bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional Versus General Anesthesia: Effect of Anesthetic Techniques on Clinical Outcome in Lumbar Spine Surgery: A Prospective Randomized Controlled Trial
Authors: Baenziger Bertram , Nadi Najia , Doerig Ramon , Proemmel Peter , Gahl Brigitta , Hodel Daniel , Hausmann Oliver N.
Published: October 2018

Background:

There are only a few prospective clinical trials investigating the effects of different anesthetic techniques on clinical outcomes after lumbar spine surgery. The purpose of this study was to evaluate clinical outcomes in patients receiving general (GA) and regional anesthesia (RA) for lumbar spine surgery.

Methods:

This was a single-center, 2-arm, trial in which 100 patients undergoing lumbar spine surgery were randomized to receive either RA or GA (50 per group). The primary endpoint was morphine consumption during the first postoperative 48 hours. In addition, anesthesia time, transition time (defined as time from end of surgery to admission to the postoperative anesthesia care unit), visual analogue scale (VAS) for pain, and patient satisfaction at hospital discharge were recorded.

Results:

There was no difference in the primary endpoint (cumulative morphine consumption at 48 h) between the 2 anesthesia types. Anesthesia and transition times were significantly shorter in the RA compared with the GA group—anesthesia time 125.4±23.6 minutes for GA versus 99.4±13.5 minutes for RA, transition time 22.5 minutes for GA versus 10.0 minutes for RA (both P<0.001). The VAS for pain on arrival to the postoperative anesthetic care unit was lower for patients who received RA compared with GA (crude and adjusted, both <0.001). 84% of patients in the RA group were completely satisfied compared with 74% in the GA group (P<0.001). There was a significant difference in the sex analysis for VAS for pain over time; females reported higher VAS for pain from the preoperative assessment to 6 weeks after the operation (P<0.001).

Conclusions:

There was no difference in postoperative morphine consumption in patients receiving GA and RA for lumbar spine surgery. RA was associated with shorter anesthesia and transition times, lower VAS for pain at arrival at the postoperative anesthesia care unit, and higher patient satisfaction at hospital discharge.
Intervention Models for Increasing Access to Behavioral Health Services Among Youth: A Systematic Review
Authors: Choi Kristen R. , Easterlin Molly C.
Published: October 2018

Objective:

The purpose of this systematic literature review is to examine interventions designed to improve access to behavioral health services among youth in the United States and to identify how the concept of access to health care has been measured and conceptualized in these studies.

Method:

The review used a systematic search strategy to identify articles published in medical, nursing, and psychological literature. The search yielded 579 initial articles, of which 69 appeared to be candidates for inclusion in the review. In the end, 19 studies qualified for synthesis in the review. Studies were required to use an experimental or quasi-experimental design and include a comparison group.

Results:

Results indicated that access to behavioral health services can be improved by providing services in schools, using telehealth models, or delivering multicomponent interventions in clinical settings. Models that incorporated parental support, peer support from other parents, or other ways of engaging parents in the utilization process, as well as multicomponent and policy interventions, helped improve access to care. In the studies reviewed, access was operationalized primarily in terms of child behavioral health service utilization.

Conclusion:

Interventions delivered in schools, engaging parents, or utilizing telehealth technology show promise for increasing access for youth affected by behavioral health disorders.
Botulinum Toxin A: A Novel Therapeutic Modality for Upper Extremity Chronic Regional Pain Syndrome
Authors: Lessard Lucie , Bartow Matthew J. , Lee James , Diaz-Abel Julian , Tessler Oren E.S.
Published: October 2018

Background:

Complex regional pain syndromes (CRPS) is a disease that is poorly understood. It is a chronic pain syndrome characterized by sympathetic disruptions as well as CNS sensitization. Botulinum Toxin-A has been shown to have efficacy in Raynaud's as well as other neuropathic pain disorders. Perhaps BTX-A warrants experimentation in the treatment of CRPS.

Methods:

Patients with CRPS refractory to 2 or more regional sympathetic nerve blocks in 2007 were included in the study. Patient's were asked to rank their initial pain on a visual analog scale of 0 to 10 (10 being the worst pain). "Tenderness maps" were marked on patient's areas of most pain in 1 by 1 centimeter grids. Each box on the grid was injected with 10 IU of BTX-A after nerve blocks with 1% lidocaine. Treatment sessions occured on a monthly basis with VAS pain scores being re-assessed immediately before the new treatment. t Test, linear regression, and Cohen's D-test were used to analyze the correlation of the data.

Results:

Study sample was 20 patients. Etiology of CRPS was 6 amputations, 4 crush injuries, 4 penetrating injuries, and 2 lacerations. Average pain reduction on VAS scale achieved was 2.05 points. Average percentage pain reduction was 22.94%. Cohen's D Test also showed a meaningful difference with a score of 1.01. Linear regression R2 = 0.491. Maximum pain reduction, on average, was achieved by treatment 9.

Conclusion:

Despite the esoteric etiology of CRPS, BTX-A has a well-demonstrated mechanism of effect. BTX-A should be further explored as a treatment modality for CRPS.
Buccal Fat Pad Excision: Proceed with Caution
Authors: Benjamin Martin , Reish Richard G.
Published: October 2018

Background:

Buccal fat pad excision is offered as a means of obtaining a more aesthetic midface. This procedure has been documented in the form of countless videos on Instagram and other social media platforms with no long-term patient follow-up. We performed a retrospective analysis of published data regarding buccal fat pad excision and sought to better elucidate pitfalls regarding this underreported procedure.

Methods:

A literature search was conducted in October 2017 through the PUBMED database regarding the utility of buccal fat pad excision in the setting of aesthetic improvement of the midface. Reference articles were screened to obtain relevant studies. A total of 121 citations were identified in the search but after eliminating duplicate studies and abstracts and utilizing predefined inclusion/exclusion criteria only 11 articles were satisfactory. None of these articles demonstrated any long-term patient follow-up.

Results:

Out of the 121 relevant citations identified, only 2 studies published describe a case series of > 5 patients regarding cheek or midface sculpturing with buccal fat pad excision for aesthetic purposes, the total sample size between these 2 studies was 53 patients. Neither of the studies had follow-up regarding patient satisfaction or related outcomes.

Conclusions:

Buccal fat pad resection as an aesthetic improvement of the midface has been described, but follow-up regarding loss of subcutaneous fat with aging and late secondary deformities have not been published in the literature. Further research in long-term patient follow-up including patient satisfaction and the encouragement of reporting postoperative complications is warranted.
ASSESSMENT OF MACULAR VASCULATURE OF CHILDREN WITH SICKLE CELL DISEASE COMPARED TO THAT OF HEALTHY CONTROLS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Roemer Ségolène , Bergin Ciara , Kaeser Pierre-Francois , Ambresin Aude
Published: October 2018

Purpose:

This study aims at describing the macular vascular features of the eyes of pediatric patients with the homozygous form of sickle cell disease (SCD) using optical coherence tomography angiography.

Methods:

This is a retrospective case series of eyes of pediatric patients with SCD, race- and age-matched to those of healthy individuals. Using optical coherence tomography angiography images of superficial capillary plexus and deep capillary plexus, the nonflow area, vascular density, and foveal avascular zone were measured. The remodeled microvascular foveal architectures obtained on optical coherence tomography angiography and fluorescein angiography were compared.

Results:

A total of 19 eyes of patients with SCD and 18 eyes of race-matched healthy controls were examined. The best-corrected visual acuity ranged from 75 to 85 letters in all cases. In the SCD series, 8 eyes displayed signs of retinopathy on funduscopy. The foveal avascular zone was significantly enlarged, the foveal vascular density was 8% lower, and there were more perifoveal vascular alterations in the eyes of patients with SCD compared to those of controls.

Conclusion:

The foveal vascular density was significantly reduced and area of the foveal avascular zone was significantly increased in the eyes of patients with SCD. Consistent architectural changes in the perifoveal capillaries were also observed in the pediatric patients with SCD.
Poststroke Sleep Disorders: An Executive Summary
Authors: Park Da-In , Choi-Kwon Smi
Published: October 2018

Background: Poststroke sleep disorders (PSSDs) are common manifestations that may lead to adverse outcomes that pose a negative impact on the daily lives of stroke survivors. However, PSSD is poorly understood in terms of etiology, assessment, treatment, and nursing management. The purpose of this executive summary is to provide an overview to broaden our understanding of PSSDs. Method: The electronic databases EMBASE, PubMed, CINAHL, Cochrane Library, and Google Scholar were searched to identify any available relevant studies. Results: The 3 main sleep disorders among stroke survivors are sleep apnea, nighttime sleep disturbances, and excessive daytime sleepiness. The PSSD prevalence ranges from 13.2% to 94.0%. Conclusion: The causative mechanism seems to be multifactorial, but occurrence may differ depending on the stroke stage. Combined use of subjective and objective assessment methods may increase PSSD detection and early treatment.
Comparison of the cuff pressures of a TaperGuard endotracheal tube during ipsilateral and contralateral rotation of the head
Authors: Kim Saeyoung
Published: October 2018

Background

Maintaining optimal intracuff pressure of the endotracheal tube is important during airway management. Rotation of the head can affect the cuff pressure of the endotracheal tube. We investigated the change in cuff pressure and the degree of tube displacement according to the direction of head rotation (toward the same side vs opposite side of tube fixation) using a TaperGuard endotracheal tube.

Methods

We conducted a prospective study in 58 patients, aged 18 to 70 years, who underwent tympanomastoidectomy under general anesthesia. TaperGuard endotracheal tube was secured at the corner of the mouth, either on the same side as that of the head rotation (Group S, n = 29) or on the opposite side (Group O, n = 29). After endotracheal intubation, the endotracheal tube cuff pressure was set at 22 cmH2O in the neutral position of the head. The cuff pressure was measured again after lateral rotation of the head and readjusted to 22 cmH2O. In addition, the change in distance from the carina to the tip of the endotracheal tube was measured before and after the change in position. The incidences of cough, sore throat, and hoarseness were assessed at 30 minutes, 6 hours, and 24 hours after surgery.

Results

There were no differences between groups in terms of patient characteristics and duration of anesthesia. The change in cuff pressure after head rotation in Group S (8.07 ± 1.07 cmH2O) was greater than that in Group O (2.24 ± 0.95 cmH2O) (P < .001). In addition, 21 (72.4%) patients in Group S and no patient in Group O had pressures above 30 cmH2O (P < .001). Furthermore, the tube tip moved away from the carina by 8.55 ± 7.01 mm in Group S and by 2.83 ± 4.72 mm in Group O (P < .001).

Conclusion

Fixation of the TaperGuard endotracheal tube on the side contralateral to head rotation was associated with a smaller intracuff pressure increase and lesser tube displacement compared to fixation of the tube on the ipsilateral side.
Individualized reconstruction for severe periprosthetic fractures around the tumor prosthesis of knee under assistance of 3D printing technology
Authors: Han Qing , Zhao Xue , Wang Chenyu , Chen Bingpeng , Wang Xiaonan , Zhang Ziyan , Zhang Kesong , Zheng Yuhao , Wang Jincheng
Published: October 2018

Introduction:

Periprosthetic femoral fractures (PFF) around tumor prosthesis of knee are stubborn problems for surgeons, huge bone defect and inappropriate biomechanics of the revision implant design can be disaster for reconstruction. With the development of three-dimensional (3D) printing technology, surgeons participate more in precise preoperative design and simulation for treatment of such fractures. In this study we explored an accurate and feasible way to restore normal anatomy and function of the knee joint with 3D printing technology.

Case presentation:

Rationale: This report explored an accurate and feasible way to treat PFF around tumor knee prosthesis in a 32 years old women with 3D printing technology, which restored normal anatomy and function of the knee joint. Patient concerns: Pain in left thigh lasted for 10 months after resection of left femoral chondroma and knee joint replacement four years ago. Diagnoses: periprosthetic femoral fractures (PFF) around tumor knee prosthesis.

Interventions:

CT images of the patient were collected and reconstructed. Parameters of bilateral femurs were virtually sliced and measured. Novel femoral stem and nail paths were specially designed by doctors according to these parameters. The prosthetic femoral stem components and navigator were customized by engineers according to the doctor's design. The residual femoral resin model, customized components and navigator were printed with Stereo Lithography Apparatus 3D printer. The shape-preconcerted allograft bone was selected as patch for the bone defect before operation with the printed bone model. All the steps were simulated preoperatively with the models printed, and then the operation was carried out. Outcomes: The operation was successfully performed. The postoperative x-ray image, MSTS93 scores were examined and the function restoration sustained well in the follow-up period from 1 month to 27 months. Lessons: 3D printing and medical interaction are key points in complex PFF cases.

Conclusion:

As for PFF of the complex tumor of knee, preoperative design and simulation with 3D printing technology may provide more accurate and effective operative outcome than traditional methods, which might be considered as a method suitable for popularization in complex and severe cases.
Exercise as an intervention for patients with end-stage liver disease
Authors: Locklear Cameron T. , Golabi Pegah , Gerber Lynn , Younossi Zobair M.
Published: October 2018

Background:

Various etiologies of chronic liver disease often result in cirrhosis. Beside obvious liver-related complications, cirrhosis also leads to loss of muscle mass and decreased exercise capacity. In this study, our aim was to conduct a systematic review of literature to investigate the efficacy of exercise interventions in patients with cirrhosis.

Method:

PubMed was used to perform the literature search. The mesh terms used were the following: (liver (and) cirrhosis (and) exercise or (exercise therapy)). The following terms were excluded: Non-alcoholic fatty liver disease (NAFLD). The search was limited to the English language and human research. The initial search was conducted on December 6, 2016 and re-reviewed May 2017.

Results:

Seven studies met selection criteria. Training interventions ranged between 4 and 14 weeks in duration with an exercise frequency of 3 to 5 days per week. Most studies demonstrated an increase in maximal oxygen consumption using gas exchange techniques. Two of 3 studies demonstrated increased distance covered in the 6-minute walk test. One study showed a clinically significant decrease in hepatic venous pressure gradient, while another showed a transient increase only during exercise. There were no adverse effects of the exercise program reported.

Conclusions:

Exercise in selected patients with cirrhosis can have potential benefit in endurance and functional outcome measures without adverse effect from exercise.
Value of using the international classification of functioning, disability, and health for stroke rehabilitation assessment
Authors: Zhang Tong , Liu Lixu , Xie Rong , Peng Ying , Wang Huifang , Chen Zhuoming , Wu Shizheng , Ni Chaomin , Zheng Jiejiao , Li Xueping , Liu Heyu , Xu Guangxu , Fan Jianzhong , Zhu Yuhong , Zhang Fang , Du Yanhui , Wang Xin , Wang Yulong , Xiao Weimin , Liu Ming , Mou Xiang , Zhao Jun , Song Luping , Li Bingjie
Published: October 2018

This study aimed to evaluate the efficiency of the International Classification of Functioning, Disability, and Health (ICF) in stroke rehabilitation assessment in China and to identify correlations between the ICF and several commonly used clinical assessment instruments for stroke.

In total, 52 hospitals and 5 premier rehabilitation and neurology research centers participated in this cross-sectional multicenter clinical study. A total of 2822 stroke patients admitted to a neurology or rehabilitation department of a participating medical center between July 2012 and June 2014 were included. The ICF checklist contains 4 parts with 128 two-level items: body functions, body structures, activities and participation, and environmental factors. We analyzed the results of ICF assessments and determined whether correlations existed between the various items of the ICF and several commonly used clinical assessment instruments.

In all but 3 instances, the scores for the ICF-b-body function, ICF-s-body structure-degree of impairment, ICF-s-body structure-impairment location, ICF-d-activity performance, ICF-d-ability performance, ICF-e-facilitator, and ICF-e-barrier correlated significantly (P < .05) with the scores for the commonly used clinical assessment instruments.

The ICF checklist is a new rehabilitation assessment instrument that is compatible with commonly used clinical assessment scales for stroke and can be used in combination with these scales.
Preliminary development of a questionnaire assessing the impact of psoriasis and psoriatic arthritis on patient's perception of sexuality
Authors: Esteve Eric , Maccari François , Delavierre Dominique , Vicariot Catherine , Charles Bénédicte , Marty Marc , Lespessailles Eric
Published: October 2018

Psoriasis and psoriatic arthritis impact sexuality and intimate relationships in both men and women, and can be associated with sexual dysfunctions.

The aim of this study was to develop and validate a specific questionnaire assessing the impact of psoriasis and psoriatic arthritis on patients’ sexuality. Two focus groups of patients, concerned by sexuality, were conducted in February 2015. Based on the verbatim transcripts, a content analysis was performed by a psychologist trained in qualitative procedures.

After analysis of the verbatim reports by the research group, a preliminary questionnaire comprising 22 questions was drawn up. The areas covered by the questions concerned: the quality of daily life, tolerance of the cutaneous state by the patient, tiredness, mobility and flexibility of the joints, outside activities involving movement of all or part of the body. In the following step the questions were then submitted to a panel of experts for selection using a Delphi method. The experts were questioned about item relevance and content. After expert consensus had been reached, the instructions to participants completing the questionnaire, the wording of items, and the possible answers were finalized.

The final questionnaire (comprising 14 questions) is entitled “Questionnaire of sexual quality of life perceived by patients with cutaneous and/or articular psoriasis” (short denomination: Qualipsosex). The quantitative step has not yet been conducted. This step will aim to evaluate the metrologic qualities (reliability, validity, and responsiveness) of the questionnaire and will need to be validated according to the consensus-based standards for the selection of health measurement instrument checklist.
The modified balloon crush technique
Authors: Roh Jae-Hyung , Kim Young-Hak , Kang Hee Jun , Lee Pil Hyung , Yoon Sung-Han , Chang Mineok , Ahn Jung-Min , Park Duk-Woo , Kang Soo-Jin , Lee Seung-Whan , Lee Cheol Whan , Park Seong-Wook , Park Seung-Jung
Published: October 2018

This study aimed to investigate the feasibility and safety of the modified balloon crush technique.

The conventional crush technique accompanies difficult and suboptimal final kissing balloon inflation (FKI)

In a single-center percutaneous coronary intervention registry, 515 patients with 515 bifurcation lesions were treated with the modified balloon technique (n = 70) or the conventional crush technique (n = 445). In contrast to the conventional crush technique, where the implanted side branch (SB) stent is crushed by expansion of the main branch (MB) stent, the modified balloon crush technique uses balloon crushing and additional SB ballooning across the crushed SB stent before MB stenting to facilitate FKI. The primary outcome of interest was major adverse cardiovascular event (MACE), a composite of all-cause death, spontaneous myocardial infarction, and target vessel revascularization.

Baseline clinical and angiographic characteristics were similar between the 2 treatment groups. FKI had comparable success rates in both groups (97.1% for the modified balloon group and 98.4% for the conventional crush group; P = .35). There were no differences in procedure time, fluoroscopic time, or contrast amount between the 2 groups. At 1-year follow up, the cumulative MACE incidences were comparable between the 2 groups (7.3% vs 8.8%; P = .73). The incidence of target lesion revascularization (TLR) was significantly lower after the modified balloon crush technique compared with the conventional crush technique (0% vs 5.6%; P = .048).

The modified balloon crush technique appears to be a feasible and safe alternative to the conventional crush technique with the potential to reduce the revascularization rate.
Effectiveness of surgical hand antisepsis using chlorhexidine digluconate and parachlorometaxylenol hand scrub
Authors: Vallejo Ricardo Becerro de Bengoa , Fernandez David Sevillano , Cervera Luis Alou , Aragón Laura Martín , Iglesias Marta Elena Losa , Yurrita Luis Rodolfo Collado , Lopez Daniel Lopez
Published: October 2018

Background:

Chlorhexidine and parachlorometaxylenol (PCMX) are antiseptics recommended for surgical hand antisepsis. To our knowledge, PCMX has not been evaluated for bactericidal efficacy “in vivo.

Methods:

We conducted a randomized, double-blind, controlled crossover trial to compare the bacterial loads on fingertips and fingernails under laboratory conditions after use of antiseptic test products, including chlorhexidine digluconate 4%, PCMX 3%, and a reference solution of propan-1-ol 60% (P-1). We assessed bacterial load after a prewash with soft soap, immediately after application of an antiseptic, and 3 hours after application and wearing of sterile, powder-free gloves. Our procedures followed those specified by European Norm (EN) 12791 for evaluating surgical hand antiseptics and using cotton swab for fingertips and fingernails.

Results:

Chlorhexidine digluconate 4% and PCMX 3% did not decrease bacterial load on the hands. The bactericidal performances of chlorhexidine digluconate 4% and PCMX 3% did not differ significantly. Chlorhexidine digluconate 4% and PCMX 3% increased bacterial load on the fingertips after participants had worn gloves for 3 hours. Fingernails had greater bacterial loads than skin on the fingertips.

Conclusions:

Chlorhexidine digluconate 4% and PCMX 3% had similar bactericidal efficacy, but they failed to meet the EN 12791 efficacy standard. Fingernails should be a particular focus of antisepsis in preparation for surgery.

The trial was registered at ClinicalTrials.gov (ID: NCT02500758).
Sertoli–Leydig cell tumors of ovary
Authors: Xu Qiong , Zou Yu , Zhang Xiao Fei
Published: October 2018

Introduction:

The purpose of this study was to report the clinical features, computed tomography (CT) and magnetic resonance imaging (MRI) findings, clinical management, and prognoses of 7 patients with Sertoli–Leydig cell tumors (SLCT) of ovary, and to review the literature of this rare condition.

Methods:

Seven patients with pathologically confirmed ovarian SLCT were included. Their clinical, CT and MRI characteristics (CT images obtained from 6 patients and MR images from 4 patients), clinical management, and prognoses of 7 patients were retrospectively analyzed.

Results:

Patients symptoms included irregular menstruation (n = 3), infertile (n = 1), vaginal bleeding after 7 years of menopause (n = 1), a palpable abdominal mass (n = 1), and abdominal pain (n = 1). Three patients had elevated alpha-fetoprotein (AFP), 1 had elevated cancer antigen 125 (CA125), and 2 had elevated Testosterone (T). The 7 tumors of 7 patients were solid or mixed solid-cystic mass with clear boundaries. The solid components of the tumors showed iso-dense on CT. On MRI, the solid components showed iso- or slightly low signal intensity (SI) on T1-weighted imaging (T1WI), high or slightly high SI on T2WI, and high on diffusion-weighted imaging (DWI) with low apparent diffusion coefficient (ADC) value. On contrast-enhanced CT and MRI, 1 tumor exhibited heterogeneous enhancement consisting of multiple nodules with relatively marked homogeneous enhancement, and other 6 tumors showed moderate or marked and constantly heterogeneous enhancements. All patients were treated with surgical excision. Only 3 had received postoperative chemotherapy. With the exception of 1 patient lost to follow-up, the other 6 patients exhibited tumor-free survival with a median follow-up time of 13.5 months, the longest follow-up time being 24 months.

Conclusion:

The patients of SLCT can present with hormonal magnification and manifest high AFP, CA125, and T levels. SLCT is characterized by a solid or mixed solid-cystic mass on CT/MR scans, and shows marked or moderated heterogeneous and constantly enhancement upon postcontrast study. The clinical characteristics and imaging findings are features and appropriated imaging should be performed whenever an SLCT is suspected.
Giant primary liposarcoma of the anterior mediastinum
Authors: Yang Yu-Shang , Bai Cheng-Yun , Li Zhong-Cheng , Li Wen-Jun , Li Yong
Published: October 2018

Rationale:

Liposarcoma is a cancerous mesenchymal tumor and the most common soft-tissue sarcoma that starts in the adipose tissue. Liposarcoma is commonly found in lower extremities and retroperitoneum, but rarely occurs in the mediastinum.

Patient concerns:

A 63-year-old male was referred to our clinic with a 6-month history of chronic cough and dyspnea.

Diagnose:

Chest x-rays demonstrated a large mass occupying the left hemithorax. Contrast-enhanced computed tomography (CT) revealed a large mass in the anterior mediastinum, which caused the extrinsic compression of the main and left pulmonary artery and the right shift of mediastinum. Diagnosis of liposarcoma was confirmed by microscopic examination and immunohistochemistry analysis.

Interventions:

The patient underwent a thoracotomy for resection of the mediastinal lesion via left thoracic approach.

Outcomes:

The patient discharged without any complications and has been continuing to follow up in clinic without any complaints.

Lessons:

The primary mediastinal liposarcoma is rare, and we recommend that the liposarcoma should be considered in the differential diagnosis of a patient presenting with a mediastinal mass.
Brachial plexus schwannoma mimicking cervical lymphadenopathy
Authors: Ryu Kyeong Hwa , Moon Jin Il , Baek Hye Jin , Cho Soo Buem , Choi Bo Hwa , An Hyo Jung , Song Dae Hyun
Published: October 2018

Rationale:

Brachial plexus schwannomas are rare benign tumors that are derived from Schwann cells. Because they are rare, and because of the complexity of the anatomy of the neck, these tumors can be a challenge to diagnose for radiologists and clinicians. In the present study, we describe a clinical case of brachial plexus schwannoma detected on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), and presenting as a palpable neck mass.

Patient concerns:

A 49-year-old woman had a palpable mass in the right neck, which had been there for the last 1 year. Metastatic cervical lymphadenopathy was suspected in the primary health clinic; therefore, the patient was referred to our hospital.

Diagnoses:

The right neck mass was a well-circumscribed oval soft tissue mass on US, CT, and MRI. US-guided core needle biopsy was performed and the mass was proved to be a schwannoma.

Interventions:

The patient did not undergo surgical excision because the brachial plexus schwannoma was small and there was no accompanying neurological symptom.

Outcomes:

The patient is being followed up regularly at the outpatient department.

Lessons:

Brachial plexus schwannoma should be considered for a differential diagnosis in patients with a palpable neck mass, and imaging studies play an important role in diagnosing the brachial plexus schwannoma.
Higher age at diagnosis of hemochromatosis is the strongest predictor of the occurrence of hepatocellular carcinoma in the Swiss hemochromatosis cohort
Authors: Nowak Albina , Giger Rebekka S. , Krayenbuehl Pierre-Alexandre
Published: October 2018

Hereditary hemochromatosis (HH) is the most common genetic disease in Caucasians which is characterized by an increased intestinal iron absorption, resulting into a progressive accumulation of iron in organs including liver, heart, and pancreas, leading to their progressive dysfunction. Hepatocellular carcinoma (HCC) is a long-term complication of HH, which contributes to increased mortality.

We evaluated the risk factors of HCC in a prospective cohort of Swiss hemochromatosis patients with a long-term follow-up.

We included 147 patients with the mean age at diagnosis of 48 years, in whom 70% were men. Overall, 9% of the patients developed HCC during the mean follow-up time of 14 years (range 1–40 years). Patients with HCC had higher age at diagnosis (61 ± 11 vs 47 ± 13 years, P = .003), more frequently liver cirrhosis on biopsy (90% vs 37.5%, P = .004), and higher serum ferritin levels [3704 (Q1:2025, Q3:4463) vs 1338 (Q1:691, Q3:2468) μg/L, P < .001], they needed more iron removed by phlebotomy until its depletion [8.9 (Q1:7.2, Q3:10.1) vs 3.8 (Q1:1.6, Q3:8.9) g, P = .029], compared to non-HCC patients. After adjustment for possible confounders, only higher age at diagnosis remained significantly associated with HCC development (odds ratio 1.19, 95% CI 0.056–0.397, P = .001, per year).

Higher age at diagnosis showed the strongest association with the occurrence of HCC in Swiss hemochromatosis patients. Patients who were diagnosed at a higher age and with a high iron overload (serum ferritin levels >1000 μg/L) require regular screening even if they have no liver cirrhosis.
Hormonal biomarkers for the noninvasive diagnosis of endometriosis
Authors: Shen Minghui , Gao Ya , Ma Xueni , Wang Bo , Wu Jiarui , Wang Jiancheng , Li Jipin , Tian Jinhui , Jia Junhai
Published: October 2018

Background:

Endometriosis is a major cause of disability and compromised the quality of life in women and teenage girls. The gold standard for diagnosis of endometriosis is laparoscopy with histology of excised endometriosis lesions. However, women can suffer for 8 to 12 years before obtaining a correct diagnosis. Several biomarkers showed good diagnostic value for endometriosis, but no studies directly or indirectly compare the diagnostic value of different biomarkers. We perform this network meta-analysis (NMA) to assess the diagnostic accuracy of hormonal biomarkers, and to find a most effective hormonal biomarker for the diagnosis of endometriosis.

Methods:

A systematic search will be performed using PubMed, EMBASE, Cochrane Library and Chinese Biomedicine Literature to identify relevant studies from inception to August 2018. We will include random controlled trials, cross-sectional studies, case-control studies, and cohort studies that evaluated the diagnostic accuracy of hormonal markers for endometriosis. The Quality Assessment of Diagnostic Accuracy Studies 2 quality assessment tool will be used to assess the risk of bias in each study. Standard pairwise meta-analysis and NMA will be performed using STATA V.12.0, MetaDiSc 1.40 and R 3.4.1 software to compare the diagnostic efficacy of different hormonal biomarkers.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

This study will summarize the direct and indirect evidence to determine the diagnostic accuracy of the hormonal biomarkers for endometriosis and attempt to find a most effective biomarker for the diagnosis of endometriosis.

Ethics and dissemination:

Ethics approval and patient consent are not required as this study is a meta-analysis based on published studies.

PROSPERO registration number:

CRD42018105126.
Prevalence of nonsuicidal self-injury in chinese middle school and high school students
Authors: Lang Junjie , Yao Yingshui
Published: October 2018

Recent studies have revealed a high rate of nonsuicidal self-injury (NSSI) behavior in Chinese students, but quantitative syntheses of pooled prevalence are sparse. There have been several NSSI prevalence meta-analyses in other populations. However, given the existence of cultural diversity, racial difference, educational system difference and so on, these results may not be ideal for Chinese populations. Furthermore, the above-mentioned meta-analyses did not include Chinese database which may have led to unintentional bias. Thus, we conducted this meta-analysis to estimate the prevalence of NSSI in Chinese middle-school students.

The databases searched included PubMed, Embase, Web of Science, CBM (Chinese database), Chinese National Knowledge Infrastructure (CNKI), Wanfang Data (Chinese database) and the Weipu database (Chinese database). The search terms included: self-injury/self-harm/self-abuse/nonsuicidal self-injury/deliberate self-harm, adolescen∗/youth/teen/students, and China/Chinese. All relevant articles published between January 2000 to November 2017, in either Chinese or English, were included. Two investigators were engaged in this process, and any disagreements were settled by a third investigator. A random effects model was then used to calculate the pooled prevalence.

A total of 420 studies with 160,348 participants were retrieved. The pooled prevalence was 22.37% (95% CI: 18.84%–25.70%). Substantial heterogeneity in prevalence estimates was revealed. Subgroup analyses showed that the pooled estimate of prevalence of life time NSSI was 14.5% (95%CI: 0.06%–22.7%), and 6–24 months NSSI was23.3% (95%CI: 20.5%–26.1%). The prevalence for males was 20.6% (95% CI: 16.1%–25.0%), and for females was 21.9% (95% CI: 17.6%–26.2%).

The prevalence of NSSI in Chinese middle-school students is relatively high. More attention should be paid to the current situation.
A randomized interventional study to promote milk secretion during mother–baby separation based on the health belief model
Authors: Liu Yi , Yao Jianrong , Liu Xinghui , Luo Biru , Zhao Xiufang
Published: October 2018

Background

Breast milk is the most important nutrition for premature babies, but mothers of premature infants have difficulty in initiating and sustaining lactation. Breastfeeding infants who are separated with mothers have decreased morbidity. Nevertheless, such decrease is limited due to insufficient milk supply resulting from mother–baby separation during lac.

Objective

To evaluate the effect of intervention methods based on the health belief model on promoting the secretion of milk among mothers who were separated with their babies.

Methods

In this prospective, randomized controlled clinical trial, we enrolled 260 separation mothers between September 26, 2016 and March 7, 2017, in a 3rd-grade women and children hospital of Chengdu. The mothers all had cesarean delivery and were randomized into 2 groups: the intervention group (educated by investigators based on the health belief) and the control group (routinely educated by obstetric nurses). Data on the onset of lactation and the milk volume during 3 days postpartum were collected. The breast swelling rate within 3 days postpartum and the exclusive breastfeeding rate at 42 days postpartum were compared. The psychologic scores of separation maternal in both groups were assessed with State-Trait Anxiety Inventory at the 3rd day postpartum.

Results

Compared with the control group, the intervention group had significantly earlier lactation time (P < .01), significantly larger milk volume (P < .01) during 24, 24 to 48, and 48 to 72 hours, and significantly lower psychologic scores (P < .01) at the 3rd-day postpartum.

The onset of lactation among mothers who initiated milk expression within 1 hour after childbirth were earlier than those who initiated milk expression between 1 and 6 hours (P < .01); the milk volume within 24-hour postpartum did not differ significantly between the 2 groups (P > .05). However, the milk volume of the early-expression group (<1 hour) was significantly higher than that of the late-expression group (1–6 hours) during 24 to 48 and 48 to72 hours (P < .05).

The breast swelling rate of separation mothers within 3 days postpartum in the intervention group was lower than that in the control group (P < .05). The exclusive breastfeeding rate of mothers in the intervention group was significantly higher than that in the control group (59% vs 35%; P < .01) at 42 days postpartum.

Conclusion

Nursing intervention based on the health belief model can stimulate milk secretion in mothers who were separated with their babies.
Hepatotoxicity of Statins as Determined by Serum Alanine Aminotransferase in a Pediatric Cohort With Dyslipidemia
Authors: Desai Nirav K. , Mendelson Michael M. , Baker Annette , Ryan Heather H. , Griggs Suzanne , Boghani Meera , Yellen Elizabeth , Buckley Lucy , Gillman Matthew W. , Zachariah Justin P. , Graham Dionne , Jonas Maureen M. , de Ferranti Sarah D.
Published: October 2018

Objective:

The aim of the study was to evaluate the hepatotoxicity of statins, as determined by serum alanine aminotransferase (ALT), in children and adolescents with dyslipidemia in real‐world clinical practice.

Study design:

Clinical and laboratory data were prospectively collected between September 2010 and March 2014. We compared ALT levels between patients prescribed versus not prescribed 3‐hydroxy‐3‐methyl‐glutaryl‐coenzyme A reductase inhibitors (statins), and then compared ALT before and after initiation of statins.

Results:

Over the 3.5‐year observation period, there were 2704 ALT measurements among 943 patients. The mean age was 14 years; 54% were boys, 47% obese, and 208 patients were treated with statins. Median follow‐up after first ALT was 18 months. The mean (SD) ALT in statin and non‐statin users was 23 (20) U/L and 28 (28) U/L, respectively. In models adjusted for age, sex, and race, ALT was 2.1 U/L (95% CI 0.1 to 4.4; P = 0.04) lower among statin users, which was attenuated after adjustment for weight category. Patients started on statins during the observation period did not demonstrate an increase in ALT over time (ALT 0.9 U/L [95% confidence interval −5.2 to 3.4] increase per year; P = 0.7).

Conclusions:

In our study population, we did not observe a higher burden of ALT elevations among pediatric patients on statins as compared to those with dyslipidemia who are not on statins, supporting the hepatic safety of statin use in childhood.
Long-term Complications and Management of Gastrointestinal Bleeding in Multifocal Lymphangioendotheliomatosis
Authors: Shakir Asiya K. , Yu Zhongxin , Altaf Muhammad Adnan
Published: October 2018

Multifocal lymphangioendotheliomatosis with thrombocytopenia is a rare disease characterized by multiple cutaneous and gastrointestinal (GI) vascular lesions and thrombocytopenia refractory to platelet and blood cell transfusions. GI bleeding can become life-threatening in this condition. We report a case of multifocal lymphangioendotheliomatosis with thrombocytopenia in a male infant with isolated GI involvement, diagnosed when he was 3 months old. The patient was managed with daily aminocaproic acid, octreotide drip, and corticosteroids for 13 months after diagnosis; he had complete resolution of symptoms by 2 years of age and showed adequate height and gain by 5 years of age. This case adds to the paucity of data in the literature pertaining to the disease’s phenotypic variability, long-term clinical course, and management of GI bleeding.
Cutaneous Leishmaniasis
Authors: Taxy Jerome B. , Goldin Harry M. , Dickie Sara , Cibull Thomas
Published: October 2018

The ulcerated papules of cutaneous leishmaniasis represent an unusual form of granulomatous dermatitis caused by Leishmania species, a protozoan transmitted by sandfly bites. As the disease is not native to North America, clinical suspicion is partially based on a compatible travel history and may result in a biopsy. The key role of standard morphology is the identification of Leishmania organisms, supplemented by Giemsa and/or CD1a immunostaining. Histologically, the organism may be confused with Histoplasma species, which is resolved by staining with methenamine silver or PAS. Four cases of cutaneous leishmaniasis are presented for which organisms were present in 3; polymerase chain reaction and DNA sequencing for speciation done by the Center for Disease Control and Prevention (CDC) was confirmatory in 3 cases, including the one case without histologically identifiable organisms. Rare unexplained cases of cutaneous leishmaniasis without a travel history have been reported outside endemic areas. The present cases emphasize the importance of diagnostic awareness of unusual infections such as this in the context of political unrest, ease of international travel, climate change and the possible expansion of geographic vector distribution. In the morphologic absence of organisms, the diagnosis may require molecular techniques, currently available on a referral basis to pathologists without charge from CDC.
Tumor Budding and Prognosis in Gastric Adenocarcinoma
Authors: Kemi Niko , Eskuri Maarit , Ikäläinen Julia , Karttunen Tuomo J. , Kauppila Joonas H.
Published: October 2018

Tumor budding has been associated with poor prognosis in several cancer types, but its significance in gastric cancer is unknown. The aim of this study was to assess the prognostic significance of tumor budding in gastric adenocarcinoma, and its main histologic types. Some 583 gastric adenocarcinoma patients who underwent surgery in Oulu University Hospital during the years 1983-2016 were included in this retrospective cohort study. Tumor budding was counted per 0.785 mm2 fields from the slides originally used for diagnostic purposes. Patients were divided into low-budding (<10 buds) and high-budding (≥10 buds) groups. Tumor budding was analyzed in relation to 5-year survival and overall survival. Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI), adjusted for confounders. Determining tumor budding was difficult in diffuse-type cancer due to the uncohesive growth pattern of these tumors. Patients with high tumor budding had worse 5-year survival compared with patients with low tumor budding (adjusted HR, 1.55; 95% CI, 1.20-2.01). In intestinal-type adenocarcinomas, the high-budding group had significantly poorer 5-year survival compared with the low-budding group (adjusted HR, 1.57; 95% CI, 1.14-2.15). There were no differences in 5-year survival between the budding groups in the diffuse type adenocarcinoma. In conclusion, high tumor budding is an independent prognostic factor in gastric adenocarcinoma, but its value is limited to the intestinal type of gastric adenocarcinoma. In diffuse type gastric adenocarcinoma, the assessment of tumor budding is hardly feasible, and it does not have prognostic relevance.
Identifying Hesitation and Discomfort with Diagnosing Sepsis: Survey of a Pediatric Tertiary Care Center
Authors: Breuer Ryan K. , Hassinger Amanda B.
Published: October 2018

Objective:

Pediatric sepsis remains a significant cause of morbidity and mortality despite the development of strategies proven to improve diagnosis and treatment. Specifically, early recognition and urgent therapy initiation are consistently associated with improved outcomes. However, providers bring these principles inconsistently to the bedside. The objective of this study was to describe practitioner knowledge of, and attitudes toward, sepsis as a means of identifying potentially modifiable factors delaying life-saving treatment. We hypothesized there would be difficulties with sepsis recognition and self-reported discomfort with making the diagnosis among all provider groups in a pediatric tertiary care center.

Methods:

Emergency department and inpatient pediatric physicians, nurses, and respiratory therapists in a single, freestanding children’s hospital received an electronic survey. Likert scales permitted anonymous self-reporting of comfort and diagnostic delays. Seven clinical vignettes assessed diagnostic knowledge. Independent sample t tests and Chi-square compared responses.

Results:

Three hundred two staff participated (73% response rate), 41% of whom had at least 10 years of clinical experience. One in 5 was uncomfortable alerting coworkers to a patient with suspected sepsis or septic shock, and almost half were uncomfortable doing so in cases of compensated shock. Every role self-reported diagnostic delays, including faculty physicians. On average, physicians answered a greater percentage of vignette questions correctly (66%), compared with nurses (58%; P = 0.013) and respiratory therapists (52%; P = 0.005).

Conclusions:

Sepsis knowledge deficits, provider discomfort, and diagnostic delays are prevalent within a tertiary care children’s hospital. Their presence and scale suggest areas for future research and targeted intervention.
Friction-lowering capabilities and human subject preferences for a hydrophilic surface coating on latex substrates: implications for increasing condom usage
Authors: Cooper Benjamin G. , Chin Stacy L. , Xiao Ruiqing , Buch Karen , Kim Ducksoo , Grinstaff Mark W.
Published: October 2018

Personal lubricants can increase user satisfaction with male condoms by reducing friction and yielding a slippery sensation. However, lubricants pose disadvantages of dilution in physiologic fluids and sloughing away over repeated articulations. To address these drawbacks, a latex surface modification, which becomes lubricious in the presence of physiologic fluid, has been developed and evaluated. This study assesses (i) the frictional performance of the lubricious coating compared to non-coated latex and latex lubricated by personal lubricant, (ii) the level of agreement between human-perceived slipperiness and machine-measured friction, and (iii) human preference for a hypothetical male condom containing the lubricious coating. Friction coefficient of the lubricious coating was 53% lower than that of non-coated latex and approximately equal to that afforded by personal lubricant. A touch test and survey of a small population sample (
N
= 33) revealed a strong correlation (
R
2
= 0.83) between human-perceived slipperiness and machine-measured friction. A majority of participants (73%) expressed a preference for a condom containing the lubricious coating, agreeing that an inherently slippery condom that remained slippery for a long duration would increase their condom usage. Such a coating shows potential to be an effective strategy for decreasing friction-associated pain, increasing user satisfaction and increasing condom usage.