bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary extra-nodal non-Hodgkin lymphoma in buttock soft tissue
Authors: Li Xiang Meng , Zhang Hai Song , Dai Xiao Li , Shi Jian Hong 
Published: December 2018

Abstract

Rationale:
Primary extra-nodal non-Hodgkin lymphoma (PE-NHL) arising in the region of the buttocks is rare. After reviewing the literature from the last 20 years, we found only 3 reported lymphomas originating from soft tissue of the buttocks. In our case, positron emission tomography/computed tomography (PET/CT) was performed for the first time, both before and after treatment, to determine the initial stage of PE-NHL and the curative effects of treatment.

Patient concerns:
We report the case of a 71-year-old woman who was admitted to our hospital due to pain, skin redness, rising skin temperature, and swelling in the right hip.

Diagnoses:
After an initial misdiagnosis of local infection, a histological examination and PET/CT were performed which revealed evidence of non-Hodgkin marginal zone B cell lymphoma of Ann Arbor stage II.

Interventions:
Following unsuccessful treatment with cephalosporin, the patient was successfully treated with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.

Outcomes:
Comparison of the PET/CT scans taken before and after treatment showed that the lesion size had decreased, as had the fluorodeoxyglucose (FDG) uptake seen in the subcutaneous tissue of the right buttock with standardized uptake value max (SUVmax) 11.6 versus 2.5, respectively. Subsequently, no relapse or distant metastasis has been detected.

Lessons:
Young doctors should suspect PE-NHL in similar cases. PET/CT is valuable in the diagnosis and treatment of PE-NHL, as well as for accurately determining PE-NHL stage and aggressiveness.
Impact of healthcare reform on the payer mix among young adult emergency department utilizers across the United States (2005–2015)
Authors: Bush Haley , Gerber Lynn H. , Stepanova Maria , Escheik Carey , Younossi Zobair M. 
Published: December 2018

Abstract
Before the patient protection and affordable care act (ACA), young adults (20 to 34) had the highest uninsured rates in the United States (US) and frequently sought care in emergency departments (EDs).
We aimed to determine if there was a measurable effect of expanded coverage, specifically the dependent coverage provision and Medicaid expansion, on the payer mix of young adults in EDs.
We performed a retrospective cross-sectional study of ED utilization among young adults across the US using the national hospital ambulatory medical care survey (NHAMCS) (2005–2015).
We examined the effect of health reform changes on the prevalence and odds of having an insurance type among ED utilizers (19–30) in 3 time periods (2005–2010), (2011–2013), and (2014–2015). Additionally, we compared the national and ED payer mix proportions among 19 to 25 and 26 to 30-year-olds.
Our results indicate significant proportional changes in the national and ED payer mix relative to a pre-ACA time period. The 2 greatest changes to the national payer mix were the reduction in the proportion of uninsured/self-payers and the increase in the proportion covered by Medicaid. Furthermore, the dependent coverage provision was effective in increasing the proportion of those (19–25) utilizing private insurance coverage. Lastly, there is now a lower proportion of uninsured young adults in the ED, and an increased proportion of those covered by Medicaid.
The change in payer mix among young adults has potential long-term consequences for the provision of emergency department services in the U.S.
Thoracic endovascular repair technique for the treatment of patent ductus arteriosus in an elderly patient
Authors: Kim Jung Hee , Baek Jong Hyun 
Published: December 2018

Abstract

Rationale:
Patent ductus arteriosus (PDA) ligation by open surgery is more difficult and dangerous in elderly patients than in infants. Nowadays, simple and safe interventional catheterization technology is used for the closure of uncomplicated isolated PDAs. Therefore, an alternative less invasive therapeutic option must be developed to treat complicated PDA.

Patient concerns:
A 53-year-old woman presented with gradually exacerbated dyspnea on effort and continuous cardiac murmurs.

Diagnosis:
Transthoracic echocardiography (TTE) and contrast-enhanced 3D computed tomography (CT) were performed and revealed a conically shaped large PDA with calcification.

Interventions:
We used a nontouch exclusion technique with thoracic endovascular repair (TEVAR) for the treatment of this rare complicated PDA. The patient had an adequate proximal landing zone, and a tapered stent graft (S&G, Bio 34–30 mm × 110 mm, Korea) was used.

Outcomes:
Aortography after stent graft implantation revealed complete occlusion of PDA and no endoleaks. The procedure was successful, and the patient showed no vascular or other complications during follow-up.

Lessons:
TEVAR is a less invasive solution for pathologies of the thoracic aorta, such as aortic dissection or aneurysm. TEVAR is an established, simple, and safe method for repairing the thoracic aorta and can be a new alternative to other transcatheter techniques for complicated PDAs in elderly patients.
Anti-TIF1γ antibody predicted malignancy of thymic tumor with dermatomyositis as an “autoimmune tumor marker”
Authors: Karino Kohei , Fujieda Yuichiro , Kawamura Takuya , Abe Nobuya , Shimoyama Shuhei , Kono Michihito , Kato Masaru , Yasuda Shinsuke , Atsumi Tatsuya 
Published: December 2018

Abstract

Rationale:
An association between inflammatory myopathy and malignancy has been recognized particularly in patients positive for anti-transcription intermediary factor 1γ (TIF1γ) antibody. We report a case of anti-TIF1γ antibody positive dermatomyositis (DM) associated with thymic carcinoma which radiographically mimicked benign tumor.

Patient concerns:
A 72-year-old man presented typical characteristic cutaneous manifestations and proximal muscle weakness with elevated levels of myogenic enzymes. An anterior mediastinal tumor was detected by computed tomography (CT) scan and radiographically assessed to be benign with distinct borders and little enhancement.

Diagnoses:
DM with anti-TIF1γ antibody and thymic carcinoma.

Interventions:
Thymic carcinoma was completely resected by surgery. DM was induced into remission with glucocorticoid treatment.

Outcomes:
The serum level of myogenic enzyme remained within normal range under low-dose glucocorticoid maintenance. No evidence of carcinoma recurrence with CT scan was observed at 1-year follow up.

Lessons:
The present case indicated that anti-TIF1γ antibody would play a role as the “autoimmune tumor marker” in patients with inflammatory myopathy.
Incidence and clinical features of patients with peritoneal dialysis peritonitis complicated by bacteremia
Authors: Tsai Chang-Chih , Hsu Chien-Chin , Chen Kuo-Tai 
Published: December 2018

Abstract
The standard treatment of peritoneal dialysis peritonitis (PD peritonitis) is intraperitoneal antibiotic therapy. In patients with PD peritonitis complicated by bacteremia, intraperitoneal antibiotics combined with elective removal of the infected intraperitoneal catheter may be inadequate.
We collected data of all patients with PD peritonitis admitted to Chi-Mei Medical Center during a 4-year period. We reviewed the medical records of the study cohort and collected their in-hospital details. Patients with positive blood culture results were assigned to the bacteremia group, whereas those with negative blood culture results were assigned to the peritonitis-only group.
We discovered that 11.0% of patients with PD peritonitis had bacteremia complications, and immunocompromised comorbidities were more common in the bacteremia group than in the peritonitis-only group (66.7% vs 37.2%, P = .022). Additionally, the bacteremia group exhibited higher temperatures, greater respiratory rates, and lower serum sodium levels than the peritonitis-only group (temperature, 37.7 vs 37.2 °C, P = .014; respiratory rate, 19.1 vs 17.9 rate/min, P = .008; serum sodium level, 130.3 vs 132.7 mEq/L, P = .031). No mortality was found in patients with PD peritonitis complicated by bacteremia after intravenous and intraperitoneal antibiotic therapy.
More than 1 in 10 patients with PD peritonitis was complicated by bacteremia, which resulted in extensive systemic derangements. Patients with immunocompromised comorbidities carried a higher risk of developing bacteremia, resulting in prolonged hospital stays. Combination of intraperitoneal and intravenous antibiotics therapies achieved fair prognoses in patients with PD peritonitis complicated by bacteremia.
Laparoscopic transabdominal preperitoneal technique versus open surgery with the ULTRAPRO Hernia System for the repair of female primary femoral hernias—an observational retrospective study
Authors: Chen Dongfeng , Su Nana , Wang Weijia , Zhang Zhaoyong , Guo Mingxiao , Lu Chunlei , Zhang Haifeng 
Published: December 2018

Abstract
Femoral hernias (FHs), predominantly seen in females, require surgery for cure. To date, surgical repair of primary FHs in female patients with either open surgery or laparoscopic operation has been poorly documented. We retrospectively investigated the treatment of female primary FHs with open surgery using the ULTRAPRO Hernia System (UHS procedure) or the laparoscopic procedure, namely, the transabdominal preperitoneal (TAPP) technique. A total of 41 female patients with primary FHs who had undergone UHS or TAPP were included in this study. The procedural parameters, post-surgical complications, treatment expense, and follow-up results were analyzed. The vast majority of patients (39/41) underwent elective operations: 15 received UHS (including 2 emergency cases) and 26 had TAPP (P = .08). The UHS group had a greater average age, due to the fact that FHs occur often in people with advanced age who tend to have systemic disease, limiting the use of general anesthesia required for TAPP. Compared with UHS, TAPP took a significantly shorter time to complete and patients undergoing TAPP had a dramatically shorter hospital stay. While no recurrence was observed in both groups, post-procedure pain and foreign body sensation were reported by significantly more patients in UHS group. The cost was greater with TAPP. Taken together, we concluded that both UHS and TAPP are effective in the management of female FHs. In view of the advantages and disadvantages between the open and the laparoscopic operation, surgeons can select a procedure according to their skills and patients’ situation.
UGT1A1 genotypes and unconjugated hyperbilirubinemia phenotypes in post-neonatal Chinese children
Authors: Abuduxikuer Kuerbanjiang , Fang Ling-Juan , Li Li-Ting , Gong Jing-Yu , Wang Jian-She 
Published: December 2018

Abstract
To retrospectively analyze and quantitatively correlate UGT1A1 (bilirubin UDP- glucuronosyltransferase gene) genotypes and unconjugated hyperbilirubinemia (UCH) phenotypes among Chinese children.
We retrospectively reviewed UCH patients, quantitatively analyzed genotype–phenotype correlation by comparing with healthy controls. Pfam database, SWISS-model, and Pymol were used for UGT1A1 protein domain analysis and protein modeling for assessing the effect of novel missense variants on protein structure.
Seventy four cases, including 21 prolonged unconjugated hyperbilirubinemia (PUCH), 30 Gilbert syndrome (GS), 22 Crigler-Najjar syndrome type II (CNS-II), and 1 Crigler-Najjar syndrome type I (CNS-I) phenotypes were analyzed. Total of 21 variants, including 7 novel variants (c.764T>A/p.L255Q, c.1112C>T/p.T371I, c.1028C>A/p.S343X, c.1047delG/p.I350YfsX16, c.996 + 5G>C/g.6923G>C, c.287G>A/p.G96E, and c.1142G>A/p.S381N) were found. In the multiple regression model, heterozygous A(TA)7TAA, G71R/P364L, and Y486D/other mutations were significantly associated with increased risk of GS, PUCH, and CNS-II, respectively. Total allele number is significantly associated with GS and CNS-II, with each increase in total allele number, the odds ratio (OR) of having GS and CNS-II increased by 1.46 and 4.47 fold, respectively. Having only functional polymorphisms in UGT1A1 gene is associated with increased risk of PUCH, and GS with OR values of 5.67 (95% CI: 1.52–21.13), and 3.88 (95% CI: 1.02–14.78), respectively. Having only mutation is associated with significantly increased risk of having GS phenotype (OR: 34.00, 95% CI: 4.65–248.37), but not CNS-II. Polymorphism plus mutation had the strongest association with CNS-II with OR value of 64.80 (95% CI: 7.68–546.41), followed by GS (OR: 4.53, 95% CI: 1.08–19.08).
We detected 7 novel variants, and quantitatively calculated risks of having specific phenotypes using genetic data. Among Chinese children, G71R and P364L is independently associated with PUCH, A(TA)7TAA is associated with GS, and Y486D or other disease-causing mutations were associated with CNS-II. Multiple alleles were associated with more severe phenotypes. Combined variant of G71R+Y486D is a common occurrence among Chinese children with UCH.
Pulmonary embolism caused by myasthenia gravis
Authors: Lin Shan , Wang Yan , Guan Wei , Shi Yingqing 
Published: December 2018

Abstract

Rationale:
Pulmonary embolism (PE) is a relatively common disease; however, myasthenia gravis leading to PE has been rarely reported in the literature. We report a case of PE in a patient with myasthenia gravis and discuss the possible mechanism underlying the development of PE. We hypothesize that inflammatory mediators may lead to endothelial injury, resulting in PE or deep venous thrombosis (DVT) in patients with myasthenia gravis.

Patient concerns:
A 45-year-old woman had a 9-year history of myasthenia gravis. She was receiving neostigmine bromide for symptomatic relief and had never been on immunosuppressive therapy.

Diagnoses:
Myasthenia gravis and pulmonary embolism.

Interventions:
Our patient was treated with low-molecular-weight heparin immediately after hospital admission. Thrombolytic therapy was later initiated as her condition deteriorated.

Outcomes:
After 2 weeks, the pulmonary artery systolic pressure on echocardiography reduced to 60 mm Hg, and venous ultrasonography showed no evidence of DVT. Her computed tomography pulmonary angiogram revealed a mural thrombus in both the main pulmonary arteries. She refused to undergo immunosuppressive therapy; hence, she was discharged on neostigmine bromide and warfarin. There was no recurrence of PE or DVT at 3- and 6-month follow-ups.

Lessons:
Patients with an autoimmune-mediated disease may have an increased risk of DVT and PE. We hypothesize that the risk may increase in the absence of immunosuppressive therapy. Hence, anticoagulant therapy may be administered early to reduce mortality from acute PE.
Retrospective observational study of micro-monovision small incision lenticule extraction (SMILE) for the correction of presbyopia and myopia
Authors: Kim Jung Sub , Ra Ho , Rho Chang Rae 
Published: December 2018

Abstract
This study was aimed to evaluate refractive and visual outcomes after micro-monovision small incision lenticule extraction (SMILE) in patients with presbyopia and myopia. In total, 72 patients (144 eyes) with a mean age of 46.0 ± 4.9 years were included in this study. The dominant eye was treated for distance vision and the nondominant eye for near vision by targeting between −0.50 and −1.75 diopters (D). Treatment efficacy, safety, and refractive stability were calculated from postoperative data including refraction, binocular uncorrected distance visual acuity (UDVA), binocular uncorrected near visual acuity, monocular uncorrected distance visual acuity, and monocular corrected distance visual acuity (CDVA). Six months post-surgery, binocular UDVA was better than or equal to 20/20 in 88% of patients. No loss in 2 or more lines was observed in the Snellen lines of corrected distance visual acuity. Mean spherical equivalent (SE) for the distance eye was −0.18 ± 0.37 D, whereas the attempted and achieved SE in the near eye were −0.90 ± 0.44 and −0.99 ± 0.54 D, respectively. In total, 79% of eyes were within ±0.50 D, and 98% within ±1.00 D, of the intended refraction. A UDVA of 0.0 logMAR (20/20) or better, and an uncorrected near visual acuity of Jaeger (J) of 3 (20/32) or better, were observed in 83% of patients. Micromonovision refractive surgery using SMILE enhanced functional near vision in presbyopic patients.
Ambient air pollution in gastrointestinal endoscopy unit; rationale and design of a prospective study
Authors: Bang Chang Seok , Lee Keunwook , Choi Jae Ho , Soh Jae Seung , Hong Ji Young , Baik Gwang Ho , Kim Dong Joon 
Published: December 2018

Abstract

Background:
A gastrointestinal endoscopy unit is frequently exposed to gastrointestinal gas expelled from patients and electrocoagulated tissue through carbonation for the treatment of gastrointestinal neoplasms or hemostasis of gastrointestinal bleeding. This can be potentially harmful to the health of not only the healthcare personnel but also patients who undergo endoscopic examinations. However, there has been scarce data on air quality in the endoscopy unit. This study aimed to measure the air quality in the gastrointestinal endoscopy unit.

Methods:
This is a prospective study using conventional portable passive air quality monitoring sensors in the gastrointestinal endoscopy unit. We will check the 6 main indoor air quality indices, as well as the atmospheric temperature, pressure, and humidity in the endoscopy unit of a single hospital in Korea. These indices are as follows: carbon dioxide (CO2), total volatile organic compounds (VOCs), particulate matter that has a diameter of <2.5 μm, nitrogen dioxide (NO2), carbon monoxide (CO), and ozone. The indices will be checked in the endoscopy unit, including the procedural area, recovery area, and area for disinfection and cleansing of equipment, at 1-minute intervals for at least 1 week, and the type and number of endoscopic procedures will also be recorded. The primary outcome of this study is to determine whether the air quality indices exceed safety thresholds and whether there is any association between ambient air pollution and the type and number of endoscopic procedures.

Conclusion:
The results of this study will provide evidence for health-related protective strategies for medical practitioners and patients in the endoscopy unit.
Risk Factors for Early Disenrollment From Colorado’s Affordable Care Act Marketplace
Authors: Gordon Sarah H. , Sommers Benjamin D. , Wilson Ira B. , Galarraga Omar , Trivedi Amal N. 
Published: December 2018

Background:
Midyear disenrollment from Marketplace coverage may have detrimental effects on continuity of care and risk pool stability of individual health insurance markets.

Objective:
The main objective of this study was to assess associations between insurance plan characteristics, individual and area-level demographics, and disenrollment from Marketplace coverage.

Data:
All payer claims data from individual market enrollees, 2014–2016.

Study Design:
We estimated Cox proportional hazards models to assess the relationship between plan actuarial value and Marketplace enrollment. The primary outcome was disenrollment from Marketplace coverage before the end of the year. We also calculated the proportion of enrollees who transitioned to other coverage after leaving the Marketplace, and identified demographic and area-level factors associated with early disenrollment. Finally, we compared monthly utilization rates between those who disenrolled early and those who maintained coverage.

Results:
Nearly 1 in 4 Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollment was 30% lower for individuals in plans receiving cost-sharing reductions and 21% lower for those enrolled in gold plans, compared with silver plans without cost-sharing subsidies. Young adults had a 70% increased hazard of disenrollment compared with older adults. Those who disenrolled midyear had greater hospital and emergency department utilization before disenrollment compared with those who maintained continuous coverage.

Conclusions:
Plan generosity is significantly associated with lower disenrollment rates from Marketplace coverage. Reducing churning in Affordable Care Act Marketplaces may improve continuity of care and insurers’ ability to accurately forecast the health care costs of their enrollees.
Cognitive Impairment in Zambians With HIV Infection and Pulmonary Tuberculosis
Authors: Hestad Knut A. , Chinyama Jonathan , Anitha Menon J. , Ngoma Mary S. , McCutchan J. Allen , Franklin Donald R. , Heaton Robert K. 
Published: December 2018

Background:
HIV infection may result in neurocognitive deficits, but the effects of pulmonary tuberculosis (TB+), a common comorbid condition in HIV infection, on cognition in HIV infections are unknown. Accordingly, we examined the effects of TB+, on neurocognitive functioning in HIV-infected (HIV+) Zambian adults.

Setting:
All participants were drawn from HIV clinics in and around Lusaka, the capital of Zambia.

Methods:
Participants were 275 HIV+, of whom 237 were HIV+ and TB-negative (HIV+/TB−), and 38 also had pulmonary TB+ (HIV+/TB+). Controls were 324 HIV- and TB-uninfected (HIV−) healthy controls. All HIV+ participants were prescribed combination antiretroviral treatment (cART). Published, demographically corrected Zambian neuropsychological norms were used to correct for effects of age, education, sex, and urban/rural residence.

Results:
Neuropsychological deficits, assessed by global deficit scores, were more prevalent in this order: 14% (46 of 324) of HIV− controls, 34% (80 of 237) of HIV+/TB−, and 55% (21 of 38) of HIV+/TB+ group. Thus, both HIV-infected groups evidenced more impairment than HIV− controls, and the HIV+/TB+ group had a higher rate of neurocognitive impairment than the HIV+/TB− group. HIV+/TB+ patients were more likely to be male, younger, less-educated, and have lower CD4 counts and detectable HIV RNA in blood compared with the HIV+/TB− patients.

Conclusions:
In HIV infection, TB may contribute to cognitive impairment, even after controlling for lower CD4 counts and viral load. Thus, systemic inflammation from HIV and TB and more advanced immune deficiency at diagnosis of HIV may contribute to impaired cognition in HIV+/TB+ patients.