bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Significance of Renal Dysfunction Among Emergency Department Observation Patients With Chest Pain
Authors: Carlberg Mark , Lum Marija , Ojcius Julia , Perkins Rachelle , Carlson Margaret , Steenblik Jacob , Madsen Troy 
Published: November 2019

Objectives:
Previous studies have demonstrated increased risk of acute coronary syndrome among patients with chest pain and renal dysfunction. The objective of this study was to investigate the impact of renal dysfunction on cardiac outcomes in patients with chest pain in an emergency department observation unit (EDOU).

Methods:
We conducted a 5-year prospective evaluation of patients evaluated in the EDOU for chest pain. We collected baseline information and data from the emergency department visit, EDOU stay, inpatient admission, and the 30-day period after presentation to the emergency department. We calculated glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. We stratified patients as having mild (GFR 60–89 mL/min per 1.73 m2) or at least moderate (GFR <60) renal dysfunction. We evaluated the rate of major adverse cardiac events (MACE: myocardial infarction, stent, coronary artery bypass graft, and death).

Results:
Of 1067 enrolled EDOU patients, the majority had at least mild renal dysfunction: 39% [95% confidence interval (95% CI): 36.1%–42%] had a GFR between 60 and 89, and 16% (95% CI: 14%–18.4%) had a GFR <60. MACE rates increased with decreasing GFR: 3.3% (95% CI: 2.1%–5.3%) for GFR ≥90, 7.3% (95% CI: 5.2%–10.2%) for GFR 60–89, and 9.1% (95% CI: 5.7%–14.3%) for GFR <60 (P = 0.005). In multivariate analysis, patients with at least mild renal dysfunction (GFR < 90) were at greater risk of MACE (P = 0.028).

Conclusions:
We noted a high prevalence of renal dysfunction among EDOU patients evaluated for chest pain. Even those with mild renal dysfunction demonstrated an increased risk of MACE. Clinicians may wish to consider renal dysfunction in selecting appropriate patients for EDOU placement.
Effects of sarpogrelate hydrochloride on peripheral arterial disease
Authors: Lu Yunxin , Li Jiangmiao , Xie Jiayi , Yu Qingliang , Liao Liang 
Published: November 2019

Abstract

Objective:
The aim of our study was to assess the efficacy and safety of sarpogrelate hydrochloride by comparing the effects of sarpogrelate with conventional treatment on the improvement of symptoms in PAD patients.

Methods:
The search was conducted in PubMed, Embase, Cochrane library database, CNKI, CBM for relevant randomized controlled trials (RCTs) before January 1st, 2019. Inclusion and exclusion of studies, assessment of quality, outcome measures, data extraction and synthesis were completed by two reviewers independently. The meta-analysis was performed with RevMan 5.3.

Results:
Totally, 12 eligible RCTs were included in our analysis. Comparing the results of sarpogrelate group and control group, sarpogrelate significantly improved ankle-brachial index (ABI) levels (SMD = 0.05, [95%CI 0.20 to 0.74, P = .0005]), dorsalis pedis artery blood flow (MD = 0.16, [95%CI 0.09 to 0.23, P < .001]) and pain-free walking distance (PFWD) (MD = 201.86, [95%CI 9.34 to 394.38, P = .04]). The pooled analysis showed that a significant decrease in hsCRP (MD = -0.57, [95%CI -1.12 to -0.02, P = .04]) and IL-6 (MD = 1.48,[95%CI 0.39 to 2.56, P = .008]) was observed in the sarpogrelate treatment.

Conclusion:
Sarpogrelate was effective for improving the symptoms of PAD and showed good tolerability without significant adverse events.
Is bipolar sealer superior than standard electrocautery for blood loss control after primary total knee arthroplasty
Authors: Chen Xinxin , Yang Wenhui , Wang Xiao 
Published: November 2019

Abstract

Background:
Whether bipolar sealer (BS) is superior to standard electrocautery in patients with primary total knee arthroplasty (TKA) remains controversial. Thus, we conducted this meta-analysis involving comparative studies (S) to evaluate whether administration with BS (I) was associated with less blood loss (O) than standard electrocautery (C) after primary TKA (P).

Methods:
PubMed (1950–January 2017), EMBASE (1974–January 2017), the Cochrane Library (January 2017 Issue 3), and the Google database (1950–January 2017) were systematically searched. Studies were included in accordance with Population, Intervention, Comparison, Outcomes, and Setting including criteria. Only the patients prepared for primary TKA and administrated with BS as the intervention group and standard electrocautery as control group were included in this meta-analysis. Outcomes include need for transfusion, total blood loss, blood loss in drainage, hemoglobin at discharge, hemoglobin drop, and length of hospital stay. Continuous outcomes and discontinuous outcomes were expressed as weighted mean difference (WMD) and risk ratio (RR) with corresponding confidence intervals (CIs), respectively. Stata 13.0 software was used for relevant data calculation.

Results:
A total of 7 clinical trials with 718 patients (398 patients in BS group and 320 in standard electrocautery group) were finally included in this meta-analysis. The pooled results indicated that administration with BS was associated with little reduction of total blood loss (WMD = −123.80, 95%CI −236.56 to −11.04, P = .031). There was no significant difference between the need for transfusion, blood loss in drainage, hemoglobin at discharge, hemoglobin drop, and length of hospital stay (P > .05).

Conclusion:
Based on the current meta-analysis, we found no evidence to support the routine use of bipolar sealer in the management of blood loss in primary TKA. Since the poor quality of the included studies, more randomized controlled trials are still needed to further identify the efficacy of BS after primary TKA.
Comparison between acupotomy and local steroid injection for the management of de Quervain disease
Authors: Sun Xiaojie , Shen Yifeng , Zhou Qiaoyin , Jia Yan , Qiu Zuyun , Li Shiliang 
Published: November 2019

Abstract

Background:
De Quervain disease (dQD) is a painful condition of the wrist that affects patients’ quality of life and work ability. Acupotomy has been widely used in the treatment of dQD. It has been reported in many articles that acupotomy can improve the clinical symptoms of dQD. However, the efficacy has not been evaluated scientifically and systematically. The aim of this systematic review protocol is to evaluate the efficacy and safety of acupotomy treatment compared with local steroid injection in patients with de Quervain disease.

Methods:
Relevant randomized controlled trials will be identified by searching 9 databases (PubMed, EMBASE, Cochrane Library, Chinese literature databases, the Chinese Biomedical Literature Database [CBM], China National Knowledge Infrastructure [CNKI], SinoMed, Technology Journal [VIP], and the Wanfang Database). Randomized controlled trials (RCTs) of Acupotomy for dQD patients will be identified independently by 2 reviewers by searching the databases from inception to October 2018. Clinical effects will be evaluated as the primary outcome. The VAS (visual analog scale) score will be assessed as a secondary outcome. RevMan V.5.3 will be used to perform a fixed effect meta-analysis, and the evidence level will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. Continuous outcomes will be presented as the mean differences or standard mean differences, while dichotomous data will be expressed as relative risks.

Results:
This study will evaluate the effectiveness and safety of acupotomy in the treatment of de Quervain disease in RCTs with high-quality VAS and RM.

Conclusion:
This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with de Quervain disease.

PROSPERO registration number:
CRD42018108786
Ultrasound for predicting difficult airway in obstetric anesthesia
Authors: Zheng Bi-Xin , Zheng Huan , Lin Xue-Mei 
Published: November 2019

Abstract

Background:
Failed intubation and ventilation during cesarean deliveries are important causes of anesthetic-related maternal mortality. Due to the physiological changes in airway anatomy, parturient had higher incidences of difficult airway than non-obstetric population. Accurate airway assessment is the first step and the most important in airway management. However, the common clinical screening tests, shown low sensitivity and specificity with a limited predictive value. Ultrasound is a quick, noninvasive, inexpensive tool, with the advancement of ultrasound technology, modern ultrasound machine is more portable with better resolution and enhanced tissue penetration, provide better imaging in tissues like epiglottis, vocal cords, ring-shaped membrane, and can be used in airway assessment. Here, the aim of the current study was to find whether preoperative ultrasound assessment of neck anatomy can predict difficult airway in parturient, and provide new ideas and a theoretical basis in the airway management of obstetric anesthesia.

Methods:
This is a prospective, observational single-blinded study in a single-center. Subjects will be recruited from patients aged from 18 to 60 years, gestational age ≥ 36 weeks, scheduled for cesarean section under general anesthesia and tracheal intubation. Ultrasound measurement will be performed to detect anterior cervical soft tissue thickness at five anatomical levels (hyoid bone, epiglottis, cricothyroid membrane, thyroid isthmus and suprasternal notch) in the upper airway. The thickness of the soft tissue in the front of the neck and clinical airway measurements will be compared between the “easy intubation” and “difficult intubation” group divided by Cormack–Lehane grade. Receiver-operating characteristic curves were used to determine the sensitivity and specificity of “difficulty prediction capability” of each sonographic and physical measurements. Clinical factors associated with difficult intubation will be determined by univariate analyses. Multiple logistic regression analysis performed to determine independent predictors of difficult intubation.

Conclusions:
The study outlined in this protocol will explore the possibility of ultrasound for predicting difficult airway in obstetric anesthesia. This may provide new insight into the practice of airway management.

Trial registration:
Chinese Clinical Trial Registry, ChiCTR1800018949.
Acupuncture for the treatment of ankle sprain
Authors: Huang Fasen , Sun Kai , Pan Xuyue , Xie Kunming , Wu Junde , Tao Jingwei , Ma Yufeng , Qi Yinze , Ma Zhanhua , Li Xinyu , Liang Huan , Wang Shulong , Lei Zhen , Chen Zhaojun 
Published: November 2019

Abstract

Background:
Ankle sprain is one of the most common musculoskeletal injuries in our daily life, which may lead to chronic ankle instability, reducing the quality of patients’ life and imposing a heavy burden on social medical security system. There are many kinds of methods treating ankle sprain, which can be divided into the conservative treatments and surgical intervention. Acupuncture is one of the conservative treatments for ankle sprain, especially in China. Therefore, we perform a systematic review and meta-analysis to evaluate the evidence for acupuncture's effectiveness, safety and cost benefits for the treatment.

Methods:
For the acquisition of required data of eligible randomized controlled trials (RCTs), literature search will be undertaken from the following database: PubMed, Embase, Web of Science, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang database. Quality assessment of the included studies will be independently performed according to the Cochrane Risk of Bias Tool by 2 investigators and the level of evidence for results will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Statistical analysis will be conducted with Revman 5.3.

Results:
From the study we will assess the effectiveness, safety and cost benefit of acupuncture on pain relief and functional improvement in patients with ankle sprain.

Conclusion:
The conclusion of this study will provide evidence to ensure the effectiveness, safety and cost benefits of acupuncture on ankle sprain, which can further guide the selection of appropriate interventions.

PROSPERO registration number:
CRD42018116829.
The triglyceride glucose index can predict newly diagnosed biopsy-proven diabetic nephropathy in type 2 diabetes
Authors: Shang Jin , Yu Dahai , Cai Yamei , Wang Zheng , Zhao Bin , Zhao Zhanzheng , Simmons David 
Published: November 2019

Abstract
Insulin resistance is usually a key factor in the development of type 2 diabetes. The triglyceride glucose (TyG) index is a marker of insulin resistance which is also implicated in the risk of nephropathy among people with type 2 diabetes. This study aimed to examine associations and potential thresholds between TyG index and the risk of newly diagnosed biopsy-proven diabetic nephropathy in people with type 2 diabetes. A nested case–control study incorporating 950 incident biopsy-proven diabetic nephropathy cases and age, gender matched 4750 patients with treated type 2 diabetes as controls selected by risk-set sampling method was implemented. The dose–response association between TyG index with subsequent risk of newly diagnosed biopsy-proven diabetic nephropathy after adjustment for age, gender, blood pressure, and other major cardiovascular risk factors were examined by conditional logistic regression model. A non-linear relationship was identified between TyG index and the risk of newly diagnosed biopsy-proven diabetic nephropathy with a potential threshold of TyG at 9.05–9.09. Similar relationships with the same threshold were also found in the analyses by fasting glucose and triglyceride levels. TyG index might be a prognostic factor in predicting newly development of biopsy-proven diabetic nephropathy among patients with treated type 2 diabetes. In people with type 2 diabetes, TyG index above 9.05–9.09 could be a prognostic threshold to identify individuals at high risk of diabetic nephropathy. Further replication studies are warranted.
Cardiac involvement in heavy and light chain amyloidosis
Authors: Otaka Yukihiro , Nakazato Yoichi , Tsutsui Takaaki , Tamura Jun’ichi 
Published: November 2019

Abstract

Introduction:
Heavy and light chain amyloidosis is an extremely rare condition. There are few reports referring to the clinical impact of cardiac involvement in heavy and light chain amyloidosis, and the significance of myocardial impairment has not yet been completely explained.

Patient concerns:
A 66-year-old Japanese man was admitted to our hospital presenting with nephrotic syndrome and congestive heart failure.

Diagnosis:
Kidney and endoscopic gastric mucosal biopsy demonstrated congophilic hyalinization in most of the glomeruli and surrounding vessel walls, which were highly positive for immunoglobulin A and lambda. Finally, the patient was diagnosed as an atypical multiple myeloma with systemic heavy and light chain amyloidosis.

Interventions:
The patient was referred to hematology for further treatment and was moved to another hospital for the administration of chemotherapy using melphalan and dexamethasone.

Outcomes:
The patient was still alive after 15-month follow-up from the initial diagnosis.

Conclusion:
Initial screening and follow-up for cardiac involvement are important for heavy and light chain amyloidosis. Further investigation for the prognosis of heavy and light chain amyloidosis is required to improve the strategies of diagnosis and treatment options for patients with this disease.
Systemic lupus erythematosus in a patient with multiple system atrophy
Authors: Pilalas Dimitrios , Chatzopoulos Georgios , Kaiafa Georgia D. , Ztriva Eleftheria , Spyridonakou Soultana , Bisbinas Vasiliki , Ioannidis Panagiotis , Hatzitolios Apostolos I. , Savopoulos Christos 
Published: November 2019

Abstract

Rationale:
Multiple system atrophy is a late-onset rare neurodegenerative movement disorder which results in debilitating disease. Fever frequently ensues in the context of infections which can be associated with significant morbidity and mortality, but among alternative diagnostic possibilities neoplasms and autoimmune disorders should be considered.

Patient concerns:
We describe a case of a prolonged febrile syndrome in a 55-year-old female patient with onset of multiple system atrophy two years before presentation. Patient history and symptoms were not contributive to guide the diagnostic work-up.

Diagnosis:
Initial evaluation provided no specific findings. Repeat testing of auto-antibodies revealed positive antinuclear and anti-ds DNA antibodies coupled with low complement which in conjunction with renal biopsy substantiated the diagnosis of systemic lupus erythematosus flare.

Intervention:
Pending the biopsy result, treatment with hydroxychloroquine and corticosteroids was initiated. Due to failure to achieve remission, azathioprine was added, but symptoms persisted. Following the diagnosis of lupus nephritis, azathioprine was discontinued and induction treatment with cyclophosphamide in accordance with the Euro-Lupus regimen was initiated and upon completion followed by maintenance therapy with mycophenolate mofetil.

Outcomes:
The patient achieved remission after cyclophosphamide was added to treatment with corticosteroids and has not experienced new flares during the next two years. The neurological syndrome has remained stable during this period.

Lessons:
To our knowledge, we report the first case of concurrent systemic lupus erythematosus and multiple system atrophy. Prolonged fever presents unique challenges in patients with rare diseases.
Reactivation Viremia in Pediatric Sepsis*
Authors: Han Moonjoo , Roberts Anna L. , Migliore Brooke A. , Cárdenas Ana María , Weiss Scott L. 
Published: November 2019

Objectives:
Reactivation viremia is associated with adverse clinical outcomes and immune dysfunction in adults with sepsis. We determined the incidence of viremia and its association with clinical outcomes and immune paralysis phenotype in children with severe sepsis.

Design:
Prospective cohort study.

Setting:
Single academic PICU from September 2016 to March 2018.

Patients:
Fifty-nine patients 2–17 years old treated for severe sepsis.

Interventions:
None.

Measurements and Main Results:
We performed real-time polymerase chain reaction assays on whole blood specimens to determine the incidence of cytomegalovirus. Cytomegalovirus was detected in three patients (5%). All patients with cytomegalovirus viremia were seropositive, with an incidence of 13% in this subset. We additionally performed Epstein-Barr virus and human herpesvirus-6 polymerase chain reaction assays on last available specimens and detected Epstein-Barr virus in 4% and human herpesvirus-6 in 30% of the study population. Overall, viremia was not associated with clinical outcomes or immune function in univariable analyses. However, viremia was associated with lower odds of complicated course (defined as death within 28 d or ≥ 2 organ dysfunctions at 7 d) after controlling for age, Pediatric Risk of Mortality III score, and blood transfusion (adjusted odds ratio, 0.08; 95% CI, 0.01–0.84; p = 0.04).

Conclusions:
Children with severe sepsis had low rates of detectable viremia, which limited analyses of its association with clinical outcomes or immune paralysis phenotype. Given the rare occurrence of cytomegalovirus viremia, in particular, our study does not support a role for viremia as a biomarker of illness severity or as a modifiable risk factor of clinical outcomes for most patients. Future studies on the role of viremia in pediatric sepsis will need to consider the challenges posed by low rates of viremia in this population.
Uncovering patterns of atomic interactions in static and dynamic structures of proteins
Authors: Venkatakrishnan A. J. , Fonseca Rasmus , Ma Anthony K. , Hollingsworth Scott A. , Chemparathy Augustine , Hilger Daniel , Kooistra Albert J. , Ahmari Ramin , Babu M. Madan , Kobilka Brian K. , Dror Ron O. 
Published: November 2019

AbstractThe number of structures and molecular dynamics simulations of proteins is exploding owing to dramatic advances in cryo-electron microscopy, crystallography, and computing. One of the most powerful ways to analyze structural information involves comparisons of interatomic interactions across different structures or simulations of the same protein or related proteins from the same family (e.g.different GPCRs). Such comparative analyses are of interest to a wide range of researchers but currently prove challenging for all but a few. To facilitate comparative structural analyses, we have developed tools for (i) rapidly computing and comparing interatomic interactions and (ii) interactively visualizing interactions to enable structure-based interpretations. Using these tools, we have developed the Contact Comparison Atlas, a web-based resource for the comparative analysis of interactions in structures and simulations of proteins. Using the Contact Comparison Atlas and our tools, we have identified patterns of interactions with functional implications in structures of G-protein-coupled receptors, G proteins and kinases and in the dynamics of muscarinic receptors. The Contact Comparison Atlas can be used to enable structure modeling, drug discovery, protein engineering, and the prediction of disease-associated mutations.Contact Comparison Atlas website:https://getcontacts.github.io/atlas/
Teacher agency in a multiyear professional development collaborative
Authors: Wagner Christopher J. , Ossa Parra Marcela , Proctor C. Patrick 
Published: November 2019

PurposeThis paper aims to report on the decisions two teachers made about how to engage with a five-year school–university collaboration that used professional development (PD) to foster changes in language instruction for teachers of multilingual learners.Design/methodology/approachA longitudinal case study was used to examine the experiences of two teachers to provide insights into classroom-level decisions and changes in instructional practices.FindingsChanges in instructional practices occurred when teachers made active, engaged choices about their own learning and teaching in the classroom. Teacher learning did not follow a consistent trajectory of improvement and contained contradictions, and early decisions about how to engage with PD affected the pace and nature of teacher learning. Through personal decisions about how to engage with PD, teachers adopted new instructional practices to support multilingual learners. Positive changes required extended time for teachers to implement new practices successfully.Practical implicationsThis collaboration points to a need for long-term PD partnerships that value teacher agency to produce instructional changes that support multilingual learners.Originality/valuePD can play a key role in transforming literacy instruction for multilingual learners. Teacher agency, including the decisions teachers make about how to engage with professional learning opportunities and how to enact new instructional practices in the classroom, mediates the efficacy of PD initiatives. This longitudinal case study contributes to the understanding of effective PD by presenting two contrasting case studies of teacher agency and learning during long-term school–university collaboration.