bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Associated With Prolonged Mechanical Ventilation and Reventilation in Acute Cervical Spinal Cord Injury Patients
Authors: Wang Hung-Chen , Chen Kuan-Yi , Lin Yu-Tsai , Chen Wu-Fu , Liaw Mei-Yun , Lin Yu-Jun , Shih Fu-Yuan , Hsu Shih-Yuan , Tsai Nai-Wen , Lin Meng-Chih , Lu Cheng-Hsien
Published: October 2019

Mini

In this study, respiratory function at the time of extubation can be useful optimal clinical guidelines for weaning and extubation attempts in patients with acute cervical spinal cord injury. Serum thiobarbituric acid-reactive substances level at admission can be a useful predictor for severity in acute cervical patients with spinal cord injury.

Study Design.

Patients who had suffered from acute blunt cervical spinal cord injury (SCI) and admitted our hospital within 24 hours after injury were included in the study.

Objective.

We compared the respiratory function and serum reactive oxidative stress (ROS) after acute cervical SCI, and tried to find out the valuable predictors of weaning in patients with acute cervical SCI.

Summary of Background Data.

Ventilation impairment is a major complication of acute cervical SCI. Evidence of oxygen radical formation in secondary injury from animal SCI models demonstrates an immediate postinjury increase in ROS production after SCI. We hypothesize that the serum ROS is associated with the severity of patients with acute cervical SCI.

Methods.

Thirty-eight adult patients who had acute cervical SCI and 58 healthy volunteers were enrolled. Respiratory function at admission, at the time of extubation and at 48 hours after extubation, serum oxidative stress, Injury Severity Score and Japanese Orthopaedic Association score at admission were compared.

Results.

The most notable predictor of mechanical ventilation more than 48 hours was serum thiobarbituric acid-reactive substances (TBARS) level at admission (P = 0.027), and the cut-off value of serum TBARS level was 731.7 μmol/L (sensitivity 87.5% and specificity 78.9%). For the reventilation ≤5 days, the notable predictors were respiratory function at the time of extubation (maximal inspiratory pressure, P = 0.040; maximal expiratory pressure, P = 0.020; and tidal volume, P = 0.036) and serum TBARS level at admission (P = 0.013), the cut-off value of serum TBARS level at admission was 762.3 μmol/L (sensitivity 100% and specificity 90.0%).

Conclusion.

In this study, respiratory function (maximal inspiratory pressure, maximal expiratory pressure, and tidal volume) at the time of extubation can be useful optimal clinical guidelines for weaning and extubation attempts in patients with acute cervical SCI. Serum TBARS level at admission can be a useful predictor for severity in acute cervical SCI patients.

Level of Evidence: 3
Intramedullary Nailing of a Periprosthetic Intertrochanteric Fracture in the Setting of Prior Hip Resurfacing: A New Technique for Fracture Fixation
Authors: Vajapey Sravya P. , Li Mengnai
Published: October 2019

We report the case of a 61-year-old male individual with a history of left hip resurfacing arthroplasty who sustained a left intertrochanteric fracture after a mechanical fall. While prior reports have described internal fixation with a femoral reconstruction nail or small frag locking compression plate for periprosthetic intertrochanteric fractures sustained around a Birmingham resurfacing prosthesis, our case is unusual in that the fracture extended into the lesser trochanter as well as the basicervical femoral neck. We present our technique for fracture fixation with a lateral entry femoral reconstruction nail and a derotation screw for this unstable injury as an alternative to currently available treatment options, which are limited to revision total hip arthroplasty.
Melanocytic Skin Neoplasms: What Lesson From Genomic Aberrations?
Authors: Urso Carmelo
Published: October 2019

Studies on the genomic aberrations in melanocytic neoplasms have shown a complex genomic landscape. In nevi and melanomas, a MAP-kinase pathway activation was generally found, produced by different chromosomal aberrations, including BRAF, NRAS, HRAS, GNAQ, GNA11, BAP1, CTNNB1, MAP2K1, PRKAR1A, and NF1 mutations, and ALK, ROS1, NTRK1, RET, MET, BRAF, NTRK3, and PRKCA fusions. Melanomas also showed a variable number of additional mutations ablating tumor-suppression mechanisms and activating other oncogenic pathways, including CDKN2A loss, PTEN loss, as well as TP53 and TERT-promoter mutations. Moreover, borderline melanocytic tumors displayed the same chromosomal aberrations, but more mutations than nevi and fewer than melanomas. In this context, the notion that melanocytic neoplasms can be classified as benign/malignant is hardly supportable, because all neoplasms harbor a certain number of mutations and the progression risk, that is, the malignant potential, is related and proportional to the burden of pathogenic mutations. Moreover, from the genomic analysis, in parallel to the current diagnostic categories of “nevi,” “melanomas,” and “melanocytomas,” some aggregations or classes of tumors based on the characteristic types of driver mutations/fusions emerge as possible and more rationale, including Spitzoid neoplasms, blue neoplasms, BAP1-inactivated melanocytic neoplasms, deep penetrating melanocytic neoplasms, pigment-synthesizing melanocytic neoplasms, and “common” melanocytic neoplasms. Each of these classes, showing the same driver mutations/fusions, demonstrates to have the same pathogenesis and may be genetically considered as a single tumor, although with a variable amount of progression risk. Histologic features, being an expression of the mutational state, could be used to obtain an approximate risk assessment in each single tumor.
CD137-CD137L Signaling Affects Angiogenesis by Mediating Phenotypic Conversion of Macrophages
Authors: Xu Yao , Yan Yang , Geng Tianxin , Wang Cuiping , Xu Yu , Yang Ping , Yan Jinchuan
Published: October 2019

Background:

Angiogenesis in atherosclerotic plaque is an important factor causing plaque hemorrhage, vulnerability, and rupture, and different phenotypes of macrophages have different effects on angiogenesis. Our previous study has demonstrated CD137-CD137L signaling, a pair of inflammatory costimulatory molecules, can promote angiogenesis in atherosclerotic plaque. Therefore, we aimed to investigate whether this signaling could affect angiogenesis by regulating phenotypic transition of macrophages.

Methods:

Male mouse primary peritoneal macrophages were extracted by intraperitoneal injection of thioglycollate, and then flow cytometry was used to detect the expression of CD137. Flow cytometry, Western blotting, quantitative real-time PCR, and enzyme-linked immunosorbent assay (ELISA) were used to assess the phenotypic changes of macrophages after different treatment. Mouse brain microvascular endothelial cells (bEnd.3) were cocultured with macrophages, and tube formation was assessed to examine angiogenesis.

Results:

We found that the number of junctions and branches of bEnd.3 were increased when CD137-CD137L signaling was activated, while such number was further increased when bEnd.3 were cocultured with macrophages. Flow cytometry showed that CD137 was expressed on almost all primary peritoneal macrophages. The expression of CD86 was decreased in the agonist CD137L group and increased in the agonist CD137L + inhibitory anti-CD137 antibody group after adding the CD137 inhibitor. The expression of CD206 in each group exhibited opposite trend compared with CD86. Moreover, the expression of inducible nitric oxide synthase at the mRNA, and protein levels were decreased after stimulating CD137-CD137L signaling, and such downward trend was reversed when CD137-CD137L signaling was inhibited. Furthermore, the expression of arginase-1 was opposite to that of inducible nitric oxide synthase. Enzyme-linked immunosorbent assay indicated that the content of interleukin-12 (IL-12) in the supernatant of macrophages in the agonist CD137L group was lower than that in the control group, and its content in the inhibited group was higher than that in the activated group. The change of interleukin-10 (IL-10) content in macrophage supernatant was opposite to that of IL-12. When AKT serine/threonine kinase 1 (Akt1) inhibitor was used to inhibit the phenotypic transformation of macrophages induced by CD137-CD137L, the number of junctions and branches formed by bEnd.3 was decreased compared with the coculture group.

Conclusions:

These results indicated that CD137-CD137L signaling could promote angiogenesis by regulating phenotypic transition of macrophages of male mice.
Myocardial Phosphodiesterases and Their Role in cGMP Regulation
Authors: Dunkerly-Eyring Brittany , Kass David A.
Published: October 2019

Cyclic nucleotide phosphodiesterases comprise an 11-member superfamily yielding near 100 isoform variants that hydrolyze cAMP or cGMP to their respective 5′-monophosphate form. Each plays a role in compartmentalized cyclic nucleotide signaling, with varying selectivity for each substrate, and conveying cell and intracellular-specific localized control. This review focuses on the 5 phosphodiesterases (PDEs) expressed in the cardiac myocyte capable of hydrolyzing cGMP and that have been shown to play a role in cardiac physiological and pathological processes. PDE1, PDE2, and PDE3 catabolize cAMP as well, whereas PDE5 and PDE9 are cGMP selective. PDE3 and PDE5 are already in clinical use, the former for heart failure, and PDE1, PDE9, and PDE5 are all being actively studied for this indication in patients. Research in just the past few years has revealed many novel cardiac influences of each isoform, expanding the therapeutic potential from their selective pharmacological blockade or in some instances, activation. PDE1C inhibition was found to confer cell survival protection and enhance cardiac contractility, whereas PDE2 inhibition or activation induces beneficial effects in hypertrophied or failing hearts, respectively. PDE3 inhibition is already clinically used to treat acute decompensated heart failure, although toxicity has precluded its long-term use. However, newer approaches including isoform-specific allosteric modulation may change this. Finally, inhibition of PDE5A and PDE9A counter pathological remodeling of the heart and are both being pursued in clinical trials. Here, we discuss recent research advances in each of these PDEs, their impact on the myocardium, and cardiac therapeutic potential.
Vitamin D insufficiency increases risk of chronic pain among African Americans experiencing motor vehicle collision
Authors: Mauck Matthew C. , Linnstaedt Sarah D. , Bortsov Andrey , Kurz Michael , Hendry Phyllis L. , Lewandowski Christopher , Velilla Marc-Anthony , Datner Elizabeth , Pearson Claire , Domeier Robert , Fillingim Roger B. , Beaudoin Francesca L. , Ting Jenny P. , McLean Samuel A.
Published: October 2019

African Americans experience an increased burden of motor vehicle collision (MVC), post-MVC musculoskeletal pain, and vitamin D insufficiency. In this prospective multicenter study, we tested the hypothesis that African Americans (n = 133) presenting to the emergency department after MVC with low peritraumatic vitamin D levels would have worse chronic musculoskeletal pain outcomes compared to individuals with sufficient vitamin D. Vitamin D levels were assessed in the early aftermath of MVC through enzyme-linked immunosorbent assay, and pain severity was assessed using the 0 to 10 numeric rating scale at 6 weeks, 6 months, and 1 year. In repeated-measures analysis, African American MVC survivors with vitamin D insufficiency experienced more severe chronic pain (β = 1.18, P = 0.031). In secondary analyses, we assessed for evidence that the effect of vitamin D on post-MVC pain outcomes is mediated, at least in part, by the influence of vitamin D on genetic variants in genes involved in immune system regulation (IL-10 and NLRP3). Genotyping was performed using a genome-wide microarray using collected DNA samples. Secondary analyses suggest that the effect of vitamin D on post-MVC pain outcomes may be influenced by genetic variation in IL-10 and NLRP3. Further studies are needed to assess the impact of vitamin D insufficiency on pain outcomes in African Americans experiencing MVC and other common trauma exposures, to assess factors affecting this relationship, and to assess the efficacy of administering vitamin D in the immediate aftermath of MVC to prevent chronic pain. Such low-cost, nonopioid interventions are urgently needed to address chronic pain development after MVC.
A population-based study of inflammatory mechanisms and pain sensitivity
Authors: Iordanova Schistad Elina , Kong Xiang Yi , Furberg Anne-Sofie , Bäckryd Emmanuel , Grimnes Guri , Emaus Nina , Rosseland Leiv Arne , Gordh Torsten , Stubhaug Audun , Engdahl Bo , Halvorsen Bente , Nielsen Christopher Sivert
Published: October 2019

Two recent studies suggest that experimental pain sensitivity is associated with low-grade systemic inflammation. However, only 2 biomarkers have been identified, and the studies were conducted in adult individuals where confounding effects of comorbid diseases cannot be excluded. We therefore tested associations between pain sensitivity and 119 inflammation-related serum biomarkers in 827 healthy adolescents (15-19 years) in the population-based Tromsø Study: Fit Futures. The main outcome measure was cold-pressor pain tolerance (CPT), tested by placing the dominant hand in circulating cold (3°C) water for a maximum of 105 seconds. Secondary outcomes were heat and pressure pain threshold and tolerance. Twelve proteins and 6 fatty acids were significantly associated with CPT after adjustment for possible confounding factors and correction for multiple comparisons. Of these, all fatty acids and 10 proteins were protective, ie, higher biomarkers levels were associated with increased CPT, whereas 2 biomarkers were associated with lower tolerance. Taken together, these biomarkers predicted completion of the tolerance test with a C-statistic of 0.65. Results for heat and pressure pain tolerance were remarkably similar, strengthening the generalizability of our findings. In this cohort of young healthy individuals, we found a relationship between inflammation-related biomarkers and pain tolerance and thresholds. Biomarkers with anti-inflammatory and analgesic effects predominated, suggesting that the development of prophylactic dietary or pharmaceutical treatments may be possible.
Health information–seeking behaviors and adherence to urgent care discharge instructions
Authors: Alberti Traci L. , Crawford Sybil L.
Published: October 2019

Background:

Although studies suggest that most patients use healthcare professionals as the main source of health information, the ease of Internet access has resulted in a growing number of people who seek health information from other sources. Health information–seeking skills and patterns may influence follow-through with treatment recommendations.

Purpose:

The purpose of this study was to explore the health information–seeking behaviors (HISBs) of urgent care (UC) patients and the association to adherence to discharge instructions.

Methods:

A HISB questionnaire was administered to adults presenting for care at a UC clinic. A repeated measure of HISB and the Medical Outcomes Study General Adherence Scale were administered 10–14 days after UC visit. Descriptive and bivariate analyses determined HISB and their association with discharge instruction adherence.

Results:

Two hundred ten patients completed all surveys. Family and friends were the most common health information source used both before and after an UC visit. Seeking health information through family/friends after the visit was negatively associated with adherence (covariate adjusted p value, .0003).

Implications for practice:

At times of episodic illness, patients tend to seek health information from family and friends with greater frequency than traditional medical, online, or paper sources. Nurse practitioners working in UC or emergent care settings should include family and friends at the time of discharge teaching because patients may use these sources for additional health information, which may affect instruction adherence.
Bronchoscopy for Chronic Unexplained Cough
Authors: Heching Moshe , Rosengarten Dror , Shitenberg Dorit , Shtraichman Osnat , Abdel-Rahman Nader , Unterman Avraham , Kramer Mordechai R.
Published: October 2019

Background:

Prior studies assessing the diagnostic utility of bronchoscopy for chronic unexplained cough have focused primarily on identifying endobronchial anomalies to determine chronic cough etiology. On the basis of our institutional experience, expanding bronchoscopy to include cultures and biopsies can considerably increase its diagnostic yield for identifying the etiology of chronic unexplained cough.

Materials and Methods:

This retrospective review analyzed bronchoscopies conducted in our institution between 2013 and 2017. Eligibility criteria were bronchoscopies conducted for chronic unexplained cough for which no etiology had been identified before the bronchoscopy. Microbiology, pathology, and cytology results from bronchoscopy were reviewed to identify the etiology of the cough.

Results:

Over the study period, 169 bronchoscopies met the eligibility criteria. The average patient age at bronchoscopy was 59.7±14.8 years; 61% were female individuals. Direct visualization identified anatomic etiologies in 48 (28%) patients, most commonly tracheobronchomalacia, and less common conditions, such as tracheobronchopathia osteochondroplastica. Microbiology cultures were positive in 33 (20%) patients, principally Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and nontuberculosis mycobacterium. Pathology results from endobronchial biopsies identified respiratory conditions associated with cough, primarily eosinophilic bronchitis (n=15), as well as neurofibromatosis (n=1) and amyloidosis (n=1). Cytology results did not reveal alternate diagnoses not previously identified.

Conclusion:

Inclusion of bronchial washings and endobronchial biopsies during bronchoscopy for chronic unexplained cough increased diagnostic yield from 28%, attributable to directly visualized anatomic etiologies, to 41%. The addition of microbiology cultures and pathology analysis significantly increased the diagnostic yield of bronchoscopy in identifying the potential etiology of chronic heretofore unexplained cough.
Periprocedural myocardial and renal injury in patients undergoing elective percutaneous coronary interventions – is there an association?
Authors: Stipinovic Mario , Percin Luka , Radonic Vedran , Jerkic Helena , Jurin Ivana , Letilovic Tomislav
Published: October 2019

Periprocedural myocardial injury (PMI) and contrast-induced nephropathy (CIN) are frequent complications of percutaneous coronary intervention (PCI) associated with early and late major adverse cardiovascular events. Both conditions are associated with similar risk factors, which could imply their possible association. The aim of our study was to assess the correlation of PMI and early postprocedural creatinine shift (ECS) as a marker of renal injury.

A total of 209 hospitalized patients with stable coronary artery disease (CAD) were enrolled, who underwent an elective PCI in a period of 12 months. All patients had their serum high-sensitivity troponin I (hsTnI) measured at baseline and 16 hours after the PCI. PMI was defined according to the elevation of postprocedural hsTnI using criteria provided by both the most recent consensus documents as well as evidence-based data. Renal injury was evaluated using the ECS concept. Serum creatinine (SCr) was also measured at baseline and at 16 hours. ECS was defined as SCr >5% at 16 hours compared to baseline.

Although incidence of both PMI (77.5%) and ECS (44.5%) were high, no association of these 2 conditions could be found. Further analyses of our data showed that diabetes is associated with a higher incidence of ECS, while patients on beta-blocker therapy had a lower incidence of ECS.

In our study, no association between PMI and ECS was found. Additional studies with a larger number of patients and longer patient observation are needed to assess the correlation between PMI and CIN as well as to validate the attractive, but controversial, concept of ECS as an early marker of CIN.
Diffuse pulmonary lymphangiomatosis
Authors: Yu Wencheng , Mi Liyun , Cong Jinpeng , Cheng Wei , Chen Yunqing , Gong Haihong
Published: October 2019

Rationale:

Diffuse pulmonary lymphangiomatos (DPL) is a rare aggressive lymphatic disorder characterized by proliferation of anastomozing lymphatic vessels and extremely rare in adult patients.

Patient concerns:

We report a case of diffuse pulmonary lymphangiomatosis in 59-year-old man presented with cough and sputum for 2 months.

Diagnoses:

Combining clinical manifestations with results of radiological, bronchoscopy, and surgical lung biopsy, it was consistent with the diagnosis of DPL.

Interventions:

After bronchoalveolar lavage and biopsy, symptom of cough got worse suddenly accompanied by excessive chyloptysis. The patient received an emergency surgical intervention and low fat medium chain fat treatment.

Outcomes:

The patient was discharged with a much better health condition.

Lessons:

This case report is the oldest patient reported in the English literature, to the best of our knowledge. Serious complications of bronchoscopy should be considered, especially in DPL patients with severely enlarged mediastinum or with thin-walled translucent vesicles under endoscopy.
Prognostic value of high stanniocalcin 2 expression in solid cancers
Authors: Hu Lixia , Zha Yanyan , Kong Fanliang , Pan Yueyin
Published: October 2019

Background:

Several studies have explored the prognostic value of stanniocalcin 2 (STC2) in various cancers, but obtained inconsistent results. Therefore, this meta-analysis was performed to determine the prognostic and clinicopathologic significance of STC2 in various cancers.

Methods:

Eligible studies were identified by searching the online databases PubMed, Embase, Web of Science, and the China National Knowledge Infrastructure up to March 2019. Hazard ratios (HRs) with 95% confidence intervals (CIs) and were calculated to clarify the correlation between STC2 expression and prognosis of different cancers. Odds ratios (ORs) with 95% CI were selected to appraise the correlation between STC2 with clinicopathologic characteristics of patients with cancer.

Results:

A total of 16 eligible studies with 4074 patients with cancer were included in our meta-analysis. The results showed that high STC2 expression can predict poor overall survival (OS) for cancer (HR = 1.48, 95% CI: 1.15–1.90, P = .002). Subgroup analysis found that high STC2 expression was associated with worse OS in Asian (HR = 1.85, 95% CI: 1.35–2.55), the reported directly from articles group (HR = 1.39, 95% CI: 1.05–1.84), survival curves group (HR = 1.93, 95% CI: 1.36–2.74), and gastric cancer (HR = 1.43, 95% CI: 1.04–1.95). Furthermore, high STC2 expression was significantly related to advanced T stage (OR = 1.83, 95% CI: 1.17–2.86, P = .008), lymph node metastasis (OR = 2.29, 95% CI: 1.51–3.45, P < .001), lymphatic invasion (OR = 2.15, 95% CI: 1.53–3.02, P < .001), venous invasion (OR = 1.97, 95% CI: 1.30–2.99, P = .001), and more advanced clinical stage (OR = 2.36, 95% CI: 1.74–3.19, P < .001)

Conclusion:

Elevated expression of STC2 suggested a poor prognosis in patients with cancer and may serve as a new tumor marker to monitor cancer development and progression.
Predisposing factors to nonfatal cardiovascular events in women with systemic lupus erythematosus. An observational, cross-sectional, multicenter study in Spain from the risk/systemic lupus erythematosus thematic network
Authors: Fernández-Garcés Mar , Haro Gonzalo , Micó María Luisa
Published: October 2019

Very few studies have been published on cardiovascular morbidity in Spanish patients diagnosed with systemic lupus erythematosus (SLE). Moreover, knowledge of the predictive factors for the occurrence of nonfatal events in this group of patients is scarce.

This was a multicenter, observational, cross-sectional study designed to ascertain the prevalence of nonfatal cardiovascular risk factors and cardiovascular events (CVEs) in 335 Spanish women diagnosed with SLE between 2003 and 2013.

The average patient age was 36.0 years (range: 26.4–45.6); 35 patients (10.7%) experienced at least 1 CVE, which most frequently affected the brain, followed by the heart, and finally, the peripheral vasculature. Both the number of admissions because of SLE (95% confidence interval [CI] odds ratio [OR] = 1.024–1.27, P = .017) and the systemic lupus international collaborating clinics (SLICC) chronicity index score (95% CI OR = 1.479–2.400, P 
= .000) resulted in an increase in the OR of these patients presenting a CVE. Regarding the classic risk factors, only the interaction between hypertension (HT) and treatment with antihypertensive drugs influenced the presence of CVEs (95% CI OR = 2.165–10.377, P = .000). The presence of a family history of early cardiovascular disease was also related to CVEs (95% CI OR = 2.355–40.544, P = .002). Binary logistic regression including the above factors resulted in a model in which the 3 main variables in each group persisted, implying that they must be independent of each other. However, the weight of the interaction between the family history of early cardiovascular disease and the interaction between HT and the use of antihypertensives was higher than for the number of admissions for SLE.

The SLE disease activity over time (measured using the SLICC) and the number of hospital admissions due to the disease itself, both increase the risk of women with SLE presenting a CVE. Classic cardiovascular risk factors, especially HT and its treatment, as well as a family history of early CVEs, should be considered when assessing the risk of nonfatal CVEs in women with SLE.
Treatment with the herbal formulation Eefooton slows the progression of chronic kidney disease
Authors: Yao Chien-An , Lin Chih-Hui
Published: October 2019

Rationale:

Patients with end-stage kidney disease (ESKD) receiving maintenance dialysis experience an overall burden of physical and emotional symptoms. However, there were limited alternative treatments to dialysis.

Patient concerns:

A 79-year-old woman with chronic kidney disease stage 5 (CKD5) and gout had refused to be on dialysis. She also had hypoglycemia, hypertension, and heart disease.

Diagnoses:

The patient had received the ultrasonography, the renal biopsy and biochemical examinations, confirming the diagnosis of renal impairment, primary hypertension, and chronic nephritic syndrome with unspecified morphologic changes.

Interventions:

She was administered with 20 mL Eefooton (a liquid formula of herbal extracts: Astragalus membranaceus 3 g, Codonopsis pilosula 3 g, Ligustrum lucidum 3 g, Panax quinquefolius 1.3 g, and Rhodiola sacra 1.3 g) orally twice a day for 6 months in addition to her regular medications.

Outcomes:

The patient was followed up for 3 months after the completion of the Eefooton adjuvant treatment. The patient's renal function was improved, and CKD progression was alleviated. After Eefooton treatment, the sizes of both kidneys in the patient increased by 8% while blood urea nitrogen (BUN) and serum creatinine concentrations were decreased. In addition, further reduction in BUN concentration was observed 2 months posttreatment.

Lessons:

This case demonstrated that Eefooton has potential therapeutic significance in patients with CKD5 who chose conservative treatment over dialysis.
Examining the associations among intraocular pressure, hepatic steatosis, and anthropometric parameters
Authors: Chen Ying-Jen , Chen Jiann-Torng , Tai Ming-Cheng , Liang Chang-Min , Chen Yuan-Yuei , Kao Tung-Wei , Fang Wen-Hui , Chen Wei-Liang
Published: October 2019

Emerging evidences had reported the positive relationship between obesity and intraocular pressure (IOP). The aim of the present study was to investigate the association between hepatic steatosis and IOP in an adult Taiwanese population.

Seven thousand seven hundred twelve males and 6325 females who received a health examination at the Tri-Service General Hospital during the period from 2010 to 2016 were included in this study.

IOP was measured by noncontact tonometry. Hepatic steatosis was diagnosed by abdominal ultrasound examination. Multivariate regression analyses were used to assess the associations among various anthropometric parameters and IOP.

After adjusting for pertinent covariables, hepatic steatosis had a closer association with increased IOP than percentage body fat, body mass index, or waist circumference (β = 0.017, 95% confidence interval [CI] = 0.006, 0.028). This relationship remained significant among males in the study population (β = 0.015, 95% CI = 0.001, 0.029). Furthermore, hepatic steatosis was significantly correlated with increased risk of high IOP (odd ratios = 1.235, 95% CI = 1.041–1.465).

Our study highlights that hepatic steatosis is a better index for assessing the relationship with increased IOP than other anthropometric parameters. Underlying pathophysiological mechanisms regulating the association between hepatic steatosis and increasing IOP and even the risk of glaucoma should be examined in further studies.
Successful treatment of a primary thoracic dumb-bell yolk sac tumor presenting with severe spinal cord compression
Authors: Li Zhenfeng , Lv Zhaorui , Yang Qiang , Li Jianmin
Published: October 2019

Rationale:

Primary thoracic dumb-bell yolk sac tumor (YST) with both epidural and extraspinal extension is a rare disease with no standard curative managements yet. The objective of this study is to report a primary thoracic dumb-bell YST presenting with severe spinal cord compression successfully treated with posterior-only approach operation, followed by chemotherapy. The management of these unique cases has not been fully documented.

Patient concerns:

A 26-mounth-old, previously healthy girl presented with progressive numbness and weakness of the lower extremities. Neurological examination revealed paralysis of both lower extremities, sensory disturbance below T-8 and bladder-bowel dysfunction.

Diagnosis:

CT and MRI of spine showed a dumb-bell mass lesion with both epidural and extraspinal extension through enlarged intervertebral foramina and marked spinal cord compression at T7–T9. The AFP level was 13738 ng/ml. Preoperative puncture and Postoperative pathology confirmed the diagnosis of YST.

Interventions:

By needle biopsy, we identified the pathological diagnosis is YST. Subsequently, the patient was treated with one-stage posterior-only approach operation, followed by 9 courses of chemotherapy based on cisplatin, bleomycin, etoposide.

Outcomes:

The patient has a complete neurologic recovery and remains recurrence free as of more than 2 years after the completion of operation. There were no other complications associated with the operation during the follow-up period.

Lessons:

YST should be considered in the range of children with thoracic dumb-bell tumor presenting with spinal cord compression. Needle biopsy is valuable for preoperative diagnosis and design of the treatment strategy. If there is no evidence of CSF spread, metastasis or multiple diseases, it is effective to remove tumors as thoroughly as possible immediately, avoid further nerve injury and conduct enough chemotherapy. This case suggests that this treatment strategy is an effective option for primary YST with both epidural and extraspinal extension and severe spinal cord compression.
Effectiveness of high-frequency oscillatory ventilation for the treatment of neonatal meconium aspiration syndrome
Authors: Hao Li-xia , Wang Fei
Published: October 2019

Background:

The purpose of this study is to raise nonjudgmental awareness and attention to current experience of high-frequency oscillatory ventilation (HFOV) for the treatment of neonatal meconium aspiration syndrome (NMAS).

Methods:

We will comprehensively search literature from the databases of Cochrane Library, PubMed, Embase, Web of Science, WorldSciNet, PsycINFO, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception until July 1, 2019 without language limitation. We will also handle searching the bibliographies of all relevant studies found for unpublished literatures. Statistical analysis will be conducted using RevMan 5.3 software.

Results:

The outcomes include function inhaled oxygen concentration, oxygenation index, arterial oxygen tension/alveolar arterial oxygen tension, partial pressure of oxygen, partial pressure of carbon dioxide, transcutaneous arterial oxygen saturation, duration of hospitalization, and adverse events.

Conclusion:

This study will provide an exhaustive view of HFOV for treating infants with NMAS.

PROSPERO registration number:

PROSPERO CRD42019140520.
Radiotherapy combined with cytokine-induced killer cell therapy for liver metastasis from rectal cancer
Authors: Dang Yazheng , Qi Tao , Gao Hongxiang , Huang Shigao
Published: October 2019

Rationale:

Colorectal cancer is the most common type of cancer leading to death; approximately 10% to 25% of rectal cancer patients present with synchronous colorectal liver metastases. However, the management of synchronous colorectal liver metastases is difficult, especially for patients unable to tolerate chemotherapy or surgery. To date, the optimum treatment of colorectal liver metastasis patients remains controversial, and the curative effect is unsatisfactory. Therefore, we established a novel therapeutic approach to treat colorectal liver metastases employing radiotherapy plus immunotherapy.

Patient concerns:

A 56-year-old man presented with mucous bloody defecation occurring >20 times a day and accompanied by fatigue and poor appetite. After 4 months, he was admitted to the hospital due to increased fecal blood volume.

Diagnosis:

Highly differentiated adenocarcinoma was diagnosed based on rectal biopsy, and abdominal computed tomography (CT) showed multiple metastatic tumors in the liver.

Interventions:

The patient underwent 1 cycle of chemotherapy, which was terminated owing to severe gastrointestinal reactions. Several days later, he was administered cytokine-induced killer (CIK) cell therapy plus adjuvant radiotherapy.

Outcomes:

Dynamic changes in the patient's tumor markers returned to normal levels, and abdominal CT and abdominal magnetic resonance imaging (MRI) revealed no metastatic liver tumors.

Lessons:

Sequent therapy provided a curative effect for liver metastasis in a rectal cancer patient. Radiation may have activated the body to produce distant effects, eliminating the live metastasis. CIK cell-immunotherapy and radiotherapy may have synergistic therapeutic effects and could be combined for successful treatment of liver metastasis from rectal cancer.
Acute onset of orofacial dystonia from promethazine treatment
Authors: Zhang Ruili , Lai Jianbo , Huang Jinwen
Published: October 2019

Rationale:

Promethazine is an antihistamine agent used commonly for nausea and allergy. Along with its anticholinergic and antidopaminergic functions, promethazine is also used for psychiatric symptoms, such as troubling sleep, anxiety, and agitation. Previous studies have reported that promethazine may occasionally elicit acute dystonia in some individuals, especially for young children and pregnant women.

Patient concerns:

The 68-year-old female patient was admitted to our hospital because of feeling anxious and intermittent palpitation for over 1 year. She developed acute orofacial dystonia following promethazine treatment.

Diagnoses:

Her diagnoses was generalized anxiety disorder.

Interventions:

Discontinuation of the offending agent, promethazine, and injection of Botulinum toxin.

Outcomes:

The acute orofacial dystonia was finally alleviated by local injection of Botulinum toxin.

Lessons:

Careful assessment of the risk of developing acute dystonia is also needed in old patients when initiating the promethazine treatment.
Sarcopenia feature selection and risk prediction using machine learning
Authors: Kang Yang-Jae , Yoo Jun-Il , Ha Yong-chan
Published: October 2019

The purpose of this study was to verify the usefulness of machine learning (ML) for selection of risk factors and development of predictive models for patients with sarcopenia.

We collected medical records from Korean postmenopausal women based on Korea National Health and Nutrition Examination Surveys. A training data set compiled from simple survey data was used to construct models based on popular ML algorithms (e.g., support vector machine, random forest [RF], and logistic regression).

A total of 4020 patients ≥65 years of age were enrolled in this study. The study population consisted of 1698 (42.2%) male and 2322 (57.8%) female patients. The 10 most important risk factors in men were body mass index (BMI), red blood cell (RBC) count, blood urea nitrogen (BUN), vitamin D, ferritin, fiber intake (g/d), primary diastolic blood pressure, white blood cell (WBC) count, fat intake (g/d), age, glutamic-pyruvic transaminase, niacin intake (mg/d), protein intake (g/d), fasting blood sugar, and water intake (g/d). The 10 most important risk factors in women were BMI, water intake (g/d), WBC, RBC count, iron intake (mg/d), BUN, high-density lipoprotein, protein intake (g/d), fiber consumption (g/d), vitamin C intake (mg/d), parathyroid hormone, niacin intake (mg/d), carotene intake (μg/d), potassium intake (mg/d), calcium intake (mg/d), sodium intake (mg/d), retinol intake (μg/d), and age. A receiver operating characteristic (ROC) curve analysis found that the area under the ROC curve for each ML model was not significantly different within a gender.

The most cost-effective method in clinical practice is to make feature selection using RF models and expert knowledge and to make disease prediction using verification by several ML models. However, the developed prediction model should be validated using additional studies.
Osimertinib or EGFR-TKIs/chemotherapy in patients with EGFR-mutated advanced nonsmall cell lung cancer
Authors: Huang Lei , Huang Hao , Zhou Xiao-Ping , Liu Jin-Feng , Li Chun-Rong , Fang Min , Wu Jun-Rong
Published: October 2019

Background:

The aim of this meta-analysis is to investigate the impact of Osimertinib on treatment efficacy in advanced nonsmall cell lung cancer (NSCLC).

Methods:

Trials comparing Osimertinib against epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs)/chemotherapy in patients with NSCLC with an epidermal growth factor receptor (EGFR) mutation were included, and the pooled data for progression-free survival (PFS), overall survival (OS), overall response rate (ORR), disease control rate (DCR), and adverse events (AEs) were analyzed.

Results:

Analysis results based on 6 eligible trials showed that Osimertinib significantly improved the overall PFS (hazard ratio [HR] = 0.38, 95% confidence interval [CI] = 0.29–0.50), improved the OS (HR = 0.66, 95% CI = 0.48–0.89), increased the ORR (odds ratio [OR] = 1.76, 95% CI = 1.14–2.72), increased the overall DCR (OR = 1.18, 95% CI = 1.02–1.37), and reduced the grade 3 or greater AEs (relative ratio [RR] = 0.50, 95% CI = 0.33–0.75) in all subgroups except in the ORR in the Exon 19 deletion (Ex19del) and/or L858R subgroup. Compared to patients with Ex19del and/or L858R mutation, patients with the T790M mutation had the benefits of a greater PFS (41.7%), a greater ORR (80.0%), a greater DCR (71.2%), and fewer grade 3 or greater AEs (70.7%) (each P < .05). Race, sex, age, EGFR mutation, and smoking history may significantly predict additional benefits from Osimertinib, but there were no significant differences between subgroups stratified by these clinical characteristics.

Conclusions:

Osimertinib showed greater treatment benefit for patients with NSCLC with EGFR mutation than EGFR-TKIs/chemotherapy, especially for T790M mutation-positive patients.
Relationship between the time required for transfer and outcomes in patients with appendicitis
Authors: Ko Ryoung Eun , Park Se Jin , Kim Ho Seung
Published: October 2019

A few studies have compared patients who were directly admitted with patients who were transferred to a tertiary facility for an appendectomy. However, there have been no reports of an association between the time to transfer and outcome in patients who underwent an appendectomy. As the only tertiary military hospital in South Korea, we occasionally encountered patients who were delayed for transfer due to the military environment. We hypothesize that patients with a longer time to transfer have a worse outcome. This study aimed to evaluate the relationship between the time to transfer and the outcome of patients who underwent an appendectomy.

Patients who underwent appendectomy in the tertiary military hospital in South Korea from May 2015 to April 2017 were analyzed retrospectively. The groups were divided by the time for the transfer. Four hours was used as the cut-off point to divide the early and delayed transfer groups. Time from symptom onset to hospitalization, time from diagnosis to surgery, and time from hospitalization to surgery were also analyzed to assess the effect of time for the transfer.

A total of 449 patients were analyzed: 293 with direct admission, 110 with early transfer, and 46 with delayed transfer. The time required for transfer was more critical for delaying appendectomy than the time from hospital admission to surgery. There was no difference in outcomes among the groups. When patients were compared according to the perforation, no differences were found in time from hospitalization to surgery, time from diagnosis to surgery, and presence of transfer. Multivariate analysis showed that a greater than 72 hours delay from symptom onset to hospitalization was associated with perforation (odds ratio = 12.61; 95% confidence interval: 3.84–41.40; P < .001).

Even if a long transfer time is necessary, an appendectomy can be performed safely if patients were administered antibiotics immediately after diagnosis.
Impact of trauma designation levels on survival of drowning victims
Authors: Dakessian Alik , Bachir Rana , El Sayed Mazen
Published: October 2019

Drowning causes significant morbidity and mortality. Healthcare regionalization aims at improving patient outcomes. This study examines the impact of trauma center level designation on survival of drowning victims.

Retrospective cohort study utilizing the National Trauma Data Bank (NTDB) 2015. Descriptive, bivariate and multivariate analyses were conducted.

The 212 patients were included. Mean age was 33.58 (±20.02) years with 69.3% (n = 147) males. Patients were mostly taken to Level I (n = 107, 50.5%) and II (n = 81, 32.8%) centers, requiring admission (43.5% (n = 96), 23.1% (n = 49) and 8.5% (n = 18) to Intensive Care, floor, and Operating Room, respectively). Overall hospital discharge survival was 83.5% (n = 177). After adjusting for confounders, there was no significant difference in survival of patients taken to Level I compared to Level II and III centers.

This study did not identify a survival benefit for patients with drowning related injuries when taken to Level I compared to Level II or III Trauma centers. Further outcome studies are needed in organized trauma systems to improve field triage criteria for specific injury mechanisms.
Assessing the Validity of Adult‐derived Prognostic Models for Primary Sclerosing Cholangitis Outcomes in Children
Authors: Deneau Mark R. , Valentino Pamela L. , Mack Cara , Alqoaer Khaled , Amin Mansi , Amir Achiya Z. , Aumar Madeleine , Auth Marcus , Broderick Annemarie , DiGuglielmo Matthew , Draijer Laura G. , El‐Matary Wael , Ferrari Federica , Furuya Katryn N. , Gottrand Frederic , Gupta Nitika , Homan Matjaz , Jensen M.K. , Kamath Binita M. , Kim Kyung Mo , Kolho Kaija‐Leena , Koot Bart , Iorio Raffaele , Martinez Mercedes , Miloh Tamir , Mohan Parvathi , Palle Sirish , Papadopoulou Alexandra , Ricciuto Amanda , Saubermann Lawrence , Sathya Pushpa , Shteyer Eyal , Smolka Vratislav , Tanaka Atsushi , Varier Raghu , Venkat Veena , Vitola Bernadette , Woynarowski Marek , Guthery Stephen
Published: October 2019

Background:

Natural history models for primary sclerosing cholangitis (PSC) are derived from adult patient data, but have never been validated in children. It is unclear how accurate such models are for children with PSC.

Methods:

We utilized the pediatric PSC consortium database to assess the Revised Mayo Clinic, Amsterdam‐Oxford, and Boberg models. We calculated the risk stratum and predicted survival for each patient within each model using patient data at PSC diagnosis, and compared it with observed survival. We evaluated model fit using the c‐statistic.

Results:

Model fit was good at 1 year (c‐statistics 0.93, 0.87, 0.82) and fair at 10 years (0.78, 0.75, 0.69) in the Mayo, Boberg, and Amsterdam‐Oxford models, respectively. The Mayo model correctly classified most children as low risk, whereas the Amsterdam‐Oxford model incorrectly classified most as high risk. All of the models underestimated survival of patients classified as high risk. Albumin, bilirubin, AST, and platelets were most associated with outcomes. Autoimmune hepatitis was more prevalent in higher risk groups, and over‐weighting of AST in these patients accounted for the observed versus predicted survival discrepancy.

Conclusions:

All 3 models offered good short‐term discrimination of outcomes but only fair long‐term discrimination. None of the models account for the high prevalence of features of autoimmune hepatitis overlap in children and the associated elevated aminotransferases. A pediatric‐specific model is needed. AST, bilirubin, albumin, and platelets will be important predictors, but must be weighted to account for the unique features of PSC in children.
Neonatal Intestinal Failure Is Independently Associated With Impaired Cognitive Development Later in Childhood
Authors: Gunnar Riikka J. , Kanerva Kaisa , Salmi Silja , Häyrinen Taru , Haataja Leena , Pakarinen Mikko P. , Merras‐Salmio Laura
Published: October 2019

Objective:

The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF.

Methods:

We conducted a cross‐sectional single‐center study at the Helsinki University Children's Hospital. Patients with IF with >60 days of parental nutrition (PN) dependency aged between 3 and 16 years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wechsler Intelligence Scale for Children, 4th edition, and Movement Assessment Battery for Children, 2nd edition.

Results:

All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age, and birth weight was 7.5 (range 3–16) years, 35 (interquartile range [IQR] 28–38) weeks and 2238 (IQR 1040–3288) grams, respectively. Median duration of PN was 13 (IQR 5–37) months and 9 patients were currently on PN. Median intelligence quotient was 78 (IQR 65–91) and 10 (35%) patients had an intelligence quotient under 70 (−2 standard deviation). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, whereas adverse motor outcome was associated with prematurity.

Conclusion:

Clinically significant cognitive and motor impairments are alarmingly common among neonatal patients with IF. We recommend early neurodevelopmental follow‐up for all children with IF.