bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of puncture sites on pneumothorax after lung CT-guided biopsy
Authors: Zeng Li-Chuan , Liao Hua-Qiang , Wu Wen-Bin , Zhang Yu-Dong , Ren Feng-Chun , Wang Qu , Xie Ming-Guo 
Published: April 2020

Abstract
To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy.
Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed.
Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P < .05). No serious side effects were detected in the period of aspiration procedure.
Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.
Effects of risperidone on blood levels of interleukin-6 in schizophrenia
Authors: Feng Ziqiao , Zhang Yunqiao , You Xu , Zhang Wenyu , Ma Yuhan , Long Qing , Liu Zijun , Hao Wei , Zeng Yong , Teng Zhaowei 
Published: April 2020

Abstract

Background:
To evaluate the association between risperidone use and interleukin-6 (IL-6) levels by conducting a meta-analysis of controlled before-and-after studies.

Methods:
Studies were identified through a systematic search of PubMed and Embase. The mean and standardized differences were extracted to calculate the standardized mean differences. IL-6 levels were compared in patients with schizophrenia before and after risperidone treatment.

Results:
Ten studies were included in the final meta-analysis. The primary findings from our study suggest that there was a significant decrease in serum IL-6 levels after risperidone treatment (P = .021). A subgroup analysis revealed the sources of heterogeneity. The sensitivity analysis indicated that the results were stable, and no publication bias was observed.

Conclusions:
The present meta-analysis provides evidence that risperidone can significantly reduce IL-6 levels in schizophrenia. IL-6 is a potential biomarker of the pathophysiology and clinical processes of schizophrenia.
Malignant risk of pelvic mass after hysterectomy for adenomyosis or endometriosis
Authors: Chao Xiaopei , Liu Yang , Ji Mingliang , Wang Shu , Shi Honghui , Fan Qingbo , Lang Jinghe 
Published: April 2020

Abstract
Pelvic mass onset following a hysterectomy due to benign disease is not rarely seen. Appropriate diagnosis and treatment are of great importance.
This study aims to analyze the clinicopathological features of patients who have received surgery for pelvic mass following hysterectomy due to gynecological benign disease, especially endometriosis or adenomyosis.
This study retrospectively analyzed the patients undergone reoperation for pelvic mass subsequently to hysterectomy from January 2012 to December 2016 in a tertiary teaching hospital.
A total of 247 patients were enrolled in this study. There is a significant difference between the patients with or without a history of endometriosis/adenomyosis. Multivariate analysis showed that the pelvic mass had a higher risk of being ovarian endometrioid carcinoma, ovarian clear cell carcinoma, ovarian endometriosis, and ovarian physiological cysts in patients with a history of adenomyosis/endometriosis.
The pathology of the subsequent pelvic mass inclines to be benign, includes ovarian endometriosis, ovarian physiological cysts, and pelvic encapsulated effusion. Postoperative adjuvant therapy for those received hysterectomy due to endometriosis/adenomyosis, like gonadotropin releasing hormone agonists (GnRHa), may contribute to the prevention of benign pelvic mass. Patients with a history of hysterectomy due to endometrisos/adenomyosis tend to have a shorter time interval between hysterectomy and pelvic malignant tumors onset.
Randomized control trial of ultrasound-guided erector spinae block versus shoulder periarticular anesthetic infiltration for pain control after arthroscopic shoulder surgery
Authors: Czuczman Mark , Shanthanna Harsha , Alolabi Bashar , Moisiuk Peter , O’Hare Turlough , Khan Moin , Forero Mauricio , Davis Kimberly , Moro Jaydeep , Vanniyasingam Thuva , Thabane Lehana 
Published: April 2020

Abstract

Introduction:
Moderate to severe postoperative pain and associated opioid use may interfere with patients’ well-being and course of recovery. Regional anesthetic techniques provide an opportunity for opioid sparing and improved patient outcomes. A new regional technique called the erector spinae plane (ESP) block has the potential to provide effective analgesia after shoulder arthroscopy with minimal risks and decreased opioid consumption. Our primary objective is to determine whether, in patients who undergo arthroscopic shoulder surgery, a preoperative ESP block reduces pain scores as compared to periarticular infiltration at the end of surgery. Additionally, we will also examine other factors such as opioid consumption, sensory block, adverse events, patient satisfaction, and persistent pain.

Methods:
This is a 2-arm, single-center, parallel-design, double-blind randomized controlled trial of 60 patients undergoing arthroscopic shoulder surgery. Eligible patients will be recruited in the preoperative clinic. Using a computer-generated randomization, with a 1:1 allocation ratio, patients will be randomized to either the ESP or periarticular infiltration group. Patients will be followed in hospital in the postanesthesia care unit, at 24 hours, and at 1 month. The study with be analyzed as intention-to-treat.

Discussion:
This study will inform an evidence-based choice in recommending ESP block for shoulder arthroscopy, as well as providing safety data. The merits of the study include its double dummy blinding to minimize observer bias, and its assessment of patient important outcomes, including pain scores, opioid consumption, and patient satisfaction. This study will also help provide an estimate of the incidence of side effects and complications of the ESP block.

Trial registration number:
NCT03691922; Recruited Date of registration: October 2, 2018.
Risk factors of perioperative blood transfusion in elderly patients with femoral intertrochanteric fracture
Authors: Dai Cheng-Qian , Wang Li-Hong , Zhu Ye-Qin , Xu Guo-Hong , Shan Jun-Biao , Huang Wei-Chun , Wei Li-Hong , Zhou Fang-Lun , Li Yong 
Published: April 2020

Abstract
This study aimed to discuss the risk factors of perioperative blood transfusion after the application of proximal femoral nail antirotation (PFNA) in the treatment of elderly patients with femoral intertrochanteric fracture (FIF). Moreover, this study also aimed to analyze the causes of perioperative blood transfusion and provide guidance for clinical treatment.
Records of elderly patients with FIF who were treated with PFNA in our hospital from September 2014 to May 2017 were reviewed. They were divided into transfused and nontransfused groups. The Student t test, Chi-squared test, and Fisher exact test were used in univariate analysis of 11 variables. Multivariate logistic regression analysis was performed to analyze the possible risk factors associated with postoperative blood transfusion after the application of PFNA in elderly patients with FIF. Correlations were sought using the Spearman rank correlation analysis.
The univariate analysis showed that age, sex, type of fracture, admission hemoglobin (Hb), admission albumin, and intraoperative blood loss were significantly associated with perioperative blood transfusion (P = .000, .019, .000, .000, .000, and .007, respectively). The multivariate logistic regression analysis demonstrated that age (P = .019, odds ratio [OR] = 1.062), type of fracture (P = .001, OR = 4.486), and admission Hb (P = .000, OR = 0.883) were independent risk factors of postoperative blood transfusion. We found a significant positive correlation between perioperative blood transfusion and age (r = 0.264, P = .000) and type of fracture (r = 0.409, P = .000), but a negative correlation between perioperative blood transfusion and admission Hb (r = −0.641, P = .000).
The main factors affecting perioperative blood transfusion are age, fracture type, and admission Hb. These results indicate that, in high-risk patients who are older in age, more unstable fractures, and lower admission Hb, monitoring Hb concentrations during the perioperative period is important to correct severe anemia in a timely manner and avoid exacerbating existing underlying diseases and inducing severe complications.
Myasthenic crisis and late deep vein thrombosis following thymectomy in a patient with myasthenia gravis
Authors: Lin Cheng-Yuan , Liu Wei-Cheng , Chiang Min-Hsien , Tsai I-Ting , Chen Jen-Yin , Cheng Wan-Jung , Ho Chun-Ning , Liao Shu-Wei , Chu Chin-Chen , Sun Cheuk-Kwan , Hung Kuo-Chuan 
Published: April 2020

Abstract

Introduction:
Surgical stress and pain are potential provoking factors for postoperative myasthenic crisis (POMC). We report the occurrence of early POMC and late deep vein thrombosis (DVT) in a man with myasthenia gravis (MG) undergoing thymectomy, addressing possible link between reversal of opioid overdose with naloxone and the triggering of POMC.

Patient concerns:
A 71-year-old man with impaired renal function (ie, estimated glomerular filtration rate [egfr]: 49.1 mL/min/1.73 m2) with diagnosis of MG made 2 months ago was scheduled for thymectomy. After uncomplicated surgery, he experienced opioid overdose that was treated with naloxone. Hyperlactatemia then developed with a concomitant episode of hypertension. Three hours after reversal, he suffered from myasthenic crisis presenting with respiratory failure and difficult weaning from mechanical ventilation.

Diagnosis:
Stress-induced hyperlactatemia and subsequent myasthenic crisis

Interventions:
Pyridostigmine and immunosuppressive therapy with prednisolone were initiated. Hyperlactatemia subsided on postoperative day (POD) 5. Tracheal extubation was performed successfully on POD 6.

Outcomes:
During the course of hospitalization, his eGFR (ie, 88.9 mL/min/1.73 m2) was found to improve postoperatively. After discharge from hospital, he developed DVT in the left femoral and popliteal veins on POD 24 when he was readmitted for immediate treatment with low-molecular-weight heparin. He was discharged without sequelae on POD 31. There was no recurrence of myasthenic crisis or DVT at 3-month follow-up.

Conclusions:
Following naloxone administration, hyperlactatemia may be an indicator of pain-related stress response, which is a potential provoking factor for myasthenic crisis. Additionally, patients with MG may have an increased risk of DVT possibly attributable to immune-mediated inflammation. These findings highlight the importance of perioperative avoidance of provoking factors including monitoring of stress-induced elevations in serum lactate concentration, close postoperative surveying for myasthenic crisis, and early recognition of possible thromboembolic complications in this patient population.
Bioinformatic identification of hub genes and key pathways in neutrophils of patients with acute respiratory distress syndrome
Authors: Hu Lan , Zhao Tianxin , Sun Yuelin , Chen Yingfu , Bai Ke , Xu Feng 
Published: April 2020

Abstract
Acute respiratory distress syndrome (ARDS) is characterized as a neutrophil-dominant disorder without effective pharmacological interventions. Knowledge of neutrophils in ARDS patients at the transcriptome level is still limited. We aimed to identify the hub genes and key pathways in neutrophils of patients with ARDS. The transcriptional profiles of neutrophils from ARDS patients and healthy volunteers were obtained from the GSE76293 dataset. The differentially expressed genes (DEGs) between ARDS and healthy samples were screened using the limma R package. Subsequently, functional and pathway enrichment analyses were performed based on the database for annotation, visualization, and integrated discovery (DAVID). The construction of a protein–protein interaction network was carried out using the search tool for the retrieval of interacting genes (STRING) database and the network was visualized by Cytoscape software. The Cytoscape plugins cytoHubba and MCODE were used to identify hub genes and significant modules. Finally, 136 upregulated genes and 95 downregulated genes were identified. Gene ontology analyses revealed MHC class II plays a major role in functional annotations. SLC11A1, ARG1, CHI3L1, HP, LCN2, and MMP8 were identified as hub genes, and they were all involved in the neutrophil degranulation pathway. The MAPK and neutrophil degranulation pathways in neutrophils were considered as key pathways in the pathogenesis of ARDS. This study improves our understanding of the biological characteristics of neutrophils and the mechanisms underlying ARDS, and key pathways and hub genes identified in this work can serve as targets for novel ARDS treatment strategies.
Methotrexate-associated lymphoproliferative disorders in the central nervous system and stomach
Authors: Kawazoe Mai , Kaneko Kaichi , Nanki Toshihiro 
Published: April 2020

Abstract

Rationale:
Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a serious complication in patients treated using methotrexate. It occasionally develops in extra-nodal sites, but rarely in the central nervous system (CNS) or in 2 different sites at the same time. We present the rare case of a patient with rheumatoid arthritis who developed lymphoma in the CNS and stomach during MTX therapy.

Patient concerns:
A 75-year-old Japanese man with rheumatoid arthritis who received methotrexate was admitted to our hospital because of gait ataxia and anorexia.

Diagnoses:
Imaging findings and biopsy led to a diagnosis of 2 different types of MTX-LPD in the central nervous system and stomach.

Interventions:
The lesion in his stomach improved after methotrexate withdrawal, whereas the cerebellar mass required high-dose methotrexate and rituximab therapy.

Outcomes:
Complete remission has been maintained for the 2 years following the initiation of chemotherapy.

Lessons:
In patients with RA who receive MTX and develop new neurological symptoms, CNS lymphoma as an MTX-LPD may be considered as a differential diagnosis.
Liver stiffness across different chronic liver disease under therapy with statin in a real life cohort
Authors: Markova Antoaneta A. , Deterding Katja , Port Kerstin , Bantel Heike , Manns Michael P. , Cornberg Markus , Wedemeyer Heiner 
Published: April 2020

Introduction
Statins have been associated with improved clinical outcomes in patients with viral hepatitis and after variceal bleeding. Still, the clinical benefit of statins is not well defined for different liver diseases. Moreover, associations between statin use and liver stiffness as well as event free survival have not been established.

Methods
Liver stiffness was evaluated in 6490 patients with liver disease (January 2012 till December 2016). Two hundred thirty-four of those received statin therapy, 468 controls without statins were selected by a 1:2 case by case matching using age, sex, underlying liver disease and BMI.

Results
Statins were given to 234 patients with chronic virus hepatitis (n = 104), nonalcoholic fatty liver disease (n = 52), autoimmune liver disease including autoimmune hepatitis, primary biliary cholangitis and primary sclerosing cholangitis (n = 31) and hepatitis of unknown origin (n = 47). Follow-up data were available for 96 and 119 pairs (mean follow-up 2 years). Statin users showed reduced inflammatory activity. Elevated liver enzymes were reported in 57% of statin-treated compared with 70% of controls (mean alanine aminotransferase level 53 vs. 74 U/l; P < 0.001). Statin use was well tolerated in this cohort. Mean liver stiffness values were 10.7 kPa (SEM 0.7) and 15.5 kPa (SEM 0.7) accordingly (P < 0.0001). Decompensation was less likely to occur in the statin group, both groups do not defer in the incidence of liver tumor occurrence, transplantation or death (odds ratio = 1, P = nonsignificant).

Conclusions
Use of statins was well tolerated irrespective of liver disease. Statin users showed reduced hepatic inflammatory activity, less severe markers of liver stiffness and portal hypertension. There might be a beneficial effect of statin on the risk to experience hepatic decompensation.
Efficacy of Second-Line Chemotherapy in Extrapulmonary Neuroendocrine Carcinoma
Authors: McGarrah Patrick W. , Leventakos Konstantinos , Hobday Timothy J. , Molina Julian R. , Finnes Heidi D. , Westin Gustavo F. , Halfdanarson Thorvardur R. 
Published: April 2020

Objectives
A platinum/etoposide doublet is standard first-line therapy for poorly differentiated neuroendocrine carcinoma (PD NEC); however, evidence to guide treatment beyond first-line regimens is lacking. This study aimed to evaluate the efficacy of second-line regimens in PD NEC.

Methods
We performed a retrospective analysis of patients treated with second-line chemotherapy for PD NEC. Inclusion criteria were previous first-line therapy with platinum/etoposide, extrapulmonary PD NEC, and follow-up data. The primary end points were overall survival (OS) and progression-free survival (PFS) after second-line therapy. Secondary end points included OS and PFS from first-line therapy.

Results
Sixty-four patients were included. The median OS from initiation of second-line therapy was 6.2 months (95% confidence interval [CI], 4.9–8.9). The median PFS was 2.3 months (95% CI, 2.0–3.2). No second-line regimen showed a statistically significant difference in OS or PFS. There was a significant increase in OS for cisplatin first-line regimens compared with carboplatin (17.0 months [95% CI, 12.5–22.6] vs 11.7 months [95% CI, 8.0–14.0]).

Conclusions
The efficacy of current second-line therapy in PD NEC is poor. No second-line regimen showed statistically significant superiority. Cisplatin was associated with longer OS regardless of second-line regimen or age. However, unmeasured confounders such as performance status or comorbidities may explain this effect.
miR-375 Inhibits Autophagy and Further Promotes Inflammation and Apoptosis of Acinar Cells by Targeting ATG7
Authors: Zhao Shang-Ping , Yu Can , Xiang Kai-Min , Yang Ming-Shi , Liu Zuo-Liang , Yang Bing-Chang 
Published: April 2020

Objectives
MicroRNAs have been considered to be closely related with the development of severe acute pancreatitis (SAP), and microRNA-375 (miR-375) was believed to be a marker of SAP. We aim to investigate the role of miR-375 in regulating SP.

Methods
Cerulein and lipopolysaccharide were used to establish the models of SAP. AR42J cell line was chosen for study in vitro. Flow cytometry was applied for assessing apoptosis. The contents of inflammatory factors were detected with related enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction assays. Hematoxylin and eosin staining was applied to observe the pathological changes of pancreatic tissues. Immunohistochemistry analysis was conducted for investigating the expression of light chain 3.

Results
The level of miR-375 in pancreatitis tissues and cell lines was upregulated. Overexpression of miR-375 promoted inflammation and the apoptosis of acinar cells through inhibiting autophagy. The binding site between miR-375 and ATG7 was identified, and miR-375 could directly regulate the ATG7. microRNA-375 suppressed autophagy and promoted inflammation and the apoptosis of acinar cells via targeting ATG7.

Conclusions
We proved that miR-375 could inhibit autophagy and promote inflammation and the apoptosis of acinar cells through regulating ATG7. This study first proves that miR-375 modulates the development of SAP through targeting ATG7.
Induction of HLA-B27–Associated Reactive Arthritis After a Wharton’s Jelly “Stem Cell” Injection
Authors: Madhoun Hareth , Landry Kristen , Baria Michael R. 
Published: April 2020

Abstract
Orthobiologic injections are an emerging treatment option for musculoskeletal conditions. Allogenic gestational tissue–derived products, including umbilical cord–derived Wharton’s jelly, are among the available options. These tissues are currently being harvested and sold by companies as an off-the-shelf “stem cell” injection for conditions such as back pain and osteoarthritis. Despite documented infections from similar umbilical cord derivatives, “stem cell clinics” continue to use them. Here, we report the first documented case of HLA-B27–associated reactive arthritis induced by a Wharton’s jelly stem cell injection. A 36-yr-old man was injected with Wharton’s jelly for low back pain and within 24 hours developed fevers, chills, polyarthritis, and enthesitis. Infectious disease work-up was negative. Inflammatory markers were elevated and his HLA-B27 antigen was positive. Initial treatment included methylprednisolone and sulfasalazine. This case highlights the unknown dangers of these allogenic injections and physicians should remain cautious about their use until further study and regulation can ensure patient safety.
Early Extended Midline Strip Craniectomy for Sagittal Synostosis
Authors: O’Connell John Edward , Ellenbogen Jonathan , Parks Chris 
Published: April 2020

Background:Isolated sagittal synostosis is the most common form of nonsyndromic craniosynostosis. The surgical management of this condition ranges from strip craniectomy to total cranial vault remodeling. In our unit, passive correction of sagittal synostosis utilizing open extended midline strip craniectomy with bilateral micro-barrel staving is performed before 22 weeks corrected age. The aim of this prospective study is to identify the effectiveness and morbidity associated with this technique.Patients and Methods:Nonsyndromic patients who underwent OMEC at a tertiaryreferral-center (Alder Hey Children's Hospital, Liverpool, UK) over a 3-year period (2014–2016) were included. In particular, we looked at pre- and postoperative cranial index (CI), as well as other secondary outcomes such as rates of transfusion and reoperation.Results:A total of 44 patients (12 female, 32 male) met the inclusion criteria. Median age at operation was 132 (range 99–171) days. Median operative time was 117 (range 89–171) minutes. Twenty-four patients underwent a blood transfusion. Median pre-op CI was 66 (range 61–74.7)%. The first post-op CI, taken a median of 56 (range 12–107) days postoperatively, was 78 (range 73–87)%. No patients required reoperation. There were no perioperative deaths.Conclusion:Early open extended midline strip craniectomy with bilateral micro-barrel staving for correction of isolated nonsyndromic sagittal synostosis is a safe and effective technique, associated with minimal morbidity, producing sustained satisfactory head shape morphology on short to medium-term follow-up.