bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Ultrasound Criteria for Arterial Invasion in Pancreatic Cancer of the Body and Tail
Authors: Yamato Mutsumi , Mikata Rintaro , Yasui Shin , Iino Yotaro , Shingyoji Ayako , Kusakabe Yuko , Ohyama Hiroshi , Sugiyama Harutoshi , Sakai Yuji , Tsuyuguchi Toshio , Yoshitomi Hideyuki , Ohtsuka Masayuki , Kishimoto Takashi , Kato Naoya 
Published: April 2020

Objectives
We aimed to determine the difference in endoscopic ultrasonography (EUS) images between portal vein (PV) and arterial invasion of pancreatic cancer and to develop criteria for arterial involvement.

Methods
We reviewed EUS data of consecutive patients who underwent distal pancreatectomy from December 2010 to May 2017. We categorized the tumor-vessel relationship into 4 and 5 types, respectively, for the PV and arteries: (a) clear separation between tumor and vessel; (b) tumor border at vessel, echo-rich vessel wall uninterrupted; (c) echo-rich vessel wall interrupted; (d) vessel contour irregularity; and (e) arterial wall thickening or echogenic band surrounding the artery. We compared EUS outcomes with surgical and pathological results.

Results
Overall, 56 patients underwent distal pancreatectomy, of whom 22 received en bloc celiac axis resection. The pathological invasion rates of PVs and arteries were 46.2% and 0% in (c), and 72.5% and 42.4% in (d) (P = 0.046, P = 0.016), respectively. The overall sensitivity and specificity were 92.1% and 83.2%, respectively, for diagnosing venous invasion and 70.0% and 84.4%, respectively, for arterial invasion.

Conclusions
Different EUS criteria may be necessary for diagnosing arterial and portal venous invasions. Criterion (d) might be appropriate for diagnosing arterial invasion.
Nonaggressive Versus Aggressive Intravenous Fluid Therapy in Acute Pancreatitis With More Than 24 Hours From Disease Onset
Authors: Cuéllar-Monterrubio Jesús Eduardo , Monreal-Robles Roberto , González-Moreno Emmanuel I. , Borjas-Almaguer Omar D. , Herrera-Elizondo José Luis , García-Compean Diego , Maldonado-Garza Héctor J. , González-González José Alberto 
Published: April 2020

ObjectiveThis study aimed to compare a “nonaggressive” hydration versus an “aggressive” hydration using Hartmann's solution in patients with acute pancreatitis (AP) with more than 24 hours from disease onset.MethodsWe included 88 patients with AP with more than 24 hours from disease onset, and were randomized into 2 groups. Group I (n = 45) received a nonaggressive hydration (Hartmann's solution at 1.5 mL kg−1h−1for the first 24 hours and 30 mL kg during the next 24 hours), and group II (n = 43) received an aggressive hydration (bolus of Hartmann's solution 20 mL kg, followed by an infusion of 3 mL kg−1h−1for the first 24 hours and then 30 mL kg for the next 24 hours).ResultsThe mean volume of fluid administered was greater in group II (P< 0.001). We did not find differences when comparing both groups in reference to persistent systemic inflammatory response syndrome (P= 0.528), pancreatic necrosis (P= 0.710), respiratory complications (P= 0.999), acute kidney injury (P= 0.714), or length of hospital stay (P= 0.892).ConclusionsOur study suggests that the clinical evolution of patients with AP with more than 24 hours from disease onset is similar using an aggressive or nonaggressive hydration.
FOLFIRINOX for Advanced Pancreatic Cancer Patients After Nab-Paclitaxel Plus Gemcitabine Failure
Authors: Matsumoto Toshihiko , Kurioka Yusuke , Okazaki Ukyo , Matsuo Yu , Kimura Shogo , Miura Kou , Tsuduki Takao , Takagi Shinjiro , Takatani Masahiro , Morishita Hirofumi 
Published: April 2020

Objectives
There is no standard chemotherapy for advanced pancreatic cancer (APC) after gemcitabine plus nab-paclitaxel (GP) failure. The aim of this study was to evaluate the efficacy and safety of FOLFIRINOX (5-Fluorouracil, leucovorin, irinotecan, and oxaliplatin) (5-Fluorouracil, leucovorin, irinotecan, and oxaliplatin) (FFX) and modified FFX (mFFX) for APC patients after GP failure.

Methods
We retrospectively evaluated the efficacy and safety of FFX in APC patients who were refractory or intolerant of GP.

Results
Between July 2014 and October 2018, 23 patients received FFX after failure of GP. The overall response rate (RR) was 23%, and the disease control rate (DCR) was 68%. The median progression-free survival (PFS) was 5.3 months (95% confidence interval, 2.5–8.9), and the median overall survival (OS) was 12.1 months (95% confidence interval, 4.0–14.2). Twelve patients received FFX, and 11 patients received mFFX. In the FFX group, the RR was 9%, the DCR was 73%, the PFS was 5.3 months, and the OS was 6.9 months. In the mFFX group, the RR was 23%, the DCR was 64%, the PFS was 4.3 months, and the OS was 12.8 months. There was no significant difference between the groups.

Conclusions
FOLFIRINOX has potential activity for patients with APC in whom GP failed.
Aberration of ARID1A Is Associated With the Tumorigenesis and Prognosis of Sporadic Nonfunctional Pancreatic Neuroendocrine Tumors
Authors: Han Xu , Chen Wenqi , Chen Pingping , Zhou Wentao , Rong Yefei , Lv Yang , Li Jian-ang , Ji Yuan , Chen Wei , Lou Wenhui , Xu Xuefeng 
Published: April 2020

Objective
The genetic aberrations that underlie chromatin remodeling in sporadic nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) remain largely unknown. Here, we investigated the dysregulation of the switch/sucrose nonfermentable (SWI/SNF) component ARID1A and its correlation with clinicopathological features and prognosis.

Methods
We sequenced the exomes of sporadic NF-pNETs. Quantitative real-time polymerase chain reaction and immunohistochemistry were used to determine messenger RNA level and protein expression.

Results
The sporadic NF-pNETs harbored 264 somatic mutations in 228 different genes, most commonly affecting the SWI/SNF components ARID1B (57.1%) and ARID1A (42.9%). The expression of ARID1A was remarkably downregulated in NF-pNETs and corresponding liver metastases compared with that in normal pancreatic islet tissue. Reduced expression of ARID1A was associated with malignant clinicopathological features (P < 0.05). The loss of ARID1A was related to a high Ki-67 index (P < 0.05). Patients with ARID1A-negative expression had a significantly worse overall survival rate than those with ARID1A-positive expression (P < 0.05). The ARID1A status was an independent predictor of overall survival, and a nomogram integrating ARID1A with clinicopathological features was proposed.

Conclusions
The loss of SWI/SNF components ARID1A may be associated with malignant behaviors and an unfavorable prognosis. Aberrations of ARID1A may contribute to tumorigenesis and metastasis in sporadic NF-pNETs.
Including Family Members in Rounds to Improve Communication in Intensive Care
Authors: Simon Kay , Sankara Ishwara R. , Gioe Christina , Newcomb Patricia 
Published: April 2020

Background:
Family members frequently function as surrogate decision-makers in critical care settings. This role requires family to establish satisfactory communication with clinicians.

Local Problem:
Posthospital patient satisfaction with communication scores were lower than desired. Investigators assumed family member satisfaction with communication could influence patient satisfaction scores.

Methods/Interventions:
Including family members in multidisciplinary daily clinical rounds was implemented in a 22-bed neurointensive care unit (ICU). Family members who attended rounds were compared with those who did not. Changes in clinician time devoted to rounding were measured.

Results:
The intervention increased time devoted to clinical rounds by 4 minutes per patient on average. Rounding dose correlated positively while depression correlated negatively with family satisfaction with communication. No harm, such as family member agitation, anxiety, or complaints, was found.

Conclusions:
Including family in rounding in the ICU appears safe and can improve family satisfaction with communication, but whether it influences patient satisfaction remains an open question.
Kernohan-Woltman Notch Phenomenon in Two Patients with Subdural Hematoma and Ipsilateral Hemiparesis
Authors: Gimarc Kayli , Massagli Teresa L. 
Published: April 2020

Case 1
A 9-yr-old boy presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation and imaging are consistent with Kernohan-Woltman notch phenomenon.

Case 2
A 19-yr-old man presents with right subdural hematoma and ipsilateral hemiparesis. Clinical presentation is consistent with Kernohan-Woltman notch phenomenon.

Clinical Pearl
Kernohan-Woltman notch phenomenon is a false-localizing neurologic sign that presents with hemiparesis ipsilateral to the primary lesion. It occurs in the setting of transtentorial herniation, during which the contralateral cerebral peduncle is compressed against the free edge of the tentorium, causing compression of descending corticospinal tract fibers.
Parathyroid Carcinoma Shown on 99mTc-Sestamibi Parathyroid SPECT/CT Scan in a Pediatric Patient
Authors: Wang Wei , Liu Jun , Liu Jie , Yang Jigang 
Published: April 2020

Abstract
A 10-year-old boy presented with back pain. 99mTc-methylene diphosphonate bone scan demonstrated the sign of metabolic bone disease, suspected due to hyperparathyroidism. 99mTc-sestamibi parathyroid SPECT/CT demonstrated focal lesion in the lower pole of the right lobe. The pathological examination demonstrated parathyroid carcinoma, which is very rare in pediatric population.
Clinical Follow-up Study of the Reconstruction of the Femoral Head With Transferred Vascularized Greater Trochanter Bone Graft for Association Research Circulation Osseous III–IV Osteonecrosis of the Femoral Head
Authors: Zhao Dewei , Fan Dechao , Liu Baoyi , Tian Simiao 
Published: April 2020

Purpose
The aim of the study was to investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by transferring a vascularized greater trochanter graft combined with osteotomy of the upper third of femoral head, in an attempt to seek an innovative approach for patients who experienced middle- to late-stage ONFH with femoral head's weight-bearing area severely collapsed.

Method
Our research included a total of 23 patients (23 hips) who accepted hip-preserving surgery by reconstructing the femoral head with transferred vascularized greater trochanter bone graft for ONFH from January 2013 to December 2017. The definition of reconstructing the femoral head is that we do the osteotomy on the upper third of the femoral head with weight-bearing area severely collapsed, and the remnant femoral head requires a hemispherical bone graft to recover the shape. A vascularized greater trochanter bone graft was next transferred and fixed at the upper portion of the remnant femoral head, and then, the shape and vascular supply of the femoral head are successfully reconstructed. The clinical assessment was performed with Harris Hip Score system. Kaplan-Meier survival curves with femoral head collapse as the end point showing the probability of progression in collapsed femoral head based on the gender, age and body mass index.

Results
Twenty-three patients (23 hips) were eventually contacted by telephone for an outpatient clinic follow-up, with a mean follow-up time of 41.35 months (varied from 16 to 72 months), no patients lost contact. Seven patients (7 hips) had radiographic stage progress. One patient (1 hip) had conversion to total hip arthroplasty at 24 months postoperatively because of progressive femoral head collapse and severely pain. The image success rate was 69.6%, clinical success rate was 65.2%, and the clinical survival rate was 96%. The average Harris Hip Score was 82.5 ± 5.5 points at the last follow-up, representing a great improvement compared with the 51.9 ± 7.2 points obtained preoperatively (P<0.05). Kaplan-Meier survival curves with femoral head collapsed as the end point showing the probability of progression in collapsed femoral head based on the sex, age, and body mass index.

Conclusions
Reconstructing the femoral head with transferred vascularized greater trochanter bone graft provides a new method for the treatment of the young Association Research Circulation Osseous stage III–IV ONFH patients with severely femoral head collapsed, which can better improve the patient's symptoms, the quality of life, and delay the age of undergoing arthroplasty in young patients.
Reconstruction of Soft Tissue Defects and Bone Loss in the Tibia by Flap Transfer and Bone Transport by Distraction Osteogenesis: A Case Series and Our Experience
Authors: Abula Abulaiti , Yushan Maimaiaili , Ren Peng , Abulaiti Alimujiang , Ma Chuang , Yusufu Aihemaitijiang 
Published: April 2020

Objective
The aim of this study is to evaluate the clinical outcome of flap transfer followed by delayed bone transport using external fixator on the soft tissue defect with segmental tibial loss.

Methods
A total of 14 patients with soft tissue defects and bone loss were treated with flap transfer combined followed by delayed bone transport using external fixator from January 2010 to January 2017 and, successfully, follow-up were included. Demographic data and data on clinical outcomes and complications were obtained from hospital record. The mean age was 35.5 years, and the average time from injury to reconstructive surgery was 4.14 months. The average soft tissue and bone defect sizes were 33.57 cm2 and 7.04 cm, respectively. Local or free flap was created to reconstruct the soft tissue defects. The Ilizarov external fixator or Orthofix limb reconstruction system (OLRS) was used to reconstruct bony defects by bifocal or trifocal bone transport using delayed distraction osteogenesis. The functional results were evaluated by Association for the Study and Application of the Method of Ilizarov scoring system, and all postoperative complications were recorded.

Results
The mean duration of follow-up after removal of fixator was 29.49 ± 4.34 months (range, 24–38 months). All wounds healed after 1-stage operation, and all transferred flaps were survived. The average interval between flap coverage and bone transportation was 13.4 weeks (range, 8–24 weeks). Eight patients used bifocal, and 6 patients used trifocal approach for bone transportation. An average external fixation time was 208.5 days (range, 168–235 days) and external fixation index was 33.6 days/cm (range, 18.8–46.5 days/cm). Superficial necrosis of the flap edge was noted in 4 cases, after debridement and regular dressing, the flap healed successfully. Bone union was achieved in all patients except 4 cases that occurred with docking site nonunion which achieved satisfactory union after application of accordion maneuver and autografting of iliac bone. All patients achieved satisfactory functional recovery and were able to walk normally.

Conclusions
The flap transfer followed by delayed distraction osteogenesis using external fixator which can be used for successful reconstruction of bone and soft tissue defects in lower leg.
Flow-Through Free Anterolateral Thigh Flap in Reconstruction of Severe Limb Injury
Authors: Yang Zhao , Xu Chao , Zhu Yonggang , Li Jun , Zou Jiwei , Xue Baobao , Yang Xiaojiang , Zhao Guangyue 
Published: April 2020

Objective
This study aimed to present the use of flow-through free anterolateral thigh (ALT) flap for the reconstruction of severe limb injury.

Patients and Methods
Four patients (2 male and 2 female subjects), with an average age of 26 (9–39) years, were included. These injuries referred to upper and lower limbs, including bone, soft tissue, nerve, and arterial segments. Two patients experienced large soft tissue defects in the lower limb and were repaired by double flow-through ALT flaps. The sizes of damaged soft tissues in the remaining 2 patients were 14 × 10 cm2 and 21 × 13 cm2, respectively. Three patients had bone fractures, in which one of them experienced bone shortening during operation. The arterial injury was observed in 2 patients and the lengths of defects were 5 and 12 cm, respectively. Flow-through free ALT flap was applied for all 4 patients.

Results
Patients were followed up for 18 months. All the flaps have survived successfully without any vascular crisis or infection. All incision wounds were under primary healing stage, without any severe complications. The flaps showed better appearance, color, texture, and satisfactory sensation. All patients had satisfactory functional recovery of their injured limbs.

Conclusions
The flow-through free ALT flap assists in overcoming complex traumatic injuries with severe soft tissue and arterial defects in the limbs. This flow-through ALT flap can be an effective alternative for reconstruction of severe limb injury.
Endoscopic Endonasal Dacryocystorhinostomy With a Novel Lacrimal Ostium Stent in Chronic Dacryocystitis Cases With Small Lacrimal Sac
Authors: Yu Bo , Qian Zhenbin , Han Xuemei , Tu Yunhai , Wu Wencan 
Published: April 2020

Purpose:
To investigate feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with an novel lacrimal ostium stent (LOS) intubation for patients with chronic dacryocystitis with small lacrimal sac.

Methods:
Patients diagnosed as chronic dacryocystitis with small lacrimal sac who preferred to surgery treatment between March 1st, 2012 and May 1st, 2015. All included subjects were randomly divided into 2 groups (Group A and Group B). Cases in group A were performed EE-DCR with LOS intubation while cases in group B were underwent EE-DCR without LOS intubation. Demographic data of each cases were collected. The success rate and the surgical outcomes of 2 groups were compared.

Results:
The success rate was much higher in group A than group B. At 3 months follow up, 61.6% of patients in group A exhibited scarring and/or granulation tissues around the ostium, which was significantly higher than the 36.4% of patients in group B. Of these patients with scars and/or granulation tissues, no statistical difference was found between 2 groups. Granuloma alone and scars with granuloma were observed in 10 patients and 2 patients, in group A and group B, respectively, resulting in a statistical significant difference for this outcome between the groups. At 9 months follow up and 12 months follow up, no significant statistical difference were found in the rate of scarring and/or granulation tissues, scars alone, granuloma alone and scars with granuloma between 2 groups.

Conclusions:
EE-DCR with novel LOS may be an effective procedure to manage chronic dacryocystitis with small lacrimal sac.
Diagnosis and Treatment of Oral Venous Malformation in a Child
Authors: Valente Vitor Bonetti , Kayahara Giseli Mitsuy , Miyahara Glauco Issamu , Biasoli Éder Ricardo , Bernabé Daniel Galera 
Published: April 2020

Abstract
Venous malformations (VMs) are congenital disorders that constitute about 40% of all vascular anomalies. These lesions do not regress spontaneously and may increase in size during childhood. The case of a 10-year-old girl with an extensive oral VM is reported. Intraoral examination revealed the presence of purplish nodules in the alveolar mucosa and gingiva from anterior maxilla. Doppler ultrasound showed a well-defined hypoechoic image and increased vascularization with low blood flow for the alveolar mucosa lesion. The patient was submitted to intralesional injections of the ethanolamine oleate/mepivacaine sclerosing solution. After four sessions, there was a significant reduction of the lesions. However, the patient abandoned the treatment and the oral VM grew progressively. After 1 year, sclerotherapy was resumed and performed weekly. After 10 session of sclerotherapy, the oral VM totally regressed. The childhood is a critical period for oral VM growth. Doppler ultrasound and sclerotherapy can be effective for the management of extensive lesions in children.
The Influence of Lip Repair on the Growth of Craniofacial Structures in Bilateral Cleft Lip and Palate Patients With Unoperated Palate From Childhood to Adulthood
Authors: Liu Yingmeng , Huang Hanyao , Shi Bing , Wang Yan 
Published: April 2020

Purpose:
Surgical treatment of complete bilateral cleft lip and palate (BCLP) is the most difficult procedure among common cleft lip and palate. This study was to research the long-term effect of lip surgery by localizing the craniofacial growth pattern of BCLP patients in the Han people in western China compared with normal healthy people from childhood to adulthood.

Patients and Methods:
A cross-sectional study included a sample of 43 BCLP patients who have received lip repair and a control group of 55 normal healthy people with Angle Class I occlusion at the similar age, gender and ethnicity, and all participants were obtained from the Department of Oral and Maxillofacial Surgery, Sichuan University. Sixteen linear and 14 angular bony landmarks were identified on lateral cephalometric radiographs at the average age of 5.6-year-old, 10.7-year-old, and 24.2-year-old. The measurements were used to represent the growth changes of cranial base, bony nasopharynx, maxillary, mandibular and maxilla-mandibular relationship. Between-group differences were assessed by using the Independent-Sample t test.

Result:
Lip repair has a slow and long-term effect on the craniofacial morphology. The tension from repaired orbicularis oris muscle would cause a decrease in maxillary sagittal length and the retroposition of maxilla combined with the mandibular functional displacement, which would cause a positive change in the postoperative facial morphology of BCLP patients in the long run.

Conclusion:
BCLP patients who have undergone lip repair at an early age have the potential to develop better facial convexity.
Outcomes Following Orbital Floor Fractures in the Elderly
Authors: Patel Alap U. , Haas Jacqueline A. , Skibba Kathryn E. , Morrison Clinton S. 
Published: April 2020

Background:
Orbital floor fractures in the elderly are controversial, with varying guidelines on indications for operative and nonoperative management. Morbidity includes changes to ocular position, inferior rectus muscle injury, and damage to the neurovascular bundle as it traverses the orbital floor. Across all facial fractures, the elderly are less frequently operated on, albeit longer hospital stays and more probably ICU admission. This study's purpose is to describe our experience with orbital floor fractures and the role of operative versus nonoperative management in the context of patient age.

Methods:
Retrospective review of orbital floor fracture coronal and sagittal CT images between 2015 and 2018 in those aged 20 to 40 (controls) or over 65 (cases). Patients were excluded if imaging revealed additional complex fractures of the upper third of the face or the midface.

Results:
Twenty-five subjects met inclusion criteria for the elderly cohort (mean age of 79.4 years) compared to 48 subjects included in the control cohort (mean age 29.9). In the elderly population the most common mechanisms of injury were mechanical fall (72%) and syncope (8%), compared to assault (69%) and MVC (13%) in the controls. Two elderly patients (8%) required operative repair of their injury, whereas fourteen had surgery (29%) in the control cohort. Overall, the mean elderly fracture size was 3.19 cm2 (SD 1.18) and the mean control fracture size was 2.83 cm2 (SD 1.67) (P
= 0.37). Within the elderly group, the mean fracture size for those who underwent surgery was 3.5 cm2 compared to 3.2 cm2 in those treated non-operatively (P
= 0.27). Within the control group, the mean fracture size for those who underwent surgery was 2.9 cm2 compared to 2.8 cm2 in those treated non-operatively (P
= 0.25).

Conclusions:
Orbital floor fractures in the elderly do not require operative intervention in most instances for management.