bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational impact of the mini-Clinical Evaluation Exercise in resident standardization training: a comparative study between resident and professional degree postgraduate trainees
Authors: Wu Yali , Gong Mingfu , Zhang Dong , Zhang Chun 
Published: May 2020

Objective We aimed to explore differences in the educational impact of the mini-Clinical Evaluation Exercise (mini-CEX) on resident (RE) and professional degree postgraduate (PDPG) trainees, as well as influencing factors, to provide suggestions for hospital managers, trainers, and trainees. Methods We performed a retrospective analysis of all scores among first-year resident standardization training trainees registered during 2017 to 2019 at Xinqiao Hospital of Army Medical University, to identify differences in mini-CEX outcomes between REs and PDPGs. Results We collected data of 154 registered trainees for retrospective analysis, including 57 PDPG trainees and 97 RE trainees. The mean (standard deviation) overall performance score of PDPGs was 84.18 (4.25), which was higher than that of REs (81.48 (3.35)). In terms of domain analysis, PDPG trainees performed significantly better than REs in history taking, physical examination, clinical diagnosis/treatment regimen, and the knowledge examination; communication skills/humanistic care were comparable between the groups. Conclusions PDPGs performed better than REs in overall competency, history taking, physical examination, clinical diagnosis/treatment regimen, and the knowledge examination. A better knowledge base, supervisor-dominated one-to-one teaching mode, higher self-esteem and learning goals, and more sophisticated responses to feedback were potential contributors to a superior educational impact of the mini-CEX.
The associations between serum vitamin D, calcium and uterine fibroids in Chinese women: a case-controlled study
Authors: Li Saisai , Chen Beilei , Sheng Bo , Wang Jing , Zhu Xueqiong 
Published: May 2020

Objective To investigate the associations between serum vitamin D, calcium and uterine fibroids in a Chinese female population. Methods In this case-control study, adult female patients with fibroids (cases) were compared with females without fibroids (controls) in terms of serum 25-hydroxyvitamin D (25OHD) and calcium levels. Results Out of 546 total participants (mean age, 41.68 ± 5.99 years; 279 with fibroids and 267 without fibroids), only 232 had serum 25OHD levels above the sufficient threshold (>20 ng/ml). In addition, females with fibroids had lower serum 25OHD levels versus those without fibroids. The prevalence of fibroids in females with deficient (<12 ng/ml) and insufficient (12–20 ng/ml) 25OHD levels were significantly higher than in females with sufficient (>20 ng/ml) 25OHD levels. Serum calcium levels were within normal range in both groups. Conclusion Hypovitaminosis D was highly prevalent among a population of Chinese females of reproductive-age, and serum 25OHD levels were lower in female patients with fibroids.
Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review
Authors: Li Yahua , Wang Yuhui , Chen Jianjian , Li Zhaonan , Liu Juanfang , Zhou Xueliang , Ren Kewei , Ren Jianzhuang , Han Xinwei 
Published: May 2020

Background Thoracogastric airway fistula (TGAF) is a serious complication of esophagectomy for esophageal cancer. We conducted a systematic review of the appropriate therapeutic options for acquired TGAF. Methods We performed a literature search to identify relevant studies from PubMed, EMBASE, and Web of Science using the search terms “gastric airway fistula”, “gastrotracheal fistula”, “gastrobronchial fistula”, “tracheogastric fistula”, “bronchogastric fistula”, “esophageal cancer”, and “esophagectomy”. Result Twenty-four studies (89 patients) were selected for analysis. Cough was the main clinical presentation of TGAF. The main bronchus was the most common place for fistulas (53/89), and 29 fistulas occurred in the trachea. Almost 73% (65/89) of patients underwent non-surgical treatment of whom 87.7% (57/65) received initial fistula closure. Twenty-three patients underwent surgery, including 19 (82.6%) with initial closure. The 1-, 2-, 3-, 6-, and 9-month survival rates in patients who underwent surgical repair were 95.65%, 95.65%, 82.61%, 72.73%, and 38.10%, respectively, and the equivalent survival rates in patients with tracheal stent placement were 91.67%, 86.67%, 71.67%, 36.96%, and 13.33%, respectively. Conclusion TGAF should be suspected in patients with persistent cough, especially in a recumbent position or associated with food intake. Individualized treatment should be emphasized based on the general condition of each patient.
Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease
Authors: Liu Bin , Zhang Hong , Wang Rong , Qu Hongdang , Sun Yifei , Zhang Wanlong , Zhang Shuye 
Published: May 2020

Objectives To investigate the effects of early administration of tirofiban after intravenous thrombolysis on early neurological deterioration in patients with branch atheromatous disease. Methods We analyzed clinical data from patients with branch atheromatous disease. We enrolled seven cases into the urokinase-only (UO) control group and 10 cases into the urokinase + tirofiban (UT) treatment group. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission and on days 3 and 5 after admission. Modified Rankin Scale (mRS) scores were obtained 3 months after admission. Results Significant differences between the UO and UT groups were evident on days 3 and 5 after admission. In the UT group, there was a significant difference between NIHSS scores at admission and on day 5, while there were no significant differences in scores in the UO group. The early neurological deterioration rates were not significantly different between the two groups. However, there were significant differences in these rates at 72 and 120 hours. Both the mRS scores and the prognoses at 3 months differed between the two groups. Conclusion Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration and improves the long-term prognosis of patients with branch atheromatous disease.
Analysis of survival of patients with metastatic malignant pleural mesothelioma
Authors: Billè Andrea , Okiror Lawrence , Harling Leanne , Pernazza Fausto , Muzio Alberto , Roveta Annalisa , Grosso Federica 
Published: May 2020

Aim: To report the outcomes and prognosis of patients with malignant pleural mesothelioma (MPM) who present with or develop metastases during treatment. Methods: This is a retrospective observational study of patients diagnosed with MPM over 7 years. Metastases at presentation or during follow-up were recorded. Multivariate Cox regression was used to evaluate the relationship of clinicopathologic variables and overall survival (OS). Logistic regression was used for propensity score matching of patients to assess chemotherapy treatment effect. Results: There were 367 patients included with a median age of 71 years (range, 29–91). A total of 69 patients (18%) had metastases: 14 at presentation and 55 during follow-up. Patients presenting with metastases had significantly worse median and 2-year OS compared to those developing metastases during follow-up: 13.3 months (95% confidence interval [CI], 2–24.6 months) and 0% versus 20.2 months (95% CI, 16.7–23.3 months) and 33%, respectively ( p = 0.029). Female sex, age >70 years, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors. There was no difference in OS of patients with locally advanced (T4) disease compared to metastatic disease (M1): median OS 10.7 months (95% CI, 5.9–15.6) versus 13.3 months (95% CI, 2–24.6) ( p = 0.18), respectively. Following propensity matching, sarcomatoid histology (hazard ratio, 7.86 [95% CI, 3.64–16.95]; p < 0.001) and multiple lines of chemotherapy (hazard ratio, 0.38 [95% CI, 0.19–0.84]; p = 0.015) were significant independent prognostic factors for OS. Conclusions: T4 disease carries a similar OS as metastatic MPM. Female sex, advanced age, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors.
Impact of Disadvantaged Neighborhoods and Lifestyle Factors on Adult Obesity: Evidence From a 5-Year Cohort Study in Australia
Authors: Keramat Syed Afroz , Alam Khorshed , Gow Jeff , Biddle Stuart J. H. 
Published: May 2020

Purpose: This study aims to investigate the impact of disadvantaged neighborhoods and lifestyle factors on obesity among Australian adults. Design: Quantitative, longitudinal research design. Setting: Cohort. Sample: Data for this study came from a cohort of 10 734 adults (21 468 observations) who participated in the Household, Income and Labour Dynamics in Australia survey. The participants were interviewed at baseline in 2013 and were followed up in 2017. Measures: Generalized Estimating Equation model with logistic link function was employed to examine within-person changes in obesity due to disadvantaged neighborhoods and lifestyle factors at 2-time points over a 4-year follow-up period. Results: Adults living in the most disadvantaged area were 1.22 (odds ratio [OR]: 1.22, 95% CI: 1.08-1.38) and 1.30 (OR: 1.30, 95% CI: 1.20-1.42) times, respectively, more prone to be overweight and obese compared with peers living at least disadvantaged area. Study results also revealed that adults who consume fruits regularly and perform high levels of physical activity were 6% (OR: 0.94, 95% CI: 0.91-0.98) and 12% (OR: 0.88, 95% CI: 0.85-0.92) less likely to be obese, respectively, compared to their counterparts. Current alcohol drinkers were 1.07 (OR: 1.07, 95% CI: 1.01-1.13) times more likely to be obese compared to peers not consuming alcohol. Highly psychologically distressed adults were 1.08 times (OR: 1.08, 95% CI: 1.02-1.13) more likely to be obese than their peers. Conclusion: This study contributes to the literature regarding disadvantaged neighborhoods and lifestyle factors, which have an influence on adult obesity rates and thus help health decision-makers to formulate effective obesity prevention strategies.
Safety and Effectiveness of Sedation With Adjunctive Ketamine Versus Nonketamine Sedation in the Medical Intensive Care Unit
Authors: Jaeger Melanie , Attridge Rebecca L. , Neff Luke A. , Gutierrez G. Christina 
Published: May 2020

Background: Ketamine, an N-methyl-d-aspartate receptor antagonist with sedative and analgesic properties, is becoming more popular as an adjunctive sedative in the critically ill patients. Methods: We conducted a single center, retrospective cohort study of patients admitted to the medical intensive care unit (MICU) between 2013 and 2018. Patients who received continuous infusion ketamine or nonketamine sedatives (NKS) including dexmedetomidine, fentanyl, midazolam, or propofol were identified. The primary outcome was percentage of Richmond Agitation-Sedation Scale (RASS) scores at goal in patients receiving ketamine as adjunct to NKS compared to those on NKS alone. Results: A total of 172 patients were included (n = 86 ketamine, n = 86 NKS). Baseline characteristics were similar with the exception of antipsychotic use, which was higher in the ketamine group ( P = .008). Percentage of RASS scores at goal was not different between groups (78.7% vs 81.4%, P = .29). Fewer patients in the ketamine group received continuous infusion fentanyl (76.7% vs 94.2%, P = .002). Patients on adjunctive ketamine required fewer days of intermittent benzodiazepines (0 [0-1] vs 1 [1-2], P < .0001). Patients receiving ketamine required less norepinephrine, receiving a median of 6.32 mg (2.4-20) versus 11.7 mg (5.2-45.2; P = .03). There was no difference in receipt of new antipsychotics or occurrence of arrhythmias. Conclusion: Addition of ketamine did not increase the percentage of RASS scores at goal versus NKS but was well tolerated. Ketamine was associated with reductions in norepinephrine requirements, days of intermittent benzodiazepine administration, and number of patients receiving continuous infusion fentanyl. Continuous infusion ketamine appears safe and effective for sedation in the MICU.
Statistical Methodology for Medical Data: Gestational Age, Birth Weight, and Hand Characteristics
Authors: Verma Surendra P. , Sharma Shreya 
Published: May 2020

We briefly review the current trend in handling the neonatal baby weight, gestational age, and other related categorical and continuous variable data, through both robust and outlier-based methods. Graphs are generally presented as smooth curves which give a wrong visual impression and totally hide the actual variability of the data, robust methods are applied without considering that they may certainly be affected by asymmetrical contamination, and the outlier-based methods are incorrectly applied without ascertaining if the individual data arrays are normally distributed, free from discordant observations. Aim: To demonstrate our new procedure for handling of neonatal baby data from two case studies. Methodology: The univariate data were handled through the application of discordancy tests in the light of new precise and accurate critical values, and significance tests were applied to both original and discordant outlier-free data arrays. The bivariate data were also handled from identifying and separating discordant outliers and reporting the quality of the coefficients in terms of standard errors. Finally, the supervised multivariate technique of linear discriminant and canonical analysis is successfully applied. Results: The results of significance tests for some cases varied from the use of all data versus censored data. The identification and separation of bivariate discordant outliers drastically improved the quality of regression lines. Linear discriminant and canonical analysis provided high success values for laboratory-controlled experiments. Conclusion: The need of obtaining both central tendency and dispersion parameters in all medical data is established. The reporting of regression coefficients with individual errors is recommended.
Role of CSF-CRP as a Diagnostic Marker in Neonatal Meningitis
Authors: Balasubramanin Prashanth , Bandiya Prathik , S. Niranjan H. , Benakappa Naveen , Shinde Rajendra 
Published: May 2020

Background: Cerebrospinal fluid C-reactive protein (CSF-CRP) in adults and children has been shown to be useful for the diagnosis of bacterial meningitis; however, it has not been evaluated in neonates. Objective: To study the role of CSF-CRP as a diagnostic marker in neonatal meningitis and determine optimal cut-offs for diagnosis. Study Design: Prospective observational study from June 2017 to December 2017. Methodology: Routine CSF analysis along with CSF-CRP was performed in neonates who qualified for lumbar puncture. Results: At a cut-off value of 3.8 mg/L, CSF-CRP had a sensitivity of 0.96 and a specificity of 0.44, with positive and negative predictive values of 0.63 and 0.91, respectively. Conclusion: CSF-CRP has higher diagnostic efficiency than other CSF markers. At a value of 3.8 mg/L, it has a high sensitivity and a negative predictive value to rule out meningitis.
Cord Blood Thyroid-Stimulating Hormone Level: Interpretation in Light of Antenatal and Perinatal Factors
Authors: Bhatia Ravi , Rajwaniya Dinesh , Paul Indira S. 
Published: May 2020

Objective: To study the influence of antenatal and perinatal factors on umbilical cord blood thyroid-stimulating hormone (CB TSH) levels. Design: Cross-sectional study. Setting: Private Medical College. Methods: CB TSH levels were measured in 1147 neonates using chemiluminescence immunoassay. The effect of antenatal and perinatal factors on CB TSH values was analyzed statistically. Results: The mean TSH value was 6.811 mIu/mL. A total of 44 neonates (3.83%) had a CB TSH value greater than 20 mIu/mL and had to be recalled for a repeat workup. CB TSH was significantly raised in first-order births, those born via normal vaginal delivery, and in those whom the lower section caesarean section (LSCS) was done for fetal distress (all P value <.05). Male babies had a significantly higher CB TSH value as compared to the females. Babies having Apgar < 7 at 1 min also had a significantly higher CB TSH value. Maternal hypothyroidism did not have any significant effect. On multivariate analysis, we found a positive correlation between birth weight, Apgar, and gestational age with CB TSH values. Conclusion: The incidence of neonates having a CB TSH greater than 20 mIu/mL was 3.83%. Male children, those delivered via normal delivery, those delivered via LSCS where fetal distress was an indication, and those requiring resuscitation, were significant factors affecting CB TSH values.
Repair of Esophageal Atresia With Trache Esophageal Fistula Through Modified Transpleural Approach by Delivering Lung Out of Main Wound
Authors: Mohanty Pramod Kumar , Majumdar Pravat Kumar , Mohanty Hiranya Kishor , Jena Pradeep Kumar , Tripathy Prasant Kumar , Mohapatra Rabindra Kumar , Dash Manas Ranjan , Sarangi Gadadhar 
Published: May 2020

Objectives: To assess the morbidity, mortality, operation time, and postoperative complications in the present modified transpleural (MTP) approach with the conventional extrapleural (EP) approach in esophageal atresia (EA) with tracheoesophageal fistula (TEF). Design: Longitudinal randomized case control study. Setting: Pediatrics Surgery Department of a tertiary care hospital. Study period: November 2009 to December 2011. Participants: Neonates above 1.5 kg body weight with EA and TEF. Results: Sex ratio is 7:3 (male and female). In total, 40% had associate anomalies. Duration of operation in MTP approach from 90 to 110 min (mean duration 98.6 min) where as in EP approach from 120 to 130 min (mean duration 121.4 min). All 3(15% wound infections were in EP group. A total of 3 develops right sided pneumothorax with 2 in MTP and 1 in EP approach group. In total, 10% (2) in MTP approach group and 5% (1) in EP group expired. Leakage in anastomotic site was seen in 2(10%) each in both the groups. Six developed stricture, out of which 4 in EP group, 2 in MTP group. Conclusion: MTP approach is less time consuming, possess less hindrance during operation. Postoperative complications are comparable. Mortality is higher in MTP group than EP group, may be because of associated lethal co morbidity.
Evaluation of eutectic lidocaine/prilocaine cream for jugular blood sampling in cats
Authors: Crisi Paolo E , De Santis Francesca , Giordano Maria V , Cerasoli Ilaria , Colucci Fabrizio , Di Tommaso Morena , Luciani Alessia 
Published: May 2020

Objectives The study aimed to evaluate the efficacy of a eutectic lidocaine/prilocaine cream (EMLA cream; Astra Pharmaceuticals) in reducing pain and reaction to venepuncture during jugular blood sampling in cats after a 30-min topical application time. Methods The study was a prospective, blind, controlled clinical trial. Eighteen healthy client-owned cats were randomly allocated to two study groups. All cats were clipped on the left jugular groove region and then, depending on the study group, either the placebo (liquid paraffin) or EMLA cream was applied to the region. The area was then kept protected for the next 30 mins. Except for the operator who administered the product, all operators were blinded to the study groups. Blood sampling was performed by an experienced operator and a stress score was assigned to each cat according to the reactions observed during the venepuncture. Also, the procedure was classified as being ‘easy’ or ‘difficult’ by the same operator. Results A significantly reduced stress score was observed in cats that received the EMLA cream compared with those belonging to the placebo group ( P = 0.048); withdrawal movements were observed in 1/9 cats treated with the EMLA cream vs 7/9 cats of the placebo group ( P = 0.015). The jugular venepuncture was defined as easy in 1/9 cats that received the placebo and in 8/9 cats in the EMLA group ( P = 0.015). Conclusions and relevance The present study provides evidence for the efficacy of the EMLA cream after a 30-min application time for jugular venepuncture in cats, together with significantly reduced stress for patients. Therefore, this study supports the routine use of EMLA cream as good practice to enhance the welfare of cats and to simplify venepuncture procedures.
In acute ischemic stroke patients with smoking incidence, are more women than men more likely to be included or excluded from thrombolysis therapy?
Authors: Rotimi Oluyemi R , Ajani Iretioluwa F , Penwell Alexandria , Lari Shyyon , Walker Brittany , Nathaniel Thomas I 
Published: May 2020

Background: Clinical factors associated with exclusion from recombinant tissue plasminogen activator in both men and women are not completely understood. The aim of this study is to determine whether there is a gender difference in clinical risk factors that excluded ischemic stroke patients with a history of smoking from recombinant tissue plasminogen activator. Methods: Retrospective data from a stroke registry were analyzed, and multivariable linear regression models were used to determine gender differences. Logistic regression models determined exclusion clinical risk factors for thrombolysis in male and female acute ischemic stroke patients with a history of smoking, while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. The Kaplan–Meier survival analysis was used to determine the exclusion probabilities of men and women with a history of smoking within the stroke population. Results: Of the 1,446 acute ischemic stroke patients eligible for recombinant tissue plasminogen activator, 379 patients with a history of smoking were examined, of which 181 received recombinant tissue plasminogen activator while 198 were excluded from receiving recombinant tissue plasminogen activator. Of the 198 patients, 75 females and 123 males were excluded from receiving recombinant tissue plasminogen activator. After multivariable adjustment for age, National Institutes of Health scores, and stroke-related factors, females who present with weakness/paresis on initial examination (OR = 0.117, 95% CI, 0.025–0.548) and men who present with a history of previous transient ischemic attack (OR = 0.169, 95% CI, 0.044–0.655), antiplatelet medication use (OR = 0.456, 95% CI, 0.230–0.906), and weakness/paresis on initial examination (OR = 0.171, 95% CI, 0.056–0.521) were less likely to be excluded from recombinant tissue plasminogen activator (thrombolysis therapy). Conclusions: In an ischemic stroke population with a history of smoking, female smokers are more likely to be excluded from thrombolysis therapy in comparison to men, even after adjustment for confounding variables.