bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetic Peripheral Neuropathy
Authors: Hsia-Kiung Maximilian
Published: January 2019

Diabetic peripheral neuropathy (DPN) is the most common cause of peripheral neuropathy in the developed world and one of the most common causes of neuropathic pain encountered, affecting about 50% of patients with type 1 or type 2 diabetes. The diagnosis of DPN is often made by self-reported symptoms, although a validated screening tool such as the Michigan Neuropathy Screening Instrument (MNSI) has been shown to be more effective. A phenomenon called insulin neuritis can also occur when blood glucose control is rapid or the patient experiences significant weight loss. Treatment of painful symptoms associated with DPN consists of prevention of symptom progression through glycemic control, oral medications such as tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors, topical medications, and, in some cases, neuromodulation using spinal cord stimulators.
Brain Infarction (Thalamus and Brainstem)
Authors: Eckman Theodore G. , Cheng Jianguo
Published: January 2019

Central post-stroke pain (CPSP) is a central neuropathic pain condition resulting from lesions of a prior cerebrovascular accident (CVA) mainly affecting the spinothalamocortical tract. About 5%–10% of patients with CVAs develop CPSP. The pain is thought to be secondary to a complex interaction of central disinhibition, central sensitization, and an imbalance of stimuli, although the exact mechanism remains unknown. The pain is located within and associated with sensory dysfunction in a region affected by a prior CVA lesion. The pain is often described as burning, stabbing, and sharp. Allodynia, hyperalgesia, and evoked dysesthesia appear to be major clinical findings for this condition. There are no specific diagnostic criteria for CPSP, and treatment is often difficult. Medications such as tricyclic antidepressants and anticonvulsants are often used. Motor cortex stimulation and deep brain stimulation are active areas of research and offer hope that additional treatment modalities may be identified.
Syringomyelia
Authors: Varma Ashwin , Bednar Timothy , Doulatram Gulshan
Published: January 2019

This chapter discusses syringomyelia, which is dilation of the spinal canal. It can be either congenital or post-traumatic. It is associated with central pain characteristics of predominantly neuropathic pain. Headaches may be present in patients with syringomyelia associated with type 1 Arnold-Chiari malformation. The size of the syrinx does not correlate to the severity of pain. Damage to the deeper layers of the dorsal horn causes an imbalance between the inhibitory and excitatory stimuli with upregulation of substance P. Electromyography shows a mixture of shortened and prolonged action potentials in syringomyelia. Somatosensory-evoked potential may be useful in the electrodiagnosis of syringomyelia. MRI plays a key role in the diagnosis of syringomyelia. Medical treatment is multifaceted and may be unsuccessful in treating the neuropathic pain. Surgery is the definitive treatment, although symptoms of pain may persist after resection. Spinal cord stimulation may offer relief to some patients and can be considered, as long as the dimensions of the vertebral canal are not significantly compromised.
Phantom Pain
Authors: Devarajan Jagan , Minzter Beth H.
Published: January 2019

This chapter discusses phantom pain, defined as an unpleasant or painful sensation in the distribution of the lost or deafferentiated body part. It is more commonly reported in the limbs but also has been reported in other body parts such as the tongue, teeth, nose, breast, part of the gastrointestinal tract, and the penis. The incidence varies from 42.2% to 78.8%. Perception of non-painful sensations from the amputated body part is known as phantom sensation. The severity and frequency of attacks slowly decrease with time during the first 6 months, after which they remain constant. Patients with significant preoperative pain, stump pain, and infection are at increased risk of developing phantom pain. The mechanism of origin is not known; it is thought to be due to peripheral nerve damage, which contributes to neural sensitization at peripheral, spinal, and supraspinal levels. Both chemical mediators and psychological factors are involved. Phantom pain improves with time and responds to conservative medical management, mirror therapy, and psychological counseling. A small percentage of cases are resistant to treatment and may require invasive neuromodulatory treatment options such as spinal cord stimulation and peripheral nerve stimulation.
Endocrine, Metabolic, and Nutritional Emergencies
Authors: Hitchner Lily
Published: January 2019

Endocrine, metabolic, and nutritional emergencies can occur at all age ranges: from the neonate who has an inborn error of metabolism to the older adult patient with thyroid disease and diabetes. Some patients with chronic medical conditions, such as diabetes, can have episodic emergencies (e.g., hyperglycemic hyperosmolar syndrome, diabetic ketoacidosis) that are precipitated by another stressor, like a myocardial infarction or infection. The chapter presents questions that cover relevant exams, imaging, and lab tests and their analysis. It is important for the emergency medicine physician to know how to treat primary endocrine abnormalities as well as to look for and treat the underlying precipitant conditions.
Dental, Head, Eye, Ear, Nose, and Throat Emergencies
Authors: Ramirez Rene , Ramos John
Published: January 2019

The section of the human body encompassing the head, ears, eyes, nose, and throat (HEENT) makes up approximately 9% of the adult human body (18% in children) and accounts for all five senses of the human body. These senses enable some of the most intimate interactions with the world around us. An array of infectious, traumatic, toxicologic, and other factors can render lifelong permanent and disfiguring outcomes and can lead to death. Patients commonly present to the emergency department with HEENT complaints or disorders, and the emergency physician must be able to accurately diagnose, treat, and stabilize such presentations.
Hematologic and Oncologic Emergencies
Authors: McCue James
Published: January 2019

Hematologic and oncologic emergencies are an uncommon reason for people to present to the emergency department (ED), but when they do, it is important to know how to diagnose and treat these conditions because many of them are life threatening. Whether it is bleeding due to conditions such as hemophilia, von Willebrand’s disease, warfarin use, or dangerous conditions related to cancer such as tumor lysis syndrome or neutropenic fever, knowing the basics will help you manage these patients and also ace the standardized tests. This chapter presents questions related to the diagnosis, clinical effects, best first response in the ED, and most appropriate treatment of a wide range of these hematologic and oncologic emergencies.
Systemic Infectious Diseases
Authors: Bauer Leah , Chooljian Carolyn , Johnson Whitney
Published: January 2019

Generalized complaints such as fever, chills, malaise, and body aches are common presentations to the emergency department (ED). Some of these are due to viral infections, and some are due to systemic bacterial infections. Clues to the specific infection can be found in the geographic location of the patient or the patient’s exposure to wildlife (e.g., ticks) and animals. The patient’s history and the timing of the illness play an important part in helping to identify the possible source or cause of the infection. This chapter presents questions related to the diagnosis, clinical effects, and most appropriate treatment of a wide range of these systemic infectious disease emergencies.
Nervous System Emergencies
Authors: Briggs Amy , Chalfin Brandon
Published: January 2019

Nervous system emergencies can present in a myriad of ways to the emergency department (ED). They affect children and adults alike. Common neurologic presentations include altered mental status, seizures, stroke, weakness, and headache. It is the emergency medicine physician’s duty, both in the ED and in test-taking situations, to pick up on clues in the presentation that help to ascertain which of these are a medical emergency requiring advanced imaging, expert consultation, and treatment and which require reassurance and outpatient management. This chapter presents questions related to the diagnosis, clinical effects, and most appropriate treatment of a wide range of these neurologic emergencies.
Procedures and Skills
Authors: Acharya Janak , Bengiamin Rimon , Gastelum Nicholas , Li Xian , Macias Fernando
Published: January 2019

Emergency medicine providers are expected to have the knowledge to be able to perform a wide range of procedures from simple wound repairs and abscess drainage to life-saving procedures such as transvenous pacing and perimortem cesarean delivery. Important to all of these procedures is an understanding of when they should be performed, potential complications, absolute and relative contraindications, and how to interpret results that are obtained as a result of the performed procedure. This chapter presents questions related to the diagnosis, clinical effects, best first response in the ED, and most appropriate treatment of a wide range of emergencies, focusing on the procedures and skills necessary to achieve the best outcomes for patients.
Patients as Art
Authors: Mackowiak Philip A.
Published: January 2019

Patients as Art: Forty Thousand Years of Medical History in Drawings, Paintings, and Sculpture traces the history of medicine through works of art stretching from the Paleolithic period to the present. Long before humans could write, before they had a medical science or possibly even a religion, they had art. Where works of art have involved patients, they have provided insight beyond aspects of sickness and health and life and death that can never be explained by science alone—humanistic aspects of the patient experience that can’t be measured or weighed or dissected. The works analyzed in this book, each of which features one or more patients, were chosen for their esthetic appeal and for the skill with which they depict important developments in medicine over time. Together they offer a compelling perspective on the history of medicine that reflects the outward expressions of artists’ innermost feelings and personal prejudices. In analyzing these works, medical historian Dr. Philip Mackowiak brings the perspective of an internist with over four decades of experience caring for patients, teaching doctors-in-training, and conducting clinical research.
Can the insider–outsider theory explain unemployment hysteresis in OECD countries?
Authors: Bakas Dimitrios , Makhlouf Yousef
Published: January 2019

Insider–outsider theory is often used as a basis for explaining the hysteretic behaviour of unemployment. Despite this, there is no empirical evidence about the validity of this theory on explaining the persistence of unemployment. This article addresses this gap, using various labour market proxies of insiders’ power for the OECD countries over 1960–2013 and employing panel unit root tests that exploit the information contained in these proxies. The results show that although the unemployment rate exhibits a pronounced hysteretic behaviour in OECD countries, this behaviour is reversed once we account for the insider–outsider proxies. Our findings thus validate the role of the insider–outsider theory as a key source of unemployment hysteresis.
Clinical Characteristics and Radiologic Features of Immunocompromised Patients With Pauci-Bacillary Pulmonary Tuberculosis Receiving Delayed Diagnosis and Treatment
Authors: Park Joung Ha , Choe Jooae , Bae Moonsuk , Choi Sungim , Jung Kyung Hwa , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Woo Jun Hee , Jo Kyung-Wook , Shim Tae Sun , Kim Mi Young , Kim Sung-Han
Published: January 2019

Background

Pauci-bacillary pulmonary tuberculosis (TB) can be delayed to diagnose and start anti-TB therapy, especially in immunocompromised patients. We therefore evaluated the clinical and radiologic features of these delayed cases.

Methods

Immunocompromised adult patients with pauci-bacillary pulmonary TB were retrospectively enrolled in a tertiary hospital in an intermediate–TB burden country over a 5-year period. We defined “missed TB” or “not-missed TB” patients as those who started anti-TB therapy after or before positive mycobacterial culture results, respectively.

Results

Of 258 patients, 134 (52%) were classified in the missed TB group, and 124 (48%) in the not-missed TB group. Positive results of molecular tests including MTB polymerase chain reaction and/or Xpert TB/RIF were only obtained in the not-missed TB group (54/106, 54%). The median diagnostic delay in the missed TB group was longer than in the other group (30 vs 6 days; P < .001). In the missed TB group, the most common working diagnoses were pneumonia (46, 34%) and lung metastasis of malignancy (40, 30%). Typical radiologic findings for TB, such as upper lobe predominance and centrilobular nodules with tree-in-bud appearance, were less common in the missed TB group than in the other group. Old age (odds ratio [OR], 1.03), solid organ transplant (OR, 3.46), solid tumor (OR, 3.83), and hematologic malignancy (OR, 4.04) were independently associated with missed TB.

Conclusions

Care is needed to differentiate pauci-bacillary TB, especially in immunocompromised patients with the mentioned risk factors, even without the usual radiologic features of TB. Additional rapid diagnostic tests to rule out pauci-bacillary TB are urgently needed.
Distinct Gut Virome Profile of Pregnant Women With Type 1 Diabetes in the ENDIA Study
Authors: Wook Kim Ki , Allen Digby W , Briese Thomas , Couper Jennifer J , Barry Simon C , Colman Peter G , Cotterill Andrew M , Davis Elizabeth A , Giles Lynne C , Harrison Leonard C , Harris Mark , Haynes Aveni , Horton Jessica L , Isaacs Sonia R , Jain Komal , Lipkin Walter Ian , Morahan Grant , Morbey Claire , Pang Ignatius C N , Papenfuss Anthony T , Penno Megan A S , Sinnott Richard O , Soldatos Georgia , Thomson Rebecca L , Vuillermin Peter J , Wentworth John M , Wilkins Marc R , Rawlinson William D , Craig Maria E ,   The ENDIA Study Group
Published: January 2019

Background

The importance of gut bacteria in human physiology, immune regulation, and disease pathogenesis is well established. In contrast, the composition and dynamics of the gut virome are largely unknown; particularly lacking are studies in pregnancy. We used comprehensive virome capture sequencing to characterize the gut virome of pregnant women with and without type 1 diabetes (T1D), longitudinally followed in the Environmental Determinants of Islet Autoimmunity study.

Methods

In total, 61 pregnant women (35 with T1D and 26 without) from Australia were examined. Nucleic acid was extracted from serial fecal specimens obtained at prenatal visits, and viral genomes were sequenced by virome capture enrichment. The frequency, richness, and abundance of viruses were compared between women with and without T1D.

Results

Two viruses were more prevalent in pregnant women with T1D: picobirnaviruses (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.0–17.1; P = .046) and tobamoviruses (OR, 3.2; 95% CI, 1.1–9.3; P = .037). The abundance of 77 viruses significantly differed between the 2 maternal groups (≥2-fold difference; P < .02), including 8 Enterovirus B types present at a higher abundance in women with T1D.

Conclusions

These findings provide novel insight into the composition of the gut virome during pregnancy and demonstrate a distinct profile of viruses in women with T1D.
Tools to Support Hospital-Based Addiction Care: Core Components, Values, and Activities of the Improving Addiction Care Team
Authors: Englander Honora , Mahoney Stacey , Brandt Kimberly , Brown Jessica , Dorfman Claire , Nydahl Alexander , Weimer Melissa , Gregg Jessica
Published: January 2019

Hospitals are increasingly filled with people admitted for medical and surgical complications of substance use disorder (SUD). Hospitalization can be a reachable moment to engage and initiate SUD care. Yet most hospitals do not have systems in place to adequately address addiction, and most providers have little to no addiction training. There is widespread need for protocols and tools to implement hospital-based SUD care. We share best practices from our hospital-based Improving Addiction Care Team (IMPACT). We include a description of interprofessional roles (medical providers, social workers, peers with lived experience in recovery) and include detailed appendices of practical tools such as medication protocols (eg, buprenorphine induction), risk assessments (eg, outpatient parenteral antibiotic therapy) and treatment tools (eg, a patient safety care plan to manage patient and staff expectations surrounding risks for in hospital drug use). A case example illustrates how IMPACT works and how tools can be applied. We hope other hospitals can adapt and integrate these tools to support widespread implementation of hospital-based SUD care.
Histopathological Features of the Development of Intestine and Mesenteric Lymph Node Injury in a Nonhuman Primate Model of Partial-body Irradiation with Minimal Bone Marrow Sparing
Authors: Parker George A. , Li Na , Takayama Kyle , Booth Catherine , Tudor Gregory L. , Farese Ann M. , MacVittie Thomas J.
Published: January 2019

Male rhesus macaques were subjected to partial-body irradiation at 10, 11, or 12 Gy with 5% bone marrow protection. Animals were euthanized when dictated by prospectively determined clinical parameters or at approximately 180 d following irradiation. Histological sections of jejunum, colon, and mesenteric lymph node were stained with hematoxylin and eosin as well as a battery of histochemical and immunohistochemical stains. The immediate postirradiation histopathological alterations in the jejunum and colon were based primarily on injury to rapidly proliferating crypt epithelial cells, though there was evidence of additional radiation-induced fibrogenic responses. There was substantial resolution of the radiation-related mucosal injury through the observation period, but microscopically visible defects in mucosal structure persisted to the end of the observation period. In the later stages of the observation period, the jejunum and colon had overt fibrosis that was most commonly located in the submucosa and serosa, with less microscopically discernible involvement of the mucosa. Mesenteric lymph nodes had an immediate postirradiation reduction in cellularity due to the known effects of irradiation on lymphoid cell populations. In later stages of the observation period the lymph nodes also developed fibrotic changes, possibly related to transmigration of immunomodulatory cells and/or signaling molecules from the radiation-damaged intestine.
Effects of Diet on Late Radiation Injuries in Rats
Authors: Moulder John E. , Fish Brian L. , Cohen Eric P. , Flowers Jessica B. , Medhora Meetha
Published: January 2019

It has been speculated that the addition of antioxidants to diet could act as either radioprotectors or as mitigators of radiation injury. In preparation for studies of the mitigation efficacy of antioxidants, rats were placed on a modified version of AIN-76A, the diet typically used in such studies. This AIN-76A diet is refined and has no synthetic antioxidants or isoflavones. Compared to the natural-ingredient Teklad 8904 diet used in previous studies, use of the AIN-76A diet from 1–18 wk after irradiation significantly reduced injury in a radiation nephropathy model. A confirmation study included an additional arm in which the AIN-76A diet was started 2 wk prior to irradiation; again, the switch to AIN-76A postirradiation mitigated radiation nephropathy (p < 0.001), but switching to the AIN-76A diet preirradiation had no effect (p > 0.2). The two diets do not differ in salt content, but the AIN-76A diet is somewhat lower in protein (18% vs. 24%). The protein source (primarily soy in Teklad 8904 vs. casein in AIN-76A) might explain the effects. However, replacing the casein in AIN-76A with soy did not change the mitigation efficacy of the diet (p > 0.2 for comparison of the different AIN-76A diets). A similar study in a rat radiation pneumonitis model also suggested mitigation by postirradiation use of AIN-76A, although the effect was not statistically significant (p = 0.07). In conclusion, base diet alone can have biologically significant effects on organ radiosensitivity, but the mechanistic basis for the effect and its dependence of timing relative to irradiation are unclear.
Comparison of Organ and Effective Photon Dose Coefficients for Reference Phantoms in Articulated and Upright Postures in Cranial and Caudal Irradiation Geometries
Authors: Bales Kathryn , Dewji Shaheen
Published: January 2019

Traditionally, dose estimations have been performed predominantly using anthropomorphic phantoms in an upright posture. However, an exclusively upright posture could reduce accuracy when estimating organ absorbed and effective doses for exposures in realistic postures. In this work, effective dose coefficients were computed using International Commission on Radiological Protection Publication 103 recommendations for monoenergetic photon plane sources (0.05–20 MeV) directed upward from below the feet (caudal) and downward from above the head (cranial) for articulated adult male and female stylized phantoms. The Monte Carlo radiation transport code and the Phantom With Moving Arms and Legs were used to calculate organ absorbed dose and effective dose coefficients for upright and two bent (45° and 90°) phantom postures. The resulting coefficients for the bent phantoms were compared to those for the upright phantoms to determine whether the upright phantoms provide a comparable and conservative estimate when conducting dose estimations/reconstructions. For the caudal source, most organs received higher doses when in a bent posture. For the cranial source, the breast, brain, and eyes received lower doses in the bent compared to the upright posture, while all other organs received higher doses. The effective doses for the articulated phantoms were higher than for the upright posture for both irradiation geometries, which could have implications when using the traditional model to estimate or reconstruct radiation doses during actual exposures.
Caught in a Web of Confusion: Assessing the Readability of University Webpages for Victims of Sexual Assault
Authors: Duncan Shannon , Yeatts Paul , Kapusta Ann , Allen Denise , Wilson Jennifer , Tilley Donna Scott
Published: January 2019

Assuring the effectiveness of Web sites in communicating critical information to a college student who has experienced sexual assault is important and complex. Recognizing that the average American reads at the eighth grade level, the National Institutes of Health and the American Medical Association recommend that information be written at a sixth-grade reading level. A sample of 10 U.S. institutions of higher education (IHE) Web sites made up the sample of the current study. The IHEs included were all participants in a project called “Cultivating Safe College Campuses,” funded by the Department of Health and Human Services. This study aimed to gain more insight into the readability of college Web sites about sexual assault resources for the intended consumer—college students. The reading level of IHE Web sites with information about sexual assault should align with the reading level of their intended audience. The average readability of sexual assault Webpages for this study's sample of IHEs was over 13, well above the reading level of the average “first time in college” student. All IHEs should review the readability of their Web sites and revise them to use consistent and defined terms and present the material in a way that is clear and accessible for the student who has experienced trauma.
Potency of descending pain modulatory system is linked with peripheral sensory dysfunction in fibromyalgia
Authors: Brietzke Aline Patrícia , Antunes Luciana Conceição , Carvalho Fabiana , Elkifury Jessica , Gasparin Assunta , Sanches Paulo Roberto Stefani , da Silva Junior Danton Pereira , Dussán-Sarria Jairo Alberto , Souza Andressa , da Silva Torres Iraci Lucena , Fregni Felipe , MD Wolnei Caumo
Published: January 2019

Fibromyalgia (FM) is characterized by chronic widespread pain whose pathophysiological mechanism is related to central and peripheral nervous system dysfunction. Neuropathy of small nerve fibers has been implicated due to related pain descriptors, psychophysical pain, and neurophysiological testing, as well as skin biopsy studies. Nevertheless, this alteration alone has not been previously associated to the dysfunction in the descending pain modulatory system (DPMS) that is observed in FM. We hypothesize that they associated, thus, we conducted a cross-sectional exploratory study.

To explore small fiber dysfunction using quantitative sensory testing (QST) is associated with the DPMS and other surrogates of nociceptive pathways alterations in FM.

We run a cross-sectional study and recruited 41 women with FM, and 28 healthy female volunteers. We used the QST to measure the thermal heat threshold (HTT), heat pain threshold (HPT), heat pain tolerance (HPT), heat pain tolerance (HPTo), and conditional pain modulation task (CPM-task). Algometry was used to determine the pain pressure threshold (PPT). Scales to assess catastrophizing, anxiety, depression, and sleep disturbances were also applied. Serum brain-derived neurotrophic factor (BDNF) was measured as a marker of neuroplasticity. We run multivariate linear regression models by group to study their relationships.

Samples differed in their psychophysical profile, where FM presented lower sensitivity and pain thresholds. In FM but not in the healthy subjects, regression models revealed that serum BDNF was related to HTT and CPM-Task (Hotelling Trace = 1.80, P < .001, power = 0.94, R
2 = 0.64). HTT was directly related to CPM-Task (B = 0.98, P = .004, partial-η
2 = 0.25), and to HPT (B = 1.61, P = .008, partial η
2 = 0.21), but not to PPT. Meanwhile, BDNF relationship to CPM-Task was inverse (B = –0.04, P = .043, partial-η
2 = 0.12), and to HPT was direct (B = –0.08, P = .03, partial-η
2 = 0.14).

These findings high spot that in FM the disinhibition of the DPMS is positively correlated with the dysfunction in peripheral sensory neurons assessed by QST and conversely with serum BDNF.
Slipped capital femoral epiphysis in an adult with congenital hypopituitarism
Authors: Huang Yi-Fan , Wang Li-Shen , Zhang Shi , Gao Yu-Hang , Liu Jian-Guo , Qi Xin
Published: January 2019

Rationale:

Slipped capital femoral epiphysis (SCFE) is a common hip problem in adolescents, usually individuals between 8 and 15 years old. Because of the frequent finding of growth abnormalities in affected children, various endocrine disturbances have been reported as the cause of the disease. However, there are few case reports of older patients in previous literature. To the best of our knowledge, congenital hypopituitarism with normal growth hormone (GH) level has not been reported.

Patient concerns:

We describe a 29-year-old man who had a 3-month history of pain in the left hip with tall stature and unobvious secondary sexual characteristics. Laboratory testing showed low thyroxine, low cortisol, low follicle-stimulating hormone, low luteinizing hormone, low testosterone, but normal GH.

Diagnoses:

Brain magnetic resonance imaging showed pituitary hypoplasia. An anteroposterior pelvis radiograph showed severe varus SCFE in the left hip, it was also confirmed with computed tomography scans.

Interventions:

The patient was treated with levothyroxine, hydrocortisone, and testosterone replacement therapy before surgery. We performed open reduction and anatomical reduction by Dunn's procedure.

Outcome:

We have followed this patient for 6 months, the left hip mobility gradually improved. No slip in the contralateral proximal femoral physis has been observed.

Lessons:

When unobvious secondary sexual characteristics and body abnormalities were found in clinical practice, endocrine condition should be evaluated, since the contralateral side may prone to slip due to the lack of endocrine therapy.
The effects of traditional Chinese exercise on hypertension
Authors: Jin Xiao , Pan BiQi , Wu Huanlin , Xu Danping
Published: January 2019

Background:

Several studies have reported the benefits of traditional Chinese exercises (TCEs) on hypertension; however, a consensus regarding the effectiveness and safety of TCEs for patients with hypertension has not been reached.

Methods and results:

Only randomized controlled trials were included in our study. A total of 16 articles involving 1164 patients with hypertension met the inclusion criteria. The results showed that TCEs can reduce BP, blood lipids (including total cholesterol and triglyceride levels) and endothelin levels and improves quality of life in hypertensive patients, however, the low-quality of the included studies made the results be of questionable significance.

Conclusions:

The results of this review suggest that there is no firm evidence to support the objective effectiveness and safety of TCEs for hypertension because of the poor quality of the studies. Well-designed, randomized placebo-controlled trial with objective outcome measures should be conducted in the future.
Does exposure to asbestos cause prostate cancer? A systematic literature review and meta-analysis: Retraction
Authors: Peng Rui , Fang Fang , Chen Zhijun , Yang Shuai , Dai Changyuan , Wang Chengyong , Guan Han , Li Qingwen
Published: January 2019

Objective

The relationship between asbestos and prostate cancer (PCa) is not well understood due to small number of cases. This study aimed to determine the incidence and mortality of PCa among workers or residents exposed to asbestos based on a systematic review and meta-analysis

Methods

All published studies citing the standardized mortality ratio (SMR) or standardized incidence ratio (SIR) of PCa in workers or residents exposed to asbestos were collected by conducting a search on PubMed, EMBASE, Cochrane Library, and Web of Science before April 2018. Standardized mortality rate for PCa with its 95% confidence interval (CI) was pooled using a fixed-/random-effect model in STATA (Version14.0). This study is registered with PROSPERO, number CRD42018095195.

Results

A total of 17 independent studies were included for the analysis. The overall pooled SMR of PCa was 1.22, with a 95% CI of 1.13 to 1.32, with no heterogeneity across the studies (I2 = 18.8%, P = .234). Subgroup analysis shows that exposure to crocidolite, cement, studies conducted in Europe and Oceania, and long study follow-up (≥25 years) all contribute to significantly higher SMR, and we found no evidence of publication bias (Begg test P value = .592, Egger test P value = .874).

Conclusions

This meta-analysis suggested that exposed to asbestos might be associated with an increased risk of PCa. High-exposure level of asbestos could contribute to significantly higher risk of PCa mortality.
Prognostic significance of elevated preoperative neutrophil-to-lymphocyte ratio for patients with colorectal cancer undergoing curative surgery
Authors: Li Hongcai , Zhao Yan , Zheng Fengying
Published: January 2019

Background:

Preoperative neutrophil-to-lymphocyte ratio (NLR) has been suggested as a useful predictive factor for prognosis in patients with various cancers. However, the prognostic value of NLR in patients with colorectal cancer (CRC) remains controversial. Therefore, the goal of this study was to perform a meta-analysis to evaluate the prognostic value of NLR in patients with CRC undergoing curative surgery.

Methods:

PubMed, EMBASE and Cochrane Library databases were searched to screen the relevant studies. Pooled hazard ratio (HR) with 95% confidence interval (CI) was used to assess the associations of preoperative NLR and overall survival (OS), disease-free survival (DFS), recurrence free survival (RFS) and disease specific survival (DSS) by STATA 13.0 software.

Results:

Sixteen studies involving 5897 patients were included in our meta-analysis. Our pooled results demonstrated that high NLR was associated with poor OS (HR: 1.66, 95%CI: 1.36–2.02, P < .001), DFS (HR = 1.54, 95%CI: 1.18–2.02, P = .002), RFS (HR = 2.31, 95%CI: 1.68–3.17, P < .001) and DSS (HR = 2.27; 95% CI: 1.75–2.96, P < .001). When the patients were stratified according to country, sample size, NLR cut-off, follow up and postoperative chemotherapy, high NLR was still significantly correlated with OS. The limitation was that the majority of enrolled studies were retrospective.

Conclusion:

Preoperative NLR may be an effective predictive biomarker for prognosis in patients with CRC. Detection of NLR may be beneficial to identify the high-risk patients who need other antitumor therapies in addition to surgery.
Acute effects of air pollutants on adverse birth outcomes in Changsha, China
Authors: Xiong Lili , Xu Zenghui , Tan Jie , Wang Hua , Liu Zhiyu , Wang Aihua , Xie Donghua , Kong Fanjuan
Published: January 2019

Evidence for the acute effects of air pollutants on adverse birth outcomes is not yet conclusive. Furthermore, there are no investigations relating to the association between air pollutants and macrosomia. The aim of this study was to determine the relationship between air pollutants and low birth weight, preterm birth, and macrosomia in Changsha. Time-series analysis, using a generalized additive model was applied. Data about the adverse birth outcomes was collected from 78 midwifery institutions. Air pollution data including SO2, NO2, particulate matter <10 μm in diameter (PM10), particulate matter <2.5 μm in diameter (PM2.5), O3, CO, and climate data were respectively collected from the Changsha Environmental Protection Agency and the Changsha Meteorological Bureau from January 2015 to December 2017. During the study period, there were 344,880 live births to be studied. In a single pollutant model, for every increase of 10 μg/m3 in PM10 and PM2.5, low birth weight increased by 0.12% (95% confidence interval [CI]: 0.01–0.23%) at a lag 06 and 0.44% (95% CI: 0.35–0.53%) at a lag 3, respectively. Preterm birth increased most by 1.60% (95% CI: 1.41–1.80%) at a lag 2 for every increase of 10 μg/m3 in SO2. The highest increases in macrosomia associated with a 10 μg/m3 increase in air pollutant were 3.53% (95% CI: 3.41–3.64%) for NO2 at lag 0, 3.33% (95% CI: 3.05–3.60%) for SO2 at lag03. Multi-pollutant models showed that only PM10 increased the low birth weight and preterm birth risk effect by 3.91% (95% CI: 3.67–4.12%) and 0.25% (95% CI: 0.14–0.37%). NO2 increased macrosomia risk by 4.14% (95% CI: 3.97–4.31%) with a 10 μg/m3 increase. There was no association observed between the air pollutants O3 and CO and adverse birth outcomes. Pregnant women should also take steps to limit their exposure to high levels of air pollutants during the final weeks of pregnancy.
Herbal medicine for acute management and rehabilitation of traumatic brain injury
Authors: Lee Boram , Leem Jungtae , Kim Hyunho , Jo Hee-Geun , Yoon Sang-Hoon , Shin Aesook , Sul Jae-Uk , Choi Ye-Yong , Yun Younghee , Kwon Chan-Young
Published: January 2019

Background:

This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of herbal medicine in treating traumatic brain injury.

Methods and analysis:

The following electronic databases will be searched up to December 2018 without language or publication status restrictions: Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature. We will also search Korean, Chinese, and Japanese databases. Any randomized controlled trials related to herbal medicine for traumatic brain injury will be included. The functional outcome, consciousness state, morbidity, and mortality will be assessed as primary outcomes. The quality of life, adverse events, and total effective rate will be evaluated as secondary outcomes. Two researchers will independently perform the study selection, data extraction, assessment of study quality, and evaluation of the quality of evidence for the main findings. Data synthesis and analysis will be performed using RevMan version 5.3. The results will be expressed as a risk ratio for the binary outcome and as the mean difference or standardized mean difference for a continuous outcome. We will synthesize the data by either fixed effects or random effects model according to a heterogeneity test or the number of studies included in the meta-analysis. The methodological quality of the included studies will be evaluated using the Cochrane Collaboration's risk of bias tool. The quality of evidence for each main outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Ethics and dissemination:

Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations.

PROSPERO registration number:

CRD42018116559.
Combined airway and esophageal stents implantation for malignant tracheobronchial and esophageal disease
Authors: Bi Yonghua , Ren Jianzhuang , Chen Hongmei , Bai Liangliang , Han Xinwei , Wu Gang
Published: January 2019

We aimed to evaluate the safety and efficacy of combined airway and esophageal stents under fluoroscopy guidance and local anesthesia for patients with malignant tracheobronchial and esophageal disease. This retrospective analysis included 35 consecutive patients underwent combined stenting from March 2012 to August 2016. All patients underwent chest computed tomography scans before stenting and during follow-up. Thirty-nine airway stents and 43 esophageal covered stents were implanted. The indication of stenting, technical success and postinterventional complications were collected and analyzed. Thirty-nine airway stents and 43 esophageal covered stents were implanted. Stenting failed in 1 airway stent, and 2 esophageal stents, with technology success rates of 97.4% and 95.3%, respectively. No procedure-related death occurred, only 1 patient died from failure of respiration due to esophagotracheal fistula. The median interval between 2 stenting was 13.0 days. Both dyspnea and dysphasia were significantly relieved after stenting. Restenosis after stenting (7.7%) was the most common complication for airway stenting, all these cases required second stenting. Stent migration (7.0%) was the most common complication after esophageal stenting, 1 case had to receive airway stenting and 1 case received replacement of esophageal stent. During follow up, 23 patients were clinically cured, 2 patients were improved in symptoms, and 1 was invalid. Eight deaths were found in total. The 1-year, 3-year, and 5-year survival rates were 82.4%, 78.8%, and 78.8%, respectively. In conclusion, combined airway and esophageal stents implantation under fluoroscopy guidance and local anesthesia are safe and effective for malignant tracheobronchial and esophageal disease.
Factors associated with limited hand motion after hand trauma
Authors: Lee Jung Soo , Kim Yeo Hyung
Published: January 2019

Hand injuries are common and have a significant impact on daily life. However, the factors associated with functional outcome after hand injuries are not well established. The purpose of this study was to identify factors that are independently associated with hand total active motion (TAM).

A total of 50 patients with unilateral complex hand injury were included in this study. The associations between various demographic, injury-related, and clinical assessment factors and TAM were determined by univariate and multivariate linear regression analyses. Nerve injuries recognized during surgery and diagnosed with electrodiagnostic (EDX) studies were compared using Pearson chi-squared test.

Among multiple injury-related and initial clinical assessment factors, nerve injury diagnosed with EDX studies, hospital stay length, elevated C-reactive protein, and skeletal injury were independently associated with TAM in the affected hand after adjusting for covariates. Nerve injuries diagnosed with EDX studies were not consistent with those recognized during surgery.

Our results suggest that high-energy trauma leading to skeletal and nerve injury with inflammation is associated with limited hand motion after surgery and postoperative immobilization. A comprehensive EDX study may enable identifying occult or recovered nerve injuries, which would be helpful in understanding limitations in finger movements.
Herpes simplex virus linear endotheliitis in a post-keratoplasty patient
Authors: Shin Jeongah , Ra Ho , Rho Chang Rae
Published: January 2019

Rationale:

To report a case of herpes simplex virus (HSV) linear endotheliitis in a 57-year-old male who had underwent keratoplasty 10 years ago. The characteristic linear keratic precipitates (KPs) resembled the Khodadoust line in graft rejection. The differential diagnosis is essential, because the treatment regimen is different between HSV linear endotheliitis and graft rejection.

Patient concerns:

The patient developed a sudden onset of ocular pain and a decrease in visual acuity in his right eye. The patient had received penetrating keratoplasty in the eye 10 years ago.

Diagnoses:

The ocular disease was evaluated using several ocular examinations, including best-corrected visual acuity (BCVA), intraocular pressure, slit lamp examination, fundus examination, and aqueous humor tap. Characteristic linear endothelial KPs were found both in the host cornea and graft cornea. Stromal edema was evident in both the donor and recipient corneas. The aqueous humor was sampled for viral polymerase chain reaction (PCR) analysis. The sample was investigated for the possible presence of HSV I, HSV II, cytomegalovirus, and varicella zoster virus. The PCR was positive for HSV I and negative for HSV II, cytomegalovirus, and varicella zoster virus.

Interventions:

The patient was treated with both antiviral and steroid treatments for 1 month. Thereafter, prophylactic antiviral treatment was continued.

Outcomes:

The subjective symptoms had improved and the cornea edema and the linear endothelial KPs had disappeared. The BCVA improved from 20/200 to 20/80.

Lessons:

HSV linear endotheliitis is the most severe form of HSV endotheliitis. This case showed characteristic endothelial KPs, which were different from the Khodadoust line of graft rejection.
Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft
Authors: Wang Xin , Cai Yunqiang , Zhao Wei , Gao Pan , Li Yongbin , Liu Xubao , Peng Bing
Published: January 2019

Rationale:

With the development of laparoscopic techniques, laparoscopic pancreatoduodenectomy was applied in various indications including pancreatic cancer. Here, we share our experience of venous resection and reconstruction with interposition graft in laparoscopic pancreatoduodenectomy in these patients.

Patient concerns:

We reviewed data of laparoscopic pancreatoduodenectomy with venous resection and reconstruction in patients with pancreatic cancer between the dates of October 2010 and November 2017.

Outcomes:

Ten patients underwent laparoscopic pancreatoduodenectomy with portal-superior mesenteric vein resection and reconstruction with interposition graft. The mean operative time was 547 min. The mean blood loss was 435 ml. The mean length of venous defect after resection was 5.4 cm. R0 resection was achieved in nine patients (90%). There was one patient who suffered from severe postoperative complication. There was no 30-day mortality in this study. The long-term patency was achieved in all patients.

Conclusion:

In this study, we demonstrate the initial experience of laparoscopic pancreaticoduodenectomy with long venous resection and reconstruction. Although applied in small number of patients, it could be another option for well-selected patients with reasonable morbidity and mortality as well as long-term outcomes in experienced minimally invasive surgical team.
Mycoprotein
Authors: Derbyshire Emma , Ayoob Keith-Thomas
Published: January 2019

Mycoprotein is derived from the filamentous fungus Fusarium venenatum, first discovered in the 1960s. Mycoprotein is high in protein and fiber and low in energy and saturated fat and contains no trans-fat or cholesterol. A systematic search of the PubMed identified 13 human studies investigating the health properties of mycoprotein, with some evidence of sustained satiety, improved metabolic profiling, and muscular protein synthetic response that warrants ongoing investigation. Mycoprotein is produced commercially, with low environmental impact, and is used as an ingredient in products marketed under the Quorn trademark.
A Multi-Institutional Study to Evaluate Automated Whole Slide Scoring of Immunohistochemistry for Assessment of Programmed Death-Ligand 1 (PD-L1) Expression in Non–Small Cell Lung Cancer
Authors: Taylor Clive R. , Jadhav Anagha P. , Gholap Abhi , Kamble Gurunath , Huang Jiaoti , Gown Allen , Doshi Isha , Rimm David L.
Published: January 2019

Assessment of programmed death-ligand 1 (PD-L1) expression is a critical part of patient management for immunotherapy. However, studies have shown that pathologist-based analysis lacks reproducibility, especially for immune cell expression. The purpose of this study was to validate reproducibility of the automated machine-based Optra image analysis for PD-L1 immunohistochemistry for both tumor cells (TCs) and immune cells. We compared conventional pathologists’ scores for both tumor and immune cell positivity separately using 22c3 antibody on the Dako Link 48 platform for PD-L1 expression in non–small cell lung carcinoma. We assessed interpretation first by pathologists and second by PD-L1 image analysis scores. Lin’s concordance correlation coefficients (LCCs) for each pathologist were measured to assess variability between pathologists and between pathologists and Optra automated quantitative scores in scoring both tumor and immune cells. Lin’s LCCs to evaluate the correlation between pathologists for TC was 0.75 [95% confidence interval (CI), 0.64-0.81] and 0.40 (95% CI, 0.40-0.62) for immune cell scoring. Pathologists were highly concordant for tumor scoring, but not for immune cell scoring, which is similar to previously reported studies where agreement is higher in TCs than immune cells. The LCCs between conventional pathologists’ read and the machine score were 0.80 (95% CI, 0.74-0.85) for TCs and 0.70 (95% CI, 0.60-0.76) for immune cell population. This is considered excellent agreement for TCs and good concordance for immune cells. The automated scoring methods showed concordance with the pathologists’ average scores that were comparable to interpathologist scores. This suggests promise for Optra automated assessment of PD-L1 in non–small cell lung cancer.