bluuebunny/crossref_metadata_2025 huggingface dataset:
Site-specific Patient-reported Outcome Measures for Hand Conditions: Systematic Review of Development and Psychometric Properties
Authors: Wormald Justin C.R. , Geoghegan Luke , Sierakowski Kyra , Price Andrew , Peters Michele , Jain Abhilash , Rodrigues Jeremy N.
Published: May 2019

Background:

There are a number of site-specific patient-reported outcome measures (PROMs) for hand conditions used in clinical practice and research for assessing the efficacy of surgical and nonsurgical interventions. The most commonly used hand-relevant PROMs are as follows: Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (qDASH), Michigan Hand Questionnaire (MHQ), Patient Evaluation Measure (PEM), Upper Extremity Functional Index (UEFI), and Duruoz Hand Index (DHI). There has been no systematic evaluation of the published psychometric properties of these PROMs.

Methods:

A PRISMA-compliant systematic review of the development and validation studies of these hand PROMs was prospectively registered in PROSPERO and conducted to assess their psychometric properties. A search strategy was applied to Medline, Embase, PsycINFO, and CINAHL. Abstract screening was performed in duplicate. Assessment of psychometric properties was performed.

Results:

The search retrieved 943 articles, of which 54 articles met predefined inclusion criteria. There were 19 studies evaluating DASH, 8 studies evaluating qDASH, 13 studies evaluating MHQ, 5 studies evaluating UEFI, 4 studies evaluating PEM, and 5 studies evaluating DHI. Assessment of content validity, internal consistency, construct validity, reproducibility, responsiveness, floor/ceiling effect, and interpretability for each PROM is described.

Conclusions:

The psychometric properties of the most commonly used PROMs in hand research are not adequately described in the published literature. DASH, qDASH, and MHQ have the best-published psychometric properties, though they have either some poor psychometric performance or incompletely studied psychometric properties. There are more limited published data describing the psychometric properties of the UEFI, PEM, and DHI.
Development of In Vitro Bioengineered Vascular Grafts for Microsurgery and Vascular Surgery Applications
Authors: Singh Gurtej , Cordero John , Wiles Brody , Tembelis Miltiadis N. , Liang Kai-Li , Rafailovich Miriam , Simon Marcia , Khan Sami U. , Bui Duc T. , Dagum Alexander B.
Published: May 2019

Introduction:

The use of vascular grafts is continuing to rise due to the increasing prevalence of coronary artery bypass grafting and microvascular flap-based tissue reconstructions. The current options of using native vessels (saphenous vein) or the synthetic grafts (Dacron) have been unable to manage current needs. In this study, we employed an original tissue engineering approach to develop a multi-layered vascular graft that has the potential to address some of the limitations of the existing grafts.

Materials and Methods:

Biomaterials, gelatin and fibrin, were used to develop a two-layered vascular graft. The graft was seeded with endothelial cells and imaged using confocal microscopy. The graft’s architecture and its mechanical properties were also characterized using histology, Scanning Electron Microscopy and rheological studies.

Results:

Our methodology resulted in the development of a vascular graft with precise spatial localization of the two layers. The endothelial cells fully covered the lumen of the developed vascular graft, thus providing a non-thrombogenic surface. The elastic modulus of the biomaterials employed in this graft was found to be 5.186 KPa, paralleling that of internal mammary artery. The burst pressure of this graft was also measured and was found close to that of the saphenous vein (~2000 mm Hg).

Conclusions:

We were successfully able to employ a unique method to synthesize a multi-layered vascularized graft having adequate biological and mechanical properties. Studies are ongoing involving implantation of this developed vascular graft in the rat femoral artery and characterization of parameters such as vascular remodeling and patency.
Lymphatic Vessel Thrombosis in a Patient with Secondary Lymphedema
Authors: Hara Hisako , Mihara Makoto , Ohtomo Rie , Tanaka Sayuri
Published: May 2019

Lymphatic thrombosis is rarer than venous thrombosis. This case report describes a patient with secondary lymphedema, who was found to have lymphatic thrombosis during lymphaticovenous anastomosis (LVA). A 51-year-old woman underwent hysterectomy and pelvic lymph node dissection for uterine cancer when she was 48 years old, and lymphedema developed in the left leg soon after the operation. She was diagnosed with lymphedema based on lymphoscintigraphic finding. Preoperative echography showed 2 hypoechoic circles measuring about 0.5 mm in diameter that did not collapse with pressure from the probe, although the veins collapsed with pressure. We diagnosed the 2 hypoechoic circles as lymphatic vessels based on the location and longitudinal continuity. During LVA, we identified 2 parallel white vessels beneath the superficial fascia. After they were cut, white material was extruded. A diagnosis of lymphatic thrombosis was made, and we ligated the lymphatic vessels, closed the wound at this site, and performed LVA at other sites (4 sites in the left and 1 site in the right leg). The postoperative course was uneventful. Histopathological examination showed hyperplasty of fibroblasts and organization in the thrombus. Lymphatic thrombosis is sometimes found in the lymphedema-affected extremities. On retrospective consideration, lymphatic thrombosis can be detected with preoperative echography.
Ischemic Complications after Nipple-sparing Mastectomy: Predictors of Reconstructive Failure in Implant-based Reconstruction and Implications for Decision-making
Authors: Salibian Ara A. , Frey Jordan D. , Bekisz Jonathan M. , Karp Nolan S. , Choi Mihye
Published: May 2019

Background:

Mastectomy flap and nipple–areola complex (NAC) ischemia can be devastating complications after nipple-sparing mastectomy (NSM). Predictors of reconstructive failure with major skin envelope ischemia and implications for decision-making remain to be fully elucidated.

Methods:

All cases of implant-based reconstruction after NSM from 2006 to June 2018 with mastectomy flap necrosis or NAC necrosis requiring debridement were reviewed. Data on patient demographics, operative characteristics, additional complications, and the nature and management of ischemic complications were collected and analyzed.

Results:

Out of 1045 NSMs, 70 cases (6.7%) had major ischemic complications. Fifty-two cases (74.3% of major ischemic complications) had isolated major mastectomy flap necrosis, 7 (10%) had full NAC necrosis and 11 (15.7%) had both. Five cases (7.1%) underwent implant exchange at the time of debridement and 15 cases (21.4%) required explantation. Explanted cases had significantly lower body mass index (22.3 versus 24.7, P = 0.013) and larger debridement size (49.5 cm2 versus 17.6 cm2, P = 0.0168). Additionally, explanted cases had a higher rate of acellular dermal matrix/mesh (100% versus 45.5%, P < 0.0001), prior radiation (20.0% versus 0%, P = 0.0083), immediate implants (46.7% versus 20.0%, P = 0.0491), major infection (30.0% versus 1.8%, P = 0.028), and both major mastectomy flap/NAC necrosis (33.3% versus 10.9%, P = 0.0494).

Conclusions:

NSM cases with major ischemia requiring explantation had a lower body mass index and significantly higher rate of preoperative radiation, immediate implant placement, use of acellular dermal matrix/mesh, and concomitant major infection. These variables should be taken into account when discussing risks with patients preoperatively and assessing the quality of mastectomy flaps and subsequent reconstructive choices intraoperatively.
Checklists, Huddles, and Debriefs: Critical Tools to Improve Team Performance in Obstetrics
Authors: TREJO FATIMA ESTRADA , IGEL CATHERINE M. , CHUANG MELEEN , BAJAJ KOMAL , BERNSTEIN PETER S.
Published: May 2019

Checklists, huddles, and debriefs are tools being more commonly adopted in health care with the goal to achieve a safer health system. Details regarding what, how and when to implement these tools in different circumstances related to women’s health are described in this review.
OUTCOMES OF VITRECTOMY IN TERSON SYNDROME
Authors: Nazarali Samir , Kherani Irfan , Hurley Bernard , Williams Geoff , Fielden Michael , Adatia Feisal , Kherani Amin
Published: May 2019

Purpose:

To characterize the presentation of Terson syndrome, the occurrence of a vitreous hemorrhage in association with intracranial hemorrhage, and report on the outcomes of vitrectomy at two major centers in Canada.

Methods:

Retrospective chart review of consecutive patients with Terson syndrome undergoing vitrectomy by retina specialists over the last 10 years. Primary outcome was the change in best-corrected visual acuity (BCVA) at 3 months from baseline. Secondary outcomes included the association between baseline BCVA and final BCVA, and the association between final BCVA and timing of surgery (early vs. later than 90 days).

Results:

A total of 14 eyes of 11 patients were included. The mean time between observation of intraocular hemorrhage and vitrectomy was 160 days. Baseline preoperative BCVA was logarithm of the minimum angle of resolution 1.57 ± 1.03 (Snellen 20/740), which improved to logarithm of the minimum angle of resolution 0.53 ± 0.82 (Snellen 20/70) at the final postoperative follow-up, P = 0.01. Baseline BCVA was not significantly correlated with final BCVA, Spearman's rho = 0.016, P = 0.957. Final BCVA did not significantly differ between those who had surgery before 90 days compared with after 90 days, P = 0.087.

Conclusion:

Vitrectomy is safe and effective and should be considered for nonclearing vitreal bleeding due to Terson syndrome. Ocular hemorrhaging in Terson syndrome can be observed conservatively for spontaneous improvement without the risk of reduced visual potential. Ophthalmic evaluation should be considered promptly after intracranial hemorrhage.
Spectrum of Microbial Keratitis Encountered in the Tropics
Authors: Khor Hui Gim , Cho Irene , Lee Kenneth Rohan Chee Keong , Chieng Lee Ling
Published: May 2019

Purpose:

To report the predisposing factors, microorganisms, antibiotic sensitivity associated with bacterial keratitis, and treatment outcomes in Miri, Borneo which has a tropical climate.

Methods:

This is a retrospective study on patients presenting with microbial keratitis in Miri, Sarawak, Borneo over a 7-year period from January 1, 2010 until December 31, 2016. Demographic data, predisposing factors, culture and sensitivity results together with treatment outcomes were studied.

Results:

There were a total of 221 cases treated as microbial keratitis with a peak age group of 21 to 30 years. The predisposing factors were trauma (49.3%), improper contact lens usage (29.1%), ocular surface diseases (5.9%), ocular surgeries (0.9%), drugs (1.8%), and other factors (19.0%). Occupational injuries among oil palm plantation workers was the leading cause within the trauma cohort (28.8%). Corneal scraping was performed in 189 cases, 61.4% of them yielded positive cultures. The cultures demonstrated that 49.1% were of bacterial origin, 46.6% were fungal, and 4.3% showed mixed growth. The most common bacteria isolated was Pseudomonas aeruginosa, which was sensitive toward ceftazidime and gentamicin antibiotics. One hundred ninety-two cases (86.9%) were treated with purely topical medication, whereas 29 cases (13.1%) required further interventions.

Conclusion:

The commonest predisposing factor for microbial keratitis was trauma. With the nearby oil palm industries, we report a corresponding increase of incidence in fungal keratitis at our center. Culture and sensitivity reports from corneal scrapings are essential in treatment guidance; however, more than a third of the microbial keratitis cases studied were culture-negative. The organisms cultured reflect the profile expected in tropical climates. Fortunately, there was no increase in resistance rates observed for the commonly used antibiotics.
Recovery of physical activity after cesarean delivery and its relationship with pain
Authors: Sharpe Emily E. , Booth Jessica L. , Houle Timothy T. , Pan Peter H. , Harris Lynnette C. , Aschenbrenner Carol A. , Eisenach James C.
Published: May 2019

Pain and physical activity are tightly intertwined. Although their relationship has been explored in chronic pain conditions, we know little about the pattern of recovery in activity and its short- and long-term relationship with pain after surgery. We recruited 103 women undergoing elective cesarean delivery and acquired daily pain assessments and hourly steps in 98 of them for 2 months after surgery. Compliance was good, with 78% of subjects missing less than 7 days of activity. Study personnel required daily checking for compliance and 20 minutes per subject per week in study. Activity increased over the first 2 postoperative months in a log(time) manner. The slope of each modeled individual curve for activity was inversely correlated (r = −0.54; P < 0.0001) with worst daily pain. After removing these 2-month trends, pain and activity within an individual day were negatively associated with each point increase in pain being inversely associated with −119 steps (95% confidence interval [CI] = −214 to −25; P = 0.013). A patient's previous experience of pain was not associated with current activity as well as current activity was not associated with future pain scores. These data, although limited by the study of a single operation in a unique social circumstance with low risk of chronic postsurgical pain, demonstrate feasibility of measuring hourly activity for 2 months after surgery. Recovery from pain and inactivity are tightly correlated, and the negative relationship between within-day pain and activity without interday carryover relationships is in stark contrast to findings in chronic pain conditions.
Factors Associated With Blood Pressure Classification in Korean University Students: A Descriptive Survey
Authors: CHOI Eun-Ju , CHANG Ae Kyung , CHOI Jin Yi
Published: May 2019

Background

The prevalence of hypertension in young adults has increased. Hypertension is known to be a leading contributor to many diseases.

Purpose

The study aimed to identify factors influencing blood pressure (BP) classification in university students and to establish a basis for the prevention and management of hypertension in young adults.

Methods

Four hundred three university students in South Korea were analyzed to determine the factors that influence BP classification. Data were analyzed using the chi-square test, analysis of variance, and multinomial logistic regression.

Results

The reference group for the logistic regression analysis included students with normal BP. The odds of being male and of having an overweight or obese body mass index were significantly higher in the prehypertension group than in the normal BP group. The odds of regular (≥ 6 months) exercise habits, having subcutaneous and borderline visceral fat types, and social support were significantly lower in the prehypertension group than in the normal BP group. The odds of being male, being overweight or obese, and having more exercise barriers were significantly higher in the hypertension group than in the normal BP group. The odds of having a high or low economic status were higher and lower in the hypertension group, respectively. Finally, the odds of having subcutaneous or borderline visceral fat types and a vigorous physical activity level were significantly lower in the hypertension group than in the normal BP group.

Conclusions

Interventions that address the factors related to BP in young adults are necessary to prevent the occurrence and progression of hypertension in young adults.
Feeding should be individualized in the critically ill patients
Authors: Berger Mette M. , Pichard Claude
Published: May 2019

Purpose of review

Any critical care therapy requires individual adaptation, despite standardization of the concepts supporting them. Among these therapies, nutrition care has been repeatedly shown to influence clinical outcome. Individualized feeding is the next needed step towards optimal global critical care.

Recent findings

Both underfeeding and overfeeding generate complications and should be prevented. The long forgotten endogenous energy production, maximal during the first 3 to 4 days, should be integrated in the nutrition plan, through a slow progression of feeding, as full feeding may result in early overfeeding. Accurate and repeated indirect calorimetry is becoming possible thanks to the recent development of a reliable, easy to use and affordable indirect calorimeter. The optimal timing of the prescription of the measured energy expenditure values as goal remains to be determined. Optimal protein prescription remains difficult as no clinically available tool has yet been identified reflecting the body needs.

Although energy expenditure can now be measured, we miss indicators of early endogenous energy production and of protein needs. A pragmatic ramping up of extrinsic energy provision by nutrition support reduces the risk of overfeeding-related adverse effects.
Nodular focal fat sparing of liver mimicking hepatocellular carcinoma in contrast-enhanced ultrasound
Authors: Fu Rong , Qiu Tingting , Ling Wenwu , Lu Qiang , Luo Yan
Published: May 2019

Introduction:

Focal fatty sparing is a manifestation of fatty liver. Nodular focal fatty sparing of liver sometimes is a mimicker of malignant lesion, especially metastatic tumor. There are some case reports about this kind of tricks revealed by computed tomography (CT) and magnetic resonance imaging. However, few reports described nodular focal sparing of liver presenting an enhancement mode of hepatocellular carcinoma (HCC) in contrast-enhanced ultrasound (CEUS).

Patient concerns:

A 37-year-old male had a long history of alcohol abuse and hepatitis B virus infection. Routine blood examination showed an elevation of triglyceride, and tumor markers were unremarkable. Conventional ultrasound indicated a diffuse fatty liver with a hypoechoic nodular lesion. CEUS revealed hyperenhancement in arterial phase and washout in late phase of this hypoechoic lesion. Contrast-enhanced CT showed a similar enhancement mode of the mass with CEUS.

Diagnosis:

A clinical diagnosis of HCC was made. Then, liver resection was conducted. Postoperative histopathologic and immunohistochemical results of the lesion revealed no presence of tumor cells except for heterogeneous hepatic steatosis. So a final diagnosis of hepatic focal fatty sparing was determined.

Interventions:

Liver resection was conducted according to the clinical diagnosis of HCC.

Outcomes:

After general postoperative administration, the patient was told to discharge. Then, he had been undergoing regular serological tests and imaging examinations in our hospital for 39 months and found no manifestation of liver tumor.

Conclusion:

According to guidelines, it is typical that hepatic focal fatty change (FFC) presents a mode of persistent iso-enhancement in CEUS. However, atypical enhancement presence of FFC in imaging examinations may occur and lead to misdiagnosis, which calls for more attention.
Subjective perceptions and psychological distress associated with the deep underground
Authors: Liu Jifeng , Liu Yilin , Ma Tengfei , Gao Mingzhong , Zhang Ru , Wu Jiang , Zou Jian , Liu Shixi , Xie Heping
Published: May 2019

This study reports the subjective perceptions and mental state of employees working in the Erdaogou Mine, affiliated with Jiapigou Minerals Limited Corporation of China National Gold Group Corporation (CJEM); these employees are pioneers working at the deepest point below ground in China. The data represent a valuable baseline from which to assess the effects of the environmental factors in the deep-underground on human physiology, psychology, and pathology.

The air pressure, relative humidity, temperature, total γ radiation dose-rate, and oxygen concentration in the CJEM in the aisles in goafs at 4 depths below ground were measured. Study subjects were administered a study-specific questionnaire that included items that targeted factors with potential to affect respondents’ health and wellbeing and included the symptom checklist-90-revised (SCL-90-R).

Air pressure, relative humidity, and temperature rose, total γ radiation dose-rate decreased, and there was no change in oxygen concentration with increasing depth below ground. Most (97.2%) respondents had a negative impression of the ambient conditions in the deep-underground space. The most commonly perceived adverse factors included moisture (74.9%), heat (33.5%), and poor ventilation (32.4%). 93.29% of respondents associated ≥1 self-reported negative physical symptom with working in the deep-underground space; the most frequent symptoms were being easily tired (48.7%), tinnitus (47.5%), and hearing loss (44.1%). Higher SCL-90-R scores were associated with the perception of >1 adverse factor in the deep-underground, spending >8 hours continuously in the deep-underground space, or working at a depth > 1000 m below ground. >1 perceived adverse factor in the deep-underground and continuously spending >8 hours in the deep-underground space were significant predictors of high SCL-90-R scores.

Adverse factors, including high temperature, humidity, and dim light, may have negative impacts on the physical and psychological health of people who spend long periods of time living and/or working in the deep-underground space.
Spontaneous thrombosis in main draining veins of unruptured cerebral arteriovenous malformations
Authors: Chen Xianyi , Lu Xiaoyang , Yan Feng , Xu Weilin , Gao Liansheng , Zheng Jingwei , Yu Jun
Published: May 2019

Rationale:

Spontaneous obliteration of unruptured arteriovenous malformations (AVMs) is rare. It occurs in <1.5% of cerebral AVMs and only 7 cases have been reported so far. This phenomenon, together with the formation and outcome of cerebral AVMs, remains barely understood. In this work, we presented a case that spontaneous venous thrombosis in main draining veins of an unruptured AVM were confirmed, and reviewed the relevant literature in order to discuss the possible mechanisms.

Patient concerns:

Clinical data and treatment of a 33-year-old man with a preliminary diagnosis as right parietal mass with secondary epilepsy.

Diagnoses:

The diagnosis of the mass was a right parietal arteriovenous malformation (AVM) that was 3.5 cm in size and supplied mainly by multiple feeders of right middle cerebral artery (MCA).

Interventions:

An operation was performed with meticulous hemostasis of the extracranial soft tissue and the AVM was resected completely.

Outcomes:

The patient's neurological deficits improved postoperatively and he was subsequently discharged 1 week after surgery.

Lessons:

Thrombosis of the draining veins may be due to venous stagnation. Spontaneous venous thrombosis in an unruptured AVM is rare. Spontaneous obliteration of an AVM can occur by 2 mechanisms: occlusion of the feeding arteries or of the draining veins. Surgical or interventional treatment of an unruptured AVM with thrombosed draining veins is highly controversial now. However, we favor an aggressive treatment strategy.
Impact of text messages in a middle-income country to promote secondary prevention after acute coronary syndrome (IMPACS)
Authors: Passaglia Luiz Guilherme , Brant Luisa Campos Caldeira , Nascimento Bruno Ramos , Ribeiro Antônio Luiz Pinho
Published: May 2019

Background:

Studies that used short message service (SMS) programs as an intervention to promote health care have shown beneficial results in the control of risk factors for ischemic heart disease in patients of high-income countries, but evidence is lacking in low or middle-income countries.

Aims:

The purpose of this study is to evaluate whether the use of SMS increases risk factor control within 6 months after discharge by acute coronary syndrome (ACS) in a middle-income country.

Methods:

It will be a 2-arm, parallel, double-blind, randomized clinical trial of 160 patients discharged after an ACS from a single center with 6 months of follow-up. The intervention group will receive 4 SMS per week offering advice, motivation and information about medication adherence, increase of regular physical activity, adoption of healthy dietary measures, and smoking cessation (if appropriate). The primary outcome is achieving 4 or 5 points in a risk factor control score, which combines the cluster effect of 5 main modifiable risk factors for ACS [low-density lipoprotein cholesterol, LDL-C <70 mg/dL, blood pressure <140/90 mm Hg, regular exercise (≥5 days/week × 30 minutes of moderate exercise per session), nonsmoker status, and body mass index, BMI <25 kg/m2]. Secondary outcomes are plasma LDL-C level, level of physical activity, blood pressure, medication adherence, proportion of nonsmokers, BMI, rehospitalization, cardiovascular death, and death from any cause. This study, as a randomized clinical trial protocol, followed the recommendations of the Standard Protocol Items (SPIRIT).

Expected outcomes:

This study aims to provide evidence of whether SMS interventions are effective in improving cardiovascular disease risk factors control in post-ACS patients in a middle-income country.

ClinicalTrials.gov Identifier:

NCT03414190 (First posted on January 29, 2018; last update on May 14, 2018) - Retrospectively registered
Risk of multiple early gastric cancers in a patient with precursor lesions and endoscopic surveillance for 7 years
Authors: Pan Hui , Fang Chaoying , He Liping , Li Houqiang , Liu Lanzai , Wang Chao , Chen Jiansu
Published: May 2019

Rationale:

Severe mucosal atrophy or intestinal metaplasia is a risk factor for synchronous and metachronous intestinal gastric cancer. Magnifying endoscopy with narrow-band imaging was useful for assessing differentiated early gastric cancer (EGC).

Patient concerns:

A 62-year-old Chinese female was diagnosed with 5 multiple EGCs or high-grade dysplasia (HGD) with endoscopic surveillance for 7 years.

Diagnoses:

Synchronous and metachronous multiple EGCs.

Interventions:

Endoscopic submucosal dissection (ESD) with en bloc resection was performed for all 5 multiple lesions. The ESD specimens were pathologically diagnosed with adenocarcinoma confined to the mucosa or HGD.

Outcomes:

After endoscopy resection, no residual, recurrent, or synchronous lesions were detected by endoscopic surveillance after ESD.

Lessons:

Long-term, meticulous endoscopic surveillance is needed to monitor risk factors associated with multiple EGCs in patients with severe mucosal atrophy or intestinal metaplasia despite successful Helicobacter pylori eradication.
Retroperitoneoscopic nephrectomy for a horseshoe kidney with hydronephrosis and inflammation
Authors: Yang Qing-Tao , Hong Yu-xiang , Hou Gao-ming , Zheng Jun-Hong , Sui Xu-Xia
Published: May 2019

Rationale:

A horseshoe kidney is the most common congenital fusion abnormality in the kidney, occurring in approximately 1 in 400 live births. Several complications including renal malignancies, ureteropelvic junction obstruction, urolithiasis, vesicoureteral reflux, and hydronephrosis can occur in this patient population.

Patient concerns:

A 28-year-old woman was admitted to hospital because of chronic left low back pain. Microscopic hematuria was not seen. Computed tomography showed the horseshoe kidney and left hydronephrosis.

Diagnoses:

On the basis of these findings and clinical manifestations, the final diagnosis was the horseshoe kidney with left renal hydronephrosis and inflammation.

Interventions:

A retroperitoneoscopic nephrectomy on the left kidney was performed.

Outcomes:

Histopathological examination of the specimen confirmed massive dilatation of the pelvicaliceal system and chronic pyelonephritic inflammation. The patient was discharged on the 7th postoperative day with no complications and no back pain. She remained well at 3 months with normal activity and good cosmetic result.

Lessons:

Retroperitoneoscopic nephrectomy can be a safe and minimally invasive surgery for horseshoe kidney treatment.
The prediction value of scoring systems in Mallory-Weiss syndrome patients
Authors: He Li , Li Zheng-Bo , Zhu Hai-Dan , Wu Xiao-Li , Tian De-An , Li Pei-Yuan
Published: May 2019

Mallory-Weiss syndrome (MWS) is a relatively less common cause of nonvariceal upper gastrointestinal bleeding. There is limited data on whether scoring systems could be used to predict the clinical outcomes in patients with bleeding due to MWS. The aim of our study is to evaluate whether the Glasgow-Blatchford score (GBS), AIMS65, and shocking index are effective in predicting the clinical outcomes of MWS.

One hundred twenty-eight patients from January 2010 to January 2017 with MWS in middle China were enrolled. Clinical features such as age, gender, causes of vomiting, endoscopic findings, GBS, AIMS65, and shocking index were recorded. The clinical outcomes including endoscopic treatment and transfusion were analyzed.

MWS accounted for 6.1% of nonvariceal upper gastrointestinal bleeding. Male-to-female ratio was 3.6:1 and median age was 51 years. Patients between 40 and 60 years were more commonly affected; 43.8% of MWS was caused by overdrinking followed by underlying gastric diseases (33.6%). However, for female patients alone, underlying gastric diseases were the leading cause (42.9%). The tears were usually single and most frequently located on the left lateral wall. In receiver-operating characteristic curve analyses, GBS system and shocking index were useful in predicting transfusion (0.856 vs 0.675). But for endoscopic intervention, these scoring systems are not helpful (P > .05).

Apart from drinking, underlying gastric disease is another important cause of MWS especially for female patients and should be paid more attention under endoscopy examination. GBS system and shocking index can be used to predict transfusion.
Clinical and pathological analysis of solitary fibrous tumors with portal vein widening
Authors: Wang Xu-Qing , Yang Han-Qing , Chen Ji-Xiang , Mao Zhen-Fa , Han He , Chen Gong , Fan Xin
Published: May 2019

Rationale:

Solitary fibrous tumors (SFTs) are rare soft-tissue tumors characterized with spindle-cell, which occur more common in the chest and rarely seen in the abdomen. So far as we knew, SFTs accompanied with venopathy of portal vein has rarely been reported.

Patient concerns:

A 36-year-old male presented with left-sided abdominal mass and portal vein expansion on ultrasound.

Diagnoses:

The post-operative histopathology confirmed the diagnosis of Solitary fibrous tumor.

Interventions:

Laparotomy was performed and the mass was completely removed.

Outcomes:

Patients had no symptoms, recovered well without recurrence; the portal vein and splenic vein dilatation were alleviated and the symptoms of portal hypertension were relieved.

Lessons:

SFTs presents with few symptoms in the early stage of the disease. A rich arteriovenous shunt is beneficial to the diagnosis of SFTs by B-ultrasound and computed tomography (CT) examinations. However, the diagnosis of SFTs must depend on histopathology.
A case of palatine tonsillar metastasis of lung adenocarcinoma
Authors: Chen Chia-Chun , Lee Chin-Tse , Chang Shih-Lun , Tsai Meng-Chen
Published: May 2019

Rationale:

Palatine tonsil is an extremely rare site for metastatic disease, accounting for 0.8% of malignant tonsillar neoplasms. To the best of our knowledge, this is the first report of metastatic adenocarcinoma in the tonsil treated with wide excision and targeted therapy, with no local recurrence 6 months postoperatively.

Patient concerns:

A 75-year-old man presented hemoptysis and mild productive cough for 2 weeks.

Diagnoses:

Palatine tonsil metastasis from lung adenocarcinoma, pT2bN0M1b, stage IVA, was confirmed.

Interventions:

Wide excision of primary lung tumor and metastatic tonsil carcinoma has been performed, and the patient was undergoing targeted therapy with the epidermal growth factor receptor inhibitor afatinib.

Outcomes:

There was no local recurrence in the oropharynx 6 months postoperatively.

Lessons:

We aim at highlighting the importance of a thorough evaluation for suspicion of tonsillar enlargement, which might be a sign of a primary malignancy elsewhere.
Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients
Authors: Wu Jian-jun , Zhang Ying-xue , Du Wei-sha , Jiang Liang-duo , Jin Rui-feng , Yu Hui-yong , Liu Jin-min , Han Mei
Published: May 2019

Objective:

To explore the clinical efficacy and safety of Qigong in reducing the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores of patients with chronic obstructive pulmonary disease (COPD).

Methods:

We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE for studies published as of Dec 31, 2018. All randomized controlled trials of Qigong in COPD patients, which met the inclusion criteria were included. The Cochrane bias risk assessment tool was used for literature evaluation. RevMan 5.3 software was used for meta-analysis.

Results:

Six studies (combined n = 415 patients) met the inclusion criteria. Compared with conventional therapy alone, Qigong in combination with conventional therapy significantly improved the following outcome measures: SDS score [mean difference (MD) −3.99, 95% CI (−6.17, −1.82), P < .001, I
2 = 69%]; SAS score[MD −4.57, 95% CI (−5.67, −3.48), P 
< .001, I
2 = 15%]; forced expiratory volume in one second/prediction (FEV1% pred) [MD 3.77, 95% CI (0.97,6.58), P < .01, I
2 = 0]; forced expiratory volume in one second (FEV1) [MD 0.21, 95% CI (0.13, 0.30), P 
< .001, I
2 = 0%]; forced vital capacity (FVC) [MD 0.28, 95% CI (0.16, 0.40), P 
< .001, I
2 = 0]; 6-minute walk test (6MWT) distance [MD 39.31, 95% CI (18.27, 60.34), P 
< .001, I
2 = 32%]; and St. George's Respiratory Questionnaire (SGRQ) total score [MD −11.42, 95% CI (−21.80, −1.03), P 
< .05, I
2 = 72%].

Conclusion:

Qigong can improve the SDS and SAS scores of COPD patients, and has auxiliary effects on improving lung function, 6MWT distance, and SGRQ score.
Comparative cardiovascular safety of selective serotonin reuptake inhibitors (SSRIs) among Chinese senile depression patients
Authors: Guo Shengyu , Chen Ling , Cheng Sixiang , Xu Huilan
Published: May 2019

Background:

Senile depression patients in China usually present with a higher risk of coronary heart disease that may trigger cardiac death. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed antidepressants in China; the cardiovascular safety of SSRIs when used in Chinese senile depression patients has not been evaluated.

Methods:

A network of meta-analysis was conducted to fill the objectives. PubMed, Embase databases, and 2 Chinese language electronic databases WANFANG and CNKI were searched for the related articles. The primary outcome of the present study was the number of cardiovascular reactions when each SSRI drug was used among senile depression patients in China. Odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were calculated within pairwise and network meta-analysis.

Results:

Fifteen trials were identified, including 1432 patients; the network meta-analysis showed that Chinese senile depression patients treated by Escitalopram were associated with a lower risk of cardiovascular reaction (CDR) than Paroxetine (ORs 0.37, 95% CI 0.14–0.37). Escitalopram also exhibited distinct advantages compared with other SSRIs. The rank of SSRIs with respect to cardiovascular safety was Escitalopram > Sertraline > Citalopram > Paroxetine > Fluoxetine, respectively.

Conclusion:

Escitalopram exhibited distinct advantages compared with other SSRIs, while Fluoxetine had the biggest cardiovascular reaction probability.
Plate-prosthesis composite reconstruction after large segmental resection of proximal humeral tumors
Authors: Wei Ran , Guo Wei , Yang Rongli , Tang Xiaodong , Yang Yi , Ji Tao
Published: May 2019

Since the standard reconstructive option after large segmental resection of proximal humeral tumors remained controversial, we designed and applied plate-prosthesis composite (PPC) for this circumstance. The purposes of the study were to: compare the functional outcome, implant survival (IS), surgical risk of PPC with those of conventional proximal humeral prosthesis (PHP); and describe the design and reconstructive procedure of PPC.

Twenty patients (11 males, 9 females), who received intraarticular proximal humeral resection without preservation of abductor mechanism, were included in this study, with a mean resection length accounting for 72.5% (range, 61.9–81.8%) of whole humeral length. According to the reconstructive options, we categorized patients into PPC group (9 patients) and PHP group (11 patients). PPC was a semi-custom-made endoprosthesis, with modular proximal part same as PHP and custom-made distal part including dumpy stem and composite lateral anatomic plate for distal humerus. The mechanical prosthetic complication was defined as the imaging evidence regardless of reoperation. The IS was defined as the time from surgery to the occurrence of mechanical prosthetic complication.

The mean follow-up time was 40.1 months (range, 14–129). The Musculoskeletal Tumor Society 93 scores of PPC and PHP group showed no significant difference (73.3% vs 70.0%, P = .46). Compared to PHP group, PPC group showed significantly lower mechanical prosthetic complication rates (0 vs 45.4%, P = .03) and better IS (86.0 vs 59.3 ± 21.7 months, P = .028). Moreover, the comparison of surgical time (3.2 vs 3.3 hours, P = .60), blood loss (288.9 vs 376.4 mL, P = .15) and perioperative complication rates (11.1% vs 18.2%, P = .58) between 2 groups showed no differences.

For reconstruction after large segmental resection of proximal humeral tumors, PPC achieved better IS while maintained similar functional outcome compared to conventional PHP without influencing the complexity and safety of surgery.
Meta-analysis of the effects of drug-coated balloons among patients with small-vessel coronary artery disease
Authors: Yang Jing-qi , Peng Jin-hua , Xu Ting , Liu Li-yun , Tu Jie-hong , Li Shun-hui , Chen Hui
Published: May 2019

Objective:

This study evaluated the clinical value of drug-coated balloons for patients with small-vessel coronary artery disease (SVD).

Methods:

A computerized literature search was performed using the databases to conduct a meta-analysis and evaluate the clinical value of drug-coated balloons among patients with SVD.

Results:

This review enrolling 1545 patients receiving drug-coated balloons and 1010 patients receiving stents (including drug-eluting stents and bare-metal stents). The meta-analysis results showed that the incidence of major adverse cardiovascular events among patients with SVD did not significantly differ between the drug-coated balloon group and the stent group within 1 postoperative year (odds ratio = 0.81, P = .5). A subgroup analysis showed that the incidence of myocardial infarction among the drug-coated balloon group was significantly lower than that among the stent group (odds ratio = 0.58, P = .04). Nevertheless, the late lumen loss of the drug-coated balloon group was significantly lower than that of the stent group (mean difference = 0.31, P = .01).

Conclusions:

Drug-coated balloons can be used to effectively reduce the incidence of myocardial infarction in patients with SVD within 1 year and decrease the extent of late lumen loss without increasing the incidence of major adverse cardiovascular events.
A case report of infant with gastric perforation caused by Candida albicans infection
Authors: Zhang Min
Published: May 2019

Rationale:

Spontaneous gastric perforation in young children is rare, and gastric perforation caused by Candida albicans infection is even rarer.

Patient concerns:

A 4-month-old infant presented with frequent retching. The results of X-rays showed obvious pneumoperitoneum but gastric vacuole was not seen.

Diagnosis:

The infant was diagnosed as spontaneous gastric perforation caused by C albicans infection based on blood culture, peritoneal fluid culture, and postoperative histopathology.

Interventions:

An emergency exploratory laparotomy was performed and a gastric perforation repair was done. The infant received antishock, antiinfection, and intravenous nutrition treatment.

Outcomes:

After operation and antiinfective symptomatic treatment, the infant recovered.

Lessons:

This case emphasized the rare C albicans infection as a cause of the gastric perforation in infant. The C albicans infection should always be thought of as an etiology for the gastric perforation in infant, to reduce the significant mortality. The early detection is necessary to treat Candida infections.
Effect of sagittal split ramus osteotomy on morphologic parameters of temporomandibular joint in patients with mandibular prognathism
Authors: Ma He-Di , Shu Jing-Heng , Deng Xu-Zhao , Liu Zhan
Published: May 2019

The purpose of this study was to evaluate the change in three-dimensional morphology and clinical symptoms of temporomandibular joint (TMJ) in class III dentofacial deformity patients postoperatively for 6 months after sagittal split ramus osteotomy (SSRO).

Seventeen patients with skeletal Class III malocclusion and 10 asymptomatic volunteers (classified as Control group) were recruited for the study and underwent cone-beam computed tomography scanning. The geometries of the maxilla and mandible were reconstructed using MIMICS (Materialise, Leuven, Belgium). The morphologic measurements of the patients’ TMJs were done before surgery and at 6-month follow-up – named as Pre and Post groups, respectively.

The joint spaces (medial joint space, superior joint space, lateral joint space, anterior joint space, and posterior joint space) of the Control group were significantly greater than those of the Pre and Post groups (P < .05), and SSRO did not significantly change the TMJ morphology parameters. Five patients were found to have preoperative temporomandibular disorder (TMD) symptoms, and 3 of them were relieved at 6 months after surgery. Postoperative TMD symptom was observed in 1 patient without preoperative TMD symptom.

SSRO did not markedly alter the TMJ morphology of the patients with mandibular prognathism. The effects of SSRO on TMD symptoms should be related to the type of deformity.
Medical resource utilization patterns and mortality rates according to age among critically ill patients admitted to a medical intensive care unit
Authors: Oh Dong Kyu , Na Wonjun , Park Yu Rang , Hong Sang-Bum , Lim Chae-Man , Koh Younsuck , Huh Jin-Won
Published: May 2019

There is ongoing controversy about how to address the growing demand for intensive care for critically ill elderly patients. We investigated resource utilization patterns and mortality rates according to age among critically ill patients.

We retrospectively analyzed the medical records of patients admitted to a medical intensive care unit (ICU) in a tertiary referral teaching hospital between July 2006 and June 2015. Patients were categorized into non-elderly (age <65 years, n = 4140), young-elderly (age 65–74 years, n = 2306), and old-elderly (age ≥75 years, n = 1508) groups.

Among 7954 admissions, the mean age was 61.5 years, and 5061 (63.6%) were of male patients. The proportion of comorbidities increased with age (64.6% in the non-elderly vs 81.4% in the young-elderly vs 82.8% in the old-elderly, P < .001 and P for trend <.001), whereas the baseline Sequential Organ Failure Assessment (SOFA) score decreased with age (8.1 in the non-elderly vs 7.2 in the young-elderly vs 7.2 in the old-elderly, P < .001, R = −.092 and P for trend <.001). Utilization rates of mechanical ventilation (48.6% in the non-elderly vs 48.3% in the young-elderly vs 45.5% in the old-elderly, P = .11) and renal replacement therapy (27.5% in the non-elderly vs 25.5% in the young-elderly vs 24.8% in the old-elderly, P = .069) were comparable between the age groups. The 28-day ICU mortality rates were lower in the young-elderly and the old-elderly groups than in the non-elderly group (35.6% in the non-elderly vs 34.2% in the young-elderly, P = .011; and vs 32.6% in the old-elderly, P = .002).

A substantial number of critically ill elderly patients used medical resources as non-elderly patients and showed favorable clinical outcomes. Our results support that underlying medical conditions rather than age per se need to be considered for determining intensive care.
Naproxen for the treatment of neoplastic fever
Authors: Zhang Hongliang , Wu Yuyong , Lin Zhongqiu , Zhong Xiaobin , Liu Taotao , Huang Zhenguang , Yang Yufang
Published: May 2019

Background:

The effect of naproxen on the treatment of neoplastic fever is still unclear. A systematic review and meta-analysis were performed to investigate the effect of naproxen in the treatment of cancer fever or suspicion. Besides, the latest and most convincing evidence was provided for the earlier use of naproxen in treating cancer patients with fever of unknown origin.

Methods:

A literature review was conducted to identify all published studies on the naproxen for the treatment of neoplastic fever. Electronic databases (eg, PUBMED, EMBASE and the Cochrane Library) were searched until October 2018. Data were extracted, and the risk of bias was assessed by 2 authors independently. Standard meta-analyses on the rate of successful treatment were conducted using a random-effects model, and relative risks were calculated with 95% confidence intervals (CIs).

Results:

A total of 15 studies, recruiting 582 participants, were included, which were 1 randomized controlled trial (RCT), 1 non-RCT, 3 cross-sectional studies, and 10 case-series studies. The result of our meta-analysis revealed that the success rate on the treatment of neoplastic fever using naproxen was 94.1% (95% CI: 87.6%–97.3%). The success rate of the suspected neoplastic fever was 79.8%; for fever of unknown origin, it also reached 67.7%. In this meta-analysis, the success rate was 98.1% (95% CI: 95.0%–99.3%) in the dosage of 250 mg twice a day. Besides, a small dose of 125 mg naproxen, 375 mg twice a day and 250 mg 3 times a day were also useful. The result of the subgroup analysis revealed that the difference was not statistically significant in the treatment success rate for solid tumors and hematologic malignant.

Conclusions:

The result of our meta-analysis suggested that naproxen exhibited a highly successful rate for the treatment of neoplastic fever. Besides, naproxen was also satisfactory in improving symptoms of suspected neoplastic fever and fever of unknown origin. The earlier use of naproxen might be able to mitigate cancer patient's suffering and enhanced their quality of life. These findings, however, rely primarily on observational data and should be interpreted rigorously. Further well-conducted trials are required to assess naproxen for the treatment of neoplastic fever.