bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary lymphedema after high ligation of the great saphenous vein surgery
Authors: Chen Ping , Chen Hui , Yang Mu , Wang Xuan
Published: December 2018

A 56-year-old male patient with secondary lymphedema in a single lower extremity presented to our hospital.

He received high ligation of great saphenous vein 3 years ago. Severe infection was observed in affected limb on postoperative day 10, and rapidly progressive pain and erythema spreading to inguinal region. He was diagnosed with secondary lymphedema after 3 years of high ligation of great saphenous vein. Compression treatment was given in affected limb to promote the lymphatic return.

The patient was followed up for 3 months now, the edema in right leg showed attenuation compared with before.
The effect of apatinib in the treatment of sorafenib resistant metastatic hepatocellular carcinoma
Authors: Han Zonghong , He Zhongming , Wang Caoye , Wang Qi
Published: December 2018

Rationale:

Most patients with hepatocellular carcinoma (HCC) have lost the chance of radical treatment at the time of their visit, and the prognosis of metastatic HCC is even worse. Sorafenib is currently regarded as a first-line systemic therapy in patients with advanced and metastatic HCC. Apatinib is a new inhibitor of vascular endothelial growth factor receptor 2 tyrosine kinase, which has been reported to be effective in some solid tumors. We herein report a case of apatinib in the treatment of the patient with metastatic HCC who was resistant to sorafenib.

Patient concerns:

A 41-year-old Chinese man with a history of chronic hepatitis B had undergone an emergency partial hepatectomy for tumor ruptured. Despite the treatment with transcatheter arterial chemoembolization and sorafenib, the progression of tumor failed to control.

Diagnoses:

Although the patient had been treated with sorafenib (400 mg, twice daily) for 10 months, computed tomography documented radiological progression.

Interventions:

Due to disease progression, failure of sorafenib and positive expression of vascular endothelial growth factor (VEGF), the drug regimen was changed to apatinib 250 mg once daily. Due to some degree of resistance, the dose was increased up to 425 mg once daily.

Outcomes:

The patient had a disease-free progression of 7 months at 250 mg apatinib. The dosage was adjusted to 425 mg due to drug resistance and the side effects were tolerable. The patient has survived a total of 19 months under apatinib.

Lessons:

Apatinib may be a substitute for the HCC patients with sorafenib resistance in the future, especially for those with high expression of VEGF.
Machine learning methods for automatic pain assessment using facial expression information
Authors: Liu Dianbo , Cheng Dan , Houle Timothy T. , Chen Lucy , Zhang Wei , Deng Hao
Published: December 2018

Introduction:

Prediction of pain using machine learning algorithms is an emerging field in both computer science and clinical medicine. Several machine algorithms were developed and validated in recent years. However, the majority of studies in this topic was published on bioinformatics or computer science journals instead of medical journals. This tendency and preference led to a gap of knowledge and acknowledgment between computer scientists who invent the algorithm and medical researchers who may use the algorithms in practice. As a consequence, some of these prediction papers did not discuss the clinical utility aspects and were causally reported without following related professional guidelines (e.g., TRIPOD statement). The aim of this protocol is to systematically summarize the current evidences about performance and utility of different machine learning methods used for automatic pain assessments based on human facial expression. In addition, this study is aimed to demonstrate and fill the knowledge gap to promote interdisciplinary collaboration.

Methods and analysis:

We will search all English language literature in the following electronic databases: PubMed, Web of Science and IEEE Xplore. A systematic review and meta-analysis summarizing the accuracy, interpretability, generalizability, and computational efficiency of machine learning methods will be conducted. Subgroup analyses by machine learning method types will be conducted.

Timeline:

The formal meta-analysis will start on Jan 15, 2019 and expected to finish by April 15, 2019.

Ethics and dissemination:

Ethical approval will be exempted or will not be required because the data collected and analyzed in this meta-analysis will not be on an individual level. The results will be disseminated in the form of an official publication in a peer-reviewed journal and/or presentation at relevant conferences.

Registration:

PROSPERO CRD42018103059.
Reversal of resistance to chemotherapy following anti-programmed cell death-1 immunotherapy in metastatic lung adenocarcinoma
Authors: Liu Xiaoli , Liu Huaimin , Luo Suxia
Published: December 2018

Rationale:

For metastatic non-small cell lung cancer with no epidermal growth factor receptor mutations or anaplastic lymphoma kinase gene rearrangements, programmed cell death-1 (PD-1) blockade is preferentially recommended post first-line chemotherapy. However, still many patients do not respond to these agents. After development of resistance to PD-1 blockade, further evaluation of chemotherapy regimen will be necessary.

Patient concerns:

A 57-year old man had cough with minimal whitish expectoration. Computed tomography (CT) scans showed that he had an upper lobe mass of his left lung and multiple lymphadenectasis, including mediastinal and hilar lymph nodes, and also to the right intrapulmonary lymph nodes.

Diagnoses:

The patient was diagnosed with adenocarcinoma after a biopsy was conducted on the upper lobe mass of his left lung.

Interventions:

The patient received pemetrexed plus cisplatin (Pem-Cis) treatment for 6 cycles and sequential thoracic radiation as a therapeutic schedule. CT demonstrated a confirmed partial response after these treatments. Three months later, the tumors continued to grow. The patient received successive pemetrexed-based chemotherapy regimens; however, these regimens failed to stop tumor progression. The patient subsequently underwent 6 cycles of PD-1 mAb pembrolizumab treatment.

Outcomes:

Sensitivity of chemotherapy was restored, and the patient displayed a reduction in the size of enlarged mediastinal and hilar lymph nodes after 2 cycles of treatment with Pem-Cis, the initially used chemotherapy regimen.

Lessons:

This outcome suggests that PD-1 blockade holds promise as a treatment strategy for reversion of chemotherapy resistance in refractory lung adenocarcinoma and warrants additional studies.
Clinical massage therapy for patients with cancer-related fatigue protocol of a systematic review
Authors: Wang Kang , Qi Shuo , Lai Hezheng , Zhu Xiaoshu , Fu Guobing
Published: December 2018

Background:

Cancer-related fatigue (CRF) is a prevalent and debilitating symptom experienced by cancer survivors, one that severely compromises functional independence and quality of life. Clinical massage therapy (CMT), as an important part of complementary and alternative medicine, is widely employed among massage therapists, physical therapists, nurses, and physicians when managing CRF. Clinical research indicates that CMT produced relief of CRF. In this systematic review, we aim to evaluate the effectiveness and safety of CMT for patients with CRF.

Methods:

We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of CMT for CRF in cancer patients: CENTRAL, Embase, MEDILINE, CINAHL and China National Knowledge Infrastructure. Each database will be searched from inception to October 2018. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses.

Results:

This proposed study will evaluate the effectiveness and safety of CMT for CRF. The outcomes will include change in quality of life, fatigue relief and adverse effect.

Conclusions:

This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of CMT for patients with CRF.

Dissemination and ethics:

The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.
Effect of sertraline in the treatment and prevention of poststroke depression
Authors: Feng Rongfang , Wang Peng , Gao Chenhao , Yang Jianbo , Chen Zixiao , Yang Yaoyao , Jiao Jiawei , Li Mengmeng , Fu Bo , Li Ling , Zhang Zhenxiang , Wang Shiguang
Published: December 2018

Background:

Morbidity of poststroke depression (PSD) remains high worldwide. Additionally, PSD causes multiple sequelae. Although sertraline has been reported to be effective in treating PSD, many studies remain inconsistent.

Methods:

PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, Clinical trials. gov, Wan fang Data (Chinese), VIP (Chinese), and CNKI (Chinese) were retrieved from inception to April 2017. Randomized controlled trials (RCTs) and self-controlled trials (SCTs) were recruited, which met the inclusion criteria in our study. The depression rating scores, the incidence of PSD, activities of daily living (ADL), neurological impairment scores, and adverse effects were assessed.

Results:

Around 11 studies were recruited in our work, including 1258 participants. For trials enrolled, the results were depicted: the reduction of depression rating scores was significant in sertraline groups (WMD −6.38; 95% CI −8.63 to −4.14; P < .00001); the incidence of PSD was significantly lower in sertraline groups (RR 0.48; 95%CI 0.35–0.67; P < .0001); there was obvious improvement of ADL (WMD 11.48; 95% CI 4.18–18.78; P = .002 <0.05) and neurological impairment (WMD −3.44; 95% CI −6.66 to −0.21; P = .04 <0.05); no significant difference between sertraline and control groups in the morbidity of adverse events (RR 0.94; 95% CI 0.83–1.06; P = .33 >0.05). However, in sensitivity analyses, the conclusions of the reduction of depression rating scores and the improvement of ADL were altered.

Conclusions:

The study suggests that sertraline has a potentially protective role compared with control groups and demonstrates sertraline is safe. However, the reduction of depression rating scores and the improvement of ADL should be considered carefully.
Compressive radial neuropathy by a synovial cyst during pregnancy
Authors: Hsiao Ching-Min , Wu Chia-Chieh , Wen Hsin-Chiao
Published: December 2018

Rationale:

Compressive radial neuropathy by a synovial cyst in the radial tunnel during pregnancy is a rare occurrence. The management of radial nerve compression caused by a synovial cyst in a pregnant patient is a surgical dilemma owing to the fetal and maternal risks of treatment.

Patient concerns and diagnosis:

A 37-year-old pregnant woman presented with progressive forearm pain at the gestational age of 12 weeks. A cyst was identified via musculoskeletal ultrasound and magnetic resonance imaging examinations in the radiocapitellar joint causing radial compressive neuropathy.

Interventions:

After regional nerve block and surgical removal of the cyst, the patient's forearm pain was alleviated without neurological deficits.

Outcome:

symptoms from nerve compression were improved after surgical treatment

Lessons:

This report illustrates the case of a pregnant woman presenting a compressive neuropathy by an enlarged cyst possibly due to the unbalance of growth factors during pregnancy. With proper diagnosis and timely surgical intervention, such patients can achieve good neurologic recovery without maternal or fetal complications.
Complete remission after hypofractionated radiotherapy for a patient with inoperable adenoid cystic carcinoma of bronchus
Authors: Wang Daquan , Bi Nan , Chen Dongfu , Wang Luhua
Published: December 2018

Rationale:

Tracheobronchial adenoid cystic carcinoma (TACC) is a rare malignancy. Surgical resection remains the standard treatment of choice. But it is frequently unresectable due to its local extension. The practicability and safety of hypofractionated radiotherapy (HRT) for TACC remains unknown since most of the TACCs are centrally located.

Patient concerns:

A 57-year-old female presented with paroxysmal cough, expectoration, and hemoptysis.

Diagnoses:

Computed tomography (CT) scan of the chest revealed a nodule originating from the wall of right primary bronchus, with 1.9∗1.2 cm in size. Bronchoscope confirmed the node on the medial wall of the right primary bronchus extending towards the carina, with a close distance of 0.5 cm. Biopsy from the node was considered as adenoid cystic carcinoma (ACC). The clinical stage of the patient was T3N0M0.

Interventions:

The patient underwent HRT with a total dose of 60Gy in twelve fractions.

Outcomes:

The patient experienced complete remission after HRT. No symptomatic radiation-induced toxicity (≥grade 2) was observed during the follow-up.

Lessons:

HRT may be a safe and effective modality for inoperable TACC.
Prognostic significance of the degree of lymphatic vessel invasion in locally advanced, surgically resectable pancreatic head cancer
Authors: Morita Kohei , Oshiro Hisashi , Mito Kumiko , Mieno Makiko Naka , Tamba-Sakaguchi Mio , Niki Toshiro , Miki Atsushi , Koizumi Masaru , Sakuma Yasunaru , Komatsubara Toshihide , Sata Naohiro , Fukushima Noriyoshi
Published: December 2018

Little is known concerning the prognostic significance of the degree of lymphatic vessel invasion in pancreatic head cancer. To address this gap in knowledge, we retrospectively examined 60 patients with locally advanced, surgically resectable pancreatic head cancer who underwent pancreaticoduodenectomy and lymph node (LN) dissection.

All cases were histopathologically diagnosed as ductal adenocarcinoma, stage II (25 pT3N0 cases, 35 pT3N1 cases). The following variables were investigated: age; sex; neoadjuvant therapy; adjuvant therapy; tumor size; tumor grade; invasion into the serosa, retropancreatic tissue, duodenum, bile duct, portal venous system and perineural area; cut margins; LN metastasis; and the number of invaded lymphatic vessels (LVI-score).

Univariate analysis demonstrated that LN metastasis and an LVI-score ≥5 were significantly associated with poor disease-free survival. Multivariate Cox regression analysis confirmed that LN metastasis and an LVI-score ≥7 were significantly associated with poor disease-free survival. Additionally, LVI-scores ≥9 and ≥10 were comparable to or surpassed the significance of LN metastasis based on the hazard ratio. Univariate analysis demonstrated that tumor size >30 mm, duodenal invasion, LN metastasis and an LVI-score ≥2 were significantly associated with poor overall survival. Multivariate Cox regression analysis confirmed that LN metastasis and LVI-scores ≥9 and ≥10 were significantly associated with poor overall survival, and an LVI-score ≥10 was comparable to or surpassed the significance of LN metastasis based on the hazard ratio.

Our study strongly suggests that a high degree of lymphatic vessel invasion is associated with a poor prognosis in patients with locally advanced, surgically resectable pancreatic head cancer.
Clinicopathologic features and outcomes of primary vaginal adenosis as a dermatologic and gynecologic burden
Authors: Han Tiantian , Jin Ying , Li Yan , Bi Yalan , Pan Lingya
Published: December 2018

In the recent 20 years, primary vaginal adenosis is extremely rare and the data of clinical presentations, management, and outcome have not been studied systematically.

In this retrospective study, women with vaginal adenosis between January 1997 and June 2017 were identified from the hospital's medical records. Data on patient age, history, symptoms, mass location, size, diagnosis, complications, treatment, and recurrence were analyzed by SPSS 20.0.

Twenty women were histopathologically diagnosed as having vaginal adenosis (mean age, 37.9 ± 10.6 years). All patients denied utero exposure. The most common symptom was vaginal pain or abnormal bleeding. For all patients, the local vaginal lesions were surgically excised. Seven patients had complications with endometriosis. 15 patients lived without recurrence, and 1 patient underwent postoperative local recurrence after 81 months. Primary vaginal squamous cell carcinoma in another patient was confirmed to arise from adenosis; she survived with disease. The remaining 3 patients developed carcinoma of different types in varied periods of a disease-free state (5 months, 30 months, and 23 years, respectively); 1 patient died of progressive disease, and 2 patients survived with disease.

Primary vaginal adenosis is a spontaneous lesion with a propensity for late canceration. Local lesion resection is the primary treatment.
The diagnostic role of miR-122 in drug-induced liver injury
Authors: Liu Yiqi , Li Ping , Liu Liang , Zhang Yilian
Published: December 2018

Background:

Drug-induced liver injury (DILI) is a potentially severe adverse drug reaction especially in susceptible patients. But there are no sensitive or specific parameters to detecting DILI. The specific expression of miR-122 in the liver has been a hotspot in the evaluation of hepatic toxicity due to its high stability and sensitivity.

Methods:

We performed a systematic literature review through July 31, 2017 to identify studies which evolved DILI patients testing miR-122 without limiting a certain drug. According to the PRISMA statement, a meta-analysis: the diagnostic role of miR-122 in DILI was made. QUADAS-2 quality evaluation table was used to evaluate the quality of the documentary evidence, PRISMA flowchart and quality evaluation table were drawn with RevMan, use Stata to calculate the sensitivity and specificity of miR-122 in diagnosing DILI, ROC curve and Deeks funnel plot were also drawn by STATA.

Results:

Eleven studies involved 194 DILI patients and 251 controls, all were tested miR-122 (fold change). Sensitivity of miR-122 in diagnosing DILI was [0.85 (95% CI, 0.75–0.91), I
2 = 53.46%] and specificity was [0.93 (95% CI, 0.86–0.97), I
2 = 65.10%], the area under ROC curve was 0.95 (95% CI, 0.93–0.97). While in acetaminophen (APAP)-induced liver injury, the sensitivity was [0.82 (95%CI, 0.67–0.91), I
2 = 65.77%] specificity was [0.96 (95%CI, 0.88–0.99), I
2 = 31.46%], AUROC was 0.97 (95% CI, 0.95–0.98).

Conclusions:

In this systematic review and meta-analysis, we found miR-122 have a high specificity in DILI, and a modest positive diagnostic effects. On the basis of the limited evidence, further research is needed to evaluate the long-term observation and more clinical data to testify miR-122 in diagnosing DILI.
Oral oxymatrine for hepatitis B cirrhosis
Authors: Jiang Xiaotao , Xie Linling , Huang Cihui , Liu Yishen , Liu Haining , Liu Binqian , Zheng Liang
Published: December 2018

Background:

Characterized by diffuse hepatic fibrosis and nodule formation, hepatitis B cirrhosis (HBC), an important result of chronic hepatitis B development, mainly contains compensated and decompensated stage. Compensated cirrhosis can further develop into decompensated stage and hepatocellular carcinoma with serious complications and high mortality. Antiviral therapy using interferon (IFN) or nucleos(t)ide analogs (NUCs) is essential for improving the prognosis of the disease but IFN has large side effects while NUCs often develop drug resistance. Antifibrosis is also an important strategy, but currently there is no effective antifibrosis drug. Pharmacologic studies have demonstrated that oxymatrine (OM) exhibits anti-hepatitis B virus (HBV) and antifibrosis effects. An increasing number of clinical controlled studies also have found that OM combined with conventional therapy could improve the curative effect and reduce adverse events incidence in treating HBC but there is no systematic review of it. Based on the extensive collection of literature, we will use meta-analysis to assess the efficacy and safety of OM for HBC.

Methods:

PubMed, MEDLINE, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang data, Chinese Scientific Journals Database (VIP), and China biomedical literature database will be searched to obtain the eligible studies published up to July 15, 2018. The primary outcome will be liver function indexes, liver fibrosis indexes, and Child–Pugh score. The secondary outcome will be hepatitis B virus DNA quantification, HBV DNA seroconversion rate, hepatitis B e antigen (HBeAg) seroconversion rate, and adverse events incidence. Data analysis will be conducted using RevMan 5.3 and Stata V.9.0 software. Trial sequential analysis (TSA) will be performed to assess the risk of random error and the validity of conclusion using TSA program version 0.9 beta.

Results:

This systematic review will provide a high quality synthesis of OM for HBC from various evaluation aspects including liver function indexes, liver fibrosis indexes and Child-Pugh score, HBV DNA quantification, HBV DNA seroconversion rate, HBeAg seroconversion rate and adverse events incidence.

Conclusion:

The systematic review will provide evidence to assess the efficacy and safety of OM in the treatment of HBC.

PROSPERO registration number:

PROSPERO CRD42018095275.
Is use of vitamin K antagonists associated with the risk of prostate cancer?
Authors: Luo Jin-Dan , Luo Jie , Lai Chong , Chen Jun , Meng Hong-Zhou
Published: December 2018

Background:

Vitamin K antagonists (VKAs) may have potential antitumor effects in prostate cancer. However, the findings of observational studies are inconsistent. The purpose of the present study was to estimate the quantitative association between VKAs use and prostate cancer risk by combining the results of all eligible observational studies.

Methods:

PubMed and Web of Science database were searched from inception until May, 2018. A DerSimonian random-effects model was used to combine the studies. Study heterogeneity was measured using the chi-squared and I
2 statistics.

Results:

Six eligible studies were eventually included in our meta-analysis. There was an inverse but not statistically significant association between ever use of VKAs and the risk of prostate cancer (relative risk [RR] 0.84, 95% confidence interval [CI] 0.70–1.01, P = .063) with large heterogeneity across studies (P < .001 for heterogeneity, I
2 = 94.6%). When analysis restricted to long term of VKAs user (>3 years), the pooled risk estimate was 0.83 (0.77–0.90) without obvious heterogeneity (P = .597, I
2 = 0.0%).

Conclusion:

This meta-analysis indicates that VKAs use may be associated with a decreased risk of prostate cancer, especially in long-term users.
Relationship of atopic dermatitis with stroke and myocardial infarction
Authors: Yuan Min , Cao Wen-Feng , Xie Xu-Fang , Zhou Huang-Yan , Wu Xiao-Mu
Published: December 2018

Background:

Lots of previous reports have suggested a potential association of atopic dermatitis (AD) with stroke and myocardial infarction (MI). However, the result is still controversial, Consequently, we conducted this meta-analysis to estimate the relationship of AD with Stroke and MI.

Methods:

PubMed, Embase, and Web of Science databases were searched from inception to June 2018. Stroke and MI were considered as a composite endpoint. We calculated pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup and sensitivity analysis were performed to assess the potential sources of heterogeneity of the pooled estimation.

Results:

A total of 12 articles with 15 studies involving 3,701,199 participants were included in this meta-analysis. Of these, 14 studies on stroke and 12 on MI. Pooled analysis showed participants with AD experienced a significant increased risk of stroke (combined HR, 1.15; 95% CI, 1.08–1.22; P = .000) and MI (combined HR, 1.13; 95% CI, 1.02–1.24; P = .014), compared with participants without AD. The risk of stroke and MI was significant both in male subjects (stroke: HR: 1.33, 95% CI: 1.14–1.56; MI: HR: 2.01, 95% CI: 1.31–3.08), but not in female subjects (HR: 1.02, 95% CI: 0.77–1.35; MI: HR: 0.98, 95% CI: 0.72–1.32). The results were more pronounced for ischemic stroke (HR: 1.16, 95% CI: 1.13–1.19) in the stratified with stroke type. Stratifying by AD type, the risk of stroke was significant in severe AD (HR: 1.29, 95% CI: 1.08–1.54) and moderate AD (HR: 1.11, 95% CI: 1.01–1.22) for MI.

Conclusions:

AD is independently associated with an increased risk of stroke and MI, especially in male subjects and ischemic stroke and the risk is associated with the severity of AD.
Analysis of PTEN expression and promoter methylation in Uyghur patients with mild type 2 diabetes mellitus
Authors: Yin Liang , Cai Wei-Juan , Chang Xiang-Yun , Li Jun , Zhu Ling-Yun , Su Xiang-Hui , Yu Xue-Feng , Sun Kan
Published: December 2018

Phosphatase and tension homolog deleted on chromosome 10 (PTEN) was considered as a promising target in type 2 diabetes mellitus (T2DM) because of its negative effects on insulin resistance. Alteration in DNA methylation is thought to play a role in the pathogenesis of T2DM. The aim of the present study was to quantitatively evaluate the promoter methylation of PTEN in Uyghur patients with mild T2DM. We evaluated methylation levels in 21 CpG sites from −2515 bp to −2186 bp relative to the translation initiation site in 55 cases of T2DM and 50 cases of normal glucose tolerance (NGT) using the MassARRAY spectrometry. In addition, PTEN mRNA and protein levels were measured by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and western blotting to determine whether DNA methylation alterations were responsible for PTEN expression. Compared with NGT groups, the PTEN mRNA expression was significantly higher in Uyghur patients with mild T2DM groups. We also showed that PTEN protein expression was upregulated in Uyghur patients with mild T2DM groups, but the level of protein kinase B (AKT) was downregulated. PTEN methylation in T2DM patients was significantly lower than that in NGT groups. In addition, 2 CpG units demonstrated a significant difference between the NGT and Uyghur patients with mild T2DM groups. Furthermore, there was a negative association between promoter methylation and PTEN expression. Together, these findings suggest that epigenetic inactivation of PTEN plays an important role in Uyghur patients with mild T2DM. The aberrant methylation of CpG sites within the PTEN promoter may serve as a potential candidate biomarker for T2DM in the Uyghur population.
Cardiac tamponade after radiofrequency ablation for hepatocellular carcinoma
Authors: Chung Min-Woo , Ha Sang-Yoon , Choi Jung-Ho , Park Hyuk-Jin , Myung Dae-Seong , Cho Sung-Bum , Lee Wan-Sik , Kim Jin-Woong , Oh Hyung-Hoon , Joo Young-Eun
Published: December 2018

Rationale:

Radiofrequency ablation (RFA) is a safe and effective local treatment modality with a low complication rate and is commonly used to treat hepatocellular carcinoma (HCC). The clinical outcome of RFA may be closely related to the location, size, and shape of index tumors, and major complications, including hemorrhage, liver abscess, infarction, visceral organ perforation, hemothorax, pneumothorax, tumoral seeding, and hepatic failure. Cardiac tamponade is a rare and serious life-threatening complication associated with RFA. To date, a review of the medical literature reported 5 cases of cardiac tamponade after RFA for HCC. Herein, we report another case of cardiac tamponade after RFA for HCC in a 56-year-old man.

Patient concerns:

He had suffered from liver cirrhosis due to alcohol abuse. He had chronic obstructive pulmonary disease. Magnetic resonance imaging showed a 3.0-cm exophytic subcapsular HCC in segment IVa of left hepatic lobe. As the patient was at high risk for surgery because of poor lung function, RFA was selected as the treatment of choice. The index tumor was located in the vicinity of the diaphragm and colon. During RFA procedure, thermal injury to the adjacent diaphragm and colon was minimized by introducing artificial ascites. Bleeding or tumoral seeding was prevented by ablating the electrode track during electrode retraction.

Diagnosis:

Two hours after RFA, the patient presented with dyspnea, chest discomfort, and low blood pressure (80/60 mm Hg), suggesting cardiac tamponade. Immediate follow-up contrast-enhanced computed tomography image depicted the slightly high attenuated hemopericardium. Transthoracic echocardiography (TTE) showed a moderate amount of pericardial effusion with tamponade and a large hematoma.

Interventions:

Under fluoroscopy and portable echocardiography guidance, a cardiologist immediately inserted a 7-French pigtail catheter into the pericardial space and collected more than 200 cc of bloody pericardial fluid.

Outcomes:

After pericardiocentesis, the patient's symptoms and hemodynamic status were dramatically improved. Follow-up TTE showed scanty amount of pericardial effusion and the drainage catheter was removed. The patient was discharged.

Lessons:

When treating HCC in the left lobe (especially segments II and IVa), attention should be paid to cardiac tamponade. The early diagnosis and immediate treatment of cardiac tamponade may increase the chance of cure.
Comparison of anchor screw fixation versus mini-plate fixation in unilateral expansive open-door laminoplasty for the treatment of multi-level cervical spondylotic myelopathy
Authors: Lin Xiang , Chen Kaiwei , Tang Haijun , Huang Xianying , Wei Changwu , Xiao Zengming
Published: December 2018

Study design:

Systematic review and meta-analysis.

Background:

Anchor screw fixation and mini-plate fixation are widely used in unilateral open-door laminoplasty. There is a great controversy over the preferred fixation method. The purpose of this study is to evaluate the clinical outcomes between anchor screw fixation and mini-plate fixation for the treatment of multilevel cervical spondylotic myelopathy (MCSM).

Methods:

Related studies that compared the clinical effectiveness of anchor screw fixation and mini-plate fixation in cervical laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to March, 2018. Included studies were evaluated according to eligibility criteria. The main end points included: preoperative Japanese Orthopedic Association (JOA) scores, postoperative JOA scores, JOA scores improvement rate, preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), lamina open angle, operation time, blood loss, C5 nerve palsy rate and axial symptoms rate.

Results:

Papers in English and Chinese were searched for the initial review, but only 12 articles in Chinese were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale (NOS). Among 809 patients, 372 underwent anchor screw fixation and 437 underwent mini-plate fixation. The results of this meta-analysis indicated that no significant difference was found in preoperative JOA score, JOA scores improvement rate, preoperative CCI, preoperative ROM, C5 palsy rate and blood loss. However, compared with mini-plate fixation, anchor screw fixation patients showed higher axial symptoms rate [RR = 1.75, 95% CI (1.31, 2.35), P <.05], lower postoperative JOA scores [SMD = −0.38, 95% CI (−0.62, −0.15), P <.05], lower postoperative CCI [SMD = −0.64, 95% CI (−0.94, −0.33), P <.05], lower postoperative ROM [SMD = −1.11, 95% CI (−2.18, −0.04), P <.05], smaller lamina open angle [SMD = −1.98, 95% CI (−3.71, −0.24), P <.05], shorter operation time [SMD = −0.33, 95% CI (−0.59, −0.07), P <.05].

Conclusions:

Compared with anchor screw fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, future well-designed, randomized controlled trials are still needed to further confirm our results.
Incomplete intestinal obstruction as an initial and persistent presentation in chronic inflammatory demyelinating polyneuropathy
Authors: Wang Long , Yuan Xiao-Zheng , Zhao Xue-Min , Wang Fu-Yu , Wang Yu
Published: December 2018

Rationale:

Autonomic symptoms are not uncommon in chronic inflammatory demyelinating polyneuropathy (CIDP), but they are mostly mild and transient and are overshadowed by somatic manifestations. Here, we report a very unusual case of CIDP with severe autonomic symptom, intestinal obstruction, as initial and persistent symptom which responded well to high-dose glucocorticoid and intravenous immunoglobulin treatment.

Patient concerns:

We described a patient with CIDP with precedent and long-lasting incomplete intestinal obstruction. Clinical manifestations were precedent and chronic abdominal pain, distension and constipation, and later numbness and weakness of lower and upper limbs. Radiograph showed incomplete intestinal obstruction, cerebrospinal fluid (CSF) showed albuminocytological dissociation and electromyography indicated neurogenic lesion.

Diagnoses:

CIDP with incomplete intestinal obstruction was diagnosed based on the history, related symptoms, typical abdominal radiograph, CSF albuminocytological dissociation, and electromyographic findings.

Interventions:

The patient was treated with intravenous methylprednisolone and immunoglobulin.

Outcomes:

After treatment, the intestinal obstruction disappeared and the somato-symptoms improved greatly and gradually.

Lessons:

This case highlights the need for diagnostic vigilance in cases of incomplete intestinal obstruction of unknown cause. We recommend CSF and electromyography examination in view of rare but possibility of CIDP.
Metanephric adenoma with low apparent diffusion coefficient value mimicking renal cell carcinoma
Authors: Chang Chun-Bi , Ng Kwai-Fong , Wong Yon-Cheong , Lee Shen-Yang , Chuang Cheng-Keng , Wang Li-Jen
Published: December 2018

Rationale:

Metanephric adenoma (MA) is a rare and often benign tumor. Most MAs were misdiagnosed as renal cell carcinomas (RCCs) preoperatively. Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping can help to differentiate benign and malignant tumors. However, there are still pitfalls in using DWI and ADC to discriminate benign and malignant lesions.

Patient concerns:

A 56-year-old woman had a right renal metanephric adenoma. The tumor showed very low ADC value preoperatively and was misdiagnosed as a renal cell carcinoma.

Diagnosis:

Intraoperative ultrasound-guided percutaneous biopsy of tumor was performed. Based on the histopathological findings and immunohistochemical stains, a diagnosis of metanephric adenoma was suggested.

Interventions:

The patient received percutaneous cryoablation of this tumor. Five years later, she underwent right partial nephrectomy because local recurrence was revealed on a follow-up computed tomography (CT).

Outcomes:

MA was confirmed again by histological examination. The patient was uneventful after surgery.

Lessons:

ADC mapping can be used for differentiating RCCs from other benign tumors by their lower ADC values. However, some benign and malignant lesions have overlapped low ADC values. This case illustrated that a benign lesion such as MA could mimic RCC on ADC, by its highly cellular component. Cryoablation is an optional treatment, which has an increased risk of local recurrence. Follow-up CT or MRI is useful and necessary for detection of local recurrence by depicting enhancing solid parts in a tumor over time.
Pressure management as an occupational stress risk factor in irritable bowel syndrome
Authors: Popa Stefan Lucian , Leucuta Daniel Corneliu , Dumitrascu Dan Lucian
Published: December 2018

Irritable Bowel Syndrome (IBS) is the most prevalent functional gastrointestinal disorder. Psychosocial stress is one of the pathogenic factors involved in the pathogenesis of IBS. The Pressure Management Indicator (PMI) is a validated questionnaire to analyze all aspects of occupational stress—a model involving sources of pressure, the mechanisms of coping, the personality, and the resulting effects of the interaction between these 3 elements. The purpose of this study was to analyze the association between socio-professional stress effects in IBS, and the relationship of IL-6 levels and salivary cortisol with occupational stress.

We conducted a prospective cross-sectional study on 76 patients (39 patients with IBS, diagnosed according to the Rome III criteria and 37 healthy controls) who were investigated using a validated self-administered questionnaire: PMI. The biologic markers of chronic stress were analyzed using salivary cortisol and the immune response with serum interleukin 6 (IL-6).

The IBS patients corresponded to the following subtypes: diarrhea-predominant: 22, constipation-predominant: 14 and mixed: 3. All the socio-professional pressure effects variables and scales were statistically significant, in an inversely proportional relation with IBS. Lower scores (poor effects) were found in IBS subjects. The adjusted odds ratios of having IBS versus healthy subjects for the socio-professional pressure effects scales were: 0.81 (95% confidence interval (CI) 0.72–0.88), for satisfaction, 0.85 (95% CI 0.78–0.91) for organization, 0.85 (95% CI 0.79–0.91) for mental wellbeing and 0.8 (95% CI 0.71–0.87) for physical wellbeing (P <.001). Also, the serum IL-6 levels were significantly higher in IBS than in controls (p < 0.001). There was no statistical difference between the salivary levels of cortisol between IBS patients and controls (P = .898).

The level of occupational stress was higher in IBS patients compared to healthy subjects (socio-professional stress effects were lower in IBS patients) and correlated with IL-6 levels. Salivary cortisol was not associated with occupational pressure management.
Non-dislocation lunate fracture combined with distal radius fracture
Authors: Guo Wenlai , Yuan Baoming , Zhu Zhe , Huang Chao , Li Rui , Wu Dankai
Published: December 2018

Rationale:

Lunate fractures are very rare, accounting for only 0.5% to 6.5% of all carpal fractures. They are mostly caused by high-energy trauma and commonly occur with fractures and dislocations of other carpal bones. It is rarely combined with Colles’ fracture and the underlying pathogenesis and prognostic significance still remain controversial.

Patient concerns:

Here we report a case of a fresh lunate fracture combined with Colles’ fracture, without dislocations of other carpal bones caused by a low-energy fall injury.

Diagnoses:

Lunate fracture, Colles’ fracture.

Interventions:

This patient received closed reduction and internal fixation (CRIF) with K-wire.

Outcomes:

The patient took follow up 1 year and the patient showed good function of the wrist joint

Lessons:

Lunate fractures have no high misdiagnosis rate. Patients suffering persistent wrist swelling after a trauma should be carefully examined and followed up to prevent severe secondary diseases and wrist joint dysfunction.
Prognostic role of neutrophil–lymphocyte ratio in esophageal cancer
Authors: Zhang Xiangwei , Jiang Yuanzhu , Wang Yang , Wang Zhaoyang , Zhao Linping , Xue Xianbiao , Sang Shaowei , Zhang Lin
Published: December 2018

Background:

The prognostic role of neutrophil-to-lymphocyte ratio (NLR) in esophageal cancer (EC) remains controversial.

Methods:

The aim of this study was to evaluate the association between NLR and oncologic outcome of EC patients through a meta-analysis. A systematic search was performed in PubMed, Web of Science and Embase for relevant studies. Meta-analysis was performed using hazard ratio (HR) and95% confidence interval (CI) as effect measures.

Results:

Finally, 33 articles with 11,039patients were included in our study. The synthesized results indicated that the elevated NLR was negatively related to overall survival (OS) (HR = 1.39, 95% CI: 1.23–1.54). When the patients were stratified according to country, pathological type, treatment strategies, sample size, and different HR estimate method, high NLR was also significantly correlated with poor OS. Similarly, elevated NLR was also associated with shorter disease-free survival (DFS), progress-free survival (PFS), relapse-free survival (RFS), and cancer-specific survival (CSS).

Conclusion:

The elevated pretreatment NLR is associated with poor oncological outcomes in patients with EC. NLR may be a significant predictive biomarker in EC. Further large-cohort studies are needed to confirm these findings.
Relationships Between Adipose Mitochondrial Function, Serum Adiponectin, and Insulin Resistance in Persons With HIV After 96 Weeks of Antiretroviral Therapy
Authors: Hulgan Todd , Ramsey Benjamin S. , Koethe John R. , Samuels David C. , Gerschenson Mariana , Libutti Daniel E. , Sax Paul E. , Daar Eric S. , McComsey Grace A. , Brown Todd T.
Published: December 2018

Objective:

Some antiretroviral therapy (ART) and HIV itself confer metabolic risk, perhaps through altered mitochondrial function and adipokines. In AIDS Clinical Trials Group study A5224s, adipose mitochondrial DNA (mtDNA) levels decreased on ART, and electron transport chain complex I (CI) and complex IV (CIV) activity decreased. Another study found decreased serum adiponectin on ART with mtDNA mutation m.10398A>G. We hypothesized that decreased adipose tissue mitochondrial function would be associated with lower adiponectin and insulin sensitivity on ART, and m.10398G would influence these changes.

Design:

Retrospective analysis of an ART-naive substudy population from A5224s.

Methods:

Analyses included adipose mtDNA levels, CI and CIV activity by immunoassay, visceral adipose tissue by computed tomography, and fasting serum glucose at week 0 and week 96 of ART. Fasting insulin and adiponectin were measured from cryopreserved serum using multiplex bead array. Homeostasis model assessment-2 (HOMA2)-IR and HOMA2-%B estimated insulin resistance and β-cell function, respectively. The m.10398A>G mtDNA variant was available from existing genetic data.

Results:

Thirty-seven participants had adipose biopsies at week 0 and week 96. Percent decreases in CIV activity and adiponectin were correlated (Spearman rho 0.41; P = 0.01); this association persisted after controlling for age, sex, body mass index, or visceral adipose tissue in single-covariate regression. HOMA2-IR correlated with decreased CIV (−0.44; P = 0.01) and CI (−0.34; P = 0.05) activity. Among 12 non-Hispanic white persons, m.10398G was associated with decreased adiponectin (P = 0.04).

Conclusions:

Decreased adipose mitochondrial activity correlated with changes in adiponectin and glucose homeostasis on ART. Previous findings that a mtDNA mutation modulates adiponectin levels in persons with HIV were replicated.
A Randomized Placebo-Controlled Trial of Low- Versus Moderate-Dose Vitamin D3 Supplementation on Bone Mineral Density in Postmenopausal Women With HIV
Authors: Yin Michael T. , RoyChoudhury Arindam , Bucovsky Mariana , Colon Ivelisse , Ferris David C , Olender Susan , Agarwal Sanchita , Sharma Anjali , Zeana Cosmina , Zingman Barry , Shane Elizabeth
Published: December 2018

Background:

Prevalence of osteoporosis and fracture is increased among older people with HIV. We compared the effects of low (1000 IU) vs moderate (3000 IU) vitamin D3(VitD) supplementation on areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD) in African American and Hispanic postmenopausal women with HIV on antiretroviral therapy.

Methods:

We performed a 12-month prospective, randomized, double-blind, placebo-controlled study with primary outcomes of change in aBMD by dual-energy X-ray absorptiometry (DXA) and secondary outcomes of change in vBMD by quantitative computed tomography and bone turnover markers. An intent-to-treat analysis was performed on 85 randomized subjects (43 low and 42 moderate) for primary DXA outcomes, and complete case analysis was performed for secondary outcomes.

Results:

Mean age was 56 ± 5 years, median CD4 count was 722 cells/mm3, and 74% had HIV RNA ≤ 50 copies/mL. Serum 25-OHD was higher in the moderate than low VitD group at 6 months (33.1 ± 10.3 vs 27.8 ± 8.1 ng/mL,P= 0.03) and 12 months, but parathyroid hormone levels remained similar. Percent change in aBMD, vBMD, and bone turnover markers did not differ between low and moderate VitD groups before or after adjustment for baseline aBMD.

Conclusions:

VitD supplementation at 3000 IU daily increased mean total 25-OHD levels in postmenopausal women with HIV, but we did not find evidence of an effect on BMD beyond those observed with 1000 IU daily. Future studies are necessary to determine whether VitD supplementation is beneficial in this patient population, and if so, what dose is optimal for skeletal health.
A review of racial/ethnic disparities in pediatric trauma care, treatment, and outcomes
Authors: LaPlant Melanie B. , Hess Donavon J.
Published: December 2018

Health disparities are an increasingly researched topic in the United States. Evidence of disparities found across the spectrum of health care includes pediatric patients. The purpose of this review is to comprehensively summarize disparities among pediatric trauma patients, evaluating both emergency department and hospital treatment and outcomes. Multiple studies describe disparities in a variety of areas of trauma care including emergency department, radiology, surgery, abuse evaluation, and discharge rehabilitation. More concerning, multiple studies report disparities in length of stay, disability, recidivism, and mortality. This review also highlights several gaps in disparity research including specialty care, inclusion of all racial/ethnic groups, and geographic differences. Few of the reviewed studies described disparity interventions; however, research regarding abuse evaluations showed that care guidelines diminished disparity. Trauma care, a routinized patient service, is subject to existing care guidelines and quality improvement programs, and may be the ideal health care setting for disparity intervention.

LEVEL OF EVIDENCE

Study type review, level V.
Muography of different structures using muon scattering and absorption algorithms
Authors: Vanini S. , Calvini P. , Checchia P. , Rigoni Garola A. , Klinger J. , Zumerle G. , Bonomi G. , Donzella A. , Zenoni A.
Published: December 2018

In recent decades, muon imaging has found a plethora of applications in many fields. This technique succeeds to infer the density distribution of big inaccessible structures where conventional techniques cannot be used. The requirements of different applications demand specific implementations of image reconstruction algorithms for either multiple scattering or absorption–transmission data analysis, as well as noise-suppression filters and muon momentum estimators. This paper presents successful results of image reconstruction techniques applied to simulated data of some representative applications. In addition to well-known reconstruction methods, a novel approach, the so-called μCT, is proposed for the inspection of spent nuclear fuel canisters. Results obtained based on both μCT and the maximum-likelihood expectation maximization reconstruction algorithms are presented.

This article is part of the Theo Murphy meeting issue ‘Cosmic-ray muography’.