A bibliometric evaluation of the top 100 cited natalizumab articles.

Natalizumab is being used in recurrent multiple sclerosis despite its history of market withdrawal due to lethal cases. We have carried out a bibliometric analysis of this drug from 1999 to February 2020 in order to assess the real impact of the use natalizumab with the goal to identify the key articles that sustain the current knowledge on the therapeutic possibilities of this compound. We have extracted from the Web of Science the top 100 most cited records (T100) and tabulated data on the journal, authors, publication year, number of citations, countries and institutions of publication, T100-records, citation density and citations per record of the works. The 100 most cited articles were selected from a total of 32,507 citations out of 2817 publications with an h-number of 74, 11.54 citations/publication, and a density of 1544.79 citations/year. Citations ranged from 63 of the paper placed in the 100th position (T100) to 1940 of the paper in the first position (T1). T2 was cited 888 times, and the difference in the number of citations between T1 and T2 was higher than that between T2 and T10. T1, T2 and T3 are clinical trials. When articles are arranged by institution and nationality having more than 10 T100 articles, biotechnology company Biogen and the USA, respectively, lead the ranking, but we also find that 8 out of 10 are academic European institutions. A co-authorship analysis reveals an intense collaborative activity between countries and institutions. We conclude that the clinical and academic communities have shown a sustained interest in natalizumab for the therapy of recurrent multiple sclerosis over the last 20 years.

Thymic Carcinoma Associated with Cerebellar Degeneration.

We present the case of a 57-year-old man with ataxia and clinical and radiological features of cerebellar degeneration. Computed tomography showed a mediastinal mass and the patient was diagnosed with thymic carcinoma. Paraneoplastic cerebellar degeneration is aninfrequent disorder and its association with thymic carcinoma very rare. LEARNING POINTS: Unexplained subacute neurological symptoms in an adult patient should beconsidered in the possibility of a paraneoplastic syndrome. In patients over 50 years of age, acute or subacute cerebellar degeneration is paraneoplastic in 50% of cases.Small-cell lung cancer is the most common cancer-causing paraneoplastic cerebellar degeneration (PCD). Despite this, mediastinal tumours such as thymus neoplasms should not be ruled out in the differential diagnosis.Antineuronal antibodies are not detected in 40% of patients with PCD, sothe exclusion of other aetiologies or the demonstration of cancer formsthe basis of the final diagnosis.

Deep Vein Thrombosis in Upper Limb in a Weightlifter.

AIM: We report an unusual case of a male weightlifter with upper extremity venous thrombosis. CASE PRESENTATION: Thrombosis affecting subclavian-axillo-humeral venous trunk produced by the compression of these veins by the trained muscles of the shoulder girdle (Paget-Schroetter syndrome) has been reported. During the study, a renal carcinoma was detected. Renal carcinoma has rarely been associated with thrombosis in the upper extremities. CONCLUSION: This case shows the importance of performing a complete study to rule out malignancies in patients with unusual venous thromboembolism.

Influence of the perioperative administration of magnesium sulfate on the total dose of anesthetics during general anesthesia. A systematic review and meta-analysis.

BACKGROUND: Magnesium sulfate displays numerous characteristics that make it a useful drug in anesthesiology (N-methyl-d-aspartate receptor antagonist, vasodilator, antiarrhythmic, inhibitor of catecholamine release and of acetylcholine in the terminal motor plate). The perioperative use of this drug as an adjuvant capable of decreasing the required dose of anesthetics, has been proposed. OBJECTIVES: To assess the influence of intravenous magnesium sulfate administration during general anesthesia on the overall dose of required anesthetics. DESIGN: A systematic review of controlled randomized trials and meta-analysis. DATA SOURCES: An electronic bibliography search in MEDLINE and in the Cochrane Database of Controlled trials (CENTRAL) up to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Randomized, double-blind trials relating to general anesthesia in elective surgery using intravenous magnesium sulfate that provide information about the anesthetic requirements in ASA I and II patients. RESULTS: 20 clinical trials were selected for the qualitative analysis and 19 for the quantitative one. The use of perioperative intravenous magnesium sulfate reduces the requirement of the anesthetic, propofol during induction (-28.52mg; CI 95% -35.22-1.82; p<0.001) and maintenance (-213.56mg; CI 95% -322.93, -104.18; p<0.001) of anesthesia. Additionally, magnesium sulfate reduces the requirement of neuromuscular non-despolarizing blocking agents (-2.99mg; CI 95% -44.47, -1.99; p<0.001) and the intraoperative consumption of fentanile(-53.57 mcg; CI 95% -75.01, -32.12; p<0.001). CONCLUSIONS: We conclude that perioperative magnesium sulfate acts as a coadjuvant drug capable of reducing anesthetic requirements.