bluuebunny/crossref_metadata_2025_split huggingface dataset:
High internal radiation exposure associated with low socio-economic status six years after the Fukushima nuclear disaster
Authors: Sawano Toyoaki , Kambe Toshiyuki , Seno Yuki , Konoe Ran , Nishikawa Yoshitaka , Ozaki Akihiko , Shimada Yuki , Morita Tomohiro , Saito Hiroaki , Tsubokura Masaharu 
Published: November 2019

Abstract

Rationale:
Managing the health of vulnerable groups is an important component of health care. Given the long-term burden of radiation-release incidents among those exposed, managing the health of vulnerable groups following a nuclear disaster is very important. However, there is limited information available concerning the long-term management of the health effects of radiation exposure in vulnerable groups following nuclear disasters. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Minamisoma City launched internal radiation exposure monitoring program for local residents, using whole body counter (WBC) units. In 2017, a man of low socio-economic status (SES), was found to have the highest level of internal contamination detected in a person living in the Soma District in recent years. This report describes the case so that the lessons learned can be applied in future nuclear disaster settings.

Patient concerns:
A 77-year-old Japanese man, who had been homeless for 2 months and had been staying in the exclusion zone of Minamisoma City, was brought to our hospital. He had become homeless because a lack of communication between social support services had led to his eviction from leased housing after free housing support for evacuees was terminated.

Diagnoses:
He was admitted with a diagnosis of dehydration and malnutrition. A WBC unit was used to assess his body burden of radioactive cesium. This revealed levels of Cs-134 and Cs-137 of 538 Bq/body and 4,993 Bq/body, respectively.

Intervention:
He received intravenous fluid therapy and health monitoring. The paperwork required for him to receive public income support was processed during hospitalization.

Outcome:
He was discharged to public housing after 9 days, and municipal workers started visiting him regularly after his discharge.

Lessons:
A high level of internal radiation contamination may occur after a nuclear disaster. This may be associated with a decline in social support, poverty, and social isolation, and may have more impact on people in poor health than on the general population. It would be useful to strengthen linkages between local government and welfare service providers to increase social support for vulnerable groups requiring health care, not only following disasters, but also under normal circumstances.
A case report of several intraoperative convulsions while using the Narcotrend monitor
Authors: Berger-Estilita Joana , Steck Katharina , Vetter Christian , Seidel Kathleen , Krejci Vladimir , Hight Darren , Kaiser Heiko 
Published: November 2019

Abstract

Introduction:
Intraoperative seizures under general anesthesia are rare and our observation is the first to demonstrate a distinct electroencephalogram (EEG) pattern on the Narcotrend monitor.

Patient concerns:
We present the case of a 30-year-old man undergoing craniotomy for glioblastoma resection under general anesthesia who suffered tonic-clonic seizures captured in a specific pattern by the intraoperative EEG.

Diagnoses:
Our depth of anesthesia monitor recorded, before the seizure, a widening of the beta-wave performance in a distinct “triangular-shaped” pattern. This pattern was repeated before the second seizure. The patient had no previous history of seizures and following surgery no further seizures were recorded.

Interventions:
A spectrogram analysis showed a distinct increase in mean absolute beta power immediately prior to the first seizure. The EEG immediately prior to the second seizure was characterized by broadband noise. Both seizures were characterized by increased mean absolute delta, theta, and beta power.

Outcomes:
The increase in EEG beta activity seen before the tonic-clonic movements may represent cortical irritability secondary to surgical manipulation, induced by electrical stimulation, reflecting progressive brain over-arousal. The attentive analysis of the relative beta power may have helped forecast the occurrence of the second seizure.

Lessons:
We report the use of a simple, inexpensive, and portable EEG-based monitoring device to assist seizure detection and decision making.
Sixteen-and-a-half syndrome with metastatic pons tumor
Authors: Choi Shin-Myeong , Kim Tae Gi , Chung Junkyu , Joo Jin-Ho , Park In-Ki , Moon Sang Woong , Shin Jae-Ho 
Published: November 2019

Abstract

Rationale:
One-and-a-half syndrome (OAAH) is characterized as the combination of ipsilateral horizontal gaze palsy and internuclear ophthalmoplegia. OAAH syndrome accompanied with 7th and 8th cranial nerve palsy is called 16-and-a-half syndrome. We aimed to report the case of 16-and-a-half syndrome with metastatic pons tumor.

Patient concerns:
A 57-year-old male diagnosed with nonsmall-cell lung cancer (NSCLC) with brain metastasis occurring 15 months ago was referred to our clinic with the chief complaint of horizontal diplopia and right gaze palsy.

Diagnosis:
According to the patient symptom, ocular examination, and radiographic findings, he was diagnosed as 16-and-a-half syndrome which was caused by brain tumor metastasis from NSCLC.

Interventions:
We referred him to hemato-oncology department and he was treated with radiation and supportive therapy.

Outcomes:
Unfortunately, the patient passed away 1 month later without improvement of ophthalmoplegia.

Lessons:
The clinical findings of our case indicate 16-and-a-half syndrome caused by brain tumor metastasis from NSCLC, which to our knowledge has not been previously reported. The case highlights a rare cause of OAAH spectrum disease and the importance of a systemic work-up including associated neurologic symptoms and brain imaging in patients with horizontal gaze palsy.
The position of the spinal cord relative to the vertebrae in adolescent idiopathic scoliosis
Authors: Miyazaki Masashi , Ishihara Toshinobu , Abe Tetsutaro , Kanezaki Shozo , Notani Naoki , Kataoka Masashi , Tsumura Hiroshi 
Published: November 2019

Abstract
We aimed to clarify the position of the spinal cord relative to the vertebra in patients with Lenke type 1 adolescent idiopathic scoliosis (AIS). In all, 35 patients with Lenke type 1 AIS who underwent posterior spinal fusion using a pedicle screw construct and preoperative computed tomography (CT) after myelography were recruited. The following radiological parameters were measured on preoperative CT myelography: spinal cord–vertebral (SV) angle, entry–spinal cord distance (ESD), ESD-X, ESD-Y, spinal cord–pedicle (SP) angle, and rotation angle (RAsag). The SV and SP angles were the smallest at T9 level, followed by T8 and T7 levels, and tended to increase cranially and caudally. The ESD was the shortest at T9 level, followed by T8 and T10 levels. The ESD-X was the smallest at T9 level, followed by T8 level, while the ESD-Y was the smallest at T10 level, followed by T9 and T8 levels. Mean RAsag increased from T4 to T9 levels and decreased from T9 to T12 levels. The ESD was significantly negatively correlated to RAsag. Among all apical vertebrae, the SV and SP angles were negatively correlated to Cobb angle. The RAsag was positively correlated while the ESD was negatively correlated to the Cobb angle. The spinal cord is close to the vertebrae in the apical vertebral region and far from the vertebrae at the upper and lower thoracic vertebral levels in AIS. Therefore, the potential risk of spinal cord injury by pedicle screw is the highest in the apical vertebral region.
Efficacy of Raman spectroscopy in the diagnosis of bladder cancer
Authors: Jin Hongyu , Lin Tianhai , Han Ping , Yao Yijun , Zheng Danxi , Hao Jianqi , Hu Yiqing , Zeng Rui 
Published: November 2019

Abstract

Background:
Bladder cancer is one of the severest human malignancies which are hardly detected at an early stage. Raman spectroscopy is reported to maintain a high diagnostic accuracy, sensitivity and specificity in some tumors.

Methods:
We carried out a complete systematic review based on articles from PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, Cochrane Library and CNKI. We identified 2341 spectra with strict criteria in 9 individual studies between 2004 and 2018 in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We summarized the test performance using random effects models.

Results:
General pooled diagnostic sensitivity and specificity of RS to kidney cancer were 94% (95% CI 0.93-0.95) and 92% (95% CI 0.90-0.93). The pooled positive LR was 10.00 (95%CI 5.66-17.65) while the negative LR was 0.09 (95%CI 0.06-0.14). The pooled DOR was 139.53 (95% CI 54.60-356.58). The AUC of SROC was 0.9717.

Conclusion:
Through this meta-analysis, we found a promisingly high sensitivity and specificity of RS in the diagnosis of suspected bladder masses and tumors. Other parameters like positive, negative LR, DOR, and AUC of the SROC curve all helped to illustrate the high efficacy of RS in bladder cancer diagnosis.
Clinicopathological characteristics, treatment, and survival outcomes of retroperitoneal desmoid-type fibromatosis
Authors: Shen Chaoyong , Wang Chengshi , Yan Jiaqi , He Tao , Zhou Xiaoquan , Ma Wenjing , He Jialing , Yin Yuan , Yin Xiaonan , Cai Zhaolun , Chen Zhixin , Zhang Hongying , Zhang Bo 
Published: November 2019

AbstractRetroperitoneal desmoid-type fibromatosis (RPDF) is a rare mesenchymal neoplasm, and it covers a broad spectrum of aggressive monoclonal, fibroblastic proliferation. There is no evidence-based or established optimal treatment available for this intriguing disease yet. Therefore, we here investigated the clinicopathological characteristics, surgical, and survival outcomes in RPDF among Chinese patients.Patients with histologically confirmed RPDF were retrospectively studied from 2010 to 2018 within the West China Hospital of Sichuan University. Demographics, clinicopathological characteristics, treatment, and survival outcome data were collected.Of the 29 cases of RPDF, 19 were females. Tumor diameter ranged from 4 to 40 cm, with a median of 10 cm. Of these patients, surgical resection was the primary treatment adopted for RPDF in 26 cases; while 3 patients underwent watchful waiting. In surgical group, complete and incomplete macroscopic resection was achieved in 21 (80.77%) and 6 (19.23%) cases, respectively. Totally, 21 (80.77%) cases underwent multi-visceral resection. With a median follow-up duration of 48 months, 11 patients experienced tumor progression for the entire cohort. Tumor progression was observed for those patients with incomplete and complete macroscopic resection in 2/5 (40.0%) and 6/21 (28.6%) cases, respectively. In the watchful waiting group, there were no documented cases of RPDF regression. The progression-free survival rate was 86.1%, 71.5%, and 62.3% at 1-, 2-, and 3-years, respectively.RPDFs are rare types of tumor, which have characteristically varied natural histories. Surgical resection had a relative favorable outcome, but some patients were associated with burden of significant surgical complications.
Effect of thoracic paraspinal block-propofol intravenous general anesthesia on VEGF and TGF-β in patients receiving radical resection of lung cancer
Authors: Sen Yang , Xiyang Hu , Yu Han 
Published: November 2019

Abstract
The objective of this study is to compare the effects of paravertebral nerve block-propofol intravenous general anesthesia (PPA) and sevoflurane inhalation general anesthesia (SGA) on the expression of serum vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-β) in patients undergoing radical resection of lung cancer.
Patients undergoing radical resection of lung cancer were divided into PPA group and SGA group. In PPA group, thoracic paraspinal nerve block was performed with 0.5% ropivacaine (2 mg/kg) before general anesthesia. Anesthesia was maintained with 2.5–3.5 μg/mL TCI of propofol. In SGA group, anesthesia was maintained with 1.0–1.5 MAC sevoflurane. The dosage of opioids during and 24 h after operation, the pain score at 2, 8, 24, 48, and 72 h after operation, and the concentrations of serum VEGF and TGF-β before and 24 h after operation were observed in the two groups.
The intraoperative dosage of remifentanil in PPA group was significantly less than that in SGA group (P < 0.05). The dosage of sufentanil in SGA group was significantly less than that in SGA group at 24 h after operation (P < 0.05). The VAS score at 2, 8, and 24 h after operation was significantly lower than that in SGA group (P < 0.05). The serum VEGF and TGF-β concentration in PPA group was significantly lower than that in SGA group (P < 0.05).
Thoracic paravertebral nerve block-propofol intravenous general anesthesia can reduce the dosage of opioids, improve the effect of postoperative analgesia, and reduce the serum concentration of tumor angiogenesis-related factors in patients undergoing radical resection of lung cancer.
Guillain-Barré syndrome associated with myasthenia gravis
Authors: Cao Yayun , Gui Mengcui , Ji Suqiong , Bu Bitao 
Published: November 2019

Abstract

Rationale:
Myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) are 2 common neurologic autoimmune diseases. Although both the diseases can present with acute or subacute onset of muscular weakness involving the limbs and bulb, the coexistence in the same patient is unusual and rarely described in the literature.

Patient concerns:
Three cases of combined MG and GBS at the department of Neurology were described. All the 3 patients developed GBS, who had had MG for 30 years, 6 years, and 6 months, respectively.

Diagnoses:
The newly developed GBS was clinically confirmed by the clinical features, electromyographic (EMG) studies, typical albumino-cytologic dissociation in cerebrospinal fluid (CSF), and positive anti-ganglioside antibodies in serum.

Interventions:
The 3 patients had been treated with intravenous immunoglobulin (IVIG), or plasma-exchange (PE), or IVIG combined with PE in the acute stage of severe muscle weakness. In light of the MG symptoms, they have received glucocorticoids, oral pyridostigmine, and immunosuppressive agents.

Outcomes:
The patient 1 was able to walk longer than 5 m with assistance (Hughes 3). The patient 2 had significantly improved, and completely recovered at the 1-year follow-up (Hughes 0). But unfortunately, the patient 3 was severely disabled and chair-bound at the last interview (Hughes 4).

Lessons:
The combination of MG and GBS is quite rare. Limbs and oculo-bulbar weakness are the cardinal manifestations of both the diseases. Although their characteristics are quite different, there are still some difficulties in diagnosing them when they occur in the same patient. Early diagnosis and proper treatment will yield satisfactory prognosis. Further researches are needed to elucidate the pathogenesis of the coexistence.
Bilateral orbital involvement of IgG4-related disease detected on 18F-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography
Authors: Dong Ping , Wang Li , Li Lin 
Published: November 2019

Abstract

Rationale:
IgG4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory condition, which could involve multiple structures, including the pancreas, salivary glands, and lymph nodes. However, cases of IgG4-RD involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate are rare.

Patient concerns:
A 51-year-old man complaining of bilateral exophthalmos, reduced vision, and weight loss of 15 kg over 2 years presented to our department for evaluation.

Diagnoses:
Based on the elevated serum IgG4 level, postoperative pathology, and the features of 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), which revealed diffuse increased FDG uptake in many structures, he was diagnosed with IgG4-related disease involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate.

Interventions:
Because of the significant bilateral proptosis and exposure keratoconjunctivitis in the right eye, bilateral soft-tissue masses located in the orbits were resected, and the patient was started on oral methylprednisolone with gradual tapering.

Outcomes:
The patient's symptoms gradually relieved after the operation and glucocorticoid therapy. Four months later, cranial axial CT revealed remarkable narrowing of soft-tissue masses in the bilateral orbits, and his serum IgG4 level reduced sharply.

Lessons:
IgG4-RD should be considered in cases of diffuse FDG uptake in the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate on PET/CT.
Clinical implication of 18F-NaF PET/computed tomography indexes of aortic calcification in coronary artery disease patients: correlations with cardiovascular risk factors
Authors: Ryoo Hyun Gee , Paeng Jin Chul , Koo Bon-Kwon , Cheon Gi Jeong , Lee Dong Soo , Kang Keon Wook 
Published: November 2019

Objective
Vascular calcification is known to be associated with cardiovascular risk factors. Recently, 18F-NaF PET has been reported to be effective for detecting early and active vascular calcification. In this study, correlations between 18F-NaF PET/computed tomography (CT) findings and cardiovascular risk factors were investigated in patients with suspected coronary artery disease.

Patients and methods
Forty patients with suspected coronary artery disease underwent 18F-NaF PET/CT. The maximum and overall burden of calcifying activity, and the overall burden of calcium deposition in the descending thoracic aorta (DTA) were measured on 18F-NaF PET/CT and they were compared with cardiovascular risk factors, particularly, with those related to metabolic syndrome.

Results
The maximum and overall burden of calcifying activity in DTA measured on 18F-NaF PET were significantly correlated with diabetes mellitus (P = 0.030 and 0.049, respectively) and serum HbA1c level (ρ = 0.433 and 0.344, respectively). In contrast, the overall burden of calcium deposition measured on CT was significantly correlated with hypertension (P < 0.001). The overall burden of calcium deposition was also significantly correlated with metabolic syndrome (P = 0.002) and 10-year cardiovascular disease risk score (P = 0.004)

Conclusion

18F-NaF uptake is closely related to diabetes mellitus, whereas aortic calcification on CT is closely related to hypertension. Although 18F-NaF uptake in DTA can be a potential prognostic factor, aortic calcification on CT is a more significant prognostic factor for overall cardiovascular risk than 18F-NaF uptake.
Swallowing Outcomes and Discharge Destinations in Acute Stroke Tube-Feeding Dependent Dysphagia Patients Treated With Neuromuscular Electrical Stimulation During Inpatient Rehabilitation
Authors: Kushner David S. , Johnson-Greene Doug , Cordero Maite K. , Thomashaw Stacy A. , Rodriguez Jennifer 
Published: November 2019

Objective
Inpatient rehabilitation study comparing swallowing outcomes and discharge destinations in acute stroke tube-feeding dependent dysphagia patients treated with neuromuscular electrical stimulation and traditional dysphagia therapy versus those treated with only traditional dysphagia therapy.

Design
Retrospective case-control study including 359 patients with acute stroke having initial Functional Oral Intake Scale scores of 3 or lower (profound to severe tube-feeding dependent dysphagia). One hundred ninety participants received neuromuscular electrical stimulation with traditional dysphagia therapy, and 169 controls received only traditional dysphagia therapy. Treatment occurred in hourly sessions 5 d/wk. Main outcome measures were comparison of Functional Oral Intake Scale scores after treatment (N = 359) and comparison of discharge destinations (n = 267).

Results
The neuromuscular electrical stimulation posttreatment mean ± SD Functional Oral Intake Scale score was 4.21 ± 2.1 versus 2.94 ± 1.96 for controls (t = 5.85, P < 0.001). The neuromuscular electrical stimulation group posttreatment mean ± SD Functional Oral Intake Scale gain was 3.24 ± 2.26 points versus 1.87 ± 2.01 for controls (t = 6.05, P < 0.001). After treatment, 51.6% (98/190) neuromuscular electrical stimulation patients had minimal or no swallowing restrictions (Functional Oral Intake Scale scores = 5–7), whereas only 26.6% (45/169) controls improved with Functional Oral Intake Scale scores of 5–7 (χ2 = 23.3, P < 0.0001). Groups differed by discharge destinations: neuromuscular electrical stimulation having more discharges to community than controls, 60% versus 44% (χ2 = 9.16, P = 0.003), and neuromuscular electrical stimulation having fewer acute care transfers compared with controls, 8% versus 25% (χ2 = 32.7, P < 0.0001).

Conclusions
Neuromuscular electrical stimulation with traditional dysphagia therapy was associated with better discharge swallowing outcomes and Functional Oral Intake Scale scores than traditional dysphagia therapy alone during inpatient rehabilitation in treating acute stroke feeding tube–dependent dysphagia and was associated with more discharges to community and less transfers back to acute care.
Targeted Therapies in Chronic Lymphocytic Leukemia
Authors: Ujjani Chaitra , Cheson Bruce D. 
Published: November 2019

Abstract
Small molecule inhibitors, including B-cell receptor antagonists and B-cell lymphoma - 2 inhibitors, have revolutionized the treatment of chronic lymphocytic leukemia (CLL). These agents have improved outcomes for patients of all prognostic backgrounds, thus securing their role in the frontline setting. Impressive activity has been demonstrated both with monotherapy and in combination with other targeted therapeutics. The most important remaining question is whether to administer small molecule inhibitors in a sequential fashion or in combination with each other and/or anti-CD20–directed therapy. Together, a number of retrospective and prospective clinical trials have provided insight into patient outcomes with different sequencing and combination strategies. While rituximab does not appear to provide significant additional benefit to ibrutinib, the incorporation of venetoclax appears to enable a deeper response and allow for a shorter duration of therapy. How durable of a response this produces and whether patients can be effectively retreated with venetoclax remain unclear. As various targeted therapy doublets and triplets are explored, it is important to investigate whether they produce significant long-term benefits over monotherapy and whether these approaches are appropriate for all patients.
Bruton Tyrosine Kinase Inhibitors
Authors: Burger Jan A. 
Published: November 2019

Abstract
Bruton tyrosine kinase (BTK) is a nonreceptor tyrosine kinase that plays a central role in the signal transduction of the B-cell antigen receptor and other cell surface receptors, both in normal and malignant B lymphocytes. B-cell antigen receptor signaling is activated in secondary lymphatic organs and drives the proliferation of malignant B cells, including chronic lymphocytic leukemia (CLL) cells. During the last 10 years, BTK inhibitors (BTKis) are increasingly replacing chemotherapy-based regimen, especially in patients with CLL and mantle cell lymphoma (MCL). Bruton tyrosine kinase inhibitors are particularly active in patients with CLL and MCL, but also received approval for Waldenström macroglobulinemia, small lymphocytic lymphoma, marginal zone lymphoma, and chronic graft-versus-host disease. Current clinical practice is continuous long-term administration of BTKi, which can be complicated by adverse effects or the development of drug resistance. Alternatives to long-term use of BTKi are being developed, such as combination therapies, permitting for limited duration therapy. Second-generation BTKis are under development, which differ from ibrutinib, the first-in-class BTKi, in their specificity for BTK, and therefore may differentiate themselves from ibrutinib in terms of adverse effects or efficacy.