bluuebunny/crossref_metadata_2025_split huggingface dataset:
Terlipressin for the treatment of acute variceal bleeding
Authors: Zhou Xinmiao , Tripathi Dhiraj , Song Tingxue , Shao Lichun , Han Bing , Zhu Jia , Han Dan , Liu Fufang , Qi Xingshun 
Published: November 2018

Abstract

Background and aim:
Acute variceal bleeding (AVB) is life-threatening. We aimed to systematically review the current evidence regarding the efficacy and safety of terlipressin for AVB in liver cirrhosis.

Methods:
We searched the PubMed, EMBASE, and Cochrane Library databases. The reference list was also hand-searched. Using a random-effect model, we combined the data obtained according to the different time points when the events developed. Odds ratio (OR) and weighted mean difference (WMD) were calculated. Quality of evidence was evaluated by the GRADE methodology.

Results:
Thirty randomized controlled trials with 3344 patients were included. Compared with no vasoactive drug, terlipressin significantly improved the control of bleeding within 48 hours (OR = 2.94, P = .0008) and decreased the in-hospital mortality (OR = 0.31, P = .008). Compared with somatostatin, terlipressin had a significantly higher risk of complications (OR = 2.44, P = .04). Compared with octreotide, terlipressin had a significantly inferior control of bleeding within 24 hours (OR = 0.37, P = .007). Compared with vasopressin, terlipressin had a significantly lower risk of complications (OR = 0.15, P = .02). Compared with terlipressin combined with endoscopic variceal ligation, terlipressin alone had significantly higher 5-day treatment failure (OR = 14.46, P = .01) and transfusion requirements within 49 to 120 hours (WMD = 1.20, P = .002). No outcome was significantly different between terlipressin and sclerotherapy. Compared with balloon tamponade, terlipressin significantly decreased the 30-day rebleeding (OR = 0.05, P = .001) and transfusion requirements (WMD = −2.70, P = .02). Quality of evidence was very low to moderate.

Conclusion:
Our findings were in accordance with the current recommendations regarding terlipressin for the treatment of AVB in cirrhosis. However, due to low quality of evidence, further studies are recommended.
Comparison of T2∗ mapping between regular echo time and ultrashort echo time with 3D cones at 3 tesla for knee meniscus
Authors: Yi Jisook , Lee Young Han , Song Ho-Taek , Suh Jin-Suck 
Published: November 2018

Abstract
The objectives of this study were to compare the ultrashort T2∗ relaxation time with the T2∗ relaxation time using the 3 dimensional (3D) cones sequence in 3 groups of patients with normal, degenerated, and torn knee menisci, and to demonstrate the additional effect of the ultrashort echo time (UTE) signal intensity.
Following institutional review board approval, 42 knee magnetic resonance imaging (MRI) scans of 42 patients who presented with knee pain and underwent knee MRIs, with the 3D Cones of UTE sequence (minimum TEs: 32 μs) and a 3T MRI scanner (Discovery 750, GE Healthcare, Waukesha, WI), were analyzed. The enrolled patients were classified into 3 subgroups:
normal meniscus on conventional MRI, with no positive meniscus-related physical examination in medical records;
meniscal degeneration with signal changes on conventional MRI; and
meniscal tear.
For the quantitative assessment, the mean values inside user-drawn regions of interest (ROIs) of the medial menisci were drawn on UTE T2∗ map and T2∗ map. For statistical analyses, 1-way analysis of variance (ANOVA) with post-hoc analysis using the Tukey HSD test was conducted to compare groups, and effect size was used to compare the discrimination power.
The ultrashort T2∗ relaxation times were higher in patients with meniscal tear than in those with normal and degeneration groups (P <.05, respectively) whereas T2∗ relaxation times were not statistically significantly different. The ultrashort T2∗ relaxation times showed higher effect sizes than the T2∗ times between tear and normal/degeneration.
The ultrashort T2∗ relaxation times showed better delineation of meniscal degeneration or tears than T2∗ relaxation times. The ultrashort T2∗ relaxation times could be more sensitive at differentiating between normal and pathologic meniscal conditions in patients.
Primary small bowel mesentery de-differentiated liposarcoma causing torsion with no recurrence for 5 years
Authors: Matsuo Kentaro , Inoue Masaya , Shirai Yasutsugu , Kataoka Tatsuki , Kagota Shuji , Taniguchi Kohei , Lee Sang-Woong , Uchiyama Kazuhisa 
Published: November 2018

Abstract

Rationale:
Liposarcoma (LPS) is a rare malignant soft-tissue tumor. Management of LPS is relatively difficult, because there are no characteristic symptoms, or biomarkers, nor any established effective treatment. Hence, the report of the accumulation of each LPS case is necessary. We experienced an extremely rare case of torsion caused by a primary small bowel mesentery LPS.

Patient's concern:
A 70-year-old male consulted our hospital with the complaints of abdominal pain and sudden vomiting.

Diagnosis:
No lump could be palpated, and tumor markers tested were within normal limits. However, computed tomography revealed an intestinal obstruction caused by torsion of the small bowel due to an LPS tumor.

Interventions:
After decompression of the intestinal obstruction by use of an ileus tube, surgical treatment was performed with rapidity.

Outcome:
The torsion was found to be caused by the tumor that originated from the small bowel mesentery. The tumor was resected along with a portion of the small bowel. The growth of adipose tissues of various sizes and containing atypical cells was detected by histopathological examination. Also, immunohistochemical examination resulted in positive immuno-reactions for MDM2, CDK4, and p16INK4, which indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 14 without any complications, and no recurrence of the tumor was observed at 5 years after the operation.

Lessons:
LPS should be considered in differential diagnosis of bowel torsion, and careful management is required because of the high possibility of recurrence. Patients should be followed carefully for at least 5 years, and further accumulation of data will be required in order to establish the appropriate management of LPS.
Pathologic and molecular studies of enterovirus 71 infection in a fatal case from a recent epidemic in China
Authors: Xing Jingjun , Wang Ke , Wei Hua , Wei Dengming 
Published: November 2018

Abstract

Rationale:
Enterovirus 71 (EV71) is identified as the primary cause of hand, foot, and mouth disease (HFMD) and mainly infects the young infants. Though some fatal cases have been reported, the underlying mechanisms of EV71 infection remain elusive and more further pathologic and molecular studies of EV71 infection are needed.

Patient concerns:
A 26-month-old girl with a history of fever and lethargy for 3 days and intermittent seizures for 2 hours associated with rash on 4 limbs was brought to a hospital.

Diagnoses:
The autopsy was performed to identify the cause of death for a medical dispute. The results of histologic examination, immunohistochemistry (IHC), nested reverse transcription polymerase chain reaction (RT-PCR), and viral isolation confirmed that this patient died of EV71 infection.

Interventions:
The patient was transferred to neonatal intensive care unit and was intubated and mechanically ventilated. The other treatment included cardiopulmonary resuscitation and intravenous injection of adrenaline.

Outcomes:
The patient presented persistent coma and intermittent seizures and suddenly developed respiratory arrest and died 16 hours after admission.

Lessons:
Our results suggest that EV71 might invade into the central nervous system (CNS) through peripheral nerves which control the digestive tract in the early stage of infection. In addition, we successfully isolated one EV71 strain. Phylogenetic analysis showed that the isolated strain clustered in the C4a of C4 subgenotype. This case also highlights that rapid deterioration in HFMD cases is still a challenge to physicians and they must pay special attention to the infants with HFMD symptoms, particularly in EV71 epidemic areas for early diagnosis and treatment.
Human deaths from drug overdoses with carfentanyl involvement—new rising problem in forensic medicine
Authors: Fomin Dmitrij , Baranauskaite Vilma , Usaviciene Emilija , Sumkovskaja Alina , Laima Sigitas , Jasulaitis Algimantas , Minkuviene Zita Nijole , Chmieliauskas Sigitas , Stasiuniene Jurgita 
Published: November 2018

AbstractCarfentanyl, an ultra-potent synthetic opioid, is approved for use only in veterinary medicine as a tranquilizing agent. However, many cases of human poisoning with carfentanyl have recently appeared in the news with limited information given and scientific literature provides only 1 case of documented human exposure to carfentanyl.Fifteen cases of death from drug overdoses with carfentanyl involvement are being presented. Fifteen blood and urine samples have been taken for alcohol and drug testing. Headspace gas chromatography was used for alcohol detection. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography–time-of-flight mass spectrometry (LC/MS TOF) system was used for drug detection.Sixty-three cases of death from poisoning with drugs have been tested for carfentanyl in the State Forensic Medicine Service. Fifteen of them were positive for carfentanyl.The cases mentioned above show that carfentanyl exposure causes signs and symptoms similar to other opioid toxicity. Carfentanyl intoxication may even be fatal if appropriate treatment is not available. Therefore, nowadays it is very important to draw forensic medicine expert's attention to new substances in drug trade.
Application of enamel matrix derivative and deproteinized bovine bone for the treatment of peri-implantitis after decontamination with an ultrasonic scaler
Authors: Park Jun-Beom 
Published: November 2018

Abstract

Rationale:
The purpose of this report is to present a case of peri-implantitis with successful regeneration. The surface of the affected dental implant was decontaminated with an ultrasonic scaler and treated with bovine-derived hydroxyapatite and enamel matrix derivative.

Patient concerns:
A 52-year-old male was referred for evaluation of a dental implant placed in the mandibular right second premolar area.

Diagnosis:
The radiographic evaluation showed the loss of supporting bone around the dental implant. Bleeding upon probing and suppuration were observed, with the deepest probing depth at 6 mm.

Interventions:
The area was firstly treated with a nonsurgical approach. After re-evaluation, a full-thickness flap was elevated. The area was well debrided using various instruments, including curettes and an ultrasonic scaler. The defect area was grafted with bovine-derived hydroxyapatite and enamel matrix derivative.

Outcomes:
Histopathologic evaluation revealed chronic inflammation with fibrosis and calcification. The evaluation at 2 years and 3 months after surgery showed that the prosthesis was functioning well. Bleeding upon probing and suppuration was not noted, and reduction of probing depth was seen, with the deepest depth at 4 mm. The area showed maintenance of graft material with increased radiopacity around the dental implant.

Lessons:
In conclusion, a case of peri-implantitis can be successfully treated with bovine-derived hydroxyapatite and enamel matrix derivative after surface decontamination with an ultrasonic scaler.
Diagnostic and Prognostic Impact of Neutrophil-to-Lymphocyte Ratio for Intraductal Papillary Mucinous Neoplasms of the Pancreas With High-Grade Dysplasia and Associated Invasive Carcinoma
Authors: Hata Tatsuo , Mizuma Masamichi , Motoi Fuyuhiko , Ishida Masaharu , Morikawa Takanori , Takadate Tatsuyuki , Nakagawa Kei , Hayashi Hiroki , Kanno Atsushi , Masamune Atsushi , Kamei Takashi , Furukawa Toru , Naitoh Takeshi , Unno Michiaki 
Published: November 2018

Objectives
The aim of this study was to evaluate the diagnostic and prognostic impact of systemic inflammatory markers for IPMN with high-grade dysplasia (HGD)/invasive carcinoma.

Methods
Neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelet-to-lymphocyte ratio, and C-reactive protein–to–albumin ratio were compared across the different histological grades of 205 IPMN cases. We also tested the diagnostic performance for IPMN with HGD/invasive carcinoma.

Results
The median (interquartile range) preoperative NLR was higher in IPMN with HGD/invasive carcinoma (2.03 [1.48–2.93]) than IPMN with low-grade dysplasia (1.74 [1.42–2.24], P = 0.0137). The C-reactive protein–to–albumin ratio and derived NLR values were also significant higher in cases with HGD/invasive carcinoma. A combination assay of NLR, carcinoembryonic antigen, and carbohydrate antigen 19-9 revealed a 58.8% sensitivity and 76.8% specificity. Among the cases with worrisome features, the high NLR values increased the positive predictive value (68.8%) compared with low values (31.8%). In IPMN cases with the associated invasive carcinoma, high NLR values showed association with the deeper vertical invasion and shorter survival periods.

Conclusions
Preoperative NLR, combined with tumor markers and image findings, can be a useful predictive marker for the presence of HGD/invasive carcinoma in IPMNs. Preoperative NLR also predicts the long-term outcomes in IPMN cases with invasive carcinoma.
Asking for Feedback
Authors: Bowen-Brady Helene , Haag-Heitman Barbara , Hunt Valerie , Oot-Hayes Margaret 
Published: November 2018

OBJECTIVE
The purpose of this study was to understand clinical nurses’ perceptions of their participation in a formal, annual peer review process at a metropolitan community hospital.

BACKGROUND
Peer review is an essential component of professional nursing practice for self-regulation of the practice and promotion of quality and safety. Robust empirical evidence of formalized and effective peer review nursing processes is not evident.

METHODS
A descriptive qualitative study with focus group interviews was used.

RESULTS
Study results validate that peer review is a meaningful and valuable process used by clinical nurses to support professional growth and development. Nurses reported using their specific peer feedback as part of their annual goal setting.

CONCLUSIONS
Results validate the importance of implementation of a structured, formal peer review process at the organizational level. The study findings identify that the essential components of an effective peer review process include education for peer facilitators and clinical nurses; dedicated time, space, and privacy to conduct peer reviews; and leadership support.
Utilization Rate of Helicobacter pylori Immunohistochemistry Is Not Associated With the Diagnostic Rate of Helicobacter pylori Infection
Authors: Son Jung H. , Lebwohl Benjamin , Sepulveda Antonia R. , Lagana Stephen M. 
Published: November 2018

Background:
Utilization rates of immunohistochemistry (IHC) for the diagnosis of Helicobacter pylori infection may vary by laboratory and/or pathologists. IHC for H. pylori is not performed routinely in our practice. Instead, it is used in selected cases at the pathologists’ discretion (and according to their specific criteria). The purpose of this study was to determine if IHC utilization rates correlated with rates of detecting H. pylori infection.

Materials and Methods:
We searched our records and investigated all gastric biopsies for 1 calendar year. H. pylori diagnostic rate and IHC utilization rate was calculated for each pathologist.

Results:
Overall, the rate of diagnosis was 12.1% and the IHC utilization rate was 45.2%. Individual pathologists had H. pylori diagnostic rates ranging from 3.6% to 34.1% (median: 11.1%) and IHC utilization ranging from 17.1% to 95.2% (median: 42.2%). The rate of detection of H. pylori infection among pathologists showed no significant correlation with rates of IHC utilization (Pearson coefficient=0.121).

Conclusions:
Increasing use of IHC is not independently associated with the diagnostic rate of infection. Ultimately, if we assume that the case mix was similar for each pathologist, it suggests that more liberal criteria to order IHC does not result in more infections diagnosed.
Provision of STD Services in Community Settings After the Loss and Return of State Funding to Support Service Provision: Observations From Select Providers in Massachusetts, 2010 and 2013
Authors: Loosier Penny S. , Carter Marion W. , Hsu Katherine K. , Doshi Sonal , Peterson Maddox Brandy L. , Kroeger Karen , Cranston Kevin 
Published: November 2018

Context:
In 2008, the $1.2 M sexually transmitted disease (STD) services line item supporting STD clinical services by the Massachusetts Department of Public Health was eliminated, forcing the cessation of all state-supported STD service delivery.

Objective:
To determine the impact on community provision of STD services after the elimination of state funds supporting STD service provision.

Design and Setting:
Rapid ethnographic assessments were conducted in May 2010 and September 2013 to better understand the impact of budget cuts on STD services in Massachusetts. The rapid ethnographic assessment teams identified key informants through Massachusetts's STD and human immunodeficiency virus programs.

Participants:
Fifty providers/clinic administrators in 19 sites (15 unique) participated in a semistructured interview (community health centers [n = 10; 53%], hospitals [n = 4; 21%], and other clinical settings [n = 5; 26%]).

Results:
Results clustered under 3 themes: financial stability of agencies/clinics, the role insurance played in the provision of STD care, and perceived clinic capacity to offer appropriate STD services. Clinics faced hard choices about whether to provide care to patients or refer elsewhere patients who were unable or unwilling to use insurance. Clinics that decided to see patients regardless of ability to pay often found themselves absorbing costs that were then passed along to their parent agency; the difficulty and financial strain incurred by a clinic's parent agency by providing STD services without support by state grant dollars emerged as a primary concern. Meeting patient demand with staff with appropriate training and expertise remained a concern.

Conclusions:
Provision of public health by private health care providers may increase concern among some community provision sites about the sustainability of service provision absent external funds, either from the state or from the third-party billing. Resource constraints may be felt across clinic operations. Provision of public health in the for-profit health system involves close consideration of resources, including those: leveraged, used to provide uncompensated care, or available for collection through third-party billing.
Optimal Muscle Selection for OnabotulinumtoxinA Injections in Poststroke Lower-Limb Spasticity
Authors: Esquenazi Alberto , Wein Theodore H. , Ward Anthony B. , Geis Carolyn , Liu Chengcheng , Dimitrova Rozalina 
Published: November 2018

Objective
The aim of the study was to identify optimal muscle selection patterns for onabotulinumtoxinA treatment of poststroke lower-limb spasticity.

Design
Adults with poststroke lower-limb spasticity (ankle Modified Ashworth Scale ≥3) were randomized to onabotulinumtoxinA (300 U, mandatory ankle plantar flexors; ≤100 U, optional lower-limb muscles) or placebo. Post hoc analysis assessed the impact of muscle selection patterns on ankle Modified Ashworth Scale and physician-assessed Clinical Global Impression of Change based on change from baseline to average of weeks 4/6 versus placebo.

Results
Among 468 patients randomized, onabotulinumtoxinA improved ankle Modified Ashworth Scale (−0.81 vs −0.61, P = 0.01) and Clinical Global Impression of Change (0.86 vs 0.65, P = 0.012) versus placebo. Injection of mandatory muscles alone was not sufficient in improving ankle Modified Ashworth Scale (P = 0.255) or Clinical Global Impression of Change (P = 0.576) versus placebo but was adequate 24 mos or less after stroke (Modified Ashworth Scale, −1.13 vs −0.62, P = 0.019; Clinical Global Impression of Change, 1.24 vs 0.68, P = 0.006). Additional injections into toe muscles (flexor digitorum longus, flexor hallucis longus) improved ankle Modified Ashworth Scale (−0.98 vs −0.52, P = 0.002) and Clinical Global Impression of Change (0.80 vs 0.38, P = 0.023) versus placebo regardless of time since stroke. OnabotulinumtoxinA was well tolerated, with no new safety findings.

Conclusions
Post hoc analyses suggested additional injections of onabotulinumtoxinA into toe flexors improved ankle Modified Ashworth Scale and Clinical Global Impression of Change scores versus mandatory muscles alone overall and with treatment initiation more than 24 mos after stroke.
Assessing Age as a Risk Factor for Complications in Autologous Breast Reconstruction
Authors: Torabi Radbeh , Stalder Mark W. , Tessler Oren , Bartow Matthew J. , Lam Jonathan , Patterson Charles , Wise M. Whitten , Dupin Charles L. , St. Hilaire Hugo 
Published: November 2018

Background:
Breast cancer is primarily a diagnosis of older women. Many patients seeking breast reconstruction are elderly women (aged 65 years or older). However, many surgeons anecdotally believe that surgery in elderly patients is inherently dangerous, or at least prone to more complications.

Methods:
The authors conducted a retrospective cohort study composed of chart review of all deep inferior epigastric perforator flap breast reconstruction patients at a single institution divided into an elderly cohort (65 years or older) and a nonelderly cohort (younger than 65 years). Cohort was the primary predictor variable. Demographic and comorbidity data were secondary predictor variables. Primary outcomes were complete flap loss, partial flap loss, or need for flap reexploration. Secondary outcomes such as wound healing problems, seroma, and others were also assessed.

Results:
There were 285 flaps in the nonelderly cohort and 54 flaps in the elderly cohort. The elderly cohort had higher rates of diabetes, hypertension, and hyperlipidemia. Chi-square analysis showed no significant differences in primary outcomes between the two cohorts. Breast wound dehiscence was significantly higher in the elderly cohort (p < 0.01). On logistic regression, being elderly was seen as a significant risk factor for complete flap loss (OR, 10.92; 95 percent CI, 0.97 to 122.67; p = 0.05). The overall success rate for the nonelderly cohort was 99.6 percent, whereas the success rate for the nonelderly cohort was 96.3 percent.

Conclusions:
Elderly women desire breast reconstruction. Free flap breast reconstruction is a viable and safe procedure in these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.