bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac tamponade complicating thoracentesis in a patient after left pneumonectomy
Authors: Zheng Mingxia , Kang Yu , Wang Tong , Wei Jiafu 
Published: April 2020

Abstract

Rationale:
Therapeutic or diagnostic thoracentesis is widely used in different clinical settings. Cardiac injury, a rare complication, could lead to fatal consequences. We describe a case of cardiac tamponade complicating thoracentesis that was recognized and rescued in a timely manner.

Patient concerns:
A 42-year-old woman underwent blind thoracentesis due to excessive left pleural effusion after left pneumonectomy surgery. She suddenly lost consciousness and was in a state of shock a few minutes after needle insertion and fluid drainage.

Diagnosis:
Bedside transthoracic echocardiography revealed pericardial effusion at a depth of 20 mm, and cardiac tamponade complicating thoracentesis was diagnosed.

Interventions:
After draining 250 mL of non-coagulated blood by pericardiocentesis under transthoracic echocardiography guidance, a tube was placed for continuous drainage over the subsequent 36 hours.

Outcomes:
The patient's hemodynamic condition was stabilized hours after pericardiocentesis. The patient was discharged in good condition a few days later.

Lessons:
Imaging assessment and guidance in the process of thoracentesis was indispensable, especially in a patient with altered intra-thoracic anatomy. Cardiac damage, as a life-threatening complication, should be considered once hemodynamic instability occurs during the procedure.
Femoral pseudotumor secondary to injury in a patient with idiopathic thrombocytopenic purpura
Authors: Sun Tao , Han Shu-Man , Wu Wen-Juan , Gao Bu-Lang 
Published: April 2020

Abstract

Rationale:
Idiopathic thrombocytopenic purpura (ITP) is the condition of having a low platelet count of unknown causes and is a poorly understood acquired hemorrhagic disease involving destruction of platelets in the reticuloendothelial system induced by antiplatelet antibodies. Patients with ITP can have traumatic intra-articular, intraosseous or soft tissue hemorrhage which may present as a rare intraosseous pseudotumor on medical imaging.

Patient concerns:
A 30-year old male patient had complaint of pain in the right leg for 1 year. Laboratory test revealed a much lower platelet count (3–12 × 109/L).

Diagnoses:
Radiography and computed tomography showed expansive bone destruction in the distal segment of the right femur, and magnetic resonance imaging revealed heterogeneous signal intensity in the lesion. Lesion curettage and pathology showed an expansion cyst with a really thin cortical bone shell containing serum-like red liquid and some sediment-like deposit. Consequently, the diagnosis of a pseudotumor was confirmed.

Interventions:
Lesion curettage and bone graft surgery were performed, and 8 units of platelet were transfused to the patient. Giant cell reaction was found on the shell of the lesion, but no tumor cell was found on pathological examination.

Outcomes:
The platelet count was 308 × 109/L 5 days after operation, and the clotting time was normal. At 6 month follow-up after lesion curettage, the patient remained normal with no deterioration in the lesion site.

Conclusion:
The diagnosis of a pseudotumor of ITP relies mainly on imaging findings of the lesion and, in particular, knowledge of the underlying bleeding disorders. Radiologist and pathologist should be aware of the characteristics of this rare complication of ITP and other bleeding disorders like hemophilia in order to avoid misinterpretation of the lesion as a tumor or infection disease.
Sepsis prevalence among patients with suspected infection in emergency department: a multicenter prospective cohort study
Authors: Oberlin Mathieu , Balen Frederic , Bertrand Lionel , Chapeau Noellie , San Cirilo Bastien , Ruols Emmanuelle , Vandercamere Thomas , Souchaud Clement , Guedj Jean François , Konan Bertille , Duval Alice , Mur Sebastien , Specia-Fajolles Anne Sophie , Salles Marie , Boullenger Eric , Vuillot Olivier , Bobbia Xavier 
Published: April 2020

Objective
In the emergency department (ED), the early identification of patients suspected of infection is a challenge for emergency physicians. Sepsis prevalence among patients with suspected infection in the ED remains uncertain. Our objective was to determine how many cases of sepsis occurred among patients with suspected infections in the ED.

Methods
This multi-center, prospective, observational study was conducted in 19 EDs in France. For 1 week, all consecutive ED patients with suspected infection (according to the emergency physician) were included. The primary endpoint was the prevalence of sepsis in the ED according to the ‘sepsis-3’ definition. Secondary endpoints involved comparisons among patients with and without sepsis.

Results
During the study period, 13 904 patients were screened; 494 (3.6%) consulted for suspected infection and were included in the study. Among them, 172 patients [39%, 95% confidence interval (CI) (34–44)] were diagnosed with sepsis. The total hospital mortality for patients with a suspected infection was 4.7% and the hospital mortality for sepsis patients was 9.9%.

Conclusion
In the ED, among patients with a suspected infection, the prevalence of sepsis as per the ‘sepsis-3’ definition was 39% [95% CI (34–44)].
Endoscopic Ultrasound–Guided Fine-Needle Aspiration Microhistology in Asymptomatic and Symptomatic Pancreatic Cystic Lesions
Authors: Vaiciunas Spencer , Taglieri Eloy , Micelli-Neto Otávio , Brunaldi Mariângela Ottoboni , Venco Filadélfio , Goldman Suzan Menasce , Kemp Rafael , dos Santos José Sebastião , Ardengh José Celso 
Published: April 2020

Objective
This study aimed to analyze the usefulness of endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) microhistology to detect malignancy in pancreatic cystic lesions (PCLs).

Methods
Patients with PCLs were identified and submitted to EUS-FNA from January 2010 to January 2017. The percentage of samples suitable for diagnostic classification by microhistology and the positive and negative likelihood ratios to detect malignancy in asymptomatic (APC) and symptomatic (SPC) PCLs were determined.

Results
Endoscopic ultrasound–guided fine-needle aspiration was performed in 510 patients. The resulting material was processed by microhistology and useful for diagnosis in 432 (84.2%). Clinical characteristics of APC (341) and SPC (169) revealed that APC patients were younger (P = 0.004) and had smaller PCLs (23 vs 35 mm; P < 0.001). In APC, we found more preneoplastic (38.7% vs 30.2%; P = 0.0016) and a lower number of malignant PCLs (8.2% vs 24.3%; P < 0.001). In APC and SPC, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of microhistology to detect malignancy were 71.4%, 99.7%, 95.2%, 97.5%, and 97.4% (k = 0.80) and 58.5%, 96.9%, 85.7%, 87.9%, and 87.6%, respectively.

Conclusions
Endoscopic ultrasound–guided fine-needle aspiration was technically feasible. Microhistology was especially useful to detect neoplastic or malignant PCLs in APC patients.
A Predictive Nomogram for Small Intestine Neuroendocrine Tumors
Authors: Kelly Susheian , Aalberg Jeffrey , Kim Michelle Kang , Divino Celia M. 
Published: April 2020

Objective
There is a scarcity of prognostic tools for small intestine neuroendocrine tumors (SI-NETs) and inconsistencies in currently available grading and staging systems. Nomograms are being proposed to address these limitations. However, none is specific to the US population. This study proposed a concise nomogram for SI-NETs using US population-based data.

Methods
Patients with SI-NETs (2004–2015) were selected from the Surveillance, Epidemiology, and End Results database. Variables selected were age, sex, race, tumor grade, primary tumor size, and TNM staging. Cox regression parameter estimates were used to generate nomogram scores.

Results
A total of 2734 patients were selected: 2050 for nomogram development and 684 for internal validation. Prognosticators, age (P < 0.0001), primary tumor size >3 cm (P < 0.0022), tumor grade (P < 0.0001), depth of invasion ≥T3 (P < 0.0280), and distant metastasis (P < 0.0001) were used to develop the nomogram. Nomogram scores ranges from 10 to 80 points with an area under the curve of 0.76, which remained consistently high during internal validation (area under the curve, 0.75).

Conclusions
This Surveillance, Epidemiology, and End Results database nomorgram is a concise prognostic tool that demonstrated high predictive accuracy.
Development of a Standardized System to Detect and Treat Early Patient Deterioration
Authors: Ashbeck Rebecca , Stellpflug Courtney , Ihrke Eriana , Marsh Scott , Fraune Marit , Brummel Ashley , Holst Chelsea 
Published: April 2020

Background:
Inpatient nurses identified the need to recognize clinical deterioration earlier, including rapid response team (RRT) activations and transfers to the intensive care unit. Surveys identified the need for better interdisciplinary communication.

Local Problem:
A system was needed to detect early clinical deterioration with structured responses promoting multidisciplinary collaboration.

Methods:
An early warning score (EWS) identified patients at risk. The system ensured timely and accurate actions were taken when scores reached 3 or above.

Interventions:
Collaborative, graded responses to EWSs and nurse-led rounds promoted communication and timely interventions.

Results:
Mortality decreased (−27%) as did multiple RRT activations on a single patient (−15%). Nurses are aware of early vital sign changes (+45%) and resident responsiveness has improved. There has been an increase in nurse/resident communication satisfaction (+31%).

Conclusions:
The system implemented reinforces the importance of patient assessment, collaboration among the multidisciplinary team, and promotes early interventions.
A 2-Year Experience With Enhanced Recovery After Surgery
Authors: Baimas-George Maria , Cochran Allyson , Tezber Kendra , Kirks Russell C. , Addor Valerie , Baker Erin , Martinie John , Iannitti David , Vrochides Dionisios 
Published: April 2020

Background:
Enhanced Recovery After Surgery (ERAS) programs reduce recovery time, length of stay (LOS), and complications after major surgical procedures.

Purpose:
We evaluated our 2-year experience with a newly implemented comprehensive ERAS program at a high-volume center after pancreatic surgery.

Methods:
Outcomes, cost, and compliance metrics were assessed in 215 patients who underwent elective pancreatic surgery (pre-ERAS; n = 99; post-ERAS: n = 116). Mann-Whitney U and χ2 tests were used to evaluate continuous and categorical variables.

Results:
There were significant decreases in LOS and cost in the post-ERAS cohorts. There were significant increases in compliance with ERAS implementation. Postoperative complication, readmission, and survival rates did not increase.

Conclusions:
Implementation of ERAS at a large-volume hospital may improve compliance and reduce costs and LOS without increasing adverse outcomes.
Impact of a Telephonic Outreach Program on Patient Outcomes Within the Heart Failure Community
Authors: Hall Esscence T. , Maduro Ralitsa S. , Morgan Merri K. , McGee Genemarie W. , Zimbro Kathie S. 
Published: April 2020

Background:
Telephonic outreach programs (TOPs) can be an effective measure to improve 30-day readmissions and self-management behaviors.

Local Problem:
Our health care providers identified that patients admitted with heart failure (HF) were among those with the highest readmission rate, so we implemented a TOP specific to HF.

Methods:
This project evaluated retrospective data from a convenience sample of adult patients admitted to our hospitals between January 2015 and June 2017, with a primary diagnosis of HF, and discharged home (N = 6271). Of those, 1708 patients also had at least partial TOP data, and a subset had timestamped TOP data (n = 1524).

Interventions:
The TOP program included patient education and personal follow-up via an automatic voice calling system that employed a series of 4 phone calls over a 27-day period.

Results:
Results showed that the TOP enhanced our hospital discharge process and contributed to program outcomes when the patients completed all 4 of the calls, with those patients having 11 times lower odds of having a 30-day readmission.

Conclusions:
The proportion of patients who completed the program reported more use of self-management behaviors compared with those who answered fewer than 4 calls. Our findings related to the lower frequency of self-management behaviors of patients who did not complete all vendor calls stress the important issue of vendor management.
The Effect of Autologous Alveolar Bone Grafting on Nasolabial Asymmetry in Unilateral Cleft Lip and Palate
Authors: Thierens Laurent A.M. , Kerckhof Eveline , De Roo Noëmi M.C. , Temmerman Liesbeth , Nadjmi Nasser , Swennen Gwen , Ortega-Castrillon Alejandra , Claes Peter , De Pauw Guy A.M. 
Published: April 2020

Abstract
The objective of this study was to examine whether an autologous alveolar bone graft has an effect on the nasolabial asymmetry in unilateral cleft lip, alveolus, and palate. Fifteen children (mean age 7.5 ± 2.4 years) with non-syndromic unilateral cleft lip and palate (CLP) were included. Non-ionizing three-dimensional images were acquired prior to and three months after the alveolar bone grafting procedure. A 2D and a landmark-independent 3D asymmetry assessment were used to detect changes of asymmetry in the nasolabial area. For the 2D assessment, a cleft and non-cleft side ratio for 4 linear nasal and 2 linear labial distances was expressed as a Coefficient of Asymmetry (CA). The 3D asymmetry assessment comprised a robust superimposition of the face with its mirror image, expressed as a root-mean-square-error (RSME) in mm. A significant decrease in the CA for the labial distance from the facial midline to the labial commissure was observed (P = 0.036). Also, the CA for the labial distance from the facial midline to the highest point of Cupid's bow increased significantly (P = 0.028). Non-significant changes were observed for the CA for the 2 nasal distances and the 2 other labial distances. No significant changes in 3D nasal asymmetry were detected (P = 0.820). Alveolar bone grafting completes the alveolar ridge but has only little to no clinical effect on the asymmetry of the secondary cleft lip nasal deformity.
The Effect of Orthognathic Surgery on Soft-Tissue Facial Asymmetry: A Longitudinal Three-Dimensional Analysis
Authors: Da Pozzo Filippo , Gibelli Daniele , Beltramini Giada A. , Dolci Claudia , Giannì Aldo Bruno , Sforza Chiarella 
Published: April 2020

Abstract
In modern orthognathic surgery, the functional results cannot disregard a good aesthetic outcome. In this study, a stereophotogrammetric longitudinal analysis of the symmetry of facial thirds was performed in 18 patients affected by Class III skeletal malocclusion, with clinical asymmetry, treated with a bimaxillary osteotomy. Their 3-dimensional facial images were acquired in the preoperative phase and 6, 12, and 24 months after surgery, and compared to those obtained in a control group of 23 subjects with Class I skeletal occlusion, without clinical asymmetry and no history of traumas or alterations at the maxillo-facial area. Images of the hemi-faces of the subjects were divided into thirds (upper, middle, lower), mirrored and superimposed to their contralateral ones; soft-tissue facial symmetry was obtained as the root mean square distance between the hemi-faces in the three thirds.
In patients, no significant differences in facial symmetry (root mean square distance) were found among the study time points (analysis of variance, P > 0.05); the lower facial third was more asymmetric than the upper one (Tukey honestly significant difference P < 0.05). Patients were significantly more asymmetric than the control subjects (Student t, P < 0.05). In conclusion, patients with Class III malocclusion exhibited a higher level of facial asymmetry than control subjects; their asymmetry did not change significantly in the different phases of the surgical and orthodontic treatment and throughout a 24-month follow-up. In skeletal Class III patients, bimaxillary osteotomy did not modify the level of asymmetry in any facial third.
Small-Incision Sutureless Surgical Technique for Subconjunctival Orbital Fat Prolapse
Authors: Kim Woojin , Yang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun 
Published: April 2020

Abstract
Surgical outcomes of 20 patients treated by one surgeon between March 2014 and August 2019 were reviewed retrospectively. The authors included 20 patients with subconjunctival orbital fat prolapse (SOFP) treated by a small-incision, sutureless surgical technique using local anesthesia. All patients were followed for at least 3 months postoperatively. Medical information such as patient's age, number of eyes involved, location of fat, surgical time and whether or not the prolapse recurred was reviewed. Twenty patients (16 men and 4 women) were included and had a mean age of 67.1 years. There were 7 bilateral and 13 unilateral SOFP cases. There were no intra-operative or postoperative complications and no cases of recurrence within a mean follow-up of 3 months. All surgeries were successful from both cosmetic and symptomatic perspectives. Our small-incision, sutureless surgical technique is an effective method to manage SOFP. This technique, performed with local anesthesia, is both cost- and time-effective.
Algorithm for Temple Reconstruction With Consideration of Anatomic and Defect Characteristics
Authors: Olshinka Asaf , Maricevich Renata , Shay Tamir , Cohen Avi A. , Ad-El Dean , Ali Kausar 
Published: April 2020

Abstract
The temple is an intriguing region of the face with unique anatomic features, such as the temporal hairline, concave contour, and close proximity to vital structures like the frontal branch of the facial nerve. However, cancerous skin lesions can plague this sun-exposed region and, when excised, it can result in large and significant defects. Reconstruction in this area is a formidable challenge for surgeons, as it requires comprehensive knowledge of temple morphology and the use of creative techniques in order to minimize disruption of surrounding functional and aesthetic structures. In this study, we describe our experience with temple reconstruction in patients of varying defect size and depth. Based on these defect characteristics, anatomic and aesthetic principles of the temple, we propose a surgical algorithm for temple reconstruction to aid surgeons in achieving optimal results.
Occult Scaphocephaly: A Forme Fruste Phenotype of Sagittal Craniosynostosis
Authors: Mantilla-Rivas Esperanza , Tu Liyun , Goldrich Agnes , Manrique Monica , Porras Antonio R. , Keating Robert F. , Oh Albert K. , Linguraru Marius George , Rogers Gary F. 
Published: April 2020

Introduction:Latent cranial suture fusions may present with mild or absent phenotypic changes that make the clinical diagnosis challenging. Recent reports describe patients with sagittal synostosis and a normal cranial index (CI), a condition termed normocephalic sagittal craniosynostosis (NSC). The goal of this study is to evaluate the shape and intracranial volume (ICV) in a cohort of NSC patients using quantitative cranial shape analysis (CSA).Methods:We identified 19 patients (7.5 ± 2.28 years) between 2011 and 2016, who presented to our hospital with NSC. Cranial index and CSA were measured from the computed tomography image. Cranial shape analysis calculates the distances between the patient's cranial shape and its closest normal shape. Intracranial volume was measured and compared to an established age-matched normative database.Results:Cranial index revealed 15 (78.9%) patients within the mesocephalic range and 4 patients (21.1%) in the brachycephalic range. Detailed CSA identified 15 (78.9%) patients with subtle phenotypic changes along the scaphocephalic spectrum (ie, subtle anterior and posterior elongation with inter-parietal narrowing) and 1 patient (5.3%) with isolated overdevelopment on the posterior part of the right parietal bone. Three patients (15.8%) had a CSA close to normal. Mean ICV was 1410.5 ± 192.77cc; most patients (78.9%) fell within ±2 standard deviations.Conclusion:Quantitative CSA revealed that most of the patients with NSC had cranial shape abnormalities, consistent with a forme fruste scaphocephaly that could not be otherwise recognized by clinical observation or CI. Given these findings, we propose the termoccult scaphocephalyto describe this condition. The associated incidence of intracranial hypertension is unknown.
Surgeon Perspectives on Benefits and Downsides of Overlapping Surgery
Authors: Perez Andrew W. , Brelsford Kathleen M. , Diehl Carolyn J. , Langerman Alexander J. 
Published: April 2020

Objective:
The aim of the study was to characterize surgeon perspectives regarding the benefits and downsides of conducting overlapping surgery.

Background:
Although surgeons are key stakeholders in current discussions surrounding overlapping surgery, little has been published regarding their opinions on the practice. Further characterization of surgeon perspectives is needed to guide future studies and policy development regarding overlapping surgery.

Methods:
Study information was sent to all members of 3 professional surgical societies. Interested individuals were eligible to participate if they identified as attending surgeons in an academic setting who work with trainees. Purposive selection was used to diversify surgeons interviewed across multiple dimensions, including subspecialty and opinion regarding appropriateness of overlapping surgery. In-depth, qualitative interviews were conducted with participants regarding their opinions on overlapping surgery.

Results:
The 51 surgeons interviewed identified a wide array of potential benefits and disadvantages of overlapping surgery, some of which have not previously been measured, including downsides to surgeon wellness and patient experience, less surgeon control over procedures, and difficulty in scheduling cases. Interviewees often disagreed as to whether overlapping surgery negatively or positively affects each dimension discussed, particularly regarding the impact on resident training.

Conclusions:
The utilization of the novel perspectives presented here will allow for targeted assessment of physician perspectives in future quantitative studies and increase the likelihood that variables measured encompass the range of factors that surgeons find meaningful and relevant. Priority areas of future research should include examining effects of overlapping surgery on surgical training and surgeon wellness.