bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiological characteristics and factors influencing falls among elderly adults in long-term care facilities in Xiamen, China
Authors: Zhang Liangwen , Zeng Yanbing , Weng Chenziheng , Yan Jiajin , Fang Ya
Published: February 2019

Falling in the elderly is an important social issue, especially for those who are in long-term care (LTC) facilities, in addition to being a significant economic burden. This study aims to investigate the epidemiological characteristics and identify the factors influencing falls in LTC residents.

We enrolled 260 participants aged 60+ years by multistage sampling across 13 LTC facilities in Xiamen, China, in 2016. Epidemiological characteristics and falls were observed and recorded during a 12-month period using a revised FROP-Com Scale. Multiple logistic regression modeling was performed to determine the factors influencing falls.

A total of 218 (83.8%) valid questionnaires were returned. 152 falls (range 1–7, mean 0.7 ± 1.3 falls/person/y) occurred in the previous year, with 69 residents (31.7%) experiencing 1 or more falls. Most participants who fell were female (71%), living in cities (85.5%), had a higher BMI (22.1 ± 4.2), and had a chronic disease (99.9%). Of all falls, 39.1% occurred in the bedroom and 26.1% in the bathroom, 58% during daytime hours between 6:00 am and noon. Thirty-six percent of falls resulted in an injury (e.g., bruises and fractures). The principal reason for falling was due to slipping (23.2%). There were 2 interactions on fall rate between ADL and feet and footwear (OR = 3.120, P<.001; OR = 3.010, P = .007 in Models 1 and 3), and between ADL and cognitive status (OR = 4.401, P<.001; OR = 4.101, P = .005 in Models 2 and 3). Multiple regression analysis indicated that ADL, balance and gait, medical conditions, cognitive status, living environment, feet and footwear and sensory loss were factors influencing falls among elderly adults in LTC facilities.

Falls occur frequently and mostly unwitnessed among elderly adults in LTC facilities, highlighting the need for more effective and individualized fall prevention. Fall efficacy enhancing programs for nursing home residents should take degree of self-care, chronic diseases, sensory loss, foot injuries, cognitive impairment, living environment, and gender into account.
Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters
Authors: Menegueti Mayra Gonçalves , Ciol Marcia A. , Bellissimo-Rodrigues Fernando , Auxiliadora-Martins Maria , Gaspar Gilberto Gambero , Canini Silvia Rita Marin da Silva , Basile-Filho Anibal , Laus Ana Maria
Published: February 2019

Background:

Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infections (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI.

Methods:

This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period, from January 1, 2005 to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI were monthly evaluated following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005–2006) was the pre-intervention period. In phase II (2007–2010), HCWs routine training on CAUTI prevention was performed twice-a-year. In phase III (2011–2014), we implemented a daily checklist for indwelling urinary catheter indications, in addition to the biannual training. In phase IV, (2015–2016) the biannual training was replaced by training only newly hired HCWs and the daily checklist was maintained.

Results:

The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively).

Conclusions:

HCWs education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI.
The role of robotic gait training and tDCS in Friedrich ataxia rehabilitation
Authors: Portaro Simona , Russo Margherita , Bramanti Alessia , Leo Antonio , Billeri Luana , Manuli Alfredo , La Rosa Gianluca , Naro Antonino , Calabrò Rocco Salvatore
Published: February 2019

Rationale:

Friedrich ataxia (FA) is the most common inherited neurodegenerative cerebellar ataxic syndrome. In patients with FA, physiotherapy is highly recommended to improve motor function outcome. Cerebellar transcranial direct current stimulation (tDCS) has been demonstrated to be effective in improving symptoms by modulating cerebellar excitability. Recently, robotic rehabilitation with Lokomat-Pro has been used to treat motor impairment in ataxic syndromes by “modulating” cortical plasticity and cerebello-motor connectivity.

Patient concerns:

A 29-year-old Italian male with FA, come to our Institute to undergo intensive rehabilitation training. He presented a moderate-to-severe spastic tetraparesis, brisk deep tendon reflexes, moderate dysarthria, occasional difficulty in speaking, and mild delay in swallowing. He was able to stand for at least 10 seconds in the natural position with constant support, and thus he used a wheelchair.

Diagnosis:

Tetraparesis in a young patient with FA.

Interventions:

The effects of a stand-alone robotic gait training with Lokomat-Pro preceded by cerebellar anodal tDCS (a-tDCS) versus Lokomat-Pro preceded by cathodal-tDCS (c-tDCS) are compared.

Outcomes:

The coupled approach (i.e., tDCS and Lokomat) demonstrated better improvement in functional motor outcomes on the Scale for the Assessment and Rating of Ataxia (SARA).

Lessons:

Although only a single case is described, we found that the combined neuromodulation-neurorobotic approach could become a promising tool in the rehabilitation of cerebellar ataxias, possibly by shaping cerebello-cerebral plasticity and connectivity.
A comparative and correlative study of the Voice-Related Quality of Life (V-RQOL) and the Voice Activity and Participation Profile (VAPP) for voice-related quality of life among teachers with and without voice disorders
Authors: Yu Lingyu , Lu Dan , Yang Hui , Zou Jian , Wang Haiyang , Zheng Meijun , Hu Juanjuan
Published: February 2019

The aim of this study was to investigate the difference and correlation between the Voice-Related Quality of Life (V-RQOL) and the Voice Activity and Participation Profile (VAPP) among teachers.

The participants were 672 teachers (218 males and 454 females, male-to-female ratio = 0.48:1) whose vocal cords were examined using a Strobolaryngoscope. Questionnaire results were obtained for both the V-RQOL and the VAPP.

Of the 672 participants, 322 teachers had voice disorders while 350 teachers did not. The most common voice complaint was hoarseness (n = 250), and the most common throat complaint was foreign body sensation (n = 129) in teachers with voice disorders. Chronic laryngitis (n = 162, 50.3%), vocal cord polyps (n = 92, 28.6%), and vocal cord nodules (n = 43.13.4%) were the most frequent diagnoses in teachers with voice disorders. Significant differences were seen on the V-RQOL and the VAPP scores between teachers with and without voice disorders, and between female and male teachers. Differences were also observed among teachers from different grades, and among different types of voice-related diseases. Moderate-to-strong correlations were observed between the VAPP total score and those for all the subscales of the VAPP and between the VAPP total score and the V-RQOL score (P < .001).

Teachers with voice disorders have a significantly poorer voice-related quality of life than those without voice disorders, as do female teachers compared with male teachers. Different groups of voice disorders have different effects on teachers’ voice-related quality of life, and primary school teachers suffer from a poorer voice-related quality of life than do high school teachers. A moderate-to-strong correlation was found between the results of the V-RQOL and the VAPP scores.
Electrical stimulation for limb spasticity in children with traumatic brain injury
Authors: Wang He , Song Guang-fu , Nie Jing , Xu Xiao-hao , Zhang Ying , Liu Jin-rui
Published: February 2019

Background:

Previous clinical studies have reported that electrical stimulation (ES) can be utilized to treat children with limbs spasticity (LS) after traumatic brain injury (TBI). Currently, no systematic review has addressed the effect of ES in children with LS following TBI. Thus, this systematic review will assess the effect and safety of ES for the children with LS after TBI.

Methods:

We will conduct the present systematic review of randomized controlled trials that will be retrieved from searches of PubMed, PsycINFO, WOS, Scopus, OpenGrey, Google Scholar, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database from the inception to the date of the literature searched. In addition, the clinical register websites, and reference lists of relevant studies will also be searched. Two independent reviewers will evaluate the eligibility criteria for all papers, extract the data and determine the methodology quality by using Cochrane risk of bias tool.

Results:

The results of this systematic review will pool the latest available data, and are expected to provide the summary of present evidence of ES for children with LS following TBI.

Timeline:

This systematic review will start on January 10, 2019 and expected to complete by June 1, 2019.

Ethics and dissemination:

No research ethic approval is needed in this study, because the data of this systematic review will not base on the individual data level. The results will be disseminated to publish at peer-reviewed journals or will present at relevant conferences.

PROSPERO registration number:

CRD42019120037
A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache
Authors: Gildir Sila , Tüzün Emine Handan , Eroğlu Goncagül , Eker Levent
Published: February 2019

Background:

In this randomized, double-blind, parallel-group trial, we aimed to explore the effectiveness of trigger point dry needling in patients with chronic tension-type headache in reducing headache frequency, intensity and duration, and improvement of health-related quality of life.

Methods:

The 168 patients in 2 neurology clinics with chronic tension-type headache. The participants were randomly assigned to one of two treatment groups for dry needling or sham dry needling, delivered in 3 sessions a week for 2 weeks. The 160 patients fulfilled the study requirements. The dry needling was applied in active trigger points located in the musculature of the head and the neck. The patients received dry needling using sterile stainless-steel acupuncture needles of 0.25 × 40 mm and 0.25 × 25 mm dimensions. The sham dry needling procedure was applied into the adipose tissue located at any area where an active trigger point was absent. The primary outcome measurement was the headache intensity. Secondary outcomes were frequency and duration of headache, and quality of life, assessed by the Short Form-36. All outcomes were measured at baseline, at the end of 2-week, and 1-month follow-up period.

Results:

In the dry needling group, intensity, frequency and duration of headache, and the scores of Short Form-36 subscales were significantly improved after treatment (P < .05). In the dry needling group, all the effect sizes for headache variables were large.

Conclusions:

The results of this clinical trial suggest that trigger point dry needling in patients with chronic tension-type headache is effective and safe in reducing headache intensity, frequency and duration, and increasing health-related quality of life.

Trial registration:

Clinical Trials NCT03500861.
Herbal medicines for metabolic diseases with blood stasis
Authors: Ko Mi Mi , Jang Soobin , Jung Jeeyoun
Published: February 2019

Background:

Herbal medicines have the potential to be alternative treatments for metabolic diseases. This systematic review will assess the efficacy of herbal medicines in treating metabolic diseases with blood stasis.

Methods and analysis:

We will search MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, 2 Korean medical databases (OASIS, NDSL), a Chinese database (China National Knowledge Infrastructure, CNKI), and a Japanese database (J-STAGE) for relevant literature. We will include all randomized controlled trials (RCTs) or quasi-RCTs evaluating the effectiveness of herbal medicine. Participants of both sexes and of any age with clinically diagnosed metabolic disease with blood stasis will be included. Primary outcomes will include Blood-stasis syndrome score, TC, TG, HDL-C and LDL-C. Secondary outcomes will Blood pressure, FBS. ECG, prevalence rate of heart disease, and response rate. The risk of bias will be assessed using the Cochrane tool for assessing risk of bias.

Discussion:

The findings of this study will provide a summary of the current state of evidence regarding the effectiveness of types of herbal medicine in managing metabolic disease with blood stasis. In addition, this review will be expected to provide a base for clinical trials to confirm the efficacy of herbal medicine for treatments of metabolic disease with blood stasis.

Trial registration number:

PROSPERO 2018 CRD42018090179.
Effect of 12-month nasal continuous positive airway pressure therapy for obstructive sleep apnea on progression of chronic kidney disease
Authors: Li Xiaoming , Liu Chengcheng , Zhang Hao , Zhang Jie , Zhao Miaoqing , Sun Dianshui , Xia Ming , Han Min
Published: February 2019

Background:

Obstructive sleep apnea (OSA) is common among patients with chronic kidney disease (CKD). CKD may increase the risk of OSA, and OSA may increase the risk of renal injury. Nasal continuous positive airway pressure (nCPAP) is the standard treatment for OSA. However, the effect of nCPAP on the progression of CKD is unclear.

Methods:

A total of 395 patients with stage 3/4 CKD were initially examined, and 269 patients (148 non-OSA cases; 79 mild OSA cases; 42 moderate/severe OSA cases) were analyzed after implementation of the exclusion criteria. The severity of OSA was determined by polysomnography (PSG). Fifty-two OSA patients (32 mild OSA cases; 20 moderate/severe OSA cases) received nCPAP treatment for 12 months. Variables associated with OSA severity and estimated glomerular filtration rate (eGFR) were evaluated before and after the 12-month nCPAP treatment.

Results:

Among all 269 CKD patients, body mass index (BMI), and eGFR had significant associations with OSA severity. Age, BMI, apnea–hypopnea index (AHI), mean SaO2%, and SaO2 <90% monitoring time had independent associations with lower eGFR. The 12-month nCPAP treatment significantly reduced the rate of eGFR decline. Univariate and multivariate analysis indicated that age, BMI, AHI, mean SaO2%, and SaO2 <90% monitoring time were independently associated with reduced eGFR. Furthermore, nCPAP treatment significantly improved eGFR, AHI, mean SaO2, and SaO2 <90% monitoring time in patients with mild OSA, and improved systolic/diastolic blood pressure, urinary protein level, eGFR, AHI, mean SaO2, and SaO2 <90% monitoring time for patients with moderate/severe OSA.

Conclusion:

This study of patients with CKD and OSA indicated that nCPAP therapy significantly ameliorated CKD progression, especially in those with moderate/severe OSA.
Prevalence of human papillomavirus type-18 in head and neck cancer among the Chinese population
Authors: Yang Funa , Yin Yulin , Li Peng , Zhang Xiaojun , Chen Defeng , Liu Yang , Wang Jian , Guo Lanwei
Published: February 2019

Background:

China has a high burden of head and neck cancer globally and oncogenic human papillomavirus (HPV) has been hypothesized as a risk factor for head and neck cancer, but research was absent for establishing HPV prevalence in China. We aimed to conduct a meta-analysis to estimate the high-risk HPV-18 prevalence of head and neck cancer in the Chinese population.

Methods:

This meta-analysis was reported following the guideline of PRISMA. The reports on HPV and head and neck cancer in a Chinese population published between Jan 1, 2006 and May 31, 2018 were retrieved via CNKI/WANFANG/MEDLINE/EMBASE/COCHRANE databases. A random-effect model was used to calculate pooled prevalence and corresponding 95% confidence intervals.

Results:

A total of 1881 head and neck cancer cases from 19 studies were included in this meta-analysis. Overall, the pooled HPV-18 prevalence among head and neck cancer cases was 6.0% (4.1%–7.9%) in China, 31.2% (13.0%–49.4%) in laryngeal cancer, 7.2% (3.9%–10.5%) in oral cancer and 0.6% (0.0%–1.3%) in oropharyngeal cancer, 18.7% (6.2%–31.2%) in fresh or frozen biopsies and 4.3% (2.5%–6.1%) in paraffin-embedded fixed biopsies, 29.5% (15.6%–43.3%) by E6/E7 region and 3.9% (0.5%–7.4%) by L1 region of HPV gene. The highest HPV-18 prevalence was found in Central China.

Conclusions:

High prevalence of HPV-18 was found in the samples of Chinese head and neck cancers. Prophylactic HPV-vaccination may reduce the burden of HPV-related head and neck cancer in China.
A case report of placental mesenchymal dysplasia
Authors: Doroftei Bogdan , Neculai-Valeanu Sabina , Simionescu Gabriela , Grab Delia , Plopa Natalia , Anton Emil , Maftei Radu
Published: February 2019

Rationale:

We report a rare case of a pregnant woman with placental mesenchymal dysplasia (PMD) and intrauterine growth restriction (IUGR) with a genetically normal fetus.

Patient concerns:

A 42-year-old woman Gravida I, Para I with pre-existent uncontrolled hypertension and uterine polyfibromatosis present at 30 weeks of gestation for diminished fetal activity during the last 2 days.

Diagnosis:

Placental mesenchymal dysplasia associated with intrauterine growth restriction, hypertension, and uterine polyfibromatosis.

Intervention:

A live male infant was delivered by emergency caesarean section.

Outcomes:

The infant, weighing 700 g, died 4 days after birth due to a massive intracerebral hemorrhage.

Lessons:

A careful examination should be done at every ultrasound in case of a fetus with IUGR to exclude some rare cases of placental pathologies. PMD can be a rare cause of IUGR with a genetically normal fetus.
Spindle cell hemangioma of the spleen
Authors: Gao Bing-Qiang , Zhou Dong-Kai , Qian Xiao-Hui , Zhang Wang , Ying Li-Xiong , Wang Wei-Lin
Published: February 2019

Rationale:

Spindle cell hemangioma (SCH) is considered a benign vascular lesion. It typically develops as a solitary nodule or multiple masses located in the dermal or subcutaneous layers of the distal extremities. To the best of our knowledge, there are no prior reports of SCH in the spleen.

Patient concerns:

A 41-year-old male was admitted to our hospital with recurrent headaches, nausea, and vomiting persisting for 5 days. Ultrasound, computed tomography, and magnetic resonance imaging revealed multiple space-occupying lesions in the spleen, and the biggest lesion was 4.8 cm × 5.4 cm in size.

Interventions:

The patient underwent laparoscopic splenectomy.

Diagnosis:

A diagnosis of spindle cell hemangioma of the spleen was made based on the histopathology.

Outcomes:

No evidence of local recurrence or distant metastases was observed over 4-year follow-up.

Lessons:

Splenic SCH may exhibit relatively high proliferative activity and be comorbid with epithelioid hemangioendothelioma or angiosarcoma, raising the possibility of malignant potential. However, the patient remained alive and disease-free 4 years after the operation. The nature of SCH in deep soft tissues requires further study.
Multifocal muscle candidiasis of the legs in a patient with acute myeloid leukemia
Authors: Yi Ping , Yang Xiang , Yang MeiFang , Zhang Yan , Li Lanjuan
Published: February 2019

Rationale:

Opportunistic infections frequently develop in immunocompromised patients, such as those with hematological malignancies, causing significant mortality. Early diagnosis of invasive fungal infections is often important and difficult due to the difficult nature of confirming infection using cytologic and histologic findings. However, we report the first case of candidal infection leading to muscle abscesses in the legs of a patient with leukemia.

Patient concerns:

A 60-year-old man with acute myeloid leukemia (AML) presented with multifocal muscle abscesses of the legs.

Diagnoses:

Multifocal muscle candidiasis of the legs was confirmed by fine-needle aspiration biopsy of 2 of the calf lesions.

Interventions:

After treatment with amphotericin B and flucytosine for 1 month, the patient was administered intravenous caspofungin for 3 months.

Outcome:

A CT scan of the abdomen and an MRI of the lower calves showed significant improvement.

Lessons:

This case highlights that fungal infection should be considered when patients present with multiple abscesses, emphasizing the value of early biopsy to confirm diagnosis and facilitate precision treatment.
A case report of 131I therapy for Graves’ disease patient with hemiagenesis
Authors: Liu Xuehui , Zhang Jianping , Meng Zhaowei , Yu Hongxu , Gao Zhimin , Li Hongjun , Liu Na
Published: February 2019

Rationale:

Thyroid hemiagenesis is a rare congenital dysplasia, whereas a variety of pathological changes may occur in residual thyroid lobe. The most frequently described pathology in residual thyroid lobe is Graves’ hyperthyroidism. Although 131I therapy has been generally recommended as the preferred treatment for Graves’ disease (GD), subjects relating to hemiagenesis are very limited, especially in China.

Patient concerns:

A 43-year-old female patient presented to our hospital on November 2014, with a 1-year history of palpitation, fatigue, and hand tremor. Her situation was getting worse within 2 months.

Diagnosis:

The thyroid function tests were suggestive of thyrotoxicosis. The technetium thyroid scintigraphy only showed an enlarged right lobe with increased tracer uptake. Then, the agenesis of left lobe and isthmus was confirmed by ultrasound and magnetic resonance imaging (MRI). Thus, a diagnosis of GD with hemiageneis of the left lobe and isthmus of thyroid was made.

Interventions:

Thiamazole was discontinued because of drug-induced hepatic injury. According to our procedures, the patient was treated by 131I.

Outcomes:

Hypothyroidism was observed 3 months after 131I therapy. After replacement therapy with L-thyroxine (LT4), the state of euthyroid maintained.

Lessons:

Once hypothyroidism occurs, regular application of LT4 and review of thyroid function is very important. Thus, patients’ compliance needs to be strengthened. Besides, we could not convince the family members of our patient to undergo ultrasonographic examination. The genetic factor of the agenesis could not be proved in this case.
Protocol for the development and validation of a driving simulator for evaluating the influence of drugs on driving performance
Authors: Iwata Mari , Iwamoto Kunihiro , Omura Tomohiro , Ando Masahiko , Ozaki Norio
Published: February 2019

Introduction:

Although automobile driving is often necessary in daily life, most package inserts for psychotropic drugs in Japan prohibit patients from driving under the influence of medication. This may be partially because no system to evaluate the influence of drugs on driving performance has been established. Standardized evaluation methods have been established in the Netherlands and the United States, but these cannot be implemented in Japan because of differences in road situations, traffic laws, and ethnicities. Therefore, to establish a method to evaluate the influence of drugs on driving performance in Japan, we planned a validation study using alcohol and a driving simulator (DS) and set a clinically meaningful threshold involving the standard deviation of lateral position (SDLP), which is a criterion standard evaluation item.

Methods:

This study was designed as a double-blind, placebo-controlled, randomized, 4-way, fourth-order crossover trial (Williams design). Twenty-four healthy Japanese men aged 21 to 64 years will be recruited through advertisements. The participants will be required to drive daily for over 3 years and to carry the active-type aldehyde dehydrogenase (ALDH) gene polymorphism (ALDH 2∗1/∗1). Participants will be randomly assigned to 4 groups based on blood alcohol concentration (BAC): 0% (placebo), 0.025%, 0.05%, and 0.09%. The amount of alcohol intake will be calculated based on Widmark formula using a beverage that is a mixture of 40% vodka and orange juice. After a practice period, each examination period will be set with 6-day intervals. The primary outcome is SDLP in a 60-minute road-tracking test using the DS. The secondary outcomes are other evaluation items in the DS tasks and DS sickness and sleepiness according to questionnaire responses. The estimated difference in SDLP between BAC levels of 0.05% and 0% will be calculated using a linear model.

Ethics and dissemination:

Ethics approval was obtained from the Ethics Committee at Hakata Clinic and the Nagoya University Medical School Hospital Bioethics Review Committee. The trial results will be disseminated through peer-reviewed publications and international conferences.

Trial registration:

This study was registered at ClinicalTrials.gov NCT 03572985 on June 28, 2018.
Correlation between clinical and pathological features of oral lichen planus
Authors: Boñar-Alvarez Paula , Pérez Sayáns Mario , Garcia-Garcia Abel , Chamorro-Petronacci Cintia , Gándara-Vila Pilar , Luces-González Romina , Otero Rey Eva , Blanco-Carrión Andres , Suárez-Peñaranda JM
Published: February 2019

Oral lichen planus (OLP) is a common, chronic, inflammatory disease of autoimmune origin. The aim of this study is to determine the correlation of the histopathological features with clinical aspects and variants of OLP.

We have retrospectively studied a group of 59 adult patients with confirmed clinical and histopathological diagnosis of OLP from the Oral Pathology Unit of the University of Santiago de Compostela (Spain). Clinical parameters: age, gender, location of the lesions, clinical type, toxic habits, and concomitant treatments were evaluated. Histopathologically, the epithelial response (hyperplasia vs atrophy), presence of ulceration, degree of interface lesion and distribution, intensity, and composition of the inflammatory infiltrate were analyzed.

Patients treated with several systemic drugs had more atrophic/erosive forms of OLP (P = .019). Plasma cells were found more commonly in cases showing deep inflammatory involvement of the connective subepithelial tissue than in those where inflammation was only superficially located (P <.001). Their presence was also associated with epithelial erosion-ulceration (P <.01).

In conclusion, patients treated with several drugs had more atrophic/erosive forms of OLP and frequently associated with a deep specific inflammatory pattern based on plasma cells. Our results could suggest that drug intake by some patients might confer a supplementary aggravating character to the disease, alone or in conjunction with other non-identified factors. More studies should be carried out to confirm this trend and to assess whether this characteristic, can actually influence the evolution of the lesions.
Diffuse alveolar hemorrhage following sugammadex and remifentanil administration
Authors: Choi Won Kyu , Lee Jae Myeong , Kim Jong Bun , Im Kyong Shil , Park Bong Hee , Yoo Su Bin , Park Cha Yun
Published: February 2019

Rationale:

Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition that accompanies general anesthesia. Negative-pressure pulmonary edema (NPPE) is a rare cause of DAH.

Patient concerns:

A 25-year-old male patient developed hemoptysis following remifentanil administration by bolus injection with sugammadex at the emergence from general anesthesia.

Diagnosis:

Chest x-ray and computed tomography showed DAH.

Interventions:

Conservative care was provided with 4L of oxygen via nasal prong, 20 mg of Lasix and 2500 mg of tranexamic acid.

Outcomes:

The patient was discharged uneventfully.

Lessons:

Muscle rigidity by remifentanil and the dissociated reversal of neuromuscular blockade by sugammadex was suspected as the cause of NPPE-related DAH. Therefore, the possibility NPPE-related DAH should be considered when using a bolus of remifentanil and sugammadex during emergence from general anesthesia.
Hoffa fracture of the femoral condyle
Authors: Zhou Yabin , Pan Ying , Wang Qingxian , Hou Zhiyong , Chen Wei
Published: February 2019

Background:

Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries.

Methods:

We searched Medline, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure, and China Biology Medicine disc, using the terms “Hoffa fracture” and “coronal fracture of femoral condyle.”

Results:

One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Radiography can reveal fracture lines. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. Open reduction and internal fixation are preferred. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. For bicondylar fractures, a median parapatellar incision can be used. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used.

Conclusion:

Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures.
Change of HER2 status during disease recurrence predicts good prognosis for primary squamous cell carcinoma of the breast
Authors: Cao Yong , Yue Yeli , Zhou Xin , luo Jie , Zeng Xiaohua , Dong JuanHui , Liang Xinrui
Published: February 2019

Rationale:

Primary squamous cell carcinoma (PSCC) of the breast is one of the least common types of breast cancer. Adjuvant treatment for PSCC remains an unresolved issue.

Patient concerns:

We reported a case of a 48-year-old postmenopausal female patients with a 2 × 2.5 cm lump presented with no symptoms.

Diagnoses:

This patient was diagnosed as PSCC of the breast. The original tumor and first recurrence exhibited triple negative phenotype, whereas the second recurrence was HER2-positive.

Interventions:

A tumorectomy with latissimus dorsi flap reconstruction for the second recurrence was performed followed by targeted therapy with trastuzumab.

Outcomes:

The patient had a complete remission, which was sustained over the 25 months of follow-up after the tumorectomy.

Lessons:

This is the first reported case in literature of a breast PSCC patient with switched immunohistochemical phenotypes during disease recurrence. Surgical resection with flap reconstruction and targeted therapy successfully treated the recurrence.
Solitary fibrous tumor of the seminal vesicle
Authors: Zhao Ru , Shan Yanqi , Zou Liwei , Zhao Hong , Zheng Suisheng
Published: February 2019

Rationale:

Solitary fibrous tumor (SFT) is an unusual neoplasm, especially when it originates from the seminal vesicle. Herein, we describe a case of SFT that arises from the seminal vesicle.

Patient concerns:

A 66-year-old man presented to our hospital complaining of a huge irregular tumor in his pelvis during a health checkup. He was worried that the tumor could be a malignant tumor and hence wanted to undergo further examination and therapy.

Diagnosis:

An inhomogeneous, mixed soft tissue tumor in the pelvis was found during computed tomography (CT) and magnetic resonance imaging. The tumor showed heterogeneous and delayed enhancement during contrast-enhanced CT. The tumor was diagnosed as a cystadenoma originated from the seminal vesicle due to its imaging features. But the pathological diagnosis was SFT that originated from the seminal vesicle.

Interventions:

Laparoscopic seminal vesicle tumor resection was performed.

Outcomes:

There was no evidence of recurrence at the 6-month follow-up.

Lessons:

SFT in the seminal vesicle is extremely rare. It is very difficult to distinguish SFT in the seminal vesicle from the primary tumors as both have similar imaging features. We describe the tumor with SFT being considered as a differential diagnosis when the tumor is found in the seminal vesicle.
Spontaneous regression of herniated nucleus pulposus
Authors: Turk Okan , Antar Veysel , Yaldiz Can
Published: February 2019

Lumbar disc hernia is common disease, affecting about 5% of the population. Many studies to date reported regression of disc herniation without surgical intervention.

Medical records of the patients who applied to the spine clinic in an outpatient setting were retrospectively reviewed. Age, sex, radiological findings, neurological examinations, and medical treatments of the patients were evaluated.

Male patients constituted 52.6% of the cases (n = 40) and 47.4% (n = 36) were female. The ages of the patients ranged from 25 to 82 years, with a mean of 48.5 ± 12.1 years. Visual analog scale (VAS) measurements ranged from 0 to 8 and the mean was determined as 2.65 ± 1.98. The VAS score of pain severity of 12 (15.78%) cases was 0, VAS score of 39 (51.31%) cases was 1 to 3, VAS score of 20 (26.31%) cases was 4 to 6, VAS score of 5 (6.57%) cases was 7 to 10. Eighteen (23.68%) of the cases underwent neuropathic pain treatment for more than 6 months. Fifteen (19.7%) patients also developed permanent motor deficits.

Findings of our study show that there was no direct association between radiological improvement and clinical improvement. Indication for surgery still existed in a high number of patients, substantial of which developed permanent motor deficits. Current results suggest that we need to advise our patients in favor of early surgery as soon as indication for surgery is established upon neurological and radiological examination.
Effectiveness of Bazhengsan formula as an adjunctive therapy to ceftriaxone for female patients with uncomplicated gonorrhea
Authors: Li Ning , Li Li
Published: February 2019

Background:

This pilot study aimed to investigate the feasible effectiveness and safety of Bazhengsan formula (BZSF) as an adjunctive therapy to ceftriaxone for female patients with uncomplicated gonorrhea.

Methods:

This pilot randomized controlled trial compared BZSF as an adjunctive therapy to ceftriaxone with ceftriaxone alone for Chinese female patients with uncomplicated gonorrhea. A total of 40 eligible patients were randomly allocated to a treatment group (received BZSF and ceftriaxone) or a control group (received ceftriaxone alone). All patients in both groups were treated for a total of 10 days. The primary outcome included bacteriological cure. It was assessed by the eradication of urogenital gonorrhea at any site cultured after taken the study medications. The secondary outcome was clinical response. For the safety assessment, adverse events were recorded during the study period.

Results:

After treatment, patients in both groups achieved promising effectiveness. However, no significant differences in bacteriological cure (P = .34), clinical response (P = .11), and safety were found between 2 groups.

Conclusion:

The findings of this study showed that BZSF as an adjunctive therapy to ceftriaxone may be not superior to the ceftriaxone alone for Chinese female patients with uncomplicated gonorrhea after 10 days treatment.
Cerebral microbleeds in patients with ischemic cerebrovascular disease taking aspirin or clopidogrel
Authors: Ge Lihong , Ouyang Xuehui , Ban Chao , Yu Haixia , Wu Qiong , Wu Hui , Liang Junguo
Published: February 2019

Cerebral microbleeds (CMBs) may be markers of intracerebral bleeding risk in patients receiving antithrombotic drugs. This study aimed to analyze CMBs and white matter hyperintensities (WMHs) in patients taking aspirin or clopidogrel.

This retrospective study included patients with ischemic cardiovascular disease administered 75 mg/day aspirin (n = 150) or clopidogrel (n = 150, matched for age and gender) for >1 year (Affiliated Hospital of Inner Mongolia Medical University, China, from July, 2010 to July, 2015). Patients underwent T2-weighted imaging, T1-weighted imaging, diffusion-weighted imaging (DWI) and enhanced T2∗-weighted angiography (ESWAN) imaging (3.0-Tesla scanner). Baseline vascular risk factors for CMBs and macroscopic bleeding (MB) were evaluated using univariate and multivariate analyses.

The aspirin and clopidogrel groups did not differ significantly in baseline characteristics or prevalences of CMBs or MB. The odds of MB were higher in patients with CMBs than in patients without CMBs in both the aspirin (odds ratio, 95% confidence interval: 4.09, 1.93–8.68; P < .001) and clopidogrel (6.42, 2.83–14.57; P < .001) groups. The odds of WMHs were also higher in patients with CMBs in both the aspirin (3.28, 1.60–6.71; P = .001) and clopidogrel (4.09, 1.91–8.75; P < .001) groups. Patients receiving treatment for >5 years showed elevated risk of CMBs in the aspirin (0.17; 0.09–0.36; P < .001) and clopidogrel (0.15, 0.07–0.33; P < .001) groups as well as higher odds of MB in the aspirin (0.34, 0.16–0.71; P = .004) and clopidogrel (0.37, 0.17–0.80; P = .010) groups.

The WMHs and MB were associated with CMBs in patients taking aspirin or clopidogrel for >1 year, and long-term use increased the risks of CMB and bleeding.
The effect of pre-hospital intubation on prognosis in infants, children and adolescents with severe traumatic brain injury
Authors: Guo Yichen , Li Ruilin
Published: February 2019

Introduction:

Traumatic brain injury is one of the leading causes of death and sources of heavy societal burden. Hypoxemia and hypercapnia are the 2 common complications of brain injury. Intubation seems to be an effective intervention for preventing the 2 complications in pre-hospital setting. But the results of the existing studies on the effect of pre-hospital intubation on prognosis of patients (aged less than 18) with severe traumatic brain injury are conflict. Thus, in this study, we aim to conduct a systematic review and meta-analysis to evaluate whether pre-hospital intubation is benefit for the prognosis in infants, children and adolescents with severe traumatic brain injury.

Methods:

We will develop a systematic search strategy which includes MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, WanFang Data and China National Knowledge Infrastructure. The WHO International Clinical Trials Registry Platform will be searched for the ongoing studies as well. The cohort studies which aim to evaluate the effect of pre-hospital intubation for infants, children and adolescents with severe traumatic brain injury will be selected. The Newcastle-Ottawa Scale will be used for assessing the risk of bias of the included studies.

Results:

The results of this study will be presented in the full-text of the systematic review.

Conclusion:

This is the first systematic review and meta-analysis about evaluation of the effect of pre-hospital intubation on prognosis in infants, children and adolescents with traumatic brain injury.

PRESPERO registration number:

CRD42019121214
Co-alteration of EGFR mutation and ALK rearrangement in non-small cell lung cancer
Authors: Shin Hong-Joon , Kho Bo Gun , Kim Min-Seok , Park Ha Young , Kim Tae-Ok , Kim Yu-Il , Lim Sung-Chul , Park Cheol-Kyu , Kim Young-Chul , Choi Yoo-Duk , Oh In-Jae
Published: February 2019

Rationale:

Current guidelines for advanced non-small cell lung cancer (NSCLC) recommend the use of targeted agents for specific driver genes after confirming genetic alterations. Although epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement are usually mutually exclusive, EGFR and ALK co-alterations have been reported increasingly in cases of NSCLC. However, the optimal treatment for these cases has not been established.

Patient concerns:

This case series describes three patients diagnosed with advanced non-squamous NSCLC who harbored EGFR and ALK co-alterations. The complaints for each case are as follows: 57-year-old woman with coughing and dyspnea in case 1, 32-year-old man with diplopia in case 2 and 77-year-old woman with chest discomfort in case 3.

Diagnoses:

Three never-smokers were diagnosed pathologically with stage IV adenocarcinoma of the lung. Subsequent molecular studies revealed the EGFR L858R mutation gene and ALK rearrangement, which were proven by real-time polymerase chain reaction and fluorescence in situ hybridization, respectively.

Interventions:

All 3 patients received first-line therapy with EGFR-tyrosine kinase inhibitors (TKIs). Cases 1 and 2 were treated with ALK-TKIs as second-line therapy and received additional EGFR-TKIs as third- and fourth-line regimens.

Outcomes:

The patients achieved partial responses to EGFR-TKIs according to radiologic findings. However, second-line ALK-TKI therapy was ineffective in cases 1 and 2.

Lessons:

Cases of NSCLC with concomitant EGFR mutation and ALK rearrangement are rare, and the selection of an optimal targeted therapy is challenging. Here, EGFR-TKI appeared to yield better outcomes than ALK-TKI in patients with NSCLC who harbored EGFR/ALK co-alterations.
Diagnostic value of cadmium-zinc-telluride myocardial perfusion imaging versus coronary angiography in coronary artery disease
Authors: Zhang Yi-Qing , Jiang Yu-Feng , Hong Lu , Chen Min , Zhang Nan-Nan , Yang Hua-Jia , Zhou Ya-Feng
Published: February 2019

Background:

Rapid progress has been made in research of cadmium-zinc-telluride (CZT) technology in the last few years, which might serve as a new method to diagnose coronary artery disease. However, compared with coronary angiography, the diagnostic value of CZT is still controversial. We aimed to evaluate diagnosis value of coronary angiography versus CZT in coronary artery disease.

Methods:

We searched the database for eligible researches associated with CZT- myocardial perfusion imaging (MPI) and invasive coronary angiography, extracted the relevant data, and rigorously screened it according to the inclusion and exclusion criteria. The accuracy indicators included sensitivity, specificity, accuracy, positive and negative likelihood ratios.

Results:

According to the inclusion and exclusion criteria, we finally found 20 studies containing 2350 patients in this search. Pooled results showed that sensitivity of CZT-MPI was 0.84% and 95% confidence interval (95% CI): 0.78 to 0.89, specificity was 0.72, 95% CI (0.62–0.76), the specificity was lower apparently. The positive likelihood ratio was 3.0, 95% CI (2.4–3.8), the negative likelihood ratio was 0.22, 95% CI (0.16–0.31), diagnostic odds ratio was 14, 95% CI (7.84–17.42).

Conclusion:

This meta-analysis showed that CZT-MPI had satisfactory sensitivity and specificity for diagnosing coronary artery disease. Larger studies are required for further evaluation.
A meta-analysis of randomized controlled trials
Authors: Li Shaojun , Tang Tian , Guo Pengfei , Zou Qing , Ao Xiaoxiao , Hu Lan , Tan Liping
Published: February 2019

Background:

To understand the clinical outcomes of selenium therapy in patients with sepsis syndrome, we conducted a meta-analysis of randomized controlled trials (RCT).

Methods:

A total of 13 RCTs comparing selenium and placebo for patients with sepsis were reviewed systematically.

Results:

However, we could not detect the association of selenium treatment with a decreased mortality at different time course (relative risk [RR] [95% confidence interval, CI]: 0.94 [0.82–1.06] at day 28; 0.73 [0.36–1.47] at day 90; 1.16 [0.78–1.71] at 6 months; respectively). Selenium supplementation did not show favorable efficacy in the incidence of renal failure, secondary infection or duration of mechanical ventilation (RR [95% CI]: 0.65 [0.41–1.03]; 0.96 [0.87–1.06]; standard mean difference [SMD] [95% CI]: 0.17 [−0.30–0.63]; respectively). Interestingly, we found that selenium therapy was benefit for sepsis patients with reduced duration of vasopressor therapy, staying time in intensive care unit and hospital, and incidence of ventilator-associated pneumonia (SMD [95% CI]: −0.75 [−1.37 to −0.13]; −0.15 [CI: −0.25 to −0.04]; −1.22 [−2.44 to −0.01]; RR [95% CI]: 0.61 [0.42–0.89]; respectively).

Conclusion:

Based on our findings, intravenous selenium supplementation could not be suggested for routine use.
Impact of diabetes duration on heart failure in Korean patients without clinical cardiovascular disease
Authors: Noh Minsu , Kwon Hyunwook , Jung Chang Hee , Lee Seung-Whan , Lee Jong-Young , Kim Min-Ju , Han Youngjin , Kwon Tae-Won , Cho Yong-Pil
Published: February 2019

We aimed to investigate the association between diabetes duration and the subsequent occurrence of heart failure (HF) in type 2 diabetes mellitus (T2DM) patients without clinical cardiovascular disease.

In this single-center, observational cohort study, a total of 3724 T2DM patients were stratified by diabetes duration into three 5-year interval subgroups. The primary outcomes were the occurrence of new-onset HF and all-cause mortality.

HF incidence (P < .001) and mortality (P = .001) were significantly higher in patients with a longer duration of diabetes (≥10 years) than in those with a shorter duration (<5 years). On multivariate analysis, diabetes duration ≥10 years was not independently associated with all-cause mortality compared with duration < 5 years, but there was a nonsignificant increased risk of HF in patients with a diabetes duration ≥10 years (P = .056). Poor glycemic control was associated with an increased risk of HF and mortality; statin use was associated with a significantly decreased risk of mortality.

Our study indicated that a longer duration of diabetes is associated with an increased risk of new-onset HF occurrence and all-cause mortality in T2DM patients without clinical cardiovascular disease.