bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing the difficult airway
Authors: Liu Hui-Hui , Wang Yong , Zhong Ming , Li Yu-Hui , Gao Huan , Zhang Jian-Feng , Ma Wu-Hua 
Published: September 2021

Abstract
Although equipment and human resources are vital elements of difficult airway management (DAM). But the approach and practice of DAM are more important. So, we conducted the present survey to address anesthesiologists of different working years in this knowledge gap.
This nationwide cross-sectional study was conducted from October 27, 2016 to November 27, 2016. The survey was completed online in New Youth Anesthesia Forum including DAM assessment, anticipated and unanticipated DAM, difficult airway algorithm, use of the front of neck access (FONA) technique and training, DAM outside the operation room, and difficult extubation management.
We received 1935 replies (44%). Mouth opening and Mallampati classification were the most common methods to evaluate difficult airways. When suffering from unanticipated difficult airway 63% less than 10 years anesthesiologists (LA) and 65% more than 10 years anesthesiologists (MA) would ask for help after trying 1 to 2 times (P = .000). More than 70% of LA and MA respondents reported preferring cannula cricothyrotomy to deal with emergency airway, 507 (41.6%) MA respondents reported that they used FONA techniques to save patients’ lives (P = .000). Nearly 70% respondents worried full stomach when intubated outside operation room and more than 80% respondents selected auscultation to identify the placement. More than 80% respondents had not used Bougie to assist extubation. A 73.2% respondents know ABS algorithm and 96.4% know Chinese airway expert consensus among MA respondents, this was significant to LA respondents (P = .000).
The respondents in the LA and MA have a training gap in their evaluation of difficult airways, trained and used FONA emergency skills, facilitated of the airway guidelines at home and abroad. Also, we should provide more airway theory and skill training to our young doctors to advanced airway skills.
Balanced crystalloids versus saline in critically ill patients
Authors: Zhu Yuhan , Guo Nan , Song Maifen , Xia Fei , Wu Yanqing , Wang Xusheng , Chen Tengfei , Yang Zhihai , Yang Siwen , Zhang Yu , Zhang Xin , Shi Qingquan , Shen Xiaoxu 
Published: September 2021

Abstract

Objective:
To compare the safety of balanced crystalloids and saline among critically ill patients in intensive care unit (ICU).

Methods:
The Medline, EMBASE, Web of Science, Cochrane Library databases were systematically searched from the inception dates to May 17, 2020 in order to identify randomized controlled trials which evaluated the safety of balanced crystalloids and saline in critically ill patients. The primary outcome was major adverse kidney events within 30 days (MAKE30). The second outcomes included 30-day mortality, ICU mortality, In-hospital mortality, ICU length of stay, hospital length of stay, creatinine highest before discharge (mg/dl) and needs for renal replacement therapy (RRT).

Results:
A total of nine randomized controlled trials involving 19,578 critical ill patients fulfilled the inclusion criteria. The outcomes of this meta-analysis showed that balanced crystalloids treatment shared the same risk of MAKE30 with saline treatment among critical ill patients [RR = 0.95; 95%CI, 0.88 to 1.01; Z = 1.64 (P = .102)]. The clinical mortality which included 30-day mortality [RR = 0.92; 95%CI, 0.85 to 1.01; Z = 1.78 (P = .075)], ICU mortality [RR = 0.92; 95%CI, 0.83 to 1.02; Z = 1.67 (P = .094)] and In-hospital mortality [RR = 0.93; 95%CI, 0.71 to 1.21; Z = 0.55 (P = .585)] were similar between balanced crystalloids treatment and saline treatment among critical ill patients. Patients who received balanced crystalloids treatment or saline treatment needed the same length of ICU stay [WMD = 0.00; 95%CI, −0.09 to 0.10; Z = 0.09 (P = .932)] and hospital stay [WMD = 0.59; 95%CI, −0.33 to 1.51; Z = 1.26 (P = .209)]. Critical ill patients who received balanced crystalloids treatment or saline treatment had the same level of creatinine highest before discharge [WMD = 0.01; 95%CI, −0.02 to 0.04; Z = 0.76 (P = .446)] and needs for RRT [RR = 1.04; 95%CI, 0.75 to 1.43; Z = 0.21 (P = .830)]. Similar results were obtained in subgroups of trials stratified according to the age of patients (children or adults).

Conclusions:
When compared with saline, balanced crystalloids could not reduce the risk of MAKE30, 30-day mortality, ICU mortality and in-hospital mortality, could not reduce the length of ICU stay, length of hospital stay, the level of creatinine highest before discharge and the needs for RRT among critical ill children and adults. Therefore, it was still too early for balanced crystalloids to replace normal saline among critical ill patients.
Syncope as the initial presentation of pulmonary embolism in two patients with hepatocellular carcinoma
Authors: Deng Dayong , Wu Haidi , Wei Huafang , Song Zikai , Yu Yang , Zhang Chongyin , Yang Lei 
Published: September 2021

Abstract

Rationale:
Pulmonary embolism (PE) has diverse clinical manifestations and syncope might be the first or only symptom of PE. Tumor disease usually presents with symptoms associated with the primary site, however, PE may be the first manifestation of occult tumors.

Patient concerns:
Here, we report 2 patients admitted to our hospital because of syncope. One patient had a chronic hepatitis B history of more than 20 years and the other patient had chronic heavy drinking for many years. Neither patient had been diagnosed with neoplastic disease before admission.

Diagnoses:
Clinical examinations, including laboratory tests and imaging tests upon admission demonstrated PE resulting in syncope. Furthermore, malignant hepatocellular carcinoma (HCC), inferior vena cava, and right atrium tumor thrombus were diagnosed.

Interventions:
Thrombolysis and anti-coagulation therapy were performed immediately after the diagnosis of PE. Twenty-seven HCC patients with PE in 27 articles from 1962 to 2020 in the PubMed database were reviewed.

Outcomes:
The improvement was achieved that no syncope recurred after treatment of PE. The oxygen partial pressure increased and the D-dimer level decreased. The clinical characteristics of 27 HCC patients with PE were summarized and analyzed.

Lessons:
It is important for clinicians to be aware that occult carcinoma might be a reason for patients with PE presenting with syncope. If PE cannot be explained by common causes, such as our patient, and HCC should be highly suspected when inferior vena cava and right atrial mass are found on imaging tests.
Laparoscopic treatment of a recurrent biliary stone forming around a Hem-o-lok clip in a patient with previous gastrectomies
Authors: Jiang Chao , Liu Xueyan , Li Shuxuan , Wu Guangzhen , Wang Guangyi , Wang Meng 
Published: September 2021

Abstract

Rationale:
A history of gastrectomy is associated with an increased incidence of gallstones requiring surgery. Endoscopic retrograde cholangiopancreatography is challenging for patients who undergo total or Billroth II gastrectomy. Laparoscopic common bile duct exploration (LCBDE) has been attempted in such cases. Herein, we report a case of choledocholithiasis in which a stone formed around a migrated Hem-o-lok clip.

Patient concerns:
A 67-year-old man was admitted to the hospital for acute right upper abdominal pain. He had a history of 2 open gastric cancer surgeries in the previous seven years and had undergone LCBDE 12 months prior to this admission. Postoperative examination revealed recurrence of bile duct stones.

Interventions:
The patient underwent repeat LCBDE plus primary closure with an evaluation of abdominal adhesion. A stone had formed around a Hem-o-lok clip in the common bile duct was removed.

Outcomes:
The patient had an uneventful recovery with no stone recurrence or movement of the remaining Hem-o-lok clips after a 1-year follow-up.

Lessons:
LCBDE with primary closure should be carefully considered in patients with certain gallstone diseases after complicated upper abdominal surgery.
Postoperative clip migration is a rare complication; hence care must be taken in placing the clip appropriately to ensure that it is not too close to the common bile duct.
Prognostic significance of platelet lymphocyte ratio in patients with melanoma
Authors: Wang Enwen , Huang Hui , Tang Long , Tian Ling , Yang Liejun , Wang Sixiong , Ma Huiwen 
Published: September 2021

Abstract

Background:
The aim of this study was to systematically evaluate the prognostic role of platelet lymphocyte ratio (PLR) in patients with melanoma through performing a meta-analysis.

Methods:
PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched for potential studies. The basic characteristics and relevant data were extracted. Hazard ratios with 95% confidence intervals (CIs) were pooled to evaluate the prognostic role of PLR in patients with melanoma.

Results:
Ten studies enrolling 2422 patients were included. The pooled hazard ratios of higher PLR for overall survival and progression-free survival in melanoma were 1.70 (95% CI, 1.22–2.37) and 1.65 (95% CI, 1.10–2.47), respectively. Sensitivity analysis and subgroup analyses were also performed. No significant publication bias was observed.

Conclusion:
Our results showed that higher PLR was associated with poorer overall survival and progression-free survival in patients with melanoma. These findings may help to determine the prognosis and explore future novel therapies based on modulating inflammation and immune responses in melanoma.
The role of CXCL10 in prognosis of patients with colon cancer and tumor microenvironment remodeling
Authors: Song Weiwei , Yin Hongli , Han Chenguang , Mao Qiantai , Tang Jing , Ji Zhaoshuai , Yan Xu , Wang Lan , Liu Shengnan , Ai Chao 
Published: September 2021

Abstract

Backgroung:
Tumor microenvironment (TME) has gradually emerged as an important research topic in the fight against cancer. The immune system is a major contributing factor in TME, and investigations have revealed that tumors are partially infiltrated with numerous immune cell subsets.

Method:
We obtained transcriptome RNA-seq data from the the Cancer Genome Atlas databases for 521 patients with colon adenocarcinoma (COAD). ESTIMATE algorithms are then used to estimate the fraction of stromal and immune cells in COAD samples.

Result:
A total of 1109 stromal-immune score-related differentially expressed genes were identified and used to generate a high-confidence protein–protein interaction network and univariate COX regression analysis. C-X-C motif chemokine 10 (CXCL10) was identified as the core gene by intersection analysis of data from protein–protein interaction network and univariate COX regression analysis. Then, for CXCL10, we performed gene set enrichment analysis, survival analysis and clinical analysis, and we used CIBERSORT algorithms to estimate the proportion of tumor-infiltrating immune cells in COAD samples.

Conclusion:
We discovered that CXCL10 levels could be effective for predicting the prognosis of COAD patients as well as a clue that the status of TME is transitioning from immunological to metabolic activity, which provided additional information for COAD therapies.
Polymorphisms of matrix metalloproteinases affect the susceptibility of esophageal cancer
Authors: Chen Hai , Xu Xianquan , Hua Congshu , Zhang Heng , Jian Junling , Ge Tengfei , Xie Jianfeng , Yu Zaicheng 
Published: September 2021

Abstract

Background:
The results of how matrix metalloproteinases (MMPs) polymorphisms affect esophageal cancer (EC) risk are not consistent, especially for MMP1,2,7 and 9. A meta-analysis focused on the impact of MMPs to digestive cancers, but not a precise analysis to EC, therefore, we designed the current study to make a clear understanding of the association between MMPs polymorphisms and EC.

Methods:
Up to March 2020, we searched several databases to find case-control cohorts concerned about the risk of MMPs polymorphisms to EC risk. Odds ratios with 95% confidence intervals under five genetic models to generate the risk predicted value. The Q test and I
2 statistics are used to estimate heterogeneity. Sensitivity analysis, Egger test, and Begg's funnel plot were employed to assess the results. In-silico analysis was performed to study the association between the polymorphism and mRNA expression.

Results:
19 case-control studies were enrolled, including 8371 EC patients and 12041 health controls. We observed the increased risk in BA vs. AA and BB + BA vs. AA models of MMP1-rs1799750 polymorphism. The protective effectiveness of EC was found in the MMP2 rs243865 polymorphism in B vs. A, BA vs. AA, and BB + BA vs. AA models. Meanwhile, the risk effect was also observed in the MMP7 rs11568818 polymorphism in most genetic models. In the furthermore bioinformatics analysis, we found that MMP1, MMP3, MMP7, MMP9, MMP12, MMP13 all increased in the tumor tissues, and the genetic alteration in the polymorphisms could impact the mRNA expression of the above MMPs.

Conclusion:
MMP1 rs1799705 and MMP7 rs1156818 polymorphisms will take part in the tumorigenesis of EC, while MMP2 rs243865 acts as a protective role to decrease the risk of EC.
Top 100 cited articles on hemodialysis
Authors: Lee Yoo Jin , Heo Chang Min , Park Sihyung , Kim Yang Wook , Park Jin Han , Kim Il Hwan , Ko Junghae , Park Bong Soo 
Published: September 2021

Abstract

Introduction:
This study was conducted to better understand hemodialysis by reviewing the most-cited articles related to it.

Methods:
We searched articles on the Web of Science and selected the 100 most frequently cited articles. Subsequently, we reviewed these articles and identified their characteristics.

Results:
The 100 most frequently cited articles were published in 21 journals. The majority of these papers were published in the following journals: Kidney International (26 articles), New England Journal of Medicine (18 articles), Journal of the American Society of Nephrology (14 articles), and the American Journal of Kidney Disease (13 articles). The 100 most-cited articles were published in 25 countries. The United States of America was the country with the highest number of publications (65 articles). The University of Michigan was the institution with the highest number of articles (14 articles). FK Port was the author with the largest number of publications (13 articles).

Conclusions:
This is the first study in the field of nephrology that provides a list of the 100 most-cited articles on hemodialysis. Through this study, clinicians will be able to recognize major academic interests and research trends in hemodialysis.
Influence of gastric morphology on gastroesophageal reflux in adults
Authors: Cheng She-Meng , Hung Kun-Long , Wang Yu-Jen , Ng Suk-Ping , Chiang Hsin-Fan 
Published: September 2021

Abstract
The study's aim was to determine if there was an association between gastric morphology and gastroesophageal reflux (GER). Few published studies have investigated the relationship between gastric morphology and the risk of GER.
A total of 777 patients were randomly selected from 3000 to 3300 patients who presented at a medical center in Taipei for annual health checkups from early 2008 through to late 2010 and underwent a series of radiographs of the upper gastrointestinal tract (UGI). GER was recorded during the real-time fluoroscopic study. Thirty-nine participants had a follow-up endoscopy, and another 164 participants were followed up by a second UGI series 12 +/ −1.5 months later, from late 2008 through to early 2022. All participants completed a lifestyle and symptom questionnaire. The variables included current smoking and alcohol consumption. Participants who had heartburn and dysphagia were included in the study. Additionally, all participants underwent a limited physical examination which recorded age, sex, body mass index, and total cholesterol and triglyceride levels.
All participants were classified into types 1 to 6 based on the gastric morphology determined from the first UGI. Cascade stomach is recognized by characteristic findings on UGI. Gastric types 2 and 3 tend to appear as cascade stomachs and were significantly associated with GER (P < .05) compared with the other groups. Morphologic type 5 appeared as an elongated sac extending downward into the pelvic cavity and was less likely to develop GER (P < .001). The results of follow-up studies by UGI and endoscopy were similar to those of the first UGI. Gastric morphologic type 2 was significantly associated, and type 5 was usually not associated, with GER and erosive esophagitis (P < .05) compared with the other groups, by both UGI and endoscopy.
Gastric morphologic types 2 and 3, with cascade stomach, might provide a relatively easy method for the development of the GER phenomenon. Gastric morphologic type 5 appeared as an elongated sac that might reduce the incidence of the GER phenomenon. The study suggested that gastric morphologic type could influence the occurrence of GER.
Using a mobile device for margin assessment of specimen mammography in breast-conserving surgery
Authors: Yun Bo La , Jang Mijung , Ahn Hye Shin , Kim Mi Young , Kim Bohyoung , Kim Sun Mi 
Published: September 2021

Abstract
To compare the performance of margin assessment of specimen mammography (SM) in patients with breast-conserving surgery (BCS) on mobile devices and 5-megapixel (5M) thin film transistor liquid crystal display (TFT-LCD) monitors based on the safety margin for pathologic results.
This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. A total of 105 consecutive breast cancer SM samples from 104 women who underwent BCS were included in the study. The SM were independently reviewed by two radiologists using mobile devices and by two additional radiologists using 5M TFT-LCD monitor. Each reader was asked to measure the shortest distance between the lesion and the lesion margin. The interpretation time was recorded. The sensitivity, specificity, and interobserver agreement were analyzed.
In total, 19% (20/105) breast specimens had a positive surgical margin (<1 mm). The mean absolute difference from the pathologic margin was 0.60 ± 0.57 cm and 0.54 ± 0.47 cm using the 5 M TFT-LCD monitor and the mobile device, respectively (without any statistical significance, P = .273). The mean interpretation time was 49.5 and 47.6 s for the 5M TFT-LCD monitor and the mobile device, respectively (P = .012). The pooled sensitivity and specificity were 60% and 74% for 5M TFT-LCD monitor, and 60% and 69% for the mobile device (P = 1.00 and P = .190, respectively). The kappa coefficient indicated moderate agreement for both the displays.
The diagnostic performance for margin assessment of SM in BCS patients on mobile devices and 5M TFT-LCD monitors are showed not statistically difference. The findings of the study provide evidence of the benefit of the mobile device for SM interpretation in patients who underwent BCS. However, a large sample size study is warranted before using a mobile device for margin evaluation on SM.
The mobile device showed comparable diagnostic performance with 5M TFT-LCD monitor in the evaluation of SM margin in patients with BCS and could be used as a display tool for immediate assessment when a dedicated LCD monitor is unavailable.
Predictive value of the monocyte-to-lymphocyte ratio in the diagnosis of prostate cancer
Authors: Xu Zhanping , Zhang Jing , Zhong Yuxiang , Mai Yuan , Huang Danxuan , Wei Wei , Huang Jianhua , Zhao Pengpeng , Lin Fuxiang , Jin Jingmiao 
Published: September 2021

Abstract
It has been reported that inflammation and immune system are related to prostate cancer. The neutrophil-to-lymphocyte ratio (NLR), as well as the platelet-to-lymphocyte ratio (PLR), have already been proposed as new indices to help diagnose prostate cancer (PCa). However, the monocyte-to-lymphocyte ratio (MLR) with regard to PCa has rarely been mentioned.
To investigate the capability of the MLR to predict PCa.
Patients who were pathologically diagnosed with PCa in our hospital and healthy control subjects who conformed to the inclusion criteria were enrolled. Patient data were recorded, including age, complete blood counts, blood biochemistry, and serum prostate-specific antigen (PSA) levels. The differences in these data between the groups were analyzed and the diagnostic value of the MLR was compared with PSA.
Our study included a total of 100 patients with PCa and 103 healthy control subjects. Patients with PCa presented with a significantly higher NLR, MLR, and PLR compared to control subjects. However, the hemoglobin and lymphocyte levels were lower (P < .05) in PCa patients. The area under the curve (AUC) of PSA and ratio of free/total serum prostate-specific antigen were 0.899 (95% confidence interval [CI]: 0.857–0.942) and 0.872 (95% CI: 0.818–0.926), respectively, while the AUC of the MLR was 0.852 (95% CI: 0.798–0.906), which was higher than that of the NLR, PLR, and any other blood parameters. Additionally, the optimal cut-off value of the MLR for PCa was 0.264, with a specificity of 87.4% and a sensitivity of 72.0%. An evaluation of the diagnostic value of MLR + PSA gave an AUC of 0.936 (95% CI: 0.902–0.970). However, the AUC of MLR + PSA + f/tPSA was 0.996 (95% CI: 0.991–1.000). The diagnostic value of MLR + NLR + PSA gave an AUC of 0.945 (95% CI: 0.913–0.977), and the specificity is 0.971.
PSA remains the most important diagnostic indicator. MLR combined with PSA and f/tPSA has the higher predictive value than PSA. It suggests that MLR may be another good predictive indicator of PCa. It can help reduce the clinical false positive rate.
Efficacy and safety of Zhen Wu Decoction against chronic heart failure
Authors: Liang Jian , Tao Xianming , Hu Dabi , Cao Yi 
Published: September 2021

Abstract

Introduction:
Chronic heart failure (CHF) is the end stage of several cardiac diseases. 50% of patients with severe CHF would survive less than 1 year, which has seriously affected patients’ survival and quality of life. The current modern therapy could improve survival and quality of life. However, a larger number of patients still suffer from repeated hospitalization, unsatisfactory efficacy, and many side effects. In China, Zhen Wu Decoction (ZWD), a classic prescription recorded in Treatise on Febrile Diseases, was widely used for CHF. In this study, we try to conduct a prospective, double-blinded, randomized, controlled study to evaluate the efficacy and safety of ZWD in the treatment of CHF patients in China.

Methods:
Patients will be randomly divided into treatment group and control group in 1:1 ratio. Guideline directed medical therapies and ZWD will be provided for patients in treatment group, while guideline directed medical therapies and ZWD-granules simulations for control group. Left ventricular ejection fraction, left ventricular end diastolic diameter, left ventricular end systolic diameter, b-type natriuretic peptide, NT-proBNP, peak VO2, VO2 maximum, exercise time, and walking distance will be recorded. The data will be analyzed by SPSS 22.0.

Conclusions:
The results will evaluate the efficacy and safety of ZWD in the treatment of CHF patients.

Trial registration:
OSF registration number: DOI 10.17605/OSF.IO/G3QNU.