bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thirty-Day Readmission After Esophageal Variceal Hemorrhage and its Impact on Outcomes in the United States
Authors: Bilal Mohammad , Abougergi Marwan S. , Tayyem Obada , Parupudi Sreeram , Rockey Don C. 
Published: August 2019

Aims:
The authors sought to determine the 30-day readmission rate of patients with esophageal variceal hemorrhage (EVH) and its impact on mortality, morbidity, and health care utilization.

Background:
EVH is a common complication of cirrhosis and leads to substantial morbidity and mortality.

Study:
The 2014 National Readmission Database was used to examine adult patients with urgent/emergent admissions and a principal diagnosis of EVH. The primary outcome was 30-day readmission. Secondary outcomes were in-hospital and 30-day mortality rate, most common reasons for readmission, readmission mortality rate, morbidity, and resource utilization. Independent risk factors for readmission were identified using multivariate regression analysis.

Results:
A total of 2003 patients with EVH were included. The mean age was 57 years and 29% of patients were female individuals. The all-cause 30-day readmission rate was 16.6%. EVH was the cause of readmission in only 5% of readmissions. Independent predictors of readmission were age and insurance type. The in-hospital and 30-day mortality rate for index admissions were 7.3% and 8.2%, respectively. For readmitted patients, the mortality rate was 3.9%. Although morbidity was lower during readmissions (prolonged mechanical ventilation: 0.4% vs. 3.5%, P<0.01 and shock: 1.8% vs. 9.9%, P<0.01), the cumulative additional length of stay was substantial at 2054 days with additional total hospitalization charges of US$20 million.

Conclusions:
The all-cause 30-day readmission rate after EVH is 16.6%, with most patients being readmitted for diagnoses unrelated to EVH. Readmission was associated with a substantial increase in in-hospital mortality and resource utilization. Risk factors for readmission were identified, which can potentially be used to decrease readmission rates.
The impact of age on intravesical instillation of Bacille Calmette–Guerin treatment in patients with high-grade T1 bladder cancer
Authors: Calò B. , Sanguedolce F. , Fortunato F. , Stallone G. , d’Altilia N. , Chirico M. , Falagario U. , Mancini Vito , Carrieri G. , Cormio L. 
Published: August 2019

Abstract
Intravesical instillation of Bacille Calmette–Guèrin (BCG) is the standard adjuvant treatment for high-risk non muscle invasive bladder cancer (NMIBC). Since its mechanism of action is supposed to be linked to the immune system efficiency and senescence could negatively affect this efficiency, BCG efficacy in the elderly has been questioned. This study aimed to assess the impact of age on BCG efficacy and safety in patients with high-grade T1 bladder cancer (BC).
Among 123 patients with high-grade T1 BCG scheduled for BCG treatment, 82 were <75 year-old (group A) and 41 were ≥75 year-old (group B). Follow-up: urine cytology and cystoscopy every 3 months for the first 2 years, every 6 months for the third year, and then yearly. Tumor recurrence was defined as pathological evidence of disease at the bladder biopsy; tumor progression was defined as pathological shift to muscle invasive disease at the bladder biopsy or the imaging techniques showing recurrent BC and distant metastasis likely related to it.
The median follow-up was 65 months (range 11-152). Recurrence occurred in 35 patients, 19 (23.2%) in the group A and 16 (39%) in the group B. Progression occurred in 18 patients, 12 (14.6%) in the group A and 6 (14.6%) in the group B. Recurrence free rate was similar in both groups up to 2 years. The 5 years progression rate was almost the same in both groups A and B (85.9% vs 84.7%), whereas the 5 years cancer-specific survival (CSS) was 92.6% in the group A and 85.4% in the group B. Of the 18 patients with progression, 11 underwent cystectomy; 12 patients died because of their BC. Kaplan–Meier plots pointed out no difference in recurrence-free, progression-free, and CSS between the 2 groups. Adverse events were similar in the 2 groups. Only 4 (3.3%) patients, 2 (2.4%) in the group A and 2 (4.8%) in the group B, experienced mild adverse reactions compatible with treatment.
Elderly patients with high-grade T1 BC are not poorer candidates to BCG treatment, as they had similar benefit and adverse reactions than those aging ≥75 years.
Serum thyroglobulin elevation after needle aspiration of the lymph nodes: the predictive value for detecting metastasis in papillary thyroid cancer patients – a pilot study
Authors: Hong Chae Moon , Jeong Ju Hye , Son Seung Hyun , Lee Chang-Hee , Jeong Shin Young , Lee Sang-Woo , Lee Jaetae , Ahn Byeong-Cheol 
Published: August 2019

Abstract
Ultrasonography (USG)-guided fine needle aspiration (FNA) is widely used for diagnosis of lymph node (LN) metastasis in papillary thyroid cancer (PTC). However, FNA cytology sometimes shows inconclusive results. Recently, the measurement of thyroglobulin (Tg) in FNA washout fluid (aspirate-Tg) has been widely adopted, but there are some difficulties in the preparation of the sample and standardization of the procedure. Here, we examined serum Tg after FNA as a new predictive marker for LN metastasis of PTC. We performed USG-guided FNA cytology and examined aspirate-Tg in PTC patients showing suspicious metastatic LNs during follow-up. We measured baseline serum thyroid stimulating hormone (TSH), Tg, and Tg antibody levels before FNA, and serum Tg level within an hour after FNA. We defined aspirate-Tg level above 0.9 ng/mL as positive, and a 30% increase in serum Tg level after FNA compared to the baseline as elevation of serum Tg. Twenty-two patients were included in our study. Nine patients (40.9%) showed elevation of Tg level after FNA, and the mean value of Tg elevation was 24.8 ± 48.0 ng/mL. Among these 9 patients, 8 were diagnosed with PTC and 1 patient showed cellular atypia on cytopathology. All these patients showed positive aspirate-Tg. Thirteen patients (59.1%) did not show elevation of Tg level after FNA. Among these patients, 2 had PTC, 2 had cellular atypia, and 9 yielded negative results for malignancy on cytopathology. Elevation of serum Tg level after FNA might have a diagnostic role for predicting LN metastasis of PTC.
Combined use of salivary biomarkers and carcinoembryonic antigen for lung cancer detection in a Chinese population
Authors: Shang Xi , Zi Huanpu , Li Yangyang , Gao Yu , Ge Changsheng , Sun Zhongmei , Zhang Youmin 
Published: August 2019

AbstractBlood-based biomarkers, such as carcinoembryonic antigen (CEA), and saliva-based biomarkers, such as mRNA, have emerged as potential liquid biopsies for non-invasive detection of many cancers. However, current tests typically use single type of biomarkers, and their sensitivity and specificity is often unsatisfactory.In this study, we developed a novel biomarker panel that measures both CEA level in blood and GREB1 and FRS2 levels in saliva to achieve high sensitivity and high specificity in detecting Non-Small Cell Lung Cancer (NSCLC).In the discovery phase, we achieved sensitivity of 96.67% and specificity of 93.33% for 30 NSCLC patients and 30 healthy controls. To further evaluate the prediction performance of our biomarker panel, we applied it to an independent set of 15 NSCLC cancer patients and 25 healthy controls. The sensitivity and specificity of our test reached 93.33% and 80.00% respectively.Our study discovered that the combined analysis of CEA and mRNA can be a novel liquid-biopsy technology for non-invasive detection of NSCLC.
Evaluation of hepatic fibrosis by ultrasonic acoustic structure quantification
Authors: Cheng Lei , Chen Yongan , Xiao Rui , Pan Yan , Guo Jia 
Published: August 2019

Abstract
To evaluate the diagnostic accuracy of ultrasonic acoustic structure quantification (ASQ) for grading hepatic fibrosis/cirrhosis by comparing ultrasonographic features of regions of interest on ASQ images with the pathological characteristics of stage F0–F4 hepatic fibrosis cases.
We retrospectively analyzed the medical records of 97 patients with chronic hepatitis who underwent ASQ evaluation at the Ultrasound Room of Dongfang Hepatobiliary Surgery Hospital (Shanghai, China) between July 2012 and October 2013. Regions of interest on stored ASQ images were analyzed to obtain cm2 values on modes, averages, and standard deviations. Correlation analysis, principal component analysis (PCA), and multivariate analysis of variance (MANOVA) of the mean cm2 values with hepatic fibrosis staging were performed. A receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of ASQ.
The mean cm2 of ASQ correlated with the pathological stage of hepatic fibrosis, with the best correlation coefficient (r = 0.81) in the right lobe below rib 2. The best cm2 average 1 and 2 values, which differed significantly among different hepatic fibrosis/cirrhosis stages, were also found in this area. The maximal area under the ROC curve (0.969) was for cm2average 1 for the F0 versus F1 to F4 group, with a low criterion (110), while the maximal criterion (145) was for cm2 average 2 for the F0–F3 versus F4 group, with a relatively small AUC (0.882).
With objective and accurate results, ASQ analysis is a promising non-invasive method for grading hepatic fibrosis, although this should be verified in further studies.
Evaluation of ocular surface impairment in meibomian gland dysfunction of varying severity using a comprehensive grading scale
Authors: Fu Jiayu , Chou Yilin , Hao Ran , Jiang Xiaodan , Liu Yushi , Li Xuemin 
Published: August 2019

Abstract
This study aimed to propose a comprehensive grading scale to evaluate different clinical manifestations in patients with varying severity of meibomian gland dysfunction (MGD) and analyze the correlations between the parameters of ocular surface impairment in MGD.
A total of 63 patients with MGD were enrolled. Ten specific symptoms were evaluated each with a subjective score and total score was applied to grade the severity of MGD. Thirty-seven patients were diagnosed with mild, 19 with moderate, and 7 with severe MGD. Slit-lamp and keratography were used to assess the signs of ocular surface and meibomian gland (MG). In vivo confocal microscopy (IVCM) was performed to evaluate the corneal nerves and dendritic cells. The differences and correlations between symptoms, signs, and IVCM parameters were analyzed.
Dryness, foreign body sensation, asthenopia, and photophobia were the most common and severe symptoms in our patients. The severe MGD group showed worse MG expressibility, Meibum score, Meiboscore, MG score, and higher nerve reflectivity (P < .05). The mild MGD group showed higher nerve density (P < .05). Total symptom score was negatively correlated with nerve density (r = –0.374, P < .05), while positively correlated with nerve reflectivity and dendritic cell density (r = 0.332 and 0.288, respectively, P < .05). MG score was correlated with nerve reflectivity (r = 0.265, P < .05).
The comprehensive grading scale was suitable for evaluating clinical manifestations in MGD of varying severity. The relationship between the specific symptoms, signs, and IVCM results concerning whole ocular surface impairment could help elucidate MGD pathophysiology and benefit evaluation or treatment in the future.
IgG4-related sialadenitis complicated with type III mixed cryoglobulinemia
Authors: Zhang Rui-Yu , Zhao Zhi-Rui , Xu Xiao-Yi , Sun Li-Jun , Dong Hong-Rui , Rui Hong-Liang , Wang Guo-Qin , Cheng Hong , Chen Yi-Pu 
Published: August 2019

Abstract

Rationale:
IgG4-related disease (IgG4-RD) is a systemic autoimmune disease and mixed cryoglobulinemia may be caused by autoimmune diseases. However, so far only 1 case of IgG4-RD complicated with mixed cryoglobulinemia is reported. Our case further confirms the close relationship between these 2 diseases.

Patient concerns:
A 55-year-old female was admitted because of dry mouth and teeth falling off.

Diagnoses:
The patient was diagnosed as IgG4-related sialadenitis (IgG4-RS) complicated with type III mixed cryoglobulinemia. IgG4-RS was confirmed by elevated serum IgG4 levels and diffuse IgG4
+
plasmocyte infiltration and storiform fibrosis in the interstitium of labial gland. Type III mixed cryoglobulinemia was confirmed by positive serum cryoglobulins and no monoclonal immunoglobulin in serum and urine.

Interventions and Outcomes:
After treatment with prednisone and cyclophosphamide, serum cryoglobulins rapidly turned negative with the remission of IgG4-RS.

Lessons:
Type III mixed cryoglobulinemia can be caused by IgG4-RS, and the underlying mechanisms need to be further explored.
Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism
Authors: Lin Jianli , Mao Jiangfeng , Wang Xi , Ma Wanlu , Hao Ming , Wu Xueyan 
Published: August 2019

Abstract

Background:
To compare the efficacies of gonadotropin-releasing hormone (GnRH) pulse subcutaneous infusion with combined human chorionic gonadotropin and human menopausal gonadotropin (HCG/HMG) intramuscular injection have been performed to treat male hypogonadotropic hypogonadism (HH) spermatogenesis.

Methods:
In total, 220 idiopathic/isolated HH patients were divided into the GnRH pulse therapy and HCG/HMG combined treatment groups (n = 103 and n = 117, respectively). The luteinizing hormone and follicle-stimulating hormone levels were monitored in the groups for the 1st week and monthly, as were the serum total testosterone level, testicular volume and spermatogenesis rate in monthly follow-up sessions.

Results:
In the GnRH group and HCG/HMG group, the testosterone level and testicular volume at the 6-month follow-up session were significantly higher than were those before treatment. There were 62 patients (62/117, 52.99%) in the GnRH group and 26 patients in the HCG/HMG (26/103, 25.24%) group who produced sperm following treatment. The GnRH group (6.2 ± 3.8 months) had a shorter sperm initial time than did the HCG/HMG group (10.9 ± 3.5 months). The testosterone levels in the GnRH and HCG/HMG groups were 9.8 ± 3.3 nmol/L and 14.8 ± 8.8 nmol/L, respectively.

Conclusion:
The GnRH pulse subcutaneous infusion successfully treated male patients with HH, leading to earlier sperm production than that in the HCG/HMG-treated patients. GnRH pulse subcutaneous infusion is a preferred method.
Assessment of the quality and content of clinical practice guidelines for post-stroke rehabilitation of aphasia
Authors: Wang Yu , Li Huijuan , Wei Huiping , Xu Xiaoyan , Jin Pei , Wang Zheng , Zhang Shian , Yang Luping 
Published: August 2019

Abstract

Objectives:
The purpose of this study was to evaluate the quality of guidelines for rehabilitation of post-stroke aphasia using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument and identify consistency of different guidelines.

Methods:
A systematic search was undertaken from inception to October 2018. Two reviewers independently screened all titles and abstracts, and assessed eligible guidelines using the AGREE-II. Agreement among reviewers was measured by using intra-class correlation coefficient (ICC).

Results:
From 5008 records screened, 8 guidelines met the inclusion criteria. The quality of guidelines was heterogeneous. Three guidelines were rated high (6.5) across; the highest rated domain was “scope and purpose" (median score 95.8%); the lowest rated domain was “rigor of development" (median score 67.2%). An overall high degree of agreement among reviewers to each domain was observed (ICC ranged from 0.60 to 0.99). The speech language therapy was recommended in 3 guidelines. Four guidelines described group treatment was beneficial for the continuum of care. However, other therapies for aphasia varied in the level of detail across guidelines.

Conclusions:
Our study indicated the quality of guidelines for post-stroke aphasia needed to be improved. Moreover, the treatment recommendations of aphasia existed discrepancy among the included guidelines. Therefore, it is suggested to pay more attention on the rigor of methodology and applicability during the process of the formulation of guideline. Future research should focus on the effectiveness, intensity, and duration of treatment measures.
Monitoring of home recovery using the 317-nursing mobile application following day-case surgery in children
Authors: Li Canping , Huang Shoujiang , Su Xiaohua , Zhang Tingting , Jiang Kewen 
Published: August 2019

Abstract
The number of elective day-case surgeries has considerably increased in recent years, especially in China. Few studies have investigated the ability of mobile applications to assist recovery for patients having undergone day-surgery; however, these studies have indicated that the use of mobile applications is cost-efficient and has a positive effect on recovery after surgery. This study aimed to evaluate the utility and efficacy of using the 317-nursing mobile application program (317NAPP) for monitoring home recovery following day-surgery involving high ligation of the hernial sac in pediatric patients.
Prospective clinical study involving 2 parallel groups.
Patients were randomly divided into the “intervention 317NAPP group” (n = 64) and the control group (n = 63). Patients were followed-up using the 317NAPP in the intervention group and via telephonic consultations in the control group. All patients were enrolled after being provided sufficient guidance with respect to discharge and health education. The health index, including the physiological function, ability to perform daily activities, and the injury response, was evaluated before and 24 hours after surgery. The time duration of each follow-up session was also evaluated in both groups.
The preoperative (T1) health index scores were significantly higher than the postoperative (T0) ones in both groups (P = .00). The quality of recovery (T1–T0) of the intervention group (10.75 ± 5.28) was better than that of the control group (11.78 ± 5.16), but the differences were not significant (P = .27). In the intervention group, the follow-up time duration was significantly lower in comparison to that in the control group (P = .00).
This study demonstrated that 317NAPP had a positive effect on recovery following day-surgery, and the time-duration for follow-up was shorter than that performed using telephonic consultation. Monitoring recovery using 317NAPP was safe, efficient, inexpensive, and relatively easy; therefore, it may help improve the recovery of patients having undergone day-surgery.
Traumatic posterior atlantooccipital dislocation with Jefferson and occipital condyle fractures
Authors: Chang Dong-Gune , Park Jong-Beom , Cho Kwang Hyun 
Published: August 2019

Abstract

Rationale:
To the best of our knowledge, this is the first report on a case of a traumatic posterior atlantooccipital dislocation (AOD) with 3-part Jefferson and occipital condyle fractures.

Patient concerns:
We report the case of a 60-year-old male with posterior AOD with 3-part Jefferson fracture and fracture of right occipital condyle. This injury occurred as a result of rolling down from a mountain. The patient complained of severe neck pain showing bony tenderness and ecchymosis in the high cervical area but did not show any neurologic abnormalities.

Diagnoses:
Reconstructed computed tomography scans clearly demonstrated a 3-part Jefferson fracture and fracture of right occipital condyle, and posteriorly displaced occiput with respect to the anterior arch of C1 and dens of C2.

Intervention:
We planned to perform occipitocervical fusion; however, the patient refused treatment. He was transferred to another hospital and lost to follow-up.

Outcomes:
Although extremely rare, patient who had posterior AOD with 3-part Jefferson and occipital condyle fractures can survive without neurological compromise, as was observed in our patient.

Lessons:
Clinical suspicion with thorough radiographic and physical examinations are very important for diagnosing of the upper cervical spine injuries such as AOD with Jefferson and occipital condyle fractures.
A laryngeal disorders prediction model based on cluster analysis and regression analysis
Authors: Byeon Haewon 
Published: August 2019

Abstract
This study provided the baseline for establishing policies for community health promotion programs to propose the clusters of multiple health risk factors and identify the risks of laryngeal disorders according to the clusters by using the national level survey representing the South Korean population. This study targeted 5941 people who completed the 5th Korean National Health and Nutrition Examination Survey. The independent variables were age, sex, smoking, high-risk drinking, education level, occupation, household income, and self-reported voice problems. The identify cluster relationship with laryngeal disorders by conducting 2-way cluster analysis and multinomial logit analysis. The prevalence of laryngeal disorder was 6.7%. The results of analysis, 3 clusters were automatically extracted. Multinomial logistic regression analysis showed that sociodemographic factors, health risk behaviors, and health status clusters were significantly related to the risk of laryngeal disorders. The males who were smoking, high-risk drinking, college graduate and above, high income, and non-manual workers had a higher risk of laryngeal disorders than females who were non-smokers, non-drinkers, 60 years old and older, economically inactive, and high school graduate. The results of this study suggested that it may be effective to classify population according to sociodemographic and health behaviors and develop health education materials and health promotion program accordingly in order to prevent laryngeal disorders.
Mature ovarian cystic teratoma with “sack of marbles” appearance on magnetic resonance imaging
Authors: Wang Anlong , Shu Yefei 
Published: August 2019

Abstract

Introduction:
Mature ovarian cystic teratoma is a cystic fatty tumor. Presence of floating fat balls in an ovarian cystic teratoma looking like a “sack of marbles” on magnetic resonance imaging (MRI) is a rare finding.

Patient concerns:
Herein, we report a 38-year old woman who was admitted to our hospital presenting with an abdominal mass and abdominal pain.

Diagnosis:
Ultrasonography revealed a giant cystic mass in the pelvis; T1-weighted MRI revealed multiple spherical signals in the lesion.

Interventions:
She underwent exploratory laparotomy and was histopathologically diagnosed with benign cystic teratoma.

Outcomes:
Finally, the patient recovered after operation. Until December 2018, she had been still healthy without recurrence of tumors.

Conclusion:
The aim of this case report was to present “sack of marbles” appearance on MRI, which will impress other doctors and improve the diagnosis of such diseases.
Ultrasound-guided peri-brachial plexus polydeoxyribonucleotide injection for a patient with postherpetic brachial plexopathy
Authors: Kim Jun Young , Hwang Jong-Moon , Park Jin-Sung , Park Sungwon , Lee Byung Joo , Park Donghwi 
Published: August 2019

Abstract

Rationale:
Although most complications of herpes zoster (HZ) are associated with the spread of varicella-zoster virus from the initially involved sensory ganglion, motor nerve impairment, such as limb weakness, is a rare but severe complication that is difficult to treat.

Patient concern:
A 73-year-old female presented with sudden left upper limb pain and weakness after HZ.

Diagnosis:
Brachial plexopathy following HZ (postherpetic brachial plexopathy).

Intervention:
Despite alleviation of the vesicles with antiviral treatments, the left upper limb weakness and neuropathic pain did not improve. After obtaining patient's consent, ultrasound-guided polydeoxyribonucleotide (PDRN) injection was performed around the left brachial plexus.

Outcomes:
The patient showed marked improvement in left arm pain from numerical rating scale (NRS) 9 to 4, 1 day after PDRN injection. Subsequently, the pain improved to NRS 3, and motor weakness improved to Medical Research Council grade 2 to 4.

Lessons:
PDRN can be considered a viable substitute for corticosteroid injection in treatment of motor weakness and neuropathic pain after HZ.