bluuebunny/crossref_metadata_2025_split huggingface dataset:
A case report of fulminant cytokine release syndrome complicated by dermatomyositis after the combination therapy with immune checkpoint inhibitors
Authors: Ohira Junichiro , Kawamoto Michi , Sugino Yoshio , Kohara Nobuo 
Published: April 2020

Abstract

Introduction:
Immune-related adverse events (ir-AEs) are increasingly becoming a concern, as immune checkpoint inhibitors (ICIs) are used more frequently. Herein, we present a case of fulminant cytokine release syndrome (CRS) complicated by dermatomyositis after the combination therapy with ICIs.

Patient concerns:
A 70-year-old male developed dermatomyositis during the course of treatment with two ICIs, nivolumab and ipilimumab. He was treated by steroid pulse therapy, but the effect was limited. Afterwards, he had acute-onset high fever, hypotension, respiratory failure, impaired consciousness, renal failure, and coagulation abnormality at the same time. C reactive protein (CRP), creatinine kinase (CK), D-dimer, and ferritin levels were considerably elevated: CRP, 24 mg/dL; CK, 40,500 U/L; D-dimer, 290 μg/mL; ferritin, 329,000 ng/mL.

Diagnosis:
CRS induced by ICI combination therapy.

Interventions:
Given that high fever and elevated CRP level indicated potential sepsis, an antibiotic was used until the confirmation of negative blood cultures. All the simultaneous acute symptoms were supposed to be CRS. He was admitted to the intensive care unit (ICU), and temporary intubation and hemodialysis were needed. Immunosuppressive therapy was reinforced by mycophenolate mofetil together with steroid, and plasma exchange was performed for the elimination of abnormal proteins.

Outcomes:
The patient's clinical symptoms and laboratory parameters gradually improved and he was discharged from the ICU in a month.

Conclusion:
Fulminant CRS can be induced by ICI combination therapy. As the initial symptoms of CRS resemble sepsis, it is important to consider CRS as a differential diagnosis and to initiate immunosuppressive therapy early when needed. In steroid-resistant cases, early introduction of other immunosuppressive therapy and plasma exchange can be effective.
Verruca plana on a tattoo
Authors: Chen Yan Jing , Nabi Owais , Diao Ping , Wan Ruo Yu , LI Li 
Published: April 2020

Abstract

Rationale:
Tattooing is a procedure where ink is inserted typically in the intraepidermal space of the skin. Multiple incidences of viral infections following tattooing which lead to warts have been reported in recent years. The aim of this report was to show a relatively rare adverse effect after tattooing – verruca plana.

Patient concerns:
A 27-year-old female presented to our department with complains of multiple verrucous papules over her 2-year-old tattoo without itch.

Diagnoses:
Pathological investigation confirmed the diagnosis as verruca plana.

Interventions:
The patient was treated with 3 cycles of liquid nitrogen cryotherapy and 5% imiquimod cream for 5 months.

Outcomes:
A significant improvement in her lesions was observed after the combined treatment.

Lessons:
Clinically, verruca plana post-tattooing is relatively less reported. We need to combine clinical manifestations with pathological results to arrive at a definitive diagnosis. Besides, there are a large numbers of post-tattoo complications and various routes of virus inoculation. Therefore, it is important for medical professionals to caution people before considering to have a tattoo.
A CARE-compliant article: a case report of possible association between recurrence of multiple evanescent white dot syndrome and the Herpesviridae family
Authors: Haw Yu-Lin , Yu Teng-Chieh , Yang Chang-Sue 
Published: April 2020

Abstract

Rationale:
Multiple evanescent white dot syndrome (MEWDS) is a self-limited multifocal chorioretinopathy that typically affects otherwise healthy young females in the second to fourth decades of life. Current understanding of the pathophysiology of MEWDS is still limited. One of the possible underlying causes is an infectious etiology.

Patient concerns:
A 24-year-old female with recurrent episodes of typical MEWDS ocular manifestation was observed over 2 years. Viral-specific antibody serologic tests showed evidence of exposure to the Herpesviridae family during the acute stage of MEWDS in the first and recurrent episodes.

Diagnoses:
MEWDS was diagnosed by the clinical findings and ancillary testing results of fundus photography, optical coherence tomography, fluorescein angiography, indocyanine green angiography and electroretinogram. The laboratory serology data was positive for varicella-zoster virus (VZV) immunoglobulin M (IgM) in the first episode and exhibited high Epstein–Barr virus (EBV) elevated immunoglobulin G (IgG) titer in the recurrent episode.

Interventions:
Due to the self-limited nature of MEWDS, we observed the clinical course without intervention.

Outcomes:
During acute onset of MEWDS, serologic data for VZV IgM antibody was positive in the first episode. Two years later, the patient had recurrent episodes of MEWDS in the contralateral eye. Serologic study showed highly elevated IgG titer (1:160) of Epstein-Barr virus capsid antigen (EB-VCA) in the acute stage. The follow-up paired serum virus serology test showed that the prior EB-VCA IgG titer decreased fourfold to 1:40 in the recovery stage.

Lessons:
Recurrence of MEWDS may be associated with acute systemic infection of the Herpesviridae family or virus-induced autoimmune inflammatory reaction.
Transesophageal and intracardiac ultrasound in arrhythmogenic right ventricular dysplasia/cardiomyopathy
Authors: Cismaru Gabriel , Grosu Alin , Istratoaie Sabina , Mada Laura , Ilea Maria , Gusetu Gabriel , Zdrenghea Dumitru , Pop Dana , Rosu Radu 
Published: April 2020

Abstract

Rationale:
Two-dimensional echocardiography (2D echo) is a major tool for the diagnosis of Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However 2D echo can skip regional localized anomalies of the right ventricular wall. We aimed to determine whether transesophageal and intracardiac ultrasound can provide additional information, on the right ventricular abnormalities compared to 2D echo.

Patient concerns:
Case 1 is a 30-year-old patient that presented in the Emergency Department with multiple episodes of fast monomorphic ventricular tachycardia (VT) manifested by palpitations and diziness. Case 2 is a 65-year-old patient that also presented with episodes of ventircular tachycardia associated with low blood pressure.

Diagnosis:
Both patients had a clear diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy confirmed by cardiac magnetic resonance imaging.

Intervention:
In both patients transesophageal and intracardiac ultrasound was performed, which brought more information on the diagnosis of ARVD/C compared to transthoracic echocardiograpy.

Outcomes:
The first patient was implanted with an internal cardiac defibrillator and treated with Sotalol for VT recurrences. He presented episodes of VT during follow-up, treated with antitachycardia pacing. The second patient was implanted with an internal cardiac defibrillator and treated with Sotalol without any VT recurrence at 18 month-follow-up.

Lessons:
Transesophageal echocardiography and intracardiac echocardiography can provide additional information on small, focal structural abnormalities in patients with ARVD/C: bulges, saculations, aneurysms with or without associated thrombus, partial or complete loss of trabeculations and hypertrophy of the moderator band. These changes are particularly important in cases with “concealed” form of the disease in which no morphological abnormalities are evident in transthoracic echocardiograpy.
Impact of emergency department management of atrial fibrillation with amiodarone on length of stay. A propensity score analysis based on the URGFAICS registry
Authors: Cabello Irene , Jacob Javier , Arranz María , Yuguero Oriol , Guzman Jorge , Moreno-Pena Anna , Frances Paloma , Santos Julia , Esquerrà Anna , Mòdol Josep-María 
Published: April 2020

Objective
Amiodarone is a widely used drug in the emergency department (ED) for control of atrial fibrillation, but it has a delayed onset of action and slow metabolism, leading to longer length of ED stay. The aim of this study was to compare the length of ED stay of atrial fibrillation patients who were treated with or without amiodarone.

Methods
We undertook a multicenter, observational, cohort study of the URGFAICS registry of older adults with atrial fibrillation who presented to five Spanish EDs and compared patients who had received amiodarone with those who had not. Afterward, we performed a propensity score matched analysis of atrial fibrillation to determine the ED length of stay related to amiodarone.

Results
Of the 1199 patients included in the registry, 225 patients (18.8%) were treated with amiodarone while 974 (81.2%) were not. We performed a univariate study depending on amiodarone administration followed by propensity score calculation according to the 14 statistically different features found previously and six significant variables, obtaining 150 patients (75 for each group) suitable for the analysis. The length of ED stay was analyzed using box plot, with a P <0.001 in the crude analysis and P = 0.012 after propensity score matching and using survival curves for the analysis of prolonged ED stay, with a log rank <0.001 in the crude analysis and log rank 0.021 after the propensity score-matched analysis.

Conclusion
Amiodarone is associated with longer length of ED stay until discharge independently of the baseline characteristics of the patients.
Risk Factors for Pancreatic Cancer and the Necessity of Long-Term Surveillance in Patients With Pancreatic Cystic Lesions
Authors: Yoshioka Teppei , Shigekawa Minoru , Ikezawa Kenji , Tamura Takeshi , Sato Katsuhiko , Urabe Makiko , Sueyoshi Hironari , Yamai Takuo , Suda Takahiro , Sakamori Ryotaro , Tatsumi Tomohide , Takehara Tetsuo 
Published: April 2020

Objectives
Pancreatic cystic lesions (PCLs) are a risk factor for pancreatic cancer (PC). Which PCLs should be surveilled and necessity of long-term observation are still controversial.

Methods
From January 2000 to March 2016, we enrolled 1137 patients with PCLs observed for 1 year. We defined PCLs with cyst size of greater than 30 mm, main pancreatic duct (MPD) of greater than 5 mm or mural nodule as high-risk group, and others as low-risk group (LRG). Kaplan-Meier method and Cox proportional hazard model were applied to assess incidence and risk factors of PC.

Results
In 107 high-risk group and 1030 LRG patients, mean observation period was 4.3 years and 5.0 years, respectively, and 5-year PC incidence was 12.0% and 2.8%, respectively. In LRG, MPD of greater than 3 mm, diabetes mellitus, and presumed branch-duct intraductal papillary mucinous neoplasia (BD-IPMN), defined as PCLs fulfilling any of multilocular formation, multiplicity, or MPD communication, were independent risk factors for PC. In 450 LRG observed for 5 years, 10-year PC incidence was higher in PCLs with our identified risk factors. There was no PC occurrence in PCLs not presumed BD-IPMN after 5-year observation.

Conclusions
Continuous surveillance is needed after 5-year observation, especially in LRG with our identified risk factors. For discontinuing surveillance, PCLs not presumed BD-IPMN at fifth year could be candidates.
Acute Pancreatitis in Patients With a Medical History of Type 2 Diabetes Mellitus
Authors: Xiao Bo , Xu Hai-bo , Jiang Zhi-qiong , Hu Jin-xiang , Yang Guo-dong 
Published: April 2020

Objective
To determine the characteristics of type 2 diabetes mellitus (T2DM)–related acute pancreatitis (AP) on magnetic resonance imaging (MRI).

Methods
Retrospectively studied 262 patients with AP were admitted to our institution and underwent MRI. Diagnosis of T2DM-related AP was based on clinical manifestations, laboratory tests, and MRI. Pancreatic/peripancreatic changes were assessed on MRI.

Results
Fifty-three (20.2%) patients with T2DM-related AP and 209 (79.8%) with nondiabetic AP were enrolled. On MRI, a higher prevalence of necrotizing pancreatitis (P < 0.001), pancreatic necrosis >30% (57.5% vs 29.2%; P = 0.006), hemorrhage (35.8% vs 19.1%; P = 0.009), abdominal wall edema (67.9% vs 46.8%; P = 0.006), walled-off necrosis (43.2% vs 14.6%; P < 0.001), and infected collections (P < 0.001) were registered in T2DM with AP. T2DM-related AP sustained greater magnetic resonance severity index (mean, 5.1 [range, 2–10] vs 3.4 [range, 1–10]; P < 0.001), higher incidence of moderate and severe pancreatitis (69.8% vs 40.2%; P < 0.001), higher organ failure (45.3% vs 22%; P = 0.001), and prolonged hospitalization (mean, 25.2 [range, 10–63] vs 16 [range, 5–48] days; P < 0.001).

Conclusions
Type 2 diabetes mellitus–related AP is more moderate-to-severe pancreatitis, and it correlates with MRI characteristics of the pancreas itself, hemorrhage, abdominal wall, and infected collections.
Creation of a “Patient” Hospital Escape Room Experience to Reduce Harm and Improve Quality of Care
Authors: San Martin Layla , Walsh Heather , Santerre Mary , Fortkiewicz Justine , Nicholson Laura 
Published: April 2020

Background:
Increases in nursing documentation requirements, adherence to regulatory standards, and workforce diversity add to the complexity of delivering safe patient care.

Purpose:
The aim was to reinforce elements of quality and safety in patient care delivery.

Approach:
In an effort to deliver necessary, though often dull, regulatory information to nursing staff, a team of nurse educators and nursing quality leaders used the concepts of a popular social game to develop an escape room.

Outcomes:
The escape room was conducted with nearly 100 learners with both a regulatory focus and a patient safety focus with success. Participants stated that teamwork, communication, and problem-solving were necessary to escape the room; nearly 60% indicated the escape room experience would contribute to changes in their nursing practice.

Conclusions:
The escape room template can be easily modified to target a myriad of learning objectives and learners of varying levels of experience.
Paucity of Clinical Practice Guidelines for the Rehabilitation of Burn Survivors
Authors: Gerber Lynn H. , Deshpande Rati , Prabhakar Shruthi , Cai Cindy , Garfinkel Steven , Pomeroy J. Mary Louise , Esselman Peter , Schneider Jeffrey 
Published: April 2020

Abstract
Clinical practice guidelines (CPGs) provide an efficient route from research to practice because they follow a prescribed, vetted process for evidence collection. CPGs offer underserved fields, such as burn rehabilitation, an accessible approach to reliable treatment. A literature search was performed using the terms “Burns AND CPGs AND Rehabilitation.” Three reviewers determined whether guideline development followed an established vetting process. “Rehabilitation” required evidence of treatment to improve, maintain, or restore human function and provide treatment to facilitate recovery. Only 160 articles were obtained and, after adding the term “functional outcome,” 62 remained for full-text review, of which 21 were eligible. When articles were scored for inclusion of both rehabilitation AND function or functional outcome AND guideline vetting, seven articles remained. One was community based. Nine articles had no recorded vetting process but addressed rehabilitation as an outcome. There is a paucity of CPGs relevant to clinical rehabilitation for burn survivors, likely a result of very few published intervention trials, rare randomized controlled trials addressing rehabilitation, absence of data to establish an evidence base for practice recommendations, an inadequate number of community-based intervention trials, and little patient input. It is likely that rehabilitation of burn survivors will improve if more people gain skills in meeting the needs of people with burn injury. An increase in trained professionals may lead to an increase in intervention trials and research to establish evidence for CPGs. People engaged in burn research have an opportunity to devise a systematic, generally agreed-upon approach toward evaluating burn patients and treatment outcomes that will permit data sharing across the world and assess patients throughout the acute and chronic phases of burn injury.
Incidental CT Findings Suspicious for COVID-19–Associated Pneumonia on Nuclear Medicine Examinations
Authors: Tulchinsky Mark , Fotos Joseph S. , Slonimsky Einat 
Published: April 2020

Abstract
Some patients undergoing routine SPECT/CT and PET/CT examinations during the COVID-19 pandemic may incidentally reveal findings of COVID-19–associated pneumonia (C-19AP) on localizing CT. It is critical for nuclear medicine physicians to develop diagnostic skills for timely recognition of typical findings of C-19AP on a localizing CT. Furthermore, it is our responsibility to know the optimal practices for safely isolating and managing such patients while protecting the staff, other patients at the facility, family and/or friend accompanying the patients, and the public in general from risky exposure to COVID-19 sources. We offer several steps following an encounter suspicious of C-19AP.
Open Reduction and Internal Fixation and Intraoperative Exploration of the Superior Retinacular Arterial System in Young Adults Garden III Femoral Neck Fracture: A 10 Case Report
Authors: Wang Zihua , Gu Luosha , Cheng Liangliang 
Published: April 2020

Abstract
At present, there is no uniform standard for the treatment of femoral neck fractures (FNFs) in young adults, and the current strategy is inclined to the native hip joint preservation. Femoral neck fractures in young adult are mostly caused by high-energy violence, and the blood supply of femoral head is severely damaged, which is prone to secondary femoral head avascular necrosis. In this article, we report 10 cases of young adult Garden III FNF treated with open reduction and internal fixation (ORIF) and microsurgical exploration of the superior retinacular vessels from 2015 to 2018, to more intuitively understand the involvement of superior retinacular vessels after displaced FNF in young adults. The results show that the SRA injury of Garden III FNF could be categorized into 3 types (type A–C), type A (6/10): the SRA vessels were kept intact, while they were pulled or compressed by displaced fracture fragment and could be revascularized by reduction; type B (3/10): the SRA vessels were avulsed with the superior retinaculum attachment avulsion fracture and could not be revascularized by reduction; and type C (1/10): the SRA vessels were ruptured, and the remnant of the vessel is present, which can be revascularized by vascular anastomosis. The previously mentioned results showed that the vascular damage of femoral head in Garden III FNF is quite complicated and might have the potential for being further classified into several subtypes.
Rotation Flaps in Series: Simple Innovation for Complex Scalp Defects
Authors: Sharma Ramesh K. , Sharma Raman 
Published: April 2020

Abstract
A 42-year-old man presented with 2 full thickness defects in left parieto-temporal and right temporo-occipital regions with normal intervening scalp tissue. These 2 adjacent but discontinuous defects were covered in one stage with an innovative rotation flap design that provided 1 flap each for these 2 defects. This innovative flap design permitted one stage reconstruction with primary closure of the donor sites.
Open Versus Closing Wedge Osteotomy and Application to Mandibular Reconstruction
Authors: Hu Shirley , Klimczak Jaclyn , Garner Weylon , Hart Hannah , Kadakia Sameep P. , Wood-Smith Donald , Abraham Manoj T. 
Published: April 2020

Purpose:
To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular reconstruction.

Methods:
A thorough review of the otolaryngology, facial plastic and reconstructive surgery, oral and maxillofacial surgery, and orthopedic surgery literature was conducted in the Ovid MEDLINE, EMBASE, and Google Scholar databases using the terms ‘osteotomy’ and ‘mandibular reconstruction.’

Results:
Traditionally, open osteotomies were thought to result in greater rates of malunion. However, multiple meta-analyses within the orthopedic literature have refuted this. Closing wedge osteotomies, on the other hand, may increase the chance of damaging a perforator. Again, no studies have evaluated the relationship between type of osteotomy and flap survival or wound healing. The particular type of osteotomy performed often depends on the type of osseous flap being utilized.

Conclusions:
Open osteotomies are a viable and even preferred alternative, particularly in flaps without consistent perforators, such as scapular free flaps.
Illustrations in the Journal of Craniofacial Surgery
Authors: Choi Sang Chul , Wu XiaJing , Hwang Kun , Kim Hun , Han Seung Ho 
Published: April 2020

Abstract
The aim of this study is to analyze the medical illustrations that appeared in the Journal of Craniofacial Surgery (JCFS) during the last 3 years (2016–2018).
All illustrations in 2676 articles from 24 issues were analyzed.
In total, 363 articles (13.6%) contained illustrations (for total of 589 illustrations), and 38 articles (1.4%) cited illustrations from other articles. The number of illustrations increased over time (152 in 2016, 181 in 2017, and 256 in 2018; P = 0.007). The signature of the illustrator appeared in 16.5% of the illustrations, and the illustrator's name was acknowledged in 7.6%. The most frequent contents of the 589 illustrations were surgical procedures (55.4%), followed by anatomy (34.1%). Among the 555 illustrations showing regions of the body, the most frequently illustrated region was the oral cavity (41.6%), followed by the eye and periorbital region (18.4%), the nose (12.4%), and the head (11.4%). Of the 555 illustrations showing tissue, the tissue most frequently depicted was bone (52.8%), followed by soft tissue (42.5%). The mean score for clarity of the intended message was 3.5 ± 1.2. The mean score for artistic skill was 3.2 ± 1.0.
As the number of illustrations in JCFS increases, it is increasingly important that information on the illustrators be given. The journal editor should recommend that authors provide the illustrators’ information. From the author's perspective, the best illustration is one that tells the story the author wants to convey to readers. Therefore, the crucial point is the expression of the author's goal, rather than the esthetics of the illustration.