bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tailor-made iliac branched device for preserving the internal iliac artery in patients with common iliac artery aneurysm
Authors: Chen Po-Lin , Hsu Hung-Lung , Chen I-Ming , Kuo Tzu-Ting , Chen Yin-Yin , Shih Chun-Che 
Published: July 2019

Background:
Endovascular repair with stent-graft is a treatment option for patient with common iliac artery aneurysm (CIAA). However, the preservation of the internal iliac artery (IIA) is a concern. The commercially available iliac branched device (IBD) requires a common iliac length of at least 5 cm, which is usually too long for Asian people. Here, we report our medium-term results of using tailor-made IBD for patients with short common iliac artery (CIA) with and without abdominal aortic aneurysm (AAA).

Methods:
A selected iliac limb of the AAA stent-graft was unloaded from the delivery system. A 6-mm fenestration hole was made at the length of the CIA from the proximal end. The edge of the hole was reinforced with the soft and radiopaque tip of a 0.014´´ wire. Then, the iliac limb was reloaded into the introduced sheath as the tailor-made IBD. It was inserted from the selected side of the femoral artery and deployed. The ipsilateral IIA was cannulated through the fenestration hole. Then, a balloon-expandable or self-expandable covered stent with an appropriate size was deployed as the bridging stent-graft.

Results:
Between March 2013 and March 2017, a total of 10 patients received the tailor-made IBDs. One patient died of systemic thromboembolism 2 days after the operation. The bridging stent-grafts remained patent in all patients, except one occluded at 1 year after operation.

Conclusion:
A tailor-made IBD is an easy-to-apply, alternative option for preserving the IIA perfusion in short CIAA patients with and without AAA.
Intravenous immunoglobulin for adjunctive treatment of severe infections in ICUs
Authors: Aubron Cécile , Berteau Florian , Sparrow Rosemary L. 
Published: July 2019

Purpose of review
This review focuses on the emerging literature regarding the use of intravenous immunoglobulins (IVIg) in critically ill patients with severe infections. The aim is to provide an accessible summary of the most recent evidence of IVIg use in sepsis and septic shock and to help clinicians to understand why there is still equipoise regarding the potential benefit of this adjunctive therapy in this setting.

Recent findings
Observational studies with propensity score matching analyses and investigating the effect of IVIg in severe infections including necrotizing soft tissue infection have been recently published. These studies suffer important flaws precluding robust conclusion to be drawn. Some recent randomized controlled trials raised interesting findings supportive of personalized medicine but are likely to be underpowered or confounded.

Summary
Insufficient evidence is available to support IVIg use in sepsis and septic shock, apart from the specific case of streptococcal toxic shock syndrome. Current literature suggests that IVIg efficacy in sepsis or septic shock could depend on the IVIg preparation (IgM-enriched or minimal IgM), time of administration (<24 h), dose, and the inflammatory/immunomodulation profile of the patients. Investigator-initiated research, incorporating these parameters, is warranted to determine whether IVIg benefits critically ill patients with severe infection.
Diagnostic value of polymerase chain reaction/acid-fast bacilli in conjunction with computed tomography–guided pleural biopsy in tuberculous pleurisy
Authors: Li Lei , Wang Ye , Zhang Rui , Liu Dan , Li Yalun , Zhou Yongzhao , Song Juan , Li Weimin , Tian Panwen 
Published: July 2019

Abstract
Patients with tuberculous pleurisy often remain undiagnosed even after blind thoracentesis and closed pleural biopsy (PB). In this study, we assessed the value of computed tomography (CT)-guided core needle biopsy of pleural lesion and evaluated the diagnostic accuracy of polymerase chain reaction (PCR)/staining for acid-fast bacilli (AFB) in suspicious tuberculous pleurisy undiagnosed in blind thoracentesis.
Patients with exudative pleural effusion (PE) without specific etiology after blind thoracentesis and closed PB were enrolled in this study. PB specimens were obtained through CT-guided core needle biopsy of pleural lesion, then underwent PCR, AFB, histopathological examination, and some routine tests. Diagnostic values were evaluated through sensitivity, specificity, negative predictive value, positive predictive value, and accuracy.
A total of 261 participants (TB group: 241, non-TB group: 20) were recruited. In this cohort, the sensitivity, specificity, and accuracy were 56.0%, 95.0%, and 59.0%, respectively for PCR, whereas 57.3%, 95.0%, and 60.2%, respectively for AFB. Their parallel test achieved an improved sensitivity (76.8%) and accuracy (77.8%), with a slight decrease in specificity (90.0%). In histopathological examination, granuloma was the most common finding in TB group (88.4%, 213/241), but also observed in non-TB group (10.0%, 2/20). In addition, pleural lymphocyte percentage in TB group was significantly higher than that of non-TB group (92% vs 61%, respectively; P = .003). However, no significant differences were found for other biomarkers.
CT-guided core needle PB is essential for patients with exudative PE but undiagnosed after blind thoracentesis. Combining with PCR and AFB, it strongly improves the diagnosis of tuberculous pleurisy.
Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery
Authors: Su I-Li , Wu Victor Chien-Chia , Chou An-Hsun , Yang Chia-Hung , Chu Pao-Hsien , Liu Kuo-Sheng , Tsai Feng-Chun , Lin Pyng-Jing , Chang Chih-Hsiang , Chen Shao-Wei 
Published: July 2019

Abstract
To investigate the incidence, outcomes, and risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients undergoing surgical repair for acute type A aortic dissection.
This retrospective study involved 270 patients who underwent surgical repair for acute type A aortic dissection between January 2009 and December 2015. Data on clinical characteristics and outcomes were collected. Patients who immediately died after surgery and with preoperative myocardial dysfunction were excluded. The included patients were divided into the ARDS (ARDS patients who met the Berlin definition) and non-ARDS groups. Primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS and was reviewed by 2 qualified physicians with expertise in critical care and cardiac surgery. Outcomes of interest were the incidence and severity of risk factors for ARDS in this population, and perioperative outcomes and survival rates were compared with patients with or without ARDS.
A total of 233 adult patients were enrolled into this study; of these, 37 patients (15.9%) had ARDS. Three, 20, and 14 patients had mild, moderate, and severe ARDS, respectively, according to the Berlin definition, with no significant difference in age, sex, and underlying disease. The ARDS group had lower mean oxygenation index (OI) than the non-ARDS group in the first 3 days post-surgery and demonstrated an improvement in lung function after the fourth day. Postoperative complication risks were higher in the ARDS group than in the non-ARDS group. However, no significant difference was observed in in-hospital mortality between the 2 groups (10.8% vs 5.6%, P = .268). Additionally, there was also no significant difference in the 3-year mortality rate between the 2 groups (P of log-rank test = .274). Postoperative hemoglobin level (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.62–0.99) and perioperative blood transfusion volume (OR: 1.07; 95% CI: 1.03–1.12) were associated with ARDS risk.
Postoperative ARDS after type A aortic dissection repair surgery was associated with risks of postoperative complications but not with risk of in-hospital mortality or 3-year mortality. A higher perioperative blood transfusion volume and a lower postoperative hemoglobin level may be risk factors for ARDS.
Effects of long-term glycemic variability on incident cardiovascular disease and mortality in subjects without diabetes
Authors: Yu Ji Hee , Han Kyungdo , Park Sanghyun , Lee Da Young , Nam Ga Eun , Seo Ji A , Kim Sin Gon , Baik Sei Hyun , Park Yong Gyu , Kim Seon Mee , Kim Nan Hee , Choi Kyung Mook 
Published: July 2019

Abstract
Increased glycemic variability (GV) is an independent risk factor for cardiovascular complications in patients with diabetes. We evaluated the risk of future development of cardiovascular disease (CVD) and death according to GV in a general population without diabetes.
We used the National Health Insurance Service, providing a population-based, nationwide database of Koreans. We included individuals without diabetes who underwent glucose measurement at least 3 times during 2002 to 2006. GV was calculated as standard deviation (SD) of fasting plasma glucose (FPG) levels. We observed development of CVD or all-cause death from 2007 to 2015, and also evaluated the mortality within 1 year after CVD.
Among 3,211,319 people, we found 23,374 incident cases of myocardial infarction (MI), 27,705 cases of stroke, and 63,275 deaths during 8.3 years of follow-up. After multivariate adjustment, GV was found to be a significant predictor of MI, stroke and all-cause death for their highest quartile, with corresponding hazard ratios (HR) of 1.08 (95% confidence interval, CI 1.04–1.11), 1.09 (95% CI 1.06–1.13), and 1.12 (95% CI 1.10–1.15), respectively. The risk of death increased more in those who had both impaired fasting glucose and the highest quartile of GV (HR 1.24 [95% CI 1.21–1.28]). Moreover, early death rate after 1 year of CVD was higher in the highest quartile of GV compared to the lowest quartile (HR 1.21 [95% CI 1.03–1.41]).
Long-term FPG variation was independently associated with CVD and mortality in a general population without diabetes.
Computer-aided detection for prostate cancer diagnosis based on magnetic resonance imaging
Authors: Liang Fuxiang , Li Meixuan , Yao Liang , Wang Xiaoqin , Liu Jieting , Li Huijuan , Cao Liujiao , Liu Shidong , Song Yumeng , Song Bing 
Published: July 2019

Abstract

Background:
Prostate cancer (PCa) is one of the most common primary malignancies in humans and the second leading cause of cancer-specific mortality among Western males. Computer-aided detection (CAD) systems have been developed for accurate and automated PCa detection and diagnosis, but the diagnostic accuracy of different CAD systems based on magnetic resonance imaging (MRI) for PCa remains controversial. The aim of this study is to systematically review the published evidence to investigate diagnostic accuracy of different CAD systems based on MRI for PCa.

Methods:
We will conduct the systematic review and meta-analysis according to the Preferred Reporting Items for a systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA) guidelines. Cochrane library, PubMed, EMBASE and Chinese Biomedicine Literature Database will be systematically searched from inception for eligible articles, 2 independent reviewers will select studies on CAD-based MRI diagnosis of PCa and extract the requisite data. The quality of reporting evidence will be assessed using the quality assessment of diagnosis accuracy study (QUADAS-2) tool. Pooled sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curves will be calculated to estimate the diagnostic accuracy of CAD system. In addition, we will conduct subgroup analyses according to the type of classifier of CAD systems used and the different prostate zoon.

Results:
This study will conduct a meta-analysis of current evidence to investigate the diagnostic accuracy of CAD systems based on MRI for PCa by calculating sensitivity, specificity, and SROC curves.

Conclusion:
The conclusion of this study will provide evidence to judge whether CAD systems based on MRI have high diagnostic accuracy for PCa.

Ethics and dissemination:
Ethics approval is not required for this systematic review as it will involve the collection and analysis of secondary data. The results of the review will be reported in international peer-reviewed journals.

Prospero registration number:
CRD42019132543.
Cluster of differentiation 30 expression in lacrimal gland and conjunctival tissues in patients with Sjögren's syndrome
Authors: Ogawa Akiko , Ogawa Yoko , Mukai Shin , Shimizu Eisuke , Kuwana Masataka , Kawakami Yutaka , Tsubota Kazuo 
Published: July 2019

Abstract

Introduction:
Sjögren's syndrome (SS) often causes lymphoproliferative disorders such as malignant lymphoma and macroglobrinemia. Approximately 5% of long-term follow-up SS patients develop malignant lymphoma. Recently, the tumor necrosis factor receptor superfamily cluster of differentiation 30 (CD30) has been thought to be implicated in malignant cells in organs affected by Hodgikin lymphoma or in a prognostic marker of diffuse large B cell lymphoma. In this study, we investigated CD30 expression in lacrimal gland and conjunctiva in patients with SS.

Methods:
We examined lacrimal gland and conjunctival tissues for the diagnosis from 3 female SS patients with a median age of 51 and 3 female chronic graft-versus-host disease (cGVHD) patients with a median age of 41. Histological analysis of these tissues of the remaining samples was conducted by methods including immunohistochemistry and electron microscopy (#20090277). We analyzed the expression and localization of cluster of differentiation 4 (CD4), cluster of differentiation 8 (CD8), cluster of differentiation 20 (CD20), CD30, and Interferon-γ in tissue sections prepared from lacrimal glands and conjunctiva in 3 each of SS and cGVHD patients.

Results:
There were more B cells and plasma cells in lobules of SS-affected lacrimal glands than in those of their cGVHD-affected counterparts. Interferon-γ was expressed on endothelia of capillaries in SS-affected lacrimal gland and conjunctival tissues whereas it was expressed on fibroblasts in their GVHD-affected equivalents. Furthermore, lacrimal glands and conjunctiva disordered by SS had a greater number of CD30+ cells than those disordered by cGVHD.

Conclusion:
Our results suggest that CD30+ cells are increased in lacrimal glands and conjunctiva affected by SS and that a subset of SS patients are thereby at risk of development malignant lymphoma.
Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery
Authors: Yuan Tianyang , Zhang Jun , Yang Lili , Wu Jiuping , Tian Haiqing , Wan Teng , Xu Derui , Liu Qinyi 
Published: July 2019

Abstract

Rationale:
Cauda equina syndrome (CES) refers to a group of symptoms that occur when the nerves in the cauda equina become compressed or damaged. The most common etiology of CES is lumbar intervertebral disc herniation, but CES following lumbar spinal surgery is rare, especially without motor dysfunction. Herein, we illustrate a case of CES that developed as a complication of spinal surgery and to deduce its possible underlying cause.

Patient concerns:
A 46-year-old man experienced lumbago, bilateral shank pain, and numbness with neurogenic claudication for 3 years due to degenerative lumbar disc herniation and spinal cord stenosis. After a thorough examination to diagnose lumbar spinal stenosis, the patient underwent bilateral decompression and pedicle screw system internal fixation with bone graft. Postoperatively, the patient showed regained strength in his bilateral shanks, and he did not complain of lumbago and shank pain, but CES occurred, which manifested as underpants-type numbness in the perineum without bladder, anal, and motor dysfunction.

Diagnoses:
CES as a postoperative complication of lumbar stenosis.

Interventions:
The patient underwent bilateral laminectomies, partial facetectomies, and pedicle screw system internal fixation and fusion with bone graft. Postoperatively, the patient performed adequate rehabilitation exercises and was expected to recover spontaneously.

Outcomes:
The symptoms of pain and claudication resolved after 3 weeks in the hospital, but an underpants-type hypoesthesia in the perineum without motor dysfunction developed. The patient experienced full recovery from CES 6 months after surgery.

Lessons:
CES as a complication of lumbar spinal surgery is very rare. Excessive sensitivity to the traction of the dural sac was, in our opinion, the most possible cause of postoperative CES in this case. When the nerve root is pulled intraoperatively, it is best not to cross the central line of the spinous process. The plane of the nerve retractor needs to be parallel to the dural sac at the pulling point to reduce the formation of shear force. Most importantly, gentle maneuver is required because sensitivity to the traction of the dural sac varies individually.
Novel diagnosis of mesenteric endometrioma
Authors: Sima Romina-Marina , Radosa Julia Caroline , Zamfir Radu , Ionescu Cringu-Antoniu , Carp Delia , Iordache Ioan-Iulian , Stănescu Anca-Daniela , Pleş Liana 
Published: July 2019

Abstract

Rationale:
Mesenteric cysts are benign gastrointestinal cystic lesions, with an incidence of <1/100 000. They usually develop in the small bowel mesentery, mesocolon (24%), retroperitoneum (14.5%), and very rarely originate from the sigmoid mesentery. Endometriomas represent a localized type of endometriosis and are usually within the ovary. Our case is unique because there are no reports in the literature of endometrial mesenteric cysts.

Patient concerns:
We present a case of a 29-year-old woman who underwent a routine gynecologic control.

Diagnosis:
Clinical examination and imaging identified 2 endometriomas on the left and posterior to the uterus.

Interventions:
The patient underwent exploratory laparoscopy. Unexpectedly, a 10 cm mesenteric cyst was identified; this was associated with adhesions in the left adnexal area and a left ovarian endometrioma. The classic surgical approach which was necessary identified the mesenteric cyst with cranial mesosigmoid and ileal adhesions, as well as distal adhesions which included the uterus, ileum, left ovarian endometrioma, left hydrosalpinx, left ureter, and rectum. The cyst was removed completely and a left adnexectomy was performed because of the presence of the endometrioma and adhesions.

Outcomes:
The patient's outcome was favorable, with discharge at 72 hours after surgery. The histopathological report revealed that both the mesenteric and ovarian cysts were endometriomas.

Lessons:
Our case is unusual in that a mesenteric cyst was identified in a patient with no clinical symptoms. Furthermore, the histopathological examination revealed the endometriotic origin of the mesenteric cyst which has not previously been reported in the literature.
Mixed large and small cell neuroendocrine carcinoma of the endometrium with serous carcinoma
Authors: Hu Ruijiao , Jiang Jiyong , Song Guangyao , Zhu Chenggong , Chen Liyan , Wang Chenhui , Wang Xiuying 
Published: July 2019

Abstract

Rationale:
Endometrial neuroendocrine carcinoma is a rare histological subtype of endometrial cancer, divided into low-grade neuroendocrine carcinoma (carcinoid) and high-grade neuroendocrine carcinoma (small cell and large cell neuroendocrine carcinoma). It is characterized by high invasiveness and poor prognosis. L/SCNEC is an extremely rare pathological type of endometrial carcinoma, and the number of reports on this condition is few globally.

Patient concerns:
A 54-year-old Chinese female presented with vaginal bleeding.

Diagnoses:
Outpatient hysteroscopy and endometrial biopsy were performed, and the pathological examination revealed that cervix was invaded by endometrial malignancy. The patient underwent a laparoscopic radical hysterectomy was diagnosed with the mixed large and small cell neuroendocrine carcinoma (L/SCNEC) of the endometrium combined with serous carcinoma III C2 (FIGO2009).

Interventions:
Chemotherapy-radiotherapy-chemotherapy “sandwich” treatment was performed as postoperative therapy.

Outcomes:
After three chemotherapy circles, the patient showed no evidence of further disease progression.

Lessons:
L/SCNEC is a rare and invasive disease. Once diagnosed, comprehensive treatments including surgery, radiotherapy, and chemotherapy can prolong the survival of patients and improve the prognosis.
Clinical characteristics and treatment of thallium poisoning in patients with delayed admission in China
Authors: Lin Guodong , Yuan Luo , Peng Xiaobo , Long Jianhai , Wang Chunyan , Bai Lili , Lu Xiaoxia , Dong Jianguang , Liu Yanqing , Wang Yongan , Qiu Zewu 
Published: July 2019

Abstract
Thallium is highly toxic and its effects are cumulative. The clinical symptoms of thallium poisoning are non-specific, thereby delaying admission and treatment. This study aimed to summarize the clinical features and treatment experience of patients with delayed admission who experience thallium poisoning.
We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had thallium poisoning and experienced a delay in hospital admission. The time from symptom onset to admission was assessed. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory test results, examination findings, treatment methods, outcomes, and follow-up information, were conducted.
A total of 34 patients with thallium poisoning were included: 8 were admitted to the hospital early or with mild delay, 9 had a moderate delay, and 17 had a severely delayed admission. The time from illness onset to admission was 13 (interquartile range, 7.5–26) days. Some patients with delayed admission had significant symptoms associated with central nervous system damage, and changes in magnetic resonance images and electroencephalograms were also noted. After admission, all patients received Prussian blue treatment, and some patients with relatively high blood concentration received blood purification treatments. Following treatment, the blood and urine thallium concentrations of all patients decreased significantly, and their symptoms were alleviated.
Our results show that delayed patient admission in cases of thallium poisoning is associated with greater risk of central nervous system damage. Use of Prussian blue combined with blood purification treatments might improve patients’ conditions.
MR imaging to detect myelolipomas of the liver
Authors: Xin Huizhen , Li Haijun , Yu Honghui , Zhang Juan , Peng Weizhi , Peng Dechang 
Published: July 2019

Abstract

Rationale:
Primary hepatic myelolipoma is a rare benign neoplasm comprising mature adipose tissue and marrow components in various proportions. Chemical shift imaging (CSI) can distinguish the lipid within the tumor clearly; however, there have been no reports on the CSI of hepatic myelolipoma.

Patient concern:
A 20-year-old woman visited our hospital after discovering a space-occupying lesion in the liver with a history of more than 1 year. She felt distension pain and discomfort under the xiphoid process, accompanied by nausea, vomiting, and occasional chest oppression.

Diagnosis:
The tumor showed a well-defined mass with a pseudocapsule and a heterogeneous appearance on both T1- and T2-weighted magnetic resonance (MR) images. CSI analysis showed a signal decline within the tumor. Based on the histopathology, the tumor was diagnosed as hepatic myelolipoma.

Interventions and Outcomes:
The patient underwent a right hepatectomy, and the postoperative vital signs were stable. Two weeks later, the patient was discharged safely.

Lessons:
Although hepatic myelolipoma is extremely rare, this condition should be considered in differential diagnosis when CSI shows that hepatic lesions contain fatty.