Related Articles

Traumatic C1-2 posterolateral dislocation with dens fracture, injury of the transverse atlantal ligament, and unilateral facet fracture with subluxation of C6-7: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8913

Authors: Park JB, Kang SS, Yeom JS

Abstract
RATIONALE: Traumatic C1-2 dislocation associated with contiguous or noncontiguous cervical spine injury is rare. Moreover, there have been no reports describing traumatic C1-2 dislocation associated with multiple contiguous and noncontiguous cervical injuries.
PATIENT CONCERNS: The authors present a case of a 20-year-old male with painful limitation of motion of the neck. This complex cervical injury occurred due to hyperextension of the head in a rotated position. The patient complained of neck pain that radiated to the left shoulder and arm, but he did not exhibit any neurological abnormalities.
DIAGNOSES: The diagnosis of the patients was traumatic C1-2 posterolateral dislocation associated with type II dens fracture (Anderson and D'Alonzo classification), type II injury of the transverse atlantal ligament (Dickman classification), and unilateral facet fracture with subluxation of C6-7.
INTERVENTIONS: The C1-2 posterolateral dislocation with type II dens fracture was successfully reduced by skull traction. The patient underwent anterior discectomy, open reduction, and fusion with plate fixation of C6-7 followed by posterior segmental fixation and fusion of C1-2.
OUTCOMES: At his postoperative 1-year follow-up, solid fusion was noted with improvement of clinical symptoms. This is the first report of traumatic C1-2 posterolateral dislocation associated with multiple C2 injuries and noncontiguous subaxial cervical injury.
LESSONS: A high index of suspicion and careful evaluation of entire cervical spine should be considered as the key to the proper diagnosis and treatment of traumatic C1-2 dislocation associated with contiguous and noncontiguous cervical injuries.

PMID: 29310380 [PubMed - indexed for MEDLINE]

Related Articles

Male breast cancer and mantle cell lymphoma in a single patient: A case report and literature review.

Medicine (Baltimore). 2017 Dec;96(48):e8911

Authors: Liu J, Wei H, Zhu K, Lai L, Han X, Yang Y

Abstract
RATIONALE: Although still relatively rare, multiple primary malignant neoplasms (MPMNs) have been increasingly reported in recent years.
PATIENT CONCERNS AND DIAGNOSES: A 65-year-old man was referred to our hospital for a painless, incidental left axillary lump. Ultrasound showed enlarged left axillary lymph nodes. An excisional biopsy was conducted on 3 lymph nodes. The pathological diagnosis was determined to be metastatic adenocarcinoma and mantle cell lymphoma (MCL) in the lymph nodes. Further physical examination of the patient yielded a 1.5-cm hard, left subareolar mass.
INTERVENTIONS AND OUTCOMES: The patient underwent modified radical mastectomy. The diagnosis was grade II invasive ductal carcinoma (stage IIA). The axillary lymph node showed MCL (stage I, group A), but not metastatic ductal carcinoma. The patient received chemotherapy, including 6 courses of CHOP (A chemotherapy protocol consists of cyclophosphamide 1.2 g day 1, doxorubicin 80 mg day 1, vindesine 4 mg day1, and prednisone 90 mg from day 1 to 5) for lymphoma and breast cancer. The patient was also administered endocrine therapy. After a 54-month follow-up, the patient was well with no evidence of disease.
LESSONS: MPMNs are easily misdiagnosed as a primary and metastatic tumor, leading to delayed or erroneous treatment. Male breast cancer in a patient with MCL is rare. Early diagnosis and proper therapy are necessary for an optimal prognosis. Further studies are required to define the mechanisms and risk factors of MPMNs.

PMID: 29310379 [PubMed - indexed for MEDLINE]

Related Articles

Isolated cerebral aspergillosis in an immunocompetent woman on treatment for bacterial infected necrotizing pancreatitis: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8908

Authors: Zhang S, Fu Q, Chen Q, Liang TB

Abstract
RATIONALE: Cerebral aspergillosis (CA) is a rare manifestation of invasive aspergillosis. It usually affects seriously immunocompromised hosts. Pancreatic bacterial or/and fungal infection is common in patients with severe acute pancreatitis.
PATIENT CONCERNS: We report the first case of an immunocompetent woman with infected necrotizing pancreatitis due to multidrug resistant Acinetobacter baumannii who, in the course of treatment, developed isolated CA.
DIAGNOSES: Magnetic resonance imaging, rather than computed tomography, revealed latent homolateral sinus disease-the possible source of the Aspergillus infection.
INTERVENTIONS: The pancreatic infection was controlled by open necrosectomy, and the CA was disappeared after neuronavigation-guided drainage and voriconazole antifungal therapy.
OUTCOME: The patient was discharged without complications. Our report revealed that persistent hyperglycemia, sepsisassociated immunoparalysis, and prolonged antibiotic use could impair severe patient's immunocompetence, making them more susceptible to opportunistic cerebral Aspergillus infection; the risk may be especially high in patients with paranasal sinus diseases.
LESSONS: Timely neurosurgical intervention combined with voriconazole antifungal therapy can provide a favorable outcome.

PMID: 29310378 [PubMed - indexed for MEDLINE]

Related Articles

Fat grafting for resurfacing an exposed implant in lower extremity: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8901

Authors: Lin YN, Chuang CH, Huang SH, Huang SH, Lin TM, Lin IW, Lin SD, Kuo YR

Abstract
RATIONALE: Although numerous reconstruction protocols have been reported for lower leg trauma, those for distal leg trauma remain few. We present the case of a woman with an implant exposure wound, who was successfully treated through fat grafting, without major flap surgery.
PATIENT CONCERNS: An 83-year-old woman with an exposed implant in lower extremity received reconstruction surgery once and the surgery failed. She refused additional major surgery and negative pressure wound therapy.
DIAGNOSES: The diagnosis of a tibia and fibula shaft open fracture (type IIIA) complicated with an exposed implant was made.
INTERVENTIONS: The procedure was performed by deploying purified and emulsified fat with a Micro-Autologous Fat Transplantation gun. The required lipoaspirate amount was grossly estimated using a standard formula: 0.5 cc of a lipoaspirate per square centimeter of wound. We prepared the lipoaspirate simply through centrifugation followed by physical emulsification. The endpoint of fat grafting was when lipoaspirate began to flow out of the wound. The initial dressing after the procedure included the topical usage of biomycin ointment with AQUACEL Foam (ConvaTec Inc., NC, USA) coverage, which was later changed to INTRASITE gel (Smith & Nephew, London, UK) with a gauze dressing for 4 weeks. After 4 weeks, dressing components were changed to Mepilex (Mölnlycke Health Care, Gothenburg, Sweden) alone.
OUTCOMES: The wound healed completely without requiring major flap surgery by 18 weeks after surgery.
LESSONS: Fat grafting is one kind of cell therapy and potentially has regenerative effects during wound healing. Fat grafting is critical in the healing processes of complicated wounds and might be considered a step in reconstruction surgery.

PMID: 29310377 [PubMed - indexed for MEDLINE]

Related Articles

Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section: A randomized controlled study.

Medicine (Baltimore). 2017 Dec;96(48):e8892

Authors: Weigl W, Bieryło A, Wielgus M, Krzemień-Wiczyńska Ś, Kołacz M, Dąbrowski MJ

Abstract
OBJECTIVES: Intrathecal morphine is used in the postoperative management of pain after caesarean section (CS), but might not be optimal for intraoperative analgesia. We hypothesized that intrathecal fentanyl could supplement intraoperative analgesia when added to a local anesthetic and morphine without affecting management of postoperative pain.
METHODS: This prospective, randomized, double-blind, parallel-group study included 60 parturients scheduled for elective CS. Spinal anesthesia consisted of bupivacaine with either morphine 100 μg (M group), or fentanyl 25 μg and morphine 100 μg (FM group). The frequency of intraoperative pain and pethidine consumption in the 24 hours postoperatively was recorded.
RESULTS: Fewer patients in the FM group required additional intraoperative analgesia (P < .01, relative risk 0.06, 95% confidence interval [CI] 0.004-1.04). The FM group was noninferior to the M group for 24-hour opioid consumption (95% CI -10.0 mg to 45.7 mg, which was below the prespecified boundary of 50 mg). Pethidine consumption in postoperative hours 1 to 12 was significantly higher in the FM group (P = .02). Postoperative nausea and vomiting (PONV) were more common in the FM group (P = .01). Visual analog scale scores, effective analgesia, Apgar scores, and rates of pruritus and respiratory depression were similar between the groups.
CONCLUSIONS: Intrathecal combination of fentanyl and morphine may provide better perioperative analgesia than morphine alone in CS and could be useful when the time from anesthesia to skin incision is short. However, an increase in PONV and possible acute spinal opioid tolerance after addition of intrathecal fentanyl warrants further investigation using lower doses of fentanyl.

PMID: 29310376 [PubMed - indexed for MEDLINE]

Related Articles

Prevention of surgical site infection after oral cancer surgery by topical tetracycline: Results of a multicenter randomized control trial.

Medicine (Baltimore). 2017 Dec;96(48):e8891

Authors: Funahara M, Yanamoto S, Ueda M, Suzuki T, Ota Y, Nishimaki F, Kurita H, Yamakawa N, Kirita T, Okura M, Mekaru Y, Arakaki K, Umeda M

Abstract
BACKGROUND: In a pilot study, we showed that topical administration of a tetracycline could decrease oral bacteria levels for 6 hours in patients who underwent oral cancer surgery combined with tracheotomy and flap reconstruction. This multicenter, randomized control trial aimed to investigate the effectiveness of topical application of tetracycline ointment for prevention of surgical site infection (SSI) associated with major oral cancer surgery.
METHODS: One hundred seventeen patients who underwent oral cancer resection combined with neck dissection, flap reconstruction, and tracheotomy were divided randomly into an intervention group (n = 56) and a control group (n = 61). The intervention consisted of topical administration of tetracycline ointment on the dorsum of the tongue every 6 hours for 48 hours postoperatively. Factors relating to the occurrence of SSI in both groups were subjected to logistic regression analysis.
RESULTS: SSI occurred in 11 patients (19.6%) in the intervention group and 22 patients (36.1%) in the control group. Multivariate analysis showed that a longer operating time and not receiving topical tetracycline were independent risk factors for development of SSI.
CONCLUSION: Administration of topical tetracycline for 48 hours postoperatively is an effective way of preventing SSI after oral cancer surgery.

PMID: 29310375 [PubMed - indexed for MEDLINE]

Related Articles

Horner syndrome as a postoperative complication after minimally invasive video-assisted thyroidectomy: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8888

Authors: Hu X, Zhang X, Gan H, Yu D, Sun W, Shi Z

Abstract
RATIONALE: Horner syndrome is an unusual complication after thyroidectomy.
PATIENT CONCERNS: We report a case of Horner syndrome in a 34-year-old female patient with Graves disease associated with papillary thyroid carcinoma who underwent left-side minimally invasive video-assisted thyroidectomy and neck dissection.
DIAGNOSIS: Horner syndrome was diagnosed based on left myosis, eyelid ptosis, and mild enophthalmos, which developed in the patient on postoperative day 2.
INTERVENTIONS: The patient was administered glucocorticoids and neurotrophic drugs on postoperative day 3.
OUTCOME: The symptoms of Horner syndrome were significantly relieved 1 year later.
LESSONS: Surgeons must be aware that Horner syndrome may be a source of iatrogenic complications, and patients also should be informed of these complications before surgery.

PMID: 29310374 [PubMed - indexed for MEDLINE]

Related Articles

A rare case of nonresterilized reinforced ETT obstruction caused by a structural defect: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8886

Authors: Kim SH, Park AY, Cho HB, Yoo JH, Park SY, Chung JW, Kim MG

Abstract
RATIONALE: Various factors can cause ventilatory failure after endotracheal tube (ETT) intubation, which is associated with increased patient morbidity and mortality.
PATIENT CONCERNS: A 76-year-old woman who was diagnosed with a hemopericardium and suspicion of a major-vessel injury due to dislocation of the clavicular fracture fixation screw.
DIAGNOSIS: Non-resterilized reinforced ETT obstruction caused by a structural defect.
INTERVENTION: Endotracheal tube was exchanged.
OUTCOMES: The ventilator profile showed rapid improvement.
LESSONS: Anesthesiologists should consider that a non-resterilized reinforced ETT may be defective. An ETT defect can cause high PIP and ETT obstruction without kinking or foreign materials.

PMID: 29310373 [PubMed - indexed for MEDLINE]

Related Articles

Acute kidney injury due to povidone-iodine ingestion: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8879

Authors: Kim CS, Kim SS, Bae EH, Ma SK, Kim SW

Abstract
RATIONALE: Povidone-iodine is a broad-spectrum antiseptic applied topically to treat wounds and prevent their infection. There have been several case reports of acute kidney injury (AKI) in burn patients after povidone-iodine irrigation and in patients receiving the substance as a sclerotherapy agent for management of lymphocele after renal transplantation. However, biopsy-confirmed AKI after ingestion of povidone-iodine has not previously been described.
PATIENT CONCERNS: A 47-year-old man who had apparently ingested povidone-iodine solution and presented with nausea, vomiting, and reduced urine output. Laboratory data revealed blood urea nitrogen of 124 mg/dL, serum creatinine of 6.3 mg/dL, impaired liver function, and leukocytosis. Urine iodine/creatinine ratio was markedly elevated.
DIAGNOSES: Acute tubular necrosis and interstitial nephritis secondary to povidone-iodine ingestion.
INTERVENTIONS: The patient was admitted to the intensive care unit and underwent continuous venovenous hemodiafiltration. Kidney biopsy showed acute tubular necrosis and interstitial nephritis. Unstained sections showed tan objects in the tubular lumina that were suspected to be povidone-iodine casts. Corticosteroid therapy (1 mg/kg/day) was started after kidney biopsy.
OUTCOMES: Renal function recovered after hemodialysis and corticosteroid medication, but not completely.
LESSONS: We have reported the first case of biopsy-confirmed AKI accompanied by increased urine iodine concentration following povidone-iodine ingestion.

PMID: 29310372 [PubMed - indexed for MEDLINE]

Related Articles

Treatment of cornual pregnancy in a patient with adenomyosis by high-intensity focused ultrasound (HIFU) ablation: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8874

Authors: Yu L, Xu L, Xu X

Abstract
RATIONALE: Cornual ectopic pregnancy in adenomyosis patients is a rare clinical condition, which may require careful approach for accurate diagnosis and treatment.
PATIENT CONCERNS: A 38-year-old woman presented with amenorrhea for 8 weeks and serum HCG levels of 1455 mmol/L. The B ultrasound showed an endometrial thickness of 1.7 cm, and the presence of a cystic structure (16 6 mm) at the right uterine horn. Color Doppler flow imaging (CDFI) accurately detected and confirmed the position of the cystic structure with its clear boundaries.
DIAGNOSES: Cornual ectopic pregnancy in adenomyosis.
INTERVENTIONS: The diagnosis was confirmed and treated by HIFU ablation. Total ablation was performed for 738 seconds without any bleeding.
OUTCOMES: Serum HCG levels decreased to < 0.1 mmol/L after 60 days post operation, and follow-up for 11 months showed a regular menstrual cycle without dysmenorrhea. Gestational sac was not obvious at postoperative 90 days by MRI. The adenomyosis associated lesion with blood perfusion became smaller at postoperative 90 days.
LESSONS: In this case, we successfully performed HIFU ablation and treated the cornual ectopic pregnancy in an adenomyosis patient for the first time, without any adverse complications.

PMID: 29310371 [PubMed - indexed for MEDLINE]

Related Articles

Characteristics of lymph node metastasis in resected adenosquamous lung cancer.

Medicine (Baltimore). 2017 Dec;96(48):e8870

Authors: Kong M, Jin J, Cai X, Shen J, Ma D, Ye M, Zhu C, Freedman S, Walters K, Xu X, Chen B

Abstract
The aim of this study was to retrospectively analyze the clinical data of resected adenosquamous lung cancer (ASLC) and to explore the influencing factors and clinicopathological characteristics of the metastasis lymph nodes. A total of 1156 consecutive patients with surgically resected lung cancer from January 2009 to June 2014 were studied. Fifty-four previously diagnosed ASLC patients were re-evaluated by experienced pathologists. IHC and H&E staining were employed to examine the primary focus and metastasis lymph nodes. The relationship between lymph node metastasis and clinicopathological characteristics of ASLC patients was then analyzed and the pathological type of metastasis lymph node was also determined. Forty-nine cases of typical ASLC were included in the study. Of the 49 ASLC patients, 26 cases presented lymph node metastasis. Lymph node metastasis was not associated with gender, smoking, tumor distribution, histological type of primary focus, and preoperative CEA level, but was associated with age ≥ 65 (P < .05) and tumor size ≥ 3 cm (P < .05). Lymph node metastasis adenocarcinoma was the main type in ASLC patients, and was related to the age and tumor size of the primary focus. Further large sample studies are necessary to identify influencing factors and clinicopathological characteristics of metastasis lymph nodes.

PMID: 29310370 [PubMed - indexed for MEDLINE]

Related Articles

Mitochondrial mutations in 12S rRNA and 16S rRNA presenting as chronic progressive external ophthalmoplegia (CPEO) plus: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8869

Authors: Lv ZY, Xu XM, Cao XF, Wang Q, Sun DF, Tian WJ, Yang Y, Wang YZ, Hao YL

Abstract
RATIONALE: Chronic progressive external ophthalmoplegia (CPEO) is a classical mitochondrial ocular disorder characterized by bilateral progressive ptosis and ophthalmoplegia. Kearns -Sayre syndrome (KSS) is a multisystem disorder with PEO, cardiac conduction block, and pigmentary retinopathy. A few individuals with CPEO have other manifestations of KSS, but do not meet all the clinical diagnosis criteria, and this is called "CPEO plus."
PATIENT CONCERNS: We report a 48-year-old woman exhibiting limb weakness, ptosis, ophthalmoparesis, and cerebellar dysfunctions.
DIAGNOSES: The patient was diagnosed as exhibiting CPEO plus syndrome.
INTERVENTIONS: The patient underwent clinical, genetic, histological, and histochemical analysis. She was treated orally with CoQ10, vitamin Bs, L-carnitine, and vitamin E.
OUTCOMES: The patient's serum creatine kinase levels, electrocardiography, and nerve conduction study results were normal; an electromyogram revealed myopathic findings. Magnetic resonance imaging showed global brain atrophy, particularly in the brainstem and cerebellum areas. A muscle biopsy showed the presence of abundant ragged red fibers. Sequencing of the mitochondrial DNA from the skeletal muscle biopsy revealed C960del mutation in 12S rRNA and homozygous mutation C2835T in 16S rRNA. She took medicines on schedule, the clinical features were similar as 2 years ago.
LESSONS: This is the first report of 2 rRNA mutations in a patient with MRI findings showing global brain atrophy, particularly in brainstem and cerebellum areas. Early recognition and appropriate treatment is crucial. This case highlights the cerebellar ataxia can occur in CPEO plus.

PMID: 29310369 [PubMed - indexed for MEDLINE]

Related Articles

Endoscopic reintervention for stent malfunction after stent-in-stent deployment for malignant hilar obstruction.

Medicine (Baltimore). 2017 Dec;96(48):e8867

Authors: Hong JB, Kang DH, Nam HS, Choi CW, Kim HW, Park SB, Kim SJ, Choi WH

Abstract
Endoscopic bilateral stenting has been increasingly performed for advanced hilar obstruction. As disease progresses, stent malfunction eventually occurs. However, endoscopic reintervention is difficult in these patients. We aimed to evaluate a suitable reintervention procedure for stent malfunction after stent-in-stent (SIS) deployment for malignant hilar obstruction.Among 52 patients with bilateral stenting performed using the SIS method between September 2009 and June 2016, 20 patients with stent malfunction were enrolled in this study. Reintervention was performed endoscopically or percutaneously. Technical and functional success rates were evaluated retrospectively.Technical and functional success rates of endoscopic reintervention were 83% (10/12) and 80% (8/10), respectively. Endoscopic bilateral and unilateral reintervention success rates were 75% (6/8) and 100% (4/4), respectively. For bilateral reintervention, either plastic or plastic and metal stents were used.Endoscopic reintervention could be considered for in-stent malfunction if patients are in fair condition after SIS placement for malignant hilar obstruction. Decisions regarding whether to use bilateral or unilateral drainage and the type of stent to use should depend on the conditions of the disease and the patient.

PMID: 29310368 [PubMed - indexed for MEDLINE]

Related Articles

Should Roux-en-Y gastric bypass biliopancreatic limb length be tailored to achieve improved diabetes outcomes?

Medicine (Baltimore). 2017 Dec;96(48):e8859

Authors: Nora M, Morais T, Almeida R, Guimarães M, Monteiro MP

Abstract
The objective is to access the role of Roux-en-Y gastric bypass (RYGB) biliopancreatic limb (BPL) length in type 2 diabetes (T2D) outcomes.RYGB is more effective than medical intervention for T2D treatment in obese patients. Despite the scarcity of available data, previous reports suggest that modifications of the RYGB limb lengths could improve the antidiabetic effects of the surgery.A cohort of obese T2D patients (n = 114) were submitted to laparoscopic RYGB, either with a standard BPL (SBPL) (n = 41; BPL 84 ± 2 cm) or long BPL (LBPL) (n = 73; BPL = 200 cm) and routinely monitored for weight loss and diabetic status up to 5 years after surgery.Baseline clinical features in the 2 patient subgroups were similar. After surgery, there was a significant reduction of body mass index (BMI) in both the groups, although the percentage of excess BMI loss (%EBMIL) after 5 years was higher for LBPL (75.50 ± 2.63 LBPL vs 65.90 ± 3.61 SBPL, P = .04). T2D remission rate was also higher (73% vs 55%, P < .05), while disease relapse rate (13.0% vs 32.5%; P < .05) and antidiabetic drug requirement in patients with persistent diabetes were lower after LBPL. Preoperative T2D duration predicted disease remission, but only for SBPL.RYGB with a longer BPL improves %EBMIL, T2D remission, and glycemic control in those with persistent disease, while it decreases diabetes relapse rate over time. The antidiabetic effects of LBPL RYGB also are less influenced by the preoperative disease duration. These data suggest the RYGB procedure could be tailored to improve T2D outcomes.

PMID: 29310367 [PubMed - indexed for MEDLINE]

Related Articles

Scrotum solitary fibrous tumor: A case report and review of literature.

Medicine (Baltimore). 2017 Dec;96(48):e8854

Authors: Zhao XY, Zeng M, Yang QY, Jing CP, Zhang Y

Abstract
BACKGROUND: A solitary fibrous tumor (SFT) is a rare clinical tumor, often manifesting as solitary nodules. It is a rare condition that occurs in the scrotum. Currently, no study has reported this condition.
CASE SUMMARY: We reported a case of an SFT in a 77-year-old man, and discuss its diagnosis, differential diagnosis, and treatment. Clinical and histopathological features, as well as the EnVision 2-step method, were used to diagnosis the SFT. The results of imaging tests and surgery indicated that the SFT was located in the right scrotum with 2 connected tumor nodules and a clear perimeter. The larger one was 11.0 cm × 9.3 cm × 8.1 cm, and the smaller one was 3.1 cm × 2.0 cm × 2.0 cm. Pathological results indicated that in both tumor nodules, tumor cells were spindle-shaped with unclear cell boundaries. The nucleus was vacuolated with mild to moderate atypia. In the larger tumor nodule, there were many thin-walled blood vessels with vasodilation or branching. In the smaller tumor nodule, rich blood vessels were found, mostly with fibrous degeneration of the thick walls of blood vessels, and more collagen-like tissue in the interstitial layers. Immunohistochemical results demonstrated diffuse, strongly positive expression of CD34, CD99, Vim, and Bcl-2 markers. The expression of the new fusion gene, NAB2-STAT6, as an alternative tool specifically confirmed the diagnosis of SFT. This patient underwent lump resection without further treatment. The patient is alive after 18-month follow-up.
CONCLUSION: This case was diagnosed as a SFT according to its histopathological features, immunophenotype. The patient is still alive at 18 months follow-up after the lump resection.

PMID: 29310366 [PubMed - indexed for MEDLINE]

Related Articles

EBV lymphoproliferative-associated disease and primary cardiac T-cell lymphoma in a STK4 deficient patient: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8852

Authors: Sherkat R, Sabri MR, Dehghan B, Bigdelian H, Reisi N, Afsharmoghadam N, Rahimi H, Rahmanian N, Klein C

Abstract
RATIONALE: Primary cardiac lymphoma (PLC) is an extremely uncommon malignancy. PCL is more common in secondary immunodeficient patients. In this report, we describe a unique case of PLC who had been diagnosed as a STK4 deficient patient. This case is the first Primary immunodeficiency (PID) patient developing PCL in the world.
PATIENT CONCERNS: An eleven-year-old girl, a known case of PID, was referred to the pediatric cardiology department because of chest pain and dyspnea. Her CXR revealed cardiomegaly without mediastinal involvement and the echocardiography showed a mild pericardial effusion and cystic-shape echogenic masses.
DIAGNOSES: After a period of missed follow up, she presented with respiratory distress following with syncope at the clinic because of a pressure effect of a large mass on the right ventricular outflow tract (RVOT) .An emergency operation was done for debulking of the tumors and resolving of RVOT obstruction. Biopsy and immunohistochemical staining was revealing "T-cell lymphoma", non-Hodgkin's type.
INTERVENTIONS: Chemotherapy was done with cyclophosphamide, methotrexate, adriamycine, vincristine, hydrocortisone and allopurinol.
OUTCOMES: The tumors shrank after chemotherapy initiation and she stayed stable for almost one month. Finally, she developed sever thrombocytopenia during her chemotherapy and died because of lung hemorrhage two months after her operation.
LESSONS: Although PCL is very rare, it must be considered in the differential diagnosis of intracardiac mass or refractory pericardial effusions, especially in PIDs which are widely known for developing EBV-associated diseases such as lymphoma.

PMID: 29310365 [PubMed - indexed for MEDLINE]

Related Articles

High circulating proprotein convertase subtilisin/Kexin type 9 concentration associates with cardiovascular risk: A meta-analysis of cohort studies.

Medicine (Baltimore). 2017 Dec;96(48):e8848

Authors: Qiu C, Zhou Q, Li X, Zhang Z, Zeng P, Cao Z, Pan B, Li X, Chen AF

Abstract
Whether the baseline circulating proprotein convertase subtilisin/Kexin type 9 (PCSK9) concentration associates with cardiovascular risk remains uncertain. This study aimed to investigate the predictive value of circulating PCSK9 in cardiovascular risk prediction.Relevant studies were searched through the MEDLINE, EMBASE, and Cochrane Library databases. The relative risk (RR) and 95% confidence interval (CI) were pooled to evaluate the association between the circulating PCSK9 concentration and cardiovascular risk. Dose-response meta-analysis was also performed in this study.A total of 11 cohort studies with 13,761 participants were included. The RR for cardiovascular risk was 1.25 (95% CI: 1.14-1.38, P < .001, I = 25%) while compared highest to lowest PCSK9 concentration. Subgroup meta-analysis, which sorted by ethnicity, base risk characteristic, and follow-up time, presented consistent results that there was a pronounced association between highest PCSK9 concentration and cardiovascular risk, such relationship was not significant in the statin-taking subjects. Seven studies were included in dose-response meta-analysis, and a nonlinear association between PCSK9 concentration and cardiovascular risk was observed [(χ test for nonlinearity = 6.7, (df = 2), P = .036].This study suggests that high circulating PCSK9 concentration associates with significantly increased cardiovascular risk, and demonstrates for the first time that it is a nonlinear dose-response association between circulating PCSK9 concentration and cardiovascular risk. These results provide the evidence that PCSK9 is an independent risk factor beyond the traditional cardiovascular risk factors and indicates a potential role of PCSK9 measurement for medical decisions. The clinical value of PCSK9 measurement and the identification of risk threshold should be confirmed in appropriately designed clinical trials.

PMID: 29310364 [PubMed - indexed for MEDLINE]

Related Articles

Perianal atypical leiomyoma: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8847

Authors: Sun P, Ou H, Huang S, Wei L, Zhang S, Liu J, Geng S, Yang K

Abstract
RATIONALE: Reports on perianal atypical leiomyoma, a perianal tumor, are rare. We confirmed a perianal atypical leiomyoma by its clinical presentation, magnetic resonance imaging findings, and immunohistochemistry.
PATIENT CONCERNS: A 28-year-old female with a perianal mass found more than 4 years ago. The 5cm_4cm_4cm sized mass was located on the left side of the anus and vagina; The magnetic resonance imaging (MRI) scan revealed: A 4.1cm × 5.2cm × 4.9cm sized round mass was observed on the left side of the circumference.
DIAGNOSES: Perianal atypical leiomyoma.
INTERVENTIONS: anal peripheral mass resection was performed under lumbar anesthesia.
OUTCOMES: The postoperative course was uneventful, healing, the patient was discharged.
LESSONS: Perianal atypical leiomyomas are benign tumors, but with the clinically atypical leiomyoma, it is sometimes difficult to distinguish between potential malignant smooth muscle tumors,and there may be malignant changes. Surgery should ensure complete resection, and to avoid postoperative recurrence, there should be a regular follow-up.

PMID: 29310363 [PubMed - indexed for MEDLINE]

Related Articles

Wrapping grafting for congenital pseudarthrosis of the tibia: A preliminary report.

Medicine (Baltimore). 2017 Dec;96(48):e8835

Authors: Yan A, Mei HB, Liu K, Wu JY, Tang J, Zhu GH, Ye WH

Abstract
OBJECTIVE: Treatment of congenital pseudarthrosis of the tibia (CPT) remains a challenge. The autogenic iliac bone graft is important consistent of treatment for CPT. The purpose of this study was to investigate the role of wrapping autogenic iliac bone graft in improvement of the curing opportunities of CPT.
METHODS: We combined Ilizarov fixator with intramedullary rodding of the tibia and wrapping autogenic iliac bone graft for treatment 51 cases of CPT between 2007 and 2010. The mean age is 3.2 years at index operation, of which 31 patients (61%) were below 3 years old. According to Crawford classification, 5 tibia had type-II morphology; 3, type-III; 43, type-IV.
RESULTS: In the postoperative follow-up of 3.5 months (range from 3 to 4.5 months), all cases were found that the bone graft sites of pseudarthrosis of the tibia showed a significant augmentation and spindle-shaped expansion as obvious change. All cases of this series have been followed-up, average followed-up time were 1.6 years (range from 7 to 3.1 years), of which 19 cases were more than 2 years. The average time of removed the Ilizarov ring fixator was 3.5 months (range from 3 to 4.5 months). According to Johnston Clinical evaluation system, 26 cases had grade I, 21 cases, grade II, 4 cases, grade III. Following the Ohnishi X-ray evaluation criteria, union of pseudarthrosis of the tibia were 42 cases, delayed union 5 cases, nonunion 4 cases.
CONCLUSION: Autogenic iliac bone graft is able to offer the activity of osteoblasts and osteogenesis induced by bone morphogenetic protein (BMP) and glycoprotein, meanwhile enclosing bone graft could help keep cancellous bone fragments in close contact around pseudarthrosis of the tibia, allowing the formation of high concentration of glycoprotein and BMP induced by chemical factors because of established the sealing environment in location, all of which could enhance the healing of pseudarthrosis of the tibia.

PMID: 29310362 [PubMed - indexed for MEDLINE]

Related Articles

Severe pertussis infection: A clinicopathological study.

Medicine (Baltimore). 2017 Dec;96(48):e8823

Authors: Palvo F, Fabro AT, Cervi MC, Aragon DC, Ramalho FS, Carlotti APCP

Abstract
We aimed to investigate the clinicopathological features of pertussis in children admitted to a tertiary-care university hospital in Brazil.This was a retrospective cohort study of all pediatric hospital admissions with pertussis from January 1, 2008 to December 31, 2014. We also reported the autopsy findings in children who died.Fifty-five patients admitted to the hospital over the study period had laboratorial confirmation of Bordetella pertussis infection, 17 (30.9%) needed pediatric intensive care unit (PICU) admission and 6 (10.9%) died. All patients who died were younger than 60 days old and unvaccinated for pertussis; 50% of them had coinfection with respiratory syncytial virus. Leukocyte count ≥40,000/mm at hospital admission was an independent risk factor for PICU admission. Mean heart rate during hospitalization ≥160 bpm was an independent risk factor for death. A cut-off point of 41,200 leukocytes/mm at hospital admission had sensitivity of 64.7% and specificity of 89.5% to predict PICU admission (area under the curve 0.75) and sensitivity of 100% and specificity of 81.6% to predict death (area under the curve 0.93). Autopsy showed medial thickening of small pulmonary arteries in 80% of patients who had pulmonary hypertension; intravascular aggregates of leukocytes or pulmonary thrombosis were not observed. Immunohistochemical staining of tissue samples obtained at autopsy identified B pertussis and respiratory syncytial virus in pulmonary and extra-pulmonary sites.Marked leukocytosis at presentation was associated with morbidity and mortality in children hospitalized with pertussis. Implementation of preventive strategies is crucial to diminish the incidence of the disease, especially in young unimmunized infants.

PMID: 29310361 [PubMed - indexed for MEDLINE]

Related Articles

Achieving stable remission with maintenance electroconvulsive therapy in a patient with treatment-resistant schizophrenia: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8813

Authors: Moeller S, Kalkwarf N, Lücke C, Ortiz D, Jahn S, Först C, Braun N, Philipsen A, Müller HHO

Abstract
RATIONALE: Up to one third of all schizophrenic patients are classified as having treatment-resistant schizophrenia (TRS). This subgroup faces remarkable medical and psychosocial damages, and pharmacotherapy is often limited due to nonresponse and/or side effects. Maintenance electroconvulsive therapy (M-ECT) might be effective in TRS.
PATIENT CONCERNS: We present a case of a 26-year-old male patient with a TRS.
DIAGNOSES: He received a treatment series of ECT sessions and a course of 24 M-ECTs.
INTERVENTIONS: The entire treatment was tolerated without significant side effects.
OUTCOMES: Moreover, the Psychotic Symptom Rating Scale (PSYRATS) scores for both positive and negative symptoms decreased and remained stable over the course of M-ECT.
LESSONS: Because of the remarkable improvement in the negative and positive symptom clusters, we propose systematic examinations in the field of M-ECT in TRS patients. These studies should integrate long-term outcome and tolerance measurements, gaining insight into the optimal duration of treatment for this indication.

PMID: 29310360 [PubMed - indexed for MEDLINE]

Related Articles

Natural teeth-retained splint based on a patient-specific 3D-printed mandible used for implant surgery and vestibuloplasty: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8812

Authors: Xing H, Wu J, Zhou L, Yang S

Abstract
RATIONALE: With respect to improving the quality of oral rehabilitation, the management of keratinized mucosa is as important as bone condition for implant success. To enhance this management, a natural teeth-retained splint based on a patient-specific 3-dimensional (3D) printed mandible was used in vestibuloplasty to provide sufficient keratinized mucosa around dental implants to support long-term implant maintenance.
PATIENT CONCERNS: A 28-year-old male patient had a fracture of the anterior andible 1 year ago, and the fracture was treated with titanium.
DIAGNOSES: The patient had lost mandibular incisors on both the sides and had a shallow vestibule and little keratinized mucosa.
INTERVENTIONS: In the first-stage implant surgery, 2 implants were inserted and the titanium fracture fixation plates and screws were removed at the same time. During second-stage implant surgery, vestibuloplasty was performed, and the natural teeth-retained splint was applied. The splint was made based upon a patient-specific 3D-printed mandible. At 30-day follow-up, the splint was modified and reset. The modified splint was removed after an additional 60 days, and the patient received prosthetic treatment.
OUTCOMES: After prosthetic treatment, successful oral rehabilitation was achieved. Within 1 year and 3 years after implant prosthesis finished, the patient exhibited a good quantity of keratinized gingiva.
LESSONS SUBSECTIONS: The proposed splint is a simple and time-effective technique for correcting soft tissue defects in implant dentistry that ensures a good quantity of keratinized mucosa.

PMID: 29310359 [PubMed - indexed for MEDLINE]

Related Articles

A systematic review and meta-analysis of robot-assisted versus laparoscopically assisted gastrectomy for gastric cancer.

Medicine (Baltimore). 2017 Dec;96(48):e8797

Authors: Wang Y, Zhao X, Song Y, Cai A, Xi H, Chen L

Abstract
BACKGROUND: Robotic-assisted gastrectomy (RAG) has been used for gastric cancer since 2002. This meta-analysis was carried out to evaluate whether RAG is safer and more effective than conventional laparoscopically assisted gastrectomy (LAG) for gastric cancer.
METHODS: We performed a manual search for these 2 types of operations (RAG and LAG) in the PubMed, Embase, and the Cochrane Library databases up to April 30, 2016. Twelve nonrandomized controlled trials that reported on RAG and LAG for gastric cancer were included. Outcomes evaluated included operation time, number of retrieved lymph nodes, blood loss, length of the resection margin, complications, and postoperative hospital stay.
RESULTS: A total of 3744 patients in 12 studies were included (1134 patients in the RAG group and 2610 patients in the LAG group). The operation time was significantly shorter in the LAG group [weighted mean difference (WMD) 42.0 (95% confidence interval, 95% CI 28.11-55.89) minutes; P < .00001], while the loss of blood volume was lower in the RAG group (P = .01). The number of retrieved lymph nodes, duration of postoperative stay, length of the proximal resection margin, length of the distal resection margin, and postoperative complications were similar between groups.
CONCLUSION: We conclude that RAG is a safe and appropriate treatment for gastric cancer patients in comparison to LAG. Nevertheless, RAG is not superior to LAG. Future research on RAG should focus on comparing the differences in retrieved lymph nodes in different tiers, evaluating the postoperative recovery and reducing the cost of the treatment.

PMID: 29310358 [PubMed - indexed for MEDLINE]

Related Articles

Risk profile, management, and outcomes of patients with venous thromboembolism attended in Spanish Emergency Departments: The ESPHERIA registry.

Medicine (Baltimore). 2017 Dec;96(48):e8796

Authors: Jimenez S, Ruiz-Artacho P, Merlo M, Suero C, Antolin A, Casal JR, Sanchez M, Ortega-Duarte A, Genis M, Piñera P, investigators of the ESPHERIA registry and the Venous Thromboembolic Disease Group of the Spanish Society of Emergency Medicine (ETV-SEMES)

Abstract
The objective of this study was to determine the clinical profile of and diagnostic and therapeutic approach to patients with venous thromboembolism (VTE) in Spanish Emergency Departments (EDs). Risk factors, adherence to clinical practice guidelines, and outcomes were also evaluated.Patients with VTE diagnosed in 53 Spanish EDs were prospectively and consecutively included. Demographic data, comorbidities, risk factors for VTE, index event characteristics, hemorrhagic risk, and mortality were evaluated. Adherence to clinical practice guidelines was assessed based on clinical probability scales, requests for determination of D-dimer, use of anticoagulant treatment before confirmation of diagnosis, and assessment of bleeding and prognostic risk. Recurrence, bleeding, and death during admission and at 30, 90, and 180 days after diagnosis in the EDs were recorded.From 549,840 ED visits made over a mean period of 40 days, 905 patients were diagnosed with VTE (incidence 1.6 diagnoses per 1000 visits). The final analysis included 801 patients, of whom 49.8% had pulmonary embolism. The most frequent risk factors for VTE were age (≥70 years), obesity, and new immobility. Clinical probability, prognosis, and bleeding risk scales were recorded in only 7.6%, 7.5%, and 1% of cases, respectively. D-dimer was determined in 87.2% of patients with a high clinical probability of VTE, and treatment was initiated before confirmation in only 35.9% of these patients. In patients with pulmonary embolism, 31.3% had a low risk of VTE. Overall, 98.7% of patients with pulmonary embolism and 50.2% of patients with deep venous thrombosis were admitted. During follow-up, total bleeding was more frequent than recurrences: the rates of any bleeding event were 4.4%, 3.9%, 5.3%, and 3.5% at admission and at 30 and 90, and 180 days, respectively; the rates of VTE recurrence were 2.3%, 1.3%, 1.7%, and 0.6%, respectively. Mortality rates were 3.4%, 3.1%, 4.1%, and 2.6% during hospitalization and at 30, 90, and 180 days, respectively.VTE had a substantial impact on Spanish EDs. The clinical presentation and risk profile for the development of VTE in patients diagnosed in the EDs was similar to that recorded in previous studies. During follow-up, bleeding (overall) was more frequent than recurrences. Adherence to clinical practice guidelines could improve significantly.

PMID: 29310357 [PubMed - indexed for MEDLINE]

Related Articles

Combined low miRNA-29s is an independent risk factor in predicting prognosis of patients with hepatocellular carcinoma after hepatectomy: A Chinese population-based study.

Medicine (Baltimore). 2017 Dec;96(48):e8795

Authors: Zhang Z, Shen S

Abstract
The prediction of prognosis of hepatocellular carcinoma (HCC) following partial hepatectomy is still an unresolved issue. The aim of this study is to identify the association between miRNA-29s family and the prognosis of patients with HCC in a large Asian cohort. We retrospectively reviewed 122 patients with HCC managed in our institution between 2008 and 2015. The expression of miRNA-29s was detected by real-time polymerase chain reaction (PCR). Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models. For the entire cohort of 122 patients, the normalized real-time PCR results showed that miRNA-29s (miR-29a, miR-29b, and miR-29c) were deregulated in tumor tissues as compared with corresponding nontumorous tissue samples. We then performed survival analysis to investigate the prognostic value of miRNA-29s. We found that low miR-29b was associated with a decreasing 5-year overall survival (OS) rate from 70.2% to 39.1% and low miR-29c was associated with a decreasing 5-year OS rate from 53.6% to 23.7%. We further conducted multivariate Cox proportional hazards analysis adding the variable of combined low miR-29b and low miR-29c. The results demonstrated that combined low miR-29b and miR-29c was an independent prognostic factor of patients with HCC. In conclusion, we found that the miRNA-29s were down-regulated in tumor tissues as compared with corresponding nontumorous tissue samples. Combined low miR-29b and miR-29c was an independent prognostic factor of patients with HCC.

PMID: 29310356 [PubMed - indexed for MEDLINE]

Related Articles

Revision surgery for lumbar hemivertebra in a 7-year-old child with 10-year follow-up-a case report: A CARE-compliant article.

Medicine (Baltimore). 2017 Dec;96(48):e8794

Authors: Xue X, Zhao S

Abstract
RATIONALE: Hemivertebrae, which are the most frequent cause of congenital scoliosis, pose a challenge in terms of prognosis and therapy. The current gold standard treatment congenital scoliosis due to a lumbar and thoracic hemivertebra would be hemivertebra resection and short level posterior spinal fusion. Paucity literatures are reported for the treatment of hemivertebra by convex fusion with posterior hemivertebra excision.
PATIENT CONCERNS: The patient was first noticed to have a spinal problem at 7 years of age. A radiograph showed two full segment hemivertebra respectively at T10, between L4 and L5, with the spine deviating to the right side. No treatment was given, but he was followed with serial radiographs. At the 15 month follow up, a surgery was performed due to scoliosis progression, consisting of a unilateral instrumentation from L4 to L5 without hemivertebrectomy or epiphysiodesis. One year after surgery, the thoracic curve became larger and larger and hump started to progress as he grew.
DIAGNOSES: Congenital scoliosis; Full segment hemivertebra at T10 and L4/5.
INTERVENTIONS: The full segment hemivertebra between L4 and L5 was excised and fusion in revision procedure. Transpedicular screws were inserted on the convex side in L4 and S1 and a rod was applied. A chart and radiological review were record at 8 years after final surgery.
OUTCOMES: Eight years after the final surgery, the patient was completely pain-free, motion of the lumbar spine was preserved and the physiological curvatures were maintained. Good coronal and sagittal alignment of the spine was observed clinically and radiographically.
LESSONS: In summary, our case showed that unilateral instrumentation without hemivertebrectomy can result in an unacceptable deformity. However, the excellent outcome can be achieved when hemivertebra was excised. Although this is only a single case, the good result with a long follow-up suggests the technique is worthwhile for very young children with lumbosacral hemivertebra. Early recognition and resection combined with limited fusion were needed for these patients.

PMID: 29310355 [PubMed - indexed for MEDLINE]

Related Articles

Mesenteric fibromatosis after resection for gastrointestinal stromal tumor of stomach: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8792

Authors: Chu Y, Guo Q, Wu D

Abstract
RATIONALE: Gastrointestinal stromal tumor and mesenteric fibromatosis are rare mesenchymal tumors. Coexistence of these two diseases is uncommon, with only a few anecdotal reports of individuals.
PATIENT CONCERNS: Clinical data and treatment of a 43-year-old man with subsequent mesenteric fibromatosis from gastrointestinal stromal tumor are summarized. The Ethics Committee of The Second Affiliated Hospital, College of Medicine, Zhejiang University approved this study, and the patient provided written informed consent form.
DIAGNOSES: The initial diagnosis of the recurrent mesenteric mass was recurrent gastrointestinal stromal tumor.
INTERVENTIONS: The operation was performed as possible at the time when the mass was found after the first surgery.
OUTCOMES: The diagnosis was revised as mesenteric fibromatosis according to the postoperative immunohistochemical staining. The postoperative condition was normal without adjuvant therapy and no recidivation has been found.
LESSONS: The potential for the coexistence of gastrointestinal stromal tumor and mesenteric fibromatosis should always be considered.

PMID: 29310354 [PubMed - indexed for MEDLINE]

Related Articles

Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8783

Authors: Zhou Y, Guo H, Cai Z, Zhang Y

Abstract
RATIONALE: Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO).
PATIENT CONCERN: Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs.
DIAGNOSES: Unstable pelvic fractures, multiple fractures of bilateral lower limbs with floating knee injury, multiple pelvic and rib fractures and multiple degloving injuries and soft tissue contusion formed the characteristics of the multiple-injury.
INTERVENTIONS: The algorithm of DCO was determined as the treatment. Early simplified procedures such as wound debridement, pelvis fixation, closed reduction and EF of the right shoulder joint, and chest wall fixation were conducted as soon as possible. After a period of time, internal fixations were applied to the fracture sites. The subsequent functional exercise was also conducted in accordance with this algorithm.
OUTCOMES: This patient got recovery after the treatments which were guided by the criterion of DCO. The restoration of limb functional and the quality of life greatly improved.
LESSONS: The DCO plays a decisive role in the first aid and follow-up treatment of this patient. The guidelines of management of complex pelvic ring injuries and floating knee should be established by authorities.

PMID: 29310353 [PubMed - indexed for MEDLINE]

Related Articles

Underweight: another risk factor for cardiovascular disease?: A cross-sectional 2013 Behavioral Risk Factor Surveillance System (BRFSS) study of 491,773 individuals in the USA.

Medicine (Baltimore). 2017 Dec;96(48):e8769

Authors: Park D, Lee JH, Han S

Abstract
Obesity is a well-established risk factor for cardiovascular disease (CVD), but the underweight population of body mass index (BMI) below 18.5 kg/m has not been an object of concern. The objective of this study is to investigate whether underweight could be an independent risk factor for CVD in a population-based cross-sectional study.Cross-sectional data of 2013 Behavioral Risk Factor Surveillance System (BRFSS) database encompassing 491,773 US adult subjects were used to assess risk for CVD. Primary outcomes were the incidence and relative risks (RRs) of CVD including stroke, heart attack/myocardial infarction, or coronary artery disease according to BMI category. All analyses used weighted sampling probabilities of data source.The underweight population had a 19.7% greater risk of CVD than did the normal-weight, and the overweight and obese population had a 50% and 96% increased risk, respectively. When adjusted with covariates, the relative risk for CVD elevated in underweight population (adjusted RR 1.34 [95% confidence interval (CI) 1.335-1.348]). Conversely, the adjusted relative risk was significantly attenuated in the obese group (adjusted RR 1.149 [95% CI 1.147-1.151]) and it was even insignificant in the overweight group (adjusted RR 1.00 [95% CI 1.000-1.003]). In subanalysis for each CVD category, being underweight among BMI status was the strongest independent risk factor for stroke (adjusted RR 1.441 [95% CI 1.431-1.450]), heart attack/ myocardial infarction (MI) (adjusted RR 1.23 [95% CI 1.217-1.233]), and angina/coronary artery disease (adjusted RR 1.20 [95% CI 1.189-1.206]). Especially among the population below 40-year old, relative risk estimates remained increased in the underweight population; persons who were underweight had a 2.3-fold greater adjusted relative risk of CVD as compared with those with normal weight when we stratified with age.Underweight below BMI 18.5 kg/m may be another risk factor for CVD, and CVD risk of the overweight and obese population largely depended on other comorbidities accompanied by obesity.

PMID: 29310352 [PubMed - indexed for MEDLINE]

Related Articles

Efficacy and safety of FOLFIRI and biotherapy versus FOLFIRI alone for metastatic colorectal cancer patients: A meta-analysis.

Medicine (Baltimore). 2017 Dec;96(48):e8767

Authors: Jiang Y, Fan H, Jiang Y, Song G, Wang F, Li X, Li G

Abstract
BACKGROUND: Previous randomized controlled trials (RCTs) and meta-analyses have demonstrated the useless of FOLFIRI alone for previously treated patients with metastatic colorectal cancer (mCRC). The role of FOLFIRI regimen combined with biological therapy is unknown. The purpose of this meta-analysis is to evaluate the efficacy and safety of combining biological therapy with chemotherapy in previously treated patients with mCRC.
METHODS: MEDLINE, EMBASE, Web of Science, Cochrane library, and ClinicalTrials.gov were searched. Eligible studies were RCTs that evaluated the efficacy and safety of the FOLFIRI regimen with or without biological therapy for previously treated patients with mCRC. The hazard ratio (HR) or risk ratio (RR) with 95% confidence interval was estimated. The Chi-squared and I-squared tests were used to assess the statistical heterogeneity.
RESULTS: The literature search identified 7 RCTs that met the inclusion criteria for the meta-analysis, and 3680 patients with mCRC were included. The meta-analysis showed that combined therapy was associated with a significant improved progression-free survival (PFS) (HR = 0.78, 95% CI = 0.72-0.85, P < .001), overall survival (OS) (HR = 0.84, 95% CI = 0.77-0.92, P < .001), and overall response rate (ORR) (RR = 1.70, 95% CI = 1.25-2.31, P = .001). Sensitivity analysis suggested that combined therapy versus FOLFIRI alone might increase the risk of Grade 3/4 AEs.
CONCLUSION: The addition of biological therapy to the FOLFIRI regimen improved the PFS, OS, and ORR compared with FOLFIRI alone for previously treated patients with mCRC. Long-term survival outcomes are warranted.

PMID: 29310351 [PubMed - indexed for MEDLINE]

Related Articles

Relationship between skeletal muscle mass and liver fibrosis markers for patients with hepatitis C virus related liver disease.

Medicine (Baltimore). 2017 Dec;96(48):e8761

Authors: Takata R, Nishikawa H, Enomoto H, Iwata Y, Ishii A, Miyamoto Y, Ishii N, Yuri Y, Hasegawa K, Nakano C, Nishimura T, Yoh K, Aizawa N, Sakai Y, Ikeda N, Takashima T, Iijima H, Nishiguchi S

Abstract
We aimed to elucidate the relationship between serum liver fibrosis markers (Mac-2 binding protein glycosylation isomer (M2BPGi), FIB-4 index, aspartate aminotransferase to platelet ratio index and hyaluronic acid), and skeletal muscle mass and to investigate factors linked to skeletal muscle mass loss (SMML) in patients with chronic hepatitis C (CHC, n = 277, median age = 64 years). We defined patients with psoas muscle index [PMI, sum of bilateral psoas muscle mass calculated by manual trace method at the lumber 3 level on the computed tomography images divided by height squared (cm/m)] less than 6.36 cm/m for male and 3.92 cm/m for female as those with SMML based on the recommendations in current guidelines. Receiver operating curve (ROC) analysis was performed for predicting SMML in 4 liver fibrosis markers and parameters linked to SMML were also investigated in the univariate and multivariate analyses. In terms of liver fibrosis stages, F4 was observed in 115 patients, F3 in 67, F2 in 38, F1 in 53, and F0 in 4. The median (range) PMI for male and female were 6.198 (2.999-13.698) and 4.100 (1.691-7.052) cm/m, respectively. There were 72 male patients with SMML (55.4%) and 58 female patients with SMML (39.5%) (P = .0112). In both male and female, a significant inverse correlation between PMI and levels of liver fibrosis markers was observed in all liver fibrosis markers. ROC analyses for predicting SMML revealed that FIB-4 index had the highest area under the ROC (AUC = 0.712), followed by M2BPGi (AUC = 0.692). In the multivariate analysis of factors linked to SMML, gender (P = .0003), body mass index (P < .0001), FIB-4 index (P = .0039), and M2BPGi (P = .0121) were found to be significant predictors. In conclusion, liver fibrosis markers, especially FIB-4 index, can be helpful for predicting SMML in CHC patients.

PMID: 29310350 [PubMed - indexed for MEDLINE]

Related Articles

Adrenocortical oncocytoma: 11 Case reports and review of the literature.

Medicine (Baltimore). 2017 Dec;96(48):e8750

Authors: Hong Y, Hao Y, Hu J, Xu B, Shan H, Wang X

Abstract
RATIONALE: Adrenocortical oncocytoma is an extremely rare tumor of the adrenal gland. Its diagnostic criteria and biological behavior has not yet reached a consensus. The purpose of this study is to investigate the clinical characteristics of adrenocortical oncocytoma.
PATIENT CONCERNS: The clinical data from 11 cases of adrenocortical oncocytoma were retrospectively analyzed. Five patients found the tumor incidentally during the healthy examination, and 3 cases found the tumor during the diagnostic work-up for the evaluation of flank pain or hypertension. A female patient manifested virilization, and Cushing's syndrome showed in two patients. The tumor diameter was ranging from 2.0-13.0 cm.
DIAGNOSES: The serum cortisol, plasma aldosterone and catecholamine metabolites were used to evaluate the function of the tumors, and enhanced CT scan was used to confirm the tumor boundary, enhancement, and lymph nodes condition.
INTERVENTIONS: Seven cases underwent laparoscopic adrenal tumor resection, 4 patients underwent open surgery. Pathological report indicated adrenocortical oncocytoma in all cases, three of which were potentially malignant.
OUTCOMES: The patients were followed up for 19-72 months, no local recurrence and distant metastases were detected in 3 cases of malignant potential cases.
LESSONS: The majority of adrenocortical oncocytoma with or without function are benign, and close follow-up observation is essential.

PMID: 29310349 [PubMed - indexed for MEDLINE]

Related Articles

Healthcare utilization and costs among patients with herpes zoster and solid tumor malignancy on chemotherapy: A retrospective cohort study.

Medicine (Baltimore). 2017 Dec;96(48):e8746

Authors: Mao J, McPheeters JT, Finelli L

Abstract
Immunosuppressed patients with solid tumor malignancies (STMs) are particularly vulnerable to herpes zoster (HZ). This study estimated the incidence of HZ and evaluated healthcare resource utilization and costs for persons with STM receiving chemotherapy with and without incident HZ.We conducted a retrospective claims study of adults with STM receiving chemotherapy between January 1, 2010 and June 30, 2014. Patients were followed from their first chemotherapy date through development of HZ, health plan disenrollment, the study end date, or 24 months. HZ incidence was calculated and stratified by patient characteristics. Adjusted HZ incidence was estimated using Poisson regression. Healthcare resource utilization and costs were compared between patients with HZ (cases) and propensity score-matched controls without HZ during a variable follow-up period. Adjusted healthcare costs were estimated using Lin regression to control for informative censoring.Of 155,480 patients with STM receiving chemotherapy, 3100 (2.0%) developed HZ, yielding an adjusted HZ incidence rate of 13.8/1000 person-years (PY). HZ cases (n = 3004) had significantly higher healthcare resource utilization than matched controls (n = 15,020). Adjusted annual costs were $48,077 for cases vs $41,645 for matched controls, corresponding to a differential cost of $6432 annually.After adjustment for potential confounders, patients with STM receiving chemotherapy had an HZ incidence of 13.8/1000 PY; those who developed HZ used more healthcare resources and incurred higher costs than those who did not. These findings suggest that HZ prevention by vaccination could improve outcomes and reduce costs in this population.

PMID: 29310348 [PubMed - indexed for MEDLINE]

Related Articles

Radical antegrade modular pancreatosplenectomy for adenocarcinomaof the body of the pancreas in a patient with portal annular pancreas, aberrant hepatic artery, and absence of the celiac trunk: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8738

Authors: Yuan H, Wu P, Chen J, Lu Z, Chen L, Wei J, Guo F, Cai B, Yin J, Xu D, Jiang K, Miao Y

Abstract
RATIONALE: Portal annular pancreas is a rare anatomic variation, where the uncinated process of the pancreas connects with the dorsal pancreas and the pancreas tissue encases the portal vein (PV), superior mesenteric vein (SMV) or splenic vein (SV). Malignancies are quite uncommon in the patients, who have an annular pancreas especially portal annular pancreas. Ectopic common hepatic artery and absence of the celiac trunk (CT) are the other infrequent abnormalities.
PATIENT CONCERNS: A 74-year-old man suffered from upper abdominal and back pain.
DIAGNOSES AND INTERVENTIONS: Contrast enhanced computed tomography indicated a low-density mass in the body of the pancreas. Pathological report showed adenocarcinoma of the body of pancreas after radical antegrade modular pancreatosplenectomy (RAMPS).
OUTCOMES: In the operation, we found the superior vein and portal vein was surrounded by the pancreatic tissue. The left gastric artery and splenic artery originated respectively from abdominal aorta, and celiac trunk was not viewed. In addition, the common hepatic artery was a branch from the superior mesenteric artery.
LESSONS: In general, this is a novel clinical case of pancreatic carcinoma happening in the portal annular pancreas which was accompanied with aberrant hepatic artery and absence of the celiac trunk at the same time. Confronted with the pancreatic neoplasms, the possibility of coexistent annular pancreas and arterial variations should be considered.

PMID: 29310347 [PubMed - indexed for MEDLINE]

Related Articles

A systematic review and meta-analysis of the impact of mineralocorticoid receptor antagonists on glucose homeostasis.

Medicine (Baltimore). 2017 Dec;96(48):e8719

Authors: Korol S, Mottet F, Perreault S, Baker WL, White M, de Denus S

Abstract
BACKGROUND: Spironolactone, a nonselective mineralocorticoid receptor antagonist (MRA), may have a deleterious effect on glycemia. The objective of this review was to assess current knowledge on MRAs' influence (spironolactone, eplerenone, and canrenone) on glucose homeostasis and the risk of diabetes.
METHOD: A systematic review was conducted using the Medline database on articles published from 1946 to January 2017 that studied the effects of MRAs on any glucose-related endpoints, without any restrictions regarding the participants' characteristics.Study design, patient population, dose and duration of intervention, and the quantitative results on glycemic markers were extracted, interpreted for result synthesis, and evaluated for sources of bias. From the articles included in the qualitative analysis, a select number were used in a meta-analysis on studies having measured glycated hemoglobin (HbA1c) or risk of diabetes.
RESULTS: Seventy-two articles were selected from the Medline database and references of articles. Results on spironolactone were heterogeneous, but seemed to be disease-specific. A potential negative effect on glucose regulation was mainly observed in heart failure and diabetes trials, while a neutral or positive effect was detected in diseases characterized by hyperandrogenism, and inconclusive for hypertension. Interpretation of data from heart failure trials was limited by the small number of studies. From a meta-analysis of 12 randomized controlled studies evaluating spironolactone's impact on HbA1c in diabetic patients, spironolactone had a nonsignificant effect in parallel-group studies (mean difference 0.03 [-0.20;0.26]), but significantly increased HbA1c in crossover studies (mean difference 0.24 [0.18;0.31]). Finally, eplerenone did not seem to influence glycemia, while limited data indicated that canrenone may exert a neutral or beneficial effect.The studies had important limitations regarding study design, sample size, duration of follow-up, and choice of glycemic markers.
CONCLUSION: Spironolactone may induce disease-specific and modest alterations on glycemia. It is uncertain whether these effects are transient or not. Data from the most extensively studied population, individuals with diabetes, do not support a long-term glycemic impact in these patients. Further prospective studies are necessary to establish spironolactone's true biological effects and their clinical implications.

PMID: 29310346 [PubMed - indexed for MEDLINE]

Related Articles

Inferior mesenteric arteriovenous fistula with nonpulsatile abdominal mass: A case report and a mini-review.

Medicine (Baltimore). 2017 Dec;96(48):e8717

Authors: Cheng L, Zhao R, Guo D, Cai K, Zou K, Yang J, Zhu L

Abstract
RATIONALE: Inferior mesenteric arteriovenous fistula (IMAVF) is a rare condition principally characterized by portal hypertension and ischemic bowel disease. Up to now, only 30 cases have been reported. Presented here is an IMAVF patient with nonpulsatile abdominal mass as the main manifestation.
PATIENT CONCERNS: A 62-year-old Chinese male who complained of abdominal discomfort for a month was admitted to our hospital. Physical examination revealed a hard and hardly mobile mass.
DIAGNOSES: Space-occupying lesions were first suspected but endoscopy did not reveal any masses. The computed tomography angiography exhibited no definite boundary between the inferior mesenteric artery and vein. The patient was diagnosed with IMAVF.
INTERVENTIONS: The treatment of IMAVF mainly includes intra-arterial embolization and surgery. In our case, fistulas were complex and the patient had symptoms of colon ischemia, so we suggested a surgical resection instead of embolization. And the postoperative biopsy also confirmed the diagnosis.
OUTCOMES: After surgery, gastrointestinal symptoms disappeared and the patient began to gain weight gradually. During the follow-up, colonoscopy showed that the anastomotic astium and colonic mucosa were normal.
LESSONS: Analysis of the case showed that computed tomography angiography is an important auxiliary examination for establishing the diagnosis of IMAVF and surgery is an effective treatment.

PMID: 29310345 [PubMed - indexed for MEDLINE]

Related Articles

Polymyositis with elevated serum IgG4 levels and abundant IgG4+ plasma cell infiltration: A case report and literature review.

Medicine (Baltimore). 2017 Dec;96(48):e8710

Authors: Anan R, Akiyama M, Kaneko Y, Kikuchi J, Suzuki K, Matsubara S, Takeuchi T

Abstract
INTRODUCTION: Polymyositis (PM) is a type of autoimmune, inflammatory myopathy. IgG4-related disease (IgG4-RD) is a recently recognized disease entity characterized by elevated serum IgG4 levels and IgG4 plasma-cell infiltration of various organs. However, several reports have described cases of other diseases that present with those features, suggesting the importance of careful differential diagnosis. Herein, we report the first case of PM with elevated serum IgG4 levels and IgG4 plasma cells in the muscles, mimicking IgG4-RD.A 73-year-old woman visited our hospital because of proximal muscle weakness of both thighs. Her blood test showed high levels of serum creatinine kinase, aldolase, and IgG4. Magnetic resonance imaging of the thighs showed muscle edema. Needle electromyography showed findings typical of myositis. Histological analysis of her left quadriceps revealed infiltration of IgG4 plasma cells as well as CD8 T cells. Scattered necrotic and regenerating muscle fibers with no specific findings for IgG4-RD (storiform fibrosis and obliterative phlebitis) were typical for PM. We diagnosed her condition as PM and treated her with 40 mg/day of prednisolone that decreased levels of muscle enzymes and improved muscle weakness.
CONCLUSION: Our case indicated that PM could present with high serum IgG4 levels and IgG4 plasma-cell infiltration, mimicking IgG4-RD. Although the mechanism of IgG4 elevation in such PM is unclear, our case highlights the necessity to recognize that high serum IgG4 levels and IgG4 plasma-cell infiltration in organs are not specific for IgG4-RD.

PMID: 29310344 [PubMed - indexed for MEDLINE]

Related Articles

Cerebrospinal fluid real-time quaking-induced conversion test for sporadic Creutzfeldt-Jakob disease in an 18-year-old woman: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8699

Authors: Yao Y, Dong X, Guan H, Lu Q

Abstract
RATIONALE: Sporadic Creutzfeldt-Jakob disease (sCJD) mainly occurs in the elderly, with the peak age of onset ranging from 55 to 75 years. The symptoms of sCJD are not unique, and laboratory tests such as magnetic resonance imaging (MRI), electroencephalogram (EEG) and cerebrospinal fluid (CSF)14-3-3 protein have low sensitivity or specificity. Therefore, excluding treatable diseases and establishing a diagnosis could be difficult in young patients with suspected sCJD. Recently, real-time quaking-induced conversion (RT-QuIC) has been used in the diagnosis of sCJD, with more than 95% sensitivity and 100% specificity.
PATIENT CONCERNS: We report the case of an 18-year-old woman presented with cerebellar ataxia, blurred vision, rapidly progressive dementia, tremor and involuntary movements, urinary incontinence, mutism, and eventually myoclonus for 16 weeks. Brain MRI scans were unremarkable at the 4th and 8th week after initial symptom presentation, but showed hyperintensity in bilateral basal ganglia and cortical ribboning at the 16th week. Typical periodic bilateral triphasic sharp wave complexes on EEG did not appear until the 16th week after initial symptom presentation.
DIAGNOSES: Due to the young age of the patient and the originally unremarkable MRI and EEG findings, we first considered treatable diseases such as autoimmune encephalitis, infections, organic acidemias and toxication. However, extensive tests ruled out these diseases. When she was finally diagnosed with probable sCJD, we were unable to perform a brain biopsy. We confirmed the diagnosis by detecting the scrapie form of prion protein in the CSF using RT-QuIC.
INTERVENTIONS: Experimental treatments with corticosteroids, intravenous immunoglobulin and ganciclovir were given.
OUTCOMES: Experimental treatments were ineffective. The patient's parents discharged her from our clinic.
LESSONS: We present a case of probable sCJD with an early onset and a complex clinical picture confirmed by RT-QuIC. This case report suggests that RT-QuIC has great value for the diagnosis of atypical cases.

PMID: 29310343 [PubMed - indexed for MEDLINE]

Related Articles

Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumor after failure with imatinib and sunitinib treatment: A meta-analysis.

Medicine (Baltimore). 2017 Dec;96(48):e8698

Authors: Zhang Z, Jiang T, Wang W, Piao D

Abstract
AIMS: This meta-analysis aimed to evaluate the safety and efficacy of regorafenib as a treatment for patients with advanced (metastatic and/or unresectable) gastrointestinal stromal tumor (AGIST) after developing resistance to imatinib and sunitinib.
METHODS: A literature search of databases such as PubMed, Embase, and Cochrane library was conducted up to February 2017. The pooled percentages and the corresponding 95% confidence intervals (CIs) were calculated using the Stata 11.0 software.
RESULTS: Four studies involving 243 patients with AGIST were included. Results revealed that approximately 49% (95% CI 30-67), 14% (95% CI 5-23), and 41% (95% CI 21-61) of patients with AGIST showed clinical benefit (including complete response), partial response, and stable disease, respectively, after regorafenib treatment, which was given after failure with imatinib and sunitinib treatments. No complete response was found in the included studies. Pooled progression-free survival was 6.58 months (95% CI 4.62-8.54). Hypertension (20%; 95% CI 7-33), hand-foot skin reaction (22%; 95% CI 17-27), and hypophosphatemia (18%; 95% CI 5-41) were common grade ≥3 regorafenib-related adverse events in patients treated with regorafenib after failure with imatinib and sunitinib treatments.
CONCLUSIONS: Forty-nine per cent of patients with AGIST benefited after regorafenib treatment after the development of resistance to imatinib and sunitinib. More studies should be performed to improve the clinical survival of patients with AGIST. Close monitoring and appropriate management of grade ≥3 regorafenib-related adverse events should be considered during treatment.

PMID: 29310342 [PubMed - indexed for MEDLINE]

Related Articles

The correlational research among serum CXCL13 levels, circulating plasmablasts and memory B cells in patients with systemic lupus erythematosus: A STROBE-compliant article.

Medicine (Baltimore). 2017 Dec;96(48):e8675

Authors: Fang C, Luo T, Lin L

Abstract
We investigated whether serum CXC ligand 13 protein (CXCL13) levels correlate with the circulating plasmablasts and memory B-cells alteration in systemic lupus erythematosus (SLE) patients. The diagnostic use of CXCL13 concentrations in active lupus was also analyzed.A total of 36 SLE patients and 18 healthy controls were included. Serum CXCL13 levels were examined by enzyme-linked immunosorbent assay. The frequency and absolute count of circulating plasmablasts and memory B cells were analyzed by flow cytometry. Receiver operating characteristic curves (ROC curves) were generated to analyze the utility of serum CXCL13 level and plasmablasts frequency as tools for the recognition of active SLE.Elevation of serum CXCL13 levels, higher plasmablasts frequency, and reduction of memory B-cells count were observed in SLE patients, compared with healthy controls. Interestingly, correlational analyses showed not only significantly positive association between CXCL13 levels and SLE Disease Activity Index (SLEDAI) or plasmablasts frequency, but an inverse correlation between CXCL13 concentration and memory B-cell count. ROC curves showed that serum CXCL13 level and plasmablasts frequency were practical in identifying active disease from overall SLE patients, with considerable accuracy.Serum CXCL13 levels correlate with the alteration of plasmablasts and memory B cells in SLE. CXCL13 may be used as a practical tool in judgment of active SLE.

PMID: 29310341 [PubMed - indexed for MEDLINE]

Related Articles

The first case report of a large deletion of the BRCA1 gene in Croatia: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8667

Authors: Musani V, Sušac I, Ozretić P, Eljuga D, Levanat S

Abstract
RATIONALE: Breast cancer is one of the most common cancers in women, and it is the leading cause of cancer related deaths in Croatia. BRCA1 and BRCA2 gene mutations are the most common cause of hereditary breast cancer.
PATIENT CONCERNS: In this report we describe a Croatian patient with no apparent family history of cancer, who developed breast cancer first at 29, and again at 33.
DIAGNOSIS: Due to the early development of first breast cancer and triple negative status of the second, the attending physician suspected a hereditary aspect.
INTERVENTIONS: Patient was sent to BRCA1 genetic testing. Subsequently, her mother and sister were sent to check for the mutation found in the patient.
OUTCOMES: BRCA1 exons 4-6 deletion was determined and sequencing confirmed the deletion as NG_005905.2:g.107648_117905del10257. Mother and sister were not affected, but since there were no available family members on the fathers' side, it was not possible to determine if this was a case of de novo mutation. Until now, only in three reports with the similar mutation the exact mutation borders were determined. The mutation in this case was not the same as previously reported and was more than twice in size.
LESSONS: All large deletions should be described at the nucleotide level, so that in cases with missing family data it would be possible to deduce if the mutation is already known. If the mutation is already known, it is probably not a de novo event, since it is unlikely that the breakpoints would be exactly the same more than once.

PMID: 29310340 [PubMed - indexed for MEDLINE]

Related Articles

An unusual case of perforation of the alimentary canal following Bigu: A Taoist fasting technique.

Medicine (Baltimore). 2017 Dec;96(48):e8653

Authors: Wang J, Jin J, Xue X, Hao Y, Li D, Xu S, Huang F

Abstract
RATIONALE: Bigu is a Taoist fasting technique interpreted as avoiding grains in the Encyclopedia of China. This technique has been used from ancient times to the present day in China and other parts of the world to achieve good health, weight loss, longevity, and even immortality. A variety of health problems have been identified in relation to the severe diet during Bigu. However, perforation of the alimentary canal has not been reported to be associated with Bigu. In the present study, we illustrated an unusual case of perforation of the alimentary canal in relation to Bigu.
PATIENT CONCERNS: A 36-year-old woman was admitted to our hospital after falling into a coma. One month before admission, she had black stool accompanied by dizziness and fatigue, while the symptoms progressively worsened. The patient reported that she stopped the intake of meat for 5 years, and further practiced Bigu for 5 months, eating only fruits and vegetables, and avoiding grains and meat.
DIAGNOSIS: Preformation of the alimentary canal.
INTERVENTIONS: Gastric bypass operation, also known as Roux-en-Y anastomosis, was undertaken. Since the patient developed thrombus with edema on the right upper limb after surgical intervention, she was subsequently treated with anticoagulation therapy using low-molecular weight heparin.
OUTCOMES: The patient's symptoms were remarkably improved and exhibited signs of recovery in follow-up examinations.
LESSONS: The case has raises serious concerns about practicing Bigu. Furthermore, it is strongly advocated that a state of Bigu for a long period of time can even be dangerous.

PMID: 29310339 [PubMed - indexed for MEDLINE]

Related Articles

Genetic polymorphism of angiotensin-converting enzyme and hypertrophic cardiomyopathy risk: A systematic review and meta-analysis.

Medicine (Baltimore). 2017 Dec;96(48):e8639

Authors: Yuan Y, Meng L, Zhou Y, Lu N

Abstract
BACKGROUND: Genetic factors in the pathogenesis of cardiomyopathies have received a lot of attention during the past 2 decades. Some studies have reported that angiotensin-converting enzyme (ACE) gene has been associated with hypertrophic cardiomyopathy (HCM). However, there have been inconsonant results among different studies. To clarify the influence of ACE on HCM, a systemic review and meta-analysis of case-control studies were performed.
METHODS: The following databases were searched to indentify related studies: PubMed database, the Embase database, the Cochrane Central Register of Controlled Trials database, China National Knowledge Information database, and Chinese Scientific and Technological Journal database. Search terms included "hypertrophic cardiomyopathy," "angiotensin converting enzyme" or "ACE," and "polymorphism or mutation."
RESULTS: Fifteen separate studies were suitable for the inclusion criterion. The selected studies contained 2972 participants, including 1047 in HCM group and 1925 controls. Pooled odds ratios (ORs) were calculated to assess the association between ACE insertion/deletion (I/D) polymorphism and HCM. Our case-control data indicated that D allele carrier is a risk allele in all genetic models: allele contrast (D vs I: OR = 1.35, 95% confidence interval [CI]: 1.10-1.65, P = .004), homozygous comparison (DD vs II: OR = 1.69; 95% CI: 1.12-2.54; P = .01), dominant model (DD + ID vs II: OR = 1.52, 95% CI: 1.15-2.02, P = .003), and recessive model (DD vs ID + II: OR = 1.34, 95% CI: 0.99-1.81, P = .03).
CONCLUSION: In summary, the current meta-analysis provided solid evidence suggesting that ACE gene I/D polymorphism was probably a genetic risk factor for HCM.

PMID: 29310338 [PubMed - indexed for MEDLINE]

Related Articles

Simulation of expected childhood and adolescent thyroid cancer cases in Japan using a cancer-progression model based on the National Cancer Registry: Application to the first-round thyroid examination of the Fukushima Health Management Survey.

Medicine (Baltimore). 2017 Dec;96(48):e8631

Authors: Takahashi H, Takahashi K, Shimura H, Yasumura S, Suzuki S, Ohtsuru A, Midorikawa S, Ohira T, Ohto H, Yamashita S, Kamiya K

Abstract
During the 4 years following the nuclear power plant accident of 2011, 39 males and 77 females were diagnosed with or suspected of having cancer based on the first-round thyroid examination of the Fukushima Health Management Survey (FHMS) targeting residents aged <19 years in Fukushima. Prior comparisons between the observed data and Japan's National Cancer Registry (NCR) data suggested that this incidence might be excessive, but such comparisons are problematic because they need not only to adjust index unit (prevalence proportion vs incidence rate), but also examine characteristics (complete enumeration mass screening for the aged 0 to 18 years vs detections in clinical settings for all the residents) and sensitivity of the examinations. The purpose of this study is to build a common model applicable to any region in Japan under nonaccident conditions, and estimate the expected prevalence based on the numbers of subjects surveyed in the FHMS using a simulation of the sensitivity.The cancer-progression model is an extension of Day and Walter's, the parameters of which were estimated by minimizing the weighted root mean squared error between the average age-specific thyroid incident rates from 2001 to 2010 in the NCR and those determined by the model. We estimated expected detectable prevalent cases by the model with their examination-participation proportions and simulated several sensitivities.Median sojourn times were 34 years (males) and 30 years (females) by the model. Simulation results showed that the numbers of observed prevalent cases were within the 95% confidence intervals of the expected prevalent cases with several sensitivities in each gender.We successfully built a cancer-progression model of thyroid cancer based on Japan's NCR data under no accident conditions. It is a tool for comparing the observed prevalence data of examinations and the NCR data, which resolved 3 issues of index unit, the characteristics and sensitivity of the examinations. Simulation results imply that the number of observed thyroid cancer cases can be detected by the FHMS first-round thyroid screening at several sensitivities under no accident conditions.

PMID: 29310337 [PubMed - indexed for MEDLINE]

Related Articles

Removal of a subdermal contraceptive implant (Implanon NXT) that migrated to the axilla by C-arm guidance: A case report and review of the literature.

Medicine (Baltimore). 2017 Dec;96(48):e8627

Authors: Park JU, Bae HS, Lee SM, Bae J, Park JW

Abstract
RATIONALE: To report the distant migration of a subdermal contraceptive implant and to suggest that C arm-guided technique is one of the feasible options for removal of the device migrated to the axilla.
PATIENT CONCERNS: A 41-year-old multipara with tingling sensation in the left axilla was referred for removal of an Implanon NXT which could not be palpated by physical examination or detected by ultrasound scanning. Finally, the device was detected by computed tomography and found migrating to the left axilla.
DIAGNOSIS: Migration of Implanon NXT to the left axilla abutting the brachial plexus.
INTERVENTIONS: The device was removed by C arm-guiding.
OUTCOMES: The patient went home without any procedure-related complications.
LESSONS: The incidence of distant migration of a subdermal implant is possible and should be checked up regularly. If the device cannot be palpated or detected by ultrasound at the original implanting site, this should be concerned. Since the single-rod subdermal implant is radiopaque, it can be detected by roentgenography. In this case the distant migration was detected in the axilla, therefore using C arm-guided technique is feasible for the removal of the migrating device. After reviewing the literature, totally 10 cases of distant migration were reported including 2 cases of migration which were advanced further to the pulmonary artery as an embolization.

PMID: 29310336 [PubMed - indexed for MEDLINE]

Related Articles

Two-stage hybrid treatment strategy for an adult patient with aortic arch coarctation, poststenotic aneurysm, and hypoplastic left subclavian artery: A case report.

Medicine (Baltimore). 2017 Dec;96(48):e8618

Authors: Pu XB, Chen SJ, Chen M, Feng Y

Abstract
RATIONALE: Coarctation of aorta in adulthood is usually complicated by other cardiovascular anomalies, posing great technical challenge for intervention.
PATIENT CONCERNS: Here, we report an extremely rare case of aortic arch coarctation combined with a poststenotic biloculated calcified aneurysm and hypoplastic left subclavian artery.
INTERVENTIONS: First, an extra-anatomic bypass was established, along with narrowing of aorta just proximal and distal to the aneurysm. While the bypass graft significantly relieved trans-coarctation gradient, the latter procedure decreased intra-aneurysm pressure and created landing zones for aneurysm occlusion. Six months later, 2 muscular ventricular septal defect occluders were deployed at the proximal and distal orifice of the aneurysm.
OUTCOMES: Follow-up computed tomography angiography confirmed the absence of contrast leakage into aneurysm.
CONCLUSIONS: A 2-stage hybrid approach described here appears to be feasible, safe, and associated with favorable clinical outcomes in the treatment of complicated aortic coarctation and poststenotic aneurysm.

PMID: 29310335 [PubMed - indexed for MEDLINE]

Related Articles

Clinical efficacy of spleen-preserving distal pancreatectomy with or without splenic vessel preservation: A Meta-analysis.

Medicine (Baltimore). 2017 Dec;96(48):e8600

Authors: Sun N, Lu G, Zhang L, Wang X, Gao C, Bi J, Wang X

Abstract
OBJECTIVE: The meta-analysis was performed to investigate the clinical efficacy of spleen-preserving distal pancreatectomy with splenic vessel preservation (SPDP-SVP) and spleen-preserving distal pancreatectomy with splenic vessel resection (SPDP-SVR).
METHODS: Potential articles were searched on the databases of Pubmed, Embase, and Chinese National Knowledge Infrastructure (CNKI) from January 1988 until March 2017. Weight mean difference (WMD) with 95% confidence interval (CI) was applied to compare the efficacy of SPDP-SVP and SPDP-SVR. Odds ratio (OR) with 95% CI was calculated to figure out the risks for complications. P< .05 or I>50% indicated significant heterogeneity. The random-effects model is used to pool data if significant heterogeneity exists; otherwise, the fixed-effects model is used. Publication bias was evaluated by Begg's funnel plot.
RESULTS: Thirteen eligible articles were obtained in the meta-analysis. SPDP-SVP seemed to relate with reduced operative time and blood loss, prolonged hospital stay, and less complications; however, the effects were not statistically significant. Meanwhile, we found that SPDP-SVP was closely related with the reduced rate of splenic infarction and gastric varices (OR = 0.16, 95% CI = 0.09-0.29; OR = 0.08, 95% CI = 0.02-0.35). No publication bias was observed in the analysis (P = .636).
CONCLUSIONS: SPDP-SVP seems to show superiority than SPDP-SVR in reducing the rate of splenic infarction and gastric varices.

PMID: 29310334 [PubMed - indexed for MEDLINE]

Related Articles

Epidemiologic features and management of elbow dislocation with associated fracture in pediatric population.

Medicine (Baltimore). 2017 Dec;96(48):e8595

Authors: Lu X, Yan G, Lu M, Guo Y

Abstract
This study was conducted to explore epidemiologic features of traumatic elbow dislocation with associated fractures in pediatric population following appropriate treatment options.Incidence of elbow dislocation with associated fractures was analyzed in 67 children using elbow radiographs. Treatment for the displaced elbow joint was performed by closed reduction and proper immobilization. Surgical intervention was applied to restore the correct alignment of the fracture. Mayo Elbow Performance Score (MEPS) was used to measure elbow joint function.Incidence of pure dislocation was observed in 7 of 67 children (10.45%). Elbow dislocation was typically accompanied by a single or multiple fractures in 39 (58.21%) and 21 (31.34%) of 67 children, respectively. In contrast, lateral humeral condyle fracture and medial humeral epicondyle fracture accounted for 35.90% and 30.77% of pediatric elbow fractures. All children with elbow fracture-dislocations received surgical intervention by open reduction and internal fixation. During follow-up, 56% to 92% of children displayed significant recovery of elbow function with improving MEPS after the displaced elbow and fractured fragments were reduced and held in place for weeks. There were statistical differences in MEPS between the types of fractures (P < .05 or P < .01).Incidence of isolated elbow dislocation without fracture is low; rather, it is frequently associated with fractures. Early surgical intervention achieves stable fixation and bony union with utility in improving elbow function in the pediatric population.

PMID: 29310333 [PubMed - indexed for MEDLINE]

Related Articles

Quantifying the direct public health care cost of systemic sclerosis: A comprehensive data linkage study.

Medicine (Baltimore). 2017 Dec;96(48):e8503

Authors: Morrisroe K, Stevens W, Sahhar J, Ngian GS, Rabusa C, Ferdowsi N, Hill C, Proudman S, Nikpour M

Abstract
To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement.

PMID: 29310332 [PubMed - indexed for MEDLINE]

Related Articles

Eliciting community perspectives on research with older adults living with HIV through focus groups.

Medicine (Baltimore). 2017 Dec;96(48):e8495

Authors: Nguyen AL, Brown B, Taylor J, Estevez M, Loftus R

Abstract
Approximately half of all people living with HIV in the US are age 50 and older. Existing research highlights the health challenges of these individuals, but little work has focused on gathering input about concerns in participating in HIV and aging research. Prior to designing a prospective cohort study on HIV and aging, we elicited feedback from potential participants on general attitudes toward participation in a prospective HIV cohort study, and perspectives on important research topics relevant to older adults living with HIV.Three qualitative focus groups were formed.Three focus groups (5-7 participants each; N = 18) were held with older adults living with HIV. All discussions were audiorecorded and transcribed. Transcripts were analyzed using content analysis.Participants emphasized the importance of data confidentiality, shared concerns about study biases arising from sponsored research, and suggested that conflicts of interest should be independently assessed by "representative" boards made of community members. They urged researchers to be mindful of research "burnout," because many people with HIV participate in multiple research studies. A number of priority research areas emerged, including the gap in provision of end-of-life services.Many older adults with HIV are knowledgeable about the research process and offer valuable insights to researchers. Addressing participant concerns can facilitate inclusion and enhance HIV research success.

PMID: 29310331 [PubMed - indexed for MEDLINE]

Related Articles

Can catheter ablation reduce the incidence of thromboembolic events in patients with atrial fibrillation?: Protocol for a systematic review and meta-analysis.

Medicine (Baltimore). 2017 Dec;96(48):e8479

Authors: Liu M, Wang Y, Chen X, Li X, Zhuang X, Wang L

Abstract
Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for thromboembolic events, especially ischemic stroke. Catheter ablation is an effective method to maintain sinus rhythm in patients with AF. Although some observational studies have shown a relatively lower stroke rate after catheter ablation, whether catheter ablation can reduce the thromboembolic risk in patients with AF remains unclear. We aim to perform a systematic review to determine whether catheter ablation can prevent thromboembolism in patients with AF.PubMed, Embase, the Web of Science, and the Cochrane Library will be searched from January 2000 to the present for randomized controlled trials (RCTs) and non-randomized studies on catheter ablation in patients with AF. Other relevant sources, such as the references and conference proceedings, will also be manually retrieved. All studies will be limited to publication in English. The primary outcome will be thromboembolic events, including stroke, transient ischemic attack, and systemic embolic events. Study screening, data collection, and study quality assessment will be independently performed by 2 researchers. Disagreements will be resolved through team discussion or consultation with a third arbitrator. The risk of bias will be appraised using the Cochrane Collaboration tool and the Newcastle-Ottawa scale according to the different study designs, and a meta-analysis will be performed using RevMan V.5.3 software. The results will be presented as risk ratios and 95% confidence intervals for dichotomous data and continuous outcomes.Catheter ablation is an effective method to cure atrial fibrillation and maintain sinus rhythm. Although it is intuitive that if AF is eliminated, the thromboembolism in the heart would be abolished, and sequently the incidence of thromboembolic events would be decreased, this in fact has not yet been clarified. This systematic review and meta-analysis will be performed with the aim of comprehensively identifying studies that have reported the impact of AF ablation on thromboembolic events in patients with non-valvular AF by comparing an ablation group and non-ablation group. These outcomes will not only produce useful evidence-based data regarding the influence of catheter ablation on thromboembolic events in patients with AF but will also provide some guidance regarding anticoagulation regimens in patients who have undergone catheter ablation.

PMID: 29310330 [PubMed - indexed for MEDLINE]

Related Articles

Impact of iterative reconstruction vs. filtered back projection on image quality in 320-slice CT coronary angiography: Insights from the CORE320 multicenter study.

Medicine (Baltimore). 2017 Dec;96(48):e8452

Authors: Fareed A, Vavere AL, Zimmermann E, Tanami Y, Steveson C, Matheson M, Paul N, Clouse M, Cox C, Lima JAC, Arbab-Zadeh A

Abstract
Iterative reconstruction has been shown to reduce image noise compared with traditional filtered back projection with quantum denoising software (FBP/QDS+) in CT imaging but few comparisons have been made in the same patients without the influence of interindividual factors. The objective of this study was to investigate the impact of adaptive iterative dose reduction in 3-dimensional (AIDR 3D) and FBP/QDS+-based image reconstruction on image quality in the same patients.We randomly selected 100 patients enrolled in the coronary evaluation using 320-slice CT study who underwent CT coronary angiography using prospectively electrocardiogram triggered image acquisition with a 320-detector scanner. Both FBP/QDS+ and AIDR 3D reconstructions were performed using original data. Studies were blindly analyzed for image quality by measuring the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image quality was assessed qualitatively using a 4-point scale.Median age was 63 years (interquartile range [IQR]: 56-71) and 72% were men, median body mass index 27 (IQR: 24-30) and median calcium score 222 (IQR: 11-644). For all regions of interest, mean image noise was lower for AIDR 3D vs. FBP/QDS+ (31.69 vs. 34.37, P ≤ .001). SNR and CNR were significantly higher for AIDR 3D vs. FBP/QDS+ (16.28 vs. 14.64, P < .001 and 19.21 vs. 17.06, P < .001, respectively). Subjective (qualitative) image quality scores were better using AIDR 3D vs. FBP/QDS+ with means of 1.6 and 1.74, respectively (P ≤ .001).Assessed in the same individuals, iterative reconstruction decreased image noise and raised SNR/CNR as well as subjective image quality scores compared with traditional FBP/QDS+ in 320-slice CT coronary angiography at standard radiation doses.

PMID: 29310329 [PubMed - indexed for MEDLINE]

Related Articles

The significance of BRAF V600E mutation status discordance between primary cutaneous melanoma and brain metastases: The implications for BRAF inhibitor therapy.

Medicine (Baltimore). 2017 Dec;96(48):e8404

Authors: Hannan EJ, O'Leary DP, MacNally SP, Kay EW, Farrell MA, Morris PG, Power CP, Hill ADK

Abstract
To compare BRAF V600E status of primary melanoma and brain metastases to assess for discordance by cross-sectional study, and to evaluate clinical implications on BRAF inhibitor therapy.Brain metastases are common in patients with advanced melanoma. Between 40% and 60% of melanomas demonstrate BRAF mutations, BRAF V600E being most common. Selective BRAF inhibitor therapy has shown improvement in outcome in patients with melanoma. It has been demonstrated that not all metastatic lesions carry the same BRAF mutation status as the primary, but the frequency in which discordance occurs remains unclear. Establishing this may have implications in the use of BRAF inhibitors in patients with melanoma brain metastases.Patients who underwent metastectomy for melanoma brain metastases were identified using our local histopathology database. A review of histology of the primary lesion and the metastasis was performed for each patient, assessing for BRAF mutation status discordance.Fourty-two patients who underwent a brain metastectomy following excision of a melanoma primary were identified over a 7-year period. Median survival was 9 months. The median Breslow thickness for the primary lesion was 3.4 mm. Six patients (14%) had discrepancy between the BRAF status of a melanoma primary and metastatic lesion. Of these 6 patients, 3 had a BRAF mutation positive primary with a BRAF mutation negative metastatic lesion, while the other 3 had a BRAF mutation negative primary with BRAF mutation positive metastasis.There is an important discordance rate in the BRAF mutation status of melanoma primaries versus brain metastases.

PMID: 29310328 [PubMed - indexed for MEDLINE]

Related Articles

Prevalence and clinical characteristics of pseudohypertension in elderly patients prepared for coronary artery angiography.

Medicine (Baltimore). 2017 Dec;96(48):e8386

Authors: Dai X, Wang H, Fang N

Abstract
BACKGROUND: Pseudohypertension (PHT) can cause adverse effects in the elderly owing to administration of antihypertension therapy. The present study aimed to determine the prevalence of PHT in the elderly and associated risk factors to investigate a noninvasive method of detection of PHT.
METHODS: We recruited 151 patients (age ≥60 years) who underwent coronary angiography. Demographic and clinical data were collected from the patients. During coronary angiography, intrabrachial arterial pressure and indirect blood pressure were measured. Brachial-ankle pulse wave velocity (ba-PWV) was measured within 2 weeks after coronary angiography.
RESULTS: Based on the differences between the direct and indirect pressure measurements, the patients were divided into a PHT group (n = 87) and a non-PHT group (n = 64). The prevalence of PHT was 57.6%, and the development of PHT was significantly associated with older age. Serum creatinine level and creatinine clearance rate were significantly higher in the non-PHT group than in the PHT group (P < .05). In addition, the PHT group had significantly higher ba-PWV and pulse pressure (PP) than the non-PHT group (P < .05). Receiver-operating characteristic curve analysis revealed that ba-PWV (AUC = 0.783) and PP (AUC = 0.791) showed a relatively good diagnostic performance for PHT.
CONCLUSIONS: PHT was present in most of the elderly who had indications for coronary angiography and associated with age and renal function. The data from the present study also suggested that both PP and ba-PWV could be used to positively predict PHT.

PMID: 29310327 [PubMed - indexed for MEDLINE]

Related Articles

Efficacy and safety of remifentanil for analgesia in cesarean delivery.

Medicine (Baltimore). 2017 Dec;96(48):e8341

Authors: Zhou X, Jin LJ, Hu CY, Chen M, Li Y, Zhang YS

Abstract
BACKGROUND: This study aimed to assess the efficacy and safety of remifentanil as a general anesthetic during cesarean delivery.
MATERIAL AND METHODS: Fifty women with singleton pregnancies undergoing cesarean delivery were randomly divided into intervention and control groups, each group containing 25 subjects. Participants in the intervention group received remifentanil (infused at 2 μg/kg/h), whereas subjects in the control group were given dexmedetomidine (infused at 0.4 μg/kg/h). Outcome measurements included mean arterial blood pressure (MAP), heart rate (HR), bispectral index (BIS), Apgar scores at 1 and 5 minutes, and the pH, PCO2, PO2, and base excess (BE) of umbilical venous and arterial blood.
RESULTS: Forty-four participants completed the study. Patients in the intervention group did not experience greater effect and safety than those in the control group (P > .05), although MAP and BIS values decreased significantly immediately before laryngoscopy (P < .05). In addition, BIS values were reduced significantly at the time of skin incision, at uterine incision, and immediately after fetal delivery when compared with baseline values in both groups (P < .01).
CONCLUSION: This study concluded that remifentanil and dexmedetomidine exhibited similar efficacy and safety during general anesthesia for cesarean delivery.

PMID: 29310326 [PubMed - indexed for MEDLINE]

Related Articles

Meta-analysis of ischemic preconditioning (IP) on postoperative outcomes after liver resections.

Medicine (Baltimore). 2017 Dec;96(48):e8217

Authors: Guo X, Liu G, Zhang X

Abstract
BACKGROUND: The protective role (decrease ischemia-reperfusion injury) of ischemic preconditioning (IP) before continuous vascular occlusion in liver resection is controversial. This meta-analysis aimed to compare the advantages and any potential disadvantages of IP maneuver.
METHODS: A systematic search in the Embase, Medline, PubMed databases, and the Cochrane Library was performed using both medical subject headings (MeSH) and truncated word searches to identify all randomized controlled trials (RCTs) published on this topic. The primary outcomes were postoperative morbidity, mortality, postoperative aspartate aminotransferase (AST) level, alanine aminotransferase (ALT) level, and total bilirubin (TB) level. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the random effects model or fixed effects model.
RESULTS: Thirteen RCTs involving 918 patients were analyzed to achieve a summated outcome. The patients have been divided into IP group (n = 455) and no IP group (n = 463) before continuous vascular occlusion. No significant difference was found in postoperative mortality between both groups (P = .30). Subgroup analysis revealed that the postoperative morbidity in the cirrhosis subgroup was significantly less for the IP group compared with the control group (P = .01). In the cirrhosis subgroup, the result was stable (P = .04), without heterogeneity (P = .59; I = 0%). Meta-analysis of AST level on postoperative day (POD) 1 indicated lower postoperative AST level in the IP group (P = .04). The analysis of ALT level showed lower ALT level in the IP group versus control group (P = .02). However, there was no difference in postoperative AST and ALT level after excluding 1 study with statistical heterogeneity (all P > .05). With respect to postoperative TB level, there was no significant difference between 2 groups.
CONCLUSION: IP cannot decrease the hospital mortality for patients undergoing hepatectomy. IP may be beneficial for patients with cirrhosis due to less morbidity in patients with liver cirrhosis. However, we cannot conclude that IP can decrease ischemia-reperfusion injury because it did not significantly decrease postoperative AST, ALT, and TB levels.

PMID: 29310325 [PubMed - indexed for MEDLINE]

Related Articles

Efficacy of the multidisciplinary tumor board conference in gynecologic oncology: A prospective study.

Medicine (Baltimore). 2017 Dec;96(48):e8089

Authors: Lee B, Kim K, Choi JY, Suh DH, No JH, Lee HY, Eom KY, Kim H, Hwang SI, Lee HJ, Kim YB

Abstract
Evidence has shown that multidisciplinary tumor board conferences (MTBCs) improve patient management for various cancer types. However, few retrospective studies have investigated MTBC efficacy for patients with gynecologic cancers. Here, we prospectively aimed to evaluate how MTBCs influence patient management in gynecologic oncology. This prospective study included 85 consecutive cases that were presented at gynecologic oncology MTBCs in our tertiary university hospital between January 2015 and April 2016. The primary endpoint was treatment plan change rate, which included both major and minor changes. Major changes were defined as exchange, addition, or subtraction of treatment modality. Minor changes included all other, such as intramodality changes or treatment time changes. The secondary endpoints were the change rates of diagnosis, diagnostic work-up, and radiological and pathological findings.The treatment plan change rate, irrespective of changes in diagnostic work-up, was 27.1%, which included 10.6% major and 16.5% minor changes. Among the treatment plan changes, changes in the treatment plan change rate alone were noted in 16.5% of cases, and changes in diagnosis and radiological findings occurred in 7.1% and 3.5% of cases, respectively. Diagnosis and radiological findings, irrespective of changes in diagnostic work-up, were also changed in 9.4% and 10.6% of cases, respectively. However, there were no changes in pathological findings. Moreover, there was a change of diagnostic method for further work-up in 23.5% of cases. The implementation rate of MTBC-determined treatment changes was 91.8%. Gynecologic oncology MTBCs resulted in considerable changes in treatment plans. Diagnosis, diagnostic work-up, and radiological findings were influenced by MTBCs. The data emphasize the importance of adopting a multidisciplinary team approach for gynecologic cancer management.

PMID: 29310324 [PubMed - indexed for MEDLINE]

Related Articles

The impact of mild, moderate, and severe visual field loss in glaucoma on patients' quality of life measured via the Glaucoma Quality of Life-15 Questionnaire: A meta-analysis.

Medicine (Baltimore). 2017 Dec;96(48):e8019

Authors: Wang Y, Alnwisi S, Ke M

Abstract
BACKGROUND: We performed a meta-analysis to determine the impact of mild, moderate, and severe visual field loss on quality of life (QoL) in patients with glaucoma.
METHODS: A comprehensive literature search was performed using the PubMed, Excerpta Medica dateBASE and China National Knowledge Infrastructure databases to identify relevant articles published before June 30, 2016. Patients' QoL was measured using the Glaucoma Quality of Life-15 Questionnaire (GQL-15).
RESULTS: In total, 401 patients with glaucoma and 205 patients without glaucoma participated in 4 experiments. The GQL-15 summary scores are statistically different between patients with and without glaucoma (standard mean difference [SMD] = 0.94, 95% confidence interval [CI]: 0.73-1.16, P < .01). GQL-15 summary scores for patients with mild, moderate, and severe visual field loss all differed significantly from those of patients without glaucoma; the SMDs for their summary scores were as follows: mild: 1.24, 95% CI: 0.26 to 2.22, P = .01; moderate: 2.05, 95% CI: 0.91 to 3.19, P < .001; and severe: 2.57, 95% CI: 1.44 to 3.71, P < .001. Two factor scores for central and near vision (SMD = -0.35, 95% CI: -1.01 to 0.30, P = .29) and glare and dark adaptation (SMD = -0.36, 95% CI: -1.01 to 0.30, P = .28) did not differ significantly between patients with mild and moderate visual field loss. However, summary scores and 2 factor scores (peripheral vision and outdoor mobility) differed significantly between patients with mild and moderate glaucoma. In addition, summary scores and all 4 factor scores differed significantly between patients with mild and severe glaucoma. Moreover, summary scores and 3 factor scores (peripheral vision, glare and dark adaptation, and outdoor mobility) differed significantly between patients with moderate and severe glaucoma. However, scores for 1 factor (central and near vision) did not differ significantly between any of the patient groups (SDM = -0.53, 95% CI = -1.33 to 0.27, P = .19).
CONCLUSIONS: Glaucoma patients with visual field loss showed significantly poorer QoL relative to that of patients without glaucoma. Patients' QoL decreased as their glaucoma severity increased.

PMID: 29310323 [PubMed - indexed for MEDLINE]

Related Articles

Effect of training in advanced trauma life support on the kinematics of the spine: A simulation study.

Medicine (Baltimore). 2017 Dec;96(48):e7587

Authors: Gordillo Martin R, Alcaráz PE, Rodriguez LJ, Fernandez-Pacheco AN, Marín-Cascales E, Freitas TT, Rios MP

Abstract
More than 7.5 million people in the world are affected by spinal cord injury (SCI). In this study, we aimed to analyze the effect of training in advanced trauma life support (ATLS) on the kinematics of the spine when performing different mobilization and immobilization techniques on patients with suspected SCI. A quasi-experimental study, clinical simulation, was carried out to determine the effect of training in ATLS on 32 students enrolled in the Master's program of Emergency and Special Care Nursing. The evaluation was performed through 2 maneuvers: placing of the scoop stretcher (SS) and spinal board (SB), with an actor who simulated a clinical situation of suspected spinal injury. The misalignment of the spine was measured with the use of a Vicon 3D motion capture system, before (pre-test) and after (post-test) the training. In the overall misalignment of both maneuvers, statistically significant differences were found between the pre-test misalignment of 62.1° ± 25.9°, and the post-test misalignment of 32.3° ± 10.0°, with a difference between means of 29.7° [(95% confidence interval, 95% CI 22.8-36.6°), (P = .001)]. The results obtained for the placing of the SS showed that there was a pre-test misalignment of 65.1° ± 28.7°, and a post-test misalignment of 33.2° ± 10.1°, with a difference of means of 33.9° [(95% CI, 23.1-44.6°), (P = .001)]. During the placing of the SB, a pre-test misalignment of 59.0° ± 28.7° and a post-test misalignment of 33.4° ± 10.0° were obtained, as well as a difference of means of 25.6° [(95% CI 16.6-34.6°), (P = .001)]. The main conclusion of this study is that training in ATLS decreases the misalignment provoked during the utilization of the SS and SB, regardless of the device used.

PMID: 29310322 [PubMed - indexed for MEDLINE]

Related Articles

The association between methionine synthase A2756G polymorphism and hematological cancer: A meta-analysis.

Medicine (Baltimore). 2017 Dec;96(48):e7469

Authors: Wu B, Liu K, Yang JP, Hu Y, Zhang J, He JX

Abstract
BACKGROUND: Numerous studies have focused on the association of methionine synthase (MS) A2756G polymorphism and acute hematological cancer risk. However, the results remain inconsistent. Therefore, a meta-analysis was performed to derive a more precise estimate of the association between them.
METHODS: This meta-analysis involved 25 articles (26 studies) including 8641 hematological cancer patients and 15,498 controls. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) of the association between MS A2756G polymorphism and the risk of hematological cancer were calculated.
RESULTS: Overall, no significant increased risks were found between MS A2756G polymorphism and hematological cancer risk under allelic homozygote (GA vs AA: OR = 0.98, 95% CI = 0.89-1.07, P = .62), heterozygote (GG vs AA: OR = 0.99, 95% CI = 0.85-1.15, P = .91), dominant (AG+GG vs AA: OR = 0.99, 95% CI = 0.90-1.08, P = .93), and recessive (GG vs AG+AA: OR = 1.00, 95% CI = 0.86-1.16, P = .97) models, respectively. In the stratified analyses by ethnicity and source of controls, there were still no significant associations between them in all genetic models.
CONCLUSIONS: Therefore, these findings demonstrate that MS A2756G polymorphism may not be a risk factor for hematological cancer.

PMID: 29310321 [PubMed - indexed for MEDLINE]

Related Articles

Talaromyces marneffei Infection.

N Engl J Med. 2017 12 28;377(26):2580

Authors: Si Z, Qiao J

PMID: 29281582 [PubMed - indexed for MEDLINE]

Related Articles

Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices.

N Engl J Med. 2017 12 28;377(26):2555-2564

Authors: Nazarian S, Hansford R, Rahsepar AA, Weltin V, McVeigh D, Gucuk Ipek E, Kwan A, Berger RD, Calkins H, Lardo AC, Kraut MA, Kamel IR, Zimmerman SL, Halperin HR

Abstract
BACKGROUND: Patients who have pacemakers or defibrillators are often denied the opportunity to undergo magnetic resonance imaging (MRI) because of safety concerns, unless the devices meet certain criteria specified by the Food and Drug Administration (termed "MRI-conditional" devices).
METHODS: We performed a prospective, nonrandomized study to assess the safety of MRI at a magnetic field strength of 1.5 Tesla in 1509 patients who had a pacemaker (58%) or an implantable cardioverter-defibrillator (42%) that was not considered to be MRI-conditional (termed a "legacy" device). Overall, the patients underwent 2103 thoracic and nonthoracic MRI examinations that were deemed to be clinically necessary. The pacing mode was changed to asynchronous mode for pacing-dependent patients and to demand mode for other patients. Tachyarrhythmia functions were disabled. Outcome assessments included adverse events and changes in the variables that indicate lead and generator function and interaction with surrounding tissue (device parameters).
RESULTS: No long-term clinically significant adverse events were reported. In nine MRI examinations (0.4%; 95% confidence interval, 0.2 to 0.7), the patient's device reset to a backup mode. The reset was transient in eight of the nine examinations. In one case, a pacemaker with less than 1 month left of battery life reset to ventricular inhibited pacing and could not be reprogrammed; the device was subsequently replaced. The most common notable change in device parameters (>50% change from baseline) immediately after MRI was a decrease in P-wave amplitude, which occurred in 1% of the patients. At long-term follow-up (results of which were available for 63% of the patients), the most common notable changes from baseline were decreases in P-wave amplitude (in 4% of the patients), increases in atrial capture threshold (4%), increases in right ventricular capture threshold (4%), and increases in left ventricular capture threshold (3%). The observed changes in lead parameters were not clinically significant and did not require device revision or reprogramming.
CONCLUSIONS: We evaluated the safety of MRI, performed with the use of a prespecified safety protocol, in 1509 patients who had a legacy pacemaker or a legacy implantable cardioverter-defibrillator system. No long-term clinically significant adverse events were reported. (Funded by Johns Hopkins University and the National Institutes of Health; ClinicalTrials.gov number, NCT01130896 .).

PMID: 29281579 [PubMed - indexed for MEDLINE]

Related Articles

Pathophysiology of Chronic Graft-versus-Host Disease and Therapeutic Targets.

N Engl J Med. 2017 12 28;377(26):2565-2579

Authors: Zeiser R, Blazar BR

PMID: 29281578 [PubMed - indexed for MEDLINE]

Related Articles

Toward Better-Quality Compounded Drugs - An Update from the FDA.

N Engl J Med. 2017 12 28;377(26):2509-2512

Authors: Woodcock J, Dohm J

PMID: 29281577 [PubMed - indexed for MEDLINE]

Related Articles

Prices of Generic Drugs Associated with Numbers of Manufacturers.

N Engl J Med. 2017 12 28;377(26):2597-2598

Authors: Dave CV, Hartzema A, Kesselheim AS

PMID: 29281576 [PubMed - indexed for MEDLINE]

Related Articles

Case 40-2017. A 32-Year-Old Woman with Headache, Abdominal Pain, Anemia, and Thrombocytopenia.

N Engl J Med. 2017 12 28;377(26):2581-2590

Authors: Sykes DB, Rosovsky RP, Singhal AB, Gonzalez RG, Moy AP

PMID: 29281575 [PubMed - indexed for MEDLINE]

Related Articles

Ventriculoperitoneal-Shunt Placement for Normal-Pressure Hydrocephalus.

N Engl J Med. 2017 12 28;377(26):e35

Authors: AbdelRazek MA, Venna N

PMID: 29281574 [PubMed - indexed for MEDLINE]

Related Articles

Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma.

N Engl J Med. 2017 12 28;377(26):2531-2544

Authors: Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, Braunschweig I, Oluwole OO, Siddiqi T, Lin Y, Timmerman JM, Stiff PJ, Friedberg JW, Flinn IW, Goy A, Hill BT, Smith MR, Deol A, Farooq U, McSweeney P, Munoz J, Avivi I, Castro JE, Westin JR, Chavez JC, Ghobadi A, Komanduri KV, Levy R, Jacobsen ED, Witzig TE, Reagan P, Bot A, Rossi J, Navale L, Jiang Y, Aycock J, Elias M, Chang D, Wiezorek J, Go WY

Abstract
BACKGROUND: In a phase 1 trial, axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, showed efficacy in patients with refractory large B-cell lymphoma after the failure of conventional therapy.
METHODS: In this multicenter, phase 2 trial, we enrolled 111 patients with diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma, or transformed follicular lymphoma who had refractory disease despite undergoing recommended prior therapy. Patients received a target dose of 2×106 anti-CD19 CAR T cells per kilogram of body weight after receiving a conditioning regimen of low-dose cyclophosphamide and fludarabine. The primary end point was the rate of objective response (calculated as the combined rates of complete response and partial response). Secondary end points included overall survival, safety, and biomarker assessments.
RESULTS: Among the 111 patients who were enrolled, axi-cel was successfully manufactured for 110 (99%) and administered to 101 (91%). The objective response rate was 82%, and the complete response rate was 54%.With a median follow-up of 15.4 months, 42% of the patients continued to have a response, with 40% continuing to have a complete response. The overall rate of survival at 18 months was 52%. The most common adverse events of grade 3 or higher during treatment were neutropenia (in 78% of the patients), anemia (in 43%), and thrombocytopenia (in 38%). Grade 3 or higher cytokine release syndrome and neurologic events occurred in 13% and 28% of the patients, respectively. Three of the patients died during treatment. Higher CAR T-cell levels in blood were associated with response.
CONCLUSIONS: In this multicenter study, patients with refractory large B-cell lymphoma who received CAR T-cell therapy with axi-cel had high levels of durable response, with a safety profile that included myelosuppression, the cytokine release syndrome, and neurologic events. (Funded by Kite Pharma and the Leukemia and Lymphoma Society Therapy Acceleration Program; ZUMA-1 ClinicalTrials.gov number, NCT02348216 .).

PMID: 29226797 [PubMed - indexed for MEDLINE]

Related Articles

Chimeric Antigen Receptor T Cells in Refractory B-Cell Lymphomas.

N Engl J Med. 2017 12 28;377(26):2545-2554

Authors: Schuster SJ, Svoboda J, Chong EA, Nasta SD, Mato AR, Anak Ö, Brogdon JL, Pruteanu-Malinici I, Bhoj V, Landsburg D, Wasik M, Levine BL, Lacey SF, Melenhorst JJ, Porter DL, June CH

Abstract
BACKGROUND: Patients with diffuse large B-cell lymphoma or follicular lymphoma that is refractory to or that relapses after immunochemotherapy and transplantation have a poor prognosis. High response rates have been reported with the use of T cells modified by chimeric antigen receptor (CAR) that target CD19 in B-cell cancers, although data regarding B-cell lymphomas are limited.
METHODS: We used autologous T cells that express a CD19-directed CAR (CTL019) to treat patients with diffuse large B-cell lymphoma or follicular lymphoma that had relapsed or was refractory to previous treatments. Patients were monitored for response to treatment, toxic effects, the expansion and persistence of CTL019 cells in vivo, and immune recovery.
RESULTS: A total of 28 adult patients with lymphoma received CTL019 cells, and 18 of 28 had a response (64%; 95% confidence interval [CI], 44 to 81). Complete remission occurred in 6 of 14 patients with diffuse large B-cell lymphoma (43%; 95% CI, 18 to 71) and 10 of 14 patients with follicular lymphoma (71%; 95% CI, 42 to 92). CTL019 cells proliferated in vivo and were detectable in the blood and bone marrow of patients who had a response and patients who did not have a response. Sustained remissions were achieved, and at a median follow-up of 28.6 months, 86% of patients with diffuse large B-cell lymphoma who had a response (95% CI, 33 to 98) and 89% of patients with follicular lymphoma who had a response (95% CI, 43 to 98) had maintained the response. Severe cytokine-release syndrome occurred in 5 patients (18%). Serious encephalopathy occurred in 3 patients (11%); 2 cases were self-limiting and 1 case was fatal. All patients in complete remission by 6 months remained in remission at 7.7 to 37.9 months (median, 29.3 months) after induction, with a sustained reappearance of B cells in 8 of 16 patients and with improvement in levels of IgG in 4 of 10 patients and of IgM in 6 of 10 patients at 6 months or later and in levels of IgA in 3 of 10 patients at 18 months or later.
CONCLUSIONS: CTL019 cells can be effective in the treatment of relapsed or refractory diffuse large B-cell lymphoma and follicular lymphoma. High rates of durable remission were observed, with recovery of B cells and immunoglobulins in some patients. Transient encephalopathy developed in approximately one in three patients and severe cytokine-release syndrome developed in one in five patients. (Funded by Novartis and others; ClinicalTrials.gov number, NCT02030834 .).

PMID: 29226764 [PubMed - indexed for MEDLINE]

Related Articles

AAV5-Factor VIII Gene Transfer in Severe Hemophilia A.

N Engl J Med. 2017 12 28;377(26):2519-2530

Authors: Rangarajan S, Walsh L, Lester W, Perry D, Madan B, Laffan M, Yu H, Vettermann C, Pierce GF, Wong WY, Pasi KJ

Abstract
BACKGROUND: Patients with hemophilia A rely on exogenous factor VIII to prevent bleeding in joints, soft tissue, and the central nervous system. Although successful gene transfer has been reported in patients with hemophilia B, the large size of the factor VIII coding region has precluded improved outcomes with gene therapy in patients with hemophilia A.
METHODS: We infused a single intravenous dose of a codon-optimized adeno-associated virus serotype 5 (AAV5) vector encoding a B-domain-deleted human factor VIII (AAV5-hFVIII-SQ) in nine men with severe hemophilia A. Participants were enrolled sequentially into one of three dose cohorts (low dose [one participant], intermediate dose [one participant], and high dose [seven participants]) and were followed through 52 weeks.
RESULTS: Factor VIII activity levels remained at 3 IU or less per deciliter in the recipients of the low or intermediate dose. In the high-dose cohort, the factor VIII activity level was more than 5 IU per deciliter between weeks 2 and 9 after gene transfer in all seven participants, and the level in six participants increased to a normal value (>50 IU per deciliter) that was maintained at 1 year after receipt of the dose. In the high-dose cohort, the median annualized bleeding rate among participants who had previously received prophylactic therapy decreased from 16 events before the study to 1 event after gene transfer, and factor VIII use for participant-reported bleeding ceased in all the participants in this cohort by week 22. The primary adverse event was an elevation in the serum alanine aminotransferase level to 1.5 times the upper limit of the normal range or less. Progression of preexisting chronic arthropathy in one participant was the only serious adverse event. No neutralizing antibodies to factor VIII were detected.
CONCLUSIONS: The infusion of AAV5-hFVIII-SQ was associated with the sustained normalization of factor VIII activity level over a period of 1 year in six of seven participants who received a high dose, with stabilization of hemostasis and a profound reduction in factor VIII use in all seven participants. In this small study, no safety events were noted, but no safety conclusions can be drawn. (Funded by BioMarin Pharmaceutical; ClinicalTrials.gov number, NCT02576795 ; EudraCT number, 2014-003880-38 .).

PMID: 29224506 [PubMed - indexed for MEDLINE]

Related Articles

Emergency Legal Authority and the Opioid Crisis.

N Engl J Med. 2017 Dec 28;377(26):2512-2514

Authors: Rutkow L, Vernick JS

PMID: 29140760 [PubMed - indexed for MEDLINE]

Related Articles

Health Care Professionals and Law Enforcement.

N Engl J Med. 2017 Dec 28;377(26):2515-2517

Authors: Derse AR

PMID: 29116879 [PubMed - indexed for MEDLINE]

Researchers have identified a new therapeutic target for the treatment of melanoma. For decades, research has associated female sex and a history of previous pregnancy with better outcomes after a melanoma diagnosis. Now, a research team says it may have determined the reason for the melanoma-protective effect.
A new study adds to accumulating research that gum disease is associated with some cancer risk. It reports a 24 percent increase in the risk of cancer among participants with severe gum disease. The highest risk was observed in cases of lung cancer, followed by colorectal cancer.
Scientists have discovered a novel role for bile acids: converting energy-storing white fat depots into energy-expending beige fat.
Scientists have, in recent decades, pinpointed neurons called 'place cells' in our brains that encode our own location in the environment, but how our brains represent the positions of others has been a mystery. New research in bats, reveals a sub-population of neurons that encode the specific location of other bats that are flying nearby.
The bacteria that cause periodontitis, a disease affecting the tissues surrounding the teeth, seems to play a part also in the onset of pancreatic cancer.
Children with Autism Spectrum Disorders (ASD) often have a hard time switching gears from one task to another. But being bilingual may actually make it a bit easier for them to do so, according to a new study.
Nonsmoking adolescents who use e-cigarettes, smokeless tobacco or tobacco water pipes are more likely to start smoking conventional cigarettes within a year, according to new research.
Researchers have identified a key role for EXD2 in protein production in the mitochondria, the cellular organelles responsible for the majority of energy generation.
Scientists have announced that they have built and tested a new biomaterial-based delivery system -- known as a hydrogel -- that will encase a desired cargo and dissolve to release its freight only when specific physiological conditions are met.
A team of researchers has developed an ultrasound-based system that can non-invasively and remotely control genetic processes in live immune T cells so that they recognize and kill cancer cells.
Preterm babies born early in the third trimester of pregnancy are likely to experience delays in the development of the auditory cortex, a brain region essential to hearing and understanding sound, a new study reveals. Such delays are associated with speech and language impairments at age 2, the researchers found.
A brain-machine interface that combines brain stimulation with a robotic device controlling hand movement increases the output of pathways connecting the brain and spinal cord, according to a study of healthy adults. This work could have implications for restoring function in stroke patients with hand paralysis.
In the fight to cure thromboinflammatory diseases, one of the target molecules is thrombin, a protein that promotes inflammation and can cause blood clots. However, inhibiting thrombin too much can lead to uncontrolled bleeding, limiting the use of anti-inflammatory drugs. Now, researchers have found that a class of small molecule called 'parmodulins' can reduce inflammation without compromising normal blood clotting, making parmodulins attractive candidates for new, safer drugs.
Historically, grandmothers have been important to their grandchildren, and the help provided by grandmothers has increased grandchild survival during the times of high child mortality. However, there have been signs that in many populations, the impact of maternal grandmothers and paternal grandmothers on their grandchildren has been different. A recent study shows that X-chromosome relatedness between grandmothers and their grandchildren did not affect grandchild survival in the 18th and 19th century Finland.
For years, attempts have been made to understand the mechanism behind the proliferation of cancer cells:  they need metabolites to grow and proliferate as much as a vehicle needs gasoline or electricity to move.  However, until now it was not known which metabolites cancer cells actually need. Medical researchers have now identified one of the mechanisms behind this process.
Researchers have developed a material-based T-cell-expansion method using APC-mimetic biomaterial scaffolds, which helps achieve greater expansion of primary mouse and human T cells than existing methods.
Researchers have used new methods in ancient DNA research to identify Salmonella enterica Paratyphi C, a pathogen that causes enteric fever, in the skeletons of victims of the 1545-1550 cocoliztli epidemic in Mexico, identifying a possible cause of this devastating colonial epidemic.
Researchers have shed new light on the genetic mechanisms that promote metastasis in the mouse model and also implicated the typical Western high-fat diet as a key environmental factor driving metastasis.
A joint industry/academia study of a cancer target protein reveals unusual relation between binding site flexibility and drug-target lifetime. The results suggest a new strategy for drug discovery.
A new study shows that impairment in mitochondria may actually protect the brain in Parkinson’s disease.
Americans are more passionate toward their romantic partners than Japanese people are because Americans live in social environments in which people have greater freedom to choose and replace their partners, a team of Japanese researchers suggest.
Scientists compared fecal samples from surfers and non-surfers to assess whether the surfers' guts contained E. coli bacteria that were able to grow in the presence of the antibiotic cefotaxime. Cefotaxime has previously been prescribed to kill off these bacteria, but some have acquired genes that enable them to survive this treatment. The study found that 13 of 143 (9 percent) of surfers were colonized by these resistant bacteria, compared to just four of 130 (3 percent) of non-surfers swabbed.
Teens who were severely bullied as children by peers are at higher risk of mental health issues, including suicidal thoughts and behaviours, according to new research.
The common practice of using patient self-report screening questionnaires rather than diagnostic interviews conducted by researchers has resulted in overestimates of the prevalence of depression, according to a new analysis.
Many of the genes involved in natural repair of the injured spinal cord of the lamprey are also active in the repair of the peripheral nervous system in mammals, according to a new study.
Over half of Canadian youth and young adults who have consumed energy drinks have experienced negative health effects as a result, according to a new study.
In a new study in rats, researchers have demonstrated that is possible to restore insulin sensitivity and glucose homeostasis by modulating electrically the carotid sinus nerve, the sensitive nerve that connects the carotid body with the brain.
Two patterns of antecedent or 'prodromal' psychiatric symptoms may help to identify young persons at increased risk of developing bipolar disorder (BD), according to a new analysis.
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.
By analyzing immune cells of children who came to the emergency department with flu symptoms, researchers found that the suite of genes these early-response cells expressed was shaped by factors such as age and previous exposures to viruses. Better understanding how early infections influence long-term immune response has implications for the diagnosis and treatment of young patients who suffer from acute respiratory tract infections.
Microscopic yeast have been wreaking havoc in hospitals around the world -- creeping into catheters, ventilator tubes, and IV lines -- and causing deadly invasive infection. One culprit species, Candida auris, is resistant to many antifungals, meaning once a person is infected, there are limited treatment options. But researchers have now confirmed a new drug compound kills drug-resistant C. auris, both in the laboratory and in a mouse model that mimics human infection.
The fat of obese people becomes distressed, scarred and inflamed, which can make weight loss more difficult.
Researchers have succeeded in the localized cooling of the heart during a heart attack, a world first. By cooling part of the heart prior to and following angioplasty, the cardiologists believe that the damage from a heart attack can be limited.
A new study strongly suggests that the brains of people who have died of Huntington's disease (HD) and Parkinson's disease (PD) show a similar response to a lifetime of neurodegeneration, despite being two very distinct diseases.
The approach could represent the first new treatment to improve survival in patients with severe scleroderma in more than four decades.
Researchers have discovered a previously unknown warning system that contributes to the body's immune system. Mitochondria in the white blood cells secrete a web of DNA fibers that raises the alarm. The results may lead to increased knowledge about autoinflammatory diseases and cancer.
Current therapies for Parkinson's disease are mainly of a replacement type and pose problems in the long term, so the challenge is to establish an early diagnosis and develop neuroprotective and neurorestorative therapies that will allow the symptoms of the disease to be slowed down or even reversed. Researcher have now documented the regenerative, neuroprotective effect of two neurotrophic factors when they are applied in a combined way.
New research reports that hyperreactive brain networks could play a part in the hypersensitivity of fibromyalgia.
In a feat of nanoengineering, scientists have developed a new technique to map electrical circuits in the brain far more comprehensively than ever before. Scientists worldwide could use the technique to uncover the architecture of different parts of the brain.
It is well known that healthy eating increases our general sense of wellbeing. Researchers have now discovered that a fiber-rich diet can have a positive influence on chronic inflammatory joint diseases, leading to stronger bones.
The failure of SSRI antidepressants can be a result of genetic variations in patients. Variations within the gene that encodes the CYP2C19 enzyme results in extreme differences in the levels of escitalopram achieved in patients, according to a new study. Prescribing the dose of escitalopram based on a patient's specific genetic constitution would greatly improve therapeutic outcomes.
Scientists have developed new technology that allows them to see which neurons are talking to which other neurons in live fruit flies.
Neuroscientists have found that even a brief episode of immune system activation within days of birth can cause persistent changes in sleep patterns concurrent with increases in epilepsy-like brain activity -- a combination of symptoms common in autism spectrum disorder (ASD) and other developmental conditions.
New research has demonstrated that an enzyme she had previously identified as playing a role in peripheral neuropathy induced by cancer chemotherapy also plays a role in peripheral neuropathy caused by diabetes. The significance of the identification of a common molecular mechanism is that the drug candidates she identified to treat chemotherapy-induced peripheral neuropathy could potentially be used to treat peripheral neuropathy caused by diabetes as well.
Asthma costs the US economy more than $80 billion annually in medical expenses, missed work and school days and deaths, according to new research.
A new study suggests an association between elevated amyloid beta levels and the worsening of anxiety symptoms. The findings support the hypothesis that neuropsychiatric symptoms could represent the early manifestation of Alzheimer's disease in older adults.
Researchers have identified genes encoding a previously undiscovered version of the botulinum neurotoxin in bacteria from a cow’s gut.
Writing a 'to-do' list at bedtime may aid in falling asleep, according to a new study. Research compared sleep patterns of participants who took five minutes to write down upcoming duties versus participants who chronicled completed activities.
Experts are warning dog and cat owners to be aware of the risks associated with feeding their pets raw meat-based diets, instead of the more conventional dry or canned pet foods.
The emotional impact of their daily workload and confrontational patients are among the key stressors for family doctors in England, reveals an analysis of feedback from general practitioners.
A new study suggests breast cancer patients taking palbociclib/letrozole combination therapy should avoid foods rich in xenoestrogens.
Dengue virus slowly takes over the endoplasmic reticulum, the production site for a subset of host proteins, and steers clear of the cytosol, the fluid-filled space where the majority of host cellular proteins are synthesized. Its viral RNA template is translated into protein in such an inefficient, lackadaisical manner that it doesn't trip alarms.
Biologists look to the past for early genetic development of tiny spider and insect eyes to find potential for research into human visual challenges.
Immune cells that process food and bacterial antigens in the intestines control the intestinal population of fungi, according to a new study. Defects in the fungus-fighting abilities of these cells may contribute to some cases of Crohn's disease and other forms of inflammatory bowel disease (IBD).
Salk scientists use gene expression to understand how astrocytes change with age.
Both the etiology and demographics of podoconiosis, a non-infectious disease which causes massive swelling of the legs, are poorly understood. To help contribute to the global atlas of podoconiosis knowledge, researchers have now described the distribution of podoconiosis in Cameroon.
A human protein known as prohibitin may play a significant role in infection of the nervous system by EV71, one of several viruses that can cause hand, foot, and mouth disease.
Genetic differences between different strains of the same pathogenic bacterial species appear to result in widely varying immune system responses, according to new research.
Brain cells that reflect self position relative to others have been identified in the rat hippocampus. Sometimes these representations are processed jointly by the same cells, depending on a rat's goals and actions. This discovery deepens our understanding of the hippocampus and its role as the brain's positioning system.
Wireless headphones, two yo-yos connected by a string, earmuffs: all these items could be used to describe a tiny structure inside a cell's nucleus. For decades, scientists could only speculate about the shape of heterochromatin, a type of chromatin -- which consists of tightly packed DNA and proteins.

Clinical/PICO Search

for DHA
Help?

Management/PICOC Search

for DHA
Help?
PubMed Logo