bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant melanoma with indiscoverable skin manifestations presenting with paresis and refractory hypercalcemia
Authors: Wang Pei-pei , Zhou Xi , Chen Xi , Wang Li-wen , Liu Yong 
Published: January 2019

Abstract

Rationale:
Malignant melanoma with indiscoverable skin manifestations is unusual and refractory hypercalcemia with high metabolic signal of the rectum as initial manifestation is very rare.

Patient concerns:
We present a case that presented with paresis, nausea, and vomiting.

Diagnoses:
Malignant melanoma with spinal metastasis.

Interventions and outcomes:
The patient underwent posterior decompression, partial tumor resection, bone cement reconstruction, and internal fixation. The patient's hypercalcemia was controlled and muscle strength was partially recovered. The immunohistochemical stainings showed Melan-A (+), HMB45 (+), s-100 (+), Vimentin (+), and AE1/AE3 (−).

Lessons:
We emphasize the necessity of screening potential existence of neoplasms for the patients with hypercalcemia. Surgical treatment is still necessary for patients with spinal metastasis.
Relationship between β-defensin-1 gene polymorphism and susceptibility and prognosis of acute respiratory distress syndrome
Authors: Feng Qijia , Liu Nan , Song Shuping , Ma Yufei 
Published: January 2019

Abstract

Objective:
The 1st exon 5′ noncoding region rs1799946 (-52A/G), rs1800972 (-44C/G), rs11362 (-20A/G) 3 single-nucleotide polymorphisms (SNPs) on human β-defensin-1 (HBD-1) gene affect its transcription and posttranscriptional mRNA stability then affect the activity of HBD-1. This study was to investigate the effects of HBD-1 gene rs1799946, rs1800972, and rs11362 locus SNPs on genetic susceptibility and prognosis of acute respiratory distress syndrome (ARDS).

Methods:
A total of 300 patients with ARDS (ARDS group) and 240 patients who were admitted to the intensive care unit and had a high risk of ARDS but did not progress to ARDS (control group) were included in this study. The genotypes of HBD-1 gene rs1799946, rs1800972, and rs11362 locus and serum HBD-1 were detected. Patients were followed for 60 days with development of ARDS as a primary outcome, ARDS-related mortality and organ dysfunction were secondary outcomes.

Results:
HBD-1 gene rs1799946 and rs11362 gene mutations were not risk factors for ARDS (P > .05). Mutation allele G of rs1800972 locus in HBD-1 gene was a risk factor for ARDS. There was no significant difference in serum HBD-1 levels between patients with different genotypes of rs1799946 and rs11362 locus in the HBD-1 gene (P > .05). HBD-1 gene rs1800972 locus wild type, heterozygous, and mutant homozygous serum levels of HBD-1 gradually decreased, the difference was statistically significant (P < .001). The 60-day survival rate of subjects with wild type, heterozygous, and mutant homozygote at the rs1800972 locus of HBD-1 gene decreased sequentially (81.7%, 48.9%, and 39.7%), and the difference was statistically significant (P < .05).

Conclusion:
The SNP of rs1800972 (-44C/G) in HBD-1 gene is associated with the risk of ARDS. The rs1800972 locus G allele carriers are more likely to develop ARDS and have a poor prognosis.
Herbal medicine (Hyeolbuchukeo-tang or Xuefu Zhuyu decoction) for treating primary dysmenorrhea
Authors: Leem Jungtae , Jo Junyoung , Kwon Chan-Young , Lee Hojung , Park Kyoung Sun , Lee Jin Moo 
Published: January 2019

Abstract

Background:
Primary dysmenorrhea is a condition characterized by painful menstrual cramps that usually occurs in the absence of any identifiable pathological condition among menstruating women, with the prevalence estimates varying between 45% and 95%. Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered as a standard treatment for primary dysmenorrhea; however, the failure rate of NSAIDs is often 20% to 25% and these drugs commonly cause adverse effects. In this review, we investigated the current evidence related to the effectiveness of Xuefu Zhuyu decoction (XZD) or Hyeolbuchukeo-tang, a traditional herbal formula, as a treatment for primary dysmenorrhea.

Methods:
Literature search was conducted about randomized controlled trials (RCTs) for XZD on primary dysmenorrhea. PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Oriental Medicine Advanced Searching Integrated System, and other Chinese, Korean, Japanese databases were searched up to December 20, 2017. Two independent reviewers extracted and assessed the data. The main outcome domains were visual analogue scale (VAS) score and response rate.

Results:
Among 475 publications, 8 RCTs involving 1048 patients were finally included. Methodological quality of included RCTs was relatively low. In 4 add-on design studies, XZD plus western medication (WM) group showed better response rate as compared to the WM sole therapy (relative risk 1.18, 95% confidence interval [1.11, 1.25], P < .01). VAS score after the 3rd month of treatment in the XZD plus WM group was also lower than that in the WM group (mean difference –0.45, 95% confidence interval [–0.79, –0.12], P < .01). In 4 XZD versus WM design studies, XZD sole therapy showed better response rate than did WM sole therapy (relative risk 1.26, 95% confidence interval [1.06, 1.49], P < .01).

Conclusion:
The existing trials showed a favorable effect of XZD for the management of primary dysmenorrhea. However, the efficacy of XZD on primary dysmenorrhea is not conclusive owing to the small number of studies and the high risk of bias. Large-scale, long-term RCTs with rigorous methodological input are needed to clarify the role of XZD for the management of primary dysmenorrhea.

Trial registration number:
CRD42016050447 in PROSPERO 2016
Rheumatoid factor as predictor of response to treatment with anti-TNF alpha drugs in patients with rheumatoid arthritis
Authors: Santos-Moreno Pedro , Sánchez Guillermo , Castro Carlos 
Published: January 2019

Abstract
We determined whether rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) can predict remission or severe disability in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor (TNF) alpha drugs.
We performed a cohort study based on the clinical data from a referral center for the treatment of RA in Bogotá, Colombia, were included patients aged ≥18 years with diagnosis of RA with an active disease and for whom a treatment scheme was begun with anti-TNF alpha medication, with a minimum follow-up time of 12 months. Disease activity of Rheumatoid Arthritis was assessed through measurement of RF, ACPA, disease activity score (DAS28), and health assessment questionnaire (HAQ). We calculated the incidence rates (IRs) for remission and severe disability. We also calculated the incidence rate ratio (IRR) for each outcome by adjusting for possible confounders using the Poisson regression method. The hypothesis was tested with a P value of <.05. Statistical analysis was performed in Stata 15.
We included 400 patients receiving an anti-TNF alpha agent. Median age was 60 years, and 322 patients were women (80.5%). RF was positive in 357 patients (89%), ACPA in 348 patients (87%), and co-positivity in 324 patients (81%). Median follow-up was 41 months (range, 12–79 months). The IR for remission was 23 per 100 person-years in RF-negative patients and 16 per 100 person-years in RF-positive patients. The adjusted IRR (age sex, treatment, and ACPA) was 1.51 (95%CI, 1.05–2.18). The IR for severe disability was 10.8 per 100 person-years in the RF-positive cohort and 2.3 per 100 person-years in the RF-negative cohort. The IRR adjusted for these factors was 4.37 (95%CI, 1.6–12). Co-positivity had a similar behavior to RF. No differences were recorded in the rates of remission or disability in ACPA-positive and ACPA-negative patients.
Our findings suggest that remission is less frequent and severe disability more frequent in RF-positive patients treated with anti-TNF alpha agents than in RF-negative patients.
Challenges in diagnosis of spinal epidural abscess
Authors: Yang Xiaowei , Guo Runsheng , Lv Xin , Lai Qi , Xie Banglin , Jiang Xiaozhen , Dai Min , Zhang Bin 
Published: January 2019

Abstract

Rationale:
Spinal epidural abscess (SEA) is a rare condition that shows a high prevalence in immunocompromised patients. The clinical presentation of SEA includes the “classic triad” of pain, fever, and neurological dysfunction. However, these nonspecific features can lead to a high rate of misdiagnosis. SEA may lead to paralysis or even death; thus, prognosis of these patients remains unfavorable.

Patient concerns:
We report a case of a multilevel (T6–T12) SEA in a 22-year-old woman.

Diagnosis:
The patient was initially diagnosed with spinal tuberculosis at a local hospital based on a history of tuberculosis exposure, as well as radiography and computed tomography. Histopathological examination of the tissue resected during laminectomy confirmed the diagnosis of SEA in this patient.

Interventions:
The patient underwent multilevel laminectomy combined with long-term antibiotic therapy.

Outcomes:
Physical examination performed 16 months postoperatively revealed that superficial and deep sensation was restored to normal levels in the lower extremities with improvement in the patient's motor function (muscle strength 2/5).

Lessons:
This case report indicates that whole spine magnetic resonance imaging is warranted in patients with SEA and that prompt surgical intervention is important at symptom onset. Long-term antibiotic therapy is also essential postoperatively.
Corneal aberrations after small-incision lenticule extraction versus Q value-guided laser-assisted in situ keratomileusis
Authors: Zhang Jun , Zheng Li , Zhao Xia , Sun Yi , Feng Wei , Yuan Minhui 
Published: January 2019

Abstract
Previous studies compared ocular aberration and visual quality after small-incision lenticule extraction (SMILE) and Q value-guided femtosecond laser-assisted in situ keratomileusis (Q-FS-LASIK), but anterior corneal surface aberration properties are poorly known. This study aimed to compare the changes in anterior corneal surface aberration after SMILE versus Q-FS-LASIK.
This was a prospective, observational cohort study. Patients with myopia and myopic astigmatism underwent SMILE or Q-FS-LASIK at Hangzhou MSK Eye Hospital between January 2015 and November 2015. High order aberration (HOA), primary spherical aberration (PSA), primary coma aberration (PCA), primary vertical coma aberration (PVCA), and primary horizontal coma aberration (PHCA) were assessed using pre- and postoperative Sirius scanning.
Both surgery were associated with significant increases in postoperative HOA, PSA, and PCA (both groups P < .01). In the SMILE group (n = 51), the variations in HOA, PSA, and PCA were no longer significant after postoperative week 2 (P > .05). In the Q-FS-LASIK group (n = 73), the variations in HOA and PCA were no longer significant after postoperative day 1 (P > .05). In the SMILE group, the 3-month changes in PCA were not correlated with spherical, spherical equivalent (SE), and spherical plus cylinder measurements. Cylinder measurements were not correlated with HOA, PSA, and PCA. In the Q-FS-LASIK group, the 3-month changes in PCA correlated with spherical, SE, and spherical plus cylinder measurements.
Both SMILE and Q-FS-LASIK resulted in an increase in HOA, PSA, and PCA at postoperative day 1, but Q-FS-LASIK introduced lower HOA and showed better stability. Spherical measurement was related to PSA.
Changes in blood flow distribution after hypogastric artery embolization and the ischaemic tolerance of the pelvic circulation
Authors: Nitta Jun , Hoshina Katsuyuki , Isaji Toshihiko 
Published: January 2019

Abstract
This study aimed to compare the pelvic cavity vasculature before and after the interventional occlusion of a hypogastric artery (IOHA) and to reveal the protective mechanism of the collateral vessels against pelvic ischaemia.
Sixty-nine patients with abdominal aortic or aortoiliac aneurysms who underwent endovascular aneurysm repair accompanied with IOHA were retrospectively analysed. Patients were divided into those who complained of buttock claudication (BC) group and asymptomatic patients (non-BC group).
Two analyses were performed. In Study 1, the factors associated with postoperative BC were evaluated in patients who underwent IOHA using only 0.035 Tornade embolization coils. In Study 2, the pelvic arterial volume (PAV) was assessed in patients with both pre- and postoperative multidetector computed tomography images. PAV was calculated by subtracting the aortoiliac artery volume from the total PAV. The PAV ratio was defined as the postoperative PAV divided by preoperative PAV and represented collateral development in the pelvis.
In Study 1, BC occurred in 16 patients (BC group) and did not occur in 25 patients (non-BC group). Significantly more coils were used in the BC group than in the non-BC group (8.6 ± 1.0 vs 5.6 ± 0.83, P = .013). Study 2 had 24 patients in the BC group and 31 patients in the non-BC group. The PAV ratio was significantly higher in the BC group than in the non-BC group (0.93 ± 0.05 vs 0.62 ± 0.04, P<.0001).
The use of more coils in IOHA is associated with BC. In addition, volumetric analysis revealed that less collateral vessel development occurred in the non-BC group than in the BC group, which might reflect a potential reservation capacity of non-BC patients for acute pelvic ischaemia.
Risk of massive blood product requirement in cardiac surgery
Authors: Huang Dou , Chen Changwei , Ming Yue , Liu Jing , Zhou Li , Zhang Fengjiang , Yan Min , Du Lei 
Published: January 2019

Abstract
Cardiac surgery under cardiopulmonary bypass (CPB) accounts for most consumption of red blood cells (RBCs). Identifying risk factors for massive red blood cell transfusion (MRT) in cardiac surgery may help to reduce this consumption.
We retrospectively analyzed 8238 patients who underwent valve surgery and/or coronary artery bypass grafting (CABG) under CPB at 2 major heart centers in China. Uni- and multivariate logistic regression was carried out to assess whether risk factors for MRT (defined as receiving at least 4 units RBCs) varied with type of cardiac surgery.
A total of 1691 patients (21%) received at least 4 units RBCs (6.77 ± 4.78 units per person). This MRT group consumed 70% of the total units of allogeneic RBCs in the study. MRT incidence was 2-fold higher among patients undergoing CABG with or without valve surgery than among patients undergoing valve surgery alone. Multivariate logistic analysis identified the following MRT risk factors common to valve surgery alone, CABG alone, and their combination: female sex, older age, renal dysfunction, lower body mass index, lower preoperative hemoglobin, and longer CPB. Several independent MRT risk factors were also identified specific to valve surgery: active endocarditis, nonatrial fibrillation, smaller left atrium diameter, abnormal international normalized ratio, and repeat surgery.
Different types of cardiac surgery share several, but not all, MRT risk factors. This study may help guide the prediction and management of patients at higher MRT risk.
Efficacy of sorafenib adjuvant therapy in northwestern Chinese patients with non-metastatic renal-cell carcinoma after nephrectomy
Authors: Wei Di , Wu Guojun , Zheng Yu , Chen Fubao , Lu Jingyi , Wang Yangmin , He Dalin , Wang He , Wang Zhiping , Chen Peng , Wang Yujie , Wang Zhiyong , Ye Yongli , Zhu Zheng , Yuan Jianlin 
Published: January 2019

Abstract
Recent studies have confirmed the efficacy of sorafenib for patients with advanced renal cell carcinoma; however, its efficacy and safety as an adjuvant therapy in patients with non-metastatic and loco-regional renal cell carcinoma after surgery remains controversial. Thus, the aim of the present retrospective study was to evaluate the efficacy of adjuvant sorafenib therapy in such patients from 8 centers in northwestern China that were treated from August 2009 to December 2016.
After surgery, the patients (n = 48) received oral sorafenib for 3 months. The control group (n = 48) comprised patients that underwent the same surgery from December 2009 to June 2016 but without adjuvant therapy who were matched 1:1 with the sorafenib group with respect to sex, age, pathological findings, disease stage and grade, operation time, and surgical procedure. The primary outcome compared between the groups was disease-free survival. Adverse events were also recorded to evaluate the safety of sorafenib. The influence of patients’ characteristics and laboratory tests on recurrence was analyzed using unconditional logistic regression.
Overall, the demographic characteristics of the 2 groups were similar. There was no significant difference in the rate of recurrence (8.3% for sorafenib patients and 6.2% for the matched patients, P = .66) or median disease-free survival between the 2 groups (hazard ratio = 1.561, 95% confidence interval = 0.349–6.987, P = .56). In multiple logistic regression analysis, increased blood urea nitrogen (BUN) emerged as an independent predictor of recurrence risk (P = .02).
These results indicate that postoperative sorafenib adjuvant therapy did not achieve the expected beneficial effect, pointing to the need for further studies to evaluate its utility in such cases.
Pectoralis major tendon transfer for recurrent anterior shoulder dislocation after primary surgery in an elderly patient
Authors: Kim Jun Bum , Hong Sijohn , Wang Soon Do , Kim Chang Hyun 
Published: January 2019

Abstract

Rationale:
Adequate stability of traumatic anterior shoulder dislocation without any obvious damage to the anterior capsulolabral structure in elderly patients can be achieved by treating the associated rotator cuff injuries. However, in case of recurrent shoulder dislocation despite rotator cuff repair, the repaired rotator cuff may be weakened or reruptured and is often impossible to repair again. Therefore, the role of the rotator cuff as a shoulder stabilizer cannot be expected. Even if the anterior joint capsule is left, it is too weak to imbrication either. An additional anterior structural reconstruction that can replace the rotator cuff and capsule is needed to prevent recurrence.

Patient concerns:
A 59-year-old man visited our clinic because of traumatic anterior dislocation of the right shoulder combined with anterior–superior rotator cuff tear. Because there was no obvious anterior capsulolabral injury, he underwent arthroscopic rotator cuff repair only. Postoperative rehabilitation was maintained; however, anterior shoulder dislocation recurred 10 months postoperatively.

Diagnosis:
Physical examination revealed anterior instability in abduction and external rotation of the shoulder joint. Magnetic resonance imaging suggested retear of the repaired anterior–superior rotator cuff and Hill–Sachs lesion of the humeral head.

Interventions:
Diagnostic arthroscopy was performed. The reruptured rotator cuff seemed impossible to repair; thus, arthroscopic remplissage procedure was performed for engaging the Hill–Sachs lesion. In addition, open pectoralis major tendon transfer for anterior stabilization was performed via the deltopectoral approach.

Outcomes:
At the 12-month follow-up, the patient showed good clinical outcomes, including internal rotation of the shoulder joint without recurrent instability.

Lesson:
Recurrent anterior shoulder dislocation after primary surgery in the elderly may be a challenging situation for surgeons. In patients with irreparable anterior rotator cuff tear and for whom reconstruction of the anterior glenoid is not indicated, pectoralis major tendon transfer is a good treatment option for satisfactory clinical outcomes without recurrence.
A left femoral artery to right femoral vein bypass graft for hemodialysis access
Authors: Wang Jian , Li Jie , Sun Jinhong , Xin Jun , Lei W-H. 
Published: January 2019

Abstract

Rationale:
As survival prospects improve for long-term patients with hemodialysis, it is common for patients to exhaust all upper extremity access options before other avenues need exploration. The purpose of this case report was to describe our experience in creating a prosthetic graft between left femoral artery and right femoral vein in a patient with history of central venous occlusion and bilateral femoral neck fracture.

Patient concerns:
A female patient with hemodialysis exhausted all upper extremity access options along with bilateral femoral neck fracture.

Diagnoses:
Patients with end-stage renal disease exhausted all upper extremity access options.

Interventions:
We performed a left femoral artery to right femoral vein dialysis access utilizing a prosthetic graft and autologous cephalic vein.

Outcome:
The graft was used for hemodialysis 3 weeks after the operation. There was no edema of the lower extremity through the immediate postoperative period as well as at follow up. The patient has been using the access for 9 months with no complication of thrombosis, infection, or bleeding.

Lessons:
Prosthetic graft between the left femoral artery and right femoral vein is a simple, safe and novel approach to creating lower extremity access. This method could be a viable means of hemodialysis access in selected patients.
Identification of risk factors affecting bone formation in gradual ulnar lengthening in children with hereditary multiple exostoses
Authors: Li Yuchan , Han Bingqiang , Tang Jingyan , Chen Mu , Wang Zhigang 
Published: January 2019

Abstract
The forearm deformity classified by Masada is a characteristic trait of patients with hereditary multiple exostoses (HME). Ulnar gradual lengthening, which was considered to be a safe and reliable procedure, was popular in treating these difficult deformities, however, delayed consolidation of the callus is uncommon but not rare in literature review. The purpose of this study was to try to identify the risk factors influencing bone healing in gradual ulnar lengthening in HME.
We retrospectively reviewed patients with HME-induced forearm deformity who underwent gradual ulnar lengthening at our hospital from 2010 to 2016. Patients’ demographic data, forearm deformity of Masada type, surgical procedure, ulnar diameter of osteotomy site, and external fixator type were recorded. We also reviewed radiographical data included gained length, axis deviation, callus form. Clinical outcome was assessed by the bone healing index (HI). Multiple linear regression was used to analyze the relationships between diffident parameters and the HI, the level of significance was set P <.05.
Thirty-three patients were included in this study. The mean follow-up period was 1.5 (range 0.5–8) years. Circular external fixators were used in 5 patients and monolateral external fixators were used in 28 patients. The mean achieved length was 4.24 cm. The mean HI was 50.3 (range 26.6–99.3) days/cm. In patient with monolateral external fixator, patient's age was positively correlated with the bone HI (P = .001), while diameter and body mass index (BMI) were negatively correlated with the HI (P = .040, .018, respectively). Patient's sex, removal of distal ulnar exostoses, lengthening percentage, and axis deviation were non-significant in the regression model.
When using monolateral external fixator for ulnar lengthening, patient's age, diameter of osteotomy site, and BMI are the most important risk factors related to bone formation. Pediatric orthopedic surgeons should consider these variables in order to avoid delayed union.