bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction for diverse fronto-orbital defects with computer-assisted designed and computer-assisted manufactured PEEK implants in one-stage operation
Authors: Yang Min , Wu Zhangyi , Yu Hai , Cheng Jun 
Published: October 2021

Abstract

Rational:
Reconstruction of complex craniofacial defects in fronto-orbital region has been reported to be extremely few. In this study, we report 2 cases with fronto-orbital defects of different etiologies in one-stage surgical reconstruction with polyetheretherketone (PEEK) prosthesis using computer-assisted design and computer-assisted manufactured (CAD–CAM) techniques.

Patient concerns:
One patient was a 49-year-old man, who admitted with a depressed and comminuted fracture in the left fronto-orbital region as a result of a motor vehicle collision. The other patient was a 45-year-old woman who was hospitalized with an unexpected diagnosis of a fronto-orbital bone tumor during a head CT examination in a minor traumatic brain injury. None of them had a significant past medical history.

Diagnoses:
The first patient's head computed tomography (CT) showed multiple depressed comminuted fractures in the right fronto-orbital region with localized frontal lobe contusion, and the diagnosis was clear when combined with the mechanism of traumatic head injuries. The second patient's head CT and magnetic resonance image suggested a right lateral orbital neoplastic lesion that distorted peripheral bone, the postoperative pathological examination demonstrated an osteoma with fibromatous hyperplasia, and thus the women's diagnosis was confirmed.

Interventions:
A three-dimensional image of both patients’ skull bone were collected from a high-resolution CT. A virtual surgical planning for lesion excision and defect remodeling based on CAD–CAM techniques was undertaken, and than the reconstruction surgery was performed in a single procedure using PEEK prosthesis. Antibacterial treatment was prescribed routinely.

Outcomes:
Postoperatively, both patients achieved excellent aesthetic restoration as well as functional recovery of the orbital cavity without neurological or infectious complications during an average 22 months follow-up.

Lessons:
The CAD–CAM PEEK implants could be a preferred option for reconstruction of patients with various complex fronto-orbital defects.
Pancreatic neuroendocrine tumor producing vasopressin
Authors: Li Jingyan , Zhang Xinxin , He Qing , Feng Wenli , Ding Li , Wang Zhuoqun , Yu Haonan , Chen Qiusong , Lu Ning , Xu Dongbo , Cui Jingqiu 
Published: October 2021

Abstract

Rationale:
Functional pancreatic neuroendocrine tumors (pNETs) rarely produce vasopressin. Here, we reported a case of pNET producing vasopressin in a 78-year-old man with hyponatremia.

Patient concerns:
The patient presented with anorexia approximately 4 years ago, and the laboratory test results indicated hyponatremia. He was hospitalized 3 times subsequently due to anorexia in the past 4 years, during which laboratory tests consistently indicated severe hyponatremia.

Diagnosis:
Upon admission, his serum osmolarity, urine osmolarity, urine sodium level, and 24-hour urine sodium level was 277 mOsm/kg H2O, 465 mOsm/kg H2O, 82.5 mmol/L, and 140.25 mmol, respectively. Gallium-68-labeled tetraazacyclododecanetetraacetic acid-Dphel-Tyr3-octreotate positron emission tomography-computed tomography showed a high uptake lesion measuring approximately 1 cm in diameter in the pancreatic body, and the possibility of pNET was considered. Besides, laboratory tests showed that adrenocorticotropic hormone, follicle-stimulating hormone, and luteinizing hormone released by the pituitary was insufficient in the case of low levels of cortisol, estradiol, progesterone, and testosterone. Thus, the diagnosis of the syndrome of inappropriate antidiuresis (SIAD) was considered along with hypopituitarism.

Interventions:
The patient underwent surgery, and pNET was confirmed by pathology examination. The immunohistochemical study showed that the tumor cells were positive for somatostatin receptors 2 and vasopressin.

Outcomes:
In the last follow-up 17 months after surgery, the patient was in good condition, taking methylprednisolone 4 mg every other day, and had been free of anorexia or hyponatremia episodes.

Lessons:
This case illustrated the potential ectopic production of vasopressin resulting in SIAD in pNETs, highlighting the adoption of gallium-68-labeled tetraazacyclododecanetetraacetic acid-Dphel-Tyr3-octreotate positron emission tomography-computed tomography and vasopressin immunohistochemical staining in the evaluation of the etiology of SIAD.
Hemorrhagic disseminated intravascular coagulation after 177Lu-Dotatate in metastatic midgut neuroendocrine tumor
Authors: Worbe Noémie , Damian Louise , Le Cam-Duchez Véronique , Levesque Hervé , Michel Pierre , Quak Elske 
Published: October 2021

Abstract

Rationale:
Peptide receptor radionuclide therapy with 177Lu-Dotatate represents a major breakthrough in the treatment of metastatic well differentiated neuroendocrine tumors. This treatment is generally well tolerated. Reported severe long-term hematological side effects are rare and include hematopoietic neoplasms and bone marrow failure.

Patients concerns:
We describe the case of a patient presenting spontaneous bleeding and bruising occurring 6 weeks after the first administration of 177Lu-Dotatate. Blood tests showed anemia, thrombocytopenia, prolonged clotting times, profound fibrinolysis and low levels of coagulation factors II and V. There were no signs of tumor lysis syndrome.

Diagnoses:
We made the diagnosis of acute disseminated intravascular coagulation.

Intervention:
Treatment consisted of multiple transfusions of fresh frozen plasma, fibrinogen and platelets, and corticosteroids. Acute disseminated intravascular coagulation (DIC) persisted for 10 days and then resolved.

Outcomes:
Metabolic imaging 5 months after the 177Lu-Dotatate administration showed disease progression. Treatment with 177Lu-Dotatate was not rechallenged due to the occurrence of DIC.

Lessons:
Our case suggests that acute hemorrhagic disseminated intravascular coagulation can be a rare and life-threatening subacute side effect of 177Lu-Dotatate peptide receptor radionuclide therapy.
Prevalence and factors associated with HIV-1 drug resistance mutations in treatment-experienced patients in Nairobi, Kenya
Authors: Scriven Yvonne A. , Mulinge Martin M. , Saleri Norah , Luvai Elizabeth A. , Nyachieo Atunga , Maina Esther N. , Mwau Matilu 
Published: October 2021

Abstract
An estimated 1.5 million Kenyans are HIV-seropositive, with 1.1 million on antiretroviral therapy (ART), with the majority of them unaware of their drug resistance status. In this study, we assessed the prevalence of drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors, and the variables associated with drug resistance in patients failing treatment in Nairobi, Kenya.
This cross-sectional study utilized 128 HIV-positive plasma samples obtained from patients enrolled for routine viral monitoring in Nairobi clinics between 2015 and 2017. The primary outcome was human immunodeficiency virus type 1 (HIV-1) drug resistance mutation counts determined by Sanger sequencing of the polymerase (pol) gene followed by interpretation using Stanford's HIV Drug Resistance Database. Poisson regression was used to determine the effects of sex, viral load, age, HIV-subtype, treatment duration, and ART-regimen on the primary outcome.
HIV-1 drug resistance mutations were found in 82.3% of the subjects, with 15.3% of subjects having triple-class ART resistance and 45.2% having dual-class resistance. NRTI primary mutations M184 V/I and K65R/E/N were found in 28.8% and 8.9% of subjects respectively, while NNRTI primary mutations K103N/S, G190A, and Y181C were found in 21.0%, 14.6%, and 10.9% of subjects. We found statistically significant evidence (P = .013) that the association between treatment duration and drug resistance mutations differed by sex. An increase of one natural-log transformed viral load unit was associated with 11% increase in drug resistance mutation counts (incidence rate ratio [IRR] 1.11; 95% CI 1.06–1.16; P < .001) after adjusting for age, HIV-1 subtype, and the sex-treatment duration interaction. Subjects who had been on treatment for 31 to 60 months had 63% higher resistance mutation counts (IRR 1.63; 95% CI 1.12–2.43; P = .013) compared to the reference group (<30 months). Similarly, patients on ART for 61 to 90 months were associated with 133% higher mutation counts than the reference group (IRR 2.33; 95% CI 1.59–3.49; P < .001). HIV-1 subtype, age, or ART-regimen were not associated with resistance mutation counts.
Drug resistance mutations were found in alarmingly high numbers, and they were associated with viral load and treatment time. This finding emphasizes the importance of targeted resistance monitoring as a tool for addressing the problem.
Acupuncture against chronic postsurgical pain in non-small cell lung cancer patients
Authors: Li Gang , Zhang Changxi , Wang Congyi , Xiao Ling 
Published: October 2021

Abstract

Introduction:
Video-assisted thoracoscopic lobectomy is the prior recommended treatment for non-small cell lung cancer (NSCLC), with the advantages of small trauma, less postoperative pain, and quick recovery. However, a large number of patients may suffer chronic postsurgical pain (CPSP), which makes the patients unwilling to practice pulmonary exercises, and it would directly affect patient's cough, sputum expectoration, and mobility. Opioids could greatly improve the quality of postoperative analgesia and the quality of life after surgery, but it is accompanied with obvious side effects. A number of clinical studies have proved that acupuncture could improve postoperative pain and reduce opioid use. In this study, we try to conduct a randomized controlled study to evaluate the efficacy and safety of plum-blossom needle acupuncture combined with Tramadol in improving CPSP after lobectomy in NSCLC patients.

Methods:
Patients will be randomly divided into treatment group (acupuncture plus Tramadol) and control group (sham acupuncture plus Tramadol) with a random number table in 1:1 ratio. The patients, outcome assessor, and statistician will be blinded. The outcomes are changes of numerical rating scale, Karnofsky performance score, brief pain inventory, blood routine, liver and kidney function. The data will be analyzed by SPSS 22.0.

Conclusions:
The results will help to evaluate the efficacy and safety of plum-blossom needle acupuncture in improving CPSP after lobectomy in NSCLC patients.
Prognostic role of serum neutrophil gelatinase-associated lipocalin in cardiac arrest patients
Authors: Kang Changshin , In Yong Nam , Park Jung Soo , You Yeonho , Min Jin Hong , Jeong Wonjoon , Ahn Hong Joon , Cho Yong Chul , Ryu Seung 
Published: October 2021

Abstract
Accurate neurological prognostication is of the utmost importance to avoid futile treatments in patients treated with targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the prognostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) by comparing with neuron-specific enolase (NSE), which is currently recommended by international guidelines in patients treated with TTM after OHCA.
The study included 85 comatose adult patients with OHCA who underwent TTM between May 2018 and December 2020. Serum NGAL and NSE were measured at 24-hour intervals until 72 hours after return of spontaneous circulation (ROSC). The primary outcome was their prognostic performance for poor neurological outcome at 3 months after OHCA.
Forty-nine patients (57.6%) had a poor neurological outcome; NGAL levels at all time points measured were significantly higher in these patients than in those with a good outcome (P < .01). NGAL showed lower maximal sensitivity (95% confidence interval [CI]) under a false-positive rate of 0% for the primary outcome compared with NSE (18.2% [95% CI 8.2–32.7] vs 66.7% [95% CI 50.5–80.4]). The combination of NGAL with NSE at 48 h showed the highest sensitivity (69.1% [95% CI 52.9–82.4]) and had the highest area under the curve (0.91 [95% CI 0.81–0.96]) for a poor outcome. The prognostic performance of NGAL alone was inadequate at all time points. However, NGAL combined with NSE at 24 and 28 hours after ROSC showed improved sensitivity compared to NGAL alone.
NGAL should be considered a supplementary biomarker in combination with NSE for prognostication in patients with OHCA treated with TTM.
Is intraoperative corticosteroid a good choice for postoperative pain relief in total joint arthroplasty? A meta-analysis of 11 randomized controlled trials
Authors: Zhang Lu-kai , Zhu Fang-bing , Gao Huan-huan , Zhang Lei , Quan Ren-fu 
Published: October 2021

Abstract

Background:
Effective postoperative analgesia is of great significance for postoperative rehabilitation. This meta-analysis aimed to investigate the efficacy of corticosteroid on pain following total joint arthroplasty.

Method:
PubMed (1996–December 2020), Embase (1996–December 2020), and the Cochrane Library (CENTRAL, December 2020) were searched and a total of 11 randomized controlled trials met our inclusion criteria.

Results:
Eleven randomized controlled trials met the inclusion criteria. Pooled data indicated the corticosteroid group was effective compared to the control group in terms of the visual analogue scale at rest (P < .05) and movement (P < .05), the total morphine equivalent consumption (P < .05), and the length of stay (P < .05), without increasing the risk of periprosthetic joint infection (P = .74) and the length of stay (P = .32).

Conclusions:
Compared to the control group, intraoperative corticosteroid was benefit to the pain management in total joint arthroplasty.
Obesity and risk for hypertension and diabetes among Kenyan adults
Authors: Temu Tecla M. , Macharia Paul , Mtui James , Mwangi Martin , Ngungi Paul W. , Wanjalla Celestine , Bloomfield Gerald S. , Farquhar Carey , Nyanjau Loise , Gathecha Gladwell K. , Kibachio Joseph 
Published: October 2021

Abstract
Despite the anticipated growth in the global burden of obesity especially in low-income countries, limited data exist on the contribution of obesity to cardiometabolic diseases in Africa.
We examined population-based samples of Kenyan adults who participated in the 2015 national chronic disease risk factor surveillance survey. Weight and height were measured, and body mass index (BMI) was calculated and used as a measure for general obesity. Waist circumference (WC), a clinical measure of central obesity was also measured. Logistic regression was used to assess the association between obesity with hypertension, diabetes, and dyslipidemia risk.
Of the 4276 participants, the median (IQR) age was 36 (27–47) years, 41% were men. One-third (37%) of the participants were centrally obese, whereas 10% were generally obese. The odds for overweight and general obesity were highest among females, adults >40 years, and those in the highest wealth quartile. Central and general obesity, assessed by WC and BMI, were associated with hypertension and dyslipidemia but not diabetes for both sexes. Compared with adults of normal weight, individuals with a BMI of ≥30 kg/m2 had an odds ratio of 2.39 (95% confidence interval [CI], 1.82–3.12) for hypertension and 2.24 (95% CI, 1.70–2.96) for dyslipidemia.
Obesity prevalence is high in Kenya and is associated with hypertension and dyslipidemia but not diabetes. Our findings indicate an urgent need to develop public health interventions to address obesity and prevent the development of comorbid conditions.
Accurate segmentation for different types of lung nodules on CT images using improved U-Net convolutional network
Authors: Zhang Xiaofang , Liu Xiaomin , Zhang Bin , Dong Jie , Zhang Bin , Zhao Shujun , Li Suxiao 
Published: October 2021

Abstract
Since lung nodules on computed tomography images can have different shapes, contours, textures or locations and may be attached to neighboring blood vessels or pleural surfaces, accurate segmentation is still challenging. In this study, we propose an accurate segmentation method based on an improved U-Net convolutional network for different types of lung nodules on computed tomography images.
The first phase is to segment lung parenchyma and correct the lung contour by applying α-hull algorithm. The second phase is to extract image pairs of patches containing lung nodules in the center and the corresponding ground truth and build an improved U-Net network with introduction of batch normalization.
A large number of experiments manifest that segmentation performance of Dice loss has superior results than mean square error and Binary_crossentropy loss. The α-hull algorithm and batch normalization can improve the segmentation performance effectively. Our best result for Dice similar coefficient (0.8623) is also more competitive than other state-of-the-art segmentation algorithms.
In order to segment different types of lung nodules accurately, we propose an improved U-Net network, which can improve the segmentation accuracy effectively. Moreover, this work also has practical value in helping radiologists segment lung nodules and diagnose lung cancer.
Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach
Authors: Okanoue Shotaro , Iwamuro Masaya , Tanaka Takehiro , Satomi Takuya , Hamada Kenta , Sakae Hiroyuki , Abe Makoto , Kono Yoshiyasu , Kanzaki Hiromitsu , Kawano Seiji , Kawahara Yoshiro , Okada Hiroyuki 
Published: October 2021

Abstract
There is no practical predictive model for the diagnosis of gastrointestinal stromal tumors (GISTs). To establish a practical predictive model for the diagnosis of subepithelial lesions in the stomach, we reviewed patients with GISTs (n = 89), schwannomas (n = 7), and leiomyomas (n = 28).
The tumor was more frequently found along the gastric cardia in the leiomyoma group (57.1%) than in the GIST/schwannoma group (2.1%, P < .01). Contrast enhancement (57.3% vs 0%, P < .01) and intra-tumoral necrosis (34.4% vs 0.0%, P < .01) were more frequently observed in the GIST/schwannoma group than in the leiomyoma group. On endoscopic ultrasonography, 58.3% of GISTs/schwannomas showed uneven echogenicity, whereas the echogenicity was uneven in 21.4% of leiomyomas (P < .01). There were no differences between the tumor color and the presence or absence of ulcer formation, tumor bleeding, irregularity of the tumor margin, cystic spaces, and hyperechoic spots between the 2 groups. Based on these results, we developed a 2-step diagnostic algorithm for GISTs/schwannomas. The first step comprises 1 endoscopic feature: a cardiac or non-cardiac location. Tumors with a cardiac location were judged as leiomyomas and those with a non-cardiac location were judged as GISTs/schwannomas, with 96.9% sensitivity and 57.1% specificity for GIST/schwannoma diagnosis. The second step comprises a combination of endoscopic (non-cardiac location), radiologic (positive contrast enhancement and intra-tumoral necrosis), and endosonographic (uneven echogenicity) features for a total of 4 points. We assigned 1 point to each feature. Tumors with scores of 2 to 4 were judged as GISTs/schwannomas, with 81.3% sensitivity and 92.9% specificity for GIST/schwannoma diagnosis.
Our predictive model will be a practical guide for the management of gastric subepithelial lesions.
Impact of pretransplant frailty and sarcopenia on the post-transplant prognosis of patients with liver cirrhosis: a systematic review
Authors: Ferreira Alexandre Pimentel , Machado Mariana Verdelho 
Published: October 2021

Introduction
Frailty and sarcopenia associate with increased mortality in patients with liver cirrhosis on the transplant waitlist. We conducted a systematic review on the impact of pretransplant frailty and sarcopenia on post-transplant outcomes in adult patients with liver cirrhosis.

Methods
We performed a search in Medline, Embase and Cochrane Central. Of the 12276 references initially recovered, 34 were included.

Results
Frailty and sarcopenia presented a negative impact on post-transplant outcomes and seemed to associate with an overall two-fold reduction in early and 50% reduction in late survival, for severe conditions, according to the largest cohorts. These patients required longer ICU and hospitalization time, had higher rates of sepsis and respiratory complications and lower graft-survival. The reversibility of frailty depended on the severity of functional impairment and on the co-morbidities contributing to frailty. Reversibility of sarcopenia occurred in only a minority of patients, in unbiased studies.

Conclusion
Frailty and sarcopenia are double-edged swords: patients with frailty/sarcopenia should be prioritized for liver transplantation due to increased mortality on the waitlist; however, severe frailty/sarcopenia may justify delisting because it associates with dismal prognosis post-liver transplantation. Patients presenting mild to moderate frailty/sarcopenia, should be submitted to liver transplantation before those conditions worsen to a level that significantly impacts post-liver transplantation outcomes.
Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma
Authors: Gündoğan Cihan , Kömek Halil , Can Canan , Yildirim Özgen Ahmet , Kaplan İhsan , Erdur Erkan , Poyraz Kerem , Güzel Yunus , Oruç Zeynep , Çakabay Bahri 
Published: October 2021

Objective
In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the primary tumor, and nodal, peritoneal and distant organ metastases of primary and recurrent gastric adenocarcinoma (GAc) with patient and lesion-based comparison.

Materials and method
Twenty-one patients with histopathologically proven newly diagnosed or recurrent GAc who underwent 18F-FDG and 68Ga-FAPI-04 imaging were included in the study. Both imaging techniques were evaluated visually according to the intensity of organ-based uptake. SUVmax and tumor-to-background ratio (TBR) values obtained from primary tumor/relapse and metastatic organs were compared statistically.

Results

68Ga-FAPI-04 uptake was positive in all 15 newly diagnosed patients, while two patients among them who had mucinous and signet ring cell carcinoma did not exhibit 18F-FDG uptake. The sensitivity and specificity of 68Ga-FAPI-04 PET/CT in detecting primary gastric were 100%, while the sensitivity and specificity of 18F-FDG were 86.6 and 100%, respectively. 68Ga-FAPI-04 imaging revealed diffuse stomach uptake in seven patients, while 18F-FDG could only show two of them. The sensitivity and specificity of in-patient-based detection of lymph node metastases were 100 and 95.2%, respectively, while these values were 71.4 and 93.7%, respectively, for 18F-FDG. For peritoneal involvement 68Ga-FAPI-04 had a sensitivity and specificity of 100%, whereas 18F-FDG had a sensitivity of 40% and a specificity of 100%.

Conclusion

68Ga-FAPI-04 PET/CT is an imaging modality with the potential of yielding more sensitive and specific findings 18F-FDG PET/CT. This modality may help avoid invasive diagnostic procedures that may be frequently required in GAc.