bluuebunny/crossref_metadata_2025_split huggingface dataset:
Semi-urgent pulmonary vein isolation using cryoballoon for haemodynamically unstable atrial fibrillation storm in a patient with low cardiac output syndrome: a case report
Authors: Koike Toshiharu , Mori Fumiaki , Maeda Ryozo , Kobayashi Ken , Sakai Masayuki , Oyabu Kenjiro , Matsui Yuko , Yoshikawa Masafumi , Sugiyama Kou , Ajiro Yoichi , Iwade Kazunori 
Published: September 2020

Abstract
Background
Atrial fibrillation and heart failure are common coexisting conditions requiring hospitalisation for heart failure and death. Pulmonary vein isolation is a well-established option for symptomatic atrial fibrillation and for atrial fibrillation concomitant with heart failure with reduced left ventricular ejection fraction. Recently, pulmonary vein isolation using cryoballoon showed non-inferiority to radiofrequency ablation with respect to the treatment of patients with drug-refractory paroxysmal atrial fibrillation. However, the effectiveness of acute-phase rhythm control by semi-urgent pulmonary vein isolation using cryoballoon in patients with haemodynamically unstable atrial fibrillation storm accompanied with low cardiac output syndrome is unclear. Herein, we present a case in which semi-urgent pulmonary vein isolation using cryoballoon was effective for acute-phase rhythm control against drug-resistant and haemodynamically unstable repetitive atrial fibrillation tachycardia accompanied with low cardiac output syndrome.

Case presentation
A 57-year-old man was hospitalised for New York Heart Association functional class 4 heart failure with atrial fibrillation tachycardia and reduced left ventricular ejection fraction of 20% accompanied with low cardiac output syndrome-induced liver damage. The haemodynamics collapsed during atrial fibrillation tachycardia, which had become resistant to intravenous amiodarone and repeated electrical cardioversions. In addition to atrial fibrillation, atrial tachycardia and common-type atrial flutter appeared on day 3. Multiple organ failure progressed gradually due to haemodynamically unstable atrial fibrillation tachycardia storm accompanied with low cardiac output syndrome. On day 4, to focus on treatment of heart failure and multiple organ failure, semi-urgent rescue pulmonary vein isolation using cryoballoon to atrial fibrillation and cavotricuspid isthmus ablation to common-type atrial flutter were performed for acute-phase rhythm control. Soon after the ablation procedure, atrial fibrillation and common-type atrial flutter were lessened, and sinus rhythm was restored. A stable haemodynamics was successfully achieved with the improvement of hepatorenal function. The patient was discharged on day 77 without complications.

Conclusions
This case demonstrates that acute-phase rhythm control by semi-urgent pulmonary vein isolation using cryoballoon could be a treatment option in patients with haemodynamically unstable atrial fibrillation tachycardia storm accompanied with low cardiac output syndrome, which is refractory to cardioversion and drug therapy.
Early changes in ambulatory electrocardiography after transcatheter closure in patients with atrial septal defect and factors affecting heart rate variability
Authors: Su Zhenyang , Cao Qing , Zhang Hao , Sun Wei , Zhang Haifeng , Sheng Yanhui , Yang Rong , Kong Xiangqing 
Published: September 2020

Abstract
Background
Factors affecting heart rate variability (HRV) in patients with atrial septal defect (ASD) have not been clarified. This study sought to identify those factors and establish a preliminary risk model.

Methods
A total of 154 patients with ASD who underwent transcatheter closure and met the study requirements were analyzed in this study. Moreover, 26 patients with patent foramen ovale (PFO) were enrolled in our study as a control group. All patients underwent echocardiography and ambulatory electrocardiography before and one day after the procedure.

Results
The standard deviation of all normal-to-normal (NN) intervals (SDNN) and the standard deviation of the averages of the NN intervals in all 5 min segments of the entire recording (SDANN) were significantly higher and the heart rate was lower after closure than before closure in patients with ASD (SDNN: 6.08, 95% CI 3.00 to 9.15, p < 0.001; SDANN: 7.57, 95% CI 4.50 to 10.64, p < 0.001; heart rate: -1.17, 95% CI − 2.86 to − 0.48, p = 0.006). Multiple regression analyses indicated that age, sex, defect diameter, heart rate and diabetes were significantly associated with HRV indices (SDNN: R2 = 0.415; P < 0.001). SDNN and SDANN had obvious correlations with right ventricular systolic pressure (SDNN: R = − 0.370, p < 0.001; SDANN: R = − 0.360, p < 0.001).

Conclusions
Factors affecting HRV in patients with ASD include age, sex, heart rate, defect size and diabetes. Furthermore, right ventricular systolic pressure plays an important role in the change in HRV.
A rare hepatic mass in an Italian resident
Authors: Borro Matteo , Murdaca Giuseppe , Greco Monica , Negrini Simone , Setti Maurizio 
Published: September 2020

Abstract
Background
Amebiasis is a rare condition in developed countries but epidemiologically growing. Clinical manifestation may range from asymptomatic to invasive disease, amoebic liver abscess being the most common manifestation. We report a peculiar case of left hepatic amoebic liver abscess in a patient without a well-known source of infection and presenting with left portal vein thrombosis.

Case presentation
Patient, working as longshoreman, presented with complaints of remittent-intermittent fever lasting from 2 weeks. Physical examination was normal. Blood tests showed mild anemia, neutrophilic leukocytosis and elevated inflammation markers. Chest x-rays was normal. Abdominal ultrasound showed multiple hypoechoic liver masses. CT-scan of abdomen showed enlarged left liver lobe due to the presence of large abscess cavity along with thrombosis of left portal vein. The indirect hemagglutination test for the detection of antibodies to Entamoeba histolytica (Eh) was positive. Ultrasound-guided percutaneous drainage revealed “anchovy sauce” pus. Metronidazole and a follow up imaging at 3 months showed resolution of abscess cavity.

Conclusion
This case shows that amoebic liver abscess is possible even in first world country patients without travel history. Left sided abscess and portal vein thrombosis are rare and hence reported.
Increased cardiovascular mortality in females with the a/a genotype of the SNPs rs1478604 and rs2228262 of thrombospondin-1
Authors: Alehagen Urban , Shamoun Levar , Wågsäter Dick 
Published: September 2020

Abstract
Background
Cardiovascular diseases are still the major cause of death in the Western world, with different outcomes between the two genders. Efforts to identify those at risk are therefore given priority in the handling of health resources. Thrombospondins (TSP) are extracellular matrix proteins associated with cardiovascular diseases. The aim of this study was to investigate variations in single nucleotide polymorphisms (SNPs) of TSP-1 and plasma expression, and associations with mortality from a gender perspective.

Methods
A population of 470 community-living persons were invited to participate. The participants were followed for 7.9 years and underwent a clinical examination and blood sampling. SNP analyses of TSP-1 rs1478604 and rs2228262 using allelic discrimination and plasma measurement of TSP-1 using ELISA were performed,

Results
During the follow-up period, 135 (28.7%) all-cause and 83 (17.7%) cardiovascular deaths were registered.
In the female population, the A/A genotype of rs2228262 and the T/T genotype of rs1478604 exhibited significantly more cardiovascular deaths compared with the A/G and G/G, or the T/C and C/C genotypes amalgamated (rs2228262: 13.7% vs 2.0%; Χ2:5.29; P = 0.02; rs1478604:17.7% vs 4.7%; Χ2:9.50; P = 0.002). Applied in a risk evaluation, the A/A, or T/T genotypes exhibited an increased risk of cardiovascular mortality (rs2228262: HR: 7.1; 95%CI 1.11–45.8; P = 0.04; rs1478604: HR: 3.18; 95%CI 1.35–7.50; p = 0.008). No differences among the three genotypes could be seen in the male group.

Conclusion
In this study the female group having the A/A genotype of rs2228262, or the T/T genotype of rs1478604 of TSP-1 exhibited higher cardiovascular mortality after a follow-up of almost 8 years. No corresponding genotype differences could be found in the male group. Genotype evaluations should be considered as one of the options to identify individuals at risk. However, this study should be regarded as hypothesis-generating, and more research in the field is needed.
A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol
Authors: Sandalic Danielle , Craig Ashley , Arora Mohit , Pozzato Ilaria , Simpson Grahame , Gopinath Bamini , Kaur Jasbeer , Shetty Sachin , Weber Gerard , Cameron Ian , Tran Yvonne , Middleton James 
Published: September 2020

Abstract
Background
Studies report rates of mild cognitive impairment (MCI) in spinal cord injury (SCI) range between 10 and 60%. This broad estimate of MCI in SCI is most likely a result of: (i) inconsistent operationalization of MCI; (ii) heterogeneity among individuals with SCI; (iii) failure to account for MCI subtypes, thereby adding to the heterogeneity of samples; and, (iv) poor control for traumatic brain injury (TBI) that obscures differentiation of MCI attributable to TBI versus other factors. There is a paucity of longitudinal studies following the course of MCI in SCI, and none that account for multiple predictors of MCI, including interactions among predictors.

Methods
An inception cohort longitudinal study will assess approximately 100 individuals aged 17–80 years with acute SCI, with measures taken at three timepoints (baseline, 3 months post-baseline, and 12 months post-injury). Data relevant to medical care received within the first 24–48 h of presentation to the emergency department will be analysed, as will measures of cognition, injury characteristics, medical history, personal factors, psychological status, psychosocial functioning, and quality of life. Latent class mixture modelling will determine trajectories for the primary outcome of interest, cognitive functioning and its subtypes, and secondary outcomes of interest such as depression. Multiple regression analyses will identify predictors of MCI and its subtypes.

Discussion
The prospective design will reveal change in cognitive functioning across time and unveil different outcome trajectories; thus addressing the lack of knowledge on trajectories of MCI and MCI subtypes in SCI. Through subtyping MCI, we hope to yield groups of cognitively impaired individuals with SCI that are potentially more homogenous and thereby stable and predictable. This is the first study to capture emergency department and acute care diagnostic evidence of mild TBI, which has been poorly controlled in previous studies. Our study will also be the first to distinguish the contribution of TBI from other factors to the development of MCI in individuals with SCI.

Trial registration
The study was prospectively registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12619001702101) on 3rd December 2019.
Prevalence and factors associated with antenatal care utilization in Ethiopia: an evidence from demographic health survey 2016
Authors: Tsegaye Berhan , Ayalew Mohammed 
Published: September 2020

Abstract
Background
Ethiopia is one of the sub-Saharan African country with high maternal mortality ratio (MMR). According to Ethiopian demographic health survey (EDHS) 2016 report, MMR is 420 among 100,000 live births. Antenatal care utilization is a key intervention to reduce these deaths through problem detection and treatment, promotion of health seeking behavior, and preparing pregnant women for birth. Therefore, this study aimed to assess prevalence and factors associated with antenatal care service utilization in Ethiopia in 2016.

Methods
Secondary data analysis was done on EDHS 2016. It was a stratified, two-stage, and cluster sampling design. Analysis has been restricted to antenatal care utilization among women who delivered at least one time in the past five years. Data were weighted to correct sampling bias. Moreover, complex data analysis was done. Bi-variate and multivariable logistic regression analyses were carried out. Adjusted odds ratio with 95% confidence interval was computed and P-value less than 0.05 considered as a statistically significance level for identification of association.

Results
Prevalence of antenatal care utilization was 62.8% [95%CI: 60.9, 64.6] in this study. Maternal educational status of primary school (AOR = 1.8,95%CI:1.2, 2.6), maternal educational status of secondary school (AOR = 4.4,95%CI: 1.1, 17.3), women who listen radio less than 1 per week (AOR = 1.9,95%CI:1.12,3.34), women who listen radio at least 1 per week (AOR = 2.6,95%CI:1.4,4.8), women in rich wealth quintile (AOR = 1.9,95%CI: 1.1, 3.2) were factors positively associated with antenatal care utilization. However, women who had traditional belief (AOR = 0.1,95%CI:0.02,0.49), and women who had five children and above (AOR = 0.6,95%CI: 0.3, 0.9) were factors associated negatively with antenatal care utilization.

Conclusions
Prevalence of antenatal care utilization is still low in Ethiopia in 2016. Maternal higher maternal educational status, frequent radio listening, higher wealth quintile, traditional belief, and greater number of children were found to be associated significantly with antenatal care utilization. Consequently, socio-economic status should be enhanced, information should be accessed by women about antenatal care utilization and family planning service through mass media. Furthermore, intensive community education program should be designed for traditional believers to increase uptake of antenatal care by stakeholders.
Microperimetry as a diagnostic tool for the detection of early, subclinical retinal damage and visual impairment in multiple sclerosis
Authors: Rohowetz Landon J. , Vu Qui , Ablabutyan Lilit , Gratton Sean M. , Kunjukunju Nancy , Wallace Billi S. , Koulen Peter 
Published: September 2020

Abstract
Background
A majority of multiple sclerosis patients experience visual impairment, often as the initial presenting symptom of the disease. While structural changes in the retinal nerve fiber layer and optic nerve have demonstrated correlations with brain atrophy in multiple sclerosis using magnetic resonance imaging, a non-invasive, cost-effective, and clinically efficacious modality to identify early damage and facilitate prompt therapeutic intervention to slow the progression of multiple sclerosis and its ocular manifestations, is still urgently needed. In this study, we sought to determine the role of macular sensitivity measured by microperimetry in the detection of subclinical multiple sclerosis-related retinal damage and visual dysfunction.

Methods
This cross-sectional observational case-control study involved population-based samples of multiple sclerosis patients and age-, race-, and gender-matched healthy control subjects. Among the key criteria for the multiple sclerosis patients were diagnosis by the McDonald criteria, visual acuity greater than 20/25, and no history of optic neuritis. Macular sensitivity and average macular thickness were measured in all subjects using microperimetry and spectral-domain optical coherence tomography, respectively. Pearson correlation coefficients were measured using bivariate correlations. Sample means, mean differences, and 95% confidence intervals were calculated using independent sample t-tests.

Results
Twenty-eight eyes from 14 MS patients and 18 eyes from 9 control subjects were included. Mean macular sensitivity of control subjects and multiple sclerosis patients in decibels was 18.2 ± 0.4 and 16.5 ± 0.4, respectively, corresponding to a mean difference of 1.7 (95% CI, 1.1–2.4; P < 0.001). Macular sensitivity was positively correlated with macular thickness in multiple sclerosis patients (r = 0.49, P = 0.01) but not control subjects (r = 0.15, P = 0.55).

Conclusions
Macular sensitivity as measured by microperimetry was decreased in multiple sclerosis patients with normal visual acuity and no history of optic neuritis. Furthermore, macular sensitivity demonstrated a positive correlation with macular thickness as measured by optical coherence tomography. As such, microperimetry may represent a non-invasive and efficient method to identify signs of subclinical visual dysfunction that correspond with early macular architectural changes characteristic of multiple sclerosis.
Regional emphysema score is associated with tumor location and poor prognosis in completely resected NSCLC patients
Authors: Heo Jung Won , Kang Hye Seon , Park Chan Kwon , Kim Sung Kyoung , Kim Ju Sang , Kim Jin Woo , Kim Seung Joon , Lee Sang Haak , Yeo Chang Dong 
Published: September 2020

Abstract
Background
Lung cancer is a frequent comorbidity of chronic obstructive pulmonary disease (COPD). However, the local risk of developing lung cancer related to regional emphysema distribution and clinical outcome has not been investigated. Our aim was to evaluate the impact of regional emphysema score (RES) on tumor location and prognosis in non-small cell lung cancer (NSCLC) patients.

Methods
We enrolled 457 patients who underwent curative surgery for NSCLC at seven hospitals at The Catholic University of Korea from 2014 to 2018. Emphysema was visually assessed for each lobe, with the lingula as a separate lobe. Semi-quantitative emphysema scoring was classified as follows: 0 = none, 0.5 = 1 to 10%, 1 = 11 to 25%, 2 = 26 to 50%, 3 = 51 to 75%, and 4 = 76 to 100%. An RES was given to each of the six lung zone: the upper, middle, and lower lobes in the right and left lungs.

Results
There were 145 patients in the high RES (≥ 3) group and 312 in the low RES (< 3) group. The mean RES in each lobe with cancer was significantly higher than that in other lobes without cancer (0.51 vs. 0.37, P <  0.001). This group showed significantly shorter disease-free survival (P <  0.001), in addition, presence of COPD, low diffusing capacity of the lung for carbon monoxide (< 80), smoking status, and poor differentiation were more frequent in this group. Also, cancer in a lobe with a higher RES (odds ratio (OR) = 1.56; 95% confidence interval (CI:1.01–2.42; P = 0.04), pathologic stage ≥ III (OR = 2.23; 95% CI: 1.28–3.89; P <  0.001), and poor differentiation (OR = 1.99; 95% CI: 1.22–3.21; P <  0.001) were independent factors for tumor recurrence.

Conclusions
The regional severity of emphysema by visual qualification was associated with the location of lung cancer, and was an independently poor prognostic factor for tumor recurrence in completely resected NSCLC patients.
Favourable long-term survival of patients with esophageal cancer treated with extended transhiatal esophagectomy combined with en bloc lymphadenectomy: results from a retrospective observational cohort study
Authors: Kröll Dino , Borbély Yves Michael , Dislich Bastian , Haltmeier Tobias , Malinka Thomas , Biebl Matthias , Langer Rupert , Candinas Daniel , Seiler Christian 
Published: September 2020

Abstract
Background
Although considered complex and challenging, esophagectomy remains the best potentially curable treatment option for resectable esophageal and esophagogastric junction (AEG) carcinomas. The optimal surgical approach and technique as well as the extent of lymphadenectomy, particularly regarding quality of life and short- and long-term outcomes, are still a matter of debate. To lower perioperative morbidity, we combined the advantages of a one-cavity approach with extended lymph node dissection (usually achieved by only a two-cavity approach) and developed a modified single-cavity transhiatal approach for esophagectomy.

Methods
The aim of this study was to evaluate the outcome of an extended transhiatal esophageal resection with radical bilateral mediastinal en bloc lymphadenectomy (eTHE). A prospective database of 166 patients with resectable cancers of the esophagus (including adenocarcinomas of the AEG types I and II) were analyzed. Patients were treated between 2001 and 2017 with eTHE at a tertiary care university center. Relevant patient characteristics and outcome parameters were collected and analyzed. The primary endpoint was 5-year overall survival. Secondary outcomes included short-term morbidity, mortality, radicalness of en bloc resection and oncologic efficacy.

Results
The overall survival rates at 1, 3 and 5 years were 84, 70, and 61.0%, respectively. The in-hospital mortality rate after eTHE was 1.2%. Complications with a Clavien-Dindo score of III/IV occurred in 31 cases (18.6%). A total of 25 patients (15.1%) had a major pulmonary complication. The median hospital stay was 17 days (interquartile range (IQR) 12). Most patients (n = 144; 86.7%) received neoadjuvant treatment. The median number of lymph nodes resected was 25 (IQR 17). The R0 resection rate was 97%.

Conclusion
In patients with esophageal cancer, eTHE without thoracotomy resulted in excellent long-term survival, an above average number of resected lymph nodes and an acceptable postoperative morbidity and mortality.
Factors associated with conducting planning for secondary oral health care services in Brazil
Authors: de Lucena Edson Hilan Gomes , da Silva Rênnis Oliveira , de Lucena Carolina Dantas Rocha Xavier , Mepatia Amalia Issufo , Cavalcanti Yuri Wanderley , de Goes Paulo Savio Angeiras , de Sousa Maria Fátima 
Published: September 2020

Abstract
Background
Planning in health services specifically aims to improve the health status of a given population, guaranteeing access with equity and justice, as well as streamlining the response of the health system to the needs perceived by the community. This research aims to identify the factors associated with planning Specialized Dental Clinics (SDCs).

Methods
Secondary data were used from the external evaluation of the database of the first National Program for Access and Quality Improvement of SDCs (NPAQI–SDCs) and the informed Outpatient Information System of the Unified Health System (OIS/UHS), which contains data on the specialized dental procedures performed at SDCs. It consisted of a quantitative study in which Pearson chi-square statistical tests (p < 0.05) and a multivariate logistic regression were applied with odds ratio (OR) estimate.

Results
The results indicated that the realization of planning in SDCs was associated with lower coverage of the Oral Health Team of the Familiy Health Strategy in a municipality (OR = 1.4; 95% CI: 1.0–1.9, p = 0.049), additional training for managers (p = 0.038), the practice of self-assessment (OR = 8.2; 95% CI: 5.8–11.6; p = 0.000) and meeting service production targets (OR = 1.9; 95% CI: 1.2–3.2; p = 0.011).

Conclusion
The results indicate that the work processes of the SDCs, especially with regard to service management, are essential to the proper functioning of the service and the practice of planning is linked to the technical capacity and commitment of service managers.