bluuebunny/crossref_metadata_2025_split huggingface dataset:
MELAS and macroangiopathy
Authors: Sun Xiangrong , Jiang Guohui , Ju Xinyue , Fu Hongmei 
Published: December 2018

Abstract

Rationale:
Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) are thought to be rarely accompanied by macroangiopathy. We reported a case of MELAS that presented right distal internal carotid arterial (ICA) stenosis and reviewed 12 similar previously reported cases involving intracranial large blood vessels.

Patient concerns:
A 38-year-old man suffered from recurrent stroke-like episodes (SE) such as alternating hemiparesis (right lesion 3 years ago and current left lesion), cortical blindness and seizure for 3 years, and was previously misdiagnosed as cerebral infarction. Magnetic Resonance Angiography (MRA) and Digital Subtraction Angiography (DSA) revealed right distal ICA stenosis and sparse cortex blood vessels, which were related to the previous SE.

Diagnoses:
He was diagnosed by genetic screening (a mitochondrial DNA A3243G point mutation) and presence of high lactic acidosis (4.03 mmol/L), which rose to 7.8 mmol/L after exercise.

Intervention:
The patient received Coenzyme Q10, vitamin C, L-arginine for 2 weeks and valproic acid sodium (400 mg bid) to prevent seizures till now.

Outcomes:
He is currently less active and intelligent than his peers, with occasional seizures, and needs family care.

Lessons:
Till date, there are 12 reported cases of MELAS combined with major cerebral arteries abnormalities including stenosis, dissection, occlusion, reversible vasoconstriction, aneurysms, and atherosclerosis. Hence, macroangiopathy in MELAS is not very rare. There is correlation between the affected vessels and the lesions in some cases, but not in others, which may increase the misdiagnosis rate. Hence, mitochondrial diseases cannot be excluded due to concurrent macroangiopathic lesions
Foreign body in the thoracic spine due to a nail gun penetrating injury
Authors: Chen Chi-Wei , Yang Shih-Chia , Liu Kuan-Ting , Wu Yen-Hung 
Published: December 2018

Abstract

Rationale:
Spinal cord injuries could be catastrophic because they may result in severe neurovascular complications. Here, we present a case of thoracic spine-penetrating injury by a nail-gun.

Patient concerns:
A 60-year-old male presented to our emergency department with complaints of progressive right chest pain for 1 week that was preceded by back pain. He had a medical history of hypertension and denied any trauma history. He had alert consciousness and stable vital signs. He was a carpenter. Upon physical and neurological examination, no obvious wounds or vesicle formation were noted, and the patient was neurologically intact.

Diagnosis:
Laboratory test results showed abnormally elevated D-dimer levels. Electrocardiography showed normal sinus rhythm. Chest radiography showed no mediastinal widening. Chest computed tomography was performed. The formal radiology report indicated a foreign body in the T4-5 spinal cord and upper back.

Interventions:
A neurosurgeon was consulted with suggestion of operation. We performed T4-5 laminectomy and foreign body removal. The foreign body, stuck to the spinal cord with dural rupture, was removed and found to be a 5 cm-long broken nail.

Outcomes:
The pain resolved immediately post operation.

Lessons:
Surgical removal of the foreign body is recommended if neurovascular complications or cerebrospinal fluid (CSF) leak is detected. Obtaining the patient's complete history, including occupation, might be helpful in determining the diagnosis. Careful interpretation of diagnostic imaging is necessary for avoiding medical disputes. Even in the absence of wounds and ecchymosis, trauma-related injury should be considered.
Acute onset of autoimmune hepatitis with sinusoidal and central vein endotheliitis, and marked involvement of activated dendritic cells
Authors: Yokomori Hiroaki , Obu Makoto , Uematsu Takayuki , Okada Takemichi , Yamazaki Hitoshi , Oda Masaya 
Published: December 2018

Abstract

Rationale:
Autoimmune hepatitis (AIH) is characterised by interface hepatitis. However, some acute cases exhibit atypical centrilobular necrosis with mild portal inflammation. Detailed histological and ultrastructural analyses of acute AIH are limited.

Patient concerns:
A 44-year-old female was admitted to our hospital with jaundice, general fatigue and liver dysfunction. Her transaminase levels were elevated, her immunoglobulin G level was 1735 mg/dL and her anti-nuclear titres were ×80.

Diagnosis:
AIH was diagnosed, and histochemical examination of a liver biopsy showed the presence of atypical histological features of prominent centrilobular necrosis and central vein and hepatic sinusoidal endotheliitis. Electron microscopy showed that dendritic cells (DCs) and lymphocytes were attached to disrupted liver sinusoidal endothelial cells (LSECs) in hepatic sinusoids and that DCs attached to LSECs via pseudopods in the central vein.

Interventions and outcomes:
The patient was started on 40 mg/day prednisolone to control the hepatic inflammation. Her aspartate and alanine aminotransferase levels started declining after prednisolone was initiated. Three weeks later, these levels had normalised. The dosage of prednisolone was gradually decreased as liver function improved. The patient remains under observation and continues to receive 2.5 mg prednisolone.

Lessons:
An important marker of acute AIH may be the presence of activated DCs in the hepatic sinusoids and central vein.
CT-quantified muscle and fat change in patients after surgery or endoscopic resection for early gastric cancer and its impact on long-term outcomes
Authors: Choi Moon Hyung , Kim Kyung Ah , Hwang Seong Su , Byun Jae Young 
Published: December 2018

Abstract
The purpose of this study was to evaluate the impact of the body composition changes on patients’ long-term outcomes after endoscopic resection or surgery for mucosal gastric cancer.
This case-control study included 96 patients who underwent endoscopic resection or surgery after propensity score matching. Areas of fat and muscle measured on CT were compared between the 2 groups. The effects of the variables on disease-free and overall survival were assessed using Cox-regression analysis and Kaplan-Meier survival analysis.
The median overall survival of the surgical and endoscopic resection groups was 91.1 and 93.9 months (P = .080). Fat area was decreased significantly more after surgery (P < .001). The number of patients with sarcopenia was increased in the surgery group. Kaplan–Meier plot showed that overall survival was significantly correlated with post-treatment sarcopenia (P = .049).
CT-based body composition analysis was helpful to evaluate the change in fat and muscle areas after treatment of early gastric cancer. The losses of fat and muscle after treatment were negatively associated with the patient overall survival.
A case report of cerebral infarction caused by polycythemia vera
Authors: Ren Shan , Gao Fang , Chen Zhigang , Wang Zhiqun 
Published: December 2018

Abstract

Rationale:
Polycythemia vera (PV) is a cloned erythrocytotic disease manifested by high proliferation and apoptosis in the bone marrow. The clinical symptoms of PV are occult. In practice, patients with cerebral infarction caused by PV are prone to misdiagnosis and missed diagnosis.

Patient concerns:
Here, we report a misdiagnosis of PV leading to cerebral infarction. The patient was a middle-aged woman who was diagnosed with acute cerebral infarction in the outpatient hospital. After treatment, the patient still had left hemiplegia, dizziness and other symptoms and was admitted to our hospital.

Diagnosis:
We did not find sufficient evidence of atherosclerotic processes in the brain infarction. However, the patient's signs and laboratory examination indicated a high suspicion of PV. A series of further examinations confirmed the final diagnosis.

Interventions:
Bone marrow suppression medications (oral hydroxyurea and subcutaneous injection of interferon) were given and subsequent prevention of cerebral infarction was implemented.

Outcomes:
Routine blood reexamination was normal and no further cerebral infarction occurred.

Lessons:
Patients with acute cerebral infarction should be considered comprehensively, and rare causes should not be ignored. It is crucial that PV be diagnosed and treated as early as possible, which can significantly improve the prognosis of patients.
Associations between vitamin D deficiency, musculoskeletal health, and cardiometabolic risk among community-living people in Taiwan
Authors: Chen Chia-Hung , Liu Li-Kuo , Chen Mei-Ju , Lee Wei-Ju , Lin Ming-Hsien , Peng Li-Ning , Chen Liang-Kung 
Published: December 2018

Abstract
The role of serum vitamin D (Vit D) in cardiometabolic and muscle health remains unclear. The study aimed to evaluate associations of Vit D and factors of healthy aging among community-living middle-aged and older people in Taiwan. Analytic data on 1839 community-living older adults were excerpted from I-Lan Longitudinal Aging Study. All participants were collected demographic characteristics, serum Vit D, functional assessment, and cardiometabolic risk factors. The prevalence of Vit D insufficiency and deficiency in this study was 50.5% and 33.6%, respectively. Among 617 participants with Vit D deficiency, 72.3% of them were women. In multivariate logistic regression, the independent risk factors of Vit D deficiency were male gender (odds ratio [OR]: 0.266; 95% confidence interval [CI]: 0.213–0.333; P < 0.001), higher BMI (OR: 1.036; 95% CI: 1.005–1.067; P = 0.022), high total cholesterol (OR: 1.437; 95% CI: 1.160–1.779; P = 0.001), and high triglyceride (OR: 1.865; 95% CI: 1.446–2.404; p < 0.001). In multinomial logistic regression for 3-level Vit D status analysis, similar trend was found among participants with Vit D insufficiency. Insulin resistance increased in 2.31 and 1.71-folds in Vit D deficiency and insufficiency groups. Besides, association between Vit D deficiency and osteopenia was found only in women. In conclusion, Vit D deficiency was more common in women, and associated with poorer musculoskeletal health and higher cardiovascular and metabolic risk, including higher BMI, DBP, insulin resistance, total cholesterol, and triglyceride.
Preoperative lymphocyte-to-monocyte ratio (LMR) could independently predict overall survival of resectable gastric cancer patients
Authors: Pan Yu-Chen , Jia Zhi-Fang , Cao Dong-Hui , Wu Yan-Hua , Jiang Jing , Wen Si-Min , Zhao Dan , Zhang Song-Ling , Cao Xue-Yuan 
Published: December 2018

Abstract
Preoperational hemogram parameters have been reported to be associated with the prognosis of several types of cancers. This study aimed to investigate the prognostic value of hematological parameters in gastric cancer in a Chinese population. A total of 870 gastric cancer patients who underwent radical tumorectomy were recruited from January 2008 to December 2012. Preoperative hematological parameters were recorded and dichotomized by time-dependent receiver operating characteristic curves. The survival curves of patients stratified by each hematological parameter were plotted by the Kaplan–Meier method and compared by log-rank test. Multivariate Cox proportional hazards models were used to select parameters independently correlated with prognosis. The median age of the patients was 60 years. The median follow-up time was 59.9 months, and the 5-year survival rate was 56.4%. Results from the univariate analyses showed that low lymphocyte count (<2.05 × 109/L), high neutrophil-to-white blood cell ratio (NWR > 0.55), low lymphocyte-to-white blood cell ratio (LWR < 0.23), low lymphocyte-to-monocyte ratio (LMR < 5.43), high neutrophil-to-lymphocyte ratio (NLR > 1.44), and high platelet-to-lymphocyte ratio (PLR > 115) were associated with poor survival of gastric cancer patients. Multivariate analysis showed that low LMR (HR: 1.49, 95% CI: 1.17–1.89, P = .001) was the only hematological factor independently predicting poor survival. These results indicate that preoperational LMR is an independent prognostic factor for patients with resectable gastric cancer.
Methylation status of the stimulator of interferon genes promoter in patients with chronic hepatitis B
Authors: Wu Chen-Si , Zhao Qian , Zhang Jun , Wang Jing-Wen , Qian Yu , Fan Yu-Chen , Wang Kai 
Published: December 2018

Abstract
The stimulator of interferon genes (STING) plays a crucial role in the recognition of a viral infection and subsequent stimulation of an immune response. However, it is unclear whether methylation of the STING promoter affects STING transcription and response to antiviral therapy. The present study determined the methylation status of the STING promoter in patients with chronic hepatitis B (CHB).
This study included 198 participants, of which 159 participants had CHB and 39 were healthy controls (HCs). Methylation-specific polymerase chain reaction was performed to detect the methylation status of the STING promoter. Reverse transcription-quantitative polymerase chain reaction was performed to determine STING mRNA level in peripheral blood mononuclear cells.
The methylation frequency of the STING promoter was significantly higher and STING mRNA level was lower in the patients with CHB than in the HCs. Presence of hepatitis B virus (HBV) DNA was independently correlated with an increased risk of STING promoter methylation. Virological response frequency was higher in the patients with CHB receiving entecavir (ETV) than in those receiving adefovir (ADV). In the ETV group, the virological response frequency was evidently lower in the patients with CHB having methylated STING promoters than in those having unmethylated STING promoters. However, there was no significant difference in the virological response frequency between ADV-treated patients having methylated and unmethylated STING promoters.
These results indicate that the hypermethylation of the STING promoter and thus the transcriptional repression of STING weaken the effect of STING in inhibiting HBV replication and decreases the effectiveness of antiviral therapy.
The use of testicular prostheses in boys
Authors: Osemlak Paweł , Jędrzejewski Grzegorz , Cielecki Czesław , Kalińska-Lipert Anita , Wieczorek Andrzej , Nachulewicz Paweł 
Published: December 2018

Abstract
Lack of the testis is an important factor in psycho-sexual development of the boys, and implantation of the prosthesis plays a very essential role in the treatment of that group of patients. Currently there are no standards regarding when prosthesis should be implanted, and which access is connected with minimal rates of complications. We present our experience of primary prosthesis implantations in boys treated in our department.
From 2000 to 2014, primary implantation of the testicular prosthesis was performed in 290 boys. The early and late post-operative complications and long-term therapeutic results were analyzed, considering age at the time of implantation, the time between the initial operation and implantation of the prosthesis, and the surgical approach.
Best results were observed in 267 patients and bad outcome in 23 patients. Prosthesis implantation in young boys operated within the first three years of life or during the first year after primary surgery was connected with statistically fewer complications (P = .002 and P < .05, respectively). Supra-scrotal access was connected with the lowest rate of complications (P = .01).
Long-term therapeutic results in boys with testicular prostheses were good in the majority of cases. Implantation of the first prosthesis should be performed early between 1 and 3 years of life in boys with lack of the testis. Implantation of a prosthesis should also be performed within 1 year after removing of testis or during orchiectomy. Supra-scrotal access should be chosen for testicular prosthesis implantation due to the best long-term results.
Correlation analysis between depression and family fitness in chronic obstructive pulmonary disease inpatients
Authors: Deng Xuexue , Song Jinping 
Published: December 2018

Abstract
To explore the relationship between depression and family fitness in chronic obstructive pulmonary disease (COPD) inpatients.
COPD inpatients (280) in our hospital from Jan to June 2016 were included. Depression level and family fitness were quantified with self-rating depression scale (SDS) and Adaptability, Partnership, Growth, Affection, and Resolve (APGAR) test. The relationship and correlation of SDS value and APGAR score was analyzed.
Family fitness for all COPD inpatients was grossly well, among which 93 patients (34.87%) experienced medium-to-severe family unfitness. Further analysis shows that better fitness correlated with less depression and worse fitness correlated with more depression. Depression levels were significantly different in patients under family fitness. Inpatients were grossly in light depression, among which 186 (69.66%) patients exhibited depression symptoms. Family fitness was significantly different among patients with different levels of depression. Correlation analysis showed that depression level was negatively correlated with family fitness.
Depression in patients is significantly correlated with family fitness. The condition of patients can be improved by active family fitness and patients’ interactions with family members. Thus involvement of family member during admitting should be encouraged.
Laparoscopic total extraperitoneal inguinal hernia repair
Authors: Georgiou Efi , Schoina Elina , Markantonis Sophia-Liberty , Karalis Vangelis , Athanasopoulos Panagiotis G. , Chrysoheris Periklis , Antonakopoulos Fotis , Konstantinidis Konstantinos 
Published: December 2018

Abstract
Laparoscopic inguinal hernia repair is one of the most frequently performed operations. However, the search for the most appropriate prosthetic materials continues to occupy the surgical community. The purpose of this study was to evaluate the postoperative short- and mid-term effects (like duration of stay, number and type of complications, and inguinal pain) of laparoscopic inguinal hernia repair using the total extraperitoneal (TEP) approach. The evaluation encompassed different types of mesh and fixation devices, as well as medications prescribed during hospitalization.
This retrospective study was conducted at the General, Laparoendoscopic, Bariatric, and Robotic Surgical Clinic of the Athens Medical Center. Clinical data from 524 patients were evaluated. The answers from an appropriately designed questionnaire completed from each individual were used to obtain information about their postoperative course. The statistical analysis was implemented in SPSS v 23.
Analysis revealed that pain sensation on discharge decreased with increasing age (P < .05). No clear relationship was found between surgical clips and pain (P = .292), as well as mesh absorbability and chronic pain (P = .539). The major postoperative complications were annoyance and discomfort (15.9%). The recurrence rate was 1.7%.
Postoperative complications following the TEP approach were mostly found to be minor; chronic pain, as an aspect of impaired quality of life, was not experienced in the majority (89.08%). The properties of prosthetic materials used and the type of medications prescribed were not found to exert a significant role in satisfactory postoperative outcomes.
Ethical Issues in Aesthetic and Reconstructive Surgical Innovation: Perspectives of Plastic Surgeons
Authors: Lee Z-Hye , Reavey Patrick L. , Rodriguez Eduardo D. , Chiu Ernest S. , Caplan Arthur L. 
Published: December 2018

Summary:
Innovative surgery is defined as a novel procedure, a significant modification of a standard technique, or a new application of an established technique. Although innovation is a crucial part of improving patient care in plastic surgery, there are various ethical considerations and dilemmas in performing unvalidated techniques and procedures, especially for non–life-threatening indications. The aim of this study was to gain a better understanding regarding the motivations and ethical considerations of plastic surgeons in their decision to perform innovative operations. An anonymous, institutional review board–approved, online survey was sent to members of the American Society of Plastic Surgeons and other international plastic surgeons worldwide. The survey asked respondents to rank various factors that influence their decisions to perform innovative plastic surgery, both reconstructive and aesthetic, on a five-point Likert scale. Seven hundred thirty-three of 26,028 plastic surgeons (response rate, 2.9 percent) responded to the survey. Although similar factors were considered to be important for both reconstructive and aesthetic operations, only approximately 50 percent of respondents considered institutional review board approval to be an important factor when considering innovation in both reconstructive (50 percent) and aesthetic surgery (51 percent), suggesting that respondents do not consider innovation a form of research that ought be subject to standard research protections. Overall, the authors’ survey suggests that more effort must be extended to ethical training in plastic surgery to create a stronger professional atmosphere regarding innovation and, possibly, to the creation of a more formal group charged with oversight of innovation.
Volumetric Changes of the Mid and Lower Face with Animation and the Standardization of Three-Dimensional Facial Imaging
Authors: Rawlani Roshni , Qureshi Hannan , Rawlani Vinay , Turin Sergey Y. , Mustoe Thomas A. 
Published: December 2018

Background:
The objective of this study was to quantify volumetric changes of the mid and lower face caused by facial expression to understand how procedural results measured by three-dimensional imaging can be influenced by lack of standardization. Secondarily, the study identified soft-tissue surface landmarks that can be used to ensure the standardization of three-dimensional images.

Methods:
Three-dimensional facial images of subjects performing 22 facial expressions or changes in head position were captured. Variable degrees of animation during smiling and frowning were also evaluated. Volumetric changes of the malar and jowl regions were quantified using a three-dimensional superimposed image subtraction technique. The translation of 14 standard soft-tissue surface landmarks was assessed during various facial animations to determine which three-dimensional landmarks can be used to standardize three-dimensional images.

Results:
Twenty subjects participated in the study. Sixteen of the 22 facial expression studies had a significant effect on malar and/or jowl volume. Significant volume changes were noted with subtle animation during smiling and frowning. A combination of five landmarks (i.e., glabella, bilateral cheilion, pogonion, and laryngeal prominence) can be used to standardize three-dimensional images for evaluation of mid and lower facial volume changes.

Conclusions:
Subtle facial expressions may cause significant volumetric changes in the mid and lower face that can mimic the desired outcomes of surgical and nonsurgical facial rejuvenation procedures. The five-point referencing system allows one to identify subtle changes in head position and facial expression and may aid in the standardization of three-dimensional images.