bluuebunny/crossref_metadata_2025 huggingface dataset:
The functional alterations in primary migraine
Authors: Xu Guixing , Cheng Shirui , Qu Yuzhu , Cheng Ying , Zhou Jun , Li Zhengjie , Liang Fanrong
Published: March 2020

Introduction:

Accumulating neuroimaging studies have found abnormal cerebral activity in migraine patients. However, the findings of studies exist many differences. Hence, this protocol aims to investigate concurrence across the neuroimaging studies to verify the functional cerebral alterations based on the latest evidence.

Methods and analysis:

Functional neuroimaging studies comparing migraineur with healthy subjects will be searched in the 4 online databases (EMBASE, the Cochrane Library, PubMed, and Web of Science) up to June 2019. The selection of studies, quality assessment, and data extraction will be conducted by 2 independent researchers. The Anisotropic effect size version of signed differential mapping (AES-SDM) methods will be used to conduct a coordinate-based meta-analysis. The bias of publication will be confirmed via the P value of Egger test. The quality of studies will be evaluated by the Newcastle-Ottawa Scale (NOS). This study is registered with PROSPERO, number CRD42019129043.

Results:

This study will deepen the understanding of functional cerebral alterations of migraine.

Conclusion:

The study will provide clear conclusion of the functional cerebral alterations based on the latest evidence.
The effectiveness of a focused rapid response team on reducing the incidence of cardiac arrest in the general ward
Authors: Ko Byuk Sung , Lim Tae Ho , Oh Jaehoon , Lee Yoonje , Yun InA , Yang Mi Suk , Ahn Chiwon , Kang Hyunggoo
Published: March 2020

Rapid response teams have been adopted to prevent unexpected in-ward cardiac arrest. However, there is no convincing evidence of optimal operation with rapid response team. Our aim was to address the impact of focused rapid response team on the safety of patients in wards. Comparison of focused with extended rapid response teams was performed in single center. The extended team operated on adult patients in whole ward (both medical and nonmedical ward) 24 hours per day, 7 days per week during 2012. In 2015, the operational time of the focused team was office hours from Monday to Friday and study population were limited to adult patients in the nonmedical ward. Unexpected in-ward cardiac arrests were compared between the extended team and focused team periods. During the focused team period, there was significant reduction in cardiac arrest per 1000 admissions in whole ward compared to the before the rapid response team period (1.09 vs 1.67, P < .001). Compared to that of the extended team period (1.42), there was also a significant reduction in cardiac arrest rate (P = .04). The cardiac arrest rate of nonmedical ward patients was also significantly decreased in the focused team period compared to that before the rapid response team period (0.43 vs 0.95, P < .001). Compared to the extended team period (0.64), there was a marginally significant reduction in cardiac arrest of nonmedical ward patients (P = .05). The focused rapid response team was associated with a reduced incidence of unexpected in-ward cardiac arrest. Further research on the optimal composition and operational time is needed.
Underweight increases the risk of primary open-angle glaucoma in diabetes patients
Authors: Na Kyung-Sun , Kim Jin-Ho , Paik Ji-Sun , Cho Won-Kyung , Ha Minji , Park Yong-Gyu , Yang Suk-Woo
Published: March 2020

The impact of underweight on the risk of developing primary open-angle glaucoma (POAG) is not known, although the association between obesity and POAG has been well studied. We evaluated the risk of POAG among underweight patients by studying a nationwide cohort sample in South Korea.

We analyzed data from the Korean National Health Insurance Research Database collected between 2009 and 2012 for 17,000,636 patients aged 40 years or older. Newly diagnosed POAG in the cohort was identified using claims data between 2009 and 2015.

A total of 442,829 individuals (2.60%) were classified as underweight (body mass index [BMI] < 18.5 kg/m2). During the follow-up period, 435,756 (2.56%) subjects were newly diagnosed with POAG. Multivariate analyses revealed that underweight was significantly related to an increased risk of future POAG development, by 9.8% and 27.8% in individuals with and without diabetes, respectively. There was a reverse J-shaped relationship between BMI and risk of POAG in the normal, impaired glucose tolerance, and diabetes groups; especially, this relationship was most notable in participants with diabetes.

Patients who were underweight exhibited a significantly higher prospective risk of POAG, even after adjusting for confounding factors.
Therapeutic efficacy of combined glucocorticoid, intravenous cyclophosphamide, and double-filtration plasmapheresis for skin sclerosis in diffuse systemic sclerosis
Authors: Suga Kensuke , Yamashita Hiroyuki , Takahashi Yuko , Katagiri Daisuke , Hinoshita Fumihiko , Kaneko Hiroshi
Published: March 2020

We treated skin sclerosis with triple therapy consisting of a glucocorticoid, intravenous cyclophosphamide, and double-filtration plasmapheresis. The objective of this study was to analyze its effectiveness in a case series of patients who received triple therapy.

We enrolled 8 patients with diffuse cutaneous systemic sclerosis (dcSSc) who received triple therapy at our hospital from 2008 to 2016. We analyzed the mean change in the modified Rodnan skin score (mRSS), percentage of the predicted forced vital capacity (%FVC), percentage of the predicted carbon monoxide diffusing capacity (%DLCO), and serum KL-6 levels from baseline to follow-up.

All patients were treated with an intermediate dose of oral prednisolone (30.6 ± 2.1 mg/day) initially. The mean cumulative dose of intravenous cyclophosphamide was 1.4 ± 0.2 g. The mean mRSS decreased significantly at follow-up compared with that at baseline (27.0 ± 3.3 vs 15.8 ± 3.5; P = .03). At the end of the treatment, the mean %FVC and %DLCO were improved moderately, although the differences were not significant. The serum KL-6 levels decreased from 578.9 ± 146.5 to 205.3 ± 43.1 U/ml (P = .02). No significant correlation was found between the change in mRSS or disease duration and the initial skin score severity.

Triple therapy may improve skin sclerosis, with effectiveness equal or superior to other reported treatments. This preliminary case series demonstrates the potential of triple therapy for treating dcSSc. However, prospective studies with long-term follow-up should be performed to assess its role.
The therapeutic efficacy of 177Lu-DOTATATE/DOTATOC in advanced neuroendocrine tumors
Authors: Wang Li-fan , Lin Lin , Wang Meng-jiao , Li Yong
Published: March 2020

Background:

Somatostatin analog therapies showed great potential for patients suffering advanced neuroendocrine tumors (NETs). This study was aimed to evaluate the therapeutic efficacy of 177Lu-DOTATATE/DOTATOC (177Lu-octreotate/octreotide) peptide receptor radionuclide therapy (PRRT) in advanced or inoperable NETs patients.

Methods:

Pubmed, Web of Science, Embase and Cochrane Library were searched from 1950 to April 2019. Eligible studies should include randomized or nonrandomized controlled trials (RCTs)-based investigations of 177Lu-octreotate/octreotide PRRT for NETs. All these studies were assessed with Response Evaluation Criteria in Solid Tumors (RECIST), RECIST 1.1, Southwest Oncology Group (SWOG) criteria or World Health Organization (WHO) criteria. Disease response rates (DRRs) and disease control rates (DCRs) were calculated according to each response criteria group. DRRs were defined as the percentages of patients with complete response (CR) + partial response (PR), while DCRs represented the percentages of patients with CR+ PR+ stable disease (SD). The pooled proportions were calculated with either a fixed-effects model or a random-effects model depending on the test for heterogeneity.

Results:

A total of 22 studies (1758 patients) were included in this meta-analysis: 8 studies with 478 patients met RECIST criteria, 10 studies with 1127 patients met RECIST 1.1 criteria, 5 studies with 459 patients met SWOG criteria, and 1 study with 40 patients met WHO criteria, and among these articles 1 study met both RECIST and RECIST 1.1 criteria and 1 met both RECIST 1.1 and SWOG criteria. The pooled DRRs were 33.0% (95% CI: 25.0%-42.0%, I

2
 = 65%), 35.0% (95% CI: 26.0%-45.0%, I
2 = 91%) and 25.0% (95% CI: 14.0%-36.0%, I

2
 = 84%) according to RECIST, RECIST 1.1 and SWOG criteria, respectively. The pooled DCRs were 79.0% (95% CI: 75.0%-83.0%, I
2 = 97%), 83.0% (95% CI: 78.0%-88.0%, I
2 = 0) and 82.0% (95% CI: 75.0%-89.0%, I
2 = 91%), respectively.

Conclusion:

In advanced NETs patients, DRRs and DCRs were significantly elevated after initial treatment with 177Lu-DOTATATE PRRT, which shows that this treatment would be beneficial and promising for advanced or inoperable NETs patients.
Effect of ureteral calculus in outpatients receiving semirigid ureteroscope laser lithotripsy
Authors: Hou Chen-Pang , Lin Yu-Hsiang , Juang Horng-Heng , Chang Phei-Lang , Chen Chien-lun , Yang Pei-Shan , Lee Chen-Che , Tsui Ke-Hung
Published: March 2020

The surgical outcomes of patients with single ureteral stones who had undergone ureteroscopic Holmium laser lithotripsy as outpatients and compare them with those of patients who had received the same procedure as inpatients. Records were obtained from January 2012 to December 2016 for selected patients who had undergone the above mentioned procedure at our institution. Patients were excluded if their ECOG performance status was ≥2, presented with multiple stones or concomitant renal stones, had histories of cancer or congenital urinary system abnormalities, or had undergone urinary system reconstruction surgery. Patients could decide whether to receive the procedure as an outpatient or inpatient. All surgeries were performed by a single surgeon. Patients preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesic requirement, rate of returning to the emergency room, stone clearance, surgical complications, and medical expenditure for the treatment courses were analyzed and compared between the 2 cohorts. In total, 303 patients met the inclusion criteria. Among them, 119 patients decided to receive ureteroscopic laser lithotripsy as outpatients, whereas 184 decided to be inpatients. The outpatient cohort was younger (P < .001), had smaller stone diameters (P < .001), and fewer comorbidity factors (P = .038). Patients with a history of stone manipulation favored receiving the procedure under admission (P < .001). After 1:1 propensity score matching, no significant differences were discovered between the cohorts with regard to operative time, rate of lithotripsy failure, and operative complications. Furthermore, rates of stone clearance, post-op urinary tract infection, analgesic requirement, and returning to the emergency room were comparable between the 2 groups. However, the medical expenditure was significantly lower in the outpatient cohort (P < .001). Our data revealed that outpatient ureteroscopic lithotripsy with a Holmium laser was more economical compared with the inpatient group and achieved favorable outcomes for patients with a single ureteral stone.
Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria – a prospective randomized trial
Authors: Liaw Mei-Yun , Hsu Chia-Hao , Leong Chau-Peng , Liao Ching-Yi , Wang Lin-Yi , Lu Cheng-Hsien , Lin Meng-Chih
Published: March 2020

Objective:

To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke.

Design:

Prospective, randomized controlled trial.

Setting:

Tertiary hospital.

Participants:

The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups.

Intervention:

Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks.

Main outcome measures:

MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis.

Results:

Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups.

Conclusions:

Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.

Clinical trial registration number (Clinical Trial Identifier): NCT03491111.
The association between the methylation frequency of BRCA1/2 gene promoter and occurrence and prognosis of breast carcinoma
Authors: Li Shu , He Yong , Li Chunli , Liu Xing , Shen Yan , Wu Yang , Bai Ningjing , Li Qiuhong
Published: March 2020

Objectives:

Breast cancer susceptibility gene 1/2 (BRCA1/2) is a promising tumor marker in many types of cancer. However, the methylation frequency of BRCA1/2 gene with occurrence risk and survival benefit of patients with breast carcinoma remains controversy. The aim of the present study was to assess the relationship between BRCA1/2 gene promoter methylation and the occurrence and prognosis in breast carcinoma based on a meta-analysis, meanwhile, this article explored the differential expression levels of BRCA1/2 gene promoter methylation in peripheral blood and tumor tissues of breast cancer patients.

Methods:

Electronic databases (PubMed, Medline, Cochrane Library, and CNKI) were searched up to June 2019. The number of BRCA1/2 promoter methylation-positive and -negative patients in breast carcinoma patients were measured, and hazard ratio (HR) with 95% confidence interval (CI) for the association between BRCA1/2 gene promoter methylation and the prognosis of breast carcinoma patients. Primary end points were presence of breast cancer, overall survival (OS), disease-free survival (DFS). Statistical analysis was performed with STATA 12.0.

Results and conclusions:

Fifty-eight articles including 19,084 individuals met full eligibility criteria. We observed that the frequency of BRCA1 gene promoter methylation was higher in breast cancer tissues compared with normal tissues, and the prognostic analysis suggested that BRCA1 gene promoter methylation was significantly associated with poor overall survival and poor disease-free survival. This study also verified that there was no statistically significant difference in the methylation frequency of BRCA1 gene promoter between peripheral blood and tumor tissues in breast cancer patients, which suggests that the detection of BRCA1 promoter methylation in peripheral blood may be a non-invasive and rapid way to monitor the occurrence breast cancer.
Prognostic role of the pretreatment C-reactive protein/albumin ratio in gastric cancer
Authors: Yang Xuanxuan , Song Xing , Zhang Luo , Wu Changping
Published: March 2020

Background:

In recent years, several studies have investigated the prognostic role of the pretreatment C-reactive protein/albumin ratio (CAR) in gastric cancer and yielded conflicting results. Therefore, we performed a meta-analysis to assess the prognostic role of the pretreatment CAR in gastric cancer.

Methods:

Studies assessing the prognostic role of the pretreatment CAR in patients with gastric cancer were searched from PubMed, Embase, and Cochrane Library up to June 6, 2019. Pooled hazard ratios (HRs) for overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) were estimated using a fixed-effects model.

Results:

Eight observational studies including 3102 patients were enrolled in this meta-analysis. The pooled result showed that patients with a high CAR had worse OS (pooled HR = 1.87; 95% confidence interval (CI) = 1.55–2.26; P < .001). Results from subgroup analyses indicated that patient country, adjuvant chemotherapy rate, and CAR cut-off value could not affected the property of the correlation (P < .001). However, the intensity of the correlation was affected by these factors. In addition, patients with a high CAR had significantly worse RFS (pooled HR = 2.11; 95% CI = 1.41–3.15; P < .001) and CSS (HR = 1.59; 95% CI = 1.08–2.35; P = .019).

Conclusion:

A high pretreatment CAR was significantly associated with poor survival for patients with gastric cancer. The prognostic significance of the pretreatment CAR in gastric cancer is need to be confirmed by clinical trials of large sample size.
Refractory solitary cervical lymph node metastasis after esophageal squamous cell carcinoma surgery and its successful treatment with immune checkpoint inhibitor
Authors: Song Wenjing , Wang Helei , Tian Yuanyuan , Liu Shiwei , Chen Xiao , Cui Jiuwei , Zhao Yuguang
Published: March 2020

Rationale:

Although the early detection and treatment of non-metastatic esophageal cancer has improved, these patients’ prognoses are still poor. Most patients with radical treatment for esophageal cancer will relapse in 3 years, and the best treatment strategy after recurrence has not been uniformly accepted. Multiform treatments may be beneficial to recurrent patients.

Patient concerns:

A 60-year-old male patient, due to routinely health examination, ulcerated lesions 30 cm away from the incisors were found by gastroscopy, pathology showed esophageal squamous cell carcinoma (ESCC).

Diagnosis:

Due to the patient's pathology, he was diagnosed with ESCC.

Interventions:

The patient underwent radical surgery for ESCC on June 28, 2015. The left cervical lymph node metastasis occurred after 20 months, and lymph node metastasis carcinoma resection was performed. After that, concurrent chemoradiotherapy was implemented, 40 days after the end of the 4 courses of chemotherapy, the left cervical metastatic lymph nodes relapsed, radioactive particle implantation was carried out, and progressed again after 1 month. The patient took apatinib for 1 week but could not tolerate due to hand-foot syndrome. Immune checkpoint inhibitor (ICI) was administered since October 27, 2017.

Outcomes:

The therapeutic effect of immune checkpoint inhibitor was evaluated as partial response (PR) after 6 courses of treatment and complete response (CR) after 15 courses of treatment. To our knowledge, this is the first case report of successful immunotherapy for refractory esophageal squamous cell carcinoma.

Lessons:

The emergence of ICIs promotes the treatment of esophageal cancer to a new era. Our observations suggest that patients for whom schedule to receive anti-programmed cell death protein-1 (anti-PD-1)/programmed cell death-ligand 1 (PD-L1) immunotherapy may require genomic testing to predict whether tumors respond to ICIs. In this case, we also present the predictors for the efficacy of targeted immunotherapy. At present, no matter which predictor of PD-L1 expression, tumor mutational burden (TMB), microsatellite instability (MSI), and tumor-infiltrating lymphocyte (TIL), a single predictor may be unconvincing and cannot accurately estimate the efficacy of immunotherapy. Multiplex detecting methods and combined biomarkers may provide new strategies. Consensus need to be reached in order to be widely applied in future studies.
Allogeneic hematopoietic stem cell transplantation for Crohn disease complicated with myelodysplastic syndrome
Authors: Zhang Ying , Lou Li-Li , Shi Xiao-Dong , Lu Sha-Sha , Zhang Li-Xia , Huang Xu , Ji Hui-Fan , Li Xu , Guo Xiao-Lin
Published: March 2020

Rationale:

Myelodysplastic syndrome (MDS) can be complicated with Crohn disease (CD). Irritable bowel disease (IBD) associated with MDS has already been reported in the past; however, hematopoietic stem cell transplantation (HSCT) is rarely performed. Herein, we report a case of CD with MDS for HSCT.

Patient concerns:

A 41-year-old man was hospitalized due to abdominal pain and intermittent fever for 40 days. Two years later, he was readmitted due to abdominal pain and diarrhea with fever for 10 days.

Diagnosis:

Symptoms, laboratory examinations, and imaging findings of the patient were indicative of CD complicated with MDS.

Interventions:

An allogeneic HSCT was performed.

Outcomes:

He died of severe lung infection 125 days post-transplantation.

Lessons:

The number of cases of CD combined with MDS remains insufficient, and no consensus opinions are available to date. Hence, HSCT is a very potential treatment method. Additional experiences are needed to determine its effectiveness.
The effectiveness of a health promotion intervention on the meaning of life, positive beliefs, and well-being among undergraduate nursing students
Authors: Tsai Fu-Ju , Hu Yih-Jin , Yeh Gwo-Liang , Chen Cheng-Yu , Tseng Chie-Chien , Chen Si-Chi
Published: March 2020

Nursing educators have a responsibility to value undergraduate nursing students’ physical, psychological, spiritual, and social health promotion.

The purpose of the study was to examine the effectiveness of a health promotion intervention concerning meaning of life, positive beliefs, and well-being among undergraduate nursing students in a health promotion curriculum.

The study was adopted a pretest, posttest, and post post-test design in 1-group experimental study with a purposive sample of 112 undergraduate nursing students who attended in a health promotion curriculum and voluntarily completed a reliable 3-part questionnaire (content validity index = 0.95; Cronbach's αs = meaning of life, 0.97; positive beliefs, 0.94; and well-being 0.96).

Undergraduate nursing students showed significant (all P < .001) improvements on the meaning of life, positive beliefs, and well-being immediately after the intervention, which were sustained over time.

Nursing educators should incorporate these variables into the health promotion curriculum to enhance undergraduate nursing students’ physical, psychological, spiritual, and social health promotion.
Effects of high-intensity interval and moderate-intensity continuous aerobic exercise on diabetic obese patients with nonalcoholic fatty liver disease
Authors: Abdelbasset Walid Kamal , Tantawy Sayed A. , Kamel Dalia M. , Alqahtani Bader A. , Elnegamy Tamer E. , Soliman Gaber S. , Ibrahim Ahmed A.
Published: March 2020

Background:

Some studies assessed the effect of aerobic exercise on diabetic obese patients with hepatic disease, while very limited studies compared high-intensity interval (HII) versus moderate-intensity continuous (MIC) on diabetic obese patients with non-alcoholic fatty liver disease (NAFLD).

Objectives:

This study was designed to assess the effects of HII versus MIC on intrahepatic triglycerides (IHTG) and visceral lipids in diabetic obese patients with NAFLD.

Design:

Randomized controlled trial.

Methods:

Forty-seven diabetic obese individuals with NAFLD were enrolled in this study. The individuals were randomly divided into 16 in HII group, 15 in MIC group, and 16 in the controls. HII group received HII exercise, MIC group received 8-week MIC exercise while the control group did not receive any exercise intervention. IHTG and visceral lipids were assessed pre- and post-intervention.

Results:

Baseline and clinical characteristics showed nonsignificant difference among the 3 groups (P > .05). Both HII and MIC groups showed a significant reduction in hepatic fat and visceral lipids (P < .05), while the controls showed nonsignificant difference (P > .05) after completing the study intervention. Postintervention analysis showed nonsignificant changes between the HII and MIC groups (P > .05).

Conclusions:

Exercise training wither HII or MIC aerobic exercise reduces IHGT and visceral lipids in diabetic obese patients with NAFLD. No differences were observed between the effects of both exercise programs on diabetic obese patients with NAFLD.
Prognostic value of precise hepatic pedicle dissection in anatomical resection for patients with hepatocellular carcinoma
Authors: Zhao Hui , Ding Wen-Zhou , Wang Hong , Gu Shen , Yan Xiao-Peng , Sun Shi-Quan , Mao Liang , Jin Hui-Han , Qiu Yu-Dong
Published: March 2020

The present study aimed to investigate the long-term and perioperative outcomes of precise hepatic pedicle dissection in anatomical resection (precise AR) vs non-anatomical resection (NAR) for hepatocellular carcinoma (HCC) patients.

Data from a total of 270 consecutive HCC patients who underwent curative hepatectomy were retrospectively collected. Propensity score matching (PSM) analysis was performed. The long-term outcomes of precise AR and NAR were analyzed using the Kaplan–Meier method and the Cox proportional hazards model.

The 1-, 3-, and 5-year overall survival (OS) rates were 90.3%, 76.2%, and 65.7% in the PS-precise AR group, respectively (n = 103); and 88.3%, 70.5%, and 52.0% in the PS-NAR group, respectively (n = 103) (P = .043). The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 83.4%, 63.2%, and 46.0% in the PS-precise AR group, respectively; and 75.7%, 47.4%, and 28.3% in the PS-NAR group, respectively (P = .002). Multivariate analysis showed that ICG-R15, BCLC staging, and microvascular invasion (MVI) were independent risk factors for OS; while tumor size, types of resection, surgical margin, and MVI were independent risk factors for RFS. Subgroup analysis indicated that the RFS rate was significantly better in the PS-precise AR group than in the PS-NAR group for patients with MVI and tumor size ≤5 cm.

After PSM, precise hepatic pedicle dissection in AR significantly improved the recurrence-free survival rate of solitary HCC patients compared with NAR, especially in those with MVI and tumor size ≤5 cm.
A case report on intensive, robot-assisted rehabilitation program for brainstem radionecrosis
Authors: Tartamella Francesco , Chillura Antonino , Pisano Maria Francesca , Cacioppo Adele , Licari Simona , Caradonna Deborah , Portaro Simona , Calabrò Rocco Salvatore , Bramanti Placido , Naro Antonino
Published: March 2020

Introduction:

Radiotherapy is a valid treatment option for nasopharyngeal carcinoma. However, complications can occur following irradiation of the closest anatomical structures, including brainstem radionecrosis (BRN). The rehabilitation is poorly described in patients with BRN, despite its usefulness in improving functional independence in patients with brain tumors. We aimed at testing the usefulness of intensive, robot-assisted neurorehabilitation program to improve functional independence in a 57-year-old male with BRN.

Patient concerns:

A 57-year-old male diagnosed with a nasopharyngeal carcinoma, received a radiation total dose of 72 Gy. Owing to the appearance of a severe symptomatology characterized by dysphagia, hearing loss, and left sided hemiparesis, the patient was hospitalized to be provided with intensive pharmacological and neurorehabilitation treatment.

Diagnosis:

Follow-up brain magnetic resonance imaging disclosed no residual cancer, but some brainstem lesions compatible with BRN areas were appreciable.

Intervention:

The patient underwent a 2-month conventional, respiratory, and speech therapy. Given that the patient only mildly improved, he was provided with intensive robot-aided upper limb and gait training and virtual reality-based cognitive rehabilitation for other 2 months.

Outcomes:

The patient reported a significant improvement in functional independence, spasticity, cognitive impairment degree, and balance.

Conclusion:

Our case suggests the usefulness of neurorobotic intensive rehabilitation in BRN to reduce functional disability. Future studies should investigate whether an earlier, even multidisciplinary rehabilitative treatment could lead to better functional outcome in patients with BRN.
Evaluation of Bioactivities of Bovine Milk Osteopontin Using a Knockout Mouse Model
Authors: Jiang Rulan , Lönnerdal Bo
Published: March 2020

Objectives:

Osteopontin (OPN) is a multifunctional protein present abundantly in human milk, but at low levels in bovine milk and infant formula. Bovine milk OPN (bmOPN) is commercially available, and may therefore, be added to formula. OPN exerts its multiple functions by binding to its receptors to activate cell signaling pathways. The OPN receptor (integrin)‐binding site is conserved across species; therefore, bmOPN may exert bioactivities in humans and mice. The objective of the present study was to evaluate bioactivities of bmOPN using an established OPN knock‐out (KO) mouse model.

Methods:

We evaluated bioactivities of bmOPN, including effects on intestinal growth, immune response, and brain development. In the present study, wild‐type (WT) pups were nursed by WT dams, KO dams, or KO dams with bmOPN supplementation from postnatal days 1 to 21 (P1‐‐P21).

Results:

Our results show that orally ingested bmOPN is partly resistant to in vivo gastrointestinal digestion, and supplemental bmOPN exhibited similar effects as mouse milk OPN (mmOPN) on promoting growth of the small intestine revealed by histological analysis of duodenum villus height and crypt depth at P10, on modifying TNF‐α response against a LPS challenge at P30, as well as promoting brain myelination by increasing expression of myelin‐associated glycoprotein (MAG) and myelin basic protein (MBP) and improving cognitive development.

Conclusions:

Our finding that bmOPN with an amino acid sequence different from mmOPN but with a conserved integrin binding site exerts bioactivities similar to mmOPN suggests that bmOPN may provide bioactivities to human infants when added to formula.
Time to Serological Cure and Associated Factors Among Syphilis Patients With and Without HIV in a Sexually Transmitted Infections Center, Thailand
Authors: Atsawawaranunt Kamolthip , Kittiyaowamarn Rossaphorn , Phonrat Benjaluck , Kamolratanakul Supitcha , Kangvalpornroj Thanyanan , Dhitavat Jittima
Published: March 2020

Background

Together with clinical correlation, nontreponemal titers are used to monitor treatment outcomes. Syphilis patients with HIV and without HIV coinfection were found to have different serological responses after treatment. This study aims to determine time to serological cure for treatment of syphilis and factors associated with it in patients with and without HIV.

Method

A descriptive study of syphilis patients who visited Bangrak STIs Center between January 1, 2007, and December 31, 2016. Univariate analysis was done to determine factors associated with serological outcomes. Survival curve analysis and multivariate Cox regression analysis were applied to compare time to serological cure between patients with various characteristics.

Results

Of 497 syphilis patients, 62.1% had serological cure, 2.2% had nonresponse, 4.6% had treatment failure or reinfection, 9.9% had serofast status, and 21.2% were undetermined because of loss to follow-up. The time to serological cure was 110 days (95% confidence interval [CI], 59–163 days) and 102 days (95% CI, 94–110 days) among patients with HIV and without HIV, respectively (P = 0.162). Time to serological cure was significantly faster in early syphilis and baseline titer ≥1:32. After adjustment with the Cox regression model, patients with early syphilis were associated with serological cure with a hazard ratio of 1.75 (95% CI, 1.32–2.32). Time to serological cure among early syphilis patients was significantly longer in HIV-positive than HIV-negative patients (P = 0.002), whereas no difference was observed in late syphilis (P = 0.104).

Conclusion

Early syphilis was associated with faster time to serological cure. HIV patients with early syphilis took longer time to reach serological cure than did HIV-negative patients, whereas no such a difference was observed in late syphilis.
Outcome of Different Approaches to Reduce Urinary Tract Infection in Patients With Spinal Cord Lesions
Authors: Chang Shih-Chung , Zeng Shengwei , Tsai Su-Ju
Published: March 2020

Neurogenic bladder disorders are common among patients with spinal cord lesions, which often result in upper and lower urinary tract complications. Urinary tract infection has remained the most frequent type of infection in this population. Our aim is to review systematically the literature on the outcome of different intervention methods to reduce urinary tract infection incidence. A literature search was conducted in the database of Medline, PubMed, Embase, and Scopus. After screening 1559 articles, 42 were included in this review. The intervention methods can be categorized into the four following groups: (1) indwelling catheterization and intermittent catheterization, (2) medications, (3) surgery, and (4) others. Intermittent catheterization is still the most recommended treatment for persons with spinal cord lesions. Hydrophilic catheters are more suitable for adults than children because of complex handling. Bladder management with spontaneous voiding is initially considered for infants and toddlers with spina bifida. Antibiotics treatment should be based on the results of urine cultures. Shortening the course of antibiotics treatment can reduce its adverse effects but may increase urinary tract infection recurrence. Because botulinum toxin injections and bladder surgery can improve urodynamic function, both are conducive toward lowering urinary tract infection incidence.
Reduction in Recurrence Rate by Combining Modified Hotz Procedure With Epicanthoplasty to Treat Congenital Epiblepharon
Authors: Nemoto Hitoshi , Nakae Seiko , Miyabe Kenta , Kuroki Tomoaki , Ito Yoshinori , Sumiya Noriyoshi
Published: March 2020

Aim

To determine whether patients with congenital lower lid epiblepharon treated with a modified Hotz procedure combined with epicanthoplasty have a decreased recurrence rate.

Patients and Methods

Patients with epiblepharon of the lower eyelid corrected using a modified Hotz method between 2007 and 2017 were evaluated retrospectively by chart review to determine rates of complications and recurrence as well as whether the Hotz method was combined with epicanthoplasty. The recurrence rates for patients treated with the Hotz method alone or in combination with epicanthoplasty were compared.

Results

A total of 60 patients (mean age, 13.6 years) and 115 eyelids were evaluated. All patients showed improvement in their symptoms and had no complications. Across the entire group, the recurrence rate for entropion was 23.5% (27 eyes). A modified Hotz procedure combined with epicanthoplasty was performed on 43 (37.4%) eyes. The recurrence rate for the group treated with a modified Hotz procedure combined with epicanthoplasty was significantly lower than that for patients who underwent the Hotz procedure alone (7.0% vs 33.3% P = 0.0012). There was no relationship between epicanthus severity and recurrence rate (P = 0.345).

Conclusion

In this study, we showed that patients who underwent a modified Hotz procedure combined with epicanthoplasty had a decreased recurrence rate. This improved outcome could be due to the simpler approach to the nasal side of the lower eyelid in epicanthoplasty, and epicanthoplasty can facilitate detachment of the upper eyelid from the lower eyelid.
Three-Dimensional Computed Tomography Analysis of Pharynx in Juvenile Patients With Unrepaired Isolated Cleft Palate
Authors: Xu Yi , Guo Siyuan , Jin Hexiu , Chen Renji
Published: March 2020

Previous research showed that pharynx in adult patients with unrepaired isolated cleft palate (UICP) significantly enlarged. However, the literature lacks studies in juvenile patients. Thus, this study aimed to conduct a 3-dimensional evaluation of pharynx in juvenile patients with UICP using cone beam computed tomography. Cone beam computed tomography images of 58 nonsyndromic patients with UICP and 60 noncleft controls aged from 4 to 13 years were acquired. Both patients and controls were divided into 3 groups according to their ages. Image processing and analyses were performed using Mimics and ZWCAD. Linear, angular, planar, and volumetric measurements and comparisons were made. Statistical analyses comparing patients with controls were performed using independent-samples t test, with the threshold of significance set at P = 0.05. Results showed that, in all age groups, anterior height (P = 0.002, P = 0.004, P = 0.004) and length of the floor (P = 0.023, P = 0.000, P = 0.024) of bony nasopharynx; transverse (P = 0.028, P = 0.031, P = 0.043) and posteroanterior (P = 0.000, P = 0.000, P = 0.000) diameters of pharyngeal airway at palatal plane; cross-sectional area of pharyngeal airway at palatal plane (P = 0.006, P = 0.001, P = 0.001); total volume (P = 0.005, P = 0.003, P = 0.038), volume above palatal plane (P = 0.001, P = 0.000, P = 0.005), and volume between palatal plane and C2 plane (P = 0.047, P = 0.025, P = 0.048) were larger in UICP patients. Based on this study, the authors can conclude that pharynx in juvenile UICP patients around the palatal plane was significantly enlarged, and narrowing of velopharyngeal orifice in palatoplasty was seemed important.
Elective Sonolucent Cranioplasty for Real-Time Ultrasound Monitoring of Flow and Patency of an Extra- to Intracranial Bypass
Authors: Hadley Caroline , North Robert , Srinivasan Visish , Kan Peter , Burkhardt Jan-Karl
Published: March 2020

Cross-sectional imaging studies or catheter angiogram are the imaging modalities of choice to evaluate bypass patency after extra- to intracranial (EC-IC) bypass surgery. Although providing accurate results, these imaging modalities are time-consuming and/or present radiation risk for the patient. Ultrasound imaging is a fast and widely available imaging modality, but is limited in this setting due to the non-sonolucent autologous bone flap covering the bypass after surgery. The recently FDA approved clear polymethyl methacrylate (PMMA) cranioplasty implant overcomes this limitation by its sonolucent characteristic, but has not yet been used in the setting of EC-IC bypass surgery. Here, the authors describe for the first time the feasibility of an elective sonolucent cranioplasty to monitor flow and patency of an EC-IC bypass in real time using ultrasound. This moyamoya patient underwent a direct superficial temporal artery to middle cerebral artery (STA-MCA) bypass, after which a PMMA implant was used to close the craniotomy defect, instead of reimplanting the autologous bone flap. Immediate postoperative bedside transcranioplasty ultrasound confirmed bypass patency and allowed for quantitative flow measurements as well as for exclusion of postoperative hemorrhage. Postoperative CTA and catheter angiogram confirmed patency of the bypass without complications. This report shows for the first time that this technique is feasible and permits bedside transcranioplasty ultrasound assessment of bypass flow in real time, confirmed with angiography. This technique may permit easy comparison of baseline findings with follow up assessments and facilitate less invasive monitoring of bypass patency.
The Correlation Between Consonant Articulation and Velopharyngeal Function in Patients With Unoperated Submucous Cleft Palate
Authors: Zhang Bei , Guo Chunli , Yin Heng , Zheng Qian , Shi Bing , Li Jingtao
Published: March 2020

Submucous cleft palate (SMCP) is a congenital condition related to abnormal muscle attachments within the soft palate. Even though hypernasality and nasal emission, the primary symptom of SMCP, have been well-documented, research on articulation errors is currently lacking. The object of this study was to examine the consonant articulation in patients with unoperated SMCP and its possible correlation with the velopharyngeal function. This study analyzed the perceptual speech assessment and nasopharyngoscopy data of 338 patients with unoperated SMCP between years 2008 and 2016 retrospectively. The mean age of the patients was 13.27 years. About 125 patients showed velopharyngeal competence (VPC), 174 velopharyngeal incompetence (VPI), and 39 marginal VPI (MVPI). Among the 338 patients, 137 presented normal articulation, 124 consonant omission, 25 compensatory articulation, 36 consonant weakening, 51 consonant substitution, and 36 posterior placement. About 70.40% VPC patients, 17.24% VPI patients, and 48.72% MVPI patients demonstrated normal articulation. About 59.20% VPI patients showed consonant omission. The results demonstrated that consonant articulation varied among patients with unoperated SMCP and was correlated with their velopharyngeal functions, while consonant omission was the most common articulation error. Velopharyngeal closure pattern was not associated with either velopharyngeal function or consonant articulation.
Risk Factors Associated With Allogenic Blood Transfusion in Primary Infant Cranial Vault Remodeling
Authors: Subichin Michael P. , Murthy Ananth S. , Patel Niyant V.
Published: March 2020

Introduction:

Cranial vault remodeling is commonly associated with high blood loss and high transfusion rates. Blood management protocols have recently been developed to minimize blood loss and reduce transfusion requirements. We sought to determine risk factors associated with blood product transfusion for infants undergoing primary cranial vault remodeling after the implementation of a blood management protocol.

Methods:

A retrospective review of patients who underwent cranial vault remodeling at a single center was performed. Patients under 18 months of age who underwent cranial vault remodeling after the establishment of a blood management protocol were included.

Results:

Thirty-five patients were identified. Eleven patients (31%) received allogenic blood transfusions. Patients who received allogenic blood transfusions had a lower absolute weight (8.8 kg versus 9.6kg P = 0.04), longer procedure times (337 minutes versus 275 minutes P < 0.01), and were more likely to have undergone fronto orbital advancement (91% versus 46% P = 0.02). There were no significant differences in age, weight percentile, and patient diagnosis between patients who received allogenic blood transfusions and those that did not (P > 0.05).

Conclusion:

Low weight, longer operative times, and fronto orbital advancement are associated with allogenic blood transfusion despite the use of a blood management protocol. Attempts to modify these factors may further improve outcomes.
Cystatin C and Sarcopenia Predict Acute on Chronic Liver Failure Development and Mortality in Patients on the Liver Transplant Waiting List
Authors: Mauro Ezequiel , Crespo Gonzalo , Martinez-Garmendia Agustina , Gutierrez-Acevedo María Nelly , Diaz Juan Manuel , Saidman Julia , Bermudez Carla , Ortiz-Patron Jorge , Garcia-Olveira Lucrecia , Zalazar Fernanda , Narvaez Adrían , Spina Juan Carlos , Orta Ramiro , Savluk Lorena , Piano Salvatore , Marciano Sebastián , Gadano Adrían
Published: March 2020

Background.

Cystatin C (CysC) is an early biomarker of renal dysfunction scarcely studied in patients awaiting liver transplantation (LT). Sarcopenia is frequent in cirrhosis and impacts prognosis. We aimed to assess the capability of these factors to predict survival and acute-on-chronic liver failure (ACLF) in patients awaiting LT, as well as early post-LT outcomes.

Methods.

Single-center study that included all cirrhotic patients listed for LT between 2014 and 2017. Competing risk regression analysis was used to evaluate the capability of liver-, kidney-, and global status-related variables at waitlist (WL) inclusion to predict WL mortality and ACLF. Variables associated with post-LT outcomes were evaluated with logistic regression analysis.

Results.

One-hundred-and-eighty patients were included. Fifty-six (31%) patients developed ACLF, 54 (30%) underwent LT and 35 (19%) died. In the adjusted competing risk regression analysis, CysC ≥ 1.5 mg/L, sarcopenia and MELD-Na were independent predictors of ACLF in the WL, while CysC ≥ 1.5 mg/L, sarcopenia and albumin were independent predictors of mortality. The cumulative incidence of ACLF and mortality at 12 months were 50% and 34% in patients with sarcopenia and CysC ≥1.5 mg/L. An estimated glomerular filtration rate by chronic kidney disease (CKD)-EPI-CysC-creatinine <60 mL/min/1.73 m2 at WL inclusion was an independent predictor of the need for renal replacement therapy (RRT) in the first month post-LT.

Conclusions.

Higher levels of CysC and sarcopenia are strongly associated with the ACLF and mortality in WL. The assessment of both risk factors may improve the prognostic evaluation and allow identifying a group of patients with a very high risk of poor outcomes while awaiting LT.
Transcranial direct current stimulation effects on hand sensibility as measured by an objective quantitative analysis device: a randomized single-blind sham-control crossover clinical trial
Authors: Zehry Hanan Ibrahim , Maaty Ahmed , El-Hagrassy Mirret M. , Ueda Akio , Kurumadani Hiroshi , Fregni Felipe , Sunagawa Toru
Published: March 2020

Studies show that transcranial direct current stimulation (tDCS) can modulate somatosensory processing, but optimum parameters for tDCS effects on hand sensibility remain in question. We aimed to test the effects of anodal tDCS (atDCS) and cathodal tDCS (ctDCS) compared with sham tDCS (stDCS) of primary motor (M1) and sensory (S1) cortices on healthy subjects’ hand sensibility. In this single-blind clinical trial, 30 randomized healthy volunteers received six tDCS sessions over 6 weeks: one session each of atDCS, ctDCS and stDCS over M1, and one session each of atDCS, ctDCS and stDCS over S1. Current perception threshold (CPT) was assessed using an objective quantitative analysis device (PainVision) at baseline, immediately (T0) and 30 min (T30) after each intervention. Our results showed that both atDCS and ctDCS of S1 and M1 significantly increased CPT. M1 ctDCS at T30 had the greatest effect of all M1 and S1 stimulation conditions (mean difference: 32.94%, Z: 3.12, effect size: 1.82, P < 0.001 The largest effect at S1 was for atDCS at T30 (mean difference: 29.87%, Z: 2.53, effect size: 1.72, P < 0.001. Our results are consistent with tDCS’ modulatory effects on hand sensation, especially M1 ctDCS and S1 atDCS.