bluuebunny/crossref_metadata_2025_split huggingface dataset:
Normotensive hypokalemic primary hyperaldosteronism mimicking clinical features of anorexia nervosa in a young patient
Authors: Huang Yen-Chu , Tsai Ming-Hsien , Fang Yu-Wei , Tu Mei-Lan 
Published: July 2020

Abstract

Rationale:
The typical clinical presentations of patients with primary aldosteronism (PA) include generalized weakness, fatigue, high blood pressure, and potassium deficiency. However, normotensive PA is rare. Therefore, an atypical presentation of normal blood pressure is a challenge for the diagnosis and treatment of PA.

Patient concerns:
A 43-year-old, thin, and tall woman (body mass index, 18.6 kg/m2) with generalized weakness for 1 day presented to our emergency department, where hypokalemia was a significant finding. The initial diagnosis was anorexia nervosa with the evidence of renal potassium wasting with low urinary sodium and chloride levels, metabolic alkalosis, normal blood pressure, and low body mass index. However, neither vomiting features nor other specific induced vomiting features were noted.

Diagnoses:
The laboratory examination revealed high plasma aldosterone level, low plasma renin activity, and extremely high aldosterone-to-renin ratio indicating the diagnosis of PA, confirmed via adrenal computed tomography.

Interventions:
Surgical adrenalectomy was performed. Pathological diagnosis was a benign cortical adenoma.

Outcomes:
Patient's serum potassium level and hormonal status became normalized after surgical removal of adrenal adenoma. She fully recovered without any further sequelae.

Lessons:
It is too early to rule out PA based on the presence of normal blood pressure in a patient with metabolic alkalosis and renal wasting hypokalemia. Moreover, PA should be considered in a normotensive patient with an unknown hypokalemic etiology to avoid delayed diagnosis and treatment.
Myofibroblast phagocytic cutaneous mucinosis: phagocytosis of mucinous substances by myofibroblasts in a distinctive cutaneous mucinosis
Authors: Nakaya Takeo , Kamiya Koji , Nakaya Michio , Tsuji Kentaro , Niki Toshiro , Ohtsuki Mamitaro , Tanaka Akira 
Published: July 2020

Abstract

Rationale:
Phagocytosis is an important physiological process for eliminating unnecessary substances or dead cells after tissue damage, such as inflammation or infarction. Phagocytosis was previously considered to be mainly performed by professional phagocytotic cells, such as macrophages. In contrast, we previously demonstrated that the phagocytosis of dead cells and unnecessary substances by myofibroblasts is as important as that by professional phagocytotic cells in myocardial infarction. Based on our discovery, we speculated that phagocytosis by myofibroblasts may be a more common pathological phenomenon also in other diseases than previously believed.

Patient concerns:
A 44-year-old male patient with atopic dermatitis developed a cutaneous reddish nodule with an underlying induration on his thigh.

Interventions:
The cutaneous lesion was surgically removed.

Diagnoses:
Histopathological examination demonstrated that the cutaneous lesion had solid infiltration by inflammatory cells, namely, plasma cells, histiocytes, and lymphocytes, in the dermis. The cutaneous lesion included mucinosis in the dermis. Inside the mucinosis, we detected cells with clear areas of mucinous substances. Some of the cells were α-smooth muscle actin-positive myofibroblasts. Electron microscopic images demonstrated that there were collagen bands in the cells with mucinous engulfment. Based on these pieces of evidence, we conclude that these mucinous phagocytotic cells were myofibroblasts, not professional phagocytotic cells, such as macrophages.

Outcomes:
There was no recurrence of the lesion.

Lessons:
The clinical appearance of this case resembled that of previously reported solitary cutaneous focal mucinoses. However, our case had distinctive characteristics, such as the phagocytosis of mucinous substances by myofibroblasts, multiple mucinous lesions in a single eruption, and the presence of inflammatory cells, which have not been previously reported. For this distinct cutaneous lesion, a clear dermatological and pathological name has yet to be determined. We propose “myofibroblast phagocytic cutaneous mucinosis” as a candidate name. In addition, our discoveries suggest that phagocytosis by myofibroblasts is not rare but rather is a common pathological phenomenon that has been undetected or unrecognized.
Value of ultrasonography in the diagnosis of carpal tunnel syndrome—a new ultrasonographic index in carpal tunnel syndrome diagnosis
Authors: Perţea Mihaela , Ursu Sergiu , Veliceasa Bogdan , Grosu Oxana-Mădălina , Velenciuc Natalia , Luncă Sorinel 
Published: July 2020

Abstract
We analyze the effectiveness of ultrasonography in diagnosing carpal tunnel syndrome (CTS) and propose the use of sonographic index of median nerve (MN) in carpal tunnel (SIMNCT) in a diagnostic algorithm and in establishing a scale of severity.
We studied a group of 344 patients with CTS symptoms, examining them by ultrasound. We measured in all patients, on the affected hand: the size of the cross-sectional area of the MN at carpal tunnel (CT) inlet and outlet, nerve morphology at passage through CT, the vertical thickness of the MN entering into the CT – G1, the lowest vertical thickness into the CT or leaving the CT – G2, the thickness of the MN in the transversal plane as entering in the CT – L. Normal values were considered the similar measurements taken on the healthy hand and we established as normal SIMNCT = 16%. We proposed the formula SIMNCT = 100% (1-G2/G1) in order to calculate the index.
Statistics show a significant sensitivity of SIMNCT (P < .0001) compared with cross-sectional area (CSA) and flattening ratio in the diagnosis of CTS. Analyzing the SIMNCT developed by us, we demonstrated a sensitivity of 94.81% and a specificity of 99.66% in CTS diagnosis. Thereby, we propose a CTS severity classification: normal = 16%, mild = 16–19%, moderate = 19% to 28%, severe = 28% to 50%, very severe > 50%.
Ultrasonography is an effective method of studying the morphology of the tunnel and compressed nerve at various CTS stages and determining the cause of compression. The SIMNCT is a valuable and practical indicator and it can be used in the CTS diagnosis.
Trans-catheter arterial chemoembolization plus Sorafenib, an unsuccessful therapy in the treatment of hepatocellular carcinoma?
Authors: Zhang Tao , Huang Weisen , Dong Haorong , Chen Yijun 
Published: July 2020

Abstract

Background:
Trans-catheter arterial chemoembolization (TACE) plus Sorafenib is recommended as one of the primary means for treating hepatocellular carcinoma (HCC). This updated meta-analysis focuses on identifying the efficacy and safety of TACE plus Sorafenib versus TACE, which remains controversial despite years of exploration.

Method:
PubMed, Medline, Embase, China Journal Full-text Database, Wanfang Database, and Weipu Database were used to retrieve the studies which are about comparing the clinical efficacy and safety of TACE+Sorafenib with TACE alone. The Review Manager (Version 5. 3) software was used to perform a meta-analysis of the results of studies which met the inclusion criteria recommended by the Cochrane Collaboration.

Result:
Compared with TACE for treating primary HCC, TACE combined with Sorafenib can improve the 1 year, 2 years, 3 years, and 5 years overall survival rate (OS) of patients, respectively, and also improve disease control rate (DCR) and objective response rate (ORR). In terms of adverse reactions, the treatment group can lead to more complications significantly, such as hand-foot skin reaction, hypertension, diarrhea, rash, hair loss, and so on, most of which are relevant to Sorafenib related adverse reactions, but most patients have a good prognosis after symptomatic treatment.

Conclusion:
The clinical efficacy of TACE combined with Sorafenib in treating primary hepatocellular carcinoma is better than TACE, and the safety is acceptable.
Posterior vertebral column resection for correction of thoracolumbar kyphosis after failed anterior instrumented fusion
Authors: Lu Jian , Dai Zhe-Hao , Li Hai-Sheng , Kang Yi-Jun , Chen Fei 
Published: July 2020

Abstract
To explore the effectiveness of posterior vertebral column resection for failed thoracolumbar anterior instrumented fusion.
Ten patients with anterior fusion with refractory pain, progressive neurological deficits, and kyphosis were recruited. Anterior removal of the implant and posterior vertebral column resection were performed. The mean operating time, intraoperative blood loss, kyphosis angle, visual analog scale pain score, Oswestry disability index, bone fusion time, and complications were assessed in a minimum 18-month follow-up.
The mean operating time was 323.5 ± 63.6 minutes, with a mean blood loss of 1189 ± 253.4 mL. The mean preoperative kyphosis angle of 54.6° ± 8.0° immediately decreased to 4.8° ± 1.5° after revision surgery and eventually to 6.8° ± 1.3° at the final follow-up. The mean bone fusion time was 6.8 ± 1.2 months. All patients had satisfactory sagittal and coronal balance with no implant failure at the last follow-up. The average visual analog scale score was 6.2 ± 1.0 preoperatively, and it decreased to 2.6 ± 0.5 at the last follow-up. No patient suffered from neurological deterioration. The Oswestry disability index decreased from 39.8% ± 4.6% preoperatively to 24.5% ± 4.7% at the final follow-up. Complications occurred in 4 patients: 3 experienced tearing of the lung, and 1 had a superficial wound infection.
Anterior removal of the implant and posterior vertebral column resection constituted a safe and effective revision surgery for patients with prior anterior fusion with rigid postsurgical deformities.
Enhanced recovery after surgery on multiple clinical outcomes
Authors: Zhang Xingxia , Yang Jie , Chen Xinrong , Du Liang , Li Ka , Zhou Yong 
Published: July 2020

Abstract

Background:
Previously, many meta-analyses have reported the impact of enhanced recovery after surgery (ERAS) programs on many surgical specialties.

Objectives:
To systematically assess the effects of ERAS pathways on multiple clinical outcomes in surgery.

Design:
An umbrella review of meta-analyses.

Date sources:
PubMed, Embase, Web of Science and the Cochrane Library.

Results:
The umbrella review identified 23 meta-analyses of interventional study and observational study. Consistent and robust evidence shown that the ERAS programs can significantly reduce the length of hospital stay (MD: −2.349 days; 95%CI: −2.740 to −1.958) and costs (MD: −$639.064; 95%CI:: −933.850 to −344.278) in all the surgery patients included in the review compared with traditional perioperative care. The ERAS programs would not increase mortality in all surgeries and can even reduce 30-days mortality rate (OR: 0.40; 95%CI: 0.23 to 0.67) in orthopedic surgery. Meanwhile, it also would not increase morbidity except laparoscopic gastric cancer surgery (RR: 1.49; 95%CI: 1.04 to 2.13). Moreover, readmission rate was increased in open gastric cancer surgery (RR: 1.92; 95%CI: 1.00 to 3.67).

Conclusion:
The ERAS programs are considered to be safe and efficient in surgery patients. However, precaution is necessary for gastric cancer surgery.
Decisive evidence corroborates a null relationship between MTHFR C677T and chronic kidney disease
Authors: Chang Hsueh-Lu , Chen Guei-Rung , Hsiao Po-Jen , Chiu Chih-Chien , Tai Ming-Cheng , Kao Chung-Cheng , Tsai Dung-Jang , Su Hao , Chen Yu-Hsuan , Chen Wei-Teing , Su Sui-Lung 
Published: July 2020

AbstractBackground:Previous meta-analyses have explored the association between the C677T polymorphism ofmethyltetrahydrofolate reductase(MTHFR)and chronic kidney disease (CKD) but there were no studies with a decisive conclusion. Furthermore, the high heterogeneity among different populations is not yet interpreted.Objectives:This study used trial sequential analysis (TSA) to evaluate whether the nowadays conclusion supported by current cumulative samples. We also applied case-weighted meta-regression to explore the potential gene–environment interactions.Methods:For the first stage of this study we conducted a case–control study involving 847 dialysis patients from 7 hemodialysis centers in Taipei during 2015 to 2018 and 755 normal controls from a health center in the Tri-Service General Hospital. The second stage combined the results from the first stage with previous studies. The previous studies were collected from PubMed, EMBASE, and Web of Science databases before January 2018.Results:From the case–control study, the T allele ofMTHFRC677T appeared to have a protective effect on end-stage renal disease compared with the C allele [odds ratio (OR): 0.80, 95% CI (confidence interval) = 0.69–0.93]. However, the meta-analysis contradicted the results in Asian (OR = 1.12, 95% CI = 0.96–1.30). The same analysis was also applied in Caucasian and presented similar results from Asian (OR = 1.18, 95% CI = 0.98–1.42). The TSA showed our case–control study to be the decisive sample leading to a null association among Asian population. The high heterogeneity (I2 = 75%) could explain the contradictory results between the case–control study and the meta-analysis. However, further case-weighted meta-regression did not find any significant interaction between measured factors andMTHFRC677T on CKD.Conclusions:High heterogeneities were found in both Caucasian and Asian, which caused the null relationship in meta-analysis while there were significant effects in individual studies. Future studies should further explore the high heterogeneity that might be hidden in unmeasured gene–environment interactions, to explain the diverse findings among different populations.
Outcome of lumbar lateral recess stenosis with percutaneous endoscopic transforaminal decompression in patients 65 years of age or older and in younger patients
Authors: Li Xiaoxiang , Liu Tao , Fan Junjun , Zhang Hongtao , Yang Chunbao , Yin Xin , Gao Haoran , Qian Jixian , Sun Siguo 
Published: July 2020

Abstract
Lateral recess stenosis is a common pathology causing clinical syndromes in the elderly population, and there is some concern regarding the number of comorbidities that can occur when performing surgery for this condition in the elderly. However, little research has focused on the issues related to older age, and limited data is available to help the clinician counsel elderly patients undergoing percutaneous endoscopic transforaminal decompression. The present study aimed to explore the safety and efficacy of percutaneous endoscopic transforaminal decompression for lumbar degenerative disease in elderly patients with lumbar lateral recess stenosis and to determine whether age and comorbidity affect the outcome and complication rate.
We identified 117 patients in our patient database who underwent percutaneous endoscopic transforaminal decompression for single-level lumbar lateral recess stenosis. Data regarding the Oswestry Disability Index and visual analog scale for back and leg pain were collected preoperatively, postoperatively, and at the last follow-up. Other data, including preoperative comorbidities, operation time, and intraoperative and postoperative complications, were recorded.
The average follow-up period was 29.9 ± 5.5 months, with a mean age of 69.8 ± 5.4 years in elderly patients (group A) and 50.4 ± 6.4 years in younger patients (group B). Group A had a higher percentage of comorbidity than group B (83.9% vs 18.0%, P < .001). Both visual analog scale scores for leg pain and Oswestry Disability Index were significantly improved in the 2 groups, and no difference was found between the groups regarding both parameters (P >.05). The elderly patients had the same high rate of favorable outcomes as group B (P > .05). Moreover, there was no difference in surgical complications, recurrence, and neurologic deficit recovery rate between both groups. No major complications or perioperative deaths occurred in both groups.
The present study demonstrates that percutaneous endoscopic transforaminal decompression for lateral recess stenosis in elderly patients may be a reasonable treatment associated with substantial benefit.
The effect of dexmedetomidine and remifentanil on the postoperative sore throat after thyroidectomy
Authors: Kim Hyuckgoo , Kwon Hyojin , Jeon Sungmin , Choi Eun Kyung 
Published: July 2020

Abstract

Background:
Postoperative sore throat (POST) is an important concern in surgical patients undergoing endotracheal intubation. Its prevalence after thyroidectomy is up to 80%. The current study aimed to assess the effect of dexmedetomidine and remifentanil on postoperative sore throat.

Methods:
Seventy-four patients who underwent thyroidectomy were randomized to receive either dexmedetomidine (group D) or remifentanil (group R). At anesthesia induction, group D received dexmedetomidine 1 μg/kg over 10 minutes, followed by continuous dexmedetomidine infusion at 0.3 to 0.6 μg/kg/hour during surgery. Group R received remifentanil of 3 to 4 ng/ml during induction, followed by 1.5 to 2.5 ng/ml remifentanil infusion during surgery. POST at rest and swallowing was assessed during the first 24 hours in serial time periods (0–1, 1–6, and 6–24 hours). Hoarseness and postoperative pain score were also assessed.

Results:
POST incidence at rest (0–1, 1–6, and 6–24 hours) and swallowing (1–6 and 6–24 hours) was lower in group D than in group R. POST severity was significantly lower in group D than in group R during each time period. The incidence of postoperative hoarseness was also lower in group D than in group R at 1 to 6 and 6 to 24 hours. The postoperative pain score was lower in group D than in group R during each time period.

Conclusion:
Intraoperative dexmedetomidine infusion reduced the incidence and severity of POST for 24 hours after thyroidectomy.
Acupotomy for third lumbar vertebrae transverse process syndrome
Authors: Jiao Lin , Xiao Yuanyi , Chi Zhenhai , Zhu Daocheng , Ouyang Xilin , Xu Wei , You Jianyu , Luo Zhaona , Yuan Fuqiang 
Published: July 2020

AbstractBackground:Acupotomy has been widely used clinically to relieve low back pain. However, the efficacy of acupotomy for the third lumbar vertebrae transverse process syndrome is still uncertain. The aim of this study is to determine the effectiveness and safety of acupotomy therapy for the third lumbar vertebrae transverse process syndrome.Methods:Relevant randomized controlled trials will be searched from the databases of PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature Database from their inception to May 2020. Two reviewers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. The RevMan V.5.3 will be used for meta-analysis.Results:This study will provide an assessment of the current state of acupotomy for the third lumbar vertebrae transverse process syndrome, aiming to show the efficacy and safety of acupotomy treatment.Conclusion:This study will provide evidence to judge whether acupotomy is an effective intervention for the third lumbar vertebrae transverse process syndrome.PROSPERO registration number:CRD42019134945.
Simulation-based training and assessment of mobile pre-hospital SARS-CoV-2 diagnostic teams in Styria, Austria
Authors: Mileder Lukas P. , Schüttengruber Gerhilde , Prattes Jürgen , Wegscheider Thomas 
Published: July 2020

Abstract
The World Health Organization has declared coronavirus disease 2019 (COVID-19) a pandemic. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the diagnostic gold standard of COVID-19. We have developed a simulation-based training program for mobile prehospital diagnostic teams in the province of Styria, Austria, and performed a prospective observational study on its applicability and effectivity.
The 1-day curriculum uses theoretical instruction, technical skills training, and simulator-based algorithm training to teach and train prehospital patient identification and communication, donning the personal protective equipment, collection of naso-/oropharyngeal swabs for SARS-CoV-2 polymerase chain reaction testing, doffing the personal protective equipment, and sample logistics. Trainings were conducted at the SIM CAMPUS simulation hospital, Eisenerz, using high-fidelity patient simulation. To ensure achievement of predefined learning outcomes, participants had to undergo a final simulator-based objective structured clinical examination.
In March 2020, 45 emergency medical assistants and 1 physician of the Austrian Red Cross participated on a voluntary basis. Forty-five of the 46 participants (97.8%) completed the curriculum successfully, with mean objective structured clinical examination ratings of 98.6%.
Using several proven educational concepts, we have successfully drafted and implemented a training program for mobile prehospital SARS-CoV-2 diagnostic teams. Based on simulation-based objective structured examinations, it has prepared participants effectively for preclinical duties.
Prevalence and factors of compassion fatigue among Chinese psychiatric nurses
Authors: Xie Wanqing , Wang Jialin , Okoli Chizimuzo T. C. , He Huijuan , Feng Fen , Zhuang Linli , Tang Ping , Zeng Li , Jin Man 
Published: July 2020

Abstract
Compassion fatigue has emerged as a detrimental consequence of experiencing work-related stress among psychiatric nurses, and affected the job performance, emotional and physical health of psychiatric nurses. However, researches on Chinese psychiatric nurses’ compassion fatigue are dearth. This cross-sectional study aimed to investigate the prevalence and factors of compassion fatigue among Chinese psychiatric nurses.
All participants completed the demographic questionnaire and the Chinese version of Professional Quality of Life Scale (ProQOL-CN). One-way ANOVA, t-tests, Levene test and multiple linear regression analysis were conducted to evaluate factors associated with compassion fatigue.
A total of 352 psychiatric nurses in 9 psychiatric hospitals from the Chengdu, Wuhan, and Hefei were surveyed. The mean scores of compassion satisfaction, burnout and secondary traumatic stress were 32.59 ± 7.124, 26.92 ± 6.003 and 25.97 ± 5.365, respectively. Four variables of job satisfaction, exercise, had children, and age range from 36 to 50 years explained 30.7% of the variance in compassion satisfaction. Job satisfaction, sleeping quality, and marital status accounted for 40.4% variables in burnout. Furthermore, job satisfaction, average sleeping quality, and years of nursing experience remained significantly associated with secondary trauma stress, explaining 10.9% of the variance.
Compassion satisfaction, burnout and secondary traumatic stress among Chinese psychiatric nurses were at the level of moderate. The higher job satisfaction, healthy lifestyle (high sleep quality and regular exercise), and family support (children, stable and harmonious marital status) positively influenced compassion satisfaction and negatively associated with burnout or secondary traumatic stress.