bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatocellular carcinoma with right atrial tumor thrombus: a systematic review
Authors: Yuan Shi-Min , Guo Yi-Xian 
Published: March 2020

Abstract
Background: Hepatocellular carcinoma with right atrial tumor thrombus is uncommon but with a dismal prognosis.
Methods: By comprehensive retrieval of literature published between 2000 and 2019, 53 reports were obtained with 187 patients recruited into this study. The extracted data included patient characteristics, tumor characteristics, treatment, follow-up and outcomes. Statistical analyses applied were student t , Fisher exact and I 2 tests. Patients were devided into 6 groups according to treatment of choices: transarterial chemoembolization (TACE), surgery, radiotherapy, chemotherapy, interventional treatment and supportive care.
Results: The overall survival rate of this cohort was 40.8%. The survival rate of patients receiving TACE was 33.3% and that of surgical patients was 41.9%. The survival time of patients with TACE was longer than surgical patients, but lack of a statistical significance. Patients had a follow-up of 15.7±16.6 (median 10) months. The patients receiving radiotherapy had the longest follow-up among all groups. Intra- and/or extrahepatic recurrence of hepatocellular carcinoma was the major mobidity. The mortality rates in a decremental sequence for patients receiving different treatments were supportive care >radiotherapy >surgery >TACE >interventional treatment. No difference was found in mortality between patients reported from case reports and those from non-case reports.
Conclusions: Even though advanced hepatocellular carcinoma with right atrial thrombus is an aggressive malignancy, the the present study showed that patients’ prognosis was improved and survival time elongated with active treatments such as TACE and surgery. The present systematic review reveals improved outcomes with active treatments against conservative treatments.
Wrist deformity, bother and function following wrist fracture in the elderly
Authors: Lawson Andrew , Santhakumar Partiban , Naylor Justine M , Churches Tim , Frost Steve , Harris Ian A 
Published: March 2020

Abstract
Objective Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: 1. determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it; 2. test if there were associations between deformity and treatment-type and between deformity and function; 3. test for associations between bother and treatment-type and between bother and function; 4. measure the test-retest reliability of the ‘bother’ question. Results Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR=3.85, p=0.006) but was not significantly associated with functional outcomes (p=0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p=0.006) and this association was clinically significant (MD=35 points). The deformity and bother questions were found to have excellent test-retest reliability; ᴋ=1.00 and ᴋ=0.92, respectively.
Structured reporting has the potential to reduce reporting times of dual-energy x-ray absorptiometry exams
Authors: Kim Su Hwan , Sobez Lara M. , Spiro Judith E. , Curta Adrian , Ceelen Felix , Kampmann Eric , Goepfert Martin , Bodensohn Raphael , Meinel Felix G. , Sommer Wieland H. , Sommer Nora N. , Galiè Franziska 
Published: March 2020

Abstract
Background
In recent years, structured reporting has been shown to be beneficial with regard to report completeness and clinical decision-making as compared to free-text reports (FTR). However, the impact of structured reporting on reporting efficiency has not been thoroughly evaluted yet. The aim of this study was to compare reporting times and report quality of structured reports (SR) to conventional free-text reports of dual-energy x-ray absorptiometry exams (DXA).

Methods
FTRs and SRs of DXA were retrospectively generated by 2 radiology residents and 2 final-year medical students. Time was measured from the first view of the exam until the report was saved. A random sample of DXA reports was selected and sent to 2 referring physicians for further evaluation of report quality.

Results
A total of 104 DXA reports (both FTRs and SRs) were generated and 48 randomly selected reports were evaluated by referring physicians. Reporting times were shorter for SRs in both radiology residents and medical students with median reporting times of 2.7 min (residents: 2.7, medical students: 2.7) for SRs and 6.1 min (residents: 5.0, medical students: 7.5) for FTRs. Information extraction was perceived to be significantly easier from SRs vs FTRs (P<0.001). SRs were rated to answer the clinical question significantly better than FTRs (P<0.007). Overall report quality was rated significantly higher for SRs compared to FTRs (P<0.001) with 96% of SRs vs 79% of FTRs receiving high or very high-quality ratings. All readers except for one resident preferred structured reporting over free-text reporting and both referring clinicians preferred SRs over FTRs for DXA.

Conclusions
Template-based structured reporting of DXA might lead to shorter reporting times and increased report quality.
A model for evaluation of the electric activity and oxygenation in the erector spinae muscle during isometric loading adapted for spine patients
Authors: Ekström Lars , Zhang Qiuxia , Abrahamson Josefin , Beck Joel , Johansson Christer , Westin Olof , Todd Carl , Baranto Adad 
Published: March 2020

Abstract
Background:
Simultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery.
Methods:

Twelve patients with degenerative lumbar spinal stenosis (DLSS) were included. They were subjected to a test protocol before and after surgery. The protocol consisted of two parts, a dynamic and an isometric Ito loading with a time frame of 60 seconds and accompanying rest of 120 seconds. The Ito test was repeated three times. EMG was measured bilaterally at the L4 level and L2 and was recorded using surface electrodes and collected (Biopac Systems Inc). EMG signal was expressed as RMS and median frequency (MF). Muscle tissue oxygen saturation (MrSO 2 ) was monitored using a Near-infrared spectroscopy (NIRS) device ( INVOS ® 5100C Oxymeter). Two NIRS sensors were positioned bilaterally at the L4 level.

The intensity of the leg and back pain and perceived exertion before, during and after the test was evaluated with a Visual Analogue Scale (VAS) and Borg RPE-scale, respectively.
Results:

All patients were able to perform and complete the test protocol pre- and postoperatively. A consistency of lower median and range values was noted in the sensors of EMG1 (15.3 µV, range 4.5-30.7 µV) and EMG2 (13.6 µV, range 4.0 -46.5 µV) that were positioned lateral to NIRS sensors at L4 compared with EMG3 (18.9 µV, range 6.5 -50.0 µV) and EMG4 (20.4 µV, range 7.5 -49.0 µV) at L2. Right and left side of the erector spinae exhibited a similar electrical activity behaviour over time during Ito test (60s). Regional MrSO 2 decreased over time during loading and returned to the baseline level during recovery on both left and right side. Both low back and leg pain was significantly reduced postoperatively.
Conclusion:

Simultaneous measurement of surface EMG and NIRS seems to be a promising tool for objective assessment of paraspinal muscle function in terms of muscular activity and local muscle oxygenation changes in response to isometric trunk extension in patients that have undergone laminectomy for spinal stenosis.

Keywords:
Spinal stenosis, EMG, NIRS, paraspinal muscle, muscle oxygenation, muscle activity, laminectomy.
Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation
Authors: Byrne Paula , Thetford Clare , Gabbay Mark , Clarke Pam , Doncaster Emily , Harding Simon 
Published: March 2020

Abstract
Background

Internationally, systematic screening for sight-threatening diabetic retinopathy (STDR) usually includes annual recall. Researchers and policy-makers support extending screening intervals, citing evidence from observational studies with low incidence rates. However, there is little research around the acceptability to people with diabetes (PWD) and health care professionals (HCP) about changing eye screening intervals.

Methods

We conducted a qualitative study to explore issues surrounding acceptability and the barriers and enablers for changing from annual screening, using in-depth, semi-structured interviews analysed using the constant comparative method. PWD were recruited from general practices and HCPs from eye screening networks and related specialties in North West England using purposive sampling. Interviews were conducted prior to the commencement of and during a randomised controlled trial (RCT) comparing fixed annual with variable (6, 12 or 24 month) interval risk-based screening.

Results

Thirty PWD and 21 HCP participants were interviewed prior to and 30 PWD during the parallel RCT. The data suggests that a move to variable screening intervals was generally acceptable in principle, though highlighted significant concerns and challenges to successful implementation. The current annual interval was recognised as unsustainable against a backdrop of increasing diabetes prevalence. There were important caveats attached to acceptability and a need for clear safeguards around: the safety and reliability of calculating screening intervals, capturing all PWDs, referral into screening of PWDs with diabetic changes regardless of planned interval. For PWDs the 6-month interval was perceived positively as medical reassurance, and the 12-month seen as usual treatment. Concerns were expressed by many HCPs and PWDs that a 2-year interval was too lengthy and was risky for detecting STDR. There were also concerns about a negative effect upon PWD care and increasing non-attendance rates. Amongst PWDs, there was considerable conflation and misunderstanding about different eye-related appointments within the health care system.

Conclusions

Implementing variable-interval screening into clinical practice is generally acceptable to PWD and HCP with important caveats, and misconceptions must be addressed. Clear safeguards against increasing non-attendance, loss of diabetes control and alternative referral pathways are required. For risk calculation systems to be safe, reliable monitoring and clear communication is required.
Pioglitazone for primary stroke prevention in Asian patients with type 2 diabetes and cardiovascular risk factors: A retrospective study
Authors: Hung Yi-Chih , Chiu Lu-Ting , Huang Hung-Yu , Bau Da-Tian 
Published: March 2020

Abstract
Background: To date, studies assessing the efficacy of pioglitazone solely for primary stroke prevention in Asian patients with type 2 diabetes mellitus (DM) and present multiple cardiovascular (CV) risk factors are rare. Thus, we aimed to assess the effect of pioglitazone on primary stroke prevention in Asian type 2 DM patients without established CV diseases but with risk factors for CV diseases. Methods: Between 2000 and 2012, we enrolled patients aged ≥18 years who were newly diagnosed with type 2 diabetes and had at least one of the following CV risk factors: hypertension, hyperlipidemia, proteinuria, and obesity. Patients with a history of stroke and those using insulin or glucagon-like peptide-1 agonist for more than 3 months were excluded. Patients were divided into the pioglitazone user group and non-pioglitazone user group based on their receipt of pioglitazone during the follow-up period. Propensity-score matching (1:1) was used to balance the distribution of the baseline characteristics and medications. Follow-up was terminated upon ischemic stroke development, withdrawal from the insurance system, or on December 31, 2013, whichever occurred first. The overall incidence of new-onset ischemic stroke in the two groups was subsequently compared. Subgroup analyses of ischemic stroke were conducted using different baseline features. Additionally, the effect of the pioglitazone exposure dose on the occurrence of ischemic stroke was evaluated. The chi-square test, Student’s t-test, Kaplan–Meier method, and log-rank test were some of the statistical tests conducted herein.Results: A total of 6,637 patients were included in the pioglitazone and non-pioglitazone group. Compared to patients who did not receive pioglitazone, those administered pioglitazone had a lower risk of developing ischemic stroke (adjusted hazard ratio: 0.72; 95% confidence interval: 0.57–0.9). Subgroup analyses defined by different baseline features did not reveal significant alterations to the observed effect of pioglitazone. Moreover, a significant trend regarding the decrease in ischemic stroke risk and the increase in pioglitazone dose (p-value for trend=0.03) was observed.Conclusion: Pioglitazone use decreased the risk of new-onset ischemic stroke in Asian patients with type 2 DM and CV risk factors.
Thermal effect of holmium laser during ureteroscopic lithotripsy
Authors: Liang Hui , Liang Lijian , Yu Yin , Huang Bin , Chen Jia’nan , Wang Chaoguo , Zhu Zhangguo , Liang Xiaozhong 
Published: March 2020

Abstract
Background: Holmium laser lithotripsy is the most common technique for the management of ureteral stone. Studies founded that holmium laser firing can produce lethal heating which will cause thermal injury towards ureter. The aim of our current study is to explore factors affecting thermal effect of holmium laser during ureteroscopic lithotripsy.Materials and Methods: An in vitro experimental model is design to simulate the ureteroscopic lithotripsy procedure. Different laser power settings (10w (0.5JX20Hz, 1.0JX10Hz), 20w (1.0JX20Hz, 2.0JX10Hz), 30w (1.5JX20Hz, 3.0JX10Hz)) with various firing time (3s, 5s, 10s) and irrigation flow rates（10ml/min, 15ml/min, 20ml/min and 30ml/min）were employed in the experiment. The temperature around the laser tip was recorded by thermometer.Results: The temperature in the “ureter” rises significantly with the increasing laser power, prolonging firing time and reducing irrigation flow. The highest regional temperature is 78.0℃ at the experimental set-up, and the lowest temperature is 23.5℃. Higher frequency setting produces more heat at the same power. Laser power<=10w, irrigation flow>=30ml/ml and “high-energy with low-frequency” can permit a safe working temperature.Conclusion: We clarify that the thermal effect of holmium laser is related with both laser working parameters and irrigation flow. The proper setting is the key factor to ensure the safety during ureteroscopic holmium laser lithotripsy.
Biofilm formation on three different endotracheal tubes: A prospective clinical trial
Authors: Thorarinsdottir Hulda Rosa , Kander Thomas , Holmberg Anna , Petronis Sarunas , Klarin Bengt 
Published: March 2020

Abstract
Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is anticipated to act as a reservoir for infecting microorganisms, contributing to the development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface it is difficult to eradicate. The aims of this clinical study were to compare biofilm formation on three widely used ETT´s with different surface properties and to explore possible predictive factors of biofilm formation.
Methods: The grade of biofilm formation on endotracheal tubes of polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated by noble metals were compared after mechanical ventilation for > 24 hours in critically ill patients. The comparison was based on scanning electron microscopy (SEM) observations of ETT surfaces and biofilm grading, surveillance and biofilm cultures, and the occurrence of VAP.
Results: A high-grade (score ≥ 7) biofilm formation on the ETTs was associated with the development of VAP (OR, 4.17; 95% CI 1.14 to 15.3; p = 0.031). Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation compared to non-coated PVC ETTs (OR, 0.18; 95% CI 0.06 to 0.59; p = 0.005 and OR, 0.34; 95% CI 0.13 to 0.93; p = 0.036, respectively). No significant difference was detected between silicon-coated ETTs and noble metal-coated ETTs (OR, 0.54; 95% CI 0.17 to 1.65; p = 0.278). The microbes found in the ETT biofilm were frequently found in surveillance cultures at intubation and often remained in the biofilm after appropriate antibiotic therapy. Colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation did not predict higher biofilm formation on ETTs.
Conclusion: Biofilm formation on ETTs were an early and frequent event in critically ill patients. High-grade biofilm formation on ETTs was associated with the development of VAP. Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation in comparison to non-coated PVC ETTs. Clinicians may consider changing the ETT after an episode of VAP to avoid microbial persistence and possibly VAP relapse.
Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study
Authors: Zantour Baha , Bouchareb Soumaya , Ati Zohra El , Boubaker Fadia , Alaya Wafa , Kossomtini Wassiaa , Sfar Mmohamed Habib 
Published: March 2020

Abstract
BackgroundDiabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) classification, stratify patients into risk categories and identify factors associated with higher-risk gradeMethodsCross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. ResultsAmong 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higher–risk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR=2.529, CI95 [1.131-5.655], p=0.024), hyperkeratosis (OR=2.658, CI95 [1.222-5.783], p=0.014) and school level (OR=0.489, CI95 [0.253-9.44], p=0.033)Conclusions Risk factors for foot ulceration were rather common in diabetic outpatients. The screening of diabetic patients at risk for foot ulceration should start early, integrated with sustainable patient education
Frequency of kdr mutations in the voltage-sensitive sodium channel (VSSC) gene in Aedes aegypti from Yogyakarta and implications for Wolbachia-infected mosquito trials
Authors: Wuliandari Juli R. , Hoffmann Ary A. , Tantowijoyo Warsito , Endersby-Harshman Nancy M. 
Published: March 2020

Abstract
Background: In the inner city of Yogyakarta, Indonesia, insecticide resistance is expected in the main dengue vector, Aedes aegypti, because of the intensive local application of pyrethroid insecticides. However, detailed information about the nature of resistance in this species is required to assist the release of Wolbachia mosquitoes in a dengue control program so that we can ensure that insecticide resistance in the strain of Ae. aegypti being released matches that of the background population.Methods: High-resolution melt genotyping was used to screen for kdr mutations associated with pyrethroid resistance in the voltage-sensitive sodium channel (VSSC) gene in Ae. aegypti of some areas in the inner city of Yogyakarta.Results: The results show that the V1016G mutation predominated, with individuals homozygous for the 1016G allele at a frequency of 82.1% and the mutant allele G at a frequency of 92%. Two patterns of co-occurrence of mutations were detected in this study, homozygous individuals V1016G/S989P; and heterozygous individuals V1016G/F1534C/S989P. We found the simultaneous occurrence of kdr mutations V1016G and F1534C at all collection sites, but not within individual mosquitoes. Homozygous mutants at locus 1016 were homozygous wildtype at locus 1534 and vice versa, and heterozygous V1016G were also heterozygous for F1534C. The most common tri-locus genotype co-occurrences were homozygous mutant 1016GG and homozygous wild-type FF1534, combined with homozygous mutant 989PP (GG/FF/PP) at a frequency of 38.28%.Conclusions: Given the relatively small differences in frequency of resistance alleles across the city area, locality variations in resistance should have minor implications for the success of Wolbachia mosquito trials being undertaken in the Yogyakarta area.
Characteristics of a single- versus multiple-injection axillary brachial plexus block: a single-blinded randomised, clinical trial
Authors: Grape Sina , Kirkham Kyle , Bloc Sébastien , Albrecht Eric 
Published: March 2020

Abstract
Background. An ultrasound-guided axillary brachial plexus block is usually performed with a multiple-injection technique. However, when the arm is abducted at 160°, the musculocutaneous nerve lies close to the axillary artery, and all four nerves can be blocked with a single-injection. This randomised controlled single-blinded trial tested the hypothesis that a single-injection technique has a reduced procedure time and is as effective as a multiple-injection technique.Methods. Fifty ASA I-III patients were randomised to receive an ultrasound-guided multiple- or single-injection axillary brachial plexus block with 32ml 1:1 mixture of mepivacaine 1% and ropivacaine 0.5%. In the single injection group, the needle was positioned below the axillary artery, without repositioning, while in the multiple injection group, each nerve was blocked separately. The primary outcome was the procedure time. Secondary outcomes included onset time of action, block success rate 30 minutes after injection, and rest, dynamic pain score (numeric rating scale, 0-10) at 24 postoperative hours.Results. The procedure time was significantly reduced in the single-injection group with a mean (95%CI) of 6min (5-6), versus 4min (4-4) in the multiple-injection group (p<0.001). Success rates were 96% [95%CI:80%-100%] and 88% [95%CI:69%-97%] in the single- and multiple-injection groups, respectively (p=0.30). Other secondary outcomes were similar between groups, except onset time that was prolonged in the single-injection group with a mean time (95%CI) of 23min (19-27) versus 17min (15-19), p=0.01.Conclusions. An axillary brachial plexus block performed with a single-injection technique is associated with a reduced procedure time, an increased onset time and an equivalent success rate.