bluuebunny/crossref_metadata_2025 huggingface dataset:
Pancreatectomy for a secondary metastasis to the pancreas
Authors: Madkhali Ahmad Abdullah , Shin Sang-hyun , Song Ki Byung , Lee Jae Hoon , Hwang Dae Wook , Park Kwang Min , Lee Young Joo , Kim Song Cheol
Published: October 2018

The aim of the present study was to evaluate the short- and long-term outcomes of secondary metastasis to the pancreas in terms of overall survival (OS) and disease-free survival (DFS) after pancreatectomy.

This retrospective study included 29 patients who underwent pancreatectomy for secondary metastasis to the pancreas between December 1995 and August 2016.

The study group was divided into renal cell carcinoma (RCC) (17 patients) and non-RCC (12 patients). The non-RCC group had 5 cases of colorectal cancer and 7 of another primary origin. The OS for the whole cohort was 86.2% at 1 year, 63.2% at 3 years, and 46.7% at 5 years. There was no significant difference between the 2 groups at 1, 3, and 5 years survival and OS. In subgroup analysis of patients who underwent curative resection, there was no significant difference in OS between the 2 groups at 1, 3, and 5 years. However, there was a significant difference in recurrence rate at 3 years (P = .035). Pathologic analysis showed that the non-RCC group had significantly more positive lymph node metastasis than the RCC group (P = .002).

Pancreatectomy for secondary metastasis has promising short- and long-term outcomes in terms of OS and DFS.
Modulation of macrophage polarization by level-1 Yo-Yo intermittent recovery test in young football players
Authors: Chiu Chen-Jan , Chi Chih-Wen , Hsieh Hui-Ru , Huang Yu-Chuen , Wu Huey-June , Chen Yu-Jen
Published: October 2018

The aim of this study was to examine the effect of the level-1 Yo-Yo intermittent recovery test (YYIRT1) on polarization of macrophages in young football players.

Fourteen male football players (19.9 ± 1.4 years old) were enrolled in this study. YYIRT1 was performed with 20-meter shuttle runs at increasing speeds and 10-second active recovery in a 5-meter distance between runs till exhaustion. Fasting blood samples were collected before and immediately after YYIRT1. Analysis for macrophage polarization by flow cytometry, reactive oxygen species (ROS) by flow cytometry, biochemical parameters by chemical reactions, and serum cytokines by ELISA were performed. The rating of perceived exertion (RPE) and cardiovascular parameters were recorded.

The time to exhaustion was 714.1 ± 114.4 seconds. The oxygen uptake (

JOURNAL/medi/04.03/00005792-201810190-00021/inline-graphic2/v/2023-09-14T035032Z/r/image-tiff

) was 48.7 ± 5.6 mL/min/kg, RPE scale was 19 ± 1, resting heart rate and maximal heart rate were 64.9 ± 8.8 beat/min and 181.9 ± 9.3 beat/min, respectively, indicating a high level of cardiopulmonary fitness. The expression of macrophage-specific CD14 and M1 marker HLA-ABC, but not M2 marker CD206, was down-regulated after YYIRT1. The intracellular ROS levels in macrophages had no significant change. In biochemical profile, the serum levels of lactic dehydrogenase (LDH), a marker of muscle damage, increased after YYIRT1 whereas no significant alteration was noted in creatine phosphokinase (CPK), blood urine nitrogen, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), and C-reactive protein. The serum levels of interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)-α had no significant change.

The YYIRT1 may induce muscle damage accompanied by modulation of macrophage polarization toward suppression of M1 phenotype in young football players.
Randomized study of intravesical pirarubicin chemotherapy with low and intermediate-risk nonmuscle-invasive bladder cancer in Japan
Authors: Naya Yoshio , Mikami Kazuya , Takaha Natsuki , Inoue Yuuta , Fujihara Atsuko , Kanazawa Motohiro , Nakanishi Hiroyuki , Miyashita Hiroaki , Ukimura Osamu
Published: October 2018

Purpose:

The objective of this study was to evaluate the efficacy, defined by the 3-year tumor recurrence-free survival rate, of intravesical chemotherapy using pirarubicin (THP) in patients with low or intermediate-risk nonmuscle-invasive bladder cancer (NMIBC).

Patients and methods:

Between October 2010 and January 2015, 206 patients were enrolled, and finally 113 were randomized to receive either a single immediate postoperative intravesical instillation of THP (30 mg) (Group A), or 8 additional weekly intravesical instillations of THP (30 mg) after a single postoperative instillation (Group B). The patients were examined by performing cystoscopy and urine cytology every 3 months after transurethral resection to determine bladder tumor recurrence. The primary endpoint was 3-year-recurrence-free survival rate.

Results:

All 113 patients were bacillus Calmette–Guérin (BCG)-naïve. The 3-year recurrence free survival rate was 63.7% for Group A and 85.3% for Group B (log-rank test, P = .0070). In patients with intermediate recurrence risk, the 3-year recurrence-free survival rate was 63.4% in Group A and 86.1% in Group B (log-rank test, P = .0036). Cox regression analysis revealed that only additional instillation of THP was a significant independent factor for recurrence-free rate in patients with intermediate risk. No patient with progression was noted during this period. Frequent adverse effects (AEs) were frequent urination and micturition pain, and no severe AEs (Grade 3 or more) occurred.

Conclusion:

Additional instillation of THP (30 mg) weekly for 8 weeks reduced the risk of tumor recurrence without severe AEs in BCG-naïve NMIBC patients with intermediate risk.
The effect of nursing intervention on preoperative cataract
Authors: Gong Dan-hui , Liu Jia-feng , Zhao Xin , Zhang Li
Published: October 2018

This retrospective study investigated the effect of nursing intervention (NIV) in Chinese patients under preoperative cataract (PC). A total of 70 eligible patients with PC were included. Thirty-five patients in an intervention group received regular clinical treatment and NIV before the surgery, while the other 35 patients received regular clinical treatment only. The NIV was applied 4 sessions, 1 week before the surgery. The primary outcome of satisfaction was measured by 11-points visual analog scale. The secondary outcomes were measured by the functional impairment caused by cataract (the VF-14), cooperativeness during the surgery period, and sleep quality. All the outcome measurements were assessed before and after the surgery. After NIV, patients in the intervention group exerted better outcomes in decreasing anxiety (P < .01), increasing current experience with satisfaction (P < .01), and enhancing the cooperativeness during the surgery period (P < .01), compared to those outcomes in the control group. The results of this study showed that NIV may help increase satisfaction in experience and cooperation, and decrease anxiety in Chinese patients with PC.
Clinical efficacy of pelvic autologous tissue reconstruction in treating pelvic organ prolapse in 36 patients
Authors: Huang Ling-Xiao , Li Ren-Liang , Sha Li-Xiao , Lin Xiao-Hua
Published: October 2018

This study aims to search for a new, economic, convenient, and low recurrence rate operation for the surgical management of pelvic organ prolapse (POP). The clinical value of the operation for treating POP was determined through retrospective case series. The new operation was called, pelvic autologous tissue reconstruction.

Women with symptomatic uterine prolapse, who required surgery, were recruited. A total of 97 women [stage III to IV, according to POP quantification (POP-Q) staging] were collected from January 2010 to December 2016. Among these women, 61 women underwent a traditional operation (TO, vaginal hysterectomy and vaginal anterior and posterior wall repair), while the remaining women underwent pelvic autologous tissue reconstruction.

First, there was no statistically significant difference in intraoperative blood loss, indwelling urethral catheter time, in-hospital time, and the time of passage of gas through the anus between the pelvic autologous reconstruction (PAR) and TO groups (P > .05). The average operation time in the PAR group was significantly longer than that in the TO group (P < .05). Second, ultrasonic parameters before and after the operation between the 2 groups were compared. The postoperative rotation angle of the urethra (UR), posterior vesicourethral angle (PVA), and bladder neck descent (BND) significantly decreased in the PAR group (P < .05). There was no statistically significant difference in UR between before and 12 months after surgery in the TO group (P > .05). Furthermore, BND increased in the TO group at 12 months after the operation, compared with that at 3 months after the operation (P < .05). There was no significant difference in PVA and UR before the surgery and at 3 and 12 months after the surgery between the 2 groups (P > .05). In addition, BND was significantly smaller in the PAR group than in the TO group at 3 and 12 months after the surgery (P < .05). Third, there was no statistically significant difference in PFIQ-7 and PISG-12 in both groups after surgery.

The stability of the pelvic floor structure was better in the PAR group than in the TO group. Furthermore, PAR is better for preventing the occurrence of pelvic floor prolapse and stress urinary incontinence after surgery.
Modified 2-port laparoscopic herniorrhaphy with Kirschner wire in children
Authors: Cao Zhiqing , Chen Jiangyi , Li Zhixiong , Li Guoxin
Published: October 2018

Background:

Pediatric inguinal hernia is one of the most common diseases in children, and laparoscopy is the main surgical method. This study aims to evaluate the efficacy of a new modified 2-port laparoscopic herniorrhaphy with Kirschner wire (TLHK) for inguinal hernia in children.

Methods:

A total of 5304 children with inguinal hernia hospitalized at the Jiangmen Center Hospital from June 2003 to May 2016 were enrolled in this retrospective study. Four thousand one hundred thirty-five children underwent TLHK that comprised the observation group, while 1169 received single incision laparoscopy (SIL) as the control group (CG). A propensity score matched cohort study was conducted between these groups. We included all patients who were diagnosed as inguinal hernia and matched comparators with a proportion of 1:1. The propensity score was calculated using logistic regression with forward stepwise selection in 4 variables. The patients’ operative details, intra- and postoperative complications, and postoperative hospital stay were analyzed. The follow-up lasted from 1 month to 2 years.

Results:

Among 5304 potential patients, the propensity score identified 270 (135 TLHK cases and 135 comparators) patients. The age, sex, body mass index, and the hernia type and location did not differ between CG and TLHK. TLHK group had a shorter operative time (unilateral: 17.4 ± 3.35 minutes vs 20.7 ± 3.71 minutes; bilateral: 20.4 ± 5.17 minutes vs 25.2 ± 5.43 minutes), less complications (2.10% vs 2.65%), lower recurrence rate (0% vs 4.44%), and similar hospital stay (2.3 ± 1.1 vs 2.1 ± 1.3) as compared with CG. No iliac vessel injury, spermatic cord vessels injury, vas deferens injury, or iatrogenic cryptorchidism occurred in either of the groups.

Conclusion:

TLHK is a safe and feasible treatment for inguinal hernia in children due to less invasion and less recurrence rate than SIL.
A bovine myeloid antimicrobial peptide (BMAP-28) and its analogs kill pan-drug-resistant Acinetobacter baumannii by interacting with outer membrane protein A (OmpA)
Authors: Guo Yijie , Xun Meng , Han Jing
Published: October 2018

Antimicrobial peptides (AMPs) exhibit multiple activities against bacteria and fungi. A bovine myeloid antimicrobial peptide (BMAP-28) belongs to the cathelicidin-derived AMPs and has antimicrobial activity. Due to the rapidly increasing number of infections and outbreaks caused by pan-drug-resistant Acinetobacter baumannii (PDRAB), we sought to determine whether BMAP-28 and its 4 analog peptides (A837, A838, A839, and A840) have antimicrobial activity against PDRAB. Furthermore, we clarified the possible mechanism of inhibition by which of BMAP-28 acts against PDRAB. In the current study, we examined the inhibitory effect of BMAP-28 and its 4 analog peptides on the growth of PDRAB through minimal inhibitory concentration (MIC) analysis and short time killing assays. We also evaluated the effects of BMAP-28 and its analogs on the bacterial cell surface through the use of field emission scanning electron microscopy (FE-SEM). In order to determine the inhibitory mechanism of BMAP-28, we examined the interaction between BMAP-28 and outer membrane proteins (OMPs), especially the interaction between BMAP-28 and A. baumannii OmpA (AbOmpA), which is the main component of OMPs, by using a quartz crystal microbalance (QCM). BMAP-28 and its 4 analogs were effective in inhibiting the growth of PDRAB and had rapid killing ability. BMAP-28 showed exceptionally strong and rapid inhibitory effects on PDRAB when compared to the other peptides and was also shown to cause damage to the cell surface of PDRAB. Moreover, QCM analysis provided evidence of potential interaction between BMAP-28 and AbOmpA. These data indicate that BMAP-28 is a promising candidate for the treatment of PDRAB infections and that its inhibitory effects were related with its binding to AbOmpA.
Detection of uric acid crystal deposition by ultrasonography and dual-energy computed tomography
Authors: Wang Yu , Deng Xuerong , Xu Yufeng , Ji Lanlan , Zhang Zhuoli
Published: October 2018

The aim of our study was to compare the performance of ultrasonography (US) and dual-energy computed tomography (DECT) in detecting the crystal deposition at lower extremity joints in patients with gout. The correlation of imaging findings with microscopic findings was further assessed whenever aspiration is available.

We recruited consecutive patients who were presented with arthritis of lower extremity from January 2012 to December 2014. All the patients underwent DECT and US scan of bilateral knees, ankles, and feet. Synovial fluid was obtained by aspiration from an acute inflammatory joint if possible.

Finally, 60 patients fulfilling the 1977 gout classification criteria were included in our study. We found that US can detect significantly more patients with crystal deposition than DECT (81.7% vs 56.7%, by US and DECT, respectively, P 
< .001). The frequency of urate crystal deposition detected by US at MTP1, knee, and ankle joints regions was 56.7%, 63.3%, and 51.7%, respectively. The percentage of positivity of double contour sign on US was 33.3%, 48.3%, and 41.7% at the joints mentioned above, respectively. There was a good correlation between ultrasound and synovial fluid analysis in detecting crystal deposition (κ = 0.87, P = .001), while the agreement between DECT and synovial fluid analysis was just fair (κ = 0.28, P = .02).

The sensitivity of US in detecting urate crystal deposition in lower extremity joints was higher than DECT. The superiority was more obvious in knee and MTP1 joints. US should be considered as the first choice of image examinations when diagnosing gout.
Increased risk of osteoporosis in patients with nonalcoholic fatty liver disease
Authors: Chen Hon-Jhe , Yang Hao-Yu , Hsueh Kuang-Chieh , Shen Cheng-Che , Chen Ru-Yi , Yu Hsien-Chung , Wang Tzu-Lin
Published: October 2018

The study aims to investigate the association between nonalcoholic fatty liver disease (NAFLD) and osteoporosis.

We employed a retrospective cohort study design using the National Health Insurance Research Database in Taiwan. Our study included 2 cohorts: 4318 patients with NAFLD and 17,272 patients without NAFLD for comparison. They were matched by sex and age on the date of enrollment between January 1, 2000 and December 31, 2003. The study population in both groups was observed from the enrollment date until December 31, 2013. The incidence and the risk ratios of subsequent osteoporosis were calculated separately in both cohorts. A Cox proportional hazards model was used to assess the potential confounding variables of NAFLD on the pathogenesis of osteoporosis.

The eligible study participants comprised 4318 patients in the NAFLD and 17,272 in control cohorts. The median follow-up duration was 10.7 and 10.83 years in the NAFLD and control groups, respectively. The risk of new-onset osteoporosis was higher in patients with NAFLD than in the comparison cohort. In addition, the difference of the incidence of new-onset osteoporosis remained significant among the 2 cohorts in the follow-up durations of within 1 year and more than 10 years. Patients with NAFLD were 1.35 times more likely to develop subsequent osteoporosis compared with those without NAFLD (95% confidence interval = 1.20–1.53).

Our finding indicates that NAFLD might increase the risk of developing new-onset osteoporosis. For earlier detection and intervention, screening for osteoporosis in patients with the NAFLD, especially those with lower income and co-morbid with diabetes mellitus and chronic obstructive pulmonary disease, may be recommended.
The relationship between HER2 overexpression and angiogenesis in gastric cancer
Authors: Ciesielski Maciej , Szajewski Mariusz , Pęksa Rafał , Lewandowska Marzena Anna , Zieliński Jacek , Walczak Jakub , Szefel Jarosław , Kruszewski Wiesław Janusz
Published: October 2018

In gastric cancer, HER2 protein overexpression is considered to be conducive to the higher proliferation activity of the tumor cells. Tumor formation is associated with angiogenesis in order to secure an abundant supply of oxygen and glucose to cancer cells. The aim of the study was to assess if HER2 overexpression is related to higher microvessel density (MVD) in the tumor stroma.

The archival samples of primary tumor from 144 consecutive patients that underwent gastric resection for cancer between August 1, 2006 and December 31, 2013 in the Department of Oncological Surgery of Medical University of Gdańsk were analyzed. CD34 was used as a marker of MVD in the tumor stroma. Both CD34 and HER2 protein expressions were tested by immunohistochemistry.

The assays were unsuccessful to estimate HER2 in 10 cases and CD34 in 14 cases due to technical reasons. The results were obtained for 128 patients. HER2 0 and HER2 1+ were considered negative, while HER2+ and HER2 3+ were recognized as positive. Mean MVD (mean number of vessels in the visual field) was 32.4 (median 29.5). Microvessel density was insignificantly higher in HER2 positive tumors. The slight difference was also seen between IHC 2+ and 3+ groups. The differences did not reach the level of statistical significance.

Statistical analysis performed in our study did not reveal the significant relationship between HER2 overexpression on the tumor cells and MVD in the tumor stroma.
Risk factors analysis and prevention of metabolic bone disease of prematurity
Authors: Chen Wenhao , Yang Changyi , Chen Hanqiang , Zhang Baoquan
Published: October 2018

The present study aims to analyze the risk factors for metabolic bone disease (MBD) of prematurity.

A total of 238 preterm infants who were born at <34 weeks of gestation and were hospitalized for at least 6 weeks in the Department of Neonatology, Fujian Maternity and Children Hospital between January 1, 2011 and November 30, 2015 were enrolled in the study. Sixteen preterm infants diagnosed with MBD were selected as the case group, and 32 non-MBD preterm infants were matched 2:1 at admission into the study. The 2 groups were compared to examine the differences in maternal obstetric conditions, conditions during parturition, neonatal conditions, and neonatal diseases and treatments. The risk factors for MBD of prematurity were analyzed using t tests, χ2 tests, and a logistic regression model.

The mean gestational age and birth weight of the case group were significantly lower (P < .05) than those of the control group. Compared with the control group, the case group had a significantly higher ratios of small-for-gestational-age infants, antenatal maternal corticosteroids use, sedative use, ventilator use, aminophylline use, diuretic use, liver function impairment, vitamin D (VitD) supplementation at more than 14 days of age, achievement of total enteral nutrition (TEN) beyond 28 days of age, and feeding intolerance.

Logistic regression analysis showed that birth at <30 weeks of gestation, VitD supplementation at >14 days of age, and achievement of TEN beyond 28 days of age were independent risk factors for MBD (P < .05).

Level of Evidence: IV
Neonatal giant hepatic hemangioma
Authors: Zhu Zhenwei , Cai Peng , Zhu Jie , Chen Jianlei , Wu Bin , Gu Zhicheng , Huang Shungen , Wang Jian
Published: October 2018

Rationale:

Hepatic hemangioma is the third most common pediatric tumor, and it is rare in the neonatal period. This case study presents a rare case of hepatic hemangioma found in a neonate.

Patient concerns:

A girl who was 18 days of age with the emergence of jaundice and an abdominal mass was admitted for physical examination in the local department.

Diagnoses:

An ultrasound showed that the hepatic left lobe was about 9 cm × 7 cm × 7 cm in size. A CT scan indicated a giant hemangioma in the hepatic left lobe. MRI detected a lesion measuring about 92 mm × 71 mm × 68 mm.

Interventions:

The patient was treated with propranolol 3.5 mg PO bid (body weight 3.8 kg) after 1 week of admission for 4 weeks, but the mass did not appear to regress. Surgery was then performed successfully.

Outcomes:

The patient recovered well without recurrence beyond one year.

Lessons:

Imaging strategies and prenatal diagnosis are vital for the diagnosis of infantile hepatic hemangioma. Propranolol is effective in both cutaneous and hepatic multifocal and diffuse hemangioma. Adequate treatment time is necessary to cure the disease. The role of propranolol in massive hepatic hemangioma remains uncertain and needs further investigation.
Family study of a novel mutation of mucopolysaccharidosis type VI with a severe phenotype and good response to enzymatic replacement therapy
Authors: Ley-Martos Myriam , Guerrero Juan M. , Lucas-Javato Marta , Remón-García Cristina , García-Lozano J. Raúl , Colón Cristóbal , Crujeiras Pablo , Rodrigues Daniel , Paúl-Sánchez Pedro , Macher Hada C.
Published: October 2018

Rationale:

Mucopolysaccharidosis type VI (MPS VI) or Maroteaux-Lamy syndrome is produced by the deficiency of the enzyme arylsulfatase B, responsible for the hydrolysis of N-acetyl-D-galactosamine, chondroitin sulfate, and dermatan sulfate.

Patient concerns:

A 3-year-old male with Moroccan origins is the index case. He had healthy consanguineous parents and 4 healthy brothers and sisters. The patient showed a wide spectrum of symptoms including skeletal dysplasia and short stature with elevated glycosaminoglycans (GAGs) in urine.

Diagnoses, interventions, and outcomes:

GAGs were quantified by spectrometry method with 1,9-dimethylen blue in 24-hour urine samples. The qualitative analysis of urine GAGs was obtained by thin-layer chromatography to determine the predominant presence of dermatan sulfate. The activities of both arylsulfatase B and beta-galactosidase as well as genetic studies were performed in dried blood spots. The genetic study was performed with deoxyribonucleic acid by massive sequencing a of lisosomal storage diseases. Results showed a new mutation c.263A > C with the severe phenotype in homozygous in the patient. The familiar study of ARSB and GLB1 genes presented some asymptomatic SNPs but with a discrete decrease in the activity of arylsulfatase B and beta-galactosidase. After an early detection by pediatricians, and both enzymatic and genetic confirmation, the patient had a good response to substitutive enzymatic treatment with galsulfase.

Lessons:

Mucoplysaccharidosis type VI is an autosomal recessive rare disease characterized by a lysosomal storage disorder. Although a number of mutations have been already associated to the disease, we have found a new mutation located in the arylsulfatase B enzyme gene. We have described that this mutation is the ultimate cause of a severe presentation of the disease.
Recurrent chronic myeloid leukemia with t (9;22;16) (q34; q11; p13) treated by nilotinib
Authors: Shu Yefei , Yang Wei , Zhang Xuejin , Xu Xiaofeng
Published: October 2018

Rationale:

Variant Philadelphia chromosome translocations involving chromosomes other than chromosomes 9 and 22 have been reported in 5% to 10% of patients with chronic myeloid leukemia (CML). Here, a case of CML with a t (9, 22, 16) (q34; q11; p13) translocation, which has never been described, is reported.

Patient concerns:

A 59-year-old female with dry cough, referred to our hospital, exhibited hepatosplenomegaly, high basophil count, and high platelet count at admission without any other known chronic diseases.

Diagnoses:

The patient was diagnosed with CML with the translocation t (9;22;16) (q34; q11; p13). The patient was treated with imatinib, a first-generation tyrosine kinase inhibitor (TKI), discontinuously, achieving a complete hematological response for 7 years. Since November 8, 2017, the patient had recurrent fever, and her platelet count rose to 1422 × 109/L. Subsequently, the E279K mutation in the BCR-ABL kinase region was detected.

Outcomes:

According to a previous report, this mutation confers sensitivity to nilotinib, a second-generation TKI. In the end, the patient received treatment with nilotinib and showed a complete hematological response.

Lessons:

The present study reports a rare case of CML with Ph chromosome and a t (9;22;16) (q34; q11; p13) translocation. For such cases about CML with variant Philadelphia chromosome translocations or BCR-ABL kinase region mutation, TKI may still be valuable.
Aminoglycoside-associated nonsyndromic deafness and speech disorder in mitochondrial A1555G mutation in a family
Authors: Ou Yang-Hao , Chen Andy Wei-Ge , Fan Jun-Yang , Cheng Wen-Ling , Lin Ta-Tsung , Chen Mu-Kuan , Liu Chin-San
Published: October 2018

Rationale:

Mitochondrial DNA mutations have been associated with many maternal inherited diseases. A1555G mutation in mtDNA effects the gene code for rRNA, resulting in the structural change of human ribosome rending it susceptible to binding of the common antibiotic, aminoglycosides. Such mutation has linked with non-syndromic hearing loss and is one of the most common mtDNA mutations in Asian populations.

Patient concerns:

A 50-year-old Taiwanese female visited our neurology department with concern for multiple members with hearing loss in her family, including herself.

Diagnoses:

Physical examination findings were not significant besides hearing loss and brain MRI did not reveal any lesions. BAEP confirmed bilateral peripheral sensory deficit. Given the multiple cases of hearing loss in the family, a genetic cause was suspected. Using PCR and sequences chromatogram technique we have identified A1555G mutation on her mtDNA affecting region codes for 12S rRNA. Additionally, we observed severe speech disorder in two young family members with the onset of hearing loss began in their early childhood.

Interventions:

The patient declined any form of intervention at the time for personal reasons.

Outcomes:

The patient was satisfied with the diagnosis, her and her families are continuously followed by our neurology department.

Lessons:

We report on a family with mtDNA mutation hearing loss that is related to exposure to aminoglycosides. Children with such mutation are at high risk for impaired linguistic function. Early identification and intervention with cochlear implant should be considered.
Effect of white-coat hypertension on arterial stiffness
Authors: Cai Peng , Peng Yan , Wang Yan , Wang Xukai
Published: October 2018

Background:

White-coat hypertension (WCH) is a debatable risk factor of cardio-cerebrovascular diseases and the current study results on the association between WCH and arterial stiffness are inconsistent. The aim was to investigate the effect of WCH on arterial stiffness using meta-analysis.

Methods:

Based on prespecified search strategies and inclusion criteria, Medline, Embase, Web Of Science, Cochrane Library, and BioSciences Information Service Preview databases were reviewed. A total of 20 studies involving 1538 WCH patients and 3582 normotensives (NT) were included. Literatures were screened for data extraction and quality assessment. Overall analysis and subgroup analysis were conducted in RevMan version 5.3 and Stata version 14.0 software.

Results:

Overall analysis showed that carotid-femoral pulse wave velocity (cf-PWV) was significantly higher in WCH group than in the NT group (P < .00001, 95% CI: 0.79–3.26). Subgroup analysis showed that in adults, cf-PWV was significantly higher in the WCH patients than in the NT subjects (P<.001, 95% CI: 0.46–0.87), while in juveniles, cf-PWV was comparable between the WCH group and the NT group (P = .25, 95% CI: −0.39 to 0.61).

Conclusion:

This meta-analysis showed that WCH may increase arterial stiffness in adult population.
Association of nurse staffing grade and 30-day mortality in intensive care units among cardiovascular disease patients
Authors: Kim Jae-Hyun
Published: October 2018

After the implementation of a policy differentiating inpatient nursing fees, no study is found in the nursing literature for intensive care unit (ICU) patients admitted with cardiovascular (CV) disease exclusively in Korea. This study investigates the relationship between ICU nurse staffing and 30-day mortality using large representative claim database.

National Health Insurance Service-Senior (NHIS-Senior) claim database from 2002 to 2013, which was released by the Korean National Health Insurance Service (KNHIS), was used in this study. We included CV disease inpatients as a primary diagnostic code (I20-I25) who had their ICU utilization records from differentiating inpatient nursing fees code, resulting in 17,081 subjects

After adjusting for confounders, the hazard ratio (HR) for 30-day mortality after discharge (HR: 1.177; P: .018) and in-hospital 30-day mortality (HR: 1.145; P: .058) were higher in general hospital (GH) than in tertiary hospital (TH). In GH setting, HR for 30-day mortality after discharge (HR: 1.499; P: .010) and in-hospital 30-day mortality (HR: 1.377; P: .042) were higher in grade 7 to 9 than grade 1 to 2, but not in TH setting.

This study shows that ICU nurse staffing related to improved mortality risk in GHs. Therefore, adequate nurse staffing to provide safe and high-quality care can be ensured by continuous monitoring and evaluation of nurse staffing.
Rare primary malignant mixed Müllerian tumor of the mediastinum
Authors: Wang Chunming , Liu Riqiang , Huang Feifei , Wei Haiming , Yu Lei
Published: October 2018

Rationale:

Malignant mixed Müllerian tumor (MMMT) of extragenital organs is rare, especially in male. To our knowledge, this is the first reported case of primary MMMT at the mediastinum in male.

Patient concerns:

A 54-year-old male was admitted to the hospital due to repeated stimulating dry cough for 2 years. His systemic examination was unremarkable. Laboratory workup revealed that all blood indicators were within normal limits. But subsequent computerized tomography (CT) scans of chest showed an abnormal soft tissue density in the area of its left, measuring approximately 4 cm in anterior-posterior dimension and 7 cm in maximum transverse dimension.

Diagnoses and Interventions:

The pathogenesis of these tumors remains controversial. The diagnosis is combined with biopsy and immunohistochemical staining. So, the patient underwent radical surgical resection and pathologic examination of the excised specimen was consistent with the diagnosis of MMMT. After surgery, he was treated by sequential chemoradiotherapy.

Outcomes:

The patient died from tumor recurrence 16 months later.

Lessons:

MMMT is a rare, highly aggressive tumor associated with interesting embryological origin, a definite diagnosis of which is only confirmed on pathological assessment. Due to its high degree of malignancy and high rate of recurrence, complete macroscopic excision of the tumor is recommended as soon as possible.
Choriocarcinoma with brain metastasis after term pregnancy
Authors: Song Liang , Li Qingli , Yin Rutie , Wang Danqing
Published: October 2018

Rationale:

Although the incidence of postpartum choriocarcinoma is extremely low, careful postpartum placental examination, histopathological examination in patients with abnormalities, and blood β-human chorionic gonadotropin (HCG) monitoring in high-risk pregnant women are necessary for early diagnosis of postpartum choriocarcinoma and improvement in prognosis.

Patient concerns:

A 32-year-old woman presented with the chief complaint of postpartum irregular vaginal bleeding for 45 days and coughing and hemoptysis for 7 days.

Diagnosis:

Clinical findings when combined with her medical history and various physical examinations confirmed the diagnosis as postpartum choriocarcinoma with brain metastases (stage IV postpartum choriocarcinoma and a risk score of 16).

Interventions:

The patient was administered three courses of multidrug chemotherapy (5-fluorouracil + actinomycin D) with intrathecal methotrexate injection. The 5-fluorouracil + actinomycin D maintenance chemotherapy regimen was continued for 4 cycles; whole brain radiotherapy was also administered.

Outcomes:

After the completion of chemotherapy and radiotherapy, the patient underwent regular follow-up examinations; no recurrence was noted for 17 months.

Lessons:

Timely diagnosis of postpartum choriocarcinoma can significantly improve its prognosis. A stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems. Blood β-HCG is a sensitive marker for evaluating therapeutic efficacy and follow-up after remission.
Nursing students’ relationships among meaning in life, well-being, and positive beliefs
Authors: Tsai Fu-Ju , Chen Cheng-Yu , Yeh Gwo-Liang , Hu Yih-Jin , Tseng Chie-Chien , Chen Si-Chi
Published: October 2018

Nursing educators have a core responsibility to develop nursing students’ health promotion. The purpose of this study was to explore nursing students regarding their relationships among meaning in life, well-being, and positive beliefs. A cross-sectional survey design was adopted in this study. Purposive sampling was used. A total of 219 nursing students participated in the study. Quantitative analysis was utilized for the data analyses. The study found that nursing students had the following mean scores on the meaning in life, 4.33 (86.60%) standard deviation (SD) 0.79; well-being, 4.23 (84.60%) SD 0.78; and positive beliefs, 4.32 (86.40%) SD 0.75. The nursing students’ characteristics, meaning in life, and well-being explained 79% of the variance in positive beliefs (adjusted R

2
 = 0.79, F = 114.57, P < .001). Nursing educators can promote meaning in life and well-being to nursing students as an effective way to increase their positive beliefs.
Validating the 6-minute walk test as an indicator of recovery in patients undergoing cardiac surgery
Authors: Chen Yueh-Chi , Chen Kun-Chung , Lu Li-Hua , Wu Yi-Liang , Lai Te-Jen , Wang Chun-Hou
Published: October 2018

The 6-minute walk test (6MWT) has been applied to assess postsurgical recovery in cardiac populations. This study mainly investigated whether the 6MWT could serve as an indicator for physical functioning in patients undergoing cardiac surgery.

Participants completed the 6MWT and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline, discharge, and 3 months postoperatively, in order to analyze the construct validity and responsiveness of the 6MWT. The participants in this study were 125 patients (92 males and 33 females) with an average age of 65.1 ± 11.1 years. The mean 6MWT was 308.9 ± 77.3 m in the preoperative phase, decreased to 277.3 ± 85.7 m at discharge, and returned to 378.1 ± 95.2 m at 3-month follow-up. The results showed that the 6-minute walk distances at baseline and at 3-month follow-up were moderately to highly correlated with the physical functioning subscale of the SF-36 (r

s
 = .44 and .54, respectively) and had weak correlation with the nonphysical functioning subscales. The recovery level of physical functioning is meaningfully associated with the 6MWT change from baseline to discharge and from baseline to 3-month follow-up. Patients with higher New York Heart Association (NYHA) Functional Classification levels had lower 6MWT. Additionally, the 6MWT was sensitive to change during the perioperative period (effect sizes from −0.51 to 1.72).

The supporting evidence includes the construct validity and responsiveness of the 6MWT. This study supports the feasibility of the 6MWT as an evaluation tool of physical functioning for assessment of postcardiac surgical recovery.
Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery
Authors: Lai Hou-Chuan , Huang Tsai-Wang , Tseng Wei-Cheng , Lin Wei-Lin , Chang Hung , Wu Zhi-Fu
Published: October 2018

Background:

Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS.

Methods:

Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated.

Results:

Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0–1]) in the P/S group and 17 (0 [0–3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33).

Conclusion:

Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.
Updates in Pediatric Pancreatology
Authors: Grover Amit S. , Freeman Alvin J. , Abu‐El‐Haija Maisam , Eisses John F. , Gardner Timothy B. , Liu Quin Y. , Lowe Mark E. , Nathan Jaimie D. , Palermo Tonya M. , Singh Vikesh K. , Trout Andrew T. , Uc Aliye , Husain Sohail Z. , Morinville Veronique D.
Published: October 2018

The Pancreas Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition aims to promote awareness of pediatric pancreatic diseases, support clinical and basic science research in the field, educate pediatric gastroenterologists, and advocate on behalf of pediatric patients with pancreatic disorders. At the 2017 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the Pancreas Committee held a full day symposium on pediatric pancreatic diseases, entitled, “Frontiers in Pediatric Pancreatology.” The symposium served as a timely and novel academic meeting that brought together individuals with a vested interest in the care of children with pancreatic disorders. The objective of this day‐long course was to update practicing gastroenterologists on the latest advances in research, management algorithms, endoscopic therapies, radiographic resources, surgical approaches, and novel drug therapies targeted to pediatric pancreatitis. Presentations were divided into 4 modules: diagnosis, risk factors, and natural history of pancreatitis; pancreatic imaging and exocrine function; management of pancreatitis; and new frontiers in pediatric pancreatitis research. The course fostered a unique ecosystem for interdisciplinary collaboration, in addition to promoting discussion and stimulating new research hypotheses regarding pediatric pancreatic disorders. Oral presentations by experts in various fields of pancreatology led to thought‐provoking discussion; in addition, a meet‐the‐professor luncheon stimulated critical evaluation of current research in pediatric pancreatic diseases, highlighting knowledge gaps and future research endeavors. The current report summarizes the major learning points from this novel symposium focusing on the growing demographic of pediatric pancreatic diseases.
Prevalence and Clinical Correlations of Somatostatin Receptor-2 (SSTR2) Expression in Neuroblastoma
Authors: Alexander Natasha , Marrano Paula , Thorner Paul , Naranjo Arlene , Van Ryn Collin , Martinez Daniel , Batra Vandana , Zhang Libo , Irwin Meredith S. , Baruchel Sylvain
Published: October 2018

Alternative radiolabeled, targeted agents are being investigated for children with relapsed neuroblastoma (NB) who do not respond to I131-metaiodobenzylguanidine (MIBG) therapy. (DOTA0-Tyr3)-octreotate targets somatostatin receptors (SSTRs), particularly SSTR2, which are expressed on NB cells. We investigated SSTR2 expression in NB tumors (36 high-risk [HR]; 33 non-HR patients) and correlated SSTR2 levels with clinical features, norepinephrine transporter (NET) expression, and MIBG avidity. SSTR2 and NET immunohistochemistry scores (0 to 3) were calculated on biopsies using digital image analysis based on staining intensity and distribution. Clinical data were correlated with SSTR2 expression. Median SSTR2 score for 69 patients was 1.31 (0.26 to 2.55). Non-HR NB was associated with a higher SSTR2 score (P=0.032). The SSTR2 expression did not correlate with age, International Neuroblastoma Staging System (INSS) stage, MYCN amplification and histology. Higher SSTR2 scores were observed in MIBG-avid versus MIBG-nonavid NB. SSTR2 score was not significantly associated with NET score (r=−0.062, P=0.62). Twenty-six patients who relapsed or progressed had a median SSTR2 score of 1.33 (0.26 to 2.55). Patients with NB including relapsed or progressive disease showed SSTR2 expression at diagnosis, suggesting they could be candidates for radiolabeled–DOTA-conjugated peptide imaging or therapy.
Activated Phosphoinositide 3 Kinase Delta Syndrome (APDS): A Primary Immunodeficiency Mimicking Lymphoma
Authors: Baleydier Frederic , Ranza Emmanuelle , Schäppi Michela , Rougemont Anne-Laure , Merlini Laura , Ansari Marc , Blanchard-Rohner Geraldine
Published: October 2018

Malignant or nonmalignant lymphoproliferative disorders together with repeated ear, nose, and throat infections should strongly motivate immunologic investigations. Indeed, we report a 7-year-old patient with a history of persistent abdominal symptoms along with recurrent ear, nose, and throat infections, who presented with intra-abdominal masses highly suggestive of a diagnostic of lymphoma, and who was diagnosed with activated-PI3K-delta syndrome, a recently described primary immunodeficiency prone to lymphoproliferation.
Validation of the Smoking Cessation Counseling Scale Chinese Version in Taiwan
Authors: Tsai Hsiu-Wen , Chen Shu-Ching , Wu Hsein-Lin , Hong Ming-Ying , Lee Yun-Hsiang , Lai Yeur-Hur
Published: October 2018

Background

Providing tobacco control (TC) and smoking cessation (SC) counseling is an important part of healthcare. An assessment tool to understand healthcare providers' experiences in providing SC counseling may enhance TC.

Objective

The aims of this study were to (1) translate and develop the Smoking Cessation Counseling Scale–Chinese version (SCCS-C) and (2) evaluate its psychometric properties in Taiwan.

Methods

This is a 2-phase instrument testing study. In the first phase, the SCCS-C was developed and translated. In the second phase, 2 groups of participants were recruited. First, 292 SC educator trainees completed the psychometric assessment measures (internal consistency reliability and construct validity). The 2-week test-retest reliability was assessed in certified TC instructors.

Results

The results showed that (1) the SCCS-C has satisfactory content validity and internal consistency reliability with a Cronbach's α of .96; (2) the overall 2-week test-retest reliability was 0.70; (3) instead of the 4-factor structure of the original scale, a 3-factor structure of the SCCS-C was identified by exploratory factor analysis to explain 65.37%; (4) construct validity was supported by significant negative correlations between SCCS-C and barriers regarding TC and positive correlations with counseling, responsibility, and self-efficacy; and (5) discriminant validity was supported by significant differences between SC educator trainees and the certified TC instructors, as well as between those living with or without smokers.

Conclusions

The SCCS-C has satisfactory reliability, test-retest reliability, and construct validity.

Implications for Practice

The SCCS-C is a valid, reliable instrument for assessing healthcare counseling activities for SC in Taiwan.
Clinical Insignficance of Monoclonal T-Cell Populations and Duodenal Intraepithelial T-Cell Phenotypes in Celiac and Nonceliac Patients
Authors: Celli Romulo , Hui Pei , Triscott Hannah , Bogardus Sidney , Gibson Joanna , Hwang Michael , Robert Marie E.
Published: October 2018

Refractory celiac disease (RCD) is a rare condition, usually managed at specialized centers. However, gastroenterologists and pathologists in general practices are often the first to consider a diagnosis of RCD in celiac patients with persistent symptoms. The distinction between type I and type II RCD is crucial as patients with RCD II have a shortened life expectancy. The diagnosis of RCD II requires the demonstration of abnormal intraepithelial lymphocytes and/or monoclonal T-cell populations in duodenal biopsies, typically assessed in formalin-fixed paraffin-embedded tissue. We investigated the clinical significance of T-cell receptor gene rearrangements and CD3/CD8 staining in formalin-fixed paraffin-embedded biopsies from 32 patients with RCD I (4), RCD II (3), newly diagnosed celiac disease (CD) (10), established CD patients with follow-up biopsies (10), and Helicobacter pylori–associated lymphocytosis (5). Clonal T-cell populations were present in all lymphocytosis groups but not in normal controls. No difference in the frequency of clonal populations or persistence of identical clones was found between RCD I and II patients. The degree of villous blunting did not correlate with clonal status in any group. No difference in the number of CD3/CD8-positive intraepithelial lymphocytes per 100 enterocytes was found between groups. We suggest that clonal evaluation of T cells should not be employed routinely in the evaluation of CD patients with persistent symptoms until common causes of “apparent refractoriness” have been excluded. In addition, lymphocyte phenotyping and T-cell clonal analysis appear to be insufficient as stand-alone tests to reliably distinguish RCD I and II.