bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hazardous Air Pollutants and Adverse Birth Outcomes in Portland, OR
Authors: Willis Mary , Hystad Perry 
Published: January 2019

Background:
The impact of multiple hazardous air pollutant (HAP) exposures during pregnancy on adverse birth outcomes is unknown. We examined associations between cumulative and individual HAP exposures and adverse birth outcomes in Portland, OR, a region that has exceeded HAP air quality guidelines for decades.

Methods:
We used vital statistics records in the Portland Metropolitan Region from 2000 to 2014 (n = 279,051 births). Prenatal exposure to 19 HAPs was assessed using a dispersion model applied to maternal residential address at delivery. We used linear and logistic multivariate regression models to assess associations between individual and cumulative HAP exposures and preterm term (PTB), term birth weight (TBW), and small for gestational age (SGA), adjusting for several potential individual and neighborhood confounding factors.

Results:
We observed no associations for composite HAP exposure metrics and adverse birth outcomes. Associations were observed in fully adjusted models comparing the highest to lowest quintiles of exposure for certain HAPs including chromium VI and TBW (−12.70; 95% confidence interval [CI]: −23.10, −2.31); 1,3-butadiene and TBW (−16.86; 95% CI: −29.66, −4.06) and SGA (1.18; 95% CI: 1.07, 1.30); and cadmium and TBW (−31.37; 95% CI: −56.20, −.54). For some HAP metrics, we observed higher HAP exposures for minority groups and large unadjusted associations between other HAPs and adverse birth outcomes, but most associations were attenuated in adjusted models.

Conclusions:
Adverse birth outcomes were not consistently associated with most HAP exposures in Portland, OR, although some specific air toxic exposures warrant further attention.
Falsely elevated thyroglobulin and calcitonin due to rheumatoid factor in non-relapsing thyroid carcinoma
Authors: Lupoli Gelsy Arianna , Barba Livia , Liotti Antonietta , La Civita Evelina , Lupoli Roberta , Riccio Enrico , Portella Giuseppe , Formisano Pietro , Beguinot Francesco , Terracciano Daniela 
Published: January 2019

Abstract

Rationale:
Thyroglobulin (Tg) is an accurate indicator of clinical outcome after total thyroidectomy in patients with differentiated thyroid carcinoma. Usually, Tg levels agree with whole body scan. However, in some patient, discordant results were found, often because of Tg immunoassay interference. Several reports indicated that 2-site immunoassay interference with heterophile antibodies (HAb) can lead to misinterpretation of the laboratory test result.

Patient concerns:
We report a case of a 46-year-old woman referred to our endocrine clinic for markedly increased calcitonin (CT) without the associated clinical picture. The measurement was repeated with the same patient sample on a different analytical platform and the result was an undetectable CT level. The measurement of Tg was repeated on 3 different analytical platforms using chemiluminescence and electrochemiluminescence immunoassays and the results were different on each platform. HAb blocking tubes resulted in a different level of both CT and Tg, suggesting the presence of a heterophile substance in the serum sample. Further characterization showed reactivity to several animal species antibodies and an elevated level of the rheumatoid factor (RF).

Diagnoses:
She was diagnosed as papillary thyroid carcinoma.

Interventions:
She had undergone thyroidectomy with lymph node dissection and radioactive therapy.

Outcomes:
She was found not to have recurrence despite a high serum Tg level.

Lessons:
Our report illustrates a rare case of falsely elevated tumor markers levels due to assay interference caused by RF. This finding pointed out the importance of close communication between the clinician and laboratory staff in order to bring to light discordance between laboratory test results and clinical picture and avoid unnecessary diagnostic procedures and overtreatment.
Hepatoid adenocarcinoma in the peritoneal cavity
Authors: Chen Xiao , Li Anqin , Wang Qiuxia , Shen Yaqi , Li Zhen , Peng Jian , Hu Daoyu 
Published: January 2019

Abstract

Rationale:
Hepatoid adenocarcinoma (HAC) is a rare extrahepatic adenocarcinoma that histologically resembles hepatocellular carcinoma (HCC). HAC of peritoneal cavity can present as a solitary mass or disseminated nodules indicating different treatment.

Patient concerns:
In this study, we present the cases of a 29-year-old man and a 64-year-old woman who suffered from HAC.

Diagnosis:
The serum alpha-fetoprotein (AFP) of both patients and ascites of 1 patient were markedly elevated. One patient presented with multiple nodular disseminated in the peritoneal cavity and the other patient has a mass between the left diaphragm and the spleen on computed tomography and magnetic resonance imaging.

Intervention:
The first patient underwent laparoscopic examination and multiple nodules were found in the peritoneal cavity, and only received chemotherapy. The second patient underwent surgery and resected the mass between left diaphragm and the spleen.

Outcome:
Histological examinations showed the nodule of the peritoneal cavity and mass belong to moderately differentiated HCC. HAC has a poor prognosis, but the 2 patients responded well to treatment.

Lesson:
HAC is frequently associated with elevated serum AFP without neoplasm in the liver. Histological and Immunohistochemistry examinations can help differential diagnosis.
Pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, with dysphagia as initial symptom
Authors: Grudzińska Ewa , Pilch-Kowalczyk Joanna , Kuśnierz Katarzyna 
Published: January 2019

Abstract

Rationale:
Pancreaticopleural and pancreaticomediastinal fistulas are rare complications of pancreatitis. They are often misdiagnosed and there are no strict guidelines of treatment. In this study, we present a brief report of a combined pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, causing dysphagia and cervical swelling as initial symptoms.

Patient concerns:
A 36-year-old female with history of alcohol abuse and pancreatitis presented progressing dysphagia and mild dyspnea on admission.

Diagnosis:
Chest X-ray and chest and abdominal computed tomography scan (CT) indicated pancreaticopleural fistula combined with pancreaticomediastinal fistula, a diagnosis confirmed by high amylase levels in pleural fluid.

Interventions:
Conservative treatment was administered and ERCP was performed but pancreatic duct stenting was impossible. The patient presented rapid anterior cervical swelling with progressing dysphagia and dyspnea. CT showed fistula penetration to the cervical region. The patient underwent urgent surgery and pancreaticojejunal anastomosis was performed.

Outcomes:
The surgery led to recovery. Six months later, the patient reported good health and weight gain.

Lessons:
Coexistence of pancreaticopleural and pancreaticomediastinal fistula with cervical penetration is an extremely rare pancreatitis complication. It presents with dysphagia and anterior cervical swelling as initial symptoms. It is important to consider this complication in all patients with history of pancreatitis, presenting with dysphagia.
Ramsay Hunt syndrome with pontine lesion
Authors: Ji Ye , Ma Guo-Mei , Kang Zhi-Lei , Zhang Yi , Han Jing-Zhe , Li Jin , Wu Dan-Dan , Wang Jia 
Published: January 2019

Abstract

Rationale:
The coexistence of Ramsay Hunt syndrome (RHS) and varicella-zoster virus (VZV) encephalitis is rare. A patient who developed RHS after being infected with VZV, along with a pontine lesion, is reported in the present study.

Patient concerns:
A 41-year-old male patient presented with his mouth askew for 7 days, and dizziness, accompanied by hearing loss for 3 days.

Diagnoses:
The patient was initially diagnosed with RHS. Brainstem encephalitis was confirmed by lumbar puncture and cerebrospinal fluid. Brain magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) revealed how VZV entered the intracranial space along the vestibulocochlear nerve and facial nerve in the acute period.

Interventions:
Intravenous acyclovir, IV, immunoglobulins (IVIg) and methylprednisolone were administered.

Outcomes:
The herpes was cleared up and left facial nerve palsy was improved, but hearing loss in the left ear did not improve.

Lessons:
An MRI was necessary for some VZV infections limited to the cranial nerve, although there was no evidence of brain stem injury. DWI provided evidence, showing how VZV entered the brain in the early stage. This allowed the doctor to judge the necessity of a lumbar puncture.
The role of the phosphatase and tensin homolog status in predicting pathological complete response to neoadjuvant anti-HER2 therapies in HER2-positive primary breast cancer
Authors: Zhang Chi , Guo Ying , Li Jiyu , Tian Xingsong , Duan Xuening 
Published: January 2019

Abstract

Purpose:
The addition of anti-HER2 therapies to neoadjuvant treatment significantly enhances pathological complete response (PCR) rate in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Selecting patients unlikely to benefit from neoadjuvant anti-HER2 therapies is increasingly important. In this study, we proposed to assess the role of the phosphatase and tensin homolog (PTEN) as a biomarker in predicting PCR to neoadjuvant anti-HER2 therapies by conducting meta-analysis.

Methods:
Our team searched Embase, Medline, and the Cochrane Library by the end of September 16, 2018, for trials on patients with HER2-positive breast cancer treated with neoadjuvant anti-HER2 therapies. The associations between PTEN expression and PCR rate were then assessed. Odds ratio (ORs) and hazard ratio (HRs) with 95% confidence intervals (CIs) with 2-sided P values were calculated. The Newcastle-Ottawa scale (NOS) was used to estimate the quality of the involved trials.

Results:
A total of 820 patients from 8 trials were included in this meta-analysis. Overall, the PTEN normal tumors was related to a significant increase in PCR rate (OR 0.55; 95% CI = 0.31–0.96; P = .04; I
2 = 54%). In different anti-HER2 agents analysis, the PTEN normal tumors was related to a significant increase in PCR rate in patients treated with trastuzumab alone (OR 0.40; 95% CI = 0.24–0.67; P = .0005; I
2 = 15%). Besides, no significant association between PTEN status and PCR rate was detected in patients treated with lapatinib alone (OR 1.90; 95% CI = 0.78–4.60; P = .16; I
2 = 0%) or trastuzumab plus lapatinib (OR 1.27; 95% CI = 0.27–5.97; P = .76; I
2 = 73%).

Conclusion:
Based on current evidence, PTEN status could be n suitable biomarker in predicting PCR rate to neoadjuvant anti-HER2 therapies, especially in trastuzumab-treated patients.
Catheter ablation of a right posterior accessory pathway in a patient with left ventricular noncompaction
Authors: Cojan-Minzat Bianca Olivia , Boarescu Paul-Mihai , Cismaru Gabriel , Rosu Radu , Cionca Carmen , Pop Dana , Zdrenghea Dumitru , Agoston-Coldea Lucia 
Published: January 2019

Abstract

Rtionale:
Left ventricular noncompaction (LVNC) is a genetic cardiomyopathy characterized by the presence of a thin compacted layer of myocardium and a spongy subendocardial layer with trabeculations and recesses. LVNC associated Wolf–Parkinson–White syndrome is very rare.

Patient concerns:
A 32-year-old male presented with short episodes of palpitations and a syncope 6 months before his hospitalization.

Diagnosis:
His ECG revealed the presence of a right posterior accessory pathway. Echocardiography identified trabeculations of the septal, apical, and lateral wall of the left ventricle, consistent with left ventricular noncompaction. Cardiac MRI confirmed the diagnosis, as the ratio between the noncompacted and compacted myocardial layer was 2.3.

Interventions:
The electrophysiological study revealed a malignant right posterior accessory pathway. Catheter ablation was successfully performed at the level of posterior tricuspid annulus. Programmed ventricular stimulation could not induce any arrhythmia at the end of the procedure.

Outcomes:
During 15 months of follow-up, the patient presented no more episodes of palpitations or syncope.

Lessons:
Left ventricular noncompaction with right accessory pathway is a rare association with genetic basis and gives a higher risk of sudden cardiac death. Catheter ablation of the accessory pathway is a valuable way of treatment in this category of patients, lowering the risk of sudden cardiac death.
Intraperitoneal infusion of ex vivo-cultured allogeneic NK cells in recurrent ovarian carcinoma patients (a phase I study)
Authors: Hoogstad-van Evert Janneke , Bekkers Ruud , Ottevanger Nelleke , Schaap Nicolaas , Hobo Willemijn , Jansen Joop H. , Massuger Leon , Dolstra Harry 
Published: January 2019

Abstract

Introduction:
Recurrent ovarian carcinoma has dismal prognosis, but control of disease and prolonged survival are possible in some patients. The estimated 5-year survival is 46% for all stages of ovarian cancer, and only 28% for metastasized disease. Notably, the majority of women with ovarian cancer are diagnosed with stage III or IV disease with a high recurrence rate. As most women with relapsed or metastatic cancer will die of progressive disease, there is an urgent need for novel therapeutic strategies. The primary aim of our study is to evaluate safety and toxicity of intraperitoneal infusion of ex vivo-expanded natural killer cells (NK), generated from CD34+ umbilical cord blood (UCB) progenitor cells, with and without a preceding non-myeloablative immunosuppressive conditioning regimen in patients suffering from recurrent ovarian cancer. The secondary objectives are to compare the in vivo lifespan, expansion, and biological activity of intraperitoneally infused NK cell products with or without preparative chemotherapy, as well as evaluate effects on disease load.

Methods:
In this phase I safety trial, 12 patients who are suffering from recurrent ovarian cancer, detected by a significant rise in serum level of CA-125 on two successive time points, will be included. Prior to UCB-NK cell infusion, a laparoscopy is performed to place a catheter in the peritoneal cavity. The first cohort of three patients will receive a single intraperitoneal infusion of 1.5-3×109 UCB-NK cells, generated ex vivo from CD34+ hematopoietic progenitor cells obtained from an allogeneic UCB unit, without a preparative chemotherapy regimen. The second group of three patients will be treated with a similar dose of UCB-NK cells following a preparative four days non-myeloablative immunosuppressive conditioning regimen with cyclophosphamide and fludarabine (Cy/Flu). If no severe toxicity is seen in these 6 patients, an extension cohort of 6 patients will be included to answer the secondary objectives.

Discussion:
This study investigates the safety of a promising new cellular therapy in a group of patients with a poor prognosis. Demonstration of safety and in vivo expansion capacity of allogeneic UCB-NK cells in the absence of Cy/Flu pretreatment will provide rationale for UCB-NK cell infusion after regular second-line chemotherapy.
Medial malleolar stress fracture resulting from repetitive stress caused by lateral ankle instability
Authors: Lee Hong Seop , Lee Young Koo , Kim Hak Soo , Lee Dhong Won , Won Sung Hun , Jung Ki Jin , Kim Chang Hyun , Kim Woo Jong 
Published: January 2019

Abstract

Rationale:
Stress fractures are most commonly sustained in the lower extremities owing to the repetitive weight-bearing forces. They are overuse injuries that are seen often in athletes, but rare in the general population, so early diagnosis and proper treatment are important to enable athletes to return to activity. This is a rare example of successful treatment of a medial malleolar stress fracture with lateral ankle instability.

Patient concerns:
A 16-year-old athlete presented with acute-onset left ankle pain. He was a baseball pitcher who had previously sprained left ankle while training. Subsequently, the ankle pain worsened, and he had tenderness on the medial aspect of his left ankle. The symptoms were mild at rest, but increased upon walking and training. Three years previously, he had sprained his ankle several times during baseball training.

Diagnosis:
Plain standing radiographs of the left ankle showed a vertical fracture line in the medial malleolus. Computed tomography also showed the vertical fracture in the medial malleolus. Magnetic resonance imaging revealed mild bone marrow edema in the medial malleolar area and total rupture of the anterior talofibular ligament.

Interventions:
Surgery was performed under general anesthesia, and we checked the instability of his ankle using a C-arm image intensifier, and the varus talar tilt angle was increased (10.3°). The medial malleolus stress fracture was fixed using tension bend wiring, and an arthroscopic modified Broström procedure was done.

Outcomes:
Two months postoperatively, the patient started walking, and raised-heel squatting. The medial malleolar fracture was completely united at the 3 months postoperatively on plain radiography, and return to full activity was achieved by 3 months postoperatively. Then the hardware was removed 1-year after operation and both the anterior drawer and external rotation stress tests were negative.

Lessons:
Medial malleolar stress fractures are rare, so they can be overlooked. With these fractures, plain radiographs are frequently normal initially because the medial malleolus consists mainly of cancellous bone. Physicians require a high level of suspicion when taking the patient's history and doing the physical examination. Because most occur in athletes, early diagnosis and proper treatment are important for patients’ subsequent athletic performance.
Cone beam versus conventional computed tomography angiography volume measurement in partial splenic embolization
Authors: Ishikawa Toru , Imai Michitaka , Okoshi Marina , Tomiyoshi Kei , Kojima Yuichi , Horigome Ryoko , Nozawa Yujiro , Sano Tomoe , Iwanaga Akito , Honma Terasu , Yoshida Toshiaki 
Published: January 2019

Abstract
When performing partial splenic arterial embolization (PSE), it can be difficult to determine the embolization ratio based on 2-dimensional digital subtraction angiography (DSA) image diagnosis alone. Therefore, at our department, we conduct computed tomography (CT) imaging intraoperatively and postoperatively to determine whether the planned embolization has been achieved. In recent years, developments in interventional radiology devices have enabled diagnostic imaging using cone beam CT. Here, we investigated whether the embolization ratio could be predicted from volume measurement with cone beam CT in PSE.
We investigated correlations between volume measurement with conventional CT angiography (CTA) and volume measurement with cone beam CTA in 11 cases that underwent PSE with cone beam CT guidance (Allura Clarity FD20; Phillips, Amsterdam, The Netherlands) between December 2013 and May 2018.
The mean subject age was 65.0 ± 5.8 years (6 men, 5 women). The subjects had underlying liver disorders of hepatitis C virus infection (4 cases), nonalcoholic steatohepatitis (4 cases), and alcohol-related disease (3 cases). A positive correlation was noted between conventional CTA and cone beam CTA, with infarction rates of 61.28 ± 9.31% and 64.04 ± 9.24%, respectively. The correlation coefficient between the 2 variables was .772.
Because blood washout occurs rapidly in the spleen, contrast medium had to be continuously injected during imaging to enable dual-phase imaging with cone beam CT. However, we successfully performed imaging up to the second phase and volume measurement for the embolization ratio by inserting a catheter into the splenic artery and confirming the cone beam CT arrival time from the DSA images. The results were almost identical to those obtained from volume measurement with conventional CT based on CTA imaging. Thus, our results suggest that the splenic embolization ratio measurement obtained via cone beam CTA can be used to assess PSE treatment endpoints.
Treatment of diaphyseal pathological fractures in children with monostotic fibrous dysplasia using cortical strut allografts and internal plating
Authors: Zhang Peng , Kang Liangqi , Hu Qimiao , Xia Chenjie , Yu Huan , Wang Lei , Lian Kejian , Lin Dasheng 
Published: January 2019

Abstract
Children with fibrous dysplasia (FD) chronically suffer from pain, pathological fractures, and limb deformities. The most effective methods for managing the associated pathological fractures remain controversial. The purpose of this study was to evaluate the clinical results of the treatment of diaphyseal pathological fractures in children with monostotic fibrous dysplasia (MFD) using cortical strut allografts and internal plating.
We retrospectively analyzed outcomes in nine children (5 boys, 4 girls) with diaphyseal pathological fractures due to MFD, who were treated with cortical strut allografts and internal plating (6 femoral fractures and 3 humeral fractures) between July 2007 and November 2012. The median age of patients in our study was 10 years (range 6–14 years). The fracture healing time, pain, extremity function, refracture, graft resorption, and complications were recorded to evaluate treatment effects.
The median time of follow-up was 69 months (range 60–75 months). All patients had good postoperative fracture healing with a median healing time of 14 weeks (range 12–16 weeks). None experienced refracture, graft resorption, nerve injury, or limitation of extremity function or other complications. The fixation remained stable in all patients, with no evidence of loosening screws after surgery.
In pediatric patients, the described surgical approach is an effective and reliable treatment method for diaphyseal pathological fractures caused by MFD. Cortical strut allografts, which act as biological bone plates, can provide good mechanical support while increasing the rate of fracture union.
Low dose of apatinib in treating chemotherapy and EGFR-TKI refractory non-small cell lung cancer
Authors: Liu Jin , Zheng Yulong , Xu Nong 
Published: January 2019

Abstract

Rationale:
Lung cancer is the leading cause of cancer-associated deaths all over the world. Although the prognosis of lung cancer has improved over the past decade due to progression in surgical techniques and systematic treatments, the patients with advanced disease still suffer poor survival. There are no standard treatment strategies for patients who have failed to respond to at least 2 lines of chemotherapy in non-small cell lung cancer (NSCLC). Apatinib, one of the latest small-molecule oral anti-angiogenesis targeted agents developed first in China, has shown remarkable anti-tumor efficacy in a variety of solid tumor types.

Patient concerns:
A 72-year-old woman underwent radical resection of the left lung cancer in July 2011, but was found a recurrence of cancer after 2 years.

Diagnoses:
The histopathological examination of the resected specimen identified the lesion as lung adenocarcinoma.

Interventions:
She received gemcitabine and carboplatin regimen as adjuvant chemotherapy for 4 cycles following the surgery in August 2011. After the tumor relapsed, she received multiple lines of chemotherapy including paclitaxel, cisplatin, docetaxel, and gemcitabine from July 2013, but still suffered progressive disease in February 2017. Then apatinib alone was used to defend against the tumor at a dose of 250 mg/d orally till December 2017.

Outcomes:
The efficacy was assessed as partial response 1 month later in March 2017. And the use of apatinib was continued till the patient died of tumor progression, achieving a progression-free survival for 10 months. During the treatment with apatinib, the patient experienced hypertension of grade 1, which was well-tolerated and manageable.

Lessons:
Apatinib might be efficient and well-tolerated for patients with advanced NSCLC who have failed to respond to multi-line treatments, even at a low dose.