bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wernicke encephalopathy concurrent with polyradiculoneuropathy in a young man after bariatric surgery
Authors: Chang Heng-Wei , Yang Pei-Yu , Han Ting-I , Meng Nai-Hsin 
Published: March 2019

Abstract

Rationale:
Bariatric surgery is the recommended treatment for morbid obesity because of its rapid and sustained body weight loss effect. Nutrient deficiency-related neurological complications after bariatric surgery are often disabling. Thus, early recognition of these complications is important. Neurological complications involving the central and peripheral nerve system after bariatric surgery were reported. However, the report on the clinical course of the concurrent involvement of central and peripheral nervous system is limited. We present a rare case of a patient who developed Wernicke encephalopathy concurrent with polyradiculoneuropathy after receiving bariatric surgery.

Patient concerns:
A 22-year-old man with a history of morbid obesity presented progressive bilateral lower limbs weakness, blurred vision, and gait disturbance 2 months after receiving laparoscopic sleeve gastrectomy. Bilateral lower limb numbness and cognition impairment were also noted.

Diagnosis:
Brain magnetic resonance imaging and electrophysiologic studies confirmed the diagnosis of Wernicke encephalopathy concurrent with acute polyradiculoneuropathy.

Interventions:
Vitamin B and folic acid were given since admission. He also received regular intensive rehabilitation program.

Outcomes:
The subject's cognitive impairment and diplopia improved 1 week after admission under medical treatments, yet lower limb weakness and gait disturbance were still noted. After a month of intensive inpatient rehabilitation, he was able to ambulate with a walker for 30 munder supervision.

Lessons:
Nutrient deficiency-related neurological complications after bariatric surgery are often disabling and even fatal. Prevention of neurological complications can be improved through close postsurgical follow-up of the nutritional status. Recognizing the signs and symptoms and evaluating the medical history are critical to the early diagnosis and treatment of this potentially serious yet treatable condition.
Simultaneous spontaneous bilateral quadriceps tendon rupture with secondary hyperparathyroidism in a patient receiving hemodialysis
Authors: Wu Weiqian , Wang Chongyang , Ruan Jianwei , Wang Haibao , Huang Yang , Zheng Wenbiao , Chen Fanghu 
Published: March 2019

Abstract

Rationale:
Simultaneous spontaneous bilateral quadriceps tendon rupture is a rare orthopedic injury; its initial diagnosis is misdiagnosed in up to 50% of patients with secondary hyperparathyroidism. Early diagnosis and surgical repair are important to achieve an excellent functional outcome.

Patient concerns:
We report a case of simultaneous spontaneous bilateral quadriceps tendon rupture associated with secondary hyperparathyroidism.

Diagnosis:
Magnetic resonance imaging showed that the quadriceps tendon was completely ruptured at the osteotendinous junction. We then found bilateral quadriceps tendon rupture during the operation.

Interventions:
The patient underwent successful tendon repair surgery.

Outcomes:
The 31-year-old female patient regained full active movement of both knee joints and was able to participate in her activities of daily living.

Lessons:
Simultaneous spontaneous bilateral quadriceps tendon rupture in a patient with secondary hyperparathyroidism (undergoing hemodialysis) is a rare orthopedic injury that can be easily overlooked at the initial presentation. Early diagnosis and surgical repair is important to achieve an excellent functional outcome. For patients with secondary hyperparathyroidism receiving hemodialysis, strict systematic treatment of hyperparathyroidism is needed to prevent rupture or re-rupture of the quadriceps tendon.
Association between intensive periodontal treatment and spontaneous intracerebral hemorrhage—a nationwide, population-based cohort study
Authors: Huang Jia-Lun , Chen Wei-Kung , Lin Cheng-Li , Lai Ching-Yuan , Kao Chia-Hung , Chiang Hsien-Hsiung , Yang Tse-Yen , Shih Hong-Mo 
Published: March 2019

Abstract
Periodontal disease is a chronic inflammation of periodontium and has a high prevalence. Periodontal disease has been discovered to be a possible risk factor for cerebrovascular diseases. The available evidence are not enough to set up a causal relationship between periodontal disease and cerebrovascular diseases. Patients with spontaneous intracerebral hemorrhage have high mortality rates. The present study investigated whether intensive periodontal treatment is a protective factor of spontaneous intracerebral hemorrhage and can reduce the risk of spontaneous intracerebral hemorrhage.
In total, 64,960 patients with a history of periodontal disease were picked out from the National Health Insurance Research Databases as a case-cohort from January 01, 2000 to December 31, 2010. They were divided on the basis of whether periodontal disease patients received intensive surgical treatment (treatment cohort) or not (control cohort). The periodontal disease patients in treatment and control cohorts were selected by propensity score matching at a ratio of 1:1. Incidences of spontaneous intracerebral hemorrhage in both cohorts were analyzed and compared.
The total hazard of spontaneous intracerebral hemorrhage was significantly decreased in the treatment cohorts compared with the control cohorts (adjusted hazard ratio = 0.60, 95% confidence interval = 0.45–0.79).
Compared with the control cohort, intensive periodontal treatment may reduce the overall incidence of spontaneous intracerebral hemorrhage, particularly in elderly patients, males, and those who received more than 2 intensive treatments.
What is the optimal cut-off threshold in self-home blood pressure measurement?
Authors: Coll-de-Tuero Gabriel , Saez Marc , Rodriguez-Poncelas Antonio , Bayó-Llibre Joan , Beltran-Vilella Marta , Reyes-Negre Carla , Dalfó-Baqué Antoni , Barceló MªAntonia 
Published: March 2019

Abstract
Two aspects arise concerning the use of self-measured blood pressure monitoring to diagnose white-coat hypertension (WCH): the presence of target organ damage (TOD) and the normal cut-off threshold. This study aims to evaluate the cardiovascular risk of WCH according to different self-measured blood pressure normal cut-off thresholds and the influence of TOD at baseline.
In all, 678 patients were followed for 6.2 years; 223 normotensive patients, 271 patients with sustained hypertension (HT), and 184 with WCH. TOD was defined as: left ventricular hypertrophy according to ECG, albuminuria, or low estimated glomerular filtration rate. The risk for different cutting points of self-measured blood pressure (<135/85 mm Hg, <130/85 mm Hg, and <130/80 mm Hg) has been determined.
The patients with HT experienced an increase in cardiovascular risk and death higher than the normotensive patients (odds ratio [OR] 7.9, 95% confidence interval [CI] 3.8–16.2 for sustained HT; and OR 3.5, 95% CI 1.6–7.4 for WCH). This was observed for all the cut-off thresholds analyzed. In white-coat hypertensive patients (cut-off <135/85 mm Hg) with TOD, the risk was higher than in normotensive patients (OR 4.5; 95% CI 1.9–10.6). Using a self-monitoring blood pressure cut-off threshold of <130/80 mm Hg without TOD at baseline, the WCH cases exhibited no differences in risk to the normotensive patients (OR 2.0, 95% CI 0.5–7.7).
The decisions being taken for patients with WCH based on the presence of TOD and a self-administered home monitoring blood pressure measurement cut-off point probably lower than the one that is currently recommended.
The Brazilian experience of implementing the active pharmacovigilance of dolutegravir
Authors: Batista Cynthia Julia Braga , Correa Renato Girade , Evangelista Livia Ramalho , Fleck Karen , Silva Leandro , Renaud Francoise , Vitoria Marco , Doherty Meg , Benzaken Adele Schwartz 
Published: March 2019

Abstract
In 2017, the Ministry of Health Brazilian started using dolutegravir (DTG) 50 mg to all people living with HIV who began antiretroviral therapy (ART) or rescue regimens. Although DTG is thought to have better tolerability levels and a lower possibility of causing adverse reactions, it is necessary to continuously evaluate the safety profile of the drug in the population. Therefore, an active pharmacovigilance project for DTG was implemented. The objective of this study was to describe the Brazilian experience of implementing pharmacovigilance and the results obtained during the period between April and December 2017.
Active pharmacovigilance was implemented through patient interviews and an online questionnaire developed in the Medication Logistics Control System (SICLOM).
Of the total number of people on DTG in Brazil (79,742) 90.33% participated in the project, and 2.24% of those who participated reported adverse reactions to the drug; of those who reported adverse reactions, 73.86% were on first-line ART regimens, and 26.13% were on third-line regimens. The mean age of the patients who had adverse reactions to DTG was 39 years; 68.79% were male, and 31.21% were female. Of the adverse reactions reported, 50.39% were considered persistent. The 3 most frequent reactions were nausea (13.34%), diarrhea (9.83%), and headaches (9.23%).
The Brazilian experience with this project has been deemed successful by federal and local managers, and the online tool to collect data has proved to be an important strategy for the pharmacovigilance of DTG as well as that of other drugs.
Pitfalls in the interpretation of the cosyntropin stimulation test for the diagnosis of adrenal insufficiency
Authors: Burgos Nydia , Ghayee Hans K. , Singh-Ospina Naykky 
Published: March 2019

Purpose of review
Adrenal insufficiency is a rare disease characterized by cortisol deficiency. The evaluation of patients suspected of having adrenal insufficiency can be challenging because of the rarity of the disease and limitations in the biochemical assessment of the cortisol status by either basal or dynamic testing [adrenocorticotropic hormone (ACTH) stimulation test]. Prompt and adequate diagnosis is of paramount importance to avoid adverse outcomes. We aimed to summarize the recent developments in the conduction and interpretation of the ACTH stimulation test for the diagnosis of adrenal insufficiency.

Recent findings
The ACTH stimulation test is commonly performed in patients suspected of having adrenal insufficiency when the basal serum cortisol levels are inconclusive. Recent literature has evaluated the impact of technical aspects such as time of the day the test is performed, type of assay and sample source used for cortisol measurement on the clinical value of this test, as well as the feasibility of reliable low dose ACTH testing.

Summary
Clinicians evaluating patients with suspected adrenal insufficiency should take into consideration the clinical presentation (likelihood of adrenal insufficiency before testing) when interpreting the results of the ACTH stimulation test and be aware of clinical and technical factors that can affect cortisol values and diagnostic accuracy of this test.
Deregulation of Drosha in the pathogenesis of hereditary hemorrhagic telangiectasia
Authors: Hata Akiko , Lagna Giorgio 
Published: March 2019

Purpose of review
The TGFβ (transforming growth factor β) superfamily – a large group of structurally related and evolutionarily conserved proteins – profoundly shapes and organizes the vasculature during normal development and adult homeostasis. Mutations inactivating several of its ligands, receptors, or signal transducers set off hereditary hemorrhagic telangiectasia (HHT), a disorder that causes capillary networks to form incorrectly. Drosha, an essential microRNA-processing enzyme, also interfaces with TGFβ signal transducers, but its involvement in vascular conditions had not been tested until recently. This review summarizes current evidence that links mutations of Drosha to HHT.

Recent findings
Genetic studies have revealed that rare missense mutations in the Drosha gene occur more commonly among HHT patients than in healthy people. Molecular analyses also indicated that Drosha enzymes with HHT-associated mutations generate microRNAs less efficiently than their wild-type counterpart when stimulated by TGFβ ligands. In zebrafish or mouse, mutant Drosha proteins cause the formation of dilated, leaky blood vessels deprived of capillaries, similar to those typically found in patients with HHT.

Summary
Recent evidence suggests that Drosha-mediated microRNA biogenesis contributes significantly to the control of vascular development and homeostasis by TGFβ. Loss or reduction of Drosha function may predispose carriers to HHT and possibly other vascular diseases.
Oxidation and erythropoiesis
Authors: Matte Alessandro , De Franceschi Lucia 
Published: March 2019

Purpose of review
Erythropoiesis is a complex multistep process going from committed erythroid progenitors to mature red cells. Although recent advances allow the characterization of some components of erythropoiesis, much still remains to be investigated particularly on stress erythropoiesis. This review summarizes recent progresses made to understand the impact of oxidative stress on normal and pathologic erythropoiesis.

Recent findings
During erythroid maturation, reactive oxygen species might function as second messenger through either transient oxidation of cysteine residues on signaling targets or modulation of intracellular signaling pathways. Thus, in erythropoiesis, efficient cytoprotective systems are required to limit possible reactive oxygen species-related toxic effects especially in stress erythropoiesis characterized by severe oxidation such as β-thalassemia. In addition, prolonged or severe oxidative stress impairs autophagy, which might contribute to the block of erythroid maturation in stress erythropoiesis. Understanding the functional role of cytoprotective systems such as peroxiredoxin-2 or classical molecular chaperones such as the heat shock proteins will contribute to develop innovative therapeutic strategies for ineffective erythropoiesis.

Summary
We provide an update on cytoprotective mechanisms against oxidation in normal and stress erythropoiesis. We discuss the role of oxidative sensors involved in modulation of intracellular signaling during erythroid maturation process in normal and stress erythropoiesis.
PIK3CA mutations in vascular malformations
Authors: Castillo Sandra D. , Baselga Eulalia , Graupera Mariona 
Published: March 2019

Purpose of review
Recently, it has been discovered that a subset of vascular malformations, of the lymphatic and venous type, are caused by oncogenic mutations in the PIK3CA gene. Now, efforts have been focused in the understanding of the molecular and cellular consequences of these mutations and the opportunities for novel-targeted therapies for these diseases.

Recent findings
Here, we review the latest findings in the biology of oncogenic PIK3CA mutations in the pathogenesis of vascular malformations. We focus on the recent development of in-vitro and in-vivo tools for the study of PIK3CA-mutant vascular malformations with special interest in preclinical models for drug testing. Also, we review the latest advances in phosphoinositide 3-kinase (PI3K) inhibitors in the clinic and their repurposing for the treatment of lymphatic malformations and venous malformations.

Summary
Oncogenic mutations on PIK3CA causing lymphatic malformations and venous malformations are also frequently found in epithelial cancer. Thus, fundamental research done in the cancer field during the past decades might be applied to the understanding of lymphatic malformations and venous malformations. Likewise, repurposing PI3K pathway inhibitors that are currently in cancer clinical trials can be used as a novel strategy for the treatment of these diseases. Here, we also open a debate for the consideration of lymphatic malformations and venous malformations as developmental tumours.
The Distributional Characteristic and Growing Trend of Pancreatic Cancer in China
Authors: Zhao Chengfei , Gao Feng , Li Quwen , Liu Qicai , Lin Xinhua 
Published: March 2019

Abstract
Pancreatic cancer is a malignant tumor with difficulty in diagnosis and treatment and was the sixth leading cause of cancer death among both men and women in China. The 5-year relative survivals of pancreatic cancer were only 7.2% in China and the lowest level in all cancers. The proportion of estimated new cases of pancreatic cancer in China was comparatively high in East China, Northeast, North China, and Northwest and relatively low in Central China, Southwest, and South China, showing obvious regional characteristics. It implies that the incidence and mortality in the eastern region are significantly higher than those in the western region, which is consistent with the result that the incidence and mortality increased from low to middle to high urbanization areas in China, and the prevalence of diabetes increased from underdeveloped to intermediately developed to developed region.
Overcoming Immunobiological Barriers Against Porcine Islet Xenografts
Authors: Li Xinyu , Meng Qiang , Zhang Lei 
Published: March 2019

Abstract
Porcine islets might represent an ideal solution to the severe shortage of living donor islets available for transplantation and thus have great potential for the treatment of diabetes. Although tremendous progress has been achieved through recent experiments, the immune response remains a major obstacle. This review first describes the 3 major pathways of rejection: hyperacute rejection mediated by preformed natural antibodies and complement, instant blood-mediated inflammatory reactions, and acute cell-mediated rejection. Furthermore, this review examines immune-related strategies, including major advances, which have been shown to extend the life and/or function of porcine islets in vitro and in vivo: (1) genetic modification to make porcine islets more compatible with the recipient, (2) optimization of the newly defined biological agents that have been shown to promote long-term survival of xenografts in nonhuman primates, and (3) development of novel immunoisolation technologies that maintain the long-term survival of islet xenografts without the use of systemic immunosuppressive drugs. Finally, the clinical application of porcine islet transplantation is presented. Even though less clinical information is available, experimental data indicate that porcine islet xenografts are likely to become a standard treatment for patients with type 1 diabetes in the future.
Clinical Features and Treatment Outcomes of Children With Anaplastic Large Cell Lymphoma in Pakistan: A Multicenter Study
Authors: Resham Shahzadi , Khan Rahil , Ashraf Shamvil , Rizvi Arjumand , Altaf Sadaf 
Published: March 2019

Background:
Different approaches have been adopted in the treatment of anaplastic large cell lymphoma (ALCL); there is a lack of consensus with regard to standard treatment. Because of paucity of data from low and middle-income countries, we reviewed the clinical features and treatment outcomes of children with ALCL.

Methods:
All ALCL patients under 16 years of age diagnosed from 2005 to 2015 at Aga Khan University Hospital and The Indus Hospital were identified. Clinical features and treatment outcomes were analyzed.

Results:
Thirty-two (n=32) patients met the inclusion criteria. Cervical Lymphadenopathy was the most common presentation (34.3%, n=11). Advanced disease was seen in 68.7% (n=22) (stages III and IV). Fourteen (42.4%) were treated on ALCL-99, 30.3% (n=10) on multicenter protocol-842 regimen, 9% (n=3) on adriamycin-prednisolone-oncovin (doxorubicin, prednisone, vincristine) regimen, and 16% (n=5) were treatment abandonments. Five-year overall survival was 70.6% (95% confidence interval: 47.8%-84.9%), and 5-year event-free survival (EFS) considering treatment abandonment and death as an event was 52.3 % (95% confidence interval: 23.5%-74.8%).

Conclusions:
Significant therapy-related mortality (27.7%) was observed. Treatment abandonment and therapy-related toxicity were the major barriers for better outcomes. However, less intensive outpatient regimens, such as adriamycin-prednisolone-oncovin regimen, may decrease the number of hospitalizations, hence reducing treatment abandonment in the low and middle-income country.
Same-Sex Mothers and Lactation
Authors: Juntereal Nina A. , Spatz Diane L. 
Published: March 2019

Abstract
Investigation of the needs of same-sex mothers practicing lactation is limited in the nursing literature. The heteronormative structure of the healthcare system has stigmatized these postpartum women and minimized the level of nursing care provided. Case reports demonstrate that same-sex mothers value inclusivity and understanding of their healthcare needs that is missing in healthcare settings. Perinatal nurses must listen attentively and think critically about their words and actions to avoid inappropriate judgments when providing care to this population. Active engagement and ongoing competence education builds the foundation that will provide perinatal nurses the knowledge they need to best support the unique needs of same-sex mothers in their lactation experience.
Surgical Technical Evidence Review for Gynecologic Surgery Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery
Authors: Kalogera Eleftheria , Nelson Gregg , Liu Jessica , Hu Q. Lina , Ko Clifford Y. , Wick Elizabeth , Dowdy Sean C. 
Published: March 2019

(Abstracted from Am J Obstet Gynecol 2018;219:563.e1–563.e19)
The Safety Program for Improving Surgical Care and Recovery (ISCR) was developed by the Agency for Healthcare Research and Quality (AHRQ) in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. The goal of this national program was to assist hospitals in improving perioperative care through adoption and implementation of evidence-based enhanced recovery pathways (ERPs).
“Pregnancy Brain”: A Review of Cognitive Changes in Pregnancy and Postpartum
Authors: Brown Elinor , Schaffir Jonathan 
Published: March 2019

Importance
The idea that pregnant women suffer from deficits in memory is widespread but poorly documented in obstetrical literature.

Objective
To review available psychology literature on the subject of cognitive changes in pregnancy in order to guide the prenatal care provider on how to counsel pregnant women.

Evidence Acquisition
An extensive review of PubMed and PsycINFO databases was conducted to gather and analyze relevant studies on cognitive changes in pregnancy.

Results
A large body of literature examining basic science and animal studies support the effects of pregnancy hormones in remodeling brain architecture and neural function. However, studies in humans are hampered by small sizes, heterogeneous methodology, and varying definitions of memory. Nevertheless, the consensus among researchers is that pregnancy does confer deficits in working memory relative to nonpregnant controls.

Conclusions and Relevance
Cognitive effects of pregnancy are likely small, and the impact on daily life is debatable. Further research is needed to determine whether these effects may confer an advantage to parous women comparable to that seen in lower mammals.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After reading this article, readers should be better able to explain prior research into the incidence of brain-related changes brought on by pregnancy; identify different types of cognition and memory that may be affected by pregnancy; and anticipate questions and appropriately counsel pregnant patients about concerns regarding cognitive changes.