bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time for a Changing of Guard
Authors: Khan Muhammad Ali , Kahaleh Michel , Khan Zubair , Tyberg Amy , Solanki Shantanu , Haq Khwaja F. , Sofi Aijaz , Lee Wade M. , Ismail Mohammad K. , Tombazzi Claudio , Baron Todd H. 
Published: October 2018

Background and Aims:
Endoscopic drainage (ED) with or without necrosectomy, and minimally invasive surgical necrosectomy (MISN) have been increasingly utilized for treatment of symptomatic sterile and infected pancreatic walled-off necrosis (WON). We conducted this systematic review to compare the safety of ED with MISN for management of WON.

Methods:
We searched several databases from inception through November 9, 2017 to identify comparative studies evaluating the safety of ED versus MISN for management of WON. MISN could be performed using video-assisted retroperitoneal debridement or laparoscopy. We evaluated difference in mortality, major organ failure, adverse events, and length of hospital stay.

Results:
Six studies (2 randomized controlled trials and 4 observational studies) with 641 patients (326 ED and 315 MISN) were included in this meta-analysis. Rates of mortality for ED and MISN were 8.5% and 14.2%, respectively. Pooled odds ratio (OR) with 95% confidence interval was 0.59 (0.35-0.98), I
2=0% in favor of ED. On subgroup analysis: no difference in mortality was seen based on randomized controlled trials [OR, 0.65 (0.08-5.11)], while ED had improved survival in observational studies [OR, 0.49 (0.27-0.89)]. Development of new major organ failure rates after interventions were 12% and 54% for ED and MISN, respectively. Pooled OR was 0.12 (0.06-0.31), I
2=25% in favor of ED. For adverse events, pooled OR was 0.25 (0.10-0.67), I
2=70% in favor of ED. There was no difference in risk of bleeding [OR, 0.68 (0.44-1.05)], while ED was associated with a significantly lower rate of pancreatic fistula formation [OR, 0.20 (0.11-0.37)], I
2=0%. Length of stay was also lower with ED, pooled mean difference was −21.07 (−36.97 to −5.18) days.

Conclusions:
When expertise is available, ED is the preferred invasive management strategy over MISN for management of WON as it is associated with lower mortality, risk of major organ failure, adverse events, and length of hospital stay.
Who are suitable for low-dose tamsulosin monotherapy as initial treatment strategy in male patients with lower urinary tract symptoms?
Authors: Kim Jae Heon , Shim Ji Sung , Choi Hoon , Park Jae Young , Kwon Soon-Sun , Bae Jae Hyun 
Published: October 2018

Abstract
This study aims to investigate the real indications for low-dose tamsulosin monotherapy for initial treatment.
A cross-sectional study was conducted in a total of 1643 patients with lower urinary tract symptoms (LUTS) and with initial low-dose tamsulosin. Initial pretreatment data including the International Prostate Symptoms Score (IPSS), prostate volume, and uroflowmetry data were reviewed. After 8 weeks of treatment, post-treatment IPSS and satisfaction was assessed. Logistic regression analysis was conducted to investigate the pretreatment factors influencing post-treatment satisfaction.
Overall satisfaction rate with low-dose tamsulosin as an initial treatment medication was 88.7%. Multivariate analysis revealed that symptom durations, IPSS voiding score, IPSS storage score, and quality of life (QoL) were determinant factors for patient satisfaction. ROC analysis revealed that a urinary score > 10 and symptom duration > 3 years showed satisfaction with a sensitivity of 85.8% and 90.6%, respectively, and specificity of 43.5% and 39.8%, respectively. Whereas, ROC analysis revealed that a storage score > 5 and QoL > 3 showed nonsatisfaction with sensitivity of 84.2% and 39.5%, respectively, and specificity of 43.5% and 45.7%, respectively. Multivariate regression analysis demonstrated that voiding score and storage score had a significant relationship with QoL (unstandardized coefficients: 0.073, 0.145, respectively; P-value: < .001, < .001, respectively).
The patient with higher storage scores and higher QoL before treatment could have a higher change of non-satisfaction. Combining treatment with anticholinergics could be considered in these patients.
The ratio of urinary sodium and potassium and chronic kidney disease progression
Authors: Koo Hoseok , Hwang Subin , Kim Tae Hee , Kang Sun Woo , Oh Kook-Hwan , Ahn Curie , Kim Yeong Hoon 
Published: October 2018

Abstract
The Na/K ratio in urine stands for the dietary of sodium and potassium intake in patients with chronic kidney disease remains unclear for the renal progression. We aimed to determine the risk of progression of chronic kidney disease based on the Na/K ratio in a 24-hour urine collection.
We determined the association between the progression of renal disease and 24-hour urinary sodium and potassium (Na/K) ratios in 2238 patients over a 5-year timespan using data obtained from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease (KNOW-CKD). Renal events were defined as a 50% decrease in the glomerular filtration rate (GFR) below baseline, or the onset of end-stage renal disease (ESRD). Patients were divided into 4 groups based on the quartile range of the 24-hour urinary sodium and potassium ratio. We analyzed those variables in the 4 groups. Multiple logistic regression analyses were performed using the data of 1001 patients to identify the independent factors associated with renal events.
Age and male sex accounted for the greatest number of patients in the group with the highest values (group 4) of the 24-hour urinary Na/K ratio (≥3.85). There was no difference in the prevalence of hypertension or diabetes mellitus, the ratio of use of antihypertensive drugs, blood pressures, or estimated GFRs. In the group with the highest urinary Na/K ratio, the 24-hour urinary Na concentration mean ± standard deviation was 188.7 ± 70.6 mmol and that of urinary K was 39.9 ± 16.1 mmol. The urinary protein excretion was highest in the group with the highest urinary Na/K ratio. In the logistic regression analysis, the effect on renal events increased with increasing urinary Na/K ratios. After adjusting for other factors, the risk of renal events was 2.48 (95% confidence interval (CI) 1.30–4.90) in group 3, and 3.75 (95% CI: 1.35–11.27) in group 4. In the Kaplan–Meier analysis, the higher the urinary Na/K ratio, the higher the rate of CKD progression.
Based on our analyses, we concluded that the higher the urinary Na/K ratio, the greater the risk of CKD progression.
Sedentary behavior and the risk of cardiac-cerebral vascular diseases in southern China
Authors: Yu Lingling , Liang Qian , Zhou Wei , Huang Xiao , Hu Lihua , You Chunjiao , Li Juxiang , Wu Yanqing , Li Ping , Wu Qinghua , Bao Huihui , Cheng Xiaoshu 
Published: October 2018

Abstract
Accumulating evidence has reported that prolonged periods of sedentary time have been recognized as a risk factor for cardiocerebrovascular disease. However, whether high levels of sedentary behavior are associated with an increased risk of cardiocerebrovascular disease in different regions remains unclear.
The aim of this study was to evaluate the association between sedentary behavior and the risk of myocardial infarction (MI) and stroke in Jiangxi Province of China.
A cross-sectional survey was conducted among 15,364 participants in Jiangxi Province of China from November 2013 to August 2014, using standardized questionnaire forms and physical measurements. Self-reported sedentary behavior in daily life and a history of MI and stroke were conducted by answering the questionnaire. The participants were examined for weight, height, waist circumference (WC), body fat percentage (BFP), visceral fat index (VAI), basal metabolic rate (BMR), and blood pressure (BP). Multivariate logistic regression analysis was performed to evaluate the association between sedentary behavior and the risk of MI and stroke after adjustment for sociodemographic characteristics, lifestyle factors, and disease-related risk factors.
Of the 15,364 eligible participants, 13,710 participants (5604 men and 8106 women, aged 15–97 years) completed the questionnaire. Subjects who had longer sedentary behavior were significantly associated with an increased risk of MI and stroke [odds ratio (OR) = 1.22, 95% confidence interval (95% CI): 1.168–1.281, P < .001; OR = 1.59, 95% CI: 1.50–1.67, P < .001]. After stratification by the categorical variable of sedentary behavior, individuals with a longer time of sedentary behavior (≥8 hours) were also related to a higher risk of MI and stroke than those in the sedentary behavior (<4 hours) group (OR = 176.62, 95% CI: 43.33–719.90, P < .001; OR = 478.52, 95% CI: 118.50–1932.36, P < .001). However, there were no significant differences between individuals in the short time of sedentary behavior (<4 hours) group and the middle time (4–8 hours) group (p > 0.05).
Excessive time spent in sedentary behavior was associated with a higher risk of MI and stroke. The results provide robust evidence to support the guideline recommendations regarding reduction of sedentary behavior in daily life.
Intraoperative cholangiography versus magnetic resonance cholangiography in patients with mild acute biliary pancreatitis
Authors: Gómez-Torres Gustavo Angel , González-Hernández Jaime , López-Lizárraga Carlos Rene , Navarro-Muñiz Eliseo , Ortega-García Odeth Sherlyne , Bonnet-Lemus Francisco Manuel , Abarca-Rendon Francisco Manuel , De la Cerda-Trujillo Liliana Faviola 
Published: October 2018

Abstract
Cholecystectomy is the only definitive management of pancreatitis secondary to gallstone disease. Approximately 20% to 30% of patients with acute biliary pancreatitis (ABP) will have persistent common bile duct (CBD) stones. Therefore, choosing a method for the early diagnosis of choledocholithiasis is essential to reduce waiting days for surgery and hospital stay in these patients.
The aim of this study was to compare the use of magnetic resonance cholangiography (MRC) and intraoperative cholangiography (IOC), and its impact on the length of the hospital stay in patients with mild ABP and an intermediate probability of choledocholithiasis.
We prospectively evaluated all patients diagnosed with mild ABP and an intermediate probability of choledocholithiasis at admission and 48 hours after, from June, 2017 to December, 2017. Study subjects were identified upon admission and were classified into 2 groups of patients according to their choledocholithiasis predictors; a MRC was performed in the group 1, and an IOC was done in group 2.
In all, 47 patients were enrolled in the final analysis of this study. Hospital stay in group 1 (CMR) patients was 8.29 (±2.69) days compared with 6.43 (±2.57) days in the group 2 (IOC) (P = .007). Mean waiting days for cholecystectomy was 17.14 (±26.04) days for group 1 and 5 (±2.69) days for group 2.
We suggest an IOC as the election method for the diagnosis of CBD stones in patients with mild ABP in medical centers similar to ours because it reduces waiting days for surgery and hospital stay compared to the MRC.
Successful treatment of disseminated intravascular coagulation by recombinant human soluble thrombomodulin in patients with acute myeloid leukemia
Authors: Ookura Miyuki , Hosono Naoko , Tasaki Toshiki , Oiwa Kana , Fujita Kei , Ito Kazuhiro , Lee Shin , Matsuda Yasufumi , Morita Mihoko , Tai Katsunori , Negoro Eiju , Kishi Shinji , Iwasaki Hiromichi , Ueda Takanori , Yamauchi Takahiro 
Published: October 2018

Abstract
Disseminated intravascular coagulation (DIC) is a life-threatening condition that frequently occurs in patients with hematologic malignancies. Currently, recombinant human soluble thrombomodulin (rTM) is a therapeutic DIC drug that is manufactured and sold in Japan only. We evaluated the efficacy of rTM compared to that of gabexate mesilate (GM), which was previously used routinely for treating DIC in Japan, in patients with acute myeloid leukemia (AML). This retrospective study enrolled 43 AML patients, including 17 with acute promyelocytic leukemia (APL), that was complicated with DIC. DIC resolution rates in non-APL AML and rTM-treated APL patients were 68.4% and 81.8%, respectively. In non-APL AML patients, the duration of rTM administration was significantly shorter than that of GM (7 vs 11 days), suggesting that rTM could improve DIC earlier than GM, although rTM was used in patients with more severe DIC. Moreover, treatment with rTM significantly improved DIC score, fibrinogen, fibrin/fibrinogen degradation product (FDP), and prothrombin time (PT) ratio. Conversely, treatment with GM only improved the DIC score and FDP. In APL patients, the duration of rTM administration was also significantly shorter than that of GM. No severe side effects associated with the progression of bleeding were observed during rTM administration. These findings suggest that rTM is safe, and its anti-DIC effects are more prompt than GM for treating AML patients with DIC.
Influence of an inconsistent appearance of antipsychotics on drug adherence in patients with schizophrenia
Authors: Lertxundi Unax , Hernandez Rafael , Corcóstegui Beatriz , Ibarra Olatz , Mentxaka Gorka , Medrano Juan 
Published: October 2018

Abstract
In this study, we aimed to determine whether an inconsistent appearance of antipsychotic drugs dispensed was associated with poorer adherence in patients with schizophrenia.
To conduct this study, we linked information from different administrative healthcare databases from the Basque Country. Patients with a medication possession ratio (<80%) were considered to be nonadherent.
More than a quarter of the study population (26.9%, 1294/4810) was nonadherent to antipsychotics. Different brands of the same antipsychotic were dispensed to 8.5% of the patients. Inconsistent appearance was not associated with nonadherence to antipsychotics. Lower adherence to antipsychotics was associated with several other factors: age ≥65 or <30 years, prescription of typical antipsychotics or of long-acting injectable compounds, and nonadherence to antihypertensive and lipid-lowering drugs.
Contrary to our expectations, we did not find a significant association between inconsistent appearance of prescribed antipsychotics and poorer adherence. The percentage of patients who were dispensed different brands of the same antipsychotics was also lower than expected.
Positive non-sentinel axillary lymph nodes in breast cancer with 1-2 sentinel lymph node metastases
Authors: Zheng Jianwei , Cai Shuyan , Song Huimin , Wang Yunlei , Han Xiaofeng , Wu Haoliang , Gao Zhigang , Qiu Fanrong 
Published: October 2018

Abstract
Recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection (ALND) can offer excellent regional control if there is sentinel lymph nodes (SLN) metastases to 1-2 nodes. This study aimed to explore the predictive factors for non-sentinel lymph node (NSLN) metastasis in breast cancer patients with 1-2 positive SLNs.
Patients with breast cancer and 1-2 positive SLN admitted between March 2009 and March 2017 and who underwent ALND after SLN biopsy (SLNB) at Beijing Chaoyang Hospital were analyzed retrospectively. Factors influencing the status of NSLN were studied by univariate and multivariate analysis.
Of 1125 patients, 147 patients had SLN metastasis (13.1%) and 119 patients (81.0%) had 1-2 positive SLNs. Among them, 42 patients (35.3%) had NSLN metastasis. The invasive tumor size (P <.001), histological grade (P =.011), lymphovascular invasion (LVI) (P =.006), and over-expression of HER2 (P =.025) significantly correlated with non-SLN metastasis by univariate analysis. LVI (LVI) (P =.007; OR: 4.130; 95% confidence interval [CI]: 1.465–11.641), invasive tumor size (P <.001; OR: 7.176; 95% CI: 2.710–19.002), and HER2 over-expression (P =.006; OR: 5.489; 95% CI: 1.635–18.428) were independently associated with NSLN metastasis by the Logistic regression model. The ROC analysis identified a cut-off point of 26 mm of tumor size (area under the receiver operating characteristic [ROC] curve [AUC] 0.712, CI: 0.614–0.811) was useful for dividing patients with positive SLN (1-2 nodes) into non-SLN-positive and non-SLN-negative groups.
For 1-2 positive SLNs of breast cancer, LVI, large invasive tumor size, and HER2 over-expression are independent factors affecting NSLN metastases.
Langerhans cell histiocytosis complicated with hemophagocytic lymphohistiocytosis in a boy with a novel XIAP mutation
Authors: Guo Xia , Li Qiang , Gao Ju 
Published: October 2018

Abstract

Rationale:
X-linked lymphoproliferative syndromes (XLPs) are rare, yet often fatal primary immunodeficiency diseases, which rarely manifest as Langerhans cell histiocytosis (LCH) complicated with hemophagocytic lymphohistiocytosis (HLH). Clinical data of a case of XLP-2 manifesting as LCH complicated with HLH was retrospectively analyzed to determine the etiology and causal gene.

Patient concerns and diagnosis:
The diagnosis of multisystem LCH was confirmed by skin biopsy and other examinations in a 13-month boy with recurrent ear discharge, fever and hemorrhagic papules for 3 months. A good therapeutic response to LCH-III protocol-directed induction chemotherapy was achieved but unremitting HLH developed 6 weeks after the initiation of induction chemotherapy. To identify possible underlying genetic causes, gene mutation analysis was undertaken. A novel XIAP gene mutation (c.99delT, p.F33fsX37) was documented.

Interventions:
After the diagnosis of HLH had been confirmed, HLH-2004-directed chemotherapy was instituted.

Outcomes:
The clinical condition of the patient had become progressively deteriorating after 8-week chemotherapy of HLH-2004 protocol, requiring frequent infusions of RBC suspensions and apheresis platelets. His parents decided to receive no further therapy, and the patient died soon after discharge.

Lessons:
Meticulous laboratory investigations including genetic studies should be undertaken in young children with LCH complicated with HLH and poor therapeutic response.
Prostaglandin E1 plus methylcobalamin combination therapy versus prostaglandin E1 monotherapy for patients with diabetic peripheral neuropathy
Authors: Jiang De-Qi , Zhao Shi-Hua , Li Ming-Xing , Jiang Li-Lin , Wang Yong , Wang Yan 
Published: October 2018

Abstract

Background:
Prostaglandin E1 (P) or methylcobalamin (M) treatment has been suggested as a therapeutic approach for diabetic peripheral neuropathy (DPN) in many clinical trial reports. However, the combined effects of 2 drugs still remain dubious.

Objective:
The aim of this report was to evaluate the efficacy of M plus P (M + P) for the treatment of DPN compared with that of P monotherapy, in order to provide a reference resource for rational drug use.

Methods:
Randomized controlled trials (RCTs) of M + P for DPN published up to September 2017 were searched. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated and heterogeneity was assessed with the I
2 test. Subgroup and sensitivity analyses were also performed. The outcomes measured were as follows: the clinical efficacy, median motor nerve conduction velocities (MNCV), median sensory nerve conduction velocity (SNCV), peroneal MNCV, peroneal SNCV, and adverse effects.

Results:
Sixteen RCTs with 1136 participants were included. Clinical efficacy of M + P combination therapy was significantly better than P monotherapy (fifteen trials; RR 1.25, 95% CI 1.18–1.32, P < .00001, I
2 = 27%). Compared with P monotherapy, the pooled effects of M + P combination therapy on nerve conduction velocity were (MD 6.29, 95% CI 4.63–7.94, P < .00001, I
2 = 90%) for median MNCV, (MD 5.68, 95% CI 3.53–7.83, P < .00001, I
2 = 94%) for median SNCV, (MD 5.36, 95% CI 3.86–6.87, P < .00001, I
2 = 92%) for peroneal MNCV, (MD 4.62, 95% CI 3.48–5.75, P < .00001, I
2 = 86%) for peroneal SNCV. There were no serious adverse events associated with drug intervention.

Conclusions:
M + P combination therapy was superior to P monotherapy for improvement of neuropathic symptoms and NCVs in DPN patients. Moreover, no serious adverse events occur in combination therapy.
Pregnancy and pulmonary hypertension
Authors: Sun Xuefeng , Feng Jun , Shi Juhong 
Published: October 2018

Abstract
Pregnancy is usually contraindicated in patients with pulmonary hypertension (PH). Risk factors associated with the outcome of this rare disease have not been specifically explored before.
Medical records were retrospectively reviewed to identify patients with coexisting PH and pregnancy or delivery at Peking Union Medical College Hospital between January 2009 and June 2018. Demographics, characteristics of PH and pregnancy, management and outcomes were analyzed.
Thirty-six pregnant women with PH were identified, including 30 cases in WHO group 1, 5 cases of group 2 and 1 case of group 4. Median pregnancy duration was 24 weeks. The overall maternal mortality rate was 8.3% (3/36), and the late fetal mortality was 31.6% (6/19). Pulmonary vascular-targeted medications were used in 17 of 26 patients with moderate or severe PH, but in none with mild PH. Maternal mortality was 2/15, 1/11, and 0 among women with severe, moderate, and mild PH, respectively. All deaths reported to be diagnosed of PH after pregnancy, and have New York Heart Association (NYHA) grades II to IV. Cesarean section was performed in 22 patients, and mortality was 3/16 among women receiving cesarean section with general anesthesia.
Maternal mortality is associated with PH classification, severity of PH, delayed diagnosis of PH, and NYHA classification. Regional anesthesia seems superior to general anesthesia for cesarean section.
Effect of microecological preparation supplementation on woman with polycystic ovary syndrome
Authors: Zhang Haibo , Wen Wenting , Shen Junlong , Wei Luxia 
Published: October 2018

Abstract

Background:
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. PCOS not only affects female fertility, but is also associated with a variety of metabolic diseases, such as type 2 diabetes. Microecological preparations include probiotics, prebiotics, and synbiotics, and a number of studies have shown its advantages in reducing cardiovascular and cerebrovascular diseases in patients with PCOS, however, no meta-analysis has been performed to confirm that. Herein, we describe the protocol of a proposed study based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that aims to systematically evaluate the efficacy and safety of microecological preparation supplementation in woman with PCOS.

Methods:
Two researchers will search 9 electronic databases (PubMed, Cochrane Library, Embase, ClinicalTrails, China National Knowledge Infrastructure, Sino Med, ScienceDirect, VIP, and Wanfang Data databases) to identify all studies that meet the inclusion criteria and were published before November 1, 2018. After information extraction and methodological quality evaluation, we will use RevMan software (version 5.3) to synthesize the data. The primary outcomes will be fasting blood glucose, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and very low-density lipoprotein cholesterol (VLDL-c).

Results:
This study will provide a high-quality synthesis of existing evidence on the effect and safety of microecological preparation supplementation on reducing cardiovascular risk of woman with PCOS.

Conclusion:
This study will determine if microecological preparation supplementation is an effective and safe intervention on reducing cardiovascular risk of woman with PCOS.

Registration:
PROSPERO (registration number: CRD42018108403).