bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term follow-up of PRPH2-associated retinal dystrophy
Authors: Zhao Zhanlin , Miere Alexandra , Mai LE Hoang , Souied Eric H
Published: September 2022

Purpose:

To report a thirteen-year follow-up of PRPH2-associated retinal dystrophy.

Methods:

A 54-year-old female patient presented with decreased vision and mild metamorphopsia in both eyes since the age of 40. A complete evaluation was performed using multimodal imaging techniques.

Results:

At presentation, fundus examination revealed multiple irregular pisciform flecks in the posterior pole sparing the peripapillary area in both eyes, as well as some mildly atrophic zones in the perifoveal area. The mildly atrophic areas evolved and merged into a central atrophic zone in the following ten years, leading to a decreased vision of less than 20/400 in both eyes. The genetic molecular diagnosis revealed a mutation in PRPH2/RDS gene (NM_000322.4:c.421T>C (p.Tyr141His)). Based on genetics, imaging, and clinical findings, a diagnosis of multifocal pattern dystrophy simulating STGD1/fundus flavimaculatus (MPDSFF) was evoked. Her mother was found to have the same gene mutation, with multiple irregular pisciform flecks in the posterior pole associated with central areolar choroidal dystrophy.

Conclusions:

This report demonstrated the thirteen-year progression of MPDSFF in a patient with a pathogenic variant of the PRPH2/RDS gene (NM_000322.4:c.421T>C (p.Tyr141His)).
Factors affecting the quality of life of family caregivers of patients with heart failure: A cross-sectional study
Authors: Kim Kyoung-A , Park Jin-Sun , Seo Kyoung-Woo , Choi Eui-Young , Ahn Jeong-Ah
Published: September 2022

Heart failure is a chronic disease requiring lifetime self-management at home by patients, who often require additional support. However, the long-term nature of this self-management presents great challenges for both heart failure patients and their family caregivers. The role of family caregivers is critical, but little is known about the relationship between the burden, stress, depressive symptoms, and quality of life in the family caregivers of heart failure patients. We aimed to explore caregiver burden, stress, depressive symptoms, and quality of life in both patients with heart failure and their family caregivers and identify the factors associated with family caregivers’ quality of life.

The sample included 120 participants (60 heart failure patients and 60 corresponding family caregivers) from cardiovascular outpatient clinics at 2 university-affiliated hospitals in South Korea from September 2018 to July 2019. The mean ages of the heart failure patients and their caregivers were 72.72 (SD = 12.73) and 57.03 (SD = 13.42) years, respectively. Caregiver burden (r = −0.601, P < .001) and caregiver depressive symptoms (r = -0.535, P < .001) were negatively correlated with the caregivers’ quality of life. The result of the hierarchical multiple regression analysis identified 3 significant factors related to the family caregivers’ quality of life: caregiver’s age (β = −0.257, P = .012), caregiver burden (β = −0.408, P = .002) and caregiver depressive symptoms (β = −0.298, P = .018), with overall explanatory power of 47.5%.

It is necessary to develop practical strategies to improve family caregivers’ quality of life by alleviating their burden and depressive symptoms. Healthcare providers should be engaged with not only heart failure patients but also their family caregivers during the disease management process to improve patients’ outcomes.
HIV incidence among men who have sex with men (MSM) in Metro Manila, the Philippines: A prospective cohort study 2014–2018
Authors: Ditangco Rossana , Mationg Mary Lorraine
Published: September 2022

The human immunodeficiency virus (HIV) epidemic in the Philippines has been driven by sexual transmission among men who have sex with men (MSM) over the past 2 decades. As the incidence of HIV infection among MSM has not been extensively evaluated, this study aimed to determine the incidence of HIV infections and the associated risk factors among MSM in Metro Manila, Philippines.

This prospective cohort study was conducted in 2 community centers in Metro Manila, the Philippines, between March 2014 and December 2018. MSM who had anal or oral sex in the past 12 months, aged ≥18 years, and confirmed HIV-negative status were enrolled. Participants were followed up every 3 months with repeat HIV testing and assessment of HIV-related practices.

Of the 708 MSM included in this study, a total of 59 HIV seroconversions occurred during the follow-up, resulting in an incidence of 2.7 (95% confidence interval: 2.1–3.5) per 100 patient-years. Multivariate risk regression analysis indicated that age (P = .002) and anal sex with a consensual male partner in the past 3 months (P = .039) were significantly associated with HIV infection.

Our study has shown high rates of incident HIV infection among Filipino MSM. This demonstrates the need for effective HIV prevention, surveillance, treatment, and intervention strategies targeting this population.
Children and adolescent patients with goiter and normal thyroid function: US findings related to underlying autoimmune thyroid diseases
Authors: Hwang Sook Min , Hwang Ji-Young , Moon Jin Hee , Yang Ik , Woo Ji Young , Lee Hye Jin
Published: September 2022

This study was conducted to investigate and compare thyroid ultrasonography (US) findings in children and adolescents with goiter and normal thyroid function with positive or negative thyroid autoimmunity. From 2000 to 2020, we reviewed initial thyroid US images in 33 autoimmune thyroid diseases (AITDs) patients and 52 nonAITD patients. Our review of the images focused on thyroid parenchymal hypoechogenicity and heterogeneous echopattern subdivided into 2 groups according to severity: hypoechogenicity 1 and 2 (HO1 and HO2) and heterogeneity 1 and 2 (HE1 and HE2). HO1 and HE1 were observed more frequently in the nonAITD group (86.5% and 42.3%, respectively), while HO2 and HE2 were observed more frequently in the AITDs group (36.4% and 81.8%, respectively). More patients in the AITDs group showed change of both US groups and thyroid function state within the follow-up periods than in nonAITD group (33.3% and 5.77%, respectively). Children and adolescent AITDs patients showed more severe parenchyma hypoechogenicity and heterogeneous echopattern compared with nonAITD patients with goiter and normal thyroid function.
A jejunal gastrointestinal stromal tumor with massive gastrointestinal hemorrhage treated by emergency surgery: A case report
Authors: Jabłońska Beata , Szmigiel Paweł , Wosiewicz Piotr , Baron Jan , Szczęsny-Karczewska Weronika , Mrowiec Sławomir
Published: September 2022

Background:

A jejunal gastrointestinal stromal tumor (GIST) is a rare neoplasm of the gastrointestinal (GI) tract. Massive bleeding due to a jejunal GIST is a diagnostic and therapeutic challenge. It may be a life-threatening GIST complication that requires urgent intervention. Acute GI bleeding, which requires urgent surgical intervention, is a very rare clinical manifestation of GIST. A jejunal GIST with massive hemorrhage with coronavirus disease 2019 in a male patient in older age with many comorbidities has been not reported in the worldwide literature.

Methods:

In this case report, we present an 80-year-old man who was admitted to surgery due to abdominal pain, melena, and hematochezia for several hours. An upper endoscopy and colonoscopy were inconclusive. A multidetector contrast-enhanced computed tomography (CT) of the abdominal and pelvic cavity showed concentric irregular thickening in the distal jejunum.

The histopathological finding showed a GIST measuring 6 cm with a mitotic index 2/50 high power fields. The patient’s hemodynamic condition deteriorated despite initial conservative treatment including a blood transfusion. Therefore, patient underwent the emergency surgery 24 hours after admission: partial jejunal resection with the tumor followed by primary end-to-end anastomosis.

Results:

The mass was removed completely. There were no surgical complications in the postoperative course. On the first postoperative day, a severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test was performed due to a persistent dry cough, which yielded a positive result. After 14 days, the patient died due to pneumonia and circulatory failure.

Conclusions:

This case indicates that jejunal GIST can present as massive lower gastrointestinal bleeding and urgent surgery can successfully stop bleeding and save the patient’s life. The CT scan was the most effective investigation to find the source of GI bleeding in this case. Therefore, we suggest performing CT in patients with acute massive lower gastrointestinal bleeding when the source of bleeding is not visible on endoscopy, and urgent surgical jejunal resection to stop life-threatening bleeding caused by a jejunal GIST.
Influence of body fatness on propofol requirements for loss of consciousness in target-controlled infusion: A STROBE-compliant study
Authors: Doo A. Ram , Ki Min Jong , Park Seong Ok , Lee Jun Ho , Ko Seonghoon
Published: September 2022

This prospective observational study evaluated the effects of body fat on the pharmacologic effect of propofol. Hundred patients aged 18 to 75 years who were scheduled to undergo orthopedic surgery under regional block were enrolled. All participants underwent bioelectrical impedance analysis and were allocated into 2 groups: the high and normal adiposity group, according to percent body fat. Following successful regional block, propofol was incrementally infused until loss of consciousness (LOC) with a target-controlled infusion pump. The effect-site concentration of propofol at LOC and the total infused dose of propofol per total body weight until LOC were recorded. At the end of the surgery, the infusion of propofol was stopped. The elapsed time to recovery of consciousness (ROC) and the effect-site concentration at ROC were recorded. These pharmacologic data were compared between 2 groups. The effect-site concentration of propofol at LOC (µg/mL) was significantly lower in the high adiposity group than in the normal group in both sexes (3.5 ± 0.4 vs 3.9 ± 0.6; P = .020 in males, and 3.4 [interquartile range: 2.9–3.5] vs 3.8 [interquartile range: 3.3–3.9]; P = .006 in females). Total dose per total body weight until LOC (mg/kg) were also significantly lower in the high adiposity group than in the normal group. There was no significant difference in the data related to ROC. The pharmacologic effects of propofol may be affected by the composition of body components. The concentration of propofol using a target-controlled infusion system may be diminished in patients with a high proportion of body fat.
Perfusion and diffusion-weighted imaging parameters: Comparison between pre- and postbiopsy MRI for high-grade glioma
Authors: Kurokawa Ryo , Baba Akira , Kurokawa Mariko , Capizzano Aristides , Ota Yoshiaki , Kim John , Srinivasan Ashok , Moritani Toshio
Published: September 2022

We aimed to evaluate the differences in dynamic susceptibility contrast (DSC)- magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) parameters between the pre- and postbiopsy MRI obtained before treatment in patients with diffuse midline glioma, H3K27-altered. The data of 25 patients with pathologically proven diffuse midline glioma, H3K27-altered, were extracted from our hospital’s database between January 2017 and August 2021. Twenty (median age, 13 years; range, 3–52 years; 12 women) and 8 (13.5 years; 5–68 years; 1 woman) patients underwent preoperative DSC-MRI and DWI before and after biopsy, respectively. The normalized corrected relative cerebral blood volume (ncrCBV), normalized relative cerebral blood flow (nrCBF), and normalized maximum, mean, and minimum apparent diffusion coefficient (ADC) were calculated using the volumes-of-interest of the tumor and normal-appearing reference region. The macroscopic postbiopsy changes (i.e., biopsy tract, tissue defect, and hemorrhage) were meticulously excluded from the postbiopsy measurements. The DSC-MRI and DWI parameters of the pre- and postbiopsy groups were compared using the Mann–Whitney U test. The ncrCBV was significantly lower in the postbiopsy group than in the prebiopsy group [prebiopsy group: median 1.293 (range, 0.513 to 2.547) versus postbiopsy group: 0.877 (0.748 to 1.205), P = .016]. No significant difference was observed in the nrCBF and normalized ADC values, although the median nrCBF was lower in the postbiopsy group. The DSC-MRI parameters differed between the pre- and postbiopsy MRI obtained pretreatment, although the macroscopic postbiopsy changes were carefully excluded from the analysis. The results emphasize the potential danger of integrating and analyzing DSC-MRI parameters derived from pre- and postbiopsy MRI.
CD20-positive subcutaneous panniculitis-like T-cell lymphoma presenting as polycranial neuropathy: A CARE-compliant case report and literature review
Authors: Xu Jing , Li Jia , Sun Ya-juan , Quan Wei , Liu Li , Zhang Qing-hui , Qin Yi-dan , Pei Xiao-chen , Su Hang , Chen Jia-Jun
Published: September 2022

Background:

Subcutaneous panniculitis-like T-cell lymphoma(SPTCL) is a very rare cytotoxic T-cell skin lymphoma involving subcutaneous tissue, and mainly affects young females. T-cell phenotype is characterized by CD3+, CD8+, and CD4−. SPTCT with polycranial neuropathy has rarely been described. SPTCL is believed to show an indolent clinical course unless patients develop haemophagocytic syndrome or sudden respiratory failure. Its treatment has not been established yet.

Case presentation:

We report a case of intractable SPTCT in a 66-year-old woman with multiple cranial nerve palsies and diabetes. She showed involvement of the bilateral facial nerve, left trigeminal nerve, left auditory nerve, and right oculomotor nerve. The single inconspicuous skin lesion in the trunk presented with an erythematous nodule with a diameter of <5 cm and a slightly pink infiltrated plaque. Electromyography revealed bilateral damage to the facial nerve. Differential immunohistochemical characteristics were observed. Immunohistochemistry demonstrated diffuse CD20 positivity. Cerebral spinal fluid analysis revealed elevated protein levels of 0.92 (0.15–0.45) g/L. Her condition regressed severely over time. She was treated with chemotherapy but died 10 months later, the probable cause of death was lung involvement.

Conclusion:

The patient’s involvement with the central nervous system may be associated with positivity for CD20. Molecular biomarkers may act as therapeutic targets for SPTCL.
SLC26A4 mutation in Pendred syndrome with hypokalemia: A case report
Authors: Lu Ya-Ting , Wang Lin , Hou Le-Le , Zheng Ping-Ping , Xu Qian , Deng Da-Tong
Published: September 2022

Rationale:

Pendred syndrome is an autosomal recessive disorder characterized by sensorineural hearing loss, inner ear malformations, goiter, and abnormal organification of iodide. It is caused by mutations in SLC26A4 gene, which encodes pendrin (a transporter of chloride, bicarbonate, and iodide). Pendred syndrome is a common cause of syndromic deafness, but the metabolic abnormalities it causes are often overlooked. Here, we report the case of a patient diagnosed with Pendred syndrome with hypokalemia.

Patient concerns:

A 53-year-old deaf-mute woman was hospitalized due to severe limb asthenia. The emergency examination showed that her blood potassium level was 1.8 mmol/L.

Diagnoses:

Through the genetic test, we found a mutation of SLC26A4 gene in NM_000441: c.2027T>A, p.L676Q, as well as the SLC26A4 exon 5-6 deletion. These genetic variations pointed to Pendred syndrome (an autosomal recessive disorder that mainly affects the inner ear, thyroid, and kidney) which is a common cause of syndromic deafness.

Interventions:

The patient was treated with potassium supplements and screened for the cause of hypokalemia.

Outcomes:

The patient was discharged after her potassium levels rose to the normal range.

Lessons:

Patients with Pendred syndrome may also have certain metabolic abnormalities; thus, more attention should be paid to them during clinical diagnosis.
Is ovarian cystectomy for atypical ovarian endometrioma safe?: A single center study
Authors: Kim Jong Mi , Hong Dae Gy
Published: September 2022

Ovarian atypical endometriosis (AE) is a premalignant lesion, and its potential to progress to endometriosis-associated ovarian cancer emphasizes its significance. However, the true risk of malignancy in AE remains unclear. Therefore, this study aimed to investigate the clinical outcomes of ovarian AE after ovarian cystectomy. We retrospectively reviewed the medical records and histopathological reports of 41 patients who had been diagnosed with ovarian AE between January 2011 and April 2020. We reviewed age, obstetric history, age at menarche, preoperative CA 125 level, C-reactive protein level, erythrocyte sedimentation rate, endometriosis stage, mean follow-up duration, postoperative hormonal therapy, and prognosis, including recurrence of endometriosis and malignant transformation. Among 41 patients with pathologically diagnosed ovarian AE, 26 were followed up after cystectomy only. The average follow-up period was 58.27 ± 33.22 months in cystectomy only patients. The mean age of the patients with cystectomy only versus that of patients with endometriosis-associated ovarian carcinoma was 32.73 ± 6.10 versus 48.29 ± 4.35 (P < .01) years. The preoperative CA 125 level was 115.63 ± 219.06 versus 225.75 ± 163.39 (P < .051) U/mL. Patients with endometriosis-associated ovarian carcinoma or other diseases and those who underwent oophorectomy were excluded. After surgery, hormone therapy was administered to 22 of 26 patients, and the remaining 4 patients were followed up without additional treatment. Endometriosis recurrence occurred in 5 patients, 1 of whom underwent second-line laparoscopic ovarian cystectomy. However, no malignant transformations were observed. Ovarian AE has a low possibility of malignant transformation. Conservative treatment is recommended after appropriate ovarian cystectomy, such as enucleation.
Tuberculosis infection related hemophagocytic lymphohistiocytosis diagnosed in patient with GZMB mutation: A case report and literature review
Authors: Wang Zhenhao , Zhang Jin , Hao Zhaonian , Meng Li , Han Zhiqiang , Hong Zhenya
Published: September 2022

Background:

Secondary hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome associated with infections, tumors and connective tissue disease. However rapid identification of the underlying infectious cause of HLH is challenging because traditional etiological diagnostics are time-consuming and sometimes fail to identify the pathogens. Metagenomic next-generation sequencing (mNGS) may be a potential optimal solution, which may help improve the clinical diagnosis of underlying infections in hematological diseases.

Case presentation:

A 28-year-old man presented with a 2-month history of intermittent fever and cytopenia. The HLH was diagnosed based on the manifestations of fever, splenomegaly, anemia, thrombocytopenia, hyperferritinemia, hyperglyceridemia, and elevated IL-2R levels. High-through-put sequencing analysis detected a GZMB mutation. While the initial detection of cultures and smears of tuberculosis was negative, TB infection was eventually identified by mNGS of blood sample. The symptoms rapidly abated during the initial administration of TB.

Conclusion:

The present case proposed that mNGS might be an effective diagnostic tool for diagnosing rare infectious cause of secondary HLH. GZMB mutation was first discovered to be present in secondary HLH.
The effects of ultrasound-guided serratus anterior plane block on intraoperative opioid consumption and hemodynamic stability during breast surgery: A randomized controlled study
Authors: Baytar Çağdaş , Aktaş Bahar , Aydin Bengü Gülhan , Pişkin Özcan , Çakmak Güldeniz Karadeniz , Ayoğlu Hilal
Published: September 2022

Aim:

To determine effect of ultrasound-guided serratus anterior plane block (SAPB) on intraoperative opioid consumption in patients undergoing oncoplastic breast surgery under general anesthesia.

Methods:

This study was conducted as a prospective, randomized controlled trial. Forty-four patients enrolled, aged 18 to 75 years with American Society of Anesthesiologists physical status I to III, undergoing elective oncoplastic breast surgery. Patients were randomly allocated to receive SAPB with 20 mL of 0.25% bupivacaine + general anesthesia (group SAPB) or only general anesthesia (group control). The primary outcome was assessing the effect of SAPB on intraoperative remifentanil consumption. Patients were assessed for emergence time, hemodynamic parameters, doses of rescue drugs used to control hemodynamic parameters, and duration of stay in the recovery room.

Results:

Preoperative SAPB with 0.25% bupivacaine reduced intraoperative opioid consumption (851.2 ± 423.5 vs 1409.7 ± 756.1 µg, P = .019). Emergence time was significantly shorter in group SAPB (6.19 ± 1.90 minutes) compared to group control (9.50 ± 2.39 minutes; P < .001). There were no significant differences in the doses of rescue drugs used for systolic blood pressure and heart rate between the groups.

Conclusions:

Preoperative SAPB with bupivacaine reduced intraoperative opioid consumption and shortened emergence time and duration of stay in the recovery unit, and hemodynamic stability was maintained without block-related complications.
Acute abdominal aortic injury during posterior lumbar fusion surgery: A case report
Authors: Wang Jianhe , Hu Yunxiang , Wang Hong
Published: September 2022

Introduction:

Vascular injury is a serious complication during lumbar fusion surgery, leading to massive blood loss and life-threatening circulatory failure. In this study, we report on a patient with abdominal aorta injury at L2-L3 level during lumbar fusion surgery via posterior approach. Fortunately, our patient was successfully managed with prompt intervention.

Patient concerns:

A 73-year-old female was admitted to our department of low back and bilateral leg pain with claudication for over 6 months.

Diagnosis:

L2-S1 spinal canal stenosis, with abdominal aorta injury at the L2-L3 level during lumbar fusion surgery via a posterior approach.

Interventions:

L2-S1 decompression and fusion via a posterior approach was employed for spinal canal stenosis. Transluminal angioplasty with stent placement was successfully performed to stop the bleeding.

Outcomes:

During the procedure, it was decided that staunching the active bleeding was necessary and attention should be paid to the vital signs and blood pressure. Vascular surgical intervention was immediately scheduled when the blood pressure dropped. After stent placement, hemodynamic parameters stabilized.

Conclusion:

In this case report we review the prevalent sites, predisposing risk factors, diagnosis, and treatment of acute abdominal aortic injury during posterior lumbar fusion surgery, in view of our case findings. Although the incidence of vascular injury during lumbar fusion surgery is low, it is often easily overlooked. Consequently, during surgery, physicians should always be alert to the risk of vascular injury and master its clinical characteristics. Once injury is suspected, active and effective measures should promptly be taken for diagnosis and treatment to avoid serious adverse consequences.
Warfarin-induced spontaneous intramural small bowel hematoma presenting as an acute abdomen: A case report
Authors: Chen Ding-Han , Soh Khay-Seng , Wang Ying-Tso , Shen Te-Chun
Published: September 2022

Rationale:

Spontaneous intramural small-bowel hematoma (SISBH) is a rare complication of anticoagulation therapy. Presentation of SISBH can vary from mild abdominal pain to an acute abdomen.

Patient concerns:

A 70-year-old woman was brought to the emergency department because of severe abdominal pain for 1 day. She had a medical history of coronary artery disease and paroxysmal atrial fibrillation and was receiving anticoagulation therapy with warfarin for 3 years.

Diagnosis:

Computed tomography disclosed disproportional dilatation of the segmental small bowel and near-total obstruction of the intestinal lumen at the level of the jejunum, indicating an acute abdomen.

Interventions:

We performed laparoscopic exploration and found a segmental distal jejunum was tense, heavy, firm, and discolored with a blue hue. Histopathological examination of the resected jejunum revealed diffuse hemorrhage and necrosis at the mucosa and submucosal layers, indicating SISBH.

Outcomes:

The patient had an uneventful recovery and was discharged in a relatively stable condition.

Lessons:

Warfarin-induced SISBH presenting as an acute abdomen is an emergency condition that needs early diagnosis and timely management. Surgical intervention may be indicated for intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage.
Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in an 11-year-old girl: A case report
Authors: Zheng Zhongren , Wang Lei , Tian Ke , Zhao Xiaowei , Ma Longfei
Published: September 2022

Rationale:

The anterior cruciate ligament (ACL) is relatively rarely injured in children and adolescents, accounting for just 0.5% of all ACL rips that occur. Avulsion fractures are more common in youngsters because their ligamentous structures are known to be stronger than their physical insertion sites. Tibial eminences have been reported to be the sites of most ACL avulsions, and both cartilaginous and osteochondral avulsion fractures have been observed, whereas the latter occurs more commonly. On the other hand, femoral osteochondral avulsion fractures of the ACL in children are uncommon, as only a few studies describe their occurrence in immature patients.

Patient concerns:

In this case report, we present an 11-year-old girl who suffered an ACL femoral attachment avulsion fracture after pivoting her knee during riding. A comprehensive formal evaluation of the knee was impractical due to the persistence of pain and tight haemarthrosis.

Diagnoses:

Femoral anterior cruciate ligament osteochondral avulsion fracture.

Interventions:

We used Two No.2Ethibond sutures to pick up the osteochondral fragment and passed across the lateral femoral condyle to come out laterally and fixed with a tie proximally, and we recommended the patient perform reasonable functional exercises postoperatively.

Outcomes:

The patient had no pain, instability, or activity limitations after 24 months of surgery. Physical examination of the patient revealed full and symmetric ROM, and normal Lachman and pivot shift test performance.

Lessons:

ACL avulsion fractures can be accurately treated with arthroscopic reduction and sutures via an inside-out technique, which can reduce the risk of persistent ligamentous laxity and reduce open surgery-related morbidity.
Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial
Authors: Park Byeong Seon , Jin Sejong , Kim Woon Young , Kang Da Som , Choi Yoon Ji , Lee Yoon Sook
Published: September 2022

Background:

Although midazolam is widely administered as an anxiolytic premedication, it may cause over-sedation and hypoxia in geriatric patients. Cranial electrotherapy stimulation (CES) is a nonpharmacological device with anxiolytic effect. This study compared the effects of CES and midazolam as a preoperative treatment in geriatric patients.

Methods:

Eighty patients, under the age of 65 to 79 years, undergoing general anesthesia were randomly assigned into midazolam premedication group (M group, n = 40) or CES pretreatment group (CES group, n = 40). The patients in the M group were intramuscularly injected with midazolam (0.07 mg/kg) 30 minutes before receiving general anesthesia. The patients in the CES group received 20 minutes of CES pretreatment on the day before and on the morning of the surgery.

Results:

In the preoperative holding area, the anxiety score (P = .02) and the sedation score (P < .001) were significantly lower in the CES group compared with those in the M group. The oxygen saturations at the preoperative holding area and the operating room were significantly higher in the CES group than those in the M group (P < .001).

Conclusion:

CES pretreatment relieved preoperative anxiety with less risk of over-sedation and respiratory depression than midazolam premedication in geriatric patients.
Diffuse low-grade glioma misdiagnosed as acute cerebral infarction: A case report
Authors: Ma Yipo , Zhang Jinfeng , Wen Ying , Chen Jinghua , Yuan Lei , Jiang Xuechun , Xu Dan , Liu Kefu
Published: September 2022

Rationale:

Diffuse low-grade gliomas (DLGGs) are relatively rare tumors that are more likely to be misdiagnosed and wrongly treated in clinical practice. We report a case of DLGG detected by computed tomography and magnetic resonance imaging (MRI).

Patient concerns:

A 58-year-old man suddenly phantom smells for half an hour and was previously healthy.

Diagnoses:

Computed tomography findings showed a leaf-shaped slightly hypodense shadow in the right temporal lobe with no obvious mass effect and an unclear boundary. MRI findings showed diffuse and slightly longer T1-weighted imaging (T1WI)/T2-weighted imaging (T2WI)signal in the right temporal lobe and hippocampus, slight hyperintensity on diffusion-weighted imaging, diffuse swelling in the right temporal lobe and hippocampus, and shallower cerebral sulci and fissures. No obvious abnormal enhancement was observed on enhanced MRI. Contrast-enhanced magnetic resonance angiography showed no obvious abnormality.

Interventions:

Intravenous thrombolysis with alteplase (rtPA) was given first.

Outcomes:

The patient had an acute and persistent generalized tonic-clonic seizure and was given antiepileptic treatment. Immunopathological and molecular genetic testing diagnosed as DLGGs. After targeted chemotherapy, the patient’s symptoms improved significantly.

Lessons:

For those cases with clinical acute neurological impairment and imaging findings similar to those of ischemic stroke, where the distribution of lesions is inconsistent with the distribution of blood vessels, and the time of onset does not match the imaging findings, the possibility of DLGGs should be considered.
The association between the serum vitamin D levels and the stroke lesion size, functional ability, and cognition in elderly Korean ischemic stroke patients
Authors: Park Jun Young , Kim Ju Hyeon , Sim Young Joo , Jeong Ho Joong , Lee Jae Hyun , Kim Ghi Chan
Published: September 2022

The purpose of this study was to confirm the association between the serum vitamin D levels and ischemic stroke lesion size, functional ability, and cognitive function in elderly ischemic stroke patients. This study included Korean ischemic stroke patients aged 65 to 85 years. The size of the lesion was measured in brain images taken within 24 hours of hospitalization. The level of 25-(OH) Vitamin D (ng/mL), a metabolite of vitamin D, in the serum collected within 48 hours of hospitalization, and the modified Barthel index (MBI), gait performance, the muscle power of hip and knee extensors on the hemiplegic side, and mini-mental status examination (MMSE) were recorded within 1 week of the onset of the disease. Each factor was compared through correlation analysis, and the significance was confirmed using the Spearman correlation coefficient method. The association between the serum vitamin D levels and the size of the ischemic stroke lesion, the MBI, gait performance, the muscle power of hip and knee extensors on the hemiplegic side, and the MMSE were analyzed. It was confirmed that there was a significant correlation between all the factors (P < .005). In patients with serum vitamin D levels of ≥ 30 ng/mL, both the functional ability and cognitive functions were better than in patients lower than 30 ng/mL. We confirmed the lower the level of serum vitamin D levels, the larger the size of the ischemic stroke lesion when it occurred in elderly Koreans. And we confirmed that serum vitamin D levels affected the functional ability and cognitive function. And we recommend that elderly Koreans should maintain their blood vitamin D level above 30 ng/mL. We believe that this will help preserve the functional ability and cognitive function when ischemic stroke occurred.
Diagnosis and treatment of tuberculosis in adults with HIV
Authors: Yang Qiaoli , Han Jinjin , Shen Jingjing , Peng Xinsen , Zhou Lurong , Yin Xuejing
Published: September 2022

Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), continues to pose a major public health problem and is the leading cause of mortality in people infected with human immunodeficiency virus (HIV). HIV infection greatly increases the risk of developing TB even before CD4+ T-cell counts decrease. Co-infection provides reciprocal advantages to both pathogens and leads to acceleration of both diseases. In HIV-coinfected persons, the diagnosis and treatment of tuberculosis are particularly challenging. Intensifying integration of HIV and tuberculosis control programmes has an impact on reducing diagnostic delays, increasing early case detection, providing prompt treatment onset, and ultimately reducing transmission. In this Review, we describe our current understanding of how these two pathogens interact with each other, new sensitive rapid assays for TB, several new prevention methods, new drugs and regimens.
Superior mesenteric artery syndrome after colectomy: A case report and literature review
Authors: Li Xiangmin , Tian Min , Yang Hui , Liu Yulin , Chen Jingbo , Tian Hu
Published: September 2022

Rationale:

Superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome, is a rare benign disease characterized by small bowel obstruction due to compression of the third portion of the duodenum by the SMA and the abdominal aorta. However, SMA syndrome after colectomy is extremely rare, establishing a clear diagnosis and formulating a treatment plan may be challenging for surgeons.

Patient concerns:

A 64-year-old male with multiple colon polyposis and constipation underwent laparoscopic subtotal colectomy with cecal-rectal anastomosis. On the seventh postoperative day, he started vomiting and complained of abdominal bloating.

Diagnosis:

An upper gastrointestinal series, computed tomography scan and computed tomography angiography confirmed the diagnosis of SMA syndrome.

Interventions:

Gastric decompression, nasojejunal tube feeding and parenteral nutrition were performed.

Outcomes:

After 3 weeks of conservative treatment, the patient showed no clinical improvement in symptoms. Subsequently, he suffered from gastrointestinal hemorrhage, deep venous thrombosis of the lower extremity and cerebral hemorrhage successively. Unfortunately, the patient eventually died.

Lessons:

Surgeons should be aware of the fact that SMA syndrome can occur after colectomy. Every attempt should be made to correct and avoid any predisposing factors perioperatively. Prompt diagnosis of SMA syndrome after colectomy and appropriate early intervention reduce mortality.
New-onset type 1 diabetes mellitus as a delayed immune-related event after discontinuation of nivolumab: A case report
Authors: Seo Je Hyun , Lim Taekyu , Ham Ahrong , Kim Ye An , Lee Miji
Published: September 2022

Rationale:

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. However, they may cause immune-related adverse events. Although there have been a few reports of new-onset type 1 diabetes mellitus (T1DM) during ICI treatment, T1DM as a delayed immune-related event after discontinuing immunotherapy is extremely rare. Herein, we report the case of an elderly veteran who presented with diabetic ketoacidosis 4 months after the discontinuation of treatment with nivolumab.

Patient concerns:

A 74-year-old veteran was treated with second-line nivolumab for advanced non–small cell lung cancer. After 9 treatment cycles, the administration was discontinued due to fatigue. Four months later, he was admitted to the emergency department in a stuporous mental state and hyperglycemia, with high glycosylated hemoglobin levels (10.6%). C-peptide levels were significantly decreased, with negative islet autoantibodies.

Diagnoses:

We diagnosed nivolumab-induced T1DM. There were no laboratory results indicating a new thyroid dysfunction or adrenal insufficiency, which are typical endocrine adverse reactions.

Interventions:

Since the hypothalamic and pituitary functions were preserved and only the pancreatic endocrine capacity was impaired, we administered continuous intravenous insulin injections, with fluid and electrolyte replacement.

Outcomes:

His serum glucose levels decreased, and symptoms improved; hence, on the 8 day of hospitalization, we switched to multiple daily insulin injections.

Lessons:

The present case indicates that regular glucose monitoring and patient education are needed for diabetic ketoacidosis after the discontinuation of ICI therapy.
Non-pharmacological intervention effects on apathy caused by central nervous system organic diseases: A network meta-analysis
Authors: Tan Shaoying , Lin Xiaoli , Liu Zan , Wu Yao , Xie Bijiao , Wang Tao
Published: September 2022

Background:

To evaluate the best non-pharmacological interventions on apathy in patients with central nervous system (CNS) organic diseases.

Methods:

We searched PubMed, Web of Science, Embase, Cochrane Library electronic databases, China national knowledge infrastructure, Wanfang and Chinese biomedical literature database studies published from 2011 to May 29, 2021. A combination of subject words and free words were used for searching. Randomized controlled trials (RCTs) of non-pharmacological interventions for apathy in patients with central nervous organic disease were included. Two researchers independently identified the eligible RCTs and extracted information. The risk of bias within each individual trial was assessed using the Cocharane Collaboration’s tool. Review Manager 5.4 and ADDIS 1.16.5 were used for data analysis.

Results:

A total of 5324 related studies were obtained in the initial screening, and final 8 RCTs including 334 patients were included, involving 4 non-pharmacological interventions of cognitive intervention, repetitive transcranial magnetic stimulation (rTMS), music therapy and occupational therapy. Direct comparison results showed that rTMS, cognitive intervention, and occupational therapy were superior to the conventional group (P < .05). Network Meta repeated rTMS, cognitive intervention was superior to the conventional group (P < .05), while the other groups did not differ from with the conventional group (P > .05). The order of superiority was rTMS, cognitive intervention, occupational therapy, music therapy, and conventional group.

Conclusion:

Current evidence suggests that rTMS and cognitive interventions are more effective than the conventional intervention in improving apathy in patients with CNS organic diseases. It still needs more non-pharmacological intervention studies with high quality, larger sample sizes for further exploration.
The Effect of Easily Implementable Changes to the “D’s of Stroke Care” in Reducing Sex Disparity in Door-to-Needle Time
Authors: Jameie Melika , Jameie Mana , Farahmand Ghasem , Ilkhani Saba , Magrouni Hana , Ranjbar Zahra , Heydari Sanaz , Shahbazi Mojtaba , Kaeedi Maryam , Amani Kiana , Amiri Rosita , Alizade Fateme , Balali Pargol , Amanollahi Mobina , Pourghaz Bahareh , Ghabaee Mojdeh
Published: September 2022

Background:

Door-to-needle (DTN) is the duration between patient’s arrival at the hospital and receiving intravenous thrombolysis in ischemic stroke settings, for which studies have reported delays in women. The “D’s of stroke care” describes 8 steps (D1 to D8) in patients’ time tracker. We implemented simple modifications to the “D’s of stroke care” by splitting D4 and D6 steps into these substeps: patients’ arrival to the emergency room (D4-A), early assessment by a neurologist (D4-B), neurologist decision on patient’s eligibility to receive recombinant tissue plasminogen activator (D6-A), and patient’s transfer to the stroke unit (D6-B). We evaluated the effect of these changes on reducing DTN time disparity between men and women.

Methods:

This study was conducted from September 2019 to August 2021, at a comprehensive stroke center. Patients were analyzed in 2 groups: group 1, before, and group 2, after using the modifications. Sex as the main variable of interest along with other covariates was regressed toward the DTN time.

Results:

In groups 1 and 2, 47 and 56 patients received intravenous thrombolysis, respectively. Although there was a significant difference in DTN≤1 hour between women and men in group 1 (36% vs. 52%, P=0.019), it was not significantly different in group 2 (P=0.97). Regression analysis showed being female was a significant predictor of DTN>1 hour in group 1 (adjusted odds ratio=6.65, P=0.02), whereas after using the modifications, sex was not a significant predictor for delayed DTN.

Conclusions:

Implementing these substeps reduced sex disparity in DTN time in our center.
Enhanced Efficiency in Pediatric Interfacility Transport Through a Centralized Hospital System Communication Center
Authors: Krennerich Emily C. , Graf Jeanine M. , Shekerdemian Lara S. , D’Ambrosio Deborah , McPherson Mona L.
Published: September 2022

OBJECTIVES:

Assess the implementation of a new centralized communication center and the effect on our institution’s interfacility transport team’s ability to respond to requests for patient transport.

DESIGN:

Retrospective review of data over 12 months prior to opening compared with 12 months after implementation of our centralized communication center.

SETTING:

Quaternary academic pediatric hospital system with three campuses, a specialized transport team with expertise in pediatric, neonatal, and maternal-fetal critical care, and a new centralized hospital system communication center.

PATIENTS:

All patients for whom transport to our hospital system was requested within the review period.

INTERVENTIONS:

Our hospital developed a multidisciplinary, centralized hub incorporating technology and integrated electronic tracking systems to coordinate real-time patient flow including intra- and interhospital transfers. One function of this center is to provide a communication center for critical care transports. Multiple new protocols and processes for transport were implemented upon opening.

MEASUREMENTS and MAIN RESULTS:

After implementation, total transports increased 60% (from 1,200 to >1,900 transports/yr). Team dispatch time decreased 40% from 57–34 minutes. Time from initiation of call to physician acceptance decreased 15% (median, 27–23 min). Over the same interval, there were 59% fewer lost transport opportunities. With this growth, our program was able to expand our transport program in scope and numbers.

CONCLUSIONS:

A centralized communication center for pediatric hospital patient flow that included specialized critical care patient transport has increased transport capacity and enhanced efficiency throughout our multicampus hospital system.
Fate of Costochondral Grafts for Micrognathia: 3D Analysis of Postoperative Length, Position, and Graft Take
Authors: Kono Hikaru , Hikosaka Makoto , Kaneko Tsuyoshi , Baba Yoshiyuki
Published: September 2022

Purpose:

Costochondral grafting is performed in the reconstruction of severe micrognathia. In this study, we report our experience with graft take, as well as unique findings that have not been focused on in the past literature such as postoperative position and changes in the shape of the graft and thinning of the skull base in contact with the graft.

Methods:

Between 2002 and 2019, costochondral grafting was performed on 15 sides of 10 patients with micrognathia. Graft take and other detailed findings such as growth, position, and changes in the shape of the grafts and skull base in contact with the grafts were evaluated using computed tomography images.

Results:

Graft take was obtained in all cases, and subsequent distraction could be performed in 8 of 10 graft sites as planned. Six of 15 grafts were displaced anterior to the preoperative planned position. However, there were no cases with complications due to deviation such as trismus. Concave deformity of the skull base in contact with the graft was observed in 9 graft sites. The thinning and bending deformation were observed in 2 grafts.

Conclusions:

Costochondral grafting was considered a reasonable method for first-line treatment of severe micrognathia. Several unique findings that have not been focused on in the past literature were observed. These should be kept in mind when performing costochondral grafting. Several modifications to the present protocol are suggested to improve the quality of graft take.
Disentangling the roles of trauma and genetics in psychiatric disorders using an Electronic Health Records-based approach
Authors: Marchese Shelby , Cuddleston Winston , Seah Carina , Johnson Jessica , Huckins Laura M.
Published: September 2022

Posttraumatic stress disorder (PTSD) requires an exposure to trauma for diagnosis by the DSM-V. Despite this, there is no documented linear relationship between degree of trauma and severity/chronicity of PTSD.

To determine whether traumatic and stressful life events (TSLEs) collected from Electronic Health Records (EHR) interact with PTSD genetics to better define individual risk of developing PTSD. We collected trauma information from patient records in the Mount Sinai BioMe™ biobank population-based cohort and tested for associations with PTSD. We generated a TSLE risk score (TRS), tested its association with PTSD, and for interactions with a polygenic risk score (PRS) of PTSD and a GWAS of PTSD using our biobank population.

We used the Mount Sinai BioMe™ biobank patient population of 31,704 individuals with matched genotype and EHR data, which has been enrolling patients since 2006. Patient enrollment in BioMe™ is unrestricted, resulting in high diversity. Our study includes 1,990 individuals with PTSD and 28,478 individuals without PTSD from the Mount Sinai BioMe™ biobank.

A total of 1,990 individuals with PTSD and 28,478 controls were analyzed (average age 42-78 years, 58.7% women). We identified a total of 22 EHR-derived TSLEs that were associated with PTSD (β> 0.029, p<1.61×10−3). TSLEs interacted with each other to increase the risk of developing PTSD, with the most significant interaction between being female (as a proxy for experiencing sexism) and being HIV+ (β=0.013, p=8.9×10−11). PRS of PTSD and lead SNPS from GWAS interacted with TSLEs and our TRS to increase PTSD risk. In addition to TRS interactions, we found significant interactions between PTSD PRS and domestic violence, and sexual assault in European Americans (β>207.74, p<1.80×10−3). rs113282988 and rs189796944 variants reached genome-wide significance in interactions with TRS (β>0.056, p<9.04×10−9), and rs189796944 in an interaction with Physical Survival TSLEs (β>0.127, p<4×10−8).

In conclusion, quantification of trauma type, severity, and magnitude—alone and in concert with genetics—provides better prediction of PTSD risk than PRS alone. Understanding who is at risk of developing PTSD allows for timely clinical intervention and possible prevention.