bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium induced by tigecycline treatment for Acinetobacter baumannii infection
Authors: Zheng Xiaoying , Jiang Huiming , Xue Lifen , Qiu Feng , Zhu Shenyin , Li Xinyu 
Published: May 2019

Abstract

Rationale:
Tigecycline is a broad-spectrum antimicrobial agent structurally belong to tetracyclines and covers against many multidrug-resistant organisms. Arising clinical cases reporting its adverse drug reactions have emerged alongside with the increasing off label use globally. By literature review, delirium caused by tigecycline has not been reported yet. We present what we believe to be the first case of tigecycline-induced delirium.

Patient concerns:
A 77-year-old male patient with end-stage renal disease was hospitalized due to acute exacerbation of chronic obstructive pulmonary disease.

Diagnosis:
The patient developed delirium after infused with a loading dose of tigecycline for pulmonary infection.

Interventions:
All potential causes inducing delirium were evaluated and the symptoms improved soon after discontinuation of tigecycline. He experienced delirium once again after reusing tigecycline for the exacerbation of the pulmonary infection even without a loading dose. Tigecycline was discontinued and the symptoms quickly relieved.

Outcomes:
According to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of his delirium.

Lessons:
Clinicians should be aware of this potential adverse effect of tigecycline. We recommend that clinicians monitor patients for signs and symptoms of delirium during treatment with tigecycline.
Efficacy, safety, and in-hospital outcomes of subcutaneous versus transvenous implantable defibrillator therapy
Authors: Chen Chao-Feng , Jin Chao-Lun , Liu Mei-Jun , Xu Yi-Zhou 
Published: May 2019

Abstract

Background:
Lead-related complication is an important drawback of trans-venous implantable cardioverter-defibrillators (TV-ICD). The subcutaneous ICD (S-ICD) was developed to overcome ICD lead associated complications; however, whether the S-ICD confers enhanced clinical benefits compared with TV-ICD remains unclear. The present systematic review and meta-analysis aimed to assess TV-ICD and S-ICD for safety, efficacy, and in-hospital outcomes in the prevention of sudden cardiac death (SCD) in patients not requiring pacing.

Methods:
The Medline, PubMed, EmBase, and Cochrane Library databases were searched for studies comparing TV-ICD and S-ICD.

Results:
A total of 9 eligible studies, including 5 propensity-matched case–control, 3 retrospective, and 1 cross-sectional studies were identified, assessing 7361 patients in all. Pool analyses demonstrated that SICD were associated with lower lead-related complication rates [odds ratio (OR) = 0.13; 95% confidence interval [CI] 0.05–0.33; I
2 = 0%], and S-ICD was more beneficial in terms of reducing ICD shocks [OR = 0.48; 95% CI 0.32–0.72, I
2 = 4%]. In addition, the patients administered S-ICD tend to have shorter length of hospital stay after implantation (SMD = −0.06; 95% CI −0.11 to 0.00, I
2 = 0%) and reduce total complication rates (OR = 0.72; 95% CI 0.50–1.03; I
2 = 18%), non-decreased quality of life (QoL). Moreover, both devices appeared to perform equally well with respect to infection rate and death.

Conclusions:
Available overall data suggested that S-ICD is associated with reducing lead-related complications, ICD shocks. In addition, S-ICD has tendency to shorten hospitalization and reduce total complications, although the difference is no significant. Equivalent death rate, infection, and QoL were found between 2 groups. Therefore, S-ICD could be considered an alternative approach to TV-ICD in appropriate patients for SCD prevention.
Decision analysis about the cost-effectiveness of different in vitro fertilization-embryo transfer protocol under considering governments, hospitals, and patient
Authors: Pan Wei , Tu Haiting , Jin Lei , Hu Cheng , Li Yuehan , Wang Renjie , Huang Weiming , Liao ShuJie 
Published: May 2019

Abstract

Objective:
The aim of this study was to explore the benefits of in vitro fertilization (IVF) for patients and hospitals under different protocols and if IVF treatment should be incorporated into health care.

Perspective:
The government should consider including IVF treatment in health insurance. Hospitals and patients could obtain the best benefit by following the hospital's recommended protocol.

Setting:
This retrospective study was conducted from January 2014 to August 2017 at an academic hospital.

Methods:
A total of 7440 patients used gonadotropin-releasing hormone agonists (GnRHa) protocol, 2619 patients used, gonadotropin-releasing hormone antagonists (GnRHant) protocol, and 1514 patients used GnRHa ultra-long protocol. Primary outcomes were live birth rate (LBR), cost-effectiveness, hospital revenue, and government investment.

Results:
The cycle times for the GnRHa protocol and the GnRHa ultra-long protocol were significantly higher than the GnRHant protocol. Patients who were ≤29 years chose the GnRHant protocol. The cost of a successful cycle was 67,579.39 ± 9,917.55 ¥ and LBR was 29.25%. Patients who were >30 years had the GnRHa protocol as the dominant strategy, as it was more effective at lower costs and higher LBR. When patients were >30 to ≤34 years, the cost of a successful cycle was 66,556.7 ± 8,448.08 ¥ and the LBR was 31.05%. When patients were >35 years, the cost of a successful cycle was 83,297.92 ± 10,918.05 ¥ and the LBR was 25.07%. The government reimbursement for a cycle ranged between 11,372.12 ± 2,147.71 ¥ and 12,753.67 ± 1,905.02 ¥.

Conclusions:
The government should consider including IVF treatment in health insurance. Hospitals recommend the GnRHant protocol for patients <29 years old and the GnRHa protocol for patients >30 years old, to obtain the best benefits. Patients could obtain the best benefit by using the protocol recommended by the hospital.
Local infiltration with cocktail analgesics during 2 level lumbar spinal fusion surgery
Authors: Ren Zhinan , Li Zheng , Li Shugang , Sheng Lin , Xu Derong , Chen Xin , Wu William Ka Kei , Chan Matthew T.V. , Ho Jeffery 
Published: May 2019

Abstract

Background:
Despite introducing novel analgesics, pain management for spine surgery remains a challenge. Multimodal pain control has recently gained popularity in surgical spine care. We proposed a novel management approach using multimodal cocktail analgesics. Injection to skin surrounding surgical incision site will be given perioperatively. This study evaluates the safety and efficacy of cocktail analgesic injection on pain management following lumbar spinal fusion surgery.

Methods:
Thirty-six patients with degenerative lumbar spinal diseases on the waiting list for lumbar spinal fusion surgery will be recruited. Patients will be randomly assigned to receive either cocktail analgesic injection or sterile saline before surgical wound closure. All patients will routinely receive postoperative intravenous patient-controlled analgesia (IV-PCA) with sufentanil on an as-needed basis without a basal dose. The primary outcome is perceived pain intensity as measured by visual analog pain score. Secondary outcomes include sufentanil consumption, time to first use of IV-PCA, rescue analgesics consumption, and the presence of adverse effects. Findings of this interventional trial will provide novel evidence supporting the superior effect of cocktail analgesic injection during surgery.

Trial registration number:
ChiCTR-IPR-17013094.
Effect of bolus tracking region-of-interest position within the descending aorta on luminal enhancement of coronary arteries in coronary computed tomography angiography
Authors: Kurokawa Ryo , Maeda Eriko , Mori Harushi , Amemiya Shiori , Sato Jiro , Ino Kenji , Torigoe Rumiko , Abe Osamu 
Published: May 2019

Abstract
To compare coronary artery luminal enhancement in coronary computed tomography angiography (CCTA) between ventral and dorsal region-of-interest (ROI) bolus tracking in the descending aorta.
The records of 165 consecutive patients who underwent CCTA with non-helical acquisition from July 2017 to March 2018 were retrospectively examined. We performed 320-row CCTA with bolus tracking [scan triggered at 260 HU in the descending aorta] and 133 patients were finally included. ROI was set in the ventral and dorsal halves of the descending aorta in 68 and 65 patients, respectively.
Contrast arrival time was significantly shorter in the dorsal group (ventral: 21.8 ± 0.372 s; dorsal: 20.7 ± 0.369; P = .0295). The mean density of the proximal and distal RCA was significantly higher in the ventral group (proximal: ventral, 428.1 ± 6.95 HU; dorsal, 405.5 ± 7.72 HU, P = .0318; distal: ventral, 418.0 ± 9.29 HU; dorsal, 393.2 ± 9.46 HU, P = .0133).
Dorsal bolus tracking ROI in the descending thoracic aorta significantly reduced preparation time and RCA CT values.
Concomitant severe influenza and cryptococcal infections
Authors: Huang Jinbao , Li Hongyan , Lan Changqing , Zou Shenghua , Zhang Hongying , Wang Xinhang , Weng Heng 
Published: May 2019

Abstract
Concomitant influenza and cryptococcal infections are rare. Herein, we describe an unusual case of an avian influenza A (H7N9) infection with several severe mixed bacterial infections and systemic super-infection with Cryptococcus neoformans presenting as ventilator-associated pneumonia (VAP) and bloodstream infection in a previously immunocompetent man during hospitalization.
A 58-year-old man was admitted to our hospital complaining of hyperpyrexia, dyspnoea, cough, and phlegm with blood. A chest computed tomography scan revealed multiple ground-glass opacities and consolidation in both lungs with right pleural effusion. An initial sputum test was positive for influenza A (H7N9) virus. After antiviral treatment and other supportive measures, the patient's condition improved. However, the patient's condition deteriorated again approximately 2 weeks after admission, and bronchoalveolar lavage fluid (BALF) and blood cultures were positive for C. neoformans. Therapy with intravenous liposomal amphotericin B and fluconazole was started. After a 2-week antifungal treatment, BALF and blood cultures were negative for C. neoformans. However, the patient had persistent lung infiltrates with severe pulmonary fibrosis with a prolonged course of disease. On hospital day 40, BALF and blood cultures were both positive for multidrug-resistant Stenotrophomonas maltophilia. Finally, the patient developed septic shock, disseminated intravascular coagulation and multi-organ failure and succumbed to treatment failure.
Cryptococcal infection can occur in patients with severe influenza during hospitalization with a more severe condition, and the clinician should be aware of this infection.
Bilateral idiopathic neuralgic amyotrophy involving selective branches of peripheral nerves with a stepwise progression
Authors: Kim Mee-Gang , Han Mi-Hyang , Kim Min-Wook , Lee Sang-Uk , Jang Dae-Hyun 
Published: May 2019

Abstract

Rationale:
This is a report about a rare case of idiopathic neuralgic amyotrophy (INA) involving selective peripheral nerve branches of bilateral upper extremities, which exhibited a stepwise progression.

Patient concern:
A 66-year-old woman presented with paresis of selective branches of bilateral median nerves, followed by paresis of bilateral posterior interosseous nerve (PIN) 8 weeks later.

Diagnoses:
We diagnosed it as INA involving the selective motor branches of bilateral median nerves and bilateral PINs. Forearm magnetic resonance imaging combined with electrodiagnostic testing helped accurately identify the affected regions, and ultrasonography demonstrated a severe constriction of the left PIN.

Interventions:
Intravenous methylprednisolone partially relieved the pain and paralysis. Surgical neurolysis of the constricted left PIN was done for persistent paralysis.

Outcomes:
The muscle power of the bilateral median nerve territories was recovered to nearly normal, but the muscle power of the left PIN territories remained at grade 1.

Lessons:
This case indicates that INA can manifest as a multiple mononeuropathy involving individual fascicular levels of peripheral nerve branches with focal constriction, and electrodiagnostic study combined with forearm MRI and ultrasonography can help in identifying affected lesion and predicting the prognosis.
Current trends in the features of male thyroid cancer
Authors: Kim Min Jhi , Lee Seul Gi , Kim Kwangsoon , Lee Cho Rok , Kang Sang-Wook , Lee Jandee , Nam Kee-Hyun , Chung Woong Youn , Jeong Jong Ju 
Published: May 2019

Abstract
This study aimed to compare the clinicopathologic characteristics and oncologic outcomes of papillary thyroid cancer (PTC) patients according to sex. Then, we validated prognostic variables to determine whether sex is a significant prognostic factor for PTC.
Between January 2007 and December 2010, 1232 men and 7276 women PTC patients underwent surgery. The patient characteristics and 5-year oncologic outcomes were compared. The stepwise Cox proportional hazards model determined the significance of survival variables.
Men PTC patients had more lymph node (LN) metastases than women, both in the total (P < .0001) and hemithyroidectomy (P < .0001) patients. Men and women showed similar 5-year recurrence-free survivals, both in total (P = .815) and hemithyroidectomy (P = .148) patients. The tumor size and the number of positive central nodes were associated with tumor recurrence, but not sex.
Sex was not an independent prognostic factor for tumor recurrence. Multicenter clinical studies with long-term follow-ups are needed to validate these results.
Examining determinants of sexual behavior among indigenous adolescents in Taiwan
Authors: Lin Li-Mei , Tung Tao-Hsin , Yeh Mei-Yu 
Published: May 2019

Abstract
A recent Taiwanese government report indicated that there were an increased number of sexual encounters among 15- to 17-year-old adolescents. Among them, indigenous Taiwanese had a higher rate of sexual encounters than did the rest of the population. However, no prior study has surveyed indigenous Taiwanese adolescents’ sexual behavior. Therefore, we examined the determinants of sexual behavior among indigenous adolescents in Taiwan.
In this cross-sectional study, the researchers chose 16 high schools as the target research population; after 2-stage random sampling, 4 of the 16 high schools were recruited to participate in the research. Data were collected through a self-report questionnaire from the participants, with a total of 521 valid responses.
Of the indigenous adolescents surveyed, 53% (N = 275) said they had touching, hugging, or kissing experiences, while 15.7% (N = 82) reported sexual behavior. The higher rate of sexual encounters among indigenous Taiwanese adolescents is associated with the gender, number of current or past romantic partners, drinking, and drug use before sexual intercourse. After adjustment for confounding factors, gender (male vs female, adjusted OR = 3.33, 95% CI: 1.83–6.07), number of heterosexual (≧1 vs no, OR = 1.67, 95% CI: 1.36–2.06), and heterosexual relationship (yes vs no, OR = 3.81, 95% CI: 1.94–7.48) appeared to be statistically significantly related sexual behaviors.
This study found that the occurrence rate of sexual behavior for indigenous adolescents was higher than the past research results, and having initiated sexual intercourse in earlier age. The results also showed the indigenous adolescents whose drinking alcohol and drug use are more experiences on sexual behaviors. The results could be applied on sexual education program in campus.
The tongue features associated with type 2 diabetes mellitus
Authors: Hsu Po-Chi , Wu Han-Kuei , Huang Yu-Chuen , Chang Hen-Hong , Lee Tsung-Chieh , Chen Yi-Ping , Chiang John Y. , Lo Lun-Chien 
Published: May 2019

Abstract
Diabetes mellitus (DM) is a public problem closely associated with numerous oral complications, such as coated tongue, xerostomia, salivary dysfunction, etc. Tongue diagnosis plays an important role in clinical prognosis and treatment of diabetes in the traditional Chinese medicine (TCM). This study investigated discriminating tongue features to distinguish between type 2 DM and non-DM individuals through non-invasive TCM tongue diagnosis.
The tongue features for 199 patients with type 2 DM, and 372 non-DM individuals, serving as control, are extracted by the automatic tongue diagnosis system (ATDS). A total of 9 tongue features, namely, tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissure, ecchymosis, teeth mark, and red dot. The demography, laboratory, physical examination, and tongue manifestation data between 2 groups were compared.
Patients with type 2 DM possessed significantly larger covering area of yellow fur (58.5% vs 22.5%, P < .001), thick fur (50.8% vs 29.2%, P < .001), and bluish tongue (P < .001) than those of the control group. Also, a significantly higher portion (72.7% vs 55.2%, P < .05) of patients with long-term diabetics having yellow fur color than the short-term counterparts was observed.
The high prevalence of thick fur, yellow fur color, and bluish tongue in patient with type 2 DM revealed that TCM tongue diagnosis can serve as a preliminary screening procedure in the early detection of type 2 DM in light of its simple and non-invasive nature, followed by other more accurate testing process. To the best of our knowledge, this is the first attempt in applying non-invasive TCM tongue diagnosis to the discrimination of type 2 DM patients and non-DM individuals.
Extramedullary relapse of leukemia after allogeneic hematopoietic stem cell transplantation
Authors: Xie Ning , Zhou Jian , Zhang Yanli , Yu Fengkuan , Song Yongping 
Published: May 2019

Abstract
Extramedullary relapse (EMR) rarely occurs after allogeneic hematopoietic stem cell transplantation (HSCT) in leukemia. This study was to investigate the clinical characteristics of EMR.
We retrospectively investigated 316 consecutive patients undergoing HSCT for acute leukemia or chronic myeloid leukemia (CML) at 2 institutions between January 2012 and February 2017. Furthermore, we analyzed and compared the risk factors and outcomes between EMR and bone marrow relapse (BMR).
The 5-year cumulative incidence of EMR was 14.1%. The EMR incidence in acute myeloid leukemia, lymphoblastic leukemia, and CML was 17.5%, 18.9%, and 5.3%, respectively. CML had a lower EMR incidence rate. Compared to the BMR group, the EMR group had a longer median relapse-free time (10.5 months vs 5 months, P = .02), and the EMR group had a higher incidence rate of chronic graft-versus-host disease (50.0% vs 20.9%, P = .009). EMR had better estimated 3-year survival rates post-HSCT, and post-relapse, than did BMR (39.5% vs 9.5%, P < .001, and 21.9% vs 10.8%, P = .001). Multivariate analysis identified that adverse cytogenetics (hazard ratio [HR] = 9.034, P < .001) and extramedullary leukemia before HSCT (HR = 2.685, P = .027) were the independent risk factors for EMR after HSCT. In the EMR group, patients who achieved complete remission (CR) had a significantly better, estimated 3-year survival than did patients who did not achieve CR (38.4% vs 14.3%, P = .014).
EMR is a significant contributor to mortality after HSCT, which appears to be resistant to most of the current therapies. Establishing effective strategies for EMR is important in improving outcomes after HSCT.
Prognostic and clinicopathological significance of Gamma-Glutamyltransferase in patients with hepatocellular carcinoma
Authors: Sun Ping , Li Yanlong , Chang Lijun , Tian Xudong 
Published: May 2019

Abstract

Background:
Many studies explored the prognostic and clinicopathological significance of pretreatment serum Gamma-Glutamyltransferase (GGT) level in hepatocellular carcinoma (HCC). However, there are inconsistent results in the prognostic and clinicopathological significance of pretreatment serum GGT level in HCC. Thus, we conducted this meta-analysis to comprehensively assess the prognostic and clinicopathological significance of pretreatment serum GGT level in HCC patients.

Methods:
We systematically searched PubMed, EMBASE and Web of Science for relevant studies (up to June 14, 2018). The estimated hazard ratios (HRs) were used to assess the association between pretreatment serum GGT level and survival in HCC patients. The estimated odds ratios (ORs) were applied to evaluate the correlation between pretreatment serum GGT and clinicopathological features in HCC.

Results:
Our results showed that high pretreatment serum GGT level was significantly correlated with poor overall survival (OS) (HR = 1.70, 95% CI: 1.54–1.87; P < .01) and disease-free survival/relapse-free survival (DFS/RFS) (HR = 1.56, 95% CI: 1.42–1.71; P < .01). Additionally, our results also revealed that there was a close correlation between GGT level and several clinicopathological features in HCC patients, including vascular invasion, tumor size, tumor number and Alpha-fetoprotein (AFP) level.

Conclusions:
This meta-analysis shows that high pretreatment serum GGT level is significantly correlated with poor survival and unfavorable clinicopathological features in HCC patients, suggesting that pretreatment serum GGT may be an economical and effective prognostic biomarker for HCC patients. However, more high-quality studies are still warranted to further validate our findings, considering there are several limitations in this meta-analysis.
The relationship of CRP and cognition in cognitively normal older Mexican Americans
Authors: Vintimilla Raul , Hall James , Johnson Leigh , O’Bryant Sid 
Published: May 2019

Abstract
C-reactive protein (CRP) is a biomarker for cardiovascular events and also has been studied as a biomarker for cognitive decline. By the year 2050 the Hispanic population in the United States will reach 106 million, and 65% of those will be of Mexican heritage. The purpose of this study was to evaluate the association between CRP levels and cognitive functioning in a sample of Mexican American older adults. A cross-sectional analysis of data from 328 cognitive normal, Mexican American participants from the community-based Health and Aging Brain Among Latino Elders (HABLE) study were performed. Statistical methods included t-test, chi square, multiple linear regression, and logistic regression modeling. Cognitive performance was measured by the Mini Mental State Examination (MMSE), Logical Memory I and II, Digit Span, FAS, and Animal Naming tests. Age, years of education, gender, diagnostic of hypertension, diabetes, and dyslipidemia were entered in the model as covariates. High CRP levels significantly predicted FAS scores (B = −0.135, P = .01), even after adjusting for covariates. Education (B = 0.30, P < .05), and diagnosis of hypertension (B = −0.12, P = .02) were also independent predictors of FAS scores. Participants with higher CRP levels had greater adjusted odds of poorer performance in the FAS test (OR = 1.75, 95% CI = 1.13–2.72, P = .01) when compared to participants with lower CRP levels. This was also true for participants with hypertension (OR = 2.20, 95% CI = 1.34–3.60, P < .05). Higher CRP levels were not associated with MMSE, logical memory, digit span, and animal naming scores. In conclusion, our study showed a clear association between CRP levels and verbal fluency and executive function in a cognitively normal community-dwelling population of Mexican-Americans.