bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery
Authors: Coble Janette , Steurer Lisa M. , Balakas Karen , Ercole Patrick M.
Published: November 2019

BACKGROUND

A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain control. Multiple methods to address pain post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain control.

METHODS

A retrospective cohort design was used to compare pain medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain. Descriptive and univariate statistics were used to detect differences.

RESULTS

The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain between the 2 groups (P = .661).

DISCUSSION

Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.
Testing Feasibility of a Mobile Application to Monitor Fatigue in People With Multiple Sclerosis
Authors: Newland Pamela , Oliver Brant , Newland John M. , Thomas Florian P.
Published: November 2019

BACKGROUND

Fatigue is a significant and burdensome symptom for patients with multiple sclerosis and is associated with other symptoms, signs, and decreased quality of life.

METHODS

A prospective pilot study was conducted with a convenience sample (n = 34) of patients with relapsing-remitting multiple sclerosis using a phone application, FatigueApp.com, to collect data on patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS]).

RESULTS

FatigueApp feasibility was good, with the ability to collect data on self-reported fatigue and other symptoms using PROMIS measures.

CONCLUSIONS

This study showed that using a phone application with PROMIS may be useful in the future to provide estimates of fatigue and other variables to facilitate clinical monitoring of fatigue for neurology clinic settings.
Effect of a Clinical Case-Study Course on Physician Assistant and Pharmacy Students' Interprofessional Care Competencies
Authors: Mazur Ziemowit , Hanes Scott D. , Kern Daniel
Published: November 2019

Purpose

To examine how the implementation of a year-long interprofessional clinical case course for pharmacy and physician assistant (PA) students affects student self-reported interprofessional collaboration-related competencies in 6 skill areas (communication, collaboration, roles and responsibilities, collaborative patient/family-centered approach, conflict management/resolution, and team functioning) and whether outcomes differed between the 2 professions.

Methods

Pharmacy and PA students completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) at the beginning and end of a year-long interprofessional, team-based clinical case course. Survey results were compared using a mixed-design analysis of variance model to determine the effect the course had on students' self-reported competencies of interprofessional care and whether the outcomes differed between student groups.

Results

One-hundred fifteen students completed both the presurvey and postsurvey. Significant improvement in student self-reported team-based behaviors were noted in 11 of the 20 ICCAS items, and results were similar among student groups.

Conclusion

This study demonstrates that an interactive, interprofessional clinical case course can positively change student self-reported team-based behaviors.
Pediatric Management of Recurrent Patellar Instability
Authors: Schlichte Lindsay M. , Sidharthan Sreetha , Green Daniel W. , Parikh Shital N.
Published: November 2019

Patellofemoral instability is a common orthopedic condition in children and adolescents, with recurrent instability often requiring surgical intervention. Age, bilateral instability, and various anatomic features such as trochlear dysplasia, patella alta, increased tibial tubercle to trochlear groove distance, and patellar tilt have all been described as risk factors for recurrent patellar instability. Medial patellofemoral ligament reconstruction has become the mainstay of treatment for addressing recurrent patellar instability in skeletally immature patients. For some patients, additional interventions such as distal realignment and guided growth procedures may be required to address anatomic pathology. This article discusses various risk factors associated with patellofemoral instability, reconstruction techniques, and a case example.
When to Add Lateral Soft Tissue Balancing?
Authors: Hinckel Betina B. , Yanke Adam B. , Lattermann Christian
Published: November 2019

Lateral patellofemoral (PF) soft tissue abnormalities range from excessive lateral PF tightness (lateral patellar compression syndrome, lateral patellar instability and arthritis), to excessive laxity (iatrogenic lateral PF soft tissue insufficiency postlateral release). The lateral soft tissue complex is composed of the iliotibial band extension to the patella, the vastus lateralis tendon, the lateral PF ligament, lateral patellotibial ligament, and lateral patellomeniscal ligament, with intimate connections between those structures. To identify lateral retinaculum tightness or insufficiency the most important tests are the patellar glide test and patellar tilt test. Imaging aids in that evaluation relying mostly on the patella position assessed by radiographs, computed tomography, and magnetic resonance imaging with referencing to the posterior femoral condyles. Lateral retinaculum lengthening (preferred) or release may be added when there is excessive lateral retinaculum tightness. A lengthening may be performed using a minimally invasive approach without compromising the lateral patella restraint. Lateral retinaculum repair or reconstruction is indicated when there is lateral retinaculum insufficiency. Lateral retinaculum surgery to balance the medial/lateral soft tissue restraints, improves patellar positioning and clinical results.
Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Case Report
Authors: Finnoff Jonathan T. , Johnson Wade
Published: November 2019

Chronic exertional compartment syndrome (CECS) is characterized by an excessive increase in intracompartmental muscle pressures after exercise. Athletes with CECS report pain, pressure, and occasionally neurologic symptoms in the affected compartment during exercise that abates with rest. Although many treatment options have been proposed, athletes often require a fasciotomy to return to unrestricted sports participation. Surgical success rates vary; complications are not uncommon; and after surgery, it usually takes athletes 6 or more weeks to return to unrestricted impact activities. This case report describes a new ultrasound-guided fasciotomy technique for the treatment of anterior leg compartment CECS. The procedure required a 3 mm incision, was performed in the office under local anesthesia, and allowed the athlete to resume running within 1 week of the procedure. Although the preliminary results of this study are promising, further translational research is required before the widespread adoption of this procedure is recommended.
Predictors of Distant Metastasis and Survival in Adenoid Cystic Carcinoma of the External Auditory Canal
Authors: Zhang Yibo , Liu Hongyan , Wu Qianru , Wang Shuyi , Dai Chunfu
Published: November 2019

Objective:

To analyze the predictors of both distant metastasis and survival in patients with adenoid cystic carcinoma of the external auditory canal.

Study Design:

Retrospective patient review.

Setting:

A single university hospital.

Patients:

Eighty-two cases with adenoid cystic carcinoma of the external auditory canal were referred to our institution between 2004 and 2016.

Main Outcome Measures:

Distant metastasis was detected by lung computed tomography, proton emission tomography computed tomography, or histopathologic examination of tissue samples. Distant metastasis predictors were analyzed using Student's t tests and χ2 tests. The log-rank tests of Kaplan–Meier survival curves were used to evaluate survival differences.

Results:

During a median follow-up of 36 months (range, 6–162 mo), distant metastasis developed in 25 patients. The occurrence of distant metastasis was significantly associated with histopathologic subtype, T classification, and local recurrence (p < 0.05). The 1-, 10-, 20-, and 25-year cumulative survival rates in the patents with DM were 95.7, 95.7, 71.7, and 0%, respectively, and all survival rates were 100% for the 57 patients without distant metastasis (p = 0.115). Median survival time after occurrence of distant metastasis was 13 months (range, 1–120 mo). Prognosis was better with solely lung metastasis than with metastases to other visceral organs or bone (p < 0.05).

Conclusions:

Distant metastasis appeared to result in a poorer prognosis, occurrence of distant metastasis was significantly associated with local recurrence, extensive surgery is recommended to achieve local control and reduce distant metastasis risk. Routine follow-up investigations for detecting distant metastasis are warranted for patients with an increased risk for distant metastasis.
A Case Series of Patients With Concurrent Otosclerosis and Superior Semicircular Canal Dehiscence
Authors: Dewyer Nicholas A. , Quesnel Alicia M. , Santos Felipe
Published: November 2019

Objective:

To describe the presentations and treatment results for patients with concurrent otosclerosis and superior semicircular canal dehiscence (SCD).

Study Design:

Retrospective case series and literature review.

Setting:

Tertiary academic medical center.

Patients:

Patients with concurrent diagnoses of otosclerosis (radiographically and/or surgically confirmed) and SCD (radiographically confirmed) in the same ear.

Intervention(s):

Review of medical records.

Main Outcome Measure(s):

Clinical presentations, outcomes following stapedotomy.

Results:

Eight patients with 10 affected ears were identified. All patients presented with slowly progressive conductive hearing loss, normal otoscopy, absent acoustic reflexes, and without other symptoms of SCD syndrome. Seven patients were treated with stapedotomy and 1 with hearing aids. Of those treated with stapedotomy, a persistent conductive hearing loss was the most common hearing result. One patient had near-complete closure of their air bone gap. None had a profound sensorineural hearing loss. Four patients had unmasking of SCD symptoms.

Conclusions:

The clinical and audiometric presentations of patients with concurrent otosclerosis and SCD are often indistinguishable from those of patients with only otosclerosis. Computed tomography of the temporal bone is the only way to identify concurrent SCD. Stapedotomy in these patients typically results in a persistent conductive hearing loss, though 14 to 33% of patients experience near-complete closure of their air bone gap. SCD symptoms are unmasked in 57 to 63% of patients who undergo stapedotomy. Further work is needed to delineate the utility of routine preoperative computed tomography scan in otosclerosis patients, and to identify prognostic factors for patients with concurrent otosclerosis and SCD who wish to undergo stapedotomy.
Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Versus Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Treatment of Gastric Varices Because of Portal Hypertension
Authors: Paleti Swathi , Nutalapati Venkat , Fathallah Jihan , Jeepalyam Sravan , Rustagi Tarun
Published: November 2019

Background:

Although gastric variceal (GV) bleeding is less common than esophageal variceal bleeding, the severity of GV bleeding is often greater with higher morbidity and mortality rates. Minimally invasive endovascular treatments such as balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) have been used for the management of GVs with varying results, and individual and institutional differences exist in the use of BRTO and TIPS. We performed a systematic review and meta-analysis to compare the feasibility, efficacy, and safety of BRTO and TIPS for the treatment of GVs because of portal hypertension.

Methods:

Searches of PubMed, EMBASE, Google Scholar, and Cochrane Library databases were performed from inception through March 2019. Summary odds ratio (OR) with 95% confidence intervals (CI) was estimated for technical success, hemostasis rate, postprocedural complications, rebleeding rate, incidence of hepatic encephalopathy, and mortality rate at 1 year utilizing a random-effects model.

Results:

Seven studies with a total of 676 patients (BRTO: 462 and TIPS: 214) were included. There was no difference in pooled technical success rate (OR, 0.87; 95% CI, 0.28-2.73; P=0.81), hemostasis rate (OR, 2.74; 95% CI, 0.61-12.26; P=0.19), and postoperative procedure-related complications (OR, 1.95; 95% CI, 0.44-8.72; P=0.38). However, treatment with BRTO was associated with lower rates of postoperative rebleeding (OR, 0.30; 95% CI, 0.18-0.48; P<0.00001), postoperative encephalopathy (OR, 0.06; 95% CI, 0.02-0.15; P < 0.00001), and mortality at 1 year (OR, 0.43; 95% CI, 0.21-0.87; P=0.02).

Conclusions:

BRTO was associated with lower rates of rebleeding, postprocedure hepatic encephalopathy, and mortality at 1 year. BRTO should be considered first-line modality for the treatment of GVs because of portal hypertension.
Prevalence and determinants of HIV shedding in breast milk during continued breastfeeding among Zambian mothers not on antiretroviral treatment (ART)
Authors: Rutagwera David Gatsinzi , Molès Jean-Pierre , Kankasa Chipepo , Mwiya Mwiya , Tuaillon Edouard , Peries Marianne , Nagot Nicolas , Van de Perre Philippe , Tylleskär Thorkild
Published: November 2019

The risk of postnatal HIV transmission exists throughout the breastfeeding period. HIV shedding in breast milk beyond six months has not been studied extensively. The aim of this study was to determine prevalence and determinants of HIV shedding in breast milk during continued breastfeeding

A cross-sectional study was nested in the PROMISE-PEP trial in Lusaka, Zambia to analyze breast milk samples collected from both breasts at week 38 post-partum (mid-way during continued breastfeeding). We measured concurrent HIV deoxyribonucleic acid (DNA) and HIV ribonucleic acid (RNA) as proxies for cell-associated HIV (CAV) and cell-free HIV (CFV) shedding in breast milk respectively. Participants’ socio-demographic date, concurrent blood test results, sub clinical mastitis test results and contraceptive use data were available. Logistic regression models were used to identify determinants of HIV shedding in breast milk (detecting either CAV or CFV).

The prevalence of HIV shedding in breast milk at 9 months post-partum was 79.4% (95%CI: 74.0 – 84.0). CAV only, CFV only and both CAV and CFV were detectable in 13.7%, 17.3% and 48.4% mothers, respectively. The odds of shedding HIV in breast milk decreased significantly with current use of combined oral contraceptives (AOR: 0.37; 95%CI: 0.17 – 0.83) and increased significantly with low CD4 count (AOR: 3.47; 95%CI: 1.23 – 9.80), unsuppressed plasma viral load (AOR: 6.27; 95%CI: 2.47 – 15.96) and severe sub-clinical mastitis (AOR: 12.56; 95%CI: 2.48 – 63.58).

This study estimated that about 80% of HIV infected mothers not on ART shed HIV in breast milk during continued breastfeeding. Major factors driving this shedding were low CD4 count, unsuppressed plasma viral load and severe sub-clinical mastitis. The inverse relationship between breast milk HIV and use of combined oral contraceptives needs further clarification. Continued shedding of CAV may contribute to residual postnatal transmission of HIV in mothers on successful ART.
Dose-escalation of oxaliplatin in hemodialysis patient treated with FOLFOX therapy
Authors: Wang Danping , Li Xiaofei , Xu Lingyan , Fang Wentong , Cai Xiaomin , Wang Ying , Wang Jiawei , Wang Yuanyuan , Zhao Fengjiao , Gu Yanhong
Published: November 2019

Rationale:

Oxaliplatin is a key part of the standard treatment for colorectal cancer which is formally contraindicated in patients with severe renal dysfunction. Here, we investigated a safe and efficient dosing schedule of oxaliplatin in folinic acid, fluorouracil, and oxaliplatin (FOLFOX) regimen by monitoring total and free platinum concentrations in plasma.

Patient concerns:

A 47-year-old female with chronic hemodialysis was diagnosed with left-sided colon cancer and underwent colectomy. One year later, she was presented with omentum metastasis and needed further treatment.

Diagnoses:

The computed tomography (CT) scanning revealed multiple omental nodules. Positron emission tomography-CT (PET-CT) showed increased uptake of the nodules.

Interventions:

The patient was treated with FOLFOX therapy every 3 weeks. The oxaliplatin began with 50 mg/m2 and gradually increased 85 mg/m2 as in the standard regimen. A 4-hour dialysis was started 1 hour after the end of oxaliplatin infusion.

Outcomes:

The free platinum concentration time curve showed a biomodel pattern. The C
max of the 1st peak we observed in our patients at the standard dose is comparable to patients with normal renal function. This patient was treated with FOLFOX for 12 courses. No apparent adverse effect was observed during the treatment.

Lessons:

The FOLFOX can be safely administered in hemodialysis patients on a long-term basis. Dose reduction of oxaliplatin is not necessarily needed if hemodialysis is performed soon after the infusion. Further studies are needed to distinguish between active and inactive oxaliplatin products during the 2nd peak of the free platinum concentration curve in this population.
Cardiac malignant peripheral nerve sheath tumor on computed tomography and magnetic resonance imaging
Authors: Li Shuang , Qiu Yue , Yu Jianqun , Liang Chunxiao , Peng Liqing
Published: November 2019

Rationale:

Malignant peripheral nerve sheath tumor (MPNST) is a very rare sarcoma of the heart, and few cases have been reported. Herein, we retrospectively reviewed clinical manifestations, imaging features and management of our patient and other reported cases.

Patient concerns:

A 32-year-old woman was referred to the emergency department of our institution with expiratory dyspnea, edema of face for a month.

Diagnosis:

The patient was initially diagnosed with asthma at a local hospital based on a history of fatigue, cough and expiratory dyspnea, as well as negative electroencephalogram (ECG) and chest radiography. Based on computed tomography (CT) and cardiac magnetic resonance imaging (CMRI) in our hospital, she was found to have a malignant tumor involving right atrium. The tumor was diagnosed as MPNST according to histopathological results.

Interventions:

The tumor was deemed unresectable during the surgery. Then, the patient was referred for chemotherapy and radiotherapy.

Outcomes:

The patient deteriorated and died 4 months later.

Lessons:

Cardiac MPNST is very uncommon with nonspecific clinical and imaging characteristics according to limited cased reported. CMR, due to the high tissue resolution and multiple sequence imaging advantages, is useful for the detection, location and evaluation whether there is involvement of adjacent structures, and may help better clinical decision-making.
Association between polymorphisms in microRNAs and susceptibility to diabetes mellitus
Authors: Chen Xi , Wang Wenjing , Li Ruien , Yu Jing , Gao Lei
Published: November 2019

Background:

Accumulated evidence has indicated the associations between single-nucleotide polymorphisms (SNPs) in microRNAs (miRNAs) and the susceptibility to diabetes mellitus (DM), but the conclusions remain controversial. This study was to investigate the true contribution of miRNA SNPs to the risk of DM by using a meta-analysis of all the published studies.

Methods:

Relevant studies were identified in the databases of PubMed and the Cochrane Library databases. The strength of associations between miRNA polymorphisms and DM risk was assessed by odds ratios (ORs) and 95% confidence intervals (95% CIs) under five genetic models using the STATA software.

Results:

Six studies, containing 2773 cases and 2632 controls, were enrolled, 5 of which evaluated miR-146a (rs2910164), 4 for miR-27a (rs895819), and 3 for miR-124 (rs531564) and 2 for miR-375 (rs6715345), miR-128a (rs11888095), miR-194a (rs3820455). The meta-analysis indicated that the G allele or GG genotype of miR-146a rs2910164 was associated with a significantly increased risk for DM compared with C allele or GC/CC genotype in Latin American population; CC genotype of miR-27a rs895819 polymorphism was associated with a significantly decreased risk for DM in Asian population compared with the TT genotype; patients carrying with CC genotype of miR-124 rs531564 had a lower probability to develop DM regardless of ethnicity; no associations were identified between polymorphisms in miR-375, miR-128a, miR-194a and the susceptibility to DM.

Conclusion:

Our study suggests that miR-146a/miR-27a and miR-124 polymorphisms may be ethnicity-dependent or -independent susceptibility factors to DM, respectively.
A case report of hereditary hemochromatosis caused by mutation of SLC40A1 gene
Authors: Yin Xin , Zhang Yu , Gao Hui , Jin Qing-long , Wen Xiao-yu
Published: November 2019

Rationale:

Hereditary hemochromatosis (HH) is a frequent autosomal recessive disease. The pathogenesis of disease is excessive intestinal absorption of dietary iron, resulting in pathologically high iron storage in tissues and organs. As a systemic disease, it has several manifestations including cirrhosis, diabetes mellitus, cardiomyopathy, joint disease. However, a proportion of patients are asymptomatic.

Patient concerns:

A 34-year-old man who had abnormal liver function for 9 months without specific symptoms. He underwent various tests, including liver biopsy and genetic testing, which eventually ruled out common liver diseases and identified iron metabolic abnormalities. In addition, we confirmed the pathogenic genes by sequencing the genes of him and his families.

Diagnosis:

Combined with the symptoms, auxiliary examinations and sequencing results, the patient was diagnosed as HH.

Interventions:

The patient was given a low iron diet and phlebotomy therapy interval 2 weeks until the ferritin is <100 mg/L.

Outcomes:

The patient’ condition is stable during the follow-up period.

Lessons:

When clinicians are confronted with unexplained liver dysfunction, the possibility of the HH should be considered. Liver biopsy and gene sequencing are helpful in diagnosis. Phlebotomy treatment is the most economical and practical treatment for HH at present, but it should vary from person to person.
Acupuncture therapy for persistent and intractable hiccups
Authors: Yang Han , Zhang Rufei , Zhou Jun , Cheng Ying , Li Juan , Xiao Qiwei , Yin Zihan , Xu Guixing , Zhao Ling , Liang Fanrong
Published: November 2019

Background:

Persistent and intractable hiccups bring serious inconvenience to patients’ work and daily life, and impair their quality of life. Relevant studies showed that acupuncture therapy might be effective in treating persistent and intractable hiccups. However, there is no consistent conclusion so far. The aim of our research is to investigate the safeties and effectiveness of acupuncture in treating patients with persistent and intractable hiccups.

Methods:

We will search randomized controlled trials (RCTs) using acupuncture therapy to treat persistent and intractable hiccups in the following 6 English electronic databases and 3 Chinese electronic databases: MEDLINE, EMBASE, the Cochrane Library, Web of Science, PsycINFO, Allied and Alternative Medicine (AMED), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) and Wanfang data. The cure rate and the total effective rate will be considered as the primary outcomes. Complete cessation within a given period post-treatment of hiccups, changes in frequency or intensity of hiccups, concomitant symptom score, and adverse events will be considered as secondary outcomes. We will use Endnote software 9.1 for studies selection, Review Manager software 5.3, and STATA 13.0 software for analysis and synthesis.

Results:

we will synthesize current studies to evaluate the the safeties and effectiveness of acupuncture for persistent and intractable hiccups.

Conclusion:

Our study will provide evidence of acupuncture therapy for persistent and intractable hiccups.
Epiduroscopic decompression of a symptomatic perineural cyst
Authors: Jeong Sangmin , Nahm Francis Sahngun , Lee Jae-Sung , Han Woong Ki , Choi Eunjoo , Lee Pyung-Bok , Lee Ho-Jin
Published: November 2019

Rationale:

Perineural cysts in the spinal canal are usually asymptomatic. However, symptoms can occur when the cyst becomes large enough to compress a nerve root. There are still no established treatment options for this disease. In this report, we describe a case of successful decompression of the large symptomatic perineural cyst using epiduroscope.

Patient concerns:

A 42-year-old male patient visited our pain center complaining of discomfort and pain in his right posterior thigh. Magnetic resonance imaging of the patient showed a large perineural cyst (53 × 31 × 21 mm) compressing the right S1 nerve. No other abnormalities that would explain the patient's symptoms were identified.

Diagnosis:

Perineural cyst at the right S1 nerve.

Interventions:

We performed an epiduroscopic decompression of the perineural cyst. After advancing the epiduroscope and locating the cyst, we used the laser to make a hole in the cyst wall. Then, the epiduroscope was advanced into the cyst, and the cystic fluid was aspirated.

Outcomes:

The symptoms of the patient were relieved after the procedure, without any complications. There was no recurrence of symptoms until 6 months after the procedure.

Lessons:

The epiduroscope is a minimally invasive method which can be used safely for decompression of symptomatic perineural cysts in the spinal canal.
Evaluation of retinal function improvement in neovascular age-related macular degeneration after intravitreal aflibercept injections with the use of the assessment of retinal sensitivity
Authors: Michalska-Małecka Katarzyna , Kałużny Jakub , Nowak Mariusz , Gościniewicz Poitr , Matysik-Woźniak Anna , Nowomiejska Katarzyna , Karpe Jacek , Rejdak Robert
Published: November 2019

This study compares 2 methods of macular function evaluation: the microperimetric examination (mean central retinal sensitivity and fixation stability) and the distance best-corrected visual acuity (BCVA) examination, which is the most frequently used method of assessing macular function in patients with newly diagnosed wet age-related macular degeneration (AMD) who have been treated with anti-vascular endothelial growth factor (VEGF) drug (aflibercept).

Prospective analysis was conducted on 44 eyes of 44 patients treated with intravitreal injection of anti-VEGF (aflibercept) because of newly diagnosed neovascular AMD. According to the research protocol, all patients had a 6-month follow-up. The response to treatment was monitored functionallybyMP-1 microperimetry, fixation, and distance BCVA assessment after injection. Improvement of retinal sensitivity and BCVA was found under aflibercept treatment. There was statistically significant improvement in retinal sensitivity in the MP-1 study 3 and 6 months from the beginning of anti-VEGF therapy. Moreover, a significant improvement in retinal sensitivity between 3 and 6 months of observation was demonstrated. At the same time, up to 3 months from the beginning of treatment, BCVA improved significantly compared to the baseline value. In the 6th month of the study BCVA remained stable without further significant improvement.

Microperimetric examination with medium sensitivity and fixation stability assessment is a very valuable test determining the retinal function. It is clear that examining the macular morphology itself in modern diagnostics is not enough to assess retinal function. Microperimetry technique is a valuable tool for functional long-term evaluation of retinal function (also for a period of more than 3 months).
Differential predictive factors for cardiovascular events in patients with or without cancer history
Authors: Sueta Daisuke , Tabata Noriaki , Ikeda Satoshi , Saito Yuichi , Ozaki Kazuyuki , Sakata Kenji , Matsumura Takeshi , Yamamoto-Ibusuki Mutsuko , Murakami Yoji , Jodai Takayuki , Fukushima Satoshi , Yoshida Naoya , Kamba Tomomi , Araki Eiichi , Iwase Hirotaka , Fujii Kazuhiko , Ihn Hironobu , Kobayashi Yoshio , Minamino Tohru , Yamagishi Masakazu , Maemura Koji , Baba Hideo , Matsui Kunihiko , Tsujita Kenichi
Published: November 2019

Although attention has been paid to the relationship between malignant diseases and cardiovascular diseases, few data have been reported. Moreover, there have also been few reports in which the preventive factors were examined in patients with or without malignant disease histories requiring percutaneous coronary intervention (PCI).

This was a retrospective, single-center, observational study. A total of 1003 post-PCI patients were divided into a malignant group, with current or past malignant disease, and a nonmalignant group. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, stroke, revascularization, and admission due to heart failure within 5 years of PCI. Kaplan–Meier analysis showed a significantly higher probability of the primary endpoint in the malignant group (P = .002). Multivariable Cox hazard analyses showed that in patients without a history of malignant, body mass index (BMI) and the presence of dyslipidemia were independent and significant negative predictors of the primary endpoint (BMI: hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.53–0.99, P = .041; prevalence of dyslipidemia: HR 0.72, 95% CI 0.52–0.99, P = .048), and the presence of multi-vessel disease (MVD) and the prevalence of peripheral artery disease (PAD) were independent and significant positive predictors of the primary endpoint (prevalence of MVD: HR 1.68, 95% CI 1.18–2.40, P = .004; prevalence of PAD: HR 1.51, 95% CI 1.03–2.21, P = .034). In patients with histories of malignancy, no significant independent predictive factors were identified.

Patients undergoing PCI with malignancy had significantly higher rates of adverse cardiovascular events but might not have the conventional prognostic factors.
The association of serum uric acid levels in psoriasis patients
Authors: Yuan Yuan , Liu Ming , Liu WenHong , Du Hua
Published: November 2019

Background:

Current research has proved that psoriasis is associated with serum uric acid (SUAC) levels. Our purpose is to clarify SUAC levels and the incidence of hyperuricemia in psoriasis patients, and to compare SUCA levels in different groups’ psoriasis patients.

Methods:

We plan to search 7 electronic bibliographic databases (PubMed, Embase, Cochrane, and 4 Chinese databases) from inception to August 2019. Literatures selection and data collection will be performed independently by 2 authors. The Newcastle–Ottawa scale will be used to assess the methodologic quality and bias of included studies. Firstly, standard pairwise meta-analysis will be used to examine the considered data synthesis. Secondly, if the identified studies appear sufficiently similar within and across the different comparisons between different groups of psoriasis patients, we will estimate SUAC levels using network meta-analysis in different age and ethnicity psoriasis patients. Mean difference, risk ratio, and 95% confidence intervals will be used to assess the SUAC levels and the incidence of hyperuricemia in psoriasis patients. The software of Stata and WinBUGS will be used to calculations.

Results:

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

Conclusion:

Our study will compare SUCA levels in different groups’ psoriasis patients through network meta-analysis, and we believe our job is very meaningful.

Ethics and dissemination:

Our study is a secondary study of the existing literature. So, ethical and dissemination approval is not required.
Nodules with nonspecific ultrasound pattern according to the 2015 American Thyroid Association malignancy risk stratification system
Authors: Xiang Pingping , Chu Xiaoqiu , Chen Guofang , Liu Binbin , Ding Wenbo , Zeng Zheng , Wu Xinping , Wang Jianhua , Xu Shuhang , Liu Chao
Published: November 2019

New sonographic patterns have been recommended by the 2015 American Thyroid Association (ATA) to stratify nodules in terms of malignancy risk and help guide biopsy decision. This study aimed to compare the ultrasound part of the ATA guidelines and the Thyroid Imaging Reporting and Data System (TIRADS-Na).

In 2013 to 2016, 708 thyroid nodules in 505 patients were confirmed by postoperative histopathology. Hypoechogenicity, solidity, microcalcification, irregular margin, and a taller-than-wide shape were considered features suggesting malignancy. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were obtained for the TIRADS and ATA guidelines.

Of the 708 nodules, 341(48.2%) and 367(51.8%) were benign and malignant, respectively. Based on the ultrasound 2015 ATA guidelines, 62 nodules had nonspecific pattern (both malignant and benign features); malignancy rates of nodules with very low, low, intermediate, and high suspicion, and nonspecific pattern were 0, 17.7%, 57.9%, 90.0%, and 69.4%, respectively (P < .001). Malignancy rates of categories 2/3/4/5 nodules by TIRADS were 0, 8.1%, 67.0%, and 90.1%, respectively (P < .001). Based on pathological results, the AUC, sensitivity, specificity, NPV, and PPV were 0.926, 96.7%, 81.5%, 84.9%, and 95.9% for TIRADS, and 0.920, 93.5%, 82.4%, 85.1%, and 92.1% for ATA patterns, respectively. The TIRADS was generally more efficient than the 2015 ATA guidelines, especially for nodules >2 cm in diameter or those with nonspecific pattern.

The TIRADS show a relative superiority over the ultrasound 2015 ATA guidelines, especially for nodules with >2 cm diameter or nonspecific pattern.
Clinical characteristics of gastrointestinal tract duplications in children
Authors: Xiang Li , Lan Jiaming , Chen Bailin , Li Ping , Guo Chunbao
Published: November 2019

Due to the various presentations of gastrointestinal tract duplications (GTD), diagnosing and management for this disease might be varied and difficult. We intend to improve the experiences for these difficult, in terms of the clinical presentations, diagnostic investigations, management.

We reviewed recent literature and retrospectively analyzed 72 pediatric patients with enteric duplication. Diagnosis was confirmed by surgery and pathological examination for imaging characteristics and clinical and pathological features.

The ages of patients ranged from one month to 12.5 years. The clinical presentations of the patients included 57 cases with abdominal pain, followed with nausea or vomiting, abdominal distension, etc. All of the patients were diagnosed by ultrasonography, and most of them presented as intra-abdominal cystic masses. Four cases were diagnosed with the cysts other than GTDs, like, mesenteric cyst, chledochal cyst and abscess, and so on. Computed tomography was performed on 65 patients. X-rays and barium meal showed the outline of the cyst structure, with intestinal displacement due to the pressure from the cyst. Among the 72 cases of enteric duplication, 45 were located with ileocecal area, 41 were ileal and 8 were colonic duplications.

Enteric duplication is very rare in children and is prone to misdiagnosis. The preoperative diagnosis of enteric duplication can be improved through comprehensive analysis of various imaging exams and closely related clinical presentations.
Comparison of intervertebral fusion rates of different bone graft materials in extreme lateral interbody fusion
Authors: Gao Yuan , Li Jiaqi , Cui Hao , Zhang Fei , Sun Yapeng , Li Zeyang , Ding Wenyuan , Shen Yong , Zhang Wei
Published: November 2019

To compare imaging indicators and clinical effects of extreme lateral interbody fusion (XLIF) using allogenic bone, autologous bone marrow + allogenic bone, and rhBMP-2 + allogenic bone as bone graft materials in the treatment of degenerative lumbar diseases.

This was a retrospective study of 93 patients with lumbar interbody fusion who underwent the extreme lateral approach from May 2016 to December 2017. According to the different bone graft materials, patients were divided into allogenic bone groups (group A, 31 cases), rhBMP-2 + allogenic bone (group B, 32 cases), and autologous bone marrow + allogenic bone (group C, 30 cases). There were no significant differences in gender, age, lesion segment, preoperative intervertebral space height, and preoperative Oswestry Dysfunction Index (ODI) and visual analogue scale (VAS) scores among the 3 groups (P > .05). Intervertebral space height, bone graft fusion rate, and ODI and VAS scores were compared immediately after surgery, and at 3, 6, and 12 months after surgery.

All groups were followed up for 12 months. The intervertebral space height was significantly higher in the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery, in comparison to before surgery (P < .05). There was no significant difference in the intervertebral space height among the 3 groups immediately after surgery and at 3, 6, and 12 months after surgery (P > .05). The fusion rate of group B and C was higher than that of groups A at 3, 6, and 12 months after surgery (P < .05). In the 3 groups, the VAS and ODI scores at 3, 6, and 12 months after surgery were significantly improved compared with the preoperative scores (P < .05). The VAS and ODI scores in groups B and C were significantly higher than those in group A (P < .05), but there was no significant difference between groups B and C (P > .05).

The rhBMP-2 + allograft bone combination had good clinical effects and high fusion rate in XLIF.
Primary mediastinal ependymoma
Authors: Ye Wei-biao , Zhou Jian-ping , Xu Yong-qiang , Lu Bi-yan , Li Zhong-jun
Published: November 2019

Rationale:

Ependymomas are neuroepithelial tumors that typically occur in the central nervous system. Ependymomas arising in the mediastinum are exceedingly rare, with only approximately 9 isolated cases reported in the literature to date.

Patient concerns:

A 35-year-old woman was referred to our hospital with complaints of progressive back pain for 3 months. Physical examination revealed decreased breathing sounds and tenderness. Contrast-enhanced computed tomography showed a soft tissue mass with heterogeneous enhancement in the right posterior mediastinum.

Diagnoses:

The diagnosis of primary mediastinal ependymomas (PMEs) was confirmed by postoperative histopathologic examination.

Interventions and outcomes:

The patient underwent surgical resection of the tumor and experienced local recurrence with neck metastasis 2 years postoperatively. She underwent reoperation for the recurrent tumors and received postoperative radiotherapy and adjuvant chemotherapy. Two years later, the patient is doing well, with no evidence of tumor progression or recurrence.

Lessons:

Since PMEs are exceedingly rare, treatment options are limited. Surgical resection seems to be the mainstay of treatment. Further evidence-based studies are required to prove the benefit of radiotherapy and chemotherapy in the treatment of PMEs.
Esophago-tracheobronchial fistula following treatment of anlotinib in advanced squamous cell lung cancer
Authors: Zhang Pin-Liang , Liu Zeng-Jun
Published: November 2019

Rationale:

Anlotinib, a novel orally administered multitargeted tyrosine kinase inhibitor, inhibiting tumor angiogenesis and growth, significantly prolonged overall survival, and progression-free survival with a manageable safety profile as a third-line therapy among refractory advanced nonsmall cell lung cancer (NSCLC) patients in ALTER 0303 trail (NCT02388919).

Patient concerns:

Two squamous cell lung cancer patients with mediastinal metastasis undergoing the treatment of anlotinib developed clinical symptom of cough, which was worse upon ingestion.

Diagnoses:

On the basis of patients’ clinical symptoms and radiographic findings, they were diagnosed with acquired esophago-tracheobronchial fistula.

Interventions:

We treated them with fully covered self-expandable metallic stents.

Outcomes:

The clinical symptom of cough was immediately relieved after palliative treatment. Both patients elected to discontinue anlotinib treatment.

Lessons:

These 2 cases imply that a close follow-up schedule for esophago-tracheobronchial fistula should be established when squamous cell lung cancer patients with mediastinal metastasis are undergoing anlotinib therapy. Early detection and adequate treatment are essential for patient symptom relief and survival.
Very early recurrence following pancreaticoduodenectomy in patients with ampullary cancer
Authors: Park Hyeong Min , Park Sang-Jae , Han Sung-Sik , Hong Seong Kweon , Hong Eun Kyung , Kim Sun-Whe
Published: November 2019

We aimed to identify the factors for very early recurrence (within 6 months) of ampullary cancer following curative resection and to compare the immunohistochemical expression rate of various antibodies between the 2 main histologic subtypes of ampullary adenocarcinoma.

In this retrospective study, the postoperative outcomes and clinicopathologic factors for very early recurrence that occurred in 14 of 93 patients who underwent pancreaticoduodenectomy (PD) for ampullary adenocarcinoma between January 2002 and August 2014 were analyzed. Thereafter, we identified the factors associated with very early recurrence following surgery. Additionally, we compared the expression rates of CK7, CK20, MUC1, MUC2, MUC5AC, MUC6, S100P, and CDX2 between the 2 main histologic subtypes of ampullary adenocarcinoma (NCC2019-0138).

The patients who underwent PD for ampullary cancer were divided into 2 groups: very early recurrence and others. Compared with the other patients, the 14 patients (32.6%) who developed very early recurrence had shorter median disease-free survival (4.2 vs 49.7 months, P = .001) and overall survival (18.2 vs 113.7 months, P < .001). Large tumor, lymph node metastasis, and pancreatobiliary type were independently associated with very early recurrence of ampullary cancer following PD.

Large tumor, lymph node metastasis, and pancreatobiliary type were the independent risk factors for very early recurrence of ampullary cancer following curative resection. Therefore, ampullary cancer patients with these factors should be considered to receive aggressive adjuvant treatment and frequent post-operative follow-up.
Association of Glutathione S-Transferase M1 null genotype with inflammatory bowel diseases
Authors: Zhou Yu-Jie , Zhao Bao-Lin , Qian Zheng , Xu Yi , Ding Ya-Qing
Published: November 2019

Background:

Ulcerative colitis (UC) and Crohn disease (CD) are the 2 main types of inflammatory bowel diseases (IBDs). Several studies have been conducted to investigate the association of Glutathione S-Transferase M1 (GSTM1) null genotype with UC and CD, but the results are inconsistent. Here, we performed a meta-analysis to clarify this controversy based on relative large sample size.

Methods:

A systematic article searching was conducted in the PubMed, EMBASE, SCOPUS, WOS, ProQuest, Chinese National Knowledge Infrastructure (CNKI), and Chinese Wanfang databases up to August 31, 2019. Meta-analysis results were synthesized by using crude odds ratio (OR) with its 95% confidence interval (CI). Heterogeneity, sensitivity analysis, subgroup analysis, and publication bias were assessed by using STATA 11.0 software.

Results:

A total of 15 relevant studies including 4353 IBDs patients (1848 CD cases, 2505 UC cases) and 5413 controls were included in this meta-analysis. Totally, we found a significant association between GSTM1 null genotype and risk to IBDs in the overall populations (OR = 1.37, 95%CI = 1.13−1.65, P = .001). Stratified by ethnicity, we found a significant association between GSTM1 null genotype and risk to IBDs in the Asian population (OR = 2.54, 95%CI = 2.15−3.00, P = .001), but not in the Caucasian population. Stratified by disease type, we found a significant association between GSTM1 null genotype with CD in the Asian population (OR = 2.37, 95%CI = 1.11−5.06, P = .026), and with UC in the Asian (OR = 2.48, 95%CI = 1.93−3.20, P = .001) population. In addition, funnel plot and Egger linear regression test suggests no publication bias in all genetic models.

Conclusion:

GSTM1 null genotype is associated with susceptibility to IBD, UC, and CD in the Asian population. Further well-designed studies are still needed to confirm these findings.
Effectiveness comparisons of Chinese patent medicine on treating premature ejaculation
Authors: Sun Song , Mo Xuwei , Li Yufeng , Gong Ziqi , Wang Jisheng , Yu Xudong , Han Liang , Zhou Hong
Published: November 2019

Background:

Premature ejaculation (PE) is a form of male sexual dysfunction. As people's lifestyle changes and the population ages, the incidence of PE continues to increase. Chinese patent medicines have been widely used in clinical practice as derivatives of traditional Chinese medicine (TCM). Many clinical trials have proven that Chinese patent medicine has a significant effect in the treatment of PE. In this systematic review, we aim to evaluate the effectiveness and safety of Chinese patent medicine for PE.

Methods:

We will search for PubMed, Cochrane Library, AMED, Embase, WorldSciNet, Nature, Science online and China Journal Full-text Database, China Biomedical Literature CD-ROM Database, and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to September 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the RevMan 5.3 and Stata 13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of PE.

Ethics and dissemination:

This systematic review will evaluate the efficacy and safety of TCM for treating PE. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.

Trial registration number:

PROSPERO CRD42017065316