bluuebunny/crossref_metadata_2025 huggingface dataset:
Mosaic Fleur-de-Profunda Artery Perforator Flap for Autologous Breast Reconstruction
Authors: Bourn Lynn , Torabi Radbeh , Stalder Mark W. , St. Hilaire Hugo , Allen Robert J. , Delatte Stephen J. , Matatov Tim S. , Torabi Rozbeh , Zakhary Joseph , Tessler Oren
Published: March 2019

Perforator-free flaps, in autologous breast reconstruction, have expanded to exploit tissue available at smaller donor sites while retaining high success and low risk rates. Abdominal based flaps, such as the deep inferior epigastric perforator, remain the most common; however, when the abdomen is not an appropriate donor site, lower extremity flaps are options. The profunda artery perforator has the benefit of hiding unsightly scar in the gluteal crease but has the drawback of poor donor site volume. Our mosaic fleur-de-profunda artery perforator flap technique for breast reconstruction has shown to increase volume with the addition of a vertical limb, include full angiosome of perforators, and exhibit donor site morbidity equivalent to a medial thigh lift.
Identification of a Novel ZNF469 Mutation in a Pakistani Family With Brittle Cornea Syndrome
Authors: Micheal Shazia , Siddiqui Sorath Noorani , Zafar Saemah Nuzhat , Gabriëla Niewold Ilse Therésia , Khan Muhammad Imran , Bergen Arthur A. B.
Published: March 2019

Purpose:

Brittle cornea syndrome (BCS) is a rare recessive disorder affecting connective tissues, most prominently in the eye. Pathogenic mutations causing BCS have been identified in PRDM5 and ZNF469 genes. This study investigates the genetic cause of BCS in a large, consanguineous Pakistani family with 4 affected and 3 unaffected individuals.

Methods:

The coding region and exon–intron splice junctions of PRDM5 and ZNF469 genes were amplified by polymerase chain reaction, and bidirectional Sanger sequencing was performed to find the pathogenic change responsible for causing the disease in the family.

Results:

A novel homozygous duplication c.9831dupC (p.Arg3278GlnfsX197) in the ZNF469 gene was identified, which was found to be co-segregating with the disease in the family.

Conclusions:

This is the first report of a ZNF469 homozygous mutation causing a BCS phenotype in a consanguineous Pakistani family. Our data extend the mutation spectrum of ZNF469 variants implicated in BCS.
Keratoconus Corneal Posterior Surface Characterization According to the Degree of Visual Limitation
Authors: Vega-Estrada Alfredo , Alio Jorge L.
Published: March 2019

Purpose:

To characterize posterior corneal surface features in patients with keratoconus and healthy controls and correlate them with the severity of the disease according to visual limitation.

Methods:

Retrospective, comparative, clinical study including 477 cases, 374 keratoconic eyes and 103 healthy corneas. Patients were classified according to the degree of visual limitation. The corneal posterior surface including shape indices and keratoconus screening indices was evaluated using the rotating Scheimpflug camera and Placido disc topographer.

Results:

Dioptric power of the posterior corneal surface increases linearly as corrected distance visual acuity deteriorates (r > 0.700; P < 0.001). A significant correlation was also observed between shape indices root mean square per unit of area (RMS/A) (posterior surface irregularity) and corrected distance visual acuity (r = −0.750; P < 0.001). In addition, keratoconus screening indices such as posterior corneal aberrations and posterior ectasia vertex (KVb) also showed significant correlation with the degree of visual limitation (r = −0.687; P < 0.001 and r = −0.789; P < 0.001, respectively). Receiver operating characteristic curves demonstrate that RMS/A and KVb showed highest discriminating capabilities between normal and mild keratoconus cases with an area under the curve of 0.96 and 0.97, respectively, with a sensitivity and specificity of more than 93% for the RMS/A and 89% and 84% for the KVb.

Conclusions:

Posterior corneal surface characteristics correlate with the degree of visual impairment and can be used for classifying patients with keratoconus. RMS/A, KVb, and posterior corneal aberrations are the most representative variables of visual function deterioration and are also useful to differentiate normal from mild keratoconus cases.
Outcomes of Cyanoacrylate Tissue Adhesive Application in Corneal Thinning and Perforation
Authors: Yin Jia , Singh Rohan Bir , Al Karmi Rani , Yung Ann , Yu Man , Dana Reza
Published: March 2019

Purpose:

To report the outcomes of cyanoacrylate tissue adhesive (CTA) application in corneal thinning and perforation.

Methods:

A retrospective interventional case series of 137 patients receiving CTA for corneal thinning and perforation in 140 eyes between 2001 and 2018 at a single center was reviewed. Success rate and factors associated with glue failure were analyzed.

Results:

Median age of the cohort was 63 years and 69 (50%) were women. One hundred fifteen patients (84%) had at least 1 systemic condition, 46 (34%) had autoimmune diseases. Eighty-nine eyes (64%) presented with perforation and 51 (36%) with thinning. The perforation/thinning was central/paracentral in 82 eyes (59%) and peripheral in 57 eyes (41%). Median size of perforation was 3.1 mm2. Causes of perforation and thinning were microbial infection in 75 (55%), sterile melt in 49 (35%), laceration in 10, and keratoprosthesis melt in 8 eyes. Median glue retention was 58 days. Success rate of glue application (defined as intact globe without surgical intervention) was 72%, 61%, and 46% at 10, 30, and 90 days after glue application, respectively. Larger size of perforation/thinning, perforation (vs. thinning), and single glue application (vs. multiple) were correlated with higher failure rate. Systemic conditions, use of topical corticosteroid, etiologies, and location of perforation/thinning were not significantly correlated with glue failure.

Conclusions:

CTA application was moderately effective in stabilizing corneal perforation and thinning in the very short-term. Multiple applications are often required. Maintenance of globe integrity after glue application decreases with time and the need for surgical intervention remains high.
Corneal Biofilm Plaques: A Novel Clinical Presentation
Authors: Córdoba Andrea , Graue-Hernandez Enrique O. , Bermudez-Magner Jose A. , Ramirez-Miranda Arturo , Irusteta Leire , Bautista-de Lucio Victor M. , Ponce-Angulo Diana G. , Bautista-Hernandez Luis A. , Navas Alejandro
Published: March 2019

Purpose:

To report a novel clinical presentation of corneal biofilms, consisting of formation of superficial and recurrent corneal plaques.

Methods:

Interventional case report. A 9-year-old boy presented with subepithelial, whitish, avascular, and recurrent corneal plaques without any clinical manifestations of active corneal inflammation and/or infection. He had a history of minor ocular trauma; otherwise, his medical history was unremarkable.

Results:

An excisional biopsy was performed under topical anesthesia. Histological analysis identified these plaques as clusters of gram-negative bacilli surrounded by an extracellular matrix. Samples were further evaluated with special stains (calcofluor white, Flamingo fluorescent dye, propidium iodide, and Gomori–Grocott) that demonstrated biofilm structures.

Conclusions:

Corneal plaques are a very rare clinical presentation of corneal biofilms that allow prolonged survival of microorganisms even in the absence of prosthetic material and clinical signs or symptoms of corneal active inflammation and/or infection.
Predictors of Local Recurrence for Eyelid Sebaceous Carcinoma: Questionable Value of Routine Conjunctival Map Biopsies for Detection of Pagetoid Spread
Authors: Sa Ho-Seok , Tetzlaff Michael T. , Esmaeli Bita
Published: March 2019

Purpose:

To identify clinicopathologic factors associated with local recurrence of eyelid sebaceous carcinoma and determine whether routine conjunctival map biopsies are necessary to detect pagetoid spread.

Methods:

The authors searched PubMed for articles on eyelid sebaceous carcinoma and pagetoid spread published in English during 1982 to 2018, and they reviewed 99 consecutive patients with eyelid sebaceous carcinoma who underwent surgical excision with frozen section control of margins performed by 1 author (BE) during 1999 to 2017.

Results:

Local recurrence rates after surgery were 5% to 25% in the literature and 6% in the authors’ cohort. Risk factors for local recurrence included T3b (>20 mm) or worse disease according to the AJCC Cancer Staging Manual, eighth edition, pagetoid spread, diffuse growth pattern, and multicentric origin. Pagetoid spread was observed in 8.3% to 70% of patients in the literature and 31% of patients in the authors’ cohort. The literature review showed that surgical excision with frozen section control is the mainstay of management of eyelid sebaceous carcinoma, with topical chemotherapy and cryotherapy used in cases with pagetoid spread. The authors found no solid evidence for added value from routine 4-quadrant conjunctival map biopsies, and some studies called into question their accuracy and yield.

Conclusions:

In patients with eyelid sebaceous carcinoma, meticulous microscopic margin control is appropriate in all cases and particularly for tumors >20 mm and adjuvant topical chemotherapy should be considered for tumors with conjunctival pagetoid spread. Routine conjunctival map biopsies are not essential, but targeted map biopsies of areas with signs suggestive of pagetoid intraepithelial spread may be appropriate to guide future closer observation or adjuvant treatments.
Lacrimal Gland Orbital Lobe Cysts Associated With Lymphoid Hyperplasia or Mucosa-Associated Lymphoid Tissue Lymphoma in Patients With Chronic Autoimmune Disease
Authors: Dutton Alice E. , McElnea Elizabeth M. , Rubinstein Tal J. , Curragh David S. , McKelvie Penny A. , Selva Dinesh , Rose Geoffrey E. , McNab Alan A.
Published: March 2019

Large cysts in the orbital lobe of the lacrimal gland are rare and are associated with Sjögren syndrome and B-cell mucosa-associated lymphoid tissue lymphoma. The authors describe 4 new cases of large orbital lobe lacrimal gland cysts. The first 2 patients, both with Sjögren syndrome, had unilateral cysts associated with chronic inflammation. Mucosa-associated lymphoid tissue lymphoma was also identified in the cyst wall of the second case and could not be completely excluded in the first case. The third patient, with a history of rheumatoid arthritis, had bilateral cysts, again associated with mucosa-associated lymphoid tissue lymphoma. The fourth patient, with no history of systemic disease, had a unilateral cyst associated with reactive lymphoid hyperplasia. Finally, the authors report the long-term outcomes of 3 previously reported cases.
Subcutaneous Tocilizumab for Thyroid Eye Disease: Simplified Dosing and Delivery
Authors: Copperman Thomas , Idowu Oluwatobi O. , Kersten Robert C. , Vagefi M. Reza
Published: March 2019

Intravenous tocilizumab has been demonstrated to be an effective disease modifying agent in the treatment of moderate to severe active thyroid eye disease. The authors describe 2 patients treated with tocilizumab using home subcutaneous administration over an accelerated, biweekly course. Both patients exhibited improvement in thyroid eye disease clinical activity and proptosis.
Lateral Canthal Clefts of the Eyelid
Authors: Lessa Sergio , Sebastiá Roberto , Pontello Joao
Published: March 2019

Purpose:

Facial clefts are congenital anomalies classified by Tessier based on their anatomical position. Tessier 8 craniofacial clefts extend from the lateral canthus to the temporal region, including bone cleft at the frontozygomatic suture, and it is characterized by the interposition of a strip of skin at the lateral canthus that disrupts the continuity of the orbicularis muscle, preventing its normal functioning.

Methods:

This is a retrospective study of 6 patients with congenital eyelid coloboma, of whom 5 underwent surgery for the removal of dermolipoma and reconstruction of the lateral canthus. After surgery, the shape and symmetry of the lid fissure was restored, and motility was maintained. Vertical and horizontal measurements of the palpebral fissure were carried out before and after surgery.

Results:

Five cases of lateral colobomas were evaluated after surgical treatment up to a year post operatively. The surgical correction with limited resection of the tumor was very effective, and the resulting small horizontal scar almost disappeared over time. In all cases, motility was maintained, and there were no cases of symblepharon. After surgery, there was improvement in the shape and symmetry of the eyelid fissures.

Conclusions:

Tessier’ Number 8 facial cleft coloboma is characterized by the interposition of a skin strip, constituting a dermolipoma between the upper and lower eyelids that disrupts the continuity of the orbicularis muscle, and lateral bone alteration. The surgical correction of dermolipoma should be performed conservatively with limited resection of the tumor. A simple canthoplasty was very effective, and the small scar practically disappears over time. The absences of bone alteration in the cases presented suggest a unusual variation of lateral canthal cleft.
CO2 Laser Lash Tilt Technique for the Treatment of Mild to Moderate Lash Ptosis and Augmentation of Upper Eyelid Blepharoplasty Results
Authors: Langelier Nicole A. , Liss Jason , Leyngold Ilya M. , Weller Christopher L. , Stinnett Sandra , Woodward Julie A.
Published: March 2019

Purpose:

To assess the safety, efficacy, and patient satisfaction of a newly described technique for the treatment of mild to moderate lash ptosis performed as augmentation to upper eyelid blepharoplasty.

Methods:

Patient medical records for 27 consecutive cases of upper eyelid blepharoplasty between January 2016 and June 2017 and 19 consecutive cases of upper eyelid blepharoplasty with the laser lash tilt procedure between July 2016 and January 2017 performed by the senior author were retrospectively reviewed. Lash position in preoperative and postoperative photographs was graded in a randomized masked fashion on a 4-point scale by 5 oculoplastic surgeons.

Results:

There was a significant improvement in mean lash position scores for the control group (0.52 ± 0.34, p < 0.001) with mean lash score improving from 1.14 ± 0.46 before surgery to 0.62 ± 0.46 after blepharoplasty alone. There was also significant improvement in mean lash position scores for the laser lash group (0.98 ± 0.52, p < 0.01) with mean lash score improving from 1.66 ± 0.62 before surgery to 0.68 ± 0.50 after blepharoplasty with laser lash treatment. The improvement in lash position seen in the laser lash group was significantly greater than the improvement seen in the control group (p = 0.001). There were no complications and all patients were satisfied with their results.

Conclusions:

Compared with upper eyelid blepharoplasty alone, the addition of the CO2 laser lash tilt technique provides a significant improvement in the upward tilt of the eyelashes as they emerge from the eyelid margin.
Characterizing Congenital Double Punctum Anomalies: Clinical, Endoscopic, and Imaging Findings
Authors: Timlin Hannah M. , Keane Pearse A. , Ezra Daniel G.
Published: March 2019

Double puncta coexist with a range of other nasolacrimal pathologies. OCT suggests that the medial of the 2 double puncta is the abnormal one, with DCG and endoscopy demonstrating a range of accessory canaliculus lengths.

Purpose:

To characterize the anatomical anomaly of congenital double puncta, identify factors contributing to epiphora and its treatment.

Methods:

Retrospective review of patients presenting with epiphora and a double lacrimal punctum over a 6-month period.

Results:

Five consecutive patients (3 female) were identified. The median age was 50 years (range 34–76). Investigations included punctum optical coherence tomography, dacryocystography, and canalicular endoscopy. The medial punctum was more morphologically abnormal when compared with healthy puncta, with optical coherence tomography showing no vertical canalicular component in 80% (4/5) of patients, and a more superficial than usual horizontal canaliculus in 80% (4/5). Dacryocystography and canalicular endoscopy showed the junction of the 2 inferior canaliculi, which was very proximal in 1, mid canalicular in 2, and at the level of the common canaliculus in 2. In 1 patient, the only abnormality identified was the double lower punctum, with a high tear meniscus and delayed fluorescence dye disappearance test. They underwent endonasal dacryocystorhinostomy with improvement of epiphora. In the other 4 patients, causes of epiphora were nasolacrimal duct stenosis with mucocoele, punctal stenosis, common canalicular stenosis with nasolacrimal duct stenosis, upper canaliculitis, and blepharitis. Their treatments included endonasal dacryocystorhinostomy, punctoplasty, canaliculotomy, and blepharitis treatment. All had improvement of epiphora following treatment.

Conclusions:

These findings suggest that the underlying canalicular anomalies are varied and that the clinical manifestation is also heterogenous. Optical coherence tomography imaging suggests that the medial of the 2 puncta is the more morphologically abnormal one, with dacryocystography and canalicular endoscopy demonstrating different accessory canaliculi lengths.
Acute Physical and Occupational Therapy and Serum Potassium: When Is It Safe?
Authors: Myszenski Adele , Hannum Nanette , Hudson Michael , Yee Jerry
Published: March 2019

Purpose:

High or low serum potassium (K+) levels are associated with increased risk of cardiac arrhythmias. No research-based guidelines or suggested values for K+ in regard to safe provision of physical therapist (PT) and occupational therapist (OT) services for patients in an acute care setting are currently available. This study was designed to determine whether patients with serum K+ levels of 3.1 to 5.9 mmol/L can participate safely in acute PT and OT interventions without serious adverse events.

Methods:

A total of 380 subjects admitted to an acute care hospital were stratified into groups with hypokalemia (K+ levels of 3.1-3.4 mmol/L), hyperkalemia (K+ levels of 5.1-5.9 mmol/L), or normal K+ levels (K+ levels of 3.5-5.0 mmol/L) and provided with standard PT or OT intervention. Baseline clinical characteristics and adverse outcomes were compared between groups.

Results:

No serious adverse events occurred. Termination of treatment due to minor adverse events occurred in 8 (2%) subject cases and all occurred in the normal K+ group (n = 8, 3%) (P = .029). Rates of adverse outcomes did not differ significantly between normal (n = 37, 15.5%) and abnormal K+ (n = 26, 16.4%) groups.

Conclusions:

Results of this study suggest that provision of PT and OT interventions for patients with serum K+ levels of 3.1 to 5.9 mmol/L is safe.
Complementary Alternative Therapies
Authors: Zito Patrick M. , Murgia Robert D.
Published: March 2019

Drugs are medications or substances that are used to modify physiologic responses and alleviate associated symptoms. In dermatology, medications and substances are utilized on a daily basis and include topical treatments to anesthetics in micrographic surgery to biologic-acting immunologic agents. The purposes of this section are to focus on drug, specifically how it works and how it is utilized, and to discuss routine alternatives (if available). In this column, we will focus on the uses, mechanism of action, and adverse effects of green tea in acne vulgaris.
To Mohs or Not to Mohs
Authors: Crumpton Kristen
Published: March 2019

Mohs micrographic surgery is a common procedure used to treat nonmelanoma skin cancers. With a clearance rate of approximately 98% in small primary basal cell carcinomas and approximately 97% in small primary squamous cell carcinomas, it is the gold standard of care. When considering a Mohs procedure, several criteria are reviewed and evaluated to make sure that Mohs is an appropriate treatment option for the specific tumor, and that the patient is an appropriate candidate to undergo Mohs. However, there are no such criteria for a specific age or functional status at which Mohs is deemed inappropriate (Connolly et al., 2012). Some may argue that patients in their 90s with a nonfatal skin cancer should not undergo an invasive surgery, as their quality of life may be impacted. Others may argue that, if they are healthy, surgery is the best answer. It is necessary for elderly patients and their caregivers to be fully informed about what type of skin cancer the patient has, its prognosis, and how it affects the patient’s quality of life. All possible treatment regimens should be explained by the provider with opinions and advice given in respect to the patients’ current health status and wishes in mind. Ultimately, care of the elderly patient regarding having or not having Mohs surgery should be a decision made between patient and provider, with the patient’s preference as the priority.
Using Social Media to Assess Mental Health and Quality of Care Among Patients With Darier Disease
Authors: McLawhorn Justin M. , Balamurugan Appathurai , Gardner Jerad M. , Kaley Jennifer R. , George Masil J.
Published: March 2019

Darier disease (DD) is a rare skin condition that has been associated with debilitating mood disorders. This is the first study on patients with DD to investigate quality of care and prevalence of psychiatric symptoms wherein the participants were recruited through social media on the World Wide Web. The objective of this report is to assess the subjective experience of DD as it relates to symptom severity, mental health, quality of life, and interdisciplinary care management using Facebook as a means of data acquisition. We developed and distributed a survey to a Facebook DD support group entitled, “Darier’s Disease, let’s know each other!!!”. We found that a third of our patient population experienced symptoms that imparted at least a significant negative impact on their quality of life. Furthermore, most respondents were not screened for depressive symptoms by standard intake questionnaires at their dermatology office visits, despite most of these patients having previously sought mental health services for anxiety/depression/or other mood symptoms secondary to their DD manifestations. We concluded that social media support groups may be a practical tool to recruit patients and assess quality of care. Furthermore, screening for the psychodermatological aspects of DD should be routine protocol for dermatology clinic nurses and dermatologists on every clinical visit.
Transtibial Prosthetic Socket Design and Suspension Mechanism: A Literature Review
Authors: Al Shuaili Nadhira , Aslani Navid , Duff Lynsey , McGarry Anthony
Published: March 2019

Introduction

The body weight of the prosthetic user is supported and distributed by the prosthetic socket during the stance phase of gait. Throughout swing phase, inertial forces (pressure and shear) are exerted by the socket suspension mechanism onto the residuum to facilitate suspension. Objectives in the study were to identify and investigate available evidence in transtibial (TT) socket design and suspension to highlight the most effective weight transfer mechanisms and suspension techniques.

Methods

A literature research was conducted comprising two parts: socket design and suspension. Boolean search terms and truncation were used using relevant keywords in online search engines to obtain precise results.

Results

Seventeen articles that met inclusion criteria were reviewed.

Conclusions

A conclusion on whether socket preference is due to the suspension mechanism or socket design itself cannot be drawn. Patellar tendon bearing (PTB) sockets are still successfully used and, in some studies, preferred over total surface bearing (TSB) sockets. Biomechanically, however, TSB sockets allow for a more even weight distribution when combined with suction, particularly vacuum-assisted socket suspension (VASS). Some limited evidence exists to support that such designs may have some effect on wound healing and early ambulation. Further research must be conducted to standardize acclimation periods. Crossover randomized controlled trials with larger sample sizes are required to establish an evidence base to improve clinical practice.
Method to Evaluate the Sagittal Plane Mobility of the Medial Arch of the Shod Foot with Foot Orthosis
Authors: Papadopoulos Anthony
Published: March 2019

Introduction

Midfoot mobility plays an important role in the orthotic treatment of foot pathomechanical disorders, such as flexible pes planus and abnormal foot pronation. The sagittal plane mobility of the medial arch of only the unshod foot with a foot orthosis has been evaluated for improving therapeutic outcomes. Because foot orthoses are in-shoe devices, it is necessary to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis to optimize in-shoe orthotic effectiveness.

Materials and Methods

This technical note describes a procedure using digital photography to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis. The procedure involves digitally photographing two weight-bearing states of the shoe in which the foot orthosis supports the foot: 1) 10% of body weight achieved by sitting, and 2) 50% of body weight achieved by standing. The two digital images of the shoe are then geometrically analyzed to calculate the displacement of the medial height of the dorsal surface of the shoe in response to the change in the two weight-bearing states.

Conclusions

Clinicians and researchers can use the method described in this note to evaluate the sagittal plane mobility of the medial arch of the shod foot with a foot orthosis. The method is clinically useful for optimizing the in-shoe effectiveness of foot orthoses to treat foot pathomechanical disorders.
Unlimbited Wellness: Telehealth for Adults with Upper-Limb Difference
Authors: Latour Debra
Published: March 2019

Introduction

Individuals with upper-limb loss/difference often require specialized services, including occupational therapy that may be difficult to access. Also, individuals are likely to encounter secondary conditions that include pain, overuse, perceptions of isolation, and social stigma. The program was developed to meet the needs vocalized by the target population, to offer a pathway using telehealth (TH) to access peers, and to become better informed about strategies that would help to prevent physical overuse and social isolation and facilitate improved self-advocacy skills with medical practitioners.

Methods

Unlimbited Wellness is based on results of a needs assessment that specifically focused on the challenges experienced by this population. Participants of the Unlimbited Wellness program interacted with peers via a TH model to learn about physical and psychosocial health conditions that may cause them disparity and to share strategies to prevent or manage them.

Results

Effectiveness of the program was assessed via a survey of participant TH experiences and changes in perceptions of pain, ability, and quality of life as measured by the McGann Client Feedback Form and the Pizzi Health and Wellness Assessment. Overall, participant post-group perceptions of health, well-being, and prosthetic satisfaction improved as compared with pre-group experiences. During the 1:1 interviews, all participants stated they felt empowered due to their engagement in peer discussions and collaborative exercises during the Unlimbited Wellness program.

Conclusions

The program results indicate that a TH service delivery can be beneficial to enact health behavior change and empower individuals with upper-limb difference.
The Accuracy of Variously Positioned Pedometers for Lower-Limb Prosthesis Users
Authors: Guerra Gary , Smith John D. , Gomez Paula , Siriwatsopon Juthamas
Published: March 2019

Introduction

Tracking the physical activity of persons with amputation is a valuable outcome measure. Identifying affordable and accurate ways of measuring activity for individuals with amputation in developed and resource-limited environments is equally valuable. Limited walking data and methods to reliably measure walking of persons with amputation exist. The purpose of this study was to evaluate accuracy of the Omron HJ-329 worn by persons with lower-limb amputations at different locations.

Methods

Nineteen lower-limb prosthesis wearers wore pedometers around the neck, in both affected and nonaffected side pockets, and on the hip of both the affected side and the contralateral side while walking at a self-selected pace for 200 m. Actual step counts (ACs) were recorded by a hand tally counter. Repeated-measures analysis of variance was used to determine differences in pedometer counts between affected and nonaffected sides and between ACs. Agreement was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and absolute percent error was calculated using ([steps detected by pedometer − AC]/AC) × 100. Alpha was set at 0.05 for all tests.

Results

No significant differences existed in pedometer counts between affected and nonaffected sides (P > 0.05), nor were any significant differences evident between any of the pedometers and ACs (P > 0.05). In our sample, there were more left affected participants; among all participants, ICCs were highest on the left hip followed by the right hip, and least in the left pocket and around the neck. Limits of agreement in the Bland-Altman plots reflected this trend as well. Absolute percentage error of pedometers was greatest in the left pocket (6.8%) and lowest for the pedometer located at the left hip (2.2%) and right hip (2.6%).

Conclusions

The individual with amputation can wear the activity monitor at any of the locations and on either the affected or nonaffected side, and it seems wearing the devices on the hip will provide the most accurate results. Among the individuals with unilateral amputation, there were no differences in metrics between affected and nonaffected limbs. For our bilateral participants, the same nondifferences were observed. The Omron HJ-329 is thus an affordable, viable activity monitor for the population of persons with lower-limb amputation.
High risk twin pregnancy complicated with severe rachiterata and huge dorsal mass suffering from refractory infection
Authors: Yang Fan , Wan Li , Qi XiaoRong
Published: March 2019

Rationale:

Severe rachiterata is rarely described as a complication of pregnancy, and it was assumed as a contraindication to pregnancy. We first report a case of severe spinal deformity associated both with scoliosis and kyphosis in pregnancy.

Patient concerns:

A 38-year-old pregnant woman [28+1 weeks of twin pregnancy, gravida 3, para 2 (G3P2)] was admitted to the emergency department with complaints of persistent productive cough, with increased expectoration, dyspnea, dizziness, fatigue, and irregular abdominal pain. She had obvious spinal protrusion of lateral bending deformity and kyphosis with “S” type distortion, and had a huge dorsal mass with refractory infection. In the third trimester of pregnancy, the anatomical changes resulted in thoracic cavity deformation, unmanageable pulmonary infections, and serious skin infections on the surface of the dorsal mass.

Diagnosis:

Single chorionic twin pregnancy with severe rachiterata and a huge dorsal mass.

Interventions:

Management was focused on treating pulmonary and skin infections and promoting fetal lung maturation. Appropriate timing of pregnancy termination and manner of delivery were decided through a multidisciplinary discussion. The patient was placed in a special position and assisted by a professional midwife during delivery.

Outcomes:

The patient and her children survived after careful care and treatment.

Lessons:

Severe spinal deformities are not contraindications for pregnancy, but the changes in the thoracic cavity caused by these deformities can result in respiratory function decline, which becomes more apparent in the third trimester, which could likely cause pulmonary infection that is difficult to treat. In the future, studies investigating prenatal care procedures, timing of pregnancy termination, and appropriate delivery method are warranted.
Relationship between mental health and awareness of the knowledge on mental health in left-behind middle school students
Authors: Du Jinling , Li Zhongchen , Jia Guodong , Zhang Qian , Chen Wenqiang
Published: March 2019

To explore the relationship between mental health of left-behind middle school students and awareness of mental health.

Using cluster sampling method to select 428 left-behind middle school students in Jinan, using the mental health scale of middle school students and self-compiled mental health cognitive attitude questionnaire.

We found left-behind middle school students’ mental health level of force, paranoia, hostility and interpersonal sensitivity, depression, anxiety, learning pressure, maladjustment, mood swings, the psychological imbalance and total score were significant difference compared with the norm of middle school students (t = 10.67, 3.86, 3.78, 7.54, 2.51, 10.18, 8.79, 3.54, 6.56, −2.13, 6.83, P < .05). The top 5 detection rates of psychological moderate health problems are learning stress, anxiety, force, emotional instability and interpersonal sensitivity. There were significant differences in the scores of left-behind middle school students with different awareness of mental health knowledge (F = 4.880, P < .01) and emotional instability (F = 4.51 4, P < .05). The awareness of mental health knowledge was significantly negatively correlated with the total score of mental health, hostility, interpersonal sensitivity, maladjustment, emotional instability, and psychological imbalance scores. (r = 0.135, 0.182, 0.194, 0.189, −0.2, 0.124, P < .05).

Left-behind middle school students’ psychological health status is poorer, and closely related with the awareness of the knowledge on mental health; to improve the level of cognitive evaluation of left-behind middle school students on mental health is expected to improve their psychological health.
Hepatoid adenocarcinoma of fallopian tube
Authors: Li Maomao , Yang Kaixuan , Wang Ping
Published: March 2019

Rationale:

Hepatoid adenocarcinoma (HAC) of the fallopian tubes is a rare malignant tumor in the female reproductive system.

Patient concerns:

An 81-year-old Chinese woman presented with an elevated serum alpha-fetoprotein (AFP) level.

Diagnosis:

Positron emission tomography-computed tomography (PET-CT) scan revealed a mass of approximately 47 × 27 mm located in the right adnexa. The tumor was diagnosed as a HAC arising from fallopian tube by immunohistochemical and histochemical technique.

Interventions:

This patient underwent surgical treatment including a bilateral adnexectomy and appendectomy. In addition, the patient underwent 5 cycles of postoperative chemotherapy.

Outcomes:

The disease has recurred approximately six months after surgery and therefore, this patient will continue to be observed.

Lessons:

Up to this point, only 4 known cases of HAC originating in fallopian tube have been published in the English literature. Further studies are needed to better understand the clinical characteristics, the prognosis, and the pathological mechanism of HAC development in the fallopian tubes.
The efficacy of flexible ureteroscopy lithotripsy and miniaturized percutaneous nephrolithotomy for the treatment of renal and proximal ureteral calculi of ≤2 cm
Authors: Jiao Binbin , Lai Shicong , Xu Xin , Zhang Meng , Diao Tongxiang , Zhang Guan
Published: March 2019

To assess the clinical effect of miniaturized percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy lithotripsy (FURL) for the treatment of renal and proximal ureteral calculi of ≤2 cm.

A retrospective analysis was carried out on clinical data of 106 patients with kidney or upper urethral calculi. Among these patients, 58 underwent the MPCNL, and 48 received FURL. Stone-free rates, operating time, blood loss, hemoglobin drop, length of hospital stay, complications, and renal damage indexes were compared.

The stone removal rates of the FURL and MPCNL groups were 81.25% versus 87.93% (p > .05). Although operating time was significantly shorter in the MPCNL group, hospital stays were significantly shorter in the FURL group. In addition, pooled analysis showed that mean estimated blood loss was significantly higher in the PCNL group but the hemoglobin decline of the FURL group and PCNL group had no significant difference. The PCNL group had no significant difference in complications compared to the FURL group. Differences on the creatinine levels and urea nitrogen levels before the operation and after the operation were not statistically significant.

FURL is an effective method for treating renal stone. FURL not only had a similar stone-free rate as compared to MPCNL but also was associated with less blood loss and more favorable recovery time. However, FURL had a longer operative time.
Clinicopathological features and prognosis factors for survival in elderly patients with pancreatic neuroendocrine tumor
Authors: Li Gang , Tian Mao-lin , Bing Yun-tao , Tao Lian-yuan , Wang Hang-yan , Jiang Bin , Yuan Chun-hui , Xiu Dian-rong
Published: March 2019

To investigate the features and prognosis of the elderly patients with pancreatic neuroendocrine tumor (pNET).

The patients diagnosed with pNETs between 2004 and 2014 were identified from the Surveillance Epidemiology and End Results database. The ethical approval was waived because the present study was analysis of the data from Surveillance Epidemiology and End Results database.

A total of 4608 patients with “one primary only” histologically pNETs were confirmed and 653 were older than 75 years. Cancer-specific survival (CSS) and overall survival (OS) were examined. The elderly patients (≥75 years) have disadvantage in CSS and OS compared with younger cohort. Multivariate logistic regression revealed that the elderly patients have increased poorly differentiated composition, and decreased proportion of Black patients, receipt of surgery, married status, and number of removed lymph node. Multivariate Cox regression analysis demonstrated worse differentiation. Patients of T3–4 and M1 stage were associated with poor CSS, while patients of being female, tumor locating at pancreatic body/tail, receipt of surgery, and being married were associated with better CSS in the elderly patients. Meanwhile, patients with higher histological grade and M1 stage have poor OS, while patients with the characteristics of female, being married, tumor location at pancreatic body/tail and tumor surgery have better OS. Distant metastatic elderly patients underwent primary site surgery had better CSS and OS than the patients without surgery.

The elderly patients have increased possibility of poorly differentiated tumor, and decreased proportion of Black patients, surgery of primary site, number of removed lymph node and married status. Worse differentiation and tumor metastasis were independent risk factors for both CSS and OS, while primary tumor located in body/tail of pancreas, female patients, surgery of tumor primary site, and being married were protective factors.
Clinical efficacy of adenomyomectomy using “H” type incision combined with Mirena in the treatment of adenomyosis
Authors: Gao Yanfei , Shan Shuzhi , Zhao Xin , Jiang Jing , Li Dongxiao , Shi Bin
Published: March 2019

To evaluate the clinical efficacy and safety of adenomyomectomy using “H” type incision combined with Mirena (LNG-IUS) in the treatment of adenomyosis.

A total of 57 women with adenomyosis who underwent adenomyomectomy using “H” type incision combined with LNG-IUS were selected. Visual analog scale (VAS), menstrual flow, uterine volume, serum CA125 levels and hemoglobin amounts were compared before and after the surgery. Meanwhile, postoperative pregnancy, adverse reactions, and recurrence were observed.

VAS score, menstrual flow, uterine volume, and serum CA125 levels in 53 patients were significantly reduced after surgery (P < . 001). Moreover, statistical significances were obtained for VAS score at 13 and 6 months, menstrual flow at 1, 3, 6, 12, and 24 months, uterine volume at 1, 3, 6, 12, 24, and 36 months and CA125 levels at 1 and 3 months (P < .05). Of the 5 patients with fertility requirements, 1 became pregnant after IVF-ET, progressed to preterm, and delivered healthy twins. Among all related adverse reactions, amenorrhea was the most common (n = 20, 37.7%). There were no cases of LNG-IUS removal, ectopia, expulsion, and incarceration, except in 2 patients due to pregnancy, 1 due to uterine bleeding, and 1 due to Mirena perforation from incision of the uterine fundus. All patients showed no relapse.

Adenomyomectomy using “H” type incision combined with Mirena constitutes a novel and effective conservative surgical procedure for adenomyosis treatment.
Clinicopathological and prognostic significance of p16 protein in nasopharynx cancer patients
Authors: Sun Lingling , Song Jingjing , Huang Qingli
Published: March 2019

Background:

p16 protein is significantly down-regulated in several cancers, which reveals that it may be a potential biomarker for cancers. However, the clinicopathological and prognostic value of p16 protein in nasopharynx cancer patients remains unclear. Therefore, we performed a meta-analysis to assess the relationships of p16 protein expression with the clinicopathological features and prognosis of nasopharynx cancer.

Methods:

PubMed, Web of Science, Embase, and Chinese CNKI were searched to obtain eligible data. The relationships of p16 protein expression with risk, clinicopathological features, and prognosis of nasopharynx cancer were analyzed with stata 14.0 software. The pooled odds ratio (OR) with 95% CI (confidence interval) and hazards ratio (HR) with 95% CI were calculated to evaluate the association between p16 protein expression and nasopharynx cancer.

Results:

A total of 28 studies with 2612 nasopharynx cancer patients were included in the meta-analysis. p16 protein expression was significantly associated with the risk, lymph node metastasis, TNM-stage (tumor-node-metastasis), distant metastasis, and T stage of nasopharynx cancer (Risk, OR = 17.82, 95% CI = 11.20–28.35; Lymph node metastasis, OR = 2.11, 95% CI = 1.42–3.14; TNM-stage, OR = 2.25, 95% CI = 1.54–3.28; Distant metastasis, OR = 3.43, 95% CI = 1.55–7.58; T-stage, OR = 1.72, 95% CI = 1.27–2.33). The negative rate of p16 protein expression in control group was 8.77%, while the negative rate of p16 protein expression in the nasopharynx cancer tissue was 63.78%. However, no significant associations of p16 expression with the overall survival and progression-free survival of nasopharynx cancer were found.

Conclusion:

The meta-analysis revealed that downregulated p16 expression was significantly associated with the risk, lymph node metastasis, TNM-stage, distant metastasis, and T stage of nasopharynx cancer. No significant association between p16 protein expression and prognosis of nasopharynx cancer was found. However, additional high-quality and multicenter studies should be conducted to validate these findings in the future.
Clinical efficacy and safety of Tripterygium wilfordii Hook in the treatment of diabetic kidney disease stage IV
Authors: Ren Daijin , Zuo Chao , Xu Gaosi
Published: March 2019

Background:

The present study aims to evaluate the clinical efficacy and safety of Tripterygium wilfordii Hook (TwH) combined with angiotensin receptor blockers/ACE inhibitors (ARB/ACEI) in the treatment of diabetic kidney disease (DKD) stage IV.

Methods:

We searched China National Knowledge Internet (CNKI), the Chinese Biomedical Database, Embase and PubMed for articles about TwH combined with ARB/ACEI in treating DKD stage IV and set the study inclusion and elimination standards.

Results:

A total of 22 randomized controlled trials (RCTs) with 1414 participants were collected for detailed evaluation. The meta-analysis results suggested that compared with the controls, the combined group showed significant effects in reducing 24-h urinary protein [mean difference (MD) = −0.87, 95% confidence interval (CI) = (−1.03, −0.71)], raising serum albumin [MD = 4.14, 95% CI (3.43, 4.85)] and the total efficiency [odds ratio (OR) = 4.84, 95% CI (3.33, 7.03)], with no statistical difference in serum creatinine between both groups [MD = −3.02, 95% CI (−6.40, 0.37), P > .05]. However, the risk of adverse reactions increased by 8% [Risk Difference (RD) = 0.08, 95% CI (0.05, 0.11)] in the combination.

Conclusions:

TwH combined with ARB/ACEI in the treatment of DKD stage IV is superior to the monotherapy of ARB/ACEI.
Development of prognostic signature and nomogram for patients with breast cancer
Authors: Su Jiao , Miao Li-Feng , Ye Xiang-Hua , Cui Meng-Shen , He Xiao-Feng
Published: March 2019

To identify prognostic signature that could predict the survival of patients with breast cancer (BC).

Breast cancer samples and normal breast tissues in the TCGA-BRCA and GSE7390 were included. Differentially expressed genes (DEGs) were identified using the “limma” method. Overall survival (OS) associated with DEGs were obtained using univariate and multivariable Cox proportional-hazards regression analysis, and the corresponding prognostic signature and nomogram were constructed. Calibration analysis and decision curve analysis (DCA) were performed.

In all, 742 DEGs were identified, 19 of which were independently correlated with the OS of BC patients. The OS of patients in the 19-gene signature low-risk group was significantly better than that in high-risk group (hazard ratio [HR] 0.3506, 95% confidence interval [CI] 0.2488–0.4939), and the 19-gene based signature was demonstrated to be an independent prognostic factor in patient with BC in the TCGA-BRCA cohort (HR 1.501, 95% CI 1.374–1.640) and validation cohort GSE7392 ((HR 0.3557, 95% CI 0.2155–0.5871, P < .0001)). The primary and internally validated C-indexes for the 19-gene signature-based nomogram were 0.817 and 8.013, respectively. The results of calibration analysis and DCA analysis confirmed the robustness and the clinical usability of the nomogram.

We constructed a prognostic signature and nomogram for patient with BC, which showed good application prospect.
A quick decrease of bone marrow edema in sacroiliac joint could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis patients
Authors: Yang Ruishan , Liu Hongda , Fan Mengpo
Published: March 2019

The purpose of this study was to investigate the correlation of bone marrow edema (BME) in sacroiliac joint (SIJ) with clinical characteristics and clinical response, and whether the quick decrease of BME could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis (AS) patients.

Ninety active AS patients underwent etanercept treatment for 6 months were enrolled consecutively and classified into standard dose group (n = 37) and dose tapering group (n = 53). BME in SIJ and clinical response were assessed by SPARCC criteria and ASAS 40 response criteria, respectively. “Quick decrease of BME in SIJ” was defined as the decrease of SPARCC score≥50% from M0 to M1.

BME in SIJ was positively correlated with pain VAS score, BASDAI score, CRP, IL-1β, IL-17, and TNF-α levels. ASAS 40 response rate at M6 was lower in dose tapering group than standard dose group, while higher in patients with a quick decrease of BME in SIJ than other patients. Besides, the ASAS 40 response rate in dose tapering group was similar to standard dose group in patients with a quick decrease of BME in SIJ but was lower than standard dose group in patients without a quick decrease of BME in SIJ at M6.

A quick decrease of BME in SIJ predicts better treatment response to etanercept, and it might be served as a novel marker for dose tapering initiation of etanercept in AS patients.