bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining the Education and Research Priorities in Pediatric Trauma Nursing: A Delphi Study
Authors: Roney Linda , McKenna Christine
Published: October 2018

Trauma has a greater impact on morbidity and mortality than all other disease processes in the pediatric population; yet, there is a gap in the literature related to the scientific basis for educating and researching future practice. The purpose of this research study was to utilize the Delphi technique to identify the current education and research priorities for pediatric trauma nursing as described by the members of the Society of Trauma Nurses. Consensus on the education and research priorities was derived from a sample (n= 25) of trauma nursing experts. The pediatric trauma nursing education priorities are the following: (1) initial resuscitation; (2) assessment; and (3) evidence-based practice. The pediatric trauma nursing research priorities are the following: (1) impact of nursing care on outcomes; (2) initial resuscitation; and (3) critical care. Future efforts in educational program development and research study should focus on these priorities.
A Diaphragmatic Hernia and Pericardial Rupture Caused by Blunt Injury of the Chest: A Case Review
Authors: Gao Ru , Jia Donghui , Zhao Huimin , WeiWei Zhang , Yangming Wang Frank
Published: October 2018

Blunt traumatic diaphragmatic hernias are most commonly seen in combination with other injuries. Right diaphragmatic ruptures with serious pericardium ruptures are relatively rare. The diagnosis of diaphragmatic hernias is not difficult; however, prior to surgery, it is difficult to judge whether pericardium damage has occurred, particularly on the right side. This injury may occur in a critical pathological state in which cardiac tissue is outside the pericardium due to the pericardial defect. Severe hemodynamic disorders or even death may occur if the patient's condition is not diagnosed and treated in a timely manner. The transportation of patients with severe trauma must be performed with extreme caution. It is necessary to weigh a wide range of differential diagnoses in a serious and thorough initial investigation.
Cholesteatoma of the External Auditory Canal: Review of Staging and Surgical Strategy
Authors: HN Udayabhanu , Prasad Sampath C. , Russo Alessandra , Grinblat Golda , Sanna Mario
Published: October 2018

Introduction:

External auditory canal cholesteatomas (EACC) is insidious in nature and rare entity. There are only few case series on EACCs and surgical strategy is not standardized.

Objectives:

1) To elucidate etiology of EACC and cardinal features. 2) To suggest a practical staging of EACC. 3) To enumerate surgical management according to stage of EACC.

Study Design:

Retrospective study in a quaternary referral center of 31 consecutive cases of EACC.

Results:

Thirty-one patients with EACC were reviewed. Unilateral otorrhea 19 (61.2%), hearing loss 22 (70.9%), and otalgia 8 (25.8%) are cardinal symptoms. Sixteen primary and 15 secondary EACCs were treated. Bone erosion was observed in 20 cases. In the present series, stage III = 12 (38.7%), stage II = 8 (25.8%), stage I = 11 (35.4%) underwent definitive treatment by surgery. Canalplasty with reconstruction was done in 19 cases of stages I and II. Of 12 cases in stage III, 3 cases underwent canalplasty with reconstruction. Subtotal petrosectomy was done in five cases. Intact canal wall mastoidectomy with canalplasty in two cases and radical mastoidectomy in two cases. Fascia, cartilage, muscle, and bone dust were used for reconstruction. Median follow-up period was 6 years and no recurrence of cholesteatoma was observed.

Conclusion:

EACC is unique entity. Intraoperative and radiological findings assist in correct and practical staging of EACC. Late stage presentations of EACC are common. Definitive surgical treatment in our series avoided recurrence of cholesteatoma.
Development of a Mixed Reality Platform for Lateral Skull Base Anatomy
Authors: McJunkin Jonathan L. , Jiramongkolchai Pawina , Chung Woenho , Southworth Michael , Durakovic Nedim , Buchman Craig A. , Silva Jonathan R.
Published: October 2018

Objectives:

A mixed reality (MR) headset that enables three-dimensional (3D) visualization of interactive holograms anchored to specific points in physical space was developed for use with lateral skull base anatomy. The objectives of this study are to: 1) develop an augmented reality platform using the headset for visualization of temporal bone structures, and 2) measure the accuracy of the platform as an image guidance system.

Methods:

A combination of semiautomatic and manual segmentation was used to generate 3D reconstructions of soft tissue and bony anatomy of cadaver heads and temporal bones from 2D computed tomography images. A Mixed-Reality platform was developed using C# programming to generate interactive 3D holograms that could be displayed in the HoloLens headset. Accuracy of visual surface registration was determined by target registration error between seven predefined points on a 3D holographic skull and 3D printed model.

Results:

Interactive 3D holograms of soft tissue, bony anatomy, and internal ear structures of cadaveric models were generated and visualized in the MR headset. Software user interface was developed to allow for user control of the virtual images through gaze, voice, and gesture commands. Visual surface point matching registration was used to align and anchor holograms to physical objects. The average target registration error of our system was 5.76 mm ± 0.54.

Conclusion:

In this article, we demonstrate that an MR headset can be applied to display interactive 3D anatomic structures of the temporal bone that can be overlaid on physical models. This technology has the potential to be used as an image guidance tool during anatomic dissection and lateral skull base surgery.
Speech Recognition in Noise for Adults With Normal Hearing: Age-Normative Performance for AzBio, BKB-SIN, and QuickSIN
Authors: Holder Jourdan T. , Levin Laura M. , Gifford René H.
Published: October 2018

Objective:

Characterize performance for adults aged 20 to 79 years with normal hearing on tasks of AzBio, Bamford–Kowal–Bench speech-in-noise (BKB-SIN), quick speech-in-noise (QuickSIN), and acoustic Quick Spectral Modulation Detection (QSMD) in the sound field.

Setting:

Cochlear implant (CI) program.

Patients:

Eighty-one adults with normal hearing and cognitive function were recruited evenly across four age groups (20–49, 50–59, 60–69, and 70–79 yr).

Interventions:

Subjects completed AzBio sentence recognition testing in quiet and in five signal-to-noise ratios (SNRs: +10, +5, 0, −5, −10 dB), as well as the BKB-SIN, QuickSIN, and QSMD tasks.

Main Outcome Measures:

AzBio, BKB-SIN, QuickSIN, and acoustic QSMD scores were analyzed to characterize typical sound field performance in an older adult population with normal hearing.

Results:

AzBio sentence recognition performance approached ceiling for sentences presented at ≥ 0 dB SNR with mean scores ranging from 3.5% at −10 dB SNR to 99% at +10 dB SNR. Mean QuickSIN SNR-50 was −0.02. Mean BKB-SIN SNR-50 was −1.31 dB. Mean acoustic QSMD score was 88%. Performance for all measures decreased with age.

Conclusion:

Adults with age-normative hearing achieve ceiling-level performance for AzBio sentence recognition at SNRs used for clinical cochlear implant and/or hearing aid testing. Thus, these tasks are not inherently contraindicated for older listeners. Older adults with normal hearing, however, demonstrated greater deficits for speech in noise compared to younger listeners—an effect most pronounced at negative SNRs. Lastly, BKB-SIN data obtained in the sound field replicated previous normative data for only the youngest age group, suggesting that new norms should be considered for older populations.
Otologic Outcomes After Blast Injury: The Brussels Bombing Experience
Authors: Van Haesendonck Gilles , Van Rompaey Vincent , Gilles Annick , Topsakal Vedat , Van de Heyning Paul
Published: October 2018

Objective:

After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients.

Study Design:

Prospective cohort study.

Setting:

Tertiary referral center.

Patients:

Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included.

Intervention:

All included patients were treated with systemic corticosteroid therapy, concurrent hyperbaric oxygen therapy (HBOT) was advised to each and every included patient.

Main Outcome Measures:

Participants underwent a routine otologic work-up including otoscopy, liminal audiometry, and subjective outcome measures related to tinnitus at baseline and at follow-up. Primary outcome was to describe the otologic morbidity after acute acoustic trauma (AAT). Secondary outcome was to evaluate the recovery of hearing loss, subjective symptoms, and tympanic membrane perforations.

Results:

Fifty-six patients were included in our population with an average age of 27 ± 13 years, and 46% women/54% men. Thirty-two patients reported subjective hearing loss, 45 reported tinnitus, 45 reported a feeling of pressure in the ear, 2 patients experienced vertigo, and 18 patients reported hyperacusis. Otoscopic examination revealed three tympanic membrane perforation (TMP). Sensorineural hearing loss (SNHL) was observed in 41% (n = 23) and mixed hearing loss in 3.6% (n = 2). No conductive hearing loss (CHL) was observed. Follow-up was obtained in 76.8%, with the last follow-up available at 47 ± 74 days. Two perforations closed spontaneously, while one persistent perforation was successfully reconstructed with complete air-bone gap closure. There was a significant improvement in subjective symptoms. SNHL improvement was observed in 52.6% (10/19), mixed hearing loss improved in both patients. Improvement in hearing thresholds was seen in patients treated with steroids and in those treated with steroids and HBOT, there was no significant difference in the degree of improvement between these two groups.

Conclusions:

Blast-related otologic injuries have a significant impact on morbidity. Comprehensive otologic evaluation and state-of-the-art treatment may lead to a significant improvement in symptoms and hearing loss.
The Cleating Stitch: An Adjunctive Technique for Percutaneous and Revision Osseointegration Screws
Authors: Fort Matthew M. , Scarbrough Megan E. , McGrew Benjamin M.
Published: October 2018

Objective:

The bone anchored hearing aid (BAHA) has become a widely used and successful option in treatment of conductive and mixed hearing loss, and single sided deafness. Despite improvements in technique and cosmesis, complications remain that can result in implant revision or removal. Herein we describe a unique adjunctive technique, the cleating stitch, in placement of osseointegration screws and examine its impact on complication rates.

Study Design:

Retrospective case review.

Setting:

Tertiary academic medical center.

Patients:

A total of 66 implants in 65 patients (35 men, 30 women) with an average age of 54 years (15–81 yr). Average follow up 10.8 months.

Intervention:

All patients underwent BAHA implant placement by a single surgeon between April 2012 and June 2017 using the linear incision or punch techniques with soft tissue reduction and placement of a cleating stitch.

Main Outcome Measure:

Main outcome measures include rates of revision surgery, overgrowth, extrusion, and Holgers reaction ≥2. Secondary outcome measures include associations between main outcome measures and outlying factors (obesity, smoking, diabetes mellitus, coronary artery disease, age).

Results:

The overall rate of revision was 3%, rate of overgrowth 1.5%, rate of extrusion 1.5%, and Holgers reaction ≥2 10.6%. Overgrowth and extrusion both required revision. Older age was associated with decreased risk of Holgers reaction ≥2 (p = 0.03) with a hazard ratio of 0.95 (confidence interval 0.9–1.0). There were no other statistically significant associations between primary outcome measures and outlying factors.

Conclusion:

The cleating stitch is an effective adjunctive technique in placement of osseointegration screws associated with low rates of overgrowth and overall revision surgery.
Recent Trends and the Impact of the Affordable Care Act on Emergency Department Visits and Hospitalizations for Gastrointestinal, Pancreatic, and Liver Diseases
Authors: Barakat Monique T. , Mithal Aditi , Huang Robert J. , Sehgal Alka , Sehgal Amrita , Singh Gurkirpal , Banerjee Subhas
Published: October 2018

Background:

The Affordable Care Act (ACA) with Medicaid expansion implemented in 2014, extended health insurance to >20-million previously uninsured individuals. However, it is unclear whether enhanced primary care access with Medicaid expansion decreased emergency department (ED) visits and hospitalizations for gastrointestinal (GI)/pancreatic/liver diseases.

Methods:

We evaluated trends in GI/pancreatic/liver diagnosis-specific ED/hospital utilization over a 5-year period leading up to Medicaid expansion and a year following expansion, in California (a state that implemented Medicaid expansion) and compare these with Florida (a state that did not).

Results:

From 2009 to 2013, GI/pancreatic/liver disease ED visits increased by 15.0% in California and 20.2% in Florida and hospitalizations for these conditions decreased by 2.6% in California and increased by 7.9% in Florida. Following Medicaid expansion, a shift from self-pay/uninsured to Medicaid insurance was seen California; in addition, a new decrease in ED visits for nausea/vomiting and GI infections, was evident, without associated change in overall ED/hospital utilization trends. Total hospitalization charges for abdominal pain, nausea/vomiting, constipation, and GI infection diagnoses decreased in California following Medicaid expansion, but increased over the same time-period in Florida.

Conclusions:

We observed a striking payer shift for GI/pancreatic/liver disease ED visits/hospitalizations after Medicaid expansion in California, indicating a shift in the reimbursement burden in self-pay/uninsured patients, from patients and hospitals to the government. ED visits and hospitalization charges decreased for some primary care-treatable GI diagnoses in California, but not for Florida, suggesting a trend toward lower cost of gastroenterology care, perhaps because of decreased hospital utilization for conditions amenable to outpatient management.
Worldwide research productivity in the field of back pain
Authors: Wang Bin , Zhao Peng
Published: October 2018

Background:

This study aimed to show the world research productivity in the field of back pain and to help researchers follow the scientific development and promote the cooperation in this field.

Methods:

Web of Science (WoS) database was searched from 1995 to 2016 without other restrictions. The keywords were as follows: “lumbar NEAR pain,” “back pain,” “dorsalgia,” “backache,” “lumbago,” “back NEAR disorder,” and “discitis.” The following information of retrieved articles was analyzed: countries/territories, journals, publication year, authors, citation reports, and institutions. Publication activity was further adjusted for countries by gross domestic product (GDP) and population size.

Results:

A total of 50,970 articles were retrieved in WoS database from 1995 to 2016. The United States published the biggest number of articles (16,818, 33.00%), followed by England (4,582, 8.99%), Germany (3,871, 7.60%), Canada (3,613, 7.09%), and Australia (3,063, 6.01%). Sweden ranked the first after adjusted for publication, and Netherlands ranked the first after adjusted for GDP. Besides, there was positive correlation between total number of publications and GDP for each country (P < .05). Harvard University was the most productive institution (917, 1.80%), Maher CG was the most productive author (229, 0.45%) and Spine was the most popular journal (3605, 7.07%) in the field of back pain research. Moreover, the article titled “Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale” in Pain had the highest citations (1749).

Conclusion:

There was a significant increase in annual publications concerning back pain research worldwide. The total number of publications was positively associated with GDP in main productive countries. The United States was the most productive country, Harvard University was the most productive institution, Maher CG was the most productive author and Spine was the most popular journal in the field of back pain.
Increased serum pentraxin-3 level predicts poor prognosis in patients with colorectal cancer after curative surgery, a cohort study
Authors: Liu Bin , Zhao Yangying , Guo Lianrong
Published: October 2018

Pentraxin-3 (PTX3) is a glycoprotein involved in inflammation and immune regulation of cancer. The aim of this study was to evaluate the serum PTX3 level in patients with colorectal cancer (CRC) and analyze its prognostic significance.

A total of 263 consecutive patients underwent radical resection for primary CRC and 126 healthy controls were enrolled in this study. Serum PTX3 level was measured within the day before surgery though enzyme-linked immunosorbent assays, comparing with the level of healthy control. Baseline demographic and clinical characteristics were recorded. The association between serum PTX3 level and survival outcome was analyzed by the Kaplan–Meier with Log-Rank test and Cox regression methods.

Mean serum PTX3 level in CRC patients was higher than that of healthy control (13.8 ± 3.2ng/mL versus 3.3 ± 1.2ng/mL, P < .001). Finally, 55 (20.9%) patients out of all 263 patients studied had died during following-up period. All patients were divided into 2 groups using the optimal cutoff value (12.6 ng/mL) of PTX3 level using a sensitivity of 68.0% and a specificity of 71.7% as optimal conditions from receiver operating curve analysis. Patients with a PTX3≥12.6ng/mL had poorer 5 years overall survival rate (76.6% versus 67.8%, P = .025) patients with a PTX3 < 12.6ng/mL in univariate analysis and serum PTX3 level also been confirmed as an independent predictor for survival for CRC in multivariate analysis (Hazard ratio, 1.468; 95% [confidence interval] CI, 1.081–1.976; P < .001).

Serum PTX3 level can serve as an independent prognostic biomarker for CRC patients after curative resection.
Malakoplakia as a cause of severe hypercalcemia through ectopic 25-hydroxyvitamin D3 1-alpha-hydroxylase expression
Authors: Chemouny Jonathan Maurice , Sannier Aurélie , Hanouna Guillaume , Champion Laure , Vrtovsnik Francois , Daugas Eric
Published: October 2018

Rationale:

Malakoplakia is a rare disease characterized by the presence of nongranulomatous macrophage infiltration. In most cases, it affects the urinary tract. Malakoplakia can cause acute kidney injury when it is localized in the kidneys.

Patient concerns:

Here, we report the case of a 65-year-old female patient with renal malakoplakia responsible for hypercalcemia. During her initial assessment, she was also diagnosed 25-OH vitamin D insufficiency, for which she was prescribed oral cholecalciferol. Three months later, she developed severe hypercalcemia with normal 25-OH vitamin D and parathyroid hormone levels and high 1,25-dihydroxyvitamin D levels.

Diagnoses:

After a superimposed granulomatous disease was excluded, malakoplakia cells were suspected to be responsible for the abnormal 25-hydroxyvitamin D3 1-alpha-hydroxylase activity, which was confirmed by immunohistochemistry.

Interventions:

Cholecalciferol was stopped, the patient was rehydrated with intravenous physiological saline, and prednisone was initiated to decrease the enzyme activity.

Outcomes:

Six months later, she displayed normal serum calcium, 25-OH vitamin D and 1,25-dihydroxyvitamin D levels.

Lessons:

This case illustrates that malakoplakia may exhibit ectopic 25-hydroxyvitamin D3 1-alpha-hydroxylase activity and cause severe hypercalcemia upon vitamin D supplementation. Therefore, such supplementation should not be given in malakoplakia patients without an actual deficiency and requires careful monitoring of serum calcium.
Risk factors related to metastasis of para-aortic lymph nodes in pancreatic ductal adenocarcinoma
Authors: Zhang Xingmao , Zhang Jie , Fan Hua , Liu Yu , He Qiang
Published: October 2018

This study was designed to explore the risk factors related to metastasis of para-aortic lymph node (PALN).

Clinicopathologic data of 241 patients with resectable or borderline resectable pancreatic cancer who underwent pancreaticoduodenectomy with extended lymphadenectomy between January 2008 and December 2015 were collected, potential factors related to metastasis of PALN were analyzed.

Positive rate of PALN was 19.5% (47/241). Univariate analysis showed that back pain (P = .028), preoperative CA19-9 level (P < .001), tumor size (P < .001), portal vein (PV)/superior mesenteric vein (SMV) invasion (P < .001), superior mesenteric artery (SMA) invasion (P < .001), and diameter > 1.0 cm were in correlation with PALN involvement, multivariate analysis revealed that preoperative CA19-9 level, PV/SMV invasion, SMA invasion and diameter > 1.0 cm were independent risk factors to metastasis of PALN. Patients with LN8+ had a higher positive rate of PALN than with LN8− (38.1% vs 15.6%, P = .001), similar results could be found when LN12+ (35.8% vs 13.2%, P < .001) and LN14+ (41.2% vs 11.0%, P < .001), multivariate analysis showed that LN8+ and LN14+ were closely in correlation with PALN metastasis.

Several factors were related to the status of PALN, preoperative CA19-9 level, PV/SMV invasion, SMA invasion and diameter > 1.0 cm were 4 independent risk factors to PALN metastasis. LN8+ and LN14+ were 2 strong predictors of PALN metastasis. A comprehensive analysis covering all possible risk factors related to metastasis of PALN should be given before design of treatment plan whenever involvement of PALN was suspected.
Arthroscopic management of elbow synovial chondromatosis
Authors: Zhu Weihong , Wang Wanchun , Mao Xinzhan , Chen You
Published: October 2018

Objective:

We aimed to identify factors that affect pain, complications, and function following elbow arthroscopy for elbow synovial chondromatosis.

Methods:

We retrospectively reviewed the cases of all patients with elbow synovial chondromatosis treated by arthroscopic synovectomy and loose body removal between January 2000 and January 2016 at our institution. Eleven patients were enrolled (8 male; mean age, 41.7 years). The mean duration of symptoms was 13.7 months, and all patients had a decreased range of motion (ROM) in the affected elbow. By Milgram criteria, there was 1 phase II case, and 10 cases were phase III.

Results:

All patients were followed postoperatively (mean follow-up, 65 months). The preoperatively restricted ROM of 100° flexion (range, 78°–120°) and extension of 30° (range, 15°–40°) were improved to 130° flexion (range, 120°–140°) and −5° hyperextension (range, −10°–0°). Pain, recorded as the pain subscore of the American Shoulder and Elbow Surgeons questionnaire for elbows, was significantly improved from 32 points (range, 20–50) preoperatively to 85 (range, 70–100) postoperatively (on a scale ranging from 0 [worst pain] to 100 [pain-free]). Recurrence occurred in 2 patients (18.2%) who then received arthroscopic synovectomy and loose body removal again. There were no fractures or neurovascular complications, and no patient developed an infection.

Conclusion:

Arthroscopic management of synovial chondromatosis of the elbow was an effective and safe therapeutic method. After the intervention, immediate and durable improvement of elbow function can be expected.
Clinical observation of 60 cases of treating cognitive disorder after cerebral injury in combination with scalp acupuncture and cognitive training
Authors: Du Jinyu , Yin Jiu , Liu Lin , Chen Jianlong , He Mingchuan
Published: October 2018

To observe the clinical effect of scalp acupuncture combined with cognitive training on cognitive disorder after cerebral injury.

Around 60 cases of cerebral injury patients for hospitalization in rehabilitation department of Chongqing Three Gorges Central Hospital from July in 2015 to June in 2017 are divided into control group and treatment group of 30 cases for each at random. The control group received routine treatment and cognitive rehabilitation training for 12 weeks. The treatment group received conventional treatment, cognitive rehabilitation training, and scalp acupuncture. Acupuncture with a scalp acupuncture is provided for the treatment group besides adopting above conventional treatment and rehabilitation training method.

Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score of both groups increases obviously after treatment compared with that before treatment, and there is difference (P < .01) through contrast. And LOTCA score of treatment group is higher than that of control group (P < .05) after treatment.

Scalp acupuncture in combination with cognitive training can effectively improve cognitive disorder degree of patients with cerebral injury, and the effect is more significant compared with simple cognitive rehabilitation training, thus it is worth of research and application.
Renal resistive index and aortic knob width relationship as a predictor of renal prognosis in essential hypertension
Authors: Sevencan Nurhayat Ozkan , Ozkan Aysegul Ertinmaz
Published: October 2018

The scientific studies that have been conducted so far highlight that renal resistive index (RI) and aortic knob width (AKW) indicate poor prognosis regarding renal and cardiovascular mortality. But the existence of a direct relationship RI and AKW is unclear. This study aims investigating the relationship between RI and the measured AKW in chest radiography of the patients with hypertensive nephropathy who do not require renal replacement therapy.

This prospective study included 268 consecutive patients with essential hypertension. Patients were divided into 2 groups as RI ≥0.7 and RI <0.7. The ROC curve, sensitivity, and specificity ratios were evaluated to determine which AKW value is the best predictive one for the RI ≥0.7.

The cutoff point of AKW was evaluated as ≥36 for the cases with RI ≥0.7: sensitivity was 71.22%; specificity was 71.32%; the positive predictive value (PPV) was 72.79; the negative predictive value (NPV) was 69.70, and the accuracy was 71.27. Area under the ROC curve ± standard error (AUC ± SE) = 0.729 ± 0.031 (P < .001).

AKW can provide important predictive information about the subclinical renal dysfunction in hypertensive patients with RI ≥0.7. Moreover; AKW is a predictive factor for both the diagnostic and prognostic evaluation of renal pathologies.
Manifestations and outcomes of nocardia infections
Authors: Steinbrink Julie , Leavens Joan , Kauffman Carol A. , Miceli Marisa H.
Published: October 2018

Nocardia is a ubiquitous environmental pathogen that causes infection primarily following inhalation into the lungs. It is generally thought to cause infection primarily in immunocompromised patients, but nonimmunocompromised individuals are also at risk of infection. We sought to compare risk factors, clinical manifestations, diagnostic approach, treatment, and mortality in immunocompromised and nonimmunocompromised adults with nocardiosis.

We studied all adults with culture-proven Nocardia infection at a tertiary care hospital from 1994 to 2015 and compared immunocompromised with nonimmunocompromised patients. The immunocompromised group included patients who had a solid organ transplant, hematopoietic cell transplant (HCT), hematological or solid tumor malignancy treated with chemotherapy in the preceding 90 days, inherited immunodeficiency, autoimmune/inflammatory disorders treated with immunosuppressive agents, or high-dose corticosteroid therapy for at least 3 weeks before the diagnosis of nocardiosis.

There were 112 patients, mean age 55 ± 17 years; 54 (48%) were women. Sixty-seven (60%) were immunocompromised, and 45 (40%) were nonimmunocompromised. The lung was the site of infection in 54 (81%) immunocompromised and 25 (55%) nonimmunocompromised patients. Pulmonary nocardiosis in immunocompromised patients was associated with high-dose corticosteroids, P = .002 and allogeneic HCT, P = .01, and in nonimmunocompromised patients with cigarette smoking, bronchiectasis, and other chronic lung diseases, P = .002.

Cavitation occurred only in the immunocompromised group, P < .001. Disseminated infection was more common in the immunocompromised, P = .01, and was highest in solid organ transplant recipients, P = .007. Eye infection was more common in nonimmunocompromised patients, P = .009. Clinical signs and symptoms did not differ significantly between the 2 groups. The initial treatment for most patients in both groups was trimethoprim-sulfamethoxazole with or without a carbapenem. All-cause 1-year mortality was 19%; 18 (27%) immunocompromised and 3 (7%) nonimmunocompromised patients died, P = .01.

Immunocompromised patients with nocardiosis had more severe disease and significantly higher mortality than nonimmunocompromised patients, but clinical presentations did not differ.
99mTc-3PRGD2 single-photon emission computed tomography/computed tomography for the diagnosis of choroidal melanoma
Authors: Yan Bing , Fu Tong , Liu Yueming , Wei Wenbin , Dai Haojie , Fang Wei , Wang Feng
Published: October 2018

Recent successes in monitoring and diagnosing a variety of tumors using 99mTc-PEG4-E[PEG4-c(RGDfK)]2 (99mTc-3PRGD2) single-photon emission computed tomography (SPECT) imaging encouraged us to expand the use of this tracer. This case-control study aimed to evaluate the feasibility of 99mTc-3PRGD2 imaging for detecting choroidal melanoma (CM) and for monitoring tumor response to plaque brachytherapy (PB). Ten consecutive patients with CM who underwent 99mTc-3PRGD2 imaging before and 3 months after PB were reviewed. The tumor-to-occipital bone (T/O) and mirrored contralateral normal tissue-to-occipital bone (N/O) ratios were calculated by region of interest analysis at baseline and 3 months post-PB. T/O values were compared between patients with CM with comorbid secondary retinal detachment (RD) and those without RD. The relationship between T/O value and tumor volume was also investigated. 99mTc-3PRGD2 SPECT/CT showed focal uptake in CM. The mean T/O ratio before PB was 1.90 ± 1.26 and the mean N/O ratio was 0.80 ± 0.21 (P 
= .02). The 99mTc-3PRGD2 concentrations in 5 patients with CM with RD were higher (T/O = 2.69 ± 1.39) than in those without secondary RD (T/O = 1.10 ± 0.18) (P 
= .008). T/O ratios at 3 months post-PB were significantly lower than that at baseline (1.23 ± 0.59, P 
= .03). There was a linear relationship between T/O and tumor volume (y-hat = 0.028 + 0.003x, R
2 = 0.768, P = .001). The 95% confidence interval for the (T/O)/volume ratio was 0.002 to 0.005. 99mTc-3PRGD2 imaging is a feasible modality for the diagnosis of CM. Furthermore, follow-up for at least 20 months after PB indicated that coanalysis of 99mTc-3PRGD2 imaging and tumor volume may provide a promising prognostic predictor in patients with CM.
Viabahn stent graft compared with prosthetic surgical above-knee bypass in treatment of superficial femoral artery disease
Authors: Waezi Narges , Saha Shekhar , Bougioukas Ioannis , Emmert Alexander , Danner Bernhard Christoph , Baraki Hassina , Kutschka Ingo , Zenker Dieter , Stojanovic Tomislav , Jebran Ahmad Fawad
Published: October 2018

The prosthetic surgical above-knee bypass (pAKB) is a standard therapy in superficial femoral artery (SFA) occlusive disease in absence of suitable vein. Viabahn graft has been established as a promising alternative. Since limited comparative data are available, we conducted a retrospective study to compare long-term outcomes of these 2 therapies in a real-world setting.

Records of 52 patients (60 limbs), who were treated by pAKB (29 limbs) or Viabahn (31 limbs) were reviewed. Patients were followed up by clinical assessment, physical examination, and resting ankle brachial index (ABI) after 3, 6, 12 months and yearly thereafter. Long-term data were available for 97% in the Viabahn and 93% for pAKB after 73 ± 3.7 months (mean ± standard error [SE]).

Long-term primary and secondary patencies in Viabahn group were 40% and 70%, respectively, after 63 ± 2.8 months (mean ± SE). Total lesion length was 19 ± 11.06 cm (mean ± SE), graft size was 6 ± 0.72 mm (mean ± SE). Hospital stay was 4.8 ± 0.72 days (mean ± SE). Limb salvage was achieved in 90%. Patients in the pAKB group showed a total lesion length of 24.39 ± 1.97 cm (mean ± SE), graft size was 7 ± 0.99 mm (mean ± SE). Long-term analysis after 83 ± 6.8 months (mean ± SE) revealed a primary patency of 78% with a secondary patency of 94%. Hospital stay was 10.4 ± 1.27 days (mean ± SE). Limb salvage was ensured in 97%. Long-term primary patency was lower for Viabahn (P = .044), secondary patency (P = .245), and leg salvage (P = .389) were not significantly different. However, hospital stay was shorter (P = .0002) for Viabahn.

Long-term analysis of Viabahn revealed a significantly lower primary patency, a similar secondary patency, limb salvage, and significantly shorter hospital stay when compared with pAKB. Our data suggest that pAKB is still a valuable option in patients suitable for an open operation. However, Viabahn can be used as a less invasive treatment in high risk patients.
Phosphaturic mesenchymal tumor and related wound problem
Authors: Xiao Xian , Sun Xiaofang , Ni Pengwen , Huang Yao , Xie Ting
Published: October 2018

Introduction:

Phosphaturic mesenchymal tumor mixed connective tissue type (PMT/MCT) is the most common type (up to 90%) of phosphaturic mesenchymal tumor (PMT), a rare clinicopathologic entity. Besides overproduction of fibroblast growth factor 23 (FGF23), there is a big variation of immunohistochemical characteristic across types of PMT, which makes it difficult to obtain an early diagnosis of PMT/MCT. As a benign tumor, PMT/MCT usually happens in subcutaneous tissues and leads to nonhealing of wound. A complete excision of PMT/MCT facilitates wound healing.

Conclusions:

Review of the existing evidence indicates that early diagnosis of PMT/MCT is critically important when treating PMT/MCT wound. Hence standardization of early diagnosis for PMT/MCT is mandated.
Winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy
Authors: Lee Sung Young , Lee Hyeok Dong , Cho Young-Shin , Han Seung Hoon
Published: October 2018

Rationale:

Scapular winging is caused by neuromuscular dysfunction of shoulder stabilizer muscles. Clinically, a winged scapula can be easily diagnosed by typical physical findings. We report a case of atypical winged scapula caused by dorsal scapular neuropathy combined with suprascapular neuropathy, which has rarely been reported.

Patient concerns:

A 25-year-old right-handed male was admitted to the clinic due to right arm weakness for 1 year. On physical examination, right winged scapula with medially rotated inferior angle was observed on flexion.

Diagnoses:

Under the diagnostic impression of a winged scapula due to long thoracic nerve injury based on physical examination, electrodiagnostic study was performed. However, the results showed right dorsal scapular neuropathy combined with suprascapular neuropathy.

Interventions:

Neck and right shoulder MRI were also performed to rule out other causes of winged scapula, but these showed only a partial thickness tear of the rotator cuff tendon. The patient received rehabilitation.

Outcomes:

The symptoms have not improved.

Lessons:

In this case, combined suprascapular neuropathy might contribute to scapular winging and can confuse the diagnosis of winged scapula based on physical findings. This is the first report that indicates suprascapular neuropathy as a contributing factor of scapular winging.
ICAM-1 gene rs5498 polymorphism decreases the risk of coronary artery disease
Authors: Liu Ailing , Wan Ailing , Feng Aifang , Rui Ruping , Zhou Bingzhi
Published: October 2018

Background:

Many studies investigated the association between intercellular adhesion molecule 1 (ICAM-1) gene rs5498 polymorphism and the risk of coronary artery disease (CAD). However, the results were inconsistent.

Methods:

To clarify convincing association, we conducted a comprehensive meta-analysis by searching in PubMed, Embase, Web of sciences, Sciences citation index, Google scholar, Cochrane Library, and the CNKI databases. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results:

A total of 29 case–control studies with 5,494 cases and 6,364 controls for rs5498 polymorphism were included. The studied populations of this meta-analysis included Caucasians and Asians. Meta-analysis showed that rs5498 polymorphism was associated with the decreased risk of CAD. Stratification analysis of ethnicity found that rs5498 polymorphism decreased the risk of CAD among Caucasians, but not among Asians. Stratification by type of CAD revealed that ICAM-1 gene rs5498 polymorphism was also correlated with the decreased risk of myocardial infarction (MI).

Conclusion:

In conclusion, this meta-analysis indicates that ICAM-1 gene rs5498 polymorphism decreases the risk of CAD.
Herbal medicine Yukgunja-tang for functional dyspepsia protocol for a systematic review of randomized controlled trials
Authors: Ko Seok-Jae , Park Jae-Woo , Lee Jae-hong , Cho Soo-ho , Lee Jaehyung , Nam Seonguk , Kim Jinsung
Published: October 2018

Background:

Functional dyspepsia (FD) is a common functional gastrointestinal disorder characterized by recurrent dyspeptic symptoms. Yukgunja-tang (YGT) is a traditional herbal formula that has been used for treating FD. This systematic review protocol aims to provide a guideline for investigating the efficacy and safety of YGT in the treatment of FD.

Methods:

The following databases will be searched from their inception until July 2018: Medline (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Complementary Medicine Database (AMED), KoreaMed, National Digital Science Library (NDSL), Korean Medical Database (KMbase), Oriental Medicine Advanced Searching Integrated System (OASIS), Korean Studies information Service System (KISS), China National Knowledge Infrastructure Database (CNKI), and Citation Information by Nii (CiNii). Randomized controlled trials (RCTs) that used YGT or modified YGT for treating FD will be included. The control groups in these RCTs will include placebo, no-treatment waiting, and conventional western medicine groups. Trials testing YGT as an adjunct to western medicine for synergistic effect will also be included. The main outcome will be the total clinical efficacy rate. Data extraction and risk of bias assessment will be performed by two independent assessors. RevMan V.5.3 will be used for data analysis.

Results:

This study will provide a high-quality synthesis of current evidence of YGT for FD from several aspects including dyspepsia-related symptoms, quality of life and adverse events.

Conclusion:

The conclusion of our systematic review will provide evidence to judge whether YGT is an effective intervention for patient with FD.

Ethics and dissemination:

The protocol does not need ethics approval because identifying information of the participants will not be revealed. The systematic review will be published in a peer-reviewed journal and disseminated electronically and in print.

Trial registration number:

PROSPERO CRD42018090139.
Sex hormone therapy's effect on dry eye syndrome in postmenopausal women
Authors: Liu Chao , Liang Kun , Jiang Zhengxuan , Tao Liming
Published: October 2018

The purpose of the study t

o assess the efficacy of sex hormone therapy in the treatment of dry eye syndrome in postmenopausal women.

The following electronic databases were searched without language restrictions: PubMed, Embase, Cochrane, and the Chinese Biomedical Database. Two reviewers collected all the literature, which was searched for relevance in English and Chinese from January 1990 to July 2017. Both of the reviewers screened documents independently, identifying the studies that met the inclusion criteria. Then, the included studies were evaluated, and the data were extracted and conversed dependently. Finally, Review Manager 5.3 (offered by the Cochrane collaboration) was used to complete the meta-analysis. An integrated mean difference (MD) with its corresponding 95% confidence interval (CI) was calculated.

A total of 358 patients with dry eye were enrolled in 7 randomized controlled trials (RCTs). We observed statistically significant improvements in the Schirmer's test scores (MD, 2.06; 95% CI, 0.74–4.46; I
2 = 97%; P = .006) after sex hormone treatment. However, the scores for tear breakup time (TBUT) (MD, 1.28; 95% CI, −1.03 to 4.68; I
2 = 99%; P = .21) and the ocular comfort index (OCI) (MD, −1.12; 95% CI, −4.42 to 1.98; I
2 = 95%; P = .48) were not improved.

This meta-analysis of 7 RCTs suggests that sex hormone therapy may be associated with better Schirmer's test scores. However, no significant differences were detected in the TBUT and OCI test scores. Consequently, sex hormone therapy has a potentially useful role in the effective management of postmenopausal women with dry eye syndrome.
99mTc-MIBI single photon emission computed tomography/computed tomography for the incidental detection of rare parathyroid carcinoma
Authors: Chen Zejun , Fu Jingjing , Shao Qing , Zhou Bin , Wang Feng
Published: October 2018

This study aimed to evaluate the characteristics of parathyroid carcinoma and to validate the diagnostic value of 99mTc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography/x-ray computed tomography (SPECT/CT) for differentiating between parathyroid carcinoma and hyperparathyroidism. Four consecutive patients with suspected primary hyperparathyroidism were enrolled in this study and underwent 99mTc-MIBI SPECT/CT, ultrasonography, enhanced CT, and MRI. Serum parathyroid hormone (PTH) and calcium were measured. All primary and recurrent lesions showed high focal uptake on 99mTc-MIBI image, whereas metastatic lymph nodes gave false negative results. The serum PTH was 165.14 ± 90.26 pmol/L, which declined rapidly after surgery. One patient with a persistently high PTH (147.5 pmol/L) after surgery presented with multiple lymphadenopathy in the neck. Higher expression of chromogranin A (CgA) further confirmed parathyroid carcinoma as a rare endocrine tumor. Parathyroid carcinoma is thus usually diagnosed incidentally based on nonspecific multiorgan symptoms of hypercalcemia and hyperparathyroidism. 99mTc-MIBI SPECT/CT may help to localize the parathyroid carcinoma, while MRI is valuable for detecting metastasis. Serum PTH and CgA serve as circulating biomarkers in parathyroid carcinoma, and raised levels of PTH and CgA together with locoregional lymphadenopathy may indicate parathyroid carcinoma. Further studies are needed.
Application of lower limb nerve block combined with slow induction of light general anesthesia and tracheal induction in elderly hip surgery
Authors: Shi Zheng-Yuan , Jiang Chun-Nan , Shao Gang
Published: October 2018

Background:

This study aims to evaluate the effectiveness and safety of lower limb nerve block combined with slow induction of light general anesthesia and tracheal intubation in hip surgery in the elderly.

Methods:

Thirty elderly patients who underwent hip surgery under the lower limb nerve block were randomly divided into 2 groups: slow induction of light general anesthesia and tracheal intubation group (group M), and laryngeal mask light general anesthesia group (group H). After undergoing total intravenous anesthesia without muscle relaxants, all patients received sciatic nerve, lumbar plexus, and paravertebral nerve blocks. The hemodynamic situations, dosage of anesthetics, time for awakening and extubation (or laryngeal mask removal), and incidence of respiratory adverse reactions in the induction period were recorded.

Results:

Compared with baseline levels, the difference in mean arterial pressure (MAP) value at each time point after intubation/laryngeal mask removal in both groups was not statistically significant (P > .05). Furthermore, the time for awakening and extubation/laryngeal mask removal, and anesthetic dosage were significantly decreased in group M, when compared with group H (P < .05). For the incidence of adverse reactions, the incidence of poor sealing and hypoxia was significantly lower in group M than in group H (P < .05), and the incidence of sore throat was significantly lower in group H than in group M (P < .05).

Conclusion:

Lower limb nerve block combined with slow induction of light general anesthesia and tracheal intubation was associated with smaller anesthetic dosage, and shorter duration of anesthesia induction and extubation/laryngeal mask after surgery.
Neck xanthogranuloma mimicking malignancy in a patient with diabetes mellitus
Authors: Chen Tzu-Pai , Yi Wan-Ling , Liu Chiang-Shin , Lin Yu-Hsuan
Published: October 2018

Rationale:

Xanthogranulomatous inflammation (XGI) is a rare inflammatory process, which mostly affects the kidney and gallbladder. It usually simulates an aggressive neoplastic process. Occurrences in the neck are extremely rare and would usually be associated with a preexisting cyst or glandular tissues.

Patient concerns:

A 49-year-old diabetic patient presented with a right painful neck mass for a week. The pretreatment computed tomography (CT) imaging with contrast demonstrated a huge ill-defined heterogeneous-enhanced lesion abutting surrounding musculatures and great vessels. Both fine needle aspiration (FNA) and ultrasound-guided core biopsy of the neck mass showed inflammatory cells only.

Diagnoses:

Histologic evaluation found granulation tissue with histiocytes and occasional Touton giant cells confirming the diagnosis of xanthogranuloma.

Interventions:

Open excisional biopsy demonstrated a yellowish mass-like lesion with abscess inside.

Outcomes:

The patient recovered from the disease without posttreatment comorbidities.

Lessons:

This case highlights the need for physicians to maintain awareness of this clinical entity and delayed- or overtreatment should be avoided in these patients due to preoperative ambiguous diagnosis.