bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin D Enhances the Efficacy of Topical Artificial Tears in Patients With Dry Eye Disease
Authors: Hwang Jin Sun , Lee Yoon Pyo , Shin Young Joo
Published: December 2018

Purpose:

To investigate the efficacy of topical carbomer-based lipid-containing artificial tears (CLAT) and hyaluronate (HU) in patients with dry eye disease (DED) based on serum 25-hydroxyvitamin D (25HD) levels and cholecalciferol (vitamin D) supplementation.

Methods:

A total of 116 patients with DED from June 2015 to June 2016 were included. The participants were divided into the vitamin D deficiency (VDD) group and the non-VDD group according to their serum 25HD levels. The patients determined the ways of cholecalciferol supplementation. Ocular Surface Disease Index (OSDI) score, visual analog pain scale score, lid hyperemia, tear breakup time (TBUT), corneal fluorescein staining score, and Schirmer test were compared between baseline and 2 weeks posttreatment after topical applications and between before and after cholecalciferol supplementation.

Results:

The OSDI and visual analog pain scale scores of both VDD and non-VDD groups decreased after application of topical CLAT and HU compared with baseline values (P < 0.05 for all, paired t test). TBUT, corneal fluorescein staining score, and lid hyperemia in the VDD group remained unaffected by topical CLAT and HU, whereas those in the non-VDD group were improved (3.2 ± 1.7 vs. 4.1 ± 2.2, 0.5 ± 0.7 vs. 0.4 ± 0.6, and 2.2 ± 0.8 vs. 1.9 ± 0.7 in the non-VDD group, P = 0.001, 0.030, and 0.012, respectively). OSDI score, TBUT, and lid margin hyperemia were improved in the intramuscular group after cholecalciferol supplementation compared with pretreatment (33.2 ± 23.2 vs. 28.5 ± 21.9, 3.5 ± 1.9 vs. 6.0 ± 2.5, and 2.2 ± 0.7 vs. 1.2 ± 0.8, P < 0.05, Wilcoxon rank test).

Conclusions:

The effect of topical CLAT and HU was dependent on serum 25HD levels. Cholecalciferol supplementation enhanced the efficacy of topical treatment and may be a useful adjuvant therapy for patients with DED refractory to topical lubricants.
A complete national cohort study of prescriptions of analgesics and benzodiazepines to cancer survivors in Norway 10 years after diagnosis
Authors: Fredheim Olav Magnus , Skurtveit Svetlana , Handal Marte , Hjellvik Vidar
Published: December 2018

Chronic pain due to surgery, radiotherapy, or chemotherapy is prevalent in long-term cancer survivors. Chronic pain due to successful cancer treatment should be treated as chronic nonmalignant pain, primarily with nonpharmacological strategies. Based on complete national data from the Cancer Registry of Norway and the Norwegian prescription database, the aim of this study was to compare the use of nonopioid analgesics, opioids, and benzodiazepines 10 years after cancer diagnosis in long-term cancer survivors and the age- and sex-adjusted general population. The 1-year periodic prevalence of use was higher in long-term cancer survivors in all the studied drug classes: opioids (143.5 vs 129.6/1000), paracetamol (88.3 vs 80.7/1000), nonsteroidal anti-inflammatory drugs (229.1 vs 221.7), gabapentinoids (13.4 vs 10.0/1000), benzodiazepines (88.3 vs 77.9/1000), and benzodiazepine-like hypnotics (118.1 vs 97.4/1000). The prevalence of persistent and high-dose opioid use (>365 defined daily doses [DDDs] and >730 DDDs, respectively, during 365 days, and prescriptions all quarters of the year) was also higher in the cancer survivors than in the general population (6.5 vs 4.8/1000 for persistent use and 2.7 vs 1.3/1000 for high-dose use). Less than 10% of persistent and high-dose users received only long-acting opioid formulations. Furthermore, most long-term cancer survivors with persistent or high-dose opioid use were also high-dose users (>100 DDDs/year) of either benzodiazepines or benzodiazepine-like hypnotics. It is an issue of concern that most of those using opioids did not adhere to guidelines regarding opioid formulation and comedication with other drugs with addictive properties.
Primary small cell carcinoma after renal transplant
Authors: Wang Xueli , Wang Fenghua , Liang Yumei , Chen Wen
Published: December 2018

Introduction:

Primary small cell carcinoma (SCC) after renal transplantation is very rare. Here, we reported 1 case of primary SCC after renal transplantation and analyzed its clinical and pathological characteristics.

Case presentation:

A 55-year-old female underwent renal transplantation in our hospital 2 years ago and had been using tacrolimus for immunosuppressive therapy. Because of abdominal distention, the patient was admitted to our hospital. Computed tomography (CT) showed a malignant tumor of left kidney. Patient underwent surgical treatment and radical nephrectomy and lymph node dissection were selected. Postoperative pathological diagnosis was primary renal parenchyma and ureteral SCC. The patient has been treated with combination chemotherapy of lowpol (100 mg per day) and etoposide (10 mg per day). His vital signs are stable now, and he is receiving further treatment in our hospital.

Conclusion:

Because of immunosuppressive drugs use, the incidence of malignancies has increased significantly after renal transplantation. This case highlights the difficulty of diagnosis of primary SCC and the necessity of checking for neuroendocrine tumor after organ transplantation.
The use of ETView endotracheal tube for surveillance after tube positioning in patients undergoing lobectomy, randomized trial
Authors: Liu Hui-Hui , Dong Fang , Liu Jia-Yi , Wei Jian-Qi , Huang Yan-Kui , Wang Yong , Zhou Tao , Ma Wu-Hua
Published: December 2018

The ETView tracheoscopic ventilation tube (TVT) is a tracheal tube (TT) incorporating a video camera and a light source in its tip. The view from the tip appears continuously on a portable monitor in the anesthesia area. We evaluated the effectiveness and usefulness of the single/double ETView TVT in monitoring the tracheal tube position during general anesthesia undergoing video-assisted thoracoscopic lobectomy.

Eighty-three patients with pulmonary bullae (American Society of Anesthesiologists (ASA) I-III) undergoing lobectomy, with general anaesthesia, were included. Patients were randomly assigned to 3 groups, based on the tube ETView double-lumen tube (VDT), ETView single-lumen tube (VST), or traditional double lumen tube (DT).

All 83 patients’ intubations were successful to achieve 1-lung ventilation: 74 patients at the first attempt (22/26 in VDT, 26/28 in VST, 26/29 in DT group) and 9 patients at the second attempt. The time to achieve 1-lung ventilation with the VDT was 58.5 ± 21.5 (mean ± SD) seconds, the VST was 38.2 ± 10.1 (mean ± SD) seconds, and the DT group was 195.5 ± 40.3 (mean ± SD) seconds. During operations, the ETView tubes provided continuous airway visualization in all patients; a good view was obtained in 24/25 patients in VDT/VST, moderate in 4/12 patients in VDT/VST, and poor in 1/1 patients in VDT/VST. When the patient left the postanesthesia care unit, all had sore throat and 26/15/25 patients in VDT/VST/DT group had hoarseness. All had good outcomes of the surgical operations.

We found the ETView tube to be helpful in the endotracheal intubation and continuous surveillance of tube position in patients with video-assisted thoracoscopic lobectomy. The ETView single lumen endotracheal tube had fewer associated complications and is superior to the 2 double-lumen tubes.
Long-term tumor-free survival in a metastatic pancreatic carcinoma patient with FOLFIRINOX/Mitomycin, high-dose, fever inducing Viscum album extracts and subsequent R0 resection
Authors: Werthmann Paul Georg , Inter Pia , Welsch Thilo , Sturm Anne-Kathrin , Grützmann Robert , Debus Markus , Sterner Martin-Günther , Kienle Gunver Sophia
Published: December 2018

Rationale:

Metastatic pancreatic cancer has a dismal prognosis. Many patients seek integrative care as an add-on to their conventional cancer treatment. Viscum album extracts (VAE)—widely used as an adjunct to cancer treatment—have cytotoxic, apoptogenic, and immune stimulatory properties. A statistically significant survival benefit has been demonstrated for VAE in advanced pancreatic cancer.

Patient concerns and diagnosis:

A 28-year old patient presented with painless jaundice and was subsequently diagnosed as pancreatic adenocarcinoma with liver metastases.

Interventions:

He was treated with FOLFIRINOX/Mitomycin, hyperthermia and fever-inducing VAE.

Outcomes:

Subsequently, the liver metastases regressed. Surgical intervention involved successful R0-resection of the primary tumor, as well as an atypical liver resection. A relapse was again treated with FOLFIRINOX/Mitomycin and hyperthermia. As of publication of this report, 49 months after initial diagnosis, the patient exhibits good condition, and is unrestricted in quality of life (till publication).

Lessons:

This case demonstrates the favorable outcome of a patient with metastatic pancreatic cancer following treatment with chemotherapy, integrative medicine, and surgical excision. As other positive outcomes in pancreatic cancer patients are related to inflammatory events, we presume the immunologic effects of VAE to have contributed to the favorable outcome here. Based on this case, and the other positive results of VAE use in pancreatic cancer, further investigations seem highly worthwhile.
Endovascular management of ruptured distal posterior inferior cerebellar artery aneurysms
Authors: Chen Xianyi , Sun Zeyu , Shi Ligen , Xu Liang , Yu Jun , Fang Bing , Zheng Jingwei , Xu Jing , Zhang Jianmin
Published: December 2018

Distal posterior inferior cerebellar artery (PICA) aneurysm is a kind of rare intracranial aneurysm with controversial evidence in managements. The main purposes of this research are to study the safety and effectiveness of parent artery occlusion (PAO) compared with selective aneurysm coiling (SAC) as well as figure out factors that affect the outcomes.

All characteristics of patients that diagnosed with ruptured distal PICA aneurysm and treated with endovascular management in our hospital from July 2009 to February 2016 were retrospectively collected. Details include complete occlusion rate, procedure-related complications and Modified Rankin Scale (mRS) of 31 months (mean) follow-up.

Total 36 patients finally met the criterions and were included in the present study. New imaging infarction was observed in 12 (33.33%) patients. And 10 of them showed no apparent neurological dysfunctions after 34 months (mean) follow-up; 1 remained coma status since the symptom onset; and 1 patient died. 27 (75%) patients got a mRS ≤ 2 at the discharge while 20 (86.96%) patients with 3-year follow-up after the operation. There is no significant difference between patients treated with SAC and PAO in both complications and functional recovery in 3-years follow-up period. Hunt&Hess classification (H&H), age, and hydrocephalus are risk factors for functional recovery at discharge.

PAO is safe and efficient in the management of distal PICA aneurysms while complications and outcomes are similar with SAC. H&H, age, and hydrocephalus are predicting factors for the mRS at discharge. Further prospective study is still needed to confirm the results of present study.
Inflammatory demyelinating neuropathies with focal segmental glomerulosclerosis
Authors: Mao Yuhe , Zhang Min , Liu Shaojun , Xu Yunyu , Xue Jun , Hao Chuanming , Lai Lingyun
Published: December 2018

Rationale:

Inflammatory demyelinating neuropathies such as Guillain–Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and focal segmental glomerulosclerosis (FSGS) are autoimmune disorders that may have a common pathogenesis. Here, we describe 2 unique cases of FSGS, 1 with GBS and the other with CIPD. We believe that reviewing these multisystemic diseases will help in better understanding of FSGS pathogenesis.

Patient concerns:

The 1st patient, a 66-year-old woman, complained of tingling and numbness in the limbs and within 2 days, she developed progressive muscle weakness. The 2nd patient was a 63-year-old man with a complaint of lower-limb edema, lower-limb weakness, and numbness.

Diagnosis:

In the 1st patient, a diagnosis of GBS was confirmed with the nerve conduction velocity test as well as CSF studies. A renal biopsy revealed FSGS. The 2nd patient was diagnosed with CIDP and a subsequent renal biopsy revealed FSGS.

Interventions:

Large dose of steroid with calcineurin inhibitor, intravenous immunoglobulin, and supportive treatment.

Outcomes:

Neurologic symptoms disappeared, urine protein was maintained at low levels, and no further recurrences were noted in 2 cases. INF2 gene mutation was not found in either case.

Lessons:

Co-occurrence of inflammatory demyelinating polyneuropathy, GBS, CIDP, and FSGS suggests synergistic cellular and humoral autoimmune mechanisms related to either cross-reactivity within antigenic targets or mimicry epitopes. Further follow-up and intensive study for the pathogenesis are necessary.
The efficacy of combined adductor canal block with local infiltration analgesia for pain control after total knee arthroplasty
Authors: Li Yanan , Li Aixiang , Zhang Yixuan
Published: December 2018

Background:

This meta-analysis aimed to evaluate the efficiency and safety of the combined adductor canal block (ACB) with local infiltration anesthesia (LIA) versus LIA alone for pain control after total knee arthroplasty (TKA).

Methods:

We searched PubMed, Medline, Embase, Web of Science, the Cochrane Library and Google databases from inception to August 2017 to selected studies that comparing the combined ACB with LIA and LIA alone for pain control after TKA. Only randomized controlled trials (RCTs) were included. Outcomes included visual analogue scale (VAS) with rest or mobilization at 8 h, 24 h and 48 h, total morphine consumption at 6 h, 24 h and 48 h, distance walked at 24 h and 48 h and the length of hospital stay.

Results:

Seven randomized controlled trial (RCTs) were finally included in this meta-analysis. The present meta-analysis indicated that, compared with LIA alone, combined ACB with LIA was associated with a reduction of VAS with rest at 24 h and 48 h and VAS with mobilization at 24 h. Additionally, combined ACB with LIA was associated with an increase of the distance walked at 24 h and a reduction of the length of hospital stay.

Conclusion:

Combined ACB with LIA could significantly reduce pain scores and morphine consumption compared LIA alone after TKA. Further multimodal large sample RCTs are needed to identify the optimal drug of ACB and LIA.
Thyroid incidentaloma as a “PAIN” phenomenon— does it always require surgery?
Authors: Kaliszewski Krzysztof , Diakowska Dorota , Ziętek Marcin , Knychalski Bartłomiej , Aporowicz Michał , Sutkowski Krzysztof , Wojtczak Beata
Published: December 2018

A thyroid nodule discovered during imaging study performed due to unrelated thyroid disease is known as a thyroid incidentaloma, while positron emission tomography (PET) associated incidental neoplasm of thyroid is known as a “PAIN” phenomenon.

To evaluate which patients with “PAIN” phenomenon should undergo surgery in regards to cytology results.

Retrospective review of 4716 patients consecutively admitted and surgically treated in tertiary surgical center. 49 (1.04%) patients with “PAIN” phenomenon were identified. All of them had ultrasound-guided fine needle aspiration biopsy (UG-FNAB) performed and cytological results were evaluated according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Patients were divided into 2 subgroups according to histopathological diagnosis: group 1 (n = 25) with benign tumor and group 2 (n = 24) with thyroid cancer.

Cytology results were the significant predictors of cancer occurrence in patients with “PAIN” phenomenon (P < .0001). Logistic regression analysis confirmed that category III or higher of TBSRTC in patients with “PAIN” phenomenon significantly increased the risk of cancer (OR = 168.7, P < .0001).

Patients with “PAIN” phenomenon and cytology assigned to category III or higher of the Bethesda system should undergo surgery due to significant risk of thyroid malignancy.
Preoperative elevated neutrophil-to-lymphocyte ratio (NLR) and derived NLR are associated with poor prognosis in patients with breast cancer
Authors: Duan Junwu , Pan Linlin , Yang Ming
Published: December 2018

Background:

Preoperative neutrophil-lymphocyte ratio (NLR) and derived NLR (dNLR) have been suggested to be correlated with the prognosis of patients with breast cancer (BC). However, the results still remain controversial. Therefore, this study was to further evaluate the prognostic potential of preoperative NLR and dNLR for BC patients using a meta-analysis.

Methods:

Relevant articles were sought in PubMed and Cochrane Library databases up to September 2018. The associations between preoperative NLR/dNLR and overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS) were assessed by the STATA software with the results presented as pooled hazard ratio (HR) with 95% confidence interval (CI).

Results:

Twenty-one studies were enrolled. Pooled results showed that elevated NLR was significantly associated with poorer OS (HR = 2.45, 95% CI: 1.69–3.54), DFS (HR = 1.54, 95% CI: 1.28–1.87) and RFS (HR = 4.05, 95% CI: 1.94–8.47) in BC patients undergoing surgery. High-preoperative dNLR was also significantly associated with worse OS (HR = 1.75, 95% CI: 1.39–2.19) and DFS (HR = 1.62, 95% CI: 1.09–2.41). Moreover, subgroup analysis showed significant associations between preoperative elevated NLR and poor prognosis were not changed by the stratification of ethnicity, cutoff of NLR, pathological stage, neoadjuvant, and adjuvant therapy.

Conclusion:

Preoperative NLR and dNLR may be effective predictive biomarkers for prognosis in patients with BC. Detection of NLR and dNLR may be helpful to identify the patients who may benefit from the surgery.
Clinicopathological and prognostic significance of zinc finger antisense 1 overexpression in cancers
Authors: Leng Yuanxiu , Luo Qing , Chen Xumei , Chen Fang , Wang Xue , Pan Yana
Published: December 2018

Background:

An increasing number of studies have recently highlighted the role of zinc finger antisense 1(ZFAS1) as a prognostic marker in cancers. However, these results remain controversial. Hence, a meta-analysis was conducted to further investigate the effects of ZFAS1 expression on clinicopathological features and survival outcomes.

Method:

All eligible studies were searched from PubMed, Embase, Web of Science, and the Cochrane Library. All included articles evaluated the relationship between the expression levels of ZFAS1 and survival, or the range of pathological features in cancer patients. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed to evaluate the effect of ZFAS1 expression on overall survival (OS), relapse-free survival (RFS), and disease-free survival (DFS). The relationship between ZFAS1 expression and clinicopathological features was determined through pooled odds ratios (ORs) and 95% CIs.

Results:

In total 8 studies, which comprised of 820 patients, were qualified for analysis. Results revealed that the overexpression of ZFAS1 was significantly associated with poor OS (HR = 1.97, 95% CI: 1.53–2.54), worse RFS (HR = 1.95, 95% CI: 1.24–3.04) and worse DFS (HR = 2.35, 95% CI: 1.43–3.88) in cancers. Further subgroup analysis revealed that ZFAS1 overexpression was significantly correlated with poor OS in different cancer types, HR obtain methods and sample sizes. In addition, this meta-analysis revealed that the upregulated expression of ZFAS1 was significantly associated with lymph node metastasis, Tumor Node Metastasis (TNM) stage, and tumor size.

Conclusions:

This meta-analysis revealed that the expression of ZFAS1 was associated with tumor prognosis. ZFAS1 could be used as a predictor for tumor progression in various cancers.
Treat the congenital pseudarthrosis of the Tibia with Ilizarov technology
Authors: Kong Ling Dong , Cheng Han Xiong , Nie Tao
Published: December 2018

Rationale:

According to previously published studies, treating pediatric patients with congenital pseudarthrosis of the tibia (CPT) is challenging. More effective methods are needed to treat this patient population.

Patient concerns:

A 7-year-old girl with congenital pseudarthrosis of the distal tibia, previously misdiagnosed as a fracture, underwent plate fixation. Unfortunately, the steel plate broke after 3 months, which led to ankle angle deformity.

Diagnoses:

Congenital pseudarthrosis of the tibia.

Intervention:

Treat the congenital pseudarthrosis of the tibia with Ilizarov technology.

Outcomes:

lower limb force recovery, bone union, and lower-limb-length equalization were achieved. Congenital pseudarthrosis of the tibia were cured.

Lessons:

The Ilizarov technique is a safe, effective, and practical treatment option for patients with CPT.
Serum amyloid A1 (SAA1) gene polymorphisms in Japanese patients with adult-onset Still's disease
Authors: Yashiro Makiko , Furukawa Hiroshi , Asano Tomoyuki , Sato Shuzo , Kobayashi Hiroko , Watanabe Hiroshi , Suzuki Eiji , Nakamura Tadashi , Koga Tomohiro , Shimizu Toshimasa , Umeda Masataka , Nonaka Fumiaki , Ueki Yukitaka , Eguchi Katsumi , Kawakami Atsushi , Migita Kiyoshi
Published: December 2018

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder in which inflammasome activation plays a pathophysiological role. In view of the inflammatory nature of AOSD, we investigated whether serum amyloid A (SAA) gene polymorphisms affect the susceptibility of patients with AOSD.

Eighty-seven Japanese patients with AOSD and 200 healthy Japanese subjects were recruited in this study. The genotypes of the -13C/T SNP in the 5′-flanking region of the SAA1 gene (rs12218) and two SNPs within exon 3 of SAA1 (2995C/T and 3010C/T polymorphisms) were determined using polymerase chain reaction fragment length polymorphism (PCR-RFLP) assay in all subjects. In AOSD patients, exons 1, 2, 3, and 10 of the MEFV gene were also genotyped by direct sequencing.

The frequency of the SAA1.3 allele was increased in AOSD patients compared with that in healthy subjects (43.1% versus 37.5%), but the difference was not significant. The −13T allele was more frequently observed in AOSD patients than in healthy subjects (50.6% versus 41.0%, P = .0336). AOSD patients with the −13T allele had been treated with immunosuppressants more frequently than those without this allele. MEFV mutations were detected in 49 patients with AOSD (49/87, 57.3%). AOSD patients with MEFV variants frequently exhibit macrophage activation syndrome, but the difference was not significant (34.7% versus 18.4%, P = .081). Also, there was no significant difference in SAA1 -13C/T allele frequency between AOSD patients with and without MEFV mutations.

Our data shows a significant association between T allele of rs12218 and AOSD in Japanese population.
Comparison of oncological benefits of deep neuromuscular block in obese patients with gastric cancer (DEBLOQS_GC study)
Authors: Lee Yoontaek , Ha Donghwan , An Liang , Jang You-Jin , Huh Hyub , Lee Chang Min , Kim Yeon-Hee , Kim Jong-Han , Park Seong-Heum , Mok Young-Jae , Lee Il Ok , Kwon Oh Kyoung , Kwak Kyung Hwa , Min Jae Seok , Kim Eun Jin , Choi Sung Il , Yi Jae Woo , Jeong Oh , Jung Mi Ran , Bae Hong Bum , Park Joong-Min , Jung Yong Hoon , Kim Jin-Jo , Kim Dal Ah , Park Sungsoo
Published: December 2018

Purpose:

Many studies have demonstrated the advantage of maintaining intraoperative deep neuromuscular block (NMB) with sugammadex. This trial is designed to evaluate the impact of muscle relaxation during laparoscopic subtotal gastrectomy on the oncological benefits, particularly in obese patients with gastric cancer.

Materials and methods:

This is a double-blind, randomized controlled multicenter prospective trial. Patients with clinical stage I–II gastric cancer with a body mass index of 25 and over, who undergo laparoscopic subtotal gastrectomy will be eligible for trial inclusion. The patients will be randomized into a deep NMB group or a moderate NMB group with a 1:1 ratio. A total of 196 patients (98 per group) are required. The primary endpoint is the number of harvested lymph nodes, which is a critical index of the quality of surgery in gastric cancer treatment. The secondary endpoints are surgeon's surgical condition score, patient's sedation score, and surgical outcomes including peak inspiratory pressure, operation time, postoperative pain, and morbidity.

Discussion:

This is the first study that compares deep NMB with moderate NMB during laparoscopic gastrectomy in obese patients with gastric cancer. We hope to show the oncologic benefits of deep NMB compared with moderate NMB during subtotal gastrectomy.

Trial registration number:

ClinicalTrials.gov (NCT03196791), date of registration: October 10, 2017.
New radiological findings and radiculomegaly in oculofaciocardiodental syndrome with a novel BCOR mutation
Authors: Kato Joji , Kushima Kazuhiko , Kushima Fumikazu
Published: December 2018

Rationale:

Oculofaciocardiodental syndrome (OFCD) patients who show radiculomegaly are very rare. We treated a new OFCD patient orthodontically, and performed longitudinal observation for 30 years. New findings, termed calcified-dental-papillae (CDPs) beneath open-apices (OAs) of developing radiculomegalies, pulp-stone-like-calcifications (PSLCs) and the process of radiculomegaly development were observed. A novel mutation of BCL-6 interacting corepressor (BCOR) was identified. Cone-beam-computed-tomography (CBCT) images of the radiculomegalies clarified their morphology.

Patient concerns:

A female patient and her parents were referred to orthodontic clinic for alignment of the teeth.

Diagnosis:

A CDP that harbored bulbous-round-calcified-tissue in the dental papilla beneath the OA of a developing radiculomegaly was found radiographically. PSLCs were observed in the dental pulp. Genetic analysis revealed a novel mutation c.265G>A on Exon 4 and diagnosed as OFCD. CBCT images confirmed round-calcified-tissue and PSLC and that the length of an affected canine was 38.0 mm and calculated as +14.8SD. These novel findings were not observed in lateral incisors and molars.

Interventions:

Observation was performed for 29 years and 3 months including orthodontic treatment for 2 years and 9 months.

Outcome:

Longitudinal follow-up for 26 years and 7 months after the treatment revealed that the development of radiculomegaly every few months or years, CDPs beneath OAs and PSLCs were observed. CDPs, PSLCs, and OAs were associated with radiculomegaly. The patient and the affected teeth including aligned teeth showed no particular change after the completion of the radiculomegaly. CBCT images showed bulbous-calcified-tissue and PSLCs in the mature dental pulp associated with radiculomegaly.

Lessons:

The radiographical findings of CDP, OA and PSLC help early diagnose of OFCD and have importance for initiating orthodontic treatment until radiculomegaly completion.
Arterial involvement in Erdheim–Chester disease
Authors: Villatoro-Villar Michel , Bold Michael S. , Warrington Kenneth J. , Crowson Cynthia S. , Goyal Gaurav , Shah Mithun , Go Ronald S. , Koster Matthew J.
Published: December 2018

Erdheim-Chester disease (ECD) is a rare histiocytosis of the “L” (Langerhans) group with multisystem involvement that can affect the large and medium-sized arteries mimicking vasculitis. Aortic involvement is common but the frequency and outcome of aortic branch vessel abnormalities are less well described.

Patients with ECD were retrospectively identified. Images containing information of arterial involvement within 6 months of diagnosis were considered baseline and compared to last follow-up studies. Two physicians independently reviewed the studies to evaluate for presence of abnormalities attributable to ECD. Age and sex-adjusted logistic regression models were used to examine associations between patient characteristics and vessel involvement at baseline.

Among a cohort of 64 patients with ECD, 63 had baseline imaging of vascular structures. ECD involvement of at least 1 segment of the aorta was observed in 56%. Abnormalities were also observed in aortic arch branches (26%), visceral branch arteries (40%), iliofemoral arteries (31%), coronary (5%), and pulmonary (3%) arteries. Perinephric fibrosis was strongly associated with the identification of abnormalities in the thoracic aorta (OR 4.92 [1.54, 15.75]; P 
= .007), abdominal aorta (OR 7.57 [2.28, 25.07]; P = .001) and visceral branch arteries (OR 6.05 [1.52, 24.03]; P = .01) but not pelvic/lower extremity arteries. Complete normalization of arterial abnormalities at follow-up was only observed in 9% or less of arterial segments involved at baseline.

Aortic and aortic branch vessel abnormalities are frequently observed in patients with ECD and are often asymptomatic. Partial and/or complete resolution of arterial findings is uncommon.
Asymmetric pattern in generalized myasthenia gravis
Authors: Carvalho Thiago Pereira de , Vianna Clara Louise , Andrade Felipe Freitas , Alvarenga Rafaela Abreu , Sales Liz de Oliveira Moura , Rodrigues Rosana Souza , Rosado-de-Castro Paulo Henrique
Published: December 2018

Rationale:

Myasthenia gravis (MG) is an uncommon autoimmune disease mediated by antibodies that attack the postsynaptic acetylcholine receptors (AchRs) at the neuromuscular junction, causing fluctuating muscle weakness, aggravated with use, and relieved with rest.

Patient concerns:

A 32-year-old woman with a diagnosis of MG based on clinical findings, eletroneuromyography, and brain magnetic resonance imaging (MRI) was admitted to our hospital with dysphagia, dysphonia, diplopia, and intense weakness, associated with a 2-day viral gastroenteritis.

Diagnoses:

Physical examination revealed globally reduced deep tendon reflexes, and tetraparesis, with muscle strength grade 4 in the left limbs and grade 2 in the right limbs. Autoantibody dosing against AchR was elevated and computed tomography scan of the thorax revealed a thymic remnant.

Interventions:

Pyridostigmine and human immunoglobulin were infused.

Outcomes:

After 7 days of the reintroduction of pyridostigmine and human immunoglobulin infusion, the patient developed complete resolution of symptoms, being discharged from the hospital. Her symptoms are still well controlled 6 months later. The patient was evaluated by a thoracic surgeon and is awaiting elective thymectomy.

Lessons:

Although our patient presented all the diagnostic criteria of MG, the markedly asymmetric limb weakness presented in previous history and clinical examination of admission was an unusual and unexpected presentation, especially considering the pathophysiology of the disease. MRI of brain without abnormalities was fundamental to rule out another associated etiology. Our review of the literature revealed just 1 case report of MG with similar presentation. This clinical manifestation becomes valuable because it contributes to the list of unexpected presentation that should motivate its suspicion.
Minimally invasive surgery for inflammatory myofibroblastic tumor of the urinary bladder
Authors: Xu He , He Ben , Tu Xiang , Bao Yige , Yang Lu , Zhuo Hui , Wei Qiang
Published: December 2018

Rationale:

Inflammatory myofibroblastic tumors of the urinary bladder (IMTUB) is exceptionally rare. Currently, no standardized treatment has been established for IMTUBs.

Patient concerns:

Herein we report three cases presenting with hematuria and anemia. A 25-year-old man experienced painless gross hematuria for 2 days and the hemoglobin level continuously dropped to 88 g/L; a 72-year-old man complaining of gross hematuria for seven days; and a 33-year-old woman presenting with gross hematuria, urgency, and frequency for the duration of 20 days, with a hemoglobin level of 61 g/L.

Diagnosis:

Ultrasonography, contrast-enhanced computed tomography (CT) scan and magnetic resonance image (MRI) indicated masses of different sizes on the walls of the urinary bladders. Diagnostic transurethral resection of bladder tumor (TURBT) was performed which revealed the diagnosis of IMTUB.

Interventions:

In our cases, we removed the tumors completely with a minimally invasive approach. The first patient received TURBT only. The other patients underwent further laparoscopic and robot-assisted laparoscopic partial cystectomy respectively for the incomplete resection of tumor by diagnostic TURBT.

Outcomes:

Histology of the resected specimen had proliferation of spindle cells with inflammation consistent with IMTUB. Immunohistochemical staining revealed that the tumor cells were positive for anaplastic lymphoma kinase (ALK), Vimentin and Ki-67 (20%–40%), negative for smooth muscle actin (SMA), S-100 and desmin confirming the diagnosis of IMTUB. Follow-up cystoscopy and CT or MRI (mean follow-up period: two years) did not detect any local recurrence or distant metastasis.

Lessons:

Bladder-sparing treatment by TURBT or partial cystectomy remains the main mode of treatment for IMTUB. Laparoscopic and robot-assisted laparoscopic approach is safe and may yield satisfactory oncological and functional results. Regular follow-up protocol is necessary after operation.
Clinical and prognostic analyses of 110 patients with N3 nasopharyngeal carcinoma
Authors: Chen Jing , Liu Tongxin , Sun Quanquan , Hu Fujun
Published: December 2018

Objective:

To analyze the clinical outcome and prognostic factors of N3 nasopharyngeal carcinomas (NPCs), provide a basis for rational treatment and improve the cure rate.

Methods:

A total of 110 patients with a pathologically confirmed diagnosis of N3 (NPC 2008 stage in China) NPC from our hospital were retrospectively included in the study conducted from April 2007 to July 2011. All patients received intensity-modulated radiation therapy. Some of these patients received various chemotherapies. The doses of the planning gross primary tumor and retropharyngeal lymph node volume, high-risk planning tumor volume, low-risk planning tumor volume, and gross tumor volume of neck lymph nodes were 6000 to 7600, 5400 to 6600, 5000 to 6000, and 6000 to 6996 cGy, respectively. The Kaplan–Meier analysis and logrank test were carried out to calculate and compare the survival rates of the patients, and the Statistical Package for the Social Sciences software version 17.0 was used for all analyses. Meanwhile, the Cox model was used to analyze the prognostic factors.

Results:

In this study, the 1-, 3-, and 5-year overall survival rates of the patients were 92.63%, 83.16%, and 70.53%, respectively. Based on the univariate analysis, T stage (P = .043) and chemotherapy (P 
= .003) were significant factors for survival. In the multivariate analysis, only chemotherapy influenced survival (Table 1

JOURNAL/medi/04.03/00005792-201812070-00076/table1/v/2024-05-24T194536Z/r/image-tiff

). Recent toxicity included radioactive oral mucosa inflammation and skin injury, and difficulty opening the mouth and hearing loss were considered late adverse reactions. None of the patients died during treatment.

Conclusions:

Patients with N3 NPC are at high risk of distant metastasis, and their 5-year survival rate is poor. The more important prognostic factors were T stage and chemotherapy. Patients with N3 NPC should be treated with combined chemotherapy and radiotherapy.
Emergence of daptomycin non-susceptible coagulase-negative Staphylococci in patients with cardiovascular device infections
Authors: Hagiya Hideharu , Sugawara Yo , Kimura Keigo , Hamaguchi Shigeto , Nishi Isao , Hayashi Masahiro , Akeda Yukihiro , Tomono Kazunori
Published: December 2018

Rationale:

Daptomycin (DAP) is a key drug for treating severe Staphylococcus infections. The emergence of DAP non-susceptible Staphylococcus aureus has been widely recognized in clinical situations, although the clinical status of DAP non-susceptible coagulase-negative Staphylococcus (CoNS) infections is unclear. We encountered 2 cases of cardiovascular device infections that were associated with DAP non-susceptible CoNS.

Patient concerns:

The first case involved a 60-year-old woman with a pump pocket infection in a left ventricular assist device. DAP non-susceptible Staphylococcus capitis subsp. ureolyticus was isolated from a blood culture after treatment using vancomycin (10 days) and DAP (6 days). The second case involved a 71-year-old man with an aortic graft infection. DAP non-susceptible S capitis subsp. ureolyticus was detected in pus after treatment using vancomycin (2 weeks) and DAP (1 week) without complete removal and debridement.

Diagnosis:

Cardiovascular device infections caused by DAP non-susceptible CoNS.

Interventions and outcomes:

Whole genome sequencing of these strains revealed multiple mutations in genes that are related to DAP-non-susceptibility in S aureus, which created amino acid substitutions in mprF, dltAB, dltD, rpoC, yycG, cls2, pgsA, and vraSR. To the very best of our knowledge, the substitution patterns were not identical to those previously reported in DAP non-susceptibile S aureus.

Lessons:

Clinicians should be cautious regarding the emergence of DAP non-susceptible CoNS, especially in cases with implanted prosthetic devices, inadequate debridement, and prior usage of vancomycin and DAP. Further studies are needed to understand the relevance of these genetic changes and DAP-non-susceptibility in CoNS strains.
Association between Helicobacter pylori infection and Sjögren syndrome
Authors: Chen Qianqian , Zhou Xiaoying , Tan Wenfeng , Zhang Miaojia
Published: December 2018

Background:

Helicobacter pylori has been proved as a risk factor of many diseases. There are some researches trying to find connection between H. pylori and Sjögren syndrome (SS). However, the conclusions of these studies are controversial. We conducted this meta-analysis to evaluate the association between H. pylori and SS.

Methods:

We searched PubMed and Embase databases for researches which include the data of H. pylori infection rate in SS and control groups. A fixed-effects model was used to analyze the risk odds ratio (OR) with 95% confidence intervals (CIs) according to the heterogeneity across the selected studies.

Results:

Nine studies with 1958 participants including 619 patients with SS met the inclusion criteria. The total infection rate of H. pylori was 53.83% (1054/1958). We found that the patients with SS had a significantly higher H. pylori infection rate than control groups (OR = 1.19, 95% CI: 1.01–1.41, P = .033). Subgroup analysis demonstrated a significantly higher H. pylori infection rate in patients with primary SS than controls (OR = 1.24, 95% CI: 1.03–1.50, P = .026).

Conclusion:

This meta-analysis is the 1st meta-analysis about the association between H. pylori and SS. The pooled data suggested a significantly higher H. pylori infection rate in patients with SS. More prospective or multicenter retrospective researches could be conducted in the future.
Factors associated with preschool workers’ willingness to continue working
Authors: Tayama Jun , Yoshida Yuri , Iwanaga Ryoichiro , Tokunaga Akiko , Tanaka Goro , Imamura Akira , Shimazu Akihito , Shirabe Susumu
Published: December 2018

In industrialized countries, the turnover rate of preschool workers is extremely high and now represents a social problem. Consequently, it has become important to promote stable early care and educational environments for this population. Several factors related to working environments are known to affect turnover intention; however, the specific factors related to turnover intention among preschool workers have not yet been identified. Considering this, the objective of the present study was to determine factors associated with preschool workers’ willingness to continue working.

The participants of this study were 1137 preschool workers based in Nagasaki Prefecture, Japan. Multivariate logistic regression analysis was used to analyze the participants’ data, with willingness to continue working for 5 years or more set as the dependent variable.

Analysis of the results for all subjects clearly showed that male sex, older age, good mental health, high number of social supports, and good work engagement have a positive effect on willingness to continue working. Further, stratifying the participants in terms of age revealed that for preschool workers under 39 years, male sex, good mental health, high number of social supports, and good work engagement act positively in regard to willingness to continue working. Meanwhile, for those over 40 years, it was found that permanent employment and good work engagement act positively in this regard. Thus, work engagement was the only common factor between preschool workers under 39 and over 40.

The findings of this cross-sectional study demonstrate that the factors associated with willingness to continue working among preschool workers differ between younger and older professionals. These findings underline the importance of considering age categories when attempting to maximize such professionals’ willingness to continue working.
Nocardial spinal epidural abscess with lumbar disc herniation
Authors: Ma Fei , Kang Min , Liao Ye Hui , Lee Guang Zhou , Tang Qiang , Tang Chao , Ding Yin Huan , Zhong De Jun
Published: December 2018

Rationale

Nocardial spinal epidural abscess is rare. The diagnosis is often difficult to make and, if delayed, poses a high risk of long-term disability. Nocardial spinal epidural abscess with severe lumbar disc herniation has not previously been reported.

Patient concerns

A 50-year-old man presented with progressive lumbago and leg pain for 6 weeks after receiving acupuncture therapy, and then the patient suddenly occurred urine retention after walking.

Diagnoses

Clinical examination revealed sign of cauda equina syndrome. Magnetic resonance imaging (MRI) revealed a Lumbar(L)4 to L5 disc herniation, L3 to Sacrum(S)1 epidural abscess, and L2 to S1 paravertebral abscess. The causative organism was Nocardia farcinica.

Interventions

An urgent paravertebral abscess debridement and right L4 to L5 laminectomy were performed. Simultaneously, the disc tissue protruding into the spinal canal was removed, as well as irrigation and drainage. And antimicrobial treatment was continued for 12 months.

Outcomes

Fortunately, the patient was able to walk with a cane and urinate autonomously without a catheter, although this remained difficult 7 days after surgery. After 1 year of treatment, the patient has recovered completely and returned to work.

Lessons

Nocardial spinal epidural abscess with severe lumbar disc herniation is extremely rare. Pain from spinal degenerative diseases often masks the early symptoms of spinal infection. It's worth noting that invasive treatment of spine is a way of causing spinal nocardial infection.
Serial measurements of KL-6 for monitoring activity and recurrence of interstitial pneumonia with anti-aminoacyl-tRNA synthetase antibody
Authors: Yamaguchi Kakuhiro , Iwamoto Hiroshi , Sakamoto Shinjiro , Horimasu Yasushi , Masuda Takeshi , Miyamoto Shintaro , Nakashima Taku , Ohshimo Shinichiro , Fujitaka Kazunori , Hamada Hironobu , Kohno Nobuoki , Hattori Noboru
Published: December 2018

The aim of this study was to evaluate whether serial measurements of serum Krebs von den Lungen-6 (KL-6) could be used to monitor disease activity and to detect recurrence in patients with interstitial pneumonia (IP) with anti-aminoacyl-tRNA synthetase antibodies (ARS-IP).

This retrospective cohort study included 44 patients with ARS-IP. Thirty-six patients had serial data of blood tests and pulmonary function tests. Baseline and longitudinal analyses were performed to investigate whether lung function parameters were associated with serum biomarkers (KL-6, lactate dehydrogenase [LDH], and C-reactive protein [CRP]) using Pearson correlation coefficient. Additionally, the diagnostic accuracy of changes in these biomarkers for detecting ARS-IP recurrence was analyzed by receiver operating characteristic curve analysis.

Baseline levels of serum KL-6 were significantly associated with vital capacity (VC) and diffusion capacity for carbon monoxide (DLco) (r = −0.40, P = .015, and r = −0.44, P = .010, respectively). Longitudinal changes in KL-6 were inversely correlated with changes in VC and DLco (r = −0.57, P <.001 and r = −0.42, P <.001, respectively), whereas those in LDH and CRP were not. Moreover, longitudinal changes in serum KL-6 were significantly associated with recurrence of ARS-IP and could be used to detect ARS-IP recurrence; the area under the curve was 0.79 (P = .002).

The present study demonstrated that serial measurement of KL-6 is useful for monitoring disease activity and detecting recurrence of ARS-IP.
A long time radiological follow-up of neuronal intranuclear inclusion disease
Authors: Chen Linglong , Wu Lin , Li Shenghong , Huang Qin , Xiong Jiajun , Hong Daojun , Zeng Xianjun
Published: December 2018

Rationale:

Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disease identified with diffusion-weighted imaging (DWI) high-intensity signal in magnetic resonance imaging (MRI). The disappearance of the abnormal signal is extremely rare.

Patient concerns:

We present the 2 cases of patients, both of them were suffering from heterogeneous symptoms. We followed up one of them for 7 years with MRI, the other accepted comprehensive MRI inspections.

Diagnoses:

DWI high-intensity signal were observed along the corticomedullary junction in MRI plan scan of heads of 2 patients. For patient 1, the hyperintensities in DWI and fluid-attenuated inversion recovery (FLAIR) images in the occipital lobe disappeared 5 years after onset. Based on the biopsy, patient 1 and 2 were diagnosed as NIID.

Interventions:

There have not effective medication and prevention for NIID. Patient 1 and 2 received symptomatic treatment.

Outcomes:

Up until now, the patients are alive but the disease is progressing.

Lessons:

DWI high-intensity signal is a strong clue for the diagnosis of NIID, but the rare case of the disappearance of it may lead to misdiagnosis.
Laparoscopic extracorporeal repair without a mesh of parasternal diaphragmatic hernia in an elderly woman
Authors: Ni Chen-Hui , Li Huan , Xia Chuan-Bao , Chen Yang-Tian
Published: December 2018

Rationale:

The case of parasternal diaphragmatic hernia is relatively rare in adults. The best way for the treatment of diaphragmatic hernia is to receive operation, yet which surgical method is the best remains unclear.

Patient concerns:

An elderly woman in the hospital was complaining about upper abdominal pain that was complicated by the parasternal diaphragmatic hernia. Such state was found accidentally in a car accident and diagnosed by a computed tomography (CT) scan.

Diagnosis:

Parasternal diaphragmatic hernia.

Interventions:

Laparoscopic surgery was performed. The hernial component was easily drawn back into the abdominal cavity, and hernia sac was resected. Closure hernia sac underwent full-thickness U-shaped transabdominal wall sutures with 3-0 Prolene (ETHICON) after straightening the needle without a mesh.

Outcomes:

The patient recovered quickly without postoperative complication. The hospital stay was 2 days. There was no recurrence and symptoms at a 6-month follow-up.

Lessons:

Laparoscopic extracorporeal repair without using a mesh is a safe, quick, and effective approach. It seems to be an effective treatment of the parasternal diaphragmatic hernia, in particular for elderly patients.