bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbital Glial Heterotopia: A Report of 2 Cases and Review of the Literature
Authors: Mehta Neesurg S. , Tenzel Phillip A. , Sharfi Duaa , Colley Patrick , Iacob Codrin , Reddy Harsha S.
Published: July 2019

Orbital glial heterotopia, commonly considered a rare congenital lesion generally presenting in children, may first become symptomatic in adulthood. Biopsy is required for diagnosis, with symptoms and prognosis dependent on location and growth of the lesion.

Purpose:

To review the clinical radiographic and histopathologic findings associated with orbital glial heterotopia.

Methods:

A literature search in PubMed and Scopus was performed to include all articles published in English between 1980 and January 1, 2019. A case series including 29 case reports of 29 patients, as well as the authors’ 2 cases, were considered in the literature review.

Results:

The majority of the cases had onset of symptoms (86%) and age at presentation (71%) before 5 years of age. The most common presenting symptoms and signs were swelling (45%), strabismus (32%), and proptosis (26%). The most common lesion locations described were inferolateral (19%) or primarily posterior orbital or apical (19%). The most common findings associated with orbital glial heterotopia were microphthalmia (10%) and anophthalmia (6%); however, the majority did not have systemic abnormalities (71%). The most common imaging modality was CT scan (71%). Diagnosis was made with histologic analysis in all cases, and confirmed after subtotal resection (35%), total resection (39%), or incisional biopsy (26%). The majority of the cases report no growth on repeat imaging, with only 3 reports of recurrence.

Conclusions:

Glial heterotopia in the orbit is a rare clinical entity most commonly presenting in children. We present 2 cases of orbital glial heterotopia in adults, with a literature on these lesions in both the pediatric and adult populations. Surgeons and pathologists should be aware of this atypical presentation in adulthood. Biopsy is required for diagnosis but is not without risk. Prognosis is generally favorable.
From education to practice: What we can learn about the workforce from a survey of new nurse practitioners
Authors: Faraz Asefeh , Salsberg Edward
Published: July 2019

Background and purpose:

To understand the posttraining plans and job market for new nurse practitioners (NPs), a survey was conducted of new family NPs (FNPs) in 2017. The survey was also designed to test the logistics and feasibility of conducting such a survey on a national scale and the usefulness of data gathered.

Methods:

A descriptive, cross-sectional study was conducted through an online survey administered to a national sample of 159 FNPs who graduated from an accredited NP program.

Conclusions:

Many new NPs are not willing or interested in moving out of their local community even if there are limited opportunities locally. There are high numbers of NPs going into private practice compared with community health or federally qualified health centers. Many new NPs have extensive previous work experience as registered nurses in hospitals; the career progression to NP shifts their work setting from inpatient to outpatient settings.

Implications for practice:

Although the job market for new NPs is generally good, with the rapid increase in NP graduates combined with the unwillingness or inability of many new NPs to move, some areas may have surpluses of NPs and limited job opportunities for new NPs, whereas other areas may have shortages upcoming. The survey of new NP graduates is a useful tool to monitor the experience of new NPs and provides valuable information to NP programs and prospective students. Future research should ensure a representative sample of new graduate NPs to accurately reflect the experience of new NPs.
Treatment of Auricular Hematomas by OK-432: How and Why It Works
Authors: Ohta Nobuo , Fukase Shigeru , Kusano Yusuke , Saito Yutaro , Tateda Yutaka , Ishida Yusuke , Ikeda Ryoukichi , Yamazaki Muneharu , Ono Junya , Izuhara Kenji
Published: July 2019

Objectives:

The aim of this article was to investigate the effectiveness and underlying mechanisms of OK-432 therapy in patients with auricular hematomas.

Study Design and Setting:

Case series with planned data collection.

Subjects and Methods:

We tried this therapy in 47 patients with auricular hematoma between April 2008 and August 2018. We aspirated as much of the fluid content of each lesion as possible with a 21-gage needle. We injected OK-432 solution into the lesion with the same needle that we used for aspiration. We performed this treatment at an outpatient basis without hospitalization.

Results:

Disappearance and marked reduction of the lesion were observed in all patients who had this therapy, and local scarring and deformity of the auricle did not occur in any patients. As adverse effects, local pain at the injection site and fever (37–38.5°C) were observed in some cases of the patients who had this therapy. The concentrations of various cytokines in each aspirate before and after OK-432 therapy were investigated. The production of tumor necrosis factor-α, interleukin-6, interleukin-8, interferon gamma, vascular endothelial growth factor, and periostin was significantly elevated in the aspirate fluid after OK-432 therapy.

Conclusion:

OK-432 therapy is simple, easy, safe, effective, and can be used as a substitute for surgery in the treatment of auricular hematoma.
Mycotic Pseudoaneurysm of Internal Carotid Artery Induced by Skull Base Osteomyelitis
Authors: Budhiraja Shilpi , Sagar Prem , Kumar Rajeev , Sharma Suresh C.
Published: July 2019

Background:

Skull base osteomyelitis (SBO) is predominantly seen in immunocompromised patients, with diabetes mellitus being the most common underlying comorbidity. Microbial aetiology is commonly bacterial, although fungal SBO is encountered in a small fraction of patients. Treatment consists of prolonged antimicrobial therapy, control of underlying comorbidity, and surgical debridement in selected cases. Involvement of cranial nerves is a common complication and is considered a poor prognostic factor. Pseudoaneurysm of internal carotid artery caused by skull base osteomyelitis is a very rare complication, limited to few case reports only.

Case:

We report the case of a 55-year-old diabetic patient with bacterial SBO who developed pseudoaneurysm of cervical–petrous part of internal carotid artery during the course of treatment.

Conclusion:

New onset symptoms or persistent symptoms in SBO suggest progressive disease and necessitate re-evaluation of the microbial aetiology and antimicrobial treatment. Skull base osteomyelitis induced aneurysm is rare but can be life threatening, if not identified and managed immediately.
A case report of cholangiocarcinoma combined with moderately differentiated gastric adenocarcinoma
Authors: Yang Yan-Hui , Deng Qing , Yang Tian-Bao , Gui Yang , Zhang Yu-xiang , Liu Jiang-Bo , Deng Qian , Liu Wei-Feng , Sun Jun-Jun
Published: July 2019

Rationale:

Multiple primary carcinoma (MPM) refers to simultaneous or successive occurrence of ≥2 types of primary malignant tumors in a single organ or in different organs of the same individual. It is rarely seen in clinical practice. Among the various types of MPM, hilar cholangiocarcinoma combined with gastric cancer is extremely rare.

Patient concerns:

The patient was a 61-year-old man who was admitted to our hospital due to upper abdominal discomfort and yellow-stained skin mucosa for 9 days.

Diagnoses:

Preoperative diagnosis: Considering the typical preoperative painless jaundice as well as his clinical imaging report, the patient received the following preoperative diagnosis: obstructive jaundice, type IV hilar cholangiocarcinoma based on Bismuth-Corlette classification, and no intrahepatic distant metastasis. Intraoperative diagnosis: The results of intraoperative snap freezing and laboratory examination indicated gastric adenocarcinoma. Therefore, the patient received an intraoperative diagnosis of obstructive jaundice, hilar cholangiocarcinoma, and gastric cancer. Postoperative pathological diagnosis: Postoperative pathological examination of the gastric lesion revealed the following results: ulcerative, moderately differentiated gastric adenocarcinoma and intestinal type in the Lauren classification of stomach cancer; moderately differentiated adenocarcinoma of the bile duct.

Interventions:

Surgical resection operation was carried out and the patient received chemotherapy after operation. But we could not strictly follow the relevant clinical guidelines to perform standardized operations and provide comprehensive treatment because of his economic situation, psychological factors, and the current medical environment in China.

Outcomes:

The patient did not receive standardized postoperative therapy. Although he lived and worked normally for 8 months after the operation, he died 10 months after surgery.

Lessons:

This report reminds us to pay close attention to the likelihood of MPM and other low-incidence diseases. The physicians and imaging clinicians should explore all clinical possibilities to avoid misdiagnosis of this rare disease and formulate effective treatment plans to maximize the therapeutic benefits for the patient.
Risk factors for drug-resistant epilepsy
Authors: Xue-Ping Wang , Hai-Jiao Wang , Li-Na Zhu , Xu Da , Ling Liu
Published: July 2019

Background:

Drug resistant epilepsy (DRE) is very common among children and adults and studies had found some related risk factors for DRE, while the results were not consistent. The aim of this study was to identify risk factors for drug-resistant epilepsy.

Methods:

Three electronic databases (Medline, Embase and Cochrane library) were searched to identify studies with a cohort design reporting on epidemiologic evidence regarding risk factors for DRE.

Results:

The pooled prevalence of DRE in newly diagnosed epilepsy patients was 25% (95% CI 17–32%). Abnormal electroencephalography (EEG) (both slow wave and epileptiform discharges) (RR 2.80; 95% CI 1.95–4.0), status epilepticus (SE) (RR 11.60; 95% CI 7.39–18.22), symptomatic etiology (RR 3.36; 95% CI 2.53–4.46), multiple seizure types (RR 3.66; 95% CI 2.37–5.64) and febrile seizures (RR 3.43; 95% CI 1.95–6.02) were identified as strong risk factors for DRE. In addition, firm conclusions cannot be drawn for poor short-term outcomes of therapy, neurodevelopment delay and high initial seizure frequency for the heterogeneity of study results. The predictive effect of focus onset seizure was not stable after removing one study and switching the effect model. Age of onset was not risk factors for DRE.

Conclusions:

The current meta-analysis identified potential risk factors for DRE. The results may contribute to better prevention strategies and treatments for DRE.
Pharmacological and non-pharmacological treatments for irritable bowel syndrome
Authors: Zhou Shenghui , Liu Xiaoli , Wang Xiaoxia , Xi Fenglin , Luo Xiaoke , Yao Liang , Tang Hao
Published: July 2019

Background:

The global prevalence of Irritable bowel syndrome (IBS) is estimated to be as high as 15% and a number of different non-pharmacological and pharmacological treatments have been used to manage IBS in clinical practice, which poses great challenges for clinicians to make appropriate decisions. Hence, a systematic review and network meta-analysis on all available pharmacological and non-pharmacological treatments for IBS is needed to provide reliable evidence.

Methods:

We will search the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane IBD Group Specialized Trials Register, MEDLINE, EMBASE, and Chinese Biomedical medicine (CBM) from inception to 31, May 2019. Randomized controlled trials of pharmacological and nonpharmacological interventions for IBS will be included. Study quality will be assessed on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Primary outcomes are global or clinical improvement and quality of life. A Bayesian network meta-analysis would be performed, and relative ranking of agents would be assessed. A node splitting method will be used to examine the inconsistency between direct and indirect comparisons when a loop connecting 3 arms exists.

Results:

Researchers will rank the effectiveness and safety of the potentials interventions for IBS according the characteristics of patients by conducting an advanced network meta-analysis based on Bayesian statistical model, and interpret the results by using GRADE approach.

Conclusion:

The conclusion of our study will provide updated evidence to rank the effectiveness and safety of pharmacological and non-pharmacological interventions for IBS.

Ethics and dissemination:

Ethical approval is not applicable since this study is a network meta-analysis based on published trials.

Protocol registration number:

CRD42018083844.
Postoperative adjuvant therapy for resectable early non-small cell lung cancer
Authors: Chai Tianci , Zhang Peipei , Lin Yuhan , Zhang Zhenyang , Lin Wenwei , Kang Mingqiang , Lin Jiangbo
Published: July 2019

Background:

Lung cancer is one of the most common malignant tumors, and non-small cell lung cancer (NSCLC) accounts for about 85% of lung cancer diagnosed. For patients with resectable early stage non-small cell lung cancer, routine postoperative adjuvant therapy can significantly prolong overall patient survival and reduce the risk of cancer recurrence. With the emergence and maturity of molecular targeted therapy and immunotherapy, the postoperative chemotherapy strategy of lung cancer patients has changed a lot. To evaluate the efficacy of postoperative adjuvant therapy (platinum-based chemotherapy, platinum-based chemotherapy plus molecular targeted therapy, platinum-based chemotherapy plus anti-angiogenic agents, or platinum-based chemotherapy plus immunotherapy) with or without radiotherapy for patients with NSCLC, we will conduct a systematic review and meta-analysis of the published or unpublished relevant randomized controlled trials.

Methods:

We will search PubMed (Medline), Embase, Google Scholar, Cancerlit, and the Cochrane Central Register of Controlled Trials for related studies published without language restrictions before June 20, 2019. Two review authors will search and assess relevant studies independently. Randomized controlled trials (RCTs) and quasi-RCTs studies will be included. We will perform subgroup analysis in different methods of postoperative adjuvant therapy for patients with resectable early NSCLC. Because this study will be based on published or unpublished records and studies, there is no need for ethics approval.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

This study will comprehensively compare the efficacy of platinum-based chemotherapy with that of molecular targeted therapy and immunotherapy for patients after surgery with resectable early NSCLC. Since large-sample randomized trials meeting the inclusion criteria of this study may be insufficient, we will consider incorporating some high-quality small-sample-related trials, which may lead to high heterogeneity and affect the reliability of the results.
The safety and efficacy of dorsal penile nerve block for premature ejaculation
Authors: Sun Song , Han Liang , Li Yufeng , Yu Xudong , Bao Binghao , Zhou Hong , Gong Ziqi
Published: July 2019

Background:

Premature ejaculation is a common sexual dysfunction disease in adult males. There are many clinical trials shown that dorsal penile nerve block can prolong the ejaculation latency to a certain extent in the vagina. In this study, we aim to use a meta-analysis to evaluate the efficacy and safety of dorsal penile nerve block for premature ejaculation.

Methods and analysis:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet, Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to February 2019. The quality of the included RCTs will be evaluated with the risk of bias (ROB) tool and evidence will be evaluated by GRADE. Data analysis will be used the special software like RevMan (version 5.3) and EndNote X7.

Results:

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of dorsal penile nerve block for premature ejaculation. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.

Trial registration number

PROSPERO CRD42019119691
An unusual cause of idiopathic megacolon in a juvenile
Authors: Liu Yinghua , Lv Zhibao , Xu Weijue , Liu Jiangbin , Huang Xiong
Published: July 2019

Rationale:

Idiopathic megacolon (IMC) is a rare condition in young children. The association of indigestible food and IMC has never been mentioned in literature.

Patient concerns:

An 11-year-old boy reported with a 1-year duration of intermittent constipation and abdominal distension after having eaten a large amount of fried sticky rice in 1 consumption.

Diagnoses:

Chronic low colonic obstruction, IMC and malnutrition.

Interventions:

This patient was managed conservatively for 1 week at first. Then he underwent loop ileostomy since conservative therapy was poorly tolerated. Enteral decompression, gut biopsy, peritoneal lavage, and drainage were performed in the same procedure.

Outcomes:

Rapid weight gain was observed 4 months after operation.

Lessons:

IMC is difficult to diagnose due to the lack of specific clinical manifestations and pathological features. The protocols for management of IMC remains controversial. To achieve a good long-term outcome, early intervention is recommended.
Small bowel perforation secondary to foreign body ingestion mimicking acute appendicitis
Authors: Ma Tantan , Zheng Wentao , An Beiying , Xia Yan , Chen Geng
Published: July 2019

Rationale:

Foreign body ingestion is often encountered in clinical practice; however, intestinal perforation owing to foreign body ingestion is rare.

Patient concerns:

Here, we present the cases of 2 patients who accidentally swallowed foreign bodies and later presented with pain in the right lower abdominal quadrant.

Diagnoses:

Both patients were initially diagnosed with acute appendicitis and underwent immediate emergency laparotomy.

Interventions:

During the operation, the appendix was found to be only mildly inflamed. On transection of the appendix, the mucosa was found to be inflamed, and yellow-white exudate was noted. We, therefore, decided to explore the entire bowel. The bowel examination revealed small bowel perforations, and palpation of the adjacent bowel revealed a hard, sharp object. The object was removed through the perforation site, the perforation was repaired, and the abdomen was closed in layers.

Outcome:

The postoperative recovery, in both cases, was uneventful.

Lessons:

Patients who swallow sharp or large foreign bodies should undergo endoscopy as soon as possible to avoid intestinal perforation. Clinicians should inquire about a history of foreign body ingestion. The preoperative diagnosis of intestinal perforation secondary to foreign body ingestion requires a high degree of clinical suspicion and awareness.
Reactive lymphoid hyperplasia of the liver
Authors: Zhang Wenyan , Zheng Shusen
Published: July 2019

Rationale:

Reactive lymphoid hyperplasia (RLH) of the liver is an uncommon benign lesion. It is usually difficult to differentiate from hepatocellular carcinoma (HCC), peripheral-type cholangiocellular carcinoma (CCC), combined HCC-CCC, and liver metastases. On account of its rarity and controversial issues, we report a case report and review the literature to discuss its clinical features, treatments, radiological, and immunohistochemical characteristics.

Patient concerns:

A 54-year-old woman had a history of primary biliary cirrhosis and chronic cholecystitis. She complained of finding a lesion in the right liver during her last medical check-up by abdominal B type ultrasound. The Contrast-enhanced computed tomography revealed a circular and low-density lesion in the right posterior lobe of the liver, approximately 22.0 × 18.7 mm in size. On magnetic resonance imaging, the lesion showed low-signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Laboratory test results were almost normal.

Diagnosis:

After the postoperative pathological and immunohistochemical examination, the patient was finally diagnosed as having RLH.

Interventions:

The patient received right posterior lobe hepatectomy and cholecystectomy.

Outcomes:

The patient was discharged 11 days after surgery. No evidence of recurrence was noted 1 year after the surgery.

Lessons:

Although RLH of the liver is rare, it is necessary to be considered in a liver lesion, especially in female patients. This case report may advance the understanding of RLH of the liver and reduce the number of mistakenly diagnosed patients.
Retrospective evaluation of the efficacy and safety of rivaroxaban in patients with cancer-associated venous thromboembolism
Authors: Oh Sang-Bo , Seol Young-Mi , Kim Hyo-Jeong , Choi Young-Jin
Published: July 2019

Abstrct

The purpose of this study was to evaluate the efficacy and safety of rivaroxaban for the treatment of cancer-associated venous thromboembolism (VTE).

We performed a retrospective chart review of cancer patients with a pulmonary embolism, deep vein thrombosis, or both. Our analysis included all patients who received rivaroxaban from March 2013 to June 2016 at the Hemato-Oncology Division at the Pusan National University Hospital in Korea.

Preliminary results identified 123 patients with a history of cancer that were treated with rivaroxaban. The average duration of rivaroxaban therapy was 95.25 days. While 35 patients had resolved VTE after the initiation of rivaroxaban, only one patient had it recur on rivaroxaban treatment. Major bleeding was observed in 6 (4.9%) patients and minor bleeding in 12 (9.8%) patients. The majority of bleeding events occurred spontaneously and most incidences of bleeding could be treated conservatively. Recurrence and major bleeding events on rivaroxaban were relatively low despite the fact that many patients had metastatic disease. Among 52 patient deaths (42.3%), none were due to VTE or bleeding complications; the cause of death in the majority of cases was cancer progression.

Rivaroxaban is effective and safe for the treatment of cancer-associated VTE.
Massive esophageal bleeding in long-standing achalasia complicated by esophageal carcinoma and aspirin-induced stasis ulcer
Authors: Cho Joon Hyun
Published: July 2019

Rationale:

Esophageal hemorrhage may occasionally develop subsequent to esophagitis and stasis ulcer, but potentially fatal esophageal bleeding is very uncommon in primary achalasia.

Patient concerns:

We describe a case of a 64-year-old man with long-standing achalasia and megaesophagus who presented acute episodes of life-threatening upper gastrointestinal bleeding.

Diagnoses and interventions:

Five esophagogastroduodenoscopies (EGD) were conducted and during each large amount of static food, bloody material, and clots should be removed from the esophagus because of impaired esophageal transit. Eventually, diffuse multiple irregular ulcers were observed in the middle and lower portions of the esophagus that were presumed to have been caused by aspirin stasis based on considerations of previous drug use. EGD also revealed a 2.0 × 2.5 cm flat nodular lesion with central ulceration at the mid-to-lower esophagus and adherent blood clots suggestive of bleeding stigma. The biopsy specimen demonstrated esophageal cancer. Accordingly, a diagnosis of massive esophageal hemorrhage in long-standing achalasia complicated by squamous cell carcinoma, possibly triggered by acute mucosal irritation and ulcer caused by aspirin stasis, was made. The patient then successfully underwent the Ivor-Lewis operation. Resultantly, the tumor was diagnosed as moderately differentiated squamous cell carcinoma stage IIA (T2N0M0).

Outcomes:

The patient's postoperative course was uneventful, and no evidence of tumor recurrence or metastasis has been found during the 6 months of follow-up examination. He was tolerating normal food with only minimal reflux symptoms.

Lessons:

Although, fortunately in the described case, esophageal cancer was diagnosed at a relatively early stage because it is the acute presentation of life-threatening upper gastrointestinal bleeding, this report cautions that when symptoms of dysphagia are aggravated, taking drugs capable of acting as local irritants, such as aspirin, could cause fatal esophageal hemorrhage in achalasia.
MiR-520f acts as a biomarker for the diagnosis of lung cancer
Authors: Zhou Yingyan , Shen Shimo
Published: July 2019

Lung cancer is a malignant tumor with high morbidity and mortality. Early diagnosis remains a great challenge for the cancer. In this study, we aimed to explore diagnostic performance of serum microRNA-520f (miR-520f) in lung cancer.

Serum specimens were collected from 139 lung cancer patients and 76 healthy volunteers. Relative expression level of serum miR-520f was detected adopting quantitative real-time polymerase chain reaction (qRT-PCR). Chi-square test was applied to evaluate the association of miR-520f with clinical parameters of the patients. Additionally, receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic value of miR-520f in lung cancer.

Serum miR-520f was down-regulated in lung cancer patients compared with healthy group (P <.001). Moreover, the expression of miR-520f was significantly associated with advanced TNM stage (P = .031) and metastasis (P = .002). The area under the curve (AUC) value of ROC curve was 0.888, suggesting that miR-520f could be a diagnostic biomarker for lung cancer. The cut-off value of serum miR-520f for lung cancer diagnosis was 1.815, with a sensitivity of 79.9% and a specificity of 84.2%.

Serum miR-520f was down-regulated in lung cancer patients, and may be a candidate biomarker for non-invasive screening of the disease.
The effect on congenital heart diseases of maternal EPHX1 polymorphisms modified by polycyclic aromatic hydrocarbons exposure
Authors: Tao Jing , Li Nana , Liu Zhen , Deng Ying , Li Xiaohong , Chen Ming , Yu Jing , Zhu Jun , Yu Ping , Wang Yanping
Published: July 2019

Polycyclic aromatic hydrocarbons (PAHs) may be 1 of etiologic factors responsible for congenital heart diseases (CHDs). Variations of the microsomal epoxide hydrolase (EPHX1) gene, as well as their possible interactions with PAHs exposure, may increase susceptibility to CHDs.

This case–control study investigated the risk of CHDs in relation to theEPHX1polymorphisms and assessed the interactions between these polymorphisms and PAHs exposure in 357 mothers of CHDs fetuses and 270 control mothers. Logistic regression models for the risk of CHDs were applied to determine the effect of genetic polymorphisms using additive, recessive, and dominant genetic models, as well as gene-exposure interactions. Multiple testing was adjusted by applying the false discovery rate (FDR).

None of the maternal genetic polymorphisms ofEPHX1was associated with CHDs occurrence. Only the single nucleotide polymorphism rs1051740 was associated with an increased risk of right-sided obstructive malformations under the recessive model (adjusted odds ratio [aOR] = 1.852, 95% confidence interval [CI]: 1.065, 3.22) before FDR correction. A possible modifying effect of PAHs exposure on genetic polymorphisms ofEPHX1was found in susceptibility to CHDs, though no multiplicative-scale interactions between maternal exposure to PAHs and polymorphisms ofEPHX1gene were seento affect the risk of CHDs.

The role ofEPHX1gene polymorphisms for CHDs need to be further evaluated, in particularly by interacting with PAHs exposure.
Association between red cell distribution width-to-platelet ratio and hepatic fibrosis in nonalcoholic fatty liver disease
Authors: Zhou Wen-Jie , Yang Jing , Zhang Ge , Hu Zheng-Qiang , Jiang Yong-Mei , Yu Fan
Published: July 2019

Background:

We aimed to assess the association between red cell distribution width-to-platelet ratio (RPR) and hepatic fibrosis in nonalcoholic fatty liver disease.

Methods:

The 388 subjects fulfilling the diagnostic criteria of Nonalcoholic fatty liver disease (NAFLD) were enrolled in this cross-sectional study. Red cell distribution, platelet, and other clinical and laboratory parameters were measured.

Results:

NAFLD patients with advanced fibrosis had significantly higher RPR than those without fibrosis (P < .001). Spearman correlation analysis showed that RPR were significantly correlated with age, sex, creatinine, hemoglobin, white blood cell, and advanced fibrosis (all with P < .05). Multivariate logistic regression analysis showed that RPR was an independent factor predicting advanced fibrosis (fibrosis-4 calculator ≥1.3) in NAFLD patients (OR: 5.718, 95%CI: 3.326–9.830, P < .001).

Conclusions:

Our findings suggested that RPR were significantly associated with advanced fibrosis in nonalcoholic fatty liver disease patients.
Noninvasive diagnosis of hereditary transthyretin-related cardiac amyloidosis
Authors: Qin Jin , Zhan Chenao , Li Haojie , Han Yunfeng , Wang Hong , Li Rui , Ma Fei , Yan Jiangtao
Published: July 2019

Rationale:

Cardiac transthyretin amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed because of the limited specificity of clinical manifestations, routine electrocardiogram, echocardiography and the traditional requirement for endomyocardial biopsy confirmation.

Patient concerns:

A 68-year-old female had suffered from lumbago for 5 years with progressive weakness, numbness in both lower limb.

Diagnosis:

The patient's clinical signs were not specific, but cardiac amyloidosis was suspected based on relative left ventricular apical sparing of longitudinal strain on echocardiography and continuous elevated serum levels of cardiac biomarkers (ultrasensitive cardiac troponin I and NT-proBNP). She was finally diagnosed hereditary transthyretin-related cardiac amylodosis by specific findings of cardiovascular magnetic resonance imaging (CMR), 99m-technetium pyrophosphate (99mTc-PYP) scintigraphy and genetic testing.

Interventions:

The patient received medications including diuretics, beta-blockers and angiotensin-converting enzyme inhibitors at the time of hospitalization. Ultimately, however, she refused further treatments and requested discharge from our hospital.

Outcomes:

A series of noninvasive technique enables the diagnosis of hereditary transthyretin-related cardiac amyloidosis.

Lessons:

While endomyocardial biopsy is not able to performed, this case demonstrates that a combination of noninvasive techniques, especially CMR, nuclear imaging, and genetic testing, may help us to make a correct diagnosis of hereditary transthyretin-related cardiac amyloidosis.
Multiple myeloma with onset of pancreas involvement
Authors: Wang Xin , Xie Huaiya , Zhang Lu
Published: July 2019

Rationale:

Multiple myeloma is the second most common hematological malignancy. Extramedullary involvement is one of the indicators of poor prognosis. There is no consensus in treatment options and the efficacy. This article reports a case of multiple myeloma with onset of pancreas involvement. Amyloidosis secondary to multiple myeloma and a partial response to the chemotherapy treatment further emphasized its rarity.

Patient concerns:

In this article, we report a 59-year-old male patient with a chief complaint of fatigue for 8 months and upper abdominal pain for 2 months.

Diagnosis:

The patients were diagnosed as amyloidosis secondary to multiple myeloma with pancreatic occupying (head–neck junction area) lesion based on laboratory examination and pathology from lymph node puncture and skin biopsy.

Interventions:

An intensive chemotherapy treatment as bortezomib, lenalidomide, dexamethasone, cisplatin, epirubicin, cyclophosphamide, and etoposide was given. Due to intolerance, treatment regimen was further adjusted to bortezomib, lenalidomide, and dexamethasone.

Outcomes:

The patient was 12 months alive. After 4 cycles of chemotherapy, a partial response was achieved and abdominal magnetic resonance imaging suggested a reduced pancreatic occupying lesion.

Lessons:

This case demonstrates that pancreatic involvement, digestive system neoplasm, and amyloidosis-related clinical features may be the earliest manifestations of multiple myeloma. For these patients, an intensive chemotherapy regimen may be a possible treatment approach.
Cryopreserved amniotic membrane and umbilical cord particulate matrix for partial rotator cuff tears
Authors: Ackley J. Freeland , Kolosky Michael , Gurin Danielle , Hampton Robert , Masin Richard , Krahe David
Published: July 2019

Amniotic membrane (AM) and umbilical cord (UC) are well known to have anti-inflammatory properties and have been shown to promote healing in various orthopedic indications. This study investigated whether intra-articular injection of AM/UC particulate matrix promotes healing of partial rotator cuff tears (RCTs).

A case series was performed on 10 patients that received injection of 50 mg AM/UC for partial RCTs that were refractory to conservative treatment. Outcomes included Penn Shoulder Score (PSS) questionnaire, range of motion examination, and magnetic resonance imaging (MRI) analysis before and at 6 months. Final MRI analysis was performed by a musculoskeletal radiologist in a blinded fashion.

Average PSS score (out of 100) increased from 46.8 ± 23.7 at baseline to 82.0 ± 19.1 at 6 months. The average PSS sub-scores of pain, satisfaction, and function increased 78.4%, 37.1%, and 82.3% from baseline, respectively. The subject's range of motion was 77.9% at baseline and increased to 99.9% at 6-months. Follow-up MRI scans did not demonstrate any significant change in RCT size. No adverse events were noted.

This small case series provides preliminary data for use of cryopreserved AM/UC particulate matrix in patients with refractory partial RCTs.
Poorly controlled type 2 diabetes with no progression of diabetes-related complications and low levels of advanced glycation end products
Authors: Nakamura Tomoka , Tsujimoto Tetsuro , Yasuda Kazuki , Chujo Daisuke , Ohsugi Mitsuru , Tanabe Akiyo , Ueki Kohjiro , Kajio Hiroshi
Published: July 2019

Rationale:

Previous studies have suggested that increased levels of advanced glycation end products (AGEs) and soluble receptor for AGE (sRAGE) are associated with diabetes-related complications. However, there is little evidence on the association between long-term levels of AGEs and sRAGE and progression of diabetes-related complications.

Patient concerns:

A 64-year-old man had poorly controlled type 2 diabetes, obesity, smoking, hypertension, and dyslipidemia. He had many risk factors for diabetes-related complications.

Diagnosis:

Despite poor glycemic control over 15 years, the patient did not exhibit diabetes-related complications.

Interventions:

We examined serum AGEs (CEL and MG-H1) and sRAGE levels in this patient over the past 10 years.

Outcomes:

The patient maintained low serum AGEs and sRAGE levels.

Lessons:

AGEs and sRAGE levels may be associated with long-term development of diabetes-related complications.
Helical blade compression failure occurred during PFNA implantation
Authors: Wang Chaoqun , Wang Qingxian
Published: July 2019

Rationale:

Femoral intertrochanteric fracture happens easily in the elderly, especially those with osteoporosis. As a standard intramedullary fixation implant, Proximal Femoral Nail Anti-rotation (PFNA) is applied to various types of stable or unstable intertrochanteric fractures of femur. Due to blade-related factors, such as cutting-through into the hip joint, cutting out or back out, there are endless postoperative failure cases of internal fixation, but reports about perioperative failure that the helical blade cannot be tightened are lacking. In this case, we firstly report an intraoperative blade compression failure and an effective technique to help surgeons out of the dilemma by using cannulated hexagonal screwdriver which was already included in the orthopedic instrument box.

Patient concerns:

An 81-year-old lady suffered left hip pain, swelling and limitation of activity, after slipping and falling when she was in the toilet.

Diagnoses:

X-ray and computed tomography (CT)-scan showed comminuted left intratrochanteric fracture with a Jensen classification of IIa type.

Interventions:

The patient was treated by closed reduction and internal fixation with PFNA. We suffered an unprecedented problem that helical blade cannot be tightened by the blade impactor as usual. For fear of helical blade disintegration during removal and a significant decrease in pullout strength after reinsertions, we eliminated the dilemma by using a cannulated hexagonal screwdriver to tighten the “problem” helical blade.

Outcomes:

The “problem” helical blade was finally locked by using the SW4.0 mm cannulated hexagonal screwdriver which was already included in the instrument box. The operation ended successfully after completing subsequent steps.

Lessons:

The cannulated hexagonal screwdriver is an effective instrument that can help surgeons out of the dilemma when the blade impactor fails to tighten the helical blade in PFNA implantation.
The association between awareness and behavior concerning the need for protection when using pesticide sprays and neurologic symptoms
Authors: Li Jiangping , Yu Hu , He Shulan , Xue Min , Tian Danian , Zhou Jian , Xie Yongxin , Yang Huifang
Published: July 2019

Pesticide exposure is a major health risk factor among agricultural workers, and poor protective behavior and a lack of awareness concerning the risks of pesticide use in developing countries may increase the intensity of pesticide exposure. This cross-sectional study aimed to explore the relationship between neurologic symptoms and protective behavior and awareness in relation to pesticide use in China. Latent class cluster analysis was used to categorize participants into 3 latent cluster subgroups, namely, a poor protective behavior subgroup, an excellent protective awareness and behavior subgroup, and a poor protective awareness subgroup, using a person-centered approach. Multivariate regression models were used to detect the association between the latent class cluster subgroups and self-reported neurologic symptoms. The results showed that poor protective behavior in pesticide use was an important negative predicator of neurologic symptoms such as reduced sleep quality, frequency of nightmares, debility, hypopsia, and hypomnesis. These findings suggest that targeted interventions for agricultural workers, especially local greenhouse farmers, are urgently needed to improve pesticide protection behavior.
Postoperative intraperitoneal hyperthermic perfusion improve survival for advanced gastric cancer
Authors: Zhang Hong-Wei , Yang Jian-Jun , Zheng Ji-Yang , Sun Li , Yang Xue-Wen , Li Guo-Cai
Published: July 2019

To evaluate the value of intraperitoneal hyperthermic perfusion (IPHP) in the treatment of gastric cancer.

Gastric cancer (GC) is a malignancy with poor prognosis, recent years have demonstrated advances in the use of IPHP for the treatment of advanced gastric cancer (AGC), but the outcome is controversial.

Between January 2015 and January 2017, 134 patients with GC were treated with IPHP in our surgery department, 130 of them were advanced GC patients, and other 1439 cases were treated without IPHP for comparison. In this retrospective cohort study, demographic, perioperative data, and follow-up data were analyzed by univariant analysis, Kaplan–Meier and Cox regression survival analysis.

We found the 1-year survival in IPHP group was significantly longer than it in non-IPHP group (85.5% vs 73.8%, P = .027). and IPHP decreased mortality 1.8 times in 2-year course (OR = 0.556, P = .004). The incidence rate of total complications in IPHP group was similar to that in the Non-IPHP group (6.67% vs 7.46%, respectively; P = .718). We classified all patients into four groups, operation alone, operation + chemotherapy, operation + IPHP, and operation + IPHP + chemotherapy. The 1-year survival in the groups was 70.2%, 77.5%, 83.1%, and 93.5%, respectively (P = .001), compared with the group of operation alone, the 2-year mortality risk was decreased 1.76 times (OR = 0.569, P = .030) and 2.59 times (OR = 0.385, P = .022) in operation + IPHP group and operation + IPHP + chemotherapy group.

Our results suggest that IPHP could contribute to improve survival of patients with gastric cancer. And the modality of operation + IPHP + chemotherapy is the optimal treatment modality for gastric cancer.
Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa
Authors: Wang Xi , Hou Haiyan , Yu Qi
Published: July 2019

Different sizes of uterine septum between infertile women and patients with abortions may have a clinical relevance in reproductive performance after surgery. This study aimed to assess if the fecundity of women after surgical correction of the uterine septum is associated with septum size.

A retrospective, single-center, cohort study was conducted in Peking Union Medical College Hospital using patients aged between 21 and 37 years. Hysteroscopic metroplasty was performed on 121 patients with a uterine septum. The septum size was assessed by ultrasonography and hysteroscopy. The subjects were divided into 3 groups: Group A consisted of 35 women with complete uterine septum (mean ± standard deviation (SD) age 28.29 ± 3.53; group B consisted of 48 women with uterine septum >2.5 cm (mean ± SD age 28.85 ± 3.63); and group C consisted of 48 women with uterine septum ≤2.5 cm (mean ± SD age 28.79 ± 3.74). Age and body mass index (BMI) were not significantly different among the 3 groups.

No serious hysteroscopic complications occurred. However, uterine septa were observed in 4 cases after surgery and 6 cases of intrauterine adhesions were observed after long-term follow-up. The abortion rate decreased, and term delivery rate increased significantly in the 3 groups after hysteroscopic metroplasty. The infertility rate was significantly lower in group C after surgery. However, no significant difference was observed in the infertility rate between groups A and B. The recurrent abortion rate was significantly lower in group A than in groups B and C before surgery. After surgery, the infertility rate was significantly higher in group A than in group B (28.57% and 10.53%, respectively; P = .048). After at least 12-months of follow-up, the pregnancy rate in group A was significantly lower than that in group C (71.43% and 89.47%, respectively; P = .048).

Uterine septum resection improves obstetrical outcomes. After surgery, the infertility rate was significantly higher in patients with complete uterine septum than in those with a large partial uterine septum, and the pregnancy rate in patients with complete uterine septum was lower than that in the patients with a small partial uterine septum.
Study protocol of the cost-effectiveness comparison of two preventive methods in the incidence of caries
Authors: Fernández-Barrera Miguel Ángel , Lara-Carrillo Edith , Scougall-Vilchis Rogelio José , Pontigo-Loyola América Patricia , Ávila-Burgos Leticia , Casanova-Rosado Juan Fernando , Casanova-Rosado Alejandro José , Minaya-Sánchez Mirna , Medina-Solís Carlo Eduardo
Published: July 2019

Introduction:

Dental caries is the most frequent oral disease worldwide and the main cause of tooth loss in children and young adults. One of the most frequently affected areas is the occlusal surfaces of the first permanent molars (FPM) due to their morphological complexity. At present, several preventive treatments can reduce the incidence of this disease in school populations. In Mexico, the most commonly used technologies are those derived from some presentation of fluoride; on the other hand, research on this topic has been limited.

Objective:

To determine the cost-effectiveness of two different methods for preventing the incidence of caries on the FPM of schoolchildren (6–8 years of age) from public primary schools.

Material and methods:

This is a randomized experimental design. Participants will be assigned to two treatment groups of 114 each. In the first group, pit and fissure sealants will be applied, whereas the second group will receive a fluoride varnish. The work will be carried out in schoolchildren that attend public elementary schools in the state of Hidalgo, Mexico. The result variable will be the incidence of caries and the total cost of each of the interventions will be calculated in order to calculate the intervention's cost-effectiveness.

Conclusion:

This work will allow us to compare the cost-effectiveness of the pit and fissure sealants and the fluoride varnish in order to determine which offers the best results.
Triglycerides and endothelial function: molecular biology to clinical perspective
Authors: Kajikawa Masato , Higashi Yukihito
Published: July 2019

Purpose of review

Recently, a high level of triglycerides has attracted much attention as an important residual risk factor of cardiovascular events. We will review and show the mechanisms underlying the association of endothelial dysfunction with hypertriglyceridemia and present clinical evidence for a relationship between endothelial function and triglycerides.

Recent findings

Clinical studies have shown that hypertriglyceridemia is associated with endothelial dysfunction. It is likely that hypertriglyceridemia impairs endothelial function through direct and indirect mechanisms. Therefore, hypertriglyceridemia is recognized as a therapeutic target in the treatment of endothelial dysfunction. Although experimental and clinical studies have shown that fibrates and omega-3 fatty acids not only decrease triglycerides but also improve endothelial function, the effects of these therapies on cardiovascular events are controversial.

Accumulating evidence suggests that hypertriglyceridemia is an independent risk factor for endothelial dysfunction. Triglycerides should be considered more seriously as a future target to reduce cardiovascular events. Results of ongoing studies may show the benefit of lowering triglycerides and provide new standards of care for patients with hypertriglyceridemia possibly through improvement in endothelial function.
Vegetarian Diet Patterns and Chronic Disease Risk
Authors: Palacios Orsolya M. , Maki Kevin C.
Published: July 2019

Vegetarianism continues to increase globally due, in part, to perceived health benefits. Results from observational studies indicate that vegetarian dietary patterns are associated with favorable cardiometabolic risk factor profiles and lower risks of chronic diseases including obesity, diabetes mellitus type 2, cardiovascular disease, and cancer. Aside from avoidance of meat and the compensatory dietary alterations, vegetarians tend to practice lifestyle habits conducive to better health. Well-controlled intervention trials show minimal or no effects of lean meat intake on traditional markers for chronic disease risk, although biologically plausible mechanisms exist through which consumption of meat and other animal products could influence risks of cardiovascular disease and some cancers. Thus, at present, the degree to which favorable health outcomes associated with vegetarian diet patterns are attributable to avoidance of animal products per se is unclear. This issue has major public health implications because more than 95% of the US population are regular consumers of meat and other animal products. This review aims to summarize the evidence regarding vegetarian diet patterns and major chronic diseases, explore possible explanations for these relationships, and identify research gaps and opportunities to better define the health effects of vegetarian dietary patterns.