bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transpulmonary thermodilution
Authors: Messina Antonio , Alicino Valeria , Cecconi Maurizio 
Published: April 2023

Purpose of review
The purpose of this article is to systematically review and critically assess the existing data regarding the use of transpulmonary thermodilution (TPTD), by providing a detailed description of technical aspects of TPTD techniques, appraising the use of TPTD-derived parameters in specific clinical settings, and exploring the limits of this technique.

Recent findings
The aim of hemodynamic monitoring is to optimize cardiac output (CO) and therefore improve oxygen delivery to the tissues. Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. TPTD is a reliable, multiparametric, advanced cardiopulmonary monitoring technique providing not only hemodynamic parameters related to cardiac function, but also to the redistribution of the extravascular water in the thorax. The hemodynamic monitors available in the market usually couple the intermittent measurement of the CO by TPTD with the arterial pulse contour analysis, offering automatic calibration of continuous CO and an accurate assessment of cardiac preload and fluid responsiveness.

Summary
The TPTD is an invasive but well tolerated, multiparametric, advanced cardiopulmonary monitoring technique, allowing a comprehensive assessment of cardiopulmonary condition. Beyond the CO estimation, TPTD provides several indices that help answering questions that clinicians ask themselves during hemodynamic management. TPTD-guided algorithm obtained by pulse contour analysis may be useful to optimize fluid resuscitation by titrating fluid therapy according to functional hemodynamic monitoring and to define safety criteria to avoid fluid overload by following the changes in the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI).
The clinical effects of Gyejibongnyeong-Hwan (Gui Zhi Fu Ling Wan) on patients with hyperlipidemia: A study protocol for a multicenter, double-blind, two-armed parallel, investigator-initiated, exploratory randomized controlled trial
Authors: Ko Mi Mi , Kim Pyung-Wha , Jung So Young , Kim Cheol-Hyun , Lee Byung-Cheol , Jung Jeeyoun 
Published: April 2023

Background:
Hyperlipidemia, the most common form of dyslipidemia, is associated with an increased risk of atherosclerotic cardiovascular diseases. There is a constant demand for therapeutic agents with relatively few side effects that can be administered from the initial stage of hyperlipidemia, herbal medicines derived from natural products can be considered candidates for treating dyslipidemia. This study aims to explore the feasibility, preliminary effectiveness, and safety of Gyejibongnyeong-Hwan (GBH) in patients with hyperlipidemia.

Methods:
This was a 2-armed, parallel, multicenter, and exploratory randomized controlled trial on dyslipidemia. We will recruit 90 patients aged 20 to 65 years with hyperlipidemia between November 2021 and December 2022. Eligible participants will be randomly assigned to receive GBH or placebo granules for 8 weeks and followed up for 4 weeks after 4 weeks of lifestyle modification. The primary outcome is the percentage changes in low-density lipoprotein cholesterol from baseline to week 8. The secondary outcomes are percentage changes in other blood lipid parameters, blood glucose parameters, and blood stasis scores. As an exploratory outcome measure, metabolite analysis will be conducted to observe changes in metabolic patterns.

Discussion:
This is the first randomized controlled trial to explore the clinical effect and safety of GBH compared to placebo control in patients with hyperlipidemia, thereby potentially facilitating better management of hyperlipidemia. The results of this pilot study could form a foundation for future large-scale confirmatory clinical trials.

Ethics and dissemination:
This study was permitted by the Ministry of Food and Drug Safety on investigational new drug application on August 12, 2021 and approved by the Institutional Review Board of Kyung Hee University, Seoul, Republic of Korea (KOMCIRB202110012001) on November 26, 2021. The results will be published in a peer-reviewed journal and disseminated electronically and in print.
Goblet cell adenocarcinoma of the anal canal with perianal Paget disease: A rare case report with literature review
Authors: Li Minhua , Yao Xiaofei 
Published: April 2023

Introduction:
AS an uncommon neoplasm, goblet cell adenocarcinoma (GCA) is characterized by mixed endocrine-exocrine features. It is almost exclusively found in the appendix. Primary GCA of the anal canal is extremely rare.

Case presentation:
Herein we describe a novel rare case of 74-year-old Chinese female who is diagnosed with GCA in the anal canal with perianal Paget disease, including a brief review of the literature. In the lesion of anal canal, the tumor was composed of signet-ring-like cells on confluent growth model and copious mucin was produced as well. Simultaneously, the results of immunohistochemistry showed signet-ring-like cells were positive for CK20, CDX2, synaptophysin (Syn), CD56, carcinoembryonic antigen (CEA) and Villin. Meanwhile, the Ki67-labeling index reached 40%. In the lesion of perianal Paget disease, the small groups of atypical neoplastic cells were present in the epidermis. Immunohistochemically, the neoplastic cells were positive for CK20, CDX2 and epithelial membrane antigen, but negative for CK7, GCDFP15, S100, HMB45, and P63. The Ki67-labeling index reached 60% in the most concentrated spot.

Conclusions:
Extra-appendiceal GCA was rare and easily under-recognizable. The diagnosis of GCA was seldom made preoperatively. Occasionally, GCA could occur in the anal canal accompanied by perianal Paget disease. So careful rectal examination was important in the patient with perianal Paget disease for avoid missing diagnosis of GCA on anal canal. GCA may show aggressive clinical behavior compared with typical well-differentiated neuroendocrine tumors. Therefore, we should pay more attention on the recognization of this rare disease.
Efficacy and safety of vesatolimod in chronic hepatitis B: A systematic review and meta-analysis
Authors: Omer Ibrahim , Abuthiyab Noorah , Al-Omari Basil , Aletani Tala , Betar Manar , Alzaid Nura , Hakami Alqassem Y. 
Published: April 2023

Background:
Vesatolimod is a toll-like receptor (TLR) agonist that is thought to suppress chronic hepatitis B (HBV) infection. This systematic review aimed to assess the safety and efficacy of vesatolimod in treating chronic hepatitis B.

Methods:
We included randomized clinical trials (RCTs) that assessed vesatolimod in patients with hepatitis B infection without hepatocellular carcinoma or liver transplantation and with reported levels of hepatitis B surface antigen (HBsAg) or liver transaminases post-intervention. We searched MEDLINE, SCOPUS, Springer, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Clinical Trials for all related articles during May 2022. Two independent authors screened articles for inclusion, and discrepancies were resolved by consensus and a third reviewer. Two independent reviewers assessed studies included in this systematic review using the Critical Appraisal Skills Programme checklist for RCTs.

Results and conclusion:
Only 4 were considered eligible from 391 articles identified through our search. All eligible studies did not report any clinically significant outcomes following the use of vesatolimod, as evidenced by the persistence of HBsAg. However, vesatolimod was associated with induction of interferon-stimulated genes (ISGs) and only mild side effects, warranting further studies to evaluate its potential for future use as a safe, tolerable anti-HBV medication. No significant differences were noted amongst trials included in either of Vesatolimod doses (Vesatolimod 1 mg, RR = 0.99, 95% CI 0.76–1.30, P = .95, I
2 = 0%; Vesatolimod 2 mg, RR = 1.06, 95% CI 0.82–1.37, P = .66, I
2 = 0%; Vesatolimod 4 mg, RR = 1.06, 95% CI 0.82–1.37, P = .66, I
2 = 0%;), further suggesting its comparable safety in comparison to oral antiviral agents.
Clinical outcome measures reporting in randomized trials evaluating Tuina therapy for chronic nonspecific low back pain: A systematic review
Authors: Zhou Xuan , Ma Qingyu , Yang Juan , Mohabbat Arya B. , Croghan Ivana T. , Tan Celia la choo , Chen Jiaxu , Bauer Brent A. 
Published: April 2023

Background:
Tuina has gained widespread attention and utilization for the management of chronic nonspecific low back pain (CNLBP). However, evidence-based guidance for choosing accurate and appropriate outcome measures of Tuina is lacking. The objective of this study is to systematically synthesize the existing outcome measures reported in randomized controlled trials (RCTs) evaluating Tuina therapy in CNLBP.

Methods:
Electronic literature searches were conducted in multiple English and Chinese databases from their inception to May 2022. RCTs were included if they involved clinical outcome measures in Tuina treatment for patients with CNLBP. Outcome instruments for each study were extracted and analyzed. Evidence from included studies were assessed using the Cochrane risk-of-bias tool.

Results:
Of the 735 identified articles, 17 articles with 1628 participants were included. Measurement domains in these RCTs were mainly reported in terms of pain (94%) and physical activity (71%), followed by safety (41%), Chinese medicine outcome (35%), and quality of life (12%). Moreover, several limitations with existing outcomes were reported, including lack of emphasis on the evaluation of quality of life, inadequate safety monitoring, as well as insufficient and vague Chinese medicine outcome measures. All trials were deemed to be of poor methodological quality.

Conclusion:
Pain and physical disability were the most frequently studied outcome domains in CNLBP treated by Tuina therapy. More rigorous and high-quality trials with appropriately selected outcome measures are needed in the future.
Dexmedetomidine improves lung compliance in patients undergoing lateral decubitus position of shoulder arthroscopy: A randomized controlled trial
Authors: Zhao Xiujie , Song Qianqian , Wang Yewen , Zhang Quanyi , Sun Chao 
Published: April 2023

Background:
The improvement of oxygenation and pulmonary mechanics in patients under general anesthesia can be achieved by dexmedetomidine (DEX) infusion. However, its role in patients undergoing lateral supine shoulder arthroscopy has not been thoroughly studied. This study aimed to evaluate the effect of DEX on lung compliance in patients undergoing shoulder arthroscopic surgery in a lateral decubitus position.

Methods:
The patients who underwent lateral recumbent shoulder arthroscopy under general anesthesia were randomly divided into the DEX group (group D) and the control group (group N). At the start of the trial, group D was given 0.5 μg/kg/hours continuous pumping until 30 minutes before the end of anesthesia; Group N was injected with normal saline at the same volume. The patients were recorded at each time point after intubation: supine position for 5 minutes (T0), lateral position for 5 minutes (T1), lateral position for 1 hour (T2), lateral position for 2 hours (T3), airway peak pressure, platform pressure, dynamic lung compliance, and static lung compliance, etc.

Results:
At the end of the drug infusion, the DEX group showed significant improved pulmonary mechanics and higher lung compliance than the control group. Compared with group N, group D’s heart rate and mean arterial pressure were lower at all time points; there was no statistical difference in Tidal volume and Pressure end-tidal carbon dioxide data at each time point in Group D.

Conclusion:
DEX can improve lung compliance and reduce airway pressure and platform pressure of patients undergoing shoulder arthroscopy in the lateral position under general anesthesia.
Supernumerary digit of bilateral hands: a rare congenital anomaly presented as a case report
Authors: Raut Ujwal , Shah Sandesh , Shrestha Garima 
Published: April 2023

Introduction:
Abnormalities in the development of hands and fingers are caused by faulty signaling centers, together with or without abnormal production of important regulatory proteins. One of those abnormalities is the supernumerary digit. Postaxial supernumerary digit can present as a functioning or a nonfunctional digit.

Case:
We describe a case of a 29-year-old male with a postaxial supernumerary digit of the ulnar aspect of the bilateral fifth digit.

Clinical Findings and Investigations:
The patient had a growth of 0.5 cm over the ulnar aspect of the proximal phalanx of the fifth digit of the right hand and 0.1 cm over the ulnar aspect of the proximal phalanx of the fifth digit of the left hand with a broad base. X-rays of bilateral hands were sent.

Intervention:
Suture ligation or surgical excision was recommended for the patient, but they were both rejected by the patient.

Conclusion:
Bilateral hands with supernumerary digits are a rare congenital defect. The differential diagnosis of digital fibrokeratoma should be used by doctors. Simple observation, suture ligation, or excision with skin sutures are examples of potential treatments.
Glioblastoma simulating an arteriovenous malformation: a case report
Authors: Faham Btissam , Nsengiyumva Emmanuel olave , Jamal Oufaa , Makhchoune Marouane , Naja Abdessamad , Lakhdar Abdelhakim 
Published: April 2023

Introduction and importance:
Glioblastoma is the most common primary malignant brain tumor in adults. It is enhanced by the abnormal proliferation of central nervous system cells called astrocytes. Microvascular endothelial proliferation is one of the criteria for a histological diagnosis. Hypervascular glioblastoma simulating an arteriovenous malformation is an involuntary manifestation and constitutes a rare entity.

Case presentation:
The authors report a case of a 44-year-old patient with no history followed. Symptoms began 6 months ago with the gradual onset of headaches without vomiting or seizures associated with a drop in normal visual acuity without neurological deficit. Cerebral imaging including cerebral angiography concluding with a right parieto-occipital cerebral process probably associated with an arteriovenous malformation.

Clinical discussion:
The management was surgical by biopsy after a right parieto-occipital bone flap concluding in glioblastoma. The patient needs chemotherapy and radiotherapy sessions with good clinical evolution.

Conclusion:
The coexistence of an arteriovenous malformation and glioblastoma remains an association whose pathophysiology still remains to be explored.
Determinants of hyperphosphatemia and its relation with hemoglobin levels among hemodialysis patients in two hospitals from Syria: a prospective cross-sectional study
Authors: Alsultan Mohammad , Kliea Marwa , Anan Mohamed T. , Abdulkader Baraa , Kazkaz Reem , Al Sultan Abdullah , Al Masri Mohamad , Hassan Qussai , Basha Kassem 
Published: April 2023

Introduction:
Hyperphosphatemia and anemia were both associated with several complications in chronic kidney disease (CKD) patients. This study aimed to determine the risk factors of hyperphosphatemia and its relation with anemia among hemodialysis (HD) patients. Secondly, it aimed to determine the prevalence of hyperphosphatemia and anemia.

Material and methods:
A prospective cross-sectional study was conducted among 146 HD patients from two HD centers in Syria, between June 2021 and March 2022. All patients at least 18 years old on maintenance HD were enrolled. The threshold of phosphorus (phos) level was divided by the upper normal range among HD patients (5.5 mg/dl). We used parametric and nonparametric statistics, the Pearson and Spearman correlations with simple and multiple linear regressions between study variables.

Results:
36.9% of patients had a serum phos level of 5.5 or less (norm phos group), and 63.1% of patients had a serum phos level higher than 5.5 (high phos group). Also, 60.9% of patients had hemoglobin (Hb) less than 10 g/dl, and 40.4% of patients had Hb at least 10 g/dl. Age, type of HD access, phos binders (P-binders), parathyroid hormone (PTH), and calcium (Ca) showed significant effects on phos levels. Most patients were using arteriovenous fistula (AVF) (89.7%) as a HD access, and the meantime on HD was higher in the norm phos group compared to the high phos group. In a multivariate and univariate logistic regression analysis, hyperphosphatemia increased with increasing urea (Ur) and creatinine (Cr) levels, while the odds declined with increasing time on HD. Hb did not show a significant relation with phos by using several statistical methods.

Discussion/Conclusion:
A high prevalence of hyperphosphatemia and anemia was encountered among this sample of HD patients from Syria. There was no correlation between phos and Hb levels in contrast to previous conflicting studies, which mandates future studies to evaluate this correlation and further efforts to determine the range of phos that could have a benefit on anemia with respect to other comorbidities.
Mortality predictive value of APACHE II Scores in COVID-19 patients in the intensive care unit: a cross-sectional study
Authors: Mehryar Hamid Reza , Yarahmadi Poya , Anzali Babak C. 
Published: April 2023

Introduction:The Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system was developed to predict hospital mortality, which can be used as a predictor of final hospital outcome in coronavirus disease 2019 (COVID-19) patients. Therefore, the present study was designed and conducted with the aim of determining the average APACHE II score in patients with COVID-19 patients.Methods:In this cross-sectional study, patients with COVID-19 infection confirmed by PCR test were enrolled in the ICU of Imam Khomeini Hospital in Urmia city during 2020–2022. The laboratory, radiological, and clinical findings of the patients were collected and evaluated. The APACHE II scores of the patients were also calculated by the specialists of ICU and Infectious Diseases Department for each patient and recorded in the checklist.Results:A total of 150 patients were examined in this study. The mean age of the patients was 53.71±16.02 years; 82 patients, or 54.7%, were male, and 68 patients, or 45.3%, were female. The mean APACHE II score was 10.12±6.3; 105 patients (0.70%) were discharged, and 45 patients (0.30%) died. The mean APACHE II score was significantly higher in patients with cough (P=0.001), shortness of breath (P=0.002), hemoptysis (P>0.001), gastrointestinal hemorrhage (P=0.002), and renal failure (P=0.001). In addition, there was a significant direct relationship between age and APACHE II score, such that APACHE II score increased significantly with age (r=0.53,P>0.001). The mean APACHE II score in men was 10.04±5.8 and in women was 10.20±6.9, and according to the results of the independentt-test, there was no statistically significant difference between the two sexes (0.88). The mean APACHE II score was lower in patients with a history of dialysis (P=0.01), thyroid disease (P>0.001), hypertension (P>0.001), ischemic heart disease (P=0.04), and diabetes (P=0.02) were significantly higher.Conclusion:Patients with gastrointestinal bleeding, cough, shortness of breath, hemoptysis, and renal failure after COVID-19 infection, with a history of dialysis, thyroid disease, hypertension, and diabetes, and intubated patients had a significantly higher APACHE II score. A significant relationship was found between patients’ age and the APACHE II score. However, this index was not a suitable criterion for predicting death in COVID-19 patients.
Bilateral hydatid cyst of the breast: a case report and review of the literature
Authors: Al Sharei Aiman , Abu-Jeyyab Mohammad , Al-Khalaileh Maysaa , Al-Awabdeh Michleen , Al-Asbahi Hanan , Al-Dwairy Salem , Al-Share Mohammad 
Published: April 2023

Hydatid cyst disease is a parasitic infestation caused by the tapeworm Echinococcus granulosus. The incidence of the disease is 1–200 cases per 100 000. The usual presentation is the formation of fluid-filled cysts in the liver or lungs and, less commonly, in the brain. The breast is a rare site of presentation for this disease. An isolated hydatid cyst in the breast is very rare, even in endemic regions, occurring in only 0.27% of all hydatid cases. Although these cases are very rare, they should be considered severe. A hydatid breast cyst may mimic a fibroadenoma, phyllodes tumor, chronic abscess, or even carcinoma. Therefore, a high incidence of misdiagnosis may occur. Preoperative diagnosis can be made using needle aspiration and imaging facilities such as breast ultrasonography, mammograms, and computerized topographic images. Nevertheless, in most cases, the final diagnosis cannot be made until the pathological report is obtained postsurgery. This paper reports the first case of a bilateral hydatid cyst of the breast that was diagnosed preoperatively by radiological facilities. We present the patient history, physical examination, and investigations, discuss the risk factors, and present our treatment plan.
A comparison of the outcomes of a novel technique of Mini-Incision and Self-Express (MISE) for breast abscess with the conventional techniques: a retrospective comparative cohort study
Authors: Chan Xiang Ting , Allen John Carson , Gudi Mihir , Lim Geok Hoon 
Published: April 2023

Background:
Conventional techniques for treatment of breast abscess, such as incision and drainage (I&D) and needle aspiration, have disadvantages. The authors aimed to compare the outcomes of a novel technique of bedside mini-incision and self-express (MISE) for breast abscess with the conventional techniques.

Methods:
Patients with a pathologically confirmed breast abscess were retrospectively identified. Patients with mastitis, granulomatous mastitis, breast fillers with infection, ruptured abscess prior to intervention, other interventions or bilateral breast infection were excluded. Data collected included patient demographics, radiological features such as size and number of abscess, treatment modality, microbiological results and clinical outcomes. These outcomes were then compared between the patients with MISE, I&D and needle aspiration.

Results:
Twenty-one patients were included. The mean age was 31.5 years old (range: 18–48). Mean abscess size was 57.4 mm (range: 24–126). 5 (23.8%), 11 (52.4%) and 5 (23.8%) had MISE, needle aspiration and I&D, respectively. Average duration of antibiotics was 1.8, 3.9 and 2.6 weeks for MISE, needle aspiration and I&D groups, respectively, which was statistically significant after adjusting for confounders (P=0.024). Mean duration of recovery was 2.8, 7.8 and 6.2 weeks for the MISE, needle aspiration and I&D groups, respectively (P=0.027), after adjusting for confounders.

Conclusion:
MISE, in suitable patients, results in shorter recovery time and lesser antibiotics usage, compared with the conventional techniques.