bluuebunny/crossref_metadata_2025_split huggingface dataset:
Malignant jejunal gastrointestinal stromal tumor with history of prostate cancer
Authors: Wei Sheng-cai , Li Wan-hu , Xu Liang , Li Wen-wu 
Published: May 2019

Abstract

Rationale:
The problem of the coexistence of gastrointestinal stromal tumor (GIST) with other neoplasms is complex, and carcinomas of prostate is one of the common types of GIST-associated cancers. Doubling time of GIST is about 3.9 months for high-risk GIST, and the treatment paradigm for GIST has required the integration of surgery and molecular therapy.

Patient concerns:
A 70-year-old man with postoperative history of prostate cancer experienced fast-growing malignant jejunal GIST with multiple peritoneal metastases within 1 year.

Diagnoses:
Enhanced computed tomography (CT) detected a neoplasm of small intestine with multiple peritoneal nodules and postoperative pathology confirmed GIST.

Interventions:
Oral imatinib after surgery, at 400 mg per day, was used for 4 years.

Outcomes:
The patient remains well, and the peritoneal nodules located in front of the rectum disappeared gradually.

Lessons:
Physicians should be aware of possibility of GIST in patients with prostate cancer and can perform abdominal examination in these patients. For postoperative patients with prostate cancer, an yearly or half-yearly abdominal and pelvic cavity examination can be performed. Suspicion and timely work-up is necessary in these postoperative prostate cancer patients, especially when they have abdominopelvic pain.
Pregabalin in the reduction of pain and opioid consumption after burn injuries
Authors: Jones Larry M. , Uribe Alberto A. , Coffey Rebecca , Puente Erika G. , Abdel-Rasoul Mahmoud , Murphy Claire V. , Bergese Sergio D. 
Published: May 2019

Abstract

Background:
The primary objective of the study was to evaluate the efficacy of 300 milligrams (mg) and 600 mg of pregabalin compared to placebo in the reduction of pain in patients with noncritical partial and full thickness burn injuries.

Methods:
A prospective, randomized, double-blinded, single center, placebo-controlled trial was conducted. Simple randomization method was used in this trial. After subjects met all the inclusion and none of the exclusion criteria, they were randomized and assigned to 1 of the 3 18-day treatments groups: Pregabalin 300 group, Pregabalin 600 group, or Placebo group. Demographics and clinical characteristics were recorded. The severity of pain was assessed by using the visual analog scale for pain intensity at baseline on day 3, day 9 ± 3, day 25 ± 7, day 90 ± 6, and day 180 ± 12.

Results:
A total of 54 subjects were randomly assigned, and 51 were included in the data analysis. Demographics and clinical characteristics did not differ significantly between the 3 groups. There was a statistically significant difference in pain between the Pregabalin 300 and Pregabalin 600 groups (P-value = .0260). The Pregabalin 300 group had 17.93 units (95% confidence interval: 1.83–34.04) higher pain scores on average than the Pregabalin 600 group, regardless of time. The adjusted P-value comparing 0 to 300 was .1618, while the adjusted P-value for 0 versus 600 was .5304. There was an overall difference in pain across time regardless of study group (P-value = <.0001). An overall difference in opioid consumption (P-value = .0003) and BSHS (P-value = .0013) across time regardless of study group was noted.

Conclusions:
Pregabalin could be part of a promising multimodal analgesic regimen in noncritical burn population. Future placebo-controlled studies assessing the use of pregabalin in burn victim patients may further endorse our findings.
Effective dose of dobutamine in augmenting free flap blood flow during reconstructive surgery of the lower extremity
Authors: Kim Sung-Hoon , Moon Young-Jin , Kim Jae-Won , Hong Jeong-Yeon , Kim Wook-Jong , Hwang Jai-Hyun 
Published: May 2019

Abstract
Success of surgical free flap transfer depends on achieving and maintaining adequate perfusion across the microvascular anastomosis. The purpose of this prospective study was to determine the optimal infusion rate of dobutamine to augment duplex ultrasound measured blood flow to the tissue flap during surgery.
Twenty-one patients undergoing general anesthesia for lower limb reconstructive surgery were recruited. The optimal dobutamine dose was evaluated using the modified Dixon's up-and-down method, starting at 6 μg·kg−1·min−1, and then titrated in increments of 1 μg·kg−1·min−1.
The optimal dose of dobutamine for improving blood flow to the tissue flap was 3.50 ± 0.57 μg·kg−1·min−1 in 50% of patients. The 95% effective dose of dobutamine calculated by probit analysis was 4.46 μg·kg−1·min−1 (95% confidence interval: 3.99–7.00 μg·kg−1·min−1).
The results of our study suggest that a dobutamine infusion rate less than 5 μg·kg−1·min−1provides significant improvement of blood flow to the tissue flap, while minimizing cardiovascular side effects.
The comparison of limited-incision versus standard-incision in treatment of carpal tunnel syndrome
Authors: Li Gaocen , Kong Lingde , Kou Ningzhao , Wang Yanxue , Yu Kunlun , Bai Jiangbo , Tian Dehu 
Published: May 2019

AbstractBackground:Carpal tunnel syndrome is a common compressive neuropathy of the median nerve. Compared with standard release, the efficacy, safety, and postoperative complications of limited carpal tunnel release remain controversial. The purpose of this study was to compare the effects of the 2 treatments.Methods:The English-language literature was searched using MEDLINE, Web of Science, and Embase. Randomized controlled trials that compared standard and limited incision for carpal tunnel release were included in the meta-analysis. Strength, interval to return to activities, the rate of adverse events, effectiveness, and operative time were compared.Results:Thirteen randomized controlled trials (RCTs) containing 1020 patients were included. Limited incision treated patients showed better early recovery of grip strength (mean difference [MD], 4.25 [0.86–7.65];P = .01) and pinch strength (MD, 1.37 [0.24–2.51];P = .02) but no advantage after more than 6 months. Patients treated with limited incision showed an earlier return to activities (MD,−8.80 [−9.21 to −8.39];P < .01) and reduced operative time (standardized mean difference [SMD], −1.68 [−3.24 to−0.12];P = .04). The rate of adverse event was significantly higher in standard group compared with that in limited group (risk ratio [RR] 0.61, 95% CI 0.38–0.96,P = .03).Conclusions:Limited incision release allows us to return to activities early, reduces operative time, decreases rate of adverse events, and improves strength during the early postoperative period. Results at 6 months or longer are similar according to current data. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.
Pyoderma gangrenosum after cesarean section treated with skin graft
Authors: Shen Jinjing , Zhang Weishe , Jiang Xiaoe 
Published: May 2019

Abstract

Rationale:
Pyoderma gangrenosum (PG) is a rare skin disease. Pregnancy is a unique physiological condition. Here we report a rare case of PG after cesarean section.

Patient concerns:
A 32-year-old female presented with wound breakdown 1 day after cesarean section, with progression to a skin ulcer and no response to antibiotic therapy.

Diagnoses:
We experienced a case of PG after cesarean section. This was initially misdiagnosed as a wound infection, with fever and wound redness as clinical manifestations.

Interventions:
The patient was initially treated with antibiotics, followed by glucocorticoid and human immunoglobulin therapy. Wound debridement, vacuum sealing negative pressure drainage, skin grafting, and hyperbaric oxygen therapy were also performed.

Outcomes:
The wound healed without adverse reactions.

Lessons:
When a surgical incision infection does not respond to antibiotic treatment and the culture is negative, PG should be considered.
Effect of dexmedetomidine on postoperative cognitive dysfunction and inflammation in patients after general anaesthesia
Authors: Yang Wan , Kong Ling-Suo , Zhu Xing-Xing , Wang Rui-Xiang , Liu Ying , Chen Lan-Ren 
Published: May 2019

Abstract

Background:
Neuroprotective effects of dexmedetomidine are reported in preclinical and clinical studies but evidence regarding the postoperative neurocognitive function is still unclear. This study performed a meta-analysis on outcomes of studies which examined neurocognitive performance and inflammatory factors to investigate the effects of dexmedetomidine on postoperative cognitive dysfunction (POCD) and inflammation in patients after general anaesthesia.

Methods:
Literatures were searched in several electronic databases and studies were selected by following precise inclusion criteria. We searched PubMed, EMBASE, the Cochrane Library, China Academic Journals full-text database (CNKI), and Google Scholar to find randomized controlled trials (RCTs) of the influence of dexmedetomidine on POCD and inflammation in patients who had undergone general anaesthesia. Two researchers independently screened the literature, extracted data, and evaluated quality of methodology against inclusion and exclusion criteria. Meta-analyses of pooled ORs of POCD incidences and mean differences in neurocognitive assessment scores and inflammation levels were carried out and subgroup analyses were performed. Stata 12.0 was used to conduct our meta-analysis.

Results:
Twenty-six RCTs were included. Compared with controls, perioperative dexmedetomidine treatment significantly reduced the incidence of POCD (pooled ORs = 0.59, 95% confidence interval (CI) 0.45–2.95) and improved Mini-Mental State Examination (MMSE) score (standardized mean difference (SMD) = 1.74, 95% CI 0.43–3.05) on the first postoperative day. Furthermore, perioperative dexmedetomidine treatment significantly decreased IL-6 (SMD = −1.31, 95% CI −1.87–0.75, P < .001) and TNF-α (SMD = −2.14, 95% CI −3.14–1.14, P < .001) compared to saline/comparators treatment. In the stratified analysis by surgical type, age, type of control, and study region, the differences were also significant between dexmedetomidine- and saline-treated patients.

Conclusion:
Perioperative dexmedetomidine treatment is associated with significantly reduced incidence of POCD and inflammation and better neurocognitive function postoperatively in comparison with both saline controls and comparator anaesthetics.
Clinical efficacy of carvedilol treatment for dilated cardiomyopathy
Authors: Li Tao , Yuan Guoliang , Ma Chengbin , Jin Peng , Zhou Changgao , Li Wei 
Published: May 2019

Abstract

Background:
Clinical trials examining the therapeutic benefit of carvedilol on patients with dilated cardiomyopathy have reported inconsistent results. The aim of this study was to evaluate the clinical efficacy of carvedilol on patients with dilated cardiomyopathy.

Methods:
PubMed, Embase, Cochrane Library, web of science, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific and Technological Journal (VIP) databases were searched for randomized controlled trials (RCTs) before March 2018. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used to evaluate the effects of carvedilol on patients with dilated cardiomyopathy.

Results:
Twenty one studies including 1146 participants were included. There were significant improvements on heart rate (HR) (WMD = –14.18, 95% CI: –17.72 to –10.63, P < .001), LVEF (WMD = 7.28, 95% CI: 6.53–8.03, P < .001), SBP (WMD = –10.74, 95% CI: –12.78 to –8.70, P < .001), DBP (WMD = –4.61, 95% CI: –7.32 to –1.90, P = .001), LVEDD (WMD = –2.76, 95% CI: −4.89 to −0.62, P = .011), LVESD (WMD = –3.63, 95% CI: –6.55 to –0.71, P = .015), LVEDV (WMD = –9.30, 95% CI: –11.89 to –6.71, P < .001), LVESV (WMD = –12.28, 95% CI: –14.86 to –9.70, P < .001) under carvedilol treatment compared with control.

Conclusion:
This meta-analysis demonstrates that carvedilol significantly improves cardiac function on patients with dilated cardiomyopathy. Further large scale, high-quality and multicenter RCTs are still required to confirm the impacts of carvedilol on patients with dilated cardiomyopathy.
Diagnosis and treatment of traumatic vascular injury of limbs in military and emergency medicine
Authors: Xu Yichi , Xu Wenjing , Wang Aiyuan , Meng Haoye , Wang Yu , Liu Shuyun , Li Rui , Lu Shibi , Peng Jiang 
Published: May 2019

Abstract

Background:
Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries.

Methods:
To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes.

Results:
Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc).

Conclusion:
We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military (“3 districts and 7 grades” model). Many issues remain to be resolved by further experience and investigation.
Carotid plaque magnetic resonance imaging and recurrent stroke risk
Authors: Deng Fengbin , Hao Xinyu , Tang Zhuoran , Mu Changping , Li Kang , Li Huaqiang 
Published: May 2019

Abstract

Background & Aims:
Carotid atherosclerotic plaque is an important cause of carotid artery stenosis. The features of carotid atherosclerotic plaque detected by relevant magnetic resonance imaging (MRI), such as lipid core, plaque hemorrhage, and fibrous cap rupture, have been confirmed to be associated with the occurrence of the first cerebral ischemic event. Meanwhile, the features of carotid atherosclerotic plaque can be used as biomarkers to predict the occurrence of cerebral ischemic event. However, the mechanism of recurrent stroke is still unclear. A systematic review and meta-analysis will be performed to summarize the association between features of carotid artery plaque detected by MRI and recurrent stroke, so as to find biomarkers that can predict recurrent stroke.

Methods:
Electronic search will be performed in PUBMED, EMBASE, Cochrane Controlled Register of Trials (CENTRAL) from inception to October 30, 2018. We will include cohort studies with an average follow-up time of >1 month in which lipid-rich/necrotic cores (LRNC), intraplaque hemorrhage (IPH), and thinned or ruptured fibrous caps (TRFC) are associated with recurrent ipsilateral stroke or ischemic events. We will perform heterogeneity assessment before carrying out meta-analysis. According to the heterogeneity, we select random effect model or fixed effect model for meta-analysis of the included cohort studies.

Results:
Review Manager 5.3 software will be used to calculate the combined hazard ratio value and 95% confidence interval (CI). This meta-analysis will provide high-quality data analysis of LRNC, IPH, and TRFC and ipsilateral recurrent stroke or ischemic events, including biomarkers as major predictors.

Conclusion:
The systematic review will provide evidence to assess the association between features of carotid plaque and ipsilateral recurrent stroke or ischemic events.

PROSPERO registration number:
PROSPERO CRD42019124043.
Evaluation of changes in choroidal thickness and the choroidal vascularity index after hemodialysis in patients with end-stage renal disease by using swept-source optical coherence tomography
Authors: Shin Yong Un , Lee Sang Eun , Kang Min Ho , Han Sang-Woong , Yi Joo-Hark , Cho Heeyoon 
Published: May 2019

Abstract
To evaluate the effect of hemodialysis on choroidal thickness and the choroidal vascularity index (CVI) in patients with end-stage renal disease (ESRD) by using swept-source optical coherence tomography.
Thirty-two eyes of 32 patients with ESRD undergoing hemodialysis were recruited prospectively. Detailed ophthalmologic examinations and swept-source optical coherence tomography were performed immediately before and after hemodialysis. Choroidal thickness maps were generated automatically by using built-in software. The CVI was calculated using binarized choroidal optical coherence tomography images. Systemic parameters such as body weight and blood pressure were also measured. The changes in systemic and ocular parameters during hemodialysis were evaluated. Subjects were divided into 2 groups (diabetes mellitus [DM] vs non-diabetes mellitus) for subgroup analysis.
Total choroidal thickness showed a significant overall decrease after hemodialysis (−10.9 ± 14.0, P <.001). In the subgroup analysis, total choroidal thickness significantly decreased in both patients with DM (−11.3 ± 13.6, P = .004) and those without (−10.6 ± 14.9, P = .020), but the reduction of choroidal thickness was observed in more subfields in patients with DM than in those without. The CVI did not significantly change after hemodialysis (P = .717). No significant systemic and ocular factors affected the changes in total choroidal thicknesses.
Choroidal thickness significantly decreased after hemodialysis in most subfields regardless of the presence of DM. Peri-hemodialysis choroidal changes could be considered in the management of patients with ESRD. Swept-source optical coherence tomography can provide ample and reliable quantitative data for monitoring ocular hemodynamic changes.
Treatment of myoclonic-atonic epilepsy caused by SLC2A1 de novo mutation with ketogenic diet
Authors: Wei Zihan , Wang Luojun , Deng Yanchun 
Published: May 2019

Abstract

Rationale:
The SLC2A1 gene encodes glucose transporter 1 on blood–brain barrier, which plays an important role in the energy supply for neurons. Mutations in SLC2A1 gene can cause many clinical syndromes, including glucose transporter type 1 deficiency syndrome and many types of epilepsy syndromes such as childhood absence epilepsy and myoclonic-atonic epilepsy, etc. Ketogenic diet has been proved to be very effective on those cases. Clinically, SLC2A1 gene mutations are quite rare.

Patient concerns:
Repeated unconsciousness and bilateral limb weakness lasted for 3 years.

Diagnoses:
Myoclonic-atonic epilepsy.

Lessons:
After taking whole exome sequencing, we found out that there is a de novo insertion mutation in the patient's SLC2A1 gene, leading to frameshift. As a result, ketogenic diet (2:1, 4 times a day) was used as the treatment. As for the patient, total calories intake per day was controlled at 1190 kcal. The calories per kg per day were 66.11 kcal/kg. The amount of ketone bodies was controlled at 2 to 3 mmol/L and the concentration of plasma glucose was controlled at 4 to 5 mmol/L.

Outcomes:
After the launch of ketogenic diet, the patient has been seizure free for nearly a year and stopped all his antiepileptic drugs.

Conclusion:
Our case suggests that gene examination is very important part of the diagnosis of epilepsy etiology and epilepsy syndromes. Ketogenic diet should be considered as the first line therapy with SLC2A1 gene mutations.
Foveal choroidal neovascularization secondary to accidental laser exposure in a dermatologist
Authors: Lee You Hyun , Kim Yu Cheol 
Published: May 2019

Abstract

Rationale:
Most laser-induced retinal injuries are caused by accidental laser discharge during the preparation of laser devices without protective goggles, laser injury during the cosmetic procedure in a dermatologist, is very rare, with no prior case reports.

Patient concerns:
A 55-year-old Asian male dermatologist visited our hospital with a 2-week history of visual disturbance in his right eye. He had experienced sudden central scotoma in the right eye while using a Q-switched Nd:YAG laser (1064 nm, 2 J/cm2, 6-mm spot size, 750 ps) 2 to 3 cm from the target without proper eye protection. He had applied a glass slide firmly onto the treatment area prior to commencing the procedure. The choroidal neovascularization (CNV) was detected via optical coherence tomography angiography (OCTA) 2 weeks after the laser injury.

Diagnosis:
Foveal CNV secondary to laser energy reflected from the glass slide.

Intervention:
Intravitreal bevacizumab (1.25 mg/0.05 mL) injection was performed.

Outcomes:
Regression of CNV was observed.

Lessons:
Retinal injury can occur not only by direct laser beam exposure but also by way of a beam reflected from a glass slide. Operators should always use laser safety eyewear during cosmetic procedures involving laser devices, so as to prevent the occurrence of ocular complications. Thorough short-term follow-up with OCTA is recommended for the prompt detection of CNV in cases of retinal laser injury.
Parallel transverse uterine incisions combined with cell salvage minimized bleeding in a patient with pernicious placenta previa and an unexplained decrease in hemoglobin after transfusion of allogeneic red blood cells
Authors: Ma Yushan , You Yong , Jiang Xiaoqin , Lin Xuemei , Chen Yan 
Published: May 2019

Abstract

Rationale:
The incidence of pernicious placenta previa (PPP) and placenta accreta (PA) is increasing in China. Excessive blood loss in these women is an important cause of maternal death and emergency hysterectomy. Performing a traditional cesarean section (CS) in women with PPP is stressful for obstetricians because avoiding cutting the placenta is difficult. As a result, sudden life-threatening bleeding may be encountered. Therefore, there is an urgent need to establish a novel operative method for PPP and PA that is safe for both the mother and neonate, and less stressful for the surgeon.

Patient concerns:
We report an extremely rare case of PPP and PA complicated with anemia and an unexplained decrease in the hemoglobin (Hb) levels after transfusion of 3 units of allogeneic red blood cells.

Diagnoses:
The patient was diagnosed with unexplained anemia, and hemolysis resulting from donor red blood cell transfusion was suspected preoperatively.

Interventions:
To minimize blood loss for safety, a new operative technique, parallel transverse uterine incisions (PTUI) in CS (PTUI CS), was used under general anesthesia in this case. Inhaled volatile sevoflurane was used for uterine relaxation during PTUI. Cell salvage was also used.

Outcomes:
PTUI CS combined with cell salvage effectively reduced bleeding and preserved the uterus in our patient. Sevoflurane was effective for uterine relaxation during PTUI CS.

Lessons:
If PPP and PA are suspected, placental magnetic resonance imaging is recommended for definitively determining whether a transverse fundal incision can be made. If feasible, we strongly recommend that PTUI CS combined with cell salvage are used to minimize bleeding for high-risk patients with PPP and PA complicated with anemia and an unexplained decrease in Hb levels after transfusion of 3 units of allogeneic red blood cells. Anesthesiologists should be vigilant to maintain uterine relaxation from the time of delivery of the neonate to a second transverse incision in the lower segment of the uterus. This is a key element of successful PTUI CS. Additionally, the use of intraoperative cell salvage is recommended when it can be expected to reduce the likelihood of donor red cell transfusion.