bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac health in patients with hepatitis B virus-related cirrhosis
Authors: Yuan Wei , Lu Hong-Zhou , Mei Xue , Zhang Yu-Yi , Zhang Zheng-Guo , Zou Ying , Wang Jie-Fei , Qian Zhi-Ping , Guo Hong-Ying 
Published: March 2019

Abstract
Not only alcoholic cirrhosis related to cardiac dysfunction, cirrhosis caused by nonalcoholic etiology including hepatitis B virus (HBV) infection also related to impaired cardiac health. The aims of present study were to perform a noninvasive evaluation of cardiac function and to evaluate exercise performance in HBV related cirrhotic patients without typical symptoms of cardiac disease.
Seventy-nine HBV related cirrhotic patients and 103 matched subjects without a previous history of cardiac involvement were recruited. Clinical examination and cardiac health evaluation were performed. The incidence, risk factors of cardiac dysfunction and exercise tolerance were investigated.
A correlation between QTc interval and model for end-stage liver disease score (R = 0.239, P = .018) was detected, however, the connection between QTc prolongation and the severity of liver disease was uncertain. Patients with HBV related cirrhosis had a tendency toward left ventricular wall thickening (P = .007). Forty-one patients (51.90%) were in accordance with the definition of cirrhotic cardiomyopathy, and a significant increase in the incidence of cardiac diastolic dysfunction (CDD) could be found with increasing Child-Pugh grade (P = .004). HBV related cirrhotic patients with CDD had a higher level of pro-brain natriuretic peptide (P = .025), international normalized ratio (P = .010) Child-Pugh score (P = .020), and a higher proportion of ascites (P < .001). The higher Child-Pugh score (odds ratio = 1.662, P = .010) was an independent diagnostic predictor of CDD. The cardiac depression and exercise tolerance also got worse with increasing Child-Pugh score (P < .001).
Impaired cardiac health was common in HBV related cirrhotic patients. Cardiogenic factors must be carefully considered in the integral therapy of cirrhosis. Hepatology physicians should lay emphasis on exercise training in daily life.
Unsuccessful removal of a totally implantable venous access port caused by thrombosis in the left brachiocephalic vein
Authors: Zhang Xi , Geng Cuizhi 
Published: March 2019

Abstract

Rationale:
Thrombosis is a common complication associated with implantable venous access ports (IVAPs) and often results in loss of catheter function but is rarely associated with difficulty in IVAP removal.

Patient concerns:
A 53-year-old woman presented to the hospital due to difficulty in IVAP removal. The patient had been diagnosed with breast cancer and received modified radical mastectomy. After that, she underwent IVAP implantation. Four and half years later, the IVAP catheter had become stuck while the catheter remained unobstructed. The patient had no special chief complaints.

Diagnosis:
Postoperative breast cancer; difficulty in removal of IVAP (caused by thrombus in the left brachiocephalic vein).

Interventions:
We injected urokinase 5 ml 1000U/L into the catheter once a day for three days but failed to remove the IVAP. Vasography showed a thrombus in the left brachiocephalic vein. Removal of the thrombus would have been very dangerous, so we decided to leave both thrombus and catheter in the body and used heparin and warfarin as anticoagulants.

Outcomes:
The general situation of the patient, followed-up for 20 months, was good and there was no psychological impact or other special chief complaints.

Lessons:
It is best to remove the IVAP in a timely manner once all treatments are finished.
Treatment for upper esophageal sphincter dysfunction in a patient with poststroke dysphagia
Authors: Wei Pengxu , Xu Yafei , Zhang Zuting , Zhang Simin , Lv Zeping 
Published: March 2019

Abstract

Rationale:
Botulinum toxin injection is a widely used procedure for the treatment of the dysfunction of the upper esophageal sphincter (UES). Although the injection can be guided by ultrasound, electromyography, or computed tomography, such techniques cannot determine the exact extent of narrowed UES and ensure that the narrowed extent is fully covered by the treatment. This report describes a dual guiding technique with ultrasound and the balloon catheter in a patient with poststroke dysphagia to improve these weaknesses.

Patient concerns:
The patient was admitted to a rehabilitation hospital 2 weeks postcerebral infarction.

Diagnoses:
Clinical presentation of the patient included severe hemiplegia and dysphagia. The fiberoptic endoscopic evaluation of swallowing (FEES) revealed penetration/aspiration when swallowing 1 ml water and 1 ml yogurt and pooling in the postcricoid region.

Interventions:
Balloon catheter dilatation procedures and Botulinum toxin injection were performed. We used a dual guiding technique with ultrasound and the balloon catheter to determine the whole segment of UES dysfunction by locating the lowest level of the impaired UES opening and to reduce difficulty in differentiating UES from adjacent tissues during Botulinum toxin injection.

Outcomes:
No persistent progress was observed on the symptoms and volume of the balloon during dilatation. The patient showed quick responses after Botulinum toxin injection. The postinjection balloon catheter dilatation showed an increased maximum volume (preinjection, 5.5 ml vs. postinjection, 14 ml), and the patient was able to eat yogurt, congee, or semi-solid food 100–150 ml 4 weeks after the injection.

Lessons:
The dual guiding method holds several advantages, suggesting that it may be considered as a promising choice in dealing with UES dysfunction.
Additional femoral nerve block analgesia does not reduce the chronic pain after total knee arthroplasty
Authors: Yao Yuan-yuan , Zhou Qing-he , Yu Li-na , Yan Min 
Published: March 2019

Abstract
Femoral nerve block analgesia was deemed to the gold standard for acute pain management after total knee arthroplasty (TKA). But effect on chronic pain management is not investigated fully. We conducted a retrospective study to explore the effect of single-injection femoral nerve block on postsurgical chronic pain.
All medical records of patients undertaking TKA between January, 2013 and June, 2014 were reviewed via the Docare anesthesia database. Patients who administrated with the self-controlled intravenous analgesia were assigned to group P. Patients who received a single-injection femoral never block combined with patient self-controlled intravenous analgesia were assigned to group N + P. The visual analog scale (VAS) score before surgery, the first postoperative day (POD 1), POD 2, 3 months, 6 months, and 12 months after surgery were extracted from medical records. Pain score was compared over these 2 groups to investigate treatment outcomes.
In all, 470 patients met the selection criteria for group P and 266 patients met the selection criteria for group N + P. Compared with group P, the VAS score decreased significantly in group N + P at POD 1 (P < .001), and the same was observed at POD 2 (P < .001); the moderate to severe pain incidence rate decreased significantly in group N + P at POD 1 (P < .01) and POD 2 (motion, P < .001). The rescued anesthesia rate reduced significantly in group N + P in POD 1 (P = .001), whereas no difference was found in POD 2 (P = .864). No difference was found at 3, 6, and 12 months after surgery (all P > .05).
The single-injection femoral nerve block could relieve the acute postsurgical pain in a short period of time. But no evidence was found that it could reduce the chronic pain between 3 and 12 months after TKA.
Herb induced liver injury after using herbal medicine
Authors: Lin Nai-Hui , Yang Hsiu-Wu , Su Yu-Jang , Chang Chen-Wang 
Published: March 2019

Abstract
In Taiwan, traditional herbal medication was included in Taiwan's National Health Insurance (NHI) system since 1996 and in 9 out of 10 hospitals have developed their own departments of traditional medicine. This study aims to address the herb-induced liver injury (HILI) after using herbal medicine on the relationship between age, gender, epidemiology, laboratory data, pathogenesis, mobility, and mortality.
We searched the PubMed database with “hepatitis after herbal medicine” and “in human” till 2018 April and returned 163 articles in a systemic review manner. Two cases reports describing in-vitro liver injury were excluded. Reviews and articles without the detailed report, laboratory data and history were excluded from this study. In the end, there were 53 articles enrolled in this study. These enrolled literatures are from France (n = 13), Germany (n = 12), Switzerland (n = 5) United States of America (n = 4), Korea (n = 4), Hong Kong (n = 4), Greece (n = 3), China (n = 2), Canada (n = 1), Italy (n = 1), Thailand (n = 1), Finland (n = 1), Taiwan (n = 1), and Japan (n = 1). The data were analyzed with a commercial statistical software Stata/SE 12.0 program Stata Corporation, College Station, TX, USA. Statistical χ2 tests were performed and the significance was set at a P value of less than .05 (2-tailed).
The ages are ranged from 15 to 78 years with the mean ± SD (standard deviation) of 48.3 ± 16.2 years old. The majority of cases are female (n = 37). In elderly, man is more commonly seen than female in HILI (37.5% vs 10.5%, P = .02). Female is vulnerable to cholestatic type of HILI than male (21.1% vs 0.0%, P = .04). Of all the cases in HILI, using pure substance are more commonly seen than mixed substance (P = .02). In gender, male patients have higher alanine aminotransferase (GPT) (IU/L) level in HILI than female ones (1560 ± 819 vs 1047 ± 706, P = .03).
In HILI, the female is more commonly seen than male, but less than male in the elderly. The pure substance more often happens to HILI than mixture substance. Female is predominant in the cholestatic type of HILI. The major prevalence of HILI is in Europe rather than Asia. HILI cases in Europe is 2.75-fold than in Asia. This could be due to fewer reports of the herb induced liver injury in Asia compared to Europe. Prevention of HILI is the best policy, because it needs to take 78 ± 59 days to recover.
Clostridium difficile-associated diarrhea following the therapy with antibiotic and proton pump inhibitors in a 77-year-old man with several comorbidities
Authors: Lv Xiaoqun , Zhang Jun , Jiang Miao , Liu Yujuan , Ren Weifang , Fang Zhonghong 
Published: March 2019

Abstract

Rationale:

Clostridium difficile-associated diarrhea (CDAD) remains a persistent challenge, with substantially increased incidence and severity. The rising burden of CDAD requires urgent identification of preventable risk factors.

Patients concerns:
A 77-year-old man with the symptoms of abdominal pain and watery diarrhea was readmitted to the hospital, who received cephalosporins and proton pump inhibitors (PPIs) during the initial hospitalization for 12 days until discharge. Antibiotic-associated diarrhea was seriously suspected. And the stool sample was immediately sent for inspection for C difficile. He had a history of chronic bronchitis, coronary heart disease, and osteonecrosis.

Diagnosis:
CDAD, renal insufficiency

Interventions:
Oral vancomycin was administered for 14 days.

Outcomes:
On the third day after readmission, the stool sample turned out to be positive for both C difficile toxin and its antigen. After 10-day treatment with vancomycin, diarrhea symptoms disappeared and his stools became normal.

Lessons:
In elderly patients with multiple comorbidities, PPIs must be administered cautiously to minimize the risk for adverse effects including CDAD. It is important to identify the preventable risk factors of CDAD for clinicians and pharmacists. Oral vancomycin therapy seems to be effective in CDAD.
A CARE-compliant article: optical coherence tomography for epithelial basement membrane dystrophy
Authors: Kuo Yi-Chun , Lee Yuan-Chieh 
Published: March 2019

Abstract

Rationale:
The etiology of anterior corneal opacities and the effect of debridement cannot be determined by biomicroscopy. Optical coherence tomography (OCT) helps identify the character and depth of these lesions.

Patient concerns:
A 45-year-old female complained of progressive blurred vision for a long time. Slit lamp biomicroscopy showed irregular, faint scar-like opacity of anterior cornea in her both eyes. Pentacam Scheimpflug camera tomography showed irregular astigmatism of anterior corneal surface. Anterior segment spectral-domain OCT revealed thickened, hyper-reflective linings, and scattered lesions, mainly in the epithelial layer.

Diagnoses:
Epithelial basement membrane dystrophy (EBMD).

Intervention:
Epithelial debridement and bandage lenses.

Outcomes:
The cornea became clear and the vision improved soon after debridement. The pathology showed thickened aberrant basement membrane extending into mid-epithelial layer, with microcyst-like lesions also noted.

Lessons:
OCT defines the depth of lesions and helps diagnosis and management of EBMD.
Changes in the neutrophil-to-lymphocyte ratio predict the prognosis of patients with advanced hepatocellular carcinoma treated with sorafenib
Authors: Hong Young Mi , Yoon Ki Tae , Hwang Tae Ho , Heo Jeong , Woo Hyun Young , Cho Mong 
Published: March 2019

Background and aim
Although sorafenib is the first systemic therapy to show survival benefit for advanced hepatocellular carcinoma (HCC), its survival benefit is variable for HCC. Systemic inflammation may be associated with survival in HCC. We investigated the use of systemic inflammation markers, including neutrophil-to-lymphocyte ratio (NLR), in the prognosis of sorafenib-treated HCC patients.

Patients and methods
We retrospectively analyzed data of 82 patients with advanced HCC who received sorafenib as the first-line treatment. Data on pretreatment and post-treatment (2–3 months after initiating sorafenib therapy, first tumor response evaluation day) clinical, laboratory, and tumor characteristics were collected. Survival-related prognostic factors were analyzed.

Results
Patients were mostly in the intermediate (12.2%) or advanced (87.8%) Barcelona Clinic Liver Cancer stages. Fifty-six (68.3%) patients had vascular invasion and 34 (41.5%) patients had extrahepatic disease. The median progression-free survival (PFS) and overall survival (OS) were 4.7 months [95% confidence interval (CI): 2.8–6.5 months] and 4.7 months (95% CI: 2.8–6.5 months). In multivariate analysis for OS, diarrhea (hazard ratio: 0.588; 95% CI: 0.348–0.993) and NLR decline (decreased compared with pretreatment) (hazard ratio: 0.479; 95% CI: 0.300–0.765) were independent factors of good OS. In the NLR decline group, the median PFS and OS were 7.1 and 7.3 months, respectively. In the NLR nondecline group, the median PFS and OS were 3.0 and 3.2 months, respectively. The difference in OS between the two groups was significant (P = 0.004).

Conclusion
A change in NLR after sorafenib therapy was associated with a better prognosis in patients with advanced HCC.
Wheelchair-Assisted Ligature Strangulation
Authors: Janík Martin , Krajčovič Jozef , Novomeský František , Straka Ľubomír , Hejna Petr 
Published: March 2019

AbstractMultiple sclerosis, currently incurable and potentially profoundly disabling demyelinating central nervous system disease, is associated with higher occurrence of suicide as affected individuals are prone to major depression and psychosis. Despite progressively incapacitating neurologic impairment, well-staffed institutions, and limited repertoire of methods of suicide, which prevents patients from purposefully ending their lives, suicide-determined patients typically commit suicide resulting from a medication overdose, sharp force traumata, self-neglect, or deliberate starvation. Here we describe a successful suicide committed by a 39-year-old wheelchair-bound, institutionalized, quadriparetic male patient with a diagnosis of multiple sclerosis with secondary progressive clinical course who utilized his motorized wheelchair to terminate his life. He tied a rope between his neck and wall bars and then propelled the wheelchair forwardly. The acceleration of the wheelchair resulted in ligature self-strangulation. This case report, with a review of the literature, is noteworthy for the rareness of the wheelchair-related fatality combined with an unusual, if not entirely unseen, suicidal mechanism in severely disabled adult.
Sez6 levels are elevated in cerebrospinal fluid of patients with inflammatory pain–associated conditions
Authors: Roitman Maria , Edgington-Mitchell Laura E. , Mangum Jon , Ziogas James , Adamides Alexios A. , Myles Paul , Choo-Bunnett Hearan , Bunnett Nigel W. , Gunnersen Jenny M. 
Published: March 2019

Abstract

Introduction:
Seizure-related protein 6 (Sez6) contributes to chronic pain development as sez6 knockout mice show attenuated pain behaviours after peripheral nerve injury, compared with control mice. The type I transmembrane isoform of Sez6 is cleaved by the β-amyloid precursor protein cleavage enzyme 1 (BACE1), resulting in Sez6 extracellular domain shedding from the neuron surface.

Objectives:
To determine whether this BACE1-shed form of Sez6 can be detected in the cerebrospinal fluid (CSF) and whether Sez6 levels in the CSF are altered in neuropathic pain or chronic inflammatory pain (IP).

Methods:
We analysed the CSF samples collected during surgery from patients with chronic neuropathic pain (n = 8) or IP (n = 33), comparing them to the CSF samples from patients with suspected subarachnoid haemorrhage that was subsequently excluded (nonsurgical group, n = 5). Western blots were used to determine the relative Sez6 levels in the CSF from the different patient and nonsurgical comparison groups.

Results:
The results show that BACE1-shed Sez6 can be readily detected in the CSF by Western blot and that the levels of Sez6 are significantly higher in the IP group than in the nonsurgical comparison group.

Conclusion:
The association between elevated Sez6 levels in the CSF and IP is further evidence for persistent alterations in central nervous system activity in chronic IP conditions.
Safety Profiles of Fat Processing Techniques in Autologous Fat Transfer for Breast Reconstruction
Authors: Ruan Qing Zhao , Rinkinen Jacob R. , Doval Andres F. , Scott Benjamin B. , Tobias Adam M. , Lin Samuel J. , Lee Bernard T. 
Published: March 2019

Background:
Autologous fat transfer is common in breast reconstruction because of its versatility for use in contour deformities. The authors examined three different fat grafting processing techniques for complications and safety profile using their institutional database.

Methods:
Retrospective review was performed of patients from a single institution who had undergone autologous fat transfer following breast reconstruction from 2012 to 2016. Individuals were separated into three cohorts according to fat harvest technique: (1) centrifugation, (2) Telfa gauze, or (3) Revolve. Complications between the groups were assessed.

Results:
A total of 267 cases of autologous fat transfer were identified (centrifugation, n = 168; Telfa, n = 44; and Revolve, n = 55). Grafting by means of centrifugation was associated with the greatest incidence of oil cysts (12.5 percent; p = 0.034), postoperative adverse events observed in the clinic (13.7 percent; p = 0.002), and total complications (25.6 percent; p = 0.001). The use of Telfa resulted in the lowest rates of oil cyst formation (0 percent; p = 0.002) and total complications (2.3 percent; p = 0.001). Grafting by means of centrifugation was also associated with the highest frequency of repeated injections among the three techniques after initial grafting (19.6 percent; p = 0.029). In contrast, Revolve demonstrated a repeated injection rate of just 5.45 percent, significantly lower when independently compared with centrifugation (p = 0.011). Multivariate analysis demonstrated that higher total graft volume (p = 0.002) and the use of centrifugation (p = 0.002) were significant risk factors for adverse events seen in the clinic postoperatively.

Conclusions:
Significant differences in postoperative outcomes exist between varying fat transfer techniques. Autologous fat transfer by means of centrifugation harbored the highest rates of complication, whereas Telfa and Revolve exhibited similar safety profiles.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Perioperative Treatment with a Prolyl Hydroxylase Inhibitor Reduces Necrosis in a Rat Ischemic Skin Flap Model
Authors: Sergesketter Amanda R. , Cason Roger W. , Ibrahim Mohamed M. , Lane Whitney O. , Lubkin David T. , Hollenbeck Scott T. , Brown David A. 
Published: March 2019

Background:
The hypoxia-inducible factor (HIF) pathway, regulated by prolyl hydroxylase, is central to tissue adaptation to ischemia. The authors tested whether the prolyl hydroxylase inhibitor dimethyloxalylglycine reduces skin flap necrosis.

Methods:
Dorsal skin flaps were raised on hairless rats, with dimethyloxalylglycine delivered intraperitoneally and/or topically for 7 days before and after surgery. After 14 treatment days, percentage of flap necrosis was compared grossly and tissue perfusion compared with an in vivo imaging system. Angiogenesis was compared using immunohistochemical CD31 staining and enzyme-linked immunosorbent assay for tissue vascular endothelial growth factor. Expression levels of HIF-1α and terminal deoxynucleotidyl transferase-mediated dUDP end-labeling were compared using immunohistochemical staining. Complete blood counts and gross necropsy specimens were obtained to assess systemic toxicity.

Results:
Dimethyloxalylglycine administration significantly improved postoperative flap viability, with combined topical and intraperitoneal dimethyloxalylglycine administration leading to reduced necrosis on postsurgical day 7 at 6 mg/kg/day, 12 mg/kg/day, 24 mg/kg/day, and 48 mg/kg/day versus controls (all p < 0.05). Compared with controls (unperfused, 39.9 ± 3.8 percent), dimethyloxalylglycine treatment led to a dose-dependent decrease in unperfused tissue at 6 mg/kg/day (11.4 ± 1.7 percent), 12 mg/kg/day (9.4 ± 4.2 percent), 24 mg/kg/day (4.7 ± 2.6 percent), and 48 mg/kg/day (1.4 ± 0.9 percent) (all p < 0.001). Topical dimethyloxalylglycine application alone administered at 48 mg/kg/day was sufficient to improve flap viability (p = 0.005). Dimethyloxalylglycine-treated flaps exhibited higher CD31 staining (p = 0.004), tissue vascular endothelial growth factor (p = 0.007), HIF-1α staining (p < 0.001), and reduced terminal deoxynucleotidyl transferase-mediated dUDP end-labeling staining (p = 0.045). There were no differences in hematocrit or macroscopic organ changes on gross necropsy.

Conclusion:
Topical and systemic targeting of the HIF-1 pathway may be a promising therapeutic approach to improve flap resistance to ischemia.
Nanofat Needling: A Novel Method for Uniform Delivery of Adipose-Derived Stromal Vascular Fraction into the Skin
Authors: Verpaele Alexis , Tonnard Patrick , Jeganathan Charan , Ramaut Lisa 
Published: March 2019

Summary:
A novel method for delivering nanofat into the skin is presented. The principle is based on documented experience with introduction of agents into the skin by means of microneedling.