bluuebunny/crossref_metadata_2025 huggingface dataset:
Semiclosure wound therapy plus negative pressure wound therapy for an older patient with grade 4 diabetic foot with concomitant vascular occlusion
Authors: Yan Yafeng , Li Wenfeng , Song Yan , Yin Pei , He Zongze , Gong Yanping , Peng Lili
Published: November 2019

Rationale:

Grade 4 diabetic foot (DF) is a severe infection that causes bone destruction, osteomyelitis, and osteoarticular damage, which, in turn, can lead to serious dry or wet gangrene, or amputation. DF is extremely difficult to treat.

Patient concerns:

A 71-year-old female patient with long-term diabetes complicated with uremia, who undergoes regular hemodialysis 2 to 3 times per week, was admitted with grade 4 DF with Pseudomonas aeruginosa infection, and concomitant vascular occlusion of the lower extremities. The patient had a concurrent nutrition and electrolyte disorder.

Diagnoses:

The patient was diagnosed with type 2 diabetes, grade 4 DF, postamputation of the 2nd toe, vascular occlusion of the lower extremities, atherosclerosis, uremia, hypoproteinemia, and electrolyte disturbances.

Interventions:

Treatment with antibiotics and comprehensive measures aimed at improving nutrition and microcirculation, controlling blood glucose, as well as balancing electrolytes were performed to ameliorate the general conditions. Nibbled debridement was used to remove devitalized tissues each time to maintain as much vital cells as possible. Open therapy was used for necrotic tissues, and dressings therapy was used simultaneously for the infected lesion. This combined treatment, involving open therapy with dressing, is referred to as “semiclosure wound therapy.” Negative pressure wound therapy (NPWT) was used after a fistula formed.

Outcomes:

During the treatment procedure, the gangrene 3rd toe was spontaneously shed; the necrotic 1st toe was removed by surgery. The wound gradually healed after 3 months of open therapy combined with dressing. High location amputation was avoided.

Lessons:

Semiclosure, which constitutes open therapy combined with the use of dressings, plus NPWT can preserve vital skin cells in the wound and control the aggravation of the infection. It is an effective and novel measure that prevents DF amputation in old patient and promotes wound union.
Proton pump inhibitors and hypomagnesemia
Authors: Srinutta Thawin , Chewcharat Api , Takkavatakarn Kullaya , Praditpornsilpa Kearkiat , Eiam-Ong Somchai , Jaber Bertrand L. , Susantitaphong Paweena
Published: November 2019

Background:

Previous meta-analyses have suggested that there might be an association between the use of proton pump inhibitors (PPIs) and the development of hypomagnesemia, although the conclusions were no definitive.

Methods:

To provide an update on this topic, we performed a meta-analysis of all observational studies that examined the association between the use of PPIs and the development of hypomagnesemia. A literature search was conducted in MEDLINE, Scopus and Cochrane Central Register of Controlled Trials (January 1970 to June 2018) to identify observational studies that examined the association between the use of PPIs and the incidence and prevalence of hypomagnesemia.

Study eligibility criteria:

In the absence of randomized controlled trials, we focused primarily on observational studies, including cross-sectional, case-control, retrospective, and prospective cohort studies. There was no limitation on sample size or study duration. Random-effect models meta-analyses were used to compute pooled unadjusted and adjusted odds ratios (ORs) for binary variables.

Results:

Sixteen observational studies were identified, including 13 cross-sectional studies, 2 case-control studies, and 1 cohort study, with a total of 131,507 patients. The pooled percentage of PPI users was 43.6% (95% confidence interval [CI] 25.0%, 64.0%). Among PPI users, 19.4% (95% CI 13.8%, 26.5%) had hypomagnesemia compared to 13.5% (95% CI 7.9%, 22.2%) among nonusers. By meta-analysis, PPI use was significantly associated with hypomagnesemia, with a pooled unadjusted OR of 1.83 (95% CI 1.26, 2.67; P = .002) and a pooled adjusted OR of 1.71 (95% CI 1.33, 2.19; P < .001). In subgroup analyses, high-dose PPI use was associated with higher odds for hypomagnesemia relative to low-dose PPI use (pooled adjusted OR 2.13; 95% CI 1.26, 3.59; P = .005).

Conclusion:

Our findings are in support of the results of the previous meta-analyses. Furthermore, we found a dose-response between the PPI use and development of hypomagnesemia.
Medicated thread moxibustion for alopecia areata
Authors: Zhang Yi-Mei , Liu Cui-Hong , Wang Yong-Cheng , Teng Hong-Li , Meng Xian-Liang , Han Xing-Jun
Published: November 2019

Rationale:

According to the literature reports and clinical studies on alopecia areata (AA) from 2008 to 2018, most clinical treatments have been oral drugs and external ointments. At present, systemic immunosuppressive therapy has been widely used in AA, but there are various side effects such as elevated liver enzymes, gastrointestinal discomfort, poor drug compliance, and repeated illness. We present a case report describing a traditional medicine treatment for AA that uses an ethnic therapy of Zhuang medicine, a kind of Traditional Chinese Medicine, namely, medicated thread moxibustion.

Patient concerns:

A 36-year-old man endured AA after going through a family misfortune. Half a year ago, his father passed away suddenly. Since then, he suffered continuous anguish, alcoholism and hair loss, especially in the past 2 months. A coin-shaped area of hair loss began to appear at the top of his head and gradually expanded to the surrounding region.

Diagnoses:

A diagnosis of AA was made in the dermatology department of a local hospital.

Interventions:

The patient was treated with the medicated thread moxibustion method of Traditional Zhuang Medicine at the Kuihua (special points of Zhuang medicine), Zusanli (ST 36), Xuehai (SP 10), Baihui (DU 20), and Taichong (LR 3) points every other day for 4 weeks.

Outcomes:

The area of hair loss showed slight improvement after 1 week of treatment. Only just a sprinkling of wooly hairs, whose color and thickness were similar to those of fine facial hairs, began to emerge sporadically from the follicles; they could be seen only in a bright light. When the patient saw the obvious curative effect, we continued the treatment for 2 weeks with the patient's consent. Three weeks later, the patchy AA area was covered with small cotton-like hairs of different lengths and uneven colors.

Lessons:

The medicated thread moxibustion method of Zhuang medicine can be an effective alternative treatment in patients with AA.
Use of MRI in the diagnosis and prognosis of acute necrotizing encephalopathy in a Chinese teenager
Authors: Li Hua , Sun Caihong , Chi Shaohua , Wang Yan , Wu Lin , Qin Xia
Published: November 2019

Rationale:

Acute necrotizing encephalopathy (ANE) is a rapidly progressing disease associated with frequent neurologic sequelae and has poor prognosis. Currently, the diagnosis and treatment of ANE rely on neuroradiologic findings and offering supportive care. Here, we report the successful treatment of a teenager diagnosed with ANE using combination of high-dose methylprednisolone and oseltamivir.

Patient concerns:

The patient, a 15-year-old female, presented with impaired consciousness and seizures secondary to acute upper respiratory tract infection. A series of brain magnetic resonance images (MRIs) were obtained toward establishing a possible diagnosis.

Diagnosis:

Based on the history of presenting illness and subsequent brain MRI scans, the patient was diagnosed to be suffering from ANE.

Interventions:

Following the diagnosis, the patient was placed on therapy comprising of high-dose methylprednisolone and oseltamivir.

Outcomes:

After treatment with methylprednisolone and oseltamivir for 15 days, the patient recovered nearly completely from ANE as confirmed by subsequent brain MRI scans. No complications or other emerging clinical symptoms were noted for the duration of follow-up that lasted 6 months.

Lessons:

Contrary to common reports, ANE can occur beyond pediatric populations and its treatment should not be restricted to supportive care. Our case suggests that the use of high-dose corticosteroids and oseltamivir leads to promising prognosis.
Rituximab in treatment of anti-GBM antibody glomerulonephritis
Authors: Uematsu-Uchida Mayu , Ohira Takehiro , Tomita Shigeki , Satonaka Hiroshi , Tojo Akihiro , Ishimitsu Toshihiko
Published: November 2019

Rationale:

Anti-glomerular basement membrane (GBM) disease is a T cell-mediated disease that has a poor prognosis with conventional therapy. We tested rituximab as a primary therapy to reduce anti-GBM antibody produced by B cells.

Patient concerns:

A 53-year old woman with complaints of a fever, headache and abdominal discomfort showed renal failure with elevated anti-GBM antibody, and renal biopsy revealed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) 1 deposition along GBM.

Diagnoses:

The patient's plasma contained autoantibodies against Goodpasture antigen, which is the NC domain of collagen IVα3, and CD4-positive helper T cells were found surrounding crescent glomeruli with the coexistence CD20-positive B cells.

Interventions:

Rituximab with steroid and plasma exchange.

Outcomes:

The levels of autoantibody for Goodpasture antigen were reduced, and the patient was able to temporarily withdraw from hemodialysis.

Lessons:

B cell depletion with rituximab is effective as an initial therapy for anti-GBM disease.
A comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula
Authors: Gu Chao , Wang Yu , Lai Lixia , Han Weiwei , Li Jiansheng , Xing Haichang , Huo Yongjun , Li Chuanting , Bai Keyun
Published: November 2019

To explore a comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula to evaluate its morphology changes.

Forty-six patients with anal fistula were enrolled. Each patient acquired a 3.0T magnetic resonance imaging (MRI) routine sequence, diffusion-weighted imaging (DWI) sequence and fat suppression T1 weighted imaging (FS T1WI) contrast enhancement (CE) scanning. To record the morphology performances of the internal orifice and the fistulas on the transverse images of fat suppression T2 weighted imaging (FS T2WI), DWI, FS T2WI combined with DWI, FS T1WI Gd-CE, with the standard of the surgical pathology results. Two observers evaluated images in consensus. The conspicuity and the diagnostic performance rate were compared between the 4 imaging data sets.

The consistencies of interobservers about the conspicuity scores and the diagnostic performance rates of the internal orifice and the fistula were good. The conspicuity of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The diagnostic performance rate of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The conspicuity of the fistula was higher for the set of FS T2WI+DWI and FS T1WI+CE than FS T2WI or DWI. There were no significantly differences between the 4 sets of FS T2WI, DWI, FS T2WI+DWI, and FS T1WI+CE in the diagnostic performance rate of the fistula.

The set of FS T2WI combined with DWI was comparable to FS T1WI CE in evaluation of anal fistula morphology changes.
The effect of contact needle therapy on fatigue in patients with cancer in palliative care
Authors: Ogawa-Ochiai Keiko , Yoshimura Kenichi , Takebe Takae , Iwahashi Mako , Shirai Akiko , Tsuda Masaki , Ogawa Masao , Ishikawa Hideki
Published: November 2019

Introduction:

Almost all patients with end-of-life cancer experience cancer-related fatigue; however, there are only a few known effective coping methods.

Objectives

: We will conduct a prospective, multi-center, single-blinded randomized controlled study to evaluate the efficacy of acupuncture for cancer-related fatigue in patients with end-of-life cancer.

Methods:

We will enroll 120 patients with cancer hospitalized in a palliative care unit or receiving consultation from a palliative care team in four hospitals. We will add acupuncture treatment; specifically, contact needle therapy (CNT), consisting of an intervention per week period to the usual care. The primary outcome measure will be the Cancer Fatigue Scale (CFS) score while the secondary outcome measures will be the Numerical Rating Scale (NRS) score for fatigue, pain, and salivary amylase levels.

Conclusion:

We will evaluate the possibility of using acupuncture therapy, that is, CNT, in relieving fatigue sensation in patients with advanced cancer.

Trial registration: UMIN000028304, registered on July 21st, 2017; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000032401
Risk factors and antimicrobial resistance profiles of Pseudomonas putida infection in Central China, 2010–2017
Authors: Tan Genmei , Xi Yang , Yuan Peihong , Sun Ziyong , Yang Daofeng
Published: November 2019

The aim of this study was to analyze the risk factors, clinical features, and antimicrobial resistance of Pseudomonas putida (P putida) isolated from Tongji Hospital in Wuhan, China.

The data of 44 patients with P putida infections were retrospectively reviewed in this study. All cases of P putida strains were detected by the clinical laboratory of Tongji Hospital in the period of January 2010 to December 2017. Antimicrobial susceptibility testing was conducted using Kirby-Bauer method.

Forty-four effective strains of P putida were isolated, including 32 inpatients and 12 outpatients. The 32 inpatients cases were obtained from various departments, which were urosurgery wards (n = 5, 15.6%), pediatrics wards (n = 4, 12.5%), hepatic surgery wards (n = 4, 12.5%), among others. The isolates had been discovered from urine specimens (28.2%), blood specimens (21.9%), sputum specimens (12.5%), and so on. Twenty-five patients had histories of catheterization before the isolation of P putida. Twenty-four patients were in immunocompromised states, 5 patients had undergone surgery, catheterization and were taking immunosuppressive therapy simultaneously. Polymicrobial infections were found in some P putida cases, especially Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Escherichia coli. All the patients had treated by antimicrobial before culture. Multi-drug-resistant strains were detected in 75% of P putida isolates. The P putida strains were resistant to trimethoprim/sulfamethoxazole (97.7%), aztreonam (88.6%), minocyline (74.3%), ticarcillin/clavulanic acid (72.7%), and sensitive to amikacin (86.4%), imipenem (62.8%), gentamicin (56.8%).

Catheterization or other invasive procedures, immunocompromised states, and underlying diseases increased the risks of P putida infections. Moreover, the P putida strains were highly resistant to trimethoprim/sulfamethoxazole, aztreonam, minocyline, ticarcillin/clavulanic acid.
Efficacy of Shegan Mahuang Decoction for asthma
Authors: Zhao Yuhua , Pang Xiaoping
Published: November 2019

Background:

Shegan Mahuang Decoction (SMD) was used widely for treatment of asthma in China; however, the clinical effect of SMD on asthma was not well concluded.

Methods:

Seven electronic databases (Medline, Cochrane library, EMBASE database, Chinese National Knowledge Infrastructure, Wanfang database, Chongqing VIP database, and Chinese Biomedicine database) will be searched for randomized controlled trials which meet the eligible criteria. Two reviewers will select studies and extract data independently. Risk of bias will be evaluated using modified Jadad score. Data synthesis will be carried out using RevMan 5.3. Sensitivity analysis and publication bias will also be investigated.

Results:

This systematic review and meta-analysis will review and synthesis current clinical evidence of SMD for the treatment of asthma.

Conclusion:

This systematic review and meta-analysis will provide high quality evidence of SMD for the treatment of asthma.

Registration:

PROSPERO CRD42019141810.
Kambin triangle approach in percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures
Authors: Wang Ye-Feng , Shen Jun , Li Suo-Yuan , Yu Xiao , Zou Tian-Ming
Published: November 2019

The aim of this study was to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) in Kambin triangle approach for the treatment of osteoporotic vertebral compression fractures (OVCFs).

Between November 2017 and September 2018, 109 patients (144 vertebral bodies) with OVCFs, with a mean age of 76.7 ± 9.9 years (55–96 years), underwent PVP in Kambin triangle approach. The time of operation, the volume of bone cement, the incidence of complication, the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score, the position of puncture needles, and the spread of polymethylmethacrylate (PMMA) in vertebral body (VB) were recorded.

All patients had been completed the operation successfully and were followed up 9.1 ± 2.9 months. The average operation time of each VB was 24.0 ± 3.5 minutes. The average volume of cement was 4.8 ± 0.6 ml. The mean VAS scores were 8.4 ± 0.7 preoperatively, 1.6 ± 0.6 at the first day postoperatively, and 1.2 ± 0.6 at the last follow-up. The mean ODI scores were 70.97 ± 7.73 preoperatively, 27.99 ± 4.12 at the first day postoperatively, and 19.65 ± 3.49 at the last follow-up. The position of puncture needles in the VB was: 119 vertebral puncture needles reached the midline, 15 were close to the midline, and 10 exceeded the midline. The spread of PMMA in the VB was: type 1 in 81 levels (56.3%), type 2 in 37 (25.7%), type 3 in 18 (12.5%), type 5 in 8 (5.5%), and no case in type 4. One case developed pneumothorax after operation. No other complications (hematoma, cement embolism, spinal cord, and nerve injury) occurred.

Kambin triangle approach in PVP, which can deliver the puncture needle to the midline of VB easily and with excellent cement distribution, is a safe and effective method.
Distinct patterns of short-chain fatty acids during flare in patients with ulcerative colitis under treatment with mesalamine or a herbal combination of myrrh, chamomile flowers, and coffee charcoal: secondary analysis of a randomized controlled trial
Authors: Langhorst Jost , Koch Anna K. , Voiss Petra , Dobos Gustav J. , Rueffer Andreas
Published: November 2019

Objectives:

Short-chain fatty acids are involved in the regulation of the gut immune system. In ulcerative colitis, short-chain fatty acids are often reduced, especially during flare. This study evaluated exploratively the pattern of butyrate and total short-chain fatty acids in patients with ulcerative colitis during flare treated either with mesalamine or a herbal preparation consisting of myrrh, chamomile flowers, and coffee charcoal which showed promising results in maintaining remission in a randomized double-blind, double-dummy, controlled clinical trial (EudraCT-Number 2007-007928-18).

Methods:

Patients were treated with the herbal preparation or mesalamine. Clinical activity was monitored by Clinical Colitis Activity Index. Using gas chromatography, we analyzed fecal samples of 38 patients who experienced a flare during treatment.

Results:

Paired t-test showed a significant decline of total short-chain fatty acids [M before = 66.12, SD = 39.59; M after = 29.83, SD = 15.05; 95% bootstrap confidence interval (20.53–55.30); P = 0.01) and of butyrate [M before 11.35, SD = 7.56; M after = 6.50, SD = 3.55; 95% bootstrap confidence interval (2.06–8.11); P = 0.02] in the event of a flare for patients treated with mesalamine but not for patients treated with the herbal preparation.

Conclusion:

Patients who received the herbal preparation did not show a significant decline of total short-chain fatty acids in the event of a flare. Since a decline of short-chain fatty acids might lead to unfavorable health impairments, a combination of the two treatments should be further investigated.
Dynamic prediction of liver cirrhosis risk in chronic hepatitis B patients using longitudinal clinical data
Authors: Wang Ying , Li Xiang-Yong , Wu Li-Li , Zheng Xiao-Yan , Deng Yu , Li Meng-Jie , You Xu , Chong Yu-Tian , Hao Yuan-Tao
Published: November 2019

Objectives:

In longitudinal studies, serum biomarkers are often measured longitudinally which is valuable to predict the risk of disease progression. Previous risk prediction models for liver cirrhosis restrict data to baseline or baseline and a single follow-up time point, which failed to incorporate the time-dependent marker information. The aim of this study is to develop risk model in patients with chronic hepatitis B for dynamic prediction of cirrhosis by incorporating longitudinal clinical data.

Methods:

Data from the hospital-based retrospective cohort at the Third Affiliated Hospital of Sun Yat-sen University, from 2004 to 2016, were analyzed. Using the multilevel logistic regression model, the time-dependent marker information and individual characteristics were taken as input, and the risk of at different time as the output.

Results:

At the end of follow-up, 8.8% of patients progressed to cirrhosis, the average estimate values of hepatitis B virus DNA and alanine aminotransferase demonstrated a downward trend, the aspartate aminotransferase/alanine aminotransferase ratio showed a flat trend overall. The important predictors were as follows: age, oral antiviral treatment, hepatitis B virus DNA. This risk prediction model had an area under the receiver operator characteristic curve of 0.835 (95% confidence interval: 0.772–0.899) and 0.809 (95% confidence interval: 0.708–0.910) in the derivation and validation sets, respectively.

Conclusion:

Longitudinal prediction model can be used for dynamic prediction of disease progression and identify changing high-risk patients.
Retrieval and re-evaluation of previously diagnosed chronic hepatitis C infections lost to medical follow-up in the Netherlands
Authors: Heil Jeanne , Soufidi Khalida , Stals Frans , Frantzen Hans , Robroek-Schaecken Astrid , Bakker C. Minke , van Nunen Annick B. , Dukers-Muijrers Nicole H.T.M. , Hoebe Christian J.P.A.
Published: November 2019

Objectives

Many individuals previously diagnosed with chronic hepatitis C virus (HCV) infection are likely to be lost to medical follow-up and, therefore, remain untreated despite new highly effective drug treatment, direct acting antivirals. We aim to identify and retrieve these chronic HCV-infected individuals to re-evaluate them and offer treatment.

Methods

Possible chronic HCV infections were identified from test results of the medical microbiological laboratory, notifications to the public health service, and the hospital registries over the past 15 years were checked in South Limburg, the Netherlands. Individuals were contacted based on the physician–patient relationship of the gastroenterologist or microbiologist (retrieval). Individuals were informed about the new treatment options, offered an HCV-RNA test, and if still positive, referred to the gastroenterologist for treatment (re-evaluation).

Results

In total, 689 individuals with a positive anti-HCV test in the past were identified, 308 (45%) were eligible for retrieval, 90 (29%) of them were retrieved, 34 (38%) of those retrieved were re-evaluated, 19 (56%) of those tested were HCV-RNA positive, and 12 (63%) of these individuals were offered treatment.

Conclusion

During every step of the retrieval chain, many patients were lost. Nevertheless, with substantial effort, we were able to identify, retrieve, and positively re-evaluate a limited number of individuals with a possible chronic HCV infection who were lost to medical follow-up (19 patients). With this case-finding approach, we were able to prevent potential severe complications in these patients and contribute to a small step in the eradication of HCV in the Netherlands.
Palliative Care in Heart Failure: A Public Health Emergency
Authors: Mosoiu Daniela , Rogozea Liliana , Landon Alison , Bisoc Alina , Tint Diana
Published: November 2019

Background:

Palliative care (PC) is the holistic care of patients with life-limiting illnesses focused on relief of suffering and maximizing quality of life for patients and their families. Patients with heart failure (HF) are the largest group eligible for PC services, but only a small percentage of them receive PC.

Areas of Uncertainty:

The optimal content and method of delivery of PC interventions to HF patients in resource-limited countries remain unknown. The integration of PC into existing HF disease management continues to be a challenge.

Data Sources:

PUBMED was searched to identify articles on the topic published in the last 5 years (2014–April 2019). One hundred thirty-six articles were identified—14 articles out of were included in the revision.

Therapeutic Advances:

Research concerning PC in HF is still scarce and comes predominantly from developed countries. PC in HF improves patients' and caregivers' outcomes in terms of dyspnea, sleep, depression, communication, coping, and care-giving burden. Specialized home-based PC services have a positive impact on patients' physical and emotional wellbeing while decreasing utilization of medical services. Fatigue, dyspnea, and pain are frequent symptoms. Evidence concerning use of opioids for dyspnea is increasing. Family caregivers offer a considerable amount of care during the disease trajectory. There is often incongruence between the carer's and the patient's wishes in terms of treatment decisions and preferences. Carers should be assessed for risk and supported in their roles in care management and care coordination.

Conclusions:

Because of the unpredictability of the disease and difficulty in prognostication, PC should be introduced at the point of diagnosis of HF. Basic education in PC needs to be introduced early in the training of cardiology staff, focused on concept definition, differencing PC and terminal care, symptom management, communication, and decision-making.
Low Response to Clopidogrel in Coronary Artery Disease
Authors: Bobescu Elena , Covaciu Alexandru , Rus Horatiu , Rogozea Liliana Marcela , Badea Mihaela , Marceanu Luigi Geo
Published: November 2019

Background:

In patients with coronary artery disease, cardiovascular mortality and other acute events showed a clear correlation with risk factors and biomarkers including platelet activation.

Study Question of This Research:

Which was the incidence of low response to clopidogrel and its correlation with risk factors and biomarkers in coronary artery disease?

Study Design:

Four hundred patients (pts) with coronary artery disease—stable angina (SA) and acute coronary syndrome—were divided into 8 groups of study, consistent with low response to clopidogrel and the type of coronary artery disease. Low response to clopidogrel—defined as adenosine diphosphate test—ADP-test of >46 U by multiple electrode platelet aggregometry was evaluated in correlation with cardiovascular risk factors and biomarkers of oxidative stress, endothelial dysfunction, hypercoagulability, high platelet reactivity.

Results:

In coronary artery disease, low response to clopidogrel significantly correlated with older than 65 years, smoking, hypertension, diabetes mellitus, body mass index of >25, previous aspirin treatment (P < 0.05), high value of total and low-density lipoprotein cholesterol, low value of high-density lipoprotein cholesterol, low response to aspirin, high mean platelets volume and von Willebrand factor activity, low flow-mediated vasodilatation, total antioxidant status (P < 0.01) and only in patients with SA of male gender (P < 0.01). The incidence of other hypercoagulability biomarkers, such as reduced values of S protein, C protein, antithrombin III, and V Factor Leiden resistance to activated protein C, was very low and not correlated with low response to clopidogrel.

Conclusions:

In coronary artery disease, low response to clopidogrel significantly correlated with the most of old cardiovascular risk factors, with previous aspirin treatment, low response to aspirin, higher mean platelets volume, higher von Willebrand factor activity, lower flow-mediated vasodilatation, and lower total antioxidant status values and only in patients with SA of male gender.
The Impact of a National Health Information Exchange Program Under a Single-payer System
Authors: Lin Jin-Hung , Cheng Shou-Hsia
Published: November 2019

Objective:

This study aimed to evaluate the impact of the PharmaCloud program, a health information exchange program implemented in 2013, on medication duplication under a single-payer, universal health insurance program in Taiwan.

Study Design:

This study employed a retrospective pre-post study design and used nationwide health insurance claim data from 2013 to 2015. A difference-in-difference analysis was conducted to evaluate the effects of inquiry rate on the probability of receiving duplicate medications and on the number of days of overlapping medication prescriptions after implementation of the PharmaCloud program.

Results:

The study subjects included patients receiving medications in 7 categories: antihypertension drugs, 217,200; antihyperlipidemic drugs, 69,086; hypoglycemic agents, 103,962; antipsychotic drugs, 15,479; antidepressant drugs, 12,057; sedative and hypnotic drugs, 56,048; and antigout drugs, 18,250. Up to 2015, the overall PharmaCloud inquiry rate has increased to 55.36%–69.16%. Compared with subjects in 2013, subjects in 2014 and 2015 had a significantly lower likelihood of receiving duplicate medication in all 7 medication groups; for instance, for antihypertension drug users, the odds ratio (OR) was 0.91 with 95% confidence interval (CI)=0.90–0.92 in 2014, and the OR was 0.81 with 95% confidence interval=0.81–0.82 in 2015. However, a higher inquiry rate led to a lower likelihood of receiving duplicate medication and shorter periods of overlapping medications only in some of the medication groups.

Conclusions:

The health information exchange program has reduced medication duplication, yet the reduction was not entirely associated with record inquiries. The hospitals have responded to the challenge of medication duplication by enhancing internal prescription control via a prescription alert system, which may have contributed to the reduction in duplicate medications and is a positive, unintended consequence of the intervention.
Comparison between single-photon emission computed tomography/computed tomography and ultrasound in preoperative detection of parathyroid adenoma: retrospective review of an institutional experience
Authors: Okudan Berna , Seven Bedri , Coskun Nazım , Albayrak Aynur
Published: November 2019

Objective

The aim of this study was to evaluate the accuracy of technetium- 99m-methoxyisobutylisonitrile (99mTc-MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) and ultrasound in preoperative localization of single parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (pHPT) who would be suitable for minimally invasive parathyroidectomy (MIP).

Methods

A retrospective study of 143 consecutive patients with biochemical evidence of hyperparathyroidism who underwent preoperative localization of parathyroid lesions using 99mTc-MIBI SPECT/CT and ultrasound, and proceeded to parathyroid surgery at our institution from January 2013 to January 2018. Of these, 125 had single adenomas and are the subject of this study. The sensitivity, positive predictive value (PPV) and accuracy of the two imaging techniques for the accurately identification and lateralization of PTAs were determined using histopathology as the criterion standard.

Results

Of 125 PTAs, the correct identification and lateralization were significantly higher by SPECT/CT than ultrasound. SPECT/CT and ultrasound detected lesions with histopathologically proven PTAs in 116 and 95 patients, respectively. The sensitivity, PPV and accuracy were 92.17, 94.64 and 87.60%, respectively, for SPECT/CT and 75.89, 90.43 and 70.25%, respectively, for ultrasound in lateralization analysis.

Conclusions

The results of our study indicate that 99mTc-MIBI SPECT/CT is more accurate than ultrasound for the preoperative identification of single PTAs in patients with pHPT who are candidates for MIP.
68Ga-prostate-specific membrane antigen PETCT-based response to androgen deprivation therapy in patients with prostate cancer
Authors: Gupta Priyamvada , Murthy Vedang , Agarwal Archi , Maitre Madan , Mhatre Nihit , Rangarajan Venkatesh
Published: November 2019

Objective

To assess the response of castration-naïve prostate cancer to androgen deprivation therapy (ADT) in 68Ga-PSMA PETCT, and test the hypothesis of differential response in primary, nodal and metastatic lesions.

Materials/methods

Patients with adenocarcinoma prostate with baseline 68Ga-prostate-specific membrane antigen (PSMA) PETCT scan, and response scan after 3–12 months of ADT from 2014 to 2017 were analyzed. Change in radiotracer uptake in the prostate, involved regional nodes and distant metastasis was semiquantitatively assessed in paired scans using maximum standardized uptake value (SUVmax). Response was categorized into complete or partial response (CR, PR) or stable disease or progressive disease (SD, PD), and correlated with known prognostic factors.

Results

Total 86 scans of 43 patients (17 metastatic, M+) were analyzed. After median 6 months of ADT, 0% primary, 23.3% nodes and 17.6% metastases showed CR; 18.6% primary, 8.3% nodes and 35% metastases showed PD. Prostate response was not significantly associated with any prognostic factor. Nodal response was higher in M0 than in M+ disease (CR 37 vs 4%, P = 0.003). Oligometastases responded better than polymetastases (CR/PR 62.5 vs 11.1%, P = 0.05). Decline in SUVmax of primary tumor correlated with decline in serum prostate-specific antigen (PSA) (90% of partial responders showed >80% decline in serum PSA vs 50% with PD, P = 0.06).

Conclusion

Primary prostatic tumor seems less likely to respond to ADT than nodal or metastatic lesions. Residual primary uptake may guide patient selection for local therapy in (oligo) metastatic prostate cancer.
Immunological considerations and concerns as pertinent to whole eye transplantation
Authors: Zor Fatih , Karagoz Huseyin , Kapucu Hulya , Kulahci Yalcin , Janjic Jelena M. , Gorantla Vijay S.
Published: November 2019

Purpose of review

The advent of clinical vascularized composite allotransplantation (VCA), offers hope for whole eye transplantation (WET) in patients with devastating vison loss that fails or defies current treatment options. Optic nerve regeneration and reintegration remain the overarching hurdles to WET. However, the realization of WET may indeed be limited by our lack of understanding of the singular immunological features of the eye as pertinent to graft survival and functional vision restoration in the setting of transplantation.

Recent findings

Like other VCA, such as the hand or face, the eye includes multiple tissues with distinct embryonic lineage and differential antigenicity. The ultimate goal of vision restoration through WET requires optimal immune modulation of the graft for successful optic nerve regeneration. Our team is exploring barriers to our understanding of the immunology of the eye in the context of WET including the role of immune privilege and lymphatic drainage on rejection, as well as the effects ischemia, reperfusion injury and rejection on optic nerve regeneration.

Elucidation of the unique immunological responses in the eye and adnexa after WET will provide foundational clues that will help inform therapies that prevent immune rejection without hindering optic nerve regeneration or reintegration.
Establishment and Characterization of 10 Human Pancreatic Cancer Cell Lines Including a HER2 Overexpressed Cell Line
Authors: Kim Soon-Chan , Shin Young-Kyoung , Kim Sun-Whe , Seo Ha-Young , Kwon Wooil , Kim Hongbeom , Han Youngmin , Lee Ja-Oh , Jang Jin-Young , Ku Ja-Lok
Published: November 2019

Objective

The incidence of pancreatic adenocarcinoma (PA) approximates its prevalence, as the malignancy is almost consistently fatal within a year. Although the currently available adjuvant therapy seems to provide survival benefit, it is only moderate, and the standard regimen has not yet been established. Therefore, more biological resources to investigate the PA are needed.

Methods

Here, we established and characterized 10 human pancreatic cancer cell lines derived from primary tumor mass. Whole exome sequencing technique was used to identify driver mutations and aberrant pathways in each cell line.

Results

Five anticancer drugs were treated to find half maximal effective concentration (EC50), and the response was analyzed in reference to mutational status. Frame shift mutations in ARID1A gene and HER2 amplification were mutually related to better response to the anticancer drugs. In contrast, frame shift mutation in MSH6 gene was associated with resistance to anticancer drugs.

Conclusions

In summary, we established 10 pancreatic cancer cell lines and integrated various molecular aberrations and features of pancreatic cancer cells. Our biological resources are expected to contribute to facilitating research on PA.
Estimation of Extracellular Volume Fraction With Routine Multiphasic Pancreatic Computed Tomography to Predict the Survival of Patients With Stage IV Pancreatic Ductal Adenocarcinoma
Authors: Fukukura Yoshihiko , Kumagae Yuichi , Higashi Ryutaro , Hakamada Hiroto , Nakajo Masatoyo , Maemura Kosei , Arima Shiho , Yoshiura Takashi
Published: November 2019

Objective

This study aimed to determine whether extracellular volume (ECV) fraction with routine equilibrium contrast-enhanced computed tomography (CT) can predict outcomes in patients with stage IV pancreatic ductal adenocarcinoma (PDAC) treated with chemotherapy.

Methods

This is a retrospective cohort study of 128 patients with stage IV PDAC who underwent multiphasic pancreatic CT before systemic chemotherapy. Contrast enhancement and ECV fraction of the primary lesion were calculated using region-of-interest measurement within the PDAC and aorta on unenhanced and equilibrium phase-enhanced CT. The effects of clinical prognostic factors and ECV fractions on progression-free survival (PFS) and overall survival (OS) were assessed by univariate and multivariate analyses using Cox proportional hazards models.

Results

The number of metastatic organs and tumor ECV fraction were significant for PFS (P = 0.005 and 0.001, respectively) and OS (P = 0.012 and 0.007, respectively). On the multivariate analysis, multiple metastatic organs (PFS, P = 0.046; OS, P = 0.047) and lower tumor ECV fraction (PFS, P = 0.010; OS, P = 0.026) were identified as independent predictors of poor PFS and OS.

Conclusion

Extracellular volume fraction with routine equilibrium contrast-enhanced CT may potentially predict survival in patients with stage IV PDAC treated with chemotherapy.
Prevalence and Associated Factors of Abdominal Pain and Disability at 1-Year Follow-up After an Attack of Acute Pancreatitis
Authors: Gougol Amir , Machicado Jorge D. , Matta Bassem , Paragomi Pedram , Pothoulakis Ioannis , Slivka Adam , Whitcomb David C. , Yadav Dhiraj , Papachristou Georgios I.
Published: November 2019

Objective

The aim of the study was to report the prevalence and predictors of abdominal pain and disability 1 year after an acute pancreatitis (AP) attack.

Methods

Patients were prospectively enrolled between December 2012 and April 2016. Enrolled subjects were contacted at a median of 13 months after enrollment. Multivariable regression models were used to determine factors independently associated with abdominal pain at follow-up.

Results

Response rate was 71% (110/155). Of respondents, median age was 51 years, 58% were female, and 14% had severe AP. At follow-up, 24% of patients reported abdominal pain (65% intermittent, 35% constant), 10% used analgesics regularly, and 6% had regular opioids use. Furthermore, 41% of patients experienced pain-related interference with work or daily activities, and 8% developed disability. On regression analysis, idiopathic etiology (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.1–13.6) failure (OR, 3.3; 95% CI, 1.1–7.9), and recurrent AP (OR, 2.9; 95% CI, 1.1–10.6) were independently associated with abdominal pain at follow-up. Disability at follow-up was associated with younger age, current smoking, and intensive care unit admission (all P < 0.05).

Conclusions

Abdominal pain and disability are potential long-term sequelae of AP. Certain pre-existing factors and pancreatitis features are associated with these outcomes at one-year follow-up of AP.
Are Opioid-Naive Patients With Acute Pancreatitis Given Opioid Prescriptions at Discharge?
Authors: Yang Allison L. , Jin David X. , Srivoleti Padmavathi , Banks Peter A. , McNabb-Baltar Julia
Published: November 2019

Objectives

Opioids are commonly used in the management of acute pancreatitis (AP). Inpatient opioid exposure is known to increase the risk of chronic opioid use after discharge. Prescription patterns for opioids at discharge for AP are unknown.

Methods

Medical records of adult AP patients who presented to the emergency department from September 1, 2013, to August 31, 2016, were reviewed. Opioid prescription at discharge was defined as a prescription for opioids in a patient who was opioid naive at admission. Multivariable logistic regression was performed to identify predictors of opioid prescription at discharge.

Results

A total of 259 opioid-naive AP patients were identified. Of these, 108 (41.6%) of 259 were discharged with an opioid prescription and 61 (56.5%) of 108 had discharge pain scores of 3 or lower. Two hundred twenty-two (85.7%) received opioids during admission and 105 (47.3%) of 222 were discharged with an opioid prescription. On multivariable analysis, predictors of discharge opioid prescription included inpatient use of opioids, female sex, and discharge pain score greater than 3.

Conclusions

In opioid-naive AP patients, 41.6% were discharged from the hospital with a new prescription for opioids, even though a significant proportion had pain scores of 3 or lower. Guidelines are needed for opioid prescriptions at discharge for AP.
A Clinical Feasible Method for Computed Tomography-Based Assessment of Sarcopenia in Patients With Chronic Pancreatitis
Authors: Ozola-Zālīte Imanta , Frøkjær Jens Brøndum , Mark Esben Bolvig , Gudauskas Tomas , Gudauskas Linas , Dedelaite Milda , Bieliuniene Edita , Ignatavicius Povilas , Pukitis Aldis , Drewes Asbjørn Mohr , Olesen Søren Schou
Published: November 2019

Objectives

Sarcopenia is a serious but often overlooked complication of chronic pancreatitis (CP). We investigated the prevalence and risk factors for sarcopenia in patients with CP and determined the utility of a computed tomography (CT)-based method, based on psoas muscle measurements, for easy and clinical feasible diagnosis of sarcopenia.

Methods

This was a retrospective multicenter study of 265 patients with CP. We used segmentation of CT images to quantify skeletal muscle mass and diagnose sarcopenia. On the same CT image as used for muscle segmentation, psoas muscle thickness and cross-sectional area were measured and receiver operating characteristic analyses defined age and sex-specific cutoffs for diagnosing sarcopenia.

Results

The prevalence of sarcopenia was 20.4%. The optimal height-adjusted psoas muscle cross-sectional area cutoff for diagnosing sarcopenia was 3.3 cm2/m2 in males and 2.5 cm2/m2 in females. The corresponding area under the receiver operating characteristic curves were 0.8 and 0.9, with sensitivities of 84% and 81% and specificities of 62% and 81%, respectively. Comparable diagnostic performance characteristics were observed for psoas muscle thickness.

Conclusions

Sarcopenia is present in 1 of 5 patients with CP. Assessment of psoas muscle parameters provides a clinical feasible method to diagnose sarcopenia.
Prognostic Factors of Acinar Cell Carcinomas
Authors: Egal Axel , Cros Jérôme , Svrcek Magali , Chiche Laurence , Belleannee Geneviève , Poizat Flora , Jouffret Lionel , Maire Frédérique , de Mestier Louis , Hammel Pascal
Published: November 2019

Objectives

Acinar cell carcinoma is a rare tumor of the pancreas. Our current series aimed to assess the clinical and morphological features of pancreatic acinar cell carcinoma and to evaluate the treatment strategies and prognosis.

Methods

This retrospective study was conducted in 3 French referral centers. Clinical data were obtained from medical records, and data about survival were then calculated and compared using statistical analysis.

Results

Forty-four patients were included (men, 81.8%; median age, 65.5 years; range, 21–85). Tumors were localized, locally advanced, or metastatic in 48.8%, 14.0%, and 37.2% of cases, respectively. Twenty-nine patients (65.9%) underwent a curative-intent resection (R0, 79.2%). First-line chemotherapy in metastatic patients was heterogeneous but mainly consisted in 5-fluorouracil-based or gemcitabine plus oxaliplatin combinations. Median disease-free survival was 12 months (range, 0–82 months). Median overall survival was 55.5 months; it was 40 months in patients with metastatic tumor compared with 106.5 months (P = 0.1058) in those with a nonmetastatic one. Age older than 60 years and a proliferation index greater than 30% were poor prognostic factors.

Conclusions

In this large series of patients with pancreatic acinar cell carcinoma, the rate of R0 resection and the prognosis of patients appeared to be much better than that of classic ductal adenocarcinomas.
Prognostic Role of Postinduction Minimal Residual Disease and Myeloid Sarcoma Type Extramedullary Involvement in Pediatric RUNX1-RUNX1T1 (+) Acute Myeloid Leukemia
Authors: Lee Jae Wook , Kim Seongkoo , Jang Pil-Sang , Chung Nack-Gyun , Cho Bin , Im Soo Ah , Kim Myungshin
Published: November 2019

Background:

Acute myeloid leukemia with the t(8;21)(q22;q22) rearrangement (RUNX1-RUNX1T1 (+) AML) is known to have a favorable prognosis. Our study aimed to determine the most important prognostic variables among an aggregate of clinical, genetic, and treatment response-based factors in pediatric RUNX1-RUNX1T1 (+) AML.

Materials and Methods:

We analyzed the characteristics and outcome of 40 patients who were diagnosed with and treated for RUNX1-RUNX1T1 (+) AML from April 2008 to December 2016 at our institution.

Results:

A<−2.2 log fusion transcript decrement after remission induction, myeloid sarcoma type extramedullary involvement (EMI) at diagnosis, higher initial white blood cell count, and presence of KIT mutation predicted lower event-free survival. Both lower fusion transcript decrement after remission induction and the presence of EMI at diagnosis proved to be significant adverse factors in the multivariate study. The 5-year event-free survival was 70.0±7.2% (28/40); 8 of the 12 relapsed patients survive disease-free, resulting in 5-year overall survival of 89.5±5.0% (36/40).

Conclusions:

Kinetics of response to remission induction chemotherapy, measured in terms of the PCR value for the fusion transcript, and the presence of myeloid sarcoma type EMI at diagnosis may predict the risk of relapse in pediatric RUNX1-RUNX1T1 (+) AML.
Delayed Diagnosis of Langerhans Cell Histiocytosis Presenting With Thyroid Involvement and Respiratory Failure: A Pediatric Case Report
Authors: He Yingyi , Xie Jianling , Zhang Hui , Wang Jiayi , Su Xiaoling , Liu Dianyue
Published: November 2019

Langerhans cell histiocytosis (LCH) is a rare disease with localized to disseminated clinical features. Thyroid involvement in LCH is rare and presenting as either a single-organ or multisystem disease, it is usually misinterpreted as another thyroid disorder. Therefore, the LCH diagnosis is often delayed. We report a pediatric case of LCH with thyroid involvement as the initial clinical manifestation progressing to respiratory failure. Clinicians should note insidious extrathyroidal laboratory abnormalities and consider infiltrative thyroid diseases, such as LCH. Systematic clinical and laboratory investigations are needed to prevent delayed diagnosis because the classic features of LCH may become evident only over time.