bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of FGF21 in the pathogenesis of cardiovascular disease
Authors: Zhang Ying , Liu Dan , Long Xiao-Xue , Fang Qi-Chen , Jia Wei-Ping , Li Hua-Ting 
Published: December 2021

Abstract
The morbidity and mortality of cardiovascular diseases (CVDs) are increasing worldwide and seriously threaten human life and health. Fibroblast growth factor 21 (FGF21), a metabolic regulator, regulates glucose and lipid metabolism and may exert beneficial effects on the cardiovascular system. In recent years, FGF21 has been found to act directly on the cardiovascular system and may be used as an early biomarker of CVDs. The present review highlights the recent progress in understanding the relationship between FGF21 and CVDs including coronary heart disease, myocardial ischemia, cardiomyopathy, and heart failure and also explores the related mechanism of the cardioprotective effect of FGF21. FGF21 plays an important role in the prediction, treatment, and improvement of prognosis in CVDs. This cardioprotective effect of FGF21 may be achieved by preventing endothelial dysfunction and lipid accumulating, inhibiting cardiomyocyte apoptosis and regulating the associated oxidative stress, inflammation and autophagy. In conclusion, FGF21 is a promising target for the treatment of CVDs, however, its clinical application requires further clarification of the precise role of FGF21 in CVDs.
The “Phillips” Ileostomy Correction Technique for Prolapsed Stoma
Authors: Bellato Vittoria , Tanis Pieter J. , Hompes Roel , Buskens Christianna J. , Sica Giuseppe S. , Bemelman Willem A. 
Published: December 2021

INTRODUCTION:
Stoma prolapse is a common complication associated with ostomy creation, causing leakage, obstruction, and sometimes incarceration. Sometimes ileostomy prolapse cannot be treated with resection and alternative methods must be applied. We propose a new surgical revisional technique for ileostomy prolapse.

TECHNIQUE:
Under general anesthesia, the prolapsed stoma is dissected and freed from the fascia and skin. The bowel is everted to create a nipple of 2-3 cm and subsequently fixed with a 3-row linear stapler, creating a “Phillips ileostomy.” The ileostomy is then sutured to the skin with 3-0 full thickness stitches.

RESULTS:
In our center, 3 patients were treated in a day surgery setting, and no complication occurred. One patient reported a prolapse recurrence after 6 months and was successfully treated with the same technique with no recurrence at 1 year.

CONCLUSIONS:
The 3-row stapler fixation of prolapsed ileostomy is simple to perform, preserves the bowel, and can be performed in the day surgery setting.
Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement From the Anti-infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology
Authors: Reuter Stephanie E. , Stocker Sophie L. , Alffenaar Jan-Willem C. , Baldelli Sara , Cattaneo Dario , Jones Graham , Koch Birgit C. P. , Kocic Danijela , Mathew Sumith K. , Molinaro Mariadelfina , Neely Michael , Sandaradura Indy , Marriott Deborah J. E. 
Published: December 2021

Abstract:
Individualization of vancomycin dosing based on therapeutic drug monitoring (TDM) data is known to improve patient outcomes compared with fixed or empirical dosing strategies. There is increasing evidence to support area-under-the-curve (AUC24)–guided TDM to inform vancomycin dosing decisions for patients receiving therapy for more than 48 hours. It is acknowledged that there may be institutional barriers to the implementation of AUC24-guided dosing, and additional effort is required to enable the transition from trough-based to AUC24-based strategies. Adequate documentation of sampling, correct storage and transport, accurate laboratory analysis, and pertinent data reporting are required to ensure appropriate interpretation of TDM data to guide vancomycin dosing recommendations. Ultimately, TDM data in the clinical context of the patient and their response to treatment should guide vancomycin therapy. Endorsed by the International Association of Therapeutic Drug Monitoring and Clinical Toxicology, the IATDMCT Anti-Infectives Committee, provides recommendations with respect to best clinical practice for vancomycin TDM.
Custom 3D-printed Titanium Implant for Reconstruction of a Composite Chest and Abdominal Wall Defect
Authors: Danker Sara J. , Mericli Alexander F. , Rice David C. , Santos David A. , Butler Charles E. 
Published: December 2021

Background:
Three-dimensional (3D) printing of implantable materials is a recent technological advance that is available for clinical application. The most common medical application of 3D printing in plastic surgery is in the field of craniomaxillofacial surgery. There have been few applications of this technology in other areas.

Methods:
Here, we discuss a case of a large, symptomatic composite thoracic and abdominal defect resulting from the resection of a chondrosarcoma of the costal marginand sections of the abdominal wall, diaphragm, and sternum. The initial and second attempts at reconstruction failed, resulting in a massive hernia. Given the size of the defect, the contiguity with a large abdominal wall defect, and the high risk of recurrence, a rigid thoracic reconstruction was essential to durably repair the thoracic hernia and serve as a scaffold to which both the diaphragm and the abdominal mesh could be secured. A custom-made plate offered the most durable and anatomically accurate reconstruction in this particular clinical scenario. This technology was used in concert with a single section of coated mesh for reconstruction of the diaphragm, chest wall, and abdominal wall.

Results:
There were no post-operative complications. The patient has improvement of his symptoms and increased functional capacity. There is no evidence of hernia recurrence 1.5 years after repair.

Conclusions:
3D printing technology proved to be a useful and effective application for reconstruction of this large thoracic defect involving the costal margin. It is an available technology that should be considered for reconstruction of rigid structures with defect-specific precision.
Associations of high anti-CMV IgG titer with renal function decline and allograft rejection in kidney transplant patients
Authors: Chen Tz-Heng , Ou Shuo-Ming , Tarng Der-Cherng 
Published: December 2021

Background:
An anti-cytomegalovirus (CMV) immunoglobulin G (IgG) antibody is produced after primary CMV infection and generally persists after the primary infection. However, it is not well-known about the relationship between anti-CMV IgG titer and outcomes in kidney transplant recipients. We, therefore, aimed to explore the role of anti-CMV IgG titer on the risks of CMV disease development, allograft rejection, renal function decline, and mortality.

Methods:
In a hospital-based study, we identified 179 CMV-seropositive kidney transplant recipients between January 2013 and December 2017. These patients were divided into low and high anti-CMV IgG titer groups, respectively. The cutoff level of anti-CMV IgG titer was determined by receiver operating characteristic curve analysis. The outcomes evaluated included CMV disease, decrease of ≥15% in estimated glomerular filtration rate (eGFR), biopsy-proven allograft rejection, and all-cause mortality.

Results:
The high anti-CMV IgG titer group (≥846.2 AU/mL) exhibited a higher risk of CMV disease (adjusted hazard ratio [aHR], 3.77; 95% CI, 1.47–9.68; p = 0.006), eGFR decline ≥15% (aHR, 2.00; 95% CI, 1.19–3.35; p = 0.009), and renal allograft rejection (aHR, 2.95; 95% CI, 1.11–7.87; p = 0.030) than the low titer group (<846.2 AU/mL).

Conclusion:
In kidney transplant recipients, a high anti-CMV IgG titer was associated with higher risks for developing CMV disease, undergoing allograft rejection, and eGFR decline.
Pupil Light Reflex for the Assessment of Analgesia in Critically Ill Sedated Patients With Traumatic Brain Injury: A Preliminary Study
Authors: Martineau-Lessard Chloé , Arbour Caroline , Germélus Naïcha-Éveline , Williamson David , De Beaumont Louis , Bernard Francis 
Published: December 2021

ABSTRACT

BACKGROUND: Analgesia monitoring is essential to preserve comfort in critically ill sedated patients with traumatic brain injury (TBI). Although pupil dilation (PD) and pain behaviors can be used to assess analgesia, these indicators require application of noxious stimulations for elicitation. Recently, the pupillary light reflex (PLR) has emerged as a nonnoxious parameter that may be used to predict analgesia requirements in non–brain-injured patients. Here, we explored whether PLR can be used for the purpose of analgesia monitoring in critically ill sedated TBI patients. METHODS: Fifteen mechanically ventilated TBI patients (11 men; 54 ± 20 years) under continuous analgesia and sedation infusions were assessed at predefined time within 72 hours of intensive care unit admission. Data collection was performed using video-pupillometry and the Behavioral Pain Scale. At each assessment, pupil size and PLR at rest were recorded followed immediately by the documentation of PD and pain behaviors elicited by a calibrated noxious stimulus. Blood concentrations of analgesics/sedatives were monitored. RESULTS: One hundred three assessments were completed. PLR resulted in an average decrease of 19% in pupil diameter, and PD resulted in an average increase of 10% in pupil diameter. Variations in PLR and PD were more pronounced in subjects who showed a Behavioral Pain Scale score greater than 3 (a recognized sign of subanalgesia) compared with those with no behavioral reaction. Multiple regression analyses suggest a significant overlap between fluctuations in pupillary reflexes and blood levels of fentanyl, not propofol. CONCLUSION: In our sample, percentages of variation in PLR and PD were found to be directly representative of TBI patients’ fentanyl blood concentration. Considering information about blood drug concentration is generally not available at bedside, PLR could be used as a proxy to assess analgesia requirements before a nociceptive procedure in critically ill sedated TBI patients who are vulnerable to stress.
Maternal health indicators in Brazil
Authors: Souza Dandara Rayssa Silva , de Morais Thiffany Nayara Bento , Costa Ketyllem Tayanne da Silva , de Andrade Fábia Barbosa 
Published: December 2021

Abstract
In addition to the maternal death indicator, Stork Network proposes the number of prenatal consultations, the gestational age of onset of prenatal care and the number of children breastfeeding.
The study aims to analyze maternal health indicators representative of the actions proposed by Stork Network in Brazil, after its implementation. Therefore, this is an ecological study of maternal health indicators in Brazil from 2012 to 2017.
Thus, it was found that the number of prenatal consultations per pregnant woman in Brazil from 2012 to 2017 increased >4 times between the first and the last year analyzed. The proportion of pregnant women who started prenatal care in the first trimester of pregnancy increased progressively each year in Brazil.
The breastfeeding coefficient also increased progressively between 2014 and 2017 in Brazil. It was found that maternal health indicators improved between 2012 and 2017 in the Brazilian territory.
Risk of bleeding with ticagrelor in elderly patients over 75 years old
Authors: Alaamri Shalan , Dalbhi Sultan Al 
Published: December 2021

Abstract

Background:
Bleeding is an untoward outcome in the management of elderly patients with acute coronary syndrome (ACS). Although the potent oral P2Y12 inhibitor, ticagrelor is clinically beneficial, its association with bleeding events in elderly ACS patients (≥75 years) is poorly understood.

Methods:
We conducted a systematic search of 7 databases up to May 20, 2020 to identify studies which examined the risk of bleeding (defined according to each study) among elderly ACS patients (≥75 years) receiving ticagrelor compared to clopidogrel. Summary risk ratios (RR) were estimated using the random effects model.

Results:
Eight studies consisting of 5 observational studies and 3 randomized controlled trials involving 7032 elderly patients met the eligibility criteria. The mean age of the patients was 77.8 years, and the mean follow-up duration was 12 months. Overall, the pooled RRs showed higher risk of a bleeding event with ticagrelor compared to clopidogrel (RR 1.20, 95% confidence interval [95% CI] 1.03–1.40; P = .017). No statistically significant heterogeneity was observed among the studies (Q = 6.93; P = .44; I2 = 0). Also, pooled RRs did not show a higher risk of major bleeding (RR 1.32, 95% CI 0.91–1.92; P = .15) or minor bleeding (RR 1.09, 95% CI 0.76–1.58; P = .64) when comparing the ticagrelor to the clopidogrel group.

Conclusions:
There is a 20% increased risk of a bleeding event in elderly ACS patients treated with ticagrelor compared to clopidogrel; for such patients, clopidogrel may be considered as an alternative agent to ticagrelor due to its lower risk of bleeding.
Clinical study on acupuncture treatment of gastrointestinal damp-heat acne
Authors: Duan Ping-Ping , Yan Chao-Qun , Feng Hui-Shang , Chen Yuan , Sun Ning , Yao Ya-Qi , Tian Kai-Bing , Wang Guang-An 
Published: December 2021

Abstract

Background:
Acne is a common inflammatory disease of sebaceous glands, which brings extensive emotional and psychological distress to patients. Although acupuncture has certain advantages in the treatment of acne, the curative effect is not exact. The purpose of this trial is to evaluate the feasibility, preliminary efficacy, and safety of the “Spleen and Stomach Guiyuan Acupuncture Method” (SSGA) in the treatment of gastrointestinal damp-heat acne.

Methods:
The proposed protocol is planned as a randomized, assessor-blind, conventional-treatment-controlled trial to evaluate the efficacy of SSGA on gastrointestinal damp-heat acne. Seventy six gastrointestinal damp-heat acne patients will be randomly divided into 2 groups and receive SSGA or conventional acupuncture treatment. The entire study period is 12 weeks, including an 8-week treatment period and a 4-week follow-up period. All patients will receive 16 sessions of acupuncture treatment over 8 weeks. The primary outcome is the investigation global assessment (IGA) at week 8, which is an overall assessment of the degree of the inflammatory and non-inflammatory lesion. The secondary outcomes include IGA, the total facial lesion count (Total Lesion Count), the acne-specific quality of life, etc at weeks 8 and 12. The Expectation and Credibility of treatment rating scale will be used to measure the patients’ attitudes to acupuncture after the first treatment. Adverse events will also be recorded.

Discussion:
This study is helpful to evaluate the feasibility, preliminary efficacy, and safety of SSGA in the treatment of gastrointestinal damp-heat acne. The results will be used in sample size calculations for subsequent large-scale studies.
Trial registration: Chinese Clinical Trial Registry ChiCTR2100047363. Registered on June 13, 2021.
Comparison of tracheal intubation between sitting position and standing position in COVID-19 patients
Authors: Wang Yong , Shi Yun , Li Yong-Xing , Zhong Ming , Zhuang Yue-Rong , Huang Wei , Ma Wu-Hua 
Published: December 2021

Abstract
It is recommended to use visual laryngoscope for tracheal intubation in a Corona Virus Disease 2019 patient to keep the operator farther from the patient. How the position of the operator affects the distance in this setting is not ascertained. This manikin study compares the distances between the operator and the model and the intubation conditions when the operator is in sitting position and standing position, respectively.
Thirty one anesthesiologists with minimum 3-years’ work experiences participated in the study. The participant's posture was photographed when he performed tracheal intubation using UE visual laryngoscope in standing and sitting position, respectively. The shortest distance between the model's upper central incisor and operator's face screen (UF), the horizontal distance between the model's upper central incisor and the operator's face screen, the angle between the UF line and the vertical line of the model's upper central incisor were measured. The success rate of intubation, the duration of intubation procedure, the first-attempt success rate, the Cormack–Lehane grade, and operator comfort score were also recorded.
When the operator performed the procedure in sitting position, the horizontal distance between the model's upper central incisor and the operator's face screen distance was significantly longer (9.5 [0.0–17.2] vs 24.3 [10.3–33.0], P ≤ .001) and the angle between the UF line and the vertical line of the model's upper central incisor angle was significantly larger (45.2 [16.3–75.5] vs 17.7 [0.0–38.9], P ≤ .001). There was no significant difference in UF distance when the operator changed the position. Cormack–Lehane grade was significantly improved when it was assessed using visual laryngoscope. Cormack–Lehane grade was not significantly different when the operator assessed it in sitting and standing position, respectively. No significant differences were found in the success rate, duration for intubation, first-attempt success rate, and operator comfort score.
The operator is kept farther from the patient when he performs intubation procedure in sitting position. Meanwhile, it does not make the procedure more difficult or uncomfortable for the operator, though all the participants prefer to standing position.
Acute intraperitoneal rupture of hydatid cysts of the liver
Authors: Mejri Atef , Arfaoui Khaoula , Omry Ahmed , Yaakoubi Jasser , Mseddi Mohammed Ali , Rchidi Jasser , Saad Sarra , Ellouze Mohammed Marouen 
Published: December 2021

Abstract
Hydatid cyst is a parasitic infection caused mainly by Echinococcus granulosus, which is generally considered benign. However, the hepatic hydatid cyst rupture in the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physicians, radiologists, anesthetists, and surgeons). This study describes clinical and paraclinical liver hydatid cyst rupture in the peritoneal cavity and details the appropriate treatment.
A retrospective review of clinical records of patients hospitalized in Jendouba Hospital for liver hydatid cyst was performed over 8 years, from January 1, 2012 to December 31, 2019. Fifteen cases of liver hydatid cyst complicated with acute rupture into the abdominal cavity were collected out of 625 hydatid liver cysts. All patients underwent emergency laparotomy allowing conservative unroofing procedure associated with peritoneal lavage and external drainage combined with necessary intensive care measures. Clinical features, therapeutic procedures’ details as well as postoperative outcomes are reported. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 20.
There were 9 men and 6 women. Patients’ age ranged from 14 to 59 years, with an average of 38 years. Two patients were admitted with abdominal trauma. Acute abdominal pain was the most common complaint. Only 1 patient had an anaphylactic shock. Abdominal ultrasonography and computed tomography scan showed discontinuous cyst wall associated to intraperitoneal fluid in all cases. Intraoperatively, the intraperitoneal effusion was clear in 13 cases and purulent in 2. All patients underwent unroofing procedures associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days, and the mean follow-up was 19 months. No case of recurrence was reported among the patients.
In endemic areas, rupture of a hepatic hydatid cyst in the abdominal cavity should be considered in every case of acute abdominal pain, especially if associated with anaphylaxis signs. Early management starting in the emergency room is needed to ensure good outcome.
A retrospective study of azithromycin and ceftizoxime for the management of children with Mycoplasma pneumoniae pneumonia
Authors: Han Li-ping , Xiao Han-yan , Fang Li-li 
Published: December 2021

Abstract
The aim of this study was to compare the clinical efficacy of azithromycin and ceftizoxime (AC) and erythromycin and amoxicillin/sulbactam (EAS) in the treatment of children with Mycoplasma pneumoniae pneumonia (MPP).
In this retrospective study, a total of 92 eligible children with MPP were included, and they were divided into a treatment group (n = 46) and a control group (n = 46). All patients were treated with intravenous ambroxol, and nebulized inhalation of budesonide and terbutaline. In addition, patients in the treatment group received AC. Patients in the control group underwent EAS. All patients in both groups were treated for a total of 10 days. Outcomes consist of erythrocyte sedimentation rate, C-reactive protein, serum lactate dehydrogenase, and interleukin 6, fever clearance time, time of cough disappearance, time of rale disappearance, time of signs disappeared by X-ray, and adverse events. All outcomes were measured after 10-day treatment.
After treatment, patients who received AC exerted better improvements in erythrocyte sedimentation rate (P < .01), C-reactive protein (P < .01), serum lactate dehydrogenase (P < .01), interleukin 6 (P < .01), fever clearance time (P < .01), time of cough disappearance (P < .01), time of rale disappearance (P < .01), and time of signs disappeared by X-ray (P < .01), than those in patients who received EAS. In addition, there were not significant differences in adverse events between 2 groups.
The results of this study showed that AC may benefit more than EAS for the children with MPP.
Association between RGS4 gene polymorphisms and schizophrenia
Authors: Xu Feng-Ling , Yao Jun , Wang Bao-Jie 
Published: December 2021

Abstract

Background:
Schizophrenia is a complex brain disorder, the pathogenesis of which remains unclear. Regulator of G-protein signaling 4 is regarded as a candidate gene for schizophrenia risk. The association between the regulator of G-protein signaling 4 gene and the risk of schizophrenia is complicated and controversial, thus, an updated meta-analysis is needed.

Methods:
A search strategy using Medical Subject Headings was developed in English (PubMed, SZGene) and Chinese (CNKI, Wanfang, and Weipu) databases. Inclusion and exclusion criteria were used to screen for eligible studies. Parameters, such as P value of Hardy–Weinberg equilibrium, odds ratios, 95% confidence intervals, P values of association, heterogeneity (P

h
), and publication bias, were analyzed by the Stata software using a random effects model. Subgroup analyses were performed to detect heterogeneity.

Results:
There were 15 articles regarding rs10917670 (8046 cases and 8837 controls), 16 regarding rs951436 (8990 cases and 10,568 controls), 15 regarding rs951439 (7995 cases and 8646 controls), 15 regarding rs2661319 (8320 cases and 9440 controls), and 4 regarding rs10759 (2752 cases and 2866 controls). The frequencies of rs10917670 and rs951439 were not significantly different between the case and control groups (P > .05). As shown by the East Asian and hospital-based subgroup analyses, the genotype TT of rs951436 might be related to the risk of schizophrenia. The genotypes CC + CT of rs2661319 and CC + CA of rs10759 were statistically different between the 2 groups, and the East Asian population contributed to these differences.

Conclusion:
The genotypes CC + CT of rs2661319 and CC + CA of rs10759 might be associated with the risk of schizophrenia.