bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomarkers of Delirium Duration and Delirium Severity in the ICU*
Authors: Khan Babar A. , Perkins Anthony J. , Prasad Nagendra K. , Shekhar Anantha , Campbell Noll L. , Gao Sujuan , Wang Sophia , Khan Sikandar H. , Marcantonio Edward R. , Twigg Homer L. , Boustani Malaz A.
Published: November 2019

Objectives:

Both delirium duration and delirium severity are associated with adverse patient outcomes. Serum biomarkers associated with delirium duration and delirium severity in ICU patients have not been reliably identified. We conducted our study to identify peripheral biomarkers representing systemic inflammation, impaired neuroprotection, and astrocyte activation associated with delirium duration, delirium severity, and in-hospital mortality.

Design:

Observational study.

Setting:

Three Indianapolis hospitals.

Patients:

Three-hundred twenty-one critically ill delirious patients.

Interventions:

None.

Measurements and Main Results:

We analyzed the associations between biomarkers collected at delirium onset and delirium-/coma-free days assessed through Richmond Agitation-Sedation Scale/Confusion Assessment Method for the ICU, delirium severity assessed through Confusion Assessment Method for the ICU-7, and in-hospital mortality. After adjusting for age, gender, Acute Physiology and Chronic Health Evaluation II score, Charlson comorbidity score, sepsis diagnosis and study intervention group, interleukin-6, -8, and -10, tumor necrosis factor-α, C-reactive protein, and S-100β levels in quartile 4 were negatively associated with delirium-/coma-free days by 1 week and 30 days post enrollment. Insulin-like growth factor-1 levels in quartile 4 were not associated with delirium-/coma-free days at both time points. Interleukin-6, -8, and -10, tumor necrosis factor-α, C-reactive protein, and S-100β levels in quartile 4 were also associated with delirium severity by 1 week. At hospital discharge, interleukin-6, -8, and -10 retained the association but tumor necrosis factor-α, C-reactive protein, and S-100β lost their associations with delirium severity. Insulin-like growth factor-1 levels in quartile 4 were not associated with delirium severity at both time points. Interleukin-8 and S-100β levels in quartile 4 were also associated with higher in-hospital mortality. Interleukin-6 and -10, tumor necrosis factor-α, and insulin-like growth factor-1 were not found to be associated with in-hospital mortality.

Conclusions:

Biomarkers of systemic inflammation and those for astrocyte and glial activation were associated with longer delirium duration, higher delirium severity, and in-hospital mortality. Utility of these biomarkers early in delirium onset to identify patients at a higher risk of severe and prolonged delirium, and delirium related complications during hospitalization needs to be explored in future studies.
Bacterial and Fungal Etiology of Sepsis in Children in the United States: Reconsidering Empiric Therapy*
Authors: Prout Andrew J. , Talisa Victor B. , Carcillo Joseph A. , Decker Brooke K. , Yende Sachin
Published: November 2019

Objectives:

Timely empiric antimicrobial therapy is associated with improved outcomes in pediatric sepsis, but minimal data exist to guide empiric therapy. We sought to describe the prevalence of four pathogens that are not part of routine empiric coverage (e.g., Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile, and fungal infections) in pediatric sepsis patients in a contemporary nationally representative sample.

Design:

This was a retrospective cohort study using administrative data.

Setting:

We used the Nationwide Readmissions Database from 2014, which is a nationally representative dataset that contains data from nearly half of all discharges from nonfederal hospitals in the United States.

Patients:

Discharges of patients who were less than 19 years old at discharge and were not neonatal with a discharge diagnosis of sepsis.

Interventions:

None.

Measurements and Main Results:

Of the 19,113 pediatric admissions with sepsis (6,300 [33%] previously healthy and 12,813 [67%] with a chronic disease), 31% received mechanical ventilation, 19% had shock, and 588 (3.1%) died during their hospitalization. Among all admissions, 8,204 (42.9%) had a bacterial or fungal pathogen identified. S. aureus was the most common pathogen identified in previously healthy patients (n = 593, 9.4%) and those with any chronic disease (n = 1,430, 11.1%). Methicillin-resistant S. aureus, P. aeruginosa, C. difficile, and fungal infections all had high prevalence in specific chronic diseases associated with frequent contact with the healthcare system, early surgery, indwelling devices, or immunosuppression.

Conclusions:

In this nationally representative administrative database, the most common identified pathogen was S. aureus in previously healthy and chronically ill children. In addition, a high proportion of children with sepsis and select chronic diseases had infections with methicillin-resistant S. aureus, fungal infections, Pseudomonas infections, and C. difficile. Clinicians caring for pediatric patients should consider coverage of these organisms when administering empiric antimicrobials for sepsis.
The Physician's Guide to Platelet-Rich Plasma in Dermatologic Surgery Part II: Clinical Evidence
Authors: Hausauer Amelia K. , Humphrey Shannon
Published: November 2019

BACKGROUND

Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge.

OBJECTIVE

To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine.

MATERIALS AND METHODS

A two-part systematic review and expert analysis of publications before October 2018.

RESULTS AND CONCLUSION

Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly.
Ulnar Nerve Injuries (Sunderland Grade V): A Simplified Classification System and Treatment Algorithm
Authors: Ghoraba Samir M. , Mahmoud Wael H. , Elsergany Mervat A. , Ayad Hashem M.
Published: November 2019

Background:

This study introduced a novel technical approach to the ulnar nerve injuries. The ulnar nerve was divided into 4 distinct surgical zones, each mandating a unique management strategy.

Methods:

A prospective observational study was conducted to verify the hypothesized algorithm. The study included 110 patients diagnosed with ulnar nerve injury (Sunderland grade 5). We divided the patients into 4 groups depending on the site of injury. Each group of patients was managed in accordance with a particular strategy, exploiting nerve transfer techniques along with the updated knowledge of the internal topography of the ulnar nerve. The motor recovery of the small muscles of the hand was assessed after 2 years of follow-up, using the disabilities of the arm, shoulder, and hand score, and other parameters including key pinch strength, hand grip strength, and the motor power of the first dorsal interosseous muscle on the Medical Research Council scale.

Results:

The mean values of the disabilities of the arm, shoulder, and hand score, key pinch strength, and hand grip strength showed a statistically significant improvement across all patient groups (P < 0.05). Of those with zone (I) injury, postoperatively, 79.9% patients attained a first dorsal interosseous muscle power grade >3 on the Medical Research Council scale, while 93.9% of patients with zone (II) damage achieved the same result. Surprisingly, 84% of patients included in both zones (III) and (IV) also recovered to the same extent.

Conclusions:

This prospective observational study examined and successfully confirmed the validity of our proposed novel algorithm for the management of ulnar nerve injuries (Sunderland grade 5).
Combination of CAD/CAM and Augmented Reality in Free Fibula Bone Harvest
Authors: Battaglia Salvatore , Badiali Giovanni , Cercenelli Laura , Bortolani Barbara , Marcelli Emanuela , Cipriani Riccardo , Contedini Federico , Marchetti Claudio , Tarsitano Achille
Published: November 2019

The CAD/CAM technology for mandibular reconstruction has improved the results in terms of outcomes in restoring mandibular complex defects. Augmented reality (AR) represents an evolution of the navigation-assisted surgery. This technology merges the images of the virtual planning with the anatomy of the patient, representing in this way an enhanced scene for the surgeon’s eye. AR can also display in a single scene additional information for the surgeon. Despite of classical navigation, this scenario can be obtained with marker-less registration method, without using reference points or fiducial markers. This technologic evolution together with the large use in our experience of CAD/CAM protocol for mandibular reconstruction we developed this feasibility study to evaluate the possibility of using a marker-less image registration system. Moreover, we tried to evaluate the overlaying of the virtual planning and its reproducibility using AR. We performed a case series of 3 consecutive patients who underwent mandibular reconstruction using AR-assisted fibular free flap harvesting applying our digital workflow. Once launched, the mobile app installed on our tablet, the registration is performed according to a shape recognition system of the leg of the patient, rendering in real time a superimposition of the anatomy of the bony, vascular, and skin of the patient and also the surgical planning of the reconstruction. AR-assisted fibular free flap harvesting was performed. We believe that AR can be a prospective improving technology for mandibular complex reconstruction.
Magnetic Resonance Imaging Volumetry of Facial Muscles in a Face Transplant Recipient
Authors: Kantar Rami S. , Wake Nicole , Alfonso Allyson R. , Rifkin William J. , Ramly Elie P. , Diaz-Siso J. Rodrigo , Rodriguez Eduardo D.
Published: November 2019

Face transplantation has evolved into a viable reconstructive option for patients with extensive facial disfigurement. Because the first face transplant procedure was described in 2005, the safety and feasibility of the procedure have been validated, and the focus of the field has shifted toward refining functional and esthetic outcomes. Recovery of muscle function following facial transplantation is critical to achieving optimal facial function and restoring facial expression. Assessment of facial muscle function in face transplant recipients has traditionally relied on clinical evaluation. In this study, we describe longitudinal changes in facial muscle volumes captured through quantitative magnetic resonance imaging in a face transplant recipient and compare these findings with functional outcomes evaluated through clinical assessment.
First Russian Experience of Composite Facial Tissue Allotransplantation
Authors: Volokh Maria , Manturova N , Fisun A , Uyba V , Voskanyan S , Khubulava G , Kalakutskiy N , Gubarev K
Published: November 2019

The facial allotransplantation technique was first introduced to the general public in 2005. The definition of the face as a complex system of organs that perform social functions made possible the adaptation of this operation into clinical practice. The year 2010 was the starting point for initial research in the Russian Federation. Based on previous achievements and existing world experience in this field, facial allotransplantation was used for the first time in 2015 in St. Petersburg. The goal of this operation was to reconstruct a soldier’s central facial area after an electric burn; he was injured in the military line of duty. This article describes complications faced regarding the preparation for this operation, the issues encountered for facial tissue removal, as well as donor selection criteria. Each stage of the composite facial allotransplantation, complications that can occur during operation, milestone results, as well as the subsequent rehabilitation and immunosuppressive therapy during the 4-year patient observation period following surgery, including the description of a single episode of cell-humoral rejection of transplanted tissue, are described in detail. The experience gained from the first facial allotransplantation performed in Russia shows the possibility of using a new composite allograft to correct deformities in the central area of the face with the achievement of a successfully functioning and aesthetically pleasing result after the operation. After 4 years of dynamic observation and individual rehabilitation programs, the main goal of the facial transplantation, that is, social re-adaptation of the patient, was achieved.
Assessment of Patient Radiation Dose during Conventional Diagnostic X-ray Examinations in Three Public Hospitals in Northern Jordan using TLDs
Authors: Ababneh Zaid Q. , Ababneh Anas M. , Bani Hani Majd S. , Ababneh Riad S. , Aljarrah Khaled M.
Published: November 2019

This study aims to measure entrance surface doses during routine chest and abdomen x-ray examinations of adult and child patients. Radiation dose measurements were performed using thermoluminescent dosimeters TLD-100s in three major public hospitals in northern Jordan on a total of 100 patients. Wide variations in entrance surface doses were observed within and between hospitals, which might be attributed to significant variations of the selected exposure parameters. For adult patients, the results have shown that the majority of entrance surface dose values from both chest and abdomen examinations were within recommended values of diagnostic reference levels. For child patients, the mean entrance surface dose from chest examinations in three age groups were 0.131 mGy (0–1 y), 0.136 mGy (1–5 y), and 0.191 mGy (5–10 y). These values were considered relatively high compared to the European reference levels and published results in the literature. However, for abdomen examinations, entrance surface dose values were relatively lower than European reference levels. Patient effective doses were estimated using a PCXMC 2.0 Monte Carlo program. The results for both adults and children were found to be relatively lower than the values reported by international publications. Due to the wide variations of entrance surface dose and the higher radiation doses delivered to child patients, this study recommends implementing a quality assurance program in such hospitals to achieve optimization between good image quality and minimum dose according to the as low as reasonably achievable principle. Moreover, the results of this work will provide a useful base for establishing local diagnostic reference levels for chest and abdomen examinations in Jordan.
Use of Reduced Activity Seeds in Breast Radioactive Seed Localization
Authors: Brost Eric , Prather Andrew , Naik Himani , Jafari Mary Ellen
Published: November 2019

Radioactive seed localization procedures, using 125I seeds of typical activity 3.7 MBq and higher, are performed to localize nonpalpable lesions in the breast for surgical excision and pathology analysis. This study evaluated the use and dosimetry of 125I seeds of activity <3.7 MBq in radioactive seed localization procedures through retrospective health record review, Monte Carlo simulation, and experimental detection. An average seed strength at the time of specimen excision of 2.48 ± 0.629 MBq was used in 295 radioactive seed localization procedures at Gundersen Health System in La Crosse, Wisconsin, US. The average explanted seed activity served as a basis for Monte Carlo simulation of an 125I IsoAid Advantage seed embedded in soft tissue, which scored the dose deposited to soft tissue. Tabulated values of the dose to postsurgical residual tissue as a function of explanted tumor radius were shown and compared with previously published results. Use of seeds of activity from 1.44 to 3.7 MBq at the time of excision did not adversely affect seed detection and excision. The absorbed dose to residual tissue calculated using Monte Carlo was an average of 1.4 times larger than previously published results when scaled to identical seed strengths. This study demonstrates that seeds of activity <3.7 MBq can be used for radioactive seed localization procedures with no loss in efficacy and a benefit of reduced radiation dose to patients. This is important because the estimated radiation dose to residual tissue is approximately 1.4 times higher than previously indicated.
University of California Replacement of Cesium Irradiators with Alternative Technologies
Authors: MacKenzie Carolyn , Iwamoto Keisuke S. , Smith Kenneth
Published: November 2019

The University of California possesses a large number of 137Cs irradiators that are used in a wide variety of medical and research applications. The university president made a system-wide decision to reduce the potential threat of malevolent use of 137Cs by switching wherever feasible to x-ray irradiators over a 3-y period of time. A Radioactive Source Replacement Working Group of involved faculty was formed to study the topic and to make recommendations as to when alternative technologies could offer equivalency. The Working Group concluded that x-ray irradiators could replace 137Cs irradiators in most applications, with some likely exceptions. They found that the depth dose curve for the 320 kVp x-ray irradiator was found to be nearly identical to that of 137Cs down to a depth in tissue of 4 cm. It was concluded that x rays (energies ≤320 keV) are more biologically effective than 137Cs gamma rays, suggesting that lower doses of x rays will be required to achieve the same biological endpoint as 137Cs gamma rays. A simple conversion factor for equating x-ray effects to 137Cs effects was not recommended because relative biological effectiveness depends on multiple factors. They concluded that each experiment should be individually calibrated when converting from 137Cs irradiators to x-ray irradiators. The lessons learned from implementing the project to date have shown the importance of having senior management buy-in, involving the research community in the decision making process and allowing for exceptions where equivalency of 137Cs to x ray cannot be established.
Aspergillus flavus Left Ventricular Assist Device Driveline Exit Site Infection
Authors: Cunningham Hayley E. , Tessmann Paul B. , Lachiewicz Anne M.
Published: November 2019

Infection is a leading cause of death after left ventricular assist device implantation, but mold infections are rare. We present a unique case of localized Aspergillus left ventricular assist device driveline exit site infection successfully treated with debridement, antifungal therapy, and device retention, but the course was complicated by emergence of triazole resistance.
Regular dosing compared with as-needed dosing of opioids for management of chronic cancer pain: systematic review and meta-analysis
Authors: Edler-Buggy Sophie , Birtwistle Jacqueline , ElMokhallalati Yousuf , Kindl Korana , Good Phillip , Bennett Michael I.
Published: November 2019

Opioids are the recommended form of analgesia for patients with persistent cancer pain, and regular dosing “by the clock” is advocated in many international guidelines on cancer pain management. The development of sustained-release opioid preparations has made regular dosing easier for patients. However, patients report that the intensity and impact of their cancer pain varies considerably day to day, and many try to find a trade-off between acceptable pain control and impact of cognitive (and other) adverse effects on daily activities. In acute care settings, (eg, postoperative) as-needed dosing and other opioid-sparing approaches have resulted in better patient outcomes compared with regular dosing. The aim of this study was to determine whether regular dosing of opioids was superior to as-needed dosing for persistent cancer pain. We systematically searched for randomised controlled trials that directly compared pain outcomes from regular dosing of opioids with as-needed dosing in adult cancer patients. We identified 4347 records, 25 randomised controlled trials meet the inclusion criteria, 9 were included in the review, and 7 of these included in meta-analysis. We found no clear evidence demonstrating superiority of regular dosing of opioids compared with as-needed dosing in persistent cancer pain, and regular dosing was associated with significantly higher total opioid doses. There was, however, a paucity of trials directly answering this question, and low-quality evidence limits the conclusions that can be drawn. It is clear that further high-quality clinical trials are needed to answer this question and to guide clinical practice.
Impact of renin-angiotensin-aldosterone system activation and body weight change on N-terminal pro-B-type natriuretic peptide variation in 100-km ultramarathon runners
Authors: Li Li-Hua , Kao Wei-Fong , Chiu Yu-Hui , Hou Sen-Kuang , Meng Chen , How Chorng-Kuang
Published: November 2019

Background:

The change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels follows a paradox imposed by strenuous endurance exercise. Previous reports showed significant body weight (BW) loss was common in ultramarathon runners. This study investigated whether the BW change and renin–angiotensin–aldosterone system activation contribute to exercise-induced NT-proBNP release.

Methods:

A total of 26 participants who finished a 100 km ultramarathon in Taiwan were enrolled. For each participant, blood samples and spot urine samples were collected 1 week before the race, as well as immediately and 24 hours after the finish. BW change was recorded to monitor the hydration status.

Results:

Prolonged endurance exercise led to a substantial increase in NT-proBNP. Compared with prerace values, NT-proBNP levels significantly increased immediately after the race (24.3 ± 20.2 pg/mL to 402.9 ± 305.9 pg/mL, p < 0.05) and maintained high levels until 24 hours after the race (143.7 ± 126.1 pg/mL, p < 0.05). The fractional excretion of sodium values was below 1% in three different time points. The 100 km ultramarathon resulted in significant BW loss and elevated renin and aldosterone levels. However, only 24 hours after the race, a positive significant relationship was found between NT-proBNP and aldosterone levels (p = 0.007, r
2 = 0.267), but a negative significant relationship between NT-proBNP and BW increased during the recovery phase (p < 0.001, r
2 = 0.372).

Conclusion:

The mechanism of NT-proBNP release immediately following the race was multifaceted. During the recovery phase, rehydration might lead to the decrease of NT-proBNP. Our observations with regard to aldosterone and NT-proBNP might be in response to help the body maintains hydration state.
The Role of Noninvasive Tests for Differentiating NASH From NAFL and Diagnosing Advanced Fibrosis Among Patients With NAFLD
Authors: Balakrishnan Maya , Loomba Rohit
Published: November 2019

Assessing for the presence of non–alcoholic steatohepatitis (NASH) and the presence of advanced fibrosis is vital among patients with non–alcoholic fatty liver disease (NAFLD) as each is predictive of disease outcomes. A liver biopsy is the gold standard method for doing so but is impossible to perform among all patients with NAFLD. Reliable methods for noninvasively detecting for the presence of NASH and advanced fibrosis are thus a pressing need. The search for noninvasive tests has been more successful for advanced fibrosis than for NASH. Clinical prediction models and elastography have acceptable accuracy for ruling out advanced fibrosis; when used together, as in a fibrosis prediction algorithm presented in this review, it can avoid the need for liver biopsy among many patients with NAFLD. Several biomarkers for identifying the presence of NASH have been studied but none are sufficiently accurate or validated. Of those studied, the most promising include CK-18 fragments, lipodomic and metabolomics candidates, and magnetic resonance elastography with proton density fat fraction. However, none are ready for clinical use and ultimately large multicenter prospective cohort studies are needed to validate select novel biomarkers.
A CARE-compliant article
Authors: Miyazaki Kunihiko , Komatsubara Satoshi , Uno Koki , Fujihara Ryuji , Yamamoto Tetsuji
Published: November 2019

Rationale:

Multicentric carpotarsal osteolysis (MCTO) is a rare hereditary disease caused by mutations in MafB, a negative regulator of osteoclastogenesis.

Patient concerns:

A 20-year-old, Japanese woman with scoliosis visited our institute for treatment. Scoliosis was apparent since she was 12 years old, but she had not sought treatment until the age of 19. Medical examination showed a typical facial appearance associated with a small forehead and hypotelorism; shortening of the fingers of both hands and both upper limbs was observed, in addition to clubfoot. No café au lait spots or mental retardation were observed. On the other hand, the trunk showed evidence of an irregular waistline and a rib hump that obviously suggested scoliosis. Neurological deficit was not observed. Spirometry showed decreased forced vital capacity (FVC). Although proteinuria was observed, renal dysfunction and hypertension were not seen. The major curve of scoliosis was 82° (MC, Th7–L2; Th11 apical vertebra), and the upper curve was 77° (UC, Th1-6; Th3 apical vertebra). In a recumbent-traction position, the major curve was 54° and the upper curve was 56°. The pelvic incidence minus lumbar lordosis (PI–LL) angle was <10° and no mismatch was observed; thoracic kyphosis was decreased to 16°.

Diagnosis:

The patient was diagnosed with symptomatic scoliosis secondary to MCTO.

Interventions:

We decided to perform a correction and fusion from Th2 to L3 using a posterior spinal instrumentation.

Outcomes:

Postoperative x-ray demonstrated scoliosis angle correction from 77° to 38° at Th1–6 and 82° to 39° at Th7–L2. Postoperative x-ray demonstrated thoracic kyphosis angle correction from 16° to 21°. The patient's height increased from 155 to 161 cm.

Lessons:

It has been 24 months since the operation, and no exacerbation has been observed. To the best of our knowledge, this is the first report of surgical treatment of scoliosis secondary to MCTO.
A 9-day-old neonate with giant scalp abscess
Authors: Liu Hongyuan , Li Zongping , Yang Liling , Yang Xu , Zhang Yan , Chen Jia
Published: November 2019

Rationale:

Neonatal scalp mass is common in clinical practice. After birth canal compression and traction force, a cephalohematoma is usually found. However, cephalohematoma with abscess is extremely rare and dangerous. So far, there have been no reported cases of multidrug-resistant Escherichia coli infections in giant neonatal scalp hematoma.

Patient concerns:

We present a 9-day-old with a scalp abscess and a large scalp defect that remained after surgical drainage.

Diagnosis:

Physical examination showed a giant mass suggestive in the parietal region. B-mode ultrasound indicated the scalp mass was liquid. The early diagnosis was massive scalp hematoma. During conservative treatment, purulent fluid flowed from the mass region through a rupture in the scalp. MR examination showed the scalp had burst and no abnormalities were found in the medial side of the skull and skull.

Interventions:

The surgeon opened up the mass and removed necrotic tissue. The scalp was severely damaged; the aseptic auxiliary materials that we made in-house were used to gradually reduce the defect.

Outcomes:

The scalp was healed by anti-infection treatment and frequent changing of the dressings. The patient was successfully treated without two-stage surgery. There were no complications.

Lessons:

A scalp hematoma is a potential site of infection. Anti-infection treatment and surgery are necessary to correct infected scalp hematoma. This work offers a new way of treating other large scalp defects.
Association between interleukin-8 gene −251 A/T polymorphism and the risk of coronary artery disease
Authors: Zhang Quanfang , Lian Zhexun , Zhang Wenzhong , Cui Yan , Wang Wugang , Wu Jun , Chen Zuoyuan , Wang Wei
Published: November 2019

Background:

The association between interleukin-8 (IL-8) gene polymorphism −251 A>T and susceptibility to coronary artery disease (CAD) has been investigated previously; however, results remain controversial. Thus, a meta-analysis was conducted to reassess the effects of this polymorphism on CAD risks.

Methods:

The PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched for relevant studies published up to December, 2018. The pooled odds ratios (OR) were calculated using STATA 13.0 software for allelic (A vs T) as well as homozygote (AA vs TT), heterozygote (AT vs TT), recessive (AA vs AT + TT), and dominant (AA + AT vs TT) genotype models, respectively.

Results:

Ten case-control studies (3744 cases and 3660 controls) were included. Overall, a significant association of IL-8 gene −251 A > T polymorphism with an increased risk of CAD was only observed in the dominant genotype model (OR = 1.48), but not others. In the subgroup analysis, significantly increased risks were also found for Chinese (OR = 1.64), polymerase chain reaction-restriction fragment length polymorphism genotyping (OR = 1.61), acute coronary syndrome (ACS) type (OR = 1.92 for 3 datasets; OR = 1.88 for 4 datasets), high quality (OR = 1.64), and age/gender matching status (OR = 1.55) under the dominant model. Furthermore, significantly increased risks were also found for ACS type under allelic (OR = 1.32 for 3 datasets; OR = 127 for 4 datasets), homozygote (OR = 1.64 for 3 datasets; OR = 1.50 for 4 datasets), heterozygote (OR = 1.32 for 3 datasets; OR = 1.30 for 4 datasets), and recessive (OR = 1.40 for 3 datasets; OR = 1.28 for 4 datasets) models.

Conclusion:

This meta-analysis suggests that Chinese patients carrying −251A allele of IL-8 may have an increased risk for the development of CAD, especially ACS.
Diastolic dysfunction is associated with an increased risk of postcontrast acute kidney injury
Authors: Lee Min-Jeong , Park Jin-Sun , Kim Hyuk-Hoon
Published: November 2019

Study objective:

Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction.

Methods:

This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT.

Results:

We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E0 (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ± 7.66 mL·min1·1.73 m2 and 11.56 ± 5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E0 was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E0 value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51–25.23, P = .015) was a significant risk factor for PC-AKI.

Conclusion:

This study demonstrated that, among the echocardiographic variables, E/E0 was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.
Screening and identification of key biomarkers in nasopharyngeal carcinoma
Authors: Zhang Ji-Zhou , Wu Zeng-Hong , Cheng Qing
Published: November 2019

As for the lack of simple and effective diagnostic methods at the early of the nasopharyngeal carcinoma (NPC), the mortality rate of NPC still remains high. Therefore, it is meaningful to explore the precise molecular mechanisms involved in the proliferation, carcinogenesis, and recurrence of NPC and thus find an effective diagnostic way and make a better therapeutic strategy.

Three gene expression data sets (GSE64634, GSE53819, and GSE12452) were downloaded from Gene Expression Omnibus (GEO) and analyzed using the online tool GEO2R to identify differentially expressed genes (DEGs). Gene ontology functional analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of the DEGs were performed in Database for Annotation, Visualization and Integrated Discovery. The Search Tool for the Retrieval of Interacting Genes database was used to evaluate the interactions of DEGs and to construct a protein–protein interaction network using Cytoscape software. Hub genes were validated with the cBioPortal database.

The overlap among the 3 data sets contained 306 genes were identified to be differentially expressed between NPC and non-NPC samples. A total of 13 genes (DNAAF1, PARPBP, TTC18, GSTA3, RCN1, MUC5AC, POU2AF1, FAM83B, SLC22A16, SPEF2, ERICH3, CCDC81, and IL33) were identified as hub genes with degrees ≥10.

The present study was attempted to identify and functionally analyze the DEGs that may be involved in the carcinogenesis or progression of NPC by using comprehensive bioinformatics analyses and unveiled a series of hub genes and pathways. A total of 306 DEGs and 13 hub genes were identified and may be regarded as diagnostic biomarkers for NPC. However, more experimental studies are needed to carried out elucidate the biologic function of these genes results for NPC.
Strumal carcinoid tumor of the ovary
Authors: Chai Wei , Zhang Wenlei , Zhou Li , Sun Xiaoyan , Jia Guifeng
Published: November 2019

Rationale:

Strumal carcinoid tumor of the ovary (SCTO) is a very rare kind of ovarian tumor. The symptoms of SCTO are often nonspecific and misleading. Therefore, a full understanding of the characteristics, diagnosis, and treatment methods of SCTO is important.

Patient concerns:

In this study, we report a 63-year-old woman with SCTO whose most obvious symptoms were abdominal distention and weight loss of 5 kg for about 1 month.

Diagnosis:

Her carbohydrate antigen 125 (CA125) levels were higher than normal. Gynecologic sonography showed an 8.8 × 7.5 cm mass with mixed density and an irregular shape behind the uterus. Pathologic and immunohistologic examinations confirmed SCTO of the right ovary.

Interventions:

The patient underwent complete surgical resection of the whole uterus, bilateral ovaries, and fallopian tubes.

Outcomes:

The patient recovered well with no obvious complications and was discharged on the 10th day postsurgery.

Lessons:

Complete surgical resection is vital to treat SCTO. Postsurgical pathologic and immunohistologic examinations can confirm a diagnosis of SCTO.
Prognostic and clinicopathological significance of long non-coding RNA UCA1 in colorectal cancer
Authors: Liu Xiaoqun , Liu Xiangdong , Qiao Tiankui , Chen Wei
Published: November 2019

Objective:

Urothelial cancer-associated 1 (UCA1), an oncogenic long non-coding RNA, was aberrantly upregulated in colorectal cancer (CRC). This study aimed to further explore the clinical value of UCA1 in CRC.

Methods:

Eligible studies were retrieved by searching Pubmed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, and Wanfang databases. Pooled hazard ratio (HR) and odds ratio (OR) with 95% confidence interval (CI) were applied to assess the prognostic role and clinical significance of UCA1.

Results:

A total of 7 eligible studies with 775 cancer patients were recruited in the meta-analysis. The results showed that UCA1 overexpression was significantly correlated with poor overall survival in patients with CRC (HR = 2.25, 95% CI: 1.77–2.87, P < .001). There was also a significantly negative association between high UCA1 levels and tumor differentiation (OR = 2.84, 95% CI: 1.87–4.31, P < .001), lymph node metastasis (OR = 3.48, 95% CI: 2.24–5.41, P < .001), distant metastasis (OR = 2.67, 95% CI: 1.32–5.38, P = .006), tumor node metastasis stage (OR = 3.01, 95% CI: 2.16–4.18, P < .001), tumor invasion depth (OR = 2.18, 95% CI: 1.03–4.61, P = .04), and tumor size (OR = 2.27, 95% CI: 1.56–3.32, P < .001).

Conclusions:

Our study revealed that UCA1 overexpression was associated with poor prognosis and more advanced clinicopathological features, suggesting that UCA1 may serve as an indicator for unfavorable outcome of patients with CRC.
Scalp acupuncture for children with cerebral palsy
Authors: Lee Go-Eun , Lee Pei-Ting , Ran Ni , Zhou Jianwei
Published: November 2019

Background:

Cerebral palsy (CP) describes a group of permanent disorders of movement and posture causing activity limitations, leading the most common movement disorder to children. Scalp acupuncture (SA) is one of several specialized acupuncture techniques, and it has been used widely in China to alleviate several CP symptoms, despite the deficiency of high-quality evidence related to this practice. Therefore, we plan to conduct a protocol of systematic review aimed at systematically reviewing all the clinical evidence on the effectiveness of scalp acupuncture for treating CP in children.

Methods:

The following electronic databases will be searched from inception to May 1, 2019 MEDLINE, PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang Database, and Chinese Biomedical Literature Database (CBM). All published English and Chinese articles randomized controlled trials (RTCs) will be included. All types of CP of children in the trials will be included in this study and these individuals will be involved as core searchers to evaluate the efficacy of scalp acupuncture. Rev Man V.5.3 software will be implemented for the assessment of bias risk, data synthesis, subgroup analysis, and meta-analyses if inclusion conditions are met. Continuous outcomes will be presented as mean difference (MD) or standard mean difference (SMD), while dichotomous data will be expressed as a relative risk.

Results:

The systematic review will synthesize the available knowledge surrounding scalp acupuncture for children with CP. The findings will be synthesized to determine the efficacy and safety of scalp acupuncture for children with CP.

Conclusion:

This protocol will present the evidence of whether scalp acupuncture is an effective intervention for children with CP.
Combining micro-plasma radio-frequency with hypofractionated electron-beam radiation as a novel treatment of keloids
Authors: Zhang Wenchao , Liu Zhifei , Zhu Lin , Zeng Ang , Ting Wenyun , Wang Xiaojun , Yu Nanze , Xia Guangpeng
Published: November 2019

Rationale:

Micro-plasma radio-frequency (MPR) technology has been demonstrated a safe and effective treatment for kinds of scars, but there is no report about the application of the MPR on keloids. In this investigation, we creatively use MPR technology combining with hypofractionated electron-beam radiation to cure keloids.

Patient concerns and Diagnoses:

From February 2013 to December 2016, 22 Asian patients (16 male, 6 female, age 19–46 years, mean age 28.14 ± 7.31 years) with keloids over half a year were enrolled in this study.

Interventions and Outcomes:

All patients received a single MPR technology treatment by roller tip at 80–100 watt, and then hypofractionated electron-beam radiation of 6 MeV were performed twice, within 24 hours and one week after the operation with 9 Gy per time. Improvement were determined by the Vancouver Scar Scales (VSS) according to digital photographs. The results show that the volume of keloids reduced significantly among most patients. Only 3 patients encountered with mild to moderate hyperpigmentation, and none of malignance and worsening or recurrence of scars was observed.

Lessons:

MPR technology combined with post-operative hypofractionated electron-beam radiation therapy is an effective method for patients with multiple keloids distributed widely on the body with minimal complications, especially for patients with widely distributed keloids.
Failure of standard methods for retrieving an unusual foreign body in esophagus
Authors: Li Dongjie , Nan Ling , Niu Kai , Yin Wanzhong , Zhu Wei , Wang Xin
Published: November 2019

Rationale:

The ingestion of a foreign body (FB) with complete impaction of the esophagus is not common. Here we report a rare case of successful retrieval of a spherical stone in the esophagus of a man with mental retardation, using gallbladder grasping forceps and rigid endoscope.

Patient concerns:

A mental retarded man came to the emergency department presenting with recurrent nausea, vomiting, and dysphagia after swallowing a spherical stone. He had previously undergone an FB extraction under general anesthesia by fiberoptic esophagoscopy, which failed.

Diagnosis:

The diagnosis of FB ingestion was confirmed by anteroposterior plain film x-ray of the chest and chest computed tomography (CT), which showed the ingested spherical FB in the upper esophagus.

Interventions:

After multiple failed attempts using other instruments, the FB was successfully removed with gallbladder grasping forceps through a rigid esophagoscope.

Outcomes:

The patient was discharged without any complications. The nasogastric tube was extubated at the 10-day follow-up.

Lessons subsections as per style:

For esophageal retrieval of uncommon FBs, the instrument used is crucial. We report our experience retrieving a large and spherical FB in the upper esophagus using gallbladder grasping forceps. This proved to be an effective strategy, eliminating the need for thoracotomy.
Epiphora after nasolacrimal duct fracture in patients with midfacial trauma
Authors: Shim Woo Sub , Cho Min Jai , Kim Jisung , Jung Hahn Jin
Published: November 2019

The aim of this study was to identify the factors related to occurrence of epiphora or requirement of dacryocystorhinostomy (DCR) in patients with midfacial trauma.

We performed a retrospective analysis of the medical records of 1038 patients with midfacial trauma from January 2005 to December 2015. Fifty-one patients (55 cases) diagnosed with nasolacrimal duct (NLD) fracture using facial bone computed tomography were enrolled. Correlation analysis was performed of patient- and injury-related factors, including age, sex, facial trauma etiology, accompanying injury, type and level of the NLD fracture, and time from injury to initial surgery, with the occurrence of epiphora and requirement for DCR.

Epiphora occurred in 14.5% and DCR was performed in 5.5% of the patients with NLD fracture. The correlation analysis revealed no significant relationship among the factors with the occurrence of epiphora and requirement for DCR.

In patients with midfacial trauma and NLD fracture, epiphora occurred in 14.5% and endoscopic DCR was performed due to persistent epiphora in 5.5% and its result was all successful.
Medical management of a child with congenital generalized lipodystrophy accompanied with progressive myoclonic epilepsy
Authors: Zhang Yi , Chen Xiaofei , Luo Feixiang , Jiang Lihua , Xu Jialu , Chen Shuohui
Published: November 2019

Rationale:

Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive hereditary disease. It is associated with metabolic complications and epilepsy is rare.

Patient Concerns and Diagnoses:

One child with BSCL2 mutation and CGL accompanied by progressive myoclonic epilepsy

Diagnosis: He was diagnosed with epilepsy, CGL, and severe malnutrition.

Interventions:

He was treated with sodium valproate, baclofen, aripiprazole, benzhexol, and lamotrigine for epilepsy.

Outcomes:

After 16 days of medical treatment for epilepsy, the disease was improved and the child was discharged with gastric tube inserted for the management of malnutrition.

Lessons:

CGL and progressive myoclonic epilepsy is rare, and the epilepsy is partially refractory to treatments. In this particular case, the nutritional status was compromised as a complication of progressive myoclonic epilepsy and had to be managed.
Association between colorectal cancer and zolpidem use in a case-control study
Authors: Lai Shih-Wei , Lin Cheng-Li , Liao Kuan-Fu
Published: November 2019

This study aimed to examine the association between colorectal cancer and zolpidem use in Taiwan.

A case-control study was conducted using the database of Taiwan National Health Insurance Program from 2000 to 2013. Participants aged 20 to 84 years with newly diagnosed colorectal cancer were selected as the cases. Sex-matched and age-matched participants without colorectal cancer were randomly selected as the matched controls. The odds ratio and 95% confidence interval for colorectal cancer associated with zolpidem use were calculated by the multivariable logistic regression model.

There were 4912 cases with colorectal cancer and 4912 matched controls without colorectal cancer. The mean age was 63 years and 58% were male participants. After adjustment for co-variables, the multivariable logistic regression model disclosed that there was no statistical association between colorectal cancer and zolpidem use (adjusted OR 1.05, 95% CI 0.95–1.15).

No statistical association can be detected between colorectal cancer and zolpidem use in Taiwan.
Effect of Balint training in gastroenterology intern nurse practitioners
Authors: Liu Wan-lu , Zhu Zheng-ri , Chen Chen , Li Jing , Moreno Olga
Published: November 2019

Background:

This study aims to assess the effect of Balint training (BT) in gastroenterology intern nurse practitioners (GINP) systematically.

Methods:

This study will search EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the September 30, 2019 with no language limitation. In addition, we will also search grey records, such as conference abstracts and dissertations. Study quality will be checked using Cochran risk of bias tool. Statistical analysis will be performed using RevMan 5.3 software.

Results:

This study will systematically evaluate the effect of BT in GINP and will provide evidence to judge whether BT is effective for GINP clinically.

Conclusion:

The results of this study may provide helpful evidence of BT in GINP in the clinical training.