bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of systemic and neuraxial morphine on the immune system
Authors: Chen Shih-Hong , Chen Shiou-Sheng , Wang Yi-Ping , Chen Li-Kuei
Published: May 2019

In the study, we tried to evaluate the effects of morphine injected through the systemic or neuraxial route on immune cell function and cytokine production in healthy women.

In total, 29 paired samples of fresh peripheral blood were collected from healthy women who had been administered morphine for anesthetic analgesia through intravenous (IV), epidural, or spinal route postpartum. Their isolated peripheral blood mononuclear cells were mitogen-activated and stained with fluorochrome-conjugated anti-CD4, anti-CD8, anti-interleukin (IL)-2, and anti-interferon (IFN)-γ antibodies for flow cytometry, and the plasma levels of cytokines, including IL-6, IFN-α2, IL-10, IL-8, GM-CSF, and monocyte chemoattractant protein (MCP)-1, were measured through enzyme-linked immunosorbent assay.

The results demonstrated that regardless of the administration route, morphine delivery slightly reduced IL-2 expression in CD4+ cells after activation, and the same effect was not noted for CD8+ cells. Intravenous or epidural morphine tended to reduce IFN-γ expression in CD8+ cells. Spinal and IV morphine substantially increased IL-6 production, whereas epidural morphine hindered IL-10 and GM-CSF production. IV morphine injection reduced MCP-1 production in plasma. Compared with spinal morphine, IV or epidural morphine may more effectively inhibit the expression of various cytokines and thus affect immune response.

All 3 routes of morphine injection tended to decrease IL-2 production by CD4+ cells, whereas IV or epidural morphine injection showed lower IFN-γ production by CD8+ cells. However, additional large-scale studies with longer follow-up durations are warranted.
Serum ROCK1 mRNA is of great diagnostic value for glioma patients
Authors: Liu Yunyang , Zhang Jianjun , Wang Dong , Yang Xinyu
Published: May 2019

The study aimed to measure the presence of rho-associated protein kinase 1 (ROCK1) mRNA in serum samples collected from glioma and investigate its diagnostic significance in glioma.

The presence of ROCK1 mRNA was examined by quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between ROCK1 mRNA and clinical characteristics was analyzed via Chi-square test. The criteria of diagnosis evaluation, including sensitivity, specificity, optimal cutoff point, and area under the curve (AUC) were determined through the receiver operating characteristic (ROC) curve analysis.

ROCK1 mRNA was significantly increased in serum samples collected from glioma patients compared to the controls (P <.05). Besides, high ROCK1 mRNA expression was tightly related with Karnofsky Performance Status (KPS) score (P = .024) and World Health Organization (WHO) grade (P = .029). However, there was no association between ROCK1 expression and gender, neurological disorders, family history and cigarette smoking (all, P >.05). In addition, the optimal cutoff point was 3.025, with the sensitivity and specificity of 88.89% and 79.25%, respectively. The AUC was 0.881, indicating that ROCK1 was a diagnostic biomarker for glioma patients (P <.0001, 95% CI = 0.829–0.933).

Serum ROCK1 mRNA is significantly up-regulated in glioma cases compared to healthy controls. ROCK1 may be a potential diagnostic biomarker in glioma.
Timely diagnosis and treatment of neonatal alloimmune thrombocytopenia caused by anti HPA-3a antibody
Authors: Yang Qiankun , Lv Xianping , Kong Yongkui , Liu Xin , Shao Ming , Zhao Yanteng , Xia Namei , Wang Shuya , Li Huidong
Published: May 2019

Rationale:

Neonatal alloimmune thrombocytopenia (NAIT) caused by anti HPA-3a antibody is rare, and the clinical features of the syndrome are not specific.

Patient concerns:

A male infant was noted to be irritable and physical examination revealed the presence of petechiae and bruising on the right arm and thigh after born.

Diagnoses:

Platelet antibodies were investigated using the monoclonal antibody-specific immobilization of platelet antigens (MAIPA) assay, platelet genotyping (HPA 1–17) was performed by polymerase chain reaction technique with sequence-specific primers (PCR-SSP). The HPA genotype of the newborn was HPA-3a/b, while that of his mother and his father were HPA-3b/b and HPA-3a/a, respectively. The sera of newborn contained antibody against the platelet of newborn's father. The HPA antibody of the newborn was identified as anti HPA-3a. The newborn was confirmed as a patient of NAIT caused by anti HPA-3a antibody.

Interventions:

A single dose of intravenous immunoglobulin (IVIG) 1 g/kg was administered from day 3 to day 7.

Outcomes:

At follow-up 3 months after discharge from the hospital, the baby was developing normally and had a normal platelet count (361 × 109/L).

Lessons:

NAIT caused by anti HPA-3a antibody is rare, and we believe this study can provide insights for diagnosing prospective cases. Prognosis of NAIT caused by HPA3a seems to be favorable if diagnosed and treated in a timely manner.
Bowel plication in neonatal high jejunal atresia
Authors: Yang Shaobo , Wang Min , Shen Chun
Published: May 2019

This study aimed to evaluate the efficacy of bowel plication as a part of the surgical treatment in neonatal high jejunal atresia.

Between January 2013 and December 2016, 43 neonates with high jejunal atresia underwent surgical treatment at the Children's Hospital of Fudan University. According to the surgical procedures the patients underwent, the neonates were divided into a bowel plication group and a nonplication group. Eighteen neonates underwent proximal bowel plication after atretic segment resection and primary anastomosis. The other 25 neonates were in the nonplication group and underwent enteroplasty after atretic segment resection. Data were retrospectively analyzed, including gestational age, birth weight, concomitant diseases, age at surgery, duration of operation, length of total parenteral nutrition (TPN), postoperative intestinal function recovery (i.e., the time of the 1st oral feeding and when the oral feeding volume reached 40 mL/kg/3 h), length of hospital stay, growth and development, complications, and reoperations.

No differences in gestational age, birth weight, concomitant disease, age at surgery, or duration of operation were found between the 2 groups. The time of the 1st oral feeding, the time when oral feeding volume reached 40 mL/kg/3 h, and duration of TPN for the bowel plication group were shorter than those for the nonplication group (9.4 ± 3.1, 14.6 ± 2.3, 9.2 ± 2.7 days, respectively, vs 13.5 ± 2.6, 17.6 ± 2.8, 14.3 ± 2.4 days, respectively, P < .05). The length of the hospital stay for the bowel plication group was significantly shorter than for the nonplication group (15.3 ± 3.1 days vs 18.5 ± 3.6 days, respectively, P < .05). In the bowel plication group, 1 patient (5.6%) underwent reoperation for intestinal stenosis resulting from neonatal necrotizing enterocolitis 1 year after the initial surgery. However, in the nonplication group, 5 patients (20%) underwent reoperation, including 3 for anastomotic stenosis and 2 for adhesive intestinal obstruction. Follow-up visits occurred for an average period of 2.8 years (6 months to 4.5 years). All infants thrived, and no differences in growth and development were found between the 2 groups.

Bowel plication after atretic segment resection and primary anastomosis improves the clinical outcome for neonates with high jejunal atresia.
Concurrent lymphoma and hemophilia B in a pediatric patient
Authors: Lu Guoyan , Qiao Lina , Li Deyuan , Liu Zhongqiang , Zhao Fumin , Yu Dan
Published: May 2019

Introduction:

Lymphoma is the third most common cancer among children in the United States and Europe. Hemophilia is a congenital bleeding disorder characterized by deficiency of coagulation factor VIII or IX. Hemophilia B is a consequence of factor IX deficiency and has an incidence of 1 in 20,000 male births. A concurrence of these 2 uncommon diseases is rare except in patients infected with the human immunodeficiency virus (HIV). We report a case of a patient with both Burkitt lymphoma and hemophilia B; this is only such report in China since 1987.

Patient concerns:

A 3-year-old boy was admitted to our hospital because of melena and jaundice for several days. His older brother had died due to hemophilia B and ventricular septal defect. The patient had not experienced any previous episodes of severe bleeding. Gradual abdominal distention was observed after admission; the patient's superficial lymph nodes were not enlarged. Results of blood routine and bone marrow examinations showed no abnormalities. He was diagnosed with sclerosing cholangitis, abdominal infection, and hepatitis. However, after treatment of reducing enzyme activity and eliminating jaundice, the patient's condition deteriorated. Hydrops abdominis was detected on abdominal ultrasonography. Tumor cells were found by pathological examination of peritoneal effusion. Both a c-myc gene translocation and a c-myc-IgH gene fusion were detected.

Diagnosis:

Burkitt lymphoma and hemophilia B.

Interventions:

The patient was transferred to the Pediatric Hematology Department of our hospital and treated with a modified B-NHL-BFM-95 protocol. During chemotherapy, platelet changes were monitored regularly and blood products were infused timely.

Outcomes:

The patient died of infection and bleeding after chemotherapy.

Conclusion:

Concurrent hemophilia and lymphoma are rare, especially in children. When encountering a patient with unexplained obstructive jaundice and massive ascites, the possibility of a tumor should be considered. Early diagnosis and adequate treatment of such tumor may improve prognosis.
Treatment of intracranial hemorrhage with neuroendoscopy guided by body surface projection
Authors: Qiu Shengli , Liu Tao , Cao Guanghui , Wu Kun , Zhao Tingsheng
Published: May 2019

Background:

We aimed to study the feasibility of body surface projection in neuroendoscopic treatment of intracranial hemorrhage (ICH), and to evaluate the prognosis of muscle strength using diffusion tensor imaging (DTI) technique.

Methods:

We utilized 3D-SLICER software and adopted hematoma body surface projection orientation to eliminate ICH by using neuroendoscope for 69 cases of spontaneous intracerebral hemorrhage. The standard of correct location was determined by the direct view of hematoma at the first operation. Evacuation rate by comparing computed tomography (CT) before and after the surgery and Glasgow coma scale (GCS) was computed. DTI was used for pyramidal tract imaging 3 weeks after the operation, while the prognosis of muscle strength was assessed after 6 months. The control group included 69 patients with basal ganglia hemorrhage who received conservative treatment during the same period.

Results:

The hematoma evacuation rate was 90.75% in average. The average GCS score rose by 4 points one week after the surgery. The shape of pyramidal tract affected the prognosis of body muscle strength, and the simple disruption type was the worst. There was no difference in mortality between the surgery group (10.1%) and the conservative group (4.3%). The muscle strength improvement value and modulate RANK score (MRS) in the surgery group were better than the control group.

Conclusion:

It is convenient and feasible to use the surface projection to determine the target of operation, and the clearance rate of hematoma is high. Pyramidal tract imaging can predict the prognosis of muscle strength.
A seven-year experience of using moderate deep inspiration breath-hold for patients with early-stage breast cancer and dosimetric comparison
Authors: Lin Chia-Hui , Lin Li-Ching , Que Jenny , Ho Chung-Han
Published: May 2019

We present our seven-year experience of using moderate deep inspiration breath-hold (mDIBH) with an active breathing control (ABC) device for patients with early-stage breast cancer and dosimetric comparison to evaluate the benefit of mDIBH on the heart, lung, and liver.

We retrospectively reviewed all patients with newly diagnosed breast cancer and having clinical stage Tis, I, or II disease treated between November 2010 and October 2017. Among the 369 patients included in this study, 107 patients were treated with mDIBH and 262 patients were treated with free breathing (FB). Dosimetric analysis was performed to compare dose distribution in the heart, lung, and liver between the two treatment groups. The chi-square test was used to compare the distribution of stage and tumor site between the two groups. The independent samples t-test was used to compare the remaining parameters between the two groups.

For all 369 patients, there was a significantly lower ipsilateral lung V5 (relative volume receiving ≧5 Gy), ipsilateral lung V10, ipsilateral lung V20, mean ipsilateral lung dose, whole lung V5, whole lung V10, whole lung V20, mean whole lung dose, heart V10, heart V30, heart V40, and mean heart dose in the mDIBH group. For 184 patients with a left-sided breast tumor, significantly lower ipsilateral lung V5, ipsilateral lung V10, ipsilateral lung V20, mean ipsilateral lung dose, whole lung V10, whole lung V20, mean whole lung dose, heart V10, heart V30, heart V40, and mean heart dose were observed in the mDIBH group. For 185 patients with a right-sided breast tumor, significantly lower ipsilateral lung V5, ipsilateral lung V10, ipsilateral lung V20, mean ipsilateral lung dose, whole lung V5, whole lung V10, whole lung V20, mean whole lung dose, heart V10, heart V30, heart V40, mean heart dose, liver V30, and mean liver dose were observed in the mDIBH group.

For early-stage breast cancer patients, mDIBH reduces not only the heart dose but also the lung and liver doses. The routine integration of mDIBH using an ABC device may decrease radiation-induced toxicity in the heart, lung, and liver.
Effect of breast cancer surgery on chest tightness and upper limb dysfunction
Authors: Lee Chung Ho , Chung Seong Yun , Kim Woo Young , Yang Seung Nam
Published: May 2019

This study aimed to investigate the possible changes in anterior chest tightness after breast cancer surgery. We also try to investigate whether anterior chest tightness is associated with upper-limb dysfunction after breast cancer surgery. Eighty-three women who underwent breast cancer surgery were evaluated before and 2 weeks, 3 months, and 9 months after surgery. Anterior chest tightness was measured using the length of the pectoralis minor muscle through 2 methods (length from the coracoid process to the fourth rib and linear distance from the table to the posterior acromion with supine position). Shoulder range of motion and the K-DASH (Korean version of Disability Arm and Shoulder Questionnaire) score were measured to quantify functional performance of upper limb. Anterior chest tightness of patients with breast cancer significantly increased after surgery. Upper limb dysfunction was observed such as reduced shoulder range-of-motion and increased K-DASH score over time. Increase in chest tightness was correlated with shoulder range-of-motion reduction. Chest tightness was not correlated with K-DASH score directly. However, shoulder range-of-motion reduction was significantly correlated with K-DASH score. Chest tightness and upper limb dysfunction increased in breast cancer survivor. Increase in chest tightness after surgery is associated with upper limb dysfunction and careful attention is required.
Intracerebral hemorrhage due to cerebral venous thrombosis during posterior cervical decompression and fusion for traumatic cervical cord injury
Authors: Tanaka Kazuya , Yoshida Takashi , Hosoi Kunihiko , Okubo Naoki , Okada Naoya , Hara Yusuke , Kabuto Yukichi , Kubo Toshikazu
Published: May 2019

Rationale:

Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that causes venous infarction and intracerebral hemorrhage (ICH) with occlusion of cerebral veins, and its incidence is estimated to be 5 per 1 million people per year, accounting for 0.5% to 1.0% of all strokes. Despite advances in the recognition of CVT, the diagnosis and treatment may be difficult because of the diversity of underlying risk factors. A rare case of ICH due to CVT during surgery is described.

Patient concerns:

A 69-year-old-man presented to our department with a history of paralyzed extremities after a backward fall and head trauma. The patient had a history of pharyngeal cancer treated with neck dissection and radiotherapy. Computed tomography (CT) images showed continuous ossification of the posterior longitudinal ligament (OPLL) at C2–5 levels and a fracture line at the caudal end plate of the C5 body. The diagnosis was traumatic cervical cord injury, so that posterior cervical decompression and fusion was performed. Immediately after surgery, the patient developed an epileptic seizure and the disturbance of consciousness persisted. MR venography and contrast CT images showed absence of flow from the superior sagittal sinus to the transverse sinus.

Diagnoses:

The diagnosis in this case was ICH due to CVT.

Interventions:

The patient was treated with anticoagulation using unfractionated heparin.

Outcomes:

The patient ultimately made a complete recovery from CVT.

Lessons:

Although risk factors for CVT are diverse, head and neck injury, patient's position during surgery, and postoperative radical neck dissection for pharyngeal cancer might have been the factors in this case. While the measures to prevent this disease are uncertain, early diagnosis and treatment are needed to avoid serious complications.
Mitochondrial A3243G mutation causes mitochondrial encephalomyopathy in a Chinese patient
Authors: Liu Xiao-Qun , Shen Shao-Qing , Yang Guo-Can , Liu Qi
Published: May 2019

Rationale:

Mitochondrial mutations are associated with a wide spectrum of clinical abnormalities. More than half of these mutations are distributed in the 22 mitochondrial tRNA genes, including tRNALeu(UUR). In particular, the A3243G mutation in the tRNALeu(UUR) gene causes mitochondrial encephalomyopathy.

Patient concerns:

A 12-year-old boy was admitted to Shaoxing People's Hospital because there is a reduction in the volume of speech, dysphonia, unable to write, recognize words, and unable to wear clothes, accompanied by unstable walking after treatment of unexplained fever and somnolence.

Diagnoses:

The proband underwent a thorough examination in our hospital and was diagnosed as mitochondrial encephalomyopathy. The proband carried the pathogenic heteroplasmic mutation A3243G mutation in mitochondrial 12S rRNA gene. Although his parents did not carry the mutation.

Interventions:

Intravenous acyclovir, ceftriaxone, and dexamethasone were used for the patient's antiviral, antimicrobial, and anti-inflammatory therapy, respectively. Intravenous mannitol was gradually tapered for reducing intracranial pressure with furosemide for inducing diuresis. Intravenous arginine could help to treat alkalosis and supple some essential amino acids. Oral oxiracetam capsules, vitamin B1, and coenzyme Q10 were used for providing nutrition and improving energy. His medications were 30 mg vitamin B1, 0.1 g vitamin C, and mecobalamin 750 μg daily after discharge from our hospital.

Outcomes:

The patient was able to walk and talk slowly with improved writing skills and no stroke-like episodes. The neurological examination was negative and muscle tension was identified as grade V.

Lessons:

Mitochondrial encephalomyopathy has different phenotypes, in addition to traditional examinations, it is important for clinicians to be familiar with genetic testing methodology as well as applications of these tests in clinic to get an accurate diagnosis.
Chinese Patent medicine to treat a 32-year-old man with sinus bradycardia and cardiac sinus arrests
Authors: Yan Dong , Xu Xiang-Ru , Qian Yu-Liang , Peng Hai-Yan , Qian Hui , Yue Bo-Wen , Zhao Li-Li , Zhang Zi-Han , Fang Zhu-Yuan
Published: May 2019

Rationale:

Sinus bradycardia refers to a sinus heart rate <60 bpm. Cardiac sinus arrests refer to the omission of atrial activation caused by transient cessation of impulse generation at the sinoatrial node. Normally, drugs such as atropine, isoproterenol, dopamine, dobutamine, or epinephrine can be used for the acute treatment of bradycardia. Temporary pacing is used for treating severe symptomatic bradycardia due to a reversible cause. Permanent cardiac pacing is used for chronic therapy of bradycardia. However, for traditional Chinese medicine (TCM), benefiting qi and nourishing yin and activating blood circulation is the general principle in treatment and show remarkable curative effects.

Patient concerns:

A 32-year-old man was found to have 1-degree atrioventricular block and sinus bradycardia during a physical examination. He reported suffering from palpitation and shortness of breath occasionally. An ambulatory electrocardiogram showed sinus arrhythmia, sinus bradycardia, and significant sinus arrhythmia. The minimum heart rate was 33 bpm (beats per minute). The number of sinus arrest was 42 and the maximum RR interval was 2216 ms.

Diagnoses:

The patient was diagnosed with bradyarrhythmia in Western medicine and “palpitation” in TCM.

Interventions:

The patient was treated with methods of benefiting qi and nourishing yin and activating blood circulation along with warming yan for nearly 5 months. CPM (Chinese patent medicine) such as Yixinshu capsule, Bingdouling oral liquid, Zhenyuan capsule, Zhibaidihuang pills were used for treatment. At the same time, he was suggested to change his lifestyles including falling asleep before 10:00 pm and abandoning spicy diets.

Outcomes:

The symptoms of palpitation and shortness of breath disappeared. The minimum heart rate increased from 33 to 42 bpm and sinus arrests did not occur. The maximum RR interval decreased from 2216 to 1650 ms and the remarkable sinus arrhythmia had improved obviously.

Lessons:

This case report shows that TCM can be an effective alternative therapy for sinus bradycardia and cardiac sinus arrests. CPM may have been a successful intervention in arrhythmias.
Tuberous sclerosis complex presenting as convulsive status epilepticus followed by hypoxic cerebropathy
Authors: Liu Xuncan , Zhang Yanfeng , Hao Yunpeng , Chen Yinbo , Chen Chen
Published: May 2019

Rationale:

Tuberous sclerosis complex (TSC) is a relatively rare, autosomal dominant, and progressive neurocutaneous disorder involving multiple organs. Heterozygous mutations in the TSC1 gene located on chromosome 9 (9q34.13) or the TSC2 gene located on chromosome 16 (16p13.3) have been shown to be responsible for this disorder. The most common clinical manifestations are abnormalities of the skin, brain, kidney, heart, and lungs. Although all seizure types have been observed in TSC patients, the present case is the first in the literature to present with convulsive status epilepticus followed by hypoxic cerebropathy.

Patient concerns:

A 33-month-old girl presented with fever and seizure followed by unconsciousness for 6 hours. Physical examination showed 4 hypopigmented macules with diameters exceeding 5 mm. Initial magnetic resonance imaging of the brain revealed diffuse edema in the bilateral cerebral cortex, cortical tubers, and subependymal nodules. Video electroencephalography showed no epileptiform activity, but diffuse slow waves intermixed with small fast waves were seen for all leads. Computed tomography brain scanning revealed bilateral cortex edema and calcified subependymal nodules.

Diagnosis:

Combined with her clinical presentation, the patient was diagnosed with TSC after molecular analysis revealed she had inherited the TSC2 c.1832G>A (p.R611Q) mutation from her mother.

Interventions:

The patient received anti-infection therapy, mannitol dehydration, hyperbaric oxygen treatment, and topiramate.

Outcomes:

One month later, the patient was in a decorticate state, presenting with unconsciousness and bilateral arm flexion and leg extension. At 6 weeks, repeated electroencephalography was normal.

Lessons:

In addition to the present case report, rare studies have reported cases of TSC presenting as convulsive status epileticus followed by hypoxic cerebropathy, which may be strongly associated with a poor prognosis. Patients with the characteristic skin lesions and epilepsy should be carefully evaluated for the possible diagnosis of TSC.
Epithelioid hemangioendothelioma of the bone
Authors: Xu Yijin , Chen Wenxin , Cheng Hui , Lin Zhiyi
Published: May 2019

Introduction:

Epithelioid hemangioendothelioma (EHE) of the bone is a very rare malignant vascular neoplasm, with biologic behavior between that of locally aggressive epithelioid hemangioma and malignant epithelioid angiosarcoma. We report a case of a patient with EHE who underwent bone scintigraphy, try to identify the characteristics of it, to highlight the clinical importance of whole-body bone scintigraphy and single-photon emission computed tomography/computed tomography (SPECT/ CT) in the diagnosis and treatment of EHE.

Patient concerns:

A 67-year-old man with no history of trauma who reported pain in both lower limbs for 6 months, which had been worsening over the last 20 days. Anteroposterior and lateral radiographs of both lower limbs revealed numerous osteolytic lesions in the tibia and fibula bilaterally. 99mTc-methylene diphosphonate (MDP) bone scintigraphy demonstrated increased tracer uptake in the pelvic and bilateral lower limb bones. SPECT/CT bone imaging showed numerous osteolytic lesions cluster in the same anatomic region, with high tracer uptake in lesion margins.

Diagnosis:

EHE of the bone.

Interventions:

Two months after the diagnosis was confirmed, the patient was rehospitalized. Nonopioid analgesic use had not provided pain relief. Magnetic resonance imaging (MRI) of both thighs showed the bone cortex was destroyed with numerous irregular lesions, and soft-tissue was involved. A second bone scintigraphy did not show any new lesions. He was administrated with recombination human endostatin injection 15 mg ivgtt qd for 14 days, combined with apatinib mesylate tablets 500 mg po qd for 18 days.

Outcomes:

He was discharged voluntarily and died 2 months later.

Conclusion:

EHE of the bone is a very rare malignant vascular neoplasm with no specific radiographic imaging features. Whole-body bone scintigraphy, especially SPECT/CT bone imaging, significantly reduces ambiguous diagnoses and is recommended before treatment.
Influence of depressive feelings in the brain processing of women with fibromyalgia
Authors: Villafaina Santos , Sitges Carolina , Collado-Mateo Daniel , Fuentes-García Juan P. , Gusi Narcis
Published: May 2019

Depression is one of the most common mental health problems which affects more than 10% of the global population. The prevalence of this disorder is higher in fibromyalgia patients. However, the influence of the combination of depression and fibromyalgia in the brain processing is poorly understood.

To explore the modifications of EEG power spectrum in women with fibromyalgia when depressive feelings are elicited.

Twenty eight women with fibromyalgia participated in this cross-sectional study. They were classified as women with depression or women without depression according to the score in the Geriatric Depression Scale. This questionnaire was used to elicit depression symptoms during the EEG recording. Analyses were performed with the standardized LOw Resolution Electric Tomography (sLORETA) software. Power spectrum were compared in the following frequency bands: delta, theta, alpha-1, alpha-2, beta-1, beta-2, and beta-3.

Fibromyalgia patients with untreated depression showed a hypoactivation of the left hemisphere when compared with fibromyalgia patients without depression. In addition, when compared fibromyalgia patients without depression and women with both fibromyalgia and depression who were taking antidepressant medications, differences in EEG power spectrum in the studied frequency bands were not found.

The current study contributes to the understanding on the influence of the combination of fibromyalgia and depression in the brain activity patterns. Patients with untreated depression showed a hypoactivation of the left hemisphere while eliciting depression symptoms. However, further research is needed, antidepressant medication might reduce the differences between patients with depression and those who do not suffer from depression symptoms.
Small incision discectomy for lumbar disc herniation in 98 patients with 5-year follow-up
Authors: Ren Zhinan , Li Zheng , Li Shugang , Xu Derong , Chen Xin
Published: May 2019

Optimal surgical technique to treat lumbar disc herniation (LDH) remains controversial. We described a small incision discectomy technique (SID), and to evaluate its safety and efficacy. A retrospective study involving 98 consecutive patients with LDH managed by SID was conducted. All patients were followed up for 5 years. Outcomes included visual analogue scale (VAS), Japanese Orthopedic Association (JOA), operative time, length of incision, blood loss, hospital stay, hospitalization costs, x-ray exposure, reoperation, and complications. The results were determined to be excellent, good, fair, or poor according to the MacNab classification. All patients completed the 5-year follow-up. Relative to preoperative scores, VAS and JOA were both significantly improved. As a whole, 93.8% (92/98) patients showed excellent or good results, 3.1% (3/98) fair, and 3.1% (92/98) poor. The operation time, length of incision, blood loss, and hospital stay were 50 ± 11.1 minutes, 2.2 ± 0.3 cm, 35 ± 3.5 mL, and 4.3 ± 0.2 days, respectively. Additionally, compared with previous literature reports, the hospitalization costs and x-ray exposure were apparently less. The reoperation and recurrence rate were 3.2% and 2.1%. No complications were observed. From these data we conclude that SID appears to be a safe, cost-effective technique for LDH, and has lower x-rays exposure time when compared with literature of percutaneous endoscopic lumbar discectomy (PELD).
Methotrexate, doxorubicin, and cisplatinum regimen is still the preferred option for osteosarcoma chemotherapy
Authors: Yu Dapeng , Zhang Shuisheng , Feng Alei , Xu Deguo , Zhu Qingshan , Mao Yantao , Zhao Yi , Lv Yajuan , Han Cuiping , Liu Rujun , Tian Yuan
Published: May 2019

Background:

We designed the study to investigate whether methotrexate, doxorubicin, and cisplatinum (MAP) chemotherapy strategy was still the preferred option for the survival of osteosarcoma patients.

Method:

We collected some trials of osteosarcoma to make a meta-analysis first. Then, we retrospectively collected data from 115 patients with osteosarcoma and performed further analysis to verify the impact of MAP regimen on the survival of patients.

Results:

Seven studies including 3433 participants met the preliminary inclusion criteria. Meta-analysis of the 3-year disease-free survival (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 0.88–1.28; P = .52) and overall survival (OR = 1.21, 95% CI: 0.70–2.11; P = .54), 5-year disease-free survival (OR = 1.07, 95% CI: 0.87–1.30; P = .54) and overall survival (OR = 0.86, 95% CI: 0.65–1.12; P = .26), and mortality rate (OR = 0.90, 95% CI: 0.70–1.17; P = .44), showed no statistically significant differences. The most common grade 3/4 adverse events were neutropenia (498 [85.9%] patients in MAP vs 533 [93.3%] in MAP plus ifosfamide and etoposide, or other adjuvant therapy drugs [MAP+]). MAP was associated with less frequent toxicities than MAP+ group with statistical significance in thrombocytopenia, febrile neutropenia, anemia, and hypophosphatemia. The same phenomenon could also be seen in the analysis of clinical data.

Conclusion:

MAP regimen remains the preferred option for osteosarcoma chemotherapy.
Associations of TLR4 gene polymorphisms with the risk of age-related macular degeneration in a Chinese Han population
Authors: Ling Yu , Xiong Fei
Published: May 2019

The study was designed to reveal the relationship of toll-like receptor 4 (TLR4, rs1927914 and rs1927907) polymorphisms with risk of age-related macular degeneration (AMD), as well as the adjustment of this association by some environmental and lifestyle factors in Chinese Han population.

TLR4 polymorphisms were genotyped by polymerase chain reaction-restricted fragment length polymorphisms and direct sequencing method in 138 AMD patients and 146 healthy controls. Genotype distribution in the control group was checked with Hardy–Weinberg equilibrium. Association of TLR4 polymorphisms and AMD risk was evaluated by χ
2 test and adjusted by age and sex, smoking and drinking. Odds ratio (OR) with 95% confidence interval (95% CI) was used to represent the association strength. Logistic regressive analysis was used to calculate the adjusted OR values.

CC genotype of rs1927914 had significantly lower frequency in AMD patients (P = .010), indicated a negative association with AMD risk (crude: OR = 0.358, 95% CI = 0.162–0.791; adjusted: OR = 0.355, 95% CI = 0.160–0.789). C allele of rs1927914 might decrease the susceptibility of AMD (crude: OR = 0.698, 95% CI = 0.497–0.982; adjusted: OR = 0.698, 95% CI = 0.495–0.984). No significant association has been discovered between TLR4 rs1927907 polymorphism and AMD susceptibility. Strong linkage disequilibrium existed between rs1927914 and rs1927907 polymorphisms. C-C haplotype was negatively associated with AMD risk (OR = 0.242, 95% CI = 0.121–0.485; OR = 0.242, 95% CI = 0.120–0.488).

CC genotype and C allele of rs1927914 were significantly associated with the decreased AMD susceptibility.
Biliary atresia combined with progressive familial intrahepatic cholestasis type 3
Authors: Zhang Ben-Ping , Huang Zhi-Hua , Dong Chen
Published: May 2019

Rationale:

Neonatal cholestasis is one of the most serious diseases in infancy. Progressive familial intrahepatic cholestasis (PFIC) is a disease that leads to intrahepatic cholestasis. It is one of the common causes of neonatal cholestasis in addition to biliary atresia (BA). The differential diagnosis of neonatal cholestasis is clinically challenging for pediatricians.

Patient concerns:

A 4-month-old female presented with severe jaundice, pruritus, and pale stool for 20 days. Abnormally strong echoes near the portal area, an abnormally small gallbladder with an irregularly stiff wall, and splenomegaly were identified on abdominal ultrasound. Blood tests showed elevated alanine aminotransferase, total bilirubin, conjugated bilirubin, gamma-glutamyltranspeptidase, and total bile acid levels.

Diagnosis:

Intraoperative cholangiography showed BA. ABCB4 gene mutation IVS13+6G>A/G was confirmed by genetic testing. The patient was diagnosed with BA combined with PFIC3.

Interventions:

Kasai portoenterostomy and ursodeoxycholic acid were used for treatment.

Outcomes:

Her clinical symptoms and blood tests improved gradually. No recurrence was noted during 1 year of follow-up.

Lessons:

Additional examinations, such as genetic testing, should be considered in patients with BA who had refractory jaundice after Kasai portoenterostomy in order to exclude intrahepatic cholestasis.
The occurrence of and predictive factors for multifocality and bilaterality in patients with papillary thyroid microcarcinoma
Authors: Kaliszewski Krzysztof , Diakowska Dorota , Wojtczak Beata , Migoń Jakub , Kasprzyk Agata , Rudnicki Jerzy
Published: May 2019

Thyroidectomy or hemithyroidectomy may be performed as treatment for papillary thyroid microcarcinoma (PTMC). However, in cases of bilateral PTMCs, only thyroidectomies should be recommended. Sometimes bilateral PTMC may be undetected in presurgical evaluations, so reoperation might be necessary after a partial thyroid resection. The aim of this study was to assess the occurrence of and predictive factors for the multifocality and bilaterality of PTMCs.

We performed a retrospective review of 4716 consecutive patients with thyroid tumors. Of these patients, 434 (9.2%) had thyroid malignancies. All patients underwent thyroidectomies with central and/or lateral lymph node dissection between January 2008 and December 2017. PTMC was identified in 177 (3.75%) individuals.

Solitary PTMC was observed in 114 (64.4%) patients, multifocal PTMC was seen in 48 (27.1%) patients, and bilateral PTMC was detected in 15 (8.5%) patients. The occurrence of solitary PTMC increased from 11.1% in 2008 to 61.9% in 2017. The occurrence of multifocal tumors significantly decreased from 77.8% in 2008 to 6.3% to 18.4% in 2013 to 2016 (P < .05). The occurrence of bilateral tumors, with respect to all PTMC cases, did not change during the 10-year period. We observed significantly higher rates of hypoechogenicity, more microcalcifications, more irregular margins, larger tumor sizes, and higher vascularity in the patients with multifocal and bilateral tumors than in the patients with solitary tumors (P < .0001 for all).

The occurrence of bilateral PTMC is not very common. In patients with PTMC, thyroidectomy should be considered when microcalcifications, an irregular tumor shape, unclear margins, hypoechogenicity, high vascularity, and a large tumor size are observed. These clinicopathological features are prognostic factors for multifocal and bilateral PTMC.
CEACAM-1 promotes myocardial injury following coxsackievirus infection by regulating the coxsackievirus-adenovirus receptor
Authors: Zhang Zaiyong , Long Cheng , Li Xinzhong , Xie Qiang , Song Mingcai , Zhang Yulan
Published: May 2019

Objective:

To determine the effects and mechanism of carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM-1, CC1)-mediated regulation of the Coxsackie and Adenovirus Receptor (CAR) after Coxsackievirus B3 (CVB3) infection.

Methods:

A mouse CC1 overexpression recombinant virus was constructed, followed by insertion of a pLVX-CEACAM 1-zsgreen-puro (rLV-CEACAM 1) plasmid into the recombinant retrovirus. Cardiac myocytes were assigned into different groups according to various treatments. The apoptosis rate and cell activity in each group were observed. Further, CAR expression and SYK, IL-1β, and p-SYK levels were measured.

Results:

The recombinant retrovirus titer was measured as 1.5 × 108 TUs/ml. The apoptosis rate of cardiac myocytes in the CC1 overexpression plus CVB3 group was significantly elevated, and the relative expression of the CAR gene was the highest in the CC1 overexpression plus CVB3 group. TNF-α and IL-1β levels increased due to CC1 overexpression and further increased after CVB3 infection. CAR protein expression also changed along with the levels of CC1, SYK, and TNF-α after infection.

Conclusion:

CC1 may promote CAR expression after CVB3 infection and regulate CAR protein expression by activating the CC1-SYK-TNF-α signaling axis during the infection process.
Granular cell tumor of the trunk of the facial nerve
Authors: Qiyong Qiang , Qinying Wang , Quancheng Li , Liang Chai , Haihong Chen
Published: May 2019

Rationale:

Granular cell tumor (GCT) is a relatively uncommon, usually benign lesion that often presents as a solitary, painless cutaneous or submucosal nodule. GCTs of the head and neck are not uncommon; however, involvement of the trunk of the facial nerve is rare.

Patient concerns:

A 55-year-old woman presented a lesion at the posterior border of the left parotid gland. Doppler ultrasound revealed a hypoechoic mass and magnetic resonance imaging disclosed an irregularly shaped lesion with unsharp borders in the posterior aspect of the left parotid gland that was hyperintense on T2-weighted images and enhancing with contrast on T1-weighted images. The remainder of the parotid gland was normal.

Diagnosis:

Following excision of the mass, diagnosis of a GCT was established and confirmed by immunohistochemistry.

Interventions:

The patient underwent surgical excision of the lesion.

Outcomes:

The patient is currently asymptomatic and without recurrence after 10 months follow-up.

Lessons:

GCT involvement of the trunk of the facial nerve is rare. Immunohistochemical staining is helpful for its diagnosis.
ATP binding cassette subfamily B member 9 (ABCB9) is a prognostic indicator of overall survival in ovarian cancer
Authors: Hou Lin , Zhang Xueying , Jiao Yan , Li Yanqing , Zhao Yuechen , Guan Yinuo , Liu Ziling
Published: May 2019

Ovarian cancer (OC) is one of the most common gynecological malignancies and owns the highest mortality rate among all gynecological malignant tumors. ATP binding cassette subfamily B member 9 (ABCB9) is an antigen processing-like (TAPL) transporter that has been found to be involved in the development and progression of various malignant tumors in accumulating reports. However, the potential role of ABCB9 in OC has never been reported.

In this study, ABCB9 expression was evaluated in normal ovarian tissues and ovarian cancer tissues using The Cancer Genome Atlas (TCGA) database. And the associations between ABCB9 expression and clinical parameters of patients of OC were evaluated by Chi-square tests. Kaplan–Meier analysis and Cox regression analysis were performed to evaluate the prognostic significance of ABCB9. GSEA was performed to explore related signaling pathway.

ABCB9 expression levels were significantly decreased in OC compared with normal ovarian tissues (P < .001). Low ABCB9 expression was associated with survival status (P = .0148) in OC. Kaplan–Meier analysis showed that low ABCB9 expression was associated with poor overall survival in OC (P = .0032). Multivariable Cox regression analysis indicated that low ABCB9 expression was an independent prognostic factor (HR 0.64; P = .01) in OC patients. Besides, epithelial mesenchymal transition, UV response, and TGF-β signaling were enriched in low ABCB9 expression phenotype, respectively, examined by gene set enrichment analysis.

These results suggest that ABCB9 is an independent prognostic indicator in OC with certain clinical significance.
Casas de Locos
Authors: Espí Forcén Fernando
Published: May 2019

Before the Enlightenment, the mentally ill in the Hispanic world received standard medical care. After the foundation of the first hospital for specific treatment for mentally ill in Valencia in 1409, a number of hospitals opened their doors to patients with mental illness across the Iberian Peninsula during the 15th century. This model of medical care for people with mental illness was carried to America and the Philippines soon after the arrival of the Spaniards. The treatment for the mentally ill in the Hispanic World influenced the development of Pinel's moral treatment and the care of the mentally ill during the Enlightenment. This article will explain the circumstances leading to the foundation of a number of specific hospitals for the mentally ill in the Hispanic territories as well as the kind of care that these patients received at the so-called casas de locos.
Autologous Mitochondrial Transfer as a Complementary Technique to Intracytoplasmic Sperm Injection to Improve Embryo Quality in Patients Undergoing In Vitro Fertilization—A Randomized Pilot Study
Authors: Labarta Elena , de los Santos Maria José , Herraiz Sonia , Escribá Maria José , Marzal Alicia , Buigues Anna , Pellicer Antonio
Published: May 2019

(Abstracted from Fertil Steril 2019;111(1):86–96)

Initial phases of embryonic development have a high requirement for ATP, and evidence shows that oocytes with high ATP levels enhance implantation of the human embryo. Decreased bioenergetic capacity in oocytes has been found to be a primary contributor to declining embryo quality with advancing maternal age or in women with premature ovarian aging.
An Image Analysis Solution For Quantification and Determination of Immunohistochemistry Staining Reproducibility
Authors: Chlipala Elizabeth A. , Bendzinski Christine M. , Dorner Charlie , Sartan Raili , Copeland Karen , Pearce Roger , Doherty Faye , Bolon Brad
Published: May 2019

With immunohistochemical (IHC) staining increasingly being used to guide clinical decisions, variability in staining quality and reproducibility are becoming essential factors in generating diagnoses using IHC tissue preparations. The current study tested a method to track and quantify the interrun, intrarun, and intersite variability of IHC staining intensity. Our hypothesis was that staining precision between laboratory sites, staining runs, and individual slides may be verified quantitatively, efficiently and effectively utilizing algorithm-based, automated image analysis. To investigate this premise, we tested the consistency of IHC staining in 40 routinely processed (formalin-fixed, paraffin-embedded) human tissues using 10 common antibiomarker antibodies on 2 Dako Omnis instruments at 2 locations (Carpinteria, CA: 30 m above sea level and Longmont, CO: 1500 m above sea level) programmed with identical, default settings and sample pretreatments. Digital images of IHC-labeled sections produced by a whole slide scanner were analyzed by a simple commercially available algorithm and compared with a board-certified veterinary pathologist’s semiquantitative scoring of staining intensity. The image analysis output correlated well with pathology scores but had increased sensitivity for discriminating subtle variations and providing reproducible digital quantification across sites as well as within and among staining runs at the same site. Taken together, our data indicate that digital image analysis offers an objective and quantifiable means of verifying IHC staining parameters as a part of laboratory quality assurance systems.
Evaluating Physician Knowledge of Commonly Prescribed Inpatient Rehabilitation Unit Discharge Medication's Costs
Authors: Capizzi Allison Nuovo , Kirk Melissa Nuntapreda , Lee Venessa Ann , Cushman Daniel M.
Published: May 2019

The aim of the study was to assess physiatrists' knowledge of the cost of medications commonly prescribed at discharge from inpatient rehabilitation units across the spectrum of practice experience from residents to attending physicians. Investigators contacted 92 pharmacies across four major regions of the United States and averaged the cash price of each medication. An electronic survey was created highlighting 17 medications in which physicians estimated the cost of a medication per pill and per month for a 30-day supply. Surveys were sent to all Accreditation Council for Graduate Medical Education–accredited programs across the United States; 43 participants responded to the survey. Most respondents overestimated the cost of the medications chosen for the survey. There was no significant difference between medication cost knowledge and practice experience (P = 0.497) or postgraduate year of training (P = 0.593). This raises awareness that physiatrists may not know the cost of medications they commonly prescribe at discharge, which may have implications on patient medication compliance, quality of care, and patient satisfaction.