bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting autonomic dysfunction in patients with glaucoma using dynamic pupillometry
Authors: Park Hae-Young Lopilly , Jung Suk Hoon , Park Sung-Hwan , Park Chan Kee
Published: March 2019

Autonomic dysfunction is a feature of glaucoma patients, which are reported to be related to glaucoma progression. We investigated pupil responses to a light flash using dynamic pupillometry in glaucoma patients to assess autonomic nervous system status. In total, 97 glaucoma patients, including 21 eyes of 21 glaucoma patients with cardiac autonomic dysfunction, were enrolled. Pupil reactions were assessed using 1 flash of white light after 2 minutes of dark adaptation and recorded using dynamic pupillometry. Changes in the radius of the pupil were evaluated as a function of several time-dependent and pupil/iris (P/I) diameter ratio parameters. Autonomic function was assessed using a cardiac heart-rate-variability test which performs 5 autonomic function tests and classifies patients with cardiac autonomic neuropathy (CAN). Comparison of pupil parameters between eyes with and without disc hemorrhage indicated larger P/I ratios in darkness, greater changes in the P/I ratio during examination, shorter latency to plateau, and shorter duration of constriction in eyes with disc hemorrhages. A comparison of pupil parameters between eyes with and without CAN showed larger P/I ratios in darkness, larger P/I ratios at maximum constriction, and prolonged latency to maximum constriction. The presence of CAN was significantly related to the P/I ratio in darkness and the latency of maximum constriction. Using dynamic pupillometry, we found that glaucoma patients with CAN dysfunction have larger baseline pupils in darkness and different constriction responses to light. Assessing the pupils might be a good method of identifying patients with autonomic dysfunction.
Clinical analysis of hepatic angioleiomyoma
Authors: Jiang Bin , Chen Qiu-Ni , Qi Fu-Zhen , Xu Jian-Bo , Yu Ya-Bin , Song Yan
Published: March 2019

Rationale:

Angioleiomyoma is an uncommon benign tumor that originates from the vascular smooth muscle cells and contains thick-walled vessels. It can appear anywhere in the body but more frequently in the extremities (especially in the lower limbs) and rarely invades the internal organs.

Patient concerns:

A 52-year-old Chinese woman was referred to our hospital because of finding liver neoplasm 2 weeks ago (case first) and a 64-year-old Chinese woman was admitted to hospital with enlargement of the hepatic neoplasm revealed in follow-up, who was diagnosed with angioleiomyoma of left kidney 2 years ago (case second).

Diagnosis:

All patients were diagnosed with hepatic angioleiomyoma by pathological results.

Interventions:

All patients received surgical treatment, with laparoscopic hepatectomy of the IVb segment in case 1 and laparoscopic hepatic left lateral lobectomy in case 2.

Outcomes:

The 2 patients have eventually recovered, and no recurrences or other complications have been observed so far.

Lessons:

Because of atypical clinical symptoms, no specificity in laboratory examination, and lack of characteristic imaging findings, angioleiomyoma is easily misdiagnosed for another disease of the liver. But with complete resection, the prognosis is generally good.
Total hospital cost, length of stay, and complications between simultaneous and staged bilateral total hip arthroplasty
Authors: Tan Zhen , Cao Guorui , Wang Guanglin , Zhou Zongke , Pei Fuxing
Published: March 2019

This retrospective cohort study aimed to compare the total hospital cost, length of stay (LOS), and incidence of complications between simultaneous bilateral total hip arthroplasty (simBTHA) and staged bilateral total hip arthroplasty (staBTHA).

We identified 256 patients who underwent staBTHA and matched them to a control group of 256 patients who underwent simBTHA from 2013 to 2016. Patients’ demographics, total hospital costs, complication rates, and LOS were recorded and compared.

Patients undergoing simBTHA were younger (52.0 ± 12.0 vs 54.9 ± 13.2 years, P = .01), were more likely to be men (55.9% vs 46.9%, P = .04). There was no significant difference in total hospital costs or complications within 90 days for simBTHA compared with staBTHA. The transfusion rate was higher (49.3% vs 10.4%, P < .01), but the LOS was shorter in the simBTHA group (8.7 ± 5.3 vs 12.1 ± 5.6 days, P < .01).

There were no differences in total hospital costs or complications within 90 days if patients were carefully selected for simBTHA. Considering the difference in baseline characteristics and the low level of evidence, further randomized controlled studies are necessary.
The association between vascular endothelial growth factor gene polymorphisms and stroke
Authors: Xu Bingdong , Zhan Rui , Mai Hongcheng , Wu Zhengdong , Zhu Peizhi , Liang Yubin , Zhang Yusheng
Published: March 2019

Background:

Numerous studies showed that vascular endothelial growth factor (VEGF) gene polymorphisms were linked with the regularity of stroke, but the results remained controversial. The aim of this meta-analysis was to determine the associations between VEGF gene polymorphisms and the risk of stroke.

Methods:

A systematic literature search of PubMed, Embase, Wed of Science, The Cochrane Library, Elsevier, China National Knowledge Infrastructure, China Biology Medicine disc, WanFang Data, VIP Database for Chinese Technical Periodicals, and Science paper Online was conducted. Two authors independently assessed trial quality and extracted data. The pooled odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of associations. Begger funnel plot and Egger test were used to estimate the publication bias of included studies. Heterogeneity assumption was assessed by Cochran Chi-squared-based Q-statistic test and I
2 test.

Results:

Thirteen publications including 23 trails with a total of 3794 stroke patients and 3094 control subjects were enrolled. About 3747 cases and 2868 controls for +936C/T, 2134 cases and 1424 controls for −2578C/A, and 2187 cases and 1650 controls for −1154G/A were examined, respectively. The results indicated that VEGF +936C/T (T vs C, OR = 1.19, 95% CI = 1.01–1.40) or −2578C/A (A vs C, OR = 1.13, 95% CI = 1.02–1.27) was positively associated with the risk of stroke, whereas there was no association between −1154G/A (A vs G, OR = 0.99, 95% CI = 0.87–1.11) polymorphism and stroke risk in our study. Among the subgroup analyses on ethnicity, the results showed that VEGF +936C/T was an increased risk of stroke in Asian population (T vs C, OR = 1.21, 95% CI = 1.01–1.44), but not −1154G/A.

Conclusion:

Our findings suggest that VEGF +936C/T and −2578C/A might be related to the risk of stroke, especially in the Asian population, but not −1154G/A.
Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm
Authors: Chen Jun , Wang Chao , Zhuo Jianyong , Wen Xue , Ling Qi , Liu Zhikun , Guo Haijun , Xu Xiao , Zheng Shusen
Published: March 2019

Rationale:

Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare.

Patient concerns:

A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months.

Diagnosis:

A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy.

Interventions:

The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length.

Outcomes:

The patient recovered uneventfully and was discharged on day 5 after surgery.

Lessons:

This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.
Villi development core-related gene expression associated with lung squamous cancer prognosis
Authors: Yin Liyuan , Wang Yonggang , Ma Guangzhi , Deng Yunfu , Zhou Qinghua
Published: March 2019

Similarities between embryonic development and tumorigenesis are reflected in biological behavior and gene expression. Although the gene signature during development and the clinical phenotype of different cancers show certain correlation pattern, the correlation between early embryo development and cancer remains largely unexplored. To compare the gene expression profile between development and cancer, our study analyzed the gene expression of chorionic villi samples at different gestational ages (6, 7, 8, 9, 10, 40 weeks) obtained from gene expression omnibus (GEO) datasets using correlation test. Then the villi development-related genes that gradually showed a positive correlation (upregulated) (n = 394) or negative correlation (downregulated) (n = 325) with time were used to construct protein-protein interaction (PPI) networks. Three subnetworks among the gradually upregulated genes and 3 subnetworks among the downregulated genes were identified using the molecular complex detection (MCODE) plugin in Cytoscape software. The most significant GO terms for villi-correlated genes were immune, inflammatory response and cell division. These gene clusters were also dysregulated in lung squamous cell carcinoma (SCC). Moreover the prognostic value of the gene clusters was then analyzed with TCGA lung SCC data, which showed 4 clusters that were associated with prognosis. Our results demonstrate the gene expression similarity between development and lung SCC and identified development-associated gene clusters that could contain prognostic information for lung SCC patients.
A new inclusion technique through an upper partial sternotomy for complicated Stanford B-type aortic dissection with an aberrant right subclavian artery
Authors: Huang Maoxun , Piao Hulin , Li Bo , Wang Yong , Wang Tiance , Zhu Zhicheng , Li Dan , Liu Kexiang
Published: March 2019

Rationale:

An aberrant right subclavian artery (ARSA), arising from the proximal descending aorta, is a common aortic arch anomaly, with an incidence of 0.5% to 2%. However, coexistence of dissection and an ARSA is extremely rare. We presented the first case of successful management of complicated Stanford B-type aortic dissection combined with an ARSA with a new inclusion technique and stent graft (SG) implantation through an upper partial sternotomy.

Patient concerns:

A 39-year-old woman with a history of severe hypertension was admitted to our hospital because of sudden-onset chest and upper back pain.

Diagnoses:

Aortic computed tomography angiography (CTA) demonstrated complicated Stanford B-type dissection with ARSA.

Interventions:

A new inclusion technique and SG implantation through an upper partial sternotomy were performed for the patient, whose aortic arch branch vessels, including ARSA, were fully preserved.

Outcomes:

The patient had an uneventful postoperative course without neurologic deficits, and no blood transfusion was required during the hospitalization. The false lumen completely disappeared on postoperative CTA.

Lessons:

This new inclusion technique through an upper partial sternotomy is a safe and feasible treatment for complicated Stanford B-type aortic dissection with an ARSA with the primary tear located in the aortic arch.
Clinical classification and individualized design for the treatment of basicranial artery injuries
Authors: Yang Hua , Li Sheng-Gang , Xiang Xin , Lv Ying , Chu Liang-Zhao , Peng Han , Wang Fan , Cao Han , Liu Jian
Published: March 2019

This study aims to explore the principles of clinical classification and individualized treatment of basicranial artery injuries based on its anatomical correlation.

The data of 172 patients with various types of basicranial artery injuries were retrospectively analyzed. Among these patients, 128 patients were male and 44 patients were female, and the average age of these patients was 28.3 years old. All patients underwent computed tomography, some patients underwent computed tomography angiography or magnetic resonance angiography, and all the diagnoses were confirmed by digital subtraction angiography (DSA). According to anatomical correlation, the injuries were classified into 5 types: vascular wall injury (type I), intradural injury (type II), epidural injury (type III), sinus injury (type IV), and skull base bone injury (type V). Individualized treatment was adopted based on the different types and characteristics of injuries.

The percentages of basicranial artery injuries were as follows: type I, 4.6%; type II, 5.8%; type III, 3.5%; type IV, 77.9%; and type V, 8.1%. All 172 patients underwent DSA to demonstrate the classification. The lesion elimination rate revealed by DSA was 99.4% immediately after the operation, 98.3% at 1 week after the operation, and 98.8% at 3 months after the operation. The follow-up after 6 months revealed that the percentage of patients in whom clinical symptoms or signs completely disappeared was 97.7%, the percentage of patients with limited eye movement or visual impairment was 1.2%, and the percentage of patients with mild limb dysfunction was 0.6%.

Basicranial artery injuries can be classified into 5 types. Individualized design of embolization therapy based on different characteristics might be applicable for basicranial artery injuries treatment.
ATOUM 6: does a multimodal intervention involving nurses reduce the use of antibiotics in French nursing homes?
Authors: Ahouah Mathieu , Lombrail Pierre , Gavazzi Gaétan , Chaaban Taghrid , Rothan-Tondeur Monique
Published: March 2019

Introduction:

Urinary tract infection (UTI) is common in elderly living in nursing homes, and antibiotics prescription for this infection is particularly challenging. In these facilities, due to the absence of on-site physicians, nurses play an essential role when an infection is suspected, as they are the ones who collect and communicate by phone all the information needed by the physician for the decision-making process. In that context, our study aims to reduce antibiotic consumption in nursing homes, using a multimodal intervention, by strengthening nurses’ involvement during the process of prescription for UTI.

Methods/design:

This is a planned 2-arm cluster randomized study of 40 nursing homes randomly assigned either to the control group or to the intervention group, using a 1:1 ratio. The intervention consists of reinforcing the nurses’ knowledge concerning antibiotics and UTI; assist their clinical judgment using a decision aid diagram; improving their communication skills with the residents, their relatives, and the prescribers; and also increasing their involvement in the intervention’ process by organizing a competition opposing the nursing homes of the interventional group to select additional intervention tools.

Analysis:

The main outcome is the reduction of the relative frequency of antibiotics prescription for UTIs in the interventional group.

Ethics and dissemination:

Ethics approval was obtained from the French Committee for the Protection of Persons (N. 19.01.04/SI CNRIPH 18.12.07.48123). An article including the main outcome will be submitted to a peer review journal.
Long-term results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children
Authors: Peterlein Christian-Dominik , Modzel Theresa , Hagen Lasse , Ruchholtz Steffen , Krüger Antonio
Published: March 2019

Since its introduction by Metaizeau and Prevot, elastic-stable intramedullary nailing (ESIN) has been used for almost all diaphyseal fractures in children. Here, we present a retrospective study analyzing the long-term results of ESIN of forearm fractures in children.

A total of 122 patients with diaphyseal forearm fractures and single subtypes in childhood were treated from 2000 to 2007 at our University Hospital by ESIN. At follow-up, the current conditions of the patients were evaluated using the Disabilities of Arm, Shoulder, and Hand (DASH) Score, and the Mayo Wrist score. Moreover, an individual questionnaire with 16 items was used to collect further information about the patient's condition and limitations as adults.

The evaluation was performed at 12.4 years (average) after surgery. In our study population (n = 90), the average DASH scores for sports, performing arts, and work were 0.4 (standard deviation: 1.45), 0.9 (standard deviation: 5.68), and 0.3 (standard deviation: 7.39), respectively. Furthermore, 77% of our patients achieved a DASH Score of 0 (optimum outcome). The average Mayo Wrist Score was 97.64 (standard deviation: 7.39), and 82% of the study population achieved a score of 100 (optimum outcome). A correlation between the DASH and Mayo Wrist Scores was found in few patients. Overall, the DASH Score, Mayo Wrist Score, and results of our individual questionnaire demonstrated convincing point values.

This study demonstrated favorable long-term results achieved by ESIN of forearm fractures in children. It seems that good outcomes, reported by various studies with short- to mid-term follow-up beforehand, do not deteriorate over time.

Level of Evidence: Level III; retrospective study; therapeutic study.
Association between serum glucose level and spot sign in intracerebral hemorrhage
Authors: Zhang Fan , Zhang Si , Tao Chuanyuan , Yang Zijia , Li Xi , You Chao , Xin Tao , Yang Mu
Published: March 2019

Hyperglycemia was proved to cause neuron death in both animal experiments and poor outcome of hemorrhage patients, but the predictive ability of admission blood glucose level for early hematoma growth in patients with intracranial hemorrhage (ICH) is still controversial. Spot sign is a well-established imaging predictor for early hematoma growth, implying active microvascular bleeding. Here, we aim to assess associations between admission serum glucose and early hematoma expansion in ICH patients, as well as spot sign.

We retrospectively reviewed all the patients with ICH from January 2017 to March 2018 in West China Hospital, Sichuan University. Admission blood glucose, clinical variables, radiological characteristics, and laboratorial parameters were obtained from medical record. According to computed tomography (CT) and computed tomography angiography (CTA) scan results, hematoma expansion and spot sign were identified by 2 experienced neuroradiologists. Multivariate logistic regression analyses were employed to adjust the associations of hematoma expansion and spot sign with other clinical parameters.

Around 42 patients exhibited early hematoma expansions and 26 exhibited spot signs over 138 enrolled patients. The average level of admission blood glucose was 7.55 mmol/L. Multivariate logistic regression analyses revealed that Glasgow Coma Scale (GCS) score on admission, hematoma volume, spot sign, and hyperglycemia were associated with hematoma expansion, whereas admission serum glucose and hematoma size were only associated with spot sign, respectively.

Admission blood glucose level is correlated with hematoma growth and incidence of spot sign. These results indicated that hyperglycemia probably plays a critical role in the pathological process of the active bleeding. Further studies should be drawn urgently to understand the potential molecular mechanism of systemic hyperglycemia in affecting prognosis of patients with ICH.
Effects of virtual reality immersive training with computerized cognitive training on cognitive function and activities of daily living performance in patients with acute stage stroke
Authors: Cho Dong-Rae , Lee Sang-Heon
Published: March 2019

Objective:

The purpose of this study was to investigate the impact of virtual reality immersive training with computerized cognitive training on the cognitive function and activity of daily living in patients with acute stroke.

Method:

We included 42 patients with acute stage stroke from C hospital in Sungnam from May, 2017 to September, 2017. The patients were randomly selected and divided into the experimental (n = 21) and control (n = 21) group. The experimental group performed virtual reality training, including Head Mount Display with computerized cognitive therapy, and the control group performed computerized cognitive therapy. Both groups trained for 30 minutes a day 5 times a week; the intervention lasted 4 weeks. To evaluate the improvement in each group, pre-post-test evaluation was conducted using the Loewenstein Occupational Therapy Cognitive Assessment and Computerized Neurocognitive Function Test for cognitive function, and Functional Independent Measure for activities of daily living.

Results:

Attention and memory in cognitive function and activity of daily living performance were improved in the both groups.

Conclusion:

Virtual reality immersive training might be an affordable approach for cognitive function and activity of daily living performance recovery for patients with acute stroke.
Additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects
Authors: Li Ang , Yang Hongjie , Zhang Jingyi , Chen Shulian , Wang Hongqiang , Gao Yanzheng
Published: March 2019

Background:

This meta-analysis was performed to determine the additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects in chronic periodontitis patients.

Methods:

Pertinent studies were identified by a search in Medline, EMBASE, the Web of Science, and the Cochrane Library. The trials searched were evaluated for eligibility. Cochrane Collaboration's Review Manager software was used to perform the meta-analyses.

Results:

Twelve eligible clinical trials were included. Pooled data found that adjunctive platelet-rich fibrin exactly yielded a significantly superior probing depth reduction compared with open flap debridement alone (weighted mean difference, 1.01; 95% confidence interval 0.95–1.08; P < .00001). The clinical attachment level (CAL) gain after treatment for 9 months was higher in patients treated with platelet-rich fibrin plus open flap debridement group than in open flap debridement-treated patients (weighted mean difference, 1.29; 95% confidence interval 0.96– 1.61; P < .00001). Similarly, the meta-analysis demonstrated that platelet-rich fibrin was superior to single open flap debridement with respect to gingival marginal level change (weighted mean difference, 0.45; 95% confidence interval 0.31–0.58; P < .00001). Regarding the hard tissue radiographic parameters, including defect depth reduction and percentage of fill defects in bone, adjunctive platelet-rich fibrin yielded significantly superior results compared with open flap debridement alone.

Conclusion:

Adjunctive use of platelet-rich fibrin with open flap debridement significantly improves fill defects when compared to open flap debridement alone. However, additional powered studies with much larger sample sizes are needed to obtain a more concrete conclusion.
Clinical application of dual-phase F-18 sodium-fluoride bone PET/CT for diagnosing surgical site infection following orthopedic surgery
Authors: Lee Jeong Won , Yu Shi Nae , Yoo Ik Dong , Jeon Min Hyok , Hong Chang-Hwa , Shim Jai-Joon , Chang Sung-Hae , Lee Sang Mi
Published: March 2019

F-18 sodium-fluoride (NaF) bone positron emission tomography (PET/CT) has been used for diagnosing various bone and joint diseases, and, with using dual-phase scan protocol, it could give the same information obtained by the 3-phase bone scintigraphy. The present study aimed to evaluate the diagnostic ability of dual-phase F-18 NaF bone PET/CT in detecting surgical site infection after orthopedic surgery.

Twenty-three patients who underwent dual-phase F-18 NaF bone PET/CT under clinical suspicion of surgical site infection of the bone following orthopedic surgery were enrolled in this study. Dual-phase bone PET/CT consisted of an early phase scan performed immediately after radiotracer injection and a conventional bone-phase scan. All dual-phase PET/CT images were visually assessed, and, for quantitative analysis, 6 parameters of dual-phase PET/CT (lesion-to-blood pool uptake ratio, lesion-to-bone uptake ratio, and lesion-to-muscle uptake ratio on both early phase and bone-phase scans) were measured.

Surgical site infection was diagnosed in 14 patients of the 23 patients. The sensitivity, specificity, and accuracy of visual analysis of dual-phase F-18 NaF bone PET/CT for diagnosing surgical site infection of the bone were 92.9%, 100.0%, and 95.7%, respectively. Among the 6 parameters, the lesion-to-blood pool uptake ratio on early phase scan showed the highest area under the receiver operating characteristic curve value (0.857, 95% confidence interval, 0.649–0.966), with the cut-off value of 0.88 showing sensitivity, specificity, and accuracy of 85.7%, 88.9%, and 87.0%, respectively.

Our study showed the high diagnostic ability of dual-phase F-18 NaF bone PET/CT for detecting surgical site infection following orthopedic surgery. Further studies are needed to compare the diagnostic ability of dual-phase bone PET/CT with other imaging modalities.
Arterial thoracic outlet syndrome caused by cervical ribs—an unusual case report
Authors: Jiang Shuai , Shen Hui , Tan Wei Qiang , Lu Hui
Published: March 2019

Rationale:

Cervical ribs are rare conditions, occurring in 0.05% to 3.0% of the population. This manuscript reports a case of arterial thoracic outlet syndrome (ATOS) associated with this congenital anomaly.

Patient concerns:

We report a 32-year-old female worker presenting pain in her left upper-extremity for 7 months. Her left hand became paler and cold when the temperature decreased, and the symptoms could not be eased through rest, physiotherapy and drugs medication.

Diagnoses:

Compression of left subclavian artery with axillary and brachial arteries thrombosis was confirmed by duplex ultrasound and computed tomography angiography. ATOS caused by cervical ribs was confirmed by medical history, physical examination, and imaging.

Interventions:

The patients underwent acute thrombolysis and balloon angioplasty.

Outcomes:

Symptoms of pain and weakness disappeared after surgery. The patient had not experienced any apparent symptom recurrence at 1-year follow-up.

Lessons:

Successful treatment of ATOS depends upon urgent assessment, accurate identification of causative factors and compression site and early diagnosis before the event of arterial thrombosis. The surgery combined with anticoagulation treatment can improve the treatment outcome of ATOS.
High-frequency ultrasonography and contrast-enhanced ultrasound for the evaluation of testicular capillary hemangioma
Authors: He Ying , Liao Huimin , Xiang Xi , Cai Diming , Qiu Li
Published: March 2019

Rationale:

Testicular capillary hemangioma (TCH) is a rare benign tumor of the testis. To the authors’ knowledge, there is currently only a few literatures describing the use of contrast-enhanced ultrasound (CEUS) to diagnose TCH. Accurate preoperative diagnosis of benign tumors can avoid orchiectomy. A case of TCH evaluated using high-frequency ultrasound and CEUS is presented.

Patient concerns:

A 21-year-old male presented with a right testicular mass during a routine physical examination, and was admitted to the authors’ hospital for definitive diagnosis and treatment.

Diagnoses:

Combined gray-scale, color Doppler ultrasonography, and CEUS did not exclude the possibility that the right testicular lesion may be a benign tumor. Combined with morphological and immunohistochemical staining results, a pathological diagnosis of TCH was considered.

Interventions:

The patient underwent right orchiectomy under general anesthesia, which proceeded smoothly.

Outcomes:

At the 12-month follow-up, the patient was completely asymptomatic and resumed all daily activities.

Lessons:

TCH is a rare benign tumor and lacks extensive previous data in imaging findings. If TCH can be diagnosed accurately before surgery, excessive or inappropriate treatment of benign lesions can be minimized, which will be beneficial to the physical and psychological health of patients.
Intrahepatic diffuse periportal enhancement patterns on hepatobiliary phase gadoxetate disodium-enhanced liver MR images
Authors: Onishi Hiromitsu , Theisen Daniel , Zachoval Reinhart , Reiser Maximilian F. , Zech Christoph J.
Published: March 2019

The purpose of this study was to investigate the findings of diffuse periportal enhancement in the liver on hepatobiliary phase gadoxetate disodium-enhanced magnetic resonance images by comparing with the finding of periportal hyperintensity on T2-weighted images and to reveal their clinical significance.

Nineteen consecutive patients with diffuse periportal enhancement on hepatobiliary phase images constituted the study population. The intrahepatic diffuse periportal enhancement finding was assessed on whether it corresponded to periportal hyperintense patterns on T2-weighted images or not in the location, and the cases were classified into 2 groups according to this characteristic. Signal intensities at the periportal areas were also assessed on T1-, T2-, diffusion-weighted and dynamic images. Furthermore, possible associations between these image findings and the final diagnoses were explored.

In 7 of the 19 patients, periportal enhancement area corresponded with the periportal hyperintensity area on T2-weighted images. In the remaining 12 patients, the finding of periportal T2-hyperintensity was absent or the periportal enhancement differed from the periportal T2-hyperintensity in the location. Diseases of the former group comprised autoimmune hepatitis, acute exacerbation of chronic hepatitis and acute alcoholic steatohepatitis, and those of the latter group primary sclerosing cholangitis, autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, and liver cirrhosis with miscellaneous etiology.

Diffuse periportal enhancement during the hepatobiliary phase did not always correspond to periportal hyperintensity on T2-weighted images. In the classification based on whether enhancement area corresponded or not, each enhancement pattern appeared in different groups of liver diseases. Specifically, the former (corresponding) was associated with active inflammation such as hepatitis and the latter (not corresponding) was predominantly associated with a chronic change such as cirrhosis. Appropriate recognition of these periportal enhancement patterns may contribute to the improved diagnosis of diffuse liver diseases.
ABCDE and ABCDEF care bundles: A systematic review protocol of the implementation process in intensive care units
Authors: Moraes Fabio da Silva , Marengo Lívia Luize , Silva Marcus Tolentino , Bergamaschi Cristiane de Cássia , Lopes Luciane Cruz , Moura Mariana Del Grossi , Fiol Fernando de Sá Del , Barberato-Filho Silvio
Published: March 2019

Background:

The awakening and breathing coordination of daily sedation and ventilator removal trials, delirium monitoring and management, and early mobility and exercise (ABCDE) and assessment, prevent and manage pain, both spontaneous awakening and spontaneous breathing trials, choice of analgesia and sedation, assess, prevent and manage delirium, early mobility and exercise, family engagement (ABCDEF) bundles are part of the science of the liberation of the intensive care unit (ICU). There are not enough studies that have evaluated the effectiveness and safety of the implementation of these bundles. This study will analyze the implementation process, estimate their effectiveness and safety, and identify barriers, facilitators and attitudes that have influenced the implementation process.

Methods:

Qualitative and quantitative studies will be eligible for our systematic review with adult patients who have been exposed to the implementation of the ABCDE or ABCDEF bundles compared to the usual care in the ICU. In order to search the implementation interventions of the bundles, we will search electronically: MEDLINE (PubMed); Excerpta Medica Database (Ovid); Cumulative Index to Nursing and Allied Health Literature (EBSCO); The Cochrane Library (Wiley); Web of Science; Virtual Health Library; and OpenGrey. We will not impose any language restrictions or publication status. Outcomes of interest include ICU and hospital length of stay; mechanical ventilation time; incidence and prevalence of delirium or coma; level of agitation and sedation; early mobilization; mortality in ICU and hospital; change in perception, attitude or behavior of the stakeholders; and change in knowledge of health professionals. The team of reviewers will independently screen search results, extract data from eligible studies, and assess risk of bias. Disagreements between the reviewers will be solved through consensus or arbitration by a third-party investigator. To assess the quality and risk of bias in randomized and quasi-randomized trials we will use the domain-based evaluation recommended by The Cochrane Handbook. Studies with other methodological designs will be evaluated using the Critical Appraisal Tools developed by The Joanna Briggs Institute. Other instruments may be used, if necessary.

Results:

The evidence derived from this study will increase the knowledge of effectiveness and safety of the implementation process of ABCDE and ABCDEF bundles.

Conclusion:

The results could guide patients and healthcare practitioners by helping to facilitate evidence-based shared care decision making.

Protocol registration:

PROSPERO CRD42019121307.
Unique finding in congenital muscular torticollis
Authors: Xiong Zhu , Zeng Shuaidan , Chen Huanxiong , Qiu Xin , Tang Gen , Tang Yu , Tang Shengping
Published: March 2019

Congenital muscular torticollis (CMT) is a common musculoskeletal abnormality in children, which has been characterized by unclarified pathological changes in the sternocleidomastoid muscle (SCM) and various hypothetical etiologies. There are 2 main hypothetical etiologies for CMT in the literature: 1 infers that CMT may represent the sequela of an intrauterine or perinatal compartment syndrome, and the other regard CMT as a maldevelopment of the fetal SCM.

To better understand the etiopathogenesis of CMT, we screened the necks of 1-day-old newborns that may potentially have CMT for evidence of SCM trauma or tumor.

A convenience sample of 2564 full-term (>37 weeks) Chinese neonates were included in this study. All neonates were screened for CMT by physical examination at birth. If CMT was suspected, further ultrasonic and physical examinations were performed. When CMT was confirmed, we provided appropriate interventions and follow-up. The progress and changes in patients with CMT were recorded.

Following physical examination, 44 of 2564 neonates were diagnosed with suspected CMT based on obvious facial asymmetry or palpable swelling or mass in the SCM. Among these, ultrasound examination showed 81.8% (36/44) had asymmetry in the thickness of the bilateral SCM. The 36 neonates were followed-up for 6 months; among them, 1 infant developed CMT and 35 showed normal development in bilateral SCM. The 1 patient with CMT underwent regular physiotherapy and recovered with no evidence of recurrence after the final 3 years of follow-up. No neonates suffered from signs of neck trauma, such as hematoma or subcutaneous ecchymosis.

There was no evidence of neck trauma in this 1 day old newborn. The pseudotumor of SCM that developed after birth underwent differentiation, maturation, and disappeared as the baby grew. The SCM asymmetry did exist in some of the newborn babies, and became symmetric with the baby's growth. Data from this clinical study and our previous ultra-structural pathological studies suggested that both prenatal and postnatal factors play important roles in CMT. We hypothesized that CMT might be a developmental disease.
Evidence of Astragalus injection combined platinum-based chemotherapy in advanced nonsmall cell lung cancer patients
Authors: Cao Ailing , He Hailang , Wang Qian , Li Lei , An Yajuan , Zhou Xianmei
Published: March 2019

Background:

Platinum-based chemotherapy is one of the standard treatments for advanced nonsmall cell lung cancer (NSCLC). Despite on an effective treatment for advanced NSCLC patients, its high toxicity and limited clinical effects have raised big concerns. Astragalus injection (AGI) has been commonly employed as an adjutant chemotherapy drug for NSCLC in China. This review was conducted to evaluate the beneficial of AGI in combination with platinum-based chemotherapy in advanced NSCLC.

Methods:

We collected all studies about AGI plus platinum-based chemotherapy for advanced NSCLC in the PubMed, EMBASE, China National Knowledge Infrastructure Database, the Cochrane Library, Wanfang Database, China Biological Medicine Database, and Chinese Scientific Journal Database established on July 2018 without language restriction. Cochrane handbook was applied to assess the quality of included trials. Stata (version 12.0) and RevMan (version 5.3) were employed for data analysis. The quality of the evidence was assessed with the GRADE approach.

Results:

Nineteen randomized controlled trials (RCTs) including 1635 patients were included to determine the effectiveness and safety of AGI combined with platinum-based chemotherapy in the treatment of NSCLC. The result of meta-analysis indicated that comparing with chemotherapy alone, AGI combined chemotherapy could significantly improve the objective response rate (relative risk [RR] = 1.19, 95% confidence interval [CI] [1.06, 1.33], P = .002), the Karnofsky performance status (RR = 2.28, 95% CI [1.63, 3.18], P < .00001), and 1-year survival rate (RR = 1.40, 95% CI [1.16, 1.70], P = .0005), meanwhile increase the percentages of CD3+ (weighted mean differences [WMD] = 11.98, 95% CI [8.0, 15.96], P < .00001), CD4+ (WMD = 2.98, 95% CI [0.45, 5.52], P = .02), CD4+/CD8+ (WMD = 0.33, 95% CI [0.20, 0.46], P < .00001), and NK cells (WMD = 9.5, 95% CI [7.25, 11.76], P < .00001), decrease the incidence of leukopenia (RR = 0.52, 95% CI [0.44, 0.61], P < .00001), platelet toxicity (RR = 0.62, 95% CI [0.50, 0.76], P < .00001), and vomiting (RR = 0.72, 95% CI [0.60, 0.87], P = .0006). Based on the system evaluation results, the GRADE system recommendation grading method was adopted to evaluate the evidence quality. The results showed that the level of evidence was low.

Conclusions:

The AGI apparently has attenuation and synergistic efficacy to platinum-based chemotherapy patients. However, considering the limits of articles included in the present researches, the recommendation is likely to be weak. High-quality RCTs are urgently used to generate conclusive results.
Revision of the medicolegal assessment criteria in hypovolemic patients
Authors: Can İsmail Özgür , Köker Murat , Solmaz Dilek , Kavakli Uğur , Bayram Başak , Karabağ Gökmen , Ünüvar Ümit , Arisoy Yücel , Özkara Erdem
Published: March 2019

Trauma scoring systems are often used for the determination of the severity level of the lesion and the clinical status in medico-legal assessment of the trauma patient. Trauma scoring systems are used also for the determination of the life-threatening conditions. Blood loss of more than 20% was reported as the only criterion for life-threatening conditions in the acute hypovolemia. The objective of this study was to revise the medico-legal assessment criteria in the patients with acute hypovolemia and to discuss other parameters, which might be used in the determination of the severity level of the clinical status.

The medical reports of the patients with acute hypovolemia due to the trauma, which were sent by the judicial authorities and by other departments of our medical faculty to the department of the forensic medicine between 1999 and 2009, were evaluated. The characteristics such as age, gender, severity of the injury, type of the trauma, history of liquid replacement or blood transfusion, vital signs, type of the physical injury, injured region of the body, presence of any chronic disease were assessed and recorded.

The mean age of the included 155 patients was 34.70 ± 16.08 years (3-87 years). 118 (76%) of patients were males and 37 females (24%). Regarding the event types, road accidents were the most common cause (60.0%) and it was followed by sharp object injuries (18.7%) and firearm injuries (11.6%). 27.7% of the subjects received 2 units blood and blood products transfusion and 21.3% only 1 unit transfusion. According to the results of the medico-legal assessment, 84.5% of the patients had life-threatening conditions.

While evaluating the severity of the clinical conditions in the hypovolemic patients, to report only the losses in percentage causes problems and limitations. Therefore, in respect of the medico-legal assessment of the hypovolemic patients, we believe that it would be more appropriate to use the physiological trauma scoring systems (like Revised Trauma Score) instead of the anatomic scoring systems.
Bilateral congenital macular coloboma and cataract
Authors: Zhang Canwei , Wu Peng , Wang Luping , Gao Jing , Huang Xudong , Jiang Yaqin
Published: March 2019

Rationale:

The case with congenital macular coloboma and cataract was rarely reported, and the pathogenic gene of the disease is still not clear. Moreover, it is difficult to improve the visual acuity of the eye with this disease.

Patient concerns:

An 11-year-old boy presented low visual acuity and horizontal nystagmus in both eyes. Ophthalmologic examination showed the patient with bilateral congenital coloboma and cataract. The visual acuity of the patient improved slightly after cataract surgery. Heterozygous mutations of frizzled-4 (FZD4) and nucleotide-binding oligomerization domain-containing protein 2 (NOD2) were identified by next-generation sequencing in this case.

Diagnosis:

Congenital macular coloboma and cataract of both eyes.

Interventions:

We performed the standard phacoemulsification and intraocular lens implantation on both eyes of the patient for the treatment of congenital cataract, and then followed up the fundus lesions regularly.

Outcomes:

Cataract surgery may improve the visual acuity of the eyes with congenital macular coloboma and cataract at some degree, but the vision of this patient was still very poor postoperatively. Furthermore, the heterozygous mutations of FZD4 and NOD2 were found in this patient.

Lessons:

Cataract surgery may improve the visual acuity of the eyes with congenital macular coloboma and cataract at some degree, and heterozygous mutations of FZD4 and NOD2 may be involved in the occurrence of congenital macular coloboma and cataract.
Incidental finding of non-Hodgkin's lymphoma in a patient affected by castration-sensitive prostate cancer
Authors: Pirozzi Angelo , Cartenì Giacomo , Scagliarini Sarah , Fusco Mario , Riccardi Ferdinando
Published: March 2019

Rationale:

This article describes the case of a patient with 2 simultaneous malignant diseases: Follicular lymphoma and ‘castration sensitive prostate cancer. Patients with multiple cancers are not easy to manage and it is difficult to find the appropriate approach and resources to use with them. We focused our attention on how to choose the correct strategy to face 2 different neoplasms and control the adverse reactions related to the corresponding treatments.

Patient concerns:

We present a case of a 71-year-old man who came to us complaining about an abnormal difficulty in urinating associated with an interrupted flow and excessive urination at night. Clinical examination detected multiple enlarged superior and inferior diaphragmatic lymph nodes.

Diagnosis:

Prostate biopsy revealed an acinar adenocarcinoma (Gleason 4+3, Grade group 3). Clinical staging by bone scan was negative but computed tomography scan (CT) detected multiple enlarged superior and inferior diaphragmatic, and inguinal lymph nodes. This type of lymph node involvement pattern is unusual for an acinar adenocarcinoma prostate cancer therefore we suspected the simultaneous presence of a lymphatic neoplasm. Fluorodeoxyglucose positron emission tomography scan. The exam showed one of the left inguinal lymph nodes had the highest standardized uptake value (13.0) so a biopsy was taken. The sample analysis confirmed the diagnosis of a follicular non-Hodgkin lymphoma of Grade 3a.

Interventions:

We used a multidisciplinary clinical approach based on Rituximab+CHOP administered every 21 days. Simultaneously, the patient underwent androgen deprivation therapy with triptorelin monthly and bicalutamide administered just during the first month of treatment. When we obtained a complete response for the lymphoma, the patient continued the therapy with Rituximab once every 2 months for the next 2 years. Then we added volumetric modulated arc therapy (VMAT) radiotherapy with simultaneous integrated boost (SIB) to androgen deprivation therapy for the duration of 1 month.

Outcomes:

After 1 year and 6 months since the conclusion of therapy for prostate cancer and Follicular lymphoma, patient's conditions are good and he is in complete remission for both diseases. Gut toxicity is reduced with a mean number of 2 to 3 discharges daily and an increased body weight.

Lessons:

The presence of diffuse lymphadenopathy and urinary symptoms in the same patients must induce the suspect of 2 contemporary cancer diseases. Parallel treatments of follicular lymphoma and prostate cancer should consider the increased risk of severe adverse effects related to the treatment and their management. We describe our therapeutic strategy to highlight the importance to balance benefits and disadvantages to get the best possible response and maintain a good quality of life in this complex setting.
Thoracic outlet syndrome in a postoperative cervical spondylotic myelopathy patient
Authors: Wang Xiao-Tao , Yao Min , Zhong Ming , Wang Yong-Jun , Shi Qi , Cui Xue-Jun
Published: March 2019

Rationale:

Thoracic outlet syndrome (TOS) is a rare disease that presents with neurogenic and vascular symptoms similar to those of cervical spondylosis. However, making the diagnosis of TOS can be challenging due to a lack of standardized objective confirmatory tests.

Patient concerns:

A 66-year-old man presented with neck, supraclavicular, and right shoulder pain as well as numbness and weakness in the right arm after surgery to correct cervical spondylotic myelopathy (CSM).

Diagnosis:

Magnetic resonance imaging confirmed the diagnosis of CSM. He was diagnosed with TOS based on the manifestations and examination findings.

Interventions:

After surgery for CSM, nonoperative management was provided.

Outcomes:

The patient reported pain relief and improving sensation in the shoulder and supraclavicular region.

Lessons:

Based on this case and the reviewed literature, to optimize the diagnosis and treatment of CSM, clinicians should consider preoperative differential diagnosis to preliminarily exclude it.
Effectiveness of neuromuscular electrical stimulation and ibuprofen for pain caused by necrosis of the femoral head
Authors: Ji Qing-Hui , Qiao Xiao-Feng , Wang Shou-Feng , Zhao Peng , Liu Shi-Chen , Xue Yu , Qiao Jian-Min , Li Yan-Bao
Published: March 2019

This retrospective study analyzed the effectiveness of neuromuscular electrical stimulation (NMES) for pain relief caused by necrosis of femoral head (NFH).

Totally, 80 cases of patients with NFH were analyzed and then were assigned to a treatment group or a control group in this study. Of these, 40 cases in the treatment group received ibuprofen and NMES therapy. The other 40 cases in the control group received ibuprofen alone. Cases in both groups were treated for a total of 6 weeks. The primary outcome of pain intensity was measured by a visual analog scale (VAS). The secondary outcome was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, adverse events (AEs) were also recorded in each case. All outcomes were evaluated before and after the treatment.

After treatment, patients in the treatment group showed more effectiveness in pain relief, as measured by VAS (P < .01) and WOMAC sub-pain scale (P < .01), except stiffness, as evaluated by WOMAC sub-stiffness scale (P = .07), and function, as assessed by WOMAC sub-function scale (P = .09), than patients in the control group. Additionally, no significant differences in AEs were detected between 2 groups.

This study found that NMES may be helpful for pain relief in patients with NFH.