bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequential Radiographic Evaluation During Closed Treatment of Distal Radius Fracture
Authors: Tantigate Direk , Salentijn Dorien , Lin James D. , Freibott Christina E. , Strauch Robert J. , Rosenwasser Melvin P.
Published: August 2019

Objectives:

To test the null hypothesis that there is no significant change in radiographic parameters, which determines an acceptable reduction, beyond 3 weeks in distal radius fractures with closed treatment.

Design:

Retrospective review of a prospectively gathered registry of distal radius fractures.

Setting:

Academic medical center.

Patients:

Patients who underwent closed treatment of distal radius fracture.

Intervention:

Sequential radiographic evaluation.

Main Outcome Measurements:

Change of radiographic measurement including radial inclination, radial height, ulnar variance, articular tilt, teardrop angle, anteroposterior distance, intra-articular gap, and step-off. We compared postreduction radiographic parameters once within 2 weeks, at the third week, at cessation of immobilization, and analyzed the interobserver reliability test.

Results:

There was a statistically significant difference between radiographic measurements, which determined an acceptable reduction between radiographs performed within 2 weeks versus the third week. Radial inclination and ulnar variance were statistically different at the third week compared with the time of cessation of immobilization. Seventy-seven percent of patients who had an acceptable reduction after 2 weeks maintained acceptable alignment at cessation of immobilization. Eighty-five percent of patients with acceptable reduction after 3 weeks maintained acceptable alignment at cessation of immobilization. Radial shortening >1.8 mm at the third week predicts an unacceptable radiographic outcome at cessation of immobilization (sensitivity 94.5% and specificity 90%).

Conclusion:

Radiographic parameters that determine acceptable reduction for closed treatment of distal radius fractures change minimally after 3-week postacceptable closed reduction. Radial shortening at the third week can be used to predict an unacceptable radiographic outcome.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Patient-reported Outcomes After Surgery for Lumbar Disc Herniation, a Randomized Controlled Trial Comparing the Effects of Referral to Municipal Physical Rehabilitation Versus No Referral
Authors: Paulsen Rune T. , Carreon Leah Y. , Andersen Mikkel Ø.
Published: August 2019

Study Design.

Randomized controlled trial.

Objective.

The aim of this study was to investigate the effect of referring patients to municipal physical rehabilitation compared to no referral on patient-reported outcomes (PROs) after surgery for lumbar disc herniation.

Summary of Background Data.

In surgical spine practice, lumbar discectomy is one of the most frequent interventions. Postoperatively, patients are typically referred to physical rehabilitation at the time of hospital discharge, and in Denmark all patients are legally entitled to a personal rehabilitation plan and referral for free rehabilitation at the municipal facilities. However, whether postoperative rehabilitation is effective in this group of patients remains controversial.

Methods.

This single-center single blinded study randomized subjects into 2 groups. Patients in the REHAB group received municipal rehabilitation starting 4 to 6 weeks postoperative, whereas patients in the HOME group were discharged after surgery without any planned rehabilitation course. Primary outcome was Oswestry Disability Index after 6 months, whereas secondary outcomes included EuroQoL-5D and Visual Analogue Scale for leg and back pain. All PROs were obtained before surgery and at 1, 3 to 6, 12, and 24 months postoperative.

Results.

A total of 146 patients were enrolled in the study: 73 allocated to the REHAB-group and 73 to the HOME-group. The groups were similar at baseline and the follow-up rate at 12 and 24 months was 78%. PROs in both groups improved significantly after surgery, but no statistically significant differences were observed between the groups at any follow-up time point in either the intent-to-treat, as-treated, and per-protocol analyses. Revision surgeries during the follow-up period were equally divided between the groups.

Conclusion.

Surgery for lumbar disc herniation is effective in relieving pain, improving function, and quality of life. The postoperative outcome is not altered significantly by referring patients to municipal physical rehabilitation compared to no referral.

Level of Evidence: 1
Evaluation of the contribution of germline variants in BRCA1 and BRCA2 to uveal and cutaneous melanoma
Authors: Johansson Peter A. , Nathan Vaishnavi , Bourke Lauren M. , Palmer Jane M. , Zhang Tongwu , Symmons Judith , Howlie Madeleine , Patch Ann-Marie , Read Jazlyn , Holland Elizabeth A. , Schmid Helen , Warrier Sunil , Glasson William , Höiom Veronica , Wadt Karin , Jönsson Göran , Olsson Håkan , Ingvar Christian , Mann Graham , Brown Kevin M. , Hayward Nicholas K. , Pritchard Antonia L.
Published: August 2019

Germline mutations of BRCA1 and BRCA2 predispose individuals to a high risk of breast and ovarian cancer, and elevated risk of other cancers, including those of the pancreas and prostate. BRCA2 mutation carriers may have increased risk of uveal melanoma (UM) and cutaneous melanoma (CM), but associations with these cancers in BRCA1 mutation carriers have been mixed. Here, we further assessed whether UM and CM are associated with BRCA1 or BRCA2 by assessing the presence, segregation and reported/predicted pathogenicity of rare germline mutations (variant allele frequency < 0.01) in families with multiple members affected by these cancers. Whole-genome or exome sequencing was performed on 160 CM and/or UM families from Australia, the Netherlands, Denmark and Sweden. Between one and five cases were sequenced from each family, totalling 307 individuals. Sanger sequencing was performed to validate BRCA1 and BRCA2 germline variants and to assess carrier status in other available family members. A nonsense and a frameshift mutation were identified in BRCA1, both resulting in premature truncation of the protein (the first at p.Q516 and the second at codon 91, after the introduction of seven amino acids due to a frameshift deletion). These variants co-segregated with CM in individuals who consented for testing and were present in individuals with pancreatic, prostate and breast cancer in the respective families. In addition, 33 rare missense mutations (variant allele frequency ranging from 0.00782 to 0.000001 in the aggregated ExAC data) were identified in 34 families. Examining the previously reported evidence of functional consequence of these variants revealed all had been classified as either benign or of unknown consequence. Seeking further evidence of an association between BRCA1 variants and melanoma, we examined two whole-genome/exome sequenced collections of sporadic CM patients (total N = 763). We identified one individual with a deleterious BRCA1 variant, however, this allele was lost (with the wild-type allele remaining) in the corresponding CM, indicating that defective BRCA1 was not a driver of tumorigenesis in this instance. Although this is the first time that deleterious BRCA1 mutations have been described in high-density CM families, we conclude that there is an insufficient burden of evidence to state that the increased familial CM or UM susceptibility is because of these variants. In addition, in conjunction with other studies, we conclude that the previously described association between BRCA2 mutations and UM susceptibility represents a rare source of increased risk.
Integrating Science, Practice, and Mentorship in Cardiac Rehabilitation
Authors: Arena Ross , Rouleau Codie R. , Campbell Tavis S. , Aggarwal Sandeep , Hauer Trina , Wilton Stephen B. , Stone James , Laddu Deepika , Ozemek Cemal , Williamson Tamara M. , Liu Hongwei , Austford Leslie D.
Published: August 2019

The evidence base supporting cardiac rehabilitation is substantial and overwhelmingly supports its utilization for all qualified patients. However, important lines of inquiry remain and require attention. This commentary provides a model for cardiac rehabilitation centers that provide patient care to meaningfully contribute to our scientific understanding of this lifestyle intervention.
Intraperitoneal hemorrhage during pregnancy and parturition
Authors: Xu Yalan , Zhou Yuxiang , Xie Junshu , Yin Xiuju , Zhang Xiaohong
Published: August 2019

We aim to investigate the diagnosis, treatment, and prognosis of intraperitoneal hemorrhage during pregnancy and parturition.

Three cases with intraperitoneal hemorrhage during pregnancy and parturition admitted to our hospital from Jan. 2008 to Jan. 2018 were included in this study. One case showed fetal distress. Abdominal ultrasonography and abdominal CT showed pyoperitoneum in 2 cases. Abdominal puncture was performed in 2 patients, and noncoagulant blood was collected. The indications of emergency caesarean section in 3 cases were intraperitoneal hemorrhage. The etiology included rupture of posterior wall of uterus, rupture of blood vessel on uterine surface, and rupture of inflammatory vessel on uterine surface, respectively. The average volume of intraperitoneal bleeding was 2630 ml, and the average transfusion volume was 1530 ml. Caesarean section, and suture hemostasis were performed in 3 cases. The gestational age of delivery were 40+6 weeks, 40+2 weeks, and 25+5 weeks, respectively. There were 1 stillborn fetus and 2 live infants. All the puerperas were cured and discharged.

Intraperitoneal hemorrhage in pregnancy is rare and is easily misdiagnosed. The mortality of pregnant women and perinatal infant is high. Therefore, early diagnosis, and timely operation is important.
The role of 18F-FDG PET/CT in management of paraneoplastic limbic encephalitis combined with small cell lung cancer
Authors: Castagnoli Helga , Manni Carlo , Marchesani Francesca , Rossi Gloria , Fattori Sara , Capoccetti Francesca
Published: August 2019

Rationale:

Limbic encephalitis is one of the most common paraneoplastic neurological disorders (PND). The role of brain Fluorine-18-fluorodeoxyglucose position emission tomography/computed tomography (CT) in paraneoplastic limbic encephalitis (PLE) and of the whole body 18F-FDG PET/CT in this setting, remains still not well defined.

Patient concerns:

We report a case of a patient with chronic inflammatory rheumatism, psoriasis and Hashimoto thyroiditis and subsequent appearance of static and dynamic ataxia and episodic memory deficit who was diagnosed as PLE combined with small cell lung cancer (SCLC).

Diagnoses:

The diagnosis of SCLC was made with EBUS-TBNA of a mediastinal lymph node.

Interventions:

Whole-body 18F-FDG PET/CT was performed for the initial staging of SCLC, in the planning of radiotherapy treatment, to evaluate therapeutic response and in the follow-up. A dedicated brain scan was included to the same PET session. Whole-body contrast enhanced computed tomography (CT) and contrast enhanced whole-brain MRI were also performed.

Outcomes:

She was administered neoadjuvant chemioterapy with Cisplatin and Etoposide with concomitant radiotherapy treatment. Whole body 18F-FDG PET/CT showed a complete metabolic response already after 3 cycles of chemioterapy. Brain functional study showed a metabolic pattern characterized by the migration of hypermetabolism in the bilateral hippocampal areas during the therapeutic treatment, which correlated with the persistence of clinical symptoms.

Lessons:

In the era of personalized medicine and targeted therapy, this case highlights the importance of the 18F-FDG PET/CT study as an accurate tool to identify PLE and to guide the diagnostic work-up of the underlying tumor. Considering that most of these are 18F-FDG avid tumors and that the 18F-FDG PET/CT scan is often added to the diagnostic work-up when screening patients for malignancy, this functional imaging can play a decisive role.
Endoscopic findings and outcome in caustic ingestion of acidic and alkaline agents in adults
Authors: Hollenbach Marcus , Tünnemann Jan , Struck Manuel Florian , Feisthammel Jürgen , Schlosser Tobias , Schaumburg Tiffany , Mössner Joachim , Hoffmeister Albrecht
Published: August 2019

Caustic ingestion in adults is a rare but potentially life-threatening problem. It remains controversial whether endoscopic findings and mortality differ between acid and alkali ingestion. We compared ingestion of these agents and evaluated prediction parameters for survival and complications.

Adult patients who presented with caustic ingestion were analyzed from 2005 to 2016. Mucosal injury was graded endoscopically by Zargar's score. Age, gender, intent of ingestion, caustic agents, comorbidities, management, complications, and mortality were examined.

Thirty-one patients met inclusion criteria and were divided into acid (n = 10) and alkali group (n = 21). Ingestion of alkali resulted in higher grades (≥III) of esophageal (56% vs 24%, P = .01) and stomach injuries (43% vs 13%, P = .05) and was mostly done with suicidal intent (76% vs 30%, P = .003). Patients in the alkali group received more often surgical interventions, mechanical ventilation and tracheotomy. Overall complications including Zargar's-score ≥ grade III, mediastinitis, and aspiration pneumonia were higher in alkali group but all showed no statistical significance (P = .73). Mortality (acid: 1 (10%), alkali: 4 (19%), P = .52), age, gender, comorbidities, and intensive care management did not differ significantly between the groups. Chronic renal failure and mediastinitis were promising prediction parameters for mortality but did not reach statistical significance. No independent risk factors for the development of esophageal stenosis were identified.

Alkaline agents caused a higher mucosal injury severity and were more often used in suicidal intent. Mediastinitis and chronic renal failure might be potential prediction parameters for survival but need to be evaluated in larger studies.
The effect of a comprehensive care and rehabilitation program on enhancing pelvic floor muscle functions and preventing postpartum stress urinary incontinence
Authors: Qi Xiaowen , Shan Juan , Peng Lei , Zhang Cuihong , Xu Fanglei
Published: August 2019

This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.

In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.

In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.

The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.
Acupuncture effect on digestion in critically ill postoperative oral and hypopharyngeal cancer patients
Authors: Ben-Arie Eyal , Kao Pei-Yu , Ho Wen-Chao , Lee Yu Chen
Published: August 2019

Introduction:

Head and neck cancer patients are at a high risk to suffer from malnourishment, a risk that increases in postoperative condition and with the use of enteral nutrition (EN). Until now patients who are suffering from indigestion in the intensive care unit (ICU) received treatment in the form of prokinetic drugs, drugs that can lead to serious side effects and only can partially improve digestion functions. Acupuncture was used successfully in several clinical trials to improve postoperative indigestion in cancer patients without any reported adverse events. The study aims are to investigate acupuncture effect in combination with prokinetic drugs in the treatment of indigestion in postoperative oral and hypopharyngeal cancer patients in the ICU.

Methods:

Single-center, double-blind randomized control trial will compare between 2 equal groups. A total of 28 patients that will meet the inclusion criteria: age 30 to 80, postplastic surgery for oral cancer or hypopharyngeal cancer, developed feeding intolerance 2 times in the first postoperative day, Apache score <20, and needed EN. Patients will be randomly divided (1:1) into treatment group or control group for 3 treatments in 3 days along with routine ICU treatment. The main outcome measurement will be the number of days a patient needs to reach his total energy expenditure.

Expected outcome:

The results will shed light on the effectiveness and safety of acupuncture in a double-blind design treating postoperative ICU cancer patients. In addition, the study presents a revolutionary double-blind design that if, will prove as successful might influence the way double-blind acupuncture studies are performed today.

Other information:

The study will be conducted in the surgical ICU department, of China medical university hospital, Taichung 404, Taiwan. The study is conducted on stable ICU patients and is anticipated to have minimum risk for adverse events. Patients enrollment and data collection will start from May 15, 2019. The study expected completion time: June 2021.
Multicenter study of lumbar discectomy with Barricaid annular closure device for prevention of lumbar disc reherniation in US patients
Authors: Strenge K. Brandon , DiPaola Christian P. , Miller Larry E. , Hill Clint P. , Whitmore Robert G.
Published: August 2019

Background:

Patients with large defects in the annulus fibrosus following lumbar discectomy have high rates of symptomatic reherniation. The Barricaid annular closure device provides durable occlusion of the annular defect and has been shown to significantly lower the risk of symptomatic reherniation in a large European randomized trial. However, the performance of the Barricaid device in a United States (US) population has not been previously reported.

Design and methods:

This is a historically controlled post-market multicenter study to determine the safety and efficacy of the Barricaid device when used in addition to primary lumbar discectomy in a US population. A total of 75 patients with large annular defects will receive the Barricaid device following lumbar discectomy at up to 25 sites in the US and will return for clinical and imaging follow-up at 4 weeks, 3 months, and 1 year. Trial oversight will be provided by a data safety monitoring board and imaging studies will be read by an independent imaging core laboratory. Patients treated with the Barricaid device in a previous European randomized trial with comparable eligibility criteria, surgical procedures, and outcome measures will serve as historical controls. Main outcomes will include back pain severity, leg pain severity, Oswestry Disability Index, health utility on the EuroQol-5 Dimension questionnaire, complications, symptomatic reherniation, and reoperation. Propensity score adjustment using inverse probability of treatment weighting will be used to adjust for differences in baseline patient characteristics between the US trial participants and European historical controls.

Ethics and dissemination:

This study was approved by a central institutional review board. The study results of this trial will be widely disseminated at conference proceedings and published in peer-reviewed journals. The outcomes of this study will have important clinical and economic implications for all stakeholders involved in treating patients with lumbar discectomy in the US.

Study registration:

ClinicalTrials.gov (https://clinicaltrials.gov): NCT03986580.

Level of evidence:

3.
Clinical application of auricular point sticking in perioperative hemostasis for elderly patients with intertrochanteric fractures of the femur
Authors: Yin Chunfang , Zhang Jincun , Er Zhaojuan
Published: August 2019

We investigated the clinical application of auricular point sticking (APS) combined with tranexamic acid in perioperative hemostasis in elderly patients with intertrochanteric fractures of the femur.

This is a prospective cohort study, and we analyzed 86 elderly patients with intertrochanteric fractures of the femur who underwent closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) between January 2016 and December 2016. The patients were divided into auricular point combined with tranexamic acid group (APS group, n = 43) and tranexamic acid alone group (Control group, n = 43). APS was performed for patients using Vaccaria seeds 1 to 2 days before the operation. The 4 acupoints of hemostasis, including spleen, diaphragm, pituitary, and adrenal gland, as well as acupoint of hip joint, were selected. Routine treatment was performed using tranexamic acid alone in the control group. Blood transfusion, intraoperative, postoperative, and total blood loss were compared between the 2 groups.

This study enrolled 36 males and 50 females aged 71 to 93 years (average age: 78.5 years). There were no significant differences in gender, age, height, weight, preoperative hematocrit level, fracture classification, operative time, and hospitalization stay (P > .05). Total blood loss was lower in the APS group than the control group (244.26, 197.87–258.50 ml vs 533.94, 424.00–598.09 ml, P < .01). The blood transfusion rate was 14.0% in the APS group and 34.9% in the control group (P = .02).

APS can reduce perioperative bleeding and decrease the need for blood transfusion in elderly patients with intertrochanteric fractures of the femur. This noninvasive method can be applied clinically. Randomized trials may be needed to confirm the findings.
Protocol for systematic reviews of school-based food and nutrition education intervention for adolescent health promotion
Authors: de Medeiros Gidyenne Christine Bandeira Silva , de Azevedo Kesley Pablo Morais , Garcia Daniel Ángel , de Oliveira Segundo Victor Hugo , de Sousa Mata Ádala Nayana , de Siqueira Karla Silveria Dias Pinheiro , Fernandes Anny Karoliny Pinheiro , Santos Raquel Praxedes dos , de Brito Trindade Débora Danielly Barros , de Oliveira Lyra Clélia , Piuvezam Grasiela
Published: August 2019

Background:

Nutrition is an important modifiable factor in combating overweight and obesity among adolescents. School has been indicated as an effective environment for influencing eating behavior; however, recent reviews assessing school-based interventions specifically for adolescents are scarce. Therefore, we propose the present systematic review with the aim to comprehensively review the quantitative and qualitative literature on the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits.

Methods:

We will search MEDLINE/PubMed, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, and ADOLEC. We will include randomized controlled trials (RCT), non-RCT, and controlled before-after studies. Risk of bias will be assessed using the EPOC Risk of Bias Tool for RCT, Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCT or controlled before-after, as well as the Critical Appraisal Skills Program (CASP) checklist for qualitative studies. We will analyze the overall strength of the evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Two independent researchers will conduct all evaluations and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed by the RevMan 5.3 software. We will conduct the study in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols.

Result:

This review will evaluate the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits. The primary outcome will be changes in adolescent food consumption. Secondary outcomes will be biological parameters (e.g., body mass index (BMI), waist circumference (WC), body composition, etc); biochemical parameters (e.g., glycemia, triglycerides, total cholesterol, etc); qualitative evidences that support or explain the effect of school-based food and nutrition education interventions on adolescent food consumption.

Conclusion:

The findings of this systematic review will summarize the latest evidence of the effects of school-based food and nutrition education interventions on adolescent health promotion. The findings will be an available reference for school-based interventions and other further research.

Registration:

PROSPERO CRD42019116520.
A study protocol of a single-center investigator-blinded randomized parallel group study to investigate the effect of an acclimatization visit on children's behavior during inhalational sedation in a United Arab Emirates pediatric dentistry postgraduate setting as measured by the levels of salivary Alpha Amylase and Cortisol
Authors: Halabi Manal Al , Hussein Iyad , Salami Anas , Awad Rawan , Alderei Najla , Wahab Ahtiq , Kowash Mawlood
Published: August 2019

Introduction:

Inhalation sedation is a proven safe method for reducing children's dental anxiety and has been used worldwide for decades. There is controversy regarding the use of acclimatization or familiarization visits for dental sedation treatment pathways for children. This may increase acceptance to the treatment based on desensitization and acclimatization principles underpinning many behavior management techniques. This study aims to identify whether, an inhalation sedation acclimatization visit is effective in reducing the stress level in anxious children as measured by salivary Alpha Amylase and Cortisol levels.

Methods:

The study is a single-center, single blinded, parallel group 2 arm clinical trial. Children in need of inhalation sedation aged 5 to 15 years from September 2019 through March 2020 attending the Postgraduate Pediatric Clinic at the Hamdan Bin Mohammed College of Dental Medicine, in Dubai, will be allocated randomly and equally to either:

At the initial visit a salivary sample will be collected at the beginning of the visit and the sedation need score will be recorded using the pediatric indicator of sedation need. Treatment for both groups will commence at the second visit. Salivary samples will be collected 15 minutes before the start of the treatment and 15 minutes after the conclusion of the treatment. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment using Frankl rating behavior scale and physiological anxiety related changes will be recorded using salivary Alpha Amylase and Cortisol levels. Mean changes of physiologic anxiety levels and corresponding 95% confidence intervals will be determined to compare the 2 treatments (sedation with familiarization and sedation without familiarization).

Discussion:

This is will be the first study to measure the effect of the acclimatization visit of nitrous oxide inhalation sedation on the level of physiological anxiety and the behavior of the pediatric patients during treatment.
Next-generation sequencing specifies Angiostrongylus eosinophilic meningoencephalitis in infants
Authors: Xie Mei , Zhou Zhen , Guo Suhua , Li Zengqing , Zhao Hui , Deng Jiusheng
Published: August 2019

Rationale:

Angiostrongylus cantonensis-induced eosinophilic meningoencephalitis (AEM) in infants is a very rare but fatal disease. Utilization of genetic assay to detect the cerebral parasite plays an important role for the treatment of the infection.

Patient concerns:

Two infants (<2 years) presented with cough, intermittent fever, mental fatigue, and poor diet.

Diagnosis:

The patients were under clinical examination and laboratory test including cardiac ultrasound, chest X-ray, blood or cerebrospinal fluid (CSF) cell counting, serum enzyme-linked immunosorbent assay (ELISA), head magnetic resonance imaging (MRI) and next-generation sequencing (NGS) on DNA from CSF. Due to hypereosinophils in patients’ peripheral blood and CSF, and abundant DNA sequences fromA cantonensisin CSF, the patients were diagnosed withAngiostrongyluseosinophilic meningoencephalitis.

Interventions:

The patients were treated with albendazole to deworm, and methylprednisolone to reduce inflammation.

Outcome:

The patients were completely recovered from AEM without relapse after 10-day treatment.

Lessons:

ELISA and MRI are not sufficiently accurate for the diagnosis of AEM in infants. NGS can specify the infection by the cerebral parasite and offers a new effective approach for the early and precise diagnosis of AEM in infants.
Treatment of syncope in tongue cancer with palliative chemotherapy in the intensive care unit
Authors: Fang Chongkai , Yang Liting , Zeng Guangbi , Huang Ruilin , Fang Wei , Chen Yao , Guan Jieshan , Li Peng , Huang Xuewu , Lin Lizhu
Published: August 2019

Rationale:

Syncope caused by head and neck cancer (HNC) is rare. However, syncope caused by tongue cancer (TC) is even rarer. In TC, syncope is caused by tumor-mediated compression of the carotid sinus and stimulation of the glossopharyngeal nerve.

Patient concerns:

In this study, we report the case of a 48-year-old male patient who was diagnosed with advanced TC and bilateral cervical lymph node metastasis. On the third day of admission, the patient experienced recurrent syncope with hypotension and bradycardia.

Diagnoses:

The patient was diagnosed with a well-differentiated squamous cell carcinoma of the tongue along with massive cervical lymph node metastasis and carotid sinus syndrome.

Interventions:

Initially, symptomatic treatment of syncope boosted the blood pressure and increased the heart rate. Thereafter, a temporary pacemaker was implanted. Finally, chemotherapy was used to control the tumor and relieve syncope.

Outcomes:

After chemotherapy, the tongue ulcers and cervical lymph node reduced in size; syncope did not recur.

Lessons:

This case shows that chemotherapy may be a valid treatment option in patients with cancer-related syncope; however, the choice of chemotherapeutic drugs is critical. Intensive care provides life support to patients and creates opportunities for further treatment.
Adenoid cystic carcinoma of the gastroesophageal junction
Authors: Shou Chun-Hui , Li Zhi-Jian , Yang Wei-Li , Tjhoi Welda E.H. , Zhao Zhi-Cheng , Yu Ji-Ren
Published: August 2019

Rationale:

Adenoid cystic carcinoma (ACC) rarely occurs in the digestive tract, particularly in the gastroesophageal junction.

Patient concerns:

A 44-year-old male vomiting blood was admitted to our hospital. Endoscopic ultrasound showed a 2.2 × 3.0 cm submucosal tumor in the gastroesophageal junction.

Diagnosis:

According to the histopathological examination, the tumor was composed predominantly of ductal epithelial and myoepithelial cells. Immunohistochemical staining revealed that the tumor expressed cytokeratin, cluster of differentiation 117, p63, and calponin. Based on these findings, ACC was diagnosed.

Interventions:

Endoscopic submucosal dissection (ESD) was performed to remove the tumor. As the margins of the ESD specimen were positive, the patient underwent total gastrectomy with D2 lymphadenectomy. Finally, neither residual tumor nor lymphatic metastasis was detected in the surgical specimens.

Outcomes:

No sign of recurrence has been detected during 36 months of follow-up as of October 2018.

Lessons:

ESD may be an alternative treatment for cardial ACC invading the submucosa.
Effects of Urinary Kallidinogenase on NIHSS score, mRS score, and fasting glucose levels in acute ischemic stroke patients with abnormal glucose metabolism
Authors: Chen Lei , Geng Lianxia , Chen Junmin , Yan Yan , Yang Lan , Zhao Jing , Sun Qian , He Junna , Bai Lin , Wang Xiaopeng
Published: August 2019

Urinary kallidinogenase may assist recovery acute ischemic stroke. This study evaluated the effect of urinary kallidinogenase on National Institute of Health Stroke Scale (NIHSS) score, modified Rankin scale (mRS) score, and fasting glucose levels in patients with acute ischemic stroke (AIS) combined with diabetes mellitus and impaired fasting glucose.

Patients with AIS and abnormal glucose metabolism were enrolled in this prospective cohort study and divided into 2 groups. The human urinary kallidinogenase (HUK) group were treated with urinary kallidinogenase and standard treatment; the control group received standard treatment. NIHSS scores, mRS scores, and fasting blood glucose were evaluated and compared.

A total of 113 patients were included: 58 in the HUK group and 55 in the control group. NIHSS scores decreased with treatment in both groups (time effect P < .05), but were lower in the HUK group (main effect P = .026). The mRS score decreased in both groups from 10 until 90 days after treatment (time effect P < .05); the 2 groups were similar (main effect, P = .130). Blood glucose levels decreased in both groups 10 days after treatment (time effect, P < .05), but there was no significant treatment effect (main effect, P = .635). Multivariate analysis showed blood uric acid >420 μmol/L (odds ratio [OR]: 0.053, 95% confidence interval [CI]: 0.008–0.350; P = .002) and application of HUK (OR: 0.217, 95% CI: 0.049–0.954; P = .043) were associated with 90% NIHSS recovery. Baseline NIHSS score was independently associated with poor curative effect.

Urinary kallidinogenase with conventional therapy significantly improved NIHSS scores in patients with AIS. Urinary kallidinogenase also showed a trend toward lower fasting blood glucose levels, although the level did not reach significance.
Coeliac disease: older patients have the most extensive small bowel involvement on capsule endoscopy
Authors: Chetcuti Zammit Stefania , Sanders David S. , Sidhu Reena
Published: August 2019

Objective

The relation between symptomatology, serology and findings on small bowel capsule endoscopy (SBCE) in patients with coeliac disease (CD) remains unclear. Clarifying such associations will help to determine whether symptoms and serology can predict severity and extent of disease on SBCE.

Methods

Patients with newly diagnosed CD were recruited. Information on SBCE was recorded. Signs and symptoms at presentation, serological markers and histological classification of the disease in the duodenum were noted.

Results

Sixty patients with newly diagnosed CD (mean age: 44.9 years, SD: ±17.4, 17–76) were included in this study. Older patients (P = 0.025) and patients presenting with iron deficiency anaemia had more extensive small bowel (SB) involvement (25.7% vs. 13.5%; P = 0.026). Those with weight loss were more likely to have SB involvement beyond the duodenum (37.5% vs. 5.8%; P = 0.027). Patients presenting with iron deficiency anaemia (53.5 vs. 42.4 years; P = 0.038) and weight loss (60.5 vs. 42.4 years; P = 0.009) were significantly older at diagnosis. Serum albumin was lower in those patients diagnosed later on in life (Pearson correlation −0.0361; P = 0.007). There was no significant association between anti-tissue transglutaminase antibody (P = 0.396) and extent of affected SB mucosa. Patients with more severe Marsh scores on histology from the duodenal bulb had more extensive SB involvement (P = 0.017).

Conclusions

This is the largest study on the use of SBCE in newly diagnosed CD. Older patients are likely to have more extensive disease on SBCE at diagnosis. Symptoms and serology had no impact on the findings on SBCE apart from weight loss and iron deficiency anaemia.
Neurodevelopmental–behavioural paediatrics
Authors: McDowell Michael , Lesslie Jane
Published: August 2019

Purpose of review

Neurodevelopmental–behavioural paediatrics (NBP) is a field of medical practice that has arisen in response to recent changes in child health epidemiology. This review considers how the profession of NBP is addressing clinical need, and discusses possibilities for future development of the field.

Recent findings

Research publications relevant to NBP clinical practice focus primarily on cause (e.g. biology, imaging, neuropsychology), early detection, diagnostic methodologies and initial treatment strategies, with emphasis on psychotropic medication. Translation of this research implies that NBP clinical services should be undertaken using algorithmic methodologies, and evaluated against treatment attributable outcomes. These strategies and outcomes potentially define the central purpose of the profession; however, they may not be sufficient to best help the children seen.

Two sets of information inform and extend consideration of NBP purpose and strategy. Firstly, longitudinal and adult studies indicate that even with treatment, problems persist in adult life for a significant proportion of children with neurodevelopmental–behavioural disorders. Secondly, NBP clinical practice deals with significant, irreducible complexity and uncertainty, arising from both child-diagnostic and contextual factors. Complexity limits the extent to which evidence-based clinical algorithms are able to inform care. Suggestions for how to address both challenges are offered.
Feasibility of de Morton Mobility Index for adult patients of all ages at low and basic functioning level: a study using the Slovenian translation
Authors: Zupanc Aleksander , Vidmar Gaj , Novak Primož , Puh Urška
Published: August 2019

We investigated metric properties of the Slovenian translation of de Morton Mobility Index in patients with musculoskeletal impairments during rehabilitation. The study included 30 inpatients, aged 22–84 years, with musculoskeletal impairments with or without impairment of peripheral nerves. They were assessed repeatedly with de Morton Mobility Index, Functional Ambulation Classification, Ten-metre Walk Test, Six-minute Walk Test, Berg Balance Scale and the motor subscale of the Functional Independence Measure. Convergent validity of de Morton Mobility Index was confirmed by good to very good correlations with the other measurements. Known-groups validity was demonstrated by significant differences in de Morton Mobility Index scores between patients who were not able to walk and those who were able to walk with or without waking aid, at admission and after 4 weeks. Predictive validity of de Morton Mobility Index for functional independence after 4 weeks of rehabilitation was moderate. Minimal clinically important difference of de Morton Mobility Index was estimated to be five points. De Morton Mobility Index was responsive after 2 and 4 weeks of rehabilitation (Cohen’s d 1.15 and 0.95, respectively). No floor or ceiling effects were identified. Internal validity of de Morton Mobility Index was confirmed by Rasch analysis. Hence, de Morton Mobility Index is a valid, unidimensional, and responsive measure of mobility for patients with musculoskeletal impairments at rehabilitation regardless of age. Its use is recommended for adult patients at low and basic functioning level.
Angioedema Risk Associated With Central Vascular Access Device Declotting
Authors: Zrelak Patricia
Published: August 2019

Little is known about the risk of angioedema with low-dose alteplase administration in the treatment of thrombotically occluded central vascular access devices (CVADs). To identify potential cases, the US Food and Drug Administration Adverse Event Reporting System database was searched. Between March 15, 2001, and August 15, 2018, there were 568 low-dose alteplase reports. Of these, 11 appear to be related to complications associated with a device or device occlusion that resulted in an angioedema-like reaction. This suggests that angioedema is a potential complication of alteplase when used for declotting CVADs—a complication that nurses should know how to recognize and treat.
The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients
Authors: Sun Fan-Ko , Hung Chao-Ming , Yao YuChun , Fu Chi-Feng , Tsai Pei-Jung , Chiang Chun-Ying
Published: August 2019

Background

Globally, cancer is the second leading cause of death. Breast cancer and gynecological cancer can damage patients’ body image and lead to psychological distress, depression, and demoralization syndrome. No studies have explored the effect of logotherapy in gynecological cancer patients’ psychological distress, depression, and demoralization.

Objective

To evaluate the effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients.

Methods

A quasi-experimental design was used in this study, involving 61 breast cancer and gynecological cancer patients: 31 in the experimental group and 30 in the control group. Participants in the experimental group received logotherapy 4 to 6 times during the 12 weeks of intervention. Outcomes were measured by the (1) Distress Thermometer, (2) Patient Health Questionnaire, and (3) Demoralization Scale Mandarin Version (DS-MV).

Results

Distress Thermometer did not differ between groups, but significant differences in favor of the intervention group were noted in the Patient Health Questionnaire (U = 674.500, P = .002); the DS-MV subcategories of loss of meaning (U = 706.500, P = .000), dysphoria (U = 673.000, P = .002), disheartenment (U = 670.000, P = .003), helplessness (U = 621.000, P = .022), and sense of failure (U = 629.500, P = .016); and the total score of the DS-MV (U = 728.500, P = .000).

Conclusion

Logotherapy was effective in the reduction of breast cancer and gynecological cancer patients’ depression and demoralization.

Implications for Practice

Clinical professionals could add logotherapy to the treatment for breast cancer and gynecological cancer patients to reduce their depression and demoralization.
Adaptation of Quality of Life Measure for Limb Lymphedema–Arm in Turkish Women With Breast Cancer–Related Lymphedema
Authors: Karayurt Özgül , Deveci Zeynep , Eyigör Sibel , Özgür İnbat Menekse
Published: August 2019

Background

Quality-of-life measures are needed for clinicians and researchers to identify quality of women’s life with breast cancer–related lymphedema (BCRL).

Objective

To adapt Quality of Life Measure for Limb Lymphedema–Arm into Turkish (TR) and to test its validity and reliability.

Methods

This is a methodological and cross-sectional study and was conducted in the lymphedema outpatient clinic of a university hospital. The study included 109 women with BCRL. After linguistic validity of the scale was achieved, confirmatory factor analyses and known group validity were used to test its construct validity. Reliability of the scale was tested with Cronbach’s α, item-total correlations, and Spearman-Brown coefficient.

Results

After linguistic validity was achieved, opinions requested from 5 experts specializing in lymphedema showed that item and content validity indexes of the scale were 1. Fit indexes of confirmatory factor analysis were as follows: χ
2/df = 1.86, root mean square error of approximation = 0.089, standardized root mean square residual = 0.09, and comparative fit index = 0.81. Known group validity analysis showed a significant difference in the mean scores for the subscales of Quality of Life Measure for Limb Lymphedema–Arm-TR, symptom, function, and body image/appearance in terms of lymphedema stages (P < .05). The internal reliability coefficients for the subscales ranged from 0.78 and 0.86. The item-total correlation coefficients ranged between 0.36 and 0.73.

Conclusion

Quality of Life Measure for Limb Lymphedema–Arm-TR was found to be valid and reliable in the TR population. It could be used in research to evaluate the quality of life in patients with BCRL.

Implications for Practice

The scale can be used to evaluate effectiveness of nursing interventions directed toward patients developing breast cancer–related lymphedema in clinical settings and studies.
Public Perceptions of Moral Insanity in the 19th Century
Authors: Hanganu-Bresch Cristina
Published: August 2019

The diagnosis of moral insanity was primarily used through the best part of the 19th century to define and justify the psychiatric treatment of a particular type of conduct in which the patient seemed otherwise rational but displayed certain inexplicable and undesirable behaviors deemed socially perverse or “unfit.” This article traces the history of this highly contested concept, which mirrors a historical arc in which psychiatry emerges as a discipline and stakes territorial claims on defining and regulating moral behavior. As illustration, I focus on the Hinchman Conspiracy Trial of 1849 as a less known case of wrongful confinement that hinged on proving the diagnosis of moral insanity in court. Moral insanity is a case study of the efforts to medicalize human ethical conduct, an effort starkly resisted by both the courts and the public. Some of the legacies of the term are the contemporary use of insanity as a legal defense, and the ability of patients to dispute psychiatric ward confinement orders in court.
Class-switched Primary Cutaneous Marginal Zone Lymphomas Are Frequently IgG4-positive and Have Features Distinct From IgM-positive Cases
Authors: Carlsen Eric D. , Swerdlow Steven H. , Cook James R. , Gibson Sarah E.
Published: August 2019

Primary cutaneous marginal zone lymphoma (PCMZL) can be subdivided into 2 groups based on immunoglobulin (Ig) heavy chain usage: IgM-positive cases that constitute a less common and more T-helper type 1–driven process, and more common heavy chain class-switched cases that are predominantly T-helper type 2–driven. Although some report a significant IgG4-positive subset, others have found a much smaller proportion. To further evaluate the proportion of IgG4-positive PCMZL, to address whether IgG4-positive cases have any distinctive characteristics, and to assess whether additional features separating IgM-positive and class-switched cases could be identified, the clinicopathologic features of 26 PCMZL obtained from 19 patients were investigated. Twenty of 26 (77%) PCMZL were heavy chain class-switched (19 IgG-positive, 1 IgA-positive), including 9 that were IgG4-positive (35%). IgG4-positive and other class-switched PCMZL were morphologically similar. IgM-positive cases occurred in older individuals (median: 69 vs. 46.5 y; P=0.0001), more often involved the subcutis (P=0.002), demonstrated plasma cells diffusely scattered versus at the periphery of the lymphoid infiltrate (P=0.005), uniformly showed follicular colonization (P=0.0001), contained more numerous B cells (P=0.0004), and were more likely to have a T-cell CD4:CD8 ratio of <3:1 (P=0.03). None of the IgM-positive PCMZL harbored a MYD88 L265P mutation. No significant differences in clinical outcome were documented. These results highlight the high frequency of IgG4-positive PCMZL, which are otherwise similar to other class-switched cases, provide additional evidence supporting the distinction between class-switched and IgM-positive cases, and emphasize the indolent nature of at least the class-switched PCMZL, which may warrant their categorization as a clonal chronic lymphoproliferative disorder.