bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lacosamide induced Brugada I morphology in the setting of septicemia
Authors: Goodnough Robert , Badea Adina , Geier Curtis , Lynch Kara L. , LeSaint Kathy T. 
Published: May 2021

Abstract

Introduction:
Brugada syndrome may be unmasked by non-antiarrhythmic pharmaceuticals or drugs. Lacosamide is an antiepileptic agent with a novel mechanism of sodium channel inhibition and has the potential to cause cardiac sodium channel blockade.

Patient concerns:
In this report, we describe the case of patient with a history of a seizure disorder who presented with Brugada I electrocardiogram morphology in the setting of septicemia.

Diagnosis:
Brugada I electrocardiogram morphology was unmasked by lacosamide antiepileptic monotherapy.

Interventions:
Lacosamide therapy was discontinued.

Outcomes:
Normalization of the electrocardiogram and resolution of Brugada morphology occurred on hospital day 1.

Conclusion:
Caution should be exercised in the use of lacosamide in those at risk for conduction delay, or in combination therapy with medications that impair renal clearance, metabolism of lacosamide, or that display inherent sodium channel blocking properties.
Comparing the efficacy of non-invasive physical therapy in improving pain and joint function of knee osteoarthritis
Authors: Cai Weisen , Xu Daoming , Xiao Anju , Tian Zongguang , Wang Tong 
Published: May 2021

Abstract

Background:
The incidence of knee osteoarthritis is increasing year by year, which seriously affects people's quality of life, especially the elderly, and has become a major public health problem. A lot of evidence shows that physical therapy has advantages in the treatment of knee joints, but there are a number of physical therapy schemes, and the efficacy of each scheme is different. This study will evaluate the clinical efficacy of different physical therapy regimens in the treatment of knee osteoarthritis (KOA) by means of network meta-analysis.

Methods:
According to the search strategy, we will retrieve the randomized controlled studies of non-invasive physical therapy in the treatment of knee osteoarthritis from CNKI, Wanfang, VIP, China Biomedical medicine, PubMed, Embase, Web of Science, and The Cochrane Library databases. The retrieval time was from the establishment of the database to March 2021. We will assess the quality of the studies using the Cochrane Risk Bias Assessment Tool and assess the strength of the evidence using the GRADE methodology. All data analyses will be performed by RevMan5.3, GEMTC 0.14.3, and Stata 14.0.

Results:
This study will evaluate the efficacy of different physical therapy in the treatment of knee osteoarthritis by evaluating the total response rate, pain relief degree, joint function score, quality of life score, adverse reactions, etc.

Conclusions:
This study will provide a reliable evidence-based basis for the selection of better physical therapy for the treatment of knee osteoarthritis.

OSF Registration number:
DOI 10.17605/OSF.IO/VX98B
Comprehensive TCM treatments combined with chemotherapy for advanced non-small cell lung cancer
Authors: Xiao Zhiwei , Chen Zhiqiang , Han Rui , Lu Liming , Li Zeyun , Lin Jietao , Hu Leihao , Huang Xuewu , Lin Lizhu 
Published: May 2021

Abstract

Objective:
We conducted this study to evaluate the efficacy and safety of traditional Chinese medicine (TCM) in advanced non-small cell lung cancer (NSCLC) patients who underwent chemotherapy.

Design:
This was a prospective, open-label, randomized controlled trial. NSCLC patients at stage IIIA, IIIB, or IV were randomly assigned to either TCM plus chemotherapy or chemotherapy alone. The comprehensive TCM treatment consisted of Kang Ai injection, herbal decoction, and Zhenqifuzheng capsules. The primary endpoint was quality of life (QOL) measured by the Functional Assessment of Cancer Therapy-Lung version 4.0. The secondary endpoints were chemotherapy completion rate, tumor response, and adverse events. All assessments were done at baseline, the third week, and the sixth week.

Results:
Thirty-nine participants were randomly assigned to the treatment group and 36 to the control group. The QOL scores were significantly improved in the treatment group compared with those of the control group in social well-being (cycle 1, P = .048; cycle 2, P = .015), emotional well-being (cycle 1, P = .047; cycle 2, P = 4.29E-05), and functional well-being (cycle 1, P = .030; cycle 2, P = .003), while the QOL scores in the above 3 domains declined in the control group (P < .05). Both groups had a decline in the physical well-being score (cycle 1, P = .042; cycle 2, P = .017) and lung cancer symptom score (cycle 1, P = .001; cycle 2, P = .001) after 2 courses of intervention. The deterioration in physical well-being and lung cancer symptoms was noticeably smaller in the treatment group (P < .05). There were significant differences between the 2 groups in social well-being, emotional well-being, functional well-being, lung cancer symptom domain, and the total score (P < .05). Patients in the treatment group had a significantly lower incidence of platelet reduction than the control group (P = .028) after 2 cycles of treatment. No significant difference in nonhematological adverse events (AEs) was observed.

Conclusion:
This study illustrated that comprehensive TCM treatment could promote the QOL of NSCLC patients, alleviate symptoms, and reduce the AEs caused by chemotherapy, verifying the synergistic and attenuating effects of TCM in NSCLC patients undergoing chemotherapy.

Trial registration:
Chinese Clinical Trial Registry (www.chictr.org.cn): ChiCTR-TRC-13003637
Sarcomatoid carcinoma associated with chronic empyema and early lung and pleural metastases
Authors: Kim Jeong keyom , Kim Min Seon , Lee Kyung Hee , Lee Ro Woon , Kim Lucia 
Published: May 2021

Abstract

Introduction:
The relationship between chronic empyema and malignant tumors, most of which are lymphoma, has been recognized for many decades. Sarcomatoid carcinoma associated with chronic empyema is extremely rare, may metastasize to other organs in the early stage, and rapidly progresses to death. As far as we know, this was the first case report on sarcomatoid carcinoma associated chronic empyema.

The patient's main concerns and important clinical findings:
A 59-year-old man presented to our hospital with a 9-year history of chronic empyema and a chief complaint of left chest wall pain for 5 months. The diagnostic contrast-enhanced computed tomography (CT) showed a large irregular soft tissue mass located on the left lower hemithorax at the margin of the empyema cavity extending to the adjacent chest wall and lung parenchyma. In addition, CT revealed pleural and pulmonary metastases surrounded by ground glass opacity.

The main diagnosis, therapeutics interventions, and outcomes:
The patient underwent CT guided percutaneous core needle biopsy (PCNB). The histopathological evaluation showed carcinomatous proliferation of pleomorphic spindle cells with extensive necrosis. Immunohistochemically, tumor cells were positive for cytokeratin and vimentin. The final histopathological diagnosis was sarcomatoid carcinoma underlying chronic empyema. The tumors showed rapid progression on serial simple radiography. Palliative treatments were performed, but the patient still developed severe dyspnea and died shortly after on day 16.

Conclusion:
Sarcomatoid carcinoma can occur very rarely as a complication of chronic empyema, and is more aggressive than usual. Early detection of developing malignancy during the follow-up of chronic empyema is an important factor for patient prognosis.
A case report of COVID-19 in refractory myasthenia
Authors: Bhagavan Sachin M. , Ramaswamy Swathi Beladakere , Govindarajan Raghav 
Published: May 2021

Abstract

Rationale:
Myasthenia gravis (MG) patients are at increased risk of COVID-19 infection and its complications due to chronic immunosuppression. COVID-19 infection can also increase the risk of myasthenia exacerbation.

Patient concerns:
The patient presented with respiratory distress, fever and chills and was diagnosed with COVID-19 pneumonia. His past medical history includes seropositive generalized MG diagnosed in 2019, hypertension, atrial fibrillation and congestive heart failure with reduced ejection failure.

Diagnoses:
Refractory seropositive generalized MG having COVID-19 pneumonia and respiratory failure (needing mechanical ventilation) with sepsis.

Intervention:
Use of intravenous remdesivir and dexamethasone and patient's myasthenic exacerbation (due to COVID-19 and its complications) was successfully treated with plasmapheresis.

Outcomes:
Patient was successfully weaned off ventilator to trach collar and was discharged to inpatient rehabiliation. He was followed up 1 month post hospital discharge and was on trach collar.

Lessons:
This case report illustrates early use of the combination therapy might be beneficial in refractory myasthenia gravis cases even with chronic immunosuppression and severe COVID-19 infection.
Quality of care and outcomes in internal medicine patients bedspaced to noninternal medicine units
Authors: Bogler Orly , Liu Jessica , Cadesky Ben , Bell Chaim M. 
Published: May 2021

Abstract
Hospital overcrowding has led to a practice known as bedspacing (in which admitted patients are placed on a different specialty's inpatient ward), yet little is known about the impact of this practice on healthcare quality.
We investigated whether hospital outcome measures differ between bedspaced general internal medicine (GIM) patients vs nonbedspaced patients.
Our retrospective study included patients admitted to GIM wards at 2 academic hospitals (2012–2014), comparing bedspaced to nonbedspaced patients, and identifying adverse events from the hospital's Electronic Patient Record.
We compared these groups with respect to actual length of stay vs the expected length of stay (% ELOS), which is defined as length of stay (LOS) divided by expected length of stay (ELOS), 30-day readmission, adverse events (falls, medication-related incidents, equipment-related incidents, first treatment related incidents, laboratory-related incidents, and operative/invasive events), and in-hospital mortality.
There were 22,519 patients analyzed with 15,985 (71%) discharged from a medical ward and 6534 (29%) discharged from a non-medical ward. Bedspaced patients had shorter lengths of stay (4.1 vs 6.2 days, P < .001) and expected lengths of stay (ELOS) (6.1 vs 6.4 days, P < .001). Bedspaced patients had a lower percentage of ELOS (% ELOS) than nonbedspaced patients (70% vs 91%, P < .001), similar readmission rates (9.8 vs 10.3 events per 100 patients, P = .24), lower in-hospital mortality rates (2.6 vs 3.3 events per 100 patients, P = .003) and fewer adverse events (0.20 vs 0.60 events per 100 patient days, P < .01).
Bedspacing of patients is common. Patients who are bedspaced to off-service wards have better outcomes. This may relate to preferential allocation practices.
The incidence of osteopenia of prematurity in preterm infants without phosphate supplementation
Authors: Angelika Dina , Ugrasena I. Dewa Gede , Etika Risa , Rahardjo Paulus , Bos Arend F. , Sauer Pieter J.J. 
Published: May 2021

Abstract
To meet their requirements for bone mineralization, it is recommended that preterm infants receive nutritional support containing calcium and phosphate. There are no clear data on the incidence of osteopenia of prematurity (OFP) in preterm infants without phosphate supplementation.
This study aimed to investigate the incidence of OFP in preterm infants without phosphate supplementation and its relationship with the duration of parenteral nutrition (PN).
This was a prospective and observational study.
This study included 30 infants aged <32 gestational weeks and weighed <1500 g at birth. All infants received PN according to a standard protocol, beginning on day 1 with calcium, without phosphate. Starting from the first day of life, all infants received human milk without fortifiers. Oral vitamin D (400 IU/d) was administered when enteral nutrition reached 100 mL/kg/d.
The diagnosis of OFP was based on radiographs that were taken of both wrists. Serum alkaline phosphatase (ALP) was measured 3 times: at the start of PN (ALP 1), at the end of PN (ALP 2), and at discharge or the expected due date (ALP 3). Radiographs were obtained on the same day as ALP 3. The duration of PN was analyzed in the presence of OFP using receiver operating characteristic curve analysis.
Among the 30 infants, 13 (43%) were diagnosed with OFP. The duration of PN was significantly longer in the OFP group than in the group without OFP (16 vs 12 days; P < .05). The provision of PN for >15 days significantly increased the risk of OFP (odds ratio, 5.40; 95% confidence interval, 1.12–26.04; P = .035).
We found a high incidence of OFP in preterm infants without phosphate supplementation. An association was found between the duration of PN and the incidence of OFP. Further research is needed to prevent the development of osteopenia in preterm infants.
Analysis of maternal and neonatal outcomes using cervical cerclage or conservative treatment in singleton gestations with a sonographic short cervix
Authors: Huang Xiaoxiu , Chen Ruizhe , Li Baohua 
Published: May 2021

Abstract
To investigate the effect of cervical cerclage or conservative treatment on maternal and neonatal outcomes in singleton gestations with a sonographic short cervix, and further compare the relative treatment value.
A retrospective study was conducted among women with singleton gestations who had a short cervical length (<25 mm) determined by ultrasound during the period of 14 to 24 weeks’ gestation in our institution. We collected clinical data and grouped the patients according to a previous spontaneous preterm birth (PTB) at <34 weeks of gestation or second trimester loss (STL) and sub-grouped according to treatment option, further comparing the maternal and neonatal outcomes between different groups.
In the PTB or STL history cohort, the cerclage group had a later gestational age at delivery (35.3 ± 3.9 weeks vs 31.6 ± 6.7 weeks) and a lower rate of perinatal deaths (2% vs 29.3%) compared with the conservative treatment group. In the non-PTB-STL history cohort, the maternal and neonatal outcomes were not significantly different between the cerclage group and conservative treatment group. More importantly, for patients with a sonographic short cervix who received cervical cerclage, there was no significant difference in the maternal and neonatal outcomes between the non-PTB-STL group and PTB or STL group.
For singleton pregnant with a history of spontaneous PTB or STL and a short cervical length (<25 mm), cervical cerclage can significantly improve maternal and neonatal outcomes; however, conservative treatment (less invasive and expensive than cervical cerclage) was more suitable for those pregnant women without a previous PTB and STL history.
Outcomes of and factors influencing the arthroscopic treatment of rotator cuff injury with the patient in the lateral-lying and beach chair positions
Authors: Zhang Minghua , Chen Daohua , Wu Rong , Chen Dongfeng , Lai Jiajing 
Published: May 2021

Abstract
To compare the postoperative effects of arthroscopy for rotator cuff injury with patients in the lateral-lying position (LLP) and beach chair position (BCP), and to identify factors influencing these effects.
Data from patients with rotator cuff injuries who underwent shoulder arthroscopy in the LLP (n = 115, 53.24%) or BCP (n = 101, 46.76%) between January 2013 and 2016 and were followed for >3 years were analyzed. The American Shoulder and Elbow Surgeons shoulder score, University of California at Los Angeles shoulder score (UCLASS), and visual analog scale (VAS) score were used to evaluate patients’ shoulder function and pain preoperatively and at the last follow-up examination. The abduction and lateral rotation angles were measured. The influences of patient characteristics were compared between the LLP and BCP subgroups defined by UCLASSs (excellent, good, acceptable, poor).
Postoperative injury characteristics, UCLASSs, and VAS scores were better in the LLP group than in the BCP group (all P < .05). Among patients with good UCLASSs, preoperative pain duration was longer in the LLP group than in the BCP group (P < .05); among those with acceptable UCLASSs, this duration was longer in the BCP group than in the LLP group (P < .05). The preoperative flexion angle differed between groups (P < .05). Among patients with excellent and good UCLASSs, the postoperative external rotation angle was greater in the LLP group than in the BCP group (P < .05). The LLP group contained more excellent UCLASSs than did the BCP group (P < .05). It also contained more small, medium, and large tear cases than did the BCP group (all P < .05).
The effect of arthroscopy for rotator cuff injury was better when the operation was performed with the patient in the LLP. Either position is suitable for the arthroscopic treatment of partial rotator cuff tears. The LLP is more suitable in cases of small and medium-sized tears and those with large preoperative lateral rotation angles. The BCP should be used for patients with large preoperative flexion angles.
Differential impacts of hemolysis on coagulation parameters of blood samples
Authors: Pan Lin-Lin , Lee Ching-Hui , Hung Kuo-Chuan , Tsai I-Ting , Wang Ming-Chung , Sun Cheuk-Kwan 
Published: May 2021

Abstract
This study aimed at investigating the impact of hemolysis on different coagulation parameters.
A total of 216 venous blood samples without visible hemolysis were collected from adult patients at a tertiary referral center over six months. The plasma obtained was quantified for six coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, antithrombin III, and protein C. The rest of the plasma from each blood sample was aliquoted into three tubes, each containing 1 mL of plasma with three different volumes of cell-free hemoglobin (i.e., 2, 4, 8 μL) from lysed RBCs to create simulated hemolyzed blood samples with hemoglobin concentration of approximately 0.1, 0.2, and 0.4 g/dL to mimic mild (1+), moderate (2+), and severe (3+) hemolysis, respectively, before repeating the coagulation tests to determine possible correlation between the simulated degree of hemolysis and the changes in test results of the coagulation parameters.
Spearman correlation analysis showed significant decreases in the values of activated partial thromboplastin time, fibrinogen, D-dimer, and protein C values with an increasing degree of simulated hemolysis (all P < .01). Comparison of the percentage bias of biological variance showed significant positive associations of cell-free hemoglobin concentrations with the percentage bias of D-dimer and protein C. However, only the former was still within the range of biological variance under condition of simulated hemolysis. Besides, the presence of cell-free hemoglobin regardless of concentration had a notable impact on the percentage bias of activated partial thromboplastin time, whereas the influence was non-significant for prothrombin time, fibrinogen, and antithrombin III.
The results showed different impacts of simulated hemolysis on six coagulation parameters, highlighting the dependence of clinical reliability on the coagulation parameter to be investigated in hemolytic blood samples.
Clinical feasibility of MR-generated synthetic CT images of the cervical spine
Authors: Jeong Hee Seok , Park Chankue , Kim Kang Soo , Kim Jin Hyeok , Jeon Chang Ho 
Published: May 2021

Abstract
We aimed to determine the incremental value of magnetic resonance generated synthetic computed tomography (MRCT), evaluate cervical ossification of the posterior longitudinal ligament (OPLL), and compare the computed tomography (CT) numbers between MRCT and conventional CT.
Twenty-two patients who underwent magnetic resonance imaging (MRI) with MRCT protocols and CT were enrolled. MRCT images were generated from 3D-T2-weighted imaging, 3D-pointwise-encoding time reduction with radial acquisition, 3D-T1-Dixon, and 3D-time-of-flight sequences. Two radiologists independently evaluated the presence of OPLL at each cervical spine level during sessions 1 (MRI alone) and 2 (MRI + MRCT). CT was the reference standard for the presence of OPLL. One reader measured the mean CT number of the vertebral body and spinous process at each cervical spine level in the MRCT and CT images.
Sensitivity for the detection of OPLL was markedly higher in session 2 (MRI + MRCT) than in session 1 (MRI alone), as measured by both readers (47% vs. 90%, reader 1; 63% vs. 93%, reader 2). The mean CT number of MRCT and CT showed a moderate to strong positive correlation (ρ = .42–.72, P < .001).
The combined use of MRCT and MRI showed improved sensitivity for the evaluation of cervical OPLL. The mean CT number of MRCT and CT showed a positive correlation.
Treatment strategies and predicting lymph node metastasis in elderly patients with papillary thyroid microcarcinoma
Authors: Li Wenhan , Tang Yao , Li Jianhui , Han Wei , Wang Danfang , Wang Yongheng 
Published: May 2021

Abstract
This study aims to explore the prognostic variables for elderly papillary thyroid microcarcinoma (PTMC) patients as well as create a nomogram that could predict the occurrence of cervical lymph node metastasis (CLNM) on the basis of a large population database with high quality.
A total of 5165 PTMC patients from Surveillance, Epidemiology, and End Results database database were enrolled in the study. In the meantime, we retrospectively collected 205 PTMC patients who underwent thyroidectomy in our medical center as an external control to test the accuracy of the model. The independent predictors of survival were identified by multivariate Cox regression analysis. Risk factors were selected as nomogram parameters to develop a model to predict CLNM. The C-index and calibration plots were used to evaluate CLNM model discrimination. The predictive nomogram was further validated in the external validation set.
76.8% of the enrolled patients underwent thyroidectomy. Overall survival and cancer-specific survival were significantly better in patients who underwent surgery than in those who did not (P < .001). Sex, tumor size, and extent of tumor were included in a multivariable logistic regression model to predict lymph node metastasis. The nomogram had good discrimination with a C-index of 0.71. The calibration curves showed perfect agreement between nomogram predictions and actual observations.
Elderly PTMC patients who received a surgical approach without radiotherapy showed survival advantage than those with other treatment strategies. Moreover, a nomogram model was established to predict the risk of CLNM, which will help clinicians in making treatment decisions.