bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal Pouchogram Predicts Pouch Failure Even in Asymptomatic Patients
Authors: Sossenheimer Philip H. , Glick Laura R. , Dachman Abraham H. , Skowron Kinga B. , Rubin Michele A. , Umanskiy Konstantin , Smith Radhika , Cannon Lisa M. , Hurst Roger D. , Cohen Russell D. , Hyman Neil H. , Rubin David T.
Published: November 2018

BACKGROUND:

Anastomotic complications after restorative total proctocolectomy with IPAA for ulcerative colitis alter functional outcomes and quality of life and may lead to pouch failure. Routine contrast enema of the pouch assesses anastomotic integrity before ileostomy reversal, but its clinical use is challenged.

OBJECTIVE:

The purpose of this research was to assess the relationship among preoperative clinical characteristics, abnormal pouchography, and long-term pouch complications.

DESIGN:

This was a retrospective chart review.

SETTINGS:

The study was conducted at a tertiary care center between 2000 and 2010.

PATIENTS:

Ulcerative colitis patients with IPAA undergoing pouchography before ileostomy closure were included.

MAIN OUTCOME MEASURES:

Patient demographics, incidence of pouch-related complications, and findings on pouchogram were recorded. Primary outcome was pouch failure, defined as excision or permanent diversion of the ileoanal pouch. Independent predictors of pouch failure were determined by multivariate regression.

RESULTS:

A total of 262 patients with ulcerative colitis were included. Contrast extravasation was seen in 27 patients (10.3%): 14 (51.9%) were clinically asymptomatic at the time of pouchogram. Six (22.2%) of 27 patients with extravasation developed pouch failure despite normalization of the pouchogram before ileostomy closure. Forty patients (15.3%) were found to have pouch-anal anastomotic stenosis; only 1 developed pouch failure. Pre-IPAA serum albumin and hemoglobin levels were inversely associated with contrast extravasation (serum albumin: OR = 0.42; hemoglobin: OR = 0.77; p < 0.05). Contrast extravasation was associated with delayed takedown operation (average = 67 d), increased risk (OR = 5.25; p < 0.01), and shorter time (median = 32.0 vs 72.5 mo; HR = 5.88; p < 0.05) to pouch failure, as well as increased risk of pouch-related complications (p < 0.05).

LIMITATIONS:

The study was limited by its retrospective nature and small number of patients who developed pouch failure.

CONCLUSIONS:

Pouchography before ileostomy takedown is useful in identifying patients with ulcerative colitis at risk for postoperative complications. Radiologic resolution of IPAA-related leak does not reliably predict healing; caution is warranted in this subgroup. See Video Abstract at http://links.lww.com/DCR/A818.
Changes in Body Mass Index and Rates of Death and Transplant in Hemodialysis Patients
Authors: Brilleman Samuel L. , Moreno-Betancur Margarita , Polkinghorne Kevan R. , McDonald Stephen P. , Crowther Michael J. , Thomson Jim , Wolfe Rory
Published: November 2018

Background:

The relationship between body mass index (BMI) and patient survival in end-stage kidney disease is not well understood and has been the subject of much debate over recent years.

Methods:

This study used a latent class joint modeling approach to identify latent groups that underpinned associations between patterns of change in BMI during hemodialysis and two competing events: transplant and death without transplant. We included all adult patients who initiated chronic hemodialysis treatment in Australia or New Zealand between 2005 and 2014.

Results:

There were 16,414 patients included in the analyses; 2,365 (14%) received a transplant, 5,639 (34%) died before transplant, and 8,410 (51%) were administratively censored. Our final model characterized patients based on five broad patterns of weight change (BMI trajectories): “late BMI decline” (about 2 years after commencing hemodialysis); “rapid BMI decline” (immediately after commencing hemodialysis); “stable and normal/overweight BMI”; “stable and morbidly obese BMI”; or “increasing BMI.” Mortality rates were highest among classes with declining BMI, and the timing of weight loss coincided with the timing of increases in mortality. Within the two stable BMI classes, death rates were slightly lower among the morbidly obese.

Conclusions:

The findings from this descriptive analysis suggest a paradoxical association between obesity and better survival. However, they also suggest that the shape of the BMI trajectory is important, with stable BMI trajectories being beneficial. Future research should be aimed at understanding the causes of weight changes during dialysis, to determine whether there could be strategies to improve patient survival.
Relationship Between UGT1A4 and UGT2B7 Polymorphisms and the Steady-State Plasma Concentrations of Lamotrigine in Patients With Treatment-Resistant Depressive Disorder Receiving Lamotrigine as Augmentation Therapy
Authors: Suzuki Takeshi , Mihara Kazuo , Nagai Goyo , Kagawa Shoko , Nakamura Akifumi , Nemoto Kenji , Kondo Tsuyoshi
Published: November 2018

Background:

In a previous study, the authors had shown that in treatment-resistant depressive disorder, an early therapeutic response to lamotrigine augmentation therapy is dependent on its plasma concentrations. Lamotrigine is mainly metabolized by UGT1A4 and UGT2B7, and polymorphisms of said UGTs that affect enzyme activities have been reported. This study investigated the effect of these polymorphisms on the steady-state plasma concentrations (Css) of lamotrigine in patients with treatment-resistant depressive disorder receiving lamotrigine as augmentation therapy.

Methods:

The subjects were 103 depressed patients who had already shown insufficient response to at least 3 psychotropics including antidepressants, mood stabilizers, and atypical antipsychotics. The diagnoses were major depressive disorder (n = 46), bipolar II disorder (n = 44), and bipolar I disorder (n = 13). They received augmentation therapy with lamotrigine for 8 weeks. The final doses of lamotrigine were 100 mg/d for 67 subjects who were not taking valproate and 75 mg/d for 36 subjects taking valproate, respectively. Blood sampling was performed at the 8th week. Plasma concentrations of lamotrigine were measured by high-performance liquid chromatography. The genotypes of UGT1A4 142T>G, UGT2B7 -161C>T, and UGT2B7 372A>G were identified by polymerase chain reaction analyses.

Results:

There were no significant relationships between these polymorphisms and the Css of lamotrigine in the subjects regardless of valproate comedication.

Conclusions:

This study suggests that these genetic polymorphisms do not affect the Css of lamotrigine in patients with treatment-resistant depressive disorder receiving lamotrigine as augmentation therapy.
Pilot Study of Self-care Breath Training Exercise for Reduction of Chronic Dyspnea
Authors: Deng Gary , Feinstein Marc B. , Benusis Lara , Tin Amy L. , Stover Diane E.
Published: November 2018

Purpose:

Dyspnea related to chronic pulmonary disorders is difficult to manage. In this single-arm study, we evaluated feasibility and potential efficacy of a self-care breath training program to reduce dyspnea that persists despite standard treatments in patients with chronic lung disease.

Methods:

Adult patients with a chronic pulmonary disorder and stable moderate dyspnea received one 30-min training on specific breathing techniques, followed by audio-guided at-home practice 15 min twice daily for 6 wk, supported with weekly telephone monitoring/coaching. The feasibility endpoints, Baseline and Transition Dyspnea Indexes, 6-min walk test, Hospital Anxiety and Depression Scale, and oxygen saturation at rest and exercise were evaluated at baseline and wk 6.

Results:

Of the 23 patients enrolled over 2 yr, 19 completed the study. A majority (74%; 95% CI, 49%-91%) completed at least 75% of the home practice sessions. Significant objective improvements in physical performance, defined as distance walked, were observed after 6 wk of intervention. On average, patients walked significantly further in the 6-min walk test (59 ft; 95% CI, 18-99; P = .007). In addition, 53% reported clinically significant (20%, defined a priori) subjective improvement in the Transition Dyspnea Index, although the difference was not statistically significant (0.7; 95% CI, −0.8 to 2.3; P = .3). No significant differences were seen in the Hospital Anxiety and Depression Scale or oxygen saturation.

Conclusions:

A low-burden, low-cost, self-care breath training program improved distance walked by patients with chronic dyspnea after 6 wk of home practice. Promising data suggest that a randomized trial of this breath training program is warranted.
The US Transuranium and Uranium Registries (USTUR): A Five-Decade Follow-Up Of Plutonium and Uranium Workers
Authors: Kathren Ronald L. , Tolmachev Sergei Y.
Published: November 2018

Dedication: The research of the US Transuranium and Uranium Registries relies heavily upon postmortem autopsy findings and radiochemical analysis of tissues. The enormous debt owed to those now-deceased registrants who unselfishly voluntarily participated in the US Transuranium and Uranium Registries program through postmortem donation of their tissues and to those still-living registrants who have volunteered to be future postmortem tissue donors is hereby acknowledged with gratitude. The scientific findings derived from postmortem analysis of these tissues have been instrumental in advancing our understanding of the actinide elements in humans and have led to refinement, validation, and confidence in safety standards for those who work with these elements as well as for the general public. To these generous and anonymous persons who made this ultimate contribution, this paper is dedicated with great thanks and admiration.
High unmet need in severe chronic pruritus in the United States: results from a survey of practicing community dermatologists
Authors: Sedlack Stuart , Yosipovitch Gil , Kerby Matthew B. , Nagle Paul C. , Ständer Sonja
Published: November 2018

Introduction:

Chronic pruritus (CP) is a symptom of many diseases, but there is a scarcity of data on this condition in the US.

Methods:

We surveyed practicing, community-based US dermatologists about aspects of CP, including the number of patients seen annually, patient characteristics, treatments, and level of unmet need. US dermatologists who responded to a screening survey and reported managing ≥10 patients with CP per year were administered a 55-question web-based survey. The survey was conducted from March 27 to April 10, 2015.

Results:

A total of 212 survey responses were included in the analysis. The prevalence of CP in the dermatologists’ practices in the previous year was reported as 4.8%. Of 9 dermatologic conditions in the survey, CP was rated as having the highest level of unmet need (8.6 on a 10-point scale). Respondents reported that 32.7% of their patients had CP classified as severe/very severe, with 53.7% of patients having CP lasting for >1 year. Most dermatologists prescribed antihistamines (77.5%) or corticosteroids (76.1%) as first-line therapy to their patients with severe/very severe CP, and 36.3% of their patients did not respond to currently available treatments.

Discussion:

The combined prevalence of CP and its high level of unmet need necessitate the development of effective/tolerable treatments for this patient population.
Early Childhood Special Education Teachers' Use of Embedded Learning Opportunities Within Classroom Routines and Activities
Authors: Rahn Naomi L. , Coogle Christan Grygas , Ottley Jennifer R.
Published: November 2018

Embedded learning opportunities are one evidence-based practice for addressing individualized education program goals for young children with special needs. In this study, we used quantitative and qualitative methods to analyze 8 early childhood special education teachers' use of embedded learning opportunities during the usual conditions of typical classroom activities. We analyzed video-recorded 10-min segments of adult-directed, child-directed, and routine activities for each teacher's use of embedded learning opportunities to address their children's individualized education plan goals. In addition, we gathered qualitative data on teachers' perceptions, barriers, and needed supports regarding embedded learning opportunities. Teachers used embedded learning opportunities infrequently, but there was significant variation among teachers. Teachers used verbal antecedents (e.g., directives, questions, and models) most frequently and were most likely to address children's communication goals. There were no differences in the rate of teachers' use of embedded learning opportunities across activity types. Teachers reported needing supports such as training and additional staff to implement embedded learning opportunities. Implications for teacher training and research are discussed.
A Value-Based Payment Model for Palliative Care
Authors: Bernstein Richard H. , Singh Laura A.
Published: November 2018

Five percent of the US population accounts for 50% of total health expenditures. This “5%” problem requires moderating Medicare cost trends. SPARK, a community-based palliative care program, focused on its costliest Medicare Advantage patients. This cohort's projected costs were 280% higher than average beneficiaries, based on Medicare's risk model. Despite significant losses during enrollees' first year, a positive 5.1% ROI was found over the program's 4 years when stop-loss insurance payments were included. SPARK demonstrates that a high-quality, community-based palliative care program can be financially self-sustaining using a value-based payment model with premium plus stop-loss income exceeding actual costs.
Preparing for Community Health Worker Integration Into Clinical Care Teams Through an Understanding of Patient and Community Health Worker Readiness and Intent
Authors: Lewis Charlotte M. , Gamboa-Maldonado Thelma , Belliard Juan Carlos , Nelson Anna , Montgomery Susanne
Published: November 2018

There is a rising demand to expand the successful roles community health workers (CHWs) offer into clinical settings (clinic-based community health worker [cCHW]) to support patient services. Using survey data, we evaluated patient and CHW readiness and intent to adopt cCHW clinical care integration. We found CHW and patient readiness to become or utilize a cCHW significantly predicted CHW and patient intent to become or utilize a cCHW; however, in our study, CHWs experienced greater readiness to serve as cCHWs than did patients to utilize cCHWs.
Clinicopathological and prognostic significance of GLUT1 in breast cancer
Authors: Deng Yu , Zou Jialing , Deng Ting , Liu Junying
Published: November 2018

Background:

Previous studies examining the prognostic value of glucose transporter 1 in breast cancer have yielded inconsistent results. We, therefore, performed a meta-analysis to clarify this issue.

Methods:

The research was reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant studies were retrieved from PubMed, Web of Science, EMBASE, and Cochrane library.

Results:

A total of 7 reports with 1861 patients were finally chosen. GLUT1 overexpression was found to be associated with high histological grade (OR = 3.74, 95% CI = 2.45–5.69, P < .001), negative PR status (OR = 0.33, 95% CI = 0.22–0.49, P < .001), and negative estrogen receptor (ER) status (OR = 0.27, 95% CI = 0.17–0.42, P < .001). However, no significant correlation was seen between GLUT1 levels and presence of lymph node metastasis, tumor size or the status of human epidermal growth factor receptor 2 (HER2). Overexpression of GLUT1 also correlated with a poor overall survival (hazard ratio [HR] = 1.65, 95% confidence interval [CI] = 1.17–2.31, P = .004) and disease-free survival (HR = 2.35, 95% CI = 1.4–3.94, P < .001). No evidence of significant publication bias was found.

Conclusion:

This meta-analysis indicates that GLUT1 expression is associated with poor prognostic and a series of clinicopathological features in breast cancer. GLUT1 might be a potential biomarker and therapeutic target in breast cancer.
Resistance profile to antimicrobial agents in the main circulating bacteria isolated from acute periodontal and endodontic infections in Latin America (MICROBE- DENT)
Authors: Abe Flávia Casale , Bergamaschi Cristiane de Cássia , Figueiró Mabel Fernandes , Lopes Luciane Cruz
Published: November 2018

Background:

Antimicrobial resistance is currently considered the main risk to global health. A variety of microbial species have been isolated from endodontic and periodontal infections. However, clinical endodontic and periodontics bacterial isolates have not been sufficiently characterized with regard to their capacity for antibiotic resistance. We aim to assess the existing evidence to estimate the prevalence of the main antimicrobial resistance and multidrug resistant organisms in endodontics and periodontics and to describe their geographic distribution in Latin America.

Methods:

All types of designs and will be restricted to Latin American studies will be included in this systematic review. MEDLINE, Embase, CINAHL, BVS (LILACS, BBO - bvsalud.org), IBECS (bases.bireme.br), Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Science databases will be searched from 2013 to December 31, 2018 for all types of study designs that report microbial infection in endodontics and periodontics and their resistance and that define the microbiological methods used to identify microorganisms. The selection of articles for inclusion will be performed by 2 reviewers using predefined eligibility criteria. The Cochrane and ROBINS-I risk of bias assessment tools will be used to assess the methodological quality of randomized control trials. The Newcastle–Ottawa scale will be used to assess the quality of methodology in observational studies. The overall quality of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) using the same principles and domains applied in the quality assessment of prognostic studies. The heterogeneity of the findings will be assessed using both the χ2 test and the I
2 statistic. Sensitivity analysis will be performed by subgroup analyses and meta-regression to investigate the effect of study-level characteristics, such as age, gender, and methodological quality score, whenever possible. Publication bias across studies will be evaluated by visual inspection of the funnel plots and Begg's test for the results covered in 10 or more studies.

Results:

The evidence derived by this study will inform best practices for patients with endodontic and periodontal problems receiving antimicrobial agents.

Conclusion:

Successful completion will significantly impact clinical practice and contribute to improved prescribing competency.

Protocol registration:

PROSPERO—CRD42018077810.
Clinical significance of prognostic nutritional index in patients with glioblastomas
Authors: Ding Jin-Duo , Yao Kun , Wang Peng-Fei , Yan Chang-Xiang
Published: November 2018

Preoperative prognostic nutritional index (PNI) has been proven to be associated with clinical outcomes in patients with malignancies. However, data regarding the role of PNI in human glioblastomas (GBMs) is lacking. We, therefore, aimed to investigate the association between PNI and clinical parameters and survival in GBM patients.

This retrospective analysis included 300 GBM patients who were surgically treated at our institute from 2008 to 2017. PNI was calculated as albumin (g/L) + 5×total lymphocyte count (109/L). SPSS 22.0, GraphPad Prism 5, and X tile were the primary tools used for data analysis, figuring drawing, and calculating optimal cutoffs, respectively.

Mean albumin value, lymphocyte count, and PNI were 42.13 ± 4.43 g/L, 1.73 ± 0.71 × 109/L, and 50.80 ± 6.01, respectively. PNI was increased in patients aged ≤60 years and in men. Moreover, PNI ≥44 was associated with improved overall survival in younger patients and women. PNI was not associated with isocitric dehydrogenase (IDH)-1R132H mutations or predicted survival in GBM patients without such mutations. Univariate analysis showed that a high preoperative Karnofsky performance score, gross total resection, completed chemoradiotherapy, IDH-1R132H mutations, and higher PNI levels were associated with favorable outcomes. Multivariate analysis showed that only completed chemoradiotherapy and IDH-1R132H mutations were independent prognostic factors.

Our results indicated that PNI is associated with age and sex in GBM patients but fails to provide independent prognostic values.
Efficacy of levetiracetam compared with phenytoin in prevention of seizures in brain injured patients
Authors: Zhao Lin , Wu Yu-Peng , Qi Jin-Long , Liu Yong-Qiang , Zhang Kai , Li Wen-Ling
Published: November 2018

Background:

Early and/or late onset in patients with brain injury (BI) is associated with a poorer prognosis, and phenytoin (PHT) is standard of care to prevent seizures. Levetiracetam (LEV), an alternative antiepileptic drug, is associated with less cognitive disruption. The purpose of this study was to evaluate the safety and efficacy of LEV in the prevention of brain traumatic seizures with the standard drug PHT.

Methods:

Search the publications on comparison the safety and efficacy of LEV against the standard agent PHT in prevention of traumatic seizures in BI to January 2018. After rigorous reviewing on quality, the data were extracted from eligible trials. All trials analyzed the summary hazard ratios of the endpoints of interest.

Results:

LEV was found not more effective than PHT in terms of overall seizure (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.51–1.05; P = .09), and late seizure (OR = 0.64; 95% CI = 0.34–1.19; P = .16) occurrence. However, there is significant difference in terms of early seizure (OR = 0.63; 95% CI = 0.40–0.99; P = .04). Moreover, there were no significant differences in terms of mortality (OR = 0.67; 95% CI = 0.43–1.05; P = .08), or side effects (OR = 1.31; 95% CI = 0.80–2.15; P = .29) between groups.

Conclusion:

The meta-analysis showed that LEV prevention of seizures was associated with early seizure rates that were lower than the PHT-prolonged course of treatment. There is no statistically significant difference in the efficacy and safety profile of PHT and LEV in cases of traumatic BI.
Associations of anthropometric adiposity indexes with hypertension risk
Authors: Deng Guijuan , Yin Lu , Liu Weida , Liu Xiaoyun , Xiang Quanyong , Qian Zhenzhen , Ma Juntao , Chen Hui , Wang Yang , Hu Bo , Li Wei , Jiang Yu
Published: November 2018

Background and objective:

The association between hypertension and obesity has been confirmed, while no agreement has been reached about which anthropometric adiposity index is the best. This meta-analysis aimed to perform a systematic review and meta-analysis on the associations of hypertension risk with body mass index (BMI), waist circumstance (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), and a prospective urban and rural epidemiology study from China (PURE-China) was added into this meta-analysis as an individual study.

Methods:

Systematic literature searching was conducted to identify relevant articles published up to September 2018 in CNKI, WANFANG Data, Web of Science, SinoMed, PubMed, MEDLINE, EMBASE, Cochrane Library and cross-referencing. Literature reporting the association of hypertension risk with BMI, WC, WHR, and WHtR were defined as eligible. PURE-China data were analyzed and included as 1 eligible study into meta-analyses. Summary odds ratio (OR) and area under receiver operating characteristic curve (AUC) were pooled using meta-analysis methods. Heterogeneity and publication bias were evaluated. Subgroups based on gender, country and study design were conducted as well.

Results:

Thirty-eight original articles including PURE-China were included into meta-analyses, involving 309,585 subjects. WHtR had the strongest association with hypertension risk (OR, 1.68; 95% confidence interval, [CI]:1.29–2.19) and prediction ability (AUC, 70.9%; 95% CI: 67.8%–74.2%), which were also confirmed in subgroup analyses based on gender and country. However, BMI was found to have the highest prediction ability in adjusted models of PURE-China and followed WC, both of which were superior to WHtR (73.7% and 73.4% vs 73.2%).

Conclusions:

Our overall meta-analysis further confirmed WHtR as a good indicator at discriminating those individuals at increased risk of hypertension, and in some cases, it is better than BMI, WC, and WHR.
Transverse testicular ectopia associated with persistent Müllerian duct syndrome treated by transseptal orchiopexy
Authors: Chung Ho Seok , Kim Sun-Ouck , Yu Ho Song , Kim Sung-Sun , Kwon Dong Deuk
Published: November 2018

Rationale:

Persistent Müllerian duct syndrome (PMDS) is rare form of male pseudohermaphroditism characterized by the presence of uterus and fallopian tubes with normal external genitalia and secondary sexual characteristics. Transverse testicular ectopia (TTE) is also a rare form of testicular ectopia that may be associated with PMDS.

Patient concerns:

We present a 2-year-old boy who presented with bilateral non-palpable testes with left inguinal mass.

Diagnosis:

TTE with PMDS.

Interventions:

On exploration, both testes were present in the left inguinal region. Uterus and fallopian tubes were located between the testes. A hysterectomy was perfomed with resection of the underdeveloped fallopian tubes. Bilateral orchiopexy was performed by placing both gonads into subdartos pouches in each scrotum with transseptal approach.

Outcomes:

Both testes were palpable in both the scrotum at 1-year postoperative follow-up and we are planning a regular follow-up.

Lessons:

In case of TTE with PMDS, optimal surgical approach with orchiopexy and excision of Müllerian duct should be needed. A long-term postoperative follow-up is necessary for assessment of malignant transformation and infertility.
Study on the incidence and risk factor of silent cerebrovascular disease in young adults with first-ever stroke
Authors: Fan Huimin , Hao Xuezeng , Yang Shuna , Li Yue , Qin Wei , Yang Lei , Yuan Junliang , Hu Wenli
Published: November 2018

Silent cerebrovascular diseases, including silent brain infarcts (SBI), white matter hyperintensity (WMH), and cerebral microbleed, are closely correlated with stroke progression. The purpose of this study was to investigate the prevalence and potential risk factors of SBI and WMH in young patients with first-ever stroke.

A total of 400 young patients with first-ever stroke were included in this study and received magnetic resonance imaging test. The distributions of stroke subtypes were analyzed based on patients’ age and gender. The prevalence of SBI and WMH was evaluated in different age groups and stroke subtypes. Independent risk factors for SBI and WMH were identified using logistic regression analysis.

The distribution of stroke subtypes was not correlated with patients’ age or gender in our study. The incidence of SBI and WMH among all of the young stroke patients was 14.50% and 8.75%, respectively, which showed an upward tendency with age. The percentages of both SBI and WMH were significantly higher in small-vessel disease patients than in cases with other subtype diseases (all P < .05). Hypertension (odds ratio [OR] = 2.645, 95% confidence interval [CI] = 1.429–4.896, P = .002 for SBI; OR = 5.474, 95% CI = 2.319–12.921, P = .000 for WMH; OR = 39.988, 95% CI = 3.988–400.949, P = .002 for SBI and WMH) and homocysteine (OR = 4.033, 95% CI = 2.191–7.425, P = .000 for SBI; OR = 5.989, 95% CI = 2.637–13.602, P = .000 for WMH; OR = 4.068, 95% CI = 1.207–13.715, P = .024 for SBI and WMH) might be potential risk factors for SBI and WMH.

The prevalence of silent cerebrovascular disease was elevated with age. Hypertension and elevated homocysteine levels were 2 risk factors for silent cerebrovascular disease in young stroke patients.
Treatment of persistent postoperative hiccups with stellate ganglion block
Authors: Lee A Ran , Cho Young Woo , Lee Jae Min , Shin Yong Joon , Han Il Sang , Lee Hyung Kwan
Published: November 2018

Rationale:

Although persistent postoperative hiccups can cause various problems (such as sleep disorders, depression, fatigue) for the patient, there has been little research on this topic. The purpose of this study is to determine the effectiveness of treating persistent postoperative hiccups with a stellate ganglion block (SGB), an injection of local anesthetic in the sympathetic nerve tissue of the neck.

Patient concerns and diagnoses:

Three patients each developed persistent hiccups within 3 days of abdominal surgery, lasting for 3 to 6 days. The patients were diagnosed as having persistent hiccups based on the hiccup duration.

Interventions and outcomes:

The 3 patients were treated with an SGB. After the procedure, the frequency and intensity of hiccups decreased and then the hiccups stopped completely.

Conclusion:

An SGB is an effective method that can be considered in conjunction with other treatments for persistent hiccups. Clinicians should be mindful of the negative effects that persistent hiccups can exert on patients.
Percutaneous endoscopic lumbar discectomy by transfacet joint approach
Authors: Ning Cong , Wang Yuanyi , Xu Feng , Zhang Wenjing , Liu Wei , Lv Zhenshan , Liu Yadong , Fu Changfeng
Published: November 2018

Rationale:

The accurate and smooth establishment of a working cannula guarantees rapid and minimally invasive treatment effects using percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH). With anatomic variations such as a hyperplastic superior articular process (SAP), the conventional transforaminal approach cannot achieve an ideal result.

Patient concerns:

A 48-year-old male patient suffered waist and left lower limb pain, with exacerbation of symptoms after exertion.

Diagnoses:

L5-S1 disc herniation, hyperplastic SAP of S1.

Interventions:

To demonstrate the segment responsible for compression, a lumbar nerve root block was carried out. This was followed by PELD via a transfacet joint approach at L5-S1.

Outcomes:

The patient experienced an improved quality of life postoperatively (i.e., visual analog score for pain = 1 and Oswestry disability index  = 88). Lumbar function and stability were preserved as of the 1-month postoperative follow-up.

Lessons:

The transfacet joint approach could extend the indications for PELD and present an alternative option in selected cases. A new concept of “subsidence foramen” is raised to characterize this anatomic variation, and it may guide working access establishment of PELD. In addition, reading imaging results carefully and individualizing treatments promote the use of PELD as minimally invasive surgery.
NRAGE is a potential diagnostic biomarker of hepatocellular carcinoma
Authors: Zou Wenshuang , Cui Junfeng , Ren Zhong , Leng Yan
Published: November 2018

Hepatocellular carcinoma (HCC) is one of the most common cancers and a leading cause of cancer-related deaths worldwide. Early diagnosis of HCC remains a great challenge in clinic. Novel and effective biomarkers are in urgent need in early diagnosis of HCC.

Serum levels of neurotrophin-receptor-interacting melanoma antigen-encoding gene homolog (NRAGE) were measured for 107 patients with HCC, 98 patients with benign liver diseases, and 89 healthy controls using quantitative real-time polymerase chain reaction. Receiver operating characteristic curve was applied to evaluate the diagnostic capacity of serum NRAGE in HCC.

NRAGE expression was significantly higher in patients with HCC than in controls (all, P < .05). Moreover, its expression was tightly correlated with TNM stage (P = .004). NRAGE could distinguish patients with HCC from healthy controls with the area under the curve (AUC) of 0.874, yielding a sensitivity of 81.3% and a specificity of 78.7%. Additionally, in differentiation between benign liver diseases and HCC, the AUC value of NRAGE was 0.726, with a sensitivity of 63.6% and a specificity of 73.5%. Meanwhile, alpha-fetoprotein also could distinguish patients with HCC from benign liver disease cases, with an AUC of 0.677, a sensitivity of 64.4%, and a specificity of 60.2%.

NRAGE could be a potential biomarker for HCC early diagnosis.
Profiles of genomic alterations in primary esophageal follicular dendritic cell sarcoma
Authors: Ren Wei , Sun Qi , Wu Pu-Yuan , Huang Bin , Yang Ju , Yan Jing , Liu Bao-Rui
Published: November 2018

Rationale:

Follicular dendritic cell (FDC) sarcoma is a rare tumor with FDC differentiation that typically arises within lymph nodes but can also occur extranodally. To date, the primary esophageal FDC sarcoma has not been reported in the English literature.

Patient concerns:

We described a 67-year-old female who foremostly presented with dysphagia, and the patient was readmitted due to a dry cough and pain of his right shoulder 2 years after initial treatment.

Diagnoses:

Primary esophageal FDC sarcoma with the right superior mediastinal lymph node metastasis.

Interventions:

The esophageal tumor was removed by endoscopic submucosal dissection at the first hospitalization. At the second hospitalization 2 years after the initial visit, the tracheal stent loaded with (125) iodine radioactive seeds was placed. The profiles of genetic variations and immunotherapeutic biomarkers were also explored by next-generation sequencing protocol from the patient's blood, esophageal primary, and mediastinal metastatic tumor samples.

Outcomes:

The patient's symptom transitorily relieved, but she gave up further treatment and died 2 months after the tracheal stent was placed. As for the genomic alterations, we found 9 gene mutations in all the samples, including checkpoint kinase 2(CHEK2), FAT atypical cadherin 1 (FAT1), tumor protein 53 (TP53), DPYD, ERBB2 interacting protein (ERBB2IP), FBXW7, KMT2D, PPP2R1A, TSC2, whereas amplification of MYC was only in the metastatic example. The analysis of clonal evolution and phylogenetic tree showed the propagation and replay of polyclonal esophageal FDC sarcoma. At the same time, the detection of biomarkers for immunotherapy revealed microsatellite stable and mismatch repair-proficient (pMMR), which predicted a relatively poor anti-programmed death (PD-1)/programmed death ligand (PD-L1) immunotherapy outcome. On the contrary, the tumor mutational burdens were 10 mutations per 1 million bases in both the primary and metastatic tumor sample, which ranked the top 23.3% in solid tumors mutational burdens database of Geneseeq and might be a good predictor of the efficacy of anti-PD-1/PD-L1 immunotherapy.

Lessons:

To the best of our knowledge, this case report announced the first case of extranodal primary esophageal FDC sarcoma in the world, and firstly revealed its unique genetic alterations profiles, which might contribute to further in-depth study of this rare disease.
Predictive value of preoperative monocyte–lymphocyte ratio among patients with localized clear renal cell carcinoma of ≤7 cm on preoperative imaging
Authors: Elghiaty Ahmed , Kim Jongchan , Jang Won Sik , Park Jee Soo , Heo Ji Eun , Rha Koon Ho , Choi Young Deuk , Ham Won Sik
Published: November 2018

We investigated the prognostic ability of preoperative monocyte–lymphocyte ratio for oncologic outcomes in non-metastatic clear cell renal cell carcinoma of ≤7 cm on preoperative computed tomography (CT).

We retrospectively reviewed 1637 patients who underwent radical or partial nephrectomy for solid renal masses ≤7 cm (2005–2014). We included 1137 patients after exclusion of benign pathology, non-clear cell, morbidity affecting inflammatory markers, metastasis, regional lymphadenopathy, positive margin, and follow up <12 months. According to cutoff values of 0.21, we had high ≥0.21 and low <0.21 preoperative monocyte–lymphocyte ratio groups. Mann–Whitney U and chi-squared tests were used for continuous and Dichotomous variables. Univariate and multivariate Cox regression analysis were used to predict factors affecting recurrence and survival. Kaplan–Meier curve was used for survival analysis.

At a median age of 56 years with a median follow up of 65 months, 51 patients had a recurrence (4.5%). There were no statistical differences between the high and low monocyte–lymphocyte ratio groups as regard the pathological characters (P > .005). Monocyte–lymphocyte ratio was a predictor for recurrence-free and cancer-specific survivals (hazard risk [HR] 2.17, P = .012 and HR 4.06, P = .004, respectively). A higher monocyte–lymphocyte ratio was significantly associated with worse, both 10-year recurrence-free (90.2% vs 94.9%) and cancer-specific survival (89.5% vs 98.8%) (Log-rank, P = .002 and P < .001, respectively).

The preoperative monocyte–lymphocyte ratio is an independent prognostic marker for recurrence-free and cancer-specific survivals after curative surgery for non-metastatic clear cell renal cell carcinoma of ≤7 cm on preoperative CT.
Hemangiomas of the tongue and the oral cavity in a myotonic dystrophy type 1 patient
Authors: Portaro Simona , Naro Antonino , Guarneri Claudio , Di Toro Giuseppe , Manuli Alfredo , Calabrò Rocco Salvatore
Published: November 2018

Rationale:

Myotonic dystrophy type 1 (DM1) is an autosomal dominant disease caused by a cytosine, guanine, thymine (CTG) trinucleotide repeat expansion in the non-coding region of dystrophia myotonica protein kinase gene, causing a multisystem involvement. To date, few studies have been performed to evaluate skin features in DM1 patients, but none reported on the possible association between the disease and tongue hemangiomas.

Patients concerns:

We report a case of a 63-year-old woman affected by DM1 and presenting, at the intraoral examination, several swelling and buish lesions occurring on buccal and palatal mucosa, and in the anterior two-thirds and margins of the tongue.

Diagnosis:

Multiple tongue hemangiomas in DM1 patient.

Interventions:

Color Doppler ultrasound revealed hypoechoic lesions with intermittent color picking suggestive of vascular lesion. Surgical excision was performed under general anesthesia. Histopathological examination was compatible with the diagnosis of cavernous hemangiomas.

Outcomes:

At 6 months follow-up, a part from the cosmetic deformity, patient's hemangiomas did not bleed, but caused functional problems with speaking, mastication, and deglutition, in addition to the same symptoms induced by DM1.

Lessons:

This case may add new details to better characterize the DM1 phenotype, suggesting that even tongue hemangiomas may be part of the DM1 multisystem involvement.
Curved periacetabular osteotomy using intraoperative real-time 3-dimensional computed tomography with a robotic C-arm system
Authors: Goshi Ariha , Fukunishi Shigeo , Okahisa Shohei , Okada Taishi , Yoshiya Shinichi
Published: November 2018

Rationale:

Curved periacetabular osteotomy (CPO) is a procedure with excellent surgical outcome that has been proposed for patients with development dysplasia of the hip (DDH). However, the surgical outcomes depend on the surgeon's experience and proficiency.

Patient concerns:

A 38-year-old female indicated she was experiencing left hip pain while walking.

Diagnoses:

The patient was diagnosed with early-stage hip osteoarthritis due to DDH.

Interventions:

The patient underwent CPO while a 3-dimensional flat-panel C-arm (Artis zeego; Sciemens Healthcare, Forchheim, Germany) was used to confirm the real-time 3-dimensional computed tomography (CT) images during surgery. It was possible to confirm the accurate osteotomy curve using CT images twice during surgery: at the time of the ischial osteotomy and the quadrilateral surface osteotomy.

Outcomes:

An ideal C-shaped osteotomy line was created as shown on the postoperative CT images. In addition, neither posterior column fracture nor intra-articular osteotomy was confirmed.

Lessons:

The CPO using Artis zeego resulted is a satisfactory outcome, and this is the 1st report in the world to discuss the benefits of Artis zeego in pelvic osteotomy.
Complementary and Alternative Medicine Use in Children With Inflammatory Bowel Disease
Authors: Phatak Uma P. , Alper Arik , Pashankar Dinesh S.
Published: November 2018

Complementary and alternative medicine (CAM) consists of products and practices that are not considered to be a part of conventional medicine. This article reviews pediatric studies on CAM in inflammatory bowel disease (IBD) along with relevant adult studies. Prevalence of CAM use ranges from 22% to 84% in children with IBD all over the world. CAM use in IBD includes diet changes, supplements, herbals, botanicals, and mind‐body therapies. Common reasons for using CAM include severe disease and concern for adverse effects of conventional medicines. Despite widespread use, there are limited studies on efficacy and safety of CAM in children. Small studies suggest a favorable evidence for use of probiotics, fish oil, marijuana, and mind‐body therapy in IBD. Adverse effects of CAM are reported but are rare. The article provides current state of knowledge on the topic and provides guidance to physicians to address CAM use in pediatric patients with IBD.
Disease Self-Efficacy and Health-Related Quality of Life in Adolescents With Sickle Cell Disease
Authors: Goldstein-Leever Alana , Peugh James L. , Quinn Charles T. , Crosby Lori E.
Published: November 2018

Adolescents and young adults (AYA) with sickle cell disease (SCD) are at risk for poor health-related quality of life (HRQOL). Research suggests that vulnerability factors (eg, disease severity) and self-management resources (eg, disease self-efficacy) jointly impact health outcomes, including HRQOL; however, this has not been studied among AYA with SCD. This study examined the relationship between disease self-efficacy, HRQOL, and disease severity in AYA with SCD. HRQOL was positively correlated with disease self-efficacy and negatively correlated with disease severity. Disease self-efficacy and severity accounted for 35% of variance in HRQOL. Findings support the impact of disease self-efficacy on HRQOL.
Using Videoconferencing for Verbal Reports to Improve Clinical Nurse Specialist Student Performance
Authors: Joiner-Rogers Glenda L. , Delville Carol L. , Timmerman Gayle M.
Published: November 2018

Purpose:

Clear, concise verbal reports are essential to clinical nurse specialists’ practice, yet current literature addressing the development of this skill is sparse. The purpose of this study is to determine the effectiveness of using videoconferencing for verbal reports as a learning strategy for improving clinical nurse specialist students’ communication competencies and advanced practice decision making.

Description of the Project:

Videoconferencing, using iPad minis issued to faculty and students, was used routinely for verbal reports on clinical cases to faculty, which included immediate faculty feedback. A verbal report template of patient chief complaint, applicable history, review of systems, physical examination/labs, differential diagnoses, and management was developed and provided to students.

Outcome:

Initial student verbal reports were disorganized, lengthy, lacking content, or containing extraneous details. After students routinely gave verbal reports via videoconferencing, verbal report time for the class decreased from more than 20 minutes to 3 to 5 minutes and the accuracy of reports also increased.

Conclusion:

A concise, clinically relevant verbal report template, combined with videoconferencing that allowed for frequent and immediate feedback from faculty, improved student communication competencies. Current technology, such as tablets and smart phones, provide videoconferencing opportunities that can be used to enhance learning for students.
Embolization of Endocardial Vegetation With Stroke Presentation
Authors: Birsic George W. , Fulcher James W. , Fiester Steven E.
Published: November 2018

This case report details the unique cause of death of a 37-year-old Caucasian woman with a history significant for intravenous drug abuse. Before her death, she complained of extremity weakness and pain. Although her death was discovered to be the result of endocarditis, her symptoms were similar to that of a stroke. Autopsy revealed a large endocardial vegetation infecting both the tricuspid and mitral valves and a patent foramen ovale. The subsequent embolization of this vegetation caused blockages in the lungs, liver, and brain. An acute embolization of these vegetations to the bilateral middle cerebral arteries is the cause of the stroke presentation. Other comorbidities, such as cardiomegaly, microscopic evidence of myocardial infarction, and atherosclerotic disease, also contributed to the cause of death. As the opioid crisis continues in the United States, it is important to review cases involving the effects of drug use. The multiple interactions between endocarditis and the aforementioned conditions are documented to not only serve as references for future autopsies but also for the treatment of patients who have similar symptoms and comorbidities.
Consecutive Immunohistochemical Staining on a Single Slide is Effective in Confirming Melanocytic Derivation
Authors: Campbell Katelynn K. , Gardner Jerad M. , Hall Kim , Osborne Amanda , Shalin Sara C.
Published: November 2018

Background:

Metastatic melanoma in sentinel lymph nodes is often elusive to detect with morphology alone. Per American Joint Committee on Cancer staging guidelines, a single atypical melanocyte in lymph node qualifies as metastasis, whether identified by morphology or immunohistochemistry, but single cell staining must be convincing. We propose that the use of a second immunohistochemical run performed on a single slide will allow for more confident diagnosis of micrometastases.

Materials and Methods:

We designed a technical study to determine whether a second antibody application on previously stained slides can successfully detect the same population of cells. Melanocytic neoplasms were stained with SOX-10 using Ventana Benchmark Ultra stainers, coverslipped, and examined, followed by coverslip removal and application of MART-1 (Ventana A103). The order of antibody application and chromagen detection kit (AP-RED vs. DAB) was reversed to establish reliability and robustness of the protocol.

Results:

All melanocytes marked with SOX-10 and MART-1, and produced a range of staining quality that varied based on order of stain application and chromagen kit were used. The optimal combination was red MART-1 applied first followed by brown SOX-10 applied second.

Conclusions:

Consecutive staining of melanocytes with SOX-10 and MART-1 may improve diagnostic confidence of melanocyte identification, particularly in detection of single cell, micrometastases in sentinel lymph nodes or in situations where dual immunohistochemical stains may be unavailable.