bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness and safety of Chinese herbal medicine Xiaoyao san for the treatment of insomnia
Authors: Li Jiamin , Mu Zhenni , Xie Jun , Ma Tongtong , Zhang Ying , Qi Xianghua , Teng Jing 
Published: July 2019

Abstract

Background:
Insomnia is one of the most common sleep problems, which can impact physical and mental quality of life, resulting in a heavy social and economic burden. Xiaoyao san, a Chinese Herbal Medicine product, has been widely used as an alternative to recommended treatments for insomnia, but still lack of evidence of evidence-based medicine, which the clinical efficacy and its safety are questioned. Accordingly, we provide a protocol to evaluate the efficacy and safety of Xiaoyao san to update the search and evaluation for the best available and security treatment for insomnia.

Methods:
This review systematic and comprehensive retrieves of 8 related databases at home and abroad. Only randomized controlled trials (RCTs) of Xiaoyao san on Insomnia published in English and Chinese will be included. The quality of the included trials including randomization, allocation concealment, blinding, withdrawal, and loss of follow-up which was evaluated using internationally accepted evaluation criteria. And then systematically comprehensive analysis of the efficacy.

Results:
This review will be to assess the efficacy and safety of Xiaoyao san for insomnia.

Conclusion:
This systematic review will provide strong evidence for the effectiveness and safety of Xiaoyao san in the treatment of insomnia.

PROSPERO registration number:
CRD42019127326
Different patterns of electroencephalography during hypoglycemia in type 1 diabetes mellitus
Authors: Ryu Han Uk , Lee Seolwon , Shin Byoung-Soo , Kang Hyun Goo 
Published: July 2019

Abstract

Rationale:
Electroencephalographic (EEG) changes are frequently observed not only by epileptic seizures but also by metabolic encephalopathies. The EEG changes during hypoglycemia are known as mixed frequency theta to delta activity with higher amplitude than the initial background rhythm. Although there are many reports about hypoglycemia induced EEG changes, few studies of hypoglycemic EEG patterns have been evaluated between arousal and sleep stage.

Patient concerns:
A 45-year-old man who had been diagnosed as type 1 diabetes mellitus for 15 years admitted to the emergency room due to seizure attack. The EEG findings of the patient showed increased amplitude of theta slowing on both hemispheres. The abnormal EEG finding had recovered and the background frequency remarkably increased as the patient fell asleep, but reappeared when he woke up.

Diagnosis:
The patient was diagnosed as hypoglycemia with altered mentality.

Interventions:
Fifty percent dextrose fluid 50 mL was loaded and maintained with 10% dextrose water afterwards.

Outcomes:
The patient improved after medical treatment.

Lessons:
The EEG presentation of hypoglycemia involves low frequency and increased amplitude of delta-theta activity. As the previous studies, we observed medium amplitude semi-rhythmic theta slowing EEG findings on both hemispheres during arousal, indicating hypoglycemia. However, it was stabilized during sleep as background frequency increased and medium amplitude of slowing disappeared. Although there are many reports about hypoglycemia induced EEG changes, few studies of hypoglycemic EEG patterns have been evaluated between arousal and sleep stage. We report a case of different EEG patterns between arousal and sleep stage during hypoglycemia.
A fish bone induced aortic arch pseudoaneurysm in a male patient
Authors: Wang Azhen , Zhou Yun , Huang Qilin 
Published: July 2019

Abstract

Rationale:
Esophageal foreign body is a commonly seen in China. However, pseudoaneurysm of the aortic arch caused by ingestion of fish bones is a rare, life-threatening condition.

Patient concerns:
A 71-year-old male was admitted to the Ear, Nose, and Throat department with a 4-day history of chest pain after eating fish.

Diagnoses:
After taking out the fish bone by rigid endoscopy, magnetic resonance imaging and computerized tomography angiography (CTA) scans revealed the presence of an aortic arch pseudoaneurysm, which was likely caused by the fish bone.

Interventions:
A successful endovascular graft exclusion surgery was performed to block the aorta ulcer.

Outcomes:
The patient recovered and was discharged 20 days after hospitalization. The patient was healthy and had no fever or chest pain 4 months after discharge from the hospital.

Lessons:
Esophageal foreign bodies may lead to life-threatening impairment of the aorta or other big arteries. When esophageal foreign bodies puncture the esophageal wall, especially in the second stenosis of the esophagus, an enhanced-contrast computed tomography scan or a CTA scan may be necessary to exclude any potential impairment of the arteries.
A large pheochromocytoma requiring aortic and inferior vena caval reconstruction
Authors: Wang Jian , Yuan Ding , Lu Ya , Ma Yukui , Huang Bin , Yang Yi , Zhao Jichun 
Published: July 2019

Abstract

Rationale:
It is difficult to discriminate malignant pheochromocytoma (PCC) from benign PCC. The requirement of abdominal aortic and inferior vena cava reconstruction is extremely rare.

Patient concerns:
We here report a case of a large pheochromocytoma in a 56-year-old woman who complained of only hand trembling and had no hypertension or other symptoms. The operation was difficult because of a tight adhesion to the circumference of great vessels. A replacement of the aortocaval vessels with grafts was necessary to remove the tumor completely.

Diagnoses:
Ultrasonography, computed tomography (CT), and catecholamine assay revealed suspecting the retroperitoneal PCC.

Interventions:
Tumor excision and reconstruction of the abdominal aorta and inferior vena cava by externally supported polytetrafluoroethylene (ePTFE) vessels were successfully performed.

Outcomes:
A follow-up CT angiography showed no recurrence and graft vessels presented good patency after 7years. Catecholamine in urine and serum assay was normal.

Lessons:
The complete resection of the tumor and infiltrated great vessels were necessary for the long-term survival of patients with a large PCC. The ePTFE graft is a good substitute for vessel reconstruction.
Intertrochanteric fracture with low-energy trauma in a young woman with anorexia nervosa
Authors: Park Jong Seok , Lee Hong Seop , Won Sung Hun , Lee Dhong Won , Jung Ki Jin , Kim Chang Hyun , Kim Ja Hyung , Lee Won Seok , Ryu Aeli , Kim Woo Jong 
Published: July 2019

Abstract

Rationale:
Anorexia nervosa is a chronic psychiatric disease defined by severe weight loss, due to fear of obesity, and self-imposed semi-starvation. Of the many complications following anorexia nervosa, low bone mineral density (BMD) is a significant risk factor for fractures. Anorexia nervosa is associated with higher risk of incident fracture in females across all age groups, and in males >40 years old. Sites at highest risk of fracture include the hip/femur and pelvis in females, and vertebrae in males with anorexia nervosa.

Patient concerns:
A 29-year-old woman known to have suffered from anorexia nervosa 15 years ago visited the emergency department due to right hip pain after falling while getting out of a taxi. During the period of anorexia nervosa, she had a body mass index (BMI) of 14.06 kg/m2 (weight, 36 kg; height, 1.60 m) and suffered from amenorrhea. At the time of presentation, she had a BMI of 19.53 kg/m2 (weight, 50 kg; height, 1.60 m) and had regular menstrual periods, indicating clinical recovery from anorexia nervosa.

Diagnoses:
Plain radiography, computed tomography, and bone scintigraphy revealed AO 31-A2.2 type right hip proximal femur intertrochanteric fracture. The BMD showed a T score of −3.9 in the hip and −3.6 at the lumbar level, indicating severe osteoporosis.

Interventions:
Osteosynthesis was performed with proximal femoral nail antirotation (PFNA) and wiring.

Outcomes:
There were no specific symptoms, such as trauma or infection, during postoperative rehabilitation and postoperative management, and she was discharged after 2 weeks. After 1 year of follow-up at our outpatient clinic, she had no complications.

Lessons:
Here, we describe an unusual case of unilateral femoral intertrochanteric fracture that occurred after clinical recovery from anorexia nervosa. This case indicated that the risk of fracture remains even after recovery of BMI. We propose that women who have clinically recovered from anorexia nervosa should be advised to undergo annual osteodensitometric analyses after consulting with specialists in other areas (psychiatry, endocrinology, eating disorders).
Changes in medical research trends of North Korea after economic sanctions
Authors: Yoon Hai-Jeon , Woo Seon Hee , Kim Daehee , Um Ju Hyun , Park Sae Hyun , Seo Ah Ram 
Published: July 2019

Abstract

Background:
In the 1980s, North Korea established a socialist health care system. However, following the food crisis and the economic sanctions, it is estimated that North Korea's health care system has experienced continuous deterioration. Thus, in the present study, we estimated the current medical research trends of North Korea through an analysis of the medical journal Korean Medicine, published in North Korea.

Methods:
We analyzed the studies in Korean Medicine, which is the only North Korean medical journal accessible to foreigners with more than 30 years of data available, based on PRISMA guidelines. We analyzed the issues of the journal published for a total of 7 years, from 1985 onwards at 5-year intervals until 2015. To evaluate changes in the North Korean medical research trends, we compared and analyzed the issues published before and after the implementation of economic sanctions against North Korea.

Results:
In this study, we analyzed 775 articles of Korean Medicine. Following economic sanctions, the number of publications on approved services (conventional therapy and diagnosis)-related articles was decreased. In contrast, the articles related to non-conventional therapy increased sharply in number. This showed a similar pattern to North Korean medical research trends seen during the food crisis of 1995 to 1997.

Conclusions:
After placement of economic sanctions on North Korea, North Korean medical research trends changed significantly. These could be indirectly estimated results suggesting that recently, the North Korean health care system had deteriorated, similarly to in the food crisis of 1995 to 1997.
bbFISH-ing in the sonication fluid
Authors: Birlutiu Rares Mircea , Birlutiu Victoria , Cismasiu Razvan Silviu , Mihalache Manuela 
Published: July 2019

Abstract
By 2030, the annual number of combined total hip and knee arthroplasty is estimated to reach 3.5 to 4 million in the US alone. In the context of a constant increase of the number of primary and revision total hip and knee arthroplasty, an increased risk of complication is expected. Prosthetic joint infections (PJIs) represent major cause of healthcare expenditure and morbidity. PJI still remain the most common and feared arthroplasty complication. A rapid and correct diagnosis of infection is decisive for a correct therapeutical management. In this setting, the Academic Emergency Hospital Sibiu adopted and implemented, with the beginning of September 2016, a new strategy for the diagnosis of PJIs strategy that uses sonication and beacon-based fluorescent in situ hybridization (bbFISH) technology.
Until November 2017, 40 patients (40 retrieved implants) were enrolled in the study. Sonication fluid (SF) was collected after sonication of the implants, and samples were harvested on aerobic and anaerobic culture media. A bbFISH was used as a rapid method of bacteria detection.
16 patients were diagnosed with PJIs (all 16 patients presented a positive culture of the SF). Comparing bbFISH with culture, 11 samples tested true-positive. As the kit doesn’t contain probes for Pseudomonas fluorescens or Ralstonia pickettii, 4 strains of R pickettii and 1 strain of P fluorescens that was associated with Staphylococcus epidermidis were not detected.
Bacteria culture of SF remains the gold standard. bbFISH holds promise to be a diagnostic tool for rapid identifying of PJIs. The bbFISH assay needs to be optimized for the detection of bacterial strains that are relevant for the PJIs field.
Anterior tibial artery occlusion post total knee arthroplasty
Authors: Li Xin , Song Yang , Wang Jincheng 
Published: July 2019

Abstract

Rationale:
Total knee arthroplasty (TKA) is a globally well-accepted surgery because of its good outcome and safety. Although TKA-associated arterial injuries occur, postoperative anterior tibial artery (ATA) occlusion has not been reported yet. Herein, we present a case of ATA occlusion after TKA.

Patient concerns:
A 42-year-old man with a 6-year history of right knee pain after right patella fracture treated with open reduction was referred to our clinic. Valgus and contracture deformities were detected in the right knee. Severe osteoarthritis (OA) in the right knee and multiple osteochondromas were observed on radiography.

Diagnosis:
On the basis of clinical and imaging findings, the patient was diagnosed with OA and multiple osteochondromas.

Interventions:
TKA was performed in the right knee and the osteochondromas were resected. ATA occlusion was found postoperatively and was treated conservatively.

Outcomes:
Although the right ATA occlusion did not resolve, the patient recovered well postoperatively, with pain relief and recovery of right knee range of motion.

Lessons:
The clinical outcome in a case of ATA occlusion after TKA demonstrates that conservative treatment could be appropriate in this context.
Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding
Authors: Castillo Lina , Prachuapthunyachart Sittichoke , Hall Mel , Shelby Shaija , Quiros-Tejeira Ruben E. , Vo Hanh D. 
Published: July 2019

Abstract
Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes.
This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded.
Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not (P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics (P = .3).
This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.
Effects of multiple training modalities in the elderly with subjective memory complaints
Authors: Hsieh Sun-Wung , Hsiao Shih-Fen , Liaw Lih-Jiun , Huang Ling-Chun , Yang Yuan-Han 
Published: July 2019

Abstract

Background:
This study investigated the effects of multiple training modalities (MTM) on senior fitness and neuropsychiatric function in the elderly with subjective memory complaints (SMC).

Methods:
This study was conducted in 24 elderly subjects with Clinical Dementia Rating (CDR) score of 0 and instrument of ascertainment of dementia 8 (AD8) score of <2. The participants were classified into SMC (n = 7) and non-SMC (n = 17).
All were assigned to receive multiple training modalities (1 hour for each training: physical fitness activities, calligraphy or drawing, and meditation) twice a week over a 16-week period.
A series of senior fitness test, and neuropsychiatric tests, namely the Traditional Chinese version Mini-Mental Status Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), and the Center for Epidemiologic Studies Depression Scale (CESD), were conducted before and after the intervention. We compared the differences of pre/posttest-MTM and SMC/non-SMC in senior fitness and the neuropsychological tests.

Results:
There was no significant difference between SMC and non-SMC groups in demographic characteristics. MTM showed significant improvement in senior fitness and CESD, but not in CASI and MMSE. Significant change in recent memory subscale of CASI was only observed in SMC group, whereas improvement of partial senior fitness and CESD were observed in both groups.

Conclusion:
MTM had effects in enhancing senior fitness and improving depressive syndromes in the elderly. MTM contributed to greater improvement in recent memory function in the SMC group than in the non-SMC group.
BNP as a potential biomarker for cardiac damage of breast cancer after radiotherapy: a meta-analysis
Authors: Zhang Cheng , Shi Dan , Yang Ping 
Published: July 2019

Abstract

Background:
To analyze whether BNP could be a potential biomarker for cardiac damage of breast cancer after radiotherapy.

Methods:
PubMed, Web of Science, ProQuest and Medline were searched using the key words “breast cancer” (“breast tumor”, “breast neoplasm”, or “breast carcinoma”), “brain natriuretic peptide” (or BNP) and “radiotherapy” (or “radiation therapy”). Four articles were selected and analyzed using the STATA 12.0 software package. The standard mean difference (SMD) and its standard error for BNP were calculated to assess the relationship between BNP and radiotherapy for breast cancer patients.

Results:
In total, 172 patients with breast cancer were identified. The pooled SMD was -0.233 (95% CI −1.113, −0.057). The pooled estimated SMD for all studies showed obvious significant difference (z = 3.99, P = .000). There was no publication bias.

Conclusions:
This meta-analysis suggested that BNP could be a biomarker of cardiac damage at high heart absorbed doses according to radiotherapy, especially for left breast cancer patients.
Occurrence of second primary malignancies in patients with neuroendocrine tumors of the digestive tract
Authors: Pirozzi Angelo , Riccardi Ferdinando , Arpino Grazia , Mocerino Carmela , Campione Severo , Molino Carlo , Cartenì Giacomo 
Published: July 2019

Abstract

Rationale:
There is an association between the presence of neuroendocrine neoplasms and incremented risk to develop second primary malignancies. This risk is estimated to be 17%. The most common secondary neoplasms were found in the Gastrointestinal and Genitourinary tracts.

Patient concerns:
A 74-year-old Caucasian patient with melaena came to our observation in June 2015. The Esophago-gastro-duodenoscopy exam found a polypoid formation in the duodenal bulb. Histopathological examination showed a well-differentiated neuroendocrine neoplasm (G1).

Diagnosis:
During the follow up for the neuroendocrine neoplasm, a CT scan was performed in August 2016 describing infiltration of the right renal sinus and the third proximal ureter segment with heterogeneous enhancement of vascular structure. An US-guided biopsy was conclusive for a Diffuse Large B Cell Lymphoma. In October 2016, a colonoscopy showed a neoplastic lesion at 20 cm from the anal orifice. The Histology exam was positive for an adenocarcinoma with a desmoplastic stroma infiltration.

Interventions:
In November 2016, the patient underwent a left hemicolectomy: the pathologic staging described a G2 adenocarcinoma pT3N1b. In May 2018, the Octreotide scan was negative. In the same month, the patient started a treatment based on 6 cycles of Rituximab, Oxaliplatin, and Capecitabine due to the persistence of lymphomatous disease and hepatic metastases. In July 2018, other 3 cycles of the same treatment were scheduled.

Outcomes:
In January 2019, due to an increase in liver metastases’ size, it was decided to start a new regimen for the colon cancer with FOLFIRI+Cetuximab. The patient is still in treatment with this regimen in April 2019.

Lessons:
The risk of a second primary tumor is increased among patients older than 70. Therefore, it is necessary to follow them using total body CT scan and endoscopic techniques of gastrointestinal and genitourinary tracts, not only for the evaluation of the neuroendocrine tumor but also for the higher risk to develop other neoplastic diseases.
Platelet distribution width, platelet count, and plateletcrit in diabetic retinopathy
Authors: Ji Shuaifei , Ning Xiaona , Zhang Babo , Shi Heng , Liu Zheng , Zhang Jie 
Published: July 2019

Abstract

Background:
Screening and diagnosis of diabetic retinopathy (DR) mainly depends on fundus examination, which is not an intuitive and simple screening or diagnostic method. Recently, the relationship between platelet parameters and DR has become a hot topic. Whether platelet parameters have clinical value in DR is controversial.

Methods:
Literature was retrieved by formal search of electronic databases (PubMed, Embase, Cochrane library, Scopus, and CNKI) and by hand searching of reference lists of related articles from the beginning of building database to December 2017. Review manager 5.3 was utilized to deal with statistical data. This study was registered at International Prospective Register of Systematic Reviews (number: CRD42018093773).

Results:
This study included 1720 DR patients, 1477 type 2 diabetic mellitus (T2DM) without DR patients and 1456 health controls in 21 eligible studies. We found there was significant increase of platelet distribution width (PDW) level in the comparison of DR versus Control group (standard mean difference [SMD] [95% confidence interval [CI]] = 1.04 [0.68, 1.40]) and DR versus T2DM without DR group (SMD [95% CI] = 0.68 [0.40, 0.95]). For platelet count (PLT), it showed obvious decrease in the comparison of DR versus T2DM without DR group (SMD [95% CI] = −0.26 [−0.49, −0.03]) and no difference in comparison of DR versus Control (SMD [95% CI] = −0.26 [−0.51, −0.00]). Subgroup analysis showed that significant result of PDW level appeared in China and Turkey in all comparisons, while similar results of PLT only in China. In addition, PDW level was different in various DR-subtypes, obvious high level in proliferation DR.

Conclusions:
We concluded that the guiding significance of PDW and PLT in diagnosis and monitor of DR, and especially, application of PDW to PDR management may have potential sense.