bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Economics: The Perspective of a Prosthetic Manufacturer
Authors: Kannenberg Andreas , Seidinger Susanne 
Published: December 2018

ABSTRACTHealth economic evaluations of pharmaceuticals and subsequently medical devices were introduced in the early 1990s and have since developed into a standard decision-making tool for payers to appraise the value of new health technologies. To the prosthetic and orthotic industry, health economics is still a new concept that may help overcome the limitations and restrictions of the current reimbursement system by driving the discussion with payers and their coverage decisions from a purely price-based to a value-based perspective. However, to move the industry in that direction, manufacturers would have to make substantial investments in qualified staff and research funding. This article gives an overview on how iterative health economic modeling could be implemented and how it would transform current research and development processes of prosthetic manufacturers. It would add another aspect to decision making, allowing to identify the most cost-effective option among several potential development projects, or even to terminate development of devices that have no chance to ever be cost-effective. The adoption of health economic methods would probably also have a dramatic impact on the manufacturer community and the marketplace as a whole. Bigger companies that are able and willing to afford the cost to generate clinical evidence and health technology assessments would probably introduce fewer innovations that are supported by better evidence than today. Smaller companies that are unable to absorb the cost would likely have to cooperate or focus on products that fit in the limitations of the current reimbursement system. As a result, we would probably see fewer innovations and many more me-too products. However, that situation would underscore a challenge that innovative manufacturers are already facing today. Payers demand high-quality evidence for new devices but tend to extrapolate the benefits demonstrated for the predicate device to similar, yet-unstudied components. That puts innovative manufacturers that invest in clinical and health economic research at a business disadvantage against technology followers. Therefore, policy makers are advised to hold individual components to comparable standards of demonstrated performance when making decisions on coverage and reimbursement.
Linagliptin-related pancreatitis in a diabetic patient with biliary calculus
Authors: Sevencan Nurhayat Ozkan , Ozkan Aysegul Ertinmaz , Kayhan Burcak 
Published: December 2018

Abstract

Rationale:
Dipeptidyl peptidase-4 inhibitors are commonly used drugs for the treatment of type 2 diabetes mellitus. While acute pancreatitis cases induced by saxagliptin, sitagliptin, and vildagliptin (all of which are members of the dipeptidyl peptidase-4 group) have been reported, there is no clear evidence suggesting that linagliptin may cause pancreatitis, and information in this regard is limited to a few studies. Moreover, no pancreatitis cases have been reported that were directly associated with linagliptin.

Patient concerns:
We present a case of linagliptin-related pancreatitis in a 79-year-old male diabetic patient with biliary calculi. The patient, who was diagnosed with acute pancreatitis 4 months after initiating linagliptin 5 mg/d treatment, was admitted to our hospital.

Diagnoses:
The patient's pancreatic enzymes were high. Ultrasonography showed multiple biliary calculi, and abdominal computed tomography showed edematous pancreatitis.

Interventions:
Linagliptin was discontinued and clinical improvement was achieved with standard acute pancreatitis treatment.

Outcomes:
This is the 1st case report suggesting that linagliptin might be associated with the risk of pancreatitis and could be an etiologic cause of pancreatitis, similar to the other members of its group.

Lessons:
While the results of previous studies stated that there was no data to prove a causal relationship between dipeptidyl peptidase-4 inhibitors and pancreatitis, concerns regarding this subject have continued to arise. Therefore, new and comprehensive studies are needed to determine the long-term effects of dipeptidyl peptidase-4 inhibitors on type 2 diabetes mellitus patients and to shed light on the side effects of these medications.
Analysis of genetic polymorphism of methylenetetrahydrofolate reductase in a large ethnic Hakka population in southern China
Authors: Zhao Pingsen , Hou Jingyuan , Wu Hesen , Zhong Miaocai 
Published: December 2018

Abstract
Methylenetetrahydrofolate reductase (MTHFR) catalyzes conversion of methylene tetrahydrofolate to methylte trahydrofolate. MTHFR C677T polymorphism has been regarded as a risk factor for various vascular diseases. Our study aimed to investigate the distribution frequencies of this polymorphism among Hakka population living in southern China. We retrospectively recruited 5102 unrelated Chinese Hakka subjects. MTHFR C677T polymorphism was tested using the polymerase chain reaction (PCR) and DNA sequencing. A total of 2358 males and 2744 females (aged from 10 years to 101 years) were included in this study. In total, 2835 (55.63%) subjects were homozygous for the C allele (CC), 1939 (38.00%) subjects were heterozygous (CT), and 325 (6.37%) subjects were homozygous for the T allele (TT). The allelic frequency of mutant T was 25.37% with 325 individual homozygous for this defective allele resulting in a frequency of about 6.37% for the TT genotype. According to the study results, the overall frequency of MTHFR C677T genotypes did not differ significantly among the gender and age groups. Our study showed the prevalence of MTHFR C677T polymorphism in a large ethnic Hakka population living in southern China. It would be important implications for the primary prevention of various vascular diseases.
Clinical and molecular analysis of epilepsy-related genes in patients with Dravet syndrome
Authors: Jiang TieJia , Shen Yaping , Chen Huai , Yuan Zhefeng , Mao Shanshan , Gao Feng 
Published: December 2018

Abstract
Dravet syndrome is considered to be one of the most severe types of genetic epilepsy. Mutations in SCN1A gene have been found to be responsible for at least 80% of patients with Dravet syndrome, and 90% of these mutations arise de novo. The variable clinical phenotype is commonly observed among these patients with SCN1A mutations, suggesting that genetic modifiers may influence the phenotypic expression of Dravet syndrome. In the present study, we described the clinical, pathological, and molecular characteristics of 13 Han Chinese pedigrees clinically diagnosed with Dravet syndrome. By targeted-exome sequencing, bioinformatics analysis and Sanger sequencing verification, 11 variants were identified in SCN1A gene among 11 pedigrees including 7 missense mutations, 2 splice site mutations, and 2 frameshift mutations (9 novel variants and 2 reported mutations). Particularly, 2 of these Dravet syndrome patients with SCN1A variants also harbored SCN9A, KCNQ2, or SLC6A8 variants. In addition, 2 subjects were failed to detect any pathogenic mutations in SCN1A and other epilepsy-related genes. These data suggested that SCN1A variants account for about 84.6% of Dravet syndrome in our cohort. This study expanded the mutational spectrum for the SCN1A gene, and also provided clinical and genetic evidence for the hypothesis that genetic modifiers may contribute to the variable manifestation of Dravet syndrome patients with SCN1A mutations. Thus, targeted-exome sequencing will make it possible to detect the interactions of epilepsy-related genes and reveal their modification on the severity of SCN1A mutation-related Dravet syndrome.
Anemia secondary to the use of sodium valproate for preventing postoperative seizures in a 79-year-old man
Authors: Li Chen , Su Lei , Lao Minxi , Zhu Shaofang , Ding Meilin 
Published: December 2018

Abstract

Rationale:
Sodium valproate is a widely used antiepileptic drug and also used to prevent postoperative seizures in neurosurgery. Anemia caused by sodium valproate is occasionally reported and most are from pediatric patients.

Patient concerns:
We present the case of a 79-year-old man who developed anemia in the setting of a short-term sodium valproate therapy for the prevention of postoperative seizures.

Diagnosis:
By testing complete blood count we found anemia and hepatic enzyme elevations arising after 3-week standard dose sodium valproate therapy for preventing postoperative seizures. Our investigations ruled out most of the known causes of anemia including infection, uncontrolled bleeding, underlying systemic disease, malnutrition, immune hemolytic anemia, and neoplasia. On the drug's discontinuation as diagnostic therapy the patient's hemoglobin began to rise spontaneously and liver function returned to normal. Thus anemia secondary to sodium valproate was considered as the most likely diagnosis.

Interventions: Sodium valproate was suspended and the patient was transfused with concentrated red blood cells.

Outcomes:
The hemoglobin recovered obviously on the drug's discontinuation.

Lessons:
Hematologic toxicity of sodium valproate can occur quickly. Regular complete blood count test helps to make prompt diagnosis and drug discontinuation leads to the recovery.
Anesthesia for patient with anti-N-methyl-D-aspartate receptor encephalitis
Authors: Wada Nozomi , Tashima Kayoko , Motoyasu Akira , Nakazawa Harumasa , Tokumine Joho , Chinzei Mieko , Yorozu Tomoko 
Published: December 2018

AbstractRationale:Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an immune-mediated syndrome caused by the production of antibodies against NMDA receptors. As NMDA receptors are important targets of many anesthetic drugs, the perioperative management of patients with anti-NMDA receptor encephalitis is challenging for anesthesiologists.Patient concerns:A 31-year-old woman presented with akinesia and aphasia, which worsened despite steroid therapy.Diagnosis:Anti-NMDA receptor encephalitis associated with ovarian teratoma.Interventions:Laparoscopic ovarian cystectomy was performed under total intravenous anesthesia (TIVA) with peripheral nerve block (PNB).Outcomes:The patient recovered without postoperative complications or any adverse events after surgery.Lessons:Ideal anesthesia for a patient with anti-NMDA receptor encephalitis is still under discussion. We decided to perform TIVA with PNB because the effect of propofol on NMDA receptors is considered less than that of volatile anesthetics; moreover, PNB may reduce the amount of propofol and opioids required for anesthesia. To conclude, TIVA with PNB may be the most appropriate method for anesthesia in a patient with anti-NMDA receptor encephalitis undergoing ovarian cystectomy.
Association between sleep duration and musculoskeletal pain
Authors: Chun Min Young , Cho Bum-Joo , Yoo Sang Ho , Oh Bumjo , Kang Ju-Seop , Yeon Cholog 
Published: December 2018

Abstract
Both extremely long and short sleep durations have been associated with increased risk of numerous health problems. This study examined the association between self-reported sleep duration and reporting of musculoskeletal pain in the adult Korean population.
This study included data from 17,108 adults aged ≥50 years, obtained from the Korea National Health and Nutrition Examination Survey 2010–2012 and 2013–2015. Self-reported daily hours slept and the presence of musculoskeletal pain in knee joint, hip joint, or low back were examined. Patients were stratified into 5 groups by their sleep duration: ≤5, 6, 7, 8, or ≥9 h. Multivariate logistic regression analysis was performed, adjusting for covariates including age, sex, marital status, smoking, alcohol use, family income level, education, physical exercise, body mass index (BMI), and stress level.
A U-shaped relationship was observed between the length of sleep duration and the presence of musculoskeletal pain. After adjusting for covariates, sleep duration of ≤5 h or ≥9 h was significantly associated with musculoskeletal pain experienced for more than 30 days over a 3-month period. We also found that the presence of multi-site musculoskeletal pain was significantly higher among those who slept for ≤5 h or ≥9 h than in those who slept for 7 h.
These findings suggest that either short or long sleep duration is associated with musculoskeletal pain among Korean adults.
Efficacy and safety of ultrasound-guided cannulation via the right brachiocephalic vein in adult patients
Authors: Xia Rui , Sun Xingwei , Bai Xuming , Zhou Yubin , Shi Jianming , Jin Yong , Chen Qian 
Published: December 2018

Abstract
Central venous catheter (CVC) insertion is difficult to perform and is a high-risk operation; ultrasound (US)-guided cannulation helps increase the odds of success while reducing the associated complications. The internal jugular vein (IJV) and subclavian vein (SCV) are the most commonly sites in US-guided CVC insertion. In the present study, we evaluated the safety and efficacy of US-guided supraclavicular right brachiocephalic vein (BCV) cannulations in adult patients.
Between January 2016 and December 2017, 428 adult patients requiring 536 CVC insertions underwent ultrasound-guided right BCV cannulation. The success rate and complications related to indwelling catheters were analyzed.
The technical success rate was 98.32% (527/536). The procedure was successful at the first try in 511 cases (95.34%). The mean operation time was 13.26 ± 3.34 minutes. The mean length of catheter introduction was 13.57 ± 3.53 cm. Incidence of intraoperative complications was 2.61%. For 3 patients, the procedure was terminated due to pneumothorax (PNX), and in 11 arterial punctures there were self-limiting hematomas. The incidence of postprocedure complications was 5.97% (32/536). These complications included catheter-related infections (n = 18) and thromboses (n = 14). Insertion lasted an average of 10.68 ± 8.77 days.
Supraclavicular, in-plane, US-guided cannulation of the right BCV is an effective and safe method for inserting central venous catheters in adult patients. It provides another option for catheter access to boost clinical performance in central venous catheterization.
IDH mutations but not TERTp mutations are associated with seizures in lower-grade gliomas
Authors: Duan Wen-chao , Wang Li , Li Ke , Wang Wei-wei , Zhan Yun-bo , Zhang Feng-jiang , Yu Bin , Bai Ya-hui , Wang Yan-min , Ji Yu-chen , Zhou Jin-qiao , Liu Xian-zhi , Zhang Zhen-yu 
Published: December 2018

Abstract
Glioma is the most common malignant tumor in the central nervous system (CNS). Lower-grade gliomas (LGG) refer to Grade II and III gliomas. In LGG patients, seizure often appears as an initial symptom and play an important role in clinical performance and quality of life of the patients. To date, the relationship between the onset of seizures and the molecular pathology in gliomas is still poorly investigated. In this study, we investigate the potential relationship between isocitrate dehydrogenase (IDH)/telomerase reverse transcriptase promoter (TERTp) mutations and preoperative seizures in patients with LGG. 289 adult LGG patients were enrolled in this study. Data of clinical characteristics and molecular pathology were acquired. Sanger sequencing was used to detect IDH/TERTp mutations. Chi-square test was performed to determine if the IDH/TERTp mutations were associated with seizures and seizure types. In 289 LGG patients, preoperative seizures accounted for 25.3% (73/289), IDH mutations accounted for 34.3%(99/289), and TERTp mutations accounted for 44.3% (128/289). The correlation analysis demonstrated that IDH mutation is a significant factor influencing the occurrence of tumor-related epilepsy (P <.001, chi-square test). On the other hand, the statistical analysis revealed no significant correlation between TERTp mutations and seizure in LGG patients (P = .102, chi-square test). The tumor-related epilepsy rates vary among different subgroups according to IDH/TERTp mutations. However, there is no definite correlation between the IDH (P = 1.000, chi-square test)/TERTp (P = .613, chi-square test) mutations and the types of epileptic seizure. IDH mutations are more common in preoperative LGG patients with epileptic symptoms, suggesting that this mutation is positively correlated with seizures. However, there was no significant correlation between TERTp mutations and seizures. Different molecular pathologic types based on IDH/TERTp have different incidences of tumor-associated epilepsy in LGGs.
A huge gastric bezoar treated by traditional Chinese medicine purgative
Authors: Dai Qianlan , Jiang Feng 
Published: December 2018

Abstract

Rationale:
Currently, the mainstream treatment for gastric bezoars is endoscopic lithotripsy. This report describes traditional Chinese medicine (TCM) purgative cured a 62-year-old woman with a huge gastric bezoar accompanied by isolated esophageal venous aneurysms and multiple bleeding gastric ulcers.

Patient concerns:
A 62-year-old woman with several symptoms, including epigastric pain, nausea, and vomiting, hiccups, heartburn, and dark, loose stools. The patient showed abdominal tenderness, positive Murphy sign, hyperactive bowel sounds, a pale tongue with scalloped edges, greasy moss, and pulse moisten. A complementary examination revealed the presence of occult blood in the vomit.

Diagnosis:
The patient was diagnosed with isolated esophageal venous aneurysms, gastric bezoars, and multiple bleeding gastric ulcers. Gastroscopy revealed a 0.6 cm blue uplift, a smooth surface, and a regular and clearly defined dentate line. A large bezoar was observed in the stomach cavity with a dark red blood in the surface. The gastric angle showed multiple lesions, with their largest diameter being 2.5 cm, blood was oozing from these ulcers.

Interventions:
The patient was prescribed a TCM purgative combined with omeprazole enteric-coated tablets. Three days after admission, the patient was diagnosed with isolated esophageal venous aneurysms, gastric bezoars, multiple bleeding gastric ulcers. A specific herbal formula was prescribed to eliminate the bezoar. In addition, conventional western medicine was used for the patient, such as pantoprazole sodium intravenous infusion to inhibit gastric acid and sodium bicarbonate solution orally to soften the gastric bezoar.

Outcomes:
After 5 days, the patient had complete relief from all remaining symptoms, including stomach pain and hiccups. Follow-up gastroscopy revealed that the venous aneurysm and gastric bezoar had disappeared, and the ulcer had reduced in size to approximately 0.6 to 0.8 cm. The patient was discharged after recovery and did not relapse for 3 years.

Lessons:
TCM combined with conventional western medicine to treat huge gastric bezoars and its complications is effective and safe, and worth to be recommended as an alternative to endoscopic lithotripsy.
Health Optimization Program for Elders
Authors: Krol Michael L. , Allen Colette , Matters Loretta , Jolly Graham Aubrey , English William , White Heidi K. 
Published: December 2018

Background:
Individuals discharged from the hospital to skilled nursing facilities (SNFs) experience high rates of unplanned hospital readmission, indicating opportunity for improvement in transitional care.

Local Problem:
Local physicians providing care in SNFs were not associated with the discharging hospital health care system. As a result, substantive real-time communication between hospital and SNF physicians was not occurring.

Methods:
A multidisciplinary team developed and monitored implementation of the Health Optimization Program for Elders (HOPE) to improve patient transitions from acute hospital stay to SNFs.

Interventions:
The HOPE used a nurse practitioner (NP) to identify geriatric syndromes, set patient/caregiver expectations, assess rehabilitation potential, clarify goals of care, and communicate information directly to SNF providers.

Results:
The intervention was feasible, addressed unmet needs and errors in the SNF transition process, and was associated with lower 30-day readmission rates compared with concurrent patients not enrolled in the HOPE.

Conclusions:
An NP-led hospital to SNF transitional care program is a promising means of improving hospital to SNF transitions.
Obstetric Anal Sphincter Injuries at Vaginal Delivery: A Review of Recently Published National Guidelines
Authors: Tsakiridis Ioannis , Mamopoulos Apostolos , Athanasiadis Apostolos , Dagklis Themistoklis 
Published: December 2018

Importance
Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries.

Objective
The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery.

Evidence Acquisition
Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on “The Management of Third- and Fourth-Degree Perineal Tears,” American College of Obstetricians and Gynecologists on “Prevention and Management of Obstetric Lacerations at Vaginal Delivery,” and Society of Obstetricians and Gynaecologists of Canada on “Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.” These guidelines were summarized and compared in terms of prevention and management of OASISs. Quality of evidence was also reviewed based on method of reporting for each guideline.

Results
This published evidence reflects the differences between the national recommendations on the prevention and management of OASISs. Especially, as for the prevention of OASIS, routine use of episiotomy is not recommended, whereas warm perineal compresses and perineal massage during the second stage of labor seem to have a protective role. In the management of OASIS, special care is needed during the repair process of the torn anorectal mucosa and the internal and external anal sphincter. The postoperative use of broad-spectrum antibiotics, oral laxatives, and analgesia is also recommended.

Conclusions
Summarized guidelines can have an impact on special care in prevention and management of OASIS; this may support the reduction of morbidity associated with that entity.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After participating in this activity, the learner should be better able to evaluate prevention strategies on OASISs in the antenatal and intrapartum period; compare management recommendations in cases of OASISs; and plan the appropriate consultation regarding future pregnancies and postpartum care in cases of OASISs.