bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful treatment of disseminated intravascular coagulation by recombinant human soluble thrombomodulin in patients with acute myeloid leukemia
Authors: Ookura Miyuki , Hosono Naoko , Tasaki Toshiki , Oiwa Kana , Fujita Kei , Ito Kazuhiro , Lee Shin , Matsuda Yasufumi , Morita Mihoko , Tai Katsunori , Negoro Eiju , Kishi Shinji , Iwasaki Hiromichi , Ueda Takanori , Yamauchi Takahiro
Published: October 2018

Disseminated intravascular coagulation (DIC) is a life-threatening condition that frequently occurs in patients with hematologic malignancies. Currently, recombinant human soluble thrombomodulin (rTM) is a therapeutic DIC drug that is manufactured and sold in Japan only. We evaluated the efficacy of rTM compared to that of gabexate mesilate (GM), which was previously used routinely for treating DIC in Japan, in patients with acute myeloid leukemia (AML). This retrospective study enrolled 43 AML patients, including 17 with acute promyelocytic leukemia (APL), that was complicated with DIC. DIC resolution rates in non-APL AML and rTM-treated APL patients were 68.4% and 81.8%, respectively. In non-APL AML patients, the duration of rTM administration was significantly shorter than that of GM (7 vs 11 days), suggesting that rTM could improve DIC earlier than GM, although rTM was used in patients with more severe DIC. Moreover, treatment with rTM significantly improved DIC score, fibrinogen, fibrin/fibrinogen degradation product (FDP), and prothrombin time (PT) ratio. Conversely, treatment with GM only improved the DIC score and FDP. In APL patients, the duration of rTM administration was also significantly shorter than that of GM. No severe side effects associated with the progression of bleeding were observed during rTM administration. These findings suggest that rTM is safe, and its anti-DIC effects are more prompt than GM for treating AML patients with DIC.
Influence of an inconsistent appearance of antipsychotics on drug adherence in patients with schizophrenia
Authors: Lertxundi Unax , Hernandez Rafael , Corcóstegui Beatriz , Ibarra Olatz , Mentxaka Gorka , Medrano Juan
Published: October 2018

In this study, we aimed to determine whether an inconsistent appearance of antipsychotic drugs dispensed was associated with poorer adherence in patients with schizophrenia.

To conduct this study, we linked information from different administrative healthcare databases from the Basque Country. Patients with a medication possession ratio (<80%) were considered to be nonadherent.

More than a quarter of the study population (26.9%, 1294/4810) was nonadherent to antipsychotics. Different brands of the same antipsychotic were dispensed to 8.5% of the patients. Inconsistent appearance was not associated with nonadherence to antipsychotics. Lower adherence to antipsychotics was associated with several other factors: age ≥65 or <30 years, prescription of typical antipsychotics or of long-acting injectable compounds, and nonadherence to antihypertensive and lipid-lowering drugs.

Contrary to our expectations, we did not find a significant association between inconsistent appearance of prescribed antipsychotics and poorer adherence. The percentage of patients who were dispensed different brands of the same antipsychotics was also lower than expected.
Positive non-sentinel axillary lymph nodes in breast cancer with 1-2 sentinel lymph node metastases
Authors: Zheng Jianwei , Cai Shuyan , Song Huimin , Wang Yunlei , Han Xiaofeng , Wu Haoliang , Gao Zhigang , Qiu Fanrong
Published: October 2018

Recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection (ALND) can offer excellent regional control if there is sentinel lymph nodes (SLN) metastases to 1-2 nodes. This study aimed to explore the predictive factors for non-sentinel lymph node (NSLN) metastasis in breast cancer patients with 1-2 positive SLNs.

Patients with breast cancer and 1-2 positive SLN admitted between March 2009 and March 2017 and who underwent ALND after SLN biopsy (SLNB) at Beijing Chaoyang Hospital were analyzed retrospectively. Factors influencing the status of NSLN were studied by univariate and multivariate analysis.

Of 1125 patients, 147 patients had SLN metastasis (13.1%) and 119 patients (81.0%) had 1-2 positive SLNs. Among them, 42 patients (35.3%) had NSLN metastasis. The invasive tumor size (P <.001), histological grade (P =.011), lymphovascular invasion (LVI) (P =.006), and over-expression of HER2 (P =.025) significantly correlated with non-SLN metastasis by univariate analysis. LVI (LVI) (P =.007; OR: 4.130; 95% confidence interval [CI]: 1.465–11.641), invasive tumor size (P <.001; OR: 7.176; 95% CI: 2.710–19.002), and HER2 over-expression (P =.006; OR: 5.489; 95% CI: 1.635–18.428) were independently associated with NSLN metastasis by the Logistic regression model. The ROC analysis identified a cut-off point of 26 mm of tumor size (area under the receiver operating characteristic [ROC] curve [AUC] 0.712, CI: 0.614–0.811) was useful for dividing patients with positive SLN (1-2 nodes) into non-SLN-positive and non-SLN-negative groups.

For 1-2 positive SLNs of breast cancer, LVI, large invasive tumor size, and HER2 over-expression are independent factors affecting NSLN metastases.
Langerhans cell histiocytosis complicated with hemophagocytic lymphohistiocytosis in a boy with a novel XIAP mutation
Authors: Guo Xia , Li Qiang , Gao Ju
Published: October 2018

Rationale:

X-linked lymphoproliferative syndromes (XLPs) are rare, yet often fatal primary immunodeficiency diseases, which rarely manifest as Langerhans cell histiocytosis (LCH) complicated with hemophagocytic lymphohistiocytosis (HLH). Clinical data of a case of XLP-2 manifesting as LCH complicated with HLH was retrospectively analyzed to determine the etiology and causal gene.

Patient concerns and diagnosis:

The diagnosis of multisystem LCH was confirmed by skin biopsy and other examinations in a 13-month boy with recurrent ear discharge, fever and hemorrhagic papules for 3 months. A good therapeutic response to LCH-III protocol-directed induction chemotherapy was achieved but unremitting HLH developed 6 weeks after the initiation of induction chemotherapy. To identify possible underlying genetic causes, gene mutation analysis was undertaken. A novel XIAP gene mutation (c.99delT, p.F33fsX37) was documented.

Interventions:

After the diagnosis of HLH had been confirmed, HLH-2004-directed chemotherapy was instituted.

Outcomes:

The clinical condition of the patient had become progressively deteriorating after 8-week chemotherapy of HLH-2004 protocol, requiring frequent infusions of RBC suspensions and apheresis platelets. His parents decided to receive no further therapy, and the patient died soon after discharge.

Lessons:

Meticulous laboratory investigations including genetic studies should be undertaken in young children with LCH complicated with HLH and poor therapeutic response.
Prostaglandin E1 plus methylcobalamin combination therapy versus prostaglandin E1 monotherapy for patients with diabetic peripheral neuropathy
Authors: Jiang De-Qi , Zhao Shi-Hua , Li Ming-Xing , Jiang Li-Lin , Wang Yong , Wang Yan
Published: October 2018

Background:

Prostaglandin E1 (P) or methylcobalamin (M) treatment has been suggested as a therapeutic approach for diabetic peripheral neuropathy (DPN) in many clinical trial reports. However, the combined effects of 2 drugs still remain dubious.

Objective:

The aim of this report was to evaluate the efficacy of M plus P (M + P) for the treatment of DPN compared with that of P monotherapy, in order to provide a reference resource for rational drug use.

Methods:

Randomized controlled trials (RCTs) of M + P for DPN published up to September 2017 were searched. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated and heterogeneity was assessed with the I
2 test. Subgroup and sensitivity analyses were also performed. The outcomes measured were as follows: the clinical efficacy, median motor nerve conduction velocities (MNCV), median sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV, and adverse effects.

Results:

Sixteen RCTs with 1136 participants were included. Clinical efficacy of M + P combination therapy was significantly better than P monotherapy (fifteen trials; RR 1.25, 95% CI 1.18–1.32, P < .00001, I
2 = 27%). Compared with P monotherapy, the pooled effects of M + P combination therapy on nerve conduction velocity were (MD 6.29, 95% CI 4.63–7.94, P < .00001, I
2 = 90%) for median MNCV, (MD 5.68, 95% CI 3.53–7.83, P < .00001, I
2 = 94%) for median SNCV, (MD 5.36, 95% CI 3.86–6.87, P < .00001, I
2 = 92%) for peroneal MNCV, (MD 4.62, 95% CI 3.48–5.75, P < .00001, I
2 = 86%) for peroneal SNCV. There were no serious adverse events associated with drug intervention.

Conclusions:

M + P combination therapy was superior to P monotherapy for improvement of neuropathic symptoms and NCVs in DPN patients. Moreover, no serious adverse events occur in combination therapy.
Pregnancy and pulmonary hypertension
Authors: Sun Xuefeng , Feng Jun , Shi Juhong
Published: October 2018

Pregnancy is usually contraindicated in patients with pulmonary hypertension (PH). Risk factors associated with the outcome of this rare disease have not been specifically explored before.

Medical records were retrospectively reviewed to identify patients with coexisting PH and pregnancy or delivery at Peking Union Medical College Hospital between January 2009 and June 2018. Demographics, characteristics of PH and pregnancy, management and outcomes were analyzed.

Thirty-six pregnant women with PH were identified, including 30 cases in WHO group 1, 5 cases of group 2 and 1 case of group 4. Median pregnancy duration was 24 weeks. The overall maternal mortality rate was 8.3% (3/36), and the late fetal mortality was 31.6% (6/19). Pulmonary vascular-targeted medications were used in 17 of 26 patients with moderate or severe PH, but in none with mild PH. Maternal mortality was 2/15, 1/11, and 0 among women with severe, moderate, and mild PH, respectively. All deaths reported to be diagnosed of PH after pregnancy, and have New York Heart Association (NYHA) grades II to IV. Cesarean section was performed in 22 patients, and mortality was 3/16 among women receiving cesarean section with general anesthesia.

Maternal mortality is associated with PH classification, severity of PH, delayed diagnosis of PH, and NYHA classification. Regional anesthesia seems superior to general anesthesia for cesarean section.
Effect of microecological preparation supplementation on woman with polycystic ovary syndrome
Authors: Zhang Haibo , Wen Wenting , Shen Junlong , Wei Luxia
Published: October 2018

Background:

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. PCOS not only affects female fertility, but is also associated with a variety of metabolic diseases, such as type 2 diabetes. Microecological preparations include probiotics, prebiotics, and synbiotics, and a number of studies have shown its advantages in reducing cardiovascular and cerebrovascular diseases in patients with PCOS, however, no meta-analysis has been performed to confirm that. Herein, we describe the protocol of a proposed study based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that aims to systematically evaluate the efficacy and safety of microecological preparation supplementation in woman with PCOS.

Methods:

Two researchers will search 9 electronic databases (PubMed, Cochrane Library, Embase, ClinicalTrails, China National Knowledge Infrastructure, Sino Med, ScienceDirect, VIP, and Wanfang Data databases) to identify all studies that meet the inclusion criteria and were published before November 1, 2018. After information extraction and methodological quality evaluation, we will use RevMan software (version 5.3) to synthesize the data. The primary outcomes will be fasting blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and very low-density lipoprotein cholesterol (VLDL-c).

Results:

This study will provide a high-quality synthesis of existing evidence on the effect and safety of microecological preparation supplementation on reducing cardiovascular risk of woman with PCOS.

Conclusion:

This study will determine if microecological preparation supplementation is an effective and safe intervention on reducing cardiovascular risk of woman with PCOS.

Registration:

PROSPERO (registration number: CRD42018108403).
Comparison of platelet-rich plasma vs hyaluronic acid injections in patients with knee osteoarthritis
Authors: Han Yan-hong , Huang He-tao , Pan Jian-ke , Lin Jiong-tong , Zeng Ling-feng , Liang Gui-hong , Yang Wei-yi , Liu Jun
Published: October 2018

Background:

Knee osteoarthritis (KOA) is a progressive joint disease involving intraarticular and periarticular structures. In recent years, there has been increasing interest in the use of autologous growth factors, such as intraarticular injections of platelet-rich plasma (PRP), to treat KOA. It is necessary to update the research and reevaluate the efficacy and safety of PRP to provide up-to-date evidence for KOA management. Therefore, we provide a protocol for a systematic review of PRP for KOA.

Methods:

The aim of this study was to retrieve papers on the topic of PRP treatment for KOA in electronic databases including PubMed, Embase, and the Cochrane Library. The search will include studies that were published from the time the databases were established until April 2018. The entire process will include study selection, data extraction, risk of bias assessment, and meta-analyses.

Results:

The literature will provide a high-quality analysis of the current evidence supporting PRP for KOA based on various comprehensive assessments including the Western Ontario and McMaster Universities Osteoarthritis Index, visual analog scale scores, International Knee Documentation Committee scores, Lequesne index scores, and adverse events.

Conclusion:

This proposed systematic review will provide up-to-date evidence to assess the effect of PRP treatment for patients with KOA.

PROSPERO registration number:

CRD42018108825.
Prognostic significance of matrix metalloproteinase 9 expression in osteosarcoma
Authors: Zhou Jian , Liu Tang , Wang Wanchun
Published: October 2018

Background:

Matrix metalloproteinase 9 (MMP-9) is significant in the progression of osteosarcoma (OS) via increasing tumor growth, invasion and metastasis. Although previous reports indicate the prognostic value of MMP-9 in OS, there is still a great degree on inconsistency between studies. Here we report a comprehensive evaluation of the value of MMP-9 in metastasis of OS by conducting a meta-analysis of published studies.

Methods:

The quantity of the studies was evaluated using the Newcastle-Ottawa quality assessment scale (NOS). Sixteen studies with a total of 816 patients with OS were examined and we calculated the pooled odds ratio (OR) with corresponding 95% confidence interval (CI) (95% CI) to evaluate that the positive expression of MMP-9 predicts neoplasm metastasis and poor survival in OS.

Results:

The results of Meta-analysis indicated that patients with positive expression of MMP-9 were significantly associated with neoplasm metastasis (OR = 4.69, 95% CI: 3.05–7.21, P <.001) and poor survival in OS with the pooled OR of 7.19 (95% CI 4.32–11.98, P <.001) when compared to their counterparts with a negative expression of MMP-9. The results of sensitivity analysis showed that the pooled OR was stable. It doesn’t significantly change when a single study was removed.

Conclusions:

The results of meta-analysis indicated that MMP-9 may be a prognostic biomarker guiding the clinical therapy for OS.
Effects of Quartz Splint Woven fiber periodontal fixtures on evaluating masticatory efficiency and efficacy
Authors: Su Jiangling , Cai Shixiong
Published: October 2018

Masticatory efficiency is altered by mobile teeth resulting from periodontal disease. The goal of our study was to investigate changes before and after fixation of mobile teeth with a Quartz Splint Woven high-strength quartz fiber splint and evaluate the fixation effect.

Forty-two patients with chronic severe periodontal disease and 2 to 3 degree tooth mobility underwent fixation with Quartz Splint Woven quartz fiber splints. Masticatory efficiency was determined before and 1 month after periodontal treatment, and 1 month after fixation. Changes in periodontal probing depth (PD) and periodontal attachment level (AL) were measured and clinical efficacy was evaluated.

Masticatory efficiency significantly increased from 39.32% to 50.95% after treatment (P < .001). One month post-fixation, mastication efficiency increased to 67.99% (P < .001). At 3 months post-fixation, efficacy was 100% and at 6 months it was 95.24%; PD decreased from (4.91 ± 0.63) to (4.19 ± 0.60) mm at 1 month post-periodontal treatment, and significantly decreased to (3.73 ± 0.60) mm 1 month post-fixation (P < .001); AL decreased from (4.43 ± 0.58) to (3.96 ± 0.51) mm 1 month after periodontal treatment. One month post-fixation, AL reduced to (3.64  ± 0.46) mm (P < .001).

Masticatory efficiency improved after periodontal treatment. Using Quartz Splint Woven quartz fiber periodontal splint for mobile tooth fixation can further improve mastication efficiency and periodontal condition. A stable and ideal fixation can be achieved within 6 months, which provides a clinical basis for treatment and preserving mobile teeth in severe periodontal disease. Mastication efficiency may be recommended as the index for evaluating curative effects of periodontal disease treatment.
Very late onset post-transplant diffuse large B cell lymphoma in a liver transplant recipient with hepatitis B
Authors: Yu Fan , Huang Yuehua , Wang Yanying , Yu Zhuo , Li Xinquan , Dong Jiahong
Published: October 2018

Rationale:

Post transplantation lymphoproliferative disorder (PTLD) is a rare but severe complication. Epstein-Barr virus (EBV) is considered an important pathogen for PTLD and EBV deoxyribonucleic acid (DNA) load is widely monitored to detect PTLD early. Hepatitis B virus (HBV) infection is rarely reported to be related with PTLD. We report a case of EBV negative (EBV−), HBV positive (HBV+) diffuse large B cell lymphoma in a patient 12 years after liver transplantation.

Patient concerns and diagnosis:

A 52-year-old man complained of worsening appetite, abdominal distension, and pruritus. Abdominal computed tomography (CT) detected a huge retroperitoneal mass and pathology of the fine needle biopsy established the diagnosis of diffuse large B cell lymphoma. Virology showed active hepatitis B viral duplication and EBV DNA was negative.

Intervention:

Treatment modalities for this patient included: reduction and subsequent cessation of immunosuppression; antiviral therapy for HBV with entecavir and adefovir; conventional chemotherapy consisting of cyclophosphamide, epirubicin, vindesine, and prednisone, followed by radiotherapy. He achieved complete remission (CR) and was kept on entecavir treatment afterwards.

Outcomes:

He has been in remission for 2 years.

Lessons:

HBV infection might have played some role in this very late onset EBV− PTLD patient. Therefore, HBV serology and HBV load should be monitored during the follow-up of HBV surface antigen positive (HBsAg+) transplant recipients and life-long antiviral therapy is required.
T-cell large granular lymphocytic leukemia associated with renal cell carcinoma
Authors: Qiu Zhi-Yuan , Wang Yan , Zhang Jun , Zhang Zhao , Fan Lei , Wang Rong , Wu Yu-Jie , Zhang Ye-Qing , Xu Wei , Li Jian-Yong
Published: October 2018

Rationale:

T-cell large granular lymphocytic leukemia (T-LGLL) is a rare lymphoproliferative neoplasm of cytotoxic T cells and renal cell carcinoma (RCC) is the most common form of kidney cancer, but T-LGLL associated with RCC has never been reported.

Patient concerns:

A 58-year-old Chinese male presented with general fatigue and intermittent-remittent fever, accompanied by palpitations and dizziness.

Diagnosis:

Radical nephrectomy was performed, and a diagnosis of clear cell carcinoma (T1N0M0, I phase) was made based on the postoperative pathology findings. With typical cellular morphology, immunophenotype and T-cell receptor gene rearrangement, a diagnosis of T-LGLL was established.

Interventions:

After radical nephrectomy, this patient remained asymptomatic without any treatment.

Outcomes:

To date, the patient is generally in good condition, without complaints of discomfort.

Lessons:

The coexistence of these 2 entities may not be coincidental, and it is likely that they may share a common pathogenic pathway related to immune dysregulation.
The biologic effect of hydrogen sulfide and its function in various diseases
Authors: Xiao Qing , Ying Jiayi , Xiang Leihong , Zhang Chengfeng
Published: October 2018

Introduction:

Hydrogen sulfide (H2S), a colorless, water soluble, flammable gas with a characteristic smell of rotten eggs, has been known as a highly toxic gas for several years. However, much like carbon monoxide (CO) and nitric oxide (NO), the initial negative perception of H2S has developed with the discovery that H2S is generated enzymatically in animals under normal conditions. With the result of this discovery, much more work is needed to elucidate the biologic effects of H2S. In recent years, its cytoprotective properties have been recognized in multiple organs and tissues. In particular, H2S plays important roles in combating oxidative species such as reactive oxygen species (ROS) and reactive nitrogen species (RNS) and protect the body from oxidative stress. Therefore, this review discusses the biologic effect of H2S and how it protects cells in various diseases by acting as an antioxidant that reduces excessive amounts of ROS and RNS.

Ethics and dissemination:

Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.

Conclusion:

H2S has been found to be cytoprotective in oxidative stress in a wide range of physiologic and pathologic conditions, an increasing number of therapeutic potentials of H2S also have been revealed. However, there is still much debate on the clear mechanism of action of H2S, so that the mechanisms of cell signaling that promote cellular survival and organ protection need to be further investigated to provide better H2S-based therapeutics.
Shear-wave elastography assessment of gluteal muscle contracture
Authors: Guo Ruiqian , Xiang Xi , Qiu Li
Published: October 2018

Rationale:

Gluteal muscle contracture (GMC) is a clinical syndrome characterized by limited hip joint function due to fibrosis and contracture of the gluteal muscle and fascia fiber. Imaging examination is significant for its diagnosis and guidance of surgical treatment.

Patient concerns:

This report presents 3 cases of GMC with bilateral involvement and summarizes the literature on the imaging findings of this disease. The clinical symptoms and presentations of the 3 cases well-matched the clinical diagnosis of GMC. Preoperative ultrasonography including elastography was performed. To our knowledge, studies based on the elastography findings of the disease are limited.

Diagnoses:

The diagnosis of GMC was finally confirmed by postoperative pathologic examination.

Interventions:

All 3 patients then have a surgical therapy which cut off the contracture tract.

Outcome:

Symptoms of abnormal gait and limited hip joint function were greatly improved after surgical treatment.

Lessons:

The elasticity of the GMC zone in patients with GMC is higher than that of the muscles in the corresponding sites of healthy people.
The prognostic value of lymph node ratio for local advanced gastric cancer patients with adjuvant chemoradiotherapy after D2 gastrectomy
Authors: Hu Min , Zhang Shu , Yang Xue , Shen Yali , Li Zhiping , Zhao Yaqin , Xu Feng , Jiang Dan , Wang Xin , Wang Yongsheng
Published: October 2018

This study aimed to find the prognostic factors of local advanced gastric cancer patients with adjuvant concurrent chemoradiotherapy after radical D2 gastrectomy, and explore the prognostic value of lymph node ratio (LNR).

We retrospectively analyzed 164 gastric cancer patients enrolled in West China Hospital from 2006 to 2013, who underwent D2 radical gastrectomy and adjuvant chemoradiotherapy. With univariate analysis and the Cox regression model, we evaluated the association of LNR and other clinical pathological characteristics with overall survival (OS) and relapse-free survival (RFS) of patients.

Of 164 gastric cancer patients, the median age at diagnosis was 60 (IQR 51–66), with 121 males (73.78%) and 43 females (26.22%). The median follow-up time was 41.5 months. One-year and 3-year OS rate of the whole cohort was 97.6% and 88.4%, with 1-year RFS rate of 90.2% and 3-year RFS rate of 76.8%, respectively. In the univariate analysis, we found that age >60years (P 
= .025), TNM stage III (P 
= .014), LNR >0.25 (P 
= .006) and radiation dose <45Gy (P 
= .048) predicted worse OS. Further multivariate analysis indicated that age >60y (HR 2.375, 95% CI 1.100–5.128; P 
= .028), TNM stage III (HR 7.692, 95% CI 1.009–58.824; P 
= .049) and LNR >0.25 (HR 2.439, 95% CI 1.075–5.525; P 
= .033) were independent prognostic factors for unfavorable OS. The COX analysis showed that related prognostic factors of worse RFS were TNM stage III (HR 3.802, 95% CI 1.506–9.615; P 
= .049) and LNR >0.25 (HR 2.326, 95% CI 1.332–4.065; P 
= .003).

LNR can be used as an important prognostic indicator for gastric cancer patients with D2 resection and adjuvant chemoradiotherapy, and LNR more than 0.25 indicates poor prognosis.
Primary hyperparathyroidism characterized by diffuse homogeneous metastatic pulmonary calcification
Authors: Jia Yuzhu , Wang Lihua , Yang Guangzhao , Mao Guoqun , Cheng Yougen , Cao Yulin
Published: October 2018

Rationale:

Primary hyperparathyroidism (PHPTI) with respiratory tract symptom is extremely rare. It is caused by autonomic oversecretion of parathyroid hormone (PTH) owing to parathyroid adenoma, hyperplasia, or tumor. The diagnosis of PHPTI often needs to be made based on medical history, clinical manifestation, laboratory tests, and imaging examination. Moreover, no study has reported PHPTI with diffuse metastatic pulmonary calcification (MPC) as the characteristic.

Patient concerns:

A 49-year-old female from Zhejiang, China, had a fever of unknown origin, cough with white crude sputum, and asthma after activity for 1 month.

Diagnosis:

The computed tomography (CT) examination revealed a homogeneous and diffuse high-density shadow in both lungs. The pathologic examination with CT-guided lung biopsy (left lung puncture) suggested interstitial inflammation of the lung tissue, combined with fibroblast proliferation as well as calcification. B-ultrasonography identified a lump in the right parathyroid gland, with a size of 4.1 × 1.7 × 1.9 cm3. Color Doppler sonography indicated rich blood flow inside the lump. Whole-body bone emission computed tomography imaging showed the enhancement of bone metabolism in bilateral lower extremities and a diffuse enhancement of radioactive distribution in both lungs. 99mTc-methoxyisobutyl isonitrile imaging suggested significantly increased MIBI uptake in the right superior pole of the thyroid gland and indicated adenoma of the right superior parathyroid. The diagnosis of PHPTI was confirmed by postoperative pathology.

Interventions:

The patient received a resection of the right parathyroid adenoma.

Outcomes:

After surgery, the symptom such as fever, coughing, and white crude sputum were significantly alleviated.

Lessons:

This novel case reported the case of a patient with PHPTI having respiratory tract infection as the 1st symptom and diffuse MPC as the symptom characteristic PHPTI, the findings of this case study might improve the recognition of PHPTI on diffuse pulmonary calcification for clinical doctors.
Prescription fill rates for acute and chronic medications in claims-EMR linked data
Authors: Park Yoonyoung , Yang Hyuna , Das Amar K. , Yuen-Reed Gigi
Published: October 2018

Nonadherence to prescribed medications poses a significant public health problem. Prescription data in electronic medical records (EMRs) linked with pharmacy claims data provides an opportunity to examine the prescription fill rates and factors associated with it.

Using a claims-EMR linked data, patients who had a prescription for either an antibiotic, antihypertensive, or antidiabetic in EMR were identified (index prescription). Prescription fill was defined as a pharmacy claim found within the 90 days following the EMR prescription. For each medication group, patient characteristics and fill rates were examined using descriptive statistics. Multivariate logistic regression was used to evaluate the association between fill rates and factors such as age, race, brand vs generic, and prior treatment during 365 days before the index date.

Among 77,996 patients with index antibiotic prescription, 78,462 with index antihypertensive prescription, and 24,013 with index antidiabetic prescription, the prescription fill rate was 73%, 74%, and 76%, respectively. Overall, African American race was negatively associated with fill rates (odds ratio [OR] 0.8 for all 3 groups). Prior treatment history was positively associated with antihypertensives (OR 5.6, 95% confidence interval [CI] 5.4–5.7) or antidiabetics (OR 4.1, CI 3.8–4.4) but negatively with antibiotics (OR 0.6, CI 0.6–0.6). Older age was an additional factor that was negatively associated with first time fill rate among patients without prior treatment.

Significant proportions of patients, especially patients with no prior treatment history, did not fill prescriptions for antibiotics, antihypertensives, or antidiabetics. The association between patient factors and medication fill rates varied across different medication groups.
Early Functional Outcomes for Pediatric Patients Diagnosed with Anti–N-Methyl-d-Aspartate Receptor Encephalitis during Inpatient Rehabilitation
Authors: Howarth Robyn A. , Vova Joshua , Blackwell Laura S.
Published: October 2018

Objective

The aims of the current study were to characterize the demographic and clinical presentation of pediatric patients diagnosed with anti–N-methyl-d-aspartate receptor encephalitis who require inpatient rehabilitation, to examine early functional outcomes, and to investigate predictors of early recovery.

Design

A retrospective chart review was conducted for 27 pediatric patients diagnosed with anti–N-methyl-d-aspartate receptor encephalitis who received intensive inpatient neurorehabilitation.

Results

On average, patients were 10.6 yrs of age (range, 2–18 yrs) at the time of symptom onset. Average time to treatment from symptom onset was 27.2 days (range, 5–91 days). Patients displayed significant improvements between admission and discharge Functional Independence Measure for Children (WeeFIM) Developmental Functional Quotient (DFQ) scores across patients (P< 0.01). Mean Functional Independence Measure for Children Total Developmental Functional Quotient score at admission was 28.6 (range, 15.0–62.6) and at discharge was 54.3 (range, 14.2–91.9). Younger age at onset, seizures, and number of treatments received were associated with worse functional outcomes at discharge. Time to initiate treatment was not found to be associated with early functional outcomes.

Conclusion

Pediatric patients diagnosed with anti–N-methyl-d-aspartate receptor encephalitis displayed significant functional gains during inpatient rehabilitation, despite persistent functional deficits at discharge, suggesting the need for ongoing monitoring and intervention.

To Claim CME Credits

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CME Objectives

Upon completion of this article, the reader should be able to (1) Recognize the clinical presentation of anti–N-methyl-d-aspartate receptor encephalitis in pediatric patients, (2) Appreciate the role of rehabilitation in the care of the pediatric patient with anti–N-methyl-d-aspartate receptor encephalitis, and (3) Identify demographic and clinical variables that predict poor functional outcomes after rehabilitation in pediatric patients with anti–N-methyl-d-aspartate receptor encephalitis.

Level

Advanced.

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
A Structured Survey on Adverse Events Occurring Within 24 Hours After Intravenous Exposure to Gadodiamide or Gadoterate Meglumine
Authors: Parillo Marco , Sapienza Martina , Arpaia Francesco , Magnani Francesca , Mallio Carlo Augusto , D'Alessio Pasquale , Quattrocchi Carlo Cosimo
Published: October 2018

Objective

This study compares the incidence of new-onset symptoms within 24 hours after enhanced magnetic resonance imaging (eMRI) with intravenous administration of gadodiamide or gadoterate meglumine compared with a control group undergoing unenhanced MRI (uMRI).

Materials and Methods

A prospective cohort study (n = 1088 patients) was designed to assess the incidence of symptoms within 24 hours after administration of gadodiamide or gadoterate meglumine. The participants underwent a structured questionnaire by phone call before and 24 hours after the MRI scan to check for symptoms that were not present before the scan. The questionnaire included a list of active questions aimed to test the prevalence of symptoms that have been proposed in the debated definition of gadolinium deposition disease (GDD) and that we recorded in this study as GDD-like. In particular, the following symptoms and signs were tested: central torso pain, arm or leg pain, bone pain, headache, skin redness (any site of the body), fatigue, and mental confusion.

Fisher exact test was used to test differences between groups with significance threshold set at P < 0.05.

Results

Within the 24 hours after the MRI scan, 8.3% of patients reported at least one new-onset symptom in the uMRI group versus 17.4% in the gadodiamide eMRI versus 17.8% in the gadoterate meglumine eMRI group. The difference between the eMRI and the uMRI group was statistically significant (P < 0.001 for gadodiamide and P < 0.001 for gadoterate meglumine). There was not a different incidence of symptoms between the gadodiamide and the gadoterate meglumine eMRI groups. For gadodiamide, fatigue (P < 0.05) and dizziness (P < 0.05) were symptoms significantly more frequent than uMRI group; for gadoterate meglumine, fatigue (P < 0.01), mental confusion (P < 0.01), and diarrhea (P < 0.01) were significantly more frequent than uMRI group.

Conclusions

We found that the onset of new symptoms within 24 hours after exposure to gadolinium-based contrast agent was more frequent than after uMRI. Among GDD-like symptoms, fatigue and mental confusion were the most frequent symptoms reported after eMRI. The other GDD-like symptoms were not overreported after eMRI versus uMRI. Thus, these results are questioning the term GDD.
Improved Patient-Independent System for Detection of Electrical Onset of Seizures
Authors: Sridevi Veerasingam , Ramasubba Reddy Machireddy , Srinivasan Kannan , Radhakrishnan Kurupath , Rathore Chaturbhuj , Nayak Dinesh S.
Published: October 2018

Purpose:

To design a non–patient-specific system to detect the electrical onset of seizures in patients with temporal lobe epilepsy.

Methods:

We used EEG data from 29 seizures of 18 temporal lobe epilepsy patients who underwent multiday video-scalp EEG monitoring as part of their presurgical evaluations. We segmented each data set into preictal and ictal phases, and identified spectral entropy, spectral energy, and signal energy as useful features for discriminating normal and seizure conditions. The performance of five different classifiers was analyzed using these features to design an automated detection system.

Results:

Among the five classifiers, decision tree, k-nearest neighbor, and support vector machine performed with sensitivity (specificity) of 79% (81%), 75% (85%), and 80% (86%), respectively. The other two, linear discriminant algorithm and Naive Bayes classifiers, performed with sensitivity (specificity) of 54% (94%), 47% (96%), respectively.

Conclusions:

The support vector machine–based seizure detection system showed better detection capability in terms of sensitivity and specificity measures as compared to linear discriminant algorithm, Naive Bayes, decision tree, and k-nearest neighbor classifiers.

Conclusions:

Our study shows that a generalized system to detect the electrical onset of seizures in temporal lobe epilepsy using scalp-recorded EEG is possible. If confirmed on a larger data set, our findings may have significant implications for the management of seizures, especially in patients with drug-resistant epilepsy.
Interrater and Intrarater Agreement in Neonatal Electroencephalogram Background Scoring
Authors: Massey Shavonne L. , Shou Haochang , Clancy Robert , DiGiovine Marissa , Fitzgerald Mark P. , Fung France W. , Farrar John , Abend Nicholas S.
Published: October 2018

Purpose:

Many neonates undergo electroencephalogram (EEG) monitoring to identify and manage acute symptomatic seizures. Information about brain function contained in the EEG background data may also help predict neurobehavioral outcomes. For EEG background features to be useful as prognostic indicators, the interpretation of these features must be standardized across electroencephalographers. We aimed at determining the interrater and intrarater agreement among electroencephalographers interpreting neonatal EEG background patterns.

Methods:

Five neonatal electroencephalographers reviewed 5-to-7.5-minute epochs of EEG from full-term neonates who underwent continuous conventional EEG monitoring. The EEG assessment tool used to classify background patterns was based on the American Clinical Neurophysiology Society's guideline for neonatal EEG terminology. Interrater and intrarater agreement were measured using Kappa coefficients.

Results:

Interrater agreement was consistently highest for voltage (binary: substantial, kappa = 0.783; categorical: moderate, kappa = 0.562), seizure presence (fair–substantial; kappa = 0.375–0.697), continuity (moderate; kappa = 0.481), burst voltage (moderate; kappa = 0.574), suppressed background presence (moderate–substantial; kappa = 0.493–0.643), delta activity presence (fair–moderate; kappa = 0.369–0.432), theta activity presence (fair–moderate; kappa = 0.347–0.600), presence of graphoelements (fair; kappa = 0.381), and overall impression (binary: moderate, kappa = 0.495; categorical: fair–moderate, kappa = 0.347, 0.465). Agreement was poor or inconsistent for all other patterns. Intrarater agreement was variable, with highest average agreement for voltage (binary: substantial, kappa = 0.75; categorical: substantial, kappa = 0.714) and highest consistent agreement for continuity (moderate–substantial; kappa = 0.43–0.67) and overall impression (moderate–substantial; kappa = 0.42–0.68).

Conclusions:

This study demonstrates substantial variability in neonatal EEG background interpretation across electroencephalographers, indicating a need for educational and technological strategies aimed at improving performance.
Proposal to use superparamagnetic nanoparticles to test the role of cryptochrome in magnetoreception
Authors: Worster Susannah Bourne , Hore P. J.
Published: October 2018

Evidence is accumulating to support the hypothesis that some animals use light-induced radical pairs to detect the direction of the Earth's magnetic field. Cryptochrome proteins seem to be involved in the sensory pathway but it is not yet clear if they are the magnetic sensors: they could, instead, play a non-magnetic role as signal transducers downstream of the primary sensor. Here we propose an experiment with the potential to distinguish these functions. The principle is to use superparamagnetic nanoparticles to disable any magnetic sensing role by enhancing the electron spin relaxation of the radicals so as to destroy their spin correlation. We use spin dynamics simulations to show that magnetoferritin, a synthetic, protein-based nanoparticle, has the required properties. If cryptochrome is the primary sensor, then it should be inactivated by a magnetoferritin particle placed 12–16 nm away. This would prevent a bird from using its magnetic compass in behavioural tests and abolish magnetically sensitive neuronal firing in the retina. The key advantage of such an experiment is that any signal transduction role should be completely unaffected by the tiny magnetic interactions (≪
k
B
T
) required to enhance the spin relaxation of the radical pair.
Uncertainty quantification of the effects of biotic interactions on community dynamics from nonlinear time-series data
Authors: Cenci Simone , Saavedra Serguei
Published: October 2018

Biotic interactions are expected to play a major role in shaping the dynamics of ecological systems. Yet, quantifying the effects of biotic interactions has been challenging due to a lack of appropriate methods to extract accurate measurements of interaction parameters from experimental data. One of the main limitations of existing methods is that the parameters inferred from noisy, sparsely sampled, nonlinear data are seldom uniquely identifiable. That is, many different parameters can be compatible with the same dataset and can generalize to independent data equally well. Hence, it is difficult to justify conclusive assertions about the effect of biotic interactions without information about their associated uncertainty. Here, we develop an ensemble method based on model averaging to quantify the uncertainty associated with the effect of biotic interactions on community dynamics from non-equilibrium ecological time-series data. Our method is able to detect the most informative time intervals for each biotic interaction within a multivariate time series and can be easily adapted to different regression schemes. Overall, this novel approach can be used to associate a time-dependent uncertainty with the effect of biotic interactions. Moreover, because we quantify uncertainty with minimal assumptions about the data-generating process, our approach can be applied to any data for which interactions among variables strongly affect the overall dynamics of the system.
Signature miRNAs in peripheral blood monocytes of patients with gastric or breast cancers
Authors: Shu Le , Wang Zhe , Wang Qizhi , Wang Yumeng , Zhang Xiaobo
Published: October 2018

The dysregulation of microRNAs (miRNAs), key posttranscriptional regulators of gene expression, is closely associated with cancer development. However, the miRNAs of monocytes, important cells of tumour immunity, have not been extensively explored. In the present study, the differentially expressed miRNAs of blood monocytes derived from gastric and breast cancer patients and healthy donors were characterized. The results indicated that 74 miRNAs were upregulated and 46 miRNAs were downregulated in monocytes of patients with breast or gastric cancers compared with the healthy donors, suggesting that these 120 miRNAs from transformed monocytes were associated with cancers. The differentially expressed miRNAs, 38 of which were novel, were further validated using quantitative real-time PCR. As an example, the results showed that miR-150-5p downregulated the CCR2 expression in monocytes by targeting Notch 3, thus leading to the suppression of tumorigenesis. The target gene analysis showed that 36 of the 120 miRNAs targeted cancer-related genes. KEGG pathway analysis indicated that the cancer-associated miRNAs were involved in pathways related to cancers, such as the HIF-1 signalling and the mTOR signalling pathways. Thus, our study provided new clues to comprehensively understand the relationship between miRNAs and cancers.
RETRACTED: Reduced interleukin-38 in non-small cell lung cancer is associated with tumour progression
Authors: Wang Feng , Zhang Weihua , Wu Tianfeng , Chu Heying
Published: October 2018

Lung cancer continues to be the leading cause of cancer-related deaths worldwide due to its high incidence, malignant behaviour and lack of major advancements in treatment strategy. The occurrence and development of lung cancer is closely related to inflammation. Thus, we conducted the present study to investigate the effects of IL-38 (interleukin-38), a newly identified anti-inflammatory factor, on non-small cell lung cancer (NSCLC), which accounts for about 85% of all lung cancers. We first evaluated the IL-38 expression in 384 pairs of NSCLC samples and their adjacent normal mucosa by real-time PCR, ELISA (enzyme-linked immunoassay) and tissue microarrays. Then the role of IL-38 on patient survival rates, cancer progression and their sensitivity to chemotherapy drugs was assessed. IL-38 was barely expressed in the NSCLC tissues but highly expressed in the adjacent normal tissues. The downregulation of IL-38 was significantly correlated with the results of the American Joint Committee on Cancer stage and degree of differentiation, and it was also shown to be an independent prognostic indicator of disease-free survival and overall survival for patients with NSCLC. Overexpression of IL-38 in NSCLC cells suppressed cell migration, invasion, proliferation and colony formation through suppressing β-catenin. IL-38 inhibited NSCLC formation in a mice model and sensitized the cancer cells to chemotherapy drugs. Our results show that IL-38 plays an inhibitory role in NSCLC development and functions as a novel prognostic indicator and a potential therapeutic target.
Cue predictability does not modulate bottom-up attentional capture
Authors: Meijs Erik L. , Klaassen Felix H. , Bokeria Levan , van Gaal Simon , de Lange Floris P.
Published: October 2018

Attention can be involuntarily captured by physically salient stimuli, a phenomenon known as bottom-up attention. Typically, these salient stimuli occur unpredictably in time and space. Therefore, in a series of three behavioural experiments, we investigated the extent to which such bottom-up attentional capture is a function of one's prior expectations. In the context of an exogenous cueing task, we systematically manipulated participants' spatial (Experiment 1) or temporal (Experiments 2 and 3) expectations about an uninformative cue and examined the amount of attentional capture by the cue. We anticipated larger attentional capture for unexpected compared to expected cues. However, while we observed attentional capture, we did not find any evidence for a modulation of attentional capture by prior expectation. This suggests that bottom-up attentional capture does not appear modulated by the degree to which the cue is expected or surprising.