bluuebunny/crossref_metadata_2025_split huggingface dataset:
Descemet Membrane Endothelial Keratoplasty in Irreversible Corneal Edema Due to Herpes Simplex Virus Endotheliitis
Authors: Basak Samar K. , Basak Soham 
Published: September 2019

Purpose:
To report the clinical outcome and postoperative course of Descemet membrane endothelial keratoplasty (DMEK) in irreversible corneal edema due to herpes simplex virus (HSV) endotheliitis.

Methods:
This is a retrospective, noncomparative, interventional case series. Nineteen eyes of 19 patients underwent standard DMEK combined with cataract surgery (triple DMEK) between May 2016 and April 2018. All patients received perioperative oral acyclovir (ACV) and prednisolone. Patients were followed up on day 1, on day 7, at 1 month, and then at 3 monthly intervals. Preoperative and postoperative best spectacle-corrected visual acuity (BSCVA), graft clarity, pachymetry, and endothelial cell loss after 1 year were recorded. Postoperative complications and HSV recurrence were noted until the last follow-up visit.

Results:
All eyes were phakic with variable grades of cataract with a preoperative BSCVA of 1.0 logarithm of the minimum angle of resolution or worse. The mean follow-up period was 19.3 ± 5.4 months. After 1 year, 14 (73.7%) eyes achieved a BSCVA of 0.3 or better. Seventeen (89.5%) patients had a clear graft at the last visit without any rejection episode. One graft failed after 16 months. After 3 months, the mean pachymetry reduced from 667.1 ± 62.1 to 512.8 ± 27.1 μm (P < 0.001). The mean endothelial cell loss after 1 year was 36.7 ± 13.4%. Three (15.8%) eyes had recurrence: one with recurrent endotheliitis and 2 with dendritic keratitis despite oral ACV, which responded to oral valacyclovir and ACV eye ointment. One patient had re-recurrence of endotheliitis after 20 months.

Conclusions:
DMEK in persistent corneal edema after HSV endotheliitis remains challenging but has encouraging outcomes. The postoperative course may be complicated by HSV recurrence. Prophylactic oral antivirals for 1 year or more and topical antivirals are useful for the prevention of recurrence.
Ability of 2 estimation methods of body fat percentage in identifying unfavorable levels of cardiometabolic biomarkers in adolescents: Results from the LabMed study
Authors: Oliveira-Santos José , Mota Jorge , Moreira Carla , Abreu Sandra , Lopes Luís , Agostinis-Sobrinho César , Santos Rute 
Published: September 2019

Background:
To assess and compare the ability of body fat percentage (BF%) estimated by 2 methods, bioelectrical impedance analysis (BIA) and by the Slaughter et al equations for triceps and subscapular skinfold thickness (SKF), in identifying unfavorable levels of several biomarkers of cardiometabolic risk.

Methods:
Cross-sectional school-based study with 529 apparently healthy adolescents (267 girls), aged 14.3 ± 1.7 years.

Results:
BF% estimated by both methods always showed higher areas under the curve (AUC) for each biomarker in girls than in boys (with the exception of BIA for leptin). BF% estimated by BIA and by SKF presented a discriminatory ability in identifying unfavorable levels in all biomarkers of cardiometabolic risk in girls; however, BF% estimated by BIA displayed the highest AUC (except for C-reactive protein). In boys, BF% estimated by SKF presented higher AUC for C-reactive protein, fibrinogen and erythrocyte sedimentation rate; and BF% estimated by BIA for complement C3 and leptin. Positive and significant associations between BIA and SKF with all biomarkers (P < .05) were found (except for SKF and complement C4 in girls, and SKF and fibrinogen and erythrocyte sedimentation rate in boys), after adjustments for pubertal stage, cardiorespiratory fitness, adherence to the Mediterranean diet and socioeconomic status.

Conclusions:
Overall, diagnostic performance was more accurate in girls. BF% estimated by BIA presented a slightly better overall discriminatory ability for each biomarker than BF% estimated by SKF in girls, while in boys no method clearly prevailed over the other.
The predictive value of age, creatinine, ejection fraction score for in-hospital mortality in patients with cardiogenic shock
Authors: Çinar Tufan , Hayiroğlu Mert İlker , Şeker Mehmet , Doğan Selami , Çiçek Vedat , Öz Ahmet , Uzun Mehmet , Lütfullah Orhan Ahmet 
Published: September 2019

Introduction:
The aim of the present study was to assess the predictive value of the age, creatinine, ejection fraction score for in-hospital mortality in patients with cardiogenic shock secondary to ST-elevation myocardial infarction.

Material and methods:
This single-center, retrospective study was based on a comprehensive analysis of the hospital records of 318 consecutive cardiogenic shock patients. The age, creatinine, ejection fraction score was calculated for each patient using the equation of age/ejection fraction +1 if creatinine level is >2 mg/dl. The study population was stratified into tertiles: T1, T2, and T3, based on the age, creatinine, ejection fraction score. The primary endpoint of the study was the incidence of in-hospital mortality.

Results:
The incidence of in-hospital mortality was significantly greater in patients with a high age, creatinine, ejection fraction score (T3 group) compared with the intermediate (T2 group) or the low score group (T1 group) [86.8% (n = 92 patients) vs. 57.5% (n = 61 patients) vs. 34.9% (n = 37 patients), respectively; P < 0.05 for each]. In multivariable models, after adjusting for all covariables, the risk of in-hospital mortality was 3.21 (95% confidence interval: 2.29–4.58) for patients allocated to the T3 group. The optimal cutoff for the age, creatinine, ejection fraction score for in-hospital mortality was 2.24, with a sensitivity of 74% and a specificity of 77%.

Conclusion:
To the best of our knowledge, this is the first study that has demonstrated a prognostic value of the age, creatinine, ejection fraction score in patients with ST-elevation myocardial infarction-related cardiogenic shock.
Total knee arthroplasty in a patient with ipsilateral hip ankylosis
Authors: Tang XianZhe , Yan ZuYun , Wang Wanchun , Liu Tang 
Published: September 2019

Abstract

Rationale:
There is a large number of people that have knee degeneration in China. Total knee arthroplasty is one of the most effective methods of treatment in the later stages of the disease. However, there are challenges when performing total knee arthroplasty on patients with ipsilateral hip akylosis. So far, there are few reports on postoperative curative effect of total knee arthroplasty for these patients. This case report records how to perform total knee arthroplasty in a patient with ipsilateral hip ankylosis.

Patient concerns:
Due to ankylosing spondylitis, the flexion of the patient's hips are restricted in 10°, which leads to a limited ipsilateral knee flexion to 30° when she is in the supine position.

Diagnoses:
Right knee osteoarthritis; right hip ankylosis.

Interventions:
We modified the traditional surgical position to allow easy exposure of the knee during surgery. After total knee arthroplasty, the patient was included in a planned training program, and was followed for 6 months.

Outcomes:
The patient walked well without ambulation aid and achieved satisfactory knee joint function.

Lessons:
Conversion of a fused hip to a total hip arthroplasty does improve the quality of life of patients, but, given the high incidence of complications and more financial burden to the patient, we modified traditional surgical position of the patient to provide ideal surgical exposure of the knee. We hope that this case can be used as a reference for clinicians to deal with similar situations.
Henoch-Schönlein purpura with intussusception and hematochezia in an adult
Authors: Cui Xiao-Han , Liu Hao , Fu Li , Zhang Chao , Wang Xu-Dong 
Published: September 2019

Abstract

Rationale:
Henoch-Schönlein purpura (HSP) is a common disease in children. However, HSP with intussusception and intestinal obstruction has a low morbidity in children and is occasionally seen in adults. Herein, a rare adult case of HSP complicated with intussusception and hemafecia that was successfully treated with surgery is described.

Patient concerns:
A 19-year-old Chinese man suffered from HSP combined with intussusception and intestinal obstruction and presented with vomiting, diarrhea, abdominal pain, and rash.

Diagnosis:
Henoch-Schönlein purpura with intussusception and intestinal obstruction.

Interventions:
The patient underwent an emergency laparotomy and manual reset.

Outcome:
The patient was discharged 7 days after surgery in stable condition. We followed the patient to the sixth month after surgery. This patient has no long-term complications after surgery.

Lessons:
HSP with intussusception and intestinal obstruction is rarely seen in adults. Patients with HSP often present with abdominal pain as the first symptom, which is easily confused with other diseases. Once the HSP is diagnosed, surgery should be performed as soon as possible, provided there is no absolute contraindication.
Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient
Authors: Schmidt-Lauber Christian , Jacobi Johannes , Polifka Iris , Hilgers Karl F. , Wiesener Michael S. 
Published: September 2019

Abstract

Rationale:
Active tuberculosis constitutes a relevant risk for kidney transplant recipients. In contrast to immunocompetent hosts, kidney transplant recipients often show atypical presentation and course of the disease impeding diagnosis. Especially extrapulmonary or disseminated infection is more frequent and can resemble malignant processes. However, reactivation of tuberculosis mostly develops within the early post-transplant course, whereas malignancies are predominantly long-term complications. We report a case of disseminated abdominal tuberculosis developing 10 years after kidney transplantation and review the underlying literature.

Patient concerns and diagnoses:
A 51-year-old lady presented with epigastric pain, diarrhea, weight loss and night sweats 10 years after deceased-donor kidney transplantation. An epigastric as well as multiple peritoneal masses were found suspicious of a cancer of unknown primary. Colonoscopy revealed a colon tumor with the biopsy showing no dysplasia but histiocytic and granulomatous infiltration with acid-fast bacilli. Mycobacterium tuberculosis was detected in the biopsy and stool and disseminated abdominal tuberculosi was diagnosed.

Interventions and outcomes:
With anti-tuberculosis therapy, the masses regressed, and all cultures became sterile, sparing graft function.

Lessons:
This case emphasizes how variable and unspecific the presentation of tuberculosis in kidney transplant recipients may be and that tuberculosis constitutes a relevant risk also in the long-term post-transplant course.
Improving functional outcome and quality of life for patients with metastatic lesion of acetabulum undergoing cement augmentation
Authors: Yan Taiqiang , Zhao Zhiqing , Tang Xiaodong , Guo Wei , Yang Rongli , Tang Shun , Dong Sen 
Published: September 2019

Abstract
There is an increased enthusiasm in treating osteolytic metastatic acetabulum via injecting polymethyl-methacrylate (PMMA) as a bone filler to provide pain relief and potential structural support. The aim of this respective study is to determine the function and quality of life improvement after cement acetabuloplasty.
Thirty two patients underwent acetabular cement augmentation between May 2014 and March 2018 were respectively reviewed. Isolated percutaneous acetabuloplasty (PA) was performed in 15 patients (group A) while radiofrequency ablation with PA (RFA-PA) in 12 patients (group B). Together with PA, open reconstructive surgery on ipsilateral femur was performed in another 5 cases (group C). Pre- and posttreatment functional evaluation and quality of life (QoL) assessment were carried out.
The average followup duration was 11.5 (range, 3–36) months. None of major complications occurred. 81.2% (26/32) of patients achieved complete pain relief. Reduction of pain intensity and improvement of functional status achieved significantly differences after treatment (P = .00). Significant improvement (P = .00) was observed in scales of global QoL and pain-related restrictions in daily activities. Both isolated PA and RFA-PA procedures were equally effective towards the improvement of function and quality of life (P > .05). Regarding 5 patients in group C, pain intensity decreased when loading the affected limb and they could walk with crutches or cane.
Bone cement acetabuloplasty is an adequate and effective mini-invasive procedure to relieve pain, restore function, and enhance the quality of life of patients for as long as possible in metastatic patients with short life expectancy. Ipsilateral surgery appears to be safe and well tolerated.
Surgery for intra-abdominal abscess due to intestinal perforation caused by toothpick ingestion
Authors: Lim Dae Ro , Kuk Jung Cheol , Kim Taehyung , Shin Eung Jin 
Published: September 2019

Abstract

Rationale:
Failure to pass though the gastrointestinal tract can result in inflammatory response, reactive fibrosis, and intestinal perforation. Fish bones, chicken bones, and toothpicks are the most common types of foreign substances that produce intestinal perforation during ingestion.

Patient concerns:
Case 1: A 49-year-old female was hospitalized with abdominal pain and a fever. The fever lasted for 5 days before hospitalization. Case 2: A 72-year-old male was hospitalized with abdominal pain and fever. The fever lasted for 4 days before hospitalization.

Diagnoses:
Case 1: An abdominal pelvic computed tomography (APCT) scan revealed a large inflammatory mass formation and linear high-density material within the inflammatory mass. The presence of foreign bodies, including acupuncture needles or intrauterine devices was ruled out. Case 2: An APCT scan revealed that there was a small abscess formation measuring about 2.5 cm abutting the abdominal wall and a parasitic infestation was ruled out.

Interventions:
Case 1: An exploratory laparotomy was performed. After removal of the abscess pocket, the sigmoid colon was found to be perforated, and there was a firm, sharp foreign body in the abscess pocket that measured about 5 cm and resembled a toothpick. Case 2: Laparoscopic exploration was then performed. When the abscess was removed from the abdominal wall using a harmony scalpel, a 4 cm foreign body that resembled a toothpick appeared in the abscess pocket.

Outcomes:
The patients recovered well after surgery and were discharged.

Lessons:
Two of the above case reports describe the cases in which the presence of toothpicks was suspected clinically, resulting in the surgery of intra-abdominal abscess caused by intestinal perforations.
Orbital neuroblastoma metastasis
Authors: Yang Wan-Ju , Zhou Yuan-Yuan , Zhao Fang , Mei Zhong-Ming , Li Shuang , Xiang Yi 
Published: September 2019

Abstract

Rationale:
Neuroblastoma is one of the most common tumors found in children, and mostly arises in the adrenal gland and paravertebral regions. Orbital neuroblastoma metastasis is relatively rare, and is associated with poor prognosis. Since the symptoms and signs of orbital neuroblastoma are not specific, its diagnosis remains challenging.

Patient concerns:
A 3-year-old girl presented with periorbital ecchymoses (raccoon eyes) and proptosis for 40 days.

Diagnoses:
Abdominal magnetic resonance imaging (MRI) and sonography analysis revealed a large mass in the left adrenal gland (primary tumor). The computed tomography and MRI further revealed multiple soft tissue masses in the skull and both orbits with erosion of the adjacent bones (the metastasis). The histological analysis of the tumor removed from the right orbit confirmed the diagnosis of neuroblastoma.

Interventions:
The mass on the right face was surgically removed.

Outcomes:
The patient exhibited no deteriorative signs at the 6-month follow-up.

Lessons:
Clinical manifestations, such as periorbital ecchymoses and proptosis, in combination with radiological analysis and histological findings, are important for the diagnosis of orbital neuroblastoma metastasis.
Syphilis and parvovirus B19 co-infection imitating a lupus nephropathy
Authors: Jaunin Eric , Kissling Sebastien , Rotman Samuel , Waeber Gérard , Halfon Matthieu 
Published: September 2019

Abstract

Rationale:
Syphilis can share clinical features with autoimmune diseases, such as cutaneous Lupus or rheumatoid arthritis. Moreover, secondary syphilis can have visceral involvement, thus affecting the kidney. Syphilitic nephropathy causes nephrotic syndrome with a classic membranous pattern. We present a unique presentation of a co-infection by syphilis and parvovirus B19 sharing all the biological and histological features of proliferative lupus nephritis (LN).

Patient concerns:
We present a case of a 71-year-old Caucasian male returning from a trip to Asia presenting with nephrotic syndrome with antinuclear antibodies (ANA) positivity.

Diagnoses:
Because of nephrotic syndrome a kidney biopsy was performed. It demonstrated a membranous nephropathy with extracapillary proliferation and a full house pattern (presence of IgA, IgG, IgM and C1Q deposits) on immunofluorescence (IF), highly suggestive of LN class III and V. However, several atypical clinical features notably the age, sex of the patient and the history of travel prompt us to search for another cause of nephropathy.

Interventions:
A serology was positive for syphilis and a PCR in the renal biopsy was also positive for parvovirus B19. Thus, a co-infection by syphilis and parvovirus B19 was funded to be the cause of the renal lesions.

Outcomes:
The proteinuria improved; a course of antibiotic was administrated because of neurologic syphilitic involvement (presence of headache with positive syphilis serology in the CSF).

Lessons:
A co-infection by syphilis and parvovirus B19 can share all the biological and histological features of proliferative LN and must be recognized as a cause of pseudo-lupus nephritis.
Squamous cell carcinoma of the renal pelvis presenting as an integumentary neoplasm of the flank
Authors: Kim Jung Ryul , Jeong Young Beom , Lee Nae Ho , Wang Sung Il 
Published: September 2019

Abstract

Rationale:
Although chronic pyelonephritis and urolithiasis are established risk factors for squamous cell carcinoma (SCC), only a minority of patients with chronic urolithiasis eventually develop SCC. It is believed that the chronic irritation leads to squamous cell metaplasia that may subsequently develop into SCC. Although studies show that SSC generally spreads locally with associated symptoms of lymphadenopathy, metastasis to the lungs and liver have also been reported. However, cases spreading to the flank have yet to be reported. Therefore, the use of reconstructive techniques for the repair of extensive soft tissue defects in the flank region after extended retroperitoneal resection, is unknown.

Patient concerns:
We report a 54-year-old man who presented with a 1-month history of an enlarged skin mass on the right flank.

Diagnoses:
The patient was subsequently diagnosed with metastatic SCC involving the patient's integumentary system near the flank region proximal to the right kidney following percutaneous nephrostomy.

Interventions:
The skin mass and the surrounding muscle tissue of the right flank were excised with a wide resection margin including radial nephrectomy. The soft tissue defect after resection was reconstructed using a unilateral gluteus maximus myocutaneous V-Y advancement flap.

Outcomes:
No recurrence of the SSC was found on follow-up CT performed 12 months postoperatively.

Lessons:
In patients with long-standing nephrolithiasis complicated by staghorn stone-related infections, biopsies from suspicious lesions detected during percutaneous nephrolithotomy may facilitate early diagnosis. The modified gluteus maximus V-Y advancement flap may be a useful technique for the reconstruction of extensive soft-tissue defects involving the flank region.
Efficacy and safety of different doses of azilsartan medoxomil in patients with hypertension
Authors: Zhang Yan , Yu Huijin , Shao Kangmei , Luo Xinyue , Wang Jiancheng , Chen Gen 
Published: September 2019

Abstract

Background:
Hypertension is one of the most common chronic diseases and an increasingly public-health challenge worldwide. Previous meta-analyses evaluated the effects of azilsartan medoxomil compared to placebo or other antihypertensive drugs in patients with hypertension. However, it is still unclear which dose of azilsartan is optimal. This study will perform a network meta-analysis to assess the efficacy and safety of different doses of azilsartan medoxomil in patients with hypertension.

Methods:
PubMed, EMBASE.com, the Cochrane library, Scopus, and Web of Science were searched from inception to May 2019. Randomized controlled trials reporting efficacy and safety of different doses of azilsartan medoxomil on hypertension will be included if they compared 1 dose of azilsartan medoxomil with another dose of azilsartan medoxomil or with a placebo. Risk of bias of the included trials will be evaluated according to the Cochrane Handbook 5.1.0. NMA will be performed in a Bayesian hierarchical framework using WinBUGS 14.

Results:
The results will be submitted to a peer-reviewed journal for publication.

Conclusion:
This study will summarize all the available data to provide reliable evidence of the value of different doses of azilsartan medoxomil for the treatment of hypertension.

PROSPERO registration number:
CRD42019136882.
Subacute combined degeneration associated with vitamin E deficiency due to small bowel obstruction
Authors: Jung Jong Burm , Kim Yuntae , Oh Kiyoung , Kim Soo A , Doh Joung Hyun , Oh Hye Jeong , Seok Jin Myoung 
Published: September 2019

Abstract

Rationale:
There have been a few reported cases of subacute combined degeneration (SCD) associated with vitamin E deficiency, but the period of intestinal malabsorption was more than several years. We present a rare case of acute onset SCD that occurred in a relatively short period of several weeks with vitamin E deficiency related to small bowel obstruction.

Patient concerns:
A 50-year-old woman had abdominal pain. A small bowel obstruction was suspected and conservative treatment was performed. She underwent bowel surgery after 2 weeks without any improvement. Following the operation, she was in a state of reduced consciousness. She was treated in an intensive care unit. Her consciousness level gradually recovered to alert in a week, but other symptoms such as ataxia, weakness on limbs, severe dysarthria, and dysphagia occurred. Since then, she had spent nearly 6 weeks in a bed-ridden state without improving.

Diagnosis:
SCD associated with vitamin E deficiency was confirmed by laboratory investigations, electrophysiologic test, and whole spine magnetic resonance imaging scans.

Interventions:
For vitamin E supplementation, she was administered a dose of 1200 mg/d. Physical therapy was focused on strengthening exercise, balance, and walker gait training. Occupational therapy was focused on activities of daily living training and dysphagia rehabilitation.

Outcomes:
After 6 weeks, her muscle strengths and functional level were substantially improved. The vitamin E level was recovered to normal range.

Lessons:
This case suggests that if neurological symptoms occur in patients with intestinal obstruction, clinicians need to consider a deficiency of micronutrients such as vitamin E and vitamin B12. Patients with short clinical courses suffer less neurological damage and achieve faster recovery.