bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal serum sFlt-1/PlGF ratio predicts the adverse neonatal outcomes among small-for-gestational-age fetuses in normotensive pregnant women
Authors: Shim So Hyun , Jeon Haeng Jun , Ryu Hye Jin , Kim So Hyun , Min Seung Gi , Kang Min Kyu , Park Hee Jin , Cha Dong Hyun 
Published: March 2021

Abstract
We investigated the predictive value of the soluble fms-like tyrosine kinase-1 (sFlt-1)-to-placental growth factor (PlGF) ratio for poor neonatal outcomes of SGA neonates in the absence of preeclampsia.
This prospective cohort study included 530 singleton pregnant women who attended a prenatal screening program at a single institution. The sFlt-1/PlGF values at 24 to 28+6 weeks and 29 to 36+6 weeks of gestation were analyzed and compared between control and SGA group (subdivided as with normal neonatal outcomes and with poor neonatal outcomes).
After 22 preeclampsia cases were excluded, 47 SGA neonates and 461 control neonates were included. In the SGA group, 17 neonates had adverse neonatal outcomes (36.1%, 17/47). The mean (±D) sFlt-1/PlGF ratio of early third trimester was significantly higher in SGA with averse neonatal outcome group than in the control group (14.42 ± 23.8 vs 109.12 3.96, P = .041) and the ratio retained an independent and significant association with SGA with adverse neonatal outcomes (odds ratio = 1.017, P = .01). A sFlt-1/PlGF ratio cut-off of 28.15 at 29 to 36+6 weeks significantly predicted adverse outcomes among SGA neonates (sensitivity = 76.9%, specificity = 88%).
In this study, sFlt-1/PlGF ratio at 29 to 36 + 6wks of SGA with adverse neonatal outcome group was significantly higher than control group. This study suggests the feasibility of the sFlt-1/PlGF ratio as helpful objective measurement for predicting the adverse SGA neonatal outcome by providing sFlt-1/PlGF cut-off value.
Effectiveness of endoscopic hemostasis in preventing diverticular bleeding with extravasation detected by contrast-enhanced computed tomography
Authors: Yamagishi Toshinobu , Kashiura Masahiro , Shindo Yuji , Yamanaka Kenichi , Tsuboi Ken , Shinhata Hakuei 
Published: March 2021

Abstract
In diverticular bleeding, extravasation detected by computed tomography indicates active bleeding. It is unclear whether an endoscopic procedure is the best method of hemostasis for diverticular bleeding. This retrospective study was conducted to examine the effectiveness of endoscopic hemostasis in preventing diverticular rebleeding with extravasation visualized by contrast-enhanced computed tomography.
This single-center, retrospective, the observational study utilized data from an endoscopic database. Adult patients admitted to our hospital due to diverticular bleeding diagnosed by colonoscopy were included. We compared the data between the extravasation-positive and extravasation-negative groups. The primary outcome was the proportion of successful hemostasis without rebleeding within 1 month after the first endoscopic procedure. Altogether, 69 patients were included in the study (n = 17, extravasation-positive group; n = 52, extravasation-negative group). The overall rebleeding rate was 30.4% (21/69). The rebleeding rate was higher in the extravasation-positive group than in the extravasation-negative group, although without a statistically significant difference. However, among the patients who underwent endoscopic hemostasis, the rebleeding rate was significantly higher in the extravasation-positive group than in the extravasation-negative group (50% [8/16] vs 10.5% [2/19], p = .022). In the extravasation-positive group, all 8 patients with rebleeding underwent repeat colonoscopy. Of these, 5 patients required additional clips; bleeding was controlled in 3 patients, while arterial embolization or surgery was required for hemostasis in 2 patients. None of the remaining 3 patients with rebleeding in the extravasation-positive group required clipping; thus, their conditions were only observed.
Many patients with diverticular bleeding who exhibited extravasation on computed tomography experienced rebleeding after endoscopic hemostasis. However, bleeding in more than half of these patients could be stopped by 2 endoscopic procedures, without performing transcatheter arterial embolization or surgery even if rebleeding occurred. Some serious major complications due to such invasive interventions are reported in the literature, but colonoscopic complications did not occur in our patients. Endoscopic hemostasis may be the preferred and effective first-line therapy for patients with diverticular bleeding who have extravasation, as visualized by contrast-enhanced computed tomography.
Calcitonin gene-related peptide receptor antagonist ubrogepant for the treatment of acute migraine
Authors: Zhang Zizhen , Shu Yunfeng , Diao Yun , Du Yang , Chen Lizhi , Liu Ying , Du Biao 
Published: March 2021

Abstract

Background:
The objective of this study is to systematically evaluate the efficacy and safety of the calcitonin gene-related peptide (CGRP) receptor antagonist ubrogepant for the treatment of acute migraine.

Methods:
Randomized controlled trials (RCTs) of ubrogepant for treatment of acute migraine were identified in PubMed, MEDLINE, EMBASE, and the Cochrane Library from database establishment to June 2020; we also searched ClinicalTrials.gov manually during the same period. Then, RevMan 5.3 software was used to perform a meta-analysis on each outcome measure.

Results:
A total of 5 RCTs involving 4903 patients were included; there were 3358 cases in the ubrogepant group and 1545 cases in the placebo group. The meta-analysis showed the following results: at 2 hours postdose, the percentages of participants reporting pain relief and the absence of photophobia, nausea, and phonophobia were significantly higher in the ubrogepant group than in the placebo group (odds ratio [OR] = 1.71, 95%CI: 1.48–1.97, P < .00001; OR = 1.33, 95%CI: 1.22–1.45, P < .00001; OR = 1.07, 95%CI: 1.03–1.11, P = .0006; OR = 1.21, 95%CI: 1.14–1.28, P < .00001). The incidence of common adverse events was similar between the 2 groups (P > .05).

Conclusion:
Ubrogepant is effective and safe for the treatment of acute migraine.

Registration number:
PROSPERO CRD42019145286.
Association between 30-day readmission rates and health information technology capabilities in US hospitals
Authors: Elysee Gerald , Yu Huihui , Herrin Jeph , Horwitz Leora I. 
Published: March 2021

Abstract
Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.
To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.
This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.
A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = −0.086; 95% Confidence Interval, −0.162 to −0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.
These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial – perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.
Delirium screening tools in the emergency department
Authors: Zhang Qian , Li Sheng , Chen Meixi , Yang Qiuyu , Cao Xiao , Ge Long , Di Baoshan 
Published: March 2021

Abstract

Background:
Delirium is a common type of acute brain dysfunction among emergency department (ED) patients. The prevalence of delirium in the ED is up to 40%. Although screening instruments used to identify delirium have been developed, it is unclear which tool is the most accurate in the ED. To address this challenging, we systematically examine the accuracy of delirium screening tools used to assess the ED patients.

Methods:
This study has been registered at the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY), and the registration number is INPLASY202110041. We will search the PubMed, EMBASE, PsycINFO, and the Cochrane Library. Studies involving patients which compared diagnostic instruments with the criteria in Diagnostic and Statistical Manual of Mental Disorders (DSM) as a reference standard will be included. We will use STATA 15.1 and MetaDiSC to make careful analysis of the results. The quality of included studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scale.

Results:
In this study, the accuracy of different screening methods among ED patients is assessed by a high-quality synthesis. The number of tools available for screening delirium in the ED, the information of studies including the countries, the study design, the sample size and the characteristic of studies, the quality of the studies and the results of meta-analysis. The systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:
According to the conclusion of the systematic review, evidence will be provided to judge which screening method is the best for the ED patients. The results will bring better understanding of screening methods in the ED and highlight gaps for future research.
Safety and efficacy of edaravone for patients with acute stroke
Authors: Shan Hailei , Jiao Guangmei , Cheng Xi , Dou Zhijie 
Published: March 2021

Abstract

Background:
We performed a randomized clinical trial protocol to assess the effectiveness of edaravone for acute stroke. We hypothesized that edaravone is beneficial in improving neurological impairment resulting from acute stroke.

Method:
The protocol was reviewed and approved by the Research Ethics Board of Affiliated Hospital of Chengde Medical University (0092-2394), each participant signed a written consent before participating, and SPIRIT guidelines were followed throughout. The inclusion criteria for patients were as follows: diagnosed as acute stroke (ischemic stroke or intracerebral hemorrhage) by head CT or MRI within 72 hours; age greater than 18; motor function disorder; Glasgow Coma Scale greater than 12. Patients with the following symptoms were excluded: concurrent serious complications, such as coma, drug allergy, mental disorder, and other severe organic lesions in the brain. Sixty patients were finally included in the study. The control group accepted conventional treatment, while the treatment group received edaravone treatment on top of the conventional treatment of the control group. After treatment, the differences in functional movement, living ability score, neurological score, treatment effect, and adverse reaction of these 2 groups were tested and compared.

Discussion:
As aging worsens, the incidence of acute stroke continues to increase. Brain damage will induce the production of oxygen radicals, which can damage the cytomembrane of brain cells and finally damage the nervous system and cause cerebral injury as well as the cerebral edema. Edaravone is an antioxidant and oxygen radical scavenger that can inhibit lipid peroxidation during the scavenging of oxygen free radicals. Besides, it can also elicit anti-inflammatory protective effects for nerve cells, increase cerebral blood flow volume, prevent the aggravation of cerebral hypoperfusion toward necrosis, reduce nerve damage, and improve neurological functions and prognosis. This is the first randomized controlled trial to assess the efficacy of edaravone for treating acute stroke. High quality, large sample size, multicenter randomized trials are still required.

Trial registration:
researchregistry6492.
The usefulness of a three-dimensional printed segmental scapula prosthesis for recovering shoulder function in a patient with scapula chondrosarcoma
Authors: Park Jong Hoon , Jung Hae Woon , Jang Woo Young 
Published: March 2021

Abstract

Rationale:
Localized chondrosarcoma of the scapula has a favorable long-term survival outcome. Therefore, recovery of shoulder function after surgery is important in middle-aged patients. Currently, three-dimensional (3-D) printing implants can be applied for personalized limb salvage surgery.

Patient concerns:
A 41-year-old woman with a palpable scapular area presented with shoulder pain for 3 months, which was aggravated during shoulder exercise.

Diagnoses:

Chondrosarcoma at left scapular (Malawer S1, Enniking II B, and grade II chondrosarcoma).

Interventions:
Wide excision for a localized chondrosarcoma at the infrascapular lesion was performed and the resected muscles around the scapula were repaired with a 3-D printed segmental scapula prosthesis for recovery of shoulder function.

Outcomes:
The affected shoulder achieved satisfactory function after operation using the 3-D printed segmental scapula prosthesis at 1 year 6 months after the operation.

Lessons:
The 3-D printed segmental scapula prosthesis is a useful method for shoulder functional recovery in patients with scapula chondrosarcoma.
The Use of hx-index to compare research achievements for ophthalmology authors in Mainland China, Hong Kong, and Taiwan since 2010
Authors: Yeh Yu-Tsen , Chien Tsair-Wei , Kan Wei-Chih , Kuo Shu-Chun 
Published: March 2021

Abstract

Background:
Ophthalmology authors in mainland China, Hong Kong, or Taiwan were interested in knowing their individual research achievements (IRAs). This study was to evaluate the most cited authors, institutes, and regions in the mainland, Hong Kong, and Taiwan in the field of ophthalmology in the recent 10 years using the hx-index and to display the result with visual representations.

Methods:
Using the PubMed search engine to download data, we conducted an observational study of citation analyses in affiliated research institutes and regions (provinces/areas) of all ophthalmology authors since 2010. A total of 19,364 published articles from 22,393 authors in the mainland, Hong Kong, and Taiwan were analyzed. The x-index and the Kano model were complemental to the hx-index in identifying IRAs. A pyramid plot was used to illustrate the importance of the author-weighted scheme (AWS) used in evaluating IRAs in academics. The hx-index combining both advantages of the h and x-index was proposed to assess individual IRAs. Furthermore, we drew

Results:
There is a significant rise over time in the number of publications. The top-ranking regions in hx-index were Shanghai (26.82), Guangdong (25.82), and Beijing (25.81). We demonstrated that Dr Wu from Taiwan published 144 articles in PMC and used the example to explain the importance of AWS when IRAs were assessed.

Conclusions:
With an overall increase in publications in the field of ophthalmology, contributions assessed by hx-indexes and the AWS should be encouraged and promoted more in the future.
The safety and efficacy of low-dose mineralocorticoid receptor antagonists in dialysis patients
Authors: Zhu Yifan , Liu Yueming , Cai Ruyi , Zheng Danna , Liang Xudong , Tao Mei , Jin Juan , Li Yiwen , He Qiang 
Published: March 2021

Abstract

Introduction:
Our aim was to evaluate the safety and efficacy of low-dose mineralocorticoid receptor antagonists (MRAs) in dialysis patients.

Methods:
We systematically searched PubMed, EMBASE, and Cochrane libraries for clinical trials on the use of MRAs in dialysis patients. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence.

Results:
We identified nine randomized controlled trials including 1128 chronic dialysis patients. In terms of safety, when hyperkalemia was defined as serum potassium level ≥5.5 mmol/L, low-dose MRAs were significantly associated with hyperkalemia (relative risk [RR] 1.76, 95% confidence intervals [CI] 1.07–2.89, P = .02); however, when hyperkalemia was defined as serum potassium level ≥6.0 mmol/L or serum potassium level ≥6.5 mmol/L, no significant association was observed between low-dose MRAs and hyperkalemia (RR 1.40, 95% CI 0.83–2.37, P = .20; RR 1.98, 95% CI 0.91–4.30, P = .09, respectively). Use of low-dose MRAs can reduce cardiovascular mortality by 54% compared with the control group (0.46, 95% CI 0.28–0.76, P = .003). Similarly, the RR of all-cause mortality for the low-dose MRAs group was 0.48 (95% CI 0.33–0.72, P = .0003).

Conclusion:
Low-dose MRAs may benefit dialysis patients without significantly increasing moderate to severe hyperkalemia.
Electrophysiological study and radiofrequency ablation of hemodynamically-instable ventricular arrhythmias in a patient with pulmonary hypertension
Authors: Zou Song , Cen Zhifu , Jia Ruikun , Lu Sijie , Hao Yan , Cui Kaijun 
Published: March 2021

Abstract

Introduction:
Hemodynamically-instable ventricular arrhythmias (VAs) are rare in patients with pulmonary hypertension (PH). To the best of our knowledge, only 1 case has been reported so far. Moreover, the pathogenesis of this kind of arrhythmia remains obscured and its treatment is challenging. Here we report another case and presented the substrate for VAs initiation and therapeutic effect of radiofrequency ablation.

Patient concerns:
This is a 57-year-old man who presented paroxysmal palpitation associated with presyncope at rest. Surface electrocardiogram (ECG) revealed frequent ventricular premature contractions and non-sustained ventricular tachycardia when symptoms occurred. He also had a history of severe PH which was secondary to atrial septal defect and partial anomalous pulmonary venous drainage and suffered from obvious dyspnea when climbing stairs World Health Organization Class III (WHO Class III).

Diagnosis:
Hemodynamically-instable VAs associated with severe PH.

Intervention:
Echocardiography revealed enlargement of right ventricle (right ventricle [RV]: 43 mm). Electrophysiological examination showed the origin of VAs is next to a small low-voltage zone of RV. Radiofrequency delivery at the origin successfully terminated VAs without occurrence of complication.

Outcome:
The patient was free from arrhythmias and got an improvement of exercise tolerance, just with mild dyspnea when climbing stairs World Health Organization Class II (WHO class II), during six-month follow up.

Lessons:
This case suggests the low-voltage zone of remodeled RV, which may be secondary to increased pulmonary artery pressure, serves as the substrate for VAs initiation in patient with PH. Radiofrequency ablation can successfully terminate VAs and the termination of VAs can significantly improve the patient's impaired exercise tolerance.
Cytomegalovirus enterocolitis with subsequent diagnosis of coexisting new-onset inflammatory bowel disease
Authors: Luangsirithanya Panupong , Treewaree Sukrit , Pongpaibul Ananya , Pausawasdi Nonthalee , Limsrivilai Julajak 
Published: March 2021

Abstract

Introduction:
Gastrointestinal (GI) cytomegalovirus (CMV) infection coexisting with or followed by a diagnosis of inflammatory bowel disease (IBD) is infrequently reported. Not recognizing this condition may delay IBD diagnosis in patients with GI-CMV disease who do not or partially respond to antiviral agents, which could consequently result in unsatisfied treatment outcomes.

Patient concerns:
Two immunocompetent patients with no known underlying GI conditions presented with acute bloody diarrhea. The first patient developed diarrhea and hematochezia after admission to intensive care unit (ICU) because of severe alcoholic pancreatitis for 10 days duration. Computed tomography abdomen showed segmental jejunal thickening. The other patient presented with a 1-week history of severe bloody diarrhea which required ICU admission. Colonoscopy showed multiple ulcers along terminal ileum and colon.

Diagnosis:
These 2 patients were initially diagnosed with CMV jejunitis and ileocolitis, respectively, based on endoscopic and histopathologic findings. Both had partial response to treatment with 3 weeks of intravenous ganciclovir. Crohn disease was suspected because of persistent ulcerations on the follow-up endoscopy with the presence of pathological features of chronic inflammation and disappearance of previously detected CMV-infected cells.

Intervention:
Both patients were treated with systemic corticosteroids and azathioprine.

Outcomes:
Both patients had complete clinical improvement. Prednisolone could be tapered off in 6 months. Follow-up video capsule endoscopy (VCE) at 6 months showed improvement of mucosal inflammation and ulcers, but neither were completely healed in the first patient. Follow-up colonoscopy at 6 months showed complete resolution of ulcers and inflammation in the second patient.

Lessons:
IBD should be suspected in patients with a diagnosis of GI-CMV disease who are immunocompetent and have a partial response to antiviral agents. This clinical scenario could be caused by either CMV infection activating immune response resulting in IBD onset, or CMV infection superimposed on pre-existing latent IBD.
Comparing SARS-CoV-2 case rates between pupils, teachers and the general population: results from Germany
Authors: Köstner Clemens , Letzel Stephan , Eggert Viktoria , Beutel Till , Dietz Pavel 
Published: March 2021

AbstractGiven the inconsistent state of research regarding the role of pupils and teachers during the SARS-CoV-2 pandemic in Germany, statewide and nationwide data of infection case rates were analyzed to contribute to the discourse. Infection data from official sources ranging from mid to late 2020 were collected, prepared and analyzed to answer the question if pupils, teachers and general population differed in active case rates or not. The data showed that pupils and teachers case rates didn’t exceeded those of the general population. In conclusion, it seems appropriate to appraise school-related measures to mitigate the SARS-CoV-2 pandemic sufficiently. Data-quality is a yet to overcome obstacle to provide good evidence-based recommendations regarding the management around infection cases in schools.