bluuebunny/crossref_metadata_2025_split huggingface dataset:
The comparison of dexmedetomidine and ketamine for pediatric dental surgery
Authors: Qiu Jin , Luo Zhifang 
Published: April 2019

Abstract

Introduction:
Dexmedetomidine and ketamine are used for the sedation of pediatric dental surgery. We conduct a systematic review and meta-analysis to compare the sedation of dexmedetomidine and ketamine for pediatric dental surgery.

Methods:
PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) assessing the influence of dexmedetomidine versus ketamine on pediatric dental surgery are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. This meta-analysis is performed using the random-effect model.

Results:
Four RCTs involving 163 children are included in the meta-analysis. Compared with ketamine for pediatric dental surgery, dexmedetomidine results in comparable sedation level (very low quality, 2 RCTs, n = 40; Std. MD = −0.26; 95% CI = −0.74 to 0.23; P = .31), intraoperative analgesia scores (very low quality, 2 RCTs, n = 98; Std. MD = 0.17; 95% CI = −0.23 to 0.57; P = .40), postoperative analgesia scores (very low quality, 2 RCTs, n = 98; Std. MD = 0.23; 95% CI = −0.17 to 0.62; P = .27), DBP (very low quality, 3 RCTs, n = 123; Std. MD = −0.38; 95% CI = −1.04 to 0.27; P = .25) and SpO2 (very low quality, 3 RCTs, n = 123; Std. MD = 0.24; 95% CI = −0.20 to 0.69; P = .28), but significantly decreases heart rate (very low quality, 3 RCTs, n = 123; Std. MD = −1.51; 95% CI = −2.75 to −0.27; P = .02) and SBP (very low quality, 3 RCTs, n = 123; Std. MD = −0.62; 95% CI = −1.16 to −0.08; P = .02), longer recovery time (very low quality, 3 RCTs, n = 138; Std. MD = 1.74; 95% CI = 0.23 to 3.25; P = .02).

Conclusions:
Dexmedetomidine and ketamine have similar sedation, analgesia scores, and hemodynamic balance, but very low quality of the evidence (GRADE) is revealed in this meta-analysis.
Case report of Triumeq (abacavir/dolutegravir/lamivudine) associated rhabdomyolysis in a human immunodeficiency virus (HIV) infected patient
Authors: Saad Muhammad , Casado-Castillo Fernando , Kelly Paul 
Published: April 2019

Abstract

Rationale:
With the existence of the human immunodeficiency virus (HIV) infection as a chronic disease, more often adverse effects of its treatment with the various antiretroviral therapies (ARTs) available have been recognized. Going further, Triumeq has been associated with a myriad of adverse effects, of which rhabdomyolysis is rarely reported in the literature.

Patient concerns:
The patient presented with muscle tenderness over the lower limbs and dark brown-to-red colored urine.

Diagnosis:
Given the presenting symptoms, as well as the laboratory testing, including elevated serum creatine kinase and liver enzymes, the diagnosis of rhabdomyolysis was made.

Interventions:
Improvement was achieved rapidly after starting intravenous fluid therapy and with discontinuation of Triumeq.

Outcomes
After discharge, repeated creatine kinase levels in the clinic have been normal and decision was made to initiate another ART and until now, no further episodes of rhabdomyolysis have developed. Regular outpatient follow-up has been ongoing for over 1 year and no complications have been identified.

Lessons:
This case aims to recognize rhabdomyolysis as a rare, but possible adverse effect associated with the use of Triumeq for HIV-infected patients and therefore clinicians prescribing this combination should be aware of this potential side effect and counsel their patients accordingly.
Primary intracranial leiomyosarcoma in an immunocompetent patient
Authors: Li Xiu-Li , Ren Jing , Niu Run-Ning , Jiang Xiao , Xu Guo-Hui , Zhou Peng , Cheng Zhu-Zhong 
Published: April 2019

Abstract

Rationale:
Primary intracranial leiomyosarcoma (LMS) is an extremely rare tumor in the central nervous system (CNS), and usually seen in immunocompromised individuals. Only a few cases of primary intracranial LMS have been documented in the literature and no study focused on their MRI findings. We reported a case of primary intracranial leiomyosarcoma in a immunocompetent patient and review its imaging features.

Patient concerns:
A 20-year-old female was admitted to our hospital, complaining with nausea, weight loss and progressive headache in recent 2 years.

Diagnosis:
The magnetic resonance imaging scan of the brain revealed a large well-defined extra-cerebral mass adherent to left temporal meninges. The mass was iso-intense on T1-weighted images (T1WI), lightly iso to hypointense on T2-weighted images (T2WI) and enhanced uniformly with contrast medium. The preoperative diagnosis is meningioma.

Interventions:
A left craniotomy was performed for the complete resection of the mass.

Outcomes:
The lesion was diagnosed via surgical histopathology and immunochemistry as leiomyosarcoma. No evidence of recurrence and complications were found in the following 13 months.

Lessions:
Primary intracranial leiomyosarcoma which has some special MR imaging features should be considered in the differential diagnosis of intracranial tumor.
A comparative evaluation of tibial metaphyseal-diaphyseal angle changes between physiologic bowing and Blount disease
Authors: Park Byoung Kyu , Park Kun Bo , Kwak Yoon Hae , Jin Seokhwan , Kim Hyun Woo , Park Hoon 
Published: April 2019

Abstract
The purpose of this study was to estimate the rate of spontaneous improvement in tibial metaphyseal-diaphyseal angle (TMDA) in physiologic bowing in comparison to that in Blount disease and to provide reference values of TMDA for monitoring patients with highly suspected to have Blount disease.
We retrospectively reviewed patients with physiologic bowing meeting the following criteria:
(1) TMDA greater than 9° before 36 months of age at initial evaluation;
(2) two or more standing long bone radiographs available; and
(3) follow-up conducted up to resolution of deformity.
Patients with Blount disease had
(1) more than 2 standing long bone radiographs obtained before 36 months of age and
(2) underwent no treatment during the period in which these images were obtained.
TMDA measurements were obtained from 174 patients with physiologic bowing and 32 patients with Blount disease. Rates of TMDA improvement were adjusted by multiple factors using a linear mixed model, with sex and laterality as fixed effects and age and individual patients as the random effects.
In the physiologic bowing group, TMDA improved significantly, by 3° per 6 months and by 6° per year. Changes in TMDA were not significant in the Blount disease group.
Knowing the rate of TMDA change can be helpful for physicians seeking to monitor infants with suspected as having Blount disease with a high TMDA and to avoid unnecessary repeat radiographic evaluations.
Effects of preoperative oral management by dentists on postoperative outcomes following esophagectomy
Authors: Shin Jung-ho , Kunisawa Susumu , Fushimi Kiyohide , Imanaka Yuichi 
Published: April 2019

Abstract
The purpose of this study was to investigate the effects of preoperative oral management (POM) by dentists on the incidence of postoperative pulmonary complications (PPCs), length of hospital stay, medical costs, and days of antibiotics administration following both open and thoracoscopic esophagectomy.
Dental plaque is an established risk factor for postoperative pneumonia, which could be reduced by POM. However, few clinical guidelines for cancer treatment, including those for esophageal cancer, recommend POM as routine perioperative care.
We extracted data of esophagectomy cases from the Japanese Diagnosis Procedure Combination database. We subsequently conducted propensity score (PS) analyses for multilevel data, including matching, inverse probability of treatment weighting (IPTW), and standardized mortality ratio weighting (SMRW), to estimate the effect of POM by dentists on the outcomes of esophagectomy.
We analyzed 3412 esophagectomy cases of which 812 were open, and 2600 were thoracoscopic surgery. In IPTW analysis to estimate the average treatment effect, the risk difference of postoperative aspiration pneumonia ranged from –2.49% to –2.02% between the POM and control groups of both open and thoracoscopic esophagectomy cases. IPTW analyses indicated that the total medical costs of thoracoscopic esophagectomy were reduced by 221,200 to 253,100 Japanese Yen (equivalent to about $2000–$2200). In PS matching and SMRW analyses to estimate average treatment effect on treated, there was no difference in outcomes between the POM and control groups.
Our results suggested that in patients undergoing open or thoracoscopic esophagectomy, POM by dentists prevented the occurrence of postoperative aspiration pneumonia. It could also reduce the total medical costs of thoracoscopic esophagectomy. Thus, POM by dentists can be considered as a routine perioperative care for all patients undergoing esophagectomy, regardless of the expected risk for PPC.
Efficacy of artificial femoral head replacement for femoral head avascular necrosis
Authors: Wang Shou-Feng , Ji Qing-Hui , Qiao Xiao-Feng , Zhao Peng , Xue Yu , Li Yan-Bao 
Published: April 2019

Abstract
Background: Femoral head avascular necrosis (FHAN) is one of the most common progressive orthopedic disorders. Previous studies have reported that artificial femoral head replacement (AFHR) can effectively treat patients with FHAN. However, no systematic review has investigated the efficacy of AFHR for FHAN. This study will assess the efficacy of AFHR for patients with FHAN.
Methods: We will search MEDLINE, EMBASE, Web of Science, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure up to March 1, 2019 without any restrictions. Any randomized controlled trials for assessing the efficacy of AFHR for patients with FHAN. The methodological quality for each eligible study will be assessed by using Cochrane risk of bias tool. Statistical analysis will be conducted by using RevMan 5.3.
Results: This study will provide current evidence of AFHR for patients with FHAN from several aspects, including pain intensity, function, and limitation of femoral head, health-related quality of life, and safety.
Conclusion: This study will provide latest evidence on assessing the efficacy and safety of AFHR for FHAN.
PROSPERO registration number: PROSPERO CRD42019126249.
Alpha-fetoprotein to transaminase ratio is related to higher diagnostic efficacy for hepatocellular carcinoma
Authors: Liu Xu , Meng Jing , Xu Hongqin , Niu Junqi 
Published: April 2019

Abstract
Alpha-fetoprotein (AFP), as the most widely used biomarker of hepatocellular carcinoma (HCC), was correlated with ongoing liver damage. The aim of this study was to evaluate the ability of inflammatory correction-based AFP to identify HCC from other liver diseases.
From March 2012 to March 2017, among 926 participants, a total of 501 patients whose transaminases were higher than the upper limit of normal range, including 166 treatment-naïve HCC patients were enrolled in our retrospective study. The liver function, white blood cell (WBC) count and serum AFP level of all patients were collected at the initial stage of admission. The area under the receiver-operating curve (AUROC) of AFP, AFP/(Aspartate aminotransferase∗Alanine aminotransferase) [AFP/(AST∗ALT)] and AFP/WBC were compared between the HCC group and the control groups for the quantifying diagnostic efficacy.
AUROCs of our novel index AFP/(AST∗ALT) were up to 0.853 (95% confidence interval, CI 0.818–0.887, P < .001) and 0.825 (95% CI 0.782–0.868, P < .001), respectively, when differentiating HCC from non-HCC patients and from cirrhosis patients, which was superior to AFP and AFP/WBC. Diagnostic performance of AFP/(AST∗ALT) could be verified in hepatitis B virus (HBV)- or hepatitis C virus (HCV)-associated HCC patients as well. What's more, AFP/(AST∗ALT) had a significant positive and moderate correlation with tumor diameter and presence of cancerous emboli or not (Spearman correlation coefficients were 0.323 and 0.305, respectively; both P < .001). For predicting HCC, the optimal cut-off value of AFP/(AST∗ALT) is 1.603, and the sensitivity and specificity were 82.8% and 72.7%, respectively, which were significantly higher than the AFP and AFP/WBC.
The serum AFP levels based on correction of liver inflammation can effectively improve the diagnostic performance of HCC, providing a new indicator that is simple, economical and pervasive for clinic.
Is There a Safety Signal for Dolutegravir and Integrase Inhibitors During Pregnancy?
Authors: Chouchana Laurent , Beeker Nathanael , Treluyer Jean-Marc 
Published: April 2019

Background:
Dolutegravir, an integrase strand transfer inhibitor (InSTI), is a major antiretroviral agent for HIV infection. Its use is promising, especially in low- and middle-income countries, because of a high resistance barrier and a good safety profile. Very recently, a World Health Organization safety signal has been raised regarding neural tube defects after the first-trimester exposure. Furthermore, to date, the experience is limited regarding the use of the other InSTI drugs (raltegravir and elvitegravir) during pregnancy. Our objective is to analyze the safety of InSTI drugs in pregnant women.

Setting:
Nation-wide database cohort analysis.

Methods:
We evaluated the risk of major birth defects according to EUROCAT classification in pregnant women, which had had a first-trimester exposure to dolutegravir, raltegravir, or elvitegravir.

Results:
We found a major birth defect rate of 1.9% in the general population between 2012 and 2016. As InSTI drugs are not used as first-line therapy in pregnant women, we found a very low exposure in this population. Among 49, 240, and 70 pregnancy outcomes exposed to dolutegravir, raltegravir, and elvitegravir, respectively, during the first trimester, there were 2, 3, and 1 major birth defects, respectively. There was no case of neural tube defect.

Conclusions:
Drug exposure to InSTI is limited in our nation-wide database. Nevertheless, our data do not support a pharmacovigilance signal on neural tube defects in women exposed to dolutegravir, raltegravir or elvitegravir during pregnancy. Owing to a small number of pregnancy outcomes, these results need to be confirmed with further studies.
Immune memory characteristics of innate lymphoid cells
Authors: Placek Katarzyna , Schultze Joachim L. , Netea Mihai G. 
Published: April 2019

Purpose of review
Immune memory is essential for host defense against invaders and it is also used as a basis for vaccine development. For these reasons, it is crucial to understand its molecular basis. In this review, we describe recent findings on memory characteristics of innate-like lymphocytes and its contribution to host protection.

Recent findings
In addition to adaptive immune cells, innate cells are also able to mount memory responses through a process called ‘trained immunity.’ Importantly, the lymphoid lineage is not restricted to cells carrying specific T-cell or B-cell receptors, but include cells with germline-encoded receptors. Recent studies show that these innate-like lymphocytes are able to generate efficient recall responses to reinfection. In different circumstances and depending on the cell type, innate-like lymphocyte memory can be antigen-specific or unspecific. Epigenetic changes accompany the generation of memory in these cells, but are still poorly defined.

Summary
Immune memory is not restricted to antigen-specific cells, but also encompass different populations of innate immune cells. Innate-like lymphocytes embrace features of both innate and adaptive immune memory, and thus bridge adaptive and innate immune characteristics.
Update and advances in community acquired bacterial meningitis
Authors: Hasbun Rodrigo 
Published: April 2019

Purpose of review
Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens.

Recent findings
Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Delaying lumbar puncture is associated with increased costs in both adults and children with meningitis and previous antibiotic therapy impacts the yield of microbiological results. Delaying antibiotic therapy is associated with worse clinical outcomes. Adjunctive steroids have reduced the mortality of adults with pneumococcal meningitis but have been associated with increased adverse outcomes in Listeria monocytogenes and Cryptococcus neoformans.

Summary
Community-acquired bacterial meningitis remains a global health concern with high morbidity and mortality especially in low-income countries. Cranial imaging should be done only in patients with an indication with an attempt to do a prompt lumbar puncture and to initiate antibiotic therapy and adjunctive steroids as soon as possible to improve clinical outcomes.
Update on spinal epidural abscess
Authors: Babic Maja , Simpfendorfer Claus S. , Berbari Elie F. 
Published: April 2019

Purpose of review
Spinal epidural abscess (SEA) is still a rare but potentially very morbid infection of the spine. In recent years, the incidence has risen sharply but the condition remains a medical conundrum wrought with unacceptably long diagnostic delays. The outcome depends on timely diagnosis and missed opportunities can be associated with catastrophic consequences. Management and outcomes have improved over the past decade. This review focuses on risk factors and markers that can aid in establishing the diagnosis, the radiological characteristics of SEA on MRI and their clinical implications, as well as the importance of establishing clear indications for surgical decompression.

Recent findings
This once exclusively surgically managed entity is increasingly treated conservatively with antimicrobial therapy. Patients diagnosed in a timely fashion, prior to cord involvement and the onset of neurologic deficits can safely be managed without decompressive surgery with targeted antimicrobial therapy. Patients with acute cord compression and gross neurologic deficits promptly undergo decompression. The greatest therapeutic dilemma remains the group with mild neurological deficits. As failure rates of delayed surgery approach 40%, recent research is focused on predictive models for failure of conservative SEA management. In addition, protocols are being implemented with some success, to shorten the diagnostic delay of SEA on initial presentation.

Summary
SEA is a potentially devastating condition that is frequently missed. Protocols are put in place to facilitate early evaluation of back pain in patients with red flags with appropriate cross-sectional imaging, namely contrast-enhanced MRI. Efforts for establishing clear-cut indications for surgical decompression of SEA are underway.
Is There an Advantage to Minimizing Surgery in Scaphocephaly? A Study on Extended Strip Craniotomy Versus Extensive Cranial Vault Remodeling
Authors: De Praeter Mania , Nadjmi Nasser , Reith Florence C.M. , Vercruysse Herman , Menovsky Tomas 
Published: April 2019

Background:
Different techniques have been described to correct scaphocephaly. In authors’ institution, total cranial vault remodeling (TCVR) was the standard of care. To limit the extent of surgery and the need for transfusion, the technique was minimized to extended strip craniectomy (ESC) without helmet therapy. This retrospective study compares outcome and morbidity between ESC and TCVR.

Methods:
Twenty-seven scaphocephalic patients were included. The ESC was performed in 9 patients between 2012 and 2014, and TCVR in 17 patients between 2008 and 2016. Data on blood loss and transfusion rate, duration of surgery, length of hospital stay (LOS), head circumference, and cephalic index (CI) were collected retrospectively. A cosmetic outcome score (COS) was developed to rate esthetic outcome since CI is a limited and crude measurement of cosmetic outcome.

Results:
The LOS was identical in both groups, but duration of surgery was significantly shorter in ESC (P < 0.0001). Transfusion rate appeared higher in the TCVR group, but differences were not significant (P = 0.11). Cosmetic outcome appeared slightly worse in the ESC group, but results were not significantly different (P = 0.66). There was, however, a significant improvement in postoperative CI in the TCVR group (P < 0.0001).

Conclusion:
The only advantage of ESC was the reduced duration of surgery, but this could not prevent the need for transfusion in this group of patients. The improvement of the CI was significantly less pronounced after ESC, but the COS was not significantly worse in the ESC group. The scar and LOS were similar in both groups. Therefore, our findings indicate that minimizing TCVR to ESC without helmet therapy does not provide significant advantages.
Analysis of Facial Injuries in Motor Vehicle Accidents According to the Location of the Seat and Seat-Belt Use
Authors: Kim Sue Min , Ha Non Hyeon , Hahn Hyung Min , Lee Il Jae , Park Myong Chul , Park Dong Ha 
Published: April 2019

Abstract
The purpose of this study was to evaluate facial trauma in accidents involving a passenger car. In particular, the authors assessed differences in types of facial trauma and severity according to the location of the seat and seat-belt use. A 7-year retrospective review of data was conducted for 419 patients with facial trauma resulting from motor vehicle accidents. Patients who used a seat belt faced a lower risk of severe soft-tissue injury in comparison with having mild soft-tissue injury than patients who did not use a seat belt (P = 0.0129). Additionally, patients who used a seat belt had a lower risk of accompanying facial bone fracture requiring surgical operation than patients who did not use a seat belt (P = 0.0168). In terms of facial bone fracture according to seat location, patients who had sat in the back seat had more risk of accompanying facial bone fracture than patients who had sat in the passenger's seat (P = 0.0392). In terms of facial bone fractures requiring surgical operation, the patients who had sat in a back seat faced more risk of needing a surgical operation than patients who had sat in the driver's seat (P = 0.0479). The results of the study reveal that wearing a seat belt effectively reduces severe facial soft-tissue injury and facial bone fracture requiring surgical operation. In particular, the authors note that sitting in a back seat is riskier in terms of facial bone injury than sitting in a front seat.