanisms. However, this treatment still lacks a systematic review for its efficacy and safety in the treatment of OP.

Methods:

Eight electronic databases will be searched from inception to November 2018 by 2 independent researchers, in order to collect qualified randomized controlled trials (RCTs) on the ZGP treatment for OP. The therapeutic effects according to bone mineral density (BMD) will be adopted as the primary outcomes. RevMan V.5.3 software will be used for the data synthesis and the Cochrane's risk of bias assessment tool will be used to assess the risk of bias.

Results:

This review will conduct a high-quality synthesis on present evidence of ZGP for OP.

Conclusion:

The conclusion of the study will indicate whether ZGP is an effective treatment for OP by providing updated evidence.

PROSPERO registration number: PROSPERO CRD 42018114366
The genetic relationship of SOX9 polymorphisms with osteoarthritis risk in Chinese population
Authors: Wang Yongcheng , Zhang Xinyu , Niu Xiaobo , Xu Yongsheng , Lu Long , Li Hua
Published: February 2019

This research aimed to reveal the relationship of SRY-type HMG box 9 (SOX9) gene polymorphisms with osteoarthritis (OA) risk in a Chinese population.

Polymerase chain reaction and direct sequencing were used for genotyping polymorphism in 152 OA patients and 139 controls. Firstly, the conformity of genotype distribution to Hardy–Weinberg equilibrium in the control group was checked. The differences in genotype and allele frequencies of our studied polymorphism were compared between the two groups using chi-square test. Odds ratio (OR) with 95% confidence interval (95%CI) was used to appraise the strength of the relationship between the polymorphism and OA occurrence. Cross-over analysis was conducted to reveal the interaction between polymorphisms in SOX9.

The AA genotype of the polymorphism rs1042667 was significantly correlated to the increased susceptibility to OA (OR = 2.075, 95%CI = 1.042–4.132). We also detected that the A allele of the polymorphism rs1042667 also obviously increased the occurrence of OA in our study (OR = 1.401, 95%CI = 1.009–1.945). Moreover, the G allele of the polymorphism rs12601701 and the A allele of the polymorphism rs1042667 could significantly elevate the risk of OA (OR = 2.075, 95%CI = 1.021–4.218).

SOX9 polymorphism rs1042667 may be a risk factor for OA in Chinese Han population. The interaction between the polymorphisms rs1042667 and rs12601701 also contribute to OA risk.
A new surgical technique “cervical internal os plasty” in cesarean delivery for placenta previa accreta
Authors: Huang Guiqiong , Wang Xiaodong , Yu Haiyan , Zhou Shu
Published: February 2019

Placenta previa accreta is an obstetrical complication that severely affects the heath of the fetus and the mother due to massive hemorrhage during pregnancy. This study reported a new suture technique called “cervical internal os plasty” to control obstetrical hemorrhage in cesarean delivery for patients with placenta previa accreta and retrospectively evaluated the safety and effectiveness of the new technique.

From January 2012 to May 2018, we collected 56 patients with this new suture technique, which repaired the damaged weak area with bleeding from the placental attachment site in the lower uterine segment, and restored the damaged anatomic internal os of the cervix. Meanwhile, we compared it with 60 cases with other conservative methods described by other obstetricians with the same qualifications. The perioperative outcomes (blood loss, blood transfusion, operative time, other applied medical technology, and so on) between the 2 groups were recorded in this report.

There were no significant differences between 2 groups among age, gravidity, parity, gestational age, and previous dilatation and curettage techniques (P > .05). Of the patients with placenta previa accrete, 77.6% (90/116) had previous dilatation and curettage. The comparison between study group and control group on the rate of postpartum hemorrhage, blood transfusion, and mean operative time, average hospitalization days after cesarean delivery, expenses was not statistically significant (P > .05). Compared with the control group, other applied supplementary techniques (including uterine tamponade, pelvic arterial embolization, or emergency hysterectomy) for the bleeding from the the placental attachment site is fewer significantly in the study group. No operative accident and hemorrhea-related complication occurred in the 2 groups.

Cervical internal os plasty is useful in patients with placenta previa accreta due to its simplicity, utility, and effectivity as well as its capacity for preserving fertility.
Effectiveness and safety of rivaroxaban for the prevention of thrombosis following total hip or knee replacement
Authors: Liu Jichao , Zhao Jinlong , Yan Yong , Su Jinping
Published: February 2019

Background:

Prophylactic anticoagulant therapy is recommended to reduce the risk of venous thromboembolism (VTE) after total hip or knee arthroplasty, and has become the standard of care. Rivaroxaban is a novel oral medication that directly inhibits factor Xa for the prevention and treatment of thromboembolic conditions.

Method:

A meta-analysis of randomized controlled trials (RCTs) was performed to determine the efficacy and safety of rivaroxaban after total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgery. We reviewed several databases including PubMed, the Cochrane Library, Embase and the US trial registry to detect appropriate RCTs for our meta-analysis. The primary efficacy outcome of this meta-analysis was the combination of any deep-vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and death from any cause. The main safety outcome was bleeding events which included significant bleeding events, clinically relevant insignificant bleeding events, or minor events. Other end points were the number of patients who received blood transfusion the volume of transfused whole blood or red blood cells, and the volume of postoperative drainage.

Result:

Thirteen RCTs were included in this meta-analysis. This meta-analysis showed that the overall rate of VTE events, DVT, PE, and death were 1%, 6%, < 1% and < 1%, respectively, for patients receiving treatment with rivaroxaban after THA and TKA surgery. The subgroup analysis demonstrated rivaroxaban had more superior effects in THA patients. The pooled analysis of bleeding events showed that the overall rate of major bleeding events, overt bleeding events associated with fall in Hb of > 2 g/DL, clinically overt bleeding events leading to transfusion of > 2 units of blood, clinically overt bleeding events leading to further surgeries, and non-major bleeding events were < 1%, < 1%, < 1%, < 1%, and 3%, respectively.

Conclusion:

This is the first systematic review of the literature providing incidence of efficacy and safety outcomes for thromboprophylaxis in THA and TKA patients. Moreover, this meta-analysis showed that rivaroxaban had more superior effect in THA patients.
Thrombolysis in an acute ischemic stroke patient with rivaroxaban anticoagulation
Authors: Chao Yen-Tung , Hu Chaur-Jong , Chan Lung
Published: February 2019

Rationale:

Whether intravenous recombinant tissue plasminogen activator (r-TPA) therapy can be administered in acute ischemic stroke patients treated with novel oral anticoagulants (NOACs), including rivaroxaban, remains controversial.

Patient concerns:

A 76-year-old woman with nonvalvular atrial fibrillation, who had been receiving 15 mg rivaroxaban once daily, was brought to the emergency department with right-side hemiparesis and aphasia. The onset of neurological deficits occurred 8 hours after the last dose of rivaroxaban administration.

Diagnosis:

The patient was diagnosed with acute ischemic stroke.

Interventions:

Intravenous infusion of 0.6 mg/kg of r-TPA (total dose: 29 mg) was performed 9 hours and 40 minutes after the last rivaroxaban administration. During r-TPA infusion, improvement in the patient's neurological deficit was observed.

Outcomes:

The clinical picture evidently improved from with National Institutes of Health Stroke Scale 21 to 16 on completion of r-TPA treatment.

Lessons:

Although current guidelines do not recommend administering thrombolytics in patients using NOACs with a doubtful anticoagulation status and administered within the last 24 or, even more strictly, 48 hours, this and other case studies suggest that r-TPA treatment could be considered in selected acute ischemic stroke patients receiving rivaroxaban or other Xa inhibitors, taking the patient's clinical condition and the prospective clinical benefits of r-TPA into account.
A single-component and hemi-hip prosthesis followed up for 43 years
Authors: Liu Yuan , Chen Hang-jun , Zhang Bin , Liu Xu-Qiang , Xiao Jun , Cheng Cheng-Kung , Dai Min
Published: February 2019

Rationale:

Giant cell tumor (GCT) is a locally aggressive bone tumor with a high recurrence rate if not completely excised. And reconstructive hip surgery using an artificial prosthesis in a young active patient is controversial because of problems related to the durability of the artificial joint.

Patient concerns:

A 30-year-old man presented with right hip pain and other more severe symptoms, but without fever or night sweats. After 4 months, he experienced intense pain at the root of the right leg and limitation of motion after falling from a bicycle.

Diagnoses:

Giant cell tumor.

Interventions:

The patient was treated with surgical resection of the total tumor, and hemiarthroplasty of the hip joint using a custom-made titanium femoral prosthesis.

Outcomes:

The patient could perform activities of daily living, even walking long distance without pain. He continued to work as a teacher for 30 years and retired 11 years after the surgery.

Lessons:

A well-designed, custom-fitted, single-component, wear-resistant joint prosthesis should be the brand-new direction of development of artificial joints.
Sonographic diagnosis of perforation of the gastric antrum caused by a foreign body
Authors: Zhao Yanan , Yang Zheng , Quan Juan , Hu Huisen
Published: February 2019

Rationale:

Ingestion of foreign bodies often occurs in clinical environments, especially in toddlers and aged patients. Although plain radiography and CT are widely used for the assessment of foreign bodies, sonography has an advantage in the diagnosis of some radiolucent foreign bodies, such as wood and bamboo materials.

Patient concerns:

An 80-year-old woman presented with a 4-day history of right upper quadrant abdominal persistent distended pain without radiation.

Diagnoses:

Radiographs, a preliminary abdominal ultrasound (US) and an abdominal computed tomography (CT) were unremarkable. A repeat abdominal US found a foreign body inserted in the gastric wall of antrum. But subsequent gastroscopy was negative. A laparotomy confirmed the diagnosis of bamboo stem penetration out of the gastric antrum.

Interventions:

The patient was treated by laparotomy and the bamboo stem was removed successfully.

Outcomes:

Bamboo stem-caused digestive perforation was confirmed by laparotomy. The perforation site was at the gastric wall of antrum. Intravenous antibiotic therapy was administered for two weeks until her body temperature dropped to a normal level, and C-reactive protein (CRP) decreased to the normal limits. she was discharged from the hospital.

Lessons:

Previous studies suggest that US can identify the location and shape of foreign bodies in the alimentary tract in toddlers. This case shows US is also effective in aged patients. The US can be utilized as a problem-solving tool when radiolucent foreign bodies are suspected, especially when the results of CT and gastroscopy are negative.
Predictive risk factors for exudative retinal detachment after vitrectomy for proliferative diabetic retinopathy
Authors: Sun Di-Fang , Wang Yan-Li , Wang Bin , Xu Chun-Ling , Zhang Gong , Li Jia , Zhang Xiao-Meng
Published: February 2019

This retrospective study investigated the risk factors of exudative retinal detachment (ERD) occurring after vitrectomy performed to treat proliferative diabetic retinopathy (PDR).

All patients were treated with vitrectomy for PDR. Patients with history(s) of the following were excluded: ocular surgery (except phacoemulsification combined with intraocular lens implantation or retinal laser photocoagulation); ocular trauma; systemic diseases; ocular diseases; uveitis; scleritis; tumor; congenital ocular disorders; or others.

Included were 205 eyes of 169 patients, of whom 18 (8.78%) developed ERD with varying degrees of exudative choroidal detachment after 1 to 3 days. Binary logistic regression showed the following association with the development of ERD: lower serum albumin concentration (P = .001); without intravitreal anti-vascular endothelial growth factor (anti-VEGF) drug injection before vitrectomy (P = .044); and history of phacoemulsification combined with intraocular lens implantation (P = .046). No association was found with gender; age; systolic pressure; diastolic pressure; panretinal photocoagulation; intraocular pressure on the 1st postoperative day; intraocular pressure on the 2nd postoperative day; serum albumin concentration; or blood urea nitrogen.

Risk factors for ERD after vitrectomy for PDR include low serum albumin concentration, without history of intravitreal anti-VEGF drug injection before surgery, and a history of phacoemulsification combined with intraocular lens implantation.
A case report on 111In chloride bone marrow scintigraphy in management of adrenal myelolipoma
Authors: Yamamoto Tatsuya , Koizumi Mitsuru , Kohno Atsushi , Numao Noboru , Inamura Kentaro
Published: February 2019

Rationale:

Adrenal myelolipoma is a benign hormone-inactive tumor composed of hematopoietic tissue and mature adipose tissue. Because this tumor tends to be rich in fat, in many cases it can be diagnosed based on computed tomography (CT) or magnetic resonance imaging (MRI) findings alone. However, in the presence of much necrosis, calcification and hematopoietic tissue and/or the absence of much fat, and in cases with tumor apoplexy, this tumor becomes difficult to differentiate from other tumors. In such cases, a bone marrow scan may be informative as a non-invasive imaging diagnostic method for preoperative diagnosis of the tumor and determination of the method for the surgical treatment. We herein report a case of huge adrenal myelolipoma with the non-adipose portion identified using an 111Indium chloride (111InCl3) bone marrow scan.

Patient concerns:

A 69-year-old woman was referred to our hospital because of a left peritoneal mass detected on a medical checkup. Abdominal CT revealed a mass measuring 14.3 cm in diameter located between the left kidney and the left adrenal gland, which showed coexistence of fat and soft tissue densities.

Diagnoses:

A bone marrow scan is a nuclear medicine examination to assess hematopoietic activity. To avoid excessive resection of the tumor, we thought that a bone marrow scan could be applied for differentiation between myelolipoma and retroperitoneal liposarcoma by evaluating the hematopoietic activity of the tumor. Tumor enucleation was performed, and pathological examination showed a diagnosis of adrenal myelolipoma.

Intervention:

The patient was treated with laparoscopic enucleation.

Outcomes:

No metastatic recurrence was found during 8 months of follow-up.

Lessons:

Diagnosis of myelolipoma by CT and MRI becomes difficult in the presence of a high volume of hematopoietic tissue. In such cases, a bone marrow scan may be informative as a non-invasive imaging diagnostic method for preoperative diagnosis of the tumor and determination of the method of surgical treatment.
Bronchoscopic cryosurgery for metastatic tumor causing central airway obstruction
Authors: Chen Tun-Yi , Goan Yih-Gang , Tang En-Kuei , Tseng Yen-Chiang
Published: February 2019

Rationale:

Bronchoscopic cryotherapy has been considered as one of the optional interventions for unresectable malignant central airway obstruction (CAO). And it provides high safety and effectiveness in airway patency re-establishment. This report describes the interventional bronchoscopic cryotherapy for a patient with CAO caused by squamous cell carcinoma of the esophagus. We display a series of dramatic change of chest radiographs before and after the intervention.

Patient concerns:

A 70-year-old man with squamous cell carcinoma of the middle third of the esophagus (initial staging, pT2N0M0; stage IIB; in January 2017) underwent Video-assisted esophagectomy and reconstruction with a gastric conduit via a substernal route. Following Chest computed tomography and positron emission tomography revealed disease progression with paratracheal metastases. Progressive dyspnea and chest pain lasted for a month, and he was admitted to the ER.

Diagnoses:

Blood gas analysis revealed type I respiratory failure (pH, 7.445; PaO2, 69.4 mmHg; PaCO2, 40.6 mmHg). Other laboratory data were grossly normal. Chest radiography revealed a total left lung collapse. Chest CT identified a tumor blocking the left mainstem bronchus with the consolidation of the left lung.

Interventions:

Dexamethasone and epinephrine inhalation were administered for initial symptom relief. Bronchoscopy performed 4 days after admission revealed a huge tumor completely occluding the left mainstem bronchus orifice. The occlusion was completely resolved following cryotherapy. Then, the first course of palliative chemotherapy with cisplatin plus fluorouracil, followed by the second course a month later, was administered.

Outcomes:

The latest chest radiograph showed a patent airway. The patient's condition remained stable for at least the following 2 months.

Lessons:

Malignant CAO is a rare but potentially life-threatening condition. Several acceptable bronchoscopy techniques exist for treatment. Cryotherapy has high safety and effectiveness in airway patency re-establishment.
Ectopic papilla of Vater in duodenum bulb
Authors: Peng Yen-Chun , Chow Wai-Keung
Published: February 2019

The major papilla of Vater can be ectopically present in the stomach, pyloric canal, duodenal bulb, and third or fourth portion of the duodenum. In this study, we determined the clinical significance of ectopic papilla of Vater by endoscopic retrograde cholangiopancreatogram (ERCP).

A retrospective study was conducted by reviewing the medical records of 6133 patients receiving ERCP from 1988 to 2011. The diagnosis was confirmed if both the common bile duct (CBD) and the main pancreatic duct (PD) drained into the same opening, either by ERCP or magnetic resonance cholangiopancreatography.

Eight patients with major papilla of Vater in the duodenal bulb were identified among 6133 patients receiving ERCP from 1988 to 2011, with an incidence rate of 0.13%. The mean age was 67 years and patients were predominantly male. Duodenal bulb deformity was noted in all patients and three of them had shallow gastric and/or duodenal ulcers. Hook-shaped CBD configuration was seen only in half of our cases. Three patients with CBD stones were treated successfully after endoscopic sphincterotomy or papillary balloon dilation.

Ectopic orifice of papilla is a rare finding of ERCP. Opacification of both the CBD and main PD from the same opening is an essential criterion for diagnosing an ectopic papilla of Vater in the duodenal bulb.
Real-world evidence of treatment for relapse of noninfectious uveitis in tertiary centers in Japan
Authors: Takeuchi Masaru , Kanda Takayuki , Kaburaki Toshikatsu , Tanaka Rie , Namba Kenichi , Kamoi Koju , Maruyama Kazuichi , Shibuya Etsuko , Mizuki Nobuhisa
Published: February 2019

Noninfectious uveitis (NIU), which pathogenesis is often autoimmune nature, occurs as a symptom of systemic syndromes or only in the eye. The standard treatment of NIU is local, topical, and oral administration of corticosteroids (CS) in combination with immunomodulatory therapy (IMT). However, additional therapeutic strategies involving topical and systemic administration of CS or others to treat relapse or exacerbation of ocular inflammation in NIU which present as various ocular manifestations have not been established. The aim of this study was to investigate therapeutic strategies used for various ocular inflammations in relapse or exacerbation of NIU and to evaluate factors associated with the treatment pattern in Japan. The subjects were 198 eyes of 156 NIU patients with relapse or exacerbation of ocular inflammation at 6 university hospitals in Japan. The most frequent disease was sarcoidosis in 23.7% of the cases, followed by Behçet disease (BD) in 21.2%, Vogt-Koyanagi-Harada (VKH) disease in 13.6%, acute anterior uveitis (AAU) in 5.6%, tubulointerstitial nephritis and uveitis syndrome (TINU) in 4.0%, and juvenile idiopathic arthritis (JIA)-associated uveitis in 3.0%. Common ocular findings were worsened anterior inflammation (AI) in 67.2% of the cases, vitreous opacity (VO) in 46.5%, macular edema (ME) in 26.8%, retinal vasculitis (RV) in 23.7%, serous retinal detachment (SRD) in 9.1%, and optic perineuritis (OPN) in 4.0%. Reinforcement of betamethasone eye drop (ED) monotherapy for only AI in both unilateral and bilateral AI, sub-tenon injection of triamcinolone acetonide (STTA) for unilateral posterior inflammation including VO and ME, and systemic therapy using CS and/or IMT for bilateral anterior and posterior inflammation were significantly more frequent. Frequencies of exacerbated individual ocular findings in sarcoidosis and BD were similar, and severe ocular inflammation associated with panuveitis required both topical and systemic therapies. These results demonstrate that reinforcement of betamethasone EDs, topical administration of triamcinolone acetonide, and long-term administration of systemic corticosteroids are the major therapeutic strategies, and reinforcement of betamethasone EDs was used for exacerbated AI independently from its use for posterior inflammation. In addition, STTA was preferentially used for VO and ME associated with posterior inflammation.
Takotsubo cardiomyopathy and giant r wave syndrome mimicking acute myocardial infarction
Authors: Wang Yong , Guo Wei , Ma Jianliang
Published: February 2019

Rationale:

The clinical features of Takotsubo cardiomyopathy largely overlap with those of acute myocardial infarction, especially in the presence of ST-segment elevation on the initial electrocardiogram. Giant R wave syndrome has mainly been observed in the hyperacute phase of acute myocardial infarction.

Patient concerns:

In this study, we report a unique case of Takotsubo cardiomyopathy that caused giant R wave syndrome.

Diagnosis:

A 71-year-old woman was transferred to hospital with new onset chest pain. An initial electrocardiogram showed ST-segment elevation in the inferior wall and anterior wall leads. Her initial cardiac troponin I levels were elevated. Acute myocardial infarction was suspected and the patient underwent emergent cardiac catheterization. A coronary angiography showed no overt stenosis in the coronary artery. After 2 hours, her chest pain disappeared and an electrocardiogram revealed that the ST segment had decreased markedly. However, on day 3, an electrocardiogram of the V1–V6 leads revealed the formation of giant R wave syndrome: giant R waves merging with the markedly elevated ST segments and the obliteration of S waves. Cardiac echocardiography showed hypokinetic apical mid-segments and hyperkinetic basal segments of the left ventricle, low left ventricular ejection (42%), and enlargement of the left ventricle. On the basis of these findings, the patient was diagnosed with early recurrent Takotsubo cardiomyopathy.

Interventions:

The patient has been treated by levosimendan and furosemide to improve cardiac function before leaving the hospital. After discharge, she was treated with a beta blocker.

Outcomes:

The patient was discharged 2 weeks later in stable condition without chest pain. One year later, during her follow-up, a repeat echocardiogram and ECG showed normal findings.

Lessons:

To the best of our knowledge, this is the first report of giant R wave syndrome on electrocardiogram following Takotsubo cardiomyopathy. Takotsubo cardiomyopathy, especially presenting with giant R wave syndrome on electrocardiogram, remains a challenging condition given its similarity to acute myocardial infarction in its early phase.
Clinical efficacy of percutaneous transforaminal endoscopic discectomy in treating adolescent lumbar disc herniation
Authors: Liu Wei , Li Qingning , Li Ziyu , Chen Lei , Tian Dasheng , Jing Juehua
Published: February 2019

Ten years ago, endoscopic techniques began to prevail in clinical treatment of lumbar disc herniation (LDH), but to date, few studies have reported the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in treating adolescent LDH. This study aimed to evaluate the surgical outcomes of PTED in treating adolescent patients with LDH.

Between June 2012 and June 2016, retrospective analysis of 43 adolescent patients diagnosed with single-segment LDH at spine surgery at the Second Affiliated Hospital of Anhui Medical University. The patients’ lower limb pain was evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). The VAS is the most commonly-used quantitative method for assessing the degree of pain in clinical practice. The measurement method is to draw a 10 cm horizontal line on a piece of paper, 1 end of which is 0, indicating no pain, while the other end is 10, which means severe pain, and the middle part indicates different degrees of pain. The clinician then asks the patient to make a mark on the line to indicate the degree of pain based on how he or she feels. The ODI is the most widely-used assessment method internationally for lumbar or leg pain at present. The ODI questionnaire is composed of 10 questions, covering pain intensity, independent living, carrying, walking, sitting, standing, sleep, travel, sex, and social life. Every category comprises 6 options, with the highest score for each question being 5 points. Thus the 1st option is worth 0 points, the last option scores 5 points, and higher scores represent more serious dysfunction. Patient satisfaction was evaluated using the modified MacNab score. Clinical outcomes were measured preoperatively, and at 3 days, 6 months, and 12 months postoperatively.

All 43 patients were followed up for 12 to 24 months. The average follow-up time was 18.33 months. The VAS scores and ODI scores at 3 days, 6 months, and 12 months postoperatively were significantly lower than before surgery. The difference was statistically significant (P < .001). The differences in VAS scores and ODI scores at 3 days, 6 months, and 12 months after surgery were also statistically significant (P < .001). According to the modified MacNab criteria, 26 cases were rated excellent, 14 cases were good, and 3 cases were acceptable at the final follow-up, and 93.02% of these patients had excellent outcomes.

The PTED is an effective and safe surgical method for the treatment of adolescent patients with LDH, but high-quality randomized controlled trials are still required to further verify these findings.
Normal body mass index (BMI) can rule out metabolic syndrome
Authors: Kobo Ofer , Leiba Ronit , Avizohar Ophir , Karban Amir
Published: February 2019

The aim of the study was to assess whether body mass index (BMI) can be used as a simple and reliable survey test for metabolic syndrome.

The study is an observational cohort study among patients who visited the Rambam Periodic Examinations Institute (RPEI). We analyzed the correlation between obesity indices and presence of metabolic syndrome. We identified the ideal value of BMI for identification of patients at risk for metabolic syndrome. We also described the correlation between different BMI values and its negative predictive value (NPV) for metabolic syndrome.

During the study years, 23,993 patients visited the RPEI, and 12.5% of them fulfilled the criteria for metabolic syndrome. Women with metabolic syndrome had higher proportion of obesity, when compared with men (89.9% vs 52.6%; P < .0001). Normal BMI had very high NPV to rule out metabolic syndrome among men and women (98% and 96%, respectively). Using receiver-operating characteristic curve, we found BMI 27 to be the ideal value for identification of metabolic syndrome for the entire cohort (area under the curve [AUC] 0.767, 95% confidence interval [CI] 0.758–0.775, P < .0001), for men (AUC 0.726, 95% CI 0.715–0.738, P < .0001), and for women (AUC 0.843, 95% CI 0.831–0.855, P < .0001). BMI below 30 provided NPV of 91.1% to rule out metabolic syndrome.

The BMI as single survey measurement of obesity offers high NPV for metabolic syndrome and can be used by physician and patients for this purpose.
Effectiveness of vitamin D for irritable bowel syndrome
Authors: Shi Sheng-Mei , Wen Yan-Li , Hou Hai-Bin , Liu Hai-Xia
Published: February 2019

Background:

Irritable bowel syndrome (IBS) is a prevalent and debilitating condition for patients who experience this disorder. Clinical researches indicate that vitamin D (VD) can help relief the symptoms of IBS. However, no systematic review has addressed this issue yet. Thus, this systematic review aims to investigate the effectiveness and safety of VD for patients with IBS.

Methods:

We will retrieve the following databases for randomized controlled trials to assess the effectiveness and safety of VD for patients with IBS: Cochrane Library, EMBASE, MEDICINE, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. Each database will be retrieved from its inception to January 31, 2019. Two researchers will independently selection studies, extract data and assess methodological quality. RevMan 5.3 software will be used to pool the data, and carry out the meta-analysis if it is possible.

Results:

This systematic review will evaluate the effectiveness and safety of VD for patients with IBS. The primary outcomes include stool frequency and abdominal pain. The secondary outcomes consist of stool status, quality of life, and adverse effects.

Conclusions:

The findings of this systematic review may provide the existing evidence on the effectiveness and safety of VD for patients with IBS.

Ethics and dissemination:

This systematic review will not require ethical approval, because all data will be extracted from the published literature. The findings of this study will be disseminated at peer-reviewed journals.

PROSPERO registration number: PROSPERO CRD42019122641.
Two-stage posterior spinal fusion for early-onset scoliosis
Authors: Uehara Masashi , Takahashi Jun , Kuraishi Shugo , Ikegami Shota , Futatsugi Toshimasa , Oba Hiroki , Takizawa Takashi , Munakata Ryo , Koseki Michihiko , Kato Hiroyuki
Published: February 2019

Rationale:

Fusionless techniques for early-onset scoliosis (EOS) have evolved to allow near-normal growth while maintaining the correction achieved during the initial surgery. However, such procedures require repeated surgeries and have increased complication rates. We have developed a 2-stage fusion technique using pedicle screws for EOS to reduce patient burden and complication risk. This series describes the clinical and radiological features of 2 patients with EOS who received 2-stage posterior spinal fusion. This surgical method for EOS represents the first of its kind.

Patient concerns:

Case 1 was a 10-year-old girl who was diagnosed as having scoliosis with Prader Willi syndrome at the age of 2 years. Her preoperative major curve Cobb angle was 100 degrees at age 10 years. Case 2 was an 11-year-old boy who was found to have scoliosis with 22q11.2 deletion syndrome at the age of 4 years. His preoperative major curve Cobb angle was 77 degrees at age 11 years.

Diagnosis:

Whole-spine radiographs were performed to diagnose scoliosis.

Interventions:

Both patients received 2-stage posterior spinal fusion.

Outcomes:

Postoperative Cobb angle of the major curve improved to 46 and 48 degrees, respectively. Thoracic height respectively improved from 160 and 148 mm before surgery to 206 and 211 mm at final follow-up. Surgical outcome as evaluated by Scoliosis Research Society-22 patient questionnaires revealed acceptable results without any severe complications.

Lessons:

Based on the present case report, 2-stage posterior spinal fusion for EOS achieves good radiological and clinical outcomes without severe complications.
Non-Robertsonian translocations involving chromosomes 13, 14, or 15 in male infertility
Authors: Zhang Hongguo , Wang Ruixue , Yu Yang , Zhu Haibo , Li Leilei , Yang Xiao , Hu Xiaonan , Liu Ruizhi
Published: February 2019

For genetic counseling of male carriers of chromosomal translocations, the specific chromosomes and breakpoints involved in the translocation are relevant to know. The structural chromosomal abnormalities may lead to abnormal sperm counts, infertility, and miscarriage. These are related to the specific chromosomes and breakpoints involved in the translocation. To date, over 200 cases of non-Robertsonian translocation in male carriers have been described that involve chromosomes 13, 14, or 15.

This study reports of 28 male carriers from our clinic with balanced reciprocal translocations of chromosome 13, 14, or 15, and a literature review of 201 cases. The 28 male carriers from our clinic were diagnosed by cytogenetic analyses: 19 subjects suffered from pregestational infertility and 9 from gestational infertility. The most common translocations were t(7;13), t(10;14), and t(3;15), observed respectively in 13 (46%), 8 (29%), and 8 (29%) of our subjects. The literature cases (n = 201) involved chromosome 13 (n = 83, 41%), chromosome 14 (n = 56, 28%) or 15 (n = 62, 31%) in which 75 breakpoints were identified, the most common breakpoint, 13q22, was observed in 12 subjects (6%), followed by 14q32 (n = 11), 15q15 (n = 9), and 15q22 (n = 9). Most breakpoints were related to gestational infertility, while breakpoints at 13p13, 13p12, 13p11.2, 13p11, 13q11, 13q15, 14p12, 14p10, 15p13, 15p10, and 15q22.2 were associated with pregestational infertility.

Carriers of non-Robertsonian translocations involving chromosome 13, 14, or 15 and experiencing infertility should receive counseling with regard to chromosomal breakpoints as there seem to be consequences for treatment. Intracytoplasmic sperm injection with preimplantation genetic diagnosis (PGD) for the carriers with oligozoospermia, microscopic testicular sperm extraction or sperm from the sperm bank for the carriers with azoospermia should be considered for pregestational infertility. The carriers with gestational infertility can choose PGD or prenatal diagnosis
Relationship between inflammatory markers and visceral obesity in obese and overweight Korean adults
Authors: Yu Ju-Yeon , Choi Won-Jun , Lee Hye-Sun , Lee Ji-Won
Published: February 2019

Obesity is now considered a state of chronic low-grade inflammation. We investigated the relationship between several inflammatory markers and body composition for identifying patients with an increased risk of visceral obesity and compared the predictive values of inflammatory indices in visceral obesity.

Six hundred individuals who received health checkups for obesity-related risk factors in Severance Hospital between January 2008 and March 2017 were included in our study. Serum inflammatory markers, such as white blood cell (WBC), high-sensitivity C-reactive protein (hsCRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) levels were assessed. Intra-abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were measured with computed tomography. We performed analysis of covariance, trend analysis, Steiger's Z tests, and multiple linear regression analysis to investigate associations between abdominal adiposity indices and inflammatory markers.

Pearson's correlation analysis revealed a stronger association of VAT with WBC counts (r = 0.157, P < .001) than with levels of NLR (r = 0.108, P = .11; Steiger's Z test, P
‡ = .04) and PLR (r = 0.036, P = .39; Steiger's Z test, P
‡ = .003). WBC and hsCRP levels linearly increased with VAT area (overall P < .001 and trend P < .001) and VAT/SAT ratio (overall P = .001 and trend P = .002; overall P < .001 and trend P < .001, respectively) but linearly decreased with SAT (overall P = .02 and trend P = .17; overall P = .03 and trend P = .01, respectively). Visceral adipose tissue area was more highly associated with WBC and hsCRP levels than with NLR and PLR. Only VAT area was significantly associated with WBC, hsCRP, and NLR levels after adjusting for confounding variables.

We found that VAT, but not SAT area is independently associated with several inflammatory markers. WBC and hsCRP are more strongly correlated with VAT compared with NLR and PLR. Thus, WBC and hsCRP could be useful parameters for identifying individuals at risk for visceral obesity and cardiometabolic diseases.
Development of Infliximab Target Concentrations During Induction in Pediatric Crohn Disease Patients
Authors: Clarkston Kathryn , Tsai Yi‐Ting , Jackson Kimberly , Rosen Michael J. , Denson Lee A. , Minar Phillip
Published: February 2019

Objectives:

Subtherapeutic drug concentrations contribute to both primary and secondary nonresponse to infliximab in children with Crohn disease (CD). The aim of this study was to evaluate treatment outcomes and infliximab concentrations at infusions 2 and 3 with an objective to establish infliximab targets during induction for primary responders.

Methods:

Single‐center, prospective cohort of anti‐ tumor necrosis factor‐alpha naïve CD patients younger than 22 years starting infliximab. Clinical response was defined with the weighted pediatric CD activity index at the fourth infusion. Rates of biological response (>50% improvement in fecal calprotectin) and maintenance concentrations ≥5 μg/mL were secondary outcomes.

Results:

We enrolled 72 patients with CD with 70 of 72 receiving infliximab monotherapy. Clinical response, biological response, and start of maintenance concentrations ≥5 μg/mL were achieved in 64%, 54%, and 22%, respectively. The median (interquartile range) infliximab concentrations at infusion 2 and 3 in clinical responders were 27.8 μg/mL (19.5–40) and 14 μg/mL (8.3–24) compared to 18.8 μg/mL (9.1–23, P < 0.001) and 7.8 μg/mL (4–13.2, P < 0.01) in nonresponders. Receiver operating characteristic analysis determined that an infliximab concentration ≥15.9 μg/mL at infusion 3 was associated with clinical response (area under the curve [AUC] 0.73), whereas an infusion 3 level ≥18 μg/mL was associated with a start of maintenance concentration >5 μg/mL (AUC 0.85). Independent predictors for infusion 3 levels <18 μg/mL included pretreatment prednisone, low body mass index, elevated erythrocyte sedimentation rate and C‐reactive protein, hypoalbuminemia, and an infusion 2 infliximab level <29 μg/mL.

Conclusions:

We found that infusion 2 (≥29 μg/mL) and infusion 3 (≥18 μg/mL) infliximab concentrations were strongly associated with improved early outcomes and higher first maintenance dose levels.
Short Peripheral Catheter Performance Following Adoption of Clinical Indication Removal
Authors: DeVries Michelle , Strimbu Kathryn
Published: February 2019

Two years following the adoption of clinical indication policies for short peripheral catheters (SPCs), a large community hospital undertook 2 extensive point prevalence reviews at 1-year intervals to study the overall outcomes associated with the SPCs. The findings were used to enhance documentation as well as staff awareness. A bundled approach was taken, focusing on insertion as well as care and maintenance needs. Consistent outcomes included at least 20% of catheters remaining functional more than 7 days and 35% more than 5 days.
Staff's Perception of the Intensive Care Outreach Nurse Role
Authors: Williams Ged , Rotering Loralee , Samuel Asha , Du Plessis Jean , Abdel Khaleq Maher H. A. , Crilly Julia
Published: February 2019

Background:

Rapid Response Systems are emerging internationally to provide a patient-focused approach to prevent potentially avoidable deaths and serious adverse events.

Local Problem:

This study focused on ward nurses in the United Arab Emirates (UAE) government hospitals who were perceived to lack the confidence and knowledge to detect and/or respond to deteriorating patients.

Method:

A cross-sectional study design was used to evaluate the Intensive Care Outreach Nurse (ICON) role from the perspectives of the ICONs, their managers/educators, and ward-based physicians and nurses. ICONs are intensive care experienced nurses with additional education in the role of rapid responder to the deteriorating patient.

Interventions:

An ICON role was implemented across 4 hospitals to respond to and support clinicians in the recognition and management of the deteriorating patient on general inpatient wards.

Results:

ICON skills perceived as most beneficial by respondents included staff education, respiratory therapy, medication administration, and intravenous access.

Conclusions:

The ICON role is able to support recognition and management of the deteriorating patients.
Academic and Community–Engaged Approach to Integrating Open Educational Resources in Population Health Course
Authors: Nguyen-Truong Connie Kim Yen , Graves Janessa M. , Enslow Electra , Williams-Gilbert Wendy
Published: February 2019

Background

Open educational resources (OERs) increase access to high-quality academic learning materials and promote affordable education in nursing.

Problem

Integrating OERs into existing nursing courses can be arduous for faculty.

Approach

An academic and community–engaged approach involved faculty, university librarians, and community stakeholders. Community leaders and population health experts helped identify OERs for a population health theory course.

Outcomes

Community stakeholders identified potential OERs, and university librarians assisted faculty in evaluating the OERs for quality.

Conclusions

Findings illustrate the value of faculty engaging with community stakeholders to help identify OERs and with university librarians to evaluate the OERs to ensure that the information presented is relevant and applicable to course objectives.