bluuebunny/crossref_metadata_2025 huggingface dataset:
Multifocal Inflammatory Pseudotumor of the Temporal Bone, Maxillary Sinus, and Orbit
Authors: Sakano Hitomi , Shih Cheng-Ping , Jafari Aria , DeConde Adam , Harris Jeffrey P.
Published: October 2018

Objective:

This is the first report of multifocal inflammatory pseudotumor (IPT) involving the temporal bone, orbit and paranasal sinus, and the use of rituximab as adjunctive therapy in multifocal temporal bone IPT.

Patient:

We describe a 46-year-old man with orbital and maxillary sinus IPT, whose disease progressed despite radiation and steroid burst. He then developed contralateral mastoid disease, otalgia, aural fullness, and hearing loss.

Intervention:

He was initiated on rituximab and prednisone therapy. Mastoidectomy with near-total tumor removal was accomplished and histopathology confirmed IPT. A literature review was also performed.

Main Outcome Measure:

Tumor regression or recurrence.

Result:

Despite disease progression after radiation and steroids, his orbital, sinus, and mastoid disease improved after surgery, steroids, and rituximab. A review of four other previously reported cases of multifocal disease involving the temporal bone suggest that multifocal disease may be a more aggressive entity with higher recurrence rate compared with solitary disease. Although surgery and steroids are typically recommended, there is currently no consensus treatment recommendation.

Conclusions:

Multifocal IPT of the temporal bone is a rare but aggressive entity for which surgery and steroid combination therapy should be first line treatment. We suggest rituximab may be an effective adjunctive treatment particularly for recurrent disease or where systemic therapy may be favored.
Systematic Review of Facial Nerve Outcomes After Middle Fossa Decompression and Transmastoid Decompression for Bell's Palsy With Complete Facial Paralysis
Authors: Casazza Geoffrey C. , Schwartz Seth R. , Gurgel Richard K.
Published: October 2018

Objectives:

The surgical timing and approach for patients with Bell's palsy and complete facial paralysis is controversial. A previous meta-analysis demonstrated no benefit from surgical decompression, however, only transmastoid decompression (TMD) was investigated. No study has evaluated both the outcomes of TMD and middle fossa decompression (MFD).

Study Design:

Systematic review with meta-analysis.

Methods:

A systematic literature search identifying all studies meeting inclusion criteria and published between 1985 and 2015 was performed. Final House–Brackmann (HB) scores were calculated and compared for TMD, MFD, and medical controls. A meta-analysis was performed to compare MFD less than or equal to 14 days versus MFD more than 14 days, TMD versus medical controls, and surgical therapy (combined MFD and TMD) versus medical controls. Observational studies without a control arm were excluded from the meta-analysis.

Results:

Average HB scores for MFD less than or equal to 14 days was 1.8, MFD more than 14 days was 2.75, and MFD medical controls was 2.4. For TMD average HB was 2.3 and for TMD medical controls average HB was 2.4. 75% MFD were performed within 14 days of onset while TMD was performed between 15 and 120 days. Meta-analysis demonstrated significantly better facial nerve outcomes for MFD performed less than or equal to 14 days versus more than 14 days (p < 0.001), but no difference between TMD versus medical controls (p = 0.78) or surgical therapy versus medical controls (p = 0.58).

Conclusion:

MFD performed within 14 days of symptom onset results in better facial nerve outcomes than MFD performed after 14 days. TMD does not offer improved outcomes over medical management however decompression was only offered after 15 days of symptom onset.
Necrotizing Otitis Externa—Analysis of 83 Cases: Clinical Findings and Course of Disease
Authors: Peled Chilaf , El-Seid Sabri , Bahat-Dinur Anat , Tzvi-Ran Lital Rahmani , Kraus Mordechai , Kaplan Daniel
Published: October 2018

Objectives:

Evaluate the relationship between clinical findings and course of disease among patients with necrotizing otitis externa (NOE).

Study Design:

Retrospective case series review.

Setting:

Tertiary referral center.

Patients:

Adult patients with no previous history of chronic ear disease, hospitalized due to NOE between the years 1990 to 2015.

Main Outcome Measures:

1) Duration of hospitalization and 2) necessity for surgery.

Results:

Eighty-one patients were included in the study, corresponding to 83 effected ears. Thirty-two patients (38.5%) were hospitalized longer than 20 days and 20 patients (24.0%) underwent surgery. Otalgia was the most common complaint (n = 71, 85.5%). Pseudomonas Aeruginosa (PA) was the most common isolated bacteria (n = 40, 48.1%). Shifting incidence of culture results was noted, as rates of PA NOE decreased and rates of sterile culture and fungal NOE increased. Duration of complaints and presence of aural discharge at admission were associated with prolonged hospitalization (p = 0.010, p = 0.011, respectively). Advanced age, duration of hospitalization, and rates of readmission were associated with surgery (p = 0.037, p < 0.001, p < 0.001 respectively).

Conclusions:

Duration of complaints and presence of aural discharge may indicate advanced NOE and require longer in-hospital treatment. Elderly patients are at increased risk for conservative treatment failure and are more likely to require surgery. With shifting incidence of pathogens, a wider empirical treatment covering nontraditional pathogens should be considered.
Outcomes of Stapedotomy With Heat-Crimped Prostheses
Authors: Murfee John , O’Connell Brendan , Haynes David , Rivas Alejandro , Dedmon Matthew , Bennett Marc
Published: October 2018

Background:

Theoretical disadvantages are associated with the use of heat-crimped piston prostheses in stapedotomy. Loose crimping could result in prosthesis displacement or slippage. Alternatively, overly tight crimping may cause trauma to the incus with resultant necrosis.

Objectives:

1) Analyze outcomes of patients undergoing stapedotomy with heat-activated piston-style prostheses, and 2) compare outcomes between prostheses made by different manufacturers.

Study Design:

Retrospective.

Setting:

Vanderbilt Medical Center.

Patients and Methods:

Cases undergoing stapedotomy between 2005 and 2016 were reviewed. Audiometric assessments were recorded in accordance with American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) guidelines. Patients who lacked audiometric follow-up before 6 months or after 1 year were excluded.

Intervention(s):

Diagnostic, therapeutic, and rehabilitative.

Main Outcome Measure(s):

Postoperative air-bone gap (ABG) and achievement of an ABG is less than or equal to 10 dB.

Results:

Three hundred fifty-eight patients met inclusion criteria. At short-term follow-up (<6 mo), the mean ABG was 11 ± 8 dB in the entire cohort; this did not differ based on manufacturer (p = 0.13). The majority of patients (63%) achieved an ABG less than or equal to 10 dB. At longer-term follow-up, the mean ABG was 9 ± 7 dB; again no differences were noted when comparing prosthesis manufacturer (p = 0.20). 70% of patients achieved an ABG less than or equal to 10 dB at longer-term follow-up. When comparing short- to long-term follow-up, ABG did not significantly change over time (p = 0.76). The overall revision rate was 1.9% (n = 7).

Conclusion:

Favorable hearing outcomes are obtained both short- and long-term following stapedotomy and placement of heat-crimped piston prostheses. Both prosthesis groups appear stable in the middle ear environment long-term, as evidenced by a 1.9% revision rate among them.
Variation in Tympanoplasty Cost in a Multihospital Network
Authors: Casazza Geoffrey C. , Thomas Andrew J. , Gurgel Richard K. , Shelton Clough , Meier Jeremy D.
Published: October 2018

Objectives:

Identify costs and operative times for tympanoplasty, and evaluate factors influencing cost and time variation.

Study Design:

Retrospective cohort study.

Setting:

Multihospital network.

Patients:

Patients undergoing tympanoplasty from 2008 to 2016. Subjects with additional procedures were excluded.

Interventions:

A multihospital network's standardized activity-based accounting system was used to determine costs and operative times of tympanoplasty.

Main Outcome Measures:

Correlation between variable factors and cost was calculated by Spearman correlation coefficients. Statistical comparisons of cost and time were made between surgeons and hospitals using an ANOVA test (Kruskal–Wallis) followed by Dunn's test to correct for multiple comparisons. All providers or hospitals with single cases were excluded for statistical comparison.

Results:

The study cohort included 487 tympanoplasties performed by 44 surgeons at 13 hospitals. Mean patient age was 18.2 ± 17.4 years. Mean cut-to-close time was 85.8 ± 56.7 minutes. Mean total encounter cost was $3491 ± $1,627. Substantial factors associated with total encounter cost were anesthesia cost (r = 0.8782; 95% CI 0.852–0.900, p < 0.001) and cut-to-close time (r = 0.7543; 95% CI 0.707–0.7949, p < 0.001). The total itemized supply cost was less correlated with total encounter cost (r = 0.3176; 95% CI 0.2128–0.4151, p < 0.001). Laser utilization (mean cost $541 ± $343) and artificial graft material (mean cost $199 ± $94) were the major supply costs.

Conclusion:

Significant variation in tympanoplasty costs exists among different surgeons and hospitals within a multihospital network. Reducing variation in costs while maintaining outcomes may improve healthcare value and eliminate waste.
Fatal case of hemophagocytic lymphohistiocytosis associated with group B streptococcus sepsis
Authors: Choi Young Bae , Yi Dae Yong
Published: October 2018

Rationale:

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease characterized by an excessive systemic inflammatory response. HLH is classified as primary or secondary, where the latter may occur in association with many infections. However, no case of HLH has been previously associated with group b streptococcus (GBS) sepsis.

Patient concerns:

We present a fatal case of HLH in a 5-year-old girl with GBS sepsis.

Diagnosis:

The present patient met 5 of the HLH criteria: fever, splenomegaly, bicytopenia, hypertriglyceridemia and/or hypofibrinogenemia, and hyperferritinemia. GBS was identified in 2 sets of peripheral blood bacterial cultures.

Interventions:

Empirical antibiotics, inotropes, and immunoglobulins were administered.

Outcomes:

The clinical course of the patient was fulminant and the patient died of septic shock 10 hours after admission to the hospital.

Lessons:

We suggest GBS infection can cause HLH and early awareness of HLH associated with GBS infection and proper effective treatment are necessary to reduce mortality.
Can radial bone mineral density predict spinal bone mineral density in patients with advanced Duchenne muscular dystrophy?
Authors: Kim Eunyoung , Cho Han Eol , Jung Ji Ho , Lee Jang Woo , Choi Won Ah , Kang Seong-Woong
Published: October 2018

In advanced Duchenne muscular dystrophy (DMD), patients with high bone fracture risk due to osteoporosis, it is difficult to measure spinal bone mineral density (BMD) because of maintaining proper posture. This study began with the idea that if we diagnose and manage osteoporosis by predicting spinal BMD through easily testable radial BMD, we could prevent fracture and improve quality of life in DMD patients. In 61 DMD patients aged 20 years or older who were admitted to Gangnam Severance Hospital from April 2013 to May 2015, radial BMD and spinal BMD were measured to compare their Z-scores. In 45 patients, the z-score was less than −2.0 in spinal BMD defined as osteoporosis. And the optimal range of Z-score in the radius was −5.2 to −5.0 (sensitivity 78.9%, specificity 71.4%). Only through the radius BMD, spinal BMD can be predicted and we suggest appropriate times for treatments.
Prognostic role of platelet to lymphocyte ratio in prostate cancer
Authors: Wang Jiangfeng , Zhou Xiaofeng , He Yuhui , Chen Xing , Liu Naibo , Ding Zhenshan , Li Junjie
Published: October 2018

Background:

Recently, the prognostic value of the platelet-to-lymphocyte ratio (PLR) has been identified in multiple cancers. However, the prognostic significance of the PLR in prostate cancer (PCa) remains conflicting. We therefore searched relevant studies and conducted a meta-analysis.

Methods:

Papers from the databases of PubMed, Web of Science, and the Cochrane Library were retrieved. Six studies comprising 1324 patients were included.

Results:

The pooled analysis demonstrated that an elevated PLR predicted poor overall survival (OS; HR = 1.85, 95% CI = 1.51–2.25, P < .001) and disease-free survival (DFS; HR = 1.4, 95% CI = 1.1–1.79, P = .007). Subgroup analyses showed that the PLR remained a significant prognostic factor for OS irrespective of ethnicity, tumor stage, or cut-off value. The PLR was an indicator of poor DFS in Asian patients, but not in Caucasian patients. No significant publication bias was detected.

Conclusion:

This meta-analysis showed that a high PLR was correlated with poor DFS and OS in patients with prostate cancer. Due to this meta-analysis being derived from a few studies, the results should be validated in clinical practice.
Genetic polymorphisms of the drug-metabolizing enzyme CYP2J2 in a Tibetan population
Authors: Cao Peilong , Zhao Qian , Shao Yuan , Yang Hua , Jin Tianbo , Li Baiya , Li Honghui
Published: October 2018

As an important metabolic enzyme, it is necessary to investigate the genetic polymorphisms of CYP2J2 among healthy Tibetan individuals. Genetic polymorphisms of CYP2J2 could affect enzyme activity and lead to differences among individual responses to drugs.

We sequenced the whole gene of CYP2J2 in 100 unrelated, healthy Tibetan volunteers from the Tibet Autonomous Region and screened for genetic variants in the promoters, introns, exons, and the 3′-UTR regions.

We detected 4 novel genetic polymorphisms of the CYP2J2 gene. The allelic frequencies of CYP2D6∗1 and ∗7 were 0.955 and 0.045, respectively. CYP2D6∗1/∗7 decreased the activity of CYP2J2 and was expressed in 9% of the sample population.

Our results provided basic data about CYP2J2 polymorphisms in a Tibetan population, suggested that the enzymatic activities of CYP2J2 might be different within the ethnic group, and offered a theoretical basis for individualized medical treatment and drug genomics studies.
Curative-intent radiotherapy in patients with oligometastatic lesions from colorectal cancer
Authors: He Xiaofeng , Zhang Pengfei , Li Zhiping , Bi Feng , Xu Feng , Wang Xin , Shen Yali , Li Qiu , Qiu Meng
Published: October 2018

The purpose of the present study was to investigate the efficacy and safety of radiotherapy for patients with oligometastases from colorectal cancer (CRC).

This was a retrospective cross-sectional study. Patients with liver and/or lung oligometastatic lesions from CRC treated with curative-intent radiotherapy in West China Hospital, Sichuan University, between 2009 and 2013 were included. Radiotherapy modality included 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and stereotactic body radiation therapy (SBRT); simultaneous chemotherapies along with radiotherapy of metastasis were allowed. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan–Meier method. Local control (LC) rates, toxicities, and factors of prognostic significance were also assessed.

A total of 40 CRC patients with 57 liver and/or lung oligometastatic lesions were included. Most of the patients (95%) had received at least 1 line of previous systemic chemotherapy. Among them, 19 patients with 26 lesions received 3D-CRT with a median dose of 51.5 Gy in 16.1 fractions, 7 patients with 11 lesions received IMRT with a median dose of 49.3 Gy in 10.4 fractions, and 14 patients with 20 lesions received SBRT with a median dose of 56.4 Gy in 6.7 fractions, respectively. The median follow-up time was 34 months (range, 9–86 months). Median OS and PFS for patients were 30.0 months [95% confidence interval (95% CI), 21.3–38.7] and 11.0 months (95% CI, 9–13), respectively. One, 3, and 5 years’ LC rates for metastasis were 63.2%, 24.6%, and 16.9%, respectively. In subgroup analysis, patients with metachronous metastases had longer OS (median, 41.0 months; 95% CI, 33.3–48.7) than patients with synchronous lesions (median, 17.0 months; 95% CI, 7.4–26.6,P = .001). All patients tolerated the radiation treatment well, and there was no treatment-related death. Multivariate analysis showed that number of metastasis lesions and simultaneous liver and lung metastases were potential survival predictors.

The study demonstrated that curative radiotherapy might be a tolerable and potential alternative for the treatment of patients with liver and/or lung oligometastases from CRC, and patients with metachronous lesions might have better survival than those with synchronous lesions when treated with curative-intent radiotherapy.
Blood homocysteine levels could predict major adverse cardiac events in patients with acute coronary syndrome
Authors: Liu Jianlin , Quan Jianjun , Li Yanzi , Wu Yue , Yang Lin
Published: October 2018

The Global Registry of Acute Coronary Events (GRACE) risk score independently predicts major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). This study aims to evaluate whether the level of plasma homocysteine in addition to the GRACE score enhances the predictive value for MACEs in patients with acute coronary syndrome.

A total of 361 patients with ACS evaluated at our hospital were included in the study and tested for blood homocysteine levels. We recorded 40 (11.1%) instances of MACE during a median follow-up of 43.3 months (quartile 40.6–44.4 months), including 29 cases (8.0%) of all-cause death and 11 cases (3.1%) of nonfatal myocardial infarction.

The GRACE score was significantly associated with homocysteine levels, and multivariate Cox regression analysis showed that both the GRACE risk score and homocysteine content were independent predictors of MACEs (HR 2.63; 95% confidence interval (CI) 1.54 to 4.49; P < .001 and 2.27; 1.06 to 4.86; P = .035, respectively). Moreover, meta-analysis showed that as the homocysteine level increased, the incidence of MACEs also increased (log-rank 8.41; P = .015). GRACE scores adjusted by homocysteine level increased the area under the curve (AUC) from 0.78 to 0.83 (P = 0.006).

Blood homocysteine levels are significantly associated with the GRACE risk score, and using both parameters can further improve risk stratification in patients with acute coronary syndrome.
Role of qSOFA in predicting mortality of pneumonia
Authors: Jiang Jianjun , Yang Jin , Jin Yongmei , Cao Jiyu , Lu Youjin
Published: October 2018

Background:

The concept of sepsis was redefined recently, and a new screening system termed the quick Sequential Organ Failure Assessment (qSOFA) was recommended for identifying infected patients at high risk for death. However, the predictive value of qSOFA for mortality in patients with pneumonia remains unclear. Thus, we performed a meta-analysis with the aim of determining the prognostic value of qSOFA in predicting mortality in patients with pneumonia.

Methods:

Embase, Google Scholar, and PubMed (up to March 2018) were searched for related articles. We constructed a 2 × 2 contingency table according to mortality and qSOFA scores (<2 and ≥2) in patients with pneumonia. Two investigators independently extracted data and assessed study eligibility. A bivariate meta-analysis model was used to determine the prognostic value of qSOFA in predicting mortality. I
2 index and Q-test were used to assess heterogeneity.

Results:

Six studies with 17,868 patients were included. A qSOFA score ≥2 was related to a higher risk for death in patients with pneumonia, with a pooled risk ratio (RR) was 3.35 (95% CI, 2.24–5.01) using a random-effects model (I
2 = 89.4%). The pooled sensitivity and specificity of a qSOFA score ≥2 to predict mortality in patients with pneumonia were 0.43 (95% CI, 0.33–0.53) and 0.86 (95% CI, 0.76–0.92), respectively. The diagnostic OR was 4 (95% CI, 3–6). The area under the summary receiver operator characteristic (SROC) curve was 0.67 (95% CI, 0.63–0.71). When we calculated the community-acquired pneumonia (CAP) subgroup, the pooled sensitivity and specificity were 0.36 (95% CI, 0.26–0.48) and 0.91 (95% CI, 0.84–0.95), respectively. The area under the SROC curve was 0.70 (95% CI, 0.66–0.74).

Conclusions:

A qSOFA score ≥2 is strongly associated with mortality in patients with pneumonia, but the poor sensitivity of qSOFA may have limitations in the early identification of mortality in patients with pneumonia.
Quantitative evaluation of retinal artery occlusion using optical coherence tomography angiography
Authors: Wang Xiaogang , Sun Bin , Wang Jie , Jia Yali , Huang David , Dong Jing
Published: October 2018

Rationale:

Retinal artery occlusion (RAO) results in painless, catastrophic vision loss in a period of seconds. Optical coherence tomography angiography (OCTA) can image retinal microcirculation, which is helpful to evaluate treatment response during the follow-up period. Using a single case with central RAO, we report its retinal perfusion changes before and after treatment using OCTA.

Patient concerns:

A 36-year-old Chinese man came to our clinic with a sudden, painless loss of vision (hand motion) in his left eye. A vasodilator (nicotinic acid) was used as the primary treatment. OCTA imaging and a visual field examination were performed to assess the retinal perfusion changes before and after treatment.

Diagnosis:

Retinal artery occlusion was considered.

Interventions:

This patient was treated with an inhaled oxygen-carbon dioxide mixture, nicotinic acid tablets (100 mg) taken orally twice a day, and intravenous infusion of nicotinic acid injections (60 mg) combined with 0.9% sodium chloride injections (100 ml) once a day for vasodilation.

Outcomes:

After treatment and 9 months of follow-up, the vessel density of the left eye at the 9-month follow-up appointment was improved in all quadrants.

Lessons:

Retinal edema and retinal atrophy were observed at the RAO onset and several months later, respectively. However, macular perfusion gradually increased after treatment. The timely administration of a vasodilator and the presence of the cilioretinal artery play important roles in the prevention of profound vision loss.
Th17 cells over 5.9% at admission indicate poor prognosis in patients with HBV-related acute-on-chronic liver failure
Authors: Zhang Geng-lin , Zhang Ting , Zhao Qi-yi , Lin Chao-shuang , Gao Zhi-liang
Published: October 2018

Our previous study demonstrated that Th17 cells increased significantly in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). However, their prognostic role in HBV-ACLF patients remains unknown.

Sixty-eight consecutive HBV-ACLF patients were enrolled in this cohort study. Th17 cells were examined using flow cytometry. Disease severity scores were assessed. ROC curves were used to evaluate the value in predicting prognosis. Survival was analyzed using Kaplan–Meier curves. Predictors of mortality were determined by regression analysis.

Th17 cells were significantly higher in HBV-ACLF patients compared to patients with chronic hepatitis B and normal controls (both P < .001). Also, Th17 cells were higher in nonsurviving HBV-ACLF patients than in surviving patients (P = .014). Th17 cells were positively correlated with CLIF-Consortium ACLF (CLIF-C ACLF) score (r = 0.240, P = .048). ROC curves showed that the frequency of Th17 cells had accuracy in predicting 90-day prognosis equivalent to MELD, MELD-Na and CLIF-C ACLF scores in HBV-ACLF (P = .34, P = .26, and P = .15, respectively). More importantly, the area under the ROC curve (AUROC) increased when Th17 cells were combined with MELD, MELD-Na or CLIF-C ACLF score than using Th17 cells alone (P = .021, P = .006, and P = .023, respectively). Kaplan–Meier analysis revealed that higher Th17 cells (≥5.9%) were closely associated with poor overall survival in HBV-ACLF (P = .0086). Additionally, multivariate regression analysis showed that the frequency of Th17 cells over 5.9% was an independent predictor of mortality (OR = 0.154, P = .025).

Circulating Th17 cells positively correlated with disease severity in HBV-ACLF. The frequency of Th17 cells over 5.9% could serve as a prognostic biomarker for HBV-ACLF patients.
Inflammatory myofibroblastic lung tumor transforming into intracranial desmoplastic noninfantile ganglioglioma
Authors: Wei Fu , Richard Seidu A. , Tan Junya , Lan Zhigang , Ju Yan
Published: October 2018

Rationale:

Inflammatory myofibroblastic tumor (IMT) of the lung often arises from excessive inflammatory response. It is one of the rare benign tumors of the lung, while desmoplastic noninfant gangliogliomas (DNIG), on the contrary, are rare intracranial benign tumors often seen in children within the first one and a half years of life.

Patient concerns:

We present a 12-year-old girl with 2 months history of none productive cough and right-sided chest pain.

Diagnoses:

Computer tomography scan of the chest revealed a soft tissue mass at the right upper lobe which was consistent with IMT. Histopathologic examination confirmed the diagnosis of IMT.

Interventions:

Thoracic surgery was successfully carried out and she further received radiotherapy. The patient recovered initially.

Outcomes:

Two years later, she complained of seizures during follow-up. Magnetic resonance imaging of the head revealed DNIG. We achieved total resection of the major lesions and she was further treated with radiotherapy. She is currently well and in school. Histopathologic examination confirmed the diagnosis of DNIG.

Lesions:

We speculate that IMT might have transformed into intracranial DNIG through metastatic process or as a result of genetic mutations or chromosomal abrasions.
Prepregnancy obesity status and risks on pregnancy outcomes in Shanghai
Authors: Shen Jie , Zhang Zhiping , Chen Ke , Lu Mei , Qian Qiao , Liu Pengfei , Gao Qingyun , Zhang Chengfeng
Published: October 2018

Obesity in women of reproductive age is not only associated with numerous adverse maternal and fetal effects prenatally but also exerts a negative influence on female fertility. The aim of this study was to investigate the situation of prepregnant obesity in Shanghai and explore the impact of prepregnant obesity on gestational weight gain as well as other pregnancy outcomes. A prospective hospital-based pregnant women cohort was established in Shanghai since January 2015. All pregnant women who were registered and expected to deliver in this hospital were included in the cohort. Nearly one fourth of pregnant women in Shanghai were overweight/obese and the prevalence of overweight/obesity was more common among women with advancing age (P < .001). Women prepregnancy overweight/obesity was associated with 3.5-fold higher risk of excessive gestational weight gain (odds ratio, OR 3.58; 95% confidence interval, CI, 2.82–4.55; P < .001). Women prepregnancy BMI was statistically related to pregnancy outcomes as macrosomia (OR 2.24; 95% CI, 1.55–3.23; P < .001), cesarean delivery (OR 2.04; 95% CI, 1.60–2.62; P < .001), maternal complications (OR 1.53; 95% CI, 1.18–1.98; P < .001). Prepregnancy obesity is associated with a much higher risk of excessive gestational weight gain and pregnancy outcomes in Shanghai. Further interventions targeting maternal obesity, especially prepregnancy obesity are required.
The efficacy of accommodative versus monofocal intraocular lenses for cataract patients
Authors: Zhou Hongwei , Zhu Chongyan , Xu Wenya , Zhou Fang
Published: October 2018

Introduction:

We performed a systematic review and meta-analysis to evaluate whether accommodative intraocular lenses (AC-IOLs) are superior for cataract patients compared with monofocal IOLs (MF-IOLs).

Methods:

Pubmed, Embase, Cochrane library, CNKI, and Wanfang databases were searched through in August 2018 for AC-IOLs versus MF-IOLs in cataract patients. Studies were pooled under either fixed-effects model or random-effects model to calculate the relative risk (RR), weighted mean difference (WMD), or standard mean difference (SMD) and their corresponding 95% confidence interval (CI). Distance-corrected near visual acuity (DCNVA) was chosen as the primary outcome. The secondary outcomes were corrected distant visual acuity (CDVA), pilocarpine-induced IOL shift, contrast sensitivity, and spectacle independence.

Results:

Seventeen studies, involving a total of 1764 eyes, were included. Our results revealed that AC-IOLs improved DCNVA (SMD = −1.84, 95% CI = −2.56 to −1.11) and were associated with significantly greater anterior lens shift than MF-IOLs (WMD = −0.30, 95% CI = −0.37 to −0.23). Furthermore, spectacle independence was significantly better with AC-IOLs than with MF-IOLs (RR = 3.07, 95% CI = 1.06–8.89). However, there was no significant difference in CDVA and contrast sensitivity between the 2 groups.

Conclusion:

Our study confirmed that AC-IOLs can provide cataract patients with DCNVA and result in more high levels of spectacle independence than MF-IOLs. Further studies with larger data set and well-designed models are required to validate our findings.
Targeted high-throughput sequencing technique for the molecular diagnosis of primary immunodeficiency disorders
Authors: Chi Zuo Hua , Wei Wei , Bu Ding Fang , Li Huan Huan , Ding Fei , Zhu Ping
Published: October 2018

The aim of this study was to investigate the usefulness of targeted high-throughput sequencing (HTS) for the molecular diagnosis of primary immunodeficiency diseases (PID).

A total of 56 clinically diagnosed or suspected PID patients were divided into 4 groups according to the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency 2015 and their chief clinical presentations. Patients and their biological family members were examined by targeted HTS, which sequenced the exons and ±10 bp flanking introns of 171 PID-related genes panel. All significant variants were confirmed by PCR-Sanger sequencing. Pathogenicity of the variants was evaluated by using bioinformatics.

A total of 117 variants in 73 genes were found in 56 patients. Accurate molecular diagnosis of PID was made in 13 (23.2%) patients, and 12 novel mutations were detected in these patients. Twenty-seven patients carried heterozygous variants that are probably pathogenic in ≥2 genes; 16 patients had only 1 missense variant, or had several variants but not >1 variant was deleterious as evaluated by bioinformatics. The meaning of the targeted HTS results of these patients remains to be studied.

Targeted HTS can make a precise molecular diagnosis of PID and detect more novel pathogenic mutations. More and more variations with ambiguous significance are discovered and explanation of these variations is a challenge to the clinicians.
No associations exists between red blood cell distribution width and serum uric acid in both sexes
Authors: Zhang Chunmei , Meng Zhaowei , Li Xue , Liu Ming , Ren Xiaojun , Zhu Mei , He Qing , Zhang Qing , Song Kun , Jia Qiyu , Chen Qian
Published: October 2018

The aim of this study was to determine whether there was a significant association between red blood cell distribution width (RDW) and uric acid (UA) in a large Chinese population.

This was a cross-sectional study with an enrollment of 80,298 ostensibly healthy participants (48,971 males, 31,327 females) during the period from 2011 to 2015. In the study, database was grouped by sex and the association between RDW and UA was analyzed by quartiles of RDW.

UA values between different sexes and RDW subgroups were analyzed by 2-way analysis of variance and Bonferroni t tests. Prevalence of hyperuricemia in different sexes was calculated. The relationship between risks of hyperuricemia and RDW level was analyzed by binary logistic regression with or without adjustment for age and body mass index.

UA values were not all the same between different sexes and RDW subgroups. Males had significantly higher hyperuricemia prevalence than females (20.00% vs 6.48%, P < .01). In addition, hyperuricemia prevalence in males decreased slightly across RDW quartiles, but was stable in females. No significant association between hyperuricemia risk and RDW was found in both sexes according to the results of multivariate logistic regression analysis. Similarly, negative results were also observed in multivariate linear analysis when both RDW and UA were considered as continuous variable.

We could not find any significant relationship between RDW and UA in both sexes.
Curative resolution of chronic thromboembolic pulmonary hypertension with pulmonary thromboendarterectomy in primary antiphospholipid syndrome
Authors: Li Can , Zhao Jiuliang , He Kun , Wu Yan , Liu Sheng , Wang Qian , Zhao Yan
Published: October 2018

Rationale:

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of antiphospholipid syndrome (APS). Once diagnosed, the recommendation for the treatment of CTEPH is long-term anticoagulation and pulmonary thromboendarterectomy (PTE). However, cardiac surgeons apply PTE cautiously for these patients, as there is an increased risk of perioperative complications. Here, we present the curative case of a patient with severe APS-associated CTEPH treated with PTE.

Patient concerns:

A 29-year-old man presented with chest pain, decreased exercise capacity, dyspnoea, and haemoptysis.

Diagnoses:

He was triple positive for antiphospholipid antibodies. Computed tomography pulmonary angiography revealed multiple, recurrent pulmonary embolisms and complete obstruction of the left pulmonary artery. He was diagnosed with APS and CTEPH.

Interventions:

After balancing the risk of thrombosis and haemorrhage, the patient underwent PTE.

Outcomes:

The patient experienced symptom relief after PTE, and electrocardiography at a six-month follow-up showed a recovery of cardiac structure and pulmonary arterial pressure.

Lessons:

After evaluating the thrombosis risk at an experienced treatment centre and the application of standard anticoagulation treatment, PTE may be a curative resolution for APS-associated CTEPH.
Case report of mixed-type autoimmune hemolytic anemia in a patient with relapsing polychondritis
Authors: Xu Qianyun , Luo Hui , Zuo Xiaoxia , Liu Sijia
Published: October 2018

Rationale:

Relapsing polychondritis (RP) is a rare autoimmune-related disease and may be associated with other autoimmune diseases.

Patient concerns

: Here we reported a case of RP patients with mixed-type AIHA. The patient was diagnosed with RP in March 2008 which was treated and the patient was in stable condition. Laboratory data revealed progressive decrease in hemoglobin during her hospitalization due to pulmonary infection in 2016. Positive Coombs’ test and moderate titer of anti-cold agglutinin was detected.

Diagnosis:

Mixed-type AIHA was diagnosed as a comorbidity in this case given the circumstance that her RP was stable and low-dose oral corticosteroids was enough to maintain remission.

Interventions:

The patient was treated with intravenous immunoglobulin and steroids.

Outcomes:

The patient's body temperature dropped and hemoglobin levels rose in 2 weeks.

Lessons:

Reports of RP patients with autoimmune hemolytic anemia (AIHA) are extremely rare and cases with the mixed-type AIHA has not been reported. Here we describe a case of RP with mixed-type AIHA which was considered as a comorbidity rather than a complication.
Infliximab as an alternative therapy for refractory adult onset Kawasaki disease
Authors: Kawaguchi Takeshi , Rikitake Yuki , Tsuruda Toshihiro , Kawata Chihiro , Rikitake Mao , Iwao Kosho , Aizawa Ayako , Kariya Yumi , Matsuda Motohiro , Miyauchi Syunichi , Umekita Kunihiko , Takajo Ichiro , Okayama Akihiko
Published: October 2018

Rationale:

Kawasaki disease (KD) is an acute febrile illness predominantly affecting children less than 5 years of age and characterized by systemic inflammation in all medium-sized arteries. Adult-onset KD (AKD) is rare with only 105 case reports published. Recently, the efficacy of infliximab (IFX) for patients with refractory KD has been demonstrated.

Patient concerns:

A previously healthy 24-year-old man was admitted because of a persistent fever, and elevated serum level of AST, ALT, LDH, and CRP.

Diagnosis:

The patients met the diagnostic criteria for KD based on the findings of persistent fever, polymorphous exanthema, unilateral cervical lymphadenopathy, non-purulent palpebral conjunctivitis and membranous desquamation. Echocardiogram revealed the dilatation at the proximal sites of the right coronary artery (7.9 mm) and left anterior descending artery (5 mm). The patient was treated with high-dose intravenous immunoglobulin (1 g/kg/day for 2 days) and ASA (100 mg daily). However, his fever and arthralgia persisted.

Interventions:

He was administered single 5 mg/kg doses of IFX.

Outcomes:

He became afebrile the next day and his arthralgia improved.

Lessons:

We report the first case of administration of IFX in a patient with AKD refractory to intravenous immunoglobulin (IVIG), and successful reduction of systemic inflammation. However, the effectiveness of IFX in the regression of coronary artery aneurysm remains to be determined.
A low abundance of Bifidobacterium but not Lactobacillius in the feces of Chinese children with wheezing diseases
Authors: Liwen Zhang , Yu Wan , Liang Ma , Kaihong Xu , Baojin Cheng
Published: October 2018

Background:

The intestinal microbiota is linked with allergic reaction diseases. However, the difference in the fecal microbiota composition between sensitized wheezy and nonsensitized subjects in Chinese children remains unknown. The aim of this study was to quantitate the amounts of fecal microbiota in wheezy children, and to explore the correlation between fecal microbiota and serum Th1/Th2/Th17-type cytokines and total IgE in these patients.

Methods:

The amounts of Bifidobacterium and Lactobacillus were determined using a 16S-RNA real-time polymerase chain reaction (PCR) method in wheezy children (cases) and nonwheezy controls. Serum Th1/Th2/Th17-type cytokines levels were measured using flow a cytometric bead array assay. In addition, the concentrations of total serum IgE was also determined.

Results:

In comparison with that in the healthy control (HC), significantly lower abundance of Bifidobacterium and lower levels of Th1 cytokines (IFN-γ and TNF-α), but higher levels of Th2-type cytokines (IL-4, IL-5) and Th17-type (IL-17A) cytokine were detected in children with bronchiolitis and asthma. But there was no significant difference in the amounts of Lactobacillus. Interestingly, the amounts of fecal Bifidobacterium were correlated positively with serum Th1 cytokines IFN-γ, and correlated negatively with serum Th17 cytokines IL-17A, Th2 cytokines IL-4 and serum total IgE in these patients.

Conclusions:

Our findings demonstrated that lower quantity of Bifidobacterium, but not Lactobacillus, may be correlated with asthma and bronchiolitis in chinese children. These results also may provide guidance in choosing the proper probiotics for wheezing children.
Free Thyroxine Determination in the Emergency Department Is a Predictor of Acute Pancreatitis Evolution
Authors: Callejón Gonzalo , Redondo Emilia , Garcia-Aranda Marilina , Castilla-Alcalá José Antonio , Prados-Torres Alexandra , Redondo Maximino
Published: October 2018

Objective

The aim of this study was to determine the prevalence and type of thyroid hormone levels alterations in patients with acute pancreatitis (AP) and analyze if variations are useful AP progression predictors.

Methods

Three groups of patients were analyzed: AP patients (n = 90), abdominal pain patients (n = 30), and healthy control subjects (n = 40). Usual blood parameters for AP diagnosis and prognosis, thyroid-stimulating hormone (or thyrotropin), FT4 (free thyroxine), FT3 (free triiodothyronine), and TT3 (total triiodothyronine) levels were analyzed.

Results

Thyroid hormone level alterations were detected only within the AP group (41% of total cases), being the reduction in T3 levels the most frequently detected deviation (15.6% of FT3 and 8.3% of TT3 cases). Alterations were not influenced by age or sex. Free thyroxine average values were also significantly higher in the AP group, compared with the healthy control group (P = 0.0005), resulting as independent predictors of both severity and mortality. Mortality in this group was 50%, with deceased patients showing FT4 levels above the reference limit.

Conclusions

Our results show that FT4 level determination during the initial clinical evaluation of patients admitted to the emergency service with AP can be included as a severity indicator to help determine the differential care of these cases.
Noninvasive neuromodulation techniques for the management of phantom limb pain: a systematic review of randomized controlled trials
Authors: Akyuz Gulseren , Giray Esra
Published: October 2018

Neuromodulation techniques work by modulating pain perception by inducing changes in polarity of the neuronal membrane and thereby cortical excitability. The aim of this review is to evaluate the efficiency and safety of noninvasive neuromodulation techniques for phantom limb pain (PLP). A systematic literature search in the PubMed, Scopus, Web of Science, and Cochrane Library databases was performed to identify studies investigating the effects of noninvasive neuromodulation for PLP. The included journal articles were assessed with Furlan et al.’s method for examining the risk of bias to assess methodologic quality, and evidence was graded using the GRADE approach. The literature search identified 239 studies. Of these 239, four studies fulfilled the inclusion criteria and were included for data extraction. Two of the studies focused on repetitive transcranial magnetic stimulation (rTMS) whereas two other concentrated on transcranial direct current stimulation (tDCS). The present review showed that there is conflicting evidence to support the use of tDCS in short term and moderate evidence to support the use of rTMS in immediate and short term. It is important to recognize that this evidence comes from a very small sample size. No serious adverse effects were reported. Further information from randomized controlled trials with larger sample size investigating immediate and short-term and long-term effects are needed to clarify the best effective stimulation parameters and number of sessions of tDCS and rTMS for PLP.
The Relationship Between Life Purpose With Depression and Disability in Acute Low Back Pain Patients
Authors: Salt Elizabeth , Wiggins Amanda C. , Rayens Mary Kay , Johnson Rachele , Hardy Jaime K. , Segerstrom Suzanne , Crofford Leslie J.
Published: October 2018

BACKGROUND:

Life purpose in acute low back pain patients is not well described in published literature.

METHODS/PURPOSE:

We used linear regression models to describe the relationship of life purpose with perceived functional disability and depression in persons with acute low back pain (N = 42) participating in a randomized clinical trial to prevent transition to chronic low back pain.

RESULTS:

In our predominantly female sample (81.8%) with a mean age of 53 years (SD = 11.6 years), 52% worked full-time. Adjusting for age, gender, and working status, life purpose was a significant correlate of depression (p = .007). For every 10-unit increase in life purpose score, the estimated depression score decreased by almost 2.5 points. A significant relationship between life purpose and perceived functional disability was not identified.

CONCLUSION:

Life purpose likely is a modifiable risk factor for depression in acute low back pain patients.
A Randomized Double-blind Placebo-Controlled Trial on the Effect of Local Analgesia on Postoperative Gluteal Pain in Patients Undergoing Sacrospinous Ligament Colpopexy
Authors: Ferrando Cecile A. , Walters Mark D.
Published: October 2018

(Abstracted from Am J Obstet Gynecol 2018;218:599.e1–599.e8)

Sacrospinous ligament (SSL) colpopexy is widely used for the treatment of vaginal apex prolapse. The procedure has a subjective success rate of 84% to 99% and an objective success rate of 67% to 93%.
A Time-and-Motion Study of Clinical Trial Eligibility Screening in a Pediatric Emergency Department
Authors: Dexheimer Judith W. , Tang Huaxiu , Kachelmeyer Andrea , Hounchell Melanie , Kennebeck Stephanie , Solti Imre , Ni Yizhao
Published: October 2018

Objective

Challenges with efficient patient recruitment including sociotechnical barriers for clinical trials are major barriers to the timely and efficacious conduct of translational studies. We conducted a time-and-motion study to investigate the workflow of clinical trial enrollment in a pediatric emergency department.

Methods

We observed clinical research coordinators during 3 clinically staffed shifts. One clinical research coordinator was shadowed at a time. Tasks were marked in 30-second intervals and annotated to include patient screening, patient contact, performing procedures, and physician contact. Statistical analysis was conducted on the patient enrollment activities.

Results

We conducted fifteen 120-minute observations from December 12, 2013, to January 3, 2014 and shadowed 8 clinical research coordinators. Patient screening took 31.62% of their time, patient contact took 18.67%, performing procedures took 17.6%, physician contact was 1%, and other activities took 31.0%.

Conclusions

Screening patients for eligibility constituted the most time. Automated screening methods could help reduce this time. The findings suggest improvement areas in recruitment planning to increase the efficiency of clinical trial enrollment.
Missed Diagnosis of Anaphylaxis in Patients With Pediatric Urticaria in the Emergency Department
Authors: Jung Woo Sung , Kim Sun Hyu , Lee Hyeji
Published: October 2018

Objectives

This study was to determine the characteristics of missed diagnosis of pediatric anaphylaxis that were registered as urticaria only at the emergency department (ED) by comparing those who had only urticaria symptoms with those who had both anaphylaxis and urticaria symptoms.

Methods

Subjects were classified into missed anaphylaxis and urticaria group according to whether satisfied anaphylaxis diagnostic criteria or not. Anaphylaxis group, those who were initially registered as anaphylaxis with urticaria and anaphylaxis symptoms simultaneously, were further investigated.

Results

The missed anaphylaxis group included 37 patients of 1051 pediatric urticaria patients. The anaphylaxis group included 11 patients. The time from symptom onset to ED arrival in the missed anaphylaxis group was shorter than the urticaria group. More patients in the missed anaphylaxis group had a history of past food allergy. Seafood, egg, and milk were more common causes of allergy in the missed anaphylaxis group; however, idiopathic causes were more common in the urticaria group. Symptom was more severe in the missed anaphylaxis group than the urticaria group. More treatments except antihistamine were performed at ED in the missed anaphylaxis group. Cardiovascular symptoms were more common in the anaphylaxis group than the missed anaphylaxis group.

Conclusions

Of all pediatric urticaria patients, 3.5% of patients were not registered as anaphylaxis although they had anaphylaxis symptoms. Missed diagnosis of anaphylaxis in pediatric urticaria patients at ED was associated with a history of past food allergy, milk, egg, and seafood as causes of allergy, treated with fluid administration, steroid, and epinephrine.