bluuebunny/crossref_metadata_2025 huggingface dataset:
The Burden of Acute Diarrheal Disease in Young Hospitalized Urban South African Children Five Years After Rotavirus Vaccine Introduction: A Retrospective Descriptive Study
Authors: Makgatho Euphrasia , Patel Firuzan , Solomon Fatima , Groome Michelle J. , Lala Sanjay G. , Vallabh Preeteeben , Dangor Ziyaad
Published: April 2019

Background:

Diarrheal disease is a leading cause of childhood morbidity and mortality worldwide. Multiple interventions, including rotavirus vaccination to infants since 2009, have reduced the incidence of diarrheal disease in South African children. Our study aimed to determine the burden of diarrheal disease 5 years after rotavirus vaccine introduction at a tertiary-level hospital.

Methods:

A retrospective review of a discharge summary database of children less than 5 years of age hospitalized with acute diarrheal illness from 2015 to 2016 at the Chris Hani Baragwanath Academic Hospital.

Results:

Diarrheal disease accounted for 14.8% of hospital admissions. The incidence (per 100,000 population) was 675.8 (95% CI: 638.8–714.3) in 2015 and 612.2 (95% CI: 577.0–648.9) in 2016. The case fatality ratio was 2.9% over the study period. The median age at diagnosis was 12 months (interquartile range: 6.2–21.4) and 50.4% of cases occurred during infancy. One third of cases were underweight and/or stunted. In a multivariable analysis using logistic regression, the adjusted odds ratio (aOR) for death was higher in children with an associated acute lower respiratory tract infection (aOR: 3.7, 95% CI: 1.2–11.5; P = 0.021), HIV infection (aOR: 9.1, 95% CI: 2.6–31.6; P = 0.001), and an age of less than 6 months (aOR: 6.9, 95% CI: 2.1–22.9; P = 0.002).

Conclusions:

Sustained reductions in diarrheal disease incidence were observed 5 years post rotavirus vaccine implementation. In children hospitalized with an acute diarrheal illness, an increased risk of mortality occurs in young infants, children that are HIV infected, and those with an associated acute lower respiratory tract infection.
Successful Whole Genome Sequencing-guided Treatment of Mycoplasma hominis Ventriculitis in a Preterm Infant
Authors: Scaggs Huang Felicia A. , Mortensen Joel , Skoch Jesse , Andersen Heidi , Staat Mary Allen , Schaffzin Joshua K. , Haslam David B.
Published: April 2019

We report a case of Mycoplasma hominis ventriculitis in a preterm neonate that was successfully identified with 16S ribosomal RNA sequencing and whole genome sequencing after failure to detect the pathogen with conventional diagnostic methods. The infant required doxycycline with subsequent clearance of the infection and no evidence of drug toxicity.
Outcomes of Congenital Zika Virus Infection During an Outbreak in Valle del Cauca, Colombia
Authors: Calle-Giraldo Juan P. , Rojas Christian A. , Hurtado Isabel C. , Barco Carolina , Libreros Diana , Sánchez Pablo J. , López Pio , Arias Alejandra , Dávalos Diana M. , Lesmes María C. , Pinzón Elisa , Ortiz Viviana A. , López-Medina Eduardo
Published: April 2019

Background:

Despite increasing information in the literature regarding congenital Zika infection, gaps remain in our knowledge of its clinical manifestations.

Methods:

We did a prospective observational study of exposed fetuses and infants whose mothers developed symptomatic and confirmed Zika infection during pregnancy in Valle del Cauca, Colombia. We performed neurological, ophthalmologic and audiologic evaluations, and classified outcomes as possibly or uncertainly related to Zika. Frequencies of outcomes were compared according to the trimester of pregnancy when infection occurred.

Results:

We evaluated 171 products of gestation including 17 pregnancy losses and 154 patients evaluated postnatally. Ninety (52.6%) pregnancies presented an adverse outcome, 36% possibly related with Zika and the remaining 64% of uncertain relation. Infection in the first trimester had the highest frequencies of adverse outcomes possibly related with Zika compared with the second and third trimesters (39% vs. 12.5% vs. 12%) with risk ratios of adverse outcomes possibly related to Zika in pregnancies infected in the first versus second or third trimester of 3.1 (95% CI: 2.4–4.1) and 3.3 (95% CI: 2.5–4.2), respectively. The frequencies of pregnancy loss and microcephaly were 9.4% and 4.5%, respectively. Auditory and ophthalmic abnormalities possibly related with Zika were present in 3% and 6% of the patients evaluated, respectively.

Conclusions:

We observed a high frequency of gestational and neonatal complications in pregnant women who acquired Zika infection, especially in early pregnancy, resulting in a broad spectrum of clinical manifestations. Preventive measures are urgently needed to reduce the clinical burden during future Zika outbreaks.
Broad-range PCR Application in a Large Academic Pediatric Center: Clinical Value and Challenges in Diagnosis of Infectious Diseases
Authors: Lucas Elizabeth J. , Leber Amy , Ardura Monica I.
Published: April 2019

Background:

Broad-range polymerase chain reaction (BR-PCR) detects infectious pathogens from clinical specimens using targets for bacteria (16S rRNA), fungi (28S rDNA), and mycobacteria (fluorescence resonance energy transfer and heat shock protein 65 gene) with reported diagnostic sensitivity and specificity ranging from 43% to 100% and 100%, respectively. We describe our experience when applying BR-PCR to clinical samples submitted for conventional infectious disease testing [conventional testing (CT)] from pediatric patients with concern for infection.

Methods:

Retrospective analysis of clinical samples obtained from Nationwide Children’s Hospital microbiology laboratory from January 2011 to December 2014 and sent for BR-PCR. Medical record review collected data on patient characteristics, clinical manifestations, laboratory results and antimicrobials prescribed, and a determination of clinical value of BR-PCR was assigned.

Results:

There were 247 clinical samples from 163 patients identified; 71 (44%) patients were immunocompromised and 192 (78%) samples reflected pretreatment with antimicrobials. A clinically significant putative organism was identified for 59 samples (24%) between all diagnostic modalities. Conventional testing identified organisms in 41 (17%) samples, 17 of which were corroborated by BR-PCR. Broad-range polymerase chain reaction identified an organism in an additional 18 samples with negative CT results and was considered to provide additional important clinical information. Broad-range polymerase chain reaction detected a bacterial or fungal organism more frequently from tissue samples than from bronchoalveolar lavage or other fluid samples (P = 0.0096, χ2).

Conclusions:

In our cohort, BR-PCR was an important adjunctive diagnostic in identifying bacteria and fungi in complex clinical situations. Additional data are needed to define the optimal clinical circumstances and specimen type in which BR-PCR can provide the highest diagnostic yield.
Impact of Childhood Pneumococcal Conjugate Vaccine on Nonnotified Clinically Suspected Invasive Pneumococcal Disease in Australia
Authors: Gidding Heather F. , Sheridan Sarah , Fathima Parveen , Moore Hannah C. , Liu Bette , McIntyre Peter B. , Palmu Arto A.
Published: April 2019

Background:

Finnish studies have shown a significant impact of 10-valent pneumococcal conjugate vaccine (PCV10) on nonnotified clinically suspected invasive pneumococcal disease (IPD). We used a similar vaccine probe design to estimate PCV7 and PCV13 impact in Australian children.

Methods:

Season and age-matched pre-PCV7 cohorts (born in 2002–2004) were compared with PCV7-early and PCV7-late, and PCV13-eligible cohorts. Using linked notification and hospitalization data, we calculated relative rate reductions (RRRs) and absolute rate reductions (ARRs) for notified IPD, and nonnotified clinically suspected IPD or unspecified sepsis (first hospitalization with an International Classification of Diseases 10th Revision-Australian Modification code: A40.3/G00.1/M00.1 or A40.9/A41.9/A49.9/G00/I30.1/M00, respectively).

Results:

Significant reductions in all outcomes were observed comparing PCV7-early and PCV7-late and PCV13-eligible to pre-PCV7 cohorts. RRRs were high for both notified and nonnotified clinically suspected IPD (range 71%–91%), but ARRs were lower for nonnotified (5–6/100,000 person-years) than for notified cases (59–70/100,000 person-years). RRRs for the combined outcome of nonnotified clinically suspected IPD or unspecified sepsis were lower at 21%–24% for PCV7-eligible cohorts and 36% for the PCV13-eligible cohort, but ARRs were considerable due to the high pre-PCV7 rates (ARR 37-31/100,000 person-years for PCV7-early and PCV7-late cohorts and 54/100,000 person-years for PCV13).

Conclusions:

This study provides a quantitative estimate of the total burden of IPD preventable by PCV7 and PCV13 vaccination programs in Australia. ARRs (compared with prevaccination) were significant but smaller than in Finland (122/100,000 for the combined outcome) and longer-term follow-up is required to determine the additional impact of PCV13 above that seen for PCV7. Country-specific studies are needed to accurately estimate the burden of pneumococcal disease preventable by vaccination and cost-effectiveness of PCV vaccination programs.
Pediatric Infectious Sacroiliitis: Characterization and Differentiation from Noninfectious Etiologies
Authors: Vardi Yoav , Levy Itzhak , Ashkenazi-Hoffnung Liat , Sherman Gilad , Berger Itay , Rom Eran , Chodick Gabriel , Landau Daniel , Scheuerman Oded
Published: April 2019

Background:

Pediatric sacroiliitis (SI) is an uncommon entity of infectious or inflammatory etiology. Recent data regarding pediatric SI are scarce. The study objective was to describe and compare the clinical features of pediatric infectious and noninfectious SI.

Methods:

We reviewed files of children ≤18 years of age, admitted with SI in 2004–2017. Patients were grouped by etiology, infectious versus noninfectious. Clinical and laboratory indices, imaging, treatment protocols and outcome were compared.

Results:

Study population included 40 patients with infectious SI (range: 3–192 months, median age: 15 months, 45% female) and 13 patients with noninfectious SI (range: 30–216 months, median age: 168 months, 62% females). Duration of symptoms before admission averaged 5.9 ± 7.5 days in the infectious group and 54.2 ± 96 days in the noninfectious group (P = 0.003). Symptoms observed solely in the infectious group included refusal to stand (n = 27, 77%); walk or crawl (n = 24, 65%); irritability (n = 20, 50%) and recent constipation event (n = 8, 20%). No significant differences in laboratory results were found. Infectious SI patients had uneventful medical history, rapid response to antibiotics and a higher rate of complete resolution of symptoms without recurrences.

Conclusions:

An acute unilateral presentation in young patients ≤2 years of age, without chronic medical conditions, suggests an infectious etiology of SI anticipated to completely resolve with antibiotic treatment, not necessitating further workup for noninfectious etiologies.
Somatosensory predictors of response to pregabalin in painful chemotherapy-induced peripheral neuropathy: a randomized, placebo-controlled, crossover study
Authors: Hincker Alexander , Frey Karen , Rao Lesley , Wagner-Johnston Nina , Ben Abdallah Arbi , Tan Benjamin , Amin Manik , Wildes Tanya , Shah Rajiv , Karlsson Pall , Bakos Kristopher , Kosicka Katarzyna , Kagan Leonid , Haroutounian Simon
Published: April 2019

Painful chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and treatment-resistant sequela of many chemotherapeutic medications. Ligands of α2δ subunits of voltage-gated Ca2+ channels, such as pregabalin, have shown efficacy in reducing mechanical sensitivity in animal models of neuropathic pain. In addition, some data suggest that pregabalin may be more efficacious in relieving neuropathic pain in subjects with increased sensitivity to pinprick. We hypothesized that greater mechanical sensitivity, as quantified by decreased mechanical pain threshold at the feet, would be predictive of a greater reduction in average daily pain in response to pregabalin vs placebo. In a prospective, randomized, double-blinded study, 26 patients with painful CIPN from oxaliplatin, docetaxel, or paclitaxel received 28-day treatment with pregabalin (titrated to maximum dose 600 mg per day) and placebo in crossover design. Twenty-three participants were eligible for efficacy analysis. Mechanical pain threshold was not significantly correlated with reduction in average pain (P = 0.97) or worst pain (P = 0.60) in response to pregabalin. There was no significant difference between pregabalin and placebo in reducing average daily pain (22.5% vs 10.7%, P = 0.23) or worst pain (29.2% vs 16.0%, P = 0.13) from baseline. Post hoc analysis of patients with CIPN caused by oxaliplatin (n = 18) demonstrated a larger reduction in worst pain with pregabalin than with placebo (35.4% vs 14.6%, P = 0.04). In summary, baseline mechanical pain threshold tested on dorsal feet did not meaningfully predict the analgesic response to pregabalin in painful CIPN.
Cooling the skin for assessing small-fibre function
Authors: Leone Caterina , Dufour André , Di Stefano Giulia , Fasolino Alessandra , Di Lionardo Andrea , La Cesa Silvia , Galosi Eleonora , Valeriani Massimiliano , Nolano Maria , Cruccu Giorgio , Truini Andrea
Published: April 2019

In this clinical and neurophysiological study using a novel cold stimulator, we aim at investigating whether cold-evoked potentials (CEPs) may prove to be a reliable diagnostic tool to assess trigeminal small-fibre function. Using a novel device consisting of micro-Peltier elements, we recorded CEPs after stimulating the supraorbital and perioral regions and the hand dorsum in 15 healthy participants and in 2 patients with exemplary facial neuropathic pain conditions. We measured peripheral conduction velocity at the upper arm and studied the brain generators using source analysis. In healthy participants and patients, we also compared CEPs with laser-evoked potentials. In the healthy participants, cold stimulation evoked reproducible scalp potentials, similar to those elicited by laser pulses, although with a latency of about 30 ms longer. The mean peripheral conduction velocity, estimated at the upper arm, was 12.7 m/seconds. The main waves of the scalp potentials originated from the anterior cingulate gyrus and were preceded by activity in the bilateral opercular regions and bilateral dorsolateral frontal regions. Unlike laser stimulation, cold stimulation evoked scalp potential of similar amplitude across perioral, supraorbital, and hand dorsum stimulation. In patients with facial neuropathic pain, CEP recording showed the selective damage of cold pathways providing complementary information to laser-evoked potential recording. Our clinical and neurophysiological study shows that this new device provides reliable information on trigeminal small fibres mediating cold sensation and might be useful for investigating patients with facial neuropathic pain associated with a distinct damage of cold-mediating fibres.
High-threshold primary afferent supply of spinal lamina X neurons
Authors: Krotov Volodymyr , Tokhtamysh Anastasia , Safronov Boris V. , Belan Pavel , Voitenko Nana
Published: April 2019

The spinal gray matter region around the central canal, lamina X, is critically involved in somatosensory processing and visceral nociception. Although several classes of primary afferent fibers terminate or decussate in this area, little is known about organization and functional significance of the afferent supply of lamina X neurons. Using the hemisected ex vivo spinal cord preparation, we show that virtually all lamina X neurons receive primary afferent inputs, which are predominantly mediated by the high-threshold Aδ- fibers and C-fibers. In two-thirds of the neurons tested, the inputs were monosynaptic, implying a direct targeting of the population of lamina X neurons by the primary nociceptors. Beside the excitatory inputs, 48% of the neurons also received polysynaptic inhibitory inputs. A complex pattern of interactions between the excitatory and inhibitory components determined the output properties of the neurons, one-third of which fired spikes in response to the nociceptive dorsal root stimulation. In this respect, the spinal gray matter region around the central canal is similar to the superficial dorsal horn, the major spinal nociceptive processing area. We conclude that lamina X neurons integrate direct and indirect inputs from several types of thin primary afferent fibers and play an important role in nociception.
Concomitant pancreatic neuroendocrine tumors in hereditary tumor syndromes: who, when and how to operate?
Authors: Han Xu , Lou Wenhui
Published: April 2019

Pancreatic neuroendocrine tumors (pNETs) might present as part of a complex of hereditary (familial) syndromes caused by germline mutations such as multiple endocrine neoplasia type 1 (MEN1), von Hippel–Lindau syndrome (VHL), tuberous sclerosis, and neurofibromatosis syndromes. Hereditary pNETs are frequently misdiagnosed because their presentation may mimic other more common diseases, resulting in diagnostic delays. Although non-operative (conservative) management could be advocated in select cases in most patients, hereby avoiding surgery without loss of oncological safety, some cases still need operative intervention before malignancy develops. The objective of this review is to address the most recent literature and the evidence it provides for the indications, timing and options of operative treatment for concomitant pNETs in hereditary tumor syndromes. Complete sequencing of the whole gene is recommended for suspected hereditary pNETs. Proven functional pNETs with hereditary tumor syndromes is a good indication for surgical treatment. Conservative management for MEN1 patients with a non-functional pNET of 2 cm or smaller is associated with a low risk of malignant transformation and metastasis development. VHL-related pNETs patients with tumor size >1.5 cm or a missense mutation or any mutation type in exon 3 may benefit from surgical intervention. The parenchyma-sparing surgical strategy should be preferentially performed whenever possible in all hereditary syndromes. The decision to recommend surgery to prevent malignant transformation and tumor spread, which is based on multidisciplinary expertise and the patient's preference, should be balanced with operative mortality and morbidity.
Hemodynamic Effects of Concomitant Mitral Valve Surgery and Left Ventricular Assist Device Implantation
Authors: Imamura Teruhiko , Nnanabu Jerry , Rodgers Daniel , Raikehlkar Jayant , Kalantar Sara , Smith Bryan , Nguyen Ann , Chung Ben , Narang Nikhil , Ota Takeyoshi , Song Tae , Burkhoff Daniel , Jeevanandam Valluvan , Kim Gene , Sayer Gabriel , Uriel Nir
Published: April 2019

There are conflicting data regarding whether concomitant mitral valve surgery (MVS) at left ventricular assist device (LVAD) implantation is beneficial. This study aimed to assess the hemodynamic effects of concomitant MVS. Of all 73 enrolled patients, 44 patients had undergone concomitant MVS and 29 patients had not. Before LVAD implantation, MVS group had higher pulmonary capillary wedge pressure (p = 0.04). After LVAD implantation, MVS group had higher mean pulmonary artery pressure and cardiac output (CO). During the hemodynamic ramp study, MVS group had steeper CO slopes (0.18 [0.13 0.28] vs. 0.15 [0.08, 0.20] L/min/step; p = 0.04) at incremental LVAD speed and achieved a higher CO at the optimized set speed (5.5 [4.7, 6.9] vs. 4.9 [4.0, 5.7] L/min; p = 0.03). One-year freedom from death or heart failure readmission was statistically comparable between the two groups (61% vs. 80%, p = 0.20). Thus far, after LVAD implantation and concomitant MVS, patients had increased pulmonary hypertension, despite having higher CO and a better response of CO at incremental LVAD speed. The implication of hemodynamic features after concomitant MVS on clinical outcomes warrants further investigation.
In the ICU – delirium post cardiac arrest
Authors: Boncyk Christina S. , Rengel Kimberly F. , Pandharipande Pratik P. , Hughes Christopher G.
Published: April 2019

Purpose of review

The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium.

Recent findings

Patient factors leading to a cardiac arrest, initial resuscitation efforts, and postresuscitation management all influence the potential for recovery and the risk for development of delirium. Data suggest that delirium in cardiac arrest survivors is an independent risk factor for morbidity and mortality. Recognizing delirium in postcardiac arrest patients can be challenging; however, detection is not only achievable, but important as it may aid in predicting adverse outcomes. Serial neurologic examinations and delirium assessments, targeting light sedation when possible, limiting psychoactive medications, and initiating patient care bundles are important care aspects for not only allowing early identification of primary and secondary brain injury, but in improving patient morbidity and mortality.

Developing delirium after cardiac arrest is associated with increased morbidity and mortality. The importance of addressing modifiable risk factors, recognizing symptoms early, and initiating coordinated treatment strategies can help to improve outcomes within this high risk population.
A novel Ser40Trp variant in IFITM5 in a family with osteogenesis imperfecta and review of the literature
Authors: Lim Jiin Ying , Bhatia Neha Singh , Vasanwala Rashida Farhad , Chay Pui Ling , Lim Kevin Boon Leong , Khoo Poh Choo , Schwarze Ulrike , Jamuar Saumya Shekhar
Published: April 2019

Osteogenesis imperfecta, is a genetically and clinically heterogeneous connective tissue disorder that disrupts bone architecture, making it fragile and more prone to fractures. While more than 85% of cases are due to variants in COL1A1 and COL1A2, variants in noncollagen genes have been identified in the remaining cases. The recurring heterozygous variant in IFITM5 (c.-14C>T) leads to osteogenesis imperfecta type V, a second missense variant in IFITM5 (c.119C>T, p.Ser40Leu) leads to phenotype resembling osteogenesis imperfecta type VI. In this report, we describe the first patient with Ser40Trp variant in IFITM5, who presented with multiple fractures in the prenatal period. She remained fracture free after birth (except for trauma-related fractures during puberty) with normal bone mineral densitometry. Her mother, who did not have a history of fracture, was noted to have somatogonadal mosaicism for this variant and became pregnant with a second child with multiple prenatal fractures, found to have the same variant. To our knowledge, this is the first case of somatogonadal mosaicism in IFITM5. In addition, we have summarized the literature on patients presenting with variant in codon 40 (serine) of IFTIM5 protein.
Increasing negative lymph node count is independently associated with improved long-term survival in resectable perihilar cholangiocarcinomas
Authors: Gao Yunfeng , Xu Dong , Wu Yu-Shen , Chen Duke , Xiong Wanchun
Published: April 2019

To evaluate the prognostic value of numbers of negative lymph nodes (NLNs) for patients with perihilar cholangiocarcinomas.

The surveillance, epidemiology, and end results database was used to screen for patients with perihilar cholangiocarcinomas. Kaplan–Meier and Cox regression analyses were used for statistical evaluations. Subsequently, propensity score matching (PSM) was performed to confirm the results.

A total of 938 patients with perihilar cholangiocarcinomas met the inclusion criteria. The cut-off number for the grouping of patients with different numbers of NLNs was 17. Both the univariate and multivariate survival analyses demonstrated that there was a significant improvement in terms of cancer-specific survival for patients with >17 NLNs, compared with patients with ≤17 NLNs. Then, the above results were confirmed via a PSM procedure. Additionally, the independent prognostic value of NLNs was evaluated in subgroup univariate and multivariate analyses of patients with stage I or stage II tumors.

The numbers of NLNs were evaluated and determined to be important independent prognostic factors for the cancer-specific survival of patients with perihilar cholangiocarcinomas.
Survey of cervical cancer and precancerous lesion prevention knowledge within community health service centers in Shanghai, China
Authors: Chen Yi , Xu Ying , Wu Dan , Li Zhunan , Zhang Zhengrong , Meng Yu , Lin Jing
Published: April 2019

To study deficiencies in knowledge of the general public health-care professionals in community health service centers regarding the prevention of cervical intraepithelial neoplasia and cervical cancer. In addition, this study examined the key content of training required for primary health-care personnel to prevent cervical precancerous lesion and cervical cancer.

A questionnaire was distributed among 172 medical staff personnel (the ratio of general practitioners and nurses was 1:1 in five community health service centers in Shanghai, China. This questionnaire assessed four knowledge areas of cervical cancer prevention using 10 single-choice questions.

Out the 172 questionnaires distributed, 105 (61.05%) were completed correctly. No statistically significant difference in the percentage of complete correct answers among the five community health service centers was seen (P = .06). Additionally, there was no significant difference in the percentage of correct answers among the three age groups surveyed: age ≤35 years, 36–45 years, and ≥46 years (P 
= .12). We did find a statistically significant difference in the percentage of correct answers between general practitioners and nurses (P = .01) and between staff with master's degrees, bachelor's degrees, and associate's degrees (P 
= .03).

General practitioners and nurses in community health service centers in Shanghai require additional education on the secondary prevention of cervical intraepithelial neoplasia and cervical cancer. The health knowledge related to human papillomavirus also needs to improve. Nurses and medical staff with lower degrees have insufficient awareness of the prevention of precancerous lesions of the cervix and cervical cancer; these two groups should be prioritized for additional training.
Influenza A (H1N1) pdm09 virus infection in a patient with incomplete Kawasaki disease
Authors: Wang Jun , Sun Fang , Deng Hui-Ling , Liu Rui-Qing
Published: April 2019

Rationale:

Kawasaki disease (KD) is a vasculitic illness of childhood associated with coronary artery dilatation, coronary artery aneurysm, arrhythmia, sudden death, and other serious cardiovascular diseases. Up to date, the etiology of KD remains unclear; however, epidemiological characteristics indicate that it may be related to as-yet-undefined pathogen infection.

Patient concerns:

A 19-month-old boy had a fever of unknown origin at 38°C for 9 days without rash, runny nose and cough.

Diagnosis:

The boy was diagnosed with incomplete KD (IKD) coincident with influenza A (H1N1) pdm09 virus.

Interventions:

He was received treatments including human immunoglobulin (2 g/kg), aspirin (30∼50 mg/kg.d), and dipyridamole (3∼5 mg/kg.d).

Outcomes:

After 24 hours of human immunoglobulin infusion, his body temperature returned normal. After hospitalization for 6 days, his symptoms disappeared and discharged from the hospital.

Lessons:

More attention should be paid to the correlation between KD and pathogen infection, especially the new influenza virus H1N1. The potential mechanism underlying viral infection-mediated KD is worthy of further investigation, which may provide scientific evidence for the pathogenesis of KD.
Prevalence of hypertension among patients aged 50 and older living with human immunodeficiency virus
Authors: Dakum Patrick , Kayode Gbenga Ayodele , Abimiku Alash’le , Avong Yohanna Kambai , Okuma James , Onyemata Ezenwa , Ali Taofeekat , Adekanmbi Victor , Uthman Olalekan
Published: April 2019

Background:

Hypertension is one of the common medical conditions observed among patients aged 50 years and elder living with HIV (EPLWH) and to date no systematic review has estimated its global prevalence.

Purpose:

To conduct a systematic review to estimate the global prevalence of hypertension among EPLWH.

Data Sources:

PubMed/MEDLINE, Embase, the Cochrane Library, and Global Health databases for relevant publications up till May 25, 2018.

Study Selection:

Observational studies (cohort or cross-sectional studies) that estimated the prevalence of hypertension among EPLWH.

Data Extraction:

Required data were extracted independently by three reviewers and the main outcome was hypertension prevalence among EPLWH.

Data Synthesis:

The 24 (n = 29,987) eligible studies included were conducted in North America, Europe, Africa, and Asia. A low level bias threat to the estimated hypertension prevalence rates was observed. The global prevalence of hypertension among EPLWH was estimated at 42.0% (95% CI 29.6%–55.4%), I

2
 = 100%. The subgroup analysis showed that North America has the highest prevalence of hypertension 50.2% (95% CI 29.2% –71.2%) followed by Europe 37.8% (95% CI 30.7%–45.7%) sub-Saharan Africa 31.9% (95% CI 18.5% –49.2%) and Asia 31.0% (95% CI 26.1%–36.3%). We found the mean age of the participants explaining a considerable part of variation in hypertension prevalence.

Conclusion:

This study demonstrated that two out of five EPLWH are hypertensive. North America appears to have the highest prevalence of hypertension followed by Europe, sub-Saharan Africa (SSA) and Asia respectively. Findings from this study can be utilized to integrate hypertension management to HIV management package. (Registration number: CRD42018103069)
Segmental zoster abdominal paresis mimicking an abdominal hernia
Authors: Yu Yan-Hua , Lin Yan , Sun Pi-Jiang
Published: April 2019

Rationale:

Herpes zoster infection typically involves the posterior root ganglia and most of the symptoms are sensory. Motor involvement can occur in the same distribution but is relatively uncommon. Segmental zoster paresis is a rare motor complication of Herpes zoster, mimicking an abdominal hernia, but it needs no surgery different from the real abdominal wall hernia.

Patient Concerns:

We present a case of a 58-year-old man with an abdominal protrusion and characteristical herpes zoster rash.

Diagnoses:

Initially, the surgeon regarded it as an abdominal hernia, while ultrasonography excluded the abdominal wall defect, and then the dermatologist diagnosed it as segmental herpes zoster abdominal paralysis.

Interventions:

He received a treatment with oral acyclovir, mecobalamin, and vitamin B1.

Outcomes:

The abdominal wall bulge disappeared after 2 months, avoiding unnecessary surgery.

Lessons:

Segmental zoster abdominal paresis, mimicking an abdominal hernia needs no surgery.
Re-expansion pulmonary edema after resection of cerebellar lesion in a patient with bronchial occupying lesion
Authors: Yu Jiang , Wang Ying , Chen Xuanyu , Cheng Ruozhu , Yang Xueli , Chen Hongzhi
Published: April 2019

Rationale:

Re-expansion pulmonary edema (RPE) is a non-cardiogenic pulmonary edema, and is secondary to pulmonary collapse caused due to various reasons. However, RPE is rarely encountered during non-thoracic surgeries and is associated with much higher risk than that occurring in thoracic surgeries.

Patient concerns:

Herein we have reported a case report of a 55-years-old male patient. Preoperative examination indicated occupying lesions in the bronchus and cerebellar hemisphere. Under general anesthesia, the patient received resection of cerebellar lesion and developed acute atelectasis, and RPE occurred when cannulation was withdrawn after re-expansion. Supportive and symptomatic treatment was given to the patient for recovery well.

Diagnosis:

RPE.

Interventions:

The trachea was cannulated and connected to a ventilator for assisted ventilation. The patient was also given symptomatic treatment including nebulization, diuresis, and anti-inflammation.

Outcomes:

The patient recovered well and was discharged on day 8 after surgery.

Lessons:

Patients with occupying lesions of the airway should undergo bronchoscopy to determine the location, size, and distance of the lesion from the incisors. The anesthesiologists should determine appropriate anesthetic regimens according to the examination results to avoid acute atelectasis and postoperative pulmonary edema.
Genetic variants in cardiac calcification in Northern Sweden
Authors: Hellman Urban , Mörner Stellan , Henein Michael
Published: April 2019

Extensive coronary calcification without significant stenosis, described as calcific coronary artery disease (CCAD) may cause abnormal myocardial perfusion and hence generalized ischemia. There is a discrepancy in the expression pattern of CCAD compared to the well-known atherosclerotic disease which raises questions about the exact pathophysiology of coronary calcification and whether there is a genetic etiology for it.

In this pilot study we studied 3 candidate genes, ectonucleotide pyrophosphatase/phosphodiesterase (ENPP1), ATP Binding Cassette Subfamily C Member 6 (ABCC6), and 5’-Nucleotidase Ecto (NT5E) involved in pyrophosphate (PPi) and inorganic phosphate (Pi) metabolism, which may predispose to coronary arterial or valvular calcification. We studied 70 patients with calcific cardiac disease; 65 with CCAD (age 43–83 years) and 5 with calcific aortic valve disease (CAVD) (age 76–82 years).

Five DNA variants potentially affecting protein function were found in 6 patients. One variant is a known disease-causing mutation in the ABCC6 gene. Our findings support that disturbances in the PPi and Pi metabolism might influence the development of CCAD and CAVD. However, segregation in the families must first be performed to ascertain any damaging effect of these variants we have found.

We report 4 new genetic variants potentially related to coronary calcification, through the disturbed Pi and PPi metabolism. The search for direct causative genetic variants in coronary artery and aortic valve calcification must be broadened with other genes particularly those involved with Pi and PPi metabolism.
Multimodal intraoperative monitoring during surgical correction of scoliosis to avoid neurologic damage
Authors: Yu Tong , Li Qiu-Ju , Zhang Xi-Wen , Wang Yao , Jiang Qi-Yao , Zhu Xiu-Jie , Jiang Zhen-De , Zhao Jian-Wu
Published: April 2019

The purpose of this study was to evaluate the application of multimodal intraoperative monitoring (MIOM) system in patients with congenital scoliosis (CS) and adolescent idiopathic scoliosis (AIS).

Twelve patients who underwent posterior surgical correction of scoliosis for CS and AIS from June 2014 to July 2018 were enrolled in this study. During the operation, we monitored the functional status of the spinal cord by MIOM. An abnormal somatosensory evoked potential was defined as a prolonged latency of more than 10% or a peak-to-peak amplitude decline of more than 50% when compared to baseline. An abnormal transcranial motor evoked potential (TcMEP) was defined as a TcMEP amplitude decrease of more than 50%. A normal triggered electromyography response, which presented with the absence of an electrical response on stimulation at 8.2 mA, indicated that the pedicle screw was not in contact with the spinal cord or nerve root.

A total of 12 patients underwent MIOM surgery, of which 9 patients with negative MIOM had no significant deterioration of neurological function postoperatively, and exhibited satisfactory surgical correction of scoliosis during follow-ups. However, the remaining 3 patients suffered from MIOM events, 2 patients had normal neurological function, and 1 patient had deteriorated neurological function postoperatively.

Using MIOM in CS and AIS surgery could promptly detect iatrogenic neurological injury at the early stage. Therefore, rapid response by appropriate intraoperative interventions can be taken to minimize the injury. Besides, stable MIOM recordings encourage surgeons to correct scoliosis even when the Cobb angle of scoliosis was extremely large.
Assessment of cerebral infarction after transient cerebral ischemic attack by ABCD2 score combined with the position of intracranial vascular stenosis
Authors: Xi Hong-Yan , Si Zhi-Hua , Li Jia-Cheng , Zhu Jian-Guo , Yan Hai-Yan
Published: April 2019

This study aims to investigate the value of the ABCD2 score combined with the position of the offending vessel stenosis in predicting the risk of transient ischemic attack (TIA) to develop into cerebral infarction.

The ABCD2 score and head magnetic resonance imaging + magnetic resonance angiography (MRA) results of 192 patients with TIA were retrospectively analyzed. With the 7th day as the endpoint time, these patients were divided into 3 groups, according to ABCD2 scores: low-risk group (n = 105), moderate-risk group (n = 60), and high-risk group (n = 27). Blood vessels were screened using head MRA results, and patients were accordingly divided into 2 groups: proximal vascular stenosis group (n = 71) and nonproximal vascular stenosis group (n = 171). Then, the association of the position of the intracranial vascular stenosis and ABCD2 score with short-term prognosis was analyzed.

Based on the ABCD2 score, the incidence of cerebral infarction after 1 week was significantly higher in the high-risk group (85.7%) than in the moderate-risk group (16.7%) and low-risk group (1.9%), and the differences were statistically significant (P < .05). When the ABCD2 score was ≥4 points, the incidence of cerebral infarction after 1 week was significantly higher in the proximal vascular stenosis group (59.1%) than in the nonproximal vascular stenosis group (30.8%), and the difference was statistically significant (P < .05). When the ABCD2 score was <4 points, the incidence of cerebral infarction after 1 week in the proximal stenosis group (2%) was not significantly different from that in the nonproximal stenosis group (1.9%, P > .05).

The ABCD2 score combined with proximal offending vessel stenosis can improve the short-term prediction of cerebral infarction in patients with TIA.
The absolute counts of peripheral T lymphocyte subsets in patient with ankylosing spondylitis and the effect of low-dose interleukin-2
Authors: An Haizhuan , Li Xin , Li Fang , Gao Chong , Li Xiaofeng , Luo Jing
Published: April 2019

The aim of this analysis is to investigate the level of T cell subsets in ankylosing spondylitis (AS) and the effect of low-dose interleukin 2 (IL-2).

This is a retrospective cohort study, we collected basic information, inflammatory markers, BASDAI scores, and T lymphocyte subsets of peripheral blood in patients with AS, baseline analysis, correlation analysis and comparative analysis before and after treatment were performed.

Data from 73 patients (of these, 36 patients were treated with IL-2) and 85 the health were included. The absolute numbers of peripheral CD4+ Treg and CD8+ Treg cells were lower, while the Th17 cell number and the ratio of Th17/CD4+ Treg and CD4+/CD8+ Treg were higher. The CD4+ Treg levels and the ratio of Th17/CD4+ Tregs were correlated with BASDAI. The CD4+ Treg, CD8+ Treg, and Th17 cells were increased after treatment with IL-2 and the ratio of Th17/CD4+ Treg was decreased.

Increase in ratio of Th17/CD4+ Treg involved in the occurrence of AS. At the same time, low-dose IL-2 could decrease the ratio of Th17/CD4+ Treg in short time, low-dose IL-2 can be used to treat autoimmune diseases to avoid adverse reactions caused by immunosuppressants. Further clinical study is needed on the efficacy of IL-2.
Factors predicting the colorectal adenoma detection rate in colonoscopic screening of a Chinese population
Authors: Wang Han , Wang Pu , Liu Xiaogang , Li Liangping , Xiao Xun , Liu Peixi , Zhang Di , Li Yi , Xu Guangre , Tu Mengtian , Song Yan
Published: April 2019

Colorectal cancer has high incidence and mortality. Early diagnosis could increase patient survival, but early diagnosis has been poor in China for the past decades. The purpose of this study is to assess the polyp detection rate (PDR) and adenoma detection rate (ADR) by colonoscopy in a Chinese population, and to determine the risk factors for adenoma.

This prospective study at Sichuan Provincial People's Hospital evaluated patients who underwent colonoscopy in September 2017 to February 2018. Basic information, exact insertion and withdrawal times, PDR, and ADR were assessed. Risk factors for colorectal adenoma in the adenoma-positive and adenoma-negative groups (based on pathology) were assessed by multivariable logistic regression analysis.

A total of 1058 procedures with 767 polyps were analyzed. The overall PDR and ADR were 36.96% (391/1058) and 24.67% (261/1058), respectively. Occurrence of adenoma was associated with age, gender, body mass index (BMI), family history of colon cancer, personal history of adenoma, diabetes mellitus, and tobacco use. There was a significant association between withdrawal time and ADR (P < .001). In the multivariable analysis, age (OR = 1.041, 95%CI 1.028–1.055; P < .001), insertion time (OR = 0.999, 95%CI 0.998–1.000; P = .009), withdrawal time (OR = 1.009, 95%CI 1.007–1.011; P < .001), personal history of adenoma (OR = 2.572, 95%CI 1.115–5.932; P = .027), and diabetes mellitus (OR = 2.221, 95%CI 1.084–4.549; P = .029) were risk factors for colorectal adenoma detection.

In a Chinese population, ADR increases with age, withdrawal time, a personal history of adenoma, and diabetes. Age, insertion and withdrawal times, and a personal history of adenoma may independently predict colorectal adenoma detection.
Acupuncture for primary osteoporosis
Authors: Huang Fan , Zhao Siyi , Qiu Mingwang , Li Yitong , Zhan Xiaoxuan , Wu Cunshu , Shi Chushuo , Sun Weipeng , Chen Guizhen , Xu Yunxiang
Published: April 2019

Background:

A large number of randomized controlled trials (RCTs) have shown that acupuncture (ACU) has certain advantages over pharmacotherapies in the treatment of primary osteoporosis (POP). However, due to the diversity of ACU treatments, its relative effectiveness have not yet been studied and explained. Therefore, based on the network meta-analysis (NMA), this study will compare the differences in the efficacy of multiacupuncture in the treatment of POP, to provide a reference for clinical treatment.

Methods:

We will search PubMed, MEDLINE, Embase, the Cochrane Library, China National Knowledge Infrastructure (CHKD-CNKI), WANFANG database (Chinese Medicine Premier), Chinese Biomedical Literature database (CBM), and VIP for relevant RCTs of ACU treatments for POP, from their inceptions to January 2019. STATA 15.0 and GEMTC software will be used to perform a NMA. The evidence will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the type 1 error rate will be assessed by trial sequential analysis (TSA).

Results:

The results of this review will be submitted to a recognized journal for publication.

Conclusion:

This proposed systematic review will evaluate the different advantages of various types of ACU in the treatment of POP.

Registration:

PROSPERO (registration number CRD42019122724).
The effect of antimicrobial photodynamic therapy on infected dentin in primary teeth
Authors: Costa-Santos Larissa , Silva-Júnior Zenildo Santos , Sfalcin Ravana Angelini , Mota Ana Carolina Costa da , Horliana Anna Carolina Ratto Tempestini , Motta Lara Jansinki , Mesquita-Ferrari Raquel Agnelli , Fernandes Kristianne Porta Santos , Prates Renato Araújo , Silva Daniela Fátima Teixeira , Deana Alessandro , Bussadori Sandra Kalil
Published: April 2019

Background:

Antimicrobial photodynamic therapy (aPDT) has been used for the treatment of dental caries. Papacarie is a gel composed of papain and chloramine employed for the partial removal of carious tissue, effective against bacteria, however, some studies report that this antibacterial action is not quite so evident. The aim of this study is to evaluate the clinical effect of aPDT on infected dentin in dental caries lesion in primary teeth.

Methods:

Thirty-two primary molars with deep occlusal dental caries will be selected and divided in 2 groups: G1 – caries removal with a low-speed drill and G2 – application of aPDT with PapacarieMBlue. After treatment, all the teeth will be restored with glass ionomer cement and followed up clinically and radiographically, with evaluations at 3, 6, and 12 months. Dentin samples before and after treatment will be analyzed microbiologically. The data will be submitted to descriptive statistical analysis of the association between the categorical variables and both age and gender using the chi-square test and Fisher exact text. The Student t test and analysis of variance will be used for the comparison of mean signs and symptoms of reversible pulpitis. Pearson correlation coefficients will be calculated for the analysis of correlations among the continuous variables.

Discussion:

Adding methylene blue dye to the formula of PapacarieMBlue might potentiate the antimicrobial action of aPDT and work more effectively on the infected dentin combined with a conservative, minimally invasive treatment.

Trial registration:

NCT02734420 on 10 march 2016.
Combined epidural adhesiolysis and balloon decompression can be effective in intractable lumbar spinal stenosis patients unresponsive to previous epidural adhesiolysis
Authors: Karm Myong-Hwan , Yoon Syn-Hae , Seo Dong-Kyun , Lee Sookyung , Lee Yongsoo , Cho Seong-Sik , Choi Seong-Soo
Published: April 2019

Moderate evidence exists regarding percutaneous epidural adhesiolysis (PEA) being an effective treatment for lumbar spinal stenosis (LSS). Although PEA is successfully performed using balloon-less epidural catheters, many patients with severe adhesions cannot obtain satisfactory results. Combined treatment with balloon-inflatable catheters for PEA and balloon decompression recently demonstrated sufficient pain relief and functional improvement in patients with intractable LSS. We compared the effects of PEA and balloon decompression in patients with intractable LSS who did not undergo PEA and those who were unresponsive to previous PEA with a balloon-less catheter.

We examined 315 patients who underwent PEA and balloon decompression with balloon-inflatable catheters. Patients with intractable LSS were divided into those without previous PEA (No-PEA) and those unresponsive to previous PEA using balloon-less catheters (Prev-PEA). The numeric rating scale, Oswestry disability index, and global perceived effect of satisfaction scale were measured at 0, 1, 3, and 6 months after the intervention. Responder analysis was performed based on changes in measured scales and indices.

A successful treatment response was observed at 1, 3, and 6 months after the intervention in 56.4%, 42.7%, and 32.9%, respectively, of the No-PEA group and in 48.9%, 37.8%, and 25.6%, respectively, of the Prev-PEA group. No significant between-group differences were detected. Pain intensities and functional status improved and were maintained throughout follow-up after PEA with balloon decompression using balloon-inflatable catheters.

This modality may represent a useful alternative to overcome the limitations of preexisting adhesiolysis procedures.