bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical features and diagnosis of new malignancy in patients with acute pulmonary embolism and without a history of cancer
Authors: Lin Yen-Chung , Chen Su-Chan , Huang Chi-Ming , Hu Yu-Feng , Chen Yun-Yu , Chang Shih-Lin , Lo Li-Wei , Lin Yenn-Jiang , Chen Shih-Ann 
Published: January 2020

Background:
Pulmonary embolism (PE) is frequently associated with cancer. This study aimed to assess patients with acute PE and identify diagnostic predictors of new cancer after 1 year of follow-up.

Methods:
One hundred and twenty-one patients with PE were enrolled consecutively from the emergency department of a single medical center in Taiwan. Data from computed tomography angiography, echocardiogram, electrocardiogram and for baseline comorbidities, clinical presentation, and laboratory parameters were recorded. The surviving discharged patients without a cancer diagnosis were followed-up for 1 year, and new malignancies were recorded.

Results:
Of 121 patients with acute PE, 44 (36%) had an underlying cancer history (cancer group), and 77 (64%) did not (noncancer group). Baseline demographic characteristics, comorbidities, clinical symptoms, biochemical parameters, echocardiogram data, and electrocardiogram data of the two groups were similar except for a higher hospital mortality rate (56.8% vs 9.1%; p < 0.001), lower body mass index (22.6 ± 4.1 vs 25.5 ± 4.9; p =0.02), higher systolic blood pressure (139.7 ± 33.7 vs 125.4 ± 24.1; p = 0.02), lower low-density lipoprotein level (67.4 ± 38.3 vs 90.4 ± 33.8; p = 0.04), lower creatinine kinase (CK; 43.0 ± 43.0 vs 83.5 ± 83.1; p = 0.01), higher myocardial band (MB) form of CK ratio (0.2 ± 0.2 vs 0.1 ± 0.1; p < 0.01), higher partial pressure of arterial oxygen (122.81 ± 81.2 vs 90.2 ± 59.4; p = 0.03), and less presentation of chest pain (15.9% vs 40.3%; p = 0.01) in the cancer group. Kaplan–Meier curve analysis revealed that the 30-day survival rate was higher in the noncancer group than in the cancer group (log-rank p = 0.04). After 1 year of follow-up, 6 of 59 (10.17%) initial non–cancer-related PE survivors were diagnosed with malignancies. After multivariate analysis, only the initial CK-MB level was associated with a diagnosis of new cancer (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.029–1.811; p = 0.03).

Conclusion:
This study suggests that the CK-MB level is associated with future malignancy in patients with PE. Patients with cancer-related PE had a worse 30-day survival rate.
Bone Pate Obliteration in Canal Wall Down Mastoidectomy: Modifications of an Established Technique
Authors: Fischer Jakob L. , Nesbitt Nicholas B. , Littlefield Philip D. 
Published: January 2020

Objective:To describe outcomes with obliteration of the mastoid and medial attic following canal wall down mastoidectomy for cholesteatoma. Our technique uses bone pate in the mastoid and cartilage in the epitympanum and supratubal recess.Study Design:Retrospective observational study.Setting:Tertiary medical center.Patients:Ten years of sequential canal wall down mastoidectomies with obliteration from one neurotologist were reviewed. This included primary and revision cases in adults and children.Main Outcome Measures:Complications, location and extent of cholesteatoma, the presence of a dry ear after surgery, cholesteatoma recidivism, revision procedures, and postoperative hearing.Results:Seventy-eight patients (79 ears) met inclusion criteria. There were few major complications. There was active follow-up of a year or more in 61. For these, the mean follow-up was 3.1 years, and approximately 90% had a dry cavity for the remainder of their follow-up. About half required minimal (if any) maintenance. There were five cases with residual disease, and no cases with recurrent disease. There were five cases that were considered failures, with three taking several years to manifest. There were no cases where cholesteatoma was buried in bone pate. A sizeable minority continued to have active tubotympanic disease despite successful treatment of the attic and mastoid.Conclusions:This seems to be a safe and reliable means to eradicate cholesteatoma and create a dry, low-maintenance cavity. It is not a cure for tubotympanic disease, and a small minority of initially stable cavities may fail several years following surgery.Level of Evidence: 4.
Rotational and translational osteotomy for treatment of severe deformity in hypophosphatemic rickets
Authors: Li Jin , Rai Saroj , Ze Renhao , Tang Xin , Liu Ruikang , Hong Pan 
Published: January 2020

Abstract

Rationale:
Hypophosphatemic rickets (HR) is a rare hereditary disease characterized by hypophosphatemia, defects in bone mineralization, and rickets, and surgical intervention is warranted for the patient of severe skeletal deformity.

Patient concerns:
Here we report a case of an 11-year-old boy who presented with severe varus deformities of the bilateral lower extremities and was associated with uncoordinated gait with multiple unintentional falls onto ground resulting in fractures of lower extremities.

Diagnoses:
He was diagnosed as HR caused by genetic mutations in the phosphate-regulating endopeptidase homologue. Based on his family history and laboratory tests, including high serum alkaline phosphatase, high urinary phosphorus, hypophosphatemia, and normal serum calcium level, the patient was diagnosed with this disorder.

Interventions:
Rotational and translational osteotomy was performed to redress the severe varus deformity and readjust the malalignment of the lower extremity.

Outcomes:
Right after the surgery, the alignment in the left lower extremity was readjusted, and his appearance seemed normal. Combined with rehabilitation and pharmacological intervention, including oral intake of phosphate and alphacalcidol, the bone healed uneventfully. After the second surgery of a similar procedure on the right femur, the patient was able to walk almost like a normal teenager.

Lessons:
This case proposed a novel technique to treat severe varus or valgus deformity of the lower extremity. HR is a rare disease, and it is important to stress its recognition to avoid delay of diagnosis and surgical intervention if necessary.
Fatal and extensive multiorgan hemorrhages in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis
Authors: Watanabe Tsuyoshi , Takizawa Naoho , Nagasaka Toru , Nakamura Yoshihiro , Ikai Hiroki , Yamamoto Mari , Murai Yukari , Takasugi Koji , Yokoyama-Kokuryo Waka , Fujita Yoshiro 
Published: January 2020

Abstract

Introduction:
Anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) is an autoantigen associated with dermatomyositis (DM). Anti-MDA5 Ab-positive DM patients frequently exhibit clinically amyopathic dermatomyositis (CADM), and develop rapidly progressive interstitial lung disease (RPILD). Even with early detection and potent combination immunosuppressive therapy, anti-MDA5 Ab-positive DM patients have a poor prognosis. In the present case report, we present a rare autopsy case of a patient with anti-MDA5 Ab+ DM with RPILD who exhibited diffuse alveolar damage (DAD) patterning in lung specimens, and extensive hemorrhages in multiple organs.

Patient concerns:
An 82-year-old Japanese man admitted with bacterial pneumonia was subsequently diagnosed with anti-MDA5 Ab-positive DM based on skin manifestations (mechanic's hand, ulcerated palmar papules, and flagellate erythema), myositis, interstitial pneumonia, and elevation of anti-MDA5 Ab titer.

Diagnosis:
The patient was diagnosed with anti-MDA5 Ab+ DM, complicated with RPILD.

Interventions:
The patient received potent immunosuppressive therapy consisting of pulse methylpredonisolone at a dose of 1000 mg for 3 days, followed by prednisolone at 60 mg/d, a 1000 mg pulse of intravenous cyclophosphamide (IVCY), and oral tacrolimus at 6 mg/d. Intravenous immunoglobulin (IVIG) at a dose of 400 mg/kg/d for 5 days was subsequently administered.

Outcomes:
Despite triple immunosuppressive therapy and IVIG, the patients’ respiratory status deteriorated, and the patient died of respiratory failure on the twelfth day after admission. An autopsy revealed pulmonary DAD and multiorgan hemorrhages, including the left iliopsoas muscle, gastric and bowl mucosa, spleen, and left adrenal gland.

Lessons:
Multiorgan hemorrhages may be a fatal complication in anti-MDA5 Ab+ DM patients.
The efficacy and safety of Health Qigong for ankylosing spondylitis
Authors: Liu Biyuan , Fan Zhu , Wang Zheyi , Li Man , Lu Tao 
Published: January 2020

Abstract

Background:
Non-pharmacological treatments (education, exercise, and physical therapy) are remain basic approaches to long-term management of ankylosing spondylitis (AS) patients. As an important part of non-pharmacological treatments, Health Qigong is widely used for AS treatment. We will perform the systematic review to confirm the safety and efficacy of Health Qigong for AS.

Methods:
Systematical search of 6 electronic databases will be done, including English and Chinese, until December 2019. All randomized controlled trials (RCTs) involving Health Qigong in combination with conventional therapy for AS will be included. Study selection, data extraction, and validation were performed independently by 2 reviewers. RevMan (V.5.3) will be used for mata-analysis.

Results:
This systematic review will identify the safety and efficacy of Health Qigong in the treatment of AS and update evidence summaries of Health Qigong. At the end of the treatment, the primary outcome is Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) with a range of 0 to 10,and the secondary outcomes will include functional ability that measured by Bath Ankylosing Spondylitis Functional Index (BASFI), mobility measured by Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion, night spinal pain, adverse reactions, laboratory measures such as erythrocyte sedimentation rate (ESR) and C protein response (CRP).

Conclusion:
This study will provide evidence that whether Health Qigong can benefit patients with ankylosing spondylitis by reducing disease activity, alleviating pain to support the application of Health Qigong in the AS treatment.

Registration number:
CRD42019159126
Risk factors for gallstone disease in Shanghai
Authors: Gu Qiyun , Zhou Guoqing , Xu Tao 
Published: January 2020

Abstract
The purpose of this study was to evaluate related risk factors for gallstone disease in Shanghai.
We analyzed successive physical examinations of 2288 adults who were recruited at the Jinshan Branch of the Sixth People's Hospital of Shanghai and Jinshan Hospital Affiliated to Fudan University Hospital from July 2010 to December 2012. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to measure the influence factors on the risks of gallstone development.
The incidence of gallstone disease was 4.11% (94/2,288). Older age (OR: 1.02; 95% CI: 1.00–1.03; P = .039), higher body weight (OR: 1.02; 95% CI: 1.00–1.04; P = .021), alanine transaminase activity (ALT) (OR: 1.02; 95% CI: 1.01–1.03; P = .001), total standard bicarbonate (SB) (OR: 1.04; 95% CI: 1.02–1.06; P < .001), free SB (OR: 1.17; 95% CI: 1.12–1.21; P < .001), and low density lipoprotein (LDL) levels (OR: 1.59; 95% CI: 1.32–1.91; P < .001) were associated with an increased risk of gallstone disease. Based on univariate logistic analysis, increased triglyceride (TG) levels were associated with a reduced risk of gallstone disease (OR: 0.76; 95% CI: 0.60–0.97; P = .024). The results of multivariable logistic regression analysis showed higher LDL levels correlated with an increased risk of gallstone disease (OR: 1.92; 95% CI: 1.31–2.81; P < .001), while age, weight, ALT, total SB, free SB, and TG levels did not affect the risk of gallstone disease.
The although unadjusted results showed age, weight, ALT, total SB, free SB, TG, and LDL levels to be associated with the risk of gallstone disease, adjusting for potential factors revealed only increased LDL levels to be associated with an increased risk of gallstone disease.
Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis in a small child
Authors: Mărginean Maria Oana , Molnar Eniko , Chinceşan Mihaela Ioana 
Published: January 2020

Abstract

Introduction:
Hemophagocytic lymphohistiocytosis (HLH) is a rare, potentially lethal disorder, characterized by a dysregulation of the immune response, leading to a severe inflammatory syndrome. Epstein–Barr virus (EBV)-associated HLH is a form of secondary HLH, a fulminant presentation of an otherwise benign viral infection.

Patient concerns:
We report the case of a 3-year-old girl who presented with fever, signs of accute upper respiratory tract infection and spontaneous, disseminated ecchymoses. Initial laboratory tests revealed pancytopenia. A bone marrow aspirate was performed, which revealed megaloblasts and numerous macrophages, with abundant foamy cytoplasm. Megaloblastic anemia was excluded, as the levels of vitamin B12 and folic acid were both within normal ranges.

Diagnosis.
Hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia, and splenomegaly were relevant criteria for the diagnosis of HLH, in accordance with the bone marrow specimen. Positive immunoglobulin M antibodies for EBV were supportive of an acute EBV infection, which was the most probable trigger of HLH. The patient's evolution was complicated by a massive epistaxis, in the context of thrombocytopenia which required plasma, thrombocyte, and erythrocyte substitutes.

Intervention.
The patient was started on a treatment regimen of 8 weeks with etoposide and dexamethasone.

Outcome:
Her evolution was favorable, the treatment being successful in remission induction.

Conclusion:
Our case emphasizes the diagnostic challenges of HLH, in a patient with EBV infection whose evolution was hindered by a severe epistaxis, with potentially fatal outcome.
Pyogenic tenosynovitis of the wrist due to Corynebacterium striatum in a patient with dermatomyositis
Authors: Kawaguchi Yohei , Okamoto Hideki , Endo Kojiro , Iwata Hidetoshi , Joyo Yuji , Nozaki Masahiro , Tamechika Shinya , Waguri-Nagaya Yuko , Murakami Hideki 
Published: January 2020

Abstract

Introduction:

Corynebacterium striatum is common contaminant in clinical specimens. Here, we report a rare case of pyogenic tenosynovitis of the wrist caused by C striatum in a dermatomyositis patient taking oral immunosuppressants.

Patient concerns:
A 67-year-old Japanese woman with dermatomyositis had a history of multiple intraarticular injections of corticosteroids to the right wrist joint for the treatment of osteoarthritis. She was admitted to our hospital with a painful lump on the right dorsal wrist lasting for three months. MRI revealed cellulitis of the dorsum of the right wrist and hand and fluid collection in the extensor tendon sheath. C striatum was detected in the cultures of three samples of synovial fluid taken from the dorsal hand.

Diagnosis:
Pyogenic tenosynovitis of the wrist due to C striatum.

Interventions:
The infection was successfully controlled with synovectomy and adjuvant antibiotic therapy.

Outcomes:
There has been no sign of recurrence for 12-months after the surgical treatment.

Lessons:
This is the first reported case of pyogenic tenosynovitis due to C striatum in a patient with dermatomyositis. Clinicians should be aware that patients undergoing immunosuppressive therapy have a risk of C striatum infection.
Idiopathic humeral head osteonecrosis mimicking rotator cuff disorders
Authors: Kuo Fang-Yu , Chen Kuan-Lin , Yen Chieh-Chi 
Published: January 2020

Abstract

Rationale:
Shoulder pain is a common complaint among patients, and rotator cuff disorders are the most common diagnoses. Humeral head osteonecrosis is easily masked by other more common diagnoses and concomitant conditions.

Patient concerns:
This challenging diagnostic report consists of 2 cases. Case 1 was that of a 59-year-old man who presented with right shoulder pain that had lasted for >1 year. Case 2 was that of a 52-year-old man who complained of right shoulder pain lasting for 6 months. They both presented with chronic right shoulder pain without relevant trauma history, and the physical examination showed a tenderness point over the right greater tuberosity.

Diagnosis:
These 2 patients were diagnosed with osteonecrosis involving the right greater tuberosity region via magnetic resonance imaging.

Interventions:
In case 1, the patient underwent cord decompression and artificial bone grafting with C-arm guidance. In case 2, the patient refused surgical intervention and decided to continue receiving physical therapy for symptom control.

Outcomes:
In case 1, the patient responded well to cord decompression and artificial bone grafting. After the surgery, the active range of motion was restored and the pain in the right shoulder diminished further. In case 2, conservative treatment helped alleviate the patient's shoulder pain but did not entirely eliminate it.

Lessons:
Physicians should always have a high index of suspicion for osteonecrosis, especially when treating chronic shoulder pain, regardless of whether there are typical symptoms/known risk factors or not.
Gene expression profile and bioinformatics analysis revealed key molecular characteristics of chordoma—before and after TNF- a treatment
Authors: Xu Guoyong , Liu Chong , Liang Tuo , Zhang Zide , Jiang Jie , Chen Jiarui , Xue Jiang , Zeng Haopeng , Lu Zhaojun , Zhan Xinli 
Published: January 2020

Abstract

Background:
Chordoma is a rare malignant tumor with limited treatment. Recent studies have shown that the proliferation and invasion ability of chordoma after Tumor necrosis factor alpha (TNF-α) treatment is enhanced, which may activate the gene pathway involved in the development of chordoma. This study tends to identify differentially expressed genes (DEGs) before and after treatment of TNF-α in chordoma cell line, providing a new target for future molecular therapy of chordoma.

Methods:
The gene expression profile of GSE101867 was downloaded from the Gene Expression Omnibus database, and the differentially expressed genes were obtained using GEO2R. Based on the CLUEGO plugin in Cytoscape, DEGs functionality and enrichment analysis. A protein-protein interaction (PPI) network was constructed using Cytoscape based on data collected from the STRING online dataset. The Hub genes are selected from the CytoHubba, the first 20 genes that coexist with the KEGG tumor-related pathway.

Results:
A total of 560 genes, including 304 up-regulated genes and 256 down-regulated genes, were selected as DEGs. Obviously, GO analysis shows that up-regulated and down-regulated DEGs are mainly enriched in biological processes such as synaptic tissue, cell adhesion, extracellular matrix organization and skeletal system development. DEGs are mainly enriched in tumor-associated pathways such as Pi3k-akt Signal path, Rap1 signal path. Three key genes were identified: PDGFRB, KDR, FGF2. All of these genes are involved in the tumor-associated pathways described previously.

Conclusion:
This study is helpful in understanding the molecular characteristics of chordoma development. Hub genes PDGFRB, KDR, FGF2 and pi3k-akt signaling pathway, Rap1 signaling pathway will become a new target for the future treatment of chordoma.
Pulmonary intimal sarcoma involving the pulmonary valve and right ventricular outflow tract
Authors: Xu Rui , Zhao Yixuan , Xu Xiaosen , Liu Shuang , Hu Chenyu , Lv Dongmei , Wu Huiying 
Published: January 2020

Abstract

Introduction:
Pulmonary artery intimal sarcoma (PAIS) is a rare and highly aggressive tumor, and approximately 80% of pulmonary cases occur in the pulmonary trunk. We report herein a case of retrograde extension of the sarcoma to the pulmonary valve and right ventricle, which is an uncommon manifestation of this lethal tumor.

Patient concerns:
A 41-year-old woman was initially diagnosed with pulmonary thromboembolism (PTE) and transferred to our hospital.

Diagnosis:
Computed tomographic pulmonary angiography (CTPA) showed that there are low-density filling defects in both pulmonary arteries, and the patient was diagnosed with PTE. However, the ultrasonographers considered that the lesion is a space-occupying type that involves the right ventricular outflow tract and pulmonary valve instead of PTE. Postoperative pathology confirmed the diagnosis of PAIS.

Interventions:
The patient underwent resection of pulmonary artery sarcoma and endarterectomy.

Outcomes:
During the follow-up via telephone 1 month after discharge, the patient reported to have been feeling well.

Conclusion:
Owing to the rarity of the disease and its non-specific clinical manifestations, approximately half of the PAIS cases are misdiagnosed or have a delayed diagnosis. Thus, improving our understanding of the disease and facilitating its early diagnosis are essential.
Efficacy and safety of dexmedetomidine combined with tramadol for patient-controlled intravenous analgesia in Chinese surgical patients
Authors: Chen Peng , Chen Fuchao , Lei Jiexin , Zhou Benhong 
Published: January 2020

Abstract

Background:
Patient-controlled intravenous analgesia (PCIA) has been suggested as an effective method of pain relief. There are several randomized controlled trials (RCTs) of dexmedetomidine (DEX) combined with tramadol for PCIA in Chinese surgical patients. The purpose of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of DEX combined with tramadol for PCIA in Chinese surgical patients from current data.

Methods:
The RCTs of DEX combined with tramadol for PCIA were gathered from the PubMed, Excerpta Medica Database, Cochrane Library, Cochrane Library, China National Knowledge Infrastructure database, and VIP databases. After data extraction and quality assessment of the included RCTs, RevMan 5.3 software was employed for the meta-analysis of visual analog scale (VAS) scores, Ramsay sedation scores, effective pressure times for PCIA, tramadol consumption, and safety.

Results:
Fourteen RCTs were included. Compared with tramadol alone, postoperative intravenous tramadol-DEX combination PCA led to lower VAS scores (weighted mean differences [WMD]12h = 0.14, 95% confidence interval [CI] v1.50 to 1.79; WMD24h = 0.78, 95% CI −0.92 to −0.62; WMD48h = 0.51, 95% CI −0.66 to −0.38; all P
< .05), lower Ramsay sedation scores (WMD24h = 0.08, 95% CI −0.14 to −0.02; WMD48h = 0.09, 95% CI −0.11 to −0.07; all P
< .05), and less postoperative tramadol consumption (WMD0–24h = −102.59 mg, 95% CI −149.68 to −55.49; WMD0–48h = −152.91 mg, 95% CI −259.93 to −45.89; all P < .05). With regard to safety, there was a significant difference between DEX-tramadol and tramadol for PCIA in terms of the incidence of postoperative nausea and vomiting, dizziness, chills, and restlessness (all P
< .05).

Conclusion:
According to the domestic evidence, this systematic review and meta-analysis suggests that DEX-tramadol PCIA is superior to tramadol in terms of analgesic efficacy and safety for Chinese surgical patients. However, because of some clear limitations (sample size and heterogeneity), these results should be interpreted with caution. Further large-scale and well-designed studies are needed to summarize and analyze the data to draw a more convincing conclusion.