bluuebunny/crossref_metadata_2025 huggingface dataset:
Unique Features of Hospitalized Children with Alveolar Pneumonia Suggest Frequent Viral-Bacterial Coinfections
Authors: Gavrieli Hila , Dagan Ron , Givon-Lavi Noga , Ben-Shimol Shalom , Greenberg David
Published: March 2020

Background:

The World Health Organization Pneumonia Expert Group (WHO-PEG) defined a standardized radiologic endpoint for childhood community-acquired alveolar pneumonia (RD-CAAP), as the most likely to be pneumococcal, not ruling out other bacteria or coinfecting viruses. We aimed to determine the characteristics associated with hospitalization among children <5 years old presenting to the pediatric emergency room (PER) with RD-CAAP.

Methods:

This study was a part of an ongoing prospective population-based surveillance on hospital visits for RD-CAAP. RD-CAAP was determined according to the WHO-PEG. The study was conducted in the prepneumococcal conjugate vaccine era (2004–2008).

Results:

Of 24,432 episodes with chest radiographs, 3871)15.8%) were RD-CAAP: 2319 required hospitalization and 1552 were discharged (outpatients). Compared with outpatients, hospitalized children had lower temperature, peripheral white cell and absolute neutrophil counts and C reactive protein serum levels, but higher rates of hypoxemia, rhinorrhea, cough and respiratory virus detection. PER visits during the respiratory virus season presented a 1.83 times higher risk of hospitalization than visits during nonrespiratory season.

Conclusions:

Although RD-CAAP is most often a bacterial infection, the unique characteristics of those visiting the PER and subsequently hospitalized suggest a frequent involvement of respiratory viruses, potentially as viral-bacterial coinfections, compared with outpatients.
Association Between Depth of Neutropenia and Clinical Outcomes in Febrile Pediatric Cancer and/or Patients Undergoing Hematopoietic Stem-cell Transplantation
Authors: Alali Muayad , David Michael Z. , Danziger-Isakov Lara A. , Bartlett Allison H. , Petty Lindsay A. , Schwartz Tovah , Pisano Jennifer
Published: March 2020

Background:

Infectious Diseases Society of America guidelines defines febrile neutropenia (FN) patients as high risk, if they have an absolute neutrophil count (ANC) ≤100 cells/µL anticipated to last >7 days. However, data evaluating the clinical significance of the depth and duration of neutropenia are limited.

Methods:

We conducted a retrospective cohort study of pediatric oncology patients presenting with FN to examine whether the effects of the depth and duration of neutropenia prior to presentation were predictive of blood stream infection (BSI), invasive fungal disease (IFD), pediatric intensive care unit (PICU) admission or length of stay.

Results:

A total of 585 FN episodes (FNEs) were identified in 265 patients. ANC at the time of presentation was <100 in 411 (70%), 100–500 in 119 (20%), and >500 cells/μL with subsequent decline to <500 cells/μL in the next 48 hours in 55 (10%) of FNEs. In the group with ANC > 500 with subsequent decline in 48 hours, rates of IFD and BSI were higher when compared with ANC < 100 cells/μL [odds ratio (OR) = 5.9, 95% confidence interval (CI): 0.7–29.6] and (OR = 2.35, 95% CI: 01.02–5.4), and patients in this group were more likely to be admitted to the PICU (OR= 5.1, 95% CI: 1.134–19.46). No difference in outcomes was identified when the groups of ANC < 100 and ANC of 100–500 cells/μL were compared. Neutropenia >7 days prior to FNE was an independent risk factor for BSI (OR = 2.88, 95% CI: 1.55–5.35 and increased length of stay.

Conclusions:

Clinicians should not be reassured when patients present with FN and initial ANC >500 cells/mL after recent chemotherapy if continued decline is expected as patients in this group are at high risk of IFD, BSI and PICU admission.
Twice- and Thrice-daily Cephalexin Dosing for Staphylococcus aureus Infections in Children
Authors: Gwee Amanda , Autmizguine Julie , Curtis Nigel , Duffull Stephen B.
Published: March 2020

Background:

Cephalexin is used for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections in children. Although 4 times daily dosing is recommended, less frequent dosing regimens are often prescribed to improve treatment acceptability and adherence. We developed a population pharmacokinetic model of cephalexin in children to determine a twice-daily (BID) and thrice-daily (TID) cephalexin dosing regimen for MSSA infections.

Methods:

A population pharmacokinetic model was developed using a nonlinear mixed effects modeling approach. The dataset used was from a prospective open-label pharmacokinetic study of orally administered cephalexin in 12 children 1–16 years of age with bone and joint infections. Simulations were performed to determine a BID and TID dosing regimen so that ≥90% of children in this age group would achieve the pharmacodynamic target for MSSA (ie, time that the free drug concentration exceeds the minimum inhibitory concentration of the bacteria for at least 40% of the dosing interval).

Results:

The final model was 1 compartment with a transit compartment model to account for delay in oral absorption. For BID dosing, doses of 22–45 and 80 mg/kg were required for MSSA with minimum inhibitory concentrations of 1–2 and 4 mg/L, respectively. For TID dosing, the respective required doses were 15–25 and 45 mg/kg.

Conclusions:

Our study proposes a BID and TID cephalexin dosing regimen that can be prospectively evaluated. Through reducing the dose frequency of this widely prescribed antibiotic, we can reduce the medication burden for children and improve treatment compliance for MSSA infections.
Coronavirus Infections in Children Including COVID-19
Authors: Zimmermann Petra , Curtis Nigel
Published: March 2020

Coronaviruses (CoVs) are a large family of enveloped, single-stranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The 2019 novel coronavirus (SARS-CoV-2) is currently causing a severe outbreak of disease (termed COVID-19) in China and multiple other countries, threatening to cause a global pandemic. In humans, CoVs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. SARS-CoV, MERS-CoV and SARS-CoV-2 seem to less commonly affect children and to cause fewer symptoms and less severe disease in this age group compared with adults, and are associated with much lower case-fatality rates. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. However, the importance of children in transmitting the virus remains uncertain. Children more often have gastrointestinal symptoms compared with adults. Most children with SARS-CoV present with fever, but this is not the case for the other novel CoVs. Many children affected by MERS-CoV are asymptomatic. The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them. In contrast, adults more often have a nosocomial exposure. In this review, we summarize epidemiologic, clinical and diagnostic findings, as well as treatment and prevention options for common circulating and novel CoVs infections in humans with a focus on infections in children.
Safety and efficacy of custom foldable silicone artificial iris implantation: prospective compassionate-use case series
Authors: Bonnet Clémence , Miller Kevin M.
Published: March 2020

Purpose:

To assess the preliminary safety and efficacy of custom silicone artificial iris implantation.

Setting:

Stein Eye Institute.

Design:

Prospective consecutive case series.

Methods:

Medical records of patients implanted with the artificial iris were reviewed and followed for 1 year. Safety measures included corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell count (ECC), surgical complications, secondary interventions, and adverse events (AEs). Efficacy measures included CDVA with glare, subjective daytime and nighttime glare graded from 0 to 10 (very significant), and subjective cosmetic appearance graded from 0 to 10 (very satisfied).

Results:

Twenty eyes (19 patients) were implanted. Safety data were mixed. CDVA improved in 13 eyes and worsened in 6. ECC decreased from 1918 ± 870 to 1405 ± 705 cells/mm2 (P = .02). Eight eyes experienced postoperative complications. There were 4 IOP elevations, 2 corneal decompensations, 1 case of cystoid macular edema, and 1 device dislocation. Four eyes underwent secondary surgical interventions including 2 AEs (1 glaucoma surgery and 1 device dislocation). Efficacy outcomes were excellent. CDVA with glare improved from 1.5 ± 0.6 to 0.7 ± 0.8 logarithm of the minimum angle of resolution (P < .01). Mean subjective daytime glare decreased from 8.9 ± 1.8 to 2.7 ± 2.6 (P < .01) and nighttime glare decreased from 7.9 ± 1.8 to 2.5 ± 2.7 (P < .01). Mean cosmesis improved from 2.2 ± 1.6 to 8.8 ± 2.1 (P < .01).

Conclusions:

Custom artificial iris implantation was moderately risky but very effective at reducing light and glare sensitivity and in improving ocular cosmesis.
Stereoelectroencephalography and the Role of the Nurse
Authors: Masemer Debbie A. , Yu Hong , Konrad Peter E. , Englot Dario J.
Published: March 2020

BACKGROUND

Stereoelectroencephalography (SEEG) is an invasive diagnostic surgical procedure used to identify specific areas of seizure activity in the brain. SEEG has been shown in both adult and pediatric populations to be a safe and effective tool for preoperative decision making.

USES

This is used in patients with medically refractory epilepsy who are potential candidates for brain surgery to control seizures. It is preferred over other invasive diagnostic procedures because of lower risk, reduced discomfort, and shorter operating times.

OUTCOMES

It has a distinct role in obtaining meaningful data that leads to more precise surgical options. All of this results in better seizure control and improved quality of life for the patients.

CONCLUSION

Knowledge of the SEEG procedure, its benefits, complications, and the neuroscience nurse's role will improve care for surgical patients and improve outcomes.
Underwater Endoscopic Repair of Superior Canal Dehiscence
Authors: Creighton Francis , Barber Samuel R. , Ward Bryan K. , Sharon Jeffrey D. , Carey John P.
Published: March 2020

Superior canal dehiscence (SCD) is a bony defect of the superior semicircular canal (SCC). Patients with SCD Syndrome (SCDS) may experience symptoms such as aural fullness, pulsatile tinnitus, hyperacusis, autophony, or pressure or noise-induced vertigo (1–3). The defect can be repaired in various ways, but there is potential for loss of perilymphatic fluid during transmastoid approaches that could result in postoperative sensorineural hearing loss (4–11). We hypothesize that if the procedure were performed “underwater” in balanced salt solution (BSS), loss of perilymphatic fluid would be minimized.

Case Report:

A 55-year-old male presented with right-sided autophony, pulsatile tinnitus, and hyperacusis. Audiometric testing demonstrated a low-frequency airbone gap and a supranormal bone-conduction threshold at 4 kHz. Ocular VEMP responses were increased amplitude. Temporal bone imaging revealed a SCC dehiscence.

The patient was taken to the operating room for an underwater, endoscopic repair of the SCC using a transmastoid approach. A cortical mastoidectomy was performed using Landmarx image navigation. BSS filled the mastoid and a 0-degree endoscope with endoscrub was used to see the SCC underwater. The SCC was entered near the ampullated end with a bur. A stepwise plugging process included applying strips of wet and dried fascia and bone dust. The non-ampullated end was similarly plugged. BSS was suctioned, and under microscopic visualization, labyrinthotomies were capped with bone chips. The patient tolerated the procedure well and was discharged the next day. There was no sensorineural hearing loss postoperatively.

Conclusion:

SCDS may be addressed surgically using multiple approaches. An underwater endoscopic repair of the SCC may be safe and effective surgical treatment.

SDC video link: http://links.lww.com/MAO/A808.
Repair of a Temporal Bone Encephalocele With the Surgical Exoscope
Authors: Garneau Jonathan C. , Laitman Benjamin M. , Cosetti Maura K. , Hadjipanayis Constantinos , Wanna George B.
Published: March 2020

Objective:

We describe our experience using the extracorporeal video microscope, the “exoscope” for repair of a temporal bone encephalocele.

Method:

The patient is a 69-year-old male with a right temporal lobe encephalocele herniating through a tegmen defect. He underwent definitive tegmen defect repair and bipolar cauterization of the encephalocele. The authors elected for a combined transmastoid and transtemporal approach in order to isolate the tegmen defect and provide watertight repair. The SynaptiveTM robotic BrightMatter (Toronto, ON) drive video exoscope monitor system was used for the entirety of the case including both the transmastoid approach and transtemporal craniotomy.

Results:

No intraoperative complications were encountered during either the transmastoid (mastoidectomy) or transtemporal craniotomy. The authors were able to complete the entire case without abandonment of the exoscope in favor of the traditional binocular microscope. Advantages of this technology in clinical practice includes high-resolution three-dimensional visualization, increased degrees of freedom for exoscope adjustment, and reduced surgeon fatigue in a fixed, unnatural posture. Limitations include decreased depth perception and increased operative time.

Conclusion:

The exoscope system is a safe and effective alternative or adjunct to the existing binocular operating microscope for lateral skull based procedures. The exoscope provides the surgeon with a comfortable, high-resolution visualization without compromising surgical exposure and patient safety.

SDC video link: http://links.lww.com/MAO/A837.
Association Analysis of Candidate Gene Polymorphisms and Audiometric Measures of Noise-Induced Hearing Loss in Young Musicians
Authors: Bhatt Ishan Sunilkumar , Dias Raquel , Washnik Nilesh , Wang Jin , Guthrie O’neil , Skelton Michael , Lane Jeffery , Wilder Jason
Published: March 2020

Introduction:

This study aimed to investigate the association between candidate genetic variants and audiometric measures of noise-induced hearing loss (NIHL) in young musicians.

Methods:

The study analyzed a database by Phillips et al. (Feasibility of a bilateral 4000–6000 Hz notch as a phenotype for genetic association analysis. Int J Audiol 2015;54:645–52.) which included behavioral hearing thresholds, distortion-product otoacoustic emissions (DPOAE), tympanometric, and genetic data of 166 participants meeting the inclusion criteria. Nineteen single nucleotide polymorphisms (SNPs) in 13 cochlear genes previously associated with NIHL in factory workers were included in the present investigation. The average hearing threshold at 3000 and 4000 Hz (AHT) and average DPOAE signal to noise ratio (DPOAE SNR) in both ears were calculated.

Results:

The regression analyses showed that two SNPs— one in KCNE1 (rs2070358) and the other in CAT (rs12273124) revealed a statistically significant relationship with DPOAE SNR in both ears. Two SNPs in MYH14 and one in GJB4 revealed a significant association with DPOAE SNR in the left ear. Two SNPs in HSP70, one in CDH23 and one in KCNJ10 showed significant association with DPOAE SNR in the right ear. None of the included SNPs showed association with AHT in both ears.

Conclusions:

A genetic variant in KCNE1 was associated with the strength of the cochlear amplifier as assessed by DPOAE SNR. Musicians carrying causal genetic variants to NIHL might exhibit changes in their auditory functions early in the lifespan even when most subjects had their hearing thresholds within normal limits. These participants are likely to show the clinical manifestation of NIHL in the future if no preventive measures are applied.
Slim Perimodiolar Arrays Are as Effective as Slim Lateral Wall Arrays for Functional Hearing Preservation After Cochlear Implantation
Authors: Woodson Erika , Smeal Molly , Nelson Rebecca C. , Haberkamp Thomas , Sydlowski Sarah
Published: March 2020

Objective:

To compare functional hearing preservation (HP) with a slim perimodiolar array (SPA) and a slim lateral wall array (SLW) in cochlear implantation (CI).

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

All adult, post-lingual CI recipients with serviceable preoperative hearing serially implanted with SPA or SLW electrodes from July 2015 through July 2018.

Interventions:

Cochlear implantation.

Main Outcome Measures:

Hearing preservation (HP). Patients with a low frequency pure-tone average (LFPTA) (125, 250, 500 Hz) threshold less than 80 dB were considered HP candidates based on preoperative audiograms. Postoperative audiograms were obtained before activation. Successful HP was defined as retention of LFPTA less than 80 dB. The change in LFPTA (ΔLFPTA) was also calculated.

Results:

One hundred twenty one patients were implanted with either the SPA or SLW electrodes, 82 (42,40) of whom were HP candidates with postoperative audiograms. Average (standard deviation, SD) preoperative LFPTA was 54.86 [19.38] and 54.38 [13.58] dB for SLW and SPA respectively, with a mean ΔLFPTA of 24.6 [15.94] and 24.92 [16.66] dB. Successful HP was achieved in 21 (50%) and 22 (55%). Preoperative LFTPA, ΔLFPTA, and postoperative LFPTA were not significantly different (p = 0.89, 0.75, 0.93) between electrodes.

Conclusions:

The SPA is as effective at immediate functional HP after CI as a SLW.
An update on nutrient modulation in the management of disease-induced muscle wasting: evidence from human studies
Authors: Brook Matthew S. , Wilkinson Daniel J. , Atherton Philip J.
Published: March 2020

Purpose of review

Skeletal muscle has many essential roles in maintaining human health, not only being crucial for locomotion, but further as a metabolically important organ. Muscle wasting in disease (cachexia) is highly prevalent, associated with poor clinical outcomes and is not fully reversible with nutritional interventions. Understanding proteostasis in diseased states is of great importance to design novel, effective nutritional/nutraceutical strategies aimed at alleviating muscle wasting. In this review, we will provide an update on muscle kinetics in disease and the effects of nutritional interventions.

Recent findings

Whole body and skeletal muscle kinetics are commonly shown to be imbalanced in disease, promoting overall catabolism that underlies the development of cachexia. However, recent advancements in defining the effectiveness of nutritional interventions on muscle anabolism are clouded by heterogenous patient populations and a lack of direct incorporation stable isotope techniques. Current recommendations are focused on combating malnutrition, with increased protein intake (high in EAA) demonstrating promise.

Recent progress in understanding catabolic states in cachexia across disease is minimal. Further, studies investigating muscle-specific protein turnover along with nutritional interventions are scarce. As such, there is a significant requirement for strong RCT's investigating both acute and chronic nutritional interventions and their impact on skeletal muscle in individual disease states.
Metacarpal tuberculosis with Nocardia infection
Authors: Tang Ruohui , Yang Jing , Liu Huayu , Zhou Kai , Fei Jun
Published: March 2020

Introduction:

Isolated metacarpal tuberculosis is rare in orthopedic surgery. In the case of poor efficacy of traditional treatment methods, such as debridement surgery and anti-tuberculosis treatment, it is necessary to consider whether there is a special type of infection. We describe a case of metacarpal tuberculosis with Nocardia infection in a patient.

Patient concerns:

A 65-year-old male patient who suffered from pain and dysfunction lasted for 6 years.

Diagnoses:

Confirmation of the diagnosis was finally achieved by isolation of M tuberculosis and Nocardia actinomycetes from bone specimens.

Interventions:

The patient underwent debridement surgery, Masquelet technique was used during the operation, and oral antibiotics were combined after surgery.

Outcomes:

Bone graft surgery was performed 6 weeks after the first surgery. We followed up on bone healing at 1 and 3 months postoperatively.

Conclusion:

Tissue-specific necrosis usually occurs in particular types of infections such as tuberculosis, which limits the spread of antibiotics. Masquelet technique seems to bring new options to solve this problem. The performance of Nocardia infection is similar to that of tuberculosis infection, so it is difficult to identify clinically. Therefore, for cases where tuberculosis is suspected, and anti-tuberculosis treatment is ineffective, the possibility of Nocardia infection needs to be considered.
Combined effect of serum alanine aminotransferase and gamma-glutamyltransferase on incidence of diabetes mellitus
Authors: Choi Sung-Hyun , Kim Bom-Taeck , Shin Junghwa , Kim Kyu-Nam
Published: March 2020

High levels of serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) are associated with increased diabetes risk. In the present study, we investigated the combined effects of ALT and GGT on the development of diabetes in a Korean population. A total of 9405 individuals (4020 women and 5385 men) without diabetes were enrolled in this study. From the baseline health screening to the follow-up examination, the development of diabetes, based on changes in ALT and GGT quartile levels, was analyzed. In addition, we analyzed the quartiles of ALT and GGT together to determine any synergistic effect from the fourth quartile of ALT and GGT on the development of diabetes. The development of diabetes gradually increased with an increase in the circulating levels of ALT and GGT. For the fourth quartile ALT and GGT, the hazard ratios of diabetes compared with the first quartile were 1.892 (95% confidence interval [CI]: 1.26–2.83, P = .002) and 3.526 (95% CI: 2.12–5.85, P < .001) after adjusting for confounders, respectively. Hazard ratios of diabetes after combining both fourth quartiles of ALT and GGT were 3.663 (95% CI: 2.42–5.52, P < .001), as compared with the first and second quartiles. Serum ALT and GGT levels are well associated with diabetes in Koreans after adjusting for confounders, and a combination of ALT and GGT levels can have a synergy in predicting the development of diabetes.
Effectiveness of tumescent solution combined with negative pressure wound therapy in traditional high ligation and stripping of the great saphenous vein
Authors: Su Feng , Cheng Liu , Tong Qiao
Published: March 2020

Traditional high ligation and stripping (THLS) is a routine operation for varicose veins. However, THLS is accompanied with postoperative subcutaneous ecchymosis and pain. In this current study, we aimed to explore the effect of tumescence solution (TS) combined with negative pressure wound therapy (NPWT) on the relief of subcutaneous ecchymosis and pain after THLS of great saphenous vein.

A total of 180 patients receiving THLS were enrolled in group A, and 120 patients undergoing THLS and TS combined with NPWT were assigned into group B. The occurrences of subcutaneous ecchymosis and pain were recorded. Moreover, the total area of subcutaneous ecchymosis was estimated by the grid method. Visual analogue scale (VAS) score was used to assess the pain level of both groups.

Preoperative characteristics were not significantly different between 2 groups. Postoperative ecchymosis occurred in 112 cases (62.2%) of group A and 41 cases (34.2%) of group B. The area of ecchymosis in group A (66.6 ± 44.5) cm2 was larger than that in group B (25.2 ± 19.9) cm2. The number of patients without obvious pain in group A (57, 31.7%) was significantly less than that in group B (77, 64.2%) after operation. In addition, VAS score in group A (3.1 ± 2.6) was higher than that in group B (2.2 ± 1.9).

In conclusion, the application of TS combined with NPWT in THLS can not only alleviate subcutaneous ecchymosis and pain, but also prevent the occurrence of subcutaneous ecchymosis and pain after operation. Therefore, it is conducive to postoperative recovery and is suitable for clinical application.
Acupuncture attenuates postoperative inflammation in patients after craniotomy
Authors: Yang Seung-Bo , Cho Seung-Yeon , Kwon Seungwon , Jung Woo-Sang , Moon Sang-Kwan , Park Jung-Mi , Ko Chang-Nam , Shin Hee Sup , Lee Seung Hwan , Koh Jun Seok , Kim Ho , Park Seong-Uk
Published: March 2020

Background:

It is important to manage inflammation after craniotomy. It may be prudent to reduce the excessive usage of antibiotics and to add supplementary treatments like acupuncture, which would be effective and safe. However, there are only a few studies available to date on the effects of acupuncture on anti-inflammatory response after craniotomy. The aim of this study was to explore the anti-inflammatory effects of acupuncture in patients after a craniotomy.

Methods:

This study was a single-center, prospective, open-label, controlled trial. Forty-four subjects who underwent craniotomy for an unruptured aneurysm, facial spasm, or brain tumor were allocated to either an acupuncture group or a control group. Both groups received postoperative routine care in the Department of Neurosurgery. The subjects in the acupuncture group also received a total of 6 acupuncture treatments sessions within 8 days after craniotomy. Acupuncture treatments included acupuncture, electroacupuncture, and intradermal acupuncture. The serum interleukin (IL)-1β and IL-6, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and erythrocyte sedimentation rate levels were assessed four times within 7 days after surgery. The presence of fever, use of additional antibiotics, presence of infection including pneumonia or urinary tract infection, and safety were also reviewed.

Results:

The IL-1β levels of subjects who underwent aneurysmal clipping were significantly lower in the acupuncture group (P = .02). TNF-α levels of subjects who underwent aneurysmal clipping at the seventh postoperative day were also significantly lower in the acupuncture group (P = .03). Six cases of fever of unknown origin were observed in the control group, while none were seen in the acupuncture group, revealing that the incidence of fever was significantly lower in the acupuncture group (P = .02). No adverse events occurred during the trial.

Conclusion:

Acupuncture showed a possibility of alleviating inflammation by attenuating the levels of proinflammatory cytokines and significantly reduced the incidence of fever of unknown origin in patients after craniotomy. Acupuncture would be suitable as an adjunctive therapy to alleviate inflammation after craniotomy.
Clinical profile and treatment outcome of collision carcinoma in cervix
Authors: Shu Pei , Li Rui , Xie Dan , He Ying , Wang Xin , Li Qingli
Published: March 2020

A collision tumor is defined by co-existence of two adjacent tumors which are histologically distinct. Little is known about the clinical manifestation, treatment, and prognosis of cervical collision cancer. The objective of the study was to investigate the management and prognosis of patients with cervical collision cancer.

We retrospectively reviewed and enrolled patients with cervical collision carcinoma from 2010 to 2018 in two institutions (West China Hospital and West China Second University Hospital). The clinical presentation, pathology, treatment, and prognosis of patients with collision carcinoma of the uterine cervix were retrospectively reviewed. Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method.

A total of 24 patients were included in this study. The proportion of cervical collision carcinoma was 0.4% in the cervical carcinoma cohort (24/6015). The median age of the patients with cervical collision cancer was 42 years. The most common presenting symptom was cervical contactive bleeding. There were 23 patients classified as International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IIB. All patients except one received radical hysterectomy, in which 21 patients received bilateral salpingo-oophorectomy (BSO) and pelvic lymphadenectomy in addition. There were 16 patients who received adjuvant chemotherapy or chemoradiotherapy. The median follow-up time was 21 months. No patient death was observed. Recurrence only occurred in two patients. The 5-year OS rates and PFS rates were 100% and 91.7%, respectively.

This study revealed that cervical collision cancer was a type of rare cervical cancer with good prognosis. Cervical collision cancer responded well to the same treatment methods as the cervical squamous cell carcinoma and was associated with few recurrence and long survival.
Hepatitis C virus treatment response to ledipasvir/sofosbuvir among patients coinfected with HIV and HCV
Authors: Banga Jaspreet , Nizami Sobia , Slim Jihad , Nagarakanti Sandhya , Portilla Mario , Swaminathan Shobha
Published: March 2020

Treatment of hepatitis C virus (HCV) infection for patients with human immunodeficiency virus (HIV) has improved with direct acting antivirals. However, outcomes among Black persons treated with ledipasvir/sofosbuvir (LDV/SOF) may be inferior to non-Blacks. We assessed responses to LDV/SOF in a cohort of Black HIV/HCV coinfected persons.

Retrospective chart reviews were conducted for Black, genotype 1 (GT1), HIV/HCV coinfected patients treated with LDV/SOF at 3 hospitals in Newark, NJ between January 2014 and July 2016. Data collected included demographics, HCV treatment history, treatment duration, and response.

One hundred seventeen HIV/HCV coinfected Black patients started treatment with LDV/SOF but 5 had no follow-up data and 5 prematurely discontinued treatment (1 due to side effects). We included 107 HIV/HCV coinfected patients who completed LDV/SOF at all 3 sites. The study population was 65% male, median age 58 years, 26% had cirrhosis, and 78% had GT1a. Thirty-one percent were treatment experienced but none with prior NS5a treatment. At baseline, median CD4 count was 680 cells/mm3, HIV viral load (VL) was <40 copies/mL in 94% and median HCV VL was 2,257,403 IU/mL. Twenty-nine percent of patients changed antiretroviral treatment before LDV/SOF treatment due to drug interactions. Six, 89, and 12 patients completed 8, 12, and 24 weeks of LDV/SOF, respectively. Overall sustained virologic response rate was 93% with 7 relapses.

In this real-world cohort of Black, GT1, HIV/HCV coinfected patients, LDV/SOF had high sustained virologic response 12 weeks post completion of treatment rate of 93%. This data supports the overall high efficacy of LDV/SOF in a historically difficult-to-treat patient population.
Paroxysmal ventricular tachycardia as a rare complication of interventional closure of ventricular spetal defect and its treatment by radiofrequency catheter ablation
Authors: Cao Jing , Xu Qian , Liu Yanbo , Yi Jun , Shi Ruizheng
Published: March 2020

Introduction:

Trans-catheter closure of peri-membranous ventricular septal defects (VSDs) using Amplatzer-Type devices, has been widely reported in the past decade. We hereby report a rare complication of frequent premature ventricular contractions (PVCs) and paroxysmal ventricular tachycardia (PVT) sustained 48 days after the closure of VSD.More importantly, the arrhythmias were successfully treated with radiofrequency catheter ablation (RFCA) after medical therapy failed to restore and maintain sinus rhythm.

Patient concerns:

We reported an 8-year-old boy with frequent PVCs and PVT sustained 48 days after the closure of VSD. The boy has no palpitation, chest distress and other uncomfortable symptoms.

Diagnosis:

This patient was diagnosed as frequent PVCs and PVT by Holter monitoring for 24 hours.

Interventions:

RFCA was administered.

Outcomes:

The patient was discharged 48 hours with no complication and remained asymptomatic 12 months after the ablation.

Conclusion:

Radiofrequency ablation helps treat PVCs and PVT in children and has a higher efficacy in restoring and maintaining sinus rhythm.
Diagnosis of drowning using postmortem computed tomography combined with endoscopic autopsy
Authors: Wang Zhuoqun , Ma Kaijun , Zou Donghua , Liu Ningguo , Li Zhengdong , Shao Yu , Chen Yijiu
Published: March 2020

Rationale:

Postmortem forensic imaging technologies provide a noninvasive/minimally invasive approach for imaging of internal organ structures of the human body to detect injuries, diseases, and other morphologic changes. Currently, postmortem forensic imaging methods have been widely used in determination of the cause of death. However, these methods do not allow histologic examinations. Endoscopic autopsy emerged in the 1990s. Thoracoscopy and laparoscopy are mainly used to examine organs and tissues in the thoracic and abdominal cavity. Target tissues are also sampled for histologic examination. By combining postmortem forensic imaging with endoscopic autopsy, comprehensive examination of the corpse, organs, and sampling for histologic examination can be carried out.

Patient concerns:

A 34-year-old woman was witnessed jumping into the river, sinking after struggling in the water. The body was found 24 hours later and confirmed with no vital signs. No preexisting medical conditions were known.

Diagnosis, interventions, and outcomes:

Postmortem computed tomography, target coronary postmortem computed tomography angiography, and endoscopic autopsy were performed before conventional autopsy. Laparoscopic examination was used to examine the abdominal organs. The diaphragm and pericardium were cut open from the abdominal cavity to allow access to the examination of lungs and heart. Tissue samples were collected from various organs for histologic examination, and a diatom test was carried out on lung samples. Postmortem computed tomography revealed fluid in the paranasal sinuses, airways, stomach, and duodenum; emphysema aquosum; and mosaic pattern of the lung parenchyma. Endoscopic examination additionally detected Paltauf spots. The results were consistent with those of conventional autopsy. Histologic examination revealed pulmonary congestion, pulmonary edema, pulmonary emphysema, pulmonary hemorrhage, and congestion in multiple organs such as the liver, spleen, and kidneys. Diatoms were detected in lung tissues, which were identical in morphology to diatoms in water samples collected from the scene. The cause of death was determined as drowning.

Conclusion:

Combining forensic imaging and endoscopic autopsy for postmortem examination yields a more comprehensive and scientific finding, and the combination is minimally invasive and more acceptable to the family members. This method can be used as an alternative for conventional autopsy under specific circumstances.
Low-grade albuminuria is associated with hearing loss in non-diabetic US males
Authors: Wang Tang-Chuan , Chang Ta-Yuan , Salvi Richard , Juan Chun-Jung , Liu Yi-Wen , Chang Chia-Hao , Chiu Chien-Jen , Lin Chia-Der , Tsai Ming-Hsui
Published: March 2020

High levels of albuminuria have been demonstrated to associate with hearing loss in non-diabetic people, while the clinical impact of low-grade albuminuria has attracted less attention. This cross-sectional population-based study aimed to examine whether hearing loss in non-diabetic United States (US) adults is independently associated with low-grade albuminuria or reduced estimated glomeruli filtration rate (eGFR).

A total of 2518 participants aged 20 to 69 years were selected from the US National Health and Nutritional Examination Survey database. Participants with diabetes or high-grade albuminuria were excluded. Hearing loss was assessed using low-frequency pure-tone average (LFPTA) thresholds (0.5, 1.0, 2.0 kHz) and high-frequency pure-tone average (HFPTA) thresholds (3.0, 4.0, 6.0, 8.0 kHz). Logistic and linear regression analyses were used to evaluate associations between renal function indicators and hearing loss.

The median age of included participants was 37.4 years, and 55% of them were female. Multivariate analysis revealed that participants with urinary albumin-to-creatinine ratio (UACR) in the highest tertile had a significantly higher risk of hearing loss (OR, 1.79; 95% CI, 1.01–3.19) and higher HFPTA thresholds (β: 2.23; SE: 0.77). Participants with eGFR <60 mL/min/1.73 m2 had higher LFPTA thresholds (β: 4.31; SE: 1.79). After stratification by sex, a significant risk remained only for males in the highest UACR tertile, with 2.18 times the risk of hearing loss (95% CI, 1.06–4.48).

Non-diabetic US males with low-grade albuminuria are at increased risk of hearing loss, independent of eGFR.
Tuina for periarthritis of shoulder
Authors: Ai Jian , Dong Youkang , Tian Qidong , Wang Chunlin , Fang Min
Published: March 2020

Background:

Periarthritis of shoulder (PAS) symptom is one of the leading causes prompting many patients to seek treatment. Tuina is a common treatment for PAS in China. But at present, there is no systematic evaluation report on its therapeutic effectiveness and safety. This protocol aims to reveal the efficacy and safety of Tuina for treating PAS.

Methods:

The following databases will be searched by electronic methods: PubMed, EBASE, WHO International Clinical Trials Registry Platform, Embase, the Chinese Biomedical Literature Database (CBM), Wan-fang Data (WANFANG), the China National Knowledge Infrastructure (CNKI), and other sources from inception to December 2019. Bias risk, subgroup analysis, data synthesis, and meta-analyses will be assessed with RevMan V.5.3 software if the data is met inclusion conditions.

Results:

This study will present a quality evidence of Tuina for the treatment of PAS patients.

Conclusion:

The systematic review will present reliable evidence to judge whether or not Tuina is a safe and effective intervention for PAS patients.

PROSPERO registration number:

CRD42019147445.
Helicobacter pylori prevalence in the Southwest of China
Authors: Wang Rui , Bai Dan , Xiang Wen , Zhang Yu-Feng , Ba Kun-Yi , Chen Xin-Zu
Published: March 2020

Objectives:

This epidemiological research will be aimed to evaluate the longitudinal changes of Helicobacter pylori prevalence in Southwest China during recent period through a systematic review and analysis.

Methods:

The database PubMed and China National Knowledge Infrastructure will be searched. The cross-sectional studies or cohort studies on either massive or hospital-based health checkup population will be potentially eligible. The study population was originated from one of the southwestern major cities, Chengdu (Sichuan), Chongqing, Kunming (Yunnan), Guiyang (Guizhou), or Lhasa (Tibet). Two reviewers will independently select studies, extract data, and assess the quality of studies. The prevalence of H pylori infection will be estimated. In the individual city, the longitudinal comparisons will be conducted to evaluate the trends referring to the earliest cross-sectional baseline. The risk ratio and its 95% confidence interval will be estimated. Subgroup analyses will be performed in sex-specific and age-specific subsets. Trend analysis for proportions (p for trend) will be estimated in the longitudinal evaluation. If applicable, the longitudinal clearance rate (%) will be estimated.

Ethics and Dissemination:

The ethical approval is not required due to the nature of literature-based research. The results will be disseminated through meetings and a peer-reviewed journal.

PROSPERO Registration Number:

CRD42019120764
Chinese herbal medicine for premature ovarian insufficiency
Authors: Shao Yifeng , Zhou Huihao , Zhou Meng , Ying Pian , Yao Zhitao , Jiang Xuelu
Published: March 2020

Background:

Premature ovarian insufficiency (POI) is the loss of function of the ovaries before age 40. Chinese herbal medicine (CHM) has been treating POI for long time. Therefore, we conduct this study to assess the efficacy and safety of CHM for POI.

Methods:

Seven databases will be searched from inception to December 31, 2018: PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang Database, and Chongqing Chinese Scientific Journal Database (CQVIP). Randomized controlled trials that used CHM will be included. Two reviewers will independently complete the study selection, data extraction, and study quality assessment according to Cochrane Collaboration. All the data will be analyzed using Review Manage 5.3 software.

Results:

This study will generate a comprehensive summary on effectiveness and safety of CHM for POI.

Conclusion:

This study may be beneficial to health policymakers, clinicians, and patients with regard to the use of CHM in POI treatment.

Trial registration number:

PROSPERO CRD 42019144629.
Apatinib combined with chemotherapy or concurrent chemo-brachytherapy in patients with recurrent or advanced cervical cancer
Authors: Guo Qiufen , Sun Yawen , Kong Enqi , Rao Linli , Chen Jinlong , Wu Qian , Zhang Tingting , Liu Naifu , Li Mingjiang , Sun Li
Published: March 2020

Objective:

Apatinib mesylate is a novel vascular endothelial growth factor receptor 2 (VEGFR-2) inhibitor, which has exhibited good safety and efficacy in several types of solid tumors. The present study aimed to assess the clinical efficacy and safety of apatinib combined with chemotherapy and concurrent chemo-brachytherapy (CCBT) in patients with recurrent and advanced cervical cancer.

Methods:

A total of 52 patients with first diagnosed recurrent or untreated International Federation of Gynecology and Obstetrics stage IVB cervical cancer admitted at Shandong Cancer Hospital and Institute between July 2016 and May 2018 were analyzed in the current randomized controlled trial. The patients were randomly divided into 2 groups: the apatinib-treated group and the control group. Patients with recurrent cervical cancer in the apatinib-treated group were administered apatinib and carboplatin-paclitaxel as first-line chemotherapy. Patients with advanced cervical cancer were administered apatinib in combination with CCBT. In control group, patients with recurrent cervical cancer were treated with chemotherapy alone while patients with advanced cervical cancer received CCBT.

Results:

The progression-free survival was significantly prolonged in apatinib group compared with control group (10.1 months; 95% confidence interval (CI), 8.42–11.79 vs 6.4 months; 95% CI, 3.88–8.92; P < .01; hazard ratio (HR), 0.44; 95% CI, 0.25–0.78; P < .01). The objective response rate in apatinib group was obviously higher than that in control group (64.3% vs 33.3%, P < .05). Proteinuria, hand–foot syndrome, mucositis, and hypertension in all Grades were statistically more common in apatinib group than in control group. Apatinib did not obviously aggravate other radiotherapy or chemotherapy side effects.

Conclusion:

Apatinib exhibited promising clinical efficacy in cervical cancer patients, resulting in an improved response rate and prolonged progression-free survival compared with the control group, and had manageable side effects. Our study revealed that apatinib combination therapy, adenocarcinoma, and bone metastasis
Radical nephrectomy combined with removal of tumor thrombus from inferior vena cava under real-time monitoring with transesophageal echocardiography
Authors: Wang Yaozhu , Wang Xu , Chang Yuan
Published: March 2020

Rationale:

Renal carcinoma is a common malignant tumor of the urinary system, 4%–10% of which are complicated with tumor thrombi in the renal vein and the inferior vena cava; in about 1% of patients, the inferior vena cava tumor thrombus invades the right atrium. Surgery is the treatment of choice. Real-time monitoring with transesophageal echocardiography (TEE) has been widely used in various operations, including cardiac and non-cardiac operations for congenital heart diseases, coronary diseases, vascular heart diseases, and aorta diseases, etc. In this article, a case of a patient with right renal carcinoma complicated with an inferior vena cava tumor thrombus is reported.

Patient concerns:

A 52-year-old man who was admitted to our hospital for lumbar pain lasting for one month.

Diagnosis:

Right renal carcinoma complicated with an inferior vena cava tumor thrombus.

Interventions:

Radical nephrectomy of the renal carcinoma and removal of an inferior vena cava tumor thrombus under real-time monitoring with TEE were performed.

Outcomes :

Radical nephrectomy was successfully performed within 5 minutes after the inferior vena cava was clamped, and then the inferior vena cava tumor thrombus was removed. On the second day after the operation, the patient's conditions improved; his consciousness was clear; he was transferred to a general ward. On the third day after the operation, the patient was able to get out of bed and was discharged on the sixth day after the operation.

Lessons:

Real-time monitoring with TEE played an important role in many aspects in the radical nephrectomy of the renal carcinoma and removal of the inferior vena cava tumor thrombus.
History of diabetes may delay antibiotic administration in patients with severe sepsis presenting to emergency departments
Authors: Abe Toshikazu , Suzuki Tomoharu , Kushimoto Shigeki , Fujishima Seitaro , Sugiyama Takehiro , Iwagami Masao , Ogura Hiroshi , Shiraishi Atsushi , Saitoh Daizoh , Mayumi Toshihiko , Iriyama Hiroki , Komori Akira , Nakada Taka-aki , Shiino Yasukazu , Tarui Takehiko , Hifumi Toru , Otomo Yasuhiro , Okamoto Kohji , Umemura Yutaka , Kotani Joji , Sakamoto Yuichiro , Sasaki Junichi , Shiraishi Shin-ichiro , Tsuruta Ryosuke , Hagiwara Akiyoshi , Yamakawa Kazuma , Takuma Kiyotsugu , Masuno Tomohiko , Takeyama Naoshi , Yamashita Norio , Ikeda Hiroto , Ueyama Masashi , Gando Satoshi
Published: March 2020

Clinical manifestations of sepsis differ between patients with and without diabetes mellitus (DM), and these differences could influence the clinical behaviors of medical staff. Therefore, we aimed to investigate whether pre-existing DM was associated with the time to antibiotics or sepsis care protocols.

This was a retrospective cohort study.

It conducted at 53 intensive care units (ICUs) in Japan.

Consecutive adult patients with severe sepsis admitted directly to ICUs form emergency departments from January 2016 to March 2017 were included.

The primary outcome was time to antibiotics.

Of the 619 eligible patients, 142 had DM and 477 did not have DM. The median times (interquartile ranges) to antibiotics in patients with and without DM were 103 minutes (60–180 minutes) and 86 minutes (45–155 minutes), respectively (P = .05). There were no significant differences in the rates of compliance with sepsis protocols or with patient-centred outcomes such as in-hospital mortality. The mortality rates of patients with and without DM were 23.9% and 21.6%, respectively (P = .55). Comparing patients with and without DM, the gamma generalized linear model-adjusted relative difference indicated that patients with DM had a delay to starting antibiotics of 26.5% (95% confidence intervals (95%CI): 4.6–52.8, P = .02). The gamma generalized linear model-adjusted relative difference with multiple imputation for missing data of sequential organ failure assessment was 19.9% (95%CI: 1.0–42.3, P = .04). The linear regression model-adjusted beta coefficient indicated that patients with DM had a delay to starting antibiotics of 29.2 minutes (95%CI: 6.8–51.7, P = .01). Logistic regression modelling showed that pre-existing DM was not associated with in-hospital mortality (odds ratio, 1.26; 95%CI: 0.72–2.19, P = .42).

Pre-existing DM was associated with delayed antibiotic administration among patients with severe sepsis or septic shock; however, patient-centred outcomes and compliance with sepsis care protocols were comparable.