bluuebunny/crossref_metadata_2025 huggingface dataset:
Rivaroxaban improves hidden blood loss, blood transfusion rate and reduces swelling of the knee joint in knee osteoarthritis patients after total knee replacement
Authors: Zhang Yi-Min , Liu Jian-Yong , Sun Xue-Dong , Zhang Miao , Liu Xiao-Guang , Chen Xiu-Li
Published: October 2018

Osteoarthritis (OA) is the third most common diagnosis made by general practitioners in older patients. The purpose of the current study is to investigate effects rivaroxaban had on both hidden blood loss and blood transfusion rate (BTR) in patients with knee OA (KOA) after going through a total knee replacement (TKR).

Between the time periods of December 2011 up until January 2015, a total of 235 patients underwent TKR and were selected to be assigned to either the rivaroxaban or nonanticoagulant groups. Coagulation function indexes before surgery and following administration of rivaroxaban, total blood loss, hidden blood loss, dominant blood loss, blood transfusion volume, hemoglobin reduction, degree of postoperative pain (visual analogue scale), the degree of knee swelling, and range of motion following surgery were all recorded. Hospital for special surgery (HSS) scores offered an objective evaluation for the knee joint functions before surgery at the intervals of 2 weeks and after surgery at intervals of 3 months, 6 months, 12 months, and 24 months.

Patients in the rivaroxaban group had shown a higher hidden blood loss, as well as a higher BTR, compared to those involved in the nonanticoagulant group. BTR was found to have been 49.59% in the rivaroxaban group, and 35.09% for the nonanticoagulant group. Patients in the rivaroxaban group had lower degrees of knee swelling than those involved in the nonanticoagulant group. There was no deep vein thrombosis (DVT) detected in the rivaroxaban group, whereas 5 DVT cases were detected in the nonanticoagulant group. In the rivaroxaban group, the HSS scores of the knee joint functions were remarkably higher at the 2-week mark in succession to the surgery than those involved with the nonanticoagulant group.

This overall data demonstrated that KOA patients after TKR had presented with a higher hidden blood loss, BRT, and lower swelling degrees of the knee joint after being treated by the rivaroxaban.
Relationship between the anxiety/depression and care burden of the major caregiver of stroke patients
Authors: Hu Ping , Yang Qing , Kong Lingna , Hu Luanjiao , Zeng Lingqiong
Published: October 2018

To investigate the anxiety/depression of caregivers of stroke patients.

This study used a cross-sectional survey design and convenience sampling.

Totally, 117 caregivers of stroke patients were enrolled. Data were collected from questionnaires. Hamilton anxiety scale, Hamilton depression scale, and Zarit caregiver burden interview were performed. Multiple linear regression and correlation analysis were used.

The anxiety score, depression score and total burden score of 117 stroke caregivers were 16.56 ± 8.02, 18.63 ± 9.39, and 25.88 ± 10.35, respectively. Anxiety symptoms, mild to moderate depressive symptoms, and severe depressive symptoms were found in 43.9%, 26.5%, and 27.4% of the caregivers, respectively. Daily care time and medical payment method were influencing factors for anxiety and depression (P < .05). Both anxiety and depression were positively correlated with total care burden score (P < .01).

Anxiety and depression are common in the caregivers of stroke patients and are closely related to care burdens. In this regard, appropriate home care guidance, psychological counseling and social support should be provided to the caregivers to reduce their physical and mental burden.
Induction therapy for clinical stage T2N0M0 esophageal cancer
Authors: Lv Hong-Wei , Xing Wen-Qun , Shen Si-Ning , Cheng Ji-Wei
Published: October 2018

Objective:

It is still controversial whether patients with clinical T2N0M0 (cT2N0M0) esophageal cancer are treated with induction therapy. The aim of this study was to determine the effect of induction therapy on cT2N0M0 esophageal cancer.

Methods and materials:

We searched PubMed, Embase, the Cochrane Library, and Medline databases from inception up to May 1, 2017. This meta-analysis was performed to compare odds ratios (OR) for 5-year overall survival (OS), pathologically understaged and overstaged after esophagectomy.

Results:

Eight retrospective studies of 2646 patients were included in the meta-analysis. Data showed that no statistically significant difference in 5-year over survival was observed between induction therapy group and direct operation group. The pooled OR and 95% confidence interval (CI) for 5-year OS were 0.92 (95% CI = 0.72–1.18; P = .52). Whereas, compared with induction therapy group, direct operation group had more pathologically understaged and less overstaged after esophagectomy.

Conclusions:

Currentclinical staging for T2N0M0 esophageal carcinoma remains inaccurate. In this study, we found that direct operation group had more pathologically understaged and less overstaged after esophagectomy compared with induction therapy group. Induction therapy could degrade the tumor staging but not improve the patient's survival.
Comparing stand-alone oblique lumbar interbody fusion with posterior lumbar interbody fusion for revision of rostral adjacent segment disease
Authors: Zhu Guangduo , Hao Yingjie , Yu Lei , Cai Yingchun , Yang Xiaowei
Published: October 2018

Spinal fusion has become a standard treatment for symptomatic intervertebral degenerative disc disease. The present study aimed to compare perioperative parameters, clinical outcomes, and radiographic results of stand-alone oblique lumbar interbody fusion (OLIF) with posterior lumbar interbody fusion (PLIF) for the revision of rostral adjacent segment disease (ASD) following prior posterior lumbar fusion.

Thirty-six patients who underwent revision surgeries for rostral ASD were retrospectively reviewed. Among them, 17 patients underwent stand-alone OLIF (OLIF group) and 19 patients underwent PLIF (PLIF group). The length of operation, intraoperative hemorrhage, bed rest duration, and length of hospital stay were compared between the 2 groups. Clinical results were evaluated with the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiological results were evaluated with disc height (DH), foraminal height (FH), retrolisthesis index (RI), and lumbar lordosis (LL), as well as the fusion rate and cage subsidence. Follow-up results at 1 week, 3 months, and 12 months postoperatively were compared between the 2 groups.

The OLIF group had less intraoperative blood loss, shorter operative time, bed rest time, and hospital stay than did the PLIF group (P < .05). The OLIF group had lower VAS scores for back pain than the PLIF group at 1 week and 3 months postoperatively (P < .05), and lower VAS scores for leg pain than the PLIF group at 1 week postoperatively (P < .05). The OLIF group had lower ODI than the PLIF group at 1 week and 3 months postoperatively (P < .05). No significant differences were found in DH and FH between the 2 groups preoperatively (P > .05); the OLIF group showed higher DH and FH than the PLIF group at all time points (P < .05). No significant differences were found in RI and LL between the 2 groups at any time point. All patients achieved fusion at 12 months postoperatively, and cage subsidence was not observed in either group.

OLIF is effective and safe for the treatment of rostral ASD following prior posterior lumbar fusion, and is superior to PLIF in terms of perioperative parameters, short-term clinical outcomes, and DH restoration, with similar fusion and reduction rates.
Comparison of diabetes risk estimate in the cities of Riyadh and Amman
Authors: Alghwiri Alia A. , Alghadir Ahmad , Awad Hamzeh , Anwer Shahnawaz
Published: October 2018

A significant rise in the prevalence of type 2 diabetes mellitus (T2DM) in the Middle-east and North Africa (MENA) region has seen over the last few decades. The present observational study aimed to evaluate and compare the risk of developing T2DM in the cities of Riyadh and Amman using the Arab Diabetes Risk Assessment Questionnaire (ARABRISK).

The ARABRISK was administered in a total of 1116 healthy male and female individuals in the age group of 40 to 74 years with no prior history of diabetes in the city of Riyadh (Saudi Arabia) and Amman (Jordan). ARABRISK is an Arabic version of the Canadian Diabetes Risk Assessment Questionnaire (CANRISK), which was adapted and validated for the use in Arab-speaking individuals in Saudi Arabia and Jordan.

The participants from Amman region had higher mean total ARABRISK score compared to the Riyadh region for all categories of ARABRISK. However, the difference was significant in both low- and high-risk categories (P = .02 and P = .01, respectively) but not significant for moderate category (P = .17). In the Riyadh population, female participants had significantly higher ARABRISK total scores compared to male in both moderate- and high-risk categories (P = .01). However, in the Amman population, male participants had significantly higher ARABRISK total scores compared to female in both low- and moderate-risk categories (P = .01).

The present study suggested an increased risk of developing T2DM in the cities of Riyadh and Amman. However, the population of Amman had a higher risk of developing T2DM compared to the population of Riyadh.
Indocyanine green angiography for preserving the ureteral branch of the uterine artery during radical hysterectomy
Authors: Long Ying , Yao Yao , Yao De-sheng
Published: October 2018

Rationale:

Conventional radical hysterectomy is frequently associated with postoperative ureteral ischemic necrosis, urinary fistula, stenosis, and kidney seeper. Some have suggested that preserving the ureteral branch during radical hysterectomy may reduce the incidence of ureteral complications. However, the feasibility of such preservation has not been explored using intraoperative imaging techniques.

Patient concerns:

Two cervical cancer patients aged 45 and 53 years were selected to undergo surgery in our hospital in October 2017. Both patients showed normal function of major organs and no special treatment was deemed necessary based on their subjective symptoms and preoperative examination.

Diagnoses:

Both patients were diagnosed with cervical cancer in stage Ib1 according to the staging scheme of the International Federation of Gynecology and Obstetrics (FIGO 2009).

Interventions:

Two patients underwent ureteral branch-sparing radical hysterectomy. During surgery, indocyanine green (ICG) fluorescence angiography was used to identify the ureteral branch and evaluate perfusion of the uterine artery, its ureteral branch and the ureter.

Outcomes:

The uterine artery and ureteral branch were clearly labeled by green fluorescence, as were the distal serous layer of the ureter and tissue supplied by the ureteral branch. During 4-month follow-up, neither patient suffered hydronephrosis, ureteral fistula or stricture.

Lessons:

ICG angiography is a useful intraoperative imaging technique for identifying the ureteral branch and evaluating the branch-sparing surgery. Based on real-time angiography, sparing the ureteral branch can maintain blood supply to the ureter distal serous layer and neighboring tissues.
Patient quality of recovery on the day of surgery after propofol total intravenous anesthesia for vitrectomy
Authors: Na Se Hee , Jeong Kyu Hee , Eum Dahae , Park Jin Ha , Kim Min-Soo
Published: October 2018

Background:

Vitrectomy under general anesthesia is considered as a candidate for ambulatory surgery. An anesthetic method with high quality of postoperative recovery should be selected for successful ambulatory surgery. We thus compared quality of postoperative recovery on the day of vitrectomy using the Quality of Recovery (QoR)-40 questionnaire between propofol total intravenous anesthesia (propofol group) and desflurane inhalation anesthesia (desflurane group) as the 2 representative anesthetic methods.

Methods:

Eighty-four patients (20–80 years old) undergoing elective vitrectomy under general anesthesia were randomized into 2 groups. The propofol group received propofol and remifentanil using effect-site target-controlled infusion (TCI), and the desflurane group received desflurane inhalation and remifentanil using effect-site TCI. We assessed quality of recovery at 6 hours after surgery through interviews using the QoR-40 questionnaire. We also collected data related to recovery and complications during emergence and recovery period.

Results:

The median of QoR-40 score on the day of surgery was significantly higher in the propofol group than that in the desflurane group (181.0 vs 169.5, respectively; P = .033). In particular, propofol group had significantly higher scores for physical comfort and physical independence dimensions. The amount of remifentanil administered was significantly higher, and the emergence time was significantly longer in propofol group. However, there were no significant differences in other complications between the 2 groups.

Conclusions:

Propofol total intravenous anesthesia provided significantly better quality of recovery on the day of surgery than desflurane inhalation anesthesia.
A large retroperitoneal lipoblastoma
Authors: Sakamoto Saki , Hashizume Naoki , Fukahori Suguru , Ishii Shinji , Saikusa Nobuyuki , Yoshida Motomu , Masui Daisuke , Higashidate Naruki , Tsuruhisa Shiori , Ozono Shuich , Tanigawa Masahiko , Naito Yoshiki , Tanaka Yoshiaki , Yagi Minoru
Published: October 2018

Introduction:

Lipoblastoma is a rare benign soft tissue tumor that occurs most commonly in infants and children. However, retroperitoneal lipoblastomas are rare, occurring in <5% of cases. We report a case of large retroperitoneal lipoblastoma and the largest collection of known retroperitoneal lipoblastomas in children in the literature.

Case presentation:

A 3-year-old girl presented with left abdominal mass. Magnetic resonance imaging (MRI) revealed a soft tissue mass measuring 12 × 8 × 6 cm in the retroperitoneal region. The mass had a clearly defined margin and a reticular pattern with an interposing fat component. Based on these findings, the mass was suspected to be a soft-tissue tumor, most likely lipoblastoma.

Laparotomy with resection of the retroperitoneal mass was performed. The tumor was easily dissected from the retroperitoneal space without injury to surrounding structure.

A histopathological examination demonstrated the mature proliferation of adipocytes and spindle-shaped cells separated by fibrovascular septa accompanied by myxoid changes. The cells were separated into lobules by septa, and areas of immature adipocytes showing a signet-ring or multivacuolar appearance were present at the periphery. Histopathological diagnosis was lipoblastoma. Follow-up at 6 months revealed no evidence of recurrence.

Conclusion:

Retroperitoneal lipoblastoma is rare and tends to be large in size when diagnosed at presentation. Complete resection should not be delayed, as impingement on the surrounding structures is imminent.
Isolated extradural Rosai–Dorfman disease causing the spinal cord compression
Authors: Li Yongning , Wang Xin , Gao Jun , Yu Shuangni , Li Zhimin
Published: October 2018

Rationale:

Rosai-Dorfman disease (RDD) is a rare benign histiocytic disease that is commonly characterized by massive painless cervical lymphadenopathy and systemic manifestations. Isolated extranodal involvement, especially spinal involvement, is extremely rare.

Patient concerns:

A 28-year-old man presented with intermittent dorsodynia and bilateral lower-limb weakness and numbness. A magnetic resonance scan (MRI) showed an extradural lesion of the T6-T9 thoracic spine that lead to cord compression.

Diagnoses:

Histopathological findings showed distinctive emperipolesis and immunohistochemistry results that were positive for cluster of differentiation CD68 and S100. Therefore, we diagnosed the Rosai-Dorfman disease.

Interventions:

we performed a nearly total surgical resection and a limited T6-T9 laminectomy.

Outcomes:

Postoperatively, the patient's symptoms were partially relieved and experienced no recurrence during the 6-month follow-up. The preoperative diagnosis of isolated spinal RDD still remains challenging.

Lessons:

Thus, we should consider RDD in the differential diagnosis of the central nervous system. Besides surgical resection, the treatment also included radiation, chemotherapy or monoclonal antibodies. However, the optimal treatment remains controversial. Therefore, we should exert all our energies on the exploration of etiology and adjuvant therapy for this disease.
Ultrasonographic features of testicular metastasis from renal clear cell carcinoma that mimics a seminoma
Authors: Huang He , Ling Wenwu , Qiu Tingting , Luo Yan
Published: October 2018

Rationale

Testicular metastases from renal cell carcinoma (RCC) are extremely rare. To the best of our knowledge, only 35 cases have been described in the literatures.

Patient concerns

A 64-year-old male presented to our urology clinic for a palpable painless mass on his right side of the scrotum by self-examination 1 week ago, with a general abdominal ultrasonographic report showing a mass in his right kidney.

Diagnoses and interventions

Scrotal B-mode ultrasound revealed a 15 × 13 × 15 mm well-defined round homogenously hypoechoic nodule with a halo at the upper pole of the right testis. Color Doppler and spectral Doppler ultrasound detected abundant intranodular and perinodular blood flow signals including both arteries and veins. Malignancy was suspected. Abdominal contrast-enhanced computed tomography identified an irregular tumor in the posterior side of the right kidney, highly suspicious for renal carcinoma. The patient received right radical nephrectomy and right partial orchiectomy. Histologically, the right renal mass was diagnosed as RCC, clear cell type, grade 2. As to the right testicular mass, a metastasis from renal clear cell carcinoma was confirmed.

Outcomes

The patient has lived with no recurrence for at least 17 months without adjuvant therapy.

Lessons

In the case, we focus on the ultrasonographic features of the testicular metastasis from RCC. Ultrasound could provide initial and helpful information for diagnosis. When finding a mass in the testicle on the ultrasound, although most of them are primary, it is important to know whether the patient has tumor history from other parts of the body. A halo may be a special feature for metastases. Contrast-enhanced ultrasound (CEUS) and ultrasonic elastography could provide more information for differential diagnoses.
Predictors of early weaning failure from mechanical ventilation in critically ill patients after emergency gastrointestinal surgery
Authors: Jung Yun Tae , Kim Myung Jun , Lee Jae Gil , Lee Seung Hwan
Published: October 2018

Mechanical ventilation (MV) is the most common therapeutic modality used for critically ill patients. However, prolonged MV is associated with high morbidity and mortality. Therefore, it is important to avoid both premature extubation and unnecessary prolongation of MV. Although some studies have determined the predictors of early weaning success and failure, only a few have investigated these factors in critically ill surgical patients who require postoperative MV. The aim of this study was to evaluate predictors of early weaning failure from MV in critically ill patients who had undergone emergency gastrointestinal (GI) surgery.

The medical records of 3327 adult patients who underwent emergency GI surgery between January 2007 and December 2016 were reviewed retrospectively. Clinical and laboratory parameters before surgery and within 2 days postsurgery were investigated.

This study included 387 adult patients who required postoperative MV. A low platelet count (adjusted odds ratio [OR]: 0.995; 95% confidence interval [CI]: 0.991–1.000; P = .03), an elevated delta neutrophil index (DNI; adjusted OR: 1.025; 95% CI: 1.005–1.046; P = .016), a delayed spontaneous breathing trial (SBT; adjusted OR: 14.152; 95% CI: 6.571–30.483; P < .001), and the presence of postoperative shock (adjusted OR: 2.436; 95% CI: 1.138–5.216; P = .022) were shown to predict early weaning failure from MV in the study population.

Delayed SBT, a low platelet count, an elevated DNI, and the presence of postoperative shock are independent predictors of early weaning failure from MV in critically ill patients after emergency GI surgery.
Complications of percutaneous liver biopsy in living donor liver transplantation
Authors: Chiu King-Wah , Lin Ting-Lung , Yong Chee-Chien , Lin Chih-Che , Cheng Yu-Fan , Chen Chao-Long
Published: October 2018

Rationale:

According to previously published studies, major complications arising from a percutaneous liver biopsy are rare and occur in less than 0.1% of cases. This report describes an approach to percutaneous liver biopsy that can help avoid damage to the liver in a living donor liver transplantation (LDLT) setting.

Patient concerns:

Case 1: In the first case a donor percutaneous liver biopsy (PLB) of both lobes of the liver was performed for pre-LDLT evaluation. The ultrasonography (US)-guided epigastric right-angle approach and an automatic one-handed cocking disposable 18G biopsy gun was used to puncture the left liver lobe to determine the presence of fatty liver. A penetrating liver injury occurred, accompanied by massive bloody ascites (about 700 cc) and subcapsular hematoma at the left lateral segment. The bleeding was managed by bi-polar coagulation during the transplant and the following liver donation procedure proceeded smoothly without any subsequent complications. Case 2: In the second case, selective right lobe PLB for clinical assessment after LDLT was performed in the recipient. Hemorrhagic shock occurred following a puncture of the right posterior branch of the right hepatic artery when using the biopsy-gun via the right lateral intercostal approach.

Diagnoses:

Extravasation was documented by angiography and emergent transhepatic arterial embolization was performed.

Intervention:

Extravasation was documented by angiography and emergent transhepatic arterial embolization with glue:lipiodol (1:4) was performed to stop bleeding.

Outcomes:

The recipient survived after medical management.

Lessons:

To prevent complications, the right-angle approach of PLB may be changed to an oblique angle using a one-fire biopsy-gun. Use of a manual Menghini's needle should be considered for left lobe liver biopsies. Since US-guided manual Menghini's needle for PLB can be observed with the needle tip inserted in the liver, needle-mediated compromising of the major vessels or biliary tree can be prevented, and it does not penetrate the liver again. A superficial puncture less than 0.5 cm away from the liver surface should be made during right lobe liver biopsy. This approach can help to avoid damage to the hepatic artery.
Supra-inguinal fascia iliaca block under ultrasound guidance for perioperative analgesia during bipolar hip arthroplasty in a patient with severe cardiovascular compromise: Retraction
Authors: Ueshima Hironobu , Otake Hiroshi
Published: October 2018

Rationale:

The relief of selective hip pain may be difficult to attain. Therefore, a deep nerve block such as epidural anesthesia or lumbar plexus nerve block is required. However, deep nerve blocks may not be possible in patients with complications, including severe cardiovascular disease.

Patients concerns:

The patient in our report had coronary stents inserted previously and required continuous anticoagulant therapy owing to severe heart failure.

Diagnosis:

Bipolar hip arthroplasty was required in our patient because of a fracture of the neck of femur on the left side.

Interventions:

We decided to perform the surgery using a fascia iliaca block (block of the femoral and the lateral femoral cutaneous nerves) by the suprainguinal approach. The fascia iliaca nerve block was performed under ultrasound guidance, using 20 mL of levobupivacaine.

Outcomes:

The surgery was performed successfully with adequate sensory block around the hip region.

Lessons:

Ultrasound-guided fascia iliaca nerve block by the supra-inguinal approach may be an effective anesthetic technique for patients undergoing surgery for fracture of the neck of femur.
Disparities in Self-reported Access to Patient-centered Medical Home Care for Children With Special Health Care Needs
Authors: Pérez Jolles Mónica , Thomas Kathleen C.
Published: October 2018

Background:

Efforts to transform primary care have been underway for over a decade. Yet, we lack understanding of the progress made in scaling up this care model nationwide and on whether patient-centered medical home (PCMH) has benefited every group of children with special health care needs (CSHCNs).

Objective:

The main objective of this study was to examine variation in caregiver service experience concordant with PCMH care over time and by child characteristics.

Research Design:

This was a cross-sectional pooled data analysis using the 2003–2012 Medical Expenditures Panel Survey data for CSHCNs, aged 5–17 years. Logistic regressions were implemented, accounting for child and parent sociodemographic, child’s health insurance, and contextual characteristics. PCMH concordant care and each component were constructed as binary variables and child functional impairment was measured with the Columbia Impairment Scale.

Results:

Thirty-one percent of children reported medical home concordant care; comprehensive (83%) and compassionate (82%) care were most prevalent, and the least common were accessible care (59%) and patient-centered care (60%). PCMH concordant care significantly increased nationwide between 2003 and 2012, but disparities remained based on child needs and sociodemographic characteristics. Multivariate regressions showed variation across medical home components.

Conclusions:

Despite increased parent perception of care that is concordant with medical home care over time, disparities remain among high-need CSHCNs. Future research may focus on better understanding how clinical settings tailor this care model, particularly on providing increased access and patient-centered care, to better serve children at the highest need.
Analysis of a Step-Up Approach Versus Primary Open Surgical Necrosectomy in the Management of Necrotizing Pancreatitis
Authors: Jones Jason D. , Clark Clancy J. , Dyer Raymond , Case L. Douglas , Mishra Girish , Pawa Rishi
Published: October 2018

Objectives

An increasing number of providers have begun to use a minimally invasive step-up approach as opposed to traditional surgical necrosectomy in the management of acute necrotizing pancreatitis. Studies have shown mixed results, thus we hypothesized that the step-up approach is safer and associated with decreased mortality and length of stay (LOS).

Methods

This is a retrospective cohort study of patients admitted from January 2010 to March 2015 who underwent interventions for walled-off pancreatic necrosis (WOPN). Primary outcomes included LOS after intervention and mortality, in-hospital and 90-day, with secondary outcomes of procedural complications.

Results

Sixty-nine patients developed WOPN requiring intervention during the study period. In-hospital mortality was 5.6% (n = 2) in the step-up cohort compared with 18.2% (n = 6) in the surgical cohort (relative risk, 3.27; 95% confidence interval, 0.71–15.09). Ninety-day mortality was 9.1% (n = 3) in the step-up cohort and 21.9% (n = 7) in the surgical cohort (relative risk, 2.41; 95% confidence interval, 0.68–8.50). Postintervention LOS was 8 days in the step-up cohort and 17 days in the surgical cohort (P = 0.62).

Conclusions

A step-up approach, as compared with primary surgical necrosectomy in the management of WOPN, results in clinically significant decreases in mortality and LOS.
Grading by the Ki-67 Labeling Index of Endoscopic Ultrasound–Guided Fine Needle Aspiration Biopsy Specimens of Pancreatic Neuroendocrine Tumors Can Be Underestimated
Authors: Hwang Hee Sang , Kim YunJae , An Soyeon , Kim Sung Joo , Kim Joo Young , Kim Sang-Yeob , Hwang Dae Wook , Park Do Hyun , Lee Sang Soo , Kim Song Cheol , Seo Dong-Wan , Hong Seung-Mo
Published: October 2018

Objectives

There is an increasing need for grading with small endoscopic ultrasound–guided fine needle aspiration biopsy (EUS-FNAB) specimens for the proper diagnosis and therapy selection of patients with unresectable pancreatic neuroendocrine tumors (PanNET). However, our understanding of EUS-FNAB specimen grading is limited compared with surgically resected specimens.

Methods

We retrospectively determined Ki-67 labeling index (LI) of 33 matched EUS-FNAB and surgically resected PanNETs with digital image analyzer. Pairwise grades between the matched biopsy and surgically resected PanNET specimens were compared.

Results

The mean Ki-67 LI was higher in surgically resected PanNET specimens (5.5%) than in biopsy specimens (3.2%;P =0.022). There was moderate agreement between the Ki-67 LI grades when individually evaluated matched biopsy and resected specimen pairs were compared (κ value = 0.62;P< 0.0001). However, discordance was noted in 6 cases (18%), and all of them were either grade 2 or 3 in resected PanNETs.

Conclusions

Although Ki-67 LI grading of EUS-FNAB specimens may be concordant with that of matched surgically resected specimens in a large proportion of the PanNET cases, Ki-67 LI grading of EUS-FNAB specimens should be carefully applied in clinical practice because of the possibility of grading underestimation with grade 2 to 3 PanNET cases.
Practice Patterns of Stereotactic Radiotherapy in Pediatrics: Results From an International Pediatric Research Consortium
Authors: Alcorn Sara , Nilsson Kristina , Rao Avani D. , Ladra Matthew M. , Ermoian Ralph P. , Villar Rosangela C. , Chen Michael J. , Kobyzeva Daria , Nechesnyuk Alexey V. , Ford Eric , MacDonald Shannon , Winey Brian , Dieckmann Karin , Terezakis Stephanie A.
Published: October 2018

Purpose/Objectives:

There is little consensus regarding the application of stereotactic radiotherapy (SRT) in pediatrics. We evaluated patterns of pediatric SRT practice through an international research consortium.

Materials and Methods:

Eight international institutions with pediatric expertise completed a 124-item survey evaluating patterns of SRT use for patients 21 years old and younger. Frequencies of SRT use and median margins applied with and without SRT were evaluated.

Results:

Across institutions, 75% reported utilizing SRT in pediatrics. SRT was used in 22% of brain, 18% of spine, 16% of other bone, 16% of head and neck, and <1% of abdomen/pelvis, lung, and liver cases across sites. Of the hypofractionated SRT cases, 42% were delivered with definitive intent. Median gross tumor volume to planning target volume margins for SRT versus non-SRT plans were 0.2 versus 1.4 cm for brain, 0.3 versus 1.5 cm for spine/other bone, 0.3 versus 2.0 cm for abdomen/pelvis, 0.7 versus 1.5 cm for head and neck, 0.5 versus 1.7 cm for lung, and 0.5 versus 2.0 cm for liver sites.

Conclusions:

SRT is commonly utilized in pediatrics across a range of treatment sites. Margins used for SRT were substantially smaller than for non-SRT planning, highlighting the utility of this approach in reducing treatment volumes.
Manual function of the unaffected upper extremity can affect functional outcome after stroke
Authors: Cho Tae Hwan , Jeong Yoon Jeong , Lee Hyo Jeong , Moon Hyun Im
Published: October 2018

Traditionally, motor deficits of ipsilesional side, generally considered as the unaffected side, have been investigated less and the influence of the impairment is unknown. To evaluate the association between the manual function test (MFT) of nonparetic limb and poststroke functional outcome. We conducted a retrospective analysis of 71 hemiplegic patients with stroke. MFT on both sides was routinely measured at admission and 1 month later after admission by an experienced occupational therapist. The parameters of functional outcome after stroke were measured with the total score of functional independence measure (FIM) and the self-care subscore of FIM. Age, initial cognitive function, and MFT of the affected hand and unaffected hand were each significant factors for independently predicting short-term functional outcome after stroke. Linear regression analysis showed that initial MFT score of unaffected side is a significant predictor for 1 month follow-up subscore FIM (P<0.0001) and total FIM score (P<0.0001). Our findings suggests that initial MFT score of the nonparetic side has a significant correlation with functional outcome. Therefore, it is important to conduct MFT on the nonparetic side as well as the paretic side. Furthermore, it is necessary to undergo rehabilitation therapy on the nonparetic side.
Clinical study of combined mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients
Authors: Guo Junyi , Qian Shuyan , Wang Yisu , Xu Aihua
Published: October 2018

Mirror therapy is a simple, inexpensive, and patient-oriented method that has been shown to reduce phantom sensations and pain caused by amputation and improve range of motion, speed, and accuracy of arm movement and function. Extracorporeal shock wave therapy (ESWT) is a new, reversible, and noninvasive method for the treatment of spasticity after stroke. To investigate the therapeutic effect of the combination of mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients. We randomly assigned 120 patients into four groups: A, B, C, and D. All groups received conventional rehabilitation training for 30 min per day, five times a week, for 4 weeks. Moreover, participants in groups A, B, and C also added mirror therapy, ESWT, and a combination of mirror and ESWT, respectively, for 20 min per day. Motor recovery and spasticity were measured using Fugl–Meyer assessment and modified Ashworth scale. The differences in the Fugl–Meyer assessment and modified Ashworth scale scores in group C were significantly greater than those of group D at all observed time points after treatment and were significantly greater than those of groups A and B (P<0.05), but no significant differences were observed between groups A and B until 12 months. Upper extremity spasticity was improved by combined mirror and ESWT.
Laparoscopic vs Transvaginal Cuff Closure After Total Laparoscopic Hysterectomy: A Randomized Trial by the Italian Society of Gynecologic Endoscopy
Authors: Uccella Stefano , Malzoni Mario , Cromi Antonella , Seracchioli Renato , Ciravolo Giuseppe , Fanfani Francesco , Shakir Fevzi , Alletti Salvatore Gueli , Legge Francesco , Berretta Roberto , Corrado Giacomo , Casarella Lucia , Donarini Paolo , Zanello Margherita , Perrone Emanuele , Gisone Baldo , Vizza Enrico , Scambia Giovanni , Ghezzi Fabio
Published: October 2018

(Abstracted from Am J Obstet Gynecol 2018;218:500.e1–500.e13)

After the introduction of total laparoscopic hysterectomy (TLH) in 1989, the significant benefits of minimally invasive techniques for improved outcomes and lower costs have allowed a substantial decrease in the rate of open abdominal hysterectomies. However, these benefits have been paralleled by an increase in the rate of vaginal cuff dehiscence, an infrequent but potentially life-threatening complication.
Characteristics of Lynch Syndrome Associated Ovarian Cancer
Authors: Woolderink J. M. , De Bock G. H. , de Hullu J. A. , Hollema H. , Zweemer R. P. , Slangen B. F. M. , Gaarenstroom K. N. , van Beurden M. , van Doorn H. C. , Sijmons R. H. , Vasen H. F. A. , Mourits M. J. E.
Published: October 2018

(Abstracted from Gynecol Oncol 2018;150(2):324–330)

Lynch syndrome (LS), an autosomal dominant tumor syndrome, is associated with increased risk of cancer. Most inherited endometrial cancers are caused by this syndrome.
The Relationship between Progression in Axial Length/Corneal Radius of Curvature Ratio and Spherical Equivalent Refractive Error in Myopia
Authors: Jong Monica , Sankaridurg Padmaja , Naduvilath Thomas John , Li Wayne , He Mingguang
Published: October 2018

SIGNIFICANCE

This study demonstrates that mean axial length/corneal radius of curvature ratio (AL/CR) can be used to detect low and high myopia but cannot clinically monitor myopia progression because the relationship between AL/CR and progression in myopia is different between low and high myopia.

PURPOSE

The purpose of this study was to investigate the relationship of AL/CR with magnitude and progression of myopia.

METHODS

Retrospective analysis was conducted comparing the right eyes of those with high myopia (n = 308; age, 7 to 16 years; myopia sphere, −6.00 diopters or worse) with those with low myopia (n = 732; age, 7 to 16 years; myopia sphere, between −0.50 and −3.50 diopters; cylinder, ≤1.00 diopters). Baseline axial length, corneal radii of curvature, and cycloplegic objective refraction were analyzed. Myopia progression in the low-myopia group at 6- and 12-month follow-up was measured, and the differences in slopes of AL/CR were compared for slow (<0.75 diopters) and fast progressing (≥0.75 diopters).

RESULTS

Mean AL/CR values were significantly different (P < .001) between high myopia (3.46 ± 0.10) and low myopia (3.16 ± 0.07). In high and low myopia, slopes of axial length versus corneal curvature radius were not significantly different (P > .05), and slopes of AL/CR versus spherical equivalent were significantly different after adjusting for spherical equivalent and age (P < .05). Slopes of AL/CR progression and spherical equivalent progression were significantly different in low myopia between fast and slow progressing (P < .001), but the relationship between progression in AL/CR and progression in spherical equivalent was not strong.

CONCLUSIONS

The AL/CR can be used to classify different grades of myopia, but it is not useful in determining the magnitude of myopia or monitoring progression because AL/CR is not linearly related to spherical equivalent and because progression in AL/CR is not strongly related to spherical equivalent progression.
Tear Lactoferrin and Features of Ocular Allergy in Different Severities of Meibomian Gland Dysfunction
Authors: Chao Cecilia , Tong Louis
Published: October 2018

SIGNIFICANCE

Meibomian gland dysfunction, but not atrophy, was associated with lower tear lactoferrin concentration, greater dry eye, and allergic symptoms, indicating greater inflammation and discomfort in patients with lower meibomian gland expressibility.

PURPOSE

Meibomian gland dysfunction can potentially damage adjacent palpebral structures, which may induce inflammation in accessory lacrimal glands and affect lactoferrin secretion. This study aimed to examine the relationships between the severity of meibomian gland dysfunction with tear lactoferrin, conjunctival cell morphology, and clinical features of ocular allergy.

METHODS

Forty subjects were divided into two groups based on the severity of meibomian gland plugging and expressibility and secondarily based on its atrophy. Dry eye and allergy questionnaires; slit-lamp examination, including lid telangiectasia; and meibography were performed. Tear lactoferrin concentration was measured using TearScan 270 MicroAssay. Impression cytology was performed on the upper palpebral conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified.

RESULTS

Twenty-two subjects with meibomian gland dysfunction were categorized into severely obstructed group (case), whereas 19 subjects had minimal/no obstruction (comparison). Lower lactoferrin (1.3 ± 0.4 vs. 1.7 ± 0.4 mg/mL, P = .007), greater dry eye (7 [1 to 10] vs. 2 [0 to 5], P = .03), and allergy symptoms (9 [4 to 23] vs. 6 [0 to 9], P = .05) were found in the cases compared with the comparisons. There were no differences in conjunctival cell morphology between groups. The plugging score was correlated with lactoferrin concentration (ρ = −0.43, P = .006), dry eye (ρ = 0.36, P = .02), and allergic symptoms (ρ = 0.33, P = .04). Greater lid margin telangiectasia was associated with meibomian gland obstruction, but not atrophy.

CONCLUSIONS

Meibomian gland activity/dysfunction, but not atrophy, may be associated with increased inflammation on the ocular surface. The inflammation may be sufficient to reduce tear lactoferrin production from damage to accessory lacrimal glands and/or meibomian gland and result in increased symptoms.
Neutralizing Peripheral Refraction Eliminates Refractive Scotomata in Tilted Disc Syndrome
Authors: Phu Jack , Wang Henrietta , Miao Sephora , Zhou Lydia , Khuu Sieu K. , Kalloniatis Michael
Published: October 2018

SIGNIFICANCE

We demonstrate that the visual field defects in patients with tilted disc syndrome can be reduced or eliminated by neutralizing the peripheral scotoma in the area of posterior retinal bowing, which may allow differentiation between a congenital anomaly and acquired pathology.

PURPOSE

Tilted disc syndrome is a congenital and unchanging condition that may present with visual field defects mimicking loss seen in neurological diseases, such as transsynaptic retrograde degeneration. Our purpose was to systematically investigate the ability of a neutralized peripheral refraction to eliminate refractive visual field defects seen in tilted disc syndrome. This was compared with the same technique performed on patients with neurological deficits.

METHODS

The Humphrey Field Analyzer was used to measure sensitivities across the 30-2 test grid in 14 patients with tilted disc syndrome using four refractive corrections: habitual near correction and with an additional −1.00, −2.00 or −3.00 D negative lens added as correction lenses. Peripheral refractive errors along the horizontal meridian were determined using peripheral retinoscopy and thus allowed calculation of residual peripheral refraction with different levels of refractive correction. Visual field defects were assessed qualitatively and quantitatively using sensitivities and probability scores in both patient groups.

RESULTS

A smaller residual refractive error after the application of negative addition lenses correlated with improvement in visual field defects in terms of sensitivity and probability scores in patients with tilted disc syndrome. Patients with established neurological deficits (retrograde degeneration) showed improvement in sensitivities but not in probability scores.

CONCLUSIONS

Neutralizing the refractive error at the region of posterior retinal bowing due to tilted disc syndrome reduces the apparent visual field defect. This may be a useful and rapid test to help differentiate between tilted disc syndrome and other pathological causes of visual field defects such as neurological deficits.
Shelf Life and Efficacy of Diagnostic Eye Drops
Authors: Hanssens Jean-Marie , Quintana-Giraldo Carolina , Jacques Sandrine , El-Zoghbi Nohade , Lampasona Vanessa , Langevin Camille , Bouchard Jean-François
Published: October 2018

SIGNIFICANCE

Pharmaceutical companies recommend discarding ophthalmic drugs 28 days after opening. This study shows that diagnostic eye drops have a low risk of contamination over a 7-month period in a controlled clinical setup. The diagnostic efficiency seems to be preserved over this period.

PURPOSE

The aim of this study was to evaluate the preservation period and the efficacy of ophthalmic preparations, such as 0.5% proparacaine hydrochloride, 1% tropicamide, 2.5% phenylephrine hydrochloride, and 1% cyclopentolate hydrochloride ophthalmic solution in a clinical and controlled setting.

METHODS

Thirty-eight primary eye care students were recruited to participate in the study. They used 25 bottles of each diagnostic drop at the Clinique Universitaire de la Vision for a 7-month period. An analysis of the bacterial contamination was repeated 10 times using both an agar plate and a nutrient broth at 0, 2, 4, 6, and 8 weeks and at 3, 4, 5, 6, and 7 months. The anesthetic, mydriatic, and cycloplegic effects were tested after 7 months of use and compared with nonopened ophthalmic bottles.

RESULTS

During the 7-month period, 4971 drops of proparacaine, 3219 drops of tropicamide and phenylephrine, and 1896 drops of cyclopentolate were administered to the patients. A total of 226 contacts between bottles and biological tissues were reported. After the 10 inoculation sessions on the agar medium at the predetermined times, no bacterial and fungal contamination was noted. No patient reported eye infections for 2 weeks after the drop instillation. Moreover, there was no difference in the efficacy when compared with new drops.

CONCLUSIONS

According to the results of the current study, diagnostic eye drops can be used with a low contamination risk beyond the recommendation date of 28 days up to 7 months, with the same efficacy, in a controlled clinical context.
iPhone-based Pupillometry: A Novel Approach for Assessing the Pupillary Light Reflex
Authors: McAnany J. Jason , Smith Brandon M. , Garland Amy , Kagen Steven L.
Published: October 2018

SIGNIFICANCE

The response of the pupil to a flash of light, the pupillary light reflex (PLR), is an important measure in optometry and in other fields of medicine that is typically evaluated by qualitative observation. Here we describe a simple, portable, iPhone-based pupillometer that quantifies the PLR in real time.

PURPOSES

The purposes of this study were to describe a novel application that records the PLR and to compare its technical capabilities with a laboratory-based infrared (IR) camera system.

METHODS

Pupil sizes were measured from 15 visually normal subjects (age, 19 to 65 years) using an IR camera system and the Sensitometer test. This test elicits pupillary constriction using the iPhone flash, records pupil size using the camera, and provides measurements in real time. Simultaneous recordings were obtained with the Sensitometer test and IR camera, and two measures were calculated: (1) dark-adapted steady-state pupil size and (2) minimum pupil size after the flash. The PLR was defined as the difference between these two measures. Pupil size was also recorded during the redilation phase after the flash. Bland-Altman analysis was used to assess the limits of agreement between the two methods.

RESULTS

Statistically significant correlations between the IR and Sensitometer test measures were found for the PLR (r = 0.91, P < .001) and redilation size (r = 0.65, P = .03). Bland-Altman analysis indicated a mean PLR difference of 6% between these two methods. The PLR limit of agreement was 14%, indicating that 95% of subjects are expected to have IR and Sensitometer test measurements that differ by 14% or less. Bland-Altman analysis indicated a mean redilation size difference of 1% between the two methods; the limit of agreement was 5%.

CONCLUSIONS

There is excellent agreement between pupil responses recorded using the Sensitometer test and IR camera. The Sensitometer test provides a highly promising approach for simple, portable, inexpensive pupillary measurements.