bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Hounsfield Units Predict Pedicle Screw Loosening in Osteoporotic Patients Following Short-Segment Lumbar Fusion
Authors: Narayanan Rajkishen , Tarawneh Omar H. , Trenchfield Delano , Meade Matthew H. , Lee Yunsoo , Opara Olivia , McCurdy Michael A. , Pineda Nathaniel , Kaye lan D. , Alhassan Fatimah , Vo Michael , Mangan John J. , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Schroeder Gregory D. 
Published: April 2024

Study Design.
Retrospective Cohort.

Objective.
(1) To determine if vertebral HU values obtained from preoperative CT predict postoperative outcomes following one to three level lumbar fusion and (2) to investigate whether decreased BMD values determined by HU predict cage subsidence and screw loosening.

Summary of Background Data.
In light of suboptimal screening for osteoporosis, vertebral computerized tomography (CT) Hounsfield Units (HU), have been investigated as a surrogate for bone mineral density (BMD).

Materials and Methods.
In this retrospective study, adult patients who underwent one to three level posterior lumbar decompression and fusion (PLDF) or transforaminal lumbar interbody and fusion (TLIF) for degenerative disease between the years 2017 and 2022 were eligible for inclusion. Demographics and surgical characteristics were collected. Outcomes assessed included 90-day readmissions, 90-day complications, revisions, patient-reported outcomes (PROMs), cage subsidence, and screw loosening. Osteoporosis was defined as HU of ≤110 on preoperative CT at L1.

Results.
We assessed 119 patients with a mean age of 59.1, of whom 80.7% were white and 64.7% were nonsmokers. The majority underwent PLDF (63%) compared with TLIF (37%), with an average of 1.63 levels fused. Osteoporosis was diagnosed in 37.8% of the cohort with a mean HU in the osteoporotic group of 88.4 compared with 169 in nonosteoporotic patients. Although older in age, osteoporotic individuals did not exhibit increased 90-day readmissions, complications, or revisions compared with nonosteoporotic patients. A significant increase in the incidence of screw loosening was noted in the osteoporotic group with no differences observed in subsidence rates. On multivariable linear regression osteoporosis was independently associated with less improvement in visual analog scale (VAS) scores for back pain.

Conclusions.
Osteoporosis predicts screw loosening and increased back pain. Clinicians should be advised of the importance of preoperative BMD optimization as part of their surgical planning and the utility of vertebral CT HU as a tool for risk stratification.

Level of Evidence.
3.
Pyruvate Kinase M2: A Potential Regulator of Cardiac Injury Through Glycolytic and Non-glycolytic Pathways
Authors: Zeng Chenxin , Wu Jiangfeng , Li Junming 
Published: April 2024

Abstract:
Adult animals are unable to regenerate heart cells due to postnatal cardiomyocyte cycle arrest, leading to higher mortality rates in cardiomyopathy. However, reprogramming of energy metabolism in cardiomyocytes provides a new perspective on the contribution of glycolysis to repair, regeneration, and fibrosis after cardiac injury. Pyruvate kinase (PK) is a key enzyme in the glycolysis process. This review focuses on the glycolysis function of PKM2, although PKM1 and PKM2 both play significant roles in the process after cardiac injury. PKM2 exists in both low-activity dimer and high-activity tetramer forms. PKM2 dimers promote aerobic glycolysis but have low catalytic activity, leading to the accumulation of glycolytic intermediates. These intermediates enter the pentose phosphate pathway to promote cardiomyocyte proliferation and heart regeneration. Additionally, they activate adenosine triphosphate (ATP)-sensitive K+ (KATP) channels, protecting the heart against ischemic damage. PKM2 tetramers function similar to PKM1 in glycolysis, promoting pyruvate oxidation and subsequently ATP generation to protect the heart from ischemic damage. They also activate KDM5 through the accumulation of αKG, thereby promoting cardiomyocyte proliferation and cardiac regeneration. Apart from glycolysis, PKM2 interacts with transcription factors like Jmjd4, RAC1, β-catenin, and hypoxia-inducible factor (HIF)-1α, playing various roles in homeostasis maintenance, remodeling, survival regulation, and neovascularization promotion. However, PKM2 has also been implicated in promoting cardiac fibrosis through mechanisms like sirtuin (SIRT) 3 deletion, TG2 expression enhancement, and activation of transforming growth factor-β1 (TGF-β1)/Smad2/3 and Jak2/Stat3 signals. Overall, PKM2 shows promising potential as a therapeutic target for promoting cardiomyocyte proliferation and cardiac regeneration and addressing cardiac fibrosis after injury.
Introduction of Western Medicines into China and Improvement on Decoctions during Modern China
Authors: Zhu Ruisi 
Published: April 2024

Abstract:
During the late Qing dynasty (1840 A.D.-1912 A.D.), a large quantity of Western medicines entered China, which continuously impacted the traditional Chinese medicine (TCM) market and revealed the shortcomings of Chinese medicines. Some personages in the TCM community followed the trend of learning from the West, and attempted to reform TCM, with the improvement on decoction becoming an important aspect of this effort. Through debates and trials, the improvement on decoction underwent three stages of conceptual evolution: “taking Chinese medicines as the foundation and referring to the dosage forms of Western medicines”, “introducing Western techniques to serve the preparation of decoctions” and “integrating the theories of TCM and Western medicine to improve decoctions”. The study on the improvement on decoction highlights the effective complementarity between modern TCM and Western medicine in the field of pharmacy, and provides valuable experience and support for the reevaluation of the value of TCM in contemporary society.
Autoimmune hemolytic anemia and thrombocytopenia in a Chinese patient with heterozygous NBAS mutations: Case report
Authors: Yang Yuanlin , Fei Xiaoming , Lei Fang , Wang Lixia , Yu Xianqiu , Tang Yu 
Published: April 2024

Rationale:
Neuroblastoma amplified sequence (NBAS)-associated disease is an autosomal recessive disorder and a broad spectrum of clinical symptoms has been reported. However, autoimmune mediated hemolytic anemia (AIHA) is rarely reported in NBAS disease.

Patient concerns:
A now 21-year-old male harbors heterozygous variants of c.6840G>A and c.335 + 1G>A and was found had retarded growth, hypogammaglobulinemia, B lymphopenia, optic atrophy, horizontal nystagmus, slight splenomegaly and hepatomegaly since childhood. This case had normal hemoglobin level and platelet count in his childhood. He developed AIHA first in his adulthood and then thrombocytopenia during the treatment of AIHA. The mechanism underlying a case with pronounced hypogammaglobulinemia and B lymphopenia is elusive. In addition to biallelic NBAS mutations, a germline mutation in the ANKRD26 (c.2356C>T) gene was also detected. So either autoimmune or ANKRD26 mutation-mediated thrombocytopenia is possible in this case.

Intervention and outcome:
He was initially managed with steroid and intermittent intravenous immunoglobulin supplement. After treatment, he responded well with a normalization of hemoglobin and serum bilirubin. But the patient subsequently experienced severe thrombocytopenia in addition to AIHA. He was then given daily avatrombopag in addition to steroid escalation. He responded again to new treatment, with the hemoglobin levels and platelet counts went back to the normal ranges. Now he was on de-escalated weekly avatrombopag and low-dose steroids maintenance.

Conclusion:
The phenotype of this case indicates that c.335 + 1G>A NBAS variant is probably a pathogenic one and c.2356C>T ANKRD26 variant is improbably a pathogenic one. AIHA may respond well to steroid even when happened in patients with NBAS disease.
Investigating acupoint selection and combinations of acupuncture for primary idiopathic tinnitus using data mining
Authors: Huang Liangliang , Fan Yushan , Lin Rui , Zhao Yiping , Mo Yaru , Luo Sen , Li Zhan 
Published: April 2024

Background:
Acupuncture is widely used in the treatment of tinnitus worldwide because of its good efficacy and safety. However, the criteria for selecting acupoint prescriptions and combinations have not been summarized. Therefore, data mining was used herein to determine the treatment principles and the most effective acupoint selection for the treatment of idiopathic tinnitus.

Methods:
The clinical research literature of acupuncture in the treatment of idiopathic tinnitus from the establishment of the database to September 1, 2023 in China National Knowledge Infrastructure, China Medical Journal Full-text Database, PubMed, Embase, Cochrane Library and Web of Science databases was retrieved and extracted. Microsoft Excel 2016 was used to establish the acupoint prescription database and the frequency statistics of acupoints, meridians and specific acupoints were carried out. IBM SPSS Statistics 25.0 software was used for cluster analysis of acupoints, and IBM SPSS Modeler18.0 software was used for association rule analysis of acupoints.

Results:
A total of 112 articles were included, involving 221 acupuncture prescriptions, including 99 acupoints, with a total frequency of 1786 times. The 5 most frequently used acupoints were Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), Ermen (TE21), and Zhongzhu (TE3). The commonly used meridians were Sanjiao meridian of hand-shaoyang, Gallbladder meridian of foot-shaoyang and Small intestine meridian of hand-taiyang. The specific points are mostly Crossing point, Five-shu point and Yuan-primary point. The core acupoint combination of association rules was Ermen (TE21)–Tinggong (SI19)–Tinghui (GB2)–Yifeng (TE17), and 3 effective clustering groups were obtained by cluster analysis of high-frequency acupoints.

Conclusion:
In this study, the published literature on acupuncture treatment of idiopathic tinnitus was analyzed by data mining, and the relationship between acupoints was explored, which provided a more wise choice for clinical acupuncture treatment of idiopathic tinnitus.
Efficacy and safety of Chinese patent medicine in the adjuvant treatment of prostate cancer: A Bayesian network meta-analysis
Authors: Wang Shiheng , Zhang Fengxia , Liu Jianfeng , Qin Peijie 
Published: April 2024

Background:
Prostate cancer is the most common cancer in men. In China, traditional Chinese medicine is used to treat prostate cancer. However, there is a lack of evidence for differences in the effectiveness and safety of different Chinese patent medicines. Therefore, we conducted this Network Meta-analysis to investigate the efficacy and safety of different Chinese patent medicines in the treatment of prostate cancer.

Methods:
We systematically search PubMed, Web of Science, Embase, Cochrane library, CNKI database, VIP database, wanfang database, and SinoMed Randomized controlled trials of Chinese patent medicines for the treatment of prostate cancer sores included in the database were retrieved until June 1, 2023. The included studies were assessed for risk of bias using Cochrane randomized controlled trial Bias risk Assessment tool. The main outcome indicators were Efficacy, Prostate Specific Antigen, and adverse reaction. Since different courses of treatment were used in the included studies, we used Bayesian mesh meta-regression to investigate the effects of treatment courses on efficacy and safety.

Results:
Twenty-seven articles were included, involving 1885 patients. Including 9 kinds of Chinese patent medicine. The results of Network Meta-analysis show that: ① efficacy: compared with androgen antagonists, Bruceolic oil emulsion (relative risk = 1.70, 95% credibility interval [CI] (1.30, 2.29)), Compound Kushen injection (relative risk = 1.39, 95%CI (1.19, 1.70)) had significant advantages. There was no significant difference among all Chinese patent medicines (P > .05). The top 3 Chinese patent medicines were Bruceolic oil emulsion, Zhibodihuang pill, Compound Kushen injection. ② Prostate specific antigen: compared with androgen antagonists, Bruceolic oil emulsion (mean difference [MD] = −10.4, 95%CI [−17.6, −3.21]), Compound Kushen injection (MD = −4.46, 95%CI [−8.80, −1.70]), Shenfu injection (MD = −14.7, 95%CI [−23.4, −6.01]) had significant advantages. The top 3 Chinese patent medicines were Shenfu injection, Bruceolic oil emulsion, Compound Kushen injection. adverse reaction: compared with androgen antagonists, there was no significant difference among all PCM (P > .05).

Conclusion:
Compared with androgen antagonists, Chinese patent medicine has significant difference in effectiveness. The effect of Chinese patent medicine is little affected by the course of treatment and dose. From comprehensive analysis, Bruceolic oil emulsion combined with androgen antagonist is the best intervention measures.
Bolus administration of remimazolam was superior to midazolam for deep sedation in elderly patients undergoing diagnostic bronchoscopy: A randomized, double-blind, controlled trial
Authors: Wu Qiuyue , Xu Rong , Zhou Xuefei , Wang Longfei , Sheng Cheng , Ding Miao , Cao Yunfei 
Published: April 2024

Background:
To date, there is no standardized practice for the use of pharmacological sedatives during flexible bronchoscopy, particularly for elderly patients. This exploratory study aimed to assess the efficacy and safety of remimazolam at a single induced dose for deep sedation in elderly patients undergoing diagnostic flexible bronchoscopy (DFB), and compare with midazolam, a commonly used sedative.

Methods:
A total of 100 elderly patients (age range 65–80 yr; American Society of Anesthesiologists Physical Status I–III) undergoing DFB were randomly allocated into 2 groups according to the sedatives used for induction: the remimazolam group and the midazolam group. Sedation induction was initiated by an intravenous bolus of remimazolam (0.135 mg/kg) or midazolam (0.045 mg/kg), respectively, both groups were combined with a high-dose of alfentanil (18 µg/kg), and supplemented with high-flow nasal cannula (HFNC) oxygen supply at a flow rate of 45 L/min. If the target depth of sedation was not achieved, propofol would be titrated as a rescue. The primary outcome was the success rate of sedation at a single induced dose to achieve target depth (Ramsay sedation score [RSS] = 4) during induction, intraoperative changes in vital signs, postoperative follow-up situation and incidence of post-bronchoscopy adverse events were evaluated as secondary outcomes.

Results:
The success rate of sedation in the remimazolam group was significantly higher than that in the midazolam group (65.2% vs 39.6%, P = .013), while the incidence of extra sleep within 6 hours after procedure was lower in the remimazolam group as compared to the midazolam group (10.9% vs 31.3%, P = .016). No statistically significant differences were observed between the 2 groups regarding hemodynamic fluctuations, incidence of hypoxemia, and cough response during the procedure, as well as postoperative recall, willingness to undergo reexamination, and other post-bronchoscopy adverse events.

Conclusions:
Bolus administration of remimazolam offers advantages over midazolam for deep sedation in elderly patients undergoing DFB, in terms of a higher success rate of sedation and a lower incidence of extra sleep within 6 hours after procedure, though the safety profiles of both groups were favorable.
Efficacy and safety of Xiaofeng powder in the treatment of chronic urticaria: A systematic review and meta-analysis
Authors: Bi Chenhao , Jia Yuqi , Wei Fengqin 
Published: April 2024

Background:
Chronic urticaria is a group of skin diseases characterized by pruritus and/or vascular oedema and belongs to the category of “addictive rash” in Traditional Chinese Medicine, and its aetiology is closely related to wind evil. Antihistamines are often used in treatment. Although they have certain effects, they also easily cause disease recurrence. Xiaofeng powder treats this disease has a significant effect in improving the disease state and reducing the recurrence rate. However, there is a lack of evidencebased research. This study to systematically evaluate the clinical efficacy of modified Xiaofeng powder in the treatment of chronic urticaria (CU).

Methods:
Computer searches of Chinese databases such as China National Knowledge Infrastructure, China Scientific Journal Database, China Biomedical Literature Database, and WanFang Date and foreign databases such as PubMed and the Web of Science were performed. We retrieved published clinical randomized controlled trials of Xiaofeng powder in the treatment of CU from the establishment of the databases to November 2023. The data were extracted from clinical trials that met the inclusion criteria of this study, and the quality was evaluated through the Cochrane Handbook of Systematic Reviews 5.1.0. Finally, a meta-analysis was performed using RevMan 5.3 statistical software.

Results:
A total of 11 randomized controlled trials involving 1076 patients were included. The cure rate odds ratio (OR) and 95% confidence interval (CI; shown in brackets) were 2.11 [1.45, 3.07]; the total effective rate OR and CI were 2.42 [1.60, 3.68]; the recurrence rate OR and CI were 0.22 [0.15, 0.34]; the adverse reaction rate OR and CI were 0.23 [0.12, 0.45]; and the mean weighted mean difference (MD) and 95% CI (shown in brackets) of itching degree, wind mass size, wind mass number and wind mass duration in symptom and sign integrals were −0.70 [−0.73, 0.67], −0.64 [−0.96, 0.31], , −0.72 [−1.23, 0.22], and −0.68 [−1.13, 0.23], , respectively.

Conclusion:
The clinical efficacy of modified Xiaofeng powder in the treatment of CU is better than that of antihistamine drugs, with lower adverse reaction and recurrence rates and higher safety. However, the quality of clinical research included is relatively low, and findings need to be confirmed by high-quality research.
A case of deep neck abscess treated with a disposable VSD wound care device: Case report and review of literature
Authors: Lu Ziyi , Zhang Xinxin , Huo Yixuan , Zhang Shoukai 
Published: April 2024

Rationale:
Vacuum sealing drainage is a novel technique for wound treatment that is characterized by adequate drainage and promotes wound healing. We report a case in which negative pressure sealing drainage was applied to treat a deep cervical abscess and achieved a good therapeutic effect.

Patient concerns:
The abscess in the neck will go down.

Diagnoses:
Deep neck abscess.

Interventions:
The usual surgical approach to treating this condition is to make a small incision to incise and drain the patient infected area where it is most visibly swollen or fluctuating, and to place a negative pressure drainage device.

Outcomes:
Eleven days after the operation, the patient neck recovered well, there was no infection in the operation area, and the patient was discharged from the hospital with improved symptoms.

Lessons:
This proves that the negative pressure closed drainage technique has potential in the treatment of deep neck abscesses and is also an effective choice in promoting wound healing, which is expected to bring better therapeutic effects to patients treated for deep neck abscesses.
The effects of vitamin C supplementation in the critically ill patients outcomes: A systematic review and meta-analysis of randomized controlled trials
Authors: Yong Su , Suping Liu , Peng Zhang , Dong Lin , Qing Wei 
Published: April 2024

Background:
Vitamin C has significant anti-inflammatory effects and is particularly important for critically ill patients. However due to inconsistent research findings in critically ill patients in meta-analysis. Therefore, the primary objective of this meta-analysis is to investigate the effects of isolated intravenous supplementation of vitamin C in adults with critical illness by comprehensively incorporating articles from randomized controlled trials.

Methods:
Articles included searching through PubMed, Embase, Medline, Cochrane Library, and Web of Science up to April 28, 2023, for articles on vitamin C and the critically ill. We calculated pooled standard relative risk (RR), mean difference (MD), and 95% confidence intervals (CIs). And the protocol for the review has been registered on PROSPERO (CRD42023425193).

Results:
There are 2047 critically ill included in 19 articles. Compared with placebo, patients who underwent intravenous vitamin C (IVVC) have reduced duration of vasopressor used (SMD 0.26; CI 0.01–0.51; I
2 = 87.0%, P = .044), mechanical ventilation (SMD −0.29; CI −0.55 to −0.03; I
2 = 36.8%, P = .031). However, the administration of IVVC had no statistical difference in 28-d mortality (RR 0.95; CI 0.80–1.11; I
2 = 12.2%, P = .337), mortality (RR 0.79; CI 0.55–1.12; I
2 = 0%, P = .188), fluid intake (SMD −0.02; CI −0.25 to 0.20; I
2 = 0%, P = .838), urine output (SMD 0.23; CI −0.03 to 0.49; I
2 = 0%, P = .084), ICU days (SMD 0.10; CI −0.03 to 0.22; I
2 = 0%, P = .127), hospital stay (SMD 0.10; CI −0.12 to 0.32; I
2 = 0%, P = .375), and pneumonia (RR 0.85; CI 0.50–1.44; I
2 = 0%, P = .552).

Conclusion:
This study comprehensively and systematically evaluated IVVC supplementation in the critically ill through a meta-analysis of RCT. There is no difference except for patients who had reduced duration of vasopressor use and mechanical ventilation by the administration of IVVC. Of course. More scientific and rigorous conclusions can be drawn from multi-center RCT research in the future.
Differential diagnosis of rare adrenal cellular schwannomas: A case report
Authors: Chen Jiali , Huang Yan , Chen Jingjing , Qi Xianzhong , Ma Yue , Wang Miaoyan , Liu Fufeng 
Published: April 2024

Background:
Adrenal cellular schwannomas are exceptionally rare stromal tumors that are often misdiagnosed due to the lack of specific radiological, serological, or clinical features. In this report, we describe the differential diagnosis of a rare adrenal cellular schwannoma.

Methods:
A 69-year-old man with a history of persistent hypertension, chronic kidney disease, hypertensive heart disease, and cardiac insufficiency was hospitalized due to bilateral lower extremity edema lasting for 3 months. Plain computed tomography at that time revealed a space-occupying lesion in the right adrenal gland. As serum levels of catecholamines, cortisol, and adrenocorticotropic hormone were within normal ranges, the edema was attributed to the chronic kidney disease and cardiac insufficiency, and the patient was referred to our hospital for surgical treatment. Contrast-enhanced computed tomography revealed heterogeneous enhancement in the adrenal mass indicating pheochromocytoma. An irregularly shaped 5 cm mass with a complete capsule in the right adrenal gland was laparoscopically resected. The postoperative histopathological diagnosis was adrenal cellular schwannoma.

Results:
The postoperative course was unremarkable and the tumor did not recur during 5 years of follow-up.

Conclusion:
Adrenal cellular schwannoma is a very rare tumor that is extremely difficult to preoperatively diagnose. Histological and immunohistochemical analyses are required for differential diagnosis and confirmation. Cellular schwannomas can transform into malignant peripheral nerve sheath tumors, but not often. Consequently, regular postoperative follow-up is required for such patients, especially imaging.