bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of germinal center B-cell-like and non-germinal center B-cell-like subtypes of bone marrow involvement in patients with diffuse large B-cell lymphoma treated with R-CHOP
Authors: Cho Min-Chul , Chung Yousun , Jang Seongsoo , Park Chan-Jeoung , Chi Hyun-Sook , Huh Jooryung , Suh Cheolwon , Shim Hyoeun 
Published: November 2018

Abstract
The prognostic significances of the germinal center B-cell-like (GCB) and non-germinal center B-cell-like (non-GCB) types of diffuse large B-cell lymphoma (DLBCL) have been reported to be different. We analyzed the effect of the cell of origin (COO) of bone marrow (BM) involvement in patients with DLBCL who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in a single institute.
The subtype of BM involvement was evaluated in 633 patients who were diagnosed with primary DLBCL and had been treated with R-CHOP. BM trephine biopsies were analyzed, and immunohistochemical staining of CD20, CD79a, and CD3 was performed. Additional staining of CD10, Bcl-6, and MUM1 was performed to determine the COO based on a previously reported algorithm.
BM involvement was present in 81 patients (12.8%). Among them, 30 patients (37.0%) had GCB-type BM involvement and 51 (63.0%) showed non-GCB-type involvement. Kaplan-Meier survival analysis showed that the non-GCB type had the worst progression-free survival (PFS) and overall survival (OS) (P <.001). In multivariate analysis controlled for the International Prognostic Index (IPI) score, non-GCB type was an independent predictor of PFS (P <.004) and OS (P =.042), whereas GCB type was not a prognostic factor independent of the IPI score.
Further prognostication based on the COO of BM involvement is a useful indicator of PFS, independent of IPI score. Accurate staging based on the COO should be included in the examination of BM in DLBCL.
Rate of and time to symptomatic remission in first-episode psychosis in Northern Malawi
Authors: Kaminga Atipatsa Chiwanda , Dai Wenjie , Liu Aizhong , Myaba Japhet , Banda Richard , Wen Shi Wu , Pan Xiongfeng 
Published: November 2018

AbstractAlthough longer duration of untreated psychosis (DUP) is associated with poor response to antipsychotic treatment, it remains unclear whether it independently influences time to symptomatic remission in first-episode psychosis (FEP). This study examined rate of symptomatic remission, and explored if DUP, premorbid functioning, global functioning, insight and socio-demographic characteristics were independently associated with time to symptomatic remission in FEP.This prospective study enrolled 126 FEP patients (aged 18–65) between June 2009 and September 2012. Subjects were followed-up monthly over 18 months after they had received antipsychotic medication. Remission in positive and negative symptoms was defined as in the Remission in Schizophrenia Working Group (RSWG) criteria. Subjects were defined as “in symptomatic remission” if they remitted in both negative and positive symptoms. At baseline, the following explanatory variables were measured: socio-demographic characteristics; DUP as short (≤5 months) and long (>5 months); premorbid functioning as deteriorating, stable poor, and stable good according to Cannon-Spoor Premorbid Adjustment Scale; global functioning as “worst (1–10) to serious (41–50)” and “moderate (51–60) to superior (91–100),” according to the Global Assessment of Functioning Scale; and insight as poor (≤8) and good (≥9) according to the Insight Scale (Birchwood). Univariate and multivariable analyses were used to generate results.Out of 126 subjects, 98 (78%) completed follow-up, of which 70 (71.4%) achieved symptomatic remission within mean duration of 8.05 (4.54) months. Besides, having long DUP and separated/divorced/widowed (adjusted hazard ratio [aHR] = 0.07, 95%CI = [0.01, 0.46]), long DUP and poor insight (aHR = 0.18, 95%CI = [0.04, 0.89]), poor insight and separated/divorced/widowed (aHR = 0.09, 95%CI = [0.01, 0.70]), deteriorating premorbid functioning (aHR = 0.47, 95%CI = [0.23, 0.97]), family history of psychiatric disorders (aHR = 0.52, 95%CI = (0.30, 0.93]), and being male (aHR = 0.47, 95%CI = [0.24, 0.92]) delayed symptomatic remission.These results propose that psychological interventions and social support for mental health problems are warranted and may enhance better response to antipsychotic medications among separated/divorced/widowed patients with long DUP or poor insight, and poor insight patients with long DUP. Deteriorating premorbid functioning, family history of psychiatric disorders and being male continue being important risk factors for poor odds of remission.
Serum electrolyte imbalance and prognostic factors of postoperative death in adult traumatic brain injury patients
Authors: Pin-on Pathomporn , Saringkarinkul Ananchanok , Punjasawadwong Yodying , Kacha Srisuluck , Wilairat Drusakorn 
Published: November 2018

Abstract
Electrolyte imbalances are common in traumatic brain injury. It shares the cause of perioperative morbidity and mortality. Types of intravenous fluid resuscitation, osmotic diuretics, massive blood loss, and intracranial pathology were considered as the potential factors to worsen electrolyte abnormalities in these patients. The aims of this study were to report the incidence of electrolyte imbalance in traumatic brain injured patients and to assess the association between electrolyte imbalance and other prognostic factors to death within 24 hours of the injury.
The study was carried out in the northern university, tertiary-care hospital of Thailand. The patients aged from 18 to 65 years old, presented with traumatic brain injury, and needed for emergency craniotomy were included. We excluded the patients who had minor neurosurgical procedures, pregnancy, and undergone cardiopulmonary resuscitation from the Emergency Department.
Among 145 patients recruited, 101 (70%) had Glasgow Coma Scale (GCS) score ≤ 8, 25 (17%) had GCS score 9 to 12, and 19 (13%) had GCS score 13 to 15. The most common diagnosis were subdural hematoma and epidural hematoma, 51% and 36%, respectively. Hypokalemia was the most common electrolyte imbalance at 65.5%. The results of the use of a multivariable logistic regression model show that the odds of postoperative death in TBI patients were increased with high levels of blood glucose, hypernatremia, and acidosis.
Hypokalemia was the most common electrolyte imbalance in TBI patients. Hypernatremia, acidosis, and hyperglycemia significantly increased the odds ratio of death in the first 24 hours post TBI.
Immediate versus conventional postoperative tracheal extubation for enhanced recovery after liver transplantation
Authors: Li Jianbo , Wang Chengdi , Jiang Yuting , Song Jiulin , Zhang Longhao , Chen Nan , Zhang Rui , Yang Lan , Yao Qin , Jiang Li , Yang Jian , Zhu Tao , Yang Yang , Li Weimin , Yan Lunan , Yang Jiayin 
Published: November 2018

Abstract

Introduction:
To systematically compare immediate postoperative tracheal extubation (IPTE) with conventional tracheal extubation (CTE) and to determine whether IPTE can achieve an enhanced recovery for adult patients underwent liver transplantation (LT) without additional risks. We designed a systematic review and meta-analysis.

Methods:
The RCTs, cohorts, case–controls, or case series that explored outcomes of IPTE after LT for adults were involved in our study. The Newcastle–Ottawa scale was used to assess the risk of bias.

Results:
A total of 15 studies (n = 4144) were included, consisting of 10 studies (retrospective cohorts; n = 3387) for quantitative synthesis and 5 studies (1 prospective cohort, and 4 case series; n = 757) for qualitative synthesis. The pooled estimates suggested IPTE could reduce time to discharge from ICU stay (TDICU) (mean difference [MD] −2.12 days, 95% confidence interval [CI] −3.04 to −1.19 days), time to discharge from the hospital (TDH) (MD −6.43 days, 95% CI −9.53 to −3.33 days), re-intubation rate (RI) (odds ratio [OR] 0.29, 95% CI 0.22–0.39), morbidity rate (MR) (OR 0.15, 95% CI 0.08–0.30) and graft dysfunction rate (GD) (IPTE vs CTE: 0.3% vs 3.8%, P < .01), and had comparable ICU survival rate (ICUS) (OR 6.67 95% CI 1.34–33.35) when compared with CTE after LT.

Conclusions:
IPTE can achieve an enhanced recovery for adult patients underwent LT without additional re-intubation, morbidity, and mortality risks. However, further work needs to be done to establish the extent definitively through carefully designed and conducted RCTs.
N-acetylcysteine improves oxidative stress and inflammatory response in patients with community acquired pneumonia
Authors: Zhang Qianwen , Ju Yuanrong , Ma Yan , Wang Tao 
Published: November 2018

Abstract
Oxidative stress is considered to be part of the pathogenic mechanism for community-acquired pneumonia (CAP) and is closely linked to inflammation. Attenuation of oxidative stress would be expected to reduce pulmonary damage. Antioxidants have been found to be effective in alleviating lung injury and protecting against damage of other organs.
The aim of the study was to compare the effect of adding N-acetylcysteine (NAC) to conventional treatment versus conventional treatment on oxidative stress, inflammatory factors, and radiological changes in CAP patients.
Eligible CAP patients at Weihai Municipal Hospital were stratified and randomly assigned to either NAC group or non-NAC group between August 2016 and March 2017. The NAC group received conventional treatment for pneumonia and NAC (1200 mg/d). Thenon-NAC group received conventional therapy. malondialdehyde (MDA), superoxide dismutase (SOD), total antioxidant capacity (TAOC), tumor necrosis factor-α (TNF-α), and computed tomography (CT) images were evaluated at baseline and after treatment. The primary endpoint indicators were the changes in oxidative stress parameters (MDA, TAOC, SOD) and TNF-α after treatment in the NAC group compared with those in the non-NAC group. The secondary endpoint indicator was any difference in CT scores after treatment in the NAC group compared with the non-NAC group.
Baseline levels of MDA, TAOC, SOD, and TNF-α were similar between the 2 groups before treatment. Plasma levels of MDA and TNF-α decreased more (P < .05 MDA:p 0.004, TNF-α:p <0.001) in the NAC group than the non-NAC group, and there was a reliable increase in TAOC content (p 0.005). There was no significant difference in increased plasma SOD activity between the groups (p 0.368), and the NAC group did not show a greater improvement from CT scores. No NAC-related adverse effects were observed.
Addition of NAC therapy for CAP patients reduced MDA and TNF-α and increased TAOC. Treatment with NAC may help to reduce oxidative and inflammatory damage in pneumonia patients.
Apatinib for salvage treatment of advanced malignant pleural mesothelioma
Authors: Du Zedong , Yu Yanxin , Wu Dajun , Zhang Guangyu , Wang Yang , He Liang , Meng RongQin 
Published: November 2018

Abstract

Rationale:
Malignant Pleural Mesothelioma (MPM) is rare cancer and has a poor prognosis with resistance to chemotherapy or radiotherapy. Until now there is no standard third-line treatment for patients who have failed second-line therapy.

Patient concerns:
A 58-year-old non-smoking female peasant of ethnic Han was admitted to the oncology department of the 363 Hospital with a primary complaint of chest tightness and breathlessness from 3 months ago.

Diagnoses:
Positron emission tomography-computed tomography (PET/CT) examination showed “dirty” pleural and parietal pleural involvement as well as mediastinal and pulmonary hilar lymph node enlargement. Finally, cancer cells were seen after repeated pleural effusion cell examination. Immunohistochemistry confirmed epithelioid of pleural mesothelioma.

Interventions:
Apatinib as a third-line treatment after failure from pemetrexed/cisplatin (PC) as the first-line chemotherapy and gemcitabine/cisplatin (GP) as the second-line chemotherapy. At first, 250 mg/day was given and 1 week later, the dose was increased to 500 mg/day.

Outcomes:
A 5-month progression-free survival was achieved and toxicity included severe hand-foot syndrome, mild proteinuria, and hypertension.

Lessons:
Apatinib may be a potential therapeutic drug for MPM, particularly as a third-line treatment in cases resistant to chemotherapeutic options.
Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty
Authors: Lin Bon-Jour , Hong Kun-Ting , Lin Chin , Chung Tzu-Tsao , Tang Chi-Tun , Hueng Dueng-Yuan , Hsia Chung-Ching , Ju Da-Tong , Ma Hsin-I , Liu Ming-Ying , Chen Yuan-Hao 
Published: November 2018

Abstract
The aim of this study is to analyze the combined impact of preoperative T1 slope (T1S) and C2-C7 sagittal vertical axis (C2-C7 SVA) on determination of cervical alignment after laminoplasty.
Forty patients undergoing laminoplasty for cervical spondylotic myelopathy (CSM) with more than 2 years follow-up were enrolled. Three parameters, including cervical lordosis, T1S, and C2-C7 SVA, were measured by preoperative and postoperative radiographs. Receiver operating characteristics (ROC) curve analysis was used to determine the optimal cut-off values of preoperative T1S and C2-C7 SVA for predicting postoperative loss of cervical lordosis. Patients were classified into 4 categories based on cut-off values of preoperative T1S and C2-C7 SVA. The primary outcome was postoperative C2-C7 SVA. Change in radiographic parameters between 4 groups were compared and analyzed.
Optimal cut-off values for predicting loss of cervical lordosis were T1S of 20 degrees and C2-C7 SVA of 22 mm. Patients with small C2-C7 SVA, no matter what the value of T1S, got slight loss of cervical lordosis and increase in C2-C7 SVA. Patients with low T1S and large SVA (T1 ≤20° and SVA >22 mm) got postoperative correction of kyphosis and decrease of C2-C7 SVA. However, patients with high T1S and large SVA (T1 >20° and SVA >22 mm) got mean postoperative C2-C7 SVA value of 37.06 mm, close to the threshold value of 40 mm.
Determination of cervical alignment after laminoplasty relies on the equilibrium between destruction of cervical structure, kyphotic force, and adaptive compensation of whole spine, lordotic force. Lower T1S means bigger compensatory ability to adjust different severity of cervical sagittal malalignment, and vice versa.
The effects of a forced-air warming system plus electric blanket for elderly patients undergoing transurethral resection of the prostate
Authors: Zhang Rui , Chen Xueli , Xiao Yan 
Published: November 2018

Abstract

Background:
Perioperative inadvertent hypothermia in elderly urology patients undergoing transurethral resection of the prostate (TURP) is a well-known serious complication, as it increases the risk of myocardial ischemia, blood loss, and surgical wound infection. We conducted this prospective randomized controlled trial to evaluate the combined effect of a forced-air warming system and electric blanket in elderly TURP patients.

Methods:
Between January 2015 and October 2017, we recruited 443 elderly male patients undergoing elective TURP with subarachnoid blockade (SAB). These were randomly divided into 3 groups: group E (intraoperative warming using electric blankets set to 38°C; n = 128); group F (intraoperative warming using a forced-air warmer set to 38°C; n = 155) and group FE (intraoperative warming using a forced-air warmer plus electric blankets, both set to 38°C; n = 160). The primary outcome was shivering and their grades. Hemodynamic changes, esophageal temperature, recovery time, incidences of adverse effects, and patient and surgeon satisfaction were also recorded.

Results:
Baseline characteristics showed no significant differences when compared across the 3 groups (P >.05). Compared with groups E and F, both HR and mean arterial pressure (MAP) in group FE were significantly decreased from T6 to T10 (P <.05). Compared with groups E and F, esophageal temperature in group FE increased significantly from T5 to T10 (P <.05). Compared with group E, esophageal temperature in group F was significantly increased from T5 to T10 (P <.05). Compared with groups F and FE, post-anesthesia care unit (PACU) recovery time was longer in group E, while compared with group F, PACU recovery time was shorter in group FE (P <.05). Compared to patients in groups E and F, those in group FE had a significantly lower incidence of arrhythmia and shivering (P <.05). The number of patients with shivering grades 0 to 3 was higher in group E than in other groups, while the number of patients with shivering grade 2 was significantly higher in group F than in group FE (P <.05). Patient and surgeon satisfaction scores were higher in group FE than in groups E and F (P <.05).

Conclusions:
Use of a forced-air warming system combined with an electric blanket was an effective method with which to retain warmth among elderly TURP patients.
Impact of nearby smoking on adolescent smoking behavior in Korea
Authors: Kim Dong Jun , Kim Sun Jung 
Published: November 2018

Abstract
Although youth smoking is a very significant topic, research on youth smoking is limited. More specifically, youth smoking studies are limited to certain schools and regions. In this study, we investigated the association between number of nearby smokers and adolescent smoking behavior.
This study used South Korea's representative Youth Risk Behavior Web-based Survey from 2014 to 2016. A total 198,814 adolescents were included in the analysis. Survey logistic regression models were used to examine the association. We also analyzed subgroup models and various combinations of nearby smokers to explain adolescent smoking behavior.
Adjusting for variables associated with smoking behavior, multivariate survey logistic regressions revealed that adolescents with more nearby smokers had a greater risk for smoking (1 person: odds ratio [OR], 5.090; 2 persons: OR, 8.405; 3 persons or more: OR, 12.039, all statistically significant). Combinations of nearby smokers also show that the risk of smoking increases as the number of people increases. In particular, smoking increased significantly when with friends.
The study found that, as the number of surrounding cigarette smokers increases, the smoking rate in teenagers increases, and there is a tendency to vary according to social status. We recommend that educators and policy makers use a variety of approaches considering social environmental factors in smoking prevention programs and smoking cessation education for adolescents.
Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock
Authors: Chien Shun-Ching , Liu Kuan-Ting , Wu Yen-Hung 
Published: November 2018

Abstract

Rationale:
Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication.

Patient concerns:
An 81-year-old man was brought to the emergency department because of consciousness disturbance for 2 days. According to his daughter, he had a history of hypertension and diabetes. Recently, his family also observed slurring of speech and easy choking. The physical examination findings were unremarkable.

Diagnosis:
Blood examination only revealed impaired renal function. Twelve-lead electrocardiography revealed sinus rhythm with first-degree atrioventricular block. Chest radiography revealed mediastinal widening. The blood pressures obtained from the 4 limbs showed no significant differences. Subsequently, brain computed tomography revealed no obvious intracranial lesion. A neurologist was consulted, and a recent ischemic stroke could not be ruled out. While in the observation area, his systolic blood pressure decreased to <90 mm Hg and he showed bradycardia, and 12-lead electrocardiography revealed an AV block and long pulse. Contrast-enhanced chest computed tomography revealed no evidence of aortic dissection. Another family member reported a history of lithium intake for bipolar disorder for >30 years. Blood examination revealed a lithium concentration of 2.65 mEq/L.

Interventions:
A nephrologist was consulted, and emergency hemodialysis was indicated. Dopamine was administered for his shock status via a right neck central venous catheter.

Outcomes:
His lithium level gradually declined after the hemodialysis, and blood pressure and consciousness level improved subsequently. The patient was discharged 9 days later in a stable condition.

Lessons:
If an emergency physician encounters a patient with altered consciousness and arrhythmia with cardiogenic shock, the patient's drug intake history should be carefully reviewed to rule out cardiovascular problems on the basis of the patient's clinical condition.
Glomus tumor of the stomach
Authors: Wu Menghui , Zhou Tianyu , Cao Donghui , Qu Limei , Cao Xueyuan 
Published: November 2018

Abstract

Rationale:
Glomus tumors (GTs) are a rare disorder originating from the glomus of the anastomoses of small arteries, usually occurring in the subungual region of the fingertips or toes and seldom occurring in the stomach. We unintentionally found a case of a gastric glomus tumor (GGT) without any upper abdominal discomfort. The diagnosis of this disease was mainly by immunohistochemistry.

Patient concerns:
The patient presented to our hospital with intermittent right abdominal pain for 1 month. Abdominal computed tomography showed a nodular enhancement lesion in the gastric antrum.

Diagnoses:
The patient was diagnosed with an ileocecal tumor and a gastric stromal tumor.

Interventions:
Surgical resection of the ileocecal and gastric tumors was performed.

Outcomes:
Pathologic examination of gastric masses revealed GT. The operation was effective, and the patient was discharged from our hospital 7 days after surgery. Upon follow-up at 3 months, the patient was asymptomatic.

Lessons:
GTs are submucosal tumors rarely found in the stomach. Surgical resection is a good choice of treatment. The GGT lacked specific clinical and imaging features, and immunohistochemistry was essential in the diagnosis of GGT.