bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mini-anterior approach for surgical reduction of developmental dysplasia of the hip: a case series
Authors: Thabet Mahmoud El-Badawy , AbdelWahab Ahmed M. , Imam Ahmed Hatem 
Published: January 2021

Background:
Our hypothesis was that the mini-anterior approach gives adequate exposure with satisfactory result in patients with developmental dysplasia of the hip.

Methods:
Twenty-three hips in 20 patients who had developmental dysplasia of the hip (18 girls and two boys) underwent surgical reduction using the mini-anterior approach. The incision extended from a point about 1 cm below and medial to the anterior iliac superior spine obliquely to a point about 1 cm lateral to the femoral pulsation. The average patient age at the time of surgery was 15 mo.

Results:
Clinical results were evaluated according to the modified McKay criteria and the cosmetic appearance of the wound. Excellent wound cosmetic appearance was present in all patients. Twenty-two hips (95.7%) were rated clinically as excellent to good, whereas only one hip was rated as fair. According to radiographic Severin grading, 20 hips (86.4%) were rated as excellent to good and only three hips (13.6%) were rated as fair.

Conclusions:
The mini-anterior approach can be used safely in patients with dysplasia of the hip who are younger than 20 mo with adequate exposure and minimal soft-tissue dissection.

Level of Evidence:
Level IV.
Functional Ability Classification Based on Moderate and Severe Kinesophobia and Demoralization Scores in Degenerative Spine Patients
Authors: Haddas Ram , Lieberman Isador , Sandu Cezar D. , Sambhariya Varun , Block Andrew 
Published: January 2021

Study Design.
A prospective cohort study.

Objective.
To assess the relationship of fear avoidance and demoralization on gait and balance and determine a threshold score for the Tampa Scale for Kinesophobia (TSK) and the Demoralization Scale (DS) that identifies spine patients with gait and balance dysfunction amplified by underlying psychological factors.

Summary of Background Data.
Fear avoidance and demoralization are crucial components of mental health that impact the outcomes in spine surgery. However, interpreting their effect on patient function remains challenging. Further establishing this correlation and identifying a threshold of severity can aid in identifying patients in whom a portion of their altered gait and balance may be amplified by underlying psychologic distress.

Methods.
Four hundred five symptomatic spine patients were given the TSK and DS questionnaires. Patient's gait and balance were tested with a human motion capture system. A TSK score of 41 and a DS score of 30 were chosen as thresholds to classify moderate versus severe dysfunction based on literature and statistical analysis.

Results.
Higher TSK and DS scores were correlated with worse walking speed (P < 0.001), longer stride time (P = 0.001), decreased stride length (P < 0.048), and wider step width (<0.001) during gait as well as increased sway across planes (P = 0.001) during standing balance. When classified by TSK scores >41, patients with more severe fear avoidance had slower walking speed (P < 0.001), longer stride time (P = 0.001), shorter stride length (P = 0.004), increased step width (P < 0.001), and increased sway (P = 0.001) compared with their lower scoring counterparts. Similarly, patients with DS > 30 had slower walking speed (P = 0.012), longer stride time (P = 0.022), and increased sway (P = 0.003) compared with their lower scoring counterparts.

Conclusion.
This study demonstrates that fear avoidance and demoralization directly correlate with worsening gait and balance. Furthermore, patients with TSK > 41 and DS > 30 have more underlying psychological factors that contribute to significantly worse function compared with lower scoring peers. Understanding this relationship and using these guidelines can help identify and treat patients whose gait dysfunction may be amplified by psychologic distress.

Level of Evidence: 3
Defining a Surgical Invasiveness Threshold for Increased Risk of a Major Complication Following Adult Spinal Deformity Surgery
Authors: Neuman Brian J. , Harris Andrew B. , Klineberg Eric O. , Hostin Richard A. , Protopsaltis Themistocles S. , Passias Peter G. , Gum Jeffrey L. , Hart Robert A. , Kelly Michael P. , Daniels Alan H. , Ames Christopher P. , Shaffrey Christopher I. , Kebaish Khaled M. 
Published: January 2021

Study Design.
Retrospective review.

Objectives.
The aim of this study was to define a surgical invasiveness threshold that predicts major complications after adult spinal deformity (ASD) surgery; use this threshold to categorize patients into quartiles by invasiveness; and determine the odds of major complications by quartile.

Summary of Background Data.
Understanding the relationship between surgical invasiveness and major complications is important for estimating the likelihood of major complications after ASD surgery.

Methods.
Using a multicenter database, we identified 574 ASD patients (more than 5 levels fused; mean age, 60 ± 15 years) with minimum 2-year follow-up. Invasiveness was calculated as the ASD Surgical and Radiographic (ASD-SR) score. Youden index was used to identify the invasiveness score cut-off associated with optimal sensitivity and specificity for predicting major complications. Resulting high- and low-invasiveness groups were divided in half to create quartiles. Odds of developing a major complication were analyzed for each quartile using logistic regression (alpha = 0.05).

Results.
The ASD-SR cutoff score that maximally predicted major complications was 90 points. ASD-SR quartiles were 0 to 65 (Q1), 66 to 89 (Q2), 90 to 119 (Q3), and ≥120 (Q4). Risk of a major complication was 17% in Q1, 21% in Q2, 35% in Q3, and 33% in Q4 (P < 0.001). Comparisons of adjacent quartiles showed an increase in the odds of a major complication from Q2 to Q3 (odds ratio [OR] 1.8; 95% confidence interval [CI]: 1.0–3.0), but not from Q1 to Q2 or from Q3 to Q4. Patients with ASD-SR scores ≥90 were 1.9 times as likely to have a major complication than patients with scores <90 (OR 1.9, 95% CI 1.3–2.9). Mean ASD-SR scores above and below 90 points were 121 ± 25 and 63 ± 17, respectively.

Conclusion.
The odds of major complications after ASD surgery are significantly greater when the procedure has an ASD-SR score ≥90. ASD-SR score can be used to counsel patients regarding these increased odds.

Level of Evidence: 3
Clinical value of assessing serum levels of inflammatory cytokines in the early diagnosis of patients with primary liver carcinoma: a retrospective observational study
Authors: He Chengwen , Wei Qin , Zhu Jun , Qin Qin , Wang Huaizhou , Liu Shanrong 
Published: January 2021

Objective:
To identify potential early diagnostic markers for hepatitis B progression to primary liver carcinoma using routine immunological tests based on 6 cytokine combinations.

Methods:

Eight hundred and ninety-nine patients with hepatitis B progressing to early primary liver carcinoma admitted to and treated at Changhai Hospital, Naval Military Medical University, Shanghai, China between March 2015 and June 2017 were included in this observational study, including 666 patients with HBsAg
+
, HBeAb
+
, HBcAb
+
liver carcinoma and 233 patients with HBsAg
+
, HBeAg
+
, HBcAb
+
liver carcinoma. Receiver operating characteristic (ROC) curves were used to evaluate the efficiency of the different cytokine in the diagnosis of hepatocellular carcinoma in patients with hepatitis B. This study was approved by the Institutional Review Board of Changhai Hospital, Naval Military Medical University, China (approval No. CHEC2020-080) on June 6, 2020.

Results:

Changed levels of interleukin (IL)-1β, IL-2R, IL-8, and tumor necrosis factor (TNF)-α were statistically significant (
P
< 0.05). The area under the ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, and Youden index for the diagnosis of primary liver carcinoma using the combination of IL-1β, IL-2R, IL-8, and TNF-α were 0.938, 79.2%, 96.7%, 96%, 82.0%, 0.759, respectively. The serum alpha-fetoprotein level in patients with primary liver carcinoma was positively correlated with IL-2R (
r
=0.3502,
P
< 0.001), IL-8 (
r
=0.1558,
P
=0.0273), and TNF-α (
r
=0.2544,
P
< 0.001) levels. The equation fitted to the results was logit(
P
)=0.086+ 0.01 × IL-2R-0.001 × IL-8-0.033 × TNF-α-0.041 × IL-1β.

Conclusion:
Our study establishes a novel, potentially valuable diagnostic model based on four cytokines related to the early stages of liver carcinoma.
The Role of Osteoclasts in Psoriatic Arthritis
Authors: Wang Zhen-Zhen , Wang Hong-Sheng 
Published: January 2021

Abstract
Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease related to psoriasis involving bone and cartilage. It is a heterogeneous disorder with a variety of clinical manifestations, which can include peripheral arthritis, axial spondylitis, enthesitis, skin and nail disease, dactylitis, uveitis, osteitis, inflammatory bowel disease. The distinctive feature of PsA is enthesitis. The characteristic bone erosion at the bone–pannus junction in PsA is mediated by osteoclasts, which are multinucleated giant cells derived from hematopoietic stem cells. Although the pathological mechanism of osteoclasts in PsA is mainly related to the destruction of the diseased joint, the exact pathogenesis of PsA is complex and the factors involved in initiation and termination of osteoclast need to be further explored. Much attention has been paid to the importance of osteoclast in psoriasis arthritis for decades. Based on the role of osteoclasts in PsA, our review discusses the formation and characteristics of multinucleated osteoclasts in PsA, summarizes current developments in osteoclast-related pathways in PsA including classical receptor activator of nuclear factor-κB-receptor activator of nuclear factor-κB ligand-osteoprotegerin pathway and immunomodulatory factors, as well as their advances and corresponding treatment. At present, the molecular and signal pathway that interacts with osteoclasts in the pathogenesis of PSA has not been fully elucidated, therefore more detailed studies are expected in the near future.
Comparison of safety and efficiency of corneal topography-guided photorefractive keratectomy and combined with crosslinking in myopic correction
Authors: Li Li , Zhang Bo , Hu Yijun , Xiong Lu , Wang Zheng 
Published: January 2021

Abstract
To compare the safety and efficiency of simple corneal topography-guided (T-CAT) photorefractive keratectomy (PRK) and T-CAT PRK combined with crosslinking (CXL) to correct myopia with borderline suspicious tomography.
Eyes with suspicious tomography (not classified as forme fruste keratoconus) underwent PRK combined with CXL. The suspicious tomography showed irregular posterior corneal morphology or maximum elevation value of the central 6 mm zone of the posterior surface (MEL) >15 μm, or Belin/Ambrósio Enhanced Ectasia Index (BAD-D) was >1.6. The PRK group was generated and matched within 2 μm for MEL, 0.3 for BAD-D value, and 0.5 D for manifest refractive spherical equivalent (MRSE) compared with the PRK-CXL group.
PRK-CXL exhibited a larger MRSE (0.09 ± 0.22 D vs −0.03 ± 0.24 D, P = .02) and a larger sphere (0.14 ± 0.22 D vs 0.01 ± 0.21 D, P = .002) compared with PRK alone at 18 months postoperatively. The magnitude change and relative change rate of stiffness parameter A1 in the PRK-CXL were smaller than in the PRK group (−15.72 ± 14.56 vs −19.95 ± 14.37, P = .04, for magnitude change and −0.16 ± 0.15 vs −0.20 ± 0.14, P = .02, for relative change rate). In the PRK-CXL and PRK groups, 4.8% and 6.9% of eyes suffered grade 0.5 haze at postoperative 18-month. No cases of ectasia were reported in either group.
PRK in combination with prophylactic crosslinking showed comparable safety and efficacy, but higher biomechanical stability compared to PRK alone, thus, the additional CXL plays a measurable role in reducing the change in corneal biomechanical properties after PRK in suspicious eyes.
Effect of a serum lactate monitoring recommendation policy on patients treated with linezolid
Authors: Im Jae Hyoung , Lee Jin-Soo , Chung Moon-Hyun , Kwon Hea Yoon , Lee Man-Jong , Baek Ji Hyeon 
Published: January 2021

Abstract
Lactic acidosis is one of the most fatal adverse effects of linezolid, an antibiotic used to treat serious infections caused by antibiotic-resistant bacteria. However, the measures to prevent lactic acidosis have not been well established.
We performed a retrospective study to analyze the impact of applying a serum lactate monitoring recommendation policy in patients treated with linezolid.
Since September 2011, we have recommended inpatient monitoring of serum lactate levels in patients treated with linezolid at our hospital. Patients were divided into two groups according to whether they were seen during the non-recommendation or recommendation periods. The frequency of serum lactate monitoring, linezolid-induced lactatemia, lactic acidosis, critical illness, and death were compared between the two periods.
After September 2011, adherence to the recommendation to monitor serum lactate increased from 6.1% to 60.1%. No difference was observed in the incidence of linezolid-induced lactatemia and lactic acidosis between the two periods. However, there was a significant difference in the incidence of linezolid-induced critical illness between the non-recommendation and recommendation periods (3 vs 0 cases, P = .044).
In patients treated with linezolid, serum lactate monitoring led to early detection of lactatemia, thus enabling rapid rescue. We recommend regular monitoring of serum lactate in all patients treated with linezolid.
Effects of aerobic exercise, traditional Chinese exercises, and meditation on depressive symptoms of college student
Authors: Song Jian , Liu Zhi-zhen , Huang Jia , Wu Jing-song , Tao Jing 
Published: January 2021

Abstract

Background:
Non-pharmacological intervention methods such as rehabilitation training or psychological treatment are mostly used in the treatment of depression owing to the limitation of adverse reactions such as drug treatment. However, the best non-pharmacological treatment strategy for depression in college students is unclear. Therefore, it is significant to discover non-drug intervention methods that can improve the depression symptoms of college students.

Method:
Electronic databases as of Sep 15, 2019, were searched, and reference lists and pharmaceutical dossiers were reviewed to detect published and unpublished studies from the date of their inception to Sep 15, 2019. With document quality evaluations and data extraction, Meta-Analysis was performed using a random effect model to evaluate the intervention effect of the aerobic exercise, traditional Chinese exercises, and meditation.

Results:
A total of 44 original studies were included. The random effect model was used to combine the effect values with Standard Mean Difference (SMD), and the results were: aerobic exercise [SMD = –0.53, 95% CI (–0.77, –0.30), I2 = 80%, P < .001], traditional Chinese exercises [SMD = –0.42, 95% CI (–0.74, –0.10), I2 = 90%, P = .01], meditation [SMD = –0.51, 95% CI (–0.90, –0.12), I2 = 79%, P = .01]. There was greater heterogeneity among the included studies: aerobic exercise (I2 = 80%, P < .001), traditional Chinese medicine methods (I2 = 90%, P < .001), and meditation (I2 = 79%, P < .001).

Conclusions:
This study revealed that the depression symptoms of college students can be effectively improved by aerobic exercise, traditional Chinese exercises, and meditation. Aerobic exercise would have a better effect on anxiety and stress while traditional Chinese exercise would have a better effect on stress. Further research (such as high-quality randomized controlled trials and long-term follow-up) is required to evaluate the effects of aerobic exercise, traditional Chinese exercise, and meditation on the depressive symptoms of college students to further apply complementary and alternative therapies.

Ethics and dissemination:
The results of the effects of aerobic exercise, traditional Chinese exercises, and meditation on depressive symptoms for a college student will be reported in a peer-reviewed publication. Hopefully, our findings from this meta-analysis can provide the most up-to-date evidence for the contribution to preventing the occurrence of depressive symptoms in college students.
Paraneoplastic pemphigus associated with small lymphocytic lymphoma
Authors: Wang Dafen , Chen Zhilu 
Published: January 2021

Abstract

Introduction:
Paraneoplastic pemphigus (PNP) is a life-threatening autoimmune blistering disease associated with underlying neoplasms. Currently, this disease is very difficult to treat.

Patient concerns:
We reported a rare case of paraneoplastic pemphigus associated with small lymphocytic lymphoma responsive to desmoglein 3 (Dsg3) and bullous pemphigoid (BP) antigen 180.

Diagnoses:
The initial diagnosis was hypothesized to be Stevens-Johnson syndrome based on the severe mucosal erosion and polymorphous skin lesions. However, the histopathological examination of the skin biopsy and immunology revealed PNP.

Interventions:
Anti-tumor therapy, immunosuppression and anti-infective therapy were administered.

Outcomes:
After a series of treatments, the skin lesions had been alleviated remarkably. Enzyme-linked immunoassays indices for Dsg3 and bullous pemphigoid antigen 180 decreased (Dsg3, 32; bullous pemphigoid antigen 180, 70.44). Unfortunately, 2 months later, the patient suffered respiratory failure due to the lung impairment of small lymphocytic lymphoma and infection. Eventually, the patient chose to be discharged from the hospital and lost the opportunity for follow-up treatment as he could not afford the expensive treatment costs.

Lessons:
It is highly susceptible to misdiagnosis due to polymorphous skin lesions. In this case, it was also initially misdiagnosed as Stevens-Johnson syndrome. Therefore, we should pay great attention to differential diagnosis. When refractory stomatitis and mucosal erosions occur, the possibility of PNP should be considered first. At the same time, pathology, immunology and other related tests as well as the examination of primary tumors should be carried out as soon as possible.
Examined lymph node count is not associated with prognosis in elderly patients with pN0 thoracic esophageal cancer
Authors: Zhang Guoqing , Guo Xiaofeng , Yuan Lulu , Gao Zhen , Li Jindong , Li Xiangnan 
Published: January 2021

Abstract
The purpose of this study was to determine whether the number of lymph nodes dissected predicts prognosis in surgically treated elderly patients with pN0 thoracic esophageal cancer. We searched the Surveillance, Epidemiology, and End Results database and identified the records of younger (<75 years) and older (≥75 years) patients with pN0 thoracic esophageal cancer between 1998 and 2015. The patient characteristics, tumor data, and postoperative variables were analyzed in this study. The Kaplan-Meier method and a Cox proportional hazard model were used to compare overall and cause-specific survival. Data from 1,792 esophageal cancer patients (older: n = 295; younger: n = 1497) were included. The survival analysis showed that the overall and cause-specific survival in the patients with ≥15 examined lymph nodes (eLNs) was significantly superior to that in the patients with 1 to 14 eLNs (P < .001); however, the difference disappeared in the older patients. After stratification by the tumor location, histology, pT classification, and differentiation between the younger and older cohorts to analyze the association between eLNs and survival, we found that the differences remained significant in most subgroups in the younger cohort. There were no differences in any subgroups of older patients. This study replicated the previously identified finding that long-term survival in patients with extensive lymphadenectomy was significantly superior to that in patients with less extensive lymphadenectomy. However, less extensive lymphadenectomy may be an acceptable treatment modality for elderly patients with pN0 thoracic esophageal cancer.
Double antithrombotic therapy for prevention of bleeding and ischemic events after percutaneous coronary intervention in patients with atrial fibrillation
Authors: Qiu Mei , Liu Shu-Yan , Zhou Hai-Rong 
Published: January 2021

Abstract

Background:
The efficacy of double antithrombotic therapy (DAT) vs. triple antithrombotic therapy (TAT) for prevention of bleeding and ischemic events in patients with atrial fibrillation following percutaneous coronary intervention (PCI) is unclear in those subgroups defined by the 5 factors (i.e., sex, age, race, history of diabetes, and type of P2Y12 inhibitor). We aimed to assess the efficacy of DAT vs TAT in these patient subgroups.

Methods:
We searched PubMed and relevant websites to include related randomized controlled trials (RCTs). Two endpoints of interest were clinically significant bleeding and major adverse cardiac events (MACE). Meta-analysis was performed stratified by 5 factors of interest (i.e., sex, age, race, history of diabetes, and type of P2Y12 inhibitor) to obtain pooled hazard ratio (HR) and 95% confidence interval (CI). Meta-regression analysis was conducted to evaluate subgroup effects. We detected publication bias by Egger test and funnel plots.

Results:
We included 4 RCTs for meta-analysis. DAT vs TAT significantly reduced the risk of clinically significant bleeding (HR 0.56, 95% CI 0.50–0.63). This effect of DAT was observed in most subgroups of interest (HR ranged from 0.54 to 0.69), and was consistent across various subgroups defined by each of the 5 factors of interest (Psubgroup ranged from 0.290 to 0.794). DAT vs TAT led to the similar risk of MACE (HR 0.98, 95% CI 0.89–1.08). This effect of DAT was observed in all subgroups of interest (all 95% CIs of HRs were across 1.0), and was consistent across various subgroups defined by each of the 5 factors of interest (Psubgroup ranged from 0.308 to 0.828). Publication bias was found only in one subgroup.

Conclusions:
Compared with TAT, DAT significantly reduces the risk of clinically significant bleeding and leads to the similar risk of MACE in patients with atrial fibrillation following PCI, irrespective of sex, age, race, history of diabetes, and type of P2Y12 inhibitor used at baseline.