bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidermolysis bullosa acquisita as an adverse effect from rituximab therapy
Authors: Wu Xueqiong , Lv Zhenhui , Li Wenjia , Meng Zhaosheng , Wan Shaw P. 
Published: December 2020

Abstract

Rationale:
Rituximab is a monoclonal antibody directed against B cells and is a first-line agent for the treatment of B cell lymphoma and a second-line agent for the treatment of idiopathic thrombocytopenic purpura (ITP). It has also been used for the treatment of several other autoimmune diseases. Epidermolysis bullosa acquisita (EBA) has never been reported as an adverse effect resulted from rituximab therapy.

Patient concerns:
A 54-year-old female presented with relapse of the ITP for around eight months. She was treated with rituximab. Intramuscular chlorpheniramine and intravenous methylprednisolone and cimetidine were used as premedication before rituximab infusion. The infusion was initially started at 50 mg/h for 1 h followed by 100 mg/h till the end of infusion. The day after rituximab infusion, the patient noticed pruritic blisters on both arms and chest skin. The next day, the lesions increased in severity and extent.

Diagnosis:
The skin biopsy established the diagnosis of EBA. H&E staining revealed subepidermal blisters infiltrated by inflammatory cells, including eosinophils and lymphocytes. Direct immunofluorescence (DIF) showed linear deposition of IgG and C3 at the dermoepidermal junction. Indirect immunofluorescence with the patient's serum on salt-split skin revealed exclusive dermal binding of circulating IgG antibasement membrane antibodies at a titer of 1:160.

Interventions:
She was treated with intravenous methylprednisolone and was continued on oral prednisolone.

Outcomes:
The lesions regressed. Six weeks later, she had a recurrence of similar lesions but in milder form. This episode subsided in 4 to 5 days with topical steroid application.

Lessons:
Physicians should consider this diagnosis when a patient develops bullous skin eruptions while undergoing Rituximab therapy.
Neuroendocrine carcinoma of the nasal cavity with epiphora as the first symptom
Authors: Wu Weiqi , Gan Puying , Xu Qihua , Wang Yaohua , Liao Hongfei 
Published: December 2020

Abstract

Rationale:
Neuroendocrine carcinomas (NECs) are rare malignancies that originate from the hormone-producing cells of the neuroendocrine system. They can grow in most organs of the body but are commonly found in the gastrointestinal and respiratory tracts. The nasal cavity is a rare site for NECs.

Patient concerns:
We report a case of NECs in a 45-year-old woman who presented with epiphora in the right eye for a year owing to an unknown reason.

Diagnoses:
The diagnosis was initially confirmed via histological and immunohistochemical assays. Postoperatively, computed tomography of the neck revealed C4 vertebral bone metastasis.

Interventions:
The tumor was endoscopically removed from the right eye. The patient received a full course of adjuvant polychemotherapy.

Outcomes:
Six months after diagnosis, the patient died due to bone metastasis.

Lessons:
Diagnosing nasal neuroendocrine carcinoma is clinically challenging. It must be distinguished from other orbital masses, such as chronic dacryocystitis or nasal polyps. The treatment should be further investigated for this rare malignancy in near future.
Evaluation of the efficiency of propofol versus isoflurane anesthesia interventions in treating elderly patients with postoperative cognitive dysfunction
Authors: Shen Yan-Xi , Chen You-Ping , Zang Hong-Cheng , Shao Gang 
Published: December 2020

Abstract

Background:
The aim of this study was to systematically evaluate the efficiency of propofol versus isoflurane anesthesia interventions in treating elderly patients with postoperative cognitive dysfunction.

Methods:
We performed an in-depth search in the PubMed, EMBASE, Cochrane Library, Chongqing VIP, WanFang, China National Knowledge Infrastructure, and SinoMed. Additionally, we reviewed the reference lists of included studies. Two independent authors examined the quality of the study and the quality of the extracted data. Regarding the dichotomous outcomes, we stated the results as relative risk, with 95% confidence intervals. We further expressed incessant outcomes as mean difference with a confidence level of 95%.

Results:
The findings of the study will be published in a peer-reviewed journal.

Conclusion:
Findings of this study will help in providing insight to establish if propofol is a suitable intervention to treat postoperative cognitive dysfunction in elderly patients.

Systematic review registration number:
INPLASY202090042
Acupuncture for gouty arthritis
Authors: Lee Gamseong , Cho Foo Young , Goo Bonhyuk , Park Yeon-Cheol 
Published: December 2020

Abstract

Backgroud:
Patients with gouty arthritis suffer from intermittent attacks of pain, chronic inflammation, and joint damage. Acupuncture has been used in East Asian countries for centuries to treat various diseases, and several clinical studies have reported that acupuncture has beneficial effects on gouty arthritis. This study aims to evaluate the effect of acupuncture in patients with gouty arthritis by conducting a systematic review and meta-analysis.

Methods:
A comprehensive search of 8 electronic databases will be performed, including MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, 4 Korean databases (KoreaMed, Korean Studies Information Service System, Research Information Service System, and Oriental Medicine Advanced Searching Integrated System), and 1 Chinese database (China National Knowledge Infrastructure). Only randomized controlled trials comparing acupuncture to conventional treatment and acupuncture with conventional treatment to conventional treatment alone for gouty arthritis will be included. Pain intensity will be considered the primary outcome. The secondary outcomes will include the pain relief duration, total effective rate, blood uric acid level, inflammatory markers, and incidence of adverse events. Two independent researchers will perform the study selection, data extraction, and quality assessment. The methodological quality of the individual included studies will be assessed using the Cochrane risk of bias tool. In the meta-analysis, for dichotomous and continuous data, risk ratios and standardized mean differences, respectively, will be estimated in addition to 95% confidence intervals.

Results
: This systematic review will evaluate the effect of acupuncture treatment for patients with gouty arthritis with respect to clinical symptoms, laboratory indicators, and safety.

Conclusion
: Our findings will help to establish the evidence of acupuncture to treat gouty arthritis.

Registration number:
PROSPERO CRD42020169668.
Overexpression of TPX2 predicts poor clinical outcome and is associated with immune infiltration in hepatic cell cancer
Authors: Zhu Hongjun , Liu Jian , Feng Jia , Zhang Qing , Bian Tingting , Li Xiaoli , Sun Hui , Zhang Jianguo , Liu Yifei 
Published: December 2020

AbstractTargeting protein for Xenopus kinesin-like protein 2 (TPX2) has been identified as an oncogene in multiple cancers. However, the associations among TPX2 expression, prognosis, and tumor immunity in hepatic cell cancer (HCC) have not been explored. We analyzed TPX2 expression by multiple gene expression databases, including Oncomine, TIMER, and UALCAN. The prognosis effect of TPX2 was analyzed by Kaplan--Meier plotter. The coexpressed genes with TPX2 were analyzed using Linked Omics. The association among TPX2 and immune infiltrates and immune checkpoints was determined by TIMER. It was found that TPX2 expression was notably upregulated in multiple HCC tissues. Overexpression of TPX2 has associations with race, age, weight, clinical stage and tumor grade, as well as poor prognosis in overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), and disease-specific survival (DSS). In addition, TPX2 expression has a positive association with the infiltration of immune cells and the expression of immune checkpoint molecules. Coexpressed genes and functional network analysis suggested several potential mechanisms of TPX2 affecting HCC progression. The findings reveal that TPX2 has associations with prognosis and infiltration of immune cells in HCC patients, which has laid a basis for in-depth study of TPX2 role in HCC.
Patient Experiences of Integrated Care in Medicare Accountable Care Organizations and Medicare Advantage Versus Traditional Fee-for-Service
Authors: Frean Molly , Covington Christian , Tietschert Maike , Bahadurzada Hassina , So Jodi , Singer Sara J. 
Published: December 2020

Background:
Health insurance design can influence the extent to which clinical care is well-coordinated. Through alternative payment models, Medicare Advantage (MA) and Accountable Care Organizations (ACOs) have the potential to improve integration relative to traditional fee-for-service (FFS) Medicare.

Objective:
To characterize patient experiences of integrated care within Medicare and identify whether MA or ACO beneficiaries perceive greater integration than FFS beneficiaries.

Design:
Retrospective cross-sectional analysis of the 2015 Medicare Current Beneficiary Survey.

Subjects:
Nationally representative sample of 11,978 Medicare beneficiaries.

Measures:
Main outcomes included 8 previously derived domains of patient-perceived integrated care (PPIC), measured on a scale of 1–4.

Results:
The final sample was 55% female with a mean (SD) age of 71.1 (11.3). In unadjusted analyses, we observed considerable variation across PPIC domains in the full sample, but little variation across subsamples defined by coverage type within a given PPIC domain. In linear models adjusting for a rich set of patient characteristics, we observe no significant benefits of ACOs nor MA relative to FFS, a finding which is robust to alternative specifications and adjustment for multiple comparisons. We similarly observed no benefits in subgroup analyses restricted to states with relatively high market penetration of ACOs or MA.

Conclusions:
Despite characteristics of ACOs and MA that theoretically promote integrated care, we find that PPIC is largely similar across coverage types in Medicare.
COVID-19 Pandemic and Thalassemia Major Patients: Transfusion Practice and Treatment Assessment
Authors: Oymak Yesim , Karapinar Tuba H. 
Published: December 2020

Background:
When the COVID-19 epidemic occurred for the first time in December 2019, the governments worldwide took some restriction measures for slowing the spread of novel coronavirus. Eventually, there was a considerable decrease in volunteer blood donations. Regular transfusions and follow-up of patients with thalassemia major (TM) should be maintained during this period. It is possible that the treatment of the patients with TM may hinder due to the difficulty of reaching the treatment center and the difficulty of blood supply. Thus, in this study, we aimed to investigate whether there were any differences in the follow-up and treatment of the patients with TM during the outbreak.

Materials and Methods:
Sixty-one patients with TM who were followed up in our center without COVID-19 contact history and symptoms were included in this study. The demographic features and red blood cell volume per kilogram they received, pretransfusion hemoglobin, serum ferritin (SF) level, biochemical parameters, and transfusion interval were recorded. The difference between the arithmetic mean of the data before and during the pandemic was evaluated.

Results:
In this study, 61 patients with TM (32 males/29 females, mean age 13.9±6.8 y) were evaluated. The mean pretransfusion hemoglobin value was 9.14±0.77 g/dL and 8.87± 0.80 g/dL before and during the pandemic, respectively (P=0.023). There was no difference between before and during the pandemic concerning transfusion interval and transfusion volume. However, SF levels increased above 1000 ng/mL in 16.6% of patients.

Conclusion:
Although blood donation decreased significantly during the pandemic, it was observed in this study that the blood needs of patients with TM could be provided. The results of the SF level showed that the management of chelation therapy should be more meticulous. However, we should be ready for the challenges in the transfusion practice of patients with TM due to fluctuations in the COVID-19 pandemic.
Low Concordance Between Pediatric Emergency Attendings and Pediatric Residents for Predictors of Serious Intracranial Injury
Authors: Duncan Ellen , Mojica Michael , Ching Kevin , Harwayne-Gidansky Ilana 
Published: December 2020

Objectives
Minor head trauma is a common cause of pediatric emergency room visits. The Pediatric Emergency Care Applied Research Network head trauma clinical decision rules (PECARN-CDR) are designed to assist clinicians in determining which patients require imaging. However, only minimal data are available on the accuracy of residents' assessments using PECARN-CDR. Prior research suggests that trainees often come to erroneous conclusions about pediatric head trauma. The objective of the present study was to assess concordance between pediatric residents' and attending physicians' assessments of children with low-risk head trauma, with the ultimate goal of improving education in pediatric trauma assessment.

Methods
This is a retrospective cohort study analyzing concordance between pediatric residents and pediatric emergency attendings who provided PECARN-CDR–based evaluations of low-risk head injuries. It is a planned subanalysis based on a prospectively collected, multicenter data set tracking pediatric head trauma encounters from July 2014 to June 2019.

Results
Data were collected from 436 pediatric residents, who encountered 878 patients. In the case of patients younger than 2 years, low concordance between residents and attendings was observed for the following elements of the PECARN-CDR: severe mechanism (κ = 0.24), palpable skull fracture (κ = 0.23), Glasgow Coma Scale (GCS) score less than 15 (κ = 0.14), and altered mental status (AMS; κ = −0.03). There was moderate to high agreement between residents and attendings for loss of consciousness (κ = 0.71), nonfrontal hematoma (κ = 0.48), and not acting normally per parent (κ = 0.35). In the case of patients older than 2 years, there was low concordance for signs of basilar skull fracture (κ = 0.28) and GCS score less than 15 (κ = 0.10). Concordance was high to moderate for history of vomiting (κ = 0.88), loss of consciousness (κ = 0.67), severe headache (κ = 0.50), severe mechanism (κ = 0.44), and AMS (κ = 0.42). Residents were more conservative, that is, more likely to report a positive finding, in nearly all components of the PECARN-CDR.

Conclusions
Resident assessment of children presenting to the ED with minor head trauma is often poorly concordant with attending assessment on the major predictors of clinically important traumatic brain injury (abnormal GCS, AMS, signs of skull fracture) based on the PECARN-CDR. Future work may explore the reasons for low concordance and seek ways to improve pediatric resident education in the diagnosis and management of trauma.
Improving Intubation Success in Pediatric and Neonatal Transport Using Simulation
Authors: Dalrymple Hannah Mary , Browning Carmo Kathryn 
Published: December 2020

Background
Pediatric and neonatal first-pass intubation rates are higher in adult trained retrieval services than in neonatal or pediatric trained services. Some authors have attributed this to more frequent opportunities to practice the skill in the adult population.

Objective
The aim of this study was to increase the first-pass intubation rate without adverse events by introducing daily intubation simulation at our mixed neonatal and pediatric retrieval service.

Methods
This prospective cohort study performed from July to December 2018 in our mixed neonatal and pediatric retrieval service involved 16 medical staff performing simulated intubation at commencement of their retrieval shift with a retrieval nurse. Checklists for neonatal and pediatric intubation were introduced to the retrieval service for the intervention cohort. Participants were asked to complete questionnaires about intubation performed on retrieval to gather data not routinely collected by the service.

Results
Seven hundred and sixty-eight patients were retrieved by the service and 70 patients required intubation by the retrieval team during the intervention period. First-pass intubation rates were higher during the intervention period compared with a historical cohort, despite less intubations being performed overall. First-pass intubation rates improved from 59% to 78% in neonatal patients (P = 0.032), 58% to 65% in pediatric patients (P = 0.68) and from 58% to 74% overall (P = 0.043). There were no severe adverse events detected during the intervention period. Minor adverse events were associated with multiple attempts at intubation (P < 0.001). Overall compliance with simulation protocol was 43.5%, and on average, each doctor completed simulation once per month.

Conclusions
Simulation is a useful adjunct to support neonatal and pediatric intubation training in the current environment of reducing intubation frequency.
A Heterogeneity Radiomic Nomogram for Preoperative Differentiation of Primary Gastric Lymphoma From Borrmann Type IV Gastric Cancer
Authors: Feng Bao , Huang Liebin , Li Changlin , Quan Yong , Chen Yehang , Xue Huimin , Chen Qinxian , Sun Shanlin , Li Ronggang , Long Wansheng 
Published: December 2020

Objective
This study aimed to preoperatively differentiate primary gastric lymphoma from Borrmann type IV gastric cancer by heterogeneity nomogram based on routine contrast-enhanced computed tomographic images.

Methods
We enrolled 189 patients from 2 hospitals (90 in the training cohort and 99 in the validation cohort). Subjective findings, including high-enhanced mucosal sign, high-enhanced serosa sign, nodular or an irregular outer layer of the gastric wall, and perigastric fat infiltration, were assessed to construct a subjective finding model. A deep learning model was developed to segment tumor areas, from which 1680 three-dimensional heterogeneity radiomic parameters, including first-order entropy, second-order entropy, and texture complexity, were extracted to build a heterogeneity signature by least absolute shrinkage and selection operator logistic regression. A nomogram that integrates heterogeneity signature and subjective findings was developed by multivariate logistic regression. The diagnostic performance of the nomogram was assessed by discrimination and clinical usefulness.

Results
High-enhanced serosa sign and nodular or an irregular outer layer of the gastric wall were identified as independent predictors for building the subjective finding model. High-enhanced serosa sign and heterogeneity signature were significant predictors for differentiating the 2 groups (all, P < 0.05). The area under the curve with heterogeneity nomogram was 0.932 (95% confidence interval, 0.863–0.973) in the validation cohort. Decision curve analysis and stratified analysis confirmed the clinical utility of the heterogeneity nomogram.

Conclusions
The proposed heterogeneity radiomic nomogram on contrast-enhanced computed tomographic images may help differentiate primary gastric lymphoma from Borrmann type IV gastric cancer preoperatively.
Use of a Dual Artificial Intelligence Platform to Detect Unreported Lung Nodules
Authors: Yen Andrew , Pfeffer Yitzi , Blumenfeld Aviel , Balcombe Jonathan N. , Berland Lincoln L. , Tanenbaum Lawrence , Kligerman Seth J. 
Published: December 2020

Objective
To investigate the performance of Dual-AI Deep Learning Platform in detecting unreported pulmonary nodules that are 6 mm or greater, comprising computer-vision (CV) algorithm to detect pulmonary nodules, with positive results filtered by natural language processing (NLP) analysis of the dictated report.

Methods
Retrospective analysis of 5047 chest CT scans and corresponding reports. Cases which were both CV algorithm positive (nodule ≥ 6 mm) and NLP negative (nodule not reported), were outputted for review by 2 chest radiologists.

Results
The CV algorithm detected nodules that are 6 mm or greater in 1830 (36.3%) of 5047 cases. Three hundred fifty-five (19.4%) were unreported by the radiologist, as per NLP algorithm. Expert review determined that 139 (39.2%) of 355 cases were true positives (2.8% of all cases). One hundred thirty (36.7%) of 355 cases were unnecessary alerts—vague language in the report confounded the NLP algorithm. Eighty-six (24.2%) of 355 cases were false positives.

Conclusions
Dual-AI platform detected actionable unreported nodules in 2.8% of chest CT scans, yet minimized intrusion to radiologist's workflow by avoiding alerts for most already-reported nodules.
Divergence in bidirectional plant-soil feedbacks between montane annual and coastal perennial ecotypes of yellow monkeyflower (Mimulus guttatus)
Authors: McIntosh Mariah M. , Bullington Lorinda , Lekberg Ylva , Fishman Lila 
Published: December 2020

SUMMARYUnderstanding the physiological and genetic mechanisms underlying plant variation in interactions with root-associated biota (RAB) requires a micro-evolutionary approach. We use locally adapted montane annual and coastal perennial ecotypes ofMimulus guttatus(yellow monkeyflower) to examine population-scale differences in plant-RAB-soil feedbacks.We characterized fungal communities for the two ecotypesin-situand used a full-factorial greenhouse experiment to investigate the effects of plant ecotype, RAB source, and soil origin on plant performance and endophytic root fungal communities.The two ecotypes harbored different fungal communities and responsiveness to soil biota was highly context-dependent. Soil origin, RAB source, and plant ecotype all affected the intensity of biotic feedbacks on plant performance. Feedbacks were primarily negative, and we saw little evidence of local adaptation to either soils or RAB. Both RAB source and soil origin significantly shaped fungal communities in roots of experimental plants. Further, the perennial ecotype was more colonized by arbuscular mycorrhizal fungi (AMF) than the montane ecotype, and preferentially recruited home AMF taxa.Our results suggest life history divergence and distinct edaphic habitats shape plant responsiveness to RAB and influence specific associations with potentially mutualistic root endophytic fungi. Our results advance the mechanistic study of intraspecific variation in plant–soil–RAB interactions.
Traditionally used aqueous herbal extracts for respiratory ailments exhibit anti-inflammatory activity
Authors: Kannian Priya , Mohana Sambasivam , Vishwarohini Manivasagam , Saleem Abdul Rahim Mohamed 
Published: December 2020

AbstractBackgroundPhytoconstituents from plants provide a huge array of medicinal properties and have been used for many centuries as household medicines in India to treat respiratory illnesses. There are limited studies on comprehensive evaluations of these plant extracts to understand their healing properties.AimTo evaluate the antimicrobial and immunomodulatory properties of the 10 commonly used medicinal plants to treat respiratory illnesses in a comprehensive manner.Materials & MethodsThe acetone, ethanol and aqueous extracts from the 10 plants were evaluated for antiviral, antifungal and antibacterial activity. Additionally, the aqueous extracts were also evaluated for immunomodulatory properties.ResultsNone of the extracts exhibited antiviral activity against the four influenza viruses, antifungal activity againstCandida albicansor antibacterial activity against Gram negative bacilli. Eight acetone extracts, nine ethanol extracts and one aqueous extract(NSAq)exhibited antibacterial activity at concentrations below 1mg/ml againstS. pyogenesand/orS. pneumoniae.All the aqueous extracts exhibited dose-dependent anti-inflammatory activity against the innate immunity cytokines, TNF-α and IL-1β, and the Th1 cytokine, IFN-γ, but not against the Th2 cytokine, IL-4.ConclusionsOverall the study elucidates that the acetone and ethanol extracts exhibit antibacterial activity, while the commonly consumed aqueous extracts ameliorate respiratory illnesses through immune modulation.