bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors and pregnancy outcomes associated with retinopathy in patients presenting with severe preeclampsia
Authors: Ye Lei , Shi Meng-dan , Zhang Yan-ping , Zhang Jia-shuo , Zhu Cai-rong , Zhou Rong 
Published: March 2020

Abstract
The visual system was reported to be affected in over half of patients with preeclampsia (PE), though fundus examination was performed only among patients complaining of visual symptoms. Delayed diagnosis and treatment of PE-related retinopathy may lead to permanent visual impairment. Therefore, we hypothesize that some clinical or laboratory parameters could predict severity of retinal damage.
The aim of the study was to explore the risk factors for retinopathy in severe preeclampsia (sPE) and investigate pregnancy outcomes with different degrees of retinopathy.
This retrospective cohort study included women with sPE who underwent ophthalmoscopy and delivered after admission to West China Second University Hospital, between June 2013 and December 2016. Clinical and laboratory characteristics were retrieved from medical records. Patients confirmed with retinopathy were followed up with telephones. Multiple logistic regression analysis was performed to identify risk factors of PE-related retinopathy.
Five hundred thirty-four patients were included, of which 17.6% having stage-1/2 retinopathy, 14.6% having stage-3/4 retinopathy, and 67.8% having normal retina. Compared with patients without retinopathy, patients with stage 3/4 retinopathy were more likely to have preterm-birth and low-birth-weight babies. Significant risk factors for stage 3/4 retinopathy in sPE included severe hypertension (odds ratio [OR] 2.24, 95% confidence interval [CI]: 1.10–4.56), elevated white blood cell (WBC) counts (OR 1.88, 95% CI: 1.05–3.35), decreased platelet counts (OR 2.12, 95% CI: 1.07–4.48), lactate dehydrogenase (LDH) concentration of >800 IU/L (OR 2.31, 95% CI: 1.05–5.06), low hemoglobin (HGB) concentrations of <110 g/L (OR 3.73, 95% CI: 1.21–11.47), 24-hour proteinuria of 2 to 5 g (OR 6.39, 95% CI: 2.84–14.39), and >5 g (OR 8.66, 95% CI: 3.67–20.44).
This study confirms the association between retinopathy and preterm-birth and low-birth weight in sPE. The risk factors for severe PE-related retinopathy, including severe hypertension, platelet and WBC count, HGB and LDH concentration, and proteinuria, are associated with the development of retinopathy. Routine and repeated fundus examination is recommended for maternal monitoring in sPE.
Insights into the role of tumor abnormal protein in early diagnosis of cancer
Authors: Li Lu-Xi , Zhang Bin , Gong Rui-Zhi 
Published: March 2020

Abstract
The aim of this study was to evaluate the clinical use of tumor abnormal protein (TAP) in the diagnosis of different cancers.
Totally 394 patients were divided into 4 groups, namely 100 healthy volunteers, 167 patients with cancer, 20 subjects with precancerous lesions, and 107 subjects with benign lesions. TAP was detected in 4 groups of research subjects using a TAP testing kit and examination system. We correlated TAP levels with a wide variety of clinical indicators as well as established cancer markers, including alpha fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9). Besides, the changes of TAP level in 51 patients with liver cancer before and after surgery, and overall survival of patients with high or low TAP expression in pancreatic, gallbladder, bile duct, and liver cancers were analyzed.
Statistically significant difference was observed in the TAP-positive ratio among subjects with cancer (79.6%) and precancerous lesions (45.0%) compared to the healthy volunteers (4.0%). TAP expression in different cancers was characterized by high sensitivity (79.64%), specificity (89.87%), positive and negative predictive value (85.25% and 85.71%), overall compliance rate (85.53%) but low omission and mistake diagnostic rate (20.36% and 10.13%), Youden index (0.6951). In addition, there was no significant difference among patients with different types of cancer (χ
2 = 2.886, P = .410), and TAP expression was shown to be correlated with AFP in liver cancer (P = .034) but not with CA19-9 in pancreatic cancer (P = .241). Moreover, the overall survival of patients with low expression of TAP in pancreatic, gallbladder, bile duct, and liver cancers were significantly higher than of patients with high expression of TAP. Compared with the preoperative patients with cancer, TAP levels decreased dramatically among postoperative subjects (P < .001).
In summary, TAP might hold promise in serving as universal indicator for the diagnosis of different cancers.
Serum ammonia levels on admission for predicting sepsis patient mortality at D28 in the emergency department
Authors: Zhao Jie , He Yarong , Xu Ping , Liu Junzhao , Ye Sheng , Cao Yu 
Published: March 2020

Abstract
We assessed the predictive value of serum ammonia level on admission for the 28-day mortality of patients with sepsis.
We retrospectively included septic patients admitted to the emergency department of West China Hospital, Sichuan University and The Fourth People's Hospital of Zigong city from June 2017 to May 2018. Patients were divided into 2 groups according to 28-day survival. Comparisons of serum ammonia level and sequential organ failure assessment (SOFA) score were made between 2 groups. Multivariate logistic regression models were employed to determine independent risk factors affecting 28-day mortality rate, and receiver operating characteristic (ROC) curve was also used to evaluate the efficacy of risk factors.
Total of 316 patients were included into the study, 221 survived to 28 days and 95 were died before 28 days. The 28-day mortality rate was 30.06%. Multivariate logistic regression analyses revealed that the ammonia level, C reactive protein, SOFA score, and the leukocyte were independent risk factors for the 28-day mortality rate. In predicting the 28-day mortality rate, the SOFA score presented an area under the ROC curve (AUC) of 0.815, and the ammonia levels presented the AUC of 0.813.
The ammonia level, C reactive protein, SOFA score, and the leukocyte are independent risk factors for 28-day mortality rate in septic patients. Moreover, the serum ammonia and SOFA score have similar predictive values. The serum ammonia level is also a suitable early indicator for prognostic evaluation of patients with sepsis as well.
Effects of recombinant human brain natriuretic peptide in patients with acute myocardial infarction undergoing percutaneous coronary intervention
Authors: Ning Cheng , Zheng Yawei , Li Jie , Liu Ming , Fang Zhuyuan 
Published: March 2020

Abstract

Objective:
To systematically review the effect of recombinant human brain natriuretic peptide (rhBNP) on the cardiac function in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).

Methods:
PubMed, Web of Science, the Cochrane Library, Chinese Biomedical Database (CBD), and China National Knowledge Infrastructure (CNKI) were electronically searched to collect randomized controlled trials (RCTs) of traditional exercise for patients with AMI undergoing PCI from the beginning of the database inception to January 2019. Two reviewers independently screened the literature, extracted data, and evaluated the quality of included studies. Then, meta-analysis was performed using the RevMan 5.3 software.

Results:
A total of 16 RCTs and 1551 patients were included. The results of the meta-analysis showed that, compared with the control-treated patients, rhBNP-treated patients with AMI had an increased left ventricular ejection fraction (LVEF) of 3.34% ([MD = 3.34, 95% CI (0.39,6.29), P = .03]) 1 week postoperatively, 6.22% ([MD = 6.22, 95% CI (4.15,8.28), P < .00001]) 4 weeks postoperatively, 7.34% ([mean difference (MD) = 7.34, 95% CI (4.52, 10.16), P < .00001]) 12 weeks postoperatively, and 5.32% ([MD = 5.32, 95% CI (3.05, 7.59), P < .00001]) 24 weeks postoperatively. Moreover, the heart failure (HF) recurrence of rhBNP-treated patients with AMI 12 weeks postoperatively was 0.24 times that of the control-treated patients ([risk ratio (RR) = 0.24, 95% CI (0.06, 0.92), P = .04]), and the difference was statistically significant. At the same time, rhBNP-treated patients had decreased N-terminal pro-brain natriuretic peptide (NT-proBNP) (24 hours, 48 hours, 72 hours) and aldosterone (Ald) (24 hours, 72 hours, 168 hours) levels in comparison with the control-treated patients.

Conclusion:
Current evidence shows that the application of rhBNP presents a greater clinical benefit to patients with AMI undergoing PCI. Due to the methodological bias in the included studies and small sample size, more high-quality studies are required to verify the study findings.

Systematic Review Registration Number:
PROSPERO (CRD42019126727)
Chondromyxoid fibroma of the temporal bone
Authors: Liu Tao , Yao Jing , Li Xiaoyu , Qi Xinmeng , Zhao Pengyun , Tan Zhiqiao , Wang Jie , Li Yongxin 
Published: March 2020

AbstractRationale:Chondromyxoid fibroma (CMF) is a rare form of benign bone tumor and easily misdiagnosed as fibrosarcoma. Hence, to explore the clinical manifestations, diagnostic tests, and therapeutic procedures for temporal bone cartilage myxoid fibroma, it is important to optimize patient treatment and avoid overtreatment. Previous research has discussed cases of CMF, but this paper presents a systematic, complete, and comprehensive introduction of this disease based on this case and related literature.Patient concerns:A 52-year-old male patient presented with pain in his right ear for 2 years and hearing loss in his right ear with tinnitus for 1 year. The patient had a history of hypertension for 9 years and it was well-controlled.Diagnosis:A computed tomography (CT) scan of the temporal bone showed an expansive growth on the right temporal bone plate and tympanic plate, presenting as a cloud-like ground glass opaque shadow involving the temporom and ibular joint, middle skull base, and small auditory bones. A magnetic resonance imaging (MRI) of the temporal bone showed a large and irregular soft tissue mass shadow on the right temporal bone plate. The right temporal bone plate was occupied by the lesion, consistent with a bone origin. From the results of the imaging examination of the patient, a lesion occupying the temporal bone in the right ear and mastoiditis in the right middle ear was initially diagnosed.Interventions:Right ear temporal bone tumor resection and abdominal fat extraction were conducted.Outcomes:Postoperative pathological results demonstrated myxoid fibroma of the temporal bone cartilage. No recurrence or severe complications were observed in 8 months of follow-up.Lessons:A finding of myxoid fibroma of the temporal bone cartilage is rare in the clinic. The growth of such tumors is slow. The temporal bone CT and inner ear MRI were helpful in diagnosis. Surgery was the principal treatment.
Machine-learning prediction of self-care activity by grip strengths of both hands in poststroke hemiplegia
Authors: Suzuki Makoto , Sugimura Seiichiro , Suzuki Takako , Sasaki Shotaro , Abe Naoto , Tokito Takahide , Hamaguchi Toyohiro 
Published: March 2020

Abstract
To investigate the relationships between grip strengths and self-care activities in stroke patients using a non-linear support vector machine (SVM).
Overall, 177 inpatients with poststroke hemiparesis were enrolled. Their grip strengths were measured using the Jamar dynamometer on the first day of rehabilitation training. Self-care activities were assessed by therapists using Functional Independence Measure (FIM), including items for eating, grooming, dressing the upper body, dressing the lower body, and bathing at the time of discharge. When each FIM item score was ≥6 points, the subject was considered independent. One thousand bootstrap grip strength datasets for each independence and dependence in self-care activities were generated from the actual grip strength. Thereafter, we randomly assigned the total bootstrap datasets to 90% training and 10% testing datasets and inputted the bootstrap training data into a non-linear SVM. After training, we used the SVM algorithm to predict a testing dataset for cross-validation. This validation procedure was repeated 10 times.
The SVM with grip strengths more accurately predicted independence or dependence in self-care activities than the chance level (mean ± standard deviation of accuracy rate: eating, 0.71 ± 0.04, P < .0001; grooming, 0.77 ± 0.03, P < .0001; upper-body dressing, 0.75 ± 0.03, P < .0001; lower-body dressing, 0.72 ± 0.05, P < .0001; bathing, 0.68 ± 0.03, P < .0001).
Non-linear SVM based on grip strengths can prospectively predict self-care activities.
Clinical course of non-small cell lung cancer patients with dry pleural dissemination
Authors: Kim Woojung , Park In Kyu , Park Samina , Kang Chang Hyun , Kim Young Tae 
Published: March 2020

Abstract
We investigated the prognosis of patients with dry pleural dissemination (DPD) of non-small cell lung cancer (NSCLC) and the risk factors of developing to malignant pleural effusion (MPE).
We retrospectively reviewed 104 patients with NSCLC and DPD, confirmed surgically from 1996 to 2016. Incidence rate and risk factors of MPE were analyzed statistically. The prognosis of NSCLC patients with MPE was evaluated using the Kaplan–Meier method.
The most common histologic type was adenocarcinoma in 95 (91.3%) patients. The median follow-up duration was 65.5 months and the median survival time was 37.7 months. MPE developed in 51 (49%) patients, and the median effusion-free interval was 41.9 months. The median survival time of the patients with and without MPE was not different (41.3 vs 31.7 months, P = .16). No predictive factors for the development of MPE were identified. Fifteen (14.4%) patients underwent invasive procedures for the management of MPE.
Almost half of all patients with NSCLC and DPD experienced MPE, and 14.4% patients developed symptomatic MPE requiring invasive procedures. MPE in DPD did not affect the survival in NSCLC patients.
Implementation and Early Evaluation of a Quantitative Electroencephalography Program for Seizure Detection in the PICU*
Authors: Rowberry Tracey , Kanthimathinathan Hari Krishnan , George Fay , Notghi Lesley , Gupta Rajat , Bill Peter , Wassmer Evangeline , Duncan Heather P. , Morris Kevin P. , Scholefield Barnaby R. 
Published: March 2020

Objectives:
To describe implementation and early evaluation of using quantitative electroencephalography for electrographic seizure detection by PICU clinician staff.

Design:
Prospective observational study of electrographic seizure detection by PICU clinicians in patients monitored with quantitative electroencephalography. Quantitative electroencephalography program implementation included a continuous education and training package. Continuous quantitative electroencephalography monitoring consisted of two-channel amplitude-integrated electroencephalography, color density spectral array, and raw-electroencephalography.

Setting:
PICU.

Patients:
Children less than 18 years old admitted to the PICU during the 14-month study period and deemed at risk of electrographic seizure.

Interventions:
None.

Measurements and Main Results:
Real time electrographic seizure detection by a PICU team was analyzed for diagnostic accuracy and promptness, against electrographic seizure identification by a trained neurophysiologist, retrospectively reading the same quantitative electroencephalography and blinded to patient details. One-hundred one of 1,510 consecutive admissions (6.7%) during the study period underwent quantitative electroencephalography monitoring. Status epilepticus (35%) and suspected hypoxic-ischemic injury (32%) were the most common indications for quantitative electroencephalography. Electrographic seizure was diagnosed by the neurophysiologist in 12% (n = 12) of the cohort. PICU clinicians correctly diagnosed all 12 patients (100% sensitivity and negative predictive value). An additional eleven patients had a false-positive diagnosis of electrographic seizure (false-positive rate = 52% [31–73%]) leading to a specificity of 88% (79–94%). Median time to detect seizures was 25 minutes (5–218 min). Delayed recognition of electrographic seizure (> 1 hr from onset) occurred in five patients (5/12, 42%).

Conclusions:
Early evaluation of quantitative electroencephalography program to detect electrographic seizure by PICU clinicians suggested good sensitivity for electrographic seizure detection. However, the high false-positive rate is a challenge. Ongoing work is needed to reduce the false positive diagnoses and avoid electrographic seizure detection delays. A comprehensive training program and regular refresher updates for clinical staff are key components of the program.
Hospital-Associated Venous Thromboembolism in a Pediatric Cardiac ICU: A Multivariable Predictive Algorithm to Identify Children at High Risk
Authors: Kerris Elizabeth W. J. , Sharron Matthew , Zurakowski David , Staffa Steven J. , Yurasek Greg , Diab Yaser 
Published: March 2020

Objectives:
Critically ill children with cardiac disease are at significant risk for hospital-associated venous thromboembolism, which is associated with increased morbidity, hospital length of stay, and cost. Currently, there are no widely accepted guidelines for prevention of hospital-associated venous thromboembolism in pediatrics. We aimed to develop a predictive algorithm for identifying critically ill children with cardiac disease who are at increased risk for hospital-associated venous thromboembolism as a first step to reducing hospital-associated venous thromboembolism in this population.

Design:
This is a prospective observational single-center study.

Setting:
Tertiary care referral children’s hospital cardiac ICU.

Patients:
Children less than or equal to18 years old admitted to the cardiac ICU who developed a hospital-associated venous thromboembolism from December 2013 to June 2017 were included. Odds ratios and 95% CIs are reported for multivariable predictors.

Measurements and Main Results:
A total of 2,204 separate cardiac ICU encounters were evaluated with 56 hospital-associated venous thromboembolisms identified in 52 unique patients, yielding an overall prevalence of 25 hospital-associated venous thromboembolism per 1,000 cardiac ICU encounters. We were able to create a predictive algorithm with good internal validity that performs well at predicting hospital-associated venous thromboembolism. The presence of a central venous catheter (odds ratio, 4.76; 95% CI, 2.0–11.1), sepsis (odds ratio, 3.5; 95% CI, 1.5–8.0), single ventricle disease (odds ratio, 2.2; 95% CI, 1.2–3.9), and extracorporeal membrane oxygenation support (odds ratio, 2.7; 95% CI, 1.2–5.7) were independent risk factors for hospital-associated venous thromboembolism. Encounters with hospital-associated venous thromboembolism were associated with a higher rate of stroke (17% vs 1.2%; p < 0.001).

Conclusions:
We developed a multivariable predictive algorithm to help identify children who may be at high risk of hospital-associated venous thromboembolism in the pediatric cardiac ICU.
Implementation of an Evidence-Based Guideline of Enteral Nutrition for Infants With Congenital Heart Disease: A Controlled Before-and-After Study*
Authors: Gu Ying , Hu Yan , Zhang Huiwen , Fu Weijia , Yang Yuxia , Latour Jos M. 
Published: March 2020

Objectives:
To describe the implementation process of a nutrition risk screening and assessment guideline for infants with congenital heart disease and to assess the impact of nurses’ behavior and the effect on infants’ outcomes.

Design:
A controlled before-and-after implementation study. The three dimensions of the integrated-Promoting Action on Research Implementation in Health Services framework were used to assess barriers and promoting factors.

Setting:
Cardiac center at Children’s Hospital of Fudan University, Shanghai, China.

Patients:
Infants with congenital heart disease (n = 142) and nurses (n = 100).

Interventions:
Implementation of an evidenced-based nutrition risk screening and assessment guideline.

Measurements and Main Results:
Implementation processes were assessed on nurses’ knowledge, attitude, behavior, and compliance of the guideline. Infants’ clinical outcomes were evaluated before-and-after the implementation. Knowledge, attitude, and behavior of nurses about nutrition risk screening and assessment increased significantly after implementing the guideline. Nurses’ compliance with the recommendations for nutritional risk screening improved significantly on three criteria; assessment of nutritional status stability (p < 0.001), assessment of nutritional status deterioration (p = 0.003), and nutritional assessment among infants with moderate risk and above (p < 0.001). The nurses’ compliance with the recommendations for nutrition assessment improved significantly in eight of the 10 criteria (p < 0.001). The proportion of infants receiving comprehensive nutrition assessment when they were first screened with moderate or high nutritional risk were higher in the intervention group (24.3% vs 83.3%; p < 0.001). The accuracy rates of nutrition risk screening were higher in the intervention group (52.9% vs 81.9%; p < 0.001).

Conclusions:
Using the integrated-Promoting Action on Research Implementation in Health Services framework contributed to a successful implementation of the nutrition guideline. The nurses’ knowledge, attitude, and behavior toward the nutrition guideline were positive resulting in a significantly higher nutrition assessments in infants with moderate or high nutritional risk.
Risk Factors for Electronic Prescription Errors in Pediatric Intensive Care Patients
Authors: Kadmon Gili , Shifrin Michal , Pinchover Michal , Nahum Elhanan 
Published: March 2020

Objectives:
To assess risk factors for electronic prescription errors in a PICU.

Design:
A database of electronic prescriptions issued by a computerized physician order entry with clinical decision support system was analyzed to identify risk factors for prescription errors.

Measurements and Main Results:
Of 6,250 prescriptions, 101 were associated with errors (1.6%). The error rate was twice as high in patients older than 12 years than in patients children 6–12 and 0–6 years old (2.4% vs 1.3% and 1.2%, respectively, p < 0.05). Compared with patients without errors, patients with errors had a significantly higher score on the Pediatric Index of Mortality 2 (–3.7 vs –4.5; p = 0.05), longer PICU stay (6 vs 3.1 d; p < 0.0001), and higher number of prescriptions per patient (40.8 vs. 15.7; p < 0.0001). In addition, patients with errors were more likely to have a neurologic main admission diagnosis (p = 0.008) and less likely to have a cardiologic diagnosis (p = 0.03) than patients without errors.

Conclusions:
Our findings suggest that older patient age and greater disease severity are risk factors for electronic prescription errors.