bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic performance of abbreviated breast MRI for screening of women with previously treated breast cancer
Authors: Kwon Mi-ri , Ko Eun Young , Han Boo-Kyung , Ko Eun Sook , Choi Ji Soo , Park Ko Woon
Published: April 2020

Rationale and objectives:

To evaluate the diagnostic performance of abbreviated screening breast magnetic resonance imaging (AB-MRI) for screening in women with previously treated breast cancer.

Materials and methods:

This retrospective study included consecutive AB-MRI from September 2015 to December 2016 in patients with previously treated breast cancer. Longitudinal medical record of patients’ demographics, outcomes of imaging surveillance and results of biopsy was reviewed. Protocol consisted of T2-weighted scanning and dynamic contrast-enhanced imaging including one pre-contrast and two post-contrast scans. A positive examination was defined as final assessment of BI-RADS 4 or 5 and negative was defined as BI-RADS 1, 2, or 3. Abnormal interpretation rate, cancer detection rate (CDR), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were analyzed.

Results:

Among total 1043 AB-MRI, 29 (2.8%) AB-MRI had suspicious findings including 26 (2.5%) BI-RADS 4 and 3 (0.3%) BI-RADS 5 assessments. CDR was 9.59 per 1000. Performance outcomes were as follows: sensitivity, 71.4%; specificity, 98.2%; accuracy, 97.8%; PPV 1, 35.7%; PPV3 50%; and NPV 99.6%. Four cancers with false negative MRI were all early cancers of <1.0 cm with node negative. One was palpable interval cancer while the others were alternative screening modality-detected asymptomatic cancers before the next MRI screening.

Conclusion:

AB-MRI showed high accuracy and NPV for detecting cancer recurrence in women with previously treated breast cancer. Missed cancers were all minimal cancers with node negative.
Association between red cell distribution width level and risk of stroke
Authors: Li Bingxian , Liu Shuo , Liu Xiaoqiang , Fang Jingnian , Zhuang Weiduan
Published: April 2020

Background:

Red cell distribution width level may have relations with the incidence and prognosis of cerebrovascular diseases. Recent researches have reported that red cell distribution width level was linked to the occurrence of stroke. However, the predicted effect of red cell distribution width in stroke is still disputed. We sought to assess the relationship between red cell distribution width and risk of stroke in this meta-analysis.

Methods:

Relevant studies were picked out from the databases of Embase, PubMed, and Cochrane Library. Hazard ratio with 95% confidence interval was chosen to analyze each trial, which was extracted from results of the highest and lowest red cell distribution width group. Funnel plots, Begg and Egger test were used to assess publication bias in the meta-analysis. Stata(12.0) was utilized to perform statistic analysis in the process.

Results:

A total of 6 studies with 5783 patients were included in this meta-analysis. The results showed that red cell distribution width level in patients with stroke was significantly higher than it in those without stroke (HR = 1.34, 95%CI:1.23–1.47, P < .001), in particular ischemic stroke(HR = 1.34,95% confidence interval:1.1–1.54, P < .001). There was no evidence of heterogeneity across the studies (P = .355, I
2 = 5.53%).

Conclusions:

The higher red cell distribution width level was associated with an increased risk of stroke, especially ischemic infarction.
Comparative diagnostic efficacy of serum Krebs von den Lungen-6 and surfactant D for connective tissue disease-associated interstitial lung diseases
Authors: Zhong Danli , Wu Chanyuan , Bai Jingjing , Hu Chaojun , Xu Dong , Wang Qian , Zeng Xiaofeng
Published: April 2020

Purpose:

The aim of the study was to estimate and compare the diagnostic accuracy of serum Krebs von den Lungen-6 (KL-6) and surfactant protein D (SP-D) for identifying interstitial lung disease (ILD) from non-ILD among connective tissue disease (CTD) patients.

Materials and Methods:

Original articles on the diagnostic accuracy of serum KL-6 and SP-D in differentiating CTD-ILD from CTD-nonILD were identified from three public databases. The overall quality of evidence and methodologic quality of each eligible study were assessed by the Grading of Recommendations, Assessment, Development and Evaluation approach and Quality Assessment of Diagnostic Accuracy Studies, respectively. We used the bivariate model to calculate random-effect sensitivity, specificity, likelihood ratios, and area under curve. Furthermore, trial sequential analysis (TSA) was used to determine whether sample sizes incorporated in the meta-analysis were powerful for evaluating the diagnostic utility. Bayesian network analysis was performed to compare the diagnostic accuracy of 2 serum biomarkers in differentiating ILD among CTD patients and various subgroups.

Results:

Twenty-nine studies were included in the quantitative synthesis. No threshold effects were observed (all P values >.05). For diagnosis of ILD among CTD patients, overall sensitivity and specificity of serum KL-6 were 0.76 (95% confidence interval [CI]: 0.68–0.82) and 0.89 (95% CI: 0.83–0.93), whereas those for serum SP-D were 0.65 (95% CI: 0.45–0.80) and 0.88 (95% CI: 0.80–0.93). Comprehensive comparison of 2 circulating biomarkers using back-calculated likelihood ratio (LR) demonstrated that serum KL-6 corresponded to a higher LR+ and a lower LR– in comparison to serum SP-D, as well as in SSc-ILD. TSA indicated that evidence for serum KL-6 and SP-D in identifying CTD-ILD is powerful; nonetheless, more trials were needed for validation of serum KL-6 and SP-D in differentiating CTD-ILD subtypes, including different CTD and ethnicities.

Conclusions:

This meta-analysis suggested that serum KL-6 had superior diagnostic accuracy to SP-D for differentiating ILD from non-ILD among CTD patients, providing a convenient and non-invasive approach for screening and management of ILD among CTD patients.
Efficacy and safety of combination of curcuminoid complex and diclofenac versus diclofenac in knee osteoarthritis
Authors: Shep Dhaneshwar , Khanwelkar Chitra , Gade Prakashchandra , Karad Satyanand
Published: April 2020

Background:

To compare the efficacy and safety of combination of curcuminoid complex and diclofenac vs diclofenac alone in the treatment of knee osteoarthritis (OA).

Methods:

In this randomized trial, 140 patients of knee OA received either curcuminoid complex 500 mg (BCM-95) with diclofenac 50 mg 2 times daily or diclofenac 50 mg alone 2 times daily for 28 days. Patients were assessed at baseline, day 14 and day 28. Primary efficacy measures were Knee injury and OA outcome score (KOOS) subscale at day 14 and day 28. Anti-ulcer effect and patient-physician's global assessment of therapy at day 28 were included as secondary endpoints. Safety after treatment was evaluated by recording adverse events and laboratory investigations.

Results:

Both treatment groups showed improvement in primary endpoints at each evaluation visit. Patients receiving curcuminoid complex plus diclofenac showed significantly superior improvement in KOOS subscales, viz. pain and quality of life at each study visit (P < .001) when compared to diclofenac. Less number of patients required rescue analgesics in curcuminoid complex plus diclofenac group (3%) compared to diclofenac group (17%). The number of patients who required histamine 2 (H2) blockers was significantly less in curcuminoid complex plus diclofenac group compared to diclofenac group (6% vs 28%, respectively;P < .001). Adverse effects were significantly less in curcuminoid complex plus diclofenac group (13% vs 38% in diclofenac group;P < .001). Patient's and physician's global assessment of therapy favored curcuminoid complex plus diclofenac than diclofenac.

Conclusion:

Combination of curcuminoid complex and diclofenac showed a greater improvement in pain and functional capacity with better tolerability and could be a better alternative treatment option in symptomatic management of knee OA.

Trial Registration:ISRCTN, ISRCTN10074826
Effect of 5 different cervical collars on optic nerve sheath diameter
Authors: Ladny Michal , Smereka Jacek , Ahuja Sanchit , Szarpak Lukasz , Ruetzler Kurt , Ladny Jerzy Robert
Published: April 2020

Background:

There is considerable evidence that prolonged use of cervical collars potentially cause detrimental effects including increase in optic nerve sheath diameter (ONSD) among healthy volunteers. Different types of cervical collars immobilize cervical spine variably well and may presumably differently influence the venous compression and hence the intracranial pressure. We therefore aimed to evaluate the influence of cervical spine immobilization with 5 different types of cervical collars on ONSD measured noninvasively by ultrasound on healthy volunteers.

Methods:

We conducted a randomized crossover trial including 60 adult healthy volunteers. Control assessment of the optic nerve sheath thickness was performed in both sagittal and transverse planes. Patient was placed supine on a transport stretcher, cervical collar was placed, and ONSD measurement was performed after 5 and 20 minutes. During the next days, the procedure was repeated with random allocation of participants and random cervical collar.

Results:

Sixty healthy volunteers were included in our study. ONSD left diameter [mm] for the baseline was 3.8 [interquartile range (IQR): 3.65–3.93)] mm. Using AMBU after 5 min, ONSD was changed up to 4.505 (IQR 4.285–4.61; P < .001) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.73 (IQR: 4.49–4.895; P < .001) and 4.925 (IQR: 4.65–5.06; P < .001), respectively. Necklite reported the lower change in ONSD: 3.92 (IQR: 3.795–4; P = 1.0) mm in 5 minutes and 3.995 (IQR: 3.875 – 4.1; P = 1.0) mm in 20 minutes. ONSD right diameter [mm] for the baseline was 3.8 (IQR 3.675–3.9) mm. Using AMBU after 5 minutes, ONSD was changed up to 4.5 (IQR 4.21–4.6) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.705 (IQR 4.455–4.9) and 4.93 (IQR 4.645–5.075), respectively. Necklite reported the lower change in ONSD -33.9 (IQR 3.795–3.99) mm in 5 minutes and 3.995 (IQR 3.86–4.09) mm in 20 minutes.

Conclusion:

We report significant increase of ONSD from the baseline after cervical collar placement among healthy volunteers at 5 minutes and 20 minutes interval. In addition, no significant difference was noted between ONSD measurements at 5 and 20 minutes. Clinicians should take proactive steps to assess the actual need of cervical collar case by case basis. Nonetheless, when needed, Necklite moldable neck brace seems to be a reasonable option.

Registration: ClinicalTrials database (www.clinicaltrials.gov, NCT03609879).
Two case reports of right atrial aneurysm
Authors: Li Hao-Peng , Ye Xian-Wang , Wang Hai-Tao
Published: April 2020

Introduction:

Right atrial aneurysm (RAA) is a rare congenital heart disease (CHD) that usually shows no symptom and is discovered occasionally. This paper introduces the clinical and imaging data obtained in 2 RAA patients and presents a related literature review with the aim of increasing understanding of this disease.

Patient focus:

One case showed chest distress, while the other showed symptoms on physical examination and positive signs.

Diagnosis:

Both of these 2 cases were diagnosed with RAA based on ultrasonography, computed tomography angiography (CTA), and enhanced magnetic resonance imaging (MRI) examinations.

Interventions:

One patient was orally administered warfarin anticoagulant therapy, while the other was given amiodarone to control arrhythmia as well as warfarin anticoagulant therapy.

Results:

The clinical symptoms of both cases were not aggravated.

Conclusions:

RAA is a rare cardiac anomaly that can induce severe complications, and it is mainly diagnosed based on imaging examinations. Conservative treatment and regular imaging monitoring are recommended for asymptomatic patients with no high-risk factors, while surgical treatment should be performed in symptomatic patients with high-risk factors.
Targeted next generation sequencing revealed a novel deletion-frameshift mutation of KCNH2 gene in a Chinese Han family with long QT syndrome
Authors: Du Fengli , Wang Guangxin , Wang Dawei , Su Guoying , Yao Guixiang , Zhang Wei , Su Guohai
Published: April 2020

Introduction:

Long QT syndrome (LQTS) is electrocardiographically characterized by a prolonged QT interval and manifests predisposition to life-threatening arrhythmia which often leads to sudden cardiac death. Type 2 LQTS (LQT2) is the second most common subtype of LQTS and caused by mutations inKCNH2gene. Up to date, >900 mutations have been reported to be related to LQT2. However, mutational screening of theKCNH2gene is still far from completeness. Identification ofKCNH2mutations is particularly important in diagnosis of LQT2 and will gain more insights into the molecular basis for the pathogenesis of LQT2.

Patient concerns:

A Chinese Han family with LQTS phenotypes was examined.

Diagnosis:

A novel deletion-frameshift mutation, c.381_408delCAATTTCGAGGTGGTGATGGAGAAGGAC, in exon 3 ofKCNH2gene was identified in a Chinese family with LQTS. On the basis of this finding and clinical manifestations, the final diagnosis of LQT2 was made.

Interventions:

Next-generation sequencing (NGS) of DNA samples was performed to detect the mutation in the LQTS-related genes on the proband and her mother, which was confirmed by Sanger sequencing. The proband was then implanted with an implantable cardioverter defibrillator and prescribed metoprolol 47.5 mg per day.

Outcomes:

This novel heterozygous mutation results in a frameshift mutation after the 128thresidue (Asparagine), which replaced the original 1031 amino acids with 27 novel amino acids (p.N128fsX156).

Conclusion:

This novel mutation presumably resulted in a frameshift mutation, p.N128fsX156. Our data expanded the mutation spectrum ofKCNH2gene and facilitated clinic diagnosis and genetic counseling for this family with LQTS.
Effect of lower esophageal gastric tube implantation in postoperative enteral nutritional support in patients with laryngeal cancer
Authors: Xiao Hongying , Liu Jianmin , Liu Sisi , Chen Xiaofang
Published: April 2020

Background:

For a long time, postoperative nutritional support for laryngeal cancer patients has depended on the gastric tube for enteral nutrition. Silica gel gastric tube is often used in clinical practice; however, the gastric tube placed in the conventional depth often leads to various complications in the stomach, thus damaging the nutritional status of patients and leading to the poor prognosis.

Methods/design:

A total of 80 patients with laryngeal cancer in otolaryngology, head and neck surgery department of Deyang people's hospital from May 2020 to April 2022 will be selected and randomly divided into control group and experimental group according to the numerical table. Patients in the control group will receive conventional gastric tube placement, with a depth of 45 to 55 cm, which can extract gastric juice. B-ultrasound accurately positioned the gastric tube in the stomach instead of the cardia, and postoperative nasal feeding nutrition will be provided. In the experimental group, the gastric tube will be pulled out 10 cm after conventional placement and no gastric juice will be extracted. B-ultrasonography verified that the gastric tube will be located below the esophagus or above the cardia, and routine nasal feeding will be performed postoperatively. Analysis for comfort and prognosis were performed by general comfort questionnaire and various index including height, body mass index, albumin value, electrolyte, wound healing, pharyngeal fistula.

Discussion:

In this study, visual simulation scale and general comfort questionnaire developed by Kolaba, an American comfort nursing specialist, were used to evaluate the comfort level of the 2 groups of patients, including pain, acid reflux, upper abdominal burning sensation, and hiccup. Objective indexes such as height, body mass index, albumin value, electrolyte, wound healing, and pharyngeal fistula were used to evaluate the prognosis of the 2 groups of patients. The visual simulation scale can preliminarily judge the subjective feelings of patients.

Trial registration:

It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000030378), Registered February 29, 2020.
Congenital unilateral proximal radioulnar synostosis
Authors: Jia Yuqing , Geng Chunyuan , Song Zikai , Lv Shijie , Dai Bin
Published: April 2020

Rationale:

Congenital proximal radioulnar synostosis is a rare genetic malformation of the upper limb. This deformity, which is found mainly in preschool-aged children, has no recognized diagnosis and treatment. Current diagnostic methods cannot effectively assess both bone structure and soft tissue abnormalities, and most surgical treatments introduce complications and do not prevent recurrence. More work is needed; therefore, to address the diagnosis and treatment of this disease.

Patient concerns:

An 8-year-old male patient was hospitalized in our department. He reported deformity and limited motion in his right elbow for the past 2 years. He denied a traumatic or family history of bony malformation. The chief complaint at the time of the hospitalization was the limitation in forearm rotation.

Diagnosis:

Digital radiography of the right elbow joint showed proximal radioulnar synostosis and a valgus deformity. A 3-dimensional computed tomography scan further showed proximal ulna and radius dysplasia as well as anterior dislocation of the radius head. The patient was diagnosed with congenital right proximal radioulnar synostosis.

Interventions:

Surgical procedures included arthrolysis of the right proximal radioulnar joint, osteotomy of the proximal radius, internal fixation with Kirschner wires, and reconstruction of the annular ligament. The right elbow was immobilized in plaster in a flexion and supination position for 2 weeks.

Outcomes:

Recurrence of the right proximal radioulnar synostosis was observed during the 6-month follow-up, but the rotation function of the patient's forearm was significantly improved.

Lessons:

The findings from this case suggest that we should carefully monitor all patients younger than 6 years old who report long-term issues with forearm rotation. This case also highlights the need to assess soft tissue and epiphysis abnormalities in addition to bone assessments via digital radiography and 3-dimensional computed tomography. We suggest that surgery should not be performed until the proximal radius epiphysis has closed. Not all cases require surgical treatment, but when surgery is needed, a suitable method should be selected according to the individual needs of the patient. Any surgery performed should treat both the bony malformations and soft tissue abnormalities to maximize the therapeutic effect and reduce complications during and after surgery.
A comparison of tiotropium/olodaterol vs tiotropium alone in terms of treatment effect for chronic obstructive pulmonary disease
Authors: He Jie , Lin Jiang-Tao
Published: April 2020

Background:

Combinations of long-acting bronchodilators with different mechanisms of action are recommended to improve prognosis and reduce risk of adverse events of chronic obstructive pulmonary disease (COPD). It is unclear whether the new combination therapy with long-acting muscarinic antagonist (LAMA) tiotropium (TIO) and long acting beta-agonists (LABA) olodaterol (OLO) was superior to tiotropium alone.

Methods:

We measured the efficacy of the TIO/OLO combination vsTIO alone for COPD patients based on electronic databases up to February 2019. After rigorous quality review, data was extracted from eligible trials. All the main outcomes were pooled analysis using RevMan software.

Results:

A total of 6 randomized controlled trials (RCTs) were identified. The pooled results of our meta-analysis demonstrated that FEV1 [MD = 0.03, 95% CI (−0.01,0.07), P = .18], FVC [MD = -0.03, 95%CI (−0.06,0.00), P = .09] and FEV1%pred [MD = 0.35, 95%CI (−0.30, 0.99), P = .29] all showed no significant difference between the 2 groups. The overall incidence of adverse effects (AEs) [OR = 1.01,95%CI (0.93,1.09), P = .87] and serious AEs [OR = 1.04,95% CI (0.82, 1.32), P = .72] in the combination group was similar to that of the TIO alone group, without statistical significance.

Conclusion:

These studies reported that the TIO/OLO combination did not show superior effects than tiotropium alone for COPD. Additionally, both therapies were well tolerated.
Wernicke's encephalopathy due to malnutrition and parenteral nutrition in a patient with cerebral infarction
Authors: Lian Xiaojiao , Wu Meng , Fan Haixia , Zhang Yi , Sun Ping
Published: April 2020

Introduction:

Wernicke's encephalopathy (WE) is a severe neuropsychiatric disorder, which results from a nutritional deficiency of thiamine. The occurrence of WE is rarely reported in patients with cerebral infarction, who often have complications of malnutrition. Cerebral infarction is a neurological disease, patients with cerebral infarction may show symptoms such as disturbance of consciousness and gait instability, which is difficult to differentiate from WE. Thus, early recognition and differential diagnosis of WE are important. We report a rare case of cerebral infarction patient who developed WE due to malnutrition and parenteral nutrition.

Patient concerns:

A 65-year-old woman was admitted to our hospital with cerebral infarction. She had lost 15 kg of weight in the past month or so and was diagnosed with malnutrition. In order to correct malnutrition, parenteral nutrition and intravenous glucose without thiamine were administered. Cognitive dysfunction, laloplegia, sleep rhythm inversion, somnolence and bilateral lower limbs weakness were presented 20 days after admission.

Diagnosis:

Brain magnetic resonance imaging confirmed the diagnosis of WE.

Interventions:

The patient was given thiamine and nutrition support therapy.

Outcomes:

The patient's cognitive impairment, laloplegia and sleep condition improved within 4 days. Neurological status continued to improve and physical activity recovered gradually within 2 weeks. She received rehabilitation training when her condition was relatively stable, and her muscle strength of limbs and physical function gradually improved.

Conclusion:

Infarction-related malnutrition may result in nutrient deficiency-related neurological complications, such as WE. Thus, it is important to pay close attention to the nutritional status of patients with cerebral infarction. In addition, early recognition and differential diagnosis of WE in patients with infarction-related malnutrition are necessary, early treatment of replete thiamine supplementation and nutrition support therapy can reduce the risk of WE and improve the prognosis.
Prediction mode of more than 5 central lymph nodes metastases in clinically node-negative ipsilateral papillary thyroid carcinoma with tumor size 1 to 4 cm
Authors: Jin Lei , Sun Hai-Li , Zhou Liang , Xie Lei , Zhuang Yi-Yu , Wang Jian-Biao
Published: April 2020

According to the 2015 American Thyroid Association guidelines, either lobectomy or total thyroidectomy was recommended for patients with papillary thyroid carcinoma (PTC) of 1 to 4 cm without extrathyroidal extension and lymph node metastasis. However, lymph node metastases showed strong association with recurrence and low survival rate, especially in PTC patients with more than 5 metastatic lymph nodes. Therefore, this study aimed to investigate the predictive factors of more than 5 central lymph nodes metastases (CLNM) in PTC patients with tumor sizes of 1 to 4 cm. A total of 382 patients with clinically node-negative (cN0) ipsilateral PTC who underwent thyroidectomy with central neck dissection between January 2012 and December 2016 were retrospectively analyzed. CLNMs of >5 were found in 54 (14.1%) patients, while CLNM was detected in 230 (60.2%) patients. Multivariate logistic regression revealed age < 45 years (P < .001), male gender (P = .013), and tumor sizes of >2 cm (P = .001) as independent predictive factors of >5 CLNMs in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm. The prediction equation (Y = 1.694 × age + 0.807 × gender + 1.190 × tumor size − 3.530) was developed, with a sensitivity (57.4%) and a specificity (80.8%), respectively, at an optimal cut-off point of −1.685. Therefore, if the predictive value was higher than −1.685 according to the equation in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm, then total thyroidectomy might be considered.
Role of diffusion tensor imaging in analyzing the neural connectivity of the parieto-insular vestibular cortex in pusher syndrome
Authors: Yeo Sang Seok , Jang Sung Ho , Oh Seunghue , Kwon Jung Won
Published: April 2020

Rationale:

Pusher syndrome is a disorder of postural control. It is associated with unilateral lesions on central vestibular system. In the current study, we attempted to identify and investigate neural connectivity of the parieto-insular vestibular cortex in a patient with pusher syndrome, using diffusion tensor imaging.

Patient concerns:

A 60-year-old male patient had left hemiplegia due to an infarction on right premotor cortex, primary motor cortex, corona radiata and temporal and occipital lobe. The patient had severe motor weakness in left upper and lower limb, left side neglect and significant pusher syndrome.

Diagnosis:

Patient was diagnosed with left hemiplegia due to an infarction in the right middle cerebral artery territory at the neurology department of a university hospital.

Interventions:

One patient and 5 control subjects of similar age participated. Diffusion tensor imaging data were acquired at 4-month and 12-month after the initial injury.

Outcomes:

Fractional anisotropy, mean diffusivity, and tract volume (TV) were measured. TV values in both affected and unaffected hemispheres of the patient were significantly decreased at 4-month compared to those of control subjects. In the unaffected hemisphere of the patient, TV value showed significant increase at 12-month compared to that at 4-month. Although the TV value at 12-month of the affected hemisphere was out of reference range, TV was considerably increased compared to that at 4-month. Mean values for fractional anisotropy or mean diffusivity in 2 hemispheres did not show significant difference compared to those of control subjects regardless of month.

Lessons:

Restoration of an injured projection pathway between the vestibular nuclei and parieto-insular vestibular cortex with recovery of pusher syndrome was found in a patient with stroke.
Case report of bilateral penetrating renal trauma caused by a wooden stick
Authors: Xie Jing , Liu Ying , Chen Tong , Xiao Ke-Feng
Published: April 2020

Rationale:

Kidney is the most frequently injured organ of the genitourinary system during trauma. Bilateral penetrating renal trauma (BPRT) is extremely rare and sporadically reported in the previous literature. Here, we reported a unique case of BPRT.

Patient concerns:

A 43-year-old man, with no medical history, was accidentally penetrated by a wooden stick and presented with sharp pain in the left flank.

Diagnosis:

Laboratory tests revealed microscopic hematuria, mildly elevated leucocyte and amylase, normal hemoglobin (145 g/L) and creatinine (1.05 mg/dl). Computed tomography demonstrated bilateral penetrating renal injuries with perinephric/subcapsular hematoma, fracture of the second lumbar vertebra and 10th rib.

Interventions:

An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma Organ Injury Scale grading system, grade V and III injuries were considered for the left and right kidney, respectively. Nephrectomy and renorrhaphy were performed on the left and right kidney, respectively.

Outcomes:

The postoperative course was uneventful. Eleven days after the surgery, the patient discharged with no complications.

Lessons:

We present a rare and challenging case which was handled successfully, and it may provide useful information for the management of BPRT.
Severe vaso-occlusive lupus retinopathy in the early stage of a pediatric patient with systemic lupus erythematosus: a case report
Authors: Huang Guoping , Shen Huijun , Zhao Jingli , Mao Jianhua
Published: April 2020

Introduction:

Systemic lupus erythematosus (SLE) is a multisystem, chronic, autoimmune disease which can affect any organ system including the eye. About one-third of the patients can be diagnosed with SLE-related eye involvement which is usually indicative of disease activity. Retinopathy is one of the most vision-threatening complications that can be associated with the disease.

Patient concerns:

An 11-year-old girl was hospitalized with complains of repeated swelling and pain in her extremities for 1 month, chest pain for 24 days, rash for 5 days and proteinuria for 1 day. On the morning of her fourth day in hospital, she suddenly complained of sudden, painless vision loss in the left eye. The ophthalmologist found that she had obstruction of central retinal vein and artery with diffuse retinal hemorrhages and macular edema.

Diagnosis:

The patient was diagnosed with systemic lupus erythematosus, lupus nephritis, and lupus retinopathy through her clinical manifestations and laboratory tests.

Interventions:

After diagnosis, she received steroid therapy, retinal laser photocoagulation, and intravitreal injection of dexamethasone (OZURDEX, Allergan Pharmaceuticals, Dublin, Ireland) early in her course.

Outcomes:

At the latest follow-up, her vision improved partially. However, she still has the possibility of subsequent neovascular glaucoma and bleeding in the future.

Conclusions:

An early diagnosis and the prompt therapeutic measures are necessary to prevent sight-threatening consequences, especially in pediatric patients with SLE.
Characteristic of extra luminal gastric stromal tumor arising from the lesser curvature of the stomach
Authors: Wang Min , Qiu Xia , He Xu , Tian Chuan
Published: April 2020

Rationale:

Gastrointestinal stromal tumor (GIST) is one of the most common malignant mesenchymal tumors of the gastrointestinal tract. They generally arise from the fourth layer (muscularis propria) and rarely from the second or third layer. Although the manifestations of gastric stromal tumors are diverse, to our knowledge, there are only several cases of an extra-gastric stromal tumor in the literature appearing with a pedunculation. Pedunculated large GISTs are not frequent and compress the neighboring organs. When they were huge, it is difficult to differentiate the origin of the masses. Thus, in the clinical setting, physicians should pay more attention to the pattern of manifestation of the gastric stromal tumor.

Patient concerns:

A 62-year-old man had no gastrointestinal symptoms or significant medical and family histories. During the health examination with US, a cystic-solid tumor was found below liver. The results of the physical examination were unremarkable, and routine laboratory data on admission did not show any abnormal findings.

Diagnosis:

Computed tomography of the abdomen showed a mixed echoic mass measuring 10 × 8 × 8 cm and located below the liver, adjacent to the gastric antrum. After endoscopic ultrasound-guided fine-needle aspiration, cytopathology showed that the specimen was filled with red blood cells, and it had no malignant cells. Histopathology revealed that the mass was a GIST, and immunohistochemical analysis showed the following: CD117(+), CD34(+), desmin(−), Dog-1(+), Ki-67% <1%, and smooth muscle actin(−).

Interventions:

Surgical resection was performed on the patient.

Outcomes:

The lesion was diagnosed as a gastric stromal tumor with a pedicle and an old hemorrhage. The patient's recovery was uneventful. After surgery, computed tomography at the 6-month and 1-year postoperative follow-up visits did not reveal relapse or any metastasis.

Lessons:

In the clinical setting, physicians should pay more attention to the pattern of manifestation of the extra-gastric stromal tumor in patients with a pedicle or hemorrhage. Additionally, endoscopic ultrasound-guided fine-needle aspiration can be used to make an accurate preoperative diagnosis of such diseases, and its findings can serve as an important basis for surgical excision of the lesions.
De-differentiation of papillary thyroid carcinoma into squamous cell carcinoma in an elderly patient
Authors: Thewjitcharoen Yotsapon , Krittiyawong Sirinate , Butadej Siriwan , Nakasatien Soontaree , Polchart Somsong , Junyangdikul Pairoj , Kanchanapituk Auchai , Himathongkam Thep
Published: April 2020

Rationale:

The unpredictability of thyroid cancer can be striking, as the disease may rapidly progress to death in some individuals. Herein, we reported a rare case of aggressive papillary thyroid cell carcinoma (PTC) in an elderly patient de-differentiated into squamous cell carcinoma (SCC).

Patient concerns:

We describe a case of a 79-year-old Thai woman presented with hoarseness and neck mass for 2 months and she had been diagnosed with a 3-cm papillary thyroid carcinoma (PTC) in the right side of the thyroid gland. Later on PTC de-differentiated into SCC within 3 years after initial presentation.

Diagnosis:

De-differentiation from papillary thyroid carcinoma to squamous cell carcinoma.

Interventions:

The patient underwent a total thyroidectomy at the initial hospital and received high dose radioactive iodine (RAI) treatment at our hospital 1 month following the surgery and then was lost to follow-up. Two years later she came back with new development of right solid-cystic neck mass which was found to be recurrent PTC. A radical neck dissection was done and another high dose RAI treatment was given. However, she developed recurrent mass with tenderness at the site above previous solid cystic mass 6 months later. Re-exploration of the neck mass revealed an inflamed midline mass 2 cm with enlarged right lateral cervical lymph nodes.

Outcomes:

A histopathological examination of the midline neck mass showed poorly differentiated SCC with lymphatic invasion. The intermingling of two morphologically distinct tumors, a typical PTC and a poorly differentiated SCC, had been identified in 1 out of 14 excised cervical lymph nodes. The patient underwent external beam radiation without chemotherapy. She is still in stable condition at 18 months post-treatment.

Lessons:

This case clearly demonstrated that SCC transformed from a pre-existing PTC. The clinician should consider a possible transformation of papillary thyroid cancer into more aggressive histological types in elderly patients who present with rapidly progressive clinical behavior. However, some patients could have long-term survival if the tumor did not transform into anaplastic thyroid cancer.
Pediatric adrenocortical tumor – review and management update
Authors: Brondani Vania B. , Fragoso Maria Candida B.V.
Published: April 2020

Purpose of review

Adrenocortical tumor (ACT) is a rare disease with an annual worldwide incidence of 0.3–0.38/million children below 15 years old, and Brazilian population presents the highest incidence because of germline mutation in the TP53. Pediatric ACT is associated with virilizing features and hypercortisolism in most cases. Malignancy is defined when local invasion or metastasis is found, and it is associated with a poor prognosis. However, the correct and early diagnosis and treatment may impact on overall and disease-free survival.

Recent findings

A complete understanding of the disease and its singularities facilitates the assistance to the pediatric patient with ACT. The new insights about adrenal tumorigenesis have provided a better understanding of this disease. In this scenario, the era of molecular studies is leading to the refinement of the taxonomy, and it is offering the opportunity to discover new biomarkers and pathways of tumorigenesis, beyond the knowing β-catenin, Insulin-like growth factor-II/IGF-IR, and the p53/Rb signaling.

The rarity of this disease makes it a real challenge. Here, we present a review focusing on clinical practice. A methodic approach aiming to clarify the diagnosis and a follow-up are suggested to guide physicians in the assistance of pediatrics patients, improving the prognosis.
Long-term cardio-metabolic outcomes in patients with classical congenital adrenal hyperplasia: is the risk real?
Authors: Gomes Larissa G. , Mendonca Berenice B. , Bachega Tânia A.S.S.
Published: April 2020

Purpose of review

Data on the long-term cardio-metabolic outcomes classical congenital adrenal hyperplasia (CAH) patients have been published with controversial results. Conventional treatment recommends hydrocortisone during childhood; and short and/or long-acting glucocorticoid during adulthood, associated or not with mineralocorticoid, in an attempt to simulate normal cortisol secretion and to normalize androgen excess. However, the balance between glucocorticoid over or undertreatment is very challenging, and patients frequently oscillate between hypercortisolism or hyperandrogenism. Considering these data, we reviewed the frequency of metabolic syndrome components and other cardiovascular risk factors in CAH.

Recent findings

Several studies reported increased prevalence obesity, abnormal body composition, increased homeostasis model assessment of insulin resistance and blood pressure levels in CAH patients. However, the evidence quality is still low, because most studies used different glucocorticoid regimes and had heterogeneous goals for hormonal control.

Despite the above-mentioned scenario of increased frequency of some cardiovascular surrogate markers in patients, most cohorts comprised young adults, and it is not known if patients will present high frequency of cardiovascular disease in the future. Prospective randomized studies comparing different glucocorticoid regimens should establish the real role of glucocorticoid and androgens on metabolic/cardiovascular profile.
Lipoprotein(a): is it more, less or equal to LDL as a causal factor for cardiovascular disease and mortality?
Authors: Langsted Anne , Nordestgaard Børge G.
Published: April 2020

Purpose of review

To summarize the recent studies directly comparing LDL and lipoprotein(a) as causal factors for cardiovascular disease and mortality.

Recent findings

In approximately 100,000 individuals from the Copenhagen General Population Study for risk of myocardial infarction, in observational analyses per 39 mg/dl (1 mmol/l) cholesterol increase, the hazard ratio was 1.3 (95% confidence interval: 1.2–1.3) for LDL cholesterol and 1.6 (1.4–1.9) for lipoprotein(a) cholesterol. In corresponding genetic analyses, the causal risk ratio was 2.1 (1.3–3.4) for LDL and 2.0 (1.6–2.6) for lipoprotein(a). Also, a 15 mg/dl (0.39 mmol/l) cholesterol increase was associated with a hazard ratio for cardiovascular mortality of 1.05 (1.04–1.07) for LDL cholesterol and 1.18 (1.12–1.25) for lipoprotein(a) cholesterol. Corresponding values for all-cause mortality were 1.01 (1.00–1.01) for LDL cholesterol and 1.07 (1.04–1.10) for lipoprotein(a) cholesterol. In genetic, causal analyses, the mortality increases for elevated lipoprotein(a) appeared to be through apolipoprotein(a) kringle IV-2 rather than through lipoprotein(a) levels per se.

On cholesterol scales, lipoprotein(a) and LDL appeared equal as causal factors for myocardial infarction; however, lipoprotein(a) was most important for mortality. Lipoprotein(a) effects may not only be due to cholesterol content but could also be due to the structure of lipoprotein(a) resembling plasminogen.
Update on pediatric lung transplantation: mir-ando into the mechanisms of chronic lung allograft dysfunction in children
Authors: Conrad Carol
Published: April 2020

Purpose of review

Lung transplantation (LTx) is a worthwhile treatment for children with end-stage lung diseases who have no practicable medical or surgical solutions. But the long-term survival remains the lowest in all solid-organ transplant, with a median survival of 5.7 years, limited by the onset of chronic lung allograft dysfunction (CLAD). This reviews a recent publication in pediatric patients that focuses on translational regulation by microRNA.

Recent findings

The mechanisms that cause transplanted lung allografts have been difficult to identify. This review discusses pertinent findings in the first and largest observational prospective study of pediatric lung transplant recipients. The review discusses the relevance of microRNA that distinguish stable patients from those who can be predicted to display graft dysfunction on a molecular panel.

The article under review detected highly specific and sensitive markers of both acute rejection and CLAD in pediatric LTx recipients. With the use of next-generation sequencing techniques, biomarkers may soon provide the basis for earlier detection of graft function and stimulate development of therapeutic interventions to impact outcomes and survival. The review touches on the relevance of these findings and how future research can build on them.
Bladder-preserving strategies for Bacillus Calmette-Guérin unresponsive non-muscle invasive bladder cancer; where are we and what will be expected?
Authors: Sari Motlagh Reza , Pradere Benjamin , Mori Keiichiro , Miura Noriyoshi , Abufaraj Mohammad , Shariat Shahrokh F.
Published: April 2020

Purpose of review

Bacillus Calmette-Guérin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) is a new definition including patients who failed intravesical BCG therapy and should not receive more BCG because of the very low efficacy and disproportionately poor prognosis. Radical cystectomy as the standard of care for these patients is associated with significant morbidity and altered quality of life. Therefore, the FDA has accepted phase II single-arm studies as a threshold to approve new agents in this setting.

Recent findings

Efforts to find an effective and safe bladder sparing strategy for BCG unresponsive patients have not been successful yet. Studies that assess nanoparticle-bound, combination or device-assisted intravesical chemotherapy to increase drug delivery and efficacy have been partly promising but suffer from limitations. Systemic immunotherapy such as checkpoint inhibitors therapy PD1/PDL1 and intravesical immunotherapy such as rAd-IFN/Syn3 have shown satisfactory efficacy so far.

Although this is much effort and enthusiasm, no bladder-sparing strategy has met the criteria set for the successful alternative to radical cystectomy in BCG unresponsive NMIBC. For BCG unresponsive patients who refuse or are unfit for radical cyctectomy, there is new hope arising with novel strategies limiting the threshold for clinical use and a multitude of promising agents in clinical trials.
Clinical Characteristics and Long‐term Outcomes of Children With Fibrosing Pancreatitis
Authors: Scheers Isabelle , Chavhan Govind B. , Chami Rose , Carman Nicholas , Scaini Vikki , Gaisano Herbert , Marcon Margaret , Gonska Tanja
Published: April 2020

Objectives:

Fibrosing pancreatitis (FP) shares clinical features with autoimmune pancreatitis (AIP), although both entities have not been definitely linked. This study aimed to assess the presence of AIP criteria in an historic FP patient cohort and investigate the clinical features, management, and long‐term outcomes of pediatric FP (P‐FP).

Methods:

Clinical data of 14 P‐FP patients from Toronto and 42 P‐FP cases from a literature review were collected and compared to pediatric AIP (P‐AIP). Toronto P‐FP patients were recontacted to assess their current health status using a brief questionnaire.

Results:

Jaundice and abdominal pain were the symptoms at presentation in 44 of 56 (79%) and 50 of 56 (89%) P‐FP patients, respectively. Common findings on cross sectional imaging were an enlarged pancreas head with narrowing of the distal common bile duct (51/54, 94%). Histopathology mainly showed gland fibrosis (39/39, 100%). Three of twelve (25%) P‐FP patients had elevated IgG4 in serum. None of the patients were treated with corticosteroids, but some underwent surgical or endoscopic intervention. Toronto patients were followed for a median of 13.6 years (interquartile range: 2.9–22.8). Complications during follow‐up included exocrine pancreatic insufficiency (3/14, 21%) and pancreatic gland atrophy (5/13, 38%); but none of the patients had disease relapse or developed diabetes type 3c. Five (5/14, 36%) patients developed other immune‐mediated diseases over time.

Conclusions:

Clinical features of patients with P‐FP resembled those recently described in a subgroup of P‐AIP presenting with jaundice. Long‐term outcome of these patients is generally good, with or without invasive interventions. As some patients may develop exocrine pancreatic insufficiency and/or other immune‐mediated diseases, ongoing clinical monitoring is recommended.
On the Chromatic Dispersion of Hydrophobic and Hydrophilic Intraocular Lenses
Authors: Eppig Timo , Rawer Antonia , Hoffmann Peter , Langenbucher Achim , Schröder Simon
Published: April 2020

SIGNIFICANCE

There is a high variation of chromatic dispersion with contemporary intraocular lens (IOL) materials. It is well known that chromatic aberration limits the optical performance especially with high-power lenses. Lens manufacturers, however, rarely provide data on the chromatic dispersion of their materials, limiting the comparability of available materials.

PURPOSE

This study aimed to analyze chromatic dispersion of hydrophobic and hydrophilic IOLs without prior knowledge of the IOLs' geometries.

METHODS

We adapted Bessel's method for measuring focal length by placing the IOL in a wet cell. The chromatic dispersion of several hydrophobic and hydrophilic IOLs was characterized by measuring their focal lengths at multiple wavelengths. From the measured focal lengths, the refractive indices and the Abbe numbers were obtained. We measured four hydrophobic and two hydrophilic IOL models with a nominal power of 21 to 29.5 D.

RESULTS

The hydrophobic IOLs had lower Abbe numbers (Abbe numbers <41) than did the hydrophilic IOLs (Abbe numbers >50). Most Abbe numbers were in agreement with the values provided by the IOL manufacturers, and the measurements were independent from IOL power. The repeatability for the Abbe number was better than ±3.5% for all lenses and better than ±2% for lenses between 21 and 26.5 D. The dispersion could be described by a Conrady model (R
2 > 0.997).

CONCLUSIONS

The hydrophobic materials showed larger dispersion than did the hydrophilic IOL materials resulting in increased chromatic aberration. The method allowed for an estimation of the IOL's Abbe number without prior knowledge of IOL geometry.