bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum NSE and S100B protein levels for evaluating the impaired consciousness in patients with acute carbon monoxide poisoning
Authors: Zhang Litao , Zhao Jing , Hao Qingqing , Xu Xin , Han Hu , Li Jianguo 
Published: June 2021

Abstract
The aim of this study was to investigate the associations between the levels of neuron-specific enolase (NSE) and S100B protein and coma duration, and evaluate the optimal cut-off values for prediction coma duration ≥ 72 hours in patients with acute carbon monoxide poisoning (ACOP).
A total of 60 patients with ACOP were divided into 3 following groups according to their status of consciousness and coma duration at admission: Awake group [Glasgow Coma Scale score (GCS score) ≥ 13 points], Coma < 72 hours group (GCS score < 13 points and coma duration < 72 h), and Coma ≥ 72 hours group (GCS score < 13 points and coma duration ≥ 72 h). The levels of serum NSE and S100B protein were measured after admission.
There were significant differences in GCS score, carbon monoxide (CO) exposure time, NSE, and S100B levels between the Coma ≥ 72 h group and the Awake group, and between the Coma < 72 h group and the Awake group. Significant differences in GCS score, NSE, and S100B levels were also found between Coma ≥ 72 h group and Coma < 72 h group. Correlation analysis showed that NSE and S100B were positively correlated (r
s = 0.590, P < .01); NSE and S100B were negatively correlated with GCS score (r
s = -0.583, r
s = -0.590, respectively, both P < .01). The areas under the curve (AUCs) of NSE, S100B, and GCS score to predict the coma duration ≥ 72 hours were 0.754, 0.791, and 0.785, respectively. Pairwise comparisons did not show differences among the 3 groups (all P > .05). The sensitivity and specificity of NSE prediction with a cut-off value of 13 μg/L were 80% and 64%, respectively, and those of S100B prediction with a cut-off value of 0.43 μg/L were 70% and 88%, respectively.
The NSE and S100B protein levels were significantly correlated with the degree of impaired consciousness and had the same clinical value in predicting coma duration of ≥ 72 hours in patients with ACOP.
A simple noninvasive model to predict significant fibrosis in children with chronic hepatitis B
Authors: Zhang Kang-Ling , Chen Xiu-Qi , Lv Zi-Li , Tang Qing , Shan Qing-Wen 
Published: June 2021

Abstract
To develop a noninvasive model to predict significant fibrosis in children with chronic hepatitis B (CHB).
A total of 116 CHB pediatric patients who underwent liver biopsy were included in the study. Liver histology, which is the gold standard for assessing fibrosis, was performed. Blood routine examination, coagulation function, liver biochemistry, viral serology, and viral load were analyzed. Receiver operating characteristic curve analysis was used to analyze the sensitivity and specificity of all possible cut-off values.
Based on the correlation and difference analyses, 7 available clinical parameters (total bile acid, gamma-glutamyl transpeptidase [GGT], aspartate transaminase, direct bilirubin to total bilirubin ratio, alanine aminotransferase, prealbumin [PA], and cholinesterase) were included in the modeling analysis. A model to predict significant liver fibrosis was derived using the 2 best parameters (PA and GGT). The original model was

. After the mathematical calculation, the G index=600 × GGT/PA2 predicted significant fibrosis, with an area under the receiving operating characteristics (AUROC) curve of 0.733, 95% confidence interval (0.643–0.811). The AUROC of the G index (0.733) was higher than that of aminotransferase to platelet ratio index (APRI) (0.680) and Fibrosis index based on 4 factors (FIB-4) (0.601) in predicting significant fibrosis in children with CHB. If the values of the G index were outside the range of 0.28 to 1.16, 52% of children with CHB could avoid liver biopsy, with an overall accuracy of 75%.
The G index can predict and exclude significant fibrosis in children with CHB, and it may reduce the need for liver biopsy in children with CHB.
Stroop interference in children with developmental dyslexia
Authors: Shen Chengwei , Jiang Qi , Luo Yan , Long Ji , Tai Xiujuan , Liu Shuqing 
Published: June 2021

Abstract
Previous studies have identified inhibitory deficits in dyslexic children, but we have little understanding of their neural mechanisms, especially for Chinese children with developmental dyslexia.
We used a double-blind controlled trial to study the electroencephalogram responses of dyslexic and non-dyslexic children when performing the Stroop color-word test.
Behavioral data showed differences in response time and accuracy between the 2 groups. In the event-related potentials (ERP) results, dyslexic children displayed larger P2 and P3b on congruent trials, while non-dyslexic children displayed larger P2 and P3b on incongruent trials, the 2 groups showed opposite brain activation patterns on the Stroop test.
Dyslexic children have poor inhibitory function, and this poor inhibition may be related to their abnormal brain activation patterns.
Immunohistochemistry in postmortem diagnosis of acute cerebral hypoxia and ischemia
Authors: Barranco Rosario , Bonsignore Alessandro , Ventura Francesco 
Published: June 2021

Abstract

Background
: Discovery of evidence of acute brain ischemia or hypoxia and its differentiation from agonal hypoxia represents a task of interest but extremely difficult in forensic neuropathology. Generally, more than 50% of forensic autopsies indicate evidence of brain induced functional arrest of the organ system, which can be the result of a hypoxic/ischemic brain event. Even if the brain is the target organ of hypoxic/ischemic damage, at present, there are no specific neuropathological (macroscopic and histological) findings of hypoxic damage (such as in drowning, hanging, intoxication with carbon monoxide) or acute ischemia. In fact, the first histological signs appear after at least 4 to 6 hours. Numerous authors have pointed out how an immunohistochemical analysis could help diagnose acute cerebral hypoxia/ischemia.
Data sources: This review was based on articles published in PubMed and Scopus databases in the past 25 years, with the following keywords “immunohistochemical markers,” “acute cerebral ischemia,” “ischemic or hypoxic brain damage,” and “acute cerebral hypoxia”.

Objectives
: Original articles and reviews on this topic were selected. The purpose of this review is to analyze and summarize the markers studied so far and to consider the limits of immunohistochemistry that exist to date in this specific field of forensic pathology.

Results
: We identified 13 markers that had been examined (in previous studies) for this purpose. In our opinion, it is difficult to identify reliable and confirmed biomarkers from multiple studies in order to support a postmortem diagnosis of acute cerebral hypoxia/ischemia. Microtubule-associated protein 2 (MAP2) is the most researched marker in the literature and the results obtained have proven to be quite useful.

Conclusion:
Immunohistochemistry has provided interesting and promising results, but further studies are needed in order to confirm and apply them in standard forensic practice.
Identification of hub genes, pathways, and related transcription factors in systemic lupus erythematosus
Authors: Wang Yanfeng , Ma Qian , Huo Zhenghao 
Published: June 2021

Abstract

Background:
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organ damage and the production of a variety of autoantibodies. The pathogenesis of SLE has not been fully defined, and it is difficult to treat. Our study aimed to identify candidate genes that may be used as biomarkers for the screening, diagnosis, and treatment of SLE.

Methods:
We used the GEO2R tool to identify the differentially expressed genes (DEGs) in SLE-related datasets retrieved from the Gene Expression Omnibus (GEO). In addition, we also identified the biological functions of the DEGs by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Additionally, we constructed protein–protein interaction (PPI) networks to identify hub genes, as well as the regulatory network of transcription factors related to DEGs.

Results:
Two datasets were identified for use from the GEO (GSE50772, GSE4588), and 34 up-regulated genes and 4 down-regulated genes were identified by GEO2R. Pathway analysis of the DEGs revealed enrichment of the interferon alpha/beta signaling pathway; GO analysis was mainly enriched in response to interferon alpha, regulation of ribonuclease activity. PPIs were constructed through the STRING database and 14 hub genes were selected and 1 significant module (score = 12.923) was obtained from the PPI network. Additionally, 11 key transcription factors that interacted closely with the 14 hub DEGs were identified from the gene transcription factor network.

Conclusions:
Bioinformatic analysis is an effective tool for screening the original genomic data in the GEO database, and a large number of SLE-related DEGs were identified. The identified hub DEGs may be potential biomarkers of SLE.
Classification of circadian pain rhythms and pain characteristics in chronic pain patients
Authors: Tanaka Yoichi , Shigetoh Hayato , Sato Gosuke , Fujii Ren , Imai Ryota , Osumi Michihiro , Morioka Shu 
Published: June 2021

Abstract
This study aimed to perform cluster analysis in patients with chronic pain to extract groups with similar circadian rhythms and compare neuropathic pain and psychological factors among these groups to identify differences in pain-related outcomes. A total of 63 community-dwellers with pain lasting at least 3 months and Numerical Rating Scale scores of ≥2 were recruited from 3 medical institutions. Their pain circadian rhythms were evaluated over 7 days by measuring pain intensity at 6-time points per day using a 10-cm visual analog scale. Cluster analysis was performed using 6 variables with standardized visual analog scale values at 6-time points for individual participants to extract groups with similar pain circadian rhythms. The results of the Neuropathic Pain Symptom Inventory and psychological evaluations in each group were compared using the Kruskal–Wallis test. The results revealed 3 clusters with different circadian rhythms of pain. The total and evoked pain subscale Neuropathic Pain Symptom Inventory scores differed among the 3 clusters. The results suggest that a thorough understanding of circadian pain rhythms in chronic pain patients may facilitate the performance of activities of daily living and physical exercise from the perspective of pain management.
Characteristics of patients with emergency attendance for severe hypoglycemia and hyperglycemia in a general hospital in Japan
Authors: Endo Keisuke , Itoh Takahito , Tanno Masaya , Ohno Kouhei , Hotta Hiroyuki , Kato Nobuo , Matsumoto Tomoaki , Ooiwa Hitoshi , Kubo Hirofumi , Miki Takayuki 
Published: June 2021

Abstract
Despite advances in treatments for diabetes mellitus (DM), severe acute glycemic crises still occur. In this study, the characteristics of patients who were transported to an emergency department due to acute glycemic crises were investigated.
We enrolled patients who were transported to our hospital by ambulance due to hypoglycemia or hyperglycemia during the period from January 2015 to December 2019. Initial glucose levels below 70 mg/dL and above 250 mg/dL were defined as hypoglycemia and hyperglycemia, respectively.
In the 5-year period, 16,910 patients were transported to our hospital by ambulance. Of those patients, 87 patients (0.51%) were diagnosed with hypoglycemia, 26 patients (0.15%) were diagnosed with hyperglycemia and 1 patient was diagnosed with lactic acidosis. Compared to patients with hypoglycemia, blood urea nitrogen, serum potassium and hemoglobin levels were higher in patients with hyperglycemia. Systolic blood pressure was lower and pulse rate was higher in patients with hyperglycemia, possibly reflecting dehydration in hyperglycemia. Patients with hyperglycemia were younger (63 vs 70 years old, median), more likely to be hospitalized (92.3% vs 23.0%) with poorer prognosis (23.1% vs 4.6%) than those with hypoglycemia. In 64 DM patients with hypoglycemia, 34 patients were treated with insulin and 24 patients were treated with sulfonylurea or glinide, and their medication was often inappropriate. Excessive alcohol intake and malnutrition were the main causes of hypoglycemia in 23 non-DM patients. The main reasons for hyperglycemia were interrupted treatment, forgetting insulin injection and infection.
To avoid acute glycemic crises, optimization of anti-DM therapy and education of patients are needed.
Prognostic value of inflammatory and nutritional markers for hepatocellular carcinoma
Authors: Xu Yingying , Yuan Xiuxue , Zhang Xiaomin , Hu Wenqing , Wang Zehua , Yao Longdi , Zong Liang 
Published: June 2021

Abstract
Many clinical studies have demonstrated that the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and Onodera's prognostic nutritional index (OPNI) are visibly involved in the prognosis of a variety of tumors. In our research, we aim to determin the prognostic impact of NLR, PLR, and OPNI for hepatocellular carcinoma (HCC).
Data of hepatocellular carcinoma patients undergoing treatment in Changzhi People's Hospital between 2011 and 2017 were reviewed. 270 patients with HCC were under inclusion criteria. The optimal cut-off points of OPNI, NLR and PLR were determined by using the X-tile program. The overall survival (OS) was analyzed by Kaplan–Meier method. Multivariate analysis was performed using Cox Proportional Hazard Regression model to determine independent prognostic indicators for HCC.
As revealed by Univariate and multivariate analysis, OPNI, Treatment, PLR, and BCLC Stage can be used as independent prognostic indicators for HCC. Comparing the P values and hazard ratios, we found out that the OPNI has greatest influence on prognosis in these indexes. The appropriate cut-off points of NLR, PLR, and OPNI were 2.5, 133.3, and 39.5, respectively. High score OPNI group had a better OS. In the analysis between OPNI and clinicopathological characteristics, there were differences in treatment, postoperative therapy, AST, ALBI grade, NLR and PLR between the high OPNI group and the low OPNI group, while others did not.
OPNI is a straightforward and effective independent prognostic indicator for HCC.
Personalized Behavioral Nutrition Among Older Asian Americans
Authors: Ko Jisook , Wang Jing , Du Yan , Jiwani Rozmin , Li Chengdong 
Published: June 2021

Abstract

Background
Metabolomics profiling is an objective assessment of metabolic responses to intricate dietary patterns. However, few studies have investigated the potential benefits associated with personalized behavioral nutrition (PBN) interventions incorporating the metabolomics approach for improving diabetes outcomes for older Asian Americans with Type 2 diabetes.

Objective
This article describes the protocol for a pilot study testing self-management of a nutrition intervention-provided personalized dietary advice incorporating metabolites phenotypic feedback and digital self-monitoring of diet and blood glucose.

Methods
A total of 60 older Asian Americans will be randomized into two groups: a PBN group and a control group. Participants in the PBN group will receive personalized dietary advice based on dietary and phenotypic feedback-used metabolic profiles. This study aims to examine the feasibility and preliminary effects of the PBN on diabetes outcomes.

Results
The study began in September 2020, with estimated complete data collection by late 2021.

Discussion
Findings from this pilot study will inform future research for developing personalized nutrition interventions for people with Type 2 diabetes.
Reducing Time to Discharge after Chemotherapy by Standardizing Workflow and Providing Outpatient Intravenous Hydration
Authors: Sitthi-Amorn Jitsuda , Ast Allison , Harper Erin , Abbott Brian , Alsaek Yaser , Bourland Wendy , Courtney Rachael , Madni Arshia , Sharma Aditya , Spencer Christopher , McCurrach Lane , Morgan Stacey , McCormick John , Wittman David , Johnson Liza-Marie 
Published: June 2021

Introduction:
Patients receiving cyclophosphamide or ifosfamide chemotherapy require intravenous fluid hydration to prevent hemorrhagic cystitis. In selected patients without medical contraindications (ie, excess nausea/vomiting), this hydration may be completed after discharge. We aimed to reduce the time to discharge after completing mesna in patients receiving cyclophosphamide or ifosfamide therapy on an inpatient chemotherapy service.

Methods:
The quality improvement team performed a medical record review to capture the time to discharge after mesna therapy and the readmission rate and used quality improvement methods to redesign discharge workflow and increase patient involvement with the discharge process.

Results:
From August 2017 through July 2018, there were 160 admission encounters (73 patients) for cyclophosphamide or ifosfamide on a dedicated chemotherapy service. Of those encounters, 89 (55.6%) were appropriate for outpatient hydration; 48 (53.9%) of these encounters involved a patient who elected to receive outpatient hydration. Although the median time to discharge for the whole cohort did not change, in encounters where patients chose intravenous outpatient hydration, the median time to discharge was reduced from 2.82 to 0.66 hours (76.6% reduction) after implementing the new discharge workflow. No patients experienced readmission within 48 hours.

Conclusions:
Discharge workflow redesign and standardization reduced the time to discharge after chemotherapy in patients who chose outpatient hydration. Outpatient intravenous hydration after cyclophosphamide or ifosfamide appears safe and feasible in selected patient populations.
Improving Patient Experience Scores in a Pediatric Emergency Department
Authors: Emerson Beth L. , Setzer Erika , Bechtel Kirsten , Grossman Matthew 
Published: June 2021

Introduction:
Patient experience (PE) is an important aspect of the quality of medical care and is associated with positive health outcomes. In the pediatric emergency department (PED), PE is complicated due to the balance of needs between the patient and their family while receiving care. We identified an opportunity to improve our PE, as measured by a survey administered to patients and families following their visit to the PED.

Methods:
Utilizing quality improvement methods, we assembled a multidisciplinary team, developed our aims, and evaluated the process. We utilized a key driver diagram and run charts to track our performance. The team additionally monitored several essential subcategories in our improvement process. We aimed to improve our overall PE score from 86.1 to 89.7 over 9 months to align with institutional objectives.

Results:
Over 6 months, we improved our overall PE score from 86.1 to 89.8. Similarly, each of our subscores of interest (physician performance, things for patients to do in the waiting room, waiting time for radiology, staff sensitivity, and communication about delays) increased. Interventions included rounding in the waiting and examination rooms, staff training, team huddles, and a cross-department committee. All measures demonstrated sustained improvement.

Conclusions:
Even in this complex setting, a multidisciplinary team’s careful and rigorous process evaluation and improvement work can drive measurable PE improvement. We are continuing our efforts to further improve our performance in excellent patient-centered care to this critical population.
Reducing High-flow Nasal Cannula Overutilization in Viral Bronchiolitis
Authors: Siraj Shaila , Compton Brandy , Russell Brittney , Ralston Shawn 
Published: June 2021

Introduction:
Heated high-flow nasal cannula (HHFNC) therapy for bronchiolitis has become increasingly prevalent without evidence that this therapy impacts patient outcomes. Lack of criteria for appropriate use may lead to overutilization, resulting in increased costs without patient benefit. Our primary aim was to decrease use of HHFNC in patients with bronchiolitis over one season.

Methods:
Patients with Bronchiolitis younger than 2 years of age admitted to the Hospital Medicine Service were included in this study. Using the model for improvement framework, we identified key drivers for HHFNC overuse and revised our bronchiolitis protocol to include low-flow nasal cannula trials before HHFNC initiation. We compared preintervention HHFNC utilization (December 2018–April 2019) with postintervention HFNC utilization (December 2019–March 2020).

Results:
One hundred ninety patients met inclusion criteria, 98 of them in the preintervention cohort and 92 in the postintervention cohort. Overall, the median age was 9 months and 65% of patients were male. Our HHFNC utilization rate decreased from 62% (61/98) to 43% (40/92) in the postintervention period. Our SPC analysis suggested special cause variation based on 7 points below the preintervention mean.

Conclusions:
This QI intervention implementing a specified low-flow nasal cannula trial before the initiation of HHFNC shows promise in reducing overall HHFNC use. Future studies should focus on clear initiation and discontinuation criteria for HHFNC use in bronchiolitis.
A Quality Improvement Initiative: Improving First-hour Breastfeeding Initiation Rate among Healthy Newborns
Authors: Patyal Neha , Sheoran Poonam , Sarin Jyoti , Singh Jeevan , Jesika Khurana , Kumar Jony , Banyal Kajal , Chauhan Kamal , Tanwar Karamvir , Siani Komal , Kaur Komalveer 
Published: June 2021

Introduction:
“No matter where a newborn takes his or her first breath, the desire to give that baby the best start in life is universal.” The best gift a mother can give her baby is the gift of health. The gift of health can be given to the baby through early and adequate breastfeeding. Globally, only 2 out of 5 newborns are put to the breast within the first hour of life. Therefore, initiating breastfeeding is an evidence-based intervention for improving neonatal survival.

Methods:
We aimed to improve the first-hour breastfeeding initiation rate from the existing 12%–80% over 3 months through a quality improvement (QI) process. The setting was antenatal, perinatal, and postnatal wards of the Maharishi Markandeshwar Institute of Medical Sciences And Research Hospital. The participants were postpartum mothers with stable newborns 35 weeks and older of gestation born by normal vaginal delivery.

Procedure for QI:
A team of nurses and obstetricians was formed; we analyzed possible reasons for delayed initiation of breastfeeding by process cycle matrix chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. The outcome measure is the proportion of eligible babies breastfed within 1 hour of delivery.

Results:
After 3 months, the first-hour initiation of breastfeeding increased from 12% to 80%, without additional resources.

Conclusions:
A QI approach achieved an improvement in first-hour breastfeeding rates after normal vaginal delivery.