bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anesthetic considerations in hyperparathyroid crisis
Authors: Kong Hao , Zhang Zhen , Zhang Hong 
Published: January 2021

Abstract

Introduction:
Hyperparathyroid crisis is a rare and potentially life-threatening complication of severe calcium intoxication. Parathyroidectomy is the only curative method for hyperparathyroid crisis. Several case reports and case series have been published on the medical and surgical treatments for hyperparathyroid crisis, however, few reports have focused on the associated perioperative anesthetic management.

Patient concerns:
A 48-year-old Chinese woman presented with a 2-week history of nausea and vomiting and complained of mental status alteration including confusion and agitation in the 24 hours prior to her admission. She denied any history of past illness. Laboratory tests showed severe hypercalcemia crisis with a serum calcium level of 5.21 mmol/L and a serum intact parathyroid hormone level of > 5000 pg/mL.

Diagnosis:
The diagnosis was hyperparathyroid crisis, acute kidney injury, acute liver injury, rhabdomyolysis, infection, and shock.

Interventions:
She underwent initial management with aggressive intravenous fluid resuscitation, loop diuretic treatment, vitamin D supplement, intravenous bisphosphonates, and calcitonin therapy. However, her condition worsened, and she was transferred to the operating theater for a parathyroidectomy under general anesthesia. She was under general anesthesia and monitored with electrocardiogram, pulse oxygen saturation, continuous arterial blood pressure, central venous pressure and nasopharyngeal temperature. Cardiac output and stroke volume variation were monitored from the FloTrac system. After liberal fluid rehydration, circulatory support, cooling treatment and calcium supplement after tumor removal, her unstable vital signs gradually improved.

Outcomes:
After meticulous anesthetic management by the anesthesiologist and complete tumor resection by the surgeon, she survived this fatal disease. The patients was discharged on postoperative day 37 without any sequelae.

Lessons:
Patients with hyperparathyroid crisis should undergo a thorough preoperative evaluation. Difficult airway, fluid depletion, multiple organ dysfunction, hypercoagulability, and concomitant diseases are the primary challenges in anesthetic management. After tumor removal, the serum calcium level should be monitored closely and calcium should be supplemented in a timely manner to prevent serious complications.
Clinicopathologic features and clinical outcomes of intravenous leiomyomatosis of the uterus
Authors: Yu Xiuzhang , Fu Jing , Cao Ting , Huang Liyan , Qie Mingrong , Ouyang Yunwei 
Published: January 2021

Abstract

Rationale:
Intravenous leiomyomatosis (IVL) is a rare and special type of smooth muscle tumor originating in the uterus. It is classified as a benign disease according to its histological features but shows the behavioral characteristics of a malignant tumor. It is easily misdiagnosed and recurrent. The purpose of this study was to retrospectively analyze clinicopathological data of 25 cases of IVL in order to enhance clinicians’ understanding of this rare disease.

Patient concerns:
We screened and identified 25 cases of IVL at our hospital from October 2013 to January 2020. Five patients had tumors.

Diagnoses:
The diagnosis in each case was pathologically confirmed after surgical treatment.

Interventions:
All patients were managed surgically. Although the surgical procedures were different, the surgical approach was geared towards achieving complete excision. Three patients received hormonal therapy with gonadotropinreleasing hormone agonists after surgery.

Outcomes:
We retrospectively reviewed all medical records and analyzed the clinicopathologic features and clinical outcomes of this disease as well as the correlations between the clinical features and risk of recurrence. Neither the symptoms nor the preoperative imaging results were suggestive of IVL in any of the cases. Except for two patients who were lost to follow-up, twenty-three patients who were followed up are still alive. Three patients experienced a recurrence.

Lessons:
The clinical manifestations and ultrasound images of IVL in the early stages are not typical; thus, IVL is easily misdiagnosed as uterine leiomyoma. Radiologists, pathologists, and surgeons should have a thorough understanding of IVL and a high index of vigilance for IVL in clinical practice. Surgery should always be aimed at achieving complete tumor excision. Patients with large lesions (≥7 cm) and lesions extending to the broad ligament may have an increased risk of recurrence. Early detection, diagnosis, and treatment are very important; once the diagnosis is confirmed, regular follow-ups are crucial.
Dichorionic twin pregnancy with sirenomelia and chromosomal anomaly in 1 fetus
Authors: Ting Yuan , Xue-Lan Li , Chun-Bao Wang , Ting Zhang , Fen Li , Zhen Han 
Published: January 2021

Abstract

Rationale:
Sirenomelia is a rare congenital malformation that threatens fetal survivals. The cases in which twin with sirenomelia and chromosomal abnormality have been seldomly reported. We reported a dichorionic twin case in which one twin had sirenomelia, the other twin had a normal phenotype, and they had different chromosomal abnormalities.

Patient concerns:
The abnormal twin was found at 22 weeks by ultrasound. The sirenomelia fetus was complicated with a thoracic stenosis, enlarged rectum without anal opening, the absence of bilateral kidneys, a single umbilical artery, a single lower limb, the abnormal curvature of spine, double outlet of right ventricle, which were the indicatives of the chromosome detection.

Diagnosis:
The copy number variation of the sirenomelia fetus was detected as a deletion of 4.8Mb in 11p11.12-11q11. The co-twin was found with del(Y)(q11.223q11.23), which was as the same as his father's. The mother had normal chromosome. The parents had normal phenotypes. It was firstly reported a microdeletion with sirenomelia fetus.

Interventions:
There was no specific treatments for the twins.

Outcomes:
Intrauterine death of the sirenomelia fetus was found at 27 weeks and postnatal death after inevitable abortion happened to the co-twin.

Lessons:
Prenatal ultrasound was responsible for recognizing sirenomelia, and the detailed ultrasound scanning and chromosome detection should be done for the co-twin. The etiology of sirenomelia remains unclear, and genetic detection is also necessary for its pathogenesis research.
Manipulation of intertrochanteric fractures in patients with below- or above-knee amputation using a fracture table
Authors: Lee Sang-Min , Suh Kuen Tak , Oh Young Kwang , Shin Won Chul 
Published: January 2021

Abstract

Rationale:
In general, in the case of an intertrochanteric hip fracture, surgery is performed using a fracture table and by fixing the patient's foot to the boot piece. In patients with amputation of the affected lower limb, it is impossible to fix the foot to the boot piece; therefore, the traction and rotation of the fracture site cannot be maintained, leading to improper patient positioning. In such cases, a fracture table cannot be used intraoperatively to stabilize the fracture site. We report 2 cases of successful intertrochanteric fracture reduction using a fracture table for patients with below- or above-knee amputation.

Patient's concerns:
Both patients presented with left hip pain resulting from a fall.

Diagnosis:
Two elderly male patients with prior limb amputations below or above the knee presented with intertrochanteric hip fractures. Previous amputation of the lower limb on the same side of the fracture made it difficult to use a fracture table intraoperatively to stabilize the fracture site.

Intervention:
We performed fracture reduction using a modified fracture table for each patient. By altering the rotation of the boot piece and using additional skin traction bands, we could maintain proper patient positioning and rotation direction and obtain sufficient traction force.

Outcomes:
The chosen outcomes were fracture alignment and union at the end of follow-up and the ability to walk and perform activities of daily living. Reduction and intramedullary nail fixation using the fracture table were successful in both cases. Appropriate fracture union was achieved within 6 months, and the preoperative walking ability and activities of daily living were recovered in both patients, who were followed-up for 28 and 24 months.

Lessons:
Modification of the usual fracture table to suit patients with lower limb amputation helped us successfully perform intertrochanteric hip fracture surgery with the usual levels of traction and rotation required of the fracture site.
Clinical application of next-generation sequencing for the management of desmoid tumors
Authors: Lee Jeong Mi , Kim Han Gyeol , Shin So Youn , Lee Seung Hyeun 
Published: January 2021

Abstract

Rationale:
Desmoid tumors are rare myofibroblastic neoplasms characterized by local invasiveness and high rates of recurrence, and sometimes mimic local recurrence of previously resected malignancies. Previous studies have suggested that molecular profiling may be useful for the diagnosis of the tumors and risk stratification. However, the clinical utility of next-generation sequencing (NGS) for the management of desmoid tumors has not been established.

Patient concerns:
A 42-year-old man visited our clinic for routine follow-up 1 year after left upper lobe lingular segmentectomy for lung adenocarcinoma.

Diagnoses:
Chest computed tomography showed a pleural mass adherent to the thoracotomy site. Positron emission tomography revealed mildly increased metabolism with a maximal standardized uptake value of 2.7 within the tumor, suggesting local recurrence of the previous neoplasm. Exploratory thoracotomy and en bloc resection of the tumor revealed spindle cells in a massive collagenous tissue consistent with a desmoid tumor.

Interventions:
NGS was performed to confirm the diagnosis and to identify any genetic alterations that might be relevant to the prognosis of this tumor. The tumor harbored an S45F mutation in CTNNB1, which has been correlated with a high recurrence rate. Therefore, we performed adjuvant radiotherapy on the resection bed at a dose of 56 Gy.

Outcomes:
The patients experienced no postoperative or radiotherapy-related complications. Periodic follow-up examinations using computed tomography were performed every 3 months, and no evidence of recurrence of either tumor was observed during the 38 months after the last surgery.

Lessons:
To the best of our knowledge, this is the first case reporting the clinical application of NGS and aggressive treatment based on the genotyping results for the management of a desmoid tumor. Our case highlights the need to consider desmoid tumors among the differential diagnoses when a pleural mass is encountered at a previous thoracotomy site. More importantly, molecular profiling using NGS can be useful for the establishment of a treatment strategy for this tumor, although further investigations are required.
Impact of the numbers of injections of platelet rich plasma on the clinical outcomes in patients with knee osteoarthritis
Authors: Wang Pan , Li Kai , Jiang Zuxin , Qiu Beiming , Nie Cheng , Luo Hongsheng , Li Zhengjiang 
Published: January 2021

Abstract

Background:
Two published meta-analyses have investigated the effects of the number of injections of platelet rich plasma (PRP) on clinical outcomes in knee osteoarthritis patients, however conflicting findings were generated.

Methods:
We will systematically search PubMed, Embase, and China National Knowledgement Infrastructure (CNKI) to capture additional eligible studies. After screening citations, extracting essential data, assessing the risk of bias, we will use RevMan software and Open BUGS to perform head-to-head and network meta-analysis of pain alleviation and improvement of joint functionality, respectively.

Discussion:
Knee joint osteoarthritis (KOA) is the main cause of joint degeneration in elderly, which seriously reduces patients quality of life. Although intra-articular PRP has been extensively prescribed to treat KOA, a definitive conclusion about the appropriate number of injections has not yet been generated in published meta-analyses. The present updated network meta-analysis will comprehensively answer this question.

Ethics and dissemination:
We will communicate our findings through participating in academic conferences or submiting it to be considered for publication in peer reviewed scholar journal.

INPLASY registration number:
We registered this protocol in International Plateform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) platform and obtained an identifier of INPLASY2020110043 (https://inplasy.com/inplasy-2020-11-0043/).
Differential cytology profiles in bronchoalveolar lavage (BAL) in COVID-19 patients
Authors: Vedder Vanessa , Schildgen Verena , Lüsebrink Jessica , Tillmann Ramona Liza , Domscheit Birgitta , Windisch Wolfram , Karagiannidis Christian , Brockmann Michael , Schildgen Oliver 
Published: January 2021

Abstract
Brochoalvelolar lavages (BALs) from patients suffering from hospitalized infections with SARS-CoV-2, other corona viruses (human coronavirus (HCoV)-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1), Influenza virus type A and B, Haemophilus influenzae and Pneumocystis jirovecii were compared cytopathologically.
The aim of the study was to evaluate if the cellular profile detectable in BAL may be specific for the respective pathogens and could lead to diagnosis of COVID-19 even in the absence of PCR results.
Differential cytology and flow cytometry datasets of 62 patients were observed and compared.
We observed a significant association between individual cell pattern changes and the causing pathogen, but no general cell distribution pattern.
The cytology pattern of the BAL fluid in COVID-19 is not specific enough to use it as a sole diagnostic criterion, although it may support clinical decision making
Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China
Authors: Chen Jing , You Huaxuan , Liu Yan , Kong Qian , Lei Anjiang , Guo Xiujing 
Published: January 2021

Abstract
The physical and psychological condition of patients with gynaecological cancer has received much attention, but there is little research on spirituality in palliative care. This study aimed to investigate spiritual well-being and its association with quality of life, anxiety and depression in patients with gynaecological cancer. A cross-sectional study was conducted in China in 2019 with 705 patients diagnosed with primary gynaecological cancer. European Organisation for Research and Treatment of Cancer quality of life instruments (EORTC QLQ-SWB32 and EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale were used to measure spiritual well-being, quality of life, anxiety and depression. Univariate and multiple linear regression analyses were performed to examine associations between spiritual well-being, quality of life, anxiety and depression. Functioning scales and global health status were positively correlated with spiritual well-being (P < .05). Anxiety and depression were negatively correlated with spiritual well-being (P < .05). Depression (−0.362, P < .001) was the strongest predictor of Existential score. Anxiety (−0.522, P < .001) was the only predictor of Relationship with self. Depression (−0.350, P < .001) and Global health (0.099, P = .011) were the strongest predictors of Relationship with others. Religion (−0.204, P < .001) and Depression (−0.196, P < .001) were the strongest predictors of Relationship with someone or something greater. Global health (0.337, P < .001) and Depression (−0.144, P < .001) were the strongest predictors of Global-SWB. Well spiritual well-being is associated with lower anxiety and depression, and better quality of life. Health providers should provide more spiritual care for non-religious patients and combine spiritual care with psychological counselling to help patients with gynaecological cancer, especially those who have low quality of life or severe symptoms, or experience anxiety or depression.
Fatal intracardiac and pulmonary arterial thromboembolic damage following ABO-incompatible living donor liver transplantation for autoimmune hepatitis
Authors: Choi Won Kyu , Kim Junghan , Choi Ho Joong , Hong Sang Hyun , Chae Min Suk 
Published: January 2021

Abstract

Rationale:
We present the case of a patient with autoimmune hepatitis who suffered fatal intracardiac and pulmonary arterial thromboembolic complications after ABO-incompatible living donor liver transplantation (ABOi LDLT) with splenectomy.

Patient concerns:
A 46-year-old female (blood type B+) with autoimmune hepatitis and hepatitis B carrier status underwent elective ABOi LDLT. The donor liver was from a 51-year-old male living donor (blood type A+). A splenectomy was performed without bleeding complications. Intraoperatively, the patients hemodynamic condition was acceptable, with no evidence of thromboembolism on transesophageal echocardiography (TEE).

Diagnosis:
Postoperatively, her platelet count increased from 15.0 to 263.0 (× 109/L) and thromboelastographic parameters indicated hypercoagulable state. She suffered acute circulatory collapse, respiratory distress and, eventually, a decline in mental status. The attending physicians in the intensive care unit (ICU) immediately performed resuscitation.

Interventions:
The patient underwent emergency exploratory surgery. Intraoperatively, hypotension, bradycardia and arrhythmia developed, together with high central venous pressure. Assessment of cardiac structure and function using rescue TEE incidentally identified multiple, huge thromboembolic clots in the cardiac chambers; therefore, the patient underwent cardiac thromboembolectomy, including cardiopulmonary bypass with hypothermia therapy.

Outcomes:
Due to severe cardiac and respiratory distress, the patient required venoarterial extracorporeal membrane oxygenation (VAECMO) in the operating room and ICU. Despite continuous resuscitation in the ICU and maintenance of VAECMO, she suffered severe hypotension and massive bleeding that eventually led to death.

Lessons:
In patients with autoimmune hepatitis, risk factors for thromboembolism should be rigorously controlled during the peak period of reactive thrombocytosis after ABOi LDLT with splenectomy.
Gender Differences in the Predictors of Suicide-related Morbidity Among Veterans Reporting Current Housing Instability
Authors: Montgomery Ann E. , Dichter Melissa E. , Blosnich John R. 
Published: January 2021

Background:
Veterans experiencing housing instability are at increased risk of suicide. Research is needed to identify gender differences in the predictors of both suicidal ideation and suicide attempt, particularly among Veterans who are unstably housed.

Objectives:
The objective of the present study was to explore whether correlates of suicide-related morbidity among unstably housed Veterans vary by gender and identify implications for improved care for these Veterans.

Methods:
The study cohort included 86,325 Veterans who reported current housing instability between October 1, 2013, and September 30, 2016. This cross-sectional study assessed differences in demographic and outcome variables by gender using χ2 analyses and a series of multiple logistic regressions predicting suicidal ideation and suicide attempt, stratified by gender.

Results:
Among unstably housed female Veterans, being younger than 40 years was associated with more than double the odds of having an indicator of suicidal ideation and >12 times the odds of having an indicator of a suicide attempt. The effect sizes associated with age were much less pronounced among unstably housed male Veterans. The presence of mental health and substance use conditions as well as a positive screen for military sexual trauma were associated with increased risk of suicide morbidity among both women and men.

Conclusions:
Intervention and prevention among unstably housed Veterans may be complicated by unpredictable living situations; further research should explore tailored interventions to address the complex needs of unstably housed Veterans and how suicide prevention can be woven throughout.
Assessment of Suicidal Intent in Self-directed Violence and Subsequent Care Received Among Military Veterans
Authors: Chen Jason I. , Cameron David C. , Laliberte Avery Z. , Hooker Elizabeth R. , Niederhausen Meike , Denneson Lauren M. 
Published: January 2021

Background:
The Veterans Health Administration’s system for documenting self-directed violence (SDV) requires that clinicians make a determination of the suicidal intent of the behavior (ie, “undetermined” intent vs. “suicide attempt”) which contributes to the enhanced care offered. Past studies suggest clinicians’ judgment of suicide risk is impacted by patient demographics regardless of clinical presentation. As women are less likely to die by suicide than men, women’s SDV may be taken less seriously; they may be more likely to have their SDV classified as “undetermined” than men, which may impact the care received.

Objectives:
This study examines whether women veterans’ SDV is disproportionately classified as “undetermined” suicidal intent versus “suicide attempt” as compared with men veterans, and how one’s classification and gender modifies the care received.

Research Design:
This was an observational, retrospective study of data from Veterans Health Administration administrative databases. We included all veterans with documented nonfatal “undetermined” SDV events and “suicide attempts” between 2013 and 2018 (N=55,878). Objectives were evaluated using mixed-effects logistic regression models.

Results:
Women veterans were disproportionately more likely than men veterans to have SDV classified as “undetermined” (odds ratio=1.17; 95% confidence interval, 1.08–1.27). Veterans who received an “undetermined” classification were significantly less likely to receive enhanced care. However, this relationship was not moderated by gender.

Conclusions:
Gender may impact clinicians’ determinations of intent of SDV, but more research is needed on the extent of classification biases and to understand causes. Further, classification of intent is critical, as there is a strong relationship between classification and enhanced care.