bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Medication Adherence and Pharmacokinetics of Dasatinib for Earlier Molecular Response in Japanese Patients With Newly Diagnosed Chronic Myeloid Leukemia: A Pilot Study
Authors: Iwamoto Takuya , Monma Fumihiko , Ohishi Kohshi , Umino Akira , Suzuki Kei , Oka Koji , Kawakami Keiki , Sekine Takao , Okuda Masahiro , Katayama Naoyuki
Published: April 2019

Background:

Tyrosine kinase inhibitors markedly improve the survival for patients with chronic myeloid leukemia (CML). However, a decrease in adherence leads to undesired therapeutic outcomes. In this study, the relationships among adherence, pharmacokinetics, response, and adverse effects for dasatinib treatment were prospectively investigated.

Methods:

This study was a prospective cohort study of patients with newly diagnosed CML at 4 general hospitals and 1 university hospital. Patients started to receive dasatinib 100 mg once daily. A Medication Event Monitoring System was used to assess medication adherence and the medication possession ratio during the 12 months. Plasma concentrations of dasatinib were measured using liquid chromatograph-tandem mass spectrometry (LC-MS/MS), and therapy responses were assessed at 3, 6, and 12 months after treatment.

Results:

Ten patients were included. An extremely high medication adherence for dasatinib was observed; the median medication possession ratio was 99.4%. All 9 CML patients with breakpoints in the major BCR-ABL achieved major molecular response (MMR; major BCR-ABL transcript level below 0.1% on the International Scale) within 12 months, and 5 achieved MMR within 6 months. The receiver operating characteristic curve analysis revealed that the cutoff value for the dasatinib area under the concentration–time curve was 336.1 ng × h/mL (accuracy 88.9%, sensitivity 80.0%, specificity 100%, and receiver operating characteristic curve–area under the concentration–time curve 0.800) for achieving MMR within 6 months. Two patients had interrupted dasatinib treatment because of pleural effusion and diarrhea with intestinal edema, respectively. These edematous adverse events developed after plasma dasatinib Cmin surpassed 3.0 ng/mL.

Conclusions:

A Medication Event Monitoring System was applied for the direct evaluation of oral dasatinib adherence for the first time, and the clinical effect of dasatinib was investigated under the strict monitoring of patient adherence. Although this study had a small sample size, the plasma concentration monitoring of dasatinib is considered to be useful to predict an earlier molecular response with fewer edematous adverse events.
Treating oxygen failure in angioedema: a case series employing noninvasive nasal positive pressure with the SuperNO2VA device
Authors: Bastien Alexandra , Pedro Michael , Cataldo Steven
Published: April 2019

Angioedema encompasses a wide-range of clinical presentations of nonpitting edema involving the dermis to the submucosal tissue. When vital structures surrounding the upper airway are involved, life-threatening hypoxemia may ensue along with difficulty in securing the airway. Supplemental oxygen devices are often insufficient in the setting of obstruction and the placement of invasive airway devices may exacerbate edema contributing to morbidity. With the tissues of the nasal cavity spared in angioedema, noninvasive positive pressure via a nasal mask is an effective modality by which upper airway patency may be maintained and high concentrations of oxygen delivered to the patient during acute episodes of angioedema. We present here 4 cases of angioedema with inadequate oxygenation where the SuperNO2VA device was used to reestablish upper airway patency and normal oxygen saturation when connected to a Mapleson C circuit in the Emergency Department. Nasal positive pressure delivery using the SuperNO2VA device should be considered as an option primary oxygenation and ventilation technique in the treatment and evaluation of patients with angioedema.
Outcomes of Descemet-Stripping Automated Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy
Authors: Mohebbi Masoomeh , Nabavi Amin , Fadakar Kaveh , Hashemi Hassan
Published: April 2019

Objectives:

To evaluate the outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) in children with congenital hereditary endothelial dystrophy (CHED).

Methods:

Eighteen eyes from 10 children with CHED who underwent standard phakic DSAEK were enrolled in this retrospective interventional case series. Medical records including slit-lamp biomicroscopy, cycloplegic refraction, visual acuity, and measurements of central corneal thickness, corneal topography, and endothelial cell density were evaluated. All complications were recorded.

Results:

The mean age of cases was 8.1±4.2 (range: 3–16) years at the time of surgery. Descemet-stripping automated endothelial keratoplasty was performed successfully in all eyes, which survived in 16/18 (88.9%) of cases during a median follow-up period of 38 (range 19–64) months. In patients with clear graft, best-corrected visual acuity was improved to a range of 20/100 to 20/40 and improved to fix and follow in one younger child. Endothelial cell density decreased by an average of 42.1%, comparing baseline and 6-month follow-up and was relatively stable thereafter. A marked flattening of the anterior corneal curvature (mean change of anterior K reading: +2.56±3.14 diopters) was observed after DSAEK. The only major complication in patients with clear graft was intraocular pressure elevation in 61.1% of the eyes, which was easily controlled with one antiglaucoma medication. None of the eyes developed cataract.

Conclusion:

Descemet-stripping automated endothelial keratoplasty is a safe and successful procedure in children with an acceptable graft survival in a mid-term follow-up period. A marked hyperopic shift could occur after DSAEK in children with CHED.
Axon degeneration: mechanistic insights lead to therapeutic opportunities for the prevention and treatment of peripheral neuropathy
Authors: DiAntonio Aaron
Published: April 2019

Peripheral neuropathy is the most common neurodegenerative disease affecting hundreds of millions of patients worldwide and is an important cause of chronic pain. Typical peripheral neuropathies are characterized by dysesthesias including numbness, crawling skin, a sensation of “pins and needles,” and burning and stabbing pain. In addition, peripheral neuropathy can affect the motor and autonomic systems leading to symptoms such as weakness, constipation, and dysregulation of blood pressure. Peripheral neuropathies can be either hereditary or acquired and are a common consequence of diabetes and treatment with chemotherapy agents. Many neuropathies are due to degeneration of long axons; however, the mechanisms driving axon loss were unknown, and so no therapies are available to preserve vulnerable axons and prevent the development of peripheral neuropathy. With the recent identification of SARM1 as an injury-activated NADase enzyme that triggers axon degeneration, there is now a coherent picture emerging for the mechanism of axonal self-destruction. Here, we will present evidence that inhibiting the SARM1 pathway can prevent the development of peripheral neuropathy, describe the emerging mechanistic understanding of the axon degeneration program, and discuss how these mechanistic insights may be translated to the clinic for the prevention and treatment of peripheral neuropathy and other neurodegenerative disorders.
Chemotherapy-induced peripheral neuropathy: where are we now?
Authors: Colvin Lesley A.
Published: April 2019

Chemotherapy-induced peripheral neuropathy (CIPN) is a major challenge, with increasing impact as oncological treatments, using potentially neurotoxic chemotherapy, improve cancer cure and survival. Acute CIPN occurs during chemotherapy, sometimes requiring dose reduction or cessation, impacting on survival. Around 30% of patients will still have CIPN a year, or more, after finishing chemotherapy. Accurate assessment is essential to improve knowledge around prevalence and incidence of CIPN. Consensus is needed to standardize assessment and diagnosis, with use of well-validated tools, such as the EORTC-CIPN 20. Detailed phenotyping of the clinical syndrome moves toward a precision medicine approach, to individualize treatment. Understanding significant risk factors and pre-existing vulnerability may be used to improve strategies for CIPN prevention, or to use targeted treatment for established CIPN. No preventive therapies have shown significant clinical efficacy, although there are promising novel agents such as histone deacetylase 6 (HDAC6) inhibitors, currently in early phase clinical trials for cancer treatment. Drug repurposing, eg, metformin, may offer an alternative therapeutic avenue. Established treatment for painful CIPN is limited. Following recommendations for general neuropathic pain is logical, but evidence for agents such as gabapentinoids and amitriptyline is weak. The only agent currently recommended by the American Society of Clinical Oncology is duloxetine. Mechanisms are complex with changes in ion channels (sodium, potassium, and calcium), transient receptor potential channels, mitochondrial dysfunction, and immune cell interactions. Improved understanding is essential to advance CIPN management. On a positive note, there are many potential sites for modulation, with novel analgesic approaches.
Neuropathic itch
Authors: Steinhoff Martin , Oaklander Anne Louise , Szabó Imre Lőrinc , Ständer Sonja , Schmelz Martin
Published: April 2019

Neuropathic itch is clinically important but has received much less attention as compared to neuropathic pain. In the past decade, itch-specific pathways have been characterized on a cellular and molecular level, but their exact role in the pathophysiology of neuropathic itch is still unclear. Traditionally, mutually exclusive theories for itch such as labeled line, temporal/spatial pattern, or intensity theory have been proposed, and experimental studies in mice mainly favor the specificity theory of itch. By contrast, results in humans also suggest a role for spatial and temporal patterns in neuropathic itch. Rarefication of skin innervation in neuropathy could provide a “spatial contrast” discharge pattern, and axotomy could induce de novo expression of the itch-specific spinal neuropeptide, gastrin-releasing peptide, in primary afferent nociceptors, thereby modulating itch processing in the dorsal horn. Thus, clinical neuropathy may generate itch by changes in the spatial and temporal discharge patterns of nociceptors, hijacking the labeled line processing of itch and abandoning the canonical scheme of mutual exclusive itch theories. Moreover, the overlap between itch and pain symptoms in neuropathy patients complicates direct translation from animal experiments and, on a clinical level, necessitates collaboration between medical specialities, such as dermatologists, anesthesiologists, and neurologists.
A bibliometric study on pancreatic cystic disease research
Authors: Cui Ming , Hu Ya , You Lei , Liu Qiaofei , A Lita , Wu Wenming , Liao Quan , Zhao Yupei
Published: April 2019

Pancreatic cystic disease is being increasingly identified in patients, and many relevant papers have been published in this field. A bibliometric analysis was previously performed to identify the most influential studies in many subject areas, and the top 100 most cited papers on pancreatic cystic disease were analyzed in this study. The Web of Science database was searched for all papers related to pancreatic cystic disease on June 9, 2018. The top 100 most cited papers were selected and listed in descending order based on the total number of citations (TCs). The author, journal, institution, country of origin, and research focus were further analyzed. The most cited papers were published between 1975 and 2015. Intraductal papillary mucinous neoplasm was the most commonly studied subtype (36%), followed by pancreatic pseudocyst (16%), solid pseudopapillary neoplasm (9%), and mucinous cystic neoplasm (7%). The average number of TCs was 282, and the average citation index value was 21. Thirty-eight journals published the top 100 papers; Annals of Surgery (n = 14) and Gastrointestinal Endoscopy (n = 11) published the most papers. Most papers were published in the United States of America (59%), with the majority from Johns Hopkins Medical Institution (15%). Canto MI from Johns Hopkins Medical Institution authored the largest number of most cited papers (n = 8). This study reviews the significant achievements and developmental trends in pancreatic cystic disease.
Predictors of Gastrin Elevation Following Proton Pump Inhibitor Therapy
Authors: Helgadóttir Hólmfridur , Lund Sigrún H. , Gizurarson Sveinbjörn , Metz David C. , Björnsson Einar S.
Published: April 2019

Goals:

The goal of this study was to elucidate the most important predictors for elevation of gastrin in patients on long-term PPI therapy through analysis of data from 2 published studies in Icelandic patients with erosive GERD.

Background:

Gastrin elevation is a known but variable consequence of proton pump inhibitor (PPI) therapy. Concerns have been raised about the clinical importance of chronic PPI induced gastrin elevation.

Study:

This cross-sectional analysis included patients with endoscopically verified erosive esophagitis receiving long-term PPI therapy. PPI exposure in dosage over weight (mg/kg) and dosage over body surface area (mg/m2) was compared with fasting gastrin levels in two separate multiple linear regression models. Data was collected on age, gender, weight, H. pylori infection, smoking, PPI duration and type.

Results:

Overall data from 157 patients (78 females) were analyzed. Median serum gastrin levels were higher in females than males (92 vs. 60 pg/mL; P=0.001). Simple linear regression showed a correlation between serum gastrin levels and gender (P=0.0008) as well as PPI exposure in mg/kg (P=0.0001) and mg/m2 (P=0.0001). Multiple linear regression analysis showed that PPI exposure, both in mg/kg (β=0.95 [CI=0.4-1.5]; P=0.001) and mg/m2 (β=0.02 [CI=0.0-0.0]; P=0.0015) along with female gender (β=0.2 [CI=0.0-0.4]; P=0.02) predicted higher gastrin values.

Conclusions:

Dosage and female gender seem to play an important role in the development of gastrin elevation on PPI therapy. A significant correlation was found between fasting serum gastrin and dosage of PPIs over weight and body surface area.
Race/Ethnicity-specific Disparities in In-Hospital Mortality and Hospital Charges Among Inflammatory Bowel Disease-related Hospitalizations in the United States
Authors: Galoosian Artin , Rezapour Mona , Liu Benny , Bhuket Taft , Wong Robert J.
Published: April 2019

Goal:

The goal of this study was to evaluate disparities in hospital outcomes among inflammatory bowel disease (IBD) related hospitalizations in the United States with a focus on ethnicity-specific disparities.

Background:

IBD-related hospitalizations contribute to significant morbidity and health care economic burden.

Methods:

IBD-related hospitalizations (identified with ICD-9) among US adults were evaluated using 2007 to 2013 Nationwide Inpatient Sample. In-hospital mortality between groups was evaluated using χ2and multivariate logistic regression models, stratified by Crohn’s disease (CD) and ulcerative colitis (UC). Inflation-adjusted total hospitalization charges were evaluated using Studentttest and multivariate linear regression.

Results:

Among 224,500 IBD-related hospitalizations (77.8% CD, 22.2% UC), overall in-hospital mortality was low (0.99% CD, 0.78% UC). Although Hispanic UC patients had a trend towards higher odds of in-hospital mortality compared with non-Hispanic whites (OR, 1.54; 95% CI, 0.95-2.51;P=0.08), no ethnicity-specific disparities were observed in CD. From 2007 to 2013, mean inflation-adjusted hospitalization charges increased from $29,632 to $41,484,P<0.01 in CD and from $31,449 to $43,128 in UC,P<0.01. On multivariate regression, hospitalization charges in Hispanic CD patients were $9302 higher (95% CI, 7910-10,694;P<0.01) and in Asian CD patients were $7665 higher (95% CI, 4859-10,451;P<0.001) than non-Hispanic whites. Compared with non-Hispanic white UC patients, Hispanics had $6910 (95% CI, $4623-$9197) higher charges and African Americans had $3551 lower charges (95% CI, –$5002 to –$2101).

Conclusions:

Although most IBD hospitalizations in the United States were among non-Hispanic whites, Hispanic patients with IBD had a trend towards higher in-hospital mortality and contributed to significantly higher hospitalization charges.
Fecal Lactoferrin for Assessment of Inflammatory Bowel Disease Activity
Authors: Dai Cong , Jiang Min , Sun Ming-Jun , Cao Qin
Published: April 2019

Objective:

Persistent disease activity is associated with a poor prognosis in inflammatory bowel disease (IBD) patients. Therefore, monitoring of IBD activity can avoid the poor prognosis. Serum biomarkers reflect a summation of systemic host responses rather than being specific for intestinal inflammation. And endoscopic monitoring is invasive, costly, and time consuming. The objective of our study was to perform a meta-analysis evaluating the diagnostic accuracy of fecal lactoferrin (FL) in assessing IBD activity.

Methods:

We systematically searched the databases from inception to May 2018 that evaluated IBD activity. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio.

Results:

Ten studies comprising 773 IBD patients were included in the meta-analysis. The pooled sensitivity and specificity values for assessing ulcerative colitis (UC) activity were 0.81 [95% confidence interval (CI), 0.64-0.92] and 0.82 (95% CI, 0.61-0.93), respectively. And the pooled sensitivity and specificity values for assessing Crohn’s disease (CD) activity were 0.82 (95% CI, 0.73-0.88) and 0.71 (95% CI, 0.63-0.78), respectively. The diagnostic performance of the FL assay in the UC patients appeared to be superior to that in the CD patients.

Conclusion:

Our meta-analysis has found that FL is an inexpensive, simple, stable, and useful screening marker with high sensitivity and modest specificity for assessing IBD activity, appearing to have greater ability to evaluate UC rather than CD.
Chronic Obstructive Pulmonary Disease and the Risk of Esophagitis, Barrett’s Esophagus, and Esophageal Adenocarcinoma
Authors: Menon Shyam , Nightingale Peter , Trudgill Nigel
Published: April 2019

Background:

Chronic gastroesophageal reflux predisposes to the development of esophageal adenocarcinoma (EAC). Asthma and medication to treat it are associated with gastroesophageal reflux and EAC. We studied subjects with chronic obstructive pulmonary disease (COPD) to examine the relationship between COPD and medication used to treat it, and the risk of reflux esophagitis, Barrett’s esophagus, and EAC.

Methods:

A case-control study from the UK General Practice Research Database was conducted. Cases were aged 50 or above with a diagnosis of COPD and were matched with controls without a diagnosis of COPD by age, general practitioners practice, and time on the database. EAC was confirmed by cross-referencing cancer registry data. Cox-regression analysis was performed to assess the relationship between COPD, reflux esophagitis, Barrett’s esophagus, and EAC.

Results:

A total of 45,141 cases were studied [24,464 male, age 75 (50 to 100) years]. Among COPD cases there were 55 esophageal cancers (30 EAC) and 506 Barrett’s esophagus, compared with 62 (34 EAC) and 329 Barrett’s esophagus among controls. COPD was not associated with EAC on univariable [0.92 (0.56 to 1.50), P=0.73] and multivariable analysis [0.85 (0.52 to 1.40), P=0.53]. COPD was however, associated with Barrett’s esophagus on univariable [0.92 (0.56 to 1.50), P=0.73] and multivariable [1.53 (1.31 to 1.78), P<0.001] analysis and reflux esophagitis on univariable [1.41 (1.36 to 1.48), P<0.001] and multivariable [1.33 (1.27 to 1.40), P<0.001] analysis.

Conclusion:

COPD is associated with an increased risk of reflux esophagitis and Barrett’s esophagus but not EAC.
Neuronavigator-guided ventriculoscopic approach for symptomatic xanthogranuloma of the choroid plexus in the lateral ventricle
Authors: Yan Chengrui , Zhu Shan , Sun Haitao , (Jenn) Wan-Ting Lee , Zhang Xiaoying , Xu Zongsheng , Kong Xiangyi , Chen Xiaolin
Published: April 2019

Xanthogranuloma of choroid plexus is an extremely rare, benign, and mostly asymptomatic intracranial lesion. We report a case of symptomatic lateral ventricular xanthogranuloma resected via a neuronavigator-guided ventriculoscopic approach. Then we review recent English medical literature and notice that craniotomies have been the most popular treatment. But our choice of a ventriculoscopic approach possesses unique advantages such as minimized neural tissue damage, shortened operative time, less blood loss, and safer access to central structures over conventional open surgeries. Informed consent has been obtained from the patient and his immediate family regarding this case report.
A case report on metastatic ileal neuroendocrine neoplasm to the breast masquerading as primary breast cancer
Authors: Papalampros Alexandros , Mpaili Eustratia , Moris Demetrios , Sarlanis Helen , Tsoli Marina , Felekouras Evangelos , Trafalis Dimitrios T. , Kontos Michael
Published: April 2019

Rationale:

Metastatic neuroendocrine neoplasms (NENs) to the breast are very rare entities comprising only 1% to 2% of all metastatic breast tumors. In this article, we describe a case of a neuroendocrine ileal neoplasm metastatic to breast and liver, with breast metastatic tumor to be the initial manifestation of the disease.

Patient concerns:

We herein report a rare case of a female patient admitted to our department with a palpable painful mass on her left breast.

Diagnosis:

The surgical and histological investigation revealed a metastatic neuroendocrine neoplasm to the breast originated from terminal ileum.

Interventions:

A left lumpectomy, right hemicolectomy, cholecystectomy, left hepatectomy along with liver metastasectomies (V, VI, VIII) plus radiofrequency ablation of lesions to the right liver lobe plus standard lymphadenectomy was performed.

Outcomes:

Considering the advanced stage of the disease, the patient received an adjuvant therapy of somatostatin analog plus everolimus. Under the guidance of oncological consultation, patients follow-up with CT and MRI scan and clinical re-evaluations in the first 3 and 6 months, substantiates no evidence of recurrence and she presents herself asymptomatic.

Lessons:

An appropriate level of suspicion and selective immunohistochemistry in these cases, particularly where no prior history of a known primary neuroendocrine neoplasm occurs, may help to diagnose a previously undetected neuroendocrine tumor elsewhere in the body and provide guidance for the appropriate treatment selection.
Evaluation of Aspergillus IgG, IgM antibody for diagnosing in chronic pulmonary aspergillosis
Authors: Guo Yiqun , Bai Yu , Yang Chunxia , Gu Li
Published: April 2019

Chronic pulmonary aspergillosis (CPA) is a slowly progressing pulmonary fungal infectious disease caused by Aspergillus. Aspergillus IgG, IgM are now considered to be valuable biomarkers in CPA diagnosing.

Our research attempts to evaluate the effectiveness of Aspergillus IgG, IgM in diagnosing CPA.

In our study, CPA patients were younger than the patients who suffered other pulmonary disease. The most common underlying disease in CPA patients was pulmonary tuberculosis. And the most common clinical symptom was hemoptysis. The comparison among the groups indicated statistical significance with regard to Aspergillus IgG and IgM between the CPA and other pulmonary disease groups (P < .01). The Aspergillus-specific IgG and IgM in infectious group exhibited higher levels than those in colonization group (P < .01). The area under the receiver operating characteristic curve of Aspergillus IgG was 0.762 (95% confidence interval: 0.664–0.860) (P < .01).

Aspergillus-specific IgG offers great diagnostic value with regard to CPA.
Health related quality of life in stroke patients and risk factors associated with patients for return to work
Authors: Chen Qi , Cao Chunni , Gong Li , Zhang Yanxiang
Published: April 2019

To clarify dynamic change of quality of life (QOL) in patients with stroke after treatment, and to explore the predictors associated with return to work (RTW) within 48 weeks.

Patients diagnosed with stroke were enrolled. All patients enrolled were asked to fill in the Short Form 36 Health Survey. For patients with stroke, SF-36 questionnaires were measured repeatedly 4 weeks after treatment. We used phone call to find out if the patient was RTW. The investigation time was 48 weeks.

Patients with stroke had lower scores in terms of physiological dimensions, such as physical functional, role limitations due to physical problems, and general health (P < .001). While patients with strokes scored significantly lower in all mental dimensions including vitality, social functioning, role limitations due to emotional problems, and mental health (P < .001). After 4-weeks treatment, we found that, except for bodily pain, scores in dimensions like physical functioning, role limitations due to physical problems, and general health had increased significantly (P < .001). Multivariate logistic regression analysis was conducted, and the result showed that older age (P = .04) and singleness (P = .03) were risk factors associated with QOL improvement in stroke patients after treatment. Outcomes of stroke patients within 48 weeks were explored. The results showed that 108 out of 136 patients RTW within 48 weeks. Average days it took for patients with cerebral infarction to return to work were 77 ± 79, significantly less than patients with cerebral hemorrhage (206 ± 159 days) and patients with subarachnoid hemorrhage (117 ± 113 days, P < .001). Multivariate analysis indicated that only QOL improvement (P = .04) and subtype of stroke (P = .01) were independent factors associated with RTW within 48 weeks.

QOL of stroke patients was significantly reduced. After treatments, the physiological quality of stroke patients increased, but the psychological quality remained low. In addition, patients with cerebral hemorrhage and patients with no significant improvement in QOL are independent risk factors for RTW. Therefore, for this subgroup of the population, early diagnosis, close follow-up and monitor of the psychological state should be provided to avoid the occurrence of adverse events.
Effect of remifentanil and midazolam on ED95 of propofol for loss of consciousness in elderly patients
Authors: You Ann Hee , Kim Ji Young , Kim Do-Hyeong , Suh Jiwoo , Han Dong Woo
Published: April 2019

Background:

Older people are more vulnerable to hemodynamic instability caused by propofol due to their decreased initial distribution volume and increased sensitivity to propofol. Midazolam or remifentanil can often be coadministered because of their synergistic or additive effects with propofol as well as amnesic properties and the blockade of sympathetic stimulation. However, no study has confirmed the appropriate dose of propofol for loss of consciousness in aged patients when administered with other drugs, including opioids or benzodiazepines.

Methods:

Patients >65 years scheduled for general anesthesia were enrolled. The patients were randomized into 3 groups using a computer-generated randomization table. Patients in group P (propofol) received only propofol for loss of consciousness, those in group PR (propofol–remifentanil) received remifentanil before propofol, and those in group PMR (propofol–midazolam–remifentanil) received remifentanil and midazolam before propofol. After propofol administration, loss of both eyelash reflex and verbal response represented success. The 95% effective dose of propofol for loss of consciousness in each group, which was the primary outcome, was determined using a modified biased coin up-and-down method.

Results:

In total, 120 patients were randomized into the 3 groups (n = 40). The 95% effective dose of propofol for loss of consciousness was 1.13, 0.87, and 0.72 mg/kg in groups P, PR, and PMR, respectively. The mean blood pressure (MBP) in group PMR was more significantly decreased before propofol injection (P = .041) as well as 2 minutes (P = .005) and 3 minutes after propofol administration (P<.001), compared with group P, but there were no intergroup differences at other time points.

Conclusions:

The effective dose of propofol for loss of consciousness in elderly patients could be decreased by 23% and 36% when remifentanil pretreatment was used without and with midazolam, respectively. However, the decrease in MBP was greater with remifentanil and midazolam pretreatment than with propofol alone. These findings suggest that pretreatment with midazolam for propofol infusions with remifentanil in elderly patients should be cautiously used, due to hemodynamic instability during induction.
Mediating effect of social support on the associations between health literacy, productive aging, and self-rated health among elderly Chinese adults in a newly urbanized community
Authors: Yang Yikai , Zhang Baiyang , Meng Hongdao , Liu Danping , Sun Min
Published: April 2019

With the growing urbanization of China, which has changed older adults’ living conditions, lifestyle, and the source of support, coupled with rapid population aging, the health status of the elderly should be paid attention to. In addition to objective indicators such as the decline of function, specific factors, such as social support, health literacy, and productive aging, also have an impact on the health outcomes of the elderly. However, the interrelationships among these factors and their potential mechanisms in the context of urbanization remain unclear. Thus, this study was the first to explore the interrelationships among social support, health literacy, productive aging, and self-rated health in older adults living in a newly urbanized community in China.

We aimed to investigate the mediating effect of social support on the associations between health literacy, productive aging, and self-rated health among elderly Chinese adults in a newly urbanized community to provide reference data for future health interventions for the elderly.

This cross-sectional study was conducted between June and August 2013. Questionnaires on social support, health literacy, productive aging, and self-rated health were administered to 992 elderly residents. Structural equation models were used to examine the relationships among these 4 variables. Statistical analyses were performed using IBM SPSS Statistics 21.0 and Mplus 7.0.

The mean scores for social support, health literacy, productive aging, and self-rated health were 34.5 ± 5.8, 13.6 ± 4.4, 11.3 ± 3.0, and 3.4 ± 0.7, respectively. Social support was directly related to self-rated health (β=0.119, 95% confidence interval [CI]: 0.041–0.198), while productive aging and health literacy had indirect associations with self-rated health via social support (β=0.071, 95% CI: 0.054–0.216; β=0.049, 95% CI: 0.066–0.183). Both productive aging (β=0.214, 95% CI: 0.047–0.381) and health literacy had direct associations with social support (β=0.327, 95% CI: 0.175–0.479), while health literacy had a direct association with productive aging (β=0.676, 95% CI: 0.604–0.748). Productive aging mediated the relationship between health literacy and social support.

Overall, improving health outcomes among older adults requires enhancement of social support, along with consideration of productive aging and health literacy.
Atypical case of posterior reversible encephalopathy syndrome related to late onset postpartum eclampsia
Authors: Masai Kaori , Ueda Yayoi , Naito Hiromichi , Tsukahara Kohei , Aokage Toshiyuki , Fujisaki Noritomo , Yamamoto Hirotsugu , Nakao Atsunori
Published: April 2019

Rationale:

Eclampsia, an obstetric emergency frequently seen in pregnant or puerperal women, is a risk factor for posterior reversible encephalopathy syndrome (PRES). Most cases of eclampsia occur postpartum. We report a woman with PRES associated with eclampsia 10 weeks post-delivery, the latest onset ever reported.

Patient concerns:

A 23-year-old healthy woman presented headache and nausea 10 weeks after delivery. Two days later, she generalized tonic-clonic seizure. Her brain MRI presented the foci which is typical of PRES.

Diagnosis:

The patient was diagnosed as PRES associated with eclampsia.

Interventions:

The patient received levetiracetam and edaravone.

Outcomes:

Her clinical course was uneventful and she fully recovered without neurological complications

Lessons:

The possible diagnosis of late onset postpartum eclampsia, even weeks post-delivery, should be considered, since initiation of early treatment averts severe complications and decreases mortality. Sharing our experience may increase awareness of PRES induced by late-onset postpartum eclampsia.
First trimester Doppler velocimetry of the uterine artery ipsilateral to the placenta improves ability to predict early-onset preeclampsia
Authors: Song Wen-Ling , Zhao Yan-Hui , Shi Shu-Jing , Liu Xian-Ying , Zheng Gui-Ying , Morosky Christopher , Jiao Yang , Wang Xiao-Jing
Published: April 2019

This study sought to investigate the effects of placental laterality on the measurements of uterine artery (UtA) Doppler velocimetry and their application in predicting early-onset preeclampsia (PE).

We conducted a prospective cohort study on all women with singleton, uncomplicated pregnancies scheduled for first-trimester nuchal translucency at our institution. Pulsatility index (PI) for both UtAs was measured by Doppler velocimetry, and placental laterality was determined. Additionally, pregnancy outcome data were abstracted from the medical records. Receiver operating characteristic curves (ROCs) were plotted.

Of the 304 patients enrolled, 247 met the inclusion criteria. Among these patients, 240 had uncomplicated delivery, while 7 had early delivery at <34 weeks due to PE. For the uncomplicated pregnancies, PI measurements of the UtA ipsilateral to the placenta were similar (left versus right UtA: 1.06 ± 0.38 vs. 1.04 ± 0.40; P = .745). However, PI measurements of the UtA contralateral to the placenta differed significantly (left versus right UtA: 1.45 ± 0.51 vs. 1.3 ± 0.47; P = .027). In predicting early-onset PE, the ideal cut-off value for the placental side PI was 1.91, with sensitivity 100% and specificity 96.3%. For nonplacental side PI, the ideal cut-off value for PI was 1.975, with sensitivity 57.1% and specificity 79.2%. Using the mean of the left and right UtA PI, the ideal cut-off value was 1.63, with sensitivity 100% and specificity 74.2%.

ROC analysis confirmed that PI measurements of the UtA on the placental side were significantly lower than those on the contralateral side, PI measurements of the UtA ipsilateral to the placenta were similar.
A case report of cyclosporine-induced myopathy with subacute muscular atrophy as initial presentation
Authors: Ding Hongyun , Li Zhen , Zhang Jianbin
Published: April 2019

Rationale:

Cyclosporine A (CsA) is a potent immunosuppressive agent originally used to prevent rejection after organ transplantation but now more frequently used for treatment of refractory autoimmune diseases. It can induce adverse effects, such as nephrotoxicity, gastrointestinal reactions, and gingival hyperplasia whist myopathy with subacute muscular atrophy are rare.

Patient concerns:

A 55-year-old male patient with idiopathic membranous nephropathy treated with cyclosporine A at 3 mg/kg/d and prednisone at 0.5 mg/kg.d for more than 20 days, gradually developed lower limb weakness, which were progressively aggravated until he was unable to stand or walk. A physical examination show muscle atrophy of both lower extremities, which was more severe in the right thigh muscle than the left, decreased muscular tension of the limbs was also observed.

Diagnoses:

Light microscopy and Transmission electron microscopy of muscle (quadriceps femoris) biopsy revealed drug-induced myopathy rather than neurogenic damage.

Interventions:

Cyclosporine was withdrawn and replaced with cyclophosphamide tablets, prednisone remain unchanged and other symptomatic therapies were also administered.

Outcomes:

His bilateral thigh muscle atrophy showed improvement and lower limb weakness was obviously alleviated and he could stand and walk with the help of others 4 weeks later. Gradually, his thigh muscle atrophy was alleviated so that he was able to walk independently. After follow-up, no similar symptoms were found in the patients.

Lessons:

CsA-induced myopathy with muscular atrophy is rare and serious, which can be identified according to pathological characteristics.
Long-segment central venous occlusion in a hemodialysis patient treated by segmented sharp recanalization strategy
Authors: Zhao Yuliang , Yang Letian , Mai Hongxia , Yu Yang , Fu Ping , Cui Tianlei
Published: April 2019

Introduction:

Among hemodialysis population, central vein occlusion (CVO) is a common complication. Percutaneous transluminal angioplasty has become the mainstay treatment these days. But the treatment of long-segment central venous occlusion remains difficult.

Patient concerns:

We presented a 73-year-old man on maintenance hemodialysis complaining of swelling of the right arm and face for 20 days. The patient underwent maintenance hemodialysis via a right internal jugular vein catheter for first 2 months of dialysis while the initial right radiocephalic wrist arteriovenous fistula (AVF) blood flow had been unsatisfactory (below 180 mL/min) for 1 month.

Diagnosis:

Digital subtraction angiography revealed long-segment CVO extending from the right subclavian vein (SV) to the right innominate vein (IV), forming an obvious included angle at the right jugular angle.

Interventions:

Since conventional guide wire transversal failed, segmented sharp recanalization was performed by separate transversal of the obstructive right SV and right IV, therefore crossing the whole lesion segment by segment, followed by balloon dilation and stent placement.

Outcomes:

No procedure-related complication was recorded during or after the operation. After a follow-up period of 5 months, the patient's AVF maintained satisfactory in blood flow, while the edema in his ipsilateral limb and face also notably ameliorated.

Conclusion:

The segmented sharp recanalization is a practical strategy in treating angled long-segment CVO which is refractory to traditional guide wire transversal in hemodialysis patients.
Diagnostic performance of cytomegalovirus (CMV) immune monitoring with ELISPOT and QuantiFERON-CMV assay in kidney transplantation
Authors: Ruan Yashi , Guo Wei , Liang Sudong , Xu Zhen , Niu Tianli
Published: April 2019

Background:

Cytomegalovirus (CMV) infection is part of major infection complications following kidney transplantation. However, more rapid and low-complexity assays are needed for CMV infection. Our study is to investigate the diagnostic efficacy of 2 novel tests, CMV-ELISPOT and QuantiFERON-CMV tests, in CMV DNA viremia and CMV infection following renal transplant.

Methods:

We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science. Case–control or cohort study designed to explore the CMV-ELISPOT and/or QuantiFERON-CMV tests in the recipients with CMV infection was considered to be eligible for this study. Sensitivity (SEN), specificity (SPE), diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curves were calculated.

Results:

We selected a total of 12 articles for systematic review and 11 of them were included in meta-analysis. For CMV-pp65 assay, the pooled SEN, SPE, and DOR were 0.73 (95% confidence interval [CI], 0.67–0.78), 0.61 (95% CI, 0.56–0.65), and 4.46 (95% CI, 3.11–6.39), respectively. For CMV-IE-1 assay, the pooled SEN, SPE, and DOR were 0.84 (95% CI, 0.78–0.88), 0.46 (95% CI, 0.42–0.51), and 5.07 (95% CI, 3.26–7.89), respectively, whereas the pooled SEN, SPE, and DOR of QuantiFERON-CMV test were 0.38 (95% CI, 0.28–0.49), 0.38 (95% CI, 0.32–0.44), and 1.02 (95% CI, 0.17–6.00).

Conclusions:

We reported that CMV-ELISPOT tests, including CMV-pp65 and CMV-IE-1, perform well in the diagnosis and prediction of CMV infection in renal transplant recipients, whereas QuantiFERON-CMV test needs further exploration.
Melioidosis, an emerging infectious disease in the Midwest Brazil
Authors: Volpe-Chaves Cláudia Elizabeth , Rodrigues Ana Cláudia Souza , Lacerda Mara Luci Gonçalves Galiz , Oliveira Caroline Tieppo Flores de , Castilho Suse Barbosa , Franciscato Caroline , Santos Ivson Cassiano de Oliveira , Assef Ana Paula D’alincourt Carvalho , Roever Leonardo , Oliveira Sandra Maria do Valle Leone de , Paniago Anamaria Mello Miranda
Published: April 2019

Rationale:

Melioidosis is an emerging infectious disease in Brazil and caused by Burkholderia pseudomallei, with high morbidity and mortality rates. A total of 28 melioidosis cases were reported in Brazil until 2015. The majority of melioidosis cases were reported in the Northwest region of Brazil and such cases were not previously detected in the Midwest region of Brazil.

Patient concerns:

A 42-year-old man was admitted with a non-productive cough, dyspnea, myalgia, diffuse abdominal pain. Pulmonary auscultation revealed a vesicular murmur, snoring sounds, and the presence of basal crackling rales in the left hemithorax. The patient evolved with several respiratory failures and he was diagnosed as the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil.

Diagnosis:

The cell isolates were subjected to 16S rRNA gene sequencing to confirm the bacterial species.

Interventions:

Administration of trimethoprim/sulfamethoxazole and meropenem stabilized the clinical condition of the patient. Subsequently upon discharge, the patient was also treated with trimethoprim/sulfametothoxazole for a year.

Outcome:

We reported the first case of community-acquired pneumonia with sepsis caused by B pseudomallei in Mato Grosso do Sul, Midwest state of Brazil and the patient survived.

Lessons:

The emergence of melioidosis in the Midwest region is being neglected and underestimated and melioidosis must be considered of the differential diagnosis in community infections.
Renal cell carcinoma originating in the free wall of simple renal cyst
Authors: Lai Shicong , Jiao Binbin , Wang Xiuhong , Xu Xin , Zhang Meng , Diao Tongxiang , Zhang Guan
Published: April 2019

Rationale:

Simple renal cyst (SRC) is a benign disease. However, rarely renal cell carcinoma (RCC) may be raised at the wall of a preexisting SRC. We herein describe 2 unusual cases of RCC arising from the outer surface of the free wall of the renal cyst.

Patient concerns:

A 75-year-old female and a male were admitted to our department because of an asymptomatic renal cystic mass. Although the case history, preoperative imaging, and intraoperative examination of the cyst were carefully evaluated, no concerns were raised with respect to the underlying malignancy.

Diagnosis:

RCC of the clear cell type was diagnosed based on the histology and pathological examination.

Interventions:

With an initial diagnosis of SRC, the retroperitoneal laparoscopic de-roofing of the SRC was performed in both of the patients. When the diagnoses were confirmed 7 days postoperative, both of them were readmitted to our department for a radical nephroureterectomy.

Outcomes:

The postoperative course was uneventful and the two patients did not undergo further chemotherapy. They are currently well and have no clinical or radiological signs of recurrence.

Lessons:

Such cases remind us that seemingly benign renal cysts may harbor underlying neoplasia. Further evaluation and periodical follow-up are also recommended on the management of those seemingly benign renal cysts.
Treatment of adenoid cystic carcinoma of the mobile tongue with anterolateral thigh flap reconstruction
Authors: Tang Xi , Zhang Chengyao , Chen Rui , Zhou Xiaohong , Zhang Yulian
Published: April 2019

Rationale:

Adenoid cystic carcinoma (ACC) is an infrequent malignant neoplasm of the salivary glands. The clinical and pathological characteristics include slow growth, perineural invasion, and local recurrence. ACC of the mobile tongue is rarely reported in the literature.

Patient concerns:

We describe a case of a 43-year-old man patient with numbness and growth in the tongue for 1 month duration. The patient reported a long-term smoking and drinking habit.

Diagnoses:

A biopsy was carried out and histopathological analysis confirmed as diagnosis of adenoid cystic carcinoma. Computed tomography (CT) of the head and neck enhanced scanning revealed an ill-defined high density mass with altered enhanced signal entities involving the anterior 2/3rd of the tongue.

Interventions:

The patient was treated with surgery and adjuvant radiotherapy. Incision was placed over the anteriorly till 2/3rd of tongue and then the femoral anterolateral free flap was used to repair and reconstruct the defect of tongue.

Outcome:

The patient is currently under a postsurgical 29-month regular follow-up, showing good swallowing and speaking function without any recurrence and metastasis.

Lessons:

This case report suggests that surgery and adjuvant radiotherapy are suitable procedures for patients with resectable ACC of the mobile tongue.
Parental knowledge, attitudes, and practices about vocal hygiene for their children in Chengdu, a city from China
Authors: Lu Dan , Yiu Edwin M.-L. , Pu Dai , Yang Hui , Ma Estella P.-M.
Published: April 2019

This study aimed to investigate the knowledge, attitudes, and practices of parents towards vocal hygiene for their children and explore the barriers against implementation of vocal hygiene in Chengdu, a city from mainland China.

An online questionnaire on knowledge, attitudes, and practice was available for parents to complete between March 1 and March 31, 2017. The questionnaire included 5 sections, general demographics; knowledge; attitudes; practices and barriers; and expectation. Scores were calculated for each category of knowledge, attitudes, and practices; and were compared using nonparametric Mann–Whitney U tests between the parents with and without a history of voice disorders. The internal consistency was assessed by Cronbach alpha coefficient. The correlations between vocal hygiene knowledge, attitude, and practice were analyzed using Spearman correlation test.

The questionnaire was completed by 1075 parents. There were certain misconceptions in vocal hygiene knowledge among parents, and the parents had higher level knowledge of positive factors than negative factors about vocal hygiene. Attitudes towards vocal hygiene were positive. Practices of vocal hygiene were poor. The most common barriers to implementation of vocal hygiene practices were related to lack of awareness and knowledge for this topic.

The level of parental vocal hygiene knowledge, practice, and barriers suggest that carry out vocal hygiene programs extremely urgent for school-aged children and their parents.