bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality risk factors in children with severe influenza virus infection admitted to the pediatric intensive care unit
Authors: Shi Tingting , Nie Zhiqiang , Huang Li , Fan Huifeng , Lu Gen , Yang Diyuan , Zhang Dongwei
Published: August 2019

Some children hospitalized for severe influenza virus infection require intensive care or die because of disease progression, which may be combined with other complications. The objective of this study was to identify the mortality risk factors in the patients with severe influenza virus infection admitted to the pediatric intensive care unit (PICU).

Seventy-seven pediatric patients with severe influenza virus infection who were admitted in the PICU at Guangzhou Women and Children's Medical Center between 2013 and 2017 were evaluated. Data were transcribed and analyzed.

The patients’ median age was 3.0 years (interquartile range, 1.0–4.0 years), with 59.7% of the patients aged <3 years. The mortality was 16.9%, and patients aged >3 years accounted for 69.2% of the cases. Influenza A virus infection was found in 83.1% of the patients. Coinfection was detected in 58.7% of the patients. Haemophilus influenzae (11.7%) and adenovirus (9.1%) were the predominant bacterial and viral pathogens isolated, respectively. Older age, oxygen saturation level of <90% at admission, acute respiratory distress syndrome, pneumorrhagia, influenza-associated encephalopathy (IEA), septic shock, low ratio of partial pressure of oxygen in arterial blood (PaO2, <60 mm Hg) to the fraction concentration of oxygen in inspired air (FiO2; P/F), higher oxygenation index, increased alanine aminotransferase level (>100 IU/L), increased aspartate aminotransferase level (>100 IU/L), increased lactate dehydrogenase level (>500 IU/L), high fraction concentration of oxygen in inspired air (FiO2 > 60%), and positive end-expiratory pressure (>8 cmH2O) were associated with poor outcome. The deceased patients were more likely to have oxygen saturation levels of <90% at admission and IEA than those who survived. Higher P/F ratio was a protective factor against death in patients.

The children with severe influenza virus infection who were admitted in the PICU were mainly aged <3 years. The presence of an oxygen saturation level of <90% at admission and IEA were the prognostic variables independently associated with mortality. Higher P/F ratio was a protective factor against death in patients.
Integrase strand-transfer inhibitors for treatment of early HIV infection
Authors: Teira Ramón , Gutierrez Mar , Galindo Pepa , Martínez Elisa , Muñoz Pepa , de la Fuente Belén , Téllez Francisco , Montero Marta
Published: August 2019

This study evaluated whether the interval from the first clinic visit until the start of antiretroviral treatment (ART) was correlated with common parameters of immunological recovery among patients with early HIV infection (EHI).

We reviewed the medical records of patients with EHI who started ART using integrase strand-transfer inhibitors (ISTIs) within the first 6 months after diagnosis. Simple linear regression analyses were performed to determine whether the interval from the first visit to the start of ART was correlated with 1-year changes in CD4+ cell count, CD8+ cell count, CD4+ percentage, and CD4+/CD8+ ratio.

Fifty-three patients with probable or definite EHI started ART using ISTIs between April 2014 and August 2016. Forty-nine patients completed 1 year of follow-up, including 48 men. The routes of HIV transmission were 1 case of needle sharing, 5 cases of heterosexual activity, and 43 cases of men who had sex with men. None of the immunological recovery parameters were correlated with time to the start of ART (CD4+ cell count: R = .12, P 
= .42; CD8+ cell count: R = .107, P 
= .5; CD4+ percentage: R = .14, P 
= .34; CD4+/CD8+ ratio: R = .23, P 
= .14). Furthermore, subgroup sensitivity analyses failed to detect significant correlations based on definite or probable diagnoses, treatment using elvitegravir or dolutegravir, or the time from HIV diagnosis to ART initiation.

This series of EHI cases indicate that using ART with ISTI-based regimens is efficacious and well-tolerated. However, earlier initiation of treatment was not significantly correlated with common parameters of immunological recovery.
Efficacy of fasudil for the treatment of aneurysmal subarachnoid hemorrhage
Authors: Wang Hao-yan , Song Guang-fu , Yang Hong-wei , Chang Xue-feng , Shen Ren-bo , Yang Fu-yi
Published: August 2019

Background:

This study aims to systematically assess the efficacy and safety of fasudil for the treatment of aneurysmal subarachnoid hemorrhage (ASH).

Methods:

This study will include all of randomized controlled trials on the efficacy and safety of fasudil for the treatment of ASH. Ten electronic databases of PubMed, Embase, Cochrane Library, Google Scholar, Web of Science, Ovid, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched from inception to the May 1, 2019 without language restrictions. We will also search gray literatures to avoid missing any other potential studies. Two authors will independently perform study selection, data extraction and management, and methodologic quality assessment. The primary outcome is limbs function. The secondary outcomes comprise of muscle strength, muscle tone, quality of life, and adverse events.

Results:

This study will provide a comprehensive literature search on the current evidence of fasudil for the treatment of ASH from primary and secondary outcomes.

Conclusion:

The results of this study will present evidence to determine whether fasudil is an effective and safety treatment for patients with ASH.

Systematic review registration:

PROSPERO CRD42019136215.
Low-dose methotrexate-induced vulvar edema
Authors: Jia Guifeng , Chai Wei , He Zhiwei , Liu Xiaojing , Wen Yan , Cui Lifeng , Gong Fengyan
Published: August 2019

Rationale:

Methotrexate (MTX) is an antimetabolite of folic acid, which is used for management of ectopic pregnancy. MTX-related toxicity may include cutaneous mucosal damage, bone marrow suppression, gastrointestinal disorders (gastritis, diarrhea, hematitis), liver and kidney function damage, pulmonary toxicity, cardiac toxicity, and nerve toxicity. However, it is not usual for vulvar edema induced by low-dose methotrexate.

Patient concerns:

In this case report, we described a patient with severe vulvar edema and oral cavity ulceration and scalp ulceration induced by low-dose MTX treatment for ectopic pregnancy. Her presenting complaints were pain in the vulva, oral cavity, and scalp.

Diagnoses:

The patient was diagnosed based on clinical findings for MTX toxic reactions.

Interventions:

Vulva was disinfectioned with iodide and Kangfuxin solution, her mouth was rinsed with mouthwash. Three compound glycyrrhizin tablets were orally administered (3 times/day). After 10 days, the broken skin and mucous membrane healed.

Outcomes:

The vulvar edema and oral cavity ulceration and scalp ulceration healed.

Lessons:

Our study demonstrated that even low-dose MTX can be induced skin and mucosal injury, patients and doctors should timely detection of drug toxicity reactions, immediately rescue, prompt discontinuation of medication, and symptomatic treatment to avoid accidental occurrence.
Congenital hepatic fibrosis and coexistent retinal macular degeneration
Authors: Li Dezhao , Qin Junjie , Sun Shijuan , Li Xu
Published: August 2019

Rationale:

Congenital hepatic fibrosis (CHF) is an autosomal recessive disease characterized by periportal fibrosis, portal hypertension, and renal cystic disease. Essentially, CHF is a variant of fibrocystic disorder in which liver and kidney are commonly affected. Other frequently associated conditions include Caroli syndrome and polycystic kidney disease. CHF is also a known accompaniment in an array of inherited disorders with multiorgan involvement.

Patient concerns:

The 20-year-old male patient with declining vision (14 years duration), intermittent gingival bleeding (7 years duration), and abdominal distension (5 years duration), presented with exacerbation of these symptoms during the prior 2 months. The patient had been previously diagnosed with retinal macular degeneration, idiopathic thrombocytopenic purpura, and hepatosplenomegaly.

Diagnoses:

Liver biopsy showed disordered hepatic acini and fibrous parenchymal banding, indicative of CHF.

Interventions:

After the treatment of diuresis and liver protectants, the clinical symptoms of the patients were improved. We subsequently recommend chromosomal analysis, although the family refused.

Outcomes:

Three months after discharge, the patient was followed up by telephone. The patient had obvious abdominal distension and we advised that he should be admitted again. But the family refused.

Lessons:

CHF is an AR disease resulting in portal hypertension and often associated with renal malformations. CHF is also linked to a number of other disorders, many of which are ciliopathies. Because the clinical manifestations of CHF are nonspecific or lacking, its diagnosis is problematic, relying largely on liver biopsy. Once CHF is identified, physicians are obligated to investigate other organ systems, particularly a search for neuromuscular, retina or renal involvement. This case underscores the value of radiologic imaging, pathologic examination, and genetic testing in successfully diagnosing a rare disease.
Overall survival of colorectal cancer by stage at diagnosis
Authors: Joachim Clarisse , Macni Jonathan , Drame Moustapha , Pomier Audrey , Escarmant Patrick , Veronique-Baudin Jacqueline , Vinh-Hung Vincent
Published: August 2019

Population-based cancer registries (PBCR) participate in epidemiological surveillance and in the evaluation of cancer types by enabling analysis of incidence and survival data over time. The aim of this study was to examine overall survival (OS) in patients with colorectal cancer (CRC) by analyzing data from the Martinique population-based cancer registry between 1993 and 2012. All colorectal cancer cases diagnosed in Martinique between 1993 and 2012 were included. Characteristics of CRC patients were analyzed according to age subgroups, namely: <50 years, 50 to 74 years and over 75 years.

We recorded the following socio-demographic and clinical variables: year of diagnosis, age at diagnosis, sex, histology, zone of residence, and subsite of the cancer. Incidence of malignant neoplasms of the colon and rectum (ICD-10 C18–21) was extracted from the Martinique Cancer Registry database. Stage at diagnosis (localized: stage I–II, regional: stage III and metastatic stage: stage IV) were also analyzed for the 2008 to 2012 period.

A total of 2230 cases of incident invasive CRC were included during the study period (1993–2012): 1171 were women (52.5%); 1588 patients (71.2%) had colon cancer. Stage at diagnosis was evaluated in 779 patients (89.6%): 486/779 (62.4%) had stage III–IV at diagnosis, including 285 (36.6%) patients with metastases at diagnosis (stage IV). One-year, 5-year and 10-year OS for the study period 1993 to 2012 was 74.6%, 43.8% and 33.0% respectively. There was a statistical difference in overall survival according to gender (P = .0153), age at diagnosis (P < .001) and stage (P < .001).

Median OS was 2.0 years (95% CI [1.4–2.1]) in the stage III–IV group during the period 2008 to 2012, whereas it was unreached in the stage I–II group. Multivariable analysis confirmed that stage III–IV at diagnosis (hazard ratio (HR) = 3.70 [2.89–4.99]; P < .0001) and colon cancer (HR = 1.30 [1.01–1.69]; P = .04) were main prognostic factors for OS. Women had a HR of 0.78 [0.62–0.96], P = .02. CRC patients in the 50 to 74 years age group had a HR of 0.63 [0.50–0.80], P = .0001.

This study underlines the importance of structuring management of CRC cancer patients.
Efficacy and safety of berberine in the treatment of type 2 diabetes with insulin resistance
Authors: Wang Yinshan , Yan Aihua , Li Shanshan , Liu Bei , Li Huimin , Yan Yong
Published: August 2019

Background:

The incidence of diabetes mellitus (DM) is increasing year by year, and various complications can endanger the lives of patients. Type 2 diabetes mellitus (T2DM) accounts for more than 90% of DM, most of which is associated with insulin resistance (IR), and IR has been shown to be closely related to the onset of T2DM and the presence of DM complications. Berberine (BBR) has been shown to improve T2DM with IR in a number of ways. In this study, we aim to evaluate the efficacy and safety of BBR in the treatment of T2DM with IR to provide the newest evidence for clinical use.

Methods and analysis:

Literature research will be divided into 2 parts: electronic search and manual search. We will search PubMed, EMBASE, The Cochrane Library, the China National Knowledge Infrastructure, China Biology Medicine disc, the China Science and Technology Journal database, and the Wanfang database online. We will select the eligible studies published up to June 30, 2019. Dissertations, conference papers, ongoing trials, internal reports, etc., are searched by manual search methods. We use Homeostatic Model Assessment for IR (HOMA-IR) as the primary outcome of T2DM with IR, and we will also focus on the patient's blood glucose levels and all adverse reactions that occur during medication.

Two reviewers will read the articles, extract the data information, and assess the risk of bias independently. Data analysis will use the software such as RevMan 5.3.5, ENDNOTE X7, and STATA 13.0.

Results:

This study will provide a high-quality synthesis of current evidence of BBR for T2DM with IR from several aspects including HOMA-IR, blood glucose levels, and adverse events.

Conclusion:

This systematic review will provide evidence to assess the efficacy and safety of BBR in the treatment of T2DM with IR.

Ethics and dissemination:

Because all of the data used in this systematic review has been published, ethical approval is not required.

Trial registration number:

PROSPERO CRD42019123225.
Robotic arm-assisted vs conventional unicompartmental knee arthroplasty
Authors: Zhang Fengjun , Li Hongcai , Ba Zhaochen , Bo Chunguang , Li Kai
Published: August 2019

Background:

Robotic arm-assisted unicompartmental knee arthroplasty (UKA) has been recommended for treatment of unicompartmental knee osteoarthritis. However, its effectiveness and safeness remain controversial compared with conventional UKA. Therefore, the goal of this study was to perform a meta-analysis to re-evaluate the effects of robotic arm-assisted UKA on clinical functional outcomes.

Methods:

PubMed, Embase, and Cochrane Library databases were searched to screen the relevant studies. Continuous data (surgical time, knee excursion during weight acceptance, American knee society score [AKSS], Oxford knee score [OKS], forgotten joint score [FJS], visual analog scale [VAS], and range of motion [ROM]) were pooled using a standardized mean difference (SMD) with their corresponding 95% confidence intervals (CIs) to estimate the effect size, while dichotomous data (complication rate, revision rate) were pooled to obtain the relative risk (RR) with a 95% CI by STATA 13.0 software.

Results:

Eleven studies involving 498 patients undergoing robotic-assisted UKA and 589 patients receiving conventional UKA were included. Our pooled results demonstrated that robotic-assisted could significantly reduce the complication rate (RR: 0.62, 95% CI: 0.45–0.85; P = .0041) and improve the knee excursion during weight acceptance (SMD: 0.62, 95% CI: 0.25–1.00; P = .001), but prolonged the surgical time (SMD: 0.74, 95% CI: 0.40–1.08; P < .001). No significant difference in the revision rate, AKSS, OKS, FJS, VAS, and ROM between robotic-assisted and conventional UKA groups.

Conclusion:

This meta-analysis demonstrates robotic-assisted UKA may be an effective and safe surgical procedure for treatment of unicompartmental knee osteoarthritis.
Association of rs10204525 genotype GG and rs2227982 CC combination in programmed cell death 1 with hepatitis B virus infection risk
Authors: Huang Chunhong , Ge Tiantian , Xia Caixia , Zhu Wei , Xu Lichen , Wang Yunyun , Wu Fengtian , Liu Feifei , Zheng Min , Chen Zhi
Published: August 2019

Single nuclear polymorphism (SNP) of programmed cell death 1 (PD-1) was reported associated with hepatitis B virus (HBV) infection, but the SNP sites studied were limited. Whether the combination of 2 or more SNP sites could better represent the relationship between PD-1 SNP and HBV infection was not studied.

Eight hundred ninety-eight HBV-infected patients (222 asymptomatic carriers [AsC], 276 chronic hepatitis B, 105 acute-on-chronic liver failure, and 295 liver cirrhosis) and 364 health controls of South China were enrolled in this study. Four PD-1 SNPs (rs10204525, rs2227982, rs41386349, and rs36084323) were selected and detected by TaqMan probe. The frequency of allele, genotype, and combination of different SNPs were compared between different groups.

For allele frequency analysis, G allele of rs10204525 was protective factor (odds ratio (OR) = 0.823, 95% confidence interval (CI) = 0.679–0.997, P = .046) and T allele of rs2227982 was predisposing factor (OR = 1.231, 95% CI = 1.036–1.463, P = .018) in HBV infection. When analyzed in genotype frequency, the genotype GG of rs10204525 and CC of rs2227982 were protective factor of HBV infection. Combination of rs10204525 GG and rs2227982 CC was potent protective factor of HBV infection (OR = 0.552, 95% CI = 0.356–0.857, P = .007) and was also associated with lower HBV load (OR = 0.201, 95% CI = 0.056–0.728, P = .008) in AsC. The 4 SNP sites were not associated with progression of HBV-related liver disease.

Rs10204525 and rs2227982 of PD-1 associate with HBV infection and combination of the 2 SNP sites can better predict host susceptibility in HBV infection.
Parvovirus B19 infection presenting with neutropenia and thrombocytopenia
Authors: Shin Hyoshim , Park Sungwoo , Lee Gyeong-Won , Koh Eun-Ha , Kim Hyun-Young
Published: August 2019

Rationale:

Parvovirus B19 (PV) infection is usually symptomless and can cause benign, short-lived conditions. Anemia associated with PRCA is the most representative hematologic manifestation, but neutropenia and thrombocytopenia have been rarely reported.

Patient concerns:

Three patients were admitted to the hospital with neutropenia and thrombocytopenia. The accompanying symptoms were fever, myalgia, rash, or arthralgia, and all patients were previously healthy.

Diagnosis:

Patients were positive for PV PCR and diagnosed with PV infection. Before the diagnosis of PV infection, 2 patients underwent BM study and almost absence of erythroid progenitor cells in BM aspiration were a clue for the PV infection. Other BM findings were hypocellular marrow and a few hemophagocytic histiocytes.

Interventions:

Patients received supportive care with follow-up of CBC.

Outcomes:

All 3 patients spontaneously recovered from neutropenia and thrombocytopenia within 3 weeks without severe complications.

Lessons:

The evaluation of PV infection should be considered in situations where there is neutropenia and thrombocytopenia in healthy individuals even without anemia as a differential diagnosis.
Down syndrome with primary thyroid diffuse large B-cell lymphoma and Hashimoto thyroiditis
Authors: Wei Luyang , Zhao Ning , Li Yalun , Zheng Xiaodan , Zhang Huaxin , Zhang Zhongtao
Published: August 2019

Rationale:

Adult patients with Down syndrome (DS) commonly develop Hashimoto thyroiditis (HT). However, primary diffuse large B-cell lymphoma (DLBCL) of the thyroid is uncommon, and its simultaneous occurrence with HT is very rare. To our knowledge, coexisting DLBCL and HT in a patient with DS has not been reported in the medical literature.

Patient concerns:

We present a 43-year-old woman with DS who reported progressive swelling of the neck on the right side and dyspnea over the previous 1 month, with associated neck ache, hoarseness, and dysphagia. Thyroid ultrasonography and computed tomography of the neck revealed a large mass in the right lobe compressing the surrounding tissues.

Diagnoses:

Based on the clinical and histopathologic findings, the patient was diagnosed with coexisting primary thyroid DLBCL and HT.

Interventions:

A palliative unilateral thyroidectomy was performed; postoperative histopathology and immunohistochemistry revealed thyroid DLBCL and HT. The patient was scheduled for chemotherapy and targeted therapy after recovering from surgery.

Outcomes:

The patient died 3 weeks after surgery due to asphyxia caused by uncontrollable growth of recurrent tumor.

Lessons:

The coexistence of DS, primary thyroid DLBCL, and HT is very rare. There is no standardized approach to the clinical identification of primary thyroid lymphoma (PTL), making early diagnosis difficult. A multidisciplinary approach and close follow-up are needed. The mechanisms of the link between DS and PTL are poorly understood and remain to be elucidated.
Treatment of postpill amenorrhea with abdominal obesity by traditional Korean medicine treatment focused on pharmacopuncture and moxibustion
Authors: Hwang Ji Hye
Published: August 2019

Rationale:

Hormone imbalance and menstrual irregularities are normal for postpill women. Pharmacopuncture and moxibustion can stimulate acupoints with herbal extract and heat, respectively, to regulate the function of qi and blood, expel pathogens, and support health.

Patient concerns:

A 39-year-old female patient presented with amenorrhea, >6 months after she had stopped taking the oral contraceptive pill, which she had taken for more than 10 years, and possible associated infertility. Additionally, she reported sudden weight gain of approximately 12 kg in 1 year.

Diagnoses:

In this study, we examined the amenorrhea lasted more than 6 months for postpill patient.

Interventions:

She refused a strong acupuncture stimulus; she underwent lower abdomen pharmacopuncture with wild ginseng complex (WGC) and moxibustion at CV4, 5 times during 1 month. As a secondary treatment, 1 g Geoseub-hwan pills were prescribed for overeating and during social events. After 5 weekly primary treatments, Geoseub-hwan was prescribed intermittently.

Outcome:

After 3 primary treatments, she began menstruation without menstrual cramps or discomfort. After 5 treatments, she exhibited improvement of body weight and body composition. At 1- and 3-month follow-up examinations, she confirmed regular menstruation without discomfort.

Lessons:

Pharmacopuncture with WGC and moxibustion may be effective for the treatment of postpill amenorrhea with abdominal obesity and can be used for patients with fear of a strong acupuncture stimulus.
Challenges of transarterial therapy for hepatocellular carcinoma in patients with chronic kidney disease
Authors: Lin Wei-Chen , Chang Chen-Wang , Chang Ching-Wei , Wang Tsang-En , Chen Ming-Jen , Wang Horng-Yuan
Published: August 2019

Poor outcomes of hepatocellular carcinomas (HCC) in chronic kidney disease (CKD) patients are well described. Transarterial therapy is the standard treatment for HCC, following which regular contrast-enhanced imaging for residual disease is recommended. CKD is considered a relative contraindication for transarterial therapy owing to renal failure.

This retrospective study investigated the outcomes of transarterial therapy in HCC patients with CKD. In total, 132 HCC patients who received transarterial therapy were enrolled, of whom 36 had CKD. Most CKD patients were elderly, with mean age of diagnosis of 69.7 ± 11.4 years. Hypertension (odds ratio [OR]; 5.06; 95% confidence interval [Cl]; 1.83–13.94), hepatitis C virus carrier rate (OR; 4.12, 95% CI; 1.13–14.99) and diabetes (OR; 3.62, 95% CI; 1.22–10.72) were significant predictors for CKD in HCC patients. Post therapy, the estimated glomerular filtration rate significantly decreased 13.7% from baseline in the CKD patients (P = .03). There were more post-therapy complications than in the non-CKD group, e.g. acute renal failure and sepsis (P < .01 vs P < .01). Overall survival in the CKD group was significantly poor (10.9 ± 8.5 vs 23.5 ± 16.3 months, P < .01).

The lower survival of CKD patients was unrelated to treatment modality or less contrast-enhanced imaging follow-up. Further research on patient care and factors leading to poor outcomes for CKD is needed.
Are heart doses associated with survival in patients with non-small cell lung cancer who received post-operative thoracic radiotherapy?
Authors: Lee Chia Ching , Chua Gail Wan Ying , Zheng Huili , Soon Yu Yang , Foo Ling Li , Thiagarajan Anuradha , Yap Swee Peng , Siow Tian Rui , Ng Wee Loon , Chua Kevin Lee Min , Yip Connie , Chia Brendan Seng Hup , Ng Yan Yee , Master Zubin , Tan Poh Wee , Tan Yun Inn , Leong Yuh Fun , Loria Joan Faith Evacula , Vellayappan Balamurugan , Koh Wee Yao , Leong Cheng Nang , Tey Jeremy Chee Seong , Tham Ivan Weng Keong , Fong Kam Weng
Published: August 2019

The aim of this retrospective national cohort study is to assess the association between various radiation heart dosimetric parameters (RHDPs), acute myocardial infarct (AMI) and overall survival (OS) outcomes in non-small cell lung cancer (NSCLC) patients treated with post-operative thoracic radiotherapy (PORT) using contemporary radiation techniques.

We identified patients with stage I to III NSCLC treated with PORT at the 2 national cancer institutions from 2007 to 2014. We linked their electronic medical records to the national AMI and death registries. Univariable Cox regression was performed to assess the association between various RHDPs, AMI, and OS.

We included 43 eligible patients with median follow-up of 36.6 months. Median age was 64 years. Majority of the patients had pathological stage III disease (72%). Median prescription dose was 60Gy. Median mean heart dose (MHD) was 9.4Gy. There were no AMI events. The 5-year OS was 34%. Univariable Cox regression showed that age was significantly associated with OS (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.10; P = .008). Radiation heart doses, including MHD, volume of heart receiving at least 5, 25, 30, 40, 50Gy and dose to 30% of heart volume, were not significantly associated with OS.

There is insufficient evidence to conclude that RHDPs are associated with OS for patients with NSCLC treated with PORT in this study. Studies with larger sample size and longer term follow-up are needed to assess AMI outcome.
“Tube in tube” interlaminar endoscopic decompression for the treatment of lumbar spinal stenosis
Authors: Cao Shiqi , Cui Hongpeng , Lu Zhengcao , Zhu Kai , Fu Bensheng , Li Wen , Zhang Jianjun , Ding Yu
Published: August 2019

To describe the Tube in Tube interlaminar endoscopic decompression method and investigate its efficacy and safety in treating lumbar spinal stenosis (LSS).

Utilizing the advantages of the micro-endoscopic decompression (MED) operation channel tube, we used a water-medium spinal endoscopy to perform trans-interlaminar canal decompression, that is, the “Tube in Tube” technique. A retrospective study was performed on 35 patients with LSS who were treated with the Tube in Tube technique. All patients were followed up to 12 months postoperatively. Visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were collected preoperatively and at 3, 6, and 12 months postoperatively. Short-form (36) health survey (SF-36) score was used to examine the general health-related quality of life (HRQoL) of patients preoperatively and at 3 and 12 months postoperatively. Modified Macnab criteria were used to examine the clinical outcomes at 3 and 12 months post-surgery.

The clinical outcomes were satisfactory, with an improvement in all scoring systems. The VAS, JOA, and ODI scores improved from 6.46 ± 1.85, 12.03 ± 4.96, and 42.17 ± 12.22 preoperatively to 2.20 ± 1.14, 21.40 ± 5.86, and 13.14 ± 7.52 at 12 months postoperatively, respectively (P < .001). The Macnab excellent or good rates reached 65.7% and 77.1% at the 3 and 12 months follow-ups. No severe complications occurred.

The Tube in Tube technique had a positive clinical outcome in LSS patients and is safe, reliable, and efficacious. However, a larger number of cases and a multi-center research design will be needed further develop the technique.

Level of Evidence: IV.
Adjuvant treatment with Xiaoqinglong formula for bronchial asthma
Authors: Wang Long , Zheng Xiuli , Hui Yi , Wang Baojia , Yang Yu , Feng Xianrong , Zhang Tianyao , Ma Li , Zhang Xiaobo
Published: August 2019

Background:

Bronchial asthma is one of the most common chronic diseases in the world and has become a serious public health problem. Combination therapy has become the first choice for clinical treatment of bronchial asthma. In addition to the combined use of routine medication, traditional Chinese medicine as an adjuvant therapy is also considered. Xiaoqinglong Decoction (XQLD) is an effective prescription of traditional Chinese medicine in treating asthma, and there are more and more clinical reports about its combination with western medicine in treating asthma. Therefore, we designed this study protocol to evaluate the adjuvant role of XQLD in the treatment of bronchial asthma.

Method:

The following electronic databases will be systematically searched from inception to April 2019: PubMed, EMBASE database, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang, Chinese Scientific Journals Database (VIP), and China Biology Medicine disc, (CBM). And the following primary outcomes will be tested, including effective rate (ER), pulmonary function (FEV1, PEF, FEV1/FVC), adverse reactions (AR). RevMan5 software will be used for literature quality evaluation and stata14.0 software will be used for data synthesis and analysis.

Result:

To evaluate the efficacy and safety of Xiaoqinglong decoction in combination therapy by observing the outcomes of efficacy, adverse reactions and pulmonary function.

Conclusion:

This study protocol will be used to evaluate the efficacy and safety of XQLD in combination with conventional drugs in the treatment of bronchial asthma, as well as the adjuvant role of XQLD in combination.

PROSPERO registration number:

CRD42019133549
Delta neutrophil index as a predictor of disease severity, surgical outcomes, and mortality rates in gastrointestinal diseases
Authors: Choi Jae Ho , Bang Chang Seok , Lee Jae Jun , Baik Gwang Ho
Published: August 2019

Background:

Delta neutrophil index (DNI) is the ratio of the number of immature granulocytes and the total neutrophil count in peripheral circulation. DNI precedes changes in white blood cell or neutrophil counts due to the course of granular leukocyte differentiation in infectious and inflammatory conditions, beginning with immature granulocyte formation. The role of DNI as a biomarker of various infectious or inflammatory conditions has been reported. However, no studies explored the potential role of DNI as an initial biomarker for predicting disease severity, surgical outcomes, and mortality rates of gastrointestinal diseases with pooled diagnostic test accuracy. This study aims to provide evidence that DNI is a predictor of disease severity, surgical outcomes, and mortality rates in patients with gastrointestinal diseases in emergency medical departments.

Methods:

MEDLINE, EMBASE, and the Cochrane Library will be searched using common keywords (inception to July 2019) by 2 independent evaluators. Inclusion criteria will be patients with gastrointestinal diseases, DNI measurements performed in the emergency department, indices of diagnostic performance (sensitivity, specificity, predictive values, and likelihood ratios) of DNI for predicting severity, surgical outcomes, and mortality rate of gastrointestinal diseases. True and false positives and negatives will be calculated based on the diagnostic indices of each study. All types of study designs with full-text literature written in English will be included. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Descriptive data synthesis will be conducted and quantitative synthesis (bivariate and hierarchical summary receiver operating characteristic model) will be performed if the included studies are sufficiently homogenous. Meta-regression, sensitivity analysis, publication bias, and Fagan nomogram will be analyzed and described.

Results:

The pooled synthesis of the diagnostic performance of various gastrointestinal diseases with different cut-off values for DNI may limit the interpretation of uniform diagnostic validity. The authors will contact the corresponding authors for the missing values, requesting the original data in each study. However, if there are no responses from these authors, these studies will be excluded.

Conclusion:

This study will provide diagnostic validity of DNI as an initial marker for the prediction of severity, surgery, and mortality of gastrointestinal diseases.
Clinical predictors and impact of bacteremia in cirrhotic patients with acute skin and skin structure infection
Authors: Lin Chun-Nan , Hsiao Cheng-Ting , Fann Wen-Chih , Wu Shu-Ruei , Chang Chia-Peng
Published: August 2019

Objective

Acute bacterial skin and skin structure infection (ABSSSI) is a common cause of acute admissions in patients with cirrhosis worldwide, but the disease is not well-understood epidemiologically with respect to factors that determine positive blood cultures or patient mortality. The aim of this study was to understand the utility of blood cultures and the association between bacteremia and mortality in cirrhotic patients with ABSSSI. We conducted a retrospective study to investigate factors associated with positive blood cultures and mortality in cirrhotic patients with ABSSSI.

Methods

A retrospective cohort study of hospitalized adult cirrhotic patients with ABSSSI was conducted in a tertiary hospital in Taiwan between March 2015 and December 2016.

Results

A total of 122 hospitalized cirrhotic patients with ABSSSI were included. The overall mortality rate was 9% (11/122), and 23 patients had positive blood culture results. Comorbidities that were significant risk factors for a positive blood culture included diabetes mellitus, acute kidney injury (AKI), and acute-on-chronic liver failure (ACLF). Significant risk factors evident in laboratory evaluations included higher model for end-stage liver disease (MELD) score, higher serum lactate, and lower serum albumin level. Bacteremia was also a significant factor associated with mortality.

Conclusion

A blood culture should be considered for cirrhotic patients with ABSSSI with diabetes mellitus, AKI, ACLF or those exhibiting abnormal albumin, lactate levels, or high MELD score because of the positive correlation between bacteremia and mortality.
Faecal calprotectin as a diagnostic marker of inflammatory bowel disease in patients with gastrointestinal symptoms: meta-analysis
Authors: Petryszyn Pawel , Staniak Aleksandra , Wolosianska Agnieszka , Ekk-Cierniakowski Pawel
Published: August 2019

Colonoscopy is the standard medical procedure to identify inflammatory bowel disease (IBD) in patients with gastrointestinal symptoms. Noninvasive measurement of faecal calprotectin concentration may replace colonoscopy in this indication. The study aimed to assess efficacy of faecal calprotectin as a diagnostic marker of IBD in patients with symptoms suggestive of such diagnosis. Meta-analysis of diagnostic accuracy studies was performed. Cochrane, EMBASE and MEDLINE databases were searched until December 2018. Inclusion criteria comprised experimental and observational studies, adults with gastrointestinal symptoms, calprotectin as index and colonoscopy as reference test, presence of data on/enabling the calculation of diagnostic accuracy parameters. For each study, sensitivity and specificity of faecal calprotectin were analysed as bivariate data. Nineteen studies were identified. The total number of patients was 5032. Calculated pooled sensitivity and specificity were 0.882 [95% confidence interval (CI), 0.827–0.921] and 0.799 (95% CI, 0.693–0.875), respectively. Following faecal calprotectin incorporation in the diagnostic work-up of 100 people with suspected IBD, 18 non-IBD patients will have a colonoscopy performed and one patient with the disease will not be referred for this examination. Faecal calprotectin concentration measurement is a useful screening test to rule out IBD, at the same time reducing the need for colonoscopy by 66.7%.
Comparison of Pharmacy Database Methods for Determining Prevalent Chronic Medication Use
Authors: Anderson Timothy S. , Jing Bocheng , Wray Charlie M. , Ngo Sarah , Xu Edison , Fung Kathy , Steinman Michael A.
Published: August 2019

Background:

Pharmacy dispensing data are frequently used to identify prevalent medication use as a predictor or covariate in observational research studies. Although several methods have been proposed for using pharmacy dispensing data to identify prevalent medication use, little is known about their comparative performance.

Objectives:

The authors sought to compare the performance of different methods for identifying prevalent outpatient medication use.

Research Design:

Outpatient pharmacy fill data were compared with medication reconciliation notes denoting prevalent outpatient medication use at the time of hospital admission for a random sample of 207 patients drawn from a national cohort of patients admitted to Veterans Affairs hospitals. Using reconciliation notes as the criterion standard, we determined the test characteristics of 12 pharmacy database algorithms for determining prevalent use of 11 classes of cardiovascular and diabetes medications.

Results:

The best-performing algorithms included a 180-day fixed look-back period approach (sensitivity, 93%; specificity, 97%; and positive predictive value, 89%) and a medication-on-hand approach with a grace period of 60 days (sensitivity, 91%; specificity, 97%; and positive predictive value, 91%). Algorithms that have been commonly used in previous studies, such as defining prevalent medications to include any medications filled in the prior year or only medications filled in the prior 30 days, performed less well. Algorithm performance was less accurate among patients recently receiving hospital or nursing facility care.

Conclusion:

Pharmacy database algorithms that balance recentness of medication fills with grace periods performed better than more simplistic approaches and should be considered for future studies which examine prevalent chronic medication use.
Photodynamic therapy of infection in burn patients
Authors: Nezhadi Javad , Eslami Hosein , Fakhrzadeh Vahid , Moaddab Seyyed R. , Zeinalzadeh Elham , Kafil Hossein S.
Published: August 2019

Burns are one of the very ordinary and destructive forms of trauma. Patients with significant thermal injury require urgent specialized care for minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. Photodynamic therapy (PDT) was discovered over 100 years ago by observing the killing of microorganisms when harmless dyes and visible light were combined in vitro. Since then it has primarily been developed as a treatment for cancer, ophthalmologic disorders and in dermatology. Multidrug-resistantAcinetobacter baumanniiinfections andPseudomonas aeruginosais considered one of the most important pathogens that represent life-threatening risk in nosocomial environments, mainly in patients with severe burns. Antimicrobial PDT is an effective and useful method to kill bacteria. The advantages of PDT include the rapid effect on bacteria and the lack of drug resistance to this system. The disadvantages of this method can be noted loses antimicrobial activity when the light source turns off and less than perfect selectivity for microbial cells over host tissue. Available data from different studies retrieve from PubMed, Scopus and Google scholar databases on antimicrobial affects of PDT. Based on existing research, PDT is one of the effective methods for the treatment of burn infections with fewer side effects and no sign of resistance.
Achieving a Zero Central Line-Associated Bloodstream Infection Rate in 4 Critical Care Units in Lebanon
Authors: Jamous Sabath , Kouatly Iman , Zaatari Rafika , Kurdahi Badr Lina
Published: August 2019

Every health care facility aims to achieve and maintain a zero central line-associated bloodstream infection (CLABSI) rate. Infections can be costly for institutions of any size and are often not covered by health insurance. The interventions put in place in this quality improvement project were implemented in 4 phases: (1) develop a new standard of care for central lines and give nurses full responsibility for the care and handling of these lines (including blood sampling); (2) revise policy and provide educational sessions to support nurses; (3) document compliance with the new policy; and (4) document CLABSI rates. The project took place during a 15-month period between January 1, 2016 and March 30, 2017, in 4 critical care units in a university medical center in Lebanon. The results revealed a reduction in CLABSI rates from a maximum rate of more than 17 per 1000 catheter days to zero per 1000 catheter days, which was sustained for 10 months. Nurse compliance with the new policy after 3 months ranged from 95% to 99%.
Safety Profile of HTX-019 Administered as an Intravenous Infusion in Patients With Cancer
Authors: Calcanes George , Vacirca Jeffrey L.
Published: August 2019

HTX-019 is a neurokinin 1 receptor antagonist approved for prevention of acute and delayed chemotherapy-induced nausea and vomiting in patients with cancer receiving moderately and highly emetogenic chemotherapy. When administered as a 30-minute intravenous (IV) infusion, HTX-019 has displayed a tolerable and favorable safety profile in healthy subjects. This is the first study to evaluate the safety profile of multiple HTX-019 infusions in patients with cancer. This retrospective analysis shows that HTX-019 administered via IV infusion has a favorable safety profile in patients with cancer, and no new treatment-emergent adverse events were identified.
Exploring the Professional Responsibility Concern Process
Authors: Raymond Christy , Toloiy Raechelle , Bergman Joshua
Published: August 2019

Background:

Registered nurses are pivotal in the analysis, recognition, and reporting of patient safety issues before harm occurs to patients. Little has been written about the relationship between the professional responsibility of reporting safety concerns and the processes that exist.

Problem:

More needs to be known about how nurses can best report factors in work environments that impact patient safety. Learning more about processes that exist amidst literature that illuminates the issues related to reporting and patient safety culture is needed. Also, best practice or key exemplars depicting how professional responsibility has been implemented are needed. Limited has been written exploring professional responsibility concern processes in Canada and internationally.

Approach:

We completed a case study exploration comprising a public facing Web site scan of information about professional responsibility-like processes across Canada, as well as an extensive literature search exploring factors that are linked with nurse reporting of patient safety concerns.

Conclusion:

Themes from related literature identify patient safety culture, leadership qualities, communication, positive nurse factors, speaking up, and whistle-blowing as important aspects that facilitate, or are related to, the ability for nurses to express professional responsibility concerns. Alberta has a well-developed system of reporting such concerns; however, the lack of research and literature on these topics requires additional focus in nursing internationally.
Increasing the Rate of Documentation of Security Interventions in the Emergency Department
Authors: Duncan Jill , Brown Nathan J. , Lock Caitlin , Trudgett Scott , Rothwell Sean , Rosengren David , Hughes James A.
Published: August 2019

Background:

Security interventions in aggressive and violent patients in the emergency department (ED) are not always documented in the clinical record, which can compromise the effectiveness of communication, and increase clinical risks.

Local Problem:

Fewer than half of all security interventions are documented in the clinical record.

Methods:

The study had a pre- and posttest design including a retrospective audit of patient medical records and a staff survey.

Intervention:

A dedicated sticker, to be completed by nursing and security staff, was placed into the clinical notes as a record of the security intervention.

Results:

From 1 month before to 1 month after implementation, the rate of documentation of security interventions in clinical notes increased from 43.3% to 68.8% (P = .01), and was maintained for 3 months after implementation.

Conclusions:

The rate of documentation of ED security interventions in clinical notes can be increased by encouraging clinicians and security staff to collaborate and share documentation responsibilities.
Reactive Depression: Lost in Translation!
Authors: Showraki Mostafa
Published: August 2019

The old classification of depression as reactive and endogenous, which are still observed in clinical practice, both cannot be accommodated under the current rubric of major depression. This is because psychiatric nosology under the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its latest fifth edition (DSM-V) is still descriptive and not etiologic. The aim of this review was to revisit reactive and endogenous categories of depression from the perspective of today's understanding of etiological pathways. From an epigenetic perspective, the old dichotomy of reactive versus endogenous is interrelated through the impact of the environment (e.g., stress). This includes familial or prenatal depression, where the environmental impact is before birth, or childhood depression, where the early life stress is the precipitating factor to genetic susceptibility. In conclusion, searching for both environmental impact (e.g., stressors) and genetic predispositions in depression, even at a clinical level, could help clinicians with better therapeutic decisions.
Is Today's 21st Century Burnout 19th Century's Neurasthenia?
Authors: Lipsitt Don R.
Published: August 2019

This essay addresses the relevance of the concept of “burnout” to concerns about the mental and physical health of today's physicians and those training to join the medical profession. Comparisons are made with the diagnosis of neurasthenia in the 19th century. Social contributors to and the influence of stress on the phenomena in each instance are presented.
The Aspirations for a Paradigm Shift in DSM-5
Authors: Zachar Peter , Regier Darrel A. , Kendler Kenneth S.
Published: August 2019

The initial plans for the DSM-5 revision envisioned a paradigm shift away from traditional diagnostic categories. However, plans for a major move from descriptive to etiologic diagnoses were quickly abandoned as infeasible. Support was much broader for adding dimensional/spectrum constructs to the categorical diagnoses, although this was interpreted in various ways. Delegation of substantial autonomy to work groups with modest central coordination was seen as problematic by some work groups and positively by others. Controversies emerged around the standards for diagnostic change, and the degree to which the same standards should be used across diagnostic groups. The Summit Group was given the final task of trying to forge a consensus among the various review groups. We conclude with thoughts about the difficulty of trying to revise an entire manual all at once and the desirability of developing clear rules for change at the outset of such a diagnostic project.