bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chemically Assisted Dissection With Sodium 2-Mercaptoethanesulfonate (MESNA) in the Surgical Management of Pediatric Cholesteatoma
Authors: de la Torre Carlos , Villamor Perla 
Published: May 2019

Objective:
To evaluate the effectiveness of the chemically assisted dissection with sodium 2-mercaptoethanesulfonate (MESNA), in the reduction of residual and recurrent cholesteatoma after mastoidectomy in children with chronic cholesteatomatous otitis media (CCOM).

Study Design:
Retrospective case–control study.

Setting:
Tertiary referral center.

Population:
One hundred forty mastoidectomies performed in patients under 18 years of age for the treatment of CCOM.

Interventions:
Chemically assisted dissection (CAD) with MESNA compared with surgical dissection without MESNA.

Main Outcome Measures:
Recidivism of cholesteatoma (recurrence and residual disease), variations in the average of bone conduction threshold after treatment, and complications.

Results:
Recidivism of cholesteatoma was significantly lower when CAD with MESNA was used (p < 0.0001). No difference was found in the mean variation of the average of bone conduction thresholds between the groups, confirming its safety profile regarding auditory function. Meatoplasty stenosis after surgery was more prevalent within CAD with MESNA group (p: 0.049).

Conclusion:
Recurrent and residual cholesteatoma remains a problem, especially in children and despite surgical techniques such as canal wall down mastoidectomy and endoscopic ear surgery. CAD with MESNA can be safe and effective to reduce recurrence rates. Multicenter and prospective studies with larger number of patients are needed to validate these findings. The higher rate of meatoplasty stenosis after CAD with MESNA merits additional clinical research to confirm these findings, as well as in vitro studies evaluating the effect of the drug on the activity of fibroblasts and other growth factors that may be involved.
Enteral nutrition better than proton pump inhibitors?
Authors: Jalil Bilal A. , El-Kersh Karim 
Published: May 2019

Purpose of review
Stress ulcer prophylaxis in critically-ill patients has been a subject of extensive research, with multiple clinical trials attempting to study the best method of stress ulcer prophylaxis with the least adverse effects. Until recently, pharmacologic prophylaxis has prevailed as the primary choice for the prevention of stress ulcers but recent clinical studies have attempted to evaluate the role of enteral nutrition in stress ulcer prophylaxis.

Recent findings
The incidence of stress ulcers that result in clinically important gastrointestinal bleeding (CIGIB) has drastically decreased over the last two decades. Furthermore, in the current era CIGB in the ICU does not seem to be associated with an increased mortality. Multiple recent clinical studies aimed to evaluate the role of proton pump inhibitors (PPIs) in patients who tolerate enteral nutrition in the ICU.

Summary
The results of multiple recent clinical studies call for re-evaluation of the routine use of PPIs in critically ill patients who tolerates enteral nutrition in the ICU. Despite the promising preliminary results, definitive recommendations need larger clinical trials that are powered to evaluate any added benefits of using PPI in critically ill patients who tolerate enteral nutrition given the low incidence of CIGB in the current era.
Detection and classification the breast tumors using mask R-CNN on sonograms
Authors: Chiao Jui-Ying , Chen Kuan-Yung , Liao Ken Ying-Kai , Hsieh Po-Hsin , Zhang Geoffrey , Huang Tzung-Chi 
Published: May 2019

Abstract
Breast cancer is one of the most harmful diseases for women with the highest morbidity. An efficient way to decrease its mortality is to diagnose cancer earlier by screening. Clinically, the best approach of screening for Asian women is ultrasound images combined with biopsies. However, biopsy is invasive and it gets incomprehensive information of the lesion. The aim of this study is to build a model for automatic detection, segmentation, and classification of breast lesions with ultrasound images. Based on deep learning, a technique using Mask regions with convolutional neural network was developed for lesion detection and differentiation between benign and malignant. The mean average precision was 0.75 for the detection and segmentation. The overall accuracy of benign/malignant classification was 85%. The proposed method provides a comprehensive and noninvasive way to detect and classify breast lesions.
Dual-interventional therapy for multiple splenic artery aneurysms in a patient with portal hypertension
Authors: Niu Hongtao , Junfeng Sha , Jianli An , Zibo Zou , Yanchao Dong 
Published: May 2019

AbstractRationale:Portal hypertension (PHT) is either a significant risk factor of development of splenic artery aneurysm (SAA), or predisposing factor of rupture.Patient concerns:A 57-year-old patient was admitted to our hospital because of multiple SAAs with PHT, suffered from episodes of haematemesis.Diagnosis:Emergency ultrasound of the abdomen showed remarkable cirrhosis and splenomegaly. Two days later, CT angiography reveal two SAA located in the splenic artery, as well as splenomegaly and features of PHT.Interventions:Transjugular intrahepatic portosystemic shunt (TIPS) was performed to decrease portal venous pressure and control esophagogastric variceal hemorrhage. Coil embolization of the main splenic artery was performed to complete thrombosis of the two SAAs and relieve critical hypersplenism.Outcomes:After 3 months, follow-up enhanced CT confirmed complete thrombosis of the main splenic artery and the two aneurysm sac, and partial splenic infarction (approximately 50%).Lessens:TIPS can control easophagogastric variceal hemorrhage and decrease portal venous pressure, coil embolization of the main splenic artery can promote permanent thrombosis of aneurysm sac and relieve hypersplenism.
Laparoscopic extralevator abdominoperineal excision for the treatment of perianal Paget's disease
Authors: Zeng Dong , Chen Jianghong , Zhu Bo , Li Junke , Wu Hongyu , Ma Dan 
Published: May 2019

AbstractRational:Perianal Paget's disease (PPD) is a very rare intraepithelial adenocarcinoma. Very few cases of PPD have been reported till date, so the treatment remains controversial and more experience is needed.Patient concerns:A 73-year-old female was admitted to several hospitals with diagnosed as “perianal eczema” in perianal lesion. After a variety of treatments, the patient's condition did not improve.Diagnoses:Abdominopelvic computed tomography and rectal magnetic resonance imaging showed thickening of the soft tissue around the anus, with significant enhancement. Histologic examination revealed the state of Paget's cells.Interventions:Laparoscopic Extralevator Abdominoperineal Excision (ELAPE) surgery was performed at our department.Outcomes:The patient recovered well. After 10 months, a check-up revealed that her perianal area was disease-free.Lessons:The aim of this report was to present the characteristics of PPD in order to improve its diagnosis and treatment. Laparoscopic ELAPE is a successful therapy.
Primary breast cancer in a patient with Wilson disease
Authors: Li Dong , Wang Jun , Gao Jinnan 
Published: May 2019

Abstract

Rationale:
Wilson disease (WD) is an autosomal recessive hereditary disease in which the patient usually has a reduced risk of developing cancer. In particular, with the exception of hepatocellular carcinoma and cholangiocarcinoma, the incidence of cancer is significantly lower in WD patients compared with the general population. This case study presents a rare case of WD complicated with primary breast cancer.

Patient concerns:
A 40-year-old woman who was diagnosed with WD at 25 years of age found a lump in her left breast. She has a family history of cancer.

Diagnoses:
Ultrasound and mammography results were highly suggestive of a malignant lesion. After core needle biopsy, it was confirmed that she had invasive breast cancer.

Interventions:
A modified radical mastectomy was performed for the left breast. As the tumor was defined as a stage IIa triple negative breast cancer, the patient would have been recommended epirubicin/cyclophosphamide + docetaxel for 8 cycles if WD was not a comorbidity. As the patient had cirrhosis and abnormal liver function, she was given paclitaxel weekly for 6 cycles instead.

Outcomes:
The patient showed good tolerance, and has not had a recurrence in 2 years.

Lessons:
We reviewed the literature for studies of patients with WD complicated with cancers, and to our knowledge, this is the first report on WD complicated with breast cancer. The patient received chemotherapy even with liver dysfunction, which suggests that patients with WD can be safely treated with paclitaxel chemotherapy under close surveillance.
A CARE-compliant article: a case report of idiopathic brachial neuritis treated with ultrasound-guided electroacupuncture
Authors: Su Po-Hsuan , Tai Chen-Jei 
Published: May 2019

AbstractRationale:Electroacupuncture is commonly used for treating nerve injury. However, studies published in recent years have not described an appropriate method for accurately identifying the location and depth of injured nerves beneath the acupoints.Patient concerns:A 26-year-old male patient had left shoulder pain and weakness after tetanus, diphtheria, and pertussis vaccination and was diagnosed with idiopathic brachial neuritis 24 months before this study. The patient had undergone prednisone and ibuprofen treatment in another hospital, but the therapeutic effect was poor and limited.Diagnoses:The nerve conduction studies showed decreased amplitude over the left supraspinatus and deltoid muscles. Electromyography showed increased giant waves and polyphasic waves with reduced recruitments in the left deltoid muscle and increased giant waves with reduced recruitment in the left supraspinatus muscle. The condition was diagnosed with idiopathic brachial neuritis.Interventions:Ultrasound was used to identify the location and depth of axillary and suprascapular nerves, and direct electroacupuncture was conducted at the quadrangular space and suprascapular notch to stimulate the nerves. Other needles were placed according to deltoid and supraspinatus muscles origins and insertions. The procedure was conducted once a week, and rehabilitation activities were conducted daily.Outcomes:The patient experienced significant improvements of left shoulder pain and muscle weakness after ultrasound-guided electroacupuncture treatment. The total shoulder pain and disability index score declined from 49.23% to 11.54%. The scores of both pain and disability domains improved and maintained stable declining after the intervention. The disability of the arm, shoulder; and hand scores declined from 60 to 23.3. According to amplitude data from nerve conduction studies, the injured axillary nerve showed remarkable improvement in the third month. Muscle strength improved to the normal state. The patient was generally satisfied with the ultrasound-guided electroacupuncture treatment.Lesson:Ultrasound-guided electroacupuncture was based on anatomical correlations between nerves and muscles and on electrical stimulation theories. The results suggest that this intervention might be an alternative therapy for idiopathic brachial neuritis. Furthermore, in this study, it had minimal adverse effects. This therapy is demonstrated to be effective in future controlled studies.
Thoracoscopic surgery for management of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis
Authors: Fang Shuai , Wu Zixiang , Wang Qi , Peng Xuyang , Zhan Tianwei , Wu Ming 
Published: May 2019

Abstract

Rationale:
Pleuroperitoneal communication (PPC) has been reported to complicate continuous ambulatory peritoneal dialysis (CAPD). However, cases of patients in whom the results of the methylene blue dye test and peritoneopleural scintigraphy were negative and treatment was thoracoscopic surgery have been rarely reported.

Patient concerns:
A 58-year-old man with end-stage chronic renal failure who underwent CAPD presented with massive right-sided hydrothorax. The pleural fluid glucose level was high. Results of both the methylene blue dye test and peritoneopleural scintigraphy were negative.

Diagnosis:
The presence of end-stage chronic renal failure and diaphragm defects amenable to repair, which were identified during thoracoscopic surgery, indicated a definite diagnosis of PPC complicating CAPD.

Interventions and outcomes:
CAPD was performed twice after the defects were repaired during thoracoscopic surgery. There was no evidence that the repaired sites were leaking again, and the patient did not complain of any discomfort during the second CAPD.

Lesson:
Although special methods such as the methylene blue dye test and peritoneopleural scintigraphy may not be useful in some cases, thoracoscopic surgery is still effective and reliable in diagnosing and repairing diaphragmatic defects.
Retrospective study of clinical features and prognosis of edaravone in the treatment of paraquat poisoning
Authors: Yi Ren , Zhizhou Yang , Zhaorui Sun , Wei Zhang , Xin Chen , Shinan Nie 
Published: May 2019

Abstract
To observe whether edaravone can protect organs and inhibit pulmonary fibrosis in patients with paraquat poisoning and to provide a method for clinical intervention for paraquat poisoning.
Forty-four cases of paraquat poisoning were collected from March 2011 to December 2017 in our hospital. Eighteen cases from March 2011 to November 2013 did not receive edaravone treatment and were considered the control group, and 26 cases from January 2014 to December 2017 were treated with edaravone and were considered the observation group. Injuries to the central nervous system, heart, liver, kidney, and digestive system were evaluated on at 24 hours, 3 days, and 7 days after hospitalization. The expression of serum inflammatory factors (interleukin [IL]-6, IL-10, tumor necrosis factor-α [TNF-α]) and oxidative stress correlation (superoxide dismutase [SOD] and malondialdehyde [MDA]) were assayed at 24 hours, 3 days, and 7 days after being hospitalized. After 7, 14, and 30 days, the changes in pathological lung characteristics in the 2 groups were assessed, and survival rates were calculated.
Edaravone significantly increased the serum levels of SOD and obviously markedly reduce the serum levels of IL-6, IL-10, TNF-α, and MDA in patients poisoned with paraquat (P < .05). Edaravone significantly protected the liver (P = .021), cardiovascular (P = .031), and renal (P = .028) organs of patients from paraquat poisoning-induced injury after 7 days but had no significant protection or improvement on respiratory and digestive tract damage. Edaravone delayed the occurrence of pulmonary fibrosis and increase the survival time of patients at 7 and 14 days (P < .05). However, the 1-month follow-up found that edaravone did not reduce pulmonary fibrosis (77.8% vs 73.1%, P = .615) and did not increase the survival rate of the patients (61.1% vs 65.3%, P = .853).
Edaravone is beneficial for protecting the kidneys and liver from paraquat poisoning through reducing oxidative stress and inhibiting inflammatory response. It can also inhibit the pulmonary fibrosis process and prolong the survival time of the patients. However, no significant improvements were seen in the probability of pulmonary fibrosis and the survival rate.
A verification of the application of the non-derivatized mass spectrometry method in newborns screening of metabolic disorders
Authors: Zheng Yulan , Chen Yao , Qiu Xiaolong , Chen Weifen , Lin Qingying , Zeng Yinglin , Zhao Hong , Zhu Wenbin 
Published: May 2019

Abstract
It is required that the clinical screening of metabolic disorders in newborns meet International Organization for Standardization 15189-2012 approval. The new tandem mass spectrometry (MS/MS) based screening system and its companion reagent should be independently authenticated before their implementation in clinical diagnosis laboratories.
Linearity, stability, accuracy, and precision evaluations were carried out to verify the performance of the Waters ACQUITY TQD MS/MS system with the NeoBase non-derivatized MS/MS PerkinElmer kit for detecting amino acids and acylcarnitine in newborns with metabolic disorders.
Statistically, the correlation coefficient (R
2) of 0.9982 to 0.9999 indicates good linearity. The measurements at the beginning and end of the reagent storage procedure were taken for stability verification. No significant difference was detected between the 2 periods. The amino acid exhibited a degree of bias in the range of 0% to 14.17%, with acylcarnitine's being was in the range of 0% to 14.84%; they consequently passed the quality assessment requirements for clinical laboratories of the China National Centre. The amino acids’ within-run, between-run, and day-to-day run precision were 1.19% to 7.68%, 1.63% to 5.01%, and 4.77% to 12.48%, respectively, while the total imprecision was 5.55% to 13.33%. Acylcarnitine's within-run, between-run, and day-to-day run precision was 1.2% to 8.43%, 0.19% to 9.60%, and 2.33% to 10.74%, respectively, while it's total imprecision was 6.57% to 13.99%. The manufacturer declared that the total imprecision of the tests, using Multiple Reaction Monitoring, should be less than or equal to 25% of the coefficient of variation for the kit's high and low-quality control levels.
The performance of the non-derivatized MS/MS screening system in detecting the amino acids and acylcarnitines passed the test's requirements. It was maintained in accordance with the routine clinical chemical detection system.
Therapeutic effect of Fu's subcutaneous needling for hemiplegic shoulder pain among stroke survivors
Authors: Liu Tong , Wen Xi , Kuang Weichuan , Wang Xiaoyin , Jiang Ye , Qiu Xiaojia , Zeng Yao , Zhang Guitao , Yu Jiani , Liu Yue 
Published: May 2019

Abstract

Background:
Hemiplegic shoulder pain (HSP) is a frequent complication after stroke and limits patients’ physical functioning of the affected arm, thus compromising their quality of life. Fu's subcutaneous needling (FSN) has been widely applied in the treatment of pain diseases in China; however, its efficacy and safety for HSP remain to be elucidated. We therefore conducted a randomized, controlled trial to summarize the current evidence on the effects of FSN on the recovery outcomes of stroke survivors with HSP.

Methods:
Here, we conduct a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of FSN in patients with HSP. A total of 60 patients with numerical rating scale (NRS) score above 1 will be recruited in the trial and randomized into FSN group or usual care (UC) group. Patients in the FSN group will receive FSN treatment combined with UC treatment while patients in the UC group will receive UC treatment alone for 4 weeks. The primary outcomes are changes of NRS at baseline, after the 1st treatment, after the final treatment and 4 weeks after the final treatment. Secondary measurements will be changes of Fugl–Meyer score, constant score, MPQ-SF score, quality of life score, and range of motion at baseline, after the final treatment, and 4 weeks after the final treatment. The safety will also be assessed by monitoring the incidence of adverse events and changes in vital signs during the study.

Discussion:
Results from this trial will significantly support the application of FSN in the recovery of patients with HSP. If found to be effective and safe, FSN will be a valuable complementary option for patients with HSP.

Trial registration:
Chinese Clinical Trial Registry: ChiCTR1900021644 (registered on March 2, 2019).
Liver function and energy metabolism in hepatocellular carcinoma developed in patients with hepatitis B-related cirrhosis
Authors: Ren Meixin , Li Juan , Xue Ran , Wang Zhongying , Coll Shengli Li , Meng Qinghua 
Published: May 2019

Abstract
Energy metabolism in patients with Hepatocellular carcinoma (HCC) accompanying by hepatitis B cirrhosis is unknown.
To compare the differences in liver functions and energy metabolism between patients with hepatitis B-related cirrhosis and patients with HCC.
This was a retrospective study of patients with hepatitis B-related cirrhosis (LC group, n = 75) and patients with HCC accompanying by hepatitis B cirrhosis (HCC group, n = 80) treated in Beijing You’an Hospital between January 2013 and June 2017. The resting energy expenditure (REE), respiratory quotient (RQ), carbohydrate oxidation rate (CHO%), fat oxidation rate (FAT%), and protein oxidation rate (PRO%) were measured using a metabolic cart. Liver function, renal function, blood coagulation, etc. were collected.
Compared to the LC group, patients with HCC had normal metabolism, but RQ (0.83 ± 0.07 vs 0.85 ± 0.08, P = .073) and CHO% (35.5% vs 49%, P = .013) were lower and FAT% was higher (41% vs 33%, P = .030). Compared with patients with LC group, albumin (ALB), γ-glutamyltranspeptadase (GGT), alkaline phosphatase (AKP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and prothrombin time activity (PTA) were elevated in the HCC group, while total bilirubin (TB), total bile acid (TBA), and international normalized ratio (INR) were reduced (P < .05). Cholinesterase (CHE) was positively correlated with RQ, CHO, and CHO% (P < .05), while negatively correlated with FAT and FAT% (P < .05). AKP was negatively correlated with RQ, CHO, and CHO% (P < .05), while positively correlated with FAT and FAT% (P < .05). TBA was negatively correlated with RQ and CHO (P < .05), while positively correlated with FAT (P < .05).
HCC leads to increased liver synthetic function and improve the liver functions of patients with LC, at least to some extent, but the nutritional metabolism was poor.
Gradual replacement of all previously circulating respiratory syncytial virus A strain with the novel ON1 genotype in Lanzhou from 2010 to 2017
Authors: Liang Xuan , Liu Dong-Hai , Chen De , Guo Li , Yang Hui , Shi Yong-Sheng , Wang Yong-Jun , Wang Wei-Kai , Xie Zhi-Ping , Gao Han-Chun , Duan Zhao-Jun , Zhang Rong-Fang 
Published: May 2019

Abstract
ON1 is a novel genotype of human respiratory syncytial virus (HRSV) subtype A, in children with acute respiratory tract infections (ARTIs). However, there is not much data on the prevalence and clinical and molecular characterization in China.
Our study is based on the children who had respiratory infections positive for RSV-A admitted by Gansu Provincial Maternity and Child-care Hospital in Lanzhou (northwestern China) during the last 7 epidemic seasons from 2010 to 2017.
In our study, different strains of the novel RSV-A genotype ON1, first identified in Canada in December 2010, were first detected in Gansu Provincial Maternity and Child-care Hospital in August 2012 and then followed by an abrupt expansion in the number of ON1 variants in the beginning of 2014 and eventually replaced all other RSV-A strains from 2015 to 2017. ON1 is characterized by a 72-nt duplication in the C-terminal region of the highly variable attachment glycoprotein (G), predicted to lengthen the polypeptide with 24 amino acids, including a 23-aa duplication, which likely changes antigenicity. New N-glycosylation sites occurred within the 23-aa duplication and 24-aa insertion of the ON1 viruses in our study. Notably, RSV infections occurred later, but peaked sooner from the 2014/2015 to 2016/2017 epidemic seasons, compared with the previous 4 seasons.
Our study concluded that genotype ON1 has caused larger outbreaks and became the predominate genotype for HRSV subgroup A in Lanzhou from 2013 to 2017, and became the sole genotype of RSV-A in 2015/2016 and 2016/2017. Our data indicate that northwest of China and the world will eventually be dominated by the ON1 RSV-A genotype, including the possibility for vaccine development. Based on trends seen in RSV-B BA genotype, which predominated for decades, there is a possibility to develop a vaccine for children in the next 10 years.