bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between changes in QRS width and echocardiographic responses to cardiac resynchronization therapy
Authors: Ma Jing , Liu Yi , Dong Yun , Chen Ming , Xia Lianghua , Xu Min 
Published: January 2020

Abstract

Background:
Numerous studies have illustrated the association of QRS width with the incidence of echocardiographic response to cardiac resynchronization therapy (CRT). This study aimed to summarize the observational studies regarding the magnitude of change in QRS width between responders and nonresponders to CRT.

Methods:
The PubMed, Embase, and the Cochrane Library were systematically searched for relevant studies investigating the changes of QRS width with the incidence of echocardiographic response to CRT from inception till May 2019. The pooled weighted mean difference (WMD) with 95% confidence interval (CI) was calculated through random-effects model.

Results:
Five prospective and 6 retrospective studies with a total of 1524 patients were selected for final analysis. The reduction of QRS width in responders was significantly greater than nonresponders (WMD: –20.54 ms; 95% CI: –26.78 to –14.29; P < .001). Moreover, responders were associated with greater percentage reduction in QRS width when compared with nonresponders (WMD: –8.80%; 95% CI: –13.08 to –4.52; P < .001). Finally, the mean change in QRS width between responders and nonresponders differed when stratified by country, study design, mean age, percentage male, ejection fraction, measuring time of postimplanted QRS, ischemic cardiomyopathy, atrial fibrillation, and study quality.

Conclusions:
These findings indicated that shortening QRS width after CRT device implantation showed association with greater incidence of echocardiographic responses to CRT. Further prospective studies should be conducted to evaluate the prognostic values of QRS width on the incidence of echocardiographic response to CRT.
Pneumocystis pneumonia after use of corticosteroids in a man with severe alcoholic hepatitis
Authors: Chung Min Woo , Kim Uh Jin , Jun Chung Hwan , Cho Sung Bum , Park Seon Young , Park Chang Hwan , Kim Hyun Soo , Choi Sung Kyu , Rew Jong Sun 
Published: January 2020

Abstract

Rationale:
Severe alcoholic hepatitis (AH) has a very high mortality rate. Current guidelines recommend oral corticosteroids as first-line agents in individuals with severe AH to reduce short-term mortality. However, systemic corticosteroids have serious adverse effects. In individuals with AH, infection, which is one of the complications of steroid use, can result in serious outcomes, such as acute-on-chronic liver failure. Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection which may occur when high-dose corticosteroids are prescribed for more than 1 month. Therefore, when high-dose corticosteroids are used, providing PCP prophylaxis is warranted. Although trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for the prophylaxis of PCP, its hepatotoxicity limits its use in patients with severe AH who are on high-dose corticosteroids. Moreover, there is a lack of consensus on which drugs should be used for PCP prophylaxis in individuals with severe AH who are on glucocorticoid treatment. Herein, we report a case of a 43-year-old male with fatal PCP that occurred after the use of corticosteroids for severe AH.

Patient concerns:
A 43-year-old alcoholic man presented with a hematoma on his right leg. His liver function was poor, and he was he was diagnosed with severe AH and treated with oral corticosteroids for 26 days. After glucocorticoid treatment, he developed a productive cough.

Diagnoses:
A sputum PCR test was positive for Pneumocystis jirovecii.

Interventions:
He was initially treated with TMP-SMX and required artificial ventilation.

Outcomes:
He developed disseminated intravascular coagulation and multi-organ failure, and died 10 days after starting TMP-SMX.

Lessons:
To date, prevention of PCP in individuals with severe AH who are on corticosteroids has been overlooked. This case illustrates the need for prophylaxis of PCP in individuals with severe AH taking corticosteroids.
Effectiveness and safety of warm needle acupuncture on chronic renal failure
Authors: Huang Cihui , Lin Yunxin , Yang Yaqin , Zeng Fangdong , Jiang Huaqing , Lin Ting , Zheng Liang 
Published: January 2020

Abstract

Background:
Warm needle acupuncture (WNA) is an integral part of the acupuncture therapy. Chronic renal failure (CRF) is a common disease, which is a type of kidney disease characterized by a slow and progressive decline in renal function. The clinical practice indicates that WNA has a therapeutic effect on CRF. Therefore, we will provide a protocol to explore the effectiveness and safety of WNA for CRF.

Methods:
We will search the randomized controlled trials literatures of WNA for CRF in 5 English databases (PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials [Cochrane Library], and World Health Organization International Clinical Trials Registry Platform) and 4 Chinese databases (Chinese national knowledge infrastructure, Chinese Scientific Journal Database Information, Wanfang Database, and Chinese biomedical literature database). The renal function will be considered as the primary outcome and the secondary outcome will include curative effect, security, syndrome according to standards for assessing traditional Chinese medicine, adverse events caused by WNA, such as dizziness, nausea, vomiting, weariness, and so on. We will use EndnoteX7 software to perform the selection of the studies. And all analyses will be conducted by using RevMan software V5.3.

Result:
This study will provide a rational synthesis of current evidences for WNM on CRF.

Conclusion:
The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on CRF.

Registration: PROS-PERO CRD42019144530
A cross-sectional study
Authors: Cui Mengzhao , Gang Xiaokun , Wang Gang , Xiao Xianchao , Li Zhuo , Jiang Zongmiao , Wang Guixia 
Published: January 2020

Abstract
Sarcopenia is a geriatric syndrome and it impairs physical function. Patients with type 2 diabetes mellitus (T2DM) are at a higher risk of sarcopenia. The purpose of this study is to explore characteristics of general information and metabolic factors of sarcopenia in patients with T2DM in the northeast of China, and provide information for the prevention and treatment of sarcopenia in clinical practice.
Patients with T2DM aged ≥65 were recruited in Changchun from March 2017 to February 2018. Questionnaires of general information, physical examination, laboratory and imaging examination were conducted. The patients were assigned into sarcopenia group and non-sarcopenia group according to the diagnostic criteria proposed by Asian working group for sarcopenia (AWGS), and the differences between 2 groups were analyzed.
A total of 132 participants were included in this study, of which, 38 (28.8%) were diagnosed with sarcopenia. 94 (71.2%) were with no sarcopenia. Logistic regression analysis showed that age (OR: 1.182, 95%CI: 1.038–1.346), trunk fat mass (TFM) (OR: 1.499, 95%CI: 1.146–1.960) and free thyroxine (FT4) (OR: 1.342, 95%CI: 1.102–1.635) were independent risk factors for sarcopenia. BMI (body mass index) (OR: 0.365, 95%CI: 0.236–0.661), exercise (OR: 0.016, 95%CI: 0.001–0.169), female (OR: 0.000, 95%CI: 0.00–0.012), metformin (OR: 0.159, 95%CI: 0.026–0.967) and TSM (trunk skeletal muscle mass) (OR: 0.395, 95%CI: 0.236–0.661) were protective factors for sarcopenia.
Sarcopenia in patients with T2DM is associated with increased age, increased TFM and increased FT4 level. Regular exercise, female, metformin administrations, high BMI and increased TSM are associated with lower risk of sarcopenia.
Comparison of fractional excretion of electrolytes in patients at different stages of chronic kidney disease
Authors: Hsiao Po-Jen , Liao Chen-Yi , Kao Yung-Hsi , Chan Jenq-Shyong , Lin Yuh-Feng , Chuu Chih-Pin , Chen Jin-Shuen 
Published: January 2020

Abstract
Kidney handling of electrolytes varies in different stages of chronic kidney disease (CKD). Diabetes mellitus (DM) plays an important role in CKD. Fractional excretion (FE) is an important means in clinical practice. The relationship between FE of electrolytes in patients at different stages of CKD is worth further investigating.
We designed a cross-sectional study in 1 teaching hospital, consecutive CKD patients were enrolled between February 2016 and January 2017. Including clinical demographic features, laboratory examination including spot urine electrolytes, blood biochemistries, and relevant medications were determined.
A total of 762 CKD patients completed the study. Of these, 218 (28.6%) had DM. Participants were grouped according to estimated glomerular filtration rate into 7 categories: hyperfiltration (HF), CKD1, CKD2, CKD3a, CKD3b, CKD4, and CKD5. Groups HF, CKD1, 2, 3a, 3b, 4 and 5 contained 83, 143, 192, 94, 82, 82, and 86 patients, respectively. FE of electrolytes tended to increase along with the decline of renal function (CKD1–CKD5) (P < .001). The relationship was similar between the DM and non-DM groups. Diabetic patients demonstrated higher FE of magnesium compared with non-DM subjects at CKD2 and CKD5 (P < .05).
CKD patients showed a progressive increase in the FE of electrolytes; FE of magnesium seemed to increase more among diabetic patients with CKD, and could be a potential predictor of CKD progression.
Risk and treatment of symptomatic epidural hematoma after anterior cervical spine surgery
Authors: Liao Yehui , Tian Yang , Ye Rupei , Tang Chao , Tang Qiang , Ma Fei , Yang Sheng , He Hongchun , Zhong Dejun 
Published: January 2020

Abstract
Symptomatic epidural hematoma (SEH) after anterior cervical spine surgery is very rare, but it has disastrous consequences for the patients. Timely diagnosis and evaluation can effectively reduce the sequelae of neurological deficit in SEH. The purpose of this study was to retrospectively analyze a subset of clinical data of SEH after anterior cervical spine surgery, and to investigate the risk factors and treatment experience of this serious complication.
Neurological deterioration after anterior cervical spine surgery was detected in six patients. Epidural hematoma was confirmed by emergency cervical magnetic resonance imaging (MRI). The patients included five males and one female, with an average age of 56.7 ± 13.1 years (range 42–76 years). Three patients had a history of drinking and/or smoking. All of the patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively, but without anticoagulant drugs or pre-spinal surgery. The coagulation function was normal in all patients. Except for one patient, who had lower blood pressure (BP) during the operation and higher BP after the operation, the other patients had a normal level of BP during the pre-, intra-, and post-operation periods. The average time was 9.9 ± 6.7 hours (range, 2−19 hours) from the postoperative period to the initial neurological deficit and 6.3 ± 6.0 hours (range, 1.8−16.7 hours) from the initial deterioration to evacuation. Five patients underwent emergency evacuation, and one patient underwent conservative treatment. Four patients who underwent evacuation and one patient who received conservative treatment achieved neurological function recovery with an American Spinal Injury Association (ASIA) grade 2.4 ± 0.9 (range, 2−4 score) score at the last follow-up. One patient with confirmed arterial epidural hemorrhage during the evaluation showed no neurological function recovery at the last follow-up.
Wide exposure of the epidural space and BP level during the perioperative period play an important role in the formation of SEH after anterior cervical spine surgery. Arterial epidural hematoma has serious consequences; therefore, early diagnosis and evaluation play an important role in the recovery from paralysis.
Acupuncture for symptomatic rotator cuff disease
Authors: Choi Seoyoung , Kim Kun Hyung 
Published: January 2020

Abstract

Background:
Rotator cuff disease (RCD) consists of subacromial impingement syndrome, rotator cuff tendinopathy or tendinitis, partial or full rotator cuff tear, calcific tendinitis, and subacromial bursitis. Acupuncture has been suggested as a meaningful nonsurgical intervention for managing shoulder pain and dysfunction. However, previous reviews have not completely addressed the role of acupuncture in the management of RCDs. The objective of this systematic review is to evaluate the effectiveness and safety of acupuncture for managing symptoms in patients with RCD.

Methods:
We will search the following databases from their inception to November 30, 2019: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine (AMED), Physiotherapy Evidence Database (PEDro), 3 Chinese databases (China Academic Journal Full-text Database (CAJ), China Doctoral Dissertations Full-text database and China Masters’ Thesis Full-text Database), 6 Korean databases (Korean studies Information Service System (KISS), National Digital Science Library (NDSL), Research Information Sharing Service (RISS), Korean Medical Database (KMBASE), Korea Institute of Science and Technology Information (KISTI), Oriental Medicine Advanced Searching Integrated System (OASIS)), and 3 trial registries (ClinicalTrials.gov, International Standard Randomized Controlled Trials Number (ISRCTN) Registry, WHO International Clinical Trials Registry Platform (ICTRP)). We will include randomized controlled trials of acupuncture for RCD. There will be no restrictions related to setting or location. The primary outcome is pain intensity and shoulder dysfunction measured on validated scales within 12 weeks. Quality assessment will be performed using the Cochrane risk of bias tool. Dichotomous outcomes will be presented as risk ratios (RR), and continuous outcomes will be presented as weighted or standardized mean differences (SMD). Each outcome will be calculated with 95% confidence intervals.

Discussion:
The updated evidence that would be provided by this review will offer useful information for patients and practitioners, and also have implications for future studies and the development of clinical practice guidelines of RCD.
Registration: Open Science Framework (OSF) Preregistration. 2019, December 5. osf.io/n2e6t
Real-world treatment patterns of renal anemia in hemodialysis patients
Authors: Kim Hyo Jin , Park Ji In , Yoo Kyung Don , Kim Yunmi , Baek Hyunjeong , Kim Sung Ho , Chang Taehoon , Kim Hye Hyeon , Lee Kye Hwa , Hwang Seungsik , Kim Clara Tammy , Koo Hoseok , Kim Ju Han 
Published: January 2020

Abstract
A multicenter cohort study.
The DialysisNet was previously developed for the management of hemodialysis (HD) patients based on the American Society for Testing and Materials Continuity of Care Records by metadata transformation. DialysisNet is a dialysis patient management program created by using the personal health record care platform to overcome the problems of registry studies, in real-time.
Here, we aimed to investigate the pattern of treatment for renal anemia in HD patients using DialysisNet.
We performed a multicenter cohort study among HD patients who were treated at one of the three Korean university-affiliated hospitals from January 2016 to December 2016. Subjects were divided into 4 hemoglobin variability groups by quartiles. The variable anemia treatment pattern was reviewed. To determine renal anemia treatment patterns, we automatically collected information on the practice of anemia treatment patterns such as erythropoietin stimulating agent (ESA) doses and administration frequencies, and targeted hemoglobin maintenance rate. Individual hemoglobin variabilities were expressed as (standard deviations)/(√(n/[n–1]).
The records of 159 patients were analyzed (Hospital A: 35, Hospital B: 21, Hospital C: 103). Mean patients’ age was 65.6 ± 12.8 years, and 61.6% were men. Overall, hemoglobin level was 10.5[7.43;13.93] g/dL. 158 (99.3%) patients were using ESA; and overall, the epoetin alfa dose was 33,000[4000;136,800] U per week. Hemoglobin levels (P = .206) and epoetin alfa doses were similar (P = .924) for patients with different hemoglobin variabilities. The hemoglobin target maintenance rate was lower in the highest hemoglobin variability group than in the lowest variability group (P = .045).
In this study, detailed information on the actual anemia treatment patterns were obtained using the DialysisNet. We expect that DialysisNet will simplify and improve the renal anemia management for both dialysis patients and health care providers.
Non-linear relationship between sleep duration and metabolic syndrome
Authors: Fan Lei , Hao Zilong , Gao Li , Qi Minjie , Feng Shixian , Zhou Gang 
Published: January 2020

Abstract
The aims of this study were to evaluate the prevalence of metabolic syndrome (MetS) and explore the association between sleep duration and MetS. This study enrolled 8 272 adults aged 18 years and older from 6 urban and 8 rural areas during 2013 to 2014in Henan China. Participants were interviewed about demographic characteristics, lifestyle factors and medical history, and physical measurements were performed. The relationships between sleep duration and MetS were evaluated and plotted by Restricted Cubic Spline Regression. The mean age was 51.5 years (SD 14.2) and 4 916 (59.4%) were female. The crude prevalence of MetS was 30.3% and the age-standardized rate was 23.6%. Men were more likely to have MetS than women (P = .01). MetS was positively associated with age, education, smoking, drinking, BMI and sleep duration, and seemed irrelevant to occupation and sedentary behavior. In terms of individual component of MetS, high blood pressure was the most prevalent component for both men and women, while the lowest prevalent was high triglycerides in men and for women was low high-density lipoprotein cholesterol (HDL-C). There was a U-shaped relationship between sleep duration and MetS and its components. Sleep duration <6 hours or >9 hours were associated with higher risk of MetS (OR from 1.10 to 2.15). The MetS was prevalent, and more than half of total adult population was suffering from high blood pressure. Sleep duration may be a determinant of metabolic health. Both short (<6 hours) and long sleep duration (>9 hours) was linked to an increased risk of MetS.
Malignancy rate of Bethesda category III thyroid nodules according to ultrasound risk stratification system and cytological subtype
Authors: Yoo Won Sang , Ahn Hwa Young , Ahn Hye Shin , Chung Yun Jae , Kim Hee Sung , Cho Bo Youn , Seo Mirinae , Moon Jae Hoon , Park Young Joo 
Published: January 2020

Abstract
The risk of malignancy is considered to be 10% to 30% for cases of thyroid nodules with atypia or follicular lesion of undetermined significance (AUS/FLUS). However, only a minority of patients with AUS/FLUS undergo surgery; therefore, the risk of malignancy might be overestimated due to selection bias. To overcome this problem, we categorized cases of thyroid nodules with AUS/FLUS using the ultrasound risk stratification system (US-RSS) to calculate the malignancy rate and identify the patients most suitable for surgical treatment.
In this retrospective observational study, we subcategorized 382 pathologically confirmed thyroid nodules with AUS/FLUS using current US-RSSs (American Thyroid Association, Korean-Thyroid Imaging Report and Data System, American College of Radiology-Thyroid Imaging, Reporting and Data System, European Thyroid Imaging Report and Data System) and calculated the malignancy rate. Additionally, cases of nodules with AUS/FLUS were categorized according to their cytological subtypes, and the malignancy rate was calculated.
Current US-RSSs showed good or moderate agreement among them. The overall malignancy rate for thyroid nodules with AUS/FLUS was 38.7%. On categorization of the nodules with AUS/FLUS, the malignancy rates were found to be 60% to 67.5% for the high suspicion category, 32.2–36.6% for the intermediate suspicion category, and 12.4% to 16.3% for the low suspicion category. The malignancy rate for nodules with cytologic atypia was significantly higher than that for nodules with architectural atypia, especially in the intermediate suspicion category.
Categorization of thyroid nodules with AUS/FLUS using current US-RSSs helps to determine the optimal course of management of patients, especially when combined with cytological subtype characterization.
Development of a Prognostic Score to Predict Mortality in Patients With Pediatric Acute Liver Failure
Authors: Lee Eun Joo , Kim Ju Whi , Moon Jin Soo , Kim Yu Bin , Oh Seak Hee , Kim Kyung Mo , Ko Jae Sung 
Published: January 2020

ABSTRACTObjectives:This study aims to develop a new prognostic score based on changes in serial laboratory data from patients with pediatric acute liver failure (PALF).Methods:We retrospectively reviewed data on 146 patients with PALF at the Seoul National University Children Hospital (SNUCH) and the Asan Medical Center (AMC). Daily morning laboratory records were obtained for up to 7 days after diagnosis of PALF: total bilirubin (TB) (mg/dL), international normalized ratio for prothrombin time (INR) at enrolment; peak TB, peak INR, peak ammonia (μmol/L); the difference between the peak TB and TB at enrollment (ie, Δpeak TB), the difference between the peak INR and INR at enrollment (ie, Δpeak INR), the maximum change in serial TB (ie, Δdaily TB), the maximum change in serial INR level (ie, Δdaily INR). We assigned nontransplanted patients in SNUCH and AMC to derivation and validation cohorts, respectively.Results:Δpeak TB, Δdaily TB, Δpeak INR, and Δdaily INR were significantly higher in the nonsurvival group. We developed a new score that can predict mortality in nontransplanted patients (derivation cohort n = 42, validation cohort n = 33). PALF‐Delta score (PALF‐Ds) = [0.232 × Δpeak TB (mg/dL)] + [2.263 × Δdaily INR] + [0.013 × peak ammonia (μmol/L)] − 4.498. The score yielded AUC 0.918 in the derivation cohort (sensitivity 81%, specificity 91%) and AUC 0.947 in the validation cohort (sensitivity 100%, specificity 89%).Conclusion:A prognostic scoring system using the change of TB/INR may be useful for predicting mortality in patients with PALF.
Predictors of Emotional Engagement in Online Graduate Nursing Students
Authors: Kuchinski-Donnelly Darlene , Krouse Anne M. 
Published: January 2020

Background
Student engagement, specifically emotional engagement, is a predictor to positive learning outcomes and academic success. Autonomy, competence, and relatedness have been associated with engagement; however, these studies have not been done in nursing.

Purpose
The purpose of this study was to examine if autonomy, competence, and relatedness predicted emotional engagement among graduate nursing students in the online learning environment.

Methods
A descriptive, correlational design was used to determine the levels of and relationships among emotional engagement and autonomy, competence, and relatedness as well as predictors of emotional engagement in students (n = 123) in online nursing programs.

Results
Findings revealed that students were emotionally engaged in their learning, and competence was the only predictor of emotional engagement.

Conclusion
Competency-based learning strategies should be implemented in online learning environments to increase the emotional engagement of graduate nursing students.