bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative combined administration of tranexamic acid and dexamethasone in total knee arthroplasty—benefit versus harm?
Authors: Yu You , Lin Hai , Wu Zhitao , Xu Peng , Lei Zhengliang 
Published: August 2019

Abstract

Background:
The purpose of this study was to investigate the benefits and harm of combined administration of tranexamic acid (TXA) and dexamethasone (Dexa) in total knee arthroplasty (TKA).

Methods:
A total of 88 consecutive patients undergoing TKA for knee osteoarthritis were stratified in 2 groups. All surgeries were performed under general anesthesia. Brief, patients in the TXA + Dexa group (n = 45) received 10 mg Dexa just after the anesthesia, and repeated at 24 hours after the surgery; and patients in the TXA group (n = 43) received 2 ml of normal saline solution at the same time. The measured outcomes were the C-reactive protein (CRP) and interleukin-6 (IL-6) from preoperatively to postoperatively, and postoperative nausea and vomiting (PONV), fatigue, range of motion (ROM), length of stay (LOS), and the analgesic and antiemetic rescue consumption

Results:
The level of CRP and IL-6 in the TXA + Dexa group were lower than that in the TXA group at 24 hours (P < .001, P < .001), 48 hours (P < .001, P < .001), and 72 hours (P < .001, P < .001) after the surgery. The pain scores in the TXA + Dexa group were lower during walking at 24 hours (P < .001), 48 hours (P < .001), and 72 hours (P < .001) and at rest at 24 hours (P = .022) after the surgery. Patients in the TXA + Dexa group had a lower nausea score, the incidence of PONV, fatigue, and the analgesic and antiemetic rescue consumption, and had a greater ROM than that in the TXA group. No significant differences were found in LOS and complications.

Conclusion:
The combined administration of TXA + Dexa significantly reduced the level of postoperative CRP and IL-6, relieve postoperative pain, ameliorate the incidence of POVN, provide additional analgesic and antiemetic effects, reduce postoperative fatigue, and improve ROM, without increasing the risk of complications in primary TKA.
Low serum vitamin D levels increase the mortality of cardiovascular disease in older adults
Authors: Yang Jun , Ou-Yang Juan , Huang Ji 
Published: August 2019

Abstract
Lower circulating vitamin D is common in older adults and may be a potential reversible risk factor for cardiovascular disease (CVD) in older adults, however, presented controversial results.
Database was searched update to February 2018. Key data were extracted from eligible studies. Dose–response meta-analysis were conducted for synthesizing data from eligible studies.
A total of 13 eligible studies involving 21,079 participants were included in this meta-analysis. Person with lower 25-hydroxyvitamin D status (25 (OH)D level <50 nmol/L) appeared to have higher mortality of CVD in older adults (RR = 1.54, 95% CI 1.24–1.91). Furthermore, a significantly higher mortality of CVD in older adults was observed for the deficient (<25 nmol/L; RR = 1.47, 95% CI 1.15–1.81) and insufficient (25–50 nmol/L; RR = 1.16, 95% CI 1.04–1.27) categories of 25 (OH)D, compared to the reference category of >75 nmol/L. Additionally, decrease of 10 nmol/L 25-hydroxyvitamin D was associated with a 7% incremental in the risk of CVD mortality in older adults.
Considering these promising results, circulating vitamin D is associated with CVD mortality increment in older adults.
Extranodal natural killer/T-cell lymphoma nasal type with central nervous system involvement mimicked tuberculous meningitis
Authors: Yang Yina , Li Zhouling , Zhiyang Chen , Liang Hui 
Published: August 2019

Abstract

Rationale:
Neurologic deficits are rare in patients with extranodal natural killer/T-cell lymphoma (NKTL), nasal type. We present a case that was initially suspected as tuberculous meningitis, but later diagnosed as central nervous system metastasis of NKTL, nasal type, which has never been published previously.

Patient concerns:
A 55-year-old Chinese man presented with persistent headache and fever. The initial head computed tomography and magnetic resonance imaging (MRI) scan was normal. Low glucose, elevated protein, and pleocytosis of cerebral spinal fluid led to a diagnosis of tuberculous meningitis. The patient did not respond to anti-tuberculosis treatment, and his symptoms aggravated. MRI showed abnormal lesions in the right hemisphere and a lesion in the maxillary sinus region.

Diagnosis:
Endoscopic biopsy of the maxillary lesion showed features consistent with NKTL. Positron emission tomography revealed a hypermetabolic mass involving the right maxillary sinus and brain.

Interventions:
The patient received chemotherapy.

Outcomes:
The patient died 30 days after chemotherapy.

Lessons:
Lymphoma of the nasal cavity and paranasal sinuses is extremely rare and may be easily misdiagnosed. Nasal NKTL metastasis should be considered when a patient presents with symptoms of leptomeningeal involvement.
Vertebral collapse and polymethylmethacrylate breakage after vertebroplasty
Authors: Huang Anquan , Fang Shenyun , Wang Liyu , Xu Renjie , Shen Jun , Zhu Guoqing , Miao Ye , Zou Tianming 
Published: August 2019

Abstract

Rationale:
Vertebral augmentation has become the main treatment for osteoporotic vertebral fractures (VFs). In this article, we report a very rare case of vertebral collapse and polymethylmethacrylate (PMMA) breakage after vertebroplasty. We describe the clinical characteristics and revision surgery performed to remove the broken PMMA cement, maintain stability, and corrects the kyphotic deformity, and we analyze the possible causes.

Patient concerns:
A 72-year-old man who suffered back pain underwent first lumbar vertebra (L1) percutaneous vertebroplasty (PVP) due to osteoporosis and a vertebral fracture in May 2013. Postoperatively, the patient's back pain was markedly alleviated. Unfortunately, his lumbar back pain recurred in November 2015.

Diagnoses:
Plain radiographs showed collapse of the L1 vertebral body, breakage of the PMMA cement, and severe kyphosis at the thoracolumbar junction.

Interventions:
The posterior pedicle was internally fixed and an anterior artificial vertebral body implant was placed to maintain stability and correct the kyphotic deformity in a 2-step surgical procedure.

Outcomes:
The back pain was alleviated and the patient returned to daily life for more than two years.

Lessons:
This case demonstrates that PVP is not a simple minimally invasive surgery, and significant postsurgical care is necessary. The true cause of this rare phenomenon remains unclear, but the long-term use of steroids, new injuries, and poorly corrected kyphosis after PVP may play a role. Surgeons must be aware of the kinds of complications that may occur, including rare complications such as vertebral lysis.
Comparison of 2 approaches in management of pregnant women with inherited trombophilias
Authors: Dugalic Stefan , Petronijevic Milos , Stefanovic Aleksandar , Stefanovic Katarina , Petronijevic Svetlana Vrzic , Stanisavljevic Dejana , Kepeci Sonja Perkovic , Milincic Nemanja , Pantic Igor , Perovic Milan 
Published: August 2019

Abstract
Previous adverse pregnancy outcomes (APO) in women with hereditary thrombophilia have emerged as new indications for prophylactic use of low-molecular-weight heparin (LMWH) during pregnancy. Recent meta-analysis conducted to establish if LMWH may prevent recurrent placenta-mediated pregnancy complications point to important therapeutic effect but these findings are absolutely not universal. Furthermore, previous studies regarding LMWH prophylaxis for APO in women with inherited thrombophilia were performed in high risk patients with previous adverse health outcomes in medical, family and/or obstetric history. Therefore, the aim of this study was to investigate the effects of LMWH prophylaxis on pregnancy outcomes in women with inherited thrombophilias regardless of the presence of previous adverse health outcomes in medical, family, and obstetric history.
Prospective analytical cohort study included all referred women with inherited thrombophilia between 11 and 15 weeks of gestation and followed-up to delivery. Patients were allocated in group with LWMH prophylaxis (study group) and control group without LWMH prophylaxis. The groups were compared for laboratory parameters and Doppler flows of umbilical artery at 28th to 30th, 32nd to 34th and 36th to 38th gestational weeks (gw), and for obstetric and perinatal outcomes.
The study group included 221 women and control group included 137 women. Mean resistance index of the umbilical artery Ri in 28 to 30, 32 to 34, and 36 to 38 gw were significantly higher in the control group compared to study group (0.71 ± 0.02 vs 0.69 ± 0.02; 0.67 ± 0.03 vs 0.64 ± 0.02; and 0.67 ± 0.05 vs 0.54 ± 0.08, respectively). Intrauterine fetal death (IUFD) and miscarriages were statistically significantly more frequent in control group compared to the patients in study (P < .001). The frequencies of fetal growth restriction (FGR) and APO were significantly higher in the control group compared to the study group (P = .008 and P < .001, respectively). In a multivariate regression model with APO as a dependent variable, only Ri was detected as a significant protective factor for APO, after adjusting for age and LMWH prophylaxis (P < .001).
We have demonstrated better perinatal outcomes in women with LMWH prophylaxis for APO compared to untreated women.
Rare concurrence of ectopic intrathyroidal parathyroid gland and papillary thyroid carcinoma within a thyroid lobe
Authors: Chen Jianguo , Wan Yingying , Chen Shuguang 
Published: August 2019

Abstract

Rationale:
The inferior parathyroid glands derive from the third branchial pouch and seldom ectopically migrate to thyroid grand, mediastinum, thymus. Ectopic intrathyroidal parathyroid grand (ETPG) is rare and it cannot be consistently detected by any imaging examinations. The unusual ETPG is easily resected during thyroidectomy, which might cause postoperative hypoparathyroidism. Auto-transplantation of even a parathyroid gland can restore parathyroid function to some extent. Until now, there are not any guidelines on the management of ETPG.

Patient concerns:
Without any symptoms, a 27-year-old female patient was admitted to our hospital for a thyroid nodule. Thyroid ultrasonography demonstrated a hypoechoic nodule, measuring 0.6 cm × 0.6 cm × 0.7 cm, with multiple punctate micro-calcifications within the right thyroid lobe. Thyroid function tests were normal. The invasive fine needle aspiration cytology for the thyroid nodule was rejected by patient.

Diagnoses:
The patient was firstly diagnosed as right thyroid hypoechoic nodule, which was pathologically proved to be papillary thyroid carcinoma (PTC) finally.

Interventions:
The patient underwent right thyroidectomy, central compartment neck dissection, parathyroid exploration, and auto-transplantation of the normal ETPG.

Outcomes:
The right thyroid hypoechoic nodule was diagnosed as PTC by pathological examination. The inferior parathyroid gland could not found in normal locations. On the cut surface of excised thyroid lobe, a yellow and soft nodule was discovered and it was pathologically diagnosed as a normal parathyroid grand. In the end, auto-transplantation of the normal ETPG was conducted. Postoperative follow-ups found both serum calcium and parathyroid hormone tests were normal.

Lessons:
ETPG in a patient with PTC is easily overlooked and unexpectedly excised for its rarity. ETPG brings about a failed parathyroid exploration. However, within the thyroid parenchyma, it might be occasionally discovered by cutting a thyroid lobe into slices. Auto-transplantation of normal ETPG is necessary.
Finite element analysis of spiral plate and Herbert screw fixation for treatment of midshaft clavicle fractures
Authors: Zhang Xiaojuan , Cheng Xiaodong , Yin Bing , Wang Jianzhao , Li Sheng , Liu Guobin , Hu Zusheng , Wu Weiwei , Zhang Yingze 
Published: August 2019

Abstract
Both spiral plate and Herbert screw fixations have been clinically adopted for treating midshaft displaced clavicle fractures. However, the biomechanical properties of the 2 implant fixations have not yet been thoroughly evaluated. Here we report the results of a finite element analysis of the biomechanical properties of midshaft clavicle fractures treated with Herbert screw and spiral plate fixation. Hebert screw fixation showed stress distribution similar to intact clavicle under all loading conditions, but provided less stability than did spiral plate fixation. Postoperatively, excessive shoulder activities and weight-bearing should be avoided. Spiral plate fixation provides greater stability, but is associated with stress shielding. These results demonstrate that Herbert screw fixation is suitable for the treatment of simple displaced clavicluar fractures, but excessive shoulder activity and weight-bearing should be avoided after the operation. Therefore, spiral plate fixation may be preferred for patients requiring an early return to activity.
A study on the paraspinal muscle surface electromyography in acute nonspecific lower back pain
Authors: Qiao Jie , Zhang Shu-Li , Zhang Jun , Feng Dan 
Published: August 2019

Abstract
Aim of this study was to determine if surface electromyography (sEMG) could provide objective data in monitoring the alteration of signal amplitude of myoelectric activity of the paraspinal muscles in the patients with acute nonspecific lower back pain (ANLBP), and to explore the correlation between sEMG data and symptom relief in the ANLBP patients before and after massage therapy.
Forty-five ANLBP patients and 20 healthy subjects were enrolled into this study. Patients were given massage therapy for 1 week. The average electromyography (AEMG), visual analogue scale (VAS), and distance of finger to floor (DFTF) were measured before and after treatment.
AEMG at flexion and maintained flexion positions were significantly higher in the ANLBP group compared to that in the control group. At extension position, in contrast, AEMG was significantly lower in the ANLBP patients than that of control group, and there was no significant difference between the 2 groups at upright position. After massage therapy for the ANLBP patients, AEMG was significantly reduced at flexion and maintained flexion positions, but significantly increased at extension position than that before treatment. VAS and DFTF were also significantly reduced after treatment. In addition, AEMG alteration at maintained flexion position was significantly correlated with improvement of VAS or DFTF.
Myoelectric activity of the paraspinal muscles in the ANLBP patients was different from that of healthy subjects. Massage therapy not only relived patients’ symptoms, but also normalized myoelectric activity of the paraspinal muscles in the ANLBP patients.
Clinical characteristics and chest computed tomography findings of smear-positive and smear-negative pulmonary tuberculosis in hospitalized adult patients
Authors: Kim Jong Hun , Kim Min Ja , Ham Soo-Youn 
Published: August 2019

Abstract
Pulmonary tuberculosis (PTB) continues to be one of the significant public health threats with significant morbidity and mortality. The present study was aimed to assess the clinical characteristics and chest computed tomography (CT) findings of smear-positive and smear-negative PTB in hospitalized adult patients.
Hospitalized adult patients diagnosed with PTB by positive Mycobacterium tuberculosis growth on acid-fast bacilli culture from bronchial aspiration or sputum from 2015 to 2017 were reviewed. Only the patients who had chest CT within 14 days of the diagnosis of PTB were included. Medical records and CT images were analyzed.
A total of 189 patients was enrolled. The median age was 62 years, and there were 118 males (62.4%). More than half of the patients had underlying chronic medical conditions (55.5%). The most common CT finding was nodular lesions (96.8%). The patients were categorized in 2 groups of smear-positive (n = 94, 49.7%) and smear-negative (n = 95, 50.3%). Between 2 groups, there was no difference in underlying medical conditions. However, there were more lesions of cavity, consolidation, bronchiectasis, upper lobe involvement, multiple lobe involvement, and lymphadenopathy in the smear-positive group. A predictive model for smear-positive tuberculosis was created based on the comparison analysis that had an area of 0.724 under the receiver operating characteristic curve. In a multivariate logistic regression analysis, CT findings of consolidation (odds ratio [OR] 2.521, 95% confidence interval [CI] 1.175–5.408, P = .02), lymphadenopathy (OR 1.947, 95% CI 1.025–3.696, P = .04), and multi-lobe involvement (OR 2.795, 95% CI 1.084–7.205, P = .03) were associated with smear-positive PTB.
PTB patients who have chest CT findings of cavity, consolidation, bronchiectasis, upper lobe involvement, multiple lobe involvement, and lymphadenopathy may be at higher risk for smear-positive TB. A predictive model may be helpful for further assessment.
Integrated analysis of circular RNA-associated ceRNA network in cervical cancer
Authors: Gong Jun , Jiang Hui , Shu Chang , Hu Mei-qin , Huang Yan , Liu Qin , Li Rong-feng , Wei Yin-zhi 
Published: August 2019

Abstract

Background:
Circular RNAs (circRNAs) have displayed dysregulated expression in several types of cancer. Nevertheless, their function and underlying mechanisms in cervical cancer remains largely unknown. This study aimed to describe the regulatory mechanisms in cervical cancer.

Methods:
We downloaded the circRNAs expression profiles from Gene Expression Omnibus database, and RNAs expression profiles from The Cancer Genome Atlas database. We established a circRNA-miRNA-mRNA and circRNA-miRNA-hubgene network. The interactions between proteins were analyzed using the STRING database and hubgenes were identified using MCODE plugin. Then, we conducted a circRNA-miRNA-hubgenes regulatory module. Functional and pathway enrichment analyses were conducted using R packages “Clusterprofile”.

Results:
Six circRNAs, 15 miRNAs, and 158 mRNAs were identified to construct the ceRNA network of cervical cancer. PPI (protein-protein interaction) network and module analysis identified 7 hubgenes. Then, a circRNA-miRNA-hubgene subnetwork was constructed based on the 1 DEcircRNAs, 3 DEmiRNAs, and 3 DEmRNAs. The KEGG pathway analysis indicated DEmRNAs are involved in progesterone-mediated oocyte maturation, cell cycle, and oocyte meiosis.

Conclusion:
These ceRNAs are critical in the pathogenesis of cervical and may serve as future therapeutic biomarkers.
Epidemiologic features of shigellosis and associated climatic factors in Taiwan
Authors: Chen Chian-Ching , Lin Chuan-Yao , Chen Kow-Tong 
Published: August 2019

Abstract
The consistent, sporadic transmission of shigellosis in Taiwan necessitates an exploration of risk factors for the occurrence of shigellosis. The purpose of this study was to study the epidemiologic characteristics and the relationship between climatic factors and the incidence of shigellosis in Taiwan. We collected data from cases of shigellosis reported to the Taiwan Centers for Disease Control (Taiwan CDC) from 2001 to 2016. Climatic data were obtained from the Taiwan Central Weather Bureau. The relationships between weather variability and the incidence of shigellosis in Taiwan were determined via Poisson regression analyses. During the 16-year study period, a total of 4171 clinical cases of shigellosis were reported to the Taiwan CDC. Among them, 1926 (46.2%) were classified as confirmed cases. The incidence of shigellosis showed significant seasonality, with the majority of cases occurring in summertime (for oscillation, P < .001). The number of shigellosis cases started to increase when temperatures reached 21°C (r2 = 0.88, P < .001). Similarly, the number of shigellosis cases began to increase at a relative humidity of 70–74% (r2 = 0.75, P < .005). The number of shigellosis cases was positively associated with the mean temperature and relative humidity in the period preceding the infection. In conclusion, the occurrence of shigellosis is significantly associated with increasing temperature and relative humidity in Taiwan. Therefore, these factors could be regarded as warning signals indicating the need to implement preventive measures.
Predictive performance of plasma neutrophil gelatinase-associated lipocalin for neurologic outcomes in out-of-hospital cardiac arrest patients treated with targeted temperature management
Authors: Lee Ji Hwan , Park Incheol , You Je Sung , Kim Min Joung , Lee Hye Sun , Park Yoo Seok , Park Hyeong Cheon , Chung Sung Phil 
Published: August 2019

Abstract
Few studies have demonstrated the prognostic potential of neutrophil gelatinase-associated lipocalin (NGAL) in post-cardiac arrest patients. This study evaluated the usefulness of plasma NGAL in predicting neurologic outcome and mortality in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). A prospective observational study was conducted between October 2013 and April 2016 at a single tertiary hospital. We enrolled 75 patients treated with TTM and collected their demographic data, cardiopulmonary resuscitation-related information, data on plasma NGAL concentration, and prognostic test results. Plasma NGAL was measured at 4 hours after return of spontaneous circulation (ROSC). The primary endpoint was the neurologic outcome at discharge and the secondary outcome was 28-day mortality. Neurologic outcomes were analyzed using a stepwise multivariate logistic regression while 28-day mortality was analyzed using a stepwise Cox regression. The predictive performance of plasma NGAL for neurologic outcome was measured by the area under the receiver operating characteristic curve and the predictability of 28-day mortality was measured using Harrell C-index. We also compared the predictive performance of plasma NGAL to that of other traditional prognostic modalities for outcome variables. Thirty patients (40%) had good neurologic outcomes and 53 (70.7%) survived for more than 28 days. Plasma NGAL in patients with good neurologic outcomes was 122.7 ± 146.7 ng/ml, which was significantly lower than that in the poor neurologic outcome group (307.5 ± 269.6 ng/ml; P < .001). The probability of a poor neurologic outcome was more than 3.3-fold in the NGAL >124.3 ng/ml group (odds ratio, 3.321; 95% confidence interval [CI], 1.265–8.721]). Plasma NGAL in the survived group was significantly lower than that in the non-survived group (172.7 ± 191.6 vs 379.9 ± 297.8 ng/ml; P = .005). Plasma NGAL was significantly correlated with 28-day mortality (hazard ratio 1.003, 95% CI 1.001–1.004; P < .001). The predictive performance of plasma NGAL was not inferior to that of other prognostic modalities except electroencephalography. Plasma NGAL is valuable for predicting the neurologic outcome and 28-day mortality of patients with OHCA at an early stage after ROSC.
This study was registered at ClinicalTrials.gov on November 19, 2013 (Identifier: NCT01987466).