bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between preoperative inflammatory markers, Ki-67 and the pathological grade of glioma
Authors: Xu Guangda , Li Chengxue , Wang Yanguo , Ma Jinan , Zhang Junchen 
Published: September 2021

Abstract
To investigate the correlation between preoperative inflammatory markers, Ki-67 expression and the pathological grade of glioma, and to provide a reference for clinical prediction of glioma prognosis.
A total of 45 glioma patients who underwent surgery with complete clinical and pathological data were in our hospital from January 2012 to December 2018 were enrolled. Glioma was divided into WHO grade I to IV. Forty-five healthy health examiners with matched clinical characteristics were included to the control group. Blood routine tests were recorded at admission in both the glioma and control group. The ratio of neutrophil to lymphocyte cytometry (NLR), derived neutrophil to lymphocyte ratio (dNLR) (white blood cell count – neutrophil count to neutrophil count), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI, serum albumin content + 5 × lymphocyte count) were calculated. The expression of Ki-67 in glioma was detected by immunohistochemistry. The relationship between the above markers, Ki-67 expression and pathological grade of glioma was evaluated with receiver operating characteristics curve analysis and Spearman correlation test. The correlation between the markers and Ki-67 were also determined.
NLR, dNLR, PLR were increased in the glioma group (P < .001, <.001, .002), whereas red blood cell distribution width (RDW) was decreased (P = .009). All the glioma samples expressed Ki-67 with varying degree. Receiver operating characteristics curve analysis reveals NLR, dNLR, PLR, and RDW have significant discriminating ability in differentiating the glioma and control sample. NLR, PLR, PNI, and Ki-67 were significantly correlated with glioma pathology grade (P = .023, .006, .019, <.05), while dNLR and RDW were not associated with glioma grade. Finally, NLR and PLR were related to Ki-67 expression in glioma patients (P = .002, .022), while dNLR and RDW were not related to Ki-67 expression.
Preoperative inflammatory markers NLR, PLR, PNI, and postoperative Ki-67 expression are associated with pathological grade of glioma. Detection of these markers may aid in better prediction of glioma prognosis.
The correlation between myocardial resilience after high-intensity exercise and markers of myocardial injury in swimmers
Authors: Gao Can , Liang Chen , Zhang Jianhong , Ma Yun , Mu Xiuxia , Xie Minhao 
Published: September 2021

Abstract
To investigate how high-intensity exercise influences an athlete's myocardial resilience and the correlation between myocardial resilience and markers of myocardial ischemic injury.
Fifteen swimmers participated in high-intensity exercises. Cardiac ultrasound was performed before and after exercise on each subject. Left ventricular general strain, systolic general strain rate, and the differences (▴general strain and ▴ general strain rate, respectively), before and after exercise were analyzed. Blood was collected at the morning of the exercise day and 6 hours after exercise to measure cardiac enzyme indicators.
The correlation between myocardial resilience and markers of myocardial injury were evaluated. Most cardiac enzymes concentrations increased after exercise (P < .05). Cardiac troponin I, creatine kinase MB, and cardiac troponin T were all correlated with the degree of ▴ peak strain (differential value of posterior wall basal segment before and after exercise) and ▴ peak strain rate (differential value before and after exercise) (P < .05).
After high-intensity exercise, the concentrations of creatine kinase MB and cardiac troponin T in the blood are positively correlated with two-dimensional ultrasound deformation indices, proving the fact that the seindices can be used as a diagnostic basis for myocardial injury, and are more sensitive than general strain. The two-dimensional strain echocardiogram is non-invasive and easily accepted by the patient. It can make up for the shortage of myocardial enzymes in the injury areas, including weak timeliness and the inability to locate injury.
Risk factors associated with the mortality rate of oral squamous cell carcinoma patients
Authors: Ahmad Paras , Nawaz Rubbia , Qurban Maria , Shaikh Gul Muhammad , Mohamed Roshan Noor , Nagarajappa Anil Kumar , Asif Jawaad Ahmed , Alam Mohammad Khursheed 
Published: September 2021

Abstract
In Malaysia, oral cancer is very common and the reported 5-year survival of such patients is nearly 50% after treatment with surgery and radiotherapy, much lower than most of the developed countries. This study aimed to investigate the socio-demographic and clinicopathological parameters that influence the mortality rate of the patients suffering from oral squamous cell carcinoma (OSCC) in the Kelantanse population.
In this retrospective study, data regarding socio-demographic, clinicopathological factors, and treatment outcome associated with OSCC were gathered from the archives of the medical records office of Hospital Universiti Sains Malaysia. For statistical analysis, simple and multiple logistic regression were performed. The significance level was set to P < .25.
A total of 211 OSCC cases were registered in Hospital Universiti Sains Malaysia from January 1, 2000 to December 31, 2018. Majority of them were male (57.82%), non-smoker (54.97%), non-alcohol consumer (91.94%), and non-betel quid chewer (93.83%) Malay (60.66%) patients. The tongue was the most commonly involved part of the oral cavity (41.52%). Histologically, the majority of the cases had moderately-differentiated OSCC (52.82%). Most of the patients were diagnosed at stage IV at the time of diagnosis (61.61%). When this study was performed, the survival status of the majority of the patients was alive (68.24%).
Within the analyzed socio-demographic and clinicopathological parameters, gender, alcohol consumption, T-classification, histological grading, and treatment status have been demonstrated as an independent risk factors for mortality rate in multivariate analysis. Hence, these parameters need to be taken into account for the individualized therapy management of OSCC patients.
Malakoplakia and xanthogranulomatous pyelonephritis treated with nephrectomy
Authors: Pan Yueh , Hong Ying Chui , Shih Hung-Jen , Chang Chin-Pao , Huang Sheng-Hsien , Wu Sheng-Chuan , Lee Liang-Ming , Wen Yu-Ching , Hsu Chih-Chen , Hsiao Chi-Hao 
Published: September 2021

Abstract

Rationale:
Malakoplakia and xanthogranulomatous pyelonephritis are chronic inflammatory conditions of the kidney characterized by the infiltration of inflammatory cells.

Patient concerns:
An 82-year-old female patient had a history of hypertension, type 2 diabetes mellitus, dyslipidemia, and end-stage renal disease under hemodialysis. She was admitted repeatedly 4 times within 4 months due to urosepsis.

Diagnosis:
The enlarged right kidney with a low-density lesion at the right middle calyx, and a well-enhanced ureter were noted on the computed tomography scan. Therefore, xanthogranulomatous inflammation was suspected. Semi-rigid ureteroscopy with biopsy was performed, and xanthogranulomatous inflammation of the ureter was confirmed on the pathology report.

Interventions:
After right open radical nephrectomy was performed, the final pathology report revealed malakoplakia with xanthogranulomatous pyelonephritis.

Outcomes:
After the surgery, she has no longer suffered from urosepsis for 8 months, and there were no adverse event or recurrence noted.

Lessons:
With this case report, we aim to emphasize that these 2 diseases are not mutually exclusive, but they may exist simultaneously in the same patient.
Plexiform fibromyxoma
Authors: Lin Min , Song Lu , Qin Shuming , Li Daosheng , Hou Gang , Li Xiaomei 
Published: September 2021

Abstract
Plexiform fibromyxoma (PF) is a rare mesenchymal neoplasm which can be misdiagnosed as the gastrointestinal stromal tumor. This tumor almost formed a lobulated intramural/submucosal mass in the gastric antrum and prepyloric area. It was considered as a benign tumor that exhibited no recurrence, metastasis, or tumor-related mortality. In this study, we reported 2 cases of gastric PF. The first case was a PF patient coexisting with gastric adenocarcinoma. The second case occurred in the gastric upper body close to gastric fundus. They underwent distal gastrectomy and laparoscopic partial gastric resection, respectively. Both of them exhibited a plexiform growth pattern in the submucosa, muscularis propria, and subserosal adipose tissues. The nodules were composed of abundant myxoid or fibromyxoid matrix riching in small thin-walled blood vessels and bland-looking spindle cells. The first case partially showed staggered growth pattern of PF and adenocarcinoma. Immunohistochemically, the spindle cells were diffusely immunoreactive for SMA and vimentin, and focally immunoreactive for CD10. It was important to distinguish the PF from other spindle cell tumors involving the stomach.
Researching on the compliance of epilepsy patients of the Phenobarbital Epilepsy Management Project in a rural area of China
Authors: Feng Xiang-Lin , Luo Bang-An , Qin Lu-Lu 
Published: September 2021

Abstract
The aim of this study was to explore the compliance of epilepsy patients in the Phenobarbital Epilepsy Management Project in a rural area of China and its influencing factors, so as to provide the basis for further strategies.
A retrospective study researching on the compliance of epilepsy patients in the Phenobarbital Epilepsy Management Project of Rural China was conducted. The Nan County, Hunan Province as a typical rural China was selected as the study site. We collected the compliance and other relative factors from 2017 to 2019 though the Phenobarbital Epilepsy Management Project data system.
The good compliance patients in the Phenobarbital Epilepsy Management Project in a rural area of China were 98.99% (393/397); only 4 cases had poor compliance. The factors affecting the compliance of epilepsy patients were “adverse reactions of digestive tract symptoms,” “how the patient felt physically, mentally, or working and learning ability during this period," and “the ratio of the attack to the previous one.”
The rate of good compliance among the epilepsy patients in the Phenobarbital Epilepsy Management Project in a rural area of China was high. More attention to education, patients’ psychology, and the curative effect of family members may improve the compliance of patients with epilepsy further.
Mapping the Location of Health Centers in Relation to “Maternity Care Deserts”
Authors: Markus Anne R. , Pillai Drishti 
Published: September 2021

Background and Objectives:
The aim was to explore the association between community health centers’ (CHC) distance to a “maternity care desert” (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors.

Measures:
Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff.

Research Design:
Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a “desert” were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234).

Results:
Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to “deserts” had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care.

Conclusions:
CHCs located closer to “deserts” and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.
Functional assessment of long bone fracture healing in Samburu County Referral Hospital (Kenya): the squat and smile challenge
Authors: Sciuto Daniele , Marzorati Mauro , Shearer David W. , Lanfranconi Francesca 
Published: September 2021

Abstract

Background:
The burden of musculoskeletal trauma is increasing in low- and middle-income countries. Due to the low clinical follow-up rates in these regions, the Squat-and-Smile test (S&S) has previously been proposed as a proxy to assess bone healing (BH) capacity after surgery involving bone fractures. This study deals with various aspects of using S&S and bone radiography examination to obtain information about an individual's ability to recover after a trauma. In summary, we performed the S&S test to assess the possibility of recovering biomechanical function in lower limbs in a remote area of Kenya (Samburu County).

Methods:
Eighty-nine patients (17.9% F; 31.7 ± 18.9 yrs) who underwent intramedullary nail treatment for femur or tibia fractures were enrolled in this study. Both S&S [evaluated by a goal attainment scale (GAS)] and x-ray (evaluated by REBORNE, Bone Healing Score) were performed at 6 and 24 weeks, postoperatively. An acceptable margin for satisfactory S&S GAS scores was determined by assessing its validity, reliability, and sensitivity.

Results:
S&S GAS scores increased over time: 80.2% of patients performed a satisfactory S&S at the 24-weeks follow-up with a complete BH. A high correlation between S&S GAS and REBORNE at the 6- and 24- weeks’ timepoint was found. Facial expression correlated partially with BH. The S&S proved to be accurate at correctly depicting the BH process (75% area fell under the Receiver Operator Curve).

Conclusion:
The S&S provides a possible substitution for bone x-ray during BH assessment. The potential to remotely follow up the BH is certainly appealing in low- and middle-income countries, but also in high-income countries; as was recently observed with the Covid-19 pandemic when access to a hospital is not conceivable.
Applying the Ottawa Ankle Rules in a Pediatric Emergency Department
Authors: Almeida Sara Isabel de , Rios Joana , Costa Lima Sofia , Oom Paulo 
Published: September 2021

Objectives
Ankle and midfoot injuries constitute one of the most frequent reasons to visit the pediatric emergency department (ED). The aims of the study were (1) to determine the feasibility of the Ottawa Ankle Rules (OARs) in a pediatric ED and its reliability to safely manage ankle and midfoot injuries and (2) to verify the impact in reducing the number of radiographs, healthcare costs, and time spent in the ED.

Methods
The prospective study enrolled 90 patients for the control group and 94 for the case group. For the control group, the standard of practice was registered. In the case group, before beginning enrolment, an instruction of how to apply the OARs were given to all clinicians. After that, OARs were applied according to patient complaints. A follow-up call was made for both groups.

Results
The mean age of the control group was 11.9 years (standard deviation, 3.267 years), whereas in the case group was 11.3 years (standard deviation, 3.533 years). Demographic and injury characteristics were similar in both groups. A significant statistical difference was verified in the number of radiographs (P = 0.001) with a reduction of 16.7% in the case group. Patients who did not perform radiography, in the case group, spent at least 1 hour less than the ones who did. The OARs have shown a sensitivity of 100% (95% confidence interval, 39.76–100.00) and specificity of 23.33% (95% CI, 15.06–33.43) with a negative predictive value of 100%.

Conclusions
The OARs are an important clinical instrument with a high sensitivity and negative predictive value, which allows clinicians to avoid unnecessary exposure to radiation without missing clinically relevant fractures.
Improving the Flow
Authors: Sobolewski Kristine A. , Koo Soojin , Deutsch Robert J. 
Published: September 2021

Background
Emergency department (ED) overcrowding has led to longer waits for patients to be seen, treated, and released. This has been coupled with an increased number of patients who leave without ever being seen by an ED provider. Improving patient throughput and decreasing ED patient length of stay while continuing to provide high-quality care is of paramount importance. Optimization of available standing orders for fever, pain, and/or nausea and vomiting at the time of nurse triage may offer an opportunity to improve patient outcomes, decrease time to medication (TTM) administration for ill and injured patients, and decrease length of stay.

Patients and Methods
This was a retrospective cohort patient analysis for patients younger than 18 years of age presenting to the ED before (February 2019) and after (February 2020) an intensive campaign aimed at educating the triage nurses regarding the use of ED standing orders for acetaminophen, ibuprofen, and ondansetron. The investigators sought to evaluate percentage change in nurse triage-initiated (NTI) orders between the 2 time frames. Secondary outcomes evaluated TTM, documented adverse effects, percentage of inappropriate medication administrations, and correlate TTMs to ED discharge.

Results
The percentage of patients who received an NTI medication was 49% in 2019 and 58% in 2020 (P = 0.257). For NTI orders, TTM initiation decreased in the postintervention group from an average of 45 minutes down to 37.6 minutes. In the overall cohort, TTM administration in the NTI group was a mean of 41.2 minutes compared with 75.9 minutes in the provider-initiated group (P < 0.0001). Length of stay was the same for the NTI versus the provider-initiated group in overall cohort (134.4 vs 142.9, P = 0.4303). No adverse events were identified.

Conclusions
Nurse-initiated medication administration at the time of triage offers an opportunity to get patients vital treatment more quickly. Medications administrated earlier in the pediatric ED encounter have a correlation to improved throughput and higher possibility of quicker discharge from the ED. Further research is needed to fully assess the impact of continuing education on improving utilization of triage standing orders and the impact on ED throughput.
Brief Report: Supporting Access to HIV Care for Children and Youth During the COVID-19 Pandemic With Telemedicine and Rideshare
Authors: Koay Wei Li A. , Prabhakar Supriya , Neilan Anne , Meyers Joanna , Lee Nara , Rakhmanina Natella 
Published: September 2021

Background:
In response to the COVID-19 pandemic, we scaled up telemedicine and rideshare services for clinic and laboratory visits for pediatric and adolescent patients with HIV.

Setting:
HIV subspecialty program for patients aged 0–24 years at Children's National Hospital, Washington, DC.

Methods:
Using the χ2 and Wilcoxon rank sum tests, we compared demographics, visit and laboratory data, and rideshare usage among patients who scheduled telemedicine at least once (telemedicine) versus those who never scheduled telemedicine (no-telemedicine) during the pandemic (April–September 2020). We compared the number and proportion of scheduled and completed clinic visits before the pandemic (April–September 2019) with those during the pandemic.

Results:
We analyzed 178 pediatric and adolescent patients with HIV (median age 17.9 years, 89.3% Black, 48.9% male patients, 78.7% perinatally infected), of whom 70.2% and 28.6% used telemedicine and rideshare, respectively. Telemedicine patients scheduled more visits (236 vs 179, P < 0.0001) and completed a similar proportion of visits (81.8% vs 86.0%, P = 0.3805) compared with no-telemedicine patients. Laboratory testing rates (81.3% versus 98.5%, P = 0.0005) were lower in telemedicine patients compared with no-telemedicine patients. Rideshare usage (12.4% versus 26.5%, P = 0.0068) was lower in telemedicine versus no-telemedicine patients. During the pandemic, most of the patients (81.0%) had HIV RNA <200 copies/mL. The total number of completed visits and the proportion of visits completed were similar before and during the pandemic.

Conclusion:
Most of the pediatric and adolescent patients with HIV used telemedicine and maintained HIV RNA <200 copies/mL during the pandemic. Despite rideshare usage, laboratory testing rates were lower with telemedicine compared with in-person visits.
First Metatarsal Bone Metastasis From Clear Cell Renal Cell Carcinoma on SPECT/CT
Authors: Chrabański Olgierd , Gołąb Tomasz 
Published: September 2021

Abstract
We report metatarsal metastasis in SPECT/CT in a 65-year-old man, 5 years after radical right nephrectomy. Tumor from first metatarsal was histopathologically proven from clear cell renal cell carcinoma. Metatarsal metastasis is very rare. Less than 0.01% of patients have metastases in the foot bone. Tumor histotype is mainly lung cancer. Metastases from renal carcinoma are often lytic with a poor osteoblastic response, there may be limited uptake of the 99mTc-MDP tracer, and all uncertain regions should be diagnosed with SPECT/CT, if it is possible.
Gender Affirming Surgery: A Comprehensive, Systematic Review of All Peer-reviewed Literature and Methods of Assessing Patient-centered Outcomes (Part 2: Genital Reconstruction)
Authors: Oles Norah , Darrach Halley , Landford Wilmina , Garza Matthew , Twose Claire , Park Chanjun S. , Tran Phuong , Schechter Loren S. , Lau Brandyn , Coon Devin 
Published: September 2021

Objective:
To perform the first systematic review of all available GAS publications across all procedures to assess outcomes reported in the literature and the methods used for outcome assessment.

Summary of Background Data:
Assessment of GAS results is complex and multidimensional, involving not only complication rates but also anatomic (eg, vaginal depth), functional (eg, urinary), and psychosocial outcomes. A fully comprehensive aggregation of all prior research would offer an essential cornerstone for continued progress.

Methods:
A systematic review was performed after PRISMA guidelines to identify all outcomes measures in GAS cohorts, including patient-centered outcomes, complications, and functional outcomes. Data were aggregated to assess pooled rates of complications, satisfaction, and other outcomes.

Results:
Overall, 15,186 references were identified, 4162 papers advanced to abstract review, and 1826 underwent full-text review. After review, there were 406 GAS cohort publications, including 171 vaginoplasty, 82 phalloplasty, 16 metoidioplasty, 23 oophorectomy/vaginectomy, and 21 with multiple procedures.
Although 68.7% of genitoplasty papers addressed patient-centered outcomes, only 1.0% used metrics validated in the transgender population. Forty-three different outcome instruments were used. No instrument was used in more than 15% of published series and 38 were used in only 1 or 2 publications.

Conclusions:
Our review found high patient satisfaction for genital procedures but little concordance between study methods, with almost 90% of patient-focused outcome metrics appearing only once or twice. Standardization of outcome instruments and measurement methods through patient-inclusive, multidisciplinary consensus efforts is the essential next step for quality improvement. As GAS continues to mature, building on current foundations with the goal of improving both surgical and patient-reported outcomes is essential.