bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Pregnancy Blood Pressure Elevations and Risk for Maternal and Neonatal Morbidity
Authors: Sutton Elizabeth F. , Rogan Sarah C. , Lopa Samia , Sharbaugh Danielle , Muldoon Matthew F. , Catov Janet M. 
Published: June 2020

OBJECTIVE:
To investigate whether women with early pregnancy elevated blood pressure (BP) or stage 1 hypertension exhibit increased risk of preeclampsia and maternal or neonatal morbidity.

METHODS:
We conducted a clinical cohort study of 18,162 women who delivered a singleton neonate from 2015 to 2018 and attended at least two prenatal appointments before 20 weeks of gestation. Data were collected within the Magee Obstetric Maternal and Infant database, an aggregate of prenatal and delivery health records. Early pregnancy BP was defined as average BP before 20 weeks of gestation, and women were classified with normal, elevated BP, stage 1 or 2 hypertension according to current guidelines. The primary outcome was preeclampsia. Secondary outcomes were severe maternal morbidity, placental abruption, gestational diabetes, and composite neonatal morbidity.

RESULTS:
Overall, 75.2% of the women were categorized with normal BP, 13.9% with elevated BP, 5.4% with stage 1 hypertension, and 5.5% with stage 2 hypertension. Risk of preeclampsia increased in a stepwise fashion with increasing BP category, adjusted for covariates (normal BP, 4.7%, referent; elevated BP, 7.3%, adjusted odds ratio [aOR] 1.29, 95% CI 1.07–1.56; stage 1, 12.3%, aOR 2.35, 95% CI 1.86–2.96), and stage 2, 30.2%, aOR 6.49, 95% CI 5.34–7.89). Results were similar among black and white women. Gestational diabetes was more prevalent among women with stage 1 (11.4%; aOR 1.50, 95% CI 1.18–1.91] and stage 2 hypertension (14.2%; aOR 1.65, 95% CI 1.30–2.10). Severe maternal morbidity and neonatal morbidity were increased only among women with stage 2 hypertension (aOR 2.99, 95% CI 2.26–3.99, and aOR 2.67, 95% CI 2.28–3.12, respectively).

CONCLUSION:
Women with elevated BP, and stage 1 and 2 hypertension in early pregnancy are at increased risk for preeclampsia. These findings emphasize the importance of applying the 2017 BP guidelines to reproductive-aged women. Strategies to incorporate these guidelines into obstetric care may also be warranted.
Higher serum angiopoietin 2 levels are independently associated with coronary microvascular dysfunction in patients with angina in the absence of obstructive coronary artery disease
Authors: Chen Shao-Min , Li Dan , Xing Xing , Li Zhao-Ping 
Published: June 2020

Abstract

Background
Angiopoietin-2 (Ang-2) is a type of endothelial growth factor involved in angiogenesis and vascular remodeling. Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease (CAD). This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD.

Methods
A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study. Coronary flow reserve (CFR) was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography. The patients were divided into the following two sub-groups according to CFR: the impaired CFR group with CFR values <2.5 and the preserved CFR group with CFR values ≥2.5. Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay. Independent predictors for impaired CFR were identified by binary logistic regression analysis. The receiver-operating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR.

Results
We found that age, percentage of female sex, N-terminal pro-B-type natriuretic peptide levels, Ang-2 levels (763.3 ± 264.9 vs. 579.7 ± 169.3 pg/mL, P < 0.001), and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR. Serum Ang-2 levels were negatively correlated with CFR (r = −0.386, P < 0.001). Binary logistic regression analysis showed that Ang-2 (odds ratio: 1.004, 95% confidence interval [CI]: 1.001–1.006, P = 0.003) and age (odds ratio: 1.088, 95% CI: 1.023–1.156, P = 0.007) were independently associated with impaired CFR. Furthermore, Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve (P < 0.001). The area under the curve was 0.712 (95% CI: 0.612–0.813).

Conclusions
High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.
Pancreatic Insufficiency in Patients Under Sorafenib Treatment for Hepatocellular Carcinoma
Authors: Díaz-González Álvaro , Belmonte Ernest , Sapena Víctor , Sanduzzi-Zamparelli Marco , Darnell Anna , Díaz Alba , Gomes da Fonseca Leonardo , Llarch Neus , Iserte Gemma , Ayuso Carmen , Forner Alejandro , Feu Faust , Bruix Jordi , Rimola Jordi , Reig María 
Published: June 2020

Goals:
To describe the occurrence of malabsorption (MA) in hepatocellular carcinoma (HCC) patients under sorafenib, the potential relationship with pancreatic insufficiency (PI), and the role of pancreatic enzymes supplementation.

Background:
With the increasing options of second-line systemic therapies for HCC, the recognition of drug intolerance using practical tools is crucial. It has been proposed that a MA syndrome could be due to sorafenib-induced pancreatic dysfunction.

Study:
All sorafenib-treated patients with suspicion of MA (defined as decreased stool consistency lasting >4 wk or presenting ≥10% body weight loss without HCC progression) were prospectively evaluated by serum markers, endoscopy, and imaging techniques.

Results:
We evaluated 81 sorafenib-treated patients and 21 developed MA suspicion (85.7% male, 81.5% Child-Pugh A, 52.4% BCLC-B, and 47.6% BCLC-C) within a median 5.9 months after starting sorafenib. The median treatment duration, follow-up, and overall survival after MA suspicion were 5.9, 20.3, and 20.3 months, respectively. Nine of them (42.9%) presented hyperparathyroidism secondary to vitamin D deficiency and 8 with PI. A gradual decrease in pancreatic volume of up to 19% was observed among patients with PI. Six of the 8 patients with PI received pancreatic enzymes, with complete recovery from MA symptoms and stabilization of pancreatic volume.

Conclusions:
We validated the association between MA and PI in 10% of sorafenib-treated patients. Pancreatic enzymes supplementation successfully led to symptomatic recovery. Awareness of this adverse event can help in the management of sorafenib irrespective of cancer type and likely, of other tyrosine kinase inhibitors for HCC patients.
The efficacy and safety of daunorubicin versus idarubicin combined with cytarabine for induction therapy in acute myeloid leukemia
Authors: Wang Hanyu , Xiao Xueting , Xiao Qirong , Lu Yanhong , Wu Yong 
Published: June 2020

Abstract

Objective:
To ascertain the efficacy and safety of daunorubicin combined with cytarabine comparing with idarubicin combined with cytarabine as a standard induction therapy for acute Myeloid leukemia by a meta-analysis.

Methods:
The randomized controlled trials included were retrieved from PubMed, Embase, and Cochrane library. We evaluated and cross-checked the randomized clinical trials (RCTs) comparing daunorubicin combined with cytarabine (DA) and idarubicin combined with cytarabine (IA) by two reviewers independently according to Cochrane Handbook for Systematic Reviewers of Interventions. The data of meta-analysis was conducted using Review Manager 5.3 and Stata 12.0 software.

Results:
A total of 6 studies containing 3140 patients were included. The primary outcomes were complete remission (CR), CR in one course (CR1), CR in two courses (CR2), overall survival (OS), and relapse rate. The secondary outcomes included adverse events and cytogenetic risk in subgroup analyses. IA showed a statistically significant in CR (RR = 1.05; 95%CI = 1.00–1.09, P = .03) and CR1 (RR = 1.11; 95%CI = 1.04–1.18, P = .003), but not in CR2 (RR = 0.97; 95%CI = 0.77–1.24, P = .83), and relapse rate (RR = 1.08; 95%CI = 0.98–1.43, P = .08). In high dose daunorubicin group, OS was significantly improved with IA compared to DA (HR = 0.89, 95%CI = 0.8–1.0, P = .041, I
2 = 0). At grade 3/4 adverse events, the difference between IA and DA was not statistically significant (infection, P = .28; cardiac toxicity, P = .15; bleeding, P = .29). In the subgroup analysis, the genotypes of the IA and DA groups were not statistically significant for comparison of CR between the two groups (P = .07).

Conclusion:
This meta-analysis showed that IA had a better efficacy in the treatment of acute myeloid leukemia than DA, even with increased doses of DA. The OS of a standard dose of IA patients was longer than that of DA patients. Our research shows that anthracycline dose intensification of daunorubicin is of no clinically relevant benefit in AML patients comparing with a standard dose of IA. When it comes to adverse drug reactions, it is not a significant difference. Therefore, in clinical practice, IA should be the first choice for induction regimen in patients with acute myeloid leukemia.
Interbody fusion in degenerative lumbar spinal stenosis with additional posterolateral fusion using Escherichia coli-derived bone morphogenetic protein-2
Authors: Choi Sung Hoon , Koo Ja Wook , Choe DaeHyun , Hur Jeong Min , Kim Dong-Hong , Kang Chang-Nam 
Published: June 2020

Abstract
This case series investigated the efficacy and optimal dose of Escherichia coli-derived bone morphogenetic protein-2 (E.BMP-2) as a bone graft substitute for additional posterolateral spinal fusion, accompanying interbody fusion procedures, for treating lumbar degenerative spinal stenosis. This study focused on the optimal dose for each segment and the efficacy of E.BMP-2 as a substitute for autogenous iliac bone graft.
Ten patients were enrolled from January 2015 to December 2015, and underwent an additional posterolateral fusion procedure, with 2.5 mg of E.BMP-2 followed by decompression, transpedicular fixation, and interbody fusion. The mean follow-up period was 13.9 months, and regular radiological examinations were performed in every case. Clinical outcomes were measured with a visual analog scale for back pain (VAS-BP), and leg pain (VAS-LP) and the Korean Oswestry Disability Index (K-ODI). All parameters were assessed preoperatively and postoperatively at 12 months.
All 18 segments treated with E.BMP-2 completely fused in 6 months as observed on both simple radiography and computed tomography. The mean fusion period was 4.5 months on simple radiography. At 12 months follow-up, VAS-BP, VAS-LP, and K-ODI scores (1.9 ± 1.5, 1.9 ± 1.9, 11.0 ± 6.6, respectively) had improved significantly compared to preoperative scores (5.5 ± 1.9, 6.5 ± 1.9, and 49.9 ± 11.5, respectively, P < .05). There were no postoperative wound infections, neurological symptoms, or complications associated with the use of E.BMP-2 during the follow-up period.
E.BMP-2 could be used to enhance the outcomes in posterolateral spinal fusion following interbody fusion surgery. In the present study, 2.5 mg of the E.BMP-2 per segment was sufficient to obtain bony union in posterolateral fusion surgery. Further large-scale trials with long-term follow-up are necessary to evaluate the various complications related to the use of E.BMP-2.
Withdrawing mycophenolate mofetil in treating a young kidney transplant recipient with COVID-19
Authors: Chen Dong , Yang Bo , Zhang Yan , Chen Liang , Wei Lai , Zhang Weijie , Wang Xinqiang , Tong Xiaolin , Chen Zhishui 
Published: June 2020

Abstract

Rationale:
Coronavirus disease 2019 (COVID-19) is a novel infectious disease and became a global issue. Treatment of COVID-19 especially in solid organ transplant recipients is empirical and controversial, especially the adjustment of the immunosuppressants.

Patient concerns:
A 29-year-old kidney transplant recipient with the symptoms of COVID-19 pneumonia.

Diagnoses:
COVID-19 pneumonia after kidney transplantation.

Interventions:
He was treated with modified immunosuppressants (unchanged dose of tacrolimus and oral corticosteroids while discontinuing mycophenolate mofetil (MMF)), antibiotics, interferon α-2b inhalation and traditional Chinese medicine.

Outcomes:
He recovered from COVID-19 pneumonia after 29 days of hospitalization. And the renal function (measured as blood urea nitrogen, serum creatinine, and urine protein) returned to normal.

Lessons:
In certain group of COVID-19 (e.g., mild to moderate cases, young patients without comorbidities), a reduction instead of an overall withdrawal of immunosuppressant in kidney transplant recipients is feasible.
Interstitial pneumonia as the initial presentation in an infant with a novel mutation of CD40 ligand-associated X-linked hyper-IgM syndrome
Authors: Li Jian , Miao Hongjun , Wu Lihui , Fang Yongjun 
Published: June 2020

Abstract

Introduction:
X-linked hyper-IgM syndrome is a type of primary combined immunodeficiency disorder caused by mutations in CD40 ligand. Opportunistic infections caused by P jirovecii, cytomegalovirus (CMV), or fungi are frequently the first presenting symptom of the patients with X-linked hyper-IgM syndrome.

Patient concerns:
Here, we report a 10-month-old infant who presented with cyanosis and shortness of breath. The infant exhibited no medical or birth history indicating a primary immune deficiency and was first diagnosed with interstitial pneumonia and acute respiratory failure on admission.

Diagnoses:
The infant was diagnosed with Pneumocystis jirovecii pneumonia combined with CMV and fungal infection through gene sequencing by nasopharyngeal swab and G-test. Whole-exome sequencing from a blood sample was performed and identified a functional mutation across the CD40 ligand gene (NM_000074;exon1;C.86_87del) resulting in an amino acid change (P.T29Sfl∗18) attributed to X-linked hyper IgM syndrome.

Interventions:
The infant received continuous positive airway pressure ventilation treatment combined with trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia, ganciclovir for CMV, voriconazole for fungal infection and substitution of high-dose immunoglobulin.

Outcomes:
Six months after discharge from our hospital, the infant remained well.

Conclusion:
Opportunistic infections should be suspected in infants presenting with severe interstitial pneumonia. Primary immune deficiency diseases should also be considered in infants diagnosed with opportunistic infections.
Corticosteroids or immunosuppressants were not superior to supportive care in IgA nephropathy patients with mild proteinuria
Authors: Pei Gaiqin , Tan Jiaxing , Tang Yi , Tan Li , Zhong Zhengxia , Zhou Ling , Chen Changyun , Qin Wei 
Published: June 2020

Abstract

Background:
We aimed to evaluate the effect of immunosuppressant therapy for immunoglobulin A nephropathy (IgAN) patients with mild proteinuria (<1 g/d).

Methods:
We recruited patients with biopsy-proven IgAN from 4 study centers. Patients were followed for more than 1 year or up to the study end point. Clinical indexes, renal pathological data, and treatment information were collected during the follow-up period. IgAN patients with mild proteinuria (<1 g/d at biopsy) were included. Patients were divided into a supportive care group (SC) and an immunosuppressant group (IT). Patients in the SC group received the optimal dose of renin angiotensin system inhibitors (RASi). Patients in the IT group received corticosteroids or immunosuppressant therapy plus RASi. Responses to therapy included complete remission (CR), partial remission (PR), no response (NR), and end stage renal disease (ESRD). A 50% decline in estimated glomerular filtration rate (eGFR) and/or ESRD was the primary end point of this study.

Results:
295 patients (36.3% male and 63.7% female) were included in this study and were followed for 49.46 ± 24.35 months. We found a significant difference in estimated glomerular filtration rate, urine protein, mesangial hypercellularity, segmental glomerulosclerosis, cellular or fibrocellular crescents, and glomerulosclerosis between the 2 treatment groups at baseline. At the final follow-up, 224 patients (75.9%) achieved CR, 7 patients (2.4%) achieved PR, 55 patients (18.6%) had NR, and 9 patients (3.1%) reached ESRD. However, no significant differences were observed between the SC and IT groups with respect to CR (76.4% vs 73.5%, P = .659), PR (2.0% vs 4.1%, P = .329), NR (18.3% vs 20.4%, P = .728), and ESRD (3.3% vs 2.0%, P = 1.000). Kidney survival rates were also comparable between the SC and IT groups (93.7% vs 94.1%, P = .808). We observed similar results after subgroup analysis according to chronic kidney disease stages or pathological manifestations. A multivariate model showed that segmental sclerosis (HR 9.55, 95% CI 1.04–88.16, P = .047) and glomerulosclerosis (HR 21.09, 95% CI 1.39–320.53, P = .028) were independent predictors of poor renal survival.

Conclusions:
Corticosteroids or immunosuppressants were not superior to supportive care in IgA nephropathy patients with mild proteinuria.
The effect of the reconstruction algorithm for the pulmonary nodule detection under the metal artifact caused by a pacemaker
Authors: Kikuchi Noriko , Yanagawa Masahiro , Enchi Yukihiro , Nakayama Akiko , Yoshida Yuriko , Miyata Tomo , Hata Akinori , Tsubamoto Mitsuko , Honda Osamu , Tomiyama Noriyuki 
Published: June 2020

Abstract
The aim was to compare the effects of metal artifacts from a pacemaker on pulmonary nodule detection among computed tomography (CT) images reconstructed using filtered back projection (FBP), single-energy metal artifact reduction (SEMAR), and forward-projected model-based iterative reconstruction solution (FIRST).
Nine simulated nodules were placed inside a chest phantom with a pacemaker. CT images reconstructed using FBP, SEMAR, and FIRST were acquired at low and standard dose, and were evaluated by 2 independent radiologists.
FIRST demonstrated the most significantly improved metal artifact and nodule detection on low dose CT (P < .0032), except at 10 mA and 5-mm thickness. At standard-dose CT, SEMAR showed the most significant metal artifact reduction (P < .00001). In terms of nodule detection, no significant differences were observed between FIRST and SEMAR (P = .161).
With a pacemaker present, FIRST showed the best nodule detection ability at low-dose CT and SEMAR is comparable to FIRST at standard dose CT.
Radial extracorporeal shock wave therapy: a novel approach for the treatment of Dupuytren's contractures
Authors: Brunelli Stefano , Bonanni Cinzia , Traballesi Marco , Foti Calogero 
Published: June 2020

Abstract

Introduction:
While the efficacy of focused Extracorporeal Shock Wave Therapy (ESWT) in the treatment of Dupuytren's disease (DD) is supported by one positive trial, the effects of radial ESWT is unclear.

Patient concerns:
A 79-year-old man with a 4-year history of impairment of left-hand function and pain due to DD with weakness and flexion deformities of middle and ring fingers. He has not been treated before for this impairment.

Diagnosis:
The diagnosis of DD was based on clinical features and ultrasound images.

Interventions:
Four weekly sessions of radial ESWT with 1400 impulses 3 bar each, 12 Hz.

Outcomes:
The limitations in activities of daily living were analyzed through the Disabilities of Arm Shoulder and Hand Questionnaire (DASH) and Michigan Hand Outcome Questionnaire (MHQ) at baseline, after four sessions of radial ESWT and at 4-months follow-up. Data analysis showed a significant reduction of hand deformities and an improvement of daily living performance. The effects continued at the 4-months follow-up.

Conclusion:
This case report demonstrates the feasibility of radial ESWT. Radial ESWT sessions may be carried out by a physiotherapist in outpatient clinics with cost reduction compared with surgical treatment and focused ESWT. Radial ESWT is a non-invasive, well tolerated therapy, so it should be considered in the DD treatment.
Can respiratory muscle training therapy effectively manage obstructive sleep apnea syndrome after stroke?
Authors: Guo Shu-wen , Dai Chang-fei , Yu Liang , Zhao Xiong-fei 
Published: June 2020

Abstract

Background:
This study will explore the effectiveness and safety of respiratory muscle training therapy (RMTT) for the treatment of patients with obstructive sleep apnea syndrome (OSAS) after stroke.

Methods:
In this study, we will systematically and comprehensively search Cochrane Library, PubMed, EMBASE, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for relevant literature from their inception to March 1, 2020 without any limitations to language and publication status. We will consider any randomized controlled trials focusing on the effectiveness and safety of RMTT for the treatment of patients with OSAS after stroke. The study quality will be checked using Cochrane risk of bias tool, and statistical analysis will be performed utilizing RevMan 5.3 software.

Results:
This study will summarize and synthesize the current evidence of RMTT for the treatment of patients with OSAS following stroke.

Conclusion:
The findings of this study will assess the present evidence for the benefits and harms of RMTT for treating OSAS after stroke, and will inform clinical practice and future research.

PROSPERO registration number:
PROSPERO CRD42020170355.
The adverse skin reactions of health care workers using personal protective equipment for COVID-19
Authors: Hu Kaihui , Fan Jing , Li Xueqin , Gou Xin , Li Xinyuan , Zhou Xiang 
Published: June 2020

Abstract
In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE.
Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE.
A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%).
When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.