bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brain abscess in a patient with psoriatic arthritis treated with adalimumab
Authors: Lo Yu-Pei , Desale Snehal , Wu Po-Yuan 
Published: March 2020

Abstract

Rationale:
In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin.

Patient concerns:
A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis (S. sanguinis), Fusobacterium nucleatum (F. nucleatum), and Parvimonas micra (P. micra).

Diagnosis:
Brain abscess with odontogenic infection.

Interventions:
The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone.

Outcomes:
A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition.

Lessons:
To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.
The efficacy and toxicity of induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma
Authors: Wang Peirong , Zhang Mingwei , Ke Chunlin , Cai Chuanshu 
Published: March 2020

Abstract

Background:
A systemic review and meta-analysis of randomized controlled trials (RCTs) was performed to compare the efficacy, toxicity and safety of concurrent chemoradiotherapy (CCRT) with or without induction chemotherapy (IC) for locoregionally advanced nasopharyngeal carcinoma (NPC).

Methods:
Research searching was performed in Web of Science, PubMed, The Cochrane Library, Embase, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Chongqing VIP Database for Chinese Technical Periodicals and Wanfang Database. RCTs including patients diagnosed with locoregionally advanced NPC without metastasis and randomly treated with IC plus CCRT and CCRT alone were included. Survival and outcome data were extracted and meta-analysis was performed using the Revman 5.3.0 software.

Results:
Ten RCTs (2280 patients) were selected and used for pooled meta-analysis. In comparison with CCRT, IC plus CCRT treatment significantly improved the overall survival (OS; HR = 0.70, 95%CI 0.56–0.87, P = .002), progression-free survival (PFS; HR = 0.75, 95%CI 0.65–0.87, P < .0001), distant metastasis failure-free survival (DMFS; HR = 0.71, 95%CI 0.58–0.85, P = .0003) and loco-regional failure-free survival (LFES; HR = 0.72, 95%CI 0.59–0.88, P = .002) of patients with locoregionally advanced NPC. Patients treated with IC and CCRT had higher incidence of grade 3–4 leucopenia and thrombocytopenia than patients treated with CCRT alone (P < .0001). No significant difference in other grade 3–4 adverse events and radiation toxicity was observed between the two groups. IC combined with CCRT improved the survival of patients with locoregionally advanced NPC.

Conclusions:
Combined IC and CCRT therapy was an efficacy treatment regimen for locoregionally advanced NPC.
Predictive effects of the intercondylar notch morphology on anterior cruciate ligament injury in males
Authors: Huang Mengquan , Li Yubiao , Li Hedan , Liao Chunlai , Xu Haitao , Luo Xiaowei 
Published: March 2020

Abstract
The effects of the intercondylar notch morphology on predicting anterior crucaite ligament (ACL) injury in males were unknown. We aimed to determine the risk factors of the intercondylar notch on ACL injury, and evaluate the predictive effects of the morphological parameters on ACL injury in males. Sixty-one patients with ACL injury and seventy-eight patients with intact ACLs were assigned to the case group and control group respectively. The notch width (NW), bicondylar width, notch width index (NWI), notch height (NH), notch cross-sectional area (CSA), notch angle (NA) and notch shape were obtained from the magnetic resonance images of male patients. Comparisons were performed between the case and control groups. Logistic regression model and the receiver operating characteristic curve were used to assess the predictive effects of these parameters on ACL injury. The NW, NWI, NH, CSA and NA in the case group were significantly smaller than those in the control group on the coronal magnetic resonance images. The NW and NWI were significantly smaller, while no significant differences of the NH and CSA were found between the 2 groups on the axial images. There was no significant difference in the notch shape between the 2 groups. The maximum value of area under the curve calculated by combining all relevant morphological parameters was 0.966. The ACL injury in males was associated with NW, NH, NWI, CSA, and NA. These were good indicators for predicting ACL injury in males.
Nonaxial Traction Mechanisms of Nursemaid's Elbow
Authors: Li Natasha , Khoo Bryant , Brown Lance , Young Tim 
Published: March 2020

Objective
This study aims to better describe those patients who present with nonaxial traction mechanisms for nursemaid's elbow.

Methods
A retrospective review on patients with the International Statistical Classification of Diseases, Ninth/Tenth Revision, code for nursemaid's elbow was performed. Patients with the classic axial traction mechanism and unknown mechanism were excluded. Demographic information and mechanism of injury were collected, and statistical analysis on this data was performed.

Results
Sixty-nine subjects with a median age of 2.4 years (interquartile range, 1.5–3.6 years) were enrolled. There was no difference in sex or sidedness. The most common mechanisms of injury were fall (57%), direct hit to the elbow (16%), and rolling over (7%). An x-ray was obtained 49% of the time. Reduction was spontaneous 12% of the time and was successfully reduced on the first attempt 87% of the time.

Conclusions
Nursemaid's elbow can occur in children with a reported nonaxial traction mechanism. They may present with history of other trauma, such as a fall, a direct blow to the elbow, or rolling over. For toddlers without the classic axial traction mechanism who refuse to move the elbow but do not have an examination consistent with fracture, it is still reasonable to suspect a nursemaid's elbow.
Point-of-Care Ultrasound for Undifferentiated Abdominal Pain in a Pediatric Patient
Authors: Leviter Julie , Constantine Erika 
Published: March 2020

Abstract
Abdominal pain is a common presentation in the pediatric emergency department and may pose a diagnostic challenge to the physician. Although most abdominal pain is benign, the presence of abdominal pain may represent a surgical emergency. We present an atypical presentation of perforated appendicitis in a child with 2 weeks of abdominal pain, in whom point-of-care ultrasound expedited diagnosis and patient disposition. We then recommend a diagnostic approach for using point-of-care ultrasound in a pediatric patient with undifferentiated abdominal pain.
Amitriptyline Intoxication in Children
Authors: Kamasak Tülay , Kader Şebnem , Mutlu Mehmet , Özkaya Kagan , Erduran Erol , Orhan Fazıl , Dilber Embiya , Kalyoncu Mukaddes , Karagüzel Gülay , Cakır Murat , Bahat Elif , Cansu Ali 
Published: March 2020

Background
Amitriptyline ingestion is an important cause of poisoning morbidity and mortality in Turkey and other countries. In contrast to adults, data concerning amitriptyline intoxication in children are limited. The purpose of this study was to investigate amitriptyline intoxication findings in the pediatric population, based on age groups and reported dosages.

Methods
The medical records of 192 patients admitted to the Karadeniz Technical University Medical Faculty Farabi Hospital Pediatric Emergency Department, Turkey, due to amitriptyline intoxication in 1997–2017 were examined retrospectively. Patients were divided into 6 groups based on amitriptyline doses and 4 groups based on age. Complete blood count, blood glucose, serum electrolytes, renal and liver function tests, coagulation tests (prothrombin time and partial thromboplastin time), and blood gas analysis were studied in all patients. Electrocardiography was performed on all children, and chest radiography and electroencephalography on those with respiratory or central nervous system symptoms.

Results
Amitriptyline intoxication was most frequently observed between the ages of 1 and 4 years. The most common signs and symptoms observed at time of hospital admission were lethargy and drowsiness (45.3%), sinus tachycardia (19.2%), and nausea and vomiting (13%). The most common laboratory finding was hyperglycemia (17.7). Six patients were intubated because of respiratory failure, and mechanical ventilation was initiated in these cases. One patient with amitriptyline overdose had persistent supraventricular tachycardia. Four children died due to amitriptyline intoxication.

Conclusions
Tricyclic antidepressant intoxication is a leading cause of mortality and morbidity in children. It is therefore particularly important to identify the clinical and laboratory findings that develop with high-dose consumption.
Impact of Guidelines Regarding Brief Resolved Unexplained Events on Care of Patients in a Pediatric Emergency Department
Authors: Sethi Anchal , Baxi Kesha , Cheng Daphne , Laffey Steven , Hartman Neal , Heller Kayla 
Published: March 2020

Objectives
This study aimed to determine if the 2016 clinical practice guidelines regarding brief resolved unexplained events (BRUE) impacted our institutional approach to infants with BRUE. We sought to determine the statement's impact on admission rates, emergency department (ED) length of stay, and return ED visits or readmissions.

Methods
We conducted a retrospective chart review of patients who presented to the ED at a tertiary pediatric hospital from January 2014 to June 2019. Diagnostic workup (laboratory testing, imaging, monitoring) in the ED was recorded. Cohorts of patients presenting pre- and post-2016 guideline were compared using χ2 and t tests. Subanalysis of higher-risk and lower-risk infant groups was also performed.

Results
The demographics of the 2 cohorts were not significantly different. Comparison showed significant reductions in invasive testing after the guideline, both overall (P = 0.005), and specifically regarding comprehensive metabolic panel, blood culture, urine culture, and chest x-ray. Infants meeting higher-risk criteria also showed decreases in invasive testing (P = 0.02). Admission to the hospital and ED lengths of stay decreased in the post–American Academy of Pediatrics statement cohort (P < 0.001 and P = 0.007, respectively). There were no increases in readmissions or repeat ED visits.

Conclusions
This study revealed significant reduction in invasive testing, shorter lengths of ED stays, and lower admission rates at a tertiary care children's hospital after the release of the American Academy of Pediatrics BRUE guideline with no increase in return ED visits or readmissions.
18F-FDG Uptake in a T2 Hypointense Paraspinal Mass
Authors: Singhal Aparna , Adhikari Narendra , de Idiaquez Bakula Diego A. , Sotoudeh Houman 
Published: March 2020

Abstract
We present a paraspinal amyloidoma found incidentally in a 77-year-old man during lymphoma workup by 18F-FDG PET/CT. A solitary FDG-avid paraspinal lesion was seen at T11–T12. MRI showed T2 hypointensity and enhancement. Lymphoma was considered the primary differential due to FDG uptake, but biopsy revealed nodules of extracellular acellular homogeneous material with apple-green birefringence on Congo red stain consistent with amyloidoma. Spinal amyloidoma is rare with few cases reported so far in literature.
Eye Symptoms in a Patient With Prostate Cancer
Authors: Kairemo Kalevi , Kangasmäki Aki , Joensuu Timo , Seregard Stefan 
Published: March 2020

Abstract
A 66-year-old man with castration-resistant prostate cancer was evaluated with 18F–prostate-specific membrane antigen (PSMA) 1007 PET/CT, which revealed extensive PSMA-positive skeletal metastases in the skull, thorax, spine, pelvis, and extremities. He was then treated 177Lu-PSMA-617 therapy. Twenty-four-hour SPECT/CT revealed additional activity not seen with 18F-PSMA adjacent to his left eye. The lesion was biopsied after the first cycle due to pain. This activity was not visible on SPECT/CT after the second treatment cycle, and his eye pain has resolved.
Ectopic Gallbladder Mimicking Choledochal Cyst on Hepatobiliary Scintigraphy
Authors: Zhang Lin , Gaballah Marian , Wen Zhe , Zhuang Hongming 
Published: March 2020

Abstract
The gallbladder is generally located at the anterolaterally situated gallbladder fossa on the undersurface of the liver, whereas choledochal cyst, as a dilation of the common bile duct, is located more posteromedially. We reported an ectopically located gallbladder, which appeared to be a choledochal cyst on hepatobiliary scintigraphy in a 10-year-old girl.
68Ga-FAPI PET/CT Improves Therapeutic Strategy by Detecting a Second Primary Malignancy in a Patient With Rectal Cancer
Authors: Chen Haojun , Zhao Liang , Ruan Dan , Sun Long , Lin Qin 
Published: March 2020

Abstract
A 71-year-old man with pathologically confirmed rectal cancer underwent 18F-FDG PET/CT before radical operation, which showed multiple nodules with low uptake in bilateral pleura and 1 solitary pulmonary nodule with slight uptake in left lung. The subpleural nodule was diagnosed as benign lesion through the biopsy. 68Ga-labeled fibroblast-activation-protein inhibitor PET/CT was performed for further evaluation, which showed low uptake in bilateral subpleural nodules but focally increased uptake in the nodule of left lung. This nodule was found to be a primary lung adenocarcinoma by the CT-guided biopsy. A diagnosis of rectum and lung double primary malignancies was finally made.
Prediction of Conservative Treatment Failure for Isolated Unilateral Mandibular Condylar Fractures Using Quantitative Measures
Authors: Mo Young Woong , Lee Dong Lark 
Published: March 2020

Background
Interest in the treatment of mandibular condyle fracture in cases of maxillofacial trauma has been a huge concern for decades because of a diversity of opinions on the topic and the relatively few studies conducted on individuals treated by physiotherapy or rehabilitation with or without intermaxillary fixation (IMF).

Methods
We measured fracture gaps between bone ends over an 8-year period from 2012 to 2019. The study cohort was composed of only conservatively treated patients. This retrospective study was conducted to identify factors that influence treatment failure by comparing a functional treatment (physiotherapy) group with an IMF group in terms of fracture gaps and other variables. In addition, an algorithm was devised to enable clinicians to determine promptly whether IMF is needed for mandibular condylar fractures.

Results
Significant correlations were observed between several parameters and malocclusion. Multiple regression analysis resulted in the following coefficients: 0.072 for fracture gap (P = 0.006) and 0.006 for age (P < 0.05) in functional treatment group. However, in the IMF group, correlations with malocclusion were 0.063 for fracture gap (P = 0.000) and 0.003 for age (P = 0.083).

Conclusions
We proposed a diagnostic algorithm for isolated unilateral mandibular condyle fractures that provides guidance regarding surgical correction. If indications for surgical correction, as regards anatomical location, fracture level, fracture gap between bone ends, and patient cooperability, are not satisfied, clinicians should select IMF or functional treatment (rehabilitation). If the fracture gap is less than 6 mm and the patient is cooperative, functional rehabilitation would be more suitable than IMF.
Submuscular Placement of Baclofen Infusion Pumps
Authors: Bogue Jarrod T. , Wald Gal , Iosim Sonia , Greenfield Jeffrey P. , Otterburn David M. 
Published: March 2020

Background
Baclofen pumps provide treatment of symptoms of spasticity for disease processes such as cerebral palsy and traumatic brain injury. These devices provide continuous infusion or periodic dosing of intrathecal baclofen (ITB). Traditionally, these pumps have been placed subcutaneously. Subcutaneous device placement has been associated with infection and extrusion. Baclofen pumps are large and range from 8 to 10 cm in diameter and 4 to 8 cm in width. Patients requiring device placement typically have a paucity of subcutaneous tissue. Cachexia coupled with the size and bulk of these devices leads to increased protusion and friction. Submuscular placement provides a well-vascularized pocket that directs the device inward eliminating protrusion and decreasing the potential for soft tissue breakdown.

Methods
A retrospective chart review of ITB pump placement in a submuscular plane by a single plastic surgeon at a major academic center in conjunction with a neurosurgeon was performed. Inclusion criteria were cases of primary placement or replacement of ITB pumps and spasticity requiring ITB. Major complications included infection, extrusion, and reoperation.

Results
Five patients during a 5-month period were treated with submuscular placement of ITB pumps. Average age of patients included was 18.4 years. Average preoperative body mass index was 18.8 kg/m2, with values ranging from 15.8 to 20.1 kg/m2. Medical histories of patients included diagnoses of cerebral palsy and traumatic brain injury causing spasticity. The most frequently cited reason for plastic surgical consultation preoperatively was cachexia. Two patients had previous baclofen pumps placed subcutaneously. Average follow-up was 6 months and ranged from 3 to 13 months. There were no major complications. One patient had a small seroma that spontaneously resolved. No patient had wound healing problems, and there were no extrusions of implanted devices or reoperations.

Conclusion
Submuscular placement of baclofen pumps provides a well-vascularized and stable environment for device placement that minimizes the dangers of pump extrusion and infection. Patients who require treatment with ITB commonly have severe cachexia, which makes subcutaneous device placement high risk. Submuscular placement should be performed in all patients with body mass index less than 20 kg/m2.
How Is the Created Alveolar Space Finally Restored After Maxillary Anterior Segmental Distraction Osteogenesis?
Authors: Kim Da So Mi , Choi Eun Hack , Sha Ha Na , Cha Jung-Yul 
Published: March 2020

Objective:
Maxillary anterior segmental distraction osteogenesis (MASDO) for cleft and palate patients is the alternative treatment option to correct malocclusion with maxillary arch deficiency and severe crowding. After MASDO, prosthetic considerations are crucial for patients with cleft lip and palate because it is related to facial esthetics and occlusal function. The objectives of this study were to investigate the final restoration type for created alveolar space by MASDO.

Methods:
Thirteen patients with cleft lip and palate who underwent MASDO and orthodontic treatment from the years 2000 to 2010 in Yonsei University were examined. Final restorations are classified as dental implants, conventional prosthesis, and orthodontic space closure. The relationship between the distracted areas and final restoration type was investigated. The authors evaluated lateral cephalograms obtained at predistraction osteogenesis (pre-DO; T1), postdistraction osteogenesis (post-DO; T2), and debond (T3), and measured changes from T1 to T2 and from T2 to T3.

Results:
There was no significant difference of final restoration percentage of dental implants, conventional prosthesis, and space closure with orthodontic treatment. However, dental implants and conventional prostheses were applied more frequently in the posterior area and in the anterior area, respectively. The relapse rate was observed as 36.7% and 22.4% in the values of N-A distance and ANB angulation in T2-T3 stage.

Conclusion:
The MASDO site should be decided, based on final restoration goal. Among the created alveolar spaces, implants were applied mainly to the posterior site and the conventional prostheses were mostly restored to the anterior site. For space closure by orthodontic approach, the area could be both anterior or posterior.
Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study
Authors: Sanders-Pinheiro Helady , Colugnati Fernando A.B. , Denhaerynck Kris , Marsicano Elisa O. , Medina José O.P. , De Geest Sabina ,   ADHERE BRAZIL Study Team
Published: March 2020

Background.
Immunosuppressive nonadherence is a risk factor for worse outcomes after kidney transplantation (KT). Brazil, having the world’s largest public, fully covered transplantation system and the second-highest KT volume worldwide, provides a unique setting for studying multilevel correlates of nonadherence (patient, healthcare provider, transplant center, and healthcare system levels) independent of patients’ financial burden.

Methods.
By applying a multistage sampling approach, we included 1105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and dose reduction assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Based on Bronfenbrenner’s ecological model, we assessed multilevel factors using established instruments and measures specifically developed for this study and analyzed their independent contribution to nonadherence by performing sequential logistic regression analysis.

Results.
The nonadherence prevalence rate was 39.7%. The following factors were independently associated with nonadherence: Patient level—having a stable partner (odds ratio [OR]: 0.75; confidence interval [CI]: 0.58-0.97), nonadherence to appointments (OR: 2.98; CI: 2.03-4.39), and nonadherence to physical activity recommendations (OR: 1.84; CI: 1.38-2.46); and transplant center level—satisfaction with the waiting room structure (OR: 0.54; CI: 0.42-0.71), consultation >30 minutes (OR: 1.60; CI: 1.19-2.14), adequacy of the consultation frequency (OR: 0.62; CI: 0.43-0.90), and centers with >500 beds (OR: 0.58; CI: 0.46-0.73).

Conclusions.
As the first multicenter study assessing multilevel correlates of nonadherence in KT, our findings point to the need for multilevel interventions beyond the patient level, targeting transplant center practice patterns as an approach to tackle nonadherence.