bluuebunny/crossref_metadata_2025_split huggingface dataset:
Giant cell carcinoma of the lung presenting as an isolated cyst containing air
Authors: Wang Meifang , Liu Yuquan , Qian Xin , Li Dan , You Hui , Wei Na , Tang Yijun 
Published: May 2019

Abstract

Introduction:
Pulmonary sarcomatoid carcinomas (PSCs) are rare tumors within the sarcomatoid carcinoma group. Giant cell carcinoma of the lung (GCCL) is a rare type of PSCs that consists entirely of highly pleomorphic tumor giant cells; the prognosis is poor.

Patient concerns:
A patient presented with a single cyst and was diagnosed with GCCL. The patient was a 59-year-old male who was admitted to the hospital with a cough. A chest computerized tomography (CT) scan showed a single, thin-walled cyst containing air in the left upper lobe of the lung. Bronchoscopy revealed chronic bronchitis. The initial diagnosis was pulmonary infection and the patient was treated with antibiotics. The cyst wall increased in thickness, and the cyst eventually formed a cavity.

Diagnosis:
Surgery was performed, and a diagnosis of GCCL was established. The stage was pT1bN1M0 (equal to stage IIB).

Interventions:
The patient underwent video-assisted thoracoscopic surgery and 4 cycles of adjuvant chemotherapy consisting of cisplatin and docetaxel. After 9 months, the patient occurred mediastinal lymph node metastasis, and received radiotherapy (60Gy/30F).

Outcomes:
His prognosis was good without progression (complete response) based on serial CT scans over 9 months of follow-up evaluations, then the patient occurred mediastinal lymph node metastasis. The patient lived during 30 months of follow-up, after which he was lost to follow-up.

Conclusion:
A solitary pulmonary parenchymal cystic lesion usually suggests an infectious disease or congenital abnormality; however, a cystic lesion is occasionally encountered in GCCL.
Iatrogenic Kaposi sarcoma of the terminal ileum following short-term treatment with immunomodulators for Crohn disease
Authors: Stasi Elisa , De Santis Stefania , Cavalcanti Elisabetta , Armentano Raffaele 
Published: May 2019

Abstract

Rationale:
Kaposi sarcoma (KS) is a mesenchymal neoplasm associated with human herpes virus-8. It is often found in patients with primary or secondary immunodeficiency. An iatrogenic form of KS is detectable in patients who have received immunosuppressive therapy. To date, there are few reported cases of patients with KS treated with immunosuppressants for inflammatory bowel disease.

Patient concerns:
We report the case of a 45-year-old young woman with abdominal pain, episodic diarrhea and a mild weight loss. The patient was treated with immunosuppressive therapy for a parietal thickening of the terminal ileum, wrongly diagnosed as Crohn disease. After 9 months after the beginning of antitumor necrosis factor-α, the patient was admitted for obstructive symptoms. A computed tomography suspected neoplasia of ileocecal region. The patient underwent an uneventful ileocecal surgical resection.

Diagnoses:
The histopathology showed endometriosis of the ileal wall and an irrefutable diagnosis of KS by immunohistochemistry-positive staining for human herpes virus-8.

Interventions and outcomes:
The patient underwent surgical resection and is disease free at 6 years follow-up.

Lessons:
This case underlines the interaction of immunosuppressive therapy with the possible consequent development of visceral KS.
Haptic fracture and dislocation of polyimide intraocular lens after neodymium:YAG laser capsulotomy
Authors: Kim Jae Suk , Kang Min Ji , Jeong Kyeong Do , Hwang Je Hyung 
Published: May 2019

Abstract

Rationale:
We report a case of haptic fracture of polyimide intraocular lens (IOL) and its dislocation after neodymium:YAG (Nd:YAG) laser capsulotomy. To the best of our knowledge, this is the first report of both the fracture and dislocation of the IOL after laser posterior capsulotomy.

Patient concerns:
A 78-year-old male was referred to our clinic with a history of decreased visual acuity after Nd:YAG laser posterior capsulotomy in the right eye. A dislocated IOL was observed on slit lamp examination.

Diagnosis:
On slit-lamp examination, dislocated IOL with intact anterior capsulorrhexis margin was observed in the right eye.

Interventions:
We removed the dislocated IOL and fixed a 3-piece IOL (Acrysof MN60AC, Alcon Laboratories, Inc) in the ciliary sulcus under retrobulbar anesthesia.

Outcomes:
After the operation, the observed uncorrected distance visual acuity (UCVA) was 20/20 and the measured intraocular pressure (IOP) was 18 mmHg; the IOL was fixed in the ciliary sulcus.

Lessons:
Three-piece, silicone-polyimide haptics in IOLs can get fractured after Nd:YAG laser capsulotomy. Thus, it is suggested that sufficient haptic dilation should be ensured while performing Nd:YAG laser capsulotomy in patients with polyimide haptics. Moreover, a small-sized capsulotomy is likely to be helpful in such patients.
Epidemiology of sepsis in Taiwan
Authors: Chen Yen-Jung , Chen Fu-Lun , Chen Jin-Hua , Wu Man-Tzu Marcie , Chen Yen-Ling , Chien Du-Shieng , Ko Yu 
Published: May 2019

Abstract
To investigate the epidemiology trend and characteristics of sepsis-related hospitalizations in Taiwan, and to compare the differences among different severity levels of sepsis.
This study is a retrospective national claim database analysis. Hospitalized adult patients with sepsis between 2010 and 2014 were identified from the Two-Million-Sample Longitudinal Health and Welfare Database (LHWD) by the International Classification of Diseases 9th Edition Clinical Modification (ICD-9-CM). The patients were divided into 3 severity groups based on their medical records during hospitalization.
The study results showed that in Taiwan, there were 643 new cases of sepsis in 100,000 Taiwanese. The mortality of all septic patients in Taiwan was 287 per 100,000 people, and the case fatality was 29.2%. It was found that the mortality and incidence of sepsis in Taiwan have increased year by year, but there has been no significant change over time. In addition, demographic variation exists in the epidemiology of sepsis. In all the rates investigated, the men's were higher than the women's and the elderly's were higher than the youths’. The analysis results also showed that the respiratory system was the most common site of organ failure in septic patients.
The incidence and mortality of any severity level of sepsis were 643, and 287 per 100,000 people in Taiwan, respectively, and the average case fatality was 29.2% during the study period (2010–2014). The respiratory system was the major infected site and site of organ dysfunction, especially in the more severe levels.
Premedication with corticosteroids does not impact the pharmacokinetics of infliximab in inflammatory bowel disease irrespective of azathioprine cotreatment
Authors: Larsen Lone , Jess Tine , Drewes Asbjørn M. , Dige Anders , Fallingborg Jan , Jacobsen Bent A. , Aagaard Bitten , Agnholt Jørgen 
Published: May 2019

Objective
Loss of infliximab (IFX) effect is a clinical challenge in the management of patients with Crohn’s disease (CD), but this can potentially be reduced with azathioprine (AZA) or with corticosteroids (CS). We aimed to study whether CS premedication with or without cotreatment with AZA could reduce antibody formation and affect the IFX elimination rate.

Patients and methods
A cross-sectional observational study was conducted at two centers with CD patients receiving maintenance IFX therapy for 12–18 months. In addition to IFX, patients received either CS premedication or not, with or without concominant AZA.

Results
Fifty-seven patients were included in the study. Thirty-one patients received premedication with CSs, and 11 (35.5%) of these also received AZA, whereas this was the case for 22 of 26 (84.6%) patients in the non-CS group. No difference in IFX trough level (P=0.10) or halftime elimination (P=0.31) was observed with or without CS premedication. Concomitant AZA was associated with significantly longer mean half-life of IFX (P=0.04). Total IFX antibody concentrations were 15.8 and 12.9 with and without CS, respectively, in those not receiving AZA versus 4.3 and 6.1 AU/ml with and without CS, respectively, in those receiving AZA (P=0.004). Premedication with CS did not have any effect on the frequency of antibody formation (P=0.28).

Conclusion
In patients with CD and in maintenance IFX therapy, premedication with CS did not influence antibody formation, IFX trough levels or IFX halftime elimination, irrespective of concomitant AZA use. However, the use of AZA was associated with higher IFX trough levels and lower total IFX antibody concentrations.
Sleep disturbances in HIV-HCV coinfected patients: indications for clinical management in the HCV cure era (ANRS CO13 HEPAVIH cohort)
Authors: Costa Marie , Rojas Teresa Rojas , Lacoste Denis , Villes Virginie , Aumaitre Hugues , Protopopescu Camelia , Yaya Issifou , Wittkop Linda , Krause Jessica , Salmon-Céron Dominique , Marcellin Fabienne , Sogni Philippe , Carrieri Maria P. 
Published: May 2019

Objectives
Although common among patients coinfected with HIV and hepatitis C virus (HCV), sleep disturbances (SD) are still poorly documented in this population in the HCV cure era. This longitudinal study aimed at analysing SD in HIV-HCV coinfected patients and identifying their clinical and sociobehavioural correlates.

Methods
We used 5-year annual follow-up data from 1047 participants in the French National Agency for Research on Aids and Viral Hepatitis Cohort 13 ‘Hépatite et VIH’ (ANRS CO13 HEPAVIH) cohort of HIV-HCV coinfected patients to identify clinical (medical records) and behavioural (self-administered questionnaires) correlates of SD (mixed-effects logistic regression). SD were identified using one item documenting the occurrence of insomnia or difficulty falling asleep (ANRS ‘Action Coordonnée 24’ self-reported symptoms checklist), and two items documenting perceived sleep quality (Center for Epidemiologic Studies Depression and WHO Quality of Life HIV-specific brief scales).

Results
Seven hundred and sixteen (68.4%) patients with completed self-administered questionnaires reported SD at their most recent follow-up visit. In the multivariable model, hazardous alcohol consumption (Alcohol Use Disorders Identification Test-Consumption score ≥ 4 for men, ≥ 3 for women) (adjusted odds ratio = 1.61; 95% confidence interval: 1.09–2.36), depressive symptoms (6.78; 4.36–10.55) and the number of other physical and psychological self-reported symptoms (1.10; 1.07–1.13) were associated independently with SD after adjustment for sex, age and employment status. HCV cure was not associated significantly with SD.

Conclusion
SD remain frequent in HIV-HCV coinfected patients and are associated with a series of modifiable behavioural risk factors. Independent of HCV cure, improved screening and comprehensive management of alcohol use, physical and psychological self-reported symptoms and depression are essential in this population. Closer investigation of these risk factors of SDs may both increase sleep quality and indirectly improve patients’ clinical outcomes.
The efficacy comparison of carvedilol plus endoscopic variceal ligation and traditional, nonselective β-blockers plus endoscopic variceal ligation in cirrhosis patients for the prevention of variceal rebleeding: a meta-analysis
Authors: Yang Jiao , Ge Ke , Chen Ling , Yang Jian-Le 
Published: May 2019

Background
Currently, the first-line treatment regimen in cirrhotic patients for variceal rebleeding prophylaxis is still under debate.

Aim
This study aimed to compare the efficacy and safety of carvedilol plus endoscopic variceal ligation (EVL) and traditional, nonselective β-blockers (NSBBs) plus EVL in preventing variceal rebleeding.

Patients and methods
Studies were found in PubMed, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Med Online, and Wiper Database. Review Manager 5.3 was used to analyze the relevant data.

Results
Nine trials including 802 patients were identified (402 for carvedilol and 400 for traditional NSBBs). Carvedilol was more efficacious than traditional NSBBs in decreasing the variceal rebleeding rate [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.38–0.75; P = 0.0003], lowering the degree of esophageal varices (OR: 4.40; 95% CI: 2.64–7.34; P < 0.00001), decreasing the mean arterial pressure (standard mean difference: − 0.35; 95% CI: − 0.56 to − 0.14; P = 0.0009), reducing the total adverse events occurrence (OR: 0.39; 95% CI: 0.28–0.53; P < 0.00001), and decreasing drug-related adverse events (OR: 0.37; 95% CI: 0.25–0.56; P < 0.00001). No difference was noted between carvedilol and traditional NSBBs with respect to mortality and heart rate (OR: 0.72; 95% CI: 0.43; 1.22; P = 0.22 and standard mean difference: 0.09; 95% CI: − 0.12 to 0.30; P = 0.40, respectively).

Conclusion
Combined with variceal ligation, carvedilol was more effective and safer than traditional NSBBs in the prevention of rebleeding in cirrhotic patients.
Upper Gastrointestinal Endoscopy in Adolescents With Severe Obesity Before Vertical Sleeve Gastrectomy
Authors: Colman Ruben J. , Woo Baidal Jennifer A. , Zitsman Jeffrey L. , Mencin Ali A. 
Published: May 2019

ABSTRACTObjectives:Esophagogastroduodenoscopy (EGD) is often performed to evaluate for mucosal and anatomical abnormalities before vertical sleeve gastrectomy (SG). Little is known, however, about how prebariatric EGD in adolescents influences clinical management or outcome. Our aim was to assess if an abnormal prebariatric EGD resulted in interventions or modification of bariatric surgery.Methods:We performed a retrospective cohort study of adolescents undergoing evaluation for bariatric surgery. We obtained demographic and anthropometric data in addition to EGD findings, biopsy pathology, gastrointestinal symptoms, and surgical outcomes. An EGD was considered abnormal if either abnormal gross findings or abnormal pathology was reported. Patients were followed until a 6‐week postop visit.Results:Of 134 patients presenting for evaluation, 94 (70%) underwent preoperative EGD. Fifty‐one (54%) had a normal EGD and 43 (46%) had EGD abnormalities including 7 with an anatomical abnormality and 36 with mild mucosal abnormalities. Among patients with EGD abnormalities, 22% received medical intervention including proton pump inhibitor (PPI) administration (n = 10) and Helicobacter pylori eradication (n = 11). GI symptoms were the only predictor of EGD abnormalities (odds ratio [OR] 4.9: 95% confidence interval [CI] 1.6–15.0; P < 0.001). No factors predicted likelihood of a post‐EGD intervention. An abnormal EGD did not correlate with any postoperative complications.Conclusions:In this cohort of adolescents undergoing evaluation for SG, 46% had an abnormal EGD, of which 22% received a medical intervention. Symptoms were the only predictor of EGD abnormalities. Abnormal EGD findings were not associated with modification of the surgery or any adverse outcome.
Relationship Between Diaphragmatic Electrical Activity and Esophageal Pressure Monitoring in Children*
Authors: Essouri Sandrine , Baudin Florent , Mortamet Guillaume , Beck Jennifer , Jouvet Philippe , Emeriaud Guillaume 
Published: May 2019

Objectives:
Mechanical ventilation is an essential life support technology, but it is associated with side effects in case of over or under-assistance. The monitoring of respiratory effort may facilitate titration of the support. The gold standard for respiratory effort measurement is based on esophageal pressure monitoring, a technology not commonly available at bedside. Diaphragmatic electrical activity can be routinely monitored in clinical practice and reflects the output of the respiratory centers. We hypothesized that diaphragmatic electrical activity changes accurately reflect changes in mechanical efforts. The objectives of this study were to characterize the relationship between diaphragmatic electrical activity and esophageal pressure.

Design:
Prospective crossover study.

Setting:
Esophageal pressure and diaphragmatic electrical activity were simultaneously recorded using a specific nasogastric tube in three conditions: in pressure support ventilation and in neurally adjusted ventilatory support in a random order, and then after extubation.

Patients:
Children in the weaning phase of mechanical ventilation.

Interventions:
The maximal swing in esophageal pressure and esophageal pressure-time product, maximum diaphragmatic electrical activity, and inspiratory diaphragmatic electrical activity integral were calculated from 100 consecutive breaths. Neuroventilatory efficiency was estimated using the ratio of tidal volume/maximum diaphragmatic electrical activity.

Measurements and Main Results:
Sixteen patients, with a median age of 4 months (interquartile range, 0.5–13 mo), and weight 5.8 kg (interquartile range, 4.1–8 kg) were included. A strong linear correlation between maximum diaphragmatic electrical activity and maximal swing in esophageal pressure (r
2 > 0.95), and inspiratory diaphragmatic electrical activity integral and esophageal pressure-time product (r
2 > 0.71) was observed in all ventilatory conditions. This correlation was not modified by the type of ventilatory support.

Conclusions:
On a short-term basis, diaphragmatic electrical activity changes are strongly correlated with esophageal pressure changes. In clinical practice, diaphragmatic electrical activity monitoring may help to inform on changes in respiratory efforts.
Does bedtime matter among patients with chronic pain? A longitudinal comparison study
Authors: McHugh R. Kathryn , Edwards Robert R. , Ross Edgar L. , Jamison Robert N. 
Published: May 2019

Abstract

Introduction:
Chronic pain patients frequently report having sleep disturbances and many tend to stay up during the night and then sleep into the day.

Objectives:
This study was designed to compare a heterogeneous group of persons with chronic pain who reported typically going to bed between the hours of 9 pm and midnight with those who go to bed at other hours of the day and night.

Methods:
Two hundred seventy-nine participants were divided between those who reported going to bed between the hours of 9 pm and midnight (N = 205) and those who reported having atypical bedtimes (N = 74) based on pre–post questionnaire data and average pain assessments from a smartphone pain application (app).

Results:
Those individuals in the atypical bedtime group reported waking up more frequently and getting fewer hours sleep (P < 0.05). These individuals also reported significantly higher pain scores, activity interference, and taking more prescription opioid medication compared with those who had typical bedtimes (P < 0.05). Based on average 3-month daily assessments, those subjects with an atypical bedtime consistently reported more sleep disturbances, pain, activity interference, negative mood, and general worsening conditions over time, and elevated pain catastrophizing, pain-related disability, emotional distress scores, and more prescription medication for pain at 3-month follow-up (P < 0.01).

Conclusion:
These results support the importance of providers asking patients with pain about what time they typically go to bed at night to gain a greater understanding of their lifestyle habits. Future studies are needed to further determine the importance of maintaining a typical bedtime among patients with chronic pain.
Loneliness, Living Alone, and All-Cause Mortality: The Role of Emotional and Social Loneliness in the Elderly During 19 Years of Follow-Up
Authors: O'Súilleabháin Páraic S. , Gallagher Stephen , Steptoe Andrew 
Published: May 2019

ABSTRACT

Objective
The aims of the study were to examine the predictive value of social and emotional loneliness for all-cause mortality in the oldest-old who do and do not live alone and to test whether these varied by functional status and personality.

Methods
Participants were 413 older adults from the Berlin Aging Study (M [SD] = 84.53 [8.61] years of age) who either lived alone (n = 253) or did not live alone (n = 160). Significance values for hazard ratios are reported having adjusted for age, sex, education, income, marital status, depressive illness, and both social and emotional loneliness.

Results
Although social loneliness was not associated with mortality in those living alone, emotional loneliness was; with each 1 SD increase in emotional loneliness, there was an 18.6% increased risk of all-cause mortality in the fully adjusted model (HR = 1.186, p = .029). No associations emerged for social or emotional loneliness among those not living alone. Examinations of potential moderators revealed that with each 1 SD increase in functional status, the risk associated with emotional loneliness for all-cause mortality increased by 17.9% (hazard ratiointeraction = 1.179, p = .005) in those living alone. No interaction between personality traits with loneliness emerged.

Conclusions
Emotional loneliness is associated with an increased risk of all-cause mortality in older adults who live alone. Functional status was identified as one potential pathway accounting for the adverse consequences of loneliness. Emotional loneliness that can arise out of the loss or absence of a close emotional attachment figure seems to be the toxic component of loneliness.
Perioperative Complications in Minimally Invasive Sacrocolpopexy Versus Transvaginal Mesh in the Management of Pelvic Organ Prolapse: Analysis of a National Multi-institutional Dataset
Authors: Kisby Cassandra K. , Occhino John A. , Bews Katherine A. , Habermann Elizabeth B. , Linder Brian J. 
Published: May 2019

Objectives
The objective of this study was to evaluate perioperative complications in women who underwent minimally invasive sacrocolpopexy (MISC) versus mesh-augmented vaginal repair (vaginal mesh) for pelvic organ prolapse.

Methods
We identified patients undergoing MISC and vaginal mesh via Current Procedural Terminology codes from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2016. Those undergoing concomitant hysterectomy were excluded. Univariate analyses were performed to compare baseline characteristics and 30-day complications. Multivariable logistic regression models were constructed to assess the association between surgical approach and complications, prolonged hospitalization, reoperation, and blood transfusion. A multivariable Cox proportional hazard model was used to evaluate hospital readmission.

Results
A total of 5722 patients were identified (2573 MISC [45%], 3149 vaginal mesh [55%]). Those undergoing MISC repairs had a significantly lower rate of urinary tract infection (3.1 vs 4.2%; P = 0.03) and blood transfusion (0.5 vs 1.4%; P < 0.001). There was no difference in reoperation rate (1.3 vs 1.6%; P = 0.35). Multivariable analysis showed no significant association of MISC with overall (odds ratio [OR], 0.91; P = 0.44), major (OR, 1.30; P = 0.31), or minor complication (OR, 0.85; P = 0.26). There were lower odds of receiving a blood transfusion (OR, 0.44; P = 0.02) and higher odds of prolonged hospitalization (>2 days; OR, 1.47; P = 0.003) for the MISC group. There was no difference in reoperation (OR, 0.79; P = 0.38) or hospital readmissions (hazard ratio, 1.25, P = 0.32).

Conclusions
Minimally invasive sacrocolpopexy was associated with a lower rate of blood transfusion than transvaginal mesh placement. There was no significant difference in 30-day complication rates, reoperation, or readmission between these prolapse procedures when performed without concomitant hysterectomy.