bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-guided continuous thoracic paravertebral block alleviates postoperative delirium in elderly patients undergoing esophagectomy
Authors: Jin Liang , Yao Rui , Heng Lei , Pang Bo , Sun Fu-Guo , Shen Ying , Zhong Jun-Feng , Zhao Pan-Pan , Wu Cong-You , Li Bei-Ping 
Published: April 2020

Abstract

Background:
Delirium is a common postoperative complication in older patients undergoing thoracic surgery and presages poor outcomes. Postoperative pain is an important factor in the progression of delirium. The purpose of this study was to test whether continuous thoracic paravertebral block (PVB), a more effective approach for analgesia, could decrease the incidence of delirium in elderly patients undergoing esophagectomy.

Methods:
A total of 180 geriatric patients undergoing esophagectomy were randomly divided into 2 groups and treated with PVB or patient-controlled analgesia (PCA). Perioperative plasma CRP, IL-1β, IL-6, and TNF-α levels were detected in all patients. Pain intensity was measured by a numerical rating scale. Delirium was assessed using the confusion assessment method.

Results:
The incidence of postoperative delirium was significantly lower in the PVB group than in the PCA group. Patients in the PVB group had lower plasma CRP, IL-1β, IL-6, and TNF-α levels and less pain when coughing after surgery.

Conclusions:
Ultrasound-guided continuous thoracic paravertebral block improved analgesia, reduced the inflammatory reaction and decreased the occurrence of delirium after surgery.
The impact of echocardiographic parameter ratio of E/E’ on the late recurrence paroxysmal atrial fibrillation in patients accepted radiofrequency catheter ablation
Authors: Gong Ke-Zeng , Yan Qin-Dan , Huang Rong-Da , Chen Jian-Hua , Chen Xue-Hai , Wang Wei-Wei , Xu Zhe , Chen Liang-Long , Fan Lin , Zhang Fei-Long 
Published: April 2020

Abstract
This study aimed to evaluate the impact of the echocardiographic parameter ratio E/E’ on the late recurrence of paroxysmal atrial fibrillation in patients after receiving radiofrequency catheter ablation.
We retrospectively examined total of 288 paroxysmal atrial fibrillation (PAF) patients that underwent a preliminary radiofrequency catheter ablation (RFCA) in our hospital. During the first phase in this study, the patients were divided into 2 groups upon AF recurrence after RFCA: Recurrent group, n = 67 patients with rapid trial arrhythmia that lasted for more than 30 seconds at 3 months after RFCA and the Nonrecurrent group, n = 221. The clinical conditions were compared between the 2 groups. During the second phase of this study, based on the results in the first phase, the patients were divided into another 2 groups according to whether the ratio of E/E’ ≥13 .45: Higher ratio of E/E’ group, n = 55 and Lower ratio of E/E’ group n = 233. The late AF recurrent rates were also compared between the 2 groups.
During the first phase, the univariate analysis indicated that the risk factors(P < .05)for PAF late recurrence included early recurrence, E’, and the ratio E/E’. The Cox multivariate analysis showed that the ratio of E/E’ and early recurrence were the independent predictors for late PAF recurrence. The ratio of E/E’ that was cut off at 13.45 also predicted atrial tachyarrhythmia recurrence with 40.3% sensitivity and 87.3% specificity. In the second phase, after completing the 1:1 matching, the Kaplan–Meier analysis indicated that the ratio of E/E’ ≥ 13.45 was associated with further recurrences after RFCA (log-rank P = .009), compared to the patients with a ratio of E/E’ < 13.45. The univariate Cox analysis indicated that an elevated ratio of E/E’(≥13.45) was the independent predictor for late PAF recurrence (HR = 3.322, 95%CI: 1.560–7.075, P = .002). However, the ratio of E/E’ cut off at 13.25 predicted atrial tachyarrhythmia recurrence with 75% sensitivity and 62.2% specificity.
The ratio of E/E’ ≥ 13.25 is an important predictor of the late recurrence of paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation (RFCA).
Acupuncture for ocular myasthenia gravis
Authors: Zhang Di , Jin Song , Zhang Leixiao , Chen Lin , Liang Fanrong 
Published: April 2020

Abstract

Background:
The aim of this systematic review with meta-analysis is to determine the efficacy and security of acupuncture in treatment of ocular myasthenia gravis and find out whether or not the quick short-term efficacy of acupuncture exists.

Methods:
The following electronic databases will be searched by 2 independent reviewers: PubMed, Cochrane Library, EMBASE, Springer, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database. All randomized controlled trials on acupuncture for ocular myasthenia gravis published in electronic databases from inception to March 1, 2020, with language restricted in Chinese and English will be included in the study.
Methodologic quality is assessed by 2 blinded reviewers independently screen and score the articles using the PEDro scale and the Cochrane Collaboration risk of bias tool. A meta-analysis was performed when there is sufficient clinical homogeneity in at least 2 studies. The Grading of Recommendations Assessment, Development and Evaluation approach is used to rate the body of evidence in each meta-analysis. When the quantitive evaluation is not available, a qualitative description of the results of single study is provided.

Results:
An evidence of variety of acupuncture treatment methods for treating ocular myasthenia gravis will be illustrated using subjective reports and objective measures of performance. The primary outcomes consisted of effective rate, MGFA PIS, QMG, and MG-composite. Secondary outcomes involve clinical absolute and relative score, titers of AchR antibodies, and the side effects. The treatment frequency and courses will be measured.

Conclusion:
This protocol will present the evidence of whether acupuncture is an effective and safe intervention for ocular myasthenia gravis.

Trial registration number:
CRD42019141325
Effects of clazosentan, cilostazol, and statins on aneurysmal subarachnoid hemorrhage
Authors: He Junfang , Zhang Li , Yu Yao , Luo Xinyue , Wei Min , Chen Gen , Shen Yanfei 
Published: April 2020

Abstract

Background
: Aneurysmal subarachnoid hemorrhage (aSAH) is a disease caused by the infiltration of blood into the subarachnoid space due to the rupture of an intracranial aneurysm. It is a serious cerebrovascular disease, with a mortality rate of about 40% worldwide, which seriously threatens human life and health. Many drugs are used to treat aSAH and its complications, and some have been tested in systematic reviews and have shown good effects. But which drug has the best effect remains unclear. This network meta-analysis (NMA) aims to assess the effectiveness and feasibility of clazosentan, cilostazol, and statins in patients with aSAH.

Methods
: We will search for EMBASE.com, PubMed, the Cochrane Library, and Web of Science from inception to December 2019. Randomized controlled trials (RCTs) reporting efficacy and safety of clazosentan, cilostazol, and statins compared with the control, or compared with each other for the treatment of aSAH will be included. Two independent reviewers will assess the risk of bias of the included RCTs with the Cochrane “Risk of bias” tool. The pairwise meta-analysis will be performed with the random-effects model. The NMA will be performed in a Bayesian hierarchical framework using Markov Chain Monte Carlo method in WinBUGS 1.4.3. Egger test and funnel plot will be used to assess the publication bias. We will evaluate the quality of evidence for each outcome according to the GRADE approach.

Results
: The results of this NMA will be submitted to a peer-reviewed journal for publication.

Conclusion
: This study will summarize up-to-date evidence to compare the efficacy and safety of clazosentan, cilostazol, and statins on aSAH.

PROSPERO registration number: CRD42019147523.
Effects of Photobiomodulation in Children with Down Syndrome and Possible Sleep Bruxism: Protocol For A Randomized, Controlled, Blind, Clinical Trial
Authors: Salgueiro Mônica da Consolação Canuto , Silva Tamiris , Motta Lara Jansiski , Horliana Anna Carolina Ratto Tempestini , Gonçalves Marcela Letícia Leal , Gomes Andréa Oliver , Pinto Marcelo Mendes , Bortoletto Carolina Carvalho , Altavista Olga Maria , Deana Alessandro Melo , Silva Daniela de Fátima Teixeira da , Santos Elaine Marcilio , Castelo Paula Midori , Fernandes Kristianne Porta Santos , Mesquita-Ferrari Raquel Agnelli , Bussadori Sandra Kalil 
Published: April 2020

Abstract
Hypotonia, particularly of the masticatory and oropharyngeal muscles, is 1 of the main characteristics of Down Syndrome (DS), resulting in impaired speech, chewing and swallowing. Moreover, the complete or partial obstruction of the airways during sleep may occur due to hypotonia of the tongue, leading to snoring and sleep disorders, such as obstructive apnea and sleep bruxism.

Objective:
Analyze salivary levels of dopamine and cortisol and muscle activity before and after treatment with low-level laser therapy administered to acupoints in children with DS.

Methods:
A randomized, controlled, clinical trial will be conducted. Individuals 4 to 17 years of age with a diagnosis of DS and possible sleep bruxism will be screened at the Integrated Health Clinic of Nove de Julho University. We will evaluate orofacial dysfunction (Nordic Orofacial Test - Screening questionnaire), Masseter muscle activity during sleep will be assessed by BiteStrip and the masticatory muscles will be evaluated by electromyography (BTS TMJOINT) head posture as well as salivary cortisol and dopamine. After the evaluations, the participants will be randomized into 2 groups: Grupo 1 – treatment with low-level laser therapy at a wavelength of 808 nm; Group 2 – sham treatment (simulated laser therapy). Treatment will be conducted twice per week for a total of 12 sessions. The data will be tabulated and treated using GraphPad Prism version 7.0. The Kolmogorov-Smirnov test will be used to determine the normality of the data. Variables that fit the Gaussian curve will be expressed as mean and standard deviation. The ANOVA 2-way will be used for comparisons between the groups, with the significance level set to 5% (P < .05).

ClinicalTrials registration number: NCT04211870.
Exercise-induced hypertension can increase the prevalence of coronary artery plaque among middle-aged male marathon runners
Authors: Kim Chul-Hyun , Park Yongbum , Chun Min Young , Kim Young-Joo 
Published: April 2020

Abstract
Marathon runners demonstrate a high incidence of coronary artery plaque; however, studies on runners with exercise-induced hypertension (EIH) are sparse. We aimed to investigate the prevalence of coronary artery plaque among marathon runners with EIH.
Veteran male marathon runners (≥40 and <60 years) underwent an exercise stress test. They were divided into 2 groups: normal blood pressure group (NBPG, n = 22), with resting systolic blood pressure (SBP)/diastolic blood pressure <140/90 mm Hg and maximal exercise SBP <210 mm Hg, and EIH group (EIHG, n = 28), with resting blood pressure <140/90 mm Hg and maximal exercise SBP ≥210 mm Hg. Coronary artery plaque and stenosis were compared using multi-detector computed tomography.
The proportion of subjects with a coronary artery calcium (CAC) score ≥10 or ≥100 units, 1 or ≥2 plaques, or plaques in ≥2 blood vessels was higher in the EIHG than in the normal blood pressure group (NBPG) (P<.05). The absolute CAC score was higher in the EIHG (42.6 ± 67.8) than in the NBPG (2.8 ± 6.0; P < .05). The CAC score distribution was higher in the EIHG (5–300 units) than in the NBPG (P < .05). The prevalence of coronary plaques and maximal luminal artery stenosis was higher in the EIHG than in the NBPG (P < .05). The EIHG showed 12 cases of stenosis, whereas the NBPG showed only 1 case (P < .05).
In marathon runners, EIH was associated with increased prevalence of coronary artery plaques and could be a new risk factor for coronary artery plaque formation. Therefore, preventive measures and EIH monitoring using an exercise stress test, alongside multi-detector computed tomography, are recommended.
Continuous versus single shot adductor canal block for postoperative pain relief after total knee arthroplasty
Authors: Tao Yulin , Mao Qingjun , Wang Jixiang 
Published: April 2020

Abstract

Background:
Adductor canal block has become a popular mode of pain management after total knee arthroplasty. This study compared a single-injection adductor canal block (SACB) with continuous adductor canal block (CACB). The hypothesis was that the 2 groups would have equivalent analgesia at 48 hours post-neural blockade.

Methods:
This is a double-blinded, randomized, controlled, equivalency trial that is conducted at a single university hospital in China. A total of 60 patients who meet inclusion criteria are randomized in a ratio of 1:1 to either CACB (0.5% ropivacaine 20 mL followed by continuous infusion of 0.2% ropivacaine at 5 mL/h for 48 hours) or SACB (0.5% ropivacaine 20 mL) group. The primary outcome is pain scores at 48 hours utilizing the visual analog scale, whereas the secondary outcomes include opioid consumption, Timed Up & Go test, ambulation distances at discharge, length of stay, and maximal flexion at discharge. All pain scores are assessed by an independent observer who is blinded to the allocation of groups.

Results:
This study has limited inclusion and exclusion criteria and a well-controlled intervention. This clinical trial is expected to provide evidence of better therapy for the pain management after total knee arthroplasty.

Trial registration:
This study protocol was registered in Research Registry (researchregistry5431).
Fibrodysplasia ossificans progressiva—a rare disease with distinctive features yet still a diagnostic challenge
Authors: Shi Xiaofei , Zhou Liqing , Shang Jingjing , Wang Ke , Chu Cong-Qiu 
Published: April 2020

Abstract

Rationale:
Fibrodysplasia ossificans progressiva (FOP) is rare genetic disease featuring progressive heterotopic ossification of soft tissues of the musculoskeletal system which leads to severe disability and premature death. Recognition of this disease is important since invasive diagnostic procedures can promote disease progression. However, despite its distinctive clinical manifestations, diagnosis can be difficult because of its rarity

Patient concerns:
A 20-year-old woman was referred to rheumatology clinic for management of “ankylosing spondylitis”. The patent had begun to have hard subcutaneous nodules when she was 1 year old, and subsequently developed hip joint pain and flexion contractures of knees and hips leading to disability.

Diagnoses:
Based on characteristic bilateral great toe deformities and radiographic images of ossification of soft tissues, a clinical diagnosis of FOP was made. This was confirmed by genetic test showing a heterozygous mutation (c.G617A) of the activin receptor 1A gene (ACVR1).

Interventions:
The patient was treated symptomatically and with supportive measures, and her condition remained stable.

Lessons:
Diagnosis of FOP can be difficult, despite its distinctive clinical manifestations, because of its rarity. Recognition of this disease is important to avoid invasive diagnostic procedures which can promote progression.
Brain-derived neurotrophic factor and glutathione peroxidase as state biomarkers in alcohol use disorder patients undergoing detoxification
Authors: Wu Shu-Yu , Chen Chien-Yu , Huang Tiao-Lai , Tsai Meng-Chang 
Published: April 2020

Abstract
The pathophysiology of alcohol use disorder (AUD) is not totally clear. The aim of this study was to investigate the serum levels of brain-derived neurotrophic factor (BDNF) and oxidative stress markers in AUD patients during alcohol detoxification. Evaluation of changes in BDNF, glutathione peroxidase (GPX), catalase, superoxide dismutase, thiobarbituric acid reactive substances, 8-hydroxy 2’-deoxyguanosine, PCC and S100B were carried out.
14 AUD inpatients and 20 healthy control subjects were recruited for this study. The serum BDNF, S100B and oxidative stress markers were measured with assay kits.
Serum levels of catalase, GPX, PCC and 8-hydroxy 2’-deoxyguanosine were significantly higher in the AUD group subjects than in the controls (P < .05). However, BDNF levels were lower in the AUD group than in the controls (P < .05). After alcohol detoxification treatment, the GPX levels in the AUD group dropped (P < .05) and the BDNF levels rose (P < .05).
The results suggest that serum BDNF and GPX levels might be state biomarkers for AUD patients undergoing alcohol detoxification.
Serum uric acid to creatinine ratio and metabolic syndrome in postmenopausal Chinese women
Authors: Tao Jing , Shen Xin , Li Jie , Cha Erdenbat , Gu Pei-Pei , Liu Jun , Zhu Wei , He Lin-Long , Li Guo-Qing , Wang Zhao 
Published: April 2020

Abstract
This study aimed to investigate the association between Serum Uric Acid (UA) to Creatinine (Cr) Ratio (UA/Cr) and metabolic syndrome (MetS) in postmenopausal women.
A total of 455 patients with MetS and 457 age- and gender- matched controls were included in the present retrospective study. Serum levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), Cr, and UA were measured. We employed logistic regression analysis to investigate the association between serum UA/Cr and MetS in postmenopausal women.
Serum UA/Cr levels were significantly higher in patients with MetS than that in control subjects (P < .05). In the correlation analysis, serum UA/Cr showed a significantly positive correlation with age, hypertension, systolic pressure (SBP), diastolic pressure (DBP), Waist, body mass index (BMI), TG, UA and negative correlation with type 2 diabetes mellitus (T2DM) and Cr (P all < .001). Moreover, multivariate analysis revealed that serum UA/Cr was still an independent risk factor for MetS (OR = 2.928, 95% CI = 2.385–3.596, P < .001) after adjustments for other confounders.
Serum UA/Cr are strongly associated with the risk of MetS in postmenopausal Chinese women.
C.292G>A, a novel glycine receptor alpha 1 subunit gene (GLRA1) mutation found in a Chinese patient with hyperekplexia
Authors: Zhang Yan , Wu Ling-Ling , Zheng Xiao-Lan , Lin Cai-Mei 
Published: April 2020

Abstract

Introduction:
Hyperekplexia is a rare hereditary neurological disorder; only 5 glycine receptor alpha 1 subunit gene (GLRA1) mutations have been reported in 5 Chinese patients. We report a Chinese infant with hyperekplexia and a novel mutation at c.292G > A.

Patient concerns:
A Chinese infant with hyperekplexia and a novel mutation at c.292G > A.

Diagnosis:
All exons of GLRA1 were sequenced in her parents and her, which revealed a mutation at c.1030C > T and another novel mutation at c.292G > A. Her diagnosis was confirmed as hereditary hyperekplexia with GlRA1 hybrid gene mutations based on the sequencing results.

Interventions:
She was treated with clonazepam.

Outcomes:
Her muscle hypertonia recovered rapidly and the excessive startle reflex to unexpected stimuli was significantly reduced.

Conclusion:
Genetic DNA sequencing is a crucial method for diagnosing hyperekplexia-related gene mutation.
Increased risk of incident primary cancer after Staphylococcus aureus bacteremia
Authors: Gotland Nanja , Uhre M.L. , Sandholdt H. , Mejer N. , Lundbo L.F. , Petersen A. , Larsen A.R. , Benfield T. 
Published: April 2020

Abstract
Susceptibility to infectious disease may be a marker of immunodeficiency caused by unrecognized cancer. To test the hypothesis, the risk of incident primary cancer was estimated among survivors of Staphylococcus aureus bacteremia (SAB) and compared to a random population cohort.
Nation-wide population-based matched cohort study. Cases of SAB were identified from a national database and incident primary cancers were ascertained by record linkage. Incidence rate (IR) and ratio (IRR) with 95% confidence interval (CI) of 27 cancers was calculated by Poisson regression.
During the first year of follow-up, 165 and 943 incident cases of cancer occurred in the case cohort (n = 12,918 (1.3%)) and the population cohort (n = 117,465 (0.8%)) for an IR of 3.78 (3.22–4.40) and 2.28 (2.14–2.43) per 100,000 person-years. The IRR was 1.65 (1.40–1.95). Of 27 cancers, 7 cancers occurred more frequently amongst cases than controls: cervical cancer (IRR 37.83 (4.23–338.47)), multiple myeloma (IRR 6.31 (2.58–15.44)), leukemia (IRR 4.73 (2.21–10.10)), sarcoma (IRR 4.73 (1.18–18.91)), liver cancer (IRR 3.64 (1.30–10.21)), pancreatic cancer (IRR 2.8 (1.27–6.16)), and urinary tract cancer (IRR 2.58 (1.23–5.39)). Compared to the control population, the risk of cancer was higher for those without comorbidity and with younger age. The overall risk of cancer during 2 to 5 years of follow-up was not increased (IRR 0.99 (95% CI: 0.89–1.11). However, the risk of pharyngeal cancer was increased (IRR 1.88 (1.04–3.39)) and the risk of liver cancer remained increased (IRR 3.93 (2.36–6.55)).
The risk of primary incident cancer was 65% higher in the SAB cohort compared to the population cohort during the first year of follow-up and included 7 specific cancers. The risk was higher for those without comorbidity and with younger age. Screening for these specific cancers in selected populations may allow for earlier detection.
Clinical event debriefing: a review of approaches and objectives
Authors: Twigg Sonia 
Published: April 2020

Purpose of reviewThis review explores four different approaches and clarifies objectives for debriefing after a clinical event in the emergency department. Psychological debriefing aims to prevent or reduce symptoms of traumatic stress and normalize recovery. Psychological first aid helps team members provide each other with pragmatic social support. Debriefing for simulation-based education promotes learning by team members. Quality improvement approaches and after action reviews focus on systems improvement.Recent findingsQualitative studies have begun to explore interactions between clinical staff after a significant clinical event. Clearer descriptions and measurements of quality improvements and the effect of clinical event debriefing on patient outcomes are appearing. An increasing number of studies describe melded, scripted approaches to the hot debrief.SummaryClinical staff have consistently indicated they value debriefing after a significant clinical event. Differing objectives from different approaches have translated into a wide variety of methods and a lack of clarity about relevant outcomes to measure. Recent descriptions of scripted approaches may clarify these objectives and pave the way for measuring relevant outcomes that demonstrate the effectiveness of and find the place for debriefing in the emergency department.