bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medium-Term (Least 5 Years) Comparative Outcomes in Anterior Cruciate Ligament Reconstruction Using 4SHG, Allograft, and LARS Ligament
Authors: Su Mengdi , Jia Xinyu , Zhang Zaihang , Jin Zhigao , Li Yong , Dong Qirong , Xu Wei 
Published: March 2019

Objective:
To compare the clinical efficacy of anterior cruciate ligament (ACL) reconstruction with 4-strand hamstring tendon autograft (4SHG), allograft and the Ligament Advanced Reinforcement System (LARS) ligament, and to find the causes of cumulative failure or nonreturn to sport.

Design:
Retrospective case series.

Setting:
Department of Orthopedic Surgery, the second affiliated hospital of Soochow University, Suzhou, Jiangsu, China.

Patients:
Three hundred six patients with isolated ACL deficiency were included. Two hundred twenty-nine patients met the inclusion/exclusion criteria, and finally, 185 of these patients participated in this study.

Interventions:
Anterior cruciate ligament reconstruction using 4SHG, allograft, and LARS.

Main Outcome Measures:
Objective knee function, subjective knee function, and information regarding return to sport, cumulative failure, and complications. Secondary: distribution of tunnel position and tunnel enlargement.

Results:
There were no statistically significant differences between the 3 groups regarding all the clinical objective and subjective results, return to sport, complications, or cumulative failures (P > 0.05). One hundred twenty-eight patients (69.2%, 128/185) returned to sport. Preoperative (after injury) Tegner scores were inferior to postoperative Tegner scores, and postoperative Tegner scores were inferior to preinjury Tegner scores (P < 0.01). The femoral tunnel malposition was significantly associated with cumulative failure (P < 0.05).

Conclusions:
There were no statistically significant differences among the 4SHG, allograft, and LARS ligament in terms of the clinical outcomes after ACL reconstruction (ACLR) at 5-years follow-up. Interestingly, ACLR could improve the functional and motorial level of the knee, but patients had great difficulty in regaining the level of preinjury movement. In addition, the malposition of the femoral tunnel was an important cause of cumulative failure.
Gut dysmotility in the ICU: diagnosis and therapeutic options
Authors: Plummer Mark P. , Reintam Blaser Annika , Deane Adam M. 
Published: March 2019

Purpose of review
To provide a comprehensive update of diagnosis and treatment of gastrointestinal dysmotility in the critically ill, with a focus on work published in the last 5 years.

Recent findings
Symptoms and clinical features consistent with upper and/or lower gastrointestinal dysmotility occur frequently. Although features of gastrointestinal dysmotility are strongly associated with adverse outcomes, these associations may be because of unmeasured confounders. The use of ultrasonography to identify upper gastrointestinal dysmotility appears promising. Both nonpharmacological and pharmacological approaches to treat gastrointestinal dysmotility have recently been evaluated. These approaches include modification of macronutrient content and administration of promotility drugs, stool softeners or laxatives. Although these approaches may reduce features of gastrointestinal dysmotility, none have translated to patient-centred benefit.

Summary
‘Off-label’ metoclopramide and/or erythromycin administration are effective for upper gastrointestinal dysmotility but have adverse effects. Trials of alternative or novel promotility drugs have not demonstrated superiority over current pharmacotherapies. Prophylactic laxative regimens to prevent non-defecation have been infrequently studied and there is no recent evidence to further inform treatment of established pseudo-obstruction. Further trials of nonpharmacological and pharmacological therapies to treat upper and lower gastrointestinal dysmotility are required and challenges in designing such trials are explored.
The microbiome and nutrition in critical illness
Authors: Oami Takehiko , Chihade Deena B. , Coopersmith Craig M. 
Published: March 2019

Purpose of review
The present review aims to describe the relationship between nutrition and the gut microbiome in critical illness.

Recent findings
Critical illness disrupts not only cells of human origin but also the intestinal microbiome, with a decrease in bacterial diversity and transformation into a pathobiome. Under basal conditions, nutrition profoundly alters microbial composition with significant salutatory effects on human health. In critical illness, enteral nutrition is recommended and has theoretical (but not proven) advantages towards improved inner microbial health and diminution of bacterial translocation. Dietary supplements such as probiotics and fiber have been shown to improve microbial derangements in health. However, their impact on the microbiome in critical illness is unclear and although they may have some beneficial effects on patient-centric outcomes, they do not alter mortality. The precise mechanisms of how nutrition and dietary supplements modulate the gut microbiome remain to be determined.

Summary
Nutrition and supplements such as probiotics appear to play a significant role in modulating the microbiome in health, yet the relationship in critical illness is unclear. Further investigation is required to determine the mechanistic determinants of the impact of nutrition on the microbiome in critical illness and the potential clinical implications of this.
Vasoactive agents to improve brain perfusion: pathophysiology and clinical utilization
Authors: Steiner Luzius A. , Siegemund Martin 
Published: March 2019

Purpose of review
This review highlights the aspects of pathophysiology that make it difficult to predict the effects of any attempt to improve brain perfusion and reviews the options to improve brain perfusion according to the needs of an individual patient, focusing on the choice of a suitable threshold for cerebral perfusion pressure.

Recent findings
Typically, vasopressors or vasodilators that do not directly influence the cerebral vascular bed are used to improve cerebral perfusion. Positive inotropic substances are rarely used, as the relationship between cardiac output and cerebral blood flow is complex and difficult to measure. Combining perfusion pressure monitoring with monitoring of brain metabolism or oxygenation to adapt cerebral perfusion to the needs of an individual patient has been disappointing. Recently, attempts to individualize perfusion pressure based on measurements of cerebrovascular autoregulation have shown promising results in the management of traumatic brain injury and during cardiac surgery. Currently, only preliminary data are available linking optimized cerebral perfusion to improved outcome.

Summary
Optimizing cerebral perfusion remains a difficult goal. All our attempts to manipulate brain perfusion are influenced in an unpredictable manner by underlying diseases. Autoregulation-based strategies to individualize cerebral perfusion management warrant further investigation.
Antiseizure medications in critical care: an update
Authors: Allen Baxter , Vespa Paul M. 
Published: March 2019

Purpose of review
Seizures and status epilepticus are very common diagnoses in the critically ill patient and are associated with significant morbidity and mortality. There is an abundance of research on the utility of antiseizure medications in this setting, but limited randomized-controlled trials to guide the selection of medications in these patients. This review examines the current guidelines and treatment strategies for status epilepticus and provides an update on newer antiseizure medications in the critical care settings.

Recent findings
Time is brain applies to status epilepticus, with delays in treatment corresponding with worsened outcomes. Establishing standardized treatment protocols within a health system, including prehospital treatment, may lead to improved outcomes. Once refractory status epilepticus is established, continuous deep sedation with intravenous anesthetic agents should be effective. In cases, which prove highly refractory, novel approaches should be considered, with recent data suggesting multiple recently approved antiseizure medications, appropriate therapeutic options, as well as novel approaches to upregulate extrasynaptic γ-aminobutyric acid channels with brexanolone.

Summary
Although there are many new treatments to consider for seizures and status epilepticus in the critically ill patient, the most important predictor of outcome may be rapid diagnosis and treatment. There are multiple new and established medications that can be considered in the treatment of these patients once status epilepticus has become refractory, and a multidrug regimen will often be necessary.
Nutritional and metabolic supplementation for the injured brain: an update
Authors: Quintard Hervé , Ichai Carole 
Published: March 2019

Purpose of review
Energy dysfunction is increasingly recognized as a key factor in the pathogenesis of acute brain injury (ABI). This one characterized by a high metabolic rate and nitrogen loss is often associated with an undernutrition support. We review the metabolism evolution and nutritional status in brain injured patient and summarize evidence on nutritional support in this condition.

Recent findings
The role of nutrition support for improving prognosis in brain injured patient has been underlined recently. A fast nutrition institution whatever the route is essential to prevent an imbalance in caloric support. Moreover, hypermetabolic state must be prevented with a sufficient nitrogen support. Glycemic control is particularly relevant in this group of patient, with the discovery of new fuel that could potentially improve cerebral metabolism and replace glucose. Few data support also the use of immunonutrition input in this group of patients.

Summary
Nutritional support is a key parameter in brain injured patient and must be initiated quickly to counteract hypermetabolic state by caring to improve caloric and nitrogen input. Recent clinical data support the use of immunonutrition, glutamine and zinc in this particular setting.
Pharmacotherapy of sodium disorders in neurocritical care
Authors: Mrozek Ségolène , Rousset David , Geeraerts Thomas 
Published: March 2019

Purpose of review
To describe the pathophysiology and pharmacotherapy of dysnatremia in neurocritical care patients.

Recent findings
Sodium disorders may affect approximately half of the neurocritical care patients and are associated with worse neurological outcome and increased risk of death. Pharmacotherapy of sodium disorders in neurocritical care patients may be challenging and is guided by a careful investigation of water and sodium balance.

Summary
In case of hyponatremia, because of excessive loss of sodium, fluid challenge with isotonic solution, associated with salt intake is the first-line therapy, completed with mineralocorticoids if needed. In case of hyponatremia because of SIADH, fluid restriction is the first-line therapy followed by urea if necessary. Hypernatremia should always be treated with hypotonic solutions according to the free water deficit, associated in case of DI with desmopressin. The correction speed should take into consideration the symptoms associated with dysnatremia and the rapidity of the onset.
Assessment and management of coagulopathy in critically-ill patients with liver failure
Authors: Saner Fuat H. , Bezinover Dmitri 
Published: March 2019

Purpose of review
This review provides insight into our current understanding of the pathophysiology and treatment of coagulopathy associated with liver failure, and bleeding risk assessment.

Recent findings
Patients with end-stage liver disease (ESLD) have a rebalanced coagulation profile and are at risk for both excessive clotting and bleeding. Hypercoagulability is associated with profound endothelial dysfunction and an increased concentration of liver-independent coagulation factors. Because of this rebalanced coagulation profile, standard laboratory tests have been demonstrated to be ineffective in either predicting and/or guiding the management of coagulopathy. Viscoelastic testing, however, is able to provide a dynamic assessment of clot formation in whole blood and has been demonstrated to be invaluable in both monitoring and management of coagulation problems associated with liver failure. More recently, there is increasing interest in thrombin generation tests to monitor coagulation in patients with ESLD.
Multiple institutional protocols for prophylaxis and treatment of ESLD-related thromboses have been developed. High-quality studies evaluating these approaches are lacking.

Summary
Patients with ESLD are at risk for excessive bleeding and clotting. Treatment of any significant coagulopathy should not be based solely on standard laboratory tests. Thrombosis prophylaxis has to be considered in susceptible populations.
Inverse regulation of serum osteoprotegerin and tumor necrosis factor-related apoptosis-inducing ligand levels in patients with leg lesional vascular calcification
Authors: Moon Ae Ran , Park Yoonkyung , Chang Jeong Hwan , Lee Sang Su 
Published: March 2019

AbstractWe hypothesized that circulating osteoprotegerin (OPG) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) levels could be associated with vascular calcification, which is predominant in diabetes.The study included 71 Korean participants (36 with diabetes and 35 without diabetes), who were sub-grouped according to the results of the ankle–brachial index (ABI) and/or X-ray computed tomography scan (CT scan). Serum OPG and TRAIL levels were assayed using the respective enzyme-linked immunosorbent assay kits. Statistical significance was analyzed using Student'sttest between the 2 groups or analysis of variance (ANOVA) among the 4 groups.Serum OPG was up-regulated in the participants with diabetes, with peripheral arterial disease (PAD), and/or with vascular calcification. TRAIL down-regulation was more strictly controlled than OPG up-regulation; it was significantly downregulated in the participants with PAD and vascular calcification, but not in the participants with diabetes. Serum OPG and TRAIL were regulated in the participants with femoral, popliteal, and peroneal artery calcification but not in the participants with aortic calcification.OPG up-regulation and TRAIL down-regulation were found to be associated with leg lesional vascular calcification; therefore, the average OPG/TRAIL ratio was significantly increased by 3.2-fold in the leg lesional vascular calcification group.
Spontaneous resolution of dermatomyositis associated with fallopian-tube carcinoma following staging surgery
Authors: Lin Chen , Ying Zheng , Sijing Chen 
Published: March 2019

Abstract

Rationale:
Paraneoplastic dermatomyositis (DM) is an inflammatory disease of the connective tissue caused by immunologic events in the presence of malignant tumors, which are typically related to ovarian, pancreatic, stomach, and colon cancer. Traditional treatment of paraneoplastic DM includes combination therapy for the underlying malignancy with systemic steroids.

Patient concerns:
A 41-year-old woman presented with facial erythema and myalgia of the extremities.

Diagnosis:
The patient was diagnosed with DM associated with a fallopian-tube carcinoma.

Interventions:
The cancer staging surgery was performed via muilt-port laparoscope and administered 6 cycles of adjuvant chemotherapy with paclitaxel (210 mg) and carboplatin (600 mg) right ovary and the left fallopian tube were removed laparoscopically.

Outcomes:
The DM healed spontaneously without the use of general glucocorticoids after the cancer staging surgery. During the 9-month follow-up, no recurrence of DM or neoplasm was observed.

Lessons:
This case highlights the fact that paraneoplastic DM can heal spontaneously after therapy for the underlying neoplasm, thereby avoiding the use of systemic steroids and their side effects. Moreover, DM can be an initial symptom for gynecological cancer such as fallopian-tube cancer. Thus, if DM is refractory to standard treatment, gynecological neoplasms should be considered.
Langerhans cell sarcoma arising from antecedent langerhans cell histiocytosis
Authors: Yi Wu , Chen Wan-yuan , Yang Tian-xin , Lan Jian-ping , Liang Wen-na 
Published: March 2019

Abstract

Rationale:
Langerhans cell sarcoma (LCS) is a rare, high-grade neoplasm characterized by overtly malignant cytologic features and a poor prognosis. Herein, we present a rare case of langerhans cell histiocytosis (LCH) that later transformed into langerhans cell sarcoma 11 months after the benign mass was excised from soft tissue in the right groin.

Patient concerns:
A 41-year-old patient who presented with a mass in the right groin for 3 years earlier after being bitten by ants.

Diagnoses:
The patient was diagnosed with langerhans cell sarcoma arising from antecedent langerhans cell histiocytosis.

Interventions:
The patient underwent with 6 cycles of a modified etoposide, cyclophosphamide, vindesine, dexamethasone (E-CHOP) regimen.

Outcomes:
The patient is currently receiving follow-up care.

Lessons:
LCH transformed into LCS is a rare case. E-CHOP as an effective first-line therapy to treat LCS cases, but, the mechanism is unclear. Due to their rarity, further data on clinical outcomes are necessary to establish the optimal treatment strategy for LCS.
Idiopathic hypereosinophilic syndrome presenting with multiple organ damage
Authors: Wu Peng , Chen Yuanguo , Zhang Haibo , Li Chen 
Published: March 2019

Abstract

Rationale:
Idiopathic hypereosinophilic syndrome (IHES) is a rare disease in which patients which present with eosinophilia-associated damage. Previous studies focused on organ damage from increased eosinophilic granulocytosis. We report IHES in a patient who presented with multiple organ damage (MOD).

Patient concerns:
A 52-year-old male presented with MOD, including myocardial damage suggestive of myocardial infarction, cardiac tamponade, respiratory failure, skin damage, and gastrointestinal damage.

Diagnoses:
The absolute eosinophil count was 12,920/mm3, much higher than occurs in other diseases associated with eosinophilia (1500/mm3), and suggesting a diagnosis of IHES.

Interventions:
Prednisone combined with hydroxyurea.

Outcomes:
At 6 months after completion of drug treatment, the patient had no chest pain or dyspnea, and the results of a blood panel, chest computed tomography, and gastroscopy were normal.

Lessons:
MOD is very rare in patients with IHES. Patients receiving prompt diagnosis and treatment have very good prognoses.
Ultrasound-guided high-intensity focused ultrasound in the treatment of uterine fibroids
Authors: Fan Hong-Jie , Zhang Chao , Lei Hong-Tao , Cun Jiang-Ping , Zhao Wei , Huang Jian-Qiang , Zhai Yue 
Published: March 2019

Abstract
The aim of the present study was to investigate factors affecting ablation effect and safety of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids (UFs).
A retrospective analysis of 346 patients with symptomatic UFs who were treated with USgHIFU was performed. All UFs was grouped based on magnetic resonance imaging (MRI) characteristics before HIFU; all adverse events and treatment data were recorded during and after HIFU. One-way analysis of variance and multiple linear regression analysis were used to evaluate the effect of USgHIFU treatment and affecting factors.
The results showed that the mean age of patients was 38.3 ± 6.1 years, with the mean nonperfusion volume rate of 74.4 ± 14.7% and the mean energy efficiency factor (EEF) of 7.2 ± 4.8 J/mm3. Except for the size group, the ablation rate was significantly different (P < .001); and the anterior, intramural, hypointense (T2WI), and mild enhancement (T1WI contrast enhancement) UFs had the highest ablation rate. The EEF of the anterior, intramural, hypointense (T2WI), mild enhancement (T1WI contrast enhancement), and >5 cm UFs had minimum value, with a statistically significant difference (P < .01). According to multiple linear regression model, the distance from the UFs ventral side to the skin, enhancement type on T1WI, size of UFs, signal intensity on T2WI, location of UFs, type and volume of fibroids all had a line relationship with EEF, and the enhancement type on T1WI was the greatest factor affecting the ablation effect. Some patients (37.6%) had thermal injury of the sacrum on MRI, but no serious adverse events were observed.
Our results suggest that USgHIFU can be safely used and have a promising prospect for treating UFs, even though its effect may be affected by anatomical features, tissue characteristics, and blood supply.
BIM deletion polymorphism predicts poor response to EGFR-TKIs in nonsmall cell lung cancer
Authors: Su Wenxia , Zhang Xiaoyun , Cai Xin , Peng Meiyu , Wang Fengbin , Wang Yuliang 
Published: March 2019

Abstract

Background:
A germline deletion in BIM (B cell lymphoma-2-like 11) gene has been shown to impair the apoptotic response to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in vitro but its impact on response to EGFR-TKIs in patients of nonsmall cell lung cancer (NSCLC) remains controversial.

Methods:
Eligible literature were searched and screened. Objective response rate (ORR) and disease control rate (DCR) were extracted and aggregated with odds ratio (OR). Hazard ratio (HR) and 95% confidence interval (CI) for progression-free survival (PFS) and overall survival (OS) were extracted and aggregated based on random-effect model.

Results:
Fourteen studies including 2694 NSCLC patients were eligible. Individuals harboring BIM deletion polymorphism had inferior ORR (OR = 0.49, 95% CI: 0.34–0.70, P < .001), inferior DCR (OR = 0.50, 95% CI: 0.30–0.84, P = .009). Patients with BIM deletion had shorter OS despite of the heterogeneity between countries (in subgroup of South Korea and Taiwan, HR = 1.34, 95% CI: 1.18–1.53, P < .001; in subgroup of other countries, HR = 2.43, 95% CI: 2.03–2.91, P < .001). The pooled analysis of PFS showed great heterogeneity (I
2 = 79%). All the reported characteristics did not account for the heterogeneity. However, 2 subgroups could be obtained through sensitivity analysis. In one subgroup, patients with BIM deletion polymorphism had shorter PFS (HR = 2.03, 95% CI: 1.71–2.40, P < .001), while in the other subgroup, no significant difference was observed (HR = 0.92, 95% CI: 0.79–1.06, P = .25).

Conclusion:
NSCLC patients with BIM deletion polymorphism show poor ORR, DCR, and OS after EGFR-TKIs treatment. BIM deletion polymorphism indicates poor response to EGFR-TKIs, and it could be used as a predictor to identify those who would benefit from EGFR-TKIs in NSCLC patients.