bluuebunny/crossref_metadata_2025_split huggingface dataset:
Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients
Authors: Lichter Yael , Gal Oz Amir , Adi Nimrod , Nini Asaph , Angel Yoel , Nevo Andrey , Aviram Daniel , Moshkovits Itay , Wald Ron , Stavi Dekel , Goder Noam 
Published: August 2024

OBJECTIVE:
Mean arterial pressure (MAP) plays a significant role in regulating tissue perfusion and urine output (UO). The optimal MAP target in critically ill patients remains a subject of debate. We aimed to explore the relationship between MAP and UO.

DESIGN:
A retrospective observational study.

SETTING:
A general ICU in a tertiary medical center.

PATIENTS:
All critically ill patients admitted to the ICU for more than 10 hours.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
MAP values and hourly UO were collected in 5,207 patients. MAP levels were categorized into 10 groups of 5 mm Hg (from MAP < 60 mm Hg to MAP > 100 mg Hg), and 656,423 coupled hourly mean MAP and UO measurements were analyzed. Additionally, we compared the UO of individual patients in each MAP group with or without norepinephrine (NE) support or diuretics, as well as in patients with acute kidney injury (AKI).
Hourly UO rose incrementally between MAP values of 65–100 mm Hg. Among 2,226 patients treated with NE infusion, mean UO was significantly lower in the MAP less than 60 mm Hg group (53.4 mL/hr; 95% CI, 49.3–57.5) compared with all other groups (p < 0.001), but no differences were found between groups of 75 less than or equal to MAP. Among 2500 patients with AKI, there was a linear increase in average UO from the MAP less than 60 mm Hg group (57.1 mL/hr; 95% CI, 54.2–60.0) to the group with MAP greater than or equal to 100 mm Hg (89.4 mL/hr; 95% CI, 85.7–93.1). When MAP was greater than or equal to 65 mm Hg, we observed a statistically significant trend of increased UO in periods without NE infusion.

CONCLUSIONS:
Our analysis revealed a linear correlation between MAP and UO within the range of 65–100 mm Hg, also observed in the subgroup of patients treated with NE or diuretics and in those with AKI. These findings highlight the importance of tissue perfusion to the maintenance of diuresis and achieving adequate fluid balance in critically ill patients.
Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysis
Authors: Liu Hilary Y. , Alessandri-Bonetti Mario , Kasmirski Julia A , Stofman Guy M , Egro Francesco M. 
Published: August 2024

Background:
Free tissue transfer is often considered a last resort in burn reconstruction due to its complexity and associated risks. A comprehensive review on free flap outcomes in delayed burn reconstruction is currently lacking. The study aimed to evaluate the available evidence on the failure and contracture recurrence rates in free flap delayed burn reconstruction.

Methods:
A systematic review and meta-analysis was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The protocol was registered on PROSPERO (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The measured outcomes were free flap loss and contracture recurrence rate.

Results:
Of the 1262 retrieved articles, 40 qualified for inclusion, reporting on 1026 free flaps performed in 928 patients. The mean age was 29.25 years [95% confidence interval (CI), 24.63–33.88]. Delayed burn reconstruction was performed at an average of 94.68 months [95% CI, − 9.34 to 198.70] after initial injury, with a follow-up period of 23.02 months [95% CI, 4.46–41.58]. Total flap loss rate was 3.80% [95% CI, 2.79–5.16] and partial flap loss rate was 5.95% [95% CI, 4.65–7.57]. Interestingly, burn contracture recurrence rate was 0.62% [95% CI, 0.20–1.90].

Conclusions:
This systematic review provides a comprehensive evaluation of the free flap outcomes in delayed burn reconstruction. The flap loss rate was relatively low, given the complexity of the procedure and potential risks. Furthermore, burn contracture rate was found to be extremely low. This study demonstrates that free flaps are a safe and effective option for delayed burn reconstruction.
Imaging the Nerve “Allograft to Muscle Target” Technique in Neuroma Management
Authors: Hale Eva S. , Tadisina Kashyap Komarraju , Jose Jean , Xu Kyle Y. 
Published: August 2024

Summary:
Neuroma management has gained significant attention in the peripheral nerve literature in the past decade. Alongside techniques such as targeted muscle reinnervation and regenerative peripheral nerve interface, another technique known as the “allograft to nowhere” has emerged. This approach involves the placement of an extended allograft at the end of a nerve, creating a regrowth zone in cases where muscle or nerve targets are not available. Although technique and outcomes research has been performed regarding the above techniques, there is a lack of imaging studies to examine postoperative outcomes. The authors present a case of recurrent neuroma management using a combined nerve allograft to nowhere + muscle target, supported by postoperative imaging.
Fecal calprotectin as an inflammatory biomarker in small bowel Crohn disease
Authors: Sousa Maria I. , Dias Emanuel , Andrade Patrícia , Macedo Guilherme 
Published: August 2024

Abstract

Background:
Small bowel capsule endoscopy (SBCE) is an essential tool for evaluation of small bowel (SB) Crohn disease (CD). Fecal calprotectin (FC) represents an important biomarker of intestinal inflammation, widely used in ulcerative colitis and CD. Our aim was to evaluate the role of FC for diagnosing inflammatory activity in patients with isolated SB CD and how it correlates with SBCE findings.

Methods:
This is a retrospective study conducted in a tertiary inflammatory bowel disease referral center that included patients with SB CD who underwent SBCE between January 2017 and February 2023. FC value was obtained from the closest stool examination to SBCE.

Results:
One hundred ninety-six patients were included: 123 were women (63%) with a mean age of 44.2 years. In the SBCE, 127 (65%) patients had a Lewis Score ≥135 and, among the 94 patients with FC >200 μg/g, 23 had LS <135, 36 had LS between 135 and 790, and 35 had LS ≥790. FC levels were predictive of endoscopic lesions in SBCE, with significant correlation between FC level and total LS (Pearson correlation coefficient 0.43, P<.001). The sensitivity and specificity were calculated for each cut-off value being respectively 78% and 45% for FC = 100 μg/g, 69% and 59% for FC = 150 μg/g and 67% and 67% for FC = 200 μg/g.

Conclusion:
FC showed moderate correlation with endoscopic findings in SBCE in SB CD. It is, therefore, a reasonable marker for predicting significant inflammatory lesions in SBCE; however, none of the cut-off had a high sensitivity or specificity.
Antihyperlipidemic drugs mitigate the elevated incidence of peptic ulcer disease caused by hyperlipidemia: A cohort study
Authors: Chen Pei-Hsien , Tsai Chiu-Lin , Hsieh Yow-Wen , Cho Der-Yang , Tsai Fuu-Jen , Lin Cheng-Li , Liao Hsien-Yin 
Published: August 2024

Background:
Several risk factors for peptic ulcer disease (PUD) have been identified; however, the recurrence rate of PUD remains high even with standard ulcer treatments. High cholesterol levels have been proposed as a risk factor for PUD, but clinical evidence remains limited. Therefore, this database study investigated whether hyperlipidemia increases PUD risk and whether antihyperlipidemic drugs reduce this risk.

Methods:
A long-term cohort design was adopted, and Taiwan’s National Health Insurance Research Database was used to enroll patients diagnosed with hyperlipidemia between 2000 and 2016. Patients without hyperlipidemia were randomly matched based on variables such as age and gender to establish a comparison cohort at a 1:1 ratio. Another cohort study was conducted to determine whether antihyperlipidemic drugs or red yeast rice prescriptions can reduce the incidence of PUD in patients with hyperlipidemia.

Results:
The overall incidence of PUD was 1.48 times higher in the hyperlipidemia cohort (203,235 patients) than in the nonhyperlipidemia cohort (adjusted hazard ratio, 1.48; 95% CI, 1.46-1.50; p < 0.001). Among the patients with hyperlipidemia, those who used antihyperlipidemic drugs with or without red yeast rice prescriptions exhibited a lower risk of developing PUD relative to those who did not use them; the adjusted hazard ratios were 0.33 (95% CI, 0.21-0.52) and 0.81 (95% CI, 0.78-0.84), respectively. When the cumulative exposure to antihyperlipidemic drugs and red yeast rice prescriptions increased, the risk of developing PUD showed a decreasing trend, which was statistically significant for antihyperlipidemic drugs but not for red yeast rice.

Conclusion:
Hyperlipidemia is associated with a higher risk of PUD, which can be reduced through the administration of antihyperlipidemic drugs with or without red yeast rice prescriptions.
Clinicopathologic and prognostic implications of HOXA gene and its associated long-noncoding RNAs expression in non-small cell carcinoma: A meta-analysis
Authors: Yang Yanhui , Huang JinYang , Wang Qi , Li Ji , Yu Lei , Xie Xiaoyang 
Published: August 2024

Background:
We conducted an investigation into the correlation between HOXA and associated long-noncoding RNAs, along with their clinicopathologic and prognostic features in non-small cell lung cancer (NSCLC).

Methods:
A comprehensive search across multiple electronic databases, including PubMed and the Web of Science, was conducted to identify relevant studies. The association between HOXA, clinicopathologic parameters, and prognosis was assessed using relative risk (RR) and hazard ratio (HR) with a 95% confidence interval (CI). Data compilation was performed using STATA 12.0 software.

Results:
A total of 11 trials involving 2058 patients with NSCLC were included in our study. Significant correlations were observed between HOXA-AS2 and TNM stage (III-IV) (RR=2.173, 95% CI: 1.386–5.437, P< 0.05) and HOTTIP and age (≥60-year-old) (RR=2.628, 95% CI: 1.185–5.829, P< 0.05) and non-smoking (RR=0.387, 95% CI: 0.156–0.959, P< 0.05). The combined results indicated a significant association between HOXA5 and increased overall survival (HR = 0.69, 95% CI = 0.57–0.84, P < .001). Additionally, HOXA-AS2, HOXA11 and HOTTIP were identified as potential independent predictors for poorer OS (HOXA-AS2: HR =3.48, 95% CI = 1.95 to 6.21, P < 0.05; HOXA11: HR=1.39, 95%CI = 1.08 to 1.79, P < 0.05; HOTTIP: HR=2.44, 95%CI = 1.10 to 5.42, P < 0.05). The prognostic significance of HOXA1, HOXA3 and HOXA4 was uncertain (HOXA1: HR=1.40, 95% CI =0.28 to 7.06, P > 0.05; HOXA3: HR=1.20, 95% CI = 0.96 to 1.50, P > 0.05; HOXA4: HR=0.97, 95% CI = 0.77 to 1.23, P > 0.05).

Conclusions:
The HOXA gene family has some potential to emerge as a novel prognostic factor for NSCLC and is correlated with some clinicopathological parameters such as the TNM stage, age and smoking. However, further meticulously designed prospective studies are warranted to substantiate these findings.
Efficacy of fidaxomicin versus vancomycin in the treatment of Clostridium difficile infection: A systematic meta-analysis
Authors: Zhao Zihan , Wu Yarui , Geng Xuhua , Yuan Congrui , Fu Yi , Yang Guibin 
Published: August 2024

Purpose:
To compare the efficacy, recurrence rate, adverse event rate and mortality of fidaxomicin compared with vancomycin in treating different types of Clostridium difficile infection (CDI).

Methods:
A systematic search was conducted on PubMed, Embase, Web of Science, Cochrane Library and clinical trial registration databases for research on fidaxomicin versus vancomycin in the treatment of CDI and the retrieval period extended from the establishment of the database to July 22, 2022. A total of 15 studies were included, including 8 RCTs and 7 retrospective cohort studies.

Results:
Results showed that there was no significant difference in the overall efficacy of the treatment between fidaxomicin and vancomycin, and results in the subgroups of CDI hypervirulent strains and recurrent CDI were obtained, but vancomycin was more effective than fidaxomicin in the treatment of severe CDI (RR = 0.94, 95% CI: 0.90–0.98, P < .01). Results showed that fidaxomicin is superior to vancomycin in terms of 40-day recurrence rate (RR = 0.52, 95% CI: 0.38–0.70, P < .01), 60-day recurrence rate (RR = 0.38, 95% CI: 0.21–0.69, P < .01) and 90-day recurrence rate (RR = 0.62, 95% CI: 0.50–0.77, P < .01). For the recurrence rate of the treatment in CDI hypervirulent strains, severe CDI and recurrent CDI, there was no significant difference between the 2 groups. In addition, there was no significant difference in the incidence of clinical adverse reactions, and same outcomes appeared in all-cause mortality at 40-day, severe CDI and recurrent CDI, but fidaxomicin was superior to vancomycin in all-cause mortality over 60-day (RR = 0.57, 95% CI: 0.34–0.96, P = .03).

Conclusion:
There were no significant differences between fidaxomicin and vancomycin in the treatment of CDI in therapeutic effectiveness and adverse reactions, while fidaxomicin was superior to vancomycin in terms of recurrence rate and long-term mortality, and vancomycin is more effective in treating severe CDI.
Effect of improving asymmetry through self-myofascial release in adolescent soccer player with hypomobility syndrome hip: A randomized controlled trial
Authors: Yan Shuren , Jiang Quan , Song Munku 
Published: August 2024

Background:
Hypomobility syndrome (HMS), or limited hip range of motion (ROM), is often reported in adolescents who train heavily. This study was aimed to investigate the impact of traditional static stretching (STR) and self-myofascial release (MFR) in adolescents with HMS hip.

Methods:
This study was a randomized controlled trial. Adolescent athletes with HMS hip were grouped as 23 STR and 23 MFR. Foam rolling was employed as the training method for MFR. Both interventions were performed twice a day for 20 minutes in 6 weeks. The training was filmed and distributed via the mobile video. Self-assessed Copenhagen Hip & Groin Outcome Score, ROM, strength, and hop tests were measured before and after the interventions. The healthy side without limitations was designated as non-HMS (nHMS) and taken as reference value.

Results:
The study participants had limitations in flexion (FLX), abduction (ABD), internal rotation (IR), and external rotation (ER). The ROM of STR group was recovered to nHMS level. The FLX and ABD of MFR group was also recovered, however the IR and ER had lower angles compared to nHMS. MFR FLX, ABD, ER strength, and single hop test were restored like that of nHMS, however STR group was substantially lower than nHMS despite the improvements. Both groups depicted lower pre-intervention Copenhagen Hip & Groin Outcome Score subscale activities daily living, sport, and physical activity compared to nHMS. Activities daily living and physical activity were improved to healthy levels after the intervention, however sport was lower than that of nHMS.

Conclusion:
Both STR and MFR had impact on hip mobility and hip self-assessment score. Furthermore, MFR had strength improvements in FLX, ABD, and ER. However, the improvements in MFR group regarding triples, crossover hops, and self-assessed sports were limited. Therefore, STR and MFR are effective in improving not only ROM but also muscle function asymmetry in HMS hip.
Clinical evolution of bladder carcinosarcoma: A case report and literature review
Authors: Wu Shuo , Wang Xiaolong , Zuo Yuliang , Wang Kuan , Ye Meihong , Wang Chaoming 
Published: August 2024

Rationale:
Bladder carcinosarcoma (BC) is a malignant tumor composed of a mixture of malignant epithelial and stromal components. Carcinosarcoma mostly occurs in the upper respiratory tract and upper gastrointestinal tract and is less common in the urinary system. The incidence of malignant tumors of the urinary system is <3%. It rarely occurs in the bladder and accounts for approximately 0.31% of all malignant bladder tumors. A literature review and this report will help to further improve our understanding, diagnosis, and treatment of bladder carcinosarcoma (BC).

Patient concern:
We describe the case of an 80-year-old female patient who was admitted to the hospital with a history of intermittent hematuria for 3 years. Furthermore, total cystectomy was refused when a BC was diagnosed. Palliative resection surgery was necessary because of the recurrent hematuria and abdominal pain.

Diagnoses:
Pathologically confirmed BC after surgery.

Interventions:
The patient’s first transurethral resection of bladder tumor (TURBT) was diagnosed as BC. However, the patient refused a total cystectomy. Two months after intravesical treatment with epirubicin, bladder tumor recurrence was observed during follow-up cystoscopy. The patient underwent a second TURBT for hemostatic treatment due to persistent hematuria. Due to hematuria and abdominal pain, a third TURBT was performed to reduce tumor size and stop bleeding. Finally, tumor recurrence resulted in bilateral hydronephrosis, and the patient underwent bilateral renal catheter drainage guided by B-ultrasound.

Outcomes:
Bladder carcinosarcoma caused uremia, electrolyte imbalance, and sepsis. Approximately 19 months after the discovery of the tumor, the patient died.

Lessons:
Radical bladder resection is recommended once a BC is diagnosed. By reporting the cases and reviewing the literature in the database, we will summarize the epidemiology, origin, etiology, clinical features, existing treatments, and prognostic factors of BC, and propose new prospects for BC therapy.
MR imaging diagnosis of small-cell carcinoma of the ovary, hypercalcemic type: A case report and literature review
Authors: Li Xinyu , Liu Zhuolin , Chen Jiake , Hao Huifen , Fan Dongmei , Huang Wenbin 
Published: August 2024

Rationale:
Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT), is a rare and aggressive gynecological tumor. We retrospectively analyzed the clinical manifestations and imaging findings of this patient and analyzed the relevant literature, with the aim of improving the ability of radiologists to differentiate SCCOHT from other ovarian tumors.

Patient concerns:
We report a case of 36-year-old woman who was diagnosed with SCCOHT. MRI suggested a malignant tumor of the left ovary. The immunohistochemical markers shows SMARCA4 negativity. Notably, hypercalcemia was not detected. Microscopically, it was consistent with the large-cell variants.

Lessions:
Despite its rarity, SCCOHT should still be considered in the differential diagnosis of ovarian malignancies. When a young female patient presents with a large unilateral tumor on MRI with a predominant solid component and significant enhancement on the contrast enhanced scans, along with hypercalcemia, SCCOHT should be considered.
Evaluating the efficacy of cognitive restructuring and exposure therapies on secondary school chemistry students’ test anxiety: A randomized trial
Authors: Eya Ngozi M. , Anumudu Juliet I. , Nweze Bernardine N. , Dave-Ugwu Priscillia O. , Egbo Joy J. , Chukwunwogor Eunice O. , Okebanama Cliff I. , Omeje Cynthia O. , Aikoye Joshua E. , Ngwainmbi Desmon , Ibrahima Ngom N. , Ugwuanyi Christian Sunday 
Published: August 2024

Background:
This study explored how cognitive restructuring (CR) and cognitive exposure therapy (CET) impacted test anxiety in chemistry students from Nsukka, Enugu State. Three research questions and hypotheses guided the investigation.

Method:
A quasi-experimental design with a pretest, posttest, and 2 experimental groups was employed. The study involved 154 SSII chemistry students from 4 purposefully chosen schools within Nsukka. The Chemistry Test Anxiety Scale, Cognitive Restructuring Chemistry Treatment Package, and Cognitive Exposure Chemistry Treatment Package served as the data collection instruments. The Chemistry Text Anxiety Scale’s internal consistency, measured by Cronbach alpha, was found to be 0.86, indicating good reliability. Descriptive statistics (mean and standard deviation) addressed the research questions, while Analysis of Covariance tested the hypotheses at a 0.05 significance level.

Results:
Results showed that the students who were exposed to CR therapy had pretest mean test anxiety score of M̄ = 78.31, standard deviation (SD) = 8.63 and posttest mean test anxiety of mean [M] = 27.06, SD = 5.71, while those exposed to cognitive exposure had a pretest mean test anxiety score of M = 77.39, SD = 8.68 and a posttest mean test anxiety score of M = 32.62, SD = 11.04. The reduction in text anxiety scores of −51.25 and −44.77 for the students exposed to CR and cognitive exposure respectively. The students exposed to CR therapy had lesser posttest mean test anxiety score than those exposed to CET. The results revealed that students receiving CR therapy displayed lower posttest anxiety scores compared to those receiving CET. Additionally, no significant interaction between treatment and gender on test anxiety was found.

Conclusion:
It was concluded that CR therapy is better than CET in the management of test anxiety among chemistry students. Based on these findings, it was recommended that cognitive behavioral therapists should be invited periodically to educate students on the negative effects of irrational thoughts on academic performance.
Cervical metastasis of breast cancer: A case report and literature review
Authors: Zhang Lu , Yang Xi , Zhang Yuanyuan , Wen Yaru , Huang Manni , An Jusheng 
Published: August 2024

Rationale:
Cervical metastasis of breast cancer is rare and its clinical manifestations are similar to those of primary cervical cancer. It is thus easy to misdiagnose, with diagnosis mainly depending on pathology and immunohistochemistry. There have been few studies on its treatment and there is thus no standard treatment plan.

Patient concerns:
This is a 64-year-old female patient presented with a 2-month history of abnormal postmenopausal vaginal discharge, who had previous history of breast cancer.

Diagnoses:
Based on the gynecological examination, imaging results, pathology, and immunohistochemical results, a diagnosis of metastatic carcinoma of the cervix and breast cancer was confirmed.

Interventions:
She received computed tomography-guided 3-dimensional high-dose-rate brachytherapy in combination with chemotherapy.

Outcomes:
She achieved complete response locally. This case provides a new local treatment option for patients with inoperable localized cervical metastases.

Lessons:
We hope that this report and the accompanying review help to enrich the literature pertaining to the treatment of rare cervical metastases, providing a foundation for the improved survival of affected patients.