bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Ceftazidime Use on Susceptibility Patterns in the Neonatal Intensive Care Unit
Authors: Miller Jamie L. , Johnson Peter N. , White Bryan P. , Neely Stephen B. , Chaaban Hala , Kassa Netsanet , Welliver Robert C. 
Published: November 2018

Background:
Ceftazidime use in the neonatal intensive care unit (NICU) has increased after a cefotaxime shortage. The impact of this change is unknown. The purpose was to assess the effect of increased ceftazidime use on susceptibilities of Gram-negative organisms in the NICU.

Methods:
Retrospective study of Gram-negative isolates identified in blood, urine, cerebrospinal fluid, tracheostomy, abdominal fluid and pleural fluid cultures from a single-center NICU over a 5-year period. Duplicate cultures that occurred within 90 days were noted. Pre- and postshortage periods were defined based on cessation of cefotaxime. Third- and fourth-generation cephalosporin susceptibility rates were compared between periods, as well as rates of extended-spectrum beta-lactamase (ESBL) Escherichia coli and Klebsiella species.

Results:
Analysis included 666 isolates. Twelve (1.8%) were duplicate isolates that occurred after a 90-day period. The preshortage period included 464 (69.7%) isolates, and the postshortage included 202 (30.3%). No significant differences in susceptibility rates were noted when excluding duplicates. No difference in ESBL rates for E. coli were noted between periods (3.8% vs. 4.9%, P =1.000). No ESBL-positive Klebsiella species were identified. A post-hoc analysis of duplicate isolates demonstrated significant lower susceptibility rates for Pseudomonas aeruginosa to ceftazidime (risk ratio 0.58; 95% CI: 0.43–0.79) and cefepime (risk ratio 0.66; 95% CI: 0.51–0.86).

Conclusions:
Ceftazidime use did not appear to affect susceptibility rates for third- and fourth-generation cephalosporins for most Gram-negative organisms in the short-term of 1.5 years. However, susceptibility rates for P. aeruginosa decreased when evaluating duplicate isolates. Long-term monitoring is needed to assess the true impact.
Predictors of Palliative Care Knowledge Among Nursing Students in Saudi Arabia: A Cross-Sectional Study
Authors: ABOSHAIQAH Ahmad E. 
Published: November 2018

ABSTRACT

Background:
Societal aging, a concern in many countries worldwide, is increasing the demand for quality palliative care in Saudi Arabia. Nursing education is responsible for providing nursing students with high levels of knowledge and competency related to palliative care.

Purpose:
The aim of this study was to investigate the predictors of palliative care knowledge among nursing students in Saudi Arabia.

Methods:
A convenience sample of 409 nursing students from one public academic institution and one private academic institution in Saudi Arabia was surveyed from November to December 2017 in this descriptive, cross-sectional study. The 20-item Palliative Care Quiz for Nursing was used to collect the data. Descriptive statistics were used to fully describe the demographic characteristics and palliative care knowledge of the participants. One-way analysis of variance and t test were used to examine the associations between palliative care knowledge and the demographic characteristics. Multiple regression analysis was conducted to identify the significant demographic predictors of this knowledge.

Results:
The mean score of the participants was 5.23 (SD = 3.24, range = 0–12), indicating poor palliative care knowledge. The participants lacked palliative care knowledge in terms of palliative care principles and philosophy, management of pain and other symptoms, and psychosocial and spiritual care. Being enrolled in a private university, being in the second year of a nursing program, having attended palliative care education sessions outside a university setting, and attending a palliative care course in the nursing program were identified as significant predictors of higher palliative care knowledge.

Conclusions/Implications for Practice:
This study may be used as a basis for formulating education policies and interventions to enhance palliative care education and clinical training among nursing students and ensure the quality of palliative care not only in Saudi Arabia but also in other countries.
Infective endocarditis complicated with nonobstructive ST elevation myocardial infarction related to septic embolism with intracranial hemorrhage
Authors: Liu Yi-Hsueh , Lee Wen-Hsien , Chu Chun-Yuan , Su Ho-Ming , Lin Tsung-Hsien , Yen Hsueh-Yei , Voon Wen-Chol , Lai Wen-Ter , Sheu Sheng-Hsiung , Hsu Po-Chao 
Published: November 2018

Abstract

Rationale:
Infective endocarditis (IE) complicated with obstructive ST elevation myocardial infarction (STEMI) has been reported in the literature and which were mostly related to coronary artery embolism, obstruction, or compression. However, there has been no reported case discussing about IE complicated with nonobstructive STEMI.

Patient concerns:
In this report, we report a 38-year-old female suffering from intermittent fever and was later diagnosed as IE. Initially antibiotic was given and mitral valve surgery was also arranged due to large vegetation with severe mitral regurgitation. Nevertheless, sudden conscious loss with desaturation happened and brain computed tomography (CT) showed intracranial and subdural hemorrhage related to possible septic embolism. In addition, electrocardiography (ECG) revealed ST elevation over precordial leads, and elevation of cardiac enzymes was also noted.

Diagnoses:
Emergent coronary angiography was arranged but result showed normal coronary arteries without any evidence of stenosis. The diagnoses of IE complicated with nonobstructive STEMI were made.

Interventions:
After coronary angiography, the patient underwent craniotomy and subdural hematoma removal. Surprisingly, follow-up ECG also revealed ST segment resolution.

Outcomes:
The patient received full course antibiotic treatment and follow-up brain CT also showed improvement of intracranial hemorrhage (ICH) and subdural hemorrhage. Because follow-up echocardiography still revealed severe mitral regurgitation with mitral valve prolapse due to leaflet destruction with partially decreased vegetation size, mitral valve replacement with bioprosthetic valve was performed and the patient was finally discharged smoothly.

Lessons:
In our knowledge, this case should be the 1st case of IE complicated with nonobstructive STEMI, which reminds physicians that nonobstructive STEMI is still an extremely rare but possible complication of IE and septic embolism related ICH should be carefully surveyed in this rare patient group.
Blood pressure lowering effect of calcium channel blockers on perioperative hypertension
Authors: Lin Yu , Ma Lina 
Published: November 2018

Abstract

Background:
Acute perioperative hypertension has been associated with poor outcomes of surgery, and the role of calcium channel blockers (CCB) on controlling perioperative blood pressure (BP) remains controversial. Thus, this meta-analysis was designed to assess the efficacy and safety of CCB in treating perioperative hypertension compared with other antihypertensive agents.

Methods:
PubMed, Medline, Cochrane, and EMABSE databases was systematically searched up to January 2018 for randomized control trials (RCTs) or other control studies comparing the efficacy of CCB versus other antihypertensive medicines for perioperative hypertension modulation. The efficacy and safety of CCB in treating perioperative hypertension were assessed through pooling mean difference (MD) with its 95% confidence interval (CI) or risk ratio (RR) with its 95% CI.

Results:
In total, 14 studies were included in the meta-analysis. There is no significant difference regarding successful treatment (RR = 2.64, 95% CI: 0.95, 7.29; I2 = 97%, P <.05), systolic blood pressure (SBP) (MD = −7.05, 95% CI: −16.27, 2.17; I2 = 78%, P <.05), overall adverse events (RR = 0.88, 95% CI: 0.66, 1.16; I2 = 54%, P = .02), atrial fibrillation (RR = 0.80, 95% CI: 0.60, 1.07; I2 = 32%, P = .20) and heart rates (MD = −1.05, 95% CI: −7.81, 5.71; I2 = 84%, P < .05) between patients treated by CCB and other drugs. In the subgroup analysis, statistical significance can be observed regarding successful treatment (RR = 3.46, 95%CI: 1.67, 7.18; I2 = 84%, P <.05) and postoperative SBP (MD = −9.98, 95%CI: −20.03, 0.08; I2 = 97%, P <.05) in the RCTs subgroup.

Conclusion:
CCB was highly effective and well tolerated for treating perioperative hypertension.
Long-term outcomes of a patient with late-onset multiple acyl-CoA dehydrogenase deficiency caused by novel mutations in ETFDH
Authors: Wang Juan , Wu Jun-Cang , Yu Xu-En , Han Yong-Zhu , Yang Ren-Min 
Published: November 2018

Abstract

Rationale:
Late-onset multiple acyl-coenzyme A dehydrogenase deficiency (MADD) mainly affects the neck extensor muscle group, which has been confirmed by novel mutations in electron-transferring-flavoprotein dehydrogenase (ETFDH). So far, a few cases have been reported with long-term follow-up. Here we report a case of late-onset MADD where the patient was followed up for 8 years during which time he underwent 2 muscle biopsies and 2 pathological examinations and his symptoms were significantly alleviated after appropriate treatments.

Patient concerns:
In September 2009, a 16-year-old male patient was hospitalized due to gradually increasing difficulty in raising his head and weakness in limb muscles over a 6-month period. During the physical examination, the patient's neck extensor muscle strength was grade III–IV. His proximal limb muscle strength was grade IV, and his distal muscle strength was normal. His blood creatine kinase (CK) was 783 U/L.

Diagnosis:
Muscle biopsy revealed a large number of vacuolar fibers, which were mainly type I fibers. These findings were consistent with the diagnosis of lipid storage myopathy (LSM). ETFDH gene test detected C.736G > A at exon 7 and C.920C > G at exon 8.

Interventions:
Coenzyme Q10 treatment was administered. The first coenzyme Q10 40 mg tid was treated for three months, with the change of coenzyme Q10 20 mg tid for 6 months, followed by the change of coenzyme Q10 10 mg tid for long-term use.

Outcomes:
The patient's condition significantly improved after 3 months. At 7th year follow-up the patient's blood CK was normal, and a second muscle biopsy revealed no muscle vacuolar fibers and no increase in lipid droplets. Subsequently, the patient was withdrawn from the coenzyme Q10 treatment, and the condition of the patient remained normal.

Lessons:
Muscle biopsy was the main method used to determine LSM. Treatment with riboflavin should be started when the diagnosis of LSM is definitive. Furthermore, ETFDH gene tests should be performed for further classification. Moreover, coenzyme Q10 may be another effective drug for MADD.
Neonatal lethal hypophosphatasia
Authors: Castells Laura , Cassanello Pía , Muñiz Felix , de Castro María-José , Couce María L. 
Published: November 2018

Abstract

Rationale:
Hypophosphatasia (HPP) is a very rare metabolic bone disease caused by loss-of-function mutations in the ALPL gene encoding the tissue nonspecific alkaline phosphatase. The severe neonatal form is considered lethal but insights into manifestations of the disease can help to increase our knowledge of the natural history for an early initiation of treatment and improvement of survival.

Patient concerns:
We report the case of a newborn in which his fetal imaging showed findings of skeletal dysplasia disorder, considering initially achondroplasia as a potential diagnosis.

Diagnosis:
A definitive diagnosis compatible with perinatal lethal HPP was established in the 1st days due to the presentation at birth with thoracic and pulmonary hypoplasia, bone hypomineralization, and undetectable alkaline phosphatase. The genetic analysis identified a new heterozygous c.413G>C mutation and another 1 c.473-2G>C previously described in the ALPL gene.

Outcomes:
The patient died on the 4th day by clinical course complicated without having started enzyme replacement therapy (ERT). Retrospectively, previous analyzes of the parents already showed both a decreased alkaline phosphatase.

Lessons:
This report highlights the importance of prenatal differential diagnosis of bone dysplasia with the key biochemical marker of alkaline phosphatase in the parents. Substitutive ERT administered very soon after birth, seems to change the prognosis in these patients with neonatal HPP.
Atypical purpura location in a pediatric patient with Henoch-Schönlein purpura
Authors: Zhang Fanhui , Chen Lihua , Shang Shiqiang , Jiang Kewen 
Published: November 2018

Abstract

Rationale:
The presence of purpura is a compulsory criteria for the diagnosis of Henoch-Schönlein purpura (HSP). Typical purpura of HSP is distributed symmetrically over the extensor surfaces of the lower limbs, buttocks, and forearms with the occasional involvement of trunk and face in children. It occurs only involving the bottom of the feet has never been reported.

Patient concerns:
A 7-year-old girl was admitted to the hospital with abdominal pain, vomiting, and fever.

Diagnoses:
Combining clinical manifestations with results of radiologic examinations, acute appendicitis was suspected and a laparotomy was considered. Purpura was found on the bottom of her feet when she was in the operating room and HSP was diagnosed.

Interventions:
The patient was treated with glucocorticosteroids, antibiotics, cimetidine, and restriction of feeding.

Outcomes:
The abdominal pain and purpura resolved at discharge and there were no recurrences in the subsequent 3-, 6-, and 12-month follow-ups.

Lessons:
Careful examination of skin including the bottom of the feet can help to direct the diagnostic workup for children with abdominal pain.
Doppler myocardial performance index combined with plasma B-type natriuretic peptide levels as a marker of cardiac function in patients with decompensated cirrhosis
Authors: Wang Li-Kun , An Xiao-Fei , Wu Xue-Liang , Zhang Su-Mei , Yang Rui-Min , Han Chao , Yang Jie-Lin , Wang Yi-Cheng 
Published: November 2018

Abstract

Background:
In chronic liver diseases, cirrhosis ranks as the 14th highest death cause worldwide, developing into decompensated cirrhosis. A potential and feasible technique in assessing cardiac function is urgent. This study explores if the Doppler myocardial performance (Tei) index combined with the plasma B-type natriuretic peptide (BNP) levels can assess cardiac function in patients with decompensated cirrhosis.

Methods:
A total of 140 individuals were selected in the study and were classified into 3 groups: control group (n = 40, healthy individuals), compensated cirrhosis group (n = 50), and decompensated cirrhosis group (n = 50). Plasma BNP levels, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and albumin (ALB) were identified by an enzyme-linked immunosorbent assay (ELISA). The correlation of Tei index between left ventricle (LV) and right ventricle (RV) as well as plasma BNP levels with cardiac function was assessed using a Pearson test analysis. All patients were subjected to this experiment for 1 year to analyze the relationship between Tei index and plasma BNP levels in prognosis of decompensated cirrhosis patients.

Results:
Patients with decompensated cirrhosis showed significantly elevated levels of ALT, AST, and TBIL level in contrary to a reduced ALB level. Cirrhosis patients also showed a significantly reduced ejection fraction (ET) index, but an increase in isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), Tei index, and plasma BNP levels in comparison to healthy individuals. ICT, IRT, Tei index, and plasma BNP levels were elevated in decompensated cirrhotic patients as opposed to compensated cirrhotic patients. These results indicate a positive correlation of both Tei index and plasma BNP levels with cirrhosis and its progression. Tei index and plasma BNP levels are positively associated with Child–Pugh classification and negatively correlated with both cardiac function and prognosis in patients suffering from decompensated cirrhosis.

Conclusion:
The study provided evidence supporting the correlation of Tei index and plasma BNP levels in decompensated cirrhotic patients with cardiac function, highlighting a potential value for evaluation.
Prevention of type 2 diabetes mellitus with acupuncture
Authors: Shi Liwei , Feng Ling , Yang Yanan , Li Xiaowen , Zhang Meizhen , Zhang Yueying , Ni Qing 
Published: November 2018

Abstract

Background:
Prediabetes is prevalent and significantly increases lifetime risk of progression to type 2 diabetes mellitus (T2DM). Acupuncture has been increasingly used for prediabetes in China but its effect is unclear. We aim to assess the efficacy and safety of acupuncture in preventing or delaying incident diabetes among individuals with prediabetes.

Methods:
The following 8 databases will be searched from inception to September 1, 2018: the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, PubMed, Embase, Chinese National Knowledge Infrastructure database, Chinese Biomedical Literature database, Chinese Scientific Journal database, Wan Fang database, and Clinical Trials. The incidence of diabetes and regression toward normoglycemia will be accepted as the primary outcomes. The Cochrane Risk of Bias tool will be used to evaluate the methodologic quality of eligible studies. Meta-analysis will be performed by Review Manager 5.3.

Results:
This study will provide a high-quality synthesis of current evidence of acupuncture in the prevention of T2DM from several aspects including the incidence of diabetes, regression toward normoglycemia, fasting plasma glucose, 2-hour plasma glucose level after a 75-g oral glucose tolerance test, glycosylated hemoglobin level, body mass index, and adverse drug events.

Conclusions:
The conclusion of this review will provide evidence to judge whether acupuncture is an effective and safe intervention for prediabetes.

PROSPERO registration number:
PROSPERO CRD42018111236.
Role of SH2B3 R262W gene polymorphism and risk of coronary heart disease
Authors: Hong Lu , Jiang Yu-Feng , Chen Min , Zhang Nan-Nan , Yang Hua-Jia , Rui Qing , Zhou Ya-Feng 
Published: November 2018

Abstract

Background:
More susceptibility genes have been proved to be associated with coronary heart disease (CHD). The goal of our study is to evaluate the association between the R262W polymorphism of SH2B3 gene and risk of CHD.

Methods:
A systematic search was conducted using PubMed, Embase, Web of Science, CNKI, and WanFang databases up to March of 2018. The data of individual study were individually performed by 2 reviewers. The meta-analysis was performed by Stata software and expressed by the pooled odds ratio (OR) and the 95% confidence interval (CI), which were calculated by specific model according to heterogeneity.

Results:
Our research was based on 12 studies involving 25,845 patients and 68,910 healthy controls. Significant association between the variant R262W and CHD were found in overall populations (OR = 1.12, 95%CI = 1.09–1.15, P = .389, I
2 = 5.4%), but not found in Asian (OR = 1.05, 95%CI = 0.98–1.12, I
2 = 0.0%) in subgroup analysis by ethnicity. In another subgroup analysis, when classified into CHD and myocardial infarction (MI), there was a significance association between R262W and CHD (OR = 1.11,95% CI = 1.07–1.15, I
2 = 13.5%) and MI (OR = 1.13, 95%CI = 1.08–1.18, I
2 = 0.0%). The Begg's funnel plot revealed no significant publication bias.

Conclusions:
The R262W polymorphism is associated with risk of CHD or MI in Europeans, but not in Asians.
Effectiveness of 18F-FDG PET/CT in the diagnosis, staging and recurrence monitoring of Ewing sarcoma family of tumors
Authors: Huang Tao , Li Feng , Yan Zexing , Ma Yupeng , Xiong Fei , Cai Xia , Zhang Qingyu , Liu Fanxiao , Dong Jinlei 
Published: November 2018

AbstractBackground:To investigate the value of positron emission tomography (PET) and PET/computed tomography (CT) using fluorine-18-fluorodeoxyglucose (18F-FDG) in the diagnosis, staging, restaging and recurrence monitoring of Ewing sarcoma family of tumors (ESFTs), a meta-analysis was performed through systematically searching PubMed, Embase, and Cochrane Central library to retrieve articles.Methods:After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity, specificity, and diagnostic odd ratio (DOR) as well as the summary receiver operating characteristic curve (SROC) were calculated involving diagnostic data (true positive, false positive, false negative, and true negative) extracted from original studies.Results:Screening determined that out of 2007, 23 studies involving a total of 524 patients were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that the sensitivity and specificity were at 86% and 80%, respectively. Additionally, a satisfactory accuracy of18F-FDG PET and PET/CT was observed in detecting ESFT recurrence, lung metastasis, and osseous metastasis.Conclusion:This meta-analysis suggests that18F-FDG PET and PET/CT with an extremely high accuracy could be considered a valuable method for detecting distant metastasis and post-operational recurrence of ESFT, which might have a profound impact on the development of treatment protocols for ESFT.
Undifferentiated carcinoma with osteoclast-like giant cells of pancreas
Authors: Guo Yun-lei , Ruan Li-tao , Wang Qiu-ping , Lian Jie 
Published: November 2018

Abstract

Rationale:
Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGCs) of the pancreas is an extremely rare and aggressive pancreatic malignancy. To our knowledge, the computed tomography (CT) findings of this disease have rarely been analyzed.

Patient concerns:
A 65-year-old man who experienced weight loss of about 4 kg over 3 months presented to our clinic. The abdominal ultrasound (US) detected a 5.8 × 5.5 cm well-defined, cystic-solid mass in the head of the pancreas, which had been present for 1 month.

Diagnosis:
A benign pancreatic tumor was initially suspected on the basis of the US findings. The patient then received serum tumor markers and CT examinations for further diagnosis, including carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), contrast-enhanced CT (CECT) and CT angiography (CTA). His CA199, CEA, and CA125 marker levels were normal, which supported the diagnosis of a benign tumor. CECT showed a well-defined cystic-solid mass in the head of the pancreas, with a slightly enhanced solid portion and pancreatic ductal dilatation, which led us to consider the possibility of a malignant tumor. CTA revealed that the tumor nourishing arteries emitted from the pancreaticoduodenal superior and inferior arteries into the mass. Then, the patient underwent a pancreaticoduodenectomy. Finally, postoperative pathology and immunohistochemistry confirmed UC-OGC of the pancreas.

Interventions:
The patient has been treated by a pancreaticoduodenectomy alone.

Outcomes:
The operation had no complications, and the patient recovered well after surgery. Ten months after surgery, the patient reviewed the CECT, and no recurrence or metastasis was noted.

Lessons:
Old patients with cystic-solid lesions in the pancreas should be aware of UC-OGC. CT findings usually show a clear boundary and a slightly enhanced mass with pancreatic duct expansion.