bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium in Covid-19 patients: Incidence, Risk Factors and Early Outcomes.
Authors: Mejia-Mantilla Jorge Humberto , Gempeler Andrés , Gaviria Leidy K , Amaya Pablo , Aldana Jose Luis , Muñoz Beatriz Elena , Pinilla Gabriel , Rivillas Julian , Scarpetta Diego , Perdomo Cristhian Camilo Rojas , Echeverri Nicolás Orozco , Sotomayor Alex , Yara Julián , Jimenez Javier A , Arango Akemi , Orozco Jorge Luis 
Published: May 2021

Abstract
Background: Delirium is a frequent event in severely ill patients; its incidence and prevalence varies depending on several factors; Covid has been associated to high incidence of delirium leading to speculation of specific mechanisms of neurotoxicity by the SARS-CoV-2. We present the analysis of risk factors for delirium incidence and the impact of delirium in the functional outcomes.Methods: We included patients admitted to a referral center in Cali, Colombia between April and August 2020. Patients were evaluated for demographics, severity of disease, comorbidities, clinical outcomes, delirium and survival at discharge. We evaluated the association of patient characteristics and disease factors with delirium incidence by multivariate analysis (Hosmer and Lemeshow) and the associations of delirium with functional outcome at dischargeResults: Among 333 patients, 58 (17.42%. 95% CI: 13.62%–21.77%) presented delirium 16 (IQR: 11 –20) days after symptom onset. Patients with delirium were older, reported muscular weakness more often, had a higher NEWS2 score at admission, and had more comorbidities (mainly Diabetes Mellitus II). Multivariate analysis of hospitalization events and treatments found mechanical ventilation as the only significant covariate. The association between need for mechanical ventilation and delirium development was estimated at OR=11.72, (95%CI=4.16–34.23). Patients who developed delirium had a higher frequency of functional impairment: mRs>2 (70.7% vs 24.7%, p<0.001) and had a prolonged ICU stay (median 13 days, IQR 8–21 vs median 5, IQR 3–10 days, p<0.0001) compared to patients without delirium.Conclusion: Our data show that premorbid functional status, the severity of respiratory disfunction and the presence of inflammatory markers are determinant in the risk of delirium; we believe that delirium is not specially related to SARS-CoV-2 infections, but rather its high frequency during this pandemic is the result of concurring factors shared between critically-ill patients and severe COVID-19 patients.
Combined Application of Chromosome Karyotype and Microarray Analysis in Fetus With Increased Nuchal Translucency
Authors: Chaohong Wang , Junxiang Tang , Yuxiu Sun , Yu Pang , Keting Tong , Jiansheng Zhu 
Published: May 2021

Abstract
Objective：To examine the risk of chromosomal abnormalities when the thickness of the nuchal translucency( NT ) is 2.5-2.9mm, to evaluate the cutoff value of NT for prenatal diagnosis, to explore the value of combined application of chromosome karyotype and microarray analysis, and to explore the relationship between NT ≥ 5.0mm and fetal prognosis. Methods：A total of 366 pregnant women who underwent prenatal diagnosis in Anhui Province Maternity and Child Health Hospital from January 2018 to August 2020 were collected, of which 241 cases had NT ≥ 2.5mm, 125 cases were elderly (35-38 years old) with NT < 2.5mm. We made grouping statistics on chromosome abnormalities,and compared the detection of chromosome abnormalities by karyotype and microarray analysis. At the same time, we followed up the fetuses with NT ≥ 5.0mm and analyzed their prognosis. Results: (1)Among the 366 cases with NT thickening,the detection rates of chromosome abnormalities by karyotype analysis and microarray analysis(CMA) were 13.39% (49/366) and 13.93% (51/366), respectively, and there was no significant difference (P>0.05), including 25 cases of trisomy 21, 5 cases of trisomy 18, 5 cases of Turner synthesis and 16 cases of other chromosome abnormalities. (2)We compared the effect of different NT value on the detection rate of pathogenic chromosomes, and found that the difference between NT ≥2.5mm and NT < 2.5mm was statistically significant(P<0.05). The detection rates of pathogenic chromosomal abnormalities in NT < 2.5mm group,2.5-2.9mm group, 3.0-3.4mm group,3.5-4.4mm group,4.5-5.4mm group and NT ≥ 5.5mm group were 0.8%(1/ 125), 11.63%(10/ 86), 17.81%(13/ 73), 20%(10/ 49), 47.62%(10/ 21) and 63.64%(7/ 11) respectively. (3)Our study found that different prenatal diagnostic indicators for abnormal chromosome detection rate difference was statistically significant(P<0.05). The detection rates of NT thickening alone and NT thickening combined with other abnormalities were 13.17%(22/ 167) and 35.14%(26/ 74) respectively(P<0.05). (4)Among 18 pregnant women with NT ≥ 5.0 mm, 9 fetuses were chromosomal abnormalities, and 9 fetuses survived healthily. Conclusions：When the NT value is 2.5-2.9mm, the incidence of fetal chromosome abnormality is significantly higher than that in the normal group. It is suggested that invasive prenatal diagnosis should be performed for pregnant women with NT ≥ 2.5mm. Chromosome karyotype analysis and CMA can complement each other, which is conducive to prenatal genetic counseling. The fetuses with NT thickening usually have good pregnancy outcomes when excluding fetal chromosome and prenatal ultrasound does not indicate any abnormalities.
Impact of COVID-19 Pandemic on Open Fractures: a Retrospective Multi-centre Cohort Study in the Different Risk Periods of China
Authors: Chen Jialei , Luo Rong , Zhong Gang , Liu Ming 
Published: May 2021

Abstract
BackgroundThe COVID-19 pandemic has had a significant impact on orthopaedic trauma worldwide, but the extent of this impact regarding the low-risk period is still unclear. This study aims to evaluate the epidemiology of open limbs fractures during the different risk periods and the effect of routine prevention and control measures.MethodsA retrospective multi-centre cohort study was conducted in three different level trauma centres. Three 60-day periods were analyzed: the high-risk period - 2020/1/24-2020/3/24, the low-risk period - 2021/1/24-2021/3/25, and the no-risk period as a control group for comparison - 2019/1/24-2019/3/25. Demographic data, medical history, and surgery and antibiotic therapy data at presentation were collected and evaluated.ResultsA total of 123 patients met the inclusion criteria. We observed a significant "J" shaped change in the total number of patients, with fewer patients in 2020 (n=34, -17%) and more in 2021 (n=48, +17%) compared to 2019 (n=41). However, fewer patients visited the level I centre in the low-risk period (82.9% 2019 vs. 70.6% 2020 vs. 56.3% 2021, P=0.024). Meanwhile, longer antibiotics therapy period (＞48 hours) were more prevalent in low-risk period (39% 2019 vs. 58.8% 2020 vs. 68.8% 2021, P=0.018). Regarding definitive closure type, increase in direct closure was observed in high-risk period (51% 2019 vs. 78.9% 2020 vs. 63.5% 2021, P=0.024). ConclusionDuring the high-risk period, the total number of patients was expected to decline, whereas in the low-risk period, the number may increase. They preferred the lower level II and III centre for patients during the pandemic rather than the higher level I centre. For surgeons, they were prone to direct closure and a more extended antibiotic therapy period. Routine prevention and control measures seem not adversely affect the treatment outcomes and process of open fractures.Trial registrationChiCTR, ChiCTR 2100046151. Registered 5 May 2021, http://www.chictr.org.cn/edit.aspx?pid=123490&htm=4.
Secondary bacterial infections trigger New Onset Atrial Fibrillation in ICU Covid-19 ARDS patients
Authors: Zakynthinos George E , Tsolaki Vasiliki , Karavidas Nikitas , Vazgiourakis Vassileios , Dimeas George , Mantzarlis Konstantinos , Vavougios George , Makris Demosthenes 
Published: May 2021

Abstract
Background

Cardiac arrhythmias, mainly atrial fibrillation (AF), is frequently reported in COVID-19 patients, yet causality has not been explored. Intensive Care Unit patients frequently present AF during critical illness. Sepsis is one of the main contributors of AF occurrence in ICU patients. The aim of the study was to explore if Covid-19 myocardial involvement is the only contributor for New Onset Atrial Fibrillation (NOAF) in intubated ICU patients.
Methods

Consecutive intubated, Covid-19ARDS patients, were prospectively studied for factors triggering NOAF. Demographics, data on Covid-19 infection duration, severity of illness and ARDS are reported. Echocardiographic findings, troponin levels and secondary infection (sepsis/septic shock) data were collected on the day of AF and compared to the preceding days’ and/or ICU admission data. Comparison was also performed between NOAF and control group (no AF) on admission.
Results

Among 105 patients screened, 79 were eligible; nineteen presented NOAF (24%). Baseline characteristics did not differ between the NOAF and control groups. Troponin levels were mildly elevated upon ICU admission in both groups. NOAF occurred on the 18 ± 4.8 days from Covid-19 symptoms’ onset, and the 8.5 ± 2.1 ICU day. Seventeen patients in the NOAF group (89.5%) presented a septic secondary infection vs 25 (41.6%) in the control group (p < 0.001). In sixteen NOAF patients (84.2%), AF occurred concurrently with a secondary septic episode. Noradrenaline, lactate levels and inflammation biomarkers presented a gradual increase in the days preceding the AF day (all p < 0.05). Troponin increased compared to admission (p = 0.017). AF did not resolve or re-occurred if sepsis persisted. Upon ICU admission left ventricular ejection fraction was rather normal, yet, global longitudinal strain was equally impaired (< 16.5%) in 63% vs 78% in the NOAF and control groups, respectively. The right ventricle was mildly dilated, and 36 (45.6%) patients had pericardial effusion. Echocardiographic findings did not change on NOAF occurrence.
Conclusion

Secondary infections seem to be major contributors for NOAF in Covid-19 patients, probably playing the role of the “second hit” in an affected myocardium from Covid-19.
Risk Stratification and Individualized Chemotherapy for Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
Authors: Kou Jia , Zhang Lu-Lu , Wen Dan-Wan , Zhou Guan-Qun , Wu Chen-Fei , Xu Si-Si , Yang Xing-Li , Zheng Wei-Hong , Qi Zhen-Yu , Sun Ying , Lin Li 
Published: May 2021

Abstract
Backgroud: The optimal treatment strategy for elderly patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains unclear. We aimed to develop individualized treatment strategies for such patients according to their pretreatment risk stratification and the degree of comorbidities.Methods: A total of 583 elderly LA-NPC patients diagnosed between January 2011 and January 2018 were retrospectively studied. Based on prognostic factors confirmed by multivariate analysis, we constructed a nomogram for disease-free survival (DFS). The entire cohort was then divided into two groups according to the nomogram cutoff value determined by X-tile analysis. The degree of comorbidities was assessed by Charlson Comorbidity Index (CCI). We performed subgroup analysis based on the degree of complications in the low- and high-risk groups to compare the survival outcomes of different treatment regimens using the Kaplan-Meier method and the log-rank test.Results: A nomogram for DFS was constructed with T/N classification, Epstein-Barr virus DNA and albumin. The high-risk group had significantly poorer survival compared with the low-risk group. The 3-year DFS and overall survival (OS) of the low-risk group and the high-risk group were 76.7% vs. 44.6%, 81.5% vs. 51.0% (both P <0.001) respectively. Only high-risk patients with fewer comorbidities (CCI =2) would benefit from induction chemotherapy combined with concurrent chemoradiotherapy, while patients in the low-risk group or the high-risk group with more comorbidities (CCI >2) would not have.Conclusion: We constructed a prognostic nomogram for DFS and generated two risk groups. Combining risk stratification and degree of comorbidities can better guide individualized treatment for elderly LA-NPC patients.
Intraspinal Space-Occupying Lesions in Children: Clinical Features, Neuroimaging and Surgical Outcomes of 27 Cases
Authors: Chang Haigang , Yan Jingkuo , Wang Yaxiao , Hui Lei , Li Yan , Ma Pengju , Jin Zhe , Wang Feng 
Published: May 2021

Abstract
Background: Pediatric intraspinal space-occupying lesions are relatively uncommon. However, these lesions can result in neurological disabilities due to misdiagnosis and delayed treatment. The main goal of the present study is to evaluate the clinical and radiological features and treatment options of pediatric intraspinal space-occupying lesions in order to improve the clinical recognition and management. Methods: Clinical data of 27 children with intraspinal space-occupying lesions who underwent surgery treatment in a tertiary-care hospital between 2010 and 2018 were retrospectively reviewed and analyzed. Results: Of these 27 patients, 14 (51.85%) were girls and 13 (48.15%) were boys. The most common age group affected was 10~14 years (62.96%, 9 girls and 8 boys in this age group). The mean age was 10.11 years old. Pain and weakness were the most common clinical symptoms. Preoperative magnetic resonance imaging (MRI) identified intramedullary (10 cases, 37.04%), intradural extramedullary (10 cases, 37.04%) and extradural (7 cases, 25.92%) lesions, respectively. The majority of the lesions were intraspinal tumors (23 cases, 85.19%). The histological diagnosis of tumors included embryonic residual tumors (6 cases, 22.22%), ependymoma (5 cases, 18.52%), primitive neuroectodermal tumors (PNET) (3 cases, 11.11%), schwannomas (2 cases, 7.4%), ganglioneuroma (1 case, 3.7%), Ewing’s sarc (1 case, 3.7%), B-cell non Hodgkin lymphoma (1 case, 3.7%), Hodgkin lymphoma (1 case, 3.7%), chondrosarcoma (1 case, 3.7%), ganglioglioma (1 case, 3.7%), and glioma (1 case, 3.7%). Conclusions: The incidence of pediatric intraspinal space-occupying lesions is low, and the clinical manifestation is lack of specificity. The prognosis for children with malignant tumors is poor and surgical resection is still the primary treatment option.
Galectin-3 as Prognostic Predictor in Patients with COVID-19 Acute Respiratory Failure
Authors: Portacci Andrea , Diaferia Fabrizio , Santomasi Carla , Dragonieri Silvano , Boniello Esterina , Serio Francesca Di , Carpagnano Giovanna Elisiana 
Published: May 2021

Abstract
Background. Galectin-3 is β-galactoside-binding lectin with several roles in immune-inflammatory response. To date, there is no evidence of Galectin-3 role as a prognostic predictor in COVID-19 disease. The aim of this study is to clarify the prognostic role of Galectin-3 in patients with COVID 19 acute respiratory failure.Methods. We enrolled 156 consecutive patients with COVID-19 disease. Routine laboratory test, arterial blood gas, chest X-ray or Computed Tomography and Galectin-3 dosage were performed. The primary outcome was to assess Galectin-3 predictive power for 30-day mortality. Secondary outcomes were 30-day Intensive Care Unit admission and Acute Respiratory Distress Syndrome stratification according to Galectin-3 dosage. We performed Mann-Whitney U and Kruskal-Wallis tests for continuous variables comparison. Fisher’s exact test or Chi-square test were used for categorical variables analysis. Relationships between Galectin-3, clinical and laboratory data were identified using Spearman analysis. Receiver Operating Characteristic curves estimated Galectin-3 predictive power for the endpoints. With a fixed cut-off of 35.3 ng/ml, Kaplan-Meier with Log-Rank test and Cox Regression were performed to assess mortality and Intensive Care Unit admission risk. Results. Galectin-3 correlated with many other prognostic predictors tested in our analysis. Moreover, patients with serum levels of Galectin-3 above 35.3 ng/ml had increased risk for mortality, Intensive Care Unit admission and severe Acute Respiratory Distress Syndrome. Conclusions. Our study demonstrates the role of Galectin-3 as a predictor of mortality, Intensive Care Unit access and ARDS stratification in patients with COVID 19 acute respiratory failure.
Renal Replacement Therapy and Concurrent Fluconazole Therapy Increase Linezolid-Related Thrombocytopenia Among Adult Patients
Authors: Hsu Yueh-chun , Chen Szu-ying , Hung Yung-jun , Huang Yu-wei 
Published: May 2021

Abstract
Background: Linezolid, an antibiotic used against gram-positive pathogens, has been reported to be associated with thrombocytopenia. However, limited information is available on susceptibility to thrombocytopenia after linezolid usage. We aimed to investigate the risk factors for linezolid-associated thrombocytopenia. Methods: We conducted a retrospective cohort study of patients aged ≥ 18 years who received linezolid for ≥ 5 d during hospitalization in 2019. Demographic information, hospitalized information and laboratory data were extracted from electronic medical records. Thrombocytopenia was defined as a platelet count of <100,000 cells/mm3 or a reduction from baseline ≥ 25%. Binary logistic regression and survival analyses were used to evaluate the risk factors for linezolid-associated thrombocytopenia.Results: A total of 98 patients were enrolled. Thrombocytopenia occurred in 52 patients (53.1%), with a median first presentation 9 d after initiation of linezolid. There was no significant difference in the mortality or proportion of platelet transfusions between patients with and without thrombocytopenia. A higher risk of linezolid-associated thrombocytopenia was found in patients who received renal replacement therapy (RRT) (OR 4.8 [1.4-16.4]), concurrent fluconazole (OR 3.5 [1.2-9.8]), or a longer duration of linezolid treatment (OR 1.1 [1.0-1.1]). Patients who received RRT or concurrent fluconazole therapy had a shorter median time to develop thrombocytopenia (with vs. without RRT: 8 vs. 15 d; with vs. without fluconazole: 11 vs. 15 d). Those who simultaneously received RRT and fluconazole had the shortest median of time (6.5 d) and the highest risk of developing thrombocytopenia (87.5%).Conclusions: Patients who received RRT, concurrent fluconazole treatment, or a longer-duration linezolid had a higher risk of developing linezolid-associated thrombocytopenia.
Transcriptome Analysis Reveals Drought Stress response Mediated by Biological Processes and Key Pathways in Gossypium darwinii
Authors: Xu Cuilian , Magwanga Richard , Khan M Kashif Riaz , Zhou Zhongli , Cai Xiaoyan , Li Yujun , Agong Stephene Gaya , Wang Kunbo , Liu Fang , Chen Haodong 
Published: May 2021

Abstract
Background: The allotetraploid wild cotton species, Gossypium darwinii, possess important traits of stress tolerance and good genetic stability that can be used for cotton improvement. In this study, we analyzed the RNA-seq transcriptomes from leaves of G. darwinii seedlings with and without drought stress. Results: A total of 86.7 million valid reads with an average length of 95.79 bp were generated from the two samples and 58,960 transcripts with a length of more than 500 bp were assembled. We searched the known proteins on the strength of sequence similarity; these transcripts were annotated with COG, KEGG, and GO functional categories. According to gene expression abundance RPKM value, we carried out RT-qPCR analysis to determine the expression pattern of the obtained transcription factors. A total of 58,961 genes was differentially expressed (DEG), with 32,693 and 25,919 genes found to be upregulated and downregulated, respectively. Through gene ontology and KEGG pathways, the upregulated genes were found to associate with all the GO terms, molecular functions (MF), biological process (BP) and cellular components (CC), which are highly linked to enhancing drought stress tolerance. The results obtained provide valuable information and a large number of transcripts, which can be exploited by cotton breeders in developing a more drought stress tolerant cotton germplasm.
Solitary Bone Metastasis and Oligometastatic Bone Disease in Breast Cancer: Are They Two Different Entities?
Authors: Zengel Baha , Kilic Mustafa , Tasli Funda , Simsek Cenk , Karatas Murat , Ozdemir Ozlem , Cavdar Demet , Durusoy Raika , Bas Kadir Koray , Uslu Adam 
Published: May 2021

Abstract
In this study, we planned to investigate the clinical course of breast cancer patients with oligometastatic bone disease (OMBD).The patients were grouped according to the characteristics and the sites of metastases. Group I included 928 patients without metastasis. Group II, OMBD group, icluded 68 patients. Group III, widespread metastasis group, consisted of 185 patients with multiple bone metastases and/or solid organ metastases.The mean overall survival of the groups were 16.7 ± 0.3 years in Group 1, and 7.8 ± 0.8 and 5.9 ± 0.4 years in Group 2 and 3, respectively (p<0,001 for the comparison of all three groups together; p <0.001 for Group 1 vs 2 & 3) and (p=0.037 for Group 2 vs. Group 3). In the subgroup survival analysis of patients in Group 2 (OMBD), the mean and median survival were 5.5 ± 0.8 and 4.0±0.8 years versus 9.2 ± 0.98 and 9.0 ±1.05 years in more than one bone metastasis and SBM patients, respectively (p = 0.019).As a result; OMBD seems to be a different disease than breast cancer with isolated bone metastases. The high risk of developing OMBD especially following locoregional recurrences increases the importance of locoregional therapy in large T and N stage tumors.
Arterial thrombosis, the unfairly forgotten actor in COVID-19: a case series
Authors: CILLÁN SERGIO RAMOS , BLANCO LAURA SOLÁN , MALLEBRERA MARTA TOMÁS , DÍAZ ANA B. ARRIBAS , NAVASCUES JAVIER CORNAGO , LORENZO JOSE LUIS LÓPEZ , SILLERO MARIA PILAR LLAMAS 
Published: May 2021

Abstract
Background. - It is known that patients with COVID-19 are at increased risk of thrombosis. Although COVID-19 infection primarily affects the lower respiratory tract system, emerging reports suggest direct and indirect cardiovascular complications. However, the key mechanisms under thrombosis development at great arterial vessels are still unclear.Case presentation. – We report the cases of 4 patients who were admitted to our hospital and suffered from arterial thrombotic complications. All of them were older than 60 years and only 1 did not have cardiovascular risk factors. It should be noted that days prior to the diagnosis of arterial thrombosis, 3 of the 4 patients were under anticoagulant treatment. It is also interesting that in contrast to already known typical microvascular locations, our patients suffered from large arterial vessels thrombosis. Furthermore, none of them would present with severe respiratory symptoms. Conclusions. – The underlying mechanism of COVID-19-associated arterial thrombosis remains unclear and might be independent of the cytokine storm that occurs in patients with COVID-19-associated venous thrombosis. Also, the role of anti-platelets agents as prophylactic treatment in high-risk patients remains unclear. Multicenter clinical trials are necessary to clarify these issues.