bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can a relatively large spinal cord for the dural sac influence severity of paralysis in elderly patients with cervical spinal cord injury caused by minor trauma?
Authors: Koike Hironori , Hatta Yoichiro , Tonomura Hitoshi , Nonomura Masaru , Takatori Ryota , Nagae Masateru , Ikoma Kazuya , Mikami Yasuo 
Published: June 2020

Abstract
Retrospective review
The degree of spinal cord compression and bony spinal canal stenosis are risk factors for the occurrence of spinal cord injury (SCI) without major fracture or dislocation, but they do not affect the severity of neurological symptoms. However, whether a relatively large spinal cord for the dural sac influences the severity of symptoms in SCI cases is unknown.
The purpose of this study was to verify the influence of spinal cord size relative to dural sac on the severity of paralysis in elderly patients with cervical SCI caused by minor trauma.
Subjects were 50 elderly patients with SCI caused by falls on flat ground. At 72 hours after injury, neurological assessment was performed using the Japanese Orthopaedic Association (JOA) scoring system. Bony canal anteroposterior diameters (APD) at mid C5 vertebral body were measured with computed tomography. We measured dural sac and spinal cord APD at the injured level and mid C5 with magnetic resonance imaging. Spinal cord compression ratio was calculated by dividing spinal cord at the injured level by spinal cord at mid C5. As the evaluation of spinal cord size relative to the dural sac, spinal cord/dural sac ratio was calculated at the injured level and mid C5. To clarify the factors influencing the severity of paralysis, the relationships between JOA score and those parameters were examined statistically.
A significant negative correlation was observed between JOA score and spinal cord/dural sac ratio at mid C5. No clear relationship was observed between JOA score and bony canal APD or spinal cord compression ratio.
In elderly patients with SCI caused by minor trauma, a relatively large spinal cord for the dural sac was shown to be a factor that influences the severity of paralysis. This result can be useful for the treatment and prevention of SCI in the elderly.
GLI1 expression in pancreatic ductal adenocarcinoma correlates the clinical significance and prognosis
Authors: Li Ruidan , Liu Zheran , Chen Ye , Hu Xiaolin , Peng Xingchen 
Published: June 2020

Abstract

Background:
Glioma-associated oncogene homolog 1(GLI1) expression correlates with the clinical significance and prognosis of several cancers. However, the evaluation of the role GLI1 expression plays in pancreatic ductal adenocarcinoma (PDAC) clinicopathological features and outcomes still lacks.

Objective:
The present study systemic reviewed the association of GLI1 expression and clinical significance as well as patients survival in PDAC.

Methods:
We systematically searched the database of The Cochrane Library, PubMed, Embase, CNKI, Weipu data, and Wanfang data according to the inclusion and exclusion criteria. (The search ended on January 1, 2019; no language restrictions). The Newcastle-Ottawa Scale (NOS) scale was implemented to assess the quality of the literature and the Review Manager 5.3 Software was used to conduct a meta-analysis. Finally, 9 studies, a total of 1058 patients, have been included.

Results:
GLI1 is more likely expressed in PDAC tissue rather than para-carcinoma tissue (OR = 2.86, 95%CI = 1.87–4.36, P < .00001). GLI1 expression is associated with the TNM stage (OR = 3.11, 95%CI = 2.01–4.79, P < .00001), perineural invasion (OR = 2.50, 95%CI = 1.28–4.91, P = .008), and lymphatic metastasis (OR = 2.73, 95%CI = 1.71–4.36, P < .0001). But the association with differentiation (OR = 1.20, 95%CI = 0.74–1.96, P = .46) and tumor size (OR = 2.41, 95%CI = 0.97–6.00, P = .06) was not significant. GLI1 expression is related to the worse overall survival in PDACs (HR = 1.68, 95%CI = 1.40–2.02, P < .00001).

Conclusion:
Positive GLI1 expression promotes the progression and metastasis of PDACs and plays an important role in the clinical significance and the patients survival.
A comparison of the effects of Chinese non-pharmaceutical therapies for premature ovarian failure
Authors: Zhang Jinhuan , Huang Xingxian , Liu Yongfeng , He Yuhai , Yu Haibo 
Published: June 2020

AbstractBackground:Premature ovarian failure (POF) is commonly treated with hormone replacement therapy (HRT). Many patients with POF choose acupuncture as a complementary therapy over HRT, due to possible adverse reactions. This systematic review and network meta-analysis (NMA) compares the efficacy of different forms of acupuncture therapies for POF.Methods:Seven databases including PubMed, the Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure database, VIP Chinese Science, and Chinese Biomedical Database were searched for randomized controlled trials (RCTs) of various acupuncture treatments for POF. This time spanned from the date of database inception to January 13, 2020. RevMan 5.3 was used to assess the bias risk of the studies. A NMA of the included studies was performed using Stata14.0.Results:A total of 408 items were searched in this study, and finally this NMA included 16 RCTS, involving 1,307 patients. It showed that acupuncture (OR:1.35,95%1.24 to 1.47) has the best effectiveness among the four acupuncture (standardized mean difference [SMD]-16.30,95% −31.33 to −1.28) is the most effective and the best in reducing follicle-stimulating hormone levels among the four acupuncture treatments. Acupuncture (SMD 26.67,95%5.95 to 47.40) and acupoint embedding (SMD41.14,95%11.90 to 70.37) were ranked in the top 2 positions, in improving estradiol, whereas acupuncture (SMD-4.90,95% −8.10 to −1.70) was than acupoint embedding and HRT, in reducing luteinizing hormone level. In addition, our conclusions have not changed significantly after the sensitivity analysis.Protocol registration number: CRD42020150508.Conclusion:With clinical evidence summarized by NMA, it is observed that acupuncture is the most promising therapy for improving menopausal symptoms, decreasing serum follicle-stimulating hormone and luteinizing hormone level. Therefore, acupuncture could be effective for patients with POF, who are intolerant to the adverse effects of hormone replacement therapy or who would prefer non-drug therapies. Further multi-center and high-quality RCT studies should be conducted to make our conclusion more rigorous.
Xiaoaiping injection as adjunct therapy for patients with advanced esophageal carcinoma
Authors: Liu Zhen , Dong Yanling , Zhu Meili , Mu Ying , Chen Lemei 
Published: June 2020

Abstract

Background:
Esophageal carcinoma (EC) is one of the worst malignant digestive neoplasms with a strong tendency of invasion and metastasis. Despite the improvement of diagnostic and therapeutic methods in the past decades, the prognosis of EC remains unsatisfactory. Xiaoaiping injection (XAPI), a famous traditional Chinese herbal medicine, has been widely applied as a promising adjunctive drug for EC. However, the exact effects and safety of XAPI have yet to be systematically investigated. We aimed to summarize the efficacy and safety of XAPI for the treatment of advanced EC through the meta-analysis, in order to provide scientific reference for the design of future clinical trials.

Methods:
Relevant randomized controlled trials (RCTs) were searched from Cochrane Library, PubMed, Google Scholar, Web of Science, Excerpt Medica Database, Medline, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, China Scientific Journal Database and Wanfang Database. Papers in English or Chinese published from January 2000 to May 2020 will be included without any restrictions.
Study selection and data extraction will be performed independently by 2 investigators. The clinical outcomes including overall response rate, complete response rate, overall survival, Disease-free survival, quality of life, immune function and adverse events, were systematically evaluated. Review Manager 5.3 and Stata 14.0 were used for data analysis, and the quality of the studies was also evaluated.

Results:
The results of this study will be published in a peer-reviewed journal, and provide more evidence-based guidance in clinical practice.

Conclusion:
Our study will draw an objective conclusion of the effects of XAPI combined with conventional treatment for advanced EC and provide a helpful evidence for clinicians to formulate the best postoperative adjuvant treatment strategy for EC patients.

INPLASY registration number:
INPLASY202050094.
Bilateral pediatric pial arteriovenous fistulas accompanying a giant arachnoid cyst with torticollis
Authors: Li Junrao , Wang Ting , Richard Seidu A. , Zhang Changwei , Xie Xiaodong , Wang Chaohua 
Published: June 2020

Abstract

Rationale:
Pial arteriovenous fistula (PAVF) occurs when intracranial arteries communicate directly with veins. PAVFs are very rare congenital vascular lesions that are commonly seen in infants and children. Arachnoid cysts are congenital cavitation often filled with cerebrospinal fluid. We present a very rare associated occurrence of bilateral pediatric PAVF and a giant arachnoid cyst presenting as torticollis in a child. So far, this is the first case.

Patient concerns:
A 6-year-old male child was referred to our facility from a local hospital due to severe torticollis.

Diagnoses:
An enhanced computed tomography scan revealed 2 slightly high-density masses at the anterior pontine cistern, right circumferential cistern, as well as left posterior occipital region. The same computed tomography scan revealed a giant arachnoid cyst in the left occipital as well as the temporal region with a thin cerebral cortex adjacent to the cyst.

Interventions:
Digital subtraction angiography confirmed that the 2 high-flow lesions were PAVFs. The patient was treated with a combination of detachable coils and Onyx Liquid Embolic System (Onyx HD-500) (Covidien/ev3 Neurovascular) via the transarterial endovascular route while the giant arachnoid cyst was managed conservatively.

Outcomes:
The torticollis resolved 2 days after the procedure. He is currently well with no neurologic deficit.

Lessons:
We advocate that in cases of PAVF with accompanying cyst, the cyst should be managed conservatively if it is not associated with intracranial hemorrhage or focal neurologic deficit.
Budesonide versus systemic corticosteroids in IgA Nephropathy
Authors: Ismail Gener , Obrişcă Bogdan , Jurubiţă Roxana , Andronesi Andreea , Sorohan Bogdan , Vornicu Alexandra , Sinescu Ioanel , Hârza Mihai 
Published: June 2020

Abstract
IgA Nephropathy (IgAN) is characterized by mesangial deposition of dominant, polymeric, galactose-deficient IgA1 molecules of gut-associated lymphoid tissue origin. We sought to evaluate the efficacy of targeting the mucosal immune system dysregulation underlying IgAN pathogenesis with a pH-modified formulation of budesonide with a maximum release of active compound in the distal ileum and proximal colon.
We did a retrospective study evaluating the efficacy of budesonide (Budenofalk) in the treatment of IgAN. From a retrospective cohort of 143 patients with IgAN followed in our department we identified 21 patients that received treatment with budesonide. These patients received budesonide at a dose of 9 mg/d in the first 12 months, followed by a dose reduction to 3 mg/d for the subsequent period. Only patients that received a 24-month treatment with budesonide were included in the analysis (n = 18). We matched the budesonide-treated cohort to 18 patients with IgAN treated with systemic steroids from the same retrospective cohort. Efficacy was measured as change in proteinuria, hematuria and estimated glomerular filtration rate over a 24-month period.
Treatment with budesonide was associated with a 24-month renal function decline of -0.22 (95%CI, -8.2 to 7.8) ml/min/1.73m2, compared to -5.89 (95%CI, -12.2 to 0.4) ml/min/1.73m2 in the corticosteroid treatment group (p = 0.44, for between group difference). The median reduction in proteinuria at 24-month was 45% (interquartile range [IQR]: -79%; -22%) in the budesonide group and 11% (IQR: -39%; 43%) in the corticosteroid group, respectively (P = .009, for between group difference). The median reduction in hematuria at 24-month was 72% (IQR: -90%; -45%) in the budesonide group and 73% (IQR: -85%; 18%) in the corticosteroid group, respectively (P = .22, for between group difference). Treatment with budesonide was well tolerated with minimal side effects.
Budesonide (Budenofalk) was effective in the treatment of patients with IgAN at high-risk of progression in terms of reducing proteinuria, hematuria and preserving renal function over 24 months of therapy.
Liver cirrhosis affects serum lactate level measurement while assessing disease severity in patients with sepsis
Authors: Cheng Chi-Yung , Kung Chia-Te , Wu Kuan-Han , Chen Fu-Cheng , Cheng Hsien-Hung , Cheng Fu-Jen , Huang Jyun-Bin , Su Chih-Min 
Published: June 2020

Background
Elevated serum lactate is associated with higher mortality in sepsis, whereas liver dysfunction is associated with higher serum lactate levels. We assessed the predictive ability of serum lactate in patients with liver cirrhosis and sepsis.

Methods
This retrospective study included 12 281 cases of suspected infection with initial serum blood lactate drawn during January 2007–December 2013.

Results
Using one-to-two propensity score matching analysis, 1053 and 2106 septic patients with and without underlying liver cirrhosis, respectively, were successfully matched. Lactate levels of survivors and nonsurvivors were 2.58 and 5.93 mmol/L, respectively, in patients without liver cirrhosis (WLC), 2.96 and 7.29 mmol/L, respectively, in patients with nondecompensated liver cirrhosis (NDLC), and 4.08 and 7.16 mmol/L, respectively, in patients with decompensated liver cirrhosis (DLC). In receiver operating characteristic curve analysis, the sensitivity and specificity for predicting mortality were 0.81 and 0.55, respectively, in the WLC group, 0.85 and 0.45, respectively, in the NDLC group, and 0.86 and 0.33, respectively, in the DLC group, using serum lactate levels >2.0 mmol/L.

Conclusions
The serum lactate level can be used to predict the severity of sepsis in patients with liver cirrhosis; however, its specificity would be lower at a cutoff of 2.0 mmol/L.
Symptom Profiles of Latina Breast Cancer Survivors
Authors: Crane Tracy E. , Badger Terry A. , Sikorskii Alla , Segrin Chris , Hsu Chiu-Hsieh , Rosenfeld Anne G. 
Published: June 2020

Abstract

Background
Symptom research among Latinas with breast cancer is limited—especially as it relates to multiple co-occurring symptoms.

Objective
The aim of the study was to identify subgroups (latent classes) of Latinas who have distinct symptom profiles while receiving radiation, chemotherapy, and/or hormonal therapy for breast cancer.

Methods
This secondary analysis included intake data from three randomized trials of supportive care psychosocial interventions for Latinas treated for breast cancer (n = 290). Prevalence of 12 symptoms—measured using the General Symptom Distress Scale—was entered into the latent class analysis to identify classes of women with different symptom profiles.

Results
Most of the participants had Stage II or III disease, and 81% reported receiving chemotherapy. On average, women reported 4.2 (standard deviation [SD] = 3) symptoms with an overall symptom distress score of 6.4 (SD = 2.5) on a 1–10 scale, with 10 being most distressing. Latent class analysis resulted in three classes that were labeled based on symptoms with the highest prevalence. Class 1 (n = 192) was “Disrupted Sleep and Tired,” Class 2 (n = 74) was “Tired,” and Class 3 (n = 24) was “Pain, Disrupted Sleep, and Tired.” Depression, anxiety, and difficulty concentrating had moderate prevalence in each of the three classes.

Discussion
Beyond the core six symptoms (depression, anxiety, fatigue, pain, disrupted sleep, difficulty concentration), the classes differed in the prevalence of other burdensome symptoms (e.g., nausea, vomiting, constipation), which provide implications for treatment. Thus, it is important to assess for the full range of symptoms so that supportive care interventions can be tailored for the distinct symptom profiles of Latinas with breast cancer.
Risk Factors for Peri-intubation Cardiac Arrest in a Pediatric Emergency Department
Authors: Pokrajac Nicholas , Sbiroli Emily , Hollenbach Kathryn A. , Kohn Michael A. , Contreras Edwin , Murray Matthew 
Published: June 2020

Objectives
Cardiac arrest is a significant complication of emergent endotracheal intubation (ETI) within the pediatric population. No studies have evaluated risk factors for peri-intubation cardiac arrest (PICA) in a pediatric emergency department (ED) setting. This study identified risk factors for PICA among patients undergoing emergent ETI in a pediatric ED.

Methods
We performed a nested case-control study within the cohort of children who underwent emergent ETI in our pediatric ED during a 9-year period. Cases were children with PICA within 20 minutes of ETI. Controls (4 per case) were randomly selected children without PICA after ETI. We analyzed potential risk factors based on published data and physiologic plausibility and created a simple risk model using univariate results, model fit statistics, and clinical judgment.

Results
In the cohort of patients undergoing ETI, PICA occurred in 21 of 543 subjects (3.9%; 95% confidence interval [CI], 2.2–5.9%), with return of spontaneous circulation in 16 of 21 (76.2%; 95% CI, 52.8–91.8%) and survival to discharge in 12 of 21 (57.1%; 95% CI, 34.0–78.2%). On univariate analysis, cases were more likely to be younger, have delayed capillary refill time, systolic or diastolic hypotension, hypoxia, greater than one intubation attempt, no sedative or paralytic used, and pulmonary disease compared with controls. Our 4-category risk model for PICA combined preintubation hypoxia (or an unobtainable pulse oximetry value) and younger than 1 year. The area under the receiver operating characteristic curve for this model was 0.87 (95% CI, 0.77–0.97).

Conclusions
Hypoxia (or an unobtainable pulse oximetry value) was the strongest predictor for PICA among children after emergent ETI in our sample. A simple risk model combining pre-ETI hypoxia and younger than 1 year showed excellent discrimination in this sample. Our results require independent validation.
HIV-exposed uninfected infant morbidity and mortality within a nationally representative prospective cohort of mother-infant pairs in Zimbabwe
Authors: Patel Monita R. , Mushavi Angela , Balachandra Shirish , Shambira Gerald , Nyakura Justice , Mugurungi Owen , Kilmarx Peter H. , Rivadeneira Emilia , Dinh Thu-Ha 
Published: June 2020

Objective:
To examine morbidity and mortality risk among HIV-exposed uninfected (HEU) infants.

Design:
Secondary data analysis of HEU infants in a prospective cohort study of mother-infant pairs.

Methods:
Infants were recruited from immunization clinics (n = 151) in Zimbabwe from February to August 2013, enrolled at 4–12 weeks age, and followed every 3 months until incident HIV-infection, death, or 18-month follow-up. We estimated cumulative mortality probability and hazard ratios with 95% confidence intervals (CIs) using Kaplan–Meier curves and Cox regression, respectively. We also described reported reasons for infant hospitalization and symptoms preceding death. Median weight-for-age z-scores (WAZ) and median age were calculated and analyzed across study visits.

Results:
Of 1188 HIV-exposed infants, 73 (6.1%) contracted HIV; we analyzed the remaining 1115 HEU infants. In total, 54 (4.8%) infants died, with median time to death of 5.5 months since birth (interquartile range: 3.6–9.8 months). Diarrhea, difficulty breathing, not eating, fever, and cough were commonly reported (range: 7.4–22.2%) as symptoms preceding infant death. Low birth weight was associated with higher mortality (adjusted hazard ratio 2.66, CI: 1.35–5.25), whereas maternal antiretroviral therapy predelivery (adjusted hazard ratio 0.34, CI: 0.18–0.64) and exclusive breastfeeding (adjusted hazard ratio 0.50, CI: 0.28–0.91) were associated with lower mortality. Overall, 9.6% of infants were hospitalized. Infant median WAZ declined after 3 months of age, reaching a minimum at 14.5 months of age, at which 50% of infants were underweight (WAZ below −2.0).

Conclusion:
Clinical interventions including maternal antiretroviral therapy; breastfeeding and infant feeding counseling and support; and early prevention, identification, and management of childhood illness; are needed to reduce HEU infant morbidity and mortality.
Perceived Roles of Bhutanese Health Care Professionals in Improving Patient Safety: A Qualitative Exploratory Descriptive Study
Authors: Pelzang Rinchen , Hutchinson Alison M. 
Published: June 2020

Background and Objectives:
Patient safety is a vital component of high quality health care and all health care professionals have a responsibility for ensuring the delivery of safe care to patients. However, little is known about how Bhutanese health care professionals perceive their roles in improving patient safety. This study aimed to explore how Bhutanese health care professionals, educators, managers, and policy makers perceived their roles in improving patient safety.

Methods:
Undertaken as a naturalistic inquiry using a qualitative exploratory descriptive research approach, a criterion-based stratified purposive sample of 94 health care professionals and managers from the Ministry of Health, a training institute, and 3 levels of hospitals were interviewed. All interview data were analyzed using content and thematic analysis strategies.

Results:
Data analysis identified 4 broad themes. Health care professionals' perceived role in safety and quality included formulating and implementing patient safety rules; management and administration of units and hospitals; patient assessment and management; and setting professional norms (including norms about peer influence and patient care/interaction).

Conclusion:
The findings revealed that Bhutanese health care professionals were aware of their roles in improving patient safety processes and practices, and providing interprofessional education or training to all levels of health care professionals could help improve communication and patient safety in the Bhutanese health care system.