bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transversus abdominis plane block provides effective and safe anesthesia in the cesarean section for an amyotrophic lateral sclerosis parturient
Authors: Wang Yun , Zhang Yi , Li Shitong , Chen Lianhua , Jiang Jihong 
Published: October 2021

Abstract

Rationale:
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with the fatal course of muscle weakness. The published experience of anesthesia management in the cesarean section with ALS parturient is scant.

Patient concerns:
A 34-year-old woman was admitted to our center complaining of obvious dysphagia together with atrophy and weakness of quadriceps at 24 weeks of her pregnancy. Cesarean was planned at 36 weeks’ gestation due to the rapid deterioration of the mother.

Diagnoses:
The results of neurological examination, electromyography and spinal magnetic resonance imaging suggested ALS according to the EI Escorial World Federation of Neurology criteria.

Interventions:
Ultrasound-guided transversus abdominis plane block with 0.6 minimum alveolar concentration sevoflurane was used in this ALS parturient during her cesarean section procedure.

Outcomes:
This anesthesia strategy successfully met the demands of the surgery, helped avoid prolonged ventilation and prevent maternal respiratory complications.

Lessons:
Transversus abdominis plane block with subanesthetic concentrations of sevoflurane can provide effective and safe anesthesia in the cesarean section for a patient with ALS.
Hypertension as a risk factor for retinal vein occlusion in menopausal women
Authors: Oh Tae Ryom , Han Kyung-Do , Choi Hong Sang , Kim Chang Seong , Bae Eun Hui , Ma Seong Kwon , Kim Soo Wan 
Published: October 2021

Abstract
Retinal vein occlusion (RVO) is an important cause of blindness. Hypertension is a well-known risk factor for RVO. Although the prevalence of hypertension increases in women after menopause, the relationship between blood pressure and RVO in women before and after menopause has not been studied in detail.
We retrospectively analyzed 2,619,206 patients from the Korean National Health Insurance System database. A Cox proportional hazard regression model was used to evaluate the independent association between blood pressure and the risk of RVO development and identify differences between premenopausal and postmenopausal women.
The incidence of RVO was higher among postmenopausal women than in premenopausal women. In the model adjusted for socioeconomic and clinical variables, there was an association between blood pressure and RVO development in premenopausal and postmenopausal women; however, this was stronger than premenopausal women.
Both systolic and diastolic blood pressure are associated with an increased risk of RVO, and their effects are more potent in premenopausal women than postmenopausal women. Thus, comprehensive management of hypertension in premenopausal women is essential to reduce the risk of RVO.
Carbohydrate antigen 125, carbohydrate antigen 15–3 and low-density lipoprotein as risk factors for intraocular metastases in postmenopausal breast cancer
Authors: Tang Jing , Yan Bo , Li Gao-Feng , Li Qiu-Yu , Liu Wen-Feng , Liang Rong-Bin , Ge Qian-Min , Shao Yi 
Published: October 2021

Abstract
The prognosis of patients with postmenopausal breast cancer (PBC) could be improved by the early detection of intraocular metastases (IOMs). However, serum biomarkers for IOMs in PBC remain elusive. In the current study, we investigated patients with PBC, and compared serum parameters in an IOM and a non-IOM group, and then differentiated the risk factors related to IOMs. A comparison between an IOM and a non-IOM (NIOM) group was performed using Student t-test and a Chi-Squared test. After constructing a Poisson regression model to identify risk factors, we plotted receiver operating characteristic curves to evaluate the predictive value of significant risk factors in detecting IOMs. The incidence of IOMs in PBC was 1.16%. The histopathology results were not significantly different between the 2 groups. The levels of serum carbohydrate antigen 125 (CA-125), carbohydrate antigen 15–3 (CA15–3) and alkaline phosphatase were significantly elevated in IOMs compared with NIOMs (P = .082, P < .001, and P < .001, respectively). Compared with NIOMs, age, carbohydrate antigen 19 to 9, hemoglobin, calcium, total cholesterol, low-density lipoprotein (LDL) and apolipoprotein A1 were remarkably lower in IOMs (P = .038, P < .001, P < .001, P = .032, P = .041, P < .001, and P = .001, respectively). Poisson regression suggested that CA-125, CA15–3 and LDL were contributing to IOMs in PBC as risk factors (OR = 1.003, 95% CI: 1.001–1.005; OR = 1.025, 95% CI: 1.019–1.033; OR = 0.238, 95% CI: 0.112–0.505, respectively). A receiver operating characteristic curve revealed that the cut-off values for CA-125, CA15–3 and LDL were 16.78 0 U/mL, 63.175 U/mL, and 2.415 mmol/L, respectively. The combination of CA-125 and CA15–3 showed significant diagnostic value (area under the curve [AUC] = 0.982, P < .001). Our investigation suggests that CA-125, CA15–3 and LDL remarkably predict IOMs in PBC as risk factors, and the combination of CA-125 and CA15–3 shows considerable diagnostic value.
A case report of atypical uterine leiomyoma
Authors: Kim Yun Sook , Lee Hyun Joo 
Published: October 2021

Abstract

Introduction:
Atypical uterine leiomyoma (ALM) shows benign behavior and does not require adjuvant therapy. As the distinction between uterine leiomyoma, ALM, and leiomyosarcoma is only possible through pathology, it is almost impossible to diagnose ALM before surgery.

Patient concerns:
A 34-year-old multigravida woman who had undergone myomectomy for leiomyoma ten years earlier presented with fibroids that had gradually increased in size.

Diagnoses:
An ultrasound scan and abdominal and pelvic computed tomography revealed large myomas. The postoperative pathologic findings confirmed the diagnosis of ALM. The Ki-67 proliferation index was 15%.

Interventions:
We performed laparoscopic myomectomy.

Outcomes:
The patient recovered well after the surgery. The patient has undergone ultrasound follow-up every six months after surgery and has been doing well for three years without any recurrence.

Conclusion:
The combination of clinical features, imaging, pathological findings, and tumor suppressor gene Ki-67 expression may be of great value in the assessment of benign, atypical, and malignant uterine smooth muscle tumors. There are still no precise methods to differentiate them before surgery, and pathology remains the gold standard for diagnosis. Periodic monitoring is recommended until menopause, although the recommended interval remains controversial.
MGMT promoter methylation in large-cell neuroendocrine carcinoma
Authors: Wang Xuefeng , Li Jingyun , Wang Yanan , Zhang Xi , Shi Hongyun 
Published: October 2021

Abstract

Introduction:
Currently, there is no consensus on the treatment of O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in large-cell pulmonary neuroendocrine carcinoma. Some studies have shown that MGMT promoter methylation could be a predictive factor for objective response and survival, but there are few reports on MGMT promoter methylation in pulmonary large-cell neuroendocrine tumors treated with radiotherapy combined with temozolomide.

Patient Concerns:
An 80-year-old man with large-cell neuroendocrine carcinoma of the lung complained of weakness in the right lower limb. Multiple organ metastases were detected on imaging examination.

Diagnosis:
Large-cell neuroendocrine carcinoma was confirmed by pathological examination after the surgery.

Interventions:
The patient had local recurrence four months after surgical treatment that progressed after administration of a variety of chemotherapeutic drugs. Good local control was achieved after local chest radiotherapy. After the occurrence of brain metastasis and multiple organ metastases, brain radiotherapy combined with oral temozolomide was administered. Subsequently, the brain metastases disappeared and metastases in the other organs decreased. Furthermore, the original pathological gene detection showed that the MGMT promoter was methylated.

Outcomes:
Owing to economic reasons, the patient stopped taking temozolomide and died of liver metastasis with hypoproteinemia four months later.

Conclusion:
Radiotherapy had a significant effect on the local lesions of this patient with pulmonary large-cell neuroendocrine carcinoma, and temozolomide was effective against systemic lesions in this case with MGMT promoter methylation. Simultaneous treatment with radiotherapy and chemotherapy in this elderly patient was effective, and the side effects were tolerable.
Accurate measurement of coronary artery calcium in cancer patients using the CT component of PET/CT scans
Authors: McConachie Peter , McKay Erin , Crane Alexis , Nguyen Nicholas , Quinn Renee , Butler S. Patrick 
Published: October 2021

Objective
The aim of this study is to establish the correlation between a CAC score derived from the CT component of PET/CT scan (CAC-PET) using in-house software as compared to the conventional technique (CAC-Standard). In addition, the incidence of high CAC scores in asymptomatic cancer patients with low-to-intermediate cardiovascular risk will be determined.

Methods
100 patients referred for oncologic PET/CT were prospectively recruited to have a conventional CAC score after their PET/CT. Patients with a history of cardiac disease were excluded. The nongated CT images from the PET/CT (CAC-PET) were analysed using validated in-house software with the results compared to those from gated CT analysed using the standard technique (CAC-Standard).

Results
The correlation of CAC scores between the two scan types was moderate [slope, 0.95; R
2 = 0.91; limits of agreement (LOA) = 0.29–5.65]. Using a conventional categorical analysis, there was complete agreement in 73% of patients with one category difference in the remainder. [interclass correlation (ICC) = 0.90; Cohen’s kappa = 0.63]. In total 28% of these asymptomatic low-to-intermediate-risk cancer patients had CAC scores over 300.

Conclusion
Estimation of CAC from the CT component of PET/CT scans is a reliable method for the detection of significant CAC in cancer patients and correlates well with the standard method. This technique should permit the calculation of cardiovascular risk in cancer patients undergoing PET/CT without any additional radiation exposure. A significant number of asymptomatic low-to-intermediate-risk cancer patients were found to have a high risk of cardiovascular disease.
Peripheral Blood Cell Variables Related to Systemic Inflammation in Patients With Unresectable or Metastatic Pancreatic Cancer
Authors: Colloca Giuseppe , Venturino Antonella 
Published: October 2021

Abstract
Systemic inflammatory response (SIR) plays a central role in the prognosis of unresectable or metastatic pancreatic ductal adenocarcinoma (mPDAC), and many SIR-related peripheral blood cell (PBC)-derived variables have been proposed as prognostic factors. The study aims to perform a systematic review and, for the more studied PBC-derived variables, a meta-analysis. A systematic review from 2000 to 2020 on 2 databases by predefined criteria was performed for PBC-derived variables in patients with mPDAC receiving chemotherapy in relation with overall survival. Eligible studies were selected by inclusion criteria, and only the PBC variables reported in at least 10 studies were evaluated by meta-analysis. Three hundred and eighty articles were found, and 28 studies were selected. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were reported in 28 and 10 articles, respectively. The subsequent meta-analyses supported the prognostic effect for both, NLR (hazard ratio, 2.10; 95% confidence interval, 1.87–2.37) and PLR (hazard ratio, 1.22; 95% confidence interval, 1.08–1.37). Heterogeneity was significant for NLR (I2 = 62%) and low for PLR (I2 = 24%). Among SIR-related PBC-derived variables, NLR is the most suitable prognostic factor for future clinical trials of patients with mPDAC.
Effect of Laparoscopic Pancreaticoduodenectomy in Elderly People
Authors: Zhang Wei , Huang Zhangkan , Zhang Jianwei , Che Xu 
Published: October 2021

Abstract
Pancreaticoduodenectomy is considered to be the most complicated operation in abdominal surgery. The purpose of this study was to evaluate the safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients. We searched PubMed, Embase, and Cochrane Library databases for relevant studies that were published before June 2020. Seven cohort studies were eligible with 3200 patients. The result of meta-analysis showed that, for the elderly, severe complications, clinical pancreas fistula, and delayed gastric emptying in the LPD group were significantly lower than those in the open pancreaticoduodenectomy (OPD) group. There was no significant difference in postoperative bleeding, reoperation, and readmission between the 2 groups. For the LPD, the mortality, delayed gastric emptying, and severe complication in elder patients were significantly higher than those in young patients. There was no significant difference in postoperative bleeding, R0 rate, reoperation rate, and readmission rate between the aged and the young. Therefore, LPD can reduce postoperative complications in elderly patients compared with OPD, which can be used as a potential alternative to OPD in elderly patients. However, laparoscopic approach cannot eliminate the high risk of postoperative death and severe complications caused by age. More high-quality studies need to be done for further verification.
Characteristics and Outcomes of Psychiatric Inpatients With Severe Mental Illness and COVID-19
Authors: Yalçin Murat , Sönmez Güngör Ekin , Ergelen Mine , Beşikçi Keleş Didem , Yerebakan Tüzer Melike , Öcek Baş Tuba , Güneş Mustafa , Genç Davut , Kirşavoğlu Betül , Metin Merve , Bülbül Alper , Kayacan Asli 
Published: October 2021

Abstract
Recent studies indicated that psychiatric inpatients with severe mental illness (SMI) are at a greater risk of morbidity and mortality from COVID-19. However, there is still little data about the impact of comorbid COVID-19 infection on the course and outcome of acute exacerbations in this population. We conducted a prospective historically matched case control study. The sociodemographic and clinical characteristics of acute psychiatric inpatients with SMI and comorbid COVID-19 (n = 21) were compared with those of historically-matched non-COVID-19 controls with SMI (n = 42). The outcomes for acute inpatients with SMI and COVID-19 were also investigated. The new-onset SMI rate was relatively higher (23.8%) in the COVID-19 group, which has characteristics similar to those of the non-COVID-19 group except for working status (p < 0.05). The COVID-19 group had a high rate of relapse (47.6%) within 6 months of discharge. Our study suggests that patients with SMI who contracted SARS-CoV-2 may have a higher rate of new-onset mental disorder. Considering the high rate of relapse during the pandemic, chronically ill patients with SMI and COVID-19 should be closely monitored after discharge.
Evaluation of a Pediatric Early Warning Score as a Predictor of Occult Invasive Bacterial Infection in the Pediatric Emergency Department
Authors: Gardiner Michael A. , Allen Coburn H. , Singh Nidhi V. , Tresselt Erin , Young Andrew , Hurley Kara K. , Wilkinson Matthew H. 
Published: October 2021

Objectives
The aims of the study were to evaluate the diagnostic performance of Pediatric Early Warning Score (PEWS) to predict occult invasive bacterial infection (IBI) in well-appearing pediatric emergency department (PED) patients without known risk factors for bacterial infection and to compare PEWS to heart rate (HR) and Emergency Severity Index (ESI).

Methods
We performed a retrospective case-control analysis of febrile PED patients aged 60 days to 18 years over a 2-year period. Subjects were excluded if they were ill appearing, admitted to an intensive care unit, or had a known high-risk condition. Cases of occult IBI were included if they had a noncontaminant positive culture other than an isolated positive urine culture. Two febrile control subjects were identified for each case. Odds ratios and receiver operating characteristic curves were evaluated to determine performance characteristics of PEWS at triage and disposition, age-adjusted HR at triage and disposition, and ESI at triage.

Results
Compared with 178 controls, 89 cases had higher disposition PEWS, higher disposition HR, lower ESI, and higher rate of hospital admission. Disposition PEWS ≥3 (odds ratio, 2.57; 95% confidence interval, 1.08–6.18), disposition HR > 99th percentile, and ESI demonstrated increased odds of occult IBI. Area under the receiver operating characteristic curve for disposition PEWS (0.56) was similar to triage PEWS (0.54), triage HR (0.54), disposition HR (0.58), and ESI (0.65).

Conclusions
Subjects with PEWS ≥3 at PED disposition have increased odds of occult IBI; however, PEWS has poor discriminative ability at all cutoffs. We cannot recommend PEWS used in isolation to predict occult IBI.
Chronic Nerve Pain after Burn Injury: An Anatomical Approach and the Development and Validation of a Model to Predict a Patient’s Risk
Authors: Klifto Kevin M. , Yesantharao Pooja S. , Lifchez Scott D. , Dellon A. Lee , Hultman C. Scott 
Published: October 2021

Background:
A model that predicts a patient’s risk of developing chronic, burn-related nerve pain may guide medical and/or surgical management. This study determined anatomy-specific variables and constructed a mathematical model to predict a patient’s risk of developing burn-related nerve pain.

Methods:
A retrospective analysis was conducted from 1862 adults admitted to a burn center from 2014 to 2019. One hundred thirteen patients developed burn-related nerve pain. Comparisons were made using 11 anatomy-specific locations between patients with and without burn-related nerve pain. The modified Delphi technique was used to select 14 potential risk variables. Multivariate regression techniques, Brier scores, area under the curve, Hosmer-Lemeshow goodness-of-fit, and stratified K-fold cross-validation was used for model development. Chronic pain was defined as pain lasting 6 or more months after release from the Burn Center.

Results:
Prevalence rates of burn-related nerve pain were similar in the development (6.1 percent) and validation (5.4 percent) cohorts [Brier score = 0.15; stratified K-fold cross-validation (K = 10): area under the curve, 0.75; 95 percent CI, 0.68 to 0.81; Hosmer-Lemeshow goodness-of-fit, p = 0.73; n = 10 groups]. Eight variables were included in the final equation. Burn-related nerve pain risk score = −6.3 + 0.02 (age) + 1.77 (tobacco use) + 1.04 (substance abuse) + 0.67 (alcohol abuse) + 0.84 (upper arm burn) + 1.28 (thigh burn) + 0.21 (number of burn operations) + 0.01 (hospital length-of-stay). Burn-related nerve pain predicted probability = 1 − 1/[1 + exp(burn-related nerve pain risk score)] for 6-month burn-related nerve pain risk score. As the number of risk factors increased, the probability of pain increased.

Conclusions:
Risk factors were identified for developing burn-related nerve pain at 11 anatomical locations. This model accurately predicts a patient’s risk of developing burn-related nerve pain at 6 months. Age, tobacco use, substance abuse, alcohol abuse, upper arm burns, thigh burns, the number of burn operations, and hospital length of stay represented the strongest predictors.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Fine Details That Improve Nasal Reconstruction
Authors: Borsuk Daniel E. , Papanastasiou Constantine , Chollet Andre 
Published: October 2021

Learning Objectives:
After studying this article, the participant should be able to: 1. Identify common negative outcomes that arise with conventional nasal reconstruction. 2. Understand the technical refinements that help avoid and reduce negative outcomes in nasal reconstruction. 3. Learn about the utility of regional axial island flaps for nasal reconstruction, in particular, the lateral nasal artery flap.

Summary:
Nasal reconstruction has been a preoccupation of surgeons dating to before 600 bc. The nose is the central focal point of the face and a key identifying facial feature, and surgery to the nose can prove to be challenging to even the most experienced surgeon. The objective of this CME article is to outline the most commonly used surgical options for each nasal aesthetic subunit, and the specific complications observed for each. The best surgical options and technical refinements are highlighted, and principles that may help restore the nose are outlined.
Failure to restore CD4+ cell count associated with infection-related and noninfection-related cancer
Authors: Malmström Stina , Wagner Philippe , Yilmaz Aylin , Svedhem Veronica , Carlander Christina 
Published: October 2021

Objective:
To assess incidence and relative risk of cancer in Sweden, by HIV status, from 1988 to 2017.

Design:
Population-based register study.

Methods:
From the Swedish Total Population Register, all people born between 1940 and 2000 (n = 8 587 629), and resident in Sweden sometime 1983–2017 were identified and linked to National HIV Register InfCareHIV, National Cancer Register, and LISA database. We present incidence and adjusted hazard ratios (adjHR) of infection and noninfection-related cancer for three periods between 1988 and 2017.

Results:
Incidence and relative risk of infection-related cancer decreased but remained higher in people with HIV (PWH) than in HIV-negative. The proportion attributable to infection remained higher in PWH than in HIV-negative (44 vs. 9%). Women with HIV had lower risk of infection-related cancer than men with HIV [adjusted hazard ratio (adjHR) 0.6, 95% CI 0.4–0.9], mainly driven by lower incidence of Kaposi's sarcoma (adjHR 0.1, 95% CI 0.0–0.4). Current viral suppression (adjHR 0.3, 95% CI 0.2–0.5) was associated with lower risk of infection-related cancer. Current CD4+ cell count less than 200 cells/μl was associated with both infection-related (adjHR 15.3, 95% CI 10.7–21.8) and noninfection-related cancer (adjHR 2.5, 95% CI 1.5–4.1), as was CD4+ cell count increases less than 100 cells/μl post antiretroviral therapy (ART) (infection-related cancer adjHR 6.6, 95% CI 4.2–10.6, noninfection-related cancer adjHR 2.0, 95% CI 1.2–3.3).

Conclusion:
Current CD4+ cell count and failure to restore CD4+ cell count both associated with infection and noninfection-related cancer. Viral suppression associated with lower risk of infection-related cancer. Early HIV detection and early adherent ART remain essential for cancer prevention.