bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple sclerosis prevalence study
Authors: Türk Börü Ülkü , Duman Arda , Kulualp Ahmet Şükrü , Güler Neşe , Taşdemir Mustafa , Yılmaz Ümit , Alp Recep , Bölük Cem 
Published: October 2018

Abstract
The prevalence of multiple sclerosis (MS) has significantly increased all over the world. Recent studies have shown that Turkey has quite a high prevalence. The aim of this study is to estimate prevalence in the Mediterranean and Black Sea regions of Turkey and to compare the results.
This study was designed as a door to door survey in 3 cities. One is located in the Mediterranean region (South), 2 are located in the Black Sea region (North). A previous validated form was used for screening in the field. The patients were examined first in the field, then in the regional health facility. McDonald criteria were used for the diagnosis.
In total, 26 patients were diagnosed with MS. The prevalence was found to be 18.6/100,000 in Artvin (Black Sea region), 55.5/100,000 in Ordu, (Black Sea region), 52.00/100,000 in Gazipaşa (Mediterranean region). The female/male ratio was 2.25.
This study is the first prevalence study which was conducted in the Mediterranean City (South) of Turkey. The prevalence rate was found to be higher than expected in the Mediterranean city of Gazipaşa. The results showed that the prevalence varies from region to region. Latitude difference was not observed.
Early severe coronary heart disease and ischemic heart failure in homozygous familial hypercholesterolemia
Authors: Kuang Hongyu , Zhou Xue , Li Li , Yi Qijian , Shou Weinian , Lu Tiewei 
Published: October 2018

Abstract

Rationale:
Familial hypercholesterolemia (FH) is a common inherited cause of coronary heart disease (CHD) and premature death in an early age. Nevertheless, an ischemic heart failure (IHF) associated with FH seems to be rare, and an early diagnosis and therapy could influence the prognosis.

Patient concerns:
In this 13-year-old girl, multiple xanthomas began to develop from the first day of birth. Until June, 2017, she was admitted to our center due to edema, oliguria, and dyspnea during exertion, which was attributed to a recent respiratory infection.

Diagnosis:
Homozygous FH (HoFH), CHD, and IHF.

Interventions:
The patient has been treated with statin, ezetimibe, aspirin, and traditional heart failure (HF) medications. In addition, the beta-blocker was simultaneously administered.

Outcomes:
Genotypes of this proband indicated homozygous mutations of low-density lipoprotein receptor (LDLR) and some co-segregated mutations, such as von Willebrand factor (VWF) and fibroblast growth factor receptors. At 6-month follow-up, we found a decreased level of plasma lipid profile, in addition to a significant improvement in 6-minute walk distance and functional class. Echocardiography indicated nonsignificant improvements in the structure and function of the heart.

Lessons:
This case report indicates that HoFH can lead to dramatically progressive endothelial damages and ventricular remodeling, severe atherosclerosis, even IHF. Genetic outcomes indicate IHF with HoFH could possibly result from LDLR mutations and some co-segregated mutations influencing endothelial function and cardiovascular remodeling. In a short-term follow-up, a combination of statins, ezetimibe, aspirin, and traditional HF agents is safe and effective for IHF with HoFH, and there is a need for further identification of drugs to ameliorate endothelial function and cardiovascular remodeling which may play an important role in long-term treatment.
Diagnosis of systemic lupus erythematosus by presence of Hargraves cells in eosinophilic pleural effusion
Authors: D’Andréa Alexia , L. Peillet Damien , Serratrice Christine , Petignat Pierre-Augute , Prendki Virginie , Reny Jean-Luc , Serratrice Jacques 
Published: October 2018

Abstract

Rationale:
Eosinophilic pleural effusion in elderly patients is most commonly due to malignancies and infections.

Patient concerns:
In rare cases, pleural eosinophilia is associated with connective tissue disease.

Diagnoses:
Presence of Hargraves cells, also called lupus erythematosus (LE) cells (polynuclear cells that have engulfed denatured nuclear material), was a key point of American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) until 1997. Now replaced by serology for autoantibodies, LE cells characterization remains useful in guiding the diagnostic strategy towards autoimmune diseases.

Interventions:
An 82-year-old woman complained about anorexia, weight loss, fatigue, and mild night fever. Clinical examination disclosed a left pleural effusion without parenchymal lesion on high contrast thoraco-abdomino-pelvic computed tomography scan. A thoracocentesis revealed an exudate with eosinophilia. Direct cytological examination showed LE cells. SLE was rapidly considered. Antinuclear antibodies were subsequently found in the serum and in the pleural effusion. Anti-nucleosome antibodies were also present without antiphospholipid antibodies. Her condition rapidly improved after initiation of prednisone and hydroxychloroquine.

Outcomes:
Six months later, the patient had no particular complain, clinical examination was strictly normal biological parameter were in normal range.

Lessons:
The assessment of an eosinophilic pleural effusion allowed to find LE cells, which rapidly suggested the diagnosis of SLE, and early initiation of appropriate treatment. LE cells are no longer a criterion for the diagnosis of SLE, but their presence in serosa is most helpful in guiding the diagnostic strategy, and specifically in atypical forms often seen in older patients.
Nonalcoholic fatty liver disease with prolactin-secreting pituitary adenoma in an adolescent
Authors: Takaki Yugo , Mizuochi Tatsuki , Nishioka Junko , Eda Keisuke , Yatsuga Shuichi , Yamashita Yushiro 
Published: October 2018

Abstract

Rationale:
Nonalcoholic fatty liver disease (NAFLD), among the commonest chronic liver disorders in children and adolescents, is considered a reflection of the current obesity epidemic in children and adults. This liver disease has been linked with various metabolic disorders, but not with prolactinoma (PRLoma).

Patient concerns:
A 13-year-old Japanese girl manifested obesity, serum transaminase and γ-glutamyltransferase elevations, and amenorrhea. Abdominal ultrasonography showed fatty liver. Her serum prolactin concentration was elevated, and cranial magnetic resonance imaging showed a pituitary mass consistent with macroadenoma.

Diagnoses:
NAFLD and PRLoma.

Interventions and outcomes:
After the patient's NAFLD failed to respond to diet and exercise, cabergoline treatment of the PRLoma decreased body weight, serum transaminase and γ-glutamyltransferase elevations, and ultrasonographic fatty liver grade as the tumor became smaller.

Lessons:
Physicians should consider the possibility of PRLoma when diet and exercise fail to improve fatty liver disease in a patient with endocrine symptoms such as amenorrhea.
Glaucoma severity and intraocular pressure reduction after cataract surgery in eyes with medically controlled glaucoma
Authors: Yoo Chungkwon , Amoozgar Behzad , Yang Kyung-Sook , Park Ji-Hye , Lin Shan C. 
Published: October 2018

Abstract
To investigate the relationship between glaucoma severity and intraocular pressure (IOP) reduction after cataract surgery in patients with medically controlled primary open-angle glaucoma (POAG).
Retrospective case series.
This study included glaucoma suspects (GS) and POAG patients who underwent cataract surgery and continued to use the same glaucoma medications during the postoperative period of 4 months. The main outcomes were percent and absolute IOP changes calculated using the preoperative IOP and the postoperative IOP at 3 months. Preoperative glaucoma medications, preoperative IOP, demographic information, biometric parameters and variables for glaucoma severity were evaluated as potential predictors of IOP change.
The average IOP reduction was 3.3 ± 2.4 mmHg (20.0%) and 2.2 ± 2.5 mmHg (13.1%) from the preoperative mean of 16.0 ± 2.9 mmHg and 15.2 ± 3.3 mmHg in the GS and POAG groups, respectively. Preoperative IOP, preoperative IOP/anterior chamber depth (preoperative IOP/ACD [PD ratio]) and preoperative IOP/retinal nerve fiber layer (RNFL) thickness (preoperative IOP/RNFL [PNFL ratio]) and preoperative IOP score x MD score x number of glaucoma medications (glaucoma index) predicted absolute IOP change in the POAG group, whereas preoperative IOP, PD ratio, PNFL ratio, and axial length (AL) did in the GS group. Preoperative IOP, PD ratio, and PNFL ratio predicted %IOP change in the POAG group, whereas only AL did in the GS group.
In medically controlled POAG eyes, structural or functional parameters for glaucoma severity did not independently predict IOP change following phacoemulsification. However, novel severity indices obtained by addition of preoperative IOP and/or glaucoma medications to the structural or functional parameter predicted IOP changes.
Apolipoprotein B is not superior to non-high-density lipoprotein cholesterol for dyslipidemic classification of glycated hemoglobin-defined diabetic patients
Authors: Xie Junhui , Hu Shuhong 
Published: October 2018

Abstract
Low-density lipoprotein (LDL) cholesterol (LDL-C) always underestimates the true cholesterol burden in diabetic patients. We aimed to explore the impact of the inclusion of apolipoprotein B (apoB) or non-high-density lipoprotein (HDL) cholesterol (non-HDL-C), which are alternative markers of LDL-related risk, results in a better classification of glycated hemoglobin (HbA1c)-defined diabetic patients into different dyslipidemic phenotypes.
We used data from the nationwide China Health and Nutrition Survey 2009 in which standardized HbA1c was measured.
The prevalence of abnormal LDL using non-HDL-cholesterol (74.1%) was similar to the prevalence rate using LDL-C (75.2%), whereas the prevalence was relatively lower when using apoB (69.6%). In normotriglyceridemic HbA1c-defined diabetic patients, apoB and non-HDL-C were not superior to LDL-C in detecting abnormal LDL. However, in hypertriglyceridemic patients, apoB and non-HDL-C were superior to LDL-C for the detection of abnormal lipid levels, but apoB was not superior to non-HDL-C in detecting abnormal LDL in hypertriglyceridemic participants.
Both apoB and non-HDL-C identify high-risk dyslipidemic phenotypes that are not detected by LDL-C in hypertriglyceridemic HbA1c-defined diabetic patients, with the superiority of non-HDL- C over apoB.
Anthracycline versus nonanthracycline adjuvant therapy for early breast cancer
Authors: Ding Wu , Li Zhian , Wang Caiyun , Dai Jiangfeng , Ruan GuoDong , Tu Chuanjian 
Published: October 2018

Abstract

Purpose:
The clinical benefits provided by using anthracycline-contained regimens in patients with early breast cancer (EBC) remain uncertain. This meta-analysis used data from all relevant trials to compare treatment outcomes for patients with EBC receiving adjuvant chemotherapy with non–anthracycline-contained regimens or anthracycline-contained regimens.

Patients and Methods:
Individual patient data were collected on 7 randomized trials comparing non–anthracycline-contained regimens with anthracycline-contained regimens, a total of 14,451 women were analyzed. The hazard ratios (HR) of disease-free survival (DFS) and overall survival (OS), and the risk ratios for grades 3 to 4 toxicities were extracted from the retrieved studies and analyzed using various statistical methods. A pooled analysis was accomplished and HR with 95% confidence intervals (95% CIs) was derived. The significant differences in DFS and OS were explored. A heterogeneity test was applied as well.

Results:
Among 7 eligible trials, significant differences in favor of anthracycline-contained regimens were seen in DFS (HR: 0.86; 95% CI: 0.78–0.95; P = .003) and in OS (HR: 0.85; 95% CI: 0.75–0.97; P = .01). Subgroup analyses of DFS showed similar treatment effects by hormone-receptor status and nodal status, but differential effects by human epidermal growth factor receptor 2 status, menopausal status, and malignancy grade. Sensitive analysis showed that the DFS of taxanes and cyclophosphamide (TC) was noninferior to anthracycline-contained regiments.

Conclusion:
Despite failing to show noninferior to the anthracycline-contained regimens in patients with EBC, it provides evidence that both regimens significantly improved the DFS and OS, and TC regimen may be noninferior to anthracycline-contained regimens.
Association of meteorological factors with pediatric acute appendicitis in China
Authors: Zhang Yao , Lyu Feng-xiang , Kang Quan , Dong Zi-xing , Zhao Tian-xin , Xie Sheng-nan , Luo Qing 
Published: October 2018

Abstract
Acute appendicitis (AA) affects between 7% and 8% of the world population and is one of the most common general surgical emergencies. The concept of seasonal patterns in the incidence of AA remains controversial. Thus, this study aimed to investigate whether meteorological factors are related to variations in the rate of pediatric AA cases at the Children's Hospital in Chongqing, China.
In total, in this retrospective survey, 3436 children younger than 18 years who had been hospitalized with AA from January 1, 2008 to December 31, 2013 were enrolled, and the meteorological factors during this period were collected.
Patients with AA showed a male/female ratio of 1.81:1; the highest incidence age ranged from 6 to 12 years old (P < .0001). The highest incidences of pediatric AA occurred in summer and autumn, with a peak in September and a trough in February. Pearson correlation analysis showed that the monthly mean temperature (r = 0.357, P = .001), monthly mean relative humidity (r = −0.357, P = .001), and monthly mean sunshine duration (r = 0.235, P = −0.031) were relatively weak correlated with pediatric AA. Multiple linear regression analysis indicated that pediatric AA occurrence was positively affected by monthly mean temperature (P < .0001) and negatively affected by monthly mean humidity (P < .0001) and monthly sum of sunshine (P < .0001), while monthly mean air pressure (P = .092), monthly wind speed (P = .143) and monthly precipitation (P = .297) were marginally associated with pediatric AA.
Pediatric AA is associated with climatic factors. Specifically, pediatric AA is more likely related to the following meteorological conditions of: high temperature (20 °C–30 °C), low humidity, and less sunshine.
Association of angiotensin-converting enzyme 2 gene polymorphism and enzymatic activity with essential hypertension in different gender
Authors: Zhang Qi , Cong Mingyu , Wang Ningning , Li Xueyan , Zhang Hao , Zhang Keyong , Jin Ming , Wu Nan , Qiu Changchun , Li Jingping 
Published: October 2018

Abstract
Angiotensin-converting enzyme 2 (ACE2) plays an important role in the development of essential hypertension (EH). The aim of this study was to investigate the relationship of ACE2 gene polymorphisms and enzymatic activity with EH in the northeastern Chinese Han population. 34 single-nucleotide polymorphism (SNP) loci of ACE2 were detected in 1024 EH patients and 956 normotensive (NT) controls by Sequenom Mass-ARRAY RS1000. Five SNPs (rs1514283, rs4646155, rs4646176, rs2285666, and rs879922) in ACE2 gene were determined to significantly associate with EH in female participants, while no SNP locus was linked to male group. Specifically, it was the first time to report that rs4646155 was significantly associated with EH in females. Furthermore, the correlation between ACE2 activity and clinical parameters were performed by Pearson correlation analysis in EH patients. We found that the ACE2 activity level was negatively correlated with body mass index (BMI), DBP, and pulse pressure, and significantly positively with ACE2 concentration, blood glucose and estrogen level in female EH patients. These results demonstrated that the genetic variants of ACE2 played vital roles in the development of EH. And the serum ACE2 activity can predict the development of cardiac dysfunction in EH patients.
Clinical experience with ferric carboxymaltose in the management of anemia in acute gastrointestinal bleeding
Authors: Ballester-Clau Raquel , Torres Vicente Gisela , Voltà-Pardo Tania , López-Barroso Laura , Cucala-Ramos Mercedes , Reñé-Espinet Josep M. , Planella de Rubinat Montse 
Published: October 2018

ObjectiveThe aim of this study was to assess the efficacy and safety of intravenous ferric carboxymaltose (FCM) following hospitalization for acute gastrointestinal bleeding (AGIB) in the context of a restrictive transfusion strategy.Patients and methodsA retrospective single-center study analyzed patients with AGIB (excluding AGIB secondary to portal hypertension) administered a single FCM dose with or without blood transfusion.ResultsEighty-six episodes in 84 patients were analyzed. Seventy-nine patients had upper AGIB. Nineteen episodes were associated with hemodynamic instability. FCM was administered during hospitalization as a single dose of 1000 mg iron in 84/86 episodes and as a single dose of 500 mg iron in two episodes, with blood transfusion in 60/86 (69.8%) episodes. The mean hemoglobin (Hb) was 9.0 g/dl at admission, 7.6 g/dl at the lowest in-hospital value, 9.4 g/dl at discharge, and 12.7 g/dl at follow-up (mean: 55 days postdischarge) (P<0.001 for follow-up vs. all other timepoints). The lowest mean in-hospital Hb value was 7.2 and 8.8 g/dl, respectively, in patients with transfusion+FCM versus FCM alone; the mean Hb was 12.4 versus 13.7 g/dl at follow-up. In patients administered FCM alone, the mean Hb at follow-up in the subpopulations aged older than or equal to 75 years (n=33), Charlson comorbidity index of at least 3 (n=48), and Hb of up to 10 g/dl at admission (n=47) were 12.6, 13.1, and 13.3 g/dl, respectively. No adverse effects were detected.ConclusionTreatment with FCM for AGIB is associated with a good erythropoietic response and anemia correction after hospitalization, even in severe episodes or when transfusion is needed. FCM is safe and well tolerated, and may support a restrictive transfusion policy.
Should Pediatricians Be Aware of Cystic Echinococcosis? A Literature Review
Authors: Tersigni Chiara , Venturini Elisabetta , Montagnani Carlotta , Bianchi Leila , Chiappini Elena , de Martino Maurizio , Galli Luisa 
Published: October 2018

ABSTRACTAmong parasitic hepatic cystic lesions, the most common disease is represented by cystic echinococcosis (CE), especially in high endemic countries. European epidemiology of CE in children is difficult to assess because of under‐reporting but is increasing, because of high immigration flows from endemic countries and an increased awareness. Hydatidosis can be localized in every part of the body. The liver and lungs are the most common localizations in both children and adults. Multiorgan involvement is rarely reported in children. Different tests are available. Usually the sensitivity of serological screening tests is variable, ranging between 60% and 90%. The immunoblot assay is used as a confirmatory test because of its higher sensitivity and specificity. Radiological tests are the criterion standard for diagnosis of CE, with an ultrasound accuracy of approximately 90%. In case of inactive and uncomplicated cysts the watch‐and‐wait approach is recommended. Albendazole, currently used for 3 to 6 months consecutively represents the most commonly used drug in children even if there is limited experience in treating children younger than 6 years of age. Percutaneous treatment with the puncture, aspiration, injection, and reaspiration technique is a minimally invasive procedure. Surgery is indicated based on cyst characteristics in case of big cysts with multiple daughter cysts, single superficial cysts at risk of spontaneous or traumatic rupture, cysts related with the biliary tract in which the percutaneous treatment is contraindicated, and cysts compressing related structures.
Symptom Trajectories of Adolescents During Hematopoietic Stem Cell Recovery
Authors: Rodgers Cheryl , Highberger Marika , Powers Kimberly , Voigt Katherine , Douglas Christian 
Published: October 2018

Background
Adolescents undergoing allogeneic hematopoietic stem cell transplantation (HSCT) experience multiple symptoms during and after the transplant. These symptoms can increase the need for medical care and reduce the quality of their life. However, little is known about symptom experiences specific to adolescents undergoing HSCT.

Objective
The primary aim was to describe symptom incidence, severity, and distress trajectories among adolescents from pre-HSCT through 90 days post-HSCT. A secondary aim was to examine the relationship between symptom trajectories and demographic and treatment factors.

Methods
A repeated-measures design was used for this prospective study. Demographic and treatment information was collected from the medical record. Symptoms were assessed with the Memorial Symptom Assessment Scale 10–18. Symptom trajectories were identified by latent class growth analysis with growth mixture modeling; logistic regression evaluated relationships of demographic and treatment characteristics on the latent classes of symptom trajectories.

Results
Two distinct latent class trajectories were identified for symptom incidence, severity, and distress. Symptom incidence declined, but symptom severity and distress remained stable. No significant relationships were noted among any demographic or treatment characteristics to any of the symptom trajectories.

Conclusions
Symptoms persist and remain severe and distressing throughout the first 90 days after HSCT, with pain and lack of energy among the highest in incidence, severity, and distress.

Implications for Practice
Awareness of symptom trajectories empowers nurses to assess for symptoms throughout the HSCT process and conduct meaningful symptom discussions with their patients.
Multi-modal Educational Curriculum to Improve Richmond Agitation-sedation Scale Inter-rater Reliability in Pediatric Patients
Authors: Kihlstrom Margaret J. , Edge Ashley P. , Cherry Kelly M. , Zarick Paul J. , Beck Shawna D. , Boyd Jenny M. 
Published: October 2018

Introduction:
The Richmond Agitation-sedation Scale (RASS) is a reliable and valid scale for assessing sedation in critically ill pediatric patients. This investigation evaluates the inter-rater reliability of the RASS in mechanically ventilated pediatric patients before and after an educational intervention.

Methods:
This prospective, interventional quality improvement study was completed in a 20-bed pediatric intensive care unit from July 2013 to July 2014. Children 0–18 years of age requiring mechanical ventilation and receiving sedative or analgesic medications were eligible. Staff completed simultaneous paired RASS assessments in 3 phases: baseline, after educational intervention, and maintenance.

Results:
Staff completed 347 paired assessments on 45 pediatric intensive care unit patients: 49 in the baseline phase, 228 in the postintervention phase, and 70 in the maintenance phase. There was a significant increase in the weighted κ after the intervention, from 0.56 (95% CI, 0.39–0.72) to 0.86 (95% CI, 0.77–0.95; P < 0.001). The improvement was maintained months later with weighted κ 0.78 (95% CI, 0.61–0.94). In subgroup analysis, there was an increase in weighted κ in patients less than 1 year of age (0.41–0.87) and those with developmental delay (0.49–0.84).

Conclusions:
The RASS is a reliable tool for sedation assessment in mechanically ventilated, sedated pediatric patients after implementation of an educational intervention. It is also reliable in patients less than 12 months of age and patients with developmental delay. The ability to easily educate providers to utilize a valid, reliable sedation tool is an important step toward using it to provide consistent care to optimize sedation.