bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Ambulatory Upper Extremity Surgery Patients Discharged Home with Perineural Catheters from a Veterans Health Administration Medical Center
Authors: King Roderick , Mariano Edward R , Yajnik Meghana , Kou Alex , Kim T Edward , Hunter Oluwatobi O , Howard Steven K , Mudumbai Seshadri C 
Published: January 2019

Abstract

Objective
The feasibility and safety of managing ambulatory continuous peripheral nerve blocks (CPNB) in Veterans Health Administration (VHA) patients are currently unknown. We aimed to characterize the outcomes of a large VHA cohort of ambulatory upper extremity surgery patients discharged with CPNB and identify differences, if any, between catheter types.

Methods
With institutional review board approval, we reviewed data for consecutive patients from a single VHA hospital who had received ambulatory CPNB for upper extremity surgery from March 2011 to May 2017. The composite primary outcome was the occurrence of any catheter-related issue or additional all-cause health care intervention after discharge. Our secondary outcome was the ability to achieve regular daily telephone contact.

Results
Five hundred one patients formed the final sample. The incidence of any issue or health care intervention was 104/274 (38%) for infraclavicular, 58/185 (31%) for interscalene, and 14/42 (33%) for supraclavicular; these rates did not differ between groups. Higher ASA status was associated with greater odds of having any issue, whereas increasing age was slightly protective. Distance was associated with an increase in catheter-related issues (P < 0.01) but not additional health care interventions (P = 0.51). Only interscalene catheter patients (3%) reported breathing difficulty. Infraclavicular catheter patients had the most emergency room visits but rarely for CPNB issues. Consistent daily telephone contact was not achieved.

Conclusions
For VHA ambulatory CPNB patients, the combined incidence of a catheter-related issue or additional health care intervention was approximately one in three patients and did not differ by brachial plexus catheter type. Serious adverse events were generally uncommon.
Metastases to the nose from clear cell renal cell carcinoma
Authors: Cui Pengfei , Cong Xiaofeng , Yin Jiaxin , Liu Miaomiao , Wang Xinhui , Yang Lei , Qu Limei , Liu Ziling 
Published: January 2019

Abstract

Rationale:
Patients with nasal metastases are seldom seen among clear cell renal cell carcinoma (CCRCC). We report a rare case presenting as a solitary nasal cutaneous nodule, and summarize the therapeutic experience of tyrosine kinase inhibitors (TKIs).

Patient concerns:
A 86-year-old man with a chief complaint of continuous back pain for 3 months and discovery of a cutaneous nodule on the nose for a month visited the oncology department of our hospital. Maxillofacial computed tomography (CT) scans demonstrated a 1.5 × 0.9 cm and ovoid soft tissue density shade at dorsum of the nose. CT of abdomen revealed a 3.5 × 2.7 cm mass in right kidney and presenting an obvious heterogeneous enhancement.

Diagnoses:
The pathological examination of nasal excision biopsy confirmed the diagnosis of nasal clear cell carcinoma. Immunohistochemical analysis indicated that the nasal metastatic tumor had a renal origin.

Interventions:
Sunitinib at a dose of 50 mg/day was administered initially, while the serious cutaneous toxicities, especially hand-foot syndrome, occurred to the patient. Subsequently, axitinib at a dose of 5 mg twice daily was accepted as second-line treatment.

Outcomes:
The nasal mass shrinked significantly after 8-week treatment of axitinib, and the primary tumor has been stable till now.

Lessons:
Axitinib successfully controlled the nasal cutaneous metastasis with mild adverse reactions, and did not aggravate the cutaneous toxicities resulting from sunitinib. The incidence of cutaneous adverse events were low which had been reported by previous studies; however, it is difficult to say that axitinib is a more effective treatment modality for RCC with nasal metastases, which requires further studies.
Application of intrapulmonary wire combined with intrapleural fibrin glue in preoperative localization of small pulmonary nodules
Authors: Zhang Wen-Hua , Bai Yan-Yan , Guo Wei , Li Ming , Chang Gui-Xia , Liu Wei , Mao Yu 
Published: January 2019

Abstract

Objective:
This study aims to investigate the accuracy of the preoperative localization of small nodules by computerized tomography (CT)-guided placing wire and intrapleural fibrin glue near the nodules at 3 days before the operation.

Methods:
From October 2015 to December 2017, a total of 79 patients, who received preoperative localization of small pulmonary nodules and surgical treatment in the Department of Thoracic Surgery of Hohhot First Hospital, were enrolled into this study. These patients were randomly divided into 2 groups: methylene blue localization group (n = 47), and modified localization group (n = 32), where the patients received preoperative localization of the small nodules by CT-guided placing wire and intrapleural fibrin glue near the nodule at 3 days before the operation. Localization accuracy, operation time and difficulty in postoperative seeking for pathological specimens were compared between these 2 groups.

Results:
In the methylene blue localization group, 3 patients had localization failure due to the intrathoracic diffusion of methylene blue, and the success rate was 93.61%. In the modified localization group, all 32 patients succeeded in the localization, and the success rate was 100%. Operation time and difficulty of finding the specimen was significantly lower in the modified localization group than in the methylene blue localization group (P < .05).

Conclusion:
The application of preoperative localization of small nodules by placing wire and intrapleural fibrin glue improves the success rate of resection, reduces operation time and the risk of the operation, and lowers the difficulty of finding pathological specimens after the operation. Hence this operative procedure is worthy of popularization.
Mandibular width as a novel anthropometric measure for assessing obstructive sleep apnea risk
Authors: Maresky Hillel S. , Klar Miriam M. , Tepper Jaron , Gavriel Haim , Ziv Baran Tomer , Shapiro Colin M. , Tal Sigal 
Published: January 2019

Abstract
Craniofacial abnormalities are a known obstructive sleep apnea (OSA) risk factor, but still need to be better characterized. This study investigates the relationship between mandibular width and the risk of developing OSA.
We retrospectively analyzed 3D reconstructions of head and neck computed tomography (CT) scans at our institution for mandibular width, neck circumference, neck fat volume (NFV), airway volume (AWV), and NFV:AWV ratio. Age, gender, and BMI were also documented. Patients were contacted to complete a STOP-BANG survey to assess OSA risk. Only patients with reconstructable scans and completed STOP-BANG questionnaires were included in the study. Survey results were analyzed to assess the correlation between mandible width and STOP-BANG. Mandible association was also compared to the associations of the other known risk factors.
The final analysis included 427 patients with a mean age of 58.98 years (standard deviation = 16.77), 56% of whom were male. Mandibular width was found to positively correlate with STOP-BANG score (r = .416, P < .001). Statistically significant differences between mandible size for each risk group was seen (P < .001). After controlling for age and sex, mandible size was significantly different only for the low risk vs. high risk groups (odds ratio = 1.11; 95% confidence interval = 1.03–1.20; P = .007). Furthermore, when stratified according to mandible size, the small mandible group (<77.50 mm) predominantly consisted of low risk patients; the medium size mandible group (77.50–84.40 mm) was predominated by intermediate risk patients, and large mandible (>84.40 mm) was predominantly seen in high risk patients. Mandible width expressed a stronger association than NFV:AWV ratio, but neck circumference and NFV had stronger associations than did mandible width.
In addition to previously documented OSA risk factors, mandibular width is positively correlated with OSA as an independent risk factor. Observation of a wide mandible (jaw) should raise awareness of OSA risk and increase screening methods when appropriate.
Efficacy of infantile hepatic hemangioma with propranolol treatment
Authors: Tsai Mu-Chieh , Liu Hsi-Che , Yeung Chun-Yan 
Published: January 2019

Abstract

Rationale:
Hepatic hemangioma is rarely discovered during the infantile period. Although most of the cases are asymptomatic, some of them may suffer life-threatening situations. In this regard, early detection is mandatory for preventing the ominous consequences that might be culminated from the disease.

Patient concerns:
A 2-month-14-day-old female infant was found incidentally to have multiple hepatic lesions during a newborn ultrasound screen. She was born smoothly at term after a non-eventful pregnancy course. Physical examination was completely normal and postnatal vital signs were stable.

Diagnosis:
Infantile multiple hepatic hemangiomas.

Intervention:
High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Propranolol was started at the age of 3 months and 7 days old with an initial dosage of 1.5 mg/kg per day and increased gradually to 2.5 mg/kg per day. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment. Eventually, hepatic lesions totally disappeared 4.5 months later. Propranolol in dosage of 2.5 mg/kg per day was continued until 6 months after the initial prescription.

Outcomes:
A period of 11-month follow-up revealed no evidence of recurrence of hemangiomas.

Lessons:
Early diagnosis and intervention are mandatory for infantile hepatic hemangiomas to prevent possible ominous consequences. Though the propranolol therapy protocol for the disease is still under developing, the current report strengthens the recommendation to use propranolol as the first-line medication for treating infantile hepatic hemangiomas.
Linear and nonlinear analyses of heart rate variability following orthostatism in subclinical hypothyroidism
Authors: Hoshi Rosangela A. , Andreão Rodrigo V. , Santos Itamar S. , Dantas Eduardo M. , Mill José Geraldo , Lotufo Paulo A. , Bensenor Isabela M. 
Published: January 2019

Abstract
Subclinical hypothyroidism (SCHypo) is associated with autonomic disturbances that can interfere in physiological responses. This study was designed to evaluate linear and nonlinear variables of heart rate variability (HRV) following postural change, comparing subjects with SCHypo to euthyroid subjects.
HRV analyses were performed in 5-minute time series collected in the supine and standing positions from a subsample of 855 participants of the ELSA-Brasil study. The cardiac autonomic nervous function was evaluated by linear time and frequency domain analyses (SDNN, RMSSD, LFms2, HFms2, and LF/HF ratio) as well as by nonlinear symbolic dynamics (0, 1, and 2 V).
After exclusions, 509 (92.0%) euthyroid and 44 (8.0%) SCHypo participants were eligible for analyses. At the baseline supine rest measurement, the 0 V symbolic pattern was higher (27.7 vs 25.4, P = .02) and 2 V was lower (18.0 vs 22.9, P = .02) than in the euthyroid group. Comparing the variation between positions, the 0 V pattern showed a lower delta in SCHypo than in Euthyroid subjects (8.0 vs 10.8%, P = .04).
SCHypo presented lower sympathetic and parasympathetic tonus at rest and a blunted sympathetic response to active postural change, marked by reduced variation in the 0 V of symbolic analysis (SA). Additionally, it is suggested that SA of HR dynamics is an alternative and, possibly, a more sensitive method for cardiac autonomic assessment following orthostatism in this population.
Efficacy of acupotomy for cerebral palsy
Authors: Kwon Chan-Young , Lee Boram , Chang Gyu Tae , Yoon Sang-Hoon 
Published: January 2019

AbstractBackground:In children, cerebral palsy (CP) is one of the most common causes of irreversible neurological sequelae. Acupotomy, a modernized acupuncture form combining the effects of microsurgery and conventional acupuncture, may show specific benefits in the treatment of CP, especially with respect to spasticity. The aim of this review was to evaluate the efficacy of acupotomy for CP.Methods:Eleven databases were comprehensively searched from their inception dates to November 27, 2018. Randomized controlled trials (RCTs) or quasi-RCTs evaluating acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment for CP were included. The methodological quality of included studies was assessed using the risk of bias tool. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analysis was performed, and the pooled data were presented as mean difference (MD) with 95% confidence interval (CI) for continuous outcomes and as risk ratio (RR) with 95% CI for dichotomous outcomes.Results:Eight studies involving 530 participants were included. In 1 study, acupotomy was associated with significantly higher total effective rate (TER) compared with Bobath (P < .01). Acupotomy combined with rehabilitation was associated with significantly higher TER (RR 1.24, 95% CI 1.01–1.52,I2 = 77%) and gross motor function measure score (MD 12.62, 95% CI 11.75–13.49,I2 = 54%), and significantly lower muscle tone of gastrocnemius measured by the Ashworth scale or the modified Ashworth scale (MD −0.97, 95% CI −1.07 to −0.88,I2 = 0%) compared with rehabilitation alone. No studies reported the incidence of adverse events. The methodological quality of the included studies and quality of evidence for the main finding were generally low.Conclusion:Current evidence shows that acupotomy as a monotherapy or as adjunctive therapy to rehabilitation treatment might have benefits in the treatment of CP. However, due to the small number of studies included, the lack of sample size, poor methodological qualities, and low quality of evidence, the findings of this review should be interpreted with caution. Larger and more rigorous, high-quality RCTs should be performed on this topic.PROSPERO registration number:CRD42018105891.
Liver heterotopia associated with congenital diaphragmatic hernia
Authors: Mito Kumiko , Amano Yusuke , Oshiro Hisashi , Matsubara Daisuke , Fukushima Noriyoshi , Ono Shigeru 
Published: January 2019

Abstract

Rationale:
Liver heterotopia associated with congenital diaphragmatic hernia (CDH) is a rare condition; to the best of our knowledge, only 17 cases have been reported to date. The histogenesis and clinicopathological features are largely unknown. We herein report 2 cases of liver heterotopia associated with CDH along with 17 cases described in the literature to shed light on their clinicopathological characteristics.

Patient concerns:
Case 1 was a vaginally delivered male newborn who presented with respiratory distress immediately after birth. Case 2 was a female fetus who was found to have left-sided CDH during gestation.

Diagnosis:
In case 1, a chest X-ray revealed left-sided CDH. In case 2, magnetic resonance imaging performed at 33 weeks of gestation revealed left-sided CDH.

Interventions:
Case 1 underwent diaphragmatic patch repair surgery 3 days after birth. Histopathological examination following surgery in case 1 revealed the presence of ectopic liver tissue in the hernia sac. Case 2 was delivered by Cesarean section, and diaphragmatic patch surgery was performed 3 days after birth. During surgery, an isolated nodule was identified on the peritoneal side of the border of the defective foramen of the diaphragm. Histopathological examination following surgery in case 2 confirmed the presence of an epidermal cyst in the hernia sac. In addition, the isolated nodule was histopathologically found to be ectopic liver tissue.

Outcomes:
In Case 1, CDH recurred at 6 months after surgery, and a second patch repair surgery was performed. The surgically removed hernia sac was found to contain microscopic ectopic liver tissue on histopathology. Case 1 recovered well after surgery, and there was no critical change during the 10-month postoperative period. Case 2 recovered well after surgery, and there was no critical change during the 20-month postoperative period.

Lessons:
There were no secondary pathological conditions associated with the presence of ectopic liver in CDH, such as torsion, infarction, rupture, intra-abdominal bleeding, or tumorization. Our observations suggest that liver heterotopia is a rare but asymptomatic condition in patients with CDH.
Clinical treatment of diabetic foot ulcer combined with Budd-Chiari syndrome
Authors: Fan Lei , Luo Huan , Liu Bing , Fa Xianen , Liu Tao , Ma Chao 
Published: January 2019

Abstract

Rationale:
Diabetic foot ulcer is a severe complication of diabetes, and most patients with diabetic foot ulcer require amputation. The incidence of Budd-Chiari syndrome is low; it is relatively rare. Diabetic foot ulcer combined with Budd-Chiari syndrome has not been reported so far.

Patient concerns:
A 52-year-old man presented with uncontrolled high body temperature, continued expansion of the lower leg and foot ulcer with increasing malodor.

Diagnosis:
The patient was diagnosed with Wagner grade 4 diabetic foot ulcer combined with Budd-Chiari syndrome.

Interventions:
Critical treatment was performed immediately after his admission to the hospital. After the patient's condition was stable, we performed an interventional procedure to relieve the inferior vena cava obstruction. Debridement was then performed on the diabetic foot ulcer. Finally, skin grafting was performed due to condition of the wound. We completed moist healing and vacuum sealing drainage throughout the treatment process.

Outcomes:
The patient was hospitalized for 56 days, and all his right lower extremity ulcers eventually healed.

Lessons:
In the treatment of diabetic foot ulcer combined with Budd-Chiari syndrome, it is necessary to develop a unified treatment plan that includes the timely treatment of Budd-Chiari syndrome upon admission, the strategic use of debridement, and the application of moist healing and vacuum sealing drainage.
Does nifedipine improve outcomes of embryo transfer?
Authors: Ng Kelvin Kwok Lap , Rozen Genia , Stewart Tanya , Agresta Franca , Polyakov Alex 
Published: January 2019

Abstract

Background:
Implantation failure is the main factor affecting the success rate of in vitro fertilization (IVF) procedures. Studies have reported that uterine contractions (UC) at the time of embryo transfer (ET) were inversely related to implantation and pregnancy rate, hence reducing the success of IVF treatments. Various pharmacological agents, with the exception of calcium channel blockers, have been investigated to improve ET outcomes by reducing UC. Thus, a double-blinded randomized, placebo-controlled trial was conducted to determine whether nifedipine, a calcium channel blocker with potent smooth muscle relaxing activity and an excellent safety profile, can improve the outcome of patients undergoing ET treatments.

Methods:
Ninety-three infertile women were recruited into 1 of 2 groups: placebo (n = 47) or nifedipine 20 mg (n = 46). Study participants were admitted 30 minutes prior to ET and given either tablet after their baseline vital signs were recorded. They then underwent ET and were observed for adverse events for another 30 minutes post-ET. Follow up of the participants’ outcomes was conducted via electronic medical records. The primary outcomes are implantation and clinical pregnancy rates. Secondary outcomes include any maternal or fetal adverse events, miscarriage, pregnancy, live births, and neonatal outcomes. Resulting data were then analyzed using t test, Pearson chi-square test, and Fisher exact test to compare outcomes between the 2 groups.

Results:
No statistical differences in the implantation rate (42.6% vs 39.1%, P = .737, rate ratio 0.868, 95% confidence interval [CI]: 0.379–1.986) and the clinical pregnancy rate (23.4% vs 26.1%, P = .764, rate ratio 1.155, 95% CI: 0.450–2.966) were detected between the placebo and the treatment groups. In addition, no statistical significance between the placebo and the treatment groups for any secondary outcomes were detected.

Conclusions:
This double blinded, randomized, and placebo-controlled trial demonstrated that the single use of 20 mg nifedipine given 30 minutes before embryo transfer did not improve the implantation rate or the clinical pregnancy rate of the infertility treatment. Further studies are required to demonstrate the clinical benefits and risks of nifedipine usage in embryo transfer.
Rhegmatogenous retinal detachment with a giant tear located in the intermediate periphery
Authors: Kohmoto Ryohsuke , Fukumoto Masanori , Sato Takaki , Oosuka Shou , Kobayashi Takatoshi , Kida Teruyo , Suzuki Hiroyuki , Ikeda Tsunehiko 
Published: January 2019

Abstract

Rationale:
We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases.

Patient concerns and diagnoses:
Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history.

Interventions:
In both cases, reattachment was achieved by performing vitrectomies.

Outcomes:
These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred

Lessons:
Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.
Sensitivity of contrast-enhanced transthoracic echocardiography for the detection of residual shunts after percutaneous patent foramen ovale closure
Authors: Zhao Hongling , Yue Qingxiong , Wang Tao , Wang Lin , Pang Zhanqi , Dong He , Yang Jian , Li Yawen , Li Shijun 
Published: January 2019

AbstractThe objective of this study is to investigate the sensitivity of contrast-enhanced transthoracic echocardiography (c-TTE) versus transesophageal echocardiography (TEE) to detect a residual right-to-left shunt (RLS) following a transcatheter patent foramen ovale (PFO) closure.A self-controlled study was conducted in a tertiary referral hospital. 57 patients with PFO who had experienced migraines underwent percutaneous PFO closure. c-TTE, TEE, and contrast-enhanced transcranial Doppler (c-TCD) at resting and Valsalva maneuver were performed during the 3-month follow-up after the closure.The closure devices were successfully implanted in all patients without complications. Three months after closure, TEE did not detect residual Valsalva shunts in any of the 57 patients; residual valsalva shunts were found via c-TTE in 15 of the 57 patients and were also observed via c-TCD. When c-TTE and/or c-TCD were used, the rate of residual RLSs detected in patients who underwent PFO closure was 26.32%, which was significantly different than the rate detected using TEE (P < .05)c-TTE and c-TCD showed equivalent sensitivity in evaluating transcatheter closure of a PFO. c-TTE could be a more cost-effective and reliable method to detect the residual shunt after PFO closure.