bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeat Cooled Radiofrequency Ablation Is Beneficial for Chronic Posterior Sacroiliac Joint Pain
Authors: Kurklinsky Svetlana , Boone M Katherine , Candler Shawn A , Schwab Adam , Ghazi Salim
Published: October 2019

Objective

This study aimed to investigate the effectiveness of repeat cooled radiofrequency ablation (CRFA) in chronic posterior sacroiliac joint (SIJ) pain.

Design

The electronic records of 41 adult patients who had successful CRFA were reviewed for duration of pain relief and utilization of medical care for six months before and after each CRFA procedure.

Setting

Academic, tertiary medical center.

Patients

Forty-one adult patients who had CRFA for chronic posterior SIJ pain.

Results

A repeat ipsilateral CRFA ablation procedure provided 9.0 months of pain relief compared with 5.5 months after the first CRFA procedure (P = 0.0378). The total number of medical treatments decreased after the first CRFA procedure (from 343 to 201). The medical cost decreased by 51.0% after the first CRFA and by 70.4% after the repeated CRFA procedure.

Conclusions

Using repeated nonsurgical, minimally invasive approach, CRFA relieves chronic posterior SIJ pain and reduces patients’ utilization of medical services.
Justifying Alexander Pope’s Unjustifiable Rhymes
Authors: Tomalin Marcus
Published: October 2019

Drawing upon recent research into historical phonology, this article re-examines the prosodic structure of Alexander Pope’s verse. The underlying purpose is to demonstrate that the widespread tendency to hear Pope’s poetry with a modern ear can lead to literary-critical interpretations that are alarmingly brittle. By contrast, a willingness to undertake some kind of pronunciation-related auditory archaeology can reveal phonological patterns that would otherwise remain hidden—and an awareness of these patterns can transform our appreciation of his intricate couplet art. A task of this kind necessarily involves a careful reading of prominent contemporaneous dictionaries, grammar textbooks, and orthoepic works, as well as recent revisionist studies of eighteenth-century English phonology. As an initial case study, the central discussion in this article will focus predominantly on two words:  and . Jonathan Swift accused Pope of deploying too many ‘unjustifiable rhymes’ for these words in his Iliad, and seeking to understand this critique leads to an exploration of how Pope structured his poetry using subtle phonological correspondences which frequently occur at locations other than the tenth syllable in his couplets.
The olfactomedin‐4 positive neutrophil has a role in murine intestinal ischemia/reperfusion injury
Authors: Levinsky Nick C. , Mallela Jaya , Opoka Amy M. , Harmon Kelli , Lewis Hannah V. , Zingarelli Basilia , Wong Hector R. , Alder Matthew N.
Published: October 2019

Olfactomedin‐4 (OLFM4) identifies a subset of neutrophils conserved in both mouse and man, associated with worse outcomes in several inflammatory conditions. We investigated the role of OLFM4‐positive neutrophils in murine intestinal ischemia/reperfusion (IR) injury. Wild‐type (WT) C57Bl/6 and OLFM4 null mice were subjected to intestinal IR injury and then monitored for survival or tissues harvested for further analyses. In vivo intestinal barrier function was determined via functional assay of permeability to FITC‐dextran. OLFM4 null mice had a significant 7‐d survival benefit and less intestinal barrier dysfunction compared with WT. Early after IR, WT mice had worse mucosal damage on histologic examination. Experiments involving adoptive transfer of bone marrow demonstrated that the mortality phenotype associated with OLFM4‐positive neutrophils was transferrable to OLFM4 null mice. After IR injury, WT mice also had increased intestinal tissue activation of NFκB and expression of iNOS, 2 signaling pathways previously demonstrated to be involved in intestinal IR injury. In combination, these experiments show that OLFM4‐positive neutrophils are centrally involved in the pathologic pathway leading to intestinal damage and mortality after IR injury. This may provide a therapeutic target for mitigation of intestinal IR injury in a variety of common clinical situations.—Levinsky, N. C., Mallela, J., Opoka, A., Harmon, K., Lewis, H. V., Zingarelli, B., Wong, H. R., Alder, M. N. The olfactomedin‐4 positive neutrophil has a role in murine intestinal ischemia/reperfusion injury. FASEB J. 33, 13660‐13668 (2019). www.fasebj.org
Recognizing emphysematous gastritis
Authors: Weaver Amanda , Weintraub Russell , Smith Brian
Published: October 2019

Emphysematous gastritis is a rare disease caused by gas-forming organisms. This article describes how a CT scan and aggressive IV drug therapy helped clinicians beat the odds for a patient with this high-mortality disease.
What every PA needs to know about anorectal pain
Authors: Hubbard Yasmine , Rizzolo Denise
Published: October 2019

Anorectal pain is common but often misdiagnosed, and patients may suffer in silence if they are too uncomfortable discussing the topic with their healthcare provider. This article reviews rectal anatomy and the signs and symptoms of several common anorectal conditions and how to manage them.
The leadless pacemaker
Authors: Groner Ashley , Grippe Kristen
Published: October 2019

Smaller leadless pacemakers placed in the right ventricle can reduce the risk of lead fracture or dislodgement and subcutaneous pocket complications, which can occur with traditional transvenous cardiac pacemakers. This article describes new leadless pacemakers and their indications.
Recognizing abdominal wall endometriosis
Authors: Huber Marisa , Grosel John , Showen Chad
Published: October 2019

Abdominal wall endometriosis is ectopic endometrial tissue in the abdominal wall. Consider this condition in any woman presenting with chronic abdominal pain and a surgical history significant for exposure of the abdominal cavity to the endometrial canal. The diagnosis can be suspected with accurate history taking and a thorough physical examination. In patients with suspected abdominal wall endometriosis, MRI is the imaging study of choice and complete surgical resection is the treatment of choice.
Can propranolol prevent progression of melanoma?
Authors: Kao Jason , Luu Brent
Published: October 2019

The worldwide incidence of melanoma has risen rapidly in the past 50 years and is a considerable public health burden in the United States, with significant financial implications. Studies have demonstrated the potential anticarcinogenic effects of antihypertensive agents, specifically beta-blockers, in patients with prostate cancer, breast cancer, and lately cutaneous malignant melanoma. This article explores the empirical clinical evidence of propranolol's anticarcinogenic effects on melanoma and the chemoprotective mechanisms of beta-blockers and other agents that have been used to modify melanoma progression.
Recognizing and treating late-life depression
Authors: Myrick Lisa
Published: October 2019

Patients over age 55 years who present with social isolation, loss of interest in activities, irritability, appetite loss, vague complaints, and insomnia are a diagnostic challenge for clinicians. This article describes a framework diagnosing and treating depression in older adults.
STEMI in a patient with mirror-image dextrocardia
Authors: Harris K. Yvonne , Umar Mohamad
Published: October 2019

ST-segment elevation myocardial infarction (STEMI) is a potentially life-threatening diagnosis that cannot be missed on ECG interpretation. However, ECG interpretation may not be straightforward in patients with dextrocardia. This case report discusses the presentation of a patient with situs inversus with dextrocardia who was found to have an acute inferior MI, and how this anatomical change results in an atypical ECG and clinical presentation.
Clinical Validation of a Dried Blood Spot Assay for 8 Antihypertensive Drugs and 4 Active Metabolites
Authors: Peeters Laura E. J. , Feyz Lida , Hameli Edon , Zwart Tom , Bahmany Soma , Daemen Joost , van Gelder Teun , Versmissen Jorie , Koch Birgit C. P.
Published: October 2019

Background:

Drug nonadherence is one of the major challenges faced by resistant hypertension patients, and identification of this problem is needed for optimizing pharmacotherapy. Dried blood spot (DBS) sampling is a minimally invasive method designed to detect and determine the degree of nonadherence. In this study, a DBS method for qualifying 8 antihypertensive drugs (AHDs) and 4 active metabolites was developed and validated using ultra high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS).

Method:

The DBS assay was validated analytically and clinically, in accordance with FDA requirements. Analytical validation was accomplished using UHPLC-MS/MS. For clinical validation, paired peak and trough levels of DBS and plasma samples were simultaneously collected and comparatively analyzed using Deming regression and Bland–Altman analyses. All concentrations below the set lower limit were excluded. Deming regression analysis was used to predict comparison bias between the collected plasma and DBS samples, with DBS concentrations corrected accordingly.

Results:

The UHPLC-MS/MS method for simultaneously measuring 8 AHDs and their metabolites in DBS, was successfully validated. With Deming regression no bias was observed in N = 1; constant bias was seen in N = 6 and proportional bias in N = 11 of the AHDs and metabolites. After correction for bias, only one metabolite (canrenone) met the 20% acceptance limit for quantification, after Bland–Altman analyses. In addition, amlodipine, valsartan, and [enalaprilate] met the 25% acceptance limit.

Conclusions:

A novel DBS assay for simultaneously qualifying and quantifying 8 AHDs and their metabolites, has been successfully developed and validated. The DBS assay is therefore a suitable method to detect drug nonadherence. However, with the exception of canrenone, the interchangeable use of plasma and DBS sampling to interpret drug quantities should be avoided.
Nontraumatic Orbital Subperiosteal Hematoma in a Case of Bernard-Soulier Syndrome With Bilateral Pansinusitis
Authors: Ali Abdullah A. , Alsafran Hend E. , Alomairah Hamad A. , Almazdi Abdulaziz A. , Behbehani, ABopth Raed S.
Published: October 2019

Orbital subperiosteal hemorrhages are usually due to trauma. However, nontraumatic subperiosteal hemorrhages have also been rarely reported. Here, the authors present a 13-year-old boy with Bernard-Soulier syndrome who presented with right orbital subperiosteal hemorrhage causing optic neuropathy which was surgically drained with full visual recovery.

The authors describe a case of rare coagulopathy (Bernard-Soulier syndrome) and pansinusitis presenting with nontraumatic subperiosteal hemorrhage.
Impression Methods for Custom Foot Orthoses—Comparing Semi–Weight-Bearing Foam and Non–Weight-Bearing Plaster Using a Kinematic Measurement of the Medial Longitudinal Arch
Authors: Balsdon Megan E.R. , Dombroski Colin E.A. , Bushey Kristen M. , Jenkyn Thomas R.
Published: October 2019

INTRODUCTION

One of the goals for custom foot orthoses (CFOs) is to provide relief for pressure-sensitive areas and provide support to the joints of the foot for an optimal weight-bearing position. The most common CFO impression methods used by practitioners include plaster bandage, foam box, fiberglass, and laser-optical scanning, and are often compared by measuring foot molds created from those methods. The objective of this study is to compare the biomechanical effects of CFOs made from two common casting methods using skeletal kinematics.

MATERIALS AND METHODS

The medial longitudinal arch (MLA) angle was measured for 13 participants of different foot types: five pes planus, four pes cavus, and four normally arched. Four conditions were compared: barefoot, shod, and CFOs made from both semi-weight-bearing foam and non-weight-bearing plaster casting methods. The MLA angle was measured from three-dimensional bone models using biplane fluoroscopy images during midstance.

RESULTS

Foam (P = 0.02) and plaster (P = 0.01) cast foot orthoses were significantly different from the barefoot condition, and the shod condition was significantly different from both foam (P = 0.004) and plaster (P = 0.014) cast orthoses. No statistically significant differences were found when comparing the two casting methods: non-weight-bearing plaster and semi-weight-bearing foam (P = 0.170).

CONCLUSIONS

Clinicians favoring one particular style of casting can feel confident, for the patient set described, that either choice will produce similar biomechanical outcomes with respect to foot kinematics.
Bracing to Treat Dropped Head Syndrome in Cancer Patients: A Retrospective Review
Authors: Knowlton Sasha E. , Zheng Mimi , Diamond Yoni , Yakaboski Michelle , Ruppert Lisa M.
Published: October 2019

Introduction

The objective of this study is to describe the use of postural bracing to treat dropped head syndrome (DHS) in cancer patients. The study design is a retrospective review over a 3-year period of cancer patients who presented to a cancer physiatry outpatient practice for treatment of DHS. Patients were individuals with a history of head and neck cancer, Hodgkin lymphoma, or other cancer with a diagnosis of DHS.

Materials and Methods

The treatment intervention was postural bracing with either a figure-of-eight orthosis with or without a lumbosacral orthosis or a thoracolumbosacral orthosis.

Results

Subjective, patient-reported improvements in pain, posture, and neck or back strength in addition to objective improvements in physical examination were made. Out of 41 patients initially evaluated for DHS who followed up in brace clinic, 61% reported a positive response to bracing with 17.1% reporting improvement in neck or back strength, 17.1% reporting improvement in pain, and 39% reporting improvement in posture.

Discussion

In this study, we present a successful alternative to treat DHS through the use of active bracing. The technique of active bracing in this population theoretically strengthens the weak muscles in head drop and improves head position. Maintenance of these achievements, although not directly studied in this project, must be performed through a regular home exercise and bracing program as patients likely have a tendency to weaken again given prior oncologic treatments.

Conclusions

Active postural bracing using a combination of a figure-of-eight brace with or without a lumbosacral orthosis or a thoracolumbosacral orthosis in conjunction with physical therapy can help improve the posture, pain, and neck and back strength of cancer patients with DHS.
Acupuncture Augmentation of Lidocaine for Provoked, Localized Vulvodynia: A Feasibility and Acceptability Study
Authors: Hullender Rubin Lee E. , Mist Scott D. , Schnyer Rosa N. , Chao Maria T. , Leclair Catherine M.
Published: October 2019

Objective

The aim of the study was to assess the feasibility and acceptability of acupuncture's augmentation of lidocaine therapy in the treatment of provoked localized vulvodynia (PLV).

Materials and Methods

For 12 weeks, women with moderate to severe PLV were randomized to either 18 sessions of traditional acupuncture (TA) or non-TA (NTA). All participants applied lidocaine 5% cream 4 times daily to the vestibule. Feasibility was assessed by recruitment, enrollment, assessment completion, and blinding. Acceptability was assessed by study visit attendance and satisfaction. The primary outcome was change in tampon test scores from baseline to week 12 and follow-up at week 24.

Results

Nineteen women enrolled and 14 completed the study. Five withdrew because of lidocaine reaction (n = 2), inability to insert tampon (n = 1), starting a new medication (n = 1), or change in vulvar diagnosis (n = 1). Participants in both groups reported pain reduction for 12 weeks. There was no statistically significant difference between groups. Women in the TA group (n = 7) experienced less pain from baseline to 12 weeks (mean difference [MD] = 42.4 ± 19.4 and MD = 35.7 ± 17.8 at week 24). In the non-TA group (n = 7), women experienced a within-group MD of 28.7 ± 28.5 at 12 weeks and an MD of 36.7 ± 17.7.

Conclusions

In this early-phase research, acupuncture augmentation of lidocaine was acceptable. The study procedures, with modifications, may be feasible for future investigation. Both acupuncture techniques showed a favorable effect; however, the contribution to pain relief is undetermined.
Efficacy of urapidil for the treatment of patients with senile hypertension and acute heart failure
Authors: Xie Yan-Zhong , Ni Jian-Ming , Zhang Shan-Jing , Ding Guo-Rong , Feng Jun-Fei
Published: October 2019

Background:

Previous clinical studies have reported that urapidil can effectively treat patients with senile hypertension (SH) and acute heart failure (AHF). However, no studies have systematically assessed the efficacy and safety of urapidil for patients with SH and AHF. Thus, this study will investigate the efficacy and safety of urapidil for SH and AHF.

Methods:

In this study, we will search the following electronic databases from inception to the June 30, 2019: MEDLINE, EMBASE, Cochrane Library, Google scholar, Springer, WANGFANG, and China Knowledge Resource Integrated Database. We will search all these electronic databases without language limitations. We will also search grey records to avoid missing potential literature. In this study, only randomized controlled trials on assessing efficacy and safety of urapidil for SH and AHF will be considered. We will use RevMan 5.3 software and STATA 15.0 software to carry out statistical analysis.

Results:

This study will evaluate the efficacy and safety of urapidil for SH and AHF by assessing all-cause mortality, change in body weight, urine output, change in serum sodium; and incidence of all adverse events.

Conclusion:

This study will provide latest evidence of the efficacy and safety of urapidil for patients with SH and AHF.

Dissemination and ethics:

This study will only analyze published data; therefore, no ethical approval is needed. The findings of this study will be published at peer-reviewed journals.

Systematic review registration:

PROSPERO CRD42019139344.
Effects of bronchial blockers on one-lung ventilation in general anesthesia
Authors: Zheng Mengliang , Niu Zhiqiang , Chen Peng , Feng Dawei , Wang Lei , Nie Yu , Wang Benqing , Zhang Zhijun , Shan Shiqiang
Published: October 2019

Background: Double-lumen bronchial tubes (DLBT) and bronchial blockers (BB) are commonly used in the anesthesia for clinical thoracic surgery. But there are few systematic clinical comparisons between them. In this study, the effects of BB and DLBT on one-lung ventilation (OLV) are studied.

Methods: The 200 patients with thoracic tuberculosis undergoing thoracic surgery, were randomly assigned to group A (DLBT) and group B (BB). Intubation time, hemodynamic changes (mean arterial pressure [MAP], heart rate [HR]), and arterial blood gas indicators (arterial partial pressure of carbon dioxide [PaCO2], arterial partial pressure of oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure [Ppeak]) at 4 time points were recorded. Complications such as hoarseness, pulmonary infection, pharyngalgia, and surgical success rate were also evaluated postoperatively.

Results: Intubation times were shorter in group B. Both MAP and HR in group A were significantly higher 1 minute after intubation than before, but also higher than those in group B. PaO2 levels were lower in both groups during (OLV) than immediately after anesthesia and after two-lung ventilation (TLV), with PaO2 being lower after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both points during OLV, PaO2 was lower in group A than in group B. No significant differences in PaCO2 were found between the 2 groups. Ppeak and Pplat were increased in both groups during OLV, with both being higher in group A than in group B. The incidence of postoperative hoarseness, pulmonary infection, and pharyngalgia were lower in group B. There was no significant difference in the success rate of operation between the 2 groups.

Conclusions: Compare with using DLBT, implementation of BB in general anesthesia has less impact on hemodynamics, PaO2 and airway pressures, and achieves lower incidence of postoperative complication.
Pulmonary lymphangitic carcinomatosis without concurrent liver metastasis from colon cancer detected using 18F-FDG PET/CT
Authors: Wang Yueqi , Su Minggang , Li Lin
Published: October 2019

Rationale:

The infiltration of tumor cells to pulmonary lymphatic system, as known as pulmonary lymphangitis carcinomatosis (PLC), is a rare presentation of pulmonary metastases.

Patient concerns:

We reported a case of a 66-year-old man after surgery, chemotherapy, and radiation therapy for colon cancer. Two months after these therapies, the patient complained of nonproductive cough for 1 week.

Diagnoses:

18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scanning revealed increased FDG uptake along the thickened bronchovascular bundles, in bilaterally scattered ground-glass opacities and in mediastinal lymphadenopathy. The transbronchial biopsy and pathological study confirmed the diagnosis of PLC.

Interventions:

Antineoplastic treatment (cetuximab) were administered after the patient was diagnosed with PLC.

Outcomes:

The patient died of respiratory failure within 3 months after the onset of his symptom.

Lessons:

18F-FDG PET/CT play an important role in identifying PLC, in selecting possible biopsy sites, and in accessing the extent of metastatic disease.
Upper gastrointestinal hemorrhage and thoracic aortic aneurysm rupture as presenting signs of Behçet disease
Authors: Yu Li-Fei , Guo Li-Wei , He Jiang-Ping , Yang Bin , Chen Chuang-Hua , Jin Jie
Published: October 2019

Introduction:

Behçet disease (BD) is an autoimmune disorder characterized by oral aphthosis, genital aphthosis, ocular lesions, and arthritis. However, other fatal complications are often misdiagnosed, which implies that the early diagnosis of the disease is important for a good prognosis.

Patient concerns:

A 51-year-old man complained of hematemesis for 5 hours and syncope once.

Diagnosis:

BD as demonstrated by esophageal ulcer and aortic aneurysm rupture.

Interventions:

Surgeries were conducted to repair the thoracic aortic aneurysm, proton-pump inhibitor was used to reduce acid secretion, antibiotics were applied for anti-infective therapy, and immunosuppressor was administered to control the injuries of BD.

Outcomes:

The patient was discharged and his medication dosage was reduced gradually until the minimum maintenance dose. In the follow-ups, the gastric ulcer and vascular aneurysm were not found.

Conclusion:

We presented a rare case of BD with the concurrence of huge esophageal ulcer and thoracic aortic aneurysms rupture, which helped us to diagnose BD at the early stage, while confronting atypical manifestations.
Case-control study examining the association between hip fracture risk and statins therapy in old people
Authors: Cheng Kao-Chi , Liao Kuan-Fu , Lin Cheng-Li , Lin Cheng-Chieh , Lai Shih-Wei
Published: October 2019

A population-based case-control study investigated possible association between statin use and risk of hip fracture among the elderly in Taiwan.

The Taiwan National Health Insurance Program database was used to identify 7464 subjects aged 65 years or older with newly diagnosed hip fracture in 2000 to 2013. An additional 7464 subjects aged 65 years or older without hip fracture were randomly selected as the control group. Hip fracture cases and controls were matched for sex, age, comorbidities, and index year of hip fracture diagnosis. Statin use was defined as “current,” “recent,” or “past” if the patient's statin prescription was respectively filled <3, 3 to 6, or ≥6 months before the date of the hip fracture. The odds ratio (OR) and 95% confidence interval (CI) for hip fracture associated with statin use was estimated using the logistic regression model.

The logistic regression analysis demonstrated that the odds of current statin use in cases with hip fracture were lower than the odds of current statin use in subjects without hip fracture (adjusted OR 0.73, 95% CI 0.65, 0.82).

The odds of current statin use in cases with hip fracture were lower than the odds of current statin use in subjects without hip fracture in elderly people in Taiwan.
The effect of environmental factors in childcare facilities and individual lifestyle on obesity among Japanese preschool children; a multivariate multilevel analysis
Authors: Goto Motohide , Yamamoto Yukiyo , Saito Reiko , Fujino Yoshihisa , Ueno Susumu , Kusuhara Koichi
Published: October 2019

Lifestyle in preschool children is associated with the onset of childhood obesity. However, the effect of environmental factors in childcare facilities on lifestyle and obesity in preschool children is unknown. The aim of this study was to determine the effect of environmental factors in childcare facilities on the association between obesity and individual lifestyle in preschool children.

Subjects included 2902 infants, aged 4 to 6 years old in Kitakyushu City, Japan. A stratified multilevel analysis was conducted with 2 strata: factors related to individual lifestyle and maternal factors as the individual level and factors related to the childcare facility as the environmental level. Two-level multilevel regression analysis was conducted with the presence or absence of obesity.

The proportion of infants with obesity was 4.2%. The childhood obesity was significantly associated with the mastication, nutritional methods during infancy, absence of breakfast, presence of skipping meals due to overeating of snacks, usual play activity, screen time on weekdays, maternal body mass index, and maternal weight increase during pregnancy at the individual level. On the other hand, childhood obesity had a significantly negative association with the receiving snacks in facilities by using multilevel analysis.

The present study revealed that establishing and maintaining environmental factors in childcare facilities may play important roles in the prevention of obesity from early childhood.
Effects of physical exercises on semen quality and reproductive outcomes in male infertility
Authors: Yan Xuhong , Dong Liang , Liu Yinghong , Yang Fang , Tan Kun , Li Junjun , Chang Degui , Yu Xujun
Published: October 2019

Background:

Infertility has troubled the world's 186 million people, and male infertility accounts for more than half. The literature of physical exercise related to semen quality has shown inconsistent results, and there is currently no systematic review to evaluate the effects of exercise on reproductive outcomes in male infertility patients. This study aims to assessing the effects of exercise interventions based on randomized controlled trials (RCTs) on semen quality and reproductive outcomes in male infertility.

Methods:

English and Chinese literature about physical exercise treatment for male infertility published before July 31, 2019 will be systematic searched in PubMed, Embase, Web of Science, Cochrane Library, Open Grey, Clinicaltrials.gov, Chinese Clinical Trial Registry, WANFANG, VIP Chinese Science and Technology Journal Database, CNKI, Chinese biomedical document service system (SinoMed). Only RCTs of patients with male infertility will be included. Literature screening, data extraction, and the assessment of risk of bias will be independently conducted by 2 reviewers, and the 3rd reviewer will be consulted if any different opinions existed. Live-birth rate, pregnancy rate, adverse events (including miscarriage), sperm concentration, progressive motility, sperm morphology, and sperm DNA fragmentation will be evaluated. Systematic review and meta-analysis will be produced by RevMan 5.3 and Stata 14.0. This protocol reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement.

Conclusion and dissemination:

We will assess the efficacy and safety of physical exercise on semen quality and reproductive outcomes in infertile men. The findings will be published in a peer-reviewed journal to provide evidence-based medical evidence for clinical decision making and the patient's lifestyle guidance.

Registration information:

PROSPERO CRD42019140294
Effect of morphine added to multimodal cocktail on infiltration analgesia in total knee arthroplasty
Authors: Zhang Yinxia , Mi Faduo , Zhao Haiyan , Xie Duowen , Shi Xiaoyuan
Published: October 2019

Background:

The local injection of multimodal cocktail is currently commonly used in the treatment of postoperative pain after total knee arthroplasty (TKA). It is still inconclusive whether the morphine added to the intraoperative injection mixture could make some difference. This meta-analysis aimed to evaluate the efficacy and safety of additional morphine injection on postoperative analgesia in TKA, and provide some useful information on morphine usage in clinical practice.

Methods:

The randomized controlled trials (RCTs) in databases including PubMed, Web of Science, Embase, Cochrane Library, Chinese biomedical literature database (CBM), and Chinese National Knowledge Infrastructure (CNKI) databases were systematically searched. Of 623 records identified, 8 RCTs involving 1093 knees were eligible for data extraction and meta-analysis according to criteria included.

Results:

Meta-analysis showed that the use of local morphine injection was not associated with significant pain relief within 48 hours postoperatively at rest and on motion (P > .05, all). The use of morphine reduced postoperative total systemic opioids consumption (P < .05). This study found no significant differences in other outcomes including knee flexion range of motion (ROM) (P > .05), extension ROM (P > .05), The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (P > .05), Post-operative nausea and vomiting occurrence (P > .05) regardless of the presence of morphine or not in the injections.

Conclusion:

Additional morphine added to multimodal cocktail did not decrease the postoperative pain scores significantly based on our outcomes, but it reduced the systemic postoperative opioids consumption in total knee arthroplasty.
Evaluation of prognostic factor and nature of acute esophageal necrosis
Authors: Kim Sun Moon , Song Kyung Ho , Kang Sun Hyung , Moon Hee Seok , Sung Jae Kyu , Kim Sae Hee , Kim Ki Bae , Lee Seung Woo , Cho Young Sin , Bang Ki Bae
Published: October 2019

Acute esophageal necrosis (AEN) is a serious disease which can causes gastrointestinal bleeding and death. Although black color change is not essential factor of organ necrosis, AEN is also known as “black esophagus.” Because of its rarity, there are limited studies regarding risk factors of mortality and recurrence. Thus, we conducted a multicenter retrospective study in order to evaluate the clinical characteristics of AEN. Method Clinical datum of AEN patients from 7 tertiary hospitals located in Daejeon-Choongcheong province were evaluated based on medical records. Our primary endpoint was risk factors for mortality and the secondary endpoint was risk factors for recurrence and clarifying whether “black esophagus” is a right terminology.

Fourty one patients were enrolled. Thirty six patients were male, mean age was 69.5 years. Nine patients had died, and 4 patients showed recurrence. Sepsis and white color change in endoscopy were related to high mortality (Chi-Squared test, P < .05). Old age, high pulse rate, low hemoglobin, and low albumin were also related to high mortality. Unexpectedly, heavy drinking showed favorable a mortality. Septic condition and high pulse rate showed poor mortality in logistic regression test (P < .05). Coexisting duodenal ulcer was related to recurrence (Chi-Squared test, P < .05). There was no difference in the underlying condition except patients with a coexisting cancer and white-form displayed lower hemoglobin level. Conclusion: Our results imply that white color change, septic condition, high pulse rate, and low hemoglobin & albumin are poor prognostic factors in AEN. Further evaluation may help clarify the findings of our study.
Longitudinal Intra- and Inter-individual variation in T-cell subsets of HIV-infected and uninfected men participating in the LA Multi-Center AIDS Cohort Study
Authors: Aziz Najib , Jamieson Beth D. , Quint Joshua J. , Martinez-Maza Otoniel , Chow Marianne , Detels Roger
Published: October 2019

To assess the intra-individual and inter-individuals biological variation and the effect of aging on lymphocyte T-cells subsets.

We assessed lymphocyte phenotypes (CD3+, CD4+, and CD8+ T-cells) in 89 HIV-1-infected and 88 uninfected white non-Hispanic men every 6 months, to examine the biological variation for those measurements, and the average change in lymphocyte phenotype over 34 years.

The markers showed significant intra-individuality in HIV-infected and uninfected individuals with index of individuality of <1.4. No mean changes were seen over the 34 years, with the exception of percentage CD4+T-cells in HIV-uninfected individuals.

In the pre-HAART era, HIV-infected individuals experienced an increase in mean absolute CD3+ T-cell numbers (11.21 cells/μL, P = 0.02) and absolute CD8+ T-cell numbers (34.57 cell/μl, P < .001), and in the percentage of CD8+ T-cells (1.45%, P < .001) per year and a significant decrease in mean absolute CD4+ T-cell numbers (23.68 cells/μl, P < .001) and in the percentage of CD4+ T-cells (1.49%, P < .001) per year.

In the post-HAART era, no changes in mean levels were observed in absolute CD3+ T-cell count (P = .15) or percentage (P = .99). Significant decreases were seen in mean count (8.56 cells/μl, P < .001) and percentage (0.59%, P < .001) of CD8+ T-cells, and increases in mean absolute count (10.72 cells/μl, P < .001) and percentage (0.47%, P < .001) of CD4+ T-cells.

With the exception of CD4 (%), no average changes per year were seen in lymphocyte phenotype of HIV-uninfected men. The results of coefficients of variation of intra and inter-individuals of this study can be useful for HIV-1 infection monitoring and in addition the observation could be a useful guide for intra- and inter-individual coefficient variations, and establishing quality goal studies of different blood biomarkers in healthy and other diseases.
Clinical analysis of high risk factors for pelvic malignant tumors after hysterectomy for benign diseases
Authors: Chao Xiaopei , Wang Xiaoxia , Xiao Yu , Ji Mingliang , Wang Shu , Shi Honghui , Fan Qingbo , Leng Jinhua , Sun Dawei , Lang Jinghe
Published: October 2019

To analyze the clinicopathological characteristics of pelvic masses after hysterectomy for benign diseases, and to analyze the related factors of benign and malignant pelvic masses.

This study retrospectively analyzed the patients undergone reoperation for pelvic mass subsequently to hysterectomy for benign disease from January 2012 to December 2016 in Peking Union Medical College Hospital.

A total of 247 patients were enrolled in this study, of which 34.01% were diagnosed with malignant tumors, and 65.99% benign tumors. Comparing the clinicopathological data of patients with benign and malignant pelvic masses, significant differences were found between the 2 groups with regard to their ages of having hysterectomy and pelvic mass resection, and the time intervals between the onset of pelvic mass and hysterectomy. In addition, patients with malignant masses tended to complain of abdominal distension and abdominal pain, while most of those with benign masses were diagnosed during physical examination. Patients with malignant pelvic masses had medical imagines of mixed masses, extraovarian derivation, as well as elevated carbohydrate antigen-125 (CA 125). Multivariate analysis showed that ages of having hysterectomy, physical examination results, abnormal defecation, cystic and solid masses, and elevated CA 125 level were independent risk factors for benign and malignant pelvic masses.

For patients having pelvic masses following hysterectomy for benign diseases, if they had hysterectomy later in their lives, and their masses were not found during physical examination, and had abnormal defecation, mixed cystic solid mass as well as elevated serum CA 125, it is suggested that special attention should be paid to the possibility of malignant tumors.
Bone cement leaking into iliac vein during artificial femoral head replacement
Authors: Cai Zhencun , Piao Chengzhe , Sun Ming , Zhou Hongyu , Gao Zhenhuai , Xiang Liangbi
Published: October 2019

Rationale:

Leakage of bone cement from femoral medullary cavity is a rare complication after hip arthroplasty, and there is no report on the leaked bone cement entering into iliac vessels.

Patient concerns:

An 89-year-old woman presented with a fracture in the right femoral neck. She had well-fixed right femoral head replacement after careful preoperative examinations, and no adverse reactions appeared. She was able to get off bed to walk at the 2nd day after surgery.

Diagnoses:

Postoperative radiograph showed leakage of bone cement into the joint through femoral medullary cavity entering into iliac vessels, but the patient complained no discomforts. She received a treatment with low-molecular weight heparin and rivaroxaban.

Outcomes:

The patient was able to walk with normal gait, without swelling in both lower extremities and discomfort in the hip. There was no other complication concerning intravascular foreign bodies.

Lessons:

This case calls into the phenomenon of leakage of injected bone cement in femoral head replacement regardless of complete and nonfractured femur, which may be into the lower limb and pelvic veins, given that, dangerous consequences will not occur.
Relationship Between Radiomics and Risk of Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma
Authors: Bian Yun , Guo Shiwei , Jiang Hui , Gao Suizhi , Shao Chenwei , Cao Kai , Fang Xu , Li Jing , Wang Li , Hua Wenda , Zheng Jianming , Jin Gang , Lu Jianping
Published: October 2019

Objective

The objective of this study was to explore the exact relationship between the arterial radiomics score (rad-score) and lymph node (LN) metastasis in pancreatic ductal adenocarcinoma (PDAC).

Methods

A total of 225 patients with pathologically confirmed PDAC who underwent multislice computed tomography within 1 month of resection from December 2016 to August 2017 were retrospectively studied. For each patient, 1029 radiomics features of arterial phase were extracted, which were reduced using the least absolute shrinkage and selection operator logistic regression algorithm. Multivariate logistic regression models were used to analyze the association between the arterial rad-score and LN metastasis.

Results

Lymph node–negative and LN-positive patients accounted for 107 (47.56%) and 118 (52.44%) of the cohort, respectively. The rad-score, which consisted of 12 selected features of the arterial phase, was significantly associated with LN status (P < 0.05). Univariate analysis revealed that the arterial rad-score and T stage were independently and positively associated with risk of LN metastasis (P < 0.05). Multivariate analyses revealed a significant association between the arterial rad-score and the LN metastasis (P < 0.0001). Higher arterial rad-score was associated with LN metastasis (P for trend <0.0001).

Conclusions

The arterial rad-score is independently and positively associated with the risk of LN metastasis in PDAC.
Topical Review: Effects of Contact Lens Wear on Corneal, Conjunctival, and Lid Margin Sensitivity
Authors: Stapleton Fiona , Chao Cecilia , Golebiowski Blanka
Published: October 2019

SIGNIFICANCE

Contemporary soft contact lenses do not affect mechanical sensitivity of the cornea, whereas conjunctival sensitivity is increased compared with nonwearers. Orthokeratology lens wear, however, reduces corneal sensitivity. The effects of contact lenses on lid margin sensitivity are unclear, and the link between ocular surface sensitivity and discomfort requires further exploration.

Although up to 50% of contact lens wearers experience discomfort with varying severity, impact, and frequency, the relationship between ocular surface sensitivity and ocular surface discomfort experienced during contact lens wear is unclear. The purpose of this review is to examine and summarize the current evidence for the impact of both historical and contemporary contact lens wear on ocular surface sensitivity, the etiology of changes in ocular surface sensitivity, contact lens wear–related factors associated with changes in ocular surface sensitivity, and the relationship between sensitivity and discomfort. Despite minimal effects on mechanical corneal sensitivity with contemporary soft contact lens wear, orthokeratology reduces corneal sensitivity through pressure-related effects. This review addresses the relevance of conjunctival and potentially lid margin sensitivity in tolerance and discomfort with contemporary lens wear and the impact of instrument and stimulus characteristics. Less invasive techniques particularly for lid margin sensitivity measurements are required. Given the potential interactions between a contact lens and the varied types of ocular surface nociceptors, instruments that allow for exploration of cold and chemical sensitivity particularly may better allow the effects of lens wear to be elucidated compared with those that explore high-threshold mechanical sensitivity alone. A better understanding of the relationships between lens wear and ocular surface sensitivity may result in improved management of contact lens discomfort.
Association Between Socioeconomic Status Mobility and Inflammation Markers Among White and Black Adults in the United States: A Latent Class Analysis
Authors: Surachman Agus , Rice Cara , Bray Bethany , Gruenewald Tara , Almeida David
Published: October 2019

Objective

This article examines whether multidimensional indicators of objective and subjective socioeconomic status (SES) across the life course can be categorized into latent classes of SES mobility and tests the associations of these categories with inflammation markers among white and black adults.

Methods

Data are from 592 non-Hispanic white and 158 non-Hispanic black participants who completed both the baseline survey and biomarkers assessment of the Midlife in the United States Refresher study. Groups of different SES mobility were examined using latent class analysis.

Results

White and black participants showed different patterns of SES mobility. Among blacks, the latent classes were as follows: 1) objectively always high (24.71%; high objective SES across the life course), 2) subjectively always high (6.48%; high subjective and low objective SES across the life course), 3) downwardly mobile (35.84%; high childhood SES, low adult SES), and 4) always low (32.97%; low childhood SES, education, and adult SES). Among whites, the latent classes were as follows: 1) always high (52.17%; high childhood SES, high education, high adult SES), 2) upwardly mobile (18.14%; low childhood SES, high education, high adult SES), 3) subjectively downward (27.74%; high childhood SES, high education, high objective adult SES, low subjective adult SES), and 4) always low (1.95%; low childhood SES, education, and adult SES). SES mobility was associated with inflammation in white (Wald χ2 values (3) = 12.89–17.44, p values < .050), but not in black adults (Wald χ2 values (3) = 2.79–7.22, p values > .050).

Conclusion

The lack of SES mobility differentiation on inflammation is an indication of diminished return for the most affluent class among black participants.
Basal Cell Carcinoma Arising over a Venous Malformation of the Forehead Communicating with the Endocranial Veins
Authors: Cucurullo Marco , Colletti Giacomo
Published: October 2019

Introduction:

An increasing number of skin cancer arising over vascular anomaly has been reported in literature. In such cases, the oncologic radicality required to threat skin malignancies may be in contrast with the safety needed when dealing with vascular malformation. As a result, treatment of this association may be insidious and treacherous and imposes a sound knowledge and carefulness.

Materials and Methods:

The authors report on a case of a 77-years-old woman affected by a basal cell carcinoma (BCC) arising over a vascular malformation of forehead. Preoperative radiological imaging revealed an underlying venous malformation (VM) communicating with intracranial district. Patient underwent sclerotherapy of the VM with gelified ethanol in order to reduce potentially fatal bleeding during surgery and, on the other hand, any leakage of the sclerosant in the intracranial veins. Excision of the BCC was then performed without complications.

Results:

Neither intra-operative nor post-operative complications were observed. Current 3-years follow-up shows no recurrence of BCC whilst the residual VM is stable and clinically silent.

Conclusions:

Mechanisms leading to the onset of skin cancers over venous malformations are still unclear. However, association between these 2 conditions may be underestimated with possible catastrophic consequences. Thorough knowledge of vascular malformations and a multidisciplinary approach is of the uttermost importance when dealing with such clinical challenges.
Autoantibodies against the prion protein in individuals with PRNP mutations
Authors: Frontzek Karl , Carta Manfredi , Losa Marco , Epskamp Mirka , Meisl Georg , Anane Alice , Brandel Jean-Philippe , Camenisch Ulrike , Castilla Joaquín , Haïk Stéphane , Knowles Tuomas , Lindner Ewald , Lutterotti Andreas , Minikel Eric Vallabh , Roiter Ignazio , Safar Jiri G. , Sanchez-Valle Raquel , Žáková Dana , Hornemann Simone , Aguzzi Adriano
Published: October 2019

Structured abstract

Objective

To determine whether naturally occurring autoantibodies against the prion protein are present in individuals with genetic prion disease mutations and controls, and if so, whether they are protective against prion disease.

Methods

In this case-control study, we collected 124 blood samples from individuals with a variety of pathogenic PRNP mutations and 78 control individuals with a positive family history of genetic prion disease but lacking disease-associated PRNP mutations. Antibody reactivity was measured using an indirect ELISA for the detection of human IgG1-4 antibodies against wild-type human prion protein. Multivariate linear regression models were constructed to analyze differences in autoantibody reactivity between a) PRNP mutation carriers versus controls and b) asymptomatic versus symptomatic PRNP mutation carriers. Robustness of results was examined in matched cohorts.

Results

We found that antibody reactivity was present in a subset of both PRNP mutation carriers and controls. Autoantibody levels were not influenced by PRNP mutation status nor clinical manifestation of prion disease. Post hoc analyses showed anti-PrPC autoantibody titers to be independent of personal history of autoimmune disease and other immunological disorders, as well as PRNP codon 129 polymorphism.

Conclusions

Pathogenic PRNP variants do not notably stimulate antibody-mediated anti-PrPC immunity. Anti-PrPC IgG autoantibodies are not associated with the onset of prion disease. The presence of anti-PrPC autoantibodies in the general population without any disease-specific association suggests that relatively high titers of naturally occurring antibodies are well tolerated. Clinicaltrials.gov identifier NCT02837705.