bluuebunny/crossref_metadata_2025_split huggingface dataset:
Monitoring mitochondrial PO2: the next step
Authors: Mik Egbert G. , Balestra Gianmarco M. , Harms Floor A. 
Published: April 2020

Purpose of review
To fully exploit the concept of hemodynamic coherence in resuscitating critically ill one should preferably take into account information about the state of parenchymal cells. Monitoring of mitochondrial oxygen tension (mitoPO2) has emerged as a clinical means to assess information of oxygen delivery and oxygen utilization at the mitochondrial level. This review will outline the basics of the technique, summarize its development and describe the rationale of measuring oxygen at the mitochondrial level.

Recent findings
Mitochondrial oxygen tension can be measured by means of the protoporphyrin IX-Triplet State Lifetime Technique (PpIX-TSLT). After validation and use in preclinical animal models, the technique has recently become commercially available in the form of a clinical measuring system. This system has now been used in a number of healthy volunteer studies and is currently being evaluated in studies in perioperative and intensive care patients in several European university hospitals.

Summary
PpIX-TSLT is a noninvasive and well tolerated method to assess aspects of mitochondrial function at the bedside. It allows doctors to look beyond the macrocirculation and microcirculation and to take the oxygen balance at the cellular level into account in treatment strategies.
Individualized blood pressure targets during postcardiac arrest intensive care
Authors: Skrifvars Markus B. , Åneman Anders , Ameloot Koen 
Published: April 2020

Purpose of review
To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics.

Recent findings
Observational data suggest that mean arterial pressure (MAP) below 65–75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care and found no significant effect on biomarkers of neurological injury. The haemodynamic interventions in those studies did not use any cerebral perfusion endpoints beyond a static MAP targets during ICU stay. Individualized, dynamic MAP targets based on assessments of cerebral perfusion and tailored to the specifics of the patient, cardiac arrest circumstances and treatment responses may be more conducive to improved outcomes. Pilot data suggest that near infrared spectroscopy monitoring may be used to determine the cerebral autoregulatory capacity and an optimal MAP, but this approach is yet to be tested in clinical trials.

Summary
Current evidence suggests targeting a MAP of at least 65–75 mmHg in PCA patients. Future studies should focus on whether certain patient groups could benefit from higher and dynamic MAP targets.
The efficacy of dexamethasone on pain management for knee arthroscopy
Authors: Peng Chuangang , Li Chen , Yuan Baoming , Jiao Jianhang 
Published: April 2020

Abstract

Introduction:
The impact of dexamethasone on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexamethasone for knee arthroscopy.

Methods:
We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of dexamethasone on pain intensity for patients with dental implant. This meta-analysis is performed using the random-effect model.

Results:
Four RCTs involving 228 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, dexamethasone supplementation has no notable effect on pain scores at 4 to 6 hours (Std. MD = 0.99; 95% CI = −2.97 to 4.95; P = .62), but exerts significantly favorable promotion to pain scores at 12 hours (Std. MD = −1.06; 95% CI = −1.43 to −0.69; P < .00001), duration of block (Std. MD = 1.87; 95% CI = 0.65 to 3.10; P = .003), time to first analgesic requirement (Std. MD = 0.90; 95% CI = 0.51 to 1.29; P < .00001), analgesic consumption (Std. MD = -1.62; 95% CI = −2.31 to −0.93; P < .00001), and patient satisfaction (Std. MD = 1.15; 95% CI = 0.73 to 1.58; P < .00001).

Conclusions:
Dexamethasone supplementation has importantly positive influence on pain control for knee arthroscopy.
Traditional Chinese medicine combined with western medicine for the treatment of secondary pulmonary tuberculosis
Authors: Li Xiangwen , Li Xinghui , Liu Qiling , Sun Na , Zhang Bei , Shi Chuandao , Zhang Rongqiang 
Published: April 2020

Abstract

Objective:
To evaluate the differences between traditional Chinese medicine combined with western medicine and western medicine alone for the treatment of secondary tuberculosis and its impact on the evaluation of clinical efficacy and safety of patients in randomized controlled trials.

Methods:
A literature search of all major academic databases was conducted (PubMed, CNKI, Wanfang, VIP). Meta-analysis was conducted using RevMan 5.3 and Stata 12.0 software for those studies that satisfied the inclusion criteria. Ethical approval was not necessary because no people or animals were selected as subjects in this meta-analysis.

Results:
Twenty-three randomized controlled trials were included in this meta-analysis. The following indicators in the treatment group (traditional Chinese medicine decoction combined with western medicine chemotherapy) improved in comparison with those in the control group:focus absorption rate (RR:1.18; 95% CI: 1.15–1.22);sputum smear negative rate (RR: 1.17; 95% CI: 1.09–1.27);comprehensive clinical effective rate (RR: 1.18; 95% CI: 1.14–1.22);cavity closure rate (RR: 1.37; 95% CI: 1.12–1.67).
The difference of Immune function indicator likes CD4+ level (SMD: 0.76; 95% CI: −0.25 to 1.76) between the treatment group and the control group was not significant. In addition, safety evaluation indicators like the decrease rate of white blood cell (WBC) and platelets (PLT) and the elevation rate of alanine aminotransferase (ALT) and uric acid (UA) in the treatment group were reduced compared with those in the control group (P < .05).

Conclusions:
The curative effect of combining traditional Chinese and western medicine for the treatment of secondary tuberculosis is better than that of western medicine alone and is conducive to reducing the incidence of adverse reactions.
Peripheral artery disease: how much inter-leg symmetry? A contrast-enhanced magnetic resonance angiography study
Authors: Secchi Francesco , Di Leo Giovanni , Delnevo Alessandra , Alì Marco , D’Angelo Ida Daniela , Nardella Veronica Gaia , Sardanelli Francesco 
Published: April 2020

Abstract
The aim of this observational retrospective study was to qualitatively and quantitatively evaluate the symmetry of atherosclerotic plaques in patients with peripheral artery disease (PAD) undergoing contrast-enhanced magnetic resonance angiography of lower limbs. We retrospectively evaluated the peripheral magnetic resonance angiography of 82 patients considering the iliac, femoral and tibial arteries. Stenosis was scored 0 (none), 1 (<50%), 2 (50%–74%), 3 (75%–99%), and 4 (occluded). Symmetry was quantified as the percentage of bilaterally-diseased arteries and using the inter-leg absolute score difference (0–4). Signs test and Cohen κ were also calculated. Seventy-one (87%) patients had ≥1 bilaterally-diseased artery, and 168 (20%) of 820 artery pairs were bilaterally affected. At least 1 bilateral stenosis was observed from 11% (right internal iliac) to 73% (right superficial femoral). All 10 arteries showed symmetry, none of the inter-leg comparisons being significantly different (P ≥ .100). Cohen κ ranged from 0.208 (common femoral) to 0.533 (internal iliac). This study showed that PAD was symmetrically distributed between the 2 legs, with the internal iliac artery being the most symmetric segment. Symmetry of PAD was quantified in 20%.
Effects of 9 oral care solutions on the prevention of oral mucositis: a network meta-analysis of randomized controlled trials
Authors: Yu Ya-Ting , Deng Jia-Lin , Jin Xian-Rong , Zhang Zhong-Zu , Zhang Xiao-Hua , Zhou Xin 
Published: April 2020

Abstract

Background:
Oral mucositis (OM) is a common, disabling, and severe early effect of chemotherapy and radiotherapy that limits the effectiveness of anticancer therapy. The prevention and treatment of OM in patients with malignant tumors is an urgent problem in the field of anticancer therapy.

Methods:
Databases including PubMed, Embase, Scopus, The Cochrane Library, and Google Scholar were searched to collect published randomized control trials (RCTs) about the effects of different oral care solutions on the prevention of OM from inception to January 2019. We used the Cochrane Handbook to assess the methodological quality of the RCTs. Two of the authors independently extracted the articles and predefined data. Network meta-analysis was then performed using Stata 15.0 software.

Results:
A total of 28 RCTs involving 1861 patients were included. The results of network meta-analysis showed that chlorhexidine, benzydamine, honey, and curcumin were more effective than placebo (P < .05) and that honey and curcumin were more effective than povidone-iodine (P < .05). Probability ranking according to the Surface Under the Cumulative Ranking curve showed the following treatments: curcumin, honey, benzydamine, chlorhexidine, allopurinol, sucralfate, granulocyte-macrophage colony-stimulating factor, povidone-iodine, and aloe.

Conclusion:
Our preliminary results indicate that curcumin and honey may serve as the preferred options for patients to prevent OM. The findings may offer an important theoretical basis for clinical prevention and treatment. However, this conclusion still requires an RCT with a larger sample size for further verification.
Diagnostic performance of abbreviated breast MRI for screening of women with previously treated breast cancer
Authors: Kwon Mi-ri , Ko Eun Young , Han Boo-Kyung , Ko Eun Sook , Choi Ji Soo , Park Ko Woon 
Published: April 2020

Abstract

Rationale and objectives:
To evaluate the diagnostic performance of abbreviated screening breast magnetic resonance imaging (AB-MRI) for screening in women with previously treated breast cancer.

Materials and methods:
This retrospective study included consecutive AB-MRI from September 2015 to December 2016 in patients with previously treated breast cancer. Longitudinal medical record of patients’ demographics, outcomes of imaging surveillance and results of biopsy was reviewed. Protocol consisted of T2-weighted scanning and dynamic contrast-enhanced imaging including one pre-contrast and two post-contrast scans. A positive examination was defined as final assessment of BI-RADS 4 or 5 and negative was defined as BI-RADS 1, 2, or 3. Abnormal interpretation rate, cancer detection rate (CDR), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were analyzed.

Results:
Among total 1043 AB-MRI, 29 (2.8%) AB-MRI had suspicious findings including 26 (2.5%) BI-RADS 4 and 3 (0.3%) BI-RADS 5 assessments. CDR was 9.59 per 1000. Performance outcomes were as follows: sensitivity, 71.4%; specificity, 98.2%; accuracy, 97.8%; PPV 1, 35.7%; PPV3 50%; and NPV 99.6%. Four cancers with false negative MRI were all early cancers of <1.0 cm with node negative. One was palpable interval cancer while the others were alternative screening modality-detected asymptomatic cancers before the next MRI screening.

Conclusion:
AB-MRI showed high accuracy and NPV for detecting cancer recurrence in women with previously treated breast cancer. Missed cancers were all minimal cancers with node negative.
Association between red cell distribution width level and risk of stroke
Authors: Li Bingxian , Liu Shuo , Liu Xiaoqiang , Fang Jingnian , Zhuang Weiduan 
Published: April 2020

Abstract

Background:
Red cell distribution width level may have relations with the incidence and prognosis of cerebrovascular diseases. Recent researches have reported that red cell distribution width level was linked to the occurrence of stroke. However, the predicted effect of red cell distribution width in stroke is still disputed. We sought to assess the relationship between red cell distribution width and risk of stroke in this meta-analysis.

Methods:
Relevant studies were picked out from the databases of Embase, PubMed, and Cochrane Library. Hazard ratio with 95% confidence interval was chosen to analyze each trial, which was extracted from results of the highest and lowest red cell distribution width group. Funnel plots, Begg and Egger test were used to assess publication bias in the meta-analysis. Stata(12.0) was utilized to perform statistic analysis in the process.

Results:
A total of 6 studies with 5783 patients were included in this meta-analysis. The results showed that red cell distribution width level in patients with stroke was significantly higher than it in those without stroke (HR = 1.34, 95%CI:1.23–1.47, P < .001), in particular ischemic stroke(HR = 1.34,95% confidence interval:1.1–1.54, P < .001). There was no evidence of heterogeneity across the studies (P = .355, I
2 = 5.53%).

Conclusions:
The higher red cell distribution width level was associated with an increased risk of stroke, especially ischemic infarction.
Comparative diagnostic efficacy of serum Krebs von den Lungen-6 and surfactant D for connective tissue disease-associated interstitial lung diseases
Authors: Zhong Danli , Wu Chanyuan , Bai Jingjing , Hu Chaojun , Xu Dong , Wang Qian , Zeng Xiaofeng 
Published: April 2020

Abstract

Purpose:
The aim of the study was to estimate and compare the diagnostic accuracy of serum Krebs von den Lungen-6 (KL-6) and surfactant protein D (SP-D) for identifying interstitial lung disease (ILD) from non-ILD among connective tissue disease (CTD) patients.

Materials and Methods:
Original articles on the diagnostic accuracy of serum KL-6 and SP-D in differentiating CTD-ILD from CTD-nonILD were identified from three public databases. The overall quality of evidence and methodologic quality of each eligible study were assessed by the Grading of Recommendations, Assessment, Development and Evaluation approach and Quality Assessment of Diagnostic Accuracy Studies, respectively. We used the bivariate model to calculate random-effect sensitivity, specificity, likelihood ratios, and area under curve. Furthermore, trial sequential analysis (TSA) was used to determine whether sample sizes incorporated in the meta-analysis were powerful for evaluating the diagnostic utility. Bayesian network analysis was performed to compare the diagnostic accuracy of 2 serum biomarkers in differentiating ILD among CTD patients and various subgroups.

Results:
Twenty-nine studies were included in the quantitative synthesis. No threshold effects were observed (all P values >.05). For diagnosis of ILD among CTD patients, overall sensitivity and specificity of serum KL-6 were 0.76 (95% confidence interval [CI]: 0.68–0.82) and 0.89 (95% CI: 0.83–0.93), whereas those for serum SP-D were 0.65 (95% CI: 0.45–0.80) and 0.88 (95% CI: 0.80–0.93). Comprehensive comparison of 2 circulating biomarkers using back-calculated likelihood ratio (LR) demonstrated that serum KL-6 corresponded to a higher LR+ and a lower LR– in comparison to serum SP-D, as well as in SSc-ILD. TSA indicated that evidence for serum KL-6 and SP-D in identifying CTD-ILD is powerful; nonetheless, more trials were needed for validation of serum KL-6 and SP-D in differentiating CTD-ILD subtypes, including different CTD and ethnicities.

Conclusions:
This meta-analysis suggested that serum KL-6 had superior diagnostic accuracy to SP-D for differentiating ILD from non-ILD among CTD patients, providing a convenient and non-invasive approach for screening and management of ILD among CTD patients.
Efficacy and safety of combination of curcuminoid complex and diclofenac versus diclofenac in knee osteoarthritis
Authors: Shep Dhaneshwar , Khanwelkar Chitra , Gade Prakashchandra , Karad Satyanand 
Published: April 2020

AbstractBackground:To compare the efficacy and safety of combination of curcuminoid complex and diclofenac vs diclofenac alone in the treatment of knee osteoarthritis (OA).Methods:In this randomized trial, 140 patients of knee OA received either curcuminoid complex 500 mg (BCM-95) with diclofenac 50 mg 2 times daily or diclofenac 50 mg alone 2 times daily for 28 days. Patients were assessed at baseline, day 14 and day 28. Primary efficacy measures were Knee injury and OA outcome score (KOOS) subscale at day 14 and day 28. Anti-ulcer effect and patient-physician's global assessment of therapy at day 28 were included as secondary endpoints. Safety after treatment was evaluated by recording adverse events and laboratory investigations.Results:Both treatment groups showed improvement in primary endpoints at each evaluation visit. Patients receiving curcuminoid complex plus diclofenac showed significantly superior improvement in KOOS subscales, viz. pain and quality of life at each study visit (P < .001) when compared to diclofenac. Less number of patients required rescue analgesics in curcuminoid complex plus diclofenac group (3%) compared to diclofenac group (17%). The number of patients who required histamine 2 (H2) blockers was significantly less in curcuminoid complex plus diclofenac group compared to diclofenac group (6% vs 28%, respectively;P < .001). Adverse effects were significantly less in curcuminoid complex plus diclofenac group (13% vs 38% in diclofenac group;P < .001). Patient's and physician's global assessment of therapy favored curcuminoid complex plus diclofenac than diclofenac.Conclusion:Combination of curcuminoid complex and diclofenac showed a greater improvement in pain and functional capacity with better tolerability and could be a better alternative treatment option in symptomatic management of knee OA.Trial Registration:ISRCTN, ISRCTN10074826
Effect of 5 different cervical collars on optic nerve sheath diameter
Authors: Ladny Michal , Smereka Jacek , Ahuja Sanchit , Szarpak Lukasz , Ruetzler Kurt , Ladny Jerzy Robert 
Published: April 2020

Abstract

Background:
There is considerable evidence that prolonged use of cervical collars potentially cause detrimental effects including increase in optic nerve sheath diameter (ONSD) among healthy volunteers. Different types of cervical collars immobilize cervical spine variably well and may presumably differently influence the venous compression and hence the intracranial pressure. We therefore aimed to evaluate the influence of cervical spine immobilization with 5 different types of cervical collars on ONSD measured noninvasively by ultrasound on healthy volunteers.

Methods:
We conducted a randomized crossover trial including 60 adult healthy volunteers. Control assessment of the optic nerve sheath thickness was performed in both sagittal and transverse planes. Patient was placed supine on a transport stretcher, cervical collar was placed, and ONSD measurement was performed after 5 and 20 minutes. During the next days, the procedure was repeated with random allocation of participants and random cervical collar.

Results:
Sixty healthy volunteers were included in our study. ONSD left diameter [mm] for the baseline was 3.8 [interquartile range (IQR): 3.65–3.93)] mm. Using AMBU after 5 min, ONSD was changed up to 4.505 (IQR 4.285–4.61; P < .001) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.73 (IQR: 4.49–4.895; P < .001) and 4.925 (IQR: 4.65–5.06; P < .001), respectively. Necklite reported the lower change in ONSD: 3.92 (IQR: 3.795–4; P = 1.0) mm in 5 minutes and 3.995 (IQR: 3.875 – 4.1; P = 1.0) mm in 20 minutes. ONSD right diameter [mm] for the baseline was 3.8 (IQR 3.675–3.9) mm. Using AMBU after 5 minutes, ONSD was changed up to 4.5 (IQR 4.21–4.6) mm. The largest change at 5 minutes and 20 minutes was using Philly 4.705 (IQR 4.455–4.9) and 4.93 (IQR 4.645–5.075), respectively. Necklite reported the lower change in ONSD -33.9 (IQR 3.795–3.99) mm in 5 minutes and 3.995 (IQR 3.86–4.09) mm in 20 minutes.

Conclusion:
We report significant increase of ONSD from the baseline after cervical collar placement among healthy volunteers at 5 minutes and 20 minutes interval. In addition, no significant difference was noted between ONSD measurements at 5 and 20 minutes. Clinicians should take proactive steps to assess the actual need of cervical collar case by case basis. Nonetheless, when needed, Necklite moldable neck brace seems to be a reasonable option.

Registration: ClinicalTrials database (www.clinicaltrials.gov, NCT03609879).
Two case reports of right atrial aneurysm
Authors: Li Hao-Peng , Ye Xian-Wang , Wang Hai-Tao 
Published: April 2020

Abstract

Introduction:
Right atrial aneurysm (RAA) is a rare congenital heart disease (CHD) that usually shows no symptom and is discovered occasionally. This paper introduces the clinical and imaging data obtained in 2 RAA patients and presents a related literature review with the aim of increasing understanding of this disease.

Patient focus:
One case showed chest distress, while the other showed symptoms on physical examination and positive signs.

Diagnosis:
Both of these 2 cases were diagnosed with RAA based on ultrasonography, computed tomography angiography (CTA), and enhanced magnetic resonance imaging (MRI) examinations.

Interventions:
One patient was orally administered warfarin anticoagulant therapy, while the other was given amiodarone to control arrhythmia as well as warfarin anticoagulant therapy.

Results:
The clinical symptoms of both cases were not aggravated.

Conclusions:
RAA is a rare cardiac anomaly that can induce severe complications, and it is mainly diagnosed based on imaging examinations. Conservative treatment and regular imaging monitoring are recommended for asymptomatic patients with no high-risk factors, while surgical treatment should be performed in symptomatic patients with high-risk factors.
Targeted next generation sequencing revealed a novel deletion-frameshift mutation of KCNH2 gene in a Chinese Han family with long QT syndrome
Authors: Du Fengli , Wang Guangxin , Wang Dawei , Su Guoying , Yao Guixiang , Zhang Wei , Su Guohai 
Published: April 2020

AbstractIntroduction:Long QT syndrome (LQTS) is electrocardiographically characterized by a prolonged QT interval and manifests predisposition to life-threatening arrhythmia which often leads to sudden cardiac death. Type 2 LQTS (LQT2) is the second most common subtype of LQTS and caused by mutations inKCNH2gene. Up to date, >900 mutations have been reported to be related to LQT2. However, mutational screening of theKCNH2gene is still far from completeness. Identification ofKCNH2mutations is particularly important in diagnosis of LQT2 and will gain more insights into the molecular basis for the pathogenesis of LQT2.Patient concerns:A Chinese Han family with LQTS phenotypes was examined.Diagnosis:A novel deletion-frameshift mutation, c.381_408delCAATTTCGAGGTGGTGATGGAGAAGGAC, in exon 3 ofKCNH2gene was identified in a Chinese family with LQTS. On the basis of this finding and clinical manifestations, the final diagnosis of LQT2 was made.Interventions:Next-generation sequencing (NGS) of DNA samples was performed to detect the mutation in the LQTS-related genes on the proband and her mother, which was confirmed by Sanger sequencing. The proband was then implanted with an implantable cardioverter defibrillator and prescribed metoprolol 47.5 mg per day.Outcomes:This novel heterozygous mutation results in a frameshift mutation after the 128thresidue (Asparagine), which replaced the original 1031 amino acids with 27 novel amino acids (p.N128fsX156).Conclusion:This novel mutation presumably resulted in a frameshift mutation, p.N128fsX156. Our data expanded the mutation spectrum ofKCNH2gene and facilitated clinic diagnosis and genetic counseling for this family with LQTS.