bluuebunny/crossref_metadata_2025 huggingface dataset:
Lateral Superficial Muscular Aponeurotic System Stacking/Superficial Muscular Aponeurotic Systemectomy With Orbicularis–Malar Fat Repositioning: A Procedure Tailored for Female Asian Patients
Authors: Gong Meihua , Yu Li , Ren Lihong , Sui Bing , Yang Daping
Published: October 2019

BACKGROUND

Important differences in facial anatomy and how faces age must be considered when performing facelifts in Asian populations. Few facelift methods are specifically designed for Asian patients.

OBJECTIVE

This study evaluated the efficacy of lateral superficial muscular aponeurotic system (SMAS)-stacking/SMAS-ectomy with orbicularis–malar fat repositioning.

MATERIALS AND METHODS

Between February 2013 and December 2016, 62 women underwent the evaluated technique and completed the follow-up (15 months, ranging from 3 to 38.5 months). Three blinded, independent observers graded wrinkles, laxity, nasolabial fold depth, malar prominence, and tear trough deformity using quantitative comprehensive grading scales. FACE-Q scale items were assessed, and complications were recorded.

RESULTS

The mean postoperative scores for wrinkles, laxity, nasolabial fold depth, malar prominence, and tear trough deformity decreased from 2.64, 2.62, 2.01, 2.06, and 2.40 to 1.48, 1.34, 0.93, 1.21, and 1.27, respectively. The preoperative and postoperative scores differed significantly for all parameters (p < .05). The FACE-Q results showed that the patients were highly satisfied with their appearance, quality of life, adverse effects, and care.

CONCLUSION

The authors' technique allows midfacial and periorbital rejuvenation and offers dual benefits by correcting individual facial asymmetries and reshaping the jowls and neck contour in Asian patients.
Orbital Pheochromocytoma Metastasis in 2 Patients With Known Pheochromocytoma
Authors: Rider Alex J. , Walsh Anna , Sollenberger Eric L. , Dryden Stephen C. , DeAngelis Kendra D. , Weir Alva B. , Fowler Brian T.
Published: October 2019

Two patients with previously diagnosed pheochromocytoma presented with facial pain and ptosis. Imaging revealed orbital lesions. Both patients were referred for surgical evaluation of the orbital mass. Surgical excision was performed for both. Pathology confirmed metastatic pheochromocytoma. Pheochromocytomas commonly metastasize to bone, liver, and other tissues. Five cases of metastasis to orbital bone have been previously described. These 2 cases are unique in that the metastases were not hormonally active, presented soon after initial diagnosis, and were treated palliatively with surgical excision. Previous treatment of orbital bony metastasis used radiotherapy. These cases demonstrate that surgical resection is a viable treatment option in these situations. Orbital metastasis of pheochromocytomas should be considered with the appropriate clinical presentation. These are the first documented cases of intraorbital metastasis, separate from the bony walls. Previously, orbital bony wall metastases were treated with radiation. Surgical excision is a viable option for treatment of such metastases.

Orbital involvement should be considered in patients with systemic disease presenting with new ocular findings.
Nasal and Lacrimal Sac Histopathology in Patients With Granulomatous Polyangiitis Undergoing Lacrimal Drainage Surgery
Authors: Stewart Christopher M. , Rose Geoffrey E.
Published: October 2019

Lacrimal sac and nasal mucosa from patients with granulomatous polyangiitis undergoing dacryocystorhinostomy usually show chronic lymphocytic inflammation with marked fibrosis, but up to half reveal active vasculitis despite long-established systemic immunosuppression and apparently “quiescent” disease.

Purpose:

To examine histological changes within nasal and lacrimal sac mucosa harvested from patients with granulomatous polyangiitis (GPA) who required lacrimal drainage surgery. As these patients were considered quiescent on clinical and serological grounds, particular attention was paid to the presence of active vasculitis.

Design:

Retrospective noncomparative case series.

Participants:

Patients with GPA who had open lacrimal drainage surgery under the care of a single surgeon between 1991 and 2017. All patients had paired biopsies of both nasal and ipsilateral lacrimal sac mucosa.

Methods:

Biopsies of the nasal and lacrimal sac mucosa, taken from the operative site during either primary or revisional open dacryocystorhinostomy, were reported by experienced ophthalmic histopathologists. Outcome measures were the surgical appearance of the tissues and the proportion of each tissue showing histological evidence of active vasculitis, chronic inflammation with or without fibrosis, marked fibrosis without inflammation, or acute-on-chronic inflammatory changes.

Results:

Paired tissues were available from 47 patients (25 females; 53%) who had undergone 64 procedures (57 primary, 7 revisional). All patients had systemic disease, this being known prior to surgery in 43 patients (with 41/43 on long-established systemic immunosuppression) and suspected clinically after the initial lacrimal examination in 4/47. Most lacrimal sacs and nasal spaces showed a variety of abnormalities, this commonly being extensive scarring. Despite most patients being considered to have inactive systemic GPA, active vasculitis was evident in 23/64 (36%) lacrimal sac biopsies and 32/64 (50%) nasal mucosal biopsies—suggesting that serological markers may not be reliable guide to disease activity where disease is of limited volume (as, for example, with limited sino-nasal disease). Chronic lymphocytic inflammation was present in a further 35/64 (55%) sacs—associated with marked fibrosis in 5—and a further 25/64 (41%) nasal biopsies (with fibrosis in 2).

Conclusions:

The lacrimal sac and nasal space are highly abnormal in most patients with GPA undergoing lacrimal drainage surgery. Despite having clinically and serologically inactive disease on established systemic immunotherapy, histological examination often shows unrecognized active vasculitis, which might indicate inadequate systemic immunosuppression for the underlying condition.
Management of a Large Congenital Hemangioma Obstructing Visual Axis: A Case Report and Review of Literature
Authors: AlShaker Sara , Jivraj Imran , Chen Haiying , Muthusami Prakash , Phillips John , DeAngelis Dan
Published: October 2019

Congenital hemangiomas comprise a subset of vascular tumors with clinicopathologic features that are distinct from the more common infantile hemangioma. The authors present a patient with a large congenital hemangioma involving the forehead and brow which obstructed the visual axis and created significant risk for deprivational amblyopia. Management of the congenital hemangioma involved customized headgear to clear the visual axis and early vascular embolization of feeder vessels with the subsequent successful surgical resection at 23 days of life.

A large amblyogenic congenital hemangioma required a multidisciplinary approach involving early vascular embolization of feeder vessels and subsequent surgical resection at 23 days of life.
Heightened risk of pain in young adult women with a history of childhood maltreatment: a prospective longitudinal study
Authors: Beal Sarah J. , Kashikar-Zuck Susmita , King Christopher , Black William , Barnes Jaclyn , Noll Jennie G.
Published: October 2019

A child maltreatment history is reported more frequently among adults with chronic pain compared with the general population; unfortunately, studies have primarily relied upon retrospective maltreatment reports by adults with chronic pain. This prospective study assessed pain symptoms in a cohort of young adult women with a documented history of child maltreatment, compared with a matched cohort of women who did not experience childhood maltreatment. Young women (N = 477) were recruited between ages 14 to 17 years and followed annually to age 19. Of these women, 57% experienced maltreatment (ie, physical, sexual, or emotional abuse, neglect; n = 273) substantiated by child welfare record. Maltreated women were demographically matched to nonmaltreated women, also confirmed by child welfare record. In adolescence, post-traumatic stress was assessed. Women were contacted as young adults (Mage = 24.76; n = 383) and surveyed about their pain experiences, including the presence of pain in the past week, pain severity (0-10), and number of body areas with pain. Mediation path analyses examining the impact of maltreatment and adolescent post-traumatic stress on young adult pain were estimated through structural equation modeling. As adults, women who had experienced child maltreatment reported higher pain intensity, a greater number of pain locations, and were more likely to experience pain in the previous week than nonmaltreated women. Adolescent post-traumatic stress partially explained the effects of maltreatment on pain. Young adult women who experienced child maltreatment are at higher risk of pain, particularly when they also experienced post-traumatic stress as adolescents.
A randomized controlled trial of 5 daily sessions and continuous trial of 4 weekly sessions of repetitive transcranial magnetic stimulation for neuropathic pain
Authors: Hosomi Koichi , Sugiyama Kenji , Nakamura Yusaku , Shimokawa Toshio , Oshino Satoru , Goto Yuko , Mano Tomoo , Shimizu Takeshi , Yanagisawa Takufumi , Saitoh Youichi ,   for the TEN-P11-01 investigators
Published: October 2019

We conducted a multicenter, randomized, patient- and assessor-blinded, sham-controlled trial to investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) of the primary motor cortex (M1) in patients with neuropathic pain (NP). Patients were randomly assigned to receive 5 daily sessions of active or sham rTMS of M1 corresponding to the part of the body experiencing the worst pain (500 pulses per session at 5 Hz). Responders were invited to enroll in an open-label continuous trial involving 4 weekly sessions of active rTMS. The primary outcome was a mean decrease in a visual analogue scale of pain intensity (scaled 0-100 mm) measured daily during the daily sessions in an intention-to-treat population. Secondary outcomes were other pain scores, quality-of-life measures, and depression score. One hundred forty-four patients were assigned to the active or sham stimulation groups. The primary outcome, mean visual analogue scale decreases, was not significantly different (P = 0.58) between the active stimulation group (mean, 8.0) and the sham group (9.2) during the daily sessions. The secondary outcomes were not significantly different between 2 groups. The patients enrolled in the continuous weekly rTMS achieved more pain relief in the active stimulation group compared with the sham (P < 0.01). No serious adverse events were observed. Five daily sessions of rTMS with stimulus conditions used in this trial were ineffective in short-term pain relief in the whole study population with various NP. Long-term administration to the responders should be investigated for the clinical use of rTMS on NP in the future trials.
Key Determinants of the Value of Random Cervical Biopsy at Colposcopy
Authors: Pretorius Robert G. , Belinson Jerome L. , Burchette Raoul J. , Wu Ruifang , Qiao You-Lin
Published: October 2019

Objective

The aim of the study was to assess whether lower proportions of cervical intraepithelial neoplasia 2+ diagnosed by random biopsy are from lower cut points defining an abnormal colposcopic impression or obtaining only one random biopsy when colposcopic impression is normal.

Methods

We compared colposcopy experiences within Shanxi Province Cervical Cancer Screening Study (SPOCCS) (n = 1,383) and Shenzhen Cervical Cancer Screening Trial (SHENCCAST) (n = 631), which had instructive differences in the cut point defining an abnormal colposcopic impression.

Results

The proportion of CIN 2+ diagnosed by random biopsy in SPOCCS (35.0%, 141/403) was higher than SHENCCAST (18.4%, 35/190, p < .001). Quadrant-specific receiver operating characteristic curves for diagnosis of CIN 2+ by colposcopic impression in SPOCCS and SHENCCAST were similar; a lower cut point for an abnormal colposcopic impression in SHENCCAST resulted in lower proportion of CIN 2+ diagnosed by random biopsy. Normal colposcopic impression was found in 85.1% (120/141) of cases of CIN 2+ diagnosed by random biopsy in SPOCCS and in 57.1% (20/35) of such cases in SHENCCAST. Of CIN 2+ diagnosed by random cervical biopsy with normal colposcopic impression, one cervical quadrant was involved with CIN 2+ in 66.7% (80/120) of colposcopies in SPOCCS and 80% (16/20) of colposcopies in SHENCCAST.

Conclusions

Colposcopy series with higher proportions of CIN 2+ diagnosed by random biopsy likely have more stringent cut points defining an abnormal colposcopic impression and have more random biopsies when the colposcopic impression is normal. At colposcopy, we advise multiple biopsies of all acetowhite epithelium or multiple random biopsies to increase the sensitivity of colposcopy.
Distribution of High-Risk Human Papillomavirus Genotypes and Multiple Infections in Preneoplastic and Neoplastic Cervical Lesions of Unvaccinated Women: A Cross-sectional Study
Authors: Iacobone Anna Daniela , Bottari Fabio , Radice Davide , Preti Eleonora Petra , Franchi Dorella , Vidal Urbinati Ailyn Mariela , Boveri Sara , Passerini Rita , Sandri Maria Teresa
Published: October 2019

Objective

The aim of the study was to investigate the distribution of high-risk (HR) human papillomavirus (HPV) genotypes and the role of multiple infection in preneoplastic and neoplastic cervical lesions, according to histology, age, and the number of genotypes per infection.

Materials and Methods

Nine hundred eighty-eight women affected by known HPV-related cervical lesions and attending the European Institute of Oncology, Milan, Italy, from December 2006 to December 2014, were selected for a cross-sectional study. Prevalence of HPV genotypes was calculated by histology and the number of genotypes per infection. Univariate and multivariable cervical intraepithelial neoplasia (CIN) 2–3 versus CIN 1 risks were estimated by logistic regression models.

Results

Overall, HPV 16 (53.1%), HPV 31 (15.1%), and HPV 58 (6.4%) were the most frequent genotypes in precancerous lesions. At multivariable analysis, HPV 16 (p = .02), 18 (p = .013), and 56 (p = .01) were significantly associated to worsen histology, whereas HPV 39 (p = .03) and 45 (p = .03) were statistically correlated only to the increasing number of genotypes per infections. Human papillomavirus 33 was the only genotype significantly related to both the number of genotypes per infection (p = .005) and age (p = .03). Infections by HR-HPV (odds ratio [OR] = 9.48, 95% CI = 3.77–23.8, p < .001), HPV genotypes covered by current vaccines (OR = 6.28, 95% CI = 4.05–9.75, p < .001), single HPV genotype (OR = 8.13, 95% CI = 4.12–16.0, p < .001), as well as age (OR = 1.13, 95% CI = 1.07–1.19, p < .001) were significantly associated to higher risk of CIN 2–3.

Conclusions

The most of CIN 2+ lesions are sustained by HR-HPV genotypes, especially the ones covered by 9-valent vaccine; therefore, the widespread use of prophylactic HPV vaccines could significantly reduce the incidence of preneoplastic and neoplastic cervical lesions.
The Clinical Utility of the Vulvar Pain Assessment Questionnaire: A Pilot Study
Authors: Dargie Emma , Pukall Caroline F. , Goetsch Martha , Stenson Amy , Leclair Catherine
Published: October 2019

Objective

The aim of the study was to document treatment-seeking experiences of women with chronic vulvar pain, comfort communicating about pain, and test the clinical utility of the screening version of the Vulvar Pain Assessment Questionnaire, screening version (VPAQscreen).

Materials and Methods

Patients scheduled for an appointment with the Program in Vulvar Health at Oregon Health and Science University were invited to complete the VPAQscreen and answer descriptive questions about previous treatment-seeking experiences and communication with health care providers. Clinicians provided provisional diagnoses based on VPAQscreen summaries, final diagnoses based on gynecological examination, and commented on alignment with clinical observations. Patients gave feedback on the accuracy and helpfulness of the VPAQscreen summary, characteristics of the questions asked, and whether their comfort communicating increased.

Results

Participants reported previously seeing approximately 5 medical doctors and 2 other health care providers and perceived them as lacking knowledge of vulvar pain syndromes. Providers indicated that VPAQscreen summaries aligned with clinical presentations and suggested provisional diagnoses with more than 80% accuracy. Participants reported that VPAQscreen summaries were helpful and accurate in summarizing symptoms. Most reported that the number, range, and readability of VPAQscreen questions were good or excellent. More than half reported that completing the VPAQscreen increased comfort when speaking with their Oregon Health and Science University physician.

Conclusions

Patients with vulvar pain often endure a lengthy process of consulting multiple clinicians before securing care. The VPAQscreen was more than 80% accurate in predicting diagnosis at this specialty clinic and was useful in assisting patients with expressing symptoms. The applicability of the VPAQscreen in general practice is unknown, although it shows promise.
Effectiveness, cost-utility, and benefits of a multicomponent therapy to improve the quality of life of patients with fibromyalgia in primary care
Authors: Caballol Angelats Rosa , Gonçalves Alessandra Queiroga , Aguilar Martín Carina , Sancho Sol Maria Cinta , González Serra Gemma , Casajuana Marc , Carrasco-Querol Noèlia , Fernández-Sáez José , Dalmau Llorca Maria Rosa , Abellana Rosa , Berenguera Anna
Published: October 2019

Introduction:

Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS).

Methods and analysis:

A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l’Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. Analysis: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out.

Ethics and dissemination:

This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals.

Trial registration:

Clinical-Trials.gov: NCT04049006.
Immune-related adverse events in cancer patients treated with immune checkpoint inhibitors
Authors: Kaur Aneet , Doberstein Taylor , Amberker Rachana Ramesh , Garje Rohan , Field Elizabeth Hirak , Singh Namrata
Published: October 2019

Immune checkpoint inhibitors (ICIs) like cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA4) and programmed death cell protein 1 (anti-PD1) have revolutionized cancer treatment. As ICI use becomes widespread, more immune-related adverse events (irAE's) are being reported. Our aim was to investigate the frequency and nature of new irAE's as well as report the frequency of flare-ups of pre-existing autoimmune conditions occurring after ICI therapy.

We performed a retrospective chart review of all patients treated for cancer with anti-PD1 or anti-CTLA4 or combination therapy at our tertiary care center from January 2014 to April 2016. Demographic data, cancer type and stage, irAE's (new immune disorders and disease flares of pre-existing autoimmune disorders on ICI therapy), and drug treatment information were extracted.

We identified 220 patients treated with ICI therapy during the study period out of which 27% (60/220) developed irAE's. 11% in anti-CTLA4 group and 16% among anti-PD1 treated patients developed irAE's. IrAE's resulted in discontinuation of cancer therapy in 28% of those who developed irAE's. 21.4% had a flare of their autoimmune disease but only 1 required discontinuation of immunotherapy.

IrAE's are an important emerging clinical disease entity for specialists to be aware of. Our study shows that ICI's can be safely used in patients with pre-existing autoimmune conditions with close monitoring. However, there is still a large unmet need to have a better understanding of how to systematically evaluate and manage patients with irAE's as well as for identifying the predictors of irAE's.
Scrotoscopy exploration of testicular rupture
Authors: Wei Yongbao , Yang Jinrui , Hong Huaishan , Gao Yunliang , Wu Jinfeng , Wu Xiang , Zhang Ruochen , Lin Le , Li Tao , Yang Fengguang , Ye Liefu , Zhu Qingguo
Published: October 2019

To examine whether scrotoscopy could be used to diagnose testicular rupture (TR) with accuracy.

This retrospective study included all patients receiving scrotoscopy followed by immediate open exploration (OE) for suspected TR at two Chinese tertiary care centers between March 2014 and March 2018.

Fifteen patients suspected of having TR were included. TR was considered in 8 patients (8/15) via emergency scrotal ultrasound (ESU) examination. Of these 8 patients, 6 cases as well as 3 other cases, a total of 9 cases (9/15) were confirmed TR by scrotoscopy and OE; the remaining 6 patients (6/15) were found disease free. The presence/absence of TR was identified correctly with scrotoscopy in all 15 cases. The rupture size of the testicular tunica albuginea (TTA) varied from 0.5 to 2 cm. Only 3 cases (3/15) had scrotal wall edema and all quickly recovered. The testis was normal in size and blood flow at 6-month follow-up visit.

Scrotoscopy accurately diagnoses TR, and may avoid unnecessary OE, especially for the patients confirmed free of disease.
Cerebral venous sinus thrombosis in a young patient with ulcerative colitis
Authors: Deskur Anna , Zawada Iwona , Błogowski Wojciech , Starzyńska Teresa
Published: October 2019

Rationale:

Cerebral venous sinus thrombosis (CVST) represents one of the most alarming forms of hemostatic abnormalities that may occur in patients with inflammatory bowel diseases (IBDs).

Patient concerns:

Here we report a case of a 25-year-old male with ulcerative colitis, who developed such thromboembolic complication during flare of the disease. CVST in our patient was clinically manifested by headache and nausea.

Diagnosis:

Angio-magnetic resonance imaging scan of the head revealed segments of contrast filling defects/absence indicating right dural venous sinus thrombosis of the transverse sinus.

Intervention:

Immediate treatment with low-molecular-weight heparin has been introduced and led to full remission of symptoms and total recanalization of the thrombotic cerebral regions.

Outcomes:

Currently (over 2 years after diagnosis) the patient is in remission of the disease, and no further thromboembolic complications have been observed.

Lessons:

Our case study highlights the clinical difficulties and challenges associated with diagnosis and treatment of CVST, as well as presents the current state of knowledge about this complication among patients with IBDs. Physicians taking care of IBD patients should be aware of this alarming hemostatic abnormality.
Prediction of in vitro fertilization outcome at different antral follicle count thresholds combined with female age, female cause of infertility, and ovarian response in a prospective cohort of 8269 women
Authors: Liao ShuJie , Xiong Jianwu , Tu Haiting , Hu Cheng , Pan Wulin , Geng Yudi , Pan Wei , Lu Tingjuan , Jin Lei
Published: October 2019

Antral follicle count (AFC) has been widely investigated for the prediction of clinical pregnancy or live birth. This study discussed the effects of AFC quartile levels on pregnancy outcomes combined with female age, female cause of infertility, and ovarian response undergoing in vitro fertilization (IVF) treatment. At present, many research about AFC mainly discuss its impact on clinical practice at different thresholds, or the analyses of AFC with respect to assisted reproductive technology outcomes under using different ovarian stimulation protocols. Factors that include ovarian sensitivity index, female age, and infertility cause are all independent predictors of live birth undergoing IVF/intracytoplasmic sperm injection, while few researchers discussed influence of female-related factors for clinical outcomes in different AFC fields.

A total of 8269 infertile women who were stimulated with a long protocol with normal menstrual cycles were enrolled in the study, and patients were categorized into 4 groups based on AFC quartiles (1–8, 9–12, 13–17, and ≥18 antral follicles).

The clinical pregnancy rates increased in the 4 AFC groups (28.25% vs 35.38% vs 37.38% vs 40.13%), and there was a negative association between age and the 4 AFC groups. In addition, female cause of infertility like polycystic ovary syndrome, Tubal factor, and other causes had great significance on clinical outcome, and ovarian response in medium (9–16 oocytes retrieved) had the highest clinical pregnancy rate at AFC quartiles of 1 to 8, 9 to 12, 13 to 17, and ≥18 antral follicles.

This study concludes that the female-related parameters (female cause of infertility, female age, and ovarian response) combined with AFC can be useful to estimate the probability of clinical pregnancy.
Stratified and prognostic value of admission lactate and severity scores in patients with community-acquired pneumonia in emergency department
Authors: Zhou Haijiang , Lan Tianfei , Guo Shubin
Published: October 2019

Background:

Community-acquired pneumonia (CAP) is a potentially life-threatening condition. The aim of this study is to investigate the stratified and prognostic value of admission lactate and severity scores (confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure <90 mm Hg systolic and/or ≤60 mm Hg diastolic, and age ≥65 years [CURB65], pneumonia severity index [PSI], sequential organ failure assessment [SOFA], qSOFA) in patients with CAP in emergency department.

Methods:

Adult patients diagnosed with CAP admitted between January 2017 and January 2019 were enrolled and divided into severe CAP (SCAP) group and nonSCAP (NSCAP) group according to international guidelines, death group, and survival group according to 28-day prognosis. Predicting performance of parameters above was compared using receiver operating characteristic curves and logistic regression model. Cox proportional hazard regression model was used to identify variables independently associated with 28-day mortality.

Results:

A total of 350 patients with CAP were enrolled. About 196 patients were classified as SCAP and 74 patients died after a 28-day follow-up. The levels of CURB65, PSI, SOFA, qSOFA, and admission lactate were higher in the SCAP group and death group. SOFA showed advantage in predicting SCAP, while qSOFA is superior in predicting 28-day mortality. The combination of SOFA and admission lactate outperformed other combinations in predicting SCAP, and the combination of qSOFA and lactate showed highest superiority over other combinations in predicting 28-day mortality.

Conclusion:

The SOFA is a valuable predictor for SCAP and qSOFA is superior in predicting 28-day mortality. Combination of qSOFA and admission lactate can improve the predicting performance of single qSOFA.
Psychological effects of advanced care on patients received endoscopic gastric cancer resection
Authors: Cao Xiao-li , Wang Xin , Li Ping , Ju Wei
Published: October 2019

Background:

This study will systematically evaluate the psychological effects of advanced care (AC) on patients who received endoscopic gastric cancer resection (EGCR).

Methods:

This study will search the following databases of Cochrane Library, Pubmed, EMBASE, Web of Science, WANGFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the present with no language limitation. All randomized controlled trials on assessing the psychological effects of AC for patients with EGCR will be included.

Results:

This study will explore the psychological effects of AC on EGCR by assessing depression, anxiety, health-related quality of life, and adverse events.

Conclusion:

This study will summarize recent evidence for the psychological effects of AC on EGCR.

PROSPERO registration number:

PROSPERO CRD42019139868.
Determinants of serum concentration of first-line anti-tuberculosis drugs from China
Authors: Lei Qian , Wang Hao , Zhao Yuan , Dang Liyun , Zhu Changsheng , Lv Xiaohui , Wang Hui , Zhou Jun
Published: October 2019

Therapeutic drug monitoring has been employed in anti-tuberculosis (TB) drugs to assess optimal dose for maximum therapeutic effects and minimal toxicity. But the determinants of serum concentration need further evidences.

In a retrospective case–control study, clinical and laboratory data were collected from 717 in-patients with TB at Xi’an Chest Hospital, China. Two hours serum concentrations of isoniazid, rifampicin, pyrazinamide as well as ethambutol were obtained and analyzed by liquid chromatography-tandem mass spectrometry.

The month 2 culture conversion group had lower concentration of isoniazid, pyrazinamide, and ethambutol than month 1 group. Statistical analysis showed that serum concentrations of isoniazid, rifampicin, pyrazinamide, and ethambutol revealed a positive relationship with dose (mg/kg) (P < .001, P < .001, P < .001, and P = .003, respectively). Furthermore, isoniazid concentration was related to smoking (P = .009) and prior TB (P = .011), while rifampicin and pyrazinamide concentrations were correlated to sex (P = .004 and 0.025, respectively). Ethambutol concentration was associated with creatinine clearance (Ccr, P = .002).

It is necessary to optimize drug doses using therapeutic drug monitoring while considering the following determinants: weight, smoking status, prior TB, sex, and Ccr. Furthermore, low 2 hours serum concentrations can be associated with longer culture conversion.
Scedosporium spp lung infection in immunocompetent patients
Authors: Liu Wei , Feng Rui-zhi , Jiang Hong-li
Published: October 2019

Scedosporium genus as a significant emerging opportunist causes a broad spectrum of disease in not only immunosuppressed but also immunocompetent patients. The lung is one of the most commonly encountered sites of Scedosporium infection. Due to its very high levels of antifungal resistance, surgery has been recommended as an important part in the treatment of pulmonary Scedosporium spp infection, even in immunocompetent cases. However, whether lung surgery could help to reduce the risk of death in immunocompetent patients is not clear.

We retrospectively retrieved the records of pulmonary infections with Scedosporium species in immunocompetent patients through a comprehensive literature search. The association of surgery on all-cause mortality was explored using binary logistic regression (BLR). Receiver operating characteristic (ROC) curve analysis was carried out to evaluate the capability of the model.

The comprehensive searching strategy yielded 33 case reports and 3 case series in total, with 40 individual patients being included. The overall mortality was 12.50%. The fatality rate was 9.09% (2/22) in cases with surgery and 16.67% (3/18) in cases without surgery (odds ratio, 0.50; 95% confidence interval, 0.07–3.38; P = .48). Consistently, BLR analysis identified no statistical association between surgery and reduced mortality (odds ratio, 1.19; 95% confidence interval, 0.09–15.64; P = .89), after adjusting for age, gender, and antifungal chemotherapy. The area under the ROC curve was 0.88.

For immunocompetent patients with pulmonary Scedosporium spp infection, surgical therapy may not be associated with reduced mortality. Surgical excision could be considered but is not imperative in this group of patients.
Secondhand Smoke Exposure and Serum Trypsinogen in Cystic Fibrosis Carriers
Authors: Ellery Kate M. , Kopp Benjamin , Conwell Darwin L. , Gariepy Cheryl
Published: October 2019

Objective

The objective of this study was to determine if infants carrying 1 cystic fibrosis transmembrane receptor (CFTR) mutation demonstrate pancreatic inflammation in response to tobacco exposure.

Methods

Cystic fibrosis carrier infants aged 4 to 16 weeks were prospectively enrolled. Tobacco exposure was assessed by survey and maternal hair nicotine analysis. Serum immunoreactive trypsinogen (IRT) levels at birth and at the time of recruitment were analyzed relative to the presence or absence of tobacco exposure. The effect of the severity of the CFTR mutation carried by the infant on the tobacco-IRT relationship was also analyzed.

Results

Forty-eight infants completed the study. Newborn screen and follow-up IRT levels were not different between exposed infants (19 by hair analysis) and nonexposed infants (29 by hair analysis). Follow-up IRT levels were lower in infants with more severe CFTR mutations (P = 0.005). There was no difference in follow-up IRT based on CFTR mutation severity in exposed infants. Nonexposed infants with milder CFTR mutations had higher median IRT values on follow-up testing than those with more severe CFTR mutations (P < 0.05).

Conclusions

The pancreas of cystic fibrosis carrier infants is affected by tobacco exposure, and those carrying less severe CFTR mutations may be more susceptible to tobacco effects.
Is Centralization Needed for Patients Undergoing Distal Pancreatectomy?
Authors: Roussel Edouard , Clément Guillaume , Lenne Xavier , Pruvot François-René , Schwarz Lilian , Theis Didier , Truant Stéphanie , El Amrani Mehdi
Published: October 2019

Objective

The centralization of complex surgical procedures is associated with better postoperative outcomes. However, little is known about the impact of hospital volume on the outcome after distal pancreatectomy.

Methods

Using the French national hospital discharge database, we identified all patients having undergone distal pancreatectomy in France between 2012 and 2015. A spline model was applied to determine the caseload cut-off in annual distal pancreatectomy that influenced 90-day postoperative mortality.

Results

A total of 3314 patients were identified. Use of a spline model did not reveal a cut-off in the annual distal pancreatectomy caseload. By taking the median number of distal pancreatectomy (n = 5) and the third quartile (n = 15), we stratified centers into low, intermediate, and high hospital volume groups. The overall postoperative mortality rate was 3.0% and did not differ significantly between these groups. In a multivariable analysis, age, Charlson comorbidity score, septic complications, hemorrhage, shock, and reoperation were independently associated with a greater overall risk of death. However, hospital volume had no impact on mortality after distal pancreatectomy (odds ratio, 0.954; 95% confidence interval, 0.552–1.651, P = 0.867).

Conclusions

Hospital volume does not seem to influence mortality after distal pancreatectomy in France, and centralization may not necessarily improve outcomes.
Assessing Variability in Reading Performance with the New Greek Standardized Reading Speed Texts (IReST)
Authors: Gleni Angeliki , Ktistakis Emmanouil , Tsilimbaris Miltiadis K. , Simos Panagiotis , Trauzettel-Klosinski Susanne , Plainis Sotiris
Published: October 2019

SIGNIFICANCE

This article evaluates the standardized Greek version of the International Reading Speed Texts (IReST) set, which enriches interlanguage comparisons and international clinical studies of reading performance. Moreover, it investigates how specific textual and subject-related characteristics modulate the variability of reading speed across texts and readers.

PURPOSE

The purpose of this study was to develop a standardized Greek version of the IReST set and investigate how specific textual and subject-related factors modulate the variability of reading speed across texts and readers.

METHODS

The English IReST texts were translated to Greek and matched for length, content, and linguistic difficulty. The Greek IReSTs were presented at a distance of 40 cm and size of 1 M to assess reading speeds of 25 normally sighted native speakers (age range, 18 to 35 years). The participants read the texts aloud while reading time was measured by stopwatch. Reading performance included measurement of reading speed in three units of analysis. Reading efficiency was assessed using a word-level oral reading task. Statistical analysis included evaluation of subject- and text-related variability, as well as correlations between reading speed and specific textual and subject-related factors.

RESULTS

The average reading speed between texts was 208 ± 24 words/min, 450 ± 24 syllables/min, and 1049 ± 105 characters/min. Differences between readers accounted for the 76.6%, whereas differences across texts accounted for the 23.4% of the total variability of reading speed. Word length (in syllables per word) and median word frequency showed a statistically significant contribution to the variability of reading speed (r = 0.95 and 0.70, respectively). Reading speed was also statistically correlated with word reading efficiency (r = 0.68).

CONCLUSIONS

The addition of the Greek version in the IReST language pack is expected to be a valuable tool for clinical practice and research, enriching interlanguage comparisons and international studies of reading performance.
Minimally Invasive Technique to Reduce the Isolated Anterior Wall Fracture of the Frontal Sinus
Authors: Jin Hong-Ryul , Shim Woo Sub , Jung Hahn Jin
Published: October 2019

Conventional open reduction and internal fixation of frontal sinus anterior wall fractures are associated with risks of visible scarring and limited access to the nasofrontal duct. The goal of this study was to report the minimally invasive surgical techniques and their results in cases with frontal sinus anterior wall fractures. A retrospective study was performed on 20 consecutive cases of isolated anterior wall fractures of the frontal sinus between July, 2008 and February, 2017. Causes of injury, interval between the injury and operation, and operation time were reviewed. The fractures were reduced using the minimally invasive techniques of endoscopic endonasal reduction or reduction through a small trephination. Anatomical and aesthetic outcomes were evaluated, and postoperative complications were reviewed. The fractures were reduced with endoscopic endonasal techniques in 11 patients and through a small trephination with a minimal incision in the forehead in 9 patients. The fractures were successfully reduced in all cases. The mean follow-up period was 21.2 months, and no postoperative complications were observed. For isolated anterior wall fractures of the frontal sinus, minimally invasive techniques, such as endonasal endoscopic reduction or reduction through a small trephination, are safe and effective options.
Advancement Flap Using Excess Skin for Upper Eyelid Full-Thickness Defects
Authors: Ito Riri , Maeda Taku , Yamamoto Yuhei , Funayama Emi , Murao Naoki , Osawa Masayuki , Ishikawa Kosuke , Ikeda Masaki , Hayashi Toshihiko
Published: October 2019

Reconstruction of upper eyelid defects should aim for a moveable lid with perfect corneal protection and good aesthetic quality. Numerous procedures to reconstruct large upper eyelid defects have been reported, but these methods require 2-stage procedures. A new method for reconstructing full-thickness upper eyelid defects after tumor excision in a single stage was presented in this study. The preferred technique uses excess skin as an advancement flap together with an ear cartilage graft for the lining. Reconstruction was performed with an advancement flap using excess skin and ear cartilage for full-thickness defects after upper eyelid tumor excision. The rectangular flap was outlined on the excess skin of the upper eyelid. After tumor resection of the full-thickness defect, the ear cartilage was sutured to the remaining tarsus. The residual levator aponeurosis and posterior lamellar were connected to the transplanted ear cartilage. The outer layer was reconstructed with an advancement rectangular flap. The authors performed this technique for 4 patients, aged 62 to 88 years, for upper eyelid reconstruction. Good functional and aesthetic results were achieved for all patients. Our method involves a single-stage reconstruction, which is simpler and less invasive than other techniques.
Epidemiology and predictors of repeat positive chlamydia tests: The Brant County cohort, Ontario, Canada
Authors: Santos Jenny Pereira , Babayan Alexey , Huang Miao Jing , Jolly Ann
Published: October 2019

Objectives

Repeat positive tests for chlamydia (CR) may help explain current high rates of chlamydia despite years of screening, partner notification and treatment to reduce sequelae. We wanted to determine the numbers of CRs over time as a proportion of all chlamydia cases, and define the differences in demographic, clinical, behavioural, and public health management indicators, between individuals who have experienced a CR and individuals who experienced a single infection in Brant County, Ontario.

Methods

A retrospective cohort was developed using notifiable disease data extracted from the integrated public health system. Cases were laboratory confirmed chlamydia and gonorrhea infections in Brant County between January 1st, 2006 and December 31st, 2015. During the study period, 3,499 chlamydia cases and 475 gonorrhea cases were diagnosed. The total number of individuals with chlamydia in that period was 3,060, including 157 coinfections with gonorrhea. Differences between those with reinfection and those with single infection were evaluated using univariate and multivariate (Cox proportional hazards model) methods.

Results

Four hundred and ninety-nine (16.30%) individuals experienced CR 28 days from initial infection; of which 328 (65.73%) occurred within 2 years and 211 (42.28%) within 1 year. The median time to CR was 276 days, consistent with existing Canadian literature. Independent risk factors for CR included being male, 25 years old or younger, and not receiving recommended treatment for initial and/or subsequent infection.

Conclusions

These findings suggest that inadequate treatment play a significant role in CR, while accounting for young age and male gender, likely due to untreated sex partners.

Key Messages

Sixteen percent of people experienced a second positive chlamydia test more than 28 days after their initial positive test in a cohort of 3,499 patients

Those who had a second positive test were more likely to be male, younger than 25 and had not received recommended antimicrobials

Confirmation of any kind of partner notification was missing in 88% of records
Incidence of Respiratory distress and its predictors among neonates admitted at neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia, 2018
Authors: Asmare Yared , Mekonen Hussien , Yirga Tadesse , Habtewold Tesfa Dejenie , Endalamaw Aklilu , Shibabaw Wondimeneh
Published: October 2019

Background

Although Respiratory distress is one of the major causes of neonatal morbidity and mortality throughout the globe, it is a serious concern more of in resource limited nations, like Ethiopia. Besides, few studies are available in developing countries. Data from different settings is needed to tackle it. Therefore, we intended to assess the incidence and predictors of respiratory distress among neonates who were admitted in neonatal Intensive care unit (NICU) at Black Lion Specialized Hospital, Ethiopia.

Methods

Institution-based retrospective follow-up study was conducted among 571 neonates from January 2013 to March 2018. Data were collected by reviewing patients chart using systematic sampling technique with a pretested checklist; entered using Epi-data 4.2 and analyzed with STATA 14. Median time, Kaplan-Meier survival estimation curve and Log-rank test were computed. Bivariable and multivariable Gompertz parametric hazards models were fitted to detect the determinant of respiratory distress. Hazard ratio with a 95% confidence interval was calculated. Variables with reported p-values < 0.05 were considered statistically significant.

Results

The proportion of respiratory distress among of neonates admitted in Black Lion specialized hospital neonatal intensive care unit was 42.9 % (95%CI: 39.3-46.1%) with incidence of 8.1/100(95%CI: 7.3, 8.9)).Being male [AHR=2.4 (95%CI:1.1,3.1)], neonates born via caesarean section [AHR:1,.9((95%CI:1.6,2.3)], home delivery [AHR :2.9 (95%CI:1.5, 5,2)], maternal diabetes mellitus [AHR 2.3(95%CI: 1.4, 3.6)], preterm birth [AHR:2.9(95%CI:1.6, 5.1)] and APGAR score less than 7 [AHR: 3.1 (95%CI:1.8,5.0)] were found to be significant predictors of respiratory distress.

Conclusions

The incidence of respiratory distress among neonates was found to be high. Those neonates delivered at home, delivered through caesarean section, preterm neonates, whose APGAR score<7, and born from diabetic mothers were more likely to develop respiratory distress. All concerned bodies should work on preventing RD and give special attention for multifactorial cause of it. Thus; it is indicated to promote health institutional delivery more. Besides, a need to establish and/or strengthen strategies to prevent the occurrence of respiratory distress among babies with low APGAR score, preterm babies, born from diabetes mellitus mothers, and delivered through caesarean section.
Not all animals are equal - farm living and allergy in Upper Bavaria
Authors: Wjst Matthias
Published: October 2019

Background

A lower allergy and asthma prevalence in farm children has been described three decades ago in Switzerland.

Objective

After years of research into bacterial exposure at farms, the origin of the farm effect is still unknown. We now hypothesize, that there is no such an effect in large industrial cattle farms with slatted floors indoors but in small farms only where animals are grazing outdoors and are having a higher endoparasite load.

Methods

We re-analyze an earlier epidemiological study by record-linkage to later agricultural surveys. The Asthma and Allergy Study in 1989/90 was a cross-sectional study of 1714 ten year old children in 63 villages covering ten different districts of Upper Bavaria. The farm effect is defined here as the association of number of cows per villager on lifetime prevalence of allergic rhinitis prevalence in the children of this village.

Results

The farm effect is restricted to small villages only. Furthermore, districts with higher Fasciola infection rates of cows, show a significant stronger farm effect than districts with lower infection rates.

Conclusions

The results warrant further research into human immune response to endoparasites in livestock.