bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Morbidity After Management of Vaginal Noncephalic Second-Twin Delivery by Residents
Authors: Schmitz Thomas , Korb Diane , Azria Elie , Deruelle Philippe , Kayem Gilles , Rozenberg Patrick , Sananès Nicolas , Sénat Marie-Victoire , Sentilhes Loic , Vayssière Christophe , Winer Norbert , Goffinet François ,   for the JUmeaux MODe d’Accouchement (JUMODA) Study Group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG)
Published: November 2018

OBJECTIVE:

To assess neonatal mortality and morbidity according to whether a resident or senior obstetrician initially managed vaginal delivery of noncephalic second twins.

METHODS:

The JUmeaux MODe d'Accouchement study was a national, prospective, population-based, cohort study of twin deliveries in 176 maternity units in France, where active management of second-twin delivery is recommended. The primary outcome of our study was a composite of neonatal mortality and morbidity. Neonatal outcomes of noncephalic second twins born at or after 32 weeks of gestation after vaginal delivery of the first twin were compared according to the initial managing practitioner—supervised resident or senior obstetrician. Deliveries performed by a senior obstetrician after failure by a resident were classified as resident deliveries. Deliveries in maternity units without residents were excluded. We used multilevel multivariable Poisson regression models and propensity score matching to control for indication bias and potential confounders, including the maternity unit status. We performed subgroup analyses according to gestational age at delivery, before or after 37 weeks of gestation, and to the noncephalic second twin presentation, breech or transverse.

RESULTS:

Among 1,376 noncephalic second-twin deliveries, 545 (39.6%) were initially managed by a resident and 831 (60.4%) by a senior obstetrician. Residents failed to deliver the second twin in 125 (22.9%) women. Composite neonatal mortality and morbidity did not differ between the resident and senior groups (13/545 [2.4%] vs 29/831 [3.5%]; adjusted relative risk 0.78, 95% CI 0.35–1.74). Subgroup analyses were consistent with the overall analysis.

CONCLUSION:

Supervised resident and senior staff management of noncephalic second-twin vaginal delivery is associated with similar neonatal morbidity and mortality, which supports continued training of residents in such deliveries.
The Residency Interview Season
Authors: Strand Eric A. , Sonn Tammy S.
Published: November 2018

Residency applicants and residency programs invest significant resources in attempting to match applicants into the best possible programs. However, recent trends have made the process increasingly inefficient. Decisions made by all parties—students, medical schools, and residency programs—have contributed to a system that has become increasingly anxiety-provoking for the students and unnecessarily cumbersome for the programs. Relatively straightforward solutions exist, however, that would improve the process for all parties involved. With improved mentoring of medical students, honest and timely assessment of applicants by programs, and, most importantly, standardizing the interview invitation timeline, candidates and programs would encounter an improved residency interview experience.
Cervical Screening by Pap Test and Visual Inspection Enabling Same-Day Biopsy in Low-Resource, High-Risk Communities
Authors: Tao Lin , Amanguli A. , Li Feng , Wang Ying Hong , Yang Lan , Mohemaiti Meiliguli , Zhao Jin , Zou Xiao Guang , Saimaiti Abudukeyoumu , Abudu Mirensha , Maimaiti Mikairemu , Chen Shi Yan , Abudukelimu Ruxianguli , Maimaiti Ayinuer , Li Shu Gang , Zhang Wei , Aizimu Ayinuer , Yang An Qiang , Wang Ju , Pang Li Juan , Cao Yu Guang , Gu Wen Yi , Zhang Wen Jie
Published: November 2018

OBJECTIVE:

To develop an effective, low-cost, single-visit cervical screening strategy incorporating a modified Pap test and visual inspection with acetic acid and Lugol’s iodine for low-income settings.

METHODS:

We conducted a prospective cohort trial. Two low-income Muslim Uyghur communities in China’s far western Kashi Prefecture served as pilot and validation study sites, respectively, and 4,049 women (aged 30–59 years) were screened. The conventional Pap test was modified using a cotton swab to collect cervical cells without scraping the cervix using an Ayre spatula, allowing visual inspection with acetic acid (and visual inspection with Lugol’s iodine if visual inspection with acetic acid was negative) to be performed in a single visit. Results from both tests were available within 1–2 hours. Women positive for either or both underwent same-day biopsy that was shipped by a courier service to a central pathology laboratory.

RESULTS:

Single-visit screening incorporating both a modified Pap test and visual inspection achieved a sensitivity of 96.0% (95% CI 91.6–100), which was superior to Pap testing (76%, 95% CI 66.3–85.7; P<.001) or visual inspection with acetic acid–visual inspection with Lugol’s iodine (48%, 95% CI 36.7–59.3; P<.001) alone in detecting cervical intraepithelial neoplasia (CIN) 2 or worse lesions. Rapid interpretation of both diagnostic procedures facilitated efficient same-day biopsy that achieved a negative predictive value of 98.2% in detecting CIN 2 or worse lesions. The increased sensitivity and minimized loss of follow-up allowed this approach to identify an extremely high prevalence of CIN 1 (2,741/100,000, 95% CI 2,238–3,245/100,000), CIN 2 or 3 (1,457/100,000, 95% CI 1,088–1,826/100,000), and cervical cancer (395/100,000, 95% CI 202–589/100,000) among these underscreened, at-risk women.

CONCLUSION:

Single-visit cervical screening with both a modified Pap test and visual inspection has greater sensitivity to detect high-grade CINs, reduces loss of follow-up, and could be an efficient low-cost strategy for low-resource settings.
What Is New in Ovarian Cancer?
Authors: Wright Jason D.
Published: November 2018

This month we focus on current research in ovarian cancer. Dr. Wright discusses four recent publications, which are concluded with a “bottom-line” that is the take-home message. A complete reference for each can be found on Box 1 on this page along with direct links to abstracts.
Intraoperative Multimodal Monitoring in Pedicle Subtraction Osteotomies of the Lumbar Spine
Authors: Shao Jianning , Lee Bryan S. , Pelle Dominic , Lee Maxwell Y. , Savage Jason , Tanenbaum Joseph E. , Mroz Thomas E. , Steinmetz Michael P.
Published: November 2018

The use of intraoperative multimodal monitoring (IOM) in spinal deformity surgeries is well documented. In particular, pedicle subtraction osteotomy (PSO), a corrective procedure for sagittal deformity of the spine, often involves IOM usage. By providing immediate feedback to the operating surgeon, IOM has the potential to eliminate or at least minimize the risk of iatrogenic neurological injury. However, despite the widespread usage of IOM, there is currently no standardization of IOM usage in complex spine surgeries, including lumbar PSOs, and decisions concerning IOM utilization are often driven by surgeon experience and preference. This creates a state of clinical equipoise, which is further complicated by the varying degrees of benefit that IOM has on patient outcomes depending on the operation and spinal levels involved. For instance, while IOM use in thoracic PSOs has been shown to be effective, there is no established consensus on the net impact of IOM use in PSOs of the lumbar spine. Although IOM has the potential to mitigate neurological damage, it also increases operation time and cost; thus, it should only be used in operations where it will have a net positive impact on patient outcomes. The question thus becomes whether PSO of the lumbar spine is one such operation. To address this, we examine the most frequently used IOM modalities and evaluate their current usage and efficacy in lumbar PSOs. Furthermore, we will also examine the utility of IOM for other surgeries of the lumbar spine, including corrective procedures for idiopathic scoliosis and degenerative scoliosis, and routine lumbar procedures, such as discectomies and decompression surgeries for foraminal and canal stenosis.
Incident Diabetes in Survivors of Critical Illness and Mechanisms Underlying Persistent Glucose Intolerance: A Prospective Cohort Study
Authors: Kar Palash , Plummer Mark P. , Ali Abdelhamid Yasmine , Giersch Emma J. , Summers Matthew J. , Weinel Luke M. , Finnis Mark E. , Phillips Liza K. , Jones Karen L. , Horowitz Michael , Deane Adam M.
Published: November 2018

Objectives:

Stress hyperglycemia occurs in critically ill patients and may be a risk factor for subsequent diabetes. The aims of this study were to determine incident diabetes and prevalent prediabetes in survivors of critical illness experiencing stress hyperglycemia and to explore underlying mechanisms.

Design:

This was a prospective, single center, cohort study. At admission to ICU, hemoglobin A1c was measured in eligible patients. Participants returned at 3 and 12 months after ICU admission and underwent hemoglobin A1c testing and an oral glucose tolerance test. Blood was also collected for hormone concentrations, whereas gastric emptying was measured via an isotope breath test. β-cell function was modeled using standard techniques.

Setting:

Tertiary-referral, mixed medical-surgical ICU.

Patients:

Consecutively admitted patients who developed stress hyperglycemia and survived to hospital discharge were eligible.

Measurements and Main Results:

Consent was obtained from 40 patients (mean age, 58 yr [sd, 10], hemoglobin A1c 36.8 mmol/mol [4.9 mmol/mol]) with 35 attending the 3-month and 26 the 12-month visits. At 3 months, 13 (37%) had diabetes and 15 (43%) had prediabetes. At 12 months, seven (27%) participants had diabetes, whereas 11 (42%) had prediabetes. Mean hemoglobin A1c increased from baseline during the study: +0.7 mmol/mol (–1.2 to 2.5 mmol/mol) at 3 months and +3.3 mmol/mol (0.98–5.59 mmol/mol) at 12 months (p = 0.02). Gastric emptying was not significantly different across groups at either 3 or 12 months.

Conclusions:

Diabetes and prediabetes occur frequently in survivors of ICU experiencing stress hyperglycemia. Based on the occurrence rate observed in this cohort, structured screening and intervention programs appear warranted.
Supplementation of p-coumaric acid exhibits chemopreventive effect via induction of Nrf2 in a short-term preclinical model of colon cancer
Authors: Sharma Sharada H. , Rajamanickam Vinothkumar , Nagarajan Sangeetha
Published: November 2018

Suppression of colorectal cancer by means of chemoprevention is gaining great attention owing to promising outcomes with less adverse effects in preclinical and clinical trials. The present study aims to explore the mechanism of chemoprevention by p-coumaric acid (p-CA) in a short-term preclinical model of colon cancer. 1,2-dimethylhydrazine-administered rats supplemented with p-CA showed downregulation of the expression of colonic proteins, namely, cyclin B1, cdc2 and mdm2, which regulate cell cycle, and immediate early response genes, namely, c-fos, c-jun and c-myc, which regulate cell proliferation. Apoptosis induction was also observed in the colon of p-CA-supplemented rats as assessed by the Bax/Bcl-2 ratio. Immunohistochemistry, immunoblotting and real-time polymerase chain reaction analysis revealed that supplementation of p-CA improved the in-vivo detoxification potential by modulating the cytoplasmic-to-nuclear ratio of nuclear factor erythroid 2-related factor 2, favouring the induction of genes responsible for cytoprotection and detoxification. The outcome of these findings suggests that p-CA inhibited polyp formation by improving the process of detoxification and apoptosis in the colon of 1,2-dimethylhydrazine-administered rats.
Cytoimmunofluorescence Diagnosis in Surgically Induced Pemphigus Foliaceus
Authors: Magdaleno-Tapial Jorge , Valenzuela-Oñate Cristian , Giacaman-von der Weth Macarena , García-Legaz Martínez Marta , Hernández-Bel Pablo , Carballeira-Braña Alexo , Sánchez-Carazo José Luis , Alegre-de Miquel Víctor
Published: November 2018

Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis.
Treatment of Complicated Anal Fistula by an Endofistular Polyurethane-Sponge Vacuum Therapy: A Pilot Study
Authors: Schniewind Bodo , Schafmayer Clemens , von Schönfels Witigo , Heits Nils G. , Kucharzik Torsten , Klein Georg , Hampe Jochen
Published: November 2018

BACKGROUND:

Treatment of supra- and transsphincteric anal fistulas remains a clinical challenge because current treatment results are variable and potentially endanger sphincter function.

OBJECTIVE:

Based on positive results of endoluminal polyurethane-sponge vacuum therapy in the upper and lower GI tract, a new system for endofistular vacuum therapy was developed for anal fistulas to utilize vacuum therapy to remove the endofistular pseudoepithelium and to induce granulation in the fistula tract.

DESIGN:

This study is based on a prospective case series.

PATIENTS:

Seven patients with complicated anal fistulas (3 associated with Crohn’s disease and 4 of cryptoglandular origin) longer than 4 cm were treated. Initially, the fistula was curettaged and the first endofistular vacuum therapy sponge was positioned in the fistula tract. The inner fistula opening was closed by suture. A 125 mm Hg constant vacuum was applied to the sponge, and the endofistular vacuum therapy sponge was changed a median of 3 (3–5) times after each 48 to 72 hours of constant vacuum therapy. After final removal, the fistulas were reevaluated every other week for 3 months.

MAIN OUTCOME MEASURE:

The main outcome measured was the closure of the fistula.

RESULTS:

All patients tolerated the therapy well and no adverse events were observed. Fistula tract closure was demonstrated within 4 weeks after the termination of vacuum therapy. One patient with cryptoglandular fistula developed a recurrence within the follow-up of 3 months.

LIMITATIONS:

This was an observational study that had no control arm.

CONCLUSION:

In this pilot case series, the results are encouraging. Because endoluminal vacuum therapy would be a new and sphincter-sparing therapy, this concept warrants further investigation in controlled trials.
Immediate and Long-term Complications of Direct-to-implant Breast Reconstruction after Nipple- or Skin-sparing Mastectomy
Authors: Lam Thomas C. , Hsieh Frank , Salinas James , Boyages John
Published: November 2018

Background:

Traditionally, breast reconstruction options after mastectomy comprise an autologous flap or staged expander/implant reconstruction, or a combination of both. Recent introduction of skin or nipple-sparing mastectomies have led to much interest in direct-to-implant immediate breast reconstructions. We performed a retrospective review of our initial experience.

Methods:

Between June 1998 and December 2010, 31 of 671 patients (4.6%) who received implant-only breast reconstruction underwent direct-to-implant immediate breast reconstruction after mastectomy for primary or recurrent cancers, or risk reduction. Their files were audited, and the primary factor examined was the failure of reconstruction with loss of prosthesis. Other complications, revision surgery, and aesthetic result are also recorded.

Results:

The mean follow-up period for the 31 patients was 49.5 months. A total of 45 mastectomies were performed for 21 primary and 4 recurrent breast cancers after previous conservation surgery and radiotherapy (RT), and 20 for risk reduction. Ten patients received RT (4 before mastectomy and 6 afterward). Average size of implants was 380.0 g (range, 205–620 g). The most common postoperative complications were seromas (20%); only 1 implant was lost (2.22%). Nineteen breasts required revision surgery after 6 months with 1 more implant lost. Despite the high revision rate, 28 (90.3%) had excellent or good aesthetic result.

Conclusions:

Immediate single-stage direct-to-implant breast reconstruction has a high rate of both immediate postoperative complications and revisions after 6 months, especially after RT. However, most complications are manageable and do not necessarily result in implant loss. Most cases can have a successful outcome without implant loss with excellent or good cosmetic results.
A comparison of the effects between 2 computerized cognitive training programs, Bettercog and COMCOG, on elderly patients with MCI and mild dementia
Authors: Lee Goo Joo , Bang Heui Je , Lee Kyoung Moo , Kong Hyun Ho , Seo Hyeun Suk , Oh Minwoo , Bang Miyeon
Published: November 2018

Background:

A computerized cognitive rehabilitation program can be used to treat patients with mild cognitive impairment or dementia. We developed a new computerized cognitive rehabilitation program (Bettercog) that contained various treatment programs for cognitive training for mild cognitive impairment or dementia. This study was conducted to compare the clinical efficacy of Bettercog and computer-assisted cognitive rehabilitation (COMCOG) that has had clinical efficacy previously proven in patients with mild cognitive impairment or dementia.

Methods:

Randomized, single-blind comparison pilot study of 20 elderly patients with cognitive decline—eight men and 12 women—with an average age of 74.3 years. Bettercog trains not only memory and attention but also orientation, calculation, executive function, language, comprehension, and spatiotemporal abilities. To retain subjects’ interest, pictures, animations, and game elements were introduced. The subjects were divided into COMCOG and Bettercog groups by random assignment and underwent 12 sessions of a computerized cognitive rehabilitation program for three weeks. In a separate space, an independent clinical psychologist conducted the Seoul Neuropsychological Screening Battery 2nd edition (SNSB-II), Korean Mini-Mental State Examination (K-MMSE), Clinical Dementia Rating (CDR), and the Korean version of the Modified Barthel Index (K-MBI) before and after treatment.

Results:

There was no significant difference between the two groups in baseline age, sex, illiteracy, years of education, and scores on the K-MMSE, CDR, SNSB-II, and K-MBI. In the posttreatment cognitive assessment, the K-MMSE scores of patients treated with Bettercog improved from 19.2 ± 3.9 to 21.3 ± 4.0 (P = .005). In the memory domain of the SNSB-II, the percentile score improved from 15.3 ± 24.5 to 24.2 ± 30.7 (P = .026). However, there was no statistically significant difference in the final K-MMSE, CDR, and SNSB-II scores between the two treatment groups. In both groups, K-MBI scores improved statistically significantly after treatment.

Conclusions:

Through this preliminary study, we verified that the newly developed computerized cognitive rehabilitation program is effective in improving cognitive function. However, 12 sessions are not enough to administer a variety of cognitive rehabilitation content to patients. It is, therefore, necessary to conduct a large-scale study using a computerized cognitive rehabilitation program that has various cognitive content.
Seromucinous hamartoma of inferior turbinate
Authors: Lee Dong Hoon , Yoon Tae Mi , Lee Joon Kyoo , Lim Sang Chul
Published: November 2018

Rationale:

Seromucinous hamartoma is a rare benign glandular proliferation of the sinonasal tract and nasopharynx, and the majority of lesions occur on the posterior nasal septum.

Patient concerns:

The patient had complaints of rhinorrhea, sneezing, and itching for a number of years, and recurrent right nasal bleeding for which the patient underwent endoscopic removal of a right inferior turbinate tumor. The biopsy result was low-grade, non-intestinal type adenocarcinoma, and the patient was referred to our hospital.

Diagnosis and Interventions:

An endoscopic medial maxillectomy of the right nasal cavity was performed. The histopathological analysis of the nasal mass revealed a seromucinous (glandular) hamartoma.

Outcomes:

The postoperative course was unremarkable. The patient has been followed up regularly for 1 year with no additional treatment and no recurrence.

Lessons:

Seromucinous hamartoma of the nasal cavity is extremely rare, especially in anterior portion of nasal cavity. It is important to distinguish seromucinous hamartoma from adenocarcinoma and to maintain regular long-term follow-up.
Breathlessness in amyotrophic lateral sclerosis
Authors: Portaro Simona , Morini Elisabetta , Santoro Maria Elena , Accorinti Maria , Marzullo Pietro , Naro Antonino , Calabrò Rocco Salvatore
Published: November 2018

Rationale:

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative multisystem disorder, presenting with limb or bulbar onset. To date, there is no cure for ALS. At some stage of the disease, patients may complain of breathlessness due to respiratory failure, thus needing a noninvasive mechanical ventilation (NIMV) support. However, breathlessness is a symptom that may be induced by different causes that must be taken into consideration in ALS management.

Patients concerns:

We report the case of an 81-year-old man, with a spinal onset ALS, who was admitted to our clinic to start NIMV because of respiratory involvement. After 3 weeks from NIMV performed at night time, with beneficial effects, he suddenly complained of breathlessness even at rest and in standing position.

Diagnosis:

Respiratory and cardiac assessments did not show new clinical events, indicating the worsening respiratory function. Due to a history of osteoporosis which was treated with biphosphonates and even though no previous bone trauma or falls were reported, we performed a spine computed tomography scan. The findings indicated multiple dorsal vertebral fractures which was a probable cause for breathlessness.

Interventions and outcomes:

Considering the neurodegenerative disease associated to respiratory failure, the cardiovascular risk factors and the age, the patient refused to undergo a surgery with kyphoplasty. A spine support was then prescribed, together with analgesic medications, with significant alleviation of pain and breathlessness.

Lessons:

The occurrence of breathlessness in a patient with ALS cannot always be related to the bulbar involvement. Other causes should be taken into account, especially when there is sudden worsening of symptoms in spite of good clinical response and compliance to NIMV treatment.
Dermoid cyst of nasal septum in an adult patient
Authors: Lee Dong Hoon , Yoon Tae Mi , Lee Joon Kyoo , Lim Sang Chul
Published: November 2018

Rationale:

Nasal dermoid cysts are rare congenital lesions and may present as a midline nasal swelling. Nasal dermoid cysts usually present at birth and are commonly diagnosed by 3 years of age. An incidentally detected nasal dermoid cyst in an adult patient is extremely rare.

Patient concern:

We report an unusual case of an adult patient with an incidentally diagnosed dermoid cyst of the nasal septum, which presented as a longstanding discharging pit in the nasal columella since childhood.

Diagnosis:

A preoperative diagnosis of dermoid cyst of the nasal septum was made.

Intervention:

We performed the external rhinoplasty incision, including a small elliptical incision for removal of the columella pit.

Outcome:

There has been no evidence of recurrence during the 2-year follow-up.

Lessons:

An incidentally detected nasal dermoid cyst in an adult patient is extremely rare. The most important point for the preoperative diagnosis of nasal dermoid cysts is to identify the presence or absence of intracranial extension. The treatment of choice for nasal dermoid cysts is complete surgical excision with clear margins.
Comparison of endoscopic thyroidectomy via a modified axillo-breast approach with the conventional breast approach for treatment of unilateral papillary thyroid microcarcinoma
Authors: Mo KangNan , Zhao Ming , Wang KeJing , Gu JiaLei , Tan Zhuo
Published: November 2018

Endoscopic thyroidectomy (ET) via an axillo-breast (ABA), axillary or breast approach (BA) is effective for treatment of unilateral papillary thyroid microcarcinoma (PTMC). However, several disadvantages still exist, including inconvenience for using endoscopic instruments and poor cosmetic results. Here, we introduced a modified ABA (MABA) to overcome these disadvantages and evaluated its therapeutic outcomes by comparison with conventional BA.

Fifty-five patients undergoing ET via MABA (n = 22) or BA (n = 33) for PTMC were retrospectively enrolled between June 2012 and June 2015. Surgical outcomes, including the operation time, blood loss, amount of drainage, number of dissected lymph nodes, complications, cosmetic satisfaction and prognosis (recurrence and survival), were analyzed.

The operation time (87.1 ± 9.3 min vs 93.2 ± 8.3 min; P = .014) and drainage tube removal time (4.4 ± 1.0 days vs 5.1 ± 1.1 days; P = .018) were shorter in the MABA group than those in the BA group. There was less postoperative drainage (54.3 ± 35.7 mL vs 137.6 ± 87.0 mL; P < .01) in the MABA group compared with the BA group. No significant differences in the blood loss (15.9 ± 7.5 mL vs 19.2 ± 11.7 mL, P = .243) and the number of dissected lymph nodes (1.8 ± 1.5 vs 2.3 ± 2.1, P = .309) were observed between the 2 groups. Subcutaneous ecchymosis occurred more frequently in the BA group than that in the MABA group (33.3% vs 9.1%; P = .038). Patients treated by MABA were more satisfied with their cosmetic results than those undergoing BA (100% vs 81.8%; P = .034). At the last follow-up time, all patients were alive although 1 patient in the BA group developed cervical lymph node recurrence ipsilateral to the original tumor at 4 years after surgery. Multivariate logistic regression analysis showed MABA surgery was a protective factor for postoperative complications (OR = 0.209, 95% confidence interval [CI] = 0.054–0.817, P = .024).

ET via the MABA strategy may be a good choice for unilateral PTMC because of shorter operation time, fewer complications, greater cosmetic satisfaction, and excellent prognosis.
Clinical characteristics and thromboembolic risk of atrial fibrillation patients with and without congestive heart failure. Results from the CRATF study
Authors: Balsam Paweł , Gawałko Monika , Peller Michał , Tymińska Agata , Ozierański Krzysztof , Zaleska Martyna , Żukowska Katarzyna , Szepietowska Katarzyna , Maciejewski Kacper , Grabowski Marcin , Borkowski Mariusz , Kołtowski Łukasz , Praska-Oginska Anna , Zaboyska Inna , Opolski Grzegorz , Bednarski Janusz
Published: November 2018

Congestive heart failure (CHF) and atrial fibrillation (AF) frequently coexist and are associated with increased risk of cardiovascular events.

To compare baseline characteristics, comorbidities and pharmacotherapy in AF patients with concomitant CHF to those without CHF.

The study included 3506 real-life AF patients with (37.1%) and without CHF — participants of the multicentre, retrospective MultiCenter expeRience in AFib patients Treated with OAC (CRAFT) trial (NCT02987062).

All patients were treated with non-vitamin K antagonist oral anticoagulants (NOAC) or vitamin K antagonists (VKA). The frequency of NOAC among patients with and without CHF was 45.6% and 43.2%, respectively (P = .17). Patients with CHF were older (73.3 vs 64.7 years, P <.001), less likely to be women (37.4% vs 42%, P = .007), had higher CHA2DS2-VASc score (3.8 ± 1.7 vs 2.6 ± 1.8, P <.001), more often had permanent AF (53.0% vs 13.4%, P <.001), chronic obstructive pulmonary disease (16.7% vs 4.9%, P <.001), coronary artery disease (64.3% vs 29.8%, P <.001), peripheral vascular disease (65.3% vs 31.4%, P <.001), chronic kidney disease (43.1% vs 10.0%, P <.001), liver fibrosis (5.7% vs 2.6%, P <.001), neoplasm (9.6% vs 7.3%, P = .05), history of composite of stroke, transient ischemic attack or systemic embolization (16.2% vs 10.7%, P <.001), pacemaker (27.4% vs 22.1%, P = .004), implantable cardioverter-defibrillator (22.7% vs 0.8%, P <.001) or transaortic valve implantation (4.0% vs 0.8%, P <.001), cardiac resynchronization therapy (8.7% vs 0.3%, P <.001), composite of kidney transplantation, hemodialysis or creatinine level > 2.26 mg/dL (3.6% vs 0.8%, P <.001) and had less often hypertension (69.4% vs 72.5%, P = .05).

Patients with AF and CHF had a higher thromboembolic risk and had more concomitant diseases.
Qishen Yiqi dripping pills for ischemic heart failure
Authors: Zhao Zhiqiang , Wang Xianliang , Hou Yazhu , Wang Shuai , Zhai Jingbo , Wang Cong , Mao Jingyuan , Zhang Boli
Published: November 2018

Background

The prognosis of ischemic heart failure (IHF) is worse than non-IHM. Improving the management of IHF remains an urgent demand. In recent years, Qishen Yiqi dripping pills (QSYQ), a type of Chinese herbal medicine (CHM), has been popular for IHF combined with standard western medicine. However, relevant scientific evidence from the real clinical practice still is insufficient. The prospective cohort study aims to assess the effectiveness and safety of QSYQ plus standard western medicine for IHF in the real clinical practice.

Methods

It is a multicenter, prospective, observational cohort study. A total of 1200 patients with IHF recruited from 84 hospitals in China will be assigned to exposure group (patients with QSYQ treatment) or non-exposed group (patients without QSYQ treatment) mainly according to patients’ preference in real clinical situation. The primary outcomes include New York Heart Association (NYHA) cardiac functional classification and Minnesota Living with Heart Failure Questionnaire (MLHFQ). The secondary outcomes include composite outcomes (all-cause mortality, frequency of re-admission or emergency due to cardiovascular events), left ventricular ejection fraction and cardiothoracic ratio, symptoms and signs obtained by the 4 Tradiational Chinese Medicine (TCM) diagnostic methods. Assessments will be performed at baseline, 1st and 3rd month after enrollment.

Discussion

It will provide new evidence on QSYQ for IHF in real clinical practice.

Study registration

This study has been registered on the Chinese Clinical Trial Registry (No: ChiCTR-ONRC-14004407).
Ursodeoxycholic acid after common bile duct stones removal for prevention of recurrence
Authors: Chen Xun , Yan Xiao-Ru , Zhang Li-Ping
Published: November 2018

Introduction:

The recurrence rate of common bile duct stones (CBDS) after removal has been reported to exceed 10% and no established pharmacologic treatment exists for the prevention of recurrent CBDS. Many studies indicated ursodeoxycholic acid (UDCA) has the potential to prevent the recurrence of CBDS. The aim of this systematic review is to evaluate the effects of UDCA for prevention of recurrence after common bile duct stones removal.

Methods and analysis:

We will systematically screen all randomized controlled trials (RCTs) published through electronically and hand searching. The following search engines including Ovid Medline, EMBASE, Cochrane CENTRAL, Proquest, Scopus, Web of Science, Pubmed, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, VIP Information, Wanfang Data. Supplementary sources will be searched including gray literature, conference proceedings, and potential identified publications in OpenGrey.eu and Google Scholar databases. Two reviewers will independently conduct the trial inclusion, data extraction and assess the quality of studies. The recurrence rate of CBDS will be assessed as the primary outcomes. The adverse event that required discontinuation of UDCA intervention and the drop-outs (lost to follow-up) before the end of the study will be measured as secondary outcomes. Methodological quality will be evaluated according to the Cochrane risk of bias. All analyses will be applied by RevMan (version 5.3).

Results:

This systemic review and meta-analysis will evaluate the effects of UDCA for prevention of recurrence after CBDS removal in RCTs.

Conclusion:

Our study will provide evidence to judge whether UDCA is an effective intervention to prevent the recurrence after CBDS removal.
Epidural hematoma after caudal epidural pulsed radiofrequency stimulation
Authors: Kim Sang Woo , Chang Min Cheol
Published: November 2018

Rationale:

Epidural hematoma is a possible complication after neuraxial procedures. Recently, caudal epidural pulsed radiofrequency (PRF) stimulation was reported as an effective method for controlling several types of chronic pain. Herein, we report on a patient who developed a lumbar epidural hematoma after receiving caudal epidural PRF stimulation.

Patient concerns:

A 75-year-old woman, who was taking oral warfarin (2 mg/d), received caudal epidural PRF stimulation for symmetrical neuropathic pain in both legs due to chronic idiopathic axonal polyneuropathy. She did not discontinue warfarin use before undergoing the procedure. Three days and 12 hours after the procedure, motor weakness suddenly manifested in the right leg (manual muscle testing [MMT] = 2–3).

Diagnoses:

Lumbar magnetic resonance imaging (MRI) performed 7 days after the PRF procedure showed a spinal epidural hematoma at the L1 to L5 levels, compressing the thecal sac. The international normalized ratio was 6.1 at the time of the MRI.

Interventions:

Decompressive laminectomy from L1 to L5 with evacuation of the hematoma was performed.

Outcomes:

Three months postoperatively, the motor weakness in the patient's right leg improved to MMT = 4 to 5.

Lessons:

This case suggests that clinicians should carefully check if patients are taking an anticoagulant medication and ensure that it is discontinued for an appropriate length of time before a caudal epidural PRF procedure is performed.
Selection of the best point and angle of lateral ventricle puncture according to DTI reconstruction of peripheral nerve fibers
Authors: Zhong Sheng , Li Weihang , Wang Bin , Ren Jiaxin , Li Hui , Zhao Yingjing , Jiang Shanshan , Fan Yuxiang , Cheng Ye , Zhao Gang , Liu Xinrui , Jin Rihua
Published: November 2018

This study aims to find accurate angles and depths of lateral ventricle puncture using diffusion tensor imaging (DTI) reconstruction, as well as to provide an optimized and alternative puncturing strategy.

A total of 90 computed tomography (CT) images and 30 CT images with DTI were analyzed. The measurements were performed on coronal, sagittal, and horizontal planes. Some distances and angles were measured to determine the best angle and penetration depth during the puncture process. Important landmarks of the lateral ventricle were also measured, and a comparison of the differences between 2 hemispheres was also assessed.

It showed that the vertical distance from the superior margin to inferior margin of the lateral ventricle was 22.2 ± 0.5 mm and the length was 124.1 ± 2.1 mm. In the frontal horn puncture approach, the penetration depth should be limited between 105.2 and 109.4 mm, the angle should be 71.6 ± 2.7°. During the occipital horn puncture approach, puncturing depth was from 90.7 to 111.4 mm, and angle was 15.3 ± 1.8°. Through the parietal lobe puncture approach, which was firstly brought out in this study, the puncturing length should be 124.4 to 130.2 mm and angle was 56.6 ± 2.0°.

The traditional recommended protocol of lateral ventricle puncture is not accurate, the refined lateral ventricle puncture protocol established in this study will reduce injury and remain function. A DTI imaging examination combining with nerve fibers reconstruction were strongly recommended before lateral ventricle puncture, which will help neurosurgeons to determine the best puncturing angles and depth.
Impacts of time interval on 18F-FDG uptake for PET/CT in normal organs
Authors: Wang Rang , Chen Haotian , Fan Chengzhong
Published: November 2018

Background:

To perform a systematic review of the effect of time interval on 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG) uptake in normal organs.

Methods:

PubMed, EMBASE, Ovid, and Cochrane databases were searched to identity all potential eligible literature. The study characteristics and relevant data were extracted and analyzed. We adopted the effect size (ES) and the coefficient of determination (R
2) to best measure the magnitude of the relation between time interval and 18F-FDG uptake in normal organs.

Results:

Seven articles and 860 participants were included. The time interval on liver and mediastinal blood pool were relatively medium (R
2=0.01–0.03, ES = –0.57 and –0.60) but noticeable (R
2 = 0.06, ES = –0.68 and –0.39), respectively. The uptake of 18F-FDG on cerebellum, spleen, bone marrow, muscle, bowel, and adipose remains to be verified as the rare studies. In addition, other factors such as body mass index and blood glucose level appeared to be important which also affect 18F-FDG uptake in normal organs.

Conclusion:

The impact of time interval on SUVs in liver and mediastinal blood pool were relatively medium but clinically noticeable. More studies need to be done to solve the relation between the SUVs of other organs and time interval.
Management of refractory chronic migraine using ultrasound-guided pulsed radiofrequency of greater occipital nerve
Authors: Kwak Soyoung , Chang Min Cheol
Published: November 2018

Rationale:

Although various oral medications and procedures are applied for managing migraine, their efficacy remains limited. To control migraine that does not respond to conventional treatments, we conducted pulsed radiofrequency (PRF) stimulation to the greater occipital nerve (GON) in 2 patients.

Patient concerns:

Patients 1 and 2 complained of chronic throbbing, pulsating, and tight headaches. Their headache intensities scored 8 and 7 on a numeric rating scale (NRS), respectively. Patient 1 experienced the headache bilaterally in the frontal, retro-orbital, parietal, and occipital regions. The initial onset of the symptoms was more than 15 years ago. Patient 2 complained of headaches in the left frontal, retro-orbital, parietal, and occipital regions, which occurred first more than 14 years ago.

Diagnoses:

According to the International Classification of Headache Disorder-3 beta criteria, the patients were diagnosed with chronic migraine.

Interventions:

Oral medications, GON block with bupivacaine and dexamethasone, and botulinum toxin injections did not alleviate the patients’ migraine.

The PRF stimulation on GON was performed under the guidance of ultrasound, at 5 Hz and 5-millisecond pulsed width for 360 seconds at 45 V. The electrode tip temperature was maintained at or below 42°C.

Outcomes:

Two weeks after applying PRF, the pain was reduced to NRS 3 in both patients, who also reported that the headache became bearable after PRF. The effectiveness of PRF on GON lasted for at least 3 months in both patients, and no adverse effects were observed.

Lessons:

Our findings suggested that the application of PRF on GON can be a useful option for treating refractory chronic migraine.
Chronic myeloid leukemia extramedullary blast crisis presenting as central nervous system leukemia
Authors: Jin Mingwei , Xuan Chengmin , Gao Jizhao , Han Rui , Xu Shumei , Wang Lei , Wang Yuan , Shi Kunpeng , Rauniyar Sunil , An Qi
Published: November 2018

Rationale:

Childhood chronic myeloid leukemia (CCML) is a malignant disease of granulocyte abnormal hyperplasia that is caused by clonal proliferation of pluripotent stem cells. The condition is relatively rare, accounting for 2.0% to 3.0% of cases of childhood leukemia. In addition, the incidence of extramedullary blast crisis in CCML presenting as central nervous system (CNS) blast crisis remaining chronic phase of the disease in bone marrow is extremely unusual.

Patient concerns:

We report a case of childhood chronic myelogenous leukemia that abandoned treatment, resulting in chronic myelogenous leukemia transforming into extramedullary blast crisis resulting in CNS leukemia, accompanied by the chronic phase of the disease in bone marrow.

Diagnoses:

Chronic myeloid leukemia extramedullary blast crisis presenting as CNS leukemia without blast crisis in bone marrow.

Interventions:

Following high-dose systemic and intrathecal chemotherapy, the patient continued to do well.

Lessons:

High-dose systemic and intrathecal chemotherapy is safe and helpful for CCML extramedullary blast crisis. A long-term follow-up is crucial.
Acellular dermal matrix in premature ejaculation
Authors: Zhang Xiaowei , Wu Yuanyi , Zhang Min , Yin Huaqi , Li Qing , Bai Wenjun , Xu Tao
Published: November 2018

Background:

To investigate the efficacy of acellular dermal matrix in penis augmentation (ADMPA) for premature ejaculation (PE).

Methods:

A total of 39 patients treated with ADM in penis augmentation from June 2014 to December 2017 were evaluated. Detailed evaluations on PE were conducted before operation and at the 6-month and 2-year follow-up visits after operation. Self-estimated intravaginal ejaculatory latency time (IELT) and 5-item version of the International Index of Erectile Function (IIEF-5) were used to measure the ejaculation and the erectile function for all subjects.

Results:

Compared to the baseline data, the IELT and IIEF-5 scores were increased, and PE was relieved at 6 months and 2 years after operation. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. The psychosexual impact of the operation was beneficial in the majority of cases.

Conclusion:

Our survey systematically evaluated the effects of ADMPA for PE. ADMPA might be an optional surgical method in patients with PE, especially for those who seek penile augmentation. However, given the small amount of cases involved in this study, further studies on the effect of ADMPA for PE were still needed.
Epidemiology of foodborne disease outbreaks from 2011 to 2016 in Shandong Province, China
Authors: Wu Guangjian , Yuan Qun , Wang Liansen , Zhao Jinshan , Chu Zunhua , Zhuang Maoqiang , Zhang Yingxiu , Wang Kebo , Xiao Peirui , Liu Ya , Du Zhongjun
Published: November 2018

Foodborne disease is a major public health concern in both developed and developing countries. China has established a nationwide Foodborne Disease Outbreak Surveillance System (FDOSS) for collection and periodic reporting of data on the occurrence and causes of foodborne disease outbreaks in China. Each provincial Centers for Disease Control and Prevention (CDC) conducts the system working.

We reviewed foodborne disease outbreaks that occurred during 2011 to 2016 in Shandong Province from the FDOSS. The Wilcoxon test was used to compare the median number of ill persons in outbreaks. All data analysis was performed using Epi Info 7.

During 2011 to 2016, Shandong CDC received reports of 1043 foodborne disease outbreaks, resulting in 8078 illnesses, 2442 hospitalizations, and 17 deaths. There were a median of 69 outbreaks annually [interquartile range (IQR) 10–342], resulting in 335 to 3824 illnesses each year. The median outbreak size was 3 persons (IQR 2–7). Hotels (including cruise ships, hotpot restaurants, barbecue shops) were the most common setting. Among the 744 (71.3%) outbreaks with an implicated food or contaminated ingredient reported, 704 (94.6%) could be assigned to one of 17 predefined commodity categories. Of the 280 outbreaks with a known etiology, 117 (41.8%) were caused by poisonous plants and animals and their toxins, 39 (13.9) were caused by nitrite, and 27 (9.6%) were caused by vibrio parahaemolyticus. Of the 491 (47.1%) outbreaks with at least a contributing factor to cause outbreak, 168 (34.2%) were caused by improper processing, and 100 (20.4) were caused by inedible and misuse.

Timely investigation, disposal and reporting of foodborne disease outbreaks provides information that might help FDOSS to make full use of efficiency and FDOSS should be continued and strengthened even more in Shandong Province, such as an increase in diagnostic laboratory capacities.
Tumor necrosis factor-alpha-308 gene promoter polymorphism associates with survival of cancer patients
Authors: Yi Fengshuang , Shi Xinyu , Pei Xuebin , Wu Xiuzhi
Published: November 2018

Background:

Tumor necrosis factor-alpha (TNF-α) is involved in cancer pathogenesis, and TNF-α-308G>A, a single-nucleotide polymorphism, is associated with cancer prognosis; however, different studies have reported inconsistent results. This meta-analysis aimed to determine the correlation between TNF-α-308G>A polymorphism and the survival of cancer patients.

Methods:

PubMed, Web of Science, Embase, Wanfang database, VIP database, and China National Knowledge Infrastructure database were used to obtain articles on association between TNF-α-308G>A polymorphism and cancer survival, published until April 2018. A meta-analysis was carried out using Stata 12.0 software to determine the pooled hazard ratio (HR) and 95% confidence intervals (95% CI). Furthermore, publication bias was assessed, and sensitivity analysis was performed to validate the analysis.

Results:

In total, 13 retrospective cohort studies including 2559 cancer patients were reviewed to estimate the association between TNF-α-308G>A polymorphism and overall survival (OS) of cancer patients. The pooled results suggested that within TNF-α-308G>A polymorphism, genotypes GA+AA/GG (HR = 1.39, 95% CI: 0.90–2.14, P < .001, I2 = 78.1%), GA/GG (HR = 1.06, 95% CI: 0.83–1.36, P = .072, I2 = 53.5%), and AA/AG+GG (HR = 3.28, 95% CI: 0.92–11.72, P = .001, I2 = 85.9%) were not associated with the OS of cancer patients. However, interestingly, the HR was greater for patients with the AA genotype than for those with the GG genotype, suggesting an association between TNF-α-308G>A polymorphism and OS among cancer patients (AA/GG, HR = 2.16, 95% CI: 1.36–3.43, P = .281, I2 = 21.5%).

Conclusion:

TNF-α-308G>A polymorphism affects the OS of cancer patients and is a potential therapeutic target for cancer.
Acupressure for insomnia
Authors: Wu Dong-Jie , Dong Hai-Cheng , Tang Tsz-Nga , Zhu Shi-Feng
Published: November 2018

Background:

Insomnia is a public sleep disorder defined as a deficiency of sleep quantity or quality. Acupressure is a low-cost treatment that has potential as an insomnia therapy.

Methods:

Four databases will be searched from inception to date. The researchers will screen clinical randomized trials of acupressure and auricular acupuncture for insomnia. The screening of the study, data extraction will be carried out independently by 2 researchers. The specific process will refer to the Cochrane Handbook for Systematic Review.

Results:

The results of the study will be published in a scientific journal after peer-review. We integrate the latest study about acupressure for insomnia.

Conclusion:

This systematic review will provide evidence for assessing the improvement of acupressure for insomnia.

Ethics and dissemination:

The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print.

PROSPERO registration: CRD42018104155.