bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbital Myxofibrosarcoma: Case Report and Review of Literature
Authors: Clair Brandon C. , Salloum George , Carruth Bryant P. , Bersani Thomas A. , Hill Robert H.
Published: October 2018

Myxofibrosarcoma is rarely found in the orbit, let alone as a primary orbital tumor. With this having only been previously reported 5 times in the literature, there is a very limited understanding of its presentation and course. Typical management involves surgical excision with or without postoperative radiotherapy. Low-grade malignancy, although rare to metastasize, still has a high rate of local recurrence and with each recurrence increases the risk of metastatic potential. With this in mind, analysis of each case is critical in better understanding the disease, and this case adds to the current literature.
Nocardia brasiliensis Preseptal Cellulitis in an Immunocompetent Patient
Authors: Kareff Samuel , Gottlieb Lindsey , Maturana Colleen , Caplivski Daniel
Published: October 2018

The Nocardia subspecies are opportunistic pathogens ubiquitous in the environment that most often cause infection in immunocompromised hosts. Here we describe a case of community-acquired preseptal cellulitis in a previously healthy man who we believe acquired the infection from contact with soil while gardening.
Mycobacterium avium Complex Cutaneous Infections in Non-HIV Patients
Authors: Rizvi Humaira , Saravolatz Louis Donald
Published: October 2018

We report a rare case of Mycobacterium avium complex cutaneous infection in a non-HIV patient with a report of 13 other cases of M. avium complex cutaneous infection in non-HIV patients found in the literature since 1992.
Predictors of 30-day Postdischarge Readmission to a Multistate National Sample of State Psychiatric Hospitals
Authors: Ortiz Glorimar
Published: October 2018

Background:

Early discharge from psychiatric inpatient care may pose challenges for the patient's recovery and may incite a rapid return to the hospital. This study identified demographic, clinical, and the continuing of care characteristics associated with rapid readmission into a sample of psychiatric inpatient hospitals.

Methods:

Cross-sectional analysis of 60,254 discharges from state psychiatric hospitals. Logistic regression explored the relationship between predictors of rapid readmission.

Results:

Eight percent of discharges were readmitted to the same hospital within 30 days after discharge. Factors significantly related with rapid readmission included white (odds ratio, 1.23; 95% confidence interval, 1.13–1.34), non-Hispanic (1.48, 1.26–1.73), not married (1.53, 1.32–1.76), voluntarily admitted (1.18, 1.05–1.33), with length of stay (LOS) ≤ 7 days (3.52, 3.04–4.08), or LOS 8–31 days (3.20, 2.79–3.66), or LOS 32–92 days (1.91, 1.65–2.22), with a schizophrenia or other psychotic disorders (1.69, 1.46–1.96) or personality disorder (1.76, 1.50–2.06), referred to a setting different from the outpatient (1.27, 1.16–1.40), or with a living arrangement different from private residence (1.54, 1.40–1.68).

Conclusions:

Disparities in rapid readmission rates exist among state psychiatric hospitals. A national overview of the individuals with mental illness at risk of being prematurely discharged may suggests insights into quality initiatives aimed at reducing rapid readmissions into psychiatric inpatient care.
Automated Postdischarge Trauma Patient Call Program
Authors: Wright Aaron , Grady Kelly , Galante Joseph
Published: October 2018

Postdischarge phone calls have been shown to improve communications between patients and health care providers, potentially reducing readmission rates, medication errors, and emergency department (ED) visits. Given the complexity of social and medical issues associated with trauma, we studied the utility of an automated phone call system as a method of identifying gaps in trauma care. The Trauma Program and the Health Management and Education Department at a Level 1 academic trauma center engaged in a collaborative quality improvement effort using the CipherHealth LLC platform to provide automated phone calls to trauma patients 2–3 days after discharge. Automated questions to patients focused upon symptoms, equipment and medications, discharge instruction comprehension, and follow-up needs. When indicated, the automated system sent an alert and prompted the timely return phone call to the patient from a registered nurse with the intent of addressing the specified issue. During the 4-month study period, 1,382 patients were discharged from the trauma service. Three hundred thirty-two calls were attempted, with 186 completed. Twenty-seven percent of the completed calls prompted a nurse to make a personalized callback to the patient. Most calls were for symptoms (26%), follow-up appointments (22%), medication issues (21%), and discharge instruction clarification (15%). Just over 25% of trauma patients requested further clarification after discharge from the hospital. The results of this pilot indicate that further follow-up is warranted to determine whether outpatient follow-up calls in the trauma population have any impact upon mitigating complications and quality measures such as reduced ED visits, readmission, and patient safety and satisfaction.
Clinical Signs of Basilar Skull Fracture and Their Predictive Value in Diagnosis of This Injury
Authors: Solai Cibele Andres , Domingues Cristiane de Alencar , Nogueira Lilia de Souza , de Sousa Regina Marcia Cardoso
Published: October 2018

Although clinical signs for the diagnosis of basilar skull fracture (BSF) are ambiguous, they are widely used to make decisions on initial interventions involving trauma patients. We aimed to assess the performance of early and late (within 48 hr posttrauma) signs for BSF diagnosis and to verify the correlation between the presence of these signs and head injury severity. We conducted a prospectively designed follow-up study at a referral hospital for trauma care in Sao Paulo, Brazil, and performed structured observations for 48 hr post-blunt head injury in patients aged 12 years or older. The following signs of BSF were considered: raccoon eyes, Battle's sign, otorrhea, and rhinorrhea. Among the 136 enrolled patients (85.3% male; mean age 40 ± 21.4 years), 28 patients (20.6%) had BSF. The clinical signs for the early or late detection of BSF had low accuracy (55.9% vs. 43.4%), specificity (52.8% vs. 30.5%), and positive predictive value (25.7% vs. 27.1%). However, the presence of these signs was correlated to head injury severity, indicated by the Glasgow Coma Scale (p = .041) and Maximum Abbreviated Injury Scale–Head region (p = .002). In view of the low accuracy of these signs, resulting low clinical value of their presence, and their high sensitivity in the late stage, the study results contraindicate the value of BSF signs for making decisions about using the nasal route for the introduction of catheters and tubes in initial trauma care.
Self-teaching to improve patient confidence in resuscitation skills: A quality improvement project
Authors: Winchester David E. , Kittles Irene
Published: October 2018

Background and purpose:

Sudden cardiac death occurs predominantly at home where cardiopulmonary resuscitation (CPR) is often not provided. We tested the hypothesis that a self-teaching kit distributed to patients would effectively increase self-confidence in CPR.

Methods:

Patients seen by an advanced registered nurse practitioner in a general cardiology clinic were offered a self-teaching kit to learn CPR. Four-point scale survey questions were assessed at distribution and via phone call at 30 days.

Conclusions:

Kits were distributed to 21 patients; of whom, 17 (81%) patients used the kit. Patients reported greater self-confidence of performing CPR (2.6 before versus 3.2 after, p < .05) and greater comfort if someone needed CPR (2.4 before versus 3.1 after, p < .05).

Implications for practice:

Self-teaching CPR kits were used by the substantial majority of patients and were effective at increasing both self-confidence and willingness to perform CPR. Similar nurse-run programs could increase awareness and impact of CPR in communities.
An educational intervention to enhance nurse practitioner role transition in the first year of practice
Authors: Thompson Angela
Published: October 2018

Background and Purpose:

Role transition is a natural process that occurs when the registered nurse pursues additional education to become a nurse practitioner (NP). Role transition generates feelings of anxiety and insecurity, leading to a longer and more tumultuous adjustment. This study investigated whether an evidence-based role transition webinar would support NP role transition during this critical period.

Methods:

This study was a nonrandomized, pretest–posttest, and single-group study using a convenience sample to address the research question: “Does completion of a role transition webinar enhance the perception of new NPs of their ability to perform well in their role?”

Conclusions:

The educational webinar was shown to have a positive influence on some aspects of the participant's reported perceptions of NP role transition. Having practical and assessable educational interventions to optimize NP role transition and determining factors that contribute to the success of these interventions would be prudent.

Implications for Practice:

This is the first quantitative study to investigate the positive association between an online educational intervention and NP role transition. A timelier and less tumultuous transition would allow NPs to perform more effectively in their new role.
Quality of Life Within the First 6 Months of Vestibular Schwannoma Diagnosis With Implications for Patient Counseling
Authors: Carlson Matthew L. , Tombers Nicole M. , Kerezoudis Panagiotis , Celda Maria Peris , Lohse Christine M. , Link Michael J.
Published: October 2018

Objective:

To evaluate quality-of-life (QOL) in patients with sporadic vestibular schwannoma (VS) with particular focus on those recently diagnosed.

Study Design:

Cross-sectional survey, Penn Acoustic Neuroma Quality of Life (PANQOL) instrument.

Setting:

Acoustic Neuroma Association and a single tertiary referral center.

Patients:

Patients with sporadic VS.

Main Outcome Measures:

Domain-specific and total PANQOL scores comparing treatment modalities after adjusting for baseline covariates of interest.

Results:

Among all 1,288 respondents there were 229 (18%) who were recently diagnosed and had not yet selected a treatment modality, 303 (24%) who were observed, 185 (14%) who underwent radiosurgery alone, 507 (39%) who underwent microsurgery alone, and 64 (5%) who underwent radiosurgery and microsurgery. After adjusting for covariates of interest, total PANQOL scores were highest for the observation cohort (65; 95% CI 62–68), lowest for patients treated with multimodality therapy (56; 51–61) and those recently diagnosed (58; 55–62), and intermediate for those who received microsurgery alone (60; 58–62) and radiosurgery alone (61; 57–64) (global comparison, p = 0.001). When comparing groups that received single-modality therapy, there were no statistically significant differences in total PANQOL scores at short (0–5 yr), intermediate (6–10 yr), or long-term (≥11 yr) follow-up after adjusting for baseline covariates (all, p > 0.05).

Conclusion:

A new diagnosis of VS frequently imparts significant anxiety on the patient and leads to a temporary reduction in QOL. Notably, anxiety domain QOL scores among patients with newly diagnosed VS are poorer than patients who have observed their tumor for 6 months or longer. When feasible, an initial period of observation may afford patients valuable time to reconcile with the new diagnosis, to learn more about treatment options, and to discover whether there is tumor growth. In turn, this valuable information can be used to inform sound decision-making regarding tumor management.
Nystagmus Findings and Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss Without Dizziness
Authors: Choi Hye Rang , Choi Seongjun , Shin Jung Eun , Kim Chang-Hee
Published: October 2018

Objectives:

To investigate the incidence of nystagmus in patients with sudden sensorineural hearing loss (SSNHL) without dizziness, and to evaluate the correlation of the presence of nystagmus with hearing recovery in those patients.

Study Design:

Retrospective study.

Setting:

Tertiary referral academic medical center.

Patients:

Thirty-eight patients with SSNHL who did not complained of dizziness were enrolled.

Main Outcome Measure:

The presence of nystagmus was evaluated by recording eye movements, and if present, nystagmus was classified as direction-fixed or positional nystagmus. Vestibular function tests were performed, including caloric test.

Results:

Of 33 idiopathic SSNHL patients without dizziness, nystagmus was observed in 22 patients (67%), of which 14 patients exhibited direction-fixed nystagmus, and 8 patients exhibited direction-changing nystagmus. Among the 14 patients with direction-fixed nystagmus, 9 displayed the paretic type, and 5 displayed the irritative type. Direction-changing nystagmus (n = 8) was defined as that in which the direction of nystagmus was changed in a supine head-roll test, and the geotropic type and apogeotropic type were observed in two and six patients, respectively. The mean initial pure tone threshold was 58.2 ± 28.1 dB and 57.3 ± 20.0 dB in SSNHL patients with and without nystagmus, respectively, which was not significantly different (p = 0.925). When hearing improvement was compared according to the presence of nystagmus, 39% (8 of 21) of patients with nystagmus were found to belong in the good prognosis group, and 72% (8 of 11) of patients without nystagmus were found to belong in the good prognosis group, which showed marginal statistical significance (p = 0.063).

Conclusion:

Nystagmus was observed in two-thirds of idiopathic SSNHL patients without dizziness, and the pattern of nystagmus was either direction fixed or direction changing. Because hearing recovery was worse in patients with nystagmus than those without it, the diagnosis of nystagmus, even in SSNHL patients without dizziness, may be important in evaluating the hearing prognosis.
Conduction Abnormalities Associated with Tricuspid Annuloplasty in Cardiac Transplantation
Authors: Rubin Geoffrey A. , Sanchez Joseph , Bayne Joseph , Avula Uma Mahesh R. , Takayama Hiroo , Takeda Koji , Naka Yoshifumi , Garan Hasan , Farr Maryjane A. , Wan Elaine Y.
Published: October 2018

Prophylactic DeVega tricuspid annuloplasty (DVA) of the donor heart has been reported to improve tricuspid regurgitation (TR), renal dysfunction, and mortality in cardiac transplant recipients. This is the first study to investigate the electrical, as well as, hemodynamic effects of DVA during orthotopic heart transplantation (OHT). Electrocardiographic, echocardiographic, and hemodynamic data of 76 patients with DVA and 104 patients without DVA who underwent OHT between 2013 and 2017 at Columbia University Medical Center (New York, NY) were studied. Patients with DVA were older (56.5 ± 1.2 vs. 52.4 ± 1.0 years of age; p = 0.017) and predominantly men (78% vs. 68%; p = 0.02). There were no significant differences in right ventricular function and TR. Patients with DVA had increased incidence of right bundle branch block compared with without DVA (37% ± 5.9% vs. 9% ± 2.9%; p < 0.001). Three patients with DVA developed complete heart block (CHB), whereas no patients without DVA developed CHB (p = 0.04). Four patients with DVA received a pacemaker (PPM), whereas only one patient in the without DVA group received a PPM. Complete heart block was significantly increased in patients who received prophylactic DVA. Possible risk of conduction abnormalities should be considered with performance of DVA annuloplasty in cardiac transplant recipients.
Pediatric Femoral Arterial Cannulations in Extracorporeal Membrane Oxygenation: A Review and Strategies for Optimization
Authors: Fraser Charles D. , Kovler Mark L. , Guzman William , Rhee Daniel S. , Lum Ying Wei , Alaish Samuel M. , Garcia Alejandro V.
Published: October 2018

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is a treatment strategy for pediatric patients with cardiopulmonary failure. Femoral cannulation is a commonly used technique for obtaining central access in children and adolescents despite high rates of vascular complications. Ischemic limb complications remain one of the most common problems facing survivors of femoral VA ECMO. Our aim is to review the literature on femoral cannulation in children and to present a review of techniques for femoral cannula placement, decannulation, and arterial repair to help minimize and ameliorate complications related to cannulation. We performed a literature review for pediatric ECMO cannulation, complications, and femoral artery repair in pediatric patients. We focused on the management of arterial and ischemia-related complications during and after ECMO support via femoral cannulation. Vascular complications are not infrequent for patients requiring ECMO support via femoral cannulation. As such, judicious distal perfusion monitoring as well as augmentation of distal flow are important strategies during mechanical support. The use of distal perfusion catheters can be used to minimize the risk of limb ischemia. As femoral cannulation grows more popular in pediatric patients, strategies for arterial repair are essential to ensure extremity perfusion upon decannulation.
Expressions of KAI1 and E-cadherin in nonsmall cell lung cancer and their correlation with vasculogenic mimicry
Authors: Ci Hongfei , Xu Zhouyi , Xu Jing , Wang Yichao , Wu Shiwu
Published: October 2018

Background:

Metastasis and recurrence are the most common reasons for treatment failure of nonsmall cell lung cancer (NSCLC). Vasculogenic mimicry (VM, new blood supply formation in malignant tumors), E-Cadherin (a calcium-dependent transmembrane glycoprotein that mediates intercellular adhesion), KAI1 (a suppressor gene of tumor metastasis) are all valuable factors for metastasis and prognosis in diverse common human cancers. However, the correlation of VM, E-Cadherin, and KAI1 in NSCLC is still unclear. In this study, we analyzed the correlations among these factors as well as their respective correlations with clinicopathological parameters and survival in NSCLC.

Methods:

The level of VM, E-Cadherin, and KAI1 in 163 tissue samples of NSCLC was examined by immunhistochemistry. Clinical data were also collected.

Results:

Levels of VM was significantly higher, and levels of KAI1 and E-Cadherin significantly lower in NSCLC tissues than in normal lung tissues. Levels of VM were positively associated with lymph node metastasis (LNM), size, grade, and tumor node metastasis (TNM) stages, and negatively associated with patients’ overall survival (OS). Levels of KAI1 and E-Cadherin were negatively correlated with LNM, size, grade, and TNM stage, and positively associated with patients’ OS. In multivariate analysis, high levels of VM, E-Cadherin, and KAI1, as well as TNM stages were independently correlated with lower OS in patients with NSCLC.

Conclusion:

VM and the expression of E-Cadherin and KAI1 may represent promising metastatic and prognostic biomarkers, as well as potential therapeutic targets for NSCLC.
The clinical efficacy of using autologous platelet-rich plasma in total hip arthroplasty
Authors: Wang Xi , Ma Jianbin , Wang Zhiyuan , Xiao Lin
Published: October 2018

This study evaluated whether intra-articular platelet-rich plasma (PRP) might prevent postoperative bleeding in total hip arthroplasty (THA).

In this study, 260 hips that underwent THA were evaluated randomly by paramedical staffs, 130 of which involved the intraoperative use of PRP, and 130 of which served as control group. Postoperative blood loss (drain bag volume), estimated blood loss, and change in hemoglobin (Hb) at day 1, 2, 4, and 7 were analyzed, respectively.

PRP-treated group had a significant decrease in mean postoperative blood loss (92.6 ± 168.2 mL) compared to control group (682.3 ± 185.5 mL, P < .01). The mean postoperative estimated blood loss (526.1 ± 236.1 mL) in the PRP-treated group was significantly less than that in the control group (629.2.2 ± 142.3 mL, P < .01). There was a statistically significant difference in Hb value (mg/dL) at day 1, 2, 4, and 7 (−1.35 vs −1.98, −1.59 vs −2.52, −1.96 vs −2.82, and −1.76 vs −2.47, P < .05).

We found a significant reduction in postoperative blood loss (drain bag volume), estimated blood loss, and change in Hb after the use of autologous platelet gel in patients of THA, and PRP appears to be effective in reducing postoperative bleeding in THA.
One case report of giant atypical leiomyoma of the ovary
Authors: Wang Qiu-Man , Zhao Ye , Ma Ying , Yao Li-Ting , Han Xiao
Published: October 2018

Rationale:

Ovarian leiomyoma is a rare ovarian tumor that occurs in 20–65 year-old women, and is mostly misdiagnosed as malignant tumor. In most reports on this type of tumor, ovarian myoma has a benign histology. Herein,we describe a case of ovarian atypical leiomyoma.

Patient concerns:

The patient is a 58-year-old woman. At the age of 40 years old, the patient underwent hysterectomy due to “hysteromyoma” and secondary anemia. The patient was admitted to our hospital due to palpation of lower abdominal mass and abdominal distention.

Diagnoses:

A mass was revealed at the left uterine appendage by pelvic ultrasound and CT.Pathology and immunohistochemistry confirmed the diagnosis of the left ovarian atypical leiomyoma.

Interventions:

Pelvic cavity resection and right adnexectomy were performed during laparotomy for the patient.

Outcomes:

Without radiotherapy or chemotherapy, there were no signs of tumor recurrence in a 9-month follow-up period.

Lessons:

When a solid mass appears in ovarian tissues, ovarian leiomyoma should be considered. Patients with this type of tumor are mostly asymptomatic. Preoperative diagnosis was difficult, intraoperative frozen section would be helpful for determining the scope of the surgery, and the correct diagnosis was made by identifying the properties of smooth muscles through postoperative pathology and immunohistochemistry.
Effect of perioperative oral management on the prevention of surgical site infection after colorectal cancer surgery
Authors: Nobuhara Hiroshi , Yanamoto Souichi , Funahara Madoka , Matsugu Yasuhiro , Hayashida Saki , Soutome Sakiko , Kawakita Akiko , Ikeda Satoshi , Itamoto Toshiyuki , Umeda Masahiro
Published: October 2018

Surgical site infection (SSI) is 1 of the frequent postoperative complications after colorectal cancer surgery. Oral health care has been reported to reduce the risk of SSI or postoperative pneumonia in oral, esophageal, and lung cancer surgeries. The purpose of the study was to investigate the preventive effect of perioperative oral management on the development of SSI after a major colorectal cancer surgery.

The medical records of 698 patients who underwent colorectal cancer surgery at 2 hospitals in Japan were reviewed. Among these patients, 563 patients received perioperative oral management (oral management group) and 135 did not (control group). Various demographic, cancer-related, and treatment-related variables including perioperative oral management intervention and the occurrence of SSI were investigated. The relationship between each variable and the occurrence of SSI was examined via univariate and multivariate analyses using Fisher exact test, 1-way analysis of variance (ANOVA), and logistic regression. The occurrence of SSI in the 2 groups was evaluated via logistic regression using propensity score as a covariate. The difference in mean postoperative hospital stay between the oral management and control groups was analyzed using Student's t test.

SSI occurred in 68 (9.7%) of the 698 patients. Multivariate analysis showed that operation time, blood loss, and perioperative oral management were significantly correlated with the development of SSI. However, after the propensity score analysis, not receiving perioperative oral management also became a significant risk factor for SSI. The odds ratio of the oral management group was 0.484 (P = .014; 95% confidence interval: 0.272–0.862). Mean postoperative hospital stay was significantly shorter in the oral management group than in the control group.

Perioperative oral management reduces the risk of SSI after colorectal cancer surgery and shortens postoperative hospital stay.
Synchronous hepatocellular carcinoma and lymphoepithelioma-like carcinoma arising from 2 different sites of the liver
Authors: Shih En-Jie , Chau Ivy Yenwen , Yeh Yi-Chen , Chau Gar-Yang
Published: October 2018

Rationale:

Most cases of primary liver cancer involve hepatocellular carcinoma (HCC). Lymphoepithelioma-like carcinoma (LELC) is defined as a tumor composed of undifferentiated epithelial cells with a prominent lymphoid infiltrate, which is rarely reported. Lymphoepithelioma-like HCC (LEL-HCC) is an uncommon variant of HCC, having an unclear process of development. Here, we report the first case involving simultaneous HCC and LEL-HCC.

Patient concerns:

A 77-year-old female was accidentally found to have a hypoechoic hepatic nodule via an abdominal ultrasound during a health examination. Abdominal computed tomography scan revealed 2 hepatic nodules with arterial phase enhancement and washout in the late phase.

Diagnoses:

We diagnosed the case with 2 distinct liver nodules, HCC and LEL-HCC.

Interventions:

With suspicion of HCC, tumor resection (liver segments 4 and 5) was then performed. Histopathological examination of tumor 1 showed a moderately differentiated HCC and tumor 2 demonstrated a LEL-HCC. Immunohistochemically, the cells of tumor 2 were immunoreactive for cytokeratin (CK), CK7, and CK19. Epstein–Barr virus encoding small RNA (EBER) in situ hybridization results were negative.

Outcomes:

Six months after resection, intrahepatic tumor recurrence was noted. Radiofrequency ablation was conducted.

Lessons:

This is an interesting case providing circumstantial evidence of simultaneous development of HCC and LEL-HCC in distinct nodules of the liver with a background of chronic hepatitis B virus infection.
Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand
Authors: Bielski Andrzej , Rivas Eva , Ruetzler Kurt , Smereka Jacek , Puslecki Mateusz , Dabrowski Marek , Ladny Jerzy R. , Frass Michael , Robak Oliver , Evrin Togay , Szarpak Lukasz
Published: October 2018

Background:

Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation.

Methods:

The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression.

Results:

Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35–49), compared with Air-Q (21 seconds, 18–32) and I-Gel (19 seconds, 17–27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001).

Conclusions:

Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.
Effect of gel seat cushion on chronic low back pain in occupational drivers
Authors: Lee Jang Woo , Lim Young-Ho , Won Yu Hui , Kim Dong Hyun
Published: October 2018

Background:

Low back pain (LBP) is an exceedingly common medical condition that results in significant medical and social burden. Sitting for a long period is a common aggravating factor for LBP. Although seat cushion is known to promote comfort, relieve pressure, and correct posture, its effect on chronic LBP has not yet been investigated. This study aimed to evaluate the clinical effect of gel seat cushion on chronic LBP in occupational drivers.

Methods:

Occupational drivers with chronic LBP lasting for >6 months were recruited. Subjects were double-blinded, randomly assigned to 2 groups (gel and foam cushion groups), and instructed to use the provided cushions while driving. Pain threshold and tissue hardness were measured at tender points using a digital algometer. Numeric pain intensity scale (NPIS), Roland–Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI) were used to analyze the primary endpoint, whereas the Beck Depression Inventory and Short Form-6D were used for the secondary endpoint.

Results:

Of 80 enrolled subjects, 75 (gel cushion group, 40; foam cushion group, 35) were included for analysis. Both groups showed significant improvement in NPIS and ODI scores following cushion use. Results for Beck Depression Inventory and Short Form-6D scores indicated that gel cushion use was significantly helpful. Change in NPIS score was significantly greater in the gel cushion group than in the foam cushion group.

Conclusion:

Gel cushion use may be effective in relieving LBP in occupational drivers seated for a long period compared with foam cushion use.
Long-term follow-up of fibular graft for the reconstruction of bone defects
Authors: Liu Siyi , Tao Shengxiang , Tan Jinhai , Hu Xiang , Liu Huiyi , Li Zonghuan
Published: October 2018

The use of fibular graft for the reconstruction of bone defects has been demonstrated to be a reliable method. The aim of this study was to assess the clinical outcome of graft union, functional outcome (hypertrophy of the graft bones) and complications of both non-vascularized and vascularized grafts.

From 1981 to 2015, 10 patients were treated using non-vascularized fibular graft or free vascularized fibular graft. The outcomes were bony union time, graft hypertrophy and complications based on radiograph and functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. Mobility of the ankle at the donor site was evaluated using the Kofoed ankle score system.

This study included 10 patients with an average follow-up of 6.8 years. The union rate for all patients was 100%. The mean union time was 21.3 weeks for vascularized fibular grafts and 30.5 weeks for non-vascularized fibular grafts (P = .310). There was a significant difference between the upper limbs and the lower limbs regarding hypertrophy of the grafts in 5 patients (P = .003). The mean MSTS score in 10 patients was 84% (range 53%–97%). Stress fracture of the graft occurred in 1 patient. Donor site complications, including valgus deformity and length discrepancy, between 2 legs occurred in 2 patients who were under 18 years of age at the time of operation (P = .114). The mean Kofoed score was 96.8 (range 88–100).

A greater increase in hypertrophy of grafts was observed with reconstruction in the lower limbs. There was no difference in MSTS score between these 2 types of grafts. Children were more likely to experience the valgus deformity at the donor site after harvesting the fibula. Keeping at least the distal 1/4 of the fibula intact during the surgery is a valid means of ensuring ankle stability at the donor site, and children should be considered for prophylactic distal tibiofibular synostosis creation to prevent the valgus deformity of the ankle at the donor site.
Selection of pancreaticojejunostomy technique after pancreaticoduodenectomy: duct-to-mucosa anastomosis is not better than invagination anastomosis
Authors: Lyu Yunxiao , Li Ting , Wang Bin , Cheng Yunxiao , Zhao Sicong
Published: October 2018

Background:

One of the most clinically significant current discussions is the optimal pancreaticojejunostomy (PJ) technique for pancreaticoduodenectomy (PD). We performed a meta-analysis to compare duct-to-mucosa and invagination techniques for pancreatic anastomosis after PD.

Methods:

A systematic search of PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov up to June 1, 2018 was performed. Randomized controlled trials (RCTs) comparing duct-to-mucosa versus invagination PJ were included. Statistical analysis was performed using RevMan 5.3 software.

Results:

Eight RCTs involving 1099 patients were included in the meta-analysis. The rate of postoperative pancreatic fistula (POPF) was not significantly different between the duct-to-mucosa PJ (110/547, 20.10%) and invagination PJ (98/552, 17.75%) groups in all 8 studies (risk ratio, 1.13; 95% CI, 0.89–1.44; P = .31). The subgroup analysis using the International Study Group on Pancreatic Fistula criteria showed no significant difference in POPF between duct-to-mucosa PJ (97/372, 26.08%) and invagination PJ (78/377, 20.68%). No significant difference in clinically relevant POPF (CR-POPF) was found between the 2 groups (55/372 vs 40/377, P = .38). Additionally, no significant differences in delayed gastric emptying, post-pancreatectomy hemorrhage, reoperation, operation time, or length of stay were found between the 2 groups. The overall morbidity and mortality rates were not significantly different between the 2 groups.

Conclusion:

The duct-to-mucosa technique seems no better than the invagination technique for pancreatic anastomosis after PD in terms of POPF, CR-POPF, and other main complications. Further studies on this topic are therefore recommended.
Therapeutic outcome of spinal implant infections caused by Staphylococcus aureus
Authors: Cho Oh-Hyun , Bae In-Gyu , Moon Song Mi , Park Seong Yeon , Kwak Yee Gyung , Kim Baek-Nam , Yu Shi Nae , Jeon Min Hyok , Kim Tark , Choo Eun Ju , Lee Eun Jung , Kim Tae Hyong , Choi Seong-Ho , Chung Jin-Won , Kang Kyung-Chung , Lee Jung Hee , Lee Yu-Mi , Lee Mi Suk , Park Ki-Ho
Published: October 2018

Spinal implant infection is a rare but significant complication of spinal fusion surgery, and the most common pathogen is Staphylococcus aureus. It is difficult to treat due to this pathogen's biofilm-forming ability and antibiotic resistance. We evaluated the therapeutic outcome of treatments for S aureus spinal implant infections. We retrospectively reviewed all patients with S aureus spinal implant infections at 11 tertiary-care hospitals over a 9-year period. Parameters predictive of treatment failure and recurrence were analyzed by Cox regression. Of the 102 patients with infections, 76 (75%) were caused by methicillin-resistant S aureus (MRSA) and 51 (50%) were late-onset infections. In all, 83 (81%) patients were managed by debridement, antibiotics, and implant retention (DAIR) and 19 (19%) had their implants removed. The median duration of all antibiotic therapies was 52 days. During a median follow-up period of 32 months, treatment failure occurred in 37 (36%) cases. The median time to treatment failure was 113 days, being <1 year in 30 (81%) patients. DAIR (adjusted hazard ratio [aHR], 6.27; P = .01) and MRSA infection (aHR, 4.07; P = .009) were independently associated with treatment failure. Rifampin-based combination treatments exhibited independent protective effects on recurrence (aHR, 0.23; P = .02). In conclusion, among patients with S aureus spinal implant infections, MRSA and DAIR were independent risk factors for treatment failure, and these risk factors were present in the majority of patients. In this difficult-to-treat population, the overall treatment failure rate was 36%; rifampin may improve the outcomes of patients with S aureus spinal implant infections.
Predictive factors of postoperative complications in single-port video-assisted thoracoscopic anatomical resection
Authors: Gonzalez-Rivas Diego , Kuo Yung Chia , Wu Ching Yang , Delgado Maria , Mercedes de la Torre , Fernandez Ricardo , Fieira Eva , Hsieh Ming Ju , Paradela Marina , Chao Yin Kai , Wu Ching Feng
Published: October 2018

The purpose of this study was to identify the risk factors for adverse events during single-port video-assisted thoracoscopic (SPVATS) anatomical resections.

We retrospectively reviewed patients who had undergone SPVATS anatomic resections between January 2014 and February 2017 in Coruña University Hospital's Minimally Invasive Thoracic Surgery Unit (CHUAC, Spain) and Chang Gung Memorial Hospital (CGMH, Taiwan). Four hundred forty-two patients (male: 306, female: 136) were enrolled in this study. Logistic regression analysis was performed on variables for postoperative complications.

Postoperative complications with a 30-day mortality occurred in 94 patients (21.3%) and with a 90-day mortality in 3 patients (0.7%) while the major complication rate was 3.9%. Prolonged air leak (PAL > 5 days) was the most common complication and came by postoperative arrhythmia. Logistic regression indicated that pleural symphysis (odds ratio (OR), 1.91; 95% confidence interval (CI), 1.14–3.18; P = .014), computed tomography (CT) pulmonary emphysema (OR, 2.63; 95% CI, 1.41–4.76; P = .002), well-developed pulmonary CT fissure line (OR, 0.49; 95% CI, 0.29–0.84; P = .009), and tumor size (≥3 cm) (OR, 2.15; 95% CI, 1.30–3.57; P = .003) were predictors of postoperative complications.

Our preliminary results revealed that SPVATS anatomic resection achieves acceptable 30- and 90-day surgery related mortality (0.7%) and major complications rate (3.9%). Prolonged Air leak (PAL > 5 days) was the most common postoperative complication. Pleural symphysis, pulmonary emphysema, well-developed pulmonary CT fissure line and tumor size (≥3 cm) were predictors of adverse events during SPVATS anatomic resection.
New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA
Authors: Li Hui-Min , Zhang Ren-Jie , Gao Hai , Jia Chong-Yu , Zhang Jian-Xiang , Dong Fu-Long , Shen Cai-Liang
Published: October 2018

Background:

Because of aging of population, osteoporotic vertebral compression fracture (OVCF) appears an increasing incidence rate. Conservative therapy (CT) and balloon kyphoplasty (BKP) have been used to treat OVCFs. However, an increase in new vertebral compression fractures at nontreated levels following BKP is of concern. It is still not clear whether new fractures were a result of BKP and the purpose of this meta-analysis was to evaluate the new fractures risk after BKP compared with CT.

Methods:

An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials and prospective nonrandomized controlled study that compared BKP with CT for patients suffering OVCF. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval.

Results:

Twelve studies were included and there was no significant difference in total new fractures (P = .33) and adjacent fractures (P = .83) between 2 treatments. Subgroup analyses did not demonstrate significant differences in follow-up period, mean age, anti-osteoporosis therapy, and the proportion of women.

Conclusion:

Our systematic review revealed that an increased risk of fracture of vertebral bodies was not associated with BKP compared with CT.
Early stage ovarian carcinoma with symptoms mimicking tuberculous peritonitis in a postmenopausal woman
Authors: Mun Seong Taek , Jang Si-Hyong , Ryu Aeli
Published: October 2018

Rationale:

Ovarian cancer has the poorest prognosis of the gynecological cancers. Early diagnosis and treatment are important, but early-stage ovarian carcinoma has nonspecific symptoms. Ultrasonography, computed tomography, magnetic resonance imaging, and serum CA-125 levels can be helpful but may not elucidate cases of diffuse peritoneal diseases mimicking carcinomatosis.

Patient concerns:

The patient had intermittent abdominal discomfort and dysuria. Abdominal-pelvic computed tomography findings were suspicious for peritoneal tuberculosis (TB) and a small cystic mass in the left ovary. The CA-125 values were normal.

Diagnoses:

She underwent laparoscopy for pathologic confirmation of tuberculous peritonitis and management of the ovary mass. Bilateral adnexectomy was performed. Histopathological examination of the surgical specimen revealed a serous ovarian carcinoma in her left ovary and salpinx.

Interventions:

Laparoscopic hysterectomy, pelvic lymphadenectomy, para-aortic nodal dissection, and omentectomy were carried out for staging evaluation.

Outcomes:

We encountered a rare case of ovary cancer stage IA serous ovarian carcinoma incidentally discovered by laparoscopy in a postmenopausal woman. She received adjuvant chemotherapy without relapse.

Lessons:

Peritoneal TB may mimic peritoneal or ovarian carcinoma, but the reverse case is rare. Hence, gynecologists should be careful in assessment of patients before treatment.
Admissions to intensive cardiac care units in France in 2014
Authors: Mercier Grégoire , Duflos Claire , Riondel Adeline , Delmas Clément , Manzo-Silberman Stéphane , Leurent Guillaume , Elbaz Meyer , Bonnefoy-Cudraz Eric , Henry Patrick , Roubille François
Published: October 2018

Geographic variation in admission to the intensive cardiac care unit (ICCU) might question about the efficiency and the equity of the healthcare system. The aim was to explain geographic variation in the rate of admission to ICCU for coronary artery disease (CAD) or heart failure (HF) in France.

We conducted a retrospective study based on the French national hospital discharge database. All inpatient stays for CAD or HF with an admission to an ICCU in 2014 were included. We estimated population-based age and sex-standardized ICCU admission rates at the department level. We separately modeled the department-level admission rates for HF and CAD using generalized linear models.

In all, 61,010 stays for CAD and 27,828 stays for HF had at least 1 ICCU admission. The ICCU admission rates were explained by the admission rate for CAD, by the diabetes prevalence, by the proportion of the population >75 years, and by the drive time to the ICCU.

This work sheds light on the finding of substantial geographic variation in the ICCU admission rates for CAD and HF in France. This variation is explained by both the age and the health status of the population and also by the drive time to the closest ICCU for HF. Moreover, ICCU admission for HF might be more prone to unwarranted variations due to medical practice patterns.
Significance of contrast-enhanced ultrasonography in differential diagnosis of thyroid nodules
Authors: Tian Qing , Zhu Haohui , Li Hui
Published: October 2018

The present study was aimed to compare the application values between 2-dimensional color Doppler ultrasonography (2DUS) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of thyroid malignant nodules.

A total of 124 patients suspectedly diagnosed with malignant thyroid nodules under conventional gray-scale ultrasonography were recruited in this study. All enrolled patients were examined by both 2DUS and CEUS.

A total of 153 nodules (94.44%) and 45 cases (90.00%) with malignant nodules were detected by the CEUS. No significant differences were noted in nodule detection rates between 2DUS and CEUS (χ2 = 1.170, P = .279; χ2 = 0.796, P = .372). The aspect ratio, microcalcification, internal echo, borderline, Vmax, resistance index, and total scores of malignant nodules were higher than those of benign nodules (all P < .05) when diagnosed by 2DUS. The peripheral/internal enhancement time, peak intensity, local enhancement, ring enhancement, and total scores of malignant nodules were significantly higher compared with those of benign nodules (all P < .05) by CEUS. Total score of malignant nodules diagnosed by 2DUS was approximately 3.5 and 2.3 points for CEUS. The diagnostic accuracy of 2DUS as observed by area under the curve was 0.821 with the cut-off value of 3.9, the sensitivity was 82.5%, and the specificity was 85.6%. The diagnostic accuracy of CEUS was 0.862 with the cut-off value of 2.8, the sensitivity was 86.7%, and the specificity was 91.3%.

Both 2DUS and CEUS are worthy of application values in the differential diagnosis from benign to malignant thyroid nodules.
The risk factors for bone metastases in patients with colorectal cancer
Authors: Li An-An , Cao Zhi-Yuan , Liu Jia-Ming , Huang Shan-Hu , Liu Zhi-Li
Published: October 2018

This retrospective analysis aim to evaluate the potential risk factors for bone metastases (BM) in patients who were diagnosed with colorectal cancer (CRC).

A total of 2790 patients diagnosed with CRC between January 2006 and December 2016 were collected in this study. All patients were divided into 2 groups, BM and no BM. The associations between biomarkers (including age, gender, histopathological types, alkaline phosphatase (ALP), carcinoembryonic antigen (CEA), cancer antigen 125, and so on), and BM in patients with CRC were analyzed. All the analyses were conducted by SPSS software (version 22.0, SPSS, Chicago, IL).

Of all patients, 74 (2.7%) were identified with BM. The level of serum ALP, CEA, and cancer antigen 125 in patients with BM were obviously higher than those without BM (P < .001, P = .005, and P < .001). And the cut-off values of ALP, CEA, and cancer antigen 125 were 85.5 U/L, 6.9 mmol/L, and 16.8 mmol/L, respectively.

ALP, CEA, and cancer antigen 125 were identified as the independent risk factors for BM in patients with CRC.