Biochemistry and physiology of cardiac muscle
The heart is composed of muscle cells (cardiomyocytes) that account for most of the heart mass and generate its pumping force. Other cell types (fibroblasts, vascular endothelial cells, vascular smooth muscle cells, immune cells) and the extracellular matrix also play key roles in cardiac function, in both health and disease. Excitation –contraction coupling links the electrical activation of cardiomyocytes to cellular contraction. Calcium is a key second messenger in this process; its entry into the cell triggers further calcium release from the sarcoplasmic reticulum, which then activates the contractile machinery. (Source: Medicine)
Source: Medicine - June 22, 2018 Category: Internal Medicine Authors: Adam Nabeebaccus, Ajay M. Shah Tags: The normal heart Source Type: research

Contents
(Source: Medicine)
Source: Medicine - June 17, 2018 Category: Internal Medicine Source Type: research

Editorial Board
(Source: Medicine)
Source: Medicine - June 17, 2018 Category: Internal Medicine Source Type: research

Interpreting clinical guidelines
Clinical practice guidelines have become an important vehicle for collating evidence examining the effectiveness and cost-effectiveness of practice, and for making recommendations for decision-makers. These recommendations can be used in several ways to improve practice, both at the level of individual decisions and at a population level. The principles for developing clinical guidelines are now well established, and have been applied to other fields including public health and social care. Users of guidelines should establish that the guidelines they are using are trustworthy and have been developed to high standards; the...
Source: Medicine - June 2, 2018 Category: Internal Medicine Authors: Phil Alderson, Ross Maconachie Tags: Health economics and sustainable medicine Source Type: research

Arthritis of large joints shown as a rare clinical feature of cytokine release syndrome after chimeric antigen receptor T cell therapy: A case report Erratum
No abstract available (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Erratum Source Type: research

Tuina for children with cerebral palsy: A protocol for a systematic review Erratum
No abstract available (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Erratum Source Type: research

Cimetropium bromide does not improve polyp and adenoma detection during colonoscope withdrawal: A randomized, double-blind, placebo-controlled study
Conclusions: Cimetropium bromide did not improve polyp and adenoma detection in the colorectum and right colon during colonoscope withdrawal, regardless of the expertness of the endoscopist. However, its use may be helpful in patients with active peristalsis or for beginning endoscopists during standard colonoscopy without a transparent cap. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Idiopathic macular hole with asteroid hyalosis: Two case reports
Conclusion: As with normal MH, MH with AH is thought to be caused by perifoveal PVD, yet as the vitreoretinal adhesion was found to be quite strong starting at the midperiphery of the fundus, we decided to keep the artificial PVD within a range where adhesion was loose. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Long-term prognosis, treatment, and outcome of patients with fever of unknown origin in whom no diagnosis was made despite extensive investigation: A questionnaire based study
In 30–50% of patients with fever of unknown origin (IUO) no explanation for the fever can be found. Prognosis and effects of empirical treatment of these patients are largely unknown. With this retrospective, questionnaire based corort study in all unexplained FUO patients in an expert center between 2003 and 2014 we studied mortality and outcome. In 131 of 274 FUO patients, FUO remained unexplained. Ninety-nine of them responded to the long-term follow up questionnaire. Adter a median duration of follow-up of 60 months, spontaneous remission of fever occured in 47.3%. Empirical treatment was effective in 66.7% of ...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Integrated assessment of differentially expressed plasma microRNAs in subtypes of nonsyndromic orofacial clefts
In this study, we integrated the expression profiles of plasma miRNAs in these 3 subtypes, and assessed the distinct and overlapping dysregulated miRNAs using Venn diagrams. Their respective target genes reported in the literature were further analyzed using pathway analysis. Results and conclusion: The results showed that distinct or overlapping signaling pathways were involved in CLO, CPO, and CLP. The common key gene targets reflected functional relationships to the Wnt, Notch, TGF-beta, and Hedgehog signaling pathways. Further studies should examine the mechanism of the potential target genes, which may provide new ...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Molecular epidemiology and antimicrobial susceptibility of human Clostridium difficile isolates from a single institution in Northern China
Because the epidemiology of Clostridium difficile infection (CDI) is region-specific, the present study was undertaken to examine the epidemiology of C difficile outbreaks in Beijing, China. Eighty nonduplicate isolates were collected from March, 2016 to December, 2016. The molecular type and phylogenetic analysis were evaluated by multilocus sequence typing (MLST). The minimum inhibitory concentrations (MICs) for 11 antibiotics and the resistance mechanisms were investigated. Sixty-five toxigenic strains (81.25%), including 22 tcdA-B+CDT- strains (27.5%) and 43 tcdA+B+CDT- strains (53.75%), and also 15 nontoxigenic stra...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

CONSORT-epidural dexmedetomidine improves gastrointestinal motility after laparoscopic colonic resection compared with morphine
Background: We have previously shown that epidural dexmedetomidine, when used as an adjunct to levobupivacaine for control of postoperative pain after open colonic resection, improves recovery of gastrointestinal motility compared with morphine. Methods: Sixty patients undergoing laparoscopic colonic resection were enrolled and allocated randomly to treatment with dexmedetomidine (group D) or morphine (group M). Group D received an epidural loading dose of dexmedetomidine (5 mL, 0.5 μg/kg), followed by continuous epidural administration of dexmedetomidine (80 μg) in 0.125% levobupivacaine (240 mL) at a r...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Characteristics of Cobb angle distribution in the main thoracolumbar/lumbar curve in adolescent idiopathic scoliosis: A retrospective controlled clinical study
A single-center retrospective analysis of 46 patients with Lenke 5 adolescent idiopathic scoliosis (AIS). To compare Cobb angle distribution in different segments of the main thoracolumbar/lumbar curve in patients with Lenke 5 AIS, and differences in the lateral-bending flexibility, the correction rate, and correction index among these segments. No studies have been reported the ratio of the different segments to the main thoracolumbar/lumbar curve in terms of curve angle distribution, lateral-bending flexibility differences between these segments, and the correction rate when surgical instrumentations are used to correc...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

The excellent antitumor effect of apatinib alone as second-line therapy in a patient with sorafenib-refractory hepatocellular carcinoma: A case report
We report an advanced HCC patient with many lung metastases who failed sorafenib treatment. Diagnoses: Sorafenib refractory HCC patient with a large number of lung metastases. Interventions: The apatinib alone was used as second line therapy. Outcomes: The patient achieved partial response (PR) soon after the treatment, which was maintained for approximately 1 year. During the entire process, the lung metastases continued to diminish. Finally, only a few lesions remained Lessons: Apatinib alone may be a good second-line therapy for advanced HCC patients who are refractory to sorafenib. However, further investig...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Heterogeneity of tissue IL-17 and tight junction proteins expression demonstrated in patients with autoimmune thyroid diseases
Th17 cells together with their hallmark cytokine interleukin (IL)-17 were identified as crucial contributing factors in the pathogenesis of thyroid autoimmunity. The cytokine-regulated tight junction (Tj) disruption is thought to be essential in the initiation and/or development of several diseases. Still, the role of IL-17 maintaining Tj integrity in autoimmune thyroid diseases (AITDs) has not yet been evaluated. We aimed to investigate integrity of the thyroid follicle by studying immunoexpression of cellular Tj – zonula occludens (ZO)-1 and claudin-1 proteins coupled to IL-17A and CD68 detection in AITD patients c...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Lumbar spinal canal osteosarcoma: A case report
Rationale: Osteosarcoma is a rare neoplasm in the lumbar spine. Although osteosarcoma can arise in any portion of the skeleton, it very rarely arises in the spinal canal, which accounts for (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke: A meta-analysis
This study provided detailed information on the net and quantitative benefits of various programs for reducing time delays to facilitate the generalization of appropriate AIS management. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Meta-Analysis of Observational Studies in Epidemiology Source Type: research

The influence of bilateral sagittal split ramus osteotomy on the stress distributions in the temporomandibular joints of the patients with facial asymmetry under symmetric occlusions
The aim of this study is to compare the differences in the stress distributions in the temporomandibular joints (TMJs) of the patients with facial asymmetry before and after bilateral sagittal split ramus osteotomy (BSSRO) under the symmetric occlusions using the three-dimensional (3D) finite element method. Ten facial asymmetry patients (Preoperative group, age 24.6 ± 4.8 years) and 10 asymptomatic subjects (Control group, age 26.8 ± 4.9 years) were recruited. After the patients underwent BSSRO, they were further assigned as the Postoperative group. 3D geometries of the finite element models of the ...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Pulmonary hemangioma mimicking bronchiectasis: A case report
Rationale: Pulmonary hemangioma is a rare thoracic condition that can lead to hemoptysis. Here we report a case that presented with lumen dilatation suggestive of bronchiectasis on high-resolution computed tomography (CT) and was misdiagnosed as bronchiectasis for more than 10 years. Patient concerns: A 41-year-old female patient was admitted to the Department of Respiratory Medicine due to hemoptysis. Diagnoses: The patient was misdiagnosed as having bronchiectasis for more than 10 years. Enhanced chest CT was not performed until treatment of recurrent hemoptysis with antibiotics and hemostatic therapy was no long...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Conservative management of acute calculous cholecystitis complicated by pancreatitis in an elderly woman: A case report
We present a rare case in which a 96-year-old woman suffered from abdominal pain, nausea, and lack of appetite for over a month. Diagnoses: She was diagnosed with acute calculous cholecystitis and pancreatitis. Interventions: She was successfully treated without surgery, regaining her physical health after 5 months. Outcomes: The question of how to manage acute calculous cholecystitis is extremely difficult in many aspects. The patient of very advanced age presented in this paper, not very well diagnosed and with a life-threating condition, survived because of careful treatment and reasonable decision-making. Les...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Transcutaneous electric nerve stimulation over acupoints for chronic obstructive pulmonary disease: Protocol for a systematic review and meta-analysis
Conclusion: This evidence may be useful to clinicians, patients, and health policy makers with regard to the use of Acu-TENS in the treatment of COPD. Ethics and dissemination: This review will not gather original data; hence, ethical approval is not required. The results will be disseminated through a peer-reviewed publication or conference presentations. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Study Protocol Systematic Review Source Type: research

Safety and efficacy of Galgeun-tang-ga-cheongung-sinyi, a herbal formula, for the treatment of chronic rhinosinusitis: A study protocol for a randomized controlled trial
This study has been registered at the Korean National Clinical Trial Registry, Clinical Research Information Service (KCT0002835). (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Study Protocol Clinical Trial Source Type: research

Posterior paraspinal muscle versus post-middle approach for the treatment of thoracolumbar burst fractures: A randomized controlled trial
Background: This randomized controlled trial (RCT) aimed to compare the clinical outcomes of thoracolumbar burst fractures (TLBFs) treated with open reduction and internal fixation via the posterior paraspinal muscle approach (PPMA) and the post-middle approach (PA). Methods: Patients with a traumatic single-level TLBFs (T10-L2), treated at our hospital between December 2009 and December 2014, were randomly allocated to Group A (PPMA) and Group B (PA). Sex, age, time from injury to surgery, the American Spinal Injury Association Impairment Scale score (ASIAIS), comorbidities, vertebral level, pre- and postoperative ky...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Successive occurrence of vertebrobasilar dolichectasia induced trigeminal neuralgia, vestibular paroxysmia and hemifacial spasm: A case report
Rationale: Study reported an extremely rare case of trigeminal neuralgia, vestibular paroxysmia, and hemifacial spasm successively occurring in a patient with vertebrobasilar dolichoectasia (VBD). Patient concerns: A 66-year-old female patient presented with episodic vertigo for 20 days before she was admitted to our hospital. Vertigo suddenly occurred when the patient rotated her head 20 days ago, the symptoms of vertigo were improved after continuous 1 to 3 seconds, and similar symptoms were repeated in sleep and rest, with a frequency of 30 to 40 times per day. The patient had a history of hypertension with poor ...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position: A randomized crossover manikin study
Conclusions: Considering that tracheal intubation can provide a more secure airway and more stable ventilation than the PLMA, re-intubation with a channeled blade-type videolaryngoscope such as the AWS may be a useful method of airway rescue for accidental extubation in patients in the prone position. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Factors predicting 2-year treatment results of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good baseline visual acuity
This study aimed to explore predictors of long-term stabilization of polypoidal choroidal vasculopathy (PCV) lesions and vision in response to injection of intravitreal ranibizumab (IVR). The treated eyes had a baseline best corrected visual acuity (BCVA) of at least 0.6 (logarithm of the minimal angle of resolution (logMAR) 0.22). We treated 45 eyes showing BCVA between 0.6 (logMAR 0.22) and 1.0 (logMAR 0), with IVR for 3 consecutive months. All eyes were confirmed to have subfoveal PCV prior to starting this treatment regimen. Additional IVR was administered at the subsequent monthly visits, if necessitated by evidence ...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Association between psoriasis and vitamin D: Duration of disease correlates with decreased vitamin D serum levelsAn observational case-control study
Recent literature has focused on the association of psoriasis with lower than normal or highly deficient vitamin D blood levels. To investigate the controversial association between psoriasis and vitamin D levels. From 2012 to 2014, 561 subjects were assessed, of which 170 had psoriasis, 51 had an autoimmune bullous, and 340 were healthy patients. Anagraphical data, 25(OH)D blood levels, and seasons of vitamin D levels assessments were recorded for each group. Vitamin D levels were significantly different among the 3 groups (K = 151.284; P = .0001). Psoriatic patients had significantly lower serum levels of 25(O...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

A case report of remission of refractory membranous nephropathy progressing to stage 4 chronic kidney disease using low-dose rituximab: A long-term follow-up
Rationale: As suggested by the 2012 KDIGO guidelines, persistent elevation of serum creatinine> 3.5 mg/dl (> 309 μmol/l) (or an estimated glomerular filtration rate (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Dacryocystitis due to sporothrix inoculated vis an unusual mode: Case report
We describe a 34-year-old female who presented with a nodule increasing in size near the medial angle of the left eye. Originally, she was misdiagnosed with a dacryocyst space-occupying lesion, and the lesion was removed by surgery. Diagnoses: Findings of fungal structures in the histopathological examination contributed to the diagnosis of Sporothrix dacryocystitis. Further culture of conjunctival secretions and contact lens storage solution was positive for Sporothrix. Interventions: She was treated with oral itraconazole, 200 mg by mouth twice daily. Outcomes: After 3 months of treatment with oral itraconazole,...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Is the mean platelet volume a predictive marker of a high in-hospital mortality of acute cardiorenal syndrome patients receiving continuous renal replacement therapy?
A high mean platelet volume (MPV) level has been demonstrated to predict poor clinical outcomes in patients with cardiovascular disease. However, the relationship between MPV and mortality in patients with acute cardiorenal syndrome (ACRS) is unknown. Therefore, we investigated the predictive value of MPV for in-hospital mortality of patients with ACRS who received continuous renal replacement therapy (CRRT) in this study. We retrospectively analyzed the demographics, etiology, severity of illness, prognosis, and risk factors of ACRS patients who underwent CRRT in our hospital from January 2009 to December 2014. Patients ...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Usefulness of tocilizumab for treating rheumatoid arthritis with myelodysplastic syndrome: A case report and literature review
We report a case of RA with MDS successfully treated with tocilizumab. To our knowledge, this is the first case of an RA patient with MDS that was successfully treated with tocilizumab. In addition, our case emphasizes that IL-6 plays a critical role in the pathogenesis of RA with MDS. Tocilizumab might be an effective treatment for RA with MDS, especially in those with high levels of IL-6, elevated C-reactive protein, and severe anemia. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Unexpected and durable response with regorafenib in a metastatic colorectal cancer patient without KDR mutation: A case report
Rationale: Regorafenib is an oral multikinase inhibitor and is approved as salvage therapy in the standard treatment of advanced colorectal cancer (CRC). Due to its limited efficacy, toxicity profile, and cost, it is necessary to identify those patients who may have the most benefit from regorafenib. In a previous case report, kinase insert domain receptor (KDR) mutation has been associated with exceptional clinical response (CR) in an elderly patient treated with a low dose of regorafenib; thus, it was hypothesized that it could represent a new predictive marker of drug response. Patient concerns: A heavily pretreate...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Acute portal vein thrombosis after hepatectomy in a patient with hepatolithiasis: A case report and review of the literature
Rationale: Portal vein thrombosis is defined as any thrombosis that develops in the portal vein system. It is considered a very rare and extremely lethal complication of hepatopancreatobiliary surgery. Patient concerns: Acute portal vein thrombosis after hepatectomy in patients with hepatolithiasisis very rare. Acute portal vein thrombosis is considered as a dangerous complication after hepatectomy. It is easy to ignore the symptom of acute portal vein thrombosis. Once the appropriate time of treatment is past, it would lead to patients‘ death. Diagnose: Acute portal vein thrombosis after hepatectomy in a pat...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A low cost kinect-based virtual rehabilitation system for inpatient rehabilitation of the upper limb in patients with subacute stroke: A randomized, double-blind, sham-controlled pilot trial
Background: We designed this study to prove the efficacy of the low-cost Kinect-based virtual rehabilitation (VR) system for upper limb recovery among patients with subacute stroke. Methods: A double-blind, randomized, sham-controlled trial was performed. A total of 23 subjects with subacute stroke ( (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Superior mesenteric venous thrombosis complicating acute appendicitis: A case report
Rationale: Superior mesenteric venous thrombosis (SMVT) is a rare condition that carries high mortality. Very few cases have been reported of SMVT, complicating acute appendicitis. Early recognition requires a high index of suspicion and is crucial in successful treatment of such a life-threatening condition. Patient concerns: A 33-year-old male presents with a 4-day history of right lower abdominal pain, nausea and subjective fever. CT scan showed acute appendicitis and a central filling defect in the superior mesenteric vein. Diagnoses: Acute appendicitis complicated by SMVT. Interventions: Intravenous antibio...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Alveolar paratesticular rhabdomyosarcoma mimicing epididymitis: Case report and literature review
Rationale: Most patients with paratesticular rhabdomyosarcoma may typically present as a unilateral, painless palpable scrotum mass. However, only a few cases of RMS presenting as painful edema of the scrotum mimicing epididymitis. We herein report an unusual case of alveolar paratesticular rhabdomyosarcoma misdiagnosed as epididymitis. Patient concerns: A 19-year-old adolescent, presented to urologist with painful swelling of the scrotum on the left side over the preceding several days. Antibiotics were administered by physician for two months and the pain improved, but the swelling did not fade. Diagnoses: Alveol...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Management of adult-onset methylmalonic acidemia with hypotonia and acute respiratory failure: A case report
We report a 26-year-old male who presented with metabolic acidosis, acute renal failure required hemodialysis and acute respiratory failure required mechanical ventilation support. Progressive hypotonia of muscles made weaning from mechanical ventilator difficult. Diagnoses: High level of serum methylmalonic acid and the mut genotype sequences confirmed the diagnosis of this adult-onset MMA. Two mut genotype sequences were found by analyzing all coding exons and exon-intron junctions. One genotype was well documented (Exon 6 Mutation, c. 1280G>A. p. G427D, heterozygous). The other mut genotype sequence had never been...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Ultrasound manifestations of enchondroma protuberans: Two case reports
We report two rare cases of enchondroma protuberans originating from phalanxes. Patient concerns: The patients visited doctors for a palpable mass in their phalanx without any pain or discomfort. Diagnoses: Biopsy is the gold standard for the diagnosis of enchondroma protuberans. Radiographs usually provide important imaging information, while studied on the ultrasound manifestation of enchondroma protuberans are still limited. In our cases, significant information about ultrasound manifestation of enchondroma protuberans were presented. Sonographic examination of enchondroma protuberans revealed a hypoechoic mass lo...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Systemic lupus erythematosus with Guillian–Barre syndrome: A case report and literature review
Conclusions: Our case highlights the importance of the early diagnosis and treatment of SLE. Systemic lupus erythematosus is a multifactorial participant autoimmune systemic disease for which the clinical manifestations are complex and diverse. Glucocorticoid and cytotoxic drugs can be used in clinical treatment. If the disease is not diagnosed early, it could also delay treatment. Patients who receive an early diagnosis and appropriate treatment may have a better prognosis. Data Sources: Data were collected from the patient's electronic medical records and the hospital laboratory medicine database. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Small cell lung cancer mimicking lymphoma in CT and 68Ga-DOTA-NOC PET/CT: A case report
Rationale: Small cell lung cancer accounts for 15-20% of all lung cancers and is the most common pulmonary neuroendocrine neoplasm. Most small cell lung cancers arise from lobar or main bronchi, the most common manifestations of small cell lung cancer is a large mass centrally located within the lung parenchyma or a mediastinal mass involving the hilus. Small cell lung cancer is easily ignored by clinicians without lung parenchyma and hilus involvement. Here, we report a case of small cell lung cancer, which was misdiagnosed as the lymphoma in contrast enhanced CT and 68Ga-DOTA-NOC PET/CT imagings. Patient concerns: A...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Management of testicular Leydig cell tumor: A case report
Rationale: Testicular Leydig cell tumor (LCT) is a rare neoplasm. It commonly presents as a painless testicular mass with or without endocrine changes. Histological and immunohistochemical examination play important roles in differentiating LCT from testicular germ cell tumors. Patient concerns: We highlight the imaging phenotype, as well as the pathological findings of a case of LCT in a 62-year-old male. Diagnoses: Preoperative noncontrast CT scan of the abdomen revealed a 7.0 × 6.4 × 5.3 cm oval mass with heterogeneous density, located in the right testis. Pelvic noncontrast MRI showed a hete...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Mammographic and ultrasound findings in poroid hidradenoma of the breast mimicking intraductal papilloma and papillary carcinoma: A case report
Rationale: Poroid hidradenoma (PH) is a rare variant of benign sweat gland neoplasm without connection to the epidermis. This tumor presents clinically as a solitary lesion with a cystic component located in the subcutaneous layer abutting the skin. On ultrasound, it appears as a circumscribed complex cystic and solid mass abutting the dermis. The occurrence of PH in the breast is very rare. Its features overlap with intraductal papilloma and papillary carcinoma. Patient concerns: A 66-year-old woman presented with a palpable lump in her right breast. Diagnoses: Clinical examination revealed dark bluish dome-shaped...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Age- and sex-related differences in body composition in healthy subjects aged 18 to 82 years
This study is a report on body composition of healthy subjects, to be used as an important data for future investigations and differences between nationalities and countries. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Case report: successful treatment of refractory SAPHO syndrome with the JAK inhibitor tofacitinib
Conclusions: The efficacy of JAK inhibitors in treating refractory SAPHO syndrome should be noted. (Source: Medicine)
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Effect of muscle strengthening exercise and time since onset in patients with amyotrophic lateral sclerosis: A 2-patient case series study
This study examined the relevance between the effect of muscle strengthening exercise and time since onset in patients with ALS. This study is a retrospective nonconsecutive case series study at a single university hospital. We included 2 patients with ALS who were admitted twice. Case 1 was a 60-year-old man with the bulbar type. He was hospitalized 10 months (ALS functional rating scale-revised, 42 points) and 1 year and 8 months (33 points) after onset. Case 2 was a 52-year-old man with the lower limb type. He was hospitalized 1 year and 3 months (44 points) and 1 year and 8 months (33 points) after onset. Physical the...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

A foreign body in the cephalic vein: A case report
Rationale: Foreign bodies in the vasculature usually cause numerous problems for clinical physicians. Physician experience with diagnosing and treating non-iatrogenic foreign body migration in the venous system is insufficient. Patient concerns: Here, we reported a 41-year-old male who had a foreign body in his left forearm following a work-related injury. Diagnoses: X-ray films indicated a 3-mm high-density shadow in the superficial soft tissue of the left forearm. During the operation, the foreign body was imaged by a C-arm fluoroscope to provide a more accurate location. Interventions: The foreign body was re...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

The capsule appearance of hepatocellular carcinoma in gadoxetic acid-enhanced MR imaging: Correlation with pathology and dynamic CT
This study aimed to evaluate the capability of gadoxetic acid-enhanced MR (GAeMR) to detect presence of capsule appearance in hepatocellular carcinoma (HCC), and to correlate it with dynamic computed tomography (CT) and pathological features. Sixty-three patients (54: 9 = M: F, mean age 55.8) surgically confirmed HCCs with preoperative CT and GAeMR were included in this retrospective study. Two readers evaluated presence of capsule appearances on CT and GAeMR images in each phase including precontrast (Pre), portal phase (PP), delayed phase (DP), transitional phase (TP), and hepatobiliary phase (HBP). Histologic capsu...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Diagnostic Accuracy Study Source Type: research

Cutaneous mucormycosis caused by Rhizopus microsporus in an immunocompetent patient: A case report and review of literature
We reported the case of a 37-year-old man presenting with a skin lesion on the left side of the chest wall with no history of trauma or primary diseases. He was firstly misdiagnosed as tuberculosis and the proper treatment was thus delayed. Diagnoses: Histopathological examination and fungal culture of the lesion confirmed cutaneous mucormycosis. The isolate was identified as Rhizopus microspores by ITS sequencing. Interventions: The patient was treated with oral posaconazole 400 mg bid for 150 days. Outcomes: The patient recovered satisfactorily. No recurrence was found during the follow-up and no side effect...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Can a pulse oxygen saturation of 95% to 96% help predict further vital sign destabilization in school-aged children?: A retrospective observational study
To determine whether a peripheral capillary oxygen saturation (SpO2) of 95% to 96% should be considered “nonurgent” in school-aged children, as suggested by the Canadian Emergency Department Triage and Acuity Scale. School-aged children (6–12 years old) with a normal body temperature (36.5–37.4°C) who visited our department between September, 2014 and August, 2015 (n = 4556) were divided into 4 groups based on SpO2: group A: 99% to 100%; group B: 97% to 98%; group C: 95% to 96%; and group D: ≤94%. The heart rate (HR), respiratory rate (RR), and hospitalization rate were compared among th...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Anterior mediastinal leiomyosarcoma mimicking thymoma: A case report
Rationale: Mediastinal leiomyosarcoma is very rare. In this paper, we report one case of anterior mediastinal leiomyosarcoma and retrospectively review the imaging findings of previously reported cases. Patient Concerns: A 61-year-old male patient was admitted to our hospital due to the presence of a mediastinal space-occupying lesion for two years. Two years previously, chest computed tomography (CT) showed a small nodule in the anterior mediastinum. Twenty days previously, the CT examination was repeated at the local hospital due to respiratory symptoms, which showed a mass in the anterior mediastinum and interstiti...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research