bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemichorea-hemiballismus as the initial manifestation of symptomatic middle cerebral artery dissection
Authors: Chen Hanfeng , Xu Ziqi 
Published: September 2020

Abstract

Introduction:
Hemichorea-hemiballismus, which spans a spectrum of involuntary, continuous, nonpatterned movement involving one side of the body, can emerge as the initial manifestation of acute ischemic stroke. However, because of its rarity in the community, the diagnosis and treatment are often delayed.

Patient concerns:
We report a unique case of a 47-year-old female who presented with acute onset hemichorea-hemiballismus. No obvious focal sign apart from involuntary, continuous, nonpatterned movement of her left arm and leg was presented.

Diagnosis:
Initial diffusion-weighted magnetic resonance imaging (MRI) was negative but significant increase of blood flow velocity in the right middle cerebral artery (MCA) stem was revealed by transcranial doppler sonography. Repeated MRI showed acute infarction in the contralateral globus pallidus. Isolated dissection of the right MCA typified by intimal flap with double lumen was identified by digital subtraction angiography and high-resolution magnetic resonance imaging (HR-MRI).

Interventions:
The patient was initially treated with dual antiplatelet agents but the uncontrollable movement deteriorated during hospitalization. Antithrombotic therapy was then intensified with combination of tirofiban and low-molecular-weight heparin. Other symptomatic treatment included volume expansion with colloidal fluid to improve cerebral perfusion. Her involuntary movement gradually diminished and the patient was discharged with rivaroxaban 15 mg/daily.

Outcomes:
The patient had recovered with significant reduction in her hemichorea-hemiballismus. Three-month follow-up HR-MRI showed complete resolution of the MCA dissection lesions.

Conclusion:
Prompt recognition of acute onset hemichorea-hemiballismus as the manifestation of acute ischemic stroke in appropriate clinical setting may reduce diagnostic delay. Multiple imaging techniques including cerebral digital subtraction angiography and HR-MRI can be applied to diagnosis and further clarify the mechanism of stroke, which facilitate in selection of secondary prevention therapies.
Exophiala lecanii-corni keratitis presenting as a serpiginous pigmented superficial lesion: a case report
Authors: Miyakubo Tomoko , Todokoro Daisuke , Satake Yoshiyuki , Makimura Koichi , Miyakubo Sumiko , Akiyama Hideo 
Published: September 2020

Abstract

Rationale:
Patients with bullous keratopathy (BK) treated by Descemet stripping automated endothelial keratoplasty (DSAEK) have a compromised cornea, due to the administration of topical steroid, postsurgical use of contact lenses, and impaired barrier function of the corneal epithelium by BK. We report a case of Exophiala lecanii-corni (E lecanii-corni) keratitis presenting as a serpiginous pigmented superficial lesion after DSAEK.

Patient concerns:
An 81-year-old woman who had undergone cataract surgeries, suffered from decreased vision in the left eye. She was diagnosed BK and she underwent DSAEK. Two months after DSAEK, a pigmented superficial lesion developed on the left cornea. The lesion migrated and recurred repeatedly and she was referred to our department. Best corrected vision was 20/220.

Diagnoses:
Light microscopy of a corneal scraping revealed branching fungal hyphae. Fungal culture showed growth of a black colony, identified as E lecanii-corni by ribosomal DNA sequencing.

Interventions:
We started topical treatment with 1% voriconazole and 1.5% levofloxacin. Antifungal susceptibility testing showed that the minimum inhibitory concentration of voriconazole was 0.06 μg/mL.

Outcomes:
The lesion scarred after treatment for 3 months, and left best corrected vision improved to 20/40.

Lessons:
Genus Exophiala is known as 1 of the “black molds” and a cause of chromomycosis. This is the first description of E lecanii-corni keratitis, and pigmented corneal epithelial lesions may be characteristic of this fungal genus.
Assessment of the efficacy of α-lipoic acid in treatment of diabetes mellitus patients with erectile dysfunction
Authors: Cai Jiawei , Chen Junmin , Zeng Qianqian , Liu Jie , Zhang Yanli , Cheng Haiping , Yao Shasha , Chen Qiu 
Published: September 2020

Abstract

Background:
Diabetes mellitus with erectile dysfunction (DMED) is one of the most common causes of disability in diabetic population, and its pathogenesis is related to a variety of factors. Because its pathogenesis is complex and the existing treatment methods have limitations, DMED is difficult to treat in clinical. Recently, some studies have shown that α-lipoic acid (ALA) is associated with DMED, but there is no systematic review and meta-analysis on the relationship between ALA and DMED.

Methods:
We will search each database from the built-in until July 2020. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science, while the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Simultaneously we will retrieve clinical registration tests and grey literatures. This study only screen the clinical randomized controlled trials (RCTs) about ALA for DMED to assess its efficacy. The 2 researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is represented by relative risk (RR), and the continuous is expressed by mean difference (MD) or standard mean difference (SMD), eventually the data is synthesized using a fixed effect model (FEM) or a random effect model (REM) depending on whether or not heterogeneity exists. Erectile dysfunction (ED) will be diagnosed by the International Index of Erectile Function 5 (IIEF-5) score. Finally, meta-analysis was conducted by RevMan software version 5.3.

Results:
This study will synthesize and provide high quality to evaluate the effectiveness of ALA supplementation for the treatment of DMED.

Conclusion:
This systematic review aims to provide new options for ALA supplementation treatment of DMED in terms of its efficacy and safety.

PROSPERO registration number:
INPLASY202070130.
Ethical decision-making in simultaneous heart–liver transplantation
Authors: Cheng Xinxing S. , Wall Anji , Teuteberg Jeffrey 
Published: September 2020

Purpose of review
Simultaneous heart–liver (SHL) transplants are only a small proportion of overall heart and liver transplantation, they have been increasing in frequency and thus challenge the equitable allocation of organs.

Recent findings
The incidence of SHL transplants is reviewed along with the outcomes of SHL transplants and their impact on the waitlist, particularly in the context of solitary heart and liver transplantation. The ethical implications, most importantly the principles of utility and equity, of SHL transplant are addressed. In the context of utility, the distinction of a transplant being life-saving versus life-enhancing is investigated. The risk of hepatic decompensation for those awaiting both solitary and combined organ transplantation is an important consideration for the principle of equity. Lastly, the lack of standardization of programmatic approaches to SHL transplant candidates, the national approach to allocation, and the criteria by which programs are evaluated are reviewed.

Summary
As with all multiorgan transplantation, SHL transplantation raises ethical issues of utility and equity. Given the unique patient population, good outcomes, lack of alternatives, and overall small numbers, we feel there is continued ethical justification for SHL, but a more standardized nationwide approach to the evaluation, listing, and allocation of organs is warranted.
Reinnervation of the Diaphragm After Bilateral Phrenic Nerve Resection and Immediate Reconstruction Using a Contralateral Phrenic Nerve Autograft
Authors: Brunetti Beniamino , Morelli Coppola Marco , Crucitti Pierfilippo , Spinelli Francesco , Stilo Francesco , Longo Filippo , Cortese Livio , Tenna Stefania , Persichetti Paolo 
Published: September 2020

Abstract
A patient affected by a voluminous synovial sarcoma of mediastinum received radical surgery, resulting in injury of both phrenic nerves. Because of the cancer location, reconstruction of the left phrenic nerve was not possible, so to prevent the patient's ventilator dependence, the right phrenic nerve was reconstructed via an autograft from the residual proximal stump of the contralateral one. In 3 months, the right hemidiaphragm function showed a full recovery, documented by ultrasonographic and radiographic assessment of diaphragmatic excursion, and the patient was weaned from mechanical ventilation. When a nerve autograft is indicated, the sural nerve still remains the criterion standard, because of the low morbidity of the donor site and ease of harvesting; however, in particular situations, such as in this unique case, the choice of an orthotopic graft may offer promising results.
Error Analysis of Robot-Assisted Orthognathic Surgery
Authors: Wu Jinyang , Hui Wenyu , Chen Shihang , Niu Jindong , Lin Yanping , Luan Nan , Zhang Shilei , Shen Steve G.F. 
Published: September 2020

Objective:
Orthognathic surgery is an effective method to correct the dentomaxillofacial deformities. The aim of the study is to introduce the robot-assisted orthognathic surgery and demonstrate the accuracy and feasibility of robot-assisted osteotomy in transferring the preoperative virtual surgical planning (VSP) into the intraoperative phase.

Methods:
The CMF robot system, a craniomaxillofacial surgical robot system was developed, consisted of a robotic arm with 6 degrees of freedom, a self-developed end-effector, and an optical localizer. The individualized end-effector was installed with reciprocating saw so that it could perform osteotomy. The study included control and experimental groups. In control group, under the guidance of navigation system, surgeon performed the osteotomies on 3 skull models. In experimental group, according to the preoperative VSP, the robot completed the osteotomies on 3 skull models automatically with assistance of navigation. Statistical analysis was carried out to evaluate the accuracy and feasibility of robot-assisted orthognathic surgery and compare the errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy.

Results:
All the osteotomies were successfully completed. The overall osteotomy error was 1.07 ± 0.19 mm in the control group, and 1.12 ± 0.20 mm in the experimental group. No significant difference in osteotomy errors was found in the robot-assisted osteotomy groups (P = 0.353). There was consistence of errors between robot-assisted automatic osteotomy and navigation-assisted manual osteotomy.

Conclusion:
In robot-assisted orthognathic surgery, the robot can complete an osteotomy according to the preoperative VSP and transfer a preoperative VSP into the actual surgical operation with good accuracy and feasibility.
Prediction Models for Recurrence of Chronic Subdural Hematoma in Patients Underwent Twist-Drill Craniostomy Combined With Urokinase Instillation
Authors: Zhuo Jianwei , Xu Yinong , Zhang Jing , Zhang Wenwen , Ji Meng , Wang Yuhai 
Published: September 2020

Abstract
The recurrence of chronic subdural hematoma (CSDH) is high post-treatment. In this study, we aimed to construct individualized models for prediction of the postoperative recurrence of CSDH in patients underwent twist-drill craniostomy combined with urokinase (UK) instillation. In total, 183 patients with CSDH were retrospectively enrolled. In summary, 21 candidate factors were retrieved from past medical records. The least absolute shrinkage and selection operator regression was adopted to reduce the high dimensionality of data. Four predictors: preoperative hematoma volume, encephalatrophy, brain re-expansion, and UK instillation frequency were filtered from the 21 candidate factors using the least absolute shrinkage and selection operator method. Binary logistic regression model was employed to establish preoperative and postoperative prediction models. The preoperative model included preoperative hematoma volume and encephalatrophy whereas the postoperative model included brain re-expansion and UK instillation frequency. The predictive performance of the nomograms was evaluated by the receiver operating characteristic curve and calibration chart. Area under curve of the preoperative and postoperative models were 0.755 (95% confidence interval: 0.690–0.889) and 0.782 (95% confidence interval: 0.720–0.936), respectively, indicating good discrimination ability. The calibration results showed good fitting between the predicted probability and the actual probability. Finally, a decision curve analysis revealed excellent clinical performance of the proposed nomograms. Functionally, the preoperative model was used to identify high-risk patients with CSDH and application of UK, while the postoperative model was applied to guide physician-patients communication during follow-up. These 2 prediction models provide a basis for further clinical and experimental studies.
Osteogenesis Differences Around Titanium Implant and in Bone Defect Between Jaw Bones and Long Bones
Authors: Liu Li-Nan , Zhang Xiao-Hui , Liu Hang-Hang , Li Ke-Han , Wu Qiong-Hui , Liu Yao , Luo En 
Published: September 2020

Abstract
The aim of this study is to evaluate the osteogenesis around titanium implant and in bone defect or fracture in jaw bones and long bones in ovariectomized (OVX) animal models. The literature on the osteogenesis around titanium implant and in bone defect or fracture in jaw bones and long bones was reviewed with charts. Fourty-eight rats were randomly divided into OVX group with ovariectomy and SHAM (sham-surgery) group with sham surgery. Titanium implants were inserted in the right mandibles and tibiae; bone defects were created in the left mandibles and tibiae. Two-week postoperatively, mandibles and tibiae of 8 rats were harvested and examined by hematoxylin and eosin staining and histological analysis; 4-week postoperatively, all mandibles and tibiae were harvested and examined by Micro-CT and histological analysis. A total of 52 articles were included in this literature review. Tibial osteogenesis around titanium implant and in bone defect in OVX group were significantly decreased compared with SHAM group. However, osteogenesis differences in the mandible both around titanium implant and in bone defect between groups were not statistically significant. OVX-induced osteoporosis suppresses osteogenesis around titanium implant and in the bone defect or fracture in long bones significantly while has less effect on that in the jaw bones.
Repeated unpredictable stress blunts alcohol-induced memory deficit in adolescent rat
Authors: Sircar Ratna 
Published: September 2020

Objective
There exists a complex interaction between alcohol and stress on brain and behavior. Alcohol and stress are both known to affect memory. Whether stress and alcohol together can modulate memory functions in adolescent rats is not known. In the present study, effects of repeated unpredictable stress (RUPS) on contextual fear conditioning, a hippocampus-related memory function, were investigated in alcohol-treated adolescent rats.

Methods
Rats were divided into four experimental groups: group i – saline-treated non-stressed rats (sal no stress), group ii – alcohol-treated non-stressed rats (alc no stress), group iii – saline-treated rats subjected to stress (sal + RUPS), group iv – alcohol-treated rats subjected to stress (alc + RUPS). All rats were trained in the fear conditioning paradigm, and 24 h later were tested for contextual fear conditioning in the conditioning chamber, and nonspecific fear memory in a modified chamber.

Results
Stress, in the presence or absence of alcohol, did not alter nonspecific fear. RUPS exposure did not affect contextual freezing in vehicle-treated adolescent rats. Compared to vehicle-treated non-stressed rats, alcohol-treated non-stressed rats showed significant impairments in contextual freezing. Alcohol-treated RUPS rats performed better in the contextual freezing task than alcohol-treated non-stressed rats.

Conclusion
RUPS exposure did not alter contextual fear conditioning in adolescent rats. Alcohol significantly reduced contextual fear memory in non-stressed rats. Alcohol-treated RUPS rats showed significantly better memory than alcohol-treated non-stressed rats. Together, these data suggest resiliency to stress-induced memory impairment in adolescent rats, and RUPS exposure causes blunting of alcohol’s negative effects on contextual fear conditioning.
Factors Associated With Seizure Adequacy Along the Course of Electroconvulsive Therapy
Authors: Tedeschi Eduardo Antonio , Patusco Lucas Mohr , Zahler Sofia , Martini Murilo , Chiavaro da Fonseca Rodrigo , Magalhães Pedro V.S. 
Published: September 2020

Objectives
Eliciting a generalized seizure is essential to electroconvulsive therapy (ECT), but there is still a need to understand how patient and session variables interact to generate a seizure of adequate quality. Here, we investigate factors associated with motor seizure length as a measure of quality in a large database of patients who underwent ECT.

Methods
This is a retrospective cohort including data from all adult inpatients who underwent ECT at a university hospital in Brazil from 2009 to 2015. We used linear mixed models to investigate the effects of patient, session, and medication on seizure length.

Results
Session information was available for 387 patients, a total of 3544 sessions and 4167 individual stimulations. Multiple stimulations were necessary in 12.4% of sessions. Median seizure length was 30 seconds. Seizure length was directly correlated with stimulus dosage and inversely correlated with the session number, patient age, prescription of anticonvulsants in the day before and β-blockers during the session, and the thiopental dose. Use of benzodiazepines was not associated with a shorter seizure duration, irrespective of dose.

Conclusions
We demonstrate here how motor seizure length evolves during a course of ECT. With a large number of sessions, we are able to integrate a host of factors in a prediction model. Seizure quality was influenced by a number of the studied factors, many of which are potentially modifiable and could be assessed before initiating and handled during treatment.
County-level exposures to greenness and associations with COVID-19 incidence and mortality in the United States
Authors: Klompmaker Jochem O , Hart Jaime E , Holland Isabel , Sabath M Benjamin , Wu Xiao , Laden Francine , Dominici Francesca , James Peter 
Published: September 2020

AbstractBackgroundCOVID-19 is an infectious disease that has killed more than 175,000 people in the US. During a time of social distancing measures and increasing social isolation, green spaces may be a crucial factor to maintain a physically and socially active lifestyle while not increasing risk of infection.ObjectivesWe evaluated whether greenness is related to COVID-19 incidence and mortality in the United States.MethodsWe downloaded data on COVID-19 cases and deaths for each US county up through June 7, 2020, from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center. We used April-May 2020 Normalized Difference Vegetation Index (NDVI) data, to represent the greenness exposure during the initial COVID-19 outbreak in the US. We fitted negative binomial mixed models to evaluate associations of NDVI with COVID-19 incidence and mortality, adjusting for potential confounders such as county-level demographics, epidemic stage, and other environmental factors. We evaluated whether the associations were modified by population density, proportion of Black residents, median home value, and issuance of stay-at-home order.ResultsAn increase of 0.1 in NDVI was associated with a 6% (95% Confidence Interval: 3%, 10%) decrease in COVID-19 incidence rate after adjustment for potential confounders. Associations with COVID-19 incidence were stronger in counties with high population density and high median home values, and in counties with stay-at-home orders. Greenness was not associated with COVID-19 mortality in all counties; however, it was protective in counties with high percentages of Black residents, high median home value, and higher population density.DiscussionExposures to NDVI had beneficial impacts on county-level incidence of COVID-19 in the US and may have reduced county-level COVID-19 mortality rates, especially in densely populated counties.
Neurological manifestations of coronavirus infections – a systematic review
Authors: Almqvist Jesper , Granberg Tobias , Tzortzakakis Antonios , Klironomos Stefanos , Kollia Evangelia , Öhberg Claes , Martin Roland , Piehl Fredrik , Ouellette Russell , Ineichen Benjamin V. 
Published: September 2020

AbstractIn order to optimize diagnostic workup of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, we systematically reviewed neurological and neuroradiological manifestations of SARS-CoV-2 and all other known human coronavirus species (HCoV). Which lessons can we learn? We identified relevant publications (until July 26th2020) using systematic searches in PubMed, Web of Science and Ovid EMBASE with predefined search strings. A total of 4571 unique publications were retrieved, out of which 378 publications were selected for in-depth analysis by two raters, including a total of 17549 (out of which were 14418 SARS-CoV-2) patients. Neurological complications and associated neuroradiological manifestations are prevalent for all HCoVs (HCoV-229E, HKU1, NL63, OC43, Middle East respiratory syndrome (MERS)-CoV, SARS-CoV-1 and SARS-CoV-2). Moreover, there are similarities in symptomatology across different HCoVs, particularly between SARS-CoV-1 and SARS-CoV-2. Common neurological manifestations include fatigue, headache and smell/taste disorders. Additionally, clinicians need to be attentive for at least five classes of neurological complications: (1) Cerebrovascular disorders including ischemic stroke and macro/micro-hemorrhages, (2) encephalopathies, (3) para-/postinfectious immune-mediated complications such as Guillain–Barré syndrome and acute disseminated encephalomyelitis, (4) (meningo-)encephalitis, potentially with concomitant seizures and (5) neuropsychiatric complications such as psychosis and mood disorders. Our systematic review highlights the need for vigilance regarding neurological complications in patients infected by SARS-CoV-2 and other HCoVs, especially since some complications may result in chronic disability. Neuroimaging protocols should be designed to specifically screen for these complications. Therefore, we propose practical imaging guidelines to facilitate the diagnostic workup and monitoring of patients infected with HCoVs.