bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal diagnosis and ultrasonographic findings of partial trisomy of chromosome 6q
Authors: Li Linlin , Yu Yang , Zhang Han , Jiang Yuting , Liu Ruizhi , Zhang Hongguo
Published: January 2021

Rationale:

Partial trisomy of the long arm of chromosome 6 syndrome is a rare chromosomal disorder with distinctive phenotypic expressivity, in which cytogenetic abnormalities are usually reported in infancy and childhood. Ultrasonographic findings on trisomy of the distal long arm of chromosome 6 in previous studies are limited.

Patient concerns:

A 32-year-old, gravida 6, para 1, pregnant woman who had 4 spontaneous abortions underwent a clinical ultrasound examination at 26 weeks of gestation.

Diagnoses:

Ultrasonographic findings were microcephaly, an acoustic image of a transparent septum, a flat nasal bridge, right pulmonary artery stenosis, and a single umbilical artery. Cytogenetic and single-nucleotide polymorphism array analyses were performed to estimate genetic factors of this diagnosis by amniocentesis.

Interventions:

After genetic counseling, the patient and her husband opted to terminate the pregnancy.

Outcomes:

Cytogenetic examination of the fetus showed the karyotype 46,XX,der(20)t(6;20)(q24;p13). The single-nucleotide polymorphism (SNP) array showed a 22.104-Mb duplication of 6q24.3q27 and a 0.784-Mb deletion of 20p13.

Lessons:

Ultrasonographic findings of fetal abnormalities, including microcephaly, an acoustic image of a transparent septum, a flat nasal bridge, right pulmonary artery stenosis, and a single umbilical artery, may be related to a 22.104-Mb duplication of 6q24.3q27 and a 0.784-Mb deletion of 20p13. More ultrasonographic and genotype studies are required to extend the phenotypic characterization of partial trisomy 6q syndrome.
Lusutrombopag as a substitute for platelet transfusion for thrombocytopenia associated with chronic liver disease in a patient undergoing endoscopic spinal surgery
Authors: Kaneko Takeshi , Takano Yuichi , Ishibashi Katsuhiko
Published: January 2021

Introduction:

Bleeding may interfere with the visual field and create difficulties in performing the intended treatment, especially in operations involving a small working space such as endoscopic spinal surgery. Therefore, it is important to reduce the risk of bleeding before surgery.

Patient concerns:

A 76-year-old female presented with a history of right anterior thigh pain along the L3 dermatome for 3-years, following a L3 compression fracture. In addition, the patient had developed autoimmune hepatitis at 50 years of age, and the platelet count on laboratory blood collection was 78 × 109/L.

Diagnosis:

Magnetic resonance (MR) images showed a narrowed foramen at the L3–4 level. L3 nerve block was effective. L3 foraminal-stenosis was suspected.

Interventions:

Micro-endoscopic laminectomy (MEL) for foraminal decompression was planned due to possible L3 nerve root compression. Lusutrombopag, a thrombopoietin (TPO) receptor agonist, was orally administered for 7 days starting 7 days preoperatively to address the risks of bleeding.

Outcomes:

The patient successfully underwent MEL without any adverse events or complications.

Conclusion:

The results obtained from the use of lusutrombopag suggested that safety measures could be implemented preoperatively, and that lusutrombopag may be a useful supplemental drug for minimally invasive treatment of patients with cirrhosis and thrombocytopenia.
Intraoperative finding and management of complete spinal cord transection after thoracolumbar traumatic fracture-dislocation
Authors: Lim Dong-Ju
Published: January 2021

Rationale:

We report the first case of the management of spinal cord transection due to thoracolumbar fracture-dislocation in human beings. There are several case reports of cord transection, but only radiological findings have been reported; we report intraoperative findings and management.

Patient concerns:

A 53-year-old man presented to the hospital after falling. He had no motor power or sensation below T10 (below the umbilicus area) dermatome level. American Spinal Injury Association (ASIA) impairment scale was grade A. Magnetic resonance imaging and computed tomography demonstrated a fracture and translation of the vertebral body at the T11-T12 level and anterior displacement of T11 on T12, with complete disruption of the spinal cord.

Diagnosis:

Complete spinal cord resection due to T11-T12 fracture-dislocation.

Interventions:

We performed spinal fusion with pedicle screw instrumentation (T10-L1) and autobone graft and decompression and repaired the dural sac to prevent cerebrospinal fluid leakage. There was no neurological recovery either immediately or 4 years post-operation at follow-up.

Conclusion:

To the best of our knowledge, this report is the first on the intraoperative finding and management of the complete transection of the spinal cord in thoracolumbar spine injury. Perfect fusion is required to facilitate rehabilitation and daily living, prevent neurogenesis, and prevent unnecessary pain such as phantom pain.
Anatomical study of the ideal cortical bone trajectory in the lumbar spine
Authors: Zhao Yong-Hui , Ma Yu-Long , Wang Long , Liang Jin-Long , Luo Hao-Tian , Xu Yong-Qing , Lu Sheng
Published: January 2021

Background:

To explore the ideal trajectory of lumbar cortical bone trajectory screws and provide the optimal placement scheme in clinical applications.

Methods:

Lumbar computed tomography (CT) data of 40 patients in our hospital were selected, and the cortical vertebral bone contour model was reconstructed in three dimensions (3D). Depending on the different regions of the screw through the entrance and exit of the pedicle, 9 trajectories were obtained through combinational design: T-Aa, T-Ab, T-Ac, T-Ba, T-Bb, T-Bc, T-Ca, T-Cb, and T-Cc. Cortical bone trajectory (CBT) screws with appropriate diameters were selected to simulate screw placement and measure the parameters corresponding to each trajectory (screw path diameter, screw trajectory length, cephalad angle, and lateral angle), and then determine the optimal screw according to the screw parameters and screw safety. Then, 23 patients in our hospital were selected, and the navigation template was designed based on the ideal trajectory before operation, CBT screws were placed during the operation to further verify the safety and feasibility of the ideal trajectory.

Results:

T-Bc and T-Bb are the ideal screw trajectories for L1–L2 and L3–L5, respectively. The screw placement point is located at the intersection of the inner 1/3 vertical line of the superior facet joint and the bottom 1/3 horizontal line of the outer crest of the vertebral lamina (i.e., 2–4 mm inward at the bottom 1/3 of the outer crest of the vertebral lamina). CBT screws were successfully placed based on the ideal screw trajectory in clinical practice. During the operation or the follow-up period, there were no adverse events.

Conclusion:

CBT screw placement based on the ideal screw trajectory is a safe and reliable method for achieving effective fixation and satisfactory postoperative effects.
Predictive value of LncRNA on coronary restenosis after percutaneous coronary intervention in patients with coronary heart disease
Authors: Liu Shengxiang , Yang Guokang , Huang Yupeng , Zhang Cheng , Jin Hongyan
Published: January 2021

Background.

Evidence shows that long-stranded non-coding RNA (LncRNA) can predict coronary artery restenosis in patients suffering from coronary heart disease after percutaneous coronary intervention, suggesting that LncRNA may become a promising biomarker for the diagnosis of coronary artery restenosis after percutaneous coronary intervention. However, its accuracy has not been systematically evaluated. Therefore, it is necessary to perform meta-analysis to certify the diagnostic value of LncRNA on coronary artery restenosis after percutaneous coronary intervention.

Methods.

PubMed, EMBASE, Cochrane Library, and Web of Science were searched for relevant studies to explore the potential diagnostic values of LncRNA on coronary artery restenosis after percutaneous coronary intervention from inception to December 2020. Data were extracted by two experienced researchers independently. The risk of bias about the meta-analysis was confirmed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Data was synthesized and heterogeneity was investigated as well. All of the above statistical analysis was carried out with Stata 14.0.

Results.

This study proved the pooled diagnostic performance of LncRNA on coronary artery restenosis after percutaneous coronary intervention.

Conclusion.

This study clarified confusions about the specificity and sensitivity of LncRNA on coronary artery restenosis after percutaneous coronary intervention, thus further guiding their promotion and application.

Ethics and dissemination.

Ethical approval is not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. This review would be disseminated in a peer-reviewed journal or conference presentations.

OSF registration number:

DOI 10.17605/OSF.IO/4QT2P.
Retrospective study of relationship between vastus medialis volume on SPECT-CT and outcome of unilateral total knee arthroplasty
Authors: Kim Hyeong Jik , Park Hyung Jun , Oh Jong Byung , Chang Moon Jong , Kang Seung-Baik , Kim Yu Kyeong , Oh So Hee , Chang Chong Bum
Published: January 2021

Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography–computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.

This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.

The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.

Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.
Inadvertent stapling of the orogastric tube during bariatric surgery
Authors: Çalikoğlu İsmail , Özgen Görkem , Yerdel Mehmet Ali
Published: January 2021

Background:

Entrapment of an orally introduced tube by stapling/stitching is an intra-operative complication of bariatric surgery with grave consequences. Incidence is unknown. No prevention/management strategy is available. A systematic review was performed to assess the absolute reported observed risk and incidence. Additionally, data on 3 cases during our entire sleeve gastrectomy (SG) experience is evaluated.

Methods:

Literature is reviewed using PubMed/Web of science data-bases. Data was recorded prospectively. Videos of orally introduced tube staplings were re-watched, presentation/recognition/management were re-evaluated. A protocol ensuring the removal of the small caliber orogastric tube (OGT) by the surgeons direct inspection was introduced after the 3rd entrapment.

Results:

Review revealed OGT as the most commonly entrapped tube following temperature probe and bougie. SG/stapling were the most common causative operation/reason, respectively. Leak rates over 20%, conversion, early-late re-operations and mortality were reported. During our 948 consecutive SGs, 3 OGT entrapments (0.32%), third one with double stapling, occurred. All were recognized/managed intraoperatively by freeing the entrapped-end of the OGT from the sleeve part of the staple-line. In doubly stapled case, second transected end could only be recognized when routine reinforcement suturing come in proximity. Defects were continuously stitched with barbed suture. No morbidity occurred. One-year excess-weight-loss was 82%. A pre-protocol incidence of 0.56% (n: 3/534) dropped to nil in the remaining 414.

Conclusion:

Iatrogenic stapling of the OGT during SG is rare, but morbid. It must be avoided by a strict protocol. Upon occurrence/recognition, stapling must immediately stop until the “entirety” of the tube, including the “specimen-part”, is retrieved, to avoid double entrapment.
Clinicopathologic features of single bone metastasis in breast cancer
Authors: Karatas Murat , Zengel Baha , Durusoy Raika , Tasli Funda , Adibelli Zehra , Simsek Cenk , Uslu Adam
Published: January 2021

The most common site for metastasis in patients with breast cancer is the bone. In this case series, we investigated patients whose surgical and medical treatment for primary breast cancer was conducted at our center and first disease recurrence was limited to only 1 bone.

We analyzed 910 breast cancer patients, 863 had no metastasis and 47 cases had a single bone metastasis ≥ 6 months after their first diagnosis. Demographic, epidemiological, histopathological and intrinsic tumor subtype differences between the non-metastatic group and the group with solitary bone metastases and their statistical significance were examined. Among established breast cancer risk factors, we studied twenty-nine variables.

Three variables (Type of tumor surgery, TNM Stage III tumors and mixed type (invasive ductalcarsinoma + invasive lobular carcinoma) histology) were significant in multivariate logistic regression analysis. Accordingly, the risk of developing single bone metastasis was approximately 15 times higher in patients who underwent mastectomy and 4.8 and 2.8 times higher in those with TNM Stage III tumors and with mixed type (invasive ductal carcinoma + invasive lobular carcinoma) histology, respectively.

In conclusion, the risk of developing single bone metastasis is likely in non-metastatic patients with Stage III tumors and possibly in mixed type tumors. Knowing this risk, especially in patients with mixed type tumors, may be instrumental in taking measures with different adjuvant therapies in future studies. Among these, treatment modalities such as prolonged hormone therapy and addition of bisphosphonates to the adjuvant treatments of stage III and mixed breast cancer patients may be considered.
Therapeutic effect of Chinese herbal medicines for post-stroke depression
Authors: Zhang Huajun , Li Ming , Xu Tianshu
Published: January 2021

Background:

Whether the addition of Chinese herbal medicine (CHM) in routine western medicines for post-stroke depression yields additional therapeutic effects still remains to be controversial. This study aimed to assess the efficacy and safety of combination of CHM with routine western medicines versus routine western medicines alone in patients with post-stroke depression (PSD).

Methods:

Electronic databases such as PubMed, EmBase, Cochrane library, and China National Knowledge Infrastructure were systematically searched from inception till October 2019. Studies designed as randomized controlled trials (RCTs) and that investigated the therapeutic effects of CHM plus routine western medicines (CHM group) versus routine western medicines alone (control group) in PSD patients were eligible. The relative risk (RR) and weighted mean difference (WMD) with 95% confidence interval (CI) were used to assess the categories and continuous data using random-effects model. Software STATA was applied to perform statistical analysis (Version 10.0; StataCorp, TX,).

Results:

A total of 18 RCTs involving a total of 1,367 PSD patients were selected for final analysis. The effective rate in CHM group was significantly higher than that in control group (RR: 1.18; 95%CI: 1.12–1.24; P < .001). Moreover, patients in CHM group showed association with lower Hamilton Depression Rating Scale (WMD: -3.17; 95%CI: -4.12 to -2.22; P < .001) and Scandinavian Stroke Scale (WMD: -3.84; 95%CI: -5.73 to -1.96; P < .001) than those in control group. Furthermore, patients in CHM were associated with high level of Barthel Index than those in control group (WMD: 11.06; 95%CI: 4.01 to 18.10; P = .002). Finally, patients in CHM group had lower risk of gastrointestinal (RR: 0.49; 95%CI: 0.31–0.77; P = .002) and neurological (RR: 0.50; 95%CI: 0.33–0.75; P = .001) adverse events than those in control group.

Conclusions:

The study findings revealed that addition of CHM to routine therapies could improve the therapeutic effects and reduce gastrointestinal or neurological adverse events.
Does patient's expectation benefit acupuncture treatment?
Authors: Yang Zuoqin , Li Yan , Zou Zihao , Zhao Ying , Zhang Wei , Jiang Huiling , Hou Yujun , Li Ying , Zheng Qianhua
Published: January 2021

Background:

Patients’ expectation to treatment response is one source of placebo effects. A number of randomized controlled trials (RCTs) reported that expectation benefits to acupuncture treatment, while some did not. Previous systematic reviews failed to draw a confirmative conclusion due to the methodological heterogeneity. It is necessary to conduct a new systematic review to find out whether expectation can influence acupuncture outcomes.

Methods:

We systematically search English and Chinese databases from their inception to 3rd October, 2020, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese BioMedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP). RCTs that evaluated the relationship between expectation and treatment response following acupuncture for adults will be included. Study selection, data extraction, and risk of bias assessment will be conducted independently. Risk of bias will be assessed by the Cochrane risk of bias assessment tool. Data synthesis will be performed by Review Manager (RevMan) software if the data is suitable for synthesis.

Results:

This systematic review will provide evidence that whether patients’ expectation impacts on the therapeutic effects of acupuncture. This protocol will be performed and reported according to the Preferred Reporting Items from Systematic Reviews and Meta-analysis Protocols (PRISMA-P) statement. The findings of this review will be disseminated through peer-reviewed publications and conference presentations.

Conclusion:

This systematic review aims to assess whether a higher level of patient's expectation contributes to a better outcome after acupuncture treatment, and in which medical condition this contribution will be more significant.

INPLASY registration number:

INPLASY2020100020 on International Platform of Registered Systematic Review and Meta-analysis Protocols.
Different Chinese patent medicine therapies for migraine
Authors: Hu Liangen , Yan Zhangren , Chen Feng , Xiao Wei , Liu Liting , Huang Chunhua
Published: January 2021

Background:

Migraine is a clinically high incidence rate of neurovascular disease. It is a recurrent headache. It is characterized by nausea, vomiting, fear of voice, and photophobia. Nowadays, a large number of randomized controlled clinical studies have shown that Chinese patent medicine has the advantages of good curative effect and high safety in the treatment of migraine. However, due to the variety of proprietary Chinese medicines, their relative effectiveness and safety have not yet been verified. Therefore, this study will use the network meta-analysis method to verify the effectiveness and safety of different kinds of Chinese patent medicines in the treatment of migraine.

Methods:

All randomized controlled trials of Toutongning capsule, Yangxue Qingnao granule, naoxintong capsules, Tianmagouteng granules in the treatment of migraine were searched from PubMed, Cochrane Library, web of science, EMBASE, sinomed, CNKI, Wanfang database, VIP. The retrieval time is from the establishment of the database to November 18, 2020. In order to avoid omission, we will manually retrieve relevant references and conference papers. According to the inclusion and exclusion criteria, we evaluated the quality and risk of all the retrieved literatures. Methodological quality assessment and bias risk will be assessed using the Cochrane bias risk tool. Revman 5.3, WinBUGS 1.4.3, and stata14.2 software will be used for all data analysis.

Results:

This study will directly or indirectly compare the effectiveness of different interventions on migraine outcome indicators, and rank the effectiveness. The main outcome measures included total effective rate (total effective rate = rocovery + obvious effective + effective/total number of cases × 100%), visual analogue scale (VAS) score, and secondary outcome indicators included analgesic effect evaluation index and quality of life scale.

Conclusion:

To provide evidence for evidence-based medicine and clinical researchers to choose more effective Chinese patent medicines to treat migraine.
Optimal intervention time and risk of the activating blood and removing stasis method in acute cerebral hemorrhage patients
Authors: Ma Ying , Zhang Dongmei , Lv Zhiguo , Cui Yabin , Fei Yutong , Chang Tianying , Yu Mingkun , Lu Jing , Huang Qingxia , Zhang Ying , Xu Peng , Lan Tianye , Wang Jian
Published: January 2021

Introduction:

Stroke is the leading cause of disability-adjusted life years in neurological diseases and has become one of the top 3 fatal diseases in the world. Cerebral hemorrhage accounts for approximately 18% to 24% of all strokes in Asian countries. Cerebral hemorrhage is one of the most destructive subtypes of stroke and has high morbidity and mortality. Based on the current research, it has been confirmed that neither surgical treatment nor current drug treatment is the most preferred treatment. Traditional Chinese medicine (TCM) is increasingly being used to treat cerebral hemorrhage, and the activating blood and removing stasis (ABRS) method has received more attention. At present, there is still a lack of high-quality clinical research on the treatment of acute cerebral hemorrhage.

Method:

We designed a multicenter, prospective, randomized, double-blind, placebo-controlled clinical trial. We aim to recruit 312 cerebral hemorrhage patients aged 18 to 80 years within 24 to 72 hours after onset. In addition to routine treatment, participants will randomly receive ABRS granules or placebo for 14 days. Those enrolled within 24 to 48 hours after onset will enter strata A, and those enrolled within 49 to 72 hours (including 48–49 hours) after onset will enter strata B. The strata sample size ratio will be 1:1. The primary outcome is the disability degree (modified Rankin Scale score, mRS) at 6 months after onset. The secondary outcomes include the percentage of hematoma enlargement after treatment, Barthel index (BI), National Institutes of Health stroke scale (NIHSS) score, mortality rate, all-cause mortality rate, TCM stroke syndrome evaluation scale score, and adverse events.

Discussion:

The study is expected to confirm the safety and effect of acute cerebral hemorrhage within 24 to 72 hours treated with the ABRS method and to determine the optimal time for intervention in this period.

Trial registration number:

ChiCTR1900022627
Anesthetic considerations in hyperparathyroid crisis
Authors: Kong Hao , Zhang Zhen , Zhang Hong
Published: January 2021

Introduction:

Hyperparathyroid crisis is a rare and potentially life-threatening complication of severe calcium intoxication. Parathyroidectomy is the only curative method for hyperparathyroid crisis. Several case reports and case series have been published on the medical and surgical treatments for hyperparathyroid crisis, however, few reports have focused on the associated perioperative anesthetic management.

Patient concerns:

A 48-year-old Chinese woman presented with a 2-week history of nausea and vomiting and complained of mental status alteration including confusion and agitation in the 24 hours prior to her admission. She denied any history of past illness. Laboratory tests showed severe hypercalcemia crisis with a serum calcium level of 5.21 mmol/L and a serum intact parathyroid hormone level of > 5000 pg/mL.

Diagnosis:

The diagnosis was hyperparathyroid crisis, acute kidney injury, acute liver injury, rhabdomyolysis, infection, and shock.

Interventions:

She underwent initial management with aggressive intravenous fluid resuscitation, loop diuretic treatment, vitamin D supplement, intravenous bisphosphonates, and calcitonin therapy. However, her condition worsened, and she was transferred to the operating theater for a parathyroidectomy under general anesthesia. She was under general anesthesia and monitored with electrocardiogram, pulse oxygen saturation, continuous arterial blood pressure, central venous pressure and nasopharyngeal temperature. Cardiac output and stroke volume variation were monitored from the FloTrac system. After liberal fluid rehydration, circulatory support, cooling treatment and calcium supplement after tumor removal, her unstable vital signs gradually improved.

Outcomes:

After meticulous anesthetic management by the anesthesiologist and complete tumor resection by the surgeon, she survived this fatal disease. The patients was discharged on postoperative day 37 without any sequelae.

Lessons:

Patients with hyperparathyroid crisis should undergo a thorough preoperative evaluation. Difficult airway, fluid depletion, multiple organ dysfunction, hypercoagulability, and concomitant diseases are the primary challenges in anesthetic management. After tumor removal, the serum calcium level should be monitored closely and calcium should be supplemented in a timely manner to prevent serious complications.
Clinicopathologic features and clinical outcomes of intravenous leiomyomatosis of the uterus
Authors: Yu Xiuzhang , Fu Jing , Cao Ting , Huang Liyan , Qie Mingrong , Ouyang Yunwei
Published: January 2021

Rationale:

Intravenous leiomyomatosis (IVL) is a rare and special type of smooth muscle tumor originating in the uterus. It is classified as a benign disease according to its histological features but shows the behavioral characteristics of a malignant tumor. It is easily misdiagnosed and recurrent. The purpose of this study was to retrospectively analyze clinicopathological data of 25 cases of IVL in order to enhance clinicians’ understanding of this rare disease.

Patient concerns:

We screened and identified 25 cases of IVL at our hospital from October 2013 to January 2020. Five patients had tumors.

Diagnoses:

The diagnosis in each case was pathologically confirmed after surgical treatment.

Interventions:

All patients were managed surgically. Although the surgical procedures were different, the surgical approach was geared towards achieving complete excision. Three patients received hormonal therapy with gonadotropinreleasing hormone agonists after surgery.

Outcomes:

We retrospectively reviewed all medical records and analyzed the clinicopathologic features and clinical outcomes of this disease as well as the correlations between the clinical features and risk of recurrence. Neither the symptoms nor the preoperative imaging results were suggestive of IVL in any of the cases. Except for two patients who were lost to follow-up, twenty-three patients who were followed up are still alive. Three patients experienced a recurrence.

Lessons:

The clinical manifestations and ultrasound images of IVL in the early stages are not typical; thus, IVL is easily misdiagnosed as uterine leiomyoma. Radiologists, pathologists, and surgeons should have a thorough understanding of IVL and a high index of vigilance for IVL in clinical practice. Surgery should always be aimed at achieving complete tumor excision. Patients with large lesions (≥7 cm) and lesions extending to the broad ligament may have an increased risk of recurrence. Early detection, diagnosis, and treatment are very important; once the diagnosis is confirmed, regular follow-ups are crucial.
Dichorionic twin pregnancy with sirenomelia and chromosomal anomaly in 1 fetus
Authors: Ting Yuan , Xue-Lan Li , Chun-Bao Wang , Ting Zhang , Fen Li , Zhen Han
Published: January 2021

Rationale:

Sirenomelia is a rare congenital malformation that threatens fetal survivals. The cases in which twin with sirenomelia and chromosomal abnormality have been seldomly reported. We reported a dichorionic twin case in which one twin had sirenomelia, the other twin had a normal phenotype, and they had different chromosomal abnormalities.

Patient concerns:

The abnormal twin was found at 22 weeks by ultrasound. The sirenomelia fetus was complicated with a thoracic stenosis, enlarged rectum without anal opening, the absence of bilateral kidneys, a single umbilical artery, a single lower limb, the abnormal curvature of spine, double outlet of right ventricle, which were the indicatives of the chromosome detection.

Diagnosis:

The copy number variation of the sirenomelia fetus was detected as a deletion of 4.8Mb in 11p11.12-11q11. The co-twin was found with del(Y)(q11.223q11.23), which was as the same as his father's. The mother had normal chromosome. The parents had normal phenotypes. It was firstly reported a microdeletion with sirenomelia fetus.

Interventions:

There was no specific treatments for the twins.

Outcomes:

Intrauterine death of the sirenomelia fetus was found at 27 weeks and postnatal death after inevitable abortion happened to the co-twin.

Lessons:

Prenatal ultrasound was responsible for recognizing sirenomelia, and the detailed ultrasound scanning and chromosome detection should be done for the co-twin. The etiology of sirenomelia remains unclear, and genetic detection is also necessary for its pathogenesis research.
Manipulation of intertrochanteric fractures in patients with below- or above-knee amputation using a fracture table
Authors: Lee Sang-Min , Suh Kuen Tak , Oh Young Kwang , Shin Won Chul
Published: January 2021

Rationale:

In general, in the case of an intertrochanteric hip fracture, surgery is performed using a fracture table and by fixing the patient's foot to the boot piece. In patients with amputation of the affected lower limb, it is impossible to fix the foot to the boot piece; therefore, the traction and rotation of the fracture site cannot be maintained, leading to improper patient positioning. In such cases, a fracture table cannot be used intraoperatively to stabilize the fracture site. We report 2 cases of successful intertrochanteric fracture reduction using a fracture table for patients with below- or above-knee amputation.

Patient's concerns:

Both patients presented with left hip pain resulting from a fall.

Diagnosis:

Two elderly male patients with prior limb amputations below or above the knee presented with intertrochanteric hip fractures. Previous amputation of the lower limb on the same side of the fracture made it difficult to use a fracture table intraoperatively to stabilize the fracture site.

Intervention:

We performed fracture reduction using a modified fracture table for each patient. By altering the rotation of the boot piece and using additional skin traction bands, we could maintain proper patient positioning and rotation direction and obtain sufficient traction force.

Outcomes:

The chosen outcomes were fracture alignment and union at the end of follow-up and the ability to walk and perform activities of daily living. Reduction and intramedullary nail fixation using the fracture table were successful in both cases. Appropriate fracture union was achieved within 6 months, and the preoperative walking ability and activities of daily living were recovered in both patients, who were followed-up for 28 and 24 months.

Lessons:

Modification of the usual fracture table to suit patients with lower limb amputation helped us successfully perform intertrochanteric hip fracture surgery with the usual levels of traction and rotation required of the fracture site.
Clinical application of next-generation sequencing for the management of desmoid tumors
Authors: Lee Jeong Mi , Kim Han Gyeol , Shin So Youn , Lee Seung Hyeun
Published: January 2021

Rationale:

Desmoid tumors are rare myofibroblastic neoplasms characterized by local invasiveness and high rates of recurrence, and sometimes mimic local recurrence of previously resected malignancies. Previous studies have suggested that molecular profiling may be useful for the diagnosis of the tumors and risk stratification. However, the clinical utility of next-generation sequencing (NGS) for the management of desmoid tumors has not been established.

Patient concerns:

A 42-year-old man visited our clinic for routine follow-up 1 year after left upper lobe lingular segmentectomy for lung adenocarcinoma.

Diagnoses:

Chest computed tomography showed a pleural mass adherent to the thoracotomy site. Positron emission tomography revealed mildly increased metabolism with a maximal standardized uptake value of 2.7 within the tumor, suggesting local recurrence of the previous neoplasm. Exploratory thoracotomy and en bloc resection of the tumor revealed spindle cells in a massive collagenous tissue consistent with a desmoid tumor.

Interventions:

NGS was performed to confirm the diagnosis and to identify any genetic alterations that might be relevant to the prognosis of this tumor. The tumor harbored an S45F mutation in CTNNB1, which has been correlated with a high recurrence rate. Therefore, we performed adjuvant radiotherapy on the resection bed at a dose of 56 Gy.

Outcomes:

The patients experienced no postoperative or radiotherapy-related complications. Periodic follow-up examinations using computed tomography were performed every 3 months, and no evidence of recurrence of either tumor was observed during the 38 months after the last surgery.

Lessons:

To the best of our knowledge, this is the first case reporting the clinical application of NGS and aggressive treatment based on the genotyping results for the management of a desmoid tumor. Our case highlights the need to consider desmoid tumors among the differential diagnoses when a pleural mass is encountered at a previous thoracotomy site. More importantly, molecular profiling using NGS can be useful for the establishment of a treatment strategy for this tumor, although further investigations are required.
Impact of the numbers of injections of platelet rich plasma on the clinical outcomes in patients with knee osteoarthritis
Authors: Wang Pan , Li Kai , Jiang Zuxin , Qiu Beiming , Nie Cheng , Luo Hongsheng , Li Zhengjiang
Published: January 2021

Background:

Two published meta-analyses have investigated the effects of the number of injections of platelet rich plasma (PRP) on clinical outcomes in knee osteoarthritis patients, however conflicting findings were generated.

Methods:

We will systematically search PubMed, Embase, and China National Knowledgement Infrastructure (CNKI) to capture additional eligible studies. After screening citations, extracting essential data, assessing the risk of bias, we will use RevMan software and Open BUGS to perform head-to-head and network meta-analysis of pain alleviation and improvement of joint functionality, respectively.

Discussion:

Knee joint osteoarthritis (KOA) is the main cause of joint degeneration in elderly, which seriously reduces patients quality of life. Although intra-articular PRP has been extensively prescribed to treat KOA, a definitive conclusion about the appropriate number of injections has not yet been generated in published meta-analyses. The present updated network meta-analysis will comprehensively answer this question.

Ethics and dissemination:

We will communicate our findings through participating in academic conferences or submiting it to be considered for publication in peer reviewed scholar journal.

INPLASY registration number:

We registered this protocol in International Plateform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) platform and obtained an identifier of INPLASY2020110043 (https://inplasy.com/inplasy-2020-11-0043/).
Differential cytology profiles in bronchoalveolar lavage (BAL) in COVID-19 patients
Authors: Vedder Vanessa , Schildgen Verena , Lüsebrink Jessica , Tillmann Ramona Liza , Domscheit Birgitta , Windisch Wolfram , Karagiannidis Christian , Brockmann Michael , Schildgen Oliver
Published: January 2021

Brochoalvelolar lavages (BALs) from patients suffering from hospitalized infections with SARS-CoV-2, other corona viruses (human coronavirus (HCoV)-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1), Influenza virus type A and B, Haemophilus influenzae and Pneumocystis jirovecii were compared cytopathologically.

The aim of the study was to evaluate if the cellular profile detectable in BAL may be specific for the respective pathogens and could lead to diagnosis of COVID-19 even in the absence of PCR results.

Differential cytology and flow cytometry datasets of 62 patients were observed and compared.

We observed a significant association between individual cell pattern changes and the causing pathogen, but no general cell distribution pattern.

The cytology pattern of the BAL fluid in COVID-19 is not specific enough to use it as a sole diagnostic criterion, although it may support clinical decision making
Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China
Authors: Chen Jing , You Huaxuan , Liu Yan , Kong Qian , Lei Anjiang , Guo Xiujing
Published: January 2021

The physical and psychological condition of patients with gynaecological cancer has received much attention, but there is little research on spirituality in palliative care. This study aimed to investigate spiritual well-being and its association with quality of life, anxiety and depression in patients with gynaecological cancer. A cross-sectional study was conducted in China in 2019 with 705 patients diagnosed with primary gynaecological cancer. European Organisation for Research and Treatment of Cancer quality of life instruments (EORTC QLQ-SWB32 and EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale were used to measure spiritual well-being, quality of life, anxiety and depression. Univariate and multiple linear regression analyses were performed to examine associations between spiritual well-being, quality of life, anxiety and depression. Functioning scales and global health status were positively correlated with spiritual well-being (P < .05). Anxiety and depression were negatively correlated with spiritual well-being (P < .05). Depression (−0.362, P < .001) was the strongest predictor of Existential score. Anxiety (−0.522, P < .001) was the only predictor of Relationship with self. Depression (−0.350, P < .001) and Global health (0.099, P = .011) were the strongest predictors of Relationship with others. Religion (−0.204, P < .001) and Depression (−0.196, P < .001) were the strongest predictors of Relationship with someone or something greater. Global health (0.337, P < .001) and Depression (−0.144, P < .001) were the strongest predictors of Global-SWB. Well spiritual well-being is associated with lower anxiety and depression, and better quality of life. Health providers should provide more spiritual care for non-religious patients and combine spiritual care with psychological counselling to help patients with gynaecological cancer, especially those who have low quality of life or severe symptoms, or experience anxiety or depression.
Fatal intracardiac and pulmonary arterial thromboembolic damage following ABO-incompatible living donor liver transplantation for autoimmune hepatitis
Authors: Choi Won Kyu , Kim Junghan , Choi Ho Joong , Hong Sang Hyun , Chae Min Suk
Published: January 2021

Rationale:

We present the case of a patient with autoimmune hepatitis who suffered fatal intracardiac and pulmonary arterial thromboembolic complications after ABO-incompatible living donor liver transplantation (ABOi LDLT) with splenectomy.

Patient concerns:

A 46-year-old female (blood type B+) with autoimmune hepatitis and hepatitis B carrier status underwent elective ABOi LDLT. The donor liver was from a 51-year-old male living donor (blood type A+). A splenectomy was performed without bleeding complications. Intraoperatively, the patients hemodynamic condition was acceptable, with no evidence of thromboembolism on transesophageal echocardiography (TEE).

Diagnosis:

Postoperatively, her platelet count increased from 15.0 to 263.0 (× 109/L) and thromboelastographic parameters indicated hypercoagulable state. She suffered acute circulatory collapse, respiratory distress and, eventually, a decline in mental status. The attending physicians in the intensive care unit (ICU) immediately performed resuscitation.

Interventions:

The patient underwent emergency exploratory surgery. Intraoperatively, hypotension, bradycardia and arrhythmia developed, together with high central venous pressure. Assessment of cardiac structure and function using rescue TEE incidentally identified multiple, huge thromboembolic clots in the cardiac chambers; therefore, the patient underwent cardiac thromboembolectomy, including cardiopulmonary bypass with hypothermia therapy.

Outcomes:

Due to severe cardiac and respiratory distress, the patient required venoarterial extracorporeal membrane oxygenation (VAECMO) in the operating room and ICU. Despite continuous resuscitation in the ICU and maintenance of VAECMO, she suffered severe hypotension and massive bleeding that eventually led to death.

Lessons:

In patients with autoimmune hepatitis, risk factors for thromboembolism should be rigorously controlled during the peak period of reactive thrombocytosis after ABOi LDLT with splenectomy.
Gender Differences in the Predictors of Suicide-related Morbidity Among Veterans Reporting Current Housing Instability
Authors: Montgomery Ann E. , Dichter Melissa E. , Blosnich John R.
Published: January 2021

Background:

Veterans experiencing housing instability are at increased risk of suicide. Research is needed to identify gender differences in the predictors of both suicidal ideation and suicide attempt, particularly among Veterans who are unstably housed.

Objectives:

The objective of the present study was to explore whether correlates of suicide-related morbidity among unstably housed Veterans vary by gender and identify implications for improved care for these Veterans.

Methods:

The study cohort included 86,325 Veterans who reported current housing instability between October 1, 2013, and September 30, 2016. This cross-sectional study assessed differences in demographic and outcome variables by gender using χ2 analyses and a series of multiple logistic regressions predicting suicidal ideation and suicide attempt, stratified by gender.

Results:

Among unstably housed female Veterans, being younger than 40 years was associated with more than double the odds of having an indicator of suicidal ideation and >12 times the odds of having an indicator of a suicide attempt. The effect sizes associated with age were much less pronounced among unstably housed male Veterans. The presence of mental health and substance use conditions as well as a positive screen for military sexual trauma were associated with increased risk of suicide morbidity among both women and men.

Conclusions:

Intervention and prevention among unstably housed Veterans may be complicated by unpredictable living situations; further research should explore tailored interventions to address the complex needs of unstably housed Veterans and how suicide prevention can be woven throughout.
Assessment of Suicidal Intent in Self-directed Violence and Subsequent Care Received Among Military Veterans
Authors: Chen Jason I. , Cameron David C. , Laliberte Avery Z. , Hooker Elizabeth R. , Niederhausen Meike , Denneson Lauren M.
Published: January 2021

Background:

The Veterans Health Administration’s system for documenting self-directed violence (SDV) requires that clinicians make a determination of the suicidal intent of the behavior (ie, “undetermined” intent vs. “suicide attempt”) which contributes to the enhanced care offered. Past studies suggest clinicians’ judgment of suicide risk is impacted by patient demographics regardless of clinical presentation. As women are less likely to die by suicide than men, women’s SDV may be taken less seriously; they may be more likely to have their SDV classified as “undetermined” than men, which may impact the care received.

Objectives:

This study examines whether women veterans’ SDV is disproportionately classified as “undetermined” suicidal intent versus “suicide attempt” as compared with men veterans, and how one’s classification and gender modifies the care received.

Research Design:

This was an observational, retrospective study of data from Veterans Health Administration administrative databases. We included all veterans with documented nonfatal “undetermined” SDV events and “suicide attempts” between 2013 and 2018 (N=55,878). Objectives were evaluated using mixed-effects logistic regression models.

Results:

Women veterans were disproportionately more likely than men veterans to have SDV classified as “undetermined” (odds ratio=1.17; 95% confidence interval, 1.08–1.27). Veterans who received an “undetermined” classification were significantly less likely to receive enhanced care. However, this relationship was not moderated by gender.

Conclusions:

Gender may impact clinicians’ determinations of intent of SDV, but more research is needed on the extent of classification biases and to understand causes. Further, classification of intent is critical, as there is a strong relationship between classification and enhanced care.