bluuebunny/crossref_metadata_2025_split huggingface dataset:
One case report of giant atypical leiomyoma of the ovary
Authors: Wang Qiu-Man , Zhao Ye , Ma Ying , Yao Li-Ting , Han Xiao 
Published: October 2018

Abstract

Rationale:
Ovarian leiomyoma is a rare ovarian tumor that occurs in 20–65 year-old women, and is mostly misdiagnosed as malignant tumor. In most reports on this type of tumor, ovarian myoma has a benign histology. Herein,we describe a case of ovarian atypical leiomyoma.

Patient concerns:
The patient is a 58-year-old woman. At the age of 40 years old, the patient underwent hysterectomy due to “hysteromyoma” and secondary anemia. The patient was admitted to our hospital due to palpation of lower abdominal mass and abdominal distention.

Diagnoses:
A mass was revealed at the left uterine appendage by pelvic ultrasound and CT.Pathology and immunohistochemistry confirmed the diagnosis of the left ovarian atypical leiomyoma.

Interventions:
Pelvic cavity resection and right adnexectomy were performed during laparotomy for the patient.

Outcomes:
Without radiotherapy or chemotherapy, there were no signs of tumor recurrence in a 9-month follow-up period.

Lessons:
When a solid mass appears in ovarian tissues, ovarian leiomyoma should be considered. Patients with this type of tumor are mostly asymptomatic. Preoperative diagnosis was difficult, intraoperative frozen section would be helpful for determining the scope of the surgery, and the correct diagnosis was made by identifying the properties of smooth muscles through postoperative pathology and immunohistochemistry.
Effect of perioperative oral management on the prevention of surgical site infection after colorectal cancer surgery
Authors: Nobuhara Hiroshi , Yanamoto Souichi , Funahara Madoka , Matsugu Yasuhiro , Hayashida Saki , Soutome Sakiko , Kawakita Akiko , Ikeda Satoshi , Itamoto Toshiyuki , Umeda Masahiro 
Published: October 2018

Abstract
Surgical site infection (SSI) is 1 of the frequent postoperative complications after colorectal cancer surgery. Oral health care has been reported to reduce the risk of SSI or postoperative pneumonia in oral, esophageal, and lung cancer surgeries. The purpose of the study was to investigate the preventive effect of perioperative oral management on the development of SSI after a major colorectal cancer surgery.
The medical records of 698 patients who underwent colorectal cancer surgery at 2 hospitals in Japan were reviewed. Among these patients, 563 patients received perioperative oral management (oral management group) and 135 did not (control group). Various demographic, cancer-related, and treatment-related variables including perioperative oral management intervention and the occurrence of SSI were investigated. The relationship between each variable and the occurrence of SSI was examined via univariate and multivariate analyses using Fisher exact test, 1-way analysis of variance (ANOVA), and logistic regression. The occurrence of SSI in the 2 groups was evaluated via logistic regression using propensity score as a covariate. The difference in mean postoperative hospital stay between the oral management and control groups was analyzed using Student's t test.
SSI occurred in 68 (9.7%) of the 698 patients. Multivariate analysis showed that operation time, blood loss, and perioperative oral management were significantly correlated with the development of SSI. However, after the propensity score analysis, not receiving perioperative oral management also became a significant risk factor for SSI. The odds ratio of the oral management group was 0.484 (P = .014; 95% confidence interval: 0.272–0.862). Mean postoperative hospital stay was significantly shorter in the oral management group than in the control group.
Perioperative oral management reduces the risk of SSI after colorectal cancer surgery and shortens postoperative hospital stay.
Synchronous hepatocellular carcinoma and lymphoepithelioma-like carcinoma arising from 2 different sites of the liver
Authors: Shih En-Jie , Chau Ivy Yenwen , Yeh Yi-Chen , Chau Gar-Yang 
Published: October 2018

Abstract

Rationale:
Most cases of primary liver cancer involve hepatocellular carcinoma (HCC). Lymphoepithelioma-like carcinoma (LELC) is defined as a tumor composed of undifferentiated epithelial cells with a prominent lymphoid infiltrate, which is rarely reported. Lymphoepithelioma-like HCC (LEL-HCC) is an uncommon variant of HCC, having an unclear process of development. Here, we report the first case involving simultaneous HCC and LEL-HCC.

Patient concerns:
A 77-year-old female was accidentally found to have a hypoechoic hepatic nodule via an abdominal ultrasound during a health examination. Abdominal computed tomography scan revealed 2 hepatic nodules with arterial phase enhancement and washout in the late phase.

Diagnoses:
We diagnosed the case with 2 distinct liver nodules, HCC and LEL-HCC.

Interventions:
With suspicion of HCC, tumor resection (liver segments 4 and 5) was then performed. Histopathological examination of tumor 1 showed a moderately differentiated HCC and tumor 2 demonstrated a LEL-HCC. Immunohistochemically, the cells of tumor 2 were immunoreactive for cytokeratin (CK), CK7, and CK19. Epstein–Barr virus encoding small RNA (EBER) in situ hybridization results were negative.

Outcomes:
Six months after resection, intrahepatic tumor recurrence was noted. Radiofrequency ablation was conducted.

Lessons:
This is an interesting case providing circumstantial evidence of simultaneous development of HCC and LEL-HCC in distinct nodules of the liver with a background of chronic hepatitis B virus infection.
Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand
Authors: Bielski Andrzej , Rivas Eva , Ruetzler Kurt , Smereka Jacek , Puslecki Mateusz , Dabrowski Marek , Ladny Jerzy R. , Frass Michael , Robak Oliver , Evrin Togay , Szarpak Lukasz 
Published: October 2018

Abstract

Background:
Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation.

Methods:
The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression.

Results:
Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35–49), compared with Air-Q (21 seconds, 18–32) and I-Gel (19 seconds, 17–27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001).

Conclusions:
Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.
Effect of gel seat cushion on chronic low back pain in occupational drivers
Authors: Lee Jang Woo , Lim Young-Ho , Won Yu Hui , Kim Dong Hyun 
Published: October 2018

Abstract

Background:
Low back pain (LBP) is an exceedingly common medical condition that results in significant medical and social burden. Sitting for a long period is a common aggravating factor for LBP. Although seat cushion is known to promote comfort, relieve pressure, and correct posture, its effect on chronic LBP has not yet been investigated. This study aimed to evaluate the clinical effect of gel seat cushion on chronic LBP in occupational drivers.

Methods:
Occupational drivers with chronic LBP lasting for >6 months were recruited. Subjects were double-blinded, randomly assigned to 2 groups (gel and foam cushion groups), and instructed to use the provided cushions while driving. Pain threshold and tissue hardness were measured at tender points using a digital algometer. Numeric pain intensity scale (NPIS), Roland–Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI) were used to analyze the primary endpoint, whereas the Beck Depression Inventory and Short Form-6D were used for the secondary endpoint.

Results:
Of 80 enrolled subjects, 75 (gel cushion group, 40; foam cushion group, 35) were included for analysis. Both groups showed significant improvement in NPIS and ODI scores following cushion use. Results for Beck Depression Inventory and Short Form-6D scores indicated that gel cushion use was significantly helpful. Change in NPIS score was significantly greater in the gel cushion group than in the foam cushion group.

Conclusion:
Gel cushion use may be effective in relieving LBP in occupational drivers seated for a long period compared with foam cushion use.
Long-term follow-up of fibular graft for the reconstruction of bone defects
Authors: Liu Siyi , Tao Shengxiang , Tan Jinhai , Hu Xiang , Liu Huiyi , Li Zonghuan 
Published: October 2018

Abstract
The use of fibular graft for the reconstruction of bone defects has been demonstrated to be a reliable method. The aim of this study was to assess the clinical outcome of graft union, functional outcome (hypertrophy of the graft bones) and complications of both non-vascularized and vascularized grafts.
From 1981 to 2015, 10 patients were treated using non-vascularized fibular graft or free vascularized fibular graft. The outcomes were bony union time, graft hypertrophy and complications based on radiograph and functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. Mobility of the ankle at the donor site was evaluated using the Kofoed ankle score system.
This study included 10 patients with an average follow-up of 6.8 years. The union rate for all patients was 100%. The mean union time was 21.3 weeks for vascularized fibular grafts and 30.5 weeks for non-vascularized fibular grafts (P = .310). There was a significant difference between the upper limbs and the lower limbs regarding hypertrophy of the grafts in 5 patients (P = .003). The mean MSTS score in 10 patients was 84% (range 53%–97%). Stress fracture of the graft occurred in 1 patient. Donor site complications, including valgus deformity and length discrepancy, between 2 legs occurred in 2 patients who were under 18 years of age at the time of operation (P = .114). The mean Kofoed score was 96.8 (range 88–100).
A greater increase in hypertrophy of grafts was observed with reconstruction in the lower limbs. There was no difference in MSTS score between these 2 types of grafts. Children were more likely to experience the valgus deformity at the donor site after harvesting the fibula. Keeping at least the distal 1/4 of the fibula intact during the surgery is a valid means of ensuring ankle stability at the donor site, and children should be considered for prophylactic distal tibiofibular synostosis creation to prevent the valgus deformity of the ankle at the donor site.
Selection of pancreaticojejunostomy technique after pancreaticoduodenectomy: duct-to-mucosa anastomosis is not better than invagination anastomosis
Authors: Lyu Yunxiao , Li Ting , Wang Bin , Cheng Yunxiao , Zhao Sicong 
Published: October 2018

Abstract

Background:
One of the most clinically significant current discussions is the optimal pancreaticojejunostomy (PJ) technique for pancreaticoduodenectomy (PD). We performed a meta-analysis to compare duct-to-mucosa and invagination techniques for pancreatic anastomosis after PD.

Methods:
A systematic search of PubMed, Embase, Web of Science, the Cochrane Central Library, and ClinicalTrials.gov up to June 1, 2018 was performed. Randomized controlled trials (RCTs) comparing duct-to-mucosa versus invagination PJ were included. Statistical analysis was performed using RevMan 5.3 software.

Results:
Eight RCTs involving 1099 patients were included in the meta-analysis. The rate of postoperative pancreatic fistula (POPF) was not significantly different between the duct-to-mucosa PJ (110/547, 20.10%) and invagination PJ (98/552, 17.75%) groups in all 8 studies (risk ratio, 1.13; 95% CI, 0.89–1.44; P = .31). The subgroup analysis using the International Study Group on Pancreatic Fistula criteria showed no significant difference in POPF between duct-to-mucosa PJ (97/372, 26.08%) and invagination PJ (78/377, 20.68%). No significant difference in clinically relevant POPF (CR-POPF) was found between the 2 groups (55/372 vs 40/377, P = .38). Additionally, no significant differences in delayed gastric emptying, post-pancreatectomy hemorrhage, reoperation, operation time, or length of stay were found between the 2 groups. The overall morbidity and mortality rates were not significantly different between the 2 groups.

Conclusion:
The duct-to-mucosa technique seems no better than the invagination technique for pancreatic anastomosis after PD in terms of POPF, CR-POPF, and other main complications. Further studies on this topic are therefore recommended.
Therapeutic outcome of spinal implant infections caused by Staphylococcus aureus
Authors: Cho Oh-Hyun , Bae In-Gyu , Moon Song Mi , Park Seong Yeon , Kwak Yee Gyung , Kim Baek-Nam , Yu Shi Nae , Jeon Min Hyok , Kim Tark , Choo Eun Ju , Lee Eun Jung , Kim Tae Hyong , Choi Seong-Ho , Chung Jin-Won , Kang Kyung-Chung , Lee Jung Hee , Lee Yu-Mi , Lee Mi Suk , Park Ki-Ho 
Published: October 2018

Abstract
Spinal implant infection is a rare but significant complication of spinal fusion surgery, and the most common pathogen is Staphylococcus aureus. It is difficult to treat due to this pathogen's biofilm-forming ability and antibiotic resistance. We evaluated the therapeutic outcome of treatments for S aureus spinal implant infections. We retrospectively reviewed all patients with S aureus spinal implant infections at 11 tertiary-care hospitals over a 9-year period. Parameters predictive of treatment failure and recurrence were analyzed by Cox regression. Of the 102 patients with infections, 76 (75%) were caused by methicillin-resistant S aureus (MRSA) and 51 (50%) were late-onset infections. In all, 83 (81%) patients were managed by debridement, antibiotics, and implant retention (DAIR) and 19 (19%) had their implants removed. The median duration of all antibiotic therapies was 52 days. During a median follow-up period of 32 months, treatment failure occurred in 37 (36%) cases. The median time to treatment failure was 113 days, being <1 year in 30 (81%) patients. DAIR (adjusted hazard ratio [aHR], 6.27; P = .01) and MRSA infection (aHR, 4.07; P = .009) were independently associated with treatment failure. Rifampin-based combination treatments exhibited independent protective effects on recurrence (aHR, 0.23; P = .02). In conclusion, among patients with S aureus spinal implant infections, MRSA and DAIR were independent risk factors for treatment failure, and these risk factors were present in the majority of patients. In this difficult-to-treat population, the overall treatment failure rate was 36%; rifampin may improve the outcomes of patients with S aureus spinal implant infections.
Predictive factors of postoperative complications in single-port video-assisted thoracoscopic anatomical resection
Authors: Gonzalez-Rivas Diego , Kuo Yung Chia , Wu Ching Yang , Delgado Maria , Mercedes de la Torre , Fernandez Ricardo , Fieira Eva , Hsieh Ming Ju , Paradela Marina , Chao Yin Kai , Wu Ching Feng 
Published: October 2018

Abstract
The purpose of this study was to identify the risk factors for adverse events during single-port video-assisted thoracoscopic (SPVATS) anatomical resections.
We retrospectively reviewed patients who had undergone SPVATS anatomic resections between January 2014 and February 2017 in Coruña University Hospital's Minimally Invasive Thoracic Surgery Unit (CHUAC, Spain) and Chang Gung Memorial Hospital (CGMH, Taiwan). Four hundred forty-two patients (male: 306, female: 136) were enrolled in this study. Logistic regression analysis was performed on variables for postoperative complications.
Postoperative complications with a 30-day mortality occurred in 94 patients (21.3%) and with a 90-day mortality in 3 patients (0.7%) while the major complication rate was 3.9%. Prolonged air leak (PAL > 5 days) was the most common complication and came by postoperative arrhythmia. Logistic regression indicated that pleural symphysis (odds ratio (OR), 1.91; 95% confidence interval (CI), 1.14–3.18; P = .014), computed tomography (CT) pulmonary emphysema (OR, 2.63; 95% CI, 1.41–4.76; P = .002), well-developed pulmonary CT fissure line (OR, 0.49; 95% CI, 0.29–0.84; P = .009), and tumor size (≥3 cm) (OR, 2.15; 95% CI, 1.30–3.57; P = .003) were predictors of postoperative complications.
Our preliminary results revealed that SPVATS anatomic resection achieves acceptable 30- and 90-day surgery related mortality (0.7%) and major complications rate (3.9%). Prolonged Air leak (PAL > 5 days) was the most common postoperative complication. Pleural symphysis, pulmonary emphysema, well-developed pulmonary CT fissure line and tumor size (≥3 cm) were predictors of adverse events during SPVATS anatomic resection.
New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA
Authors: Li Hui-Min , Zhang Ren-Jie , Gao Hai , Jia Chong-Yu , Zhang Jian-Xiang , Dong Fu-Long , Shen Cai-Liang 
Published: October 2018

Abstract

Background:
Because of aging of population, osteoporotic vertebral compression fracture (OVCF) appears an increasing incidence rate. Conservative therapy (CT) and balloon kyphoplasty (BKP) have been used to treat OVCFs. However, an increase in new vertebral compression fractures at nontreated levels following BKP is of concern. It is still not clear whether new fractures were a result of BKP and the purpose of this meta-analysis was to evaluate the new fractures risk after BKP compared with CT.

Methods:
An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials and prospective nonrandomized controlled study that compared BKP with CT for patients suffering OVCF. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval.

Results:
Twelve studies were included and there was no significant difference in total new fractures (P = .33) and adjacent fractures (P = .83) between 2 treatments. Subgroup analyses did not demonstrate significant differences in follow-up period, mean age, anti-osteoporosis therapy, and the proportion of women.

Conclusion:
Our systematic review revealed that an increased risk of fracture of vertebral bodies was not associated with BKP compared with CT.
Early stage ovarian carcinoma with symptoms mimicking tuberculous peritonitis in a postmenopausal woman
Authors: Mun Seong Taek , Jang Si-Hyong , Ryu Aeli 
Published: October 2018

Abstract

Rationale:
Ovarian cancer has the poorest prognosis of the gynecological cancers. Early diagnosis and treatment are important, but early-stage ovarian carcinoma has nonspecific symptoms. Ultrasonography, computed tomography, magnetic resonance imaging, and serum CA-125 levels can be helpful but may not elucidate cases of diffuse peritoneal diseases mimicking carcinomatosis.

Patient concerns:
The patient had intermittent abdominal discomfort and dysuria. Abdominal-pelvic computed tomography findings were suspicious for peritoneal tuberculosis (TB) and a small cystic mass in the left ovary. The CA-125 values were normal.

Diagnoses:
She underwent laparoscopy for pathologic confirmation of tuberculous peritonitis and management of the ovary mass. Bilateral adnexectomy was performed. Histopathological examination of the surgical specimen revealed a serous ovarian carcinoma in her left ovary and salpinx.

Interventions:
Laparoscopic hysterectomy, pelvic lymphadenectomy, para-aortic nodal dissection, and omentectomy were carried out for staging evaluation.

Outcomes:
We encountered a rare case of ovary cancer stage IA serous ovarian carcinoma incidentally discovered by laparoscopy in a postmenopausal woman. She received adjuvant chemotherapy without relapse.

Lessons:
Peritoneal TB may mimic peritoneal or ovarian carcinoma, but the reverse case is rare. Hence, gynecologists should be careful in assessment of patients before treatment.
Admissions to intensive cardiac care units in France in 2014
Authors: Mercier Grégoire , Duflos Claire , Riondel Adeline , Delmas Clément , Manzo-Silberman Stéphane , Leurent Guillaume , Elbaz Meyer , Bonnefoy-Cudraz Eric , Henry Patrick , Roubille François 
Published: October 2018

Abstract
Geographic variation in admission to the intensive cardiac care unit (ICCU) might question about the efficiency and the equity of the healthcare system. The aim was to explain geographic variation in the rate of admission to ICCU for coronary artery disease (CAD) or heart failure (HF) in France.
We conducted a retrospective study based on the French national hospital discharge database. All inpatient stays for CAD or HF with an admission to an ICCU in 2014 were included. We estimated population-based age and sex-standardized ICCU admission rates at the department level. We separately modeled the department-level admission rates for HF and CAD using generalized linear models.
In all, 61,010 stays for CAD and 27,828 stays for HF had at least 1 ICCU admission. The ICCU admission rates were explained by the admission rate for CAD, by the diabetes prevalence, by the proportion of the population >75 years, and by the drive time to the ICCU.
This work sheds light on the finding of substantial geographic variation in the ICCU admission rates for CAD and HF in France. This variation is explained by both the age and the health status of the population and also by the drive time to the closest ICCU for HF. Moreover, ICCU admission for HF might be more prone to unwarranted variations due to medical practice patterns.