bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac tamponade after radiofrequency ablation for hepatocellular carcinoma
Authors: Chung Min-Woo , Ha Sang-Yoon , Choi Jung-Ho , Park Hyuk-Jin , Myung Dae-Seong , Cho Sung-Bum , Lee Wan-Sik , Kim Jin-Woong , Oh Hyung-Hoon , Joo Young-Eun 
Published: December 2018

Abstract

Rationale:
Radiofrequency ablation (RFA) is a safe and effective local treatment modality with a low complication rate and is commonly used to treat hepatocellular carcinoma (HCC). The clinical outcome of RFA may be closely related to the location, size, and shape of index tumors, and major complications, including hemorrhage, liver abscess, infarction, visceral organ perforation, hemothorax, pneumothorax, tumoral seeding, and hepatic failure. Cardiac tamponade is a rare and serious life-threatening complication associated with RFA. To date, a review of the medical literature reported 5 cases of cardiac tamponade after RFA for HCC. Herein, we report another case of cardiac tamponade after RFA for HCC in a 56-year-old man.

Patient concerns:
He had suffered from liver cirrhosis due to alcohol abuse. He had chronic obstructive pulmonary disease. Magnetic resonance imaging showed a 3.0-cm exophytic subcapsular HCC in segment IVa of left hepatic lobe. As the patient was at high risk for surgery because of poor lung function, RFA was selected as the treatment of choice. The index tumor was located in the vicinity of the diaphragm and colon. During RFA procedure, thermal injury to the adjacent diaphragm and colon was minimized by introducing artificial ascites. Bleeding or tumoral seeding was prevented by ablating the electrode track during electrode retraction.

Diagnosis:
Two hours after RFA, the patient presented with dyspnea, chest discomfort, and low blood pressure (80/60 mm Hg), suggesting cardiac tamponade. Immediate follow-up contrast-enhanced computed tomography image depicted the slightly high attenuated hemopericardium. Transthoracic echocardiography (TTE) showed a moderate amount of pericardial effusion with tamponade and a large hematoma.

Interventions:
Under fluoroscopy and portable echocardiography guidance, a cardiologist immediately inserted a 7-French pigtail catheter into the pericardial space and collected more than 200 cc of bloody pericardial fluid.

Outcomes:
After pericardiocentesis, the patient's symptoms and hemodynamic status were dramatically improved. Follow-up TTE showed scanty amount of pericardial effusion and the drainage catheter was removed. The patient was discharged.

Lessons:
When treating HCC in the left lobe (especially segments II and IVa), attention should be paid to cardiac tamponade. The early diagnosis and immediate treatment of cardiac tamponade may increase the chance of cure.
Comparison of anchor screw fixation versus mini-plate fixation in unilateral expansive open-door laminoplasty for the treatment of multi-level cervical spondylotic myelopathy
Authors: Lin Xiang , Chen Kaiwei , Tang Haijun , Huang Xianying , Wei Changwu , Xiao Zengming 
Published: December 2018

Abstract

Study design:
Systematic review and meta-analysis.

Background:
Anchor screw fixation and mini-plate fixation are widely used in unilateral open-door laminoplasty. There is a great controversy over the preferred fixation method. The purpose of this study is to evaluate the clinical outcomes between anchor screw fixation and mini-plate fixation for the treatment of multilevel cervical spondylotic myelopathy (MCSM).

Methods:
Related studies that compared the clinical effectiveness of anchor screw fixation and mini-plate fixation in cervical laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to March, 2018. Included studies were evaluated according to eligibility criteria. The main end points included: preoperative Japanese Orthopedic Association (JOA) scores, postoperative JOA scores, JOA scores improvement rate, preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), lamina open angle, operation time, blood loss, C5 nerve palsy rate and axial symptoms rate.

Results:
Papers in English and Chinese were searched for the initial review, but only 12 articles in Chinese were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle–Ottawa scale (NOS). Among 809 patients, 372 underwent anchor screw fixation and 437 underwent mini-plate fixation. The results of this meta-analysis indicated that no significant difference was found in preoperative JOA score, JOA scores improvement rate, preoperative CCI, preoperative ROM, C5 palsy rate and blood loss. However, compared with mini-plate fixation, anchor screw fixation patients showed higher axial symptoms rate [RR = 1.75, 95% CI (1.31, 2.35), P <.05], lower postoperative JOA scores [SMD = −0.38, 95% CI (−0.62, −0.15), P <.05], lower postoperative CCI [SMD = −0.64, 95% CI (−0.94, −0.33), P <.05], lower postoperative ROM [SMD = −1.11, 95% CI (−2.18, −0.04), P <.05], smaller lamina open angle [SMD = −1.98, 95% CI (−3.71, −0.24), P <.05], shorter operation time [SMD = −0.33, 95% CI (−0.59, −0.07), P <.05].

Conclusions:
Compared with anchor screw fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, future well-designed, randomized controlled trials are still needed to further confirm our results.
Incomplete intestinal obstruction as an initial and persistent presentation in chronic inflammatory demyelinating polyneuropathy
Authors: Wang Long , Yuan Xiao-Zheng , Zhao Xue-Min , Wang Fu-Yu , Wang Yu 
Published: December 2018

Abstract

Rationale:
Autonomic symptoms are not uncommon in chronic inflammatory demyelinating polyneuropathy (CIDP), but they are mostly mild and transient and are overshadowed by somatic manifestations. Here, we report a very unusual case of CIDP with severe autonomic symptom, intestinal obstruction, as initial and persistent symptom which responded well to high-dose glucocorticoid and intravenous immunoglobulin treatment.

Patient concerns:
We described a patient with CIDP with precedent and long-lasting incomplete intestinal obstruction. Clinical manifestations were precedent and chronic abdominal pain, distension and constipation, and later numbness and weakness of lower and upper limbs. Radiograph showed incomplete intestinal obstruction, cerebrospinal fluid (CSF) showed albuminocytological dissociation and electromyography indicated neurogenic lesion.

Diagnoses:
CIDP with incomplete intestinal obstruction was diagnosed based on the history, related symptoms, typical abdominal radiograph, CSF albuminocytological dissociation, and electromyographic findings.

Interventions:
The patient was treated with intravenous methylprednisolone and immunoglobulin.

Outcomes:
After treatment, the intestinal obstruction disappeared and the somato-symptoms improved greatly and gradually.

Lessons:
This case highlights the need for diagnostic vigilance in cases of incomplete intestinal obstruction of unknown cause. We recommend CSF and electromyography examination in view of rare but possibility of CIDP.
Metanephric adenoma with low apparent diffusion coefficient value mimicking renal cell carcinoma
Authors: Chang Chun-Bi , Ng Kwai-Fong , Wong Yon-Cheong , Lee Shen-Yang , Chuang Cheng-Keng , Wang Li-Jen 
Published: December 2018

Abstract

Rationale:
Metanephric adenoma (MA) is a rare and often benign tumor. Most MAs were misdiagnosed as renal cell carcinomas (RCCs) preoperatively. Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping can help to differentiate benign and malignant tumors. However, there are still pitfalls in using DWI and ADC to discriminate benign and malignant lesions.

Patient concerns:
A 56-year-old woman had a right renal metanephric adenoma. The tumor showed very low ADC value preoperatively and was misdiagnosed as a renal cell carcinoma.

Diagnosis:
Intraoperative ultrasound-guided percutaneous biopsy of tumor was performed. Based on the histopathological findings and immunohistochemical stains, a diagnosis of metanephric adenoma was suggested.

Interventions:
The patient received percutaneous cryoablation of this tumor. Five years later, she underwent right partial nephrectomy because local recurrence was revealed on a follow-up computed tomography (CT).

Outcomes:
MA was confirmed again by histological examination. The patient was uneventful after surgery.

Lessons:
ADC mapping can be used for differentiating RCCs from other benign tumors by their lower ADC values. However, some benign and malignant lesions have overlapped low ADC values. This case illustrated that a benign lesion such as MA could mimic RCC on ADC, by its highly cellular component. Cryoablation is an optional treatment, which has an increased risk of local recurrence. Follow-up CT or MRI is useful and necessary for detection of local recurrence by depicting enhancing solid parts in a tumor over time.
Pressure management as an occupational stress risk factor in irritable bowel syndrome
Authors: Popa Stefan Lucian , Leucuta Daniel Corneliu , Dumitrascu Dan Lucian 
Published: December 2018

Abstract
Irritable Bowel Syndrome (IBS) is the most prevalent functional gastrointestinal disorder. Psychosocial stress is one of the pathogenic factors involved in the pathogenesis of IBS. The Pressure Management Indicator (PMI) is a validated questionnaire to analyze all aspects of occupational stress—a model involving sources of pressure, the mechanisms of coping, the personality, and the resulting effects of the interaction between these 3 elements. The purpose of this study was to analyze the association between socio-professional stress effects in IBS, and the relationship of IL-6 levels and salivary cortisol with occupational stress.
We conducted a prospective cross-sectional study on 76 patients (39 patients with IBS, diagnosed according to the Rome III criteria and 37 healthy controls) who were investigated using a validated self-administered questionnaire: PMI. The biologic markers of chronic stress were analyzed using salivary cortisol and the immune response with serum interleukin 6 (IL-6).
The IBS patients corresponded to the following subtypes: diarrhea-predominant: 22, constipation-predominant: 14 and mixed: 3. All the socio-professional pressure effects variables and scales were statistically significant, in an inversely proportional relation with IBS. Lower scores (poor effects) were found in IBS subjects. The adjusted odds ratios of having IBS versus healthy subjects for the socio-professional pressure effects scales were: 0.81 (95% confidence interval (CI) 0.72–0.88), for satisfaction, 0.85 (95% CI 0.78–0.91) for organization, 0.85 (95% CI 0.79–0.91) for mental wellbeing and 0.8 (95% CI 0.71–0.87) for physical wellbeing (P <.001). Also, the serum IL-6 levels were significantly higher in IBS than in controls (p < 0.001). There was no statistical difference between the salivary levels of cortisol between IBS patients and controls (P = .898).
The level of occupational stress was higher in IBS patients compared to healthy subjects (socio-professional stress effects were lower in IBS patients) and correlated with IL-6 levels. Salivary cortisol was not associated with occupational pressure management.
Non-dislocation lunate fracture combined with distal radius fracture
Authors: Guo Wenlai , Yuan Baoming , Zhu Zhe , Huang Chao , Li Rui , Wu Dankai 
Published: December 2018

Abstract

Rationale:
Lunate fractures are very rare, accounting for only 0.5% to 6.5% of all carpal fractures. They are mostly caused by high-energy trauma and commonly occur with fractures and dislocations of other carpal bones. It is rarely combined with Colles’ fracture and the underlying pathogenesis and prognostic significance still remain controversial.

Patient concerns:
Here we report a case of a fresh lunate fracture combined with Colles’ fracture, without dislocations of other carpal bones caused by a low-energy fall injury.

Diagnoses:
Lunate fracture, Colles’ fracture.

Interventions:
This patient received closed reduction and internal fixation (CRIF) with K-wire.

Outcomes:
The patient took follow up 1 year and the patient showed good function of the wrist joint

Lessons:
Lunate fractures have no high misdiagnosis rate. Patients suffering persistent wrist swelling after a trauma should be carefully examined and followed up to prevent severe secondary diseases and wrist joint dysfunction.
Prognostic role of neutrophil–lymphocyte ratio in esophageal cancer
Authors: Zhang Xiangwei , Jiang Yuanzhu , Wang Yang , Wang Zhaoyang , Zhao Linping , Xue Xianbiao , Sang Shaowei , Zhang Lin 
Published: December 2018

Abstract

Background:
The prognostic role of neutrophil-to-lymphocyte ratio (NLR) in esophageal cancer (EC) remains controversial.

Methods:
The aim of this study was to evaluate the association between NLR and oncologic outcome of EC patients through a meta-analysis. A systematic search was performed in PubMed, Web of Science and Embase for relevant studies. Meta-analysis was performed using hazard ratio (HR) and95% confidence interval (CI) as effect measures.

Results:
Finally, 33 articles with 11,039patients were included in our study. The synthesized results indicated that the elevated NLR was negatively related to overall survival (OS) (HR = 1.39, 95% CI: 1.23–1.54). When the patients were stratified according to country, pathological type, treatment strategies, sample size, and different HR estimate method, high NLR was also significantly correlated with poor OS. Similarly, elevated NLR was also associated with shorter disease-free survival (DFS), progress-free survival (PFS), relapse-free survival (RFS), and cancer-specific survival (CSS).

Conclusion:
The elevated pretreatment NLR is associated with poor oncological outcomes in patients with EC. NLR may be a significant predictive biomarker in EC. Further large-cohort studies are needed to confirm these findings.
Relationships Between Adipose Mitochondrial Function, Serum Adiponectin, and Insulin Resistance in Persons With HIV After 96 Weeks of Antiretroviral Therapy
Authors: Hulgan Todd , Ramsey Benjamin S. , Koethe John R. , Samuels David C. , Gerschenson Mariana , Libutti Daniel E. , Sax Paul E. , Daar Eric S. , McComsey Grace A. , Brown Todd T. 
Published: December 2018

Objective:
Some antiretroviral therapy (ART) and HIV itself confer metabolic risk, perhaps through altered mitochondrial function and adipokines. In AIDS Clinical Trials Group study A5224s, adipose mitochondrial DNA (mtDNA) levels decreased on ART, and electron transport chain complex I (CI) and complex IV (CIV) activity decreased. Another study found decreased serum adiponectin on ART with mtDNA mutation m.10398A>G. We hypothesized that decreased adipose tissue mitochondrial function would be associated with lower adiponectin and insulin sensitivity on ART, and m.10398G would influence these changes.

Design:
Retrospective analysis of an ART-naive substudy population from A5224s.

Methods:
Analyses included adipose mtDNA levels, CI and CIV activity by immunoassay, visceral adipose tissue by computed tomography, and fasting serum glucose at week 0 and week 96 of ART. Fasting insulin and adiponectin were measured from cryopreserved serum using multiplex bead array. Homeostasis model assessment-2 (HOMA2)-IR and HOMA2-%B estimated insulin resistance and β-cell function, respectively. The m.10398A>G mtDNA variant was available from existing genetic data.

Results:
Thirty-seven participants had adipose biopsies at week 0 and week 96. Percent decreases in CIV activity and adiponectin were correlated (Spearman rho 0.41; P = 0.01); this association persisted after controlling for age, sex, body mass index, or visceral adipose tissue in single-covariate regression. HOMA2-IR correlated with decreased CIV (−0.44; P = 0.01) and CI (−0.34; P = 0.05) activity. Among 12 non-Hispanic white persons, m.10398G was associated with decreased adiponectin (P = 0.04).

Conclusions:
Decreased adipose mitochondrial activity correlated with changes in adiponectin and glucose homeostasis on ART. Previous findings that a mtDNA mutation modulates adiponectin levels in persons with HIV were replicated.
A Randomized Placebo-Controlled Trial of Low- Versus Moderate-Dose Vitamin D3 Supplementation on Bone Mineral Density in Postmenopausal Women With HIV
Authors: Yin Michael T. , RoyChoudhury Arindam , Bucovsky Mariana , Colon Ivelisse , Ferris David C , Olender Susan , Agarwal Sanchita , Sharma Anjali , Zeana Cosmina , Zingman Barry , Shane Elizabeth 
Published: December 2018

Background:Prevalence of osteoporosis and fracture is increased among older people with HIV. We compared the effects of low (1000 IU) vs moderate (3000 IU) vitamin D3(VitD) supplementation on areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD) in African American and Hispanic postmenopausal women with HIV on antiretroviral therapy.Methods:We performed a 12-month prospective, randomized, double-blind, placebo-controlled study with primary outcomes of change in aBMD by dual-energy X-ray absorptiometry (DXA) and secondary outcomes of change in vBMD by quantitative computed tomography and bone turnover markers. An intent-to-treat analysis was performed on 85 randomized subjects (43 low and 42 moderate) for primary DXA outcomes, and complete case analysis was performed for secondary outcomes.Results:Mean age was 56 ± 5 years, median CD4 count was 722 cells/mm3, and 74% had HIV RNA ≤ 50 copies/mL. Serum 25-OHD was higher in the moderate than low VitD group at 6 months (33.1 ± 10.3 vs 27.8 ± 8.1 ng/mL,P= 0.03) and 12 months, but parathyroid hormone levels remained similar. Percent change in aBMD, vBMD, and bone turnover markers did not differ between low and moderate VitD groups before or after adjustment for baseline aBMD.Conclusions:VitD supplementation at 3000 IU daily increased mean total 25-OHD levels in postmenopausal women with HIV, but we did not find evidence of an effect on BMD beyond those observed with 1000 IU daily. Future studies are necessary to determine whether VitD supplementation is beneficial in this patient population, and if so, what dose is optimal for skeletal health.
A review of racial/ethnic disparities in pediatric trauma care, treatment, and outcomes
Authors: LaPlant Melanie B. , Hess Donavon J. 
Published: December 2018

ABSTRACT
Health disparities are an increasingly researched topic in the United States. Evidence of disparities found across the spectrum of health care includes pediatric patients. The purpose of this review is to comprehensively summarize disparities among pediatric trauma patients, evaluating both emergency department and hospital treatment and outcomes. Multiple studies describe disparities in a variety of areas of trauma care including emergency department, radiology, surgery, abuse evaluation, and discharge rehabilitation. More concerning, multiple studies report disparities in length of stay, disability, recidivism, and mortality. This review also highlights several gaps in disparity research including specialty care, inclusion of all racial/ethnic groups, and geographic differences. Few of the reviewed studies described disparity interventions; however, research regarding abuse evaluations showed that care guidelines diminished disparity. Trauma care, a routinized patient service, is subject to existing care guidelines and quality improvement programs, and may be the ideal health care setting for disparity intervention.

LEVEL OF EVIDENCE
Study type review, level V.
Muography of different structures using muon scattering and absorption algorithms
Authors: Vanini S. , Calvini P. , Checchia P. , Rigoni Garola A. , Klinger J. , Zumerle G. , Bonomi G. , Donzella A. , Zenoni A. 
Published: December 2018

In recent decades, muon imaging has found a plethora of applications in many fields. This technique succeeds to infer the density distribution of big inaccessible structures where conventional techniques cannot be used. The requirements of different applications demand specific implementations of image reconstruction algorithms for either multiple scattering or absorption–transmission data analysis, as well as noise-suppression filters and muon momentum estimators. This paper presents successful results of image reconstruction techniques applied to simulated data of some representative applications. In addition to well-known reconstruction methods, a novel approach, the so-called μCT, is proposed for the inspection of spent nuclear fuel canisters. Results obtained based on both μCT and the maximum-likelihood expectation maximization reconstruction algorithms are presented.
This article is part of the Theo Murphy meeting issue ‘Cosmic-ray muography’.
Novel muon imaging techniques
Authors: Yang Guangliang , Clarkson Tony , Gardner Simon , Ireland David , Kaiser Ralf , Mahon David , Jebali Ramsey Al , Shearer Craig , Ryan Matthew 
Published: December 2018

Owing to the high penetrating power of high-energy cosmic ray muons, muon imaging techniques can be used to image large bulky objects, especially objects with heavy shielding. Muon imaging systems work just like CT scanners in the medical imaging field—that is, they can reveal information inside of a target. There are two forms of muon imaging techniques: muon absorption imaging and muon multiple scattering imaging. The former is based on the flux attenuation of muons, and the latter is based on the multiple scattering of muons in matter. The muon absorption imaging technique is capable of imaging very large objects such as volcanoes and large buildings, and also smaller objects like spent fuel casks; the muon multiple scattering imaging technique is best suited to inspect smaller objects such as nuclear waste containers. Muon imaging techniques can be applied in a broad variety of fields, i.e. from measuring the magma thickness of volcanoes to searching for secret cavities in pyramids, and from monitoring the borders of countries checking for special nuclear materials to monitoring the spent fuel casks for nuclear safeguards applications. In this paper, the principles of muon imaging are reviewed. Image reconstruction algorithms such as Filtered Back Projection and Maximum Likelihood Expectation Maximization are discussed. The capability of muon imaging techniques is demonstrated through a Geant4 simulation study for imaging a nuclear spent fuel cask.
This article is part of the Theo Murphy meeting issue ‘Cosmic-ray muography’.