bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Topical and Systemic Retinoids in Solid Organ Transplant Recipients: Update and Review of the Current Literature
Authors: Herold Mitchell , Good Allison J. , Nielson Colton B. , Longo Maria I.
Published: August 2019

BACKGROUND

Solid organ transplant recipients (SOTRs) are at an increased risk of epithelial malignancies, mainly squamous cell carcinoma, and its precursor lesions such as actinic keratoses, warts, and porokeratosis, which may respond to retinoid therapy.

OBJECTIVE

To review the published evidence on the efficacy and safety of topical and systemic retinoids for the treatment and prophylaxis of malignant and premalignant conditions that mostly afflict SOTRs.

MATERIALS AND METHODS

Systematic review of the literature to summarize the level of evidence and grade of recommendation for retinoid therapy with emphasis in the SOTR population.

RESULTS

Acitretin has the highest strength of recommendation (Grade A) for prophylaxis of nonmelanoma skin cancer (NMSC) and treatment and prophylaxis of actinic keratoses in SOTR. In nonimmunosuppressed patients, acitretin and isotretinoin have a Grade B recommendation for treatment of recalcitrant warts. Topical retinoids have not shown efficacy in preventing NMSC in immunocompetent patients.

CONCLUSION

Retinoids constitute a highly efficacious alternative for the management of the most common conditions that affect SOTRs. Acitretin has the most robust evidence for chemoprophylaxis in SOTRs. Knowledge about the specific indications and expected side effects of topical and systemic retinoids may help optimize their therapeutic potential.
Lumen Diameter and Associated Anatomy of the Superior Labial Artery With a Clinical Application to Dermal Filler Injection
Authors: Money Silas M. , Wall Weston B. , Davis Loretta S. , Edmondson Anna C.
Published: August 2019

BACKGROUND

Vascular compromise and subsequent tissue necrosis is a rare but disfiguring complication of dermal filler injection that frequently occurs in regions of the lip and nasolabial fold supplied by the superior labial artery (SLA).

OBJECTIVE

The purpose of this study was to examine lumen diameter and other anatomical features of the SLA relevant to dermal filler injection in the clinical setting.

MATERIALS AND METHODS

Eighteen adult cadavers were dissected. Detailed measurements of the SLA were taken at predetermined points along its course.

RESULTS

Lumen diameter of the SLA was largest at the labial commissure (0.85 ± 0.34 mm; Point P1) and smallest at the midline (0.56 ± 0.21 mm; Point P4). The deepest mean cutaneous depth of the SLA was at its branch point from the facial artery (5.49 ± 1.95 mm; SLA branch point), whereas the most superficial mean cutaneous depth was at the midpoint between the labial commissure and peak of Cupid's bow (4.29 ± 1.54 mm; Point P2).

CONCLUSION

The variable, superficial course of the SLA and its large caliber place it at significant risk for intra-arterial injection with dermal filler at all points along its course.
Comparison of 2-Octylcyanoacrylate Versus 5-0 Fast-Absorbing Gut During Linear Wound Closures and the Effect on Wound Cosmesis
Authors: Zhuang Anne R. , Beroukhim Kourosh , Armstrong April W. , Sivamani Raja K. , Eisen Daniel B.
Published: August 2019

BACKGROUND

Although the use of 2-octylcyanoacrylate (OCA) in cutaneous surgery offers increased efficiency, there is scant data comparing scar outcomes achieved with OCA versus 5-0 fast-absorbing gut suture (FG).

OBJECTIVE

To compare scar cosmesis achieved with OCA versus FG for surgical wound closure.

MATERIALS AND METHODS

A total of 44 patients with postoperative defects of at least 3 cm were included. Half of each wound was randomized to receive closure with either OCA or FG. At 3 months, patients and 2 blinded observers evaluated each scar using the Patient and Observer Scar Assessment Scale (POSAS).

RESULTS

The total observer POSAS score (mean [SD]) for the side repaired with OCA (12.3 [4.72]) and the side that received FG (11.6 [4.36]) did not differ significantly (p = .40). There was no significant difference in the total patient POSAS scores between closure with OCA (14.9 [8.67]) and FG (14.6 [8.90]) (p = .70). Based on observer POSAS scores, scar pigmentation was significantly worse on the scar half repaired with OCA (1.98 [0.91]) compared with FG (1.79 [0.80]) (p = .05).

CONCLUSION

With the exception of inferior scar pigmentation with OCA, there was no statistically significant difference in wound cosmesis after linear wound closure with OCA versus FG.
Downward Rotation of the Capsulopalpebral Fascia, Orbital Septum, and Orbital Fat Complex: A New Technique for Lower Eyelid Rejuvenation
Authors: Huang Zhenying , Lee Yongkuk , Yan Gen , Wang Kai
Published: August 2019

Background:

Filling of the orbitomalar sulcus through fat conservation and relocation is important for the lower eyelid rejuvenation procedure and has been reported on extensively. This study aimed to introduce a new technique—downward rotation of the capsulopalpebral fascia, septum, and fat complex in lower eyelid blepharoplasty to correct orbitomalar sulcus depression.

Methods:

Eighty-six patients who underwent transcutaneous lower eyelid blepharoplasty for cosmetic purposes from March 2015 to March 2016 were included in this study. The results were evaluated based on pre- and postoperative photographs, surgical records, and questionnaires.

Results:

The patients had no permanent or major complications. There were no fat hernia recurrences, diplopia, fat granulomas, or soft tissue irregularities. Approximately 98% of the patients were satisfied with the outcome.

Conclusions:

This technique more completely fills the orbitomalar sulcus and reinforces the anterior wall of the lower lid septum with capsulopalpebral fascia by rotating the orbital fat downward with the septum and capsulopalpebral fascia. Thus, it lowers the recurrence rate of the lower lid fat hernia and does not require fat removal. In particular, it has a distinct advantage in terms of the correction of the orbitomalar sulcus depression in reoperation cases, especially in patients who undergo fat removal or those with excessive fat removal.
Novel Use of Targeted Muscle Reinnervation in the Hand for Treatment of Recurrent Symptomatic Neuromas Following Digit Amputations
Authors: Daugherty Timothy H.F. , Bueno Reuben A. , Neumeister Michael W.
Published: August 2019

Targeted muscle reinnervation (TMR) has been shown to decrease neuroma pain after major limb loss; however, it has not previously been described for the treatment of symptomatic neuromas in the hand after digit amputations. This report describes the use of TMR in the hand for treatment of a patient with recurrent neuromas after ray amputation of the index and long fingers that were refractory to traditional treatments. TMR was performed first for the superficial branch of the radial nerve 6 years ago to treat the dorsal neuroma pain. Following this, there was complete resolution on the dorsal aspect of the hand, however, continued neuroma pain on the volar aspect of the hand. This was treated more recently with excision of the neuromas and TMR to motor branches of the intrinsic muscles of the hand. Outcomes were measured with a numerical rating scale and Patient-Reported Outcomes Measurement System assessments and revealed decreased pain postoperatively and less interference of her activities due to pain. This report demonstrates the ability to perform TMR within the hand with good results when used for the treatment of symptomatic neuromas.
Influence of High-Intensity Interval Training Versus Continuous Training on Functional Capacity in Individuals With Heart Failure
Authors: Araújo Bruna T. S. , Leite Jéssica C. , Fuzari Helen K. B. , Pereira de Souza Renata Janaína , Remígio Maria Inês , Dornelas de Andrade Armèle , Lima Campos Shirley , Cunha Brandão Daniella
Published: August 2019

Introduction:

Cardiac rehabilitation programs reduce the risk of death and acute events related to the disease through the association of various modalities of exercise. When implemented in high-intensity interval training (HIIT) programs, it may allow for gradual adaptation of the skeletal muscles to greater exercise intensities. The present systematic review aimed to determine whether HIIT promoted a greater increase in exercise tolerance in comparison with continuous aerobic training in individuals with heart failure.

Methods:

A systematic search for articles indexed in the PubMed/MEDLINE, LILACS, SciELO, PEDro, Scopus, and Web of Science databases was carried out. The descriptors used for the search followed the description of the MeSH/DeCS terms with no language or year of publication restrictions. When possible, a meta-analysis was performed and the quality of the evidence was evaluated using the GRADE scale.

Results:

The broad search strategy resulted in 5258 titles, and a total of 7 articles were included in the qualitative synthesis. A low quality of evidence was observed demonstrating that interval training is superior to continuous aerobic training for improving peak oxygen uptake, which reflects an increase in functional capacity of these individuals and moderate quality of evidence regarding improved quality of life and left ventricular ejection fraction.

Conclusion:

High-intensity interval training and continuous training provide benefits for patients, however, the quality of evidence still does not allow us to indicate whether there is a superiority of HIIT over conventional continuous exercise training using the variables analyzed.
Effect of Cardiac Rehabilitation on Sexual Satisfaction Among Patients After Coronary Artery Bypass Graft Surgery
Authors: Rakhshan Mahnaz , Toufigh Afsoon , Dehghani Azimeh , Yaktatalab Shahrzad
Published: August 2019

Purpose:

After coronary artery bypass graft (CABG) surgery, many patients experience diminished sexual function and satisfaction. The present study aimed to investigate the effect of outpatient cardiac rehabilitation (OCR) on the level of sexual satisfaction among post-CABG patients.

Methods:

A clinical trial was performed at the Al-Zahra Hospital, Shiraz, Iran, from July 2017 to January 2018. Based on the inclusion criteria, 104 post-CABG patients were recruited into the study. The participants were randomly assigned to the intervention (OCR) group (n = 52) or the usual care group (n = 52). The intervention group received 20 sessions of OCR, whereas the usual care group received the routine hospital care and education. Data were collected using the Index of Sexual Satisfaction and a demographic data sheet. The data were analyzed using the SPSS software, v23.0 (IBM) and the independent sample t test, paired-samples t test, and χ2 test.

Results:

There was no statistically significant difference in the mean pre-intervention score for sexual satisfaction between the groups. However, a statistically significant difference in the mean post-intervention score for sexual satisfaction was observed between the groups (P < .001). The difference in the mean pre- and post-intervention scores for sexual satisfaction in the intervention group was statistically significant (P < .001), whereas there was no significant difference in the usual care group.

Conclusion:

Post-CABG patients who completed the OCR program experienced an increased level of sexual satisfaction. It is, therefore, recommended to include an OCR program as part of the patient treatment and aftercare following CABG surgery.
Exercise Rehabilitation Improves Cardiac Volumes and Functional Capacity in Patients With Endomyocardial Fibrosis
Authors: Sayegh Ana Luiza Carrari , dos Santos Marcelo R. , Rondon Eduardo , de Oliveira Patricia , de Souza Francis R. , Salemi Vera M. C. , Alves Maria-Janieire de N. N. , Mady Charles
Published: August 2019

Purpose:

Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy associated with low functional capacity and high mortality rates. Exercise training has been proved to be a nonpharmacological treatment of cardiovascular diseases. Therefore, the purpose of this study was to determine the effects of exercise rehabilitation in EMF patients.

Methods:

Twenty-two EMF patients, functional classes II and III (New York Heart Association [NYHA]), were randomized to the control (C-EMF) or exercise rehabilitation (Rehab-EMF) group. Patients in the Rehab-EMF group underwent 4 mo of exercise rehabilitation, whereas patients in the C-EMF group were instructed to maintain their usual daily routine. Peak oxygen uptake (

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2), cardiac function, and quality of life were evaluated. All assessments were performed at baseline and after 4 mo.

Results:

After 4 mo of rehabilitation, peak

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2 increased in the Rehab-EMF group (17.4 ± 3.0 to 19.7 ± 4.4 mL/kg/min, P < .001), whereas the C-EMF group showed no difference (15.3 ± 3.0 to 15.0 ± 2.0 mL/kg/min, P = .87). Also, post-intervention, peak

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2 in the Rehab-EMF group was greater than that in the C-EMF group (P < .001). Furthermore, the Rehab-EMF group, when compared to the C-EMF group, showed an increase in left ventricular end-diastolic volume (102.1 ± 64.6 to 136.2 ± 75.8 mL vs 114.4 ± 55.0 to 100.4 ± 49.9 mL, P < .001, respectively) and decrease in left atrial diastolic volume (69.0 ± 33.0 to 34.9 ± 15.0 mL vs 44.6 ± 21.0 to 45.6 ± 23.0 mL, P < .001, respectively). Quality-of-life scores also improved in the Rehab-EMF group, whereas the C-EMF group showed no change (45 ± 23 to 27 ± 15 vs 47 ± 15 to 45 ± 17, P < .001, respectively).

Conclusion:

Exercise rehabilitation is a nonpharmacological intervention that improves functional capacity, cardiac volumes, and quality of life in EMF patients after endocardial resection surgery. In addition, exercise rehabilitation should be prescribed to EMF patients to improve their clinical condition.
Glaucoma Drainage Devices and Reasons For Keratoplasty
Authors: Knier Catherine G. , Wang Feng , Baratz Keith , Khanna Cheryl L.
Published: August 2019

Précis:

Over 10 years in a tertiary care setting, glaucoma drainage devices (GDDs) have not increased as a reason for keratoplasty.

Purpose:

The purpose of this study was to determine whether the reasons for keratoplasty have changed between 10 years in a tertiary care setting, with special attention to the rate of GDDs as a reason for keratoplasty.

Methods:

Patients aged 18 years or above who underwent keratoplasty at Mayo Clinic, Rochester, MN from 2005 to 2006 and 2015 to 2016 were studied. All reasons for keratoplasty performed in the study time period are assessed, including patients who previously had a GDD implanted in the same eye. After analyzing the reasons for keratoplasty, we assess whether the reasons for keratoplasty have changed between 2005 to 2006 and 2015 to 2016 in association with the increasing placement of GDDs.

Results:

The number of keratoplasty procedures performed in the 2 time periods increased by 62% from 163 (2005 to 2006) to 264 (2015 to 2016), whereas GDD placement increased by 164% from 80 GDD (2005 to 2006) to 211 GDD (2015 to 2016). Although the performance of keratoplasty increased between the 2 points in time, the frequency of each cause for keratoplasty did not change significantly. The majority of keratoplasties were performed due to corneal disease, and GDDs made up a small portion of reasons for keratoplasty (2005 to 2006, 4.29%; 2015 to 2016, 5.68%).

Conclusions:

The frequency of GDDs as a reason for keratoplasty has not changed significantly between 10 years in this tertiary care setting. Patients with GDDs who later required keratoplasty had associated features including multiple surgical procedures and comorbid infection, pseudophakic bullous keratopathy, Fuchs dystrophy, pseudoexfoliation, uveitis, and congenital glaucoma.
Jackhammer Esophagus After Lung Transplantation
Authors: Cangemi David J. , Flanagan Ryan , Bailey Abbey , Staller Kyle , Kuo Braden
Published: August 2019

Goals:

We sought to determine the incidence of jackhammer esophagus (JE) after lung transplantation (LT) and identify potential risk factors for the development of JE after LT.

Background:

JE is a rare esophageal motility disorder, and its pathophysiology remains unclear. Lung transplantation has been implicated as a potential risk factor for JE, but the incidence of JE after LT is unknown.

Study:

A retrospective cohort of adult patients who underwent LT at 2 tertiary care centers over 7.5 years was reviewed. Analysis was performed on patients who underwent a high-resolution esophageal manometry (EM) study before and after LT. JE was defined according to the latest Chicago classification, version 3.0.

Results:

A total of 57 patients without JE identified on pre-LT EM also underwent an EM study after LT. Fifteen (25.4%) were found to have new JE after LT. Patients with newly diagnosed JE after LT were older (61.3±5.3 y vs. 51.6±15.6 y; P=0.02) and more often had chronic obstructive pulmonary disease (COPD; 47.6% vs. 16.6%; P=0.03) compared with those without COPD. There was a trend toward increased risk for JE among female individuals (60% vs. 33.3%; P=0.07) and those with shorter surgical anastomosis times (75.8±12.2 min vs. 84.4±14.3; P=0.06). There was no significant difference between body mass index, opioid use, pretransplant EM findings, surgical ischemic time, occurrence of gastroparesis, or measured post-LT outcomes between the 2 groups.

Conclusions:

JE occurs not uncommonly in patients after LT. Older age and COPD pre-LT may be significant risk factors.
Asymmetric atrophy of cervical multifidus muscles in patients with chronic unilateral cervical radiculopathy
Authors: Yun Yeocheon , Lee Eun Jeong , Kim Yong , Kim Jin Chul , Lee Seung Ah , Chon Jinmann
Published: August 2019

The purpose of this study was to assess whether the asymmetry of cervical multifidus muscles occurred in radiculopathy patients, and if it did, whether it was related to the chronicity of unilateral cervical radiculopathy by assessing the cross-sectional area (CSA) of multifidus muscles using magnetic resonance imaging (MRI).

This study used a retrospective design and was conducted from January 2013 to August 2016. Seventy-seven patients (age 18–65) who had unilateral neck pain, symptom duration of 3 months to 1 year, and who were diagnosed with unilateral 6th cervical radiculopathy by electrodiagnostic testing, were included in study. The CSA of cervical multifidus muscles was measured at the midpoint between the lower margin of the upper vertebra and upper margin of the lower vertebra on axial MRI. Relative CSA (rCSA), which is the ratio of the CSA of muscles to that of the lower margin of C5 vertebra was also obtained.

At the C4-5 and C6-7 levels, CSA and rCSA of cervical multifidus muscles showed no statistically difference between the affected and unaffected sides. At the C5-6 level, multifidus muscles were significantly smaller in the affected side (at the C5-6 level, P value of CSA.007 and P value of rCSA.102).

The atrophy of multifidus muscles ipsilateral to cervical radiculopathy was observed in patients who had chronic unilateral cervical radiculopathy.
Gene mutation detection of urinary sediment cells for NMIBC early diagnose and prediction of NMIBC relapse after surgery
Authors: Zhu Feng , Zhang Yan , Shi Lei , Wu Chun-lei , Chen Shuai-qi , Zheng Hang , Song Dong-kui
Published: August 2019

Early diagnose of bladder cancer could lead to good prognosis and high 5-year-survival rate. Among bladder cancer, about 75% patients with were nonmuscle-invasive bladder cancer (NMIBC). Patients were painful and easily get infected during bladder cancer diagnosis, which mainly depends on invasive cystoscopy and low-sensitivity urine exfoliation cytology. Meanwhile, relapse after surgery was also becoming the major problem for patients. Exploring noninvasive, high-sensitivity, and painless method is very important and meaningful for NMIBC treatment.

Firstly, we found potential related gene mutation sites for NMIBC by searching COSMIC database and related study. Urinary sediment cells of patients both in normal group (patients with benign) and NMIMC group were collected before and after operation for potential gene mutation site detecting. Meanwhile, the urinary sediment cells of relapse patients and good prognosis people in NMIBC group after surgery were also collected for further Gene mutation detection and NMIBC relapse after surgery prediction.

Fourteen genes (152 mutation sites) were selected between 95 NMIBC patients and 67 control patients, which were FGFR3, TP53, PIK3CA, and others. Compared with control group, mutation ratio of above 14 genes was higher in NMIBC group. NMIBC diagnose model was established by 5 times cross-validation and had a good effects, which included the all mutation site in FGFR3, TP53, PIK3CA, ARID1A, STAG2, and KTM2D. On the contrary, the relapse rate was 30.5% among 95 patients for about 1.5-year follow-up time. Compared with control group, smoking rate and tumor grade were higher in relapse group. Meanwhile, mutation rate of FGFR3, TP53, PIK3CA, ERBB3, and TSC1 in relapse group were higher than that in normal group. According to the mutation sites of FGFR3, TP53, PIK3CA, and ERBB3 and the combination of urinary sediment cells genetic mutation and relapse status, a predicted model for NMIBC relapse was also established, which had 90% accuracy.

The diagnosed NMIBC model (based on FGFR3, TP53, PIK3CA, ARID1A, STAG2, and KTM2D gene mutation) and predicted relapse model (based on FGFR3, TP53, PIK3CA, and ERBB3 gene mutation) possess high accuracy and would be applied in early diagnose and early predicting relapse of patients.
Effects of smoking and physical exercise on respiratory function test results in students of university
Authors: Dugral Esra , Balkanci Dicle
Published: August 2019

We explored the effects of smoking and exercise on pulmonary function (PF) in young adults.

This was a 2-year, prospective cross-sectional study on university students. We recorded age, gender, weight, height, pulmonary symptoms, smoking status, and sports habits. Spirometry was used to evaluate lung function; we recorded the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and the FEV1/FVC ratio.

A total of 1014 (552 female, 464 male) subjects were included. Smokers reported significantly more wheezing and sputum production than nonsmokers, but exhibited better FVC and FEV1 values. Those who smoked less than half a pack/d had significantly poorer FVC and FEV1 levels than nonsmokers. Smokers exhibited significantly lower FEV1/FVC ratios than nonsmokers. Overall, those who exercised exhibited better FEV1 and FVC levels, but this was attributable entirely to females.

The spirometric percentile data were adjusted for gender, age, and height, and used as indicators of health status (good: >90: average: 25–90, poor <25). ln males, PF was associated with regular exercise (good: 7.8, average: 6.5, poor: 14.2, P = .02). The smoking rate was higher in the “good” group (males: good: 31.3, average: 30, poor: 17.9, P = .02/females: good: 22.4, average: 17.9, poor: 10.4, P = .02).

On multivariate regression analysis, above-average PF test results were associated with age (1.32 [1.04–1.69]) and exercising at least once per week (4.06 [1.16–14.20]) in males. In females, above-average results were associated with irregular exercise (2.88 [1.36–6.09]), age (1.85 [1.44–2.37]), and exercising until palpitations developed (0.18 [0.04–0.88]).

Smoking improves lung function in young adults; these are “healthy smokers.” Physical activity did not improve lung function, but the absence of physical activity significantly worsened lung function.
Acupotomy for the treatment of lumbar spinal stenosis
Authors: Kwon Chan-Young , Yoon Sang-hoon , Lee Boram , Leem Jungtae
Published: August 2019

Background:

Lumbar spinal stenosis (LSS) is caused by neural compression due to narrowing of the lumbar spinal canal or neural foramen. Surgical intervention is a standard treatment for LSS; however, the steep increase in the surgical rate, post-operative complications, and comparatively low long-term satisfaction are considered to be limitations of this surgical approach. Conversely, acupotomy is a minimally invasive technique that combines the effects of conventional acupuncture with micro-incision, which may offer an alternative to surgery for the treatment of LSS. This review was conducted to investigate and critically review the current evidence on the efficacy and safety of acupotomy for LSS.

Methods:

Eleven databases were searched from their respective inception dates to December 28, 2018. Randomized controlled trials (RCTs) comparing acupotomy and wait-list, sham treatment, or active controls were included. The quality of the included studies was assessed using risk-of-bias tool.

Results:

Seven RCTs were included in this review and meta-analysis. The methodological quality of the included studies was generally poor. The acupotomy treatment group was associated with significantly lower visual analogue scale scores (range 0∼10) (5 RCTs; mean difference [MD] −1.55, 95% confidence interval [CIs] −2.60 to −0.50; I2 = 94%) and higher Japanese Orthopedic Association Score (3 RCTs; MD 4.70, 95% CI 3.73 to 5.68; I2 = 0%) compared to the active control group. In subgroup analysis based on the type of active controls, acupotomy retained significant benefits over lumbar traction and acupuncture, as well as over lumbar traction, spinal decompression, and acupuncture. Safety data were reported in only 1 study, and no adverse events occurred in either the acupotomy or the acupuncture control group.

Conclusion:

According to current evidence, acupotomy might be beneficial for treating LSS. Acupotomy showed consistent superiority over lumbar traction, but the results were mixed in comparisons with other interventions, such as spinal decompression and acupuncture. However, the findings should be interpreted cautiously, given the poor methodological quality of the included studies, and potential small-study effects. Further larger, high-quality, rigorous RCTs should be conducted on this topic and rigorous reporting of acupotomy procedures and safety data should be encouraged.
Chronic myelitis associated with zoster sine herpete
Authors: Miyake Zenshi , Tomidokoro Yasushi , Nohara Seitaro , Tamaoka Akira
Published: August 2019

Rationale:

Neurological complications of varicella-zoster virus (VZV) infection include cerebral infarction, meningoencephalitis, segmental sensory disturbance, facial nerve palsy, and myelitis. Chronic myelitis is rarely reported. Diagnosis of VZV infection can be confirmed by elevated anti-VZV immunoglobulin G (IgG) antibody or detection of VZV DNA in the cerebrospinal fluid (CSF), the former reported to be superior. The detection rate of VZV DNA is generally thought to decrease with time after the onset of the condition. The utility of VZV DNA polymerase chain reaction (PCR) is thus thought to be limited to the acute phase of the disease. The presence of skin lesions also helps to render a diagnosis; however, cases of zoster sine herpete (ZSH), the occurrence of segmental symptoms without skin lesions, renders the diagnosis of VZV infection more difficult. Antiviral drugs, such as acyclovir, are the treatment of choice to resolve VZV infections.

Patient concerns:

A 65-year-old Japanese man felt heaviness and a throbbing pain on the ulnar side of the right forearm. He was previously diagnosed with cervical spondylosis, and received nonsteroidal anti-inflammatory drugs with little improvement. Contrast cervical magnetic resonance imaging showed a swelling and an increased signal intensity of the spinal cord, and an enhancing lesion, all of which were suggestive of myelitis.

Diagnosis:

We found no evidence for diagnoses of sarcoidosis, Behçet disease, multiple sclerosis, or neuromyelitis optica spectrum disorder. The CSF analysis revealed an elevation of the total protein concentration and that the patient was positive for VZV DNA, while anti-VZV IgG was not elevated. The patient was therefore diagnosed with ZSH myelitis.

Interventions:

We administered acyclovir and valaciclovir as the first therapy. At the time of recurrence, we used high-dose acyclovir, vidarabine, and high-dose methylprednisolone pulse therapy.

Outcomes:

The patient's dysesthetic pain in the right upper limb improved following the first antiviral therapy. Two months later, he suffered a recurrence, but the second therapy significantly relieved his symptoms.

Lessons:

VZV infection should be regarded as an important differential diagnosis of chronic myelitis. VZV DNA PCR should be performed even in the chronic phase of the condition to introduce the possibility of antiviral therapy as a treatment option.
Is low body mass index a risk factor for semen quality? A PRISMA-compliant meta-analysis
Authors: Guo Dan , Xu Min , Zhou Qifan , Wu Chunhua , Ju Rong , Dai Jiazhen
Published: August 2019

Background:

Male infertility has become a worldwide public health problem. However, the effect of low body mass index (BMI) is still controversial.

Methods:

Relevant articles in Pubmed, Embase, Web of science, and Wanfang database published until September 2017 were searched without language restriction. We performed a meta-analysis about low BMI and semen parameters containing total sperm count, concentration, semen volume, and sperm motility (overall and progressive), including 709 men with low BMI and 14,622 men with normal BMI.

Results:

Thirteen studies were included in this meta-analysis and a total of 15,331 individuals were accumulated. We pooled data from these articles and found standardized weighted mean differences in semen parameters (total sperm count and semen volume) showed significant difference between low BMI and normal BMI.

Conclusions:

This systematic review with meta-analysis has confirmed that there was a relationship between low BMI and semen quality, which suggesting low BMI may be a harmful factor of male infertility. Yet lacking of the raw data may influence the accuracy of the results. Further researches are needed to identify the role of underweight in male sterility.
Tibial tubercle avulsion fracture according to different mechanisms of injury in adolescents
Authors: Shin Yong-Woon , Kim Dae-Wook , Park Kun-Bo
Published: August 2019

Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.

Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.

There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients’ BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.

Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.
Expression of CD133 is associated with poor prognosis in stage II colorectal carcinoma
Authors: Park Youn Young , An Chang Hyeok , Oh Seong Taek , Chang Eun Deock , Lee Jaeim
Published: August 2019

CD133 is currently believed to be one of the best colorectal cancer stem cell markers. This study aimed to evaluate prognostic significance of CD133 expression in colorectal cancer patients.

A total of 303 patients with stage I to III colorectal cancer who underwent curative surgical resection from 2003 to 2008 at a single institution were included. CD133 expression was evaluated using immunohistochemical staining, and clinicopathological data were retrospectively reviewed. The patients were dichotomized after scoring CD133 expression (0 to 2+: low CD133 expression vs 3+ to 4+: high CD133 expression) according to the extent of area of CD133 positive tumor cells (<50% vs ≥50%) and pattern of staining (membranous staining of the luminal surface and/or staining of cellular debris in the tumor glands and cytoplasm).

The 5-year overall survival (OS) (61.9% vs 80.2%,P = .001) and disease-free survival (64.8% vs 75.8%,P = .026) were poorer in the high CD133 expression group than the low CD133 expression group. In the multivariate analysis for risk factors of OS in the whole population, higher nodal stage (N2 compared to N0: hazard ratio [HR] 3.141; 95% confidence interval [CI] 1.718–5.744,P < .001), perineural invasion (HR 2.262; 95% CI 1.347–3.798,P = .002) and high CD133 expression (HR 1.929; 95% CI 1.221–3.048,P = .005) were independent poor prognostic factors of OS. Subgroup analyses according to each TNM stage revealed that CD133 expression was associated with OS only within the stage II patients (HR 3.167 95% CI 1.221–8.216,P = .018). Furthermore, the stage II patients demonstrating the high CD133 expression showed survival benefit of adjuvant chemotherapy, regardless of high-risk feature positivity (HR 0.201 95% CI 0.054–0.750,P = .017).

High CD133 expression is correlated with poor prognosis in colorectal cancer patients after radical resection. The CD133 expression may serve as a more potent and informative biomarker for prognosis than conventional high-risk features in the stage II colorectal cancer patients.
Diagnostic accuracy of serum dickkopf-1 protein in diagnosis hepatocellular carcinoma
Authors: Li Zhenjie , Mou Lisha , Gao Haibin , Zeng Yi , Tang Xueyi , Deng Xuesong , Pu Zuhui , Ni Yong , Zhan Yongqiang
Published: August 2019

Background:

To verify the accuracy of serum dickkopf-1 protein (DKK-1) in the diagnosis of hepatocellular carcinoma (HCC) by an updated meta-analysis.

Methods:

We searched potential eligible studies in PubMed and Embase before July 8, 2018. Sensitivity (SN), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), summary receiver operating characteristics curve (sROC), and diagnostic odds ratio (DOR) were pooled with their 95% confidence intervals CIs) using a bivariate random-effects model.

Results:

A total of 8 articles contained 10 studies on diagnosis of HCC with DKK-1 alone,7 articles contained 9 studies on diagnosis of HCC with a-fetoprotein (AFP) alone and 5 articles contained 7 studies on diagnosis of HCC with DKK-1 + AFP were identified. The pooled SN, SP, PLR, NLR, and DOR of DKK-1 alone, AFP alone and DKK-1 + AFP were 0.72 (95% CI: 0.70–0.75), 0.62 (95% CI:0.59–0.64) and 0.80 (95% CI:0.78–0.83), 0.86 (95% CI: 0.84–0.87), 0.82 (95% CI:0.80–0.84) and 0.87 (95% CI: 0.85–0.88), 4.91 (95% CI: 2.73–8.83), 3.60 (95% CI:2.01–6.44) and 6.18 (95% CI: 4.68–8.16), 0.32 (95% CI: 0.22–0.47), 0.49 (95% CI:0.40–0.60) and 0.20 (95% CI: 0.15–0.26), and 17.21 (95% CI: 9.10–32.57), 7.45 (95% CI:3.69–15.01) and 31.39 (95% CI: 23.59–43.20), respectively. The area under the sROC was 0.88, 0.70, and 0.92 for the 3 diagnostic methods.

Conclusions:

Serum DKK-1 + AFP showed a high accuracy for diagnosis of HCC, and serum DKK-1 alone had moderate accuracy as compared to a previous meta-analysis, while AFP alone owned an unsatisfied diagnostic behavior for HCC. Due to the limitations of the current analysis, further well-designed studies are needed to confirm the diagnostic value of DKK-1 and DKK-1 + AFP in HCC diagnosis.
Minimally invasive pancreatoduodenectomy is associated with lower morbidity compared to open pancreatoduodenectomy
Authors: Yan Jia-fei , Pan Yu , Chen Ke , Zhu He-pan , Chen Qi-long
Published: August 2019

Background:

Minimally invasive pancreatoduodenectomy (MIPD) is being increasingly performed as an alternative to open pancreatoduodenectomy (OPD) in selected patients. Our study aimed to present a meta-analysis of the high-quality studies conducted that compared MIPD to OPD performed for pancreatic head and periampullary diseases.

Methods:

A systematic review of the available literature was performed to identify those studies conducted that compared MIPD to OPD. Here, all randomized controlled trials identified were included, while the selection of high-quality, nonrandomized comparative studies were based on a validated tool (i.e., Methodological Index for Nonrandomized Studies). Intraoperative outcomes, postoperative recovery, oncologic clearance, and postoperative complications were also evaluated.

Results:

Sixteen studies matched the selection criteria, including a total of 3168 patients (32.1% MIPD, 67.9% OPD). The pooled data showed that MIPD was associated with a longer operative time (weighted mean difference [WMD] = 80.89 minutes, 95% confidence interval [CI]: 39.74–122.05, P < .01), less blood loss (WMD = −227.62 mL, 95% CI: −305.48 to −149.75, P < .01), shorter hospital stay (WMD = −4.68 days, 95% CI: −5.52 to −3.84, P < .01), and an increase in retrieved lymph nodes (WMD = 1.85, 95% CI: 1.33–2.37, P < .01). Furthermore, the overall morbidity was significantly lower in the MIPD group (OR = 0.67, 95% CI: 0.54–0.82, P < .01), as were total postoperative pancreatic fistula (POPF) (OR = 0.79, 95% CI: 0.63–0.99, P = .04), delayed gastric emptying (DGE) (OR = 0.71, 95% CI: 0.52–0.96, P = .02), and wound infection (OR = 0.56, 95% CI: 0.39–0.79, P < .01). However, there were no statistically significant differences observed in major complications, clinically significant POPFs, reoperation rate, and mortality.

Conclusion:

Our study suggests that MIPD is a safe alternative to OPD, as it is associated with less blood loss and better postoperative recovery in terms of the overall postoperative complications as well as POPF, DGE, and wound infection. Methodologic high-quality comparative studies are required for further evaluation.
Clinical manifestation of pediatric mediastinal tumors, a single center experience
Authors: Chen Chieh-Ho , Wu Kang-Hsi , Chao Yu-Hua , Weng De-Fu , Chang Jeng-Sheng , Lin Chien-Heng
Published: August 2019

Medical decisions should be well-planned to improve prognosis and reduce complications of mediastinal tumors. In this study, we analyzed the clinical presentations of pediatric mediastinal tumors and their correlation with long-term clinical outcome.

Forty patients under 18 years of age diagnosed with mediastinal tumors at China Medical University Children's Hospital between 2001 and 2016 were enrolled. The patients’ sex, age of onset, initial clinical symptoms, and treatment outcomes were analyzed.

75% of the patients with mediastinal tumors in this study were men, and the median age of onset was 13 years old (age range: 0–17 years). The overall mortality rate was 40%. The most common tumors were lymphoma (47.5%), followed by germ cell tumors (12.5%), neuroblastoma (12.5%), and thymoma (7.5%). Neuroblastoma was more prevalent in girls younger than 5 years old. The initial presentations of these patients included breathing difficulty (65%), productive cough (47.5%), pleural effusion (54.5%), superior vena cava (SVC) syndrome (35%), neck mass (35%), airway compression (32.5%), fever (30%), chest pain (27.5%), and pericardial effusion (25%). Lymphomas were more likely to be accompanied by neck mass (52.6% vs19.0%, P = .04) and SVC syndrome (52.6% vs 19.0%, P = .026), yet also had a better 1-year-survival rate (68.4% vs 52.4%, P = .02).

Overall, lymphoma should be suspected when children present with neck mass and SVC syndrome. Neuroblastoma with a posterior mediastinal origin should be suspected among children younger than 5 years old. Tumor-related airway obstruction, pleural effusion, and pericardial effusion were leading cause of cardiopulmonary instability during sedation for invasive procedures, which should be managed cautiously.
The incidence and risk factors for surgical site infection in older adults after gastric cancer surgery
Authors: Kim Jung Ho , Kim Jinnam , Lee Woon Ji , Seong Hye , Choi Heun , Ahn Jin Young , Jeong Su Jin , Ku Nam Su , Son Taeil , Kim Hyoung-Il , Han Sang Hoon , Choi Jun Yong , Kim Chang Oh , Yeom Joon-Sup , Hyung Woo Jin , Song Young Goo , Noh Sung Hoon , Kim June Myung
Published: August 2019

Surgical site infection (SSI) is a well-known complication in older adults. However, there have been no studies on SSI after gastrectomy in older adults. Therefore, we aimed to investigate the incidence, risk factors, and outcomes of SSIs after gastrectomy in older adults.

We performed a retrospective cohort study of older adults, aged 65 years or older, who underwent gastrectomy between January 2015 and December 2015 at the Severance Hospital in Seoul, Korea. The incidence and outcomes of SSIs after gastrectomy were evaluated, and the risk factors for SSI were identified using multivariate analyses.

We identified 353 older adults who underwent gastrectomy. Of these, 25 patients (7.1%) developed an SSI. Multivariate analysis indicated that open surgery (odds ratio, 2.71; 95% confidence interval, 1.13–6.51; P = .03) and a longer operation time (odds ratio, 1.01; 95% confidence interval, 1.00–1.01; P = .04) were independent risk factors for SSI after gastrectomy. In the SSI group, the incidence of postoperative fever (84.0% vs 51.8%; P < .001), length of postoperative hospital stay (13 days vs 6 days; P < .001), and re-admission rates within 30 days postoperatively (32.0% vs 3.4%; P < .001) were significantly higher than those in the non-SSI group.

The risk factors for SSI in older adults after gastrectomy were open surgery and a longer operation time. When an SSI occurred, the postoperative hospital stay was prolonged and the chances of having a postoperative fever and being re-admitted within 30 days increased.
Mapping the knowledge structure and trends of epilepsy genetics over the past decade
Authors: Gan Jing , Cai Qianyun , Galer Peter , Ma Dan , Chen Xiaolu , Huang Jichong , Bao Shan , Luo Rong
Published: August 2019

Introduction:

Over the past 10 years, epilepsy genetics has made dramatic progress. This study aimed to analyze the knowledge structure and the advancement of epilepsy genetics over the past decade based on co-word analysis of medical subject headings (MeSH) terms.

Methods:

Scientific publications focusing on epilepsy genetics from the PubMed database (January 2009–December 2018) were retrieved. Bibliometric information was analyzed quantitatively using Bibliographic Item Co-Occurrence Matrix Builder (BICOMB) software. A knowledge social network analysis and publication trend based on the high-frequency MeSH terms was built using VOSviewer.

Results:

According to the search strategy, a total of 5185 papers were included. Among all the extracted MeSH terms, 86 high-frequency MeSH terms were identified. Hot spots were clustered into 5 categories including: “ion channel diseases,” “beyond ion channel diseases,” “experimental research & epigenetics,” “single nucleotide polymorphism & pharmacogenetics,” and “genetic techniques”. “Epilepsy,” “mutation,” and “seizures,” were located at the center of the knowledge network. “Ion channel diseases” are typically in the most prominent position of epilepsy genetics research. “Beyond ion channel diseases” and “genetic techniques,” however, have gradually grown into research cores and trends, such as “intellectual disability,” “infantile spasms,” “phenotype,” “exome,” “ deoxyribonucleic acid (DNA) copy number variations,” and “application of next-generation sequencing.” While ion channel genes such as “SCN1A,” “KCNQ2,” “SCN2A,” “SCN8A” accounted for nearly half of epilepsy genes in MeSH terms, a number of additional beyond ion channel genes like “CDKL5,” “STXBP1,” “PCDH19,” “PRRT2,” “LGI1,” “ALDH7A1,” “MECP2,” “EPM2A,” “ARX,” “SLC2A1,” and more were becoming increasingly popular. In contrast, gene therapies, treatment outcome, and genotype-phenotype correlations were still in their early stages of research.

Conclusion:

This co-word analysis provides an overview of epilepsy genetics research over the past decade. The 5 research categories display publication hot spots and trends in epilepsy genetics research which could consequently supply some direction for geneticists and epileptologists when launching new projects.
Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients
Authors: Zhu Chao , Yin Jian , Wang Bin , Xue Qingmei , Gao Shan , Xing Linyu , Wang Hua , Liu Wei , Liu Xinhui
Published: August 2019

Background:

Most clinical guidelines recommend a restrictive red-blood-cell (RBC) transfusion threshold. However, indications for transfusion in patients with a hip fracture have not been definitively evaluated or remain controversial. We compared the pros and cons of restrictive versus liberal transfusion strategies in patients undergoing hip fracture surgery.

Methods:

Electronic databases were searched to identify randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) to investigate the effects of a restrictive strategy versus its liberal counterpart in patients undergoing hip fracture surgery. The main clinical outcomes included delirium, mortality, infections, cardiogenic complications, thromboembolic events, cerebrovascular accidents, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I2test. Both Begg and Egger tests were used to assess potential publication bias.

Results:

We identified 7 eligible RCTs and 2 eligible RCSs, involving 3,575 patients in total. In patients undergoing hip fracture surgery, we found no differences in frequency of delirium, mortality, the incidence rates of all infections, pneumonia, wound infection, all cardiovascular events, congestive heart failure, thromboembolic events or length of hospital stay between restrictive and liberal thresholds for RBC transfusion (P >.05). However, we found that the use of restrictive transfusion thresholds is associated with higher rates of acute coronary syndrome (P <.05) while liberal transfusion thresholds increase the risk of cerebrovascular accidents (P <.05).

Conclusion:

In patients undergoing hip fracture surgery, clinicians should evaluate the patient's condition in detail and adopt different transfusion strategies according to the patient's specific situation rather than merely using a certain transfusion strategy.