bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phyllodes tumor of the breast with nipple discharge
Authors: Jing Pengfei , Wei Bing , Yang Xiaoqin 
Published: December 2018

Abstract

Rationale:
Phyllodes tumors (PTs) of the breast are rare biphasic fibroepithelial neoplasms which usually present with unilateral palpable breast lumps. Here we reported a case of borderline PTs with multifocal intraductal lesions whose primary clinical manifestation was nipple discharge.

Patient concerns:
A rare case of PT with nipple discharge in a 26-year-old young lady accepted a wide local excision on her left breast, and the pathological examination turned out to be a malignant phyllodes tumor. After a 12-month follow-up, no local or distant recurrence was observed.

Diagnosis:
Borderline PTs with multifocal intraductal lesions

Interventions:
The patient received wide local excision with clear margin. After the operation, the patient is undergoing surveillance through ultrasonography and physical examination every 3 months.

Outcomes:
After a follow-up of 12 months, no local or distant recurrence was observed.

Lessons:
The lesions of the PTs are often manifested with unilateral, palpable masses in the breast. There are very few case reports of PTs manifested with nipple discharge in the literature. We should improve the understanding of the multiple clinical manifestations of PTs.
Practice styles, knowledge and attitudes of general practitioners and gastroenterology specialists who treat gastroesophageal reflux disease
Authors: Carter Dan , Dickman Ram 
Published: December 2018

Abstract
As little is known on the subject, our aim was to compare practice styles, knowledge and attitudes of general practitioners (GPs), and gastroenterology specialists (GIs) regarding the treatment of gastroesophageal reflux disease (GERD).
An internet survey designed by the authors was sent nationwide and randomly to 290 GIs and 1312 GPs. We assessed for the burden of GERD, indications for referral for a GI consultation, criteria for proton pump inhibitors (PPIs) selection, and main unmet treatment needs.
Forty (14%) GIs and 132 (10%) GPs returned the questionnaire. Both groups treat 13 to 14 GERD patients weekly (mean age 41–50 years). The most common first and second line drug of choice in both groups was omeprazole and esomeprazole, respectively. GIs stated that the most important consideration for the selection of treatment was high safety profile, whereas GPs considered it to be a rapid symptomatic relief. In the case of first and second line PPI failures, GIs tended to prescribe a non PPI treatment, whereas GPs restarted esomeprazole. GIs stated that the most prevalent conceived limitations of PPI treatment were nighttime heartburn and undesirable side effects, whereas GPs considered treatment inflexibility and drug interactions.
GIs and GPs hold different practice styles, knowledge, and attitudes on the treatment of GERD. Our findings ascertain the need for the development of updated National Clinical Guidelines focusing on GERD.
Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation
Authors: Garaud Thomas , Gervais Christine , Szekely Barbara , Michel-Cherqui Mireille , Dreyfus Jean-François , Fischler Marc 
Published: December 2018

Abstract

Background:
Transcutaneous electrical nerve stimulation (TENS) is often used for the treatment of low-back pain (LBP). However, its effectiveness is controversial.

Objective:
To determine the efficacy of TENS in the treatment LBP when associated to a therapeutic education program (TEP).

Design:
Open randomized monocentric study.

Setting:
University hospital between 2010 and 2014.

Patients:
A total of 97 patients suffering from LBP.

Interventions:
Routine care (TENS group) or routine care plus a therapeutic education program (TENS-TEP group) based on consultation support by a pain resource nurse.

Main outcome measures:
EIFEL and Dallas Pain Questionnaire scores.

Results:
Twenty-two patients (44%) were still assessable at the end-of-study visit, whereas 33 (70%) were assessable at the same time point in the TENS-TEP group (P = .013). The EIFEL score and the Dallas score had a similar evolution over time between groups (P = .18 and P = .50 respectively). Similarly, there were no significant differences between the groups with respect to resting pain scores (P = .94 for back pain and P = .16 for leg pain) and movement pain scores (P = .52 for back pain and P = .56 for leg pain). At Month 6, there was no significant difference between the groups (P = .85) with regard to analgesics and social impact. Two patients presented a serious adverse event during the study (one in each group) but non-attributable to the treatment studied.

Conclusion:
This study does not support the use of TENS in the treatment of patients with chronic LBP even though patients benefited from a therapeutic education program by a pain resource nurse. However, the higher number of premature withdrawals in the TENS group may be due to early withdrawal of patients who did not experience improvement of their symptoms.
Sudden seizure during cesarean section
Authors: Zhou Wenqin , Zhu Qing 
Published: December 2018

Abstract

Rationale:
A first seizure can range from a fleeting subjective experience or a twitch (myoclonic jerk) through to a tonic-clonic convulsion. A first seizure occurred in a parturient during cesarean section is very rare. We describe the case of a parturient who suffered seizure when the fetus was delivered.

Patient concerns:
Our patient is a 31-year-old parturient with a first seizure during cesarean section.

Diagnoses:
Seizure.

Interventions:
The patient received supportive therapy to maintain oxygen supply and propofol was administered to terminate seizure during cesarean section.

Outcomes:
after therapy, the patient regained full consciousness and normal spontaneous respiration. She had no recall of the seizure attack. The post-operative recovery was uneventful.

Lessons:
Symptoms during seizure are very important to diagnose. It will be both harmful to mother and the fetus, when the pregnant woman suffers seizure during pregnancy or cesarean delivery. In this situation, supportive therapy need to be immediately initiate and propofol may be the most suitable drug to terminate seizure during cesarean delivery.
Metallothioneins may be a potential prognostic biomarker for tumors
Authors: Wang Lei , Xin Fuli , Lin Nanping , Wang Yingchao , Liu Xiaolong , Liu Jingfeng 
Published: December 2018

AbstractBackground:Metallothioneins (MTs) were reported to be associated with many kinds of tumors’ prognosis, although MTs expression varied greatly among tumors. To assess the prognostic value of Metallothioneins (MTs) in different kinds of tumors, comprehensive literature search was conducted to perform a meta-analysis.Methods:Eligible studies were identified by PubMed, MEDLINE, Web of Science (WOS), the Cochrane Library of Systematic Reviews, EMBASE, China National Knowledge Infrastructure (CNKI), WANFANG database and SinoMed database up to December 2017, which was designed to assess the prognostic value of MTs in different kinds of tumors. The main endpoint events were overall survival (OS) and disease-free survival (DFS). Hazard ratios (HRs) and its variance were retrieved from the original studies directly or calculated using Engauge Digitizer version 4.1. Random or fixed effects model meta-analysis was employed depending on the heterogeneity. Publication bias was evaluated by funnel plots, Begg and Egger tests.Results:A total of 22 studies were enrolled in this meta-analysis, including 2843 tumor tissues (1517 were MTs negative/low, and 1326 were MTs high). Results showed that there was significant association between MTs expression and tumors’ OS (HR = 1.60; 95%CI 1.34∼1.92,P < .00001). Subgroup analysis showed that high level of MTs expression was associated with prolonged OS in liver cancer (HR = 0.65, 95%CI 0.48∼0.89,P = .007), but it was on the contrary in the tumor of ovary (HR = 1.47, 95%CI 1.01∼2.14,P = .04), bladder (HR = 1.71, 95%CI 1.21∼2.42,P = .002), intestine (HR = 3.13, 95%CI 1.97∼4.97,P < .00001), kidney (HR = 3.31, 95%CI 1.61∼6.79,P = .001). However, there was no significant association between MTs expression and OS in breast (HR = 1.02, 95%CI 0.69∼1.51,P = .93).Conclusions:MTs could be taken as a potential prognostic biomarker for tumors, and uniqueness of MTs prognostic value in liver cancer deserved further study.
Lactulose for the treatment of Chinese children with chronic constipation
Authors: Cao Yuan , Liu Shi-ming 
Published: December 2018

AbstractBackground:This study aimed to investigate the efficacy and safety of lactulose for the treatment of Chinese children with chronic constipation.Methods:A total of 100 children with chronic constipation were included in this randomized controlled trial. They were equally and randomly allocated to a treatment group (n = 50) and a placebo group (n = 50). The participants in the treatment group received lactulose, while the subjects in the placebo group received placebo intervention. The children in both groups were treated for a total of 6 weeks. The primary outcome was daily stool frequency. The secondary outcomes consisted of stool consistency, measured by the Bristol Stool Form Scale, abdominal pain, flatulence, as well as the adverse events. All outcomes were measured at baseline and after 6-weeks treatment.Results:After 6 weeks treatment, lactulose showed better outcomes in daily stool frequency (P < .01), and stool consistency (P < .01), except the abdominal pain (P = .24), and flatulence (P = .44), compared with the placebo. Additionally, no significant differences regarding all adverse events were detected between 2 groups.Conclusion:The results of this study found that lactulose is efficacious for Chinese children with chronic constipation after 6-weeks of treatment.
Syncope as the initial presentation of pulmonary embolism in a young adult with testicular tumor
Authors: Song Zikai , Lv Shijie , Qin Ling , Cao Hongyan , Wu Haidi , Deng Dayong 
Published: December 2018

Abstract

Rationale:
Venous thrombus embolism (VTE) includes deep-vein thrombosis (DVT) and pulmonary embolism (PE) which may be an initial symptom for patients with cancer. PE has diverse clinical manifestations and is a rare complication of testicular tumor (TT).

Patient concerns:
Here, we report a 21-year-old man admitted to our hospital due to syncope.

Diagnoses:
Clinical examinations upon admission demonstrated PE resulting in syncope. Further, a malignant TT, liver metastasis, and inferior vena cava (IVC) thrombosis were diagnosed.

Interventions:
Low molecular heparin was administered immediately after PE was diagnosed.

Outcomes:
The patient suffered from cardiac arrest on hospitalization.

Lessons:
Physicians should consider the possibility of TT when a young male patient presents with syncope and is diagnosed with PE that cannot be explained by a common cause. Treatment for TT and PE should be performed as early as possible to improve the prognosis of patients combine with TT and PE.
Acute renal failure in a patient with PR3-ANCA and monoclonal immunoglobulin deposition disease
Authors: Cassol Clarissa A. , Rao Pawan K. , Braga Juarez R. 
Published: December 2018

Abstract

Rationale:
Acute renal failure developing over a short period of time with evidence of glomerular disease by urine sediment microscopy characterizes the clinical syndrome of rapidly progressive glomerulonephritis (RPGN), of which the most common causes are ANCA-associated glomerulonephritis (GN), immune-complex mediated GN and anti-GBM disease.

Patient concerns:
This was a middle-aged gentleman who presented with acute renal failure and a positive PR3-ANCA.

Diagnosis:
Renal biopsy showed an unusual combination of PR3-ANCA GN with focal crescents, monoclonal immunoglobulin deposition disease (MIDD) and mesangial IgA deposition on renal biopsy.

Interventions:
Serum and urine protein electrophoresis (UPEP) and immunofixation showed no detectable monoclonal paraprotein; bone marrow biopsy was negative for plasma cell neoplasia. He received high dose steroids and rituximab.

Outcomes:
The patient did not respond to treatment and progressed to end-stage renal failure within 2 months after presentation.

Lessons:
To our knowledge, the simultaneous occurrence of MIDD, PR3-ANCA and mesangial IgA has not been reported. This case highlights not only the diagnostic but also the therapeutic challenges that such a complex case presentation poses to clinicians, where the culprit may not always be what would seem most obvious (such as ANCA in a patient with RPGN) but may, in fact, be an underlying and unsuspected disease, or possibly a combination of both.
Cisplatin-induced cardiotoxicity with midrange ejection fraction
Authors: Hu Yang , Sun Bin , Zhao Bin , Mei Dan , Gu Qing , Tian Zhuang 
Published: December 2018

Abstract

Rationale:
Cisplatin monotherapy-induced cardiotoxicity is rare, and the prevalence remains unknown. It's extremely important to stop cisplatin when cardiotoxicity is considered.

Patient concerns:
A 53-year-old woman developed cervical cancer. She was administered cisplatin (37 mg/m2/wk) for 3 weeks, but the left ventricular ejection fraction (LVEF) declined from 70% to 48%.

Diagnosis:
Electrocardiogram showed first-degree atrioventricular block and ST-segment depression by 0.05 mv on leads II, III, and V3–5. Neither cardiac markers nor N-terminal pro-B-type natriuretic peptide (NT-pro BNP) was elevated. After a careful physical examination and laboratory investigation, we confirmed that cervical cancer did not progress and no other cause was evident. So we figured cardiotoxicity might be induced by cisplatin.

Interventions:
Cisplatin was stopped and cardioprotective therapies were given to the patient.

Outcomes:
After discontinuing cisplatin and adding cardioprotective therapies, the LVEF increased to 50% and 53%, respectively (M-mode echocardiography) after 17 and 90 days, which further confirmed our diagnosis.

Lessons:
According to this case and literature review, cisplatin-induced cardiotoxicity should be considered for the patient. When necessary, we should discontinue the suspected drug to confirm diagnosis. Cardioprotective therapies would minimize the drug-induced cardiovascular adverse events and improve patients’ outcome.
Effect of transcutaneous electrical acupoint stimulation on the EC50 of remifentanil suppressing responses to tracheal extubation in elderly patients
Authors: Yin Chun-Ping , Li Ya-Nan , Zhao Juan , Zhang Qi , Guo Yang-Yang , Gao Fang , Wang Xiu-Li , Wang Qiu-Jun 
Published: December 2018

Abstract
Transcutaneous electrical acupoint stimulation (TEAS) is a emerging treatment which combines transcutaneous electrical nerve stimulation with traditional acupoint therapy. The present study was aimed to evaluate the effect of TEAS on the effective concentration (EC50) of remifentanil suppressing tracheal extubation response in elderly patients.
Fifty-three patients undergoing spine surgery were randomly divided into 2 groups: control group (group C, n = 26) and transcutaneous electrical acupoint stimulation group (group TEAS, n = 27). The EC50 values for remifentanil TCI were determined using sequential method and probit analysis.
The remifentanil EC50 of that suppressed responses to extubation during anesthetic emergence was 1.20 ng/mL in group TEAS, a value that was significantly lower than the 1.64 ng/mL needed by patients in group C.
The TEAS can enhance the efficacy of remifentanil on suppressing responses to tracheal extubation in elderly patients, the EC50 of remifentanil can reduce approximately 27% compared with group C.
The impact of a heat wave on mortality in the emergency department
Authors: Oray Nese Colak , Oray Deniz , Aksay Ersin , Atilla Ridvan , Bayram Basak 
Published: December 2018

Abstract
Extreme heat wave increases the number of emergency department (ED) admissions and mortality rates. The purpose of our study is to investigate the effects of the heat wave experienced in Izmir province of Turkey on mortality.
During a 9-day period between 17th and 25th June 2016 (study period), air temperature values were higher than the seasonal norms in Izmir, Turkey. In this cross-sectional study, nontraumatic admissions and in-hospital mortality rates were compared this historical interval of the extreme heat wave with the same period of the previous year and the other 21 days of June 2016.
The average air temperature between 17th and 25th June 2016, was higher than the average air temperature of the previous year's same period and the average air temperature from the other 21 days of June 2016 (27.8 ± 3.6 °C, (24.5 ± 1.9°C, 24.1 ± 2.1°C, respectively) (P <.01)
During the study period, the mean number of ED visits and mortality rates were significantly higher than the previous year's same period (320 ± 30/day vs 269 ± 27/day, [P <.01], and 1.6% vs 0.7%, [P <.01]).
Although the admission rate was similar between the study period and the other 21 days of June 2016 (320 ± 30/day vs 310 ± 32/ day, [P = .445]); in-hospital mortality rate was significantly higher during study period (1.6% vs 0.7%, [P <.01]).
During the extreme heat waves, ED admissions and in-hospital mortality rates are increased. Precautions should be addressed for adaptation of people to extreme hot weather.
Is aquatic exercise more effective than land-based exercise for knee osteoarthritis?
Authors: Dong Rui , Wu Yunyao , Xu Shibing , Zhang Lei , Ying Jun , Jin Hongting , Wang Pinger , Xiao Luwei , Tong Peijian 
Published: December 2018

Abstract

Background:
This study aimed to systemically review the effectiveness of aquatic exercise (AQE) compared to land-based exercise (LBE) in treating knee osteoarthritis (OA).

Methods:
The Medline, Embase, Web of Science, Cochrane Central Register of Controlled Clinical Trials, CINAHL, and psyclNFO databases were comprehensively searched for randomized controlled trials (RCTs) evaluating the effectiveness of AQE and LBE for knee OA from their inception date to September 24, 2018. The risk of bias was examined using the Cochrane Collaboration Tool, and Review Manager 5.3 was used for data collation and analysis.

Results:
Eight RCTs were included, involving a total of 579 patients. The meta-analysis showed that there was no significant difference between AQE and LBE for pain relief, physical function, and improvement in the quality of life, for both short- and long-term interventions, in patients with knee OA. However, the adherence and satisfaction level for AQE was higher than for LBE. Compared to no intervention, AQE showed a mild effect for elevating activities of daily living (standardized mean difference [SMD]: −0.55, 95% confidence interval [CI] [−0.94, −0.16], P = .005) and a high effect for improving sports and recreational activities (SMD: −1.03, 95% CI [−1.82, −0.25], P = .01).

Conclusion:
AQE is comparable to LBE for treating knee OA.
Cardiovascular risk of sitagliptin in ischemic stroke patients with type 2 diabetes and chronic kidney disease
Authors: Liang Chung-Yu , Chen Dong-Yi , Mao Chun-Tai , Hsieh I-Chang , Hung Ming-Jui , Wang Chao-Hung , Wen Ming-Shien , Cherng Wen-Jin , Chen Tien-Hsing 
Published: December 2018

Abstract
Limited data are available about the cardiovascular (CV) safety and efficacy of sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, in ischemic stroke patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Ischemic stroke patients with T2DM and CKD were selected from the Taiwan National Health Insurance Research Database (NHIRD) from March 1, 2009 to December 31, 2011. A total of 1375 patients were divided into 2 age- and gender-matched groups: patients who received sitagliptin (n = 275; 20%) and those who did not (n = 1,100). Primary major adverse cardiac and cerebrovascular events (MACCE), including ischemic stroke, hemorrhagic stroke, myocardial infarction (MI), or CV death, were evaluated. During a mean 1.07-year follow-up period, 45 patients (16.4%) in the sitagliptin group and 165 patients (15.0%) in the comparison group developed MACCEs (Hazard ratio [HR] 1.05; 95% confidence interval [CI], 0.75–1.45). Compared to the non-sitagliptin group, the sitagliptin group had a similar risk of ischemic stroke (HR 0.82; 95% CI, 0.51–1.32.), hemorrhagic stroke (HR 1.50; 95% CI, 0.58–3.82), MI (HR 1.14; 95% CI, 0.49–2.65), and CV mortality (HR 1.06; 95% CI, 0.61–1.85). The use of sitagliptin in recent ischemic stroke patients with T2DM and CKD was not associated with increased or decreased risk of adverse CV events.
Isolated pancreatic tuberculosis with elevated CA 19-9 levels masquerading as a malignancy
Authors: Sun Pi-Jiang , Lin Yan , Cui Xi-Jun 
Published: December 2018

Abstract

Rationale:
Primary pancreatic tuberculosis is extremely rare, it presents with non-specific clinical symptoms and imaging features; it may be falsely identified as a malignancy of the pancreas.

Patient Concerns:
A 41-year-old male with no history of tuberculosis presented to our hospital with a 2-week history of jaundice.

Diagnoses:
Abdominal computed tomography (CT) showed a heterogeneous irregular hypodense mass in the head of the pancreas causing dilatation of the common bile duct (CBD), and it was enhanced after infusion of contrast material. Serum cancer antigen (CA) 19-9 was 124 U/mL (normal: 0–40 U/mL). He was preoperatively diagnosed as having a pancreatic carcinoma.

Interventions:
A Whipple procedure (pancreaticoduodenectomy) was performed. The pancreatic tuberculosis was confirmed based on the postoperative histopathologic specimens and acid-fast stain of the drainage. Then isoniazid, rifampicin, and ethambutol were given for 6 months.

Outcomes:
The patient recovered very well. There was no evidence of tuberculosis recurrence, and the patient remained free of symptoms during the follow-up examination 1 year after surgery.

Lessons:
Pancreatic tuberculosis should be considered when the mass is located on the head of the pancreas even with elevated serum CA19-9 levels.
A comprehensive comparison of fluorescence in situ hybridization and cytology for the detection of upper urinary tract urothelial carcinoma
Authors: Jin Hongyu , Lin Tianhai , Hao Jianqi , Qiu Shi , Xu Hang , Yu Ruichao , Sun Sheng , Zhang Peng , Liu Zhenhua , Yang Lu , Liu Liangren , Han Ping , Wei Qiang 
Published: December 2018

Abstract

Objective:
To compare the relative effectiveness of fluorescence in situ hybridization (FISH) and cytology in diagnosing upper urinary tract urothelial carcinoma (UUT-UC) and to evaluate the advantages and potential deficiencies of FISH analysis.

Methods:
We performed a complete systematic review based on studies from PubMed/Medline, Embase, Web of Science, Ovid, Web of Knowledge, and Cochrane Library. We identified 2031 patients with strict criteria in 14 individual studies between January 2005 to November 2017 in accordance to preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, we summarized the test performance using bivariate random effects models.

Results:
FISH was superior to cytology in terms of pooled sensitivities (84.0%, 95% confidence interval [CI] 74.4–90.5% vs 40.0%, 95% CI 33.6–46.7%). FISH and cytology were similar to each other in terms of pooled specificities, which were 89.5% (95% CI 85.3–92.6%) for FISH and 95.9% (95% CI 91.2–98.1%) for cytology.

Conclusion:
We confirm the superiority of FISH over cytology in terms of sensitivity and find similar diagnostic outcomes between them based on systematic analysis. Therefore, we demonstrate that FISH is extremely sensitive while still very reliable with a relatively low error rate for diagnosing UUT-UC.