bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and risk of surgical site infection after adult femoral neck fractures treated by surgery
Authors: Ji Chenni , Zhu Yanbin , Liu Song , Li Jia , Zhang Fei , Chen Wei , Zhang Yingze 
Published: March 2019

Abstract
Surgical site infections (SSI) are devastating complications after surgery for femoral neck fractures. There are a lot of literature have shown a strong association between diabetic patients and SSI. This study aimed to identify diabetes as an independent risk factor of SSI, focusing on femoral neck fractures, and to investigate the other potential risk factors for SSI.
We retrospectively collected data from patients who underwent surgery for femoral neck fractures through the medical record management system at a single level 1 hospital between January 2015 and June 2016. Demographic and clinical patient factors and characteristics of SSI were recorded. The case group was defined as patients with SSI and the control group was defined as patients without SSI. Univariate and multivariate analyses were performed to determine the risk factors for SSI.
Data were provided for 692 patients, among whom 26 had SSI, representing an incidence rate of 3.67%. In the SSI group, 24 (3.47%) patients had superficial infection and 2 (0.29%) had deep infection. On multivariate analysis, diabetes (P < .001) was determined an independent risk factor of SSI, so were surgery performed between May and September (P = .04), body mass index (P = .031), corticosteroid therapy (P = .003), anemia (P = .041), and low preoperative hemoglobin levels.
Our results suggest that clinicians should recognize patients with these factors, particularly diabetes. And taking management optimally in the preoperative period will prevent the SSI after femoral neck fracture.
Signet-ring cells in the bone marrow as an indication of cryptic metastasis of breast carcinoma
Authors: Ma Shuang , Jr Bruce D. Leckey , Zhang Wan-Lin , Xu Hong-Tao , Yang Lian-He , Wang Endi 
Published: March 2019

Abstract

Rationale:
Signet-ring cell is a rare morphological finding in bone marrow, which usually indicates metastatic carcinoma from either the gastrointestinal tract or a primary hematolymphoid neoplasm. Here, we present a very unusual case of lobular breast carcinoma with metastasis to the bone marrow.

Patient concerns:
A 67-year-old female with estrogen receptor (ER)-positive lobular breast carcinoma was staged as T3N3M0, and treated with modified radical mastectomy followed by chemotherapy and radiotherapy. One year after treatment, she was noted to have moderate thrombocytopenia on complete blood count with the remainder of the parameters within normal limits. Radiographic examination revealed no evidence of recurrent disease.

Diagnosis:
Bone marrow biopsy was performed to exclude therapy-related myelodysplastic syndrome (MDS), which demonstrated hypercellularity with “hyperplastic” hematopoiesis. Upon closer inspection, a few signet-ring cells were identified which morphologically resembled histiocytes. These formed an interstitial infiltrate among the predominantly hematopoietic elements, and could have been easily overlooked. Immunohistochemistry demonstrated that these signet-ring cells were positive for pancytokeratin as well as ER which confirmed metastatic lobular breast carcinoma. On retrospective review of the aspirate smear, rare signet-ring cells were identified.

Interventions:
The patient was treated with additional chemotherapy.

Outcomes:
The patient eventually succumbed to overt dissemination after 14 months.

Lessons:
Due to the relative discohesiveness of lobular breast carcinoma, the cells frequently assume single-cell infiltration in bone marrow. This attribute, along with small cell size, bland cytologic features and paucity of tissue response, contributes to its escaping from identification on hematoxylin-eosin (H&E) sections. In this case, the signet-ring cells were hidden in apparently hyperplastic hematopoiesis. Careful inspection raised the possibility of occult metastasis which was readily detected and confirmed with immunohistochemistry.
Red blood cell transfusion threshold after pediatric cardiac surgery
Authors: Deng Xicheng , Wang Yefeng , Huang Peng , Luo Jinwen , Xiao Yunbin , Qiu Jun , Yang Guangxian 
Published: March 2019

Abstract

Background:
Restrictive red blood cell transfusion strategy is implemented to minimize risk following allogeneic blood transfusion in adult cardiac surgery. However, it is still unclear if it can be applied to pediatric cardiac patients. The purpose of this systematic review and meta-analysis was to determine the effect of postoperative restrictive transfusion thresholds on clinical outcomes based on up-to-date results of randomized controlled trials (RCTs) and observational studies in pediatric cardiac surgery.

Method:
We searched for RCTs and observational studies in the following databases: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ClinicalTrials.gov from their inception to October 26, 2017. We also searched reference lists of published guidelines, reviews, and relevant articles, as well as conference proceedings. No language restrictions were applied and no observational study met the inclusion criteria.

Results:
Four RCTs on cardiac surgery involving 454 patients were included. There were no differences in the pooled fixed effects of intensive care unit (ICU) stay between the liberal and restrictive transfusion thresholds (standardized mean difference SMD, 0.007; 95% confidence interval CI, −0.18–0.19; P = .94). There were also no differences in the length of hospital stay (SMD, −0.062; 95% CI, −0.28−0.15; P = .57), ventilation duration (SMD, −0.015; 95% CI, −0.25–0.22; P = .90), mean arterial lactate level (SMD, 0.071; 95% CI, −0.22–0.36; P = .63), and mortality (risk ratio, 0.49; 95% CI, 0.13–1.94; P = .31). There was no inter-trial heterogeneity for any pooled analysis. Publication bias was tested using Egger, Begg, or the trim-and-fill test, and the results indicated no significant publication bias.

Conclusion:
Evidence from RCTs in pediatric cardiac surgery, though limited, showed non-inferiority of restrictive thresholds over liberal thresholds in length of ICU stay and other outcomes following red blood cell transfusion. Further high-quality RCTs are necessary to confirm the findings.
Association of polymorphisms in STRA6 gene with gestational diabetes mellitus in a Chinese Han population
Authors: Hu Shimin , Yan Junxia , You Yiping , Yang Guilian , Zhou Hui , Li Xun , Liao Xin , Tan Hongzhuan 
Published: March 2019

Abstract
Cell and animal experiments have found that in addition to being a retinol transporter, Stimulated by Retinoic Acid 6 (STRA6) also functions as a surface signaling receptor by which retinol regulates insulin responses. Several studies revealed that the STRA6 gene may contribute to the pathogenesis of type 2 diabetes mellitus (T2DM). Gestational diabetes mellitus (GDM) and T2DM have some risk factors in common. The present study was directed to investigate whether the 3 single nucleotide polymorphism (SNPs) (rs11633768, rs351219, and rs736118) of STRA6 correlate with the development of GDM in Chinese pregnant women. We also aimed to estimate the relationship between SNPs with fasting blood glucose level, 1-hour and 2-hour blood glucose levels after 75 g oral glucose intake, fasting insulin and insulin resistance levels to better study the relationship between STRA6 and glucose metabolism.
Case–control studies were conducted to compare the GDM and control groups. A total of 334 cases and 367 controls were recruited. Three tagSNPs of STRA6, rs11633768, rs351219, and rs736118, were selected. A chi-square test, logistic regression, and linear regression were used to estimate the relationship between SNPs with GDM risk and oral glucose tolerance test (OGTT), fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels. Regression analyses were all adjusted by maternal age, pre-pregnancy BMI, and weekly BMI growth. The Bonferroni correction was applied for multiple comparisons.
After adjusting the maternal age, pre-pregnancy BMI and weekly BMI growth, STRA6 rs736118 was associated with fasting insulin level (Beta = −1.468, P = .036), and the association between rs736118 and HOMA-IR was of borderline significance (Beta = −0.290, P = .093) under the dominance model.
This study found that there is a significant association between STRA6 polymorphism and GDM.
Can surgical treatment be justified for neuroendocrine carcinoma of the gallbladder?
Authors: You Yung Hun , Choi Dong Wook , Heo Jin Seok , Han In Woong , Choi Seong Ho , Jang Kee-Taek , Han Sunjong 
Published: March 2019

Abstract
Clinical features and treatment of GB neuroendocrine carcinoma (GB-NEC) are not well understood. This study aimed to analyze clinical outcomes of GB-NEC and verify the oncologic benefit of surgical treatment.
From October 1994 to December 2014, the medical records of 31 patients with GB-NEC at a single center were retrospectively reviewed. There were 18 inoperable cases due to distant metastasis, including 7 of best supportive care (Tx.1) and 11 of non-operative palliative treatment (Tx.2). 4 patients received non-curative, palliative resection (Tx.3). Only 9 patients were able to undergo curative-intent resection (Tx.4).
Among the 31 patients with GB-NEC, preoperative mean value of carbohydrate antigen 19-9 (CA 19-9) was 74.8 ± 156.1 U/mL and the median overall survival time was 10 months (range 7.0-12.0 months). Of these, 21 (67.7%) patients received systemic treatment. Among 9 patients who underwent curative-intent resection (Tx.4), 9 patients had poorly differentiated cancer cells and 7 patients received radical cholecystectomy. 6 patients had adjuvant treatment including concurrent chemoradiation therapy (CCRT) or chemotherapy alone. The recurrence rate was 88.9%. The median overall survival between 4 groups was as follows: 4.0 (3.0–18.0) months in Tx.1 (n = 7) versus 9.0 (3.0–21.0) months in Tx.2 (n = 11) versus 11.0 (3.0–15.0) months in Tx.3 (n = 4) versus 23.0 (8.0–34.0) months in Tx.4 (n = 9), respectively. Significant differences in median overall survival time existed between Tx.2 and Tx.4; 9 (3.0–21.0) months versus 23.0 (8.0–34.0) months (P = .017).
Most GB-NECs show poor biologic behavior. Nonetheless, curative-intent resection could possibly promote longer survival than other treatment modalities for GB-NEC. Efforts to undergo curative resection through early detection and development of adjuvant treatment are needed.
Effectiveness of peer pressure on computed tomography use for dizziness/vertigo patients
Authors: Chuang Po-Chun , Huang Yi-Syun , Chiang Charng-Yen , Zhang E-Wai , Cheng Fu-Jen 
Published: March 2019

Abstract
Dizziness/vertigo is a common complaint in the emergency department (ED). We aimed to evaluate the effect of peer pressure on decision making in emergency physicians (EPs) to use computed tomography (CT) for patients with dizziness/vertigo.
We conducted a before-and-after retrospective case review of patients who visited the ED with dizziness/vertigo. EPs were categorized into 3 groups according to seniority (in years of experience: >12, 7–12, and <7). The rate of CT use for EPs, patient number, and CT use were e-mailed monthly to update the EP team on the benchmark rate and shape of the behavior.
Among the 1657 (preintervention) and 1508 (postintervention) patients with dizziness/vertigo, 320 (19.3%) and 230 (15.3%), respectively, underwent brain CT. A decrease in the rate of CT use was observed in the postintervention group (odds ratio [OR] = 0.743, 95% confidence interval [CI] = 0.615–0.897), especially in junior EPs (years of experience, <7; OR = 0.667, 95% CI: 0.474–0.933) and younger patients (age, <60) (OR = 0.625, 95% CI: 0.453–0.857).
The intervention strategy created peer pressure through e-mail reminders and decreased the rate of CT use for patients with isolated dizziness/vertigo, especially in junior EPs and younger patients.
A multicenter, randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of Huangqi Guizhi Wuwutang granule in patients with rheumatoid arthritis
Authors: Wang Yiru , Liu Yang , Xi Zhijie , Yu Yang , Liu Li , Mao Jianchun , Xiao Lianbo , Gu Xiaohua , Yao Min , Cui Xuejun , Shi Qi , Wang Yongjun , Liang Qianqian 
Published: March 2019

Abstract

Background:
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by swelling, pain, and synovial damage. Effective methods lack in the treatment of RA. A traditional prescription in use for thousands of years in China, Huangqi Guizhi Wuwutang granule (HGWG) is still chosen to relieve pain and prevent joint malformation in RA patients. However, no evidence-based medical research has been organized to assess the effectiveness and safety of HGWG for RA.

Methods/design:
We will conduct a multicenter, randomized, double-blind, placebo-controlled clinical trial to determine whether HGWG can relieve pain and protect joints. We will randomly divide 120 patients with active RA into 2 groups, treated for 12 weeks. Main measurement is the rate of ACR50 score (American College of Rheumatology) from the baseline to 12 weeks. Secondary measurements include rate of ACR20/70, change of Disease Activity Score (DAS) 28, Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient Assessment of Arthritis Pain, Patient Global Assessment of Arthritis, and AIS score. The time points are set as baseline, 2 weeks, 4 weeks, 8 weeks, 12 weeks, 24 weeks, and 48 weeks. In addition, the rate of ACR50 from the baseline to 2 weeks, 4 weeks, 8 weeks, 24 weeks, and 48 weeks’ follow-up are also the secondary outcome measures.

Discussion:
The findings of this research will elucidate the efficacy and safety of HGWG and provide an alternative treatment for RA. In addition, our data will benefit the clinical decision-making on active RA and possibly be incorporated into future guidelines.

Trial registration:
ClinicalTrials.gov ID: NCT03593837.
Effectiveness of therapeutic strategies for patients with neck pain
Authors: Gao Qiang , Gao Weipeng , Xia Qing , Xie Chunyu , Ma Jian , Xie Liangzhen 
Published: March 2019

Abstract

Background:
Neck pain is a common discomfort or more intense forms of pain in the cervical region. Neck pain has a large impact on individuals and their families, communities, healthcare systems, and businesses throughout the world. Therapeutic strategies are widely used for patients with neck pain in clinical practice, but the effectiveness of each therapeutic strategy is still unclear. The aim of this study is to assess the efficacy and safety of therapeutic strategies for neck pain.

Method:
Seven electronic databases will be searched regardless of publication date or language. Randomized controlled trials will be included if they recruited participants with neck pain for assessing the effect of each therapy. Primary outcomes will include pain score. The risk of bias will be assessed by 2 authors using the Cochrane tool of risk of bias. Network meta-analysis in random effects model will be conducted to estimate the indirect and mixed effects of therapeutic strategies for neck pain by R-3.5.1 software. The confidence in cumulative evidence will be assessed by grading of recommendations assessment, development, and evaluation.

Results:
This study will be to assess the effect and safety of therapeutic strategies for neck pain.

Conclusions:
This study will assess the effect of different therapeutic strategies for neck pain and provide reliable evidence for the choice of treatments.

Systematic review registration:
PROSPERO (CRD42019102385).
Nonalcoholic fatty liver disease represents a greater metabolic burden in patients with atherosclerosis
Authors: Han Jie , Wang Yong , Yuan Zhongshang , Liu Lu , Zhao Meng , Guan Qingbo , Zhang Haiqing , Li Qiu , Xu Jin , Gao Ling , Zhao Jiajun , Zhang Xu 
Published: March 2019

Abstract
How nonalcoholic fatty liver disease (NAFLD) is linked to atherosclerosis is still disputed. This study aimed to explore the association between NAFLD and atherosclerosis among adults in Shandong province, China.
A total of 6849 individuals were enrolled in the final analyses for a community-based study. The relationship between NAFLD and atherosclerosis was evaluated after adjusting for common confounding factors.
Hypertension, diabetes, and higher serum low-density lipoprotein cholesterol (LDL-c) level were positively correlated with NAFLD. An odds ratio (OR) (95% confidence interval [CI]) of 1.325 (range 1.157–1.518) for hypertension, 2.153 (range 1.814–2.555) for diabetes, and 1.161 (range 1.071–1.259) for LDL-c was noticed. These factors also were positively correlated with atherosclerosis, with an OR (95% CI) of 1.501 (range 1.286–1.751) for hypertension, 1.716 (range 1.414–2.084) for diabetes, and 1.344 (range 1.231–1.466) for LDL-c. The prevalence of metabolic syndrome was higher in the atherosclerosis+NAFLD group (81.8%) when compared with the NAFLD-only (30.3%), atherosclerosis-only (32.2%), and control (20.3%) groups (P <.01).
NAFLD and atherosclerosis have common metabolic characteristics, such as hypertension, diabetes, and higher serum LDL-c level. Patients with NAFLD in combination with atherosclerosis were found to have a more severe metabolic burden and greater chances of having hypertension, diabetes, dyslipidemia, and higher metabolic syndrome scores than those in the other groups.
The effects of high impact exercise intervention on bone mineral density, physical fitness, and quality of life in postmenopausal women with osteopenia
Authors: Yu Pei-An , Hsu Wei-Hsiu , Hsu Wei-Bin , Kuo Liang-Tseng , Lin Zin-Rong , Shen Wun-Jer , Hsu Robert Wen-Wei 
Published: March 2019

Abstract
Osteoporosis and osteopenia prevailed in postmenopausal women and predisposed to osteoporotic fractures that increase mortality, morbidity, and the cost of social care. Here, we investigated the effect of 24 weeks of aerobic dancing on the bone miner density, physical fitness and health-related quality of life (HRQoL) in postmenopausal women with osteopenia. Total 80 participants (control [CON]: 40; exercise [EX]: 40) were included in the final analysis. The EX group underwent a 24-week aerobic dance intervention. Bone mineral density (BMD), physical fitness, and SF-36 questionnaire were assessed at baseline and 24-weeks. The BMD change in the femoral neck at the 24-weeks were significantly different between the 2 groups (CON: −1.3 ± 2.7%, EX: 3.1 ± 4.6%, P = .001). Grip strength, sidestep and physical functional domain of HRQoL in the EX group were significantly improved compared to the CON. The results were suggested 24-week aerobic dance intervention could result in the lower the incidence of bone fracture through increasing BMD and decreasing fall risk for postmenopausal women.
Knowledge and attitude of nonpsychiatric physicians regarding suicide in spinal cord injury patients and need for structured psychiatric education for suicide prevention
Authors: Lee Su-Jin , Nam Tae-Woo , Kim Chul-hyun , Hwang Jong-moon 
Published: March 2019

Abstract

Background:
The knowledge and attitude of nonpsychiatric physicians regarding suicide in spinal cord injury (SCI) patients is important to prevent the accident related to suicide. However, most existing studies have focused on perception of and attitudes among psychiatric physician and mental health care worker.
The aim of this study is to investigate awareness and attitude regarding suicide among clinicians treating patients with spinal cord injury, and the necessity of education for suicide prevention.

Methods
A total of 29 subjects (N = 29; surgical group n = 17, nonsurgical group n = 12) participated in the study, 6 fellows and 23 residents. They answered a newly revised questionnaire that incorporated 18 items regarding perception of and attitude toward suicide, awareness of suicide in treatment of spinal cord injury patients, and psychiatric consultation; 13 items regarding education and experience; and 4 subjective items regarding their department. A χ
2 test was performed to investigate differences in sociodemographic factors, awareness of and attitude toward suicide, and clinical experience with spinal cord injury patients. Binary logistic regression analysis was used to identify correlation between the questionnaire items.

Results:
There were significant differences between surgical and nonsurgical clinicians in 1 question (Q6) about awareness of and attitude toward suicide (P < .05) and in 2 questions (Q21, Q25) about psychiatric consultation and experience with suicide-related education (P < .01). The correlation analysis revealed significant differences in certain questions among awareness and attitude (P < .05) and age (P < .05) and specialty (P < .01). Two sets of questions (Q16/Q31, Q17/Q26) showed correlation between clinical experience with spinal cord injury patients and awareness of and attitude toward suicide (P < .05).

Conclusion:
Education regarding suicide prevention and suicide-related clinical experience with spinal cord injury patients is important for nonpsychiatric clinicians, such as those in the fields of orthopedics, neurosurgery, and rehabilitation medicine.
Gestational diabetes mellitus increases the detection rate and the number of oral bacteria in pregnant women
Authors: Yao Han , Xu Dan , Zhu Zhichao , Wang Guoyun 
Published: March 2019

Abstract
In the present study, we aimed to investigate the association between gestational diabetes mellitus (GDM) and the oral microbial imbalance in the second trimester of pregnancy.
Three hundred thirtyone women in the second trimester of pregnancy who underwent prenatal examinations at the Third Affiliated Hospital of Soochow University from February 2018 to August 2018 were included in this study. Personal parameters including the age, education level, and body mass index (BMI) at 28 weeks of gestation were recorded. Gestational diabetes mellitus (GDM) was diagnosed according to the Standards of Medical Care in Diabetes-2011 recommended by American Diabetes Association (ADA). After the significant difference of each parameter was erased by a propensity-score matched (PSM) analysis at a 1:1 ratio, the oral health conditions and the oral flora in pregnant women with GDM were compared with those in nondiabetic pregnant women.
Our data demonstrated that 65 of the 331 pregnant women (19.6%) were diagnosed with GDM. Results from the matched data including 59 matched pairs of pregnant women showed that the gingival index (GI), plaque index (PI), tooth mobility degree (TMD), probing depth (PD), and bleeding on probing (BOP) of pregnant women with GDM were higher or more severe than those of nondiabetic pregnant women (P < .05). The detection rate of tuberculosis bacilli, Black-pigmented bacteria, and Capnocytophaga in pregnant women with GDM was higher than those in nondiabetic pregnant women (P = .000, P = .026, and P = .030, respectively). In addition, pregnant women with GDM had fewer oral streptococci (P = .000) and lactobacilli (P = .000) and more oral anaerobic bacteria (P = .000), tuberculosis bacilli (P = .000), Black-pigmented bacteria (P = .007), Capnocytophaga (P = .000), and actinomycetes (P = .000).
The detection rate and the number of oral bacteria in pregnant women with GDM were higher than those in nondiabetic pregnant women in the second trimester of pregnancy.