bluuebunny/crossref_metadata_2025_split huggingface dataset:
The predictors of clinical outcomes in brainstem arteriovenous malformations after stereotactic radiosurgery
Authors: Ai Xiaolin , Xu Jianguo 
Published: June 2021

Abstract
The brainstem arteriovenous malformations (BS-AVMs) have a high morbidity and mortality and stereotactic radiosurgery (SRS) has been widely used to treat BS-AVMs. However, no consensus is reached in the explicit predictors of obliteration for BS-AVMs after SRS.
To identify the predictors of clinical outcomes for BS-AVMs treated by SRS, we performed a retrospective observational study of BS-AVMs patients treated by SRS at our institution from 2006 to 2016. The primary outcomes were obliteration of nidus and favorable outcomes (AVM nidus obliteration with mRS score ≤2). For getting the outcomes more accurate, we also pooled the results of previous studies as well as our study by meta-analysis.
A total of 26 patients diagnosed with BS-AVMs, with mean volume of 2.6 ml, were treated with SRS. Hemorrhage presentation accounted for 69% of these patients. Overall obliteration rate was 42% with mean follow-up of more than five years and two patients (8%) had a post-SRS hemorrhage. Favorable outcomes were observed in 8 patients (31%). Higher margin dose (>15Gy) was associated with higher obliteration (P = .042) and small volume of nidus was associated with favorable outcomes (P = .036). After pooling the results of 7 studies and present study, non-prior embolization (P = .049) and higher margin dose (P = .04) were associated with higher obliteration rate, in addition, the lower Virginia Radiosurgery AVM Scale (VRAS) was associated with favorable outcomes (P = .02) of BS-AVMs after SRS.
In the BS-AVMs patients treated by SRS, higher margin dose (19–24Gy) and non-prior embolization were the independent predictors of higher obliteration rate. In addition, smaller volume of nidus and lower VRAS were the potential predictors of long-term favorable outcomes for these patients.
The efficacy of acupuncture and moxibustion for early and middle-stage osteonecrosis of the femeral head
Authors: Jin Hongguang , Li Linhui , Yu Wen , Fu Yong 
Published: June 2021

Abstract

Background:
Osteonecrosis of the femeral head (ONFH) occurs predominantly in young- and middle-aged people, and the disability rate is high in the late stage of the disease and most patients have to undergo total hip replacement. Clinically, increasing attention is paid to intervening early and middle-stage ONFH so as to delay its progress. Acupuncture and moxibustion (AM) is a unique method for treating ONFH in China. This study aims to summarize the advantages of AM for the treatment of ONFH.

Methods:
A comprehensive literature search was conducted on the database with languages of English and Chinese. The medical subject titles used are “Osteonecrosis of the femoral head” and “acupuncture and moxibustion.” Related words in the title or abstract including but were not limited to “necrosis of the femoral head,” “avascular necrosis of the femoral head,” “ischemic necrosis of the femoral head,” “caput femoris necrosis,” “bone paralysis,” “bone erosion,” and “bone atrophy.”

Results:
Nine randomized controlled trials were identified in this meta-analysis that included 630 subjects. Meta-analysis showed that the trial group that treated with conventional therapy combined with AM had a higher effective rate (Z = 2.27 P = 0.02) and excellent and good rate (Z = 4.85 P < 0.00001) and Harris hip function score (HHS) (Z = 2.31 P = 0.02) and lower incidence of related adverse reactions during treatment (Z = 2.82 P = 0.005) compared with the control group that treated with conventional therapy alone.

Conclusions:
AM for early and middle-stage ONFH is an effective and relatively safe intervention, which can improve the effective rate and excellent and good rate and HHS, and reduce the adverse reaction rate. Clinically, early and middle-stage ONFH can be intervened by combining with AM while taking conventional therapy to improve the efficacy.
Laser photocoagulation for the treatment of bilateral late-onset retinopathy of prematurity-related retinal detachment in an adult male
Authors: Lin Ting Yi , Feng Kathy Ming , Chang Yun Hsiang , Liang I. Chia 
Published: June 2021

Abstract

Rationale:
Retinopathy of prematurity (ROP) is one of the major leading causes of childhood visual morbidity worldwide. Retinal break and traction develop in regressed ROP can further result in rhegmatogenous or tractional retinal detachment years or even decades later.

Patient concerns:
Here, we reported a case of bilateral ROP related late complication in a 36-year-old male with a chief complaint of increased floaters in his left eye.

Diagnoses:
The fundus examination showed demarcation lines over temporal side in both eyes with tractional retinal detachment and retinal breaks anterior to the lines. A diagnosis of ROP-related late complication of combined tractional and rhegmatogenous retinal detachment was made.

Interventions:
Peripheral laser photocoagulation along the demarcation lines for confining the detachment area in both eyes was performed with a stable condition during follow up.

Outcomes:
After laser retinopexy, the patient was followed up at one week and four months later with stable laser scars and without progression of the retinal detachments.

Conclusion:
Regressed ROP-associated retinal detachment can occur at any time during life. Special care and follow-up may be necessary for these patients.
Multiple endocrine neoplasia 2A with RET mutation p.Cys611Tyr
Authors: Li Yan , Tan Ya-qin , Tang Zhi-xiang , Liao Qing-hui , Guo Zhong-qiu , Lai Kang-bao , Wang Rong , Chen Yu-hua 
Published: June 2021

Abstract

Rationale:
Multiple endocrine neoplasia 2A (MEN2A) is a rare autosomal-dominant genetic syndrome, frequently misdiagnosed or neglected clinically, resulting in delayed therapy to patients.

Patient concerns:
A 47-year-old Chinese male patient underwent laparoscopic right adrenal tumorectomy, and postoperative pathology confirmed the tumor as pheochromocytoma (PHEO). He was readmitted to the department of endocrinology and metabolism due to constant increase in carcinoembryonic antigen (CEA) at 5 months after the operation.

Diagnosis:
The patient was confirmed with medullary thyroid carcinoma (MTC), multiple neck lymph node metastasis, and pituitary microadenoma. The p.Cys611Tyr (c.1832G>A, C611Y) mutation was detected. Therefore, he was diagnosed with MEN2A.

Interventions:
He underwent total thyroidectomy. The gene-sequencing analysis of his family was conducted, and the C611Y mutation was detected in his daughter.

Outcomes:
The level of carcinoembryonic antigen decreased significantly after thyroidectomy in this patient. Long-term follow-up management was conducted. Elevated serum calcitonin and bilateral thyroid nodules were found in his 13-year-old daughter. Thus, MEN2A was highly suspected and she was suggested to undergo total thyroidectomy.

Conclusion
Patients with MEN2A should be screened regularly and managed by a multidisciplinary team.
COVID-19 phobia in a boy with undiagnosed autism spectrum disorder
Authors: Sakamoto Shoko , Miyawaki Dai , Goto Ayako , Harima Yuji , Tokuhara Daisuke , Inoue Koki 
Published: June 2021

Abstract

Rationale:
Coronavirus disease 2019 (COVID-19) is affecting mental health profoundly. Previous studies have reported pandemic-related anxiety. Anxiety disorder and autism spectrum disorder (ASD) are common comorbidities. However, there has been no report of any patient with undiagnosed ASD who developed anxiety disorders caused by the COVID-19 pandemic. In this case report, we describe an 8-year-old Japanese boy with undiagnosed ASD who developed COVID-19 phobia, resulting in avoidant restrictive food intake disorder (ARFID).

Patient concerns:
As COVID-19 was highly publicized in the mass media and the risk of droplet infection was emphasized upon, the patient began to fear viral contamination from food, culminating in a refusal to eat or even swallow his saliva. He was admitted to a pediatric medical center in Osaka with life-threatening dehydration and was then referred to our child psychiatry department.

Diagnosis:
We diagnosed the patient with COVID-19 phobia resulting in ARFID. We identified ASD traits from his present social communication skills and developmental history.

Interventions:
We provided psychoeducation of ASD for the parents and administered supportive psychotherapy.

Outcomes:
Shortly after our intervention to relieve his ASD-related anxiety, his dysphagia improved.

Lessons:
Our findings suggest that children with undiagnosed ASD may develop COVID-19 phobia. In these cases, intervention for ASD may be more appropriate than starting treatment for anxiety disorders as the first-line option. COVID-19 is the biggest pandemic in the recent past, and more undiagnosed ASD patients who develop COVID-19 phobia may seek treatment. Clinicians should consider the underlying ASD in these patients and assess their developmental history and present social communication skills.
Fluorescence angiography-assisted debridement of critically perfused glabrous skin in degloving foot injuries
Authors: Vasella Mauro , Guidi Marco , Waldner Matthias , Calcagni Maurizio , Giovanoli Pietro , Frueh Florian S. 
Published: June 2021

Abstract

Rationale:
Degloving foot injuries are challenging to treat and associated with life-long sequelae for patients. An appropriate debridement of ischemic soft tissues with maximal preservation of glabrous skin is key during the reconstruction of these injuries. Indocyanine green (ICG) fluorescence angiography is an established technique for the intraoperative evaluation of tissue perfusion.

Patient concerns:
Two patients sustained complex foot injuries in traffic accidents, including multiple fracture dislocations and extensive degloving of the plantar skin.

Diagnosis:
Clinical inspection revealed significant degloving of the glabrous skin in both patients.

Interventions:
After fracture fixation, ICG fluorescence angiography-assisted debridement with immediate latissimus dorsi free flap reconstruction was performed.

Outcomes:
In both cases, this technique allowed a precise debridement with maximal preservation of the glabrous skin. The healing of the remaining glabrous skin was uneventful and the 6-month follow-up was characterized by stable soft tissues and satisfying ambulation.

Lessons:
ICG fluorescence angiography is a safe, user-friendly, and quick procedure with minimal risks, expanding the armamentarium of the reconstructive surgeon. It is highly useful for the debridement of extensive plantar degloving injuries and may also help to minimize the number of procedures and the risk of infection.
Transient oculomotor paralysis after cerebral angiography
Authors: Qiu Tao , Dai Xiaoyan , Gong Qingping , Pu Rongmei , Xiao Hua , Shi Qiang , Deng Xiaoyong , Chen Ming , Guo Zhaoyun 
Published: June 2021

Abstract

Rationale:
A special case of transient oculomotor nerve palsy after cerebral angiography.

Patient concerns:
A 55-year-old man developed oculomotor nerve dysfunction after right radial artery puncture angiography.

Diagnoses:
Cerebral angiography-induced oculomotor nerve palsy.

Interventions:
According to the patient's disease state, intravenous drip of dexamethasone 10 mg/d.

Outcomes:
Magnetic resonance imaging (MRI) showed no abnormalities, and the patient recovered completely after 48 hours of hormone therapy.

Lessons:
Transient eye palsy caused by contrast agent encephalopathy is a clinically rare neurological dysfunction caused by adverse effects of contrast agents. Early prevention and correct treatment are critical.
Open total dislocation of ankle joint without fractures
Authors: Chi Yu-lei , Gao Xu , Xu Ying-jie , Bu Xian-min , Han Liang , Zhang Xu , Gao Long-fei , Tian Rong-hua , Wang Hai-bin , Wu Bin 
Published: June 2021

Abstract

Rationale:
Open total dislocation of ankle joint is rare and often caused by high-energy injury. The present study describes a patient with open total lateral dislocation of ankle joint without fractures and obtained a satisfactory clinical result following early debridement and irrigation, one-stage repairment of ligaments, and plaster external fixation.

Patient concerns:
The patient, a 45-year-old male, complained of right foot pain with bleeding and limited motion. Physical examination showed a 15-cm open wound at the medial ankle region, with soft tissues impaired and ankle bones exposed. The 3 dimensional reconstruction computed tomography (CT) examination showed an open total dislocation of ankle joint without concomitant fractures.

Diagnoses:
open total lateral dislocation of ankle joint without fractures

Interventions:
Early modern wound care including thorough debridement and irrigation on the wound was performed to remove contaminated soft tissues. Subsequently, the dislocated ankle joint was reduced by hand and the medial and lateral collateral ligaments were repaired using wire anchors.

Outcomes:
The medial wound healed at 2 weeks after surgery, and several common complications such as infection and skin necrosis did not occur. The last follow-up showed a good range of metatarsal flexion and extension of the injured foot, and obvious signs of traumatic arthritis were not observed. According to Kaikkonen ankle function score, the patient was assessed with 90 points.

Lessons:
For open total dislocation of ankle joint, early treatment should focus on debridement and irrigation, reduction and fixation of the dislocated ankle, protection of the weak soft tissues, and stable external fixation to promote wound healing and reduce the incidence of related complications.
Is higher-level trauma center care associated with better outcomes in patients injured by low-energy trauma?
Authors: Tonkins Michael , Bradbury Daniel , Bramley Paul , Sabir Lisa , Wilkinson Anna , Lecky Fiona 
Published: June 2021

AbstractBackgroundIn high-income countries trauma patients are becoming older, more likely to have comorbidities, and are being injured by low-energy mechanisms, chiefly ground-level falls. It is currently unknown whether existing trauma systems improve the outcomes of these patients. This systematic review investigates the association between higher-level trauma center care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma.MethodsA pre-registered systematic review (CRD42020211652) of subject databases and grey literature, supplemented by targeted manual searching, was conducted in January 2021. Studies were eligible if they reported outcomes in adults admitted to hospital due to low-energy trauma. Studies were excluded if participants were not adults or were not admitted to hospital. Studies in lower- and middle-income settings were excluded due to differences in demographics and healthcare systems. Risk of bias was assessed by independent reviewers using the Robins-I tool. In the presence of study heterogeneity a narrative synthesis was pre-specified.ResultsThree observational studies were included from 2,898 unique records. The studies’ risk of bias was moderate-to-serious due to potential residual confounding and selection bias. All studies compared outcomes among adults injured by ground-level falls treated in trauma centers verified by the American College of Surgeons in the USA. The studies reported divergent results. One demonstrated improved outcomes in level 3 or 4 trauma centers (Observed: Expected Mortality 0.973, 95%CI 0.971-0.975), one demonstrated improved outcomes in level 1 trauma centers (Adjusted Odds Ratio 0.71, 95%CI 0.56-0.91), and one demonstrated no difference between level 1 or 2 and level 3 or 4 trauma center care (Adjusted Odds Ratio 0.91 (0.80-1.04).ConclusionsThere is currently no strong evidence for the efficacy of major trauma centers in caring for adult patients injured by a ground-level fall. Further studies at lower risk of bias and studies conducted outwith the USA are required.Level of EvidenceLevel III systematic review and meta-analysis
Temporally-Informed Random Forests for Suicide Risk Prediction
Authors: Bayramli Ilkin , Castro Victor , Barak-Corren Yuval , Madsen Emily M. , Nock Matthew K. , Smoller Jordan W. , Reis Ben Y. 
Published: June 2021

AbstractBackgroundSuicide is one of the leading causes of death worldwide, yet clinicians find it difficult to reliably identify individuals at high risk for suicide. Algorithmic approaches for suicide risk detection have been developed in recent years, mostly based on data from electronics health records (EHRs). These models typically do not optimally exploit the valuable temporal information inherent in these longitudinal data.MethodsWe propose a temporally enhanced variant of the Random Forest model - Omni-Temporal Balanced Random Forests (OTBRFs) - that incorporates temporal information in every tree within the forest. We develop and validate this model using longitudinal EHRs and clinician notes from the Mass General Brigham Health System recorded between 1998 and 2018, and compare its performance to a baseline Naive Bayes Classifier and two standard versions of Balanced Random Forests.ResultsTemporal variables were found to be associated with suicide risk. RF models were more accurate than Naive Bayesian classifiers at predicting suicide risk in advance (AUC=0.824 vs. 0.754 respectively). The OT-BRF model performed best among all RF approaches (0.339 sensitivity at 95% specificity), compared to 0.290 and 0.286 for the other two RF models. Temporal variables were assigned high importance by the models that incorporated them.DiscussionWe demonstrate that temporal variables have an important role to play in suicide risk detection, and that requiring their inclusion in all random forest trees leads to increased predictive performance. Integrating temporal information into risk prediction models helps the models interpret patient data in temporal context, improving predictive performance.
Establishing consensus on emergency department interventions that could be conducted in sub-acute care settings for non-emergent paramedic transported visits: A RAND/UCLA modified Delphi study
Authors: Strum Ryan P , Tavares Walter , Worster Andrew , Griffith Lauren E , Costa Andrew P 
Published: June 2021

ABSTRACTBackgroundPatients transported by paramedics for non-emergent conditions are increasing in Ontario and contribute to an emergency department (ED) crisis. Redirecting certain patients to sub-acute healthcare may be beneficial and suitable. We examined if ED interventions conducted on non-emergent paramedic transported patients could be conducted in sub-acute health centres.MethodsA RAND/UCLA modified Delphi study was conducted. Twenty emergency and primary care physicians rated the suitability of the 150 most frequently recorded interventions for completion in sub-acute healthcare centres and provided comments to augment ratings. Interventions were performed on non-emergent adult patients transported by paramedics to an ED, and abstracted from the National Ambulatory Care Reporting System database (January 1, 2014 to March 31, 2018). We used two rounds of a modified Delphi process and set consensus at 70% agreement.ResultsConsensus was reached on 146 (97.3%) interventions; 103 interventions (68.7%) were suitable for sub-acute centres, 43 (28.7%) for ED only; 4 (2.6%) did not receive consensus. For sub-acute centres, all 103 interventions were rated for urgent care centres; walk-in medical centres were applicable for 46 (30.6%) and nurse practitioner-led clinics for 47 (31.3). Diagnostic imaging availability, physician preferences and staffing were determining factors for discrepancies in sub-acute centre ratings.InterpretationThe majority of included ED interventions performed on non-emergent patients transported by paramedics were identified as suitable for urgent care clinics, with one-third being suitable for either walk-in medical centres or nurse practitioner-led clinics. In combination with additional patient details and supports, knowledge of interventions suitable for sub-acute healthcare centres will inform a patient classification model for paramedic-initiated redirection of patients from ED.Study registrationIDISRCTN22901977.
Genotype-stratified GWAS meta-analysis reveals novel loci associated with alcohol consumption
Authors: Koyanagi Yuriko N. , Nakatochi Masahiro , Ito Hidemi , Kasugai Yumiko , Narita Akira , Kawaguchi Takahisa , Ikezaki Hiroaki , Hishida Asahi , Hara Megumi , Takezaki Toshiro , Koyama Teruhide , Mikami Haruo , Suzuki Sadao , Katsuura-Kamano Sakurako , Kuriki Kiyonori , Nakamura Yasuyuki , Takeuchi Kenji , Hozawa Atsushi , Kinoshita Kengo , Sutoh Yoichi , Tanno Kozo , Shimizu Atsushi , Oze Isao , Kawakatsu Yukino , Taniyama Yukari , Imoto Issei , Tabara Yasuharu , Takahashi Meiko , Setoh Kazuya , Suzuki Shiori , Goto Atsushi , Katagiri Ryoko , Yamaji Taiki , Sawada Norie , Tsugane Shoichiro , Wakai Kenji , Yamamoto Masayuki , Sasaki Makoto , Matsuda Fumihiko , Iwasaki Motoki , Brennan Paul , Matsuo Keitaro 
Published: June 2021

AbstractAn East Asian-specific variant onaldehyde dehydrogenase 2(ALDH2rs671, G>A) is the major genetic determinant of alcohol consumption. We performed an rs671 genotype-stratified genome-wide association study meta-analysis in up to 40,679 individuals from Japanese populations to uncover additional loci associated with alcohol consumption in an rs671-dependent manner. No loci satisfied the genome-wide significance threshold in wild-type homozygotes (GG), but six loci (ADH1B, ALDH1B1, ALDH1A1, ALDH2, GOT2, andMYOM1-MYL12A) did so in heterozygotes (GA). Of these, three loci (ALDH2, GOT2, andMYOM1-MYL12A) were novel, and two (ADH1BandALDH1B1) showed genome-wide significant interaction with rs671. Our results identify a new genetic architecture associated with alcohol consumption, and shed additional light on the genetic characteristics of alcohol consumption among East Asians.
Effectiveness of mRNA COVID-19 Vaccines among Employees in an American Healthcare System
Authors: Shrestha Nabin K. , Nowacki Amy S. , Burke Patrick C. , Terpeluk Paul , Gordon Steven M. 
Published: June 2021

ABSTRACTBackgroundThe mRNA SARS-CoV-2 vaccines have shown great promise in clinical trials. The purpose of this study was to evaluate the effectiveness of these vaccines under real-world conditions in the USA.MethodsEmployees of the Cleveland Clinic Health System, previously not infected with SARS-CoV-2, and working in Ohio on Dec 16, 2020, the day COVID-19 vaccination began, were included. The cumulative incidence of SARS-CoV-2 infection, over the next 5 months, was compared among those who received the vaccine and those who did not, by modeling vaccination as a time-dependent covariate in Cox proportional hazards regression analyses adjusted for the slope of the epidemic curve as a continuous time-dependent covariate.ResultsOf the 46866 included employees, 28223 (60%) were vaccinated by the end of the study period. The cumulative incidence of SARS-CoV-2 infection was much higher among those not vaccinated than those vaccinated. Only 15 (0.7%) of the 2154 SARS-CoV-2 infections during the study occurred among those vaccinated. After adjusting for the slope of the epidemic curve, age, and job type, vaccination was associated with a significantly reduced risk of SARS-CoV-2 infection (HR 0.03, 95% C.I. 0.02 – 0.06, p < 0.001), corresponding to a vaccine effectiveness rate of 97.1% (95% CI 94.3 – 98.5). Vaccine effectiveness was 89.2% at 7 days and 95.0% at 14 days after the first vaccine dose.ConclusionsThe mRNA SARS-CoV-2 vaccines are over 97% protective against COVID-19 in the working-age population, with substantial protection possibly apparent within a few days of the first dose.SummaryThe effectiveness of mRNA SARS-CoV-2 vaccines was evaluated among 46866 employees in an American healthcare system. After adjusting for age, job type, and the phase of the epidemic, vaccination was 97.1% effective in preventing COVID-19 among the fully vaccinated, and 89.2% protective within 7 days of the first dose.