bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery
Authors: Meng-Meng Tong , Xue-Jun Xu , Xiao-Hong Bao
Published: July 2019

Purpose:

Some studies have reported that warmed humidified carbon dioxide (CO2) insufflation in adult laparoscopic surgery could reduce pain and improve the core body temperature (CBT). However, similar studies are lacking in infants. Thus, this study aimed to investigate the clinical effects of warmed, humidified CO2 insufflation in pediatric patients undergoing major laparoscopic surgeries.

Methods:

From January 2015 to December 2017, infants who underwent major laparoscopic surgeries in Ningbo Women and Children's Hospital were randomized to Group A (standard CO2 insufflation) or Group B (warmed humidified CO2 insufflation, 35°C, 95% relative humidity). Change in CBT at the end of surgery was the primary outcome. Secondary outcomes included surgery time, intraoperative blood loss, oxygen saturation (SO2), and Face, Legs, Activity, Cry and Consolability (FLACC) scale. These variables were compared between the 2 groups.

Results:

Sixty-three infants (38 females, 25 males) were included; 30 patients were in Group A and 33 in Group B. The diseases treated with the laparoscopic approach included congenital megacolon, congenital diaphragmatic hernia, and intestinal malrotation. No deaths were noted. CBT was significantly higher in Group B at the end of surgery (P = .021). The occurrence of postoperative shivering (P = .02), hypothermia (P = .032), bowel movement (P = .044), and hospital stay (P = .038) was significantly different between the 2 groups; Group B had less shivering and hypothermia occurrence after surgery. Moreover, Group B demonstrated a more rapid postoperative recovery of bowel movement and shortened hospital stay than Group A. There was no statistical difference in operative time (P = .162), intraoperative blood loss (P = .541), SO2 (P = .59), and FLACC scale (P = .65) between the 2 groups.

Conclusion:

The use of warmed humidified CO2 insufflation in infants undergoing major laparoscopic surgery was helpful for maintaining normothermia and was associated with several positive postoperative outcomes, including less shivering and hypothermia, faster recovery of bowel movement, and shortened hospital stay.
Acquired pure red cell aplasia in a patient with ankylosing spondylitis- a case report and literature review
Authors: Shao Xianfang , Wei Wei , Zhao Yangzhi , Liang Xinyue , Liu Qiuju
Published: July 2019

Rationale:

Acquired pure red cell aplasia (PRCA) can be a secondary response to some autoimmune disorders. However, there is no data about the possibility of acquired PRCA being a secondary complication to ankylosing spondylitis (AS).

Patient concerns:

A 42-year-old male who had a history of AS for 14 years. He got serious anemia 17 months ago. Bone marrow smear indicated PRCA.

Diagnose:

He was diagnosed with acquired PRCA secondary to AS.

Intervention:

The combination treatment of immunosuppressants with hematopoiesis stimuli was successful.

Outcomes:

The patient recovered from PRCA, and showed improvement in his AS.

Lessons:

Acquired PRCA can be secondary to AS. Cyclosporine is effective in controlling AS arthritis syndrome and in addition to immunosuppressants, promotion of erythroid hematopoiesis is equally important.
Women successfully treated for severe intrahepatic cholestasis of pregnancy do not have increased risks for adverse perinatal outcomes
Authors: Yang Jielian , Chen Chong , Liu Min , Zhang Shuye
Published: July 2019

Intrahepatic cholestasis of pregnancy (ICP) increases adverse perinatal outcome (APO) incidence. Whether successful treatment of severe ICP reduces APO risk is unclear.

This retrospective, single-center study in China enrolled consecutive women with ICP who had term delivery (≥37 weeks, singleton) between August 2013 and June 2016. Patients were divided into the mild ICP (serum bile acids (SBA) ≤40 μmol/L throughout pregnancy) and severe ICP (SBA >40 μmol/L during pregnancy but fell after ursodeoxycholate therapy) groups. Baseline characteristics, laboratory investigations, and maternal and neonatal outcomes were assessed. Logistic regression was used to identify factors associated with meconium staining of amniotic fluid (MSAF) and APOs.

Seventy-three patients were included (mild ICP group, n=47; severe ICP group, n=26). Pruritus was more common in the severe ICP group (65.4% vs 40.4%; P <.05), but other baseline characteristics were similar. Compared with the mild ICP group, the severe ICP group had higher SBA at first visit and peak value, higher direct bilirubin before delivery and 4 days postpartum, and lower gamma-glutamyltransferase at peak value, before delivery and 4 days postpartum (P <.05). Other laboratory parameters, type of delivery, hemorrhage, and liver function abnormality were similar between groups, although the severe ICP group had longer duration of hepatic dysfunction (P <.05). Birth weight was lower in the mild ICP group (P <.05), but other fetal outcomes were similar between groups. Logistic regression identified no factors (including SBA group) associated with APOs or MSAF.

Women successfully treated for severe ICP do not have increased risks for APOs.
Clinical outcomes and time to recurrence of phototherapeutic keratectomy in Japan
Authors: Hieda Osamu , Kawasaki Satoshi , Yamamura Kiyoshi , Nakatsukasa Mina , Kinoshita Shigeru , Sotozono Chie
Published: July 2019

To assess the indications, outcomes and time to recurrence of phototherapeutic keratectomy (PTK) for anterior corneal pathology.

This study involved 714 eyes of 477 consecutive patients (mean age: 66.0 ± 15.2 years; range: 6–101 years) who underwent PTK as the initial surgical intervention for an anterior corneal pathology. In case of each patient, the cornea treated by PTK, followed up by slit-lamp examination and corrected distance visual acuity (CDVA) testing. Main outcome measures included Slit-lamp findings (1), CDVA (2), patients’ complaints (3).

The mean follow-up period was 44.0 ± 38.8 months (range: 1–156 months).

We treated 376 granular corneal dystrophy (GCD) eyes, 238 band keratopathy (BK) eyes, 23 epithelium attachment disorder eyes, 16 gelatinous drop-like corneal dystrophy (GDLD) eyes, 13 lattice corneal dystrophy (LCD) eyes, and 48 eyes with other corneal diseases. The CDVA significantly improved from LogMAR 0.65 ± 0.61 pre PTK to LogMAR 0.26 ± 0.39 post PTK. A 2 or more lines increase of CDVA was observed in GCD eyes (67.8%), BK eyes (49.2%), epithelium attachment disorder eyes (57.1%), GDLD eyes (87.5%), LCD eyes (76.9%), and other corneal disease eyes (60.4%). The recurrence of BK was rare. GCD recurred slowly. Epithelium attachment disorder eyes remitted simultaneously, and recurred comparatively faster.

PTK was proved to be a successful therapy for all 6 corneal disease categories. Disease recurrence after PTK differed among the diseases, and surgeons should recognize the different rates of disease recurrence after PTK surgery.
Lobar location of lesions in computed tomography-guided lung biopsy is correlated with major pneumothorax
Authors: Yan Weipeng , Guo Xiaofang , Zhang Jing , Zhou Junfen , Chen Changchun , Wang Manxiang , Zhang Zhaoxi , Liu Yulin
Published: July 2019

Pneumothorax is a common complication in computed tomography (CT)-guided percutaneous lung biopsy (CPLB). Whether the lobar location of lesions contributes to the incidence of pneumothorax should be further clarified.

A total of 1452 consecutive patients who underwent CPLB between January 2010 and March 2018 were retrospectively analyzed. The incidence of pneumothorax was compared among 5 different lobe biopsies. Minor pneumothorax was defined as pneumothorax without chest tube placement and major pneumothorax was defined as pneumothorax with chest tube placement.

The positive diagnosis rate of pathology for this cohort was approximately 84%, with 22.5% (326/1452) of the patients experiencing pneumothorax. The rates of pneumothorax were 19.5%, 24.5%, 33.9%, 21.4%, and 23.9% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively (P = .09). Chest tube placement was necessary in 19.0% (62/326) of the patients with pneumothorax. The rates of major pneumothorax were 5.3%, 2.6%, 10.2%, 4.7%, and 2.6% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe biopsies, respectively (P = .02). This result was further confirmed by the propensity score-matching method. Moreover, 8.7% (127/1452) of the patients experienced puncture of fissure, the rates of which were 13.5%, 5%, 10.2%, 9.1%, and 4.3% for the right upper lobe, right lower lobe, right middle lobe, left upper lobe, and left lower lobe, respectively (P < .001). Within the pneumothorax patient group, the rate of lobe fissure puncture (15.2%) was significantly lower in patients with minor pneumothorax than (51.6%) in those with major pneumothorax (P < .001).

Upper and middle lobe lesion biopsies show a significantly high rate of major pneumothorax, which may be due to more puncture of fissure. It is crucial to carefully distinguish the fissure around lesions and bypass it to avoid major pneumothorax.
Bioinformatics analysis of differentially expressed genes involved in human developmental chondrogenesis
Authors: Zhou Jian , Li Chenxi , Yu Anqi , Jie Shuo , Du Xiadong , Liu Tang , Wang Wanchun , Luo Yingquan
Published: July 2019

Osteoarthritis (OA), also known as degenerative arthritis, affects millions of people all over the world. OA occurs when the cartilage wears down over time, which is a worldwide complaint. The aim of this study was to screen and verify hub genes involved in developmental chondrogenesis as well as to explore potential molecular mechanisms.

The expression profiles of GSE51812 were downloaded from the Gene Expression Omnibus (GEO) database, which contained 9 samples, including 6-week pre-chondrocytes (PC, 6 independent specimens) and 17-week fetal periarticular resting chondrocytes (RC, 3 independent specimens). The raw data were integrated to obtain differentially expressed genes (DEGs) and were further analyzed with bioinformatics analysis. The Gene Ontology (GO) and pathway enrichment of DEGs were conducted via Database for Annotation, Visualization, and Integrated Discovery (DAVID). The protein-protein interaction (PPI) networks of the DEGs were constructed based on data from the search tool for the retrieval of interacting genes (STRING) database. An intersection figure was provided to show the relationship between the DEGs identified in this study and genes from any existed related studies.

A total of 9486 DEGs, including 4821 upregulated genes and 4665 downregulated genes were observed. The top 30 developmental chondrogenesis associated genes were identified, including matrix metalloproteinase (MMP)1, MMP3, MMP13, prostaglandin-endoperoxide synthase 2 (PTGS2), and so on. The majority of DEGs, including PTGS2, CCL20, CHI3L1, LIF, CXCL8, and CXCL12 were intensively enriched in immune-associated biological process terms, including inflammatory, and immune responses. Additionally, the majority of DEGs were mainly enriched in NF-kappa β (NF-kβ) signaling pathway and tumor necrosis factor (TNF) signaling pathway. The hub genes identified in STRING and Cytoscape databases included MMP1, MMP3, MMP13, PTGS2 and so on. Among the top 30 upregulated and downregulated DEGs, there were 15 genes have been reported to be associated with OA or developmental chondrogenesis.

This large scale gene expression study observed genes associated with human developmental chondrogenesis and their relative GO function, which may offer opportunities for the research for cartilage tissue engineering and novel insights into the prevention of OA in the near future.
The effect of zinc supplementation in pre-diabetes
Authors: Du Xuqin , Shi Lipeng , Gao Hong , Fu Xiaoxu , Zhang Xiyu , Zhang Yuan , Xie Chunguang
Published: July 2019

Background:

The number of people with diabetes and pre-diabetes is growing exponentially. Human studies have shown that zinc supplementation is beneficial for pre-diabetes. However, owing to the low quality, small sample size, and methodological heterogeneity of these studies, this conclusion is not convincing. Consequently, in order to determine whether zinc supplementation is effective and safe in pre-diabetic patients, it is necessary to conduct a meta-analysis of high-quality clinical trials.

Methods:

We will retrieve MEDLINE (PubMed), EMBASE, the Web of Science, Cochrane Library, and the ClinicalTrials.gov website without restriction on language. Randomized controlled trials (RCTs) of Zinc supplementation for adult patients with pre-diabetes will be searched in multiple databases from inception to October 2020. The primary outcome of the meta-analysis is the HbA1c. The secondary outcomes include the fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI). Two assessors will utilize the Cochrane Collaboration's risk of bias tool to evaluate the RCTs and all statistical data will be analyzed by using the Review Manage software V5.3.0.

Results:

This study will provide high-quality synthesis of effectiveness and safety of zinc supplementation for pre-diabetes.

Conclusion:

This systematic review and meta-analysis will provide the available evidence to assess whether the zinc supplementation is beneficial to glucose control and insulin resistance in patients with pre-diabetes.

PROSPERO registration number:

CRD 42018095724
Acute compartment syndrome
Authors: Guo Jialiang , Yin Yingchao , Jin Lin , Zhang Ruipeng , Hou Zhiyong , Zhang Yingze
Published: July 2019

Background:

Acute compartment syndrome (ACS) is defined as a clinical entity originated from trauma or other conditions, and remains challenging to diagnose and treat effectively. The review was aim to present the controversy in diagnosing, treating ACS. It was found that there was no criterion about the ACS, and result unnecessary osteotomy. The presence of clinical assessment (5P) always means the necrosis of muscles and was the most serious or irreversible stage of ACS. Besides pressure methods, the threshold of pressure identifying ACS was also controversial.

Methods:

Immediate surgical fasciotomy was important to prevent severe suquelae of the ACS. However, there was still controversy about the right time that fasciotomy should be done to avoid irreversible ischemic changes. The most important thing to treat ACS was comprehension to the true injury mechanism, but a systemic classification about traumatic mechanism in most literature was not clear.

Results:

After observations to fracture patients with blister, we recommended that surgeons dealing with such emergencies should be vigilant, and the indication for fasciotomy should be strictly controlled following with injury mechanism especially for patients without severe soft tissue injury.

Conclusion:

For those crushing and soft tissue injuries, the current evidence based strategies for managing patients was useful, but for those fracture related injury, more examination was necessary to avoid overtreatment especially for those patients with blister observed. In facing patients, medical history, injured mechanism should be paid special attention, and rigorous classification about traumatic etiology was the key for the treatment of these patients.
Ultrasound is highly specific in diagnosing compensated cirrhosis in chronic hepatitis C patients in real world clinical practice
Authors: Yen Yi-Hao , Kuo Fang-Ying , Chen Chien-Hung , Hu Tsung-Hui , Lu Sheng-Nan , Wang Jing-Houng , Hung Chao-Hung
Published: July 2019

Ultrasound is routinely used during the evaluation of liver cirrhosis. Inter-observer variability is considered a major drawback. This retrospective study investigated the accuracy of ultrasound in diagnosing compensated cirrhosis (i.e., modified Knodell F3, F4) in chronic hepatitis C (CHC) patients in real world clinical practice. Consecutive treatment-naive CHC patients who underwent liver biopsy (LB) prior to interferon therapy from 1997 to 2010 were enrolled. Ultrasound was performed by 30 hepatologists prior to LB. Ultrasound-identified cirrhosis was defined as small liver size, nodular liver surface and coarse liver parenchyma. LB was used as a reference, and the diagnostic accuracy of ultrasound was assessed and compared. Fibrosis was scored according to the modified Knodell classification. A cohort comprising 1738 patients, including 922 men and 816 women with a mean age of 52.5 years, was analyzed in the present study. The distribution of the patients’ modified Knodell scores was F0 = 336, F1 = 489, F2 = 165, F3 = 315, F4 = 433. Ultrasound-identified cirrhosis was noted in 283 patients. Using ultrasound-identified cirrhosis to predict compensated cirrhosis, the sensitivity was 34.0%, the specificity was 97.1%, the positive predictive value was 89.8%, the negative predictive value was 66.1%, the positive likelihood ratio was 11.6, and the negative likelihood ratio was 0.68. The area under the ROC curve (AUROC) was 0.66.

Despite being affected by inter-observer variability, ultrasound is highly specific in diagnosing compensated cirrhosis in CHC patients in real world clinical practice. However, the sensitivity is low.
Why is the recognition rate of psychological distress under-estimated in general hospitals? A cross-sectional observational study in China
Authors: Wang Yu , Murray Alexandra M. , Toussaint Anne-Kristin , Chen Liang , Guo Wan-Jun , He Ning , Luo Shan-Xia , Yu Jian-Ying , Liu Yang , Huang Ming-Jin , Dong Zai-Quan , Zhang Lan
Published: July 2019

This study aimed to investigate the recognition rate of psychological distress in general hospitals in China and to examine the main associated factors.

Using a cross-sectional study design, the questionnaires were administered to a total of 1329 inpatients from a tertiary hospital. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire (PHQ-15) and the Whiteley-7 (WI-7) were used to assess patients’ mental health status. Two subjective questions were used to identify the awareness of psychological distress in patients and doctors.

The frequency of psychological distress measured by the questionnaires was high in our sample (53.4%). However, the recognition rates of both patients (34.9%) and by doctors (39.1%) was low. The concordance rate between patients and doctors of whether the patient had psychological distress or not was extremely poor (Kappa = 0.089, P = .001). Factors associated with the poor concordance rate included patients’ annual household income and clinically significant self-reported symptoms of anxiety and hypochondriasis.

The recognition rate of psychological distress was underestimated and this may be related to a lack of awareness of mental disturbances and patients’ low annual household income.
Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall
Authors: Hsu Hao-Eng , Chen Cheng-Yu
Published: July 2019

Rationale:

Tuberculous retropharyngeal abscess is rare, but it can be fatal if not treated appropriately. It usually occurs secondary to tuberculosis of the cervical spine. Moreover, tuberculous abscess involving the chest wall is relatively rare in skeletal tuberculosis. Although the optimal treatment is controversial, most clinicians suggest a combination of sufficient antituberculous medication and complete resection to prevent recurrence and increase therapeutic efficacy. Herein, we present an unusual case of retropharyngeal abscess with cervical Pott disease and tuberculous abscess of the chest wall.

Patient concerns:

The patient was a 27-year-old Indonesian woman who had neck pain, dysphagia, and odynophagia, but no neurological deficit. Examination of the oral cavity showed anterior displacement of the posterior pharyngeal wall. The mass over the right anterior chest wall measured approximately 5 × 4 cm in size.

Diagnoses:

Radiography and computed tomography findings were suggestive of retropharyngeal abscess extending to the cervical spine and chest wall abscess.

Interventions:

She was admitted to the hospital for treatment. Drainage of the retropharyngeal and chest wall abscesses with debridement of the chest wall was performed.

Outcomes:

No complications occurred after early surgical treatment and administration of antituberculous medication. The patient recovered well and went back to her own country after discharge.

Lessons:

Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall are both complicated diagnoses that physicians have to consider in similar patient presentations.
Refractory Sjögren's syndrome myelopathy successfully treated with subcutaneous tocilizumab
Authors: Ishikawa Yuichi , Hattori Koto , Ishikawa Junichi , Fujiwara Michio , Kita Yasuhiko
Published: July 2019

Rationale:

It is known that 5% to 34% of Sjögren's syndrome (SS) cases are complicated by neuropathy in the form of myelitis. Although SS myelopathy (SSM) is often treated with glucocorticoid (GC) and immunosuppressants such as cyclophosphamide (CY), a therapeutic strategy for SSM has not been established.

Patient concerns:

A 65-year-old female was admitted with weakness and thermal hypoalgesia in the lower limbs. Four months before this admission, she showed weakness in her lower limbs and thermal hypoalgesia of bilateral upper and lower limbs. Magnetic resonance imaging (MRI) revealed that the cause of her neurological symptoms was cervical myelitis. She was diagnosed with SS because she tested positive for the ophthalmic test (Schirmer's test and fluorescent test) and for the anti-SS-A antibodies. Therefore, myelitis was thought to be a complication of SS. She was treated with GC and CY. Both neurological symptoms and MRI findings temporarily improved, and the GC dose was gradually decreased. One month before this admission, her neurological symptoms and MRI findings were exacerbated. Upon relapse of SSM, serum amyloid A protein (SAA) level was markedly elevated.

Diagnoses:

Based on MRI findings, the diagnosis was SSM relapse.

Interventions:

Treatment by subcutaneous tocilizumab (TCZ) 162 mg every two weeks was introduced.

Outcomes:

After introducing TCZ, her neurological symptoms and MRI findings gradually improved. SAA levels remained low. At eight months after the introduction of TCZ, the GC dose has been decreased and so far, the myelitis has not relapsed.

Lessons:

This case report is the first report suggesting the effectiveness of TCZ for refractory SSM. Subcutaneous TCZ might be an effective therapeutic option for treating refractory SSM when SAA levels are elevated.
Do rheumatoid arthritis patients have more major complications and length of stay after lower extremities fracture surgery?
Authors: Hsu Huan , Kung Pei-Tseng , Ku Ming-Chou , Lan Joung-Liang , Chou Wen-Yu , Tsai Wen-Chen
Published: July 2019

Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular diseases and fractures. This retrospective cohort study explored whether patients with RA face higher complication risks or longer hospital stays than other patients when they had a lower limb fracture that required the surgery. Patients aged >45 years who received lower limb fracture surgeries between 2005 and 2012 were selected from the National Health Insurance Research Database, and 10 related variables including sex and age were used in propensity score matching to pair RA patients with non-RA patients in a 1:4 ratio. The final study sample comprised 1109 patients with RA and 4436 non-RA patients. The results indicated that 5.57% of the study sample had postoperative complications, accounting for 5.05% of patients with RA and 5.70% of the control group. After conditional logistic regression analysis was performed, the risk of major complications has no significant differences between patients with RA and the control group (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.61–1.24; P > .05). However, the comorbidity severity score exerted a significant effect on complications; patients with scores ≥3 were 2.78 times more likely to experience complications (OR = 2.78; 95% CI 1.52–5.07). When considering different types of complications, patients with RA were less likely to be exposed to the risk of stroke (OR = 0.48). After controlling all related factors, no significant differences were observed in the complication risks or deaths between the 2 groups (P > .05). Regarding hospitalization length, the average stay for all patients was 8.12 days; after controlling related factors, the hospitalization length for patients with RA was 0.97 times that of the control group, which was nonsignificant (P > .05). These results may provide some information to healthcare professionals when providing treatments.
Treatment rationale and design of the induction chemotherapy and adjuvant thoracic radiation in resectable N2-3A/3B non-small cell lung cancer (ICAT) study
Authors: Tsunezuka Hiroaki , Inoue Masayoshi
Published: July 2019

Background:

The optimal treatment strategy for stage N2–3A/3B non-small cell lung cancer (NSCLC) remains controversial owing to its heterogeneity. Although multimodal therapy is considered the standard therapeutic approach for stage N2–3A/3B resectable NSCLC patients, the optimal combination strategy still needs to be clarified.

Patients and methods:

In total, 25 male and female patients aged between 20 and 75 years with stage N2–3A/3B resectable NSCLC will be included. Eligible patients will undergo tri-modality therapy comprising induction chemotherapy (3 cycles of combination therapy with carboplatin and nab-paclitaxel), followed by surgery and postoperative radiotherapy. Recruitment was commenced in April 2017, with a planned last follow-up in March 2024. As of May 2019, 1 subject has been enrolled. The primary endpoint is the treatment completion rate. The secondary endpoints are objective response rate (ORR) of induction chemotherapy, treatment-related adverse event, recurrence-free survival (RFS) time, and overall survival (OS) time. RFS and OS time will be calculated as the time from this study registration to first recurrence and all-cause death, respectively.

Ethics and dissemination:

The protocol was approved by the institutional review boards of Kyoto Prefectural University of Medicine and all the participating hospitals. Written informed consent was obtained from all patients before registration, in accordance with the Declaration of Helsinki. The study results will be disseminated via publication in peer-reviewed journals.

Trial registration:

Trial registration number UMIN000025010 and jRCT1051180028
Diffuse ileal ganglioneuromatosis mimicking a gastrointestinal stromal tumor
Authors: Yin Xiaonan , Chen Xin , Shu Renjia , Shen Chaoyong , Yin Yuan , Cai Zhaolun , Wang Jian , Zhao Zhou , Chen Huijiao , Zhang Bo
Published: July 2019

Rationale:

Intestinal ganglioneuromatosis (IGNM) is a rare disease, defined by an abnormal proliferation of ganglion cells, nerve fibers and Schwann cells in the enteric nerve system.

Patient concerns:

A 54-year-old woman presented with a one-year history of recurrent episodes of hypogastric pain, with vomiting, nausea, melena, and weight loss of 10 kg in recent 5 months.

Diagnoses:

The patient was diagnosed as a diffuse IGNM by pathological examination.

Interventions:

A complete excision of the tumor was performed.

Outcomes:

On follow-up after 26 months, the patient was asymptomatic without complications.

Lessons:

This report showed a rare case of diffuse IGNM not associated with NF1 or MEN2b. Preoperative radiological examination suggested an intestinal GIST, yet the final diagnosis of diffuse IGNM was made according to the pathological examination of the resected specimen. Although the prevalence of ganglioneuromatosis is low, this condition should be considered in the differential diagnosis of intestinal mass in adults.
Association of prehospital oxygen administration and mortality in severe trauma patients (PROMIS)
Authors: Kondo Yutaka , Gibo Koichiro , Abe Toshikazu , Fukuda Tatsuma , Kukita Ichiro
Published: July 2019

Until now, we routinely administered oxygen to trauma patients in prehospital settings irrespective of whether oxygen delivery affected the prognosis. To determine the necessity of prehospital oxygen administration (POA) to trauma patients, we aimed to assess whether POA contributed to in-hospital mortality.

This was a multicenter propensity-matched cohort study involving 172 major emergency hospitals in Japan. During 2004 to 2010, 70,683 patients with trauma aged ≥15 years were eligible for enrolment. The main outcome measures were survival until hospital discharge after POA, and propensity score analyses were used to adjust for patient factors and hospital site.

Of 32,225 trauma patients, 19,985 (62.0%) were administered oxygen by the emergency medical services in prehospital settings and 12,240 (38.0%) did not receive oxygen. Overall, 29,555 patients (90.7%) survived till hospital discharge. In the multivariable unconditional logistic regression, POA had an odds ratio (OR) of 0.33 (95% confidence interval [CI], 0.30–0.37; P <.001) for favorable in-hospital mortality. Furthermore, there were significant differences in all the important variables between the POA and no POA groups (P <.001); therefore, we used propensity score matching analysis. After adjustment for the covariates of selected variables, we found that POA was not associated with a higher rate of survival after hospitalization (adjusted OR, 1.02; 95% CI, 0.99–1.04; P = .27). Even after adjustment for all covariates, POA did not improve in-hospital mortality (adjusted OR, 1.01; 95% CI, 0.99–1.03; P = .08).

In this study, POA did not improve in-hospital mortality in trauma patients. However, further studies are needed to validate our results.
HBV DNA levels impact the prognosis of hepatocellular carcinoma patients with microvascular invasion
Authors: Li Lian , Li Bo , Zhang Ming
Published: July 2019

To discuss the prognostic correlation between hepatitis B virus DNA (HBV DNA) level and HBV-related hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI).

Data from HCC patients undergoing hepatectomy with pathological evidence of MVI were retrospectively collected and 1:1 propensity scoring matching (PSM) analysis was performed. According to the HBV DNA levels before and after surgery, the disease-free survival (DFS) and overall survival (OS) were evaluated using the Kaplan–Meier method, and the Cox proportional hazards regression was used to analyze the risk factors associated with the postoperative prognosis. After 1:1 PSM, 139 pairs of patients were enrolled in the high preoperative HBV DNA level group (H group) and low preoperative HBV DNA level group (L group), and after operation, patients with high preoperative HBV DNA levels were divided into the persistently high HBV DNA level group (P group) and the decreased HBV DNA level group (D group).

According to the multivariate analysis, the HBV DNA level of 2000 IU/ml or greater before operation was significantly associated with the DFS (hazard ratio, 1.322; 95%CI, 1.016–1.721) and OS (hazard ratio, 1.390; 95%CI, 1.023–1.888). A persistent HBV DNA level of 2,000 IU/ml or greater after operation was also the independent risk factor of DFS (hazard ratio, 1.421; 95%CI, 1.018–1.984) and OS (hazard ratio, 1.545; 95%CI, 1.076–2.219).

For the HBV-related HCC patients with MVI, preoperative high HBV DNA copies are prognostication of poorer prognosis, and effective antivirus treatment would significantly improve the patients’ prognosis.
Effects of cognitive behavioral therapy on psychological adjustment in Chinese pediatric cancer patients receiving chemotherapy
Authors: Zhang Ping , Mo Lin , Torres Joseph , Huang Xiaoyan
Published: July 2019

Background:

Cognitive behavioral therapy (CBT) has been widely used in pediatric cancer patients to promote psychological adjustment (PA). Considering the diversity of region and culture in China, its effect in Chinese population is not well defined. Therefore, our study is to explore the effect of CBT on improving PA in Chinese pediatric cancer patients receiving chemotherapy.

Methods:

One hundred four Chinese pediatric cancer patients receiving chemotherapy were divided into CBT group and control group randomly and equally. The resilience and negative mood were applied to evaluate the ability of psychological adjustment (PA). The Conner-Davidson Resilience Scale (CD-RISC) and depression anxiety stress scale (DASS) were employed to measure resilience and negative mood before and after intervention. The SPSS 22.0 software was used to analyze data.

Results:

Prior to the intervention, the ability of psychological adjustment between 2 groups showed no significant difference (P > .05 for all). After intervention, the total CD-RISC score was significantly higher (56.09 ± 7.29 vs 44.75 ± 5.40), whereas the scores of depression (4.57 ± 2.94 vs 7.25 ± 4.25), anxiety (5.83 ± 3.07 vs 8.66 ± 4.92), stress (7.51 ± 4.33 vs 11.17 ± 4.25) were obviously lower in CBT group than those in the control group (P < .05 for all). Moreover, the decline of negative mood score in Yolk sac tumor children was the most evident in CBT group. While the resilience changes of cancer children in stage III was most obvious.

Conclusions:

CBT can effectively help Chinese pediatric cancer patients modify distorted cognition to have a positive attitude towards cancer and chemotherapy. This treatment enhances resilience and relieves negative mood, which results in good psychological adjustment ability, especially in Yolk sac tumor and stage III. It has a beneficial effect on better treatment cooperation and high long-term quality of life.
Observation of single spinal anesthesia by 25G needle puncture through a lateral crypt for hip surgery in elderly patients
Authors: Tang Zairong , Zhang Cheng , Xu Zhifei , Jin Feng , Liang Dongliang
Published: July 2019

Background:

Lumbar spine hyperosteogeny and ligament calcification are common in the elderly and anesthesia puncture through the conventional approach is difficult in this age group, and repeated puncture can increase the risk of spinal hematoma and nerve injury. This study aimed to observe the feasibility and safety of single spinal anesthesia administered with 25G needle through the lateral crypt for lower-extremity fracture surgery in elderly patients.

Methods:

The subjects were 60 elderly patients in our hospital (aged 65–80 years; ASA grades I and II) scheduled for lower-extremity fracture surgery (procedure was predicted to last within 2 h) under single spinal anesthesia by different approaches through L3–4. They were randomly divided into 2 groups: in the first group, 25G needle was used in a vertical approach (group C, n=30); in the second, 25G needle was passed through the inner edge of the small joints of L3–4 to the lateral crypt (group L, n=30). After successful completion of the puncture procedure, 2.5 mL of 0.5% hyperbaric ropivacaine was used for spinal anesthesia. We then recorded the puncture times, sensory block level, and adverse reactions (e.g., headache, lumbago, and lower limb pain).

Results:

No significant differences in onset time, sensory block level and adverse reaction were noted between the 2 groups. The puncture success rate in group L was not significantly higher and the number of attempts per puncture was not significantly less than that in group C (93.3% vs 70%) (P = .063). Nerve-root irritation was more frequent in group L than in group C but with no significant difference (P > .05).

Conclusion:

Single spinal anesthesia through the lateral crypt approach is safe and effective for lower-extremity fracture surgery in elderly patients. Thus, this approach is a feasible alternative when the conventional approach fails.
Management of biochemical recurrence after radical prostatectomy for prostate cancer
Authors: Shen Jiayan , Zang Shoumei , Yu Xiaokai , Zhao Feng , Jiang Peng , Zhong Baishu , Zhou Hua , Yan Senxiang
Published: July 2019

Rational:

How to manage patients with prostate cancer (PCa) with biochemical recurrence (BCR) following primary curative treatment is a controversial issue. Multiple disciplinary team (MDT) mechanism may propose an appropriate treatment plan for patients and can effectively improve patient prognosis and survival, reduce patient diagnosis and treatment waiting time, and greatly improve patient satisfaction.

Patient concerns:

Here, we presented a case of a 77-year-old man with a persistently elevated serum level of prostate-specific antigen (PSA), who had a history of radical prostatectomy (RP) and of 9 years endocrine therapy.

Diagnoses:

Castration-resistant prostate cancer and locally recurrent prostate cancer.

Interventions:

Androgen-deprivation therapy was first utilized 2 months after RP, due to the consideration of BCR on May 5, 2007. And during the next 9 years, he was treated with different endocrine agents but failed to maintain serum levels of PSA stable. Finally, the MDT suggested patient to perform salvage radiation therapy (SRT). Under MDT mechanism, we avoid secondary surgery, so as to reduce the patients’ mental suffering and cost of patient care.

Outcomes:

EPIC26 scale assessment revealed leak-free urine, good urine control, no defecation abnormalities or blood in the stool, no breast tenderness and breast enlargement significantly improved. The patient now has no adjuvant therapy, including endocrine therapy. The patient achieved good prognosis through local RT.

Lessons:

Pelvic SRT for patients with locally recurrent PCa may restore the same radical effect as RP. And more importantly, MDT mechanism plays an important role in making the most appropriate decisions for patients.
Intrahepatic mass-forming cholangiocarcinoma growing in a giant hepatic hemangioma
Authors: Zhou Mengqi , Ling Wenwu , Luo Yan
Published: July 2019

Rationale:

Hepatic hemangioma (HH) is a common benign tumor with a high number of normal or abnormal blood vessels. Intrahepatic cholangiocarcinoma (ICC) is a relatively common malignant primary hepatic carcinoma (10%–15%) with high incidence rate and high fatality, yet low discovery rate in the early stages. Ultrasonography (US), computed tomography, and magnetic resonance imaging (MRI) are frequently used and indispensable imaging techniques for the diagnosis of hepatic lesions. It is possible to differentiate a liver lesion from HH with high accuracy owing to their different patterns and hemodynamic characteristics.

Patient concerns:

A 59-year-old Asian woman was referred to hospital for a hepatic mass, which was 9.0 × 6.5 cm in size, The patient was tested positive for hepatitis B antigen but negative for serum alpha-fetoprotein and carbohydrate antigen 199 and had a slightly elevated carcinoembryonic antigen level (3.56 ng/ml).

Diagnosis:

Liver US and MRI were performed. Grey-scale US revealed a huge heterogeneous mass on the right lobe with a point and line-like blood flow signal on Doppler US. Dynamic contrast-enhanced MRI showed heterogeneous annular nodular enhancement in the arterial phase. An initial diagnosis of HH was made based on the clinical history and imaging results; however, histopathologic examination of the liver lesions revealed modest to severe atypical hyperplasia of intrahepatic bile duct epithelium, cancerization, and mid to high differentiated mass-forming type cholangiocarcinoma combined with focal organized hemangioma.

Interventions:

The intrahepatic mass-forming cholangiocarcinoma (IMCC) lesion was considered a focal organization of hemangioma during operation and was surgically removed. No routine chemotherapy was performed after the operation.

Outcomes:

The IMCC recurred 23 months after surgery, with elevated serum CA19-9 and CA125. Liver damage was evident, and the patient developed jaundice. The patient was discharged without active treatment and died in 4 months.

Lessons:

Although preoperative imaging of focal hepatic lesions is indispensable, intraoperative frozen section analysis and histopathological examination remain essential for definitive diagnosis. This is particularly important for high-risk patients and those with suspected malignancy.
Seed dispersal by dispersing juvenile animals: a source of functional connectivity in fragmented landscapes
Authors: González-Varo Juan P. , Díaz-García Sarah , Arroyo Juan M. , Jordano Pedro
Published: July 2019

Juvenile animals generally disperse from their birthplace to their future breeding territories. In fragmented landscapes, habitat-specialist species must disperse through the anthropogenic matrix where remnant habitats are embedded. Here, we test the hypothesis that dispersing juvenile frugivores leave a footprint in the form of seed deposition through the matrix of fragmented landscapes. We focused on the Sardinian warbler (Sylvia melanocephala), a resident frugivorous passerine. We used data from field sampling of bird-dispersed seeds in the forest and matrix of a fragmented landscape, subsequent disperser identification through DNA-barcoding analysis, and data from a national bird-ringing programme. Seed dispersal by Sardinian warblers was confined to the forest most of the year, but warblers contributed a peak of seed-dispersal events in the matrix between July and October, mainly attributable to dispersing juveniles. Our study uniquely connects animal and plant dispersal, demonstrating that juveniles of habitat-specialist frugivores can provide mobile-link functions transiently, but in a seasonally predictable way.
Nectar, humidity, honey bees (
Apis mellifera
) and varroa in summer: a theoretical thermofluid analysis of the fate of water vapour from honey ripening and its implications on the control of
Varroa destructor
Authors: Mitchell Derek
Published: July 2019

This theoretical thermofluid analysis investigates the relationships between honey production rate, nectar concentration and the parameters of entrance size, nest thermal conductance, brood nest humidity and the temperatures needed for nectar to honey conversion. It quantifies and shows that nest humidity is positively related to the amount, and water content of the nectar being desiccated into honey and negatively with respect to nest thermal conductance and entrance size. It is highly likely that honeybees, in temperate climates and in their natural home, with much smaller thermal conductance and entrance, can achieve higher humidities more easily and more frequently than in man-made hives. As a consequence, it is possible that
Varroa destructor
, a parasite implicated in the spread of pathogenic viruses and colony collapse, which loses fecundity at absolute humidities of 4.3 kPa (approx. 30 gm
−3
) and above, is impacted by the more frequent occurrence of higher humidities in these low conductance, small entrance nests. This study provides the theoretical basis for new avenues of research into the control of varroa, via the modification of beekeeping practices to help maintain higher hive humidities.
Phenotypic plasticity in the mandibular morphology of Japanese macaques: captive–wild comparison
Authors: Kamaluddin Siti Norsyuhada , Tanaka Mikiko , Wakamori Hikaru , Nishimura Takeshi , Ito Tsuyoshi
Published: July 2019

Despite the accumulating evidence suggesting the importance of phenotypic plasticity in diversification and adaptation, little is known about plastic variation in primate skulls. The present study evaluated the plastic variation of the mandible in Japanese macaques by comparing wild and captive specimens. The results showed that captive individuals are square-jawed with relatively longer tooth rows than wild individuals. We also found that this shape change resembles the sexual dimorphism, indicating that the mandibles of captive individuals are to some extent masculinized. By contrast, the mandible morphology was not clearly explained by ecogeographical factors. These findings suggest the possibility that perturbations in the social environment in captivity and resulting changes of androgenic hormones may have influenced the development of mandible shape. As the high plasticity of social properties is well known in wild primates, social environment may cause the inter- and intra-population diversity of skull morphology, even in the wild. The captive–wild morphological difference detected in this study, however, can also be possibly formed by other untested sources of variation (e.g. inter-population genetic variation), and therefore this hypothesis should be validated further.
Biochar application on paddy and purple soils in southern China: soil carbon and biotic activity
Authors: Yan Shen , Niu Zhengyang , Zhang Aigai , Yan Haitao , Zhang He , He Kuanxin , Xiao Xianyi , Wang Nianlei , Guan Chengwei , Liu Guoshun
Published: July 2019

Soil carbon reserves are the largest terrestrial carbon pools. Common agricultural practices, such as high fertilization rates and intensive crop rotation, have led to global-scale environmental changes, including decreased soil organic matter, lower carbon/nitrogen ratios and disruption of soil carbon pools. These changes have resulted in a decrease in soil microbial activity, severe reduction in soil fertility and transformation of soil nutrients, thereby causing soil nutrient imbalance, which seriously affects crop production. In this study, 16S rDNA-based analysis and static chamber-gas chromatography were used to elucidate the effects of continuous application of straw biochar on soil carbon pools and the soil microbial environments of two typical soil types (purple and paddy soils) in southern China. Application of biochar (1) improved the soil carbon pool and its activity, (2) significantly promoted the release of soil CO
2
and (3) improved the soil carbon environment. Soil carbon content was closely correlated with the abundance of organisms belonging to two orders, Lactobacillales and Bacteroidales, and, more specifically, to the genus
Lactococcus
. These results suggest that biochar affects the soil carbon environment and soil microorganism abundance, which in turn may improve the soil carbon pool.
Cooperation in the Prisoner’s Dilemma: an experimental comparison between pure and mixed strategies
Authors: Heuer Leonie , Orland Andreas
Published: July 2019

Cooperation is—despite not being predicted by game theory—a widely documented aspect of human behaviour in Prisoner’s Dilemma (PD) situations. This article presents a comparison between subjects restricted to playing pure strategies and subjects allowed to play mixed strategies in a one-shot symmetric PD laboratory experiment. Subjects interact with 10 other subjects and take their decisions all at once. Because subjects in the mixed-strategy treatment group are allowed to condition their level of cooperation more precisely on their beliefs about their counterparts’ level of cooperation, we predicted the cooperation rate in the mixed-strategy treatment group to be higher than in the pure-strategy control group. The results of our experiment reject our prediction: even after controlling for beliefs about the other subjects’ level of cooperation, we find that cooperation in the mixed-strategy group is lower than in the pure-strategy group. We also find, however, that subjects in the mixed-strategy group condition their cooperative behaviour more closely on their beliefs than in the pure-strategy group. In the mixed-strategy group, most subjects choose intermediate levels of cooperation.