bluuebunny/crossref_metadata_2025 huggingface dataset:
The Match: To Thine Own Self Be True
Authors: Prober Charles G.
Published: December 2018

The residency match process, culminating with the Match Day celebration, plays out in medical schools across the United States and Canada every year. The process may seem strange and mysterious for observers outside of medicine. The notion that each graduating student’s employer for the next several years is first revealed to thousands of people, all at the same moment, through the opening of an envelope is surreal. The emotional reactions accompanying the process range from jubilance to deep disappointment. Much attention and care have been given to developing the algorithm underpinning the Match, and the process seems just: Optimization favors applicants over training programs. Witnessing students as they progress to their next stage of medical training is special for those involved in medical education. Faculty are filled with pride. But the process is far from perfect. The author of this Invited Commentary notes several concerns about the Match: the arduous process that students undergo to maximize their chances of success; the costs attendant to the travel and related expenses of multiple, geographically dispersed interviews; and the metrics that students and their medical schools use to judge the outcomes. The author worries that for some students, the “ideal” match may not be the one driven by their dreams and aspirations but, rather, by an amalgamation of those of many well-meaning friends, family members, and faculty. Medical students should seek advice and guidance, but the author hopes that, ultimately, students follow their own drumbeat and are true first to themselves.
Graduating Fellows’ Procedural Comfort Level With Pulmonary Critical Care Procedures
Authors: Knox Daniel B. , Wong William W.
Published: December 2018

Background:

Graduating fellows from pulmonary and critical care programs are expected to independently perform bronchoscopy and common medical procedures in the intensive care unit. Given variable exposure and learning opportunities at different training programs, little is known about how comfortable graduating fellows are with these procedures.

Methods:

A survey concerning the ACGME required procedures for pulmonary and critical care fellowship was sent to graduating fellows and program directors at all ACGME accredited subspecialty fellowship programs in pulmonary, critical care, and combined pulmonary critical care medicine.

Results:

Critical care fellows performed the most intubations, paracenteses, arterial lines, central venous catheter insertions, and cardioversions, but did not perform as many bronchoscopy related procedures as the other subgroups. Pulmonary and combined pulmonary/critical care fellows performed and felt confident in most procedures. Program directors from all specialties agreed with the fellows overall about the procedural confidence gained during training. There also appeared to be a correlation between number of procedures performed and the confidence of the proceduralist. There appears to be a certain threshold number of successful completions to achieve confidence for independent practice for each surveyed procedure.

Conclusion:

There is a correlation between a fellow’s procedural comfort with independent practice and the number of successful attempts by a graduating fellow. There are no universal guidelines that outline the appropriate number of successful attempts needed for independent practice, and our data strongly suggests that there is a threshold for each procedure across these three subspecialties.
Effect of hand washing and personal hygiene on hand food mouth disease
Authors: Guo Nana , Ma Huilai , Deng Jian , Ma Yanxia , Huang Liang , Guo Ruiling , Zhang Lijie
Published: December 2018

There are no specific treatment drugs and vaccine for Hand Foot and Mouth Disease (HFMD). Taking effective preventive measures is particularly important for control of HFMD infection. The objective of this study is to evaluate the effect of intervention of intensive education on hand hygiene on HFMD.

We randomized 64 villages into intervention and control groups in Handan, Hebei province, China. Parents and caregivers of children 6 to 40 months age group in intervention villages received intensive education on hand hygiene. Control group received general education. The intervention period was from April 1 to July 31, 2011 and April 1 to July 31, 2012. We measured and compare the knowledge and incidences of HFMD between 2 groups.

We collected 6484 questionnaires, including 3583 in the intervention group [response rate: 96% (3583/3726)] and 2901 in the control group [response rate: 90% (2901/3224)]. We observed that hand washing habit of children and parent, knowledge of HFMD of parents, children's daily cleaning habits scores improved in the intervention group and higher than that in the control group at both the end of year 1 (April 1–July 31, 2011)and year 2 (April 1–July 31, 2012). The incidence of HFMD (2.1%) in intervention group was significantly lower than that in control group (4.2%) at year 2 (χ2 = 22.138,P <.001). The positive percent of coli-form on the hand swabs in intervention group (2.00%) were significantly lower than that in control group (9.45%) at the end of year 2.

The intervention of intensive education on hand hygiene effectively improved the personal hygiene both of children and parents, as well as reduced the incidence of HFMD. We suggested expanding the intervention measures in community to prevent HFMD.
Sudden cardiac death due to the Wolff–Parkinson–White syndrome
Authors: Qiu Mingjie , Lv Bin , Lin Wei , Ma Jing , Dong Hongmei
Published: December 2018

Rationale:

The Wolff–Parkinson–White syndrome (WPW) is a benign heart disease with accessory pathways, which can result in cardiac arrhythmias. The purpose of this case report is to introduce a rare case of sudden cardiac death (SCD) with a mild myocardial bridge and a history of WPW.

Patient concerns:

A 25-year-old man with known WPW syndrome died at night while sleeping.

Diagnoses:

Diagnosis of WPW syndrome is based on typical electrocardiogram findings with a documented dysrhythmia before the victim's death.

Interventions:

At autopsy, no traumatic injury or common poisons were found, only a slight myocardial bridge was detected. We performed whole exome sequencing and identified several genetic variations related to SCD.

Outcomes:

We considered that the cause of death in this case was SCD in which arrhythmia might play an important role.

Lessons:

This case highlights SCD can occur in WPW patients with mild or unrecognized structural abnormality. Postmortem genetic examination can assist the diagnosis of sudden cardiac death, especially when no lethal structural abnormality is found in the decedent.
Calcifying fibrous tumor of the terminal ileum mesentery
Authors: Prucker Johannes , Salaheddin-Nassr Yarub , Leidl Stefan
Published: December 2018

Rationale:

Calcifying fibrous tumors (“CFT”) are recognized as extremely rare mesenchymal tumors with benign biological behavior and low rates of recurrence are seen after removal. The first case of a CFT was reported in 1988 as a possibly inflammatory triggered pseudotumor in deep soft tissue of children. Histologically, the tumor is typically composed of dense hyalinized collagen with paucicellular infiltration of lymphocytes and fibroblasts as well as psammomatous or dystrophic calcifications. It can affect soft tissue in very different anatomical locations, also intrathoracic and intra-abdominal, mimicking various different diagnoses. The etiology is understood to be unclear. Asymptomatic CFTs can be found incidentally on medical images.

Patient concerns:

We present the case of a calcifying tumorous lesion found incidentally in the mesentery of the terminal ileum of a 34-year-old male patient in February 2016 undergoing a computed tomography for a urinary tract infection.

Diagnosis:

Histopathological and immunhistochemical examination after surgery revealed a CFT.

Interventions:

Our patient underwent lower abdominal median laparotomy for tumorectomy.

Outcomes:

Two years after surgery the patient is free of a recurrence.

Lessions:

We add another case of intra-abdominal CFT to medical literature to provide more information about this very seldom tumor. While the etiology of CFT should be further investigated, diagnosis and therapy seem clarified. CFT should be kept in mind as a rare differential diagnosis of calcifying tumors also in the abdominal cavity. Immunohistological work-up is important for finding the diagnosis and may also help solving pathogenetical questions.
Upregulated delta-like protein 3 expression is a diagnostic and prognostic marker in endometrial cancer
Authors: Wang Juan , Zhang Kaishuo , Liu Zi , Wang Tao , Shi Fan , Zhang Yingbing , Su Jin , Jia Yina
Published: December 2018

Upregulated delta-like protein 3 (DLL3) functions as a Notch ligand and has been a target for cancer therapy. The present study assessed DLL3 expression as a tumor marker for endometrial cancer.

RNA-Seq expression data and clinicopathologic records from 545 patients with endometrial cancer were downloaded from The Cancer Genome Atlas database. Mann–Whitney U and logistic regression tests were applied to associate the level of DLL3 expression with clinical variables from the patients. Kaplan–Meier curves and log-rank tests were performed to compare overall survival of patients stratified by different levels of DLL3 expression. Multivariate Cox regression tests were used to analyze independent predictors for endometrial cancer. DLL3 expression was upregulated in endometrial cancer tissues compared to para-carcinoma tissues (P = .0003). High DLL3 expression was associated with the age of patients (odds ratio [OR] = 1.74), advanced stages of the International Federation of Gynecology and Obstetrics system (OR = 2.9), grade III/IV (OR = 5.1), myometrial invasion (OR = 2.2), pelvic involvement (OR = 12.9), and para-aortic lymph node metastasis (OR = 9.9) (all P ≤ .001). Furthermore, upregulated DLL3 expression was also associated with a median overall survival of 112 months (HR = 1.85, confidence internal 1.202–2.846, P = .005). The multivariate analysis showed that DLL3 overexpression and advanced tumor stages, grades, and lymph node metastases were all independent prognostic predictors for endometrial cancer.

The DLL3 expression could be a potential and novel tumor marker for early diagnosis and an independent predictor of poor survival for patients with endometrial cancer.
The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement
Authors: Huang LiLi , Zhou XiaoShuang , Yang XiaoYun , Yu Hai
Published: December 2018

Background:

Frailty is a syndrome of impaired physiologic reserve and decreased resistance to stressors and can often be seen in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). Preoperative frailty status is thought to be related to adverse outcomes after TAVR. We conducted this systematic review and meta-analysis to determine the impact of preoperative frailty status on outcomes among patients after TAVR.

Methods:

PubMed, Embase, and the Cochrane Library were searched for relevant studies through January 2018. Fourteen articles (n = 7489) meeting the inclusion criteria were finally included. Possible effects were calculated using meta-analysis.

Results:

The pooled risk ratios (RRs) of late mortality (>6 months) and acute kidney injury after TAVR in frail group were 2.81 (95% confidence interval (CI) 1.90–4.15, P < .001, I2 = 84%) and 1.41 (95% CI 1.02–1.94, P = .04, I2 = 24%), respectively. Compared with non-frail group, significantly higher incidence of 30-day mortality (RR 2.03, 95% CI 1.63–2.54, P < .001, I2 = 0%) and life threatening or major bleeding after TAVR (RR 1.48, 95% CI 1.20–1.82, P < .001, I2 = 14%) was found in frail group. There was no significant association between frailty and incidence of stroke after TAVR (RR 0.93, 95% CI 0.53–1.63, P = .80, I2 = 0%).

Conclusion:

Preoperative frailty status is proved to be significantly associated with poor outcomes after TAVR. Our findings may remind doctors in the field of a more comprehensive preoperative evaluation for TAVR candidates. More well-designed and large-sample sized prospective studies are further needed to figure out the best frailty assessment tool for patients undergoing TAVR.
Insulin autoimmune syndrome
Authors: Chen Fangyuan , Yang Jianming , Liu Yanqun , Wang Wen , Zhu Li , Wang Wei , Yang Jun , You Wei
Published: December 2018

Rationale:

Insulin autoimmune syndrome (IAS) is a rare endocrine disease characterized by repeated fasting hypoglycemia or episodes of hypoglycemia late after meals, elevated serum insulin, and positivity for insulin autoantibody (IAA) or insulin receptor antibody (IRA). We summarize the clinical manifestations and treatment experiences of 3 patients with IAS.

Patient concerns:

One patient with >20-year history of type 2 diabetes mellitus had irregular episodes of hypoglycemia 2 years of after treatment with insulin. Another patient with a 6-year history of type 2 diabetes mellitus presented irregular episodes of hypoglycemia after 6 months of treatment with insulin. One patient with a history of Graves’ disease showed hypoglycemia after administration of thiamazole.

Diagnosis:

Serum islet cell antibody (ICA) and glutamic acid decarboxylase antibody (GADA) were negative, while antibody insulin autoantibodies were positive in all the 3 patients. Two patients demonstrated diabetes mellitus after an oral glucose tolerance test, while one had normal glucose tolerance. Furthermore, serum insulin levels significantly elevated and did not matched C peptide levels. No abnormalities were found on enhanced MRI of the pancreas, and all 3 patients were clinically diagnosed with IAS.

Interventions:

In case one, insulin aspart 30 injection was withdrawn after admission. In addition, the patient was prescribed sublingual acarbose 3 times daily. Two weeks after admission, prednisone acetate was administered orally once daily at night. In case 2, insulin aspart 30 injection was withdrawn after admission, the patient was prescribed sublingual acarbose 3 times daily with a meal. Five days after admission, oral prednisone acetate was administered once daily at night. In case 3, oral propylthiouracil was prescribed and thiamazole withdrawn after admission, and the patient consumed an extra meal before sleeping.

Outcomes:

At the 3-month follow-up visit, the hypoglycemic episodes had disappeared, serum insulin levels were significantly decreased, and insulin antibody (IA) levels were no longer detectable in all 3 patients.

Lessons:

For those patients with high-insulin hypoglycemia, IAA should be evaluated if serum insulin concentrations are inconsistent with C peptide levels. Therapeutically, a lower dose of glucocorticoids with more appropriate medication timing can be used to achieve good results.
Comparison of effective teaching methods to achieve skill acquisition using a robotic virtual reality simulator
Authors: Shim Ji Sung , Kim Jae Yoon , Pyun Jong Hyun , Cho Seok , Oh Mi Mi , Kang Seok Ho , Lee Jeong Gu , Kim Je Jong , Cheon Jun , Kang Sung Gu
Published: December 2018

Background:

To compare the superiority of teaching methods for acquiring a proficient level of surgical skill in a robotic surgery-naïve individual using a robotic virtual reality simulator.

Methods:

This study employed a prospective, randomized study design to assess student's learning curve. We divided 45 subjects into 3 groups: those with expert proctoring (group I), those who watched only an educational video (group II), and those with independent training (group III; n = 15 per group). The task used in this study was the Tube 2 and it imitates a vesicourethral anastomosis in robotic prostatectomy. The effects were analyzed by the time to end the task after overcoming the learning curve which is determined by several performance parameters.

Results:

The number of task repetitions required to reach the learning curve plateau was 45, 42, and 37 repetitions in groups I, II, and III, which means that there was continuous improvement in performing the task after 40 repetitions only in groups I and II. The mean time for completing the task during the stabilization period was significantly different between group I and group III and group II and group III, which means that the independent training method was inferior to the other methods (group I vs. group II vs. group III: 187.38 vs. 187.07 vs. 253.47 seconds, P < .001).

Conclusions:

This study's findings showed that an educational video can be as beneficial as expert proctoring, which implies that the development of a standardized educational video would be worthwhile.
Effect of nerve electrical stimulation for treating chemotherapy-induced nausea and vomiting in patients with advanced gastric cancer
Authors: Guo Wen-cheng , Wang Fang
Published: December 2018

Background:

This randomized controlled trial evaluated the effectiveness of nerve electrical stimulation (NES) for the treatment of chemotherapy-induced nausea and vomiting (CINV) in patients with advanced gastric cancer (AGC).

Methods:

One hundred twenty-four eligible patients with AGC were included in this randomized controlled trial. They were equally divided the NES group and the sham group. The patients in the NES group received NES intervention, while the subjects in the sham group underwent sham NES. The primary outcome included symptoms severity and appetite. The secondary outcomes included quality of life, as measured by the MD Anderson Symptom Inventory (MDASI) score, and functional impairment, as evaluated by the Karnofsky score. Additionally, adverse events were also documented during the period of the treatment.

Results:

After treatment, NES showed greater effectiveness in reducing the severity of nausea (P = .02), and vomiting (P = .04), as well as the appetite improvement (P = .02), compared with the sham NES. Furthermore, no adverse events related to NES treatment were detected.

Conclusion:

The results of this study demonstrated that NES may help to relieve CINV in patients with AGC. Future studies are still needed to warrant these results.
A feasibility study using cadaver
Authors: Kang Seok , Yoon Joon Shik , Lee Chung Ho , Kim Guk-Han , Choi Hyuk , Kim Jae Do , Park Hong Seok
Published: December 2018

Intermittent catheterization is an effective bladder management strategy for patients with incomplete bladder emptying. For self-catheterization, sufficient hand function in both hands is necessary. We have developed a novel automatic urinary catheterization device to induce self-IC for patients with bladder dysfunction and upper extremity disability. The aim of this study was to investigate the feasibility of this novel automatic catheterization device.

This study was performed using 4 fresh cadavers. First, 400 mL of normal saline was filled into the cadaver bladder. Then, the catheter was inserted using the newly developed device. The catheter insertion was performed 3 times for each cadaver, with the penis positioned at 45°, 90°, and 135°, respectively. A transrectal ultrasonography was performed during the catheterization. We evaluated whether the catheter was successfully inserted into the bladder at each position of penis and whether the urethrovesical junction was injured when inserting the catheter. We also measured the volume of normal saline evacuated from the bladder after successful catheterization.

With the penis positioned at 45° and 90°, catheter insertion was successful without any damage to the urethrovesical junction. However, when the penis was at 135°, the catheter could not be inserted into the bladder. When the automatic catheter insertion was successful, the bladder was successfully emptied. On average, 81.56 ± 3.26% of normal saline was discharged from the bladder and 11.13 ± 2.09% was remained.

The newly developed automatic urinary catheterization device could insert the catheter effectively and safely. This device would be a useful tool for the urinary catheterization of bladder dysfunction patients with upper extremity disability.
Genetic polymorphisms of methylenetetrahydrofolate reductase C677T and risk of ischemic stroke in a southern Chinese Hakka population
Authors: Hou Jingyuan , Zeng Xing , Xie Yunquan , Wu Hesen , Zhao Pingsen
Published: December 2018

Previous studies have shown that methylenetetrahydrofolate reductase (MTHFR) gene to be a genetic risk factor for the susceptibility to ischemic stroke. The aim of this case-control study was to investigate whether the polymorphisms ofMTHFRC677T were associated with the susceptibility to ischemic stroke in a southern Chinese Hakka population. In this study, a total of 1967 ischemic stroke patients and 2565 controls of Chinese Hakka ethnicity were recruited. TheMTHFRC677T polymorphisms were genotyped by polymerase chain reaction (PCR) amplification and microarray method. The risk of ischemic stroke was estimated by logistic regression analysis. The frequencies of CC, CT, and TT genotypes were 52.67% versus 55.63%, 40.31% versus 38.52%, and 7.02% versus 5.85% in patients with ischemic stroke versus controls, respectively. The frequency of T allele was significantly higher in ischemic stroke patients (27.17%) than in controls (25.11%) (P = .026, odds ratio [OR] 1.113, 95% confidence interval [CI] 1.013–1.223). The homozygous TT genotype in the ischemic stroke patients was associated with increased risk (P = .049, OR 1.132, 95% CI 1.001–1.281) when compared with the controls after adjustment for age and sex. The positive association was only found in dominant model without adjustment for age and sex (P = .047, OR 1.127, 95% CI 1.002–1.268). Also, the carrier status of theMTHFRT allele was identified as an independent risk factor for the development ischemic stroke even after the adjustment for conventional risk factors (P = 0.047, OR 1.109, 95% CI 0.964–1.225). Our results provide evidence that variants ofMTHFRC677T gene may influence the risk of developing ischemic stroke in a southern Chinese Hakka population. Further studies are needed to confirm this association, which will promote the development of strategies for prevention and treatment of ischemic stroke in our study population.
Pleomorphic rhabdomyosarcoma metastasis to small intestine causing intussusception
Authors: Xi Shiwen , Tong Weihua
Published: December 2018

Rationale:

Pleomorphic rhabdomyosarcoma (PRMS) is a rare soft tissue malignancy which is frequently misdiagnosed and associated with metastasis to the lungs, lymph nodes, and bone marrow. Case studies are needed to improve the awareness of the disease and our understanding of it.

Patient concerns:

In this study, we present a case of a 36-year-old man with a lesion on the right back shoulder. Lesion was confirmed by magnetic resonance imaging (MRI) around the right armpit, subscapularis, deltoid, and infraspinatus muscle, with oozing surrounding soft tissues.

Diagnosis:

The tumor was diagnosed as PRMS which metastasized to the intestine, where it caused intussusception.

Interventions:

The patient was treated by complete surgery in combination with neo-adjuvant chemotherapy including ifosfamide and epirubicin.

Outcome:

The patient remained alive 6 months after the treatment with no recurrence and metastasis.

Lesson:

PRMS can be aggressive, and surgical treatment in combination with multidrug chemotherapy can be used in the management.
The effect of Baduanjin qigong combined with CBT on physical fitness and psychological health of elderly housebound
Authors: Jing Liwei , Jin Yanpeng , Zhang Xiaoli , Wang Fenglan , Song Yuyu , Xing Fengmei
Published: December 2018

Background:

To investigate the effectiveness of Baduanjin qigong combined with cognitive-behavior therapy (CBT) on the physical fitness and psychological health of elderly housebound.

Materials and methods:

The 120 elderly housebound were randomly divided into 3 intervention groups: Baduanjin training, Baduanjin training combined with CBT, and CBT. The interventions were conducted by means of home visits over 6 months. Spirometry, SF-36 health survey of quality of life, and Lawton and Brody Instrumental Activities of Daily Living Scale (IADL) were used to collect physical health data, and self-evaluation of overall health status, self-evaluation of loneliness, and short-form geriatric depression scale (GDS-15) were used to collect mental health data at baseline, 3 months, and 6 months after intervention. Data was analyzed by repeated measures analysis of variance (rANOVA) and chi-squared test (χ2 test).

Results:

Forced vital capacity (FVC), maximum voluntary ventilation (MVV), quality of life (QOL), and self-reported health status were significantly increased (P < .05) in the group receiving joint Baduanjin and CBT intervention at 3 months and 6 months, as compared to the Baduanjin only group or the CBT only group. Activities of daily living (ADL), self-evaluated loneliness, and level of depression were significantly lowered (P < .05) in the group receiving joint Baduanjin and CBT intervention at 3 months and 6 months, as compared to the Baduanjin only group or the CBT only group.

Conclusions:

Physical and psychological statuses of elderly housebound were significantly improved by Baduanjin training combined with CBT. The effect of the combined intervention exceeded that of CBT or Baduanjin alone.
A quality improvement pilot assessment of the safety and associated outcomes of a viable cryopreserved umbilical tissue allograft as an adjunct surgical wrap in peroneus brevis tendon repair
Authors: Sundblad Kyle W. , Tassis Elisabet K.
Published: December 2018

Surgical tendon repairs of the lower extremity are frequently associated with post-operative (post-op) risks that result in poor patient outcomes. Initially, increased pain levels may contribute to extended post-op rehabilitation while the development of tissue adhesions and fibrosis limit long-term functionality through reduced range of motion. Several surgical methods describing incorporation of various augmentative graft materials in tendon repair exist. However, reports demonstrating technique and both short- and long-term patient outcomes are lacking. Recently, advances in tissue preservation technology have led to the commercialization of human placental allografts. Of these available allogeneic biomaterials, the components found in human placental membranes may provide anti-inflammatory, antimicrobial, anti-adhesive, and antifibrotic properties to benefit surgical outcomes.

Here, the authors introduce and technically describe the use of a viable cryopreserved umbilical tissue (vCUT) (Stravix, Osiris Therapeutics, Inc., Columbia, MD) as a complementary surgical wrap in primary tendon repair, with particular focus on the peroneus brevis. A pilot study was undertaken to assess the safety and potential for secondary rehabilitative outcomes associated with the use of vCUT in 5 tendon repair cases. The use of vCUT as a surgical tendon wrap was evaluated via the following primary endpoints at post-op day 7:

Secondary investigative endpoints included clinical and rehabilitative outcome measures for comparative pain reduction and transition times to both controlled ankle movement (CAM) boot and normal shoe ambulation.

All patients were followed for an average of 24.15 months (range 16.75–26.5 months) after surgery. For primary safety measures, erythema, tenderness, drainage, heat, and swelling was absent in all 5 surgical sites. None of the patients required post-op use of narcotics past day 7. The potential for long-term rehabilitative improvement with adjunct use of vCUT was also demonstrated through reduced pain and reduced transition times to functional and non-assisted ambulation in normal shoewear as compared to historical controls managed without vCUT.

This surgical technique is simple and safe for patients and preliminary findings have demonstrated favorable clinical and rehabilitative outcomes over historically observed controls.
Facial paralysis as a presenting symptom of infant leukemia
Authors: Wang Liyuan , Wang Zhiling , Wan Chaomin , Cai Xiaotang , Zhang Ge , Lai Chunqi
Published: December 2018

Rationale:

Facial paralysis as the initial clinical presentation of infant leukemia (IL) is rare, and the rate of its misdiagnosis is high. Identifying the clinical characteristics of IL with facial paralysis as the initial symptom is necessary to improve the understanding of the causes of facial paralysis and IL.

Patient concerns:

A 10-month-old infant had facial paralysis and recurrent fever. He was misdiagnosed as having bacterial meningitis for >2 months.

Diagnoses:

The infant was diagnosed as having acute monocytic leukemia (M5) with central infiltration based on examinations of the bone marrow and cerebrospinal fluid by flow cytometry.

Interventions:

Before the diagnosis of leukemia, the patient was given meropenem, ceftriaxone, vancomycin, and ampicillin successively for anti-infective treatment for 2 months, and dexamethasone for several days. But he gave up further treatment after confirmed diagnosis.

Outcomes:

Our patient discontinued treatment and discharged. From literature review, there were 6 cases (including this case) of IL with facial paralysis as the initial symptom. 80% of patients were misdiagnosis and treated with a corticosteroid in the early stage, and the mortality was 33.3%.

Lessons:

The clinical symptoms of IL with facial paralysis are not typical, with a high rate of misdiagnosis. When the cause of facial paralysis is unknown or the advance treatment effect is poor, tumor diseases should be considered. Corticosteroids should be carefully administered to children with facial paralysis.
Balanced crystalloids for intravenous fluid therapy in critically ill and non-critically ill patients
Authors: Ma Peifen , Wang Bo , Zhang Jun , Shen Xiping , Yu Liping , Dou Xinman
Published: December 2018

Background:

The balanced crystalloids have become a substitute for saline for fluid resuscitation. Some studies have investigated the clinical effect and adverse event of differently balanced crystalloids, but they have no consistent conclusions. This study aims to assess and compare the effect of differently balanced crystalloids for intravenous fluid therapy in critically ill and non-critically ill patients using network meta-analysis (NMA).

Methods:

Electronic databases including PubMed, EMBASE, Cochrane Library, Web of Science, Clinical Trials.gov, and the International Clinical Trials Registry Platform (ICTRP) will be searched from inception to April 2018. We will include randomized controlled trials (RCTs) that reported the effect and adverse event of balanced crystalloids. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian NMA will be performed using R software. GRADE will be used to explore the quality of evidence.

Results:

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

Conclusion:

This NMA will summarize the direct and indirect evidence to assess the effect of differently balanced crystalloids.

Ethics and dissemination:

Ethics approval and patient consent are not required as this study is an NMA based on published studies.

PROSPERO registration number:

CRD42018093818.
Genetic polymorphism (rs246079) of the DNA repair gene uracil N-glycosylase is associated with increased risk of cervical carcinoma in a Chinese population
Authors: Ye Feng , Wang Hanzhi , Liu Jia , Cheng Qi , Chen Xiaojing , Chen Huaizeng
Published: December 2018

The aim of this case-control study was to clarify the relationship between uracil N-glycosylase (UNG) rs3219218 and rs246079 genotypes and risk of cervical squamous cell cancer (CSCC). Modified polymerase chain reaction-mismatch amplification (MA-PCR) was applied for genotyping UNG rs3219218 (A/G) and UNG rs246079 (A/G) polymorphisms in 400 CSCC, 400 cervical intraepithelial neoplasia (CIN) III, and 1200 normal controls. We observed no association between the UNG rs3219218 (A/G) polymorphism and risk of CIN III or CSCC. However, risk of CIN III (odds ratio [OR] = 1.58) and CSCC (OR = 2.08) was significantly increased in cases with the homozygous GG genotype of UNG rs246079. At the UNG rs246079 (A/G) locus, individuals with the G allele or G carrier (GG + AG) genotype were at higher risk for CIN III (OR = 1.34) and CSCC (OR = 1.55). In the high-risk HPV (HR-HPV) positive group, homozygous GG of the UNG rs246079 genotype was associated with significantly increased risk of CSCC (OR = 2.37) and CIN III (OR = 1.81). Meanwhile, the proportion of G allele was significantly increased in CIN III (49.2%, OR = 1.33) and CSCC (52.5%, OR = 1.50) groups. G allele or G carrier (GG + AG) genotype was identified as a high-risk factor in CSCC (OR = 1.67) while in the CIN III group, no major differences were evident relative to the control group (OR = 1.45). A particularly high level of enrichment grouping was evident according to the number of sexual partners in the CIN III (P = .036) and CSCC (P = .001) groups. Our data clearly suggest an association between UNG rs246079 (A/G) and CSCC carcinogenesis, supporting the potential application of this polymorphism as a genetic biomarker for early prediction of cervical carcinoma.
Adenocarcinoma of the ascending colon in a 31-year-old pregnant woman
Authors: Xu Youzheng , Kong Beihua , Shen Keng
Published: December 2018

Rationale:

Colorectal cancer (CRC) is the 2nd most common type of cancer in females and the 3rd in males, worldwide. It occurs rarely during pregnancy and is often associated with poor prognosis, due to the unspecific manifestations until advanced stage. Majority of CRC are localized in the rectum (63%) and the sigmoid colon (20%) during pregnancy.

Patient concerns:

In thisstudy, we report the case of a pregnant woman who was diagnosed with adenocarcinoma of the ascending colon at her 33rd gestational week. She was referred to our department from local hospital with low fever and right-sided flank pain, which had lasted for nearly half a year and severely aggravated for 5 days. Previous prenatal examinations contributed the pain to kidney stones or uterine contractions.

Diagnoses:

After a caesarean section and tumor resection of a mass at the hepatic flexure of colon, tumor histology of frozen section confirmed the diagnosis of ulcerative adenocarcinoma of the ascending colon with a diameter of 10 cm. Final pathologic evaluation showed a grade 1 adenocarcinoma with negative lymph nodes (16/0), R0 resection, pT4b pN0 M0 and Dukes B stage.

Interventions:

A healthy female infant was delivered by caesarean section, right after which a right hemicolectomy and ileostomy was performed. Pathology examination proved an early stage adenocarcinoma with no lymphatic metastasis. Patient received chemotherapy with folinic acid, fluorouracil, and oxaliplatin (FOLFOX) after recovery smoothly and got discharged 1 month after surgery.

Outcomes:

Patient showed no relapse or progression during the follow-up time of 2 years after operation and chemotherapy.

Lessons:

Rare occurrence of CRC during pregnancy and limited experience concerning its diagnosis and treatment bring obstacle to both patients and physicians. Symptoms as constipation and abdominal pain must be inspected carefully. With a perfect coordination between different disciplines, CRC with pregnancy can be ideally treated with better prognosis.
Evaluating the prevalence, awareness, and control of hypertension, diabetes, and dyslipidemia in Korea using the NHIS-NSC database
Authors: Boo Sunjoo , Yoon Young Joo , Oh Hyunjin
Published: December 2018

This study aimed to evaluate the prevalence, awareness, and control of hypertension, diabetes, and dyslipidemia in Korea according to sex and age, and to identify factors that were associated with the prevalence, awareness, and control of these cardiovascular risk factors among middle-aged Koreans.

A cross-sectional analysis was conducted using 2013 data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. A total of 136,755 individuals were considered eligible based on no history of stroke or heart disease, age of 40 to 64 years at the examination, and completion of health examinations. Data regarding demographic factors and cardiovascular risk factors had been obtained using questionnaires, physical examinations, and blood tests.

Hypertension was the most prevalent condition among middle-aged Koreans (25.76%), followed by dyslipidemia (16.58%) and diabetes (10.22%). Among these three conditions, dyslipidemia was associated with the lowest awareness rates (24.14%). Hypertension and diabetes were more prevalent among men than among women, although the prevalence of dyslipidemia was higher among women > 50 years old. The prevalence of hypertension and diabetes increased with advancing age among men and women, although the prevalence of dyslipidemia decreased with age among men (highest prevalence: 50.59% among men aged between 40 and 44 years). Among Korean men (relative to women), the odds ratios were 1.50 for hypertension, 1.96 for diabetes, and 0.82 for dyslipidemia. Age, central obesity, and body mass index were significantly associated with the development of all 3 conditions.

There are sex- and age-specific patterns in the prevalence, awareness, and control of hypertension, diabetes, and dyslipidemia in Korea. Dyslipidemia is becoming increasingly common although most middle-aged Koreans are not aware of this condition leading to low control rate. These results may help identify population subgroups at a high risk of hypertension, diabetes, and dyslipidemia, and may guide the management of cardiovascular disease in Korea.
Development of screening tool for child abuse in the korean emergency department
Authors: Paek So Hyun , Jung Jin Hee , Kwak Young Ho , Kim Do Kyun , Ryu Jeong Min , Noh Hyun , Kyong Yeon Young , Kang Young Joon
Published: December 2018

Mandatory reporting rate of suspected child abuse by health care provider is relatively low in South Korea. The purpose of the study was to develop a screening tool for child abuse and evaluate the feasibility of using this screening tool in emergency department (ED) of South Korea. Injured children younger than 14 years old in the ED were enrolled as subjects to use this screening tool. Candidate items for screening tool were decided after reviewing relevant previous studies by researchers. Using the modified Delphi method, it was judged that the consensus for items of screening tool was achieved in 2 rounds, and the final item of the screening tool was decided through the discussion in the final round. The registry including the developed screening tool was applied to 6 EDs over 10 weeks. Variables of the registry were retrospectively analyzed. A child abuse screening tool called Finding Instrument for Non-accidental Deeds (FIND) was developed. It included 8 questions. One item (suspected signs in physical examination) had 100% agreement; 3 items (inconsistency with development, inconsistent history by caregivers, and incompatible injury mechanism) had 86.7% agreement; and 4 items (delayed visit, inappropriate relationship, poor hygiene, and head or long bone injury in young infants) had 80% agreement. During the period of registry enrollment, the rate of screening with FIND was 72.9% (n = 2815). 36 (1.3%) cases had 1 or more “positive” responses among 8 items. Two (0.07%) cases were reported to the Child Protection Agency. An ED based screening tool for child abuse consisting of 8 questions for injured children younger than 14 years old was developed. The use of screening tools in Korean ED is expected to increase the reporting rate of child abuse. However, further study is necessary to investigate the accuracy of this screening tool using a national child abuse registry.
Effect of hydrokinesitherapy on balance and walking ability in post-stroke patients
Authors: Wang Xin , Guo Taipin , Wang Tao , Jiang Bo , Su Yan , Tang Xiaoxia , Liao Jianglong , Xie Guanli
Published: December 2018

Introduction:

Brain stroke is the second most common cause of death and major cause of disability in adults, representing a huge burden on patients and their families. Hydrokinesitherapy, a type of physical rehabilitation, may be beneficial to post-stroke recovery. We will systematically assess the clinical effectiveness and safety of hydrokinesitherapy for rehabilitation of stroke survivors in this review.

Methods:

We will perform a systematic search to identify all potentially relevant published studies on this topic. Online electronic databases including MEDLINE (via PubMed), EMBASE (via embase.com), Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, CINAHL (via EBSCOhost) and SPORTDiscus (via EBSCOhost) will be searched without language restrictions from their inception to September 30, 2018. All relevant randomized controlled trails (RCTs) will be screened according to predetermined inclusion criteria. Two independent reviewers will evaluate the methodological quality of each study included. One reviewer will extract data and another reviewer will check the accuracy. Any disagreements will be discussed with a third reviewer. The posture balance and walking ability will be defined as primary outcomes. Activities of daily living (ADL), drop-out and adverse events will also be assessed as secondary outcomes. The evaluation of methodological quality, data analysis will be completed using Cochrane Review Manager 5.3 according to Cochrane Handbook for Systematic Reviews of Interventions.

Trial registration number:

CRD42018110787.
Successful treatment of malignant thymoma with sacrum metastases
Authors: Liu Shuzhong , Zhou Xi , Song An , Huo Zhen , Li William A. , Rastogi Radhika , Wang Yipeng , Liu Yong
Published: December 2018

Rationale:

Malignant thymoma in the spine is a rare disease without standard curative managements so far. The objective of this article is to report a very rare case of recurrent malignant thymoma with sacrum metastases causing severe lumbosacral pain, which was presented with acute radiculopathy and treated with 2 operations combined with stabilization and cement augmentation. The management of these unique cases is not well-documented.

Patient concerns:

A 75-year-old man presented with lumbosacral pain, radiating pain and numbness of the left extremity. The patient underwent thymectomy in 2008, and posterior spinal cord decompression, tumor resection and a stabilization procedure in 2011. Pathologic results confirmed malignant thymomas of the spine. Imaging studies revealed the density of soft tissues, obvious bony destruction in the sacrum, and significant spinal cord obstruction.

Diagnoses:

We believe this is a less-documented case of metastatic thymoma of the sacral spine presenting with back pain and radiculopathy, and presenting as a giant solid tumor.

Interventions:

The patient underwent osteoplasty via a posterior approach. Pathologic results confirmed malignant thymomas of the sacral spine.

Outcomes:

The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 6-month and 1-year follow-up visit. There were no other complications associated with the operation during the follow-up period.

Lessons:

This article emphasizes metastatic thymoma of the spine, although rare, should be part of the differential when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the metastatic thymoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment.
Primary hepatic leiomyosarcoma presenting as a thick-walled cystic mass resembling a liver abscess
Authors: Liu Weihai , Liang Wenjie
Published: December 2018

Rationale:

Hepatic leiomyosarcoma is a rare malignant tumor, and in rare instances, its combination with fever may lead to misdiagnosis of liver abscess. In our case, the presence of the tumor was considered by the presence of blood vessels through the observation of hepatic tumor wall.

Patient concerns:

A 38-year-old woman who had been diagnosed with a liver abscess in a local hospital consulted our institution by complaining left upper quadrant pain and fever. The diagnosis was questioned in our workup, since no obvious inflammatory marker was found in the circulation, and contrast-enhanced computed tomography revealed a huge thick-walled mass in the right liver with multiple tortuous vessels within the wall.

Diagnosis:

Imaging revealed a neoplastic lesion rather than liver abscess. The enhancement of the solid tumor tissues was reduced during the portal phase and delayed phase, which was consistent with a wash-out enhancement. The histopathologic and immunohistochemical results confirmed the diagnosis was primary hepatic leiomyosarcoma. A pulmonary nodule during the postoperative follow-up was diagnosed as metastatic leiomyosarcoma tumor through surgery.

Interventions:

A right hepatectomy was performed to cure the hepatic mass. In the follow-up, a metastatic tumor in the lung was resected, followed by chemotherapy.

Outcomes:

Lung metastasis and liver recurrence occurred at 25 and 39 months after liver surgery, respectively. Then the patient was lost to follow-up.

Lessons:

Leiomyosarcoma is associated with a dismal prognosis, but outcomes for these patients may be improved by the combined surgical resection and chemotherapy.
Traumatic displacement of teeth into maxillary sinus and the retrieval assisted by computer-assisted navigation
Authors: Wang Hang , Yang Chan-Yuan , Li Zhi
Published: December 2018

Rationale:

Traumatic displacement of teeth into the maxillary sinus is rare. This report described a case of 2 molars accidentally displaced into the maxillary sinus and the retrieval of teeth assisted by computer-assisted navigation.

Patient concern:

A 16-year-old male patient suffered from maxillofacial trauma with the first and second molars in the left maxilla were missing, and an orificium fistula to the maxillary sinus appeared in the dentition region of molars.

Diagnose:

The tomography revealed 2 tooth-like hyperdensity images in the left maxillary sinus.

Intervention:

Computer-assisted navigation surgery was scheduled for the retrieval surgery, and the displaced teeth were removed from the maxillary sinus smoothly.

Outcomes:

The patient displayed uneventful wound healing without postoperative complications in the maxillary sinus.

Lessons:

Surgeons should be alert to the presence of missing teeth in maxillofacial trauma and avoid missed diagnosis, and computer-assisted navigation is recommended for the retrieval of teeth displaced into the maxillary sinus.