bluuebunny/crossref_metadata_2025 huggingface dataset:
Pipeline Embolization of an Infectious Basilar Artery Aneurysm in a 2-Year-Old Child: Case Report, Discussion of the Literature and Perioperative Considerations
Authors: Ares William J , Tonetti Daniel A , Greene Stephanie , Sharma Mahesh S , Xavier Frederico , Jankowitz Brian T , Jadhav Ashutosh
Published: January 2019

BACKGROUND AND IMPORTANCE

Flow diversion of intracranial aneurysms has been rarely described in the pediatric population. Here we discuss the technical and perioperative complexities inherent in the flow diversion of an infectious basilar apex aneurysm in a 2-yr-old child with significant medical comorbidities.

CLINICAL PRESENTATION

Following judicious oral administration of dual anti-platelet agents and intra-arterial administration of calcium channel blockers to treat vasospasm, standard endovascular procedures were used to place a flow diverting stent across the neck of a rapidly enlarging infectious aneurysm of the basilar apex.

Following the uncomplicated procedure, the patient demonstrated progressive thrombosis of the previously noted basilar apex aneurysm over a 3-mo period. The patient was therefore felt to be safe to proceed with, and eventually underwent, uncomplicated orthotopic heart transplant.

CONCLUSION

Flow diversion of complex intracranial aneurysms in pediatric patients with significant medical comorbidities is feasible and safe; however, considerations have to be made in the pre- and perioperative care of these patients given the propensity for low-weight and complicated systemic disease processes.
Level of Low Back Pain–Related Disability Is Associated with Risk of Subsequent Falls in an Older Population: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS)
Authors: Kimachi Kimihiko , Kimachi Miho , Takegami Misa , Ono Rei , Yamazaki Shin , Goto Yoshihito , Onishi Yoshihiro , Sekiguchi Miho , Otani Koji , Konno Shin-ichi , Kikuchi Shin-ichi , Fukuhara Shunichi , Yamamoto Yosuke
Published: January 2019

Objectives

To examine the longitudinal association between baseline disability due to low back pain (LBP) and future risk of falls, particularly significant falls requiring treatment, in a community-dwelling older population.

Methods

This was a prospective population-based cohort study using data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS; 2008–2010). A total of 2,738 residents aged ≥60 years were enrolled. LBP was assessed using the Roland-Morris Disability Questionnaire (RMDQ), and the level of LBP-related disability was divided into three categories (none, low, and medium to high). Incidence of falls over the following year was determined using a self-reported questionnaire after the one-year follow-up period. The risk ratio (RR) for LBP-related disability associated with any fall and any fall requiring treatment was estimated using log binomial regression models.

Results

Data were analyzed for 1,358 subjects. The prevalence of LBP at baseline was 16.4%, whereas 122 (8.9%) participants reported a low level of LBP-related disability and 101 (7.4%) reported medium to high levels of LBP-related disability. Incidence of any fall and falls requiring treatment was reported by 22.1% and 4.6% of participants, respectively. Subjects with medium to high levels of disability were more likely to experience subsequent falls (adjusted RR = 1.53, 95% confidence interval [CI] = 1.21–1.95) and falls requiring treatment (adjusted RR = 2.55, 95% CI = 1.41–4.60) than those with no LBP-related disability.

Conclusions

Level of LBP-related disability was associated with an increased risk of serious falls in a general population of community-living older adults. These findings can alert health care providers involved in fall prevention efforts to the important issue of activity-related disability due to LBP.
Education, training, and experience in public health ethics and law within the UK public health workforce
Authors: Viens A M , Vass Caroline , McGowan Catherine R , Tahzib Farhang
Published: January 2019

Background

Public health ethics and law (PHEL) is a core professional competency for the public health workforce. However, few data are available describing the extent to which UK public health workforce members experience ethical and legal issues or have sufficient educational and/or training background to adequately deal with such issues.

Methods

An anonymous online survey was developed for dissemination via member mailing lists of the: Faculty of Public Health, Royal Society of Public Health, and UK Public Health Register. Public Health England also included a link to the survey in their newsletter. The survey included questions about education, training, and experience in relation to PHEL. The survey was deployed from October 2017 to January 2018.

Results

The survey was completed by a diverse sample of five hundred and sixty-two individuals. The majority of respondents reported: (i) regularly encountering ethical issues, (ii) resolving ethical issues through personal reflection, (iii) having little or no education and training in PHEL, and (iv) questioning whether they have dealt with ethical issues encountered in practice in the best way.

Conclusions

The results suggest that there is a need to develop and support wider PHEL capacity within the UK public health workforce through the provision of PHEL education, training, guidance, and mentoring.
Driving Pressure during Thoracic Surgery
Authors: Park MiHye , Ahn Hyun Joo , Kim Jie Ae , Yang Mikyung , Heo Burn Young , Choi Ji Won , Kim Yung Ri , Lee Sang Hyun , Jeong HeeJoon , Choi Soo Joo , Song In Sun
Published: January 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Recently, several retrospective studies have suggested that pulmonary complication is related with driving pressure more than any other ventilatory parameter. Thus, the authors compared driving pressure–guided ventilation with conventional protective ventilation in thoracic surgery, where lung protection is of the utmost importance. The authors hypothesized that driving pressure–guided ventilation decreases postoperative pulmonary complications more than conventional protective ventilation.

Methods

In this double-blind, randomized, controlled study, 292 patients scheduled for elective thoracic surgery were included in the analysis. The protective ventilation group (n = 147) received conventional protective ventilation during one-lung ventilation: tidal volume 6 ml/kg of ideal body weight, positive end-expiratory pressure (PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n = 145) received the same tidal volume and recruitment, but with individualized PEEP which produces the lowest driving pressure (plateau pressure–PEEP) during one-lung ventilation. The primary outcome was postoperative pulmonary complications based on the Melbourne Group Scale (at least 4) until postoperative day 3.

Results

Melbourne Group Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving pressure group, as compared with 18 of 147 (12.2%) in the protective ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The number of patients who developed pneumonia or acute respiratory distress syndrome was less in the driving pressure group than in the protective ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio 0.42; 95% CI, 0.19 to 0.92).

Conclusions

Application of driving pressure–guided ventilation during one-lung ventilation was associated with a lower incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery.
Primary Small Cell Neuroendocrine Tumor Within a Urethral Diverticulum
Authors: Sisler Katelin , Knutson Alex , McLennan Mary
Published: January 2019

BACKGROUND:

Primary small cell neuroendocrine carcinoma of the urinary tract is a very rare cancer, accounting for fewer than 0.5% of urinary tract tumors. These are aggressive neoplasms with high rates of metastases. Urethral diverticula can be found in up to 6% of women.

CASE:

A 31-year-old woman presented with a clear vaginal discharge and an anterior vaginal wall mass that was thought to be a recurrent cyst. After surgical dissection, she was noted to have a urethral diverticulum with a solid nodule at the base. Final pathology showed a high-grade small cell neuroendocrine carcinoma.

CONCLUSION:

Malignancy in a urethral diverticulum can occur in young patients. Clinicians should be aware of this possibility when choosing to manage urethral lesions expectantly.
Bovine Pericardial Graft for Second-Trimester Cesarean Scar Dehiscence
Authors: Stephens Angela , Patel Khilen , Davis Janet , Ghamande Sharad
Published: January 2019

BACKGROUND:

Cesarean scar dehiscence is rare in pregnancy. When it occurs late in pregnancy, management typically involves delivery of the fetus with concurrent uterine repair. However, consensus regarding management earlier in gestation is lacking.

CASE:

A 30-year-old African American woman, gravida 5 para 2113, presented with cesarean scar dehiscence confirmed by magnetic resonance imaging at 20 weeks of gestation. She desired pregnancy continuation and underwent repair of the dehiscence at 23 weeks of gestation using bovine pericardial graft. She subsequently underwent cesarean delivery at 35 weeks of a healthy neonate after going into preterm labor.

CONCLUSION:

Bovine pericardial graft is a viable option for repair of cesarean scar dehiscence in the second trimester.
Reducing Cesarean Delivery Surgical Site Infections
Authors: Kawakita Tetsuya , Iqbal Sara N. , Landy Helain J. , Huang Jim C. , Fries Melissa
Published: January 2019

OBJECTIVE:

To examine the association of a resident-driven quality initiative with cesarean delivery surgical site infections.

METHODS:

This was a quasi-experimental, preintervention and postintervention study of women undergoing cesarean delivery at 23 weeks of gestation or greater between January 2015 and June 2018 at a single tertiary care center. We implemented a resident-driven, evidence-based surgical bundle, excluding women who underwent emergency cesarean or had chorioamnionitis. The bundle included routine prophylactic antibiotics (both cefazolin and azithromycin), chlorhexidine alcohol skin preparation, use of clippers instead of a razor, vaginal cleansing with povidone iodine, placental removal by umbilical cord traction, subcutaneous tissue closure if wound thickness greater than 2 cm, suture skin closure, dressing removal between 24 and 48 hours, and use of postoperative chlorhexidine soap. Our primary outcome was surgical site infections (superficial incisional, deep incisional, and organ or space surgical site infections) occurring up to 6 weeks postpartum. Outcomes were compared between the preimplementation period (January 2015–August 2016) and postimplementation period (December 2016–June 2018). Coarsened Exact Matching with k-to-k solution was performed using age, race–ethnicity, body mass index, rupture of membranes, and labor.

RESULTS:

In total, 1,624 underwent cesarean delivery in the preimplementation and 1,523 postimplementation periods, respectively; 1,100 women in the postimplementation period were matched to 1,100 women in the preimplementation period. The rate of surgical site infections in the unmatched cohort was significantly lower in the postimplementation period compared to those in the preimplementation period (2.2% [33/1,523] vs 4.5% [73/1,624]; odds ratio [OR] 0.47 [95% CI 0.31–0.71]; P<.001). This decrease in the rate of surgical site infections remained statistically significant after matching (1.9% [21/1,100] vs 4.1% [45/1,100]; OR 0.46 [0.27–0.77]; P<.001).

CONCLUSION:

After implementation of a resident-driven quality initiative using a surgical bundle, we observed a significant decrease in cesarean surgical site infections.
Omega-3 Polyunsaturated Fatty Acid Deficiency and Progressive Neuropathology in Psychiatric Disorders: A Review of Translational Evidence and Candidate Mechanisms
Authors: McNamara Robert K. , Almeida Daniel M.
Published: January 2019

Meta-analytic evidence indicates that mood and psychotic disorders are associated with both omega-3 polyunsaturated fatty acid (omega-3 PUFA) deficits and progressive regional gray and white matter pathology. Although the association between omega-3 PUFA insufficiency and progressive neuropathological processes remains speculative, evidence from translational research suggests that omega-3 PUFA insufficiency may represent a plausible and modifiable risk factor not only for enduring neurodevelopmental abnormalities in brain structure and function, but also for increased vulnerability to neurodegenerative processes. Recent evidence from human neuroimaging studies suggests that lower omega-3 PUFA intake/status is associated with accelerated gray matter atrophy in healthy middle-aged and elderly adults, particularly in brain regions consistently implicated in mood and psychotic disorders, including the amygdala, anterior cingulate, hippocampus, prefrontal cortex, and temporal cortex. Human neuroimaging evidence also suggests that both low omega-3 PUFA intake/status and psychiatric disorders are associated with reductions in white matter microstructural integrity and increased rates of white matter hyperintensities. Preliminary evidence suggests that increasing omega-3 PUFA status is protective against gray matter atrophy and deficits in white matter microstructural integrity in patients with mood and psychotic disorders. Plausible mechanisms mediating this relationship include elevated pro-inflammatory signaling, increased synaptic regression, and reductions in cerebral perfusion. Together these associations encourage additional neuroimaging research to directly investigate whether increasing omega-3 PUFA status can mitigate neuropathological processes in patients with, or at high risk for, psychiatric disorders.
Accuracy and Safety Study of Intracavitary Electrocardiographic Guidance for Peripherally Inserted Central Catheter Placement in Neonates
Authors: Ling Qiying , Chen Hong , Tang Min , Qu Yi , Tang Binzhi
Published: January 2019

The purpose of this study is to investigate the accuracy and safety of intracavitary electrocardiogram (IC-ECG) guidance for the localization of peripherally inserted central catheter (PICC) in neonatal patients. A total of 160 neonatal patients were randomly assigned to receive either anthropometric measurement combined with IC-ECG guidance (n = 80) or conventional anatomical landmark guidance (n = 80) for PICC catheter tip positioning. The catheter tip position was confirmed by postinsertion radiograph and data were interpreted by independent radiologists. Subsequent catheter-related complications of neonates between 2 groups were also compared. The first-attempt target rate was 95.0% (95% confidence interval, 90.1%-99.9%) in IC-ECG–guided PICCs, significantly higher than 78.8% (95% confidence interval, 69.6%-87.9%) in the anatomical landmark guidance group (P < .05). In contrast, IC-ECG–guided PICCs provided a significantly lower overall incidence of the catheter-related complications (3.75%), compared with those guided by anatomical landmarks only (23.75%). Thus, combined use of anatomical landmark and IC-ECG guidance improved the first-attempt target rate of PICC placement and decreased catheter-related complications. These findings indicated a superior accuracy and safety of IC-ECG guidance to conventional anatomical landmark method in neonatal PICC practice.
Effects of Bronchoscopic Lung Volume Reduction Coil Treatment on Arterial Blood Gases
Authors: Gülsen Askin
Published: January 2019

Background:

Bronchoscopic lung volume reduction (BLVR) coil treatment is an increasingly used treatment modality for selected severe emphysema patients in recent years. Emphysema causes dynamic hyperinflation, loss of elastic recoil, air trapping, and decreased exercise capacity in advanced stages. This process progresses over time, leading to hypoxic and hypercapnic respiratory failure. The goal of this study is to elucidate the effects of BLVR coil treatment on arterial blood gas parameters in severe emphysema patients with respiratory failure.

Methods:

This is a retrospective study performed at a single pneumology center in Turkey. In total, this study included 39 patients diagnosed with severe emphysema who underwent bilateral BLVR coil treatment according to the general inclusion and exclusion criteria in the literature. The patients baseline and 12-month data were collected from medical records.

Results:

Twelve months after BLVR coil treatment, significant improvements were observed in patients’ pulmonary function tests, an increase in partial pressure of oxygen in arterial blood (PaO2) from 58.05±9.36 to 73.82±13.3 (P<0.000) and decrease in partial pressure of carbon dioxide in arterial blood (PaCO2) of hypercapnic patients (from 51.60±4.1 to 46.55±6.6 mm Hg; P=0.001).

Conclusion:

BLVR coil treatment is reliable and effective in emphysema patients who have hypoxic or mild hypercapnic respiratory failure. Besides improving lung function, BLVR coil treatment can significantly increase PaO2 and decrease PaCO2 in the medium term.
Posterior reversible encephalopathy syndrome with spinal cord involvement but without hemisphere lesions
Authors: Liu Lu , Dai Dawei , Cao Fan , Zhang Liming , Wang Xun
Published: January 2019

Rationale

Posterior reversible encephalopathy syndrome (PRES) was termed by Hinchey
[1]
in 1996. Patients have a reversible vasogenic brain edema in imaging and acute neurological symptoms such as headache, seizures, encephalopathy, and visual disturbances when suffering from hypertension, pre-eclampsia/eclampsia, renal failure, immunosuppressive medications, autoimmune disorders, sepsis, thrombocytopaenia, hypocalcaemia, alcohol withdrawal, and many other potential causes.
[2,3]
de Havenon A et al
[4]
have proposed a new syndrome named PRES with spinal cord involvement (PRES-SCI). The patients with PRES-SCI have similar symptoms these of PRES. Patients have neurologic signs with the spinal cord involved and lesions in magnetic resonance imaging (MRI) extending to the cervicomedullary junction, usually with extreme elevation in blood pressure and a history of hypertensive retinopathy.
[4]
We administrated a young patient whose condition was consistent with PRES-SCI except for the hemisphere lesions.

Patient Concerns

A 20-year-old Asian male patient was admitted for a 1 week history of blurred vision and weakness of the limbs. He has had poorly controlled hypertension for 1 year before admission. In emergency room, his blood pressure could raise to 260/140mmHg. Neurological examinations and cerebral spinal fluid tests were negative. The MRI of the brain and spinal cord showed reversible lesions in the medulla and upper cervical spinal cord that extended to the lower thoracic spine.

Diagnosis

Taking into account the characteristic lesions in the MRI as well as the reversible course upon treatment, he was diagnosed PRES-SCI.

Interventions

He was treated with medicines for the hypertension.

Outcomes

His symptoms rapidly improved and finally the lesions on the MRI of the brain and spianl cord disappeared.

Lessons

Clinicians should suspect PRES-SCI when patients have mild or no neurologic signs accompanied with extreme elevation in blood pressure and lesions in spinal cord. Spinal lesions alone may be a subtype of PRES-SCI.
Gene polymorphism associated with TNF-α (G308A) IL-6 (C174G) and susceptibility to coronary atherosclerotic heart disease
Authors: Yuepeng Jiang , Zhao Xiaoxuan , Zhao Yang , Li Liu
Published: January 2019

To evaluate the association between gene polymorphisms of TNF-α G308A, IL-6 C174G, and coronary atherosclerotic heart disease (CHD) risk.

We used computers to collect related case-control studies. After screening, a meta-analysis was conducted to assess the strength of association by Stata 12.0 software.

Thirty-five articles were included. Among them, 17 studies were related to TNF-α (G308A) gene mutation and CHD, and 18 studies examined IL-6 (C174G) gene mutation. According to the results of subgroup analysis of ethnicity, it suggested that TNF-α (G308A) polymorphism was not significantly associated with CHD risk under all models in Asians (P > .05). There were no connected of IL-6 C174G polymorphism with CHD risk under all models in Caucasians after subgroup analysis (P > .05).

The present evidence shows that TNF-α (G308A) have no connected with the risk of CHD in Asians; IL-6 (C174G) gene were not associated with the risk of CHD in Caucasians.
Different treatments for acute myocardial infarction patients via outpatient clinics and emergency department
Authors: Chien Ching-Wen , Wang Cheng-Hua , Chao Zi-hao , Huang Song-Kong , Chen Pei-En , Tung Tao-Hsin
Published: January 2019

To investigate relevant factors and patients with acute myocardial infarction (AMI) were admitted during between weekdays and weekends period.

Retrospective population-based study setting: from the 2005 population-based national health insurance underwriting database of millions of people, random sampling (National Health Insurance Research Database [NHIRD]-Longitudinal Health Insurance Database [LHID] 2005).

In 2000 to 2009 data of NHIRD, subjects presented with first episode AMI who had received the thrombolytic therapy (TPA), or percutaneous coronary artery intervention (PTCA) or coronary artery bypass graft (CABG) during between weekdays and weekends period.

From 2000 to 2009 among patients with first AMI total of 2007 people, the weekday group 1453 people, the weekend group 554. The total mortality within 1 year showed 33.53%, the first-day mortality occupied 8.07% in 1 year of total mortality, increased mortality after admission 3 months later. Cox regression analysis showed that AMI has presented significant risk of death, there are 4 items: weekends, age, Charlson comorbidity index (CCI), thrombolytic therapy; in the other variables including emergency, hospital level, hospital ownership, and urban-rural gap are not significant differences. Further using hierarchical logistic regression analysis for Stratification of AMI mortality risk, it has significant that showed the hospital level, age, CCI, thrombolytic therapy; but emergency, PTCA and 3 CABG treatment are not significant differences.

It was approved by the hierarchical logistic regression analysis after stratified correction that the present study will have a direct impact on weekdays and weekends death in the hospital level. It will also affect the individual level.
A novel application of B-ultrasonography at various head positions in the diagnosis of untypical uveitis-glaucoma-hyphema (UGH) syndrome
Authors: Wu Nianlang , Zhang Huicheng , Chen Bin , Ding Wenting
Published: January 2019

Rationale:

Uveitis-glaucoma-hyphema (UGH) syndrome could be identified by conventional ultrasound biomicroscopy (UBM) and B-ultrasonography, but failed in some untypical cases. We introduced a novel application of B-ultrasonography in diagnosis of UGH syndrome in a rare case.

Patient concerns:

A 60-year-old woman was referred for distending pain with blurred vision for more than 1 month in the right eye after cataract surgery.

Diagnoses:

B-ultrasound scanner and UBM demonstrated the Intraocular Lens (IOL) was centered in the bag. No chafing in all directions was detected between IOL and iris/ciliary body. The proposed diagnoses were iridocyclitis and secondary glaucoma of the right eye.

Interventions:

The symptoms were not improved after antiinflammation and intraocular pressure (IOP) lowering treatment for 1 month. B-ultrasonography was applied in horizontal, sitting, and head-down positions. The results demonstrated movements of IOLs when position changed. The IOLs were in contact with the iris pigment epithelium in sitting position and head-down positions but not in horizontal position. The dynamic interactions between IOLs and iris/ciliary body implied a diagnosis of UGH syndrome. The IOLs were then extracted.

Outcomes:

Two weeks after the IOLs explantation, the IOP significantly reduced to a normal level in both eyes. Ten-month follow-up showed that the IOP was maintained at a normal level.

Lessons:

The chronically intermittent chafing between IOL and iris in specific head positions would also lead to UGH syndrome. Dynamic application of B-ultrasonography in various head positions could be useful in the diagnosis of an untypical UGH syndrome.
Complex pulmonary arteriovenous fistula in mother and daughter
Authors: Zhang Xin , Zheng Mingxia , Li Xingjian , Yan Yejun , Yang Caixia , Zhao Zhengang , Feng Yuan , Chen Mao
Published: January 2019

Rationale:

Complex pulmonary arteriovenous fistula (PAVF) is unusual, and even rarer in 2 members of a family. PAVF may not appear on chest X-ray or computed tomography imaging, especially in asymptomatic patients, and therapy is limited. Herein, PAVFs occurring in a mother and daughter are described, with the current standard methods of diagnosis and treatment of PAVF.

Patient concerns:

A 34-year-old woman and her 13-year-old daughter presented with light cyanosis of the nail beds but were otherwise asymptomatic, and physical examination was unremarkable. Their arterial oxygen saturation levels were low (80–85%).

Diagnoses:

Angiography led to a diagnosis of PAVF involving the bilateral lung in both women.

Interventions:

The combined use of coils with occluder (patent ductus arteriosus, or PDA) to obstruct the fistula.

Outcomes:

After interventional treatment, the patients’ arterial oxygen saturation improved rapidly (90–95%). At 6-month follow-up, the patients’ symptoms and oxygen saturation were normal.

Lessons:

PAVF is an autosomal dominant disease. Here, the characteristics of the 2 patients were very similar. Using detachable coils and then a PDA occluder is a highly efficient method for treating complex PAVFs.
The correlation between affected renal function and affected renal residual volume
Authors: Chen Fang-Min , Hu Rui-Jie , Jiang Xi-Nan , Zhong Si-Wen , Tang Shuai
Published: January 2019

Laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been widely used in the treatment of localized renal tumors. However, the impact of ischemia-reperfusion injury (IRI) during SRPN remains controversial. This study aims to evaluate the correlation between affected renal function and affected renal volume after SRPN for localized renal tumor treatment, explore the effect of IRI on renal function after SRPN.

A total of 39 patients who underwent SRPN for localized renal tumor from June 2009 to April 2012 were reviewed. These patients were followed-up for 5 years. The preoperative affected renal glomerular filtration rate (aGFRpre), postoperative affected renal glomerular filtration rate (aGFRpost), preoperative affected renal volume (aVolpre), and postoperative affected renal volume (aVolpost) were collected during the follow-up period. The correlation between aGFRpost/aGFRpre and aVolpost/aVolpre was compared.

A total of 33 patients were successfully followed up. After 3, 6, 12, 24, and 60 months, aGFRpost was 34.6 ± 4.6, 34.7 ± 4.8, 34.9 ± 4.4, 35.1 ± 4.4, and 35.2 ± 4.2 mL/min. The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659 (P = .000), 0.667 (P = .000), 0.663 (P = .000), 0.629 (P = .000), and 0.604 (P = .000), respectively. The limitation of this study was the small cohort size.

For the localized renal tumor, aGFRpost was associated with aVolpost, but was not associated with intraoperative factors, such as the time of clamping of the affected segmental renal artery. As a part of nephrons, the resected tumor tissue caused the lack of inherent nephrons, resulting in the loss of renal function. More nephrons should be maintained before resecting the tumor completely during SRPN.

Trial registration: ChiCTR-RRC-17011418.
Human papilloma virus identification in ocular surface squamous neoplasia by p16 immunohistochemistry and DNA chip test
Authors: Shrestha Tina , Choi Won , Kim Ga Eon , Yang Jee Myung , Yoon Kyung Chul
Published: January 2019

The aim of this study was to identify the association between human papilloma virus (HPV) infection and ocular surface squamous neoplasia (OSSN) usingp16 immunohistochemistry (IHC) and deoxyribonucleic acid (DNA) chip test.

Thirty-eight patients who underwent surgical excision of OSSN were retrospectively studied using tissue samples. The IHC was performed to assess the expression ofp16 and DNA chip test was used to detect 24 HPV serotypes.

Among the 38 OSSN samples, 32 cases (84.2%) were histopathologically categorized as pre-invasive type and 6 cases (15.8%) as invasive type. The IHC forp16 showed strong positivity in 12 cases (31.6%), whereas it was negative in 26 cases (68.4%). On the other hand, only one case (2.6%) of invasive OSSN was positive for the HPV16 serotype, as assessed by DNA chip test.

In OSSN,p16 expression was positive in approximately 1/3rd of the cases, whereas the majority of the 24 HPV serotypes were negative forp16. Our findings suggest that only a weak association exists between HPV infection and OSSN.
The association of depression following percutanous coronary intervention with adverse cardiovascular events
Authors: Liu Yanfei , Zhao Yinke , Tian Jinfan , Tong Tiejun , Gao Rui , Liu Yue
Published: January 2019

Introduction:

Percutanous coronary intervention (PCI) has been increasingly used for patients suffered from severe coronary artery disease. However, physical trauma and potential adverse events related to the procedure often result in detrimental psychological stress. Accumulating evidences have shown that depression is closely related to coronary artery disease. However, the association of depression following percutanous coronary intervention with adverse cardiovascular events is still unknown.

Objective:

This review is designed to assess the prognostic association of depression following PCI with adverse cardiac events.

Methods and analysis:

The following databases will be searched, PubMed, the EMBASE, CINAHL and Web of Science of English-language publications from inception to 30 October 2018. Cross-referencing from retrieved studies will be conducted additionally, and observational studies were included. Two independent review authors will do the study selection on the basis of the study eligibility criteria. Extracted data will be used for quantitative and qualitative evidence synthesis as well as to assess methodological quality of studies using the Newcastle-Ottawa checklist. The primary objective of this review is adverse cardiac events, presented as a composition of myocardial infarction, repeat coronary revascularization, cardiac readmission, and cardiac death. The accumulated evidence is evaluated and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results and conclusions:

This review will explain the association of depression following percutanous coronary intervention with adverse cardiovascular events, and provide physicians with scientific evidence for psychological intervention in patients after PCI.

Prospero registration number:

CRD42018112486.
Intraoperative hypothermia is a significant prognostic predictor of radical cystectomy especially for stage II muscle-invasive bladder cancer
Authors: Morozumi Kento , Mitsuzuka Koji , Takai Yuki , Katsumata Yuki , Kuromoto Akito , Hoshi Senji , Numahata Kenji , Arai Yoichi
Published: January 2019

The objective of this study was to evaluate intraoperative hypothermia as a predictor of complication and prognosis in patients with muscle-invasive bladder cancer treated with radical cystectomy.

The data of 124 patients treated with radical cystectomy for muscle-invasive bladder cancer in our department, from 2003 to 2016, were retrospectively collected. The patients were divided into 2 groups according to the lowest intraoperative deep body temperature, that is, the hypothermia group (<96.8°F) and the normothermia group (≥96.8°F). Preoperative and intraoperative variables were compared among the 2 groups, and factors associated with complications, recurrences, and survivals were analyzed.

Sixty-eight (54.8%) of the 124 patients presented intraoperative hypothermia. There was no significant difference in the patient's characteristics between the 2 groups. Postoperative complications (Clavien–Dindo ≤III) of any types occurred in 15 patients (22.1%) in the hypothermia group, as compared with 8 patients (14.3%) in the normothermia group (P = .27). The hypothermia group had a higher pathologic stage (P = .029) and a higher recurrence rate within 12 months (P = .013), as compared with the normothermia group. Intraoperative hypothermia was an independent prognostic factor for overall survival in all patients (hazard ratio [HR] 2.47; 95% confidence interval [CI], 1.01–2.85; P = .047). When stratified by disease stage, stage II intraoperative hypothermia was an independent prognostic factor for disease-free survival (HR 3.35; 95% CI, 1.27–8.83; P = .015) and overall survival (HR 4.24; 95% CI, 1.38–12.9; P = .011).

This study suggests that intraoperative hypothermia could be a significant predictor for recurrence and survival in muscle-invasive bladder cancer treated with radical cystectomy.
The influence of pelvis reposition exercises on pelvic floor muscles asymmetry
Authors: Oleksy Łukasz , Mika Anna , Kielnar Renata , Grzegorczyk Joanna , Marchewka Anna , Stolarczyk Artur
Published: January 2019

Objective:

The assessment of pelvis reposition exercise efficacy in the treatment of pelvic floor muscles (PFM) asymmetry. The hypothesis was that PFM asymmetry may have a functional reason related to lumbopelvic complex misalignment.

Design:

A parallel group trial with follow-up

Methods:

Thirty young women were divided into 2 groups: experimental (n = 15) and control (n = 15). In experimental group one, a 15-minute trial of pelvis reposition exercise was carried out. Ober test, the Thomas test, and transabdominal PFM ultrasound measurements were performed in both groups.

Results:

In the experimental group both the Ober and Thomas tests were positive at baseline in most subjects. After the exercise, improvement was noted in Ober test (P = .005; d = 0.75 on the right side, P = .005; d = 0.78 on the left side) and in the Thomas test (P = .005; d = 0.66 on the right side, P = .005; d = 0.67 on the left side). At baseline, the ultrasonographic evaluation of PFM performed during resting and during voluntary pelvic muscles contraction showed the right–left length asymmetry. The return of symmetrical PFM work after pelvis reposition exercise was observed in the experimental group. There were no statistically significant changes in the control group.s

Conclusions:

We suggest that after reposition exercises, the pelvis was more symmetrically aligned in relation to body axis; therefore, the muscles of the pelvic floor have functional length and did not shorten or lengthen due to pelvis rotation. In this study, for the first time, it was presented that PFM asymmetry visible in ultrasonography may be corrected by this specific exercise. Further analysis of the causes of this asymmetry may lead to more accurate treatment of PFM dysfunctions.
Septic patients presenting with apparently normal C-reactive protein
Authors: Wasserman Asaf , Karov Ruth , Shenhar-Tsarfaty Shani , Paran Yael , Zeltzer David , Shapira Itzhak , Trotzky Daniel , Halpern Pinchas , Meilik Ahuva , Raykhshtat Eli , Goldiner Ilana , Berliner Shlomo , Rogowski Ori
Published: January 2019

The presentation of septic patients with low C-reactive protein (CRP) concentrations to the emergency room (ER) might convey an erroneous impression regarding the severity of the disease.

We analyzed a retrospective study of septic patients admitted to the internal medicine departments of a relatively large tertiary medical center, following admission to the ER. These patients had CRP concentrations of <31.9 mg/L, the determined cut-off for CRP concentrations in a large cohort of apparently healthy individuals in the community (n = 17,214, upper limit of mean + 3 standard deviations).

By processing the electronic medical records, we found 2724 patients with a diagnosis of sepsis, 476 of whom had an admission CRP concentration of <31.9 mg/L. Following further analysis of these records, we found that 34 of the 175 patients (19.4%) who fulfilled the definition of sepsis, died within 1 week of hospitalization. Of special interest was the finding that within <24 h, a significant increment from a median CRP of 16.1 mg/L (IQR 7.9–22.5) to 58.6 mg/L (IQR 24.2–134.4), (P < .001) was noted, accompanied by a velocity change from 0.4 ± 0.29 to 8.3 ± 24.2 mg/L/h following antibiotic administration (P < .001).

ER physicians should take into consideration that septic patients with a high in-hospital mortality rate can present with CRP concentrations that are within the range observed in apparently healthy individuals in the community. A second CRP test obtained within 24 h following antibiotic administration might influence attitudes regarding the severity of the disease.
The genetic association between EGF A61G polymorphism (rs4444903) and risk of colorectal cancer
Authors: Zhu Yi , Chen ZhiHeng , Jiang HongGang , Lu BoHao
Published: January 2019

Background:

Colorectal cancer was a complex disease with multiple causative factors including genetic and environmental factors, as well as the interaction of the 2 factors. Relationship between epidermal growth factor (EGF) A61G polymorphism and colorectal cancer risk has been widely investigated previously, whereas results derived from these studies were inconclusive and controversial. The aim of this study was to investigate the association between the EGF A61G polymorphism and colorectal cancer using a meta-analysis of existing literature.

Methods:

Literature search was conducted from PubMed, EMBASE, China National Knowledge Infrastructure, Wanfang, and Cochrane library databases before July 2017. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the strength of the association between EGF A61G and colorectal cancer.

Results:

A total of 9 studies that involved 1448 cases and 1928 healthy controls and found allelic (OR = 1.18, P = .04) and recessive models (OR = 1.36, P = .03) of EGF A61G were significantly associated with the risk of colorectal cancer. Stratification analyses by ethnicity indicated that the EGF 61G significantly increased the risk of colorectal cancer in the Caucasian subgroup (OR = 1.24, P = .02), but not in Asian subgroup (OR = 1.12, P = .08). And the frequency of GG genotype of EGF A61G significantly increased in cases than that in healthy controls in both Caucasian (OR = 1.40, P = .04) and Asian subgroups (OR = 1.27, P = .01). Furthermore, the sample sources and genotyping methods seem to have no influence on the correction of EGF A61G and colorectal cancer susceptibility (P > .05).

Conclusion:

The results indicate that EGF A61G might increase the risk of colorectal cancers.
Adverse drug events observed with 150 mg versus 300 mg secukinumab for the treatment of moderate to severe plaque psoriasis
Authors: Zhang Li , Yang Hua , Chen Qihong , Zhao Jing
Published: January 2019

Background:

Secukinumab has been approved for the treatment of moderate to severe plaque psoriasis. However, safety measures concerning drug administration is vital during treatment. Understanding the right way to administer drugs is important to reduce any serious adverse drug event. In this analysis we aimed to systematically show the risk of adverse drug events which were observed with 150 mg versus (vs) 300 mg secukinumab for the treatment of moderate to severe plaque psoriasis.

Methods:

The major online databases: Cochrane Central, MEDLINE, www.ClinicalTrials.com and EMBASE were searched for relevant publications based on the comparison of secukinumab 150 mg vs 300 mg for the treatment of moderate to severe plaque psoriasis. Adverse drug events were considered as the clinical endpoints. Statistical analysis was carried out by the RevMan 5.3 software. Risk ratios (RR) and 95% confidence intervals (CIs) were generated to represent the data following statistical analysis.

Results:

Seven studies with a total number of 2361 participants were included. Results of this analysis showed that the risk of any adverse event (RR: 1.00, 95% CI: 0.96–1.05; P = .94), the risk of serious adverse events (RR: 1.04, 95% CI: 0.75–1.43; P = .82) and the risk of adverse events leading to drug discontinuation (RR: 0.98, 95% CI: 0.61–1.57; P = .92) were not significantly different between 150 mg vs 300 mg secukinumab for the treatment of moderate to severe plaque psoriasis. When the detailed adverse drug events were studied, the risks of infection or infestation (RR: 1.11, 95% CI: 0.98–1.25; P = .09), naso-pharyngitis (RR: 1.05, 95% CI: 0.90–1.23; P = .55), headache (RR: 0.92, 95% CI: 0.68–1.25; P = .60), diarrhea (RR: 1.14, 95% CI: 0.75–1.73; P = .55), pruritus (RR: 0.82, 95% CI: 0.56–1.22; P = .33), arthralgia (RR: 0.96, 95% CI: 0.67–1.38; P = .83), upper respiratory tract infection (RR: 0.98, 95% CI: 0.70–1.36; P = .89), hypertension (RR: 1.22, 95% CI: 0.83–1.81; P = .31), nausea (RR: 1.39, 95% CI: 0.63–3.04; P = .42), and cough (RR: 1.46, 95% CI: 0.67–3.19; P = .34) were still not significantly different between these 2 dosage regimens.

Conclusion:

Secukinumab 150 mg and 300 mg were both equally tolerable and might safely be used for the treatment of moderate to severe plaque psoriasis. No significant adverse drug events were observed with any of the dosage.
Use of the SYNTAX Score II to predict mortality in interventional cardiology
Authors: Yang Hua , Zhang Li , Xu Chen Hong
Published: January 2019

Background:

As the SYNTAX Score has limitations, it should be replaced by another better angiographic tool. By comparing mortality that was observed following percutaneous coronary intervention (PCI) in patients who were allotted a low versus a high score, we aimed to systematically investigate mortality prediction using the SYNTAX Score II in Interventional Cardiology.

Methods:

Electronic databases were searched for relevant publications using the terms “SYNTAX Score II and percutaneous coronary intervention.” The main outcome was all-cause mortality. This analysis was carried out by the RevMan 5.3 software [risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated].

Results:

A total number of 9443 participants were enrolled for this analysis. As different studies reported different range of SYNTAX Score II, we further classified these scores range into 4 different groups: 17 < SS > 17, 20 < SS > 20, 22 < SS > 22, and 26 < SS > 26 appropriately. Results of this analysis showed that the risk of mortality in patients with a high SYNTAX Score II (SS > 17) was significantly higher (RR: 2.65, 95% CI: 1.05–6.73; P = .04) than patients with a low SYNTAX Score II (SS < 17). Even when participants with a low SYNTAX Score II (SS < 20) were compared with patients who were assigned to a higher SYNTAX Score II (SS > 20), a significantly higher risk of mortality was associated with a high SYNTAX Score II (RR: 3.73, 95% CI: 1.99 – 6.96; P = .0001).

Conclusion:

Following PCI, the risk of mortality was higher in those patients with a high SYNTAX Score II. The SYNTAX Score II might be considered as an important tool to predict mortality in Interventional Cardiology. Future research should further explore the benefits of this tool.
Malignant perivascular epithelioid cell tumor in the female genital tract
Authors: Liu Chia-Hao , Chao Wei-Ting , Lin Shih-Chieh , Lau Hei-Yu , Wu Hua-Hsi , Wang Peng-Hui
Published: January 2019

Background:

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor, located at various anatomic sites, including the female genital tract. This study aimed to evaluate the clinicopathological characteristics of patients with PEComa arising from the female genital tract.

Methods:

A retrospective study was conducted in Taipei Veterans General Hospital (Taipei VGH) between 2008 and 2018. All published English cases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were also included in the current review.

Results:

A total of 114 women from PRISMA and 3 women from Taipei VGH were identified. The uterus was the most commonly involved site (82/114, 71.9%), followed by the cervix (12/114, 10.5%). Immunohistochemical staining showed that nearly all gynecological PEComas were positive for human melanoma black 45 (113/114, 99.1%). More than half of the gynecological PEComas were immunoreactive for desmin (50/85, 58.8%). Multi-modality treatment, including surgery and mammalian target of rapamycin (mTOR) inhibitors as targeted therapy, provided long-term disease-free survival (cure rate ranging from 50% to 100%, based on the different anatomic sites of the female genital tract).

Conclusion:

Multi-modality treatment, including cytoreductive surgery and mTOR inhibitors with/without chemotherapy and/or radiation, should be considered for the management of women with PEComas in the genital tract.
Analgesic effect of trigger point injection and EMLA for shoulder pain in patients undergoing total laparoscopic hysterectomy
Authors: Kim Ji Eun , Kim Ji Young , Lee Hye Sun , Seok Suhyun , Kil Hae Keum
Published: January 2019

Backgroud:

The purpose of this study was to evaluate the effects of trigger point injection (TPI) and eutectic mixture local anesthetics (EMLA) cream on the postoperative shoulder pain in patients undergoing total laparoscopic hysterectomy.

Methods:

In this randomized, single-blinded, and controlled study, total 75 patients were randomly allocated to TPI group (n = 25), EMLA group (n = 25), and control group (n = 25). TPI group received TPIs with 2 mL of 0.2% ropivacaine, and EMLA group received an occlusive dressing with EMLA cream 2 g on both shoulders. Overall, abdominal, and shoulder pains were evaluated at rest and in motion on postoperative day 3.

Results:

The incidence of shoulder pain was significantly reduced in EMLA group (56%) compared to control (88%) or TPI (88%) groups (P = .025 in both); the severity of shoulder pain was mitigated in EMLA and TPI groups compared to control group (P < .001, each). Consequently, the overall pain decreased in EMLA group and TPI group (P = .023). The patients with exercise habit (n = 31) showed lower incidence of pain than patients without exercise habit (n = 26) (P = .002, P = .005, and P = .037 in overall, abdominal, and shoulder pain, respectively). TPI or EMLA treatments decreased shoulder pain irrespective of exercise habit (P = .001 and P < .001, respectively), but decreased overall pain only in patients without exercise habit (P = .019). Lastly, EMLA lowered overall pain score at the time of first analgesic request in ward compared to control group (P = .02).

Conclusions:

TPI and EMLA with occlusive dressing effectively reduced the shoulder pain after total laparoscopic hysterectomy.
Balance control, agility, eye–hand coordination, and sport performance of amateur badminton players
Authors: Wong Towel K.K. , Ma Ada W.W. , Liu Karen P.Y. , Chung Louisa M.Y. , Bae Young-Hyeon , Fong Shirley S.M. , Ganesan Balasankar , Wang Hsing-Kuo
Published: January 2019

In this study, balance performance, agility, eye–hand coordination, and sports performance were compared between amateur badminton players and active controls.

Thirty young adult badminton players and 33 active controls participated in the study. Static single-leg standing balance (with eyes closed) was measured using a force platform, and dynamic balance was measured using the Y Balance Test (lower quarter). Agility was measured using a hexagon agility test, and eye–hand coordination was measured using a computerized finger-pointing task. Sports performance was quantified by the number of times a shuttlecock fell in a designated area following a badminton serve.

The badminton players had superior accuracy in badminton serving (P < .001) relative to the active controls. However, no significant between-group differences were noted in all other outcome variables (P > .05).

Amateur badminton players had more favorable sports performance, but not balance performance, agility, or eye–hand coordination, than controls.