bluuebunny/crossref_metadata_2025 huggingface dataset:
Titanium Elastic Nails Are a Safe and Effective Treatment for Length Unstable Pediatric Femur Fractures
Authors: Siddiqui Ali A. , Abousamra Oussama , Compton Edward , Meisel Erin , Illingworth Kenneth D.
Published: November 2019

Background:

Controversy exists regarding the treatment of length unstable pediatric femoral shaft fractures. The purpose of this study was to investigate the outcomes of skeletally immature children with length unstable femur fractures treated with titanium elastic nails (TENs).

Methods:

A retrospective review was conducted on all patients with femoral shaft fractures at a tertiary care pediatric hospital from April 2006 to January 2018. Patients with femoral shaft fractures treated with TEN and minimum 6 months follow-up were included. Exclusion criteria were age 11 years or above, weight >50 kg, pathologic fracture, and neuromuscular disorders. Femur fractures were categorized into 2 groups: length unstable (spiral, comminuted, or long oblique fractures) versus length stable (transverse and short oblique). Complications and reoperations were compared between the groups.

Results:

A total of 57 patients with 58 femoral shaft fractures were included. The mean age was 5±2 (1 to 11) years and mean follow-up was 20.4±18.1 (6.0 to 81.2) months. The mean weight was 22.9±7.7 (11.0 to 40.5) kg. There was no difference in age (P=0.32), weight (P=0.28) or follow-up length (P=0.57) between patients with length unstable fractures and those with length stable fractures. A total of 32/58 (55%) fractures were length unstable and 26/58 (45%) were length stable. Mean time to union was 4.6 months, and there was no significant difference in mean time to union between the 2 groups (P=0.71). Thirty-one complications occurred in 27 patients. There was no difference between groups in the incidence of major complications requiring revision surgery (P=0.68) and minor complications that did not require revision surgery (P>0.99).

Conclusions:

In children with femoral shaft fractures treated with TEN, there was no difference in the incidence of complications or reoperations between those with length unstable fractures and those with length stable fractures. TEN are a safe and effective choice for operative fixation of length unstable femoral shaft fractures in children.

Level of Evidence:

Level III—retrospective comparative study.
Importance of Early Improvement in the Treatment of Low Back Pain With Physical Therapy
Authors: Walston Zachary , McLester Cherilyn
Published: November 2019

Study Design. .

A retrospective observational study.

Objective.

Assess the time course of functional outcome improvements during a physical therapy (PT) episode of care for patients with low back pain. In addition, assess the impact of patient variables, such as symptom duration, on the time course of functional outcome improvements.

Summary of Background Data.

Early improvement in patient-reported symptoms and functional limitations may play an important role in the eventual success of an intervention. Early improvements in pain are associated with greater improvement in disability and depression in patients with low back pain.

Methods.

A total 11,945 patients were included. Intake functional status (FS), FS change at discharge, predicted FS change at discharge, FS change at first progress report (FS1), duration of symptoms before treatment, and duration of PT episode of care were assessed. Pearson correlation analysis was used to assess correlation between collected variables and FS change.

Results.

The mean FS change was 16.995 units, mean FS1 was 12.024 units, total duration was 63.591 days, and duration at FS1 was 28.969 days, indicating 70.72% of FS change occurred in the first 45.45% of the episode of care. Similar results occurred in all symptom duration categories, ranging from “0 to 7 days" to “greater than 6 months" duration. Correlation analysis demonstrated that FS1 had the greatest correlation to FS. A strong correlation (r > 0.7) was demonstrated in all symptom duration categories ranging from 0.741 to 0.805.

Conclusion.

The results of this study yield further support for the importance of rapid functional improvements during a PT episode of care. In addition, patients demonstrated roughly two-thirds of their improvement in the first 40% of visits regardless of their symptom duration. This study may help clinicians identify a need to modify a plan of care if insufficient early improvement is observed.

Level of Evidence: 3
Circulating miR-155-5p as a Novel Biomarker of Lumbar Degenerative Disc Disease
Authors: Divi Srikanth N. , Markova Dessislava Z. , Fang Taolin , Guzek Ryan , Kurd Mark F. , Rihn Jeffrey A. , Hilibrand Alan S. , Anderson David Greg , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: November 2019

Mini

Circulating microRNAs provide an insight into current disease states. Comparing patients with degenerative disc disease to healthy controls, patients with disc disease were found to have significantly downregulated levels of miR-155-5p. This marker was found to be an accurate diagnostic predictor for the presence of degeneration (P = 0.006).

Study Design.

Case-control study measuring differential gene expression of circulating microRNA (miRNA) in patients with degenerative disc disease (DDD).

Objective.

To identify miRNA dysregulation in serum samples of patients with DDD compared to healthy controls (HC).

Summary of Background Data.

Early DDD can be a difficult diagnosis to make clinically, with lack of positive and specific findings on physical exam or advanced imaging. miRNAs are a class of molecules that act as gene regulators and have been shown to be dysregulated in local degenerative disc tissue. However, to date no studies have identified dysregulation of serum miRNA in patients with DDD.

Methods.

Whole blood samples were obtained from 69 patients with DDD and 16 HC. Patient-reported outcomes were collected preoperatively and degree of DDD was classified using Pfirrmann grade on preoperative imaging. Differential gene expression analysis using a screening assay for several hundred miRNAs and further characterization for five specific miRNAs (miR-16-5p, miR-21-5p, miR-142-3p, miR-146a-5p, and miR-155-5p) was performed. In addition, a pro-inflammatory cytokine multiplex assay and bioinformatics analysis were done.

Results.

The initial screening assay showed 13 miRNA molecules that were significantly dysregulated in DDD patients, with miR-155-5p showing significant downregulation (p = 0.027) and direct interactions with the pro-inflammatory cytokine IL-1β, and the tumor suppressor genes p53 and BRAF. Analyzing the whole cohort, miR-155 showed an almost four-fold downregulation in DDD patients (−3.94-fold, P < 0.001) and was the sole miRNA that accurately predicted the presence of disc degeneration (P = 0.006). Downregulation of miR-155 also correlated with increased leg pain (P = 0.018), DDD (P = 0.006), and higher Pfirrmann grade (P = 0.039). On cytokine analysis, TNF-α (0.025) and IL-6 (P < 0.001) were significantly higher in DDD patients.

Conclusion.

Serum miR-155-5p is significantly downregulated in patients with DDD and may be a diagnostic marker for degenerative spinal disease.

Level of Evidence: N/A
Paraspinous Muscle Flaps for the Treatment of Complex Spinal Wounds
Authors: Inglesby Dani C. , Young Zachary T. , Alshareef Mohammed , Ritter Alexandra , Gunasekaran Arunprasad , Kalhorn Stephen P. , Lance Tavana M.
Published: November 2019

Mini

This retrospective case series investigated paraspinous flaps for coverage of complex spinal wounds. 6.90% of patients developed postoperative wound infections and 0.00% of patients required instrumentation removal for infection. This suggests that these flaps may offer a long-term solution in wound management for patients with repeated spinal operations.

Study Design.

Retrospective case series.

Objective.

To investigate the efficacy and complication profile of the use of paraspinous muscle flaps for closure of complex spinal wounds.

Summary of Background Data.

Paraspinous muscle flap closure offers an innovative option in difficult-to-manage post-spinal surgery wounds. Current literature reports are mixed in terms of success and complication rates of these flap procedures, with most sources citing a wound complication rate of 20%.

Methods.

This case series investigated the hospital course of 58 patients undergoing paraspinous flap closure after spinal surgery between the years 2014 and 2018. Information gathered includes: demographics, surgery indication, location, and length of incision on the spine, nutrition labs, previous spinal surgeries, preoperative wound class, operative times, length of hospital stay, and complication rates including reoperation, wound infection, and other postoperative complications.

Results.

Of the 58 patients undergoing spinal muscle flap closure, 51 (87.93%) had undergone previous spinal surgery with an average of 2.12 previous surgeries in these patients. Mean albumin and prealbumin were 2.62 and 13.75, respectively. 4/58 (6.90%) developed a wound infection or experienced a continuation of their chronic osteomyelitis. Of the 57 patients that had spinal instrumentation, three (5.26%) had spinal implants removed at the time of surgery and two (3.51%) had it removed or replaced later for mechanical complications. No patients had instrumentation removed for chronic infections. One (1.72%) experienced reoperation for wound-related complications. These rates are lower than most complication rates in the current literature.

Conclusion.

The plastic and reconstructive paraspinous muscle flap has promising results as a closure option for complex spinal wounds following neurosurgical cases. Further investigation is called for to determine the applicability of these results to the general population.

Level of Evidence: 4
Prevalence and Risk Factors for Thrombotic Complications Following Venovenous Extracorporeal Membrane Oxygenation: A CT Scan Study*
Authors: Parzy Gabriel , Daviet Florence , Persico Nicolas , Rambaud Romain , Scemama Ugo , Adda Mélanie , Guervilly Christophe , Hraiech Sami , Chaumoitre Kathia , Roch Antoine , Papazian Laurent , Forel Jean-Marie
Published: November 2019

Objectives:

The aims of this study were to: 1) analyze the cannula-associated deep vein thrombosis frequency after venovenous extracorporeal membrane oxygenation using a CT scan and 2) identify the associated risk factors for cannula-associated deep vein thrombosis.

Design:

Retrospective observational analysis at a single center.

Setting:

Tertiary referral university teaching hospital.

Patients:

Patients under venovenous extracorporeal membrane oxygenation with a femorofemoral or femorojugular cannulation admitted for acute respiratory distress syndrome or primary graft dysfunction after pulmonary transplantation. CT scan was performed within 4 days after decannulation.

Interventions:

None.

Measurements and Main Results:

We included 105 of 228 patients screened. Bacterial pneumonia was the main indication of venovenous extracorporeal membrane oxygenation (46.7%). CT scans were performed at a median of 2 days (1–3 d) after decannulation. Cannula-associated deep vein thrombosis was found in 75 patients (71.4%) despite it having a mean activated partial thromboplastin time ratio of 1.60 ± 0.31. Femorofemoral cannulation induced femoral cannula-associated deep vein thrombosis more frequently than femorojugular cannulation (69.2% vs 63.1%, respectively; p = 0.04). Seventeen of the 105 patients (16.2%) had a pulmonary embolism. Multivariate logistic regression analysis showed that higher the percentage of thrombocytopenia less than 100 G/L during extracorporeal membrane oxygenation period, lower the risk for developing cannula-associated deep vein thrombosis (hazard ratio, 0.98; 95% CI, 0.98–1.00; p = 0.02).

Conclusions:

Cannula-associated deep vein thrombosis after venovenous extracorporeal membrane oxygenation is a frequent complication. This plead for a systematic vascular axis imaging after venovenous extracorporeal membrane oxygenation. Thrombocytopenia is associated with a reduction in the occurrence of thrombotic events.
Discovery of Radiocesium-bearing Particles in Masks Worn by Members of the Public in Fukushima in Spring 2013
Authors: Higaki Shogo , Kurihara Yuichi , Takahashi Yoshio
Published: November 2019

To investigate the publics’ internal exposure by inhalation of radiocesium from the Fukushima Daiichi nuclear disaster in 2011, we examined the activity of radiocesium and radiocesium-bearing particles adhering to nonwoven fabric masks worn daily by members of the public in spring 2013 and 2014. We found a maximum cumulative 137Cs activity of 4.58 ± 0.15 Bq in 4 wk of spring 2013, which is 20.8% of the activity measured for the same subject in spring 2012 using the same method. This decrease was faster than the physical decay of radiocesium. Radiocesium was detected in 21 of 722 masks in 2013; three of these included type A radiocesium-bearing particles. The activity ratio of the radiocesium-bearing particles on the mask to the total radiocesium was at most approximately 20%. The two radiocesium sources, radiocesium-bearing particles and fugitive dust, are both insoluble particles. The largest internal dose from inhalation was 7.6 μSv in spring 2013, which is negligible compared to the dose limit recommended for members of the public by the International Commission on Radiological Protection.
Acute Unilateral Ptosis and Myositis Following the H1N1 Influenza Vaccine
Authors: Basilious Alfred , Jivraj Imran , DeAngelis Dan
Published: November 2019

The authors present a rare case of sudden onset unilateral complete ptosis occurring hours after administration of the H1N1 influenza vaccine. A complete workup for autoimmune and neurological disease was negative. MRI of the orbits demonstrated unilateral orbital myositis involving the left superior rectus/levator complex, superior oblique, and medial rectus muscles. Ptosis resolved spontaneously over 2 months without intervention. An autoimmune mechanism may explain rare cases of orbital myositis following administration of the H1N1 influenza vaccination.

A case of acute onset and spontaneous resolution of complete unilateral ptosis and orbital myositis post H1N1 influenza vaccination.
Colectomy Averted
Authors: Brothers Todd N. , Charpentier Margaret M. , Shah Shivani , Tandon Richa
Published: November 2019

Clostridioides difficile infection is considered an urgent public health threat by the Centers for Disease Control and Prevention. Recent practice guidelines recommend either vancomycin or fidaxomicin for an initial episode of C. difficile infection and further recommend a subtotal colectomy in severe cases. There are limited data discussing novel approaches for fidaxomicin administration in severe C. difficile infection to avert colectomy. We describe an off-label route of fidaxomicin administration through a loop ileostomy twice daily with successful outcome.
IBD in India
Authors: Banerjee Rupa , Pal Partha , Nugent Zoann , Ganesh Girish , Adigopula Bhargavi , Pendyala Sushmita , Bernstein Charles N.
Published: November 2019

Background:

Inflammatory bowel disease (IBD) is emerging in the developing world but phenotypic data are limited. We aimed to describe the phenotype, clinical presentation, disease behavior, and treatments of IBD in a large cohort in India.

Methods:

All persons presenting to the Asian Institute of Gastroenterology in Hyderabad, India since 2004 with a confirmed diagnosis of IBD were enrolled. The demographic profile at the first visit, family history of IBD, smoking history, time from first symptom onset to diagnosis, use of anti-tuberculousis treatment before IBD-specific treatment, disease phenotype, and medication history were collected by interview and chart review. Disease and family history and treatments used were updated at each follow-up visit.

Results:

Of 4006 persons enrolled, 59.9% had ulcerative colitis (UC) and the majority were male (60.3%). The median diagnostic delay in both UC and Crohn’s disease (CD) was at least 2 years. At the time of diagnosis only 4.5% of CD were smokers and only 3.8% of UC were ex-smokers. Positive family history was uncommon (2.1%). The phenotype of persons with CD included 22.9% with stricturing disease and 9.4% with fistulizing disease. The most common site of disease was ileocolonic (40.9%) and only 2.5% had perineal fistulas. Among those with UC 18.7% had proctitis and 30.3% had pancolitis.

Conclusions:

This is the largest cohort of persons with IBD reported from Asia. Although there are several demographic differences between persons with IBD from India compared with the West, the phenotypes of the disease are not highly different.
A novel etanercept biosimilar Anbainuo plus methotrexate exhibits increased cost-effectiveness compared to conventional disease-modifying anti-rheumatic drugs in treating rheumatoid arthritis patients
Authors: Tian Feng , Li Jing-Yang , Wen Zhen-Hua , Luo Xiao-Wen , Deng Li , Zhang Liang , He Jing-Yun
Published: November 2019

The aim of this study was to evaluate the cost-effectiveness of Anbainuo (ABN) plus methotrexate (MTX) (ABN + MTX) versus conventional disease-modifying anti-rheumatic drugs (cDMARDs) in rheumatoid arthritis (RA) patients.

Forty-eight moderate to severe RA patients underwent ABN + MTX or cDMARDs treatment were consecutively enrolled and assigned to ABN + MTX group (n = 26) and control group (n = 22). Patients were followed up and their disease activity and quality of life (QoL) were evaluated at 3rd month, 6th month and 12th month after initiation of treatment. Treatment costs of 2 groups were calculated, then pharmacoeconomic analysis was performed.

ABN + MTX increased drug cost and total cost while decreased indirect cost compared with cDMARDs after 12-month treatment. ABN + MTX group gained additional 0.22 quality-adjusted life years (QALY) and yielded an incremental cost-effectiveness ratio (ICER) of ¥104,293.6 per QALY after treatment. Sensitivity analysis reveals that rising ABN price by 20% produced an ICER of ¥130,403.6 per QALY, which was still lower than 3 times of the mean gross domestic product (GDP) per capita during the same period in China (¥165,960). Besides, ABN + MTX was more cost-effective in severe RA patients compared to moderate RA patients.

ABN + MTX is cost-effective in treating moderate to severe RA patients compared with cDMARDs, although the total cost of ABN + MTX is relatively higher.
Is genomic screening necessary for fetuses who suffer moderate to severe tricuspid regurgitation?
Authors: Liu Lei , Shi Xiaoqing , Yue Peng , Zheng Xiaolan , Hua Yimin , Zhou Kaiyu , Li Yifei
Published: November 2019

Rationale:

Tricuspid regurgitation (TR) is a frequent finding during echocardiography screening in fetal or neonatal life, which reveals a weak association between TR and cardiac malformation. Except for structural abnormalities, dilated cardiomyopathy (DCM) ranks as the top reason for early child morbidity and mortality among all kinds of cardiomyopathy. In the early fetal stage, cardiac abnormalities detected by early fetal genetic testing followed by abnormalities on ultrasound would provide more valuable information for parents and physicians to make a better therapeutic schedule.

Patient concerns:

A case of severe TR was found via the fetal ultrasound screening. After birth, this child suffered severe heart dysfunction, and echocardiography confirmed a DCM phenotype within a very short time.

Diagnosis and intervention:

A 40-year-old female received routine fetal echocardiographic screening, which demonstrated that the fetus presented severe TR. Six months after birth, the baby experienced severe heart failure, as the EF dropped to 22% with an extremely large LV chamber. The genomic sequence had been determined, and 3 pathogenic gene mutations located in 2 genes, cardiac troponin T (TNNT2) c.548G>A, desmoplakin (DSP) c.3146C>T, and DSP c.5213G>A, were identified. Finally, the patient was diagnosed with DCM. This child received digoxin, hydrochlorothiazide, spironolactone diuresis, captopril, and L-carnitine, and the symptoms of heart failure had been controlled as the patient waited for heart transplantation.

Outcomes:

During the follow-up, the patient still suffered from poor heart function and an enlarged left ventricle. Concomitantly, the parents placed her on a waiting list for heart transplantation.

Lessons:

Fetal TR is a common phenomenon, and many studies have indicated that isolated TR is not an appropriate predictor of chromosomal abnormalities or congenital heart defects. However, according to this case, it is urgent to recommend that the mother should take advantage of free fetal DNA analysis in a maternal blood sample to obtain further molecular evidence once fetal echocardiography reveals moderate to severe TR with any maternal high-risk factors for birth defects.
Assessment of the efficacy of acupuncture and chiropractic on treating Cervical spondylosis radiculopathy
Authors: Zuo Guang , Gao Tian-Ci , Xue Bing-He , Gu Chuang-Chuang , Yan Yun-Tao , Zhang Yong-Wang , Liu Rui-Jia , Du Shuang-Qing
Published: November 2019

Background:

Cervical spondylosis radiculopathy (CSR) is often described as neck pain accompanied with radiating pain and neurologic symptoms, such as numbness, muscle weakness, and diminished reflexes, in 1 or both upper extremities. As people's lifestyle changes and the population ages, the incidence of CSR continues to increase. Many clinical trials have proven that acupuncture and chiropractic has a significant effect in the treatment of CSR. In this systematic review, we aim to evaluate the effectiveness and safety of acupuncture and chiropractic for CSR.

Methods:

We will search PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials included in the ChinaResources Database. The time is limited from the construction of the library to February, 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of CSR.

Trial registration number:

CRD42019119941.
The influence of MRAS gene variants on ischemic stroke and serum lipid levels in Chinese Han population
Authors: Song Yan , Ma Rui , Zhang Hongjuan
Published: November 2019

Previous studies have indicated that muscle RAS oncogene homolog (MRAS) gene played an important role in cardiovascular diseases. However, the effect of MRAS genetic variations on ischemic stroke (IS) is still not clear. The aim of the current study was to investigate the association between the MRAS polymorphism and IS risk in Han populations.

Three SNPs (rs40593, rs751357, rs6782181) at MRAS were selected for genotyping in a sample of 240 IS patients and 430 controls. Logistic regression was performed to evaluate the association of 3 SNPs with IS and IS subgroups.

No association of MRAS SNPs with IS risk was observed, while G allele of rs40593 was associated with increased risk of cerebral infarction area. Compared with carriers of the AA genotype, the risk of carriers of the AG+GG genotype increased, with an OR (95%CI) of 2.337 (1.175–4.647), P = .016. In relation to lipid profile, rs40593, rs751357, rs6782181 were associated with increased total cholesterol (TC) levels.

Summarily, this study suggested that MRAS rs40593 may contribute to the increased risk of area of cerebral infarction of IS in Han population. rs40593, rs751357, and rs6782181 were associated with higher serum TC levels.
Rivaroxaban for cancer-associated venous thromboembolism
Authors: Liang Bo , Zhao Li-Zhi , Liao Hui-Ling , Gu Ning
Published: November 2019

Background:

All cancers increase developing venous thromboembolism risk, and VTE is the second-leading cause of death among cancer patients. The anticoagulant drugs are considered to be the optimal treatment for patients with cancer-associated VTE. However, there is still controversy whether rivaroxaban, a new oral anticoagulant, can lead to better outcomes globally.

Methods:

We will search PubMed, Web of Science, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure for relevant published studies before 1 September, 2019, without any language restrictions. Only published randomized controlled trials that meet the inclusion criteria will be included. Subgroup analysis of the type of cancer, the type of VTE, cancer stage, age, sex, ethnicity, history of smoking and drinking as well as the mean, dose and duration of anticoagulants will be performed.

Discussion:

Our study aims to estimate the efficacy and safety of rivaroxaban for patients with cancer-associated VTE and to provide recommendations to key stakeholders.

Trial registration:

PROSPERO, October 23, 2019, CRD42019143265, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143265.
Pancreas lipiodol embolism induced acute necrotizing pancreatitis following transcatheter arterial chemoembolization for hepatocellular carcinoma
Authors: Tan Youwen , Sheng Jianhui , Tan Huiying , Mao Jianzhong
Published: November 2019

Rationale:

Transcatheter arterial chemoembolization (TACE) is recognized as one of the most commonly used modalities for non-surgical treatment for advanced hepatocellular carcinoma (HCC). Ectopic lipiodol embolism is an extremely rare complication of TACE.

Patient concerns:

A 61-year-old man who had a 10-year history of cirrhosis caused by hepatitis B infection was diagnosed with ascites and HCC. Subsequently, the patient underwent TACE. However, he experienced persistent left upper abdominal pain, poor appetite, nausea, moderate fever and accompanied by elevation of serum and urine amylase on the 2nd and 3nd day after treatment.

Diagnoses:

The patient was diagnosed as having acute hemorrhagic necrotizing pancreatitis based on biochemical and inflammatory markers and CT findings. We deduced that the acute necrotizing pancreatitis was caused by a small branch of the left hepatic artery feeding the pancreas tail and embolizing the drug and lipiodol shunting to the tail of the pancreas.

Interventions:

The patient was treated for 5 days according to the comprehensive treatment of acute necrotizing pancreatitis, by the inhibition of the secretion of pancreatic juice, relieving pain, and total parenteral nutrition and forbidding diet. The symptoms of the patient were observed to improve, and SAMS and urinary amylase (UAMS) level decreased to 143 IU/L and 254 IU/L, respectively and oral diet was permitted.

Outcome:

After a period of 2 weeks, the contrast abdominal CT showed slightly decreased fluid collection of the peri-pancreatic space. Moreover, it also showed flocculous and linear high-density shadow in the pancreatic tail, suggesting lipiodol deposition in the pancreatic tail. Subsequently, the symptoms were observed to abate, and the patient left the hospital. On the 21st day after TACE, the patient had a follow up in our outpatient department; the biochemical characteristics and inflammatory markers were observed to be normal

Conclusion:

AP is still a rare complication after TACE. Etiology is still attributed to the occurrence of shunting and embolization drug reflux. Strategies strengthening the catheter tip that is placed as close to the distal branches of the hepatic artery for the possible careful injection of embolic materials is still the key to avoid post-TACE AP.
Vitamin D deficiency is highly prevalent in malnourished inpatients and associated with higher mortality
Authors: Merker Meret , Amsler Aline , Pereira Renata , Bolliger Rebekka , Tribolet Pascal , Braun Nina , Hoess Claus , Pavlicek Vojtech , Bilz Stefan , Sigrist Sarah , Brändle Michael , Henzen Christoph , Thomann Robert , Rutishauser Jonas , Aujesky Drahomir , Rodondi Nicolas , Donzé Jaques , Stanga Zeno , Mueller Beat , Schuetz Philipp
Published: November 2019

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.

Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.

The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03–1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01–2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48–1.13, P = .15).

Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.
Young male with syphilitic cerebral arteritis presents with signs of acute progressive stroke
Authors: Shi Min , Zhou Yuan , Li Yadi , Zhu Yuting , Yang Bing , Zhong Li , Pan Rui , Yang Dongdong
Published: November 2019

Introduction

Neurosyphilis is a chronic infection of the central nervous system that is commonly found in adult with long latency periods. Neurosyphilis-attributed deaths in young patients have grown exponentially in the past decade, yet there have been few studies on the early stages of neurosyphilis.

Patient concerns

A young male patient with syphilitic cerebral arteritis was evaluated in our clinic for the clinical signs of progressive ischemic stroke.

Diagnosis

The progression of syphilitic cerebral arteritis was observed through computed tomography imaging, magnetic resonance imaging, magnetic resonance angiogram, and transcranial color Doppler. The pathological changes and clinical outcomes were reviewed. In this specific case, the development of syphilitic cerebral arteritis was dynamic, continuous, and rapid. The pathogenesis was related to Heubner arteritis, in which the formation of a mural thrombus (MT) causes the severe obstruction of blood flow without complete occlusion, leading to an increased risk of infarction. In this patient, formation of the MT resulted in the infarction of the smaller vessels and narrowing of the larger vessels. The partial dislodgment of the MT from the arterial wall of the larger vessels occluded the smaller vessels, leading to infarction.

Interventions

Standard pharmacotherapy for the treatment of the cerebral infarction and a single course of penicillin were applied.

Outcomes

Muscle strength was recovered. The Glasgow Coma Scale score was 15, whereas the NIH Stroke Scale score was 0. The increase in blood flow of the right MCA was accompanied by severe stenosis with compensation of the anterior communicating artery. In addition, moderate to severe stenosis of the right vertebral artery and the basilar artery was suspected. There was a possibility that the right posterior communicating artery was recruited for compensation.

Conclusion

Progressive stroke was the initial symptom of the neurosyphilis. Disease progression is rapid and difficult to control with a single course of penicillin.
Bisphosphonates as a therapeutic choice for multifocal epithelioid hemangioma of bone
Authors: Tang Lizhi , Chen Guangwen , Wang Qin , John Jobin , Lu Chunyan
Published: November 2019

Rationale:

Epithelioid hemangioma (EH) of bone is an intermediate vascular tumor that can be locally aggressive. The optimum management of multifocal EH of bone is not well delineated. We described our experience treating one patient with multifocal EH of bone in an effort to document the effect of bisphosphonates in bone EH.

Patient concerns:

In this report, a 53-year old male patient presented with back pain which was initially been diagnosed of multiple bone metastatic carcinoma by 18F-FDG PET/CT scan and bone scintigraphy.

Diagnosis:

CT-guided bone biopsy of ilium indicated that puncture tissue had irregular hyperplasia of thick and thin-walled blood vessels, immunohistochemistry revealed positive staining for CD31 and CD34, negative for CAMTA-1, PCK and EMA, which confirmed the diagnosis of multiple EH.

Interventions:

The patient was treated with 4 times of intravenous Zometa (zoledronate, 4 mg each time) with average three-month interval. Bone metabolic markers including serum bone specific alkaline phosphatase (BALP) and type I collagen cross-linked C-terminal telopeptide (CTX) levels were closely monitored before and after use of bisphosphonates each time.

Outcome:

BALP and CTX were significantly lowered following intravenous Zometa and the back pain improved with integrated therapy including bone graft fusion internal fixation surgery and vertebroplasty.

Conclusions:

EH of multiple bones responded favorably to intravenous Zometa with improvement of bone metabolic markers. After 1 year on follow-up, the patient was doing well with no significant pain. We suggest that bisphosphonates should be considered in the treatment of multifocal osteolytic EH of bone.
Coexistence of nontuberculous mycobacterium and IgG4-related disease in a solitary pulmonary nodule
Authors: Bae Kyungsoo , Jung An Hyo , Jeon Kyung Nyeo , Hyun Song Dae , Kim Sung Hwan , Kim Ho Cheol
Published: November 2019

Rationale:

Immunoglobulin G4-related disease (IgG4-RD) is regarded as an immune-mediated systemic fibroinflammatory disease. Several studies have linked IgG4-RD to infections such as tuberculosis and actinomycosis. However, the coexistence of IgG4-RD and non-tuberculous mycobacterium (NTM) in a single pulmonary nodule has not been reported yet.

Patient concerns:

A 76-year-old male patient presented with cough and sputum. A solitary pulmonary nodule suspicious of lung cancer was found on chest CT.

Diagnosis:

Through video-assisted thoracoscopic biopsy, a diagnosis of co-existing NTM and IgG4-RD in a single nodule was made.

Interventions:

Antibiotic treatment was applied for pneumonia developed after surgery. The patient was also supported by extracorporeal membrane oxygenation and mechanical ventilation since his pneumonia was refractory to medical treatment.

Outcomes:

The patient expired on the 60th postoperative day due to multiple organ failure.

Lessons:

IgG4-RD can occur singularly or accompanied by other diseases. We report a solitary pulmonary nodule caused by NTM and concurrent IgG4-RD, suggesting a possible association between these 2 entities. Immunologic relations between IgG4-RD and accompanying infection should be further investigated.
Predictive performance of aortic arch calcification for clinical outcomes in patients with acute coronary syndrome that undergo percutaneous coronary intervention
Authors: Ma Xiaoteng , Dong Lisha , Shao Qiaoyu , Zhou Zhen , Tian Jing , Ma Yue , Yang Jie , Lv Sai , Cheng Yujing , Shen Hua , Yang Lixia , Wang Zhijian , Zhou Yujie
Published: November 2019

Currently, little is known regarding the predictive utility of aortic arch calcification (AAC) for clinical outcomes in patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI). The present study was designed to investigate the predictive performance of AAC as detected by chest x-ray for clinical outcomes among ACS patients undergoing PCI.

A total of 912 patients who were diagnosed as ACS and treated with PCI were included in this prospective, cohort study. All study participants received chest x-rays on admission, and a semiquantitative 4-point scale was used to assess the extent of AAC. The primary end point was defined as a composite of major adverse cardiovascular events (MACE) comprising death, nonfatal stroke, nonfatal myocardial infarction, and unplanned repeat revascularization. The key secondary end point was the composite of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction. The prognostic values of AAC were assessed in multivariate Cox-proportional hazards regression analyses adjusted for major confounders.

The mean follow-up duration was 917 days and, during the follow-up period, MACE occurred in 168 (18.4%) patients. Kaplan-Meier analyses revealed significantly higher incidences of the primary and key secondary end points in patients with higher AAC grades (log-rank test; all P < .001). Multivariate Cox-proportional hazards regression analyses showed that, in comparison to AAC grade 0, the hazard ratios of AAC grades 1, 2, and 3 for predicting MACE were 1.63 (95% confidence interval [CI] 0.99–2.67), 2.15 (95% CI 1.27–3.62), and 2.88 (95% CI 1.41–5.86), respectively. The C-index of the variables, including peripheral arterial disease and serum levels of triglyceride for predicting MACE, was 0.644 (95% CI 0.600–0.687) versus 0.677 (95% CI 0.635–0.719) when AAC grades were also included; the continuous net reclassification improvement was 16.5% (8.7%–23.4%; P < .001).

The extent of AAC as detected by chest x-ray is an independent predictor of MACE among ACS patients undergoing PCI. Further research is warranted to evaluate whether specific treatment strategies that are established based on AAC extent are needed for optimal risk reduction in relevant patient populations.
Effects of Detector Sampling on Noise Reduction in Clinical Photon-Counting Whole-Body Computed Tomography
Authors: Klein Laura , Dorn Sabrina , Amato Carlo , Heinze Sarah , Uhrig Monika , Schlemmer Heinz-Peter , Kachelrieß Marc , Sawall Stefan
Published: November 2019

Objectives

Reconstructing images from measurements with small pixels below the system's resolution limit theoretically results in image noise reduction compared with measurements with larger pixels. We evaluate and quantify this effect using data acquired with the small pixels of a photon-counting (PC) computed tomography scanner that can be operated in different detector pixel binning modes and with a conventional energy-integrating (EI) detector.

Materials and Methods

An anthropomorphic abdominal phantom that can be extended to 3 sizes by adding fat extension rings, equipped with iodine inserts as well as human cadavers, was measured at tube voltages ranging from 80 to 140 kV. The images were acquired with the EI detector (0.6 mm pixel size at isocenter) and the PC detector operating in Macro mode (0.5 mm pixel size at iso) and ultrahigh-resolution (UHR) mode (0.25 mm pixel size at iso). Both detectors are components of the same dual-source prototype computed tomography system. During reconstruction, the modulation transfer functions were matched to the one of the EI detector. The dose-normalized contrast-to-noise ratio (CNRD) values are evaluated as a figure of merit.

Results

Images acquired in UHR mode achieve on average approximately 6% higher CNRD compared with Macro mode at the same spatial resolution for a quantitative D40f kernel. Using a sharper B70f kernel, the improvement increases to 21% on average. In addition, the better performance of PC detectors compared with EI detectors with regard to iodine imaging has been evaluated by comparing CNRD values for Macro and EI. Combining both of these effects, a CNRD improvement of up to 34%, corresponding to a potential dose reduction of up to 43%, can be achieved for D40f.

Conclusions

Reconstruction of UHR data with a modulation transfer function below the system's resolution limit reduces image noise for all patient sizes and tube voltages compared with standard acquisitions. Thus, a relevant dose reduction may be clinically possible while maintaining image quality.
Persistent Symptoms in People With Celiac Disease Despite Gluten-Free Diet
Authors: Roos Susanne , Liedberg Gunilla M. , Hellström Ingrid , Wilhelmsson Susan
Published: November 2019

Studies show that people with celiac disease have reduced well-being and have persistent symptoms, mainly related to the gastrointestinal tract. The aim of this study was to analyze how persons in a celiac disease member association report their symptoms, health, and life satisfaction. A questionnaire, with both open and closed questions, was distributed to all members (n = 726) of a celiac association in the southeast of Sweden. The response rate was 74.5%, of which 524 (72%) said they had received a celiac disease diagnosis and were thus included in the study. Almost half of the participants (40.7%–42.2%) stated that they had persistent celiac disease symptoms despite following a gluten-free diet. Diarrhea, abdominal pain, and congestion were persistent symptoms reported and could contribute to a lower health status compared with people without persistent symptoms. The life satisfaction scale (LiSat-9) showed differences in 5 of 9 variables between the groups. Living with celiac disease is far from easy when you have persistent symptoms. People with celiac disease require follow-up by healthcare services, and a new treatment needs to be developed because following the gluten-free diet alone does not seem to alleviate symptoms in everyone.
Using Physiologic, Genetic, and Epigenetic Information to Provide Care to Clients Who Are Obese
Authors: Elder Betty , Pile Debra , Bett Carol
Published: November 2019

The pathology of obesity is a complex process involving interactions among behavioral, environmental, immunologic, genetic, and epigenetic factors. This article gives a broad overview of obesity. The physiology of fat storage, influence of eating behaviors on obesity, and the genetic relationship between eating and food sources are discussed. Specific genes that have been associated with obesity are introduced, with information on leptin and genes such as FTO, GLUT4, and others. This synopsis of obesity expands into environmental influences and epigenetic factors. These include food selection, gut microbiota, pregnancy, and exercise. The nurse will gain specific knowledge to assist in tailoring therapies specific to clients who are working to overcome the long-term effects of this disorder
Tepidiforma bonchosmolovskayae gen. nov., sp. nov., a moderately thermophilic Chloroflexi bacterium from a Chukotka hot spring (Arctic, Russia), representing a novel class, Tepidiformia, which includes the previously uncultivated lineage OLB14
Authors: Kochetkova Tatiana V. , Zayulina Kseniya S. , Zhigarkov Vyacheslav S. , Minaev Nikita V. , Chichkov Boris N. , Novikov Andrei A. , Toshchakov Stepan V. , Elcheninov Alexander G. , Kublanov Ilya V.
Published: November 2019

A novel aerobic moderately thermophilic bacterium, strain 3753OT, was isolated from a Chukotka hot spring (Arctic, Russia) using the newly developed technology of laser engineering of microbial systems. Сells were regular short rods, 0.4×0.8–2.0 µm in size, with a monoderm-type envelope and a single flagellum. The temperature and pH ranges for growth were 42–60 °C and pH 6.5–8.5, the optima being 50–54 °C and pH 7.3. Strain 3753OT grew chemoorganoheterotrophically on a number of carbohydrates or peptidic substrates and volatile fatty acids, and chemolithoautotrophically with siderite (FeCO3) as the electron donor. The major cellular fatty acid was branched C19 : 0. Phosphatidylethanolamine, phosphatidylglycerol and two unidentified phospholipids as well as two yellow carotenoid-type pigments were detected in the polar lipid extract. Strain 3753OT was inhibited by chloramphenicol, polymyxin B, vancomycin, streptomycin, neomycin and kanamycin, but resistant to the action of novobiocin and ampicillin. The DNA G+C content was 69.9 mol%. The 16S rRNA gene as well as 51 conservative protein sequence-based phylogenetic analyses placed strain 3753OT within the previously uncultivated lineage OLB14 in the phylum

Chloroflexi

. Taking into account the phylogenetic position as well as phenotypic properties of the novel isolate, the novel genus and species Tepidiforma bonchosmolovskayae gen. nov., sp. nov., within the Tepidiformaceae fam. nov., the Tepidiformales ord. nov. and the Tepidiformia classis nov. are proposed. The type strain of Tepidiforma bonchosmolovskayae is 3753OT (=VKM B-3389T=KTCT 72284T).
Supporting Computational Apprenticeship through educational and software infrastructure. A case study in a mathematical oncology research lab
Authors: Madamanchi Aasakiran , Thomas Madison , Magana Alejandra , Heiland Randy , Macklin Paul
Published: November 2019

There is growing awareness of the need for mathematics and computing to quantitatively understand the complex dynamics and feedbacks in the life sciences. Although several institutions and research groups are conducting pioneering multidisciplinary research, communication and education across fields remains a bottleneck. The opportunity is ripe for using education research-supported mechanisms of cross-disciplinary training at the intersection of mathematics, computation and biology. This case study uses the computational apprenticeship theoretical framework to describe the efforts of a computational biology lab to rapidly prototype, test, and refine a mentorship infrastructure for undergraduate research experiences. We describe the challenges, benefits, and lessons learned, as well as the utility of the computational apprenticeship framework in supporting computational/math students learning and contributing to biology, and biologists in learning computational methods. We also explore implications for undergraduate classroom instruction, and cross-disciplinary scientific communication.
Idiosyncratic liver alterations of five frog species to land use changes in the Brazilian Cerrado
Authors: Franco-Belussi Lilian , Provete Diogo B. , Borges Rinneu Elias , de Oliveira Classius , de Souza Santos Lia Raquel
Published: November 2019

Changes in land use trigger environmental changes that can lead to decreased biodiversity and species loss. The liver is an essential detoxification organ that reflects systemic physiological responses to environmental changes. Here, we tested whether land use changes influence the amount of substances from the hepatic cellular catabolism and melanomacrophages of five anuran species in the Brazilian Cerrado. We used routine histological and histochemical techniques. We then use recently developed ecological methods to relate functional traits to environmental variables. There was an increase in the amount of melanin in environments with high proportion of agriculture, as well as variation in the amount of lipofuscin and hemosiderin. Therefore, the area of melanomacrophages in the liver and the metabolic products in their cytoplasm can be used as biomarkers of environmental changes in regions with intense agricultural activities. Our results add a new perspective to the influence of land use changes on environmental health by highlighting the effect of environmental changes on internal morphological aspects of animals.