bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and CT characteristics of healthcare workers with COVID-19
Authors: Xiong Ying , Zhang Qiang , Sun Dong , Zhu Wenzhen 
Published: July 2020

Abstract
A large number of healthcare workers have been infected with coronavirus disease-2019 (COVID-19). We aimed to investigate their clinical and chest computed tomography (CT) characteristics.
The clinical, laboratory test and CT features of 43 medical and hospital staff with confirmed COVID-19 (MP group, 26–70 years old) were retrospectively analyzed, and compared to 43 non-medical related patients (non-MP group, 26–71 years old). Follow-up CT characteristics were analyzed to assess the disease progression in the period of hospitalization.
At admission, the main complaints of the MP group, including fever (81.4%), fatigue (48.8%) and cough (41.9%), were similar to the non-MP group. The C-reactive protein, erythrocyte sedimentation rate, and lactate dehydrogenase levels were higher in the non-MP group than the MP group (17.5 ± 22.4 mg/L, 20.2 ± 23.4 mm/H and 219 ± 66U/L, respectively, P < .05). Ground-grass opacities, consolidation, interstitial thickening were common CT features of both groups. The severity of opacities on initial CT were less in the MP group (5.3 ± 3.9 scores) than in the non-MP group (9.1 ± 4.8 scores, P < .05). Before regular treatments, the sum score of the opacities showed weak to moderate correlations with duration, C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase levels (R ranged from 0.341–0.651, P < .05). In the study time window, the duration from illness onset to when the most obvious pulmonary opacities were observed, according to CT findings, were similar in the MP group (13.3 ± 6.6 days) and the non-MP group (13.8 ± 5.1 days, P = .69). Mild to moderate anxiety and depression were observed in both groups.
Despite greater knowledge of how to protect themselves than the general population, healthcare workers are also susceptible to COVID-19 infection. Occupational exposure is a very important factor. Healthcare workers have a higher vigilance about the infection in the early stage of the disease.
A systematic review and meta-analysis of the efficacy and safety of arbidol in the treatment of coronavirus disease 2019
Authors: Wang Xuemei , Xie Ping , Sun Guojuan , Zhao Min , Deng Zhumei , Zhou Yunxia , Bao Shuting 
Published: July 2020

AbstractBackground:Coronavirus disease 2019 (COVID-19) is highly contagious, and the epidemic has spread to hundreds of countries around the world, and seriously threatens the life safety of people around the world. Arbidol is an antiviral drug with high potential against COVID-19, but evidence of effectiveness and safety is lacking. The systematic review protocol aims to formulate a research plan that can evaluate the efficacy and safety of arbidol for COVID-19.Methods:The retrieval time will be from the database establishment to June 2020. The retrieval database will include the Cochrane Library, PubMed, Embase, OVID, CNKI, Wanfang, VIP, CBM, etc. The primary outcome will be clinical efficacy, and the secondary results will be accompanying symptoms, time for the temperature to return to normal, time of novel coronavirus nucleic acid turning negative, blood sample test, Computed Tomography examination, length of hospitalization, adverse reactions, and adverse events. RevManV.5.3 software will be used for meta-analysis, and fixed effects model, random-effects model, subgroup analysis, and descriptive analysis will be adopted according to the heterogeneity of the research results.Results:To provide the latest evidence of clinical efficacy and safety of arbidol in the treatment of COVID-19.Conclusion:Our study will provide the latest evidence analysis of the efficacy and safety of arbidol for COVID-19, to provide evidence-based medicine for the prevention and control of this epidemic.Registration details:PROSPERO CRD42020189203.
Efficacy and safety of dapagliflozin plus saxagliptin vs monotherapy as added to metformin in patients with type 2 diabetes
Authors: Zhuang Yan , Song Jin , Ying Miaofa , Li Mingxing 
Published: July 2020

Abstract

Background:
This study aim at evaluating the efficacy and safety of dapagliflozin plus saxagliptin vs monotherapy as added to metformin in patients with type 2 diabetes mellitus (T2DM).

Method:
PubMed, Cochrane library, Embase, CNKI and Wanfang databases were searched up to 31 December 2019. Randomized controlled trials (RCTs) applicable in dapagliflozin plus saxagliptin vs monotherapy as added to metformin in the treatment of T2DM were included. The outcomes included changes in HbA1c, FPG, body weight, SBP, DBP and adverse reactions. Fixed or random effects model were used to assess these outcomes.

Results:
In this study, 8 RCTs involved 7346 patients were included. Compared with dapagliflozin plus metformin(DM) group, patients treated with dapagliflozin plus saxagliptin add on to metformin(DSM) could significantly increase the adjusted mean change levels of HbA1c, FPG, SBP and DBP(P < .00001, SMD = −4.88, 95%CI = −6.93∼−2.83; P < .00001, SMD = −6.50, 95%CI = −8.55∼−4.45; P < .00001, SMD = −0.97, 95%CI = −1.15∼−0.78; P < .00001, SMD = −2.00, 95%CI = −2.20∼−1.80), but no major difference in body weight loss showed(P = .12, SMD = 0.92, 95%CI = −0.22∼2.06). Furthermore, DSM therapy displayed better effects than saxagliptin plus metformin(SM) in the adjusted mean change levels of HbA1c, FPG, body weight and SBP(P < .00001, SMD = −7.75, 95%CI = −8.84∼−6.66; P < .00001, SMD = −7.75, 95%CI = −8.84∼−6.66; P = .04, SMD = −3.40, 95%CI = −6.64∼−0.17; P = .04, SMD = −7.75, 95%CI = −8.84∼−6.66), whereas no obvious difference in lowering DBP(P = .18, SMD = −16.35, 95%CI = −40.12∼7.41). Additionally, compared with DM and SM groups, there were no remarkable difference in the incidence of nausea, influenza, headache, diarrhea, urinary tract infection and renal failure for patients taking DSM, but the incidence of genital infection and hypoglycemia were higher in DSM group.

Conclusions:
Patients taking the DSM therapy had better effects in reducing the level of HbA1c, FPG, body weight, SBP and DBP than the DM and SM therapy. However, patients treated with DSM therapy are more likely to have hypoglycemia and genital infection. Dapagliflozin plus saxagliptin may be a suitable therapy strategy for patients with T2DM inadequately controlled with metformin, and this will provide a clinical reference for the treatment of T2DM.
Variable Mechanisms of Sudden and Unexpected Death in Cases of Occult Carcinoma of the Larynx
Authors: Byard Roger W. , Heath Karen 
Published: July 2020

Abstract
Two cases of clinically undiagnosed laryngeal squamous cell carcinomas in men aged 57 and 66 years, respectively, are reported that resulted in sudden death from upper airway occlusion. The cause of the terminal event differed between the 2 cases with acute airway narrowing being precipitated by tenacious mucopurulent secretions in case 1 and hemorrhage from surface ulceration with glottic occlusion by blood clot in case 2. At autopsy, the immediate cause of acute airway compromise in cases of space-occupying laryngeal lesions may, therefore, be due to the synergistic effects of different factors.
Developments in X-Ray Contrast Media and the Potential Impact on Computed Tomography
Authors: Schöckel Laura , Jost Gregor , Seidensticker Peter , Lengsfeld Philipp , Palkowitsch Petra , Pietsch Hubertus 
Published: July 2020

Abstract
Over the past 120 years, continuous developments in medical imaging has improved diagnosis and treatment for many diseases and has thereby improved treatment outcome and quality of life of many patients. The number of computed tomography (CT) examinations is today increasing by 4% per year worldwide, for a total of approximately 300 million CT scans per year. About 40% of CT scans are contrast enhanced. Intravenous iodinated contrast media are commonly used for contrast enhancement in CT scans to evaluate diseases and determine treatment response. The current gold standards for intravenous x-ray contrast media in CT or interventional angiography are iodinated low- and iso-osmolar compounds such as iopromide, iohexol, or iodixanol. Both classes have similar and favorable efficacy and safety profiles. Although iodine is biologically inert, iodinated contrast media can cause adverse reactions. In the future, one possibility would be to develop iodine-free contrast media that are better suited to higher x-ray tube voltage ranges, allowing greater flexibility for scanning protocols and thus leading to techniques that can provide equivalent diagnostic value at lower doses of radiation. Iodine-free contrast media would in addition provide an alternative to the market standard that could offer benefits for patients with known reactions to low-osmolality contrast media or thyroid disorders. The development of a new contrast medium, however, needs to be put in context with all upcoming technological advances in x-ray and CT. New detector technologies and artificial intelligence algorithms will in the future also improve the CT image reconstruction enabling the reduction of contrast media and radiation doses.
Impact of Confounding Thoracic Tubes and Pleural Dehiscence Extent on Artificial Intelligence Pneumothorax Detection in Chest Radiographs
Authors: Rueckel Johannes , Trappmann Lena , Schachtner Balthasar , Wesp Philipp , Hoppe Boj Friedrich , Fink Nicola , Ricke Jens , Dinkel Julien , Ingrisch Michael , Sabel Bastian Oliver 
Published: July 2020

Objectives
We hypothesized that published performances of algorithms for artificial intelligence (AI) pneumothorax (PTX) detection in chest radiographs (CXRs) do not sufficiently consider the influence of PTX size and confounding effects caused by thoracic tubes (TTs). Therefore, we established a radiologically annotated benchmarking cohort (n = 6446) allowing for a detailed subgroup analysis.

Materials and Methods
We retrospectively identified 6434 supine CXRs, among them 1652 PTX-positive cases and 4782 PTX-negative cases. Supine CXRs were radiologically annotated for PTX size, PTX location, and inserted TTs. The diagnostic performances of 2 AI algorithms (“AI_CheXNet” [Rajpurkar et al], “AI_1.5” [Guendel et al]), both trained on publicly available datasets with labels obtained from automatic report interpretation, were quantified. The algorithms' discriminative power for PTX detection was quantified by the area under the receiver operating characteristics (AUROC), and significance analysis was based on the corresponding 95% confidence interval. A detailed subgroup analysis was performed to quantify the influence of PTX size and the confounding effects caused by inserted TTs.

Results
Algorithm performance was quantified as follows: overall performance with AUROCs of 0.704 (AI_1.5) / 0.765 (AI_CheXNet) for unilateral PTXs, AUROCs of 0.666 (AI_1.5) / 0.722 (AI_CheXNet) for unilateral PTXs smaller than 1 cm, and AUROCs of 0.735 (AI_1.5) / 0.818 (AI_CheXNet) for unilateral PTXs larger than 2 cm. Subgroup analysis identified TTs to be strong confounders that significantly influence algorithm performance: Discriminative power is completely eliminated by analyzing PTX-positive cases without TTs referenced to control PTX-negative cases with inserted TTs. Contrarily, AUROCs increased up to 0.875 (AI_CheXNet) for large PTX-positive cases with inserted TTs referenced to control cases without TTs.

Conclusions
Our detailed subgroup analysis demonstrated that the performance of established AI algorithms for PTX detection trained on public datasets strongly depends on PTX size and is significantly biased by confounding image features, such as inserted TTS. Our established, clinically relevant and radiologically annotated benchmarking cohort might be of great benefit for ongoing algorithm development.
Management of Mid-Vault Asymmetry in Secondary Unilateral Cleft Lip-Nose Deformity
Authors: Park Joo Seok , Jeong Hyung Hwa , Koh Kyung S. 
Published: July 2020

Abstract
The focus of secondary rhinoplasty for patients with a cleft lip after facial growth has been on correcting nasal tip asymmetry and distorted cleft-side lower lateral cartilage. However, some patients present with mid-vault asymmetry even after secondary rhinoplasty. The authors propose camouflage procedures for patients with a unilateral cleft lip and without symptoms of nasal airway obstruction. In camouflage procedures, autologous cartilage or acellular dermal matrix was used for onlay grafting and placed on the upper lateral cartilage. In this report, case examples are described to illustrate the surgical techniques and results. This method enables the correction of mid-vault asymmetry without the use of an additional septal spreader graft.
The Pericranial Flap as a Salvage Procedure in Pediatric Neurosurgical Complications
Authors: Karami Reem A. , Atallah Georgio M. , Ghanem Odette Abou , Abu Sittah Ghassan , Ibrahim Amir E. 
Published: July 2020

Abstract
The pericranium is a vascularized structure that can be used for the treatment of complex scalp and skull defects. It is also utilized as a prophylactic measure to prevent wound complications in high-risk patients. In this study, we looked at the use of the pericranial flap in pediatric patients. A retrospective chart review was done in the American University of Beirut Medical Center from February 2010 to 2020. Ten pediatric patients were identified who required either prophylactic pericranial flap (n
=
3) or for treatment of a chronic draining sinus (n =
7). Patients were followed up for an average of 23 days. There were no cases of infection, hematoma, seroma, or meningitis. Only 1 case developed dehiscence of the skin. It was managed conservatively and healed within 2 weeks. The pericranial flap is a workhorse flap for scalp and skull reconstruction, with no donor site morbidity and thus should always be considered.
Early Screening of Risk for Multidrug-Resistant Organisms in the Emergency Department in Patients With Pneumonia and Early Septic Shock: Single-Center, Retrospective Cohort Study
Authors: Yiang Giou-Teng , Tzeng I-Shiang , Shui Hao-Ai , Wu Meng-Yu , Peng Ming-Yieh , Chan Chih-Yu , Chan Edward D. , Wu Yao-Kuang , Lan Chou-Chin , Yang Mei-Chen , Huang Kuo-Liang , Wu Chih-Wei , Chang Chia-Hui , Su Wen-Lin 
Published: July 2020

ABSTRACT

Objectives:
Pneumonia is the fourth leading cause of death globally, with rapid progression during sepsis. Multidrug-resistant organisms (MDROs) are becoming more common with some healthcare-associated pneumonia events. Early detection of MDRO risk improves the outcomes; however, MDROs risk in pneumonia with sepsis is unknown. This study investigated the disease outcomes of pneumonia with septic shock in patients admitted in the emergency department (ED) intensive care unit (ICU), a population with a high prevalence of MDROs, after early screening of MDROs risk.

Methods:
In this retrospective cohort study, patients with pneumonia and early septic shock (n = 533) admitted to the ED at the Taipei Tzu Chi Hospital from 2013 to 2019 were selected. The study population was divided into four subgroups after the MDROs risk and screening procedure were completed within 1 or 6 h of admission. ICU mortality and multidrug antibiotic therapy were compared.

Results:
The high-risk MDROs groups had higher percentage of P aeruginosa than the low-risk group. Furthermore, the appropriate ED first antibiotics were higher in the 1-h subgroup than in the 6-h subgroup of the high-risk MDROs group. In multivariate analysis, the 6-h high-risk MDROs group had an adjusted odds ratio of 7.191 (95% CI: 2.911–17.767, P < 0.001) and 2.917 (95% CI: 1.456–5.847, P = 0.003) for ICU mortality and multidrug therapy in the ICU, respectively, after adjusting for other confounding factors.

Conclusions:
MDRO screening within 1 h is recommended following admission of patients with pneumonia and early septic shock in the ED, especially in areas with a high prevalence of MDROs.
Quantification of Intraoperative Blood Loss in a Simulated Scenario Using a Novel Device
Authors: Piekarski Florian , Gerdessen Lara , Schmitt Elke , Friedrichson Benjamin , Neef Vanessa , Meybohm Patrick , Zacharowski Kai , Raimann Florian J. , Wunderer Florian 
Published: July 2020

ABSTRACT

Background:
Particularly for protracted bleeding situations, the realization of a relevant blood loss is necessary for early initiation of therapy to avoid hemodynamic instability and shock. The frequently used visual assessment of blood loss is known to be incorrect. An innovative option to address this problem is a mobile application using colorimetric image correction and analysis.

Methods:
The objective of this study was to evaluate the clinical applicability and accuracy of a novel mobile device application using colorimetric image correction and analysis for blood loss estimation. Scenarios of blood-filled surgical sponges were created to evaluate the accuracy of colorimetric-based blood loss estimation and visual and gravimetric blood loss estimation.

Results:
Fifty-three anesthesiologists ran through the scenarios. The estimated blood loss correlated the least with the reference blood loss in the visual technique (Rho: 0.52; P < 3.7×10−16), followed by the gravimetric technique (Rho: 0.73; P = 2.8×10−05). The best correlation was found in the colorimetric blood loss measurement (Rho: 0.77; P = 3.53×10−06). A median overestimation per scenario of 133.0 mL (interquartile range [IQR] 33.0 mL–283.0 mL) was observed when using the visual method, whereas 32.5 mL (IQR 10.8 mL–44.0 mL) was overestimated with the gravimetric method and 31 mL (IQR 17.0 mL–42.8 mL) with the colorimetric method. Especially in the case of blood loss underestimation, the application has the least deviation from the reference.

Conclusion:
The blood loss measured in the sponges correlated strong with the reference blood loss, showing the smallest median overestimation and the smallest deviation in underestimation. The visual estimation shows serious errors, where the gravimetric method is prone to errors, especially in dilution. The colorimetric method offers an easily implementable possibility to monitor blood loss in real time and to initiate early diagnostic and therapeutic measures in case of persistent blood loss. The influence of real-time estimation of colorimetric blood loss on transfusion decisions should be the subject of future studies.
Effects of Systemic Hypothermia on Microcirculation in Conditions of Hemodynamic Stability and in Hemorrhagic Shock
Authors: Caminos Eguillor Juan Francisco , Ferrara Gonzalo , Kanoore Edul Vanina Siham , Buscetti María Guillermina , Canales Héctor Saúl , Lattanzio Bernardo , Gatti Luis , Gutierrez Facundo Javier , Dubin Arnaldo 
Published: July 2020

ABSTRACT

Introduction:
Although hypothermia is independently associated with an increased mortality in trauma patients, it might be an effective therapeutic approach for otherwise lethal hemorrhage. The effect of hypothermia on microcirculation, however, has been poorly studied in this setting. Our goal was to characterize the effects of hypothermia on microcirculation in normal conditions and in severe hemorrhagic shock.

Methods:
In anesthetized and mechanically ventilated sheep, we measured cardiac output (CO), renal blood flow (RBF), and systemic and renal O2 consumption (VO2). Cortical renal, intestinal villi, and sublingual microcirculation was assessed by IDF-videomicroscopy. After basal measurements, sheep were assigned to hypothermia (n = 12) and normothermia (n = 12) groups. Central temperature was reduced to ∼34°C and maintained at baseline in each group, respectively. Measurements were repeated after 1 h of hemodynamic stable conditions and 1 h of severe hemorrhagic shock.

Results:
In conditions of hemodynamic stability, the hypothermia group showed lower CO, RBF, and systemic and renal VO2 than the normothermia group. Red blood cell velocity was also lower in renal, villi, and sublingual microvascular beds (836 ± 195 vs. 1,066 ± 162, 916 ± 105 vs. 1051 ± 41, and 970 ± 182 vs. 1,102 ± 49 μm/s, respectively; P < 0.0001 for all). In hemorrhagic shock, most of the microvascular variables were similarly compromised in both the groups. In hypo- and normothermia groups, the percentage of reduction in perfused vascular density was higher in renal than in intestinal and sublingual microcirculation (66 ± 31 vs. 31 ± 23 and 15 ± 15%, and 78 ± 26 vs. 32 ± 37 and 18 ± 21%, P < 0.01 for both).

Conclusions:
This is the first experimental study assessing the effect of systemic hypothermia on microcirculation in severe hemorrhagic shock. The main finding was that hypothermia did not hamper additionally the microcirculatory derangements induced by hemorrhagic shock. In addition, renal microcirculation was more susceptible to hemorrhagic shock than villi and sublingual microcirculation.
Luteolin Suppresses Sepsis-Induced Cold-Inducible RNA-Binding Protein Production and Lung Injury in Neonatal Mice
Authors: Zhang Yuanyuan , Zhang Jia , Ren Yifan , Li Teng , Bi Jianbin , Du Zhaoqing , Wu Rongqian 
Published: July 2020

ABSTRACT
Neonatal sepsis is a life-threatening inflammatory condition. Extracellular cold-inducible RNA-binding protein (CIRP), a proinflammatory mediator, plays a critical role in the pathogenesis of sepsis-induced lung injury in neonates. Luteolin, a polyphenolic flavonoid, has potent anti-inflammatory properties. However, the effects of luteolin on CIRP production and neonatal sepsis-induced lung injury remained unknown. We therefore hypothesize that treatment with luteolin suppresses CIRP production and attenuates lung injury in neonatal sepsis. To study this, sepsis was induced in C57BL/6J mouse pups (5–7 days) by intraperitoneal cecal slurry injection (CSI). One hour after CSI, luteolin (10 mg/kg body weight) or vehicle (normal saline) was administered through intraperitoneal injection. CIRP mRNA and protein were determined and lung injury was assessed at 10 h after CSI. Our results showed that administration of luteolin decreased CIRP mRNA and protein, improved lung architecture, reduced lung edema, and apoptosis after CSI. To examine the direct effect of luteolin on CIRP production, peritoneal macrophages were isolated from neonatal mice and stimulated with 100 ng/mL LPS with or without the presence of luteolin. The result indicates that luteolin directly inhibited LPS-induced CIRP production in neonatal macrophages. In addition, luteolin also downregulated hypoxia-inducible factor-1α (HIF-1α) and NOD-like receptor 3 (NLRP3) expression in septic neonates and in LPS-stimulated neonatal macrophages. In conclusion, administration of luteolin suppresses CIRP production and attenuates lung injury in neonatal sepsis. The beneficial effect of luteolin may be related to downregulation of HIF-1α and NLRP3 expression in neonatal macrophages. Luteolin may be developed as an adjunctive therapy for neonatal sepsis.