bluuebunny/crossref_metadata_2025_split huggingface dataset:
The latest diagnostic criteria and treatment options for neuromyelitis optica
Authors: Moore Randy R. , Tanner Meagan 
Published: October 2019

ABSTRACT
Neuromyelitis optica, also known as Devic disease, is an autoimmune disorder that affects the spinal cord and optic nerve. This atypical demyelinating syndrome can be difficult to diagnose and responds poorly to treatments that are used for multiple sclerosis, a similar demyelinating disease. This article discusses the epidemiology, pathophysiology, clinical presentation, latest diagnostic criteria, and treatment options for neuromyelitis optica and neuromyelitis spectrum disorders.
What is the role of triple inhaled therapy in COPD?
Authors: Petite Sarah E. 
Published: October 2019

ABSTRACT
Triple inhaled therapy for maintenance of chronic obstructive pulmonary disease (COPD) consists of an inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting beta2-agonist. Recent clinical studies evaluating triple therapy found a reduction in COPD exacerbations compared with other combination therapies. This article discusses the role of triple therapy in treating patients with COPD.
Association Between Excessive Weight Gain During Pregnancy and Persistent Low Back and Pelvic Pain After Delivery
Authors: Matsuda Naoka , Kitagaki Kazufumi , Perrein Emeline , Tsuboi Yamato , Ebina Aoi , Kondo Yuki , Murata Shunsuke , Isa Tsunenori , Okumura Maho , Kawaharada Rika , Horibe Kana , Ono Rei 
Published: October 2019

Study Design.
Retrospective study.

Objective.
To investigate the association between gestational weight gain (GWG) during pregnancy and persistent low back and pelvic pain (LBPP) after delivery.

Summary of Background Data.
Persistent LBPP after delivery is a risk factor for developing depression and chronic pain as well as incurring sick leave. Women experience weight gain during pregnancy. Excessive weight gain places a greater burden on the musculoskeletal system. However, little is known about how GWG is associated with LBPP after delivery.

Methods.
After Ethics Committee approval, we analyzed 330 women at 4 months after delivery who had LBPP during pregnancy. The exclusion criteria were as follows: specific low back pain, multiple birth, and incomplete data. Four months after delivery, LBPP was assessed using a self-report questionnaire. Persistent LBPP was defined as pain at 4 months after delivery with an onset during pregnancy or within 3 weeks after delivery. GWG was calculated as the difference between the pregnancy weight and the prepregnancy weight, which we categorized into three groups: <10, 10 to <15, and ≥15 kg. Other confounding factors including age, height, weight at 4 months after delivery, parity, gestational week, mode of delivery, weight of the fetus, and prepregnancy LBPP were assessed. We used logistic regression analysis to calculate LBPP odds ratios (ORs) according to GWG.

Results.
The prevalence of persistent LBPP was 34.1% (n = 113). Compared with women with a GWG of <10 kg, women with a GWG of ≥15 kg had a higher prevalence of persistent LBPP (OR = 2.77, 95% confidence interval (95% CI) = 1.28–5.96, adjusted OR = 2.35, 95% CI = 1.06–5.21); however, no significant difference was found for women with a GWG of 10 to <15 kg (OR = 1.18, 95% CI = 0.72–1.92, adjusted OR = 1.02, 95% CI = 0.61–1.72).

Conclusions.
Our study showed that excessive weight gain during pregnancy is one of the risk factors of persistent LBPP. Appropriate weight control during pregnancy could help prevent persistent LBPP after delivery.

Level of Evidence: 3
Utility of Physiologically Based Pharmacokinetic Modeling in Point-of-Care Decisions: An Example Using Digoxin Dosing in Continuous Venovenous Hemodiafiltration
Authors: Srinivasan Meenakshi , Hirani Raiz , Tsiu Melissa , Kabani Khadija , Chaturvedula Ayyappa , Palasik Brittany 
Published: October 2019

Abstract:
We describe the case of a patient on continuous venovenous hemodiafiltration with atrial fibrillation with rapid ventricular response and hypotension requiring vasopressor use, which warranted digoxin therapy. In the absence of guidelines specifying appropriate digoxin dosing in patients undergoing continuous venovenous hemodiafiltration, anecdotal evidence-guided digoxin dosing was performed for this patient using plasma digoxin concentration-based therapeutic drug monitoring. We use this case to demonstrate the potential role of physiologically based pharmacokinetic modeling in assisting therapeutic decision making.
A Modified Levator Resection to Improve Postoperative Lagophthalmos and Eyelid Lag
Authors: Al-Faky Yasser H. , Abu El-Eneen Mohamed A. , Selim Khaled M. , Ali Hassan A. 
Published: October 2019

Releasing the central attachment between levator palpebrae superioris muscle and Whitnall’s ligament during levator aponeurosis resection allows better levator excursion and minimizes postoperative lagophthalmos, eyelid lag, and corneal complications.

Purpose:
To assess the effect of releasing the central attachment between the Whitnall’s ligament (WL) and the levator palpebrae superioris muscle on the postoperative levator function (LF), eyelid lag, and degree of lagophthalmos.

Methods:
This retrospective case-control study included patients with moderate and severe simple congenital ptosis who underwent skin approach levator aponeurosis resection (LR) as a primary procedure with a minimum of 6-month follow up. Patients were divided into 2 groups; the first group underwent LR without WL release (control group) while the second group underwent LR with WL release. Preoperative demographics and clinical data were reviewed. Postoperative LF, eyelid lag, and degree of lagophthalmos as well as surgical outcomes were compared and analyzed in both groups.

Results:
A total of 81 patients (88 eyelids) were included in this study. There were 50 males (61.7%). The mean age was ±SD 12.0 ± 9.5 years. The first group included 43 eyelids while the second had 45 eyelids. There was no statistical difference in demographics and preoperative data between both groups. The postoperative LF was higher in the second group (10.7 ± 2.1 mm) with less consecutive eyelid lag compared with the control group (7.8 ± 1.9 mm) (p < 0.001). The control group had acquired more postoperative lagophthalmos compared with the second group (p < 0.001). Complete surgical success was achieved in 82.2% in the second group compared with 60.5% in the control group (p = 0.024).

Conclusions:
Releasing the central attachment between WL and levator palpebrae superioris muscle has achieved an improvement in LF with minimal postoperative eyelid lag, lagophthalmos, and corneal complications.
Glaucoma Filtering Bleb Analysis Before and After Aponeurotic Blepharoptosis Surgery
Authors: Yunoki Tatsuya , Tojo Naoki , Oiwake Toshihiko , Otsuka Mitsuya , Hayashi Atsushi 
Published: October 2019

In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be highly safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.

Purpose:
To evaluate the effectiveness and safety of aponeurotic blepharoptosis surgery and the morphology of filtering bleb in patients with filtrating bleb.

Methods:
This retrospective case series included 7 consecutive patients (9 eyes) with filtering bleb after trabeculectomy. They underwent transcutaneous levator aponeurotic advancement from May 2018 to April 2019. The authors evaluated margin reflex distance-1 and intraocular pressure and analyzed filtering bleb morphology, such as filtering bleb volume, filtering bleb height, and filtering bleb wall thickness, using anterior segment optical coherence tomography before and after aponeurotic advancement. The authors also evaluated intra and postoperative complications.

Results:
The mean age was 75.6 ± 7.8 years; the mean duration from glaucoma surgery to blepharoptosis surgery was 36.9 ± 26.8 months; the mean follow-up after blepharoptosis surgery was 6.1 ± 2.9 months. The mean margin reflex distance-1 value changed significantly from 0.7 ± 0.8 mm before surgery to 3.3 ± 0.4 mm after surgery (p < 0.0001). The mean intraocular pressure showed no significant change from 12.9 ± 2.6 mm Hg before surgery to 12.7 ± 3.3 after surgery. In the filtering bleb analysis using anterior segment optical coherence tomography no significant differences were found, such as in bleb volume, height and wall thickness, before and after blepharoptosis surgery. There were no intraoperative complications in any of the cases. A postoperative corneal disorder was seen in 1 eye, but there was no infection of or damage to filtering bleb in any of the cases during the postoperative follow-up period.

Conclusions:
In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.
Feasibility and performance of catheter ablation with zero-fluoroscopy approach for regular supraventricular tachycardia in patients with structural and/or congenital heart disease
Authors: Morka Aleksandra , Śledź Janusz , Deutsch Karol , Ludwik Bartosz , Zagrodzka Magdalena , Szydłowski Lesław , Stec Sebastian 
Published: October 2019

Abstract
Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).
Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.
Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ± 13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ± 16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ± 24.6 vs 49.1 ± 23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P
= .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).
ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.
Thoracic myelopathy caused by an extremely rare aberrant epidural ligament
Authors: Hirai Takashi , Yoshii Toshitaka , Tanimoto Takahiro , Ushio Shuta , Sasaki Shinichi , Inose Hiroyuki , Yuasa Masato , Okawa Atsushi 
Published: October 2019

Abstract

Rationale:
The meningovertebral ligaments are a group of tissues that connect the dura and the vertebral bone. Abnormal fibrous ligaments in the canal space, which are essentially different from these ligaments, have been identified and their presence very rarely results in spinal disorder.

Patient concerns:
A 20-year-old Mongolian woman had developed persistent headache at 15 years of age. She then became unable to run fast when she was 19 years old and had progressively declining ability to move. She complained of back pain and unstable gait 6 months prior to presentation. Physical examination revealed exaggerated deep tendon reflexes in the lower extremities and decreased proximal leg muscle strength bilaterally.

Diagnoses:
Magnetic resonance imaging (MRI) revealed abnormal bands compressing the spinal cord at the T10/11 level, with large epidural lipomatosis dorsal to the dural tube.

Intervention:
To decompress the cord, posterior laminectomy for T3-L3 and removal of the heterotopic ligaments were performed with T8-L1 posterior fusion.

Outcomes:
Sufficient decompression of the cord was noted on postoperative MRI at the affected segments. The patient could subsequently walk without a cane and headache resolved immediately after the operation.

Lessons:
The presence of an aberrant epidural band is a rare pathologic state that often coexists with a surrounding lipomatosis and can lead to spinal cord compression. Removal of the band is a promising treatment for myelopathy caused by the compressive lesion.
Preoperative prolonged fasting causes severe metabolic acidosis
Authors: Zhou WenQin , Luo LinLi 
Published: October 2019

Abstract

Rationale:
Preoperative prolonged fasting may cause starvation ketoacidosis. Herein, we report of a case of starvation ketoacidosis due to long-term fasting before surgery.

Patient concerns:
We report of a case of metabolic acidosis due to prolonged fasting in a previously healthy 44-year-old woman during a total laparoscopic hysterectomy. Hyperventilation was observed to occur when the surgery was completed. Metabolic acidosis and hypoglycemia were demonstrated by blood gas analysis of the radial artery.

Diagnosis:
Metabolic acidosis.

Interventions:
The patient received sodium bicarbonate and 5% glucose fluid at the end of the surgery.

Outcomes:
The tracheal tube was successfully removed when the tidal volume of the patient returned to normal after the therapy. However, the patient suffered pulmonary edema when she was transferred to the intensive care unit (ICU). With treatments with furosemide and sodium bicarbonate, acidosis and pulmonary edema were completely corrected at 8 hours after the surgery. On the second day after the surgery, the patient suffered nausea and vomiting. Nausea and vomiting were not completely relieved on the sixth day after the operation; therefore, the patient was transferred to the Department of Gastroenterology for further therapy.

Lessons:
This case suggests that although the concept of enhanced recovery after surgery (ERAS) has been adopted by most physicians because of its positive outcomes, the issue of prolonged fasting still exists, and such patients may be exposed to the risk of starvation ketoacidosis.
Clinical study of ultrasound-guided transversus abdominis plane block for analgesia after cesarean section
Authors: Gao Yuanchao , Guo Mengzhuo , Du Chunyan , Zhang Haijing , Zhang Huan 
Published: October 2019

AbstractBackground:Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia are 2 common methods of maintaining analgesia after cesarean section. In recent years, transversus abdominis plane block (TAPB) has been gradually applied clinically to reduce opioid analgesics and has achieved good results. Therefore, we performed this study to compare the efficacy and side effects of TAPB and PCIA in analgesia after cesarean section.Methods:One hundred patients who underwent cesarean section were randomly classified into 2 groups. Following surgery, one group underwent ultrasound-guided TAPB and the other group underwent PCIA. Pain intensity according to the visual analog scale (VAS; 0 for no pain and 10 for severe intolerable pain) was assessed at 2, 4, 6, 8, 12, and 24-hour postsurgery in both groups. The postoperative complication rate and patient satisfaction were also measured.Results:No significant differences were found in the VAS scores between the groups (P > .05). However, the incidence of postoperative complications in the TAPB group was significantly lower than that in the PCIA group (P < .05). Furthermore, patient satisfaction in the TAPB group was significantly higher than that in the PCIA group (P < .05).Conclusion:This study demonstrated that ultrasound-guided TAPB can achieve the same analgesic effect as PCIA after cesarean section but with even higher patient satisfaction.
Dosimetric comparison of incidental radiation to the internal mammary nodes after breast-conserving surgery using 3 techniques-inverse intensity-modulated radiotherapy, field-in-field intensity-modulated radiotherapy, and 3-dimensional conformal radiotherapy
Authors: Song Yuanfang , Yu Ting , Wang Wei , Li Jianbin , Sun Tao , Qiu Pengfei , Xu Min , Shao Qian 
Published: October 2019

Abstract

Background:
The study aimed to evaluate and compare the dosimetric parameters of incidental irradiation to internal mammary node (IMN) from inverse intensity-modulated radiotherapy (I-IMRT) and field-in-field IMRT (F-IMRT), and 3-dimensional conformal radiotherapy (3D-CRT) in patients after breast-conservation surgery (BCS).

Methods:
Eighty-four patients with BCS were selected. The breast, tumor bed, and IMN, including intercostal spaces (ICS) 1 to 3, were contoured. Three plans were generated. The prescription doses for the breast and tumor bed were 50.4 Gy/28 F and 60.2 Gy/28 F, respectively. If there was no tumor bed boost, patient was treated with 50 Gy/25 F for the whole breast only. The IMN was not included in planning target volume.

Results:
The median mean dose (Dmean) of the IMNtotal (ICS 1–3) was 2740.2 cGy, 2973.9 cGy, and 2951.4 cGy for I-IMRT, F-IMRT, and 3D-CRT, respectively. Differences were not detected between any of the plans. After separating ICS 1 to 3 for further analysis, neither of the Dmean of ICS 1 to 2 was significantly different between the plans. However, for ICS 3, the median Dmean was highest for I-IMRT, and those for 3D-CRT and F-IMRT were not significantly different. After separating the 3 techniques for further analysis, the median Dmean was highest in ICS 3 and lowest in ICS 1 for all the 3 techniques.

Conclusion:
All 3 techniques failed to attain an adequate dose to cure subclinical disease, and there were no significant differences among the 3 techniques. It is risky to avoid IMN irradiation (IMNI) using any of the 3 techniques during whole-breast radiotherapy in women with indications for elective IMNI. However, in era of systematic therapy, whether the incidental dose could meet clinical acquirements needs further follow-up.
Successful treatment of refractory edema with traditional herbal medicine
Authors: Lee Gayoung , Cho Jung-Hyo , Son Chang-Gue , Lee Namhun 
Published: October 2019

Abstract

Rationale:
Refractory edema is characterized by persistent swelling which does not react to diuretic use and sodium restriction. Traditional herbal medicine, Gwack Rhyung Tang and Chunggan extract effectively treated refractory lower limb edema caused by cirrhosis and improved liver function.

Patient concerns:
A 64-year-old male patient with a history of hypertension, diabetes mellitus, hepatic encephalopathy, and cellulitis presented lower limb edema which did not react to diuretics for more than 7 months.

Diagnoses:
Refractory edema caused by cirrhosis.

Interventions:
The patient was treated for 25 days using Gwack Rhyung Tang and Chunggan extract.

Outcomes:
Loss of body weight, decrease in circumferences of both lower limb and improvement of liver function biochemistry results are checked. There was no recurrence or aggravation of the condition up to 3 weeks of follow-up periods.

Lessons:
Traditional herbal medicine can be an effective alternative for refractory edema due to cirrhosis with improving liver function.
Coexistence of Fabry disease with IgM nephropathy
Authors: Wu Huizhen , Behera Tapas Ranjan , Gong Jianguang , Shen Quanquan 
Published: October 2019

Abstract

Rationale:
Coexistence of Fabry disease and IgM nephropathy is rare. The varying severity and unapparent clinical manifestation of Fabry disease makes it difficult to recognize when coexisting with another more prevalent cause of nephropathy requiring electron microscopy and genetic testing to confirm their coexistence.

Patient concerns:
A 54-year-old female presented with proteinuria without any clinical signs or family history of Fabry disease.

Diagnoses:
Immunostaining of the renal biopsy identified mesangial IgM deposition diagnosing it as IgM nephropathy. The light microscopy indicated prominent vacuolization of podocytes. Further examination of toluidine blue stained semi-thin sections and electron microscopy revealed blue bodies and myelin bodies in the cytoplasm of podocytes, respectively. Mutation analysis detected missense mutation establishing the diagnosis of coexisting Fabry disease.

Interventions:
The patient was treated with angiotensin-converting enzyme inhibitors. Enzyme replacement therapy was not administered due to financial constraints.

Outcomes:
After 2 months of treatment the patient demonstrated urine protein to creatinine ratio of 0.21 g/g.

Lessons:
Identifying coexistence of Fabry disease with other nephropathy requires meticulous pathologic investigations including electron microscopy especially when Fabry disease presents with atypical phenotype.
An unusual case of pediatric-type follicular lymphoma
Authors: Zhang Hanyu , Sun Shuai , Zhang Biru , Yang Hongyu 
Published: October 2019

Abstract

Rationale:
Pediatric-type follicular lymphoma (PTFL) is a rare neoplasm with features that differ from those of adult-type follicular lymphoma. Compared to patients with adult-type follicular lymphoma, PTFL patients often show an excellent response. Preoperative diagnosis is challenging and, therefore, an accurate diagnosis is based on the findings of postoperative pathological examination and immunohistochemistry.

Patient concerns:
A 13-year-old boy presented with a slow-growing mass on the right side of his neck.

Diagnoses:
The patient was diagnosed with PTFL based on the findings of histopathological examination and immunohistochemistry.

Intervention:
The mass was completely resected.

Outcomes:
After 12 months of postoperative follow-up, the patient achieved good recovery without recurrence.

Lessons:
The optimal treatment for PTFL has not yet been defined. However, patients with PTFL always show satisfactory prognoses, regardless of treatment strategy (targeted radiotherapy, multiagent chemotherapy, or “watch and wait” strategy). Clinically, pathological and immunohistochemical analyses are necessary in the diagnoses of PTFL cases, especially for distinguishing PTFL from reactive follicular hyperplasia, to avoid unnecessary treatment.
Mushroom intoxication, a fatal condition in Romanian children
Authors: Mărginean Cristina Oana , Meliţ Lorena Elena , Mărginean Maria Oana 
Published: October 2019

Abstract

Rationale:
Approximately 5000 species of wild mushroom are reported worldwide, of which 100 are documented as poisonous and <10 are fatal. The clinical picture of patients with wild mushroom intoxication depends mostly on the type of ingested mushroom, ranging from mild gastrointestinal symptoms to organ failure and death.

Patient concerns:
We report 2 children, sister and brother admitted in our clinic for gastrointestinal symptoms: abdominal pain, nausea, vomiting, and diarrhea after wild mushroom ingestion.

Diagnosis:
The laboratory tests revealed hepatic cytolysis syndrome, hyperbilirubinemia, impaired coagulation status, hypoalbuminemia, hypoglycemia, and electrolytic unbalances in both cases. Abdominal ultrasound showed hepatomegaly and ascites.

Intervention:
After admission, both cases received penicillin by vein, activated charcoal, liver protectors, glucose, and electrolytes perfusions. Nevertheless, their status worsened and required the transfer to the pediatric intensive care unit for appropriate supportive measure. Therefore, therapeutic plasma exchange was initiated along with N-acetyl cysteine and hemostatic drugs.

Outcomes:
Despite all these therapeutic interventions, both cases developed hepatorenal syndrome and died after a couple of days from ingestion.

Lessons:
Mushroom poisoning remains a public health problem in developing countries. Preventable strategies and education regarding the consumption of wild type mushrooms are essential for decreasing the morbidity and mortality rates in these areas.