bluuebunny/crossref_metadata_2025 huggingface dataset:
A Skin Plaque Preceding Systemic Relapse of Gamma-Delta Hepatosplenic T-Cell Lymphoma
Authors: Santonja Carlos , Carrasco Loreto , Pérez-Sáenz María de los Ángeles , Rodríguez-Pinilla Socorro-María
Published: November 2019

Hepatosplenic T-cell lymphoma (HSTL) is an uncommon, aggressive peripheral T-cell lymphoma with a dismal prognosis, usually expressing gamma-delta T-cell receptor on immunohistochemical study. We report the second instance in the literature of a solitary skin nodule heralding recurrence of HSTL. The patient was a 40-year-old man in apparent remission from HSTL, 4 years after chemotherapy and autologous bone marrow transplant. Biopsy of a flank lesion showed atypical lymphoid cells involving the dermis with a perivascular and periadnexal pattern, and fat lobules of the subcutaneous tissue. Their phenotype mirrored that of previous biopsies, with expression of CD2, CD3, CD7, CD56, and T-cell receptor-gamma, and lack of T-cell receptor-beta, CD4, CD5, and CD8. Cutaneous involvement by HSTL has rarely been reported either at initial diagnosis or at recurrence, and represents a diagnostic pitfall for primary cutaneous gamma-delta T-cell lymphoma.
Exogenous Ochronosis as an Elastotic Disease: A Light-Microscopic Approach
Authors: Ho Jonathan D. , Vashi Neelam , Goldberg Lynne J.
Published: November 2019

Background:

Exogenous ochronosis (EO) is a deposition disease associated with application of hydroquinone-containing preparations. Characteristic ochronotic bodies (OBs) arise from endogenous connective tissues, most often reported as collagen. We highlight a significant role for elastic fibers as a precursor tissue.

Objective:

To evaluate elastic tissue pathology in EO, specifically as it relates a precursor role in ochronotic body formation.

Methods:

In this retrospective observational study, a literature review using PubMed/MEDLINE database was conducted to ascertain the most commonly ascribed precursor connective tissue. Eleven histopathologic cases of EO were identified. Patient demographics and clinical characteristics were recorded. Slides were reviewed for the presence and grade of solar elastosis (SE), the relationship of OBs to elastotic material, the presence of elastotic fibers transitioning to OBs, and positivity of bodies with Verhoeff–van Gieson elastic tissue stain.

Results:

Elastic fibers are uncommonly reported as the major precursor tissue of OBs. SE was uniformly present in our cases, and the majority demonstrated heavy/high-grade elastosis. Elastotic fibers transitioning to OBs were observed in all cases, and the bodies demonstrated Verhoeff–van Gieson positivity.

Limitations:

Small sample size.

Conclusions:

Ochronotic body formation is associated with SE, and bodies appear to arise from damaged elastic fibers.
Impact of Preoperative Acetaminophen and Carbohydrate Loading on Pain and Functional Status in Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancers
Authors: Aleisa Abdullah , Naccarato Laura , Gramz Morgan , Patel Jalak , Nguyen Bichchau
Published: November 2019

BACKGROUND

Preoperative acetaminophen and carbohydrate loading has been shown to improve the functional recovery of surgical patients.

OBJECTIVE

To determine the effects of preoperative acetaminophen and carbohydrates on functional outcomes and the use of pain medications after surgery in patients undergoing Mohs Micrographic Surgery (MMS) for nonmelanoma skin cancer (NMSC).

MATERIALS AND METHODS

One hundred patients treated with MMS for NMSC at an academic center were randomized into a control group receiving standard preoperative care or an intervention group receiving acetaminophen and carbohydrate drinks immediately before surgery. Patients rated levels of pain, thirst, hunger, anxiety, and fatigue on the day of surgery on a scale of 0 to 100, and reported through a phone interview the use of pain medications within 48 hours of surgery.

RESULTS

There was no significant difference between intervention and control groups in maximum pain score on the day of surgery; maximum pain score 48 hours after surgery; use of nonopioid pain medications; and use of opioids. However, the intervention group had lower anxiety levels during and at the end of surgery.

CONCLUSION

Patients undergoing MMS for NMSC reported very low levels of pain during and after surgery. Preoperative acetaminophen and carbohydrate loading had no impact on pain levels or the use of pain medications but did reduce levels of anxiety.
Reoperation of Lower Extremity Microsurgical Reconstruction When Facing Postsplenectomy Thrombocytosis
Authors: Song Ping , Patel Nirav , Pu Lee L.Q.
Published: November 2019

Patients who sustain high-energy polytrauma are a unique population in that their mechanism of injury may induce multiorgan damage requiring immediate interventions such as splenectomy and bony fixation for mangled extremities. This results in the intersection of certain conditions, such as postsplenectomy thrombocytosis with the need for soft tissue reconstruction, often with free tissue transfer, for limb salvage after severe trauma to the lower extremity. However, there are no treatment guidelines in the management of postsplenectomy thrombocytosis in the setting of a lower extremity free flap reconstruction. We present a patient who had initial free tissue transfer to the lower extremity complicated by delayed microvascular thrombosis at postoperative day 4, during which time his platelet count exceeded more than 1,000,000/mm3. However, a successful second lower extremity free tissue transfer was achieved after platelet-reductive treatment with platelet apheresis during the perioperative period. Our patient went on to heal from his second free flap without further complications. Thus, thrombocytosis in the setting of free tissue transfer requires perioperative intervention to correct this hematologic condition. An innovative utilization of platelet apheresis may ensure the success of free tissue transfer by addressing the thrombocytosis in microsurgical patients after splenectomy.
Acute Fatty Liver of Pregnancy
Authors: NELSON DAVID B. , BYRNE JOHN J. , CUNNINGHAM F. GARY
Published: November 2019

Acute fatty liver of pregnancy (AFLP) is a rare, but potentially fatal condition, characterized by hepatic failure typically in the third trimester of pregnancy that is associated with multiorgan involvement resulting in a number of clinical and laboratory abnormalities. The cornerstone of management of AFLP includes prompt recognition, preparation for delivery, and supportive care such as reversal of coagulopathy. Early diagnosis, prompted delivery, and supportive care have resulted in improved maternal morbidity and mortality. This review focuses on the epidemiology, etiology, clinical presentation, diagnosis, management, and resolution of AFLP.
TEN-YEAR FOLLOW-UP OF PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION TREATED WITH INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS
Authors: Starr Matthew R. , Kung Felix F. , Mejia Camilo A. , Bui Yvonne T. , Bakri Sophie J.
Published: November 2019

Purpose:

To identify the visual acuity outcomes of patients with age-related macular degeneration treated with intravitreal anti–vascular endothelial growth factor injections over a 10-year period.

Methods:

This was a retrospective, cohort study of eyes with exudative age-related macular degeneration that received ≥2 intravitreal anti–vascular endothelial growth factor injections and had at least 10 years of follow-up after the initiation of treatment. Snellen visual acuity was recorded at baseline and then annually until the last year of follow-up. Optical coherence tomography data were collected at the time of treatment initiation and at the last examination visit. A subanalysis was performed on patients who continued to receive anti–vascular endothelial growth factor therapy using a modified treat and extend protocol versus those who discontinued treatment for longer than 1 year.

Results:

One hundred thirty eyes of 115 patients met the inclusion criteria. The mean follow-up after treatment initiation was 11.1 ± 0.7 years. Eyes received an average of 45.1 ± 32.3 intravitreal injections in total and a mean of 5 to 7 injections per year. The baseline mean logMAR visual acuity was 0.61 ± 0.5 (Snellen acuity 20/81), and the final mean logMAR visual acuity was 0.88 ± 0.7 (20/152, P value = <0.0001). There were 40 eyes that received at least one injection every year. These eyes did not have a significant change in visual acuity between the baseline and final examinations 0.47 ± 0.4 (20/59 vs. 0.58 ± 0.5 [20/76, P = 0.28]), whereas the eyes that did not receive at least one injection every year saw a significant decline in visual acuity 0.67 ± 0.5 (20/94 vs. 1.01 ± 0.7 [20/205, P < 0.0001]).

Conclusion:

Eyes with exudative age-related macular degeneration that received intravitreal injections every year had stable visual acuity over a 10-year period. Continuous intravitreal anti–vascular endothelial growth factor therapy may stabilize visual acuity for 10 years and potentially longer.
A PILOT CLINICAL STUDY OF TREATING RHEGMATOGENOUS RETINAL DETACHMENT BY SILICONE RUBBER BALLOON SCLERAL BUCKLING
Authors: Zhang Baike , Li Cheng , Jia Yong , Li Xiaodan , Guo Lisha , Wang Chunlei , Tian Xuemin
Published: November 2019

Purpose:

To evaluate the efficacy and primary safety of treating rhegmatogenous retinal detachment (RRD) using foldable capsular vitreous body scleral buckling.

Methods:

Five patients with simple RRD were treated with foldable capsular vitreous body scleral buckling. B-ultrasound and fundus photography examining of retina reattachment were used to evaluate the postsurgery efficacy. The safety of the treatment was evaluated based on the occurrence of infection, eye pain, diplopia, elevated intraocular pressure, and other serious postoperative complications after surgery. The observation time after the operation was at least 12 weeks.

Results:

The simple RRD of all five patients was successfully reattached before being evaluating by B-ultrasound and fundus photography after surgery. Visual acuity was enhanced in two patients who were macularly affected. One patient had temporary diplopia and eye movement limitation after surgery. No other complications were recorded.

Conclusion:

This pilot study determined that foldable capsular vitreous body scleral buckling can be efficacious and safe for simple RRD. The results indicate that this surgery may be a novel alternative to the current extraocular procedures for simple RRD.
MULTIMODAL IMAGING OF A PRESUMED EMBOLIC CILIORETINAL ARTERY OCCLUSION
Authors: Fernández-Avellaneda Pedro , Fragiotta Serena , Breazzano Mark P. , Freund K. Bailey
Published: November 2019

Purpose:

To describe clinical features including multimodal imaging in a rare case of presumed embolic cilioretinal artery occlusion with long-term follow-up examination.

Methods:

A 61-year-old man presented after noticing an acute-onset central scotoma in the left eye during coronary arteriography. Fundus color photography, red-free imaging, near-infrared reflectance, spectral domain optical coherence tomography (OCT), fluorescein angiography, and swept-source OCT angiography were performed.

Results:

Color and red-free fundus imaging both showed retinal whitening in the territory corresponding to a cilioretinal artery in the left eye. Consistent with an ischemic event, the near-infrared reflectance showed a hyporeflective area in the same location. Spectral domain OCT showed hyperreflectivity and generalized thickening of the inner nuclear layer, ganglion cell layer, and retinal nerve fiber layer. Seven years later, color, red-free, and near-infrared reflectance imaging appeared normal, but the spectral domain OCT showed thinning of all retinal layers in the affected area. Furthermore, swept-source OCT angiography demonstrated markedly reduced capillary flow signal in the superficial and deep capillary plexuses, corresponding to a persistent scotoma described by the patient.

Conclusion:

This case report illustrates hallmark features of a rare presumed embolic cilioretinal artery occlusion and its long-term manifestations with thorough historical and multimodal imaging data. When standard fundus imaging with color, red-free, and near-infrared reflectance appears normal years after a retinal vascular insult, OCT and OCT angiography can corroborate a patient's persistent visual deficit and provide clarity to the diagnosis.
Valve of Rosenmüller: Endoscopic Real-Time Analysis of Two Subtypes and Potential Functional Implications
Authors: Ali Mohammad Javed
Published: November 2019

Detailed anatomical features of the valve of Rosenmϋller can help our understanding of the focal anatomy and tear rheology.

Purpose:

The aim of this study was to examine the endoscopic anatomy of the valve of Rosenmüller in real-time and its potential functional implications.

Methods:

High-definition endoscopic documentation of the valve of Rosenmüller (VOR) during 50 powered endoscopic dacryocystorhinostomy over a period of 2 years were reviewed. The presence or absence of the valves were assessed and when present, each of the valves were studied for their anatomical configuration, shape, precise location, and changes with opening and closing of the internal common opening (ICO) and with the presence and absence of the probe.

Results:

VOR was noted in 68% of the subjects studied and 2 distinct subtypes were noted with type I being more common. The Type 1 VOR was a stand-alone, freely mobile, elliptical valve arising from the superior or postero-superior portion of the medial edge of the ICO. The Type II VOR was a group of a superior and inferior mucosal fold, arising from the superior and inferior portions of the medial edge of the ICO. When the ICO opens slowly, the valve tends to fall outwards towards the lacrimal sac. When the ICO slowly closes back, the valve moves inward towards the common canaliculus.

Conclusions:

This is the first study to demonstrate the in-vivo presence of VOR. Two different types of VOR were noted with characteristic shapes, locations, and movements of each. Where present, VOR fulfills the criteria of a true valve. The study proposes that the term “valve of Huschke” is a misnomer and when present, is actually part of the overall anatomical and functional unit of VOR.
Predictors of Indwelling Pleural Catheter Removal and Infection
Authors: Porcel José M. , Torres Magdalena , Pardina Marina , Civit Carmen , Salud Antonieta , Bielsa Silvia
Published: November 2019

Background:

Indwelling pleural catheters (IPCs) offer ambulatory management of symptomatic persistent pleural effusions, but their widespread use is somewhat hampered by the risk of pleural infection and the inconvenience of carrying a catheter for a prolonged period of time. Factors associated with these 2 limitations were analyzed in this study.

Methods:

Retrospective review of consecutive patients who had undergone IPC placement over a 5 ½-year period. Time to IPC removal was analyzed with the Fine and Gray competing risks survival model, with competing risk being death. A binary logistic regression method was used to evaluate factors influencing IPC-related pleural infections.

Results:

A total of 336 IPCs were placed in 308 patients, mostly because of malignant effusions (83%). IPC removal secondary to pleurodesis was achieved in 170 (51%) procedures at a median time of 52 days. Higher rates of IPC removal were associated with an Eastern Cooperative Oncology Group (ECOG) grade of 0 to 2 [subhazard ratio (SHR)=2.22], an expandable lung (SHR=1.93), and development of a multiseptated pleural space (SHR=1.37). IPC-related pleural infections occurred in 8% of the cases, and were more often seen in hepatic hydrothoraces [odds ratio (OR)=4.75] and pleural fluids with a C-reactive protein <15 mg/L before the IPC insertion (OR=4.42).

Conclusion:

IPC removal is more likely to occur in patients with good performance status whose lungs fully expand after drainage. Hepatic hydrothorax is the most significant predictor of IPC-related infections.
Transbronchial Cryobiopsy in Interstitial Lung Disease
Authors: She Shelley , Steinfort Daniel P. , Ing Alvin J. , Williamson Jonathan P. , Leong Paul , Irving Louis B. , Jennings Barton R. , Saghaie Tajalli
Published: November 2019

Background:

Transbronchial lung cryobiopsy (TBCB) plays an increasing role in the evaluation of diffuse parenchymal lung disease with acceptable diagnostic yield and safety profile compared with that of video-assisted thoracoscopic surgical lung biopsy on most reports. However, published outcomes with regard to safety and complication rates vary. We aim to determine the safety profile of TBCB when performed using a standardized protocol consistent with recently published expert guidelines.

Materials and Methods:

We reviewed prospectively maintained databases from 5 Australian tertiary referral centers. The procedures were performed in accordance with a recent expert statement recommending standardization of TBCB procedures, in particular with fluoroscopy, a secured airway, and prophylactic bronchial blockers. Periprocedural complications were assessed along with clinical outcomes.

Results:

A total of 121 patients underwent TBCB between August 2013 and August 2017 following a standardized protocol using general anesthesia. Of them, 84 patients (66.7%) were discharged on the day of the procedure. Pneumothorax occurred in 18 patients (14.9%), 13 (10.7%) of whom required chest tube drainage. Moderate bleeding occurred in 15 patients (13.2%) and severe bleeding in 1 (0.83%). Histopathologic diagnosis was made in 80 patients (66.1%).

Conclusion:

Pooled outcomes from Australian tertiary centers indicate that TBCB is safe when performed in a protocolized fashion. Active measures to anticipate and manage bleeding and to direct biopsy position result in low rates of major complications.
Validating the Utility of High Frequency Ocular Vestibular Evoked Myogenic Potential Testing in the Diagnosis of Superior Semicircular Canal Dehiscence
Authors: Lin Kenny , Lahey Ryan , Beckley Rachel , Bojrab Dennis , Wilkerson Brent , Johnson Emily , Babu Seilesh , Hong Robert S.
Published: November 2019

Introduction:

Ocular vestibular evoked myogenic potential (oVEMP) is a diagnostic test employed in the evaluation of superior semicircular canal dehiscence (SSCD) syndrome. Previous work showed that the presence of the n10 component of oVEMP at 4000 Hz was diagnostic of SSCD with perfect sensitivity and specificity of 1.0 in a series of 22 patients. This study sought to validate the diagnostic accuracy of high-frequency oVEMP with comparison to 500 Hz oVEMP and cervical vestibular evoked myogenic potential (cVEMP) in a larger series of patients.

Methods:

Retrospective chart review of 171 patients with clinical symptoms consistent with SSCD who underwent oVEMP and cVEMP testing. Dehiscence of the superior semicircular canal (SCC) on high-resolution computed tomography (CT) imaging of the temporal bone was used to identify cases of likely SSCD. The presence or absence of 4000 Hz oVEMP n10 responses, increased amplitude of 500 Hz oVEMP responses, and reduced threshold of 500 Hz cVEMP responses were identified for each patient.

Results:

SCC dehiscence was identified by CT imaging in 48 of 171 patients with symptoms consistent with SSCD. High-frequency oVEMP testing at 4000 Hz elicited a n10 response in 40 of 48 (83.3%) of patients and was present in 48 of 171 (28.1%) patients overall. The corresponding sensitivity was 0.83, specificity was 0.93, positive predictive value was 0.83, and negative predictive value was 0.93. oVEMP and cVEMP testing at 500 Hz was less accurate with sensitivity of 0.62 and 0.64, respectively, and specificity of 0.73 and 0.73, respectively.

Conclusion:

The presence of a 4000 Hz oVEMP n10 response was predictive of SSC dehiscence on CT imaging among patients with symptoms consistent with SSCD with sensitivity of 0.83, specificity of 0.93, positive predictive value of 0.83, and negative predictive value of 0.93. A negative finding strongly rules out SSCD. High-frequency oVEMP was more accurate than 500 Hz oVEMP or cVEMP.
Validation of the Hearing Handicap Inventory for Adults Scale for Spanish-Speaking Patients
Authors: Carrillo Alvaro , Medina María del Mar , Polo Ruben , Alonso Daniel , Vaca Miguel , Muriel Alfonso , Fernandez Borja , Rivera Teresa , Cobeta Ignacio
Published: November 2019

Objective:

To perform translation, cross-cultural adaptation, and validation of the hearing handicap inventory for adults scale (HHIA) to the Spanish language.

Study Design:

Prospective study.

Setting:

Tertiary neurotologic referral center.

Patients:

The study included 104 hearing impaired persons. Inclusion criteria were adults with untreated hearing loss, diagnosed in the past 12 months. A control group of 30 normal hearing subjects was also recruited.

Intervention:

HHIA was translated and translated back, and a pretest trial was performed. Feasibility, internal consistency, test-retest reliability, construct validity, and ceiling and floor effects were assessed for the present study.

Main Outcome Measures:

The mean overall score of the HHIA was 31.9 (0–100 scale, lowest to highest handicap). Cronbach's α was 0.95. Intraclass correlation coefficient was performed for each item, with an overall score of 0.95. The k coefficient scores ranged between moderate and almost perfect in all patients. The emotional score of the HHIA was correlated with the mental component of the SF-12.

Conclusions:

Feasibility, internal consistency, reliability, and construct validity outcomes in the current study support the validity of the Spanish version of the HHIA.
Clinical impact of low-radiation computed tomography coronary angiography diagnosis for coronary artery stenosis
Authors: Li Jian-Jun , Zeng Ming
Published: November 2019

Background:

The objective of this study aims to assess the clinic impact of low-radiation computed tomography coronary angiography (LR-CTCA) diagnosis for coronary artery stenosis (CAS).

Methods:

This study will comprehensively search the following electronic databases from inception to the present: PUBMED, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, VIP database, WANGFANG, and China National Knowledge Infrastructure. All these electronic databases will be searched without language restrictions. All case-controlled studies on assessing the clinical impact of LR-CTCA diagnosis for patients with CAS will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be utilized to evaluate the methodological quality for each qualified studies.

Results:

We will assess the clinic impact of LR-CTCA diagnosis for CAS by measuring sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio.

Conclusion:

The results of this study will summarize the latest evidence of LR-CTCA diagnosis for CAS.

Systematic review registration:

PROSPERO CRD42019139336.
Characteristics of help-seeking behavior among bipolar disorder patients
Authors: Wang Dongxin , Ma Jing , Tan Lihong , Chen Yan , Zhou Xuhui , Wang Huiying , Guo Jing , Li Xiaosong , Liu Xuejun
Published: November 2019

To analyze the factors that affecting the help-seeking behavior of bipolar disorder (BD) patients by conducting interviews BD individuals in Hunan province of China.

In 2015, 72,999 people from 123 counties of Hunan province of China were interviewed through multistage stratified random sampling. Twelve items of general health questionnaire (GHQ-12) and abnormal behavioral clue questionnaire were used as screening tools. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (SCID) was used as a diagnostic tool.

Among the 75 BD patients, 36% (27/75) sought help. Compared with help-seekers, non-help-seekers were more likely to be older, divorced, or widowed, mostly illiterate or elementary education, family monthly income at least 3000 ¥, more physically consulted in the past year, able to effective work or study, at a stable illness status. 70.4% help-seekers firstly sought help from a medical institution. The main reasons that patients did not seek help were economic problem, did not know where to seek help, unsatisfied with medical services, afraid of mental health stigma, and other problems, such as traffic inconvenience.

Non-help-seekers were faced with more difficulties in their social functions and social interactions.
Comparative study of magnifying narrow-band imaging and conventional white light endoscopy in the diagnosis of Helicobacter pylori status after eradication therapy
Authors: Tahara Tomomitsu , Horiguchi Noriyuki , Yamada Hyuga , Yoshida Dai , Terada Tsuyoshi , Okubo Masaaki , Funasaka Kohei , Nakagawa Yoshihito , Shibata Tomoyuki , Ohmiya Naoki
Published: November 2019

Predicting Helicobacter pylori (Hp) status by endoscopic finding would be useful in recent clinical condition that the use of proton-pump inhibitors, anti-platelet, and anti-coagulant have become widespread. We aimed to elucidate the diagnostic accuracy of magnifying narrow-band imaging (M-NBI) endoscopy in distinguishing Hp status in patients with or without history of successful Hp eradication and compare this accuracy to the diagnostic accuracy of conventional white light (WL) endoscopy.

Two hundred seven endoscopic examinations before and after Hp eradication were performed in prospective 163 patients. Endoscopic images by using the M-NBI and conventional WL were stored electronically and randomly allocated to 2 readers for evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were assessed by reference to Hp status assessed by conventional clinical test.

Sensitivity, specificity, PPV, NPV, and accuracy for predicting Hp status for the conventional WL was 72.2%, 75.5%, 72.2%, 75.5%, and 73.9% for the first reader; 86.6%, 57.3%, 64.1%, 82.9%, and 71.0% for the second reader. On the other hand, sensitivity, specificity, PPV, NPV, and accuracy for predicting Hp status for the M-NBI was 96.9%, 93.6%, 93.1%, 97.1%, and 95.2% for the first reader; 92.8%, 93.6%, 92.8%, 93.6%, and 93.2% for the second reader, respectively. The diagnostic accuracy of M-NBI was significantly higher than that of WL (P < .0001 for both readers). Inter-observer agreement of M-NBI (k = 0.83) was also better than that of WL (k = 0.53).

M-NBI was capable of distinguishing Hp status before and after eradication therapy.
Comparison of chest radiographic findings between severe fever with thrombocytopenia syndrome and scrub typhus
Authors: Yun Ji Hyun , Hwang Hye Jeon , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Woo Jun Hee , Kim Mi Young , Kim Sung-Han
Published: November 2019

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by SFTS virus (SFTSV) which involves multiple organ systems, including lungs. However, there is limited data on lung involvement of SFTS. Therefore, the present study investigated the chest radiographic findings of SFTS, including computed tomography (CT), and compared these with those of scrub typhus, which is the most common tick-borne illness in South Korea and share risk factors and occur in similar settings.

Medical records of patients with confirmed SFTS and scrub typhus in a tertiary hospital in Seoul (South Korea), between January 2014 and June 2018, were reviewed. Initial chest radiography and CT were reviewed by 2 experienced radiologists.

A total of 39 patients with SFTS and 101 patients with scrub typhus were analyzed. All patients except 3 patients with scrub typhus in both groups received chest radiography. Cardiomegaly (90%) and patchy consolidation with ground glass opacity (GGO) pattern (31%) were more common in SFTS group than scrub typhus group (20%, P < .001 and 2%, P < .001, respectively). About half of each group received chest CT. Consolidation (29%) and pericardial effusion (24%) were more common in SFTS group than scrub typhus group (6%, P = .02 and 4%, P = .008, respectively). Interstitial thickening in chest radiography (58%) and chest CT (65%) was more frequent in scrub typhus group than SFTS group (18%, P < .001 and 19%, P < .001, respectively).

Cardiomegaly with/without pericardial effusion and patchy consolidation with GGO pattern were more frequent in SFTS group, whereas interstitial thickening was more frequent in scrub typhus group. These findings will assist the early differentiation of SFTS from scrub typhus.
Mutation in PHKA2 leading to childhood glycogen storage disease type IXa
Authors: Zhu Qian , Wen Xiao-Yu , Zhang Ming-Yuan , Jin Qing-Long , Niu Jun-Qi
Published: November 2019

Introduction:

Glycogen storage disease (GSD) type IX, characterized by liver enlargement and elevated aminotransferase levels, is the most frequent type of GSD. The global incidence of GSD type IXa is only about 1/100,000 individuals. Case reports of GSD type IX are rare in China. We present the first case report of GSD type IXa in Northeast China caused by mutation of PHKA2.

Patient concerns:

An 11-year-old boy was referred to our hospital because of liver enlargement with consistently elevated transaminase levels over 6 months.

Diagnosis:

Histopathological results following an ultrasound-guided liver biopsy confirmed a diagnosis of GSD. Further genetic testing showed that the patient had GSD type IXa caused by the c.133C>T mutation in PHAK2.

Interventions:

We placed the patient on a high-protein and high-starch diet and provided hepatoprotective and supportive therapy.

Outcomes:

The patient's transaminase levels decreased significantly and were nearly normal at 10-month follow-up.

Conclusion:

This is the first reported case of GSD type IXa in Northeast China. We hope that the detailed and complete report of this case will provide a reference for the diagnosis of liver enlargement of unknown etiology in future clinical practice.
Spinocerebellar ataxia 2 in a family with different phenotypes
Authors: Li Yuanyuan , Chang Ying , Liu Xiufeng , Li Yanyan , Yan Yayun
Published: November 2019

Rationale:

Spinocerebellar ataxia 2 (SCA2) is a genetic disease, mainly characterized by ataxia. A number of other neurological symptoms also have been described, such as Parkinsonism, cognitive dysfunction, autonomic dysfunction, even the signs of motor neuron disease and so on. Mostly, In the same family, clinical performance is the same in most cases. Here, we describe a father and his son who suffered from SCA2, but their first manifestations were different.

Patient concerns:

The father exhibited progressive bradykinesia and rigidity, which resulted in the dysfunction of walking and caring himself. He hoped to relieve his symptoms by taking medicine. But the son presented with ataxia which was mild that the discomfort did not affect his daily life with none treated.

Diagnosis:

Both of them were given SCA2 tests. Briefly, we designed primers around the CAG trinucleotide, repeated the spinal cerebellar ataxia subtype gene, performed PCR expansion, and then calculated the specific number of repetitions by capillary electrophoresis. Abnormal expansion was detected in them through SCA2 sequencing with different repeat numbers of CAG, and then they were diagnosed with SCA2 sequencing.

Interventions:

The father was treated with dopaminergic drugs, but the son was not administered treatment.

Outcomes:

The father's symptoms are improved and he can take care of himself. The son has none difficulty in his daily life.

Lessons:

It is rare that different individuals in the same family with SCA2 have different manifestations. The genetic testing is a crucial method to diagnose the disease of SCA2.
Prenatal diagnosis of lingual cyst and spontaneous regression before birth
Authors: Zhang Yixiu , Ouyang Yunshu , Meng Hua , Wu Xining , Niu Zihan
Published: November 2019

Rationale:

We report a case of fetal lingual cyst that was diagnosed prenatally using 2-dimensional and 3-dimensional images during routine second trimester screening. To the best of our knowledge, this is the first description of a cystic lesion disappearing before birth.

Patient concerns:

A 36-year-old woman at 22 weeks’ gestation showed the presence of an oral cystic lesion in routine second trimester ultrasound screening. The lesion measured 18 × 15 × 15 mm.

Interventions:

A follow-up ultrasound examination was performed every 4 to 6 weeks.

Outcomes:

The cyst disappeared in a follow-up ultrasound examination at 35 and 37 weeks of gestation. A male newborn who weighed 3480 g was delivered with no feeding difficulties. The boy was followed to 6 years after birth. The child had normal growth and development, and there was no recurrence of the cyst.

Lessons:

Prenatally diagnosed lingual cysts are uncommon findings that can include many different pathologies with a wide spectrum of severity. Lingual cysts usually have a good prognosis.
Nonalcoholic fatty liver disease is associated with both subcutaneous and visceral adiposity
Authors: Kure Takeshi , Mawatari Seiichi , Imamura Yasushi , Oda Kohei , Kumagai Kotaro , Hiramine Yasunari , Miyahara Hironori , Kanmura Shuji , Moriuchi Akihiro , Uto Hirofumi , Horiuchi Masahisa , Ido Akio
Published: November 2019

Nonalcoholic fatty liver disease (NAFLD) is recognized as a hepatic manifestation of metabolic syndrome because of the association with visceral obesity. However, the association between NAFLD and subcutaneous fat accumulation remains unclear.

The study population included 3197 participants in regular health checkups, who were both hepatitis B virus surface antigen and hepatitis C virus antibody-negative, and consumed <20 g of alcohol per day. They were divided according to 4 quantiles of subcutaneous fat area (SFA) and visceral fat area (VFA) on computed tomography. Fatty liver was diagnosed using ultrasonography (FL-US).

The prevalence of FL-US increased across the SFA categories, even after adjusting for the VFA, in both men (P < .001) and women (P < .001). This significant association between FL-US and the SFA was already detected from the second SFA quantile. It is noteworthy that the mean body mass index (BMI) of the subjects in the second quantile was 23.7 kg/m2 in men and 22.6 kg/m2 in women. Independent positive associations were observed between alanine aminotransferase elevation, and both the SFA and VFA in men, while gamma glutamyl transpeptidase elevation was independently associated with the VFA, but not the SFA, in both men and women. Similarly, the components of metabolic syndrome were independently associated with the VFA, but were less strongly associated (or not associated at all) with the SFA.

This cross-sectional study suggests that NAFLD is independently associated with both visceral and subcutaneous adiposity ab initio, which is a characteristic that distinguishes NAFLD from other components of metabolic syndrome.
The suction-assisted laryngoscopy assisted decontamination technique toward successful intubation during massive vomiting simulation
Authors: Lin Li-Wei , Huang Chi-Chieh , Ong Jiann Ruey , Chong Chee-Fah , Wu Nai-Yuan , Hung Shih-Wen
Published: November 2019

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.

In this pilot before–after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The “pass” of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.

The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan–Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57–2.91).

The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.
A prognostic nomogram for distal bile duct cancer from Surveillance, Epidemiology, and End Results (SEER) database based on the STROBE compliant
Authors: Zhao Ye-Yu , Chen Si-Hai , Wan Qin-Si
Published: November 2019

In this study, we aimed to develop a reliable nomogram to estimate individualized prognosis for patients with distal bile duct cancer (DBDC) and compare the predictive value with the American Joint Committee on Cancer staging system.

Data of 1110 patients diagnosed with DBDC were recruited from the Surveillance, Epidemiology, and End Results database between 1973 and 2015. All patients were randomly divided into the training (n = 777) and validation (n = 333) cohorts, respectively. Multivariate Cox regression was performed to identify the independent risk factors. The Akaike information criterion was used to select covariates for constructing a nomogram. The predictive ability of the nomogram was assessed by concordance index (C-index) and area under receiver operating characteristic curve (AUROC) compared to tumor-node-metastasis (TNM) staging system.

A nomogram integrating 8 risk factors was developed with a higher C-index than that of the TNM staging system (training data set, 0.70 vs 0.61; validation data set, 0.71 vs 0.57). The AUROCs of the nomogram for 1-year and 3-year overall survival (OS) predication were 0.76 and 0.78 in the training cohort, 0.78 and 0.77 in the validation cohort. However, AUROCs of the TNM stage for predicting 1-year and 3-year OS were all below 0.60. Calibration curves showed the optimal agreement in predicating OS between nomogram and actual observation. In addition, this nomogram can effectively distinguish the OS between low and high-risk groups divided by the median score (P < .01).

Present study was the first one to construct a prognostic nomogram of DBDC patients, which has the potential to provide individual prediction of OS.
Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes
Authors: Kim Jiwoon , Ahn Chul Woo , Fang Sungsoon , Lee Hye Sun , Park Jong Suk
Published: November 2019

Background:

Metformin can cause serum vitamin B12 deficiency, but studies on the influence of its duration and dose are lacking. We investigated vitamin B12 deficiency in patients with type 2 diabetes using metformin, in conjunction with other related factors.

Method:

This cross-sectional study included 1111 patients with type 2 diabetes who took metformin for at least 6 months. Serum vitamin B12 levels were quantified using a competitive-binding immunoenzymatic assay, and vitamin B12 deficiency was defined as serum B12 <300 pg/mL. Information on metformin use and confounding variables were collected from records or questionnaires and interviews.

Result:

Serum vitamin B12 deficiency occurred in 22.2% of patients (n = 247). After adjusting for confounders, a 1 mg increase in daily metformin dose was associated with a 0.142 pg/mL decrease in vitamin B12 (P < .001). Compared with a daily dose of <1000 mg, the adjusted odds ratios for 1000 to 1500, 1500 to 2000, and ≥2000 mg metformin were 1.72 (P = .080), 3.34 (P < .001), and 8.67 (P < .001), respectively. Vitamin B12 deficiency occurred less often in patients taking multivitamins (odds ratio 0.23; P < .001). After adjusting for confounding factors, there was no correlation between B12 deficiency and duration of metformin use. Serum homocysteine levels showed significant negative correlation with vitamin B12.

Conclusion:

Metformin at ≥1500 mg/d could be a major factor related to vitamin B12 deficiency, whereas concurrent supplementation of multivitamins may potentially protect against the deficiency. Serum homocysteine levels were negatively correlated with vitamin B12 levels, suggesting that B12 deficiency due to metformin use may occur at the tissue level. However, this hypothesis will require further study.
Associations between tumor necrosis factor-α and interleukin-6 polymorphisms and unexplained recurrent spontaneous abortion risk
Authors: Zhao Xiaoxuan , Jiang Yuepeng , Ping Yunlu , Guo Hongwei , He Meirong , Feng Xiaoling
Published: November 2019

To evaluate the associations between Tumor necrosis factor-α (TNF-α)(-238G>A) and Interleukin-6 (IL-6)(-174G>C) polymorphism and risk of unexplained recurrent spontaneous abortion (URSA).

Correlated case-control studies were collected by computer retrieval. A meta-analysis was conducted by Stata 12.0 software to analysis the strength of association between polymorphism of TNF-α -238G>A and IL-6 -174G>C and URSA.

Twenty-one articles with twenty-two studies were included, of which 12 and 10 studies were respectively related to mutation of TNF-α -238G>A, IL-6 -174G>C and URSA. The integrated results showed that the TNF-α-238G>A gene mutation was significantly correlated with the risk of URSA under homozygote model (AA vs GG;OR 1.533,95% CI 1.022–2.301) and recessive model (AA vs GG+AG;OR 1.571,95%CI 1.050–2.350)(P < .05). There was no association between URSA and TNF-α -238G>A under heterozygote model (AG vs GG;OR 0.963,95% CI 0.816–1.137), dominant model (AA+AG vs GG; OR 1.031,95%CI 0.880–1.209) and additive model (A vs G;OR 1.046,95%CI 0.909–1.203)(P > .05). The results of subgroup analysis based on ethnicity showed that -238G>A was significantly correlated with the risk of URSA in Asians under all gene models except for heterozygote model (AG vs GG; OR 1.129,95% CI 0.857–1.487) (P < .05). In Caucasians, it was dominant model (AA+AG vs GG; OR 1.430,95%CI 1.040–1.965) (P < .05) rather than others that showed relationship with URSA. From the integrated results, association was manifested between -174G>C and URSA under all gene models (P < .05) except for recessive model (CC vs GG+CG, OR 1.166, 95%CI 0.938–1.449) (P > .05), which is identical to subgroup analysis based on ethnicity.

It is of great guiding significance for screening out and preventing URSA among high-risk women to test on TNF-α -238G>A and IL-6 -174G>C under gene models mentioned above which are highly associated with the risk of URSA, which can act as biological markers for URSA.
Effects of Chaihu-Shugan-San capsule for psychogenic erectile dysfunction
Authors: Ren Feiqiang , Ma Ziyang , Shen Yifeng , Li Guangsen , You Yaodong , Yu Xujun , Li Zhengjie , Chang Degui , Zhang Peihai
Published: November 2019

Background:

Erectile dysfunction (ED) affects many adult men worldwide. Many studies on the brain of psychogenic ED have shown significant cerebral functional changes and reduced volume of gray matter and white matter microstructural alterations in widespread brain regions. Chaihu-Shugan-San (CHSGS) capsule has been used to treat ED from the 20th century in China. However, clinical research of CHSGS capsule in the treatment of ED was lack. We design this study to evaluate the efficacy and safety of CHSGS capsule in the treatment of patients suffering from psychogenic ED. Furthermore, we also aim to provide a new evidence as well as an innovation of the clinical treatment in psychogenic ED.

Methods:

This study is designed as a multi-center, 3-arms, randomized trial. From the perspective of psychogenic ED, we will divide patients into 3 groups, which are placebo group, tadalafil group and CHSGS group. One hundred thirty-five patients will be randomly allocated to receive placebo, CHSGS capsule or tadalafil oral pharmacotherapy. After the period of 4-week treatment, the outcome of primary assessment changes in the brain MRI, IIEF-5, EHS, and QEQ total scores from baseline. Secondary assessments include the SEAR, HAMA-14, HAMD-17 scores, response rate of the patients and their partners.

Discussion:

We designed this study based on previous research about psychogenic erectile dysfunction (ED). This study will provide objective evidences to evaluate the effects of CHSGS capsule as an adjuvant treatment for psychogenic ED.

Trial registration number:

chictr.org.cn, ChiCTR-IOR-1800018301.
Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures
Authors: Wen Hongjie , Zhu Shouyan , Li Canzhang , Chen Zhong , Yang Huagang , Xu Yongqing
Published: November 2019

Background

There is no consensus regarding the surgical treatment of humeral shaft fracture. The present meta-analysis was performed to compare the efficacy and safety between antegrade intramedullary nailing (IMN) and plating for humeral shaft fracture.

Methods

PubMed, MEDLINE, Cochrane Library, EMBASE, Clinical Trails, Ovid, ISI Web of Science, and Chinese databases including WanFang Data, China National Knowledge Infrastructure were searched through March 10, 2019. The Review Manager software was adapted to perform statistical analysis and relative risk (RR) were used for the binary variables, and weighted mean difference and standardized mean difference (SMD) were used to measure the continuous variables. Each variable included its 95% confidence interval (CI).

Results

A total of 15 trials with 839 patients were included in the analysis. There was significant difference between IMN group and plate group in blood loss (SMD = 3.49, 95% CI: 1.19, 5.79, P = .003) and postoperative infections (RR = 3.04, 95% CI: 1.49, 6.24, P = .002). Additionally, significant difference was observed between minimally invasive plate osteosynthesis (MIPO) group and IMN group in nonunion rate (RR = 3.20, 95% CI: 0.12, 0.84, P = .02). Statistical significance was also observed between the open reduction plate fixation group and IMN group in restriction of shoulder and elbow joints results (RR = 0.49, 95% CI: 0.26, 0.96, P < .05). No significant difference was observed for the operation time, American Shoulder and Elbow Surgeons score, nerve injury, delayed union, reoperation in either group.

Conclusion

IMN may be superior to plate in reducing blood loss and postoperative infections for the treatment of humeral shaft fracture. However, MIPO was superior to IMN group in nonunion and equal to IMN in other parameters. Further research is required and future studies should include analysis of assessments at different stages and follow-up after removal of the implants.