bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Rurality With Survival and Guidelines-Concordant Management in Early-stage Non–Small Cell Lung Cancer
Authors: Nicoli Charles D. , Sprague Brian L. , Anker Christopher J. , Lester-Coll Nataniel H. 
Published: June 2019

Background:Rural populations of the United States have not experienced a similar degree of decline in lung cancer mortality recently seen nationwide. Several investigations examining survival differences in rural lung cancer patients have been incongruent. We investigated the association of rural residence with survival outcomes and receipt of guidelines-concordant treatment in early-stage non–small cell lung cancer (NSCLC).Methods:Retrospective study of National Cancer Data Base patients with NSCLC diagnosed from 2004 to 2015. Comparisons of survival outcomes and guidelines-concordant management with lobectomy or stereotactic body radiation therapy among rural and nonrural patients, classified according to the US Department of Agriculture’s Rural-Urban Continuum Codes.Results:We identified 840,566 patients; 18.7% resided in rural areas. Rurality was associated with greater proportions of males, white patients, and higher comorbidities. Larger proportions of rural stage I patients (53.4%) did not undergo guidelines-concordant management with lobectomy or stereotactic body radiation therapy relative to nonrural patients (50.1%,P<0.001). Although rural patients within each stage at diagnosis have a significant disparity in overall survival (OS), stage I NSCLC had the largest absolute difference (nonrural=61.4 mo, rural=50.3 mo, difference of 11.1 mo,P<0.0001). In multivariable Cox regression, rurality was independently associated with impaired survival in both all-stages (hazard ratio=1.08,P<0.001) and stage I NSCLC (hazard ratio=1.09,P<0.001).Conclusions:Small differences exist in OS among all rural NSCLC patients, but rural patients with stage I NSCLC have a marked disadvantage in OS. Rurality is an independent risk factor for decreased survival in all-stages and stage I NSCLC.
Retrospective analysis of HEART Score results in cost saving
Authors: Arnold Sandra A. , Grant Cathy , Magdic Kathy , Hickey Gavin W. , Tedesco Mary Beth 
Published: June 2019

ABSTRACT

Background and purpose:
Chest pain (CP) is one of the most frequent chief complaints of patients presenting to the emergency department (ED). Diagnoses range from life-threatening acute coronary syndrome (ACS) to less concerning musculoskeletal injury. Patients are frequently admitted for comprehensive cardiac evaluation. However, it is estimated that <10% are diagnosed with ACS. Identifying low-risk patients who can be safely discharged from the ED results in lower cost burden and less patient days. The HEART Score is a recently validated tool for undifferentiated CP in the ED used to identify low-risk patients. The purpose of this project was to ascertain if the HEART Score could be utilized in the Veteran population for the evaluation of undifferentiated chest pain.

Local problem:
There is no standard assessment tool used in the ED at the Veterans Administration Pittsburgh Healthcare System (VAPHS) to evaluate CP in low-risk patents.

Methods:
As part of a quality improvement initiative, a retrospective analysis was performed on patients presenting to the ED with CP over a 6-month period. A total of 197 VAPHS patients were identified through the computerized medical record system. HEART Scores were calculated for each patient. Patients scored as low risk (score of 0–3) were further evaluated for major adverse cardiac events (MACE) and cost saving.

Conclusions:
Approximately 28% (56) of the patients presenting to the ED with CP were at low risk based on the HEART Score. There were no MACE. There were cost savings compared with usual care ($1,145 vs. $4,700).

Implications for practice:
The HEART Score can be safely used to identify low-risk patients and result in cost savings for Veteran population.
Postpartum problems in primary care: Focus on postpartum depression and diabetes
Authors: Cabrera Jacqueline P. 
Published: June 2019

ABSTRACT
Postpartum depression and diabetes are common diagnoses affecting many childbearing women annually. Nevertheless, disease management by the primary care provider can be complicated by late entry to care or insufficient care. Pharmacotherapeutic interventions must be initiated appropriately to address the disease progression while supporting breastfeeding. This study explores the course of postpartum depression and diabetes in a postpartum woman using the case study application and analysis along with interventions and education that can help primary care providers in reducing the complications that come from undiagnosed depression and diabetes in the postpartum period.
Incidence of dysphagia of zero-profile spacer versus cage-plate after anterior cervical discectomy and fusion
Authors: Yang Zhongmeng , Zhao Yao , Luo Jiaquan 
Published: June 2019

Abstract

Background:
The purpose of this study is to evaluate the rate of dysphagia between zero-profile spacer versus cage-plate for the treatment of multilevel cervical spondylotic myelopathy (CSM).

Methods:
The authors searched electronic databases for relevant studies that compared the clinical effectiveness of zero-profile spacer versus cage-plate for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) score and fusion rate, dysphagia rate, adjacent segment degeneration, and cervical lordosis. Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of each study. Data extraction and quality assessment were conducted, and RevMan 5.2 was used for data analysis.

Results:
A total of 10 studies were included in our meta-analysis. Our pooled data revealed that zero-profile spacer was associated with decreased dysphagia rate at postoperatively 1, 3, and 6 months, and the final follow-up when compared with cage-plate group. No significant difference was observed in terms of postoperative JOA score, NDI score, and fusion rate. Compared with zero-profile spacer, the postoperative adjacent segment degeneration was significant higher in cage-plate. Pooled data from the relevant studies revealed that cervical lordosis was significantly lower in zero-profile spacer compared with cage-plate.

Conclusions:
Our meta-analysis reveals zero-profile spacer is better than the cage-plate in terms of dysphagia. This suggests zero-profile spacer is a superior alternative invention for the treatment of multilevel CSM to reduce the risk of dysphagia.
Natural history of leiomyomas beyond the uterus
Authors: Barnaś Edyta , Raś Renata , Skręt-Magierło Joanna , Wesecki Mariusz , Filipowska Justyna , Książek Mariusz , Skręt Andrzej , Widenka Kazimierz 
Published: June 2019

Abstract

Rationale:
Most leiomyomas are located in the uterus. Leiomyomas are rarely found outside the uterus and classified as leiomyoma beyond the uterus (LBU). This group consists of disseminated peritoneal leiomyomatosis, benign metastasizing leiomyoma, intravenous leiomyomatosis, parasite leiomyoma located in the broad ligament and retroperitoneal space. The descriptions of the patients who suffer from these types of leiomyomas are presented mainly in case reports.

Patient concerns:
A 34-year-old multiparous woman was operated on multiple recurrent uterine leiomyoma in parametrium. At one time, 32 leiomyomas were removed. Thirteen months following it, in next laparotomy, 132 leiomyomas were excised. Histologically, both were intravenous leiomyomas (IVLs).

Diagnosis and Interventions:
In follow-up, computed tomography (CT) and magnetic resonance imaging scans were performed to look for next recurrent leiomyoma. Accidentally, the mass was found in inferior vena cava which was diagnosed as intravenous vena cava leiomyoma. The mass was removed and the final diagnosis of intravenous myoma was confirmed in histopathology.

Outcomes:
CT scan performed 3 months after the surgery for leiomyoma in vena cava revealed no pathology. Next 10 months’ follow-up was uneventful.

Lessons:
The recurrent multiple uterine leiomyoma precede LBU. The uterine leiomyoma spreads intravenously route to parametria as parasite leiomyoma, then to vena cava. It has to be taken into account in follow-up.
Romiplostim-related myelofibrosis in refractory primary immune thrombocytopenia
Authors: Kim Hyun-Young , Park Sung Woo , Kim Jung Hoon , Kang Jung Hun , Lee Won Seop , Song Haa-Na 
Published: June 2019

Abstract

Rationale:
Primary immune thrombocytopenia (ITP) is an immune-mediated disease that is defined as increased platelet destruction and impaired platelet production. Treatment is recommended for highly selected patients, the standard regimen includes glucocorticoid, intravenous immunoglobulin (IVIG). The recombinant thrombopoietin (TPO) receptor agonists, romiplostim, stimulate platelet production and have approved for glucocorticoid or IVIG, splenectomy-refractory chronic ITP patients.

Patient concerns:
A patient has been diagnosed with ITP, reftractory to steroid, IVIG, splenectomy, danazol, and cyclosporine. The patient received romiplostim to normalize his platelet count, however, over the course of the following year, his platelet counts progressively decreased despite increasing the romiplostim dosing.

Diagnoses:
A peripheral blood smear showed a severe leukoerythroblastic reaction and bone marrow biopsy demonstrated myelofibrosis due to romiplostim.

Outcomes:
Since this diagnosis, romiplostim was discontinued for a while, after 3 months, romiplostim was re-administered to improve thrombocytopenia. His platelet count recovered to 70,000/mm3 after the administration of romiplostim at 2 μg/kg, and he did not experience complications for 6 months.

Lessons:
This report represents the first evidence of romiplostim-induced myelofibrosis, which was associated with increased levels of bone marrow reticulin and Masson trichrome staining.
The relationship between physical fitness and health self-assessment in elderly
Authors: Knapik Andrzej , Brzęk Anna , Famuła-Wąż Anna , Gallert-Kopyto Weronika , Szydłak Dorota , Marcisz Czesław , Plinta Ryszard 
Published: June 2019

Abstract

Background:
The process of population aging inclines to seek determinants of the quality of life in the older people. Health self–assessment is the one of the main elements of the quality of life. In the older people it is associated with functional efficiency. The aim of the study was to determine correlations of physical fitness and health self-assessment.

Methods:
The study group included 123 people aged 60 to 86 years. Physical fitness was evaluated using the Senior Fitness Test (SFT). Self-esteem of health was assessed by the SF-36 questionnaire.

Results:
The analysis included sex factor and the occurrence of chronic diseases. When comparing with healthy participants, people suffering from chronic diseases revealed a lower level of physical fitness (P < .05) and health self-assessment (P < .05). The results of a significant percentage of study participants were worse than norms proposed as standards. The percentage of people below norms varied depending on sex, age, and SFT assessment and ranged from 0 to 89.5%.

Conclusion:
Physical fitness and health self-assessment among elderly may be strongly determined by cultural conditions, for example, habits, lifestyle in various regions. The application of conclusions suggests that the key element of rehabilitation programs among elderly should be focused on improving coordination and locomotor capabilities. Assessment of the elderly is more clearly associated with physical fitness in women than in men and also more in patients chronically ill than in healthy person. Comprehensive assessment of physical fitness according to standardized values does not indicate the diversity by sex.
Ketosis-prone diabetes mellitus in an obese adolescent
Authors: Tan Huiwen , Wang Chun , Yu Yerong 
Published: June 2019

Abstract

Rationale:
In recent years, there are more new insights into the clinical susceptibility, pathophysiological mechanism, and progression of classification and treatment of ketosis-prone diabetes mellitus (KPDM), which was once described as Idiopathic Type 1 Diabetes, Type 1B Diabetes or Flatbush Diabetes. ketosis-prone diabetes mellitus is still a heterogeneous syndrome reported in African-American or western Sub-Sahara-African, Hispanic descendant, and recently in Asian.

Patient concerns:
An obese 17-year-old student was admitted to a tertiary referral hospital (teaching hospital), presenting with thirst, polyuria fatigue, and a 9 kg weight loss in the preceding two weeks.

Diagnoses:
Physical examination showed body mass index (BMI) was 32.77 kg/m2, arterial blood gas revealed a pH of 7.31. Serum glucose was 27.8 mmol/L with strong positive uric ketones (++++). Hemoglobin A1c (HbA1c) was 13.6%. The glucose disposal ratio (GDR) during the steady-state of euglycemic clamp test was 5.62 mg/kg/min and M value was 2.87 mg/kg/min during hyperglycemic clamp test. Those findings were sufficient to establish a diagnosis of ketosis-prone diabetes mellitus.

Interventions:
This obese patient with KPDM received intensive insulin therapy and fluids infusion, and during the remainder of hospitalization his insulin requirement was approximately 1.5 U per kilogram of body weight per day. Blood glucose monitoring was rigorous until the diabetic ketoacidosis under control.

Outcomes:
He achieved the near-nomalglycemic remission uneventfully. At 12-month follow-up, his treatment was adjusted from insulin subcutaneous injection to oral hypoglycemic drugs.

Lesson:
The present study of this obese adolescent with negative auto-antibodies but unprovoked diabetic ketoacidosis and partially preserved beta cell functional reserve after the acute of diabetic ketosis suggested that he has the phenotype of “A–β+” KPDM. Further study of this syndrome will help illustrate the inadequacy of current classification and targeted therapies.
Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment
Authors: Wang Feifei , Ma Zhuo , Wu Xinan , Liu Lihong 
Published: June 2019

Abstract

Rationale:
Toxic epidermal necrolysis (TEN) is a life-threatening, immunologically mediated, and usually drug-induced disease. Rarely, clinical pharmacists participating in finding the etiology have been reported.

Patients concerns:
A 33-year-old male presented to the emergency department with a 1-day history of fever and rash. The patient, being newly diagnosed with gout 10 days ago, received allopurinol at a dose of 250 mg by mouth daily. After 10 days’ exposure to allopurinol, the patient manifested with an “influenza-like” prodromal phase (fever of 38°C, throat pains), which was treated with amoxicillin and nonsteroidal anti-inflammatory drugs of the oxicam type. The next day, he developed a worsening fever of 39.5°C, accompanied by a pruriginous rash all over his body.

Diagnosis:
On physical examination, we observed coalescing dusky red macules over >60% of his body surface area, with blisters and detachment of large sheets of necrolytic epidermis all over his chest and face. The diagnosis of TEN was confirmed.

Interventions:
The patient recovered following treatment with short-term high-dose methylprednisolone sodium succinate, immunoglobulin therapy, topical medication, and supportive therapy.

Outcomes:
He showed a slow but progressive improvement both in symptoms and cutaneous manifestations. Reepithelization of the skin was achieved after 3 weeks.

Lessons:
Drug-induced-TEN is potentially fatal. This case underlines the necessity of asking medication history in detail and detecting related drug gene to correctly identify the cause of TEN.
Lung adenocarcinoma metastasizing to fibrous histiocytoma
Authors: Liu Yang , Dai Bing 
Published: June 2019

Abstract

Rationale:
Tumor-to-tumor metastasis is an uncommon phenomenon, and the tumor metastatic to mesenchymal tumor is extremely rare. To our knowledge, this is the first case of lung adenocarcinoma metastasizing to fibrous histiocytoma.

Patient concerns:
A 58-year-old Chinese woman was admitted to our hospital with a complaint of progressive enlargement of a mass in the right upper arm without pain, heat (localized warmth), redness, and swelling, for a year.

Diagnoses:
Ultrasound revealed a mass with relative clear boundary in the right upper arm near elbow joint. Uneven echoes, and blood flow signals were showed within the mass. The tumor was well-demarcated from the surrounding tissue a thin fibrous capsule. Scattered enlarged cells with hyperchromatic pleomorphic nuclei were dispersed in an otherwise typical cutaneous fibrous histiocytoma. These atypical cells arranged in poorly glandular structures or irregular epithelioid nest and were demonstrated as metastatic lung adenocarcinoma by immunohistochemical staining. We reviewed the biopsy section and found these 2 sites of adenocarcinoma shared similar histologic morphological features. Therefore, the final diagnosis was lung adenocarcinoma metastasizing to fibrous histiocytoma.

Interventions:
The patient was diagnosed with lung adenocarcinoma by bronchoscopic biopsy 3 months ago and received 4 cycles of NP (Vinoreltraye [NVB] + cis-platinum) chemotherapy program. The patient underwent a total resection of the mass in right upper arm.

Outcomes:
The patient died of multiple organ failure after 10 months since she was diagnosed as lung adenocarcinoma.

Lessons:
The accumulation of lipid droplets in fibrous histiocytoma may be a potential reason for modifying pre-metastatic niche, and therefore create a tumor microenvironment suitable for metastasis.
A typical 22q11.2 deletion syndrome and pseudohypoparathyroidism
Authors: Liu Xi-Juan , Yan Chen , Jia Jing-Yu 
Published: June 2019

AbstractRationale:It is rare to find 22q11.2 deletion syndrome with pseudohypoparathyroidism in children. Furthermore, the phenotypic spectrum of this disorder varies widely.Patient concerns:A patient was diagnosed with pseudohypoparathyroidism at age 14 years because of convulsions, hypocalcemia, hyperphosphatemia, normal parathyroid hormone levels, and basal ganglia calcifications. Thereafter, the child presented with symptoms of nephrotic syndrome; subsequently, he was diagnosed with nephrotic syndrome at the local hospital.Diagnosis:At our hospital, multiplex ligation-dependent probe amplification confirmed that the patient had 22q11.2 deletion syndrome.Interventions:The patient continued to be treated with calcium supplements.Outcomes:Seizure activity and proteinuria ceased.Lessons:Signs of this syndrome include delayed speech development due to velofacial dysfunction, recurrent croup attacks during early childhood due to latent hypocalcemia, and mild dysmorphic features. The findings of this patient indicated that 22q11.2 deletion syndrome may include a wide spectrum of clinical findings and that this diagnosis needs to be considered for all patients presenting with hypocalcemia, regardless of age.
Clinical outcome after lipectomy in the management of patients with human immunodeficiency virus-associated dorsocervical fat accumulation
Authors: Chen Song , Gui Xi-en , Cao Qian , Routy Jean-Pierre 
Published: June 2019

Abstract
Lipo-accumulation of the dorsocervical fat pad (“buffalo hump”) is a complication observed in people living with human immunodeficiency virus (HIV). We described the clinical outcome of people living with HIV with “buffalo hump” treated by excisional lipectomy.
From April 2013 to March 2018, medical records of people living with HIV, who received care in our hospital have been evaluated. Among them, patients with dorsocervical fat accumulation treated by excisional lipectomy have been retrospectively assessed.
Nine patients with “buffalo hump” among 2886 people living with HIV (3.1‰, 9/2886) were included. Eight were women with a mean age of 47.9 ± 8.0 years old (range, 36–60). Most of them have been infected by blood transfusion (77%, 7/9) and the mean duration of HIV infection was 14.1 ± 5.5 years (range, 6–22). The mean duration for antiretroviral therapy was 8.8 ± 2.1 years (range, 6–11). The mean pre-ART CD4+ T cell count was 91.3 ± 76.5 cells/μL (range, 4–233) and 477.4 ± 271.8 cells/μL (range, 114–926) at the time of surgery. All 9 patients underwent excisional lipectomy of their hypertrophied dorsocervical fat pad. The mean size of the excised specimens was 14 × 11 × 6 cm. The median follow-up time was 24 months (range, 2–60), all 9 patients reported satisfaction with their results, with no recurrence has been observed.
Corrective surgery used to treat localized fat accumulations in people living with HIV with “buffalo hump” showed a favorable effect and can therefore be considered when necessary. Whereas drugs such as integrase inhibitors may avoid lipo-accumulation related syndrome and should be given to people living with HIV in China.
Management of venous perforation during central venous catheterization in hemodialysis patients
Authors: Xu Li-Yun , Chen De-Jun , Wang Sha-Sha , Chen Lu , Qi Feng , Liu Man-Man 
Published: June 2019

Abstract

Rationale:
In recent years, central venous catheterization (CVC) has become widely used for hemodialysis patients. Based on 3 cases, we discussed the detection and management of venous perforation at an early stage.

Patients concerns:
Patients 1 (male, 77 years), 2 (male, 82 years), and 3 (male, 30 years) were diagnosed with uremia and underwent hemodialysis.

Diagnoses:
Computed tomography suggested pneumomediastinum in patient 1 and pneumothorax in patient 2 after a replacement of the temporary hemodialysis catheter. In patient 3, X-ray suggested that the tip of the catheter was approximately at the plane of the fifth thoracic vertebrate after the temporary catheter was placed.

Interventions:
In patients 1 and 2, the catheters were maintained where they were for about 2 weeks until a false lumen formed outside the catheter. In patient 3, the catheter was withdrawn at once when vein perforation was observed.

Outcome:
In patients 1 and 2, the catheters were adjusted successfully under digital subtraction angiography (DSA) guidance 2 weeks later. In patient 3, hemothorax developed, and a total of approximately 1000 mL of bloody fluid was drained.

Lessons:
When venous perforation occurs during CVC, it is safer and more reliable to adjust or withdraw the catheter under DSA guidance after a false lumen forms outside the catheter.
Bacterial Content of Fortified and Unfortified Holder Pasteurized Donor Human Milk During Prolonged Refrigerated Storage
Authors: Mandru Cosmina , Perrin Maryanne T. , Iyer Radha , Liveris Dionysios , Schwartz Ira , Alpan Gad , Parvez Boriana 
Published: June 2019

ABSTRACTObjective:To assess the microbial growth in unfortified and fortified Holder pasteurized donor human milk (HPDHM) during 96 hours of refrigerated storage in a clinical setting.Methods:Thirty‐six unfortified samples and 77 fortified samples of HPDHM were prepared in a neonatal intensive care milk preparation room and stored in the NICU refrigerator at 4°C to simulate a real‐life feeding environment. One milliliter aliquots were removed at 24‐hour intervals and cultured in duplicate for bacterial growth on solid blood agar medium. Viable bacterial colonies were characterized using standard microbiological methods.Results:96.5% of milk samples manipulated in a vertical laminar flow hood were negative for bacterial growth. In the remainder 3.5% of the samples, the maximum growth was 1 colony forming unit/0.1 ml plated. Higher colony counts were observed when the laminar hood was not used. In all cases, the colonies represented common skin bacteria and demonstrated an inconsistent and unsustained growth. Fortifier status and storage time were not significantly associated with increased bacterial growth (P > 0.05).Conclusions:Unfortified and fortified HPDHM remain largely free of bacterial growth for up to 96 hours of refrigerated storage in NICU settings. Sample handling techniques are important for preventing microbial contamination.