bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupoint embedding therapy improves nonalcoholic fatty liver disease with abnormal transaminase
Authors: Dai Liang , Ooi Vee Voon , Zhou Wenjun , Ji Guang
Published: January 2020

Background:

Non-alcoholic fatty liver disease (NAFLD) with abnormal transaminase were main targeted disorder in clinical intervention. Acupuncture embedding has been used as a modified acupuncture therapy in current management, while no comprehensive summarization has been established. Hence, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of acupoint embedding alone or in combination for NAFLD with abnormal transaminase, and to provide potential regimen for further verification.

Methods:

Seven English and Chinese databases were systematically researched from inception to February 28, 2019, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese biomedical literature database (SinoMed), Chinese National Knowledge Infrastructure (CNKI), Chinese VIP information (VIP), and WanFang database. Academic dissertations were also searched as supplement. The searching terms included “nonalcoholic fatty liver disease,” “acupoint embedding,” “clinical trial,” with their corresponding synonyms. Randomized controlled trials (RCTs) and quasi-RCTs involving acupoint embedding alone or in combination for adult patients with NAFLD with abnormal transaminase were included. The diagnosis of NAFLD should be confirmed by radiologic evidence. Two researchers independently completed predefined data sets extraction and quality assessment. STATA 15.0 was applied to estimate the combined effect presented as odds ratio or mean difference (MD) with a 95% confidence interval (CI). The primary outcome was the change of serum alanine aminotransferase (ALT).

Results:

A total of fifteen studies with 1349 patients were included. Meta-analysis reported that acupoint embedding alone or in combination was superior to conventional medications on ALT change (MD: 16.58, 95%CI: [10.42, 22.74], P < .001). The benefits were also demonstrated in other outcomes, including aspartate aminotransferase, triglyceride, and total cholesterol, total efficacy rate and radiological efficacy rate. The safety profile of acupoint embedding was satisfactory. BL18 (Ganshu) was the most frequently utilized acupoint.

Conclusion:

To some extent, the systematic review supported the application of acupoint embedding in management of NAFLD, while further high-quality studies should be designed to evaluate the practical effect of acupoint embedding.
Effect of combined parenteral and enteral nutrition for patients with a critical illness
Authors: Luo Yi , Qian Yingxiang
Published: January 2020

Background:

Whether combined parenteral nutrition (PN) and enteral nutrition (EN) is superior to EN alone remains controversial.

Objectives:

This study aimed to evaluate the efficacy and safety of combined PN and EN versus EN alone for critically ill patients based on published randomized controlled trials (RCTs).

Data sources:

Studies designed as RCTs evaluating the treatment effectiveness of combined PN and EN versus EN alone for critically ill patients were identified from PubMed, Embase, and the Cochrane Library from inception to April 2019.

Methods:

The pooled relative risks and weighted mean differences with corresponding 95% confidence intervals were calculated using the random-effects model. Twelve RCTs recruiting a total of 5609 adults and 1440 children were selected for the final meta-analysis.

Results:

The summary relative risks indicated that combined PN and EN was not associated with the risk of all-cause mortality, respiratory infection, urinary tract infection, and nutrition-related complications. Moreover, combined PN and EN was associated with longer hospital stay and higher albumin and prealbumin levels compared with EN alone. No significant differences were, however, found between combined PN and EN and EN alone in terms of ventilatory support, intensive care unit stay, and transferrin and C-reactive protein levels.

Conclusions:

This study showed that combined PN and EN significantly increased hospital stay duration and albumin and prealbumin levels compared with EN alone for critically ill patients. Large-scale RCTs should be conducted to compare the treatment effectiveness of combined PN and EN versus EN alone for critically ill patients due to a specific cause.
Relationship between body mass index and arterial stiffness in a health assessment Chinese population
Authors: Tang Biwen , Luo Fangxiu , Zhao Jiehui , Ma Jing , Tan Isabella , Butlin Mark , Avolio Alberto , Zuo Junli
Published: January 2020

Pulse wave velocity (PWV) is a reliable measurement of arterial stiffness. Our study assesses the association between body mass index (BMI) and brachial-ankle PWV (baPWV) in a healthy cohort and seeks to explain possible mechanisms associated with the obesity paradox.

A cross-sectional study was conducted in 578 normal individuals. The mean age was 48.3 ± 14.6 years, and 468 (81.0%) were men. 288 subjects (49.8%) were overweight and obese. baPWV and ankle-brachial index (ABI) were performed to evaluate arterial stiffness and atherosclerosis respectively. Normal weight was defined as 18.5 < BMI <25 kg/m2, overweight as 25 ≤ BMI < 28 kg/m2 and obesity as BMI ≥28 kg/m2.

The overweight/obese subjects had significantly higher baPWV than the normal-weight group (1490.0 ± 308.0/1445.2 ± 245.2 cm/s vs 1371.2 ± 306.4 cm/s, P < .001). For the whole cohort, baPWV showed a significant positive correlation with BMI (r = 0.205, P < .001). However, baPWV was significantly lower as BMI increased: 1490.0 ± 308.0 cm/s (overweight); 1445.2 ± 245.2 cm/s (obese); P < .001) when adjusted for age, gender, heart rate, mean blood pressure, and cardiovascular risk factors (glucose, cholesterol, triglyceride, and low-density lipoprotein). For the whole cohort BMI was negatively associated with baPWV (β = −0.06, P = .042). ABI showed no relationship with BMI. In a middle-age healthy Chinese population, arterial stiffness measured as baPWV increased with BMI.

Evidence of reduced arterial stiffness with increasing BMI when accounting for all other cardiovascular risk factors may contribute to underlying factors involved in the obesity paradox that becomes more prominent with increasing age.
Management of Schwannoma in the hepatoduodenal ligament
Authors: He Yan-an , Yan Chao , Chen Yao , Zhu Li-gang , Cai Ming , Wang Wen-tao
Published: January 2020

Rationale:

Schwannomas are neoplasms that originate from Schwann cells of the peripheral nerve sheath with a low malignant potential. Considering that Schwannomas often occur in the upper extremities, trunk, head, and neck, but in the hepatoduodenal ligament has seldom been reported.

Patient concerns:

A 70-year-old man was referred to our hospital for further evaluation of distension in upper abdomen. Abdominal ultrasonography reported that an anechoic mass was found between the pancreatic head and portal vein, which was measured to be about 5.5 × 4 × 4 cm. No blood flow signal was found within the mass by color doppler ultrasound. Subsequently, abdominal contrast enhanced computed tomography revealed that a well-defined round soft-tissue was above the pancreatic head and adjacent to the common heapatic artery, and it had no obvious enhancement in the arterial phase and portal phase.

Diagnoses:

Schwannomas in the hepatoduodenal ligament.

Interventions:

After the work-up of a multidisciplinary team, a right complete excision was carried out and schwannoma was diagnosed by pathology.

Outcomes:

The patient's postoperative course was uneventful, and he left the hospital 10 days after the operation. Additionally, at the time of writing, recurrence was not observed with a follow-up of 17 months.

Lessons:

schwannomas in the hepatoduodenal ligament are extremely rare with benign behavior. Surgical resection is the gateway to cure it; however, accurate preoperative diagnosis of the schwannomas in the hepatoduodenal ligament is a huge challenge because neither the clinical symptoms nor the imaging manifestations are specific.
Delayed esophagopleural fistula after endoscopic injection sclerotherapy for esophageal varices
Authors: Sui Mingliang , Tang Weibing , Wu Changjiang , Yang Jinhu , Liu Huiping , Huang Chaofa , Hu Xianzhu , Xia Damei , Yang Yadi
Published: January 2020

Rationale:

Esophagopleural fistula (EPF) is a rare critical life-threatening condition that features high misdiagnosis rate. Although various surgical and conservative techniques have been developed for the treatment of EPF, the mortality rate of EPF remains high.

Patient concerns:

An 81-year-old man with hepatic cirrhosis caused by schistosomiasis was admitted with upper gastrointestinal bleeding.

Diagnoses:

Upper endoscopy revealed bleeding large esophageal varices, and endoscopic injection sclerotherapy (EIS) was performed. Two weeks after the EIS was performed, the patient developed pyrexia, left-sided pleuritic chest pain. Air and pleural effusion were showed in the left pleural cavity by high-resolution computed tomography (HRCT), and a linear fistulous communication was noticed from the distal esophagus. These findings were consistent with hepatic cirrhosis, esophageal varices, upper gastrointestinal bleeding, and esophagopleural fistula.

Interventions:

The patient was intensively treated with endoscopic self-expandable metallic stent (covered-SEMS) implantation and comprehensive treatments (including thoracic closed drainage, antibiotics, nasojejunal nutrition, and antacids).

Outcomes:

The patient was completely cured without recurrence during a 6 months of follow-up by comprehensive conservative treatments.

Lessons:

This case indicates that pleural effusion with food residue is a specific finding in EPF. Thorax CT exhibited high sensitivity for the diagnosis of EPF. Endoscopic self-expandable metallic stent implantation and comprehensive conservative treatments may be preferable for the severe liver disease with EPF.
The analysis of the association between the copy numbers of survival motor neuron gene 2 and neuronal apoptosis inhibitory protein genes and the clinical phenotypes in 40 patients with spinal muscular atrophy
Authors: Zhang Yinhong , He Jing , Zhang Yunqian , Li Li , Tang Xinhua , Wang Lei , Guo Jingjing , Jin Chanchan , Tighe Sean , Zhang Yuan , Zhu Yingting , Zhu Baosheng
Published: January 2020

In this article, the correlation between the copy number of survival motor neuron 2 (SMN2) gene, neuronal apoptosis inhibitory protein (NAIP), and the phenotype of spinal muscular atrophy patients were analyzed.Forty patients with spinal muscular atrophy (SMA) were included in the study at the Department of Medical Genetics of the First People's Hospital and the Department of Neurology of the Second People's Hospital in Yunnan Province from January 2012 to September 2018. Multiplex ligation-dependent probe amplification assay was performed to determine the copy numbers of SMN2 and NAIP genes. Statistical analysis was performed to determine the correlation between copy numbers of the SMN2 and NAIP genes and the clinical phenotypes of SMA.Our results show that among the 40 SMA patients, there were 13 type I cases, 16 type II cases and 11 type III cases. A total of 37 patients possessed a homozygous deletion of SMN1 exons 7 and 8, while the other 3 SMA patients possessed a single copy of SMN1 exon 8. There was no correlation between SMA subtypes and the deletion types of SMN1 exon 7 and 8 (P = .611). The percentage of 2, 3, and 4 copies of SMN2 exon 7 was 25.0%, 62.5%, and 12.5%, respectively. The percentage of 0, 1, and 2 copies of NAIP exon 5 was 10%, 57.5%, and 32.5%, respectively. The distributions of SMN2 and NAIP copy numbers among various SMA types were significantly different (all P < .05). Five combined SMN1-SMN2-NAIP genotypes were detected, of which 0-3-1 genotype had the highest proportion than the others, accounting for 42.5%. The copy number of SMN2 and NAIP gene had synergistic effect on SMA phenotype. The combined SMN1-SMN2-NAIP genotypes with fewer copies were associated with earlier onset age, higher mortality, and smaller average age at death in SMA patients.

Therefore, we conclude that the copy number variance of SMN2 and NAIP is correlated with the SMA phenotype. Analysis of the copy number structure of the SMN1-SMN2-NAIP gene is helpful for SMA typing, disease prognosis prediction, and genetic counseling.
Somatotypes and hand-grip strength analysis of elite cadet sambo athletes
Authors: Trivic Tatjana , Eliseev Sergey , Tabakov Sergey , Raonic Vuk , Casals Cristina , Jahic Dzenan , Jaksic Damjan , Drid Patrik
Published: January 2020

The objectives of this research were to establish somatotype and hand-grip strength between elite cadet male and female sambo athletes divided by weight categories.

A total of 97 elite cadet sambo athletes, participants of the World Cadets Sambo Championships 2018 participated in the study. Male and female sambo athletes were divided by official weight categories. Anthropometrical variables were taken in order to calculate somatotypes and hand-grip strength. A one-way analysis of variance and Tukey's post hoc tests were used to compare group differences by weight categories.

Results of this study provide the first description of somatotype and hand-grip strength of elite male and female cadet sambo athletes in relation to weight category. A typical somatotype in male sambo athletes was endomorphic mesomorphs with a predominance of musculoskeletal tissue, while female athletes differed concerning weight category. Overall, an increase in handgrip strength across weight categories was noted. Hand-grip strength increases linearly from the lightest to the heaviest weight category except in −66 and −84 kg in male athletes. Differences in handgrip strength of female athletes were detected between the lightest group and last six groups in all three variables in favor of last six as well as −44 and kg −48 kg compared with the heaviest.

To the best of our knowledge, this study provides the first normative data of somatotype and hand-grip strength analyses in relation to age, gender, and weight categories of cadet sambo athletes. The anthropometric profile of sambo athletes changed according to their weight category. Mesomorphy was the most dominant somatotype component in male athletes, while female had three different types of somatotype component in relation to weight category. In conclusion, we found differences in hand-grip strength related to weight category, which can be linked to the muscle mass of athletes. Future studies should focus on somatotype and strength handgrip values of international compared to national level sambo athletes.
The clinical characteristics and outcomes of carotid body tumors in Chinese patients
Authors: Chen Yangjing , Li Yanzi , Liu Jianlin , Yang Lin
Published: January 2020

This study aims to investigate the clinical characteristics and outcomes of carotid body tumors in Chinese patients in the last decade. A systematic search was conducted without limits and included studies published between January 2006 and December 2016 according to PubMed, the Chinese Science Citation Database, the China Science Periodical Database and the China National Knowledge Infrastructure. Relevant synonyms for the search terms “paraganglioma” and “carotid body tumor” were applied, and the clinical data were evaluated and analyzed. There were 1810 cases of CBTs reported in the last decade, of which females accounted for 60.22%, and the mean age was 40.60 years, with most cases being sporadic (98.51%). Surgical resection was performed in 1791 cases: vessel repair occurred in 38.88% of the cases, carotid ligation occurred in 1.42% of the cases, and 1.05% of the patients refused treatment. Some patients underwent selective embolization, and the results showed that embolization could decrease procedure time and blood loss (P < .01). Stroke and death occurred in 1.95% and 0.39% of patients, respectively. Malignant CBTs accounted for 4.30% of cases, and the metastatic sites involved were local metastasis (46.88%), lung (31.25%), bone (21.88%), liver (12.50%), and brain (9.38%). The overall survival rate was 98.87% 36 months after the procedure, and the survival rate of metastatic cases was 56.25% 6 months after recurrence; however, only 21.88% of metastatic cases received radiotherapy. The CBTs of Chinese patients showed some clinical features that were different from those of Western patients.
Fluctuations of antimitochondrial antibodies and anti-gp210 antibody in a patient with primary biliary cholangitis and Sjögren syndrome with subsequent autoimmune hemolytic anemia
Authors: Zhao Dan-Tong , Liu Yan-Min , Han Ying , Zhang Hai-Ping , Zhao Yan , Yan Hui-Ping
Published: January 2020

Rationale:

Primary biliary cholangitis (PBC) is a rare autoimmune cholestatic liver disease. It is often associated with extrahepatic autoimmune disorders. However, the concurrence of PBC and Sjögren syndrome (SS) with the subsequent onset of autoimmune hemolytic anemia (AIHA) is extremely rare.

Patient concerns:

This study investigated a 60-year-old woman admitted to our hospital with complaints of xerostomia for 5 years, pruritus for 3 years, and abnormal liver function for 3 months.

Diagnoses:

The patient was suffering from typical clinical PBC and SS, and developed decompensated liver cirrhosis after 32 months of ursodeoxycholic acid (UDCA) therapy. In May 2018, she was readmitted to the hospital with a high fever of 39 °C, coughing, and sever fatigue without remission after 3 days of cephalosporin antibiotic therapy. During the clinical course of PBC, her antimitochondrial antibodies (AMA) titers fluctuated from 1:1000 to negative and then to weakly positive, determined by indirect immunofluorescence (IIF), immunoblotting, and enzyme-linked immunosorbent assay (ELISA) based on recombinant mitochondrial antigens; furthermore, her titers of anti-gp210, an antinuclear antibody (ANA), increased sharply. Laboratory tests and imaging were performed to diagnose PBC and SS in September 2015. However, she was subsequently diagnosed with AIHA after 32 months of UDCA therapy based on the identification of pancytopenia, increased reticulocyte (RET) count, and a positive result from the direct Coombs test.

Interventions:

UDCA, hepatic protectant, albumin infusion, chest drainage, rational antibiotic use, diuretics, and methylprednisolone were used to treat the patient.

Outcomes:

Liver cirrhosis was complicated by the development of AIHA, which became severe at 42 months of follow-up.

Lessons:

This is the first case report showing a patient with comorbid PBC and SS, as well as the sequential development of AIHA with decreased AMA and increased anti-gp210 titers; this may have been due to immunodeficiency. These findings stress the importance of the serological screening of ANA profile, as well as repeated measurement of ANA and AMA to track PBC progression and prognosis.
Prolonged hyperamylasemia in patients with acute pancreatitis is associated with recurrence of acute pancreatitis
Authors: Kim Young Sun , Chang Jae Hyuck , Kim Tae Ho , Kim Chang Whan , Kim Jae Kwang , Han Sok Won
Published: January 2020

Serum amylase levels in patients with acute pancreatitis often remain or fluctuate above the upper normal limit for over a week. This study investigated the clinical characteristics of patients with prolonged hyperamylasemia and their prognoses, including recurrence.

We retrospectively analyzed patients with first attacks of acute pancreatitis in a single center between March 2010 and December 2016. Patients were divided into 2 groups according to normalization of the serum amylase levels within a week.

A total of 313 patients were enrolled after exclusion. The serum amylase levels were normalized within a week in 205 patients (65.5%, group 1) and elevated over a week in 108 patients (34.5%, group 2). Group 2 was more related to alcohol, higher computed tomography (CT) severity index, local pancreatic complication, and moderately severe pancreatitis than group 1 (P < .05). Recurrent pancreatitis developed significantly more in group 2 (39.8%) than in group 1 (19.5%) (P < .001). The factors related to recurrent pancreatitis were amylase group, sex, alcohol, CT severity index, necrosis, and severity of pancreatitis (P < .05). Multivariate analysis showed that recurrent pancreatitis was independently associated with amylase group (odds ratio [OR] 2.123, 95% confidence interval [CI]= 1.227–3.673, P = .007) and alcohol (OR 2.023, 95% CI 1.134–3.611, P = .017).

In conclusion, prolonged hyperamylasemia over a week is associated with recurrence of acute pancreatitis.
Cystic-solid hemangioblastoma at the cerebellopontine angle
Authors: Lan Zhigang , Richard Seidu A. , Zhang Yuekang
Published: January 2020

Rationale:

Hemangioblastomas (HMGs) originating from the cerebellopontine angle (CPA) are extremely uncommon. Nevertheless, the cystic-solid form of this lesion at the above location is even rarer.

Patient concerns:

We present a 31-years old male with a right ear hearing loss of 3 months duration. He did not experience earache or discharge before the hearing loss. He; however, experienced visual acuity and dizziness. General physical examination did not yield much.

Diagnoses:

Computed tomography and magnetic resonance imaging revealed a cystic-solid mass at right CPA. We initial misdiagnosed the lesion as an acoustic neuroma with cystic changes. Immunohistochemistry studies revealed HMG.

Interventions:

The lesion was total surgical resection via the retro-sigmoid approach.

Outcomes:

The patient's symptomatology resolved after the surgery. Two years follow-up show no recurrence of the lesion and the patient is well.

Lesions:

Identification of feeding arteries and electro-coagulating them during the operation minimized intraoperative bleeding. The tumor should usually be dissected out whole and not piece meal fashion. Pre-operative CTA is very useful in outlining the vasculature of the tumor.
Trigeminal neuralgia associated with cerebellar pial arteriovenous fistula
Authors: Wang Shenghu , Mo Jun , Gai Shiying , Ou Changjiang , Chen Yili
Published: January 2020

Rationale:

Trigeminal neuralgia (TN) is frequently associated with compression at the root entry zone of the trigeminal nerve by an aberrant loop of an artery, tributaries of the petrosal vein, tumors, aneurysm, and vascular malformation. TN associated with a cerebellar pial arteriovenous fistula (PAVF) has not been described previously.

Patient concerns:

A 65-year-old man presented with right-sided TN. Cerebral angiography revealed a right cerebellar PAVF and magnetic resonance imaging demonstrated a mixed compression of the petrous vein complex and anterior inferior cerebellar artery at the right trigeminal nerve.

Diagnosis:

Due to the patient's symptoms, radiographic findings, he was diagnosed with TN and PAVF.

Interventions:

Coiling combined with use of the liquid embolic agent Onyx was used for the complete embolization of the fistula.

Outcomes:

Complete relief of the pain was achieved 3 months after endovascular treatment, and the patient has remained pain-free during 2 years of follow-up.

Conclusions:

Endovascular treatment with a combination of coils and Onyx embolization is an effective approach for complete resolution of rarely occurring TN caused by mixed venous and arterial compressions associated with cerebellar PAVF.
Computer-assisted navigation for removal of the foreign body in the lower jaw with a mandible reference frame
Authors: Chen Shuo , Liu Ying-Heng , Gao Xin , Yang Chan-Yuan , Li Zhi
Published: January 2020

Rationale:

In surgery of the lower jaw, the application of computer-assisted navigation is complicated and challenging due to the mobile nature of the mandible. In this study, we presented a computer-assisted navigation surgery for removal of the foreign body in the lower jaw with a mandible reference frame, basing on the strategy that the mandible is independent as an entity.

Patient concerns:

A 41-year-old male patient, identified as having a broken fissure bur that displaced into the mandibular lingual soft tissue, was referred to our department. The fissure bur broke accidentally and then displaced into the soft tissue when the patient underwent extraction of the left mandibular impacted third molar.

Diagnosis:

A metallic foreign body in the left lower jaw, confirmed by orthopantomography.

Interventions:

A computer-assisted navigation surgery with a customized mandible reference frame.

Outcomes:

The broken bur was removed successfully. Satisfactory wound healing and mouth opening was achieved, without postoperative complications.

Lessons:

Surgeons should be alert to the presence of broken bur in the lower jaw and avoid its displacement into deep facial space, and computer-assisted navigation with a mandible reference frame is recommended for removal of the foreign body in the lower jaw.
Myopathy after rapid correction of hyperthyroidism
Authors: Lu Ran , Wang Haining , Hong Tianpei , Gao Hongwei
Published: January 2020

Rationale:

Myalgia and elevated creatine kinase (CK) have been reported during the treatment of hyperthyroid patients. The causes of these symptoms are usually considered to be treatments of antithyroid drugs (ATDs), thyroidectomy or radio-iodine (131-I). However, the underlying cause may be the rapid correction of thyrotoxicosis (or relative hypothyroidism), which was usually neglected in clinical practice.

Patient concerns:

This report describes a case of a 25-year-old female with typical symptoms and laboratory test results of Grave hyperthyroidism. The patient complained about fatigue and myalgia 7 weeks after receiving methimazole (MMI) treatment. Blood tests showed dramatically elevated serum CK level, although free triiodothyronine (FT3) and free thyroxine (FT4) level had returned to the normal reference range. MMI was; therefore, discontinued and the patient's muscular symptoms disappeared quickly with the normalization of CK level and the relapse of hyperthyroidism. Later she received 131-I treatment and suffered similar muscular symptoms when FT3 and FT4 decreased to the normal range. This time, her symptoms were quickly relieved by levothyroxine (L-T4) replacement treatment.

Diagnoses:

Myopathy induced by rapid correction of hyperthyroidism (or relative hypothyroidism).

Interventions:

MMI was discontinued after the patient's first episode of muscular symptoms. And for her second episode of muscular injury after 131-I treatment, we initiated L-T4 supplementation.

Outcomes:

For the 2 episodes of muscular injury after ATDs or 131-I treatment, both of the interventions mentioned above brought a rapid relief of symptoms accompanied with normalization of CK level and restoration of thyroid hormone level.

Lessons:

Myopathy can be caused by a rapid reduction of thyroid hormone during the treatment of hyperthyroidism. This relative hypothyroidism syndrome should be considered if patients make complaints about fatigue and myalgia, even when thyroid hormone level is within the normal range during the antithyroid treatments. Serum CK level and thyroid function should be closely monitored post antithyroid treatments. Reduction of ATD dosage or replacement of thyroid hormone is suggested to relieve muscular symptoms.
Case Report of acute myeloid leukemia with “WT1, ATRX, CEBPA, CSMD1, IKZF1, and LRP1B mutation and translocation between chromosome 1 and 19” developing from Philadelphia-negative chronic myeloid leukemia after TKI therapy
Authors: Zhu Huan , Yang Bin , Liu Jia , Wu Wei , Ling Yun
Published: January 2020

Rationale:

The success of tyrosine kinase inhibitor (TKI) therapy has greatly prolonged the survival time of patients with chronic myeloid leukemia (CML), harboring the characteristic Philadelphia (Ph) chromosome. However, a fraction of patients, achieving complete cytogenetic response after TKI therapy, develop a myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) with additional clonal chromosomal abnormalities in Philadelphia-negative cells (CCA/Ph–).

Patient concerns:

A 56-year-old woman with AML, developing from Philadelphia-negative CML after TKI therapy. She showed 6 kinds of somatic variants—CEBPA, ATRX, WT1, CSMD1, IKZF1, and LRP1B mutation after diagnosed as AML.

Diagnosis:

The patient was diagnosed with chronic phase CML that developed to AML after achieving durable complete cytogenetic response (CCR) and major molecular response (MMR).

Interventions:

The patient was treated with TKI therapy at the period of CML. When diagnosed with AML, she received induction chemotherapy regimens, consolidation therapy, and allogeneic hematopoietic stem cell transplantation subsequently.

Outcomes:

The patient has been CCR and MMR for nearly 4 years, and has achieved complete remission after intervention related to AML. She is now preparing for allogeneic hematopoietic stem cell transplantation.

Lessons:

These rare occurrences highlight the importance of exploring the relevant pathogenesis of AML developing from CML after TKI therapy. In addition to monitoring molecular changes in the course of CML, cytogenetic analysis, or next-generation sequencing of CML patients should be performed.
S-1 plus apatinib followed by salvage esophagectomy for irinotecan-refractory small cell carcinoma of the esophagus
Authors: Zhang Chu , Yu Guang-Mao , Zhang Miao , Wu Wenbin , Gong Long-Bo
Published: January 2020

Rationale:

Small cell carcinoma of the esophagus (SCCE) is an uncommon but lethal disease characterized by dismal prognosis. Only 10% of advanced SCCE patients survive longer than 1 year. Resection is a choice for limited-stage cases, whereas the optimal treatment regimen for primary SCCE is yet to be elucidated. To the best of our knowledge, the efficacy of S-1 plus apatinib for irinotecan-refractory SCCE has not been reported before.

Patient concerns:

A 61-year old, previously healthy male was admitted for dysphagia and fatigue. Endoscopic biopsy revealed a tumor in the middle third of the esophagus. Further exams including abdomen computed tomography excluded distant metastasis.

Diagnoses:

Primary SCCE (pT1bN1M0, IIB) was established after salvage operation.

Interventions:

The tumor was enlarged after 1 cycle of first-line chemotherapy using irinotecan plus cisplatin, which indicated drug resistance. Second-line oral apatinib (425 mg daily) plus S-1 (60 mg, twice daily for 4 weeks with a 2-week drug-free interval) for a month showed efficacy, as shown by decreased serum neuron-specific enolase and stable of the esophageal lesion. Thereafter, salvage minimally invasive Ivor-Lewis esophagectomy and 2-field lymph node dissection was performed, followed by oral apatinib plus S-1 at the prior dosage for 6 months. In addition, maintenance therapy using low-dose apatinib (250 mg daily) plus S-1 (40 mg, twice daily for 4 weeks with a 2-week interval) were administered for another 6 months. Then the patient was followed up irregularly at the outpatient clinic.

Outcomes:

The adverse events including hand-foot syndrome, hypertension, vomiting, leukopenia, impaired hepatic function, and fatigue were mainly tolerable. Forty months after the operation, he was readmitted for back pain and disseminated bone metastases appeared in magnetic resonance images. His progression-free survival could not be obtained precisely, and his overall survival was longer than 40 months up to September 2019.

Lessons:

S-1 plus apatinib followed by a timely esophagectomy with curative intent might be an alternative option for chemotherapy-refractory SCCE in selected patients. Better evidence is warranted.
Acupuncture for restless legs syndrome
Authors: Huang Kaiyu , Liang Shuang , Han Dong , Guo Rubao , Chen Lei , Grellet Antoine
Published: January 2020

Background:

Restless legs syndrome (RLS) is a neurological disorder that causes an irresistible urge to move the legs. An increasing number of studies have been published in recent years to support the effectiveness of acupuncture for RLS. We will conduct a comprehensive systematic review and meta-analysis to evaluate the evidence of randomized controlled trials for acupuncture treatment of RLS.

Methods:

The following electronic databases will be searched: PubMed, Embase, Web of Science, Cochrane Library, the China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and China Science and Technology Journal Database. The range of publication time will be from the inception of the database to September 2019. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Any disagreement will be resolved by discussion with the third reviewer. Review Manager Software 5.3 will be used for meta-analysis. The Cochrane risk of bias tool will be used to assess the risk of bias.

Results:

This study will provide a high-quality evidence to assess the effectiveness and safety of acupuncture for RLS.

Conclusions:

This systematic review will explore whether acupuncture is an effective and safe intervention for RLS.

Registration:

PROSPERO CRD42019148948.
Symptoms of anxiety and depression in relatives after decisions of withholding and withdrawing life-sustaining treatments in emergency departments
Authors: Douplat Marion , Masbou Hélène , Tazarourte Karim , Berthiller Julien , Potinet Véronique , Le Coz Pierre , Schott Anne-Marie , Jacquin Laurent
Published: January 2020

Objective

The aim of our study was to assess anxiety and depression in patients’ relatives after a decision of withholding and withdrawing life-sustaining treatments.

Methods

We conducted a prospective observational multicenter study in three university hospitals’ emergency departments. The Hospital Anxiety and Depression Scale (HADS) was assessed on the relatives of patients admitted in emergency departments 3 days and 21 days after the decision of withholding or withdrawing life-sustaining treatments.

Results

Among the 109 patients with a decision of withholding or withdrawing life-sustaining treatments, 88 relatives were included and 74 (67, 8%) completed the 21-day follow up. Among those, 14 (18.9%) and 13 (17.6%) displayed symptoms of anxiety and depression at 3 days, respectively. After 21 days, symptoms anxiety and depression were still present in the same way for nine (12.2%) of the relatives. The median total HADS score was 13.5 [interquartile range (IQR): 8–16] at 3 days and 10 [IQR: 5–17] at 21 days. The symptoms of depression at 21 days were more frequent for the relatives of patients who died at 21 days (P = 0.03).

Conclusion

We found symptoms of anxiety and depression in relatives after decisions of withholding and withdrawing life-sustaining treatments in emergency departments, which persist at 21 days. Further studies are needed to support these results and to search the relatives at risk to develop these symptoms.
Critical Incident Techniques and Reflection in Nursing and Health Professions Education
Authors: Steven Alison , Wilson Gemma , Turunen Hannele , Vizcaya-Moreno M. Flores , Azimirad Mina , Kakurel Jayden , Porras Jari , Tella Susanna , Pérez-Cañaveras Rosa , Sasso Loredana , Aleo Giuseppe , Myhre Kristin , Ringstad Øystein , Sara-Aho Arja , Scott Margaret , Pearson Pauline
Published: January 2020

Background

The termscritical incident techniqueandreflectionare widely used but often not fully explained, resulting in ambiguity.

Purpose

The aims of this review were to map and describe existing approaches to recording or using critical incidents and reflection in nursing and health professions literature over the last decade; identify challenges, facilitating factors, strengths, and weaknesses; and discuss relevance for nursing education.

Methods

A systematic narrative review was undertaken. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature were searched using MeSH terms, returning 223 articles (2006-2017). After exclusions, 41 were reviewed.

Results

Articles were categorized into 3 areas: descriptions of the development of an original tool or model, critical incidents or reflection on events used as a learning tool, and personal reflections on critical incidents.

Conclusions

Benefits have been identified in all areas. More attention is needed to the pedagogy of reflection and the role of educators in reflection.
Simulation to Enhance Empathy of Nursing Students Toward Patients With Alcohol Use Disorder
Authors: Patterson Jodi , Duke Gloria , Stocks Eric , Hermanns Melinda
Published: January 2020

Background

Empathy can be challenging when caring for individuals with alcohol use disorders (AUDs).

Purpose

This study examined the effectiveness of simulation for enhancing the empathy of nursing students toward patients with AUD.

Methods

A mixed-methods study used a pretest-posttest intervention measurement of empathy with the Comprehensive State Empathy Scale (CSES) and focus groups. Quantitative data were analyzed with t tests, whereas thematic analysis evaluated the qualitative data.

Results

No significant differences were found between pre- and post-CSES scores. The subscales of empathic concern and shared affect were significant: empathic concern, t
55 = − 2.16, P = .04, and shared affect, t
55 = −2.16, P = .02. Empathic imagination reached significance for students with personal experience with someone with an AUD, t
54 = −2.39, P = .02.

Conclusions

Additional research is warranted regarding the effect of simulation on empathic concern, shared affect, and empathic imagination toward individuals with AUD.
Health Literacy and Outcomes of a Community-Based Self-Help Intervention
Authors: Kim Miyong T. , Kim Kim B. , Ko Jisook , Murry Nicole , Xie Bo , Radhakrishnan Kavita , Han Hae-Ra
Published: January 2020

Background

Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy’s effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research.

Objective

The aim of this study was to empirically examine underlying mechanisms of health literacy’s role in diabetes management among a group of Korean Americans with Type 2 diabetes mellitus.

Methods

Data from a randomized clinical trial of a health literacy-focused Type 2 diabetes self-management intervention conducted during 2012–2016 in the Korean American community were collected at baseline and at 3, 6, 9, and 12 months. A total of 250 Korean Americans with Type 2 diabetes participated (intervention, 120; control, 130). Participants were first-generation Korean American immigrants. Health literacy knowledge was measured with the original Rapid Estimate of Adult Literacy in Medicine and the diabetes mellitus-specific Rapid Estimate of Adult Literacy in Medicine. Functional health literacy was measured with the numeracy subscale of the Test of Functional Health Literacy in Adults and the Newest Vital Sign screening instrument, which also uses numeracy. Primary outcomes included glucose control and diabetes quality of life. Multivariate analyses included latent variable modeling.

Results

A series of path analyses identified self-efficacy and self-care skills as significant mediators between health literacy and glucose control and quality of life. Education and acculturation were the most significant correlates of health literacy.

Discussion

Despite inconsistent findings in the literature, this study indicates that health literacy may indirectly influence health outcomes through mediators such as self-care skills and self-efficacy. The study highlights the importance of health literacy, as well as underlying mechanisms with which health literacy influences processes and outcomes of diabetes self-management.
Disease Characteristics, Radiologic Patterns, Comorbid Diseases, and Ethnic Differences in 32 Patients With Rosai-Dorfman Disease
Authors: Elshikh Mohamed , Schellingerhout Dawid , Rayan Jesse , Taher Ahmed , Elsayes Ahmed K. , Mujtaba Bilal , Garg Naveen
Published: January 2020

Objective

Rosai-Dorfman disease (RDD) is a rare and idiopathic nonneoplastic disease of histiocytes that is characterized by lymphadenopathy and extranodal disease. In this study, we documented anatomical preferences, imaging findings, comorbid diseases, and ethnic differences in 32 RDD patients.

Methods

We conducted a retrospective review of pathologically confirmed cases seen at our institution from 1998 to 2016. These cases were analyzed for (a) anatomical locations, (b) radiologic appearance, (c) comorbid diseases, and (d) differences between ethnic groups.

Results

We found 32 patients with RDD, 18 were women and 14 were men. There were 51 lesions in all patients, 23.5% of which were nodal, involving 11 lymph node regions, and 76.5% were extranodal. Cervical lymph nodes and maxillofacial area were the most common affected nodal and extranodal locations, respectively. Only 4 (12.5%) of 32 patients had pure nodal involvement, whereas 20 (62.5%) of 32 had pure extranodal disease and 8 (25%) of 32 had mixed nodal and extranodal disease.

Anatomically, RDD affected multiple organs in our cohort, including the lymphatic system, maxillofacial area (glandular and nonglandular tissues), superficial soft tissue, central nervous system, breast, peritoneum, gastrointestinal tract, and lungs.

Radiologically, RDD presentation was variable from an organ to another. However, most lesions were hypermetabolic on 18F-fluorodeoxyglucose positron-emission tomography/computed tomography and isointense on T1-weighted magnetic resonance imaging. Computed tomographic findings were extremely variable between organs.

Comorbid diseases were found in 11 patients. Those patients had 17 comorbid diseases; the most common were autoimmune diseases, viral diseases, and cancer.

The organ distribution of RDD was slightly different between ethnic groups. The most frequent disease location for African Americans was lymph nodes; for whites, central nervous system and nonglandular maxillofacial (27.3% each); for Asians, lymph nodes, subcutaneous tissue, and nonglandular maxillofacial (25% each); and for Hispanics, lymph nodes and glandular maxillofacial (33.3% each).

Conclusions

Rosai-Dorfman disease represents a wide-spectrum disease not limited to lymph nodes. Radiologically, RDD has diverse imaging findings. However, most lesions were hypermetabolic on 18F-fluorodeoxyglucose positron-emission tomography/computed tomography and isointense on T1-weighted imaging. Patients with RDD have a high rate of comorbid diseases including autoimmune disease, viral infections, and cancer.
Comparison of Pediatric Familial Mediterranean Fever Patients Carrying Only E148Q Variant With the Ones Carrying Homozygous Pathogenic Mutations
Authors: Tanatar Ayşe , Karadağ Şerife Gül , Sönmez Hafize Emine , Çakan Mustafa , Ayaz Nuray Aktay
Published: January 2020

Objective

The aims of this study were to compare demographic data, clinical features, and severity scores of familial Mediterranean fever patients carrying E148Q variant with the patients having homozygous pathogenic MEFV mutations and to evaluate both of these groups for the performance of Tel-Hashomer, Livneh, and pediatric diagnostic criteria.

Methods

The demographic and clinical data of patients with familial Mediterranean fever either heterozygous or homozygous for E148Q variant (group 1) and patients with homozygous mutations (M694V, M694I, M680I, V726A) (group 2) were collected retrospectively. All patients were evaluated for 3 diagnostic criteria.

Results

E148Q variant was present in 128 patients (22.9%), 112 of whom had heterozygous and 16 of whom had homozygous E148Q mutation. Group 2 had 430 patients (77.1%), 372 of whom had homozygous M694V mutation, 50 of whom had homozygous M680I mutation, 5 of whom had homozygous V726A mutation, and 3 of whom had homozygous M694I mutation. Pleuritis, arthritis, recurrent fever, erysipelas-like erythema, and anemia were significantly more common in group 2 than group 1 (p < 0.05). Moderate and severe Pras scores were significantly higher in group 2 (p < 0.001). During attack-free periods, C-reactive protein, erythrocyte sedimentation rate, and serum amyloid A were found significantly higher in group 2 than in group 1 (p < 0.05). The percentage of children diagnosed according to Tel-Hashomer and pediatric criteria was significantly higher in group 2 than in group 1 (p < 0.05). Both groups show similar diagnostic utility by Livneh criteria.

Conclusions

Children with the E148Q variant met the 3 diagnostic criteria; they had a milder disease course both clinically and in laboratory means.
Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: A retrospective pre-post study
Authors: Coles Sherry Jenna , Erdogan Mete , Higgins Sean D. , Green Robert S.
Published: January 2020

BACKGROUND

Prolonged immobility has detrimental consequences for critically ill patients admitted to the intensive care unit (ICU). Previous work has shown that early mobilization of ICU patients is a safe, feasible and effective strategy to improve outcomes; however, few of these studies focused on trauma ICU patients. Our objective was to assess the impact of implementing an ICU early mobilization protocol (EMP) on trauma outcomes.

METHODS

We conducted a retrospective pre-post study of adult trauma patients (>18 years old) admitted to ICU at a Level I trauma center over a 2-year period prior to and following EMP implementation, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared outcomes (mortality, length of stay [LOS], ventilator-free days) between patients admitted during pre-EMP and post-EMP periods, and assessed for factors associated with outcomes using binary logistic regression and generalized linear models.

RESULTS

Overall, 526 patients were included in the analysis (292 pre-EMP, 234 post-EMP). Ages ranged from 18 years to 92 years (mean, 49.0 ± 20.4 years) and 74.3% were men. The post-EMP group had lower ICU mortality (21.6% vs. 12.8%; p = 0.009) and in-hospital mortality (25.3% vs. 17.5%; p = 0.031). After controlling for confounders, patients in the post-EMP group were less likely to die in the ICU (odds ratio, 0.43; 95% confidence interval, 0.24–0.79; p = 0.006) or in-hospital (odds ratio, 0.55; 95% confidence interval; 0.32–0.94; p = 0.03). In-hospital LOS, ICU LOS, ICU-free days, and number of ventilator-free days were similar between the two groups.

CONCLUSION

Trauma patients admitted to ICU during the post-EMP period had decreased odds of ICU mortality and in-hospital mortality. This is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.

LEVEL OF EVIDENCE

Therapeutic, level III.