bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Harm Events on 30-Day Readmission in Surgical Patients
Authors: Kandagatla Pridvi , Su Wan-Ting K. , Adrianto Indra , Jordan Jack , Haeusler Jessica , Rubinfeld Ilan 
Published: March 2020

ABSTRACT
Readmission is an increasingly important focus for improvement regarding quality, value, and patient burden in our surgical patient population. We hypothesized that inpatient harm events increase the likelihood of readmission in surgical patients. We created a system-wide inpatient registry with 30-day readmission. A surgical subset was created, and harm events were tracked through the electronic health record system. Between 2015 and 2017, 37,048 surgical patient encounters met inclusion criterion. A total of 2,887 patients (7.69%) were readmitted. After multiple logistic regression of the highly significant harm measures, seven harm measures remained statistically significant (p < .05). Those with the three highest odds ratios were mucosal pressure ulcer, Clostridium difficile, and glucose <40. Incorporating harm measures to the traditional risk, predictive model for 30-day readmission improved our model performance (area under the ROC curve from 0.68 to 0.71). This study demonstrated that inpatient hospital-based harm events can be electronically monitored and used to predict 30-day readmission.
TBX4 variants and pulmonary diseases: getting out of the ‘Box’
Authors: Haarman Meindina G. , Kerstjens-Frederikse Wilhelmina S. , Berger Rolf M.F. 
Published: March 2020

Purpose of review
In 2013, the association between T-Box factor 4 (TBX4) variants and pulmonary arterial hypertension (PAH) has first been described. Now – in 2020 – growing evidence is emerging indicating that TBX4 variants associate with a wide spectrum of lung disorders.

Recent findings

TBX4 variants are enriched in both children and adults with PAH. The clinical phenotype associated with a TBX4 variant seems to be milder than that in other PAH-associated gene mutations. Further, TBX4 variants have increasingly been associated with a variety of clinical and histopathological phenotypes, including lethal developmental parenchymal lung diseases such as not only acinar dysplasia in neonates, but also less outspoken parenchymal lung diseases in children and adults.

Summary
The clinical phenotype of a TBX4 variant has recently been recognised to expand from bone disorders to different types of lung diseases. Recent data suggest that variants of TBX4, a transcription factor known to be an important regulator in embryonic development, are not rare in both children and adults with PAH and/or developmental parenchymal lung diseases.
The clinical features and related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients
Authors: Wang Guorong , Li Yinfeng , Wu Chunlin , Guo Lin , Hao Liqiong , Liao Hongyi , Xiao Xue , Liu Shanshan , Luo Lei 
Published: March 2020

Abstract
Peripherally inserted central venous catheter (PICC) is the main venous access for cancer patients when they receive chemotherapy and nutritional support, but PICC-related venous thrombosis has become one of the most common and serious complications. It is very important to further explore the relationship among these features, so that prevent and treat the PICC-related thrombosis.
To investigate the clinical features and the related factors of PICC-related upper extremity asymptomatic venous thrombosis in cancer patients, and to provide theoretical basis for the prevention of venous thrombosis.
A total of 127 tumor patients with PICC catheterization were selected. Thrombus was detected by color Doppler ultrasound at different times: before catheterization and 24 hours after catheterization, and every week. The study was terminated at the time of thrombosis, and patients who did not develop thrombus were terminated after 6 weeks of follow-up. The clinical characteristics and influencing factors of asymptomatic thrombosis such as vessel diameter, blood flow velocity, thrombosis time, location, and the thrombosis stages were recorded.
The incidence of PICC-related upper limbs asymptomatic thrombosis was 48.82% (62/127), and the median time was 3 days. The incidence within 24-hour was 37.1% and within 1 week was 85.49%. A total of 81 venous thrombosis were found in 62 patients with asymptomatic thrombosis, there were 19 (23.5%) venous thrombosis in the deep veins while 62 (76.5%) in the superficial veins. Furthermore, thrombosis stages can be divided into 3 levels: stage I accounted for 51.85% (42/81), stage II accounted for 37.04% (30/81), and stage III accounted for 11.11% (9/81). The group trajectory analysis indicated the 3 changes of blood flow velocity during the follow-up period: downward trend, upward trend, and steady fluctuations. Survival analysis indicated that the cohort with downward trend have the high risk of thrombosis (67.90% vs 19.00% vs 45.10%). Cox proportional hazards model suggested that the patient's Eastern Cooperative Oncology Group score (hazard ratio [HR] 2.791, 95% confidence interval [CI] 0.08–0.76) and blood flow velocity (HR 0.250, 95% CI 2.01–3.87) was the risk of PICC-related asymptomatic thrombosis.
PICC catheterization can affect blood flow and asymptomatic thrombosis can occur at an early stage. Patient's upper limb activities should be guided to promoting blood circulation, thus effectively preventing thrombosis. Asymptomatic thrombosis can also be detected by color Doppler ultrasound system, within a recommended time of 1 week after catheterization.
High versus low ligation of inferior mesenteric artery during laparoscopic radical resection of rectal cancer
Authors: You Xiaolan , Liu Qinghong , Wu Jian , Wang Yuanjie , Huang Chuanjiang , cao Gan , Dai Jiawen , Chen Dehu , Zhou Yan 
Published: March 2020

Abstract
Laparoscopic radical resection is standard treatment for resectable rectal cancer. However, whether high or low inferior mesenteric artery (IMA) ligation should be performed remains controversial. This retrospective cohort study compared the advantages and disadvantages of low vs high IMA ligation in patients undergoing laparoscopic total mesorectal excision for rectal cancer.
Rectal cancer patients (n = 322) undergoing total mesorectal excision at our institution in 2010 to 17 were enrolled; 174 underwent high IMA ligation group and 148 low IMA ligation (LIMAL group). Baseline data on patients, operative indices, economic indices, pathology findings, perioperative complications, and survival in the 2 groups were analyzed retrospectively.
The low IMA ligation group had significantly higher anus retention ratio (P = .022), shorter hospital stay (P = .025), lower medical expenses (P = .032), fewer cases of anastomotic leakage (P = .023) and anastomotic stricture (P < .001), and lower incidence of postoperative genitourinary dysfunction (P = .003). Cox regression analysis indicated that local recurrence, distant metastasis, tumor differentiation, and tumor-node-metastasis stage were independently associated with survival.
Low ligation of the IMA during laparoscopic radical resection of rectal cancer appears to be associated with a lower risks for anastomotic leakage, anastomotic stricture, and genitourinary dysfunction, a shorter hospital stay, and lower costs. In contrast, the rate of lymph node harvest, tumor recurrence rate, metastasis, or mortality was not found to be related with the level of IMA ligation.
Acupuncture as adjuvant therapy for diabetic foot
Authors: Lee Maosheng , Li Huilin , Liu Deliang 
Published: March 2020

Abstract

Background:
Diabetic foot (DF) problems are common throughout the world, about one-fourth of them develop a foot ulcer and serious cases would suffer from amputation, which seriously affects the patient's work and life. Previous studies indicated that acupuncture as adjuvant therapy would be effective in treating DF. However, these studies have no consistent results. Therefore, the aim of our study was to explore the efficacy and safety of acupuncture as adjuvant therapy for DF.

Methods:
The randomized controlled trials associated with acupuncture therapy (or as adjuvant therapy) for DF will be included. We will search 6 electronic databases relevant to health sciences, including PubMed, Embase, the Cochrane Library, the Chinese databases Sino-Med, CNKI, and WANFANG database. All searches were from databases inception to March 30, 2019. The primary outcomes are the total curative effective rate, and the hemodynamic parameter and adverse events will be deemed as secondary outcomes. The Stata15.1 software and Review Manager (RevMan 5.3; Cochrane Collaboration, Copenhagen, Denmark) will be used for analysis, to assess the bias risk, subgroup analysis, and data synthesis.

Results:
In this systematic review and meta-analysis, we will synthesize the studies to assess the safety and efficacy of acupuncture as adjuvant therapy for DF.

Conclusion:
The summary of our study will clarify whether acupuncture as adjuvant therapy could be an efficient method for DF.
Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon
Authors: Li Ya Peng , Feng Ya Nan , Liu Chun Long , Zhang Zhi Jie 
Published: March 2020

Abstract

Background:
The purposes of this study were to examine the feasibility of using the MyotonPRO digital palpation device in measuring the passive stiffness of gastrocnemius muscle belly and Achilles tendon; to determine between-days test–retest reliability of MyotonPRO; and to evaluate the acute effect of paraffin therapy on stiffness measurements in healthy participants.

Methods:
It is a randomized controlled trial. Twenty healthy participants (male, n = 10; female, n = 10; total, n = 20) were recruited to evaluate the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Dominant and nondominant legs were randomly divided into an experimental side (20 cases) and a control side (20 cases). The experimental side received 20 minutes of paraffin therapy.

Results:
The stiffness of muscle and tendon in the experimental side decreased significantly after paraffin therapy (P < .01), whereas no significant differences in stiffness measurements were found in the control side (P > .05). The passive stiffness of muscle and tendon was positively correlated with the ankle from 30° plantar flexion to10° dorsiflexion for dominant legs. Between-days test–retest reliability in stiffness measurements was high or very high (ICCs were above 0.737).

Conclusion:
Paraffin therapy induces a decrease in the passive stiffness of gastrocnemius muscle belly and Achilles tendon. Furthermore, the MyotonPRO can reliably determine stiffness measurements.
Associations of cardiovascular disease morbidity and mortality in the populations watching major football tournaments
Authors: Wang Huajun , Liang Lunchang , Cai Ping , Zhao Jianli , Guo Lan , Ma Huan 
Published: March 2020

Abstract

Background:
Whether or not increased hospitalizations and/or deaths due to cardiovascular disease during major football tournaments (MFTs) remains controversial. We undertook a systematic review and meta-analysis of published studies to assess the relationships of cardiovascular events and MFTs.

Methods:
Observational studies reporting relationship of cardiovascular disease morbidity and mortality with MFTs during the days of games or within 2 weeks after game season were included. Relative risk ratios (RR) with 95% confidence interval (CI) were pooled and analyzed using a random/fixed-effects model.

Results:
Nineteen cross-sectional observational studies that examined the association between MFTs and non-fetal cardiovascular events and mortality were found to be eligible from 3419 references, for inclusion in the systematic review and meta-analysis. Of the 10 studies reported hospitalizations due to non-fetal acute cardiovascular events, the pooled RR was 1.17 (95% CI 1.01–1.36). Of the 10 studies reported cardiovascular mortality the pooled RR was 1.03 (95% CI 1.00–1.05). Of the studies examining the mortality, 6 studies reported the lost or win of the national team. Pooling of four studies where their national teams lost the MFTs produced a RR for the mortality of 1.19 (95% CI: 1.09–1.30), and 4 studies of the 6 whose national teams won produced a pooled RR for cardiovascular mortality of 0.88 (0.79–0.98).

Conclusion:
This systematic review and meta-analysis showed an increased risk of hospitalization due to non-fetal acute cardiovascular events and cardiovascular mortality with watching MFTs.
Temporal subtraction of low-dose and relatively thick-slice CT images with large deformation diffeomorphic metric mapping and adaptive voxel matching for detection of bone metastases
Authors: Tsuchiya Mitsuteru , Masui Takayuki , Katayama Motoyuki , Hayashi Yuki , Yamada Takahiro , Terauchi Kazuma , Kawamura Kenshi , Ishikawa Ryo , Mizobe Hideaki , Yamamichi Junta , Sakahara Harumi , Goshima Satoshi 
Published: March 2020

Abstract
To evaluate the improvement of radiologist performance in detecting bone metastases at follow up low-dose computed tomography (CT) by using a temporal subtraction (TS) technique based on an advanced nonrigid image registration algorithm.
Twelve patients with bone metastases (males, 5; females, 7; mean age, 64.8 ± 7.6 years; range 51–81 years) and 12 control patients without bone metastases (males, 5; females, 7; mean age, 64.8 ± 7.6 years; 51–81 years) were included, who underwent initial and follow-up CT examinations between December 2005 and July 2016. Initial CT images were registered to follow-up CT images by the algorithm, and TS images were created. Three radiologists independently assessed the bone metastases with and without the TS images. The reader averaged jackknife alternative free-response receiver operating characteristics figure of merit was used to compare the diagnostic accuracy.
The reader-averaged values of the jackknife alternative free-response receiver operating characteristics figures of merit (θ) significantly improved from 0.687 for the readout without TS and 0.803 for the readout with TS (P value = .031. F statistic = 5.24). The changes in the absolute value of CT attenuations in true-positive lesions were significantly larger than those in false-negative lesions (P < .001). Using TS, segment-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the readout with TS were 66.7%, 98.9%, 94.4%, 90.9%, and 94.8%, respectively.
The TS images can significantly improve the radiologist's performance in the detection of bone metastases on low-dose and relatively thick-slice CT.
The association between Bell's palsy and rheumatoid arthritis
Authors: Lee Sang-Yeon , Lim Jae-Sung , Oh Dong Jun , Park Bumjung , Park Il-Seok , Choi Hyo Geun 
Published: March 2020

Abstract
This study aimed to evaluate the relationship between Bell's palsy and rheumatoid arthritis in a national sample cohort from Korea.
Data were collected for individuals ≥20 years old from 2002 to 2013 in the Korean National Health Insurance Service-National Sample Cohort. We extracted data for patients with rheumatoid arthritis (n = 7628) and 1:4-matched controls (n = 30,512) and analyzed the occurrence of Bell's palsy in both groups. Matching was performed based on age, sex, income, and region of residence. Rheumatoid arthritis was diagnosed according to International Classification of Disease-10 (ICD-10) codes (M05-M06) and the prescription of biological agents and/or disease-modifying antirheumatic drugs. Bell's palsy patients were diagnosed according to ICD-10 code H912 and treatment ≥2 times with steroids. Adjusted hazard ratios (HRs) were calculated using stratified Cox proportional hazard models for the Charlson comorbidity index and 95% confidence intervals (CIs). Subgroup analyses based on age and sex were also performed.
The rates of Bell's palsy were similar between the rheumatoid arthritis group (0.5% [38/7628]) and the control group, with no significant difference (0.4% [124/30,512], P = .270). The adjusted HR for Bell's palsy was 1.12 (95% CI, 0.78–1.62) in the rheumatoid arthritis group (P
= .540). In the subgroup analyses according to age and sex, the relationship between Bell's palsy and rheumatoid arthritis did not reach statistical significance.
The risk of Bell's palsy was not increased in patients with rheumatoid arthritis.
Rapid Advancement in Enteral Nutrition Does Not Affect Systemic Inflammation and Insulin Homeostasis Following Pediatric Cardiopulmonary Bypass Surgery*
Authors: Floh Alejandro A. , Herridge Joann , Fan Chun-Po S. , Manlhiot Cedric , McCrindle Brian W. , Van Arsdell Glen , Balmer-Minnes Diana , Schwartz Steven M. 
Published: March 2020

Objectives:
To determine impact of enteral nutrition delivery on the relationship among inflammation, insulin resistance, and outcomes following pediatric cardiopulmonary bypass surgery.

Design:
Pilot, randomized study analyzed according to intention-to-treat analysis.

Setting:
Pediatric cardiac ICU.

Patients:
Infants (≤ 6 mo) undergoing cardiopulmonary bypass.

Interventions:
Patients randomly assigned to receive rapid escalation to enteral nutrition reaching goal feeds by 27 hours or standard feeding practice reaching goal feeds by 63 hours. Feeds were initiated on the first postoperative day.

Measurements and Main Results:
Fifty patients were randomized equally to study arms. Patients were a median (interquartile range) of 16 days old (7–110 d old), undergoing biventricular surgery (88%) with a median cardiopulmonary bypass time of 125 minutes (105–159 min). Serial blood samples were drawn before and after cardiopulmonary bypass, cardiac ICU admission, and every 12 hours (up to 96 hr) for glucose, insulin, and cytokines (interleukin-1α, interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α) levels. Glucose-insulin ratio was calculated to quantify insulin resistance. Patient characteristics, time to enteral nutrition initiation, enteral nutrition interruptions, and insulin administration were similar across intervention arms. FF reached goal feeds at similar intervals as standard feeding (39 hr [30–60 hr] vs 60 hr [21–78 hr]; p = 0.75). No difference in cytokine, insulin, or glucose-insulin ratio was noted between groups. Higher inflammation was associated with increased glucose-insulin ratio and higher risk of adverse events. In multivariable models of interleukin-8, FF was associated with increased glucose-insulin ratio (estimate of effect [95% CI], 0.152 [0.033–0.272]; p = 0.013). Although higher interleukin-8 was associated with an elevated risk of adverse event, this relationship was possibly mitigated by FF (odds ratio [95% CI], 0.086 [0.002–1.638]; p = 0.13).

Conclusions:
A FF strategy was not associated with changes to early enteral nutrition delivery. Inflammation, insulin resistance, and morbidity were similar, but FF may modify the relationship between inflammation and adverse event. Multicenter nutrition studies are possible and necessary in this vulnerable population.
Validation of an Electronic Pediatric Index of Mortality 2 Score in a Mixed Quaternary PICU*
Authors: Joyce Emily L. , Crana Christine M. , Yabes Jonathan , Kellum John A. 
Published: March 2020

Objective:
To assess the validity of an electronic version of the Pediatric Index of Mortality 2 score.

Design:
Retrospective observational study.

Setting:
Pediatric and cardiac ICUs at a quaternary medical center.

Patients:
Patients more than 60 days old admitted to the PICU or cardiac ICU between January 1, 2010, and December 31, 2014.

Interventions:
None.

Measurements and Main Results:
After adapting the Pediatric Index of Mortality 2 score into a version applicable to retrospective electronic health record data, it was validated in a mixed-ICU cohort. A manually ascertained Pediatric Index of Mortality 2 score was directly compared with the electronically derived electronic version of the Pediatric Index of Mortality 2 score in 100 randomly selected patients with good agreement between score components with nine out of 11 components having an intraclass correlation coefficient or Cohen κ greater than or equal to 0.6. In assessing the electronic version of the Pediatric Index of Mortality 2 score in the entire cohort of 12,582 patient encounters, it had good discrimination with area under the receiver operating curve of 0.89, appropriate calibration with no significant difference between observed and expected deaths, and excellent predictive ability with a Brier score of 0.0135.

Conclusions:
The Pediatric Index of Mortality 2 score can be adapted to utilize retrospective electronic health record data with acceptable discrimination, calibration and accuracy a large mixed-ICU cohort.
Sedation, Analgesia, and Neuromuscular Blockade: An Assessment of Practices From 2009 to 2016 in a National Sample of 66,443 Pediatric Patients Cared for in the ICU*
Authors: Patel Anita K. , Trujillo-Rivera Eduardo , Faruqe Farhana , Heneghan Julia A. , Workman T. Elizabeth , Zeng-Treitler Qing , Chamberlain James , Morizono Hiroki , Kim Dongkyu , Bost James E. , Pollack Murray M. 
Published: March 2020

Objectives:
To describe the pharmaceutical management of sedation, analgesia, and neuromuscular blockade medications administered to children in ICUs.

Design:
A retrospective analysis using data extracted from the national database Health Facts.

Setting:
One hundred sixty-one ICUs in the United States with pediatric admissions.

Patients:
Children in ICUs receiving medications from 2009 to 2016.

Exposure/Intervention:
Frequency and duration of administration of sedation, analgesia, and neuromuscular blockade medications.

Measurements and Main Results:
Of 66,443 patients with a median age of 1.3 years (interquartile range, 0–14.5), 63.3% (n = 42,070) received nonopioid analgesic, opioid analgesic, sedative, and/or neuromuscular blockade medications consisting of 83 different agents. Opioid and nonopioid analgesics were dispensed to 58.4% (n = 38,776), of which nonopioid analgesics were prescribed to 67.4% (n = 26,149). Median duration of opioid analgesic administration was 32 hours (interquartile range, 7–92). Sedatives were dispensed to 39.8% (n = 26,441) for a median duration of 23 hours (interquartile range, 3–84), of which benzodiazepines were most common (73.4%; n = 19,426). Neuromuscular-blocking agents were dispensed to 17.3% (n = 11,517) for a median duration of 2 hours (interquartile range, 1–15). Younger age was associated with longer durations in all medication classes. A greater proportion of operative patients received these medication classes for a longer duration than nonoperative patients. A greater proportion of patients with musculoskeletal and hematologic/oncologic diseases received these medication classes.

Conclusions:
Analgesic, sedative, and neuromuscular-blocking medications were prescribed to 63.3% of children in ICUs. The durations of opioid analgesic and sedative medication administration found in this study can be associated with known complications, including tolerance and withdrawal. Several medications dispensed to pediatric patients in this analysis are in conflict with Food and Drug Administration warnings, suggesting that there is potential risk in current sedation and analgesia practice that could be reduced with practice changes to improve efficacy and minimize risks.