bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report
Authors: Ferry Joseph Frank , Youssef Samuel , Wu Pierce , Hegerova Livia 
Published: June 2020

Abstract
Background
Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5–10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5–10%.
Case presentation:
We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi.
Conclusions
Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery.
Attitude and education needs of emergency doctors in providing palliative and end-of-life care in Hong Kong: A prospective cross-sectional analysis based on self-reported surveys
Authors: Wong Kwun Hang , Yang Marc Li Chuan , Woo Raymond Kam Wing , Wong Oi Fung , Kwong Wing Yan , Tse Choi Fung , Lam Shing Kit , Ma Hin Man , Lit Chau Hung Albert , Shih Yau Ngai 
Published: June 2020

Abstract
Background: With the aging population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are brought into the spotlight. The Accident and Emergency Department (AED) is often the first medical contact for the public. The objectives of this study were to evaluate the attitude of emergency doctors in providing palliative and EOL cares in Hong Kong, and to investigate the education needs for emergency doctors in these areas.Methods: A questionnaire study was conducted involving emergency doctors from 6 AEDs in Hong Kong. The questionnaires covered the attitudes of emergency doctors towards the palliative and EOL cares in terms of the role of palliative and EOL care in AED, the specific obstacles in providing such cares, their comfort level with the cares and further education needs The attitudes of emergency doctors from the AEDs with EOL care service were compared with those from the AEDs without such services. Results: One hundred and forty-five emergency doctors completed the questionnaires, in which 60 respondents from the AEDs with EOL care service. Significant proportions from both groups recognized that palliative and EOL cares were an important competence for them, but its role and priority in emergency care were uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Participants from AEDs with EOL care service were more comfortable to provide the care and discuss it with patients and relatives. Further education needs identified including management of physical complaints, communication skills and EOL care ethics.Conclusions: The study identified obstacles in promoting palliative and EOL cares in the AEDs in Hong Kong. Education on the communication skills and ethical issues were necessary as well. With the combination of elements of routine AED practice and the basic palliative medicine skill set, it would promote the development of this emerging field in Emergency Medicine in the future.
Risk factors of depression in type 2 diabetes mellitus with lower extremity arterial disease in China
Authors: Chai Sanbao , Zhang Xiaomei , Yuan Ning , Liu Yufang , Xin Sixu , Sun Jianbin , Ji Linong 
Published: June 2020

Abstract
BackgroundWe aimed to evaluate the prevalence and risk factors of depression in type 2 diabetes mellitus with lower extremity arterial disease. Methods: Four hundred and forty-one patients with type 2 diabetes mellitus were recruited from Peking University of International Hospital. All patients completed the Self-rating Depression Scale, which includes 20 items, using a 4-point scale. Univariable and multivariable logistic regression was conducted to investigate risk factors of depression in patients with lower extremity arterial disease. Results: The prevalence of depression in lower extremity arterial disease group was significantly higher than that in non- lower extremity arterial disease group(25% vs 16%, P = 0.018). In lower extremity arterial disease group(n = 215), depression score(46.18 ± 7.38 vs 44.03 ± 6.53, P = 0.003) significantly increased compared with non lower extremity arterial disease group(n = 226). Compared with male depressive patients, the proportion of female depressive patients(38% vs 15%, P = 0.003) was significantly higher in lower extremity arterial disease group. The depression score of female depressive patients(57.83 ± 3.29 vs 55.26 ± 1.59, P = 0.003) was significantly higher than that of male depressive patients. An increased risk of depression in female patients(crude OR: 2.50, 95% CI: 1.38–4.54, P = 0.003; adjusted OR: 2.34, 95% CI: 1.26–4.36, P = 0.008) and in patients with low body mass index(crude OR: 0.88, 95% CI: 0.80–0.96, P = 0.005; adjusted OR: 0.89, 95% CI: 0.81–0.97, P = 0.011) was detected. Conclusion: Both low body mass index and female are risk factors for depression.
Histone Methyltransferase WHSC1 Inhibits Colorectal Cancer Cell Apoptosis via Targeting Anti-apoptotic BCL2
Authors: Wang Yu , Tang Xin , Guo Mei , Sun Gang , Zhou Kun , Pang Wenjing , Hou Yichao , Hou Lidan , Zhu Liming , Cao Dachun , Meng Xiangjun 
Published: June 2020

Abstract
Background: WHSC1 is a histone methyltransferase that facilitates histone H3 lysine 36 dimethylation (H3K36me2), which is a permissive mark associated with active transcription. Colorectal cancer (CRC) is the 4th deadliest and 3rd most frequent cancer globally. However, the role of WHSC1 in CRC progression remains unknown.Methods: qRT-PCR, immunoblotting assays (WB), and immunohistochemistry (IHC) staining was performed to investigate WHSC1 expression levels in CRC tissues and normal tissues. CCK-8 assays, colony formation assays, and flow cytometry were also used to assess the effect of WHSC1 depletion in CRC cell proliferation, apoptosis and oxaliplatin sensitivity in vitro. A cell line-derived xenograft model in nude mice was performed to determine the role of WHSC1 in CRC cell apoptosis in vivo.Results: WHSC1 as well as H3K36me2 were highly expressed in clinical CRC tissues compared with in normal counterparts. High WHSC1 expression was correlated with poorer prognosis in CRC patients. Knockdown of WHSC1 significantly promoted CRC cell apoptosis and inhibited tumour growth in vivo. Further mechanistic investigation revealed that WHSC1 directly binds to the promoter region of BCL2 gene and regulate its H3K36 dimethylation level, so BCL2 expression is markedly decreased after WHSC1 depletion.Conclusions: Our findings demonstrated that knockdown of WHSC1 promoted colon cancer cell apoptosis and suppressed CRC tumorigenesis through targeting BCL2 transcription, suggesting WHSC1 activity may be a potential therapeutic target for the treatment of CRC.
Gene Expression Patterns Associated With Tumor-Infiltrating CD4+ and CD8+ T Cells In Invasive Breast Carcinomas
Authors: Wang Zhanwei , Xu Jiamin , Yang Xi , Pan Yuefen , Shen Junjun , Liu Jin , Han Shuwen 
Published: June 2020

Abstract
Objective This study investigated the gene expression patterns associated with tumor-infiltrating CD4 + and CD8 + T cells in invasive breast carcinomas.Methods The gene expression data and corresponding clinical phenotype data from the Cancer Genome Atlas Breast Invasive Carcinoma (TCGA-BRCA) were downloaded. The stromal and immune score were calculated using ESTIMATE. The differentially expressed genes (DEGs) with a high vs. low stromal score and a high vs. low immune score were screened and then functionally enriched. The tumor-infiltrating immune cells were investigated using the Cibersort algorithm, and the CD4 + and CD8 + T cell-related genes were identified using a Spearman correlation test of infiltrating abundance with the DEGs. Moreover, the miRNA-mRNA pairs and lncRNA-miRNA pairs were predicted to construct the competing endogenous RNAs (ceRNA) network. Kaplan-Meier (K-M) survival curves were also plotted.Results In total, 478 DEGs with a high vs. low stromal score and 796 DEGs with a high vs. low immune score were identified. In addition, 39 CD4 + T cell-related genes and 78 CD8 + T cell-related genes were identified; of these, 14 genes were significantly associated with the prognosis of BRCA patients. Moreover, for CD4 + T cell-related genes, the chr22-38_28785274-29006793.1–miR-34a/c-5p–CAPN6 axis was identified from the ceRNA network, whereas the chr22-38_28785274-29006793.1–miR-494-3p–SLC9A7 axis was identified for CD8 + T cell-related genes.Conclusions The chr22-38_28785274-29006793.1–miR-34a/c-5p–CAPN6 axis and the chr22-38_28785274-29006793.1–miR-494-3p–SLC9A7 axis might regulate cellular activities associated with CD4 + and CD8 + T cell infiltration, respectively, in BRCA.
Sustained Effects on Lung Function in Community Members Following Exposure to Hazardous PM2.5 Levels from Wildfire Smoke
Authors: Orr Ava , Migliaccio Cristi A.L. , Buford Mary , Dykstra Sarah , Migliaccio Christopher 
Published: June 2020

Abstract

Background: Extreme wildfire events are becoming more common and while the immediate risks to susceptible populations (i.e. elderly, asthmatics) are appreciated, the long-term health effects are not known. Historically, wildfire smoke exposure studies have consisted almost exclusively of retroactive health reports, including emergency department visits, hospital admissions, provider visits with emphasis on specific ICD codes. In 2017, the Seeley Lake, MT area experienced unprecedented levels of wildfire smoke from July 31 to September 18, with a daily average of 220.9 mg/m3. The aim of this study was to provide health assessments in the community as temporally close to the fires as possible and evaluate potential adverse health effects with multiple visits over two years. Additionally, the members of the community of Thompson Falls, MT were evaluated in 2018 as a comparison, due to their Northern Rockies location and 5-fold less smoke exposure during the same time period.Methods: Using the IPHARM (Improving Health Among Rural Montanans) infrastructure and experience to perform mobile health screenings, the Seeley Lake community was visited following the fires. The study resulted in the recruitment of a cohort (n=95, average age: 63 years), for a rapid response screening activity shortly following the wildland fire event, and two follow-up visits in 2018 and 2019. Results: The community experienced 35 of 49 days with >150 mg/m3 of PM2.5 which fell within the range of the Environmental Protection Agency designation of “very unhealthy”. Analysis of spirometry data found a significant decrease in lung function (FEV1/FVC ratio: forced expiratory volume in first second/forced vital capacity) and a more than doubling of participants that fell below the lower limit of normal (13.2% in 2017 to 41.7% in 2018) one year following the wildfire event, and remained decreased two years (35.9%) post exposure. In addition, observed FEV1 was significantly lower than predicted values. Conclusion: These findings suggest that wildfire smoke can have long-lasting effects on human health. As wildfires continue to increase both here and globally, understanding the health implications is vital to understanding the respiratory impacts of these events as well as developing public health strategies to mitigate the effects.
Salvage Chemoradiation Therapy for Recurrence After Radical Surgery or Palliative Surgery in Esophageal Cancer Patients: A Prospective, Multicenter Clinical Trial Protocol
Authors: Chang Xiao , Deng Lei , Ni Wenjie , Li Chen , Han Weiming , Gao Linrui , Wang Shijia , Zhou Zongmei , Chen Dongfu , Feng Qinfu , Liang Jun , Bi Nan , Lv Jima , Gao Shugeng , Mao Yousheng , Xue Qi , Xiao Zefen 
Published: June 2020

Abstract
Background: Currently, adjuvant therapy is not recommended for patients with thoracic esophageal squamous cell carcinoma (TESCC) after radical surgery, and a proportion of these patients go on to develop locoregional recurrence (LRR) within 2 years. Besides, there is no evidence for salvage chemoradiation therapy (CRT) in patients with residual tumor after esophagectomy (R1/R2 resection). In addition, factors like different failure patterns and relationship with normal organs influence the decision for salvage strategy. Here, we aimed to design a modularized salvage CRT strategy for patients without a chance of salvage surgery according to different failure patterns (including R1/R2 resection), and further evaluated its efficacy and safety.Methods: Our study was designed as a one arm, multicenter, prospective clinical trial. All enrolled patients were stratified in a stepwise manner based on the nature of surgery (R0 or R1/2), recurrent lesion diameter, involved regions, and time-to-recurrence, and were further assigned to undergo either elective nodal irradiation or involved field irradiation. Then, radiation technique and dose prescription were modified according to the distance from the recurrent lesion to the thoracic stomach or intestine. Ultimately, four treatment plans were established.Discussion: This prospective study provided high-level evidence for clinical salvage management in patients with TESCC who developed LRR after radical surgery or those who underwent R1/R2 resection. Trial registration: ClinicalTrials.gov, NCT03731442, Registered 12 Octomber2018, https://clinicaltrials.gov/NCT03731442
Different Effects of Metabolic Syndrome on Dementia According to Dementia Type: Analysis Based on the National Health Insurance Service Database of Gangwon Province in South Korea
Authors: KIM YEO JIN , Kim Sang Mi , Jeong Dae Hyun , Lee Sang-Kyu , Ahn Moo-Eob , Ryu Ohk-Hyun 
Published: June 2020

Abstract
BackgroundMetabolic syndrome is a cluster of conditions that occur together, increasing the risk of cardiovascular disease. However, the relationshipbetween metabolic syndrome and dementia has remained controversial. Using nationwide population cohort data, we investigated the associationbetween metabolic syndrome and dementia,according to the dementia type.MethodsWe analyzed data of 84,144 individuals,in the aged group of more than 60 years,between January 1, 2009,to December 31, 2009, at Gangwon province by using the information of the(Korean) National Health Insurance Service. After eight years of gap, in 2017, we investigated the relationship between metabolic syndrome and dementia. We classified Dementia either as dementia of the Alzheimer type (AD) or vascular dementia (VD). AD and VD were defined according to criteria in the International Classification of Disease, Tenth Revision, Clinical Modification codes.ResultsMetabolic syndrome was associated with AD, while it was not associated with VD. All five components of metabolic syndrome were associated with AD, independently. However, among components of metabolic syndrome, only the high glucose level was associated with VD. Body Mass Index (BMI), fasting glucose and smoking were also associated with AD. A history of the previous stroke was associated with both AD and VD.ConclusionsMetabolic syndrome was associated with AD, while was not associated with VD. VD was associated only with several risk factors that could affect the vascular state rather than a metabolic syndrome. We suggested that the effect of metabolic syndrome on dementia would be different depending on the type of dementia.
Prevalence and Associated Factors of the Metabolic Syndrome Among a National Population Based Sample of 18-108 Year-olds in Iraq: Results of the 2015 Steps Survey
Authors: Pengpid Supa , Peltzer Karl 
Published: June 2020

Abstract
Background:Thisstudyaimed to assess the prevalence and associated factors of the metabolic syndrome (MetS)among 18-108 year-old persons inIraq.Method: Nationally representative cross-sectional data were analysed from 3,703 18-108 year old persons (32 years median age) that participated in the “2015Iraq STEPS survey,” with complete MetS measurements.Results: Results indicate that39.4% of 18-108 year-olds had MetS (harmonized definition), 39.8% among women and 39.0% among men, and the mean number of MetS components was 2.4 (SD=1.4), 2.4(SD=1.4) among women and 1.5 (SD=1.4) among men. In adjusted logistic regression analysis, older age, current and past smoking and general overweight and obesity were associated with MetS. In addition, in unadjusted analysis, having lower education, ever alcohol use, and low physical activity were associated with MetS. In adjusted linear regression analysis, male sex, lower education, and obesity were associated with greater number of MetS components.Conclusion: Two in five participants had MetS and several associated indicators were found which couldbe supportive in designing interventionactivities.
“We Can’t Handle Things We don’t Know About”: Perceived Neurorehabilitation Needs and Challenges for Malawian Paediatric Cerebral Malaria Survivors
Authors: Boubour Alexandra , Mboma Sebastian , Võ Tracy , Birbeck Gretchen L. , Seydel Karl B. , Mallewa Macpherson , Chinguo Dorothy , Gladstone Melissa , Mohamed Suraya , Thakur Kiran T. 
Published: June 2020

Abstract
Background: We sought to identify perceptions of neurorehabilitation needs and challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Methods: An exploratory approach was used to qualitatively investigate current available neurorehabilitation services; investigate the needs of caregivers, CM survivors, providers, and the community; and identify challenges and methods to accessing neurorehabilitation services. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs).Results: Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs). FGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable.Conclusions: There is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.
Clinical Characteristics, Risk Factors and Outcomes of Mixed Candida Albicans/Bacterial Bloodstream Infections
Authors: Zhong Li , Zhang Shufang , Tang Kankai , Zhou Feifei , Zheng Cheng , Zhang Kai , Cai Jiachang , Zhou Hongwei , Wang Yesong , Tian Baoping , Zhang Zhaocai , Cui Wei , Dong Zhaohui , Zhang Gensheng 
Published: June 2020

Abstract
Purpose: The purpose of this study was to explore the clinical features, risk factors, and outcomes of the mixed Candida albicans/bacterial bloodstream infections (mixed-CA/B-BSIs) compared with monomicrobial Candida albicans bloodstream infection (mono-CA-BSI) in adult patients in China.Methods: All adult hospitalized cases of Candida albicans bloodstream infection (CA-BSI) were recruited in the retrospective observational study from January 1, 2013, to December 31, 2018.Results: Of the 117 patients with CA-BSI, 24 patients (20.5%) were mixed-CA/B-BSIs. The most common co-pathogens were Coagulase-negative Staphylococcus (24.0%), followed by Klebsiella pneumoniae (20.0%) and Staphylococcus aureus (16.0%). In multivariable analysis, prior ICU stay>2days (adjusted odds ratio [OR], 7.808; 95% confidence interval [CI], 1.264-48.233) was an independent factor of mixed-CA/B-BSIs. In comparison with mono-CA-BSI, patients with mixed-CA/B-BSIs developed with prolonged length of mechanical ventilation [17.5(4.5,34.8) vs. 3.0(0.0,24.5), P=0.019], prolonged length of ICU stay [22.0(14.3, 42.2) vs. 8.0(0.0, 31.5), P=0.010], whereas the mortality was not significantly different. Conclusions: A high rate of mixed-CA/B-BSIs is among CA-BSI, and Coagulase-negative Staphylococcus is the predominant co-existed species. Prior ICU stay>2 days is an independent risk factor for mixed-CA/B-BSIs. Although there is no difference in mortality, the outcomes of patients with mixed-CA/B-BSIs including prolonged length of mechanical ventilation and prolonged length of ICU stay were worse than those with mono-CA-BSI, which deserves further attention of clinicians.