bluuebunny/crossref_metadata_2025_split huggingface dataset:
Schwannoma of the thyroid bed
Authors: Kang Ji Yun , Yi Kyung Sik , Cha Sang-Hoon , Choi Chi-Hoon , Kim Yook , Lee Jisun , Son Seung-Myoung 
Published: January 2020

Abstract

Rationale:
Schwannomas involving the thyroid gland are very rare and only a few cases have been reported in the literature. However, previous reports did not distinguish between thyroid bed schwannomas and intrathyroidal schwannomas. Here, we report a thyroid bed schwannoma mimicking a malignant thyroid nodule and review the literature on thyroid bed schwannomas.

Patient concerns:
A 33-year-old woman presented at our hospital with mild neck swelling.

Diagnosis:
Thyroid ultrasound revealed a well-defined, oval-shaped, markedly hypoechoic solid nodule with echogenic foci suggesting macro- and microcalcifications in the left thyroid gland. The lesion was considered a “highly suspicious” intrathyroidal nodule, based on the guidelines for the assessment of thyroid nodules. Fine needle aspiration was performed twice, but the cytological results were nondiagnostic.

Interventions:
Left thyroidectomy was performed, and schwannoma of the thyroid bed was confirmed on histopathologic analysis.

Outcomes:
The patient was in a stable condition after surgery, and the thyroid function test results were within the normal range.

Lessons:
Diagnosis of a schwannoma of the thyroid bed is challenging because its incidence is extremely low, and it is often misdiagnosed as an intrathyroidal nodule on ultrasonography. Therefore, it is advisable to adopt a diagnostic strategy to perform additional core needle biopsy in cases of thyroid nodules with nondiagnostic fine needle aspiration results and to consider the location of the lesion more carefully to determine the suitable therapy.
Use of nitroglycerin for parallel transverse uterine cesarean section in patients with pernicious placenta previa and placenta accrete and predicted difficult airway
Authors: Ma Yushan , You Yong , Jiang Xiaoqin , Lin Xuemei 
Published: January 2020

Abstract

Rationale:
The incidence of obstetric hemorrhage due to pernicious placenta previa (PPP) and placenta accreta is currently increasing in China. Parallel transverse uterine incision (PTUI) cesarean section (CS) is a novel technique designed to avoid transecting the placenta and control postpartum hemorrhage during CS in these patients in our hospital. A key point of anesthesia management related to PTUI CS involves keeping the uterus relaxed. General anesthesia (GA) has often been performed, and inhaled volatile anesthetics have traditionally been recommended for this purpose; however, GA may be contraindicated in patients with difficult airways.

Patient concerns:
The patient was predicted to have a difficult airway, and GA may have resulted in potentially life-threatening complications. An alternative and safer method of achieving uterine relaxation during PTUI CS was thus required.

Diagnoses:
The patient was diagnosed with PPP, and a predicted difficult airway was suspected preoperatively.

Interventions:
PTUI CS was planned to control postpartum hemorrhage and preserve fertility during CS. Uterine relaxation during PTUI CS was achieved with intravenous nitroglycerin under combined spinal-epidural anesthesia.

Outcome:
Intravenous nitroglycerin and combined spinal-epidural anesthesia achieved uterine relaxation during the time from delivery of the neonate to making the second transverse incision in the lower segment of the uterus during PTUI CS. Both the parturient and neonate were well and were discharged 4 days later.

Lessions:
Intravenous nitroglycerin and combined spinal-epidural anesthesia may offer an alternative to GA for achieving uterine relaxation in patients with PPP and a predicted difficult airway undergoing PTUI CS to control postpartum hemorrhage.
Pediatric-onset systemic lupus erythematosus with coronary artery dilation
Authors: Zhang Hui , Zhang Lijuan , Guo Nan 
Published: January 2020

AbstractIntroduction:Though pediatric-onset systemic lupus erythematosus (SLE) is at high risk of coronary artery involvement, coronary artery dilation appears to be a rare characteristic of pediatric-onset SLE. In this article, we described 1 pediatric-onset SLE patient with coronary artery dilation at the diagnosis of SLE, in order to better diagnose and manage this cardiac complication of SLE in children.Patient concerns:A 13-year-old boy was admitted in hospital for daily fevers with the highest temperature of 39.2°C over 10 days, with rash, non-exudative conjunctivitis, cervical adenopathy, knee, and ankle arthralgi. The result of echocardiogram implicated coronary artery dilation and aortic regurgitation. Further laboratory tests showed: Coomb's test (+), decreased C3 complement. The results of immunologic tests were only to find ANA (+) with titer 1:3200, ds-DNA (+).Diagnosis:This patient was diagnosed as SLE complicated with coronary artery dilation.Interventions:The patient was treated with intravenous methylprednisolone pulse therapy. He was discharged home on prednisone maintain treatment.Outcomes:As soon as treatment, his temperature returned to normal, with recovery of rash, conjunctivitis, knee, and ankle arthralgi. However, the echocardiogram of this patient after 3 months also had dilation of left coronary artery (LCA) and right coronary artery (RCA).Conclusions: Cardiac complication can occur during the entire course of SLE, suggesting that routine echocardiogram surveillance may be necessary for all SLE patients to prevent morbidity and mortality from cardiovascular events.
The prevalence of spinal muscular atrophy carrier in China
Authors: Li Chao , Geng Yanfang , Zhu Xiaodan , Zhang Linghua , Hong Zhantong , Guo Xiaoling , Xia Chenglai 
Published: January 2020

Abstract

Introduction:
Spinal muscular atrophy (SMA) was the second most fatal autosomal recessive hereditary disease in clinic. There had been no detailed study to characterize the prevalence of SMA carrier among people in China. So, we conducted a systematic review and meta-analysis to obtain a reliable estimation of the prevalence of SMA carrier to characterize its epidemiology for the first time.

Methods:
We systematically searched for articles in kinds of important electronic databases, including PubMed, Embase, Wanfang Database and China National Knowledge Infrastructure (CNKI) to identify all relevant literatures about carrier rates of SMA in China. The prevalence was performed by forest plot choosing random effect models. The publication bias was evaluated by means of funnel plots and Egger test. The sensitivity analysis was carried out by the method of omitting any literature at a time. Combined with the results of subgroup analysis, the source of heterogeneity was also discussed absolutely.

Results:
A total of 10 studies published between 2005 and 2016 were included in our analysis at last. The sample size ranged from 264 to 107,611 in included studies. The random effect models of meta-analysis showed that the overall carrier rate of SMA was 2.0% (95% confidence interval [CI], 1.7%–2.3%) in a heterogeneous set of studies (I2 = 64%). There was a gradual rise trend observed in the SMA carrier rate during the study period. The funnel plots and Egger test (Coef = 0.02, t = −0.45, P = .667 > .05) showed no obvious potential risk of publication bias.

Conclusion:
The overall carrying rate of SMA was high as 2.0% and may be on a slow upward trend. So it was recommended that the countries should take active and effective measures to roll out routine prenatal screening and health genetic counseling for SMA as early as possible. What is more, further studies also need to be conducted to explore the etiology and epidemic factors of SMA to better control the risk of this common birth defect.
Performance of 68Ga-DOTA-SST PET/CT, octreoscan SPECT/CT and 18F-FDG PET/CT in the detection of culprit tumors causing osteomalacia: a meta-analysis
Authors: Jiang Yuanyuan , Hou Guozhu , Cheng Wuying 
Published: January 2020

Objectives
The objective of this study was to assess and compare the performance of 68Ga-DOTA-conjugated-somatostatin-receptor-targeting-peptides (68Ga-DOTA-SST) PET/CT, octreoscan-SPECT/CT and 18F-FDG-PET/CT in the detection of tumor-induced osteomalacia (TIO).

Methods
Relevant studies reporting the performance 68Ga-DOTA-SST PET/CT, octreoscan-SPECT/CT and 18F-FDG-PET/CT in TIO were identified by searching PubMed, EMBASE, and Web of Science (last updated June 2019). Two authors independently extracted the numbers of true and false positives, and true and false negatives. The pooled estimates on a per-patient basis were calculated with 95% confidence interval (CI) obtained using a random-effects model.

Results
Fourteen studies comprising 346 patients were included in this meta-analysis. The meta-analysis provided the following results on a per-patient analysis. The pooled sensitivities of both 68Ga-DOTA-SST PET/CT (90%, 95% CI 82–95%) and octreoscan-SPECT/CT (83%, 95% CI 75–89%) were found to be significantly higher (P < 0.005) than that of 18F-FDG PET/CT (67%, 95% CI 53–80%). There was no statistically significant difference between the sensitivity of 68Ga-DOTA-SST PET/CT and octreoscan-SPECT/CT (P = 0.161). Owing to the low number of articles with true negative findings, the pooled specificities were not calculated. A total of 287 tumors were identified in 287 patients according to the data the included studies offered. The majority of the tumors were located in the lower extremities (59.6%, 171/287), followed by craniofacial regions (24.0%, 69/287), torso (9.4%%, 27/287), and upper extremities (6.9%, 20/287).

Conclusion
This meta-analysis demonstrates that somatostatin receptor-based imaging modalities outperformed 18F-FDG PET/CT in the detection of TIO, with 68Ga-DOTA-SST PET/CT performing slightly better than octreoscan-SPECT/CT.
Comparison of Choroidal Thickness Measurements Using Semiautomated and Manual Segmentation Methods
Authors: Zhao Mei , Alonso-Caneiro David , Lee Roger , Cheong Allen M. Y. , Yu Wing-Yan , Wong Ho-Yin , Lam Andrew K. C. 
Published: February 2020

SIGNIFICANCE
This study demonstrated that a semiautomated segmentation method could help inexperienced practitioners to obtain choroidal thickness as good as experienced practitioners.

PURPOSE
The purpose of this study was to compare choroidal thickness measurements obtained by semiautomated and manual segmentation methods.

METHODS
Optical coherence tomography images of 37 eyes from 37 healthy young subjects acquired by a spectral-domain optical coherence tomography device were reviewed retrospectively. Two naive examiners measured choroidal thickness using manual and semiautomated methods, whereas two experienced examiners used only the semiautomated method. The semiautomated method referred to a fully automated segmentation program customized based on MATLAB and followed manual verification. After highlighting the inner and outer choroidal boundaries through automated segmentation, examiners reviewed these boundaries in each B-scan and conducted manual revisions if segmentation errors occurred. After selecting points where correct boundary was located, the software used a spline fit to blend the corrected region with the rest of the boundary. All measurements were summarized in a 6-mm Early Treatment Diabetic Retinopathy Study grid. Operation time spent to complete retinal and choroidal segmentation on each eye was recorded. Between-examiner agreements, that is, intraclass correlation coefficient and coefficient of reproducibility (CoR), were calculated among four sets of semiautomated measurements, and within-examiner agreements were comparisons between manual and semiautomated results from the same naive examiners. Eyes with thin or thick choroids were also analyzed separately.

RESULTS
The between-examiner and within-examiner agreements were excellent with intraclass correlation coefficient of 0.976 or greater. Pairwise within-examiner CoRs ranged from 17.4 to 47.1 μm. Pairwise between-examiner CoRs were between 13.0 and 38.9 μm. Eyes with thin choroid had better agreements than those with thick choroids. On average, naive examiners saved 3 to 5 minutes per eye using the semiautomated method.

CONCLUSIONS
With the help of a dedicated software, inexperienced practitioners could obtain choroidal thickness measurements with accuracy similar to experienced practitioners. Processing time with the semiautomated method was also reduced.
Assessing the Impact of En Face Retinal Nerve Fiber Layer Imaging on Clinical Decision Making for Glaucoma Suspects
Authors: King Brett J. , Swanson William H. , Klemencic Stephanie A. , Chaglasian Michael , Teitelbaum Bruce A. , Clark Christopher A. , Speilburg Ashley M. , Grogg Jane Ann , Peabody Todd D. 
Published: February 2020

SIGNIFICANCE
Assessing and managing glaucoma are a complicated process in which experience plays a key role in decision making. Although advanced glaucoma is more easily diagnosed, patients with early glaucoma or who present with suspicious findings are more complicated. A need to aid clinicians in the decision-making process exists.

PURPOSE
The purpose of this study was to assess the impact of en face ocular coherence tomography images to clinical decision making when added to standard presentations of circumpapillary retinal nerve fiber layer thickness and automated perimetry.

METHODS
Thirty participants from two centers presenting either as a glaucoma suspect or for an initial glaucoma evaluation were enrolled. Six masked investigators were given standard presentations of circumpapillary retinal nerve fiber layer thickness and perimetry. They were asked if glaucomatous damage was present as well as a recommended plan of management on 5-point Likert scales. They were then given en face images of the retinal nerve fiber layer in three different presentations coupled with the standard presentation, and the questions were repeated. An intraclass correlation coefficient (ICC) was generated.

RESULTS
The masked investigators had moderate agreement from the standard presentation for assessment (ICC = 0.67 [95% confidence interval {CI}, 0.54 to 0.80] and ICC = 0.69 [95% CI, 0.52 to 0.80], respectively), as well as with the addition of the en face images (ICC = 0.69; 95% CI, 0.56 to 0.81). The en face images tended to change decisions in both assessment and plan toward likely to have glaucoma and likely to start treatment.

CONCLUSIONS
The addition of en face images to a standard presentation has an impact on clinical decision making. Although en face images seem to influence the decision toward likely to have glaucoma and likely to treat, it is unclear if this leads to a more accurate decision. Further investigations seem warranted to assess sensitivity and specificity of this approach.
An 8-Year Retrospective Study on Suicides in Washington, DC
Authors: Cuchara Breanna , Diaz Francisco J. 
Published: January 2020

Abstract
The suicide rate in the United States has been increasing steadily over the previous 10 years. In DC, these results are not mirrored. The suicide rate has a tendency to be lower than the rest of the country. During this retrospective review of suicides in DC, factors such as medical history and toxicology results were examined.
In this study performed over 8 years (2009–2016), 394 suicides occurred. It was found that decedents committed suicide mostly by hanging (31.2%), firearms (20.3%), or drug intoxication (15.7%). The average age was 44.5 years. Similar to national statistics, male individuals committed suicide at a higher rate (77.9%) than did female individuals (22.1%). The toxicology data showed that ethanol (26.4%), antidepressants (20.1%), opioids (14.9%), and benzodiazepines (12.9%) were the drugs most frequently involved, although the finding of no drugs was most common (33.7%). Ethanol was present in 5 methods of suicide that include death by hanging, drowning, firearm, suffocation, and poisoning.
This research provides information that may be useful for public health officials when confronting the issue of suicide. It is hoped that it will encourage other medical examiner offices to perform toxicological analysis and autopsy of all suicide cases.
Early Recognition and Emergency Treatment of Sepsis and Septic Shock in Children
Authors: Hilarius Kristel W.E. , Skippen Peter W. , Kissoon Niranjan 
Published: February 2020

Abstract
Early diagnosis and treatment of sepsis and septic shock in children results in improved outcomes. However, diagnosis is hampered by lack of specific diagnostic tests and relies on the recognition of the alterations of vital signs and protean systemic manifestations associated with infections, signs that mimic many critical illnesses. As a result, the early diagnosis of sepsis is usually presumptive and is based on the suspicion or presence of an infection in combination with the systemic changes. Suspicion should be heightened in vulnerable risk groups such as those with immune compromise due to underlying disease or medication use. Thus, on many occasions, treatment of sepsis is initiated on clinical suspicion pending the outcomes of ongoing evaluations and laboratory findings.
What is of relevance to the emergency clinicians is the initial recognition, resuscitation, and treatment in the first few hours of presentation. To best accomplish these tasks, contemporary guidelines suggest that the use of a “recognition bundle” containing a trigger tool for rapid identification, a “resuscitation and stabilization bundle” to enable adherence to best practice, and a “performance bundle” to identify and overcome barriers to best practice be used.
Although there are no universally acceptable tools to accomplish these tasks, the various iterations used in quality improvement initiatives have consistently demonstrated better care processes and outcomes. In this article, we outline the contemporary approach to sepsis in the first hours after presentation.
Distraction Therapy to Correct Trismus Following Noma
Authors: Holle Jürgen , Kubiena Harald , Issa Ousmane Hamady 
Published: January 2020

Abstract
Trismus is a frequent complication of healed Noma infection and is caused by soft tissue and muscle contraction. Free-flap surgery is recommended to replace the missing oral mucosa and soft tissue. However, significant complications can occur if this surgery is performed in places like Africa, where conditions are usually less than optimal. In 2007, the authors started to treat patients with trismus in Niamey, Niger by distracting the soft tissue and muscle constriction between the jaws with a bone distractor continuously for 1 month with the aim of achieving a mouth opening of 3 cm. The distraction was limited to 1 mm/d. performed under local anesthesia with some sedation. Minor complications such as infection in the pin holes were easily managed. In 2009, 2 patients with trismus after Noma with a follow-up of 2 years were reported. Till date, the authors have successfully performed trismus release in more than 69 patients in Niamey and Guinea Bissau. The present study analyses the results of distraction therapy in 40 patients with follow-ups until 60 months. At the end of distraction, the mean interincisal distance was 2.7 ± 0.5 cm. Mouth opening 6 months after distraction had not reverted. However, 3 to 5 years after treatment, some signs of relapse were detected, with an average mouth opening of 1.5 ± 1.9 cm. Physiotherapy was unfortunately not feasible. The presented results strongly support the efficacy of distraction therapy to correct trismus in Noma patients.
Reducing Donor-specific Antibody During Acute Rejection Diminishes Long-term Renal Allograft Loss: Comparison of Early and Late Rejection
Authors: Lichvar Alicia B. , Tremblay Simon , Leino Abbie D. , Shields Adele R. , Cardi Michael A. , Abu Jawdeh Bassam G. , Govil Amit , Kremer Joseph , Cuffy Madison , Paterno Flavio , Diwan Tayyab , Brailey Paul , Girnita Alin , Alloway Rita R. , Woodle E. Steve 
Published: January 2020

Background.
Reduction in donor-specific antibody (DSA) has been associated with improved renal allograft survival after antibody-mediated rejection (AMR). These observations have not been separately analyzed for early and late AMR and mixed acute rejection (MAR). The purpose of this study was to evaluate long-term responses to proteasome inhibitor–based therapy for 4 rejection phenotypes and to determine factors that predict allograft survival.

Methods.
Retrospective cohort study evaluating renal transplant recipients with first AMR episodes treated with proteasome inhibitor–based therapy from January 2005 to July 2015.

Results.
A total of 108 patients were included in the analysis. Immunodominant DSA reduction at 14 days differed significantly (early AMR 79.6%, early MAR 54.7%, late AMR 23.4%, late MAR 21.1%, P < 0.001). Death-censored graft survival (DCGS) differed at 3 years postrejection (early AMR 88.3% versus early MAR 77.8% versus late AMR 56.7% versus late MAR 54.9%, P = 0.02). Multivariate analysis revealed that immunodominant DSA reduction > 50% at 14 days was associated with improved DCGS (odds ratio, 0.12, 95% CI, 0.02-0.52, P = 0.01).

Conclusions.
In summary, significant differences exist across rejection phenotypes with respect to histological and DSA responses. The data suggest that DSA reduction may be associated with improved DCGS in both early and late AMR.
Biomimetic optics: liquid-based optical elements imitating the eye functionality
Authors: Ivanova Natalia 
Published: February 2020

The optical systems mimicking the eye functions are of great importance in various applications including consumer electronics, medical equipment, machine vision systems and robotics. This optics offers advantages over traditional optical technologies such as the superior adaptation to changing conditions and the comprehensive range of functional characteristics at miniature sizes. This paper presents a review on the recent progress in the development of human eye-inspired optical systems. Liquid-based and elastomer-based tunable optical elements are discussed with the focus on the actuation mechanism, optical performance and the possibility of integration into artificial eye systems.
This article is part of the theme issue ‘Bioinspired materials and surfaces for green science and technology (part 3)’.
Evaluation of Myocardial Perfusion and Immune Cell Response in Cardiac Allograft Dysfunction of Heart-Transplant Patients
Authors: Kim Paul J. , Contijoch Francisco , Morris Gerald P. , Wong Darrin , Chi Neil C. , Yarahmadi Pourya , Tada Yuko , Salmi Darren , Nguyen Patricia 
Published: January 2020

BackgroundWe investigated the myocardial perfusion differences and changes in immune cell response in heart-transplant patients with nonspecific graft dysfunction (NGD) compared to cardiac allograft vasculopathy (CAV) patients and normal heart-transplant patients.Methods and ResultsWe prospectively studied 17 heart-transplant patients (59.8±14.1 years, 78% male) from January to June 2016. Regadenoson stress cardiac MRI was performed in the patients and peripheral blood obtained contemporaneously to isolate peripheral blood mononuclear cells (PBMCs). Stress myocardial perfusion showed significantly decreased myocardial perfusion using maximum upslope method in NGD and CAV patients compared to normal heart-transplant patients. Myocardial scar by late gadolinium enhancement also was significantly increased in nonspecific graft dysfunction patients compared to normal. Evaluation of PBMCs by flow cytometry showed a trend towards increased activated HLA-DR+T cells in NGD patients compared to normal. Clinical outcomes for cardiac hospitalization, allograft loss/retransplant, death were assessed at 8 years.ConclusionsNGD shows decreased stress myocardial perfusion by cardiac MRI and a trend towards increased activated T cells in PBMCs, suggestive of an immune-mediated cause for allograft dysfunction.