bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of lower esophageal gastric tube implantation in postoperative enteral nutritional support in patients with laryngeal cancer
Authors: Xiao Hongying , Liu Jianmin , Liu Sisi , Chen Xiaofang 
Published: April 2020

Abstract

Background:
For a long time, postoperative nutritional support for laryngeal cancer patients has depended on the gastric tube for enteral nutrition. Silica gel gastric tube is often used in clinical practice; however, the gastric tube placed in the conventional depth often leads to various complications in the stomach, thus damaging the nutritional status of patients and leading to the poor prognosis.

Methods/design:
A total of 80 patients with laryngeal cancer in otolaryngology, head and neck surgery department of Deyang people's hospital from May 2020 to April 2022 will be selected and randomly divided into control group and experimental group according to the numerical table. Patients in the control group will receive conventional gastric tube placement, with a depth of 45 to 55 cm, which can extract gastric juice. B-ultrasound accurately positioned the gastric tube in the stomach instead of the cardia, and postoperative nasal feeding nutrition will be provided. In the experimental group, the gastric tube will be pulled out 10 cm after conventional placement and no gastric juice will be extracted. B-ultrasonography verified that the gastric tube will be located below the esophagus or above the cardia, and routine nasal feeding will be performed postoperatively. Analysis for comfort and prognosis were performed by general comfort questionnaire and various index including height, body mass index, albumin value, electrolyte, wound healing, pharyngeal fistula.

Discussion:
In this study, visual simulation scale and general comfort questionnaire developed by Kolaba, an American comfort nursing specialist, were used to evaluate the comfort level of the 2 groups of patients, including pain, acid reflux, upper abdominal burning sensation, and hiccup. Objective indexes such as height, body mass index, albumin value, electrolyte, wound healing, and pharyngeal fistula were used to evaluate the prognosis of the 2 groups of patients. The visual simulation scale can preliminarily judge the subjective feelings of patients.

Trial registration:
It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000030378), Registered February 29, 2020.
Congenital unilateral proximal radioulnar synostosis
Authors: Jia Yuqing , Geng Chunyuan , Song Zikai , Lv Shijie , Dai Bin 
Published: April 2020

Abstract

Rationale:
Congenital proximal radioulnar synostosis is a rare genetic malformation of the upper limb. This deformity, which is found mainly in preschool-aged children, has no recognized diagnosis and treatment. Current diagnostic methods cannot effectively assess both bone structure and soft tissue abnormalities, and most surgical treatments introduce complications and do not prevent recurrence. More work is needed; therefore, to address the diagnosis and treatment of this disease.

Patient concerns:
An 8-year-old male patient was hospitalized in our department. He reported deformity and limited motion in his right elbow for the past 2 years. He denied a traumatic or family history of bony malformation. The chief complaint at the time of the hospitalization was the limitation in forearm rotation.

Diagnosis:
Digital radiography of the right elbow joint showed proximal radioulnar synostosis and a valgus deformity. A 3-dimensional computed tomography scan further showed proximal ulna and radius dysplasia as well as anterior dislocation of the radius head. The patient was diagnosed with congenital right proximal radioulnar synostosis.

Interventions:
Surgical procedures included arthrolysis of the right proximal radioulnar joint, osteotomy of the proximal radius, internal fixation with Kirschner wires, and reconstruction of the annular ligament. The right elbow was immobilized in plaster in a flexion and supination position for 2 weeks.

Outcomes:
Recurrence of the right proximal radioulnar synostosis was observed during the 6-month follow-up, but the rotation function of the patient's forearm was significantly improved.

Lessons:
The findings from this case suggest that we should carefully monitor all patients younger than 6 years old who report long-term issues with forearm rotation. This case also highlights the need to assess soft tissue and epiphysis abnormalities in addition to bone assessments via digital radiography and 3-dimensional computed tomography. We suggest that surgery should not be performed until the proximal radius epiphysis has closed. Not all cases require surgical treatment, but when surgery is needed, a suitable method should be selected according to the individual needs of the patient. Any surgery performed should treat both the bony malformations and soft tissue abnormalities to maximize the therapeutic effect and reduce complications during and after surgery.
A comparison of tiotropium/olodaterol vs tiotropium alone in terms of treatment effect for chronic obstructive pulmonary disease
Authors: He Jie , Lin Jiang-Tao 
Published: April 2020

Abstract

Background:
Combinations of long-acting bronchodilators with different mechanisms of action are recommended to improve prognosis and reduce risk of adverse events of chronic obstructive pulmonary disease (COPD). It is unclear whether the new combination therapy with long-acting muscarinic antagonist (LAMA) tiotropium (TIO) and long acting beta-agonists (LABA) olodaterol (OLO) was superior to tiotropium alone.

Methods:
We measured the efficacy of the TIO/OLO combination vsTIO alone for COPD patients based on electronic databases up to February 2019. After rigorous quality review, data was extracted from eligible trials. All the main outcomes were pooled analysis using RevMan software.

Results:
A total of 6 randomized controlled trials (RCTs) were identified. The pooled results of our meta-analysis demonstrated that FEV1 [MD = 0.03, 95% CI (−0.01,0.07), P = .18], FVC [MD = -0.03, 95%CI (−0.06,0.00), P = .09] and FEV1%pred [MD = 0.35, 95%CI (−0.30, 0.99), P = .29] all showed no significant difference between the 2 groups. The overall incidence of adverse effects (AEs) [OR = 1.01,95%CI (0.93,1.09), P = .87] and serious AEs [OR = 1.04,95% CI (0.82, 1.32), P = .72] in the combination group was similar to that of the TIO alone group, without statistical significance.

Conclusion:
These studies reported that the TIO/OLO combination did not show superior effects than tiotropium alone for COPD. Additionally, both therapies were well tolerated.
Wernicke's encephalopathy due to malnutrition and parenteral nutrition in a patient with cerebral infarction
Authors: Lian Xiaojiao , Wu Meng , Fan Haixia , Zhang Yi , Sun Ping 
Published: April 2020

Abstract

Introduction:
Wernicke's encephalopathy (WE) is a severe neuropsychiatric disorder, which results from a nutritional deficiency of thiamine. The occurrence of WE is rarely reported in patients with cerebral infarction, who often have complications of malnutrition. Cerebral infarction is a neurological disease, patients with cerebral infarction may show symptoms such as disturbance of consciousness and gait instability, which is difficult to differentiate from WE. Thus, early recognition and differential diagnosis of WE are important. We report a rare case of cerebral infarction patient who developed WE due to malnutrition and parenteral nutrition.

Patient concerns:
A 65-year-old woman was admitted to our hospital with cerebral infarction. She had lost 15 kg of weight in the past month or so and was diagnosed with malnutrition. In order to correct malnutrition, parenteral nutrition and intravenous glucose without thiamine were administered. Cognitive dysfunction, laloplegia, sleep rhythm inversion, somnolence and bilateral lower limbs weakness were presented 20 days after admission.

Diagnosis:
Brain magnetic resonance imaging confirmed the diagnosis of WE.

Interventions:
The patient was given thiamine and nutrition support therapy.

Outcomes:
The patient's cognitive impairment, laloplegia and sleep condition improved within 4 days. Neurological status continued to improve and physical activity recovered gradually within 2 weeks. She received rehabilitation training when her condition was relatively stable, and her muscle strength of limbs and physical function gradually improved.

Conclusion:
Infarction-related malnutrition may result in nutrient deficiency-related neurological complications, such as WE. Thus, it is important to pay close attention to the nutritional status of patients with cerebral infarction. In addition, early recognition and differential diagnosis of WE in patients with infarction-related malnutrition are necessary, early treatment of replete thiamine supplementation and nutrition support therapy can reduce the risk of WE and improve the prognosis.
Prediction mode of more than 5 central lymph nodes metastases in clinically node-negative ipsilateral papillary thyroid carcinoma with tumor size 1 to 4 cm
Authors: Jin Lei , Sun Hai-Li , Zhou Liang , Xie Lei , Zhuang Yi-Yu , Wang Jian-Biao 
Published: April 2020

Abstract
According to the 2015 American Thyroid Association guidelines, either lobectomy or total thyroidectomy was recommended for patients with papillary thyroid carcinoma (PTC) of 1 to 4 cm without extrathyroidal extension and lymph node metastasis. However, lymph node metastases showed strong association with recurrence and low survival rate, especially in PTC patients with more than 5 metastatic lymph nodes. Therefore, this study aimed to investigate the predictive factors of more than 5 central lymph nodes metastases (CLNM) in PTC patients with tumor sizes of 1 to 4 cm. A total of 382 patients with clinically node-negative (cN0) ipsilateral PTC who underwent thyroidectomy with central neck dissection between January 2012 and December 2016 were retrospectively analyzed. CLNMs of >5 were found in 54 (14.1%) patients, while CLNM was detected in 230 (60.2%) patients. Multivariate logistic regression revealed age < 45 years (P < .001), male gender (P = .013), and tumor sizes of >2 cm (P = .001) as independent predictive factors of >5 CLNMs in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm. The prediction equation (Y = 1.694 × age + 0.807 × gender + 1.190 × tumor size − 3.530) was developed, with a sensitivity (57.4%) and a specificity (80.8%), respectively, at an optimal cut-off point of −1.685. Therefore, if the predictive value was higher than −1.685 according to the equation in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm, then total thyroidectomy might be considered.
Role of diffusion tensor imaging in analyzing the neural connectivity of the parieto-insular vestibular cortex in pusher syndrome
Authors: Yeo Sang Seok , Jang Sung Ho , Oh Seunghue , Kwon Jung Won 
Published: April 2020

Abstract

Rationale:
Pusher syndrome is a disorder of postural control. It is associated with unilateral lesions on central vestibular system. In the current study, we attempted to identify and investigate neural connectivity of the parieto-insular vestibular cortex in a patient with pusher syndrome, using diffusion tensor imaging.

Patient concerns:
A 60-year-old male patient had left hemiplegia due to an infarction on right premotor cortex, primary motor cortex, corona radiata and temporal and occipital lobe. The patient had severe motor weakness in left upper and lower limb, left side neglect and significant pusher syndrome.

Diagnosis:
Patient was diagnosed with left hemiplegia due to an infarction in the right middle cerebral artery territory at the neurology department of a university hospital.

Interventions:
One patient and 5 control subjects of similar age participated. Diffusion tensor imaging data were acquired at 4-month and 12-month after the initial injury.

Outcomes:
Fractional anisotropy, mean diffusivity, and tract volume (TV) were measured. TV values in both affected and unaffected hemispheres of the patient were significantly decreased at 4-month compared to those of control subjects. In the unaffected hemisphere of the patient, TV value showed significant increase at 12-month compared to that at 4-month. Although the TV value at 12-month of the affected hemisphere was out of reference range, TV was considerably increased compared to that at 4-month. Mean values for fractional anisotropy or mean diffusivity in 2 hemispheres did not show significant difference compared to those of control subjects regardless of month.

Lessons:
Restoration of an injured projection pathway between the vestibular nuclei and parieto-insular vestibular cortex with recovery of pusher syndrome was found in a patient with stroke.
Case report of bilateral penetrating renal trauma caused by a wooden stick
Authors: Xie Jing , Liu Ying , Chen Tong , Xiao Ke-Feng 
Published: April 2020

Abstract

Rationale:
Kidney is the most frequently injured organ of the genitourinary system during trauma. Bilateral penetrating renal trauma (BPRT) is extremely rare and sporadically reported in the previous literature. Here, we reported a unique case of BPRT.

Patient concerns:
A 43-year-old man, with no medical history, was accidentally penetrated by a wooden stick and presented with sharp pain in the left flank.

Diagnosis:
Laboratory tests revealed microscopic hematuria, mildly elevated leucocyte and amylase, normal hemoglobin (145 g/L) and creatinine (1.05 mg/dl). Computed tomography demonstrated bilateral penetrating renal injuries with perinephric/subcapsular hematoma, fracture of the second lumbar vertebra and 10th rib.

Interventions:
An emergency exploratory laparotomy was executed immediately. According to the American Association for the Surgery of Trauma Organ Injury Scale grading system, grade V and III injuries were considered for the left and right kidney, respectively. Nephrectomy and renorrhaphy were performed on the left and right kidney, respectively.

Outcomes:
The postoperative course was uneventful. Eleven days after the surgery, the patient discharged with no complications.

Lessons:
We present a rare and challenging case which was handled successfully, and it may provide useful information for the management of BPRT.
Severe vaso-occlusive lupus retinopathy in the early stage of a pediatric patient with systemic lupus erythematosus: a case report
Authors: Huang Guoping , Shen Huijun , Zhao Jingli , Mao Jianhua 
Published: April 2020

Abstract

Introduction:
Systemic lupus erythematosus (SLE) is a multisystem, chronic, autoimmune disease which can affect any organ system including the eye. About one-third of the patients can be diagnosed with SLE-related eye involvement which is usually indicative of disease activity. Retinopathy is one of the most vision-threatening complications that can be associated with the disease.

Patient concerns:
An 11-year-old girl was hospitalized with complains of repeated swelling and pain in her extremities for 1 month, chest pain for 24 days, rash for 5 days and proteinuria for 1 day. On the morning of her fourth day in hospital, she suddenly complained of sudden, painless vision loss in the left eye. The ophthalmologist found that she had obstruction of central retinal vein and artery with diffuse retinal hemorrhages and macular edema.

Diagnosis:
The patient was diagnosed with systemic lupus erythematosus, lupus nephritis, and lupus retinopathy through her clinical manifestations and laboratory tests.

Interventions:
After diagnosis, she received steroid therapy, retinal laser photocoagulation, and intravitreal injection of dexamethasone (OZURDEX, Allergan Pharmaceuticals, Dublin, Ireland) early in her course.

Outcomes:
At the latest follow-up, her vision improved partially. However, she still has the possibility of subsequent neovascular glaucoma and bleeding in the future.

Conclusions:
An early diagnosis and the prompt therapeutic measures are necessary to prevent sight-threatening consequences, especially in pediatric patients with SLE.
Characteristic of extra luminal gastric stromal tumor arising from the lesser curvature of the stomach
Authors: Wang Min , Qiu Xia , He Xu , Tian Chuan 
Published: April 2020

Abstract

Rationale:
Gastrointestinal stromal tumor (GIST) is one of the most common malignant mesenchymal tumors of the gastrointestinal tract. They generally arise from the fourth layer (muscularis propria) and rarely from the second or third layer. Although the manifestations of gastric stromal tumors are diverse, to our knowledge, there are only several cases of an extra-gastric stromal tumor in the literature appearing with a pedunculation. Pedunculated large GISTs are not frequent and compress the neighboring organs. When they were huge, it is difficult to differentiate the origin of the masses. Thus, in the clinical setting, physicians should pay more attention to the pattern of manifestation of the gastric stromal tumor.

Patient concerns:
A 62-year-old man had no gastrointestinal symptoms or significant medical and family histories. During the health examination with US, a cystic-solid tumor was found below liver. The results of the physical examination were unremarkable, and routine laboratory data on admission did not show any abnormal findings.

Diagnosis:
Computed tomography of the abdomen showed a mixed echoic mass measuring 10 × 8 × 8 cm and located below the liver, adjacent to the gastric antrum. After endoscopic ultrasound-guided fine-needle aspiration, cytopathology showed that the specimen was filled with red blood cells, and it had no malignant cells. Histopathology revealed that the mass was a GIST, and immunohistochemical analysis showed the following: CD117(+), CD34(+), desmin(−), Dog-1(+), Ki-67% <1%, and smooth muscle actin(−).

Interventions:
Surgical resection was performed on the patient.

Outcomes:
The lesion was diagnosed as a gastric stromal tumor with a pedicle and an old hemorrhage. The patient's recovery was uneventful. After surgery, computed tomography at the 6-month and 1-year postoperative follow-up visits did not reveal relapse or any metastasis.

Lessons:
In the clinical setting, physicians should pay more attention to the pattern of manifestation of the extra-gastric stromal tumor in patients with a pedicle or hemorrhage. Additionally, endoscopic ultrasound-guided fine-needle aspiration can be used to make an accurate preoperative diagnosis of such diseases, and its findings can serve as an important basis for surgical excision of the lesions.
De-differentiation of papillary thyroid carcinoma into squamous cell carcinoma in an elderly patient
Authors: Thewjitcharoen Yotsapon , Krittiyawong Sirinate , Butadej Siriwan , Nakasatien Soontaree , Polchart Somsong , Junyangdikul Pairoj , Kanchanapituk Auchai , Himathongkam Thep 
Published: April 2020

Abstract

Rationale:
The unpredictability of thyroid cancer can be striking, as the disease may rapidly progress to death in some individuals. Herein, we reported a rare case of aggressive papillary thyroid cell carcinoma (PTC) in an elderly patient de-differentiated into squamous cell carcinoma (SCC).

Patient concerns:
We describe a case of a 79-year-old Thai woman presented with hoarseness and neck mass for 2 months and she had been diagnosed with a 3-cm papillary thyroid carcinoma (PTC) in the right side of the thyroid gland. Later on PTC de-differentiated into SCC within 3 years after initial presentation.

Diagnosis:
De-differentiation from papillary thyroid carcinoma to squamous cell carcinoma.

Interventions:
The patient underwent a total thyroidectomy at the initial hospital and received high dose radioactive iodine (RAI) treatment at our hospital 1 month following the surgery and then was lost to follow-up. Two years later she came back with new development of right solid-cystic neck mass which was found to be recurrent PTC. A radical neck dissection was done and another high dose RAI treatment was given. However, she developed recurrent mass with tenderness at the site above previous solid cystic mass 6 months later. Re-exploration of the neck mass revealed an inflamed midline mass 2 cm with enlarged right lateral cervical lymph nodes.

Outcomes:
A histopathological examination of the midline neck mass showed poorly differentiated SCC with lymphatic invasion. The intermingling of two morphologically distinct tumors, a typical PTC and a poorly differentiated SCC, had been identified in 1 out of 14 excised cervical lymph nodes. The patient underwent external beam radiation without chemotherapy. She is still in stable condition at 18 months post-treatment.

Lessons:
This case clearly demonstrated that SCC transformed from a pre-existing PTC. The clinician should consider a possible transformation of papillary thyroid cancer into more aggressive histological types in elderly patients who present with rapidly progressive clinical behavior. However, some patients could have long-term survival if the tumor did not transform into anaplastic thyroid cancer.
Pediatric adrenocortical tumor – review and management update
Authors: Brondani Vania B. , Fragoso Maria Candida B.V. 
Published: April 2020

Purpose of review
Adrenocortical tumor (ACT) is a rare disease with an annual worldwide incidence of 0.3–0.38/million children below 15 years old, and Brazilian population presents the highest incidence because of germline mutation in the TP53. Pediatric ACT is associated with virilizing features and hypercortisolism in most cases. Malignancy is defined when local invasion or metastasis is found, and it is associated with a poor prognosis. However, the correct and early diagnosis and treatment may impact on overall and disease-free survival.

Recent findings
A complete understanding of the disease and its singularities facilitates the assistance to the pediatric patient with ACT. The new insights about adrenal tumorigenesis have provided a better understanding of this disease. In this scenario, the era of molecular studies is leading to the refinement of the taxonomy, and it is offering the opportunity to discover new biomarkers and pathways of tumorigenesis, beyond the knowing β-catenin, Insulin-like growth factor-II/IGF-IR, and the p53/Rb signaling.

Summary
The rarity of this disease makes it a real challenge. Here, we present a review focusing on clinical practice. A methodic approach aiming to clarify the diagnosis and a follow-up are suggested to guide physicians in the assistance of pediatrics patients, improving the prognosis.
Long-term cardio-metabolic outcomes in patients with classical congenital adrenal hyperplasia: is the risk real?
Authors: Gomes Larissa G. , Mendonca Berenice B. , Bachega Tânia A.S.S. 
Published: April 2020

Purpose of review
Data on the long-term cardio-metabolic outcomes classical congenital adrenal hyperplasia (CAH) patients have been published with controversial results. Conventional treatment recommends hydrocortisone during childhood; and short and/or long-acting glucocorticoid during adulthood, associated or not with mineralocorticoid, in an attempt to simulate normal cortisol secretion and to normalize androgen excess. However, the balance between glucocorticoid over or undertreatment is very challenging, and patients frequently oscillate between hypercortisolism or hyperandrogenism. Considering these data, we reviewed the frequency of metabolic syndrome components and other cardiovascular risk factors in CAH.

Recent findings
Several studies reported increased prevalence obesity, abnormal body composition, increased homeostasis model assessment of insulin resistance and blood pressure levels in CAH patients. However, the evidence quality is still low, because most studies used different glucocorticoid regimes and had heterogeneous goals for hormonal control.

Summary
Despite the above-mentioned scenario of increased frequency of some cardiovascular surrogate markers in patients, most cohorts comprised young adults, and it is not known if patients will present high frequency of cardiovascular disease in the future. Prospective randomized studies comparing different glucocorticoid regimens should establish the real role of glucocorticoid and androgens on metabolic/cardiovascular profile.