bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-World Evidence of Disease Burden in Obese Patients Hospitalized With Acute Bacterial Skin and Skin-Structure Infections
Authors: McGinnis Emily , Ayyagari Rajeev , Tan Ruo-Ding , Tuttle Edward , Cammarata Sue , Tillotson Glenn
Published: October 2018

Purpose

Common causes of hospitalizations in the United States are acute bacterial skin and skin-structure infections (ABSSSIs). The objectives of this retrospective study were to characterize hospitalized ABSSSI patients including comorbidities and identify the microorganisms associated with the infection.

Methods

Adults (>18 years) hospitalized with 1 or more primary ABSSSI diagnosis were selected from the Cerner Health Facts electronic medical records database between 2009 and 2013. Causative microorganisms for ABSSSI and Gram-stain type were identified from microbiology culture, including patients with methicillin-resistant Staphylococcus aureus (MRSA).

Results

Of the 11,705 patients identified, 51.8% were male, with a mean age of 55 years at admission; 49.7% were obese; and 30.9% had diabetes. More than half (56.6%) of patients had no microbiology culture results. Of the patients with an identified ABSSSI-causing pathogen, 63.9% were gram-positive, including 18.4% infected with MRSA; 11.9% were gram-negative; and 24.2% had mixed infections (gram-positive and gram-negative), including 3.6% with MRSA. After adjusting for confounding variables, a significant association was noted between obesity and 30-day ABSSSI-related readmission among males, patients younger than 65 years, and patients without MRSA.

Implications

Hospitalized ABSSI patients had comorbidities, including obesity, diabetes, hypertension, and depression, which can complicate antibiotic selection. Patient characteristics and pathogen coverage must be considered in antibiotic selection in ABSSSI.
Attitudes Concerning Antipsychotic Depot Medication in the German General Population
Authors: Schmidt-Kraepelin Christian , Engelke Christina , Kahl Kai G. , Cordes Joachim
Published: October 2018

Background

Treatment of schizophrenia with depot medication has advantages compared with oral medication, and among these include an improved compliance. Despite such advantages, prescription rates in many European countries are lower than 20%. The aim of this survey was to study the attitudes toward depot medication among the German general population. To the best of our knowledge, only selective samples have been investigated up until now.

Methods

A representative sample of 754 people were interviewed via telephone by a professional market research and polling organization. The questionnaire queried demographic characteristics, experience with medication, and the treatment of mental disorders. Subjects' attitudes toward medication in general, long-term medication, and depot medication were surveyed.

Results

Most (66.7%) of the subjects stated that they would be willing to receive depot medication. Subjects who experienced the treatment of mental disorders were more likely to be willing to receive depot medication. Among the reasons for not using depot medication, “fear of injection” (66.3%) and “more self-control when taking medication as tablets” (48.9%) were stated as the most frequent reasons.

Conclusions

This study found a good acceptance of antipsychotic depot medication among the German general population in terms of willingness to receive such treatment. We argue that the clinical practitioners' assumptions that depot formulations would be refused by many patients are unsubstantiated.
Delayed Effect and Gain Restoration After Intratympanic Gentamicin for Menière's Disease
Authors: Martin-Sanz Eduardo , Diaz Joaquin Yanes , Esteban-Sanchez Jonathan , Sanz-Fernández Ricardo , Perez-Fernandez Nicolas
Published: October 2018

Objective:

This study aimed to evaluate the changes in the VOR gain after intratympanic gentamicin therapy and to correlate them with the mid-term effects on the control of vertigo, in a population of Menière's disease patients.

Study Design:

The study design was a prospective “Outcomes research.”

Setting:

Tertiary referral center.

Patients:

This study included 20 patients with unilateral Menière's disease refractory to medical therapy for at least 1 year, and treated with an on demand intratympanic gentamicin protocol.

Intervention:

Therapeutic.

Main Outcome Measure: Audiometry, caloric testing, and a vHIT before beginning the protocol were performed. Patients underwent weekly vHIT assessments until a significant gain reduction was observed. Subsequently we performed vHIT tests 1 month after the therapy completion, and then every 3 months for at least 1 year.

Results:

Complete vertigo control (class A) was achieved in 14 patients at the 12-month follow-up assessment. We observed a significant reduction in VOR gain values at the 3-week follow-up assessment. We found a significant correlation between the 1-month posttreatment ipsilateral hVOR gain and the rate of vertigo recurrence after the first IT gentamicin treatment (p = 0.012; r2 = 0.400). At the mid-term assessment, 10 patients exhibited a significant partial recovery of the hVOR gain.

Conclusions:

The delayed effect of intratympanic gentamicin and the subsequent gain restoration are factors that may influence the patients’ outcome. The feasibility of the vHIT system makes it a useful tool to monitorize the VOR changes.
Bioactive Glass Granules Inhibit Mature Bacterial Biofilms on the Surfaces of Cochlear Implants
Authors: Höing Benedikt , Kirchhoff Lisa , Arnolds Judith , Hussain Timon , Buer Jan , Lang Stephan , Arweiler-Harbeck Diana , Steinmann Joerg
Published: October 2018

Hypothesis:

Biofilm formation on cochlear implant (CI) surfaces differs between bacterial species and can be reduced by the application of S53P4 bioactive glass.

Background:

The formation of bacterial biofilms on medical devices, such as cochlear implants, can lead to chronic infections resulting in the need for implant removal. In this study, various surfaces of three CI implant kits from different manufacturers were examined for bacterial biofilm formation and reduction of a pre-existing biofilm by the application of bioactive glass.

Methods:

Biofilm formations of 4 bacterial species causing implant-related infections were tested on 17 different surfaces: Pseudomonas aeruginosa (ATCC9027), Staphylococcus aureus (ATCC6538), Staphylococcus epidermidis (ATCC12228), and Streptococcus pyogenes (ATCC19615). For P. aeruginosa and S. aureus biofilm reduction after application of S53P4 bioactive glass was evaluated.

Results:

All tested microbial species formed biofilms on the examined CI surfaces in a strain-dependent manner. For S. aureus, a significantly higher biofilm formation on metal components compared with silicone was found whereas the other strains did not show a material specific biofilm formation. Application of S53P4 bioactive glass resulted in a significant reduction of P. aeruginosa and S. aureus mature biofilm.

Conclusion:

The four bacteria species displayed biofilm formation on the CI surfaces in a species- and material-specific manner. The results show that bioactive glass can reduce biofilm formation on CI materials in vitro. Future studies are necessary to confirm the results in vivo.
Microwave ablation combined with transcatheter arterial chemoembolization is effective for treating unresectable hepatoblastoma in infants and children
Authors: Jiang Yizhou , Zhou Shaoyi , Shen Gang , Jiang Hua , Zhang Jing
Published: October 2018

The present study is to evaluate the feasibility and efficacy of microwave ablation (MWA) combined with transcatheter arterial chemoembolization (TACE) in the treatment for unresectable hepatoblastoma in infants and children. A total of 17 patients with PRETEXT stage III and IV hepatoblastoma that was unresectable by conventional resection were included in the present study. The patients were treated with TACE, MWA, and chemotherapy. All cases were diagnosed by computed tomography (CT) and liver tumor biopsy before TACE procedure. All patients received 2 courses of TACE and 1 to 2 times of MWA. Finally, several cycles of chemotherapy were arranged. Among the 17 patients, 14 were alive and had normal alpha-fetoprotein (AFP) levels. The other 3 patients died from tumor progression. The follow-up periods ranged from 10 to 68 months. Complete ablation was achieved in the 14 patients (14/17, 82.35%). Most patients were well tolerated during the whole course except for 1 patient with pneumonedema after TACE and another 1 with biloma after MWA. No marked chemotherapeutic agent-induced toxicity occurred. After chemotherapy or TACE, transient blood indicators and symptoms were observed as follows: myelosuppression, abnormal liver function, gross hematuria, fever, and abdominal pain. Transient symptoms after MWA were fever, abdominal pain, and massive gross hematuria. The present study demonstrates that MWA combined with TACE is a safe and effective method for treating unresectable hepatoblastoma in infants and children with controllable side effects.
Rituximab for idiopathic and IgG4-related retroperitoneal fibrosis
Authors: Wallwork Rachel , Wallace Zachary , Perugino Cory , Sharma Amita , Stone John H.
Published: October 2018

Retroperitoneal fibrosis (RPF) refers to a fibro-inflammatory lesion in the retroperitoneum, often anterolateral to the aorta. Most cases are due to IgG4-related disease (IgG4-RD) or are idiopathic. RPF can lead to severe morbidity. Treatment strategies remain poorly-defined. We evaluated the efficacy and safety of rituximab (RTX) for idiopathic or IgG4-related RPF.

We retrospectively reviewed the records of patients who had RPF treated with RTX. Treatment response was determined by assessing changes in both clinical features, including symptoms and laboratory measurements, as well as in the radiographic dimensions of the lesion.

Twenty-six patients with IgG4-related (n = 19) or idiopathic RPF (n = 7) were identified. Patients without histopathological evidence of IgG4-RD on either retroperitoneal biopsies or sampling of extra-retroperitoneal organs were considered to have idiopathic RPF. Of the 26 patients, 19 (73%) received RTX without additional glucocorticoids. All 19 patients who presented with pain reported symptomatic improvement following RTX. Among 25 patients with follow-up imaging, 22 (88%) had radiologic improvement. Among 10 patients with ureteral stents and/or percutaneous nephrostomy tubes, 4 (40%) underwent successful stent or tube removal. Responses to treatment were similar among those treated with RTX monotherapy and those treated with RTX and glucocorticoids. RTX was generally well tolerated, but 3 (12%) patients experienced severe infections.

In this study, RTX for RPF led to resolution of symptoms in all patients and radiographic improvement in the majority. Prospective studies of RTX for RPF are indicated.
Surgical debridement for acute invasive fungal rhinosinusitis during the pre-engraftment phase of allogeneic hematopoietic stem cell transplantation
Authors: Cheng Hao-yu , Yuan Lei , Wang Jing-bo
Published: October 2018

Rationale:

Surgical intervention may be not a contraindication for acute invasive fungal rhinosinusitis (AIFR) during the pre-engraftment period of allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Patient concerns:

We present 2 cases involving patients with AIFR in the pre-engraftment phase of allo-HSCT.

Diagnoses:

Both patients received surgical debridement combined with systemic antifungal treatment. The biopsies identified the diagnosis of AIFR in these 2 cases.

Outcomes:

The 2 patients obtained normal hematopoiesis without recurrence of AIFR.

Lesson:

Our experience with these 2 cases suggests that prompt endoscopic surgical debridement is not an absolute contraindication for allo-HSCT recipients with AIFR during the pre-engraftment period. If permitted, urgent, radical, and aggressive but careful endoscopic debridement should be performed together with systemic antifungal treatment once AIFR has been diagnosed or suspected.
Primary hypothyroidism in a child leads to pituitary hyperplasia
Authors: Cao Junguo , Lei Ting , Chen Fan , Zhang Chaochao , Ma Chengyuan , Huang Haiyan
Published: October 2018

Rationale:

A sellar mass in children is most often seen in craniopharyngeal tumors, intracranial germ cell tumors, or pituitary adenomas. However, pituitary hyperplasia secondary to primary hypothyroidism (PHPH) is not commonly seen in children.

Patient concerns:

A 10-year-old girl was admitted due to growth retardation and obesity for 4 years. On physical examination, the patient had a height of 118 cm, body weight of 46 kg, body mass index (BMI) of 33.0 kg/m2.

Diagnoses:

After magnetic resonance imaging (MRI) and laboratory tests, her initial diagnosis was Hashimoto's thyroiditis, primary hypothyroidism, and reactive pituitary hyperplasia.

Interventions:

She was treated with oral L-thyroxine tablets.

Outcomes:

After 6 months, physical examination showed a height of 125 cm, weight of 36 kg, BMI of 23.0 kg/m2. She developed well, with 12 cm of yearly growth thereafter.

Lessons:

The diagnosis of PHPH in a child is very important and sometimes difficult. Based on the summary and analysis of previous cases, we can learn that the main manifestations of PHPH include growth arrest and obesity, perhaps accompanied by symptoms caused by a decreased thyroid hormone concentration and elevated prolactin (PRL) concentration. Intracranial MRI shows diffuse enlargement of the anterior lobe of the pituitary gland, with a dome-shaped blunt edge change. Thyroid hormone levels may decrease, whereas the thyroid stimulating hormone (TSH) level increases, commonly accompanied by an elevated PRL, reduced growth hormone (GH) levels, and positive findings of TPOAb and TGAb. Improvement of symptoms and the normalization of hormone levels as well as restoration of pituitary size can be achieved after treated with thyroid hormone replacement therapy. And a hasty decision on surgical resection should be avoided when the diagnosis is uncertain.
Comparison of the response of frequently relapsing steroid-dependent minimal change nephrotic syndrome to rituximab therapy between childhood-onset and adult-onset disease
Authors: Iwabuchi Yuko , Miyabe Yoei , Makabe Shiho , Nakano Marie , Manabe Shun , Karasawa Kazunori , Moriyama Takahito , Nitta Kosaku
Published: October 2018

Rituximab has been approved in Japan for the treatment of intractable nephrotic syndrome, but in cases of childhood-onset disease only; its efficacy and safety in adult-onset disease has yet to be established. This study was undertaken to evaluate the efficacy of rituximab and adverse effects in patients with adult-onset minimal change nephrotic syndrome (MCNS).

The study involved 32 childhood-onset cases (mean age at onset: 8.6 years) and 19 adult-onset cases (mean age at onset: 30.6 years) of frequently relapsing steroid-dependent MCNS, all of whom received intravenous rituximab drip infusion (375 mg/m2 body surface area per dose) at 4 time points at 6-month intervals. Relapse frequency, oral dose of immunosuppressants, and adverse effects were compared between the 2 groups.

Remission was maintained in all cases in the childhood-onset and adult-onset groups; a significant reduction in relapse frequency was noted during the first 24 months of rituximab therapy (0.3 ± 0.7 times and 0.3 ± 0.6 times in the childhood-onset and adult-onset groups, respectively; P < .001). Oral corticosteroid therapy could be discontinued in 81.3% of cases of the childhood-onset group (26/32 cases) and in 70.6% of cases of the adult-onset group (12/17 cases); the oral corticosteroid dose was reduced significantly to 0.9 ± 2.5 mg/day in the childhood-onset group and to 0.8 ± 1.6 mg/day in the adult-onset group (P < .001). Cyclosporin treatment was also discontinued in 87.5% of cases in the childhood-onset group (21/24 cases) and in 80.0% of cases of the adult-onset group (15/21 cases); the oral cyclosporin dose was reduced significantly to 8.6 ± 27.4 mg/day and 9.2 ± 22.0 mg/day, respectively (P < .001). Regarding adverse reactions, infusion reactions developed at a frequency of 21.1% and 19.7% in both groups, respectively, with no significant inter-group difference (P = .72).

Rituximab showed significant efficacy in adult-onset MCNS, with a comparable incidence of adverse reactions to that in childhood-onset cases, suggesting that this drug can also be used safely in adult-onset MCNS.
Correlation between CTLA4 genetic polymorphisms, its serum protein level and the susceptibility to recurrent spontaneous abortion
Authors: Li Li , Liu Jia , Qin Shuang , Li Ruiman
Published: October 2018

Present study was aimed to detect the influence of cytotoxic T-lymphocyte associated protein 4 (CTLA4) gene polymorphisms for the risk of recurrent spontaneous abortion (RSA), as well as the serum level of CTLA4 protein in RSA patients.

One hundred thirty-three RSA patients and 146 healthy persons were recruited in this case–control study. PCR-RFLP was used to genotype the CTLA4 gene polymorphisms both in case and control groups. Serum level of CTLA4 was detected by ELISA kit. Quantitative variables were compared by t test or Mann–Whitney U test between groups. Qualitative variables were evaluated by χ
2 test or Fisher exact test. Association strength was expressed by odds ratios (ORs) and 95% confidence intervals (95% CIs).

G allele of rs4553808 (P = .027, OR = 0.570, 95% CI = 0.345–0.942) and T allele of rs5742909 (P = .027, OR = 0.570, 95% CI = 0.345–0.942) were distinctly associated with reduced susceptibility of RSA. Distinctly negative association has been discovered between rs231775 AA genotype and RSA susceptibility (P = .040, OR = 0.427, 95% CI = 0.188–0.973). CTLA4 protein had significantly higher serum level in RSA patients than in healthy controls (P = .028). In RSA patients, AA genotype carriers had higher CTLA4 serum level than that GG genotype carriers (17.83 ± 6.35 ng/mL vs 10.41 ± 7.28 ng/mL, P = .039).

Minor alleles of CTLA4 polymorphisms might inhibit the RSA susceptibility via upregulated the protein expression level.
The distinguishable DNA whole genome methylation profile of 2 cases of pediatric precursor B acute lymphoblastic leukaemia (BCP ALL) with prodromal, preleukemic phase
Authors: Chaber Radosław , Gurgul Artur , Wróbel Grażyna , Tomoń Anna , Paszek Sylwia , Potocka Natalia , Haus Olga , Lejman Monika , Łach Kornelia , Szmatoła Tomasz , Jasielczuk Igor , Rybka Blanka , Ryczan-Krawczyk Renata , Stąpor Sylwia , Ciebiera Krzysztof , Arthur Christopher J. , Zawlik Izabela
Published: October 2018

Rationale:

A prolonged, prodromal phase before definitive paediatric precursor B acute lymphoblastic leukaemia (BCP ALL) diagnosis is rarely observed.

Patients concerns:

In the first, the patient presented with an aplastic preleukemic phase, whilst the second presented with a rheumatic-like preliminary phase.

Diagnoses:

The case reports of two patients with BCP ALL with a prodromal phase lasting a few weeks are presented.

Interventions and outcomes:

DNA whole genome profile methylation analysis of bone marrow cells obtained at diagnosis revealed a pattern of methylation that was readily distinguishable from both healthy and standard course BCP ALL bone marrow samples.

Lessons:

The biological implication of this observation remains unclear, with many differentially methylated loci involved in many processes like neurogenesis, cell projection organization and adhesion along with leucocyte activation and apoptosis. The prevalence and clinical significance of these methylation changes is unknown but this data indicates that the epigenetic basis of BCP ALL with a prolonged, prodromal phase requires a more detailed assessment.
Treatment of focal dystonia involving multiple muscles with a single injection of botulinum toxin A to 1 muscle
Authors: Lee Sung Young , Lee Hyeok Dong , Cho Young-Shin , Han Seung Hoon
Published: October 2018

Rationale

Botulinum toxin A (BTX-A) injection is effective in treating focal dystonia. However, there are no prior reports regarding the treatment of progressive focal dystonia by a single BTX-A injection that affect a distant muscle.

Patient concerns

A 19-year-old male was referred to the rehabilitation clinic with a complaint of involuntary movement in his left big toe. The involuntary movement pattern was initially observed in the abduction direction only; however, it progressed to irregular mixed patterns in the flexion and abduction directions.

Diagnoses

In needle electromyography, abnormal dystonic patterns were observed in the left abductor hallucis (AH), flexor hallucis longus, and flexor hallucis brevis muscles.

Interventions and outcomes

These symptoms resolved with a single BTX-A injection to the AH muscle.

Lessons

In this case, a single BTX-A injection to 1 muscle for treating progressive focal dystonia was effective on a distant noninjected muscle.
SLICC damage index score in systemic lupus erythematosus patients and its associated factors
Authors: Ghazali Wan Syamimee Wan , Daud Saidatul Manera Mohd , Mohammad Nurashikin , Wong Kah Keng
Published: October 2018

The aims of this study were to determine damage index in systemic lupus erythematosus (SLE) patients based on Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) and to determine the laboratory and clinico-demographic factors affecting SDI.

This is a retrospective cohort study of 94 SLE patients attending rheumatology clinics in 2 local hospitals in Kelantan, Malaysia. The patients were divided into 2 groups based on SDI score assigned by the attending physician, 0 (without damage) or ≥1 (with damage). Newly diagnosed SLE patients with disease duration less than 6 months were excluded.

A total of 45 (47.9%) SLE patients showed damage by SDI score. Majority of the subjects had neuropsychiatric damages (21/94; 22.3%) followed by skin (12/94; 12.8%) and musculoskeletal (6/94; 6.4%) damage. SDI score was significantly associated with higher disease duration (6.2 ± 6.57 years vs 4.5 ± 3.7 years; P = .018), lower prednisolone dose (8.74 ± 10.89 mg vs 4.89 ± 3.81 mg; P < .001), hypertension (P = .007), and exposure to cyclophosphamide (P = .004). Hypertension (P = .020), exposure to cyclophosohamide (P = 0.013), and lower prednisolone dose (P = .023) were significantly associated with damage by multivariable analysis.

Higher SDI score was significantly associated with exposure to cyclophosphamide, suggesting that lower cyclophosphamide doses or alternative therapeutic agents are recommended.
Osteoblastoma of the frontal bone invading the orbital roof
Authors: Wang Kun , Yu Feidan , Chen Keng , Niu Huanjiang , Wang Yirong , Yang Shuxu , Cai Xiujun
Published: October 2018

Rationale:

Osteoblastoma is an uncommon primary bone tumor that involves any part of the skeleton. But its occurrence in the skull is extremely rare.

Patients concerns:

A 30-year-old female was admitted to our hospital, because of the mass in the right frontal region with the history of headache for 3 years without nausea or vomiting.

Diagnosis:

Initial differential diagnoses included hemangiopericytoma, atypical intraosseous meningioma, calvarial osteosarcoma, fibrous dysplasia, and histiocytosis, based on the results of enhanced CT and MRI.

Interventions:

A total surgical resection of the mass was performed.

Outcomes:

Postoperative histopathologic analysis demonstrated the typical features of osteoblastoma, the benign bone neoplasm. Serial radiologic examination did not show recurrence in the 6 months follow-up.

Lessons:

The radiologic appearance of the osteoblastoma is always confusing and makes the diagnosis difficult. We hope our case can give some clinical clues for the diagnosis and management of the disease.
Infections and internal medicine patients
Authors: Fabbian Fabio , De Giorgi Alfredo , Boari Benedetta , Misurati Elisa , Gallerani Massimo , Cappadona Rosaria , Cultrera Rosario , Manfredini Roberto , Rodrìguez Borrego Maria A. , Lopez-Soto Pablo J.
Published: October 2018

Infectious diseases (ID) are frequently cause of internal medicine wards (IMW) admission. We aimed to evaluate risk factors for in-hospital mortality (IHM) in IMW patients with ID, and to test the usefulness of a comorbidity score (CS).

This study included ID hospital admissions between January 2013, and December 2016, recorded in the database of the local hospital. ICD-9-CM codes were selected to identify infections, development of sepsis, and to calculate a CS.

We analyzed 12,173 records, (age 64.8 ± 25.1 years, females 66.2%, sepsis 9.3%). Deceased subjects (1545, 12.7%) were older, had higher percentage of sepsis, pulmonary infections, and endocarditis. Mean value of CS was also significantly higher. At multivariate analysis, the odds ratio (OR) for sepsis (OR 5.961), endocarditis (OR 4.247), pulmonary infections (OR 1.905), other sites of infection (OR 1.671), and urinary tracts infections (OR 0.548), were independently associated with IHM. The CS (OR 1.070 per unit of increasing score), was independently associated with IHM as well. The calculated weighted risk, obtained by multiplying 1.070 for the mean score value in deceased patients, was 19.367. Receiver operating characteristic (ROC) analysis showed that CS and development of sepsis were significant predictors for IHM (area under the curve, AUC: 0.724 and 0.670, respectively).

Careful evaluation of comorbidity in internal medicine patients is nowadays matter of extreme importance in IMW patients hospitalized for ID, being IHM related to severity of disease, type and site of infection, and also to concomitant comorbidities. In these patients, a careful evaluation of CS should represent a fundamental step in the disease management.
Prognostic value of serum proadrenomedullin in catheter-related bloodstream infection in the intensive care unit
Authors: Ni Juping , Sun Yingjie , Qu Hongping , Wang Aqian , Cao Yunshan , Li Xiang
Published: October 2018

Patients with catheter-related bloodstream infection (CRBSI) have a poor prognosis. Proadrenomedullin (pro-ADM) has emerged as a valuable marker of sepsis. The potential role of pro-ADM in predicting the prognosis of CRBSI was evaluated. We enrolled 25 CRBSI patients and pro-ADM level was measured within 24 hours after each admission. Survival was assessed after 28 days. Among 25 patients with CRBSI, 14 patients survived. Pro-ADM in survivors was significantly lower than that in non-survivors (3.71 ± 1.30 vs 5.58 ± 1.18 nmol/L). The area under the curve (AUC) for pro-ADM was 0.87 (95% CI 0.68–0.97) with a cut-off value of 4.67 nmol/L, providing sensitivity of 85.7% and specificity of 81.8%. The AUCs for PCT, WBC, and CRP were 0.76 (95% CI 0.55–0.90), 0.72 (95% CI 0.50–0.88), and 0.69 (95% CI 0.48–0.86), respectively. Kaplan–Meier survival curves showed pro-ADM ≥ 4.67 nmol/L was associated with higher mortality (log-rank p = 0.001). Moreover, the pro-ADM level was significantly higher in patients with septic shock than those without shock (5.44 ± 1.17 vs 3.54 ± 1.18nmol/L). The mortality of patients with septic shock was higher than that of patients without shock (69.2% vs 16.7%, P = .008). In conclusion, pro-ADM could be used as a prognostic marker of CRBSI in critically ill patients.
A case report of unexpected sudden cardiac death due to aortic rupture following laparoscopic appendectomy
Authors: Joo Chunghee , Min Joo-Won , Noh Giyong , Seo Jaeho
Published: October 2018

Introduction:

Aortic dissection is a very rare but life-threatening condition associated with a high mortality. Unexpected sudden cardiac death due to aortic rupture following laparoscopic appendectomy is very rare and may be difficult to diagnose. However, early diagnosis of aortic dissection is essential for the timely treatment and outcome of aortic dissection.

Case presentation:

A 50-year-old man underwent a laparoscopic appendectomy. Postoperatively, the patient complained of dyspnea and chest pain. In 25 minutes after arrival in the postanesthesia care unit (PACU), the patient was in asystole. Then, he underwent cardiopulmonary resuscitation (CPR) according to advanced cardiac life support (ACLS) protocol using 1 mg of epinephrine, one 200J DC shock for ventricular fibrillation (V-fib). After that, his noninvasive blood pressure (NIBP) was 80/40 mm Hg, pulse rate (PR) was 140 beats/min, and peripheral oxygen saturation (SpO2) was 84%. His electrocardiogram (ECG) finding was atrial fibrillation (A-fib). After 20 minutes, the patient developed asystole rhythm again and CPR was restarted. He remained severely hypotensive despite vasopressors and died after 5 hours CPR. A forensic autopsy was performed postmoterm and thoracic and abdominal aortic dissection along the root of ascending aorta was present and massive hematoma within right and left thorax was present.

Conclusion:

Acute aortic disease can be difficult to recognize; therefore, diagnosis is sometimes delayed or missed. It is important to recognize the atypical symptoms of aortic dissection and maintain a broad differential diagnosis if patients complained of abdominal pain.
Safety and efficacy of AAIR pacing in selected patients with sick sinus syndrome
Authors: Senaratne Janek , Herath Thiloththama Thisaranie , Beaudette Diane , Irwin Marleen , Gulamhusein Sajad , Senaratne Manohara Piyasiri
Published: October 2018

Background:

The DANPACE study suggested implanting dual-pacing dual-sensing dual-response rate-adaptive (DDDR) pacemakers in patients with sick sinus syndrome, even though 90.7% of their atrial-pacing atrial-sensing inhibited-response rate-adaptive (AAIR) group did not require upgrade. Most centers implant DDDR pacemakers due to risk of future atrioventricular (AV) block. Given that AAIR pacemakers are less expensive, have one less lead with potentially one less point of complication, we question whether DDDR pacemakers are superior to AAIR pacemakers. We aim to describe long-term outcomes of AAIR implants.

Methods:

Patients presenting to the Grey Nuns Hospital in Edmonton, Canada from 1990 to 2012 with sick sinus syndrome without AV block had AAIR pacemakers implanted. Outcomes that were measured over the follow-up time included need for ventricular lead reoperation, incidence of AV block and incidence of sudden cardiac death from AV block.

Results:

During this period, 330 patients presented with sick sinus syndrome. Eighty-seven (26.4%) patients met criteria for and received AAIR pacemakers. Seventy-eight (91.8%) did not require upgrade over mean follow-up of 10.6 ± 0.6 years. Amongst this group, 31 patients (39.7%) were alive, whereas 47 (60.3%) were deceased at end of follow-up due to other comorbidities. No sudden deaths were attributable to AV block. Only 7 patients (8.2%) required ventricular lead reoperation: 2 (2.4%) presented urgently with symptomatic AV block; 3 (3.5%) had atrial fibrillation requiring beta-blockade; 1 (1.2%) had atrial lead dislodgment; and 1 (1.2%) was electively upgraded at battery end-of-life.

Conclusions:

This study looks at safety of AAIR pacemakers with only 2.4% of patients developing AV block requiring urgent upgrade. Approximately 91.8% of patients remained with their original AAIR pacemakers (mean follow-up 10.6 vs 5.4 years in DANPACE). Our findings are similar to the DANPACE study but our conclusions are different as we believe AAIR pacing should be considered for selected patients with sick sinus syndrome without AV block.
Resolution of obstructive sleep apnea after mandibular distraction osteogenesis in setting of delayed tongue–lip adhesion takedown
Authors: Randall Robyn S. , Kian Aaron , Chin Katherine , French Brooke
Published: October 2018

Rationale:

There is a high prevalence of obstructive sleep apnea (OSA) in patients with Pierre Robin sequence (PRS), and treatment approaches are highly variable. One approach is a temporary tongue-lip adhesion (TLA) that acts as a temporizing measure while the mandible continues to grow and is usually taken down at 1 year of age.

Patient concerns:

Side effects of prolonged tongue-lip adhesion and optimal workup and treatment of persistent OSA in the setting of a tongue-lip adhesion.

Diagnoses:

Pierre Robin sequence (PRS), persistent obstructive sleep apnea (OSA), and tongue-lip adhesion (TLA).

Interventions:

Mandibular distraction osteogenesis (MDO), adenotonsillectomy, and tongue-lip adhesion takedown.

Outcomes:

Resolution of OSA.

Lessons:

This case puts into question the efficacy of isolated TLA in infants with Pierre Robin sequence and OSA, and places emphasis on the importance of considering an earlier workup of other potential causes of obstruction and the potential need for MDO as a primary or adjunctive approach to treatment.
Heterogeneous spectrum of EXT gene mutations in Chinese patients with hereditary multiple osteochondromas
Authors: Li Yuchan , Wang Jian , Tang Jingyan , Wang Zhigang , Han Bingqiang , Li Niu , Yu Tingting , Chen Yulin , Fu Qihua
Published: October 2018

Hereditary multiple osteochondroma (HMO) is one of the most common genetic skeletal disorders. It is caused by mutations in either EXT1 or EXT2 resulting in abnormal skeletal growth and morphogenesis. However, the spectrum and frequency of EXT1 and EXT2 mutations in Chinese patients with HMO was not previously investigated.

Mutations were identified by performing Sanger sequencing analysis of the complete coding regions and flanking intronic sequences of EXT1 and EXT2, followed by multiplex ligation-dependent probe amplification (MLPA) analysis to detect gene deletions or duplications that could not be identified by the Sanger sequencing method.

The present study identified pathogenic mutations in 93% (68/73) of unrelated HMO probands from 73 pedigrees. Mutations in EXT1 and EXT2 were identified in 53% (39/73) and 40% (29/73) of families. We identified 58 distinct mutations in EXT1 and EXT2, including 20 frameshift mutations, 16 nonsense mutations, 7 missense mutations, 9 splice site mutations, 5 large deletions, and 1 in-frame deletion mutation. Twenty-six of these mutations were novel and 32 were previously reported. Most of the mutations in EXT1 were base deletions or insertions (21/33), whereas the majority of those in EXT2 were single base substitution (18/25).

Complete sequencing of both the EXT1 and EXT2 followed by MLPA analysis is recommended for genetic analysis of Chinese patients with HMO. This study provides a comprehensive characterization of the genetic aberrations found in Chinese patients with HMO and highlights the diagnostic value of molecular genetic analysis in this particular disease.
Multiple sclerosis prevalence study
Authors: Türk Börü Ülkü , Duman Arda , Kulualp Ahmet Şükrü , Güler Neşe , Taşdemir Mustafa , Yılmaz Ümit , Alp Recep , Bölük Cem
Published: October 2018

The prevalence of multiple sclerosis (MS) has significantly increased all over the world. Recent studies have shown that Turkey has quite a high prevalence. The aim of this study is to estimate prevalence in the Mediterranean and Black Sea regions of Turkey and to compare the results.

This study was designed as a door to door survey in 3 cities. One is located in the Mediterranean region (South), 2 are located in the Black Sea region (North). A previous validated form was used for screening in the field. The patients were examined first in the field, then in the regional health facility. McDonald criteria were used for the diagnosis.

In total, 26 patients were diagnosed with MS. The prevalence was found to be 18.6/100,000 in Artvin (Black Sea region), 55.5/100,000 in Ordu, (Black Sea region), 52.00/100,000 in Gazipaşa (Mediterranean region). The female/male ratio was 2.25.

This study is the first prevalence study which was conducted in the Mediterranean City (South) of Turkey. The prevalence rate was found to be higher than expected in the Mediterranean city of Gazipaşa. The results showed that the prevalence varies from region to region. Latitude difference was not observed.
Early severe coronary heart disease and ischemic heart failure in homozygous familial hypercholesterolemia
Authors: Kuang Hongyu , Zhou Xue , Li Li , Yi Qijian , Shou Weinian , Lu Tiewei
Published: October 2018

Rationale:

Familial hypercholesterolemia (FH) is a common inherited cause of coronary heart disease (CHD) and premature death in an early age. Nevertheless, an ischemic heart failure (IHF) associated with FH seems to be rare, and an early diagnosis and therapy could influence the prognosis.

Patient concerns:

In this 13-year-old girl, multiple xanthomas began to develop from the first day of birth. Until June, 2017, she was admitted to our center due to edema, oliguria, and dyspnea during exertion, which was attributed to a recent respiratory infection.

Diagnosis:

Homozygous FH (HoFH), CHD, and IHF.

Interventions:

The patient has been treated with statin, ezetimibe, aspirin, and traditional heart failure (HF) medications. In addition, the beta-blocker was simultaneously administered.

Outcomes:

Genotypes of this proband indicated homozygous mutations of low-density lipoprotein receptor (LDLR) and some co-segregated mutations, such as von Willebrand factor (VWF) and fibroblast growth factor receptors. At 6-month follow-up, we found a decreased level of plasma lipid profile, in addition to a significant improvement in 6-minute walk distance and functional class. Echocardiography indicated nonsignificant improvements in the structure and function of the heart.

Lessons:

This case report indicates that HoFH can lead to dramatically progressive endothelial damages and ventricular remodeling, severe atherosclerosis, even IHF. Genetic outcomes indicate IHF with HoFH could possibly result from LDLR mutations and some co-segregated mutations influencing endothelial function and cardiovascular remodeling. In a short-term follow-up, a combination of statins, ezetimibe, aspirin, and traditional HF agents is safe and effective for IHF with HoFH, and there is a need for further identification of drugs to ameliorate endothelial function and cardiovascular remodeling which may play an important role in long-term treatment.
Diagnosis of systemic lupus erythematosus by presence of Hargraves cells in eosinophilic pleural effusion
Authors: D’Andréa Alexia , L. Peillet Damien , Serratrice Christine , Petignat Pierre-Augute , Prendki Virginie , Reny Jean-Luc , Serratrice Jacques
Published: October 2018

Rationale:

Eosinophilic pleural effusion in elderly patients is most commonly due to malignancies and infections.

Patient concerns:

In rare cases, pleural eosinophilia is associated with connective tissue disease.

Diagnoses:

Presence of Hargraves cells, also called lupus erythematosus (LE) cells (polynuclear cells that have engulfed denatured nuclear material), was a key point of American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) until 1997. Now replaced by serology for autoantibodies, LE cells characterization remains useful in guiding the diagnostic strategy towards autoimmune diseases.

Interventions:

An 82-year-old woman complained about anorexia, weight loss, fatigue, and mild night fever. Clinical examination disclosed a left pleural effusion without parenchymal lesion on high contrast thoraco-abdomino-pelvic computed tomography scan. A thoracocentesis revealed an exudate with eosinophilia. Direct cytological examination showed LE cells. SLE was rapidly considered. Antinuclear antibodies were subsequently found in the serum and in the pleural effusion. Anti-nucleosome antibodies were also present without antiphospholipid antibodies. Her condition rapidly improved after initiation of prednisone and hydroxychloroquine.

Outcomes:

Six months later, the patient had no particular complain, clinical examination was strictly normal biological parameter were in normal range.

Lessons:

The assessment of an eosinophilic pleural effusion allowed to find LE cells, which rapidly suggested the diagnosis of SLE, and early initiation of appropriate treatment. LE cells are no longer a criterion for the diagnosis of SLE, but their presence in serosa is most helpful in guiding the diagnostic strategy, and specifically in atypical forms often seen in older patients.
Nonalcoholic fatty liver disease with prolactin-secreting pituitary adenoma in an adolescent
Authors: Takaki Yugo , Mizuochi Tatsuki , Nishioka Junko , Eda Keisuke , Yatsuga Shuichi , Yamashita Yushiro
Published: October 2018

Rationale:

Nonalcoholic fatty liver disease (NAFLD), among the commonest chronic liver disorders in children and adolescents, is considered a reflection of the current obesity epidemic in children and adults. This liver disease has been linked with various metabolic disorders, but not with prolactinoma (PRLoma).

Patient concerns:

A 13-year-old Japanese girl manifested obesity, serum transaminase and γ-glutamyltransferase elevations, and amenorrhea. Abdominal ultrasonography showed fatty liver. Her serum prolactin concentration was elevated, and cranial magnetic resonance imaging showed a pituitary mass consistent with macroadenoma.

Diagnoses:

NAFLD and PRLoma.

Interventions and outcomes:

After the patient's NAFLD failed to respond to diet and exercise, cabergoline treatment of the PRLoma decreased body weight, serum transaminase and γ-glutamyltransferase elevations, and ultrasonographic fatty liver grade as the tumor became smaller.

Lessons:

Physicians should consider the possibility of PRLoma when diet and exercise fail to improve fatty liver disease in a patient with endocrine symptoms such as amenorrhea.
Glaucoma severity and intraocular pressure reduction after cataract surgery in eyes with medically controlled glaucoma
Authors: Yoo Chungkwon , Amoozgar Behzad , Yang Kyung-Sook , Park Ji-Hye , Lin Shan C.
Published: October 2018

To investigate the relationship between glaucoma severity and intraocular pressure (IOP) reduction after cataract surgery in patients with medically controlled primary open-angle glaucoma (POAG).

Retrospective case series.

This study included glaucoma suspects (GS) and POAG patients who underwent cataract surgery and continued to use the same glaucoma medications during the postoperative period of 4 months. The main outcomes were percent and absolute IOP changes calculated using the preoperative IOP and the postoperative IOP at 3 months. Preoperative glaucoma medications, preoperative IOP, demographic information, biometric parameters and variables for glaucoma severity were evaluated as potential predictors of IOP change.

The average IOP reduction was 3.3 ± 2.4 mmHg (20.0%) and 2.2 ± 2.5 mmHg (13.1%) from the preoperative mean of 16.0 ± 2.9 mmHg and 15.2 ± 3.3 mmHg in the GS and POAG groups, respectively. Preoperative IOP, preoperative IOP/anterior chamber depth (preoperative IOP/ACD [PD ratio]) and preoperative IOP/retinal nerve fiber layer (RNFL) thickness (preoperative IOP/RNFL [PNFL ratio]) and preoperative IOP score x MD score x number of glaucoma medications (glaucoma index) predicted absolute IOP change in the POAG group, whereas preoperative IOP, PD ratio, PNFL ratio, and axial length (AL) did in the GS group. Preoperative IOP, PD ratio, and PNFL ratio predicted %IOP change in the POAG group, whereas only AL did in the GS group.

In medically controlled POAG eyes, structural or functional parameters for glaucoma severity did not independently predict IOP change following phacoemulsification. However, novel severity indices obtained by addition of preoperative IOP and/or glaucoma medications to the structural or functional parameter predicted IOP changes.
Apolipoprotein B is not superior to non-high-density lipoprotein cholesterol for dyslipidemic classification of glycated hemoglobin-defined diabetic patients
Authors: Xie Junhui , Hu Shuhong
Published: October 2018

Low-density lipoprotein (LDL) cholesterol (LDL-C) always underestimates the true cholesterol burden in diabetic patients. We aimed to explore the impact of the inclusion of apolipoprotein B (apoB) or non-high-density lipoprotein (HDL) cholesterol (non-HDL-C), which are alternative markers of LDL-related risk, results in a better classification of glycated hemoglobin (HbA1c)-defined diabetic patients into different dyslipidemic phenotypes.

We used data from the nationwide China Health and Nutrition Survey 2009 in which standardized HbA1c was measured.

The prevalence of abnormal LDL using non-HDL-cholesterol (74.1%) was similar to the prevalence rate using LDL-C (75.2%), whereas the prevalence was relatively lower when using apoB (69.6%). In normotriglyceridemic HbA1c-defined diabetic patients, apoB and non-HDL-C were not superior to LDL-C in detecting abnormal LDL. However, in hypertriglyceridemic patients, apoB and non-HDL-C were superior to LDL-C for the detection of abnormal lipid levels, but apoB was not superior to non-HDL-C in detecting abnormal LDL in hypertriglyceridemic participants.

Both apoB and non-HDL-C identify high-risk dyslipidemic phenotypes that are not detected by LDL-C in hypertriglyceridemic HbA1c-defined diabetic patients, with the superiority of non-HDL- C over apoB.
Anthracycline versus nonanthracycline adjuvant therapy for early breast cancer
Authors: Ding Wu , Li Zhian , Wang Caiyun , Dai Jiangfeng , Ruan GuoDong , Tu Chuanjian
Published: October 2018

Purpose:

The clinical benefits provided by using anthracycline-contained regimens in patients with early breast cancer (EBC) remain uncertain. This meta-analysis used data from all relevant trials to compare treatment outcomes for patients with EBC receiving adjuvant chemotherapy with non–anthracycline-contained regimens or anthracycline-contained regimens.

Patients and Methods:

Individual patient data were collected on 7 randomized trials comparing non–anthracycline-contained regimens with anthracycline-contained regimens, a total of 14,451 women were analyzed. The hazard ratios (HR) of disease-free survival (DFS) and overall survival (OS), and the risk ratios for grades 3 to 4 toxicities were extracted from the retrieved studies and analyzed using various statistical methods. A pooled analysis was accomplished and HR with 95% confidence intervals (95% CIs) was derived. The significant differences in DFS and OS were explored. A heterogeneity test was applied as well.

Results:

Among 7 eligible trials, significant differences in favor of anthracycline-contained regimens were seen in DFS (HR: 0.86; 95% CI: 0.78–0.95; P = .003) and in OS (HR: 0.85; 95% CI: 0.75–0.97; P = .01). Subgroup analyses of DFS showed similar treatment effects by hormone-receptor status and nodal status, but differential effects by human epidermal growth factor receptor 2 status, menopausal status, and malignancy grade. Sensitive analysis showed that the DFS of taxanes and cyclophosphamide (TC) was noninferior to anthracycline-contained regiments.

Conclusion:

Despite failing to show noninferior to the anthracycline-contained regimens in patients with EBC, it provides evidence that both regimens significantly improved the DFS and OS, and TC regimen may be noninferior to anthracycline-contained regimens.