bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged Postoperative Ileus Significantly Increases the Cost of Inpatient Stay for Patients Undergoing Elective Colorectal Surgery: Results of a Multivariate Analysis of Prospective Data at a Single Institution
Authors: Mao Howe , Milne Tony G.E. , O’Grady Gregory , Vather Ryash , Edlin Richard , Bissett Ian 
Published: December 2018

BACKGROUND:
Prolonged postoperative ileus is a common major complication after abdominal surgery. Retrospective data suggest that ileus doubles the cost of inpatient stay. However, current economic impact data are based on retrospective studies that rely on clinical coding to diagnose ileus.

OBJECTIVE:
The aim of this study was to determine the economic burden of ileus for patients undergoing elective colorectal surgery.

DESIGN:
Economic data were audited from a prospective database of patients who underwent surgery at Auckland City Hospital between September 2012 and June 2014.

SETTINGS:
Auckland City Hospital is a large tertiary referral center, using an enhanced recovery after surgery protocol.

PATIENTS:
Patients were prospectively diagnosed with prolonged postoperative ileus using a standardized definition.

MAIN OUTCOME MEASURES:
The cost of inpatient stay was analyzed with regard to patient demographics and operative and postoperative factors. A multivariate analysis was performed to determine the cost of ileus when accounting for other significant covariates.

RESULTS:
Economic data were attained from 325 patients, and 88 patients (27%) developed ileus. The median inpatient cost (New Zealand dollars) for patients with prolonged ileus, including complication rates and length of stay, was $27,981 (interquartile range= $20,198 to $42,174) compared with $16,317 (interquartile range = $10,620 to $23,722) for other patients, a 71% increase in cost (p < 0.005). Ileus increased all associated healthcare costs, including medical/nursing care, radiology, medication, laboratory costs, and allied health (p < 0.05). Multivariate analysis showed that ileus remained a significant financial burden (p < 0.005) when considering rates of major complications and length of stay.

LIMITATIONS:
This is a single-institution study, which may impact the generalizability of our results.

CONCLUSIONS:
Prolonged ileus causes a substantial financial burden on the healthcare system, in addition to greater complication rates and length of stay in these patients. This is the first study to assess the financial impact of prolonged ileus, diagnosed prospectively using a standardized definition. See Video Abstract at http://links.lww.com/DCR/A825.
Tissue Acquisition During EBUS-TBNA
Authors: Pickering Edward M. , Holden Van K. , Heath Jonathon E. , Verceles Avelino C. , Kalchiem-Dekel Or , Sachdeva Ashutosh 
Published: December 2018

Background:
Previous studies have shown that needle gauge size has no significant impact on diagnostic yield during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Our objective was to determine whether cell blocks obtained via the new Flex 19G EBUS-TBNA needle would contain more cellular material based on cell area compared with those obtained from a 21G needle.

Methods:
A prospective analysis of patients undergoing EBUS-TBNA at our institutions was performed. Sampling of the same lesion(s) with both the Flex 19G and 21G needles was performed in an alternating manner. In total, 47 patients with suspected lung cancer or mediastinal/hilar lymphadenopathy were included with a total of 83 lesions biopsied. Cell block area was calculated using the Aperio ImageScope software.

Results:
Mean cell area in the Flex 19G group was 7.34±12.46 mm2 compared with 5.23±10.73 mm2 in the 21G group (P=0.02). In the malignant subgroup, the average cell area was 16.16±16.30 mm2 in the Flex 19G group versus 11.09±15.55 mm2 in the 21G group (P=0.02). No significant difference was noted in the mean cell area within the nonmalignant subgroup, 1.80±3.01 mm2 in the 19G group versus 1.56±1.79 mm2 in the 21G group (P=0.60).

Conclusion:
The cell area obtained via the 19G needle was significantly larger than that obtained with the 21G needle. Further multicenter randomized studies are needed to identify the utility of the Flex 19G needle in diagnosing/subtyping lymphoproliferative disorders and adequacy for molecular testing in non–small cell lung cancer.
Differential expression of circulating long non-coding RNAs in patients with acute myocardial infarction
Authors: Zhong Zhixiong , Hou Jingyuan , Zhang Qifeng , Li Bin , Li Cunren , Liu Zhidong , Yang Min , Zhong Wei , Zhao Pingsen 
Published: December 2018

Abstract
Long noncoding RNAs (lncRNAs) are non-protein coding transcripts regulating various critical physiological and pathological processes, yet limited information is available about lncRNAs expression in acute myocardial infarction (AMI). We aimed to identified differentially expressed lncRNAs in blood samples of patients with AMI to assess their diagnostic value. Differential expression of lncRNAs in peripheral blood mononuclear cells (PBMC) of patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) was compared by RNA sequencing method and validated by real-time polymerase chain reaction (PCR). The area under the receiver operating characteristic curve (ROC) was used to evaluate diagnostic accuracy. Gene ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of lncRNA-coexpressed mRNAs were conducted to determine the related biological modules and pathological pathways. RNA sequencing data showed that 58 lncRNAs were differentially expressed between NSTEMI patients and STEMI patients, including 42 upregulated lncRNAs and 16 down-regulated lncRNAs. The ROC curves showed that ENST00000508020.2, LNC_001265, LNC_001526, and LNC_002674 could distinguish AMI patients with preferable sensitivity and specificity. GO enrichment analysis of lncRNA-coexpressed mRNAs indicated that the biological modules were correlated with cell adhesion, calcium ion homeostasis, complement receptor mediated signaling pathway, and immune system process. KEGG pathway analysis indicated that the lncRNAs-co-expressed mRNAs were involved in the regulation of peroxisome proliferators-activated receptors (PPAR) signaling pathway, mTOR signaling pathway, Insulin signaling pathway, HIF-1 signaling, and chemokin signaling pathway. Our results are in line with the previous findings, suggesting that differential expression of lncRNAs would be helpful to understand the molecular mechanism of AMI and might be useful biomarkers for noninvasive diagnostic application. Further studies are still needed to verify our findings and hypothesis.
High prevalence of IgE sensitization against house dust mites in pregnant women
Authors: Yeh Chang-Ching , Wu Keh-Gong , Wang Peng-Hui 
Published: December 2018

Abstract
There is an increase in prevalence and financial burden of childhood atopic disorders in recent years. Understanding allergic conditions of pregnant women is important for developing strategies for prevention and management of allergy-related diseases. However, little is currently known about the atopic conditions in pregnant women.
The sera from 46 pregnant women were analyzed for allergen-specific IgE antibodies using the Optigen assay and SDS-PAGE immunoblot analysis.
Results from the Optigen assay showed that 20 (43%) of the 46 serum samples analyzed demonstrated IgE reactivity against mite p (Dermatophagoides pteronyssinus) (95%), mite f (D farinae) (95%), house dust (60%), cat (25%), shrimp (20%), crab (15%), cockroach (10%), dog (5%), latex (5%), willow black (5%), and timothy grass (5%). Nineteen of the 20 Optigen-positive sera demonstrated IgE reactivity against both the house dust mites D pteronyssinus and D farina, with 10 of them having a high IgE CLA class value of 4. IgE reactivity to the house dust mite D pteronyssinus was confirmed in SDS-PAGE-immunoblots, which correlated well with the intensity of IgE-binding to the 15-kDa D pteronyssinus component and to the purified recombinant Der p 2 major house dust mite allergen.
A high prevalence of IgE sensitization against house dust mites during pregnancy is noted, which is worthy of clinical attention. Children of IgE-sensitized mothers should be closely monitored for development of allergenic disorders.
Conventional 99mTc-(hydroxy) methylene diphosphate remains useful to predict osteosarcoma response to neoadjuvant chemotherapy
Authors: Kubo Tadahiko , Furuta Taisuke , Sakuda Tomohiko , Ochi Mitsuo , Adachi Nobuo 
Published: December 2018

Abstract

Background:
The current standard of chemotherapy response evaluation holds the most important prognostic factor to be the histological assessment of the tumor necrosis of the excised lesion, but the major challenge is to find an early prognostic factor that will allow the adjuvant treatment regimen to be adjusted. The objective of this systematic review is to provide an up-to-date and unprecedented summary of the value of 99mTechnetium-methylene diphosphate or -hydroxymethylene diphosphate (99mTc-MDP/HMDP) scintigraphy for the preoperative evaluation of osteosarcoma response to chemotherapy.

Methods:
Studies evaluating the alteration ratio (percentage change of the Tc-99m -MDP/HMDP uptake between before and after neoadjuvant chemotherapy) to predict the histological response of osteosarcoma to chemotherapy were searched for in MEDLINE, EMBASE, and Web of Science. A meta-analysis of individual patient data (IPD) was performed to determine the optimal cut-off point from the receiver operating characteristic (ROC) curve. Additionally, aggregate data (AD) meta-analysis was performed to compare the value of 99mTc-MDP/HMDP scintigraphy with that of other quantitative modalities, such as dynamic magnetic resonance imaging (MRI), 201Tl scintigraphy, and 18F-FDG PET-CT.

Results:
Seven studies with 154 patients were included for the IPD meta-analysis. The optimal cut-off point of the alteration ratio was 31.0%. Five studies with 123 patients were considered for the AD meta-analysis. The pooled sensitivity and specificity were 0.76 (95% CI, 0.63–0.86) and 0.89 (95% CI, 0.79–0.95), respectively. There was a significant difference between the good and poor responders in terms of the diagnostic odds ratio. The summary ROC curve demonstrated that the area under curve (AUC) was 0.892, indicating excellent diagnostic accuracy.

Conclusion:
Our findings have suggested that conventional 99mTc-MDP/HMDP scintigraphy remains as useful as recent quantitative modalities to predict the histological response of osteosarcoma to neoadjuvant chemotherapy.
Successful treatment with temozolomide in an elderly woman with advanced pulmonary large-cell neuroendocrine carcinoma
Authors: Wei Juan , Dong Xiao Fang , Hu Zu Liang , Tang Sheng , Lu Yi Fang 
Published: December 2018

Abstract

Rationale:
Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a rare type of lung cancer, and 40% of patients are in stage IV at initial diagnosis. It has an extremely poor prognosis with a 1-year survival rate of 27%. Patients with LCNEC are predominantly male, older, and heavy smokers. There has been no clinical trial conducted to determine the best treatment for advanced LCNEC. Temozolomide (TMZ) has been successfully used to treat a variety of malignancies, such as glioblastoma multiforme, astrocytoma, non-small-cell lung carcinoma. However, its efficacy in advanced stage pulmonary LCNEC has rarely been studied.

Patient concerns:
We present the rare case of a 69-year-old woman with advanced pulmonary LCNEC. She complained of recurrent dry cough for more than 1 month.

Diagnoses:
After chest computed tomography (CT) and biopsies of supraclavicular lymph nodes, the diagnosis of stage IIIB LCNEC of the lung was made.

Interventions:
Four cycles of chemotherapy with etoposide and cisplatin was administered as the first-line regimen. As the disease progressed, we administered icotinib and liposomal paclitaxel. Finally, we administrated TMZ as the third-line regimen.

Outcomes:
The patient showed partial response after 5 months. She has survived for 19 months from the time of diagnosis with a good performance status.

Lessons:
TMZ appears to be an efficacious option to treat elderly patients with advanced LCNEC.
A comparative study on the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain in patients with laparoscopic cholecystectomy
Authors: Kamali Alireza , Ashrafi Taha Hojati , Rakei Siamak , Noori Gholamreza , Norouzi Afsaneh 
Published: December 2018

Abstract

Background:
Today, the ever-expanding technology is inevitably shadowing on all aspects of human life. This study was aimed to compare the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain.

Methods:
The study population consisted of 132 patients aged 18 to 70 years and from both genders, who were candidates for emergency cholecystectomy or elective surgery. Group A consisted of 66 patients who received dexmedetomidine, and Group B included 66 patients with paracetamol administration. The amount of postoperative pain was measured on the basis of visual analog scale, arterial blood pressure, as well as heart rate at recovery and 4, 12, and 24 hours after surgery.

Results:
The mean age in the 2 groups was similar and almost equal to 52 years; there was no difference in the sex ratios in both groups (P > .05). Pain score in the paracetamol group was significantly lower than that in the dexmedetomidine group (P = .04); nevertheless, there were no group differences in the mean scores of pain during these hours (P > .05). The median opioid use in 24 hours after operation in the paracetamol group was lower when compared with that in the dexmedetomidine group, and the mean duration of analgesia in the paracetamol group was higher when comparing with dexmedetomidine group. Furthermore, in both groups, mean arterial pressure and preoperative PR interval were similar at various times.

Conclusion:
The findings demonstrated that both regimens of drugs can control the hemodynamic status of patients during laparoscopic cholecystectomy, which provides effective postoperative analgesia for pain management.
Corneal dysplastic melanosis associated with recurrent corneal erosions
Authors: Lee Hyo Kyung , Lee Cheol , Kim Mee Kum 
Published: December 2018

Abstract

Rationale:
Pigmented lesions of conjunctiva and cornea can be observed in various conditions, from the benign nevus to malignant melanoma. Pigmented acquired melanosis (PAM) is one of them, which is a neoplastic proliferation with malignant transformation potential of melanocytes. However, to our knowledge, there has been no report as to a disturbance of corneal barrier function caused by PAM. Here we report a case of corneal PAM which led to recurrent corneal erosions.

Patient concerns:
A 60-year-old woman was referred with a 4-month history of intractable recurrent epithelial erosions in the left eye. She denied any history of ocular trauma or surgery. Slit-lamp examination showed small epithelial defects and loose epithelium of overlying pigmented corneal lesions. The pigmentations were scattered in the corneal epithelial layer, from limbus to the central cornea.

Diagnosis:
Conservative treatment with therapeutic contact lens and oral doxycycline did not completely cure the corneal erosion. En bloc resection of the pigmented epithelium with cryotherapy and temporary amniotic membrane transplantation were performed. Histopathologic examination demonstrated pigmented melanocytes with mild atypia, scattered mainly in the corneal basal epithelium. Immunohistochemically, the cells were positive for Melan A/MART-1 and negative for CD68 and S100. The Ki-67 proliferation index was low. Therefore, it was diagnosed as primary acquired dysplastic melanosis causing epithelial barrier dysfunction.

Interventions:
We performed en bloc resection of the pigmented epithelium with cryotherapy and temporary amniotic membrane transplantation.

Outcomes:
After the resection, recurrent corneal erosions and epithelial loosening were completely resolved. Although some pigmented lesions were recurred in the limbal epithelium at 8 o’clock, corneal erosion did not recur during the follow-up for 9 months.

Lessons:
Our report suggests that primary acquired dysplastic corneal melanosis may cause epithelial dysfunction resulting in recurrent corneal epithelial erosions.
Identifying risk factors of lateral lymph node recurrence in clinically node-negative papillary thyroid cancer
Authors: Ryu Young Jae , Kang Shin Jae , Cho Jin Seong , Yoon Jung Han , Park Min Ho 
Published: December 2018

Abstract
There is still debate regarding the role of routine central lymph node (LN) dissection in treating clinically node-negative papillary thyroid cancer (PTC). The aim of this study was to investigate the risk factors for lateral recurrence after total thyroidectomy and prophylactic bilateral central LN dissection in clinically node-negative PTC patients.
We retrospectively collected the medical records of 1406 PTC patients who underwent total thyroidectomy and prophylactic bilateral central LN dissection between January 2004 and December 2008. We used Cox- proportional hazards regression analyses to inspect the predictive factors for recurrence.
During a median follow-up of 107 months (range, 13–164 months), 68 (4.8%) and 37 (2.6%) patients experienced recurrence in any lesion and in lateral neck LN, respectively. Male, main tumor size >1 cm, nodal factors (pathologic N1a, positive delphian LN, and LN ratio >0.15), lymphovascular invasion, and extrathyroidal extension (ETE) were significantly associated with lateral neck LN recurrence in univariate analysis. Multivariate analysis showed that male (hazard ratio [HR], 2.217; 95% confidence interval [CI], 1.057–4.647; P = .035), main tumor size >1 cm (HR, 2.257; 95% CI, 1.138–4.476; P = .020), pathologic N1a (HR, 5.957; 95% CI, 2.573–13.789; P < .002), minor ETE (vs no ETE; HR, 3.027; 95% CI, 1.315–6.966; P = .009), and gross ETE (vs no ETE; HR, 4.058; 95% CI, 1.685–9.774; P = .002) were independent predictors for lateral neck LN recurrence.
Among patients with pathologic N1a, those with LN ratio of more than 0.55 had worse lateral neck LN recurrence-free survival. Lateral neck LN recurrence in clinically node-negative PTC patients is predicted by the factors of male, main tumor size >1 cm, ETE, and pathologic N1a.
Clinical effects of mindfulness meditation and cognitive behavioral therapy standardized for insomnia
Authors: Cheong Moon Joo , Lee Go-Eun , Kang Hyung Won , Kim Sooim , Kim Hye Kyung , Jo Han-ik , Kang Yeonseok , Kim Jae-Hyo , Baek Hyeon-Gi 
Published: December 2018

Abstract

Introduction:
This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of mindfulness meditation and cognitive behavioral therapy programs as a psychological intervention for insomnia disorders.

Methods and analysis:
We will search the following 11 electronic databases without language or publication status restrictions: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. Furthermore, we will also search 5 Korean-language databases (Oriental Medicine Advanced Searching Integrated System, Korean studies Information Service System, Research Information Service System, Korean Medical Database, and Korea Citation Index). The study selection and data extraction will be performed independently by 2 authors. The study quality assessment and evaluation of the quality of evidence for the main findings will be performed independently by 2 authors using the Cochrane tool for assessing risk of bias and predefined criteria (the Grading of Recommendations Assessment, Development, and Evaluation approach). Data synthesis and analysis will be performed using RevMan Version 5.3. Data will be synthesized by either a fixed effects or random effects model according to a heterogeneity test or the number of studies included in the meta-analysis. If any plan for documenting important protocol amendments changes, the researchers will have a revision agreement and then register the modification in the International Prospective Register of Systematic Reviews (PROSPERO).

Ethics and dissemination:
Ethical approval will not be required because individual patient data are not included and because this protocol is for a systematic review. The findings of this systematic review will be disseminated through conference presentations.
PROSPERO registration number: CRD42018111217.
Multiple cavernous hemangiomas of the lung and liver mimicking metastasis
Authors: Zhuang Bo-wen , Li Wei , Chen Zhi-feng , Cao Chuang-jie , Xie Xiao-yan , Xie Xiao-hua 
Published: December 2018

Abstract

Rationale:
Cavernous hemangiomas are benign vascular malformations that usually involve the skin, subcutaneous tissue, and liver. Described herein was multiple masses in the lung and liver mimicking metastasis, which was proved to be cavernous hemangiomas histologically.

Patient concerns:
A 78-year-old man with complaint of dizziness for 3 days was referred to the local hospital for medical attention.

Diagnoses:
Multiple masses in the lung and liver was diagnosed pathologically as cavernous hemangioma.

Interventions:
Because of the benign pathological characteristic and multiple distribution, no treatment except some symptomatic treatment for dizziness was administered.

Outcome:
After more than 2 years of follow-up visits, the patient had no apparent symptoms and was healthy.

Lessons:
Proper diagnosis of multiple cavernous hemangiomas is essential. The final diagnosis depends on the pathology results. The most appropriate management is follow-up. Surgical treatment is suitable for large or symptomatic lesions which can result in satisfactory prognoses.
A case report of endoscopic therapy for radiation-induced hemorrhagic gastritis in patient with recurrent hepatocellular carcinoma
Authors: Liang Ma , Liwen Zhang , Juan Dai , Yun Zhuang , Yanbo Ding , Jianping Chen 
Published: December 2018

Abstract

Rationale:
Radiation-induced hemorrhagic gastritis is an infrequent cause of upper gastrointestinal bleeding and difficult to manage. The current standard treatment has not been well established.

Patient concerns:
We described a 32-year-old male patient with hemorrhagic gastritis induced by external radiotherapy for hepatocellular carcinoma recurrence.

Diagnoses:
The endoscopic examination showed a diffuse area of bleeding in the gastric antrum.

Interventions:
After failure of conventional hemostasis treatment, we successfully stopped the hemorrhage with repeated endoscopic argon plasma coagulation (APC) combined with low-dose polyglycerol sclerotherapy.

Outcomes:
The patient was followed up for 6 months to date without recurrence.

Lessons:
Based on this case, we think that endoscopic APC combined with low-dose polidocanol sclerotherapy can be tried as a treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.