bluuebunny/crossref_metadata_2025 huggingface dataset:
Leukocytoclastic Vasculitis Caused by Disseminated Cutaneous Sporotrichosis: A Case Report and Review of the Literature
Authors: Shi Ying , Yu Yan , Li Shan-Shan , Cui Yan
Published: January 2022

Cutaneous leukocytoclastic vasculitis (CLV) is a vasculitis that involves mainly small blood vessels in the skin. CLV has different causes (drugs, infections, or neoplastic or systemic inflammatory diseases). Sporotrichosis has rarely been associated with CLV. We report a case of disseminated cutaneous sporotrichosis caused by microorganisms in the Sporothrix clade in a Chinese woman with a tuberculous peritonitis history. Her lesions included many ulcers with crusts on the limbs. A skin biopsy yielded a histologic diagnosis of leukocytoclastic vasculitis. Periodic acid–Schiff and Grocott methenamine silver stains revealed numerous round-to-oval, thick-walled yeast cells in the necrotic tissue of the dermis. Mycological cultures grew pure dark brown wrinkled and villous fungus colonies morphologically and microscopic characteristics suggestive of the pathogenic Sporothrix clade which was followed confirmed as Sporothrix globosa (S. globosa) by the PCR method and sequencing based on calmodulin gene. Although infrequently, Sporothrix clade may cause CLV and should be considered in its differential diagnosis.
Moraxella nonliquefaciens–Associated Ecthyma Gangrenosum in a Pediatric Patient With Cancer
Authors: Starkey Grant , Lee Erica , Clarey Dillon , Georgesen Corey
Published: January 2022

In this brief report, we describe a 16-year-old patient with pre–B-cell acute lymphoblastic leukemia on chemotherapy who presented to the emergency department with a fever and “bruise-like” area on his left forearm. Empiric antibiotic therapy was initiated, and initial tissue biopsy demonstrated findings consistent with ecthyma gangrenosum. On day 4 of admission, initial blood cultures grew Moraxella nonliquefaciens, and targeted antibiotic therapy was initiated and continued for a total of 21 days. The patient was discharged after 6 days of in-patient therapy and made a full recovery. M. nonliquefaciens has been reported to be associated with multiple types of infection, but no cases of M. nonliquefaciens–associated ecthyma gangrenosum were identified in the literature review for this report. Given this unique case and the empiric risks and broad differential associated with cutaneous manifestations in immunocompromised patients, obtaining a skin biopsy for histological examination is imperative for diagnostic workup.
PRAME Expression in Challenging Dermal Melanocytic Neoplasms and Soft Tissue Tumors With Melanocytic Differentiation
Authors: Kline Nicholas , Menge Tyler D. , Hrycaj Steven M. , Andea Aleodor A. , Patel Rajiv M. , Harms Paul W. , Chan May P. , Bresler Scott C.
Published: January 2022

Preferentially expressed antigen in melanoma (PRAME) is an immunohistochemical biomarker that is diffusely expressed in most cutaneous melanomas and is negative in most benign nevi. Histologically challenging dermal melanocytic neoplasms, such as cellular blue nevi (CBN) and deep penetrating nevi (DPN), and soft tissue tumors with melanocytic differentiation, such as clear cell sarcoma and perivascular epithelioid cell tumor, may resemble primary or metastatic melanoma. PRAME immunohistochemistry (IHC) was applied to archived formalin-fixed, paraffin-embedded specimens of various dermal melanocytic neoplasms and soft tissue neoplasms with melanocytic differentiation. Staining was graded based on the percentage of melanocytes labeled (0–4+ as previously reported). The gold standard was final pathologic diagnosis using histologic, immunophenotypic, and in some cases molecular findings. Fifty-four cases were evaluated. 62.5% (5/8) of blue nevus-like melanomas and 50% (1/2) of DPN-like melanomas were PRAME positive (4+). Of the other tumors, 100% (20/20) of CBN (including 1 atypical CBN with borderline features); 100% (12/12) of DPN, combined DPN, or borderline DPN; 88.9% (8/9) of perivascular epithelioid cell tumors; and 100% (3/3) of clear cell sarcoma were PRAME negative (0–2+). Within the borderline categories specifically, all 8 tumors (1 borderline CBN and 7 borderline DPN) showed low (0–2+) PRAME expression. Overall, the sensitivity for melanoma in this context was 60%, with a specificity of 97.7%. Although our sample size is limited, the results suggest that IHC staining for PRAME may be useful in supporting a diagnosis of melanoma in the setting of challenging dermal melanocytic neoplasms and other epithelioid neoplasms with melanocytic differentiation. However, PRAME IHC lacks sensitivity in this context.
World Atmospheric CO2, Its 14C Specific Activity, Non-fossil Component, Anthropogenic Fossil Component, and Emissions (1750–2018)
Authors: Skrable Kenneth , Chabot George , French Clayton
Published: January 2022

After 1750 and the onset of the industrial revolution, the anthropogenic fossil component and the non-fossil component in the total atmospheric CO2 concentration, C(t), began to increase. Despite the lack of knowledge of these two components, claims that all or most of the increase in C(t) since 1800 has been due to the anthropogenic fossil component have continued since they began in 1960 with “Keeling Curve: Increase in CO2 from burning fossil fuel.” Data and plots of annual anthropogenic fossil CO2 emissions and concentrations, C(t), published by the Energy Information Administration, are expanded in this paper. Additions include annual mean values in 1750 through 2018 of the 14C specific activity, concentrations of the two components, and their changes from values in 1750. The specific activity of 14C in the atmosphere gets reduced by a dilution effect when fossil CO2, which is devoid of 14C, enters the atmosphere. We have used the results of this effect to quantify the two components. All results covering the period from 1750 through 2018 are listed in a table and plotted in figures. These results negate claims that the increase in C(t) since 1800 has been dominated by the increase of the anthropogenic fossil component. We determined that in 2018, atmospheric anthropogenic fossil CO2 represented 23% of the total emissions since 1750 with the remaining 77% in the exchange reservoirs. Our results show that the percentage of the total CO2 due to the use of fossil fuels from 1750 to 2018 increased from 0% in 1750 to 12% in 2018, much too low to be the cause of global warming.
131I Intake and Regulatory Compliance Following Administration of Capsular 131I Sodium Iodide for Treatment of Thyroid Disorders
Authors: Jafari Mary Ellen , Paik David S.
Published: January 2022

Intake of 131I by nuclear medicine technologists and physician Authorized Users was evaluated using bioassay data from administration of 131I sodium iodide in capsular form during a 5-year period. Maximum estimated annual intake of 131I sodium iodide, based on bioassay measurements performed at 24 hours post administration, ranged from 10.9 to 35.6 kBq for all staff. Intake by Authorized Users was higher than that by nuclear medicine technologists due to state requirement for Authorized Users to physically administer therapeutic dosages of radiopharmaceuticals. All intake values were less than 10% of the 131I thyroid ALI of 50 microcurie3 (1,850 kBq), indicating that monitoring may be discontinued for staff participating in routine administration of 131I capsules in which volatilization is not suspected. Elimination of bioassay performance has permitted more flexibility in patient scheduling and improved workflow and efficiency.
Prenatal and Childhood Immuno-Metabolic Risk Factors for Adult Depression and Psychosis
Authors: Kappelmann Nils , Perry Benjamin I. , Khandaker Golam M.
Published: January 2022

Depression and psychosis have a developmental component to their origin. Epidemiologic evidence, which we synthesize in this nonsystematic review, suggests that early-life infection, inflammation, and metabolic alterations could play a role in the etiology of these psychiatric disorders. The risk of depression and psychosis is associated with prenatal maternal and childhood infections, which could be mediated by impaired neurodevelopment. Evidence suggests linear dose-response associations between elevated concentrations of circulating inflammatory markers in childhood, particularly the inflammatory cytokine interleukin 6, and the risk for depression and psychosis subsequently in early adulthood. Childhood inflammatory markers are also associated with persistence of depressive symptoms subsequently in adolescence and early adulthood. Developmental trajectories reflecting persistently high insulin levels during childhood and adolescence are associated with a higher risk of psychosis in adulthood, whereas increased adiposity during and after puberty is associated with the risk of depression. Together, these findings suggest that higher levels of infection, inflammation, and metabolic alterations commonly seen in people with depression and psychosis could be a cause for, rather than simply a consequence of, these disorders. Therefore, early-life immuno-metabolic alterations, as well as factors influencing these alterations such as adversity or maltreatment, could represent targets for prevention of these psychiatric disorders. Inflammation could also be an important treatment target for depression and psychosis. The field requires further research to examine sensitive periods when exposure to such immuno-metabolic alterations is most harmful. Interventional studies are also needed to test the potential usefulness of targeting early-life immuno-metabolic alterations for preventing adult depression and psychosis.
Brick by Brick: Building a Transdiagnostic Understanding of Inflammation in Psychiatry
Authors: Thylur David S. , Goldsmith David R.
Published: January 2022

Inflammatory phenomena are found in many psychiatric disorders—notably, depression, schizophrenia, and posttraumatic stress disorder. Inflammation has been linked to severity and treatment resistance, and may both contribute to, and result from, the pathophysiology of some psychiatric illnesses. Emerging research suggests that inflammation may contribute to symptom domains of reward, motor processing, and threat reactivity across different psychiatric diagnoses. Reward-processing deficits contribute to motivational impairments in depression and schizophrenia, and motor-processing deficits contribute to psychomotor slowing in both depression and schizophrenia. A number of experimental models and clinical trials suggest that inflammation produces deficits in reward and motor processing through common pathways connecting the cortex and the striatum, which includes the nucleus accumbens, caudate nucleus, and putamen.

The observed effects of inflammation on psychiatric disorders may cut across traditional conceptualizations of psychiatric diagnoses. Further study may lead to targeted immunomodulating treatments that address difficult-to-treat symptoms in a number of psychiatric disorders. In this review, we use a Research Domain Criteria framework to discuss proposed mechanisms for inflammation and its effects on the domains of reward processing, psychomotor slowing, and threat reactivity. We also discuss data that support contributing roles of metabolic dysregulation and sex differences on the behavioral outcomes of inflammation. Finally, we discuss ways that future studies can help disentangle this complex topic to yield fruitful results that will help advance the field of psychoneuroimmunology.
Next-Generation Sequencing-Based Diagnosis of Bacteremic Listeria monocytogenes Meningitis in a Patient with Anti-Interferon Gamma
Authors: Xing Fanfan , Hung Derek L. L. , Lo Simon K. F. , Chen Shuang , Lau Susanna K. P. , Woo Patrick C. Y.
Published: January 2022

Although various opportunistic infections have been described in patients with anti-interferon gamma autoantibodies, so far there is no Listeria monocytogenes infection reported to be associated with this primary immunodeficiency. Here, we describe the first case of bacteremic L. monocytogenes meningitis in a 59-year-old Chinese man with anti-interferon gamma autoantibodies, who presented with acute onset of fever and severe headache. Blood culture was positive but culture of the cerebrospinal fluid was negative, although it showed features suggestive of partially treated bacterial meningitis. The presence of L. monocytogenes in the cerebrospinal fluid was confirmed by next-generation sequencing. Avoidance of high-risk food items in these patients is important for the prevention of listeriosis. The use of antibiotic regimens that cover Listeria is crucial for empirical treatment, particularly if such patients develop acute or subacute meningitis. Next-generation sequencing is becoming an important diagnostic modality for culture-negative infections.
Overuse Injury to Proximal Phalanx in Throwing Athlete (Little Leaguer's Finger): A Case Report
Authors: Goodeill Teigen , Umberhandt Robert , Vela Luis
Published: January 2022

The young, overhead throwing athlete is prone to overuse injuries because of their variable skeletal maturity and often improper technique. An overuse injury to the digit(s) in the overhead throwing athlete, Little Leaguer's Finger, has never been discussed in the literature to our knowledge. We present a case of a 14-year-old man with atraumatic pain, swelling, and edema to his dominant pitching index finger after throwing greater than 90 pitches in one setting. Initial workup of the patient, including an MRI, ruled out an infectious process, and it was determined that there was a stress epiphysitis within the proximal phalanx of the digit. Symptoms within the digit resolved given time, rest, and cessation of throwing activities. The purpose of this report was to stress the importance of establishing the etiology of finger pain in the throwing athlete and to describe a previously unreported overuse injury, Little Leaguer's Finger.
The top 50 most cited articles in carpal tunnel syndrome research
Authors: Lei Lei , Yin Shanshan , Meng Fanyuan , Zhou Ya , Xu Xuan , Ao Li Juan , Xu Rui , Chen Mo Xian
Published: January 2022

Background:

Citation analysis was applied to identify the influential studies in the specific field. More and more literature related to carpal tunnel syndrome (CTS) have been published in recent years. To our knowledge, no one has performed a citation analysis of CTS. Thus, our study identified the top 50 influential articles pertaining to CTS and conduct an analysis of their characteristics.

Methods:

The Web of Science database was used to identify all the articles from 1900 to 2020. We obtained the top 50 articles ranked by citation times, and articles were included and excluded based on the relevance to CTS. Also, we collected the information about journal name, level of evidence, source country and institution, and research type for further analysis.

Results:

The top 50 articles were published between 1959 and 2012. The number of citations ranged from 151 to 1083. The citation density was between 3.23 and 40.27 per year. Muscle Nerve published most articles in CTS research, followed by Journal of Bone and Joint Surgery American Volume. The USA was the leading country, and all the top 5 institutions were from the USA. Katz JN with the highest h-index published most articles. Level III was the most common evidence level.

Conclusions:

We identified the top 50 cited articles related to CTS. These influential articles might provide researchers with a comprehensive list of the major contribution related to CTS research.
Development of prognostic predictive model with neutrophil–lymphocyte ratio (NLR) in patients with gastric signet ring carcinoma
Authors: Yang Shihai , Li Shangdong
Published: January 2022

The risk factors have not been well-defined for prognosis in gastric signet ring cell carcinoma (GSRC) patients. This study is designed to prognosticate survival in GSRC patients by establishing and verifying a predictive model with neutrophil–lymphocyte ratio (NLR).

A total of 147 GSRC patients from Department of Surgical Oncology, Neimenggu Baogang Hospital, Inner Mongolia Medical University were retrospectively reviewed. A predictive model was established using Cox proportional hazards. The performance of the model was evaluated by ROC curves.

In present study, we found that overall survival (OS) (P < .001, Fig. 1A) and tumor recurrence rate (P = .036, Fig. 1B) in the NLR ≤ 2.8 group were significantly better than those in the NLR > 2.8 group. These results showed that NLR ≤ 2.8 was significant prognostic factor related with both OS and tumor recurrence in patients with GSRC. After adjusting for competing risk factors, NLR ≤ 2.8 (hazard ratio [HR]: 2.625, 95% confidence interval [CI]: 1.505–5.3166, P = .003), tumor size (HR: 3.024, 95% CI: 1.521–4.186, P = .005), and tumor metastasis (HR: 3.303, 95% CI: 1.25–4.525, P = .012) remained independent predictors of tumor recurrence rate and OS. Our results showed that comparing with the model without NLR (area under ROC curve: 0.798), the model with NLR (area under ROC curve: 0.826) had significant better predictive power than the model without NLR, which further confirmed the value of NLR in predicting prognosis of patients with GSRC.

In conclusion, a high NLR value independently predicts poor survival in patients with GSRC after surgery. The NLR may help oncologists evaluate outcomes of patients received surgical resection and chemotherapy in order to choose alternative therapies for patients with high NLR value.
Different acupotomy for stenosing tenosynovitis
Authors: Wei Lingzhi , Tong Qi , Liu Yue , Hou Xinju , Zhi Fang
Published: January 2022

Background:

Stenosing tenosynovitis (STS) is a chronic aseptic inflammation caused by mechanical friction. The main clinical manifestations are local pain and limited activity of the affected parts, which reduce people's quality of life. The clinical effect of acupotomy in the treatment of STS is significant, and the operation is simple and the side effect is small. But there are many kinds of acupotomology, and there is a lack of comparative study between different Acupotomology. In this study, the effectiveness of 4 commonly used needle knife therapies (v-knife, oblique knife, crochet knife, flat knife) was ranked by the method of network meta.

Methods:

CNKI, Wanfang, VIP, Sinomed, PubMed, and Cochrane Library were searched to collect randomized controlled trials of v-knife, oblique knife, crochet knife, and flat knife in the treatment of STS. The search time limit is from the date of establishment to October 15, 2021. Revman5.3, gemtc 0.14.3, and stata14.2 were used for data analysis, and Cochrane bias risk assessment tool was used to screen and evaluate the quality of included literatures.

Conclusion:

Objective to provide evidence-based medicine evidence for clinical selection of the best needle knife treatment scheme for STS.
Analysis of the nystagmus characteristics of cupula diseases
Authors: Wang Zhaoxia , Zhang Yang , Guo Qiang , Lin Ying , Li Juan-Juan
Published: January 2022

Introduction:

Clinically, there is a kind of patients with positional vertigo or dizziness, which occurs when they turn left or right, look down or up, lie down or sit up. With a long duration and varying frequency, it is not consistent with the manifestations of benign paroxysmal positional vertigo (BPPV). In addition, the persistent geotropic direction-changing positional nystagmus (PG-DCPN) was observed in a supine head-roll test.

Patient concerns:

With no apparent trigger for visual rotation and a sense of self instability, an 81-year-old female patient had suffered from vertigo for 3 days. The vertigo occurred every day, lasting several minutes each time, and associated with head movements and changes in body position. In a supine head-roll test, it appeared persistent geotropic direction-changing positional nystagmus for a long time, without latency, fatigability and in the presence of 3 zero planes.

Diagnosis:

Light cupula.

Interventions:

Difenidol hydrochloride 25 mg orally 3 times/day for 2 weeks and betahistine hydrochloride 12 mg orally 3 times/day for 1 month were administered.

Outcomes:

After 1 month of treatment, the patient's vertigo symptoms disappeared. And in the supine head-roll test, the persistent geotropic direction-changing positional nystagmus disappeared.

Conclusion:

We report the characteristics of nystagmus produced in a typical patient with light cupula during the supine head-roll test. After reviewing the relevant literatures, we believe that a simpler method can be used to identify canalolithiasis and cupula disease, to distinguish light and heavy cupula, and to determine the pathological semicircular canal to which the lesion belongs.
Optimal duration of antiviral treatment in patients with gastrointestinal cytomegalovirus disease at a low and high risk of relapse
Authors: Jung Kyung Hwa , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han
Published: January 2022

We evaluated the association between antiviral treatment duration and relapse of gastrointestinal (GI) cytomegalovirus (CMV) disease by analyzing the risk factors for relapse.

Patients who were diagnosed with GI CMV disease at a tertiary hospital from January 2008 to April 2019 were retrospectively enrolled. Patients with relapsed disease were those with a recurrence of GI CMV disease at least 4 weeks after the initial antiviral treatment.

Of 238 participants, including 145 (51.9%) with upper and 93 (48.1%) with lower GI CMV diseases, 27 (11.3%) had experienced relapses. The difference in antiviral treatment duration between the relapsed and nonrelapsed GI CMV groups was not significant (median days, 21.0 vs 17.0, P = .13). Multivariate analysis revealed that hematologic malignancy (odds ratio, 3.73; P = .026) and ulcerative colitis (odds ratio, 4.61; P = .003) were independent risk factors for relapse. Participants with at least one of these risk factors and those with no independent risk factors were classified under the high- (relapse rate, 25.9%) and low-risk of relapse groups (relapse rate, 6.7%), respectively. Accordingly, we further stratified 180 (75.6%) and 58 (24.4%) participants under the low- and high-risk of relapse groups, respectively. There was no significant difference in relapse rates between the high- and low-risk groups according to antiviral treatment duration.

Approximately 10% of the participants experienced relapses after antiviral treatment, with hematologic malignancy and ulcerative colitis featuring as risk factors. Therefore, prolonged antiviral treatment might not be helpful in preventing GI CMV disease relapse.
Change in metabolic parameters and reproductive hormones from baseline to 6-month hormone therapy
Authors: Qi Tongyun , Wang Xueqing , Huang Yizhou , Song Yang , Ma Linjuan , Ying Qian , Chatooah Namratta Devi , Lan Yibin , Chen Peiqiong , Xu Wenxian , Chu Ketan , Ruan Fei , Zhou Jianhong
Published: January 2022

Adequate evidence showed hormone therapy (HT) reduces the risk of new-onset diabetes in midlife women by decreasing fasting glucose and insulin. However, the improvement of these diabetic biomarkers varied with each individual in clinical observations. The objective of our study was to investigate potential baseline factors associated with the change of fasting glucose and insulin during HT.

A retrospective cohort study was performed among 263 midlife participants aged 40 to 60 years with menopausal symptoms who have received 6-month individualized HT. Demographic information and laboratory indicators including reproductive hormone, lipid profiles, diabetic indicators were collected and measured at baseline and were followed-up. A series of statistical analyses were performed to confirm the effectiveness of HT and compare the baseline factors between participants with different glycemic or insulinemic response. Multivariable linear regression model with stepwise variable selection was further used to identify the associated factor with the change of fasting glucose and insulin.

Of all participants, fasting glucose (P = .001) and fasting insulin (P < .001) were significantly decreased after individualized HT. Significant differences in baseline reproductive hormones were observed in participants with different glycemic response to HT (P < .001 for both follicle stimulating hormone [FSH] and estradiol). Stepwise linear regression model showed that in addition to baseline fasting glucose levels, baseline FSH was also independently associated with the change of fasting glucose (β = −0.145, P = .019 for baseline FSH) but not fasting insulin. Greater reduction in fasting glucose in women with higher FSH levels was observed even though they have already been in better metabolic conditions (P = .037).

Midlife women with higher baseline FSH levels have greater reduction in fasting glucose but not fasting insulin. FSH could be an independent predictor of glycemic response to HT in peri- and postmenopausal women.
Characteristics of peripheral blood Gamma-glutamyl transferase in different liver diseases
Authors: Xing Mindan , Gao Min , Li Jia , Han Ping , Mei Ling , Zhao Lili
Published: January 2022

Gamma-glutamyl transferase (GGT) is a marker of oxidative stress and cholestasis. Because of its low specificity, clinicians usually ignore its diagnostic value.

To compare and analyze the clinical features of GGT in primary biliary cholangitis (PBC), drug-induced liver injury (DILI), alcoholic liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD) from the perspective of different causes instead of the severity of the disease.

We observed the distribution characteristics and the rate of abnormality of GGT in the above 4 diseases. The relationship between GGT and alanine aminotransferase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), total serum bilirubin, triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol was analyzed using Spearman correlation.

The highest level of GGT was up to 1000.00 to 2000.00 U/L in PBC and DILI, and the highest level of GGT was more than 2000.00 U/L in ALD, yet the difference was not statistically significant (P > .05). The highest level of GGT was only about 200.00 U/L in NAFLD and was the lowest in 4 liver diseases. Also, GGT was positively correlated with ALP, TC in PBC and DILI. Also, in ALD, GGT was positively correlated with ALT, AST, ALP, TG, and TC. In NAFLD, GGT was positively correlated with ALT, AST, and TG.

The abnormal GGT in PBC and cholestasis DILI was associated with cholestasis; in ALD, it was associated with oxidative stress and cholestasis, and in NAFLD, it was associated with oxidative stress. GGT levels had different characteristics in different liver diseases, which were closely related to the pathogenesis of liver diseases.
Anesthetic management of ventricular-peritoneal shunt implantation in osteogenesis imperfecta type IIB
Authors: To Mayumi , Kamizato Kota , Shinzato Hayato , Kakinohana Manabu
Published: January 2022

Introduction:

Osteogenesis imperfecta (OI), a rare congenital disorder, has a risk of bone fracture and progressive bone deformity. OI type II is the most serious subtype, and very few reports on its anesthetic management exist. Patients face several anesthetic difficulties, of which easy fracturing of OI-affected bones is critical. Herein, we report our experience with the anesthetic management of a patient with OI type II.

Patient concerns and diagnoses:

Through genetic testing, a 14-month-old girl (height: 45 cm, weight: 3.9 kg) was diagnosed with OI type IIB due to COL1A gene abnormality. The clinical manifestations included hydrocephalus, blue sclera, dental dysplasia, short stature, limb deformity and shortening, thoracic hypoplasia, rabbit eye, left inguinal hernia, and tricuspid valve regurgitation. Physical examination revealed an enlarged head due to skull dysplasia and hydrocephalus. The pediatrician confirmed that mask ventilation was possible even under spontaneous breathing, and that there was no history of bone fracture during mask holding.

Interventions and outcomes:

The patient was scheduled for gastrostomy and ventriculo-peritoneal shunt implantation. An arterial pressure line was inserted at the neonatal intensive care unit. Propofol and remifentanil were selected for general anesthesia. Confirming that mask-assisted ventilation was possible under sleep, rocuronium was administered. Attentive mask ventilation was performed via the 2-person method to avoid fractures. We were able to intubate successfully using a Macintosh laryngoscope. A microcuff endotracheal tube was used. For ventilation, pressure control ventilation was selected and sedative dosage was adjusted using the patient state index as an indicator. The patient was sedated, intubated, and returned to the neonatal intensive care unit. She was extubated on the sixth postoperative day. No bone fractures were noted.

Conclusion:

OI type II is the most severe subtype with high mortality, and there are few reports on its anesthetic management. Easy fractures can be a problem in airway maintenance, blood pressure measurement, and repositioning. We performed the procedure attentively, avoiding jaw and cervical fractures during mask ventilation and endotracheal intubation. For respiratory management, we chose pressure control ventilation using a cuffed tracheal tube and circulatory control was attained via an arterial line inserted preoperatively. No complications occurred.
Ultrasound evaluation of diaphragm motion in BAG-3 myofibrillar myopathy
Authors: Zhan Liqiong , Lv Lan , Chen Xinyuan , Xu Xiang , Ni Jun
Published: January 2022

Rationale:

Mutations in Bcl-2-associated athanogene-3 (BAG-3) can cause a rare subtype of myofibrillar myopathies (MFMs), characterized by progressive muscle weakness, cardiomyopathy, and severe respiratory insufficiency in childhood. Little is known about diaphragmatic function in BAG-3 MFM. To our knowledge, this is the first case report of detailed evaluation of diaphragmatic function with ultrasound in BAG-3 MFM.

Patient concern:

We describe the case of a 15-year-old girl who complained of fever and shortness of breath. Diaphragmatic sonography revealed bilateral diaphragmatic paralysis. Shortness of breath progressed to respiratory failure approximately 3 months later.

Diagnosis:

A neurologist was consulted and genetic sequencing identified a p.Pro209Leu mutation in BAG-3, yielding diagnosis of BAG-3 MFM leading to bilateral diaphragmatic paralysis.

Interventions:

Respiratory muscle training and long-term mechanical ventilation.

Outcomes:

It is quite unfortunate for this patient to have a poor prognosis due to the lack of effective treatment for this genetic disorder.

Lessons:

This case provides more clinical information for this rare disease which may cause severe diaphragm pathological damage leading to respiratory failure in BAG3 MFM and a future study with a systematic evaluation of a greater number of patients will be necessary to characterize this population.
Dabrafenib- and trametinib-associated glomerular toxicity
Authors: Jo Eunmi , Rhee Harin
Published: January 2022

Rationale:

Combined treatment with dabrafenib, a B-RAF inhibitor, and trametinib, a mitogen-activated protein kinase inhibitor, is an effective option for patients with metastatic melanoma. A few cases of acute kidney injury associated with tubulointerstitial nephritis and 1 case of nephrotic syndrome have been reported in patients on this drug combination; however, progressive renal injury has not been reported. In this case study, we report a patient with metastatic melanoma who developed glomerular capillary endothelial toxicity and progressive glomerular sclerosis during combination therapy.

Patient concern:

Our patient was an 80-year-old woman with a history of type 2 diabetes and chronic kidney disease.

Diagnosis and intervention:

She was diagnosed with metastatic melanoma and commenced combination therapy with dabrafenib and trametinib.

Outcomes:

Her renal function progressively deteriorated; by month 20 after treatment commencement, her serum creatinine level had increased from 1.59 to 3.74 mg/dL. The first kidney biopsy revealed marked glomerular and endothelial cell damage. Her medication was stopped, but no improvement was evident. At 5 months after the first biopsy, her serum creatinine level had increased to 5.46 mg/dL; a second kidney biopsy revealed focal segmental glomerular sclerosis and marked tubulointerstitial fibrosis. She was started on hemodialysis.

Lessons:

We describe a patient with a metastatic melanoma who developed progressive kidney failure during treatment with dabrafenib and trametinib. The most prominent microscopy findings were glomerular endothelial damage in the initial kidney biopsy and accelerated glomerular sclerosis and tubulointerstitial fibrosis in the follow-up biopsy. We hypothesize that a decreased renal reserve and impairment of kidney repair capacity caused by inhibition of B-RAF, a downstream mediator of vascular endothelial growth factor, may explain the progressive kidney injury.
Acupuncture and electroacupuncture for stroke
Authors: Choi Tae-Young , Ang Lin , Jun Ji Hee , Lee Hye Won , Yun Jong-Min , Kim JiHee , Moon Byung Soon , Joo Min Cheol , Lee Myeong Soo
Published: January 2022

Background:

The aim of this study was to undertake a systematic overview of meta-analyses and published systematic reviews to identify whether and when acupunctureand electroacupuncture are deemed efficacious treatment options for stroke and stroke-related disorders.

Methods:

Four databases, namely, PubMed, AMED, EMBASE, and the Cochrane Library will be searched from their inception. Two reviewers will independently perform study selection, data extraction, and assessment. This will be followed by an assessment of the methodological and report quality using the Assessment of Multiple Systematic Reviews-2 tool. Finally, the study will entail the assessment of evidence quality by employing the Grading of Recommendations Assessment, Development, and Evaluation system.

Results:

This overview is expected to provide data on using acupuncture for stroke and stroke-related disorders on the basis of the included systematic reviews’ qualitative and quantitative syntheses.

Conclusion:

This overview will assess the benefits as well as hazards of acupuncture for stroke, subsequently providing patients and practitioners with useful information and have implications for future studies on the topic.

Trial registration number:

Reviewregistry1263
Overview of the mortality from external causes of reproductive-age women in Brazil
Authors: de Souza Ana Mayara Gomes , Costa Ketyllem Tayanne da Silva , de Morais Thiffany Nayara Bento , de Andrade Fábia Barbosa
Published: January 2022

Studies have shown that a new demographic and epidemiological profile has been emerging in women of childbearing age, mainly due to the increase in life expectancy, reduction in infant mortality, higher survival in old age, and the drop in fertility rate.

To evaluate the external (violence) causes of mortality among women in Brazil from 2007 to 2016.

This is a quantitative, ecological study of temporal trends and correlations of the main causes of mortality of women of childbearing age and their association with age, from 2007 to 2016 in Brazil. The collected data were extracted from the Departamento de Informática do Sistema Único de Saúde database called the Mortality Information System.

It was possible to identify a considerable increase among the Brazilian states, with the highest coefficient of mortality from external causes, especially the northern regions. The highest coefficient identified among the evaluated states was 3.57 per 10,000, and in the northeast and southeast, external causes mainly affected young women aged 10 to 29 years.

It is necessary for managers and health professionals to be more aware of the diseases that affect this population.
Evaluation of the relationship between the spleen volume and the disease activity in ulcerative colitis and Crohn disease
Authors: Kawashima Kazumasa , Onizawa Michio , Fujiwara Tatsuo , Gunji Naohiko , Imamura Hidemichi , Katakura Kyoko , Ohira Hiromasa
Published: January 2022

Inflammatory bowel disease (IBD) is caused by the activation of an abnormal immune response in the intestinal mucosa; the spleen is involved in the main immune response. Ulcerative colitis (UC) and Crohn disease (CD) have different inflammatory mechanisms; this study aimed to quantitatively measure and compare the spleen volumes between patients with UC and CD and examine the relationship between spleen volume and disease activity in both.

We retrospectively analyzed 44 patients with IBD aged 30–60 years (UC group, n = 24; CD group, n = 20). The control group comprised 19 patients with pancreatic cysts that did not affect the spleen volume. All patients underwent computed tomography (CT) between April 2014 and March 2019. Using the Image J software, spleen volumes in the UC, CD, and control groups were measured accurately from the CT images and adjusted for the body weight.

No significant differences in the sex, age, or body weight were noted between the UC and CD groups and the control group. The spleen volumes, adjusted for the body weight, were 2.2 ± 1.0 cm3/kg, 2.0 ± 1.0 cm3/kg, and 3.6 ± 1.7 cm3/kg in the control, UC, and CD groups, respectively. The volumes differed significantly between the CD and control groups (P = .01), but not between the UC and control groups (P = .43). Furthermore, a significant strong correlation was found between the disease activity and the body weight-adjusted spleen volume in patients with CD (P < .01).

The spleen volume, adjusted for the body weight, was significantly larger in patients with CD than in the controls and was also strongly correlated with the CD activity. These results suggest that the immune response in CD may affect the spleen volume.
Difference between bone age at the hand and elbow at the onset of puberty
Authors: Jang Woo Young , Ahn Kyung-Sik , Oh Saelin , Lee Ji Eun , Choi Jimi , Kang Chang Ho , Kang Woo Young , Hong Suk-Joo , Shim Eddeum , Kim Baek Hyun , Je Bo-Kyung , Jung Hae Woon , Lee Soon Hyuck
Published: January 2022

In the pubertal period, bone age advances rapidly in conjunction with growth spurts. Precise bone-age assessments in this period are important, but results from the hand and elbow can be different. We aimed to compare the bone age between the hand and elbow around puberty onset and to elucidate the chronological age confirming puberty onset according to elbow-based bone age.

A total of 211 peripubertal subjects (127 boys and 84 girls) who underwent hand and elbow radiographs within 2 months was enrolled. Two radiologists and a pediatric orthopedic surgeon assessed bone age. Hand bone age was graded using the Greulich–Pyle (GP) method, and elbow bone age was determined using the Sauvegrain method. The correlation of 2 methods was evaluated by Demining regression analysis, and the mean absolute difference (MAD) with chronological age was compared between pre-pubertal and pubertal subjects. Receiver-operating characteristic curve analysis was performed to determine the chronological age confirming puberty onset.

There was a statistically significant difference in bone age revealed by the GP and Sauvegrain methods in the pubertal group. In the pubertal group, the MAD was 1.26 ± 0.90 years with the GP method and 0.61 ± 0.47 years with the Sauvegrain method in boys (P < .001), while in girls, the MAD was 0.84 ± 0.60 years and 0.53 ± 0.36 years with the same 2 methods (P = .033). The chronological age for confirming puberty onset using the elbow was 12.2 years in boys and 10.3 years in girls.

The bone ages of hand and elbow were different at puberty, and the elbow was a more reliable location for bone-age assessment at puberty. Puberty onset according to elbow occurred slightly earlier than expected.
Diagnostic method for malignant pleural effusion distinguishing malignant mesothelioma from lung cancer using pleural carcinoembryonic antigen and hyaluronic acid levels
Authors: Saraya Takeshi , Ohkuma Kosuke , Fujiwara Masachika , Ishii Haruyuki
Published: January 2022

Malignant mesothelioma (MM) is difficult to diagnose because of the lack of parenchymal opacities, often revealing minimal or absent pleural thickening. Furthermore, pleural effusion has diverse differential diagnoses, including malignancies, infections, as well as collagen vascular and other benign diseases. In general practice, lung cancer (LC) is the most common malignancy causing pleural effusion; therefore, a simple method using pleural diagnostic markers to differentiate between LC and mesothelioma is crucial.

We retrospectively reviewed the data of 530 adult patients diagnosed with pleural effusion between January 2010 and December 2020 in an outpatient or inpatient setting. Patients with pathologically diagnosed MM or LC with cytologically positive (class IV or V) pleural effusion were analyzed, and the characteristics of these 2 diseases were compared.

During the study period, 27 patients diagnosed with MM and 100 patients diagnosed with LC were enrolled. Receiver operating characteristic curve analysis demonstrated that pleural carcinoembryonic antigen (CEA) and hyaluronic acid (HA) could discriminate MM from LC with an area under the curve of 0.925 (95% confidence interval [CI]: 0.879–0.972, P < .001) and 0.815 (95% CI: 0.686–0.943, P < .001), respectively. To diagnose MM, the accuracy of pleural HA >30,000 ng/mL revealed a sensitivity of 75.0%, specificity of 72.6%, and odds ratio of 7.94 (95% CI: 2.5–25.2, P = .001); pleural CEA <6.0 ng/mL revealed a sensitivity of 95.2%, specificity of 84.9%, smaller negative likelihood ratio of 0.06, and odds ratio of 112.5% (95% CI: 14.4–878.1, P < .001). Multiple logistic regression analysis revealed that these 2 parameters could discriminate MM from LC, with a hazard ratio of 23.6 (95% CI: 2.437–228.1, P = .006) and 252.3 (95% Cl: 16.4–3888.1, P < .001), respectively, and their combination had a high specificity of 98.3%.

Pleural CEA (≥6.0 ng/mL) can rule out MM with a high degree of certainty, and the positive results for combination of pleural CEA <6.0 ng/mL and HA >30,000 ng/mL can confirm MM with high specificity, prior to cytological or pathological examinations.
Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder
Authors: Gao Mingzhou , Zhang Hao , Gao Zhan , Cheng Xunshu , Sun Ya , Qiao Mingqi , Gao Dongmei
Published: January 2022

Introduction:

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are becoming common mental diseases in women impairing daily functioning. Estimation of the epidemiological burden of PMS/PMDD can serve as scientific basis for prevention and management of premenstrual disorders. Herein, we firstly provide a protocol to perform estimation on the prevalence and risk factors for PMS/PMDD in the general population globally and regionally.

Methods/design:

The PubMed, Web of Science, Chinese National Knowledge Infrastructure, the Cochrane Central Register of Controlled Trials (Cochrane Library), Chinese VIP Information, EMBASE, Wanfang Database, as well as the Chinese Biomedical Literature Database will be queried to find related studies containing information on the prevalence of PMDD (2011–2021). Two independent reviewers will comb the literature and abstract the data characteristics. Disparities will be reconciled via consents. The primary outcome will be the global prevalence. The random-effect model will be employed to pool the assessments. The standard χ
2 tests, as well as the I
2 statistic will be used to determine heterogeneity. Furthermore, the meta-regression analysis will be employed to estimate the differences in study-level characteristics. All the statistical analyses will be carried out in the software Stata v 15.0 (Stata Corporation, College Station, TX), as well as the R (v R 3.5.1, R Foundation for Statistical Computing, Vienna, Austria) software.

Discussion:

Based on existing evidence, our study will offer a high-quality synthesis for global and regional prevalence, burden, and risk factors of PMS/PMDD. Effective strategies will be made for prevention and management of epidemiological burden on the PMS/PMDD, even premenstrual disorders.

Ethics and dissemination:

This study does not involve the specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of the study.

INPLASY registration number:

INPLASY2021120065.
Diagnostic sensitivity of traumatic axonal injury of the spinothalamic tract in patients with mild traumatic brain injury
Authors: Jang Sung Ho , Kim Seong Ho , Kwon Hyeok Gyu
Published: January 2022

Diffusion tensor tractography (DTT) can detect traumatic axonal injury (TAI) in patients whose conventional brain magnetic resonance imaging results are negative. This study investigated the diagnostic sensitivity of TAI of the spinothalamic tract (STT) in patients with a mild traumatic brain injury (TBI) suffering from central pain symptoms, using DTT.

Thirty-five patients with central pain following mild TBI and 30 healthy control subjects were recruited for this study. After DTT-based reconstruction of the STT, we analyzed the STT in terms of configuration (narrowing and/or tearing) and the DTT parameters (fractional anisotropy and tract volume).

Thirty-three (94.3%) patients had at least 1 DTT parameter value at 1 standard deviation below the control group value, and 20 (57.1%) patients had values at 2 standard deviations, below the control group value. All 35 patients showed STT abnormalities (tearing, narrowing, or both) on DTT.

A high diagnostic sensitivity of TAI of the STT in patients with mild TBI was achieved. However, the small number of subjects who visited the university hospital and the limitations of DTT should be considered when generalizing the results of this study.
Using Root Cause Analysis to Inform a Falls Practice Change in the Home Care Setting
Authors: Brullo Jennifer , Rushton Sharron , Brickner Carlin , Madden-Baer Rose , Peng Timothy
Published: January 2022

Falls are a significant health problem in community-dwelling older adults, resulting in injuries, deaths, and increased healthcare costs. Falls were a quality concern for a Northeastern home care agency and this project aimed to evaluate the falls prevention process for older adults receiving home care services by determining potential root causes of falls and to identify a practice change. This quality improvement project used a root cause analysis methodology with a retrospective matched case-control design. Records of patients with falls were assessed for falls prevention process fidelity and compared with patients without a fall matched on the Missouri Alliance for Home Care-10 (MAHC-10) assessment, examining plan of care accuracy and patient fall risk factors. Findings indicated fidelity concerns in the fall prevention process, with gaps in care planning aligned with identified risk factors. Interventions to mitigate identified MAHC-10 risk factors on care plans were present less than 50% of the time for four of the six factors. Polypharmacy (7.46%) and pain affecting function (9.21%) were most frequently unaddressed risk factors in the care plan. Recommendations included implementation of a falls prevention pathway, including standardized falls risk assessment, universal falls precautions in the care plan with tailored interventions based on risk factors, and referral initiation when necessary.
Primary Prevention of Ovarian Cancer: A Patient Decision Aid for Opportunistic Salpingectomy
Authors: Van Lieshout Laura A. M. , Gelderblom Malou E. , De Hullu Joanne A. , The Regina , Van Ginkel Alexandra A. , Oerlemans Anke J. M. , Smeets Kirsten M. W. H. , Schreurs Malou P. H. , Piek Jurgen M. J. , Hermens Rosella P. M. G.
Published: January 2022

(Abstracted from Am J Obstet Gynecol 2021; doi: 10.1016/j.ajog.2021.09.010)

The site of origin of the most common ovarian cancer subtype—high-grade serous—is the fallopian tube epithelium. Accumulating evidence has clearly demonstrated that surgical removal of the fallopian tube in premenopausal and postmenopausal woman can reduce the lifetime risk of ovarian cancer.