bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative Transcranial Motor-evoked Potential Stimulation Does Not Seem to Cause Seizures
Authors: Burbridge Mark A. , Nguyen Viet , Min Jung Gi , Jaffe Richard A. , Ahuja Brian , Shah Amit D. , Lee Leslie H. , Cho Charles , Sandoval Breanna , López Jaime R.
Published: December 2019

Background:

Intraoperative neurophysiological monitoring is of critical importance in evaluating the functional integrity of the central nervous system during surgery of the central or peripheral nervous system. In a large recent study, transcranial motor-evoked potentials (TcMEPs) were found to be associated with a 0.7% risk of inducing a seizure as diagnosed by clinical observation and electromyography in patients having general anesthesia with intravenous anesthetics. The gold standard for seizure diagnosis, however, is electroencephalography (EEG). The aim of this single-institution retrospective study is to ascertain the risk of intraoperative seizures detected using EEG during surgeries in adult patients undergoing intraoperative monitoring with TcMEPs.

Methods:

The authors retrospectively reviewed the intraoperative EEG records of 1175 patients anesthetized with a variety of anesthetic agents, including volatile and intravenous anesthetics, to ascertain the rate of EEG-diagnosed seizures attributable to TcMEPs.

Result:

Our analysis did not reveal a single seizure event attributable to TcMEPs in 1175 patients.

Conclusion:

The intraoperative use of TcMEPs does not seem to cause seizures.
Ergonomics in Dermatologic Surgery: Lessons Learned Across Related Specialties and Opportunities for Improvement
Authors: Chan Justin , Kim Dong Joo , Kassira-Carley Sama , Rotunda Adam M. , Lee Patrick K.
Published: December 2019

BACKGROUND

As the practice of dermatology becomes increasingly procedurally based, there is a concordant rise in musculoskeletal injury (MSI) risk. Dermatologic surgeons are most susceptible and, although the majority suffer from MSI, few have received any formal ergonomics training. This stems from a lack of awareness of this troubling trend and a paucity of research and education on the ergonomics of dermatologic surgery.

OBJECTIVE

To highlight pertinent ergonomics principles and strategies from other specialties that could be translated into dermatology, and to synthesize general recommendations aimed at reducing MSI among dermatologic surgeons.

MATERIALS AND METHODS

A comprehensive search of the PubMed and Cochrane Reviews databases from 1975 to 2019 was conducted, using a combination of ergonomics-related search terms, generating 6 publications from the dermatology literature and 58 from the fields of dentistry, medicine, and select surgical subspecialties.

RESULTS

This multidisciplinary approach yielded multiple interventions that could be applied directly (i.e., adequate lighting, adjustable operating tables, and surgical seat heights) or indirectly pending further investigation into their feasibility (i.e., video displays of the surgical field to allow neutral head and neck postures).

CONCLUSION

Although much can be learned from decades of prior ergonomics research from other specialties, considerations that are unique to dermatology remain and must be addressed with specialty-specific research.
The Unhappy Cosmetic Patient: Lessons From Unfavorable Online Reviews of Minimally and Noninvasive Cosmetic Procedures
Authors: Watchmaker Lauren E. , Watchmaker Jacqueline D. , Callaghan Daniel , Arndt Kenneth A. , Dover Jeffrey S.
Published: December 2019

BACKGROUND

The number of patients receiving minimally and noninvasive cosmetic procedures is increasing. Often, patients turn to online review forums to gain and share advice regarding cosmetic procedures. Understanding and discussing patient-reported outcome data can help align physician and patient expectations and ultimately help improve the patient experience.

OBJECTIVE

To determine the most common reasons patients are dissatisfied with a selection of minimally and noninvasive cosmetic procedures.

MATERIALS AND METHODS

Negative patient reviews from the RealSelf.com website were analyzed, and the reason for patient discontent was recorded for the following treatments: tissue stabilized-guided subscision, cryolipolysis, electromagnetic therapy, deoxycholic acid injections, energy-induced thermolysis, radio thermoplasty, threadlifts, and ultrasound therapy.

RESULTS

One thousand two hundred four reviews were included in analysis. For all treatments analyzed, the most common reason for patient dissatisfaction was ineffectiveness (n = 782, 65.0%), followed by complications (n = 301, 25.0%). The most common complications were as follows: lumps for tissue stabilized-guided subscision (n = 6, 50.0%), treated area enlargement for cryolipolysis (n = 23, 22.1%), swelling for deoxycholic acid injections (n = 9, 47.4%), numbness for energy-induced thermolysis (n = 6, 35.3%), fat loss for radio thermoplasty (n = 26, 53.1%) and ultrasound therapy (n = 32, 48.5%), and indentations for threadlifts (n = 10, 30.3%).

CONCLUSION

Ineffectiveness and complications were the most common reasons for dissatisfaction among all treatments analyzed. Patient-reported outcome data may offer insight into how physicians can improve their patient's satisfaction with cosmetic procedures.
Effect of Intensive and Standard Lipid-Lowering Therapy on the Progression of Stroke in Patients With Coronary Artery Syndromes: A Meta-Analysis of Randomized Controlled Trials
Authors: Xie Chengjuan , Zhu Mingyu , Hu Ying , Wang Kai
Published: December 2019

This meta-analysis demonstrated the effect of intensive versus standard statins on the risk of stroke in patients with coronary artery syndromes (CAS). PubMed, Embase, the Cochrane library, and clinicaltrials.gov were searched, and the retrieved studies were undertaken for randomized controlled trials (RCTs) throughout September 2018. Studies that were designed as RCTs and recruited at least 1000 CAS patients followed up greater than 1 year were eligible for this study. The summary relative risk with the 95% confidence interval was used as an effect estimate and calculated using the random-effects model. Five RCTs comprising a total of 39,612 coronary syndrome patients with reported 1236 stroke events were included in this meta-analysis. The summary result indicated a 14% reduction in the risk of stroke in CAS patients receiving intensive statin therapy as compared to standard statin therapy. The significant differences mainly occurred in mean age ≥60 years (P = 0.007), percentage of males ≥80% (P = 0.011), percentage diabetes mellitus ≥ 15% (P = 0.018), percentage hypertension ≥50% (P = 0.030), percentage of current smokers <30% (P = 0.011), percentage of prior myocardial infarction ≥50% (P = 0.011), percentage of peripheral arterial disease ≥10% (P = 0.030), patients with stable CAS (P = 0.011), patients using atorvastatin (P = 0.015), follow-up duration ≥3 years (P = 0.011), and study with moderate quality (P = 0.013). Intensive statin therapy should be considered for CAS patients at high risk of stroke events. Further large-scale RCT should be conducted to verify the results of stratified analysis in this study.
SPECTRAL FUNDUS AUTOFLUORESCENCE EXCITATION AND EMISSION IN ABCA4-RELATED RETINOPATHY
Authors: Müller Philipp L. , Dysli Chantal , Hess Kristina , Holz Frank G. , Herrmann Philipp
Published: December 2019

Purpose:

To systematically and longitudinally investigate the characteristics of flecks in ABCA4-related retinopathy under different fundus autofluorescence (AF) excitation and emission spectra.

Methods:

A total of 132 eyes of 66 patients with ABCA4-related retinopathy were investigated using multimodal AF imaging and spectral domain optical coherence tomography. Autofluorescence imaging with blue (BAF), green (GAF), and near-infrared (NIR-AF) excitation wavelengths obtained by a confocal scanning laser ophthalmoscope was compared with AF imaging obtained by an innovative confocal light-emitting diode-based retinal imaging system (Color-AF) that allows for separation of short (green emission fluorescent component) and long (red emission fluorescent component) autofluorescence emission components.

Results:

Color-AF, BAF, and GAF, overall, revealed similar presentation of hyperautofluorescent flecks. Flecks that showed predominantly red emission fluorescent component matched with hyperautofluorescent flecks in NIR-AF. Over the observation time of 5 to 14 months, flecks showed a transition in the AF emission spectrum to shorter wavelengths (red emission fluorescent component to green emission fluorescent component), associated with a progressed disruption of overlaying outer retinal bands in optical coherence tomography. Newer hyperautofluorescent flecks usually revealed predominantly red emission fluorescent component.

Conclusion:

By separation of the AF spectra, the remodeling of fluorophores and associated structural changes can be monitored over time indicating a novel and susceptible surrogate marker for disease progression and potential therapeutic effects.
Shell-vial Assay in Diagnosis of Disseminated BCG Infection in an Immunodeficient Child
Authors: Fellag Mustapha , Saad Jamal , Barlogis Vincent , Michel Gérard , Drancourt Michel
Published: December 2019

We are reporting a case of Bacillus Calmette-Guérin vaccine-disseminated infection in a 19-month-old HIV-negative girl diagnosed with severe combined immunodeficiency. While standard culture protocols failed to isolate and culture the Mycobacterium bovis Bacillus Calmette-Guérin strain, it was isolated from skin and mesenteric lymph node biopsies using the shell-vial assay, allowing whole-genome sequencing and in silico drug susceptibility testing.
Systematic Review and Meta-analysis of Postlicensure Observational Studies on Human Papillomavirus Vaccination and Autoimmune and Other Rare Adverse Events
Authors: Willame Corinne , Gadroen Kartini , Bramer Wichor , Weibel Daniel , Sturkenboom Miriam
Published: December 2019

Background:

Because of the limited number of subjects in prelicensure studies, autoimmune diseases and other rare adverse effects of vaccines may go undetected. Since 2006, millions of human papillomavirus (HPV) vaccine doses have been distributed and a considerable amount of postlicensure safety data has been generated. The objective of this study was to review available HPV postlicensure safety studies and to summarize risk estimates of autoimmune and other rare diseases.

Methods:

For this systematic review and meta-analysis, we searched literature databases to identify any postlicensure safety studies related to HPV vaccination and autoimmune adverse events from inception to April 16, 2019. Pooled risk estimates were computed using fixed- or random-effects models if at least 2 estimates per disease and per HPV vaccine were available.

Results:

Twenty-two studies met our inclusion criteria. The studies applied various methodologies and used different types of data sources and outcome definitions. Quadrivalent HPV vaccine (4vHPV) was most commonly assessed. Type 1 diabetes mellitus, immune thrombocytopenia purpura and thyroiditis diseases were most frequently reported. The meta-analysis was conducted on 35 diseases corresponding to 48 pooled risk estimates. Majority of the pooled estimates showed no significant effect (n = 43). Three negative (paralysis, immune thrombocytopenia purpura and chronic fatigue syndrome) and 2 positive (Hashimoto and Raynaud diseases) associations were detected.

Conclusion:

Our study demonstrated an absence of clear association between HPV vaccines and autoimmune and other rare diseases. The review also highlights the need for more systematic collaborations to monitor rare safety adverse events.
Temporo-Parietal Flap Incorporated Into a Modified Osteo-Odonto Keratoprostheses Protocol for Longevity of the Dental Lamina
Authors: Rao Anupam C. A. , Toalster Nicholas , Moloney Greg , Webber Shannon
Published: December 2019

Purpose:

To describe a novel pedicled temporo-parietal flap to delay laminar resorption in a modified osteo-odonto keratoprosthesis (MOOKP) and measure resorption of the dental lamina by an objective method.

Methods:

A retrospective case series was performed on patients who received an osteo-odontokeratoprosthesis for Steven-Johnson-Syndrome. Surgeries were performed between October 2016 and November 2017 by the same surgical team (G.M. and S.W.). A modified temporo-parietal flap was incorporated into stage 1 of the MOOKP procedure. CT Scans were performed post op and on follow up. Volumetric evaluation was achieved by automated software analysis of 3D reconstructed CT images (Vitrea, Software Version 6.7.6, Cannon Medical Systems ANZ Pty Ltd).

Results:

The procedure was performed in 3 eyes from 3 patients. Patients were followed up for stage 2 review at 9.6 months on average (22–55 weeks). One case was complicated by early postoperative hematoma of the buccal graft; however, this was managed conservatively. Another case required relaxing incisions at the time of flap creation due to increased vascularized collagenous tissue. On follow up, volume changes in the dental lamina were minimal.

Conclusions:

Loss of laminar volume can potentially jeopardize the success of the MOOKP, and consequently cause significant visual, graft or globe complications. The long-term success of this method needs further evaluation; however, initial results suggest a possible role for pedicle grafts in maintenance of the dental lamina. Furthermore, objective CT-based calculation of laminar volume may reduce inter-study variability and standardize comparison of techniques.
Loss of Pacer Spikes as electrocardiographic (EKG) Artifact Due to Microdebrider Use During Endoscopic Dacryocystorhinostomy
Authors: Pham Chau , Setabutr Pete
Published: December 2019

As intraoperative use of electronic equipment becomes more common, familiarity with the potential for electrocardiographic artifact generated by these instruments is increasingly important. The authors' patient underwent endoscopic dacryocystorhinostomy under general anesthesia for treatment of acute on chronic dacryocystitis secondary to acquired nasolacrimal duct obstruction. She had previously had pacemaker placement for treatment of sick sinus syndrome and low ejection fraction heart failure, and use of a microdebrider intraoperatively resulted in loss of pacer spikes and interference signal on electrocardiographic leading to placement of a magnet. Post-operatively, examination of the microdebrider cord revealed a tear that likely lead to the artifactual electrocardiographic signal influencing the decision for magnet placement. Although there were no long-term ill effects, placement of the magnet was an unnecessary intervention that may have been avoided by prompt recognition of artifactual changes that may be induced by intraoperative use of electronic instrumentation.
Examining the Role of Retrobulbar Hyaluronidase in Reversing Filler-Induced Blindness: A Systematic Review
Authors: Paap Michael K. , Milman Tatyana , Ugradar Shoaib , Goldberg Robert , Silkiss Rona Z.
Published: December 2019

Purpose:

To provide a systematic review of the literature concerning retrobulbar hyaluronidase injections as a treatment for hyaluronic acid gel filler-induced blindness and evaluate the level of evidence for this proposed therapy.

Methods:

The authors performed a search of English language articles published on the use of retrobulbar hyaluronidase to reverse vision loss precipitated by hyaluronic acid gel fillers. Articles reviewed included case reports/series, experimental investigations, expert opinion commentaries, and major reviews. To date, there have been no case–control, cohort, or randomized control studies to evaluate this treatment. Five anecdotal descriptions of hyaluronic acid gel filler blindness treated specifically with retrobulbar hyaluronidase were identified, for a total of 9 patients. One hundred twelve articles in total on this treatment and related topics, including filler-induced blindness and alternative treatments, were identified and reviewed.

Results:

Of the 9 documented cases of patients treated with retrobulbar hyaluronidase for hyaluronic acid-induced blindness, visual improvement was demonstrated in 2 cases. The successes, however, are undermined by inconsistent pretreatment ophthalmic assessment and documentation. Animal studies demonstrate mixed results. Laboratory studies document the inability of hyaluronidase to cross the optic nerve sheath.

Conclusions:

There is not currently enough evidence to support retrobulbar hyaluronidase as a treatment for filler-induced blindness. Additional studies are needed to further evaluate its efficacy and explore alternative treatments.
Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion
Authors: DeMatteo Carol A. , Lin Chia-Yu A. , Foster Gary , Giglia Lucia , Thabane Lehana , Claridge Everett , Noseworthy Michael D. , Hall Geoffrey B. , Connolly John F.
Published: December 2019

Objective:

The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth.

Design:

A prospective cohort of children/youth with concussion.

Setting:

Childhood Disability Research Centre.

Participants:

One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department.

Intervention:

Provision of RTS/RTA guidelines.

Main Outcome Measures:

Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores.

Results:

Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively.

Conclusions:

Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.
Lipid keratopathy and septal abscess
Authors: Heo Sung Jae , Kim Jung Soo , Kwon Sam Hyun , Kim Jong Seung
Published: December 2019

Rationale:

Epistaxis is a common otorhinolaryngological emergency, but septal abscess has not been reported before as a complication of epistaxis.

Patient concerns:

We report a case of a 51-year-old man complaining of nasal obstruction and facial numbness for 3 weeks. He had a history of epistaxis, and had been treated with electrocauterization of the left nasal septum at a local clinic 1 month earlier.

Diagnoses:

On nasal endoscopy, swelling of the septum was noticed; computed tomography (CT) was performed, and revealed a septal abscess.

Interventions:

The patient was treated with incision and drainage under local anesthesia. A left vertical hemitransfixion incision was made and 4 mL of purulent material was drained. There was no quadrangular septal cartilage.

Outcomes:

On the 5th postoperative day, the patient complained of blurred vision in his right eye. Visual acuity of the left eye was 0.5, but acuity of the right eye was finger count at 50 cm. Examination of the right eye revealed a whitish fan-shaped corneal opacity on the medial side with neovascularization, diagnostic of lipid keratopathy.

Conclusion:

Electrocautery of epistaxis should be performed carefully during hemostasis, and there should be careful follow-up after the procedure to detect the occurrence of septal hematoma or septal abscess. These conditions should be treated as early as possible to avoid further serious complications. Since lipid keratopathy is difficult to treat once it occurs, care should be taken to avoid a septal abscess.
Moxibustion therapy for treating patients with primary osteoporosis
Authors: Hui Xin , Wang Hao , Yao Qin , Zhao Baixiao , Ha Lue
Published: December 2019

Background:

Primary osteoporosis (POP) is a common disease among elderly, which increase the risk of fracture and impact to the quality of life. As a Chinese traditional therapy, moxibustion has been commonly applied in treating chronic musculoskeletal diseases in China. Many trails have shown that moxibustion therapy is effective in treating primary osteoporosis. The protocol aims to present the methods used to access the effectiveness and safety of moxibustion therapy for patients with primary osteoporosis.

Methods:

The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trails(CENTRAL), Pubmed, EMBASE, China National Knowledge Infrastructure(CNKI), Chinese Biomedical Literature Database(CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomized controlled trials related to moxibustion therapy for treating primary osteoporosis will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. We will select the fixed-effects or random-effects model according to the heterogeneity assessment for data synthesis. Bone mineral density(BMD) will be the primary outcomes. Visual analogue scale(VAS), response rate, TCM Syndrome scale(TCMSS), bone gla protein(BGP), alkaline phosphatase(BALP), blood calcium(Ca), blood phosphate(P), quality of life(QOL) will be the second outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference(WMD) or standard mean difference (SMD) 95% CIs for continuous data.

Trial registration number:

PROSPERO CRD42019129507
The efficacy and safety of different doses of glucocorticoid for autoimmune hepatitis
Authors: Zhang Chi , Wu Shan-Shan , Dong Xiao-Qin , Wu Zhao , Zhao Hong , Wang Gui-Qiang
Published: December 2019

Background:

Glucocorticoid as the standard treatment of autoimmune hepatitis has been recommended with different doses. The purpose of this study is to compare the efficacy and safety of high and low doses for clinical practice.

Methods:

Medline, Embase, and Cochrane Library were searched until January 16th, 2019 for cohort studies or randomized controlled trials in patients with autoimmune hepatitis. Glucocorticoid 60 mg/d or 1 mg/kg/d was defined as high dose and 40 to 50 mg/d or 0.5 mg/d as low dose. Outcome of interests includes the incidence of the biochemical remission, adverse event, and endpoint events. Double arcsine method with a random-effect model was used to combine the incidence. Potential heterogeneity was explored by meta-regression and subgroup analysis.

Results:

Overall, 25 studies (3305 patients) were included, with 10 studies in the high dose group and 15 in low dose group. The biochemical remission rate in the high and low dose group was 0.79 (95% confidence interval [CI] [0.72, 0.85]) and 0.72 (95% CI [0.65, 0.78]), respectively. The incidence of endpoint events and adverse event in the high were slightly higher (0.03, 95% CI [0.02, 0.04]; 0.42, 95% CI [0.30, 0.53]) than that of the low dose group (0.01, 95% CI [0.00, 0.01]; 0.39, 95% CI [0.15, 0.63]).

Conclusions:

For autoimmune hepatitis patients, 60 mg/d or 1 mg/kg/d of glucocorticoid gives higher biochemical remission rate and higher incidence of endpoint events and adverse events.
Comparison of recovery profiles in patients with Parkinson's disease for 2 types of neuromuscular blockade reversal agent following deep brain stimulator implantation
Authors: Park Yong-Seok , Kim Jaewon , Kim Sung-Hoon , Moon Young-Jin , Kwon Hye-Mee , Park Hee-Sun , Kim Wook-Jong , Ha Seungil
Published: December 2019

As an anesthetic reversal agent, there are concerns with cholinesterase inhibitors regarding worsening of Parkinson's disease (PD)-related symptoms. Sugammadex, a relatively new reversal agent, does not inhibit acetylcholinesterase and does not require co-administration of an antimuscarinic agent. The present study compared the recovery profiles of 2 agents initially administered for reversal of neuromuscular blockade in patients with advanced PD who underwent deep brain stimulator implantation.

A total of 121 patients with PD who underwent deep brain stimulator implantation were retrospectively analyzed. Patients were divided into 1 of 2 groups according to the type of neuromuscular blockade reversal agent (pyridostigmine vs sugammadex) initially administered. Recovery profiles reflecting time to extubation, reversal failure at first attempt, and hemodynamic stability, including incidence of hypertension or tachycardia during the emergence period, were compared.

Time to extubation in the sugammadex group was significantly shorter (P < .001). In the sugammadex group, reversal failure at first attempt did not occur in any patient, while it occurred in seven (9.7%) patients in the pyridostigmine group (P = .064), necessitating an additional dose of pyridostigmine (n = 3) or sugammadex (n = 4). The incidence of hemodynamic instability during anesthetic emergence was significantly lower in the sugammadex group than in the pyridostigmine group (P = .019).

Sugammadex yielded a recovery profile superior to that of pyridostigmine during the anesthesia emergence period in advanced PD patients. Sugammadex is also likely to be associated with fewer adverse effects than traditional reversal agents, which in turn would also improve overall postoperative management in this patient population.
Regression of a symptomatic varix after transarterial embolization of a brain arteriovenous malformation
Authors: Li Guichen , Wang Guangming , Yu Jing , Hou Kun , Yu Jinlu
Published: December 2019

Rationale:

Brain arteriovenous malformation (BAVM)-associated varix is always asymptomatic, and no special treatment is needed. However, there is no consensus regarding how to address a varix that has led to clinical manifestation.

Patient concerns:

An 11-year-old girl was admitted complaining of left hemiparesis for 4 days. She was previously healthy and denied any history of similar ictus. She was alert, and a physical examination performed upon admission was unremarkable except for the left hemiparesis.

Diagnoses:

Head magnetic resonance imaging (MRI) showed a linear and round flow void and perilesional edema in the region of the right basal ganglia, indicating a BAVM. Gadolinium-enhanced MRI showed peripheral enhancement of the round lesion. Computed tomography angiography (CTA) showed that the BAVM was fed by the ipsilateral posterior cerebral artery and anterior choroidal artery and drained into the vein of Galen. A large varix was also noted at the top of the BAVM and was consistent with the round flow void observed at the right basal ganglia on MRI. The Spetzler-Martin grading scale was grade IV

Interventions:

The patient experienced a TAE of the BAVM nidus with liquid embolic agent.

Outcomes:

A follow-up investigation showed regression of the varix, although there was still some residual BAVM. The patient experienced a favorable recovery.

Lessons:

In the case of a BAVM-associated symptomatic varix, if surgical resection cannot readily be performed, initial TAE of the BAVM nidus can be attempted.
Delayed spontaneous rupture of cavernous segment of the internal carotid artery following dual ophthalmic segment aneurysms treatment with pipeline embolization device
Authors: Ting Wang , Richard Seidu A. , Changwei Zhang , Chaohua Wang , Xiaodong Xie
Published: December 2019

Rationale:

The incidence of double aneurysms on the ophthalmic segment of the internal carotid artery (ICA) is very rare. Nevertheless, delayed rupture of a parent artery instead of the aneurysmal sac following pipeline embolization device (PLED) is unusual.

Patient concerns:

We present a 72-year-old female who was admitted at our facility with gradual onset of nonspecific visual changes.

Diagnosis:

Conventional angiography revealed 2 aneurysms located at the ophthalmic segment of the left ICA.

Interventions:

Both aneurysms were successfully treated with PLED.

Outcomes:

Two months after discharge, the patient was rushed into the emergency with bilateral conjunctival congestion. Computed tomography revealed intracranial hemorrhage at left temporal lobe while digital subtraction angiography established a left direct carotid cavernous fistula. We utilized stent (Solitaire 6∗30) assisted coils to occlude the fistula. The patient is well and go about her normal duties.

Lessions:

Manipulation of the tortuous parent artery resulted in a focal traumatic weakness in the artery and subsequently a delay tear. We are of the view that, endovascular surgeons should be on the lookout for this complication following flow deviation treatment modalities.
Verification a model of predicting vaginal birth after cesarean delivery in Chinese pregnant women
Authors: Xu Ping , Feng Ying , Shen Huaxiang , Luo Jing , Tao Yueping
Published: December 2019

The objective of our research was to confirm the prediction role of Grobman model for vaginal birth after cesarean (VBAC) in Chinese pregnant women. In this research, 535 pregnant who had once cesarean delivery and the least once subsequent try to a vaginal labor in Jiaxing of China were involved. The Grobman background factors and five new factors were included. Overall, in total of 456 women had successful VBAC, the success percent was 85.2%. The new background variable “maternal height” was considered as an additional predictor for VBAC. The Grobman model's area under the curve (AUC) was 0.811 (95% CI = 0.751–0.870) and the AUC of this modified model combined 2 new factors was 0.834 (95% CI = 0.781–0.886). Nevertheless, there has no markedly difference between these 2 models of the AUC. In conclusion, the Grobman model was suitable for Chinese pregnant. However, further improvements were needed to make a new predictive model of VBAC success rate for Chinese pregnant women through analyzing the clinical data of vaginal trial delivery after cesarean section.
Extramedullary plasmacytoma of the kidney in an HIV-positive patient
Authors: Li Yubing , Wang Chundan , Yan Jiashen , Jiang Shaobo
Published: December 2019

Rationale:

Extramedullary plasmacytoma (EMP) is a very rare malignant neoplasm arising from clonal proliferation of atypical plasma cells. Most EMPs involve mucosal lymphoid tissue, particularly in the nasopharyngeal area, respiratory tract, and head and neck region. Such neoplasms of the kidney in patients with a human immunodeficiency virus (HIV) infection are extremely rare.

Patient concerns:

A 55-year-old male who had been diagnosed with HIV 1 year previously presented with a 2-week history of intermittent right abdominal pain and gross hematuria.

Diagnoses:

Ultrasonography and computed tomography detected a mass that occupied the upper half of the right kidney. A clinical diagnosis of a renal tumor was suspected.

Interventions:

The patient subsequently underwent a retroperitoneal radical nephrectomy. The postoperative pathological diagnosis was solitary EMP of the kidney. Adjuvant radiation therapy was provided at doses of 50 Gy in 20 fractions.

Outcomes:

Currently, the patient is alive and disease free at 7 months postoperatively. To the best of our knowledge, this is the first case of a primary renal EMP in a patient with HIV.

Lessons:

The present case illustrates that this rare type of solitary EMP associated with acquired immune deficiency syndrome can occur in the kidney. Additionally, although rare, solitary EMP should be considered in the differential diagnosis of a renal mass in HIV-infected patients.
Ultrasound follow-up of spontaneous tears of the plantar fascia treated with conservative therapies
Authors: Cocco Giulio , Ricci Vincenzo , Boccatonda Andrea , Abate Michele , Guagnano Maria Teresa , Schiavone Cosima
Published: December 2019

Rationale:

The plantar fascia (PF) is an important anatomical structure that stabilizes the longitudinal arch of the foot. While plantar fasciitis is a common pathology affecting the foot, tears of the PF are uncommon injuries characterized by acute pain in the plantar aspect of the foot. The main purpose of this paper was to describe, in detail, how the ultrasonographic pattern of PF rupture can be combined with the clinical features to define the prognosis and promptly plan the therapeutic approach.

Patient concerns:

In the first case, a 39-year-old male patient was seen due to acute pain in the mid plantar foot which appeared 3 days after a tennis match. The pain was accompanied by a “snap” noise and intense pain. In the second case, a 44-year-old male patient was seen due to pain in the heel region which appeared 2 days after a running session.

Diagnosis:

One case of noninsertional complete tear of the central bundle of the PF with retraction of the 2 stumps and 1 case of partial tear of the central bundle of the PF at the level of the insertional region.

Interventions:

Both patients were treated with conservative therapies including load management, oral nonsteroidal anti-inflammatory drugs, foot orthosis, and restriction of sport activities.

Outcomes:

At follow-up, the patient with spontaneous complete tear of the PF (noninsertional area) showed a small fibrous bridge between the 2 stumps, with partial alignment of the proximal and distal portions, the ability to walk for a medium to long-distance, and difficulty going up and downstairs. The patient with the spontaneous partial tear (insertional area) showed complete fibrous scar tissue with restoration of the fascial continuity, and the ability to walk for a long-distance and go up and downstairs without pain.

Lessons:

Based on the clinical and ultrasonographic findings, we suggest that partial tear of the PF in the insertional region presents a favorable prognosis with complete recovery, both clinically and anatomically, while a complete tear in the noninsertional region is associated with partial functional and histological recovery when managed with a conservative approach. Therefore, coupling the clinical findings with the sonohistologic pattern is a valuable approach to plan the most suitable treatment for patients with spontaneous PF tear.
Giant lipoma in the hand
Authors: Kim Kwang Seog , Lee Hyeok , Lim Dong Seob , Hwang Jae Ha , Lee Sam Yong
Published: December 2019

Rationale:

Although lipomas are the most common benign form of soft tissue tumor in the body, giant lipomas of the hand, defined as >5 cm in diameter, are extremely rare.

Patient concerns:

A 49-year-old man presented with a soft and fixed lump in the left hypothenar area. The mass was not tender, but it was associated with symptoms of tingling sensation and paresthesia in the left ring and little fingers that had lasted for 4 years.

Diagnoses:

Preoperative image studies revealed an encapsulated and multilobulated mass, which measured 8 cm × 5 cm × 2 cm. Basic histologic examination identified the specimen as a lipoma and further immunohistochemical studies ruled out the possibility of malignancy.

Interventions:

To enable a complete excision of the mass, the palmar digital branch of the ulnar nerve for the little finger passing through the mass was temporarily transected. After complete excision of the mass, the branch was coapted again under microscopy.

Outcomes:

Complete sensory recovery was achieved 6 months after surgery, without any sign of recurrence.

Lessons:

Although giant lipomas in the hand can extend to vital components such as neurovascular structures, muscles, and tendons, meticulous en bloc resection can provide excellent results without any complications.
Diagnostic value of hemoglobin and neutrophil-to-lymphocyte ratio in Behcet Disease
Authors: Zhang Zunni , Su Qisheng , Zhang Liqian , Yang Zheng , Qiu Yuling , Mo Wuning
Published: December 2019

The purpose of our study was to investigate the diagnostic value of NLR, hemoglobin (HB) and combine NLR with HB in the BD patients.

Sixty-seven patients with BD were diagnosed in the rheumatology or dermatology between June 2015 and June 2019; 92 matching healthy physical examiners were included in our study. SPSS was used for statistical analysis.

Compared with the healthy control, NLR was increased (P < .001), while the HB level was decreased (P < .001) in the patients of BD. In addition, ESR and CRP were increased in BD patients. NLR has no relationship with CRP and ESR, while the HB levels were negatively correlated with CRP and ESR (r = –0.293, P = .046; r = –0.431, P = .002). ROC curve analysis revealed the AUC of NLR and HB were 0.797 and 0.798 (P < .001). When combined NLR with HB, the AUC was 0.897 (P < .001). Besides, logistic regression analysis demonstrated that NLR and HB were independent risk factors in the BD patients.

We observed that the diagnostic value of NLR, HB and combined NLR with HB in the BD patients were high, particularly when combine NLR with HB. NLR and HB were independent risk factors in the BD patients. In addition, HB levels related to the disease activity of BD patients.
Description of a transient proximal tubulopathy induced by amino acids perfusion in peptide receptor radionuclide therapy
Authors: Lenain Rémi , Hamroun Aghilès , Lion Georges , Chamley Paul , Bui Linh , Lionet Arnaud , Hazzan Marc , Provôt François
Published: December 2019

Rationale:

Peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs is a targeted internal radiotherapy method used to treat tumors expressing somatostatin receptors. Concomitant amino acids perfusion is systematically performed in order to inhibit the proximal tubular uptake of the radionuclide and thus prevent nephrotoxicity.

Patient concerns:

a 67-year-old woman with an intestinal neuroendocrine tumor with multiple lymphadenopathies and liver metastases. The patient displayed a carcinoid syndrome with flushes including facial erythrosis and paresthesia. During the treatment, the patient exhibited emesis and severe cramps.

Diagnosis:

We describe incomplete proximal tubulopathy induced by an amino acid therapy with [177Lu]-DOTA0-Tyr3-octreotate, which was reversible after treatment discontinuation. This diagnosis relies on metabolic acidosis, hypophosphatemia due to renal loss, tubular proteinuria and generalized aminoaciduria. Serum creatinine remained stable during and after the procedure.

Interventions:

PRRT with radiolabeled somatostatin analog ([177Lu]-DOTA0-Tyr3-octreotate). In order to prevent PRRT induced nephrotoxicity, we used a solution of 20 amino acids including 22 g/L Lysine and 16.8 g/L Arginine. Metoclopramide was successfully used to control vomiting. During the treatment and at the time of cramps, the blood sample showed hypophosphatemia at 0.3 mmol/L justifying intravenous phosphate supplementation. The cramps disappeared after this infusion.

Outcomes:

Hypophosphatemia with low TmPO4/GFR was observed as well as an increase in β2-microglobulinuria, urinary polyclonal light chains, and amino aciduria involving all amino acids. All these disturbances disappeared the day after the treatment and there was no acute kidney injury after 5 PRRT sessions. Six months after PRRT discontinuation, the patient had neither renal failure nor proximal tubulopathy. Aminoacid induced tubulopathy involves the main ligands of the megalin receptor. It has recently been demonstrated that cilastatin is a megalin inhibitor in the proximal tubule and therefore could represent an attractive alternative to amino acids for this purpose.

Lessons:

This case report is a description of a nephroprotective strategy in which partial, and transient tubulopathy is induced, in order to decrease proximal absorption of a tubulotoxic molecule. This little known strategy could be used to prevent proximal tubular injury caused by others megalin-mediated nephrotoxicity medication.
Bioinformatic analysis of the molecular mechanism underlying bronchial pulmonary dysplasia using a text mining approach
Authors: Zhou Weitao , Shao Fei , Li Jing
Published: December 2019

Bronchopulmonary dysplasia (BPD) is a common disease of premature infants with very low birth weight. The mechanism is inconclusive. The aim of this study is to systematically explore BPD-related genes and characterize their functions.

Natural language processing analysis was used to identify BPD-related genes. Gene data were extracted from PubMed database. Gene ontology, pathway, and network analysis were carried out, and the result was integrated with corresponding database.

In this study, 216 genes were identified as BPD-related genes with P < .05, and 30 pathways were identified as significant. A network of BPD-related genes was also constructed with 17 hub genes identified. In particular, phosphatidyl inositol-3-enzyme-serine/threonine kinase signaling pathway involved the largest number of genes. Insulin was found to be a promising candidate gene related with BPD, suggesting that it may serve as an effective therapeutic target.

Our data may help to better understand the molecular mechanisms underlying BPD. However, the mechanisms of BPD are elusive, and further studies are needed.
Efficacy of herbal medicine (Gegen Qinlian Decoction) on ulcerative colitis
Authors: Fan Yuling , Yi Wen , Huang Han , Mei Zhigang , Feng Zhitao
Published: December 2019

Background:

This systematic review aims to evaluate the efficacy of Gegen Qinlian Decoction (GQD) for ulcerative colitis (UC).

Methods:

PubMed, EMBASE, Springer LINK, Cochrane Library, the China National Knowledge Infrastructure, Chongqing Weipu Database for Chinese Technical Periodicals, Wan-fang Database, and Chinese Biomedicine Database were searched from their inception to December 2018 for randomized controlled trials comparing the use of GQD alone or in combination with western medicine (WM) with that of WM therapies for UC. Outcomes on the therapy's effectiveness rate, ulcerative colitis endoscopic index of severity (UCEIS), recurrence rate, and adverse events were extracted and analyzed by Review Manager 5.3 software. Meta-analysis was combined with fixed or random-effects model, and risk ratios (RR) and 95% confidence intervals (CI) were calculated for all outcomes. Two researchers independently reviewed each trial to determine its inclusion. The Cochrane risk of bias assessment tool was used for quality assessment.

Results:

We included 22 trials involving 2028 patients with UC. When compared with WM therapy, GQD significantly improved the clinical effectiveness (n = 591, RR = 1.21, 95% CI: 1.12–1.31,P < .00001) and recurrence rate (n = 94, RR = 0.23, 95% CI: 0.10–0.54, P = .0006). GQD plus WM was more effective in improving the clinical effectiveness (n = 1337, RR = 1.21, 95% CI: 1.16–1.27, P < .00001), and decreasing UCEIS scores (n = 384, mean difference  = −0.63, 95% CI: −1.26–−0.01,P = .05), recurrence rate (n = 179, RR = 0.18, 95% CI: 0.06–0.61, P = .006). In addition, the adverse events for GQD (n = 238, RR = 0.20, 95% CI: 0.02–1.68, P = .14) and GQD plus WM (n = 427, RR = 0.37, 95% CI: 0.15–0.90, P = .03) was significantly lower than that for WM alone. Noted adverse events primarily included gastrointestinal symptoms, headache, dizziness, and leukocytopenia.

Conclusions:

This meta-analysis shows that GQD used alone or in combination with WM might have potential benefits in curing UC. However, there is no sufficient evidence to draw definite conclusion supporting the effect of GQD for UC due to poor methodological quality of the included trials. More rigorously designed investigations and studies with large sample sizes should be conducted to establish clinical evidence further.
The impact of major depressive disorder on adaptive function
Authors: Park Eun-Hee , Jung Myung Hun
Published: December 2019

Although functional impairment is very common among patients with major depressive disorder (MDD) and is a necessary diagnostic criterion for MDD, clinicians have not directed their attention beyond the mood symptoms of MDD. We aimed to multi-dimensionally assess the functional abilities of patients with MDD using a standardized scale of adaptive function reported by caregivers or parents to identify the nature and degree of functional impairment in patients with MDD.

This study was conducted in 40 depressive patients aged 19 to 60 years. Patients were screened according to the DSM-IV-TR and a Hamilton Depression Rating Scale score ≥8. We administered the parent/caregiver rating form of the Korean Vineland Adaptive Behavior Scale to assess functional outcomes in the patients.

Patients with MDD showed significant differences in both global and domain-specific functional abilities compared to those of the normal group (all t > −6.35, P < .05) and the patients’ premorbid IQ (all t > 4.30, P < .001). The number of episodes among clinical factors was negatively correlated with overall adaptive functioning (r = −0.32, P < .05) and expressive communication (r = −0.42, P < .01).

Our present study replicates existing evidence showing impairment in both broad and various functional areas in patients with MDD, suggesting the importance of quantitatively assessing functional outcomes and acquiring information about functioning from informants other than patients.
The preservation and application of the submandibular gland in oral squamous cell carcinoma (STROBE)
Authors: Zeng Wen , Qiu Cheng-yu , Liu Jia-feng , Pan Yiyun , Li Rong , Luo Keqing , Tian Ke-qiang , Xiao Fu-fu , Xie Jun-hui , Zhang Xiangmin
Published: December 2019

This prospective study aimed to investigate metastases of oral squamous cell carcinoma (OSCC) to cervical lymph nodes and submandibular glands and to analyze the safety and feasibility of preserving and using submandibular glandular flaps to repair postoperative OSCC defects.

Overall, 330 patients with OSCC who met the inclusion criteria were enrolled in the study from January 2014 to July 2018. OSCC metastasis to cervical lymph nodes and submandibular glands was investigated using intraoperative frozen section and postoperative pathological observation. Fifteen patients who underwent repair of postoperative OSCC defects with submandibular glandular flaps were monitored for postoperative wound healing, complications, pathology, and appearance satisfaction and were followed up long term.

Among the 330 patients with OSCC, the most common type was tongue cancer (138/330); 204 patients were node negative and 126 were node positive. Of 363 samples of the submandibular gland, 7 were metastatic with stage IV lesion, 5 were directly invaded by the primary tumor, and 2 were metastatic with extranodal extension in level Ib. None of the submandibular gland samples showed intraglandular hematogenous and nodal metastases. The repair of OSCC defects with submandibular glandular flaps was successful in all 15 patients, including 11 males and 4 females, with an age range of 19–74 years and a mean of 51 years. Of 15 patients, some had complications with heart and cerebrovascular diseases, diabetes, or chronic respiratory disease. All the submandibular glandular flaps survived postoperatively without any complications, and the mucosification on the surface was adequate. Follow-ups (median duration: 14 months) revealed the satisfactory recovery of shape and function without any local recurrences or distant metastases.

Direct invasion is the main form of OSCC metastasis to the submandibular gland, while hematogenous and nodal metastases are uncommon. Preservation of the submandibular gland is oncologically safe. Thus, repair of postoperative OSCC defects with submandibular gland flaps is a feasible and promising procedure.