bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive Factors for Bowel Dysfunction After Sphincter-Preserving Surgery for Rectal Cancer: A Single-Center Cross-sectional Study
Authors: Park Youn Young , Yang Seung Yoon , Han Yoon Dae , Cho Min Soo , Hur Hyuk , Min Byung Soh , Lee Kang Young , Kim Nam Kyu
Published: March 2019

BACKGROUND:

With increasing rates of sphincter preservation because of advances in preoperative chemoradiation, restoration of bowel continuity has become a main goal of rectal cancer treatment. However, in many patients, postoperative bowel dysfunction negatively affects the quality of life.

OBJECTIVE:

This study aimed to analyze predictors of bowel dysfunction after sphincter-preserving surgery in patients with rectal cancer.

DESIGN:

This was a cross-sectional study.

SETTINGS:

Assessment of bowel dysfunction was conducted between November 2015 and June 2017 at our institution.

PATIENTS:

A total of 316 patients with rectal cancer who underwent sphincter-preserving surgery between February 2009 and April 2017 and agreed with an interview for assessing bowel dysfunction were included.

MAIN OUTCOME MEASURES:

Bowel dysfunction was assessed with the Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner score. All the assessments were conducted face-to-face by the same interviewer.

RESULTS:

The median time interval between the restoration of bowel continuity and assessment was 10 months (interquartile range, 3–37), and the median total Memorial Sloan Kettering Cancer Center and Wexner scores were 65 (interquartile range, 58–73) and 6 (interquartile range, 0–11). The time interval was correlated with the Memorial Sloan Kettering Cancer Center scores (rho, 0.279) and Wexner scores (rho, –0.306). In a multivariate analysis, handsewn anastomosis and short time interval (≤1 year) were independently associated with poor bowel function (Memorial Sloan Kettering Cancer Center score ≤65). A short time interval (≤1 year), preoperative chemoradiation, and ileostomy were independently associated with major fecal incontinence (Wexner ≥8).

LIMITATIONS:

Selection bias may be inherent.

CONCLUSIONS:

Bowel function recovers with time after the restoration of bowel continuity. A short time interval, handsewn anastomosis, preoperative chemoradiation, and ileostomy were significantly associated with poor bowel function or major fecal incontinence. Surgeons should discuss postoperative bowel dysfunction and its predictive factors with the patients. See Video Abstract at http://links.lww.com/DCR/A930.
Cyclodextrin Ameliorates the Progression of Atherosclerosis via Increasing High-Density Lipoprotein Cholesterol Plasma Levels and Anti-inflammatory Effects in Rabbits
Authors: Wang He , Zhang Xinwei , Yu Biao , Peng Xiaohuan , liu Ying , Wang Anbei , Zhao Dazhong , Pang Daxin , OuYang Hongsheng , Tang Xiaochun
Published: March 2019

To investigate the therapeutic effects of cyclodextrin on the development of atherosclerosis in rabbits, we evaluated the effects of (2-hydroxypropyl)-β-cyclodextrin (HPβCD) therapy on the organ coefficient, lipid profiles, inflammatory cytokines, and atherosclerotic plaques in rabbits fed a high-fat diet. Our results demonstrated that HPβCD therapy reduced plasma triglyceride levels and inflammatory cytokine levels but increased plasma high-density lipoprotein cholesterol levels. HPβCD therapy produced a significant decrease in the atherosclerotic lesion area and reduced macrophage and collagen content in the lesions. The expression levels of inflammatory genes in aortic plaques were significantly reduced by HPβCD treatment, but the expression of ATP-binding cassette (ABC) transporters A1 (ABCA1) and G1 (ABCG1) in aortic plaques and livers increased significantly. HPβCD therapy may produce additional antiatherosclerotic benefits likely via increasing high-density lipoprotein cholesterol levels.
Effects of Low-Dose Sacubitril/Valsartan on Different Stages of Cardiac Hypertrophy in Salt-Loaded Hypertensive Rats
Authors: Hamano Go , Yamamoto Koichi , Takami Yoichi , Takeshita Hikari , Shimosato Takashi , Moritani Toshinori , Rakugi Hiromi
Published: March 2019

Background:

Sacubitril/valsartan was shown to attenuate the development of cardiac hypertrophy with enhanced blood pressure reduction compared with valsartan alone in animal models. We investigated whether a low-dose sacubitril/valsartan has blood pressure–independent effects on cardiac hypertrophy and pulmonary edema using a rat model of hypertension and obesity.

Methods and Results:

In plan 1, male SHR/NDmcr-cp rats fed normal or phase-increased high salt were treated with vehicle, 6-mg/kg sacubitril/valsartan or 3-mg/kg valsartan, for 6 months. In plan 2, after high-salt loading for 6 months, drugs were administered for 4 months. Antihypertensive effects of the 2 drugs were similar during all study periods. In plan 1 with normal salt, there were no differences between treatments in the left ventricle weight/body weight (BW), or lung weight/BW as an index of cardiac hypertrophy or pulmonary edema, respectively. These indexes were smaller in high-salt-fed rats with sacubitril/valsartan than vehicle. In plan 2, both indexes did not differ between vehicle and sacubitril/valsartan. Ventricle weight/BW was lower in valsartan than sacubitril/valsartan. In plan 2, gene markers of cardiac dysfunction were upregulated by sacubitril/valsartan compared with the other groups.

Conclusions:

Low-dose sacubitril/valsartan may have different effects depending on the stage of cardiac hypertrophy in rats.
Ligustilide Ameliorates the Permeability of the Blood–Brain Barrier Model In Vitro During Oxygen–Glucose Deprivation Injury Through HIF/VEGF Pathway
Authors: Wu Sipeng , Wang Ning , Li Jing , Wang Guangyun , Seto Sai Wang , Chang Dennis , Liang Huazheng
Published: March 2019

Chuanxiong rhizome has been widely used for the treatment of cerebral vascular disease in traditional Chinese medicine. The integrity of blood–brain barrier (BBB) is closely linked to the cerebral vascular disease. The protective effects of ligustilide, the major bioactive component in Chuanxiong rhizome, on cerebral blood vessels have been reported previously, but its effects and potential mechanism on BBB have not been entirely clarified. In the current work, the effects of ligustilide on BBB permeability and the underlying molecular mechanisms had been investigated using the model of BBB established by coculturing astrocytes and brain microvascular endothelial cells isolated from the rat brain. The ischemia-damaged model of BBB has been established with oxygen and glucose deprivation (OGD). Our results indicated that OGD significantly increased the permeability in the coculture BBB model. This OGD-induced increase in permeability could suppress by ligustilide in a concentration-dependent manner. Also, ligustilide promoted both gene and protein expression of tight junction proteins. Ligustilide suppressed the upregulation of HIF-1α, vascular endothelial growth factor, and AQP-4 in the BBB model induced by OGD. Collectively, all results have demonstrated that ligustilide is capable of reducing the permeability of BBB in vitro model induced by OGD through HIF-1α/vascular endothelial growth factor pathway and AQP-4, which provide a new target for the clinical application of ligustilide on BBB after stroke in future.
Real-Life Indications to Sacubitril/Valsartan Treatment in Patients With Chronic Systolic Heart Failure
Authors: Pinto Giuseppe , Tondi Lara , Gemma Marco , De Marco Alessandro , Silipigni Carmen , Spoladore Roberto , Margonato Alberto , Fragasso Gabriele
Published: March 2019

Objective:

International guidelines recommend the introduction of sacubitril/valsartan (Entresto) in patients with heart failure (HF) and reduced ejection fraction (EF), who remain symptomatic, despite optimal uptitrated therapy. The purpose of the following analysis is to verify the real-life eligibility for sacubitril/valsartan in a population of patients suffering from chronic HF, regularly monitored in a single HF clinic and treated according to guideline-directed medical therapy (GDMT).

Methods:

From a total of 1070 patients regularly monitored in our HF Clinic between January 2011 and September 2017, the clinical records of 224 patients with HF and reduced EF on optimized GDMT were retrospectively analyzed.

Results:

Of 224 analyzed patients, 75 improved their EF or were asymptomatic after uptitration of GDMT during follow-up; 50 were not on angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for different reasons; 13 patients had systolic blood pressure ≤100 mm Hg, so they were not eligible for sacubitril/valsartan introduction. The remaining patients were still symptomatic (NYHA ≥2), and therefore, sacubitril/valsartan introduction was indicated in these 86 patients (38.4%) of 224 enrolled.

Conclusion:

In patients with HF and reduced EF, where GDMT is appropriately achieved, indication to sacubitril/valsartan treatment is around 38%.
Benefits of SubCyclo Laser Therapy Guided by High-frequency Ultrasound Biomicroscopy in Patients With Refractory Glaucoma
Authors: Benhatchi Nassima , Bensmail Djawed , Lachkar Yves
Published: March 2019

Purpose:

The purpose of this study was to evaluate the efficacy and safety of subliminal cyclophotocoagulation using a 25% duty cycle diode laser (Supra 810, SubCyclo, Quantel Medical).

Methods:

This was a pilot study of patients who underwent a SubCyclo photocoagulation procedure with a 25% duty cycle, between April 2016 and April 2017 at the Glaucoma Institute of Saint Joseph Hospital of Paris. All patients presented with an evolving moderate to severe glaucoma that were resistant to previous surgical treatments or with a contraindication for filtration surgery. Laser settings were programmed as follows: power 2000 mW, “on” time 0.63 ms, “off” time 1.9 ms, and 25% duty cycle per 100 seconds to each eye.

Results:

A total of 44 eyes of 34 patients were treated with subliminal cyclophotocoagulation, with a mean follow-up time of 12 months. Surgical success was defined as IOP ranging 6 to 21 mm Hg or a 20% IOP reduction at the last 12 months follow-up visit. The mean age of patients was 63.83±16.2 years. The mean preoperative IOP was 32.8±11.8 mm Hg which then decreased postoperatively to 24.02±7.03 mm Hg after 1 day, 18.34±8.31 mm Hg after 1 week, 18.26±8.53 mm Hg after 1 month, 20.5±8.53 mm Hg after 3 months, 18.9±9.2 mm Hg after 6 months and 18.8±9.3 mm Hg after 12 months. Our preliminary study using Subcyclo transscleral cyclophotocoagulation with a 25% duty cycle showed a 37% IOP reduction from the baseline after 3 months with a single laser session and a 45% reduction at the last 12 months follow-up, after more than one laser session. The mean number of ocular antihypertensive medications used was 3.4±1.7 before treatment which decreased to 3.0±1.6 after treatment. No significant complications or anatomic modifications were found after subliminal cyclophotocoagulation.

Conclusions:

Subliminal cyclophotocoagulation with a 25% duty cycle is a safe and effective procedure for reducing IOP in cases of refractory glaucoma and seems to be safer than conventional transscleral cyclophotocoagulation.
Comparison of Central Corneal Thickness Measurements Using Optical and Ultrasound Pachymetry in Glaucoma Patients and Elderly and Young Controls
Authors: Pillunat Karin R. , Waibel Soeren , Spoerl Eberhard , Herber Robert , Pillunat Lutz E.
Published: March 2019

Précis:

Optical and ultrasound pachymetry cannot be used interchangeably in young, healthy adults. In elderly, healthy and glaucoma patients the speed of ultrasound in the cornea increases because of changing corneal biomechanical characteristics in age and disease and the different devices could be used interchangeably.

Purpose:

The purpose of this study was to compare central corneal thickness (CCT) using optical and ultrasound pachymetry in patients with open-angle glaucoma and young as well as elderly, healthy controls. Further to investigate whether the devices could be used interchangeably.

Methods:

In total, 69 eyes of 41 glaucoma patients, 51 eyes of 32 elderly and 50 eyes of 25 young controls were consecutively included in this cross-sectional observational study. Optical CCT measurements were obtained using the noncontact Specular Microscope CEM-530 (NCSM). Ultrasound pachymetry (USP) was measured using the Pachy Meter SP 3000.

Results:

In young subjects (27.2±4.8 y), the mean CCT taken with NCSM and USP was 562.1±33.6 μm and 565.8±35.8 μm, respectively. This was significantly different (USP>NCSM, P=0.019). In elderly subjects (70.6±10.7 y) CCT measured with NCSM (562.5±27.8 μm) compared to USP (564.9±27.1 μm) was not statistically significantly different (P= 0.121). In glaucoma patients (65.0±11.1 y), USP measured thinner CCT values compared to NCSM, without significant differences between the devices (NCSM 525.3±32.3 μm; USP 522.9±33.15 μm; P=0.067). CCT was significantly thinner in comparison to both healthy groups (P< 0.001).

Conclusions:

In young subjects, ultrasound pachymetry measurements are higher than they are with optical pachymetry. This difference is no longer observed in elderly subjects and is even reversed in glaucoma patients. A higher speed of ultrasound in the cornea due to changing corneal biomechanical properties in the elderly and glaucoma patients could explain this. The devices could be used interchangeably in older and glaucoma patients, but not in young individuals.
Bacteroides Spp. Blebitis, Keratitis, and Endophthalmitis Following Uncomplicated Trabeculectomy
Authors: Parker Jack S. , Dockery Philip W. , Parker John S. , Crosson Jason N. , Kilpatrick David , Samuels Brian
Published: March 2019

Purpose:

To describe the first known case of Bacteroides spp. related blebitis, keratitis, and endophthalmitis following uncomplicated trabeculectomy.

Methods:

This was a case report and literature review.

Case:

A 63-year-old immunocompetent white male underwent uncomplicated trabeculectomy of his right eye. Two weeks later, a blebitis with adjacent keratitis was diagnosed, progressing over several days to endophthalmitis despite hourly topical fortified antibiotic therapy. Although gram stain and culture of the bleb surface, a conjunctival suture, the aqueous humor, and the vitreous were negative, topical real-time quantitative polymerase chain reaction testing disclosed the presence of Bacteroides spp. Following treatment with topical and intravitreal clindamycin and intravenous meropenem, all clinical evidence of infection resolved. Best spectacle–corrected visual acuity improved to 20/25 (0.8) subsequent to combined cataract extraction, intraocular lens implantation, and pars plana vitrectomy for persistent vitreous debris.

Conclusions:

Bacteroides may be a rare cause of postoperative blebitis, keratitis, and endophthalmitis. A favorable outcome may be attained, provided that an accurate diagnosis and effective treatment can be provided, which may be facilitated by real-time quantitative polymerase chain reaction in select cases.
Medium-Term (Least 5 Years) Comparative Outcomes in Anterior Cruciate Ligament Reconstruction Using 4SHG, Allograft, and LARS Ligament
Authors: Su Mengdi , Jia Xinyu , Zhang Zaihang , Jin Zhigao , Li Yong , Dong Qirong , Xu Wei
Published: March 2019

Objective:

To compare the clinical efficacy of anterior cruciate ligament (ACL) reconstruction with 4-strand hamstring tendon autograft (4SHG), allograft and the Ligament Advanced Reinforcement System (LARS) ligament, and to find the causes of cumulative failure or nonreturn to sport.

Design:

Retrospective case series.

Setting:

Department of Orthopedic Surgery, the second affiliated hospital of Soochow University, Suzhou, Jiangsu, China.

Patients:

Three hundred six patients with isolated ACL deficiency were included. Two hundred twenty-nine patients met the inclusion/exclusion criteria, and finally, 185 of these patients participated in this study.

Interventions:

Anterior cruciate ligament reconstruction using 4SHG, allograft, and LARS.

Main Outcome Measures:

Objective knee function, subjective knee function, and information regarding return to sport, cumulative failure, and complications. Secondary: distribution of tunnel position and tunnel enlargement.

Results:

There were no statistically significant differences between the 3 groups regarding all the clinical objective and subjective results, return to sport, complications, or cumulative failures (P > 0.05). One hundred twenty-eight patients (69.2%, 128/185) returned to sport. Preoperative (after injury) Tegner scores were inferior to postoperative Tegner scores, and postoperative Tegner scores were inferior to preinjury Tegner scores (P < 0.01). The femoral tunnel malposition was significantly associated with cumulative failure (P < 0.05).

Conclusions:

There were no statistically significant differences among the 4SHG, allograft, and LARS ligament in terms of the clinical outcomes after ACL reconstruction (ACLR) at 5-years follow-up. Interestingly, ACLR could improve the functional and motorial level of the knee, but patients had great difficulty in regaining the level of preinjury movement. In addition, the malposition of the femoral tunnel was an important cause of cumulative failure.
Gut dysmotility in the ICU: diagnosis and therapeutic options
Authors: Plummer Mark P. , Reintam Blaser Annika , Deane Adam M.
Published: March 2019

Purpose of review

To provide a comprehensive update of diagnosis and treatment of gastrointestinal dysmotility in the critically ill, with a focus on work published in the last 5 years.

Recent findings

Symptoms and clinical features consistent with upper and/or lower gastrointestinal dysmotility occur frequently. Although features of gastrointestinal dysmotility are strongly associated with adverse outcomes, these associations may be because of unmeasured confounders. The use of ultrasonography to identify upper gastrointestinal dysmotility appears promising. Both nonpharmacological and pharmacological approaches to treat gastrointestinal dysmotility have recently been evaluated. These approaches include modification of macronutrient content and administration of promotility drugs, stool softeners or laxatives. Although these approaches may reduce features of gastrointestinal dysmotility, none have translated to patient-centred benefit.

‘Off-label’ metoclopramide and/or erythromycin administration are effective for upper gastrointestinal dysmotility but have adverse effects. Trials of alternative or novel promotility drugs have not demonstrated superiority over current pharmacotherapies. Prophylactic laxative regimens to prevent non-defecation have been infrequently studied and there is no recent evidence to further inform treatment of established pseudo-obstruction. Further trials of nonpharmacological and pharmacological therapies to treat upper and lower gastrointestinal dysmotility are required and challenges in designing such trials are explored.
The microbiome and nutrition in critical illness
Authors: Oami Takehiko , Chihade Deena B. , Coopersmith Craig M.
Published: March 2019

Purpose of review

The present review aims to describe the relationship between nutrition and the gut microbiome in critical illness.

Recent findings

Critical illness disrupts not only cells of human origin but also the intestinal microbiome, with a decrease in bacterial diversity and transformation into a pathobiome. Under basal conditions, nutrition profoundly alters microbial composition with significant salutatory effects on human health. In critical illness, enteral nutrition is recommended and has theoretical (but not proven) advantages towards improved inner microbial health and diminution of bacterial translocation. Dietary supplements such as probiotics and fiber have been shown to improve microbial derangements in health. However, their impact on the microbiome in critical illness is unclear and although they may have some beneficial effects on patient-centric outcomes, they do not alter mortality. The precise mechanisms of how nutrition and dietary supplements modulate the gut microbiome remain to be determined.

Nutrition and supplements such as probiotics appear to play a significant role in modulating the microbiome in health, yet the relationship in critical illness is unclear. Further investigation is required to determine the mechanistic determinants of the impact of nutrition on the microbiome in critical illness and the potential clinical implications of this.
Vasoactive agents to improve brain perfusion: pathophysiology and clinical utilization
Authors: Steiner Luzius A. , Siegemund Martin
Published: March 2019

Purpose of review

This review highlights the aspects of pathophysiology that make it difficult to predict the effects of any attempt to improve brain perfusion and reviews the options to improve brain perfusion according to the needs of an individual patient, focusing on the choice of a suitable threshold for cerebral perfusion pressure.

Recent findings

Typically, vasopressors or vasodilators that do not directly influence the cerebral vascular bed are used to improve cerebral perfusion. Positive inotropic substances are rarely used, as the relationship between cardiac output and cerebral blood flow is complex and difficult to measure. Combining perfusion pressure monitoring with monitoring of brain metabolism or oxygenation to adapt cerebral perfusion to the needs of an individual patient has been disappointing. Recently, attempts to individualize perfusion pressure based on measurements of cerebrovascular autoregulation have shown promising results in the management of traumatic brain injury and during cardiac surgery. Currently, only preliminary data are available linking optimized cerebral perfusion to improved outcome.

Optimizing cerebral perfusion remains a difficult goal. All our attempts to manipulate brain perfusion are influenced in an unpredictable manner by underlying diseases. Autoregulation-based strategies to individualize cerebral perfusion management warrant further investigation.
Antiseizure medications in critical care: an update
Authors: Allen Baxter , Vespa Paul M.
Published: March 2019

Purpose of review

Seizures and status epilepticus are very common diagnoses in the critically ill patient and are associated with significant morbidity and mortality. There is an abundance of research on the utility of antiseizure medications in this setting, but limited randomized-controlled trials to guide the selection of medications in these patients. This review examines the current guidelines and treatment strategies for status epilepticus and provides an update on newer antiseizure medications in the critical care settings.

Recent findings

Time is brain applies to status epilepticus, with delays in treatment corresponding with worsened outcomes. Establishing standardized treatment protocols within a health system, including prehospital treatment, may lead to improved outcomes. Once refractory status epilepticus is established, continuous deep sedation with intravenous anesthetic agents should be effective. In cases, which prove highly refractory, novel approaches should be considered, with recent data suggesting multiple recently approved antiseizure medications, appropriate therapeutic options, as well as novel approaches to upregulate extrasynaptic γ-aminobutyric acid channels with brexanolone.

Although there are many new treatments to consider for seizures and status epilepticus in the critically ill patient, the most important predictor of outcome may be rapid diagnosis and treatment. There are multiple new and established medications that can be considered in the treatment of these patients once status epilepticus has become refractory, and a multidrug regimen will often be necessary.
Nutritional and metabolic supplementation for the injured brain: an update
Authors: Quintard Hervé , Ichai Carole
Published: March 2019

Purpose of review

Energy dysfunction is increasingly recognized as a key factor in the pathogenesis of acute brain injury (ABI). This one characterized by a high metabolic rate and nitrogen loss is often associated with an undernutrition support. We review the metabolism evolution and nutritional status in brain injured patient and summarize evidence on nutritional support in this condition.

Recent findings

The role of nutrition support for improving prognosis in brain injured patient has been underlined recently. A fast nutrition institution whatever the route is essential to prevent an imbalance in caloric support. Moreover, hypermetabolic state must be prevented with a sufficient nitrogen support. Glycemic control is particularly relevant in this group of patient, with the discovery of new fuel that could potentially improve cerebral metabolism and replace glucose. Few data support also the use of immunonutrition input in this group of patients.

Nutritional support is a key parameter in brain injured patient and must be initiated quickly to counteract hypermetabolic state by caring to improve caloric and nitrogen input. Recent clinical data support the use of immunonutrition, glutamine and zinc in this particular setting.
Pharmacotherapy of sodium disorders in neurocritical care
Authors: Mrozek Ségolène , Rousset David , Geeraerts Thomas
Published: March 2019

Purpose of review

To describe the pathophysiology and pharmacotherapy of dysnatremia in neurocritical care patients.

Recent findings

Sodium disorders may affect approximately half of the neurocritical care patients and are associated with worse neurological outcome and increased risk of death. Pharmacotherapy of sodium disorders in neurocritical care patients may be challenging and is guided by a careful investigation of water and sodium balance.

In case of hyponatremia, because of excessive loss of sodium, fluid challenge with isotonic solution, associated with salt intake is the first-line therapy, completed with mineralocorticoids if needed. In case of hyponatremia because of SIADH, fluid restriction is the first-line therapy followed by urea if necessary. Hypernatremia should always be treated with hypotonic solutions according to the free water deficit, associated in case of DI with desmopressin. The correction speed should take into consideration the symptoms associated with dysnatremia and the rapidity of the onset.
Assessment and management of coagulopathy in critically-ill patients with liver failure
Authors: Saner Fuat H. , Bezinover Dmitri
Published: March 2019

Purpose of review

This review provides insight into our current understanding of the pathophysiology and treatment of coagulopathy associated with liver failure, and bleeding risk assessment.

Recent findings

Patients with end-stage liver disease (ESLD) have a rebalanced coagulation profile and are at risk for both excessive clotting and bleeding. Hypercoagulability is associated with profound endothelial dysfunction and an increased concentration of liver-independent coagulation factors. Because of this rebalanced coagulation profile, standard laboratory tests have been demonstrated to be ineffective in either predicting and/or guiding the management of coagulopathy. Viscoelastic testing, however, is able to provide a dynamic assessment of clot formation in whole blood and has been demonstrated to be invaluable in both monitoring and management of coagulation problems associated with liver failure. More recently, there is increasing interest in thrombin generation tests to monitor coagulation in patients with ESLD.

Multiple institutional protocols for prophylaxis and treatment of ESLD-related thromboses have been developed. High-quality studies evaluating these approaches are lacking.

Patients with ESLD are at risk for excessive bleeding and clotting. Treatment of any significant coagulopathy should not be based solely on standard laboratory tests. Thrombosis prophylaxis has to be considered in susceptible populations.
Inverse regulation of serum osteoprotegerin and tumor necrosis factor-related apoptosis-inducing ligand levels in patients with leg lesional vascular calcification
Authors: Moon Ae Ran , Park Yoonkyung , Chang Jeong Hwan , Lee Sang Su
Published: March 2019

We hypothesized that circulating osteoprotegerin (OPG) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) levels could be associated with vascular calcification, which is predominant in diabetes.

The study included 71 Korean participants (36 with diabetes and 35 without diabetes), who were sub-grouped according to the results of the ankle–brachial index (ABI) and/or X-ray computed tomography scan (CT scan). Serum OPG and TRAIL levels were assayed using the respective enzyme-linked immunosorbent assay kits. Statistical significance was analyzed using Student'sttest between the 2 groups or analysis of variance (ANOVA) among the 4 groups.

Serum OPG was up-regulated in the participants with diabetes, with peripheral arterial disease (PAD), and/or with vascular calcification. TRAIL down-regulation was more strictly controlled than OPG up-regulation; it was significantly downregulated in the participants with PAD and vascular calcification, but not in the participants with diabetes. Serum OPG and TRAIL were regulated in the participants with femoral, popliteal, and peroneal artery calcification but not in the participants with aortic calcification.

OPG up-regulation and TRAIL down-regulation were found to be associated with leg lesional vascular calcification; therefore, the average OPG/TRAIL ratio was significantly increased by 3.2-fold in the leg lesional vascular calcification group.
Spontaneous resolution of dermatomyositis associated with fallopian-tube carcinoma following staging surgery
Authors: Lin Chen , Ying Zheng , Sijing Chen
Published: March 2019

Rationale:

Paraneoplastic dermatomyositis (DM) is an inflammatory disease of the connective tissue caused by immunologic events in the presence of malignant tumors, which are typically related to ovarian, pancreatic, stomach, and colon cancer. Traditional treatment of paraneoplastic DM includes combination therapy for the underlying malignancy with systemic steroids.

Patient concerns:

A 41-year-old woman presented with facial erythema and myalgia of the extremities.

Diagnosis:

The patient was diagnosed with DM associated with a fallopian-tube carcinoma.

Interventions:

The cancer staging surgery was performed via muilt-port laparoscope and administered 6 cycles of adjuvant chemotherapy with paclitaxel (210 mg) and carboplatin (600 mg) right ovary and the left fallopian tube were removed laparoscopically.

Outcomes:

The DM healed spontaneously without the use of general glucocorticoids after the cancer staging surgery. During the 9-month follow-up, no recurrence of DM or neoplasm was observed.

Lessons:

This case highlights the fact that paraneoplastic DM can heal spontaneously after therapy for the underlying neoplasm, thereby avoiding the use of systemic steroids and their side effects. Moreover, DM can be an initial symptom for gynecological cancer such as fallopian-tube cancer. Thus, if DM is refractory to standard treatment, gynecological neoplasms should be considered.
Langerhans cell sarcoma arising from antecedent langerhans cell histiocytosis
Authors: Yi Wu , Chen Wan-yuan , Yang Tian-xin , Lan Jian-ping , Liang Wen-na
Published: March 2019

Rationale:

Langerhans cell sarcoma (LCS) is a rare, high-grade neoplasm characterized by overtly malignant cytologic features and a poor prognosis. Herein, we present a rare case of langerhans cell histiocytosis (LCH) that later transformed into langerhans cell sarcoma 11 months after the benign mass was excised from soft tissue in the right groin.

Patient concerns:

A 41-year-old patient who presented with a mass in the right groin for 3 years earlier after being bitten by ants.

Diagnoses:

The patient was diagnosed with langerhans cell sarcoma arising from antecedent langerhans cell histiocytosis.

Interventions:

The patient underwent with 6 cycles of a modified etoposide, cyclophosphamide, vindesine, dexamethasone (E-CHOP) regimen.

Outcomes:

The patient is currently receiving follow-up care.

Lessons:

LCH transformed into LCS is a rare case. E-CHOP as an effective first-line therapy to treat LCS cases, but, the mechanism is unclear. Due to their rarity, further data on clinical outcomes are necessary to establish the optimal treatment strategy for LCS.
Idiopathic hypereosinophilic syndrome presenting with multiple organ damage
Authors: Wu Peng , Chen Yuanguo , Zhang Haibo , Li Chen
Published: March 2019

Rationale:

Idiopathic hypereosinophilic syndrome (IHES) is a rare disease in which patients which present with eosinophilia-associated damage. Previous studies focused on organ damage from increased eosinophilic granulocytosis. We report IHES in a patient who presented with multiple organ damage (MOD).

Patient concerns:

A 52-year-old male presented with MOD, including myocardial damage suggestive of myocardial infarction, cardiac tamponade, respiratory failure, skin damage, and gastrointestinal damage.

Diagnoses:

The absolute eosinophil count was 12,920/mm3, much higher than occurs in other diseases associated with eosinophilia (1500/mm3), and suggesting a diagnosis of IHES.

Interventions:

Prednisone combined with hydroxyurea.

Outcomes:

At 6 months after completion of drug treatment, the patient had no chest pain or dyspnea, and the results of a blood panel, chest computed tomography, and gastroscopy were normal.

Lessons:

MOD is very rare in patients with IHES. Patients receiving prompt diagnosis and treatment have very good prognoses.
Ultrasound-guided high-intensity focused ultrasound in the treatment of uterine fibroids
Authors: Fan Hong-Jie , Zhang Chao , Lei Hong-Tao , Cun Jiang-Ping , Zhao Wei , Huang Jian-Qiang , Zhai Yue
Published: March 2019

The aim of the present study was to investigate factors affecting ablation effect and safety of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids (UFs).

A retrospective analysis of 346 patients with symptomatic UFs who were treated with USgHIFU was performed. All UFs was grouped based on magnetic resonance imaging (MRI) characteristics before HIFU; all adverse events and treatment data were recorded during and after HIFU. One-way analysis of variance and multiple linear regression analysis were used to evaluate the effect of USgHIFU treatment and affecting factors.

The results showed that the mean age of patients was 38.3 ± 6.1 years, with the mean nonperfusion volume rate of 74.4 ± 14.7% and the mean energy efficiency factor (EEF) of 7.2 ± 4.8 J/mm3. Except for the size group, the ablation rate was significantly different (P < .001); and the anterior, intramural, hypointense (T2WI), and mild enhancement (T1WI contrast enhancement) UFs had the highest ablation rate. The EEF of the anterior, intramural, hypointense (T2WI), mild enhancement (T1WI contrast enhancement), and >5 cm UFs had minimum value, with a statistically significant difference (P < .01). According to multiple linear regression model, the distance from the UFs ventral side to the skin, enhancement type on T1WI, size of UFs, signal intensity on T2WI, location of UFs, type and volume of fibroids all had a line relationship with EEF, and the enhancement type on T1WI was the greatest factor affecting the ablation effect. Some patients (37.6%) had thermal injury of the sacrum on MRI, but no serious adverse events were observed.

Our results suggest that USgHIFU can be safely used and have a promising prospect for treating UFs, even though its effect may be affected by anatomical features, tissue characteristics, and blood supply.
BIM deletion polymorphism predicts poor response to EGFR-TKIs in nonsmall cell lung cancer
Authors: Su Wenxia , Zhang Xiaoyun , Cai Xin , Peng Meiyu , Wang Fengbin , Wang Yuliang
Published: March 2019

Background:

A germline deletion in BIM (B cell lymphoma-2-like 11) gene has been shown to impair the apoptotic response to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in vitro but its impact on response to EGFR-TKIs in patients of nonsmall cell lung cancer (NSCLC) remains controversial.

Methods:

Eligible literature were searched and screened. Objective response rate (ORR) and disease control rate (DCR) were extracted and aggregated with odds ratio (OR). Hazard ratio (HR) and 95% confidence interval (CI) for progression-free survival (PFS) and overall survival (OS) were extracted and aggregated based on random-effect model.

Results:

Fourteen studies including 2694 NSCLC patients were eligible. Individuals harboring BIM deletion polymorphism had inferior ORR (OR = 0.49, 95% CI: 0.34–0.70, P < .001), inferior DCR (OR = 0.50, 95% CI: 0.30–0.84, P = .009). Patients with BIM deletion had shorter OS despite of the heterogeneity between countries (in subgroup of South Korea and Taiwan, HR = 1.34, 95% CI: 1.18–1.53, P < .001; in subgroup of other countries, HR = 2.43, 95% CI: 2.03–2.91, P < .001). The pooled analysis of PFS showed great heterogeneity (I
2 = 79%). All the reported characteristics did not account for the heterogeneity. However, 2 subgroups could be obtained through sensitivity analysis. In one subgroup, patients with BIM deletion polymorphism had shorter PFS (HR = 2.03, 95% CI: 1.71–2.40, P < .001), while in the other subgroup, no significant difference was observed (HR = 0.92, 95% CI: 0.79–1.06, P = .25).

Conclusion:

NSCLC patients with BIM deletion polymorphism show poor ORR, DCR, and OS after EGFR-TKIs treatment. BIM deletion polymorphism indicates poor response to EGFR-TKIs, and it could be used as a predictor to identify those who would benefit from EGFR-TKIs in NSCLC patients.
Efficacy of exercise for improving functional outcomes for patients undergoing total hip arthroplasty
Authors: Wu Jia-Qi , Mao Lin-Bo , Wu Jian
Published: March 2019

Background:

The objective of this meta-analysis was aimed to illustrate the functional outcomes of exercise for total hip arthroplasty (THA) patients.

Methods:

In July, 2018, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on exercise for functional outcomes for THA patients were retrieved. The primary endpoint was walking speed. Other outcomes included physical activity scale, Harris hip score, pain scores, abduction strength, and the length of hospital stay. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.

Results:

Ten clinical studies with 441 patients were ultimately included in the meta-analysis. Compared with the control group, exercise was associated with an increase of the walking speed by 0.15 m/s than control group (weighted mean difference [WMD] 0.15; 95% confidence interval [CI] 0.08, 0.22; P = .000). Also, exercise group could also increase Harris hip score (WMD 8.49; 95% CI 5.19, 11.78; P = .000) and abduction strength than control group (WMD 9.75; 95% CI 5.33, 14.17; P = .000). What is more, exercise has a beneficial role in reducing the pain scores (WMD −1.32; 95% CI −2.07, −0.57; P = .001) and the length of hospital stay (WMD −0.68; 95% CI −1.07, −0.29; P = .001) than the control group. However, there was no significant difference between the physical activity scale (WMD −2.13; 95% CI −6.31, 2.05; P = .317).

Conclusions:

Compared with control group in the management of THA, postoperative exercise has a better pain relief and clinical outcomes. Considering the beneficial of the postoperative exercise, we take a positive attitude toward use exercise for patients with THA.
Multiple schwannomas of the digital nerves and common palmar digital nerves
Authors: Jiang Shuai , Shen Hui , Lu Hui
Published: March 2019

Rationale:

Benign schwannoma is the most common tumor of peripheral nerves while plexiform multiple schwannomas are rare conditions. This manuscript reported a case of multiple Schwannomas characterized by unusual location.

Patient concerns:

We report a 34-year-old workman presented with multiple nodules in his forefinger, middle finger and palm respectively for 5 years. He felt pain combined with paraesthesias in fingers and palm. The symptoms could be eased through rest and drugs medication.

Diagnosis:

Three Schwannomas were found in surgery respectively. Histologic findings confirmed the diagnosis of schwannomas.

Interventions:

We removed all of the 3 schwannomas completely without damaging the continuity of the nerve.

Outcomes:

Six months after the surgery, the patient had had not experienced any symptom recurrence.

Lessons:

Successful treatment of multiple schwannomas depends upon accurate diagnosis. Early surgery can improve the treatment outcome of multiple schwannomas.
Increased expression of plakophilin 3 is associated with poor prognosis in ovarian cancer
Authors: Qian Hua , Yuan Donglan , Bao Jingjing , Liu Fuxing , Zhang Wenyan , Yang Xumei , Han Gaohua , Huang Junxing , Sheng Haihui , Yu Hong
Published: March 2019

Considering the essential role of plakophilin 3 (PKP3) in the maintenance cell-cell adhesion, dysregulation of PKP3 is involved in human diseases. This study aimed to explore the clinical significance of PKP3 in ovarian cancer. Immunohistochemistry was performed to examine the PKP3 expression in 157 cancer specimens from primary ovarian cancer patients. PKP3 was expressed in both the cytoplasm and nucleus. Eighty-one (51.6%) out of 157 ovarian cancer tissues showed PKP3 expression, while absent expression was observed in normal ovarian tissues. High PKP3 expression was associated with lymph node metastasis (LNM, P = .004) and advanced International Federation of Gynecology and Obstetrics (FIGO) stage (P = .013). Patients with high PKP3 expression had shorter overall survival (OS) than those with low PKP3 expression (60.2 months vs 74.2 months, P = .021). However, no association between PKP3 expression and progression-free survival (PFS) was observed (P = .790). Cox regression analysis indicated that PKP3 expression was an independently predictive factor for the OS of patient with ovarian cancer (adjusted HR = 1.601, 95%CI: 1.014-2.528, P = .043), especially those with FIGO stages III and IV disease (adjusted HR = 1.607, 95%CI: 1.006–2.567, P = .047). The gene expression profiling interactive analysis (GEPIA) databases also showed that PKP3 was upregulated in ovarian cancer (P < .001) and patients with high PKP3 expression had shorter OS (P = .004). In conclusion, our findings suggest that PKP3 is upregulated in ovarian cancer and is likely involved in the progression of ovarian cancer. PKP3 might therefore serve as a prognostic biomarker for patients with ovarian cancer.
Outcomes and modifiable resuscitative characteristics amongst pan-Asian out-of-hospital cardiac arrest occurring at night
Authors: Ho Andrew Fu Wah , Hao Ying , Pek Pin Pin , Shahidah Nur , Yap Susan , Ng Yih Yng , Wong Kwanhathai Darin , Lee Eui Jung , Khruekarnchana Pairoj , Wah Win , Liu Nan , Tanaka Hideharu , Shin Sang Do , Ma Matthew Huei-Ming , Ong Marcus Eng Hock
Published: March 2019

Studies are divided on the effect of day-night temporal differences on clinical outcomes in out-of-hospital cardiac arrest (OHCA). This study aimed to elucidate any differences in OHCA survival between day and night occurrence, and the factors associated with differences in survival.

This was a prospective, observational study of OHCA cases across multinational Pan-Asian sites. Cases were divided according to time call received by dispatch centers into day (0700H–1900H) and night (1900H–0659H). Primary outcome was 30-day survival. Secondary outcomes were prehospital and hospital modifiable resuscitative characteristics.

About 22,501 out of 55,881 cases occurred at night. Night cases were less likely to be witnessed (40.2% vs. 43.1%, P < .001), more likely to occur at home (32.5% vs. 29%, P < .001), had non-shockable initial rhythms (90.8% vs. 89.4%, P < .001), lower bystander CPR rates (36.2 vs. 37.6%, P = .001), lower bystander AED application rate (0.3% vs. 0.7%, P < .001), lower rates of prehospital defibrillation (13% vs. 14.4%, P < .001), and were less likely to receive prehospital adrenaline (9.8% vs. 11%, P < .001). 30-day survival at night was lower with an adjusted odds ratio of 0.79 (95% CI 0.73–0.86, P < .001). On multivariate logistic regression, occurrence at night was associated with decreased provision of bystander CPR, bystander AED application, and prehospital adrenaline.

30-day survival was worse in OHCA occurring at night. There were circadian patterns in incidence. Bystander CPR and bystander AED application were significantly lower at night in multivariate analysis. This would at least partially explain the decreased survival at night.
Diagnosis of pulmonary aspergillosis-related broncholithiasis in a child undergoing bronchoscopy
Authors: Meng Chen , Zhang Zhongxiao , Liu Xia , Yan Xiuli , Shi Chong , Liu Na , Wang Xinxin , Ma Jing
Published: March 2019

Rationale:

Broncholithiasis is a rare disease and is characterized by calcification in the tracheobronchial tree. This disease has a predilection in the adult and occurrence is rare in children. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience during the diagnosis and treatment procedures.

Patient concerns:

We report a 9-year- and 6-month-old girl who complained of chronic cough and recurrent wheeze for 2 months.

Diagnosis:

Bronchialithiasis were found under bronchoscope. Pathologic examination revealed aspergillosis.

Interventions:

The stone and surrounding granulation tissue were removed using a bronchoscope and the patient was treated with antifungal therapy.

Outcomes:

The patient was in good general health without any clinical symptoms during the follow-up period.

Lessons:

Pulmonary Aspergillus infection can cause bronchiolithiasis. Stones were removed under bronchoscope, and anti-Aspergillus therapy was effective.
Continuous versus intermittent infusions of antibiotics for the treatment of infectious diseases
Authors: Chen Chang-Hua , Chen Yu-Min , Chang Yu-Jun , Wang Shu-Hui , Chang Chih-Yen , Yen Hua-Cheng
Published: March 2019

Background:

Severe sepsis and pneumonia are common problems in the intensive care units (ICUs) and cause high morbidity and mortality. Optimal doses and appropriate routes of antibiotics are critical to improve their efficacy, but their appropriate routes remain controversial.

Objective:

The efficacy of antibiotic administration among critically ill patient populations remains controversial. Therefore, the present meta-analysis aimed to investigate the effectiveness of antibiotic administration in patients with infection and to assess whether the effect differs between the two antibiotic administration types.

Methods:

A systematic search of studies on continuous infusions of intravenous antibiotics and traditional intermittent infusions of antibiotics for patients with infection was performed mainly in PubMed. The odds ratios (ORs) of the microbiological results as primary outcome and mortality rate, length of stay, and duration of antibiotic treatment as secondary outcomes were evaluated.

Results:

The meta-analysis comprised 9 randomized controlled trials (RCTs) and 4 retrospective studies comprising 1957 participants. Current analysis showed that the overall OR of clinical success between the continuous and intermittent groups was 0.675 (95% confidence interval [CI]: 0.523–0.870). Comparing continuous and intermittent groups, the subgroup analysis showed a lower ICU stay (OR 0.834, 95% CI: 0.542–1.282), a higher mortality (OR 1.433, 95% CI: 1.139–1.801), and a longer antibiotic duration (OR 1.055, 95% CI: 0.659–1.689), but the results of present meta-analysis were not significant because of the limited number of enrolled trials.

Limitations:

Heterogeneity of included trials and studies.

Conclusions:

The results of present meta-analysis were insufficient to recommend continuous infusion of intravenous antibiotics better than traditional intermittent infusions of antibiotics at routine clinical care. Hope large-scale RCT to provide more rebuts evidence for making recommendations to warrant continuous infusions of intravenous antibiotics at clinical practice.