bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence quality assessment of sodium tanshinone IIA sulfonate injection intervention coronary heart disease angina pectoris: An overview of systematic reviews and meta-analyses
Authors: Peng Lufeng , Fan Maoxia , Li Junhai , Chen Wenqiang 
Published: November 2023

Background:
Sodium tanshinone IIA sulfonate injection (STS) is widely used in the clinical treatment of coronary heart disease angina pectoris (CHDAP). This article systematically summarizes and evaluates the available evidence for STS in the treatment of AP, and assess its quality.

Methods:
Two researchers searched and extracted 8 databases for systematic reviews (SRs)/meta-analyses (MAs), and independently assessed the methodological quality, risk of bias, reporting quality, and quality of evidence of SRs/MAs included in randomized controlled trials (RCTs). Tools used included the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the risk of bias in systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results:
This overview includes 11 SRs/MAs that use quantitative calculations to comprehensively evaluate various efficacies of STS in AP intervention. The methodological quality, reporting quality, risk of bias, and quality of evidence for outcome measures of SRs/MAs were all unsatisfactory. All SRs/MAs are of low quality according to the results of the AMSTAR-2 assessment, and only a small number of SRs/MAs were assessed as low risk of bias based on the results of the ROBIS assessment, and none of the SRs/MAs has been fully reported on the checklist. According to GRADE system, 33 outcomes were extracted from the included SRs/MAs for evaluation, of which 12 were rated as moderate-quality evidence, 7 as low-quality evidence, and 14 as very low-quality evidence. Limitations included the lack of essential items such as protocol registration, screening of duplicate studies, provision of a list of excluded studies and assessment of publication bias.

Conclusion:
Tanshinone IIA Sulfonate Sodium Injection may be an effective and safe treatment method. However, further standardized, comprehensive SRs/MAs and RCTs are needed to provide evidence-based medical support.
Sucking lollipop after awakening from sevoflurane anesthesia reduces the degree of emergence agitation in children undergoing ambulatory surgery: A prospective randomized controlled trial
Authors: Mo Xiaofei , Zeng Jiequn , Wu Xiaoying , Huang Fa , Zhang Kunling 
Published: November 2023

Background:
Emergence agitation (EA) is a common complication in pediatric anesthesia, especially in preschool children maintained by sevoflurane, with incidence ranging up to 80%. The purpose of the study was to determine whether sucking lollipop after awakening from sevoflurane anesthesia reduced the degree of EA in children undergoing ambulatory surgery.

Methods:
In this prospective study, 40 children aged 2 to 6 years scheduled for ambulatory surgery with sevoflurane were enrolled. They were randomly allocated to 1 of 2 groups after evaluating baseline EA levels using the pediatric anesthesia emergence delirium (PAED) scale immediately after awakening from general anesthesia: group L (sucking lollipop) or group C (control group, without sucking lollipop). The primary outcome was the overall PAED score after intervention. Pain score, parental satisfaction, the incidence of propofol rescue and negative postoperative behavioral changes (NPOBCs) were assessed.

Results:
The overall PAED score after intervention was significantly lower in Group L compared with Group C, with an estimated difference of −1.857 (95% CI, −2.884 to −0.831; P < .001) using generalized estimating equations. However, no significant intergroup differences were observed in the pain score, parental satisfaction, the incidence of propofol rescue and NPOBCs.

Conclusions:
Sucking lollipop after awakening from sevoflurane anesthesia reduced the degree EA in children undergoing ambulatory surgery.
Confusion in the monitoring of coagulation function in pregnant and neonate patients with severe disease: A case reports and brief literature review
Authors: Wang Yuefang , He Jiajing , Zhang Xia , Zhang Ge 
Published: November 2023

Rationale:
Different populations have their own unique physiological and pathological characteristics. However, in specialized maternal and child hospitals, there is currently a lack of standardized methods for assessing coagulation dysfunction, both domestically and internationally.

Patient concerns:
A 19-day-old neonate was transferred to neonatal intensive care unit with cyanosis, nasal bleeding for 6 hours, and a consciousness disorder for 5 hours. A 33-year-old woman presented with hydramnios and a 39 + 3week intrauterine pregnancy. All indicators before delivery were normal, but postpartum hemorrhage occurred after delivery.

Diagnoses:
We retrospectively analyzed 1 neonate with pulmonary hemorrhage accompanied by thrombocytopenia and 1 pregnant patient with amniotic fluid embolism.

Interventions:
The new coagulation indicators, such as thrombin-antithrombin complex, plasmin-alpha 2 antiplasmin complex, thrombomodulin, and tissue plasminogen activator-plasminogen activator inhibitor-1 complex, have been indicated to be valuable. In neonates, it is necessary to continuously monitor special items combined with specific therapeutic agents, such as tranexamic acid. In cases where postpartum hemorrhage occurs with low fibrinogen levels, it is essential to effectively identify patients with severe amniotic fluid embolism from a high incidence of specimen clotting.

Outcomes:
The neonate’s oxygen saturation stabilized, and after 5 days of treatment with low molecular weight heparin, thrombin-antithrombin complex and plasmin-alpha 2 antiplasmin complex returned to normal levels. The pregnant began to remove the remaining thrombus, the patient’s condition recovered, and she had a good prognosis.

Lessons:
For pregnant and neonatal critical illnesses, it is necessary to develop personalized coagulation monitoring programs that provide realistic and reasonable treatment recommendations. Such programs should consider the unique physiological and pathological characteristics of different populations to ensure effective management of critically ill patients.
Clinical value of glucocorticoids for severe community-acquired pneumonia: A systematic review and meta-analysis based on randomized controlled trials
Authors: Peng Biao , Li Jin , Chen Minwei , Yang Xianghui , Hao Meng , Wu Feifei , Yang ZhiChao , Liu Da 
Published: November 2023

Background:
Severe community-acquired pneumonia (sCAP) is characterized by severe symptoms and a poor prognosis, especially with the recent global impact of novel coronavirus in recent years. The use of glucocorticoids in sCAP is currently a subject of debate. To evaluate the clinical efficacy and safety of glucocorticoids and provide guidance for their rational use in clinical practice, we conducted this study.

Methods:
We searched PubMed, Web of Science, and China National Knowledge Infrastructure using the following search terms: “pneumonia”, “pneumonias”, “Pulmonary Inflammation”, “Pulmonary Inflammations”, “Lung Inflammation”, and “Lung Inflammations”. The primary outcomes included mortality and the length of hospital stay. The secondary outcomes included the duration of mechanical ventilation, duration of vasoactive drug use, gastrointestinal bleeding, and multiple infections. The Cochrane Collaboration was used to assess the risk of bias of the included studies. Stata/MP14 was used for meta-analysis.

Results:
These studies contained information on 1252 patients who received glucocorticoids and 1280 patients who did not. Meta-analysis showed that there was no difference in terms of mortality [risk ratio (RR) = 0.93, 95% confidence interval (CI): 0.81–1.07, P
> .05], gastrointestinal bleeding (RR = 1.38, 95% CI: 0.83–2.30, P
<
.05), multiple infections (RR = 1.17, 95% CI: 0.90–1.53, P
> .05) and length of hospital stay (mean difference [MD] = −0.87, 95% CI: −2.35 to 0.61, P
> .05) between the hormonal and nonhormonal groups. However, there was a significant difference in the duration of mechanical ventilation (MD = −1.54; 95% CI, −1.89 to −1.12, P
<
.05) and the duration of use of vasoactive drugs (MD = −14.09, 95% CI: −15.72 to −12.46, P < .05).

Conclusion:
Glucocorticoids reduced the duration of mechanical ventilation duration and vasoactive drug use in sCAP patients without increasing the risk of adverse events including hyperglycemia and multiple infections. However, there was no significant difference in mortality or length of hospital stay in sCAP patients between glucocorticoid and non-glucocorticoid groups. Glucocorticoids could be recommended for patients with sCAP with respiratory failure or hemodynamic instability.
Management of syncope in the Emergency Department: a European prospective cohort study (SEED)
Authors: Reed Matthew J. , Karuranga Suvi , Kearns David , Alawiye Salma , Clarke Ben , Möckel Martin , Karamercan Mehmet , Janssens Kelly , Riesgo Luis Garcia-Castrillo , Torrecilla Francisco Moya , Golea Adela , Fernández Cejas Juan Antonio , Lupan-Muresan Eugenia Maria , Zaimi Edmond , Nuernberger Alexander , Rennét Ondřej , Skjaerbaek Christian , Polyzogopoulou Effie , Imecz Judit , Groff Paolo , Camilleri Rene , Cimpoesu Diana , Jovic Miljan , Miró Òscar , Anderson Rory , Laribi Said ,   on behalf of the SEED investigators
Published: November 2023

Background and importance
In 2018, the European Society of Cardiology (ESC) produced syncope guidelines that for the first-time incorporated Emergency Department (ED) management. However, very little is known about the characteristics and management of this patient group across Europe.

Objectives
To examine the prevalence, clinical presentation, assessment, investigation (ECG and laboratory testing), management and ESC and Canadian Syncope Risk Score (CSRS) categories of adult European ED patients presenting with transient loss of consciousness (TLOC, undifferentiated or suspected syncope).

Design
Prospective, multicentre, observational cohort study.

Settings and participants
Adults (≥18 years) presenting to European EDs with TLOC, either undifferentiated or thought to be of syncopal origin.

Main results
Between 00:01 Monday, September 12th to 23:59 Sunday 25 September 2022, 952 patients presenting to 41 EDs in 14 European countries were enrolled from 98 301 ED presentations (n = 40 sites). Mean age (SD) was 60.7 (21.7) years and 487 participants were male (51.2%). In total, 379 (39.8%) were admitted to hospital and 573 (60.2%) were discharged. 271 (28.5%) were admitted to an observation unit first with 143 (52.8%) of these being admitted from this. 717 (75.3%) participants were high-risk according to ESC guidelines (and not suitable for discharge from ED) and 235 (24.7%) were low risk. Admission rate increased with increasing ESC high-risk factors; 1 ESC high-risk factor; n = 259 (27.2%, admission rate=34.7%), 2; 189 (19.9%; 38.6%), 3; 106 (11.1%, 54.7%, 4; 62 (6.5%, 60.4%), 5; 48 (5.0%, 67.9%, 6+; 53 (5.6%, 67.9%). Furthermore, 660 (69.3%), 250 (26.3%), 34 (3.5%) and 8 (0.8%) participants had a low, medium, high, and very high CSRS respectively with respective admission rates of 31.4%, 56.0%, 76.5% and 75.0%. Admission rates (19.3–88.9%), use of an observation/decision unit (0–100%), and percentage high-risk (64.8–88.9%) varies widely between countries.

Conclusion
This European prospective cohort study reported a 1% prevalence of syncope in the ED. 4 in 10 patients are admitted to hospital although there is wide variation between country in syncope management. Three-quarters of patients have ESC high-risk characteristics with admission percentage rising with increasing ESC high-risk factors.
The association between levosimendan and mortality in patients with sepsis or septic shock: a systematic review and meta-analysis
Authors: Ge Zengzheng , Gao Yanxia , Lu Xin , Yu Shiyuan , Qin Mubing , Gong Chao , Walline Joseph Harold , Zhu Huadong , Li Yi 
Published: November 2023

Background
Levosimendan is increasingly being used in patients with sepsis or septic shock because of its potential to improve organ function and reduce mortality. We aimed to determine if levosimendan can reduce mortality in patients with sepsis or septic shock via meta-analysis.

Evidence sources and study selection
We comprehensively searched the PubMed, Embase, Web of Science, and Cochrane Library databases from inception through 1 October 2022. Literature evaluating the efficacy of levosimendan in patients with sepsis or septic shock was included.

Data extraction and outcome measurements
Two reviewers extracted data and assessed study quality. A meta-analysis was performed to calculate an odds ratio (OR), 95% confidence intervals (CI), and P-values for 28-day mortality (primary outcome). Secondary outcomes included changes in indexes reflecting cardiac function before and after treatment, changes in serum lactate levels in the first 24 h of treatment, and the mean SOFA score during the study period. Safety outcomes included rates of tachyarrhythmias and total adverse reactions encountered with levosimendan.

Results
Eleven randomized controlled trials were identified, encompassing a total of 1044 patients. After using levosimendan, there was no statistical difference between groups for 28-day mortality (34.9% and 36.2%; OR: 0.93; 95% CI [0.72–1.2]; P = 0.57; I2 = 0%; trial sequential analysis-adjusted CI [0.6–1.42]) and sequential organ failure assessment (SOFA) score, and more adverse reactions seemed to occur in the levosimendan group, although the septic shock patient’s heart function and serum lactate level improved.

Conclusion
There was no association between the use of levosimendan and 28-day mortality and SOFA scores in patients with septic shock, though there was statistically significant improvement in cardiac function and serum lactate.
Disparities in Access to Spasticity Chemodenervation Specialists in the US: A Retrospective Cross-Sectional Study
Authors: Kazerooni Rashid , Healy Sean , Verduzco-Gutierrez Monica 
Published: November 2023

Abstract

Objective
Explore variations in access to spasticity chemodenervation specialists across several geographical, ethnic, racial, and population density factors.

Design
A retrospective cross-sectional study on Medicare Provider Utilization and Payment Data. Providers with substantial adult spasticity chemodenervation practices (SASCPs) were included. Ratios were assessed across geographical regions as well as hospital referral regions (HRRs). A multivariate linear regression model for the top 100 HRRs by beneficiary population was created, using backward stepwise selection to eliminate variables with p-values >0.10 from final model.

Results
A total of 566 providers with SASCPs were included. Unadjusted results showed lower access in non-urban versus urban areas in the form of higher patient:provider ratios (83,106 vs 51,897). Access was also lower in areas with ≥25% Hispanic populations (141,800 vs 58,600). Multivariate linear regression results showed similar findings with urban HRRs having significantly lower ratios (-45,764 [p = 0.004] versus non-urban) and areas with ≥25% Hispanic populations having significantly higher ratios (+96,249 [p = 0.003] versus <25% Hispanic areas).

Conclusions
Patients in non-urban and highly Hispanic communities face inequities in access to chemodenervation specialists. The Medicare data set analyzed only includes 12% of the US patient population, however this elderly national cross-sectional cohort represents a saturated share of patients needing access to spasticity chemodenervation therapy. Future studies should venture to confirm whether findings are limited to this specialization, and strategies to improve access for these underserved communities should be explored.
Application of PainDETECT in pediatric chronic pain: how well does it identify neuropathic pain and its characteristics?
Authors: Hess Courtney W. , Van Orden Amanda R. , Mesaroli Giulia , Stinson Jennifer N. , Borsook David , Simons Laura E. 
Published: November 2023

Abstract

Introduction:
Neuropathic pain (NP) arises from nerve damage or disease, and when not defined, it can impair function and quality of life. Early detection allows for interventions that can enhance outcomes. Diagnosis of NP can be difficult if not properly evaluated. PainDETECT is a NP screening tool developed and successfully used in adults.

Objectives:
We evaluated the validity of painDETECT in a pediatric population.

Methods:
Adolescents and young adults (10–19 years old) completed painDETECT and quantitative sensory testing (QST), which assessed mechanical allodynia and hyperalgesia, common symptoms of NP. Pain diagnoses, including neuropathic pain (n = 10), were collected through documentation in the medical chart. Descriptive statistics were used to examine age, gender, pain diagnoses, and painDETECT scores. Kruskal–Wallis H tests were conducted to examine differences in QST results across painDETECT categorizations.

Results:
Youth with chronic pain (N = 110, Mage = 15.08 ± 2.4 years, Nfemale = 88) and peers without pain (N = 55, Mage = 15.84 ± 3.9 years, Nfemale = 39) completed the painDETECT. The painDETECT scores for youth with pain (M = 12.7 ± 6.76) were significantly higher than those for peers without pain (M = 2.05 ± 2.41). PainDETECT demonstrated 80% sensitivity and 33% specificity in a pediatric population. Individuals who screened positively on the PainDETECT had significantly higher mechanical allodynia (M = 0.640 ± 0.994) compared with those who screened negatively (M = 0.186 ± 0.499; P = 0.016).

Conclusion:
PainDETECT demonstrated the ability to screen for NP, and QST mechanical allodynia results were consistent with a positive NP screen. Results of the study offer preliminary support for the ongoing assessment of the painDETECT as a brief, inexpensive, and simple-to-use screening tool for pediatric patients with primary pain complaints.
The Association of Organizational, Environmental, and Staffing Characteristics of Residential Care Facilities and the Risk Rating of Statutory Notifications: A Cross-Sectional Study in Ireland
Authors: Dunbar Paul , McGrane Niall , Keyes Laura M. 
Published: November 2023

ObjectivesSafety incidents (SIs) are an indicator of quality in health and social care services. Safety incident research has largely focused on acute health care settings. We aimed to examine the association of organizational, environmental, and staffing characteristics of residential care facilities (RCFs) and severity of regulatory SI notifications.MethodsThis was a retrospective analysis of SI notifications to the regulator for social care in Ireland received in 2018 and 2019. The mean risk rating of SI notifications for each RCF was used as the outcome. Regression analysis was conducted for the association of RCF characteristics (beds, staff to bed ratio, staff full-time equivalent (FTE), nurse to bed ratio, nurse FTE, number of RCF operated by the service provider, non-statutory or statutory provider) and the outcome, separately for nursing homes and residential disability services.ResultsA total of 53,268 SI notifications were received. One thousand nine hundred RCFs were operational during the period: 594 (31.3%) for RCF-Nursing home and 1304 (68.7%) for RCF-Disability. For nursing homes, in the most adjusted model, the number of RCF operated by a provider (βcoefficient [95% confidence interval] = 0.508 [0.223–0.793]) was positively associated with mean risk rating of SI. For disability services, the following characteristics were positively associated in the most adjusted model: beds (0.081; 0.060–0.101), staff to bed ratio (0.068; 0.017–0.120), nurse to bed ratio (0.356; 0.044–0.667), staff FTE (0.029; 0.015–0.042), and number of RCF operated by a provider (0.067; 0.050–0.084).ConclusionsVarious modifiable organizational, environmental, and staffing characteristics and severity of SI notifications were associated in this study, most of which were related to RCF-Disability. Policymakers and providers of social care services should be cognizant of the relationship of these characteristics and severity of SI, when designing and planning residential care.
68Ga-FAPI-04 PET/CT in Assessment of Fibroblast Activation in Keloids
Authors: Wang Jiarou , Yu Nanze , Wang Guochang , Wang Rongxi , Li Linlin , Jiang Yuanyuan , Sui Huimin , Sun Yixin , Li Zhijin , Long Xiao , Zhu Zhaohui 
Published: November 2023

Purpose
Keloids are benign fibroproliferative disorders characterized by the massive proliferation of fibroblasts. Fibroblast activation plays a key role in the invasive growth of keloids. Therefore, a prospective pilot study was conducted to explore the value of 68Ga-FAPI-04 PET/CT in the assessment of keloids activity.

Patients and Methods
Twenty-five patients with keloid were enrolled to conduct 68Ga-FAPI-04 PET/CT. All patients accepted surgery to remove part of the lesions within 1 week. SUVmean and SUVmax were measured for semiquantitative analysis and compared with the Vancouver Scar Scale, Laser Speckle Contrast Imaging, pathology, and immunohistochemical stains.

Results
A total of 123 lesions were detected in 25 patients, most of which were distributed in the anterior chest wall. The 68Ga-FAPI-04 uptake was significantly different at different sites (P < 0.0001). There was uptake heterogeneity within the keloid lesions, and a significant difference was found between the edge and center of some large lesions. The SUVmax of 68Ga-FAPI-04 showed significantly correlation with the Vancouver Scar Scale (r = 0.565, P < 0.0001) moderately and the Laser Speckle Contrast Imaging parameters mildly. The SUVmax of 68Ga-FAPI-04 had a moderate correlation with FAPI expression (r = 0.520, P = 0.022). Moreover, collagen, fibroblast activator protein, and Ki-67 expression were found higher at the edges of keloid tissue than in the center.

Conclusions

68Ga-FAPI-04 PET/CT can reflect the distribution characteristics of activated fibroblasts in keloid tissue and may provide a novel method for keloid evaluation for further fibroblast-related therapies.
Elevated 18F-AIF-FAPI-04 Uptake in Hepatic Hemangioma
Authors: Sun Yuyun , Cai Xin , Wang Zheng , Sun Yun , Cheng Jingyi 
Published: November 2023

Abstract
A 67-year-old woman who was diagnosed with intrahepatic cholangiocellular carcinoma (CCC) by biopsy underwent 18F-FDG and 18F-AIF-FAPI-04 PET/CT for initial and treatment assessment. In addition to CCC, she had a history of hepatic hemangioma for 3 years. 18F-FDG PET/CT images showed increased uptake in CCC, but no uptake in hemangiomas. However, images on 18F-AIF-FAPI-04 PET/CT indicated negative 18F-AIF-FAPI-04 uptake in CCC, but intense activity in hemangiomas. Our case illustrates that hepatic hemangioma demonstrated intense 18F-AIF-FAPI-04 uptake, and final diagnosis should be made with caution.