bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do We Have Adequate Flexion-extension Radiographs for Evaluating Instability in Patients With Lumbar Spondylolisthesis?
Authors: Morita Tomonori , Yoshimoto Mitsunori , Terashima Yoshinori , Tanimoto Katsumasa , Iesato Noriyuki , Ogon Izaya , Oshigiri Tsutomu , Teramoto Atsushi , Emori Makoto , Takashima Hiroyuki , Hirota Ryosuke , Fujimoto Shutaro , Yamashita Toshihiko 
Published: August 2019

Study Design.
A retrospective cohort study of consecutive patients.

Objective.
To investigate whether adequate flexion-extension was acquired in standard functional radiographs in lumbar spondylolisthesis.

Summary of Background Data.
In lumbar spondylolisthesis, flexion-extension radiographs taken in the standing position are most commonly used to evaluate spinal instability. However, these functional radiographs occasionally depend on the patient's effort and cooperation, they can provide different results.

Methods.
This study included 92 consecutive patients diagnosed with L4-5 degenerative lumbar spondylolisthesis. We analyzed the flexion-extension radiographs taken with the patient being led by the hand (LH) and those taken without LH (NLH). Sagittal translation (ST), segmental angulation (SA), posterior opening (PO), and lumbar lordosis (LL) were measured on functional radiographs taken in both tests. Then, ST, SA, PO, detection rate of instability, and LL observed in LH were compared with those observed in NLH. Furthermore, the correlation of the difference was evaluated between ST, lumbar angulation, and LL.

Results.
A relative value of ST was 9.5% ± 4.3% in LH and 5.6% ± 3.3% in NLH, which differed significantly (P < 0.001). SA and PO were also significantly greater in LH than in NLH. The detection rate of instability was 71.7% in LH and 30.4% in NLH (P < 0.001). LL measurement on flexion showed 17.6° ± 13.5° in LH and 28.2° ± 12.2° in NLH, which differed significantly (P < 0.001). However, no significant difference was found in LL on extension between LH and NLH. There was a moderate correlation between the difference of ST, SA, PO, and LL on flexion.

Conclusion.
Flexion with physical assistance was useful for the detection of abnormal lumbar mobility. Taking radiation exposure into consideration, physical assistance such as using a table in front of a patient could lead the similar evaluation of the segmental instability.

Level of Evidence: 2
Right- Versus Left-sided Exposures of the Recurrent Laryngeal Nerve and Considerations of Cervical Spinal Surgical Corridor
Authors: Rajabian Ali , Walsh Michael , Quraishi Nasir A. 
Published: August 2019

Study Design.
Cadaveric study on fresh unprocessed, nonpreserved, undyed specimens which have not previously been reported.

Objective.
We aimed to perform surgically relevant exposures of the anterior cervical spine with particular attention to observing the potential vulnerabilities of the RLN on right and left.

Summary of Background Data.
Vulnerability of the RLN in the anterior cervical spine approach on the right versus left is the subject of ongoing debate. Although most cadaveric studies focus on course variations, structural relations of RLN, they have been done in preserved (fixed) cadavers without relevance to the needs of spinal exposure.

Methods.
Twelve fresh undyed cadavers had extensive layer by layer dissections by 2 surgeons (one with extensive experience as anatomy dissector). Both sides were explored for vulnerability during cervical spinal procedures. Each dissection was carried out in a phased approach and deliberately explored beyond what can be afforded in live surgery to allow the reader to conceptualize a better view of the structures.

Results.
In all specimens, we consistently demonstrated that the right surgical corridor involved manipulation of the nerve and its branches especially below C5 to achieve optimum midline access: in the right corridor, the RLN is on its oblique course to the tracheoesophageal groove. On the left, RLN is already in the tracheoesophageal groove and out of the surgical field involving minimal direct mobilization of the nerve.

Conclusion.
RLN surgical anatomy photographed here is novel in using fresh unprocessed cadaveric specimens which has previously not been reported.
Right surgical corridor, below C5, involves retraction/manipulation of RLN for achieving optimum spinal midline access, highlighting potential surgical vulnerability of right RLN.

Level of Evidence: 3
Synthetic Human Angiotensin II in Pediatric Patients With Vasodilatory Shock: A Report on Two Patients
Authors: Bailey Dwight M. , Chima Ranjit S. , Tidmarsh George F. , Williams Mark D. 
Published: August 2019

Background:
Severe sepsis and septic shock continue to be an important problem in children, with hospital mortality rates for pediatric severe sepsis as high as 25%.

Case Summary:
Two pediatric patients with septic shock requiring high dose vasopressors, who were treated with angiotensin II as part of an open-label study. Both patients had a significant increase in mean arterial pressure shortly after initiation of angiotensin II, with a reduction of the dose of catecholamines and vasopressin infusions. Serious adverse events reported were not attributable to angiotensin II by investigators. One patient survived, and one died related to progressive cerebral edema.

Conclusions:
Angiotensin II may represent another therapeutic option for pediatric patients who remain hypotensive despite receiving fluids and standard vasopressor therapy and deserves further study.
Comparison of Self-controlled Designs for Evaluating Outcomes of Drug–Drug Interactions
Authors: Bykov Katsiaryna , Franklin Jessica M. , Li Hu , Gagne Joshua J. 
Published: August 2019

Background:
Self-controlled designs, both case–crossover and self-controlled case series, are well suited for evaluating outcomes of drug–drug interactions in electronic healthcare data. Their comparative performance in this context, however, is unknown.

Methods:
We simulated cohorts of patients exposed to two drugs: a chronic drug (object) and a short-term drug (precipitant) with an associated interaction of 2.0 on the odds ratio scale. We analyzed cohorts using case–crossover and self-controlled case series designs evaluating exposure to the precipitant drug within person-time exposed to the object drug. Scenarios evaluated violations of key design assumptions: (1) time-varying, within-person confounding; (2) time trend in precipitant drug exposure prevalence; (3) nontransient precipitant exposure; and (4) event-dependent object drug discontinuation.

Results:
Case–crossover analysis produced biased estimates when 30% of patients persisted on the precipitant drug (estimated OR 2.85) and when the use of the precipitant drug was increasing in simulated cohorts (estimated OR 2.56). Self-controlled case series produced biased estimates when patients discontinued the object drug following the occurrence of an outcome (estimated incidence ratio [IR] of 2.09 [50% of patients stopping therapy] and 2.22 [90%]). Both designs yielded similarly biased estimates in the presence of time-varying, within-person confounding.

Conclusion:
In settings with independent or rare outcomes and no substantial event-dependent censoring (<50%), self-controlled case series may be preferable to case–crossover design for evaluating outcomes of drug–drug interactions. With frequent event-dependent drug discontinuation, a case–crossover design may be preferable provided there are no time-related trends in drug exposure.
RELATIONSHIP BETWEEN CHOROIDAL VASCULAR HYPERPERMEABILITY, CHORIOCAPILLARIS FLOW DENSITY, AND CHOROIDAL THICKNESS IN EYES WITH PACHYCHOROID PIGMENT EPITHELIOPATHY
Authors: Sakurada Yoichi , Fragiotta Serena , Leong Belinda C.S. , Parikh Ravi , Hussnain S. Amal , Freund K. Bailey 
Published: August 2019

Purpose:
To use swept-source optical coherence tomography and swept-source optical coherence tomography angiography to investigate potential relationships between choroidal vascular hyperpermeability (CVH) seen with indocyanine green angiography (ICGA), choriocapillaris flow density, and choroidal thickness in eyes with pachychoroid pigment epitheliopathy.

Methods:
Patients with pachychoroid pigment epitheliopathy were prospectively imaged with 12-mm × 12-mm swept-source optical coherence tomography, 12-mm × 12-mm swept-source optical coherence tomography angiographyA, and ICGA. Binarized choriocapillaris OCTA images were superimposed with ICGA images in which CVH area had been isolated. Choriocapillaris flow density within or outside the quadrants of CVH was calculated and the ratio of these two values was determined. The presence of CVH and choroidal thickness was evaluated at 9 locations within a central 3-mm × 3-mm area to explore the relationship between these 2 factors.

Results:
Ten eyes from 10 patients were enrolled in the present study. Choriocapillaris flow density within quadrants of CVH area was significantly lower compared with quadrants without CVH (P < 0.001). The mean choriocapillaris flow density ratio was 0.86 ± 0.10 (range: 0.65–0.99). From among the 90 locations in 10 study eyes, 48 were within areas of CVH. Choroidal thickness was greater in quadrants of CVH compared with areas without CVH (P < 0.001, 455 ± 122 µm vs. 297 ± 93 µm).

Conclusion:
Reduced choriocapillaris flow density, increased choroidal thickness, and CVH appear to co-localize in eyes with pachychoroid pigment epitheliopathy.
A case report of oral contraceptive misuse induced cerebral venous sinus thrombosis and dural arteriovenous fistula
Authors: Huang Qingling , Chai Xue , Xiao Chaoyong , Cao Xuan 
Published: August 2019

Abstract

Rationale:
Consumption of oral contraceptive pills (OCP) is a known risk factor for cerebral venous sinus thrombosis (CVST) among women. Development of dural arteriovenous fistula (dAVF) afterwards was very uncommon. We present a rare chronic complication of development of dAVF after CVST.

Patient concerns:
A 22-year-old woman suffered headache for a week. She was then admitted into our hospital.

Diagnosis:
Contrast enhanced magnetic resonance venography (MRV) demonstrated the thrombosis of the left transverse-sigmoid sinus the second day.

Interventions:
The intravenous thrombolysis was carried out. As the symptoms improved, the patient was discharged, while the treatment with oral dabigatran continued. However, 3 months after the onset, magnetic resonance imaging (MRI) showed swelling brainstem, and digital subtraction angiography (DSA) confirmed a dAVF. Clipping of the fistula was conducted, and her clinical symptoms improved gradually.

Outcomes:
The patient was transferred to rehabilitation center later, and received follow-up care.

Lessons:
When a patient taking OCP and suffering from a sudden headache, a clinical suspicion of possible CVST should always arise to avoid the onset of dAVF as soon as possible.
Ossifying fibroma in the mandibular angle mimicking metastatic clear cell renal cell carcinoma
Authors: Matsuda Shinpei , Yoshimura Hitoshi , Yoshida Hisato , Taga Minekatsu , Imamura Yoshiaki , Kiyoshima Tamotsu , Sano Kazuo 
Published: August 2019

Abstract

Rationale:
Ossifying fibroma is benign fibro-osseous neoplasm. The authors report a case of ossifying fibroma in the mandibular angle suspected as metastasis of clear cell renal cell carcinoma.

Patient concerns:
A 74-year-old man presented to the primary hospital complaining of frequent urination. A tumor in the left kidney was detected via an abdominal computed tomography scan. The patient then visited the Department of Urology at our hospital.

Diagnoses:
According to whole-body imaging examinations, the patient was suspected of having renal cancer with mandibular metastasis. Also, a cystic lesion of the maxilla was revealed.

Interventions:
Left nephrectomy was performed by urologists, and the patient was diagnosed with clear cell renal cell carcinoma of the left kidney. Approximately 1 month later, resection with a safety margin of the mandibular lesion and removal of the maxillary lesion were performed by oral and maxillofacial surgeons.

Outcomes:
The patient was diagnosed with ossifying fibroma of the mandible and an odontogenic keratocyst of the maxilla via a histopathological examination. Eighteen months have passed since the operation without clinical and imaging findings associated with recurrence.

Lessons:
Ossifying fibroma in the mandibular angle of elderly patients is extremely rare. Surgeons should consider the possibility of metastasis when osteolytic lesions of the jaw are found in patients with cancer.
Circulating JNK pathway-associated phosphatase level correlates with decreased risk, activity, inflammation level and reduced clinical response to tumor necrosis factor-α inhibitor in Crohn disease patients
Authors: Shi Xue , Yang Wei , Wang Nian , Zhu Junyi 
Published: August 2019

Abstract

Objective:
This study aimed to investigate the correlation of serum Jun-amino-terminal kinase (JNK) pathway-associated phosphatase (JKAP) level with disease risk, severity, inflammation, and treatment response to tumor necrosis factor (TNF)-α inhibitor in Crohn disease (CD) patients.

Method:
Ninety-six active CD patients and 90 healthy controls (HCs) were consecutively enrolled. Serum JKAP level of participants was determined via enzyme-linked immunosorbent assay (ELISA). In CD patients, C-reactive protein (CRP), erythrocyte sedimentation rate, Crohn disease activity index (CDAI), and inflammatory cytokine levels (determined by ELISA) were recorded. All CD patients underwent infliximab (IFX) treatment for 12 weeks, then treatment response (defined as decrement of CDAI ≥70) was assessed at week 12 (W12).

Results:
Serum JKAP level in CD patients was lower compared to HCs, and it disclosed a good predictive value for decreased CD risk; meanwhile, it was negatively correlated with CRP level, CDAI score, TNF-α, interleukin (IL)-6, and IL-17 levels in CD patients. Sixty-eight (70.8%) patients achieved treatment response to IFX at W12, and JKAP level was increased at W12 compared to baseline. Interestingly, baseline JKAP level in response patients was decreased compared to nonresponse patients, and it exhibited a good predictive value for decreased treatment response to IFX, multivariate logistic regression revealed that JKAP was an independent factor for predicting reduced IFX response.

Conclusion:
Circulating JKAP expression correlates with decreased disease risk, activity, and inflammation level, and it could be served as a novel biomarker for predicting reduced clinical response to TNF-α inhibitor in CD patients.
Chuankezhi injection for asthma
Authors: Li Meichen , Zheng Wenjiang , Zhang Chaoyuan , Yan Qian , Peng Zijing , Xie Fuqi , Hong Yu , Liu Xiaohong 
Published: August 2019

Abstract

Background:
Asthma is a chronic inflammatory disease characterized by recurrent attacks of breathlessness and wheezing, which often worsen at night or in the early morning and vary from person to person in severity and frequency. Chuankezhi injection (CKZ), as a new Chinese medicine, was recently found to have a good clinical effect on asthma. Whereas neither systematic nor meta-analysis of randomized controlled trials (RCTs) explain the efficacy of CKZ in treating asthma. Therefore, we provide a protocol to evaluate the efficacy and safety of CKZ for asthma.

Methods:
From inception until April 2019, a systematic and comprehensive literature search will be conducted in both 4 Chinese databases and 3 English databases. RCTs will be included related to CKZ for asthma. We will assess the quality of the included trials in accordance with the risk of bias tools in Cochrane manual 5.1.0. We will use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method to assess the certainty of the estimated evidence. Data analysis will be performed using the STATA 15.0.

Results:
This systematic review aims to assess the effectiveness and safety of CKZ for the treatment of asthma, in order to provide evidence for the clinical practice of Chinese medicine. This protocol will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. The results of this meta-analysis will be submitted to a peer-reviewed journal once it is completed.

Conclusion:
The consequence of this study will furnish proof to evaluate if CKZ is effective in the treatment of asthma.

PROSPERO registration number:
ROSPERO CRD42019134458.
A case-control study on the relationship between miRNAs single nucleotide polymorphisms and sepsis risk
Authors: Zhang Yan , Li Min , Bao Lanying , Hu Pengfei 
Published: August 2019

Abstract
MicroRNAs (miRNAs) play an important role in the pathogenesis of sepsis, but the association of miRNAs single nucleotide polymorphisms (SNPs) and sepsis risk is not clear. We analyzed plasma levels of miR-187, miR-21, and miR-145 in 180 patients with sepsis and 180 healthy controls were analyzed, and the SNPs: rs12605436, rs13137, and rs353291 were detected by sequencing. Plasma levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 were measured in all subjects by enzyme-linked immunosorbent assay (ELISA). The results showed that the levels of TNF-α and IL-6 in the plasma of patients with sepsis were significantly higher than those in patients of the control group (P < .0001). Plasma levels of miR-187 in patients with sepsis were significantly lower than those in the control group, while those of miR-21 and miR-145 were significantly higher than those in the control group (P < .0001). Plasma levels of miR-187 in sepsis patients were inversely correlated with those of TNF-α and IL-6 (r = −0.2841, −0.2163), and plasma levels of miR-21 and miR-145 were positively correlated with those of TNF-α and IL-6 (r = 0.615, 0.3057, 0.4465, 0.2734). The T allele of the miR-187 SNP rs12605436 was found to be a risk factor for sepsis (OR = 1.403, 95% CI = 1.205–1.612, P < .001). The T allele of the miR-21 SNP rs13137 and the T allele of the miR-145 SNP rs353291 (OR = 0.685, 95% CI = 0.566–0.820, P < .001) were found to be a protective factor for sepsis (OR = 0.755, 95% CI = 0.632–0.896, P < .001). From our results, we can see that the plasma levels of miRNAs containing the SNPs rs12605436, rs13137, and rs353291 are associated with the occurrence of sepsis.
Long term follow-up in a patient with prune-belly syndrome – a care compliant case report
Authors: Cornel Aldea , Duicu Carmen , Delean Dan , Bulata Bogdan , Starcea Magdalena 
Published: August 2019

Abstract

Rationale:
Malformative uropathies represent a major cause of Chronic Kidney Disease (CKD) in children. Genitourinary system is the most frequent and sever affected in Prune-Belly syndrome cases. That is why the findings of early diagnosis and vigilant monitoring for these situations remain a major challenge for the medical team.

Patient concerns:
We present the clinical course of a 10 years old child with diagnosis of Prune-Belly syndrome. A urinary tract abnormality was suspected starting 25 weeks of gestation, when a routine ultrasound showed oligohydramnios, increased size urinary bladder, bilateral hydronephrosis and megaureters, thin abdominal wall.

Diagnosis:
Prenatal suspicion of Prune-Belly syndrome plays a deciding role in renal disease progression. A detailed clinical exam at birth established the diagnosis of Prune-Belly syndrome. Renal ultrasound confirmed bilateral grade III hydronephrosis and megaureters, with empty bladder, suggesting an obstruction at this level. A persistent urachus was confirmed by catheterization. Later it was used for imaging study that showed bilateral high grade reflux.

Interventions:
The main goal of any treatment is to preserve kidney function. Treatment options depend on the clinical picture. The pregnancy was closely monitorized, but fetal distress appeared so early labor was induced at 32 weeks. At beginning a temporary catheter was placed into the urachus which expressed urine. The urachus drain was left in place until the age of 6 weeks, when a bilateral ureterostomy was performed. Skeletal and genital malformations were present too; the child has undergone several surgeries to solve these abnormalities.

Outcomes:
At the age of 10 years, he is a well-adapted child. He has had fewer than 3 urinary tract infections per year. Long term follow-up showed a relatively slow decline in the estimated Glomerular Filtration Rate in our child (62 ml/1.73m2/min).

Lessons:
This case suggests that induced early labor could prove beneficial for early upper urinary tract decompression through earlier access to surgery. This is an option especially in situations or region where vesicoureteric or vesicoamniotic shunt placement is not available.
Fatal contrast medium-induced adverse response to iohexol in carotid artery angioplasty
Authors: Yang Zhiqi , Li Rong , Yue Jinbin , Wei Yaxuan , Zhang Xiaoyan , Yin Rong 
Published: August 2019

Abstract

Rationale:
Adverse drug reactions (ADRs) to iohexol occur infrequently and generally result in good outcomes. This report describes a 51-year-old man suffering from an ADR to iohexol (Omnipaque 300), which proved fatal.

Patient concerns:
The patient was admitted to hospital due to intermittent dizziness over 2 years and transient numbness and weakness of the right limbs for 1 week. The patient was investigated using carotid artery angioplasty (CAA), during which the patient suffered a sudden disorder of consciousness and a tonic-clonic seizure leading to status epilepticus. After the CAA, the patient suffered from increasing cerebral edema volume.

Diagnoses:
Results of digital subtraction angiography and computed tomography angiography performed at another hospital before the CAA suggested severe stenosis of the left internal carotid artery at the spinal C1 level. In the processes of intraoperative and postoperative CAA, the patient developed severe allergic reactions to the contrast agent including epilepsy, brain tissue edema, and renal failure, which were typical according to the 10th edition of the American College of Radiology Manual on Contrast Media (ACR Manual on Contrast Media, Version 10.3, 2017).

Interventions:
The patient was treated with antiepileptic, antianaphylactic therapy, and control of blood pressure. Due to rapid and severe brain edema, a decompressive craniectomy was performed on the left side, but it was unsuccessful in reducing brain edema. Subsequently, the patient was started on continuous renal replacement therapy for progressive renal dysfunction.

Outcomes:
Despite the use of a variety of medical and surgical interventions, it was not possible to control the patient's condition, which gradually declined leading to death, 7 days post-CAA.

Lessons:
To the authors’ knowledge, this represents the 1st case of fatal contrast-induced ADR to iohexol during CAA. Although a variety of preoperative tests for iohexol allergy were performed according to recommendations from the ACR Manual on Contrast Media (Version 10.3, 2017), severe complications related to iodized contrast agent still occurred. If the ADR had been recognized sooner and decompressive craniectomy and continuous renal replacement therapy were applied earlier, it would have improved the patients’ prognosis.