bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of vitamin D supplementation on cardiovascular risk factors in shift workers
Authors: Fajardo Virginia Capistrano , de Oliveira Fernando Luiz Pereira , Machado-Coelho George Luiz Lins , Pimenta Fausto Aloísio Pedrosa , de Freitas Silvia Nascimento , Ribeiro Antônio Luiz Pinho , Soares Maria Marta Sarquis , Lauria Marcio Weissheimer , Farias Rosielle da Costa , França Ive Bahia , do Nascimento Neto Raimundo Marques
Published: May 2019

Objective:

The present clinical study aims to describe protocol to evaluate the effects of vitamin D3 supplementation on the cardiovascular risk factors in a population of rotating shift workers.

Design:

A randomized, double-blind, placebo-controlled, parallel group clinical trial testing 2 oral dosages of cholecalciferol (14,000 IU and 28,000 IU per week) for 12 months.

Setting:

The primary outcome for evaluation is an 18% reduction in hypertriglyceridemia (≥150 mg/dL) between pre and postintervention measurements. Baseline characteristics of the study population will be summarized separately within each randomized group, and will use tests for continuous and categorical variables. For all tests, a P < .05 will be considered significant. The analysis of primary and secondary outcomes will use an intention-to-treat population and a per-protocol population. The primary and secondary outcomes will be compared separately between each treatment group and placebo, using binary logistic regression or regressão de Poisson for proportions (for binary outcomes) and using linear regression for differences in means (for continuous endpoints), with 95% confidence intervals.

Participants:

Rotating shift workers, adults aged between 18 and 60 years, with hypovitaminosis D and alterations in at least 1 of the following parameters: fasting glucose, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol, blood pressure, and waist circumference.

Conclusion:

This clinical trial aims to contribute to the gap in knowledge about the potential, dose, and time of vitamin D supplementation to generate beneficial effects on triglycerides in a population at increased risk for hypertriglyceridemia and vitamin D deficiency.
Urachal remnant with heterotopic sinus in an adult male
Authors: Sun Zhao-Hui , Kong Xiang-Hui , Huang Wen-Jie , Chen Gang , Huang Xiao-Jun
Published: May 2019

Introduction:

Urachal remnant with heterotopic sinus is an extremely rare congenital anomaly, and usually coexists with other congenital anomalies. We report the case of a 32-year-old adult male with urachal remnant with heterotopic sinus.

Patient concerns:

A 32-year-old adult male presented with purulent secretion in the heterotopic sinus on the dorsal side of the normal external urethral orifice and pain in the balanus since 5 months.

Diagnosis:

The computed tomography scan demonstrated a 4 cm cystic mass next to the anterior wall of the urinary bladder. Retrograde urethrography was performed, which demonstrated that this mass communicated with the heterotopic sinus on the dorsal side of the normal external urethral orifice. Cystoscopy showed that there was no communication between the mass and the bladder. Pathology results confirmed that this mass was urachal tissue.

Interventions:

The patient underwent a laparoscopy surgery to undertake the cystic mass, part of the anterior wall of urinary bladder and the epithelium of channel which communicated with the cystic mass.

Outcomes:

The patient was discharged without any complications after 6 months and follow-up was continued in the clinic.

Conclusions:

Urachal remnant with heterotopic sinus is rare, and we recommend that urachal remnant should be considered when a patient presents with a mass in the retropubic space.
Successful removal of multiple magnetic foreign bodies in the digestive tract of children by gastroscopy
Authors: Lyu Xintong , Pi Zhuang , Wang Zhaoxia , Wu Lan , Wang Libo , Pang Xiaoli
Published: May 2019

Rationale:

Gastrointestinal foreign body (FB) is an emergency commonly encountered by the pediatric gastroenterology department. Management of their extraction requires knowledge and careful consideration of removal techniques.

Patient concerns:

Two little girls swallowed multiple magnets that stuck together for >3 days, which was an indication for surgery.

Diagnosis:

X-ray revealed dense shadows in the left abdomen. However, the abdominal examination revealed a soft abdomen without tenderness, rebound tenderness, or muscle rigidity.

Intervention:

The multiple magnets were removed by endoscopy instead of surgery.

Outcome:

We conducted sufficient preoperative assessment and preparation. Eventually, we successfully removed the multiple magnets by endoscopy, and no perforation or fistula formation was observed. Surgery was avoided.

Lessons:

Swallowing multiple magnets isn’t a rare emergency in children. Physicians must be aware that surgery is not the only option even if multiple magnets are swallowed for >12 hours. Endoscopic removal can be considered if there is no obstruction, perforation, or fistula formation upon careful patient assessment. If endoscopic removal fails, surgical treatment should be performed as soon as possible to avoid serious complications.
Cerebral arterial air embolism after computed tomography-guided hook-wire localization of a pulmonary nodule
Authors: Wang Ming-Yi , Liu Yong-Sheng , An Xiang-Bo , Li Ke , Liu Yong-Jian , Wang Feng
Published: May 2019

Rationale:

Cranial arterial air embolism is a rare but potentially fatal complication after computed tomography (CT)-guided pulmonary interventions.

Patient concerns:

A 64-year-old man was diagnosed with a pulmonary nodule (diameter: approximately 1 cm) in the right lower lobe. The patient developed convulsions after CT-guided hook-wire localization.

Diagnosis:

Cranial CT revealed arborizing/linearly distributed gas in the territory of the right middle cerebral artery.

Interventions:

The patient was administered hyperbaric oxygen, antiplatelet aggregation therapy, and dehydration treatment.

Outcomes:

Clinical death occurred 55 hours after air embolism.

Lessons:

Systemic air embolism is a serious complication of lung puncture. Clinicians should improve their understanding of this complication and remain vigilant against air embolism.
Traumatic lumbar disc herniation mimicking epidural hematoma
Authors: Kim Ju-Hwi , Kim Soo-Han , Lee Seul-Kee , Moon Bong Ju , Lee Jung-Kil
Published: May 2019

Rationale:

We report a rare case of traumatic lumbar disc herniation mimicking epidural hematoma.

Patient concerns:

A 39-year old man presented with acute bilateral leg and back pain, following a crushing injury caused by a crane collapse.

Diagnosis:

A computed tomography scan revealed multiple compression fractures of the thoracolumbar spine, including a burst fracture of the L4 vertebral body. Magnetic resonance imaging (MRI) showed an epidural mass, extending longitudinally and causing dural sac compression behind the L3 vertebra. The mass had isosignal intensity on T1-weighted imaging and showed mixed high and low signals on T2-weighted imaging. On the basis of the patient's clinical history and imaging findings, our provisional diagnosis was an epidural hematoma following major trauma.

Interventions:

An emergency L3 laminectomy was performed with percutaneous screw fixation of L3-5. Intraoperatively, 3 large herniated disc fragments were found at L3 with no evidence of hematoma.

Outcomes:

The patient recovered normal motor function after surgery. At the last follow-up, 3 years after surgery, there was no residual neurological deficit apart from intermittent lower back pain.

Lessons:

In cases where MRI findings reveal an epidural lesion with a longitudinal shape, similar to an epidural hematoma, with mixed signal intensity on T2-weighted images and high peripheral signal intensity on T1-weighted images, traumatic disc herniation should be included in the differential diagnosis.
Radiomics features analysis of PET images in oropharyngeal and hypopharyngeal cancer
Authors: Liao Ken Ying-Kai , Chiu Chuang-Chien , Chiang Wan-Chi , Chiou Yu-Rou , Zhang Geoffrey , Yang Shih-Neng , Huang Tzung-Chi
Published: May 2019

This study used radiomics image analysis to examine the differences of texture feature values extracted from oropharyngeal and hypopharyngeal cancer positron emission tomography (PET) images on various tumor segmentations, and finds the proper and stable feature groups. A total of 80 oropharyngeal and hypopharyngeal cancer cases were retrospectively recruited. Radiomics method was applied to the PET image for the 80 oropharyngeal and hypopharyngeal cancer cases to extract texture features from various defined metabolic volumes. Kruskal-Wallis one-way analysis of variance method was used to test whether feature value difference exists between groups, which were grouped by stage, response to treatment, and recurrence. If there was a significant difference, the corresponding feature cutoff value was applied to the Kaplan–Meier estimator to estimate the survival functions. For the various defined metabolic volumes, there were 16 features that had significant differences between early (T1, T2) and late tumor stages (T3, T4). Five images and 2 textural features were found to be able to predict the tumor response and recurrence, respectively, with the areas under the receiver operating characteristic curves reaching 0.7. The histogram entropy was found to be a good predictor of overall survival (OS) and primary relapse-free survival (PRFS) of oropharyngeal and hypopharyngeal cancer patients. Textural features from PET images provide predictive and prognostic information in tumor staging, tumor response, recurrence, and have the potential to be a prognosticator for OS and PRFS in oropharyngeal and hypopharyngeal cancer.
Pleural effusion as a substitute for tumor tissue in detecting EGFR/ALK mutations in non-small cell lung cancer
Authors: Pang Caishuang , Ma Huiwen , Qin Jiangyue , Wang Sixiong , Wan Chun , Yang Ting , Shen Yongchun , Wang Donglin
Published: May 2019

Background:

Pleural effusion (PE) has been reported useful in many studies for testing epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) with variable results. This systematic review and meta-analysis was performed to elucidate whether PE could be used as a surrogate for tumor tissue to detect EGFR mutations.

Methods:

We extracted 2 × 2 diagnostic table from each included study and calculated data on specificity, sensitivity, negative likelihood ratio (NLR), positive likelihood ratio (PLR) ,and diagnostic odds ratio (DOR). We used the area under curve (AUC) and summary receiver operating characteristic curve (SROC) to summarize the overall diagnostic performance and assessed publication bias by Deeks’ funnel plot.

Results:

Our meta-analysis included 15 eligible publications. The following summary estimates for diagnostic parameters of the EGFR mutations detection in PE were made: sensitivity, 0.86 (95%CI 0.83–0.89); specificity, 0.93 (95%CI 0.91–0.95); PLR, 8.53 (95%CI 5,94–12.25); NLR, 0.18 (95%CI 0.13–0.25); DOR, 63.40 (95%CI 38.83–103.51); and AUC, 0.94. Funnel plot indicated publication bias insignificant.

Conclusions:

The meta-analysis suggests that EGFR mutation detecting in PE, especially supernatants, is a promising surrogate for tumor tissue in EGFR mutations testing of patients with NSCLC.
Changes of intraocular pressure and ocular perfusion pressure during controlled hypotension in patients undergoing arthroscopic shoulder surgery
Authors: Kim Yong-Shin , Han Na-Re , Seo Kwon Hui
Published: May 2019

Purpose:

The aim of the present study is to evaluate the effects of deliberate hypotensive anesthesia on intraocular pressure (IOP) and ocular perfusion pressure (OPP) and compare the effects of propofol total intravenous anesthesia (TIVA) and desflurane anesthesia on IOP and OPP.

Methods:

A total of 50 patients undergoing arthroscopic shoulder surgery in the lateral decubitus position were randomized to receive desflurane or propofol anesthesia. Mean arterial pressure (MAP) was maintained in the range of 60–75 mm Hg during hypotensive anesthesia. IOP was measured using a handheld tonometer at 7 time points: before induction (T1, baseline); immediately after endotracheal intubation (T2); 10 minutes after position change to lateral decubitus (T3); 10, 30, and 50 minutes after the start of hypotensive anesthesia (T4–T6); and at the end of surgery (T7).

Results:

MAP decreased about 35% to 38% during hypotensive anesthesia. Compared to baseline values, the IOP at T6 in dependent and non-dependent eyes decreased by 0.43 and 2.74 mm Hg, respectively in desflurane group; 3.61 and 6.05 mm Hg, respectively in the propofol group. IOP of both eyes in the propofol group was significantly lower than in the desflurane group from T2 to T7. OPP of both eyes in both groups was significantly lower than at baseline, except at T2 in the desflurane group. OPP of both eyes in the propofol group was significantly higher than that in the desflurane group at T5 and T6.

Conclusions:

Hypotensive anesthesia reduced IOP and OPP, but propofol TIVA maintained higher OPP than desflurane anesthesia. These findings suggest that propofol TIVA can help mitigate the decrease of OPP during hypotensive anesthesia.
Predictive value of serum uric acid levels for adverse perinatal outcomes in preeclampsia
Authors: Ryu Aelie , Cho Nam Jun , Kim Yun Sook , Lee Eun Young
Published: May 2019

Preeclampsia is a multisystem disorder associated with pregnancy and is a common cause of perinatal morbidity. The aim of this study was to determine whether elevated serum uric acid levels, alone or in combination with other laboratory factors could predict preeclampsia in women with adverse perinatal outcomes.

We conducted a prospective observational study of women who were admitted to Soonchunhyang University Cheonan Hospital from January 2016 to December 2016. Demographic, clinical and laboratory data were collected for each pregnancy at the time of delivery. Women were grouped according to status (preeclampsia or normotensive), and a logistic regression analysis was used to determine the relationship between serum uric acid levels and adverse outcomes.

The mean age of the study participants was 31.3 ± 5.0 years. In patients with preeclampsia, serum uric acid level was associated with the severity of preeclampsia, including blood pressure (R = 0.321, P = .014), serum creatinine levels (R = 0.505, P < .001), and proteinuria (P = .014), as well as adverse fetal outcomes, including preterm labor (P = .027) and low birth weight delivery (P = .001). The optimal maternal serum uric acid threshold that predicted low birth weight at delivery was 6.35 mg/dL (sensitivity, 0.58; specificity, 0.95). The multivariable logistic regression model that was used to predict low birth weight at delivery displayed an area under the receiver-operating characteristic curve of 0.902 (95% confidence interval, 0.817–0.986).

In women with preeclampsia, maternal serum uric acid level is an important parameter for predicting low birth weight. Additionally, the combination of uric acid, hemoglobin, and bilirubin levels appear to be optimal for predicting low birth weight in women with preeclampsia.
A comparison of surgical outcomes between robot and laparoscopy-assisted adenomyomectomy
Authors: Shim Jung In , Jo Eun-hye , Kim Miseon , Kim Mi Kyoung , Kim Mi-La , Yun Bo Seoung , Seong Seok Ju , Jung Yong Wook
Published: May 2019

We aimed to investigate the feasibility of robotic adenomyomectomy and compared surgical outcomes between laparoscopic and robotic approaches for adenomyomectomy.

We retrospectively reviewed the data of women who were diagnosed with adenomyosis and underwent adenomyomectomy through a minimally invasive approach between January 2014 and March 2018 at the CHA Gangnam Medical Center, Seoul, Republic of Korea. Patient demographics and operation-related outcomes were compared between the robotic and laparoscopic surgery groups.

We evaluated 43 women who underwent adenomyomectomy through a minimally invasive approach (21 underwent a laparoscopic and 22 underwent a robotic adenomyomectomy). All 22 women who had originally been scheduled to undergo robotic adenomyomectomy could successfully undergo the robotic surgery without requiring conversion to laparotomy and/or serious complications. No statistically significant differences in patient demographics were observed between the robotic and the laparoscopic surgery groups. No significant intergroup difference was observed in the operative time, estimated blood loss, weight of the resected nodule, and length of hospitalization (160.0 vs 212.5 min, P = .106; 500.0 vs 300.0 mL, P = .309; 60.0 vs 70.0 g, P = .932; and 5.0 vs 6.0 days, P = .277). No serious perioperative complications were observed in either group.

Robotic adenomyomectomy is feasible for women with adenomyosis. Surgical outcomes of robotic adenomyomectomy were comparable to those of a laparoscopic approach. There was, however, no superiority of robotic adenomyomectomy in terms of surgical outcomes. Further multicenter prospective studies using standardized surgical procedures are needed to confirm the conclusion of this study.
Association between rs20417 polymorphism in cyclooxygenase-2 and gastric cancer susceptibility
Authors: Chen Shimin , Chen Lu , Tan Yuling , Wang Jiehong
Published: May 2019

Objective:

Previous studies have reported an association between cyclooxygenase-2 (COX-2) polymorphism and gastric cancer (GC) susceptibility, but their results are controversial. This meta-analysis was intended to evaluate the relationship between the COX-2 rs20417 polymorphism and GC susceptibility in different ethnic groups.

Methods:

We searched PubMed, EMBASE, Web of Knowledge, and the Chinese Biomedical Database (CBM) for relevant case-control studies published up to October 6, 2018, which reported an association between the COX-2 rs20417 polymorphism and gastric cancer risk. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of this association.

Results:

15 papers detailing case-control studies were included in the analysis, which included a total of 2848 GC cases and 4962 healthy controls. The meta-analysis results indicated that the COX-2 rs20417 polymorphism was associated with increased GC susceptibility under allele (G vs C: OR = 1.67, 95%CI = 1.19–2.35, P = .003), heterozygous (GG vs CG: OR = 1.44, 95%CI = 1.03–2.02, P = .034), dominant (GC+CC vs GG: OR = 1.66, 95%CI = 1.18–2.34, P = .004), homozygous (GG vs CC:OR = 2.20, 95%CI = 1.07–4.54, P = .033), and recessive models (CC vs GG+CG:OR = 2.05, 95%CI = 1.09–3.85, P = .025). An analysis of ethnic subgroups revealed that the COX-2 rs20417 polymorphism was significantly associated with GC susceptibility in Asians under all 5 models (G vs C: OR = 2.22, 95%CI = 1.66–2.96, P < .001; GG vs CC: OR = 4.29, 95%CI = 1.94–9.50, P < .001; GG vs CG: OR = 1.86, 95%CI = 1.34–2.58, P < .001; CC vs GG+CG: OR = 3.73, 95%CI = 1.92–7.24, P < .001; GC+CC vs GG: OR = 2.20, 95%CI = 1.65–2.93, P < .001). Helicobacter pylori positive patients suffered a high risk of GC, compared to H pylori negative patients under the dominant model (OR = 3.09, 95%CI = 1.80–5.32, P < .001).

Conclusion:

This meta-analysis of 15 case-control studies provides strong evidence that the COX-2 rs20417 polymorphism increases the risk of GC susceptibility in general populations, especially in Asians. Helicobacter pylori positive patients and those with the COX-2 rs20417 polymorphism had a higher risk of developing GC.
Glomerulonephritis triggered by chronical aortic graft infection in a male with Loeys–Dietz syndrome
Authors: Zhou Xu-jie , Liu Li-jun , He Pei-xin , Zhou Fu-de
Published: May 2019

Rationale:

Glomerulonephritis triggered by a chronically infected graft is increasingly identified because of widely used implanted device. Removal of the aortic graft and sustained antibiotic therapy is the usual approach to maximize the chance of renal recovery, but as this case shows graft removal is not always possible.

Patient concerns:

A 35-year-old man with intractable and recurrent fever had acute renal failure in sustained antibiotic therapy.

Diagnoses:

Renal biopsy suggested crescentic glomerulonephritis. 18fluorodeoxyglucose/positron emission tomography–computed tomography showed increased metabolic activity at the site of aortic graft, reminding that chronic infection of an implanted graft can lead to severe glomerulonephritis. TGFBR2 c.1133G>T mutation was observed in mutation analysis, which was reported to be associated with Loeys–Dietz syndrome.

Interventions:

Although infection was properly controlled with appropriate antimicrobial treatment, his renal dysfunction did not improve. A short-term inclusion of low-dose corticosteroid significantly benefit without introducing harm.

Outcomes:

He partly recovered from renal injury.

Lessons:

In patients with glomerulonephritis triggered by a long-duration infection, low-dose corticosteroid therapy may be considered when renal dysfunction secondary to nephritis does not improve after appropriate antimicrobial treatment.
Effect of different doses of intravenous oxycodone and fentanyl on intubation-related hemodynamic responses
Authors: Koh Gi-Ho , Jung Ki Tae , So Keum Young , Seo Jong Sik , Kim Sang Hun
Published: May 2019

Background:

Intubation using direct laryngoscopy is a risky and painful procedure that is associated with undesirable hemodynamic changes such as tachycardia, hypertension, and arrhythmia. Recently, intravenous oxycodone was introduced and used for the control of acute postoperative pain and to attenuate intubation-related hemodynamic responses (IRHRs), but there is insufficient information regarding its proper dosage. We investigated the attenuating effects of different doses of oxycodone and fentanyl on IRHRs.

Methods:

For calculating oxycodone effective dose (ED95), which attenuated all IRHR changes to less than 20% over baseline values in 95% of male patients at 1 minute after intubation, oxycodone 0.1 mg/kg was injected for the first patient 1 hour before intubation, and the next dose for each subsequent patient was determined by the response of the previous patient using Dixon up-and-down method with an interval of 0.01 mg/kg. After obtaining the predictive oxycodone ED95, 148 patients were randomly allocated to groups receiving normal saline (group C), oxycodone ED95 (group O1), oxycodone 2 × ED95 (group O2), or fentanyl 2 μg/kg (group F). We recorded the incidence of “success” as a less than 20% change from baseline values in all IRHRs 1 minute after intubation.

Results:

The predictive oxycodone ED95 was 0.091 (0.081–0.149) mg/kg. The incidence of “success” was highest in group O2 (75.7%), followed by group O1 (62.2%) and group F (45.9%) with significant differences between the groups (P < .001). The systolic, diastolic, mean arterial pressure, and heart rate were not significantly different among groups after administration of either oxycodone or fentanyl. The percentage hemodynamic changes of the group O2 were significantly lower than those of groups F and O1, but the absolute percentage hemodynamic changes were not significantly different among groups F, O1, and O2. The recalculated oxycodone ED95 with probit analysis (0.269 mg/kg) was needed to prevent any arterial pressure and heart rate changes.

Conclusions:

Oxycodone 0.182 mg/kg is more effective in attenuating all IRHRs than fentanyl 2 μg/kg with safe hemodynamic changes. Further research is required to determine if the recalculated oxycodone ED95 (0.269 mg/kg) is also effective and hemodynamically safe for preventing all IRHRs.
Older menarche age and short reproductive period linked to chronic kidney disease risk
Authors: Noh Ji Hyun , Koo Hoseok
Published: May 2019

This study aimed to investigate the association between reproductive period and menarche age and chronic kidney disease (CKD) in South Korean postmenopausal women.

This was a cross-sectional study of the data for 8510 postmenopausal women using the results of Korean National Health and Nutrition Examination Surveys over the past 6 years.

Of the total 8510 postmenopausal women, 790 (10.23%) were CKD patients. The menarche age in the CKD group was 16.2 ± 1.9 years old, which was higher than that in the non-CKD group (P < .001). The reproductive period of the CKD group was 32.4 ± 5.7 years, which was shorter than 33.3 ± 5.4 years in the non-CKD group (P < .001). The prevalence of CKD was 4.7% at a menarche age of 11 years or younger, which increased with increasing of menarche age, reaching 9.9% at menarche age of 16 years or older. According to the length of the reproductive period, the prevalence of CKD was 13.9% for the group less than 20 years of period and decreased significantly with increasing length of reproductive period. The prevalence of proteinuria was 7.2% in women with reproductive period of less than 20 years and significantly less in women with a reproductive period longer than 45 years (2.3%). The prevalence of CKD and proteinuria increased with increasing of menarche age, and the prevalence of CKD and proteinuria decreased with increasing of reproductive period.

The results suggest that CKD was associated with older menarche age and a short reproductive period. Management of life patterns and medical problems in women with old age at menarche and a short reproductive period should be considered.
The necessity of routine postoperative laboratory tests in enhanced recovery after surgery for primary hip and knee arthroplasty
Authors: Wu Xiang-Dong , Xiao Peng-Cheng , Zhu Zheng-Lin , Liu Jia-Cheng , Li Yu-Jian , Huang Wei
Published: May 2019

Introduction:

Over the last few decades, the concepts of minimally invasive surgery and enhanced recovery after surgery (ERAS) protocols have been introduced into the field of total joint arthroplasty (TJA), and tranexamic acid (TXA) has been widely used in TJA. Modern-day surgical techniques and perioperative care pathways of TJA have experienced unexpected improvements. Recently, the necessity of the practice of ordering routine postoperative laboratory tests for patients undergoing primary TJA has been challenged, especially in the context of implementation of ERAS protocols in TJA. These studies have consistently suggested that routine postoperative laboratory tests are not necessary in modern-day primary, unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA), and laboratory tests after surgery should only be obtained for patients with risk factors. However, it remains unclear whether routine postoperative laboratory tests after THA and TKA remains justified in the Chinese patient population. Therefore, we developed this study to address this issue.

Methods and analysis:

This retrospective cohort study will include adult patients who underwent primary unilateral THA or TKA and received multimodal perioperative care pathways according to ERAS protocols. The following patient data will be collected from the electronic medical record system: patients’ demographics, preoperative and postoperative laboratory values, operation time, intraoperative blood loss, TXA use, tourniquet use, postoperative length of stay, and any medical intervention directly related to abnormal laboratory values. The main study outcomes are the incidence of acute anemia requiring transfusion and incidence of hypoalbuminemia requiring albumin supplementation. The secondary outcomes are the rates of acute kidney injury, incidence of abnormal serum sodium level, incidence of abnormal serum potassium level, and incidence of abnormal serum calcium level. These clinical data will be analyzed to determine the incidence of abnormal postoperative laboratory values following primary unilateral THA and TKA; to clarify the frequency of any medical intervention directly related to abnormal postoperative laboratory values; and to identify risk factors that predispose patients to have abnormal postoperative laboratory results.

Study registration:

Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900020690.
Retrospective observational analysis of hospital discharge database to characterize primary pulmonary hypertension and its outcomes in Spain from 2004 to 2015
Authors: de-Miguel-Díez Javier , Lopez-de-Andres Ana , Hernandez-Barrera Valentin , Jimenez-Trujillo Isabel , Mendez-Bailon Manuel , de Miguel-Yanes Jose M. , Muñoz-Rivas Nuria , Romero-Maroto Martin , Jimenez-Garcia Rodrigo
Published: May 2019

To examine trends in the incidence, characteristics and outcomes, and to identify factors associated with in-hospital mortality (IHM) of patients hospitalized for primary pulmonary hypertension (PPH) in Spain (2004–2015).

We included all patients hospitalized with PPH and included in the Spanish National Hospital Discharge Database.

We analyzed 46,883 discharges of patients (7.14% with PPH as their primary diagnosis). Incidence rates decreased from 6.15 cases per 100,000 inhabitants in 2004–06 to 3.40 in 2013–15 (P < .001). Mean age rose from 66.43 ± 21.28 to 69.73 ± 21.12 years (P < .001) and the proportion of females increased over the study period (58.44% vs 60.71%; P < .001). Comorbidity using the Charlson Comorbidity Index (CCI) also increased with 16.07% having CCI ≥3 in 2004–06 vs 21.795 in 2013–15. Median length of hospital stay (LOHS) was 1 day longer in period 2004–06, than in 2013–15 (9 vs 8 days; P < .001). The proportion of patients who were considered a readmission and the mean costs increased from 15.7% and 3712.46€ in the first period to 17.14% and 4040.28€ in 2013–15 (P < .001). IHM increased from 8.2% in 2004–06 to 9.93% in 2013–15 (P < .001). The predictors’ of IHM among PPH patients included comorbidity and use of mechanical ventilation. Primary diagnosis of PPH did not predict higher IHM (OR 1.07; 95%CI 09–1.26).

Our data indicates that the incidence of hospitalizations decreased in Spain between 2004 and 2015. Parallel, LOHS also decreased during this period. By contrast, comorbidity increased over time in PPH patients, as well as readmission rates, costs and IHM.
Intracranial Rosai-Dorfman disease with the petroclival and parasellar involvement mimicking multiple meningiomas
Authors: Wang Chao , Kuang Pingding , Xu Fangfang , Hu Ling
Published: May 2019

Rationale:

Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis. Petroclival RDD is extremely rare. To the best of our knowledge, only 7 cases of petroclival RDD have been reported so far. Herein, we present the 8th case of intracranial RDD with the petroclival and parasellar involvement mimicking multiple meningiomas.

Patient concerns:

A 57-year-old woman presented with a 1-year history of vision diminution and 1-month hearing loss in her right ear.

Diagnoses:

Contrast-enhanced Magnetic resonance imaging (MRI) of the brain demonstrated multiple well-defined, homogenous mass which closely related to the dura mater in the bilateral parasellar and petroclival regions range from the basement of anterior to posterior cranial fossa. The lesions were T1 isointense, T2 hypointense, and homogeneously enhanced. Initial diagnosis of multiple meningiomas was made according to MRI findings. Final diagnosis of RDD was confirmed by histopathological and immunohistochemical examinations after subtotal surgical resection.

Interventions:

The patient received subtotal resection because multiple lesions were extensive.

Outcomes:

The vision diminution recovered well after the surgery but the hearing loss in her right ear was still persisted.

Lessons:

Although rare, a standard RDD typically are dural-based, extra-axial, well-circumscribed masses mimicking meningioma, and presenting with characterized hypo to isointense on T1-weighted images, hypo to isointense on T2-weighted images, and obvious enhancement. Resection of the intracranial lesion is the most effective treatment. In case of subtotal resection, the application of adjunctive radiotherapy and/or steroid agents should be advised. Final diagnosis of RDD should be confirmed by histopathological and immunohistochemical examinations.
p53 involvement in clonal hematopoiesis of indeterminate potential
Authors: Chen Sisi , Liu Yan
Published: May 2019

Purpose of review

Clonal hematopoiesis of indeterminate potential (CHIP) increases with age and occurs when a single mutant hematopoietic stem cell (HSC) contributes to a significant clonal proportion of mature blood lineages. Somatic mutations in the TP53 gene, which encodes the tumor suppressor protein p53, rank in the top five among genes that were mutated in CHIP. This review focuses on mechanisms by which mutant p53 promotes CHIP progression and drives the pathogenesis of hematological malignancies, including myelodysplastic syndromes, and acute myeloid leukemia.

Recent findings

TP53 was frequently mutated in individuals with CHIP. Although clinical studies suggest that expansion of HSCs with TP53 mutations predisposes the elderly to hematological neoplasms, there is a significant gap in knowledge regarding the mechanisms by which TP53 mutations promote HSC expansion. Recent findings suggest that several cellular stressors, including hematopoietic transplantation, genotoxic stress, and inflammation, promote the expansion of HSCs with TP53 mutations. Further, TP53 mutations identified in CHIP cooperate with genetic and/or epigenetic changes in leukemogenesis.

TP53 mutations identified in CHIP are associated with increased risks of de novo and therapy-related hematological neoplasms. Thus, targeting mutant p53 and related pathways holds great potential in preventing CHIP progression and treating hematological malignancies.
Growing old in the age of heterogeneity: the perils of shifting clonality
Authors: Gustafsson Karin , Scadden David T.
Published: May 2019

Purpose of review

Hematopoietic stem cells (HSC) are functionally heterogeneous in a clone-specific manner. The complexity of that heterogeneous mix of cells is progressively lost with age as a myeloid-dominant hematopoietic system is established. Yet, the function of this diversity, as well as the consequences of its loss, remains unknown. This review will bring together recent advances in HSC diversity and novel insights into myeloid heterogeneity and specification in order to bring focus on how this may affect the ageing individual.

Recent findings

The ageing haematopoietic system is dominated by a low number of active HSC clones that produce an excess of myeloid cells. In addition, individual myeloid progenitors and their mature progeny are proving to be more functionally restricted than previously recognized. The presence or absence of a particular type of myeloid cell can greatly affect the outcome of various pathological processes.

Myeloid cells are important drivers of many ageing-associated diseases. The loss of HSC heterogeneity, with a possible concomitant restriction of myeloid cell diversity, could significantly impact health during ageing.
Rural health, telemedicine and access for pediatric surgery
Authors: Kohler Jonathan E. , Falcone Richard A. , Fallat Mary E.
Published: May 2019

Purpose of review

Access to care for children requiring pediatric general or specialty surgery or trauma care who live in rural areas remains a challenge in the United States.

Recent findings

The expertise of specialists in tertiary centers can be extended to rural and underserved areas using telemedicine. There are challenges to making these resources available that need to be methodically approached to facilitate appropriate relationships between hospitals and providers. Programs, such as the National Pediatric Readiness Project and the HRSA Emergency Medical Services for Children Program enhance the capability of the emergency care system to function optimally, keep children at the home hospital if resources are available, facilitate transfer of patients and relationship building, and develop necessary transfer protocols and guidelines between hospitals.

Telehealth services have the potential to enhance the reach of tertiary care for children in rural and underserved areas where surgical and trauma specialty care is not readily available, particularly when used to augment the objectives of national programs.
Percutaneous Drainage of an Iliopsoas Hematoma in a Hemophilia Patient
Authors: Kaçar Dilek , Ergun Onur , Kara Abdurrahman , Çulha Vildan , Özbek Namik Y.
Published: May 2019

In patients with hemophilia, the usual treatment for both iliopsoas hematoma and associated femoral nerve compression is conservative. The case presented herein is a moderate hemophilia A patient with significant femoral neuropathy due to iliopsoas hematoma whose symptoms could not be managed with an aggressive factor VIII replacement program for >2 weeks. An unusual treatment option - percutaneous catheter insertion and aspiration of the hematoma - alleviated the examination findings and reversed his abilities.
An Ethical Discussion on Voluntarily Stopping Eating and Drinking by Proxy Decision Maker or by Advance Directive
Authors: Christenson Julie
Published: May 2019

The number of people living with Alzheimer disease and other dementias continues to grow because of the aging of the US population. Increasingly, the issue of patient- and/or surrogate-directed withholding of oral, hand-fed food and fluids in cases of late-stage dementia is confronting caregivers. Major media outlets have covered several cases wherein patients with explicit directives or clear surrogate decision making were not allowed to face the end of their lives according to their wishes. Ethical and legal scholars, as well as many end-of-life advocacy groups, are working to develop a framework and provide guidance in these cases. A local hospice organization was faced with these ethical deliberations when an activated proxy decision maker advocated for caregivers to stop hand feeding an incapacitated patient with end-stage dementia. In this article, this case is summarized, and this important ethical issue is presented in the setting of a literature review and nursing implications.
Progress in Pharmacological and Surgical Management of Tourette Syndrome and Other Chronic Tic Disorders
Authors: Pandey Sanjay , Dash Deepa
Published: May 2019

Background:

Tourette syndrome (TS) and other chronic tic disorders are clinically heterogenous and cause physical discomfort, social difficulties, and emotional distress. In addition to tics, TS patients have a variety of behavioral comorbidities, including obsessive-compulsive disorders and attention-deficit hyperactivity disorders. TS treatment is multidisciplinary, involving behavioral therapy, oral medications, and botulinum toxin injections.

Methods:

Relevant studies on pharmacological and surgical treatment options for TS and other chronic tic disorders, their limitations and current recommendations were reviewed using the PubMed search till April 2, 2018. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies. This review aims to discuss the progress in pharmacological and surgical treatment options for TS and other chronic tic disorders.

Results and Conclusions:

Both typical and atypical antipsychotic agents are mainstays of pharmacological treatment of TS and other chronic tic disorder patients; however, their use is limited by serious side effects considering their potential of dopamine blockade. Because of the phenotypic variability, no medication has proven effective for all persons with TS and other chronic tic disorders. Botulinum toxin has emerged as a good therapeutic option, especially for focal and dystonic tics. But, their uses are limited by lack of sufficient evidence and high cost. Surgical treatment is considered in medically refractory and severely disabled tics patients. Deep brain stimulation has replaced lesional surgeries; however, there is uncertainty regarding the selection of patients and target of stimulation.
Incidence of Seizures in Fat Embolism Syndrome Over a 10-Year Period
Authors: Kavi Tapan , Teklemariam Ephrem , Gaughan John , Schorr Christa
Published: May 2019

Background and Purpose:

Data regarding the incidence of seizures in patients diagnosed with fat embolism syndrome (FES) are lacking. We examined the incidence of seizures in patients with FES, and the impact of seizures on outcomes over a 10-year period.

Methods:

Using the National Inpatient Sample data set we identified adults (age 18 y old or above) with a diagnosis of FES (ICD-9 958.1) between 2005 and 2014, and categorized them according to the presence or absence of seizures. We excluded patients with a history of epilepsy or traumatic brain injury

Results:

Of the 66,227,531 discharges, we identified 1888 patients (0.003%) with FES of which 53% were male and mean age of 56 (±57.45). Seizure or epilepsy rate in patients with FES was 2.86% (1.69% with seizures and 1.16% with epilepsy), as compared with 3.6% in all hospitalized patients without FES. The Charlson Comorbidity Index for all FES patients was 2.38 (±5.28) and was similar for those with and without seizures. Hospital length of stay was higher in patients with FES and seizures versus those without seizures (14.59 vs. 10.82 d, P=0.09). No statistically significant difference in mortality was observed between the 2 groups.

Conclusions:

The rate of seizure and epilepsy in patients with FES is low when compared with rates in all hospitalized patients or in patients with other causes of acute neurological injury such as intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury. Further studies are needed to provide recommendations for antiepileptic medication use in FES.
Are Elderly Patients Optimally Corrected with Spectacles in the Longer Term after Cataract Surgery?
Authors: Råen Marianne , Kristianslund Olav , Østern Atle Einar , Sandvik Gunhild Falleth , Drolsum Liv
Published: May 2019

SIGNIFICANCE

Our study suggests that patients would benefit from adjusting their distance spectacles several years after cataract surgery. This may lead to a better quality of life for these patients.

PURPOSE

The purpose of this study was to determine whether patients' distance vision is optimally corrected with spectacles 6 to 7 years after cataract surgery and whether patients with glaucoma who regularly visit an ophthalmologist have more correct power in their spectacles.

METHODS

A total of 153 patients (153 eyes) who underwent cataract surgery with phacoemulsification at Oslo University Hospital were examined 6 to 7 years after surgery. Patients with better or equal best-corrected distance visual acuity in the study eye compared with the other eye were included (n = 90; 59%). Vision-related outcomes were measured and analyzed, including a modified version of the visual function questionnaire, Visual Function-14 (VF-14).

RESULTS

A significant difference was found in the logMAR score between the patients' habitual correction (if any) and those with best-corrected distance visual acuity measured at the postoperative study examination (0.20 ± 0.40 and 0.10 ± 0.39, respectively;P< .0001). Patients with glaucoma (n = 17) did not have more correct power of their spectacles than did patients without glaucoma (n = 73;P= .38). The overall mean VF-14 score was 89%, with a statistically significant correlation between a high VF-14 score and a good habitual distance correction (r= −0.82;P< .0001).

CONCLUSIONS

This study indicates that, although the patients are quite satisfied with their visual function 6 to 7 years after cataract surgery, many patients are not making the most of their visual potential. Thus, there seems to be a need for better monitoring of patients' distance refraction and spectacle use for an extended period after cataract surgery.
The Impact of Presentation Mode and Technology on Reading Comprehension among Blind and Sighted Individuals
Authors: Stepien-Bernabe Natalie N. , Lei Daisy , McKerracher Amanda , Orel-Bixler Deborah
Published: May 2019

SIGNIFICANCE

Technological advancements have made distributing reading materials in audio formats more common. Investigating how presentation mode impacts comprehension among sighted and blind individuals will inform the distribution of information to enhance comprehension.

PURPOSE

The aims were (1) to investigate the hypothesis that reading comprehension is enhanced by increased physical engagement and cognitive effort through text or braille and (2) to explore how assistive technology impacts comprehension for blind individuals.

METHODS

In a within-subjects design, 31 sighted and 34 blind participants read and listened to scientific passages and verbally answered free-response questions about what they read and heard. For sighted participants, passages were presented in text and human voice actor recordings. For blind participants, passages were presented with hard-copy braille, a refreshable braille display, voice actor recordings, and a screen reader.

RESULTS

Comprehension scores were analyzed using mixed-effects regression and pairwise comparisons on the estimated marginal means. In study 1, the comprehension difference between text or hard-copy braille and the voice actor formats was assessed to address the first aim. Sighted participants had better comprehension with text (mean, 74.8%; 95% confidence interval [CI], 70.5 to 79.1%) than with a voice actor (mean, 69.7%; 95% CI, 65.4 to 74.0%; P = .02), and blind participants had superior comprehension with hard-copy braille (mean, 70.4%; 95% CI, 63.3 to 77.5%) than with a voice actor (mean, 61.9%; 95% CI, 54.7 to 69.0%; P = .03). In study 2, the comprehension differences among blind participants between the four formats were investigated to address the second aim. Comprehension was better with hard-copy braille (mean, 70.6%; 95% CI, 63.4 to 77.7%) than with a screen reader (mean, 60.7%; 95% CI, 53.5 to 67.9%; P = .02) and better with a braille display (mean, 69.7%; 95% CI, 62.5 to 76.9%) than with a screen reader (P = .04).

CONCLUSIONS

Study 1 supports the hypothesis that more physically engaging tasks enhance comprehension, and study 2 suggests that listening to scientific materials using a synthesized voice may reduce comprehension ability compared with hard-copy braille and braille displays.
Laryngeal Extranodal Nasal-type Natural Killer/T-cell Lymphoma
Authors: Xiang Chun-xiang , Chen Zi-hang , Zhao Sha , Gao Li-min , Tao Qing , Zuo Zhuo , Liu Xiao-yu , Liu Wei-ping
Published: May 2019

Extranodal natural killer/T-cell lymphoma, nasal-type (ENKTL-N) initially presented in larynx is a rare condition without distinctive clinicopathologic features, with a challenging pathologic diagnosis. This study aimed to evaluate the clinicopathologic features and diagnosis of laryngeal ENKTL-N and spread awareness regarding ENKTL-N. A series of 31 cases of laryngeal ENKTL in one Chinese institution over a 9-year interval was retrospectively analyzed. Median age was 50 years (range, 13 to 77 y) with a male/female ratio of 5.2:1 (26/5). All patients initially presented with hoarseness and/or laryngalgia, and 10 patients (32.3%) experienced B symptoms. The supraglottic region was the most common site of occurrence (58.1%), the glottic area being the rarest site (6.5%). The mucosal squamous epithelium was detected in 26 specimens and pseudoepitheliomatous hyperplasia was observed in 8 cases (8/26, 30.8%). “Keratin-pearls” and a “pseudoinvasive” pattern were observed in 2 cases. Follow-up data were available for 26 patients (83.9%), the median survival duration was 9 months, and the overall survival rate at 5 years was 29.6%. Univariate analysis revealed that patients experiencing B symptoms (P=0.019) and age above 60 years had a significantly low survival (P=0.049) and that combined radiotherapy and chemotherapy prolongs overall survival (P<0.001). Laryngeal ENKTL-N is a rare entity with high aggressiveness and a poor prognosis. Multiple biopsies are usually required owing to secondary infection and massive necrosis. Laryngeal EKTL-N may mimic inflammatory lesions or well-differentiated squamous cell carcinoma. Therefore, clinical vigilance is essential to prevent misdiagnosis or a delayed diagnosis.