bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Renal Injury After the Use of Polyethylene Glycol for Outpatient Colonoscopy
Authors: Cheng Chi-Liang , Liu Nai-Jen , Tang Jui-Hsiang , Kuo Yen-Lin , Lin Cheng-Hui , Lien Jau-Min , Tsui Yi-Ning , Lee Bai-Ping , Hung Hsiang-Ling 
Published: October 2018

Goal:
The goal of this study was to estimate the risk of renal injury after the use of 3-L polyethylene glycol (PEG) before outpatient colonoscopy.

Background:
Population-based studies showed that the use of PEG was associated with renal injury, but this association has not been confirmed by prospective study.

Study:
Patients ≥40 years of age with an estimated glomerular filtration rate ≥30 mL/min were screened for enrollment. Laboratory data were collected before, during, and after the colonoscopies. Patients with a ≥30% increase in baseline serum creatinine levels were followed until a peak level was detected. Renal injury included acute renal dysfunction (ARD) and acute kidney injury (AKI), defined as a 30% to 49% increase and ≥50% increase in creatinine levels compared with the baseline, respectively.

Results:
A total of 1163 patients (mean age, 55.7 y) completed the study. Baseline and first postcolonoscopy laboratory data were obtained an average of 17.0 days before and 17.3 days after the colonoscopies were performed, respectively. Renal injury was identified in 32 patients; 26 patients (2.2%) had ARD, and 6 patients (0.5%) had AKI. All patients with renal injury recovered fully during follow-up. In the subgroup analysis, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) before colonoscopy was statistically associated with the development of AKI (odds ratio, 6.5; 95% confidence interval, 1.2-35.5; P=0.03).

Conclusions:
This prospective study showed that the use of PEG was associated with a small risk of renal injury. NSAIDs use was statistically associated with AKI in the context of colonoscopy for which PEG was used for bowel preparation.
Risk of sexually transmitted infections following depressive disorder
Authors: Huang Sheng-Yun , Hung Jeng-Hsiu , Hu Li-Yu , Huang Min-Wei , Lee Shyh-Chyang , Shen Cheng-Che 
Published: October 2018

Abstract
Depressive disorder is a severe mental disorder associated with functional and cognitive impairment. Numerous papers in the literature investigated associations between sexually transmitted infections (STIs) and psychiatric illnesses. However, the results of these studies are controversial.
We explored the relationship between depressive disorder and the subsequent development of STIs including human immunodeficiency virus (HIV) infection, primary, secondary, and latent syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis.
We identified patients who were diagnosed with the depressive disorder in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without the depressive disorder who were matched according to age and sex. The occurrence of subsequent new-onset STIs was evaluated in both cohorts.
The depression cohort consisted of 5959 patients, and the comparison cohort consisted of 23,836 matched control patients without depressive disorder. The incidence of subsequent STIs (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.34–1.76) was higher among the depressed patients than among the patients in the comparison cohort. Furthermore, female gender compared to male (HR 1.58, 95% CI 1.24–2.01) and young age <40-year-old (HR 1.79, 95% CI 1.38–2.32) are both risk factors for acquisition of STIs in depression patient. For individual STI, the results indicated that the patients with depressive disorder exhibited a markedly higher risk for subsequent STIs including HIV infection, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis.
Depressive disorder might increase the risk of subsequent newly diagnosed STIs including HIV infection, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis in Taiwan population. Clinicians should pay particular attention to STIs in depression patients. Depression patients, especially those with the history of high-risk sexual behaviors, should be routinely screened for STIs.
Pharmacologic prevention of postoperative delirium after on-pump cardiac surgery
Authors: Tao Rui , Wang Xiao-Wen , Pang Liang-Jun , Cheng Jun , Wang Yong-Mei , Gao Guo-Qing , Liu Yu , Wang Chao 
Published: October 2018

Abstract

Background:
Postoperative delirium is a prevalent and disabling mental disorder in patients undergoing on-pump cardiac surgery. There is some evidence that the use of pharmacological interventions may reduce the risk of developing of postoperative delirium. Therefore, the aim of this meta-analysis was to determine the effect of pharmacologic agents for the prevention postoperative delirium after cardiac surgery.

Methods:
Randomized controlled trials (RCTs) were identified through a systematic literature search of electronic databases and article references up to October 2016. End points included incidence of postoperative delirium, severity of postoperative delirium, cognitive disturbances of postoperative delirium, duration of postoperative delirium, length of stay in intensive care unit (ICU) and hospital, and short-term mortality.

Results:
A total of 14 RCTs with an aggregate of 14,139 patients were included. The results of the present meta-analysis show that pharmacologic agents significantly decrease postoperative delirium [relative risk (RR), 0.83; 95% confidence interval (95% CI), 0.75–0.91, P < .00001] and duration of postoperative delirium (RR = −0.37, 95% CI = −0.47 to −0.27, P < .00001) after on-pump cardiac surgery. In addition, subgroup analysis shows that dexamethasone and dexamethasone were associated with a trend toward a reduction in postoperative delirium (RR, 0.45; 95% CI, 0.30–0.66, P < .0001; RR, 0.80; 95% CI, 0.68–0.93, P = .003, respectively). However, our results fail to support the assumption that pharmacologic prophylaxis is associated with a positively reduction in short-term mortality, length of ICU, or hospital stay.

Conclusion:
This meta-analysis suggests that the perioperative use of pharmacologic agents can prevent postoperative delirium development in patients undergoing cardiac surgery. However, there remain important gaps in the evidence base on a few small studies with multiple limitations. Further large-scale, high-quality RCTs are needed in this area.
Using an informatics education strategy to resolve the dilemma of teaching transplantation in medical institutions
Authors: Hsieh Ming H. , Shih Fu-Jong , Sheu Shuh-Jen , Wang Shoei-Shen , Shih Fu-Jin 
Published: October 2018

Abstract
In Taiwan, the current survival rate 1 year after transplantation exceeds 80%. However, the number of organ/tissue donors per year in Taiwan is extremely low, resulting in increased mortality. This is also true in Europe and in the United States. Recently, data from the Taiwan Organ Registry and Sharing Center showed that, although fundraising for organs/tissues slightly increased, the number of donors did not exhibit a corresponding growth trend. Identifying appropriate donors and the provision of good quality transplantation care by medical team members are current challenges. Hence, the application of information technology to in-service education for organ transplantation professionals has been suggested.
This was a qualitative study that employed qualitative content analysis with purposive and snowball sampling. The study participants (n = 8, mean age 39.88 ± 3.06 years) included medical staff involved in tissue/organ transplantation from 4 leading medical centers and 3 regional teaching hospitals, and those who participated in the informatics education system.
The interviewees from multidisciplinary medical teams showed the status of and dilemma in organ fundraising/donation/transplantation, noting 6 core themes. Regarding relevant education and training, 4 core themes were identified.
Current educational courses for organ fundraising/donation/transplantation are inadequate and seem to provide insufficient information to multidisciplinary medical teams. Hence, it is necessary to develop a theoretical construct to create a complete curriculum framework and to establish complete fit-in professional and ethical organ transplantation learning programs based on informatics technology to increase the interdisciplinary exchange of experience.
Hemichorea associated with cavernous angioma and a small errhysis
Authors: Qiu Jiqing , Cui Yu , Sun Lichao , Guo Yunbao , Zhu Zhanpeng 
Published: October 2018

Abstract

Rationale:
Chorea is a movement disorder characterized by randomly appearing involuntary movements of the face, neck, limbs, or trunk. Hemichorea is unilateral, involving one side of the body. Hemichorea is commonly caused by non-ketotic hyperglycemia and/or cerebrovascular injury to the contralateral basal ganglia.

Patient concerns:
Here, we report the case of a patient diagnosed with hemichorea who had diabetes, cavernous angioma, and a small intracranial errhysis. Routine testing showed the patient's blood glucose level was slightly higher than the normal range.

Interventions:
The errhysis was too small to be treated.

Diagnoses:
Brain magnetic resonance imaging showed a cavernous angioma with a small errhysis in the right putamen.

Outcomes:
Hemichorea was completely resolved after 4 months.

Lessons:
If diabetes is well controlled and imaging indicates brain lesions suggestive of a recent stroke, a diagnosis of post-stroke hemichorea should be considered.
Dysphagia with fatal choking in oculopharyngeal muscular dystrophy
Authors: Chen Andy Wei-Ge , Wu Shey-Lin , Cheng Wen-Ling , Chuang Chieh-Sen , Chen Chih-Hua , Chen Mu-Kuan , Liu Chin-San 
Published: October 2018

Abstract

Rationale:
Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant late-onset progressive muscle disorder typically characterized by ptosis, difficulty in swallowing, and proximal limb weakness. Underdiagnosis of OPMD is common in Asian countries and results in delayed diagnoses and fatal events.

Patient concerns:
Here, we report the case of a 53-year-old female who suffered from progressive dysphagia and experienced several choking events involving solid material. An extensive family history of dysphagia was noted, and 2 family members had died as a result of aspiration.

Diagnoses:
PABPN1 genotyping and DNA sequence analysis revealed a heterozygous (GCG)10(GCA)3GCG mutation that led to the diagnosis of OPMD.

Interventions:
Rehabilitation exercises, namely, the Shaker exercise and the Masako maneuver, were suggested.

Outcomes:
Improved swallowing ability with safe food intake was noted after 2 months of training. Surgical intervention will be considered when progression of the disease is noted.

Lessons:
Underdiagnosis and a lack of awareness of OPMD may lead to choking, aspiration pneumonia, and death in multiple members of affected families. Currently, there is no definitive treatment for OPMD, but rehabilitation exercises and surgical intervention are helpful in relieving dysphagia.
Prevalence and outcome of acute gastrointestinal injury in critically ill patients
Authors: Zhang Dong , Li Yuting , Ding Lili , Fu Yao , Dong Xuechao , Li Hongxiang 
Published: October 2018

Abstract

Background:
The aim of the study was to investigate the prevalence and impact of acute gastrointestinal injury (AGI) on clinical outcomes in critically ill patients.

Methods:
The PubMed, Cochrane, and Embase databases were searched to identify trials that assessed gastrointestinal injury in critically ill patients. Outcome measures were prevalence of AGI among critically ill patients; incidence of mortality among critically ill patients with AGI, and incidence of mortality stratified by severity of AGI.

Results:
The meta-analysis included 14 studies. The prevalence of AGI in critically ill patients was 40% [95% confidence interval (CI), 27%–54%]; the incidence of mortality among critically ill patients with AGI was 33% (95% CI, 26%–41%). There was a higher risk of mortality in critically ill patients with AGI compared to those without AGI [risk ratio (RR) = 2.01; 95% CI 1.20–3.37, P = .008). Subgroup analyses of studies that defined AGI according to European Society of Intensive Care Medicine (ESICM) criteria confirmed these findings and showed that the risk of mortality was higher in critically ill patients with more severe AGI (ESICM grade III and IV vs grade II) [RR of 1.86 (95% CI 1.48–2.34), P < .00001].

Conclusion:
AGI is common in critically ill patients, mortality in critically ill patients with AGI is high, and severity of AGI is associated with mortality. The widespread clinical use of standard criteria with a severity gradation will facilitate the diagnosis and management of AGI in critically ill patients.
Performance of noninvasive laser Doppler flowmetry and laser speckle contrast imaging methods in diagnosis of Buerger disease
Authors: Omarjee Loukman , Larralde Antoine , Jaquinandi Vincent , Stivalet Olivier , Mahe Guillaume 
Published: October 2018

Abstract

Rationale:
Buerger disease (BD) is a nonatherosclerotic, inflammatory, segmental vascular occlusive disease, which affects small and medium-sized arteries and veins and is triggered by substantial tobacco exposure. Angiographic findings consistent with BD are required for diagnosis. Laser Doppler flowmetry (LDF) and laser speckle contrast imaging (LSCI) could represent potential noninvasive alternative techniques to angiography.

Patient concerns:
We report the case of a 49-year-old smoker who developed an ischemic ulcer in the distal segment of the second finger of the left hand. He had no medical history.

Diagnoses:
In our vascular center, LDF and LSCI are conducted routinely for digital artery disease diagnosis. LDF was indicative of digital obstructive artery disease (DOAD). Postocclusive reactive hyperemia, assessed by LCSI, demonstrated no skin blood flow (SBF) perfusion in the distal phalanx of the thumb, index, middle, and auricular fingers. Angiography confirmed BD, showing distally located multisegmental vessel occlusion and corkscrew collaterals in this patient's hands.

Interventions:
Ilomedine treatment was initiated and smoking cessation was definitive.

Outcomes:
Recently, the patient had an improvement in clinical condition despite the persistence of a small zone of necrosis of the left index finger 28 days post-treatment.

Lessons:
Our observation suggests that where suspicion of BD is based on clinical criteria, combining LDF and LSCI could represent a noninvasive, safe means of reaching BD diagnosis. Further clinical trials are necessary to confirm this novel observation.
Natural prognosis of carbapenem-resistant Acinetobacter baumannii bacteremia in patients who did not receive appropriate antibiotic treatment
Authors: Kim Tark , Lee Eun Jung , Park Seong Yeon , Yu Shi Nae , Lee Yu Mi , Park Ki-Ho , Park Se Yoon , Jeon Min Hyok , Choo Eun Ju , Kim Tae Hyong , Lee Mi Suk 
Published: October 2018

Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is a major issues in current era. The aim of study was to investigate the natural prognosis and prognostic factors associated with 28-day mortality in patients with CRAB bacteremia who were not receiving appropriate antibiotic treatment.
Adult patients with CRAB bacteremia were retrospectively identified between April 2012 and March 2015 at 5 tertiary hospitals in Republic of Korea. Patients who were transferred to another hospital within 28 days of onset of bacteremia and who receive appropriate antibiotics more than 48 hours were excluded. We investigated prognostic factors associated with 28-day mortality in patients with CRAB bacteremia without appropriate antibiotic treatment.
Of enrolled 205 patients, 143 (69.8%) patients died within 28 days after blood culture. Of patients with 28-day mortality, 88.9% (127/143) of patients died within 5 days. Of 78 patients who survived more than 5 days, the 28-day mortality was 20.5% (16/78). Diabetes mellitus (adjusted odds ratio [aOR] 3.81, 95% confidence interval [95% CI] 1.19–12.20), immunocompromised (aOR 8.72, 95% CI 2.62–29.70), sequential organ failure assessment (SOFA) ≥ 10 (aOR 13.87, 95% CI 3.70–51.96), vasopressor use (aOR 7.03, 95% CI 1.79–27.60), and pneumonia (aOR 4.44, 95% CI 1.67–11.78) were found to be the factors independently associated with the 28-day mortality.
The 28-day mortality in patients with CRAB bacteremia without appropriate treatment was high, although some patients could survive. Severity and underlying conditions were important prognostic factors in patients with CRAB bacteremia.
Epidemiology of Pediatric Acute Pancreatitis in Taiwan
Authors: Cheng Yu‐Jyun , Yang Hsin‐Yi , Tsai Ching‐Fang , Lin Jen‐Shyang , Lee Hung‐Chang , Yeung Chun‐Yan , Chen Solomon Chih‐Cheng 
Published: October 2018

ABSTRACTObjective:Pediatric acute pancreatitis (AP) may be different from adult AP in various respects. This study focuses on the epidemiology and medical resource use of pediatric AP in Taiwan.Methods:Patients aged 0 to 18 years with AP were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases, Ninth Revision code of AP 577.0. The medical resource use was measured by length of hospital stay and hospital charges.Results:Between 2000 and 2013, a total of 2127 inpatient cases of pediatric AP were collected, which represented a hospitalization rate of 2.83 per 100,000 population. The incidence by age had 2 peaks, the first peak was at age 4 to 5 years old, and the second one started rising from 12 to 13 years old until adulthood. The incidence by year increased from 2.33 to 3.07 cases per 100,000 population during the study period. The average hospital stay is steady, but the medical cost is increasing. Girls have longer hospital stays, higher medical expenditures, more use of endoscopic retrograde cholangiopancreatography possibly due to more comorbidities with biliary tract diseases than boys (P < 0.05). The mortality in cases of AP is mostly associated with systemic diseases rather than AP itself.Conclusions:The incidence of pediatric AP in Taiwan is in a rising trend. There are gender differences in length of hospital stay, medical costs, use of endoscopic retrograde cholangiopancreatography and comorbidities.
Biliary Atresia Relevant Human Induced Pluripotent Stem Cells Recapitulate Key Disease Features in a Dish
Authors: Tian Lipeng , Ye Zhaohui , Kafka Kim , Stewart Dylan , Anders Robert , Schwarz Kathleen B. , Jang Yoon‐Young 
Published: October 2018

ABSTRACTBiliary atresia (BA) is the most common cause of pediatric end‐stage liver disease and the etiology is poorly understood. There is no effective therapy for BA partly due to lack of human BA models. Towards developing in vitro human models of BA, disease‐specific induced pluripotent stem cells (iPSCs) from 6 BA patients were generated using non‐integrating episomal plasmids. In addition, to determine the functional significance of BA‐susceptibility genes identified by genome‐wide association studies (GWAS) in biliary development, a genome‐editing approach was used to create iPSCs with defined mutations in these GWAS BA loci. Using the Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 system, isogenic iPSCs deficient in BA‐associated genes (GPC1 and ADD3) were created from healthy iPSCs. Both the BA patient‐iPSCs and the knock out (KO) iPSCs were studied for their in vitro biliary differentiation potential. These BA‐specific iPSCs demonstrated significantly decreased formation of ductal structures, decreased expression of biliary markers including CK7, EpCAM, SOX9, CK19, AE2, and CFTR and increased fibrosis markers such as alpha smooth muscle actin, Loxl2, and Collagen1 compared to controls. Both the patient‐ and the KO‐iPSCs also showed increased yes‐associated protein (YAP, a marker of bile duct proliferation/fibrosis). Collagen and YAP were reduced by treatment with the anti‐fibrogenic drug pentoxifylline. In summary, these BA‐specific human iPSCs showed deficiency in biliary differentiation along with increased fibrosis, the 2 key disease features of BA. These iPSCs can provide new human BA models for understanding the molecular basis of abnormal biliary development and opportunities to identify drugs that have therapeutic effects on BA.
Assessment of Proliferative Index Between the Tumor Margin, Center of Tumor, and the Invasive Tumor Front of Oral Squamous Cell Carcinoma With the Help of Mcm-2: An Immunohistochemical Study
Authors: Alrani Devendra , Niranjan Kochli C. , Sarathy Niharika A. 
Published: October 2018

Aim:
The knowledge of cellular proteins that involves cell cycle and its control system is essential for understanding tumor biology. Minichromosome maintenance protein (Mcm-2), a component of prereplicative complex, essential for initiating DNA replication, is deregulated in different malignant lesions, and is expressed throughout the whole cell cycle including the G0 and G1 phases. This characteristic cell cycle event is not found in other proliferative markers such as geminin, AgNOR, Ki-67, and proliferating cell nuclear antigen. The aim of the present study was to analyze and compare the expression of Mcm-2 in normal oral mucosa (NM) and oral squamous cell carcinomas at tumor margins (TM), the tumor center (TC), and the invasive tumor front (ITF), with correlation of clinicopathologic features.

Materials and Methods:
Tissues from 50 oral squamous cell carcinomas and 10 NM were archived retrospectively and stained with an antibody directed against the Mcm-2 antigen. A quantitative method was used to score the Mcm-2 expression in NM, TM, TC, and ITF. Nuclei labeling index for each case was estimated as the percentage of immunoreactive nuclei among 500 cells separately for NM, TM, TC, and ITF.

Results:
Nuclei labeling index increases progressively from NM (49.08%), TM (67.79%), and TC (76.87%) to ITF (87.77%).

Conclusions:
Cell proliferation by Mcm-2 at the ITF had a strong positive relationship with TC, TM. Mcm-2, a pan-cell cycle marker, is more sensitive in comparison with other conventional proliferative markers, which can be a better prognostic indicator.