bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of BioMime Morph stent in treating left main triple vessel disease: a case report
Authors: Sharma Yash Paul , Santosh Krishna , Panda Prashant , Prasad Krishna , Uppal Lipi , Y S Shrimanth , Pruthvi C. R. , Dinakar B. 
Published: August 2020

Abstract
Background
Diffuse long coronary lesions require long overlapping stents which produce less than optimal long-term results. Sizing of long stents becomes difficult owing to tapering of coronaries and overlapping with excessive metal which makes restenosis a nagging problem on long-term follow-up. The optimal stent sizing becomes even more important when left main (LM) needs to be treated along with left ascending artery (LAD) or left circumflex artery (Lcx). The chronic total occlusions (CTO) represent other complex diffuse coronary lesions which not only require higher expertise and better hardware but also usually long lengths of overlapping stents. The long-tapered sirolimus-eluting stent system (BioMime Morph) has been successfully used in long diffuse lesions in individual coronaries including CTO but the use of the same in LM-LAD/LM-Lcx diffuse lesions has not been explored well where its tapered design can really be favourable.

Case presentation
We here present a case of a 51-year-old hypertensive male presented with NSTEMI and angiography showing left main triple vessel disease with CTO of right coronary artery (RCA). We successfully stented the LM-LAD and RCA (staged) using a long-tapered BioMime Morph system. IVUS was used for optimising the LM-LAD stent. At 6 months follow-up, the patient was doing well on double anti-platelets.

Conclusion
Complex coronary disease, involving the left main and LAD diffusely and CTO of RCA, can be well managed by using a single long-tapered stents thereby avoiding multiple stenting strategy. The stents with decremental diameter will provide better adaptation to the vessel size and their natural tapering. The usage of intravascular imaging helps in better optimisation of stents
Chest CT findings of COVID-19-infected patients, are there differences between pediatric and adult patients? A systematic review
Authors: Azadbakht Javid , Haghi-Aminjan Hamed , Farhood Bagher 
Published: August 2020

Abstract
Background
Purpose of this study was to deliver a report of chest CT findings of COVID-19-infected pediatric and adult patients and to make an age-based comparison. A systematic search was conducted in accordance with PRISMA guidelines to identify relevant studies in the electronic databases of PubMed, Scopus, ProQuest, ScienceDirect, and Web of Sciences from January 1, 2020 to March 27, 2020 using search terms in the titles and abstracts. Based on our inclusion and exclusion criteria, 762 articles were screened. Finally, 15 eligible articles which had adequate data on chest CT findings of COVID-19-infected patients were enrolled in this systematic review.

Results
In pediatric patients (15 years old or younger), peripheral distribution was found in 100% of cases, ground glass opacities (GGO) in 55.2%, bilateral involvement in 50%, halo sign in 50%, unilateral involvement in 30%, consolidation in 22.2%, crazy paving pattern in 20%, nodular opacities in 15%, pleural effusion in 4.2%, lymphadenopathy in none, and normal imaging in 20.8% of cases. On the other hand, in adult patients, bilateral involvement was reported in 76.8%, GGO in 68.4%, peripheral distribution in 62.2%, mixed GGO and consolidation in 48.7%, consolidation in 33.7%, crazy paving pattern in 27.7%, mixed central and peripheral distribution in 25.0%, unilateral involvement in 15.2%, nodular opacities in 9.2%, pleural effusion in 5.5%, central distribution of lesions in 5.4%, lymphadenopathy in 2.4%, and normal imaging in 9.8% of cases.

Conclusion
According to the findings of this systematic review, children infected with COVID-19 can present with normal or atypical findings (nodular opacities/unilateral involvement) in chest imaging more frequently than adult patients. Therefore, more caution should be taken to avoid misdiagnosis or missed diagnosis in infected children. Besides, clinical and laboratory findings need to be considered more decision-making for pediatric patients with normal or atypical chest CT scan but high suspicion of COVID-19.
Vertebral artery compression of medulla oblongata causing isolated symptom of dizziness: two case reports
Authors: Mahrous Mahmoud M. , Busaad Ibrahim A. 
Published: August 2020

Abstract
Background
Symptomatic medulla oblongata compressing lesions due to dilated vertebral artery are rare in the literature. The symptoms are extremely heterogeneous and not correlated to the severity of compression in many cases.

Case presentation
This paper describes two cases with vertebral artery compression of medulla oblongata complaining only from dizziness without any other neurological symptoms or signs. In both cases, videonystagmography revealed positional nystagmus. Head magnetic resonance imaging showed abnormal dilatation, elongation, and tortuosity of the vertebral artery compressing the medulla oblongata. Vestibular rehabilitation was described in both cases and had a significant effect on symptom improvement.

Conclusion
In the study cases, the sense of vertigo and/or unsteadiness is due to vertebral artery compression of medulla oblongata and can be an isolated symptom. Positional nystagmus is the only sign in vestibular evaluation.
Diagnostic Performance of Indocyanine Green Plus Methylene Blue Versus Radioisotope Plus Methylene Blue Dye Method for Sentinel Lymph Node Biopsy in Node-Negative Early Breast Cancer
Authors: Agrawal Sanjit Kumar , Hashlamoun Izideen , Karki Banira , Sharma Abhishek , Arun Indu , Ahmed Rosina 
Published: August 2020

PURPOSE Sentinel lymph node biopsy (SLNB) by dual-dye method (radioisotope plus blue) is the gold standard for axillary staging in patients with breast cancer, but in developing countries, logistic issues and financial constraint play a vital role. Recently, indocyanine green (ICG) has emerged as an alternative to radioisotope (technetium-99 [Tc-99]) for SLNB in breast cancer. This study compared the diagnostic performance of Tc-99 plus methylene blue (MB) dye versus ICG + MB dye SLNB. METHODS Two hundred seven patients with early breast cancer (T1-3N0) were included in the study from 2017 to 2019. SLNB was done either with Tc-99 + MB or with ICG + MB as per availability of radioisotope. SLN identification rate (IR), SLN positivity rate, and metastatic SLN counts were compared between the 2 groups. RESULTS IR was 199 (96%) of 207. IR was 95% in Tc-99 + MB compared with 97% with ICG + MB. The mean number of SLNs identified were 3.17 (standard deviation [SD], 1.84), with > 1 SLN identified in 87% patients by Tc-99 + MB. SLN was positive in 31.3% of patients with a metastatic SLN count of 0.37 (SD, 0.76). With ICG + MB, the number of SLNs was 2.73 (SD, 1.55), with > 1 SLN identified in 79% of patients. Twenty-eight percent of patients had positive SLNs, with a metastatic SLN count of 0.41 (SD, 0.77). A sharp decline in the availability of Tc-99 was observed, with 58% of patients in 2014 and only 12% of patients in 2018. CONCLUSION ICG is equivalent to Tc-99 for SLNB in early breast cancer and has a good potential to be adopted by surgeons in resource-constrained setups.
Bevacizumab Plus mFOLFOX6 Versus mFOLFOX6 Alone as First-Line Treatment for RAS Mutant Unresectable Colorectal Liver-Limited Metastases: The BECOME Randomized Controlled Trial
Authors: Tang Wentao , Ren Li , Liu Tianshu , Ye Qinghai , Wei Ye , He Guodong , Lin Qi , Wang Xiaoying , Wang Mingliang , Liang Fei , Cui Yuehong , Xu Jianmin 
Published: August 2020

PURPOSE To assess the effects of bevacizumab plus modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) as first-line treatment of RAS mutant unresectable colorectal liver metastases. METHODS From October 2013 to December 2017, patients with RAS mutant unresectable liver-limited metastases from colorectal cancer were randomly assigned to receive mFOLFOX6 plus bevacizumab (arm A) or mFOLFOX6 alone (arm B). The resectability of liver metastases was determined by a local multidisciplinary team. The primary end point was the actual rate of patients converted to R0 resection for liver metastases. Secondary end points included tumor response, survival, and toxicity. The block randomization method was used. RESULTS The intention-to-treat population comprised 241 patients. A total of 121 patients were randomly assigned to arm A and 120 to arm B. The median follow-up time was 37.0 months for all patients. The R0 resection rates for liver metastases were 22.3% (27 of 121 patients) in arm A and 5.8% (7 of 120 patients) in arm B, with a significant difference ( P < .01). Patients in arm A had significantly better objective response rates (54.5% v 36.7%; P < .01), median progression-free survival (9.5 v 5.6 months; P < .01) and median overall survival (25.7 v 20.5 months; P = .03) compared with those in arm B. The addition of bevacizumab was associated with more frequent proteinuria (9.9% v 3.3%; P = .04) and hypertension (8.3% v 2.5%; P < .05). CONCLUSION For patients with initially unresectable RAS mutant colorectal liver metastases, bevacizumab combined with mFOLFOX6 increased the resectability of liver metastases and improved response rates and survival compared with mFOLFOX6 alone.
Glucocorticoid Resistance in Premature Adrenarche and PCOS: From Childhood to Adulthood
Authors: Panayiotopoulos Aristotle , Bhangoo Amrit , Khurana Divya , Ten Svetlana , Michl Josef , Ghanny Steven 
Published: August 2020

Abstract

Context
We hypothesize that impaired glucocorticoid sensitivity (GC sensitivity) plays a role in the development of premature adrenarche (PA) and polycystic ovarian syndrome (PCOS) by increasing androgen synthesis.

Objective
To study glucocorticoid sensitivity in vitro in subjects with PA and PCOS.

Patients and Methods
Fourteen subjects (10 girls, 4 boys, 6.9 ± 0.6 years) with PA; 27 subjects with PCOS (17 ± 2.5 years) and 31 healthy controls were enrolled in the study. All subjects and controls underwent GC sensitivity analysis in vitro using a fluorescein labeled-dexamethasone (F-DEX) assay. A GC sensitivity index (GCSI) was calculated as area under the curve of the F-DEX assay results. Subjects were classified as GC resistant if the GCSI ≤ 264 and GC sensitive if the GCSI ≥ 386.

Results
In the PA group, 8 of 14 subjects were resistant with GCSI of 179.7 ± 39.9, 4 were within the normal range with GCSI of 299.6 ± 27.9, and 2 had increased GC sensitivity with GCSI of 423.5 ± 47.9. In the PCOS group, 18 of 27 subjects were GC-resistant with GCSI of 180.9 ± 58.2, 8 were within the normal range with GCSI of 310.7 ± 26.4, and 1 had increased GCSI of 395.4. In the PCOS GC-resistant subgroup, cortisol was higher compared with PCOS with normal GCSI (P &lt; 0.05). In the combined PCOS plus female control group, GCSI correlated negatively with cortisol and testosterone (P &lt; 0.05).

Conclusion
GC resistance was found in more than 50% of patients with PCOS and PA. The findings strongly suggest that GC resistance is associated with states of PA and PCOS.
The psychological impact of the COVID-19 pandemic on medical students in Turkey
Authors: Torun Fuat , Torun Sebahat Dilek 
Published: August 2020

Objective: We aimed to investigate the knowledge of medical students about COVID-19, the effects of the traumatic situation they experienced, the stress they perceived and the factors affecting them. In addition, we aimed to learn the thoughts of the students about the virus due to the uncertainties.
Methods: The study was carried out online between April 30, May 5, 2020 with a questionnaire prepared with googleforms. For the study, all students studying at the Faculty of Medicine of Istanbul Yeni Yüzyıl University were called through class representatives and WhatsApp class groups. The questionnaire included sociodemographic information, knowledge and sources of information about the disease, to agreement degree the proposition whether covid 19 is produced as a biological weapon. The Perceived Stress Scale (PSS) and Impact of Events Scale-Revised (IES-R) were applied.
Results: The total number of participants was 275 students. No student was infected with COVID-19 at the time of the survey. The presence of chronic disease in the participants was found to be a factor that increased anxiety (p = 0.01). Majority of participants (60.40%) stated that they agree with COVID-19 is a biological weapon. The mean scores of women ‘s total PSS and IES-R were higher than men. It was found that the families of the students had a lower monthly income than the minimum monthly wage is increasing the anxiety about getting COVID-19 infection and perceived stress. One-third of the students reported that sleep and appetite were impaired than the before pandemic. The announcements and website of Ministry of Health and the social media was the main source of information of the participants.
Conclusions: It was found that medical students were highly worried about being infected with COVID-19. The scores obtained from the pre-clinic students’ anxiety to become infected with COVID-19, PSS and IES-R total scores were found to be significantly higher than their clinical students.
doi: https://doi.org/10.12669/pjms.36.6.2985
How to cite this:Torun F, Torun SD. The psychological impact of the COVID-19 pandemic on medical students in Turkey. Pak J Med Sci. 2020;36(6):1355-1359. doi: https://doi.org/10.12669/pjms.36.6.2985
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Lipidomics reveal the protective effects of a vegetable-derived isothiocyanate against retinal degeneration
Authors: Kwa Faith A. , Dulull Nabeela K. , Roessner Ute , Dias Daniel A. , Rupasinghe Thusitha W. 
Published: August 2020

Background:Age-related macular degeneration (AMD) is a leading cause of blindness in the ageing population. Without effective treatment strategies that can prevent disease progression, there is an urgent need for novel therapeutic interventions to reduce the burden of vision loss and improve patients’ quality of life. Dysfunctional innate immune responses to oxidative stress observed in AMD can be caused by the formation of oxidised lipids, whilst polyunsaturated fatty acids have shown to increase the risk of AMD and disease progression in affected individuals. Previously, our laboratory has shown that the vegetable-derived isothiocyanate, L-sulforaphane (LSF), can protect human adult pigment epithelial cells from oxidative damage by upregulating gene expression of the oxidative stress enzyme Glutathione-S-Transferase µ1. This study aims to validate the protective effects of LSF on human retinal cells under oxidative stress conditions and to reveal the key players in fatty acid and lipid metabolism that may facilitate this protection.Methods:Thein vitrooxidative stress model of AMD was based on the exposure of an adult retinal pigment epithelium-19 cell line to 200µM hydrogen peroxide. Percentage cell proliferation following LSF treatment was measured using tetrazolium salt-based assays. Untargeted fatty acid profiling was performed by gas chromatography-mass spectrometry. Untargeted lipid profiling was performed by liquid chromatography-mass spectrometry.Results:Under hydrogen peroxide-induced oxidative stress conditions, LSF treatment induced dose-dependent cell proliferation. The key fatty acids that were increased by LSF treatment of the retinal cells include oleic acid and eicosatrienoic acid. LSF treatment also increased levels of the lipid classes phosphatidylcholine, cholesteryl ester and oxo-phytodienoic acid but decreased levels of phosphatidylethanolamine lipids.Conclusions:We propose that retinal cells at risk of oxidative damage and apoptosis can be pre-conditioned with LSF to regulate levels of selected fatty acids and lipids known to be implicated in the pathogenesis and progression of AMD.
Jupyter notebook-based tools for building structured datasets from the Sequence Read Archive
Authors: Bernstein Matthew N. , Gladstein Ariella , Latt Khun Zaw , Clough Emily , Busby Ben , Dillman Allissa 
Published: August 2020

The Sequence Read Archive (SRA) is a large public repository that stores raw next-generation sequencing data from thousands of diverse scientific investigations. Despite its promise, reuse and re-analysis of SRA data has been challenged by the heterogeneity and poor quality of the metadata that describe its biological samples. Recently, the MetaSRA project standardized these metadata by annotating each sample with terms from biomedical ontologies. In this work, we present a pair of Jupyter notebook-based tools that utilize the MetaSRA for building structured datasets from the SRA in order to facilitate secondary analyses of the SRA’s human RNA-seq data. The first tool, called the Case-Control Finder, finds suitable case and control samples for a given disease or condition where the cases and controls are matched by tissue or cell type. The second tool, called the Series Finder, finds ordered sets of samples for the purpose of addressing biological questions pertaining to changes over a numerical property such as time. These tools were the result of a three-day-long NCBI Codeathon in March 2019 held at the University of North Carolina at Chapel Hill.
Preserving the endothelial glycocalyx in patients undergoing cardiopulmonary bypass: a prospective randomised interventional pilot study of lidocaine and doxycycline (LiDEG trial)
Authors: Pannekoek Adrian , Johnson Mark , Buggy Donal , Pavey Warren 
Published: August 2020

Background: During major surgery, particularly heart surgery, an element of the lining of blood vessels, known as the endothelial glycocalyx (EG), can be damaged. This can lead to swelling, low oxygen levels, kidney failure and other problems, which delay recovery. There are laboratory studies that show lidocaine (a local anaesthetic) and doxycycline (an antibiotic) may help protect this lining. The study agents are widely available, cheap and safe drugs. Trial design and objective: This is a phase IV, single centre, prospective, unblinded, randomised, parallel-group trial. The objectives of the trial are to investigate the role of doxycycline and lidocaine as potential agents to reduce EG shedding and correlate with early postoperative outcomes. Methods: 60 adult patients undergoing heart surgery requiring cardiopulmonary bypass (CPB) will be randomly assigned to one of three groups: doxycycline group (oral doxycycline, 200mg preoperatively); lidocaine group (perioperative intravenous lidocaine, 1.5mg/kg bolus at induction followed by 2mg/kg/hr infusion for the duration of surgery); and control group (standard care). The randomisation will be undertaken using a sealed opaque envelope method. The primary outcome will be the relative difference in the biochemical marker of EG injury, syndecan-1, at different timepoints in the intraoperative and early post-operative period. Secondary endpoints include vasopressor requirements, markers of organ dysfunction (lung, kidney, brain, arrhythmia), coagulation and inflammation. Discussion: EG injury is ubiquitous in patients undergoing CPB. Maintaining homeostasis of this delicate layer would appear to be a valuable therapeutic target. To date no agents have been shown to be effective in protecting the EG. Our study agents have shown some promise in the preclinical setting and would represent a novel therapeutic approach should they show a protective effect. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12619000621112 (26th April 2019).
Lifestyle and reproductive health: the aetiology of ovarian cancer in Pakistan
Authors: Alvi Qurratulann , Baloch Gul Muhammad , Chinna Karuthan , Dabbagh Ali 
Published: August 2020

Ovarian cancer is a fatal gynaecological cancer and eighth most common cancer in women globally. Lifestyle, reproductive and sociodemographic factors are among the influential parameters that may significantly affect the risk of ovarian cancer and its mortality rate. However, the epidemiological investigations have shown that the risk of ovarian cancers associated with these factors is different in varied geographical distributions. Lifestyle and reproductive factors have not been investigated thoroughly across a wide cultural diversity. The objective of this study is to investigate the association of these factors with ovarian cancer in Pakistan. This investigation will focus on the lifestyle effects of fat intake, intake of tea, habitual exercise, use of talc, personal hygiene, habit of holding urine for long time, obesity on ovarian cancer among Pakistani women. Reproductive variables will include age at menarche, natural menopausal age, parity, nulliparity (miscarriages, abortion, stillbirths), infertility, fertility treatment, tubal ligation, oral contraceptive use, and family history of breast or ovarian cancer. Sociodemographic variables will include effect of age, income, education, and geographical location. A case-control study will be conducted in the major cancer hospitals of Pakistan and the patients will also be interviewed. The controls will be recruited outside the hospital. For controls the same age limit and residency requirements will be applied. The information gained from this research will be an important contribution to develop programs for health promotion, with a focus on ovarian cancer prevention and women’s health. The findings could be used for health policies and planning to prevent ovarian cancer. The research will pave the way for a public policy and interventions to reduce the burden of ovarian cancer in Pakistan.
Comment on Lachenmeier et al (2020) “Are side effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination?”: disputation on various points in the publication
Authors: Kruse Daniel , Beitzke Bernhard 
Published: August 2020

This Correspondence article is a counterstatement to a Brief Report published by Lachenmeier and co-workers on 17th February 2020 in F1000Research: “Are side effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination?”. This counterstatement proposes that the authors of that article neither present proof or evidence for the alleged side effects of CBD products (no case reports presented with utilisable data), nor do they show that side effects are due to the presence of THC. Primarily, there is no clear definition of THC because the authors do not explain whether they mean Delta9-THC only (without its precursor tetrahydrocannabinolic acid (THCA)) or total-THC (the sum of Delta9-THC and its precursor THCA, normalised to THC); indeed EU Recommendation 2016/2115 on the monitoring of cannabinoids in food requires the measurement and documentation of the precursor acids complementary to the decarboxylated cannabinoids. The key part of the authors’ work – Table 2 with the assessment of the CBD products – leaves the reader in the dark about the nature of “THC”. This is all the more concerning because acid-free Delta9-THC is psychotropic but THCA is not. Additionally, the classification of the CBD products (“toxicity assessment”) presented is based on the assignment of the quantitative relation to the LOAEL (lowest observed adverse effect level) of THC (2.5 mg of acid-free Delta9-THC per adult and day as assigned by EFSA, 2015). However, many assumptions by Lachenmeier et al. on daily intake of CBD products are questionable, in particular food supplements, where the recommended daily consumption was missing on the label. Finally, the authors of the paper also compare their findings with the German recommendations on maximum levels of total-THC in food, ignoring that those limits refer to total-THC and the ready-to-eat products, and not to the food ingredient itself – in particular hemp tea products.