bluuebunny/crossref_metadata_2025 huggingface dataset:
Ginkgo leaf extract and dipyridamole injection as adjuvant treatment for acute cerebral infarction
Authors: Liu Yongyong , Wu Xuqi , Yu Zhenwei
Published: February 2019

Background:

Acute cerebral infarction (ACI) is one of the most commonly seen cerebral vascular disease and the current therapy options are not satisfied. Ginkgo leaf extract and dipyridamole injection (GDI) is widely used as adjuvant therapy for ACI. However, there is no systemic review and meta-analysis published regarding the efficacy and safety of GDI. Herein, we describe the protocol of a proposed study aims to systemically evaluate the efficacy and safety of GDI in ACI patients.

Methods:

Five electronic databases (Medline, EMBase, Cochrane database, China National Knowledge Infrastructure, and Wanfang database) will be searched up to February 28, 2018. Randomized controlled trials (RCTs) meet the eligibility criteria will be identified and included. Data synthesis will be run using RevMan software after the data extraction and risk of bias assessment of included studies. The primary outcomes of this study are effective rate and adverse event rate.

Results:

This study will provide a high-quality synthesis of RCTs on the efficacy and safety of GDI as an adjuvant therapy in the treatment of ACI.

Conclusion:

This systemic review and meta-analysis will provide high quality evidence to evaluate GDI as adjuvant therapy in patients with ACI.

Registration: PEROSPERO CRD42018107112
Yinchenhao decoction for chronic hepatitis B
Authors: Xu Lu , Xie Tian , Shen Tao , Jian Shengnan
Published: February 2019

Background:

Chronic hepatitis B (CHB) is a very critical threat to public health worldwide, and is the primary cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Yinchenhao decoction (YCHD) is a classic prescription of traditional Chinese medicine for the treatment of jaundice. Despite the satisfactory clinical efficacy of YCHD in the treatment of CHB, the safety of YCHD is still uncertain. Therefore, we will provide a systematic review of YCHD in CHB treatments.

Methods:

The purpose of this review is to retrieve relevant literature on YCHD therapy for CHB in the electrical databases, including 4 Chinese databases (e.g., Wanfang database, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical database (CBM), Chinese Science and Technology Periodical database (VIP)) and 3 English databases (e.g., PubMed, Cochrane Library, and EMBASE). The literatures involved are from the establishment of the databases to January 2019. The primary outcomes are HBV-DNA, HBeAg, and ALT. We will calculate the data synthesis for meta-analysis using RevMan V.5.3 software if the results are suitable.

Results:

This study will offer a high-quality composite of existing evidence for YCHD in CHB treatment according to HBV-DNA quantitative detection, HBeAg qualitative detection, ALT levels, TCM syndrome evaluation criteria, status changes in quality of life assessment participants, and adverse events.

Conclusion:

This systematic review will provide evidence to assess the clinical efficacy of YCHD in the treatment of patients with CHB.

PROSPERO registration number:

PROSPERO CRD42019119720.
Effects of yoga on patients with chronic nonspecific neck pain
Authors: Li Yunxia , Li Siyuan , Jiang Jieqiong , Yuan Sue
Published: February 2019

Background:

Chronic nonspecific neck pain (CNNP) has a high prevalence and is more common among younger people. Clinical practice suggests that yoga is effective in relieving chronic pain.

Objectives:

This meta-analysis aimed to quantitatively summarize the efficacy of yoga for treating CNNP.

Data sources:

We searched for trials in the electronic databases from their inception to January 2019. English databases including PubMed, MEDLINE, Cochrane Library, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Ind Med; Chinese databases including China National Knowledge Infrastructure (CNKI), WanFang Database, and VIP Information. We also conducted a manual search of key journals and the reference lists of eligible papers to identify any potentially relevant studies we may have missed. We placed no limitations on language or date of publication.

Study eligibility criteria:

We included only randomized controlled trials (RCTs) and q-RCTs evaluating the effects of yoga on patients with CNNP. The primary outcomes for this review were pain and disability, and the secondary outcomes were cervical range of motion (CROM), quality of life (QoL), and mood.

Participants and interventions:

Trails that examined the clinical outcomes of yoga intervention in adults with CNNP compared with those of other therapies except yoga (e.g., exercise, pilates, usual care, et al) were included.

Study appraisal and synthesis methods:

Cochrane risk-of-bias criteria were used to assess the methodological quality, and RevMan 5.3 software was used to conduct the meta-analysis.

Results:

A total of 10 trials (n = 686) comparing yoga and interventions other than yoga were included in the meta-analysis. The results show that yoga had a positive effects on neck pain intensity (total effect: SMD = −1.13, 95% CI [−1.60, −0.66], Z = 4.75, P < .00001), neck pain-related functional disability (total effect: SMD = −0.92, 95% CI [−1.38, −0.47], Z = 3.95, P < .0001), CROM (total effect: SMD = 1.22, 95% CI [0.87, 1.57], Z = 6.83, P < .00001), QoL (total effect: MD = 3.46, 95% CI [0.75, 6.16], Z = 2.51, P = .01), and mood (total effect: SMD = −0.61, 95% CI [−0.95, −0.27], Z = 3.53, P = .0004).

Conclusions and implications of key findings:

It was difficult to make a comprehensive summary of all the evidence due to the different session and duration of the yoga interventions, and the different outcome measurement tools in the study, we draw a very cautious conclusion that yoga can relieve neck pain intensity, improve pain-related function disability, increase CROM, improve QoL, and boost mood. This suggests that yoga might be an important alternative in the treatment of CNNP.

Systematic review registration number:

Details of the protocol for this systematic review and meta-analysis were registered on PROSPERO and can be accessed at www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42018108992.
Comparison of clinical outcomes and safety between laminectomy with instrumented fusion versus laminoplasty for the treatment of multilevel cervical spondylotic myelopathy
Authors: Lin Xiang , Cai Jie , Qin Chuan , Yang Qinghua , Xiao Zengming
Published: February 2019

Study design:

Systematic review and meta-analysis.

Objectives:

Posterior laminectomy with instrumented fusion and laminoplasty are widely used for the treatment of multilevel cervical spondylotic myelopathy (MCSM). There is great controversy over the preferred surgical method. The purpose of this study is to evaluate the clinical outcomes and safety between laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM.

Methods:

Related studies that compared the effectiveness of laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to April 2018. Included studies were evaluated according to eligibility criteria. The main endpoints included: preoperative and postoperative Japanese Orthopedic Association (JOA) scores, preoperative and postoperative visual analog scale (VAS), preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), overall complication rate, C5 nerve palsy rate, axial symptoms rate, operation time and blood loss.

Results:

A total of 15 studies were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale (NOS). Among 1131 patients, 555 underwent laminectomy with instrumented fusion and 576 underwent laminoplasty. The results of this meta-analysis indicated no significant difference in preoperative and postoperative JOA scores, preoperative and postoperative VAS, preoperative and postoperative CCI, preoperative ROM and axial symptoms rate. However, compared with laminoplasty, laminectomy with instrumented fusion exhibited a higher overall complication rate [RR = 1.99, 95% confidence intervals (CI) (1.24, 3.21), P <.05], a higher C5 palsy rate [RR = 2.22, 95% CI (1.30, 3.80), P <.05], a decreased postoperative ROM [SMD = −1.51, 95% CI (−2.14, −0.88), P <.05], a longer operation time [SMD = 0.51, 95% CI (0.12, 0.90), P <.05] and increased blood loss [SMD = 0.47, 95% CI (0.30, 0.65), P <.05].

Conclusion:

These results suggested that both posterior laminectomy with instrumented fusion and laminoplasty were determined to be effective for MCSM. However, laminoplasty appeared to allow for a greater ROM, lower overall complication and C5 palsy rates, shorter operation time and lower blood loss. Future well-designed, randomized controlled trials are still needed to further confirm our results.
Prognostic and clinicopathological value of MUC1 expression in colorectal cancer
Authors: Li Chao , Liu Tao , Yin Libin , Zuo Didi , Lin Yuyang , Wang Lei
Published: February 2019

Background:

Accumulating evidence supports the overexpression of mucin 1 (MUC1) in colorectal cancer (CRC), but the value of elevated MUC1 expression remains controversial. Here, we evaluated the prognostic and clinicopathological value of MUC1 expression in CRC.

Materials and methods:

The Web of Science, PubMed, Embase, Cochrane Library, and Wanfang databases, as well as the China Biology Medicine disc (CBMdisc) and China National Knowledge Infrastructure (CNKI) were searched for studies on MUC1 expression and prognosis of CRC through July 20, 2018. The pooled relative risks (RRs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated to evaluate the prognostic and clinicopathological value of MUC1 expression in CRC. The Revman version 5.3 package and STATA, version 12 were employed for pooled analysis and analysis of publication bias.

Results:

This meta-analysis included 16 published studies. The combined analysis showed that CRC patients with high MUC1 expression had a worse clinical outcome in overall survival (OS) (HR = 1.51, 95% CI = 1.30–1.75, P <.00001). In addition, high MUC1 expression was associated with higher TNM stage (RR = 1.44, 95% CI = 1.17–1.77, P = .0007), greater depth of invasion (RR = 1.30, 95% CI = 1.10–1.53, P = .002), and lymph node metastasis (RR = 1.47, 95% CI = 1.20–1.80, P = .0002) of CRC. However, the elevated MUC1 expression was not related to disease-free survival/recurrence-free survival (DFS/RFS) (HR = 1.51, 95% CI = 0.78–2.89, P = .22), histological grade (RR = 1.15, 95% CI = 0.96–1.38, P = .12), gender (RR = 0.95; 95% CI = 0.83–1.08, P = .44), tumor size (RR = 1.11, 95% CI = 0.85–1.44, P = .44), tumor site (RR = 1.01, 95% CI = 0.88–1.16, P = .84), or mucinous component (RR = 0.83, 95% CI = 0.60–1.14, P = .24) in CRC.

Conclusion:

Our findings indicated that high MUC1 expression represents a marker of poor prognosis in CRC. Meanwhile, elevated MUC1 expression was associated with advanced TNM stage, greater depth of invasion, and lymph node metastasis.
Helicobacter pylori infection combined with non-alcoholic fatty liver disease increase the risk of atherosclerosis
Authors: Yu Lo-Yip , Hu Kuang-Chun , Liu Chun-Jen , Hung Chung-Lieh , Bair Ming-Jong , Chen Ming-Jen , Wang Horng-Yuan , Wu Ming-Shiang , Shih Shou-Chuan , Liu Chuan-Chuan
Published: February 2019

Atherosclerosis has severe consequences on human health. Carotid artery plaques are a condition typically caused by atherosclerosis. Previous studies showed that nonalcoholic fatty liver disease (NAFLD) and Helicobacter pylori (H pylori) are risks factors for carotid artery plaque formation. We hypothesize that the combination of NAFLD with H pylori infection increases the risk of carotid artery plaque formation.

A total of 4669 subjects aged > 40 years who underwent routine health checkups between January 2006 and December 2015 were retrospectively reviewed. A serial examination, including abdominal ultrasound, carotid artery ultrasound and esophago-gastroduodenoscopy (EGD), and biopsy urease testing, was conducted.

In total, 2402 subjects were enrolled. There were no differences in H pylori infection status among patients with or without NAFLD. There was a trend of more participants with both NAFLD and H pylori infection (number [N]=583) presenting carotid artery plaque (N = 187,32.08%) than participants without NAFLD and H pylori infection (N = 589) who presented plaque formation (N = 106, 18.00%). Participants who had both H pylori infection and NAFLD had the highest risk of any carotid artery plaque (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.413–2.636) based on a multivariate logistic regression analysis. This analysis also showed that age >60 years, male sex, low-density lipoprotein (LDL) >130 mg/dL, and H pylori infection were independent risk factors for concomitant NAFLD and carotid artery plaque formation.

The combination of H pylori infection and NAFLD increases carotid artery plaque formation. H pylori eradication and NAFLD control may be warranted to prevent carotid artery plaque formation.
Circadian variations in electric current responses at ryodoraku points across the waking stage
Authors: Bae Jang-Han , Ku Boncho , Bae Se-Eun , Kim Jaeuk U.
Published: February 2019

Human body undergoes the 24-hour daily rhythm in response primarily to light and darkness. The circadian rhythms of biomarkers reflect bodily conditions including the prognosis of some pathologies. As a sensitive index of sympathetic nervous response (SNR), electrodermal activity (EDA) is a recent research topic in healthcare industry as a noninvasive and easy-access biosignal. The EDA response at Ryodoraku points (RPs) is of potential clinical usage in relation to SNR and meridian theory, but still remains in its primitive development stage.

In this study, the 24-hour variations of EDA for 14 hospitalized participants were monitored over 3 days using a Ryodoraku device, and a circadian model of EDA was constructed using a cosinor analysis based on the linear mixed effect model.

As a result, EDA at every RP showed a circadian cycle with its value the lowest in the morning and increased gradually until the late afternoon, and monotonically decreased again until the next morning. Circadian variations were observed in EDAs of all 12 RPs. However, Ryodoraku-specific features were not detected. Midline estimating statistic of rhythm (MESOR) values in men and young group were higher than in women and old group, and cosinor analysis showed significant circadian rhythms, especially for men and young groups. Especially, circadian variation in EDA in the young group went above 35% of the MESOR value.

It implies that the circadian rhythm should be considered for the Ryodoraku analysis to examine bodily conditions or the prognosis of some pathologies.
Bilateral vocal fold immobility in a single tertiary hospital in northern Taiwan
Authors: Shen Shang-Po , Chang Hung-Yang , Chang Jui-Hsing , Hsu Chyong-Hsin , Peng Chun-Chih , Lee Kuo-Sheng
Published: February 2019

To determine the natural history of patient with bilateral vocal fold immobility (BVFI), and to identify the factors or predictors associated with the tracheostomy and duration of cannulation for those who require tracheostomy.

A retrospective review was carried out at a single tertiary referral center over a 23-year period of infants less than 1 year old who presented with BVFI. All information related to sex, etiology, gestational age at birth, vocal fold (VF) position at diagnosis, presence of concomitant airway disease, age at attainment of VF movement, age at decannulation, and current tracheostomy status were recorded to perform descriptive and comparative analyses.

Forty-one patients were enrolled, and the tracheostomy rate was 80.5% (33/41). Those with a median VF position had a higher rate of tracheostomy in comparison with those with a paramedian VF position (P = .003). Among patients who underwent tracheostomy, 77.4% (24/31) were eventually decannulated. The median duration of cannulation was 4.4 years (range: 0.8 − 10.7 years). Those who were found to have attainment of VF movement at less than 1-year-old had a shorter duration of cannulation than others (mean: 1.9 years vs 5.2 years, P < .001). The mortality rate of those patients who received tracheostomy was 9.7% (3/31).

Although a high tracheostomy rate was found in BVFI patients, most of them underwent decannulation. The earlier attainment of VF movement is achieved, the shorter duration of cannulation is required. This information is important for physicians while following up BVFI patients who have undergone tracheostomy.
A case report of a giant mature teratoma of the thyroid gland in a young girl
Authors: Lv Zhibao , Bai Xiaoling , Sheng Qingfeng , Liu Jiangbin , Wu Yibo
Published: February 2019

Rationale:

Teratomas are extremely rare in the thyroid gland. A cervical teratoma presenting as a cystic or mixed thyroid lesion can be easily confused with a thyroglossal duct cyst. It is difficult for pediatricians to differentiate between these 2 types of lesions.

Patients concerns:

A 2-year-old girl who presented a growing thyroid mass for 14 months showed a mass in her left thyroid lobe under contrast-enhanced computed tomography (CT).

Diagnosis and interventions:

Ultrasonography found a mass of 5 × 3.5 cm within the left lobe of the thyroid gland, and the sonogram revealed areas with echo-free and mixed-echo patterns. There was no accumulation of technetium-99m pertechnetate on the thyroid scintigraphy (cold thyroid nodule). CT scan showed a mass (5.0 × 3.0 × 2.5 cm in size) that extended from the left thyroid lobe to the anterior mediastinum with no evident enhancement and clear margins that contained calcifications. Complete excision without intraoperative capsule disruption was achieved. Histologically, the thyroid mass was diagnosed as a mature teratoma.

Outcomes:

The postoperative course was uneventful after follow-ups for 2 years, and the patient had no inflammatory signs or evidence of recurrence.

Lessons:

Thyroid teratoma is rare in infants and is usually benign; however, some thyroid teratomas are malignant and inclined to relapse. The authors emphasize that thyroid teratomas in children should be included in the differential diagnosis of cystic lesions located in the head and neck area. Complete resection is essential for good outcomes. In addition, long-term follow-ups are warranted to follow the complications of the malignant or recurrent disease.
Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis
Authors: Wang Lifei , Wang Yanhui , Li Yalin , Yan Zhongyang , Li Yunhuan , Lu Lu , Lu Tianxiang , Wang Xin , Zhang Shengjuan , Shang Yanxia
Published: February 2019

Vitrectomy combined with internal limiting membrane peeling (ILMP) treats high myopic foveoschisis with good results, but there is a risk of iatrogenic macular holes, which may be reduced by preserving the internal limiting membrane of the central fovea. This study compared complete ILMP with partial ILMP, both combined with 25G vitrectomy, for the treatment of high myopic foveoschisis.

Thirty-three cases (33 eyes) of high myopic foveoschisis were retrospectively analyzed. They underwent 25G vitrectomy combined with C3F8 gas filling; Group A (20 patients, 20 eyes) underwent complete ILMP, while Group B (13 patients, 13 eyes) underwent partial ILMP to preserve the internal limiting membrane of the central fovea. Patients were followed up for 6 months and underwent best corrected visual acuity (BCVA), intraocular pressure, diopter, slit lamp microscopy, indirect ophthalmoscope, A-mode and/or B-mode ultrasound, and optical coherence tomography. Surgical complications were recorded.

Up to the last follow-up, the BCVA improved and central fovea thickness (CFT) was lower compared with before surgery in both groups (All P < .05). There were no significant differences in BCVA and CFT at each time point between the groups (P > .05). Most of the postoperative retinas of the 2 groups were completely reattached, with disappearance of the macular retinoschisis cavity. Two patients in the Group A and none in the Group B developed a macular hole during follow-up (P = .508).

The results did not support the superiority of partial ILMP over complete ILMP in reduced incidence of macular hole. Both methods had a similar curative effect.
Sex differences in the relationship between cognitive impairment and overweight or obesity in late life
Authors: Noh Hye-Mi , Han Junhee , Kim Yeo Jin , Jung Jin-Hyung , Roh Yong Kyun , Song Hong Ji
Published: February 2019

The relationship between body weight changes in late life and cognitive function is controversial.

We investigated whether weight gain or loss in late life affected cognitive function in community-dwelling older adults over a 3-year period.

Our study used data from the Survey of Living Conditions and Welfare Needs of Korean Older Persons and included 3859 subjects (aged ≥65 years) with normal cognition at baseline. At baseline and the 3-year follow-up, body weight and height were measured, and cognitive function was assessed using the mini-mental state examination. Based on their body mass index (BMI) at baseline and follow-up, we divided the subjects into 4 groups: weight gain (baseline BMI <23 kg/m2and follow-up BMI ≥23 kg/m2); weight loss (baseline BMI ≥23 kg/m2and follow-up BMI <23 kg/m2); stable overweight/obese (BMI ≥23 kg/m2at both visits); and stable non-overweight/obese (BMI <23 kg/m2at both visits). Incidence rates (IRs) of cognitive impairment per 100 persons and IR ratios (IRRs) were calculated for each group and adjusted for confounding variables.

At the 3-year follow-up, 610 cases of cognitive impairment (15.8%) were identified. The stable overweight/obese group had the lowest IR (14.0, 95% confidence interval [CI] 12.45–15.71) and was therefore used as the reference group when calculating IRRs for cognitive impairment. When men and women were evaluated separately, IRs between groups were significantly different only for women. The stable non-overweight/obese group (IRR 1.65, 95% CI 1.22–2.22) and the weight gain group (IRR 1.93, 95% CI 1.24–3.01) had higher IRs than those in the stable overweight/obese group. As a gain or loss of adiposity, the IR of the weight gain group (IRR 1.17, 95% CI 0.74–1.84) was not different from that of the stable non-overweight/obese group. Also, the IR of weight loss group (IRR 1.09, 95% CI 0.71–1.67) was not significantly different from that of the stable overweight/obese group.

We suggest that overweight or obese older women at baseline had cognitive benefits. However, additional gain or loss of adiposity in late life did not affect the risk of cognitive impairment.
Nucleostemin expression in breast cancer is a marker of more aggressive phenotype and unfavorable patients’ outcome
Authors: Sami Manal M. , Hachim Mahmood Y. , Hachim Ibrahim Y. , Elbarkouky Ahmed H. , López-Ozuna Vanessa M.
Published: February 2019

Cancer stem cells (CSCs) are postulated to play significant role in the pathogenesis, progression as well as drug resistance of breast cancer. Nucleostemin (NS) is thought to be a key molecule for stemness, and the clinical impact of NS immunoreactivity in breast cancer can indicate its actual role and future therapeutic potentials.

The current study is an observational study with an attempt to evaluate the correlation between NS expression (protein and gene expression levels) and different clinicopathological attributes of invasive breast cancer. For that reason, we investigated NS immunohistochemistry expression on commercial tissue microarray (TMA) of 102 patients and 51 archival specimens from patients admitted to Saqr Hospital, Ras Al Khaimah and diagnosed in Al Baraha Hospital, Dubai, UAE. In addition, the association between NS (GNL3) gene expression and different prognostic parameters as well as patient outcome was also evaluated using 2 large publicly available databases.

Interestingly, we found NS expression to be associated with less differentiated and more advance stage. In addition, NS expression was significantly higher in larger size (P = .001) and LN-positive tumors (P = .007). Notably, NS expression was significantly correlated to P53 positive (P = .037) status. Furthermore, NS was found to be more expressed in the highly aggressive breast cancer subtypes including human epidermal growth factor receptor 2 (HER-2) and triple negative breast cancer (TNBC) subtypes. Moreover, our results also showed that high GNL3 gene expression to be associated with poor patient outcome and higher chances of tumor recurrence.

Our results highlight NS expression as a marker of aggressive phenotype and poor outcome and indicate its possible use as a potential target for CSC-associated breast cancer management.
The value of neutrophil to lymphocyte ratio and gamma-glutamyl transpeptidase to platelet ratio in patients with hepatocellular carcinoma
Authors: Hu Zuojian , Chen Huaping , Chen Siyuan , Huang Zhili , Qin Shanzi , Zhong Jianing , Qin Xue , Li Shan
Published: February 2019

Our study aimed to evaluate the value of neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) in patients with hepatocellular carcinoma (HCC).

A total of 565 patients with pathological diagnosis of HCC were retrospectively analyzed and 414 patients diagnosed with cirrhosis were treated as a control group. All clinical materials were collected from the First Affiliated Hospital of Guangxi Medical University.

The preintervention NLR, GPR, and α-fetoprotein (AFP) were significantly higher in HCC patients than in the controls (P
NLR < .000, P
GPR < .000, P
AFP < .000). The NLR and GPR were correlated with the Barcelona clinic liver cancer (BCLC) stages, Child-Pugh grades, and tumor size, but not with Edmondson–Steiner grades. Combined use of NLR or GPR with AFP produced larger area under the curve (AUC) (AUCNLR+AFP = 0.916; AUCNLR+AFP = 0.953) than NLR (P < .000), GPR (P < .000), or AFP (P < .000) used alone.

The preintervention hematologic parameters (NLR and GPR) studied herein were associated with the BCLC stages of HCC. Combined use of NLR or GPR with AFP may improve early detection and diagnosis of HCC.
Circulating microRNAs in adrenal tumors
Authors: Igaz Peter
Published: February 2019

Purpose of review

Circulating microRNAs represent promising minimally invasive markers of several diseases including tumors. As the preoperative diagnosis of different adrenal tumors is difficult, for example, diagnosis of adrenocortical or adrenomedullary malignancy, circulating microRNAs might be helpful in their clinical management.

Recent findings

Observations regarding the applicability of circulating microRNAs isolated both from unfractionated plasma or serum and from extracellular vesicle preparations for the diagnosis of adrenocortical malignancy have been published. Data show that circulating microRNA might be exploited for monitoring adrenocortical cancer progression. Circulating microRNA profiles of adrenal myelolipoma have also been published that might be useful for differentiating adrenocortical cancer and adrenal myelolipoma in dubious cases.

In this review, recent advances in the field of circulating microRNAs in adrenal tumors are discussed.
Factors Influencing Nurses' Use of Local Anesthetics for Venous and Arterial Access
Authors: Alobayli Fatimah Yahya
Published: February 2019

The use of local anesthetics to relieve pain associated with intravenous cannulation and arterial blood gas sampling is given low priority in many health institutions. This review sought to identify factors influencing nurses' use of local anesthetics for these procedures. The Database Syntax Guide for Systematic Reviewers was used; health-relevant studies were critically assessed with appropriate Critical Appraisal Skills Programme tools. Significant factors influencing the use of local anesthetics for parenteral procedures were identified, including the level of effectiveness among types of local anesthetics, the perceived benefits of facilitating needle insertions and patient satisfaction, the underestimation of pain associated with needle punctures, time concerns, physician authorization, and costs.
Emergency Neurology Oral Cases for Trainee Assessment and Education
Authors: Loochtan Aaron I. , Spector Andrew R. , Sinha Saurabh R. , Lerner David P.
Published: February 2019

Objectives:

Neurological emergencies comprise much of neurology residency, but there may be a lack of clinical experience. For our program, oral examinations have been used to assess resident readiness for additional clinical independence. In this study, we examined the perceptions of learners and examiners of oral case examinations.

Methods:

Six attending physicians administered case-based oral examinations to 8 trainees. Each case involved a chief complaint and progressed through a clinical encounter. Following the examination, each attending physician and trainee completed an online 5-point Likert scale survey of content and educational value. Statistical analysis of point assignment based on Likert scale responses was performed.

Results:

Six attendings (100% response) and 7 trainees (87.5% response) completed the assessment. The trainees assessed all 6 cases. Residents had negative responses for 3 cases with specific concern in “feedback” and “learning experience.” Residents responded with less positive response than attendings for “The case is easy to understand and progressed in a logical fashion” (3.90 for residents vs. 4.83 attendings; P=0.015) and “The case complexity is appropriate for level of training” (4.14 vs. 4.83; P=0.033). Attendings noted better understanding of trainees thought processes following oral examinations. Trainees noted feedback as the most useful component of case-based assessments.

Conclusions:

Case-based assessment in neurology training allows for rapid evaluation of trainees’ abilities to critically think. There is general agreement from attendings and trainees that case-based assessment is a useful and positive learning tool. The responses from this survey are being used to modify the cases for future examinations.
A Case of Overlap Posterior Cortical Atrophy and Logopenic Variant Primary Progressive Aphasia
Authors: Fitzpatrick Donal , Blanco-Campal Alberto , Kyne Lorraine
Published: February 2019

Posterior cortical atrophy (PCA) and logopenic variant primary progressive aphasia (LvPPA) are considered early-onset dementias most commonly caused by Alzheimer pathology. PCA is characterized by a progressive decline in higher order visual processing functions, whereas LvPPA is a form of primary progressive aphasia. The clinical presentation of both syndromes is typically earlier in life relative to the more typical “amnestic” form of Alzheimer disease. Prominent language deficits have been well described in PCA. Here, we describe the case of a 56-year-old man presenting with overlapping anatomic, clinical, and cognitive features of PCA and LvPPA and review the existing literature relating to the clinical features shared by these conditions, exploring the etiology, and implications for clinical practice in cases with a PCA-LvPPA overlap syndrome. In PCA, atrophy occurs in temporoparietal-occipital regions, whereas in LvPPA atrophy occurs at the temporoparietal junctions, with left-sided predominance. A defective phonological loop (a short-term storage system which holds speech sounds in memory for 1 to 2 s) seems to underlie the logopenic syndrome in both conditions. Other parietal lobe deficits, in proximity to both language and visual processing areas, such as dyscalculia and ideomotor apraxia are also commonly found in both conditions. We suspect that cases with an overlap PCA-LvPPA syndrome are relatively underreported which may relate to the fact that these cases occur on a spectrum depending on the stage of disease progression and do not easily fit into strict diagnostic categories according to existing criteria of PCA and LvPPA, respectively.
Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa
Authors: Francis Suzanna C. , Miiro George , Nakuya Kevin , Rutakumwa Rwamahe , Nakiyingi-Miiro Jessica , Nabaggala Grace , Musoke Saidat , Namakula Juliet , Tanton Clare , Torondel Belen , Ross David A. , Weiss Helen A.
Published: February 2019

Background

Few studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda.

Methods

Assenting girls with parental consent from 3 secondary schools were provided instructions for sampling, and randomly allocated to self-collection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview.

Results

Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15–17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortable with self-collection. Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the arm without nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8–22).

Conclusions

In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.
Case Series: Pediatric Herpes Simplex Keratitis
Authors: Bodack Marie I.
Published: February 2019

SIGNIFICANCE

Although the clinical appearance of pediatric ocular herpes simplex virus (HSV) is similar in children and adults, there is evidence that stromal disease and recurrences are more common in pediatric patients. Misdiagnosis of these patients is common, and patients can develop corneal scarring and amblyopia.

PURPOSE

This case series will review important clinical concepts on pediatric ocular HSV including differences in presentation and current treatment recommendations.

CASE REPORTS

Three pediatric patients with HSV keratitis are presented: a 6-year-old girl who was treated for unilateral disease over the course of 3 years, a 7-year-old boy who presented with bilateral disease, and a 3-year-old girl in whom the diagnosis was not apparent initially. All patients were successfully treated with oral acyclovir and topical steroids. One patient was also treated with topical antivirals.

CONCLUSIONS

Pediatric HSV keratitis should be considered as a differential diagnosis in pediatric patients who present with keratitis. Accurate diagnosis of these patients is important so that amblyopia does not develop. Pediatric ocular HSV patients can be successfully treated with topical and/or oral medications, although their treatment duration may be 12 months or longer.
Transient Erythroblastopenia of Childhood
Authors: Burns Rebekah A. , Woodward George A.
Published: February 2019

Transient erythroblastopenia of childhood is a form of pure red cell aplasia that is self-limited and occurs in children 4 years old and younger. It is characterized by an absence or a significantly reduced quantity of erythroblasts in the bone marrow without underlying congenital red blood cell abnormalities. Transient erythroblastopenia of childhood should be considered in previously healthy children who present with normocytic anemia and lack of reticulocytosis without evidence of blood loss, hemolysis, or other causes of bone marrow suppression. Evaluation should be targeted at ruling out other causes of anemia. Management is mainly supportive, although some children may require blood transfusions for symptomatic anemia. Most patients demonstrate a return of hematopoiesis within two weeks of diagnosis and normalization of blood counts within two months.
Relationship Between Body Mass Index and Rehabilitation Outcomes in Subacute Stroke With Dysphagia
Authors: Morone Giovanni , Iosa Marco , Paolucci Teresa , Muzzioli Luca , Paolucci Stefano
Published: February 2019

Objective

The aim of the study was to investigate the association between body mass index and rehabilitation outcome in hemiparetic patients with stroke in subacute phase.

Design

This was a prospective study testing the correlation between body mass index and the effectiveness of rehabilitation, measured using Barthel Index scores. We enrolled patients with subacute stroke (n = 664; age, 68 ± 14 yrs; length of hospital stay, 84 ± 34 days). We assessed the body mass index and Barthel Index both at admission and discharge. The effectiveness of rehabilitation was computed as the percentage increment in Barthel Index score with respect to the maximum achievable improvement.

Results

Effectiveness of rehabilitation was significantly correlated with the body mass index at discharge (R = 0.111, P = 0.004) and percentage change in body mass index (R = 0.253, P < 0.001), but not with body mass index at admission (R = 0.006, P = 0.869).

Conclusions

In addition to body mass index value, our findings suggest that rehabilitation outcomes can be influenced by the change in body mass index during rehabilitation.
Perceptions of Fall Circumstances, Recovery Methods, and Community Participation in Manual Wheelchair Users
Authors: Rice Laura A. , Peters Joseph , Sung JongHun , Bartlo Wendy D. , Sosnoff Jacob J.
Published: February 2019

Objective

The aim of the study was to examine the circumstances surrounding the worst fall experienced by full-time manual wheelchair users in the past 12 mos, the recovery process, and influence on community participation.

Design

A mixed-method research study was conducted. Semistructured interviews were conducted to understand the circumstances of the worst fall experienced and the recovery process. A quantitative fear of falling assessment and the community participation indicators were used to further evaluate the influence of the fall.

Results

There were 20 manual wheelchair users (mean ± SD, 47 ± 13 yrs, 55% male). Falls most commonly occurred outside during wheelchair propulsion. Falls were attributed to both intrinsic and extrinsic factors. Seventy percent of participants reported a fear of falling and 80% required assistance to recovery. No significant correlations were found between fall frequency and community participation indicator scores. Participants who needed assistance to recover (56.70 ± 17.66) had lower community participation indicator importance scores compared with participants able to recover independently (88.93 ± 22.13), P = 0.05.

Conclusions

Falls are complex and most manual wheelchair users need assistance to recover. Comprehensive programs including education on prevention and postfall management are needed. Results may increase understanding of the circumstances associated with falls and inform the development of evidenced-based clinical practice guidelines.
Restoration of Upper Limb Function After Chronic Severe Hemiplegia
Authors: Jovanovic Lazar I. , Kapadia Naaz , Lo Lorna , Zivanovic Vera , Popovic Milos R. , Marquez-Chin Cesar
Published: February 2019

Functional electrical stimulation therapy (FEST) is a state-of-the-art treatment for retraining motor function after neurological injuries. Recent literature suggests that FEST can be further improved with brain-computer interface (BCI) technology. In this case study, we assessed the feasibility of using BCI-triggered FEST (BCI-FEST) to restore upper limb function in a 57-yr-old man with severe left hemiplegia resulting from a stroke 6 yrs before enrollment in the study. The intervention consisted of two blocks of forty 1-hr BCI-FEST sessions, with three sessions delivered weekly. During therapy, a single-channel BCI was used to trigger the stimulation programmed to facilitate functional movements. The measure of the feasibility of the BCI-FEST included assessing the implementation and safety of the intervention. Clinical improvements were assessed using (a) Functional Independence Measure, (b) Action Research Arm Test, (c) Toronto Rehabilitation Institute – Hand Function Test, and (d) Fugl-Meyer Assessment Upper Extremity test. Upon completion of 80 therapy sessions, 14-, 17-, and 18-point changes were recorded on Action Research Arm Test, Fugl-Meyer Assessment Upper Extremity test, and Toronto Rehabilitation Institute – Hand Function Test, respectively. The participant also indicated improvement as demonstrated by his ability to perform various day-to-day tasks. The results suggest that BCI-FEST is safe and viable.
A Quantitative Analysis of Online Plastic Surgeon Reviews for Abdominoplasty
Authors: Qiu Cecil S. , Hockney Sara M. , Turin Sergey Y. , Dorfman Robert G. , Kim John Y. S.
Published: February 2019

Background:

Online reviews increasingly influence patients’ decision-making. This is the first systematic, quantitative analysis of online reviews for abdominoplasty.

Methods:

Reviews for abdominoplasty were sampled from RealSelf, Yelp, and Google for six major metropolitan areas. A standard social sciences framework known as grounded theory was used to evaluate factors affecting satisfaction. The relative importance of factors was quantified using odds ratios.

Results:

Seven hundred ninety-four reviews met inclusion criteria. There was significant geographic variation with respect to number of reviews (p < 0.01) and average rating (p = 0.014). The authors identified 10 statistically significant themes affecting satisfaction. Of these, aesthetic outcome was the most mentioned theme [n = 368 (46.3 percent)] and the most dominant driver of satisfaction. Interactions with staff had the second highest odds ratio, driven by the fact that all negative staff interactions led to negative reviews. Postoperative care had the next highest odds ratio, and was demonstrated to counteract the negative effects of poor surgical outcomes on satisfaction. The occurrence of a surgical complication and the cost of surgery were least associated with satisfaction.

Conclusions:

This analysis is the first to use quantitative methods to identify dominant and nondominant factors affecting patient satisfaction in cosmetic surgery. The authors found that aesthetic outcome, staff interactions, and postoperative diligence were the most critical factors affecting satisfaction in abdominoplasty, whereas postoperative complications and cost were least important. Understanding the relative importance of factors may help to improve and protect one’s online reputation.
Use of a Waterproof Camera Immersed in Povidone-Iodine to Improve Intraoperative Photography
Authors: Purnell Chad A. , Alkureishi Lee W. T. , Koranda Carly , Patel Pravin K.
Published: February 2019

Intraoperative photography has the potential to raise costs and introduce possible contamination but is essential for documentation in plastic surgery. The authors evaluate their use of a waterproof camera immersed in povidone-iodine for taking intraoperative photographs in an efficient manner. A waterproof camera is immersed in povidone-iodine during surgery and photographs are taken as needed by the operating surgeon or assistant without a change of gloves. A retrospective chart review was performed, evaluating serious infections and the number of photographs taken per procedure in the years before and after the camera was used. Bacterial cultures were taken of three areas of the camera on 10 consecutive operating days and evaluated for growth. The number of serious infections did not change after the camera protocol was implemented. The mean number of photographs taken per case increased significantly with the use of this camera. All cultures of the camera were negative. The use of a waterproof camera immersed in povidone-iodine allows efficient and improved intraoperative photographic documentation by the surgeon. It does not appear to increase the risk of infection or introduce contamination.
Echogenicity of Palmar Dupuytren’s Nodules Is Not a Predictor of Disease Progression in Terms of Increase in Nodule Size
Authors: Molenkamp Sanne , Broekstra Dieuwke C. , Werker Paul M. N.
Published: February 2019

Background:

Ultrasound might enable us to measure Dupuytren’s disease activity and predict disease progression. The aim of this study was to analyze whether echogenicity of Dupuytren’s nodules can be used to predict progression in terms of increase in nodule size.

Methods:

Ultrasonographic assessment of a Dupuytren’s nodule was performed in 91 patients participating in an existing longitudinal cohort study. Images were scored for echogenicity by two observers. Echogenicity of 89 nodules was matched to growth 1 year later using linear regression analysis. Sensitivity analysis was performed using data obtained 1 year before ultrasound. The interobserver and intraobserver reliability was calculated using the intraclass correlation coefficient.

Results:

Hypoechogenicity was not a predictor of growth 1 year later (beta = −0.019, p = 0.748). Sensitivity analysis looking at the year before ultrasonographic measurement showed that hypoechogenic nodules were more likely to have grown in the past year (beta = 0.173, p = 0.011). However, these data were influenced by nodules that developed in the year before ultrasound. The intraobserver reliability of echogenicity of Dupuytren’s nodules was excellent (intraclass correlation coefficient, 0.996; 95 percent CI, 0.993 to 0.998) and the interobserver reliability was fairly good but imprecise (intraclass correlation coefficient, 0.688; 95 percent CI, 0.329 to 0.977).

Conclusions:

Hypoechogenicity is not a predictor of progression in terms of increase in nodule size measured by physical examination 1 year later. When using ultrasound to assess echogenicity of Dupuytren’s nodules, the use of a single observer leads to more consistent results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk III.