bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blade needle therapy versus conventional acupuncture for knee osteoarthritis: A meta-analysis
Authors: Yin Xunlong , Liu Yuan , Liu Wu , Liang Wei , Liang Qingyong 
Published: August 2022

Background:
This study investigated the hypothesis that the efficacy of blade needle therapy for the treatment of knee osteoarthritis (KOA) is superior to that of conventional acupuncture. In addition, the efficacy of blade needle therapy versus conventional acupuncture for the treatment of KOA was analyzed in a meta-analysis.

Methods:
Randomized controlled trials (RCTs) of blade needle therapy and conventional acupuncture for treating KOA were retrieved from the electronic databases CNKL, Wanfang, VIP, PubMed, EMBASE and the Cochrane Library from the commencement of each database to July of 2021. Data were extracted and evaluated by 2 reviewers independently. RevMan 5.3 software was used to conduct the meta-analysis after the studies were evaluated.

Results:
A total of 11 RCTs were included, all from China, involving 1142 patients. The meta-analysis results showed that the effective rate of the blade needle group was better than that of the conventional acupuncture group (OR = 3.61, 95% CI [2.56–5.10], P < .00001).

Conclusion:
The efficacy of blade needle treatment for KOA is superior to that of conventional acupuncture, but more high-quality studies are needed for future validation due to the low proportion of high-quality studies included and the possible bias factor.
Midgut malrotation presenting with hyperemesis gravidarum: A case report
Authors: Zhao Hongjiang , Wu Linzhen , Yang Bin , Shang Hongkai 
Published: August 2022

Rationale:
Midgut malrotation is a rare congenital abnormality resulting from failure of complete intestinal rotation and subsequent fixation during early fetal development. There appeared to be no obvious symptoms in most patients, and a few patients may exhibit symptoms similar to hyperemesis gravidarum, such as nausea and vomiting. Here, we present a case of midgut malrotation presenting as hyperemesis gravidarum.

Patient concerns:
A 27-year-old woman with an intrauterine pregnancy of 27 + 6 weeks complained of severe nausea and vomiting for 2 weeks.

Diagnosis:
Magnetic resonance imaging showed obvious dilatation in the proximal part of the duodenum and gastric cavity and the absence of a duodenal path dorsal to the superior mesenteric artery, which was diagnosed as midgut malrotation.

Interventions:
Considering that the patient’s vital signs were stable, without manifestation of peritonitis or the risks of surgery to the fetus, conservative treatment was adopted. Unfortunately, the fetus developed severe hydrocephalus at 32 weeks. The patient and her family decided to abandon the fetus, and a mid-trimester-induced abortion was performed.

Outcomes:
The related symptoms completely disappeared after delivery, and the relevant examination after discharge also confirmed the presence of midgut malrotation without gastrointestinal discomfort within 1 year after delivery.

Lessons:
Midgut malrotation can be considered as a differential diagnosis of hyperemesis gravidarum. Conservative treatment under close monitoring is desirable in pregnant women diagnosed with midgut malrotation.
Bariatric surgery and the neurohormonal switch: Early insulin resistance recordings after laparoscopic sleeve gastrectomy
Authors: Haran Cheyaanthan , Lim Yu kai , Aljanabi Imad , Bann Simon , Wickremesekera Susrutha 
Published: August 2022

Laparoscopic sleeve gastrectomy (LSG) is a bariatric operation with a safe risk profile. It has been proven to successfully reduce weight, decrease insulin resistance (IR), and ameliorate diabetes mellitus. The aim of this study was to determine if there is an early improvement in IR after LSG and its association with weight loss.
This was a prospective observational study of 32 patients who underwent LSG at a single center over a 3-year period. Serum insulin and fasting glucose levels were recorded preoperatively, on day 1 postoperatively, and 3 weeks after LSG. IR levels were calculated using the Homeostasis Model Assessment 2 Version 2.23. IR levels were compared along with the overall weight loss, via body mass index. β-cell function was the secondary outcome.
IR significantly improved the day after surgery with a statistically significant mean difference of 0.89 units (P = .043) and significantly more so 3 weeks postoperatively, with a mean difference of 4.32 units (P < .0005). β-cell function reduced 3 weeks postoperatively, with a mean difference of 23.95 %β (P = .025), while body mass index significantly reduced, with a mean difference of 4.32 kg/m2 (P < .0005).
Early improvement of IR was observed on postoperative day 1 after LSG before any weight loss. This raises the possibility of an undetermined, underlying neurohormonal switch that improves IR. Further investigation is needed to determine this mechanism, as it may lead to an improvement in the medical management of diabetes mellitus.
Revisiting factors associated with blood culture positivity: Critical factors after the introduction of automated continuous monitoring blood culture systems
Authors: Lin Pei-Chin , Chang Chia-Ling , Chung Yi-Hua , Chang Chih-Chun , Chu Fang-Yeh 
Published: August 2022

Blood culture is the main tool used to identify causative pathogens. Adequate volume and number of culture sets are considered key to blood culture positivity rate. It is not known whether these factors remain critical to the positivity rate after the introduction of automated continuous blood culture system monitoring.
We measured blood volume per bottle and described the distribution of blood volume and number of culture sets. Multivariate logistic regression was performed to determine the independent association of blood volume, number of culture sets, diagnosis of sepsis in a patient, and other covariates with blood culture results.
Only 6.9% of the blood culture bottle volumes complied with the guidance (8–10 mL), with the highest culture positivity rate (18%). Of the culture events, only one set of blood was cultured in 60.9% of events. In the multivariate analysis, blood culture volume per event (odds ratio [OR], 1.09 [95% confidence interval [CI], 1.06–1.11]), patients with a diagnosis of sepsis (OR, 2.86 [95% CI, 2.06–3.98]), and samples from the emergency department (OR, 2.29 [95% CI, 1.72–3.04]), but not the number of culture sets (OR, 0.74 [95% CI, 0.50–1.12]), were observed to be statistically significant with respect to blood culture positivity rate.
Our results revealed that the total blood culture volume and the diagnosis of sepsis were critical factors affecting blood culture positivity rate. However, the proportion of blood culture bottles with the optimal blood volume was very low, and optimizing blood volume would be key to increasing blood culture positivity rate.
Effects of resilience, burnout, and work-related physical pain on work-life balance of registered nurses in South Korean nursing homes: A cross-sectional study
Authors: Min Deulle 
Published: August 2022

Background:
While nursing homes increase, the number of registered nurses (RNs) working there continues to decline. This study explored the effects of resilience, burnout, and work-related physical distress on the work-life balance of RNs to improve retention rates.

Methods:
This cross-sectional study involved 155 RNs working in 37 nursing homes, spread across 10 South Korean cities. Data were collected from May to July 2019 using self-report questionnaires, with items relating to general and work-related characteristics, work-life balance, resilience, and burnout. Multiple regression analysis was performed to identify factors affecting participants’ work-life balance, including variables that showed significant results in univariate analysis. All analyses were performed using the PASW SPSS win 26.0 program.

Results:
Participants’ average age was 48.48 years, and they had been working as RNs for 17.36 years on average. Work-related physical pain was reported by 70.3% of participants. Resilience had a positive correlation with work-life balance (r = 0.38; P < .001), whereas burnout had a negative correlation with work-life balance (r = −0.45; P < .001). Work-related physical pain (β = −0.27; 95% confidence interval [CI], −25.89 to −7.48), resilience (β = 0.20; 95% CI, 0.02–0.70), and burnout (β = −0.33; 95% CI, −0.9 to −0.24) affected participants’ work-life balance.

Conclusion:
Interventions to facilitate work-life balance among nursing home RNs must aim to increase resilience and reduce burnout and work-related physical pain. A healthy work-life balance should improve RN retention in nursing homes, boosting the safety and quality of life of residents in turn.
Isolated sigmoid varicose vein rupture and hemorrhage: A case report
Authors: Li Weiwei , Wang Jianli , Fu Hua , Liu Jinlong 
Published: August 2022

Rationale:
Ectopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of these varices often results in life-threatening hemorrhage. Management guidelines for ectopic variceal bleeds are not yet standardized because cases are rare and treatment approaches described in the literature vary considerably.

Patient concerns:
A 53-year-old woman with a 20-year history of chronic hepatitis C cirrhosis came to our hospital for treatment due to intermittent black stools for 4 days. After admission, the patient developed hemorrhagic shock, with hemodynamic instability.

Diagnosis:
Postoperative histological examination confirmed the diagnosis of sigmoid varicose veins.

Intervention:
Emergency colonoscopy showed that a varicose vein mass in the sigmoid colon wall 30 cm from the anus was ruptured and bleeding. Percutaneous transhepatic inferior mesenteric venography revealed the presence of a varicose mass of sigmoid colon veins. After embolization of the sigmoid varicose veins with spring coils, angiography showed that the hemorheology of the distal varicose vein mass was slow but not completely blocked. Three days after embolization, the patient had hematochezia again. Splenectomy and sigmoid colon resection were performed immediately.

Outcomes:
Follow-up computed tomography showed no residual varices were observed after sigmoid colon resection.

Lessons:
Ectopic varices, which are rare sequelae of portal hypertension, need to be taken seriously because bleeding from these varices can be catastrophic. We report a case of isolated sigmoid variceal rupture and hemorrhage due to portal hypertension in cirrhosis. The patient experienced failure of endoscopic hemostasis and sigmoid colon venous coil embolization. She was eventually successfully brought to hemostasis by surgery.
High plasma soluble thrombomodulin levels indicated poor prognosis of decompensated liver cirrhosis: a prospective cohort study
Authors: Wei Xinhuan , Du Xiaofei , Liu Yali , Wu Jun , Zhang Jing 
Published: August 2022

Objective
Hepatic sinusoidal endothelial injury is a prominent characteristic of liver cirrhosis. We determined plasma soluble thrombomodulin (sTM) levels in cirrhosis patients to evaluate the relationship between vascular injury and long-term prognosis.

Methods
A prospective single-center study was performed. The participants were followed up for every 6 months or until death or transplantation. A chemiluminescent enzyme immunoassay was used to establish a baseline sTM.

Results
Among the 219 patients with decompensated liver cirrhosis, 53.42% were caused by hepatitis B and hepatitis C. Plasma sTM levels were much higher in cirrhosis than in healthy controls and increased parallel with Child-Pugh classification (P < 0.01) and the amount of ascites (P = 0.04). After adjusting for sex, age, international normalized ratio, bilirubin, and other potential factors, multivariate Cox regression revealed that per TU/ml elevation of plasma sTM causes an increase of 8% in mortality, and per-SD elevation of thrombomodulin causes a 53% increase in mortality. As the mortality rates in low (5.90–12.60 TU/ml) and medium (12.70–18.00 TU/ml) sTM levels were similar, so we chose the cutoff of 18.00 TU/ml to divide into two groups, and K-M analysis indicated that patients with sTM >18.0 TU/ml demonstrated an additional 2.01 times death risk (95% CI, 1.13–7.93; P = 0.01) than those with sTM ≤18.0 TU/ml.

Conclusion
Plasma sTM in cirrhosis was significantly increased in parallel with the severity of liver dysfunction. sTM elevation than 18 TU/ml indicated a poor prognosis of decompensated liver cirrhosis.
Survival Rates After Pediatric Traumatic Out-of-Hospital Cardiac Arrest Suggest an Underappreciated Therapeutic Opportunity
Authors: Lanyi Maria , Elmer Jonathan , Guyette Francis X. , Martin-Gill Christian , Venkat Arvind , Traynor Owen , Walker Heather , Seaman Kristen , Kochanek Patrick M. , Fink Ericka L. 
Published: August 2022

Objectives
Children with traumatic arrests represent almost one third of annual pediatric out-of-hospital cardiac arrests (OHCAs). However, traumatic arrests are often excluded from study populations because survival posttraumatic arrest is thought to be negligible. We hypothesized that children treated and transported by emergency medical services (EMS) personnel after traumatic OHCA would have lower survival compared with children treated after medical OHCA.

Methods
We performed a secondary, observational study of children younger than 18 years treated and transported by 78 EMS agencies in southwestern Pennsylvania after OHCA from 2010 to 2014. Etiology was determined as trauma or medical by EMS services. We analyzed patient, cardiac arrest, and resuscitation characteristics and ascertained vital status using the National Death Index. We used multivariable logistic regression to test the association of etiology with mortality after covariate adjustment.

Results
Forty eight of 209 children (23%) had traumatic OHCA. Children with trauma were older than those with medical OHCA (13.2 [3.8–15.9] vs 0.5 [0.2–2.4] years, P < 0.001). Prehospital return of spontaneous circulation frequency for trauma versus medical etiology was similar (90% vs 87%, P = 0.84). Patients with trauma had higher mortality (69% vs 45% P = 0.004).

Conclusions
More than 8 of 10 children with EMS treated and transported OHCA achieved return of spontaneous circulation. Despite lower survival rates than medical OHCA patients, almost one third of children with a traumatic etiology survived throughout the study period. Future research programs warrant inclusion of children with traumatic OHCA to improve outcomes.
Are 2 Radiographic Views As Good as 3 Views to Diagnose Ankle Fractures in Children and Adolescents?
Authors: Abouassaly Marcel , Blumetti Francesco Camara , Gauthier Luke , Willis Ross Baxter , Kontio Ken , Highmore Kerri , Abdeen Nishard , Plint Amy Catherine , Tse Sandy , Barrowman Nick , Moroz Paul John 
Published: August 2022

Objectives
Ankle radiographs are among the most commonly obtained trauma images in the pediatric population, with the standard 3 views (AP/mortise [M]/lateral [L]) routinely ordered in the emergency department. The purpose of this study was to compare the diagnostic accuracy, sensitivity, and specificity of sets of 2 views (AP/L or M/L) with the standard 3 views.

Methods
One hundred twenty sets of ankle radiographs of skeletally immature patients obtained in the emergency department of a level 1 pediatric trauma center were used. These included sets with and without fractures. Sets of 3 and 2 views were reviewed by pairs of pediatric-trained orthopedic surgeons, radiologists, and emergency physicians. Each completed 3 randomized viewing sessions where all possible combinations for each set of radiographs were reviewed. Diagnoses for the 3 sets of views were compared for accuracy, sensitivity, and specificity.

Results
Overall accuracy, sensitivity, and specificity for all reviewers were as follows: AP/M/L 74%, 94%, and 90%, AP/L 71%, 90%, and 94%, as well as M/L 69%, 90%, and 91%. P values for accuracy, sensitivity, and specificity of AP/L and M/L compared with 3 views were 0.34, 0.04, and 0.52, as well as 0.04, 0.004, and 1.00, respectively.

Conclusions
In skeletally immature patients, statistically significant differences in accuracy were obtained when comparing the standard 3 AP/M/L views with more limited M/L views, suggesting that this set of 2 views is not as accurate. Differences in sensitivity of limited views were also statistically significant. Conversely, differences in accuracy between the standard 3 views and AP/Lateral views were not statistically significant. While more limited AP/L views may be comparable in accuracy and specificity and lead to dramatically decreased radiation and costs, this can be at the expense of less diagnostic sensitivity and increased risk of misdiagnosing or missing certain fractures.

Level of Evidence
Level III
Benzodiazepine Use for Pediatric Patients With Suspected Nonconvulsive Status Epilepticus With or Without Simplified Electroencephalogram
Authors: Takase Ryo , Sasaki Ryuji , Tsuji Satoshi , Uematsu Satoko , Kubota Mitsuru , Kobayashi Tohru 
Published: August 2022

Objectives
In the present study, we aimed to determine the changes in the administration rate of benzodiazepines for pediatric patients with suspected nonconvulsive status epilepticus (NCSE) before and after the introduction of simplified electroencephalography (sEEG) in the emergency department.

Methods
This retrospective cohort study included patients who were younger than 18 years and were admitted to the emergency department from August 1, 2009, to July 31, 2017, with altered level of consciousness and nonpurposeful movement of eyes or extremities after the cessation of convulsive status epilepticus. Patients with apparent persistent convulsions, those who were fully conscious on arrival, and those who were transferred from another hospital were excluded. The patients were categorized into pre and post groups based on the introduction of sEEG, and benzodiazepine administration was compared between the 2 groups.

Results
During the study period, 464 patients with status epilepticus visited our emergency department and 69 and 93 patients fulfilling the study criteria were categorized into the pre and post groups, respectively. There were no significant differences in patient background characteristics between the 2 groups. Simplified electroencephalography was recorded in 52 patients in the post group. Benzodiazepines were administered in 44 of 69 patients (63.8%) in the pre group and 44 of 93 (47.3%) in the post group, and the benzodiazepine administration rate was significantly decreased after the introduction of sEEG (P = 0.04). The hospitalization rate was significantly lower in the post group, but there were no significant differences in the rates of intensive care unit admission, reconvulsion after discharge, and final diagnoses between the 2 groups.

Conclusions
Simplified electroencephalography might aid in determining the need for anticonvulsant treatment for suspected NCSE in pediatric patients. Albeit not a definitive diagnostic tool, sEEG might be a reliable choice in the evaluation of pediatric patients with suspected NCSE.
Childhood tuberculosis
Authors: Cameron Lindsay H. , Cruz Andrea T. 
Published: August 2022

Purpose of review
We discuss the most recent literature to support the identification of children at risk for tuberculosis and optimal testing and treatment strategies.

Recent findings
The identification and management of children with tuberculosis has increased in complexity due to the recent severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) pandemic, greater use of immunosuppressive agents, and the administration of shorter, rifamycin-containing treatment regimens. Advancements in the diagnosis and treatment of tuberculosis in children include: use of interferon gamma release assays (IGRAs); molecular-based tests; and shorter courses of treatment. While the essential steps to identify and treat children at risk for tuberculosis remain unchanged, providers must be aware of impact of these challenges.

Summary
The SARS-CoV-2 pandemic will likely have a negative impact on global tuberculosis control. It is important that countries maintain a comprehensive approach to the identification and management of children at risk for tuberculosis. Increasing evidence supports enhanced utilization of IGRAs and molecular-based testing to improve the diagnosis of tuberculosis in children. Shorter course, rifamycin-based treatment regimens are available to treat children with tuberculosis infection; however, their use is limited in some immunosuppressed children due to drug-drug interactions.
New approaches to management of fever and neutropenia in high-risk patients
Authors: Douglas Abby , Thursky Karin , Slavin Monica 
Published: August 2022

Purpose of review
Patients receiving treatment for acute leukaemia and haematopoietic cell transplantation (HCT) have prolonged neutropenia and are at high risk of neutropenic fever, with bacterial and particularly invasive fungal infections as feared complications, possessing potentially serious consequences including intensive care admission and mortality. Concerns for these serious complications often lead to long durations of broad-spectrum antimicrobial therapy and escalation to even broader therapy if fever persists. Further, the default approach is to continue neutropenic fever therapy until count recovery, leaving many patients who have long defervesced on prolonged antibiotics.

Recent findings
This article details recent progress in this field with particular emphasis on early discontinuation studies in resolved neutropenic fever and improved imaging techniques for the investigation of those with persistent neutropenic fever. Recent randomized controlled trials have shown that early cessation of empiric neutropenic fever therapy is well tolerated in acute leukaemia and autologous HCT patients who are clinically stable and afebrile for 72 h. Delineation of the best approach to cessation (timing and/or use of fluoroquinolone prophylaxis) and whether this approach is well tolerated in the higher risk allogeneic HCT setting is still required. Recent RCT data demonstrate utility of FDG-PET/CT to guide management and rationalize antimicrobial therapy in high-risk patient groups with persistent neutropenic fever.

Summary
Acute leukaemic and autologous HCT patients with resolved neutropenic fever prior to count recovery can have empiric therapy safely discontinued or de-escalated. There is an emerging role of FDG-PET/CT to support decision-making about antibiotic and antifungal use in high-risk persistent/recurrent neutropenic fever patients.