bluuebunny/crossref_metadata_2025 huggingface dataset:
Lateral Antebrachial Cutaneous Nerve as Autologous Graft for Mini-Invasive Corneal Neurotization (MICORNE)
Authors: Bourcier Tristan , Henrat Carole , Heitz Antoine , Kremer Samira Fafi , Labetoulle Marc , Liverneaux Philippe
Published: June 2019

Purpose:

We describe the first case of a novel surgical technique of mini-invasive corneal neurotization (MICORNE) using the lateral antebrachial cutaneous nerve as a graft nerve and the contralateral supraorbital nerve as a donor nerve in a herpetic patient with a neurotrophic keratopathy (NK).

Methods:

A MICORNE procedure was performed in a 32-year-old man with a 5-year history of herpes simplex virus (HSV)-related NK in the right eye (RE). Visual acuity and corneal sensation were assessed over 9 months of follow-up. HSV-1 and HSV-2 genomes were screened preoperatively and postoperatively in the patient's tears using the quantitative polymerase chain reaction technique. A high does of the oral antiviral prophylaxis was prescribed during the follow-up.

Results:

Preoperative best-corrected visual acuity was 20/200 in the RE. A Cochet–Bonnet esthesiometer revealed complete corneal anesthesia (<5 mm ie, >15.9 g/mm2) in all quadrants in a scarred and neovascularized cornea. Twelve months after the procedure, the visual acuity of the RE was 20/80 and corneal sensitivity had increased to 40 mm, that is, 0.8 g/mm2 (superior quadrant), 35 mm, that is, 1 g/mm2 (inferior quadrant), 40 mm (temporal quadrant), 35 mm, that is, 1 g/mm2 (nasal quadrant), and 40 mm (centrally). We observed no clinical recurrence of herpes, and HSV was not detected in tears during the follow-up period.

Conclusions:

We report the first case of MICORNE, a novel surgical technique of corneal neurotization in a herpetic patient with NK. Despite the potential risk of viral recurrence, our patient showed dramatic improvement in corneal sensation and visual acuity.
Episcleral Venous Pressure and the Ocular Hypotensive Effects of Topical and Intracameral Prostaglandin Analogs
Authors: Lee Susan S. , Robinson Michael R. , Weinreb Robert N.
Published: June 2019

There is a limit beyond which increasing either the concentration of a prostaglandin analog (PGA) or its dosing frequency fails to produce increases in ocular hypotensive efficacy with topical dosing. Intracameral PGA dosing with a bimatoprost implant, however, does not exhibit the same intraocular pressure (IOP)-lowering plateau at studied concentrations, and the maximum-achievable ocular hypotensive effects are not yet known. This suggests that the bimatoprost intracameral implant may activate another mechanism of action in addition to the mechanism(s) activated by topical application. Episcleral venous pressure (EVP) is a key determinant of IOP, and experimental manipulation of the episcleral vasculature can change both EVP and IOP. The recent observation that topical and intracameral PGA drug delivery routes produce different patterns of conjunctival hyperemia suggested that the differences in the IOP-lowering profiles may be caused by differing effects on the episcleral vasculature. Recent experiments in animals have shown that topical PGAs increase EVP, while the bimatoprost intracameral implant causes a smaller, transient increase in EVP, followed by a sustained decrease. The increase in EVP could be limiting the IOP-lowering efficacy of topical PGAs. In contrast, the decrease in EVP associated with the bimatoprost implant could explain its enhanced IOP-lowering effects. Further research on EVP as a target for IOP lowering is indicated to improve our understanding of this potentially important pathway for treating patients with glaucoma.
Health Knowledge and Adherence as Predictors of Viral Burden and CD4+ T-Cell Count in Youth and Young Adults Living With HIV
Authors: Lynn Courtney , Chenneville Tiffany , Bradley-Klug Kathy , St. John Walsh Audra , Dedrick Robert F. , Rodriguez Carina A.
Published: June 2019

Health literacy influences HIV treatment for youth and, thus, is a research priority. We explored health knowledge and self-reported adherence, as indicators of health literacy, among youth living with HIV (YLWH) and the association between health literacy and health outcomes. A total of 102 YLWH ages 13–25 years participated in the study. Participants completed the Brief Estimate of Health Knowledge and Action-HIV Version; CD4+ T-cell counts and viral loads were extracted from participant medical records. Participants had a moderate amount of HIV knowledge, and most reported taking their medications under most conditions. Decreasing action scores were statistically associated with an increased likelihood of having a detectable viral load. Health literacy is an important factor that should be addressed by practitioners working with YLWH. More research is needed to determine the best way to measure and improve health literacy.
Endovascular graft exclusion for treating Stanford type B acute aortic dissection in aged population
Authors: Chen Tongyun , Jiang Nan , Zhao Feng , Xu Dong , Gao Jinyu , Chen Qingliang
Published: June 2019

The aim of this study was to investigate the efficiency of endovascular graft exclusion for treating Stanford type B acute aortic dissection (AAD) in aged population.

Forty-six consecutive patients aged ≥65 years with Stanford type B AAD underwent endovascular therapy in Tianjin Chest Hospital between 2010and 2015 were included in this study. All patients received echocardiography, contrast-enhanced CT, hepatic and renal functions tests, and the blood and urine routine examinations. After the procedure, annual review of the whole aortic computed tomography (CT) was performed for all patients before discharge, as well as 3 months, 6 months and12 months after surgery. All patients were followed up until December, 2015. The outcomes of the whole aortic CT and survival rate were analyzed.

Five patients (10.87%) died. Among the 5 cases, 2 showed perioperative death induced by cerebral infarction, 1 died because of newly developed AD 8 months after surgery, and 2 died because of acute myocardial infarction (n = 1) and renal/cardiac failure (n = 1). The other 41 patients (89.13%) were symptom-free with satisfactory conditions.

Endovascular stent-graft placement was effective for treating the senior patients with Stanford type B AAD.
Better prediction for FGR (fetal growth restriction) with the sFlt-1/PIGF ratio
Authors: Visan Valeria , Scripcariu Ioana Sadiye , Socolov Demetra , Costescu Amelia , Rusu Daniela , Socolov Razvan , Avasiloaiei Andreea , Boiculese Lucian , Dimitriu Cristina
Published: June 2019

The aim of this study was to check whether the sFlt-1/PIGF ratio, established as the biomarker for preeclampsia, reduces the false positive rate of late fetal growth restriction (FGR) detection by ultrasound biometry.

This was a prospective case-control study, conducted at one regional maternity hospital in Romania. Study participants included singleton pregnancy women for whom the estimated fetal weight (EFW) at 28 to 35 weeks was < 10 percentiles and as controls, pregnant women with EFW >10 percentiles. All pregnancies were dated in the first trimester by crown-rump-length. We also recorded maternal characteristics, pregnancy and neonatal outcomes.

The primary outcome measures were the relation between the sFlt-1/PIGF ratio and incidence of FGR. Secondary outcome was establishing a threshold for statistical significance of the marker and influence of other conditions (e.g., pre-eclampsia) on the accuracy of the marker in FGR prediction.

Included in the study were 37 pregnant women and 37 controls.

When we used ultrasound (US) biometry and maternal risk factors to estimate EFW <10 percentiles, the sensitivity was 44.4% with a specificity of 89% for an FPR (false positive result) of 10%. When we combined the US biometry and maternal risk factors with sFlt1/PIGF ratio, for a cut off of 38, the sensitivity was 84.21%, and the specificity was 84.31% for an FPR of 10%. The cut off value (36) did not change if we considered all cases of SGA, including those with associated preeclampsia or if we considered only FGR cases without associated preeclampsia.

When associated with maternal factors and US biometry, the sFlt1/PIGF ratio enhanced the sensitivity for detecting late FGR.
Transphyseal anterior cruciate ligament reconstruction in adolescents with substantial remaining growth causes temporary growth arrest resulting in subclinical leg-length discrepancy
Authors: Jeon Ji Young , Lee Jaehyung , Kang Michael Seungcheol
Published: June 2019

The purpose of the present study was to investigate the characteristics of growth disturbances in patients with remaining growth after transphyseal anterior cruciate ligament (ACL) reconstruction who were confirmed to have no definite postoperative physeal abnormalities on magnetic resonance imaging (MRI).

Forty adolescents (mean age 15.6 ± 1.0 years [range 12.2–16.8], mean follow-up 2.7 ± 0.7 years [range 2.0–5.5 years]), who underwent transphyseal ACL reconstruction and were confirmed to have no focal physeal disruptions on follow-up MRIs 6 to 12 months after the operation, were retrospectively evaluated. The patients were grouped according to the leg-length growth of the uninjured side, measured on scanograms, obtained before surgery, and at the final follow-up.

Leg-length discrepancies (LLD) at the last follow-up were greater in patients with leg growth ≥4 cm than in those with leg growth <4 cm (5.3 ± 9.0 mm vs −0.3 ± 4.2 mm, P = .033); however, no significant difference was observed between subgroup patients with leg growth of 4 to 6 cm or ≥6 cm (5.6 ± 10.4 mm vs 4.8 ± 7.0 mm, P = .958). On multivariate analysis, leg growth was a significant predictive factor for the final LLD (P = .030).

Adolescents with additional leg-length growth after transphyseal ACL reconstructions presented with greater LLDs (as shown in the <4 cm vs ≥4 cm groups), but they also presented a ceiling effect (as shown in the 4–6 cm vs ≥6 cm subgroups). Transphyseal ACL reconstructions appeared to cause temporary growth arrest/disturbances in patients with substantial remaining growth which then resumed resulting in clinically insignificant LLDs.
Comparison of the aperture and midportion femoral tunnel widening after anterior cruciate ligament reconstruction
Authors: Celik Haluk , Lee Dae-Hee
Published: June 2019

Background:

To identify whether the aperture or the midportion of the femoral tunnel had a larger tunnel widening in patients who undergo ACL reconstruction.

Methods:

PubMed, EMBASE and Cochrane Library were searched for relative studies that evaluated tunnel widening in patients underwent arthroscopic ACL reconstruction. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening. Random-effects meta-analyses were performed to pool the outcomes of tunnel widening by estimating the standardized mean differences in tunnel widening and their 95% confidence intervals (CIs), Publication bias was assessed using funnel plots and Egger test when the number of included studies was >10.

Results:

Eleven included studies compared tunnel widening between the aperture and the midportion. In these studies, 372 and 92 patients underwent single- and double-bundle ACL reconstructions, respectively. Subgroup analyses in terms of evaluation imaging tool for tunnel widening showed no significant differences in tunnel widening between the aperture and the midportion of the femoral tunnel regardless of plain radiograph (mean difference, 0.02 mm; P = .97), computed tomography (mean difference 0.08 mm; P = .55), and magnetic resonance imaging (mean difference, 0.13 mm; P = .78). Likewise, no significant difference in femoral tunnel widening was found between the aperture and the midportion, irrespective of transtibial (mean difference, 0.18 mm; P = .57), anteromedial (mean difference, 0.02 mm; P = .90), and outside-in techniques (mean difference, 0.01 mm; P = .98).

Conclusion:

No significant difference in femoral tunnel widening was found between the aperture and the midportion in the patients who underwent ACL reconstruction.
Magnetic resonance imaging-guided targeted biopsy in risk classification among patients on active surveillance
Authors: Xue Wenbin , Huang Yu , Li Tao , Tan Ping , Liu Liangren , Yang Lu , Wei Qiang
Published: June 2019

Background:

The aim of this study was to assess the sensitivity and accuracy of magnetic resonance imaging-guided targeted biopsy (MRI-TB) in patients undergoing active surveillance (AS) procedure.

Methods:

We searched databases to identify relevant studies which compared MRI-TB with systemic biopsy for diagnosing prostate cancer in patients on AS. Outcomes included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the curve (AUC) and publication bias of AS group, confirmatory biopsy group and follow-up biopsy group.

Results:

Fourteen articles involving 1693 patients were included. In AS group, the sensitivity was 0.62 (95% confidence interval [CI], 0.57−0.68), specificity was 0.89 (95% CI, 0.87−0.90), NLR was 0.43 (0.31−0.60), PLR was 4.90 (3.50−6.86), DOR was 12.75 (7.22−22.51), and AUC was 0.8645. In confirmatory biopsy group, the sensitivity was 0.67 (0.59−0.74), specificity was 0.89 (0.86−0.91), NLR was 0.42 (0.27−0.65), PLR was 4.94 (3.88−6.30), DOR was 14.54 (9.60−22.02), and AUC was 0.8812. In follow-up biopsy group, the sensitivity was 0.35 (0.22−0.51), specificity was 0.88 (0.82−0.92), NLR was 0.76 (0.52−1.11), PLR was 3.06 (1.71−5.50), DOR was 4.41 (2.15−9.03), and AUC was 0.8367.

Conclusion:

MRI-TB has a moderate-to-high diagnostic accuracy for diagnosing and reclassifying patients on AS with high specificity and AUC value under the SROC curve.
The effect of neuromuscular reversal agent on postoperative pain after laparoscopic gastric cancer surgery
Authors: Oh Tak Kyu , Ji Eunjeong , Na Hyo-Seok
Published: June 2019

Use of sugammadex for neuromuscular block reversal is associated with fewer postoperative complications than neostigmine; however, the effects on postoperative pain outcomes are largely unknown. In this retrospective study, we investigated the relationship between neuromuscular reversal agents and postoperative pain-related outcomes following laparoscopic gastric cancer surgery.

We reviewed the electronic health records of patients who underwent laparoscopic gastric cancer surgery between January 2010 and June 2017. Patients were divided into a sugammadex group and a neostigmine group, according to the neuromuscular block reversal agent used. We compared the pain outcomes in the first 3 days postoperatively (POD 0–3), length of hospital stay, and postoperative complications (Clavien-Dindo grade ≥II).

During the study period, 3056 patients received sugammadex (n = 901) or neostigmine (n = 2155) for neuromuscular reversal. After propensity score matching, 1478 patients (739 in each group) were included in regression analysis. In linear regression analysis, intravenous morphine equivalent consumption (mg) during POD 0 to 3 was higher in the sugammadex group than in the neostigmine group [coefficient 103.41, 95% confidence interval (CI): 77.45–129.37; P <.001]. However, hospital stay was shorter (coefficient: −0.60, 95% CI −1.12 to −0.08; P = .025) and postoperative complication rate was lower (odds ratio: 0.20, 95% CI 0.07–0.58; P = .003) in the sugammadex group.

In this retrospective study, patients undergoing laparoscopic gastric cancer surgery who received sugammadex for neuromuscular block reversal exhibited greater postoperative analgesic requirements than those who received neostigmine but had a shorter hospital stay and a lower postoperative complication rate. A randomized and blinded study should be conducted in the future to confirm the findings of the present study.
Delayed endoscopic removal of sharp foreign body in the esophagus increased clinical complications
Authors: Yuan Jingjing , Ma Mengjie , Guo Yang , He Bili , Cai Zhenzhai , Ye Bin , Xu Lei , Liu Jiang , Ding Jin , Zheng Zhongfa , Duan Jianhua , Wang Liangjing
Published: June 2019

Foreign bodies impaction in the esophagus is a common clinical emergency. The aim of this study was to investigate the clinical features of foreign body ingestion, and to analyze the risk factors of complications during the endoscopic procedure.

From 18 general hospitals in Zhejiang Province in China, 595 patients who underwent gastroscopic removal of ingested foreign bodies were prospectively recruited. Patient characteristics, clinical features, foreign body features, clinical outcomes, and complications were documented.

The most common types of foreign body in the esophagus were sharp objects (75.9%), including fish bones (34.0%), chicken bones (22.1%), and fruit nuclei (17.1%). The remaining types were non-sharp objects (24.1%), including food bolus (14.6%). Most objects were lodged in the proximal esophagus (75.9%). Foreign body-related complications occurred in 63 patients (10.5%), including hemorrhage (5.0%), perforation and infection (5.5%). The complication rate was increased by 4.04- and 8.48- fold when endoscopic retrieval was performed after impacted for over 24 and 48 hours, respectively, after impaction, as compared with within 12 hours. Logistic regression analysis revealed that the patients with sharp objects developed more complications than those with non-sharp ones (odds ratio, 2.85; 95% confidence interval, 1.08–7.50; P = .034). However, complications were unrelated with the location in the esophagus or length of foreign bodies (P > .05).

Sharp objects were the most frequently ingested foreign bodies in the esophagus in China. The prevalence of complications was increased in the patients with long foreign body retention time (>24 hours) and sharp objects. Sharp foreign bodies in the esophagus are recommended to be removed within 24 hours.
Fecal microbiota transplantation to treat Parkinson's disease with constipation
Authors: Huang Hongli , Xu Haoming , Luo Qingling , He Jie , Li Mengyan , Chen Huiting , Tang Wenjuan , Nie Yuqiang , Zhou Yongjian
Published: June 2019

Rationale:

Fecal microbiota transplantation (FMT) is recognized as an emerging treatment through reconstruction of gut microbiota. Parkinson's disease is a neurodegenerative disorder, which is accompanied by constipation. Here we first reported a patient with Parkinson's disease and constipation that were obviously relieved after FMT.

Patient concerns:

A 71-year-old male patient presented with 7 years of resting tremor, bradykinesia (first inflicted the upper limbs and subsequently spread to lower limbs), and intractable constipation (defecation needing more than 30 minutes).

Diagnoses:

Parkinson's disease for 7 years; constipation >3 years.

Interventions:

The patient had used madopar, pramipexole, and amantadine for anti-Parkinson and showed partially mitigation while laxative therapy for constipation failed. Finally FMT was performed.

Outcomes:

The patient successfully defecated within 5 minutes and maintained daily unobstructed defecation until the end of follow-up. The patient's tremor in legs almost disappeared at 1 week after FMT but recurred in the right lower extremity at 2 months after FMT.

Lessons:

Gut microbiota reconstruction may have therapeutic effects for Parkinson's disease patients, especially those who have gastrointestinal symptoms and limited treatment choices.
Placenta membranacea: an anormaly of the placenta
Authors: Tang Lu , Xu Liangzhi , Hu Ying , Zhang Li , Wei Qiang , Wu Lin
Published: June 2019

Rationale:

The placenta membranacea (PM) is a rare type of placental abnormality, which is associated with placenta previa, antepartum hemorrhage (APH), postpartum hemorrhage (PPH), chorioamnionitis, fetal growth restriction (FGR), preterm birth even stillbirth. The purpose of this case report is to summarize the characteristics and analyze the relevant factors of PM.

Patients concerns:

Repetitive B-ultrasound of the first patient demonstrated a thin placenta covering the most part of uterine wall, which completely covers the internal cervical ostium for 22 weeks. B-ultrasound of the second patient showed placenta partially covering the internal cervical ostium and fetus small for gestation age for 23 days. The third patient complained of abdominal pain and vaginal discharge for 1 day.

Diagnoses:

Diagnosis of PM is based on Doppler ultrasound apparatus, and confirmed by pathology.

Interventions and Outcomes:

In the first patient, elective cesarean section was performed. The second patient required termination of pregnancy due to poor postnatal outcome. The third patient underwent intrauterine fetal death. Of these 3 cases, one delivered a term fetus by cesarean section complicated with placenta previa and placenta accreta, one terminated the pregnancy because of serious fetal growth retardation, and the other underwent intrauterine fetal death.

Lessons:

High-resolution color Doppler ultrasound apparatus can improve the diagnostic accuracy, and close antenatal surveillance followed by proper arrangement of delivery may improve neonatal outcomes.
Investigation of candidate genes of non-syndromic cleft lip with or without cleft palate, using both case–control and family-based association studies
Authors: Ge Xing , Hong Jia-Wei , Shen Jun-Yu , Li Zheng , Zhang Rui , Wang Qi , Ding Zhen , Chen Gang , Xu Li-Chun
Published: June 2019

Objective:

Non-syndromic cleft of the lip and/or palate (NSCL/P) is one of the most common polygenic diseases. In this study, both case–control and family-based association study were used to confirm whether the Single Nucleotide Polymorphisms (SNPs) were associated with NSCL/P.

Methods:

A total of 37 nuclear families and 189 controls were recruited, whose blood DNA was extracted and subjected to genotyping of SNPs of 27 candidate genes by polymerase chain reaction-improved multiple ligase detection reaction technology (PCR-iMLDR). Case–control statistical analysis was performed using the SPSS 19.0. Haplotype Relative Risk (HRR), transmission disequilibrium test (TDT), and Family-Based Association Test (FBAT) were used to test for over-transmission of the target alleles in case-parent trios. The gene–gene interactions on NSCL/P were analyzed by Unphased-3.1.4.

Results:

In case–control statistical analysis, only C14orf49 chr14_95932477 had statistically significant on genotype model (P = .03) and allele model (P = .03). Seven SNPs had statistically significant on TDT. None of 26 alleles has association with NSCL/P on FBAT. Some SNPs had haplotype-haplotype interactions and genotype-genotype interactions.

Conclusion:

C14orf49 chr14_95932477 was significantly different between cases and controls on genotype model and allele model by case–control design. Seven SNPs were significantly different on HRR. Four SNPs were significantly different on TDT.
Health education strategies targeting maternal and child health
Authors: Herval Álex Moreira , Oliveira Danielle Peruzzo Dumont , Gomes Viviane Elisângela , Vargas Andrea Maria Duarte
Published: June 2019

Background:

Health education during pregnancy is important to improve maternal and children outcomes. However, the strategies must be specifically designed for each context and demographic characteristics. Our objective was identify health education strategies targeting pregnant women with the intention of improving results of pregnancy at an urban level.

Methods:

We conducted a scoping review of the literature to answer the question: “what health education strategies targeting pregnant women were reported by primary healthcare teams or the community promoting health in pregnancy, childbirth, postpartum and childhood?” Potential eligible studies were selected using PubMed, Web of Science, LILACS and SciELO by 2 reviewers.

Results:

From a total of 3105 articles, 23 were deemed eligible. We identified 9 educational methodologies focusing on different outcomes of pregnancy, birth or maternal wellbeing.

Conclusions:

It is important that health education strategies continue after childbirth, independent of the strategy. All the strategies presented in this review are suitable for transfer with a moderate chance of success of implementation or improvement of current education methodologies. Further research is required on health education, including a higher number of patients.
The incidence of spondyloarthritis in Slovenia
Authors: Hočevar Alojzija , Potočnik Pucelj Nataša , Ješe Rok , Pavič-Nikolič Milena , Tomšič Matija , Rotar Ziga
Published: June 2019

Epidemiological studies of spondyloarthritides (SpA) are rare and data for our country are lacking. We aimed to determine the incidence of SpA in a well-defined region in Slovenia.

We performed a retrospective chart review of adults diagnosed with SpA between January 2014 and December 2016 at an integrated secondary/tertiary medical center, which provides rheumatology services to almost a half of the adult national population, that is, 700,000 adults. Potential cases were ascertained by searching the electronic medical records for ICD-10 codes M02∗, M07∗, M13∗, M45∗, M 46.1, K50∗, K51∗, and L40∗. SpA cases were stratified as axial and peripheral SpA and then the annual incidence rates of SpA overall and both subsets were estimated.

During the 3-year period we identified 302 SpA cases (55.0% males, median [interquartile range] age 46.7 [35.0–57.5] years). 98 (32.5%) of them had predominantly axial SpA and the remainder peripheral SpA. The estimated annual incidence rate per 100,000 adults in our region was 14.3 (95% confidence interval [CI] 12.8–16.0) for SpA overall, 4.6 (95% CI 3.8–5.6) for axial SpA, and 9.6 (95% CI 8.4–11.1) for peripheral SpA.

The estimated annual incidence rate of 14.3 cases per 100,000 adults in SpA overall was comparable to that of rheumatoid arthritis in our population. The peripheral SpA was twice as common as axial SpA.
Hypothalamic sydrome as an initial presentation of Wernicke encephalopathy
Authors: Zhu Sha , Qiang Jun , Xia Qing , Wang Yanshu , Zhang Jun , Liu Xianzeng
Published: June 2019

Rationale:

Wernicke encephalopathy (WE) is a syndrome characterized by an acute or subacute onset of ataxia, ophthalmoplegia, and mental status changes. To our knowledge, hypothalamic syndrome is rare in WE.

Patient concerns:

A 73-year-old female patient with acute cerebral infarct, who showed initial symptoms of vomiting, nausea, ataxia, and subsequent anorexia, was treated with parenteral nutritional supplement for 20 days. Nevertheless, the patient still developed refractory hyponatremia despite the appropriate sodium supplement given for a week following parenteral nutritional supplement. In fact, after 14 days of parenteral nutritional supplement, the patient gradually showed hypotension and apathy. Hyponatremia, hypotension, anorexia and apathy were signs of hypothalamic syndrome.

Diagnoses:

Finally, the patient was diagnosed as WE by head magnetic resonance imaging, which showed symmetrical lesions in T2-weighted imaging images and FLAIR high signal intensity in the periaqueduct, hypothalamus, thalamus, mammiliary bodies, medulla oblongata, and vermis cerebelli.

Interventions:

The patient was given thiamine supplementation.

Outcomes:

The patient regained consciousness within 3 days. The sings of hyponatremia, hypotension, and apathy were relieved subsequently.

Lessons:

When patients develop unexplained hypothalamic syndrome, we should think of the possibility of WE. The concomitant presence of hyponatremia, hypotension, anorexia, and apathy in WE is rare. Therefore, this case is reported here for discussion.
Net clinical benefit analysis of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and chronic kidney disease
Authors: Shen Nan-Nan , Zhang Xue-Min , Le Ke-Jia , Wei An-Hua , Wu Yue , Gu Zhi-Chun
Published: June 2019

Background:

Atrial fibrillation (AF) is increasingly prevalent in chronic kidney disease (CKD) patients. The efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) in AF and CKD patients remains unknown. This systematic review and meta-analysis will mainly assess net clinical benefit (NCB) property of NOACs versus warfarin in patients with AF and CKD by a pooled-analysis.

Methods:

We will search Medline, Embase, Cochrane Library, and Clinical Trials.gov Website comprehensively for eligible randomized controlled trials that report the efficacy and safety outcomes according to renal function of NOACs. Relative risks and their 95% confidence intervals will be calculated using fixed- and random-effects models. Subgroup, sensitivity, and regression analyses will be performed to evaluate intertrial heterogeneity and bias of the results. NCB that balance stroke/systemic embolism (SSE) and major bleeding will be calculated using Singer's method.

Results:

This systemic review and meta-analysis will evaluate the NCB of NOACs versus warfarin via SSE, major bleeding and all-cause death in patients with CKD.

Conclusions:

This study will provide new evidence for clinical profile of NOACs on SSE, major bleeding, all-cause death, and NCB in CKD patients.

PROSPERO registration number:

CRD42019116940.
Efficacy of Houttuynia eye drops for the treatment of vernal keratoconjunctivitis
Authors: Yu Lingyan , Chen Xueying , Yu Zhenwei
Published: June 2019

Background:

Vernal keratoconjunctivitis (VKC) is a common eye disease and can result in permanent decrease or loss of vision. Houttuynia eye drops (HED) is used for the treatment of VKC. However, the clinical evidence of HED has not been well concluded. Herein, we described a proposed systemic review and meta-analysis to evaluate the clinical efficacy of HED for the treatment of VKC.

Methods:

Six electronic databases (Medline, Embase, the Cochrane database, Chinese National Knowledge Infrastructure, Wanfang database, and Chinese Biology and Medicine database) will be searched for randomized controlled trials (RCTs) which evaluating the clinical efficacy of HED for the treatment of VKC. Studies meet the eligibility criteria will be included. Data of the included studies will be extracted and the quality will also be evaluated. Data synthesis will be performed using RevMan software. Sensitivity analysis and publication bias will also be investigated.

Results:

This study will provide high-quality systemic review and synthesis of RCTs on efficacy of HED for the treatment of VKC.

Conclusion:

This systemic review and meta-analysis will conclude the efficacy of HED for the treatment of VKC.

Registration:

PROSPERO CRD42019124737
Concomitant pulmonary sarcoidosis and HIV infection
Authors: Yang Yan , Cheng Yusheng , Wang Chenghui
Published: June 2019

Rationale:

Sarcoidosis is an immune-mediated systemic disease, and the increase in CD4+ T lymphocyte cells is considered as a key factor for the development of sarcoidosis. The acquired immune deficiency syndrome (AIDS) is well known as the impaired immune system and characterized by relative lack of CD4+ T lymphocytes. Thus, the coexistence of sarcoidosis and HIV infection has rarely been reported.

Patient concerns:

A 65-year-old female patient was admitted to our respiratory ward complained of fatigue, chest distress, and a persistent dry cough for 2 months.

Diagnoses:

The chest computed tomography scan showed diffuse reticulonodular infiltrates and mediastinal and hilar lymphadenopathy. Fibreoptic bronchoscopy along with transbronchial biopsy and transbronchial needle aspiration was performed. The pathological findings revealed noncaseating granulomas, and the patient was found to be HIV-seropositive through enzyme-linked immunosorbent assay and confirmed as HIV by the centers for disease control and prevention.

Interventions:

The patient was administered oral methylprednisolone 20 mg/day for pulmonary sarcoidosis and then referred to the hospital for infectious diseases receiving subsequent treatment for HIV.

Outcomes:

clinical symptoms relieved 3 months later after treatment.

Lessons:

The coexistence of sarcoidosis and HIV infection is rare because of paradoxical roles of CD4-positive T cells in the pathogenesis of AIDS and sarcoidosis.
The effects of diffusion and perfusion MRI mismatch on the admission blood glucose and blood pressure values measured in the first 12 hours of acute stroke
Authors: Gür-Özmen Selen , Güngör–Tunçer Özlem , Krespi Yakup
Published: June 2019

Patients with severe stroke and salvageable brain tissue at admission, who have higher glycaemic and blood pressure levels, may have a risk of iatrogenic hypoglycemia/iatrogenic hypotension. In this study, we examined the relationship between the presence of diffusion-weighted imaging (DWI)/perfusion-weighted imaging (PWI) mismatch, admission blood glucose level, and admission blood pressure level in patients who were admitted in the first 12 hours after onset. We studied 212 patients who were prospectively and consecutively registered to the stroke unit from 2006 to 2009. Correlations between mismatch and admission blood pressure level (ABPL) and admission blood glucose level (ABGL) were analyzed using multivariate logistic regression. Mismatch (P = .064, adjusted OR = 2.297, 95% CI, 0.953–5.536) was not associated with a high ABGL in the whole group. However, after excluding patients with diabetes mellitus (DM) (n = 67, 35%), mismatch (P = .033, adjusted OR = 3.801, 95% CI, 1.110–13.015), an impaired level of consciousness, use of anti-DM medication, glycated hemoglobin levels, and cardioembolic aetiology were independent predictors of a high ABGL. The presence of mismatch or proximal vessel occlusion was not associated with ABPL. Female sex (P = .048) and total anterior circulation stroke (P = .008) were independent predictors associated with a higher ABPL. We conclude that patients with hyperacute ischemic stroke with PWI/DWI mismatch are more likely to have hyperglycemia.
Intervention for burnout among English education undergraduates: implications for curriculum innovation
Authors: Igbokwe Uche Lebechi , Nwokenna Edith Nwakaego , Eseadi Chiedu , Ogbonna Chimaobi Samuel , Nnadi Ekwutosi Monica , Ololo Kennedy Okechukwu , Enyoghasim Oguwuike Michael , Otu Otu Akanu , Uma Kalu Ebi , Onuora Theresa Ngozi , Onwube Onyebuchi , Ogbuagu Anuli Regina
Published: June 2019

Background/Objective:

The present study investigated the effect of Rational Emotive Behavior Therapy (REBT) intervention on burnout among English education undergraduates in southeastern Nigeria.

Method:

The study adopted a randomized controlled trial design. A total of 96 English education undergraduates with high burnout symptoms in the participating universities took part in the study. These were randomly assigned to groups – intervention group (n = 48) and control group (n = 48). The Oldenburg Burnout Inventory for students (OLBI-S) was used for data collection. The collected data were analyzed using 2-way mixed repeated measure ANOVA at .05 probability level.

Result:

Results showed that the REBT program significantly reduced the burnout level among English education undergraduates in the intervention group compared to the students in the no-intervention control group as measured by the OLBI-S subscales. Also, the students who benefited from the REBT program maintained reduced burnout levels when the researchers conducted a follow-up.

Conclusion:

Given the present finding, the REBT program is an effective intervention for preventing and managing burnout among students. The present study has important curriculum innovation implications as far as English education is concerned especially in the Nigerian context. This intervention program can be included in the students’ curriculum activities so as to equip the students with necessary therapeutic skills to manage burnout symptoms presently and in the future.
Radiofrequency neurotomy in chronic lumbar and sacroiliac joint pain
Authors: Chen Chia-Hsien , Weng Pei-Wei , Wu Lien-Chen , Chiang Yueh-Feng , Chiang Chang-Jung
Published: June 2019

Background:

Effective treatment of low back pain (LBP) originating in the lumbar and sacroiliac joints is difficult to achieve. The objective of the current study was to compare the clinical effectiveness of radiofrequency (RF) neurotomy versus conservative nonsurgical approaches for the management of chronic lumbar and sacroiliac joint pain.

Methods:

The PICOS framework was adhered to (P [population]: patients with a history of chronic function-limiting lumbar and sacroiliac joint pain lasting at least 6 months; I [intervention]: RF neurotomy; C [comparator]: other nonsurgical treatments; O [outcomes]: the Oswestry Disability Index (ODI), measurement for pain, and a quality of life (QoL) questionnaire; S [study design]: meta-analysis). Two trained investigators systematically searched Medline, Cochrane, EMBASE, and ISI Web of Knowledge databases for relevant studies published in English through March 2019.

Results:

Patients treated with RF neurotomy (n = 528) had significantly greater improvement in ODI scores, pain scores and QoL measured by EQ-5D compared with controls (n = 457); however, significant heterogeneity was observed when data were pooled from eligible studies. In subgroup analyses, patients who received RF neurotomy had a significantly greater improvement in ODI scores compared with those with sham treatment. Patients treated with RF achieved significantly greater improvement in pain scores compared with controls who received sham treatment or medical treatment. In a subgroup analysis of pain in the sacroiliac joint and in lumbar facet joints, the RF neurotomy group achieved a significantly greater improvement in ODI score and pain scores compared with the control group. The ODI score and pain score were improved after 2 months of follow up in the analyses stratified by follow-up duration.

Conclusions:

Use of RF neurotomy as an intervention for chronic lumbar and sacroiliac joint pain led to improved function; however, larger, more directly comparable studies are needed to confirm this study's findings.
Comparison of urinary TIMP-2 and IGFBP7 cut-offs to predict acute kidney injury in critically ill patients
Authors: Zhang Dongquan , Yuan Yuan , Guo Longfei , Wang Quanhong
Published: June 2019

Background:

Tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are recently identified urinary biomarkers of acute kidney injury (AKI) in critically ill patients. Because their predictive accuracies vary widely, a meta-analysis was performed to evaluate the accuracy of previously reported urinary TIMP-2 and IGFBP7 cut-offs for predicting AKI.

Methods:

This meta-analysis was reported following the guideline of PRISMA. Four databases, PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase, were systematically searched from inception to June 2018 by 2 investigators, who independently selected studies, extracted relevant data, and evaluated study quality. A bivariate model was used to calculate the pooled estimates.

Results:

The search identified 5 studies with 1619 critically ill patients. Urinary TIMP-2 and IGFBP7 cut-off points of 0.3 (ng/ml)2/1000 had a sensitivity of 0.89 [95% confidence interval (CI) 0.85–0.93], a specificity of 0.48 (95% CI 0.45–0.51) and a diagnostic odds ratio (DOR) of 8.33 (95% CI 5.55–12.52). The area under the curve (AUC) estimated by the summary receiver operating characteristic (SROC) curve was 0.748. Based on 891 critically ill patients from 4 studies, urinary TIMP-2 and IGFBP7 cut-off points of 2.0 (ng/ml)2/1000 had a sensitivity of 0.45 (95% CI 0.37–0.53), a specificity of 0.93 (95% CI 0.91–0.95) and a DOR of 11.43 (95% CI 7.43–17.57). The AUC estimated by SROC was 0.844.

Conclusion:

Cut-off values around 0.3 (ng/ml)2/1000 (high sensitivity) and 2.0 (ng/ml)2/1000 (high specificity) could be accurate surrogate biomarkers predicting AKI in critically ill patients. The urinary TIMP-2 and IGFBP7 cut-off point of 2.0 (ng/mL)2/1000 appears to have the highest overall accuracy.

Trial registration:

PROSPERO registration number 2018: CRD42018084457 Registered on 11 February 2018.
Difficulties in tracheal extubation due to phrenic nerve injury during massive mediastinal tumor resection
Authors: Wang Kui-Rong , Liu Fan-Fan , Zhou Yan-Feng
Published: June 2019

Rationale:

Massive mediastinal tumors present a major challenge for surgery and anesthesia management due to possible perioperative circulation and respiratory dysfunction.

Patient concerns:

A 36-year-old female underwent difficulty with tracheal extubation and required mechanical ventilation for 3 months after resection of a massive mediastinal tumor.

Diagnoses:

Postoperative B-ultrasound examination of diaphragmatic motor weakness and electrophysiological examination indicated respiratory failure due to phrenic nerve injury.

Interventions:

The patient failed tracheal extubation several times after the operation and finally a tracheotomy was performed. Mechanical ventilation, anti-infective treatment, and systemic supportive treatment were provided.

Outcomes:

The patient recovered well after tracheotomy and approximately 3 months of ventilation support.

Lessons:

Weaning difficulty caused by phrenic nerve injury seriously affected patient postoperative rehabilitation. To reduce the occurrence of similar problems, intraoperative phrenic nerve electrophysiological monitoring should be conducted.
Efficacy of amlodipine besylate and Valsartan for the treatment of mild to moderate hypertension
Authors: Wang Xiao-ou , Tian Wen
Published: June 2019

Background:

Clinical researchers found that Amlodipine besylate and Valsartan (ABVS) can effectively treat mild to moderate hypertension (MMH). However, no study has systematically investigated its efficacy and safety for patients with MMH. Thus, present study will systematically assess the efficacy and safety of ABVS for patients with MMH.

Methods:

MEDICINE, Cochrane Library, EMBASE, Ovid, PsycINFO, Web of Science, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure will be searched for literatures related to the topic from inception to the present without language limitations. All randomized controlled trials that assess the efficacy and safety of ABVS for patients with MMH will be considered for inclusion. Two researchers will independently select study, extract data, and assess risk of bias for all eligible studies.

Results:

The primary outcome includes the change of seated diastolic blood pressure. The secondary outcomes consist of the change of seated systolic blood pressure, health-related quality of life, and the tolerability.

Conclusions:

The results of this study will summarize the latest evidence on ABVS for the treatment of MMH.

Ethics and dissemination:

This study does not need ethical approval, because it will not use individual data. The results of this study are expected to be published at peer-reviewed journals.

PROSPERO registration number:

PROSPERO CRD42019133123.
Acupuncture for lumbar myofascial pain Protocol for a systematic review of randomized controlled trials
Authors: Chen Yupei , Li Xiaohong , Xu Jing , Chen Jie , Huo Zejun , Zhang Li
Published: June 2019

Background:

Lumbar myofascial pain is a major contributor to chronic low back pain. Acupuncture has been applied as an effective treatment for chronic low back pain worldwide. However, few critical systematic reviews focus on the effect of acupuncture on chronic low back pain caused by lumbar myofascial pain have been published. The study aims to evaluate the current evidence on the efficacy of acupuncture for chronic low back pain caused by lumbar myofascial pain.

Methods:

A total of 7 databases will be searched from their inception to March 2019, including PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure database, the Chinese Biomedical database, and the Wanfang database. Randomized controlled trials (RCTs) that compared the effect of acupuncture for lumbar myofascial pain will be included. The primary outcomes will be reduction of lumbar myofascial pain assessed by Visual Analog Scale (VAS). Secondary outcomes are questionnaires to evaluate the effects of treatment on patients’ daily life activities and psychological status; and adverse events. The primary and secondary outcomes will be assessed before (0 day) treatment and at 0, 7, 30, and 90 days after treatment. Data synthesis will be computed by RevManV.5.3.5 software when a data-analysis is allowed. Methodological quality will be evaluated with the risk of bias according to Cochrane Handbook.

Results:

The results of this study will be published in a peer-reviewed journal.

Conclusion:

The study will provide evidence to illustrate acupuncture is an effective therapeutic intervention for chronic low back pain caused by lumbar myofascial pain.

Trial registration number:

PROSPERO CRD42019129735
Infracardiac total anomalous pulmonary venous return in a patient with Williams syndrome
Authors: Zou Yanqiang , Wu Jie , Wang Guohua , Zhou Cheng , Dong Nianguo
Published: June 2019

Rationale:

Total anomalous pulmonary venous return (TAPVR) is a rare condition, accounting for 1% of all congenital heart diseases, and an atypical cardiovascular abnormality in Williams syndrome (WS). Here, we report a rare case of WS combined with infracardiac TAPVR.

Patient concerns:

A female newborn presented shortness of breath and purpura after crying at the age of 10 days.

Diagnosis:

Based on clinical symptoms and laboratory and echocardiographic findings, the patient was diagnosed with infracardiac TAPVR.

Interventions:

We performed infracardiac total anomalous pulmonary venous connection repair surgery.

Outcomes:

The operation was successful and the patient was discharged from the hospital uneventfully after 2 months of treatment. However, we diagnosed the patient with WS in addition to infracardiac TAPVR 6 months postoperatively.

Lessons:

This case demonstrates that patients with WS can have associated infracardiac TAPVR. The postoperative growth patterns and changes in the diameters of the aorta and pulmonary arteries were related closely to our early diagnosis of TAPVR associated with WS.
High Quality of Care Persists With Shifting Depression Services From VA Specialty to Integrated Primary Care
Authors: Leung Lucinda B. , Escarce José J. , Yoon Jean , Sugar Catherine A. , Wells Kenneth B. , Young Alexander S. , Rubenstein Lisa V.
Published: June 2019

Background/Objective:

Offering depression collaborative care services in primary care (PC) settings can reduce use of nonintegrated mental health care resources and improve mental health care access, particularly for vulnerable PC patients. Tests of effects on depression care quality, however, are needed. We examined overall quality of depression care and tested whether increasing clinic engagement in Veterans Affairs (VA)’s Primary Care-Mental Health Integration (PC-MHI) services was associated with differences in depression care quality over time.

Methods:

We conducted a retrospective longitudinal cohort study of 80,136 Veterans seen in 26 Southern California VA PC clinics (October 1, 2008–September 30, 2013). Using multilevel regression models adjusting for year, clinic, and patient characteristics, we predicted effects of clinic PC-MHI engagement (ie, percent of PC patients receiving PC-MHI services) on 3 VA-developed longitudinal electronic population-based depression quality measures among Veterans newly diagnosed with depression (n=12,533).

Results:

Clinic PC-MHI engagement rates were not associated with significant depression care quality differences. Across all clinics, average rates of follow-up within 84 or 180 days were, 66.4% and 74.5%, respectively. Receipt of minimally appropriate treatment was 80.5%. Treatment probabilities were significantly higher for vulnerable PC patients (homeless: 4.5%, P=0.03; serious mental illness: 15.2%, P<0.001), than for otherwise similar patients without these characteristics.

Conclusions/Policy Implications:

Study patients treated in PC clinics with greater PC-MHI engagement received similarly high quality depression care, and even higher quality for vulnerable patients. Findings support increasing use of PC-MHI models to the extent that they confer some advantage over existing services (eg, access, patient satisfaction) other than quality of care.