bluuebunny/crossref_metadata_2025 huggingface dataset:
Contralateral Interhemispheric Transfalcine Approach for Intra-Axial Medial Occipital Lesion: 2-Dimensional Operative Video
Authors: Zhao Xiaochun , Cavallo Claudio , Labib Mohamed A , Borba Moreira Leandro , Lee Michaela , Liebelt Brandon D , Nakaji Peter
Published: April 2019

Safe access to intra-axial mesial cortical lesions is challenging. When approached through standard transcortical approaches, normal white matter tracts such as the superior longitudinal fasciculus, corona radiata, and optic radiations may be violated en route to the lesion. Conversely, use of ipsilateral interhemispheric approaches necessitates retraction and manipulation of edematous and friable perilesional tissue. The contralateral interhemispheric transfalcine (CIHTF) approach may circumvent these challenges. The CIHTF approach uses a gravity-created window between the ipsilateral hemisphere and the falx and allows direct access contralaterally by opening the falx.

We demonstrate the CIHTF approach for an intra-axial, medial occipital/precuneus lesion in a 69-yr-old man presenting with left homonymous hemianopia. MRI revealed a heterogeneously enhancing intra-axial lesion in the right mesial occipital lobe. After the patient gave voluntary informed consent, a CIHTF approach was planned, with the patient positioned laterally, right side up (IRB approval was unnecessary). A lumber drain facilitated gravity autoretraction of the ipsilateral lobe. Within the created trajectory, the falx was opened with use of a nerve hook attached to monopolar electrocautery. The contralateral lesion was visualized and removed piecemeal with the assistance of fluorescence imaging. Postoperative MRI showed complete removal. The patient reported a significant vision improvement. The diagnosis was metastatic adenocarcinoma from the lung; subsequent radiosurgery was recommended. MRI at the 8-mo follow-up revealed no recurrence of the lesion.

The CIHTF approach is feasible for a mesial intra-axial lesion because it offers gravity autoretraction, a large working angle, and avoidance of parenchymal swelling. Used with permission from Barrow Neurological Institute.
MaizeEmpty Pericarp602Encodes a P-Type PPR Protein That Is Essential for Seed Development
Authors: Ren Zhenjing , Fan Kaijian , Fang Ting , Zhang Jiaojiao , Yang Li , Wang Jianhua , Wang Guoying , Liu Yunjun
Published: April 2019

Pentatricopeptide repeat (PPR) proteins play crucial roles in intron splicing, which is important for RNA maturation. Identification of novel PPR protein with the function of intron splicing would help to understand the RNA splicing mechanism. In this study, we identified the maize empty pericarp602 (emp602) mutants, the mature kernels of which showed empty pericarp phenotype. We cloned the Emp602 gene from emp602 mutants and revealed that Emp602 encodes a mitochondrial-localized P-type PPR protein. We further revealed that Emp602 is specific for the cis-splicing of mitochondrial Nad4 intron 1 and intron 3, and mutation of Emp602 led to the loss of mature Nad4 transcripts. The loss of function of Emp602 nearly damaged the assembly and accumulation of complex I and arrested mitochondria formation, which arrested the seed development. The failed assembly of complex I triggers significant upregulation of Aox expression in emp602 mutants. Transcriptome analysis showed that the expression of mitochondrial-related genes, e.g. the genes associated with mitochondrial inner membrane presequence translocase complex and electron carrier activity, were extensively upregulated in emp602 mutant. These results demonstrate that EMP602 functions in the splicing of Nad4 intron 1 and intron 3, and the loss of function of Emp602 arrested maize seed development by disrupting the mitochondria complex I assembly.
Assessing the Threat Posed by Registered Firearms Dealers in the UK
Authors: Bryant Robin , Arditti Roger , Gustafson Kristian
Published: April 2019

This article examines the threat posed by Registered Firearms Dealers (RFDs) in the UK, based on an analysis of 12 case studies of dealers found to have committed serious criminal acts and 29 semi-structured interviews with law enforcement agencies and representatives of ‘shooting’ organizations. The analysis reveals a number of concerns with the regulatory and enforcement regimes surrounding RFDs. Our research demonstrates that RFDs have the capability and opportunity to pose a threat to public security but a key challenge remains to identify and assess the likelihood of RFD criminal intent. At the time of writing, there were no standardized structured methodologies to identify intent during the RFD licencing process. However, via a novel ‘Indicators and Warnings’ analysis, we provide a basis for how this might be undertaken. The article concludes with a discussion about how the potential threat posed by a small minority of RFDs might be reduced.
Trade Effects of Customs Reform: Evidence from Albania
Authors: Fernandes Ana Margarida , Hillberry Russell , Alcántara Alejandra Mendoza
Published: April 2019

Despite enormous academic interest in international trade costs and keen policy interest in efforts to reduce them, little is known about the effects of trade facilitation measures. This study evaluates a significant Albanian reform that sharply reduced physical inspections of import shipments. An estimation strategy that isolates quasi-random variation in the allocation of shipments to physical inspections is used to show that reduced inspections significantly increase imports. Import flows that are observed least frequently see the largest trade responses to reduced inspections. The effect of inspections on imports is virtually independent of changes in clearance time and clearance time uncertainty. Tariff and other tax revenues collected at the border rise in direct proportion to growth in declared import value. There is no compelling evidence that reduced inspections increase evasive behavior, perhaps because most of Albania's imports are tariff-free.
Identification of a New Powdery Mildew Resistance Gene pmDHT at or Closely Linked to the Pm5 Locus in the Chinese Wheat Landrace Dahongtou
Authors: Qie Yanmin , Sheng Yuan , Xu Hongxing , Jin Yuli , Ma Feifei , Li Lihui , Li Xiuquan , An Diaoguo
Published: April 2019

Chinese wheat landrace Dahongtou was resistant to 35 of 38 tested Chinese isolates of Blumeria graminis f. sp. tritici at the seedling stage. Genetic analysis of the F2 populations and their derived F2:3 families of crosses of Dahongtou with the susceptible varieties Mingxian 169 and Huixianhong indicated that the resistance of Dahongtou to B. graminis f. sp. tritici isolate E09 was conferred by a single recessive gene, tentatively designated as pmDHT. The gene was mapped to chromosome arm 7BL and flanked by markers Xwmc526/XBE443877 and Xgwm611/Xwmc511 at genetic distances of 0.8 and 0.3 cM, respectively. The chromosomal position of pmDHT was similar to the multi-allelic Pm5 locus on 7BL. Allelism tests with crosses of Dahongtou with Fuzhuang 30 (Pm5e) and Xiaobaidong (mlxbd) indicated that pmDHT was allelic to both Pm5e and mlxbd. However, pmDHT showed a different pattern of resistance to the 38 B. graminis f. sp. tritici isolates compared with wheat lines with Pm5a, Pm5b, Pm5e, mlxbd, and PmHYM and also differed from PmSGA. Thus, pmDHT was identified most likely as a new allele or at least a closely linked gene of the Pm5 locus. This gene can be transferred into susceptible wheat cultivars/lines and pyramided with other resistance genes through marker-assisted selection to improve powdery mildew resistance.
A qPCR Assay for the Detection ofPhytophthora cinnamomiIncluding an mRNA Protocol Designed to Establish Propagule Viability in Environmental Samples
Authors: Kunadiya Manisha B. , Dunstan William D. , White Diane , Hardy Giles E. St. J. , Grigg Andrew H. , Burgess Treena I.
Published: April 2019

Phytophthora cinnamomi causes root and collar rot in many plant species in natural ecosystems and horticulture. A species-specific primer and probe PCIN5 were designed based on a mitochondrial locus encoding subunit 2 of cytochrome c oxidase (cox2). Eight PCR primers, including three forward and five reverse, were designed and tested in all possible combinations. Annealing temperatures were optimized for each primer pair set to maximize both specificity and sensitivity. Each set was tested against P. cinnamomi and two closely related clade 7 species, P. parvispora and P. niederhauseri. From these tests, five primer pairs were selected based on specificity and, with a species-specific P. cinnamomi probe, used to develop quantitative real-time PCR (qPCR) assays. The specificity of the two most sensitive qPCR assays was confirmed using the genomic DNA of 29 Phytophthora isolates, including 17 isolates of 11 species from clade 7, and representative species from nine other clades (all except clade 3). The assay was able to detect as little as 150 ag of P. cinnamomi DNA and showed no cross-reaction with other Phytophthora species, except for P. parvispora, a very closely related species to P. cinnamomi, which showed late amplification at high DNA concentrations. The efficiency of the qPCR protocol was evaluated with environmental samples including roots and associated soil from plants artificially infected with P. cinnamomi. Different RNA isolation kits were tested and evaluated for their performance in the isolation of RNA from environmental samples, followed by cDNA synthesis, and qPCR assay. Finally, a protocol was recommended for determining the presence of P. cinnamomi in recalcitrant environmental samples.
The Reverse Oblique Supracondylar Humerus Fracture: Description of a Novel Fracture Pattern
Authors: Heffernan Michael J. , Lucak Thomas , Igbokwe Linus , Yan Justin , Gargiulo Dominic , Khadim Muayad
Published: April 2019

Background:

Sagittal profile descriptions of supracondylar humerus fractures are limited. We describe a reverse oblique (RO) pattern in which the distal fragment has a prominent anterior spike that is displaced posterior to the proximal fragment. This pattern presents a challenge during closed manipulation utilizing traditional reduction maneuvers. The purpose of this study is to compare the clinical and radiographic characteristics of the RO and non-RO patterns of supracondylar humerus fractures. We hypothesized that the RO pattern would be associated with greater soft tissue trauma.

Methods:

Retrospective evaluation of operative supracondylar humerus fractures treated at a tertiary pediatric hospital from 2014 to 2016. Patients were categorized into RO and non-RO groups for analysis. Associated neurovascular injuries were compared between groups.

Results:

Two hundred ninety-nine consecutive patients were reviewed. The RO fracture pattern was seen in 12 patients. All displaced RO fractures were able to be closed reduced with a modification to the traditional reduction sequence. Overall cohort rates of preoperative soft tissue injury included antecubital ecchymosis 16.8%, nerve palsies 15%, and vascular compromise 6.4%. Compared with non-RO fractures, the RO fracture group had significantly higher rates of anterior interosseous nerve (AIN) palsies (P=0.013), antecubital ecchymosis (P=0.018), and compartment syndrome (P=0.043). When comparing RO with non-RO type II fractures, there were no differences in soft tissue injury (P=0.439). Compared with non-RO type III fractures, RO type III fractures had higher rates of AIN injury (P=0.047), antecubital ecchymosis (P=0.007), and overall soft tissue injury (P=0.009).

Conclusions:

This study introduces a previously undescribed supracondylar humerus fracture subtype: the RO fracture. We found increased rates of soft tissue compromise including antecubital ecchymosis and AIN palsy in this fracture type. Further, traditional reduction methods proved to be ineffectual for this fracture pattern. We utilized a simple modification that allowed for closed reduction and percutaneous pinning of displaced RO fractures.

Level of Evidence:

Level III—prognostic.
A Review of Exercise Interventions in Pulmonary Arterial Hypertension and Recommendations for Rehabilitation Programing
Authors: Ozemek Cemal , Berry Michael J. , Arena Ross
Published: April 2019

Pulmonary arterial hypertension (PAH) is characterized by impaired pulmonary vascular structure and function and is commonly associated with symptoms of dyspnea, fatigue, and potentially syncope. With chronic exposure to elevated pulmonary pressures, dramatic right ventricular dysfunction is common, thereby compromising cardiorespiratory fitness and increasing the risk of mortality. Collective investigative efforts, both at the preclinical and clinical levels, have established the safety and efficacy of regular exercise training in improving quality of life, cardiorespiratory fitness, and the physiologic profile of patients with PAH. Although the total volume of exercise training studies in patients with PAH pales in comparison with other chronic conditions, evidence for the optimal training recommendations is emerging. This review aims to provide a synopsis of the current exercise training literature in patients with PAH and provide preliminary training recommendations that can be implemented in rehabilitation programs.
Assessing brain injury after cardiac arrest, towards a quantitative approach
Authors: Cronberg Tobias
Published: April 2019

Purpose of review

Withdrawal of life-sustaining therapy due to a presumed poor neurological prognosis precedes most deaths in patients who have been resuscitated after an out-of-hospital cardiac arrest and are being treated in an ICU. Guidelines to support these critical decisions recommend a multimodal strategy based on advanced diagnostic methods. This review will discuss clinical experience with the 2015 guidelines and recent developments towards more accurate quantification of posthypoxic brain injury.

Recent findings

Qualitative assessment of clinical findings, neurophysiological signals and radiological images are prone to error due to the individual assessors’ experience and competence. Currently, the only quantitative method for assessment of postarrest brain injury in regular clinical use is the measurement of neuron-specific enolase in serum. Since 2015 several promising methods to standardize assessment have been introduced including pupillometry, standardized electroencephalography interpretation and the quantification of somatosensory evoked potentials, computed tomography and MRI-signals. In addition, novel and superior blood biomarkers are on the verge of clinical introduction.

The current guidelines for neuroprognostication include a step-by-step multimodal algorithm but many patients will still be left with an uncertain prognosis 4–5 days after cardiac arrest. Novel quantitative methods are a necessary step to a more nuanced prediction of outcome for this group of patients.
Cardiac arrest: prediction models in the early phase of hospitalization
Authors: Dumas Florence , Bougouin Wulfran , Cariou Alain
Published: April 2019

Purpose of review

There is a need for an early assessment of outcome in patients with return of spontaneous circulation after cardiac arrest. During the last decade, several models were developed in order to identify predictive factors that may facilitate prognostication and stratification of outcome.

Recent findings

In addition to prognostication tools that are used in intensive care, at least five scores were recently developed using large datasets, based on simple and immediately available parameters, such as circumstances of arrest and early in-hospital indicators. Regarding neurological outcome, predictive performance of these models is good and even excellent for some of them. These scores perform very well for identifying patients at high-risk of unfavorable outcome. The most important limitation of these scores remains the lack of replication in different communities. In addition, these scores were not developed for individual decision- making, but they could instead be useful for the description and comparison of different cohorts, and also to design trials targeting specific categories of patients regarding outcome. Finally, the recent development of big data allows extension of research in epidemiology of cardiac arrest, including the identification of new prognostic factors and the improvement of prediction according to the profile of populations.

In addition to the development of artificial intelligence, the prediction approach based on adequate scores will further increase the knowledge in prognostication after cardiac arrest. This strategy may help to develop treatment strategies according to the predicted severity of the outcome.
Efficacy and safety of Gelidium elegans intake on bowel symptoms in obese adults
Authors: Choi Hyoung Il , Cha Jae Myung , Jeong In-Kyung , Cho In-Jin , Yoon Jin Young , Kwak Min Seob , Jeon Jung Won , Kim Soo Jin
Published: April 2019

Background/aims:

Gelidium elegans (GE) is known to have antiobesity effects and beneficial effects on functional bowel symptoms in preclinical studies. The aim of this study was to determine the efficacy and safety of GE intake on bowel symptoms in obese human adults.

Methods:

This 12-week single-center randomized double-blind placebo-controlled study was performed from September 2016 to May 2017. Consecutive obese subjects were randomly assigned (1:1) to either GE (1 g) or placebo (1 g) once daily group for 12 weeks. Patients’ bowel symptoms were evaluated using the Bristol Stool Form Scale, Constipation Scoring System (CSS), and Patient Assessment of Constipation-Symptoms (PAC-SYM) questionnaire.

Results:

The stool symptom score of PAC-SYM significantly improved in the GE group compared with the placebo group after the 12-week treatment (P = .041). Abdominal discomfort score of CSS significantly decreased at 12 weeks compared to that at baseline in the GE group (P = .003), but not in the placebo group (P = .398). In addition, abdominal discomfort score of CSS slightly decreased in the GE group compared with the placebo group after the 12-week treatment (P = .060). However, stool consistency, total CSS score, and PAC-SYM score did not change significantly in both GE group and the placebo group over the 12-week treatment period.

Conclusions:

GE treatment for 12 weeks improved the stool symptom score on the PAC-SYM and abdominal discomfort score on the CSS in obese adults. However, further research is needed in large-scale human studies.
Acute exacerbation of Hashimoto's thyroiditis in a patient treated with dimethyl fumarate for multiple sclerosis
Authors: Ciurleo Rosella , Sessa Edoardo , Marino Silvia , D’Aleo Giangaetano , Bramanti Placido , Rifici Carmela
Published: April 2019

Introduction:

Dimethyl fumarate (DMF) has been recently approved for first-line monotherapy of Multiple Sclerosis (MS). Its effects are due to mechanism modulating the immune system and activating antioxidative and neuroprotective pathways.

Patient concerns:

A 59-year-old female patient affected by chronic Hashimoto's thyroiditis (HT) from 10 years was diagnosed with relapsing remitting MS in 2013. She started therapy with DMF in November 2016.

Diagnosis:

After 2 months of therapy with DMF, the results of thyroid function test were abnormal. Thyroid ultrasonography confirmed the diagnosis of acute exacerbation of HT.

Interventions:

This condition led to discontinuation of DMF therapy.

Outcome:

Two months after the interruption of DMF therapy, the findings of thyroid function test were within normal limits.

Conclusion:

The association of MS with autoimmune thyroid diseases supports a common immune-mediated pathogenic mechanism. We assume that the acute exacerbation of HT in our MS patient is associated not with the immunomodulatory effect of DMF but rather with its antioxidative mechanism.

Constant monitoring of thyroid hormone levels should be recommended especially if the MS patients in treatment with DMF are affected by concomitant autoimmune thyroid diseases.
Disseminated histoplasmosis from a calcified lung nodule after long-term corticosteroid therapy in an elderly Japanese patient
Authors: Kobayashi Keigo , Asakura Takanori , Kawada Ichiro , Hasegawa Hanako , Chubachi Shotaro , Ohara Kentaro , Kuramoto Junko , Sugiura Hiroaki , Fujishima Seitaro , Iwata Satoshi , Umeyama Takashi , Katano Harutaka , Uwamino Yoshifumi , Miyazaki Yoshitsugu , Kamei Katsuhiko , Hasegawa Naoki , Betsuyaku Tomoko
Published: April 2019

Rationale:

Histoplasmosis occurs most commonly in Northern and Central America and Southeast Asia. Increased international travel in Japan has led to a few annual reports of imported histoplasmosis. Healed sites of histoplasmosis lung infection may remain as nodules and are often accompanied by calcification. Previous studies in endemic areas supported the hypothesis that new infection/reinfection, rather than reactivation, is the main etiology of symptomatic histoplasmosis. No previous reports have presented clinical evidence of reactivation.

Patient concerns:

An 83-year-old Japanese man was hospitalized with general fatigue and high fever. He had been treated with prednisolone at 13 mg/d for 7 years because of an eczematous skin disease. He had a history of travel to Los Angeles, Egypt, and Malaysia 10 to 15 years prior to admission. Five years earlier, computed tomography (CT) identified a solitary calcified nodule in the left lingual lung segment. The nodule size remained unchanged throughout a 5-year observation period. Upon admission, his respiratory condition remained stable while breathing room air. CT revealed small, randomly distributed nodular shadows in the bilateral lungs, in addition to the solitary nodule.

Diagnosis:

Disseminated histoplasmosis, based on fungal staining and cultures of autopsy specimens.

Interventions:

The patient's fever continued despite several days of treatment with meropenem, minocycline, and micafungin. Although he refused bone marrow aspiration, isoniazid, rifampicin, ethambutol, and prednisolone were administered for a tentative diagnosis of miliary tuberculosis.

Outcomes:

His fever persisted, and a laboratory examination indicated severe thrombocytopenia with disseminated intravascular coagulation. He died on day 43 postadmission. During autopsy, the fungal burden was noted to be higher in the calcified nodule than in the disseminated nodules of the lung, suggesting a pathogenesis involving endogenous reactivation of the nodule and subsequent hematogenous and lymphatic spread.

Lessons:

Physicians should consider histoplasmosis in patients with calcified nodules because the infection may reactivate during long-term corticosteroid therapy.
Efficacy of postprocedural anticoagulation after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction
Authors: Song Pil Sang , Kim Min Jeong , Jeon Ki-Hyun , Lim Sungmin , Park Jin-Sik , Choi Rak Kyeong , Kim Je Sang , Lee Hyun Jong , Kim Tae-Hoon , Choi Young Jin , Lim Do-Sun , Yu Cheol Woong
Published: April 2019

There exists controversy on whether and for how long anticoagulation is necessary after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

We aimed to study the impact of prolonged (>24 h) or brief (<24 h) postprocedural anticoagulation on infarct size assessed by cardiac magnetic resonance (CMR) after 30 days as well as on left ventricular ejection fraction (LVEF) and left ventricular (LV) remodeling evaluated by 2D-echocardiography after 9 months from the INNOVATION trial (Clinical Trial Registration: NCT02324348).

Of the 114 patients (mean age: 59.5 years) enrolled, 76 (66.7%) received prolonged anticoagulation therapy (median duration: 72.6 h) and 38 (33.3%) patients received brief anticoagulation therapy (median duration: 5 h) after primary PCI. There was no significant difference in infarct size (mean size: 15.6% after prolonged anticoagulation versus 19.8% after brief anticoagulation, P = .100) and the incidence of microvascular obstruction (50.7% versus 52.9%, P = .830) between the groups. Even after adjusting, prolonged anticoagulation therapy could not reduce larger infarct (defined as >75 percentile of infarct size; 19.7% versus 35.3%; adjusted odd ratio [OR]: 0.435; 95% confidence interval [CI]: 0.120–1.57; P = .204). Similar results were observed in subanalyses of major high-risk subgroups. Moreover, follow-up LVEF <35% (3.2% versus 7.4%; adjusted OR: 0.383; 95% CI: 0.051–2.884; P = .352) and LV remodeling (defined as >20% increase in LV end-diastolic volume; 37.1% versus 18.5%; adjusted OR: 2.249; 95% CI: 0.593–8.535; P = .234) were similar between groups.

These data suggest that prolonged postprocedural anticoagulation may not provide much benefit after successful primary PCI in patients with STEMI. However, further studies are needed.
Transfusions and cost-benefit of oral versus intravenous tranexamic acid in primary total hip arthroplasty
Authors: Wang Ning , Xiong Xiaojiang , Xu Lixin , Ji Ming , Yang Tao , Tang Jin , Yang Yong , Liu Wangwei , Chen Hongxia
Published: April 2019

Background:

The purpose of this study was to assess the cost benefit and transfusions of oral and IV tranexamic acid (TXA) in primary total hip arthroplasty (THA).

Methods:

PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing oral and IV TXA in primary THA. Primary outcomes were total blood loss, maximum hemoglobin drop, transfusion requirements, and cost benefit. Secondary outcomes were length of stay, deep venous thrombosis (DVT) and/or pulmonary embolism (PE).

Results:

Four independent RCTs were included involving 391 patients. There was no difference in the total blood loss (P = .99), maximum hemoglobin drop (P = .73), and the length of stay (P = .95) between the 2 groups. Transfusion requirements (P = .97) were similar. The total mean cost was the US $75.41 in oral TXA group and the US $580.83 in IV TXA group. The incidence of DVT (P = .3) did not differ significantly between the 2 groups, and no PE was reported in all studies.

Conclusion:

Oral TXA shows similar efficacy and safety as IV TXA in reducing total blood loss, maximum hemoglobin drop and transfusion requirements in primary THA. However, oral TXA may be more cost-benefit than IV TXA.

Level of Evidence:

Level I, therapeutic study.
Bile reflux gastritis cystica profunda
Authors: Deng Shenghe , Cao Yinghao , Shen Liming , Wang Jiliang , Tao Kaixiong , Wang Guobin , Li Jiang , Cai Kailin
Published: April 2019

Rationale:

Gastritis cystica profunda (GCP) is a rare gastric lesion involving cystic dilation of the gastric glands extending into the submucosa. It is usually observed at anastomotic sites in the stomach of patients who have undergone gastric procedures. Bile reflux GCP is rare in patients who have not undergone gastric surgery. Here, we report a rare case of a patient with GCP associated with bile reflux, who had no history of gastric surgery.

Patient concerns:

A 50-year-old man presented with intermittent abdominal fullness for 2 years, along with nausea. He had never undergone gastric surgery. Endoscopic ultrasonography (EUS) showed a thickened gastric wall and an echo-poor submucosal layer of the gastric fundus. A 3 cm × 2 cm × 1.5 cm lesion was noted.

Diagnosis:

Bile reflux GCP

Interventions:

Endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection (ESD) were performed, and the lesion was removed. Conventional pathological examination revealed GCP with glands hyperplasia and a yellow-brown deposit, which was considered bile. The findings were consistent with a diagnosis of GCP without malignancy.

Outcomes:

Upper gastrointestinal barium meal revealed postoperative changes at the gastric fundus. Gastroscopy performed at 6 months after surgical resection showed superficial gastritis with bile reflux.

Lessons:

The findings suggest that GCP etiology varies and that GCP can be caused by bile reflux but without malignancy. Additionally, GCP is not limited to patients who have previously undergone gastric surgery. Moreover, it is difficult to identify. EUS and ESD might be good approaches for the diagnosis and treatment of GCP.
Effect of Fufang Biejia Ruangan Tablet on lowering biochemical and virological parameters of hepatic fibrosis in patients with chronic hepatitis B
Authors: Huang Chaoyuan , Shen Danting , Sun Shuning , Huang Yuancheng , Xin Yijun , Luo Hu , Chen Yinzhen , Zhou Zipu , Liu Fengbin , Chen Xinlin
Published: April 2019

Background:

Liver cirrhosis is one of the end-stage chronic liver diseases. Individuals with chronic hepatitis B (CHB) are at an increased risk of developing liver cirrhosis. Practice guidelines underline that Nucleos(t)ide analogs (NAs) should be the first-line treatment for hepatitis B virus (HBV)-related cirrhosis. However, prolonged use of NAs may lead to drug resistance and kidney impair and does not reverse the fibrosis of liver. Fufang Biejia Ruangan Tablet (RGT), as a traditional Chinese medicine (TCM), has been proved to be effective in the treatment of liver fibrosis. Hence, we will perform meta-analysis in order to evaluate the efficacy and safety of RGT in the treatment of hepatic fibrosis in patients with CHB.

Methods:

To search for relative literatures up to February 2019 by computer from the following databases: PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodicals Database, Chinese BioMedical Database and Wanfang Data. Included criteria are randomized controlled trials and cohort studies of hepatic fibrosis in patients with CHB treated by RGT. The primary outcome measures include biochemical and virological parameters. We will use Stata 13.0 software for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. The reporting bias will be assessed by a funnel plot and the funnel plot symmetries will be evaluated by Begg and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence.

Results:

This systematic review will provide a synthesis of RGT for hepatic fibrosis in patients with CHB from various evaluation aspects including biochemical and virological parameters, HBV DNA levels HBeAg status and seroconversion, adverse events incidence.

Conclusion:

The systematic review will provide evidence to assess the efficacy and safety of RGT in the treatment of hepatic fibrosis in patients with CHB.

PROSPERO registration number:

ROSPERO CRD 42018095122.
Questionnaire study on the utility of autopsy case conferences related to emergency medicine practices
Authors: Maeda Hideyuki , Tsujimura Takako , Yoshida Ken-ichi
Published: April 2019

We examined whether and how conferences on cases of medico-legal autopsy after emergency medicine (EM) practices improved the diagnostic accuracy and expertise of emergency medicine practitioners (EMPs) and forensic pathologists (FPs); we also examined the necessity of imaging in autopsy diagnoses. We additionally discuss whether imaging could replace autopsy.

An unsigned, self-administered questionnaire was distributed to the attendees of monthly case conferences during which EMPs and FPs discussed EM-associated autopsy cases. The questionnaire addressed the following 6 questions: was the conference useful for forensic medicine or EM practices, was autopsy necessary for each case, were the autopsy and clinical diagnoses consistent, was imaging necessary for autopsy diagnosis, and should autopsy results be disclosed to the public. Participants were autopsy operators, third-party EMPs, and FPs, primarily from universities in and near Tokyo.

Fifty-two cases were discussed; more than 80% of the attendees acknowledged the usefulness of autopsy and the conferences, and 33.6% corrected their diagnoses by considering autopsy information. Major clinical misdiagnoses were corrected by autopsy in 35.3% of cases, including procedure-related hemorrhage, intoxication, asphyxia, fat embolism, diabetes, organ injuries, and subarachnoid hemorrhage (SAH). Approximately 75% of the attendees recognized the usefulness of imaging for autopsy. However, in a series of four SAH cases, the clinical diagnoses were corrected after the conferences more often by EMPs than by FPs. In a violence-related case, false legal judgment was prevented because the conference discussion corrected the clinical diagnosis from traumatic to natural.

In conclusion, the conference improved the accuracy and expertise of diagnoses provided by EMPs and FPs; conference participation led to the correction of major clinical misdiagnoses as well as that of the first diagnoses issued by attendees in more than one-third cases. The usefulness of imaging for autopsy was acknowledged by two thirds of the attendees. Our results also suggested that imaging cannot replace autopsy in deaths related to procedure or violence and in several categories of deaths such as intoxication and asphyxia.
Effectiveness of advanced nursing care on depression in patients with ovarian cancer
Authors: Lu Zhen-hua , Kang Xiao-qin
Published: April 2019

Background:

This systematic review will assess the effectiveness of advanced nursing care (ANC) on depression in patients with ovarian cancer (OC).

Methods:

We will identify any relevant randomized controlled trial from Cochrane Library, MEDLINE, Embase, Web of Science, Springer, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from their inceptions to March 5, 2019. The primary outcome includes depression. The secondary outcomes consist of anxiety, quality of life, and adverse events. Data that meets all the eligibility criteria will be extracted, pooled, and analyzed by using RevMan 5.3 software. Methodological quality for each eligible study will be assessed by using Cochrane risk of bias tool.

Results:

This study will analyze depression, anxiety, quality of life, and adverse events of ANC on depression in patients with OC.

Conclusion:

The findings of this study will provide the latest evidence for the effectiveness and adverse events of ANC on depression in patients with OC.

Ethics and dissemination:

No ethic approval is required for this study, because all the data will be extracted from previous published studies. The results of this study will be presented at conference or will be published at a peer-reviewed journal.

PROSPERO registration number:

PROSPERO CRD42019126374.
Indolent T-cell lymphoproliferative disease with synchronous diffuse large B-cell lymphoma
Authors: Guo Linjie , Wen Zhonghui , Su Xueying , Xiao Shuyuan , Wang Yufang
Published: April 2019

Rationale:

Indolent T-cell lymphoproliferative disease (T-LPD) of gastrointestinal tract is a rare recently described disease that seldom progresses. We report a case of T-LPD with synchronous diffuse large B-cell lymphoma (DLBCL) that cause aggravation of disease.

Patient concerns:

A 46-year-old Chinese male presented with intermittent paraumbilical colic pain, bloating, and occasional diarrhea for 10 years. His condition aggravated with partial bowel obstruction recently. The patient was diagnosed as T-LPD initially based on histological result and T-cell receptor-gamma clonal gene rearrangement test. The patient was followed without chemotherapy. His condition stabilized for 1 year and then deteriorated with small intestine perforation.

Diagnosis:

The patient was diagnosed as indolent T-LPD and DLBCL finally.

Interventions:

The patient had surgery for intestine perforation and received chemotherapy for DLBCL and T-LPD afterward.

Outcomes:

At 6 months follow-up, the patient continued to have resolution of his symptoms.

Lessons:

Early detection of high-grade transformation of T-LPD or the coexistence of aggressive lymphoma is essential for the patient. DLBCL may coexist in the indolent course of T-LPD. The diagnosis of T-LPD should be made cautiously in case with progressing symptoms such as intestinal obstruction.
Higher monocyte count with normal white blood cell count is positively associated with 10-year cardiovascular disease risk determined by Framingham risk score among community-dwelling Korean individuals
Authors: Kim Jung-Hwan , Lee Yong-Jae , Park Byoungjin
Published: April 2019

The cardiovascular disease (CVD) has been identified as a leading cause of premature mortality among middle-aged and elderly individuals globally. Inflammation plays an important role in aging and age-related diseases, such as atherosclerosis and CVD. White blood cell (WBC) count is an inexpensive, simple biomarker of systemic inflammations and includes several cell subtype counts, such as neutrophils, monocytes, lymphocytes, basophils, and eosinophils. However, which component of a WBC count has the ability to predict CVD remains controversial. The objective of this study was to assess the association between monocyte counts and 10 year-CVD risk among community-dwelling Korean individuals using the Framingham risk score (FRS). We studied a total of 627 participants aged over 30 years who underwent routine health examinations. The mean age of the study population was 48.1 ± 11.7 years, and 56.9% were male. In the multiple regression analysis, the independent contribution of monocyte count to Framingham 10-year CVD risk was 0.217 ± 0.092 (P = .018) after adjusting for confounding variables. We found that of the various WBCs, monocyte count is an independent predictor of CVD risk. Further larger-scale prospective cohort studies are warranted to determine these associations in the future.
Negative pressure pulmonary edema after general anesthesia
Authors: Liu Ruizhu , Wang Jian , Zhao Guoqing , Su Zhenbo
Published: April 2019

Rationale:

Negative pressure pulmonary edema (NPPE) is a dangerous clinical complication and potentially life-threatening emergency without prompt diagnosis and intervention during recovery period after anesthetic extubation.

Patient concerns:

A 25-year-old woman has undergone endoscopic thyroidectomy. After extubation, the patient developed acute respiratory distress with high airway resistance accompanied with wheezing, oxyhemoglobin saturation (SpO2) decreased to 70%. With positive pressure mask ventilation, her condition was stable, SpO2 99%. However, the patient developed pink frothy sputum with diffuse bilateral rales 30 min later after transported to surgical intensive care unit (SICU).

Diagnoses:

Negative pressure pulmonary edema.

Interventions:

The patient was undergone assisted ventilation with continuous positive airway pressure (CPAP) and furosemide 20 mg was given intravenously.

Outcomes:

Postoperative day (POD) 2 her condition became stable, computed tomography (CT) scan indicated the pulmonary edema disappeared. The patient was discharged 6 days later. No abnormalities were observed during following 4 weeks.

Lessons:

Although usually the onset of NPPE is rapid, with individual differences NPPE is still challenging. Increased vigilance in monitoring, diagnosis, and treatment are essential to prevent aggravation and further complication.
Hypereosinophilic vasculitis
Authors: Alzayer Husam , Hasan Manal Ahmed
Published: April 2019

Introduction:

The Revised International Chapel Hill Consensus Conference 2012 subdivides vasculitides based on combinations of features that separate different forms of vasculitis into definable categories. Hypereosinophilic vasculitis with sparing of the respiratory tract and renal system is a rare presentation that is yet to be described in the Revised International Chapel Hill Consensus Conference 2012 report that addresses nomenclature of vasculitides. This is a condition that involves a vascular injury due to either a primary eosinophilic vasculitis or an underlying connective tissue disease and it predisposes patients to a prothrombotic state.

Patient concerns:

A 39-year-old patient presented with left hand digital ischemia, preceded by Raynaud phenomenon, and vasculitic rash. For 3 months, he was having digital ischemia affecting the left 2nd and 3rd digits in the form of pallor and gangrenous discoloration with a preceding history of a pinpoint pruritic rash affecting his lower limbs that extended to involve the trunk and upper limbs over a short period of time and responded to only a tapering dose of oral steroids. Examination revealed a delayed capillary refill in all left-hand digits and a weak left radial pulse but no bruit. The rest of his peripheral vascular examination was unremarkable.

Diagnosis:

Investigations revealed an absolute eosinophilic count of 4.34 K/μL and erythrocyte sedimentation rate of 44 mm/h. A magnetic resonance angiogram showed a beaded appearance of the left ulnar artery distally and the radial artery branches in the left hand and subsequently was diagnosed with hypereosinophilic vasculitis.

Interventions:

He was started on oral prednisone of 1 mg/kg daily orally tapering done as well as azathioprine for maintenance.

Outcomes:

Two weeks postdischarge, the patient was seen in the outpatient department where his ischemic symptoms improved, and his skin rash healed. Noticed improvement in his splinter hemorrhages was also detected. He continued to do well on 2 years follow-up

Conclusion:

This case reflects the importance of frequent reevaluation for vasculitic diseases criteria and nomenclature. Hypereosinophilic vasculitis with absent respiratory and renal involvement is a rare presentation with scarce evidence to guide treatment.
Efficacy of ranibizumab for the treatment of diabetic retinopathy
Authors: Ren Yong-bo , Su Xing-jie , Qi Yan-xiu , Luan He-qun , Sun Qi
Published: April 2019

Background:

Previous clinical trials have reported that ranibizumab can be used to treat diabetic retinopathy (DR) effectively. However, no study has been conducted to evaluate its efficacy for patients with DR systematically. Thus, this study will specifically and systematically assess the efficacy and safety of ranibizumab for DR.

Methods:

Cochrane Library, EMBASE, PUBMED, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database will be searched from inceptions to the March 20, 2019 for studies related to the topic. This study will only consider publicly released randomized controlled trials for evaluating the effect and safety of ranibizumab for DR. No language restrictions will be imposed for all databases search. Methodological quality of each included trial will be assessed by Cochrane risk of bias tool. Statistical analysis will be performed by Stata 12.0 software.

Results:

This study will provide recent summary evidence of ranibizumab for DR. Primary outcomes include percentages with retinopathy improvement, and cumulative probabilities for retinopathy worsening. Secondary outcome consist of visual function, best-corrected visual acuities, central subfield thickness, total macular volume, peripheral visual field loss, retinal neovascularization, and adverse events.

Conclusion:

The findings of this study may provide theoretical basis for clinical practice refer and may benefit more patients with DR.
Massive abscess with prolonged respiratory failure due to newly diagnosed myotonic dystrophy
Authors: Ota Koshi , Nakamura Yoshitsugu , Nakamura Eriko , Takashima Shogo , Oka Masahiro , Ota Kanna , Sakaue Masahide , Sano Yohei , Takasu Akira
Published: April 2019

Rationale:

Myotonic dystrophy is a progressive multisystem genetic heterogeneous disorder. General anesthesia with opioids increases the risk of prolonged postanesthetic respiratory recovery in myotonic dystrophy patients.

Patient concerns:

A 20-year-old previously healthy woman was transferred to our emergency department for further workup of respiratory failure, and massive ascites with abscess caused by endometriosis. Hypercapnic respiratory failure persisted under intensive care unit (ICU) management, but finally improved after cessation of fentanyl as a sedative agent.

Diagnosis:

Myotonic dystrophy type 1.

Interventions:

Massive ascites with abscess was accordingly managed by drainage, antibiotics, and an antifungal agent. Myotonic dystrophy type 1 was confirmed after molecular genetic testing revealed a cytosine-thymine-guanine repeat length of 400 to 450 in the DMPK gene.

Outcomes:

The patient was discharged without complications on hospital day 69.

Lessons:

Myotonic dystrophy should be considered when hypercapnic respiratory failure persists in sedated ICU patients. Opioids should not be used for perioperative management of patients with myotonic dystrophy.
Can Changes in Service Delivery Models Improve Program Quality and Efficiency? A Closer Look at HIV Programs in Kenya and Uganda
Authors: Kandasami Stephanie , Shobiye Hezekiah , Fakoya Ade , Asiimwe Sarah , Inimah Maureen , Etukoit Michael , Morrison Linden , Johnson Michael , Dybul Mark
Published: April 2019

Background:

With the scale-up of antiretroviral treatment, many health facilities in low- and middle-income countries have implemented innovative practices targeted at overcoming operational challenges and delivering efficient quality HIV services. However, many of these practices remain largely unexplored as a means to better reach the global 90-90-90 targets.

Setting:

A study was conducted on selected facilities in districts of country programs supported by The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The aims of the study were to understand how facilities seek to improve the delivery and uptake of HIV services and to examine what innovative practices might be contributing to their success.

Methods:

The study used a qualitative approach through observations, document reviews, and semistructured interviews with site management and clinical staff to identify service delivery innovations in 30 health facilities in Kenya and Uganda.

Results:

Eleven innovative practices were observed along the HIV care cascade. These practices led to improvements in the quality of testing, treatment, and retention across the facilities. Effective human resource and data management processes also enabled the implementation of these innovative practices.

Conclusions:

Many facilities use innovative practices along the HIV care cascade to address bottlenecks and challenges. These have the potential to improve the quality and efficiency of service delivery and support the attainment of the 90-90-90 treatment targets. Replicating these practices would require further implementation research and a mind shift of donors, governments, and implementers from a metric of coverage to a stronger focus on efficiency and impact.
Immune-mediated encephalitis for the infectious disease specialist
Authors: Venkatesan Arun
Published: April 2019

Purpose of review

Autoimmune encephalitis is increasingly recognized and must be distinguished from infectious forms of encephalitis. Moreover, physicians should be aware of infectious triggers of autoimmune encephalitis and of infectious complications associated with treatment.

Recent findings

Recent epidemiological studies suggest that the incidence of autoimmune encephalitis may rival that of infectious encephalitis. Although distinguishing autoimmune from infectious forms of encephalitis on clinical grounds can be challenging, recently proposed diagnostic criteria can provide some assistance. There has been an explosion in our knowledge of autoimmune encephalitis associated with antibodies to neuronal cell surface antigens, and two of the most common forms, anti-NMDA receptor encephalitis and anti-LGI1 encephalitis, are typically associated with distinctive clinical features. Although tumors have long been known to trigger autoimmune encephalitis, it has been recently recognized that herpes simplex encephalitis may trigger the generation of antineuronal autoantibodies resulting in an autoimmune neurologic relapse. Both first and second-line therapies for autoimmune encephalitis are associated with infectious complications, whereas emerging treatments, including anakinra and tocilizumab, may also result in increased susceptibility to certain infections.

The diagnosis and management of autoimmune encephalitis is complex, and awareness of diagnostic criteria and modalities, typical clinical syndromes, infectious triggers of disease, and infectious complications of therapies is critical in optimizing care for affected patients.