bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical significance of myositis-specific autoantibody profiles in Japanese patients with polymyositis/dermatomyositis
Authors: Temmoku Jumpei , Sato Shuzo , Fujita Yuya , Asano Tomoyuki , Suzuki Eiji , Kanno Takashi , Furuya Makiko Yashiro , Matsuoka Naoki , Kobayashi Hiroko , Watanabe Hiroshi , Koga Tomohiro , Shimizu Toshimasa , Kawakami Atsushi , Migita Kiyoshi
Published: May 2019

Myositis-specific autoantibodies, such as anti-melanoma differentiation associated gene 5 (MDA5) and anti-anti-amino acyl-tRNA synthetases (ARS) antibodies, are associated with interstitial lung diseases (ILD), which determine the prognosis of polymyositis/dermatomyositis (PM/DM) patients. However, there is a paucity of data on the clinical correlation between anti-Sjögren syndrome-related antigen A (anti-SSA)/Ro52 antibodies in PM/DM. We investigated the prevalence of myositis-specific autoantibodies including anti-SSA/Ro52 antibody and assessed the clinical significance of these antibodies in patients with PM/DM.

We retrospectively reviewed demographic data and clinical outcomes in patients with PM/DM. The study population comprised 24 patients with PM and 60 patients with DM. The presence of anti-myositis-specific antibodies (MDA5, ARS, Jo-1, SSA/Ro52) was determined by immunosorbent assay (ELISA).

Anti-MDA5 antibody was detected in 18 patients with DM (n = 60). Anti-ARS/anti-SSA/Ro52 antibodies were detected in 31 and 39 patients with PM/DM (n = 84). Rapidly progressive ILD patients were mainly found in the anti-MDA5 antibody-positive DM group. During the follow-up period, 9 patients died. Kaplan–Meier analysis demonstrated that survival rates seem to be lower in DM patients with anti-MDA5 antibodies compared with those without anti-MDA5 antibodies. Furthermore, dual positivity for anti-SSA/Ro52 and anti-MDA5 antibodies was significantly higher in nonsurviving DM patients compared with survivors.

Although the presence of anti-ARS or anti-MDA5 antibodies is a prognostic marker in patients with PM/DM, combined presence of anti-SSA/Ro52 and anti-MDA5 antibodies represent another marker for clinical outcome in DM patients. Our results suggest that anti-SSA/Ro52 antibody positivity in DM patients with anti-MDA5 antibody reveals a subgroup of DM patients with poor prognosis.
Meta-analytic evaluation for the spatio-temporal patterns of the associations between common risk factors and type 2 diabetes in mainland China
Authors: Zhou Ting , Liu Xiang , Liu Yuanyuan , Li Xiaosong
Published: May 2019

There is a dearth of accurate information about the associations between risk factors and type 2 diabetes in mainland China. We conducted a systematic review and meta-analysis to explore the spatio-temporal patterns of the associations between common risk factors and type 2 diabetes in adults at least 18 years old in mainland China.

We searched English and Chinese databases from January 1st, 1997 to December 31st, 2017 for relevant observational studies. Overall and stratification analyses including secular trends and temporal distributions were conducted, odds ratio (OR) and 95% confidence interval (CI) were calculated by applying random-effects model.

Thirty-five studies were included. Type 2 diabetes was positively associated with a family history of type 2 diabetes (OR 2.89, 95%CI 2.38–3.49), hypertension (OR 2.73, 95%CI 2.25–3.36), central obesity (OR 2.28, 95%CI 1.94–2.68), dyslipidemia (OR 2.23, 95%CI 1.70–2.91), hypertriglyceridemia (OR 2.18, 95%CI 1.64–2.92), general obesity (OR 1.90, 95%CI 1.66–2.18), hypercholesterolemia (OR 1.65, 95%CI 1.32–2.06), smoking (OR 1.26, 95%CI 1.13–1.40), and drinking (OR 1.20, 95%CI 1.05–1.36), whereas a negative association with female gender (OR 0.87, 95%CI 0.78–0.97) existed. Except for female gender and drinking, the pooled effects of temporal and spatial stratification for the other five risk factors were consistent with the above results. For temporal stratification, the ORs of general obesity increased gradually during the periods of 1992 to 2005, 2006 to 2010, and 2011 to 2017, while the ORs of a family history declined. For regional stratification, the magnitudes of ORs for hypertension, dyslipidemia, and hypercholesterolemia in northern areas were larger than that in southern areas, while opposite situation occurred for a family history. Except for the factor a family history, provincial results for the other nine risk factors differed from the overall results and among provinces.

Effect differences existed for modifiable and non-modifiable risk factors in secular trends and regional distribution, which is of potential public health importance for type 2 diabetes prevention.
High expression of survivin predicts poor prognosis in cervical squamous cell carcinoma treated with paclitaxel and carboplatin
Authors: Zhang Yunzhong , Yan Hong , Li Ruiping , Guo Yuzhen , Zheng Rongfang
Published: May 2019

Lack of effective biomarkers is one of the challenges in current neoadjuvant chemotherapy to predict drug response and sensitivity of cervical squamous cell carcinoma (CSCC). The present study was designed to investigate the correlation of the expression of survivin, an inhibitor of apoptosis with the prognosis of CSCC patients undergoing neoadjuvant chemotherapy.

A total of 117 CSCC patients treated with paclitaxel and carboplatin between May 2015 and April 2017 in the Second Hospital of Lanzhou University were retrospectively analyzed. The pathologic diagnosis and classification of CSCC were based on the Guidelines of the International Federation of Gynaecology and Obstetrics (FIGO). The efficacy was defined as complete remission (CR), partial remission (PR), and stability disease (SD). The expressions of survivin, vascular endothelial growth factor (VEGF), and Ki67 were determined with immunohistochemistry. Data were analyzed with SPSS software.

Univariate analysis showed that survivin expression had no correlation with ages, FIGO stage, macroscopic type, lymphovascular invasion, depth of lymphovascular invasion, lymph node metastasis, and tumor size among 117 CSCC patients. However, survivin expression was positively correlated with pathological grade (R = 0.691, P < .001). Multivariate analysis revealed that survivin expression was independently correlated with grades (P < .001). In addition, the analysis of correlation indicated that survivin expression is positively correlated with VEGF expression (R = 0.820, P < .001) and Ki67 expression (R = 0.673, P < .001). The numbers (percentages) of complete remission (CR), partial remission (PR), and stability disease (SD) were 11 (9.4%), 91 (77.8%), and 15 (12.8%) respectively after the treatment of paclitaxel and carboplatin. Univariate analysis showed that efficacy of treatment was negatively correlated with pathological grade (R = 0.513, P < .001), Ki67 expression (R = 0.586, P < .001), VEGF expression (R = 0.476, P < .001) and survivin expression (R = 0.519, P < .001). Multivariate analysis revealed that efficacy of treatment was independently correlated with grades (P = .028), Ki67 (P < .001), and survivin expression (P = .015).

The results suggested that survivin expression is negatively correlated with the prognosis of CSCC patients treated with paclitaxel and carboplatin. Therefore, survivin expression might be a marker for prognosis in CSCC following neoadjuvant chemotherapy.
Phospholipase A2 receptor–associated membranous nephropathy in a patient with IgG4-related disease
Authors: Muhsin Saif A. , Masia Ricard , Smith Rex N. , Wallace Zachary S. , Perugino Cory A. , Stone John H. , Niles John L. , Cortazar Frank B.
Published: May 2019

Rationale:

IgG4-related disease (IgG4-RD) is a multiorgan disease of unestablished prevalence that is characterized histopathologically by a dense lymphoplasmacytic infiltrate enriched with IgG4-expressing plasma cells and associated with storiform fibrosis. Tubulointerstitial nephritis (TIN) is the most common renal manifestation of IgG4-RD, but membranous nephropathy (MN) has also been described and often occurs in the context of concurrent TIN. Patients with IgG4-related MN have been characteristically negative for autoantibodies to the phospholipase A2 receptor (PLA2R).

Patient concerns:

A 45-year-old man presented with abdominal pain and lower extremity edema.

Diagnosis:

Histopathological evaluation of pancreas and liver biopsies established a diagnosis of IgG4-RD. Renal biopsy confirmed a diagnosis of PLA2R-associated MN without evidence of concurrent TIN.

Interventions:

The patient was treated with rituximab, a short course of low-dose, oral cyclophosphamide, and a rapid glucocorticoid taper.

Outcomes:

The patient achieved remission of MN after 8 months of therapy and maintained remission of IgG4-RD.

Lessons:

PLA2R-associated MN may be a rare manifestation of IgG4-RD. Systematic evaluation of larger cohorts of IgG4-RD patients for the presence of PLA2R autoantibodies and the investigation of PLA2R-associated MN cohorts for evidence of IgG4-RD would facilitate the understanding of the nature of the relationship between these observations.
Association of total testosterone, free testosterone, bioavailable testosterone, sex hormone–binding globulin, and hypertension
Authors: Yang Qingtao , Li Zhenjie , Li Wencai , Lu Liang , Wu Haoqiang , Zhuang Yiyi , Wu Kusheng , Sui Xuxia
Published: May 2019

Low testosterone has been inversely associated with hypertension. Our objective was to determine the associations between total testosterone (TT), free testosterone (FT), bioavailable testosterone (BioT), sex hormone–binding globulin (SHBG), and hypertension. Two hundred fifty-three men were enrolled in this study. TT and SHBG were measured by chemiluminescent immunoassay, and FT and BioT were calculated. Hypertension was defined as systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg. Our results showed that hypertensive men had higher SHBG levels, and lower FT and BioT, compared to normotensive men. FT and BioT were inversely associated with SBP and DBP after adjusting for covariates (age, smoking, alcohol consumption, and physical activity). Furthermore, there was a significant decrease in the odds ratios for hypertension in the third and fourth quartiles of BioT and FT, compared to the lowest quartile before and after adjusting for covariates. In contrast, the OR for hypertension in the third quartile of SHBG was lower than the highest quartile. Our data show that FT and BioT are inversely correlated with SBP, DBP, and hypertension in men.
Thyroid diseases increased the risk of type 2 diabetes mellitus
Authors: Chen Rong-Hsing , Chen Huey-Yi , Man Kee-Ming , Chen Szu-Ju , Chen Weishan , Liu Po-Len , Chen Yung-Hsiang , Chen Wen-Chi
Published: May 2019

Thyroid function may alter carbohydrate metabolism via influence of insulin, which may in terms of derangement of thyroid function and insulin function result in the development of type 2 diabetes mellitus (T2D). We investigated the association of thyroid disorders with T2D by a cohort study of the Taiwan nationwide health insurance database.

A sub-dataset of the National Health Insurance Research Database (NHIRD) was used in this study. The thyroid disease (both hyper- and hypo-thyroidism) group was chosen from patients older than 18 years and newly diagnosed between 2000 and 2012. The control group consisted of randomly selected patients who never been diagnosed with thyroid disease and 4-fold size frequency matched with the thyroid disease group. The event of this cohort was T2D (ICD-9-CM 250.x1, 250.x2). Primary analysis was performed by comparing the thyroid disease group to the control group and the second analysis was performed by comparing the hyperthyroidism subgroup, hypothyroidism subgroup, and control group.

The occurrence of T2D in the thyroid disease group was higher than the control group with hazard ratio (HR) of 1.23 [95% confidence interval (CI) = 1.16–1.31]. Both hyperthyroidism and hypothyroidism were significantly higher than control. Significantly higher HR was also seen in female patients, age category of 18 to 39-year-old (y/o) and 40 to 64 y/o subgroups. Higher occurrence of T2D was also seen in thyroid disease patients without comorbidity than in the control group with HR of 1.47 (95% CI = 1.34–1.60). The highest HR was found in the half-year follow-up.

There was a relatively high risk of T2D development in patients with thyroid dysfunctions, especially in the period of 0.5 to 1 year after presentation of thyroid dysfunctions. The results suggest performing blood sugar tests in patients with thyroid diseases for early detection and treatment of T2D.
Balloon-stent kissing technique versus jailed wire technique for interventional treatment of coronary bifurcation lesions
Authors: Jin Zhe , Song Linlin , Zheng Zhenguo , Zhang Shuying , Wang Meilan
Published: May 2019

Side-branch occlusion is a serious complication of provisional one-stent strategies used to treat coronary bifurcation lesions. The aim of the study was to compare the short- and long-term clinical outcomes between the balloon-stent kissing technique (BSKT) and jailed wire technique (JWT) in patients with non-left coronary bifurcation lesions.

This prospective, double-blinded, randomized controlled study enrolled 89 consecutive patients (aged 18–85 years) with 90 true bifurcation lesions (hemadostenosis ≥70%; bifurcation angle <90°; Medina classification 1.1.1, 1.0.1, or 0.1.1) who underwent percutaneous coronary intervention (PCI) at the Zhongshan Hospital Affiliated to Dalian University (China) between January 2013 and May 2016. The patients were randomly divided into the BSKT (44 patients, 45 lesions) and JWT (45 patients, 45 lesions) groups. The intervention was conducted according to technical requirements using a single-stent strategy. Operative success rate, occurrence of complications, postoperative quantitative coronary angiography, and incidence of perioperative and long-term major adverse cardiovascular events (MACEs) were compared between groups.

The intervention success rate was 100% in both groups. After main-branch stenting, the BSKT was associated with significantly lower rates of side-branch occlusion (0% vs 15.6%, P < .05) and side-branch post-processing (8.9% vs 26.7%, P < .05) than the JWT. The BSKT was associated with significantly lower degrees of postoperative proximal main-branch residual stenosis (6.1 ± 5.1% vs 9.6 ± 8.6%, P < .05) and side-branch ostial stenosis (51.6 ± 20.6% vs 70.3 ± 20.8%, P < .05) than the JWT. The incidence of perioperative MACEs was significantly lower in the BSKT group than in the JWT group (0% vs 13.3%, P < .05). Patients were followed for a mean duration of 19.0 ± 6.1 months. The occurrence rates of long-term MACEs, angina of Canadian Cardiovascular Society grade ≥2, and severe heart failure were not significantly different between groups.

The BSKT is a safe and effective technique that may have advantages over the JWT with regard to protection of the side-branch during PCI for bifurcation lesions.
Effectiveness and safety of warm needle acupuncture on insomnia in climacteric women
Authors: Xu Hong Wei , Du Wei , He Lingling , Kuang Xiuying
Published: May 2019

Background:

Warm needle acupuncture (WNA) is a traditional Chinese medicine (TCM) therapy which combines technical advantages of acupuncture and moxibustion. Climacteric insomnia is a common symptom in climacteric women, which can seriously affect the physical and mental health of patients. Relevant studies have been reported that WNA can improve insomnia in climacteric women. In this protocol, the effectiveness and safety of WNA on insomnia in climacteric women will be explored.

Methods:

Seven electronic databases include 3 English databases [Excerpta Medica database (EMBASE), PubMed, the Cochrane Central Register of Controlled Trials (Cochrane Library)] and 4 Chinese databases [Chinese VIP Information, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM) and Wanfang Database] for randomised controlled trials (RCT) of WNA on insomnia in climacteric women will be searched. The changes of the Pittsburgh sleep quality index was used as the main outcome, and the secondary outcome includes the changes of the Kupperman score, serum hormone level, and TCM syndrome score, as well as the adverse events caused by WNA. We will use RevMan software V5.3 to help us to analyze all data and use a Cochrane risk of bias tool to help us to assess the methodological quality for RCTs.

Result:

This study will provide reliable evidence for WNA on insomnia in climacteric women

Conclusion:

The findings will be an available reference to evaluate the effectiveness and safety of WNA on insomnia in climacteric women.

Registration:

PROS-PERO CRD42019125743.
Effect of Fatigue Three-Needle acupuncture therapy in a patient with cancer-related fatigue
Authors: He Lijun , Xu Danghan , Jia Chao , Xu Nuo , Lin Lizhu , Lin Jietao
Published: May 2019

Rationale:

Cancer-related fatigue (CRF) is a persistent, subjective sense of tiredness or exhaustion experienced by cancer patients. Acupuncture is a safe and feasible optional method for adjunctive treatment for CRF. However, the therapeutic effect of the Fatigue Three-Needle acupuncture therapy in patients with CRF has not been well-investigated.

Patient concerns:

A 53-year-old woman had been experiencing fatigue since the radical resection of sigmoid colon cancer 2 years ago, for which she underwent traditional Chinese medicine treatment.

Diagnosis:

After some review, she was diagnosed with CRF. Although she underwent traditional Chinese medicine treatment, she continued experiencing fatigue symptoms.

Interventions:

When she visited our hospital, she was treated with the Fatigue Three-Needle for 3 sessions a week, 30 minutes per session.

Outcomes:

After 4 weeks of treatment, the patient felt refreshed and relieved from the fatigue.

Lessons:

The finding from this case provides further evidence for the therapeutic benefits of the Fatigue Three-Needle therapy for patients with CRF, suggesting that acupuncture treatment with the Fatigue Three-Needle is an effective option for patients with CRF.
Percutaneous endoscopic treatment for cervical ligamentum flavum gouty tophus
Authors: Xie Lin , Zhang Xiang , Xi Zhipeng , Li Jingchi
Published: May 2019

Rationale:

Cervical ligamentum flavum gout (CLFG) is relatively rare, and its clinical manifestations are complicated; hence, it is often confused with ligamentum flavum ossification. Gout tophi may relate to certain risk factors, such as renal insufficiency and lack of long-term effective uric acid treatment.

Patient concerns:

A 73-year-old man had a half-year history of left upper extremity pain and numbness, which was aggravated 6 months ago.

Diagnoses:

Computed tomography (CT) indicated spinal stenosis at the level of C5/6. Cervical stenosis was believed to be mostly related to the ossification of ligamentum flavum. The histological examination of the material removed during the surgery revealed fibrous tissues with pools of amorphous debris having a foreign body giant cell reaction, which is typical of urate gout.

Interventions:

We performed complete decompressions for this case with CLFG using posterior percutaneous endoscopic technique.

Outcomes:

The patient experienced a progressive improvement in the left upper extremity pain after the surgery, and no signs of cerebrospinal fluid leakage, infection, or other complications were experienced.

Lessons:

The clinician should include spinal gout in the differential diagnosis when dealing with patients with hyperuricemia, renal insufficiency, and axial pain with or without neurologic deficits. We have applied the percutaneous endoscopic technique for the treatment of spinal gout. It performed direct decompression with minimizing trauma and instability, which could be used as an alternative choice.
Effectiveness and safety of fire needle on periarthritis of shoulder
Authors: Huang Cihui , Xie Linling , Lin Yunxin , Zheng Liang
Published: May 2019

Background:

Fire needle which is an integral part of the acupuncture therapy. Periarthritis of shoulder (PAS) is a common disease, which brings lots of pain for patients. The clinical practice indicates that fire needle has a therapeutic effect on the PAS. Here, we will provide a protocol to explore the effectiveness and safety of fire needle for the PAS.

Methods:

We will search the randomized controlled trails (RCT) literatures of fire needle for the PAS in 9 electronic databases, including 5 English databases (PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials [Cochrane Library], and WHO International Clinical Trials Registry Platform [TCTRP]) and 4 Chinese databases (Chinese National Knowledge Infrastructure [CNKI], Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database [CBM]). We will consider the Ability assessment of daily living activities (ADL) as the primary outcome and the secondary outcome will include visual analogue scale (VAS), shoulder range of motion (ROM) and adverse events incidence caused by fire needle, such as dizziness, nausea, vomiting, weariness, etc. The selection of the studies will be performed by EndnoteX7 software. All analyses will be conducted by using RevMan software V5.3.

Result:

This study will provide a rational synthesis of current evidences for fire needle on PAS.

Conclusion:

The conclusion of this study will provide evidence to judge the effectiveness and safety of fire needle on PAS.

Registration:

PROS-PERO CRD42019119686.
Cervical langerhans cell histiocytosis mimicking cervical tuberculosis
Authors: Rao Jingcheng , Rao Yuhang , Wang Chong , Cai Yuqiang , Cao Guangru
Published: May 2019

Rationale:

Langerhans cell histiocytosis (LCH) involving adult cervical vertebrae is relatively rare clinically.

Patient concerns:

An 18-year-old male patient exhibited a 1-month history of neck pain, restricted neck mobility, and numbness and weakness of both upper limbs. The patient reported no pain at other sites, exhibited no fever or night sweats, and was unable to recall any recent injury.

Diagnoses:

On the basis of the radiological features of the lesion and laboratory tests, there was a high possibility that the patient had a tuberculosis lesion. Postoperative GeneXpert and Mycobacterium tuberculosis (MTB) culture results showed MTB negative. Postoperative pathological results showed: (Cervical 4 vertebrae) LCH.

Interventions:

Our department did an anterior approach operation. The patient was treated with prednisone combined with vincristine after operation.

Outcomes:

The patient was discharged from the hospital with complete remission of cervical pain and rapid relief of neurological symptoms.

Lessons:

Computed tomography-guided biopsy of lesion tissue must be performed when a suspected infection occurs in young patients. If possible, the lesion tissue obtained during the operation should be cultured and pathologically examined for early diagnosis.
Dose-related healing of artificial ulcers after endoscopic submucosal dissection using esomeprazole
Authors: Ko Jihwan , Kim Su Jin , Kang Dae Hwan , Choi Cheol Woong , Kim Hyung Wook , Park Su Bum
Published: May 2019

Background:

Endoscopic submucosal dissection (ESD) is a standard procedure for treating gastric neoplasms. However, ESD causes larger artificial ulcers other than mucosal resection methods. We conducted this prospective randomized controlled study to evaluate the effect of stronger acid suppression on ESD ulcers caused by doubling the proton pump inhibitor (PPI) dose and compare the effects of 20-mg (standard dose) and 40-mg (double dose) esomeprazole (EswonampTM, Daewon Pharmaceutical Co., Ltd., Seoul, Korea) on ulcer healing.

Methods:

One hundred ninety-seven patients who underwent gastric ESD from July 2017 to December 2017 at Pusan National University Yangsan Hospital were enrolled and randomly assigned to the standard or double-dose group. Change in ulcer size from the day of ESD to 4 weeks after ESD and the scar-change rate were compared between the groups.

Results:

There were no significant differences in ulcer contraction (84.5% in 20 mg group vs 86.3% in 40 mg group, P = .91) or scar-change rate (30.9% vs 30.6%, P > .99) between the groups. In a multivariate analysis, initial ulcer size [odds ratio (OR) 0.24; 95% confidence interval (CI) 0.11–0.50] and early gastric cancer (OR 0.22, 95% CI 0.08–0.58) were significantly associated with delayed ulcer healing.

Conclusions:

Both 40 and 20-mg esomeprazole have similar effects on ESD-induced ulcer area reduction, suggesting that strong acid suppression does not necessarily result in rapid artificial ulcer healing.

Trial registration number:

RCT no.: KCT0002885
Anti-N-methyl-d-aspartate receptor encephalitis associated with reactivated Epstein–Barr virus infection in pediatric patients
Authors: Hou Ruolin , Wu Jing , He Dake , Yan Yumei , Li Ling
Published: May 2019

Rationale:

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is the most frequent autoimmune encephalitis in children, and its presentation is various. The disease can be triggered by various infections.

Patient concerns:

Case 1 was a 7-year-old female with the presentation of seizure, repeated fever, language disorder, and decreased muscle strength of the right limbs; Case 2 was a 7-year-old male with the manifestation of repeated emesis, headache, involuntary movement, altered personality, seizures, and cognitive impairment; Case 3 was a 2-year-old female with repeated fever, emesis, seizures, coma, and decreased muscle strength of limbs. Anti-NMDAR antibody was identified in cerebrospinal fluid (CSF) in the 3 cases, confirming the diagnosis of anti-NMDAR encephalitis. Pathogenic examinations revealed positive serum Epstein–Barr virus (EBV)-nuclear antigen and EBV-capsid antigen (CA)-IgG antibodies in the 3 cases, as well as positive EBV-early antigen (EA)-IgG antibody in CSF. Case 1 also had positive EBV-CA-IgA antibody; Case 3 also had positive EBV-CA-IgA and EBV-CA-IgG antibodies.

Diagnoses:

Anti-NMDAR antibody and EBV-EA-IgG antibody in CSF were tested positive in the 3 cases. Thus, they were diagnosed as anti-NMDAR encephalitis associated with reactivated EBV infection.

Interventions:

All of the 3 cases received immunoglobulin, corticosteroid, and ganciclovir treatment. Cases 2 and 3 also received antiepileptic drugs due to repeated seizures. In addition, Case 3 also received assistant respiration, plasma exchange, and rituximab.

Outcomes:

The 3 cases were substantially recovered after treatment. Repeat CSF analysis showed decreased titer of the anti-NMDAR antibody.

Lessons:

Reactivated EBV infection may trigger anti-NMDAR encephalitis in children, which has not been reported previously. Related possible virology tests should be completed while diagnosing the disease.
Percutaneous osteoplasty for the management of a humeral head metastasis
Authors: Shi Guan , Liu Qingshan , Chen Hao , Feng Fei , Jia Pu , Bao Li , Tang Hai
Published: May 2019

Rationale:

Percutaneous osteoplasty (POP) has been proved effective to relieve pain in metastases of vertebral, pelvis, and femur. Nevertheless, there are few reports about the effectiveness of POP in the humeral head metastases. In this study, we described 2 patients with humeral head metastases treated with POP in our hospital.

Patient concerns:

Case 1 was a 79-year-old man with vertebral and right humeral head metastasis after radical surgery or and periods of chemotherapy for bladder cancer. He suffered constant severe back and right shoulder joint pain even if taking much non-steroidal anti-inflammatory drugs. Case 2 was a 59-year-old woman with vertebral and right humeral head metastasis from lung cancer. She received regular radiotherapy and took much painkillers to relieve pain. However, the pain could not be relieved any more after 1 month and severely affects sleeping and daily activities.

Diagnosis:

Both 2 patients were diagnosed as vertebral metastases and right proximal humeral head metastases.

Interventions:

POP was performed to treat the right humeral head metastases. Percutaneous vertebroplasty (PVP) was performed to treat vertebral metastases.

Outcomes:

After surgery, the patients experienced significant decrease in pain and better motor function. Both patients did not suffer from pulmonary embolism, infection, nerve injury, and bone cement syndrome.

Lessons:

For the pain that cannot be relieved by radiotherapy and analgesic drugs, POP is a safe and beneficial minimally invasive procedure that provides immediate and substantial relief from pain for humerus head metastases.
Carotid duplex parameters to predict long term outcomes of ischemic stroke patients receiving intra-arterial thrombectomy treatment
Authors: Chang Yu-Jun , Lin Chih-Ming , Ou Yang-Hao , Liu Chi-Kuang , Chen Wei-Liang , Chang Shih-Liang
Published: May 2019

Early treatment of acute ischemic stroke with intravenous thrombolysis therapy (ITT) followed by intra-arterial thrombectomy (IAT) is a promising new treatment option for improving functional outcomes. Identifying patients who will benefit from this treatment combination is important.

A total of 92 acute ischemic stroke patients who received ITT and IAT with a minimum of 1-year follow-up were included in the study. All parameters of clinical and imaging examinations at baseline were examined which parameters were significantly correlated with the 1-year functional outcomes (modified Rankin scale [mRS], National Institute of Health Stroke Scale [NIHSS], and Barthel Index) after stroke. Receiver-operating characteristic (ROC) curves analysis was performed to estimate the diagnostic performance of each significantly related parameter. Youden index was used to determine the optimal threshold value. Multivariate logistic regression model analyses were applied to verify the results of predicting the favorable functional outcomes.

Immediate postoperation outcome with modified thrombolysis in cerebral infarction grading showed that total of 62 patients qualified for satisfactory result (2b or 3). In predicting NIHSS improvement, ROC curve analysis showed that a cutoff point of vertebral artery pulsatility index (VA PI)-ipsilateral ≤2.3 yields the best diagnostic performance (area under the ROC curve [AUC] = 0.728); in predicting mRS improvement, VA PI-ipsilateral ≤1.92 and internal carotid artery resistance index (ICA RI)-ipsilateral ≤0.71 yield good diagnostic performance (AUC = 0.697 and 0.672, respectively); and ICA RI-contralateral ≤0.70 or plaque index-ipsilateral ≤2 had better diagnostic accuracy (AUC = 0.764 and 0.689, respectively) than other indices to predict Barthel index improvement. The multivariate analysis also showed that these 5 indices were those more powerful and highly significant favorable functional outcomes predictors.

Parameters of pulsatility and resistance index from carotid duplex could be easily accessed and noninvasive. The outcome of ischemic stroke patients receiving ITT followed by IAT can be forecasted by these 2 crucial predictors that hint the patients’ functional outcomes as well as guiding first line in-charge clinician in terms of decision making.
Expression of circular RNAs in gynecological tumors
Authors: Liu Kangsheng , Zhang Qin , Pan Feng , Wang Xiang Dong , Wenjing Hu , Tong Hua
Published: May 2019

Background:

The rapid development of bioinformatic technology is boosting the discovery of components hiding in the darkness. As a type of universal, conservative, tissue-specific and stable molecules, circular RNA (circRNA) is a class of endogenous non-coding RNA that has no 5’ cap and 3’ poly(A) tail and forms a covalently closed continuous loop. At present, 3 types of circRNAs including exonic circRNA (ecRNA), intronic circRNA (ciRNA), and axon-intronic circRNA have been reported. Nowadays informatic technology and high-throughput sequencing have verified the abundance of endogenous circRNAs in eukaryocytes, with predominantly expressed in the cell cytoplasm. Their unique sequences endow them with special functions, such as miRNA sponge, selective transcription or splicing, and attaching to RNA-binding proteins.

Data sources:

This review was based on articles published in PubMed databases up to January, 2019, with the following keywords: “circular RNA”, “database”, and “reproductive tumor” (Flow chart).

Objectives:

Original articles and reviews on the topics were selected.

Results:

Studies have uncovered the interplay between circRNAs and the development of ovarian epithelial tumors, ovarian carcinoma, and cervical carcinoma, which suggesting the potential of circRNAs as biomarkers or therapeutic targets for human diseases.

Conclusions:

Circular RNA has been found to play a role in gynecological tumors diseases. Meanwhile, we reviewed the studies on how CircularRNA participate in gynecological tumors, which provides a basis for the study of CircularRNA in gynecological tumors.
A randomized trial comparing the efficacy of single-dose and double-dose administration of rectal indomethacin in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis
Authors: Lai Jian-Han , Hung Chien-Yuan , Chu Cheng-Hsin , Chen Chih-Jen , Lin Hsiang-Hung , Lin Han-Jung , Lin Ching-Chung
Published: May 2019

Background and Aims:

The before-procedure or after-procedure rectal indomethacin administration was shown to be useful in preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. We designed this prospective randomized study to compare the efficacy of single-dose and double-dose rectal indomethacin administration in preventing post-ERCP pancreatitis (PEP).

Methods:

We enrolled patients who underwent the ERCP in Taipei Mackay Memorial Hospital from 2016 June to 2017 November. Patients were randomly assigned to 2 groups: single and double-dose groups. The primary endpoint was the frequency of post-ERCP pancreatitis.

Results:

A total 162 patients participated in this study, and there were 87 patients randomly assigned to the single-dose group, and 75 patients were assigned to the double-dose group. In the high-risk patients, the incidence of PEP was lower in double-dose patients (4.8%) than the single-dose patients (9.5%), but there was no significant difference (P =.24). Difficult cannulation was the only 1 risk factor for PEP after rectal indomethacin treatment.

Conclusions:

Single-dose rectal indomethacin administration immediately after ERCP in general population is good enough to prevent PEP, but difficult cannulation could induce the PEP frequency up to 15.4% even under rectal indomethacin use.
ECMO support in cardiac intervention of severe pulmonary stenosis
Authors: Yu Xiang , Zhou Rong-Hua
Published: May 2019

Rationale:

Patients of critical pulmonary artery stenosis would face severe hypoxemia, cardiac failure as well as massive hemorrhage during percutaneous balloon dilation and pulmonary arterial stent implantation. Here, we present a case in which the elective use of extracorporeal membrane oxygenation (ECMO) support successfully facilitated safe percutaneous balloon dilation of pulmonary artery and stent implantation on a patient with severe pulmonary artery stenosis caused by aorto-arteritis.

Patient concerns:

A 47-year-old man was hospitalized due to 10 years of post-exercise exhaustion and shortness of breath. Half a month ago the symptoms deteriorated. He also manifested systemic edema and could only sit upright to breath during night time. Computed tomographic angiography (CTA) indicated severe pulmonary stenosis caused by aorto-arteritis.

Diagnoses:

Right pulmonary artery stenosis, left pulmonary artery occlusion, severe tricuspid regurgitation, right atrium, and ventricle enlargement, atrial fibrillation with rapid ventricular rates, NYHA class IV, pulmonary infection.

Interventions:

V-A ECMO support was considered during percutaneous balloon dilation of pulmonary artery and stent implantation.

Outcomes:

The patient remained hemodynamically stable throughout the procedure with no inotropic support. ECMO was successfully weaned off after the intervention, with no procedural complications. Postoperative echocardiography indicated much better heart function, and he was discharged uneventfully 5 days later.

Conclusion:

V-A ECMO is capable of preventing hypoxemia and providing effective circulation support during cardiac intervention in patients of severe pulmonary stenosis.
Efficacy of anti-PD-1 antibody SHR-1210 as second-line treatment in hepatocellular carcinoma patient with sorafenib resistance
Authors: Zhu Hong , Yang Xi , Zhao Yaqin , Yi Cheng
Published: May 2019

Rationale:

Hepatocellular carcinoma (HCC), one of the most common cancers worldwide, is an aggressive tumor with very poor prognosis. Regorafenib was the first agent to show a survival benefit over placebo in patients who showed progression while being treated with sorafenib, but it remains an unsatisfactory agent owing to its serious side effects. Therefore, more efficient and milder therapies are needed.

Patient concerns:

Herein, we report a patient with advanced HCC with many lung metastases who showed progression during sorafenib treatment.

Diagnoses:

HCC with lung metastases (stage IVB).

Interventions:

SHR-1210 alone was used as second-line treatment.

Outcomes:

Although the lung metastases did not decrease 3 months after the treatment, they decreased significantly at 6 months after the treatment and partially disappeared. The tumor response indicated partial response. Furthermore, all of the lung metastases continued to decrease at about 17 months after treatment. The alpha-fetoprotein levels showed a similar trend. After a follow up of 19 months, the patient remains in good health.

Lessons:

SHR-1210 alone as a second-line treatment for a patient with HCC showed excellent antitumor effects. We think that SHR-1210 may exert its antitumor effects through a late-onset model, which persist for a long time. The side effects were mild and well tolerated.
Common Problems Found in the Methodological Approach to Small Bowel Biopsies in the Diagnosis of Celiac Disease
Authors: Donat Ester , Roca Maria , Masip Etna , Polo Begoña , Ramos David , Ribes‐Koninckx Carmen
Published: May 2019

Small bowel biopsy (SBB) is not always helpful to establish celiac disease diagnosis. Hence we have conducted a retrospective study to know the amount of SBB in our center that was not optimal for this purpose. Histological findings were not appropriate for diagnosis in 3.56% (34 out of 955). The main problem encountered was inadequate sample cutting, although this could be solved by a new recut in almost 30% of cases.
Benign Phyllodes Tumor in Children: A Study of 8 Cases and Review of the Literature
Authors: Hafeez Safina , Balarezo Fabiola , Ricci Andrew
Published: May 2019

Phyllodes tumor (PT) occurs predominantly in middle-aged women, and although its occurrence in young women, adolescents, and even children is documented, presentation in the pediatric population has been the least well studied because of its rarity. Incompletely defined in children with PT are recurrence rates and optimal surgical management. We retrospectively studied the pathology database of Hartford Hospital from 2010 to 2017 to find all cases of PT in patients 18 years of age or younger. A series of 8 children/adolescents with breast masses diagnosed as benign PT were identified. Patients were 14 to 16 years of age (mean 15.2 y) and tumor size ranged from 2.2 to 7.2 cm (mean 4.4 cm). Both breasts were equally affected. All patients were treated with excision, tantamount to simple enucleation in most cases, and positive or “tumor-abutting” margins were universal. Mean follow-up after surgery was 27.5 months, during which time a single recurrence (at 9 mo) became manifest, which was re-excised and again showed benign PT. There were no pathologic features (including marginal status) that could have predicted the sole recurrence. Despite positive margins, the local recurrence rate for pediatric benign PT appears acceptably low (1 in 8 cases) such that reflex re-excision is probably unnecessary.
Acute Swollen Calf Pain With a Diagnosis of Hemophilia Following an MRI
Authors: Gourishankar Anand , C. Sridhar Divyaswathi , Rodriquez Nidra
Published: May 2019

Hemarthrosis is a common musculoskeletal presentation in hemophilia. Intramuscular bleed is not uncommon. We report a young child who had a minor injury and calf swelling. He was initially diagnosed with deep vein thrombosis (DVT). Magnetic resonance imaging confirmed intramuscular hematoma and factor VIII assay confirmed hemophilia.
Central Venous Line Associated Deep Vein Thrombosis in Hospitalized Children
Authors: Dhir Aditi , DeMarsh Samantha , Ramgopal Archana , Worley Sarah , Auron Moises , Hupertz Vera , Onimoe Grace
Published: May 2019

An increase in the incidence of deep vein thrombosis (DVT) has been reported in pediatric patients over the past decade. The presence of central venous line (CVL) is a major contributing risk factor with conflicting data on the relative risk of DVT with various types of central lines. We aimed to assess the incidence of and identify potential risk factors for DVT overall and with different types of CVL individually. A retrospective chart review of pediatric patients with a CVL placed at Cleveland Clinic Children’s from 2011 to 2016 was conducted. Data collected included demographics, potential risk factors, CVL characteristics and related thrombotic events. The study cohort consisted of 376 CVLs in 325 patients between 0 and 26 years of age. There were 1.6 thrombi per 10,000 line-days (95% confidence interval: 1.0, 2.5), and the overall incidence of DVT was 5.1%. The incidence of DVT was highest with tunneled catheters (5/16=31%) versus with peripherally inserted central catheters (4/111=3.6%) or with ports (10/249=4%, P<0.001), and whereas there were overarching significant risk factors for CVL-associated thrombi, these risk factors differed in significance when analyzed by the CVL type. The study supports the need for continued improvement in pediatric hospital practices for early identification of patients at a higher thrombosis risk.
Disturbances in NK Cells in Various Types of Hemophagocytic Lymphohistiocytosis in a Population of Polish Children
Authors: Popko Katarzyna , Górska Elżbieta , Wołowiec Magdalena , Malinowska Iwona
Published: May 2019

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease associated with immune system hyperactivation and the appearance of serious systemic disturbances. The purpose of this study was an assessment of natural killer (NK) cell disturbances in a group of children with clinical signs of HLH. A total of 43 children with HLH and 17 healthy children were enrolled in the study. NK phenotyping, intracellular perforin staining, and cytotoxicity tests were performed by using the flow cytometry method. HLH patients were divided into 6 HLH types: 9% infection-related HLH; 7% malignancy-related HLH; 21% macrophage activating syndrome; 12% familial hemophagocytic lymphohistiocytosis; 2% X-linked lymphoproliferative syndrome; and 49% as HLH of unknown background. A positive correlation was observed between cytotoxicity and NK cells in children with HLH (P=0.01). In all HLH groups, the percentage of NK cells was significantly lower than in the control population. The spontaneous cytotoxicity was significantly lower in HLH patients. The results presented in this study indicate the importance of impaired function and the number of NK cells in the pathogenesis of HLH. Nonetheless, the background of disturbances seems to be different in various cases.
Anticipating Disruptive Innovations With Foresight Leadership
Authors: Pesut Daniel J.
Published: May 2019

The purpose of this article is to discuss the importance of foresight leadership to anticipate disruptive innovations in health care. Nursing foresight leadership is defined. Types of foresight leadership styles are described. Selected disruptive trends in health care are identified. Strategies to develop foresight leadership are discussed. Foresight requires transformational leadership skills. Resources to support the development of foresight leadership are referenced. Readers are invited to engage in actions and learning activities to develop foresight leadership capacity to anticipate disruptive innovations in health care and build transformational leadership capacity of people in the profession of nursing.
Implementing a Clinical Practice Guideline on Opioid-Induced Advancing Sedation and Respiratory Depression
Authors: Kamendat Josephine , Dabney Beverly W. , McFarland Marilyn , Gilbert Gregory E. , Richards-Weatherby Kathleen
Published: May 2019

Background:

Opioid-induced respiratory depression (OIRD) is a serious adverse reaction associated with opioid administration.

Local Problem:

The purpose of this quality improvement study was to evaluate the impact of implementing a clinical practice guideline for OIRD in a medical-surgical setting lacking standardized monitoring techniques and reporting criteria for patients receiving opioid analgesia.

Methods:

An American Society for Pain Management Nursing protocol was implemented in 4 medical/surgical units. The impact on OIRD-related nurse knowledge, documentation, and opioid-related rapid response calls was measured pre- and postimplementation.

Results:

Nurse OIRD-related knowledge significantly increased. The number of naloxone administrations associated with prior intravenous opioid analgesic administration did not significantly change. However, there was a significant decrease in the postimplementation number of respiratory distress–related rapid response calls.

Conclusions:

Implementation of the American Society for Pain Management Nursing guidelines had a positive impact on knowledge, documentation, early intervention of OIRD, and the number of opioid-related rapid response calls.
Use of Whole Genome Sequencing for the Molecular Comparison of Neisseria gonorrhoeae Isolates With Decreased Susceptibility to Extended Spectrum Cephalosporins From 2 Geographically Different Regions in America
Authors: Gianecini Ricardo A. , Zittermann Sandra , Oviedo Claudia , Galas Marcelo , Pardo Pilar Ramon , Allen Vanessa G. , Galarza Patricia , Melano Roberto G.
Published: May 2019

Background

Neisseria gonorrhoeae isolates with reduced susceptibility or resistance to the recommended first-line antimicrobial therapy have been described in several countries. The purpose of this study was to use genome analyses to compare the molecular characteristics of N. gonorrhoeae isolates with decreased susceptibility to extended-spectrum cephalosporin from Ontario, Canada, and Argentina.

Methods

A total of 128 N. gonorrhoeae isolates, collected in 2015, were included. The susceptibility to penicillin G, tetracycline, ciprofloxacin, cefixime, ceftriaxone, and azithromycin was determined using the agar dilution method. Isolates were subjected to whole genome sequencing, and an in silico analysis was performed to identify antimicrobial resistance determinants and for genotyping.

Results

Decreased susceptibility to extended-spectrum cephalosporin was mainly associated with penA mosaic allele 34.001, together with an mtrR promoter A deletion and porB1b alterations G120K/A121N. N. gonorrhoeae multiantigen sequence typing ST1407 or closely related genotypes were identified circulating in both regions.

Conclusions

An international multi-drug resistant clone of N. gonorrhoeae was associated with decreased susceptibility to extended-spectrum cephalosporin (ESC) in 2 different regions in America. Evidence of clonal dissemination of the organism in some regions suggests that the strength of surveillance programs and establishment of collaborative projects are essential.