bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of postmastectomy pain syndrome and associated risk factors
Authors: Gong Youwei , Tan Qixing , Qin Qinghong , Wei Changyuan 
Published: May 2020

Abstract
Postmastectomy pain syndrome (PMPS) is a frequent complication of breast surgery, and is considered a chronic neuropathic pain in the side of surgery which persists more than 3 months. We conducted a retrospective analysis of the largest reported cohort to investigate the prevalence of PMPS and to analyze its associated risk factors as well as the influence on quality of life (QoL). Two thousand thirty-three surgically-treated female patients diagnosed between 2012 and 2017 with early-stage breast cancer were asked to complete a questionnaire survey about their current chronic neuropathic pain problems and quality of life. Multivariate logistic regression analyses were applied to determine the associated risk factors of PMPS. Results have shown that 1983 (97.5%) patients responded and completed a questionnaire survey. Among them, PMPS was found in 28.2% of patients. In univariate analysis, age≤35 years, tumor staging, history of chronic pain, total mastectomy, and axillary lymph node dissection (ALND) were significantly correlated with PMPS (P < .05). Multivariate analysis showed that age≤35 years, history of chronic pain, total mastectomy, and ALND were the independent risk factors of PMPS. QoL outcomes have shown that the global QoL score, physical function score, role function score, and social function score in the PMPS group were reduced in the PMPS group (P < .05), while the difference in emotional function score and cognitive function score showed no statistical significance (P > .05). Besides, patients with PMPS have worse body image, sexual enjoyment, and more breast symptoms. In conclusion, PMPS is linked with a high incidence among breast cancer patients, and has a considerable negative influence on the quality of life. In addition, age, total mastectomy, ALND, and history of chronic pain are the independent risk factors of PMPS.
Removal of bent intramedullary nail
Authors: Suh You-Sung , Lee Won-Seok , Ahn Joonghyun , Choi Hyung-Suk , Baek Min Jung , Choi Sung-Woo 
Published: May 2020

Abstract

Introduction:
The removal of bent intramedullary (IM) nail can become a challenge. Therefore, various methods have been reported for the extraction of nails after femoral refracture. We want to share our successful treatment.

Patient concerns:
Case 1. A 44-year-old man was admitted to our clinic after falling while playing soccer. He complained severe right thigh pain with a visible deformity of the femur. His medical history revealed a right femoral shaft fracture caused in a traffic accident which had been treated with intramedullary nailing. Case 2. A 27-year-old man, who had suffered a right femur fracture after a motorcycle accident and been treated with an IM nail, presented after falling down the stairs. He had severe right thigh pain without any open wound or neurologic deficit.

Diagnosis:
Case 1. Plain radiographs revealed a refracture of the right femoral shaft and a bent IM nail. The initial varus deformity of the nail was 60.1° in the coronal plane. Case 2. The valgus deformity of the nail was 16.1° with an apex-posterior angulation of 34.8° in the sagittal image of plain radiographs.

Interventions:
Case 1. Initial manual reduction was tried in emergency room. Then, under general anesthesia closed reduction of the fracture and bent IM nail was done. After closed reduction, the nail was straightened and extracted smoothly. Case 2. Closed manipulation was attempted initially. But no difference in the deformity was achieved. Therefore, via skin incision, the bent nail was progressively sectioned with high-speed cutting burr until the nail could be straightened.

Outcomes:
Case 1. The patient was mobilized with partial-weight bearing assisted with a crutch on postoperative day two. One year after surgery, the fracture union was complete and the patient was pain-free. Case 2. Six months after surgery, the fracture union was complete with sufficient callus formation around the fracture site.

Conclusion:
There is no gold standard method to remove a bent IM nail. However, since manual reduction to straighten the bent nail causes minimal soft tissue damage, it should be considered first. If it fails, other methods should be attempted, progressing from the minimally invasive technique to more invasive methods.
Periictal electroclinical characteristics of postictal generalized electroencephalographic suppression after generalized convulsive seizures
Authors: Tang Yingying , Xia Wei , Yan Bo , Zhao Lili , An Dongmei , Zhou Dong 
Published: May 2020

Abstract
The aim of this study was to investigate the demographic, clinical, and electrophysiological characteristics of postictal generalized electroencephalography (EEG) suppression (PGES), thereby facilitating the recognition of PGES and providing clues regarding its risk factors, pathophysiology, and relationship with sudden unexpected death in epilepsy patients (SUDEP).
We retrospectively reviewed 237 generalized convulsive seizures (GCSs) in 126 patients during long-term video-EEG (VEEG) recordings. The associations of PGES and prolonged PGES (duration >20 seconds) with person- and seizure-specific variables were evaluated independently using SPSS software.
Eighty patients (63.5%, 80/126) exhibited PGES after 127 GCSs (53.6%, 127/237) with an average PGES duration of 41.31 ± 24.03 seconds. The tonic phase was significantly prolonged in patients with PGES and prolonged PGES. PGES was independently associated with ictal semiology, which was attributable to the different proportions of GCS type 1. After seizure termination, patients with PGES had a higher percentage of postictal unresponsiveness and immobility, including oropharyngeal immobility. Between prolonged and short-duration PGES, the former was more likely to phase out gradually followed by immediate body movement, whereas the latter tended to have an abrupt, evoked termination followed by delayed body movement.
Prolonged tonic duration, GCS type 1, postictal unresponsiveness, and immobility were more prone to occur with PGES, which might imply that hyperactivation of inhibitory neural networks underlies the pathophysiology of PGES and subsequent SUDEP. Any form of periictal bedside care, whether it constitutes effective medical intervention or not, is advisable due to its possible contribution to the interruption of PGES. Regardless of the PGES termination pattern, the neural network resuscitation process was progressive.
Analgesia for spinal anesthesia positioning in elderly patients with proximal femoral fractures
Authors: Lee Ki Hwa , Lee Soo Jee , Park Jae Hong , Kim Se Hun , Lee Hyunseong , Oh Dae Seok , Kim Yong Han , Park Yei Heum , Kim Hyojoong , Lee Sang Eun 
Published: May 2020

Abstract
Elderly patients with femoral fractures are anticipated to endure the most pain caused by positional changes required for spinal anesthesia. To improve pain relief, we compared the analgesic effects of intravenous dexmedetomidine-ketamine and dexmedetomidine-fentanyl combinations to facilitate patient positioning for spinal anesthesia in elderly patients with proximal femoral fractures. Forty-six patients were randomly assigned to two groups and received either 1 mg/kg of intravenous ketamine (group K) or 1 μg/kg of intravenous fentanyl (group F) concomitant with a loading dose of dexmedetomidine 1 μg/kg over 10 minutes, then dexmedetomidine infusion only was continued at 0.6 μg/kg/h for following 20 minutes, and titrated at a rate of 0.2 to 0.6 μg/kg/h until the end of surgery. After completion of the infusion of either ketamine or fentanyl, the patients were placed in the lateral position with the fracture site up. The pain score (0 = calm, 1 = facial grimacing, 2 = moaning, 3 = screaming, and 4 = unable to proceed because of restlessness or agitation) was used to describe the pain intensity in each step during the procedure (lateral positioning, hip flexion, and lumbar puncture), and quality score (0 = poor hip flexion, 1 = satisfactory hip flexion, 2 = good hip flexion, and 3 = optimal hip flexion) was used to describe the quality of posture. Group K showed a median pain score of 0 (0-1), 0 (0–0) and 0 (0–0) in lateral positioning, hip flexion and lumbar puncture, respectively, while group F showed a score of 3 (2.75–3), 3 (2–3) and 0 (0–1), respectively. The pain score in lateral positioning (P < .0001) and hip flexion (P < .0001) was significantly lower in group K than group F. Group K showed the significantly higher quality scores of spinal anesthesia positioning (P = .0044) than group F. Hemodynamic adverse effects, such as bradycardia, hypotension, and desaturation, were not significantly different between the groups. The administration of dexmedetomidine-ketamine showed a greater advantage in reducing pain intensity and increasing the quality with patient positioning during spinal anesthesia in elderly patients with proximal femoral fractures, without any serious adverse effects.
Effect of enhanced recovery after surgery program on patient-reported outcomes and function recovery in patients undergoing liver resection for hepatocellular carcinoma
Authors: Ren Qiu Ping , Luo Yan-Li , Xiao Feng Ming , Wen Tian-Fu , Wu Meng-Hang , Juan-Wan  , Xie Ze-Rong 
Published: May 2020

Abstract
The aim of this study was to investigate the effect of enhanced recovery after surgery (ERAS) on perioperative outcomes, with an emphasis on patient-reported outcomes (PROs) and functional recovery.
We compared the clinical outcomes in a cohort of 275 patients undergoing liver resection before and after the implementation of ERAS. The PROs were preoperatively and postoperatively compared until 14 days after surgery using the MD Anderson Symptom Inventory.
The patients in the ERAS group experienced fewer symptoms and a shorter functional recovery time than the patients in the non-ERAS group. The group × time interactions were different between the groups for pain (F = 4.70, P = .001) and walking (F = 2.75, P = .03). On the 3rd, 4th, and 5th days after surgery, the ERAS group experienced less pain and more walking than the non-ERAS group. The ERAS group experienced less fatigue (0.407 [95% confidence interval, CI: −0.795, −0.020], P = .035), less sleep interference (0.615 [95% CI: −1.215, −0.014], P = .045), a lower rate of reduced appetite (0.281 [95% CI: −0.442, −0.120], P = .001), and less abdominal distension (0.262 [95% CI: −0.504, −0.020], P = .034) than the non-ERAS group. Those in the ERAS group had a significantly shorter median time from surgery to mild fatigue (5.41 vs 6.87 days, P = .003), mild pain (4.45 vs 6.09 days, P = .001), mild interference when walking (3.85 vs 5.54 days, P < .001), and mild interference when sleeping (5.49 vs 7.43 days, P < .001). ERAS patients were more likely than non-ERAS patients to achieve a functional recovery (5.70 vs 6.79 days, P < .001) status in a shorter time period. The ERAS pathway, operation time, and the minimally invasive approach were independent predictors of functional recovery time.
In hepatocellular carcinoma liver resection patients, the primary mechanism of ERAS is to reduce the postoperative interference burden and promote rapid functional recovery.
Soluble PD-L1: a potential immune marker for HIV-1 infection and virological failure
Authors: Avendaño-Ortiz José , Rubio-Garrido Marina , Lozano-Rodríguez Roberto , del Romero Jorge , Rodríguez Carmen , Moreno Santiago , Aguirre Luis A. , Holguín África , López-Collazo Eduardo 
Published: May 2020

Abstract
Despite viral control, basal chronic inflammation and its related comorbidities remain unsolved problems among HIV-infected individuals. Soluble factors derived from myeloid cells have emerged as potent markers associated with HIV-related comorbidities and mortality. In the present report, we explored the relationship between soluble programmed death-ligand 1 (sPD-L1) and HIV-1 infection, antiretroviral therapy (ART), CD4/CD8 ratio, viral load (VL), and sexually transmitted coinfections.
A prospective observational study on 49 HIV-1 infected adults.
We found sPD-L1 levels were significantly higher in 49 HIV infected subjects than in 30 uninfected adults (1.05 ng/ml vs 0.52 ng/ml; P < .001). In this line, sPD-L1 levels were found to be elevated in 16 HIV infected subjects with undetectable VL compared with the uninfected subjects (0.75 ng/ml vs 0.52 ng/ml; P = .02). Thirteen ART-treated individuals with virological failure exhibited the highest sPDL1 levels, which were significantly higher than both 20 ART naïve infected individuals (1.68 ng/ml vs 0.87 ng/ml; P = .003) and the 16 ART-treated individuals with suppressed viremia (1.68 ng/ml vs 0.79 ng/ml; P = 002). Entire cohort data showed a statistically significant positive correlation between VL and sPD-L1 levels in plasma (r = 0.3; P = 036).
Our findings reveal sPDL-1 as a potential biomarker for HIV infection especially interesting in those individuals with virological failure.
Sequential changes to intraocular lens dislocation caused by vigorous ocular massage
Authors: Tsai Wei-Shan , Lee Yuan-Chieh 
Published: May 2020

Abstract

Rationale:
Although intraocular lens (IOL) dislocations have been reported after uneventful cataract surgeries, no sequential changes have ever been demonstrated. Our case showed the sequential changes to IOL dislocation caused by vigorous ocular massage.

Patient concerns:
A 42-year-old man complained of blurred vision in the left eye 8 years after uneventful phacoemulsification. The IOL was still well-centered, but curvilinear tears of the anterior and posterior capsule along the optic border of IOL and vitreous herniation were noted. In the following month, the IOL subluxated inferiorly. A careful history taking revealed a recent habit of vigorous ocular massage. The subluxation was stable for 2 years after avoiding ocular massage, but dislocation into vitreous occurred after taking a spring water bath (spa) bath with massage.

Diagnosis:
IOL dislocation.

Interventions:
Pars plana vitrectomy to remove the dislocated IOL and implantation of a 3-piece IOL into sulcus were performed.

Outcomes:
The IOL was well-centered. The visual acuity returned to 20/20.

Lessons:
Ocular massage might cause tear of the intact fibrotic capsule and dislocation of IOL. The capsule along the border of the optics might be a weak point against ocular massage.
Root canal morphology of maxillary and mandibular first premolars analyzed using cone-beam computed tomography in a Shandong Chinese population
Authors: Wu Di , Hu Dan-qing , Xin Bing-chang , Sun De-gang , Ge Zhi-pu , Su Jing-yuan 
Published: May 2020

Abstract
The aim of this study was to explore the root morphology and root canal configuration of first premolars among Shandong Chinese residents using cone-beam computed tomography (CBCT).
Randomly selected CBCT images were collected from 648 patients (44% women, 56% men). In total, 1268 maxillary and 1296 mandibular first premolars were analyzed. The number of roots and the canal configuration were recorded and identified based on Vertucci's classification.
The majority of the maxillary first premolars had 1 root (67.4%), followed by 2 roots (32%). A 2-canal configuration (89%) was the most prevalent observation. For mandibular first premolars, 98.8% had 1 root and 81% presented the type I configuration. There were no statistical differences in the number of roots or morphology in terms of the left/right side or sex (P > .05).
Among Chinese residents, the majority of maxillary first premolars had 1 root and 2 canals, whereas the most common anatomical configuration for mandibular first premolars was 1 root with 1 canal.
High expression of SRY-box transcription factor 30 associates with well differentiation, absent lymph node metastasis and predicts longer survival in nonsmall-cell lung cancer patients
Authors: Liu Cui , Liu Yameng , Tian Jun , Zhang Shengli , Li Xinmiao , Zhai Xiemin , Feng Qiang 
Published: May 2020

Abstract
The present study aimed to investigate SRY-box transcription factor 30 (SOX30) expression in nonsmall-cell lung cancer (NSCLC) tumor tissues and adjacent noncancerous tissues, and further explore the correlation of tumor SOX30 expression with clinical characteristics and survival profiles in patients with NSCLC.
Totally, 365 patients with NSCLC who underwent resection were screened, and SOX30 expression was detected in their tumor tissues and adjacent noncancerous tissues via immunohistochemistry (IHC) assay, which was assessed by a semiquantitative method considering the multiplying staining intensity score and staining density score. According to the tumor SOX30 expression, patients were categorized as tumor SOX30 low (IHC score ≤3) and high (IHC score 4–12) patients, the latter were further divided into tumor SOX30 high+ (IHC score 4–6), high++ (IHC score 7–9), and high+++ (IHC score 10–12) patients.
SOX30 was downregulated in NSCLC tumor tissues compared with adjacent noncancerous tissues. Meanwhile, tumor SOX30 high expression associated with well differentiation, absent lymph node metastasis, decreased TNM stage, but did not associated with age, gender, history of smoke and drink, hypertension, hyperlipidemia, diabetes, tumor size, or carcinoembryonic antigen level. Both accumulating disease-free survival and overall survival were the longest in tumor SOX30 high+++ patients, followed by tumor SOX30 high++ patients, and tumor SOX30 high+ patients, and the shortest in tumor SOX30 low patients. Besides, tumor SOX30 high expression was an independent predictor for longer disease-free survival and overall survival.
Tumor SOX30 exhibits the potential to be a novel biomarker for survival prediction of patients with NSCLC.
Does butylphthalide affect on hemodynamics in patients with watershed stroke?
Authors: Jia Li-na , Zhang Ya-juan , Ma Rong , Song You 
Published: May 2020

Abstract

Background:
This study will specifically investigate the effect of butylphthalide on hemodynamics in patients with watershed stroke (WS).

Methods:
We will search the following databases from their inceptions to the March 1, 2020: Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge Infrastructure. All relevant randomized controlled trials on exploring the effect of butylphthalide on hemodynamics in patients with WS will be considered for inclusion. No language limitation will be imposed to this study. All study quality will be checked using Cochrane risk of bias tool. RevMan 5.3 software will be utilized for data analysis.

Results:
This study will summarize the latest evidence to investigate the effect of butylphthalide on hemodynamics in patients with WS.

Conclusion:
Findings from this study will provide theoretical basis of butylphthalide on hemodynamics in patients with WS for clinician and future research.

Dissemination and ethics:
This study is carried out based on the published data, thus, no ethical approval is required. We will submit this study to a peer-reviewed journal for publication.

Systematic review registration:
INPLASY 202030006.
Postoperative delirium in patients undergoing surgery for bone metastases
Authors: Hindiskere Suraj , Kim Han-Soo , Han Ilkyu 
Published: May 2020

Abstract
Postoperative delirium (PD), characterized by acute onset of global impairment in consciousness and cognition, is a common complication following major surgeries and is often associated with adverse outcomes. Because of the multiple comorbidities of the patient along with extensive nature of the surgery, patients undergoing surgery for bone metastases may be prone to developing PD. However, no study exists regarding PD in patients who undergo surgery for bone metastases.
Two hundred seventy six patients with mean age of 64 years (range, 16–94) who underwent surgery for bone metastases were reviewed. The diagnosis of PD was made by the psychiatrist, according to fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Possible perioperative clinic-pathologic factors that may be associated with the development of PD were investigated.
Among the 276 patients, 9% (n = 25) developed PD. On multivariate logistic regression analysis, history of psychiatric disorders (odds ratio [OR] = 9.63; 95% confidence interval [CI] 1.78–21.74, P = .004), high preoperative serum C-reactive protein (CRP) level (OR = 1.17; 95% CI 1.06–1.29, P = .001), low preoperative serum albumin level (OR = 0.13; 95% CI 0.03–0.48, P = 0.002), and high dose of opioid analgesics received in the immediate postoperative period (OR = 1.05; 95% CI 1.01–1.07, P = .001) were independently associated with the development of PD. Patients with PD had lower survival (log rank, P = .001) than patients without PD.
Incidence of PD is considerable in patients undergoing surgery for bone metastases. History of psychiatric disorders, preoperative serum albumin and CRP levels, and the dose of postoperative opioid analgesics are associated with the development of PD.
How to guide PCI?
Authors: Pang Jun , Ye Liwen , Chen Qingwei 
Published: May 2020

Abstract

Background:
Traditional coronary angiography (CA) as a main technique has been used to determine the coronary artery anatomy and guide percutaneous coronary intervention (PCI). We mainly focused on whether the new techniques could improve the patients’ mortality, major adverse cardiovascular events (MACEs), and myocardial infarction.

Methods:
For the network meta-analysis, we searched the trials of different PCI guidances from MEDLINE, Current Contents Connect, Google Scholar, EMBASE, Cochrane Library, PubMed, Science Direct, and Web of Science. The last search date was December 10, 2018.

Results:
The analyses of all results found that there was no significant difference in mortality among the groups. Randomized clinical trials (RCT) analysis showed that intravascular ultrasound (IVUS)-guided PCI was significantly superior to CA, fractional flow reserve, instantaneous wave-free ratio, optical coherence tomography. However, CA, fractional flow reserve, instantaneous wave-free ratio, and optical coherence tomography showed no difference in reducing mortality. The analyses of all results found that there was no significant difference in the incidence of MACEs among the groups. RCTs analysis showed that IVUS-guided PCI was significantly superior to CA, but there was no significant difference among the other groups. The analyses of all results or RCTs showed that there was no significant difference in myocardial infarction incidence among the groups.

Conclusion:
IVUS-guided PCI is an effective method to decrease all-cause death MACEs.