bluuebunny/crossref_metadata_2025 huggingface dataset:
Hispanic adults’ physical activity and sedentary behavior profiles: examining existing data to drive prospective research
Authors: Heredia Natalia I , Lee MinJae , Reininger Belinda M
Published: May 2019

Background

Because physical activity (PA) and sedentary behavior (SB) are two distinct, interdependent behaviors, increases in PA may influence SB. As a limited number of SB interventions have been tested in Latino/Hispanic samples,. The purpose of this study is to assess if there was more PA and less SB in a Hispanic border community where there had been a PA-targeted community-wide campaign since 2005.

Methods

This cross-sectional study included Hispanic adults (N = 676) sampled from both intervention and comparison Texas-Mexico border communities in 2010. Our dependent variable was four-categories based on meeting PA guidelines and excessive SB (≥540 mins/day) cut-points. We conducted adjusted multivariable analysis to assess the association of intervention group with the PA/SB groupings.

Results

In 2010, most adults were in the Low PA/Low SB group. Compared to the comparison group, the intervention group had 6.45 (p < 0.001) times the adjusted odds of being in the High PA/Low SB vs. Low PA/High SB group.

Conclusions

Five years into the campaign, more PA and less SB were more likely in the intervention community, indicating the association of some PA interventions with SB. PA-targeted interventions should capture effects on SB to expand the literature on effective SB interventions for Hispanic adults.
Cardiovascular and renal outcomes following percutaneous coronary intervention in a population with renal disease: a case-control study
Authors: Allen L A , Pyart R D , Holmes J , Donovan K L , Anderson R A , Phillips A O
Published: May 2019

Background

Patients with renal disease are less likely to undergo percutaneous coronary intervention (PCI) due to concerns about poor outcomes.

Aim

We describe outcomes following PCI in individuals with chronic kidney disease (CKD), as compared with matched controls with comparable CKD who did not undergo PCI. We also identified factors predictive of poor outcomes following PCI amongst patients with CKD.

Design

Retrospective observational case-control study.

Methods

Cases were individuals with CKD (stages 1–5) undergoing PCI between 2008 and 2014. Controls were age, gender and creatinine-matched individuals not requiring PCI. We compared mortality between groups using Kaplan–Meier curves and Cox regression modelling. We assessed changes in serum creatinine using Wilcoxon Rank testing. We explored the relationship between biochemical and haematological measures (baseline creatinine, calcium, phosphate, calcium-phosphate product, parathyroid hormone, white cell count, haemoglobin, platelet count, c-reactive protein and total cholesterol) and post-PCI mortality, using logistic regression.

Results

We identified 144 cases and 144 controls. Mortality was significantly lower amongst cases compared with controls [hazard ratio 0.46 (95% confidence intervals 0.31, 0.69)]. PCI did not result in a significant change in renal function (P=0.52). Amongst cases, serum creatinine and calcium-phosphate product were predictors of mortality following PCI.

Conclusion

Cases undergoing PCI had lower mortality, and PCI was not associated with accelerated CKD progression. On this data, PCI should not be deferred as a treatment option in patients with CKD. Serum creatinine and calcium-phosphate product predict mortality following PCI in this cohort, and may be useful in risk-stratifying patients with CKD being considered for PCI.
Certification, Lawsuits and the Role of Epidemiology in the Yokkaichi Asthma Episode in the 1960s and 1970s: Lessons and Legacy
Authors: Feng Danyang
Published: May 2019

Yokkaichi asthma, one of the four big pollution diseases of Japan, occurred as a result of the operation of local petrochemical complexes in the city of Yokkaichi in the early 1960s. This article explores how Yokkaichi asthma was caused, how it was certified by local government and how the air pollution victims ultimately won a lawsuit against the polluting corporations. Yoshida Katsumi, a Medical Professor at Mie Prefectural University, consulted the Atomic Bomb Medical Law to establish Yokkaichi’s own certification system. Because both leukaemia and asthma are non-specific diseases, they may also be caused by non-pollution-related factors. In the Yokkaichi lawsuit, Yoshida applied the epidemiological causation to the legal judgment for the purpose of providing compensation to individuals. As the case for compensation unfolded from 1967 to 1972, epidemiological knowledge, legal theory and social norms were deployed to advance the plaintiffs’ claim, whose success set a good example for other legal proceedings.
Low seroprevalence rates of Zika virus in Kuala Lumpur, Malaysia
Authors: Sam I-Ching , Montoya Magelda , Chua Chong Long , Chan Yoke Fun , Pastor Andrew , Harris Eva
Published: May 2019

Background

Zika virus (ZIKV) is believed to be endemic in Southeast Asia. However, there have been few Zika cases reported to date in Malaysia, which could be due to high pre-existing levels of population immunity.

Methods

To determine Zika virus (ZIKV) seroprevalence in Kuala Lumpur, Malaysia, 1085 serum samples from 2012, 2014–2015 and 2017 were screened for anti-ZIKV antibodies using a ZIKV NS1 blockade-of-binding assay. Reactive samples were confirmed using neutralization assays against ZIKV and the four dengue virus (DENV) serotypes. A sample was possible ZIKV seropositive with a ZIKV 50% neutralization (NT50) titre ≥20. A sample was probable ZIKV seropositive if, in addition, all DENV NT50 titres were <20 or the ZIKV NT50 titre was >4-fold greater than the highest DENV NT50 titre.

Results

We found low rates of possible ZIKV seropositivity (3.3% [95% confidence interval {CI} 2.4 to 4.6]) and probable ZIKV seropositivity (0.6% [95% CI 0.3 to 1.4]). Possible ZIKV seropositivity was independently associated with increasing age (odds ratio [OR] 1.04 [95% CI 1.02 to 1.06], p<0.0001) and male gender (OR 3.5 [95% CI 1.5 to 8.6], p=0.005).

Conclusions

The low ZIKV seroprevalence rate, a proxy for population immunity, does not explain the low incidence of Zika in dengue-hyperendemic Kuala Lumpur. Other factors, such as the possible protective effects of pre-existing flavivirus antibodies or reduced transmission by local mosquito vectors, should be explored. Kuala Lumpur is at high risk of a large-scale Zika epidemic.
Severity and costs associated with hospitalization for dengue in public and private hospitals of Surat city, Gujarat, India, 2017–2018
Authors: Bajwala Viral R , John Denny , Rajasekar T Daniel , Murhekar Manoj V
Published: May 2019

Background

Dengue is major public health problem in India, especially in urban areas. We conducted a study to estimate the severity and costs of treatment among hospitalized dengue patients in Surat city, Gujarat, India.

Methods

We reviewed the medical records of dengue patients hospitalized in five tertiary care facilities (private [n=2], semi-government [n=2] and government [n=1]) between April 2017 and March 2018. We used the World Health Organization 2009 classification to classify the severity of dengue. A resource utilization approach was used to estimate the cost of illness in US dollars (US$) (inflation adjusted to 2018) from a quasi-societal perspective (excluding non-medical cost) for dengue hospitalization.

Results

Of the 732 hospitalized dengue patients, 44.7% had no warning symptoms, 39.5% had warning signs and 15.8% had severe dengue. The mean cost of hospitalization was US$86.9±170.7. The cost of hospitalization was 28.8 times higher in private hospitals compared with government hospitals. Consultant charges in private hospitals, laboratory investigations in semi-government hospitals and registration with admission charges in government hospitals accounted for 27.3%, 39.4% and 53% of the direct cost in these facilities, respectively.

Conclusions

A better triage system for hospitalization, subsidizing costs in the public sector and cost capping in the private sector can help to reduce the cost of hospitalization due to dengue so as to ensure affordability for larger portion of the society for universal health coverage.
Highlights in allergic contact dermatitis 2018/2019
Authors: Johansen Jeanne D. , Werfel Thomas
Published: May 2019

Purpose of review

The purpose was to highlight recent findings especially concerning new and old allergens, trends, diagnosis and causes of contact allergy.

Recent findings

Nickel is still the most frequent cause of contact allergy in women and piercings remain an important risk factor. Countries with a long history of regulation of contact allergens have the lowest level of contact allergy to nickel and chromium in Europe. Among the most frequent causes of fragrance contact allergy is terpenes, which are oxidized such as limonene, linalool and in some countries: geraniol. Methylisothiazolinone is still causing considerable problems due to hidden exposures. Acrylates are emerging allergens and 2-hydroxyethyl methacrylate has been included in the 2019 update of the baseline series, as many new cases are seen due to long-lasting nail polish based on acrylates and glue (isobornyl acrylate) in insulin pumps. More than 10 new allergens have been described, which need to be considered in diagnosing contact allergy.

Allergic contact dermatitis is a frequent problem, it also constitutes a challenge to diagnose due to many potential contact allergens. The main culprit allergens remain the same, new significant causes are found especially within acrylates.
Neurotrophic factors and nerve growth factor in ocular allergy
Authors: Sacchetti Marta , Bruscolini Alice , Lambiase Alessandro
Published: May 2019

Purpose of review

During allergic reaction, nervous and immune systems mutually interact through release of mediators, including neurotrophic factors and nerve growth factor (NGF). These mediators modulate allergic reaction through binding their receptors expressed by immune and structural cells and by stimulating neuropeptide release by nerves. The role of neuropeptides and NGF has been demonstrated in allergic asthma and rhinitis, and, to a lesser extent, in allergic conjunctivitis. The aim of this review are to elucidate the evidence of the role of NGF and neuropeptides in the pathogenesis of allergic conjunctivitis.

Recent findings

NGF modulates allergic reaction by stimulating release of cytokines, inflammatory mediators and neuropeptides by immune and structural cells and nerve endings at the site of inflammation. Evidence showed that local and systemic NGF levels increase in patients with allergic conjunctivitis, including allergic rhinoconjuncivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis. We recently described an increase of conjunctival p75NTR expression in patients with allergic rhinoconjuncivitis, and an increase of tear levels of NGF after conjunctival provocation test with allergen.

NGF modulates ocular allergic reaction. Increasing understanding of the role of neuropeptides in allergic conjunctivitis may pave the way to the development of novel therapeutic approaches and improvement of patients’ management.
The Effect of Tobacco Use on Postoperative Pain Following Anterior Cervical Discectomy and Fusion
Authors: Patel Dil V. , Yoo Joon S. , Lamoutte Eric H. , Karmarkar Sailee S. , Singh Kern
Published: May 2019

Study Design:

This was a retrospective cohort study.

Objective:

To identify the differences in inpatient pain scores, narcotic consumption, and patient-reported outcomes (PROs) between tobacco users and nonusers following an anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

Previous studies have investigated tobacco use as a risk factor for negative postsurgical outcomes following spine surgery; however, few studies have analyzed the effects of tobacco on pain following ACDF.

Methods:

Patients undergoing primary, 1-level, or 2-level ACDF were retrospectively reviewed and stratified by tobacco use at the time of surgery. Inpatient pain scores and narcotic consumption were collected. Neck Disability Index and Visual Analogue Scale (VAS) neck and arm pain scores were collected preoperatively and at 6-week, 3-month, and 6-month follow-up visits. Differences in demographics and perioperative characteristics were assessed using χ2 analysis and multivariate linear regression. An association between immediate postoperative pain, narcotics consumption, and long-term PROs was tested for using multivariate linear regression.

Results:

A total of 192 patients were included and stratified by tobacco use: tobacco (n=25) and nontobacco (n=167). There were no significant differences in demographic and perioperative characteristics. No statistical differences were observed in inpatient VAS pain scores and narcotic consumption on postoperative day 0 and postoperative day 1. Preoperative VAS neck pain and arm pain was greater in tobacco users, however, improvements in neck and arm pain were similar in the postoperative period through 6-month follow-up. In addition, no statistical differences in Neck Disability Index were observed preoperatively or at any postoperative time points.

Conclusions:

Our study suggests that tobacco use does not influence inpatient pain scores, narcotic consumption, and improvements in PROs following ACDF. As such, tobacco users and nonusers should receive similar postoperative pain management protocols following surgery.

Level of Evidence:

Level III.
How to Write an Effective Results Section
Authors: Snyder Nathan , Foltz Carol , Lendner Mayan , Vaccaro Alexander R.
Published: May 2019

Developing a well-written research paper is an important step in completing a scientific study. This paper is where the principle investigator and co-authors report the purpose, methods, findings, and conclusions of the study. A key element of writing a research paper is to clearly and objectively report the study’s findings in the Results section. The Results section is where the authors inform the readers about the findings from the statistical analysis of the data collected to operationalize the study hypothesis, optimally adding novel information to the collective knowledge on the subject matter. By utilizing clear, concise, and well-organized writing techniques and visual aids in the reporting of the data, the author is able to construct a case for the research question at hand even without interpreting the data.
A Brief Communication on Circulating PD-1-positive T-Regulatory Lymphocytes in Melanoma Patients Undergoing Adjuvant Immunotherapy With Nivolumab
Authors: Gambichler Thilo , Schröter Ulrike , Höxtermann Stefan , Susok Laura , Stockfleth Eggert , Becker Jürgen C.
Published: May 2019

Upregulation of T-regulatory lymphocytes (Tregs) is one of numerous immune escape mechanisms of malignancies. In the present pilot study we aimed to study the effect of adjuvant nivolumab during the initiation of treatment on circulating Tregs subpopulations in patients with stage III melanoma. We subsequently recruited patients with stage III melanoma who had the indication for adjuvant anti-programmed death 1 (PD-1) treatment with nivolumab. Blood collections were performed before the initiation of nivolumab and before every 2-week therapy cycle. Flow cytometry was performed for the determination of circulating CD4+CD25highCD127−PD-1+(PD-1+Tregs) and CD4+CD25highCD127−CTLA-4+ (CTLA-4+Tregs) Treg populations. Circulating PD-1+Tregs [18.1% (range, 2.9%–41.7%) vs. 4.2% (0.4%–9.8%), P=0.0001] significantly decreased after the first cycle of immunotherapy and maintained decreased during a 3-month course of treatment. By contrast, CTLA-4+Tregs significantly increased after the first nivolumab dose when compared with CTLA-4+Tregs before the second treatment [0.75 (0–45.5) vs. 2.1 (0.1–90.8), P=0.0002]. Blood levels of PD-1+Tregs and CTLA-4+Tregs remained more or less decreased and increased during a 3-month therapy with nivolumab, respectively. Data of PD-1+Tregs as well as CTLA-4+Tregs was not significantly associated with frequencies of immune-related adverse events (P<0.05). In conclusion, we have demonstrated that circulating PD-1+Tregs of melanoma patients in stage III rapidly and continuously decline after the initiation of adjuvant treatment with the PD-1 blocking antibody nivolumab. By contrast, this decline is paralleled with an increase of CTLA-4+Tregs. The expression of PD-1 and CTLA-4 on Tregs might be a potential biomarker for the efficacy of immune checkpoint blockade in melanoma.
The effect of vaginal erbium laser treatment on sexual function and vaginal health in women with a history of breast cancer and symptoms of the genitourinary syndrome of menopause: a prospective study
Authors: Arêas Fernanda , Valadares Ana L.R. , Conde Délio Marques , Costa-Paiva Lúcia
Published: May 2019

Objectives:

To assess the effects of vaginal erbium laser treatment on the vaginal health and sexual function of postmenopausal women with a history of breast cancer.

Methods:

An open, prospective, therapeutic intervention study was conducted with 24 postmenopausal women with a history of breast cancer and vaginal dryness, and/or dyspareunia, who had not used vaginal hormone therapy for at least 6 months. The women were treated using a 2,940-nm Erbium: YAG laser (Etherea-MX, Athena, São Carlos, São Paulo, Brazil), with 90o and 360o scanning scopes, between August, 2017 and October, 2017 in a private clinic in a city of southeastern Brazil. Vaginal erbium laser treatment was performed at three sessions with a 30-day interval between each session. Sexual function was assessed before and 1 month after treatment using the Short Personal Experiences Questionnaire. Questions related to genitourinary symptoms were also applied. Vaginal health was assessed before each laser session using the Vaginal Health Index Score.

Results:

Mean age was 53.7 years. Vaginal health improved, as shown by an increased overall score (P < 0.001). The effect size was large between pretreatment and post-treatment scores for vaginal elasticity, fluid volume, epithelial integrity, and moisture. The effect size was also significant for the overall sexual function score and for the score in the dyspareunia domain between pretreatment and 1 month after the final treatment session.

Conclusion:

Vaginal erbium laser may represent a novel therapeutic option for improving vaginal health and sexual function in postmenopausal women with a history of breast cancer.
A Simplified and Practical Surgical Treatment for Medial Ectropion: A Case Report
Authors: Pinelli Massimo , Starnoni Marta , De Santis Giorgio
Published: May 2019

We present the case of a 81-year-old patient with right facial palsy suffering from recurrent medial ectropion with lower lateral dislocation of the lacrimal punctum causing epiphora and photophobia. The patient was first treated for ectropion with lateral tarsal strip procedure. Unfortunately, this surgical procedure did not get the expected result. This was the reason we used the Mitek anchor system to fix the lower lateral dislocation of the punctum. We had no recurrence of symptoms during a follow-up period of 18 months.
Prosthetic Breast Reconstruction and Red Breast Syndrome: Demystification and a Review of the Literature
Authors: Nahabedian Maurice Y.
Published: May 2019

Red breast syndrome (RBS) represents an inflammatory condition that rarely occurs in the setting of acellular dermal matrix use after prosthetic reconstruction. It is characterized by erythema or rubor that occurs directly over the ADM, and its appearance resembles that of a cellulitis. There have been many explanations with regard to etiology, but none have addressed the physiologic alterations leading to the onset and resolution of RBS. RBS is postulated to be the result of lymphatic disruption and is self-limiting. Resolution is postulated to be the result of angiolymphatic regeneration and the re-establishment of lymphatic flow within the mastectomy skin flap and the ADM, resulting in the clearance of inflammatory mediators responsible for the localized erythema.
Reverse Abdominoplasty Advancement Flap: An Innovative Option in Breast Reconstruction in Post-Massive Weight Loss Patients
Authors: Asiry Abdulaziz , Garrido Ignacio , Chaput Benoit , Chantalat Elodie , Vaysse Charlotte
Published: May 2019

With the increase in obesity in the world, we observe more and more bariatric surgeries. Simultaneously, the incidence of breast cancer increases. The reverse abdominoplasty has been essentially described to lift the upper part of the abdomen for the individual who has loose excess skin in the supraumbilical region. The application of reverse abdominoplasty flap has been extended beyond aesthetic procedures to breast reconstructive interventions. We present an innovative option of postbreast cancer reconstruction by reverse abdominoplasty advanced flap following massive weight loss.
A Framework to Harness the Power of Quality Collaboratives to Improve Perinatal Outcomes
Authors: LEE KING PATRICIA A. , YOUNG DANIELLE , BORDERS ANN E.B.
Published: May 2019

The Illinois Perinatal Quality Collaborative developed a framework for successfully engaging teams and implementing statewide obstetric and neonatal quality improvement (QI) initiatives. This framework includes: (1) engaging hospitals to create an environment of improvement; (2) motivating hospital teams to facilitate change at their hospital; and (3) supporting hospital teams through the 3 pillars of QI—collaborative learning opportunities, rapid-response data, and QI support—to achieve initiative goals and improve outcomes for mothers and newborns. Utilizing this framework, the Illinois Perinatal Quality Collaborative Severe Maternal Hypertension Initiative engaged teams and achieved initiative goals.
Antibiotics for the Treatment of Staphylococcal Infections in the Obstetric Patient
Authors: FINLEY TORY A. , DUFF PATRICK
Published: May 2019

This review addresses current epidemiology and treatment of obstetric staphylococcal infections. It also examines current prophylaxis methods and the efficacy of universal screening.
Cognitive self-regulation influences pain-related physiology
Authors: Matthewson Gordon M. , Woo Choong-Wan , Reddan Marianne C. , Wager Tor D.
Published: May 2019

Cognitive self-regulation can shape pain experience, but its effects on autonomic responses to painful events are unclear. In this study, participants (N = 41) deployed a cognitive strategy based on reappraisal and imagination to regulate pain up or down on different trials while skin conductance responses (SCRs) and electrocardiogram activity were recorded. Using a machine learning approach, we first developed stimulus-locked SCR and electrocardiogram physiological markers predictive of pain ratings. The physiological markers demonstrated high sensitivity and moderate specificity in predicting pain across 2 data sets, including an independent test data set (N = 84). When we tested the markers on the cognitive self-regulation data, we found that cognitive self-regulation had significant impacts on both pain ratings and pain-related physiology in accordance with regulatory goals. These findings suggest that self-regulation can impact autonomic nervous system responses to painful stimuli and provide pain-related autonomic profiles for future studies.
Nerve growth factor antibody for the treatment of osteoarthritis pain and chronic low-back pain: mechanism of action in the context of efficacy and safety
Authors: Schmelz Martin , Mantyh Patrick , Malfait Anne-Marie , Farrar John , Yaksh Tony , Tive Leslie , Viktrup Lars
Published: May 2019

Chronic pain continues to be a significant global burden despite the availability of a variety of nonpharmacologic and pharmacologic treatment options. Thus, there is a need for new analgesics with novel mechanisms of action. In this regard, antibodies directed against nerve growth factor (NGF-Abs) are a new class of agents in development for the treatment of chronic pain conditions such as osteoarthritis and chronic low-back pain. This comprehensive narrative review summarizes evidence supporting pronociceptive functions for NGF that include contributing to peripheral and central sensitization through tropomyosin receptor kinase A activation and stimulation of local neuronal sprouting. The potential role of NGF in osteoarthritis and chronic low-back pain signaling is also examined to provide a mechanistic basis for the observed efficacy of NGF-Abs in clinical trials of these particular pain states. Finally, the safety profile of NGF-Abs in terms of common adverse events, joint safety, and nerve structure/function is discussed.
Effects of an Education Intervention on Nursing Students' Knowledge and Attitudes Regarding Skin Self-Examination and Skin Cancer Risks
Authors: ERKİN Özüm , AYGÜN Özcan
Published: May 2019

Background

The incidence of skin cancers is increasing in Turkey as well as worldwide. Nurses have a potentially influential role to play in educating the public about skin cancer prevention.

Purpose

The purpose of this study was to teach nursing students the risks of skin cancer and the steps involved in conducting related skin self-examinations to encourage positive attitudes toward skin cancer protection and early detection.

Methods

This research used a quasi-experimental, single-group, pretest–posttest design. The study population was composed of all the nursing students who were currently enrolled in a university in Muğla, a city in southern Turkey (n = 900). The study analysis included the 332 nursing students who had completed both the pretest and posttest assessments. An intervention to raise awareness about skin cancer risks and skin self-examination was carried out using educational materials that included posters/pictures, brochures, a PowerPoint slideshow, and a video. The posttest assessment was done 6 weeks after the pretest.

Results

The participants were 18–23 years old, and 67.5% were female. Furthermore, 3.6% had undergone a routine (external) screening for skin cancer, and 14.5% believed that they were at risk for skin cancer. The mean score for knowledge of skin cancer risks for those participants who had completed the program was 5.75 ± 1.20 in the pretest and 6.84 ± 1.17 in the posttest (minimum: 0, maximum: 8). The mean posttest score was higher than the pretest score in this group, F(1, 329) = 6.49, p = .011, and a significant difference was found between the mean pretest and posttest score for knowledge of the ABCDE rule (p < .05).

Conclusions

Educating nursing students about skin self-examination increased their level of knowledge about both skin cancer risks and the ABCDE rule. We believe that this and similar educational programs are an effective way to increase the knowledge and awareness of nurses regarding skin cancer and to improve their attitudes toward performing skin self-examination.
Combined navigated drilling and arthroscopy facilitate minimally invasive surgical treatment of ulnar–radial joint dislocation caused by epiphyseal premature closure
Authors: Yu Tong , Yuan Bao-Ming , Jiang Yi-Kun , Li Qi-Wei , Wang Qian , Kang Li-Heng , Zhang Xi-Wen , Wu Dan-Kai , Zhao Jian-Wu
Published: May 2019

Rationale:

In this paper, the efficacy and safety of using navigated drilling and arthroscopy (NDA) to assist surgery for ulnar–radial joint dislocation caused by epiphyseal premature closure (EPC) are described. Deformity correction surgery was mentioned in the literature, but there were numerous complications, for example, poor correction, infection, neurovascular injury, osteofascial compartment syndrome, failure of internal fixation, and nonunion after osteotomy. In order to minimize surgical complications, we utilized navigated drilling to finish accuracy bone bridge resection and applied arthroscopy to assess wrist lesions.

Patient concerns:

An 11-year-old male patient showed swelling and pain of the left wrist.

Diagnoses:

The patient was diagnosed with a postoperative of Kirschner wire internal fixation for epiphyseal injury, left lower ulnar–radial joint dislocation, left wrist deformity, and EPC.

Interventions:

A NDA was used to assist the bone bridge resection in this patient.

Outcomes:

Pain was relieved clearly in the patient. Dorsiflexion increased from 60.8° to 85.3°, palmar flexion increased from 45.3° to 65.8°, supination increased from 41.3° to 69.5°, and pronation increased from 31.6° to 62.9°. The preoperative disabilities of the arm, shoulder, and hand (DASH) score was 86.1, which was increased to 16.4 postoperatively. Surgery designing lasted for 2 minutes, bone bridge resection lasted for 56 minutes, and fluoroscopic time was 2.4 minutes. Complications, for example, neurological injury, vascular injury, infection and deformity aggressive, were not found during the 5-month follow up.

Lessons:

The outcome of the present study suggests that the NDA maximizes the bone bridge resection accuracy in EPC treatment, which is made efficient by reducing surgical trauma and avoiding neurovascular injury. An experience was gained that in the process of bone bridge removal, the bit of navigated drill should be continuously washed with normal saline to cool down, so as to avoid damage of nerve caused by heat conduction.
Natural history and therapeutic strategies of post-pancreatoduodenectomy abdominal fluid collections
Authors: Zhao Ning , Cui Jing , Yang Zhiyong , Xiong Jiongxin , Wu Heshui , Wang Chunyou , Peng Tao
Published: May 2019

Trial Design:

The aim of this study was to identify independent risk factors for post-pancreatoduodenectomy (post-PD) abdominal fluid collections (AFCs) and evaluate our management protocol on it.

Methods:

A retrospective analysis of consecutive 2064 cases who underwent PD over the past decade in 1 single center was conducted. The patients were divided into AFCs and non-AFCs group. Univariable and multivariate logistic regression analysis was performed to identify independent risk factors of AFCs. The AFCs group was compared with the non-AFCs group with respect to the incidence of postoperative outcomes. The characteristics of AFCs were further analyzed in terms of clinical manifestations.

Results:

Two thousand sixty-four cases with pancreaticoduodenectomy were recruited and 15% of them were found AFCs. Diameter of main pancreatic duct ≤3 mm was found to be an independent predictor of AFCs (P < .001), along with soft pancreatic texture (P = .002), mesenterico-portal vein resection (P < .001), and estimated intraoperative blood loss >800 mL (P < .001). The incidence of mild complications was significantly higher in AFCs group than in non-AFCs group (34% vs 20%, P < .001), whereas no significant differences were noted in the rate of severe complications between these 2 groups (15% vs 15%, P = .939).

Conclusion:

Enhanced drainage is recommended as an effective measure to decrease the incidence of severe complications caused by post-PD AFCs.
Comparison of dexamethasone intravitreal implant with intravitreal anti-VEGF injections for the treatment of macular edema secondary to branch retinal vein occlusion
Authors: Ji Kaibao , Zhang Qinglin , Tian Man , Xing Yiqiao
Published: May 2019

Background:

This meta-analysis compared the efficacy and safety of dexamethasone intravitreal implant (DEX) and anti-vascular endothelial growth factor (anti-VEGF) in the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).

Methods:

The PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for published studies comparing DEX with anti-VEGF for the treatment of ME caused by BRVO. Outcomes of the selected studies included best-corrected visual acuity (BCVA), central macular thickness (CMT), and adverse events. Review Manager (RevMan) 5.3 was used to analyze the data.

Results:

Six trials comparing the efficacy and safety of DEX with anti-VEGF were included in this meta-analysis. At 1 month, DEX achieved a mean BCVA superior to that achieved by anti-VEGF (MD = −0.11, P < .0001), in addition to a superior mean BCVA change (MD = −0.35, P < .00001). At 3 months, the mean BCVA showed a significant difference (MD = −0.06, P = .03) between DEX and anti-VEGF treatment, while the mean BCVA change was similar to that with anti-VEGF treatment (MD = −0.06, P = .11). However, neither mean BCVA nor mean BCVA change showed a significant difference between DEX and anti-VEGF treatment at 6 months (MD = 0.08, P = .06; MD = 0.06, P = .43, respectively). Mean CMT and mean CMT change were significantly lower in the DEX group than in the anti-VEGF group at 1 month (MD = −53.63 μm, P < .00001; MD = −60.1 μm, P = .005, respectively). However, at 3 months, mean CMT and mean CMT change were similar between DEX and anti-VEGF treatment (MD = 17.4 μ, P = .74; MD = 18.01 μm, P = .72, respectively). Although mean CMT in the anti-VEGF group was not significantly lower than that in the DEX group at 6 months (MD = 55.53, P = .07), the mean CMT change from baseline achieved by the anti-VEGF treatment was significantly superior to that obtained with DEX (MD = 75.53, P = .0002). Concerning adverse events, no statistically significant differences were observed in the incidence of cataract (OR = 4.25, P = .07), but the use of DEX led to a higher risk of intraocular pressure elevation compared with anti-VEGF treatment (OR = 12.04, P = .006).

Conclusions:

Our results show that visual acuity recovery and CMT were better in the DEX group than in the anti-VEGF group after 1 and 3 months, although the difference in CMT at 3 months was not significant. However, there were no significant differences in terms of visual acuity and CMT between the two groups after 6 months of follow-up. Therefore, DEX may be recommended as the first treatment option in ME associated with BRVO.
A novel mutation in SPTA1 identified by whole exome sequencing in a Chinese family for hereditary elliptocytosis presenting with hyperbilirubinemia
Authors: Xi Yaming , Wang Lina , Zhang Pengpeng , Jia Mingfeng , Li Zijian
Published: May 2019

Rationale:

Hereditary elliptocytosis is an inherited disorder characterized by the elliptical red blood cells (RBCs) on the peripheral blood smear and related hemolysis, mainly results from a heterozygous mutation in the genes that encode protein 4.1, α-spectrin, β-spectrin. Mutations of SPTA1 are the most common.

Patient concerns:

A 21-year-old female presented with left epigastric pain and jaundice with numerous elliptical RBCs on blood film. The family history review discovered jaundice in her sibling.

Diagnosis:

A novel heterozygous mutation of SPTA1 was detected in the proband, her brother and father, c.7220_7221del:p.Tyr2407∗ in exon 52. Bioinformatics analysis indicated that this mutation was likely pathogenic and results in early termination of transcription and production of defective protein.

Interventions:

The proband underwent splenectomy and cholecystectomy due to symptomatic splenomegaly and gallstone.

Outcomes:

After surgery, the bilirubin levels decreased to normal (i.e., total bilirubin 16.4 μmol/L; indirect bilirubin 12.3 μmol/L), and the pain and uncomfortableness in the upper abdomen relieved completely.

Lessons:

We suggest that simultaneous whole exome sequencing of causative genes of all family members is a useful strategy to identify pathogenetic mutations for hereditary RBC membrane disorders, mainly in cases with an ambiguous phenotype.
The effect of early Helicobacter pylori eradication on the healing of ESD-induced artificial ulcers
Authors: Song Wen chong , Wang Xiao feng , Lv Wei wei , Xu Xiao yan , Tian De min
Published: May 2019

Background:

The role of Helicobacter pylori eradication is still not clear in endoscopic submucosal dissection (ESD)-induced artificial ulcer. This study investigates the therapeutic effects of H. pylori eradication on ESD-induced artificial ulcers.

Methods:

Eighty-four patients with ESD-induced artificial ulcers were enrolled. H. pylori eradication success subgroup (Group A1) and H. pylori eradication failure subgroups (Group A2) received standard triple therapy orally for 7 days, followed by esomeprazole 20 mg bis in die (bid) orally for the remainder of the treatment period (4 weeks in total). The H. pylori positive (Group B1) and H. pylori negative subgroups (Group B2) received esomeprazole 20 mg bid orally for 4 weeks. Ulcer healing was evaluated by gastroscopy, and H. pylori was identified by a C13 breath test or an Hp-RUT 2 and 6 months after treatment.

Results:

Successful eradication of H. pylori can promote healing of ESD-induced artificial ulcers. The ESD-induced artificial ulcer healing rate in Group A1 was statistically higher than that in Groups A2, B1, and B2.

Conclusion:

Our results indicated that early H. pylori eradication therapy can promote ESD-induced artificial ulcer healing in H. pylori positive patients with ESD-induced artificial ulcers.
A spontaneous protruded angle-supported anterior chamber intraocular lens
Authors: Lin Hsin-Le , Tseng Gow-Lieng
Published: May 2019

Rationale:

Anterior chamber intraocular lens (ACIOL) remains a surgical option for visual rehabilitation during complicated cataract surgeries with minimal or no capsular support. ACIOL causing scleral perforation is rare, and the involved causes remain debatable.

Patient concerns:

Here, we present the case of a 62-year-old female with spontaneous protrusion of an angle-supported ACIOL haptic tip through an extracapsular cataract extraction (ECCE) wound, who presented with progressive right-eye ptosis and right-side headache.

Diagnosis:

The slit lamp examination showed a vertically aligned angle-supported Kelman Multiflex ACIOL in the anterior chamber. The ACIOL had deviated upward, with upper haptic protruding from the previous ECCE scleral tunnel wound. Fundus examination and optical coherence tomography (OCT) revealed cystoid macular edema (CME) with mild epiretinal membrane (ERM).

Interventions:

The patient was treated with ACIOL extraction, pars plana vitrectomy, ERM peeling, and scleral-fixated posterior chamber IOL implantation.

Outcomes:

Three months after surgery, the best-corrected visual acuity in the right eye improved to 20/80 and the right-side headache and hyperemia of the conjunctiva had significantly subsided. Repeated OCT revealed improved CME.

Lessons:

Poor construction of the scleral tunnel incision may cause wound dehiscence. The vertically aligned ACIOL haptic tip resting at the angle may exert stress toward the dehiscent wound, exacerbating tissue erosion and causing scleral perforation with haptic tip exposure.
Gluteal, abdominal, and thoracic multiple impalement injuries
Authors: Ugoletti Lara , Zizzo Maurizio , Castro Ruiz Carolina , Pavesi Erica , Biolchini Federico , Annessi Valerio
Published: May 2019

Rationale:

Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients.

Patient concerns:

A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way.

Diagnosis:

Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object.

Interventions:

After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery.

Outcomes:

Patient was discharged on 9th postoperative day in good general clinical condition.

Lessons:

Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.
Acute dystonic reaction induced by a single dose of clebopride
Authors: Seo Young Woo , Ko Seung Hyun , Jang Tae Chang , Kim Gyun Moo
Published: May 2019

Rationale:

Clebopride is known as a dopamine antagonist used for alleviating emetic symptoms with minimal side effects. Herein, we report a case of acute dystonic reaction possibly caused by administration of clebopride in a young male.

Patient concerns:

A 19-year-old with no special medical conditions, visited a local clinic complaining of abdominal discomfort, associated with nausea and vomiting. The patient was prescribed with tiropramide, clebopride, simethicone, and mosapride citrate, only to visit the emergency department for abrupt neck pain followed with dystonic reactions upon oral administration of the drugs. The patient suffered involuntary movements of the neck to the right, while maintaining voluntary motor controls of the neck to the left.

Diagnosis:

Vital signs and neurological exams showed no obscurity and the preliminary blood workup (a complete blood count and measurement of electrolytes, inflammatory marker levels, copper concentration, etc) were all within normal ranges. Additional imagery tests including brain computed tomography (CT), neck contrast-enhanced CT, and magnetic resonance imaging failed to prove any focal lesion pertinent to the condition. Drug screening was done and then clebopride was suspected to be the cause of the dystonic reactions.

Interventions:

Benztropine (1 mg) was administered orally.

Outcomes:

The patient's symptoms improved after 1 hour, and he was observed for 6 more hours for possible recurrences before he was discharged. The patient was referred to an outpatient neurology department for 1 month, during which he had no recurrence or other extrapyramidal symptoms.

Lessons:

Although it is uncommon to experience extrapyramidal symptoms by clebopride, its chemical closeness to metoclopramide may induce such symptoms under certain clinical situations. Therefore, physicians should take in consideration of this effect and dwell in caution upon prescribing the drug.
Low interferon-gamma release in response to phytohemagglutinin predicts the high severity of diseases
Authors: He Xing , Liu Li-Ying , Ji Xiao-Kun , Xian Ya-Bin , Yan Yong-Jun , Xu Hui-Juan , Sha Li , Pu Chun-Li , Zhou Jun-Yan , Yuan Chun-Yan , Yang Mei , Zheng Song-Guo
Published: May 2019

A clinically useful immune biomarker could potentially assist clinicians in their decision making. We stimulated T-cell proliferation to secret interferon gamma (IFN-γ) by phytohemagglutinin, and then measured the production of IFN-γ (mitogen value [M value]). We aimed to determine the relationship between the M value, clinical severity, and outcomes of diseases.

In all, 484 patients admitted to intensive care units were enrolled in this retrospective study. The Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were collected within the first 24 hours. M value, C-reaction protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and routine blood tests were analyzed and collected during the study.

When APACHE II scores were greater than 15 and M values were less than 6, the hospital mortality rose in a straight line. There was an inverse correlation between APACHE II score and M value (r
s = −0.212, P < .001). There was a positive correlation between M value and lymphocyte numbers (b’ = 0.249, P < .001); however, there was an inverse correlation between M value and WBC (b’ = −0.230, P < .001), and ESR (b’ = −0.100, P = .029). Neurological diseases had the greatest influence on APACHE II scores (b’ = 10.356, P < .001), whereas respiratory diseases had the greatest influence on M value (b’ = 1.933, P < .001). Furthermore, in the respiratory system, severe pneumonia had a greater influence on M value. Taking the APACHE II score as the gold standard, the area under the curve of M was 0.632 (95% confidence interval [CI] 0.575–0.690, P < .001), PCT was 0.647 (95% CI 0.589–0.705, P < .001), CRP was 0.570 (95% CI 0.511–0.629, P = .022), and ESR was 0.553 (95% CI 0.494–0.612, P = .078). Divided by M value = 5, the positive predictive value of the M value is 37.22% (115/309) and negative predictive value is 75.43% (132/175).

The results show that the M values, PCT, and CRP were better than ESR to predict the severity of diseases. The number and proportion of lymphocytes also affected the result of the M value. To a certain extent, the M value may be a clinically useful immune biomarker, which may help clinicians objectively evaluate the severity of diseases, especially in the respiratory system.
Association of Interleukin-31 gene polymorphisms with risk of cryptorchidism in a Chinese population
Authors: Zou Bing , Yu Zhihai , Huang Jing , Tan Chunlin , Wang Haiyun , Fu Jian , Li Xin , Wang Xiaojun , Cui Shu , Tang Tielong
Published: May 2019

This study aims to investigate the possible association between Interleukin-31 (IL-31) gene polymorphisms and cryptorchidism risk.

Two single nucleotide polymorphisms of IL-31, rs7977932 (C/G) and rs4758680 (C/A), were selected to be investigated in this study. Polymerase chain reaction-restriction fragment length polymorphism methods were used to discriminate the selected single nucleotide polymorphisms of IL-31 gene. A hospital-based case-control study of 112 cryptorchidism patients and 425 healthy controls was conducted.

The frequencies of the C allele of rs4758680 in the patients with cryptorchidism were significantly higher compared with those in controls (89% vs 83%, P = .02, OR = 0.58, 95% CI = 0. 37–0.92). Compared with CC genotype in dominant model, notable decreased frequencies of A carriers (CA/AA genotypes) were observed in cryptorchidism patients (P = . 03, OR = 0.58, 95% CI = 0.35–0.96).

Results demonstrated that IL-31 gene polymorphisms were associated with the genetic susceptibility to cryptorchidism in a Chinese population. Compared with CC genotype, the A carriers (CA/AA genotypes) of rs4758680 were protect factors in cryptorchidism susceptibility.
Single nucleotide and structural variants of CYP2D6 gene in Kinh Vietnamese population
Authors: Nguyen Ha Hai , Ma Thuong Thi Huyen , Vu Nhung Phuong , Bach Quynh Thi Nhu , Vu Thang Hong , Nguyen Ton Dang , Nong Hai Van
Published: May 2019

CYP2D6 genetic variations could result in alteration of CYP2D6 enzyme activity, leading to dissimilarity among individuals in regard of drug metabolism.

This study aims to detect all genetic variants, allele, and genotype frequencies of CYP2D6 gene in 136 unrelated healthy Kinh Vietnamese volunteers. All single nucleotide variants (SNVs) and structural variations (SVs) of CYP2D6 gene were identified by Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA) assay.

Totally, 30 SNVs and 9 SVs including a whole gene deletion, 8 hybrid structures, and tandem arrangements were identified. Of the 7 novel SNVs detected, the 3157G>T (R329L) substitution was predicted to be deleterious by PROVEAN; the 3851G>A (W358X) variant resulted in a truncated protein; and the 2988G>A variant located in the intron 6 was predicted to be capable of modifying splicing motif by Human Splicing Finder. We determined 29 different genotypes of CYP2D6 from 136 individuals. The most common alleles were the CYP2D6∗10 (43.75%), ∗1 (18.75%), and tandem arrangement ∗36-∗10 (12.13%).

This study provides best information on CYP2D6 polymorphism comprising the newly discovered SNVs, structural variations, and their frequencies in Kinh Vietnamese. These new data would be valuable in view of precise dosing of CYP2D6 metabolized drugs and giving better treatment outcome.