bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitiligo-like lesions in a patient treated with nivolumab for renal cell carcinoma
Authors: Lolli Cristian , Medri Matelda , Ricci Michela , Schepisi Giuseppe , Filograna Alessia , De Giorgi Ugo , Stanganelli Ignazio 
Published: December 2018

Abstract

Rationale:
The introduction of immune check-point inhibitors (ICIs) in the treatment of solid neoplasms is associated with the need to know and manage a new type of side effects that are commonly defined immune-mediated adverse events. Dermatologic immune-mediated adverse events are relatively common. Vitiligo-like lesions, defined as hypopigmented skin lesions, have already been associated with the use of ICIs in particular in patients with malignant melanoma, probably due to a common autoimmune mechanism against both melanoma cells and normal melanocytes. The onset of vitiligo-like lesions is very rare in non-melanoma patients and nowadays only few cases are described in the literature.

Patient concerns:
We described the case of a heavily pre-treated woman affected by renal cell carcinoma that has been treated with nivolumab for 2 years obtaining a stabilization of disease after an initial mild progression. After 9 months from the beginning of nivolumab, when the disease has reached its maximum stabilization, the patient developed vitiligo-like lesions of the back win halo nevi.

Diagnoses:
Vitiligo like lesion of the back not pre-existing before nivolumab treatment. The etiology was assumed to be nivolumab related as a result of an autoimmune activation against normal melanocytes.

Interventions:
The patient was followed with dermatological evaluations without changes in nivolumab dose and schedule

Outcomes:
No variations of the described lesions were recorded after the first description. The patients underwent a durable stabilization of her tumor.

Lessons:
This case on the one hand is the first case of vitiligo-like lesions associated with ICIs in patients affected by renal cell carcinoma, and on the other hand it seems to confirm that the onset of immumomediate adverse reactions, but in particular vitiligo lesions, can probably be considered a sign of response to immunological treatments probably as a consequence of activation of the immune response.
Self-perceived limitations and difficulties by Primary Health Care Physicians to assist emergencies
Authors: Cernuda Martínez José Antonio , Castro Delgado Rafael , Arcos González Pedro 
Published: December 2018

Abstract
The study was aimed to identify the training received in Emergency Medicine by physicians and the limitations and difficulties self-perceived by those physicians to assist in emergencies, as well as to analyze the differences according to the work context.
Observational cross-sectional study made by a survey using a self-administered questionnaire to a representative simple random sample (with replacement) of 294 doctors (n) working at the Primary Health Care centers out of the total of 851 doctors (N) that form the staff of physicians of Primary Health Care system of Asturias (Spain).
In rural areas, the most frequently mentioned reasons were the lack of practical skills (32.65%), absence of adequate material (20.41%), lack of theoretical knowledge (8.16%), and poor equipment conditions (4.08%). In the semi-urban area, the most common reasons were the lack of practical skills (19.61%), lack of theoretical knowledge (10.78%), absence of adequate material (8.82%), and poor equipment conditions (4.90%). Finally, in the urban area, the main reason was the lack of practical skills (23.40%), absence of adequate material (20.21%), lack of theoretical knowledge (9.57%), and poor equipment conditions (4.26%). The differences were significant (P = .003) among the 3 work context.
The absence of practical skills is the most frequent cause referred by doctors of the 3 areas as a key to not act correctly in an emergency. The doctors of the rural area perceive that they are better prepared in general to solve emergencies and it is the professionals of 3 areas that report having carried out more basic cardiopulmonary resuscitation, advanced and attention to the polytraumatized patient courses.
Altered brain volume and its relationship to characteristics of carotid plaques in asymptomatic patients
Authors: Tuo Jia , Liu Yunhai , Liao Weihua , Gu Wenping , Yang Shuai , Tan Xinglin , Tang Tao , Chen Hua , Feng Jie , Wen Yanbin , He Wei , Huang Qing 
Published: December 2018

Abstract
Carotid plaque is an aggregate marker of exposure to vascular risk factors, which are linked to structural brain changes. We investigated prestroke global and regional changes in brain volume in a carotid plaque population of cognitively healthy individuals and the association between carotid plaque characteristics and these changes.
A total of 76 participants were divided into healthy control (HC, n = 28), vulnerable plaque (n = 27) and stable plaque groups (n = 21). All subjects underwent carotid ultrasound and brain magnetic resonance imaging (MRI). Voxel-based morphometry (VBM) was used to examine differences in regional gray matter volumes (rGMVs) among the different groups.
The plaque group had a significantly lower mean total cerebral brain volume (TCBV) than the HC group (P = .03). Carotid intima-media thickness (CIMT) was negatively correlated with TCBV (r = -0.311, P = .006) and rGMV in the right thalamus (r = -0.589, P = .001). The rGMVs of the right middle occipital gyrus and bilateral lingual gyrus were significantly different between the unstable and stable groups. The gray-scale median (GSM) of the plaque and the total plaque risk score (TPRS) were correlated with the volume of the right middle occipital gyrus (r=-0.478, P = .001; r = 0.541, P = .001) and bilateral lingual gyrus (r = -0.419, P = .003; r = 0.288, P = .04).
Carotid plaque is related to the volume of the brain parenchyma and right thalamus. The rGMVs of the right middle occipital gyrus and bilateral lingual gyrus differed between the vulnerable plaque and stable plaque groups, and the characteristics of carotid plaques may serve as indexes that reflect these changes
Traditional Chinese medicine for post-stroke depression
Authors: Huang Wanlin , Liao Xiaoqin , Tian Jinhui , Wu Jing , Shan Yawei , Zhou Weini 
Published: December 2018

Abstract

Background:
Post-stroke depression (PSD) is common in stroke survivors, with significantly negative effects and serious impairments in terms of personal and social functioning. While both pharmacological and traditional Chinese medicine (TCM) interventions have been administered for PSD, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank, describing the protocol of a systematic review and network meta-analysis (NMA), the commonly used TCM interventions for PSD.

Methods and analysis:
We will search CENTRAL (the Cochrane Central Register of Controlled Trials), CINAHL, Embase, PubMed, CBM and PsycINFO, the US National Institutes of Health and the World Health Organisation International Trials Registry Platform search portal from inception to November 2018. There will be no restrictions on language, publication year or publication type. Only randomized clinical trials (RCTs) accessing any TCM treatments against active comparator or other controls for PSD will be included. The primary outcomes will be efficacy (the total number of participants, declining more than 50% on the total score between baseline) and acceptability of treatment (dropout rate due to any cause). A Bayesian NMA will be performed to compare all relative outcome of different TCM interventions. we will conduct the network meta-regression meta-analyses of data on the sex ratio, the types of stroke and the treatment duration of TCM interventions. Potential explanations in extra subgroup analyses according to the results of heterogeneity and inconsistency will be explored, and sensitivity analyses will be conducted to assess the robustness of the findings.

Trials registration number:
PROSPERO CRD42018082400.

Conclusion:
Our study will generate evidence for TCM in the treatment of PSD and help to reduce the uncertainty about the effectiveness of PSD management, which will encourage further suggestions for TCM clinical practice or guideline.
Transcutaneous auricular vagus nerve stimulation in treating major depressive disorder
Authors: Wu Chunxiao , Liu Peihui , Fu Huaili , Chen Wentao , Cui Shaoyang , Lu Liming , Tang Chunzhi 
Published: December 2018

Abstract

Background:
Transcutaneous auricular vagus nerve stimulation (taVNS), as a noninvasive intervention, has beneficial effects on major depressive disorder based on clinical observations. However, the potential benefits and clinical role of taVNS in the treatment of major depressive disorder are still uncertain and have not been systematically evaluated. Therefore, we performed a systematic review and meta-analysis to evaluate the effectiveness and safety of taVNS in treating major depressive disorder.

Methods:
Four electronic databases, namely, Embase, MEDLINE, the Cochrane Library and PsycINFO, were searched for all related trials published through May 1, 2018. We extracted the basic information and data of the included studies and evaluated the methodological quality with the Cochrane risk of bias tool and the nonrandomized studies-of interventions (ROBINS-I) tool. A meta-analysis of the comparative effects was conducted using the Review Manager 5.3 software.

Results:
A total of 423 citations from the databases were searched, and 4 studies with 222 individuals were included in the meta-analysis. The taVNS technique could decrease 24-item HAMD scores more than the sham intervention (MD: −4.23, 95% CI: −7.15, −1.31; P = .005) and was also more effective in decreasing Self-Rating Depression Scale scores ((MD: −10.34, 95% CI: −13.48, −7.20; P < .00001), Beck Depression Inventory scores (MD: −10.3, 95% CI: −18.1, −2.5; P = .01) and Self-Rating Anxiety Scale scores (MD: −6.57, 95% CI: −9.30, −3.84; P < .00001). However, there was no significant difference in the Hamilton Anxiety Rating Scale scores between the taVNS and sham taVNS groups (MD: −1.12, 95% CI: −2.56, 0.32; P = .13). No obvious adverse effects of taVNS treatment were reported in the included studies.

Conclusion:
The results of the analysis preliminarily demonstrated that taVNS therapy can effectively ameliorate the symptoms of major depressive disorder, providing an alternative technique for addressing depression. However, more well-designed RCTs with larger sample sizes and follow-ups are needed in future studies to confirm our findings.
Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures
Authors: Liu Feng-Yu , Zhao Zheng-Qi , Ren Liang , Gu Zhen-Fang , Li Feng , Ding Wen-Yuan , Sun Xian-Ze 
Published: December 2018

Abstract

Rationale:
The kyphosis caused by old osteoporotic vertebral compression fracture usually requires osteotomy to correct it. Various osteotomy techniques have been reported, but each has its own advantages and disadvantages.

Patient concerns:
We reviewed 2 cases of old osteoporotic vertebral compression fractures with kyphosis in our hospital. One patient complained of persistent low-back pain, another patient complained of low-back pain and weakness of both lower extremities.

Diagnosis:
Old osteoporotic vertebral compression fractures with kyphosis were diagnosed based on computer tomography and magnetic resonance imaging.

Interventions:
We performed modified grade 4 osteotomy for 2 patients.

Outcomes:
Both patients said significant improvement in preoperative symptoms, and x-ray showed that the kyphosis was corrected. Both patients were satisfied with the treatment at the last follow-up, and the kyphosis was not aggravated.

Lessons:
Modified grade 4 osteotomy is an effective option for the treatment of old osteoporotic fracture with kyphosis. It can restore the spine sequence and achieve better clinical result.
Ectopic relapse of IgG4-related disease presenting as IgG4-related sclerosing cholecystitis
Authors: Ishigami Keisuke , Shitani Masahiro , Kimura Yasutoshi , Hasegawa Tadashi , Masaki Yoshiharu , Ito Ayako , Akutsu Noriyuki , Yamamoto Motohisa , Motoya Masayo , Sasaki Shigeru , Takahashi Hiroki , Takemasa Ichiro , Nakase Hiroshi 
Published: December 2018

Abstract

Rationale:
Immunoglobulin (Ig) G4-related disease (IgG4-RD) is a chronic inflammatory disorder characterized by high levels of serum IgG4, swollen organs with fibrosis and abundant infiltration of IgG4-positive plasmacytes.

Patient Concerns:
An 82-year-old male visited our hospital for an evaluation of a pancreatic enlargement and a bilateral submandibular adenopathy. Further investigation revealed elevation of serum IgG4 and bilateral lacrimal submandibular adenopathy. We diagnosed him with IgG4-related disease (IgG4-RD) and started administration of corticosteroid (CS) therapy. Both pancreatic enlargement and adenopathy rapidly improved; however, there was a new occurrence of diffuse wall thickening of the gallbladder during CS treatment.

Diagnosis:
Radiological examination revealed diffuse wall thickening of the gallbladder, and its inner layer was smooth and homogenous. These findings suggested an inflammatory change, but the possibility of malignancy could not be excluded.

Interventions:
The patient underwent laparoscopic cholecystectomy for a pathological diagnosis.

Outcomes:
Histological examination revealed a transmural infiltration of IgG4 positive plasma cells and dense fibrosis. The patient was pathologically diagnosed with IgG4 related cholecystitis presenting as an ectopic relapse.

Lessons:
There are 2 major types of IgG4-related cholecystitis, a diffuse wall thickening type and a mass formation type. It is sometimes difficult to differentiate IgG4-related cholecystitis with gallbladder cancer.
Corticosteroid (CS) is effective for induction of remission; however, we sometimes encounter disease relapse after reduction of CS dose. We should be mindful that some patients may relapse with new organ involvements even if the primary site and serum IgG4 level are well controlled.
Pharmacologic interventions for preventing delirium in adult patients after cardiac surgery
Authors: Wen Junru , Zeng Hai , Li Zunjiang , He Guoxin , Jin Yueling 
Published: December 2018

Abstract

Background:
Delirium is common in adult patients undergoing cardiac surgery and related to a high morbidity and mortality. Although a variety of pharmacologic interventions have been applied in delirium prevention, there is still uncertainty concerning which drug is optimal. Thus, we plan to conduct a systematic review and network meta-analysis (NMA) of published studies to assess the efficacy and safety of pharmacologic interventions for preventing delirium among those patients.

Methods:
A systematic literature search will be conducted in Embase, PubMed, and the Cochrane Library. The primary outcome will be the incidence of postoperative delirium. Secondary outcomes will include all-cause mortality and length of hospital or intensive care unit stay. A frequentist NMA will be conducted using Stata version 14.0. The inconsistency between direct and indirect comparisons will be evaluated using a node splitting method. In addition, surface under the cumulative ranking area will be used to evaluate superiority of different treatments.

Results:
The findings of our review will be submitted to a peer-reviewed publication.

Conclusion:
Our study will generate convincing evidence regarding the effectiveness and safety of different pharmacologic interventions for delirium prevention in cardiac surgery patients.
Sine causa tetraparesis
Authors: Galli Jessica , Gavazzi Francesco , De Simone Micaela , Giliani Silvia , Garau Jessica , Valente Marialuisa , Vairo Donatella , Cattalini Marco , Mortilla Marzia , Andreoli (Laura , Badolato Raffaele , Bianchi Marika , Carabellese Nice , Cereda Cristina , Ferraro Rosalba , Facchetti Fabio , Fredi Micaela , Gualdi Giulio , Lorenzi Luisa , Meini Antonella , Orcesi Simona , Tincani Angela , Zanola Alessandra , Rice Gillian , Fazzi Elisa 
Published: December 2018

Abstract
Tetraparesis is usually due to cerebral palsy (CP), inborn errors of metabolism, neurogenetic disorders and spinal cord lesions. However, literature data reported that about 10% of children with tetraparesis show a negative/non-specific neuroradiological findings without a specific etiological cause. Aicardi Goutières Syndrome (AGS) is a genetic encephalopathy that may cause tetraparesis. Interferon signature is a reliable biomarker for AGS and could be performed in sine-causa tetraparesis. The aim of the study was to examine the type I interferon signature and AGS related-genes in children with sine causa tetraparesis, to look for misdiagnosed AGS. A secondary aim was to determine which aspects of the patient history, clinical picture and brain imaging best characterize tetraparesis due to an interferonopathy.
Seven out of 78 patients affected by tetraparesis, characterized by unremarkable pre-peri-postnatal history and normal/non-specific brain magnetic resonance imaging (MRI) were selected and underwent anamnestic data collection, clinical examination, brain imaging review, peripheral blood interferon signature and AGS-related genes analysis.
At our evaluation time (mean age of 11.9 years), all the 7 patients showed spastic-dystonic tetraparesis. At clinical onset brain MRI was normal in 4 and with non-specific abnormalities in 3; at follow-up 3 patients presented with new white-matter lesions, associated with brain calcification in 1 case. Interferon signature was elevated in one subject who presented also a mutation of the IFIH1 gene.
AGS should be considered in sine-causa tetraparesis. Core features of interferonopathy-related tetraparesis are: onset during first year of life, psychomotor regression with tetraparesis evolution, brain white-matter lesions with late calcifications. A positive interferon signature may be a helpful marker to select patients with spastic tetraparesis who should undergo genetic analysis for AGS.
Discrepancy between perfusion- and diffusion-weighted images in ischemic stroke
Authors: Hur Wook , Kim Bum Joon , Shin Byoung-Soo , Kang Hyun Goo 
Published: December 2018

Abstract

Rationale:
With the development of multi-slice computed tomography (CT) technology, perfusion CT angiography (p-CTA) is now widely used for the diagnosis of acute cerebral infarction. Although p-CTA has the advantage of distinguishing between an ischemic penumbra and an infarct core, more research is needed with respect to its clinical use.

Patient concerns:
A healthy 36-year-old man experienced sudden dizziness while swimming. His dizziness persisted irrespective of the change in position, and then improved during transport. He had no neurological abnormality when he arrived at the emergency room.

Diagnoses:
CT perfusion findings suggested left cerebellar infarction. P-CTA revealed a markedly delayed mean transit time, delayed time to peak, and increased cerebral blood volume in the left posterior inferior cerebellar artery territory at admission. However, the diffusion-weighted image (DWI) taken a few hours later revealed a large right cerebellar infarction.

Interventions:
Because of the time window, thrombolysis could not be performed and anti-platelet therapy was started.

Outcomes:
Dysarthria and right-sided limb ataxia were newly developed before DWI (after p-CTA). Persistent foramen ovale was detected through transesophageal echography and identified as the cause of the stroke.

Lessons:
This case report suggests that dynamic image changes can occur within a short period of time depending on the vascular status and hemodynamic changes of the patients.
Endoscopic submucosal dissection of papillary adenocarcinoma of stomach; protocol for a systematic review and meta-analysis
Authors: Bang Chang Seok , Choi Jae Ho , Lee Jae Jun , Baik Gwang Ho 
Published: December 2018

Abstract

Background:
Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who has a negligible risk of lymph node metastasis. Papillary adenocarcinoma (PAC) of stomach is a rare histologic variant of gastric cancer and categorized into EGC with differentiated-histology. However, aggressive features such as higher rate of lymphovascular invasion (LVI) or submucosal invasion have been reported, whereas comparable lymph node metastasis (LNM) rate to the lesions meeting the current ESD criteria also has been reported. This study aimed to evaluate the feasibility of ESD for EGC with PAC.

Methods:
We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to December 2018 by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC with PAC, Intervention: ESD or surgery, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence, procedure-related adverse event, LVI or LNM that enabled an evaluation of the feasibility of ESD. All types of study design with full text will be sought and included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned, and quantitative synthesis will be used if the included studies are sufficiently homogenous. Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled.

Results:
The results will provide evidence for efficacy and safety of ESD for EGC with PAC.

Conclusion:
This study will provide evidence of ESD for EGC with PAC.
Associated risk factors for psychological distress in patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection
Authors: Lee San , Oh Seung-Taek , Lee Hyeok , Lee Jae Seung , Pak Haeyong , Choi Won-Jung , Jeon Han Ho 
Published: December 2018

Abstract
This study aimed to evaluate the psychological distress and associated risk factors for distress among patients with gastric epithelial neoplasm undergoing endoscopic submucosal dissection (ESD).
A total of 91 patients treated with ESD for gastric epithelial neoplasm between May 2015 and June 2016 were prospectively enrolled. Sociodemographic factors, psychological distress, anxiety, depression, stress, and associated risk factors for psychological distress were evaluated the day before ESD.
Twenty-six (28.6%) patients were identified as patients with psychological distress. The psychological distress group had a higher female ratio and more depression and anxiety symptoms than the non-distress group. Distress was also related to stress level. A multivariate analysis showed that unmarried status (odds ratio [OR], 4.94; 95% confidence interval [CI], 1.13–21.56, P = .034), anxiety (OR, 1.24; 95% CI, 1.12–1.39, P <.001), and stress (OR, 1.06; 95% CI, 1.01–1.12, P = .011) were associated with psychological distress.
An unmarried status and a high level of anxiety and stress were associated with more psychological distress in patients undergoing gastric ESD. It could be helpful to screen and proactively monitor patients with such conditions before performing gastric ESD.