bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reporting Patterns of Sialorrhea Comparing Users of Clozapine to Users of Other Antipsychotics
Authors: Man Wai Hong , Wilting Ingeborg , Souverein Patrick , Meyboom Ronald , Egberts Toine , Heerdink Eibert R. 
Published: April 2020

Abstract

Background
Sialorrhea is a non–life-threatening, but potentially invalidating adverse drug reaction (ADR) in patients using clozapine. In light of the very serious ADRs (agranulocytosis and myocarditis), sialorrhea is at risk to be overlooked by health care professionals. In this study, the sialorrhea reporting patterns of clozapine compared with other antipsychotics were assessed by evaluating differences in relative reporting frequency and reporter type.

Methods
A case/noncase disproportionality analysis using data from VigiBase (1968–2016) was performed. Reports of antipsychotics with “salivary hypersecretion” as ADR were considered as cases, and those with ADRs other than salivary hypersecretion were defined as noncases. Relative reporting frequencies were expressed as reporting odds ratios (RORs), and multivariate logistic regression was performed with the drug-ADR pair as unit of analysis to estimate RORs with 95% confidence intervals (CIs).

Results
A total of 1,169,254 drug-ADR pairs from 425,304 unique Individual Case Safety Reports were identified. Sialorrhea was relatively more frequently reported in clozapine (n = 2732 [1.1%]) compared with other antipsychotics (n = 2911 [0.31%]; ROR, 3.60; 95% CI, 3.41–3.79) and was reported relatively more often by consumers (ROR, 19.8; 95% CI, 15.1–25.9) compared with health care professionals (ROR, 2.44; 95% CI, 2.27–2.63).

Conclusions
Sialorrhea was reported almost 4 times more often with clozapine use than with other antipsychotic use and was reported 8 times more often by patients than by health care professionals. This provides a signal of disproportion in sialorrhea occurrence among clozapine compared with other antipsychotics and in light of the disproportionality between reporter and an underreporting by health care professionals, underlining the importance to incorporate sialorrhea into the shared decision process when commencing clozapine therapy.
Pregabalin as a Treatment for Anxiety in Patients With Dementia With Lewy Bodies
Authors: Segers Kurt , Baxevani Ermioni , Benoit Florence , Meyts Jean-Marie , Surquin Murielle 
Published: April 2020

Abstract

Background
Anxiety is a common and invalidating symptom of dementia with Lewy bodies (DLB).

Methods
To evaluate the efficacy of pregabalin as a treatment for anxiety in DLB, we screened all medical files of our patients with DLB for the use of pregabalin in this context.

Findings
Overall, pregabalin was well tolerated. Ten (62.5%) of 16 patients showed an improvement of anxiety, whereas in 3 of them, anxiety disappeared completely, at respectively 3, 11, and 22 months of follow-up, with total daily doses ranging from 75 to 150 mg. Positive response to pregabalin was associated with a significant reduction in benzodiazepine use.

Conclusions
Pregabalin seems a useful and safe tool for treating anxiety in patients with DLB.
Clozapine-Related Diarrhea and Colitis
Authors: Rask Susanna Maria , Luoto Kaisa E. , Solismaa Anssi , Jokinen Elina , Jussila Airi , Kampman Olli 
Published: April 2020

Abstract

Background
During clozapine treatment, diarrhea is a rare but clinically relevant adverse effect. Cases of microscopic colitis and eosinophilic colitis have been previously reported.

Procedures
We present 4 patients who developed severe diarrhea in early weeks of clozapine therapy.

Findings
Two patients had significant peripheral eosinophilia 1 week after diarrhea symptoms. One of these patients also had Charcot-Leyden crystals in stool afterward, confirming the presence of eosinophils in the gut lumen. One of our patients had a confirmed microscopic colitis and later also neutropenia, which required treatment.

Conclusions
Charcot-Leyden crystals in stool may be associated with concurrent diarrhea and eosinophilia during clozapine treatment, which is a previously unreported finding. Occurrence of blood dyscrasias with diarrhea symptoms during clozapine treatment needs further investigation to understand the possible shared mechanisms.
Teaching Differential Diagnosis: Tool Box Techniques
Authors: Satterly Lynn-Beth 
Published: April 2020

Abstract
Differential diagnosis is one of the most challenging skills for a new clinician to learn. Typically, students are first exposed to the process of differential diagnosis in problem-based learning sessions. In general, techniques and tools to use in performing this important task are not universally or consistently taught, so successful clinicians learn this process largely from observing other more experienced clinicians. This article presents effective techniques and assignments that can be used to teach the process of differential diagnosis, enabling novice clinicians to become more accurate and proficient diagnosticians earlier on. Rubrics for evaluation and the theory behind these techniques are also provided.
Coronary bifurcations treated with thin-strut drug-eluting stents: a prespecified analysis of the randomized BIO-RESORT trial
Authors: Buiten Rosaly A. , Warta Sanne , Ploumen Eline H. , Doggen Carine J.M. , van der Heijden Liefke C. , Hartmann Marc , Danse Peter W. , Schotborgh Carl E. , Scholte Martijn , Linssen Gerard C.M. , Zocca Paolo , von Birgelen Clemens 
Published: April 2020

Background
Treatment of a coronary bifurcation lesion is often required in routine clinical practice, but data on the performance of very thin-strut biodegradable polymer drug-eluting stents are scarce.

Methods
Comparison of biodegradable polymer and durable polymer drug-eluting stents in an all comers population (BIO-RESORT) is a prospective, multicenter randomized clinical trial that included 3514 all-comer patients, who were randomized to very thin-strut biodegradable polymer-coated sirolimus- or everolimus-eluting stents, versus thin-strut durable polymer-coated zotarolimus-eluting stents. The approach of bifurcation stenting was left at the operator’s discretion, and provisional stenting was generally preferred. This prespecified analysis assessed 3-year clinical outcome of all patients in whom treatment involved at least one bifurcation with a side-branch diameter ≥1.5 mm.

Results
Of all BIO-RESORT trial participants, 1236 patients were treated in bifurcation lesions and analyzed. Single- and two-stent techniques were used in 85.8% and 14.2%, respectively. ‘True’ bifurcation lesions (main vessel and side-branch obstructed) were treated in 31.1%. Three-year follow-up was available in 1200/1236 (97.1%) patients. The main endpoint target vessel failure (composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization) occurred in sirolimus-eluting stents in 42/412 (10.3%) and in zotarolimus-eluting stents in 49/409 (12.1%) patients (P-logrank = 0.40). In everolimus-eluting stents, target vessel failure occurred in 40/415 (9.8%) patients (vs. zotarolimus-eluting stents: P-logrank = 0.26). There was no between-stent difference in individual components of target vessel failure. Findings were consistent in patients with single-vessel treatment and patients treated with a single-stent technique.

Conclusions
Three years after stenting all-comers with bifurcation lesions, clinical outcome was similar with the sirolimus-eluting and everolimus-eluting stents versus the zotarolimus-eluting stent.
Parameters of fluid responsiveness
Authors: Shi Rui , Monnet Xavier , Teboul Jean-Louis 
Published: April 2020

Purpose of review
On the basis of recent literature, we summarized the new advances on the use of available dynamic indices of fluid responsiveness.

Recent findings
Reliability of passive leg raising to assess fluid responsiveness is well established provided that a real-time haemodynamic assessment is available. Recent studies have focused on totally noninvasive techniques to assess its haemodynamic effects with promising results. Presence of intra-abdominal hypertension is associated with false-negative cases of passive leg raising. Use of pulse pressure and stroke volume variations is limited and other heart–lung interaction tests have been developed. The tidal volume challenge may overcome the limitation of low tidal volume ventilation. Preliminary data suggest that changes in pulse pressure variation during this test well predict fluid responsiveness. Growing evidence confirms the good predictive performance of the end-expiratory occlusion test. All these dynamic tests allow selecting appropriate fluid responders and preventing excessive fluid administration. Performance of a mini-fluid challenge may help for the decision-making process of fluid management if other tests are not available.

Summary
Several new dynamic variables and monitoring techniques to predict fluid responsiveness were investigated in the past years. Nevertheless, further research investigating their reliability and feasibility in larger cohorts is warranted.

Video abstract

http://links.lww.com/COCC/A32
This is your toolkit in hemodynamic monitoring
Authors: Kaufmann Thomas , van der Horst Iwan C.C. , Scheeren Thomas W.L. 
Published: April 2020

Purpose of review
To appraise the basic and more advanced methods available for hemodynamic monitoring, and describe the definitions and criteria for the use of hemodynamic variables.

Recent findings
The hemodynamic assessment in critically ill patients suspected of circulatory shock follows a step-by-step algorithm to help determine diagnosis and prognosis. Determination of accurate diagnosis and prognosis in turn is crucial for clinical decision-making. Basic monitoring involving clinical examination in combination with hemodynamic variables obtained with an arterial catheter and a central venous catheter may be sufficient for the majority of patients with circulatory shock. In case of uncertainty of the underlying cause or to guide treatment in severe shock may require additional advanced hemodynamic technologies, and each is utilized for different indications and has specific limitations. Future developments include refining the clinical examination and performing studies that demonstrate better patient outcomes by targeting hemodynamic variables using advanced hemodynamic monitoring.

Summary
Determination of accurate diagnosis and prognosis for patients suspected of circulatory shock is essential for optimal decision-making. Numerous techniques are available, and each has its specific indications and value.
Monitoring coherence between the macro and microcirculation in septic shock
Authors: Bakker Jan , Ince Can 
Published: April 2020

Purpose of review
Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation.

Recent findings
Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the deterioration of microcirculatory perfusion. However, in many cases the restoration of adequate macrocirculatory parameters is frequently not associated with improvement in microcirculatory perfusion. This relates not only to the cause of shock, where there are some differences between different forms of shock, but also to the type of treatment.

Summary
The improvement in macrohemodynamics during the resuscitation is not consistently followed by subsequent changes in the microcirculation. This may result in both over-resuscitation and under-resuscitation leading to increased morbidity and mortality. In this article the principles of coherence and the monitoring of the microcirculation are reviewed.
Effect of cognitive-behavioral therapy with music therapy in reducing physics test anxiety among students as measured by generalized test anxiety scale
Authors: Ugwuanyi Christian S. , Ede Moses O. , Onyishi Charity N. , Ossai Osita V. , Nwokenna Edith N. , Obikwelu Lauretta C. , Ikechukwu-Ilomuanya Amaka , Amoke Chijioke V. , Okeke Agnes O. , Ene Catherine U. , Offordile Edmund E. , Ozoemena Lilian C. , Nweke Maduka L. 
Published: April 2020

Abstract

Background:
The study determined the effect of cognitive-behavioral therapy (CBT) with music in reducing physics test anxiety among secondary school students as measured by generalized test anxiety scale.

Methods:
Pre-test post-test randomized control trial experimental design was adopted in this study. A total of 83 senior secondary students including male (n = 46) and female (n = 37) from sampled secondary schools in Enugu State, Nigeria, who met the inclusion criteria constituted participants for the study. A demographic questionnaire and a 48-item generalized test anxiety scale were used for data collection for the study. Subjects were randomized into treatment and control groups. The treatment group was exposed to a 12-week CBT-music program. Thereafter, the participants in the treatment group were evaluated at 3 time points. Data collected were analyzed using repeated measures analysis of variance.

Results:
The participants who were exposed to CBT-music intervention program significantly had lower test anxiety scores at the post-treatment than the participants in the control group. Furthermore, the test anxiety scores of the participants in the CBT-music group were significantly lower than those in the control group at the follow-up measure. Thus, the results showed a significant effect of CBT with music in reducing physics test anxiety among secondary school students.

Conclusion:
We concluded that CBT-music program has a significant benefit in improving the management of physics test anxiety among secondary school students.
Topiramate for hypoxic ischemic encephalopathy
Authors: Chen Guoming , Chen Yijun , Xie Yaying , Huang Ruilan , Chen Tengyu , Shi Peiyu , Zhang Zhaoping , Hou Yingyue , Xing Wanli , Wei Li 
Published: April 2020

Abstract

Background:
Hypoxic ischemic encephalopathy (HIE) is brain injury caused by different reasons and the most common diagnosed is neonatal HIE. Most of the existing treatments have their own shortcomings or there are still some unexplained mechanisms in it. Topiramate (TPM) is a new drug for the treatment for seizures in neonates with HIE, but is currently used off-label. Our protocol aims to access the efficiency and safety of TPM for HIE.

Methods and analysis:
Eight databases will be searched by 2 independent researchers for the article on the topic of using TPM as treatment for HIE, including PubMed, the Cochrane Central Register of Controlled Trials (Cochrane Library), Embase, and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wang Fang Database and Chinese Science and Technology Periodical database (VIP). The included papers are those published from the established date of the databases to 2019. The therapeutic effects based on the grade of neonatal behavioral neurological assessment will be regarded as the primary outcomes. RevMan V5.3 will be used to compute the data synthesis and carry out meta-analysis. The risk of bias will be appraised by the Cochrane risk of bias tool. Rare ratio for dichotomous outcomes and mean different for continuous data will be expressed with 95% confidence intervals (CI) for analysis. A random effects model or a fixed effects model will be employed, when heterogeneity is found or not. Subgroup analysis and sensitivity analysis will be applied if the heterogeneity is obvious.

Results:
This study will provide the recent evidence of TPM for HIE from reducing seizure acticity.

Conclusion:
The conclusion of this study will provide proof to evaluate if TPM is effective and safe in the treatment of HIE.
PROSPERO registration number: PROSPERO CRD42018117981
Kanglaite injection plus fluorouracil-based chemotherapy on the reduction of adverse effects and improvement of clinical effectiveness in patients with advanced malignant tumors of the digestive tract
Authors: Song Qi , Zhang Jie , Wu Qibiao , Li Guoping , Leung Elaine Lai-Han 
Published: April 2020

Abstract

Background:
The digestive tract malignancies are a series of malignant tumor with high morbidity and mortality. Traditional Chinese medicine (TCM) combined with chemotherapy drugs interventions have been applied for the treatment of malignant tumors in Asian countries for dacades. This study aimed to assess the effectiveness and safety on the combination of Kanglaite injection and fluorouracil-based chemotherapy for treating digestive tract malignancies.

Purpose:
To assess the effectiveness and safety on the combination of Kanglaite injection and fluorouracil-based chemotherapy for digestive tract malignancies.

Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed when conducting the meta-analysis. Randomized controlled trials (RCTs) of Kanglaite injection combined with fluorouracil-based chemotherapy in the treatment of digestive tract malignant tumors were selected and assessed for inclusion. RevMan 5.3 software (Cochrane Collaboration, Oxford, UK) was used for meta-analysis. The objective response rate (ORR) was defined as the primary endpoint, and the disease control rate (DCR), quality of life (QoL), and toxicities were the secondary outcomes.

Results:
20 RCTs enrolling 1339 patients with advanced digestive tract malignancies were included. The methodological quality of most included trials was low to moderate. Compared with fluorouracil-based chemotherapy alone, Kanglaite injection plus fluorouracil-based chemotherapy can improve DCR (risk ratio (RR) = 1.18, 95% confidence interval (CI) 1.11–1.25, P < .00001), ORR (RR = 1.35, 95% CI 1.18–1.54, P < .00001), QoL (RR = 1.58, 95% CI 1.35–1.85, P < .00001), and can reduce adverse drug reactions (ADRs) such as myelosuppression (RR = 0.33, 95% CI 0.25–0.43, P < .00001), leukopenia (RR = 0.31, 95% CI 0.22–0.43, P < .00001), thrombocytopenia (RR = 0.6, 95% CI 0.38–0.49, P = .03), neutropenia (RR = 0.26, 95% CI 0.12–0.55, P = .0005), anemia (RR = 0.41, 95% CI 0.23–0.75, P = .004), gastrointestinal reaction (RR = 0.35, 95% CI 0.27–0.46, P < .00001), nausea/vomiting (RR = 0.41, 95% CI 0.28–0.61, P < .00001), diarrhea (RR = 0.34, 95% CI 0.18–0.62, P = .0004), hepatotoxicity (RR = 0.28, 95% CI 0.17–0.47, P < .00001), neurotoxicity (RR = 0.58, 95% CI 0.41–0.82, P = .002), mucositis (RR = 0.59, 95% CI 0.29–1.21, P = .15).

Conclusion:
Kanglaite injection combined with fluorouracil-based chemotherapy could remarkably improve the clinical effectiveness and reduce the adverse effects in patients with advanced malignant tumors of the digestive tract which may provide evidence to judge whether TCM is an effective and safe intervention for the digestive tract malignancies.
Surgical treatment for type II macular hole retinal detachment in pathologic myopia
Authors: Xin Wenjian , Cai Xuehong , Xiao Yun , Ji Leibing , Gu Yongxin , Lv Wenjuan , Jiang Jize 
Published: April 2020

Abstract
To observe the effectiveness and complications of inverted internal limiting membrane insertion through 25-G minimally invasive vitrectomy assisted with autologous blood adhesion fixation and combined with gas tamponade type-II macular hole retinal detachment in pathologic myopia.
This was a retrospective study. The best-corrected visual acuity, intraocular pressure, macular hole closure, retinal reattachment, and systemic and ocular adverse events were observed.
Twenty-three eyes were operated. Best-corrected visual acuity before surgery and at 3 and 6 months were 2.25 ± 0.47, 1.85 ± 0.32, and 1.32 ± 0.36 LogMAR (P < .001). On days 2 to 5, all the retinas reattached, and the macular holes closed. On days 5 to 9, 5 eyes showed increased intraocular pressure. At 2 and 4 months, 2 eyes showed retinal detachment recurrence. No serious systemic or ocular adverse events were observed.
This surgical technique showed clinical benefits and no significant complications. Clinical trials are necessary to confirm efficacy and safety.
Carotid intima media thickness in older children and adolescents with HIV taking antiretroviral therapy
Authors: Majonga Edith D. , Chiesa Scott T. , McHugh Grace , Mujuru Hilda , Nathoo Kusum , Odland Jon Oyvind , Kaski Juan Pablo , Ferrand Rashida A. 
Published: April 2020

Abstract
Increased carotid intima-media thickness (cIMT) is reported in both adults and children with human immunodeficiency virus (HIV) in high income settings and is associated with an increased risk of cardiovascular disease, but data from sub-Saharan Africa is lacking.
We assessed cIMT using ultrasound in perinatally HIV-infected children aged 6 to 16 years taking antiretroviral therapy (ART) for ≥6 months compared with HIV-uninfected controls in Harare, Zimbabwe. Groups were compared using unpaired t test and potential predictors of cIMT were assessed using multiple linear regression.
A total of 117 participants with HIV, of whom 55 (45%) were female and 75 healthy uninfected controls were included. Participants with HIV were younger than uninfected controls, 10.7 (2.4) years versus 11.9 (2.6) years (P = .001). Mean cIMT was 0.40 (0.05) mm in those with HIV versus 0.40 (0.04) mm in healthy controls (P = .377). There was no association between cluster of differentiation 4 count, HIV viral load, and duration on ART and cIMT.
Children with HIV taking ART have similar cIMT to uninfected children. Increasing numbers of children with HIV are reaching adulthood and longitudinal studies to assess the effect of long-term HIV and ART on vascular changes are required.
Cerebral oxygen desaturation in patients with totally thoracoscopic ablation for atrial fibrillation
Authors: Li Guohui , Yang Liqiao , Sun Yuan , Shen Sai’e 
Published: April 2020

Abstract

Background:
Epicardial radiofrequency ablation for stand-alone atrial fibrillation under total video-assisted thoracoscopy has gained popularity in recent years. However, severe cardiopulmonary disturbances during the surgery may affect cerebral perfusion and oxygenation. We therefore hypothesized that regional cerebral oxygen saturation (rSO2) would decrease significantly during the surgery. In addition, the influencing factors of rSO2 would be investigated.

Methods:
A total of 60 patients scheduled for selective totally thoracoscopic ablation for stand-alone atrial fibrillation were enrolled in this prospective observational study. The rSO2 was monitored at baseline (T0), 15 min after anesthesia induction (T1), 15 minute after 1-lung ventilation (T2), after right pulmonary vein ablation (T3), after left pulmonary vein ablation (T4) and 15 minute after 2-lung ventilation (T5) using a near-infrared reflectance spectroscopy -based cerebral oximeter. Arterial blood gas was analyzed using an ABL 825 hemoximeter. Associations between rSO2 and hemodynamic or blood gas parameters were determined with univariate and multivariate linear regression analyses.

Results:
The rSO2 decreased greatly from baseline 65.4% to 56.5% at T3 (P < .001). Univariate analyses showed that rSO2 correlated significantly with heart rate (r = -0.173, P = .186), mean arterial pressure (MAP, r = 0.306, P = .018), central venous pressure (r = 0.261, P = .044), arterial carbon dioxide tension (r = -0.336, P = .009), arterial oxygen pressure (PaO2, r = 0.522, P < .001), and base excess (BE, r = 0.316, P = .014). Multivariate linear regression analyses further showed that it correlated positively with PaO2 (β = 0.456, P < .001), MAP (β = 0.251, P = .020), and BE (β = 0.332, P = .003).

Conclusion:
Totally thoracoscopic ablation for atrial fibrillation caused a significant decrease in rSO2. There were positive correlations between rSO2 and PaO2, MAP, and BE.