bluuebunny/crossref_metadata_2025 huggingface dataset:
Bony Orbital Volume Expansion in Thyroid Eye Disease
Authors: Ugradar Shoaib , Goldberg Robert A. , Rootman Daniel B.
Published: December 2018

Purpose:

To quantify changes to the bony orbital volume (BOV) in patients with thyroid eye disease (TED) relative to normal controls.

Methods:

In this case–control study, all patients affected with TED seen over a 2-year period were screened for study entry. Eligible participants were adults with clinical evidence of TED and CT scans of their orbits obtained during the course of their routine care. Exclusion criteria included the history of decompression surgery and/or medical or other ophthalmic conditions that could alter the orbital anatomy. The primary outcome was the measurement of the BOV. Secondary outcome measures included the relationships between BOV and muscle volume, fat volume, Hertel measurements, duration of the disease, and the occurrence of dysthyroid optic neuropathy in patients with TED. Three-dimensional reconstructions of the orbits were created to measure BOV, muscle volume, and fat volume.

Results:

A total of 100 participants were included in the study, contributing 200 orbits. This sample was comprised of 50 patients with TED (37 female, 13 male) and 50 controls (37 female and 13 male). There were no differences between the control and patient groups in age or sex. Of the patients with TED, 14 were diagnosed with dysthyroid optic neuropathy (15 orbits, 1 case was bilateral). The mean (standard deviation [SD]) clinical activity score for males was 4.1 (2.29) and 4.35 (2.63) for females. The mean (SD) BOV for males in the TED group was 28.62 ml (3.47), while that of the control group was 24.59 ml (2.19). This difference was significant (p < 0.01). The mean (SD) BOV for females with TED was 24.33 ml (2.39), while that of the female control group was 20.97 ml (1.84). This was again significant (p < 0.01). There was a significant relationship between the BOV and fat volume (p <0.05). There were no significant relationships between BOV and: muscle volume, duration of disease (p = 0.705), Hertel measurements (p = 0.212), age (p = 0.9), and dysthyroid optic neuropathy (p = 0.12).

Conclusions:

This study found that the BOV is significantly greater in patients with TED, suggesting that TED is associated with widespread bony remodeling of the orbit.
Comparative Study Between Daubechies and Coiflets Wavelet Decomposition Mother Families in Feature Extraction of BCI Based on Multiclass Motor Imagery Discrimination
Authors: Elmahdi Rania , Amed Nosaiba Yusuf , Amin Magdy Baker M. , Hamza Alnazier O. , Babaker Sanaa Ali , Elgylani Walaa Abd Alrahman
Published: December 2018

Brain-computer interface (BCI) is a method of direct communication between the human brain and the computer without the need for the use of other physical organs such as peripheral muscles, where the interface allows the human to order any electronic device using brain activity only. Multiclass discrimination of motor imagery movements is one of the BCI applications that uses electrical signals measured from brain or muscles; these signals were filtered and processed using time, space, and frequency feature extraction techniques, and machine learning algorithms to construct a system achieve best performance. The objective of this research was to make a comparative study between different wavelet Daubechies and Coiflets families mother functions used as feature extraction to discriminate between 4 classes of imagined movements. The coefficients of different Wavelet Daubechies (2-20) and Coiflets (1-5) were examined in calculating common spatial filters to discriminate between 4 imagined classes, where 4 detail levels of the wavelet coefficients were calculated; support vector machine was used as a classifier that enables the classification of imagined movements. The algorithms applied to the BCI competition IV data set 2a. Result yields performance of 0.53 and 0.52 average κ coefficients using Db2 and Coif1, respectively.
Digging Into CND
Authors: Hyman William A.
Published: December 2018

Evaluating and resolving user complaints arising from their use of a medical device is a key element of an effective clinical engineering program. Unfortunately, a finding of “could not duplicate,” or a variant, is a well-known outcome. Understanding why events might be difficult to duplicate can aid in their resolution.
The Suitability of Grounded Theory Research for Correctional Nursing
Authors: Dhaliwal Kirnvir , King-Shier Kathryn , Hirst Sandra P.
Published: December 2018

The tension between custody and caring is particular to correctional nursing practice, including issues such as the correctional priorities of safety and security that often dominate nursing practice. The evidence that should underlie correctional nursing practice is regrettably sparse. There are two reasons a grounded theory (GT) approach is paramount for building foundational knowledge to advance correctional nursing practice. First, the development of theories regarding correctional nursing practice will provide an in-depth understanding of this subspecialty of nursing and lead to further research endeavors. Second, correctional nursing practice is a process carried out in correctional institutions. The GT approach is “process oriented” and thus is appropriate for exploring the implementation of correctional nursing practice. Two GT approaches have evolved since first described by Glaser and Strauss. We contend that the approach offered by Strauss and Corbin may be more beneficial for studying how correctional nurses implement their practice.
The Economic Value of Mobility with a Prosthesis
Authors: Boone David Alan
Published: December 2018

The primary purpose for creation of a leg prosthesis is to enable mobility, including standing, transferring, and walking. It is proposed that to adequately assess the health economic ramifications of alternatives in prosthetic care for persons who have had an amputation, one should consider the value of mobility. This article explores some key constructs in elucidation of the value of mobility with a prosthesis: 1) mobility is not binary; it has quality aspects that impact its value; 2) overall direct health care costs have been shown to be reduced beyond the cost of associated prosthetic technologies when this technology improves safety and reduces injury; 3) amputation creates chronic disability that is better reflected by the burden of disease than by mortality alone in health economic analyses; and 4) significant indirect value is provided by a prosthesis that enables physical activity and the resulting health benefits. Human needs and health economic goals can be aligned. Invention of new technology that maximizes physical restoration and human potential should be evaluated not only on its cost, but also on the substantial value provided.
Health Technology Assessment as Theoretical Framework to Assess Lower-Limb Prosthetics—Issues and Opportunities from an International Perspective
Authors: Cutti Andrea G. , Lettieri Emanuele , Verni Gennaro
Published: December 2018

Lower-limb prosthetics is rapidly advancing through innovative technologies. Simultaneously, patients in need of prosthetic rehabilitation treatments are expected to double by 2050. Unfortunately, available economic resources are not growing at a comparable pace. The result is the widening gap between what is technologically possible and what is economically sustainable. In this context, health technology assessment (HTA) stands out as a multidisciplinary process, grounded on scientific evidence, that can support decision makers on how best to allocate limited funds to health interventions and technologies. The aim of this contribution is to introduce the HTA concepts and methods of possible interest for the field of orthotics and prosthetics (O&P) in general and lower-limb prosthetics, in particular, from an international perspective. This will be accomplished by answering six questions:

1. What is HTA and how does it differ from evidence-based practice (EBP)?

2. Why should we care about HTA in O&P?

3. Do policy makers care about HTA reports?

4. Are there structured tools to run HTA appraisals that are suitable for the O&P field?

5. Are there challenges to consider when running an HTA on medical devices, including lower-limb prosthetics?

6. Are there strategies to adopt to improve evidence collection and HTA on lower-limb prosthetics?

Collectively, the answers culminate in the position that HTA is highly desirable, but poses challenges to O&P, because medical devices have unique features (e.g., incremental innovation and operator dependence), and because the level of evidence is generally low. To address these challenges, we proposed seven driving concepts that can improve evidence collection and the HTA of lower-limb prosthetics. Among them, managed entry agreements, registry big data, and Internet-of-things strategies can support value-for-money approaches and can mark a true change in lower-limb prosthetic accessibility.
Economic Benefits of Microprocessor Controlled Prosthetic Knees: A Modeling Study
Authors: Chen Christine , Hanson Mark , Chaturvedi Ritika , Mattke Soeren , Hillestad Richard , Liu Harry H.
Published: December 2018

Background

Advanced prosthetic knees allow for more dynamic movements and improved quality of life, but payers have recently started questioning their value. To answer this question, the differential clinical outcomes and cost of microprocessor-controlled knees (MPK) compared to non-microprocessor controlled knees (NMPK) were assessed.

Methods

We conducted a literature review of the clinical and economic impacts of prosthetic knees, convened technical expert panel meetings, and implemented a simulation model over a 10-year time period for unilateral transfemoral Medicare amputees with a Medicare Functional Classification Level of 3 and 4 using estimates from the published literature and expert input. The results are summarized as an incremental cost effectiveness ratio (ICER) from a societal perspective, i.e., the incremental cost of MPK compared to NMPK for each quality-adjusted life-year gained. All costs were adjusted to 2016 U.S. dollars and discounted using a 3 percent rate to the present time.

Results

The results demonstrated that compared to NMPK over a 10-year time period: for every 100 persons, MPK results in 82 fewer major injurious falls, 62 fewer minor injurious falls, 16 fewer incidences of osteoarthritis, and 11 lives saved; on a per person per year basis, MPK reduces direct healthcare cost by $3,676 and indirect cost by $909, but increases device acquisition and repair cost by $6,287 and total cost by $1,702; on a per person basis, MPK is associated with an incremental total cost of $10,604 and increases the number of life years by 0.11 and quality adjusted life years by 0.91. MPK has an ICER ratio of $11,606 per quality adjusted life year, and the economic benefits of MPK are robust in various sensitivity analyses.

Conclusions

Advanced prosthetics for transfemoral amputees, specifically MPKs, are associated with improved clinical benefits compared to non-MPKs. The economic benefits of MPKs are similar to or even greater than those of other medical technologies currently reimbursed by U.S. payers.
Ruptured Extensor Pollicis Longus Tendon After a Nondisplaced Distal Radius Fracture in a Young Adult Soccer Player
Authors: Bogart Robert , Vidlock Kathryn
Published: December 2018

Forearm fractures of the distal radius are one of the most common fractures seen in the upper extremity, and they represent approximately 1/6 of fractures treated in the emergency department. Forearm fractures are associated with a rare but known complication of a delayed ruptured extensor pollicis longus (EPL) tendon. This sequela is more commonly seen in adults after a nondisplaced distal radius fracture, with much variability in the incidence ranging from 0.07% to 5%. By contrast, this complication in the pediatric population is almost exclusively seen after a displaced or unstable fracture necessitating surgical correction with open reduction and internal fixation.
Self-expanding metal stent procedure for afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer
Authors: Cha Ra Ri , Cho Su Beom , Kim Wan Soo , Kim Jin Joo , Lee Jae Min , Lee Sang Soo , Kim Hyun Jin , Cho Jin Kyu
Published: December 2018

Rationale:

Self-expanding metal stent placement is a useful procedure for intestinal obstruction. Afferent loop syndrome after gastrectomy is an uncommon complication of gastroenterostomy reconstruction. Ascending cholangitis caused by afferent loop syndrome is a potential, but rare, complication.

Patient concerns:

A 73-year-old man with abdominal pain and vomiting was admitted to the emergency room. His medical history was significant for subtotal gastrectomy with Billroth II anastomosis for benign gastric ulcer perforation 40 years prior. He had notable tenderness to palpation, particularly on the epigastric area, and a temperature of 39.0°C.

Diagnosis:

Abdominal computed tomography revealed afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer.

Interventions:

Percutaneous catheter drainage for management of ascending cholangitis was performed on the day of admission. He was subsequently treated with self-expandable metal stent insertion into the stenotic lesion.

Outcomes:

After treatment with percutaneous transhepatic insertion of a self-expanding stent, the patient achieved complete resolution of symptoms. The patient died of disease progression 2 months later, without further recurrence of afferent loop syndrome.

Lessons:

Our case shows that insertion of a metal stent via percutaneous transhepatic biliary drainage (PTBD) can effectively treat ascending cholangitis and resolve afferent loop syndrome in inoperable patients.
Standard-dose versus low-dose multidetector computed tomography examinations in patients with uncontrolled chronic rhinosinusitis
Authors: Huang Wei , Ye Jian , Guan Xinli
Published: December 2018

Background:

Multidetector computed tomography (MDCT) images for rhinosinusitis may have a risk of radiation hazards. Reduction in radiation dose may lead to a compromise in quality of MDCT images and have chances of postoperative complications.

Objective:

The aim of the study was to test the applicability of low-dose MDCT protocols for decision-making of sinus surgeries of patients with uncontrolled chronic rhinosinusitis.

Design:

Randomized, double-blind (patients and evaluators blind), controlled, trial.

Setting:

People's Hospital of Guanghan, China.

Patients:

A total of 288 patients with clinically confirmed uncontrolled chronic rhinosinusitis were subjected to randomization (1:1 ratio).

Interventions:

Patients were subjected to low-dose preoperative protocols of MDCT (n = 144; ldMDCT group) or standard-dose preoperative protocols of MDCT (n = 144; sdMDCT group).

Outcome measures:

Image analysis was performed by the workstation. Lund-Mackay score, modified Lund-Mackay score, estimated radiation exposure, and surgical complications were evaluated for each patient. The χ2 independent test or 2-tailed paired t test were performed for statistical analysis.

Results:

The preoperative MDCT images for standard-dose protocol had better quality than low-dose protocol (P < .001, q = 4.57). The area of images that give confidence for sinus surgery at one time was higher for standard-dose MDCT protocol technique than low-dose MDCT protocol method. Patients of ldMDCT group with large growth of nasal polyps (P = .03, q = 5.35) and complete opacification of sinuses (P = .03, q = 7.94) had complications after sinus surgeries. Either low-dose or standard-dose MDCT protocol was performed, the experience of otolaryngologist had decreased complication after surgeries.

Conclusion:

Preoperative low-dose MDCT should be used for diagnosis of uncontrolled chronic rhinosinusitis for decision making of sinus surgeries.

Level of Evidence:

III.

Trial registration:

researchregistry4264 dated 1 March 2016 (www.researchregistry.com).
Small hepatocellular carcinoma suppressed by chemotherapy for synchronous gastric carcinoma after laparoscopy-assisted radical distal gastrectomy
Authors: Wang Chao , Luo Xin , Dong Shui-Lin , Leng Chao , Zhang Bi-Xiang , Zhang Bin-Hao
Published: December 2018

Rationale:

Synchronous gastric carcinoma and hepatocellular carcinoma (HCC) is rare. It is hard to distinguish synchronous HCC from metastatic liver cancer in this condition. The treatment and prognosis is quite different for synchronous HCC of gastric carcinoma and liver metastasis of gastric carcinoma.

Patient concerns:

A 68-year-old man with a chief complaint of epigastric pain for 1 year, accompanied by reflux and belching. The patient was diagnosed with gastric carcinoma (cT4NxM0) and laparoscopy-assisted radical distal gastrectomy was performed. This was followed by chemotherapy of FOLFOX regimen. However, a liver nodule growth was observed after postoperative systemic treatment.

Diagnosis:

The initial diagnosis was liver metastasis of gastric carcinoma. However after hepatectomy of segment VI and VII as well as thrombectomy of right hepatic vein, histology revealed intermediate to poor differentiated HCC. Hence this case was diagnosed as synchronous gastric carcinoma and HCC.

Interventions:

A preventive transcatheter arterial chemoembolization (TACE) was conducted at 4 weeks after hepatectomy. Another FOLFOX regimen was suggested, but was refused by the patient.

Outcomes:

The patient survived without tumor recurrence for 9 months after the second surgery.

Lessons:

Synchronous HCC should be routinely distinguished from gastric carcinoma liver metastasis, especially for patients with hepatitis B virus (HBV) infection. The FOLFOX4 regimen for treating gastric carcinoma liver metastasis may have inhibited the progression of primary HCC in this case. This patient with HCC benefited from liver resection, inspite of hepatic vein tumor thrombosis.
Subthreshold micropulse laser photocoagulation therapy in a case of bilateral retinal astrocytic hamartomas with tuberous sclerosis complex
Authors: Yan Shenshen , Chen Yanyun , Chen Rui , Tian Bei , Li Zheqing
Published: December 2018

Rationale:

Report a case of bilateral multiple retinal hamartomas (RAHs) in a patient with tuberous sclerosis complex (TSC) and introduced a new method (subthreshold micropulse laser photocoagulation) for the treatment of RAHs.

Patient concerns:

A 20-year-old man with TSC complained of decreased vision and metamorphosia in both eyes for 2 months. At presentation, visual acuity (VA) was 20/32 in the right eye and 20/40 in the left eye. Fundus photographs, optical coherence tomography, fundus fluorescein angiography (FFA), and indocyanine green angiography indicated multiple RAHs in both eyes.

Diagnoses:

Bilateral retinal astrocytic hamartomas.

Interventions:

In the right eye, 577 nm photocoagulation was adopted to treat the RAHs with obvious fluorescein leakage in FFA. The paramacular RAHs were treated by subthreshold micropulse mode to minimize the damage to macula. Photocoagulation therapy was administrated in the left eye after 1 dose of intravitreal ranibizumab treatment.

Outcomes:

After photocoagulation therapy (including subthreshold micropulse laser photocoagulation for the paramacular RAHs in both eyes), the VA improved to 20/25 OD and 20/32 OS with no recurrence of exudation.

Lessons:

About 577 nm photocoagulation for the peripheral RAHs in combination with subthreshold micropulse laser photocoagulation for RAHs in the macular zone is a good option for multiple RAHs in patients with TSC.
Spinal epidural abscess associated with an epidural catheter in a woman with complex regional pain syndrome and selective IgG3 deficiency
Authors: Noori Selaiman Ahmad , Gungor Semih
Published: December 2018

Rationale:

Continuous epidural infusion of local anesthetic may be an alternative to sympathetic blocks in refractory cases of complex regional pain syndrome (CRPS). Spinal epidural abscess (SEA) is a well-known complication associated with this technique, especially in patients with immune deficiencies. We herewith report a cervical SEA associated with an epidural catheter in a woman with CRPS and selective IgG3 subclass deficiency.

Patient concerns:

Severe pain interfering with activities of daily living.

Diagnosis:

Complex regional pain syndrome type-1 with involvement of upper extremity.

Interventions:

The patient underwent inpatient epidural infusion for management of left upper extremity CRPS. Her history was notable for previous left shoulder injury requiring numerous surgical revisions complicated by recurrent shoulder infections, and selective IgG3 deficiency. She received antibiotic prophylaxis and underwent placement of a C6–C7 epidural catheter. On day 5, she became febrile. Neurological examination remained unchanged and an MRI demonstrated acute fluid collection from C3-T1. The following day she developed left arm weakness and was taken for emergent cervical decompression. Intraoperative abscess cultures were positive for Pseudomonas aeruginosa.

Outcomes:

Postoperatively, the patient's neurological symptoms and signs improved.

Lessons:

Patients with selective IgG3 deficiency who are being considered for epidural catheterization may benefit from expert consultation with infectious diseases specialist. A history of recurrent device- or tissue-related infections should alert the clinician to the possible presence of a biofilm or dormant bacterial colonization. Close monitoring in an ICU setting during therapy is recommended. In case of early signs of infection, clinicians should have a high suspicion to rule out a SEA in immunocompromised patients.
Early ST-segment elevation acute myocardial infarction after thrombolytic therapy for acute ischemic stroke
Authors: Manea Maria Mirabela , Dragoş Dorin , Stoica Emanuel , Bucşa Adrian , Marinică Ioana , Tuţă Sorin
Published: December 2018

Rationale:

Acute ST-segment elevation myocardial infarction (STEMI) is a rare complication of acute ischemic stroke (AIS) during thrombolytic therapy. We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches.

Patient concerns:

A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block).

Diagnoses:

The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion.

Interventions:

Four hours after the onset of STEMI, stenting was performed, normalizing the coronary blood flow.

Outcomes:

The patient died 2 days thereafter because of persistent cardiogenic shock.

Lessons:

Our case is remarkable owing to the unusually early (<1 hour) occurrence of STEMI after i.v. rtPA administration. A third-degree atrioventricular block after thrombolysis for AIS could signal a STEMI onset. New and ongoing trials are assessing whether adjunct administration of direct thrombin inhibitors of rtPA in the first 24 hours after thrombolysis for AIS can prevent early recurrent ischemic events.
Primary gastric inflammatory myofibroblastic tumor
Authors: Cheng Bingxue , Yang Chen , Liu Zhou , Liu Lijian , Zhou Li
Published: December 2018

Rationale:

Primary gastric inflammatory myofibroblastic tumor is extremely rare. Only a few cases were reported in the domestic and foreign medical literature with corresponding imaging findings of this disease even more rarely reported.

Patient concerns:

We present one case of a 52-year-old female patient with upper abdominal pain, acid reflux, and belching for 2 months.

Diagnoses and Interventions:

Electron ultrasound gastroscopy (EUS) revealed elevation of gastric antrum mucosa. A whole abdominal and pelvic multi-slice spiral computed tomography (CT) detected a round nodule in the gastric antrum with considerably delayed enhancement, with initial suspicion of gastrointestinal stromal tumors (GISTS). Then a laparoscopic assisted distal gastrectomy was performed. Finally, the postoperative pathology confirmed the diagnosis of primary gastric IMT.

Outcomes:

After 6 months of follow-up, the patient was still alive without any evidence of metastasis or recurrence.

Lessons:

Familiarizing with the CT features of this rare tumor may raise radiologists’ awareness of the disease and potentially could avoid misdiagnosis.
Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage
Authors: Sun Jing , He Zhidong , Nan Guangxian
Published: December 2018

Rationale:

Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct flow of blood into the subarachnoid cavity due to the rupture of the diseased vessels at the base or surface of the brain. Cerebral venous sinus thrombosis (CVST) affects approximately 5 people per million and accounts for approximately 1% of all stroke events. CVST with both SAH and multifocal intracerebral hemorrhage (ICH) as the first presentation is extremely rare.

Patient concerns:

A 57-year-old woman presented with dizziness, nausea, and vomiting.

Diagnosis:

Neuroimaging confirmed a diagnosis of CVST.

Interventions:

The patient was treated with dehydration, scavenging free radicals, and nerve protection therapy.

Outcomes:

After 4 weeks of systematic treatment, the patient resumed independent daily activities and was discharged with only slight non-fluent aphasia. She did not exhibit recurrent thrombosis at an 18-month follow-up point.

Main Lessons:

The usual treatment for sinus thrombosis is anticoagulation or local thrombolysis. Systemic anticoagulation is the first-line treatment for CVST, even in patients with cerebral hemorrhage or SAH. The present patient's hemorrhage clearly contraindicated heparin; therefore, no anticoagulants or thrombolytic agents were administered during the 4-week hospitalization. We discuss issues for consideration in similar cases and provide an example of determining an individualized approach to treatment.
Recurrence of multiple metastases after surgical removal of a primary malignant solitary fibrous tumor from the main bronchus
Authors: Lv Guangchao , Wang Kaizhong , Li Miao , Li Zhijun , Zheng Awangdang , Pang Qisheng
Published: December 2018

Rationale:

Limited knowledge is available regarding solitary fibrous tumors (SFTs), about 15% of which are malignant. In particular, the long-term survival of patients with malignant SFTs (mSFTs), the disease course, and the potential for recurrence of second primary tumors or distant metastases are largely undetermined.

Patient concerns:

We report a rare case in which an mSFT was found at the main bronchus of the right lung of a 37-year-old man.

Diagnosis:

The tumor cells of mSFT were spindle-shaped and expressed antigen Ki-67, B-cell lymphoma 2, cluster of differentiation 31, and vimentin.

Interventions:

A total pneumonectomy was performed.

Outcomes:

The patient developed fibrosarcoma of the small intestine at 6 months, as well as extensive pleural and peritoneal metastases at 1 year, after removal of the primary mSFT from the right main bronchus.

Lessons:

From these findings, we expect that patients with primary mSFT, especially of the lung, have a high potential to develop second tumors or distant metastases. Close monitoring after surgery is necessary to improve the outcomes of these patients.
Endoscopic ultrasound-guided internalization of a pancreaticocutaneous fistula utilizing a balloon-target technique
Authors: Imai Michitaka , Takahashi Yoshifumi , Sato Toshihiro , Maruyama Masaki , Isokawa Osamu
Published: December 2018

Rationale:

Endoscopic ultrasound (EUS)-guided treatment has been recently described for internalizing refractory pancreaticocutaneous fistulas (PCFs). However, the existing techniques are limited because of the difficulty in accessing nondilated pancreatic ducts or fistulas. In an attempt to overcome this limitation, we present a case where a EUS-guided intervention utilizing a balloon-target technique was employed to internalize a PCF into the stomach.

Patient concerns:

A 78-year-old woman underwent percutaneous drainage and 4 percutaneous endoscopic necrosectomies for walled-off pancreatic necrosis (WOPN) after severe acute pancreatitis due to choledocholithiasis. Although the WOPN was resolved, refractory PCFs remained.

Diagnosis:

Pancreaticocutaneous fistulas.

Interventions:

An echoendoscope was introduced into the stomach, but the narrow PCF lumen made visualization of the fistula by EUS difficult. Subsequently, a balloon catheter was percutaneously inserted into the fistula, and then the inflated balloon was visualized by EUS from the stomach. The balloon was punctured with a 19-gauge fine needle through the posterior wall of the upper body of the stomach (balloon-target technique). A guidewire was then passed through the fistula to the outside of the body through the EUS scope. After dilating the gastro-fistula space with an 8-mm balloon dilation catheter, a 7-French double pigtail catheter was placed from the stomach into the PCF.

Outcomes:

The percutaneous drainage tube was removed after one week, and the patient was discharged 6 months after admission. No adverse outcomes have been observed in the 2 years since the procedure.

Lessons:

PCFs can be successfully managed using EUS-guided internalization with a balloon-target technique.
Association between alcoholic interventions and abstinence rates for alcohol use disorders
Authors: Gao Jiamin , Cao Jun , Guo Tao , Xiao Yunyue
Published: December 2018

Objective:

The aim of present study is to quantitatively evaluate the association between different interventions and abstinence rates based on network meta-analysis.

Method:

Following PRISMA guidelines, randomized clinical trials that compared different alcoholic interventions for alcohol use disorders associated with abstinence rates in treatment sessions or/and follow-up sessions were recruited. Main data synthesis was performed by Bayesian random-effects network meta-analyses, and the relative ranking of interventions was estimated by cumulative probability P values (SUCRA). Funnel plot symmetry was used to detect publication bias. Moreover, pair-wised comparison was also conducted to determine the statistical difference and forest plots were generated to calculate the differences between the groups. The Grades of Recommendations Assessment, Development and Evaluation (GRADE) criteria were utilized for the recommendations of evidence from pairwise direct comparisons.

Results:

A total of 137 RCTs containing 27,282 participants and 8 variations of psychotherapy, pharmacotherapy, contingency management, and brief intervention used as treatment interventions were included. In summary, contingency management plus psychotherapy was demonstrated to be effective and possessed the best rank of achieving the highest abstinence rate in treatment sessions (SUCRA, 0.61). Pharmacotherapy plus psychotherapy also revealed its efficacy and was associated with the highest abstinence rate in follow-up sessions (SUCRA, 0.40). More importantly, psychotherapy alone was demonstrated not to be associated with higher abstinence rates in both treatment (OR, 1.052; 95% CI, 0.907–1.220) and follow-up sessions (OR, 0.967; 95% CI, 0.552–1.693), yet pharmacotherapy seemed to be the only intervention associated with higher abstinence rates compared to controls in both sessions (treatment session: OR, 1.074; 95% CI, 1.002–1.152) (follow-up session: OR, 1.442; 95% CI, 1.094–1.900).

Conclusions:

Contingency management plus psychotherapy and pharmacotherapy plus psychotherapy were demonstrated to be associated with the highest abstinence rates in treatment sessions and follow-up sessions, respectively. However, contingency management and pharmacotherapy seemed to be the substantial crucial factors allowing for the maintenance of the highest abstinence rates in respective sessions, although we need more evidence for further validation.
Protocol for a systematic evaluation of pediatric pharmacy development and pediatric pharmacy experts’ research area in China
Authors: Li Hao , Huang Shi-Ying , Zhang Shun-Guo , Chen Min-Ling , Gu Zhi-Chun , Shi Fang-Hong
Published: December 2018

Background:

The pediatric pharmacy research status of children's hospitals in China is still unknown. Our previous findings suggest the regional differences in academic level in tertiary (grade III level A) children's hospitals in China.

Methods:

This systemic evaluation described in this protocol will be conducted to follow the Cochrane Handbook. We will perform a systemic literature search of relevant databases including Chinese databases (CNKI, Wanfang Data, VIP Paper Check System) and English databases (Medline, EMbase, Cochrane Library) from inception to December 31, 2018. The search strategy will be enacted according to the guidance offered from the Cochrane Handbook. Two rounds of searches will be conducted to prevent the omission of relevant literature. A pre-set grading standard will be used to give calculation weight (W) to evaluate the quality of each article. Data synthesis will be performed using STATA software (version 13.1, Statacorp, College Station, Texas). Pediatric pharmacy development index (PPDI) of each hospital will be used to evaluate the pediatric pharmacy development in each tertiary children's hospitals. The cumulative calculation weight (∑W) and annual calculation weight (∑yearW) will be used to evaluate the academic level of pharmaceutical departments in different tertiary children's hospitals. Subgroup analysis will be performed to compare the number of different types of articles published between different hospitals base on different research areas such as policy research, basic research, and clinical research.

Results:

In this article, we will evaluate pediatric pharmacy development and the research area of pediatric pharmacy experts in China. Based on the results from this research, we will analyze the professional backgrounds of pediatric pharmacy experts from 23 tertiary children's hospitals in China. According to the contents and research directions of literature published by the pediatric pharmacy experts in these 23 hospitals, we will determine the professional field of pediatric pharmacy experts and establish an expert database. In the process of formulating the related national or local policies in the future, the expert database will be selected accurately to reach the expert consensus.

Conclusion:

Our study will provide a comprehensive picture of pediatric pharmacy development in China. The pediatrics pharmacy expert's database constructed by this study will be used to build consensus on pediatric pharmacology in the future.
Medial patellofemoral ligament reconstruction in children
Authors: Matuszewski Łukasz , Tramś Marek , Ciszewski Andrzej , Wilczyński Michał , Tramś Ewa , Jakubowski Paweł , Matuszewska Anna , John Kishore
Published: December 2018

Background:

Many surgical procedures have been described to treat recurrent patellar dislocation, but none of these techniques has been successful in all patients. The goal of the study was to evaluate the results of medial patellofemoral ligament reconstruction in children. Two operative procedures were evaluated; a fascia lata allograft and an autologous gracilis graft.

Methods:

Forty-four children (27 girls and 17 boys) between 13 and 17 years of age with unilateral recurrent patellar dislocation underwent medial patellofemoral ligament (MPFL) reconstruction. Patients were operated in two orthopedic centers. The 1st group contained 22 patients and surgery was performed using a fascia lata allograft. In the 2nd group of patients which also contained 22 children and autologous gracilis graft was used. The mean age of the patients was 14.9 years and the mean follow-up was 24 months. Preoperatively, all patients were evaluated clinically (Kujala score questionnaire) and radiologically. The same evaluation was used 18 to 30 months postoperatively to estimate the results of our treatment.

Results:

In 1st group of children operated with cadaver allografts, the Kujala score significantly improved from 73.91 points preoperatively to 94.50 points postoperatively (P < .001). The average duration of operating procedure was 1 hour and 35 minutes. As shown by subjective symptoms, the results in 95% of patients were rated as good or very good. All children returned to full activity. Similar results were obtained in patients in 2nd group, where MPFL was reconstructed with ipsilateral gracilis tendon. Kujala score increased from 70.77 points preoperatively to 94.32 postoperatively (P < .001). Our results were estimated as good or very good in 93% of patients. All patients that were operated returned to full activity. However, median duration of operation was longer and lasted 1 hour and 55 minutes.

Conclusions:

Both techniques were effective in the short-term (18–30 months) in treatment of recurrent patellar dislocation. The use of cadaver allograft spares the hamstring muscles and reduces the time of surgery. Therefore, such study appears to be useful because it provides valuable information that would help to guide treatment of this condition in children. Level of evidence II-2
Aldosteronism with mild hypokalemia presenting as life-threatening ventricular arrhythmias
Authors: Shao Dongpu , Wang Shudong , Zhou Shanshan , Cai Qingyuan , Zhang Rangrang , Li Hang , Zheng Yang , Zhang Zhiguo
Published: December 2018

Rationale:

Primary aldosteronism (PA) with hypokalemia increases the risk of life-threatening ventricular arrhythmias. Cases of PA with malignant arrhythmia as the first symptom have been reported. The role of severe hypokalemia in triggering malignant ventricular arrhythmia is well documented. However, few cases of PA with mild hypokalemia that presented with life-threatening ventricular tachycardia have been reported.

Patient concerns:

A 74-year-old man was admitted to our hospital 25 hours after suffering from syncope caused by ventricular tachycardia without chest pain. Electrocardiogram showed ST segment depression and T wave inversion in leads III, avF, V4–V6. Mild QT prolongation was observed during sinus rhythm. Blood tests showed mild hypokalemia and elevated plasma aldosterone level. Abdominal computed tomography showed a nodule in the left adrenal gland. Coronary angiography revealed stenosis in the right coronary artery.

Diagnosis:

Prolonged QT interval, hypokalemia, high level plasma aldosterone, a nodule in the left adrenal gland and right coronary artery stenosis led to a diagnosis of aldosterone hyperplasia and adrenal nodule with ischemic heart disease.

Intervention:

Intravenous potassium and magnesium were administered to correct hypokalemia and a stent was implanted in the right coronary artery for vascularization. A prescription aldosterone receptor antagonist, spironolactone, was prescribed for hyperaldosteronemia.

Outcomes:

During 6 months of follow-up, no episodes of ventricular tachycardia or syncope occurred, and serum potassium level remained normal.

Lessons:

In patients with ventricular tachycardia and mild hypokalemia, physicians need to consider that PA and ischemia heart disease may be one of the possible causes of electrical storm.
Inflammation-based Glasgow Prognostic Score in patients with acute ST-segment elevation myocardial infarction
Authors: Jia Yu , Li Dongze , Cao Yu , Cheng Yisong , Xiao Lei , Gao Yongli , Zhang Lin , Zeng Zhi , Wan Zhi , Zeng Rui
Published: December 2018

The inflammation-based Glasgow Prognostic Score (GPS), which involves C-reactive protein and serum albumin levels, has been reported to be a strong independent predictor of mortality in many cancers. This study aimed to investigate whether the GPS is associated with mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).

In this study, 406 consecutive patients with STEMI at our emergency department (ED) who were undergoing pPCI were prospectively enrolled and assigned a GPS of 0, 1, or 2. Kaplan–Meier survival and multivariable Cox regression analyses were used to evaluate the associations between the GPS and long-term mortality.

Twenty-three patients (5.7%) died at the hospital, and 37 (9.7%) died during follow-up (14.4 [9.3–17.6] months). Compared with patients with a lower GPS, those with a higher GPS had significantly higher in-hospital mortality (GPS = 0 vs GPS = 1 vs GPS = 2: 3.3% vs 6.3% vs 28.0%, P < .001), follow-up mortality (4.6% vs 14.3% vs 55.6%, P < .001), and cumulative mortality (9.6% vs 21.1% vs 71.1%, P < .001). Multivariable Cox regression analysis revealed that in patients with a GPS of 1 and 2 (versus 0), the multivariable adjusted hazard ratios (HR) for all-cause mortality were 2.068 (95% CI: 1.082–3.951, P = .028) and 8.305 (95% CI: 4.017–17.171, P < .001), respectively, after controlling for all of the confounding factors. Subgroup analysis showed that a higher GPS was associated with an increased risk of cumulative mortality in the different subgroups.

The GPS on admission may be useful for stratifying the risk of adverse outcomes in patients with STEMI undergoing pPCI in the ED.
The epidemiology of cancer in the United Arab Emirates
Authors: Radwan Hadia , Hasan Hayder , Ballout Rami A. , Rizk Rana
Published: December 2018

Objective:

We conducted a systematic review to explore the United Arab Emirates (UAE)'s cancer-specific epidemiological profiles.

Methods:

We followed the standardized methods for conducting and reporting systematic reviews. We employed a highly sensitive and extensive strategy to identify all studies on the prevalence and incidence of cancer in the UAE, searching electronic databases and the grey literature. We assessed the methodological quality of the studies, summarized them, and qualitatively analyzed their results.

Results:

We included 4 retrospective studies published between 2003 and 2011, reporting data gathered between 1982 and 2004. The majority of the data were collected from national cancer registries and addressed adult Emiratis and certain cancer types. All included studies employed validated procedures for diagnostic confirmation. The overall age-standardized cancer rates were 70.1 and 74.2 per 100,000 in males and females, respectively. Lung, gastric, and prostate cancer ranked as the top 3 types in Emirati males; while breast, cervical, and thyroid cancer were the top 3 types in Emirati females. Men exhibited higher rates of lung and stomach cancers compared with women. The majority of the studies were of acceptable methodological quality.

Conclusions:

Our findings highlight the need for high-quality future research and systematic cancer data collection and registration to provide reliable data on the current incidence of cancer. We hope that our findings guide the tailoring of interventions aimed at curbing cancer rates in the UAE.
The significant impact of age on the clinical outcomes of laparoscopic appendectomy
Authors: Lasek Anna , Pędziwiatr Michał , Kenig Jakub , Walędziak Maciej , Wysocki Michał , Mavrikis Judene , Myśliwiec Piotr , Bobowicz Maciej , Astapczyk Kamil , Burdzel Mateusz , Chruściel Karolina , Cygan Rafał , Czubek Wojciech , Dowgiałło-Wnukiewicz Natalia , Droś Jakub , Franczak Paulina , Hołówko Wacław , Kacprzyk Artur , Karcz Wojciech Konrad , Konrad Paweł , Kopiejć Arkadiusz , Kot Adam , Krakowska Karolina , Kukla Maciej , Leszko Agnieszka , Łozowski Leszek , Major Piotr , Makarewicz Wojciech , Malinowska-Torbicz Paulina , Matyja Maciej , Michalik Maciej , Niekurzak Adam , Nowiński Damian , Ostaszewski Radomir , Pabis Małgorzata , Polańska-Płachta Małgorzata , Rubinkiewicz Mateusz , Stefura Tomasz , Stępień Anna , Szabat Paweł , Śmiechowski Rafał , Tomaszewski Sebastian , von Ehrlich-Treuenstätt Victor , Wasilczuk Maciej , Wojdyła Anna , Wroński Jan Wojciech , Zwolakiewicz Leszek
Published: December 2018

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults.

Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1—<40 years old; Group 2—between 40 and 64 years old; Group 3—between 65 and 74 years old; and Group 4—75 years old or older. Groups were compared in terms of peri- and postoperative outcomes.

The ratio of complicated appendicitis grew with age (20.97% vs 37.50% vs 43.97% vs 56.84%, P < .001). Similarly, elderly patients more frequently suffered from perioperative complications (5.06% vs 9.3% vs 10.88% vs 13.68%, P < .001) and had the longest median length of stay (3 [Interquartile Range (IQR) 2–4] vs 3 [IQR 3–5], vs 4 [IQR 3–5], vs 5 [IQR 3–6], P < .001) as well as the rate of patients with prolonged length of hospital stay (LOS) >8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48 hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days).

The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome.
Successful treatment of isolated oral lichen planus on lower lip with traditional Chinese medicine and topical wet dressing
Authors: Yu FeiYan , Xu Na , Zhao Bin , Ren XiuYun , Zhang Fang
Published: December 2018

Rationale:

Biopsy is very important for the diagnosis of oral lichen planus (OLP) on the lips. Traditional Chinese medicine (TCM) can be used to coordinate the whole body, soften and eliminate swellings and masses, and regulate the functions of qi and blood. Therefore, TCM could be an effective and safe treatment for OLP. Wet dressing is particularly important for the treatment of lip diseases. We report on a rare case of OLP on the lower lip.

Patient concerns:

A 38-year-old female patient presenting with a history of recurrent erosion, bleeding, and pain on her lower lip for 10 years.

Diagnoses:

Erosive OLP of the lower lip.

Interventions:

The patient was treated for 4 months using TCM comprising “Qingwen Jiedu Kouyankang granules,” total Paeonia glucosides, and a combination of hormones and anti-inflammatory agents applied locally using a wet dressing.

Outcomes:

Lip erosion was improved remarkably after 1 month, and there was no recurrence or aggravation of the condition. The duration of the follow-up period was 5 months.

Lessons:

The therapeutics used here were effective and safe for the treatment of OLP and could improve the quality of life in patients with lip erosion. The therapeutics provide new insight into the treatment of OLP on the lip.