bluuebunny/crossref_metadata_2025_split huggingface dataset:
Equipment failure of intravenous syringe pump detected by increase in Narcotrend stage
Authors: Niu Kai , Guo Chunjie , Han Chunying , Teng Shiyong 
Published: November 2018

Abstract

Rationale:
Awareness is the recovery of consciousness during general anesthesia. It occurs when patients under general anesthesia receive inadequate anesthetic medications to maintain unconsciousness during surgery. Equipment failure is a common cause of intraoperative awareness.

Patient concerns:
A 16-year-old boy, 85 kg in weight, was admitted to our hospital for thyroglossal cystectomy under general anesthesia. Six minutes after the intubation, we noted that the Narcotrend index indicated a condition of light anesthesia and the patient was observed to be in tears.

Diagnosis:
Improper positioning of the syringe fixing clamp on the CP700TCI infusion pump caused equipment failure and light anesthesia.

Interventions:
Bolus of 50 mg propofol and 2 mg midazolam were administered manually by syringe, and inhalation of 2% sevoflurane was supplemented. Infusion pump was replaced.

Outcomes:
The Narcotrend index of the patient returned to state of deep anesthesia following manual administration of the anesthetic medications. Following the surgery, the patient had an uneventful recovery, and did not present with evidence of awareness.

Lessons:
Users of the CP700TCI syringe pump should pay attention to the position of the syringe fixing clamp. Anesthesiologists should check all the equipment according to a defined checklist prior to anesthesia. Narcotrend monitor could help to detect light anesthesia and prevent potential awareness.
Effects of motivational methods on oral hygiene of orthodontic patients
Authors: Huang Jing , Yao Yunxia , Jiang Jiuhui , Li Cuiying 
Published: November 2018

Abstract

Objective:
The aim of our study was to qualitatively and quantitatively synthesize the evidence regarding ways to improve motivation of oral hygiene among orthodontic patients with fixed appliances and identify the effects of motivational methods via comparing the oral hygiene condition before and after the motivations.

Methods:
An electronic search was conducted in PubMed, Ovid, Embase, and the Crochrane Library for relevant random controlled trials (RCT) and clinical controlled trial (CCT) published before May 1st, 2017 with manual search in addition. Search and selection of studies, quality assessment, data extraction and synthesis was completed by 2 reviewers independently. Plaque index (PI) and gingival index (GI) at 1, 3, 6-month were pooled with Review Manager 5.3. Bias of included studies was evaluated.

Results:
In total, 12 studies fulfilled the inclusion criteria of this systematic review, of which, 5 were included in the meta-analysis. Motivational methods had statistically significant advantage regarding PI in the experimental group over control group at 1, 3, 6-month, while GI was significantly better controlled in the study group at 3, 6-month. The quality of included studies was moderate.

Conclusion:
It is worthy for orthodontists to put in additional efforts to motivate patients to maintain good oral hygiene throughout the entire treatment process.
Cerebrospinal fluid rhinorrhea in a bilateral frontal decompressive craniectomy patient caused by strenuous activity
Authors: Wang Guangming , Sun Lichao , Li Wenchen , Yu Jinlu 
Published: November 2018

Abstract

Rationale:
Iatrogenic cerebrospinal fluid (CSF) rhinorrhea in a bilateral frontal decompressive craniectomy patient triggered by strenuous sport is rare. To the best of our knowledge, no similar case has yet been reported.

Patient concerns:
Herein, we report a case of CSF rhinorrhea in a 37-year-old man. He had previously suffered a traumatic brain injury in a traffic accident, and a subsequent bilateral frontal decompressive craniectomy operation was performed. Based on the frontal skull defect peculiarity, strenuous exercise may have caused drastic CSF pressure waves to tear the dura mater of the anterior skull base, resulting in CSF rhinorrhea.

Diagnoses:
The thin-slice computerized tomography (CT) images revealed a frontal skull defect and the open frontal sinus. In addition, in the opened frontal sinus, low-density liquid-filled areas were visible.

Interventions:
During surgery, the torn dura was carefully repaired, and the frontal sinus was filled with temporal muscle, fascia, and fibrin glue. A simultaneous cranioplasty was performed.

Outcomes:
The patient was followed-up postoperatively for 12 months to date without rhinorrhea recurrence. Recovery was uneventful.

Lessons:
Patients with skull defects should avoid strenuous sports, and cranioplasty should be performed as early as possible in order to decrease the likelihood of a dural tear and prevent the occurrence of CSF leakage. After cranioplasty, the skull should be restored to a closed state to reduce the damaging effects of CSF waves during movement. It is important to maintain normal intracranial pressure to reduce the recurrence rate of CSF rhinorrhea.
The effects of tonsillectomy by low-temperature plasma on the growth development and psychological behavior in children with obstructive sleep apnea hypopnea syndrome
Authors: Cao Ying-Chun , Wang Xiang-Yun , Xu Wei-Wei , Li Jian-Dong , Yu Qiu-Hong 
Published: November 2018

Abstract
We investigated the effects of tonsillectomy by low-temperature plasma on the growth development and psychological behavior in children with obstructive sleep apnea hypopnea syndrome (OSAHS).
This study included 72 moderate and severe OSAHS children with tonsils or adenoids hypertrophy, which were randomly assigned into either the study group (n = 36) or the control group (n = 36). Patients in study group underwent tonsillectomy by low-temperature plasma, while in the control group underwent tonsil-pecking, then the efficacy were compared.
The time of surgery, VAS scores on postoperative day 1, 3, and 7 were significantly lower in the study group than in the control group, and the efficiency was significantly higher in the study group than the control group (P = .018). In the study group, the BMI was lower, the score of C-WISC (VIQ, PIQ, and FIQ) was higher, the score of CBCL social competence was higher and the score of behavioral questions was lower than that in the control group; differences were statistically significant (P = .022). The serum levels of IgA, IgG, and IgM, as well as the percentage of T lymphocytes, between the study group and the control group were not significantly different (P = .132).
Tonsillectomy by low-temperature plasma was effective on the treatment of children with severe OSAHS, and could improve growth development and psychological behavior.
The combination of Caprini risk assessment scale and thrombotic biomarkers to evaluate the risk of venous thromboembolism in critically ill patients
Authors: Fu Yang , Liu Yumei , Chen Si , Jin Yaxiong , Jiang Hong 
Published: November 2018

Abstract
To evaluate the correlation between the Caprini risk assessment scale and plasma thrombosis biomarkers and estimate the validity of this method in identifying critically ill patients at high risk of venous thromboembolism (VTE).
Patients with VTE who were admitted to the intensive care unit (ICU) department of West China Hospital SiChuan University from October 2016 to October 2017 were enrolled in this case–control study. We retrieved relative clinical data and laboratory test results included in the Caprini risk assessment scale to calculate the Caprini score and compared thrombosis biomarkers between various risk stratifications (low, moderate, high, and highest).
A total of 151 critically ill patients were enrolled in our research, including 47 VTE and 94 non-VTE patients. The differences in Caprini score and levels of thrombosis biomarkers between the VTE and control group were significant. Thrombomodulin (TM) was positively correlated with Caprini score (R-value was .451, P < .05). Based on the receiver operating characteristic analysis, TM, tissue plasminogen activator-inhibitor complexes, D-dimer, and fibrinogen degradation products had a certain diagnostic efficiency in distinguishing VTE from others (P < .05). Using the logistic regression model, we identified that 5 risk factors, namely drinking history, major surgery (>3 hours), swollen legs (current), TM, and D-dimer, were independent factors for the occurrence of VTE in critically ill patients admitted in the ICU.
Thrombosis markers were positively correlated with Caprini risk stratification. The combination of plasma markers and Caprini risk assessment scale can further increase the predictive value in critically ill patients with VTE.
Does pigtail catheters relieve pneumothorax?
Authors: Fang Ming , Liu Guilin , Luo Guoliang , Wu Tianyu 
Published: November 2018

Abstract

Background:
Pigtail catheter drainage has been usually applied for the treatment of pleural effusion and pneumothorax. Our aim was to investigate the application and efficacy of pigtail catheters for pneumothorax.

Methods:
We carried out a meta-analysis of retro- or pro-spective studies addressing the effect of pigtail catheters for pneumothorax. We presented success rates of pigtail catheter drainage as primary outcomes, and considered the duration of drainage, and complication rates as secondary outcomes. Pooled data were available using the fixed or random effects model. Heterogeneity, sensitivity, and subgroup analyses were performed.

Results:
The meta-analysis was based on 16 articles with a total of 1067 patients. Our analyses showed that pooled success rates were 0.77 (0.71–0.82), )furthermore, duration of drainage was 5.61 (3.99–7.23), and complication rates 0.18 (0.09–0.27). Subgroup results according to causes of pneumothorax and patient characteristics were robust and all consistent with overall outcomes.

Conclusion:
These suggested that pigtail catheter insertion within radiological guidance may provide a safe and effective way for the treatment of pneumothorax. More large-scale and prospective studies were required to determine these findings.
A comparison of shoulder muscular performance and lean mass between elite and recreational swimmers
Authors: Cheung Arthur T.H. , Ma Ada W.W. , Fong Shirley S.M. , Chung Louisa M.Y. , Bae Young-Hyeon , Liu Karen P.Y. , Kam Kevin W.K. , Chung Joanne W.Y. 
Published: November 2018

AbstractThis study compared the shoulder muscular performance and lean mass between elite and recreational swimmers.Thirty elite swimmers (mean age ± standard deviation = 23.1 ± 3.5 years) and 21 recreational swimmers (mean age ± standard deviation = 20.8 ± 2.1 years) participated in the study. Maximum muscle strength and time to maximum muscle strength of shoulder flexor, extensor, abductor, and adductor muscles were measured using a handheld dynamometer. Lean mass of the arms and body (excluding the head) were measured using dual-energy x-ray absorptiometry (DXA).Results revealed that compared with recreational swimmers, elite swimmers had higher maximum muscle strength of the shoulder flexor, extensor, abductor, and adductor muscles (allP < .001). The time to reach maximum muscle strength of all shoulder muscles showed no significant difference between the 2 groups (P > .05). The lean mass values in the left arm (P = .037), right arm (P < .001), and whole body (P = .014) were higher in elite swimmers than recreational swimmers.Elite swimmers had greater shoulder maximum muscle strength compared with recreational swimmers though the time taken to reach maximum muscle strength was similar between the 2 groups. Elite swimmers also showed a higher lean mass in both arms and their entire body when compared with recreational swimmers. The results may be useful for recreational swimmers who intend to advance to professional level, and for talent identification and early development of elite swimmers.
Association of smoking with risk of stroke in middle-aged and older Chinese
Authors: Gan Yong , Wu Jiang , Li Liqing , Zhang Shengchao , Yang Tingting , Tan Shuran , Mkandawire Naomie , Zhong Yanyan , Jiang Jie , Wang Zhihong , Lu Zuxun 
Published: November 2018

AbstractAlthough the impacts of smoking on health are well established, it is unclear on how they affect the Chinese population aged ≥40 years. This study aimed to investigate the association between smoking and risk of stroke in middle-aged and older Chinese adults, based on the data from the China National Stroke Prevention Project.A community-based cross-sectional study with 12,704 (5681 men, 7023 women) Chinese adults aged ≥40 years was conducted to examine the association of smoking with stroke. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).Among the study population, a total of 524 stroke survivors were identified. The age-adjusted prevalence of stroke was 4.06% for both sexes, 2.95% for women, and 5.38% for men. The multivariate-adjusted ORs (95% CI) of stroke associated with current cigarette smoking and former cigarette smoking were 1.67 (1.24–2.25) and 1.93 (1.29–2.87), respectively. Compared with those who were never-smokers, the multivariate-adjusted OR of stroke (95% CI) were 1.48 (0.96 to –2.29), 1.75 (1.20–2.56), and 2.37 (1.20 to –4.68) for those who smoked 1 to 10, 11 to 20, and ≥21 cigarettes per day; and 0.51 (0.19 to –1.42), 1.90 (1.36 to –2.67), and 2.01 (1.17 to –3.46) for those who smoked 1 to 19, 20 to 39, and ≥40 years, respectively (bothP < .001 for linear trends). Among former smokers, the multivariable-adjusted ORs of stroke by duration of smoking cessation (compared with never smokers) for <5, 5 to 19, and ≥20 years were 3.47 (1.42–8.49), 3.37 (1.95–5.80), and 0.95 (0.49–1.84), respectively (P = .009 for linear trend). The increased odds of stroke with smoking were more evident among participants who were men, >60 years old, or without family history of stroke than their counterparts.This study suggests the increased odds of stroke in current cigarette smokers with a graded increase in prevalent risk that depended on how many cigarettes and how many years were smoked. Moreover, quitting smoking appears to decrease this excess risk substantially.
Diagnostic challenges and good treatment outcomes in pediatric paraganglioma of the abdomen
Authors: Cui Qingyang , Lu Jun , Zhang Chong , Tan Shun 
Published: November 2018

Abstract

Rationale:
Paraganglioma is a catecholamine-producing neuroendocrine tumor. Management of paraganglioma including its diagnosis is difficult, because it has no characteristic symptoms and many diseases can manifest as headache and high blood pressure. Herein, we report a rare case of paraganglioma of the abdomen with headache and initial normal blood pressure.

Patient concerns:
A 9-year-old Chinese girl was hospitalized because of intermittent headache persisting for more than 9 months and recurrent headache for 15 days, accompanied by weight loss, impaired heat tolerance, and otherwise normal blood pressure.

Diagnoses:
We eventually diagnosed paraganglioma.

Interventions:
Her paroxysmal hypertension subsided over 1 month after surgical removal of the tumor.

Lessons:
Intermittent headache and normal hypertension as the initial symptoms of paraganglioma can easily lead to misdiagnosis as another disease (e.g., renal artery stenosis, primary hyperaldosteronism, Takayasu's arteritis), and its differential diagnosis is difficult. When a patient presents with intermittent hypertension, clinicians should consider a diagnosis of paraganglioma. The comprehensive use of ultrasonography, computed tomography (including enhanced computed tomography and 3D reconstruction), magnetic resonance imaging, and plasma catecholamine measurement can aid the diagnosis of paraganglioma.
Case report of dependent venous contrast pooling and layering in a patient without acute cardiogenic shock
Authors: Wagner Willi L. , Spira Daniel , André Florian , Kantharajah Ajith , Kauczor Hans-Ulrich , Mokry Theresa 
Published: November 2018

Abstract

Rationale:
We present a case of incidental venous contrast pooling and layering in a patient without sudden cardiac arrest or cardiogenic shock.

Patient concerns:
The patient presented with only discrete symptoms and did not suffer fatal cessation of the cardiac pump function during or shortly after the scan.

Diagnosis:
The patient showed stigmata of venous gravity-dependent pooling and layering of contrast medium, which has frequently been described as a sign of imminent cardiogenic shock and cardiac arrest.

Interventions:
A cardiologic consultation including echocardiography was initiated.

Outcomes:
Echocardiography confirmed valvular heart disease and biventricular heart failure. A subsequent follow-up CT acquired 8 months after the incidental finding showed no signs of dependent contrast pooling.

Lessons:
Pooling and layering of contrast medium can occur in patients not suffering acute fatal cessation of the cardiac pump function. Nonetheless, any signs of venous pooling observed in CT examinations, especially gravity-dependent layering of contrast medium, are indicative of severe heart dysfunction and should prompt immediate cardio-pulmonary monitoring and increased level of medical care.
Novel exploration of customized 3D printed shoulder prosthesis in revision of total shoulder arthroplasty
Authors: Zou Yun , Yang Yingying , Han Qing , Yang Kerong , Zhang Kesong , Wang Jincheng , Zou Yongwei 
Published: November 2018

Abstract

Rationale:
This paper describes the application of individual customized 3-dimensional (3D) printed macro-porous Ti6Al4 V shoulder prosthesis in the revision of total shoulder arthroplasty (TSA) for the patient with severe bone defects.

Patient concerns:
A 47-year-old male had been under proximal humeral resection and TSA due to shoulder chondrosarcoma 6 years ago, but a second surgery to insert a new prosthesis was then performed because the prosthesis became loose 2 months ago leaving severe bone defects which conventional prosthesis was not suitable for revision of TSA. American Shoulder and Elbow Surgeons’ Form (ASES), Neer and Constant-Murley score were 36, 39, and 39, respectively.

Diagnoses:
The patient was diagnosed with shoulder bone defects and restriction of the shoulder movement.

Interventions:
3D printed shoulder model and computer-aided design (CAD) were used for prosthesis design and surgical simulation. The novel 3D printed titanium alloy shoulder prosthesis was customized subsequently to be used in the revision of TSA. The patient was followed up regularly after surgery. The ASES, Neer Shoulder score and Constant-Murley Shoulder score were evaluated during pre-operation, post-operation, and follow-up.

Outcomes:
Prosthesis was successfully implanted to complete anatomic reconstruction intraoperatively. The scores of ASES, Neer, and Constant-Murley were gradually increased after the operation. According to the X-ray, the bone healed satisfactorily without change of prosthetic position at 3rd and 12th months after the operation. The function of shoulder could meet the requirements of daily activities.

Lessons:
The application of customized 3D printed titanium alloy shoulder prosthesis in the revision of TSA achieves satisfactory results. It provides a novel method for the similar revision surgery with severe bone defects.
Metastatic thymic carcinoid responds to chemoradiation and octreotide
Authors: Mei Zhu , Wang He , Ren Shengnan , Wei Juan , Gu Yanhong 
Published: November 2018

Abstract

Rationale:
Thymic carcinoids are a rare type of malignant neuroendocrine tumors which have a poor prognosis due to their distant metastasis, invasive behaviour, and postoperative recurrence. Surgical resection is still the fundamental mode for treating thymic carcinoids. Here, we report the rapid shrinkage of an atypical thymic carcinoid with multiple metastases following chemoradiation plus octreotide as a first-line therapy

Patient concerns:
A 39-year-old Chinese man presented with chest tightness, dyspnea with a history of lumbago and untreated malignant thymoma.

Diagnosis:
Thoracic computed tomography (CT) scan revealed an anterior mediastinal mass with pulmonary and multiple bone metastases as well as bilateral pleural and pericardial effusions. Percutaneous needle biopsy was performed on the mediastinal mass and the pathological diagnosis was neuroendocrine carcinoma of moderately differentiation (atypical carcinoid)

Interventions:
The tumor was considered unresectable because of extensive invasion into the lung and various bones. The patient was started on paclitaxel and oxaliplatin per 21 days for 4 cycles, and on 20 mg of depot formulation of octreotide once per 21 days. After 2 cycles of chemotherapy, the patient received concurrently mediastinal radiotherapy (39.6 Gy × 22 fractions).

Outcomes:
A follow-up CT of the chest at the completion of his fourth chemotherapy regimen demonstrated, approximately 22% of tumor shrinkage. There were no signs of disease progression but the patient refused further chemoradiation treatment. The patient received monthly treatment of octreotide and zoledronate and his progression-free survival reached 18 months. Due to uncontrollable disease progression, the patient expired.

Lessons:
Early diagnosis and radical surgery of thymic carcinoid are very important. However, radiotherapy (combined/noncombined chemotherapy) must be considered if radical resection is not performed. We believe that further study of chemoradiation and octreotide with the palliative intent of preparing tumors for shrinkage is warranted as a strategy to improve curative management of neuroendocrine tumors.
Cord-derived mesenchymal stem cells therapy for liver cirrhosis in children with refractory Henoch–Schonlein purpura
Authors: Mu Kai , Zhang Jing , Gu Yan , Li Hongjuan , Han Yan , Cheng Na , Feng Xiaoyu , Ding Guoyu , Zhang Rongjun , Zhao Yuqi , Wang Hongmei 
Published: November 2018

Abstract

Rationale:
To explore the curative effect of human umbilical cord-derived mesenchymal stem cell (ucMSC) therapy for patients with liver cirrhosis complicated with immune thrombocytopenia and refractory Henoch–Schonlein purpura (HSP).

Patient concerns:
A 12-year-old boy presented to our hospital with an 11-month history of purpura on the skin of both lower limbs accompanied by thrombocytopenia. The patient had a history of repeated swelling and painful dorsum pedis, followed by skin redness.

Diagnosis:
Bone marrow slides showed megakaryocyte maturation disorder. Based on the pathology and drug abuse history, he was diagnosed with nodular cirrhosis, secondary allergic purpura, and thrombocytopenia, etiologies related to his drugs and an immune dysfunction.

Interventions:
ucMSC transplantation was performed, the liver damaging drugs were discontinued, and the appropriate liver immunosuppressive drugs were administered. ucMSCs were injected 8 times/wk in 2 months, with a median cell count of 5.65 × 107/L, ranging from 5.48 to 5.98 × 107/L.

Outcomes:
As the patient's skin rash resolved, his platelets gradually increased to >150 × 109/L and liver transaminase levels gradually decreased to a normal level. Ultrasonography of the abdomen indicated that the round nodules in the liver decreased in size and that the spleen thickness also decreased.

Lessons:
This is a unique case of significant HSP with associated thrombocytopenia in a patient with liver cirrhosis. Long-term oral administration of excessive herbal medicine may cause liver damage. We believe that ucMSCs provide a novel approach for the treatment of liver cirrhosis.