bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asymptomatic uterine metastasis of breast cancer: Case report and literature review
Authors: Kong Dechen , Dong Xiaotong , Qin Peiyan , Sun Daqing , Zhang Zhengtao , Zhang Yan , Hao Furong , Wang Mingchen 
Published: October 2022

Rationale:
Uterine metastasis from breast cancer is extremely rare. Asymptomatic patients with cervical metastases from breast cancer are rarer and more likely to be missed. We present an asymptomatic patient with breast cancer metastasized to the uterus and share opinions on diagnosing and treating for this kind of cases.

Patient concerns:
We present the case of a 64-year-old woman who was diagnosed with both breast cancer and uterine fibroids after examination. She had no symptoms of gynecological disease during breast cancer treatment. A positron emission tomography/computed tomography (PET/CT) scan was performed during reexamination, revealing multiple metastases of the bone throughout the body and an abnormal hypermetabolic mass in the uterus. It was later confirmed as uterine metastasis by pathology.

Diagnosis:
A diagnosis of metastatic breast invasive lobular carcinoma was established after a uterine curettage.

Interventions and outcomes:
Treatment of the uterine metastasis included systemic chemotherapy, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO), postoperative radiotherapy, and postoperative chemotherapy. The patient eventually refused further treatment for personal reasons and died at home.

Lessons:
Breast cancer metastases to the uterus are very rare and further research is needed for their diagnosis and treatment. During reexamination of breast cancer patients, clinicians must be alert to metastasis to gynecologic organs. This is particularly important in hormone receptor-positive patients with asymptomatic distant metastasis.
Underwater endoscopic mucosal resection of upper gastrointestinal subepithelial tumors: A case series pilot study (with video)
Authors: Kim Su Jin , Kim Tae Un , Choi Cheol Woong , Kim Hyung Wook , Park Su Bum , Ryu Dae Gon 
Published: October 2022

Introduction:
Underwater endoscopic mucosal resection (UW-EMR) has been recently introduced as an effective technique for rectal third layer subepithelial tumors. Therefore, we aimed to assess the safety, efficacy, and procedure time of UW-EMR for upper gastrointestinal subepithelial tumors (SETs) originating from the deep mucosal and/or submucosal layers.

Methods:
Between August 2018 to July 2022, a total of 17 SETs (7 duodenal SETs, 6 gastric SETs, and 4 esophageal SETs) were included in this study. On endoscopic ultrasound examinations, the tumors were found to be embedded in the submucosa without muscularis propria invasion. All SETs were resected successfully using UW-EMR. The characteristics of the tumors and their R0 resection rate, adverse event rate, and recurrence rate were evaluated retrospectively.

Results:
The mean tumor size was 0.9 cm (range, 0.3-1.5 cm). En bloc resection and complete resection rates were 100%, respectively. The patients showed no complications such as perforation or bleeding. Histologic assessments of the resected tumors revealed 9 neuroendocrine tumors (7 on the duodenum, 2 on the stomach), 2 gastric cystica profunda, 1 gastric follicular lymphoma, 1 gastric fibromyxoma, 3 esophageal granular cell tumors, and 1 esophageal adenoid cystic carcinoma. The mean procedural time was 3.2 min (range, 1.3-8.7 minutes). The overall en bloc and complete resection rates were 100%, respectively. No recurrence was observed during the follow-up period.

Conclusion:
UW-EMR is a safe and effective treatment for upper gastrointestinal SETs embedded in the submucosal layer. Further studies are needed to compare other endoscopic resection techniques.
Pneumothorax/pneumomediastinum as a complication of foreign body inhalation in 3 pediatric patients: A case series
Authors: Alahmari Ahmed K. , Alhelali Abdullah A. , Alahmari Abdullah K. , Ahmed Nehad J. , Alkathiri Assaf A. , Ardi Khalid T. , Baali Mohammed H. , Mubarki Musleh H. , Alhamoud Mohammed A. 
Published: October 2022

Introduction:
Foreign body inhalation (FBI) is a serious and common emergency in children. Such children present in the emergency room (ER) with cough, shortness of breath, choking, or wheezing but rarely present with pneumomediastinum.

Patient concerns:
Three children aged 2 to 5 years (2 girls and 1 boy) were seen in our ER complaining of FBI. Emergency bronchoscopy removal of the inhaled foreign body was performed; however, all 3 patients developed pneumomediastinum.

Diagnosis:
A foreign body inhalation complicated by Pneumomediastinum/pneumothorax.

Intervention and outcomes:
All the patients underwent emergency bronchoscopy and foreign body removal. After the ER intervention, 2 children were placed in the pediatric intensive care unit, and the pneumomediastinum resolved without intervention. The third patient required an operation for chest tube placement, which was then observed in the pediatric intensive care unit, and had several chest radiography follow-ups. After 5 days, the patient exhibited clinical improvement, and the chest tube was removed.

Conclusion:
In this case series, we present 3 cases of children aged 2 to 5 years seen in our ER with a history of different types of organic FBI complicated by pneumomediastinum/pneumothorax. Pneumomediastinum/pneumothorax is a rare complication of FBI in pediatric patients. However, such complications require multidisciplinary collaboration for early diagnosis and intervention.
Perimedullary arteriovenous fistula was misdiagnosed as intervertebral disc herniation: A case report
Authors: Yuan Zhengbo , Xiong Fengzhen , Li Zefu 
Published: October 2022

Introduction:
Spinal perimedullary arteriovenous fistula (PMAVFS) is a rare intradural vascular malformation with a high rate of misdiagnosis. In adults, most spinal PMAVFs are small and low-flow, starting with progressive spinal dysfunction.

Patient concerns:
The patient was a 58-year-old male who presented with both lower limbs numb with intermittent walking weakness, obvious at both ankles, and no obvious inducing and relieving factors. The local hospital considered the diagnosis of lumbar disc herniation after MR examination; he was treated with lumbar fixation and fusion.

Diagnosis:
After admission, a ce-MRA examination showed that the left spinal artery at the T10 level showed small branch blood vessels in the local area. The distal end was unclear, which seemed to be connected with the drainage vein of the spinal cord. The digital subtraction angiography (DSA) result indicated that the left intercostal artery of T10 sent the Adamkiewicz artery down to the level of L4, and an arteriovenous fistula was seen. The fistula was located at the lower edge of the L4 level and then drained to the upper premedullary vein to the level of T4 after a short descending. It was finally diagnosed as a perimedullary arteriovenous fistula.

Interventions:
It was cured by cutting the arteriovenous fistula in the spinal canal by indocyanine green-assisted angiography.

Outcomes:
we report a case of PMAVFS misdiagnosed as lumbar disc herniation with resection and internal fixation. In our hospital, the final diagnosis was a perimedullary arteriovenous fistula, which was cured by cutting off the arteriovenous fistula within the spinal canthus.

Conclusion:
Spinal perimedullary arteriovenous fistula (PMAVFS) is a rare intradural vascular malformation with a high rate of misdiagnosis. In adults, most spinal PMAVFs are small and low-flow, starting with progressive spinal dysfunction. It is hoped that this can provide warnings to more neurosurgeons and reduce the occurrence of misdiagnosis.
Current status and trends of pulmonary rehabilitation in South Korea: National level data analysis using Health Insurance Review and Assessment Service (HIRA) database from 2016 to 2018
Authors: Kim Hyo-Jung , Choi Hee-Eun , Jang Hang-Jea , Kim Hyun-Kuk , Park Jin-Han , Lee Jae-Ha , Kim Tae-Hoon 
Published: October 2022

In South Korea, there are few studies to understand the current status of pulmonary rehabilitation in clinical practice and develop it. This study aimed to assess the current status and annual changes in the number and pattern of prescriptions for pulmonary rehabilitation before and after its insurance coverage.
The trends of pulmonary rehabilitation before and after its insurance coverage commencement were evaluated using the data of 24,380 patients during the 3-year period from 2016 to 2018 that were archived by the National Health Information Database of the Health Insurance Review and Assessment Service in South Korea. The annual total number of patients who received pulmonary rehabilitation was stratified by the type of prescription, sex, age, type of insurance, medical institution, and region. In addition, the frequencies of pulmonary rehabilitation for various diagnoses were investigated using the major codes of the Korean Standard Classification of Disease.
The patients who received pulmonary rehabilitation increased by approximately 2 times from 5936 in 2016 (before insurance coverage) to 10,474 in 2019. Before 2017, most patients underwent simple pulmonary rehabilitation coded as MM290. However, since the insurance coverage of rehabilitation exercise for pulmonary disease (MM440), the proportions of patients receiving them increased. Men underwent pulmonary rehabilitation more often than women, and >70% of the patients were aged >60 years. Most patients received pulmonary rehabilitation at tertiary hospitals in Seoul. In 2016, pulmonary rehabilitation was prescribed more frequently for cerebral infarction; after 2017, it was prescribed more frequently for lung cancer.
This study summarized the current status and trends of pulmonary rehabilitation in South Korea before and after National Health Insurance Service coverage, which commenced on January 1, 2017. A significant increase in the number of pulmonary rehabilitations was confirmed after the insurance coverage.
Correlation between ERα gene polymorphism and multiple sclerosis and neuromyelitis optica
Authors: Xing Weifang , Hong Mingfan , Wei Zhisheng , Zhang Wensheng 
Published: October 2022

Objective:
To study the polymorphism distribution of estrogen receptor (ER) α gene and the correlation between different types of polymorphism in multiple sclerosis (MS) and neuromyelitis optica (NMO) patients.

Methods:
Forty-six cases of MS and NMO diagnosed from June 2018 to December 2019 were collected. Peripheral venous blood samples were collected. The patient’s gender, age of onset, course of disease, and other clinical data were recorded. Fifty-eight healthy volunteers of the same age and sex were selected. By means of Pvu II and Xba I restriction fragment length polymorphism enzyme recognition sites of ER α gene, polymerase chain reaction-restriction fragment length polymorphism analysis was conducted.

Results:
There was no significant difference in the frequency distribution of ER α gene’s PP, Pp, and pp genotype between MS and NMO case group and control group (P = .598). Frequency distribution of ER α gene’s XX, Xx, and xx was statistically significant between MS and NMO case group and control group (P = .021). Among them, distribution of Xx and Xx gene frequency between patient group and the control group was statistically significant (P = .001, OR = 4.622, 95% CI: 1.803–11.852). There was no significant correlation between ER α genotypes and the onset age in patient group (P > .05). The difference was statistically significant in disease duration of XX and Xx genotype (P = .006). The comparison of Xx and xx genotype frequency distribution in gender exists a difference(P = .047, OR = 7.500, 95% CI: 1.023–54.996).

Conclusions:
Xba I gene polymorphisms in the ER α gene have correlation with MS and NMO. Xba I gene could be a risk factor of MS and NMO pathogenesis, especially the women with Xx genotype are more vulnerable. Xba I gene polymorphisms in the ER α gene may impact the disease duration of MS and NMO, or rather, the disease duration of Xx genotype persists longer than Xx genotype. Pvu II gene polymorphisms in the ER α gene has no correlation with MS and NMO.
Increase in body temperature in pediatric patients after costal cartilage harvest in microtia reconstruction: A retrospective observational study
Authors: Longhao Piao , Yoon Seung Zhoo , Choi Yoon Ji , Xu Guo-Shan , Kim Dahyeon , Lim Choon-Hak 
Published: October 2022

Background:
Previous evidence has clearly shown that maintaining normothermia in children undergoing surgery is difficult and is associated with adverse outcomes. Therefore, this study aimed to retrospectively analyze the changes in body temperature over time in 2 different types of microtia reconstruction surgeries, namely, embedding, and elevation surgeries.

Methods:
We performed a retrospective chart review of patients who underwent microtia reconstruction (embedding and elevation) between July 2012 and February 2015 (n = 38). The changes in body temperature between the 2 types of surgeries were compared.

Results:
During microtia reconstruction, the body temperature in the embedding surgery group was significantly higher than that in the elevation surgery group from 1 hour after the start of surgery to 1 day after the surgery (P < .001). Time, group, and time-group interaction were associated with an increase in body temperature (P < .001) but not the warming method.

Conclusion:
We found an increase in body temperature in patients with microtia who underwent embedding surgery (autologous costal cartilage harvest surgery), and this was related to the type of surgery and not to the warming method. Therefore, further research is warranted to determine the cause of the increase in body temperature during this surgery.
Treatment for overactive bladder: A meta-analysis of tibial versus parasacral neuromodulation
Authors: Wang Zhi-Hong , Liu Zhi-Hong 
Published: October 2022

Background:
The study aimed to assess the efficacy and safety of parasacral neuromodulation (PNS) versus tibial nerve stimulation (TNS) for patients with overactive bladder (OAB).

Methods:
Databases including PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials were systematically searched from January 1, 1999 to September 9, 2022. The improvements in a 3-day voiding diary were set as the primary outcomes. Then, the scores of overactive bladder-validated 8-question awareness tool (OAB-V8), King’s health questionnaire (KHQ), and international consultation on incontinence questionnaire overactive bladder (ICIQ-OAB) were also evaluated.

Results:
Five articles (4 randomized controlled trials [RCTs] and 1 prospective study) including 255 OAB patients were enrolled. Two kinds of neuromodulations had similar performances in the micturition (mean difference [MD] = 0.26, 95% confidence interval [CI]: –0.51 to 1.04, P = .50), urgency episodes (MD = –0.16, 95% CI: –0.64 to 0.31, P = .50), incontinence episodes (MD = 0.09, 95% CI: –0.41 to 0.59, P = .72), as well as in the nocturia episodes (MD = 0.04, 95% CI: –0.45 to 0.52, P = .89). Furthermore, there was no difference regarding ICIQ-OAB scores (P = .83), KHQ (P = .91), and OAB-V8 scores (P = .83). Importantly, included studies reported no adverse events in the 2 groups.

Conclusion:
TNS and PNS had similar effectiveness for the treatment of OAB, moreover, without any identified adverse events in both groups. However, well-designed RCTs are stilled needed to verify our results.
Diltiazem as a cyclosporine A-sparing agent in heart transplantation: Benefits beyond dose reduction
Authors: Alyaydin Emyal , Reinecke Holger , Tuleta Izabela , Sindermann Juergen R. 
Published: October 2022

Diltiazem (DZ) is widely prescribed in transplant recipients because of its drug-drug interactions with calcineurin inhibitors (CNI). However, these interactions have been primarily investigated in renal transplantation, and data regarding the long-term efficacy and safety of DZ in orthotopic heart transplantation (OHT) are still sparse.
Our study aimed to elucidate the extent to which the co-prescription of DZ reduces the dose required to maintain adequate blood levels of cyclosporine A (CsA) and the resulting effect on morbidity and mortality in OHT recipients.
We performed a retrospective single-center analysis of OHT recipients on a long-term immunosuppressive regimen based on CsA and mycophenolate mofetil (MMF).
The study population consisted of 95 adult OHT recipients with a mean follow-up of 15.8 ± 6.7 years. DZ was co-prescribed in 39 subjects (41.1%) and was associated with a 28.6% reduction of the mean CsA daily dose (P < .001). Patients on DZ had less frequent rejection episodes (P = .002), better renal function (P = .009) and a lower rate of end-stage renal disease (P = .008). Additionally, they developed later cardiac allograft vasculopathy (CAV). We observed no prognostic relevance of DZ co-prescription in univariate and multivariate Cox-regression analyses.
In addition to reducing the CsA dose required to maintain adequate blood through levels, DZ may have nephroprotective properties in OHT. The co-administration of DZ may decelerate the development of CAV and reduce the frequency of the rejection episodes. However, the beneficial influence on morbidity has no impact on mortality.
Effect of transversus abdominis plane block on the quality of recovery in laparoscopic nephrectomy: A prospective double-blinded randomized controlled clinical trial
Authors: Park Jun-Mo , Lee Joonhee 
Published: October 2022

Background:
Poorly controlled acute postoperative pain after laparoscopic nephrectomy may adversely affect surgical outcomes and increase morbidity rates. In addition, excessive use of opioids during surgery may slow postoperative endocrine and metabolic responses and cause opioid-related side effects and opioid-induced hyperalgesia. The purpose of this study was to evaluate the effect of ultrasound-guided transversus abdominis plane (TAP) block on the postoperative quality of recovery and intraoperative remifentanil requirement in laparoscopic nephrectomy.

Methods:
Sixty patients who underwent laparoscopic nephrectomy were randomly divided into 2 groups: TAP and Control groups. After induction of anesthesia and before awakening from anesthesia, the TAP group was administered 40 mL of 0.375% ropivacaine and the Control group was administered 40 mL of normal saline to deliver ultrasound-guided TAP block using 20 mL of each of the above drugs. The main objectives of this study were to evaluate the effect of the TAP block on quality of recovery using the Quality of Recovery 40 (QoR-40) questionnaire and assessments of intraoperative remifentanil requirement. In addition, to evaluate the postoperative analgesic effect of the TAP block, the total usage time for patient-controlled analgesia (PCA) and the number of PCA bolus buttons used in both groups were analyzed.

Results:
The QoR-40 score, measured when visiting the ward on the third day after surgery, was significantly higher in the TAP group (171.9 ± 23.1) than in the Control group (151.9 ± 28.1) (P = .006). The intraoperative remifentanil requirement was not significantly different between the groups (P = .439). In the TAP group, the frequency of bolus dose accumulation at 1, 2, 3, 6, 12, 24, 48, and 72 hours after surgery was low enough to show a significant difference, and the total usage time for PCA was long enough to show a significant difference.

Conclusion:
In conclusion, we determined that ultrasound-guided TAP block during laparoscopic nephrectomy improves the quality of postoperative recovery and is effective for postoperative pain control but does not affect the amount of remifentanil required for adequate anesthesia during surgery.
Lifestyle interventions after colorectal cancer surgery using a mobile digital device: A study protocol for a randomized controlled trial
Authors: Kim Young Il , Park In Ja , Kim Chan Wook , Yoon Yong Sik , Lim Seok-Byung , Yu Chang Sik , Kim Jin Cheon , Lee Yura , Kim Harin , Chung Seockhoon , Choi Chang-Min , Lee Hui Jeong , Kim Kyung Won , Ko Yousun , Yun Sung-Cheol , Jo Min-Woo , Lee Jong Won 
Published: October 2022

Background:
In treating colorectal cancer, surgical techniques and adjuvant treatments have advanced over the past century, but relatively less attention has been given to improve health-related quality of life (HRQOL). Recent studies report a significant association between cancer recurrence and patient lifestyle after surgery, hence emphasizing the need to assist patients to reduce this risk through appropriate lifestyle choices. The proposed study will evaluate the effects of digital interventions on lifestyle after surgery for colorectal cancer using mobile applications.

Methods:
A randomized controlled trial design was proposed. A total of 320 patients diagnosed with colorectal cancer aged between 20 and 70 years were to be enrolled and randomized in equal numbers into 4 groups (3 groups assigned to different mobile applications and a control group). Surveys that evaluate HRQOL, physical measurements, and metabolic parameters (fasting glucose, hemoglobin A1C, triglyceride, high-density lipoprotein cholesterol), and fat/muscle mass measurements by abdominal computed tomography (CT), will be conducted prior to surgery and every 6 months post-surgery for 18 months. Statistical analysis will be used to compare the outcomes between groups.

Discussion:
Results from this study could provide evidence that easily accessible mobile applications can influence patient lifestyles. Results showing minimal effects of such applications could also be constructive for improving healthcare-related applications.
Creating a Standardized Post-Fall Debrief Tool
Authors: Farley Holley , Stepanek Meghan , Aquino Carla , Whalen Madeleine 
Published: October 2022

Background:
Performing post-fall debriefing improves patient outcomes through learning from defects and addresses adherence to fall prevention programs.

Local Problem:
While addressing an increase in fall rates, a quality improvement team discovered there was no standardized tool or process for completing post-fall debriefing.

Methods:
The team used the Plan-Do-Study-Act (PDSA) process to improve the post-fall debrief tool, with an analysis of pilot using the implementation science RE-AIM framework.

Interventions:
Three units with a high focus on falls and an established debriefing culture participated in pilot to generate and standardize a post-fall debrief tool.

Results:
Through 2 revisions with end user and champion feedback, the tool was refined to assess any contributing factors to the fall.

Conclusion:
Through use of the PDSA cycle, the team established content validity of the post-fall debrief tool. This tool is appropriate for inpatient adult and pediatric scale-up and complementary to current fall risk assessment tools.
Ensuring Rapid Response Team Care Aligns With Patients' Limitations of Medical Therapy
Authors: Mininni Nicolette C. , Whiteman Kimberly , Stephens Kimberly , George Elisabeth , Swanson-Biearman Brenda 
Published: October 2022

Background:
Rapid response teams (RRTs) are designed to improve patient care during deterioration in clinical condition.

Local Problem:
Patients' desired limitations of medical therapy (LOMTs) were not documented or communicated to the RRT, and patients received care not aligned with their wishes.

Methods:
A multidisciplinary team developed a process for improving documentation, communication of LOMTs, and care delivery on 3 medical cardiology units. The team implemented 3 Plan-Do-Study-Act (PDSA) cycles over 6 months.

Interventions:
In cycle 1, team members taught the unit nurses, RRT members, and physicians to share LOMTs during handoff communications. Cycle 2 engaged case managers in LOMT documentation. In cycle 3, unit-based RRT simulation was conducted.

Results:
All care delivered by the RRT aligned with the documented LOMTs. Documentation of LOMTs increased from 76% to 82.5% (P = .014).

Conclusions:
Education, scripting, and simulation were successful strategies to ensure that care given during RRT events aligned with patients' wishes.