bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHOROIDAL VASCULARITY INDEX QUANTIFICATION IN GEOGRAPHIC ATROPHY USING BINARIZATION OF ENHANCED-DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHIC SCANS
Authors: Giannaccare Giuseppe , Pellegrini Marco , Sebastiani Stefano , Bernabei Federico , Moscardelli Fabiana , Iovino Claudio , Napoli Pietro E. , Campos Emilio 
Published: January 2019

Purpose:
To evaluate choroidal structural changes occurring over time in geographic atrophy (GA) secondary to age-related macular degeneration using choroidal vascularity index (CVI).

Methods:
Enhanced-depth imaging optical coherence tomography scans of 34 patients with GA and 32 control subjects were retrospectively analyzed. Data were collected at baseline and after a mean follow-up of 18.3 ± 8.3 months. Choroidal images were binarized using the ImageJ software, and the luminal area and stromal area were segmented. Choroidal vascularity index was defined as the ratio of luminal area to total choroid area.

Results:
Patients with GA showed significantly lower values of CVI, total choroid area, luminal area, and subfoveal choroidal thickness compared to control subjects (65.83 ± 3.95 vs. 69.33 ± 3.11, P < 0.001; 0.400 ± 0.239 mm2 vs. 0.491 ± 0.132, P = 0.006; 0.263 ± 0.152 mm2 vs. 0.340 ± 0.094, P = 0.002; 185.2 ± 79.8 µm vs. 216.8 ± 58.8 µm, P = 0.036, respectively). Best-corrected visual acuity was significantly correlated only with choroidal thickness (R = −0.509; P = 0.002). During the follow-up period in patients with GA, subfoveal choroidal thickness decreased from 185.2 ± 79.8 to 152.2 ± 73.1 (P = 0.001), stromal area increased from 0.138 ± 0.090 mm2 to 0.156 ± 0.068 (P = 0.028), and CVI decreased from 65.83 ± 3.95 to 62.24 ± 3.63 (P < 0.001).

Conclusion:
This study showed for the first time that CVI is reduced in patients with GA, and that this metric further worsened during the follow-up period.
Impact of prehospital mechanical ventilation
Authors: El Sayed Mazen J. , Tamim Hani , Mailhac Aurelie , Mann N. Clay 
Published: January 2019

Abstract
Prehospital use of ventilators by emergency medical services (EMS) during 911 calls is increasing. This study described the impact of prehospital mechanical ventilation on prehospital time intervals and on mortality.
This retrospective matched-cohort study used 4 consecutive public releases of the US National Emergency Medical Services Information System dataset (2011–2014). EMS activations with recorded ventilator use were randomly matched with activations without ventilator use (1 to 1) on age (range ± 2 years), gender, provider's primary impression, urbanicity, and level of service.
A total of 5740 EMS activations were included (2870 patients per group). Patients in the ventilator group had a mean age of 69.1 (±17.3) years with 49.4% males, similar to the non-ventilator group. Activations were mostly in urban settings (83.8%) with an advanced life support level of care (94.5%). Respiratory distress (77.8%) and cardiac arrest (6.8%) were the most common provider's primary impressions. Continuous positive airway pressure was the most common mode of ventilation used (79.2%).
Mortality was higher at hospital discharge (29.0% vs 21.1%, P = .01) but not at emergency department (ED) discharge (8.4% vs 7.4%, P = .19) with prehospital ventilator use. Both total on-scene time and total prehospital time intervals increased with reported ventilator use (4.10 minutes (95% confidence interval [CI]: 2.71–5.49) and 3.59 minutes (95% CI: 3.04–4.14), respectively).
Ventilator use by EMS agencies in 911 calls in the US is associated with higher prehospital time intervals without observed impact on survival to ED discharge. More EMS outcome research is needed to provide evidence-based prehospital care guidelines and targeted resource utilization.
A case report of metastatic lung adenocarcinoma with long-term survival for over 11 years
Authors: Matsuzaki Tatsu , Iwami Eri , Sasahara Kotaro , Kuroda Aoi , Nakajima Takahiro , Terashima Takeshi 
Published: January 2019

Abstract

Rationale:
This is the first known report in the English literature to describe a case of metastatic non-small cell lung cancer that has been controlled for >11 years.

Patient concerns:
A 71-year-old man visited our hospital because of dry cough.

Diagnosis:
Chest computed tomography revealed a tumor on the left lower lobe with pleural effusion, and thoracic puncture cytology indicated lung adenocarcinoma.

Interventions:
Four cycles of carboplatin and docetaxel chemotherapy reduced the size of the tumor; however, it increased in size after 8 months, and re-challenge chemotherapy (RC) with the same drugs was performed. Repeated RC controlled disease activity for 6 years. After the patient failed to respond to RC, erlotinib was administered for 3 years while repeating a treatment holiday to reduce side effects. The disease progressed, and epidermal growth factor receptor (EGFR) gene mutation analysis of cells from the pleural effusion detected the T790 M mutation. Therefore, osimertinib was administered, which has been effective for >1 year.

Outcomes:
The patient has survived for >11 years since the diagnosis of lung cancer.

Lessons:
Long-term survival may be implemented by actively repeating cytotoxic chemotherapy and EGFR-tyrosine kinase inhibitor administration.
Myocardial infarction following a blunt chest trauma
Authors: Li Xiangdong , Wang Zhiyuan , Yang Yushuang , Meng Fanbo , He Yuquan , Yang Ping 
Published: January 2019

Abstract

Rationale:
Blunt cardiac injury (BCI) is a common complication after blunt chest trauma, which can lead to mild arrhythmia, severe chamber or valvular rupture, or even death. Myocardial infarction following blunt chest trauma is a rare but fatal condition.

Patient concerns:
A 38-year-old, previously healthy, man was admitted to our hospital with a complaint of dyspnea. He had a history of being hit in the chest by a high-speed screw while working in a factory 3 months before he was admitted to the hospital.

Diagnosis:
After performing coronary angiography and echocardiography, he was finally diagnosed with myocardial infarction.

Interventions:
He received optimized medications, including diuretics, β-blockers, and cardiac stimulants.

Outcomes:
At the 4-year follow-up, the patient was diagnosed as having chronic heart failure with a reduced ejection fraction.

Lessons:
Owing to the first doctor's lack of experience and knowledge with this case, the patient was misdiagnosed and treatment was delayed, which subsequently led to heart failure.
BCI can lead to myocardial infarction if patients are misdiagnosed and treatment is delayed. Thus, surgeons and physicians should consider cardiac complications in patients with chest trauma to reduce the incidence of its misdiagnosis.
Changes in glaucoma medication numbers after cataract and glaucoma surgery
Authors: Chen Hsin-Yi , Lin Cheng-Li , Kao Chia-Hung 
Published: January 2019

Abstract
To determine whether cataract or glaucoma and combined cataract and glaucoma surgery (CGS) affect glaucoma medication usage.
We recruited patients who received new diagnoses of glaucoma, either primary open-angle glaucoma (POAG) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 365.1) or primary angle-closure glaucoma (PACG) (ICD-9-CM code 365.2), between 1998 and 2011 and had undergone cataract surgery alone (CS), glaucoma surgery alone (GS), or CGS under the National Health Insurance program in Taiwan. CS, GS, and CGS in all the patients were performed after the glaucoma diagnosis date. The patients were subdivided into CS, CGS, and GS groups. The number of glaucoma medications, including prostaglandin analogs, β-blockers, carbonic anhydrase inhibitors, α-agonists, pilocarpine, and a combination of drugs, in each prescription, were compared before and after surgery.
The mean number of glaucoma medications in each prescription before the surgery increased from approximately 0.5/1 (CS/CGS + GS) to a peak of 1.75/3 within 3 months before the index date. The mean number of glaucoma medications in each prescription reduced to 0 (CS group) and to approximately 0.5 (CGS and GS) at the end of the 3-year follow-up period. The mean number of glaucoma medications in each prescription significantly reduced at the time points within 6 months, between 6 months and 2 years, and during 2 to 3 years after surgery in each group. At the end of the 3-year period, the reduction effect was most evident in the CS group. Similar trends were also observed in the POAG and PACG group.
CS, GS, and CGS significantly reduced the number of glaucoma medications used by the glaucoma patients.
Identification of a novel mutation of FGFR3 gene in a large Chinese pedigree with hypochondroplasia by next-generation sequencing
Authors: Yao Guixiang , Wang Guangxin , Wang Dawei , Su Guohai 
Published: January 2019

Abstract

Rationale:
Hypochondroplasia (HCH) is the mildest form of chondrodysplasia characterized by disproportionate short stature, short extremities, and variable lumbar lordosis. It is caused by mutations in fibroblast growth factor receptor 3 (FGFR3) gene. Up to date, at least thirty mutations of FGFR3 gene have been found to be related to HCH. However, mutational screening of the FGFR3 gene is still far from completeness. Identification of more mutations is particularly important in diagnosis of HCH and will gain more insights into the molecular basis for the pathogenesis of HCH.

Patient concerns:
A large Chinese family consisting of 53 affected individuals with HCH phenotypes was examined.

Diagnoses:
A novel missense mutation, c.1052C>T, in FGFR3 gene was identified in a large Chinese family with HCH. On the basis of this finding and clinical manifestations, the final diagnosis of HCH was made.

Interventions:
Next-generation sequencing (NGS) of DNA samples was performed to detect the mutation in the chondrodysplasia-related genes on the proband and her parents, which was confirmed by Sanger sequencing in the proband and most of other living affected family members.

Outcomes:
A novel missense mutation, c.1052C>T, in the extracellular, ligand-binding domain of FGFR3 was identified in a large Chinese family with HCH. This heterozygous mutation results in substitution of serine for phenylalanine at amino acid 351 (p.S351F) and co-segregates with the phenotype in this family. Molecular docking analysis reveals that this unique FGFR3 mutation results in an enhancement of ligand-binding affinity between FGFR3 and its main ligand, fibroblast growth factor 9.

Lessons:
This novel mutation is the first mutation displaying an increase in ligand-binding affinity, therefore it may serve as a model to investigate ligand-dependent activity of FGF-FGFR complex. Our data also expanded the mutation spectrum of FGFR3 gene and facilitated clinic diagnosis and genetic counseling for this family with HCH.
Significant response of low-dose apatinib monotherapy in brain metastases of triple-negative breast cancer
Authors: Li Ting , Wang Shan-Bing , Lei Kai-Jian , Jiang Mao-Qiong , Jia Yu-Ming 
Published: January 2019

Abstract

Rationale:
The potential efficacy of apatinib in patients with advanced triple-negative breast cancer (TNBC) has been observed in a previous phase II clinical study. However, there is no study to evaluate its efficacy and safety in TNBC patients with brain metastasis (BM). Here we report one case that apatinib exhibited excellent antitumor effects in a breast cancer patient with brain metastasis, with no serious treatment-associated with adverse event.

Patient concerns:
In this case report, one Chinese woman who was diagnosed with stage IV TNBC with multiple bone, lung, and brain metastases was unable to tolerate chemotherapy and refused whole-brain radiation therapy (WBRT) due to her poor physical condition. She had previously undergone radical mastectomy and intravenous chemotherapy.

Diagnoses:
Triple-negative breast cancer.

Interventions:
The patient underwent left radical mastectomy with ipsilateral axillary lymph node dissection, and the following adjuvant chemotherapy, but developed multiple bone, lung, and brain metastases. Due to her poor physical condition, chemotherapy was not eligible for her. And she refused WBRT and chose to take low-dose apatinib (250 mg, oral, daily) monotherapy.

Outcomes:
After 2 months of treatment, the symptom of headache and vomiting relieved and all the brain metastases (BMs) lesions disappeared.

Lessons:
Low-dose apatinib monotherapy may be an alternative treatment for patients with poor physical condition. Preclinical and clinical studies should be conducted to further evaluate the mechanism and efficacy of apatinib in the treatment of BM from TNBC, as well as to explore the optimal dose of the drug.
An uncommon spontaneous right distal tubal pregnancy post bilateral laparoscopic sterilization
Authors: Lin Ching-Min , Ku Yu-Lun , Cheng Yu-Tzu , Giin Ngo Yeh , Ou Yu-Che , Lee Meng-Chih , Lee Chung-Yuan 
Published: January 2019

Abstract

Rationale:
Tubal sterilization as a contraception method has a high success rate; however, it also carries a low risk of incidental pregnancy. A majority of these pregnancies are ectopic. In this study, we report a rare case of spontaneous right distal tubal pregnancy after bilateral laparoscopic tubal sterilization.

Patient concerns:
A 36-year-old woman who had undergone bilateral laparoscopic tubal sterilization presented with abdominal pain and a positive test for pregnancy.

Diagnosis:
Ectopic pregnancy was suspected based on absence of gestational sac in the uterine cavity on ultrasound and elevated beta-human chorionic gonadotropin (β-hCG) level.

Intervention:
Since the patient had unstable vitals, emergency laparoscopic surgery was performed, which revealed a right distal fallopian tube pregnancy. We performed a complete bilateral residual tubal stump excision.

Outcomes:
The patient recovered well after surgery, with a reduction in β-hCG level, and was discharged after 3 days.

Lessons:
To ensure complete sterilization, the gap at the excised end needs to be adequately widened and enhanced with electro-destruction to prevent formation of a fistula.
Free bipaddled anterolateral thigh flap for simultaneous reconstruction of large larynx and prelaryngeal skin defects after resection of the local recurrent laryngeal cancer invading the cricoid cartilage and prelaryngeal skin
Authors: Liu Jun , Lv Dan , Deng Di , Wang Ji , Li Linke , Chen Fei 
Published: January 2019

Abstract

Rationale:
After total or near-total laryngectomy and resection of prelaryngeal skin, laryngeal defects and prelaryngeal skin defects often remain a great challenge for head and neck surgeons when considering simultaneous reconstruction of. In this case report, a free bipaddled anterolateral thigh (ALT) was used for such defects reconstruction.

Patient concerns:
For this 50-year-old male patient whose recurrent tumor invaded the cricoid cartilage and the prelaryngeal skin, supracricoid partial laryngectomy with a cricohyoidepiglottopexy would no longer be an option. However, the patient had a strong requirement of preserving lung-power speech, making total laryngectomy and chemoradiotherapy not acceptable.

Diagnosis:
Pathologic result demonstrated well-differentiated squamous cell carcinoma. A PET-CT of the whole body showed extralaryngeal extension of the tumor invading the cricoids cartilage and prelaryngeal ribbon muscles and skin. Meanwhile, the video-laryngoscpy showed smooth laryngeal mucosa.

Interventions:
A near-total laryngectomy and resection of prelaryngeal skin were performed. The resultant defects were reconstructed with a free bipaddled ALT flap.

Outcomes:
The patient is 18 months postsurgery with no locoregion tumor recurrence, taking oral feeds, partial lung-power speech and not decannulated. Laryngostenosis was shown by the videolaryngoscopy, MRI and CT scan.

Lessons:
A free bipaddled ALT flap could be utilized for simultaneous reconstruction of large larynx and prelaryngeal skin defects, and allows partial laryngeal function preservation in selected local recurrent laryngeal cancer invading the cricoid cartilage and prelaryngeal skin.
Concomitant cryoglobulinemic vasculitis and cold agglutinin disease successfully treated with bortezomib
Authors: Liu Xiao-hang , Liu Mei-xi , Jin Fan , Zhang Meng , Zhang Lu 
Published: January 2019

Abstract

Rationale:
Concomitant cryoglobulinemic vasculitis and cold agglutinin disease (CAD) is an extremely uncommon clinical scenario. The role of bortezomib in the treatment of cryoglobulinemic vasculitis needs further investigation.

Patient concerns:
A 72-year-old Chinese woman presented with a 25-year history of cyanosis of the extremities after cold exposure, which worsened and was accompanied with purpuric skin lesions and proteinuria in recent years. Laboratory data demonstrated hemolysis. Cold agglutinin and cryoglobulin tests were positive. There was no evidence for malignancies after blood, image, and pathologic tests.

Diagnoses:
Concomitant cryoglobulinemic vasculitis and CAD.

Interventions:
The patient was treated with bortezomib-based regimen, including bortezomib, cyclophosphamide, and dexamethasone.

Outcomes:
The patient responded well to the treatment. Both symptoms and laboratory tests significantly improved. The patient's condition was in a state of sustained remission in the 6-month follow-up.

Lessons:
This rare case promotes further understanding of these 2 diseases and suggests that bortezomib is a promising treatment in type I cryoglobulinemic vasculitis.
Malignant peripheral nerve sheath tumor of the nasal cavity and nasopharynx in a child
Authors: Li Qian , Pan Hongguang , Li Lan , Cao Juan 
Published: January 2019

Abstract

Rationale:
Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms with only a few reported cases affecting the nasal cavity, paranasal sinuses, and anterior skull base.

Patient concerns:
A 12-year-old girl with a mass in her nose was admitted to the Department of Otorhinolaryngology of Shenzhen Children's Hospital. She had a 4-month history of progressive, unilateral right nasal obstruction, unilateral mucopurulent rhinorrhea, foul nasal odor, snoring, hyposmia, occasional epistaxis, and no headache, no facial numbness, without eye swelling and vision loss.

Diagnose:
A computed tomography (CT) scan of the paranasal sinuses showed a mass (right inflammatory polyp and calcification) involving the nasal cavity, the right maxillary sinusitis, ethmoid sinusitis. There was no nasal septum, orbital, or skull base involvement. On the basis of pathological and immunohistological findings, the tumor was diagnosed as an MPNST with heterogeneous components (cartilage and bone) mesenchymal differentiation after the operation.

Interventions:
The girl was treated by surgery and chemotherapy.

Outcomes:
The postoperative course was uneventful. There was no recurrence observed during the 3-year follow-up.

Lessons:
The primary MPNST in the nasal cavity is rare, if nasal neoplasms do not respond well to vasoconstrictors and glucocorticoids in children, the possibility of a tumor should be considered. If new organisms grow rapidly with hemorrhagic necrosis, the possibility of a malignant tumor is greater.
Vision-related quality of life and depression in rhegmatogenous retinal detachment patients
Authors: Du Yi , Mo Xiang-Hong , Li Xiao-Li , Zeng Jin , Luo Wenjing , Huang Min-Li 
Published: January 2019

Abstract
The aim of this cross-sectional study is to evaluate vision-related quality of life (VRQoL) and depression in patients with rhegmatogenous retinal detachment (RRD).
The VRQoL and depression were evaluated in 58 patients with unilateral RRD and 58 healthy controls, using the Chinese version of the National Eye Institute Visual Function Questionnaire (CHI-VFQ-25) and the Chinese version of Beck Depression Inventory-II, respectively.
Composite scores of the CHI-VFQ-25 were significantly lower in the RRD patients, compared with the healthy controls (P < .001). Lower composite scores were associated with older age (P < .01), severer visual loss (P < .05), longer duration of the disease (P < .05), and macular involved (P < .05). The proportion of depression was significantly higher in RRD patients than healthy controls (39.66% vs 5.17%, P < .001). The depression of RRD patients was associated with the longer duration of the disease (r=0.268, P < .001).
The RRD patients suffer from poor VRQoL and a high proportion of depression. Physicians should pay more attention to mental health in RRD patients.
Brain metastasis in pancreatic cancer
Authors: Sasaki Takashi , Sato Tatsuya , Nakai Yousuke , Sasahira Naoki , Isayama Hiroyuki , Koike Kazuhiko 
Published: January 2019

Abstract

Rationale:
Brain metastases are extremely rare for patients with pancreatic adenocarcinoma due to the poor prognoses. In the present study, we reported 2 cases of pancreatic adenocarcinoma with brain metastases.

Patient concerns:
The 1st patient was diagnosed asymptomatic brain metastasis by a follow-up brain magnetic resonance imaging (MRI) due to a medical history of subarachnoid hemorrhage. The 2nd patient experienced dizziness, neck pain, and seizure. Computed tomography (CT) was used for the diagnosis of brain metastasis because he was inserted a pacemaker.

Diagnosis:
In case 1, brain MRI revealed that a solitary brain metastasis 14-mm in size was identified at the cortico-medullary junction in the left frontal lobe. In case 2, brain enhanced CT revealed multiple brain metastases with calcification at the cerebral cortex. Times to develop central nervous system metastasis were 19 months and 33 months, respectively.

Interventions:
The 1st patient was treated with 45.2 Gy γ-knife irradiation for the solitary brain metastasis, and the 2nd patient was treated with supportive care due to the poor general condition.

Outcomes:
The prognoses of these 2 patients were 13 months, and 32 days from the diagnosis of brain metastasis. The 1st patient did not experience complication of a γ-knife irradiation and brain metastasis was controlled until death.

Lessons:
The incidence of brain metastases from pancreatic adenocarcinoma is expected to increase due to prolonged survival from improved treatment. Therefore, increased awareness of brain involvement is necessary when neurological disorder is suspected in patients with advanced pancreatic cancer.
Effects of seating education and cushion management for adaptive sitting posture in spinal cord injury
Authors: Park Myoung-Ok , Lee Sang-Heon 
Published: January 2019

Abstract

Rationale:
Pressure ulcers can frequently occur in spinal cord injured patients living in wheelchairs. Therefore, to manage the cushion in sitting posture is important for preventing ulcers.

Patient concerns:
The patients visited seating clinic in rehabilitation hospital for uncomfortable sitting posture. The patients were asked for posture control and cushion air management training in a sitting posture to prevent sores.

Diagnosis:
The diagnosis was spinal cord injury.

Interventions:
Two patients with spinal cord injury were subjected to posture training while the quantity of air in the cushion was being modulated to minimize gluteal pressure by measuring the pressure in the sitting position in the driver's seat using an X-sensor.

Outcomes:
In Case 1, as a result of air control, contact area showed 1108.06 cm2, average pressure 45.20 mmHg, contact area increased, and mean pressure decreased. In Case 2, the contact area 974.19 cm2 and the average area 41.00 mmHg were measured by applying the change to the ROHO low-Quardro type, showing a decrease in the average body pressure from the initial stage.

Lessons:
From the results of this study, it was found that measurement of body pressure and posture training using a sensor that provides visual feedback is effective in preventing pressure ulcer. Therefore, it is necessary to perform routine control of the sitting pressure in the clinic and management training of the air cell cushion.