bluuebunny/crossref_metadata_2025 huggingface dataset:
Impaired neuromuscular control up to postoperative 1 year in operated and nonoperated knees after anterior cruciate ligament reconstruction
Authors: Lee Jin Hyuck , Han Seung-Beom , Park Jong-Hoon , Choi Jae-Hyuk , Suh Dae Keun , Jang Ki-Mo
Published: April 2019

The current study was performed to assess serial changes in neuromuscular control until 1 year postoperatively in nonathletic patients undergoing anterior cruciate ligament reconstruction (ACLR).

Ninety-six patients were included. Serial neuromuscular control tests were performed preoperatively, at 6 months, and 1 year postoperatively. Neuromuscular control was evaluated using acceleration time (AT) and dynamic postural stability (overall stability index, OSI). Functional activity levels were assessed using the Tegner activity-level scale.

Preoperative AT of quadriceps and hamstrings in operated knees was 78.9 ± 6.4 and 86.5 ± 6.2 ms, respectively, which significantly reduced to 56.9 ± 2.0 and 62.5 ± 2.8 ms at 1 year (P = 0.006 and 0.002, respectively). In nonoperated knees, preoperative AT of quadriceps and hamstrings was 47.6 ± 1.7 and 56.5 ± 1.7 ms, respectively, which was significantly prolonged to 54.3 ± 2.0 and 67.9 ± 2.7 ms at 1 year (P = 0.02 and 0.001, respectively). Preoperative OSI of nonoperated knees was 1.2 ± 0.0°. It significantly increased to 1.5 ± 0.1° at 1 year (P < 0.001). In operated knees, preoperative OSI was 1.8 ± 0.1°. It significantly decreased to 1.4 ± 0.1° at 1 year (P = 0.001). Tegner scale at 6 months and 1 year were significantly lower than pre-operative scale (P < 0.001). AT and OSI on both knees showed significant negative correlation with Tegner scale at 6 months and 1 year.

Neuromuscular control in both knees was not restored to preoperative levels of the nonoperated knees until 1 year after ACLR. Therefore, clinicians and physical therapists should attempt to enhance neuromuscular control in both nonoperated and operated knees.
Congenital absence of the penis (aphallia)
Authors: Qiang Shuai , Li Feng Yong , Zhou Yu , Yuan Ye , Li Qiang
Published: April 2019

Rationale:

Absence of the penis, known as aphallia, is a very rare congenital anomaly. It is believed to be a result of either the absence of the genital tubercle or its failure to fully develop and is associated with the level of hormones and chromosomal rearrangements. The failure of the genital tubercle influences the development of the penis and partly depends upon testosterone secreted by Leydig cells of the testis. Chromosomal polymorphisms may affect the functions of protection and regulation, potentially leading to susceptibility to congenital diseases. Herein, an extremely rare case of a congenital absence of the penis is described.

Patient concerns:

A 3-month-old was brought to the OPD by his parents with complaints of absence of penis since birth and urine being passed rectally. When he was born, he was registered as a boy because his chromosomes were 46XY but with 9qh+. Local examination revealed the total absence of the penis. The scrotum was well developed. The testes were palpable bilaterally. The anal opening was located normally. No urethral orifice could be identified. However, his parents had not yet decided whether to accept treatment. The child has been lost to follow up.

Diagnosis:

Congenital absence of the penis (aphallia) (46 XY normal male karyotype).

Interventions:

We explained the nature of the abnormality and management options to the parents. However, it was much regretted that the patient was too young to make a decision and that his parents had not made a decision yet. They left without any further contact.

Outcome:

Because the parents left our hospital without any contact, it has not been possible to develop a follow-up plan.

Lessons:

In consideration of the rarity and devastating psychosocial consequences of this case, we accordingly call for active cooperation with doctors to minimize the negative impact of this malformation. Early assignment of gender avoids confusion and contradiction. Parental confidence solidifies the child's own confidence in his or her gender.
Hemophagocytic lymphohistiocytosis due to Streptococcus suis in a 12-year-old girl
Authors: Liu Shuang-Shuang , Wang Yue , Xue Lu , Ma Cui , Li Chun-Huai
Published: April 2019

Rationale:

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that can be caused by bacterial infection. Streptococcus suis (S. suis) is a zoonotic pathogen that can cause severe disease in both pigs and humans. We report the first-ever documented case of HLH secondary to S. suis infection.

Patient concerns:

A 12-year-old girl presented with fever, rash, hepatosplenomegaly, pancytopenia, and elevated levels of ferritin and soluble CD25. Bone marrow examination revealed hemophagocytosis. Blood culture was positive for S. suis.

Diagnosis:

A diagnosis of hemophagocytic syndrome due to S. suis was established.

Interventions:

We treated the patient with intravenous immunoglobulin, intravenous imipenem, and supportive care.

Outcomes:

The patient eventually showed complete recovery.

Lessons:

Inflammatory response plays an important role in S. suis infection. Aberrant inflammatory response to S. suis infection may induce HLH. This case report illustrates that early definitive diagnosis and prompt treatment is a key imperative in patients with suspected S. suis infection.
Acute pancreatitis with abdominal bloating and distension, normal lipase and amylase
Authors: Wang Yuan-Yu , Qian Zhen-Yuan , Jin Wei-Wei , Chen Ke , Xu Xiao-Dong , Mou Yi-Ping , Zhang Wei
Published: April 2019

Rationale:

Acute pancreatitis is an inflammatory disorder of the pancreas, and its correct diagnosis is an area of interest for clinicians. In accordance with the revised Atlanta classification, acute pancreatitis can be diagnosed if at least 2 of the following 3 criteria are fulfilled: abdominal pain; serum lipase (or amylase) activity at least 3 times the upper limit of normal; or characteristic findings of acute pancreatitis on contrast-enhanced computed tomography (CT) or, less often, magnetic resonance imaging or transabdominal ultrasonography. Diagnostic imaging is essential in patients with no or slight enzyme elevation. If enzymes are normal in cases with abdominal distension, there is clinical doubt about the diagnosis of acute pancreatitis, so an early CT scan should be obtained and other life-threatening disorders excluded.

Patient concerns:

A 50-year-old male presented with a 1-day history of abdominal bloating and distension. On physical examination, abdominal bulging and mild epigastric tenderness were detected. Laboratory evaluation showed normal amylase and lipase. There was no abnormality on abdominal ultrasound or CT of the abdomen and pelvis. On the fourth day of admission, CT of the abdomen and pelvis showed a hypodense lesion in the pancreas surrounded by a moderate amount of peripancreatic fluid.

Diagnoses:

In accordance with the revised Atlanta classification, acute pancreatitis was diagnosed, based on the presence of abdominal pain, and the results of the CT scan of the abdomen and pelvis.

Interventions:

The patient was treated with fasting, gastrointestinal decompression bowel rest, intravenous rehydration, and somatostatin.

Outcomes:

After 2 days of treatment, his abdominal distension was significantly relieved, and the patient was discharged on the seventh day of admission. At the 3-month follow-up, the patient had no recurrence of pancreatitis.

Lessons:

This case of abdominal distension could not be explained by common causes, such as ascites, bowel edema, hematoma, bowel distension, or ileus, which led us to suspect pancreatitis.
Traumatic neuroma in mastectomy scar
Authors: Chen Wenyi , Zhang Huan , Huang Jiayan , Li Yixuan , Zhang Zhang , Peng Yulan
Published: April 2019

Rationale:

Traumatic neuroma is a reparative proliferative response of the nerve after trauma or surgery, which rarely occurs in the breast. However, it must be distinguished from tumor recurrence.

Patient concerns:

A 78-year-old woman underwent left-sided modified radical mastectomy for invasive carcinoma, 7 years before this case. Two painless nodules near the mastectomy scar were discovered in regular follow-up physical examination. A 62-year-old woman had received right-sided modified radical mastectomy for intraductal carcinoma, 4 years before this case. An asymptomatic nodule near the mastectomy scar was detected during follow-up ultrasound (US) examination.

Diagnosis:

The lesions in both patients were diagnosed as traumatic neuroma.

Interventions:

The first patient underwent excisional biopsy. The second patient underwent US guided core-needle aspiration, followed by conservative therapy.

Outcomes:

Neither patient complained of any discomfort, nor both exhibited normal physical and US findings during follow-up examinations.

Lessons:

Newly discovered nodules with the benign imaging features near the mastectomy site of a patient, especially with the tail sign, traumatic neuromas should be taken into consideration. Routine US examination is important for follow-up of breast cancer patients who have undergone mastectomy.
Acute myocardial infarction as the first manifestation of Takayasu arteritis
Authors: Zhang Ting , Peng Bo , Tu Xiang , Zhang Shan , Zhong Sen , Cao Wenzhai
Published: April 2019

Rationale:

Takayasu arteritis (TA) is a chronic inflammatory disease involving the aorta and its major branches. Initial diagnosis is usually difficult due to the highly variable symptoms. Acute myocardial infarction (AMI) is a very rare presentation in patients with TA. Moreover, the choice of early management for these patients is not well established.

Patient concerns:

A 34-year-old woman was taken to the Emergency Department of our hospital, presenting with a sudden onset and persistent retrosternal chest pain radiating to both upper extremities for 2 hours. Blood pressures were different between 2 arms with 151/115 mm Hg on the right arm and 140/100 mm Hg on the left arm.

Diagnoses:

The patient was diagnosed with TA according to the medical history, physical examination, and vascular imaging.

Interventions:

Primary percutaneous coronary intervention (PPCI) was performed to restore the coronary flow of left anterior descending. Meanwhile, combination of oral glucocorticoids and immunosuppressive agents was administered to halt disease progression of TA.

Outcomes:

Chest pain was relieved without rest and exertional angina. The patient achieved long-term remission without symptom relapse during our follow-up.

Lessons:

Percutaneous coronary intervention was essential and effective in AMI of TA. Timely immunosuppressive therapy could improve the long-term outcome.
Primary yolk sac tumor originating from the endometrium
Authors: Song Liang , Wei Xiaoxia , Wang Danqing , Yang Kaixuan , Qie Mingrong , Yin Rutie , Li Qingli
Published: April 2019

Rationale:

Yolk sac tumors (YSTs) are malignant germ cell tumors that secrete alpha-fetoprotein (AFP). These tumors commonly develop in infants, young children, and young women and often originate in the gonads. Primary endometrial YST is a very rare malignancy, and a primary endometrial YST in the absence of abnormal AFP levels is even rarer.

Patient concerns:

A 38-year-old woman presented with the chief complaint of prolonged menstruation and increased menstrual bleeding with a duration of more than 2 months.

Diagnoses:

Postoperative pathology confirmed a diagnosis of endometrial YST with metastasis to the greater omentum (stage IVB).

Interventions:

The patient underwent a laparoscopic extrafascial hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, abdominal para-aortic lymphadenectomy, omentectomy, and appendectomy. Additionally, she received 6 courses of multidrug chemotherapy (bleomycin, etoposide, and cisplatin; BEP).

Outcomes:

After completing chemotherapy, the patient underwent regular follow-up examinations. No recurrence was noted during a 24-month follow-up period.

Lessons:

YST is mainly treated using surgery and chemotherapy, which may spare endocrine functions in young patients. The BEP regimen appears to be an effective postoperative chemotherapy regimen for patients with endometrial YST.
A novel case of global developmental delay syndrome with microdeletion at 10p14–p15.3 and microduplication at 18p11.31–p11.32
Authors: Zhang Danyan , Zhu Yijian , Feng Xuefei , Dai Limeng , Ma Mingfu , Li Lianbing , Guo Hong , Zhao Letian , Zhang Yuping , Bai Yun
Published: April 2019

To characterize the etiology underlying a novel case of global developmental delay syndrome (GDDS) identified in a female child, aged 3 years old. This syndrome is a common pediatric presentation estimated to affect 3.65% of children aged 3 to 17 years.

The proband's detailed family history was used to infer a likely mode of inheritance for the GDDS. Genomic DNA samples collected from the proband and her parents were evaluated using conventional karyotyping, multiplex ligation-dependent probe amplification (MLPA), comparative genomic hybridization microarray (aCGH), and fluorescent in situ hybridization (FISH) analysis techniques.

An analysis of the proband's family history suggested that she inherited the GDDS from her father. The conducted conventional karyotyping and MLPA methods failed to identify a causative defect for the GDDS; however, the aCGH analysis revealed both a 6.6-Mb deletion at p14–p15.3 of chromosome 10 (arr[hg19]; 100,026–6,710,183), and a 6.3-Mb duplication at p11.31–p11.32 of chromosome 18 (arr[hg19]; 136,226–6,406,733) in the proband. The conducted FISH analysis subsequently determined that these mutations resulted from a balanced translocation t(10;18)(p15.3; p11.32) carried by the proband's father. Finally, a bioinformatic analysis of the proband's mutations revealed ZMYND11 as a promising candidate causative gene for this case of GDDS.

The present study demonstrates that the aCGH method can be used to effectively identify the location and approximate size of microdeletions and/or microduplications, but not balanced reciprocal translocations. The nonconventional analysis methods used in the present study may be applicable to other GDDS cases with elusive etiology, and likewise, ZMYND11 should be considered as a potential causative gene during the investigation of future GDDS cases.
Primary malignant mesothelioma of the diaphragm with liver invasion
Authors: Huang Wen-Jing , Li Zhi-Han , Wang Zhao , Yang Mai-Qing , Xu Hong-Tao
Published: April 2019

Rationale:

Malignant mesothelioma is a malignant tumor with poor prognosis, which usually originates in the pleura, peritoneum, and pericardial cavity. Mesotheliomas that originate from the diaphragm are very rare. Here, we report a case of primary malignant mesothelioma of the diaphragm with liver invasion.

Patient concerns:

A 66-year-old woman was admitted to our hospital because of a “liver space-occupying lesion,” without any special clinical symptoms. Imaging examinations suggested a cystic-solid mixed lesion in the right lobe of the liver.

Diagnosis:

The tumor was diagnosed as epithelioid mesothelioma of the diaphragm with liver invasion.

Intervention:

The patient underwent abdominal surgery in our hospital to remove the diaphragmatic mass, liver mass, and part of the diaphragm.

Outcomes:

The postoperative course was uneventful.

Lessons:

Primary diaphragmatic malignant mesothelioma is very rare and may involve liver or lung tissue and be mistaken for liver or lung tumor. Accurate diagnosis depends on careful pathological examination. Immunohistochemical staining is very useful to distinguish this tumor from other liver or diaphragmatic tumors.
Traditional Chinese medicine for management of recurrent and refractory Crohn disease
Authors: Lai Hezheng , Wang Kang , Dong Qing , Zhu Xiaoshu , Li Xiaoke , Qi Shuo
Published: April 2019

Introduction:

Crohn disease (CD) is a chronic relapsing systemic inflammatory disease afflicting the gastrointestinal system with a high morbidity. There has been increasing clinical interest in traditional Chinese medicine (TCM) treatment for CD. This report aims to present patient outcome of therapeutic management using TCM in combination with pharmacologic therapy.

Patient concerns:

A 53-year-old woman with a more than 23-year history of chronic indigestion, reflux, abdominal pain, and excessive diarrhea, and a more than 21-year history of recurrent refractory CD. The condition had been managed for 21 years with ongoing pharmacologic therapy, and surgical intervention; however, with poor therapeutic effect.

Diagnosis:

In this study, the diagnosis of CD was based on integrating patient symptoms and radiologic findings and biopsy results. The patient had no differential diagnosis.

Interventions:

The patient received acupuncture treatment at an approximate frequency of once per week for a total of 21 sessions until November 5, 2018. The patient also received Chinese herbal medicine (CHM) on an as-needed basis to manage her symptoms.

Outcomes:

Patient reported symptoms of chronic indigestion, reflux, abdominal pain, and excessive diarrhea were substantially improved by combined TCM and pharmacologic therapy intervention, while the dosage of her medication was reduced.

Conclusion:

Following acupuncture treatment, improvements of subjective symptoms: chronic indigestion, reflux, abdominal pain, and excessive diarrhea, were observed. CHM provided immediate relief of indigestion, reflux, and abdominal pain. TCM may be a potential therapeutic strategy to manage clinical symptoms of CD, if this is proven useful in future RCT studies.
A safe percutaneous technique for the reduction of irreducible femoral neck fractures using ultrasound localization of the femoral vascular and nervous structures at the hip
Authors: Yu Shuisheng , Xu Xinzhong , Pandey Nitesh Raj , Zhao Yao , Jing Juehua
Published: April 2019

We present a safe percutaneous technique for the placement of Kirschner wires into the femoral head to assist in the reduction of irreducible femoral neck fractures using ultrasound to identify the vascular and nervous structures about the hip.

From January 2011 to June 2014, a total of 36 patients (25 males and 11 females) were enrolled in this study. Patients were placed on a fracture reduction table for limb traction. After 3 unsuccessful reductions with limb traction, ultrasound-guided localization of the patient's femoral artery, vein, and nerve at the hip was performed. These structures were marked on the overlying skin and then Kirschner wires were inserted into the femoral head avoiding these marked structures. After the surgery, the Kirschner wire insertions were routinely reviewed by ultrasound, the hip fracture reduction and the femoral nerve sensorimotor function were routinely examined as well.

All 36 patients with an irreducible variant of a femoral neck fracture showed anatomic reduction under C-arm fluoroscopy using ultrasound to avoid K wire injury to the femoral vascular structures and nerve. No major vascular injury during operation. In post-surgical ultrasound examination, local hematoma formation was not evident. There was normal function of the femoral nerve. On follow-up, there were no infections, wound problems, recurrence of fracture displacement, laxity, or implant breakage.

Preoperative ultrasonic localization of the femoral artery, vein, and femoral nerve safely allowed. Kirschner wire placement under C-arm fluoroscopy into the femoral head to assist in fracture reduction. This assisted reduction method for irreducible femoral neck fractures had a number of advantages, including closed anatomic reduction with minimal attempts, used simple equipment, and avoided further destruction of the blood supply to the femoral head.
ALBI/ST ratio versus FIB-4 and APRI as a predictor of posthepatectomy liver failure in hepatocellular carcinoma patients
Authors: Zhang Ze-Qun , Yang Bo , Zou Heng , Xiong Li , Miao Xiong-Ying , Wen Yu , Zhou Jiang-Jiao
Published: April 2019

A precise and noninvasive method to predict posthepatectomy liver failure (PHLF) in clinical practice is still lacking. Liver fibrosis or cirrhosis accompanied with varying degrees of portal hypertension plays an important role in the occurrence of PHLF in hepatocellular carcinoma (HCC) patients. This study aims to compare the predictive ability of the albumin-bilirubin score to spleen thickness ratio (ALBI/ST) versus fibrosis-4 index (FIB-4) and aspartate aminotransferase to platelet count ratio index (ARPI) for the occurrence of PHLF. We retrospectively enrolled 932 patients who underwent liver resection for HCC between 2010 and 2017. The predictive accuracy of ALBI/ST ratio, FIB-4, and APRI for occurrence of PHLF was evaluated by receiver operating characteristic curve analysis. PHLF was diagnosed in 69 (7.4%) patients. The ALBI/ST ratio was found to be a significant predictor of PHLF. The AUC of ALBI/ST (AUC = 0.774; 95% CI, 0.731–0.817; P <.001) was larger than that of FIB-4 (AUC = 0.696; 95% CI, 0.634–0.759; P <.001) and APRI (AUC = 0.697; 95% CI, 0.629–0.764; P <.001). Multivariate analysis demonstrated that ALBI/ST ratio was a strong risk factor of PHLF in all hepatectomy subgroups. In conclusion, the ALBI/ST ratio has a superior predictive ability for PHLF compared with APRI and FIB-4.
Effectiveness, safety, and economic evaluation of topical application of a herbal ointment, Jaungo, for radiation dermatitis after breast conserving surgery in patients with breast cancer (GREEN study)
Authors: Shin Seungwon , Jang Bo-Hyoung , Suh Hae Sun , Park Seung-Hyeok , Lee Jin-Wook , Yoon Seong Woo , Kong Moonkyoo , Lim Yu Jin , Hwang Deok-Sang
Published: April 2019

Introduction:

This is a prospective, open-label, parallel-group, randomized controlled trial that evaluates the effectiveness and safety of adjuvant application of Jaungo (JUG) for radiation-induced dermatitis (RD) in breast cancer patients undergoing radiation therapy, in comparison with general supportive care (GSC).

Methods/design:

Eighty female patients, who have been diagnosed with unilateral breast cancer, will be allocated to either the JUG or GSC group with an allocation ratio of 1:1 after breast conservation surgery, in the Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea. Both the groups will be subjected to GSC, but only the JUG group participants will apply adjuvant JUG ointment on the irradiated skin for 6 weeks, twice a day. The primary outcome of this study is the assessment of incidence rate of RD using the Radiation Therapy Oncology Group (RTOG) for toxicity gradation of 2 or more. Maximum pain level, quality of life, adverse reactions, and pharmacoeconomic evaluations will also be included.

Discussion:

The primary outcome will be statistically compared using the logrank test after estimating the survival curve using the Kaplan–Meier method. Continuous variables will be tested using independent t test or Mann–Whitney U test. The adverse events will be evaluated with Chi-square or Fisher exact test. All the data will be analyzed at a significance level of 0.05 (two-sided) with R software (The R Foundation).

Trial registration:

CRIS (Clinical Research Information Service), KCT0003506, 14 February 2019.
Effects of photobiomodulation therapy on inflammatory mediators in patients with chronic non-specific low back pain
Authors: Tomazoni Shaiane Silva , Costa Leonardo Oliveira Pena , Joensen Jon , Stausholm Martin Bjørn , Naterstad Ingvill Fjell , Leal-Junior Ernesto Cesar Pinto , Bjordal Jan Magnus
Published: April 2019

Introduction:

Low back pain (LBP) is ranked as one of the most prevalent health conditions. It is likely that some inflammatory mediators could be associated with pain and disability in these patients. Photobiomodulation therapy (PBMT) is a non-pharmacological therapy often used in patients with LBP and one of the possible mechanisms of action of therapy is modulate inflammatory mediators. However, to date there are no studies that evaluated the effects of PBMT on the levels of inflammatory mediators in patients with LBP. The aim of this study is to evaluate the acute effects of PBMT on systemic levels of inflammatory mediators and pain intensity in patients with chronic non-specific low back pain.

Methods and analysis:

This is a prospectively registered, two-arm randomized placebo-controlled trial with blinded patients, assessors and therapists. Eighteen patients with chronic non-specific LBP will be randomized into 2 groups: placebo or active PBMT. The treatment will be provided in a single session. The primary outcome will be levels of prostaglandin E2 (PGE2). The secondary outcomes will be levels of necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and pain intensity. Biochemical and clinical outcomes will be measured at baseline and 15 minutes after the single treatment session.

Discussion:

Despite PBMT be used in musculoskeletal disorders such as LBP, to the best of our knowledge this is the first study that will investigate a possible biological mechanism behind the positive clinical effects of PBMT on non-specific chronic low back pain.

Ethics and dissemination:

The study was approved by the Regional Research Ethics Committee. The results will be disseminated through publication in peer-reviewed international journal and conferences.

Trial registration number:

NCT03859505.
Efficacy and safety of probiotics in eradicating Helicobacter pylori
Authors: Shi Xiaoguang , Zhang Junhong , Mo Lingshan , Shi Jialing , Qin Mengbin , Huang Xue
Published: April 2019

Background:

Due to decreasing eradication rate and increasing side effects, probiotics have gradually become an important supplement to standard eradication regimens for Helicobacter pylori.

Objective:

To evaluate the effectiveness and safety of probiotics in facilitating the eradication of H pylori and to explore the best timing and duration of probiotic supplementation, use of eradication regimens, strains, locations, and common side effects.

Methods:

Eligible studies were retrieved from the PubMed, EMBASE, Cochrane Library, Web of Science, and CNKI databases, and we applied the Stata 12.0 software for the standard meta-analysis and network meta-analysis.

Results:

Forty eligible studies with 8924 patients were included in the analysis. We used a random-effects model (I
2 = 52.1% and I
2 = 81.4%) to analyze the eradication rate and the incidence of total side effects by intention to treat (ITT). Compared with the control group, a higher eradication rate (relative risk [RR] 1.140, 95% confidence interval (CI) 1.101–1.180, P < .001) and lower incidence of total side effects (RR 0.470, 95% CI 0.391–0.565, P < .001) were observed in the probiotic group. In the subgroup analysis, we evaluated the surface under the cumulative ranking curve scores for the before + same (75.2%), >2 weeks (92.6%), probiotic + quadruple regimen (99.9%), Lactobacillus (73.6%), multiple strains (72.1%), China (98.5%) groups. The rankings of common side effects are shown in Table 6. SUCRA scores for diarrhea (39.7%), abdominal pain (43.9%), nausea (78.8%), taste disturbance (99.6%), vomiting (7.1%), and constipation (30.9%) were reported. The consistency of all comparison groups was good.

Conclusions:

Probiotics improved the eradication rate and reduced side effects when added to the treatments designed to eradicate H pylori. The use of probiotics before the eradication treatment and throughout the eradication treatment, and also the use of probiotics for more than 2 weeks, exerted better eradication effects. Probiotics combined with the bismuth quadruple regimen was the best combination. Lactobacillus and multiple strains were better choices of probiotic strains. The eradication effect observed in China was better than the effect observed in other countries.
Sewing needles in the lungs of children
Authors: Deng Xicheng , Huang Peng , Wang Jinghua , Yi Liwen , Liu Jian , Yang Guangxian
Published: April 2019

Rationale:

Foreign bodies are common in children. However, it is uncommon to have a “sewing needle” penetrating the body percutaneously rather than via a natural orifice. Such cases have been reported from across the world, with needles being found in regions such as the cranium, abdomen, limbs, neck, scrotum, and buttocks. Few cases with a needle inserted in the lung have been reported.

Patient concerns:

We present 2 cases where the needles were found in the chest wall/lung because of suspected child abuse. In the first case, foreign bodies were present in the chest wall and the lung. In the other case, the pointed end was oriented towards, and was very close to, the great arteries.

Diagnoses:

Both cases were diagnosed incidentally when chest X-ray was being performed for other reasons.

Interventions:

Surgery was indicated for both cases, and the needles were excised uneventfully.

Outcomes:

The postoperative course in both cases was uneventful.

Lessons:

It is worth noting that in both cases, neither the guardians nor the victims themselves could tell when and how the needles got lodged in the lungs. Collective information suggested that these 2 cases probably involved child abuse. Child abuse in China has long been underestimated and underrecognized. There is still much left to do to tackle this important issue, especially in rural areas.
Cervical ganglioneuroma
Authors: Xu Tianni , Zhu Wei , Wang Ping
Published: April 2019

Rationale:

Ganglioneuromas are benign neoplasm of neuroblastic origin which arise from central or peripheral parts of the autonomic nervous system. They are normally found at posterior mediastinum, retroperitoneum, and the adrenal gland but ganglioneuromas are rarely found in the cervical region.

Patient concerns:

A 12-year-old boy was admitted with a left-lateral neck mass slow growing over a 7-days duration. The tumor was painless and was not associated with any systemic or compression-related symptoms. No symptoms of Horner's syndrome, including ptosis, myosis, ipsilateral facial anhidrosis, and flushing, were observed. Laboratory routine tests were within normal limits, and magnetic resonance imaging demonstrated a solid and well-circumscribed mass in the carotid space.

Diagnosis:

Due to the patient's symptoms, laboratory test results together with radiographic investigation findings, the 12 years old boy was diagnosed with cervical ganglioneuroma combined with tetralogy of Fallot.

Interventions:

Surgical excision.

Outcomes:

The postoperative period was uneventful with the exception of Horner's syndrome on the left side in short period, and it was finally resolved after 8 months recovery. The patient is now in stable condition after operation, with improvement in symptoms during follow-up recovery.

Lessons:

Ganglioneuromas should be accounted as the differential diagnosis of pediatric soft tissue tumors of the head and neck. The diagnosis for ganglioneuromas in cervical region can only be ascertained with postoperative pathologic examination, and excision is considered as the only effective treatment modality known so far which may cause Horner's syndrome at times. However, patients have a favorable prognosis without recurrence overall.
CD20-negative primary middle ear diffuse large B-cell lymphoma coexpressing MYC and BCL-2 secondary to acute lymphoblastic leukemia
Authors: Ding Chao , Huang Ying , Shi Mingxia , Nie Bo , Li Yuntao , Wu Kun , Yang Jinrong , Zeng Yun
Published: April 2019

Rationale:

Second diffuse large B-cell lymphoma (DLBCL) after treatment of acute lymphoblastic leukemia (ALL) is uncommon. To our knowledge, primary middle ear DLBCL which presents CD20-negative and coexpression of MYC and BCL-2 has not been reported yet.

Patient concerns:

A 20-year-old Chinese man complained fever and weakness for 2 months. Subsequently bone marrow morphology and flow cytometry immunophenotype suggested ALL. Administrated with 9 cycles of multiagent combined chemotherapy, he felt right ear progressive hearing loss, otalgia, aural fullness. Otoendoscopic examination revealed a pitchy mass obstructing the right external auditory canal. Then the mass resection was performed for biopsy and immunohistochemistry examination.

Diagnosis:

The mass was diagnosed as DLBCL which was negative for CD20 and double expression of MYC and BCL-2.

Interventions:

Chemotherapy.

Outcomes:

The patient eventually gave up and died of severe infection.

Lessons:

Although intensive chemotherapy has markedly improved the survival of ALL, more and more secondary cancers have been reported. In addition, primary middle ear lymphoma is much rare; hence, it is easy to be misdiagnosed. Furthermore, DLBCL with negative CD20 and double expression of MYC and BCL-2 is aggressive, which is characterized by chemotherapy resistance and inferior survival rates. We discuss this case aiming at raising awareness of tumors secondary to ALL and exploring the appropriate treatment options for the rare DLBCL.
Extraskeletal myxoid chondrosarcoma of the leg in a child
Authors: Al Khader Ali , Nsour Esra , Al-Zubi Raneem Bassam , Al Maadat Hakam Mansor Dahar
Published: April 2019

Rationale:

Extraskeletal myxoid chondrosarcoma is a slow-growing soft tissue tumor of adults with a propensity for local recurrence and eventual metastasis. Only 17 pediatric and adolescent cases have been reported.

Patient concerns:

Here we present an 11-year-old boy with a 3-year history of a slowly growing painless left leg mass. Magnetic resonance imaging of the lesion revealed a subfascial well-circumscribed lesion with intramuscular extension in the medial gastrocnemius muscle of the left leg.

Diagnoses:

He underwent wide local excision of the mass and the histomorphological and immunohistochemical findings were consistent with extraskeletal myxoid chondrosarcoma.

Interventions:

Possible radiotherapy was the further management plan.

Outcomes:

He was in good condition with no evidence of recurrence at 6 months postsurgery.

Lessons:

Although pediatric cases of extraskeletal myxoid chondrosarcoma were reported to be aggressive, the tumor in this case demonstrated indolent behavior. Furthermore, the tumor in this case showed primitive round cell foci which adds to a previous study that especially reported this morphology in pediatric cases.
Hemolymphangioma involving bones and bladder detected on 68Ga-NEB PET/CT
Authors: Hou Guozhu , Jiang Yuanyuan , Jian Shan , Niu Yiru , Cheng Wuying
Published: April 2019

Rationale:

Hemolymphangioma is a rare developmental defect of combined vasal and lymphatic vasculature. It is very rare that hemolymphangioma affects the bones and bladder simultaneously, and this condition has never been reported in PubMed.

Patient concerns:

A 12-year-old male has a history of hospitalization for recurrent episodes of chyluria of 8 years duration and progressively worsening gross hematuria with right hip pain for 6 months.

Diagnosis:

Chylous test of urine fluid was positive. There was no organic disease in the kidneys. 68Ga-NOTA-Evans Blue (NEB) positron emission tomography/computed tomography (PET/CT) images demonstrated clearly several round and strip-shaped low-density shadows with mildly increased radioactive uptake in both bladder wall and pelvis, including sacral, pubic, and ischial bones. Histopathological analysis of biopsy on pubic and ischial bones confirmed the diagnosis of hemolymphangioma.

Interventions:

The patient received treatment with traditional Chinese medicine.

Outcomes:

At the 6-month follow-up visit, the patient's symptoms of chyluria, hematuria, and pain were all mitigated.

Lessons:

Hemolymphangioma is a rare benign disease. 68Ga-NEB PET/CT is a specific method for the lymphatic system, and it might provide more accurate and comprehensive information about the disorder of the lymphatic system compared with CT and magnetic resonance imaging. When patients suffer from suspected lesions of the lymphatic system, 68Ga-NEB PET/CT might be recommended.
Transurethral resection versus holmium laser enucleation of the prostate
Authors: Bai Fuding , Feng Sheng , Xu Congcong , Xu Zhen , Chen Jijun , Zheng Yichun
Published: April 2019

Objectives:

The purpose of this study was to compare transurethral resection of the prostate (TURP) versus holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) focusing on perioperative thrombin generation and fibrinolysis.

Methods:

Sixty-five BPH patients were prospectively randomly assigned to undergo TURP (n = 32) or HoLEP (n = 33). The prothrombin fragment (PF) 1+2, thrombin-antithrombin complex (TAT), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) were measured preoperatively, at the 1st day and 3rd day after surgery.

Results:

PF1+2, TAT, t-PA, and PAI-1 significantly elevated at day 1 and day 3 after surgery (P < .05) and remarkedly decreased from the 1st day to the 3rd day (P < .05). The levels of PF1+2 and TAT were higher in TURP group postoperatively than that in HoLEP group (P < .05). There is no significant difference between 2 groups in regard of t-PA and PAI-1 (P > .05).

Conclusion:

The activation of thrombin generation and fibrinolysis system were noticed in BPH patients after TURP or HoLEP. TURP may associate with a higher hypercoagulable thrombotic risk than HoLEP.
Successful management of isolated pulmonary Langerhans cell histiocytosis in a 50-year-old man with early diagnosis using transbronchial cryobiopsy
Authors: Feng Yan-mei , Li Yi-shi , Li You-lun , Wang Pu , Guo Rui
Published: April 2019

Rationale:

Isolated pulmonary Langerhans cell histiocytosis (PLCH) is rare in adults. The gold standard diagnosis requires surgical lung biopsy. However, few cases have been diagnosed with transbronchial cryobiopsy (TBCB) sampling in the early stages of the disease, particularly in China.

Presenting concerns:

A 50-year-old man was referred for dry cough and exertional dyspnea of more than 1 week. High-resolution computed tomography (HRCT) of the chest revealed symmetric nodules and cyst lesions with upper lobe infiltrate. Further history taking indicated that he had smoked 20 cigarettes per day for more than 30 years. Therefore, PLCH was highly suspected. However, he refused surgical lung biopsy, and TBCB was attempted to complete diagnosis.

Diagnosis:

Emission computed tomography excluded the possibility of extrapulmonary involvements, and pathological findings supported the diagnosis of isolated PLCH.

Interventions:

Smoking cessation and prednisone treatment were used for patient management.

Outcomes:

The symptoms receded with significant improvement of chest HRCT during 2-months of follow-up.

Lessons:

Early diagnosis contributes to the prognosis of isolated PLCH in adults, and TBCB may be an alternative to conventional surgical lung biopsy for pathological diagnosis of PLCH.
Interpreting Patient-reported Outcome Scores for Clinical Research and Practice
Authors: Shi Qiuling , Mendoza Tito R. , Cleeland Charles S.
Published: April 2019

Objectives:

Cutpoints are specific numeric values used to create discrete categories for patient-reported outcome (PRO) items or scales. Cutpoints are widely used in both clinical research and practice. This article offers a definition for cutpoints, describes strategies for determining actionable cutpoints, and discusses considerations related to interpreting cutpoints in clinical applications.

Methods:

We clarify the definition of cutpoints for PRO measures and summarize the major statistical approaches for identifying cutpoints, including multivariate analysis of variance and receiver operating characteristic and regression modeling.

Discussion:

We review issues related to cutpoint determination and interpretation that should be considered when integrating PROs into clinical research and practice, including the selection of anchors, variability of cutpoints, and clinical burden that may be generated when a cutpoint is used as a threshold for further clinical action.

Key Points:

Cutpoints are widely used to categorize PRO responses in both clinical research and practice. Cutpoints can be derived for PRO measures regardless of the response scale used; however, the mild, moderate, and severe categories generated from numeric cutpoints are distinct from the mild, moderate, and severe categories found in some PRO measures that use verbal descriptors as response options. Bootstrap analysis is recommended to quantify the variability of cutpoints. The application of cutpoints is limited by how well the anchors are chosen and how cutpoints developed using group-level data are applied at the individual level.
Engaging Patients and Clinicians in Online Reporting of Adverse Effects During Chemotherapy for Cancer
Authors: Absolom Kate , Gibson Andrea , Velikova Galina
Published: April 2019

Introduction:

During cancer treatment the timely detection and management of adverse events is essential for patient safety and maintaining the quality of life. Electronic patient self-Reporting of Adverse events: Patient Information and aDvice (eRAPID) was devised to support oncology practice, by allowing patients to self-report symptoms online at home during and beyond cancer treatment. Fundamentally the eRAPID intervention delivers immediate severity-tailored feedback directly to patients to guide self-management strategies or hospital contact. Patient data are available in electronic health records for hospital staff to access and review as part of clinical assessments.

Methods for Interpreting and Addressing Patient-Reported Outcome (PRO) Scores:

The eRAPID intervention has 5 main interconnecting components (clinical integration into standard care pathways, patient symptom reports, self-management advice, information technology, and staff/patient training). Following guidance for the development of complex interventions and using a mixed methods approach, eRAPID was created through a number of stages and tested in a series of usability settings before undergoing systematic evaluation in a randomized controlled trial. These developmental stages are described here with a focus on how decisions were made to enhance patient and professional engagement with symptom reports and encourage interpretation and clinical utilization of the data.

Discussion:

Clinically embedded PRO interventions involve a number of elements and stakeholders with different requirements. Following extensive developmental work eRAPID was pragmatically designed to fit into current oncology practices for reviewing and managing chemotherapy-related toxicities.
A Case Management System for Integrating Patient-reported Outcome Assessment in Clinical Practice
Authors: Zahrieh David , Alexander Alex , Fruth Briant , Tan Angelina D. , Le-Rademacher Jennifer , Warsame Rahma , Croghan Katrina , Sloan Jeff A.
Published: April 2019

Introduction:

What if you could only ask one question of the patient during a clinic visit? Further, suppose the patient’s biggest concern can pragmatically be incorporated into routine clinical care and clinical pathways that can address the patient’s single biggest concern can be identified. If the principal concern can be dealt with efficiently at each visit through key stakeholder case management, positive outcomes should result. Therefore, motivated by the need for patient-centered health care visits, the Beacon electronic patient-reported outcomes (PRO) quality of life (QOL) tool was developed.

Methods:

Central to the tool is that at each health care visit, the patient’s biggest concern is electronically communicated to the health care team. Therefore, the tool can help catalyze important discussions between the health care team and the patient, perhaps on topics that would not have been discussed otherwise at a routine visit. In recognition of the community of resources needed to provide comprehensive care, the tool generates clinical pathways or actions that can be pursued to address the patient’s biggest concern. The concern is efficiently triaged such that members of the health care community with appropriate expertise and resources are identified to address and manage that single biggest concern signaled by the patient. A report, which can be uploaded into the patient’s medical chart, is created and provides a list of resources for a case manager to assist the patient and contains graphical presentations of the patient’s QOL and a history of prior concerns. The report also labels potentially significant changes in QOL.

Discussion:

The tool, which has been applied successfully in several health conditions, acts as a beacon to health care providers so that a patient’s self-reported concern can be consistently and effectively integrated into their care.

Key Points:

It is impractical to try to deal with every patient concern in every visit. The key to the Beacon tool is that at each visit the patient’s biggest concern is identified, clinical pathways indicated, and resources efficiently matched to address the patient’s biggest concern.
A Rasch Measurement Theory Approach to Improve the Interpretation of Patient-reported Outcomes
Authors: Browne John P. , Cano Stefan J.
Published: April 2019

Introduction:

Interpretability is a key challenge for researchers, clinicians, and patients interested in using the output of patient-reported outcome (PRO) instruments. When rich and detailed meaning is required to assist individual patients to make treatment choices we propose that the item content of psychometric rating scales should be better leveraged to improve interpretability.

Methods:

Modern psychometric methods such as Rasch measurement theory allow PRO users to map patient progress up or down a scale over time to item benchmarks. These benchmarks represent the relative difficulty associated with each item contained in a scale. The most difficult items benchmark the best overall outcome on a scale and the least difficult items represent the worst overall outcome. The group-level effects of different treatment options can also be mapped to item benchmarks and compared with those of individual patients.

Discussion:

The proposed method leverages the content already available in PRO instruments to improve interpretation. This approach locates both individuals (in this instance breast cancer patients undergoing surgery) and treatments (in this instance breast reconstruction techniques), on a hierarchy of health variables where each variable represents a progressively more advanced step in the recovery process. The approach can specify the aspects of a health concept where patients are currently competent, and the aspects which they might gain from a new treatment. It can also assist attempts by industry to communicate specific treatment benefits to their target audience.

Key Points:

The method is best applied when patients need guidance about the likely benefits of different treatment options, when a PRO instrument has been developed using a modern psychometric method such as Rasch measurement theory, when there is good evidence from well-conducted studies of the group-level benefits of different treatment options, and these benefits have been measured using appropriate PROs. The method depends on good “fit” of individual patient responses to an underlying model. However, even when fit is poor it may be useful for patients to understand the “ladder” of health achievements for their condition (from the perspective of the average patient) and where different treatment options sit on this ladder.