bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and tolerability of initial low-dose lenvatinib to treat differentiated thyroid cancer
Authors: Yamazaki Haruhiko , Iwasaki Hiroyuki , Takasaki Hirotaka , Suganuma Nobuyasu , Sakai Rika , Masudo Katsuhiko , Nakayama Hirotaka , Rino Yasushi , Masuda Munetaka 
Published: March 2019

Abstract
Some patients with differentiated thyroid cancer (DTC) may require an initial low dose (LD) of lenvatinib. However, few studies have investigated the efficacy of LD lenvatinib. We compared the efficacy and tolerability of lenvatinib at an initial LD to those of the standard initial dose of 24 mg in patients with DTC.
In this cross-sectional study, records of patients with DTC treated with lenvatinib were retrospectively reviewed. Patients were divided into 2 groups based on the initial dose of lenvatinib: a full-dose (FD) group that received an initial dose of 24 mg/d and a LD group that received an initial dose of less than 24 mg/d. Categorical variables were compared with the Fisher exact test and continuous variables with Student t test. A progression-free survival (PFS) curve was constructed with the Kaplan–Meier method. A probability (P) value of < .05 was considered statistically significant.
Thirty-six patients with DTC were treated with lenvatinib (30 in the FD group and 6 in the LD group). The response rates were 43% and 33% in the FD and LD groups, respectively. The median PFS duration was 696 [95% confidence interval (CI): 318–not available (NA)] days in the FD group. The median PFS of the LD group was not reached (95% CI: 124–NA) (P = .293). Treatment interruptions were required in 25 (83%) patients in the FD group and 4 (67%) in the LD group (P = .573). Dose reductions were required in 28 (93%) patients in the FD group and 4 (67%) in the LD group (P = .121). There were no significant differences in the incidences of common adverse events between the 2 groups.
The LD group also required dose reduction and interruption frequently. Since these findings are only the short-term results of a limited number of cases, a large number of cases and long-term observations are needed to determine whether an initial LD is effective for patients with DTC in poor general condition.
The prevalence of myopia and the factors associated with it among university students in Nanjing
Authors: Huang Luoming , Kawasaki Hiromi , Liu Yiqun , Wang Zhongliang 
Published: March 2019

Abstract
Myopia, a common eye disease, is a global health burden that is increasing worldwide. Although the risk factors for myopia among children have been extensively investigated, those among university students have not. The aim of our study was to investigate the prevalence of myopia and the factors associated with it among university students in Nanjing.
Subjects were selected from among the university students using a stratified random sampling method. A total of 1200 first-year university students were invited to participate in the study. A self-reported questionnaire was used to collect data on the students’ demographic information, history of parental myopia, and behavioral factors, such as having bad postures while reading or writing, performing eye exercises, taking breaks after 30 minutes of continuous reading, using computers or smartphones, sleep, near-work, and outdoor activity. Univariate analyses were performed to find the associations between myopia and the various parameters. Factors that were statistically significant in univariate analyses were selected as candidate variates for multivariate analysis.
The overall prevalence of myopia was 86.8%: 86.1% among males, and 88.0% among females (χ2 = 0.68, P = .411). Chi-squared tests showed that parental myopia, performing eye exercises, taking breaks after 30 minutes of continuous reading, and engaging in outdoor activity were significantly associated with myopia (P < .001, P = .034, P < .001, and P = .002, respectively). Having at least 1 parent with myopia was a risk factor for myopia (OR = 3.58, 95% CI = 1.96–6.54); whereas, taking breaks after 30 minutes of continuous reading and performing at least 2 hours of outdoor activity per day were protective against myopia in multivariate analysis (OR = 0.61, 95% CI = 0.41–0.93; and OR = 0.45, 95% CI = 0.2–0.99; respectively).
The prevalence of myopia among university students was 86.8%. Parental myopia was a risk factor for myopia. Taking breaks after 30 minutes of continuous reading, and engaging in at least 2 hours of outdoor activity were associated with less myopia. In addition, performing eye exercises was associated with less myopia on univariate analysis.
Malignant melanoma of the esophagus complicated with poorly differentiated mucinous adenocarcinoma of the stomach
Authors: Li Ji , Liu Yan , Wang Bin , Sun Xun , Meng Xiangwei 
Published: March 2019

Abstract

Rationale:
Primary malignant melanoma of the esophagus (PMME) is a rare malignancy that only accounts for <2% of all primary esophageal tumors. Here, we report the even rarer occurrence of PMME in combination with poorly differentiated mucinous adenocarcinoma of the stomach.

Patient concerns:
A 64-year-old man was presented to the hospital with >1 month of eating dysphagia. Enhanced computed tomography (CT) scan only found a space-occupying lesion in the lower esophagus with moderate enhancement. However, gastroscope showed not only esophageal masses, but also gastric mucosa changes.

Diagnoses:
Poorly differentiated mucinous adenocarcinoma and PMME were diagnosed based on pathological biopsy and immunohistochemical methods.

Interventions:
The patient underwent laparoscopic gastric cancer radical surgery, esophageal resection, and colonic replacement of the esophagus.

Outcomes:
Abdominal CT and esophagography performed 1 week after surgery showed that it was consistent with postoperative changes without other abnormalities. However, the patient died 3 months after discharge without receiving any other treatment.

Lessons:
This case suggests more attention should be drawn to the diagnosis of multiple primary malignant neoplasms in elder patients, and also highlights the need to fulfill comprehensive examinations before surgery in case of misdiagnosis. Besides, it is challenging to finding a reasonable treatment for such rare condition.
The controversy of esophageal carcinosarcoma
Authors: Xu Xiaoyang , Xu Yan , Wang Jiang , Zhao Can , Liu Chang , Wu Bin , Gao Lei , Dai Guangquan , Dai Dongqiu 
Published: March 2019

Abstract

Rationale:
Esophageal carcinosarcoma (ECS) is defined as a relatively rare malignant neoplasm with both epithelial carcinomatous and sarcomatous components. Besides, there were so many various controversies in ECS. This article describes a case of ECS that was effectively treated with radical esophagectomy and adjuvant chemotherapy. Also, we discuss the presentation, differential diagnosis, treatment, and prognosis of ECS.

Patient concerns:
A 58-year-old man presented with a history of progressive dysphagia and precordial pain after swallowing for 1 month.

Diagnosis:
Esophagogastroduodenoscopy (EGD) revealed a large polypoid neoplasm that occupied the esophageal lumen 30 to 34 cm from the incisors. On the characteristic morphology, clinical symptom and biopsy findings, the ECS was the primary considerated. Computed tomography (CT) examination demonstrated no radiological evidence of metastatic disease.

Interventions:
The patient underwent an Ivor Lewis esophagectomy, coupled with adequate lymph node dissection (2-field lymphadenectomy). ECS was confirmed by pathology report of postoperative. Then, the patient underwent adjuvant chemotherapy with docetaxel, oxaliplatin, and capecitabine.

Outcomes:
The patient remained alive without tumor recurrence at 24 months after multidisciplinary therapy.

Lessons:
It is generally treated by surgery, radiotherapy, and chemotherapy according to the protocols used for other esophageal cancers (EC). However, there is no recommended clinical treatment for ECS because of the rarity of the disease. Esophagectomy with extended lymphadenectomy followed by adjuvant chemotherapy with docetaxel, oxaliplatin, and capecitabine may be recommended treatment for ECS. Chemotherapy regimen with docetaxel, oxaliplatin, and capecitabine may be a suitable adjuvant therapy for ECS.
Preoperative balloon pulmonary angioplasty enabled noncardiac surgery of a patient with chronic thromboembolic pulmonary hypertension (CTEPH)
Authors: Watanabe Kenji , Ito Nobuko , Ohata Takuya , Kariya Taro , Inui Hiroshi , Yamada Yoshitsugu 
Published: March 2019

Abstract

Rationale:
Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease with a poor prognosis, characterized by chronic thromboembolic obstruction of the pulmonary arteries and pulmonary hypertension. Balloon pulmonary angioplasty (BPA) is a newly emergent treatment for CTEPH, which may substitute pulmonary endarterectomy, the standard but more invasive treatment for CTEPH. Here, we report the case of a CTEPH patient who underwent 2 noncardiac surgeries without complications after preoperative intervention of BPA.

Patient concerns:
A 79-year-old man presented with severe osteoarthritis of bilateral knees, with adaptation of total knee arthroplasty (TKA). Transthoracic echocardiogram revealed severe pulmonary hypertension with estimated right ventricular systolic pressure of 140 mm Hg.

Diagnosis:
Pulmonary arteriography revealed total occlusion of the upper branch of the right pulmonary artery, and ventilation/perfusion scan showed multiple mismatched perfusion defects. His pulmonary artery pressure (PAP) was as high as 89/25 (46) mm Hg with normal range of pulmonary capillary wedge pressure. He was diagnosed with CTEPH.

Interventions:
Four BPA sessions for 8 branches of the bilateral pulmonary arteries were done, until the mean PAP (mPAP) went under 30 mm Hg. For the TKA, we selected spinal anesthesia in order to minimize intraoperative hemodynamic changes. Cardiac surgeons were standby in case extracorporeal membrane oxygenation (ECMO) initiation was required.

Outcomes:
With appropriate pain management and use of intravenous vasopressors, intraoperative vital signs were stable. No symptoms of hemodynamic collapse were observed postoperatively. The patient was discharged on the 46th postoperative day following rehabilitation. Two years later, left-side unicompartment knee arthroplasty (UKA) was scheduled. Right heart catheterization study revealed the mPAP was 30 mm Hg, nearly the same value as the last study. The operation was performed under spinal anesthesia with continuous arterial pressure monitoring without need for intraoperative vasopressor. He was discharged without complications on the 24th postoperative day.

Lessons:
BPA can be an effective preoperative intervention for CTEPH patients undergoing noncardiac surgery.
Comparison of the accuracy of cannulated pedicle screw versus conventional pedicle screw in the treatment of adolescent idiopathic scoliosis
Authors: Yilar Sinan 
Published: March 2019

Abstract

Background:
Pedicle screws are commonly used to treat adolescent idiopathic scoliosis (AIS). Many studies have discussed the rates and effects of pedicle screw misplacement. In this study, to increase the accuracy rate, cannulated pedicle screws were inserted into the periapical vertebrae, highly rotated vertebrae, and vertebrae with very thin pedicles in a single patient group. We compared these results with those of a patient group who underwent conventional pedicle screw placement.

Methods:
Twenty-eight AIS patients treated surgically between 2015 and 2017 with cannulated pedicle screws or conventional pedicle screws were included. Group 1 (n = 15) received cannulated pedicle screws, whereas group 2 (n = 13) received conventional pedicle screws. Postoperative computed tomography scans were used to evaluate pedicle screw position. Pedicle perforation was assessed using the classification by Rao et al: grade 0, no perforation; grade 1, only the threads outside the pedicle (less than 2 mm); grade 2, core screw diameter outside the pedicle (2–4 mm); and grade 3, screw entirely outside the pedicle. Medial screw malposition was measured between the medial pedicle wall and the medial margin of the screw. Lateral screw malposition was measured between the lateral corpus wall and lateral screw margin.

Results:
Placement accuracy of 703 screws (group 1, 376; group 2, 327) was evaluated. A total of 142 (20.1%) pedicle screw perforations occurred: 63 (17.1%) in group 1 and 79 (25%) in group 2 (P < .05). There was no statistically significant intergroup difference in medial perforation (group 1, 34 [9%] vs group 2, 31 [10%]). Lateral perforation was significantly less common in group 1 (n = 29; 7.7%) than in group 2 (n = 4; 14.7%) (P = .0002).

Conclusions:
The use of cannulated screws to treat AIS decreases perforation and complication rates. Although it did not significantly lower the medial perforation rate, it dramatically reduced the lateral perforation rate. The use of cannulated screws enables intraoperative confirmation of placement accuracy. Our data suggest that cannulated pedicle screw use to treat AIS is safer and more efficient.
The outcome of intervertebral surgery in the treatment of lumbar tuberculosis in children
Authors: Liang Qiang , Pu Yu , Wang Qian , Shi Jiandang , Sun Guangwei , Liu Liehua , Jin Weidong , Wang Zili 
Published: March 2019

Abstract
During the operation of treating lumbar tuberculosis in children, a long-segment or short-segment fixation, and fusion method were usually applied, which would adversely affect the function of normal motion unit. And so, we have been focusing on how we can shorten the range of fixation and fusion using intervertebral surgery. The objective of this retrospective study is to investigate the clinical outcome of intervertebral surgery, in the treatment of lumbar tuberculosis in children.
From June 2003 to June 2013, 18 children with lumbar tuberculosis underwent intervertebral surgery, using a combined posterior and anterior approach, in our hospital. The surgical treatments included posterior pedicle screw fixation of affected vertebrae and posterolateral bone grafting, anterior debridement, compression, and strut bone grafting. Indicators such as preoperative and postoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, neurological function, visual analog scale (VAS) score, kyphotic Cobb angle, complications, healing of lesions, bone graft healing, and recurrence were statistically analyzed.
The mean follow-up time was 86.5 months (range, 62–120 months). Three months after the operation, all patients’ ESR and CRP levels decreased to normal, and both the American Spinal Injury Association neurological function scores and VAS scores improved. Successful bone graft healing was achieved, with lesions completely healed at 6 months after surgery, and no recurrence occurred. The preoperative kyphotic was 24.00° ± 13.15° (range −10°–39°), which decreased to −4.61° ± 7.31° (range −19°–10°) postoperative (Z = −4.34, P < .01); the mean deformity correction angle was 28.61° ± 8.43° (range 9°–43°). There was no significant difference between the kyphotic angle measured immediately after surgery at (−4.61° ± 7.31°) and the kyphotic angle measured at 5-year follow-up at (−3.11° ± 7.56°). The mean loss of correction was 1.50° ± 0.90°.
Intervertebral surgery using a combined posterior and anterior approach is an effective and safe method for the treatment of lumbar tuberculosis in children. It can also preserve the function of normal motor segments to the maximum extent.
Hemodialysis interval and its association with emergency care and mortality
Authors: Chien Ching-Wen , Huang Chi-Jung , Chao Zi-Hao , Huang Song-Kong , Chen Pei-En , Tung Tao-Hsin 
Published: March 2019

Abstract
End-stage renal disease (ESRD) incidence in Taiwan is highest worldwide. This study analyzed the relationship between health resource use and patients on hemodialysis (HD) asking for medical help as well as the outcomes in Taiwan.
This was a retrospective cohort study that analyzed the medical data of patients on dialysis, which were collected from the National Health Insurance Database of Taiwan for the period 2000 to 2010. The study sample was screened out, and new patients starting HD from 2001 to 2005 were considered.
The daily distribution of patients with ESRD in the Monday, Wednesday, and Friday (MWF) and Tuesday, Thursday, and Saturday (TTS) groups who underwent emergent HD showed remarkable person–time on Monday and Tuesday, respectively. The disease (complication) distribution in the MWF group was higher than that in the TTS group, and the statistics of heart-failure-associated diseases were significantly different. Considering 5-year survival status, the mortality rate of patients with HD was 21.94% (255 of 1162), among which those with a history of cerebrovascular disease and diabetes were 68.63% and 72.16%, respectively.
Long interdialytic intervals may induce emergency dialysis. Therefore, the frequency of emergent HD therapy has increased (thrice a week), as predicted in the current HD policy.
Treatment with Brivanib alaninate as a second-line monotherapy after Sorafenib failure in hepatocellular carcinoma
Authors: Zhu Hong , Zhang Chunyan , Yang Xi , Yi Cheng 
Published: March 2019

Abstract

Rationale:
Hepatocellular carcinoma (HCC) is one of the most frequent causes of cancer-related death worldwide. Its poor prognosis is due to the high invasiveness of the disease and limited efficacy of available treatments.

Patient concerns:
We reported an HCC patient who developed lung metastases 1 year after HCC resection. Sorafenib was then initiated; however, disease progression was noted 3 months later. Sorafenib therapy was initially maintained due to lack of effective alternatives, but disease progression continued.

Diagnoses:
HCC patient with lung metastases, and pulmonary portal, and mediastinal lymph node metastases (stage IVB).

Interventions:
Brivanib alaninate was used alone as second-line therapy.

Outcomes:
All metastases showed increased size on radiographic imaging approximately 3 months after brivanib alaninate was initiated. However, 2.5 months later, the lung metastases significantly decreased in size or disappeared. The pulmonary portal, and mediastinal lymph node metastases also significantly decreased in size. At 9.5 months after brivanib alaninate initiation, the pulmonary portal, and mediastinal lymph node metastases nearly disappeared, and the lung metastases continued to decrease in size. Alpha fetoprotein (AFP) level showed the same change pattern as the tumor-response observed on radiographic imaging. The total duration of brivanib alaninate treatment was 11 months, which was stopped due to repeated grade 2 thrombocytopenia. The other side effects were tolerable. Fifteen months after initiation of brivanib alaninate, the patient remained in very good condition without evidence of disease progression.

Lessons:
Brivanib alaninate alone as second-line therapy showed excellent antitumor efficacy for an HCC patient with numerous lung and lymph node metastases. It may exert its antitumor effects in a delayed-onset fashion. We suggest that patients receive brivanib alaninate for a long duration to fully determine its efficacy.
Significance of radiology in the diagnosis and management of ruptured left gastric artery aneurysm associated with acute pancreatitis
Authors: Valluru Bimbadhar , Yang Bin , Sharma Kalyan , Adam Ahmed Abdullahi , Wei Du , Zhou Zhou , Ali Mahamed Osman 
Published: March 2019

Abstract

Rationale:
Left gastric artery aneurysms are very rare which progresses into hemorrhagic shock and diagnosis is very challenging particularly in patients with acute pancreatitis and cholecystitis whose vitals become unstable suddenly.

Patient concerns:
A 72-year-old female has presented with severe progressing abdominal pain was treated with total parenteral nutrition for acute pancreatitis based on preliminary work up, but suddenly became unstable with dropping vitals over the ensuing 48 hours. Physical examination has a positive Murphy sign and appeared lethargic. She has no past history of any chronic systemic illness or malignancy.

Diagnoses:
Ruptured left gastric artery aneurysm and left hepatic artery aneurysm with intraperitoneal hemorrhage associated with acute pancreatitis and cholecystitis.

Interventions:
Emergency interventional surgery was performed to embolize both the aneurysms and the giant aneurysmal sac of the left gastric artery was secured with a micrometallic occluding coil which eventually controlled the active hemorrhage.

Outcomes:
The patient became stable and was discharged after 15 days without any recurrence or complications during the 6-month follow-up.

Lessons
This case is a peculiar example of a missed diagnosis of left gastric artery aneurysm associated with acute pancreatitis and cholecystitis with deteriorating clinical condition. Exhaustive radiological investigations are necessary for early diagnosis correlating with presenting clinical situations. Radiologists should be familiar with the challenges in diagnosis and management.
Early oral feeding versus traditional feeding after transanal endorectal pull-through procedure in Hirschsprung's disease
Authors: Ashjaei Bahar , Ghamari Khameneh Afshar , Darban Hosseini Amirkhiz Gisoo , Nazeri Niloofar 
Published: March 2019

Abstract
Our study questioned whether the outcome of postoperative early oral feeding is different from traditional postoperative feeding in children with Hirschsprung's disease who underwent transanal endorectal pull-through.
This was an observational and comparative study. Patients were allocated into 2 groups. Age, gender, fever, surgery-related infectious, abdominal distension, bowel obstruction, need for reoperation, peritonitis, anastomosis leak, and abscess formation were assessed. IV fluids and antibiotics usage were recorded. A Chi-square test, independent sample unpaired Student t test and Mann–Whitney test were used. P-value < .05 was considered statistically significant.
Infections occurred in no patient in group 1 and 1 patient in group 2. Stenosis occurred in 3 patients in group 1 and 2 patients in group 2. Abdominal distension occurred in 4 patients in group 1 and 3 patients in group 2. Fever occurred in 2 patients in group 1 and 1 patient in group 2 within the first 24 hours and it occurred in 13 and 17 patients, respectively, within 48 hours. All patients of group 1 (n = 15) were treated with antibiotics and intravenous fluid administration; 1 patient for 24 hours, 12 patients for 48 hours, and 1 for 72 hours, respectively. All patients of group 2 (n = 18) were treated with antibiotics and intravenous fluid administration for 5 days. We noted a significant difference regarding the duration of antibiotic treatment and intravenous fluid administration after 72 hours.
This study showed that there was no difference between the outcomes of early and traditional postoperative feeding. Due to a significant difference in the antibiotics and IV fluid administration intervals between these 2 groups which cause a prolonged hospital stay and higher costs, it seems that early postoperative feeding is superior to traditional strategy.