bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delaying Surgery in Type III Supracondylar Humerus Fractures Does Not Lead to Longer Surgical Times or More Difficult Reduction
Authors: Prabhakar Pooja , Ho Christine A. 
Published: April 2019

Objective:
To determine if delay in surgical treatment of type III supracondylar humerus fracture would affect the length of operative time.

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center.

Patients/Participants:
This is a series of 309 modified Gartland type III supracondylar fractures treated operatively from 2011 to 2013.

Intervention:
Fifteen hours was defined as the cutoff between early and delayed treatment. A total of 53.7% (166/309) fractures were treated early, and 46.4% (143/309) were delayed.

Main Outcome Measurements:
Surgical time was defined as “incision start” to “incision close.” Fluoroscopy time was used as a surrogate for difficulty of reduction.

Results:
Time from injury to operating room was shorter for high-energy fractures (fractures with soft-tissue or neurovascular injury) versus low-energy fractures (12.9 vs. 15.3 hours, P < 0.0001); however, surgical time (37.3 vs. 31.8 minutes, P = 0.004) and fluoroscopy time (54.6 vs. 48.6 seconds, P = 0.027) were longer in high-energy fractures versus low-energy fractures. Among low-energy fractures, no significant difference was detected in the surgical time between the early and delayed treatment groups or in the fluoroscopy time. In addition, there was no statistically significant difference found in the surgical or fluoroscopy time with the presence of a surgical assistant.

Conclusions:
Delay in surgery did not result in a longer surgical time or more difficult reduction for type III supracondylar humerus fracture. Patients with low-energy fractures still underwent a shorter operative time even with delay from injury to surgery.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assessing the Need for Common Perioperative Laboratory Tests in Pediatric Patients With Femoral Shaft Fractures
Authors: Adams Alexander J. , Baldwin Keith D. , Arkader Alexandre , Sankar Wudbhav N. 
Published: April 2019

Background:
Femoral shaft fractures are a common cause for hospital admission and surgery in pediatric patients, and laboratory studies are often ordered for historical concerns of excessive bleeding. Recent literature has challenged these assumptions, and unnecessary testing causes undue pain and costs in children. No previous studies have offered evidence-based recommendations for perioperative laboratories in isolated pediatric femoral shaft fractures.

Methods:
We retrospectively reviewed all patients presenting with femoral shaft fractures at our pediatric trauma center between 2013 and 2017. Patients with multitrauma injuries, metabolic/neuromuscular diseases, or intensive care unit stays were excluded. Necessity of laboratory tests was determined by rates of anemia, blood transfusions, specialist consultations, and delayed surgeries. Ordering patterns were recorded, with cost estimation based on Healthcare Bluebook.

Results:
We reviewed 95 patients (mean age, 7.9±4.8 y; 70 males). Treatments included elastic nails (33/95, 34.7%), reamed intramedullary nails (24/95, 25.3%), plates/screws (12/95, 12.6%), and spica casting (26/95, 27.4%). Of 32 patients with preoperative coagulation laboratories, 11 were abnormal; however none resulted in hematology consultations or procedure delays. Seventy-five patients (78.9%) and 15 patients (15.8%) had complete blood counts preoperatively and postoperative day 1, respectively. Four patients (4.2%) had hemoglobin<8 g/dL postoperatively, however, there were no perioperative blood transfusions. Of these 4, 3 underwent either reamed intramedullary nails or open reduction internal fixation with plates/screws. Twenty-six patients (27.4%) had preoperative basic metabolic panels that did not alter medical care. On the basis of our criteria, over 72% of laboratories appeared unnecessary, with a total potential cost of $8567. Over 80% of orders were from the emergency department by residents or attending physicians.

Conclusions:
Perioperative laboratory orders may be unnecessary in most isolated pediatric femoral shaft fractures, subjecting patients to extraneous costs, and associated pain. However, laboratories may be justified based on clinical circumstances or for older patients treated with reamed nails or plates/screws. Evidence-based recommendations for perioperative laboratory orders offer the potential to improve quality and value and minimize harm in pediatric orthopaedic trauma.

Level of Evidence:
Level III—retrospective comparative study (therapeutic).
Challenges Experienced By North Korean Refugee Doctors in Acquiring a Medical License in South Korea: A Qualitative Analysis
Authors: Ha Shin , Choi Hui Ran , Lee Jong Koo , Lee Yo Han 
Published: April 2019

Introduction:
In general, refugee doctors encounter difficulties in regularly practicing medicine in their host countries. In particular, many barriers impede the efforts of North Korean refugee doctors (NKRDs) who have settled in South Korea to acquire a medical license in the country. This study examines the experiences and opinions of NKRDs in their attempts to acquire permission to legally practice medicine in South Korea and the opinions of South Korean experts regarding this matter.

Methods:
In-depth interviews were conducted among 23 participants divided into 2 groups. The first group comprised 16 NKRDs recruited through snowball sampling, whereas the second group included 7 South Korean doctors experienced in operating programs assisting NKRDs in license acquisition.

Results:
All participating NKRDs perceived that they face grave difficulties at every stage of acquiring a South Korean medical license and, particularly, in gaining recognition for their educational credentials. Furthermore, South Korean experts expressed the necessity of supporting, establishing, and expanding a system in the country whereby NKRDs can acquire a medical license.

Discussion:
Strengthening and changing their clinical competency to meet South Korean standards is the best option for NKRDs to acquire a medical license. Furthermore, the study reveals that the government should eliminate the obstacles in medical license acquisition by NKRDs and support the latter in their efforts to improve and demonstrate their competency.
Adnexal tumors in menopausal women: surgery or surveillance?
Authors: Burgess Brian T. , Ueland Frederick R. 
Published: April 2019

Abstract
Asymptomatic ovarian tumors in menopausal women do not always require surgical removal. Experts recommend an initial evaluation with transvaginal ultrasound to help characterize the tumor's malignant risk. Low-risk tumors can be monitored with ultrasound, whereas high-risk tumors should be referred to a gynecologic oncologist. Indeterminate tumors require secondary testing with the strategies outlined in this Practice Pearl.
Treatment of menorrhagia due to aplastic anemia by hysteroscopic resection of endometrial functional layer and levonorgestrel-releasing intra-uterine system
Authors: Yang Huadi , Xu Xuqun , Jiang Xuelu , Yao Zhitao 
Published: April 2019

Abstract

Rationale
In women, menorrhagia associated with aplastic anemia (AA) is secondary to thrombocytopenia and can be acute and severe. Endometrial ablation or hysterectomy has been reported to achieve beneficial results. However, serious limitations and long-term complications exist. We report this clinical case series with the aim of sharing our experiences and exploring a safe and effective way to treat abnormal uterine bleeding (AUB) AA women with future fertility desire.

Patient concerns
The 3 young patients aged 25 to 29 years old suffered from AUB secondary to AA.

Diagnosis
They were diagnosed with AA by bone marrow biopsy and presented with symptoms and signs of AUB without other identified causations.

Interventions
When the platelet count was between 30∗109 /L∼50∗109 /L after a blood transfusion, each patient received a hysteroscopic resection of endometrial functional layer and was fitted a levonorgestrel-releasing intra-uterine system (LNG-IUS) in uterine cavity following the surgery.

Outcomes
All the patients recovered without incident and were discharged in clinically stable conditions.

Lessons
In conclusion, AUB secondary to AA can be acute and severe. Hemostasis is more difficult due to progressive pancytopenia. For young women with future fertility desire, LNG-IUS following hysteroscopic resection of endometrial functional layer is a safe and effective way against endometrial ablation or hysterectomy.
Effects of mirror therapy on muscle activity, muscle tone, pain, and function in patients with mutilating injuries
Authors: Yun Da-Eun , Kim Myoung-Kwon 
Published: April 2019

Abstract

Background:
This study assessed the effectiveness of mirror therapy (MT) on muscle elasticity, pain, and function in patients with mutilating injuries.

Methods:
Thirty patients with impaired function due to mutilating injuries were assigned randomly to experimental or control group. The experimental group (n = 15) received MT (30 minutes a day, 3 days a week for 4 weeks) and conventional physical therapy after each MT session while the control group (n = 15) only received conventional physical therapy.

Results:
There were significant differences in pain and hand function within each group (pre-intervention vs post-intervention) and between groups (experimental vs control) (P < .05). However, there was no significant difference in muscle elasticity between groups (P > .05).

Conclusion:
Although MT cannot result in significant changes in muscle elasticity in a clinical setting, it does have positive effects by reducing pain and improving hand function. Thus, MT can be effective for patients with impaired function due to mutilating injuries.
Impact of inflammation-mediated response on pan-coronary plaque vulnerability, myocardial viability and ventricular remodeling in the postinfarction period - the VIABILITY study
Authors: Morariu Mirabela , Hodas Roxana , Benedek Theodora , Benedek Imre , Opincariu Diana , Mester Andras , Chitu Monica , Kovacs Istvan , Rezus Ciprian , Pasaroiu Dan , Mitra Noemi , Szilágyi Sándor M. , Georgescu Dan , Rezus Elena 
Published: April 2019

Abstract

Introduction:
While the role of inflammation in acute coronary events is well established, the impact of inflammatory-mediated vulnerability of coronary plaques from the entire coronary tree, on the extension of ventricular remodeling and scaring, has not been clarified yet.

Materials and methods:
The present manuscript describes the procedures of the VIABILITY trial, a descriptive prospective single-center cohort study. The main purpose of this trial is to assess the link between systemic inflammation, pan-coronary plaque vulnerability (referring to the plaque vulnerability within the entire coronary tree), myocardial viability and ventricular remodeling in patients who had suffered a recent ST-segment elevation acute myocardial infarction (STEMI). One hundred patients with STEMI who underwent successful revascularization of the culprit lesion in the first 12 hours after the onset of symptoms will be enrolled in the study. The level of systemic inflammation will be evaluated based on the serum biomarker levels (hs-CRP, matrix metalloproteinases, interleukin-6) in the acute phase of the myocardial infarction (MI) and at 1 month. Pan-coronary plaque vulnerability will be assessed based on serum biomarkers known to be associated with increased plaque vulnerability (V-CAM or I-CAM) and at 1 month after infarction, based on computed tomographic angiography analysis of vulnerability features of all coronary plaques. Myocardial viability and remodeling will be assessed based on 3D speckle tracking echocardiography associated with dobutamine infusion and LGE-CMR associated with post-processing imaging methods. The study population will be categorized in 2 subgroups: subgroup 1 - subjects with STEMI and increased inflammatory response at 7 days after the acute event (hs-CRP ≥ 3 mg/dl), and subgroup 2 - subjects with STEMI and no increased inflammatory response at 7 days (hs-CRP < 3 mg/dl). Study outcomes will consist in the rate of post-infarction heart failure development and the major adverse events (MACE) rate.

Conclusion:
VIABILITY is the first prospective study designed to evaluate the influence of infarct-related inflammatory response on several major determinants of post-infarction outcomes, such as coronary plaque vulnerability, myocardial viability, and ventricular remodeling.
Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer
Authors: Zhu Jinfeng , Zeng Wei , Ge Lei , Yang Xinhui , Wang Qisan , Wang Haijiang 
Published: April 2019

Abstract

Background:
The differences in efficacy between capecitabine and 5-fuorouracil (5-FU) in neoadjuvant chemoradiotherapy (CRT) of locally advanced rectal cancer (LARC) are not well recognized. We performed this meta-analysis to analyze the effect of capecitabine and 5-FU on neoadjuvant CRT to more accurately understand the differences between the 2 drugs.

Methods:
MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database were performed to identify all published studies investigating the efficacy of capecitabine in neoadjuvant CRT of LARC versus 5-FU before August, 2017. Primary endpoint was the odds ratio (OR) for improving pathological complete response (pCR) rate of patients with LARC. Secondary endpoints were the ORs of efficiency for downstaging tumor and increasing R0 resection in patients with LARC. Safety analyses were also performed. The OR was the principal measurement of effect, which was calculated as capecitabine group versus 5-FU group, and was presented as a point estimate with 95% confidence intervals (CIs). All calculations and statistical tests were performed using RevMan 5.3 software.

Results:
In all, 2916 patients with LARC enrolled in the 10 studies were divided into capecitabine group (n = 1451) and 5-FU group (n = 1465). The meta-analysis showed that capecitabine improved pCR (OR 1.34, 95% CI 1.10–1.63), and R0 resection rate (OR 1.92, 95% CI 1.10–3.36). There were no statistically significant differences either in overall downstaging rate (OR 1.31, 95% CI 0.79–2.16) or in the tumor downstaging rate (OR 1.24, 95% CI 0.79–1.92), but there was a significant difference of the nodal downstaging rate between the 2 groups (OR 1.68, 95% CI 1.11–2.54). There was no statistically significant difference in sphincter preservation rate between the 2 groups (OR 1.36, 95% CI 0.96–1.92). No obvious safety concerns about mortality and complications were raised in these studies. There were no statistically significant differences in 3-year disease-free-survival (OR 1.29, 95% CI 0.75–2.20), and in grade 3 to 4 acute toxicity during CRT (OR 0.63, 95% CI 0.31–1.30).

Conclusions:
Compared with 5-FU-based neoadjuvant CRT, capecitabine-based neoadjuvant CRT can safely improve pCR, nodal down-staging, ad R0 resection of patients with LARC.
Ectopic liver tissue in the esophagus
Authors: Zhang Zi-Li , Wang Jin-Liang , Guo Chun-Li , Li Qi , Li Lin , Pang Yi , Meng Xiang-Chao 
Published: April 2019

Abstract

Introduction:
Ectopic liver (EL) is a rare entity, which is reported to develop at various sites, such as the abdominal cavity, the retroperitoneal cavity, the pleural cavity, and the mediastinum.

Patient concerns:
A 27-year-old previously healthy Chinese man suffered from a discontinuous abdominal pain in the upper abdomen for 2 months.

Diagnosis:
The upper gastrointestinal endoscopy revealed there was a polypoid mucosal uplift on the distal region of the esophagus near the cardia.

Interventions:
Endoscopic polypectomy was performed.

Outcomes:
Pathology examination showed the liver tissue.

Conclusion:
EL should be excised as it may possibly lead to the development of a malignancy. Endoscopic resection was found to be safe and reliable in this case.
A case report dysregulated neutrophil extracellular traps in a patient with propylthiouracil-induced anti-neutrophil cytoplasmic antibody-associated vasculitis
Authors: Watanabe-Kusunoki Kanako , Abe Nobuya , Nakazawa Daigo , Karino Kohei , Hattanda Fumihiko , Fujieda Yuichiro , Nishio Saori , Yasuda Shinsuke , Ishizu Akihiro , Atsumi Tatsuya 
Published: April 2019

Abstract

Rationale:
Neutrophil extracellular traps (NETs) are immune defence systems that release extracellular chromatin and myeloid granules including myeloperoxidase (MPO) to kill pathogens. An experimental animal study recently demonstrated that disordered NETs induced by propylthiouracil (PTU) could contribute to the production of MPO anti-neutrophil cytoplasmic antibody (ANCA) and the development of ANCA-associated vasculitis (AAV). However, the role of dysregulated NETs in the pathogenesis of human AAV remains unclear.

Patient concerns:
We report a 19-year-old woman with Graves’ disease on PTU presented fever, polyarthralgia, and lung hemorrhage with high titer of MPO-ANCA. This patient had a variety of atypical ANCAs and disordered NETs in vitro.

Diagnoses:
A diagnosis of PTU-induced AAV (PTU-AAV).

Interventions:
The PTU was discontinued and she was treated with immunosuppressants and plasmapheresis for reducing pathogenic autoantibodies.

Outcomes:
Clinical manifestations including fever, polyarthralgia, and lung hemorrhage were on remission with a decrease of dysregulated NETs.

Lessons:
The clinical course of this PTU-AAV case indicated that dysregulated NETs would play a role in the development of ANCA and the pathogenesis of AAV.
(CONSORT) Wound closure using Dermabond after excision of hemangioma on the lip
Authors: Chang Jung Woo , Cho Kyu Sang , Heo Woong , Lee Jang Hyun 
Published: April 2019

Abstract

Background:
As the lip contains ample blood supply, hemangiomas often occur in this area. When surgical excision is performed, wound closure is important. To prevent infection from saliva and food, watertight wound closure is needed. The purpose of this study is to demonstrate the usefulness of Dermabond for wound closure after hemangioma excision on the lip.

Methods:
Between December 2015 and August 2017, 11 patients with lip hemangioma underwent surgical excision. When closing the wound, Dermabond was used for skin closure after subcutaneous sutures. Demographic data and complications were recorded. Scars were evaluated with the Vancouver scar scale (VSS), and the postoperative shape of the lip was assessed on a 10-point satisfaction scale at 1 month and 6 months postoperatively.

Results:
All cases completely healed without any complications, such as wound dehiscence or infection. There were no recurrences at postoperative 1 month during the follow-up period. The aesthetic results of the scars were also excellent. The average VSS score on postoperative 1 month was 4.2, and it decreased to 2.2 at postoperative 6 months. The average patient satisfaction score at postoperative 1 month was 7.4, and it increased to 9.5 at postoperative 6 months.

Conclusion:
Dermabond is useful for wound closure after hemangioma excision on the lip. It prevents wound contamination, and yields acceptable aesthetic results.
A novel AVPR2 missense mutation in an Asian family with inherited nephrogenic diabetes insipidus
Authors: Zhang Min , Yu Qin , Chen Chen , Han Jian , Cheng Bin , Tian Dean 
Published: April 2019

Abstract

Rationale:
X-linked nephrogenic diabetes insipidus (NDI) is a rare inherited disease, and is characterized by renal resistance to arginine vasopressin (AVP). Its diagnosis can be clinically challenging. The application of molecular genetic analysis can provide a rapid and definitive diagnosis.

Patient concerns:
A 75-year-old woman presented with recurrent nausea and vomiting was admitted to the Department of Gastroenterology. The patient had a strong family history of polydipsia and polyuria. Sequencing analysis of the antidiuretic hormone arginine vasopressin receptor 2 (AVPR2) revealed the novel missense mutation p. Trp164Cys (c.492G>G/C) in exon 2. There was a heterozygous mutation in the patient's sister and niece, while there was a mutation in her sons, brother and nephews. The locus is located on the X chromosome Xq28, and its mutation can lead to X linked recessive NDI. The p. Trp164Cys mutation of AVPR2 gene has not been reported in literature before. The mutation was predicted to be probably damaging by several prediction methods, including SIFT and PolyPhen-2. There was no significant abnormal variation in other detection regions of the gene. And there was also no abnormal variation in AVP and AQP2 genes in this family.

Diagnosis:
X-linked NDI was diagnosed according to the patient's family history and DNA sequencing analysis.

Interventions and outcomes:
After treated with desmopressin, antiemetic drugs and massive infusion glucose transfusion, the patient's urine volume decreased and electrolyte disturbance was corrected, and the symptoms of nausea and vomiting gradually disappeared.

Lessons:
The patients with suspected congenital NDI should undergo genetic sequencing analysis of AVPR2, AVP and AQP2 genes. A definitive diagnosis can benefit patient and avoid unnecessary investigations.
Efficacy of submucosal bupivacaine injection for pain relief after endoscopic submucosal dissection
Authors: Jung Jang Han , Jang Hyun Joo , Bang Chang Seok , Baik Gwang Ho , Park Se Woo 
Published: April 2019

Abstract

Background and aim:
Although abdominal pain is a common adverse event related to endoscopic submucosal dissection (ESD), it can be sometimes underestimated by endoscopists. There are some endoscopic interventions available for the prevention of post-ESD pain, but their efficacy has not been established. We investigated whether a submucosal injection of bupivacaine (BP) can reduce procedure-related abdominal pain compared with the standard method.

Methods:
We performed a multicenter, double-blinded, randomized controlled trial of 86 adult patients referred for ESD as treatment for gastric neoplasms. Patients were randomly assigned to either the BP submucosal or conventional solution group. Questionnaires were collected when the study began (baseline) and immediately after ESD, as well as at 6, 12, and 24 hours post-operatively. The primary outcome was indicated by the visual analog scale (VAS) evaluated at 6 hours after procedure.

Results:
There were no significant differences in primary outcomes between groups and among all time points (immediately, 12, and 24 hours after ESD). The VAS and short-form McGill pain (SF-MP) scores were higher immediately after ESD than at 6, 12, or 24 hours post-operatively. The incidence of abdominal pain immediately after ESD was 94.0% (78/83) for all patients of both groups, and there was no significant difference between the 2 groups in the rate of abdominal pain immediately after ESD (BP group 37/40 [92.5%] versus non-BP group 41/43 [95.3%], P = .934). In univariable and multivariable analyses, BP did not have protective effect on post-ESD abdominal pain.

Conclusions:
Submucosal BP injection does not promote pain relief or mitigate the effects of post-ESD abdominal pain.