bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standing and supine positions are better than sitting in improving rightward deviation in right-hemispheric stroke patients with unilateral spatial neglect: A randomized trial
Authors: Onaka Hitoshi , Kouda Ken , Nishimura Yukihide , Tojo Hidenori , Umemoto Yasunori , Kubo Toshikazu , Tajima Fumihiro , Mikami Yukio 
Published: November 2022

Trial design:
How body position affects unilateral spatial neglect (USN) is unclear. This cluster randomized trial aimed to examine the effects of different positions (supine, sitting, and standing) on USN in stroke patients.

Methods:
Twenty stroke patients (hemorrhage [n = 11], infarction [n = 9]) who were right-handed, had left hemiplegia due to right hemisphere damage that occurred within the last 2 years, and were in a state of arousal with a Glasgow Coma Scale score of 15 were included in the study. Table-top pen-and-pencil tests for USN (Bells Test, Line Bisection, Scene Copy, and Star Cancellation) were randomly conducted in the supine, sitting, and standing positions.

Results:
The mean values in each test were significantly smaller in the supine position than were those in the sitting position (P = .015, .047, .015, and <.001), and those in the standing position were significantly smaller than those in the sitting position (P = .007, <.001, =.006, and < .001). The results of the 4 tests in the standing position were similar to those in the supine position.

Conclusions:
Body position affects USN in stroke patients and that the standing and supine positions improve USN better than the sitting position. Some possible mechanisms are: muscle contractions in the lower limbs and the trunk could have affected results in the standing position, and reduction in gravitational stimulation in the supine position could have played a role.
Oxygen reserve index guided fraction of inspired oxygen titration to reduce hyperoxemia during laparoscopic gastrectomy: A randomized controlled trial
Authors: Ahn Jin Hee , Shim Jae-Geum , Park Jiyeon , Lee Sung Hyun , Ryu Kyoung-Ho , Cho Eun-Ah 
Published: November 2022

Background:
The usefulness of the oxygen reserve index (ORi) in reducing hyperoxemia remains unclear. We designed this study to investigate whether fraction of inspired oxygen (FiO2) adjustment under a combination of ORi and peripheral oxygen saturation (SpO2) guidance can reduce intraoperative hyperoxemia compared to SpO2 alone.

Methods:
In this prospective, double-blind, randomized controlled study, we allocated patients scheduled for laparoscopic gastrectomy to the SpO2 group (FiO2 adjusted to target SpO2 ≥ 98%) or the ORi-SpO2 group (FiO2 adjusted to target 0 < 0 ORi < .3 and SpO2 ≥ 98%). The ORi, SpO2, FiO2, arterial partial pressure of oxygen (PaO2), and incidence of severe hyperoxemia (PaO2 ≥ 200 mm Hg) were recorded before and 1, 2, and 3 hours after surgical incision. Data from 32 and 30 subjects in the SpO2 and ORi-SpO2 groups, respectively, were analyzed.

Results:
PaO2 was higher in the SpO2 group (250.31 ± 57.39 mm Hg) than in the ORi-SpO2 group (170.07 ± 49.39 mm Hg) 1 hour after incision (P < .001). PaO2 was consistently higher in the SpO2 group than in the ORi-SpO2 group, over time (P = .045). The incidence of severe hyperoxemia was higher in the SpO2 group (84.4%) than in the ORi-SpO2 group (16.7%, P < .001) 1 hour after incision. Higher FiO2 was administered to the SpO2 group [52.5 (50–60)] than the ORi-SpO2 group [40 (35–50), P < .001] 1 hour after incision. SpO2 was not different between the 2 groups.

Conclusion:
The combination of ORi and SpO2 guided FiO2 adjustment reduced hyperoxemia compared to SpO2 alone during laparoscopic gastrectomy.
Special presentation of bronchobiliary fistula after transcatheter arterial chemoembolization: A case report
Authors: Lo Yuan-Chun , Hsu Ping-Wen , Chew Fatt-Yang , Chen Hung-Yao 
Published: November 2022

Rationale:
Transcatheter arterial chemoembolization (TACE) is a widely adopted treatment for advanced stage hepatocellular carcinoma (HCC). Nevertheless, several complications may occur, such as hepatic artery injury, nontarget embolization, pulmonary embolism, hepatic abscess, biloma, biliary strictures, and hepatic failure. However, bronchobiliary fistula is rarely mentioned before.

Patient concerns:
A 65-year-old man with HCC underwent the TACE procedure, and then he encountered fever, dyspnea, abdominal pain, and abundant yellowish purulent bronchorrhea.

Diagnosis:
Bronchobiliary fistula was diagnosed based on the computed tomography (CT) scan of his chest, which revealed the right lower lobe of his lung was connected to a hepatic cystic lesion.

Interventions:
Percutaneous transhepatic cystic drainage was performed, and we obtained yellowish bile, showing the same characteristics as the patient’s bronchorrhea.

Outcomes:
We kept drainage of his biloma and provided supportive care as the patient wished. Unfortunately, the patient passed away due to progressive right lower lobe pneumonia 2 weeks later.

Lessons:
This case exhibits a typical CT scan image that was helpful for the diagnosis of post-TACE bronchobiliary fistula. Post-TACE bronchobiliary fistula formation hypothesis includes biliary tree injuries with subsequent biloma formation and diaphragmatic injuries. Moreover, the treatment of bronchobiliary fistula should be prompt to cease pneumonia progression. Therefore, we introduce this rare complication of post-TACE bronchobiliary fistula in hopes that future clinicians will keep earlier intervention in mind.
Benefit and safety of antibiotics for Alzheimer’s disease: Protocol for a systematic review and meta-analysis
Authors: Gao Lin , Shuai Yinqi , Wen Lihong , Zhang Hong , Zhang Yi , Zhang Xiaoyun 
Published: November 2022

Background:
Alzheimer's disease (AD) is an age-related degenerative change of the central nervous system, the cause of which remains unclear. Recent studies have found that brain inflammation caused by microbial infections may be one of the etiologies of AD, and antibiotics as novel treatments may be beneficial for delaying the development of AD. Several prospective studies have investigated the effects of different antibiotics on Alzheimer's disease. However, no systematic review or meta-analysis has evaluated the benefits and safety of antibiotics in AD patients.

Methods:
This study will analyze randomized controlled trials and observational studies published from database inception to December 31, 2022, and included direct or indirect evidence. Studies will be retrieved by searching PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Clinical Trials, CNKI, and Wan Fang databases. The outcomes of this study included the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog), Montreal Cognitive Assessment (MoCA), Standardized Mini-Mental State Examination (SMMSE), Clinical Dementia Rating (CDR), Frontal Functioning Scale (FAB), Dysfunctional Behavior Rating Instrument (DBRI), Activities of Daily Living (ADLs) Index, and Geriatric Depression Scale (GDS). The risk of bias will be assessed using the Cochrane risk-of-bias assessment instrument for randomized controlled trials. A random-effect/fixed-effects model will be used to summarize the estimates of the mean difference/risk ratio using a 95% confidence interval.

Results:
This study will analyze the benefits and safety of antibiotics in patients with AD.

Conclusion:
The results of this analysis will provide evidence to evaluate the benefits and safety of antibiotics in the treatment of AD.
A low-dose therapy of fibrinogen supplement during perioperative period of total knee arthroplasty in an asymptomatic man with congenital dysfibrinogenemia: A case report
Authors: Meng Decheng , Zhang Runzi , Ji Chenni , Gao Shijun , Wang Juan 
Published: November 2022

Rationale:
Congenital dysfibrinogenemia (CD) is a rare coagulation system disease that is often treated without unified management. Individualized treatment thereof presents clinicians with great challenges.

Patient concerns:
A patient who was about to undergo total knee arthroplasty was found to have CD.

Diagnoses:
Coagulation screening revealed low fibrinogen, prolonged thrombin time, minor prolonged prothrombin time, and normal activated partial thromboplastin time were detected during admission, but no abnormal personal and family history findings were observed. Therefore, CD and hypofibrinogenemia were suspected. The gene sequencing confirmed the diagnosis of CD.

Interventions:
The patient received plenty and low level of fibrinogen concentrate during 2 perioperative periods, respectively.

Outcomes:
Successful clinical outcomes were obtained using different treatment strategies.

Lessons:
In contrast to prior case reports, this case illustrates the feasibility of low dosing of fibrinogen supplements within an asymptomatic patient in a selective operation. Changes in the level of fibrinogen and fibrin degradation product are of great importance for individualized treatment after supplementation.
Efficacy and safety of metronomic chemotherapy in maintenance therapy for metastatic colorectal cancer: A systematic review of randomized controlled trials
Authors: Chen Li , Cao Xin , Li Jing , Liu ChaoMin , Jiang Ting 
Published: November 2022

Background:
The current studies on metronomic chemotherapy in mCRC are all aimed at patients after multi-line therapy failure, and only a few studies have focused on maintenance treatment after successful first-line therapy.

Methods:
The PubMed, Embase, Cochrane Library, Wanfang, CNKI, and VIP were searched, and the relevant data was extracted, including media progression-free survival (mPFS), media overall survival (mOS), and grade 3/4 adverse events (AEs).

Results:
We included 4 randomized controlled trials (RCTs), 2 RCTs showed that metronomic maintenance chemotherapy could significantly improve mPFS compared to observation group; another RCT showed that metronomic maintenance chemotherapy group did not have low mPFS than the bevacizumab maintenance treatment (MT). The final RCT showed that dual-agent metronomic chemotherapy combined with bevacizumab MT did not improve mPFS compared with bevacizumab MT. The 3 RCTs showed that the metronomic maintenance therapy could not effectively improve mOS in mCRC compared to observation group or bevacizumab MT, while another RCT reported that the mOS in metronomic maintenance chemotherapy group was similar to bevacizumab MT. AEs was mostly mild and manageable. Grade ≥ 3 AEs are mostly nonhematological toxicity, and no deaths related to AEs were reported.

Conclusion:
This systematic review indicates that metronomic chemotherapy for mCRC MT can improve mPFS in some patients and is relatively safe. However, improvements in OS in most RCTs are arguable. Therefore, we need further studies to verify its long-term efficacy.
Hemorrhagic, hypovolemic shock resuscitated with Ringer’s solution using bicarbonate versus lactate: A CONSORT-randomized controlled study comparing patient outcomes and blood inflammatory factors
Authors: Han Sheng-Jin , Zhou Zheng-Wu , Yang Cui , Wei Kun-Peng , Ma Jian-Zhong , Chu Zeng-Fei , Gu Peng 
Published: November 2022

Background:
Isotonic crystalloids are the preferred solution for the initial clinical management of patients with multiple trauma, among which lactated Ringer’s solution and normal saline are the most widely used, but both have clinical limitations. Bicarbonated Ringer’s solution (BRS), which provides physiological levels of bicarbonate ions and electrolyte ions, can be used to supplement missing extracellular fluid and correct metabolic acidosis.

Methods:
A prospective, randomized controlled study enrolled 63 patients with traumatic hepatic rupture and hemorrhagic shock. They were randomly assigned to the Bicarbonated group (n = 33) or the Control group (n = 30), which received restrictive fluid resuscitation with sodium bicarbonate Ringer’s solution or sodium lactate Ringer’s solution, respectively. The levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, arterial blood lactic acid and potential of hydrogen (pH) were measured prior to, 1, 3, 24, and 72 hours following resuscitation. The primary outcomes were patient survival, shock-related complications, and comparison of the inflammatory factors.

Results:
The incidence of complications in the Bicarbonated group was significantly lower than in the Control group (15.15% vs 40.0%; P < .05). The intensive care unit length of stay and mechanical ventilation time in the Bicarbonated group were significantly shorter than in the Control group (all P < .01). The levels of IL-6 and TNF-α in the Bicarbonated group were significantly lower 1 hour following resuscitation than prior to resuscitation (P < .01), whereas these levels in the Control group were increased following 1h of resuscitation as compared with before resuscitation (P < .01). Following resuscitation, the levels of IL-6, TNF-α and lactate in the Bicarbonated group were significantly lower than in the Control group (P < .01). Moreover, in the Bicarbonated group, the lactic acid level decreased and the pH value increased significantly following resuscitation, whereas there was no difference in lactic acid levels and pH value between pre- and 1 hour post-resuscitation in the Control group (P > .05).

Conclusion:
The shock-related complications were dramatically reduced from using BRS in these patients. Additionally, the BRS was found to better inhibit the expression of inflammatory factors in their peripheral blood and could correct acidosis.
A rare case of Takotsubo syndrome with ventricular septal rupture: Case report
Authors: Alsheikh Hamada , Shaheen Nour , Saber Wageih , Meshref Mostafa , Amro Yara , Shaheen Ahmed , Ahmed Mahmoud Galal , Swed Sarya 
Published: November 2022

Introduction:
Takotsubo cardiomyopathy (TCM) mimics acute coronary syndrome and is characterized by reversible left ventricular (LV) apical ballooning in the absence of angiographically substantial coronary artery stenosis.

Patient concerns:
A 31-year-old man with acute dejection, physical stress, and psychological strain from the dread of losing his work arrived at the emergency department with chest pain, and discomfort that had lasted 3 hours.

Diagnosis:
Once the coronary angiography revealed normal epicardial coronaries, the case was retroactively diagnosed, and the levels of cardiac enzymes were increased.

Interventions:
The amount of necrotic tissue was so little that the surgeon could only verbally convey it. It is completely closed with the help of a Dacron sheet. The patient received surgical closure of the VSR a few days after having a surgical consultation.

Outcomes:
No postoperative echocardiogram was required, and the patient was sent home in great general condition.

Conclusion:
The presence of TCM with a ruptured LV wall was extremely rare because our patient had neither clinical risk indicators nor a family history of coronary artery disease. As a Takotsubo syndrome severe complication, we underline the significance of identifying, diagnosing, and treating it.
Effects of rosuvastatin/ezetimibe on senescence of CD8+ T-cell in type 2 diabetic patients with hypercholesterolemia: A study protocol
Authors: Ju Sang Hyeon , Ku Bon Jeong 
Published: November 2022

Background:
A decade ago, systemic inflammation became widely recognized as an etiology of type 2 diabetes mellitus (T2DM) and complications thereof. Senescent CD8 + T cells of T2DM patients exhibit increased secretion of pro-inflammatory cytokines and enhanced expression of cytotoxic molecules, contributing to systemic inflammation. Recently, many anti-inflammatory roles played by statins and ezetimibe (cholesterol-lowering drugs) have been reported. We will explore the effects of statin/ezetimibe therapy on CD8 + T cell senescence in patients with T2DM and hypercholesterolemia.

Methods:
This 2-group, parallel, randomized, controlled clinical trial will recruit 108 subjects with T2DM and low-density lipoprotein-cholesterol (LDL-C) levels ≥100 mg/dL and randomly assign them to rosuvastatin/ezetimibe and rosuvastatin groups at a 1:1 ratio. Blood samples will be drawn at baseline and after 12 weeks of medication. The primary outcomes will be the LDL-C-lowering effects after 12 weeks. The secondary outcomes will be changes in the senescent (CD28 − CD57+) CD8 + T cell proportions; the levels of circulating pro-inflammatory cytokines, cytotoxic molecules, interleukin-1, transforming growth factor-β, fasting glucose, and HbA1c; and biochemical indices of kidney, liver, and muscle function. Symptoms and signs of predictable adverse events (myopathy and hepatitis) will be routinely monitored.

Discussion:
We will evaluate the effects of statin/ezetimibe on CD8 + T cell senescence. Statin/ezetimibe may exert a beneficial immunomodulatory effect.
A pooled analysis of the association between sarcopenia and osteoporosis
Authors: Yu Xiaochao , Sun Shuo , Zhang Shaoxiong , Hao Qinggang , Zhu Boheng , Teng Yirong , Long Qing , Li Shujun , Lv Yan , Yue Qiaoning , Lu Sheng , Teng Zhaowei 
Published: November 2022

Background:
Sarcopenia is a progressive generalized skeletal muscle disorder that causes the accelerated loss of muscle mass and function. Osteoporosis is a systemic condition of the skeleton that results in low bone mass and quality. Several studies have suggested that osteoporosis and sarcopenia are interrelated; however, a few studies indicate the lack of a significant association between sarcopenia and osteoporosis. We aimed to evaluate the association between sarcopenia and osteoporosis via a systematic review and pooled analysis.

Methods:
From the inception of the PubMed and Embase databases until September 2022, we conducted a systematic search for studies evaluating the relationship between sarcopenia and osteoporosis. Study appraisal and synthesis methods: We included observational studies that provided 95% confidence intervals (CIs) and risk estimates. Two reviewers independently extracted data and assessed the quality of the research. The random-effects model was applied to the pool analysis, and the odds ratios (ORs) and 95% CIs were finally calculated.

Results:
The primary statistic was the mutual risk between sarcopenia and osteoporosis. According to the inclusion criteria, 56 studies (796,914 participants) were finally included. Sarcopenia was significantly correlative to the risk of osteoporosis (OR, 3.06; 95% CI, 2.30–4.08), and each standard deviation increase in relative appendicular skeletal muscle mass was significantly related to a decreased risk of osteoporosis (OR, 0.65; 95% CI, 0.56–0.75). Osteoporosis observably referred to a higher risk of sarcopenia (OR, 2.63; 95% CI, 1.98–3.49).

Conclusion:
Our research indicated that sarcopenia and osteoporosis are highly positively correlated. Osteoporosis is closely associated with the risk of sarcopenia. Our finding highlights the importance of sarcopenia screening for those at risk of osteoporosis, and vice versa. However, heterogeneity was noted among the studies, and this might have influenced the accuracy of the results. Therefore, the results of our study should be interpreted with caution.
Repetitive transcranial magnetic stimulation in patients with fibromyalgia: A protocol for systematic review and network meta-analysis
Authors: Wang Yangyang , Lei Junfang , Qiao Hong , Tang Jiqin , Fan Xiaohua 
Published: November 2022

Background:
Fibromyalgia is a chronic disease characterized by widespread pain. Repetitive transcranial magnetic stimulation (rTMS) effectively relieves pain intensity in patients with fibromyalgia. The frequency and target site of rTMS have significant roles in therapy effectiveness. However, there is disagreement over the best rTMS protocol. Thus, we will conduct a thorough systematic review and network meta-analysis to rank the efficacy of these various rTMS protocols and determine which is most beneficial in lowering pain and enhancing the quality of life.

Methods:
Databases PubMed, Web of Science, Embase, and Cochrane Library will be searched for clinical randomized controlled trials of rTMS in fibromyalgia. The retrieval time is from the inception of the database until October 1, 2022. Following the Cochrane Handbook, 2 reviewers will independently review the literature, extract data, and evaluate the risk of bias of included articles. Pain intensity and quality of daily life are outcome indicators. Stata 17.0 and ADDIS 1.16.8 software will be used for pairwise meta-analysis and network analysis to evaluate the effectiveness of rTMS and the ranking probability of all protocols. The recommended grading assessment, development, and evaluation will be used to assess the overall quality of the evidence.

Results:
The meta-analysis and probability ranking of the network determined the best TMS protocol for fibromyalgia.

Conclusion:
This study will provide systematic support of evidence-based medicine for TMS in fibromyalgia, integrate the results of direct and indirect comparisons of the efficacy of different rTMS protocol, and provide the best one.
Prophylactic antibiotics induce early postcraniotomy seizures in neurosurgery patients: A case series
Authors: Lee Nawon , Jee Dae-Lim , Kim Hyuckgoo 
Published: November 2022

Rationale:
Antibiotics can cause central nervous system disturbances, manifesting as dizziness, confusion, headache, and seizures. Seizures due to antibiotic administration are related to increased excitatory neurotransmission because antibiotics act as competitive antagonists of the γ-aminobutyric acid type A receptor.

Patient concerns and clinical findings:
All 5 patients, comprising 4 females and one male and aged 45 to 72 years, underwent open craniotomy with additional surgical maneuvers according to their specific disease. All patients presented American Society of Anesthesiologists Physical Status grades 1 to 2. There were no specific underlying diseases, except hepatitis C and hypertension. However, seizures developed sequentially in the 5 patients after neurosurgery.

Diagnoses, interventions, and outcomes:
Early postcraniotomy seizures (PCS) developed in the patients after neurosurgery. Prophylactic antibiotics were administered in all cases to prevent infection due to open craniotomy. This included the administration of 10 g and 2 g of an antibiotic (cefotiam HCL; Jetiam Intravenous Injection 1g®) an hour before the surgery in the ward and half an hour before the surgery in the operating room, respectively. After surgery, cefotiam HCL 2 g was administered in all patients on the day of surgery. Five patients had myoclonic seizure or generalized tonic–clonic seizure several times at emergence or in the intensive care unit.

Lessons:
Early PCS occurred in every patient when an overdose of the prophylactic antibiotic was administered. This report showed that the preoperative prophylactic antibiotic cefotiam administered in double doses evoked early PCS within a few hours of drug administration. Furthermore, such experiences caution that preoperative intravenous cephalosporins, including cefotiam, should be administered carefully in open craniotomy.