bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterizing Social and Academic Aspects of School Anxiety in Pediatric Chronic Pain
Authors: Gibler Robert C. , Beckmann Emily A. , Lynch-Jordan Anne M. , Kashikar-Zuck Susmita , Mano Kristen E. Jastrowski
Published: April 2019

Objective:

School anxiety is a prevalent and debilitating mental health problem among youth with chronic pain. Despite evidence that anxiety in the context of school is associated with significant school-related disability, no studies have examined specific aspects of school anxiety in a pediatric chronic pain population.

Materials and Methods:

Adolescents with chronic pain (n=30) and age-matched and sex-matched controls (n=30) and their parents completed questionnaires assessing school anxiety and functioning.

Results:

Adolescents with chronic pain reported significantly more cognitive, behavioral, and psychophysiological symptoms of school anxiety relative to healthy controls. Youth with pain also endorsed significantly greater school anxiety in situations involving negative social evaluation and peer aggression. Exploratory analyses indicated that adolescents with chronic pain reporting school refusal behaviors more strongly endorsed behavioral and psychophysiological school anxiety symptoms, and more symptoms in social-evaluative situations. Youth with pain reporting lower school functioning endorsed more cognitive school anxiety symptoms and anxiety in situations involving academic failure relative to those reporting higher functioning.

Discussion:

Present results offer a nuanced perspective into the underlying sources of school anxiety among adolescents with chronic pain. Our findings may inform future research efforts and targeted school functioning interventions. In particular, findings suggest that an individualized approach to the assessment of school anxiety which considers the unique sources of anxiety (eg, social vs. academic) may lay the groundwork for the refinement of school functioning interventions in pediatric chronic pain.
Tension Band Plate (TBP)-guided Hemiepiphysiodesis in Blount Disease: 10-Year Single-center Experience With a Systematic Review of Literature
Authors: Jain Mohit J. , Inneh Ifeoma A. , Zhu Huirong , Phillips William A.
Published: April 2019

Background:

Primary treatment for Blount disease has changed in the last decade from osteotomies or staples to tension band plate (TBP)-guided hemiepiphysiodesis. However, implant-related issues have been frequently reported with Blount cases. The purpose of our study is to evaluate the surgical failure rates of TBP in Blount disease and characterize predictors for failure.

Methods:

We performed an Institutional Review Board–approved retrospective chart-review of pediatric patients with Blount disease to evaluate the results of TBP from 2008 to 2017 and a systematic literature review. Blount cases defined as pathologic tibia-vara with HKA (hip-knee-ankle) axis and MDA (metaphyseal-diaphyseal angle) deviations ≥11 degrees were included in the analysis. Surgical failure was categorized as mechanical and functional failure. We studied both patient and implant-related characteristics and compared our results with a systematic review.

Results:

In 61 limbs of 40 patients with mean follow-up of 38 months, we found 41% (25/61) overall surgical failure rate and 11% (7/61) mechanical failure rate corresponding to 11% to 100% (range) and 0% to 50% (range) in 8 other studies. Statistical comparison between our surgical failure and nonfailure groups showed significant differences in deformity (P=0.001), plate material (P=0.042), and obesity (P=0.044) in univariate analysis. The odds of surgical failure increased by 1.2 times with severe deformity and 5.9 times with titanium TBP in the multivariate analysis after individual risk-factor adjustment. All 7 mechanical failures involved breakage of cannulated screws on the metaphyseal side.

Conclusions:

Most of the studies have reported high failure rates of TBP in Blount cases. Besides patient-related risk factors like obesity and deformity, titanium TBP seems to be an independent risk factor for failure. Solid screws were protective for mechanical failure, but not for functional failure. In conclusion, efficacy of TBP still needs to be proven in Blount disease and implant design may warrant reassessment.

Level of Evidence:

Level III—retrospective comparative study with a systematic review.
The 5-Item Modified Frailty Index Is Predictive of Severe Adverse Events in Patients Undergoing Surgery for Adult Spinal Deformity
Authors: Yagi Mitsuru , Michikawa Takehiro , Hosogane Naobumi , Fujita Nobuyuki , Okada Eijiro , Suzuki Satoshi , Tsuji Osahiko , Nagoshi Narihito , Asazuma Takashi , Tsuji Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: April 2019

Study Design.

A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 ± 19 yrs, 91% female, follow-up 4.3 ± 1.9 yrs) from a multicenter database.

Objective.

To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs).

Summary of Background Data.

Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven.

Methods.

SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients’ frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients.

Results.

Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to ≥2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3–3.7).

Conclusion.

The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients.

Level of Evidence: 4
Fibroblast Growth Factor 9 Is Upregulated Upon Intervertebral Mechanical Stress-Induced Ligamentum Flavum Hypertrophy in a Rabbit Model
Authors: Hayashi Kazunori , Suzuki Akinobu , Terai Hidetomi , Ahmadi Sayed Abdullah , Rahmani Mohammad Suhrab , Maruf Mohammad Hasib , Habibi Hasibullah , Hori Yusuke , Yamada Kentaro , Hoshino Masatoshi , Toyoda Hiromitsu , Takahashi Shinji , Tamai Koji , Ohyama Shoichiro , Imai Yuuki , Nakamura Hiroaki
Published: April 2019

Study Design.

Case-control study of an animal model.

Objective.

To investigate the factors that are upregulated and potentially related to degenerative changes in the ligamentum flavum (LF) upon mechanical stress concentration.

Summary of Background Data.

LF hypertrophy is reported to be associated with mechanical stress. However, few studies, using exhaustive analysis with control subjects, on the molecular mechanisms of LF hypertrophy have been published.

Methods.

Fourteen rabbits were used for this study. The first group underwent L2–3 and L4–5 posterolateral fusion with instrumentation and resection of the L3–4 supraspinal muscle to concentrate the mechanical stress on L3–4, whereas the other group underwent a sham operation. The deep layer of the LF from L2–3 to L4–5 in both groups was harvested after 16 weeks. Gene expression was evaluated exhaustively using DNA microarray and real-time polymerase chain reaction (RT-PCR). Fibroblast growth factor 9 (FGF9) protein expression was subsequently examined by immunohistological staining.

Results.

A total of 680 genes were found to be upregulated upon mechanical stress concentration and downregulated upon mechanical shielding compared with those in the sham group. Functional annotation analysis revealed that these genes not only included those related to the extracellular matrix but also those related to certain FGF families. On RT-PCR validation and immunohistological analysis, we identified that the FGF9 protein increases in the LF upon mechanical stress, especially in the area wherein degenerative changes were frequently identified in the previous literature.

Conclusion.

FGF9 and its pathway are suggested to contribute to the degenerative changes in the LF following mechanical stress. This finding will be helpful in further understanding the molecular mechanism of human LF degeneration.

Level of Evidence: N/A
The Effect of Intraoperative Vertebral Anesthesia on Osteoporotic Fractures Treated With Percutaneous Kyphoplasty
Authors: Mao Genwen , Alemayehu Dereje G. , Yang Yimin , Wen Tao , Ou Yiyan , Cheng Yifan , Ren Zhiwei
Published: April 2019

Study Design:

A prospective randomized cohort study.

Objective:

The objective of this study was to investigate the effect of intraoperative vertebral anesthesia on osteoporotic vertebral compression fractures (OVCFs) when treated with percutaneous kyphoplasty (PKP).

Summary of Background Data:

Only a few studies have evaluated the intraoperative pain reducing strategies during PKP.

Materials and Methods:

A total of 64 patients with OVCFs were enrolled in the study. All of the patients were randomized into 2 groups: the traditional local anesthesia group (from the skin to the periosteum, group A) and the experimental group (from the skin to a vertebral body, group B). Visual Analogue Scale (VAS) score was used to evaluate the degree of pain at six time points, that is, VAS before surgery, VAS during balloon dilation, VAS during bone cement injection, VAS soon after surgery, and VAS 12 hours and 24 hours after surgery. In addition, we noted the patients’ willingness to undergo reoperation if necessary, and the variations in surgical complications between the 2 groups.

Results:

There was no significant difference in VAS score before surgery between the 2 groups (t=1.694, P=0.095). The VAS scores during balloon dilatation, bone cement injection and soon after surgery were significantly different between the 2 groups (t=4.405, P=0.000; t=2.481, P=0.016; t=2.992, P=0.004, respectively). The willingness to undergo reoperation was significantly different between 2 groups (χ2=6.020, P=0.049), whereas the complications showed no significant difference (χ2=0.000, P=0.754).

Conclusions:

Traditional local anesthesia combined with vertebral anesthesia was effective in alleviating perioperative pain during PKP. No serious complication was noted during the operation.

Level of Evidence:

Level I.
FARP1 Facilitates Cell Proliferation Through Modulating MAPK Signaling Pathway in Cutaneous Melanoma
Authors: Chen Zhao-Hui , Wang Li-Hua
Published: April 2019

Purpose:

The purpose of our study was to investigate the biological functions of FARP1 gene in cutaneous melanoma.

Methods:

The mRNA expression level of FARP1 in cutaneous melanoma was analyzed based on the data obtained from ONCOMINE and The Cancer Genome Atlas database. Kaplan–Meier analysis was conducted to explore the association between FARP1 expression and the overall survival time of patients with cutaneous melanoma. The mRNA expression of FARP1 in melanoma cells was determined by qRT-PCR. A-375 cell line with silenced FARP1 was constructed to explore its biological functions. Cell proliferation, migration, and invasion abilities were determined by CCK8 assay, wound-healing assay, and transwell assays, respectively. Western blot was performed to explore the protein expression of FARP1, pMEK, MEK, pERK, and ERK.

Results:

Our results showed that the expression level of FARP1 was upregulated in cutaneous melanoma tissues and cells. Kaplan–Meier analysis revealed that high expression of FARP1 is predictive of shorter overall survival time in patients with cutaneous melanoma. Through CCK8 assay, we found that knockdown of FARP1 in A-375 cells exhibited dramatically inhibitory effect on cell proliferation. The results of wound-healing and transwell assays revealed that the motility of A-375 cells was notably suppressed after silencing FARP1. Moreover, the relative expression levels of pMEK/MEK and pERK/ERK decreased remarkably in A-375 cells following being transfected with si-FARP1.

Conclusions:

Our present results preliminary proofed that FARP1 possibly acts as a promoter in cutaneous melanoma development and possesses the potential to be a therapeutic target in patients with cutaneous melanoma.
Echogenicity Is Related to Skeletal Muscle Strength in Patients With Acute Respiratory Failure
Authors: Berry Michael J. , Files D. Clark , Campos Claudia L. , Bakhru Rita N. , Skaggs Brittany M. , Morris Peter E.
Published: April 2019

Purpose:

Patients with acute respiratory failure (ARF) show changes in skeletal muscle structure and strength. The purpose of this study was to examine the relationship between muscle thickness, echogenicity, and strength in patients with ARF.

Methods:

Thirteen (6 females, 7 males) patients with ARF participated in the study. Knee extensor strength was measured via a handheld dynamometer and quadriceps images were obtained via ultrasonography at hospital discharge. The ultrasonograms were used to obtain muscle thickness and both mean ± SD echogenicity of the rectus femoris, vastus lateralis, and vastus medialis. Partial correlations, controlling for age, body mass index, and fluid intake were used to describe the relationships among knee extensor strength and echogenicity and muscle thickness.

Results:

Knee extensor strength and vastus lateralis SD echogenicity were significantly correlated when controlling for age, body mass index, and fluid intake (r = 0.69, P = .029). Knee extensor strength and vastus lateralis echogenicity were 19.1 ± 8.0 kg and 19.8 ± 5.4 units, respectively. No other correlations between strength and ultrasound measures were found to be significant.

Conclusion:

These results show skeletal muscle echogenicity to be significantly correlated with skeletal muscle strength in patients with ARF. As such, it may be useful in identifying muscle weakness in these patients when they are unable or unwilling to perform voluntary strength testing.
Occupational Radiation Protection Aspects of Alkaline Leach Uranium in Situ Recovery (ISR) Facilities in the United States
Authors: Brown Steven H.
Published: April 2019

In situ recovery or in situ leach (ISR/ISL) uranium facilities, also referred to in the past as “uranium solution mining” have operated since the late 1960s in the US and in recent years have accounted for over 70% of US production and, internationally, approximately half of worldwide uranium supplies. Note that throughout this paper, the uranium in situ recovery process, also known as in situ leach, will be abbreviated as “ISR.” This paper presents a summary of the occupational radiation protection aspects of typical ISR processes being employed in the United States today that have traditionally used alkaline-based uranium recovery solutions known as lixiviants. The paper describes the health physics and associated monitoring programs necessary to adequately measure and control radiological doses to workers based on the radiological character of these processes. Although many radiological characteristics are similar to that of conventional mills, conventional-type tailings as such are not generated. However, liquid and solid by-product materials may be generated and impounded, which can result in sources of occupational exposure. Some special monitoring considerations are required due to the manner in which 222 Rn gas is involved in the process. The major aspects of the health physics and radiation protection programs that have been developed at these facilities over many years are discussed and listed in the Conclusion section of the paper.
Assessing the Committed Effective Dose From 226Ra in Thermal Spring Water From San Diego De Alcala, Chihuahua, Mexico
Authors: Villalba Lourdes , Colmenero-Sujo Luis , Rubio-Arias Héctor , Pinales-Munguia Adán , Mireles-García Fernando , Dávila-Rangel Ignacio , Pinedo-Vega José L. , Ochoa-Rivero Jesús
Published: April 2019

The oral administration of mineral-rich spring water is known as hydropinic treatment and is used to treat certain ailments. Health benefits are attributed to thermal spring water containing radioactive elements such as radium; this has popularized use of such radioactive water in various parts of the world, causing those who ingest it to increase their internal radiation dose. The goal of this study was to assess the activity concentrations of 226Ra present in the thermal spring waters of San Diego de Alcala, in the state of Chihuahua, Mexico, and to estimate the health risk posed to patients by the effective dose received from ingesting this water during hydropinic treatments. Water samples were taken from different areas of the San Diego de Alcala thermal springs, and pH, temperature, electrical conductivity, and total dissolved solids were measured. The 226Ra activity concentrations were measured with a liquid scintillation counter. The activity concentrations of 226Ra in sampled water varied from 125 to 452 mBq L−1 with an average of 276 ± 40 mBq L−1. The committed effective dose from each of the 226Ra activity concentrations found in samples ranged from 9.80 × 10−5 to 4.0 × 10−3 mSv for hydropinic treatments being carried out in San Diego de Alcala thermal spring spas. Different treatments had different intake rates (200, 600, 1,000, and 1,500 mL d−1) and occurred over periods of 2 or 3 wk. According to the guidelines of the US Environmental Protection Agency, the maximum permissible amount of radium in drinking water is 185 mBq L−1; the 226Ra content in most of the collected samples exceeded this limit. The committed effective doses varied with 226Ra concentration and intake rate; none exceeded the World Health Organization’s reference dose for drinking water of 0.1 mSv y−1, which is the maximum amount to which the population should be exposed.
Randomized Controlled Trial: Split-dose and Same-day Large Volume Bowel Preparation for Afternoon Colonoscopy Have Similar Quality of Preparation
Authors: Castro Fernando J. , Al-Khairi Baker , Singh Harjinder , Mohameden Mosaab , Tandon Kanwarpreet , Lopez Rocio
Published: April 2019

Goals:

We compare bowel cleanliness in patients taking same-day versus split-dose 4-L polyethylene glycol laxative for afternoon colonoscopy. Secondary objectives included patient satisfaction, adverse effects and patient tolerability.

Background:

Afternoon colonoscopies have been associated with inadequate bowel preparation and lower adenoma detection rates. Same-day (morning) or split-dosing of the laxative have improved preparation quality but differences between these options are unclear.

Materials and methods:

Single-center prospective randomized endoscopist blinded trial. Patients aged 18 years and above prescribed 4-L polyethylene glycol for colonoscopy were randomized into same-day or split-dose preparation. Preparation quality was assessed using the Ottawa Bowel Preparation Scale. Patient satisfaction and side effects was collected using a questionnaire. Intention-to-treat and per-protocol analysis were performed.

Results:

A total of 300 patients (158 split-dose, 142 same-day) were evaluated. No statistically significant difference was seen on total Ottawa score among the groups (P=0.47) or by individual colonic segments in intent-to-treat and per-protocol analysis. Patients in split-dose group were more likely to complete the entire preparation (P=0.01) but reported more sleep loss (P=0.001). The same-day preparation group reported higher incidence of vomiting (P=0.036). Patients ingesting bowel preparation ≥7 hours before colonoscopy had higher total Ottawa scores (P=0.001).

Conclusions:

There were no differences in quality of preparation in patients taking same-day versus split-dose preparation for afternoon colonoscopy. Those receiving same-day preparation were less likely to lose sleep but more likely to have emesis. These differences should be considered when selecting a bowel preparation regimen.
Methotrexate-associated primary hepatic lymphoma and cranial neuropathy in a patient with rheumatoid arthritis
Authors: Park Ji Eun , Lee Kyung Mi , Choi Hye Young , Ahn Sung Eun , You Myung-Won
Published: April 2019

Rationale:

Rheumatoid arthritis (RA) shows a variable clinical expression in patients. Articular disease is common manifestation, but patients may rarely present with extra-articular manifestation such as cranial neuropathy. Also, primary hepatic lymphoma (PHL) has rarely been reported in patient treated with immunosuppressive drug such as methotrexate (MTX) for RA. We herein describe a case of cranial neuropathy and MTX-related PHL in a woman receiving MTX for RA.

Patient concerns:

A 73-year-old women received MTX treatment for more than 5 years, presented with recurrent cranial neuropathies. During therapy of cranial neuropathies, liver enzyme levels were elevated.

Diagnoses:

The patient was diagnosed as RA by laboratory examination. A series of examinations had been launched to evaluate any possible cause of the extra-articular manifestation of the patient including ultrasound, computed tomography, magnetic resonance image (MRI) and positron emission tomography of the liver and MRI of the brain. Finally, the patient diagnosed as MTX-associated PHL and cranial neuropathy.

Interventions:

The patient underwent 4-year MTX therapy for RA at first with prednisolone. After that, she had been treated with cyclophosphamide therapy for cranial neuropathy. The liver biopsy was performed for hepatic lesion.

Outcomes:

MTX was discontinued, but no improvement of PHL and elevated liver enzyme was observed during the 3 weeks. The patient received 6 cycles of chemotherapy for 3 months and achieved complete remission including PHL and cranial neuronal lesion with symptom. No instances of relapse have occurred in 2 years of follow-up.

Lessons:

The present case is the extremely rare case in which MTX-related PHL and cranial neuropathy were involved together in the RA patient. It is necessary to examine long-term follow up hepatic and neurologic examinations that patient had a long history of receiving MTX therapy for RA.
The comparison of dexmedetomidine and ketamine for pediatric dental surgery
Authors: Qiu Jin , Luo Zhifang
Published: April 2019

Introduction:

Dexmedetomidine and ketamine are used for the sedation of pediatric dental surgery. We conduct a systematic review and meta-analysis to compare the sedation of dexmedetomidine and ketamine for pediatric dental surgery.

Methods:

PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) assessing the influence of dexmedetomidine versus ketamine on pediatric dental surgery are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. This meta-analysis is performed using the random-effect model.

Results:

Four RCTs involving 163 children are included in the meta-analysis. Compared with ketamine for pediatric dental surgery, dexmedetomidine results in comparable sedation level (very low quality, 2 RCTs, n = 40; Std. MD = −0.26; 95% CI = −0.74 to 0.23; P = .31), intraoperative analgesia scores (very low quality, 2 RCTs, n = 98; Std. MD = 0.17; 95% CI = −0.23 to 0.57; P = .40), postoperative analgesia scores (very low quality, 2 RCTs, n = 98; Std. MD = 0.23; 95% CI = −0.17 to 0.62; P = .27), DBP (very low quality, 3 RCTs, n = 123; Std. MD = −0.38; 95% CI = −1.04 to 0.27; P = .25) and SpO2 (very low quality, 3 RCTs, n = 123; Std. MD = 0.24; 95% CI = −0.20 to 0.69; P = .28), but significantly decreases heart rate (very low quality, 3 RCTs, n = 123; Std. MD = −1.51; 95% CI = −2.75 to −0.27; P = .02) and SBP (very low quality, 3 RCTs, n = 123; Std. MD = −0.62; 95% CI = −1.16 to −0.08; P = .02), longer recovery time (very low quality, 3 RCTs, n = 138; Std. MD = 1.74; 95% CI = 0.23 to 3.25; P = .02).

Conclusions:

Dexmedetomidine and ketamine have similar sedation, analgesia scores, and hemodynamic balance, but very low quality of the evidence (GRADE) is revealed in this meta-analysis.
Case report of Triumeq (abacavir/dolutegravir/lamivudine) associated rhabdomyolysis in a human immunodeficiency virus (HIV) infected patient
Authors: Saad Muhammad , Casado-Castillo Fernando , Kelly Paul
Published: April 2019

Rationale:

With the existence of the human immunodeficiency virus (HIV) infection as a chronic disease, more often adverse effects of its treatment with the various antiretroviral therapies (ARTs) available have been recognized. Going further, Triumeq has been associated with a myriad of adverse effects, of which rhabdomyolysis is rarely reported in the literature.

Patient concerns:

The patient presented with muscle tenderness over the lower limbs and dark brown-to-red colored urine.

Diagnosis:

Given the presenting symptoms, as well as the laboratory testing, including elevated serum creatine kinase and liver enzymes, the diagnosis of rhabdomyolysis was made.

Interventions:

Improvement was achieved rapidly after starting intravenous fluid therapy and with discontinuation of Triumeq.

Outcomes

After discharge, repeated creatine kinase levels in the clinic have been normal and decision was made to initiate another ART and until now, no further episodes of rhabdomyolysis have developed. Regular outpatient follow-up has been ongoing for over 1 year and no complications have been identified.

Lessons:

This case aims to recognize rhabdomyolysis as a rare, but possible adverse effect associated with the use of Triumeq for HIV-infected patients and therefore clinicians prescribing this combination should be aware of this potential side effect and counsel their patients accordingly.
Primary intracranial leiomyosarcoma in an immunocompetent patient
Authors: Li Xiu-Li , Ren Jing , Niu Run-Ning , Jiang Xiao , Xu Guo-Hui , Zhou Peng , Cheng Zhu-Zhong
Published: April 2019

Rationale:

Primary intracranial leiomyosarcoma (LMS) is an extremely rare tumor in the central nervous system (CNS), and usually seen in immunocompromised individuals. Only a few cases of primary intracranial LMS have been documented in the literature and no study focused on their MRI findings. We reported a case of primary intracranial leiomyosarcoma in a immunocompetent patient and review its imaging features.

Patient concerns:

A 20-year-old female was admitted to our hospital, complaining with nausea, weight loss and progressive headache in recent 2 years.

Diagnosis:

The magnetic resonance imaging scan of the brain revealed a large well-defined extra-cerebral mass adherent to left temporal meninges. The mass was iso-intense on T1-weighted images (T1WI), lightly iso to hypointense on T2-weighted images (T2WI) and enhanced uniformly with contrast medium. The preoperative diagnosis is meningioma.

Interventions:

A left craniotomy was performed for the complete resection of the mass.

Outcomes:

The lesion was diagnosed via surgical histopathology and immunochemistry as leiomyosarcoma. No evidence of recurrence and complications were found in the following 13 months.

Lessions:

Primary intracranial leiomyosarcoma which has some special MR imaging features should be considered in the differential diagnosis of intracranial tumor.
A comparative evaluation of tibial metaphyseal-diaphyseal angle changes between physiologic bowing and Blount disease
Authors: Park Byoung Kyu , Park Kun Bo , Kwak Yoon Hae , Jin Seokhwan , Kim Hyun Woo , Park Hoon
Published: April 2019

The purpose of this study was to estimate the rate of spontaneous improvement in tibial metaphyseal-diaphyseal angle (TMDA) in physiologic bowing in comparison to that in Blount disease and to provide reference values of TMDA for monitoring patients with highly suspected to have Blount disease.

We retrospectively reviewed patients with physiologic bowing meeting the following criteria:

(1) TMDA greater than 9° before 36 months of age at initial evaluation;

(2) two or more standing long bone radiographs available; and

(3) follow-up conducted up to resolution of deformity.

Patients with Blount disease had

(1) more than 2 standing long bone radiographs obtained before 36 months of age and

(2) underwent no treatment during the period in which these images were obtained.

TMDA measurements were obtained from 174 patients with physiologic bowing and 32 patients with Blount disease. Rates of TMDA improvement were adjusted by multiple factors using a linear mixed model, with sex and laterality as fixed effects and age and individual patients as the random effects.

In the physiologic bowing group, TMDA improved significantly, by 3° per 6 months and by 6° per year. Changes in TMDA were not significant in the Blount disease group.

Knowing the rate of TMDA change can be helpful for physicians seeking to monitor infants with suspected as having Blount disease with a high TMDA and to avoid unnecessary repeat radiographic evaluations.
Effects of preoperative oral management by dentists on postoperative outcomes following esophagectomy
Authors: Shin Jung-ho , Kunisawa Susumu , Fushimi Kiyohide , Imanaka Yuichi
Published: April 2019

The purpose of this study was to investigate the effects of preoperative oral management (POM) by dentists on the incidence of postoperative pulmonary complications (PPCs), length of hospital stay, medical costs, and days of antibiotics administration following both open and thoracoscopic esophagectomy.

Dental plaque is an established risk factor for postoperative pneumonia, which could be reduced by POM. However, few clinical guidelines for cancer treatment, including those for esophageal cancer, recommend POM as routine perioperative care.

We extracted data of esophagectomy cases from the Japanese Diagnosis Procedure Combination database. We subsequently conducted propensity score (PS) analyses for multilevel data, including matching, inverse probability of treatment weighting (IPTW), and standardized mortality ratio weighting (SMRW), to estimate the effect of POM by dentists on the outcomes of esophagectomy.

We analyzed 3412 esophagectomy cases of which 812 were open, and 2600 were thoracoscopic surgery. In IPTW analysis to estimate the average treatment effect, the risk difference of postoperative aspiration pneumonia ranged from –2.49% to –2.02% between the POM and control groups of both open and thoracoscopic esophagectomy cases. IPTW analyses indicated that the total medical costs of thoracoscopic esophagectomy were reduced by 221,200 to 253,100 Japanese Yen (equivalent to about $2000–$2200). In PS matching and SMRW analyses to estimate average treatment effect on treated, there was no difference in outcomes between the POM and control groups.

Our results suggested that in patients undergoing open or thoracoscopic esophagectomy, POM by dentists prevented the occurrence of postoperative aspiration pneumonia. It could also reduce the total medical costs of thoracoscopic esophagectomy. Thus, POM by dentists can be considered as a routine perioperative care for all patients undergoing esophagectomy, regardless of the expected risk for PPC.
Efficacy of artificial femoral head replacement for femoral head avascular necrosis
Authors: Wang Shou-Feng , Ji Qing-Hui , Qiao Xiao-Feng , Zhao Peng , Xue Yu , Li Yan-Bao
Published: April 2019

Background: Femoral head avascular necrosis (FHAN) is one of the most common progressive orthopedic disorders. Previous studies have reported that artificial femoral head replacement (AFHR) can effectively treat patients with FHAN. However, no systematic review has investigated the efficacy of AFHR for FHAN. This study will assess the efficacy of AFHR for patients with FHAN.

Methods: We will search MEDLINE, EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure up to March 1, 2019 without any restrictions. Any randomized controlled trials for assessing the efficacy of AFHR for patients with FHAN. The methodological quality for each eligible study will be assessed by using Cochrane risk of bias tool. Statistical analysis will be conducted by using RevMan 5.3.

Results: This study will provide current evidence of AFHR for patients with FHAN from several aspects, including pain intensity, function, and limitation of femoral head, health-related quality of life, and safety.

Conclusion: This study will provide latest evidence on assessing the efficacy and safety of AFHR for FHAN.

PROSPERO registration number: PROSPERO CRD42019126249.
Alpha-fetoprotein to transaminase ratio is related to higher diagnostic efficacy for hepatocellular carcinoma
Authors: Liu Xu , Meng Jing , Xu Hongqin , Niu Junqi
Published: April 2019

Alpha-fetoprotein (AFP), as the most widely used biomarker of hepatocellular carcinoma (HCC), was correlated with ongoing liver damage. The aim of this study was to evaluate the ability of inflammatory correction-based AFP to identify HCC from other liver diseases.

From March 2012 to March 2017, among 926 participants, a total of 501 patients whose transaminases were higher than the upper limit of normal range, including 166 treatment-naïve HCC patients were enrolled in our retrospective study. The liver function, white blood cell (WBC) count and serum AFP level of all patients were collected at the initial stage of admission. The area under the receiver-operating curve (AUROC) of AFP, AFP/(Aspartate aminotransferase∗Alanine aminotransferase) [AFP/(AST∗ALT)] and AFP/WBC were compared between the HCC group and the control groups for the quantifying diagnostic efficacy.

AUROCs of our novel index AFP/(AST∗ALT) were up to 0.853 (95% confidence interval, CI 0.818–0.887, P < .001) and 0.825 (95% CI 0.782–0.868, P < .001), respectively, when differentiating HCC from non-HCC patients and from cirrhosis patients, which was superior to AFP and AFP/WBC. Diagnostic performance of AFP/(AST∗ALT) could be verified in hepatitis B virus (HBV)- or hepatitis C virus (HCV)-associated HCC patients as well. What's more, AFP/(AST∗ALT) had a significant positive and moderate correlation with tumor diameter and presence of cancerous emboli or not (Spearman correlation coefficients were 0.323 and 0.305, respectively; both P < .001). For predicting HCC, the optimal cut-off value of AFP/(AST∗ALT) is 1.603, and the sensitivity and specificity were 82.8% and 72.7%, respectively, which were significantly higher than the AFP and AFP/WBC.

The serum AFP levels based on correction of liver inflammation can effectively improve the diagnostic performance of HCC, providing a new indicator that is simple, economical and pervasive for clinic.
Is There a Safety Signal for Dolutegravir and Integrase Inhibitors During Pregnancy?
Authors: Chouchana Laurent , Beeker Nathanael , Treluyer Jean-Marc
Published: April 2019

Background:

Dolutegravir, an integrase strand transfer inhibitor (InSTI), is a major antiretroviral agent for HIV infection. Its use is promising, especially in low- and middle-income countries, because of a high resistance barrier and a good safety profile. Very recently, a World Health Organization safety signal has been raised regarding neural tube defects after the first-trimester exposure. Furthermore, to date, the experience is limited regarding the use of the other InSTI drugs (raltegravir and elvitegravir) during pregnancy. Our objective is to analyze the safety of InSTI drugs in pregnant women.

Setting:

Nation-wide database cohort analysis.

Methods:

We evaluated the risk of major birth defects according to EUROCAT classification in pregnant women, which had had a first-trimester exposure to dolutegravir, raltegravir, or elvitegravir.

Results:

We found a major birth defect rate of 1.9% in the general population between 2012 and 2016. As InSTI drugs are not used as first-line therapy in pregnant women, we found a very low exposure in this population. Among 49, 240, and 70 pregnancy outcomes exposed to dolutegravir, raltegravir, and elvitegravir, respectively, during the first trimester, there were 2, 3, and 1 major birth defects, respectively. There was no case of neural tube defect.

Conclusions:

Drug exposure to InSTI is limited in our nation-wide database. Nevertheless, our data do not support a pharmacovigilance signal on neural tube defects in women exposed to dolutegravir, raltegravir or elvitegravir during pregnancy. Owing to a small number of pregnancy outcomes, these results need to be confirmed with further studies.
Immune memory characteristics of innate lymphoid cells
Authors: Placek Katarzyna , Schultze Joachim L. , Netea Mihai G.
Published: April 2019

Purpose of review

Immune memory is essential for host defense against invaders and it is also used as a basis for vaccine development. For these reasons, it is crucial to understand its molecular basis. In this review, we describe recent findings on memory characteristics of innate-like lymphocytes and its contribution to host protection. 

Recent findings

In addition to adaptive immune cells, innate cells are also able to mount memory responses through a process called ‘trained immunity.’ Importantly, the lymphoid lineage is not restricted to cells carrying specific T-cell or B-cell receptors, but include cells with germline-encoded receptors. Recent studies show that these innate-like lymphocytes are able to generate efficient recall responses to reinfection. In different circumstances and depending on the cell type, innate-like lymphocyte memory can be antigen-specific or unspecific. Epigenetic changes accompany the generation of memory in these cells, but are still poorly defined.

Immune memory is not restricted to antigen-specific cells, but also encompass different populations of innate immune cells. Innate-like lymphocytes embrace features of both innate and adaptive immune memory, and thus bridge adaptive and innate immune characteristics.
Update and advances in community acquired bacterial meningitis
Authors: Hasbun Rodrigo
Published: April 2019

Purpose of review

Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens.

Recent findings

Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Delaying lumbar puncture is associated with increased costs in both adults and children with meningitis and previous antibiotic therapy impacts the yield of microbiological results. Delaying antibiotic therapy is associated with worse clinical outcomes. Adjunctive steroids have reduced the mortality of adults with pneumococcal meningitis but have been associated with increased adverse outcomes in Listeria monocytogenes and Cryptococcus neoformans.

Community-acquired bacterial meningitis remains a global health concern with high morbidity and mortality especially in low-income countries. Cranial imaging should be done only in patients with an indication with an attempt to do a prompt lumbar puncture and to initiate antibiotic therapy and adjunctive steroids as soon as possible to improve clinical outcomes.
Update on spinal epidural abscess
Authors: Babic Maja , Simpfendorfer Claus S. , Berbari Elie F.
Published: April 2019

Purpose of review

Spinal epidural abscess (SEA) is still a rare but potentially very morbid infection of the spine. In recent years, the incidence has risen sharply but the condition remains a medical conundrum wrought with unacceptably long diagnostic delays. The outcome depends on timely diagnosis and missed opportunities can be associated with catastrophic consequences. Management and outcomes have improved over the past decade. This review focuses on risk factors and markers that can aid in establishing the diagnosis, the radiological characteristics of SEA on MRI and their clinical implications, as well as the importance of establishing clear indications for surgical decompression.

Recent findings

This once exclusively surgically managed entity is increasingly treated conservatively with antimicrobial therapy. Patients diagnosed in a timely fashion, prior to cord involvement and the onset of neurologic deficits can safely be managed without decompressive surgery with targeted antimicrobial therapy. Patients with acute cord compression and gross neurologic deficits promptly undergo decompression. The greatest therapeutic dilemma remains the group with mild neurological deficits. As failure rates of delayed surgery approach 40%, recent research is focused on predictive models for failure of conservative SEA management. In addition, protocols are being implemented with some success, to shorten the diagnostic delay of SEA on initial presentation.

SEA is a potentially devastating condition that is frequently missed. Protocols are put in place to facilitate early evaluation of back pain in patients with red flags with appropriate cross-sectional imaging, namely contrast-enhanced MRI. Efforts for establishing clear-cut indications for surgical decompression of SEA are underway.
Is There an Advantage to Minimizing Surgery in Scaphocephaly? A Study on Extended Strip Craniotomy Versus Extensive Cranial Vault Remodeling
Authors: De Praeter Mania , Nadjmi Nasser , Reith Florence C.M. , Vercruysse Herman , Menovsky Tomas
Published: April 2019

Background:

Different techniques have been described to correct scaphocephaly. In authors’ institution, total cranial vault remodeling (TCVR) was the standard of care. To limit the extent of surgery and the need for transfusion, the technique was minimized to extended strip craniectomy (ESC) without helmet therapy. This retrospective study compares outcome and morbidity between ESC and TCVR.

Methods:

Twenty-seven scaphocephalic patients were included. The ESC was performed in 9 patients between 2012 and 2014, and TCVR in 17 patients between 2008 and 2016. Data on blood loss and transfusion rate, duration of surgery, length of hospital stay (LOS), head circumference, and cephalic index (CI) were collected retrospectively. A cosmetic outcome score (COS) was developed to rate esthetic outcome since CI is a limited and crude measurement of cosmetic outcome.

Results:

The LOS was identical in both groups, but duration of surgery was significantly shorter in ESC (P < 0.0001). Transfusion rate appeared higher in the TCVR group, but differences were not significant (P = 0.11). Cosmetic outcome appeared slightly worse in the ESC group, but results were not significantly different (P = 0.66). There was, however, a significant improvement in postoperative CI in the TCVR group (P < 0.0001).

Conclusion:

The only advantage of ESC was the reduced duration of surgery, but this could not prevent the need for transfusion in this group of patients. The improvement of the CI was significantly less pronounced after ESC, but the COS was not significantly worse in the ESC group. The scar and LOS were similar in both groups. Therefore, our findings indicate that minimizing TCVR to ESC without helmet therapy does not provide significant advantages.
Analysis of Facial Injuries in Motor Vehicle Accidents According to the Location of the Seat and Seat-Belt Use
Authors: Kim Sue Min , Ha Non Hyeon , Hahn Hyung Min , Lee Il Jae , Park Myong Chul , Park Dong Ha
Published: April 2019

The purpose of this study was to evaluate facial trauma in accidents involving a passenger car. In particular, the authors assessed differences in types of facial trauma and severity according to the location of the seat and seat-belt use. A 7-year retrospective review of data was conducted for 419 patients with facial trauma resulting from motor vehicle accidents. Patients who used a seat belt faced a lower risk of severe soft-tissue injury in comparison with having mild soft-tissue injury than patients who did not use a seat belt (P = 0.0129). Additionally, patients who used a seat belt had a lower risk of accompanying facial bone fracture requiring surgical operation than patients who did not use a seat belt (P = 0.0168). In terms of facial bone fracture according to seat location, patients who had sat in the back seat had more risk of accompanying facial bone fracture than patients who had sat in the passenger's seat (P = 0.0392). In terms of facial bone fractures requiring surgical operation, the patients who had sat in a back seat faced more risk of needing a surgical operation than patients who had sat in the driver's seat (P = 0.0479). The results of the study reveal that wearing a seat belt effectively reduces severe facial soft-tissue injury and facial bone fracture requiring surgical operation. In particular, the authors note that sitting in a back seat is riskier in terms of facial bone injury than sitting in a front seat.
Strain and Shear Wave Elastography in Diagnosis of Retrobulbar Neuritis
Authors: Oğurel Tevfik , Burulday Veysel
Published: April 2019

Background:

In the early stages of retrobulbar neuritis (RN), the optic disc appears normal on ophthalmoscopy. Therefore, the diagnosis of RN is usually made clinically. However, imaging tools are needed for precise diagnosis of RN, and usually MRI is used. In this study, we investigated the diagnostic performance of strain elastography (SE) and shear wave elastography (SWE) in patients with RN. Elastography is a new sonographic technique and a noninvasive ultrasound method for evaluating the elastic properties of tissues based on static compression: the elastographic techniques of SE compress the tissues axially, and SWE uses waves that are generated by transducers and interact with the tissue.

Methods:

The study included 40 eyes of 20 patients with sudden visual loss, who were diagnosed with RN. The eyes of the patients were divided into 2 groups: the eye with a diagnosis of RN was the group of RN eyes, and the healthy second eye was the group of control eyes. Ophthalmologic examination, orbital and brain MRI, SE, and SWE were performed. SE color mapping was divided into 3 types: blue-hardest tissue (Type 1), blue/green-hard tissue (Type 2), and green-intermediate tissue (Type 3). All patients were treated with high-dose corticosteroids. The measurements of SE and SWE were made immediately after diagnosis and 1 month after treatment.

Results:

The mean age of 11 male and 9 female patients was 38.3 ± 12.2 years. At the time of diagnosis, the mean shear wave values for the control eyes were 18.47 ± 7.26 kPa (kilopascals), and the mean shear wave values for the RN eyes were 37.21 ± 8.24 kPa. There was a statistically significant difference between the control and RN eyes at the time of diagnosis (P < 0.001). The mean shear wave value was 19.92 ± 4.77 kPa in the RN eyes after treatment. There was a statistically significant difference in values at the time of diagnosis and after treatment (P < 0.001). Strain types found in the RN eyes before treatment were Type 1 in 60% of eyes, Type 2 in 25%, and Type 3 in 15%; at the end of the treatment, Type 2 was observed in 25% of eyes and Type 3 in 75%, while Type 1 was not observed.

Conclusions:

SE and SWE may be important alternative diagnostic tools in the diagnosis of RN.