bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can pathologists reliably establish ampulla of Vater carcinoma histologic subtype on H&E alone? Concordance of subtype and comparison to immunohistochemistry-established subtype
Authors: Tanager Kevin S. , Li Yueying , Alpert Lindsay , Setia Namrata , Weber Christopher , Hart John , Xiao Shu-Yuan 
Published: November 2019

AbstractHistologic subtyping of ampulla of Vater carcinoma (ampullary carcinoma, AC) may guide choice of adjuvant chemotherapy for advanced disease, as intestinal (INT) subtype may have a better treatment response and survival as compared to the pancreatobiliary (PB) and mixed (MIX) subtypes. However, ambiguous morphologic features can result in inconsistent subtyping among pathologists. Recently immunohistochemistry (IHC) for cytokeratin (CK)7, CK20, CDX2, and the Mucin (MUC) family proteins had been used to aid in the subtyping. It is important to determine if accurate subtyping can be achieved based on hematoxylin and eosin (H&E) evaluation alone, or if IHC is required. In this study, 5 gastrointestinal pathologists evaluated 34 cases of AC for histologic subtype (PB, INT, or MIX) based on H&E stain alone. IHC studies (CK7, CK20, and CDX2) were used to determine a gold standard subtyping for comparison (strong CK7 with weak CK20 and CDX2 = PB; strong CK20 or CDX2 and weak CK7 = INT; strong CK7 and CK20 or CDX2 = MIX). Interobserver concordance (kappa) was calculated. Percent correctness of subtyping was calculated in relation to IHC-established subtype gold standard. Interobserver concordance for subtype was fair (kappa 0.31). Percent correctness for subtype against IHC-established subtype was 50% for a majority (3 or more) of pathologists. In all 11 cases with 4 or 5 pathologists being concordant, the subtype was also correctly identified. In addition, data on chemotherapy regimen and overall survival was gathered from the electronic medical record. Patients who were assigned a subtype at time of diagnosis tended to receive gemcitabine for PB subtype, and FOLFOX-based therapy for INT subtype, with some cases diagnosed as “not-otherwise specified” typically also receiving gemcitabine. Survival data were limited by loss to follow-up. In conclusion, despite 11 cases with strong concordance and correctness, overall subtyping concordance was only fair, and a majority of the 5 pathologists correctly identified the subtype in only 50% of cases. Thus, while some AC cases yield clear-cut subtyping, significant discrepancy among pathologists remains. It appears that utilization of IHC to identify subtype in AC cases is necessary to provide accurate, reliable prognostic and therapeutic information.
The effect of pre-procedural sublingual nifedipine on radial artery diameter
Authors: Bi Xile , Jia Hongdan , Wang Qingsheng 
Published: November 2019

Objective
This study aimed to investigate the effect of nifedipine on radial artery (RA) relaxation before puncture for coronary intervention.

Methods
In all, 120 patients were randomly assigned to nifedipine or control group. The diameter, resistance index (RI), and peak systolic velocity (PSV) of the RA were observed at 5, 15, and 30 min after nifedipine administration by a Doppler ultrasound examination.

Results
The greatest effect on RA diameter, PSV and resistance index (RI) was observed 5 minutes after sublingual nifedipine administration. The RA parameter were associated with the baseline diameter.

Conclusions
Sublingual nifedipine administration before RA puncture has an obvious dilatation effect on small diameter RAs.
The role of computer-based clinical decision support systems to deliver protective mechanical ventilation
Authors: Khemani Robinder G. , Hotz Justin C. , Sward Katherine A. , Newth Christopher J.L. 
Published: November 2019

Purpose of review
Mechanical ventilation of adults and children with acute respiratory failure necessitates balancing lung and diaphragm protective ventilation. Computerized decision support (CDS) offers advantages in circumstances where complex decisions need to be made to weigh potentially competing risks, depending on the physiologic state of the patient.

Recent findings
Significant variability in how ventilator protocols are applied still exists and clinical data show that there continues to be wide variability in ventilator management. We have developed a CDS, which we are currently testing in a Phase II randomized controlled trial. The CDS is called Real-time Effort Driven ventilator management (REDvent). We will describe the rationale and methods for development of CDS for lung and diaphragm protective ventilation, using the REDvent CDS as an exemplar.

Summary
Goals for achieving compliance and physiologic objectives can be met when CDS instructions are simple and explicit, provide the clinician with the underlying rule set, permit acceptable reasons for declining and allow for iterative adjustments.
Adverse Events After Inpatient Colonoscopy in Octogenarians
Authors: Olaiya Babatunde , Adler Douglas G. 
Published: November 2019

Background and Aim:
Colonoscopy is commonly performed in the elderly who have a higher proportion of lower gastrointestinal (GI) tract disorders. However, few studies have evaluated the safety of colonoscopy specifically in the octogenarian population. The goal of this study is to examine the safety of colonoscopy among octogenarians over a 16-year period. We also examine risk factors associated with morbidity and mortality in octogenarians after inpatient colonoscopy.

Materials and Methods:
We queried the National Inpatient Sample to identify octogenarians who had a colonoscopy during hospitalization from 1998 to 2013. We examined inpatient GI-related adverse events including colonic perforation, postcolonoscopy bleeding, and splenic injury. We also examined all-cause mortality rates after colonoscopy.

Results:
About a quarter of inpatient colonoscopies performed annually were in octogenarians. Of 296,385 colonoscopies included in our study, colon perforation, postcolonoscopy bleeding, and splenic injury occurred in 11, 9, and 0.22 per 1000 colonoscopies, respectively. Overall mortality rate was 2.8%, most (2.5%) dying within 30 days of colonoscopy. After controlling for covariates, those who had colon perforation, postcolonoscopy bleeding, or splenic injury were at a much higher risk of inpatient mortality.

Conclusions:
There seems to be a higher risk of adverse GI-related events after colonoscopy in octogenarians as compared with the general population. Furthermore, occurrence of adverse GI-related events increased the risk of mortality among octogenarians regardless of comorbid status.
Individualized intervention to improve rates of exclusive breastfeeding
Authors: Huang Pan , Yao Jianrong , Liu Xinghui , Luo Biru 
Published: November 2019

Abstract

Background:
Despite breastfeeding is significant benefits for maternal and infant, the discontinuation of breastfeeding is high. Some of studies showed that the effect of intervention in improving the rate of exclusively breastfeeding is unclear. The aim of this study is to investigate the effectiveness of individualized intervention compared with routine care in improving rates of exclusive breast feeding.

Methods:
Women were divided into two groups. We provided individual antenatal breastfeeding education and postnatal lactation support to intervention group. Control group received routine care. Significance was set at P < .05.

Results:
We recruited 352 women of whom 176 were randomized to intervention group, 176 to control group. In total, 293 (83.2%) completed 4 months of follow-up. At discharge from hospital, 43.2% of women randomized to intervention group were exclusively breastfeeding compared with 30.0% of women in control group (relative risk 1.78; 95% confidence interval [CI] 1.12–2.82). At 4 months, 70.9% of women in the intervention group were exclusively breastfeeding compared with 46.2% of the women in the control group (2.84; 1.76–4.60). At discharge from hospital, 95.1% of women in the intervention group were breastfeeding on demand compared with 68.1% of women receiving routine care (9.00; 4.09–19.74). At 4 months, 94.6% of women in intervention group were breastfeeding on demand compared with 75.9% of women in the control group (5.57; 2.48–12.49).

Conclusion:
The regular ongoing individualized antenatal education and postnatal support can effective increase the rates of exclusive breastfeeding from delivery to postpartum 4 months and change the breastfeeding behavior.
Small intestinal autotransplantation for spontaneous isolated superior mesenteric artery dissection
Authors: Wei Jiangpeng , Yang Yi , Zheng Jianyong , Chen Dongli , Wang Weizhong , Zhao Qingchuan , Li Xiaohua , Wu Guosheng 
Published: November 2019

Abstract

Introduction
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare differential diagnosis for patients presenting with abdominal pain. Due to limited cases reported, surgical management strategies are poorly defined.

Patient concerns
A 54-year-old man presented to our emergency department with a 4-day history of epigastric pain combined with nausea and vomiting. The pain was dull, constant, and unbearable. It was accompanied by abdominal distention, but there was no radiating pain, chills, fever, or hematochezia. The patient did not have a history of abdominal surgeries, or tobacco or illicit drug use.

Diagnosis
A contrast-enhanced computerized tomography (CT) scan demonstrated an isolated and spontaneous superior mesenteric artery dissection with aneurysmal evolution of the false lumen, involving multiple side branches. The middle-lower jejunum and the whole ileum were extensively dilated, and the middle jejunum was ischemic with edema.

Interventions
Exploratory laparotomy and autologous small bowel transplantation.

Outcomes
The patient was successfully treated using exploratory laparotomy and intestinal autotransplantation (IATx) without bowel resection and had a stable recovery without complications.

Conclusion
For patients with severe mesenteric ischemia or those who fail to respond to initial conservative treatment, IATx may be a reasonable treatment strategy.
Use of sacubitril/valsartan in Marfan syndrome–related cardiomyopathy
Authors: Spoto Silvia , Valeriani Emanuele , Locorriere Luciana , Anguissola Giuseppina Beretta , Pantano Angelo Lauria , Terracciani Francesca , Bono Maria Caterina , Costantino Sebastiano , Ciccozzi Massimo , Angeletti Silvia 
Published: November 2019

Abstract

Rationale:
Marfan syndrome is a rare cause of heart failure due to primary or secondary cardiomyopathy. Recently, sacubitril/valsartan—an angiotensin receptor blocker-neprilysin inhibitor—has been added in clinical practice as a standard therapy for heart failure. To our knowledge, there are no data on sacubitril/valsartan's effects on cardiovascular outcomes in patients with Marfan syndrome.

Patient concerns:
A 24-year-old man was admitted to our Internal Medicine Department due to dyspnea, ascites, and leg swelling. Arterial blood gas analysis revealed severe hypoxemia with respiratory and metabolic alkalosis. Hilar congestion was highlighted on chest x-ray.

Diagnoses:
Recurrent acute decompensated heart failure with reduced ejection fraction despite optimal medical therapy in Marfan-related cardiomyopathy.

Interventions and outcomes:
Sacubitril/valsartan was added to optimal medical therapy after hemodynamic stabilization allowing progressive clinical, laboratoristic, and echocardiographic improvement. Patient maintained a free survival from heart failure and a good quality of life until 9-month follow-up.

Lessons:
Sacubitril/valsartan should be effective on pathophysiologic mechanisms and cardiovascular outcomes of Marfan syndrome–related cardiovascular complications.
Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia
Authors: Shi Bi-chuan , Li Jiao , Jiang Ji-wei , Li Mei-xin , Zhang Jian , Shang Xiu-li 
Published: November 2019

Abstract

Rationale:
Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS.

Patient concerns:
A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis.

Diagnoses:
Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (−), EBV IgM (−), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a “boomerang sign” and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed.

Interventions:
We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation.

Outcomes:
The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day.

Lessons:
In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary β2-microglobulin (β2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.
The association between biologic agents and the risk of cardiovascular events in patients with psoriasis and psoriatic arthritis
Authors: Ma Jie , Liang Ning , Chen Jialiang , Bai Yanping 
Published: November 2019

Abstract

Background:
Psoriasis (Pso) is a chronic, recurrent, and inflammatory disease involving genetic and immune factors. Psoriatic arthritis (PsA), accounting for 30% of Pso, is an inflammatory arthropathy. Pso and PsA are associated with increased cardiovascular events (CVEs). Biologic therapies for Pso and PsA are drawing arising attention for its therapeutic effects. Large evidences have shown that biologic agents could lower the risk of CVEs in patients with Pso and PsA. However, not all studies support this point. A systematic review is needed.

Methods:
Four databases (PubMed, Web of Science, The Cochrane Library, and EMBASE) will be searched from the inception to July 1st, 2019. Randomized controlled trials and observational studies (including case-control studies and cohort studies) reporting CVEs in patients with Pso and PsA treated with biologic agents will be included. The primary outcome is the incidence of CVEs. The secondary outcome is the incidence of each individually reported cardiovascular event. Study selection, data extraction, and assessment of quality will be conducted independently by 2 reviewers. RevMan5.3.5 software will be used for data synthesis.

Results:
The results of this study will provide evidence for the effect of biologic agents on the risk of CVEs in patients with Pso and PsA, so as to further provide guidance for clinical management.

Conclusion:
The findings of this study will be published in a peer-reviewed journal.

PROSPERO registration number:
CRD42019142778
Effect of denosumab, a human monoclonal antibody of receptor activator of nuclear factor kappa-B ligand (RANKL), upon glycemic and metabolic parameters
Authors: Abe Ichiro , Ochi Kentaro , Takashi Yuichi , Yamao Yuka , Ohishi Hanako , Fujii Hideyuki , Minezaki Midori , Sugimoto Kaoru , Kudo Tadachika , Abe Makiko , Ohnishi Yasushi , Mukoubara Shigeaki , Kobayashi Kunihisa 
Published: November 2019

Abstract
Osteoporosis is a complication of type 2 diabetes mellitus (T2DM). Blockade of receptor activator of nuclear factor kappa-B ligand (RANKL) improves osteoporosis, but might also improve glucose tolerance through reduction of hepatic insulin resistance. However, the effect of denosumab (a human monoclonal antibody of RANKL) upon glycemic and metabolic parameters is controversial. We revealed the effect of denosumab upon glycemic and metabolic parameters for 52 weeks. We evaluated 20 individuals diagnosed with both osteoporosis (male and female: postmenopausal) and T2DM. We measured glycemic and metabolic parameters before and 26/52 weeks after administration of denosumab (60 mg per 26 weeks) without changing any other medication each patient was taking. All patients completed the study without complications and the T-score (lumbar spine and femoral neck) improved significantly from baseline to 52 weeks after denosumab administration (P < .001, .001, respectively). None of the glycemic parameters changed significantly from baseline to 26 weeks after denosumab administration, but levels of glycated hemoglobin and homeostasis model assessment of insulin resistance improved significantly from baseline to 52 weeks after administration (P = .019, .008, respectively). The levels of liver enzymes did not change significantly from baseline to 26 weeks after denosumab administration, but levels of aspartate transaminase and alanine aminotransferase improved significantly from baseline to 52 weeks after administration (P = .014, .004, respectively). None of the markers of lipid metabolism and body mass index changed significantly from baseline to 26/52 weeks after denosumab administration. These data demonstrated that denosumab is useful for T2DM patients with osteoporosis for glycemic control via improvement of insulin resistance. Also, the effect of denosumab might be due to improvement of hepatic function.
Three case reports
Authors: Carretero-González Alberto , Salamanca Santamaría Javier , Castellano Daniel , de Velasco Guillermo 
Published: November 2019

Abstract

Rationale:
Hepatotoxicity is a well-known adverse effect of vascular endothelial growth factor receptor (VEGFR) tyrosine-kinase inhibitors (TKIs), usually employed for the treatment of metastatic renal cell carcinoma (mRCC). Immune checkpoint inhibitors (ICIs) have been shown to improve survival in specific patients with mRCC, but concerns have arisen over their safety profile, particularly as regards the risk of liver damage in those patients receiving TKIs sequentially or concurrently with these new drugs. Here, we report three cases of hepatitis presentation in patients receiving TKIs after ICIs that should potentially be considered in current clinical practice, where a combination of these hepatotoxic drugs is becoming increasingly used.

Patients concerns:
All three patients were receiving TKIs therapy and presented with nonspecific clinical deterioration and liver enzyme elevation in different time frames according to the start of treatment. All were previously treated with ICIs.

Diagnoses:
After performing imaging techniques and complementary laboratory tests for the differential diagnosis of hepatic injury, the diagnosis of potentially TKI-induced hepatitis was assumed in all these cases. Hepatic biopsy was performed only in the first case in order to confirm the diagnosis.

Interventions:
Potential toxic drugs were interrupted and steroids course with slow reduction regimen was administered in all these cases because of the previous use of ICIs.

Outcomes:
The patients described improved with this conservative treatment without complications during the following weeks. Only one case presented a new episode of mild hepatic alteration while on treatment with following treatment.

Lessons:
Taking into account this new therapeutic context, stricter monitoring for potentially increased/altered adverse events should be indicated. Adequate patient selection and consideration of the safety profile of the different drugs used could help to optimize treatment in the near future.
Bilateral diffuse retinal pigment epithelium proliferation induced by choroidal inflammation
Authors: Tanaka Miyuki , Kamoi Koju , Nagaoka Natsuko , Ishida Tomoka , Karube Hisako , Takase Hiroshi , Ohno-Matsui Kyoko 
Published: November 2019

Abstract

Rationale:
Proliferation of retinal pigment epithelium (RPE) is typically observed in limited ocular disorders, in connection with the local mechanism of RPE proliferation-mediated wound repair. Bilateral and diffuse type RPE proliferation is considered to be associated with paraneoplastic syndromes, such as a bilateral diffuse uveal melanocytic proliferation. However, other reported diseases that induce bilateral diffuse RPE proliferation are quite rare, especially for patients who are considered to have a non-malignant status.

Patient concerns:
The bilateral eyes of a 47-year-old woman with bilateral ocular inflammation, presented united multiple small to medium white retinal lesions during the disease progress.

Diagnoses:
Optical coherence tomography showed scattered serous retinal detachments, choroidal folds, choroidal thickening and diffuse RPE proliferation. As autofluorescence and angiography showed a “giraffe pattern”, bilateral diffuse uveal melanocytic proliferation was suspected. However, systemic investigations identified no malignancy. In consideration of the above findings, choroidal inflammation was thought to be the major cause of this condition.

Interventions:
The patient was administered intensive systemic steroids. Over the next 2 months, the amount of steroid was tapered off.

Outcomes:
After administration, the bilateral diffuse RPE proliferation settled down. During the 2-year follow-up, there was no recurrence of ocular inflammation and diffuse RPE proliferation, or any other malignancy found.

Lessons:
This finding demonstrates that bilateral diffuse RPE proliferation can be generated as a secondary phenomenon of choroidal inflammation in patients with a non-malignant status.