bluuebunny/crossref_metadata_2025 huggingface dataset:
Bank Geographic Diversification and Systemic Risk
Authors: Chu Yongqiang , Deng Saiying , Xia Cong
Published: December 2019

Exploiting staggered interstate banking deregulation as exogenous shocks to bank geographic expansion, we examine the causal effect of geographic diversification on systemic risk. Using the gravity-deregulation approach, we find that bank geographic diversification leads to higher systemic risk measured by the change in conditional value at risk ($\Delta$CoVaR) and financial integration (Logistic($R^{2}))$. Furthermore, we document that geographic diversification affects systemic risk via its impact on asset similarity. The impact of geographic diversification on systemic risk is stronger in BHCs located in states comoving less with the U.S. aggregate economy.
When new nurses talk, nursing organizations listen
Authors: Levine Mary Ellen
Published: December 2019

As new nurse retention is a challenge for the nursing profession, nursing organizations must work to address the needs of these nurses, be a resource to meet their needs, and promote the importance of belonging to a professional organization. This article outlines one state nursing association's efforts to solicit feedback from new nurses in an online survey and describes the survey's findings and recommendations for future directions.
Measles
Authors: Stinchfield Patricia Ann
Published: December 2019

Measles has re-emerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization. Prompt diagnosis and isolation can help reduce measles transmission.
Arthrodiastasis in the management of Perthes disease: a systematic review
Authors: Ibrahim Yasser H. , Kersh Mohamed Ahmed A.L. , Fahmy Hesham
Published: December 2019

This systematic review explores the relevant literature to assess the efficacy of the use of arthrodiastasis in the management of Perthes disease. Until this moment, arthrodiastasis is not well established for its use in Perthes disease as opposed to other containment procedures. Furthermore, there are no clear indications for its use in this disease. Twelve articles were matched to the inclusion criteria and all articles were reviewed and radiological and clinical data were collected and compiled. As regards the hip flexion range of motion, the average preoperative flexion range of motion was 55.32°, while the postoperative was 90°. The average preoperative hip abduction range of motion was 12.28° and postoperative was 35.28°. Mean preoperative hip internal rotation range of motion was 8.69° and postoperatively was 24.93°. Mean preoperative external rotation range of motion was 21.73°, while the postoperative range was 33.71°. Final Stulberg classification was ascertained showing most patients ending with stages two and three. Complications were also assessed with most of which being superficial pin tract infections. The use of arthrodiastasis is a valid treatment option for Perthes disease; however, more articles need to be produced showing comparative data of arthrodiastasis versus other containment procedures. Level of evidence – level 1: systematic review.
Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3C adolescent idiopathic scoliosis: a minimum 4-year follow-up
Authors: Duramaz Altuğ , Karaali Evren , Öztürk Vedat , Ziroğlu Nezih , İlter Mehmet Hakan , Bayrak Alkan
Published: December 2019

The purpose of this retrospective study was to determine the most appropriate distal fusion level in terms of clinical results and radiological changes in Lenke 3C adolescent idiopathic scoliosis (AIS). Between June 2010 and May 2014, a total of 90 consecutive patients who underwent surgery for Lenke 3C AIS were divided into three groups as L2, L3, and L4 according to the fusion levels and compared in terms of functional and radiological outcomes. Patients were evaluated with Scoliosis Research Society 22 (SRS 22) and the Oswestry disability index (ODI) at the final follow-up. Preoperative standard posteroanterior and lateral whole-spine radiographs and lateral bending radiographs were used to evaluate the curves. All patients were also assessed with lumbar MRI at the final follow-up, and classified for each patient in terms of disc degeneration (DD) and facet joint degeneration (FJD). There was a statistically significant difference between the groups in terms of ODI category (P = 0.001). The rate of minimal disability in the L3 group, moderate disability in the L2 group, and severe disability in the L4 group were higher. Statistically significant differences were observed between the groups in terms of pain, body image, mental health, and total score distribution from the SRS-22 domains (P < 0.05). No significant difference was observed between the groups in terms of DD and FJD in MRI (P = 0.263). Although the preoperative functional scores could not be evaluated due to the retrospective nature of the study, it was observed that the only significant difference between the groups was the SRS-22 score. The best SRS-22 score was obtained in patients in whom fusion was stopped at L3.
Flow-Controlled Ventilation Attenuates Lung Injury in a Porcine Model of Acute Respiratory Distress Syndrome: A Preclinical Randomized Controlled Study
Authors: Schmidt Johannes , Wenzel Christin , Spassov Sashko , Borgmann Silke , Lin Ziwei , Wollborn Jakob , Weber Jonas , Haberstroh Jörg , Meckel Stephan , Eiden Sebastian , Wirth Steffen , Schumann Stefan
Published: December 2019

Objectives:

Lung-protective ventilation for acute respiratory distress syndrome aims for providing sufficient oxygenation and carbon dioxide clearance, while limiting the harmful effects of mechanical ventilation. “Flow-controlled ventilation”, providing a constant expiratory flow, has been suggested as a new lung-protective ventilation strategy. The aim of this study was to test whether flow-controlled ventilation attenuates lung injury in an animal model of acute respiratory distress syndrome.

Design:

Preclinical, randomized controlled animal study.

Setting:

Animal research facility.

Subjects:

Nineteen German landrace hybrid pigs.

Intervention:

Flow-controlled ventilation (intervention group) or volume-controlled ventilation (control group) with identical tidal volume (7 mL/kg) and positive end-expiratory pressure (9 cm H2O) after inducing acute respiratory distress syndrome with oleic acid.

Measurements and Main Results:

Pao
2 and Paco
2, minute volume, tracheal pressure, lung aeration measured via CT, alveolar wall thickness, cell infiltration, and surfactant protein A concentration in bronchoalveolar lavage fluid. Five pigs were excluded leaving n equals to 7 for each group. Compared with control, flow-controlled ventilation elevated Pao
2 (154 ± 21 vs 105 ± 9 torr; 20.5 ± 2.8 vs 14.0 ± 1.2 kPa; p = 0.035) and achieved comparable Paco
2 (57 ± 3 vs 54 ± 1 torr; 7.6 ± 0.4 vs 7.1 ± 0.1 kPa; p = 0.37) with a lower minute volume (6.4 ± 0.5 vs 8.7 ± 0.4 L/min; p < 0.001). Inspiratory plateau pressure was comparable in both groups (31 ± 2 vs 34 ± 2 cm H2O; p = 0.16). Flow-controlled ventilation increased normally aerated (24% ± 4% vs 10% ± 2%; p = 0.004) and decreased nonaerated lung volume (23% ± 6% vs 38% ± 5%; p = 0.033) in the dependent lung region. Alveolar walls were thinner (5.5 ± 0.1 vs 7.8 ± 0.2 µm; p < 0.0001), cell infiltration was lower (20 ± 2 vs 32 ± 2 n/field; p < 0.0001), and normalized surfactant protein A concentration was higher with flow-controlled ventilation (1.1 ± 0.04 vs 1.0 ± 0.03; p = 0.039).

Conclusions:

Flow-controlled ventilation enhances lung aeration in the dependent lung region and consequently improves gas exchange and attenuates lung injury. Control of the expiratory flow may provide a novel option for lung-protective ventilation.
Isobaric tags for relative and absolute quantitation-based quantitative proteomic analysis of X-linked inhibitor of apoptosis and H2AX in etoposide-induced renal cell carcinoma apoptosis
Authors: Liu Tian-Shu , Chen Chao , Zhou Biao , Xia Bo-Wen , Chen Zong-Ping , Yan Yong
Published: December 2019

Background:

X-linked inhibitor of apoptosis (XIAP) is a vital factor in the anti-apoptosis mechanism of tumors and is highly expressed in renal cell carcinoma (RCC). However, the mechanism through which XIAP regulates DNA damage repair is unknown. This study investigated the regulatory mechanism of XIAP in etoposide-induced apoptosis in two Caki-1 cell lines with high or low XIAP expression.

Methods:

The two cell lines were established using RNA interference technology. The differentially expressed proteins in the two cell lines were globally analyzed through an isobaric tags for relative and absolute quantitation-based quantitative proteomics approach. Proteomic analysis revealed 255, 375, 362, and 5 differentially expressed proteins after 0, 0.5, 3, and 12 h of drug stimulation, respectively, between the two cell lines. The identified differentially expressed proteins were involved in numerous biological processes. In addition, the expression of histone proteins (H1.4, H2AX, H3.1, H3.2, and H3.3) was drastically altered, and the effects of XIAP silencing were accompanied by the marked downregulation of H2AX. Protein-protein interactions were assessed and confirmed through immunofluorescence and Western blot analyses.

Results:

The results suggested that XIAP may act as a vital cell signal regulator that regulates the expression of DNA repair-related proteins, such as H2AX, and influences the DNA repair process.

Conclusions:

Given these functions, XIAP may be the decisive factor in determining the sensitivity of RCC cell apoptosis induction in response to chemotherapeutic agents.
Combined detection of urine specific gravity and BK viruria on prediction of BK polyomavirus nephropathy in kidney transplant recipients
Authors: Chen Xu-Tao , Wang Ze-Yuan , Huang Yang , Wang Jin-Yuan , Yang Shi-Cong , Chen Wen-Fang , Chen Pei-Song , Li Jun , Deng Rong-Hai , Huang Gang
Published: December 2019

Background:

BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is an important cause of dysfunction and failure of renal transplants. This study aimed to assess the diagnostic performance of morning urine specific gravity (MUSG) in diagnosing BKPyVAN in kidney transplant recipients.

Methods:

A total of 87 patients, including 27 with BKPyVAN, 22 with isolated BKPyV viruria, 18 with T cell-mediated rejection (TCMR), and 20 with stable graft function, were enrolled in the First Affiliated Hospital of Sun Yat-Sen University from March 2015 to February 2017. MUSG at biopsy and during a follow-up period of 24 months after biopsy was collected and analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of MUSG to discriminate BKPyVAN.

Results:

At biopsy, the MUSG of BKPyVAN group (1.008 ± 0.003) was significantly lower than that of isolated BK viruria group (1.013 ± 0.004, P < 0.001), TCMR group (1.011 ± 0.003, P = 0.027), and control group (1.014 ± 0.006, P < 0.001). There was no significant difference in MUSG among the isolated BK viruria group, TCMR group, and control group (P = 0.253). In BKPyVAN group, the timing and trend of MUSG elevate were consistent with the timing and trend of the decline of viral load in urine and plasma, reaching a statistical difference at 3 months after treatment (1.012 ± 0.003, P < 0.001) compared with values at diagnosis. ROC analysis indicated that the optimal cut-off value of MUSG for diagnosis of BKPyVAN was 1.009, with an area under the ROC curve (AUC) of 0.803 (95% confidence interval [CI]: 0.721–0.937). For differentiating BKPyVAN and TCMR, the optimal MUSG cut-off value was 1.010, with an AUC of 0.811 (95% CI: 0.687–0.934).

Conclusion:

Combined detection of MUSG and BKPyV viruria is valuable for predicting BKPyVAN and distinguishing BKPyVAN from TCMR in renal transplant recipients.
Deliberate Practice: Applying the Expert Performance Approach to Gynecologic Surgical Training
Authors: SCHMIDT PAYTON C. , FENNER DEE E.
Published: December 2019

Surgical training is shifting from the historical Halstedian apprenticeship model to outcomes-based methods. Surgical residents can reach a higher level of performance when utilizing deliberate practice and the expert performance approach. This article discusses methods for implementing deliberate practice and the expert performance approach into gynecologic surgical training programs.
A Complicated Case of Haemophilus influenzae Endocarditis in an Adult
Authors: Dylewski Joe , De l'Étoile-Morel Samuel
Published: December 2019

Bacterial causes for infective endocarditis have changed over the years, with Staphylococcus aureus now being the most common pathogen isolated. With the advent of routine childhood vaccinations, invasive infections caused by Haemophilus influenzae have become rare. We wish to report a case of infective endocarditis caused by H. influenzae that was complicated by meningitis, septic arthritis, and stroke.
Management of the Patient With HIV/Hepatitis C Drug Interactions: A Guide for Nurses and Nurse Practitioners
Authors: Starbird Laura E. , Hong Hyejeong , Sulkowski Mark S. , Farley Jason E.
Published: December 2019

Approximately one third of patients coinfected with HIV and hepatitis C virus (HCV) who initiate direct-acting antivirals (DAAs) for HCV treatment may have to switch antiretroviral therapy (ART) because of drug interactions. ART switches can negatively affect quality of life, increase HIV symptom burden, and delay HCV therapy. Approaches to identify ART/DAA drug interactions that minimize the impact of switching ART are urgently needed. Nurses can lead the way in addressing this new and major need. We provide a guide for registered nurses and nurse practitioners who care for patients coinfected with HIV and HCV to identify HIV/HCV drug interactions and manage ART/DAA coadministration when needed.
Static and Dynamic Cognitive Performance in Youth and Collegiate Athletes With Concussion
Authors: Brilliant Anna N. , Meehan William P. , Howell David R.
Published: December 2019

Objective:

To determine if individuals with a concussion demonstrate altered cognitive performance while standing still or while walking relative to uninjured controls.

Design:

Cross-sectional.

Setting:

Sports-medicine clinic.

Participants:

Youth and collegiate athletes diagnosed with a concussion, assessed within 10 days of injury, and a group of uninjured control subjects.

Independent Variables:

Concussion and control groups.

Main Outcome Measures:

Participants stood still for 30 seconds while completing a cognitive task (spelling words backward, serial subtraction, or reverse month recitation) and completed a similar set of cognitive tasks while walking. Our primary outcome variables were (1) overall cognitive task performance (accuracy) and (2) the total number of task items completed during testing (completion rate) during standing and walking conditions.

Results:

One hundred ninety-one participants completed the study: 94 with concussion (tested mean = 5.1 ± 2.9 days postconcussion; 51% female; mean age = 17.1 ± 3.3 years) and 97 control subjects (40% female; mean age = 17.5 ± 2.1 years). The concussion group completed significantly fewer responses than the control group while standing still (37.3 ± 14.5 vs 45.1 ± 17.6 responses; P = 0.03) and while walking (22.7 ± 7.5 vs 33.6 ± 13.4 responses; P < 0.001). They were also significantly less accurate at spelling words backward (81.2 ± 28.6% correct vs 89.8 ± 15.0% correct; P = 0.049) and reciting months in reverse order (95.8 ± 10.4% correct vs 98.2 ± 4.2% correct; P = 0.034) while walking.

Conclusions:

Athletes displayed lower cognitive task accuracy rates after concussion compared with control subjects during backward spelling and reverse month recitation tasks while walking but similar levels of accuracy while standing. Assessment of cognitive performance during dynamic tasks may be a clinically viable method to evaluate post-concussion deficits.
Assessment of the efficacy of Chinese patent medicine on treating pain caused by prostate cancer
Authors: Gong Xiaoyong , Wang Ji-sheng , Yu Xu-dong , Liu Rui-jia , Chu Li-yuan , Li Yuan-yuan , Lei Yi , Li Hong
Published: December 2019

Introduction

With the development of economy and the acceleration of population aging, Prostate cancer (PCa) has presented a situation of high morbidity and mortality worldwide. The recent studies have shown that Chinese patent medicine combined with endocrine therapy in the treatment of prostate cancer not only plays a synergistic role in enhancing the efficacy. This review hopes to adopt meta-analysis to evaluate the efficacy and safety of Chinese patent medicine in the treatment of pain caused by prostate cancer and provides evidence for its application in clinical practice.

Methods and analysis

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to June 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of pain caused by prostate cancer.

Ethics and dissemination

This systematic review will evaluate the efficacy and safety of Chinese patent medicine for pain caused by prostate cancer. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.

Trial registration number

PROSPERO CRD42019131544.
The expression of mouse double minute 2 homolog and P73 had no correlation with growth arrest DNA damage-inducible gene 45α in patients with non-small-cell lung carcinoma
Authors: Wang Bo , Liang Chaoyang , Liu Huifeng , Lin Jixing , Wang Bailin , Fan Kaijie , Ren Zhipeng , Wang Bin , Li Tong , Qi Kang , Tian Xiaodong
Published: December 2019

To investigate the difference in messenger ribonucleic acid (mRNA) and protein expression of growth arrest DNA damage-inducible gene 45α (GADD45α), mouse double minute 2 homolog (MDM2), and P73 in cancer and cancer-adjacent tissues in patients with non-small-cell lung carcinoma (NSCLC).

We compared the mRNA expression of GADD45α and MDM2 and the protein expression of GADD45α, MDM2, and P73 in lung cancer and cancer-adjacent tissues in NSCLC patients by quantitative real-time PCR, immunohistochemistry (IHC), and Western Blot (WB). We analyzed GADD45α, MDM2, and P73 expression in patients with different pathological types of NSCLC, and the correlation of these genes with gender, smoking history, and TNM/T stages.

IHC results suggested that MDM2 protein expression significantly increased in cancer tissues in female patients (P = .01), but not in male patients. In addition, WB results indicated that P73 protein expression significantly decreased in cancer tissues in patients with adenocarcinoma (P = .03), but not squamous carcinoma.

MDM2 and P73 protein levels were differentially regulated in cancer and cancer-adjacient tissues in patients with sub types of NSCLC. There was no significant difference in GADD45α expression between cancer and cancer-adjacent tissues in NSCLC patients.
Management of an extensive odontogenic keratocyst
Authors: Khan Abdul Ahad , Qahtani Saad Al , Dawasaz Ali Azhar , Saquib Shahabe A. , Asif Shaik Mohammed , Ishfaq Mohammad , Kota Mohammad Zahir , Ibrahim Mohammed
Published: December 2019

Introduction:

The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. Despite the aggressive nature, previous literature as early as 1970s reported the fact that parakeratinized OKC can be treated by means of marsupialization alone.

Patients concerns:

The patient had reported with a complaint of pain and swelling in relation with a tooth in mandibular right quadrant.

Diagnosis:

This case report discusses features of a rare, extensive, panmandibular OKC that is only second of its kind mentioned in the literature.

Intervention:

As a usual treatment protocol, marsupialization was attempted first. Immunohistochemical analysis revealed reduced expression of Ki-67 and B cell lymphoma 2 (bcl-2) markers after marsupialization from 2 separate sites. However, due to incomplete resolution in the lower right anterior region, an aggressive approach was taken by curetting it out surgically along with associated teeth and cortical plate followed by application of Carnoy's solution.

Outcome:

Postsurgery uneventful healing of the lesion was noted on regular follow-up visits with complete resolution at 40 months. The case has been followed for 10 years with no sign of relapse and reoccurrence.

Conclusions:

Based on the expression of markers it can thus be concluded that Ki-67 and bcl-2 are site specific and bear strong relationship with the recurrence of OKCs.
A potential cause of adolescent onset Dyke-Davidoff-Masson syndrome
Authors: Li Yiyang , Zhang Tao , Li Bo , Li Jing , Wang Li , Jiang Zhibin
Published: December 2019

Rationale:

Dyke-Davidoff-Masson syndrome (DDMS) is a rare syndrome commonly occurring in children and characterized by cerebral hemiatrophy, hypertrophy of the skull, epilepsy, and mental retardation.
[1,2]
However, few have been reported in China, especially in teenagers. This case investigated its possible cause and explored a relative effective solution.

Patient concerns:

A 24-year-old female came to department having experienced recurrent seizures for 12 years.

Diagnosis:

DDMS was diagnosed from its manifestations, biochemistry indexes, and imaging (computed tomography angiography, magnetic resonance venography, and so on).

Interventions:

Several drugs are used to treat the disease, including valproate, carbamazepine, topiramate, and ginkgo biloba extract.

Outcomes:

Under the medicine treatment of magnesium valproate with carbamazepine, the patient experienced partial seizures approximately once per month that lasted 30 to 60 seconds each without any complications observed during a follow-up period of 24 months.

Conclusion:

The imaging and clinical features of DDMS in this teenager were similar to those in classic infantile-onset cases. A potential cause of the disease could be brain trauma, which impaired the middle cerebral artery and reduced cerebral blood supply, leading to epilepsy and hemiatrophy.

Lessons:

It was concluded early diagnosis and pharmacotherapy are the keys to preventing intellectual decline in DDMS patients. Moreover, the combination of magnesium valproate and carbamazepine could significantly reduce the frequency and duration of seizures, despite not eliminating them completely.
Concurrent treatment with rituximab and plasma exchange for severe refractory granulomatosis with polyangiitis
Authors: Song Ran , Chung Sang Wan , Lee Yeon-Ah
Published: December 2019

Rationale:

Rituximab is recommended to induce remission of severe granulomatosis with polyangiitis (GPA). Plasma exchange (PE) may be considered in the setting of rapidly progressive glomerulonephritis (RPGN) with a serum creatinine increase of more than 5.6 mg/dl or diffuse alveolar hemorrhage (DAH). However, there are no sufficient studies on combination therapy with rituximab and PE in GPA.

Patient concerns:

A 23-year-old woman was admitted with fever, abdominal pain, and diarrhea on suspicion of infectious colitis. Colonoscopy showed hemorrhagic colitis and antibiotic treatment was ineffective. Physical examination revealed episcleritis and skin lesions similar to Janeway lesions or Osler nodes on her palms and soles. Transesophageal echocardiogram (TEE) revealed mitral valve vegetation mimicking infective endocarditis. However, no pathogen was grown in the blood culture. Ten days after admission, blood-tinged sputum and respiratory distress developed. Imaging studies of lung, bronchoscopy, and bronchoalveolar lavage indicated DAH. Moreover, serum creatinine levels rapidly increased from 0.8 mg/dl to 6.1 mg/dl with proteinuria.

Diagnosis:

The patient was diagnosed with GPA and non-infectious endocarditis, DAH, and RPGN, based on a biopsy which revealed pauci-immune crescentic glomerulonephritis with granuloma and leukocytoclastic vasculitis and antineutrophil cytoplasmic antibodies against proteinase 3- positivity.

Interventions:

Initial methylprednisolone pulse therapy (1 g daily for 3 days) proved unsuccessful. After initiating PE, creatinine levels began to slowly decline, but DAH continued to deteriorate. Rituximab combined with PE therapy was considered. We performed PE every 2 to 3 days for 5 total treatments combined with rituximab (375 mg/m2, once weekly for 4 weeks).

Outcomes:

After the combination treatment of rituximab and PE, alveolar hemorrhage stopped. Chest X-ray and laboratory data, including serum creatinine and hemoglobin, notably improved. Mitral valve vegetation was no longer observed in follow-up TEE. GPA remained stable with low dose prednisolone and immunosuppressants over a follow-up period of 5 years.

Lessons:

This case suggests that the use of rituximab and concurrent PE may represent a promising combination for severe and refractory GPA.
Huge peliosis hepatis mimicking cystic echinococcosis
Authors: Liu JinHeng , Wang YanTin , Yin SiNeng , Ke NengWen , Liu XuBao
Published: December 2019

Rationale:

Peliosis hepatis (PH), which is characterized by blood-filled cavities in the liver, is a rare disease. Its diagnosis depends on postoperative pathological examinations and immunohistochemistry.

Patient concerns:

A 44-year-old female complained of right-middle upper abdominal pain and distension for 1 month, with occasional vomiting and fever.

Diagnosis:

Because of the similar imaging features, the patient was initially misdiagnosed as cystic echinococcosis (CE). The immunoassay of echinococcosis was negative. Irregular hepatectomy was performed. Eventually, the patient was diagnosed with PH based on postoperative histopathology and immunohistochemistry.

Interventions:

The patient underwent hepatectomy. Then, the cystic lesion was collected for intraoperative pathological examination. Thus, the blood liquid was extracted from the cystic lesion. Pringle maneuver was administered to prevent bleeding, and then the whole cystic lesion was removed.

Outcomes:

She recovered smoothly and there was no relapse occurred during 6 months’ follow-up.

Lessons:

It is difficult to differentiate PH from CE and other hepatic diseases due to the lack of special imaging features. Pathological examinations and immunohistochemistry can provide a confirmed diagnosis of PH.
Comparison of analgesic and anxiolytic effects of nitrous oxide in burn wound treatment
Authors: Li Lin , Pan Qiong , Xu Le , Lin Renqin , Dai Jiaxi , Chen Xinyan , Jiang Meiyun , Chen Zhaohong
Published: December 2019

Aim:

We compared the effects of 50% N2O and N2O titration in burn management to alleviate pain and anxiety associated with burn dressing.

Methods:

In this single-blind prospective randomized controlled trial, 70 stable adult burn patients were randomized to 2 groups during May 2015 to January 2016. The experimental group was titrated with N2O ranging from 30% to the ideal sedation concentration before dressing change until the end. The control group was treated with 50% N2O 2 minutes before dressing change until the end. Pain, anxiety, vital signs, and the highest concentrations of N2O inhaled were recorded at 1 minute before N2O inhalation (T0), dismantling of outer (T1), inner dressings (T2), debridement (T3), drug-smearing (T4), bandaging (T5), and 10 minutes after completion of the procedure (T6).

Results:

The pain and anxiety scores in the experimental group performed significantly less than the control group during T2-T6. The systolic blood pressure in T2 and the heart rate at T2 and T3 varied significantly between the 2 groups. The highest N2O concentrations of the experimental group were mainly 60% to 70% at T2 (87.9%), T3 (87.9%), and T4 (81.8%).

Conclusion:

N2O titration significantly reduced pain and anxiety in burn patients, with minimal side effects.
Efficacy of sodium-glucose co-transporter 2 inhibitors in patients with type II diabetes
Authors: Danjuma Mohammed Ibn-Mas’ud , Shokri Shaikha Al , Saud Arwa Ibrahim YA Al , Elshafei Mohamed Nabil Abdelsalam , Fatima Haajra , Doi Suhail , Bidmos Mubarak Ariyo
Published: December 2019

Background:

Recent systematic reviews have evaluated the efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT2) inhibitors (SGLT2I) in improving glycaemic control and mortality in patients with type II diabetes mellitus. None have incorporated the most recent study or utilized the generalized pairwise modeling methodology network meta-analysis (NMA), as well as a novel bias risk assessment approach.

Methods:

We propose to conduct literature search of all randomized controlled clinical trials published in English language evaluating the efficacy of (SGLT2I) versus placebo or usual standard of care from the inception of following databases to September 30, 2019: Controlled Clinical Trials Cochrane Controlled Trials Register (CCTR), Cochrane Database of Systematic Reviews (CDSR), EMBASE, Database of Abstracts of Reviews of Effectiveness (DARE), PubMed. Two reviewers will independently search these databases to identify studies that satisfy pre-specified eligibility criteria. Study bias risk assessment amongst other methodology quality evaluation of the studies will be carried out using a novel risk bias assessment tool.

Results:

We anticipate that the result of this review will provide additional insight into the ranking of the efficacy of various (SGLT2I) in type II diabetic patients especially as it relates to mortality, glycemic control, and body weight reduction.

Conclusion:

The result of this review will be useful informing therapeutic decisions by policy makers with regards to commissioning of diabetic care.

Prospero registration number: CRD42019139708
The role of hydroxyurea to prevent silent stroke in sickle cell disease
Authors: Hasson Carla , Veling Lisa , Rico Juan , Mhaskar Rahul
Published: December 2019

Background:

Chronic blood transfusions are standard of care for stroke prevention in sickle cell disease but is not cost effective and not without risks. Hydroxyurea has emerged as an option in the prevention of silent stroke in sickle cell disease.

Objective:

To evaluate the role of hydroxyurea in preventing silent strokes in a systematic review by adhering to the Cochrane guidelines.

Methods:

PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials were searched for the related articles. Eligibility criteria included randomized controlled trials (RCTs) comparing the use of hydroxyurea vs blood transfusions and observational studies evaluating the role of hydroxyurea to prevent stroke and silent stroke in patients with sickle cell anemia or sickle cell β thalassemia. The meta-analysis was conducted using STATA software version 13.

Results:

We included 10 single arm observational studies with 361 participants, and one RCT study with 60 participants receiving hydroxyurea, respectively. There were no deaths attributed to hydroxyurea. The results revealed that 1% (95% CIs 0.0 to 0.05) of patients receiving hydroxyurea had stroke. 18% (95% CIs 0.03 to 0.4) of the hydroxyurea patients had silent stroke. 24% (95% CIs 0.02 to 0.57) of the hydroxyurea patients had adverse events attributed to hydroxyurea.

Conclusion:

Our findings suggest that hydroxyurea is safe and may prevent silent stroke and stroke in sickle cell disease. More high-quality studies including RCTs are needed.
Management of infective corneal ulcers in a high-income developing country
Authors: AlMahmoud Tahra , Elhanan Mohamed , Elshamsy Mohamed H. , Alshamsi Hanan N. , Abu-Zidan Fikri M.
Published: December 2019

Microbial keratitis is a major risk for corneal blindness worldwide. We aimed to study the clinical presentation and outcome of hospitalized patients having infective corneal ulcers.

All patients who were diagnosed as microbial keratitis and were admitted to Al-Ain Hospital during the period July 2011-Dec 2016 were retrospectively studied. Patients’ demography, predisposing factors, symptoms and signs at presentation, time to presentation after onset of symptoms, microbial isolates, hospital stay, and visual acuity (VA) outcome were studied.

74 patients with corneal ulcers were hospitalized. 79.7% were males. The median (range) age was 44 years (1–91). 36.5% had trauma as a risk factor. The main presenting symptoms were pain (90.5%), red eye (79.7%), and decreased vision (63.5%). All patients had stromal infiltrate while 39.2% had hypopyon at presentation. The average time from the start of the symptoms to hospital presentation was 11 (1–90) days. The mean (range) hospital stay was 10.6 (1–60) days. Forty eyes were culture positive. Bacteria were identified in 27 eyes and fungus in 16. Pseudomonas aeruginosa (9 eyes) and Staphylococcus epidermis (5 eyes) were the most common bacterial islolates. Aspergillus (6 eyes) was the most common fungus species. 95.2% of the bacterial isolates were susceptible to the quinolone antibiotics group. Twenty eight (51.9%) patients had a vision worse than 6/60 in the affected eye.

Corneal ulcer poses a significant threat to the sight of an affected eye. Trauma was the most common risk factor for corneal ulcers. Usage of eyes personal protective equipment for high risk occupations and earlier accessibility to health care may reduce the impact of corneal ulcers in our community.
PMS2 germline mutation c.1577delA (p.Asp526Alafs∗69)-induced Lynch syndrome-associated endometrial cancer
Authors: Cui Man-Hua , Zhang Xi-Wen , Yu Tong , Huang Dong-Wei , Jia Yan
Published: December 2019

Rationale:

Lynch syndrome (LS) is an autosomal dominant cancer predisposition condition caused by germline heterozygous mutations in mismatch repair (MMR) genes. However, as one of the MMR genes, PMS2 mutation-induced LS-associated endometrial cancer (LSAEC) was rarely reported.

Patient concerns:

A 26-year-old female patient suffered from prolonged menstrual period and increased menstrual flow for 2 months.

Diagnoses:

The patient was diagnosed with cervix CIN III, endometrial cancer (EC), anemia, and LS.

Interventions:

Total hysterectomy, bilateral salpingectomy, pelvic lymphadenectomy were performed for treating EC, while ovariectomy was refused by the patient. The patient underwent postoperative chemotherapy with paclitaxel combined with carboplatin for 6 courses of treatment. Laparoscopic partial enterectomy was applied for treating colon cancer 5 years later after the surgery treatment for EC. Besides, Sanger sequencing and high-throughput genome sequencing were employed to detect the genetic status of the family that included two generations with four members. Immunohistochemistry (IHC) staining was used to identify the function of PMS2 mutation.

Outcomes:

The 26-year-old Chinese patient suffered from LSAEC and recovered well after surgery. A PMS2 germline heterozygous mutation (c.1577delA) was confirmed by gene sequencing 5 years later. In addition, PMS2 mutation was verified by IHC. The patient was followed up for 7 years.

Lessons:

Carrying PMS2 germline mutation (c.1577delA) confers an extremely high susceptibility of suffering from LS-associated cancers. Thus, close clinical monitoring and prophylactic surgery are highly recommended to reduce the morbidity and mortality of LS-associated cancers.
Multiple cerebral microbleeds and atypical β-amyloid deposits
Authors: Lee Jin San , Lee Kyung Mi , Kim Hyug-Gi , Hong Il Ki
Published: December 2019

Rationale:

Cerebral microbleeds are increasingly recognized in various neurological disorders such as cerebral amyloid angiopathy (CAA), Alzheimer disease, and stroke. The presence and number of cerebral microbleeds are known to be independent predictors of cognitive impairment.

Patient concerns:

A 73-year-old woman visited our memory disorder clinic complaining of progressive memory impairment, which started 2 years ago.

Diagnoses:

The patient had innumerable cortical/subcortical cerebral microbleeds in the entire brain. We diagnosed the patient with amnestic mild cognitive impairment due to CAA. Interestingly, only focal β-amyloid deposits at the bilateral parietal cortices were seen on amyloid positron emission tomography (PET) scan.

Interventions:

We have observed changes in her cognitive function without any medication.

Outcomes:

The cognitive function of the patient was unchanged during the follow-up period.

Lessons:

Our case was interesting in a few aspects, including the number of cerebral microbleeds and the atypical β-amyloid deposition pattern on amyloid PET scan. Further studies on more cases are needed to evaluate β-amyloid burden and distribution patterns in CAA.
Application of the healthcare failure mode and effects analysis system to reduce the incidence of posture syndrome of thyroid surgery
Authors: Zhang Li , Zeng Ling , Yan Yuanting , Hang Qinwen
Published: December 2019

This study aimed to investigate the application of the healthcare failure mode and effect analysis (HFMEA) to reduce the incidence of posture syndrome of thyroid surgery (PSTS).

Subjects before (n = 78, July 2017–December 2017) and after (n = 114, January 2018–June 2018) HFMEA implementation (The Second Hospital of Nanjing, Nanjing University of Chinese Medicine) were selected. The training for PSTS was optimized using HFMEA.

The occurrence of PSTS was reduced from 59% to 18% after HFMEA (P < .001). Symptoms of pain and nausea and vomiting were also decreased after HFMEA (all P < .001). The critical thinking ability of 34 medical personnel to evaluate the reduction of thyroid postoperative posture syndrome increased from 246 ± 19 to 301 ± 14 (P < .001) after HFMEA.

HFMEA was used to create preoperative posture training procedures for PSTS, bedside cards for training, innovative preoperative posture training equipment, and a diversified preoperative posture training health education model.
Gender- and age-dependent tongue features in a community-based population
Authors: Hsu Po-Chi , Wu Han-Kuei , Huang Yu-Chuen , Chang Hen-Hong , Chen Yi-Ping , Chiang John Y. , Lo Lun-Chien
Published: December 2019

This study, an important groundwork for clinical tongue diagnosis and future traditional Chinese medicine (TCM) research, tested the hypothesis that some tongue features vary significantly between different gender and age groups by utilizing an automatic tongue diagnosis system (ATDS).

A cross-sectional study of 1487 participants from a community-based population was performed. Study subjects with ages ranging from 20 to 92 were categorized into 3 groups: <40, 40 to 64, and ≥65 years old, and the subjects were also stratified according to gender. Tongue images were collected at the end of each normal health examination routine to further derive the relevant tongue features of every participant by using the ATDS developed by our team. There were a total of nine tongue features that were identified: tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissure, ecchymosis, teeth mark, and red dot. The corresponding tongue features, demography, and physical/laboratory examination data were compared between different gender and age groups.

Our study showed that, compared to females, males had enlarged tongue shape, thicker fur, more fissures and fewer teeth marks (all P < .001), and also had more red tongue color (P = .019), normal saliva (P = .001), more red dots (P = .005) and yellower fur (P = .014). In females, increasing age was associated with more enlarged tongue shape, thicker fur, yellower fur, more saliva, fissures and fewer teeth marks (all P < .001), more ecchymoses (P = .009), and more red tongue color (P = .023). These associations of age with more fissures, fewer teeth marks, fewer red dots (P < .001), median tongue shape (P = .029), and wet saliva (P = .014) were also evident in males, but other relationships were not clearly evident.

Even though most of the common tongue features derived from a community-based population are consistent with TCM theory, yet some significantly gender- and age-dependent tongue characteristics were identified. These disparities in tongue features associated with gender or age shall be prudently taken into consideration in clinical tongue diagnosis and future TCM research.
Median sternotomy versus minimally invasive thymectomy for early-stage thymoma
Authors: Tianci Chai , Shen Zhimin , Chen Sui , Lin Yuhan , Gao Lei , Zhang Zhenyang , Kang Mingqiang , Lin Jiangbo
Published: December 2019

Background:

The completeness of resection is an important prognostic factor for early resectable thymoma. Since its inception 2 decades ago, median sternotomy has been recognized as the gold standard method for the treatment of all types and stages of thyomas. Minimally invasive surgical techniques, including video-assisted and robot-assisted surgery, have been rapidly developed as an alternative to traditional open approach surgery. Compared with traditional open approach surgery, minimally invasive approach has better cosmetic effect, faster improvement of lung function, reduction of surgical trauma, length of stay, and complications. We believe that this is an appropriate time and there is a need for a systematic, comprehensive, and objective assessment of the 2 surgical modalities in order to provide reliable evidence for clinicians to determine the best treatment for patients with early resectable thymoma.

Methods:

Pubmed (Medline), Web of Science, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomized controlled trials (RCTs), quasi-RCTs, and Hi-Q (high quality) prospective cohort trials published or unpublished in any language before March 1, 2020. Subgroup analysis will be performed in tumor pathological stage and ethnicity. PROSPERO registration number: CRD42019133724.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

This study will be the first to assess the efficacy and safety of median sternotomy recognized as the gold standard method for the treatment of all types and stages of thyomas and minimally invasive thymectomy for patients with early-stage thymoma. This study will assess whether minimally invasive thoracoscopic and robotic assisted thymectomy can be used as an alternative to traditional median sternotomy for patients with early resectable thymoma and provide high-quality and reliable evidence for clinicians’ decision-making.
Highlighting the importance of early diagnosis of cyclic vomiting syndrome in adults
Authors: Tang Cuilan , Dai Ning
Published: December 2019

Introduction:

Cyclic vomiting syndrome (CVS) is a potentially exhausting disorder and has an adverse impact on quality of life, but it is poorly recognized and is always misdiagnosed leading to a diagnostic delay of several years, especially in adults.

Patient concerns:

We report a case of a 32-year-old woman with recurrent severe nausea, vomiting, and abdominal pain, and repeated visits to the emergency department or the outpatient department for 4 years. Each time she was diagnosed with gastroenteritis or gastritis, and recovered after supportive treatment including antiemetics, maintenance of water and electrolyte balance, and a proton pump inhibitor.

Diagnosis:

Laboratory examinations, gastroenteroscopy, chest and abdominal computed tomography, and brain magnetic resonance imaging all failed to reveal abnormalities that would explain her symptoms. Based on typical symptoms and the exclusion of other diseases associated with repeated vomiting, the diagnosis was made as CVS.

Interventions:

She was given orally amitriptyline, 50 mg per night, and olanzapine, 1.25 mg per night.

Outcomes:

The treatment was effective in inducing remission, and symptoms did not recur after treatment. The treatment lasted for 2 months and stopped. Her symptoms did not recur over the 10-month follow up.

Conclusion:

CVS is not rare in adults, but its diagnosis is usually delayed due to poor recognition of the condition. Clinician awareness of CVS should be enhanced to improve early diagnosis.

Core tip: Cyclic vomiting syndrome has a tremendous impact on the quality of life, but it is poorly recognized and is always misdiagnosed leading to a diagnostic delay of several years, especially in adults. The article presented a case report of cyclic vomiting syndrome of adult; we hope the article will attribute to increased awareness of physician and reduce delayed diagnosis.
Digital clubbing occurring in intrathoracic Hodgkin lymphoma
Authors: Gai Xiaoyan , Yang Wei , Zhu Hong , Sun Yongchang
Published: December 2019

Rationale:

Digital clubbing is rarely associated with lymphoma. This study reports a case of intrathoracic Hodgkin lymphoma with digital clubbing and reviews the current literature regarding the clinical characteristics of this condition.

Patient concern:

A 21-year-old woman presented with a 3-month history of cough and 1 month of fever, with apparent digital clubbing. A computed tomography (CT) scan of the lungs revealed a large pulmonary mass.

Diagnosis:

A CT-guided transthoracic needle biopsy was conducted. Pathology determined a diagnosis of Hodgkin lymphoma.

Interventions:

The patient underwent 6 courses of chemotherapy and intensification, followed by autografting.

Outcomes:

The patient recovered and a complete hematological remission was obtained. The patient is alive with no evidence of disease 60 months after diagnosis, with the digital clubbing of the fingers and toes completely resolved.

Conclusion:

Patients with digital clubbing and intrathoracic lesions need to be examined carefully to determine tumor malignancy.
Effect of eradicating hydrogen-forming small intestinal bacterial overgrowth with rifaximin on body weight change
Authors: Lee Seok-Hoon , Cho Doo-Yeoun , Joo Nam-Seok , Kim Kyu-Nam
Published: December 2019

Hydrogen formed by small intestinal bacterial overgrowth in patients with non-constipated irritable bowel syndrome has an inverse relationship with obesity. However, the effect of eradicating small intestinal hydrogen-producing bacterial overgrowth on the body weight of these patients has not yet been reported. The aim of this study was to investigate body weight changes after eradicating small intestinal bacterial overgrowth with rifaximin treatment in patients with non-constipated irritable bowel syndrome.

We reviewed the charts of patients with non-constipated irritable bowel syndrome who showed abdominal symptoms with documented lactulose hydrogen breath test results in order to diagnose small intestinal bacterial overgrowth. A total of 153 patients were enrolled in the study and divided into quartiles according to body mass index (BMI) and body weight.

In the lowest body weight quartile, the BMI and body weight were significantly increased (0.4 kg/m2, P = .038; 0.6 kg, P = .010, respectively) in patients with negative lactulose hydrogen breath tests after rifaximin treatment. However, there was no significant change in body weight in the other quartiles. Despite treatment with rifaximin for 12 weeks, there was no change in BMI or body weight in any group of patients with consistently positive lactulose hydrogen breath tests.

Eradication of hydrogen formed by small intestinal bacterial overgrowth does not cause clinically significant changes in body weight.