bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between metabolic syndrome and knee structural change on MRI
Authors: Pan Feng , Tian Jing , Mattap Siti Maisarah , Cicuttini Flavia , Jones Graeme
Published: June 2019

Objective

To examine the association of metabolic syndrome (MetS) and its components with knee cartilage volume loss and bone marrow lesion (BML) change.

Methods

Longitudinal data on 435 participants from a population-based cohort study were analysed. Blood pressure, glucose, triglycerides and high-density lipoprotein (HDL) were collected. MetS was defined based on the National Cholesterol Education Program–Adult Treatment Panel III criteria. MRI of the right knee was performed to measure cartilage volume and BML. Radiographic knee OA was assessed by X-ray and graded using the Altman atlas for osteophytes and joint space narrowing.

Results

Thirty-two percent of participants had MetS and 60% had radiographic knee OA. In multivariable analysis, the following were independently associated with medial tibial cartilage volume loss: MetS, β = −0.30%; central obesity, β = −0.26%; and low HDL, β = −0.25% per annum. MetS, hypertriglyceridaemia and low HDL were also associated with higher risk of BML size increase in the medial compartment (MetS: relative risk 1.72, 95% CI 1.22, 2.43; hypertriglyceridaemia: relative risk 1.43, 95% CI 1.01, 2.02; low HDL: relative risk 1.67, 95% CI 1.18, 2.36). After further adjustment for central obesity or BMI, MetS and low HDL remained statistically significant for medial tibial cartilage volume loss and BML size increase. The number of components of MetS correlated with greater cartilage volume loss and BML size increase (both P for trend <0.05). There were no statistically significant associations in the lateral compartment.

Conclusion

MetS and low HDL are associated with medial compartment cartilage volume loss and BML size increase, suggesting that targeting these factors has the potential to prevent or slow knee structural change.
Deprescribing at the end of life in older patients
Authors: Stinson Matthew J. , Gurevitz Samuel , Carrigan Anna
Published: June 2019

In the United States, the adult population that will need hospice and palliative care is expected to double in the next 40 years. In primary care, providers are often faced with tough decisions on how to manage patients' medications at the end of life. This article describes how to deprescribe in the last year of life.
Competence-Based Curriculum Development in Nursing Education: A Story From the Western Balkans
Authors: Bokonjić Dejan , Račić Maja , Mašić Srdjan , Oruč Mirza , Rybarova Lubica , Vidović Kristina , Drieghe Belinda , van Wieren Johan , Çurçija Erard , Seiti Luis
Published: June 2019

This article describes the process of competence-based curriculum development in nursing education at Western Balkan (WB) universities. Nursing education in the WB has been noncompliant with the standard educational approaches of the European Union’s directive on regulated professions. The overall aim of the TEMPUS project “Competency-Based Curriculum Reform in Nursing and Caring in Western Balkan Universities” was to bring curricular reform for bachelor’s nursing education in the WB region in line with competence-based education and professional standards to demonstrate compliance with all member countries of the European Union.
A National Study of Longitudinal Consistency in ACGME Milestone Ratings by Clinical Competency Committees: Exploring an Aspect of Validity in the Assessment of Residents’ Competence
Authors: Hamstra Stanley J. , Yamazaki Kenji , Barton Melissa A. , Santen Sally A. , Beeson Michael S. , Holmboe Eric S.
Published: June 2019

Purpose

To investigate whether clinical competency committees (CCCs) were consistent in applying milestone ratings for first-year residents over time or whether ratings increased or decreased.

Method

Beginning in December 2013, the Accreditation Council for Graduate Medical Education (ACGME) initiated a phased-in requirement for reporting milestones; emergency medicine (EM), diagnostic radiology (DR), and urology (UR) were among the earliest reporting specialties. The authors analyzed CCC milestone ratings of first-year residents from 2013 to 2016 from all ACGME-accredited EM, DR, and UR programs for which they had data. The number of first-year residents in these programs ranged from 2,838 to 2,928 over this time period. The program-level average milestone rating for each subcompetency was regressed onto the time of observation using a random coefficient multilevel regression model.

Results

National average program-level milestone ratings of first-year residents decreased significantly over the observed time period for 32 of the 56 subcompetencies examined. None of the other subcompetencies showed a significant change. National average in-training examination scores for each of the specialties remained essentially unchanged over the time period, suggesting that differences between the cohorts were not likely an explanatory factor.

Conclusions

The findings indicate that CCCs tend to become more stringent or maintain consistency in their ratings of beginning residents over time. One explanation for these results is that CCCs may become increasingly comfortable in assigning lower ratings when appropriate. This finding is consistent with an increase in confidence with the milestone rating process and the quality of feedback it provides.
Natural History of Spastic Hip Disease
Authors: Lins Laura A.B. , Watkins Colyn J. , Shore Benjamin J.
Published: June 2019

Background:

Hip displacement in children with cerebral palsy is common and related to a child’s gross motor function. Progressive lateral hip displacement can result in severe pain, impaired function and quality of life. The purpose of this paper is to review the literature to identify the natural history of untreated spastic hip displacement in children with cerebral palsy.

Methods:

A search of the literature was carried out using PubMed to identify papers describing the natural history of spastic hip displacement in children with cerebral palsy. Population-based studies, large retrospective cohort series, and randomized trials were included when available; expert opinion and case series were excluded.

Results:

A total of 79 articles were reviewed. Articles were then subdivided into 4 main categories: epidemiology, pathophysiology, outcome, and prevention. The prevalence of hip displacement as defined as a migration percentage >30% was found to be 33% in pooled population-based studies. The risk of hip displacement was found to be linked to a child’s gross motor function. Hip surveillance programs have been shown to be sustainable and capable of preventing hip dislocation. The majority of children with hip dislocation do develop pain, decreased function, and impaired health-related quality of life (HRQOL).

Conclusions:

Children with cerebral palsy are at risk of progressive lateral hip displacement proportional to their gross motor function. Untreated progressive lateral hip displacement has been shown to negatively impact a child’s HRQOL and hip surveillance can decrease the incidence of hip dislocation.
The Natural History of Adolescent Idiopathic Scoliosis
Authors: Weinstein Stuart L.
Published: June 2019

Introduction:

Adolescent idiopathic Scoliosis (AIS) affects 2% to 3% of the population of which only 0.3% to 0.5% of affected patients will have a curvature of >20 degrees, the curve magnitude at which treatment is generally recommended. For AIS the current natural history data is limited and most of the information comes from a small body of literature from the University of Iowa.

Methods:

The Iowa natural history studies began as retrospective reviews but beginning in 1976, the cohort was followed prospectively. Outcomes assessed in this group of patients included; mortality, pulmonary function, pregnancy-(effect of pregnancy on scoliosis and the effect of scoliosis on pregnancy), radiographic, curve progression, and osteoarthritis. In addition, validated questionnaires were used to evaluate back pain, pulmonary symptoms, general function, depression, and body image.

Results:

Patients with untreated AIS can function well as adults, become employed, get married, have children, and grow to become active older adults. Unfortunately, untreated scoliosis may lead to increased back pain and pulmonary symptoms for patients with large thoracic curves. Patients with untreated AIS can also develop substantial deformity, and the cosmetic aspect of this condition cannot be disregarded.

Conclusions:

The summary findings of this unique lifetime natural history of AIS patients provides patients and parents a solid evidence base upon which to make informed decisions.
Natural History of Slipped Capital Femoral Epiphysis
Authors: Mathew Smitha E. , Larson A. Noelle
Published: June 2019

Background:

Slipped capital femoral epiphysis (SCFE) occurs at a rate of 1 in 10,000 to 20,000 children.

Methods:

A PubMed search was undertaken to evaluate recent SCFE literature. A convenience sample of articles were selected and summarized.

Results:

Most slips appear well tolerated long-term with ∼5% resulting in total hip arthroplasty (THA) at 20-year follow-up. Classic data reveals poor outcomes following closed reduction for treatment of SCFE. Improvements in intraoperative fluoroscopy and avoidance of pin penetration have reduced the rates of chondrolysis. Unfortunately, avascular necrosis remains a known risk in patients, occurring in 15% to 50% of patients following acute, unstable slips. This is the most common cause of THA in patients with SCFE. Rate of THA due to degenerative arthritis secondary to SCFE is more difficult to determine and occurs at a later age. Although realignment procedures to address anatomic abnormalities from SCFE have increased in popularity, it is unclear if this prevents degenerative arthritis and subsequently reduces the rate of THA. SCFE patients face an increased risk of disability and death due to their underlying medical comorbidities. Interventions for weight loss, blood pressure management, and lifestyle adjustments should be considered at the time of SCFE diagnosis.

Conclusions:

SCFE remains a challenging and common condition for pediatric orthopedists. Although innovative techniques have been proposed, long-term outcome data still supports in situ pinning for stable slips, and in situ pinning with capsular decompression for unstable slips to minimize the risk of avascular necrosis.
The Natural History of Pediatric and Adolescent Shoulder Dislocation
Authors: Franklin Corinna C. , Weiss Jennifer M.
Published: June 2019

Background:

Twenty percent of shoulder dislocations occur in people younger than 20 years old. Management of anterior shoulder instability in young patients remains an evolving and controversial topic. Herein we review the natural history of anterior shoulder dislocation in young patients.

Methods:

The English-language literature was searched for studies examining the natural history of pediatric and adolescent shoulder dislocation. Recurrent dislocation was the primary outcome of interest in most studies.

Results:

Most studies found that recurrent instability was likely in young patients. Several systematic reviews reported the recurrence rate for young patients to be >70%. Recurrent instability was likely to cause greater damage to the joint and may result in more extensive and costly surgery.

Conclusions:

Most studies agree that recurrent anterior shoulder instability is likely in young patients. Some authors advocate for consideration of early surgery in this high-risk population.
Mummified Cells are a Common Finding in Cutaneous Hodgkin Lymphoma and Can Be Used as a Diagnostic Clue
Authors: Kastnerova Liubov , Belousova Irena E. , Hadravsky Ladislav , Kerl Helmut , Cerroni Lorenzo , Kerl Katrin , Boudova Ludmila , Jindra Pavel , Cerna Katerina , Michal Michal , Kazakov Dmitry V.
Published: June 2019

Specific cutaneous involvement in Hodgkin lymphoma is rare. In cutaneous lesions, the diagnosis is usually based on the recognition of diagnostic Reed–Sternberg cells and its variants. In nodal Hodgkin lymphoma, so-called mummified cells (cells with condensed cytoplasm and pyknotic eosinophilic or basophilic nuclei) are often seen. They are sometimes conspicuous and easy to recognize, thus serving as a clue to the diagnosis. Our objective was to study cases of cutaneous Hodgkin lymphoma to identify the occurrence of mummified cells. We studied 12 patients (4 women and 8 men; age range 23–80 years). In 6 patients, cutaneous and extracutaneous disease was identified almost simultaneously; in 4 patients, lymph node disease preceded cutaneous involvement; and in the remaining 2 patients, the skin lesions were the presenting sign, whereas lymph node involvement occurred later. Histopathological, immunohistochemical, and molecular-genetic studies, including rearrangements for TCR, IgH genes, and PCR for EBV, were performed. Cutaneous biopsy specimens revealed either a multinodular or diffuse infiltrate, included small lymphocytes, eosinophils, plasma cells, and macrophages, but in all cases, diagnostic Reed–Sternberg cells and its variants were identified. Mummified cells were detected in 9 cases, either as occasional scattered mummified cells often requiring a search (6 cases) or being conspicuous, grouped and therefore easily identified (3 cases). Immunohistochemically, in all 7 cases studied, mummified cells were positive for both CD30 and CD15. It is concluded that mummified cells are encountered in a majority of cases of cutaneous Hodgkin lymphoma.
Scleromyxedematous Changes in a Patient With Long-Standing Mycosis Fungoides Who Progressed to Sézary Syndrome
Authors: Miraflor Allen P. , Pulitzer Melissa P. , Myskowski Patricia L. , Geller Shamir
Published: June 2019

Mycosis fungoides (MF) variants with different clinicopathologic and immunohistochemical features have been well-delineated. We report a case of scleromyxedematous changes arising in a patient with long-standing MF who progressed to Sézary syndrome (SS) shortly afterward. Total-skin electron-beam radiation therapy resulted in an excellent response, controlling both the MF/SS and the scleromyxedematous lesions; however, the patient died few months later. Although mucin deposition has been described in association with MF/SS (mainly follicular mucinosis in folliculotropic MF), there are limited reports in the literature on dermal mucinosis and scleromyxedematous changes in MF/SS. The mechanism of this association and its prognostic implications requires further investigation.
Quality Assessment of Dried Blood Spots from Patients With Tuberculosis from 4 Countries
Authors: Zuur Marlanka A. , Veenhof Herman , Aleksa Alena , van't Boveneind-Vrubleuskaya Natascha , Darmawan Endang , Hasnain Md Golam , Heysell Scott K. , Jongedijk Erwin M. , Koster Remco A. , Magis-Escurra Cecile , Martinez Nilza , Molinas Gladys , Mondal Dinesh , Mulyani Ully A. , Perwitasari Dyah A. , Tsivunchyk Andrej , Touw Daan J. , Alffenaar Jan-Willem C.
Published: June 2019

Background:

Dried blood spot (DBS) sampling is a blood collection tool that uses a finger prick to obtain a blood drop on a DBS card. It can be used for therapeutic drug monitoring, a method that uses blood drug concentrations to optimize individual treatment. DBS sampling is believed to be a simpler way of blood collection compared with venous sampling. The aim of this study was to evaluate the quality of DBSs from patients with tuberculosis all around the world based on quality indicators in a structured assessment procedure.

Methods:

Total 464 DBS cards were obtained from 4 countries: Bangladesh, Belarus, Indonesia, and Paraguay. The quality of the DBS cards was assessed using a checklist consisting of 19 questions divided into 4 categories: the integrity of the DBS materials, appropriate drying time, blood volume, and blood spot collection.

Results:

After examination, 859 of 1856 (46%) blood spots did not comply with present quality criteria. In 625 cases (34%), this was due to incorrect blood spot collection. The DBS cards from Bangladesh, Indonesia, and Paraguay seemed to be affected by air humidity, causing the blood spots not to dry appropriately.

Conclusions:

New tools to help obtain blood spots of sufficient quality are necessary and environmental specific recommendations to determine plasma concentration correctly. In addition, 3% of the DBS cards were rejected because the integrity of the materials suggesting that the quality of plastic ziplock bags currently used to protect the DBS cards against contamination and humidity may not be sufficient.
Evaluation of Total Donor Endothelial Viability After Endothelium-Inward Versus Endothelium-Outward Loading and Insertion in Descemet Membrane Endothelial Keratoplasty
Authors: Chong Elaine W. , Bandeira Francisco , Finn Prema , Mehta Jodhbir S. , Chan Elsie
Published: June 2019

Purpose:

This study compares endothelial cell density (ECD) and viability between 2 different techniques used to prepare and insert Descemet membrane endothelial keratoplasty (DMEK) donor tissues. The first technique uses the naturally forming Descemet membrane (DM) scroll where the endothelial cells face outward; in the second technique, the DM is folded into thirds (trifold) with the endothelial cells facing inward.

Methods:

Eighteen cadaveric corneas from 9 donors (matched pairs) were used to compare the 2 tissue-insertion techniques. In the scroll, endothelium-outward technique, standard DMEK preparation was used, and the naturally forming DM scroll was inserted into a Geuder Cartridge. In the trifold, endothelium-inward technique, DMEK preparation was undertaken by folding the donor tissue into thirds before being pulled into the EndoGlide Ultrathin. In each case, the tissue was injected onto a glass slide. Endothelial cell counting was performed using microscopy preinjection and postinjection, and vital staining using calcein acetoxymethyl (AM) was used for quantitative cell viability analysis across the whole tissue.

Results:

Manual ECDs using direct microscopy did not demonstrate a statistically significant difference in ECD between the 2 injection techniques. Using vital staining of the entire 8.0-mm diameter tissue, there was a significantly higher percentage of viable cells using the trifold, endothelium-inward technique (63.1%) compared with the scroll, endothelium-outward technique (41.5%) (P = 0.013). There was no difference in the pattern of cell loss between the 2 groups.

Conclusions:

Greater endothelial cell viability was observed using the trifold, endothelium-inward technique compared with the scroll, endothelium-outward technique.
Syphilis Screening Practices of Family Care Providers
Authors: Pinto Casey N. , Sneeringer Katie , Muller Alison
Published: June 2019

Background

The incidence of syphilis has doubled since 2000 and continues to increase. Improving syphilis screening practices is an important factor in controlling the spread. The major predictors of syphilis screening among family care providers were investigated.

Methods

A cross-sectional pilot survey consisting of 27 questions was administered electronically to 3 major health systems located in central Pennsylvania. The target population consisted of primary care physicians, nurse practitioners, and physician assistants. Statistical tests were performed to measure the associations between the predictors and the primary outcome variable of syphilis screening rate.

Results

Fifty-two surveys were completed and included. There was no significant association between provider type or provider-patient contact time with syphilis screening rate (P > 0.05). A positive relationship between providers who reported having a standard spoken phrase for sexual health queries and syphilis screening rate trended toward significance (P = 0.07). Qualitative data indicated some provider bias in screening patients only when they are symptomatic or during well woman visits.

Conclusions

Family care providers who have a standard spoken phrase when addressing sexual health are more likely to ask sexual behavior questions and are more likely to screen for syphilis. Biased screening practices are aimed at women, despite higher syphilis prevalence in men, demonstrating a need for increased efforts to educate providers about syphilis, and provide training programs to encourage the assessment of patient risk for exposure to sexually transmitted diseases.
Emergency Colostomy in Craniopagus Conjoined Twins
Authors: Kottappurath Manu , Jeenepalli Srinivasa Kishore , Mandelia Ankur
Published: June 2019

Although nurses plays a vital role in perioperative preparation and management, no nursing literature is available regarding intraoperative preparations for surgery on a conjoined twin. We report the perioperative preparation and nursing management for an emergency nonseparation surgery for a pair of craniopagus conjoined twins.
Exertional Heatstroke in a Marathon Runner Complicated by Concurrent Use of an Antipsychotic Medication Affecting Thermoregulation
Authors: Gessel Trevor , Lin Cindy Y.
Published: June 2019

We report the case of a half-marathon runner who presented with exertional heatstroke (EHS), whose management was confounded by concurrent treatment of his bipolar disorder with olanzapine. Antipsychotics can have a profound effect on thermoregulation and can cause athletes to present with features of neuroleptic malignant syndrome in the setting of EHS. It is vital for medical providers to consider the thermoregulatory effects of all medications, including antipsychotics, when providing care during sporting events.
Acute cerebral infarction following a Trimeresurus stejnegeri snakebite
Authors: Zeng Xiangxia , Hu Jinlun , Liang Xiaohuan , Wu Yixia , Yan Mei , Zhu Menghuan , Fu Yue
Published: June 2019

Rationale:

Acute cerebral infarction after snake bites is rare. The underlying mechanism causing the thrombotic process remains complex and unknown.

Patient concerns:

We herein describe a 49-year-old female who was bitten by a Trimeresurus stejnegeri. After 4 days of biting, she developed acute ischemic infarct.

Diagnosis:

The patient exhibited right side weakness and speech disturbances. Brain computed tomography (CT) scan showed no sign about cerebral hemorrhage symptoms, and brain magnetic resonance imaging (MRI) showed acute ischemic infarct in the left territory. The patient confirmed a diagnosis of acute cerebral infarction following a T. stejnegeri bite.

Interventions:

The patient received an injection of polyvalent anti-snake venom serum, neuroprotective therapy, and anti-platelet aggregate treatment.

Outcomes:

At the 3-month follow-up visit, the patient's left lower extremity swelling disappeared, the right limb muscle strength recovered, and the modified Rankin scale (mRS) score was 4 points.

Lessons:

The patient was diagnosed with acute ischemic infarct interrelated to snake bite; further investigations were needed to ascertain mechanism. The clinicians should pay more attention to identify potential victims of neurologic complications, to reduce the mortality rate of snake bite.
Feasibility of high-resolution manometry for decision of feeding methods in patients with amyotrophic lateral sclerosis
Authors: Suh Jee Hyun , Park Donghwi , Kim In Soo , Kim Hayoung , Shin Cheol Min , Ryu Ju Seok
Published: June 2019

As amyotrophic lateral sclerosis (ALS) progresses, dysphagia gets worse due to the weakening of pharyngeal musculature. As oral feeding becomes more difficult or dangerous due to worsening dysphagia, tracheal aspiration, or undernutrition, the necessity for tube feeding becomes increasingly important. This study aims to establish a standard pressure point by applying pharyngeal pressure using high-resolution manometry (HRM) to start tube feeding in patients with ALS.

This study was designed as a retrospective analysis of prospectively collected data. Forty-one patients with ALS and 20 healthy subjects were participated. Both groups were evaluated using HRM, videofluoroscopic swallowing study (VFSS), and pulmonary function test. The swallowing pressure along the velopharynx (VP), tongue base (TB), pre-upper esophageal sphincter (UES), lower pharynx, and cricopharyngeus, as well as minimal UES pressure were measured using HRM.

There was significantly positive correlation between the pressure of cricopharyngeus and forced expiratory volume in 1 second (FEV1). And there were significant correlations between results of VFSS and FEV1, FEV1%, forced vital capacity (FVC), and FVC%. There was a significant difference in the pressure of TB and cricopharyngeus between the control group and the ALS patient group. The pressures of VP, TB, lower pharynx, and cricopharyngeus have a significant correlation with the recommended feeding type by VFSS.

Because it is possible to use HRM to quantitatively assess pharyngeal and respiratory weaknesses and it is more sensitive than other evaluation tools, the cutoff value of HRM parameters may be used to decide the feeding type in patients with ALS.
Can endoscopists differentiate cytomegalovirus esophagitis from herpes simplex virus esophagitis based on gross endoscopic findings?
Authors: Jung Kyung Hwa , Choi Jonggi , Gong Eun Jeong , Lee Jeong Hoon , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Woo Jun Hee , Kim Do Hoon , Kim Sung-Han
Published: June 2019

Differential diagnosis between herpes simplex virus (HSV) esophagitis and cytomegalovirus (CMV) esophagitis is challenging because there are many similarities and overlaps between their endoscopic features. The aims of this study were to investigate the implications of the endoscopic findings for the diagnosis of HSV and CMV esophagitis, and to develop a predictive model for differentiating CMV esophagitis from HSV esophagitis.

Patients who underwent endoscopic examination and had pathologically-confirmed HSV or CMV esophagitis were eligible. Clinical characteristics and endoscopic features were retrospectively reviewed and categorized. A predictive model was developed based on parameters identified by logistic regression analysis.

During the 8-year study period, HSV and CMV esophagitis were diagnosed in 85 and 63 patients, respectively. The endoscopic features of esophagitis were categorized and scored as follows: category 1 (−3 points): discrete ulcers or ulcers with vesicles, bullae, or pseudomembranes, category 2 (−2 points): coalescent or geographic ulcers, category 3 (1 points): ulcers with an uneven base, friability, or with a circumferential distribution, category 4 (2 points): punched-out, serpiginous, or healing ulcers with yellowish exudates. And previous history of transplantation (2 point) was included in the model as a discriminating clinical feature. The optimal cutoff point of the prediction model was 0 (area under receiver operating characteristic curve: 0.967), with positive scores favoring CMV esophagitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 96.8%, 89.4%, 92.6%, 87.3%, and 97.5%, respectively.

The predictive model based on endoscopic and clinical findings appears to be accurate and useful in differentiating CMV esophagitis from HSV esophagitis.
Association between salivary amylase enzyme activity and obesity in Saudi Arabia
Authors: Aldossari Norah Mubarak , El Gabry Eman E. , Gawish Gihan E.H.
Published: June 2019

Obesity is a significant public health concern that predisposes individuals to a high risk of premature mortality. Previous studies also reported that low serum concentrations of AMY1 have been associated with obesity. The aimed of the study to assess the relationship between salivary amylase (AMY1) activity and body mass index (BMI) in Saudi male and female adults in Riyadh. This study included a total of 200 (100 individuals who were overweight and obese and 100 who had normal body weight [control individuals]) Saudi participants aged 20 to 50 years old. They were recruited from physical fitness clubs and were school employees in Riyadh City. The dietary food intake was assessed using a 24-hour dietary recall. The activity of the AMY1 was measured using a microplate fluorescence reader. A significant (P ≤ .05) increase was observed in the incidence of hypertension, dyslipidemia, diabetes mellitus (DM), and family history of overweight and obesity in overweight and obese individuals than in the control individuals, and these were in parallel to the significant increase in weight, waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. A significant (P ≤ .05) increase was also observed in the carbohydrate and total fat dietary intake of overweight and obese individuals in relation to the respective dietary reference intake (DRI) values. AMY1 activity was significantly lower than the reference values in the overweight and obese group. Furthermore, AMY1 activity was significantly (P ≤ .05) reverse with weight, WC, HC, and BMI in both males and females in the overweight and obese group. In conclusion, the Saudi overweight and obese population seems to be at risk of low AMY1, which correlates with their obesity.
Treatment with verapamil for restoration of sinus rhythm in atrial fibrillation with rapid ventricular response
Authors: Wang Xiaoou , Lin Yanxia , Chen Ling , Liang Dongke , Lin Jie , Qi Guoxian , Tian Wen
Published: June 2019

Rationale:

Atrial fibrillation (AF) is a common arrhythmia disease that can cause thromboembolic disease and/or heart failure, resulting in increased mortality. Propafenone, amiodarone, and flecainide are recommended for converting AF to sinus rhythm. Beta blockers, verapamil, diltiazem, and digoxin are recommended for controlling AF with fast ventricular rate (VR). In this case report, we found that verapamil successfully converted AF into sinus rhythm.

Patient concerns:

A 92-year-old woman presented with fast VR AF with a history of coronary heart disease, hypertension, and diabetes.

Diagnoses:

Verapamil can successfully convert AF into sinus rhythm.

Interventions and Outcomes:

The patient was treated with amiodarone or propafenone, yet still had AF. After stopping amiodarone and propafenone, the patient was given verapamil to control the VR, and following 9 days of treatment the patient switched to sinus rhythm. When verapamil treatment was stopped, the patient experienced AF recurrence. Upon receiving verapamil again, the AF again converted into sinus rhythm.

Lessons:

For the treatment of AF, nondihydropyridine calcium antagonists can be tried in the absence of antiarrhythmic drugs.
Intrahepatic adrenocortical adenoma arising from adrenohepatic fusion mimicking hepatic malignancy
Authors: Cho Yong Soo , Kim Jin Woong , Seon Hyun Ju , Cho Ju-Yeon , Park Jun-Hee , Kim Hyung Joong , Choi Yoo Duk , Hur Young Hoe
Published: June 2019

Rationale:

Intrahepatic adrenocortical adenoma (IAA) arising from adrenohepatic fusion (AHF) is rare and its imaging findings are not well established. Moreover, it is easily misdiagnosed as malignant hepatic tumor in patients at risk of malignancy. Its key finding is the connection between the tumor and adrenal gland. When IAA from AHF is suspected, biopsy should be considered to avoid unnecessary surgery. Herein, we report 2 cases of IAA from AHF.

Patient concerns:

A 59-year-old woman was admitted due to a 1.5-cm hypoechoic nodule in the right hepatic lobe detected on ultrasound for hepatocellular carcinoma (HCC) surveillance due to chronic hepatitis B. Contrast-enhanced computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) were performed to evaluate the hepatic mass. Another 75-year-old woman was admitted due to rectal adenocarcinoma detected on colonoscopy. Contrast-enhanced CT depicted a 2.5-cm mass in the right hepatic lobe.

Diagnosis:

In case 1, CT and MRI showed a 1.5-cm subcapsular mass in the right hepatic lobe with typical findings of HCC in a patient with chronic hepatitis B. The mass was confirmed as IAA from AHF after the laparoscopic surgery. In case 2, CT showed advanced rectal malignancy and a 2.5-cm poorly enhancing mass in the right hepatic lobe. The tentative diagnosis was hepatic metastasis. However, based on the connection between the tumor and adrenal gland during preoperative review, the presumed diagnosis was changed to IAA from AHF, which was confirmed on biopsy.

Interventions:

The hepatic mass connected with the right adrenal gland was laparoscopically resected in case 1. Laparoscopic lower anterior resection for rectal malignancy and percutaneous biopsy for the hepatic mass were performed in case 2.

Outcomes:

The first patient had an uneventful recovery, without recurrence on the 3-year follow-up CT. The second patient had an uneventful postoperative course and has been alive for 12 months postoperatively without pathologically proven IAA changes on follow-up CT.

Lessons:

When hepatic mass is found adjacent to the right adrenal gland on imaging, the connection between the tumor and adrenal gland should be investigated. When IAA arising from AHF is suspected, biopsy should be considered to avoid unnecessary surgery.
Association between genotypes of rs34436714 of NLRP12 and serum tumor necrosis factor-alpha in inflammatory bowel disease
Authors: Dellaporta Erminia , Lazaridis Lazaros-Dimitrios , Koussoulas Vasilleios , Netea Mihai G. , Giamarellos-Bourboulis Evangelos J. , Triantafyllou Konstantinos
Published: June 2019

We aimed to investigate the impact of the single nucleotide polymorphisms of rs34436714 of the NOD-like receptor protein 12 gene on the production of tumor necrosis factor-alpha (TNFα) in patients with inflammatory bowel disease (IBD)

In a matched case-control study 90 patients with IBD, 56 with Crohn disease (CD) and 34 with ulcerative colitis, were genotyped and compared to 98 healthy comparators matched for age and gender. Expression level of TNFα, interleukin (IL)-6, IL-12, and soluble triggering receptor expressed on myeloid cells were measured in patients’ sera. Peripheral blood mononuclear cells (PBMCs) were isolated and stimulated for TNFα production.

Serum TNFα was greater among carriers of GT/TT genotypes than GG genotypes of rs34436714. Stimulated TNFα production was also higher in carriers of GT/TT genotypes. The frequency of CD with fistulizing behavior and with CD involving the small intestine was greater among carriers of GT/TT genotypes than of the GG genotype. Distribution of the GG, GT, and TT genotypes of rs34436714 were in Hardy–Weinberg equilibrium in both groups. The genotype distribution was the same in both groups.

Carriage of minor frequency alleles of rs34436714 was accompanied by greater circulating levels of TNFα and by greater capacity for stimulated TNFα production by PBMCs. These alleles had an impact on the phenotype of patients with CD.
Effect of acupuncture at 3 anti-fatigue acupoints in the treatment of cancer-related fatigue in patients with cancer
Authors: Liao Muxi , Xie Yizi , Yan Jiao , Lin Tong , Ji Shuliang , Li Zongyao , Zhao Wenjing , Yang Yaqin , Lin Lizhu , Lin Jietao
Published: June 2019

Background:

Cancer-related fatigue (CRF), is a common distressing symptom of cancer. What's more, “Three anti-fatigue acupoints” is one of the most important components of “Jin's 3-needle therapy” created by Rui Jin, a professor of Guangzhou University of Chinese Medicine, which can be used in the treatment of CRF. In this article, researchers will assess the safety and effect of acupuncture at 3 anti-fatigue acupoints on CRF in patients with cancer.

Methods:

Literature search for relevant articles up to October 2018 will be carried out in 9 databases: Cochrane Library, Embase, PubMed, VIP, CBM, CNKI, Wanfang Database, CiNii, and OASIS. The included literatures will be randomized controlled trials of acupuncture at 3 anti-fatigue acupoints on CRF in patients with cancer. The certain common scales, which reflect the patients’ fatigue degree or life quality will be the primary outcome measures. The secondary outcome measures will be defined with the blood index. After collecting the data, we will utilize Stata V.13.0. to perform data synthesis, subgroup analysis, partial sequence analysis, sensitivity analysis, and so on. A funnel plot will be used to assess reporting biases. And the funnel plot will be evaluated by the Egger and Begg tests. The quality of evidence will be judged by the grading of recommendations assessment, development, and evaluation.

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

Our study will provide the evidence for the clinical efficacy and safety of acupuncture at 3 anti-fatigue acupoints in the treatment of CRF.
IGF-1 polymorphisms modulate the susceptibility to osteonecrosis of the femoral head among Chinese Han population
Authors: Wang Jun , Liu Hongyun , Zhang Qiliang
Published: June 2019

The study was performed to investigate the genetic associations of IGF-1 polymorphisms rs35767, rs5742714, and rs972936 with susceptibility to osteonecrosis of the femoral head (ONFH) among Chinese Han population.

Totally, 101 ONFH patients and 128 healthy controls were enrolled. Hardy–Weinberg equilibrium (HWE) was detected with chi-square test in control group. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated to estimate the relationship between IGF-1 polymorphisms and ONFH risk. Besides, hyplotype analysis was performed to examine linkage disequilibrium between the studied polymorphisms.

Genotype AA and allele A of polymorphism rs35767 were more frequent in control group, and offered protection for ONFH onset (AA: OR = 0.382, 95% CI = 0.158-0.923; A: OR = 0.650, 95% CI = 0.442–0.956). Furthermore, the negative relationship was also observed between ONFH risk and polymorphism rs5742714 under the comparisons CG vs CC, and G vs C (OR = 0.395, 95%CI = 0.199–0.787; OR = 0.346, 95%CI = 0.191–0.627). While the polymorphism rs972936 significantly enhanced the disease risk (CT vs CC: OR = 2.434, 95% CI = 1.184–5.003; TT vs CC: OR = 2.497, 95% CI = 1.040–5.990). Furthermore, haplotype analysis demonstrated that C-T (rs5742714–rs972936) could increase ONFH risk (OR = 2.177, 95% CI = 1.444–3.283), while G-T might be a protective factor for ONFH (OR = 0.472, 95% CI = 0.254–0.878).

IGF-1 polymorphisms rs35767, rs5742714, and rs972936 show significant association with ONFH risk.
Expression of IL-17 and its gene promoter methylation status are associated with the progression of chronic hepatitis B virus infection
Authors: Tian Cui-Huan , Dai Jun , Zhang Wei , Liu Yan , Yang Yan
Published: June 2019

To explore interleukin-17 (IL-17) and its epigenetic regulation during the progression of chronic hepatitis B virus (HBV) infection.

A total of 162 patients with chronic HBV infection, including 75 with chronic hepatitis B (CHB), 54 with hepatitis B-associated liver cirrhosis and 33 with hepatitis B-associated hepatocellular carcinoma (HBV-HCC), were enrolled in this study. Thirty healthy adults of the same ethnicity were enrolled in the control group. Whole venous blood was obtained from the patients and normal controls (n = 30). Clinical and laboratory parameters were assessed, and we performed enzyme-linked immunosorbent assay and quantitative real-time PCR to measure the serum levels and relative mRNA expression of IL-17, respectively. IL-17 promoter methylation in peripheral blood mononuclear cells was assessed by methylation-specific PCR. We analyzed the serum and mRNA levels of IL-17 and IL-17 promoter methylation in the 4 groups as well as the effect of methylation on serum IL-17 levels. Correlations between the IL-17 promoter methylation status and clinical parameters were analyzed by Spearman correlation analysis.

Compared to the normal control group, the patient groups exhibited significantly higher serum and relative mRNA levels of IL-17. The methylation distribution among the patients was significantly lower than that among the normal controls (P < .05), with the HBV-HCC group showing the lowest IL-17 gene methylation frequency. The average IL-17 promoter CG methylation level was negatively correlated with IL-17 mRNA expression (r = −0.39, P = .03), and negative correlations between IL-17 promoter methylation and prothrombin time activity (r = −0.585, P = .035), alanine aminotransferase (r = −0.522, P < .01), aspartate aminotransferase (r = −0.315, P < .05), and the model for end-stage liver disease score (r = −0.461, P < .05) were observed. IL-17 serum levels in the methylated-promoter groups were significantly lower than those in the unmethylated-promoter groups.

IL-17 expression and promoter methylation were associated with chronic HBV infection progression, especially in the HBV-HCC group. The IL-17 promoter status may help clinicians initiate the correct treatment strategy at the CHB stage.
Application of the cuff rectum drainage tube in total mesorectal excision for low rectal cancer
Authors: Ye Weipeng , Zhu Zhipeng , Liu Gang , Chen Borong , Zeng Junjie , Gao Jin , Wang Shengjie , Cai Hejie , Xu Guoxing , Huang Zhengjie
Published: June 2019

To investigate therapeutic effect of cuff rectum drainage tube (CDT) in preventing the postoperative complications of total mesorectal excision (TME) and promoting the recovery of the patients.

The clinical data of 84 cases of low rectal cancer performed TME from June 2015 to June 2017 in the First Affiliated Hospital of Xiamen University were analyzed retrospectively. All the cases were performed anus-retained operation without preventive colostomy. Patients were divided into 2 groups according to the material of the anorectal drainage tube placed in the colonic cavity. Group I (CDT group) was transanal cuff rectal drainage tube placement (Patent No. ZL 201320384337.8) (n = 48), and group II (conventional group) was transanal clinical conventional drainage tube placement (n = 36). Anastomotic fistula incidence, the time of anal exsufflation, postoperative first ambulation time, intestinal function recovery time, the incidence of interrelated complications of drainage tube and postoperative hospital stay between 2 groups were analyzed retrospectively.

Both postoperative first ambulation and anal exhaust time in CDT group were shorter than those in the conventional group ([2.3 ± 0.4] d vs [3.0 ± 0.2] d, P < .05; [3.3 ± 0.3] d vs [3.9 ± 0.5] d, P < .05). Meanwhile, the postoperative hospital stay of CDT group was significantly decreased than that in the conventional group ([10.3 ± 1.6] d vs [11.8 ± 1.1] d, P < .05). Significant different occurrence of complications existed in anastomotic fistula (2.1% [1/48] vs 16.7% [6/36], P < .05), frequent defecation (8.3% [4/48] vs 27.8% [10/36], P < .05), defecating unfinished feeling (12.5% [6/48] vs 30.6% [11/36], P < .05), drainage tube complication (4.2% [2/48] vs 22.2% [8/36], P < .05).

The cuff rectum drainage tube may reduce incidence of anastomotic fistula after TME, shorten postoperative first ambulation and anal exsufflation time, enable faster recovery with good toleration and decrease postoperative hospital stay.
Quick-SOFA score to predict mortality among geriatric patients with influenza in the emergency department
Authors: Chang Su-Hen , Yeh Chien-Chun , Chen Yen-An , Hsu Chien-Chin , Chen Jiann-Hwa , Chen Wei-Lung , Huang Chien-Cheng , Chung Jui-Yuan
Published: June 2019

The quick sequential organ failure assessment (qSOFA) score is widely used to assess the risk of sepsis and predict in-hospital mortality in patients with suspected infection. However, its ability to predict mortality among geriatric patients with influenza in the emergency department (ED) remains unclear. Therefore, this study was conducted to delineate this issue.

A retrospective case–control study was conducted on geriatric patients (age ≥65 years) with influenza who visited the ED of a medical center between January 01, 2010, and December 31, 2015. Demographic data, vital signs, past histories, influenza subtypes, and treatment outcomes were included in the analysis. We assessed the accuracy of the qSOFA score in predicting 30-day mortality via logistic regression. Covariate adjustment of the area under the receiver operating characteristic curve (AUROC) via regression modeling was performed too.

In total, 409 geriatric ED patients with mean age of 79.5 years and nearly equal sex ratio were recruited. The mean qSOFA score was 0.55 ± 0.7. The Hosmer–Lemeshow goodness-of-fit test was 0.79 for qSOFA score. Patients with qSOFA score of ≥2 (odds ratio, 4.21; 95% confidence interval [CI], 1.56–11.40) had increased in-hospital mortality. qSOFA score of ≥2 also had excellent in-hospital mortality discrimination with an adjusted AUROC of 0.81 (95% CI, 0.71–0.90). A qSOFA of ≥2 had prominent specificity of 0.89 (95% CI, 0.86–0.92).

An increase in qSOFA score of 2 greatly predicts mortality in geriatric patients with influenza.
Impacts of nurse-led clinic and nurse-led prescription on hemoglobin A1c control in type 2 diabetes
Authors: Wang Qun , Shen Yan , Chen Yongmin , Li Xiaohua
Published: June 2019

Background:

To evaluate the impacts of nurse-led clinic and nurse-led prescription on hemoglobin A1c (HbA1c) control in type 2 diabetes.

Methods:

We searched relevant publications in English and Chinese database and conducted meta-analysis by Stata 12.0. We divided the case groups of included studies into 2 categories according to the role of nurse: nurse-led clinic and nurse-led prescription. Nurse-led clinic was implemented on the basis of standard diabetes care provided by doctor, and control group also receive the standard diabetes care but without nurse-led clinic. The doctor mentioned above might work alone or in a health care team. Nurse-led prescription was prescribed by nurse independently and compared with that of doctor.

Results:

The meta-analysis shown that, compared with the standard diabetes care, nurse-led clinic significantly decreases HbA1c level (standard mean difference [SMD] = −0.767; 95% confidence interval [CI]: −1.062, −0.471; P < .001). In subgroup analysis, nurse-led clinic also had positive impacts on controlling HbA1c level, no matter in developed countries (SMD = −0.353; 95% CI: −0.6, −0.106; P = .005) or developing countries (SMD = −1.114; 95% CI: −1.498, −0.73; P < .001). Additionally, there was no significant difference between nurse-led prescription and doctor prescription in controlling HbA1c levels (SMD = −0.203; 95% CI: −0.434, 0.029; P = .086).

Conclusion:

The nurse-led clinic had positive significance for HbA1c control. Meanwhile, the impact of nurse-led prescription on controlling HbA1c is comparable to that of doctor. It is valuable to provide nurse-led clinic on the basis of standard diabetes care provided by doctor to better control HbA1c, and nurse-led prescription should be provided when doctor-led service is limited.
Base excess in predicting the prognosis of patients with paraquat poisoning
Authors: Zhang Feng Wei , Gao Jie , Zhang Su Li , Wu Cheng Pu , Li Yong , Bai Wen Jing , Feng Shun Yi
Published: June 2019

Background:

Although the prognostic significance of base excess (BE) in patients with paraquat (PQ) poisoning has been investigated for several years, the results remain controversial. Thus, we performed for the first time a comprehensive meta-analysis to explore the value of BE in predicting the prognosis of patients with PQ poisoning.

Methods:

We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, and the Chinese National Knowledge Infrastructure to identify all relevant papers that were published up to August 2018. The data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and subgroup analysis.

Results:

Pooled analysis revealed that a decreased BE is correlated with poor mortality (pooled OR = 21.358, 95% CI: 12.716–35.873, P < .001). Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 78% (95% CI: 0.66–0.86), 88% (95% CI: 0.66–0.97), 6.6 (95% CI: 2.2–19.9), 0.25 (95% CI: 0.18–0.36), and 26 (10–69), respectively. No publication bias was detected by Egger test (P = .263) and Begg test (P = .462). Sensitivity analyses indicated no important differences among the estimates of effects.

Conclusion:

Our findings show that BE is useful for predicting the prognosis of PQ poisoning.