bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intermittent Bolus Versus Continuous Paravertebral Infusion on Postoperative Pain after Unilateral Mastectomy: A Retrospective Cohort Study.
Authors: Volio Andrew , Kim Daniel , Skolaris Alexis , Nutcharoen Aratara , Ayad Sabry 
Published: January 2021

Abstract
Background: Persistent pain is a common complication after mastectomy for breast cancer, and postoperative analgesia through paravertebral infusion is a promising technique for pain control after mastectomy. Although paravertebral local anesthetic infusion can be performed using continuous or intermittent bolus modes, there is no evidence of superiority of either infusion mode.Methods: We retrospectively studied patients who had undergone unilateral mastectomy with paravertebral catheter placed for postoperative analgesia between October 2017 and September 2018. Logistic regression was created to estimate the relative risk for moderate to severe pain defined by average pain scores greater than 4 using a 0 to 10 Numeric Rating Scale (NRS) within first 24 hours after surgery. Opioid consumption was compared using a Student T-test for difference in means using the log-transformed cumulative opioid consumption converted to milligrams of oral morphine equivalents (OME) within the first 48 hours after surgery.Results: 49 patients were included (continuous infusion group: 14; bolus infusion group: 35). Bolus paravertebral infusion was associated with reduction of relative risk of moderate to intense pain (adjusted relative risk: -0.96; 95%CI: -1.81, -0.1; p = 0.029) but there was no association with reduction in opioid consumption (difference of means: -1.4mg of OME; 95%CI: -2.78, 1.42; p = 0.33).Conclusion: Intermittent bolus infusion was associated with reduction of relative risk for moderate to severe postoperative pain for unilateral mastectomies. Therefore, paravertebral catheter infusion modality may influence postoperative pain experience after unilateral mastectomies.
Prognostic Nutritional Index Predicts Clinical Outcome in Patients with Cerebral Venous Sinus Thrombosis
Authors: Zhao Jiawei , Liu Kai , Li Shen , Gao Yuan , Zhao Lu , Liu Hongbing , Fang Hui , Wu Jun , Sun Shilei , Li Yusheng , Song Bo , Xu Yuming 
Published: January 2021

Abstract
Background: Lower prognostic nutritional index (PNI) is related to poor prognosis of cardiovascular disease. However, little is known about PNI and its relationship with prognosis in cerebral venous sinus thrombosis (CVST).Methods: From January 2013 to June 2019, we retrospectively identified consecutive CVST patients. We selected patients in acute / subacute phase as subjects. Poor prognosis was defined as modified Rankin Scale (mRS) of 3-6. Multivariate logistic regression analysis was used to confirm if lower PNI was associated with poor prognosis. Results: A total of 297 subjects with 12-month follow-up data were enrolled. Thirty-three (11.1%) had poor outcome. Multivariate logistic regression analysis suggested that PNI was an important predictive factor of poor outcome in acute/subacute CVST (odds ratio, 0.903; 95% CI, 0.833-0.978; P = 0.012). The optimal cut-off value for predicting a poor prognosis of PNI was 44.2. Kaplan-Meier analysis and log-rank test suggested that the lower the PNI value, the higher the mortality rate (P<0.001). In addition, the nomogram we set up showed that lower PNI was an index of poor prognosis. The c-indexes for the cute/subacute patients with CVST was 0.872.Conclusions: Lower PNI is correlated with a higher risk of adverse clinical outcome in patients with acute/subacute CVST.
Stratifying Non-Small Cell Lung Cancer Patients Using an Inverse of The Treatment Decision Rules - Validation Using Electronic Health Records With Application to An Administrative Database&nbsp;
Authors: Kim Min-Hyung , Park Sojung , Park Yu Rang , Ji Wonjun , Kim Seul-gi , Choo Minji , Hwang Seung-sik , Lee Jae Cheol , Kim Hyeong Ryul , Choi Chang-Min 
Published: January 2021

Abstract
Background To validate a stratification method using an inverse of treatment decision rules that can classify non-small cell lung cancer (NSCLC) patients in real-world treatment records.Methods (1) To validate the index classifier against the TNM 7th edition, we analyzed electronic health records (EHRs) of NSCLC patients diagnosed from 2011 to 2015 in a tertiary referral hospital in Seoul, Korea. Predictive accuracy, stage-specific sensitivity, specificity, positive predictive value, negative predictive value, F1 score, and c-statistic were measured.(2) To apply the index classifier in an administrative database, we analyzed NSCLC patients in Korean National Health Insurance Database, 2002-2013. Differential survival rates among the classes were examined with the log-rank test, and class-specific survival rates were compared with the reference survival rates.Results (1) In the validation study (N =1,375), the overall accuracy was 93.8% (95% CI: 92.5%-95.0%). Stage-specific c-statistic was the highest for stage I (0.97, 95% CI: 0.96-0.98) and the lowest for stage III (0.82, 95% CI: 0.77-0.87).(2) In the application study (N = 71,593), the index classifier showed a tendency for differentiating survival probabilities among classes. Compared to the reference TNM survival rates, the index classification under-estimated the survival probability for stages IA, IIIB, and IV, and over-estimated it for stages IIA and IIB.Conclusion The inverse of the treatment decision rules has a potential to supplement a routinely collected database with information encoded in the treatment decision rules to classify NSCLC patients. It requires further validation and replication in multiple clinical settings.
A New Approach for GNSS-IR&nbsp;Snow Depth Monitoring With Slope Correction and Error Prediction
Authors: Chen Peng , Li Zheng , Zheng Naiquan 
Published: January 2021

Abstract
With the continuous development of GNSS (Global Navigation Satellite System) technology, GNSS-IR (GNSS Interferometric Reflectometry) has become a research hotspot in the field of snow surface monitoring, and the accuracy and reliability have been initially verified. We focus on the reasons for the low accuracy of the existing GNSS-IR snow depth inversion. Therefore, we use the P351 station data in the PBO (Plate Boundary Observatory) network in the United States to monitor the snow depth during the four years from 2011 to 2015. The actual measured snow depth at station 490 in the SONTEL network is used as the true value for accuracy verification. We studied the relationship between the inversion error caused by the slope and the slope angle and the satellite elevation angle, and proposed a slope correction method. The results show that the RMSE (Root Mean Square Error) of snow depth inversion after slope correction is reduced from 12.1 cm to 10.7 cm, the accuracy is improved by 11.6 %. In addition, it is found that there is an apparent correlation between the retrieved snow depth and the inversion error. With the increase of snow depth, the error gradually changes from positive to negative, and the absolute value of error still increases with the increase of snow depth after the error changes to negative. To this end, we introduce BPNN (Back Propagation Neural Network) to train the inversion snow depth and inversion error of the three snowfall periods from 2011 to 2014, then predicts and corrects the snow depth inversion error during the snowfall period from 2014 to 2015. The results show that the RMSE of the corrected GNSS-IR snow depth inversion is reduced from 10.7 cm to 5.7 cm, and the accuracy is increased by 46.7 %. The overall accuracy of the GNSS-IR snow depth inversion is improved by 52.9 % after the slope correction and the BPNN error prediction is performed, which further verifies the accuracy and effective of the approach that proposed by us.
Ascorbic Acid Greatly Decreases Creatine Kinase Levels in An Animal Model of Statin/Fibrate-Induced Myopathy
Authors: Askarian Fatemeh , Zabihi Mohsen , Hekmatimoghaddam Seyedhossein , Nooshabadi Mohammadreza Rashidi , Zabihi Mohammad sajjad 
Published: January 2021

Abstract
BackgroundDrug-induced myopathy is one of the frequent forms of muscle disease, and drugs used for hyperlipidemia, especially the statins are a common culprit, and particularly when combined with a fibrate. Clinicians usually measure plasma levels of three enzymes, creatine kinase (CK), aldolase and lactate dehydrogenase (LDH) for diagnosis of myopathy and determination of its severity. Physical exercise can aggravate statin-associated muscular disease. The question is whether antioxidants like ascorbic acid (vit. C) can prevent such myopathy.MethodsIn this experiment a combination of oral atorvastatin (ATV, 80 mg/kg/day, orally) and gemfibrozil (GMF, 1000 mg/kg/day, orally) was used for ten days plus exercise in days 8, 9 and 10 to induce myopathy in rats. To add physical exercise, the forced swimming test was applied in the last three days. Ascorbic acid (50 mg/kg/day, orally) was added to ATV/GMF plus exercise regimen throughout the 10 days in the treatment group. The mean blood levels of CK, aldolase and LDH were measured in addition to swimming tolerance times. ResultsThere was a significantly lower swimming tolerance time (P < 0.05) and higher CK levels (P < 0.01) in rats receiving ATV/GMF/Vit.C plus exercise compared with rats not taking Vit.C. LDH and aldolase didn’t decrease significantly.ConclusionsA protective role of vit.C against drug-induced myopathy is suggested by the findings of this study.
Low Intensity Focused Ultrasound Augmented Multifunctional Nanoparticles for Integrating Ultrasound Imaging and Synergistic Therapy of Metastatic Breast Cancer
Authors: Zhang Qian , Wang Wen , Shen Hongyuan , Tao Hongyu , Wu Yating , Ma Liyuan , Yang Guangfei , Chang Ruijiao , Wang Jiaxing , Zhang Hanfei , Wang Chenyu , Zhang Furong , Qi Jiaojiao , Mi Chengrong 
Published: January 2021

Abstract
The metastasis of breast cancer is believed to have a negative effect on its prognosis. Benefiting from the remarkable deep-penetrating and non-invasive characteristics, sonodynamic therapy (SDT) demonstrates a whole series of potential leading to cancer treatment. To relieve the limitation of monotherapy, a multifunctional nanoplatform has been explored to realize the synergistic treatment efficiency. Herein, we establish a novel multifunctional nano-system which encapsulates chlorin e6 (Ce6, for SDT), perfluoropentane (PFP, for ultrasound imaging), and docetaxel (DTX, for chemotherapy) in a well-designed PLGA core-shell structure. The synergistic nanoparticle (CPDP NPs) featured with excellent biocompatibility and stability primarily enables its further application. Upon low intensity focused ultrasound (LIFU) irradiation, the enhanced ultrasound imaging could be revealed both in vitro and in vivo. More importantly, combined with LIFU, the nanoparticle exhibits intriguing antitumor capability through Ce6 induced cytotoxic reactive oxygen species as well as DTX releasing to generate a concerted therapeutic efficiency. Furthermore, this treating strategy actives a strong anti-metastasis capability by which lung metastatic nodules have been significantly reduced. The results indicate that the SDT-oriented nanoplatform combined with chemotherapy could be provided as a promising approach in elevating effective synergistic therapy and suppressing lung metastasis of breast cancer.
A Case of Prolonged Shedding of SARS-Cov-2 with Rapid Decay of IgG Antibody
Authors: Huang Jin-Bao , Lan Chang-Qing , Huang Ming-Xiang , Wang Xin-Hang 
Published: January 2021

Abstract
BackgroundCoronavirus disease 2019 (COVID-19) epidemic is still spreading rapidly around the world. Recent cases with prolonged detection of SARS-CoV-2 RNA have been successively reported and the phenomenon of false-negative real-time polymerase chain reaction (RT-PCR) results of SARS-CoV-2 RNA or “repositive” was also described in patients with COVID-19.Case presentationA 69-year-old female with hypertension, total hysterectomy for hysteromyoma and suspected lung tumor presented with moderate COVID-19 symptoms was testing positive for SARS-CoV-2 RNA by RT-PCR when she travelled from USA to China. The patient required second and third re-hospitalization due to repositive SARS-CoV-2 test results of throat swaps during post-charge solitary isolation and observation. The serum SARS-CoV-2-IgG decayed rapidly and disappeared on illness day 139 when the throat swab was still positive for SARS-CoV-2 RNA. Finally the virus shedding lasted at least146 days (the last positive test result of throat swap on illness day 146 and the first true-negative test result on illness day 151) from her initial positive test.Conclusions Prolonged viral shedding of SARS-CoV RNA is prone to occur in an immunocompromised host. With the change of host immune status, SARS-CoV-2 detection can be repeatedly positive. The SARS-CoV-2-IgG may decrease rapidly and disappear before the virus removal, indicating there may be certain limitations on the protective effect of antibody against SARS-CoV-2 which deserves attention of clinicians.
Association Between Glycemic Gap and Mortality in Critically Ill Patients with Diabetes
Authors: Lou Ran , Jiang Li , Zhu Bo 
Published: January 2021

Abstract
Objectives: Dysglycemia is pervasive and associated with poor outcomes in critically ill patients. Hyperglycemia, hypoglycemia and blood glucose fluctuation might all affect the outcomes, but appropriate level of blood glucose is uncertain especially in patients with diabetes regarding to the situation of glucose control before hospitalization. This study was aimed to investigate the effect of difference between mean blood glucose during ICU stay and level of blood glucose prior to admission to ICU upon outcomes of critically ill patients with diabetes.Method: This retrospective study undertaken in a 24-bed intensive care unit(ICU). Patients with diabetes expected to stay for more than 24hs were enrolled, HbA1c was tested within 3 days after admission and converted to the A1C-derived average glucose (ADAG) by the equation: ADAG = [ ( HbA1c * 28.7 ) – 46.7 ] * 18-1, arterial blood glucose measurements were fourth per day routinely during the first 7 days after admission, the mean glucose level(MGL) and SOFA (within 3 days, 5 days and 7days) were calculated for each person, GAPadm and GAPmean was calculated as admission blood glucose and MGL minus ADAG respectively, the incidence of moderate hypoglycemia(MH), severe hypoglycemia (SH), total dosage of glucocorticoids and average daily dosage of insulin within 7 days, duration of renal replacement therapy(RRT), ventilator-free hours and non-ICU stay days within 28 days were also collected. Patients enrolled were divided into survival group and non-survival group according to survival or not at 28-day, compare GAPadm and GAPmean between the two groups and explore the relationship between GAP and mortality in these critically ill patients.Results: 431 patients were enrolled and divided into survival group (n=256) and non-survival group (n=175). It was shown that two groups had comparable level of HbA1c, the non-survivors had greater APACHE II, SOFA, GAPadm, GAPmean-3, GAPmean-5, GAPmean-7 and higher MH and SH incidences. Less duration of ventilator-free, non-ICU stay and longer duration of RRT were recorded in non-survival group, of whom received less carbohydrates intake, higher insulin daily dosage and glucocorticoid dosage. GAPmean-5 had the greatest predictive power with AUC of 0.807(95%CI: 0.762-0.851), the cut-off value was 3.6mmol/L(sensitivity 77.7% and specificity 76.6%). The AUC was increased to 0.852(95%CI: 0.814-0.889) incorporated with SOFA5 (NRI = 11.34%, P < 0.001 ). Conclusion: Glycemic GAP between mean level of blood glucose especially MGL within 5 days after admission to ICU and A1C-derived average glucose was independently associated with 28-day mortality of critically ill patients with diabetes. The predictive power was optimized with addition of the top level of SOFA within 5 days.
Gitelman Syndrome in a Pregnant Woman
Authors: Huo Feifei , Li Nan , Zhang Dong 
Published: January 2021

Abstract
Background: Gitelman syndrome (GS) is an autosomal recessive inherited salt-losing tubulopathy resulted from a loss-of-function mutation in the gene SLC12A3 encoding the thiazide-sensitive sodium-chloride cotransporter (NCCT) protein located in the distal renal tubules. Investigations revealed hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria and increased activity of renin-angiotensin-aldosterone system. There have been very few case reports on Gitelman syndrome in pregnancy, and some cases showed adverse consequences of the fetus.Case presentation: We presented a case report of a pregnant female with hypokalemia, a large amount of intravenous potassium was required to maintain a relatively normal level of serum potassium.Therefore, further laboratory examinations and whole blood DNA sequencing were carried out. The patient was eventually diagnosed with Gitelman syndrome. In terms of treatment, the amount of potassium supplementation was gradually reduced, and magnesium supplementation was intermittently provided at the same time to maintain the patient's serum potassium at about 3.0mmol/L and serum magnesium at about 0.8mmol/L. Obstetric ultrasound during hospitalization indicated normal fetal development, and the patient was discharged from hospital after her condition improved.Conclusions: The clinical manifestations of GS are non-specific, and there is a lack of evidence-based treatment guidelines for pregnant GS patients, so multidisciplinary management of pregnant GS women is essential. Treatment should be cautious and individual, and the electrolytes should be closely monitored to avoid complications caused by electrolyte disturbance and strive to obtain a good maternal and fetal outcome.
Anterior Hybrid Construction of Multilevel Cervical Disc Disease and Spondylotic Spinal Stenosis: Surgical Results and Factors Affecting Adjacent Segment Problems
Authors: YILMAZ MURAT , YUCESOY Kemal , ERBAYRAKTAR Resat Serhat , ALTINAG Rifat Saygin 
Published: January 2021

Abstract
Objective: We aimed to evaluate reliability, radiological outcomes and the impacts of anterior cervical hybrid construction on the adjacent segments for the multilevel cervical degenerative disc disease (mCDDD) and spondylotic spinal stenosis (SSS).Methods: A retrospective analysis was performed using data extracted from the medical files of 195 patients (105 males, 90 females; mean age: 47.7 years). From 2008 to 2018, these patients underwent anterior cervical hybrid construction for symptomatic contiguous at least 2-level cervical degenerative disc diseases and cervical spondylosis. Clinical and radiological data including Neck Disability Index (NDI), Visual Analogue Scale (VAS), local cervical degenerative disk disease in adjacent segments on magnetic resonance imaging (MRI) views and complications were reviewed. Results: The mean clinical and radiological follow-up was 45.2 months (range: 24 to 102). Radiculopathy and/or myelopathy were the main clinical problems in all patients. The mean VAS scores of HC for arm pain were 7.4±0.8 preoperatively; 2.8±0.6, 1 month after surgery; 2.3±0.6, 6 months after surgery; 1.8±0.6, 12 month after surgery; and 1.6±0.6, 24 months after surgery. The mean NDI scores (mean±SD) of HC significantly improved after surgery (on admission, 57.2±5.5%; 1 month after surgery, 27.35±5.3%; 6 month after surgery, 21.43±2.8%; 12 months after surgery, 21.9±2.3%; 24 months after surgery, 20.6±2.6%, p=0.006). Hoarseness and dysphagia were the most common complications and osteophyte formation was the most frequent radiographic change.Conclusion: Anterior cervical hybrid construction appears to be an acceptable option in the management of multilevel cervical degenerative disc diseases and spondylotic spinal stenosis.
The Impact of COVID-19 Lockdown on Physical Activity and Weight Gain Among Active Adult Population in Israel. A Cross-Sectional Study
Authors: Dor-Haim Horesh , Katzburg Sara , Revach Pola , Levin Hagai , Barak Sharon 
Published: January 2021

Abstract
The COVID-19 outbreak holds public health concerns. Staying at home, increases sedentary behavior, with unintended adverse outcomes. Since organized recreation and sports facilities were closed, we aimed to study how the crisis of closure affected exercise habits and weight gain among the trainee population in Israel, assess the frequency of activity and age-adjusted weight gain, measure and ability to embrace digital media, as an alternative training frameworkA cross-sectional survey consisted of a multiple-choice questionnaire that was obtained using a web-based survey application. 1,202 trainees who exercise on a regular basis, anonymously answered the questionnaire sent by their coaches regarding their activity and weight gain during lockdown times. Results confirmed that 70% of Israelis trained less than their usual routine, 60% used digital media for training, 55% gained weight. Half of the respondents gained more than 2 kg, with an average increase of 1.2 kg. However, those who exhibited a higher physical activity level gained less weight. Using digital media for training was associated with higher physical activity levels. The aged population was less likely to use digital media.Since increased sedentary behavior could increase the risk for potential worsening of health conditions, health agencies should look for strategies, especially in the aged population, including digital media to promote physical activity and subsequently, preventing the increased burden of future comorbidities worsening by a sedentary lifestyle.
Management of hemophagocytic lymphohistiocytosis in pregnancy
Authors: Liu Congcong , Gao Jinsong , Liu Juntao 
Published: January 2021

Abstract
Background: The diagnosis of hemophagocytic lymphohistiocytosis (HLH) in pregnancy is challenging due to its rarity. There is currently no consensus on the treatment of HLH during pregnancy. We aim to analyze and summarize the clinical characteristics of HLH in pregnancy, and to discuss effective diagnostic and treatment options.Methods: Thirteen patients with HLH during pregnancy who were diagnosed and treated at the Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences from January 2000 to December 2019 were studied retrospectively. We collected data on treatment regimens and on maternal and pregnancy outcomes.Results: All patients had a singleton pregnancy, with a median age of 28 years (range, 22–33 years) and a median gestational age of 23 weeks (7–36 weeks). There were underlying associated diagnoses in six patients; of the patients, 12 (92.3%, 12/13) were treated with corticosteroids, and a good efficiency was achieved in 5 (41.7%, 5/12) of them. Two patients who were treated with dexamethasone and etoposide after termination of pregnancy achieved CR. Two patients attained remission after termination of pregnancy. Four pregnant women died, and the mortality rate was 30.77% (4/13). Fetal or neonatal death up to 1 week after delivery occurred in eight (61.54%) pregnancies, and there were four cases of miscarriage, two of stillbirth, and two of neonatal death. Complications included premature birth (57.14% of neonates), small for gestational age (SGA, 7.70%), premature rupture of membranes (15.38%), and fetal stress (15.38%).Conclusion: Early diagnosis and treatment are important for maternal survival, and corticosteroids are the first choice for most patients with HLH during pregnancy. For patients who do not respond to corticosteroids, etoposide, and termination of pregnancy may be life- saving.