bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of regional cerebral oxygen saturation during one-lung ventilation under desflurane or propofol anesthesia: A randomized trial
Authors: Hayashi Keishu , Yamada Yuko , Ishihara Takuma , Tanabe Kumiko , Iida Hiroki 
Published: October 2022

Background:
During one-lung ventilation (OLV), deterioration of pulmonary oxygenation reduces arterial oxygen saturation and cerebral oxygen saturation (rSO2). However, oxidative stress during OLV causes lung injury, so the fraction of inspiratory oxygen (FiO2) should be kept as low as possible. We investigated the changes in rSO2 under propofol or desflurane anesthesia while percutaneous oxygen saturation (SpO2) was kept as low as possible during OLV.

Methods:
Thirty-six patients scheduled for thoracic surgery under OLV in the lateral decubitus position were randomly assigned to propofol (n = 19) or desflurane (n = 17) anesthesia. FiO2 was set to 0.4 at the start of surgery under two-lung ventilation (measurement point: T3) and then adjusted to maintain an SpO2 of 92% to 94% after the initiation of OLV. The primary outcome was the difference in the absolute value of the decrease in rSO2 from T3 to 30 minutes after the initiation of OLV (T5), which was analyzed by an analysis of covariance adjusted for the rSO2 value at T3.

Results:
The mean rSO2 values were 61.5% ± 5.1% at T3 and 57.1% ± 5.3% at T5 in the propofol group and 62.2% ± 6.0% at T3 and 58.6% ± 5.3% at T5 in the desflurane group. The difference in the absolute value of decrease between groups (propofol group − desflurane group) was 0.95 (95% confidence interval, [−0.32, 2.2]; P = .152).

Conclusions:
Both propofol and desflurane anesthesia maintain comparable cerebral oxygenation and can be used safely, even when the SpO2 is kept as low as possible during OLV.
Systematic review and meta-analysis of acupuncture in the treatment of cognitive impairment after stroke
Authors: Wang Zhen-Zhi , Sun Zhen , Zhang Mei-Ling , Xiong Kang , Zhou Feng 
Published: October 2022

Background:
We aim to make a systematic evaluation of the clinical efficacy of acupuncture in the treatment of cognitive impairment after stroke, to provide evidence-based medical evidence for clinical practice.

Methods:
We searched all the randomized controlled trials of China National Knowledge Infrastructure, Wan fang data knowledge service platform, VIP Chinese periodical service platform full-text Journal Database, Chinese Biomedical Literature Database, Cochrane Library Database, and PubMed Database about acupuncture treatment of post-stroke cognitive impairment (PSCI). Two researchers independently screened the literature and extracted the data according to the inclusion and exclusion criteria. The bias risk assessment manual of Cochrane collaboration Network was used to evaluate the bias risk, and all data were analyzed by Stata16.0.

Results:
Fourteen articles were included, with a total of 2402 patients. Meta-analysis showed that acupuncture combined with routine therapy could significantly reduce the score of cognitive impairment symptoms compared with the control group. The mini-mental state examination scale (MMSE) score (weighted mean difference [WMD] = 3.23, 95% confidence interval [CI]: 1.89–4.56, P < .01), Montreal cognitive assessment scale (MoCA) score (WMD = 3.41, 95% CI: 0.93–5.89, P < .01), Barthel index of activities of daily living (MBI) score (WMD = 4.59, 95% CI: 1.43–7.75, P < .01), and Lowenstein assessment scale (LOTCA) score (WMD = 8.60, 95% CI: 6.32–10.89, P = .00) were significantly improved in the patients receiving group acupuncture combined with routine therapy.

Conclusion:
Acupuncture combined with routine therapy seems to be more effective than conventional therapy alone in the treatment of PSCI. However, the differences between different acupuncture types need to be clarified in more high-quality randomized controlled trials.
The safety of esophageal cancer surgery during COVID-19
Authors: Wang Qiuxiang , Yao Chengjiao , Li Yilin , Luo Lihong , Xie Fengjiao , Xiong Qin , Wu Ruike , Wang Juan , Feng Peimin 
Published: October 2022

Background:
The ongoing coronavirus disease 2019 (COVID-19) pandemic has drastically challenged the safety of on esophageal cancer (EC) surgery during COVID-19. The study aimed to evaluate the safety of EC surgery during the COVID-19 pandemic.

Methods:
This systematic review was performed in accordance with the PRISMA-P 2015 guidelines and registered in PROSPERO (registration number: CRD42022335164). A systematic search of PubMed, Embase, Cochrane Library, Web of Science, Medline, Chinese National Knowledge Infrastructure database, Chinese Scientific Journal database, and Wan Fang database was conducted to identify potentially relevant publications from January 2020 to May 2022. All data were independently extracted by two researchers. We will apply a fixed-effect model or random effect model basis on the heterogeneity test and employ with RevMan 5.4.1 software for data synthesis. The dichotomous surgical outcomes used risk ratios or risk differences, and for continuous surgical outcomes, mean differences (MD) or standardized MD, both with 95% confidence intervals were used. The primary outcomes were postoperative complications, anastomotic leaks, and mortality. The secondary outcomes were total hospital stay, postoperative stay, preoperative waiting, operation time, blood loss, transfusion, postoperative intensive care unit (ICU) stay, number of patients needing ICU stay, and 30-day readmission.

Results:
This study will comprehensively summarize the high-quality trials to determine the safety of EC surgery during COVID-19.

Conclusion:
Our systematic review and meta-analysis will present evidence for the safety of EC surgery during COVID-19.
The clinical efficacy of Shenmai injection in the prophylaxis and treatment of intradialytic hypotension: A protocol for systematic review and meta-analysis
Authors: Xiang Zhen , Lin Xin , Wang Jun , Yu Guodan 
Published: October 2022

Background:
Intradialytic hypotension (IDH) is a common complication in hemodialysis. IDH can induce vomiting, chest tightness and syncope, and hemodialysis shall be discontinued in patients with severe IDH. As is revealed in related studies, Shenmai injection (SMI) can be used in the prophylaxis and treatment of IDH. However, there is still a lack of consensus about the efficacy among reported studies, which cannot provide compelling evidence. Therefore, a meta-analysis was conducted in this study to further investigate the efficacy and safety of SMI in the prophylaxis and treatment of IDH.

Methods:
PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data were systematically retrieved from their establishment to June 2022. Subsequently, literature screening, data extraction, quality evaluation and cross-checking of results were performed according to the Cochrane Handbook. Besides, a meta-analysis was performed with the assistance of Revman 5.3 software.

Results:
This study will evaluate whether SMI is effective in the prophylaxis and treatment of IDH.

Conclusions:
The latest evidence for the efficacy and safety of SMI in the prevention and treatment of IDH can be provided through this study.
Cost-effectiveness of home care services versus hospital care for pediatric patients worldwide: A protocol for systematic review and meta-analysis
Authors: Lopes-Júnior Luís Carlos , Pessanha Raphael Manhães , Bomfim Emiliana , de Lima Regina Aparecida Garcia 
Published: October 2022

Background:
Despite the expansion of home care services (HCS) in several countries, there is still a need to systematically investigate the available evidence on the cost-effectiveness of this type of service compared to hospital care in the world, particularly for the pediatric population. Hence, we aimed to systematically synthesize and critically evaluate the evidence on the cost-effectiveness of HCS versus in-hospital services worldwide.

Methods:
A systematic review and meta-analysis protocol guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Ten databases will be searched: MEDLINE/PubMed, Cochrane Library, Excerpta Medica database, cummulative index to nursing and allied health literature (CINAHL), Web of Science, SCOPUS, Science Direct, PsycINFO, Latin American and Caribbean Health Sciences Literature and Chinese national knowledge infrastructure with no restrictions on publication date or languages. A checklist for assessing the quality of reporting of economic evaluation studies will be applied. To assess the methodological quality of evidence from observational research on comparative effectiveness, the Good Research for Comparative Effectiveness Checklist v5.0 will be used. The heterogeneity among the studies will be assessed using the I
2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the R statistical software, v.4.0.4. In addition, we will rate the certainty of evidence based on Grading of Recommendations Assessment, Development and Evaluation. All methodological steps of this review will be performed independently and paired by 2 reviewers and conducted and managed in the EPPI-Reviewer Software™.

Results:
The results may have relevance for the basis of public health policies, regarding the forms of organization of HCS, especially in terms of complete economic evaluations through cost-effectiveness analysis in relation to hospital care.

Conclusion:
To the best of our knowledge this will be the first systematic review and metanalysis to synthesize and critically evaluate the evidence on the cost-effectiveness of HCS versus in-hospital services worldwide. The review will adopt a rigorous approach, adhering to PRISMA Statement 2020, using a comprehensive and systematic search strategy in 10 databases, further the gray literature, pre-prints, with no time period or language restrictions.
Comparative efficacy and safety of pharmacological interventions for severe COVID-19 patients: An updated network meta-analysis of 48 randomized controlled trials
Authors: Cheng Qinglin , Zhao Gang , Chen Junfang , Jia Qingjun , Fang Zijian 
Published: October 2022

Background:
To date, there has been little agreement on what drug is the "best" drug for treating severe COVID-19 patients. This study aimed to assess the efficacy and safety of different medications available at present for severe COVID-19.

Methods:
We searched databases for randomized controlled trials (RCTs) published up to February 28, 2022, with no language restrictions, of medications recommended for patients (aged 16 years or older) with severe COVID-19 infection. We extracted data on trials and patient characteristics, and the following primary outcomes: all-cause mortality (ACM), and treatment-emergent adverse events (TEAEs).

Results:
We identified 4021 abstracts and of these included 48 RCTs comprising 9147 participants through database searches and other sources. For decrease in ACM, we found that ivermectin/doxycycline, C-IVIG (i.e., a hyperimmune anti-COVID-19 intravenous immunoglobulin), methylprednisolone, interferon-beta/standard-of-care (SOC), interferon-beta-1b, convalescent plasma, remdesivir, lopinavir/ritonavir, immunoglobulin gamma, high dosage sarilumab (HS), auxora, and imatinib were effective when compared with placebo or SOC group. We found that colchicine and interferon-beta/SOC were only associated with the TEAEs of severe COVID-19 patients.

Conclusion:
This study suggested that ivermectin/doxycycline, C-IVIG, methylprednisolone, interferon-beta/SOC, interferon-beta-1b, convalescent plasma (CP), remdesivir, lopinavir/ritonavir, immunoglobulin gamma, HS, auxora, and imatinib were efficacious for treating severe COVID-19 patients. We found that most medications were safe in treating severe COVID-19. More large-scale RCTs are still needed to confirm the results of this study.
Discovery of resident memory T cells in inflammatory vitiligo: A case report
Authors: Xu YanLi , Zhang Bao-Xiang , Lin Mao , Zhang Lu 
Published: October 2022

Rationale:
The purpose of this report was to describe resident memory cluster of differentiation 8 (CD8) + T cells may contribute to the progression of inflammatory vitiligo.

Patient concerns:
A 32-year-old male has a stable vitiligo for 1 year, then some patches present inflammatory erythema. Two years later, the inflammatory patches enlarged and joined together, and the remaining 2 common patches shows repigmentation and no change respectively. Both CD69 + CD8 + T cells and CD103 + CD8 + T cells showed marked increase in inflammatory vitiligo than common vitiligo.

Diagnosis:
Histological findings show that the numbers of lymphocytes are increased in inflammatory vitiligo than common vitiligo. Immunofluorescence staining show that the numbers of CD69 + CD8 + T cells demonstrated a marked increase in inflammatory vitiligo than common vitiligo.

Interventions:
Without any intervention.

Outcomes:
The previous upper 2 patches on the abdomen with erythematous rim were enlarged and joined together. However the lowest lesion with uninflamed common rim on the abdomen remained static, the one on the right groin showed spot-like repigmentation.

Lessons:
This case report demonstrates that resident memory CD8 + T cells may contribute to the progression of inflammatory vitiligo.
Risk factors of postoperative hydrocephalus following decompressive craniectomy for spontaneous intracranial hemorrhages and intraventricular hemorrhage
Authors: Wu Yi-Chieh , Liao Hsiang-Chih , Lin Jang-Chun , Chou Yu-Ching , Ju Da-Tong , Hueng Dueng-Yuan , Tang Chi-Tun , Tseng Kuan-Yin , Chou Kuan-Nien , Lin Bon-Jour , Feng Shao-Wei , Chen Yi- An , Chung Ming-Hsuan , Wang Peng-Wei , Liu Wei-Hsiu 
Published: October 2022

Introduction:
Hydrocephalus is a complication of spontaneous intracerebral hemorrhage; however, its predictive relationship with hydrocephalus in this patient cohort is not understood. Here, we evaluated the incidence and risk factors of hydrocephalus after craniectomy.

Methods:
Retrospectively studied data from 39 patients in the same hospital from 2016/01 to 2020/12 and analyzed risk factors for hydrocephalus. The clinical data recorded included patient age, sex, timing of surgery, initial Glasgow Coma Scale score, intracerebral hemorrhage (ICH) score, alcohol consumption, cigarette smoking, medical comorbidity, and blood data. Predictors of patient outcomes were determined using Student t test, chi-square test, and logistic regression.

Results:
We recruited 39 patients with cerebral herniation who underwent craniectomy for spontaneous supratentorial hemorrhage. Persistent hydrocephalus was observed in 17 patients. The development of hydrocephalus was significantly associated with the timing of operation, cigarette smoking, and alcohol consumption according to the Student t test and chi-square test. Univariate and multivariate analyses suggested that postoperative hydrocephalus was significantly associated with the timing of surgery (P = .031) and cigarette smoking (P = .041).

Discussion:
The incidence of hydrocephalus in patients who underwent delayed operation (more than 4 hours) was lower than that in patients who underwent an operation after less than 4 hours. nonsmoking groups also have lower incidence of hydrocephalus. Among patients who suffered from spontaneous supratentorial hemorrhage and need to receive emergent craniectomy, physicians should be reminded that postoperative hydrocephalus followed by ventriculoperitoneal shunting may be necessary in the future.
Hemicranial postural headache as a first symptom of a spontaneous carotid cavernous fistula: A case report
Authors: Liu Li , Zhong Yushi , Wu Bin , Tang Xianbi , Yi Ziwei , Pan Chuzheng 
Published: October 2022

Rationale:
Spontaneous carotid cavernous fistula (CCF) is rare, and the expression of headache caused by it can be variable.

Patient concerns:
A case of a man hospitalized for high-intensity hemicranial headache which was aggravated by lying down and relieved when standing or sitting. The pain was of a pulsating character, localized on the right, behind the eye, followed by nausea and vomiting. He gradually appeared with ophthalmoplegia, decreased visual acuity and epistaxis.

Diagnosis:
Digital subtraction angiogram (DSA) showed a pseudoaneurysm arising from the internal carotid artery (ICA) that projected anteriorly and medially into the sphenoid sinus with occluded fistula.

Interventions:
The pseudoaneurysm was successfully treated with covered stent.

Outcomes:
The patient was then followed up clinically at the outpatient and seen in the outpatient clinic with no further episodes of nasal bleeding or new neurologic deficit. The vision loss and ophthalmoparesis were unchanged.

Lessons:
Hemicranial postural headache may be the first and characteristic sign of spontaneous CCF.
MRI changes of adjacent segments after transforaminal lumbar interbody fusion (TLIF) and foraminal endoscopy: A case–control study
Authors: Wang Shunmin , Yang Deyu , Zheng Gengyang , Cao Jie , Zhao Feng , Shi Jiangang , You Ruijin 
Published: October 2022

Background:
Intervertebral foramen endoscopy has developed rapidly, but compared with transforaminal lumbar interbody fusion (TLIF), the progress of degeneration is unknown. We aim to compare the changes of intervertebral disc and intervertebral foramen in adjacent segments after TLIF and endoscopic discectomy for patients with lumbar disc herniation (LDH).

Methods:
From 2014 to 2017, 87 patients who were diagnosed with single-level LDH and received surgery of TLIF (group T, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up (FU). The neurological function was originally evaluated by the Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration Pfirrmann scores.

Results:
There was no significant difference in baseline characteristics, JOA improvement rate, reoperation rate and complications between the two groups. The age, average blood loss, average hospital stays and average operation time in group F were lower than those in group T. During the last FU, HIS, CA and FA decreased in both groups, and the changes in group T were more significant than those in group F (P < .05). There was no significant difference in FH changes between the two groups (P > .05).

Conclusion:
Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar disc height loss and intervertebral foramina reduction in the adjacent segment after endoscopic surgery is lower.
Changes of ACE2 in different glucose metabolites and its relationship with COVID-19
Authors: Lu Yamin , Xing Chenhao , Lv Xiuqin , Zhang Cuigai , Liu Guangxia , Chen Fang , Hou Zhan , Zhang Donghui 
Published: October 2022

Background:
To study the changes and effects of angiotensin-converting enzyme 2 (ACE2)/angiotensin 1-7 (Ang1-7) and ACE/AngII in people with different glucose metabolisms and to explore the possible mechanisms underlying the severity of COVID-19 infection in diabetic patients.

Methods:
A total of 88 patients with type 2 diabetes, 72 patients with prediabetes (impaired fasting glucose, 30 patients; impaired glucose regulation, 42 patients), and 50 controls were selected. Changes and correlations of ACE2, Ang1-7 and other indicators were detected among the three groups. Patients were divided into four groups according to the course of diabetes: <1 year, 1–5 years, 5–10 years, and >10 years. ACE2 and Ang1-7 levels were compared and analyzed.

Results:
ACE2 and Ang1-7 increased with the severity of diabetes (P
0 < .05 or P < .01). The levels of ACE2 and Ang1-7 in the longer course group were lower than those in the shorter course group, whereas the levels of ACE, Ang II, and interleukin-6 (IL-6) gradually increased (P < .05). Pearson correlation analysis showed that ACE2 was positively correlated with IL-6, FBG, and 2hPBG levels in the prediabetes group. In the diabetic group, ACE2 was positively correlated with Ang1-7 and negatively correlated with ACE, AngII, IL-6, and C-reactive protein levels. Multiple linear regression analysis showed that IL-6 and ACE were the main factors influencing ACE2 in the diabetic group.

Conclusion subsections:
ACE2/Ang1-7 and ACE/AngII systems are activated, and inflammatory cytokine release increases in prediabetes. With the prolongation of the disease course, the effect of ACE2/Ang1-7 decreased gradually, while the effect of ACE/AngII increased significantly. Dysfunctions of ACE2/Ang1-7 may be one of the important mechanisms underlying the severity of COVID-19 infection in patients with diabetes.
Metastatic malignant melanoma from anorectum presenting as an isolated breast tumor: A case report and literature review
Authors: Yi Xiaokang , Chen Hao , Wang Ankang , Liu Feng , Zhang Hua-Mao 
Published: October 2022

Rationale:
Anorectal malignant melanoma regularly exhibits a biological aggressive behavior which is metastasizing to lung, bone, brain or other organs and tissues early in the course of the disease. Compared with melanoma in the other parts of the body, anorectal malignant melanoma is relatively rare. Metastatic to the breast tissue from anorectal malignant melanoma or from other extra-mammary tumors are very rare.

Patient concerns:
We report the case of a 65-year-old female who suffering from anorectal malignant melanoma and implemented complete surgical resection. Two years later, a space-occupying lesion in the outer upper quadrant of the right breast was observed on a chest CT.

Diagnosis:
The right breast was excised, and breast metastasis of anorectal malignant melanoma was histologically confirmed.

Interventions:
Radical mastectomy of the right breast was performed, and no lymph nodes or other metastases were observed.

Outcomes:
The patient’s operative course was uneventful. The patient completely recovered and transfers to the oncology department for further treatment.

Lesson:
The patient presented with an isolated breast tumor. Duo to Malignant melanoma could mimic many kind of poorly differentiated tumors, it is difficult to diagnose accurately, especially when it appears as an isolated mammary tumor. Because of the treatment measures and prognosis between malignant melanoma and breast cancer are entirely different.