bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasonographic features of testicular metastasis from renal clear cell carcinoma that mimics a seminoma
Authors: Huang He , Ling Wenwu , Qiu Tingting , Luo Yan 
Published: October 2018

Abstract

Rationale
Testicular metastases from renal cell carcinoma (RCC) are extremely rare. To the best of our knowledge, only 35 cases have been described in the literatures.

Patient concerns
A 64-year-old male presented to our urology clinic for a palpable painless mass on his right side of the scrotum by self-examination 1 week ago, with a general abdominal ultrasonographic report showing a mass in his right kidney.

Diagnoses and interventions
Scrotal B-mode ultrasound revealed a 15 × 13 × 15 mm well-defined round homogenously hypoechoic nodule with a halo at the upper pole of the right testis. Color Doppler and spectral Doppler ultrasound detected abundant intranodular and perinodular blood flow signals including both arteries and veins. Malignancy was suspected. Abdominal contrast-enhanced computed tomography identified an irregular tumor in the posterior side of the right kidney, highly suspicious for renal carcinoma. The patient received right radical nephrectomy and right partial orchiectomy. Histologically, the right renal mass was diagnosed as RCC, clear cell type, grade 2. As to the right testicular mass, a metastasis from renal clear cell carcinoma was confirmed.

Outcomes
The patient has lived with no recurrence for at least 17 months without adjuvant therapy.

Lessons
In the case, we focus on the ultrasonographic features of the testicular metastasis from RCC. Ultrasound could provide initial and helpful information for diagnosis. When finding a mass in the testicle on the ultrasound, although most of them are primary, it is important to know whether the patient has tumor history from other parts of the body. A halo may be a special feature for metastases. Contrast-enhanced ultrasound (CEUS) and ultrasonic elastography could provide more information for differential diagnoses.
Predictors of early weaning failure from mechanical ventilation in critically ill patients after emergency gastrointestinal surgery
Authors: Jung Yun Tae , Kim Myung Jun , Lee Jae Gil , Lee Seung Hwan 
Published: October 2018

Abstract
Mechanical ventilation (MV) is the most common therapeutic modality used for critically ill patients. However, prolonged MV is associated with high morbidity and mortality. Therefore, it is important to avoid both premature extubation and unnecessary prolongation of MV. Although some studies have determined the predictors of early weaning success and failure, only a few have investigated these factors in critically ill surgical patients who require postoperative MV. The aim of this study was to evaluate predictors of early weaning failure from MV in critically ill patients who had undergone emergency gastrointestinal (GI) surgery.
The medical records of 3327 adult patients who underwent emergency GI surgery between January 2007 and December 2016 were reviewed retrospectively. Clinical and laboratory parameters before surgery and within 2 days postsurgery were investigated.
This study included 387 adult patients who required postoperative MV. A low platelet count (adjusted odds ratio [OR]: 0.995; 95% confidence interval [CI]: 0.991–1.000; P = .03), an elevated delta neutrophil index (DNI; adjusted OR: 1.025; 95% CI: 1.005–1.046; P = .016), a delayed spontaneous breathing trial (SBT; adjusted OR: 14.152; 95% CI: 6.571–30.483; P < .001), and the presence of postoperative shock (adjusted OR: 2.436; 95% CI: 1.138–5.216; P = .022) were shown to predict early weaning failure from MV in the study population.
Delayed SBT, a low platelet count, an elevated DNI, and the presence of postoperative shock are independent predictors of early weaning failure from MV in critically ill patients after emergency GI surgery.
Complications of percutaneous liver biopsy in living donor liver transplantation
Authors: Chiu King-Wah , Lin Ting-Lung , Yong Chee-Chien , Lin Chih-Che , Cheng Yu-Fan , Chen Chao-Long 
Published: October 2018

Abstract

Rationale:
According to previously published studies, major complications arising from a percutaneous liver biopsy are rare and occur in less than 0.1% of cases. This report describes an approach to percutaneous liver biopsy that can help avoid damage to the liver in a living donor liver transplantation (LDLT) setting.

Patient concerns:

Case 1: In the first case a donor percutaneous liver biopsy (PLB) of both lobes of the liver was performed for pre-LDLT evaluation. The ultrasonography (US)-guided epigastric right-angle approach and an automatic one-handed cocking disposable 18G biopsy gun was used to puncture the left liver lobe to determine the presence of fatty liver. A penetrating liver injury occurred, accompanied by massive bloody ascites (about 700 cc) and subcapsular hematoma at the left lateral segment. The bleeding was managed by bi-polar coagulation during the transplant and the following liver donation procedure proceeded smoothly without any subsequent complications. Case 2: In the second case, selective right lobe PLB for clinical assessment after LDLT was performed in the recipient. Hemorrhagic shock occurred following a puncture of the right posterior branch of the right hepatic artery when using the biopsy-gun via the right lateral intercostal approach.

Diagnoses:
Extravasation was documented by angiography and emergent transhepatic arterial embolization was performed.

Intervention:
Extravasation was documented by angiography and emergent transhepatic arterial embolization with glue:lipiodol (1:4) was performed to stop bleeding.

Outcomes:
The recipient survived after medical management.

Lessons:
To prevent complications, the right-angle approach of PLB may be changed to an oblique angle using a one-fire biopsy-gun. Use of a manual Menghini's needle should be considered for left lobe liver biopsies. Since US-guided manual Menghini's needle for PLB can be observed with the needle tip inserted in the liver, needle-mediated compromising of the major vessels or biliary tree can be prevented, and it does not penetrate the liver again. A superficial puncture less than 0.5 cm away from the liver surface should be made during right lobe liver biopsy. This approach can help to avoid damage to the hepatic artery.
Supra-inguinal fascia iliaca block under ultrasound guidance for perioperative analgesia during bipolar hip arthroplasty in a patient with severe cardiovascular compromise: Retraction
Authors: Ueshima Hironobu , Otake Hiroshi 
Published: October 2018

Abstract

Rationale:
The relief of selective hip pain may be difficult to attain. Therefore, a deep nerve block such as epidural anesthesia or lumbar plexus nerve block is required. However, deep nerve blocks may not be possible in patients with complications, including severe cardiovascular disease.

Patients concerns:
The patient in our report had coronary stents inserted previously and required continuous anticoagulant therapy owing to severe heart failure.

Diagnosis:
Bipolar hip arthroplasty was required in our patient because of a fracture of the neck of femur on the left side.

Interventions:
We decided to perform the surgery using a fascia iliaca block (block of the femoral and the lateral femoral cutaneous nerves) by the suprainguinal approach. The fascia iliaca nerve block was performed under ultrasound guidance, using 20 mL of levobupivacaine.

Outcomes:
The surgery was performed successfully with adequate sensory block around the hip region.

Lessons:
Ultrasound-guided fascia iliaca nerve block by the supra-inguinal approach may be an effective anesthetic technique for patients undergoing surgery for fracture of the neck of femur.
Disparities in Self-reported Access to Patient-centered Medical Home Care for Children With Special Health Care Needs
Authors: Pérez Jolles Mónica , Thomas Kathleen C. 
Published: October 2018

Background:
Efforts to transform primary care have been underway for over a decade. Yet, we lack understanding of the progress made in scaling up this care model nationwide and on whether patient-centered medical home (PCMH) has benefited every group of children with special health care needs (CSHCNs).

Objective:
The main objective of this study was to examine variation in caregiver service experience concordant with PCMH care over time and by child characteristics.

Research Design:
This was a cross-sectional pooled data analysis using the 2003–2012 Medical Expenditures Panel Survey data for CSHCNs, aged 5–17 years. Logistic regressions were implemented, accounting for child and parent sociodemographic, child’s health insurance, and contextual characteristics. PCMH concordant care and each component were constructed as binary variables and child functional impairment was measured with the Columbia Impairment Scale.

Results:
Thirty-one percent of children reported medical home concordant care; comprehensive (83%) and compassionate (82%) care were most prevalent, and the least common were accessible care (59%) and patient-centered care (60%). PCMH concordant care significantly increased nationwide between 2003 and 2012, but disparities remained based on child needs and sociodemographic characteristics. Multivariate regressions showed variation across medical home components.

Conclusions:
Despite increased parent perception of care that is concordant with medical home care over time, disparities remain among high-need CSHCNs. Future research may focus on better understanding how clinical settings tailor this care model, particularly on providing increased access and patient-centered care, to better serve children at the highest need.
Analysis of a Step-Up Approach Versus Primary Open Surgical Necrosectomy in the Management of Necrotizing Pancreatitis
Authors: Jones Jason D. , Clark Clancy J. , Dyer Raymond , Case L. Douglas , Mishra Girish , Pawa Rishi 
Published: October 2018

Objectives
An increasing number of providers have begun to use a minimally invasive step-up approach as opposed to traditional surgical necrosectomy in the management of acute necrotizing pancreatitis. Studies have shown mixed results, thus we hypothesized that the step-up approach is safer and associated with decreased mortality and length of stay (LOS).

Methods
This is a retrospective cohort study of patients admitted from January 2010 to March 2015 who underwent interventions for walled-off pancreatic necrosis (WOPN). Primary outcomes included LOS after intervention and mortality, in-hospital and 90-day, with secondary outcomes of procedural complications.

Results
Sixty-nine patients developed WOPN requiring intervention during the study period. In-hospital mortality was 5.6% (n = 2) in the step-up cohort compared with 18.2% (n = 6) in the surgical cohort (relative risk, 3.27; 95% confidence interval, 0.71–15.09). Ninety-day mortality was 9.1% (n = 3) in the step-up cohort and 21.9% (n = 7) in the surgical cohort (relative risk, 2.41; 95% confidence interval, 0.68–8.50). Postintervention LOS was 8 days in the step-up cohort and 17 days in the surgical cohort (P = 0.62).

Conclusions
A step-up approach, as compared with primary surgical necrosectomy in the management of WOPN, results in clinically significant decreases in mortality and LOS.
Grading by the Ki-67 Labeling Index of Endoscopic Ultrasound–Guided Fine Needle Aspiration Biopsy Specimens of Pancreatic Neuroendocrine Tumors Can Be Underestimated
Authors: Hwang Hee Sang , Kim YunJae , An Soyeon , Kim Sung Joo , Kim Joo Young , Kim Sang-Yeob , Hwang Dae Wook , Park Do Hyun , Lee Sang Soo , Kim Song Cheol , Seo Dong-Wan , Hong Seung-Mo 
Published: October 2018

ObjectivesThere is an increasing need for grading with small endoscopic ultrasound–guided fine needle aspiration biopsy (EUS-FNAB) specimens for the proper diagnosis and therapy selection of patients with unresectable pancreatic neuroendocrine tumors (PanNET). However, our understanding of EUS-FNAB specimen grading is limited compared with surgically resected specimens.MethodsWe retrospectively determined Ki-67 labeling index (LI) of 33 matched EUS-FNAB and surgically resected PanNETs with digital image analyzer. Pairwise grades between the matched biopsy and surgically resected PanNET specimens were compared.ResultsThe mean Ki-67 LI was higher in surgically resected PanNET specimens (5.5%) than in biopsy specimens (3.2%;P =0.022). There was moderate agreement between the Ki-67 LI grades when individually evaluated matched biopsy and resected specimen pairs were compared (κ value = 0.62;P< 0.0001). However, discordance was noted in 6 cases (18%), and all of them were either grade 2 or 3 in resected PanNETs.ConclusionsAlthough Ki-67 LI grading of EUS-FNAB specimens may be concordant with that of matched surgically resected specimens in a large proportion of the PanNET cases, Ki-67 LI grading of EUS-FNAB specimens should be carefully applied in clinical practice because of the possibility of grading underestimation with grade 2 to 3 PanNET cases.
Practice Patterns of Stereotactic Radiotherapy in Pediatrics: Results From an International Pediatric Research Consortium
Authors: Alcorn Sara , Nilsson Kristina , Rao Avani D. , Ladra Matthew M. , Ermoian Ralph P. , Villar Rosangela C. , Chen Michael J. , Kobyzeva Daria , Nechesnyuk Alexey V. , Ford Eric , MacDonald Shannon , Winey Brian , Dieckmann Karin , Terezakis Stephanie A. 
Published: October 2018

Purpose/Objectives:
There is little consensus regarding the application of stereotactic radiotherapy (SRT) in pediatrics. We evaluated patterns of pediatric SRT practice through an international research consortium.

Materials and Methods:
Eight international institutions with pediatric expertise completed a 124-item survey evaluating patterns of SRT use for patients 21 years old and younger. Frequencies of SRT use and median margins applied with and without SRT were evaluated.

Results:
Across institutions, 75% reported utilizing SRT in pediatrics. SRT was used in 22% of brain, 18% of spine, 16% of other bone, 16% of head and neck, and <1% of abdomen/pelvis, lung, and liver cases across sites. Of the hypofractionated SRT cases, 42% were delivered with definitive intent. Median gross tumor volume to planning target volume margins for SRT versus non-SRT plans were 0.2 versus 1.4 cm for brain, 0.3 versus 1.5 cm for spine/other bone, 0.3 versus 2.0 cm for abdomen/pelvis, 0.7 versus 1.5 cm for head and neck, 0.5 versus 1.7 cm for lung, and 0.5 versus 2.0 cm for liver sites.

Conclusions:
SRT is commonly utilized in pediatrics across a range of treatment sites. Margins used for SRT were substantially smaller than for non-SRT planning, highlighting the utility of this approach in reducing treatment volumes.
Laparoscopic vs Transvaginal Cuff Closure After Total Laparoscopic Hysterectomy: A Randomized Trial by the Italian Society of Gynecologic Endoscopy
Authors: Uccella Stefano , Malzoni Mario , Cromi Antonella , Seracchioli Renato , Ciravolo Giuseppe , Fanfani Francesco , Shakir Fevzi , Alletti Salvatore Gueli , Legge Francesco , Berretta Roberto , Corrado Giacomo , Casarella Lucia , Donarini Paolo , Zanello Margherita , Perrone Emanuele , Gisone Baldo , Vizza Enrico , Scambia Giovanni , Ghezzi Fabio 
Published: October 2018

(Abstracted from Am J Obstet Gynecol 2018;218:500.e1–500.e13)
After the introduction of total laparoscopic hysterectomy (TLH) in 1989, the significant benefits of minimally invasive techniques for improved outcomes and lower costs have allowed a substantial decrease in the rate of open abdominal hysterectomies. However, these benefits have been paralleled by an increase in the rate of vaginal cuff dehiscence, an infrequent but potentially life-threatening complication.
Characteristics of Lynch Syndrome Associated Ovarian Cancer
Authors: Woolderink J. M. , De Bock G. H. , de Hullu J. A. , Hollema H. , Zweemer R. P. , Slangen B. F. M. , Gaarenstroom K. N. , van Beurden M. , van Doorn H. C. , Sijmons R. H. , Vasen H. F. A. , Mourits M. J. E. 
Published: October 2018

(Abstracted from Gynecol Oncol 2018;150(2):324–330)
Lynch syndrome (LS), an autosomal dominant tumor syndrome, is associated with increased risk of cancer. Most inherited endometrial cancers are caused by this syndrome.
The Relationship between Progression in Axial Length/Corneal Radius of Curvature Ratio and Spherical Equivalent Refractive Error in Myopia
Authors: Jong Monica , Sankaridurg Padmaja , Naduvilath Thomas John , Li Wayne , He Mingguang 
Published: October 2018

SIGNIFICANCE
This study demonstrates that mean axial length/corneal radius of curvature ratio (AL/CR) can be used to detect low and high myopia but cannot clinically monitor myopia progression because the relationship between AL/CR and progression in myopia is different between low and high myopia.

PURPOSE
The purpose of this study was to investigate the relationship of AL/CR with magnitude and progression of myopia.

METHODS
Retrospective analysis was conducted comparing the right eyes of those with high myopia (n = 308; age, 7 to 16 years; myopia sphere, −6.00 diopters or worse) with those with low myopia (n = 732; age, 7 to 16 years; myopia sphere, between −0.50 and −3.50 diopters; cylinder, ≤1.00 diopters). Baseline axial length, corneal radii of curvature, and cycloplegic objective refraction were analyzed. Myopia progression in the low-myopia group at 6- and 12-month follow-up was measured, and the differences in slopes of AL/CR were compared for slow (<0.75 diopters) and fast progressing (≥0.75 diopters).

RESULTS
Mean AL/CR values were significantly different (P < .001) between high myopia (3.46 ± 0.10) and low myopia (3.16 ± 0.07). In high and low myopia, slopes of axial length versus corneal curvature radius were not significantly different (P > .05), and slopes of AL/CR versus spherical equivalent were significantly different after adjusting for spherical equivalent and age (P < .05). Slopes of AL/CR progression and spherical equivalent progression were significantly different in low myopia between fast and slow progressing (P < .001), but the relationship between progression in AL/CR and progression in spherical equivalent was not strong.

CONCLUSIONS
The AL/CR can be used to classify different grades of myopia, but it is not useful in determining the magnitude of myopia or monitoring progression because AL/CR is not linearly related to spherical equivalent and because progression in AL/CR is not strongly related to spherical equivalent progression.
Tear Lactoferrin and Features of Ocular Allergy in Different Severities of Meibomian Gland Dysfunction
Authors: Chao Cecilia , Tong Louis 
Published: October 2018

SIGNIFICANCE
Meibomian gland dysfunction, but not atrophy, was associated with lower tear lactoferrin concentration, greater dry eye, and allergic symptoms, indicating greater inflammation and discomfort in patients with lower meibomian gland expressibility.

PURPOSE
Meibomian gland dysfunction can potentially damage adjacent palpebral structures, which may induce inflammation in accessory lacrimal glands and affect lactoferrin secretion. This study aimed to examine the relationships between the severity of meibomian gland dysfunction with tear lactoferrin, conjunctival cell morphology, and clinical features of ocular allergy.

METHODS
Forty subjects were divided into two groups based on the severity of meibomian gland plugging and expressibility and secondarily based on its atrophy. Dry eye and allergy questionnaires; slit-lamp examination, including lid telangiectasia; and meibography were performed. Tear lactoferrin concentration was measured using TearScan 270 MicroAssay. Impression cytology was performed on the upper palpebral conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified.

RESULTS
Twenty-two subjects with meibomian gland dysfunction were categorized into severely obstructed group (case), whereas 19 subjects had minimal/no obstruction (comparison). Lower lactoferrin (1.3 ± 0.4 vs. 1.7 ± 0.4 mg/mL, P = .007), greater dry eye (7 [1 to 10] vs. 2 [0 to 5], P = .03), and allergy symptoms (9 [4 to 23] vs. 6 [0 to 9], P = .05) were found in the cases compared with the comparisons. There were no differences in conjunctival cell morphology between groups. The plugging score was correlated with lactoferrin concentration (ρ = −0.43, P = .006), dry eye (ρ = 0.36, P = .02), and allergic symptoms (ρ = 0.33, P = .04). Greater lid margin telangiectasia was associated with meibomian gland obstruction, but not atrophy.

CONCLUSIONS
Meibomian gland activity/dysfunction, but not atrophy, may be associated with increased inflammation on the ocular surface. The inflammation may be sufficient to reduce tear lactoferrin production from damage to accessory lacrimal glands and/or meibomian gland and result in increased symptoms.
Neutralizing Peripheral Refraction Eliminates Refractive Scotomata in Tilted Disc Syndrome
Authors: Phu Jack , Wang Henrietta , Miao Sephora , Zhou Lydia , Khuu Sieu K. , Kalloniatis Michael 
Published: October 2018

SIGNIFICANCE
We demonstrate that the visual field defects in patients with tilted disc syndrome can be reduced or eliminated by neutralizing the peripheral scotoma in the area of posterior retinal bowing, which may allow differentiation between a congenital anomaly and acquired pathology.

PURPOSE
Tilted disc syndrome is a congenital and unchanging condition that may present with visual field defects mimicking loss seen in neurological diseases, such as transsynaptic retrograde degeneration. Our purpose was to systematically investigate the ability of a neutralized peripheral refraction to eliminate refractive visual field defects seen in tilted disc syndrome. This was compared with the same technique performed on patients with neurological deficits.

METHODS
The Humphrey Field Analyzer was used to measure sensitivities across the 30-2 test grid in 14 patients with tilted disc syndrome using four refractive corrections: habitual near correction and with an additional −1.00, −2.00 or −3.00 D negative lens added as correction lenses. Peripheral refractive errors along the horizontal meridian were determined using peripheral retinoscopy and thus allowed calculation of residual peripheral refraction with different levels of refractive correction. Visual field defects were assessed qualitatively and quantitatively using sensitivities and probability scores in both patient groups.

RESULTS
A smaller residual refractive error after the application of negative addition lenses correlated with improvement in visual field defects in terms of sensitivity and probability scores in patients with tilted disc syndrome. Patients with established neurological deficits (retrograde degeneration) showed improvement in sensitivities but not in probability scores.

CONCLUSIONS
Neutralizing the refractive error at the region of posterior retinal bowing due to tilted disc syndrome reduces the apparent visual field defect. This may be a useful and rapid test to help differentiate between tilted disc syndrome and other pathological causes of visual field defects such as neurological deficits.