bluuebunny/crossref_metadata_2025 huggingface dataset:
Mammary Analogue Secretory Carcinoma Arising in the Parotid Gland of Child
Authors: Shigeta Rie , Orgun Doruk , Mizuno Hiroshi , Hayashi Ayato
Published: December 2018

Mammary analogue secretory carcinoma (MASC) of salivary glands is a newly recognized tumor entity. We report a child who was initially diagnosed with lymphangioma and referred to our institute for sclerotherapy, only to find out that the tumor was in fact MASC after excision. This case of MASC is in a 7-year-old boy, the youngest case so far reported. He referred to his primary care physician with a infra-auricular swelling, and it was diagnosed as lymphatic malformation he was referred to our institution for sclerotherapy. For Doppler and ultrasound magnetic resonance imaging, there was a distinct cystic lesion with a heterogeneous solid lesion inside. Minimally invasive treatment such as sclerotherapy was thought to be more desirable due to a pediatric case, the risk of postoperative facial paralysis and scar. However, even the successful treatment of cystic lesion with sclerotherapy, solid lesion of the tumor could be remained without pathological findings. Otolaryngologist also thought the importance of pathological diagnosis, and we finally chose surgical excision. The tumor was ultimately diagnosed as MASC considering histological and genetic findings. For child case, we tend to treat patient less invasively, and it might bring a risk of MASC being incorrectly treated nonsurgically such as with sclerotherapy. This could lead to tumor progression and wider radical excision at last. We believe that histological diagnosis should become the priority in similar cases of mixed solid and cystic tumors to avoid incorrect treatment, and we need to choose surgical excision by understanding the character of salivary gland tumor occurring in childhood.
Beyond 30 Days: A Risk Calculator for Longer Term Outcomes of Prosthetic Breast Reconstruction
Authors: Blough Jordan T. , Vu Michael M. , Qiu Cecil S. , Mlodinow Alexei S. , Khavanin Nima , Fine Neil A. , Kim John Y. S.
Published: December 2018

Background:

Despite growing use of surgical risk calculators, many are limited to 30-day outcomes due to the constraints of their underlying datasets. Because complications of breast reconstruction can occur well beyond 30 days after surgery, we endeavored to expand the Breast Reconstruction Risk Assessment (BRA) Score to prediction of 1-year complications after primary prosthetic breast reconstruction.

Methods:

We examined our prospective intrainstitutional database of prosthetic breast reconstructions from 2004 to 2015. Patients without 1-year follow-up were excluded. Pertinent patient variables include those enumerated in past iterations of the BRA Score. Outcomes of interest include seroma, surgical site infection (SSI), implant exposure, and explantation occurring within 1 year of tissue expander placement. Risk calculators were developed for each outcome using multivariate logistic regression models and made available online at www.BRAScore.org. Internal validity was assessed using C-statistic, Hosmer-Lemeshow test, and Brier score.

Results:

Nine-hundred three patients met inclusion criteria. Within 1-year, 3.0% of patients experienced seroma, 6.9% infection, 7.1% implant exposure, and 13.2% explantation. Thirty-day, 90-day, and 180-day windows captured 17.6%, 39.5%, and 59.7% of explantations, respectively. One-year risk calculators were developed for each complication of interest, and all demonstrated good internal validity: C-statistics for the 5 models ranged from 0.674 to 0.739, Hosmer-Lemeshow tests were uniformly nonsignificant, and Brier scores ranged from 0.027 to 0.154.

Conclusions:

Clinically significant complications of prosthetic breast reconstruction usually occur beyond the 30-day window following tissue expander placement. To better reflect long-term patient experiences, the BRA Score was enhanced with individualized risk models that predicted 1-year complications after prosthetic reconstruction (BRA Score XL). All models performed as well as, if not better than, the original BRA Score models and other popular risk calculators such as the CHA2DS2VASc Score. The patient-friendly BRA Score XL risk calculator is available at www.brascore.org to facilitate operative decision-making and heighten the informed consent process for patients.
NEW PROPOSAL FOR THE PATHOPHYSIOLOGY OF TYPE 3 NEOVASCULARIZATION AS BASED ON MULTIMODAL IMAGING FINDINGS
Authors: Spaide Richard F.
Published: December 2018

Purpose:

To investigate the imaging characteristics of early Type 3 neovascularization and propose a new pathophysiologic sequence for early disease.

Methods:

Patients were evaluated with a comprehensive ophthalmologic examination to include fundus photography, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, and volume-rendered optical coherence tomography angiography. Relevant literature was also reviewed.

Results:

There were 10 eyes of 9 patients who had a mean age of 87 (range 79–93) years and 7 were women. The patients were seen to have distributed areas of cystoid macular edema, not necessarily contiguous with areas of fluorescein or optical coherence tomography angiographic evidence of neovascularization, which colocalized with each other. Areas of hemorrhage were not necessarily contiguous with observed neovascularization. In some patients, massive amounts of edema were imaged, although the associated neovascular invasion was small and did not reach deeper portions of the retina. These findings were readily responsive to intravitreal injections of anti–vascular endothelial growth factor (VEGF) medication. Review of published literature showed conflicting pathophysiologic proposals, which did not abide with contemporaneous imaging findings.

Conclusion:

Type 3 neovascularization likely grows in response to increased cytokine levels, particularly VEGF, in a permissive environment. Elevated levels of VEGF have been shown to cause hemorrhage, edema, and telangiectasis in the macula, suggesting some of the manifestations of Type 3 neovascularization are related to increased tissue VEGF levels and not necessarily to the neovascularization alone. A proposal based on imaging and histopathologic findings and known physiologic effects of VEGF is presented.
Fourier Analysis of Corneal Irregular Astigmatism Due to the Anterior Corneal Surface in Dry Eye
Authors: Koh Shizuka , Maeda Naoyuki , Ogawa Mai , Asonuma Sanae , Takai Yoshihiro , Maruyama Kazuichi , Klyce Stephen D. , Nishida Kohji
Published: December 2018

Objectives:

To evaluate corneal irregular astigmatism due to the anterior corneal surface using Fourier harmonic analysis with a Placido ring–based corneal topographer (Placido-based topographer) and three-dimensional anterior segment optical coherence tomography (OCT) in dry eyes.

Methods:

Forty-four eyes of 44 subjects with dry eye and 20 eyes of 20 normal control subjects were enrolled. Corneal topographic data were obtained using a Placido-based topographer and OCT. Dioptric data from the central 3-mm zone of the anterior corneal surface were decomposed using Fourier harmonic analysis. Spherical, regular astigmatism, and irregular astigmatism (asymmetry and higher-order irregularity) refractive error components of the cornea from the two imaging modalities were compared.

Results:

Both asymmetry and higher-order irregularity values were significantly greater in dry eyes than in control eyes for both the Placido-based topographer and OCT measurements (all P<0.05). In dry eyes, measured values of asymmetry and higher-order irregularities were significantly smaller when obtained with OCT than with the Placido-based topographer (both P<0.001). By contrast, these parameters were not significantly different between the two devices in control eyes. In dry eyes, severity of superficial punctate keratopathy in the central corneal region was correlated with irregular astigmatism.

Conclusions:

The amount of corneal irregular astigmatism, quantified using Fourier harmonic analysis, was significantly higher in dry eyes than in normal eyes. Measurements obtained with OCT and the Placido-based topographer differed in subjects with dry eyes. Therefore, caution should be practiced when trying to use these measurements interchangeably.
Economic Science in Lower-Limb Prosthetic Rehabilitation: The Consumer’s Perspective
Authors: Richmond Jack
Published: December 2018

Prosthetic care for people living with limb loss has proved to be one of the most rehabilitative technologies in medicine. Many who have received lower-limb prosthetic care are living lives considered to be completely ordinary to highly extraordinary.

From the consumer’s perspective, the question of the economic value of prosthetic care is, “To what degree will this prosthetic care help to restore my mobility, my confidence, and my ability to live my life as I choose?”

Developing the tools that will provide better answers to this value question is not easy, but it is essential to the future of prosthetic care in an era of rapidly increasing technology and health care cost. Multiple tools to measure outcomes already exist; the key is adapting them to patient-centric models that identify value to patients, providers, and payers.

The purpose of this article is to present the consumer’s perspective on the economic value of prosthetic care through a better understanding of patient expectations and to encourage more patient-centered over device-centered research.
Economic Value of Prosthetic Services among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study
Authors: Dobson Allen , El-Gamil Audrey , Shimer Matt , DaVanzo Joan E.
Published: December 2018

Context

There are few studies of the economic impact or value of lower extremity prosthetic services. Results from this study can inform the value proposition concerning prosthetic services within military health, where over 40,000 Veterans with limb-loss receive care for their amputations through the Veterans Administration health care system.

Purpose

To determine the extent to which Medicare patients who received selected prosthetic services had less health care utilization, lower Medicare payments, and/or fewer negative outcomes compared to matched patients not receiving these services.

Methods

This retrospective cohort analysis using Medicare claims data (2007–2010) and propensity score matching techniques to control for observable selection bias based on etiological diagnosis, comorbidities, patient characteristics, and historical health care utilization one year before the etiological diagnosis. Findings: Patients who received lower extremity prostheses had comparable Medicare episode payments ($6,099 per-member-per-month for study group, $6,015 per-member-per-month for comparison group) and better outcomes than patients who did not receive prostheses. Study group patients were more likely to receive extensive outpatient therapy than comparison group patients ( P < 0.05). Receiving physical therapy is associated with fewer hospitalizations and emergency room visits, and less facility-based care ( P < 0.05), essentially offsetting the cost of the prosthetic over a 12-month time frame.
Postural Control Deficits After Repetitive Soccer Heading
Authors: Caccese Jaclyn B. , Buckley Thomas A. , Tierney Ryan T. , Rose William C. , Glutting Joseph J. , Kaminski Thomas W.
Published: December 2018

Objective:

To determine the acute effects of repetitive soccer heading on postural control.

Design:

Prospective study; participants were divided into 2 groups: a soccer heading group and a control group.

Setting:

Biomechanics laboratory.

Participants:

One hundred sixty participants, including youth (age = 13.0 ± 0.8 years), high school (age = 17.2 ± 1.0 years), and collegiate (age = 20.2 ± 1.3 years) male and female soccer players, participated in this study.

Interventions:

Participants in the soccer heading group performed 12 soccer headers (initial velocity = 11.2 m/s). Postural control testing was performed both before (PRE) and immediately after (POST) the purposeful soccer headers. Control participants performed postural control testing PRE and POST a 15-minute wait period. During postural control testing, participants were asked to stand on the MobileMat (Tekscan Inc, Boston, Massachusetts) for two 2-minute intervals with their hands on their hips and their feet together with one eyes-open and one eyes-closed trial.

Main Outcome Measures:

Using the center-of-pressure data, 95% area, sway velocity, and ApEn were calculated. Multilevel linear models were used to analyze the effects of age, sex, group, condition, and concussion history simultaneously.

Results:

Participants in the soccer heading group had significantly higher sway velocity POST than participants in the control group after controlling for age, sex, concussion history, condition, and PRE (t = −3.002; P = 0.003; 95% confidence interval, −0.482 to −0.100). There were no significant differences from PRE to POST for 95% area, M/L ApEn, and A/P ApEn.

Conclusions:

Repetitive soccer heading does not affect most postural control measures, even among youth athletes. However, sway velocity increased after heading relative to control participants independent of age, sex, and concussion history.
Effective But Not Adhered to: How Can We Improve Adherence to Evidence-Based Hamstring Injury Prevention in Amateur Football?
Authors: van der Horst Nick , Hoef Sander van de , Otterloo Paul van , Klein Milan , Brink Michel , Backx Frank
Published: December 2018

Objectives:

To investigate adherence to a Nordic hamstring exercise (NHE) program in a real-world context of male amateur football, and the perceptions of end users (players) and intervention deliverers (coaches and medical staff) about adherence to this proven effective program.

Design:

Retrospective cohort study.

Setting:

Dutch amateur football.

Participants:

Two hundred sixty-four players, 23 coaches, and 29 medical staff from Dutch amateur football teams that participated in a national randomized controlled trial 2 years earlier.

Independent Variables:

Nordic hamstring exercise program.

Main Outcome Measures:

Nordic hamstring exercise program adherence during 2014 and 2015. Intervention or control group allocation during the trial, transfers, and personal perception about adherence to the program were also examined.

Results:

Of all players, 69% reported never, 16% sometimes, 6% frequently, 5% often, and 4% always performing exercises of the NHE program. Adherence to the NHE program was higher among players who had been in the NHE arm of the previous trial and among players who had not been transferred to another club compared with players who had been transferred. Key factors in stimulating players to adhere to the NHE program were knowledge of the NHE and personal motivation. Coaches and medical staff members also mentioned personal motivation and consensus with team staff as key factors to encourage NHE adherence.

Conclusions:

Among high-level male amateur football players, adherence to an evidence-based hamstring injury-prevention program was very low. It is essential to recognize factors that stimulate or limit adherence to injury-prevention programs for effective programs to actually lead to a reduction in hamstring injuries in a real-world context.
A case report on filamin A gene mutation and progressive pulmonary disease in an infant
Authors: Calcaterra Valeria , Avanzini Maria Antonietta , Mantelli Melissa , Agolini Emanuele , Croce Stefania , De Silvestri Annalisa , Re Giuseppe , Collura Mirella , Maltese Alice , Novelli Antonio , Pelizzo Gloria
Published: December 2018

Rationale:

Mesenchymal stem cells (MSC) play a crucial role in both the maintenance of pulmonary integrity and the pathogenesis of lung disease. Lung involvement has been reported in patients with the filamin A (FLNA) gene mutation. Considering FLNA's role in the intrinsic mechanical properties of MSC, we characterized MSCs isolated from FLNA-defective lung tissue, in order to define their pathogenetic role in pulmonary damage.

Patient concerns:

A male infant developed significant lung disease resulting in emphysematous lesions and perivascular and interstitial fibrosis. He also exhibited general muscular hypotonia, bilateral inguinal hernia, and deformities of the lower limbs (pes tortus congenitalis and hip dysplasia). Following lobar resection, chronic respiratory failure occurred.

Diagnosis:

Genetic testing was performed during the course of his clinical care and revealed a new pathogenic variant of the FLNA gene c.7391_7403del; (p.Val2464AlafsTer5). Brain magnetic resonance imaging revealed periventricular nodular heterotopia.

Interventions and outcomes:

Surgical thoracoscopic lung biopsy was performed in order to obtain additional data on the pathological pulmonary features. A small portion of the pulmonary tissue was used for MSC expansion. Morphology, immunophenotype, differentiation capacity, and proliferative growth were evaluated. Bone marrow-derived mesenchymal stem cells (BM-MSC) were employed as a control. MSCs presented the typical MSC morphology and phenotype while exhibiting higher proliferative capacity (P <.001) and lower migration potential (P=.02) compared to control BM-MSC.

Lessons:

The genetic profile and altered features of the MSCs isolated from FLNA-related pediatric lung tissue could be directly related to defects in cell migration during embryonic lung development and pulmonary damage described in FLNA-defective patients.
Effect of adjuvant hormone therapy in patients with prostate cancer
Authors: Liu Feng , Sun Daju , Zhou Xueying , Ding Youpeng , Ma Yanan , Hou Yi , Kong Xiangbo , Wang Zhixin
Published: December 2018

Objectives:

To summarize the evidence regarding the treatment effect of adjuvant hormone therapy (AHT) in patients with prostate cancer (PCa). AHT following radiotherapy, chemotherapy, or surgery is widely used in patients with PCa. However, the treatment effect is inconsistent in individual trials.

Methods:

The electronic databases including PubMed, EmBase, and Cochrane Library were searched to identify randomized controlled trials (RCTs) in September 2016. RCTs that evaluated the effects of AHT in patients with PCa were included. Hazard ratio (HR) and relative risks (RR) were used to measure the treatment effects of AHT using a random effects model. The analyses were further stratified by factors that could affect the treatment efficacy.

Results:

A total of 14,594 potential studies were identified, and 27 RCTs were included. Compared with the control group, patients who received AHT were associated with a significant improvement in overall survival (OS) (HR: 0.78; 95% confidence interval [CI]: 0.71–0.85; P <.001), disease-free survival (DFS) (HR: 0.50; 95% CI: 0.39–0.65; P <.001), total mortality (RR: 0.90; 95% CI: 0.85–0.96; P = .001), recurrence (RR: 0.70; 95% CI: 0.60–0.81; P <.001), and disease-specific mortality (RR: 0.70; 95% CI: 0.56–0.87; P <.001). However, no significant difference was observed between AHT and control for response rate (RR: 1.75; 95% CI: 0.91–3.37; P = .095).

Conclusions:

The findings of this meta-analysis confirmed that patients who received AHT had a significant improvement in OS, DFS, total mortality, recurrence, and disease-specific mortality. Further, large-scale RCTs are required to evaluate the treatment effect in specific subpopulations.
Tissue preservation through socket-shield technique and platelet-rich fibrin in immediate implant placement
Authors: Guo Tianqi , Nie Ran , Xin Xirui , Wang Hanchi , Qi Manlin , Yu Kaixuan , Wang Yao , Du Liuyi , Zhou Yanmin
Published: December 2018

Rationale:

In this report, a combination of socket-shield technique (SST) and platelet-rich fibrin (PRF) technique was used for immediate implant placement on a fractured central incisor. During the follow-up visit, cone beam computed tomography (CBCT) and clinical observation were used to evaluate the preservation outcome of peri-implant bone and gingiva.

Patient concerns:

The patient was a 28-year-old healthy female patient who desired her fractured 21 to be replaced with an implant-supported single crown; the fractured 21 comprised a post-core crown with insufficient residual bone at the labial site.

Diagnosis:

The root of 21 exhibited a complex root fracture; the labial portion of the alveolar ridge was thin (<1 mm) and partial ankylosis of the residual root was observed.

Interventions:

Modified SST was applied to the labial portion of the residual root. The implant was placed immediately at the lingual site of the retained socket-shield root fragment; PRF was the placed in the gap between the root fragment and the implant. Final prosthodontic treatment was performed at 24 weeks after implant placement.

Outcomes:

Clinical examination and CBCT scanning at various follow-up visits time showed that the periodontal tissue was well- preserved. At 6 months after surgery, the average horizontal and vertical peri-implant bone resorption was 0.4 mm; a follow-up visit at 18 months post-loading indicated that peri-implant tissue was well preserved by the shield-technique and no significant peri-implant tissue resorption was displayed.

Lesson Subsections:

In cases of anterior teeth with intact but insufficient residual alveolar ridge, the SST with PRF may be effective for preservation and maintenance of stable peri-implant tissue.
Association between MEFV polymorphisms and the susceptibility to ankylosing spondylitis in a Chinese Han population
Authors: Song Jingtao , Zhao Lei , Jiao Jiaxun , Wei Wei
Published: December 2018

The aim of this study was to explore the genetic association of Mediterranean fever (MEFV) gene polymorphisms rs3743930 and rs11466023 with ankylosing spondylitis (AS) susceptibility in a cohort of Chinese Han population.

Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used for genotyping MEFV polymorphisms in 131 AS patients and 127 healthy controls. Chi-square test was employed to compare the genotype and allele distributions between the case and control groups. Odds ratio (OR) with 95% confidence interval (CI) was calculated to assess the association between MEFV gene polymorphisms and AS incidence.

The frequency of the G allele of MEFV polymorphism rs3743930 in the AS group was significantly higher than that in the healthy control group (36.64% vs 28.35%, P < .05). And individuals carrying the GG genotype showed 2.896 folds higher risk of developing AS when compared with CC genotype carriers (OR = 2.896, 95% CI = 1.115–7.519). But no significant differences were detected in either genotype or allele distributions between case and control groups for the polymorphism rs11466023 (P > .05).

MEFV gene polymorphism rs3743930 might be significantly associated with AS susceptibility in Chinese Han population, and its G allele might predict high risk of AS.
Incomplete Kawasaki disease in the 2-month-old infant
Authors: Ma Wei , Sun Juan , Wang Huaili
Published: December 2018

Rationale:

The diagnosis of Kawasaki disease (KD) is difficult and is often delayed for children whose age falls outside the typical age range of 6 months to 5 years, especially for those with incomplete KD (IKD) or atypical features.

Patient concerns:

A 2-month-20-day-old girl presented to our hospital with a chief complaint of intermittent fever for 1 day and 1 episode of seizure, with poor feeding and swelling of feet.

Diagnosis:

Until the appearance of red cracked lips, a diagnosis of IKD was considered. A rise in periungual desquamation of the hands confirmed the diagnosis.

Interventions:

Intravenous immunoglobulins were administered and aspirin and dipyridamole were used orally.

Outcome:

The temperature, C-reactive protein, and erythrocyte sedimentation rate returned to normal level and there was no coronary artery lesion.

Lessons:

This case highlights that the diagnosis of IKD should be considered in children whose primary presentation is fever and neurologic features, lacking principal clinical findings, particularly those <6 months of age.
Hemobilia caused by pancreatic arteriovenous malformation
Authors: Liu Xiaolei , Huang Jia , Tan Haidong , Yang Zhiying
Published: December 2018

Rationale:

Hemobilia caused by arteriovenous malformation is extremely rare but could be lethal. To date, most reports have been single-case reports, and no literature reviews are available.

Patient concerns:

A 47-year-old man presented to the emergency department with abdominal pain and fever. He complained of abdominal pain and weight loss for the past 2 months.

Diagnoses:

Contrast-enhanced computed tomography and magnetic resonance imaging showed a heterogenous lesion located in pancreatic head and tumor was suspected.

Interventions:

Endoscopic retrograde cholangiopancreatography was performed and bleeding from papilla of Vater could be viewed. Nasobiliary drainage was placed to alleviate the pain and jaundice. Emergency laparotomy was performed due to the recurrence of severe pain and bleeding, and pancreatoduodenectomy was then performed. Macroscopic examination showed the ulceration connected with collected vessels which were located in pancreatic head and microscopic examination confirmed the presence of arteriovenous malformation.

Outcomes:

The patient recovered uneventfully and was discharged 10 days after the surgery. He is asymptomatic on 4-month follow up.

Lessons:

Arteriovenous malformation is a rare cause of hemobilia, but it could lead to life threatening bleeding. Transarterial embolization could be effective to control the bleeding temporarily, however repeated hemorrhage may occur. Surgical resection may be a better option.
Effect of cancer characteristics and oncological outcomes associated with laparoscopic colorectal resection converted to open surgery
Authors: Wu Bo , Wang Wei , Hao Guangjie , Song Guoquan
Published: December 2018

Background:

Although laparoscopic colorectal cancer resection is an oncologically safe procedure equivalent to open resection,the effects of conversion of a laparoscopic approach to an open approach remain unclear.This study evaluated the cancer characteristic and oncological outcomes associated with conversion of laparoscopic colorectal resection to open surgery.

Method:

We conducted searches on PubMed, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials. We included the literature published until 2018 that examined the impact of laparoscopic conversion to open colorectal resection. Only randomized control trials and prospective studies were included. Each study was reviewed and the data were extracted. Fixed-effects methods were used to combine data, and 95% confidence intervals (CIs) were used to evaluate the outcomes.

Results:

Twelve studies with 5427 patients were included. Of these, 4672 patients underwent complete laparoscopic resection with no conversion (LAP group), whereas 755 underwent conversion to an open resection (CONV group). The meta-analysis showedsignificant differences between the LAP group and converted (CONV) group with respect to neoadjuvant therapy (P = .002), location of the rectal cancer (P = .01), and recurrence (P = .01). However, no difference in local recurrence (P = .17) was noted between both groups.

Conclusion:

Conversion of laparoscopic to open colorectal cancer resection is influenced by tumor characteristics. Conversion of laparoscopic surgery for colorectal cancer is associated with a worse oncological outcome.
An ectopic adrenocortical adenoma in renal hilum presenting with Cushing's syndrome
Authors: Lu Difei , Yu Nan , Ma Xiaowei , Zhang Junqing , Guo Xiaohui
Published: December 2018

Rationale:

Ectopic adrenal tissue is the adrenal rests along the path from gonads to adrenal glands during embryogenesis. Ectopic adrenocortical adenoma is a rare disease represented with over-production of cortisol by the ectopic adrenocortical tissue.

Patient concerns:

An 18-year-old Chinese female patient was presented with weight-gain for 6 months. She had elevated plasma cortisol and a solitary mass was revealed using computed tomography scan in the left renal hilum.

Diagnosis:

The tumor was removed and the immunohistochemical profile indicated an ectopic adrenocortical adenoma.

Interventions:

After the tumor was removed, the patient was under glucocorticoid replacement therapy in 6-month.

Outcomes:

During 6-month of follow-up, the patient showed no signs of tumor recurrence.

Lessons:

Ectopic adrenocortical adenoma is difficult to diagnose due to its low incidence, and the ectopic rests in renal hilum could be misdiagnosed as renal cell carcinoma. This case reminds clinicians to be aware of ectopic site in the diagnosis of adrenocorticotropic hormone (ACTH) independent Cushing's syndrome. Immunohistochemical stain may assist in evaluating the origin of the ectopic rests. A certain rate of local recurrence indicated the need of long-term follow-up.
CT-pathologic correlation in lung adenocarcinoma and squamous cell carcinoma
Authors: Yue Jun-Yan , Chen Jie , Zhou Feng-Mei , Hu Ying , Li Mei-Xia , Wu Qing-Wu , Han Dong-Ming
Published: December 2018

Distinguishing lung adenocarcinoma from squamous cell carcinoma (SCC) is clinically important. Computed tomography (CT) scan is an economical, effective, noninvasive, commonly available, and quick diagnostic way for lung cancer. In this study, we aim to compare the CT characteristics in adenocarcinoma and SCC.

Data from 275 cases (259 adenocarcinoma and 16 SCC) were retrospectively compared. CT characteristics, including lesion size and shape, single/multifocal lesions, location of the tumor, the margin of lobes, whether the lesion had deep lobulated margin, bronchial cut-off sign, signs of dilated bronchial arteries, signs of vascular bundle thickening, signs of short burrs, spinous processes, and pleural indentation, were compared in 148 cases (137 adenocarcinoma and 11 SCC).

Patients with adenocarcinoma were more likely to be female (44.2% vs 25.0%, P = .017). Compared with SCC, adenocarcinomas were more likely to have deep lobulated margin (81.0% vs 54.5%, P = .038), less likely to have smooth lobes margin (2.7% vs 83.3%, P < .001), more likely to have vascular bundle thickening (37.2% vs 0, P = .016) and pleural indentation (59.9% vs 18.2%, P = .01), and marginally less likely to have dilated bronchial arteries (17.5% vs 45.5%, P = .064). No significant difference was observed regarding to characteristics, including tumor size, location of the tumor, signs of bronchial cut-off, dilated bronchial arteries, short burrs, or spinous processes.

CT scan has the potential to help to distinguish lung adenocarcinoma and SCC in a fast and commonly available way. CT could be a rough but fast way to diagnosis, and may thus shorten the waiting time to treatment and allow more time for clinicians, patients, and their families to prepare for future treatment.
A scoring system to predict HBsAg seroclearance in hepatitis B and C coinfected patients treated with interferon and ribavirin in an Asian cohort
Authors: Yen Yi-Hao , Kee Kwong-Ming , Kuo Fang-Ying , Chang Kuo-Chin , Hu Tsung-Hui , Lu Sheng-Nan , Wang Jing-Houng , Hung Chao-Hung , Chen Chien-Hung
Published: December 2018

Current guidelines recommend that patients with hepatitis B virus-hepatitis C virus (HBV-HCV) coinfection be treated with direct anti-viral agents (DAAs). Compared with DAAs, pegylated interferon (PEG-IFN) and ribavirin therapy has the advantages of treating both viruses while maintaining an acceptable HCV sustained virological response (SVR) rate (70–80%) in Asian cohorts. In this study, we aimed to develop a simple scoring system to predict hepatitis B surface antigen (HBsAg) seroclearance in these patients. We enrolled 201 patients with HCV-HBV coinfection after IFN and ribavirin therapy. The study population was randomly allocated into derivation and validation sets in a 1:1 ratio. In the derivation cohort, multivariate analysis by Cox regression analysis revealed that HBsAg seroclearance was associated with age > 60 years (HR: 5.55, 95% CI: 1.68–18.37, P = .005), male gender (HR: 3.88, 95% CI: 1.18–12.80, P = .03), and qHBsAg level ≤100 IU/ml (HR: 4.87, 95% CI: 1.20–19.74, P = .03). Regression coefficients were used to build up a risk score, and the accuracy of the risk score was evaluated by using the area under the receiver operating characteristic curve (AUROC). The patients were classified into either a low-risk group or high-risk group based on the risk scores. Twenty-three (23.0%) patients in the derivation cohort and 30 (29.7%) patients in the validation cohort showed HBsAg seroclearance with an AUROC of 71.8%, sensitivity of 65.22%, and specificity of 75.32%. In the validation cohort, the 5-year HBsAg seroclearance incidence rates were 23.4% in the low-risk category and 43.8% in the high-risk category (HR = 2.21; 95% CI, 1.04–4.68, P = .04)

The risk scoring system could be used to predict HBsAg seroclearance for HCV-HBV coinfected patients treated with IFN and ribavirin.
S-1 plus cisplatin with concurrent radiotherapy for stage III non-small cell lung cancer
Authors: Qie Shuai , Li Yanhong , Shi Hong-yun , Yuan Lanhui , Zhang Xi
Published: December 2018

Introduction:

The present study aims to assess the efficacy and safety of S-1 plus cisplatin as concurrent chemoradiation (experimental group [EG]) compared with standard concurrent chemoradiation regimens (control group[CG]) in patients with local advanced non-small cell lung cancer.

Methods:

The Cochrane library, pubmed, and Ovid (elsevier) were retrieved. The included randomized controlled trials (RCT) were evaluated, and the statistical analysis was performed using RevMan 5.3 software. Cochrane handbook was applied to evaluate the methodological quality. Statistical significance was considered as P <.05.

Results:

There were 5 randomized control trials identified eligible for the meta-analysis. Meta-analysis of the pooled date suggested that overall survival (OS) (HR, 0.81; 95% CI, 0.58–1.13; P = .21, heterogeneity P = 1.00, I2 = 0%), progressives free survival (PFS) (HR, 0.82; 95% CI, 0.62–1.09; P = .18, heterogeneity P = .83, I2 = 0%) and 1,2,3-year OS (1-year OS: RR 1.03; 95% CI: 0.92–1.15, p = 0.59), (2-year OS: RR 1.14; 95% CI: 0.98–1.34, P = .09), (3 -year OS: RR 1.14; 95% CI: 0.90–1.44, P = .29) were not significantly different. The combination of S-1 and cisplatin had lower grade 3 or 4 leukocytopenia, neutropenia, (RR = 0.54, 95% CI: 0.38–0.75, P = .0003; RR = 0.23,95% CI: 0.14–0.36, P <.00001;, respectively). The rates of nausea, diarrhea, thrombocytopenia, pneumonitis, anorexia, anemia, febrile neutropenia were much the same in the 2 groups (RR = 1.35, 95% CI: 0.68–2.68, P = .38; RR = 1.85, 95% CI: 0.61–5.60, P = .28; RR = 1.67, 95% CI: 0.88–3.17, P = .12; RR = 1.19, 95% CI: 0.44–3.21, P = .73; RR = 1.35, 95% CI: 0.68–2.68, P = .38; RR = 0.86, 95% CI:0.55–1.34, P = .50; RR = 0.63, 95% CI:0.35–1.14, P = .13;, respectively).

Conclusions:

This meta-analysis of 5 randomized control trails demonstrates that EG results similar OS, PFS, and 1,2,3-year OS, compared with CG, with lower risk of leukocytopenia, neutropenia.
Angiosarcoma originating in the anterior mediastinum
Authors: Tan Yan-Bin , Yu Xin-Feng , Fan Jun-Qiang , Li Jin-Fan
Published: December 2018

Rationale:

Angiosarcomas are malignant vascular tumors, and angiosarcoma occurring in the anterior mediastinum is rare. Here we report a case of angiosarcoma that originated in the anterior mediastinum treated with surgery, followed by radiotherapy and synchronous chemotherapy.

Patient concerns:

A 56-year-old female was admitted to our hospital with chest pain for 3 days. Chest computerized tomogram (CT) examination showed a heterogeneous mass in the anterior superior mediastinum, and after injection of contrast agent, the mass showed obvious heterogeneous enhancement. Magnetic resonance imaging (MRI) with T1 weighted image (T1WI) showed isointensity and T2 weighted image (T2WI) showed heterogeneous signal intensity, the mass showed an obvious heterogeneously enhancement after intravenous administration of contrast material.

Diagnosis and interventions:

Surgical resection operation was carried out. According to its morphologic and immunohistochemic feature of tumor cells which expressing CD31, CD34, and ERG, the tumor was categorized as an angiosarcoma. After operation, the patient received radiotherapy and synchronous chemotherapy.

Outcomes:

At present, 8 months postoperatively, no signs of recurrence have been observed.

Lessons:

Although angiosarcoma in anterior mediastinum is rare, when a mass located in this area, a more careful immunohistological analysis should be performed to avoid overlooking the presence of angiosarcoma.
Unusual aspiration of coin in the lower respiratory tract
Authors: Fang Ning , Wang Zhuo , Shang Jing , Zhang Zhenyu , Wang Xin
Published: December 2018

Rationale:

Foreign body (FB) aspiration in adults is occasionally encountered. The aspiration and impaction of a coin in the lower respiratory tract is an unusual accident. This report presents 2 rare adult cases of FB aspiration with coin impaction in larynx and trachea, respectively.

Patient concerns:

Two patients presented to the emergency department separately. Both had a similar history of inadvertent ingestion of a 5-jiao coin that was accidentally enveloped in dumplings. The ingestion was immediately followed by violent cough.

Diagnosis:

The diagnosis of foreign body aspiration was confirmed by chest x-ray. In the first patient, chest computed tomography (CT) confirmed the shape of the coin and it was located in the laryngeal area, facing C5. In the second patient, CT revealed a metal-density FB located in the tracheal carina.

Interventions:

In the first patient, direct laryngoscopy was performed and the 5-Jiao coin was removed in a direction parallel to the vocal cords. In the second patient, rigid bronchoscopy was used to remove the coin.

Outcomes:

The postoperative period was uneventful in both the patients.

Lessons:

During FB removal, the coin should be positioned parallel to the vocal cords during its retrieval through the glottis. Due attention must be paid to avoid asphyxia due to positional changes of the coin in the trachea. Early diagnosis and intervention is the key in such cases as delay can cause catastrophic complications.
Fluoroscopy-guided subclavian vein catheterization in 203 children with hematologic disease
Authors: Pang Huajin , Chen Yong , He Xiaofeng , Zeng Qingle , Ye Peng
Published: December 2018

Subclavian vein catheterization plays an important role in the treatment of children with hematologic disease. However, catheter placement is a difficult and high-risk procedure in children.

Fluoroscopy-guided subclavian vein catheterization was used in 203 children (mean age, 6.99 years ± 3.722 years; range, 1–16 years) with hematologic disease. The number of vein punctures, catheterization success rate, fluoroscopy time, operation time, and surgical complications were recorded.

There was a 100% success rate for fluoroscopy-guided subclavian vein catheterization. A total of 124 cases (61.1%) were successful on the first venipuncture attempt; 171 cases (84.2%) achieved success within 3 attempts. Twenty-five cases had 4 to 6 time venipunctures and the remaining 7 cases underwent ≥7 time venipunctures. All catheter tips were successfully placed at the junction of the superior vena cava and the right atrium. Fluoroscopy times ranged from 16 to 607 seconds (mean, 65.46 ± 85.864 seconds). Operation time ranged between 5 and 25 minutes (mean, 10.38 ± 4.036 minutes). Arterial punctured was happened during surgery in 2 cases. There were 2 cases of catheter-related infection, but no other complications. The mean follow-up time was 35 days; range 20 to 50 days.

Fluoroscopy-guided subclavian vein catheterization in children is a safe procedure, with a high success rate, resulting in a reduced number of venipunctures, optimal catheter placement, and reduced complications.
Pathological fracture of the mandible caused by radicular cyst
Authors: Xiao Xian , Dai Jia-Wei , Li Zhi , Zhang Wei
Published: December 2018

Rationale:

Pathological fracture of the mandible caused by radicular cyst is rare. This report describes a unique case of a mandibular pathological fracture caused by radicular cyst, arising from an endodontically treated molar.

Patient concern:

A 49-year-old female was referred to our department with persistent pain in left mandibular angle, accompanying with restricted mouth opening and malocclusion.

Diagnose:

An orthopantomograph (OPG) showed a unilocular lesion with a relatively well-defined border, and the lesion was associated with a fracture in the inferior border of the mandible.

Intervention:

This patient was treated through curettage of the cyst combined with open reduction and internal fixation of the fracture.

Outcomes:

At the 1-year follow-up visit, the patient did not have any complaints, and the radiographs indicated the consolidation of the fracture without recurrence of cyst.

Lessons:

This case report highlights the routine follow-up of endodontically treated teeth in order to check for apical healing and detect the cystic change at early stages.
Delayed-onset central poststroke pain due to degeneration of the spinothalamic tract following thalamic hemorrhage
Authors: Jang Sung Ho , Kim JongHoon , Lee Han Do
Published: December 2018

Rationale:

Recent studies have used diffusion tensor tractography (DTT) to demonstrate that central poststroke pain (CPSP) was related to spinothalamic tract (STT) injury in patients with stroke. However, few studies have been reported about delayed-onset CPSP due to degeneration of the STT following a stroke.

Patient's concerns:

A 57-year-old female patient presented with right hemiparesis after stroke. Two weeks after onset, she did not report any pain. At approximately 6 months after onset, she reported pain in the right arm and leg, and the pain slowly intensified with the passage of time. At 14 months after onset, the characteristics and severity of her pain were assessed to be continuous pain without allodynia or hyperalgesia; tingling and cold-sensational pain in her right whole arm and leg (visual analog scale score: 5).

Diagnoses:

The patient was diagnosed as the right hemiparesis due to spontaneous thalamic hemorrhage.

Interventions:

Clinical assessment and diffusion tensor imaging (DTI) were performed 2 weeks and 14 months after onset.

Outcomes:

She suffered continuous pain in her right whole arm and leg (visual analog scale score: 5). On DTT of the 2-week postonset DTI scans, the configuration of the STT was well-preserved in both hemispheres. However, in contrast to those 2-week postonset results, the 14-month postonset DTT results showed partial tearing and thinning in the left STT. Regardless, both the 2-week and 14-month postonset DTT showed that the left STT passed through the vicinity of the thalamic lesion.

Lessons:

Diagnostic importance of performing a DTT-based evaluation of the STT in patients exhibiting delayed-onset CPSP following intracerebral hemorrhage.
The efficiency and regimen choice of adjuvant chemotherapy in biliary tract cancer
Authors: Yin Luxi , Xu Qi , Li Jingjing , Wei Qing , Ying Jieer
Published: December 2018

Biliary tract cancer (BTC) patients have poor prognosis even following radical resection. To improve the current status, more evidence is required clarifying the role of adjuvant chemotherapy. This study aim is to evaluate the efficacy of adjuvant chemotherapy and discuss the regimen choices.

We retrospectively analyzed the clinical data of 80 patients who underwent curative-intent R0 resection from 2008 to 2016. Among them, 40 patients had received adjuvant chemotherapy, and the others in the observation group were 1:1 matched by clinical characteristics including gender, age, tumor stage, and ECOG performance status score. Kaplan–Meier analysis was performed to compare DFS and OS. Potential confounding factors were adjusted by Multivariate analysis.

In the entire patient cohort, the mean disease-free survival (DFS) time of BTC patients with adjuvant chemotherapy and observation was 18.63 ± 3.63 months versus 10.36 ± 1.67 months, respectively (P = .029). There was no significant difference observed in overall survival (OS) time (33.72 ± 5.02 vs 21.05 ± 4.12 months, P = .114). On multivariate analysis, adjuvant chemotherapy and N factor were found to be significant factors for DFS, and sex, age, T factor were found to be significant factors for OS. Besides, subgroup analysis indicated that combination chemotherapy prolonged DFS time of BTC patients than single-agent to some extent, and oral agents showed efficacy to improve OS.

This retrospective study demonstrates that adjuvant chemotherapy contributes to DFS, but is unsatisfactory for improving OS. Combination chemotherapy contained oral agents provides a possibility of therapeutic strategy for improving surgical outcomes of BTC patients.
Perioperative risk assessment with Euroscore and Euroscore II in patients with coronary artery or valvular disease
Authors: Czub Paweł , Cacko Andrzej , Gawałko Monika , Tataj Emanuel , Poliński Jakub , Pawlik Kacper , Cichoń Romuald , Hendzel Piotr
Published: December 2018

Nowadays, both the European System for Cardiac Operative Risk Evaluation (EuroSCORE) logistic (ESL) and EuroSCORE II (ESII) models are used worldwide in predicting in-hospital mortality after cardiac operation. However, these scales are based on different populations and represent different medical approaches. The aim of the study was to assess the effectiveness of the ESL and the ESII risk scores in predicting in-hospital death and prolonged hospitalization in intensive care unit (ICU) after coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve replacement (MVR) by comparison of an estimated risk and a real-life observation at a reference cardiac surgery unit.

This retrospective study was based on medical records of patients who underwent a CABG, AVR, or MVR at a reference cardiac surgery unit in a 2-year period. Primary endpoint was defined as in-hospital death. Secondary endpoint was a prolonged hospitalization at the ICU, defined as longer than 3 days.

The study encompassed 586 patients [114 (23.1%) female, mean age 65.8 ± 10.5 years], including 493 patients undergoing CABG, 66 patients undergoing AVR, and 27 patients undergoing MVR. The ESL and ESII risk scores were higher in MVR subgroup (31.7% ± 30.5% and 15.3% ± 19.4%) and AVR subgroup (9.7% ± 11.6% and 3.2% ± 4.2%) than in CABG subgroup (6.9% ± 10.4% and 2.5% ± 4.1%; P < .001). Subgroups of patients were significantly different in terms of clinical, biochemical, and echocardiography factors. Primary endpoint occurred in 36 (6.1%) patients: 21 (4.3%), 7 (10.6%), and 8 (29.7%) in CABG, AVR, and MVR subgroups, respectively. The ESII underestimated the risk of mortality. Secondary endpoint occurred in 210 (35.8%) patients: 172 (34.9%), 22 (33.4%), and 16 (59.3%) in CABG, AVR, and MVR subgroups, respectively.

In the study, the perioperative risk estimated with the ESL and the ESII risk scores was compared with a real-life outcome among over 500 patients. Regardless of the type of surgery, result in the ESL was better correlated with the risk of in-hospital death.