bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Infectious Sacroiliitis: Characterization and Differentiation from Noninfectious Etiologies
Authors: Vardi Yoav , Levy Itzhak , Ashkenazi-Hoffnung Liat , Sherman Gilad , Berger Itay , Rom Eran , Chodick Gabriel , Landau Daniel , Scheuerman Oded 
Published: April 2019

Background:
Pediatric sacroiliitis (SI) is an uncommon entity of infectious or inflammatory etiology. Recent data regarding pediatric SI are scarce. The study objective was to describe and compare the clinical features of pediatric infectious and noninfectious SI.

Methods:
We reviewed files of children ≤18 years of age, admitted with SI in 2004–2017. Patients were grouped by etiology, infectious versus noninfectious. Clinical and laboratory indices, imaging, treatment protocols and outcome were compared.

Results:
Study population included 40 patients with infectious SI (range: 3–192 months, median age: 15 months, 45% female) and 13 patients with noninfectious SI (range: 30–216 months, median age: 168 months, 62% females). Duration of symptoms before admission averaged 5.9 ± 7.5 days in the infectious group and 54.2 ± 96 days in the noninfectious group (P = 0.003). Symptoms observed solely in the infectious group included refusal to stand (n = 27, 77%); walk or crawl (n = 24, 65%); irritability (n = 20, 50%) and recent constipation event (n = 8, 20%). No significant differences in laboratory results were found. Infectious SI patients had uneventful medical history, rapid response to antibiotics and a higher rate of complete resolution of symptoms without recurrences.

Conclusions:
An acute unilateral presentation in young patients ≤2 years of age, without chronic medical conditions, suggests an infectious etiology of SI anticipated to completely resolve with antibiotic treatment, not necessitating further workup for noninfectious etiologies.
Somatosensory predictors of response to pregabalin in painful chemotherapy-induced peripheral neuropathy: a randomized, placebo-controlled, crossover study
Authors: Hincker Alexander , Frey Karen , Rao Lesley , Wagner-Johnston Nina , Ben Abdallah Arbi , Tan Benjamin , Amin Manik , Wildes Tanya , Shah Rajiv , Karlsson Pall , Bakos Kristopher , Kosicka Katarzyna , Kagan Leonid , Haroutounian Simon 
Published: April 2019

Abstract
Painful chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and treatment-resistant sequela of many chemotherapeutic medications. Ligands of α2δ subunits of voltage-gated Ca2+ channels, such as pregabalin, have shown efficacy in reducing mechanical sensitivity in animal models of neuropathic pain. In addition, some data suggest that pregabalin may be more efficacious in relieving neuropathic pain in subjects with increased sensitivity to pinprick. We hypothesized that greater mechanical sensitivity, as quantified by decreased mechanical pain threshold at the feet, would be predictive of a greater reduction in average daily pain in response to pregabalin vs placebo. In a prospective, randomized, double-blinded study, 26 patients with painful CIPN from oxaliplatin, docetaxel, or paclitaxel received 28-day treatment with pregabalin (titrated to maximum dose 600 mg per day) and placebo in crossover design. Twenty-three participants were eligible for efficacy analysis. Mechanical pain threshold was not significantly correlated with reduction in average pain (P = 0.97) or worst pain (P = 0.60) in response to pregabalin. There was no significant difference between pregabalin and placebo in reducing average daily pain (22.5% vs 10.7%, P = 0.23) or worst pain (29.2% vs 16.0%, P = 0.13) from baseline. Post hoc analysis of patients with CIPN caused by oxaliplatin (n = 18) demonstrated a larger reduction in worst pain with pregabalin than with placebo (35.4% vs 14.6%, P = 0.04). In summary, baseline mechanical pain threshold tested on dorsal feet did not meaningfully predict the analgesic response to pregabalin in painful CIPN.
Cooling the skin for assessing small-fibre function
Authors: Leone Caterina , Dufour André , Di Stefano Giulia , Fasolino Alessandra , Di Lionardo Andrea , La Cesa Silvia , Galosi Eleonora , Valeriani Massimiliano , Nolano Maria , Cruccu Giorgio , Truini Andrea 
Published: April 2019

Abstract
In this clinical and neurophysiological study using a novel cold stimulator, we aim at investigating whether cold-evoked potentials (CEPs) may prove to be a reliable diagnostic tool to assess trigeminal small-fibre function. Using a novel device consisting of micro-Peltier elements, we recorded CEPs after stimulating the supraorbital and perioral regions and the hand dorsum in 15 healthy participants and in 2 patients with exemplary facial neuropathic pain conditions. We measured peripheral conduction velocity at the upper arm and studied the brain generators using source analysis. In healthy participants and patients, we also compared CEPs with laser-evoked potentials. In the healthy participants, cold stimulation evoked reproducible scalp potentials, similar to those elicited by laser pulses, although with a latency of about 30 ms longer. The mean peripheral conduction velocity, estimated at the upper arm, was 12.7 m/seconds. The main waves of the scalp potentials originated from the anterior cingulate gyrus and were preceded by activity in the bilateral opercular regions and bilateral dorsolateral frontal regions. Unlike laser stimulation, cold stimulation evoked scalp potential of similar amplitude across perioral, supraorbital, and hand dorsum stimulation. In patients with facial neuropathic pain, CEP recording showed the selective damage of cold pathways providing complementary information to laser-evoked potential recording. Our clinical and neurophysiological study shows that this new device provides reliable information on trigeminal small fibres mediating cold sensation and might be useful for investigating patients with facial neuropathic pain associated with a distinct damage of cold-mediating fibres.
High-threshold primary afferent supply of spinal lamina X neurons
Authors: Krotov Volodymyr , Tokhtamysh Anastasia , Safronov Boris V. , Belan Pavel , Voitenko Nana 
Published: April 2019

Abstract
The spinal gray matter region around the central canal, lamina X, is critically involved in somatosensory processing and visceral nociception. Although several classes of primary afferent fibers terminate or decussate in this area, little is known about organization and functional significance of the afferent supply of lamina X neurons. Using the hemisected ex vivo spinal cord preparation, we show that virtually all lamina X neurons receive primary afferent inputs, which are predominantly mediated by the high-threshold Aδ- fibers and C-fibers. In two-thirds of the neurons tested, the inputs were monosynaptic, implying a direct targeting of the population of lamina X neurons by the primary nociceptors. Beside the excitatory inputs, 48% of the neurons also received polysynaptic inhibitory inputs. A complex pattern of interactions between the excitatory and inhibitory components determined the output properties of the neurons, one-third of which fired spikes in response to the nociceptive dorsal root stimulation. In this respect, the spinal gray matter region around the central canal is similar to the superficial dorsal horn, the major spinal nociceptive processing area. We conclude that lamina X neurons integrate direct and indirect inputs from several types of thin primary afferent fibers and play an important role in nociception.
Concomitant pancreatic neuroendocrine tumors in hereditary tumor syndromes: who, when and how to operate?
Authors: Han Xu , Lou Wenhui 
Published: April 2019

Abstract
Pancreatic neuroendocrine tumors (pNETs) might present as part of a complex of hereditary (familial) syndromes caused by germline mutations such as multiple endocrine neoplasia type 1 (MEN1), von Hippel–Lindau syndrome (VHL), tuberous sclerosis, and neurofibromatosis syndromes. Hereditary pNETs are frequently misdiagnosed because their presentation may mimic other more common diseases, resulting in diagnostic delays. Although non-operative (conservative) management could be advocated in select cases in most patients, hereby avoiding surgery without loss of oncological safety, some cases still need operative intervention before malignancy develops. The objective of this review is to address the most recent literature and the evidence it provides for the indications, timing and options of operative treatment for concomitant pNETs in hereditary tumor syndromes. Complete sequencing of the whole gene is recommended for suspected hereditary pNETs. Proven functional pNETs with hereditary tumor syndromes is a good indication for surgical treatment. Conservative management for MEN1 patients with a non-functional pNET of 2 cm or smaller is associated with a low risk of malignant transformation and metastasis development. VHL-related pNETs patients with tumor size >1.5 cm or a missense mutation or any mutation type in exon 3 may benefit from surgical intervention. The parenchyma-sparing surgical strategy should be preferentially performed whenever possible in all hereditary syndromes. The decision to recommend surgery to prevent malignant transformation and tumor spread, which is based on multidisciplinary expertise and the patient's preference, should be balanced with operative mortality and morbidity.
In the ICU – delirium post cardiac arrest
Authors: Boncyk Christina S. , Rengel Kimberly F. , Pandharipande Pratik P. , Hughes Christopher G. 
Published: April 2019

Purpose of review
The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium.

Recent findings
Patient factors leading to a cardiac arrest, initial resuscitation efforts, and postresuscitation management all influence the potential for recovery and the risk for development of delirium. Data suggest that delirium in cardiac arrest survivors is an independent risk factor for morbidity and mortality. Recognizing delirium in postcardiac arrest patients can be challenging; however, detection is not only achievable, but important as it may aid in predicting adverse outcomes. Serial neurologic examinations and delirium assessments, targeting light sedation when possible, limiting psychoactive medications, and initiating patient care bundles are important care aspects for not only allowing early identification of primary and secondary brain injury, but in improving patient morbidity and mortality.

Summary
Developing delirium after cardiac arrest is associated with increased morbidity and mortality. The importance of addressing modifiable risk factors, recognizing symptoms early, and initiating coordinated treatment strategies can help to improve outcomes within this high risk population.
Increasing negative lymph node count is independently associated with improved long-term survival in resectable perihilar cholangiocarcinomas
Authors: Gao Yunfeng , Xu Dong , Wu Yu-Shen , Chen Duke , Xiong Wanchun 
Published: April 2019

Abstract
To evaluate the prognostic value of numbers of negative lymph nodes (NLNs) for patients with perihilar cholangiocarcinomas.
The surveillance, epidemiology, and end results database was used to screen for patients with perihilar cholangiocarcinomas. Kaplan–Meier and Cox regression analyses were used for statistical evaluations. Subsequently, propensity score matching (PSM) was performed to confirm the results.
A total of 938 patients with perihilar cholangiocarcinomas met the inclusion criteria. The cut-off number for the grouping of patients with different numbers of NLNs was 17. Both the univariate and multivariate survival analyses demonstrated that there was a significant improvement in terms of cancer-specific survival for patients with >17 NLNs, compared with patients with ≤17 NLNs. Then, the above results were confirmed via a PSM procedure. Additionally, the independent prognostic value of NLNs was evaluated in subgroup univariate and multivariate analyses of patients with stage I or stage II tumors.
The numbers of NLNs were evaluated and determined to be important independent prognostic factors for the cancer-specific survival of patients with perihilar cholangiocarcinomas.
Survey of cervical cancer and precancerous lesion prevention knowledge within community health service centers in Shanghai, China
Authors: Chen Yi , Xu Ying , Wu Dan , Li Zhunan , Zhang Zhengrong , Meng Yu , Lin Jing 
Published: April 2019

Abstract
To study deficiencies in knowledge of the general public health-care professionals in community health service centers regarding the prevention of cervical intraepithelial neoplasia and cervical cancer. In addition, this study examined the key content of training required for primary health-care personnel to prevent cervical precancerous lesion and cervical cancer.
A questionnaire was distributed among 172 medical staff personnel (the ratio of general practitioners and nurses was 1:1 in five community health service centers in Shanghai, China. This questionnaire assessed four knowledge areas of cervical cancer prevention using 10 single-choice questions.
Out the 172 questionnaires distributed, 105 (61.05%) were completed correctly. No statistically significant difference in the percentage of complete correct answers among the five community health service centers was seen (P = .06). Additionally, there was no significant difference in the percentage of correct answers among the three age groups surveyed: age ≤35 years, 36–45 years, and ≥46 years (P
= .12). We did find a statistically significant difference in the percentage of correct answers between general practitioners and nurses (P = .01) and between staff with master's degrees, bachelor's degrees, and associate's degrees (P
= .03).
General practitioners and nurses in community health service centers in Shanghai require additional education on the secondary prevention of cervical intraepithelial neoplasia and cervical cancer. The health knowledge related to human papillomavirus also needs to improve. Nurses and medical staff with lower degrees have insufficient awareness of the prevention of precancerous lesions of the cervix and cervical cancer; these two groups should be prioritized for additional training.
Influenza A (H1N1) pdm09 virus infection in a patient with incomplete Kawasaki disease
Authors: Wang Jun , Sun Fang , Deng Hui-Ling , Liu Rui-Qing 
Published: April 2019

Abstract

Rationale:
Kawasaki disease (KD) is a vasculitic illness of childhood associated with coronary artery dilatation, coronary artery aneurysm, arrhythmia, sudden death, and other serious cardiovascular diseases. Up to date, the etiology of KD remains unclear; however, epidemiological characteristics indicate that it may be related to as-yet-undefined pathogen infection.

Patient concerns:
A 19-month-old boy had a fever of unknown origin at 38°C for 9 days without rash, runny nose and cough.

Diagnosis:
The boy was diagnosed with incomplete KD (IKD) coincident with influenza A (H1N1) pdm09 virus.

Interventions:
He was received treatments including human immunoglobulin (2 g/kg), aspirin (30∼50 mg/kg.d), and dipyridamole (3∼5 mg/kg.d).

Outcomes:
After 24 hours of human immunoglobulin infusion, his body temperature returned normal. After hospitalization for 6 days, his symptoms disappeared and discharged from the hospital.

Lessons:
More attention should be paid to the correlation between KD and pathogen infection, especially the new influenza virus H1N1. The potential mechanism underlying viral infection-mediated KD is worthy of further investigation, which may provide scientific evidence for the pathogenesis of KD.
Prevalence of hypertension among patients aged 50 and older living with human immunodeficiency virus
Authors: Dakum Patrick , Kayode Gbenga Ayodele , Abimiku Alash’le , Avong Yohanna Kambai , Okuma James , Onyemata Ezenwa , Ali Taofeekat , Adekanmbi Victor , Uthman Olalekan 
Published: April 2019

Abstract

Background:
Hypertension is one of the common medical conditions observed among patients aged 50 years and elder living with HIV (EPLWH) and to date no systematic review has estimated its global prevalence.

Purpose:
To conduct a systematic review to estimate the global prevalence of hypertension among EPLWH.

Data Sources:
PubMed/MEDLINE, Embase, the Cochrane Library, and Global Health databases for relevant publications up till May 25, 2018.

Study Selection:
Observational studies (cohort or cross-sectional studies) that estimated the prevalence of hypertension among EPLWH.

Data Extraction:
Required data were extracted independently by three reviewers and the main outcome was hypertension prevalence among EPLWH.

Data Synthesis:
The 24 (n = 29,987) eligible studies included were conducted in North America, Europe, Africa, and Asia. A low level bias threat to the estimated hypertension prevalence rates was observed. The global prevalence of hypertension among EPLWH was estimated at 42.0% (95% CI 29.6%–55.4%), I

2
= 100%. The subgroup analysis showed that North America has the highest prevalence of hypertension 50.2% (95% CI 29.2% –71.2%) followed by Europe 37.8% (95% CI 30.7%–45.7%) sub-Saharan Africa 31.9% (95% CI 18.5% –49.2%) and Asia 31.0% (95% CI 26.1%–36.3%). We found the mean age of the participants explaining a considerable part of variation in hypertension prevalence.

Conclusion:
This study demonstrated that two out of five EPLWH are hypertensive. North America appears to have the highest prevalence of hypertension followed by Europe, sub-Saharan Africa (SSA) and Asia respectively. Findings from this study can be utilized to integrate hypertension management to HIV management package. (Registration number: CRD42018103069)
Segmental zoster abdominal paresis mimicking an abdominal hernia
Authors: Yu Yan-Hua , Lin Yan , Sun Pi-Jiang 
Published: April 2019

Abstract

Rationale:
Herpes zoster infection typically involves the posterior root ganglia and most of the symptoms are sensory. Motor involvement can occur in the same distribution but is relatively uncommon. Segmental zoster paresis is a rare motor complication of Herpes zoster, mimicking an abdominal hernia, but it needs no surgery different from the real abdominal wall hernia.

Patient Concerns:
We present a case of a 58-year-old man with an abdominal protrusion and characteristical herpes zoster rash.

Diagnoses:
Initially, the surgeon regarded it as an abdominal hernia, while ultrasonography excluded the abdominal wall defect, and then the dermatologist diagnosed it as segmental herpes zoster abdominal paralysis.

Interventions:
He received a treatment with oral acyclovir, mecobalamin, and vitamin B1.

Outcomes:
The abdominal wall bulge disappeared after 2 months, avoiding unnecessary surgery.

Lessons:
Segmental zoster abdominal paresis, mimicking an abdominal hernia needs no surgery.
Re-expansion pulmonary edema after resection of cerebellar lesion in a patient with bronchial occupying lesion
Authors: Yu Jiang , Wang Ying , Chen Xuanyu , Cheng Ruozhu , Yang Xueli , Chen Hongzhi 
Published: April 2019

Abstract

Rationale:
Re-expansion pulmonary edema (RPE) is a non-cardiogenic pulmonary edema, and is secondary to pulmonary collapse caused due to various reasons. However, RPE is rarely encountered during non-thoracic surgeries and is associated with much higher risk than that occurring in thoracic surgeries.

Patient concerns:
Herein we have reported a case report of a 55-years-old male patient. Preoperative examination indicated occupying lesions in the bronchus and cerebellar hemisphere. Under general anesthesia, the patient received resection of cerebellar lesion and developed acute atelectasis, and RPE occurred when cannulation was withdrawn after re-expansion. Supportive and symptomatic treatment was given to the patient for recovery well.

Diagnosis:
RPE.

Interventions:
The trachea was cannulated and connected to a ventilator for assisted ventilation. The patient was also given symptomatic treatment including nebulization, diuresis, and anti-inflammation.

Outcomes:
The patient recovered well and was discharged on day 8 after surgery.

Lessons:
Patients with occupying lesions of the airway should undergo bronchoscopy to determine the location, size, and distance of the lesion from the incisors. The anesthesiologists should determine appropriate anesthetic regimens according to the examination results to avoid acute atelectasis and postoperative pulmonary edema.
Genetic variants in cardiac calcification in Northern Sweden
Authors: Hellman Urban , Mörner Stellan , Henein Michael 
Published: April 2019

Abstract
Extensive coronary calcification without significant stenosis, described as calcific coronary artery disease (CCAD) may cause abnormal myocardial perfusion and hence generalized ischemia. There is a discrepancy in the expression pattern of CCAD compared to the well-known atherosclerotic disease which raises questions about the exact pathophysiology of coronary calcification and whether there is a genetic etiology for it.
In this pilot study we studied 3 candidate genes, ectonucleotide pyrophosphatase/phosphodiesterase (ENPP1), ATP Binding Cassette Subfamily C Member 6 (ABCC6), and 5’-Nucleotidase Ecto (NT5E) involved in pyrophosphate (PPi) and inorganic phosphate (Pi) metabolism, which may predispose to coronary arterial or valvular calcification. We studied 70 patients with calcific cardiac disease; 65 with CCAD (age 43–83 years) and 5 with calcific aortic valve disease (CAVD) (age 76–82 years).
Five DNA variants potentially affecting protein function were found in 6 patients. One variant is a known disease-causing mutation in the ABCC6 gene. Our findings support that disturbances in the PPi and Pi metabolism might influence the development of CCAD and CAVD. However, segregation in the families must first be performed to ascertain any damaging effect of these variants we have found.
We report 4 new genetic variants potentially related to coronary calcification, through the disturbed Pi and PPi metabolism. The search for direct causative genetic variants in coronary artery and aortic valve calcification must be broadened with other genes particularly those involved with Pi and PPi metabolism.
Multimodal intraoperative monitoring during surgical correction of scoliosis to avoid neurologic damage
Authors: Yu Tong , Li Qiu-Ju , Zhang Xi-Wen , Wang Yao , Jiang Qi-Yao , Zhu Xiu-Jie , Jiang Zhen-De , Zhao Jian-Wu 
Published: April 2019

Abstract
The purpose of this study was to evaluate the application of multimodal intraoperative monitoring (MIOM) system in patients with congenital scoliosis (CS) and adolescent idiopathic scoliosis (AIS).
Twelve patients who underwent posterior surgical correction of scoliosis for CS and AIS from June 2014 to July 2018 were enrolled in this study. During the operation, we monitored the functional status of the spinal cord by MIOM. An abnormal somatosensory evoked potential was defined as a prolonged latency of more than 10% or a peak-to-peak amplitude decline of more than 50% when compared to baseline. An abnormal transcranial motor evoked potential (TcMEP) was defined as a TcMEP amplitude decrease of more than 50%. A normal triggered electromyography response, which presented with the absence of an electrical response on stimulation at 8.2 mA, indicated that the pedicle screw was not in contact with the spinal cord or nerve root.
A total of 12 patients underwent MIOM surgery, of which 9 patients with negative MIOM had no significant deterioration of neurological function postoperatively, and exhibited satisfactory surgical correction of scoliosis during follow-ups. However, the remaining 3 patients suffered from MIOM events, 2 patients had normal neurological function, and 1 patient had deteriorated neurological function postoperatively.
Using MIOM in CS and AIS surgery could promptly detect iatrogenic neurological injury at the early stage. Therefore, rapid response by appropriate intraoperative interventions can be taken to minimize the injury. Besides, stable MIOM recordings encourage surgeons to correct scoliosis even when the Cobb angle of scoliosis was extremely large.