bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Quality of Randomized Controlled Trials of Complex Regional Pain Syndrome Published in the Journal of Clinical Pain Medicine Field
Authors: Lee Seung Wook , Kim Kyu Shik , Chung Jae Hoon , Park Hyung Joon , Sohn Yong Seok , Jeon Woo Jae , Cho Sang Yun , Shin Woo Jong 
Published: September 2020

Abstract
Background: Complex regional pain syndrome is a disease characterized by chronic pain caused by tissue damage and worsens over time. The quality of randomized controlled trials on complex regional pain syndrome is low due to the rarity of the disease and difficulty in designing studies. Therefore, we evaluated the completeness of evidence by assessing the quality. Methods: We searched articles that were published between 1998 and 2017. The quality was assessed using the Jadad scale, van Tulder scale, and the Cochrane collaboration risk of bias tool.Results: A total of 72 articles on complex regional pain syndrome have been published. Only 31 articles were found to have a low risk of bias according to the Cochrane Collaboration. On the Jadad and van Tulder scale, 52 and 58 articles, respectively, were assessed as high quality. Only a few trials described the randomization method adequately and presented allocation concealment correctly. We also found that research trials with funding statements had higher Jadad scales than unfunded (P = 0.03). Furthermore, articles that described the sample size were of significantly higher quality (P < 0.01) than those that did not. Conclusions: There was no observed improvement in quality over time. In particular, the performance rate of the allocation concealment for the analyzed papers was low. In addition, we found that the number of high-quality articles increased when institutional review board approval was granted and funding provided. For the future, we recommend that researchers focus their efforts on conducting high-quality studies.
Diagnostic Accuracy of D-dimer Testing and the Revised Geneva Score in the Prediction of Pulmonary Embolism
Authors: Abolfotouh Mostafa A. , Almadani Khaled , Rowaily Mohammed A. Al 
Published: September 2020

Abstract
Background. Pulmonary embolism (PE) diagnosis can sometimes be challenging due to the disease having nonspecific signs and symptoms at the time of presentation. The aim of the present study was to evaluate the validity of the D-dimer in combination with the revised Geneva score (RGS) in prediction of Pulmonary embolism.Methods. This is a retrospective study of 2010 patients with suspected PE who had undergone both D-dimer testing followed by chest CT angiography (CTPA). The predictive accuracy of D-dimer, adjusted D-dimer and the revised Geneva score were calculated. ROC curve was applied to allocate the optimum RGS cutoff for PE prediction.Results. Of all patients, the mean age was 52.2±20.2 years, two-thirds (65.1%) were females, with previous history of; DVT or PE (2%), surgery and/or fracture of lower limb (6.9%), active malignant conditions (14.4%), unilateral lower limb pain (0.6%), and hemoptysis (0.7%).The overall prevalence of PE was 16%. It was 0% in the low, 25.8% in intermediate and 88.9% in high clinical probability categories of RGS. Both conventional and age-adjusted D-dimer thresholds showed significant level of agreement (kappa=0.081, p<0.001), high sensitivity (94% & 92.8%), high NPV (91.2% & 91.4%), low specificity (12.3% & 15.3) and low PPV (17.5% & 17.8%), respectively. Combination of the age-adjusted D-dimer threshold and RGS at a cut-off of 5 points would provide 100% sensitivity and 61.7% specificity 34.1% PPV, 100% NPV and 0.87 AUC. At a RGS cutoff <5 points, PE could be have been excluded in 64.2% of patients with an abnormal age-adjusted D-dimer threshold without further imaging.Conclusion. Conventional and age-adjusted D-dimer tests showed high levels of agreement in prediction of PE, high sensitivity and low specificity. RGS has a good performance in PE prediction. Application of a clinical decision rule, using the revised Geneva score, and age adjusted D-dimer threshold could increase the number of patients in whom PE could be excluded without further imaging.
An Accidental Bronchial Obstruction Caused by Detached Cuff: Case Report and Literature Review
Authors: Zhu Kaibin , Bu Jianlong , Liu Mengfeng , He Changjun , Lang Yaoguo , Xu Shidong 
Published: September 2020

Abstract
Background The airway obstructions are usually caused by secretions, mucus plugs, blood clots, malposition of bronchial blockers (BBs) cuff or twist of the tube by oral biting. In this paper, we report a case of accidental bronchial obstruction as a result of a cuff detaching from the BBs catheter.Case presentation A 48-year-old male was admitted to our department due to small cell lung cancer. He had received two cycles of neoadjuvant chemotherapy with etoposide plus cisplatin and was scheduled a right upper lobe resection by thoracotomy. During the surgery, the patient was intubated with an 8.0-mm internal diameter BBs tube (Univent tube). When the anesthesiologist tried to remove the BBs towards the end of surgery, the cuff got detached accidentally and obstructed the airway leading to improper expansion of the middle lobe. This condition was determined later by the 6.0-mm bronchoscope and the cuff was removed with forceps. Conclusions We report this case aiming to remind other colleagues that the cuff detachment in the surgical procedure is still a potentially fatal incident even it rarely happens nowadays. It is important to check the BBs apparatus meticulously through the whole operative procedure. The routine use of 4.0-mm bronchoscope should be highly recommended during the entire airway management when a bronchial obstruction is suspected.
Association factors with severe cases and antiviral drug assessment in patients with COVID-19
Authors: Gong Xiaowei , Guo Xianfeng , Kang Shiwei , Li Yan , Gao Haixiang , Yuan Yadong 
Published: September 2020

Abstract
Background

Due to the latent onset of novel coronavirus disease 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies. This study aimed to identify the factors associated with severe COVID-19 and evaluate the current antiviral drugs, especially in severe patients.
Methods

This was a retrospective observational study performed at the No. 7 Hospital of Wuhan (Wuhan, China) with hospitalized patients confirmed with COVID-19 from January 11 to March 13, 2020. Multivariable logistic regression analysis was used to identify the associated factors of severe COVID. Treatment of antivirus drugs were collected and evaluated.
Results

Of the 550 patients, 292 (53.1%) were female and 277 (50.4%) were ≥ 60 years old. The most common symptom was fever (n = 372, 67.7%), followed by dry cough (n = 257, 46.7%), and dyspnea (n = 237, 43.1%), and fatigue (n = 224, 40.7%). Among the severe patients, 20.2% required invasive ventilator support and 18.0% required non-invasive ventilator. The identified risk factors for severe cases were: age ≥ 60 years (odds ratio (OR) = 3.02, 95% confidence interval (CI): 1.13–8.08, P = 0.028), D-dimer > 0.243 µg/ml (OR = 2.734, 95%CI: 1.012–7.387, P = 0.047), and low oxygenation index (OR = 0.984, 95%CI: 0.980–0.989, P < 0.001). In severe cases, the benefits of arbidol alone was 73.3%, which was better than ribavirin (7/17, 41.2%, P = 0.029).
Conclusions

Age ≥ 60 years, D-dimer > 0.243 µg/ml, and lower oxygenation index were associated with severe cases. Arbidol might provide more clinical benefits in treating patients with severe COVID-19 compared with other antiviral drugs.
Why Do Healthcare Professionals Fail to Escalate as Per the Early Warning System (EWS) Protocol? A Qualitative Evidence Synthesis of the Barriers and Facilitators of Escalation
Authors: Neill Sinead M O , Clyne Barbara , Bell Miriam , Casey Avilene , Leen Brendan , Smith Susan M , Ryan Mairin , O’Neill Michelle 
Published: September 2020

Abstract
Background: Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS). Methods: A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorized into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence.Results: Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, Empowerement, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation.Conclusions: The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care.
Growth in ataxia telangiectasia
Authors: Natale Valerie , Cole Tim J , Rothblum-Oviatt Cynthia , Wright Jennifer , Crawford Thomas , Lefton-Greif Maureen , McGrath-Morrow Sharon , Schlechter Haley , Lederman Howard M. 
Published: September 2020

Abstract
Background
Ataxia telangiectasia (A-T) is a DNA repair disorder that affects multiple body systems. Neurological problems and immunodeficiency are two important features of this syndrome. At this time, two main severity groups are defined in A-T: classic (the more severe form) and mild. Poor growth is a common problem in classic A-T. An objective of this study was to develop growth references for classic A-T. Another objective was to compare growth patterns in classic A-T and mild A-T with each other and with the general population, using the CDC growth references. A final objective was to examine the effects of chronic infection on height.
Results
We found that classic A-T patients were smaller overall, and suffered from height and weight faltering that continued throughout childhood and adolescence. When compared to the CDC growth references, the median heights and weights for both male and female patients eventually fell to or below the 3rd centile on the CDC charts. Height faltering was more pronounced in females. Birthweight was lower in the classic A-T group compared to mild A-T and the general population, whereas birth length was not. Finally, we investigated height and BMI faltering in relation to number of infections and found no association.
Conclusions
Classic A-T appears to affect growth in utero. Although children appear to grow well in very early life, faltering begins early and is unrelenting.
Prognostic Factors for Persistent Symptoms in Adults With Mild Traumatic Brain Injury: Protocol for an Overview of Systematic Reviews
Authors: Déry Julien , De Guise Élaine , Lamontagne Marie-Eve 
Published: September 2020

Abstract
Background: Mild traumatic brain injury (mTBI) is an increasing public health problem, and persistent symptoms following mTBI have several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide prevention of long-term disabilities and to intervene with mTBI patients. Prognosis of chronic symptoms in mTBI has stimulated several empirical primary research papers and many systematic reviews. We aim to integrate these heterogenous factors into a model in order to have a better understanding of such prognostic factors on the development of chronic symptoms.Methods: We will conduct an overview of systematic reviews following steps described in the Cochrane Handbook. We will search for systematic reviews in databases using a search strategy to include articles that review evidence about prognosis of persistent symptoms after an mTBI in the adult population. Two reviewers will independently screen all references and then select eligible reviews based on eligibility criteria. Any disagreements will be discussed by the two reviewers and if consensus is not reached, we will consult a third reviewer. A data extraction grid will be used to extract relevant information. The risk of bias included will be rated using ROBIS tool. Data will be synthesized into a comprehensive conceptual map in order to have a better understanding of the predictor factors that could impact the recovery after mTBI.Discussion: Results will help multiple stakeholders, such as clinicians and rehabilitation program managers, to understand the prognosis of long-term consequences following an mTBI. It could guide stakeholders to recognize predisposing, precipitating, and perpetuating factors of their patients and to invest their time and resources on patients needing the most.Systematic review registration: PROSPERO CRD42020176676
The Modification and Optimization of Retroperitoneal Laparoscopic Radical Nephrectomy for the Treatment of Localized Renal Cell Carcinoma
Authors: Zhang Yimu , Zhou Zhengyu , Bai Jiyan , Tian Pei , Yang Dong , Zhao Pengcheng , Li Jing , He Chaohong 
Published: September 2020

Abstract
Background: We report our modified surgical technique of retroperitoneal laparoscopic radical nephrectomy (RLRN) and assess its perioperative outcomes and postoperative complications, with a focus on operative time (OT). Methods: We retrospectively analyzed a single-center, single-surgeon cohort of 130 consecutive patients who underwent RLRN between January 2015 and March 2019. A study group of 65 patients who received modified RLRN was compared with a control group of 65 patients who received classical RLRN. OT, estimated blood loss ( EBL ), perioperative complications, postoperative first exhaust time (PFET), pathological stage, and postoperative hospital stay (PHS) were compared between the two groups. Results: All demographic, clinical, and pathological variables were comparable between the groups. No differences were observed in perioperative complications (p=0.648), peritoneal injuries (p=0.843), PFET (p=0.448), pathological stage (p=0.767), and PHS (p=0.304). The modified RLRN group resulted in a significantly reduced overall OT (53.8±8.4 min vs. 60.5±10.6 min, p=0.000), peritoneal injury intervention subgroup OT (56.3±9.8 min vs. 75.2±12.4 min, p=0.000), and EBL (55.7±10.1 mL vs. 62.3±11.6 mL, p=0.001) compared with the classical RLRN group. We observed a significant reduction in OT and EBL but no increase in postoperative complications, PFET, or PHS with modified versus traditional RLRN for localized renal carcinoma.Conclusions: Findings from this study present a modified RLRN surgical technique that is standardized, more precise, and has better practicability.
Does Respiratory Co-Infection Facilitate Dispersal of SARS-CoV-2? Investigation of a Super-Spreading Event in an Open-Space Office
Authors: Weissberg Dana , Böni Jürg , Rampini Silvana , Kufner Verena , Zaheri Maryam , Schreiber Peter W. , Abela Irene A. , Huber Michael , Sax Hugo , Wolfensberger Aline 
Published: September 2020

Abstract
Background: Super-spreaders are individuals infecting disproportionately large numbers of contacts. They probably play a crucial role in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a super-spreading event within a team working in an open-space office and investigate factors potentially having facilitated SARS-CoV-2 transmission.Methods: In this retrospective cohort study, semi-structured telephone interviews with all team members were carried out to identify symptoms, contacts, and adherence to basic hygiene measures. During site visits, we gathered information about workplace and seating arrangements. The secondary attack rate in office and households was calculated. Potential respiratory viral co-infections were assessed by multiplex PCR. SARS-CoV-2 whole-genome sequencing was performed using a tiled-amplicon sequencing approach.Results: Of 13 team members, 11 fell ill with Coronavirus disease 2019 (COVID-19). Due to the sequence of events and full genome sequence data, one person was considered the index case for this outbreak, directly infecting 67% to 83% of the teammates. All team members reported repetitive close contacts among themselves during joint computer work, team meetings and a “Happy Birthday” serenade. Two individuals shared nuts and dates. The arrangement of the office and meeting rooms precluded sufficient adherence to physical distancing. The index case and a further individual were diagnosed with an adenovirus serotype 4 co-infection, but secondary household attack rate was not higher for co-infected individuals. Conclusion: We identified several environmental and behavioral factors that probably have facilitated the transmission of SARS-CoV-2. The relevance of the adenovirus co-infection remains unclear and merits further investigation.
Litterfall, Decomposition and Nutrient Release in Sacred Forests of Western Odisha, India.
Authors: Pradhan Antaryami , Behera Niranjan 
Published: September 2020

Abstract
Background Recognizing that litterfall and decomposition are key ecosystem functions for ecosystem stability in a terrestrial ecosystem, litterfall and decomposition in four sacred forests were studied from western part of Odisha. The present study focuses on the detailed aspects of litter dynamics, decomposition and consequent release of nutrients to the forest floor. The results obtained in this study will be beneficial in understanding the ecosystem functioning associated with nutrient cycling, which helps in determining possible management strategies for optimization of ecosystem functioning and productivity of these sacred forests. Results Litterfall and standing litter showed a seasonal pattern with most of the litter accumulated during the dry seasons and lowest in the rainy season. However, no significant difference was observed between the litterfall patterns of the sacred forests. The annual turnover rate (KL) was found to be in the range of 3.59/yr to 4.22/yr in studied sacred forests. The litter decomposition study was performed by litter bag technique and almost 95% of mass loss was observed within a period of 6 months. Such fast decomposition leads to faster rate of nutrient release across the sites. The studied elements can be set in the following order as regards to their return to the topsoil during decomposition in the order of K (Potassium) > N (Nitrogen) > P (Phosphorus). The approximate amount of nutrient released to the forest soil is quantified in the range of 184.76 to 33.61kg/ha of NPK (Nitrogen, Phosphorus and Potassium) in different sacred forests.Conclusion Such nutrient release and dynamics in sacred forests, may contribute an effective nutrient flow to the topsoil as well as to the surrounding agricultural landscapes boosting agricultural productivity and sustainability. This signifies the role of sacred forests in rendering an important ecological service in terms of nutrient cycling.
The impact of technology use on agricultural production in Rwanda (2016 season A, B, C)
Authors: UBARIJORO Jules Maurice , NDIKUBWIMANA Jean Bosco , DUKUNDE Angelique , MUZUNGU Eric Shyaka 
Published: September 2020

Abstract
This study deals with the impact of technology use on agricultural productivity in Rwanda with purpose of assessing the impact of technology adoption in agriculture to its productivity in season A, B, and C in 2016 .The researchers used data from Rwanda seasonal agricultural survey (RSAS) to successfully complete the analysis. Chi-square, cross tabulation analysis and multiple linear regression analysis were used to identify the impact of technology use on agricultural production. From bivariate analysis find that there are some existing technologies that are not influencing production just because of low level of their utilization and multiple linear regressions was found that some of the technologies such as use of improved seed, use organic fertilizers, area and use irrigation were showed that are statistically significant on agricultural production with p-values of 0.0455, 0.0313, 0.000, and 0.0457 respectively which means that, these technologies increased agricultural production for few farmers who used technologies in 2016. Researchers conclude that, technologies were inefficiently used by farmers due to the accessibility of these technologies and then recommend the Government policy makers, farmers policy makers, researchers and farmers to consolidate their efforts towards technology adoption in agriculture sector to ensure food security and sustainable agriculture and also further researches that will emphasis on adding certain variables which reduce the farmers’ vulnerability to loss the income are highly encouraged.
Microstructural Evolution of H-BN&nbsp;Matrix Composite Ceramics With Amorphous La2O3-Al2O3-SiO2&nbsp;Glass Phase During Hot Pressing
Authors: Qiu Baofu , Duan Xiaoming , Zhang Zhuo , Zhao Chen , Niu Bo , He Peigang , Cai Delong , Chen Lei , Yang Zhihua , Wang Yujin , Jia Dechang , Zhou Yu 
Published: September 2020

Abstract
BN-La2O3-Al2O3-SiO2 composite ceramics were fabricated by hot press sintering using h-BN, La2O3, Al2O3 and amorphous SiO2 as the raw materials. The effects of sintering temperature on the microstructural evolution, bulk density, apparent porosity, and mechanical properties of h-BN composite ceramics were investigated. The results indicated that ternary La2O3-Al2O3-SiO2 liquid phase was formed during sintering process, which provided an environment for the growth of h-BN grains. With increasing sintering temperature, the cristobalite phase precipitation and h-BN grain growth occurred at the same time, which had the significant influence on the densification and mechanical properties of h-BN composite ceramics. The best mechanical properties of BN-La2O3-Al2O3-SiO2 composite ceramics were obtained under sintering temperature of 1700 °C, and the elastic modulus, flexural strength, and fracture toughness were 80.5 GPa, 266.4 MPa and 3.25 MPa·m1/2, respectively.