bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrosurgical and Electrocautery Device Failures and Best Reporting Practices
Authors: Block Frank E. , Waheed Saphia , Lee Ting-Hsuan Joyce
Published: December 2018

Electrosurgical units play a vital role in operating rooms today. Their failures have the potential to harm both patients and surgeons. In this article, US Food and Drug Administration (FDA) postmarket safety reports involving electrosurgical units were examined to determine the most common failure categories of these devices. Based on this analysis, mechanical failure was the most prevalent failure experienced, primarily through part detachment, failing to articulate or movement/motion issues, or improper or poor cutting. When these issues are properly reported to FDA, FDA can work with manufacturers to improve these devices and ensure that these devices remain safe and effective.
Automated Management System for Accreditation of Clinical Engineering Department in Hospitals
Authors: Wahed Manal Abdel , EL Kady Khaled W. , Saleh Neven
Published: December 2018

The primary objective of clinical engineering department (CED) in hospitals is to provide a broad-based engineering program that addresses all aspects of healthcare technology. However, accreditation of this department is rarely considered in the literature. In this study, we attempted to identify systematic differences in quality management between the Joint Commission International (JCI)–accredited and non–JCI-accredited CED by designing a specific automated evaluation system depending on the technology of cloud computing. Understanding the similarities, dissimilarities, and factors that sustain accreditation within hospitals is the main aim of this work. Another goal is to investigate, describe, and prioritize the measurements and requirements demanded to achieve a minimum accepted level that qualifies nonaccredited ones to be JCI accredited. A questionnaire that targeted the clinical engineering department was developed. It comprises CED roles and the corresponding JCI standards to differentiate accredited from nonaccredited CEDs. A score index has been developed using answering rates of questionnaire to assess CED roles and overall performance of the department. Based on the score index, the CED is classified into 4 classes. System verification was carried out using a data set of 9 Egyptian hospitals. The results revealed the minimum benchmark level of acceptance for JCI accreditation. The system proves its consistency and correctly separated JCI-accredited from nonaccredited CEDs.
Development and Reliability Testing of a Patient Education Performance Tool for Physical Therapy Students
Authors: Forbes Roma , Mandrusiak Allison
Published: December 2018

Background and Purpose.

While patient education is an expected competency for physical therapy graduates, no instrument is available for assessing student performance of patient education. The objective of this study was to report on the development of a physical therapy patient education (PTPE) performance tool and to examine its internal consistency, interrater and test–retest reliability.

Methods.

Items for the PTPE performance tool were generated from a previous study using expert consensus. To measure interrater reliability, 3 independent assessors used the tool to examine 45 physical therapy students' performance of patient education in an objective standardized clinical examination (OSCE; video-recorded). To measure test–retest reliability, the tool was applied twice with an interval of 16 days. To measure internal consistency, the tool was used to assess 164 video-recorded student OSCE performances.

Outcomes.

Panel agreement on the PTPE performance tool was achieved. Interrater reliability of the individual assessment items ranged from 0.57 (item 5) to 0.89 (item 1). The overall test–retest reliability for the tool was 0.76. Individual items ranged from 0.61 (item 5) to 0.86 (item 7). The overall internal consistency was 0.81, indicating acceptable agreement.

Discussion and Conclusion.

The PTPE performance tool demonstrates acceptable reliability and internal consistency as an assessment tool for student performance of patient education. The results warrant further investigation of the PTPE in wider student, clinical and professional settings.
Weight reduction and cardiovascular benefits
Authors: Zhao Yingke , Yu Branda Yee-Man , Liu Yanfei , Tong Tiejun , Liu Yue
Published: December 2018

Background:

There is widespread obesity paradox in cardiovascular diseases, the cardiovascular influence from weight management remains controversial. Moreover, previous publications indicating that different weight reduction extent might lead to various results. Thus, it is of importance to reassess the cardiovascular benefits of weight management strategies.

Objectives:

This review is designed to assess the association between weight loss and cardiovascular outcomes.

Methods:

Clinical trials including randomized control trials, observational studies reported a weight change before and after weight interventions including lifestyle intervention, as well as pharmacotherapies were included. Three major databases will be searched to retrieve the appropriate studies. Dual selection and abstraction of data will be conducted by 2 authors independently. The population, intervention, comparator, outcomes, study characteristics framework will be used to extract all the necessary data from included studies. The risk of bias assessment will be conducted in duplicate based on the Cochrane risk of bias guideline for randomized controlled trials (RCTs) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement for observational studies respectively. The primary outcomes will be the cardiovascular mortality, and the secondary outcomes are all-cause mortality and new cardiovascular events. A meta-analysis will be considered if there is sufficient homogeneity among selected studies. Follow the criteria of Grading of Recommendations, Assessment, Development and Evaluation (GRADE), the quality of the cumulative evidence will be evaluated.

Results and conclusions:

The results of this systematic review could provide reliable and concrete evidence for weight loss and its cardiovascular benefits.

Prospero registration number: CRD42018108582.
Corneal power changes with Scheimpflug rotating camera after hyperopic LASIK
Authors: Whang Woong-Joo , Yoo Young-Sik , Joo Choun-Ki
Published: December 2018

To evaluate surgically induced refractive change (SIRC) by manifest refraction and corneal power changes using an automated keratometer and Scheimpflug rotating camera, and to find the best keratometric measurements reflecting SIRC after hyperopic laser-assisted in situ keratomileusis (LASIK).

This retrospective study included 18 eyes of 18 patients undergoing hyperopic LASIK using the Schwind Amaris 750S excimer laser. All measurements were performed preoperatively and 12 months postoperatively. Cycloplegic manifest refractions were performed and keratometric measurements were obtained via an RK-5 automated keratometer and a Pentacam rotating Scheimpflug camera. Sim K, true net power (TNP), and total corneal refractive power (TCRP) at 2.0 to 5.0 mm were analyzed using a Scheimpflug camera.

The mean manifest refractive changes in the spherical equivalent (SE) at the corneal plane were 2.32 ± 1.65 D at 12 months postoperatively. The refractive power changes by the automated keratometer and Sim K were significantly less than SIRC (P = .043 and P = .048, respectively). Both TNP and the TCRP in the 5.0 mm zone produced lesser mean differences with SIRC (0.05 D and 0.06 D) and showed closer agreements with SIRC on Bland-Altman plots and higher correlation coefficients with SIRC.

Corneal power measured on the anterior corneal surface underestimated SIRC. TCRP at the 5.0 mm zone provided by a Pentacam Scheimpflug camera reflected the SIRC accurately and precisely, and would be applicable for prediction of intraocular power before cataract surgery and follow-up measurement of corneal refractive power.
A rare case report of hypertrophic cardiomyopathy induced by catecholamine-producing tumor
Authors: Olmati Federica , Petramala Luigi , Bisogni Valeria , Concistré Antonio , Saracino Vincenza , Oliviero Gaia , Bonvicini Maria , Mezzadri Martina , Ciardi Antonio , Iannucci Gino , De Toma Giorgio , Frustaci Andrea , Letizia Claudio
Published: December 2018

Rationale:

Catecholamine-producing tumors are rare, occurring in less than 0.2% of patients with hypertension, but can have relevant cardiovascular morbidity and mortality.

Patient concerns:

A 37-year-old woman presented with a history of dyspnea, chest pain, palpitations, and paroxysmal hypertension. Electrocardiogram, echocardiogram, and cardiac magnetic resonance showed severe LVH with a prevalent involvement of the anterior portion of interventricular septum. Endomyocardial biopsy found severe hypertrophy with disarray of cardiomyocytes and ultrastructural evidence of contraction and necrosis of myocytes. Hormone investigations revealed high values of 24-hours urinary metanephrines. Abdominal computed tomography (CT) showed an enlarged left adrenal gland with a strong uptake of 123I—metaiodobenzylguanidine at scintigraphy scan.

Interventions:

Thus, the adrenal tumor was surgically removed.

Outcomes:

At follow-up examination, the patient's metanephrines levels were normalized and the transthoracic echocardiogram showed a reduction of LVH.

Diagnosis and lessons:

We report a rare case of catecholamine–induced cardiomyopathy due to an adrenal adenoma mixed with nodules enriched in epinephrine-types secreting granules.
Association between rs1800629 polymorphism in tumor necrosis factor-α gene and dilated cardiomyopathy susceptibility
Authors: Zhang Yongdong , Cao Yanhong , Xin Linlin , Gao Ningning , Liu Bingshuang
Published: December 2018

Objective:

Several published studies have investigated the association between the −308G/A (rs1800629) polymorphism in the tumor necrosis factor-α (TNF-α) gene and the risk of dilated cardiomyopathy (DCM). However, the TNF-α gene polymorphism has a controversial role in the pathogenesis of DCM among different populations. In the present study, a meta-analysis was performed to resolve this inconsistency.

Methods:

Potentially eligible papers reporting an association between the TNF-α rs1800629 polymorphism and DCM susceptibility were searched in 4 databases including PubMed, EMBASE, Chinese Biomedical Database (CBM), and the Cochrane Library up to April 1, 2018. The odds ratio (OR) with its 95% confidence interval (CI) was used to estimate the strength of the associations. Subgroup analysis based on the ethnicity, studies with or without ischemic and valvular DCM was conducted. Publication bias detection was conducted using Begg test.

Results:

Nine papers detailing case-control studies were included, reporting a total of 1339 DCM cases and 1677 healthy controls. The meta-analysis results indicated that TNF-α rs1800629 was associated with increased DCM susceptibility in the populations studied under the heterozygous model (AG vs GG: OR = 1.91, 95% CI = 1.05−3.50, P = .035) and dominant model (AG + AA vs GG: OR = 1.87, 95% CI = 1.01−3.45, P = .046). In the subgroup analysis for ethnicity, rs1800629 polymorphism was significantly associated with the susceptibility of DCM for Asians under the 5 models (A vs G: OR = 2.87, 95% CI = 1.56−5.30, P = .001; AA vs GG: OR = 3.95, 95% CI = 1.13−13.82, P = 0.031; AG vs GG: OR = 3.8, 95% CI = 1.57−9.19, P = .003; AA vs GG + AG: OR = 2.51, 95% CI = 1.41−4.49, P = .002; AG + AA vs GG: OR = 3.77, 95% CI = 1.54−9.20, P = .004).

Conclusion:

There may be a moderate association between TNF-α rs1800629 polymorphism and DCM susceptibility in the whole populations studied; however, TNF-α rs1800629 polymorphism was significantly associated with the susceptibility of DCM for Asians, which indicates that such associations may be different between ethnicities.
Case report of traumatic abdominal wall hernia caused by seat belt
Authors: Lyu Yun-Xiao , Ma Hui-Yang
Published: December 2018

Rationale:

Traumatic abdominal wall hernia (TAWH) is a rare form of hernia that is caused by disruption of the abdominal wall musculature and fascia. The diagnostic criteria and classification of TAWH are still unclear; furthermore, the ideal timing and method of surgical treatment are still unclear. Herein, we report a case of TAWH and describe the surgical approach used.

Patient concerns:

A 71-year-old Han Chinese female presented for swelling in the right lower abdominal quadrant. The patient underwent exploratory laparotomy because of a car collision before 1 year ago.

Diagnosis:

She was finally diagnosed with TAWH according to the abdominal computed tomography (CT) and surgery.

Interventions:

She was performed with an open surgery to repair the TAWH.

Outcomes:

The patient was discharged without complications and showed no recurrence or complications during a follow-up period of 6 months.

Lessons:

TAWH is a rare form of hernia that presents a diagnostic and therapeutic challenge. The appropriate timing and approach of surgical treatment for TAWH depend on a case-by-case basis. This case highlights that delayed selective surgery may be more suitable for stable patients.
A study of the effects of 8-week acupuncture treatment on patients with Parkinson's disease
Authors: Yeo Sujung , van den Noort Maurits , Bosch Peggy , Lim Sabina
Published: December 2018

Background:

Parkinson's disease (PD) is a degenerative brain disorder, resulting in decreased neural responses in the supplementary motor area, putamen, and thalamus. Previous research showed that acupuncture was able to improve the motor dysfunction. The primary aim of this study is to assess the efficacy of longer acupuncture treatment for preventing brain degeneration in patients with PD.

Methods:

Ten outpatients with PD were recruited from Kyung Hee Medical Hospital. Behavioral and neural responses were examined before and after 8 weeks of acupuncture treatment. A semi-individualized treatment approach was used; patients were treated for 15 minutes with 120-Hz electro-acupuncture at the right GB34 and Taechung (LR3), followed by manual acupuncture based on the individual symptoms of the patient.

Results:

Immediately after 8 weeks of acupuncture treatment, the Unified Parkinson's Disease Rating Scale (UPDRS) sub-scores and the depression scores for the patients had statistically decreased compared to the scores before acupuncture treatment; moreover, 8 weeks later, these scores remained stable. Compared to the neural responses before the acupuncture stimulation, those after the acupuncture treatment were significantly higher in the thalamus, cingulate gyrus, anterior cingulate, lingual gyrus, parahippocampal gyrus, lateral globus pallidus, mammillary body, middle temporal gyrus, cuneus, and fusiform gyrus. Finally, a positive correlation was found between the UPDRS and the mean magnetic resonance signal change for the thalamus.

Conclusion:

This study found beneficial clinical effects of 8-week acupuncture treatment in the brains of patients with PD.
The prognostic value of C-reactive protein to albumin ratio in patients with lung cancer
Authors: Deng Tai-Bing , Zhang Jing , Zhou Yong-Zhao , Li Wei-Min
Published: December 2018

Background:

To perform a meta-analysis of retrospective studies exploring the association of C-reactive protein to albumin (CAR) with overall survival (OS) in patients with lung cancer.

Methods:

Relevant studies were enrolled by searching databases of PubMed, Cochrane Library, Web of Science, and Embase were searched until July 16, 2017. We combined the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the correlation between CAR and OS in patients with lung cancer

Results:

Four studies involving 1257 participants from several countries were involved in the meta-analysis. In a pooled analysis of all studies, elevated CAR predicted poor OS (HR: 2.13; 95% CI: 1.52–2.97; P < .05). Subgroup analysis showed that high level of CAR predicted poor OS in patients with lung cancer though multivariate analyses on 1092 participants (HR: 1.63; 95% CI: 1.24–2.51; P < .001) and the heterogeneity decreased to 45.4%. Moreover, a similar trend was observed in patients receiving surgery (HR: 2.64; 95% CI: 2.08–3.35; P < .001) and chemotherapy (HR: 1.75; 95% CI: 1.93–2.57; P = .004). And the HRs for patients receiving surgery was moderately higher than that for patients receiving chemotherapy.

Conclusion:

Our findings indicate that CAR may have a prognostic value in lung cancer as we detected a significant association between elevated CAR and poorer OS. However, further studies are warranted to draw firm conclusions.
Diagnosis and treatment of the pharyngeal glial choristoma accompanied with incomplete cleft palate
Authors: Chen Fang , Xu Hongming , Gu Meizhen , Li Xiaoyan
Published: December 2018

Introduction:

A choristoma formed by heterotopic tissue rarely occurs in the throat, especially one accompanied with cleft palate in a new-born baby.

Patient concerns:

An 18-month-old female patient was admitted to the hospital for apparent snoring symptoms accompanied by mouth breathing and sleep apnea. In addition, the patient presented with weak aspiration and nasal leakage during fluid intake.

Diagnosis:

The patient received routine physical examination and endoscopy showing that there was a wide fissure which split from the palate vertical anterior cleft to 1/3 of the hard palate. Meanwhile, we found an unclear-bordered uplift in the left palate and a soft mass. The radiographs revealed a mass with inhomogeneous density convex to the pharyngeal cavity.

Interventions:

The patient was subsequently referred for surgical resection and tissue diagnosis of choristoma was confirmed by pathological examination. H&E staining showed well demarcated mature brain tissue with scattered sand-like calcification.

Outcomes:

According to the diagnosis, the patient suffered from pharyngeal glial choristoma and incomplete cleft palate. The surgical resection and repair were performed together. The postoperative recovery was very good.

Lessons:

Choristoma rarely occurs in the head and neck, especially if accompanied by cleft palate. Early diagnosis for choristoma relies heavily on clinical examination and radiological imaging. Complete resection of choristoma remains the gold standard for treatment of these patients.
Associations of the ABCA1 gene polymorphisms with plasma lipid levels
Authors: Lu Zhan , Luo Zhi , Jia Aimei , Yu Liuqin , Muhammad Irfan , Zeng Wei , Song Yongyan
Published: December 2018

Background:

Studies on the associations of the adenosine triphosphate-binding cassette transporter A1 gene (ABCA1) rs2230806, rs2230808, and rs2066714 polymorphisms with plasma lipid levels have reported apparently conflicting findings. This meta-analysis aimed to clarify the relationships between the 3 polymorphisms and fasting lipid levels.

Methods:

A comprehensive search of the literature was carried out by using the databases including Medline, Google Scholar, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, and VIP. The studies that presented mean lipids and standard deviations or standard errors according to the rs2230806, rs2230808, and/or rs2066714 genotypes were examined and included. The random effects model was used. Standardized mean difference and 95% confidence interval were used to assess the differences in lipid levels between the genotypes. Heterogeneity among studies was tested by Cochran's χ2-based Q-statistic, and Galbraith plots were used to detect the potential sources of heterogeneity. Publication bias was assessed by Begg's rank correlation test as well as funnel plots.

Results:

Sixty-two studies (48,452 subjects), 12 studies (9853 subjects) and 14 studies (10,727 subjects) were identified for the rs2230806, rs2230808, and rs2066714 polymorphisms, respectively. A dominant model was used for all the polymorphisms in this meta-analysis. The A allele carriers of the rs2230806 polymorphism had higher levels of high-density lipoprotein cholesterol (HDL-C) (P <.001), and lower levels of low-density lipoprotein cholesterol (LDL-C) (P =.03) and triglycerides (TG) (P <.01) than the non-carriers. The A allele carriers of the rs2230808 polymorphism had higher levels of total cholesterol (TC) (P <.001) than the non-carriers. The G allele carriers of the rs2066714 polymorphism had higher levels of TC (P <.01) and HDL-C (P = .02) than the non-carriers.

Conclusion:

The ABCA1 rs2230806, rs2230808, and rs2066714 polymorphisms are significantly associated with plasma lipid levels in the present meta-analysis.
Complete remission of both immunoglobulin light chain amyloidosis and psoriasis after autologous hematopoietic stem cell transplantation
Authors: Chen Wencui , Ren Guisheng , Zuo Ke , Huang Xianghua
Published: December 2018

Rationale:

Immunoglobulin light chain amyloidosis (AL amyloidosis) is characterized by the deposition of abnormal amyloid protein produced by a pathological plasma cell clone in various organs and soft tissues. Hematopoietic stem cell transplantation (HSCT) is an effective way to treat AL amyloidosis. Psoriasis is a common autoimmune disease (AID) and HSCT is a potential treatment for severe AIDs. We report a rare case of AL amyloidosis coincidence with psoriasis obtained continuous complete remission of the 2 diseases by autologous hematopoietic stem cell transplantation (ASCT).

Patient concerns:

A 58-year-old man with a 30-year history of psoriasis complaining of edema and hypotension for 2 weeks was referred to our institution. His urine protein was quantified 2.83 g/day, without hematuria and decrease of glomerular filtration rate.

Diagnosis:

Renal biopsy confirmed AL amyloidosis and multiple myeloma was excluded by bone marrow cytomorphologic examination.

Interventions:

Chemotherapy regimen based on bortezomib and thalidomide had achieved hematologic partial remission, but the kidney had no response and psoriasis was still active. Furthermore, he received a standard myeloablative conditioning with high dose melphalan followed by ASCT.

Outcomes:

The erythema with slivery scales of psoriasis vulgaris gradually improved and almost disappeared after granulocyte implantation. He obtained persistent hematological complete remission, organ response and recovery of psoriasis.

Lessons:

We report a rare case of AL amyloidosis coincidence with psoriasis treated by ASCT. The outcome of this patient indicated that ASCT has therapeutic values both in AL amyloidosis and AIDs.
Comparison of efficacy and safety of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia
Authors: Choi Hye Duck , Chae Seung Min
Published: December 2018

Objective:

Dyslipidemia is a major risk factor for the development of cardiovascular disease. Both statins and omega-3 fatty acids demonstrate beneficial effects on lipid concentrations. The goal was to evaluate the safety and efficacy of combination therapy with statins and omega-3 fatty acids.

Methods:

We performed a systematic review and meta-analysis of published data to compare the safety and efficacy of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia. Six articles were assessed in the present meta-analysis (quantitative assessment) and qualitative assessment.

Results:

In terms of efficacy, the combination treatment afforded a significantly greater reduction in total cholesterol/high-density lipoprotein cholesterol than statin alone did [standard difference in means = −0.215; 95% confidence interval (CI) −0.359–−0.071]. However, there was no significant difference in low-density lipoprotein (LDL) cholesterol between the 2 groups. Qualitative assessment of other lipid parameters was performed. Combination therapy with statins and omega-3 fatty acids was generally more effective on lipid concentration than statin monotherapy. In terms of safety, there were no significant differences in total adverse events between the 2 groups. Gastrointestinal adverse events were found to be significantly increased in patients receiving combination therapy using the fixed-effects model (relative risk = 0.547; 95% CI 0.368–0.812).

Conclusions:

We suggest that combination therapy with statins and omega-3 fatty acids enhances lipid profile, except LDL cholesterol, compared with statin monotherapy. Nevertheless, statin and omega-3 fatty acid combination should be cautiously recommended, taking into account the clinical importance of LDL cholesterol and safety issues associated with their concomitant use.
Sudden unilateral vision loss in an adult with Behcet disease
Authors: Gao Yunxia , Lyu Shuyuan , Bao Li , Zhang Ming
Published: December 2018

Rationale:

Behcet disease is an autoimmune vasculitis, involving multiple systems and organs. It is often chronic and recurrent, and involves all levels of arteries and veins.

Patient concerns:

A 40-year-old Chinese male with sudden vision loss in his right eye for 3 days was reported.

Diagnoses:

The patient was diagnosed as bilateral uveitis (obstructive retinal vasculitis in the right eye) and Behcet disease.

Interventions:

The patient was given topical corticosteroids and compound tropicamide eye drops in our department. In addition, he was also hospitalized in the Rheumatology Department, and received systemic infusion of methylprednisolone and cyclophosphamide.

Outcomes:

Best corrected visual acuity vision acuity of the left eye was 20/20 and that of the right eye was no light perception after 2 weeks. During the telephonic follow-up after 1 year, the patient reported 2 recurrent episodes of uveitis in the left eye, which improved after treatment at the local hospital.

Lessons:

It cautions ophthalmologists of the high possibility of vasculitis in young and middle-aged patients with retinal vascular occlusion. It also reminds the ophthalmologists investigate systemic diseases, and obtain detailed medical history, not just depending on specific laboratory findings. This case further suggests that Behcet disease has diverse manifestations, complex diagnosis, and severe lesions, and the recurrence rate must be controlled to minimize irreversible consequences such as sudden vision loss during recurrence.
Racial/ethnic differences in reporting versus rating of healthcare experiences
Authors: Chung Sukyung , Mujal Gabriella , Liang Lily , Palaniappan Latha P. , Frosch Dominick L.
Published: December 2018

Asians are reported to have poorer healthcare experience than non-Hispanic Whites (NHWs), but the sources of the differences are not understood. One explanation is Asian's reluctance to choose extreme responses in survey. We thus sought to compare NHW-Asian differences in responses to healthcare experience surveys when asked to report versus rate their experiences. Patients of an outpatient care system in 2013 to 2014 in the United States were studied. Patient experience surveys were sent after randomly selected clinic visits. Responses from 6 major Asian subgroups and NHWs were included (N = 61,115). The surveys used a combined questionnaire of Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Press Ganey surveys. CG-CAHPS questions are framed as “reporting” and Press Ganey questions as “rating” of experiences. We compared the proportion of favorable (or top box) responses to 2 related questions, one from CG-CAHPS and another from Press Ganey, and assessed racial/ethnic differences when using each of the 2 related questions, using a Pearson chi-squared test for independence. All Asian subgroups were less likely to select top box than NHWs for all questions. The Asian-NHW differences in "rating” questions were larger than the difference in related “reporting” questions. Of those who chose top box to CG-CAHPS questions (e.g., “Yes” on a question asking “Waited < 15 minutes”), their responses to related Press Ganey questions varied widely: 47% to 57% of Asian subgroups versus 67% of NHWs rated wait time as “Very good.” The extent of racial/ethnic differences in patient-reported experiences varies based on how questions are framed. The observed poorer experiences by Asians are in part explained by their worse rating of similar objectively measurable experiences.
The clinical impact of patients with bloodstream infection with different groups of Viridans group streptococci by using matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS)
Authors: Su Ting-Yi , Lee Ming-Hsun , Huang Ching-Tai , Liu Tsui-Ping , Lu Jang-Jih
Published: December 2018

The accuracy of matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) for identifying viridans group streptococcus (VGS) was improving. However, the clinical impact of identifying VGS had not been well recognized. Our study had comprehensively studied the clinical manifestations and outcome of VGS blood stream infection by using MALDI-TOF MS for identification.

This retrospective study enrolled 312 adult patients with a monomicrobial blood culture positive for VGS. Blood culture was examined through MALDI-TOF MS.

The most common VGS species were the Streptococcus anginosus group (38.8%) and Streptococcus mitis group (22.8%). Most species showed resistance to erythromycin (35.6%), followed by clindamycin (25.3%) and penicillin (12.5%). Skin and soft tissue infection and biliary tract infection were significantly related to S. anginosus group bacteremia (P = .001 and P = .005, respectively). S. mitis group bacteremia was related to infective endocarditis and bacteremia with febrile neutropenia (P = .005 and P < .001, respectively). Infective endocarditis was also more likely associated with S. sanguinis group bacteremia (P = .009). S. anginosus group had less resistance rate to ampicillin, erythromycin, clindamycin, and ceftriaxone (P = .019, <.001, .001, and .046, respectively). A more staying in intensive care unit, underlying solid organ malignancy, and a shorter treatment duration were independent risk factors for 30-day mortality. This study comprehensively evaluated different VGS group and their clinical manifestations, infection sources, concomitant diseases, treatments, and outcomes. Categorizing VGS into different groups by MALDI-TOF MS could help clinical physicians well understand their clinical presentations.
Long-term follow-up of endovascular repair of iatrogenic superior vena cava injury
Authors: Altuwaijri Talal , Nouh Thamer , Alburakan Ahmed , Altoijry Abdulmajeed
Published: December 2018

Rationale:

This report aimed to present the long-term follow-up results of the management of superior vena cava (SVC) rupture during balloon angioplasty in an attempt to relieve SVC obstruction as a result of hemodialysis (HD) catheter-related central vein stenosis.

Patient concerns:

We present a case of a 42-year-old woman with end-stage renal disease on HD for 4 years, initially from an autogenous fistula for 2.5 years and then from a right internal jugular vein (IJV) catheter. She presented with clinical manifestations of SVC obstruction (dilated anterior chest wall and abdominal wall veins and facial swelling), which progressed over the last 1.5 years.

Diagnosis:

A venogram confirmed right and left brachiocephalic vein and SVC obstruction.

Interventions:

She underwent balloon angioplasty of the SVC through the right IJV, during which the dilated area ruptured, resulting in right hemothorax and hypovolemic shock. A covered stent was placed over the bleeding site, and the patient recovered.

Outcomes:

Rapid and skilled endovascular intervention through placement of a covered stent at the bleeding site can be lifesaving.

Lessons:

It is superior to open surgical management in terms of complexity and morbidity especially in patients who are poor surgical candidates, and its durability is proving to be comparable.
Successful pregnancy and delivery in uremic patients with maintenance hemodialysis
Authors: Cao Yun , Zhang Yide , Wang Xinmei , Zhang Yuquan , Fan Yaping , Shi Hui , Dai Houyong
Published: December 2018

Rationale:

It is reported that successful pregnancies in dialyzed uremic women are rare. Over the past years, despite advances in clinical management and technology in dialysis for pregnancy in patients receiving maintenance hemodialysis, uremia remains a high risk factor for adverse outcomes in mother and fetus.

Patient concerns:

In this article, we present a case of pregnancy in a 34-year-old uremic woman on dialysis. After the pregnancy was diagnosed and confirmed, intensive dialysis and multidisciplinary care according to the recommendations in the available literatures were provided.

Diagnoses:

Single pregnancy of 31+4 GWs (gestational weeks), fetal growth restriction, polyhydramnios, and uremia.

Outcomes:

At 31 weeks’ gestation and 4 days, she was admitted to our hospital due to premature rupture of membranes and abdominal pain. Then a female baby weighed 1700 g was delivered successfully. After one year of follow-up, the mother feels well and the baby is healthy.

Lessons:

Intensive dialysis, detailed management and multidisciplinary approaches are necessary for optimal outcomes in uremic pregnant mother and fetus.
Fetal congenital heart disease
Authors: Cai Meiying , Huang Hailong , Su Linjuan , Lin Na , Wu Xiaoqing , Xie Xiaorui , An Gang , Li Ying , Lin Yuan , Xu Liangpu
Published: December 2018

Background:

Congenital heart disease (CHD) is one of the most common birth defects; however, the mechanisms underlying its development are poorly understood. Recently, heritable genetic factors, including copy number variations (CNVs) and single nucleotide polymorphisms (SNPs), have been implicated in its etiology. The aim of this study was to investigate the utility of a SNP array for the prenatal diagnosis of CHD and the improvement of prenatal genetic counseling and to compare this approach to traditional chromosome analysis.

Methods:

One hundred and fortysix cases of CHD detected by prenatal echocardiography were analyzed. Of these, 110 were isolated CHD and 36 were of CHD with extracardiac defects. SNP analysis was performed using the Affymetrix CytoScan HD platform, which was followed by karyotype analysis. All annotated CNVs were validated by fluorescence in situ hybridization.

Results:

Karyotype analysis identified chromosomal abnormalities in 19 of 146 cases. In addition to the 15 chromosomal abnormalities that were consistent with the results of karyotype analysis, the SNP array identified abnormal CNVs in an additional 15.2% (22/145) cases; of these, 15 were pathogenic CNVs, three were variations of uncertain clinical significance, and four were benign CNVs. The rates at which the SNP array detected pathogenic CNVs differed significantly between cases of isolated CHD and CHD with extracardiac defects (13.6% vs. 72.2%, P = .001). The results of the SNP array also affected the rate of pregnancy termination.

Conclusion:

Combining SNP array with cytogenetic analyses is particularly effective for identifying chromosomal abnormalities in CNVs in fetuses with CHD, which also affects obstetrical outcomes.
ABO incompatible living donor liver transplantation using dual grafts and pure laparoscopic donor right hepatectomy
Authors: Han Young Seok , Ha Heontak , Han Ja Ryung , Lim Kyoung Hoon , Chun Jae Min
Published: December 2018

Rationale:

Because of the shortage of deceased donors, living donor liver transplantation (LDLT) has become the main procedure to treat patients with end-stage liver disease in Asian countries. However, many potential donors are excluded because of donor safety and graft volume issues. In addition, large abdominal wounds after open surgery for hepatectomy could be a reason for hesitating to agree to liver donation, particularly when attempting to recruit young female donors.

Patient concerns:

On volumetric computed tomography (CT) examination, remnant liver volume was too small to guarantee the safety of the male donor, and the right hemiliver volume of the female donor was not sufficient to meet the recipient‘s metabolic demand. The young female donor also worried about a large abdominal wound following open surgery.

Interventions:

We performed ABO-incompatible LDLT using dual grafts and right-sided graft was obtained by pure laparoscopic donor right hepatectomy in a young female donor.

Outcomes:

The postoperative course was uneventful in both donors and the recipient is presently doing well in satisfactory condition 7 months after liver transplantation.

Lessons:

We overcame these volumetric and cosmetic issues through dual living donor liver grafts using a combination of conventional surgery for 1 donor and laparoscopic right hepatectomy for a second ABO-incompatible donor. We think this procedure can be a good option for the expansion of donor pools.
Tumor control of third ventricular central neurocytoma after gamma knife radiosurgery in an elderly patient
Authors: Park Sue-Jee , Jung Tae-Young , Kim Seul-Kee , Lee Kyung-Hwa
Published: December 2018

Rationale:

Central neurocytoma is rare benign tumor that occurs in high probability in young adults in the lateral ventricle. Herein, we report an unusual case of an elderly woman who was diagnosed with central neurocytoma isolated to the third ventricle. This deeply located tumor was effectively treated using gamma knife radiosurgery (GKR).

Patient concerns:

A 79-year-old woman was admitted to hospital with gait disturbance and cognitive dysfunction.

Diagnosis:

Brain magnetic resonance imaging (MRI) revealed a homogenously enhancing multilobulated mass in the posterior third ventricle measuring 1.8 cm in size. The tumor was diagnosed as a central neurocytoma isolated to the third ventricle.

Interventions:

Neuronavigation-guided endoscopic third ventriculostomy and biopsy were performed. One week following surgery, GKR was performed using a prescribed dose of 14 Gy with 50% isodose lines, and a target volume of 1.62 cc.

Outcomes:

Three months after GKR, brain MRI revealed a decrease in the size (to 1.4 cm) of the multilobulated strong enhancing mass in the posterior third ventricle, and the patient's symptom of confusion was improved.

Lessons:

Previous studies have reported that tumors in unusual locations, such as those isolated to the third ventricle, are different according to age, either in young children or elderly individuals. Although complete surgical resection is an effective treatment for central neurocytoma, it is often difficult to approach these tumors through surgery. GKR could, therefore, be an alternative primary treatment option for deeply located central neurocytomas in elderly patients.
Sarcoidosis of the medulla oblongata causing intractable hiccoughs and numbness of extremities
Authors: Chen Xi-yuan , Ren Zhuo-chao , Huang Xiao-jun
Published: December 2018

Rationale:

Sarcoidosis is a multisystem disorder characterized by noncaseating granulomas. The nervous system is involved in 5 to 16% of the patients. However, neurosarcoidosis in the medulla oblongata presenting as hiccough is remarkably rare.

Patient concern:

A 55-year-old female was admitted to our hospital suffering from intractable hiccough and progressive numbness of extremities.

Diagnosis:

The MR imaging revealed a circumscribed mass lesion located on the medulla oblongata. The mass was hyperintense on T2-weighted images and enhanced homogeneously with gadolinium-diethylenetriamine penta-acetic acid. The cerebrospinal fluid analysis showed a moderately elevated protein content and a significant lymphocytosis 86.5%. Electrocardiogram (ECG) showed complete atrioventricular block. Bilateral supraclavicular, hilar, and mediastinal lymphadenopathy was diagnosed in a CT scan. Transbranchial needle aspiration biopsy revealed noncaseating granuloma consisting of epithelioid cells, lymphocytes, and rare multinucleated giant cells which was consistent with sarcoidosis. The diagnosis of multisystemic sarcoidosis was made.

Interventions and outcomes:

The patient underwent a permanent pacemaker insertion, and was successfully treated with corticosteroids.

Lessons:

It is important to consider neurosarcoidosis in the differential diagnosis of intramedullary lesion, since a right recognition may lead to appropriate treatment with steroids and avoid needlessly extensive surgery.
Characterisation of gut, lung, and upper airways microbiota in patients with non-small cell lung carcinoma
Authors: Bingula Rea , Filaire Marc , Radosevic-Robin Nina , Berthon Jean-Yves , Bernalier-Donadille Annick , Vasson Marie-Paule , Thivat Emilie , Kwiatkowski Fabrice , Filaire Edith
Published: December 2018

Background:

Several studies have confirmed the important role of the gut microbiota in the regulation of immune functions and its correlation with different diseases, including cancer. While brain-gut and liver-gut axes have already been demonstrated, the existence of a lung-gut axis has been suggested more recently, with the idea that changes in the gut microbiota could affect the lung microbiota, and vice versa. Likewise, the close connection between gut microbiota and cancer of proximal sites (intestines, kidneys, liver, etc.) is already well established. However, little is known whether there is a similar relation when looking at world's number one cause of death from cancer—lung cancer.

Objective:

Firstly, this study aims to characterise the gut, lung, and upper airways (UAs) microbiota in patients with non-small cell lung cancer (NSCLC) treated with surgery or neoadjuvant chemotherapy plus surgery. Secondly, it aims to evaluate a chemotherapy effect on site-specific microbiota and its influence on immune profile. To our knowledge, this is the 1st study that will analyse multi-site microbiota in NSCLC patients along with site-specific immune response.

Methods:

The study is a case-controlled observational trial. Forty NSCLC patients will be divided into 2 groups depending on their anamnesis: Pchir, patients eligible for surgery, or Pct-chir, patients eligible for neoadjuvant chemotherapy plus surgery. Composition of the UAs (saliva), gut (faeces), and lung microbiota (from broncho-alveolar lavage fluid (BALF) and 3 lung pieces: “healthy” tissue distal to tumour, peritumoural tissue and tumour itself) will be analysed in both groups. Immune properties will be evaluated on the local (evaluation of the tumour immune cell infiltrate, tumour classification and properties, immune cell phenotyping in BALF; human neutrophil protein (HNP) 1–3, β-defensin 2, and calprotectin in faeces) and systemic level (blood cytokine and immune cell profile). Short-chain fatty acids (SCFAs) (major products of bacterial fermentation with an effect on immune system) will be dosed in faecal samples. Other factors such as nutrition and smoking status will be recorded for each patient. We hypothesise that smoking status and tumour type/grade will be major factors influencing both microbiota and immune/inflammatory profile of all sampling sites. Furthermore, due to non-selectivity, the same effect is expected from chemotherapy.
Burden of diabetic retinopathy in mainland China
Authors: Zhong Yifan , Wu Jinyang , Yue Song , Zhang Guisen , Liu Lei , Chen Lei
Published: December 2018

Background:

Diabetic retinopathy (DR) is the leading cause of vision loss in adults of working age. Although existing systematic reviews of the prevalence of DR for mainland China have been reported, but several studies have been newly reported. Further some potential factors for DR are still discrepant and inconclusive. The aim of current research is to identify relevant literature regarding the prevalence of DR and DR-related factors in mainland China. In addition, we will project the number of individuals affected with DR in mainland China in years 2030 and 2050.

Methods:

This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. To identify publications in English or Chinese languages on the prevalence of DR in mainland China, a comprehensive step-by-step search of the PubMed, Embase, Web of Science, VIP Chinese Periodical, and China National Knowledge Infrastructure (CNKI) databases will be performed. Two reviewers will independently review the studies for eligibility according to the predefined inclusion and exclusion criteria. The quality of the included studies will be evaluated according to the National Health Institute Quality Assessment tool and Quality Assessment Manual. A random-effect model (DerSimonian-Laird method) will be used for the meta-analysis. Heterogeneity and publication bias among studies will be estimated by the I
2 statistic and Begg funnel plot, respectively.

Results:

This systematic review study will provide an evidence of prevalence, risk factors, and national burden for DR in mainland China.

Conclusion:

The study will give an explicit evidence to provide preventative measures of DR.

PROSPERO registration number: CRD42018094565.
Epidemiology of playground equipment related/unrelated injuries to children
Authors: Suh Dongbum , Jung Jin Hee , Chang Ikwan , Lee Jin Hee , Jung Jae Yun , Kwak Young Ho , Kim Do Kyun
Published: December 2018

The aim of study was to understand the epidemiology of playground injury and to find the factors related to the clinically significant injuries. This retrospective observational study enrolled children (age 0–18 years old) who visited the emergency departments (ED) of 6 hospitals in Korea.

We obtained and analyzed the data from the ED injury surveillance system, which was supported by the Korea Centers for Disease Control. Clinically significant injury (Cs injury) was defined as the injuries that caused hospital admission for more than one day. The factors associated with injury and clinical outcome were compared between admitted and discharged patient groups. Multivariable logistic regression and the population attributable fraction were used to identify significant factors for hospitalization.

A total of 1458 patients were enrolled. The proportion of patients who visited ED due to injuries unrelated to the playground equipment use was 57.8%. The majority of Cs injury was upper extremity fractures (68.1%). The risk factors for admission were the 6- to 11-year old age group (OR 5.7, 95% CI 1.3–25.0) and public playground (OR 2.4, 95% CI 1.1–5.3); the population attributable factor of these factors was 51.3% and 36.0%, respectively.

This study shows that approximately 60% of the patients visited ED due to injury unrelated to the playground equipment use. The risk factors of Cs injuries were ages 6 to 11 and public playgrounds. The results of the study can be helpful to formulate the prevention policy against playground injury.
Sepsis-induced Takotsubo syndrome in young premenopausal women
Authors: Wang Fan , Wen Wei
Published: December 2018

Rationale:

Takotsubo syndrome (TTS) most commonly occurs in postmenopausal women who have been exposed to a triggering event such as acute physical or emotional distress. Sepsis-induced TTS in young premenopausal women were rarely reported. In particular, the relationship between sepsis-induced TTS and sepsis-induced cardiomyopathy (SIC) remains to be illuminated.

Patient concerns:

Two young premenopausal women were admitted to the hospital with sepsis and myocardial involvement.

Diagnosis:

Both patients fully met the Mayo Clinic criteria for TTS.

Interventions:

Both patients received anti-infection and fluid infusion treatment.

Outcomes:

Both patients were discharged without complications and the follow-up ultrasonic echocardiography showed normal results.

Lessons:

In this report, we describe 2 young premenopausal women with sepsis-induced TTS. There is an overlap between sepsis-induced TTS and SIC, and SIC could be a special type of TTS, which occurs under the stress of sepsis.