bluuebunny/crossref_metadata_2025 huggingface dataset:
Large pulmonary sclerosing pneumocytoma with massive necrosis and vascular invasion: a case report
Authors: Sakai Takashi , Miyoshi Tomohiro , Umemura Shigeki , Suzuki Jun , Nakasone Shoko , Okada Satoshi , Tane Kenta , Aokage Keiju , Goto Koichi , Motoi Noriko , Ishii Genichiro , Tsuboi Masahiro
Published: July 2019

Pulmonary sclerosing pneumocytoma (PSP) is pathologically classified as an adenoma and behaves in a benign manner. However, some cases of PSP displayed pathologically malignant behavior, such as lymph node metastasis and necrosis. A 64-year-old woman was referred to our hospital complaining of a cough and breathlessness. Histopathological analysis of the resected specimen by left pneumonectomy and lymph node dissection revealed a large PSP measuring 15 × 14 cm in size, with massive necrosis and vascular invasion. This case was the largest ever reported and suggested that clinico-histological presentation of PSP sometimes showed an aggressive phenotype like advanced lung cancer.
‘IVC contrast level: a sign of cardiovascular dysfunction’
Authors: Verma Mansi , Bhatia Vikas , Singh Lokesh , Debi Uma , Sandhu Manavjit
Published: July 2019

Contrast blood level in intrahepatic inferior vena cava (IVC) on arterial contrast-enhanced CT images is referred to as IVC layering or IVC contrast level sign. This sign is important to recognize as it has dismal prognosis and requires immediate attention. The causes described in literature include cardiogenic shock, cardiac arrest and cardiac tamponade. We hereby present three cases depicting IVC contrast level sign.
Intravenous, Perioperatively Administered Lidocaine Regulates Serum Pain Modulators’ Concentrations in Children Undergoing Spinal Surgery
Authors: Kościelniak-Merak Barbara , Batko Ilona , Kobylarz Krzysztof , Sztefko Krystyna , Tomasik Przemysław J
Published: July 2019

Objectives

We analyzed the influence of perioperative, intravenous (i.v.) lidocaine infusion as a part of multimodal anesthesia on concentrations of selected pain modulators.

Design

An observational study.

Setting

University Children’s Hospital in Cracow, Poland, from May 2015 to May 2018.

Subjects

Forty-four children undergoing extensive spinal surgery, divided into two groups after surgery: the study group (N = 23), anesthetized generally with lidocaine as a co-analgesic, and the control group (N = 22), anesthetized generally without lidocaine.

Methods

We assessed proinflammatory mediators like neuron growth factor (NGF), high mobility group box 1 (HMGB1), interleukin 6 (IL-6), and FOS protein before, immediately after, six hours and 12–15 hours after surgery. We evaluated pain intensity at corresponding time points using a 10-point numerical/graphical scale.

Results

We observed that children in the lidocaine group had reduced pain intensity in the resting state and during movement until six hours after surgery when compared with controls. We found lower NGF concentrations in the lidocaine group vs controls only at six hours after surgery. Mean HMGB1 concentrations during the postoperative period in the study group were relatively stable, whereas we observed significant increases at six hours after surgery and a slight decrease at 12–15 hours after surgery in the control group. IL-6 concentrations at six hours were lower in lidocaine patients when compared with controls. We noted a negative correlation between HMGB1, NGF, Il-6, and lidocaine concentrations after surgery. We did not find any differences in FOS protein concentrations between the groups.

Conclusions

Our findings suggest that intraoperative and postoperative i.v. lidocaine administration as a part of multimodal anesthesia may reduce inflammatory-dependent postoperative pain intensity.
Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: the need to ‘act locally and think globally’
Authors: Sibai Abla M , Najem Kteily Martine , Barazi Rana , Chartouni Mia , Ghanem Maguy , Afifi Rima A
Published: July 2019

Background

Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations.

Methods

Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness.

Results

Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines’ supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program.

Conclusions

Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more ‘local testing’ of modified interventions within such contexts. This can then inform ‘thinking globally’ on guidelines for the delivery of NCD care in crisis settings.
A Transaction-Cost Perspective on the Multitude of Firm Characteristics
Authors: DeMiguel Victor , Martín-Utrera Alberto , Nogales Francisco J , Uppal Raman
Published: July 2019

We investigate how transaction costs change the number of characteristics that are jointly significant for an investor’s optimal portfolio and, hence, how they change the dimension of the cross-section of stock returns. We find that transaction costs increase the number of significant characteristics from 6 to 15. The explanation is that, as we show theoretically and empirically, combining characteristics reduces transaction costs because the trades in the underlying stocks required to rebalance different characteristics often cancel out. Thus, transaction costs provide an economic rationale for considering a larger number of characteristics than that in prominent asset-pricing models.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Circadian regulation of sleep in a pre-clinical model of Dravet syndrome: dynamics of sleep stage and siesta re-entrainment
Authors: Sanchez Raymond E A , Bussi Ivana L , Ben-Hamo Miriam , Caldart Carlos S , Catterall William A , De La Iglesia Horacio O
Published: July 2019

Study Objectives

Sleep disturbances are common co-morbidities of epileptic disorders. Dravet syndrome (DS) is an intractable epilepsy accompanied by disturbed sleep. While there is evidence that daily sleep timing is disrupted in DS, the difficulty of chronically recording polysomnographic sleep from patients has left our understanding of the effect of DS on circadian sleep regulation incomplete. We aim to characterize circadian sleep regulation in a mouse model of DS.

Methods

Here we exploit long-term electrocorticographic recordings of sleep in a mouse model of DS in which one copy of the Scn1a gene is deleted. This model both genocopies and phenocopies the disease in humans. We test the hypothesis that the deletion of Scn1a in DS mice is associated with impaired circadian regulation of sleep.

Results

We find that DS mice show impairments in circadian sleep regulation, including a fragmented rhythm of non-rapid eye movement (NREM) sleep and an elongated circadian period of sleep. Next, we characterize re-entrainment of sleep stages and siesta following jet lag in the mouse. Strikingly, we find that re-entrainment of sleep following jet lag is normal in DS mice, in contrast to previous demonstrations of slowed re-entrainment of wheel-running activity. Finally, we report that DS mice are more likely to have an absent or altered daily “siesta”.

Conclusions

Our findings support the hypothesis that the circadian regulation of sleep is altered in DS and highlight the value of long-term chronic polysomnographic recording in studying the role of the circadian clock on sleep/wake cycles in pre-clinical models of disease.
Sexual Laborers and Entrepreneurial Women: Articulating Collective Identity in India’s HIV/AIDS Response
Authors: Vijayakumar Gowri
Published: July 2019

This article uses ethnographic and interview methods to compare two groups of sex workers in Bangalore, both of which formed during the response to the HIV/AIDS epidemic. In this context, donor priorities fundamentally shaped the landscape for sex worker organizations, but the two groups formed very different collective identities. I argue that the content of collective identity is not predetermined by the conditions set by global Northern funding. Instead, I show how collective identity is articulated, in a locally specific process of relating political orientations to local associational fields, within, but not predetermined by, global funding constraints. As each group positioned itself in a distinct local associational field, it articulated a distinct collective identity, the Women’s Collective as entrepreneurial women (a more respectable collective identity), and the Union as sexual laborers (a more transgressive one). Articulation unfolded through material as well as symbolic processes, shaping members’ life trajectories and their understandings of them. This article complicates accounts of Northern funding and institutional opportunities as predetermining the paths and visions of social movements.
From obligation to opportunity: future of patient-reported outcome measures at the Veterans Health Administration
Authors: Coles Theresa M , Wilson Sarah M , Kim Bo , Beckham Jean C , Kinghorn Warren A
Published: July 2019

When implemented systematically and longitudinally outside of the clinical encounter, patient-reported outcome measures may bolster the therapeutic alliance, enable new opportunities for clinician-patient communication, and improve patient satisfaction and clinical outcomes.
Osteosynthesis Technique for Periprosthetic Femoral Fractures: A Case of Interprosthetic Fracture Between a Total Knee Arthroplasty and a Dynamic Hip Screw
Authors: Page Jessica L. , Leighton Ross K.
Published: July 2019

Periprosthetic fractures remain a challenging component of every trauma practice. Total joints have become common in very elderly patients, creating a variety of implanted stress risers that make subsequent fractures unique challenges to address. This creates the need to build a construct that will allow for early weight bearing while trying to reduce the potential for further fractures in the same bone. A minimally invasive submuscular approach with long periprosthetic locking plates can be used for a periprosthetic femoral fracture.

Video available at:
http://links.lww.com/JOT/A803
Managing the Endosteal Fibula During Arthroplasty for Proximal Humeral Fracture Sequelae
Authors: Amini Michael H.
Published: July 2019

Augmentation of proximal humeral fracture fixation with an endosteal fibular allograft has increased in popularity because it biomechanically improves construct stability and potentially may lead to a lower rate of humeral head collapse. However, the potential need for arthroplasty after proximal humeral fracture fixation may still arise. Placing a humeral stem in the presence of an existing intramedullary fibular graft is challenging because the fibula is dense cortical bone and is typically well-integrated by the time an arthroplasty would be performed. Some have proposed burring the proximal humerus open to receive a stem, or using cannulated intramedullary reamers until a humeral stem can be placed. These steps are tedious and inefficient. We have found the most efficient technique as treating the fibula as if it were a well-fixed humeral stem: freeing it up from the native bone and removing it in its entirety.

Video available at:http://links.lww.com/JOT/A802
Attention-Deficit Hyperactivity Disorder, Disruptive Behaviors, and Drug Shortage
Authors: Hastings Elizabeth , Poon Jennifer , Robert Sophie , Nyp Sarah S.
Published: July 2019

CASE:

Kyle is a 10-year-old boy with Down syndrome and intellectual disability who is being followed up by a developmental behavioral pediatrician for attention-deficit hyperactivity disorder (ADHD) and anxiety. Kyle was initially taking a long-acting liquid formulation of methylphenidate for ADHD and fluoxetine for anxiety. Several months ago, the liquid formulation was on back order, and the methylphenidate formulation was changed to an equal dose of a long-acting capsule. Kyle is not able to swallow pills; therefore, the contents of the capsule were sprinkled onto 1 bite of yogurt each morning. Over the course of the next month, Kyle's behaviors became increasingly difficult. He was not able to tolerate loud or crowded places, and despite a visual schedule and warnings, he would become aggressive toward adults when directed to transition away from preferred activities. Fluoxetine was increased from 0.4 to 0.6 mg/kg/day at that time.

One month later, his parents reported that although there may have been slight improvement in Kyle's irritability since the increase in fluoxetine, they felt he was nonetheless more aggressive and less cooperative than his previous baseline. Kyle was returned to the long-acting liquid formulation of methylphenidate at that time, and a follow-up was scheduled 2 weeks later.

On return to clinic, his parents reported that Kyle's behaviors had continued to become increasingly difficult. He was described as uncooperative and aggressive at home and school. Kyle was easily upset any time he was not given his way, his behavior was corrected, or he felt that he was not the center of attention. When upset, he would yell, bite, kick, spit, or throw his body to the ground and refuse to move. At 110 pounds, Kyle's parents were no longer able to physically move his body when he dropped to the ground. This was a safety concern for his parents because he had displayed this behavior in the parking lot of a busy shopping area. Because of Kyle's aggressive and unpredictable behavior, parents no longer felt comfortable taking him to public places. Family members who had previously been comfortable staying with Kyle while his parents were out for short periods would no longer stay with him. Overall, the behaviors resulted in parents being unable to go to dinner as a couple or provide individual attention to their other children. The parents described the family as “on edge.” How would you approach Kyle's management?
Maximizing Plastic Surgery Education Impact: Lessons from Resident Learning Styles and Experiential Learning Theory
Authors: Saldanha Francesca Y. L. , Levites Heather A. , Staffa Steven J. , Roussin Christopher , Allori Alexander C. , Rogers-Vizena Carolyn R.
Published: July 2019

Background:

Residents in many surgical disciplines express a strong preference for hands-on learning, but no studies have focused on plastic surgery. This initial study aims to ascertain the learning styles of plastic surgery residents, and identify potential trends that may better guide curriculum development.

Methods:

Kolb Learning Style Index v. 3.1 was administered to plastic surgery residents across all training levels at three residency programs. The Kolb Learning Style Index is a 12-item questionnaire that characterizes an individual’s learning style into 1 of 4 major categories: converging; accommodating; assimilating; and diverging.

Results:

The surveyed cohort of plastic surgery residents (n = 45) demonstrated a diverse mix of learning styles: converging (38%, n = 17); accommodating (24%, n = 11); diverging (20%, n = 9); and assimilating (16%, n = 7). One resident was balanced between converging and accommodating (2%, n = 1). Despite varied learning styles, the majority (64%, n = 29) demonstrated a preference for “active experimentation,” for example, hands-on learning.

Conclusions:

A preliminary assessment of learning styles among plastic surgery residents suggests that they have mixed learning styles. This contrasts with the existing literature from other surgical specialties where a single learning style dominates. However, like these other specialties, active experimentation is particularly valued. As such, it behooves the plastic surgery educator to continue to strive for balance between book learning and hands-on experience for residents at all levels of training, to engage residents with all learning styles.
Nipple-Sparing Mastectomy and Prepectoral Implant/Acellular Dermal Matrix Wrap Reconstruction in Large Ptotic Breasts
Authors: Khalil Haitham H. , Malahias Marco N. , Youssif Sherif , Ashour Tarek , Rhobaye Saif , Faroq Tahir
Published: July 2019

Nipple-sparing mastectomy (NSM) with simultaneous prepectoral direct to implant reconstruction and acellular dermal matrix (ADM) is increasingly offered to patients opting for prophylactic or therapeutic mastectomies. The recent introduction of prepectoral implant/ADM in the armamentarium of breast reconstruction has proven to reduce pain and animation deformity. Despite this promising method, patients with macromastia and ptotic breasts remain a challenging group to treat. More often they would require secondary corrective procedures and can experience high failure rate and unsatisfactory outcomes. The authors present their experience in utilizing a bipedicled nipple-areola complex dermal flap through Wise pattern to achieve a successful NSM with prepectoral implant/ADM (Braxon) wrap (IBW) as a single stage in patients with large ptotic breasts. Patients seeking NSM with large ptotic breasts were included in the study in the period between 2016 and 2018. They were offered a single-stage Wise pattern NSM and immediate prepectoral IBW breast reconstruction. The technique and outcomes were recorded. Sixteen reconstructions were performed in 8 women with a median age of 32 years (range, 27–50 years) and a median body mass index of 32 kg/m2 (range, 29–39 kg/m2). The resected breasts weight ranged from 750 to 1,600 g (median, 890 g). All procedures were completed successfully with no nipple-areola complex necrosis or failure experienced during the follow-up period (range, 3–24 months) with all patients reported excellent satisfaction. The authors’ results demonstrate that this technique could be safely planned for NSM in large ptotic breasts with excellent durable outcomes.
The Double-reverse Wedge Excision Technique: A Novel Approach to Reconstruction of Stahl’s Ear Deformity
Authors: Sinnott Catherine J. , Boutros Christina , Davenport Thomas A. , Ruotolo Rachel A.
Published: July 2019

Stahl’s ear deformity presents with an abnormal third crus of the antihelix and varying degrees of severity. This paper aims to describe a novel technique for reconstruction of Stahl’s ear involving a double-reverse wedge excision of the third crus cartilage and skin, as well as use of Mustardé sutures to recreate the superior crus and Furnas sutures to complete the auricular setback. This novel technique for correction of Stahl’s ear deformity produces a more stable aesthetic result versus classic otoplasty with desired auricular setback, minimal reduction in the size of the ear, and limited scarring on the anterior auricular surface. Reconstruction of Stahl’s ear deformity can be accomplished using this double-reverse wedge excision technique of the third crus cartilage and skin with Mustardé and Furnas sutures to recreate the superior crus and complete auricular setback, effectively restoring anatomic harmony to the ear.
Congenital Amniotic Constriction Band of the Pelvis: First Reported Case and Proposed Classification Criterion
Authors: Graham Emily , Garlick Jared W. , Johns Dana
Published: July 2019

Congenital amniotic band syndrome (ABS) is a complex disorder characterized by a spectrum of rare congenital anomalies, with constriction bands as their hallmark manifestation. Constriction bands about the thorax, abdomen, or pelvis are rare. There is no consensus in the classification criterion for constriction bands of the thorax, abdomen, or pelvis in the literature. We present the first true pelvic constriction band in a newborn female with ABS. This case adds valuable information to the literature on ABS. The authors propose a classification criterion to further classify constriction bands of the thorax, abdomen, and pelvis using accepted and reliable anatomical landmarks.
A Two-step Technique for Neo-umbilicoplasty in the Abdominal Reconstructive Population
Authors: Ngaage Ledibabari M. , Kokosis George , Kachniarz Bartlomiej , Pedreira Rachel , Rada Erin M. , Nam Arthur J. , Pearl Jonathan , Kavic Stephen , Rasko Yvonne M.
Published: July 2019

The umbilicus is the centerpiece of the abdomen and an important cosmetic landmark. Secondary intention healing can be used to create the illusion of an umbilicus in reconstructive surgery. However, there is a sparsity of literature on the role of neo-umbilicoplasty in this subset of patients and how they perceive their new umbilicus. We conducted a retrospective review of patients who received a neo-umbilicus during an abdominal reconstructive operation in 2016–2018. The umbilicus was amputated intraoperatively and tacking sutures were placed to create an indentation in the soft tissue; an inverted-V incision was sutured to create the illusion of an umbilicus. Postoperatively, patients were asked to rate their satisfaction with umbilicus appearance on a 5-point Likert scale. Of the 10 patients included; the majority were female (9:1), with a mean age of 37 years (range: 26–50) and mean BMI 29 (range: 21–38). The most common procedure performed at time of neo-umbilicoplasty was hernia repair (80%). There were no wound complications associated with the neo-umbilicus. Satisfaction was high (median 5, range: 1–5) and independent of time since surgery. Three patients gave scores below 5 and cited reasons of “lack of indentation” (n = 3, scores 4, 4, and 1), and “insufficiently notable scar” (n = 1, score 1). We hereby describe a simple surgical technique for neo-umbilicoplasty in patients undergoing reconstructive abdominal surgery that leads to long-lasting cosmetic satisfaction. Further studies of patient-reported outcomes and refinement of the technique will maximize the aesthetically pleasing results.
The Association Between Modified Intracoronary Thrombus Grade and Cardiovascular Risk Factors and Initial Laboratory Findings in Patients Undergoing Primary Percutaneous Coronary Intervention
Authors: Nozari Younes , Geraiely Babak , Kassaian Seyed Ebrahim , Saroukhani Sepideh , Mortazavi Seyedeh Hamideh
Published: July 2019

The thrombus burden has been shown to affect the immediate results of primary coronary intervention and the outcome of the patients. The aim of the present study was to determine the cardiovascular risk factors and initial laboratory findings associated with angiographic thrombotic grade based on the new reclassified grading method. A total of 394 consecutive patients presenting with a first ST-elevation myocardial infarction treated by primary coronary intervention were retrospectively evaluated between March 2014 and March 2017. Patients were divided into 2 groups of low thrombus grade (grades 1–3) and high thrombus grade (grade 4). The results showed that the patients with high thrombus grade had markedly higher white blood cell (WBC) counts, platelet counts, and initial troponin levels (P values were <0.001, 0.004, and <0.001, respectively). After logistic regression analysis, high WBC count had the strongest association with high thrombus grade [odds ratio: 3.185, 95% confidence interval: 1.349–7.520; P = 0.008]. The initial troponin level also had significant association with high thrombus grade, whereas high platelet count had a borderline statistical significance (odds ratio: 2.250, 95% confidence interval: 0.928–5.459; P = 0.073). In conclusion, the present study demonstrated that high WBC and higher levels of baseline troponin were associated with high angiographic thrombus grade in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions
Authors: Wallins Joseph S. , Cajiao Karen M. , McCarthy Killian J. , Estrada-Roman Alisson , Gavin Michael C.
Published: July 2019

Introduction:

Alternatives to the emergency department (ED) for expedient and high-value team-based cardiology care for patients with chest pain, volume overload, palpitations, and other urgent, but not life-threatening cardiac conditions are lacking. Here, we report on the development of the Cardiac Direct Access Unit (CDAc), an ambulatory cardiology unit with exam rooms, observation bays, and an advanced heart failure clinic.

Methods:

Patients referred to the CDAc are seen same-day by an attending cardiologist in a space independent from the ED. We performed a retrospective review of 1146 consecutive patients referred to the CDAc in its first year of operation. Among patients who were referred for urgent same-day evaluation, 60.1% were discharged home without observation.

Results:

Among the patients observed or directly discharged from CDAc, 2.4% were readmitted within 30 days for a related symptom. The highest rate of readmission (7.5%) was for heart failure, which compares favorably with guidelines for readmission benchmarks.

Conclusion:

Our first year of data suggests that a cardiology-directed observation unit may serve as a high-value alternative to the ED for appropriately selected patients.
Comparative effectiveness of 3 Traditional Chinese Medicine treatment methods for idiopathic pulmonary fibrosis
Authors: Pang Li-Jian , Liu Jian-Ping , Lv Xiao-Dong
Published: July 2019

Introduction:

The morbidity of idiopathic pulmonary fibrosis (IPF) was found in an increasing trend, progressive worsening of symptoms and deterioration in lung function tend to trigger off a lower quality of life (QoL). Only pirfenidone and nintedanib have been recommended in the guidelines, which can modify the disease process. However, no evidence was verified to significantly alleviate the main clinical manifestations of IPF. At present, Chinese herbal formula (CHF) is widely prescribed as an adjunct to western medicine to treat the disease, and have shown promising benefits on clinical symptoms and QoL. There are mainly 3 Traditional Chinese Medicine (TCM) treatment methods guiding the composition of CHFs, which are devoting to comfort the common symptoms of IPF. Nevertheless, the paucity of direct comparative evidence of them posed a challenge for clinicians to determine the relative merits options. Therefore, we formulate this protocol, which is described for a systematic review to investigate relative advantages among different TCM treatment method and provide more reliable evidence for clinical decision-making.

Methods and analysis:

A systematic literature search will be employed in 10 electronic databases. Inclusion criteria are randomized control trials of CHFs composed based on the 3 TCM treatment methods, which act as an adjuvant treatment with routine drugs, compared with routine drugs alone. The primary outcomes we focus on include St George's Hospital Respiratory Questionnaire (SGRQ) scores, TCM symptom (dyspnea, cough) scores. The research screening, data extraction, and methodological quality assessment will be conducted by 2 individuals separately, and dispute will be adjudicated by a third senior reviewer. We will employ network meta-analysis (NMA) in a Bayesian framework with vague priors and the surface under the cumulative ranking curve (SUCRA) to obtain the comprehensive rank for the 3 TCM treatment methods.

Results:

This systematic review will provide an evidence of CHFs composed under the guidance by 3 TCM treatment methods with routine drugs, compared with routine drugs alone for IPF, and will submit to a peer-reviewed journal for publication.

Conclusion:

The conclusion of this systematic review will provide evidence for relative advantages among the 3 TCM treatment methods.
Systematic review with network meta-analysis
Authors: Zhang Xiao-Hong , Liang Hui-Min
Published: July 2019

Background and objective:

Ischemic stroke is a foremost cause for disability and death worldwide. This study is conducted in order to compare the diagnostic values between transcranial Doppler ultrasound (ultrasonography), computed tomography (CT), and magnetic resonance imaging (MRI) in patients suffering from ischemic stroke by performing a network meta-analysis.

Methods:

We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the seven different imaging methods. These imaging techniques include ultrasonography, computed tomography (traditional CT, computed tomography angiography [CTA], computed tomography perfusion [CTP]), and MRI (traditional MRI, diffusion-weighted imaging [DWI], magnetic resonance angiography), in order to properly diagnose ischemic stroke patients.

Results:

Thirteen eligible diagnostic trials were enrolled into this network meta-analysis. The results of the traditional meta-analysis showed that among CT methods, CTP showed higher sensitivity, NPV, and accuracy; among MRI methods, DWI had relatively higher sensitivity, NPV, and accuracy. The results of network meta-analysis showed that DWI had relatively higher sensitivity, NPV, and accuracy when compared with traditional CT, CTA, magnetic resonance angiography and traditional MRI. CTP showed higher SUCRA among CT methods while DWI showed higher SUCRA among MRI methods. A cluster analysis revealed that DWI had the highest diagnostic value in terms of sensitivity, PPV, NPV, and accuracy amongst the aforementioned seven imaging techniques.

Conclusion:

This network meta-analysis provides supporting evidence to the idea that DWI has a higher diagnostic value regarding ischemic stroke among MRI methods, and CTP has a poor diagnostic value among CT methods, which provide therapeutic considerations for Ischemic stroke intervention.
Elevated fasting serum glucose levels increase the risk of hepatocellular carcinoma
Authors: Liu Tong , Wang Wanchao , Cui Haozhe , Sun Miaomiao , Wang Yiming , Liu Xining , Cao Liying , Liu Hai , Liu Siqing
Published: July 2019

Previous studies have demonstrated a positive relationship between liver cancer and diabetes mellitus. However, elevated fasting blood glucose (FBG) itself may be a risk factor for the development of hepatocellular carcinoma (HCC) rather than diabetes, and during the follow-up period, death is an event that may occur before the occurrence of HCC, which should be dealt with competing risk models. Our study aims to investigate the relationship between FBG and new-onset HCC by using competing risk regression models.

We prospectively studied the relationship between FBG concentrations and risk of HCC in a cohort of 93,447 participants who were free of prior HCC, and whose demographic characteristics and biochemical parameters were recorded. Cox proportional hazards regression models and competing risk regression models were used to evaluate the association between FBG concentrations and risk of incident HCC.

A total of 302 participants were diagnosed with HCC among 93,447 subjects during 810,499 person-years of follow-up. The multivariable hazard ratios (HRs) [95% confidence interval (95% CI)] for the association of FBG and log(FBG) with HCC were 1.07 (1.01∼1.12), 1.84 (1.23∼2.74) in an analysis adjusted for other potential variables. In the multivariable adjusted analysis, participants who were in 4.82 mmol/L≤FBG≤5.49 mmol/L group and FBG >5.49 mmol/L group would have increased the risk of HCC by 47% and 69%, respectively. In a cause-specific hazard model (CS model), the multivariable HRs (95% CI) for the association of FBG with HCC were 1.46 (1.09∼1.98), 1.69 (1.27∼2.27) in the multivariable adjusted analysis. Similar results were also observed in sub-distribution hazard function model (SD model) with corresponding multivariate HRs (95% CI) of 1.46 (1.09∼2.00), 1.69 (1.25∼2.27) in 4.82 mmol/L≤FBG≤5.49 mmol/L group and FBG >5.49 mmol/L group, respectively.

Higher FBG concentrations itself were positively associated with new-onset HCC in the Cox proportional hazards regression models and competing risk models. FBG concentrations can be used as a scientific and important way to identify individuals with a higher risk of HCC and control of FBG concentrations might serve as a possible way to decrease the risk of HCC among Chinese population.

Trial registration: ChiCTR–TNRC–11001489. Registered August 24, 2011 (retrospectively registered).
Effects of moxibustion on pain behaviors in patients with rheumatoid arthritis
Authors: Shen Biyu , Sun Qian , Chen Haoyang , Li Yongchang , Du Xian , Li Huiling , Xu Guang-yin
Published: July 2019

Background:

Pain is the main symptom of patients with rheumatoid arthritis (RA). Reports of the effects of moxibustion on patients with rheumatoid arthritis have reached various conclusions. The aim of this meta-analysis was to evaluate the effect of moxibustion on pain in patients with RA.

Methods:

A systematic search of MEDLINE, EMBASE, the Cochrane Library, and the Chinese databases Wan Fang Med Database, CNKI, and VIP (until November, 2018) was used to identify studies reporting pain (on a visual analogue scale (VAS)), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF) levels, response rate, and the ACR50 rate in patients with RA. Results were expressed as mean difference (MD) and 95% confidence intervals (CI).

Results:

Six studies involving 281 participants were included. Moxibustion had significant effects on pain (VAS: MD = −0.53, 95% CI [−0.94, −0.12], P =.01). Moreover, moxibustion had effects on CRP (MD = −2.84, 95% CI [−5.13, −0.55], P =.01), ESR (MD = −8.44, 95% CI ([−13.19, −3.68], P =.0005), and RF (MD = −6.39, 95% CI [−18.57, 5.79], P =.30). Additionally, it had effects on response rate (n = 249, RR = 1.26, 95% CI [1.11, 1.43], P =.0004) and ACR50 rate (n = 140, RR = 1.44, 95% CI [1.11, 1.88], P =.007).

Conclusion:

We found that moxibustion with Western medicine therapy is superior to Western medicine therapy alone for pain in patients with RA. Moxibustion had significant effects on pain in patients with RA, but the effects of moxibustion on inflammatory factors in RA were unclear.
Comparative effectiveness of different forms of traditional Chinese medicine for treatment of post-stroke depression
Authors: Chen Huiling , Zhao Meidan , Li Xiuming , Zhang Yanhong , Hao Yu , Xiao Ergang , Gao Wenyuan , Wang Hongwu
Published: July 2019

Background:

Traditional Chinese medicine (TCM) therapy is effective for post-stroke depression (PSD). TCM therapy encompasses various forms of practices. However, the comparative effectiveness of these therapies is still not clear. Here, we provide a network meta-analysis protocol to compare the effects of different types of TCM therapy on PSD, using both direct and indirect evidence.

Methods:

Twelve databases investigation will be conducted through the keywords from their inception to June 1, 2019. At least 2 independent reviewers will identify eligible articles. EndNote X7 software is utilized to manage the literatures and RevMan V.5.3 (The Cochrane Collaboration) software is for data processing throughout the review. The package “netmeta” (version 0.5-0) in R (version 3.0.2, The R Foundation for Statistical Computing) will be used to perform network meta-analysis (NMA). In addition, the overall quality of evidence is evaluated by GRADEPro software, and Cochrane Collaboration Risk of Bias Tool is employed for the methodological quality. Generally speaking, this review protocol is reported according to the preferred reporting items for systematic review and meta-analysis protocols 2015 guidelines.

Results:

According to this protocol, it will provide evidence in support of, or against, the hypothesis that TCM therapy for PSD is more effective than pharmacotherapy. The results of this study will also provide evidence on relative efficacy of different forms of TCM. Furthermore, this analysis will show which form(s) of TCM therapy is (are) the most effective.

Conclusion:

The results will help PSD doctors and patients choose the treatment regimen which is effective, time-saving and economical.

PROSPERO registration number:

CRD42016041594.
A study on the correlation between radiation field size and gamma index passing rate for MatriXX
Authors: Xie Kai , Sun Hongfei , Gao Liugang , Sui Jianfeng , Lin Tao , Ni Xinye
Published: July 2019

This study aimed to analyze the influence of the radiation field size on the passing rate of the treatment planning system using MatriXX if the field irradiated the circuit.

Two sets of static fields which were 10 cm and 30 cm in the left-right direction (X), and was 31 cm to 40 cm in gun-target direction (Y) were designed. In these fields, the gantry was 0 and the monitor units were 200 MU. Two plans from an esophagus carcinoma patient with a planning target volume of 86.4 cm3 and a cervical carcinoma patient with a planning target volume (PTV) of 2094.1 cm3 were chosen. The passing rates of these plans were gained without and with protecting the circuit area from lead alloys. The gamma analysis was used and the standard was set to 3%/3 mm.

The verification passing rate decreased from 95.0% to 69.2% when X was 10 cm while Y increased from 31 cm to 40 cm. With the protection from low melting point lead alloys, the passing rate was from 96.2% to 89.6%. The results of the second set of plans without lead alloys were similar but the passing rate decreased more sharply. The passing rates of the 2 patients were 99.5% and 57.1%. With the protection of the lead alloys, their passing rates were 99.8% and 72.1%, respectively.

The results showed that with the increase of the radiation field size in the Y direction, more areas were irradiated in the circuit, and the passing rate gradually decreases and dropped sharply at a certain threshold. After putting lead alloys above the circuit, the passing rate was much better in the static field but was still less than 90% in the second patient volumetric modulated arc therapy (VMAT) because the circuit was irradiate in other directions. In daily QA, we should pay attention to these patients with long size tumor.
Effectiveness and safety of transvenous extraction of single- versus dual-coil implantable cardioverter-defibrillator leads at single-center experience
Authors: Ząbek Andrzej , Boczar Krzysztof , Dębski Maciej , Ulman Mateusz , Pfitzner Roman , Musiał Robert , Lelakowski Jacek , Małecka Barbara
Published: July 2019

The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead.

This study shows that extraction of dual-coil leads seems to be comparably safe and effective to extraction of single-coil leads. On the other hand, it requires longer fluoroscopy time and frequent utilization of advanced tools.
Intraosseous epithelioid haemangioendothelioma of the mandible
Authors: Yang Haili , Wang Jun , Song Li , Zou Haixiao
Published: July 2019

Introduction:

Epithelioid haemangioendothelioma (EHE) is a rare vascular neoplasm that primarily occurs in the soft tissues of the extremities, with “intermediate” or “borderline” malignant biological characteristics and a propensity for recurrence and metastasis. Oral cavity involvement is extremely rare, with only 5 reported cases of intraosseous EHE of the mandible. Herein, we report an additional case and review the related literature.

Patient concerns:

A 44-year-old man was referred to our institution with a 2-month history of left lower lip numbness and a 2-week history of painful swelling of the left mandible. He had received antibiotic treatment, which failed to ameliorate his symptoms. His medical and family histories were not significant.

Diagnosis:

Enhanced computed tomography revealed a poorly defined, 4.5 × 3.5 × 1.0 cm osteolytic lesion in the angle and ramus of the mandible, as well as an eroded lingual cortex. Histopathological examination confirmed a diagnosis of EHE.

Interventions:

Surgical resection was performed via segmental mandibulectomy and the defect was reconstructed using a vascularized fibular flap.

Outcomes:

The patient did not exhibit signs of locoregional recurrence after 3 years of follow-up.

Conclusions:

Intraosseous EHE of the mandible is an unpredictable lesion with a relatively benign course; however, the few reported cases of this disease do not highlight any factors that can predict the risk of locoregional recurrence or metastasis. There is also no consensus regarding the optimal treatment for intraosseous EHE; however, we recommend extensive local excision with close clinical follow-up.
Successful management of severe acute respiratory distress syndrome caused by sodium polystyrene sulfonate aspiration
Authors: Ko Cheng-Yu , Liu Ping-Yen , Chen Po-Wei
Published: July 2019

Rationale:

Sodium polystyrene sulfonate is commonly administered to treat hyperkalemia. Severe pneumonia due to aspiration of this drug is rare and no survival case has thus far been reported.

Patient concerns:

A 45-year-old man was hospitalized for acute decompensated heart failure and acute kidney injury with hyperkalemia. He aspirated sodium polystyrene sulfonate while consuming the drug. Severe acute respiratory distress syndrome (ARDS) developed rapidly, and he was transferred to the intensive care unit (ICU).

Diagnoses:

Chest radiography results after aspiration showed new consolidation in the left upper lung. He underwent emergency bronchoscopy, which revealed a considerable amount of yellow mud-like material in the trachea and bronchi. Chest radiography results after the bronchoscopic removal of the foreign material revealed rapid resolution of the left upper lung consolidation.

Interventions:

In the ICU, mechanical ventilation with low tidal volume and high positive end-expiratory pressure was administered and extracorporeal membrane oxygenation (ECMO) was set up for treating severe ARDS. We arranged an emergency bronchoscopy for diagnosis and removal of polystyrene sulfonate.

Outcomes:

ECMO was discontinued after 10 days and the patient was discharged after approximately 2 weeks.

Lessons:

Aspiration of sodium polystyrene sulfonate is not common but can be lethal. Clinicians should be cautious and appropriately inform patients of the aspiration risk while administering this drug. Mechanical ventilation and bronchoscopy were effective treatments for severe ARDS caused by aspiration of this drug.
A case of bilateral leg edema associated with levofloxacin
Authors: Na Jeonggu , Lee Tae Won , Bae Eunjin , Lee Eun Ju , Jang Ha Nee , Cho Hyun Seop , Chang Se-Ho , Park Dong Jun
Published: July 2019

Rationale:

A number of medicines are associated with edema. However, only 2 cases of edema of both lower legs, associated with levofloxacin, have been reported.

Patient:

We report the case of levofloxacin–associated bilateral leg edema in an 81–year-old male. The patient was referred to the Division of Nephrology due to edema limited to both lower legs, which had developed 1 day before. He had undergone supraglottic laryngectomy due to supraglottic cancer in our institution 6 months ago. He had been admitted to the Department of Otolaryngology due to persistent aspiration and general weakness 5 days ago.

Diagnosis:

The patient had no underlying diseases that could result in edema. No abnormalities were detected in several diagnostic tests. He strongly denied using other medications including herbal or traditional remedies, recreational drugs, or drugs of abuse. The patient had been intravenously administered levofloxacin at 750 mg per day 5 days earlier; on this basis levofloxacin–induced edema was suspected.

Interventions and outcomes:

Levofloxacin was immediately withdrawn and conservative management (salt restriction and withdrawal of intravenous fluid) was initiated. His edema was completely restored within 3 weeks after withdrawal of levofloxacin.

Outcomes:

The patient stopped taking levofloxacin and he did not have any recurrent edema until his death due to uncontrolled pneumonia.

Lessons:

Levofloxacin should be added to the list of drugs associated with the development of bilateral leg edema. This might obviate the need for time–consuming studies for diagnostic purposes and application of ineffective or harmful treatments.
Epithelial keratitis mimicking herpes simplex keratitis in a patient after cataract surgery
Authors: Zou Ming , Zhang Yi , Huang Xi , Gao Sheng , Liu Chunling
Published: July 2019

Rationale:

Epithelial keratitis is a common complication after cataract surgery. Many factors have been attributed to this clinical phenomenon.

Patient concerns:

An 82-year-old woman without previous herpes simplex keratitis (HSK) underwent an uncomplicated clear corneal phacoemulsification procedure in the right eye. In the late postoperative period, epithelial keratitis developed in this same eye.

Diagnosis:

An initial diagnosis of HSK was made clinically. The lesion was refractory to antiviral treatment and had progressed. After topical acyclovir cessation and vigorous lubrication, a diagnosis of toxic keratitis was finally made.

Outcomes:

The corneal epithelial defect and dendritic lesion presented initially. Responding to antiviral treatment, this corneal lesion aggravated and revealed large epithelial erosion. After topical acyclovir cessation and initiation of vigorous lubrication, the toxic keratitis was completely resolved.

Lessons:

Epithelial keratitis following cataract surgery is a common complication and can be misdiagnosed early in its disease course. Physicians should be alert to the possibility of HSK. Polymerase chain reaction detection is helpful in diagnosing this disease.