bluuebunny/crossref_metadata_2025 huggingface dataset:
How are pain and traumatic stress symptoms related in acute whiplash–associated disorders? An investigation of the role of pain-related fear in a daily diary study
Authors: Eather Adele , Kenardy Justin , Healy Karyn L. , Haynes Michele , Sterling Michele
Published: April 2019

Comorbidity of pain and posttraumatic stress disorder is well recognized, but the reason for this association is unclear. This study investigated the direction of the relationship between pain and traumatic stress and the role that pain-related fear plays, for patients with acute whiplash–associated disorder. Participants (n = 99) used an electronic diary to record hourly ratings of pain, traumatic stress, and fear of pain (FOP) symptoms over a day. Relationships between pain, traumatic stress, and pain-related fear symptoms were investigated through multilevel models including variables lagged by 1 hour. Traumatic stress was associated with previous pain, even after controlling for previous traumatic stress and current pain; current pain was not associated with previous traumatic stress. The relationship between traumatic stress and previous pain became negligible after controlling for FOP, except for traumatic stress symptoms of hyperarousal that were driven directly by pain. Overall, these results support a pain primacy model, and suggest that pain-related fear is important in the maintenance and development of comorbid pain and traumatic stress symptoms. They also confirm that traumatic stress symptoms of hyperarousal are central in this relationship. Differences between this study and others that reported mutual maintenance can be understood in terms of different stages of whiplash-associated disorder and different intervals between repeated measurements. Traumatic stress may affect pain over longer time intervals than measured in this study. Future research could explore how relationships between traumatic stress symptoms, pain, and FOP change over time, and whether previous experiences of traumatic stress influence these relationships.
Remembering the pain of surgery 1 year later: a longitudinal examination of anxiety in children's pain memory development
Authors: Noel Melanie , Rosenbloom Brittany , Pavlova Maria , Campbell Fiona , Isaac Lisa , Pagé M. Gabrielle , Stinson Jennifer , Katz Joel
Published: April 2019

Children who develop greater negatively-biased recall of pain (ie, recalled pain is higher than the initial pain report) following surgery are at risk for developing chronic pain; therefore, identifying risk factors for the development of biased pain memories is important. Higher anxiety has been implicated in the development of greater negatively-biased recall of pain; however, studies have not examined anxiety at multiple time points before and after a surgery and its relationship to children's postsurgical pain memories after 1 year. This prospective study examined a cohort of 237 children and adolescents undergoing major surgery. Anxiety sensitivity, pain catastrophizing, and pain anxiety were assessed at baseline, 48 to 72 hours after surgery, and at 6- and 12-month follow-ups. Pain intensity at rest, movement-evoked pain intensity, and pain unpleasantness were assessed daily in hospital. Memories for pain were elicited via telephone 1-year post surgery. Findings revealed that children who had higher levels of anxiety at baseline and 48 to 72 hours after surgery developed greater negatively-biased recall of pain intensity 12 months after surgery. Specifically, higher anxiety sensitivity at baseline and greater tendencies to catastrophize about pain at baseline and in the immediate acute recovery phase were most strongly linked to greater negatively-biased recall of pain. Greater negatively-biased recall of pain was related to higher pain intensity at 6 and 12 months post surgery. Findings support conceptual models of anxiety and pain memory biases and can inform intervention efforts to reduce anxiety in the pre- and post-op periods to minimize negative biases in pain memories.
Development and course of chronic widespread pain: the role of time and pain characteristics (the HUNT pain study)
Authors: Landmark Tormod , Romundstad Pål , Butler Stephen , Kaasa Stein , Borchgrevink Petter
Published: April 2019

Chronic widespread pain (CWP) is common and associated with loss of functioning and health. Subjects with chronic nonwidespread pain (CnWP) are at increased risk of developing CWP, but few studies have described the nature of the development over time. We followed a random sample of 3105 participants from the population-based HUNT 3 study with 5 annual measurements of pain over 4 years. Although 29% reported CWP on at least 1 occasion, only 7% reported it consistently on 4 or 5 occasions. The average annual cumulative incidence was 5%, and the recovery rate was 38%. In mutual adjusted analysis, the risk of developing CWP from 1 year to the next was higher in subjects with chronic pain (relative risk [RR] = 2.4; 95% confidence interval [CI]: 1.8-3.4), 2 or more pain regions (RR = 3.3; 95% CI: 2.5-4.4), moderate pain or more (RR = 1.8; 95% CI: 1.5-2.6), and with comorbid chronic disease (RR = 1.6; 95% CI: 1.3-1.9). Developing CWP was associated with a modest concurrent change in self-reported mental and physical health. The risk of developing CWP between the fourth and fifth occasions was 80% lower for subjects without a history of CWP, compared to those with a history of CWP. For subjects without previous CWP, the development was associated with previously reported CnWP, but not with the number of occasions with CnWP, in analyses adjusted for sex, age, and pain severity. A substantial proportion of the new cases of CWP originates from subjects floating below and above the definition for CWP over time and, thus, does not seem to involve major transitions in health.
Medical therapeutics: mortality effects, uncertainty, and informed consent
Authors: Nunes José Pedro L.
Published: April 2019

Many drugs used in medical therapeutics are able to save human lives. Unfortunately, many such drugs have also led to the death of patients. This fact raises important issues discussed in light of a number of cases taken from cardiovascular therapeutics. Medical therapeutics currently includes a vast number of different types of interventions, including drugs, devices, surgery, and diets. In what regards drugs, we currently use molecules with profound influences on the human body—some of which leading occasionally to negative outcomes or even to patient death. A reasonable degree of statistical certainty goes along with a large degree of individual uncertainty—a phenomenon is seen in a group of patients but a quite different phenomenon may be seen in a particular case. When treating an individual patient, it is his/her interest and personal preferences that must be taken into consideration, not the interests of society or of science. The choice of medical therapy with a definite intrinsic mortality risk must imply strict accordance from the part of the patient. Since many therapeutic modalities do carry a definite mortality risk, an overall change in medical practice is necessary. Informed consent should be the rule, and should be the starting point for medical therapeutics.
Congenital muscular torticollis: where are we today? A retrospective analysis at a tertiary hospital
Authors: Amaral Daniela M. , Cadilha Rui P.B.S. , Rocha José Afonso G.M. , Silva Ana Isabel G. , Parada Fernando
Published: April 2019

Background:

The congenital muscular torticollis is characterized by a persistent lateral flexion of the head to the affected side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. The majority of the cases resolve with conservative management, with parents/caregivers education and physical therapy.

The aim of this study was to assess demographic and clinical characteristics, treatment options, and outcome, amongst infants referred to pediatric rehabilitation consultation due to congenital muscular torticollis.

Methods:

Retrospective cohort study of infants diagnosed with congenital muscular torticollis between January 2012 and December 2014. Obstetric and perinatal data, clinical presentation, comorbidities, treatment, and outcome were abstracted from clinical records.

Results:

One hundred six infants were included. There was no sex predominance and mean age at first pediatric rehabilitation consultation was 11.6 (10.4) weeks. Most women were primiparous (76.4%), dystocic labor predominated (73.6%), and pelvic fetal presentation occurred in 20.8%. At examination, 49.1% of the infants had abnormalities, beyond the tilt cervical, mainly range of motion restrictions and palpable nodule in sternocleidomastoid muscle. Among the 87 children who performed the cervical ultrasound, 29 (27.4%) had anomalies. Associated clinical conditions such as hip dysplasia were identified. The majority (71.7%) were submitted to conservative treatment, 30.2% in the Pediatric Rehabilitation Department. Most infants (97.2%) showed a complete resolution of the torticollis.

Conclusions:

Congenital muscular torticollis is the most common cause of torticollis in the infants. Early diagnosis, parent/caregivers education, and conservative treatment are crucial to achieving good results.
Knowledge Regarding Child Victims of Commercial Sexual Exploitation and the Feasibility of Using a Smartphone Application: A Pilot Study
Authors: Goldman Sheree , Goyal Deepika
Published: April 2019

Purpose:

This pilot study examined the knowledge level and feasibility of using a smartphone application (app) to identify victims of sexual exploitation.

Methods:

Using a quantitative, pretest–posttest design, a convenience sample of 103 law enforcement officers living in the Western United States was assigned to a control (n = 38) or intervention (n = 65) group. Participants provided demographic data and completed an investigator-developed questionnaire to assess their knowledge of commercial sexual exploitation of children (CSEC). Questionnaires were completed twice, with the intervention group completing the posttest after being given the opportunity to test-drive a smartphone app designed to identify CSEC victims. Participants in the intervention group were also asked to rate the ease and usefulness of the app and preferred format of resources. Data were analyzed using descriptive statistics and mixed analysis of variance.

Results:

Few participants had received training in CSEC. Knowledge increased significantly more for the intervention group compared with the control group (p = 0.009), and similar results were noted with CSEC protocol questions (p = 0.005). Intervention group participants stated the app was easy to use (59%) and useful (63.9%) and preferred the CSEC information in the form of an app versus printed materials (85%).

Conclusion:

Results of this study suggest an overall low level of CSEC knowledge in our sample of law enforcement officers. However, a smartphone app may be feasible in identifying victims of sexual exploitation. Earlier recognition of CSEC victims promotes earlier referral to interdisciplinary health and human services.
An Evidence-Based Approach to Suicide Risk Assessment After Sexual Assault
Authors: Cochran Courtney B.
Published: April 2019

Sexual violence occurs in all gender, socioeconomic, religious, and ethnic groups. The trauma of sexual violence negatively affects both a person's physical and mental health. Individuals often experience suicidal ideations in the aftermath of a sexually violent event. On the basis of an understanding of the causative relationship between sexual violence and increased suicidality, a quality improvement study was developed to enhance the direct nursing care provided to clients at the time of the forensic examination and the aftercare provided to clients after discharge at a single-site sexual assault clinic. The study consisted of the implementation of three interventions including (a) use of an evidence-based suicide risk assessment tool, (b) establishment of a nursing protocol to standardize the community resource referral process, and (c) education of the clinic's nursing staff. These interventions provided the nursing staff with a standardized method to identify each client's suicide risk while also referring them to appropriate aftercare services in the local community. Results indicated that it was highly beneficial to screen all clients for suicide risk as it promoted client safety and acted as a catalyst for the emotional healing process.
The Acceptability and Feasibility of Implementing an Online Educational Intervention With Nurses in a Provincial Prison Context
Authors: Almost Joan , Gifford Wendy A. , Doran Diane , Ogilvie Linda , Miller Crystal , Rose Donald N. , Squires Mae , Carryer Jennifer , McShane Julie , Miller Kim
Published: April 2019

Background

Correctional nursing requires a strong knowledge base with access to continuing education (CE) to maintain and enhance competencies. Nurses working in provincial prisons have reported many challenges in accessing CE, with online learning being identified as a potential solution. Limited research was found, however, which examined the correctional context in the development and delivery of online learning for nurses. The purpose of this study was to develop an online educational intervention tailored to correctional nurses and determine the feasibility and acceptability of implementing the intervention in a provincial prison context.

Methods

A sequential mixed methods study was conducted. Participants included nurses from three correctional settings in the province of Ontario, Canada. Semistructured interviews examined contextual factors and educational needs. Delphi surveys determined the educational topic. Preintervention and postintervention questionnaires examined the context, educational content, and intervention's acceptability and feasibility.

Results

The online intervention focused on mental health and addictions with two 30-minute webinars delivered back-to-back over 15 weeks. Respondents expressed satisfaction with the convenience of online learning at work using short webinars, as well as the topics, relevance of information, and teaching materials, but dissatisfaction with presentation style. The feasibility of the intervention was limited by access to technology, time to attend, education space, and comfort with technology.

Discussion

The findings from this study provide insight to guide the future development of online CE for correctional nurses. If changes are made within correctional facilities in collaboration with nurses and managers, online learning holds the potential to facilitate access to ongoing professional development.
Pediatric and Adolescent Figure Skating Injuries: A 15-Year Retrospective Review
Authors: Kowalczyk Agnieszka D. , Geminiani Ellen T. , Dahlberg Bridget W. , Micheli Lyle J. , Sugimoto Dai
Published: April 2019

Objective:

To analyze the characteristics of injuries sustained by young figure skaters who were evaluated at regional pediatric sports medicine clinics.

Design:

Retrospective chart review (2003-2017).

Setting:

Sports medicine clinics at a tertiary-level pediatric medical center.

Patients:

Two hundred ninety-four figure skaters (271 female and 23 male). Age rage: 9 to 19 years. Mean age: 14.2 ± 2.3 years.

Interventions:

None.

Main Outcome Measures:

Mechanism of injury (acute vs overuse), injured body areas, diagnoses for most commonly injured body areas, and distribution of bone stress injuries.

Results:

Eight hundred sixty-four figure skating–related injuries were identified. Approximately 68.9% were overuse and 31.1% were acute. In female figure skaters, the most frequently injured body areas were foot/ankle (29.6%), knee (19.3%), and back (15.8%). In male figure skaters, they were foot/ankle (25.4%), hip (16.4%), and knee (14.9%). Most common diagnoses at these body areas were tendinopathy (foot/ankle), extensor mechanism (knee), and posterior column bone stress injuries (back). All injuries to anterior knee structures, excluding bone contusions, were categorized as extensor mechanism injuries. About 11.8% of all injuries were bone stress reactions/fractures with the majority occurring at the back (42.2%), foot/ankle (32.4%), and lower leg (15.7%).

Conclusion:

Most injuries sustained by figure skaters were overuse and occurred most commonly at the foot/ankle (29.6%), knee (19.3%), and back (15.8%). Approximately 1 in 10 injuries were bone stress reactions/fractures, and nearly 1 in every 3 skaters who presented with back pain was diagnosed with a posterior column bone stress injury. Health care providers who take care of young figure skaters need to maintain a high index of suspicion for overuse injuries, especially bone stress reactions/fractures.
Do routine blood test results help in the diagnosis of spine tumors? A retrospective study of the significance of pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios from 503 spine tumor patients
Authors: Li Yan , Wang Ben , Zhou Siyu , Jiang Liang , Yang Shaomin , Liu Xiaoguang , Wei Feng , Zhang Hua , Wang Yiyuan , Liu Zhongjun
Published: April 2019

The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are not fully evaluated for the diagnosis of musculoskeletal tumors, especially spine tumors. The objective of our study was to assess the feasibility of NLR and PLR as indicators for pretreatment diagnosis of spine tumors.

Patients who underwent surgical treatment in our hospital for spine tumors were retrospectively analyzed. Blood test results (neutrophil, lymphocyte, and platelet counts) and final pathological results from surgery or biopsy specimen were collected. Spine tumors were divided into 4 groups. Diagnostic values of NLR and PLR were analyzed using the area under the receiver operating characteristic (ROC) curve (AUC).

There were 503 patients included. The average age of all patients was 46.3 years. Age, NLR, and PLR were significantly different between benign and malignant tumors groups (P < .05), and ROC analysis showed that the AUC was 0.704 and 0.637 for NLR and PLR. Age, location, NLR, and PLR were significantly different between primary and nonprimary tumor groups (P < .05), and ROC analysis showed that the AUC was 0.713 and 0.647 for NLR and PLR. Age, location, NLR, and PLR were significantly different between primary benign and primary malignant tumor groups (P < .05), and ROC analysis showed that the AUC was 0.624 and 0.577 for NLR and PLR.

Pretreatment NLR and PLR had clinical significance in the identification and pretreatment diagnosis of spine tumors. Additionally, NLR and PLR were significantly different between benign and malignant tumors, primary and nonprimary tumors, and primary benign and primary malignant tumors.
Is there agreement between evaluators that used two scoring systems to measure acute radiation dermatitis?
Authors: Fuzissaki Marceila de Andrade , Paiva Carlos Eduardo , Gozzo Thais de Oliveira , Maia Marcelo de Almeida , Canto Paula Philbert Lajolo , Maia Yara Cristina de Paiva
Published: April 2019

To analyze the agreement between the nurses evaluating radiodermatitis that used the Radiation Therapy Oncology Group (RTOG) and the World Health Organization (WHO) scales.

A prospective and longitudinal study conducted in 2016 to 2017, in a university hospital. We analyzed 855 images of irradiated sites of 100 breast cancer women during radiotherapy. In order to evaluate the agreement between 3 observers that evaluated theses irradiated sites Krippendorff's alpha and weighted kappa were obtained and analyzed.

The pairwise agreement among the evaluators was fair and moderate (RTOG scale: 0.408, 95% confidence interval, CI 0.370–0.431; WHO scale: 0.559, 95% CI 0.529–0.590). In addition, the general agreement rates were 10.2% and 29.2%, respectively. When assessing the overall absolute agreement between the evaluators according with different phototypes and types of surgery, there was a fair agreement according to the RTOG scale when evaluating patients with phototype V or VI and mastectomy (3.7% and 8.8%, respectively).

The RTOG and WHO scales should be used with caution in clinical practice to identify the prevalence of radiodermatitis and the severity. Another point of caution is that skin phototype and the type of surgery may influence the analysis outcome. An illustrative scale was designed and proposed, by our group, aiming to improve accuracy and agreement between evaluators that will be tested in subsequent clinical studies.
Impacts of cognitive-behavioral intervention on anxiety and depression among social science education students
Authors: Ezegbe Bernedeth N. , Eseadi Chiedu , Ede Moses Onyemaechi , Igbo Janet N. , Anyanwu Joy I. , Ede Kelechi R. , Egenti Nkechi T. , Nwokeoma Bonaventure N. , Mezieobi Daniel I. , Oforka Theresa O. , Omeje Grace N. , Ugwoezuonu Amanda U. , Nwosu Nneka , Amoke Chijioke V. , Offordile Edmund E. , Ezema Luke C. , Ikechukwu-Ilomuanya Amaka B. , Ozoemena Lilian C.
Published: April 2019

Background:

Anxiety is a common disorder which refers to a significant and persistent fear of one or more social or performance situations. This study investigated the impacts of cognitive-behavioral intervention on anxiety and depression among undergraduate students enrolled in social science education programs at public universities in the Southeast Nigeria.

Methods:

Participants were 55 undergraduate students enrolled in social science education programs at public universities in the Southeast Nigeria. The adequacy of the sample size used was determined using GPower software. Cognitive-behavioral treatment manuals on anxiety and depression were used to deliver the intervention. Data analyses were completed using repeated measures analysis of variance.

Results:

Results indicated a significant positive impact of cognitive-behavioral intervention on anxiety and depression among social science education students exposed to the cognitive-behavioral intervention when compared to the waitlisted group. Results also showed that there was a significant time × group interaction for anxiety and depression. Follow-up tests showed that significant reduction in anxiety and depression persisted after 3 months for the cognitive-behavioral intervention group in comparison to the waitlisted control group.

Conclusion:

We concluded that cognitive-behavioral intervention was a successful intervention which decreased the symptoms of anxiety and depression in social science education students who participated in the study. Additional studies are recommended to further corroborate the influence of cognitive-behavioral intervention in the reduction of anxiety and depressive symptoms in the Nigerian undergraduate student population.
Effects of eplerenone on blood pressure and glucose metabolism in Japanese hypertensives with overweight or obesity
Authors: Adachi Hisashi , Kakuma Tatsuyuki , Kawaguchi Machiko , Kumagai Eita , Fukumoto Yoshihiro
Published: April 2019

Objective:

The impact of aldosterone blockade using eplerenone on hypertensives with obesity has not been clarified. We compared the efficacy and safety between eplerenone and trichlormethiazide in hypertensives with overweight or obesity.

Methods:

A prospective, randomized, open-labeled, blinded-endpoint design, multicenter trial enrolled 204 hypertension-treated outpatients with obesity [body mass index (BMI) ≥25 kg/m2] evaluated by ambulatory blood pressure (BP) measurement. Patients were randomly assigned to receive 50 mg of eplerenone (n = 102) or 1 mg of trichlormethiazide (n = 102), each of which were administered once every morning. Primary efficacy endpoints were systolic and diastolic BPs and biomarkers of glucose metabolism after 6 months of treatment.

Results:

At baseline, BPs were comparable between the two groups. Systolic/diastolic blood pressure (SBP/DBP) were reduced from 153.9 ± 12.6/84.6 ± 11.8 to 129.8 ± 14.2/73.7 ± 12.2 mm Hg by eplerenone therapy and from 152.2 ± 12.5/85.2 ± 10.9 to 133.8 ± 12.6/76.1 ± 8.6 mm Hg by trichlormethiazide therapy (all; P < .001). The efficacy of SBP reduction after adjustment for age, sex, and BMI was significantly greater in the eplerenone group than the trichlormethiazide (P = .034), although the efficacy of DBP reduction was marginally significant (P = .072). Especially, the efficacy of BP reduction was more effective for aged over 65 years than less than 65 years. However, biomarkers of glucose metabolism were not significantly different between these 2 groups.

Conclusion:

The eplerenone therapy was more effective in BP lowering in hypertensives with overweight or obesity than the trichlormethiazide therapy, especially in the elderly.
Practical application of the ATOM study
Authors: Paz Marco A. , Farrerons Monica , Saez Marc , Saurina Carme , Pinto Marc Garcia , Castro Sonia , Sobrino Javier , de Tuero Gabriel Coll
Published: April 2019

Background:

The response to antihypertensive drugs is predictable. The absence of precise prescription recommendations to treat arterial hypertension (HT) lead to use drugs unable to reduce blood pressure (BP) to target values.

We published ATOM study, in which we found significant differences in the ability to reduce BP between the different drugs.

The objective of the study was to determine the expected decrease in blood pressure with the use of commercialized doses of the drugs commonly used in the treatment of HT in clinical practice, to avoid the use of drugs or combinations that even with the best response, are unable to obtain the necessary BP decrease to reach the goal.

Methods:

The analysis was based on the results of the ATOM study. To convert the mean doses of the different drugs and combinations in commercialized doses, the conclusions of the study by Law et al have been applied.

Results:

Based on the results, two tables were drawn, one for systolic BP and the other for diastolic BP, where the doses of the different drugs and combinations are classified according to the BP decrease that can be expected from them. In order to favor the use of the tables in clinical practice, the different drugs have been grouped in intervals of 10 millimeters of mercury (mmHg) for the decrease of the systolic BP and of 5 mmHg for the diastolic BP.

Conclusions:

Recommendations for the use of antihypertensive treatments should not be limited to pharmacological families. They should also consider differences between drugs or specific combinations. From the data of the ATOM study we have implemented tables that express the effect of the drugs commonly used in clinical practice and that should allow the clinicians to choose with care the treatment to use.
Clinical features and genetic analysis of childhood sitosterolemia
Authors: Huang Dan , Zhou Qiong , Chao Yun-Qi , Zou Chao-Chun
Published: April 2019

Rationale:

Sitosterolemia is a rare autosomal recessive disorder of dyslipidemia due to mutations of genes ABCG5 and ABCG8, leading to highly elevated plasma levels of plant sterols and expanded body pools of cholesterol.

Patient concerns:

We present a 9-year-old and a 7-year-old Chinese boy with hypercholesterolemia and xanthomas of sitosterolemia due to ABCG5 gene mutations. We also make a literature review of another 30 sitosterolemic children cases that have been reported with virulence ABCG5 gene mutations.

Diagnosis:

We took peripheral blood samples from 2 patients and their parents to conduct genetic analysis by next-generation sequencing (NGS) technologies.

Interventions:

The 2 patients received dietary modifications without pharmaceuticals treatment.

Outcomes:

A c.1166G>A (Arg389His) homozygosis mutation in exon 9 was observed in case 1, whereas a c.751C>T (Gln251∗) homozygosis mutation in exon 6 was found in case 2. Literature review found another 30 pediatric cases with sitosterolemia due to ABCG5 gene mutation. The lipid profile was normalized and xanthomas got smaller with combined therapy of a combined low-cholesterol and low-phytosterols diet.

Lessons:

These suggested that in patients (especially Asian patients) with multiple xanthomas, severe hypercholesterolemia, or elevated low-density lipoprotein-cholesterol, sitosterolemia should be considered in the differential diagnosis. Early diagnosis is important, and restriction of both cholesterol and phytosterols diet should suggested for these patients.
A case report of Guillain Barré syndrome revealing underlying infective endocarditis due to Cardiobacterium hominis
Authors: Diallo Kévin , Jacquet Caroline , Alauzet Corentine , Beguinot Isabelle , May Thierry , Selton-Suty Christine , Hoen Bruno , Goehringer Francois
Published: April 2019

Rationale:

Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy presumed to result from an infection-triggered autoimmune reaction.

Patient concerns:

This paper describes a 53-year-old man admitted to hospital for deterioration of his general condition.

Diagnosis:

He developed GBS, confirmed by lumbar puncture and electromyogram, which recovered after intravenous immunoglobulins. A grade 2 aortic regurgitation was detected by transthoracic echocardiography upon diagnosis of GBS, but in the absence of fever, no further investigations were conducted. A few weeks later, the patient presented with fever and infective endocarditis (IE) was diagnosed after the identification of vegetation on the aortic valve with transesophageal echocardiography. The etiologic agent was identified as Cardiobacterium hominis based on 3 positive blood cultures and DNA detection in valvular material.

Interventions:

IE was cured with a 6-week course of antibiotics and aortic valve replacement.

Outcomes:

The patient completely recovered from Guillain-Baré syndrome and IE.

Lessons:

This case of GBS associated with C hominis endocarditis, emphasizes the importance of blood cultures and transesophageal echocardiography for the detection of IE and highlights the insidious nature of C hominis endocarditis which is often diagnosed late.
Parotid ductal stenosis after facial cosmetic surgery (2 case reports)
Authors: Choi Jeong-Seok , Kim Young-Mo , Lim Jae-Yol
Published: April 2019

Rationale:

Facial cosmetic surgery sometimes causes complications involving surrounding tissues. In particular, parotid damage may cause fibrous tissue formation, ductal stenosis, and obstruct salivary flow. Affected patients usually complain of symptoms such as pain and swelling.

Patient concerns:

The authors report 2 cases of obstructive parotitis, arising as a complication of facial cosmetic surgery that were treated successfully using sialendoscopic procedures.

Diagnosis:

A diagnosis of parotid ductal stenosis was made based on medical history, clinical manifestations, imaging studies, and sialendoscopic findings for the 2 patients.

Interventions:

The successful sialendoscopic procedures was given to the 2 patients.

Outcomes:

The 2 patients have shown no recurrent symptoms during follow-up.

Lessons:

Surgeons that perform facial cosmetic procedures should attain a thorough knowledge of the surgical anatomy of the parotid region and sialendoscopic procedure may be helpful for the management of obstructive parotitis due to complication of cosmetic surgery.
Sclerosing pneumocytoma
Authors: Khanna Akriti , Alshabani Khaled , Mukhopadhyay Sanjay , Lam Louis , Ghosh Subha
Published: April 2019

Rationale:

Sclerosing pneumocytoma is a rare benign lung neoplasm seen in middle aged adults with a female predominance. Originally thought to be vascular in origin, this rare entity is now understood to be epithelial in nature. On imaging, sclerosing pneumocytoma manifests as a well circumscribed nodule or mass, often juxtapleural in location. On histopathology, sclerosing pneumocytoma is composed of cuboidal “surface cells” and round “stromal cells,” both of which show nuclear staining for thyroid transcription factor-1 (TTF-1). Here we review the existing literature on sclerosing pneumocytoma and present a case of sclerosing pneumocytoma in a highly unusual endobronchial location.

Patient concerns:

This case is a 43 year old woman who presented with chronic cough.

Diagnosis:

Imaging revealed a right upper lobe nodule with an endobronchial component.

Interventions and outcomes:

Endoscopic biopsy was performed, and pathologic diagnosis was confirmed.

Lessons:

Although extremely rare, endobronchial presentation of sclerosing pneumocytoma is possible, and should remain on the differential for patients with endobronchial pulmonary lesions. Pathologic tissue analysis is necessary to confirm this uncommon diagnosis.
Diffuse large B-cell lymphoma involving peripheral nervous system with IgM antibodies against GM1 and GD1b
Authors: Jiang Zhaocai , Ju Weina , Luo Shen , Yang Yu
Published: April 2019

Rationale:

The occurrence of peripheral neuropathy associated with non-Hodgkin's lymphoma (NHL) is uncommon. And autoimmunity may play an important role. We report a case of the patient with NHL, has sensorimotor demyelinating polyneuropathy.

Patient concerns:

The patient presented with a 1-month history of progressive numbness at the distal extremities and motor weakness of the lower limbs. Meanwhile, patient also endorsed a painful lump on her right cheek. And then the enlarged cervical and supra clavicular lymph nodes were observed on admission. Biopsy of the lymph nodes showed NHL. Serum IgM antibodies against GM1 and GD1b were also positive.

Diagnosis:

Biopsy of the lymph nodes showed NHL. Serum IgM antibodies against GM1 and GD1b were also positive. Thus, the patience was diagnosed with lymphoma and sensorimotor polyneuropathy.

Interventions:

Patient refused the further treatment.

Outcomes:

After 11-month follow-up, the weakness of bilateral lower limbs worsens.

Lessons:

We have presented a case of NHL involving peripheral polyneuropathy with IgM antibodies against GM1 and GD1b. Patients may initially present with peripheral nerve complications or develop them during the course of lymphoma, even when in remission. This could complicate the diagnosis of peripheral polyneuropathy secondary to NHL.
Unhealthy changes in eating habits cause acute onset hypertension in the normotensive community-dwelling elderly—3 years cohort study
Authors: Kakamu Takeyasu , Hidaka Tomoo , Kumagai Tomohiro , Masuishi Yusuke , Kasuga Hideaki , Endo Shota , Sato Sei , Takeda Akiko , Koizumi Makoto , Fukushima Tetsuhito
Published: April 2019

The aim of this study was to determine what lifestyle changes can predict acute onset hypertension in the normotensive community-dwelling elderly.

This study targeted elderly people enrolled in National Health Insurance in Fukushima Prefecture, Japan. The subjects were 24,490 people who took all of the specific health examination conducted by National Health Insurance in fiscal years 2013, 2014, and 2015 continuously and had a recorded systolic blood pressure (BP) <130 mm Hg and diastolic BP <85 mm Hg in the first 2 fiscal years. We examined their lifestyle changes for the first 2 fiscal years using the questionnaires given at the health examination. Multivariate Poisson regression analysis was conducted to examine the relationship between new-onset hypertension observed at the last examination and unhealthy lifestyle changes.

The mean age of the subjects was 61.5 ± 8.2 years old at baseline. We observed new-onset hypertension in 1.062 subjects at the last examination. Of the study subjects, 12,027 (49.1%) answered to having at least one of the items of unhealthy lifestyle change in the questionnaire. In the multivariate logistic regression, eating supper before bedtime showed a significant increase in the risk ratio for acute onset hypertension (risk ratio 1.27, 95% confidence interval, 1.01–1.58).

This study indicated that eating before bedtime is a risk factor of new-onset hypertension in the normotensive community-dwelling elderly. Adequate health guidance to avoid unhealthy lifestyle changes is required even in normotensive people as this hypertension is preventable.
Effectiveness of a multi-faceted intervention among elementary school children
Authors: Chuang Hai-Hua , Lin Rong-Ho , Chen Jau-Yuan , Yeh Wei-Chung , Lin Hsiu-Fong , Ueng Steve Wen-Neng , Hsu Kuang-Hung
Published: April 2019

Childhood obesity has been shown to be closely related to future obesity and comorbidities. As its prevalence and impact has increased significantly worldwide, researchers have focused on prevention and intervention. This study assessed a multifaceted intervention for elementary school children.

A retrospective data collection with a cohort analysis was employed. A 16-week school-based intervention with nutritional intervention, physical activity, and behavioral education was designed and conducted by a multidisciplinary team for 1860 children aged 6 to 13 years. Basic information, anthropometrics, and physical fitness (PF) were recorded before and after the intervention. The differences compared with a reference group, and compared between subgroups, were analyzed.

Significant favorable changes in body weight and composition were found. Children's height, weight, and muscle weight increased, whereas BMI, BMI z-score (zBMI), waist circumference, hip circumference, waist-hip ratio, waist-height ratio, body fat percentage, and visceral fat area decreased. Sit-ups and 800-m run time significantly improved. Girls exhibited a greater reduction in body weight outcomes; boys improved more in body composition and PF. Students with higher zBMI had a greater reduction in all anthropometrics; students with lower zBMI showed greater PF improvement, except for the 800-m run.

The intervention improved weight measures, body composition, and PF. Subgroup differences suggested the need for sex- and weight-specific interventions.
Prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease in a tertiary hospital in Malaysia
Authors: Sahadevan Mahavishnu , Chee Kok Han , Tai Mei-Ling Sharon
Published: April 2019

There is limited information regarding the prevalence of extracranial carotid atherosclerosis in the patients with coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery in South East Asia. The primary objective was to assess the prevalence of extracranial carotid stenosis, raised carotid intima media thickness (CIMT), and plaques in the patients with CAD undergoing elective CABG. The secondary objective was to evaluate the risk factors for extracranial carotid atherosclerosis.

A total of 119 consecutive patients with CAD undergoing elective CABG in a tertiary hospital in Malaysia were recruited. Data on the demographic characteristics and risk factors were collected. The ultrasound carotid Doppler findings comprising of raised CIMT, plaques, and stenosis in the extracranial carotid vessels were recorded.

The mean age of the patients was 64.26 ± 10.12 (range 42–89). Most of the patients were men (73.1%). The patients consisted of 44 (37%) Malays, 26 (21.8%) Chinese, and 49 (41.2%) Indians.

A total of 67 (56.3%) patients had raised CIMT, 89 (74.8%) patients had plaques, and 10 (8.4%) patients had stenosis in the internal and common carotid arteries. The mean age of patients with plaques was higher compared to those without plaques (66.00 ± 9.63 vs 59.10 ± 9.92, P = .001). The body mass index (BMI) of patients with stenosis was higher compared to those without stenosis (28.35 ± 4.92 vs 25.75 ± 3.16, P = .02).

The patients with plaques were more likely to be older, whereas the patients with carotid stenosis were more likely to have higher BMI.
Changes in facial temperature measured by digital infrared thermal imaging in patients after transnasal sphenopalatine ganglion block
Authors: Kim Na Eun , Park Bumhee , Moon Yeo Rae , Lee Sook Young , Gil Ho Young , Kim Sunok , Lee Seryeon , Chang Hyuk Soo , Jeong Hae Won , Park Hyungbae , Lee A Ram , Ahn Soohwan , Kim Tae Kwang , Kim Ji Eun , Choi Jong Bum
Published: April 2019

Sphenopalatine ganglion block (SPGB) is a technique developed in the 1990s for the management of head and neck pain patients. Recently, transnasal sphenopalatine ganglion block (TN-SPGB) has been widely used for these patients; however, no objective methods exist for validating the success of TN-SPGB. In this study, we measured the changes in facial temperature before and 30 minutes after TN-SPGB by using digital infrared thermal imaging (DITI) to validate its success.

The medical records of patients, who underwent TN-SPGB and facial DITI between January 2016 and December 2017, were reviewed. TN-SPGB and facial DITI were performed 36 times in 32 patients. The changes in facial temperatures measured at the forehead (V1), maxillary area (V2), and mandibular area (V3) by using DITI before and 30 minutes after TN-SPGB were recorded and compared. The temperatures on the ipsilateral and contralateral sides of these areas were also compared. The comparison between pain relief group and pain maintenance group was analyzed.

After TN-SPGB, the temperature decreased significantly on both sides of V1 (P = .0208, 0.0181). No significant differences were observed between the ipsilateral and contralateral sides (P > .05). There was no correlation between changes in temperature and changes in pain score in the pain regions after the procedure (P > .05).

The temperature decreased significantly in V1 area at 30 minutes after TN-SPGB compared with the temperature before TN-SPGB. Based on these results, we propose using DITI to measure temperature changes as an objective method for verifying the success of TN-SPGB.
Effectiveness of music therapy with relaxation technique on stress management as measured by perceived stress scale: Retraction
Authors: Ogba Francisca N. , Ede Moses O. , Onyishi Charity N. , Agu Patricia U. , Ikechukwu-Ilomuanya Amaka B. , Igbo Janet N. , Egenti Nkechi , Manafa Ifeyinwa , Amoke Chijioke , Nwosu Nneka C. , Omeke Faith C. , Nwafor Bernedeth N. , Amadi Kingsley C. , Nwokenna Edith N. , Ugwoke Samuel C.
Published: April 2019

Background:

Living in Nigerian environment is enough stress. In our time, many students could not cope with the stress of school environment like ours and others are still suffering from different health problems attributed to stress. Based on this, we investigated the effect of music therapy with relaxation technique on stress management among university students in southeastern Nigeria.

Methods:

Participants for the study were 142 university students in the Southeastern Nigeria. Perceived stress scale (PSS) was used to measure the symptoms of stress. Statistical tool used was repeated measures with analysis of variance (ANOVA) to ascertain the effectiveness of music therapy with relaxation. Among other tools used was Partial η2 to examine the effect sizes and level of changes inthemanagement of stress across groups.

Results:

The finding indicated that there were no baseline differences in levels of stress management between participants in the treatment and waitlist control conditions. Results revealed significant improvement in stress management for participants in the music therapy with relaxation group, whereas the waitlist control group showed no significant change in their score over the same period. Furthermore, the positive effect of music therapy with relaxation was maintained at follow-up.

Conclusion:

The findings of this study suggest that the efficacy of music therapy with relaxation technique for improving the students’ stress management can be consistent at follow-up. Hence, music therapists, counsellors and psychotherapists should continue to investigate the beneficial effects of music therapy with relaxation on stress management among university students in every part of the world.
Green tea extract for treatment of cancers
Authors: Cheng Kai , Chi Nan-Nan , Liu Jun-Dong
Published: April 2019

Background:

Previous clinical studies suggested that green tea extract (GTE) may benefit patients with a variety of cancers. However, its efficacy is still inconclusive. Thus, the objective of this study will systematically collate the clinical studies testing its efficacy and safety for cancers.

Methods:

We will perform a systematic review of clinical studies assessing the efficacy of GTE in variety of cancers. We will search Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDILINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), and Chinese Biomedical Literature Database (CBM) using a comprehensive strategy. We will also screen the reference lists of relevant studies to identify any additional studies for potential inclusion. All databases will be searched up to February 1, 2019. All eligible case-control studies and randomized controlled trials will be included in this study. Two independent authors will review all searched literature. Upon inclusion of trials, we will extract data by using a predefined standardized form. The risk of bias assessment will be evaluated by using Cochrane risk of bias tool. We will use RevMan 5.3 software to pool the data and carry out meta-analysis.

Results:

The primary outcome includes overall response rate. The secondary outcomes comprise of overall survival, progression-free survival, the disease control rate, and any adverse events.

Conclusions:

The results of this study will contribute to the understanding of the efficacy of GTE in the setting of cancers and promote future research of GTE in patients with cancers.

Dissemination and ethics:

The results of this systematic review are expected to be published through peer-reviewed journals. This study does not need ethic approval, because it does not utilize individual patient data.

Systematic review registration:

PROSPERO CRD42019125111.
Managing Adult-onset Still's disease: The effectiveness of high-dosage of corticosteroids as first-line treatment in inducing the clinical remission. Results from an observational study
Authors: Ruscitti Piero , Cipriani Paola , Liakouli Vasiliki , Guggino Giuliana , Carubbi Francesco , Berardicurti Onorina , Ciccia Francesco , Giacomelli Roberto
Published: April 2019

To assess the effectiveness of the treatment with high dosage of corticosteroids (CCSs), as first-line therapy, in inducing remission in naïve Adult-onset Still's disease (AOSD) patients compared with low dosage of CCSs, after 6 months. To further evaluate the rate of patients maintaining the remission and the rate of CCSs discontinuation, after additional 12 months of follow-up.

A retrospective evaluation of patients prospectively followed was designed to compare the rate of clinical remission in naïve AOSD patients treated with high dosages of CCSs (0.8–1 mg/kg/day of prednisone-equivalent) or low dosage of CCSs (0.2–0.3 mg/kg/day of prednisone-equivalent), after 6 months. An additional analysis was performed to compare the rate of monocyclic pattern between these groups, after further 12 months of follow-up.

The clinical remission was achieved in a higher percentage of patients treated with the first-line treatment with high dosage of CCSs than treated the first-line treatment with low dosage of CCSs. At the end of 18 months of follow-up, a larger percentage of patients treated the first-line treatment with high dosage of CCSs was classified as monocyclic pattern and discontinued CCSs when compared with patients treated the first-line treatment with low dosage of CCSs. Patients defined as CCSs non-responder were treated with methotrexate (MTX)+CCSs or with combination therapy CCSs+MTX+biologic drug. The clinical remission was observed in a percentage of these patients.

We showed the effectiveness of the first-line treatment with high dosage of CCSs in inducing clinical remission in naïve AOSD patients when compared with the first-line treatment with low dosage of CCSs. The first-line treatment with high dosage of CCSs was also associated with the achievement of monocyclic pattern and CCSs discontinuation, after 18 months of follow-up.