bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel subchondral bone-grafting procedure for the treatment of giant-cell tumor around the knee
Authors: Wu Minhao , Yao Shiyi , Xie Yuanlong , Yan Feifei , Deng Zhouming , Lei Jun , Cai Lin 
Published: November 2018

Abstract
The vast majority of giant-cell tumors occur around the knee and characteristically affect the subchondral bone. Thermal damage to the articular cartilage arising from the application of polymethylmethacrylate (PMMA) or extensive intralesional curettage presents a challenging problem to orthopedic surgeons and patients due to compliance issues. For this reason, we developed a new subchondral bone-grafting procedure to restore massive bone defects and reduce degenerative changes in the knee.
The aim of this study was to describe the novel subchondral bone-grafting procedure and evaluate clinical outcomes in patients with giant-cell tumors around the knee.
This retrospective single-center study included a total of 27 patients with giant-cell tumors in the distal femur and proximal tibia admitted to our department from January 2012 to December 2015 and treated with aggressive intralesional curettage. Eleven males and 16 females were included. All cases underwent subchondral autograft bone grafting followed by bone cement reconstruction and instrument internal fixation. The Musculoskeletal Tumor Society (MSTS) score and short form-36 (SF-36) were applied to assess the functional outcome of the knee joint and quality of life. Tumor recurrence, Kellgren and Lawrence (KL) grade, and the distance of the cement to the articular surface were assessed throughout the sample.
All cases were followed up after surgery for an average of 32.9 ± 7.1 months (range 25–57 months). At the end of the follow-up period, all patients were alive and free from pulmonary metastasis. Complications associated with this surgery occurred only in 1 patient (3.7%), who presented with an incision infection that resolved with regular dressing and antibiotics. No fractures, instrument breakage, or joint fluid leakage occurred. Local recurrence occurred in 1 case (3.7%) at the distal femur after 23 months and was treated by wide resection followed by prosthesis reconstruction. Twenty-four patients (89%) did not develop radiographic findings of osteoarthritis: at the final follow-up 2 patients (7.4%), had progressed to KL1 and 1 patient had progressed to KL2. According to the MSTS scoring system, the functional score of the affected knee joint at the last follow-up ranged from 80% to 97%, with an average of 87.3%. The quality of life parameters assessed by the SF-36 survey at the last follow-up ranged from 47 to 96, with an average of 77.
For patients with giant-cell tumor of bone near the knee, subchondral bone grafting combined with bone cement reconstruction is recommended as a feasible and effective treatment modality.
Role of preoperative endoscopic clipping in laparoscopic distal gastrectomy for early gastric cancer
Authors: Park Dae Hwa , Moon Hee Seok , Sul Ji Young , Kwon In Sun , Yun Gee Young , Lee Seo Hee , Park Jae Ho , Kim Ju Seok , Kang Sun Hyung , Lee Eaum Seok , Kim Seok Hyun , Sung Jae Kyu , Lee Byung Seok , Jeong Hyun Yong 
Published: November 2018

Abstract
In this study, we evaluate the usefulness of preoperative endoscopic clipping for early gastric cancer (EGC) localization in laparoscopic distal gastrectomy.
We retrospectively screened all consecutive patients who underwent laparoscopic distal gastrectomy for EGC by 1 surgeon at Chungnam National University Hospital between January 2014 and December 2016. Patients who underwent combined surgery and patients who had tumors at the lower third of the stomach were excluded. Endoscopic clipping was performed prior to surgery by specialized endoscopists. During the operation, endoscopic metal clips were found using surgical devices, and laparoscopic vessel clips were attached on the presumed site; thereafter, intraoperative radiographs were obtained for confirmation.
We analyzed a total of 196 patients; of them, 101 were classified into the clipping group (CG) and 95 into the non clipping group (NCG). The 2 groups were comparable regarding their demographic characteristics. The CG showed less additional resection (2 of 101 patients [2.0%] vs 9 of 95 patients [9.4%], P = .021) and better outcomes in terms of the operation time (P = .000), duration of hospital stay (P = .036), and postoperative atelectasis (P = .001) than the NCG.
Preoperative endoscopic clipping was helpful in determining the exact resection margin in laparoscopic distal gastrectomy for EGC.
Nivolumab therapy for metastatic collecting duct carcinoma after nephrectomy
Authors: Yasuoka Shotaro , Hamasaki Tsutomu , Kuribayashi Eigo , Nagasawa Masato , Kawaguchi Takanori , Nagashima Yoji , Kondo Yukihiro 
Published: November 2018

Abstract

Rationale:
Collecting duct carcinoma (CDC) is a rare type of nonclear renal cell carcinoma, often presenting at an advanced stage of the disease, and standard treatment guidelines have not been established.

Patient concerns:
A 73-year-old man was admitted to our hospital with complaints of fever and lower right back pain.

Diagnoses:
Computed tomography revealed a poorly defined tumor of the right kidney without metastasis. The patient underwent right radical nephrectomy and was diagnosed with clinical stage T1bN0M0 renal cancer; the pathological findings showed collecting duct carcinoma.

Interventions:
After nephrectomy, multiple lung metastases were found in the following month, so first-line chemotherapy of gemcitabine (1000 mg/m2 on days 1 and 8, every 21 days) and cisplatin (70 mg/m2 on day 2, every 21 days) was administered. Due to disease progression, targeted therapy with axitinib (10 mg/body) and second-line chemotherapy of paclitaxel (200 mg/m2 on day 1, every 21 days) and carboplatin (area under the curve of 6 on day 1, every 21 days) were subsequently administered. However, the lung metastases progressed and new metastases spread to the right adrenal gland, liver, and lymph nodes. Based on the high expression of programmed death-ligand 1 in tumor cells, we treated the patient with the immune checkpoint inhibitor nivolumab.

Outcomes:
After 2 courses of treatment, he experienced a partial response and improved performance status, and thus was discharged from the hospital. To date, the patient is on his fifth course of treatment as an outpatient without disease progression.

Lessons:
The findings of our study suggest that nivolumab may be effective even if the patient has highly progressive CDC with a low PS, if PD-L1 is highly expressed in the tumor cells.
The association between body mass index and the risk of different gastrointestinal cancers
Authors: Ma Xueni , Gao Ya , Li Jipin , Zhang Dekui , Tian Jinhui 
Published: November 2018

Abstract

Background:
Changes in our lifestyle over the past few decades have led to a significant increase in the worldwide prevalence of both overweight (defined as a body mass index [BMI]≥25 kg/m2) and obesity (BMI≥30 kg/m2), thus leading to numerous harmful consequences for an individual's health. Several meta-analyses support the link between obesity and different gastrointestinal cancers, but substantial heterogeneity exists between studies. We will synthesize published systematic reviews to evaluate the association between body mass index (BMI) and the incidence and mortality of different gastrointestinal cancers.

Methods:
PubMed, EMBASE, and the Cochrane Library will be systematically searched for systematic reviews, meta-analyses, and pooled analyses in July, 2018. Two review authors will independently screen titles and abstracts for relevance, assess full texts for inclusion, carry out data extraction, and appraise methodological quality using AMSTAR checklist and reporting quality using PRISMA statement. The association between BMI and different gastrointestinal cancers will be estimated by computing the pooled relative risk (RR) and its 95% confidence interval (CI), which will be calculated from the adjusted RR, odds ratio, or hazard ratio, and 95% CI offered in the studies. Heterogeneity between studies will be assessed with the I

2
statistic as a measure of the proportion of total variation in estimates that is due to heterogeneity, where I

2
values of 25%, 50%, and 75% correspond to cut-off points for low, moderate, and high degrees of heterogeneity. The random effects model will be used as the pooling method when significant heterogeneity existed and the fixed effect model will be used when no heterogeneity was observed. Possible publication bias will be tested by Begg and Egger test.

Discussion:
This overview of systematic reviews will provide an accessible, comprehensive synthesis with which to inform clinicians and the development of guidelines for the management of the individuals with high BMI.

Ethics and dissemination:
Only published secondary data will be used in this study, and therefore ethics approval is not required.

PROSPERO registration number: CRD42018107334.
Effects of Shuganjianpihuatanxingqi decoction on mild subclinical hypothyroidism
Authors: Bai Litao , Zhao Jing , Gao Jialiang , Li Fei , Wei Fan , Li Jun , Xiao Yao , Han Xu , Wang Yaoli , Wang Danwei , Wu Fangying , Wei Junping 
Published: November 2018

Abstract

Introduction:
Mild subclinical hypothyroidism (SCH) can cause depression, fatigue, cognitive dysfunction, or other hypothyroid symptoms, and even progress to hypothyroidism. The treatment of mild SCH is controversial. Shuganjianpihuatanxingqi decoction (SD) is a frequently prescribed Chinese herbal medicine in patients with mild SCH. However, scientific evidence is needed to confirm the therapeutic effect of SD.

Methods and analysis:
This study is a randomized, double-blind, and controlled clinical trial. A total of 228 participants with the diagnosis of mild SCH will be randomly assigned to the SD or placebo group in a ratio of 1:1. Participants will receive treatment for 12 weeks and undergo 12-month follow-up. The primary outcome measure is the thyroid-stimulating hormone level, and secondary outcomes will be the differences in the results of Thyroid-related Quality of Life Questionnaire, blood lipids, and Traditional Chinese Medicine Symptom Score Scale between baseline and at 12 weeks after intervention.

Ethics and dissemination:
The study has been approved by Guang’anmen Hospital of China Academy of Chinese Medical Sciences (no.2018-005-ky-01). The trial results will be published via peer-reviewed journals and the Clinical Research Information Service.

Trial registration number:
ChiCTR1800015781 (approval date: 20 April 2018).
A case report of metastatic breast cancer initially presenting with esophageal dysphagia
Authors: Liu Ailing , Feng Yunlu , Chen Bo , Li Li , Wu Dongsheng , Qian Jiaming , Yang Aiming 
Published: November 2018

Abstract

Rationale:
Breast cancer metastasis to the esophagus is uncommon. To our knowledge, the present case is the first report of breast cancer with dysphagia as the initial symptom.

Patient concerns:
A 62-year-old woman was admitted to our hospital for progressive dysphagia.

Diagnoses:
Endoscopic ultrasound-guided fine needle biopsy of the esophageal lesion found poorly differentiated carcinoma, and surgical resection of the breast nodule revealed invasive ductal carcinoma.

Interventions:
The patient underwent an esophagectomy, and the immunohistochemistry of surgical specimen was identified as metastatic breast cancer. Then patient was treated with chemotherapy and hormone therapy.

Outcomes:
The patient remained symptom-free during 5 months of follow-up examinations.

Lessons:
This case indicates that metastatic breast cancer to the esophagus should be considered as a cause of esophageal stricture in older women.
Massive idiopathic spontaneous hemothorax complicating anti-N-methyl-d-aspartate receptor encephalitis
Authors: Wang Xin , Lai Yutian , Li Pengfei , Zhou Kun , Che Guowei 
Published: November 2018

Abstract

Rationale:
Spontaneous hemothorax is a subcategory of hemothorax which can be life threatening. The etiology of spontaneous hemothorax can be various, and in some rare cases the causes remained unknown. Hence, it is quite difficult to establish the diagnosis. Here, we report a case of spontaneous hemothorax in a young female patient who was recently diagnosed with anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDAR encephalitis).

Patient concerns:
A 20-year-old female was transferred to emergency department of our hospital from local hospital presented with insomnia, mood lability, tonic-clonic seizure, and decreased level of consciousness.

Diagnoses:
The diagnosis of anti-NMDAR encephalitis was established by detection of cerebrospinal fluid (CSF) and serum antibodies to the NMDA receptor. During the hospital stay, the patient developed massive spontaneous hemothorax and was confirmed by closed-tube thoracostomy.

Interventions and outcomes:
Video-assisted thoracotomy was performed to evacuate the blood clots and also to obtain pleural biopsy specimen for diagnostic evaluation. However, the reason of hemothorax remained idiopathic. The postoperative status of this patient was uneventful, and she was discharged on postoperative day 45 as her mental status improved markedly.

Lessons:
In this case, the patient had both anti- NMDAR encephalitis and autoimmune thyroid disease. Based on it, we suspected that the patient subjected to severe autoimmune response and inflammatory reaction, which might explain the pathologic changes of parietal pleura and visceral pleura. We recommend the suspicion of spontaneous hemothorax should be considered when the patients with autoimmune diseases present with hemorrhage-related signs or symptoms.
Okbyungpoongsan (Yupingfeng) for treating allergic rhinitis
Authors: Lee Minseong , Kim Youngjo , Lee Ju Ah 
Published: November 2018

Abstract

Background:
Okbyungpoongsan (OBPS) is widely used as a treatment for allergic rhinitis (AR) in Far East countries. Many clinical trials have assessed the efficacy and safety of the OBPS formula for treating AR. Here, we systematically will review the clinical evidence for and against administration of OBPS.

Methods and analysis:
All RCTs of decoctions or modified decoctions will be included. The methodological quality of the RCTs will be analyzed using the Cochrane Collaboration tool for assessing risk of bias, while confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument.

Ethics and dissemination:
This systematic review will be published in a peer-reviewed journal and will also be disseminated electronically and in print. The review will be updated to provide additional information and guide healthcare practices.
Registration number: CRD42017080292.
Outcomes of Noninvasive Ventilation in Obese Patients With Acute Asthma Exacerbations
Authors: Thapamagar Suman B. , Doshi Viral , Shenoy Sundeep , Ganesh Aarthi , Lankala Shilpa 
Published: November 2018

Background:
The role of noninvasive positive pressure ventilation (NIPPV) in acute asthma exacerbation is controversial. However, the outcome of NIPPV in obese patients with asthma during such exacerbation has not been well studied despite well-established relationship between obesity and asthma.

Study Question:
Does body mass index (BMI) play a role in the outcome of NIPPV during an acute exacerbation and does it predict of the success or failure of NIPPV?

Study Design:
The study was a retrospective analysis by design. The purpose of the study was to assess factors predicting the success or failure of NIPPV. The entire cohort was divided into 2 groups: patients who failed NIPPV and patients who did not. Univariate and multivariate regression analysis was used to predict the variables. Stepwise selection method was used to select variables for final regression model.

Results:
A total 96 patients were included in the study. Of those, 18 patients (18.9%) failed NIPPV and required endotracheal intubation (group 1). Rest (78.1%) did not fail NIPPV (group 2). Mean age of the study population was 48.8 years and 53% of patients were female. In the univariate analysis, the group that did not fail NIPPV (group 2) had significantly higher number of obese patients (47.9% versus 22.2%; P 0.013). Multivariate analysis showed significant association between BMI categories (BMI of 30 or more) and failure of NIPPV (odds ratio 0.26, 95% confidence interval, 0.08–0.85; P-value 0.017). Forced introduction of smoking status as a risk factor did not change the significance of association.

Conclusion:
Despite the limitations of the study design and the sample size, our analysis showed that patients with high BMI (obese) fared well with NIPPV during acute asthma exacerbation. Because there are controversies on use of NIPPV during asthma exacerbation, larger-scale prospective studies are needed to better understand the role of NIPPV in obese patients with asthma during acute exacerbation.
A Survey Assessing Pediatric Transport Team Composition and Training
Authors: Patel Meral M. , Hebbar Kiran B. , Dugan Mark C. , Petrillo Toni 
Published: November 2018

Objective
The aim of this study was to assess national pediatric/neonatal specialty transport teams' composition and training requirements to determine if any current standardization exists.

Methods
This was a survey of the transport teams listed with the American Academy of Pediatrics via SurveyMonkey.

Results
While most of the teams maintain internal criteria for team competency and training, there is large variation across team compositions. The vast majority of the teams have a nurse-led team with the addition of another nurse, medic, and/or respiratory therapist regardless of mode of transport. Many of the teams report adjusting team composition based on acuity. Fewer than 15% of teams have a physician as a standard team member. More than 80% required a minimum number of supervised intubations prior to independent practice; however, the number varied largely from as little as 3 to as many as 30. Eighty-eight percent of the teams report using simulation as part of their education program, but again there were marked differences between teams as to how it was used.

Conclusions
There is tremendous variability nationally among pediatric/neonatal transport teams regarding training requirements, certifications, and team composition. The lack of standardization regarding team member qualifications or maintenance of competency among specialized transport teams should be looked at more closely, and evidence-based guidelines may help lead to further improved outcomes in the care of critically ill pediatric patients in the prehospital setting.
Implementing the 2016 American Academy of Pediatrics Guideline on Brief Resolved Unexplained Events
Authors: Brand Donald A. , Mock Ann , Cohn Elizabeth , Krilov Leonard R. 
Published: November 2018

Objectives
A “brief resolved unexplained event” refers to sudden alterations in an infant's breathing, color, tone, or responsiveness that prompt the parent or caregiver to seek emergency medical care. A recently published clinical practice guideline encourages discharging many of these infants home from the emergency department if they have a benign presentation. The goal is to avoid aggressive inpatient investigations of uncertain benefit. The present research explored parents' reactions to the prospect of returning home with their infant following such an event.

Methods
The study used qualitative research methods to analyze semistructured, audio-recorded interviews of parents who had witnessed a brief resolved unexplained event between 2011 and 2015 and taken their infant to the emergency department of an academic teaching hospital.

Results
A total of 22 parent interviews were conducted. The infants included 8 boys and 14 girls aged 3.6 ± 3.5 months (mean ± SD). Qualitative analysis of interview transcripts revealed a near-universal apprehension about the child's well-being, ambivalence about the best course of action after the evaluation in the emergency department, and need for reassurance about the unlikelihood of a recurrence. Parents did not, however, answer the main research question with a single voice: attitudes toward the return-home scenario ranged from unthinkable to extreme relief. Two-thirds of parents expressed at least some reservations about the idea of returning home.

Conclusions
Successful implementation of the 2016 guideline will require close attention to the parent's point of view. Otherwise, parental resistance is likely to compromise clinicians' best efforts.
Socioeconomic Status and Analgesia Provision at Discharge Among Children With Long-Bone Fractures Requiring Emergency Care
Authors: Ortega Henry W. , Velden Heidi Vander , Truong Walter , Arms Joseph L. 
Published: November 2018

Background
Inadequate treatment of painful conditions in children is a significant and complex problem. The objective of this study was to examine the effect of socioeconomic status on the provision of analgesic medicines at discharge in children treated emergently for a long-bone fracture.

Methods
A retrospective review of all patients during a 1-year period with a long-bone fracture treated in 2 urban pediatric emergency departments (EDs) was performed.

Results
Eight hundred seventy-three patients were identified who met our inclusion criteria. Sixty percent of patients received a prescription for an opioid-containing medicine, and 22% received a prescription for an over-the-counter analgesic medicine at ED discharge. Socioeconomic status had no effect on opioid analgesic prescriptions at discharge. Patients in the lowest-income group were younger, presented to the ED longer after an injury, were likely nonwhite, and had higher rates of over-the-counter analgesic medicine prescriptions provided at discharge. Higher-income patients were likely white and non-Hispanic, presented to the ED sooner, and were less likely to receive a prescription for a nonopioid analgesic medicine.

Conclusions
Socioeconomic status is associated with different nonopioid analgesic prescription patterns in children treated in the ED for a long-bone fracture, but had no effect on opioid analgesic prescriptions.