bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Toxicity After Initiating Immune Checkpoint Inhibitor Treatment in Patients With Rheumatoid Arthritis
Authors: Efuni Elizaveta , Cytryn Samuel , Boland Patrick , Niewold Timothy B. , Pavlick Anna , Weber Jeffrey , Sandigursky Sabina 
Published: January 2020

Introduction
Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancer. Rheumatoid arthritis (RA) is associated with an increased risk of malignancies; however, patients with RA have been excluded from ICI trials. In this study, we evaluated risk of toxicity after initiation of ICI treatment in RA patients.

Methods
We conducted a single-institution, medical records review analysis to assess the incidence of immune-related adverse events (irAEs) and autoimmune disease (AID) flares among patients with AIDs treated with ICIs from 2011 to 2018. A subgroup analysis for RA patients was performed with frequencies of irAEs and AID flares reported.

Results
Twenty-two patients with RA who were treated with ICI for malignancy were identified. At the time of ICI initiation, 86% had inactive RA disease activity. Immune-related adverse events occurred in 7 (32%) of patients, with 2 (9%) developing grade 3 (i.e., severe) irAEs. Immune checkpoint inhibitors were temporarily discontinued because of irAEs in 5 patients (23%), and permanently in 1 patient. Rheumatoid arthritis flares occurred in 12 patients (55%). Of those, 10 (83%) received oral corticosteroids with an adequate treatment response.

Conclusions
Our analysis suggests that irAEs following ICI treatment are not increased among RA patients compared with other cancer patients. Heightened RA disease activity during ICI treatment is common, but most adverse events are manageable with oral corticosteroids, and few require permanent ICI discontinuation. A close collaboration between the oncologist and rheumatologist is advisable when considering ICIs in patients with RA.
Safety Analysis of Iobitridol as a Nonionic Contrast Medium
Authors: Gorodetski Boris , Heine Oliver , Wolf Michael , Collettini Federico , Hamm Bernd , Darmon-Kern Elisabeth , Penzkofer Tobias 
Published: January 2020

Objectives
Our study sought to reevaluate the safety and diagnostic efficacy of iobitridol as a nonionic contrast medium after almost 20 years of use.

Materials and methods
This noninterventional postmarketing surveillance noncontrolled, multicenter (168 centers in Germany) study enrolled 94,960 patients receiving intravenous or intra-arterial iobitridol. The majority of the adjusted population (n = 92,550, 98.2%) underwent either computed tomography examination (n = 46,502, 49.3%) or intravenous urography (n = 46,048, 48.8%). A standardized questionnaire was used to ascertain patient's information, known risk factors, renal function status, premedication, type of examination, injection of contrast agent, imaging quality, diagnostic value, and safety.

Results
A total of 469 patients (0.49%) experienced an adverse event (AE), and 24 patients (0.025%) reported a serious AE (SAE). All patients recovered and no fatal event occurred. The prevalence of AE was significantly higher in patients with at least one risk factor, with premedication, with a history of AE, in female and patients younger than 60 years old (P < 0.05). Presence of at least one risk factor is the only predictive factor for the prevalence of SAE (P = 0.042). In patients with a history of AE, premedication did not significantly lower the AE rate (P = 0.737). No statistically significant difference in the prevalence of AE between the different combination of cortisone and/or antihistamines as pretreatment was found.

Conclusions
Iobitridol is a safe contrast medium with a high tolerability and efficacy. Presence of risk factors such as cardiovascular diseases, allergies, or asthma was the only significant predictive factor for an AE and an SAE. Premedication did not significantly lower the occurrence of an AE and an SAE.
Role of 68Ga–Prostate-Specific Membrane Antigen PET/CT in Disease Assessment in Glioblastoma Within 48 Hours of Surgery
Authors: Gupta Manoj , Choudhury Partha Sarathi , Premsagar Ishwar Chandra , Gairola Munish , Ahlawat Parveen 
Published: January 2020

Abstract
Within 48 hours after surgery, disease assessment in glioblastoma is a challenge for both the clinician and the radiologist. Certain technical and logistical issues prevail in this period. 68Ga–prostate-specific membrane antigen PET/CT is a known molecular imaging marker in prostate cancer. Its role in high-grade gliomas has been recently discussed. We present a case of a 39-year-old man with recurrence glioblastoma of the right frontal lobe and underwent resurgery. After surgery, 68Ga–prostate-specific membrane antigen PET/CT showed residual disease along the posterior and inferior margin of the postoperative cavity.
The Hot Pleura
Authors: Qureshi Pir Abdul Ahad Aziz , Asghar Namra , Bashir Humayun , Niazi Imran Khalid , Akhtar Noreen 
Published: January 2020

Abstract
Renal cell carcinoma (RCC) is the most common solid renal malignancy that metastasizes typically to lungs, bones, liver, adrenals, and lymph nodes. Isolated pleural metastases of RCC are extremely rare, with only few cases reported in the literature. We report one such case of a 60-year-old woman, a known case of RCC of the left kidney who underwent nephrectomy, and on follow-up, PET/CT scan revealed diffuse thick nodular hypermetabolic left pleural thickening, which was later biopsied and turned out to be pleural metastases from RCC. No other site of metastases was found.
Primary Hepatocellular Carcinoma With Intense 68Ga-PSMA Uptake But Slight 18F-FDG Uptake on PET/CT Imaging
Authors: Erhamamci Seval , Aslan Nesrin 
Published: January 2020

Abstract

68Ga-PSMA PET/CT imaging is an emerging imaging modality in prostate cancer. PSMA expression is also reported for nonprostate malignancies, including primary hepatocellular carcinoma. Herein, we present a case of a 74-year-ald man with recently diagnosed hepatocellular carcinoma who was referred for 18F-FDG PET/CT imaging for initial staging. The patient underwent 18F-FDG PET/CT as part of staging procedure; he also underwent 68Ga-PSMA PET/CT. PET/CT images revealed only slight 18F-FDG uptake in the liver lesion, but intense 68Ga-PSMA uptake, without any metastatic lesion seen elsewhere in the body.
Rare Esophageal Leptomeningeal Metastases Detected on 18F-FDG PET/CT
Authors: Lu Yang , Wang Linghua , Ajani Jaffer A. 
Published: January 2020

Abstract
A 62-year-old man with a history of locally advanced poorly differentiated adenocarcinoma of the gastroesophageal junction had received induction chemotherapy and concurrent chemoradiation. A 6-month follow-up FDG PET/CT revealed nearly resolved primary malignancy, but new hypermetabolic mediastinal lymph node metastasis and abnormal hypermetabolism in the cerebellum region. Brain MRI and lumbar puncture confirmed leptomeningeal metastasis.
Clinically Applied Anatomy
Authors: Sinha Sumedha R. , Entezampour Mo , Davis Kendrick , Vyas Raj M. 
Published: January 2020

Purpose
Today, medical education emphasizes clinical applications of anatomic knowledge. In 2014, we instituted Clinically Applied Anatomy (CAA) within first-year Human Gross Anatomy at our university. The course was designed and overseen by academic plastic surgery. We hypothesized CAA would positively impact students' understanding, performance, and interest in human anatomy.

Methods
From 2014 to 2018, 13 CAA case-based didactics were integrated into the anatomy curriculum without changing the total anatomy-related student hours; each emphasized the clinical relevance of overlooked (or memorized) anatomic detail. Clinically Applied Anatomy instructors led associated clinical cadaver dissections. Upon course completion, students from each participating class were anonymously surveyed.

Results
One hundred sixty-four students completed the survey (75% response). Eighty-six percent reported CAA increased mastery of human anatomy, 77% stated CAA improved examination performance, 87% agreed CAA increased interest in anatomy itself, and 96% reported CAA increased their critical thinking of how understanding anatomy affects clinical care. Nearly half (49.4%) responded that CAA increased interest in applying for a procedurally oriented residency. When considering future integration of CAA into the medical school curriculum, 9% of students wanted less CAA, 61% wanted the same, and 30% wanted more.

Conclusions
Clinically Applied Anatomy significantly impacts medical students' anatomy education. Currently, 17 CAA faculty from 7 departments/divisions participate in all 26 of our school's anatomy sessions. As per our institution, we advocate this cost-effective and impactful initiative be led by academic plastic surgeons. These clinicians possess broad and specialized anatomic expertise as well as the leadership and interdisciplinary working relationships needed to enroll a multidisciplinary team of clinical educators.
Evaluation and Factors of Quality of Life Among Patients With Neurofibromatosis Type 1–Associated Craniofacial Plexiform Neurofibromas
Authors: Ren Jie-Yi , Gu Yi-Hui , Wei Cheng-Jiang , Huang Xin , Xu Xiang-Wen , Gu Bin , Zan Tao , Wang Zhi-Chao , Li Qing-Feng 
Published: January 2020

Objectives:The aim was to evaluate overall quality of life (QOL) and investigate impact factors in Chinese neurofibromatosis type 1 (NF1) patients, particularly in those with craniofacial plexiform neurofibromas (pNFs).Methods:The Impact of NF1 on quality of life (INF1-QOL) Questionnaire were completed from a department of plastic and reconstructive surgery by 27 patients. Patients were 3 to 49 years of age. The correlation between subdomains were calculated using Pearson correlation. The difference between groups were evaluated using Fisher exactt-test.Pvalue <0.05 were considered significant.Results:In age group of craniofacial pNFs, significant difference presented in cosmetic appearance, role and outlook on life and general QOL. Higher impact on general QOL in adults (6/8) than children (1/7) pointed to more impaired QOL in adults, as well as 2 subdomains including appearance, role and outlook on life. The patients who have more than 50 cutaneous neurofibromas (cNFs) (6/7) presented a significantly greater negative impact on the role and outlook of life. No statistically significant difference of QOL were detected between craniofacial and non-craniofacial pNFs patients.Conclusions:Age and cNFs were 2 main factors that have a negative impact on QOL in craniofacial pNFs patients. Adults reported lower QOL in cosmetic appearance, the role and outlook of life and general QOL. Patients with more than 50 cNFs reported more negative impact on the role and outlook of life. A multidiscipline management for these patients is required, including psychosocial intervention.
Postoperative Complications of Box-Shift Osteotomy for Orbital Hypertelorism
Authors: Jiang Taoran , Yu Zheyuan , Chi Tzu-Yang , Kang Bo Kyoung , Gao Jiaman , Wei Min , Yuan Jie , Xu Liang , Duan Huichuan , Mu Xiongzheng , Cao Dejun 
Published: January 2020

Objective:
To summarize and analyze the postoperative complications of box-shift osteotomy performed at our center for Chinese orbital hypertelorism patients from 2008 to 2017.

Method:
This retrospective study reviews the records of 78 patients with complete medical records and at least 2 years of postoperative follow-up data. Both radiologic and anthropometric assessments were conducted before, 1 month after and 2 years after surgery to evaluate the bony and soft-tissue alterations. Postoperative complications were recorded during hospitalization and at each follow-up visit and divided into 3 groups: acute complications that occurred within 1 month after surgery; early complications that occurred within 6 months after surgery; and long-term complications that occurred within 2 years after surgery.

Results:
Both bony and soft-tissue alterations were significant at 1 month after surgery. The acute complications that occurred in our center included infection (12.8%), cerebrospinal fluid leakage (29.5%), epilepsy (2.6%), and nasal tip skin necrosis (1.3%). The early complications included strabismus (11.5%) and nasolacrimal duct obstruction (3.8%). The long-term complications included insufficient correction (55.1%), palpable metal implants (92.3%) and a drooping nasal tip (33.9%). Due to the insufficient correction and the continued growth of rib graft, the difference in the hypertelorism index and nasal length, between one month and 2 years postoperatively were statistically significant (P < 0.01). Other radiographic and anthropometric measurements changed with growth without a significance difference between 1 month and 2 years after surgery.

Conclusion:
In this study, we recorded all postoperative complications of box-shift osteotomy. The challenge of our future work is to identify methods for decreasing the incidence of these complications.
A Rare Instance of Primary Oncocytic Schneiderian Papilloma of Middle Ear and Eustachian Tube With a Combined Trans Oto and Nasal Approach Resection
Authors: Fu Ze-Ming , Zhao Li-Ping , Guo Ying-Yuan , Guan Guo-Fang 
Published: January 2020

Abstract
Oncocytic Schneiderian papillomas are rare tumours which usually arise in the sinonasal region. This paper presents, to the authors’ knowledge, the first reported case of oncocytic Schneiderian papilloma arising primarily from the middle ear and eustachian tube. The resection of the tumor was performed with an endoscopic approach of combined trans oto and nasal. Oncocytic Schneiderian papilloma in the middle ear and eustachian tube is extremely rare as a primary lesion and challenging to manage. Very few documents have provided guide of resection using the endoscopic approach when this tumor extends to involve the eustachian tube. Our study illustrates that the endoscopic approach of combined trans oto and nasal is a good choice for tumor resection of middle ear and eustachian tube.
Method of Reducing Thoracic Deformity in Auricular Reconstruction
Authors: Dong Weiwei , Song Yupeng , Jiang Haiyue , He Leren , Pan Bo , Yang Qinghua 
Published: January 2020

Abstract
Autologous costal cartilage graft is an important material in orthopedic surgery. However, postoperative deformity of costal cartilage in donors is also a matter of concern. In our clinical experience, the preservation of the intercostal perichondrium, the replantation of part of the costal cartilage, and wearing an elastic chest strap for half a year are all ways to avoid thoracic deformity. Methods by which to avoid thoracic deformity is still the focus of our efforts.
Review of Preferential Suspicious Genes in Microtia Patients Through Various Approaches
Authors: Lu Meng , Lu Xiaosheng , Jiang Haiyue , Pan Bo 
Published: January 2020

Abstract
Recently, an increasing trend of the birth prevalence of anotia/microtia is observed in China, contributed by changes of social environment and lifestyle. There seems to be no major breakthroughs in exact pathogenesis of microtia, though the research results related to molecular genetics unceasingly appear. In this review, the authors focus on the results of various research methods which the authors regard as the preferential suspicious gene pool to facilitate the exploration of the pathogenic genes of microtia, knowing that the mechanism of microtia is very complicated. The advantages and limitations of these various approaches will also be systematically delineated. The authors believe that this review will give a deep insight in the genetic research of microtia and help plastic surgeons manage congenital microtia more effectively.
Inverse Correlation Between Incidence and Mortality of Acute Kidney Injury in Critically Ill Patients: A Systematic Review
Authors: Komaru Yohei , Inokuchi Ryota , Iwagami Masao , Hamasaki Yoshifumi , Nangaku Masaomi , Doi Kent 
Published: January 2020

ABSTRACT

Background:
The reported incidence and mortality of acute kidney injury (AKI) in patients in intensive care units (ICUs) is remarkably different even with standardized AKI criteria. The aim of this study was to investigate the correlation between the incidence and mortality of patients with AKI in ICUs.

Methods:
We systematically reviewed clinical studies regarding adult ICU patients with AKI using Kidney Disease: Improving Global Outcomes-equivalent criteria from 2004 to May 1, 2018. We searched MEDLINE, EMBASE, and Cochrane Library to investigate the correlation between the incidence and mortality of patients with AKI in each cohort. Studies with small number of participants (less than 500) were excluded. The correlation between the incidence of AKI and mortality of patients was evaluated using a regression model.

Results:
Our review yielded 76 cohorts, comprising 564,455 patients in ICU (median age, 60.5 years; men, 59.5%). The mortality of all patients did not correlate with the incidence of AKI in each cohort; however, the mortality of patients with AKI significantly decreased [squared correlation coefficient (R2) = 0.18, regression coefficient (β) = −0.25, P < 0.001] as the incidence of AKI increased. This correlation was also observed in a subgroup analysis limited to the clinical setting of general ICUs, and among patients with mild or severe AKI.

Conclusions:
An inverse correlation between the incidence of AKI and the mortality of patients with AKI may indicate an advantage of frequent AKI occurrence, possibly because of increased awareness and larger exposure to AKIs; further study is needed, however, to confirm the causality.

Trial registration:
The protocol was registered in PROSPERO database (CRD 42019129322).
Hybrid Laparoendoscopic-Radiologic Procedure for Laparoscopic Cholecystectomy Complicated With Choledocolithiasis
Authors: Tian Daguang , Zhu Hong , Wei Xiaoping 
Published: January 2020

Purpose:
The removal of common bile duct stones (CBDS) is routinely performed as either a 1-stage or 2-stage procedure. Despite many developments in both methods, the optimal approach has not been established to date. This study aimed to investigate the value and short-term outcomes of hybrid laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) combined with intraoperative endoscopic nasobiliary drainage (IO-ENBD) after primary duct closure (PDC) and intraoperative cholangiography (IOC) in patients with concomitant gallbladder stones (GBS) and CBDS.

Materials and Methods:
Forty-seven patients with GBS and CBDS who underwent LC and LCBDE, PDC with IO-ENBD, and IOC were retrospectively enrolled. Stone characteristics and removal, operative data, and postoperative outcomes were recorded and analyzed.

Results:
A total of 46 (97.87%) procedures were completed without conversion to open surgery. The mean operating time was 127.15±8.36 minutes (range, 97 to 158 min). Three patients (6.38%) had residual stones during IOC but achieved 100% stone clearance eventually. Postoperative pancreatitis and bile leakage rates were 4.26% and 2.13%, respectively.

Conclusion:
A hybrid procedure combining LC and LCBDE, PDC with IO-ENBD, and IOC is safe and feasible for concomitant GBS and CBDS.
Pediatric extremity vascular trauma: It matters where it is treated
Authors: Prieto James M. , Van Gent Jan Michael , Calvo Richard Y. , Checchi Kyle D. , Wessels Lyndsey E. , Sise Michael J. , Sise C. Beth , Bansal Vishal , Martin Matthew J. , Ignacio Romeo C. 
Published: January 2020

BACKGROUND
Extremity vascular injuries in children are rare events that present unique therapeutic challenges. The absence of a pediatric-specific protocol for definitive care of these injuries risks variability in treatment practices and outcomes. Using a nationwide data set, we investigated variations in the management and outcomes of pediatric patients with peripheral vascular trauma and characterized differences based on hospital category.

METHODS
Retrospective cohort study using the American College of Surgeons (ACS) National Trauma Data Bank to identify patients 16 years or younger with extremity vascular trauma admitted in calendar year 2016. Hospitals were categorized as ACS-verified pediatric trauma centers (Level I or II), ACS-verified adult trauma centers (Level I or II), or other hospitals (all other trauma centers and nondesignated hospitals). Patient data were evaluated by hospital category.

RESULTS
Among 164,882 pediatric admissions, 702 patients were identified for analysis. There were 430 (61.3%) patients with upper-extremity injuries, 270 (38.5%) with lower-extremity injuries, and 2 (0.2%) had both. Mean age was 11.5 years, and 51.6% were blunt-injured. Overall, 40.2% were admitted to pediatric trauma centers, 28.9% to adult trauma centers, and 30.9% to other hospitals. Hospitals without ACS trauma center verification had a significantly higher amputation rate than any ACS-verified adult or pediatric center (p = 0.013).

CONCLUSION
The incidence of pediatric extremity vascular injury is low. Hospitals with ACS trauma center verification have greater pediatric limb salvage rates than those without verification. Future study should seek to identify specific regional or resource-related factors that contribute to this disparity.

LEVEL OF EVIDENCE
Epidemiological, level III.
An analysis of overtriage and undertriage by advanced life support transport in a mature trauma system
Authors: Yoder Austin , Bradburn Eric H. , Morgan Madison E. , Vernon Tawnya M. , Bresz Kellie E. , Gross Brian W. , Cook Alan D. , Rogers Frederick B. 
Published: January 2020

BACKGROUND
While issues regarding triage of severely injured trauma patients are well publicized, little information exists concerning the difference between triage rates for patients transported by advanced life support (ALS) and basic life support (BLS). We sought to analyze statewide trends in undertriage (UT) and overtriage (OT) to address this question, hypothesizing that there would be a difference between the UT and OT rates for ALS compared with BLS over a 13-year period.

METHODS
All patients submitted to Pennsylvania Trauma Outcomes Study database from 2003 to 2015 were analyzed. Undertriage was defined as not calling a trauma alert for patients with an Injury Severity Score (ISS) of 16 or greater. Overtriage was defined as calling a trauma alert for patients with an ISS of 9 or less. A logistic regression was used to assess mortality between triage groups in ALS and BLS. A multinomial logistic regression assessed the adjusted impact of ALS versus BLS transport on UT and OT versus normal triage while controlling for age, sex, Glasgow Coma Scale, systolic blood pressure (SBP), pulse, Shock Index and injury year.

RESULTS
A total of 462,830 patients met inclusion criteria, of which 115,825 had an ISS of 16 or greater and 257,855 had an ISS of 9 or less. Both ALS and BLS had significantly increased mortality when patients were undertriaged compared with the reference group. Multivariate analysis in the form of a multinomial logistic regression revealed that patients transported by ALS had a decreased adjusted rate of undertriage (relative risk ratio, 0.92; 95% confidence interval, 0.87–0.97; p = 0.003) and an increased adjusted rate of OT (relative risk ratio, 1.59; 95% confidence interval, 1.54–1.64; p < 0.001) compared with patients transported by BLS.

CONCLUSION
Compared with their BLS counterparts, while UT is significantly lower, OT is substantially higher in ALS—further increasing the high levels of resource (over)utilization in trauma patients. Undertriage in both ALS and BLS are associated with increased mortality rates. Additional education, especially in the BLS provider, on identifying the major trauma victim may be warranted based on the results of this study.

LEVEL OF EVIDENCE
Epidemiological, Level III.