bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior occipital intramuscular hemangioma mimicking arteriovenous malformation
Authors: Chen Hao , Xu Baofeng , Wang Guangming , Guo Yunbao , Hou Kun , Yu Jinlu
Published: March 2019

Rationale:

Intermuscular hemangioma (IH) usually occurs in the muscles of the limbs and trunk, but can rarely occur in the occipital region. IH in the occipital region is easily misdiagnosed as arteriovenous malformation (AVM).

Patient concerns:

A 31-year-old woman had a right occipital mass for 5 months without pulsation.

Diagnosis:

Head computered tomography angiography (CTA) and digital substraction angiography (DSA) examinations showed that the lesion was mainly vascular, approximately 3 × 5 cm in size, and supplied by occipital arteries and the muscular branches of vertebral arteries. The venous drainage of the lesions communicated with the suboccipital vein plexus and the paravertebral vein in the venous phase, indicating AVM. Postoperative histological investigation showed the lesion was a hemangioma.

Interventions:

It was recommended for surgical removal. The surgery was carried out under general anesthesia. The lesion showed a clear boundary. The occipital artery touched the anterior margin of the lesion, was exposed and ligated, and was removed around the lesion. The lesion consisted of massive blood vessels, and the surrounding muscles were swollen, indicating IH.

After the lesion was removed, the normal muscle tissue around the lesion was also removed.

Outcomes:

The patient achieved a good recovery after surgery, and pathology confirmed IH. A postoperative 1-year CTA review was performed and showed partial residual, then the radiotherapy was recommended. She refused further radiotherapy, follow-up 2 years later showed no enlargement of the lesion.

Lessons:

Although IH rarely occurs in the occipital region, this can occur. Due to the complexity of the drainage veins in the occipital region, these IH are prone to misdiagnosis as AVM.
Effect of ALDH2 polymorphism on cancer risk in Asians
Authors: Zuo Wei , Zhan Zhenyu , Ma Lin , Bai Wei , Zeng Shanggan
Published: March 2019

Numerous studies have investigated the association between ALDH2 gene rs671G>A polymorphism and various cancer type in Asians. However, the results remain inconclusive.

We conducted a comprehensive meta-analysis including 63 articles with 66 studies containing 25,682 cases and 47,455 controls retrieved by searching PubMed and Embase electronic databases up to March 5, 2018.

Pooled results indicated that ALDH2 gene rs671 polymorphism was significantly associated with the overall cancer risk in Asians (homozygous model: odds ratio [OR] = 0.85, 95% confidence interval [CI] = 0.72–0.99, P = .042; heterozygous model: OR = 1.32, 95% CI = 1.14–1.52, P  < .001; recessive model: OR = 0.73, 95% CI = 0.60–0.88, P = .001; dominant model: OR = 1.32, 95% CI = 1.16–1.51, P < .001; and allele comparison model: OR = 1.11, 95% CI = 1.03–1.19, P = .004), especially in esophageal cancer and among the Chinese and the Japanese.

Our results suggest that ALDH2 rs671 polymorphism is associated with the overall cancer risk in Asians. Well-designed prospective studies with more information about gene–environment interaction, such as drinking, should be conducted to validate our findings.
Scalp acupuncture treatment for children's autism spectrum disorders
Authors: Liu Chang , Li Ting , Wang Zhijie , Zhou Rui , Zhuang Lixing
Published: March 2019

Background:

Autism spectrum disorder (ASD) is a neurodevelopment disorder without definitive cure. Previous studies have provided evidences for efficacy and safety of scalp acupuncture in children with ASD. However, the efficacy of scalp acupuncture treatment (SAT) in children with ASD has not been evaluated systematically. The objective of this study is to evaluate the efficacy of SAT in children with ASD.

Methods:

Information from 6 databases, including MEDLINE, EMBASE, Cochrane database, AMED, China National Knowledge Infrastructure, and Wanfang Data, were retrieved from the inception of each database from 1980 through September 2018. Randomized controlled trials evaluating the efficacy of SAT for patients with ASD were included. The primary outcome measures were the Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC). The secondary outcome measures were Psychoeducational Profile (Third Edition) (PEP-3) scores. Risk of bias assessment and data synthesis were conducted with Review Manager 5.3 software. Methodological quality was assessed with the Cochrane risk of bias tool.

Results:

Fourteen trials with 968 participants were conducted and 11 of the trials were suitable for meta-analysis. Compared with behavioral and educational interventions, SAT significantly decreased the overall CARS scores for children under 3 years old (mean difference (MD) = 3.08, 95% confidence interval (CI) [−3.96, −2.19], P < .001) and above 3 years old (MD = 5.29, 95% CI [−8.53, −2.06], P < .001), ABC scores (MD = 4.70, 95% CI [−6.94, −2.79], P < .001). Furthermore, SAT significantly improved PEP-3 scores in communication (MD = 3.61, 95% CI [2.85, 4.37], P < .001), physical ability (MD = 2.00, 95% CI [1.16, 2.84], P < .001), and behavior (MD = 2.76, 95% CI [1.80, 2.71], P < .001).

Conclusion:

SAT may be an effective treatment for children with ASD. Given the heterogeneity and number of participants, randomized controlled trials of high quality and design are required before widespread application of this therapy.
Effects of receptor activator nuclear factor κB gene polymorphisms on the susceptibility to knee osteoarthritis
Authors: Wang Changcheng , Luo Li , Tian Fengde , An Ning , Zhang Yao , Hao Ruihu , Li Dongyi , Zhou Zihao , Xiao Peng , Guo Lin
Published: March 2019

The present study aimed to explore genetic association of receptor activator nuclear factor κB (RANK) polymorphisms with individual susceptibility to knee osteoarthritis (OA) in different Kellgren–Lawrence (KL) grades.

This case–control study included 138 knee OA patients and 145 healthy individuals. RANK rs1805034 and rs8086340 polymorphisms were genotyped through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The effects of RANK polymorphisms on knee OA risk were analyzed via χ2 test or Fisher exact test, and the results were expressed using odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

The C allele of rs1805034 polymorphism had significantly higher frequency in knee OA patients than in controls (P = .044), indicating that this allele could increase the risk of knee OA (OR = 1.424, 95% CI = 1.010–2.008). Besides, the CC genotype and C allele of the rs1805034 polymorphism were significantly associated with elevated risk of knee OA in moderate grade (CC vs TT: P = .018, OR = 3.071, 95% CI = 1.187–7.941; C vs T: P = .012, OR = 1.787, 95% CI = 1.131–2.823). However, rs8086340 polymorphism had no significant association with knee OA risk

The C allele of RANK rs1805034 polymorphism is closely correlated with increased risk of knee OA, especially for moderate grade.
Blood sugar control among type 2 diabetic patients who travel abroad
Authors: Lin I-Wen , Chang Hao-Hsiang , Lee Yi-Hsuan , Wu Yi-Chun , Lu Chia-Wen , Huang Kuo-Chin
Published: March 2019

The dose adjustment of anti-diabetic drugs during traveling abroad remains an important issue for the diabetic patients. However, there are few studies exploring the changes in blood sugar in patients with type 2 diabetes mellitus (T2DM) when traveling abroad. The study aimed to investigate the hypoglycemic episodes, sugar control, and associated factors during travel among patients with T2DM.

A questionnaire was administrated to T2DM patients visiting the family medicine clinic in a medical center from September 2016 to April 2017. The Chi-square test was used to examine the differences in risk factors of hypoglycemia between hypoglycemic group and non-hypoglycemic group. Multivariate logistic regression models were used to examine the risk factors for the hypoglycemia.

A total of 65 males and 74 females completed the questionnaire. The mean age was 59.3 ± 12.1 year olds, the mean BMI was 28.1 ± 5.9 kg/m2, and the mean HbA1C was 7.4 ± 1.1%. There was 8.6% of diabetic patients reporting hypoglycemic episodes during travel. The hypoglycemic episodes were significantly related to the numbers of crossing time zones after adjusting for possible confounders. Only 21.6% of subjects told physicians their travel plan whereas two third of the physicians did not provide pre-travel consultation.

The hypoglycemic episodes sometimes occurred and were related to the numbers of crossing time zones in diabetic travelers. The proportion of pre-travel consultation was low in patients with T2DM. Besides, most of the physicians did not offer pre-travel education when patients mentioned their traveling plan. The willing and ability of physicians to offer the pre-travel diabetic education deserved further investigation.
Effectiveness and safety of warm needle acupuncture on children with cerebral palsy
Authors: Chen Long An , Liu Hui Tuan , Huang Cihui , Zhang Lu , Zeng Fangdong , Xie Bo
Published: March 2019

Background:

Warm needle acupuncture (WNA) is an integral part of the acupuncture therapy, which combines acupuncture and moxibustion. Children with cerebral palsy (CP) is a common disease in children, which seriously affects children's growing development, physical and mental health. The clinical practice indicates that WNA has a therapeutic effect on children with CP. Here we will provide a protocol to explore the effectiveness and safety of WNA for children with CP.

Methods:

We will search the randomized controlled trails (RCT) literatures of WNA for children with CP in 5 English databases [PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), and WHO International Clinical Trials Registry Platform (ICTRP)] and 4 Chinese databases [Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)]. Activity of Daily Living Scales (ADL) of the patient will be considered as the primary outcome and the secondary outcome will include 88 items of gross motor function scale (GMFM-88), Gesell Growth Table (GGT), Criteria for judging efficacy and adverse events caused by WNA such as dizziness, nausea, vomiting, weariness, etc. The selection of the studies will be performed by EndnoteX7 software. And we will conduct all analyses with RevMan software V5.3.

Result:

This study will provide a rational synthesis of current evidences for WNA on children with CP.

Conclusion:

The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on children with CP.

Registration

PROS-PERO CRD42019122034
Hidden blood loss during perioperative period and the influential factors after surgery of thoracolumbar burst fracture
Authors: Yin Mengchen , Chen Guanghui , Yang Jian , Tong Zhengyi , Xu Jinhai , Huang Quan , Ma Junming , Mo Wen
Published: March 2019

Surgical therapy is vital for thoracolumbar burst fracture in restoring vertebral height, correcting kyphosis, decompressing nervous, and maintaining stability. Patients have unexpectedly lower hemoglobin levels postoperatively, which is remarkably inconsistent with the measured blood loss. However, hidden blood loss (HBL) is often neglected.

To investigate HBL during perioperative period and determine its influential factors after surgery.

A total of 68 patients who underwent surgery in our institution between January 2015 and January 2017 were included in the study. The demographic information, including the patients’ age, gender, weight, height, duration of symptoms, surgery approach, time of operation, volume of drainage, classification of fracture, percentage of vertebral height loss and restoration, was collected. HBL was calculated according to the Gross formula. Influential factors were further analyzed using multivariate linear regression analysis.

The mean HBL was 303.5 (range 18.4–803.5) mL, accounting for 67.5% of total blood loss. It indicated that the amount of HBL was much higher than we expected. Multiple and stepwise regression analysis revealed that blood loss, preoperative activated partial prothrombin time (APPT), percentage of anterior and medium vertebral height restoration were positively correlated with HBL. The association between HBL and the influential factors was analyzed based on the regression model equation: HBL = [1 + e [216.737 + 0.627∗blood loss + 10.817∗APTT + 207.549∗anterior height restoration + 20.002∗medium height restoration]]−1.

HBL during perioperative period accounted for a substantial portion of the total blood loss and was much larger than what we thought. The blood loss, preoperative APPT, percentage of anterior and medium vertebral height restoration were positively correlated with HBL. Therefore, more attention needs to be paid to HBL to ensure patients’ safety.
A novel diagnostic method for distinguishing parapneumonic effusion and empyema from other diseases by using the pleural lactate dehydrogenase to adenosine deaminase ratio and carcinoembryonic antigen levels
Authors: Saraya Takeshi , Ohkuma Kosuke , Koide Takashi , Goto Hajime , Takizawa Hajime , Light Richard W.
Published: March 2019

Pleural effusions are a common medical problem not only for pulmonologists but also for general physicians, often needing thoracentesis for a definite diagnosis. However, thoracentesis cannot always reveal malignant cells or microbiological evidence.

In this context, we prospectively enrolled a total of 289 patients with pleural effusions due to diverse etiologies: parapneumonic effusion (PPE) (63), empyema (22), tuberculous pleural effusion (TBPE) (54), malignant pleural effusion (MPE) (140), or chronic renal failure (CRF)/congestive heart failure (CHF) (10). The MPE group consisted of lung cancer (adenocarcinoma, n = 90; squamous cell carcinoma, n = 5; small cell carcinoma, n = 4), malignant lymphoma (n = 17), malignant mesothelioma (n = 11), malignant melanoma (n = 3), and metastasis from other organs (n = 10).

This study demonstrated that the pleural lactate dehydrogenase (LDH)to adenosine deaminase (ADA) ratios differed significantly between patients with CHF/CRF, MPE, TBPE, empyema, and PPE. We discovered a simple method to differentiate pleural diseases based on the pleural LDH to ADA ratio and carcinoembryonic antigen (CEA). A pleural LDH to ADA ratio greater than 15.5 and a pleural CEA level of less than 5 ng/mL is indicative of PPE or empyema rather than TBPE, MPE, or transudative pleural effusion (CRF, CHF).

This method has a sensitivity of 62.0%, a specificity of 91.0%, and an area under the receiver operating characteristic curve of 0.765 (95% confidence interval [CI]: 0678–0.852, P < .001), odds ratio of 16.6 (95% CI: 7.28–37.8, P < .001), a positive likelihood ratio (LR) of 6.8, and a negative LR of 0.02.
Chondroma of laryngeal cartilage mimicking thyroid tumor
Authors: Tan ZiQiao , Yao Mengwei , Liu Tao , Wang Shaohua , Xu Jing , Zhang Yonghong , Yang Xinxin , Ma Dengdian , Li Xiaoyu
Published: March 2019

Rationale:

Cartilaginous tumors of the larynx are rare. This report describes an atypical case with chondroma of laryngeal cartilage presenting as cervical mass, which was misdiagnosed as a thyroid tumor.

Patient concern:

A 73-year-old Chinese man with a 1-month history of cervical mass. The neck color Doppler ultrasound and CT of thyroid showed a space-occupying lesion in the upper right pole of the thyroid gland.

Diagnoses:

Chondroma of laryngeal cartilage was confirmed at the time of surgery.

Interventions:

After relevant examinations, subtotal thyroidectomy and excisional biopsy of the neck mass were performed under general anesthesia. However, the rapid pathology of the tumor (thyroid right lateral lobe) indicated chondroma, so the patient underwent laryngeal chondroma resection and tracheotomy under general anesthesia.

Outcomes:

After surgery, given the advanced age of the patient, long surgical duration and poor cardiorespiratory function, the patient suffered sudden cardiac death after the operation.

Lessons:

Cartilaginous tumor of the larynx is rare, and approximately 250 cases have been reported till date. It is difficult to diagnose cartilaginous tumors of the larynx in the early stage, and they are easily misdiagnosed. Early diagnosis, radical surgery, and long-term follow-up are key to prolong survival.
Neurofibromatosis type I with malignant peripheral nerve sheath tumors in the upper arm
Authors: Zhang Lili , Sun Fangfang , Li Hongyu , Du Jie , Zhao Lirong
Published: March 2019

Rationale:

Malignant peripheral nerve sheath tumor occurring in the context of neurofibromatosis type I (NF1) is relatively rare. Herein, we report a case of NF1 with malignant peripheral nerve sheath tumor in the upper arm.

Patient concerns:

A 24-year-old man presented with a mass in the medial part of the left upper arm that had been present for more than 20 years. In the previous 1 year prior to admission, the mass had grown significantly. Physical examination showed cafe-au-lait spots of variable sizes throughout the body and multiple masses in the medial part of the left upper arm. Three months later after the resection of the masses, the patient was readmitted to our department due to tumor recurrence. Two months after the extended resection, in situ recurrence of the tumor was noted again. Four months after the operation and the administration of radiotherapy, a mass was found in the outside of the left upper arm.

Diagnosis:

Immunohistochemical staining showed the masses were positivity for vimentin, CD34, and S100; the tumor cells were negative for PGP9.5, CD57, EMA, and SMA. The Ki-67 labeling index was approximately 40%. A diagnosis of malignant peripheral nerve sheath tumor was made.

Interventions:

Surgical resection was performed for both the primary tumors and the 2 subsequent recurrence tumors. The patient underwent radiotherapy with 60 Gy in 30 fractions after the third operation. Four months after the administration of radiotherapy, the patient underwent tumorectomy of a mass in the outside of the left upper arm.

Outcomes:

During the 4-month follow-up after the fourth operation, the patient's condition was stable.

Lessons:

Malignant peripheral nerve sheath tumor in NF1 is an exceedingly rare entity that poses a great diagnostic challenge. High-frequency ultrasound can support the diagnosis.
Short- and long-term outcomes of totally robotic versus robotic-assisted right hemicolectomy for colon cancer
Authors: Liu Dongning , Li Jieming , He Penghui , Tang Cheng , Lei Xiong , Jiang Qunguang , Li Taiyuan
Published: March 2019

Totally robotic right hemicolectomy (TRRH) is a novel alternative surgical method used for the treatment of colon cancer. The aim of this study was to compare both the short-and long-term outcomes of TRRH and robotic-assisted right hemicolectomy (RARH) for the treatment of colon cancer.

We performed a 1:2 matched propensity score analysis. We then retrospectively analyzed all procedures (64 cases TRRH and 128 cases RARH) carried out by a single surgeon between December 4, 2014 and June 20, 2018 at a large center. Both short-and long-term surgical outcomes were compared between 2 different groups.

Based on the propensity score matching, we selected 64 patients that had undergone TRRH treatment and 128 patients who had undergone RARH treatment. The preoperative clinical–pathological characteristics were well matched between the 2 groups. We observed no significant differences between the 2 groups in postoperative pathological outcomes. The mean operative time was found to be significantly longer in the TRRH group compared to the RARH group (168.2 ± 9.1 minutes vs 153.4 ± 7.4 minutes, P = .034). The mean operative incision length was found to be significantly longer in the TRRH group than in the RARH group (4.5 ± 0.6 cm vs 6.9 ± 1.1 cm, P = .023). Postoperative pain score (visual analog scale at day 1) was found to be significantly lower in the TRRH group than in the RARH group (2.9 ± 1.3 vs 4.1 ± 2.1, P = .005). The time to pass flatus was observed to be statistically lower in the TRRH group (P = .042). We observed 3 twists of mesentery in the RARH group, while none were observed in the TRRH group (P < .050). Both the 3-year overall survival (TRRH [91.6%] vs RARH [89.2%], P = .467) and the 3-year disease-free survival (TRRH [81.4%] vs RARH [78.2%], P = .551) were determined to be comparable between the 2 groups studied here.

We show that TRRH is a safe and feasible treatment option for colon cancer patients in terms of both short- and long-term outcomes. High-volume, randomized, controlled trials with sufficient follow-up studies will need to be carried out in order to confirm this rationale.
Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction
Authors: NanZhu Yang , Xin Li , Xianghua Yun , Jun Chen , Min Li
Published: March 2019

To investigate the risk factors of nosocomial pneumonia (NP) in elderly patients with acute cerebral infarction (ACI).

In this study, 324 aged 70 years and over patients with ACI who were admitted to the inpatient department of TianJin First Hospital (China) from January 2012 to February 2018 were retrospectively analyzed. The patients were divided into NP group (80 patients) and non-NP group (244 patients) according to whether NP was occurred 48 hours after hospitalization. Baseline profiles and biochemical analyses were compared between 2 groups. Information regarding risk factors for NP in elderly patients with ACI was collected from all patients. Associations with NP and outcome were evaluated.

Among the total patients, NP occurred in 80 (24.69%) patients. There were no statistically significant differences between risk of NP and sex, current drinking, diabetes mellitus, stroke history, and levels of serum UA, TG, HDL-C, LDL-C, Glucose, chloride, potassium. Multivariate logistic regression analysis showed that the independent risk factors for NP were living alone (OR 4.723; CI 1.743∼12.802; P = .002), initial NIHSS score (OR 1.441; CI 1.191∼1.743; P = .000), NRS2002 score (OR 0.139; CI 0.087∼0.223; P = .000), BMI (OR 1.586; CI 1.353∼1.858; P = .000), a past pneumonia history (OR 0.073; CI 0.017∼0.321; P = .001), atrial fibrillation (AF) (OR 0.129; CI 0.033∼0.499; P = .003), CRP (OR 1.050; CI 1.017∼1.085; P = .003), BUN (OR 0.603; CI 0.448∼0.812; P = .001) and Cr (OR 1.036; CI 1.015∼1.057; P = .001). Level of albumin was an independent protective factor of NP in elderly patients with ACI (OR 0.865; CI 0.750∼0.999; P = .048). Furthermore, elderly patients with ACI who had NP had worse clinical outcomes both during hospitalization and after discharge (P < .05).

We identified significant risk factors for NP in elderly patients with ACI, including living alone, initial NIHSS score, malnutrition, a past pneumonia history, AF, CRP, and Renal function were associated with NP in elderly patients with ACI. The clinical course was worse and the duration of hospital stay was longer in NP patients than in non-NP patients.
Takotsubo cardiomyopathy associated with serotonin syndrome in a patient with stroke
Authors: Jang Sung Ho , Nam Jong-Ho , Lee Jun , Chang Min Cheol
Published: March 2019

Rationale:

Takotsubo cardiomyopathy (TC) is characterized by transient left ventricular dysfunction. We describe a patient with stroke who presented with TC caused by serotonin syndrome (SS) following the administration of serotonergic and dopaminergic agents.

Patient concerns:

A 55-year-old man with stroke was administered venlafaxine, tianeptine, ropinirole, carbidopa/levodopa, bromocriptine, and methylphenidate during rehabilitation. The patient presented with clinical features of SS (mental confusion, agitation, hyperhidrosis, chills, rigidity, and tachycardia), which persisted over 24 hours. The day after his SS symptoms disappeared, the patient's blood pressure decreased, and he developed tachycardia.

Diagnoses:

Echocardiography revealed an extensively akinetic apical segment and a severely hypokinetic midventricular segment of the left ventricle with basal hyperkinesia. The ejection fraction was reduced to 38%, and he was diagnosed with TC by the cardiologist.

Interventions:

He was administered oxygen at 8 to 10 L/minutes via a Venturi mask, and norepinephrine bitartrate was administered intravenously. Hydration was maintained with normal saline infusion.

Outcomes:

Following appropriate management of TC, the patient was hemodynamically stable with significant recovery of his left ventricular wall motion.

Lessons:

Prognosis of TC is usually favorable; however, it could be fatal in some cases. Clinicians should be aware of the potential development of TC in patients with stroke presenting with SS following the administration of serotonergic and dopaminergic agents.
The epidemiology of coronary artery bypass surgery in a community hospital
Authors: Ziv-Baran Tomer , Mohr Rephael , Yazdchi Farhang , Loberman Dan
Published: March 2019

During the last decades, the increased number of percutaneous interventions procedures causes a significant change in the profile of patients referred to coronary artery bypass grafting (CABG). We aimed to study changes in patients’ characteristics and procedural outcomes of patients referred to CABG in a community hospital during the first 15 years of the millennium.

A historical cohort study of all patients who underwent CABG in Cape Cod Hospital was performed. The period was divided into 2 sub-periods, 2000 to 2008 and 2009 to 2014. Patients’ characteristics and procedure outcomes were compared. Data on age, sex, comorbidities, Society of Thoracic Surgery risk scores and surgical adverse outcomes (stroke, coma, and 30-days mortality) were collected.

During the study period, 1108 patients underwent CABG; 612 were operated before 2009 and 496 after. Age and sex were similar in the 2 periods. The patients in the later period presented lower risk for mortality and stroke (P <.001). Diabetes (DM) was more common in the later period (P <.001) while peripheral vascular disease (PVD) (P <.001) and left main disease (LM) (P = .017) were more common in the earlier period. Mortality rates were similar between the 2 periods. Post-operative stroke (1.8%) and coma (0.8%) were presented only in the later period. In conclusion, a significant change in CABG patients’ characteristics was observed.

In conclusion, patients in the later period had lower risk score and were more likely to present with DM and less with PVD and LM. Despite the lower risk, the mortality rate was similar.
Prognostic values of 18F-FDG PET/CT metabolic parameters and clinical figures in locally advanced pancreatic cancer underwent chemotherapy combined with stereotactic body radiation therapy
Authors: Zhang Anyu , Ren Shengnan , Yuan Yuan , Li Xiao , Zhu Xiaofei , Jiang Lingong , Li Danni , Zuo Changjing
Published: March 2019

Stereotactic body radiation therapy (SBRT) has emerged to be a preference treatment for locally advanced pancreatic cancer (LAPC) patients. In this study, we aimed to investigate the prognostic roles of 18F-FDG PET/CT metabolic parameters and clinical figures in LAPC patients underwent chemo-SBRT combined therapy.

During January 2013 to January 2017, 23 LAPC patients who underwent 18F-FDG PET/CT within 2 weeks before treatment were recruited and retrospectively analyzed. Maximum standardized uptake values (SUVmax), SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG), chemoradiotherapy (CRT) sequence, and relevant clinical figures were grouped upon the median values, then analyzed by Kaplan–Meier method and Cox proportional hazard models for their prognostic evaluation.

The median overall survival (OS) and progression-free survival (PFS) of all patients were 16.7 months and 11.3 months, respectively. According to the statistic results, the longest diameter of tumor (LDT), MTV, TLG, and CRT sequence were associated with OS (all P <.05). Among which, LDT and MTV were proved to be the independent prognostic factors for OS (hazard ratio [HR]: 3.437, 3.015, both P <.05). Additionally, LDT and CRT sequence were found associated with PFS (both P <.05), and CRT sequence was the independent prognostic factor for PFS in chemo-SBRT treated LAPC patients (HR: 0.130, P <.05).

For LAPC patients received chemotherapy and SBRT combined therapy, MTV and LDT showed independent prognostic values for OS. Meanwhile, CRT sequence was an independent PFS prediction factor.
The prognosis of bulky hepatocellular carcinoma with nonmajor branch portal vein tumor thrombosis
Authors: Jang Tyng-Yuan , Huang Ching-I. , Yeh Ming-Lun , Lin Zu-Yau , Chen Shinn-Cherng , Chuang Wan-Long
Published: March 2019

A bulky, solitary hepatocellular carcinoma (HCC) with nonmajor branch portal vein tumor thrombosis (PVTT) was staged as T2 in the tumor-node-metastasis (TNM) system. We aimed to evaluate the prognosis of this group of patients.

A total of 2643 patients with HCC in a medical center were consecutively enrolled. The stage of HCC was determined according to the 7th edition of American Joint Committee on Cancer staging system. Patients who were diagnosed as having solitary HCC larger than 5 cm with nonmajor portal vein thrombosis (VP1-VP2) and no lymphadenopathy or metastasis were included.Bulky HCC with nonmajor branch PVTT and without metastasis and lymphadenopathy was identified in 0.15% (4 out of 2643 patients) of the patients with HCC. Child–Pugh scores of the patients were A to B. Tumor sizes all were larger than 5 cm (mean: 6.8 ± 1.0 cm). All patients had nonmajor branch of PVTT. Three patients initially received trans-arterial chemoembolization (TACE) therapy, and 1 patient refused treatment because of old age. The response to TACE was poor: 2 patients rapidly progressed to main portal vein thrombosis, and their tumors enlarged within a half year. Only 1 patient's disease remained stable but progressed gradually 2 years later. The median survival time was 16.5 months. The 1- year, 2-year, and 3-year survival rate was 100%, 50%, and 0%, respectively.

Solitary HCC > 5 cm with PVTT of a nonmajor branch gave dismal prognoses and required aggressive treatment such as hepatic resection or combination therapy. In our opinion, it should be staged as T3 rather than a T2 in the TNM staging system.
Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery
Authors: Lin Wei-Lin , Lee Meei-Shyuan , Wong Chih-Shung , Chan Shun-Ming , Lai Hou-Chuan , Wu Zhi-Fu , Lu Chueng-He
Published: March 2019

Background:

As reported, patients experience less postoperative pain after propofol-based total intravenous anesthesia (TIVA). In the present study, we investigated the postoperative analgesic effects between propofol-based TIVA and desflurane anesthesia after spine surgery.

Methods:

Sixty patients were included who received (surgical time >180 minutes) lumbar spine surgery. Patients were randomly assigned to receive either TIVA (with target-controlled infusion) with propofol/fentanyl-based anesthesia (TIVA group) or desflurane/fentanyl-based anesthesia (DES group), titrated to maintain Bispectral Index values between 45 and 55. All patients received patient-controlled analgesia (PCA) with fentanyl for postoperative pain relief. Numeric pain rating scale (NRS) pain scores, postoperative fentanyl consumption, postoperative rescue tramadol use, and fentanyl-related side effects were recorded.

Results:

The TIVA group patients reported lower NRS pain scores during coughing on postoperative day 1 but not day 2 and 3 (P = .002, P = .133, P = .161, respectively). Less fentanyl consumption was observed on postoperative days 1 and 2, but not on day 3 (375 μg vs 485 μg, P = .032, 414 μg vs 572 μg, P = .033, and 421 μg vs 479 μg, P = .209, respectively), less cumulative fentanyl consumption at postoperative 48 hours (790 μg vs 1057 μg, P = .004) and 72 hours (1210 μg vs 1536 μg, P = .004), and total fentanyl consumption (1393 μg vs 1704 μg, P = .007) when compared with the DES group. No difference was found in rescue tramadol use and fentanyl-related side effects.

Conclusion:

Patients anesthetized with propofol-based TIVA reported less pain during coughing and consumed less daily and total PCA fentanyl after lumbar spine surgery.
Risk factors of postoperative acute lung injury following lobectomy for nonsmall cell lung cancer
Authors: Kim Hyun Jung , Cha Seung Ick , Kim Chang-Ho , Lee Jaehee , Cho Joon Yong , Lee Youngok , Kim Gun-Jik , Lee Deok Heon
Published: March 2019

Acute lung injury following lung resection surgery is not rare and often related to mortality. Although it has been a significant clinical and economic impact associated with increased intensive care unit (ICU) utilization, length of hospital stay, and associated cost, it is unpredictable. Aims of this study were to identify the modifiable risk factors of postoperative acute lung injury (PALI) following lung cancer surgery.

We retrospectively analyzed medical records of 354 cases of lung cancer surgery in the tertiary university hospital from January 2012 to December 2015. PALI was defined as bilateral diffuse pulmonary infiltration on chest radiography, oxygenation failure (PaO2/FiO2 < 300), and absence of sign of left ventricular failure within a week from operation. We classified patients into either PALI group or non-PALI group and compared clinical characteristics of two groups. Logistic regression model was fitted to evaluate the risk factor of PALI.

Among 354 cases of lung cancer surgeries, 287 lobectomies were analyzed. The overall incidence of PALI was 2.79% (8/287); four patients developed pneumonia with acute respiratory distress syndrome, and four patients developed ALI without clinical infection sign. There was no difference in baseline characteristics between PALI group and non-PALI group, but in operative parameters, a larger amount of fluid infusion was observed in PALI group. Logistic regression model showed underlying ischemic heart disease (OR 7.67, 95% CI 1.21–47.44, P = .03), interstitial lung disease (OR 30.36, 95% CI 2.30–401.52, P = .01), intravascular crystalloid fluid during surgery (OR 1.10, 95% CI 1.00–1.20, P = .04), and intraoperative transfusion (OR 56.4, 95% CI 3.53–901.39, P < .01) were risk factors of PALI. PALI increases ICU admission, use of mechanical ventilator, duration of hospital stay, and mortality.

The clinical impact of PALI is marked. Significant independent risk factors have been identified in underlying ischemic heart disease, interstitial lung disease, intravascular crystalloid fluid, and transfusion during surgery.
The effect of diabetes on the risk and mortality of acute lung injury/acute respiratory distress syndrome
Authors: Ji Mingxia , Chen Mengyan , Hong Xiaofei , Chen Tiejiang , Zhang Ning
Published: March 2019

Background:

The role of pre-existing diabetes in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is still controversial. This systematic review and meta-analysis of observational studies aimed to evaluate the effect of diabetes on the risk and mortality of ALI/ARDS.

Methods:

A comprehensive literature search was performed in PubMed, Scopus, Cochrane Central Register of Controlled Trails and Web of Science for their inception to September 2018. Summary risk estimates were calculated with a DerSimonian and Laird random-effects model. Heterogeneity was evaluated using Cochran chi-square test and the I2 statistic.

Results:

Ultimately, 14 studies with a total of 6613 ALI/ARDS cases were included. The risk of ALI/ARDS was not significantly reduced in diabetes patients (OR 0.82, 95% CI 0.57–1.18, P = .283), with obvious heterogeneity across studies (I2 = 72.5%, P < .001). Further analyses in the meta-analysis also showed no statistically significant associations between pre-existing diabetes and in-hospital mortality (OR 0.79, 95% CI 0.51–1.21, P = .282) or 60-day mortality of ALI/ARDS (OR 0.91, 95% CI 0.75–1.11, P = .352).

Conclusion:

This systematic review and meta-analysis of observational studies indicates that pre-existing diabetes have no effect on the risk and mortality of ALI/ARDS.
Challenges in the delivery of surgical care for head and neck cancer patients in the Hong Kong Special Administrative Region and China
Authors: Chan Jason Y.K. , Wong Eddy W.Y. , Xue Lingbin , Liang Fa Ya
Published: March 2019

Purpose of review

This article aims to explore the ethical dilemmas faced by head and neck surgeons in the Hong Kong Special Administrative Region (HKSAR) and China in the provision of safe, oncological sound and timely care for head and neck cancer patients.

Recent findings

There is no literature, in particular, in relation to the treatment of head and neck cancer patients and priority setting in head and neck surgery. However, through examining the healthcare provision and sociocultural backgrounds of the HKSAR and China, certain aspects, such as traditional Chinese medicine and medical guan xi (Seeking medical care for personal connections) have been shown to significantly influence the provision of care in China. Medical guan xi facilitates inequity and is problematic in developing a system based on justice, equity, nonmalfeasance and beneficence. In the HKSAR, resource limitations are related to the maldistribution of healthcare between the public and private sectors, resulting in significant time constraints for surgery and oncology care of patients. There is informal application of ethical frameworks for priority setting, however, these have neither been formally supported nor enforced from an administrative level that needs to be addressed.

In the HKSAR, there needs to be a strengthening of an ethical framework for priority setting to adhere to justice for our patients and healthcare providers in treating head and neck cancer patients. In China, priority setting is largely set by sociocultural practices that are endemic, in particular, medical guan xi that is inequitable and needs to be addressed to improve the doctor–patient relationship.
Hepatic Venous Pressure Gradient Measurements in Children
Authors: Ebel Noelle H. , Carlin Kristen , Shaffer Michele L. , Shivaram Giri , Hawkins Matthew , Lane Erin R. , Cooper Kara , Lindquester Will S. , Gadodia Gaurav , Murray Karen F.
Published: March 2019

Objectives:

In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children.

Methods:

Utilizing retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data.

Results:

Forty‐one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (n = 15), chronic liver disease (n = 12), hepatic noncirrhotic portal hypertension (n = 4), acute liver failure (n = 3), and nonhepatic causes of portal hypertension (n = 7). Elevated mean HVPG measurements were found in children with acute liver failure (10 mmHg, range 4–12) and chronic liver disease (7 mmHg, range 1–12). HVPG measurements did not correlate with the histological severity of fibrosis (ρ = 0.23, P = 0.14) or portal inflammation (ρ = 0.24, P = 0.29), and no difference was found in HVPG when comparing children with and without a history of variceal bleeding (P = 0.43).

Conclusions:

HVPG measurements do not correlate significantly with the degree of hepatic fibrosis on biopsy. Furthermore, HVPG measurements are not associated with the presence of varices or history of variceal bleeding, suggesting the possibility of intrahepatic shunting in children with advanced liver disease. Therefore, unlike in adults, HVPG measurements may not accurately predict children who are at risk of complications from portal hypertension.
A Symptom Self‐report Tool for Children With Inflammatory Bowel Disease (IBDnow)
Authors: Vernon‐Roberts Angharad , Lopez Robert N. , Frampton Chris , Gearry Richard B. , Lemberg Daniel A. , Day Andrew S.
Published: March 2019

Objectives:

Clinical symptom evaluation for children with inflammatory bowel disease (IBD) is typically done using composite tools: the Pediatric Crohn's Disease Activity Index (PCDAI) and Pediatric Ulcerative Colitis Activity Index (PUCAI). Both rely on clinician interpretation of child or parent symptom recall. No universal self‐report tool has yet been developed for children with IBD to assess and report their symptoms. The research objective was to develop a self‐report tool that produced information congruent with that obtained by clinicians using the PUCAI or PCDAI.

Methods:

A children's symptom self‐report tool (IBDnow) was developed with picture and text Likert symptom scales. The clinician and child completed their reports during the same outpatient consultation. Agreement levels were calculated at the individual level (identical child and clinician answers), category level (symptom severity), and aggregate level (cohort scores). Internal consistency was measured with Cronbach alpha.

Results:

One hundred children from Christchurch (New Zealand) (n = 65), and Sydney (Australia) (n = 35) completed the study (Crohn's Disease (CD):88, ulcerative colitis (UC):12), mean age 13.9 years (±3.6). Mean individual agreement was 0.76 (±0.19). Category severity had very good or good inter‐rater reliability for 5 of the 7 symptom scales and overall severity agreement of 76%. Aggregate mean scores were significantly different between clinicians (14.9, ±18.8), and participants (21.6, ±19.4), (P <0.005, confidence interval −9.0, −4.4), but 60 pairs had scores within a 10% margin. Cronbach alpha was 0.74.

Conclusions:

This self‐report tool had good proportionate agreement between raters, and good crude agreement for symptom categories. Assigning PUCAI or PCDAI scores caused inter‐rater discrepancies to be misleadingly magnified. Pediatric gastroenterologists may consider utilizing IBDnow to elicit symptom self‐reports from children with IBD to enable them to communicate meaningful information on their ongoing symptom burden. This would be a positive step in helping children feel included in clinical encounters and promoting self‐management, at the same time producing valid, subjective symptom recall.
Infliximab Paradoxical Psoriasis in a Cohort of Children With Inflammatory Bowel Disease
Authors: Courbette Olivier , Aupiais Camille , Viala Jerome , Hugot Jean‐Pierre , Louveau Baptiste , Chatenoud Lucienne , Bourrat Emmanuelle , Martinez‐Vinson Christine
Published: March 2019

Objectives:

In adult inflammatory bowel disease (IBD) treated by anti‐TNF antibodies, paradoxical psoriasis has an estimated prevalence of 1.6 to 22%, especially in infliximab (IFX)‐treated patients. Little is known in the pediatric IBD (PIBD) populations.

Methods:

All patients ages from 2 to 18 years with Crohn disease (CD) or ulcerative colitis (UC) and treated for the first time by IFX between January 2002 and March 2014, were considered for inclusion in this retrospective study performed in a tertiary PIBD centre. Paradoxical psoriasis events together with clinical and biological data were collected in all patients. Comparisons between psoriasis and control groups were performed using univariate statistical analyses.

Results:

One hundred and twenty‐three CD patients and 24 UC patients were treated with IFX. Twenty patients (13.6%) experienced a paradoxical psoriasis. All of them were affected by CD. Perianal CD was more frequent in the psoriasis group (P = 0.033). Fourteen patients (70%) were in remission when skin lesions occurred. Paradoxical psoriasis was diagnosed 355 days (median, interquartile range [IQR] 239; 532) after the initiation of IFX corresponding to the eighth injection (median, IQR: 6; 15). Psoriasis lesions were controlled by local steroids in all cases and no patients discontinued IFX therapy.

Conclusions:

13.6% of our IBD patients treated with IFX developed psoriasis during a median follow‐up of 23.9 months (IQR: 11.6; 36.5). Crohn disease patients with perianal disease were at a higher risk to develop this common side effect.
Severity and the Treatment of Depression
Authors: Zimmerman Mark
Published: March 2019

Severity is an important consideration in treatment decision-making for depression. Two controversies in the treatment of depression are related to the issue of severity. First, are antidepressants only effective for severely depressed patients? Second, should the severity of depression be used as the basis for recommending medication or psychotherapy as first-line treatment? More specifically, should patients with severe depression preferentially be treated with medication? A related question is whether psychotherapy is beneficial for severely depressed patients. Some controversial articles sparked coverage in the popular press related to these questions and stimulated subsequent research on the impact of depression severity on treatment efficacy. The results of three recent large pooled analyses of patient level data indicate that the efficacy of antidepressants is not limited to the narrow band of patients who score highest on symptom severity scales. A meta-analysis of 132 controlled psychotherapy studies of more than 10,000 patients found that greater mean baseline symptom severity did not predict poorer response. A pooled analysis of individual patient data from 16 studies comparing antidepressants and cognitive behavior therapy found that severity was not associated with differential treatment outcome. These results are discussed in the context of recommendations in official treatment guidelines.
Breakthrough in Global Consensus for the Diagnosis of Malnutrition in Adults in Clinical Settings
Authors: Jensen Gordon L. , Cederholm Tommy
Published: March 2019

The Global Leadership Initiative on Malnutrition was convened by several of the major global clinical nutrition societies to build consensus on criteria for diagnosis of malnutrition (ie, undernutrition) for adults in clinical settings. The malnutrition criteria for consideration were identified from existing widely used approaches. They were then ranked by ballot among the Global Leadership Initiative on Malnutrition participants. There was strong endorsement of 3 phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). A consensus construct is proposed for the diagnosis of malnutrition that requires at least 1 phenotypic criterion and 1 etiologic criterion. Phenotypic metrics are suggested for severity grading. The etiologic criteria are intended to help guide interventions and anticipated outcomes. Going forward, our immediate priorities include promoting dissemination, implementation, validation studies, and feedback.