bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combination of pembrolizumab and imatinib in a patient with double KIT mutant melanoma
Authors: Abdou Yara , Kapoor Ankita , Hamad Lamya , Ernstoff Marc S. 
Published: November 2019

Abstract

Rationale:
The treatment of metastatic melanoma has been revolutionized in the past decade because of the development of immunotherapies and targeted therapies. Despite these developments, there is still an unmet clinical need for more advanced combination therapies for the subset of patients who remain resistant to immunotherapy or targeted therapy alone. To our knowledge, no reports have been published on combinations of PD-1 blockades and c-KIT inhibitors in melanoma patients. Furthermore, data are limited regarding the safety and efficacy of this combination in patients harboring KIT mutations.

Patient concerns and diagnosis:
We report a case of an 82-year-old female with metastatic melanoma who was found to have double KIT mutations at V559 and N822I.

Interventions:
She was treated with a combination of c-KIT inhibitor and PD-1 blockade after being resistant to anti-PD-1 monotherapy.

Outcomes:
Patient developed two episodes of grade 2 liver toxicity requiring treatment breaks followed by a dose reduction. Her transaminitis eventually resolved and patient remained on combination treatment for almost two years with good control of her disease prior to progression.

Lessons:
Treatment options for patients who progress after PD-1 inhibitors are very limited; therefore, there is a high unmet clinical need for this patient population. Combining Imatinib with checkpoint inhibitors may be efficacious in patients with metastatic melanoma and KIT mutations. This novel combination can cause additional toxicities which seem to be overall manageable.
Traumatic combined vertical atlanto-occipital and atlanto-axial dislocations with 2-part fracture of the atlas
Authors: Park Jong-Beom , Chang Dong-Gune , Kim Whoan Jeang , Kim Eung Sic 
Published: November 2019

Abstract

Rationale:
To our knowledge, this is the first report of traumatic combined vertical atlanto-occipital dislocation (AOD) and atlanto-axial dislocation (AAD) with 2-part fracture of the atlas.

Patient concerns:
The first case was of a 31-year-old woman admitted to the emergency room comatose after a traffic accident. The second case was of a 21-year-old woman admitted to the emergency room comatose after a fall.

Diagnoses:
Traumatic combined vertical AOD and AAD with 2-part fractures of the atlas was diagnosed using plain radiography, 2-dimensional computed tomography, and/or magnetic resonance imaging of the cervical spine.

Intervention:
The first patient received immediate intubation and cardiopulmonary resuscitation in the emergency room. The second patient also received immediate intubation in the emergency room. After her vitals stabilized, she underwent occipitocervical fusion with instrumentation.

Outcomes:
The first patient died 2 days after the accident. The second patient remained quadriplegic in a ventilatory-dependent state at 1 year after surgery. She continues to receive comprehensive rehabilitation.

Lessons:
Immediate respiratory support and surgical stabilization are important for saving lives in this kind of extremely unstable and fatal complex upper cervical spine injury.
Semiclosure wound therapy plus negative pressure wound therapy for an older patient with grade 4 diabetic foot with concomitant vascular occlusion
Authors: Yan Yafeng , Li Wenfeng , Song Yan , Yin Pei , He Zongze , Gong Yanping , Peng Lili 
Published: November 2019

Abstract

Rationale:
Grade 4 diabetic foot (DF) is a severe infection that causes bone destruction, osteomyelitis, and osteoarticular damage, which, in turn, can lead to serious dry or wet gangrene, or amputation. DF is extremely difficult to treat.

Patient concerns:
A 71-year-old female patient with long-term diabetes complicated with uremia, who undergoes regular hemodialysis 2 to 3 times per week, was admitted with grade 4 DF with Pseudomonas aeruginosa infection, and concomitant vascular occlusion of the lower extremities. The patient had a concurrent nutrition and electrolyte disorder.

Diagnoses:
The patient was diagnosed with type 2 diabetes, grade 4 DF, postamputation of the 2nd toe, vascular occlusion of the lower extremities, atherosclerosis, uremia, hypoproteinemia, and electrolyte disturbances.

Interventions:
Treatment with antibiotics and comprehensive measures aimed at improving nutrition and microcirculation, controlling blood glucose, as well as balancing electrolytes were performed to ameliorate the general conditions. Nibbled debridement was used to remove devitalized tissues each time to maintain as much vital cells as possible. Open therapy was used for necrotic tissues, and dressings therapy was used simultaneously for the infected lesion. This combined treatment, involving open therapy with dressing, is referred to as “semiclosure wound therapy.” Negative pressure wound therapy (NPWT) was used after a fistula formed.

Outcomes:
During the treatment procedure, the gangrene 3rd toe was spontaneously shed; the necrotic 1st toe was removed by surgery. The wound gradually healed after 3 months of open therapy combined with dressing. High location amputation was avoided.

Lessons:
Semiclosure, which constitutes open therapy combined with the use of dressings, plus NPWT can preserve vital skin cells in the wound and control the aggravation of the infection. It is an effective and novel measure that prevents DF amputation in old patient and promotes wound union.
Proton pump inhibitors and hypomagnesemia
Authors: Srinutta Thawin , Chewcharat Api , Takkavatakarn Kullaya , Praditpornsilpa Kearkiat , Eiam-Ong Somchai , Jaber Bertrand L. , Susantitaphong Paweena 
Published: November 2019

Abstract

Background:
Previous meta-analyses have suggested that there might be an association between the use of proton pump inhibitors (PPIs) and the development of hypomagnesemia, although the conclusions were no definitive.

Methods:
To provide an update on this topic, we performed a meta-analysis of all observational studies that examined the association between the use of PPIs and the development of hypomagnesemia. A literature search was conducted in MEDLINE, Scopus and Cochrane Central Register of Controlled Trials (January 1970 to June 2018) to identify observational studies that examined the association between the use of PPIs and the incidence and prevalence of hypomagnesemia.

Study eligibility criteria:
In the absence of randomized controlled trials, we focused primarily on observational studies, including cross-sectional, case-control, retrospective, and prospective cohort studies. There was no limitation on sample size or study duration. Random-effect models meta-analyses were used to compute pooled unadjusted and adjusted odds ratios (ORs) for binary variables.

Results:
Sixteen observational studies were identified, including 13 cross-sectional studies, 2 case-control studies, and 1 cohort study, with a total of 131,507 patients. The pooled percentage of PPI users was 43.6% (95% confidence interval [CI] 25.0%, 64.0%). Among PPI users, 19.4% (95% CI 13.8%, 26.5%) had hypomagnesemia compared to 13.5% (95% CI 7.9%, 22.2%) among nonusers. By meta-analysis, PPI use was significantly associated with hypomagnesemia, with a pooled unadjusted OR of 1.83 (95% CI 1.26, 2.67; P = .002) and a pooled adjusted OR of 1.71 (95% CI 1.33, 2.19; P < .001). In subgroup analyses, high-dose PPI use was associated with higher odds for hypomagnesemia relative to low-dose PPI use (pooled adjusted OR 2.13; 95% CI 1.26, 3.59; P = .005).

Conclusion:
Our findings are in support of the results of the previous meta-analyses. Furthermore, we found a dose-response between the PPI use and development of hypomagnesemia.
Medicated thread moxibustion for alopecia areata
Authors: Zhang Yi-Mei , Liu Cui-Hong , Wang Yong-Cheng , Teng Hong-Li , Meng Xian-Liang , Han Xing-Jun 
Published: November 2019

Abstract

Rationale:
According to the literature reports and clinical studies on alopecia areata (AA) from 2008 to 2018, most clinical treatments have been oral drugs and external ointments. At present, systemic immunosuppressive therapy has been widely used in AA, but there are various side effects such as elevated liver enzymes, gastrointestinal discomfort, poor drug compliance, and repeated illness. We present a case report describing a traditional medicine treatment for AA that uses an ethnic therapy of Zhuang medicine, a kind of Traditional Chinese Medicine, namely, medicated thread moxibustion.

Patient concerns:
A 36-year-old man endured AA after going through a family misfortune. Half a year ago, his father passed away suddenly. Since then, he suffered continuous anguish, alcoholism and hair loss, especially in the past 2 months. A coin-shaped area of hair loss began to appear at the top of his head and gradually expanded to the surrounding region.

Diagnoses:
A diagnosis of AA was made in the dermatology department of a local hospital.

Interventions:
The patient was treated with the medicated thread moxibustion method of Traditional Zhuang Medicine at the Kuihua (special points of Zhuang medicine), Zusanli (ST 36), Xuehai (SP 10), Baihui (DU 20), and Taichong (LR 3) points every other day for 4 weeks.

Outcomes:
The area of hair loss showed slight improvement after 1 week of treatment. Only just a sprinkling of wooly hairs, whose color and thickness were similar to those of fine facial hairs, began to emerge sporadically from the follicles; they could be seen only in a bright light. When the patient saw the obvious curative effect, we continued the treatment for 2 weeks with the patient's consent. Three weeks later, the patchy AA area was covered with small cotton-like hairs of different lengths and uneven colors.

Lessons:
The medicated thread moxibustion method of Zhuang medicine can be an effective alternative treatment in patients with AA.
Use of MRI in the diagnosis and prognosis of acute necrotizing encephalopathy in a Chinese teenager
Authors: Li Hua , Sun Caihong , Chi Shaohua , Wang Yan , Wu Lin , Qin Xia 
Published: November 2019

Abstract

Rationale:
Acute necrotizing encephalopathy (ANE) is a rapidly progressing disease associated with frequent neurologic sequelae and has poor prognosis. Currently, the diagnosis and treatment of ANE rely on neuroradiologic findings and offering supportive care. Here, we report the successful treatment of a teenager diagnosed with ANE using combination of high-dose methylprednisolone and oseltamivir.

Patient concerns:
The patient, a 15-year-old female, presented with impaired consciousness and seizures secondary to acute upper respiratory tract infection. A series of brain magnetic resonance images (MRIs) were obtained toward establishing a possible diagnosis.

Diagnosis:
Based on the history of presenting illness and subsequent brain MRI scans, the patient was diagnosed to be suffering from ANE.

Interventions:
Following the diagnosis, the patient was placed on therapy comprising of high-dose methylprednisolone and oseltamivir.

Outcomes:
After treatment with methylprednisolone and oseltamivir for 15 days, the patient recovered nearly completely from ANE as confirmed by subsequent brain MRI scans. No complications or other emerging clinical symptoms were noted for the duration of follow-up that lasted 6 months.

Lessons:
Contrary to common reports, ANE can occur beyond pediatric populations and its treatment should not be restricted to supportive care. Our case suggests that the use of high-dose corticosteroids and oseltamivir leads to promising prognosis.
Rituximab in treatment of anti-GBM antibody glomerulonephritis
Authors: Uematsu-Uchida Mayu , Ohira Takehiro , Tomita Shigeki , Satonaka Hiroshi , Tojo Akihiro , Ishimitsu Toshihiko 
Published: November 2019

Abstract

Rationale:
Anti-glomerular basement membrane (GBM) disease is a T cell-mediated disease that has a poor prognosis with conventional therapy. We tested rituximab as a primary therapy to reduce anti-GBM antibody produced by B cells.

Patient concerns:
A 53-year old woman with complaints of a fever, headache and abdominal discomfort showed renal failure with elevated anti-GBM antibody, and renal biopsy revealed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) 1 deposition along GBM.

Diagnoses:
The patient's plasma contained autoantibodies against Goodpasture antigen, which is the NC domain of collagen IVα3, and CD4-positive helper T cells were found surrounding crescent glomeruli with the coexistence CD20-positive B cells.

Interventions:
Rituximab with steroid and plasma exchange.

Outcomes:
The levels of autoantibody for Goodpasture antigen were reduced, and the patient was able to temporarily withdraw from hemodialysis.

Lessons:
B cell depletion with rituximab is effective as an initial therapy for anti-GBM disease.
A comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula
Authors: Gu Chao , Wang Yu , Lai Lixia , Han Weiwei , Li Jiansheng , Xing Haichang , Huo Yongjun , Li Chuanting , Bai Keyun 
Published: November 2019

Abstract
To explore a comparable method to Gd-contrast enhancement in the preoperative evaluation of anal fistula to evaluate its morphology changes.
Forty-six patients with anal fistula were enrolled. Each patient acquired a 3.0T magnetic resonance imaging (MRI) routine sequence, diffusion-weighted imaging (DWI) sequence and fat suppression T1 weighted imaging (FS T1WI) contrast enhancement (CE) scanning. To record the morphology performances of the internal orifice and the fistulas on the transverse images of fat suppression T2 weighted imaging (FS T2WI), DWI, FS T2WI combined with DWI, FS T1WI Gd-CE, with the standard of the surgical pathology results. Two observers evaluated images in consensus. The conspicuity and the diagnostic performance rate were compared between the 4 imaging data sets.
The consistencies of interobservers about the conspicuity scores and the diagnostic performance rates of the internal orifice and the fistula were good. The conspicuity of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The diagnostic performance rate of the internal orifice was higher for the set of FS T2WI, FS T2WI+DWI, and FS T1WI+CE than DWI. The conspicuity of the fistula was higher for the set of FS T2WI+DWI and FS T1WI+CE than FS T2WI or DWI. There were no significantly differences between the 4 sets of FS T2WI, DWI, FS T2WI+DWI, and FS T1WI+CE in the diagnostic performance rate of the fistula.
The set of FS T2WI combined with DWI was comparable to FS T1WI CE in evaluation of anal fistula morphology changes.
The effect of contact needle therapy on fatigue in patients with cancer in palliative care
Authors: Ogawa-Ochiai Keiko , Yoshimura Kenichi , Takebe Takae , Iwahashi Mako , Shirai Akiko , Tsuda Masaki , Ogawa Masao , Ishikawa Hideki 
Published: November 2019

Abstract

Introduction:
Almost all patients with end-of-life cancer experience cancer-related fatigue; however, there are only a few known effective coping methods.

Objectives
: We will conduct a prospective, multi-center, single-blinded randomized controlled study to evaluate the efficacy of acupuncture for cancer-related fatigue in patients with end-of-life cancer.

Methods:
We will enroll 120 patients with cancer hospitalized in a palliative care unit or receiving consultation from a palliative care team in four hospitals. We will add acupuncture treatment; specifically, contact needle therapy (CNT), consisting of an intervention per week period to the usual care. The primary outcome measure will be the Cancer Fatigue Scale (CFS) score while the secondary outcome measures will be the Numerical Rating Scale (NRS) score for fatigue, pain, and salivary amylase levels.

Conclusion:
We will evaluate the possibility of using acupuncture therapy, that is, CNT, in relieving fatigue sensation in patients with advanced cancer.

Trial registration: UMIN000028304, registered on July 21st, 2017; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000032401
Risk factors and antimicrobial resistance profiles of Pseudomonas putida infection in Central China, 2010–2017
Authors: Tan Genmei , Xi Yang , Yuan Peihong , Sun Ziyong , Yang Daofeng 
Published: November 2019

Abstract
The aim of this study was to analyze the risk factors, clinical features, and antimicrobial resistance of Pseudomonas putida (P putida) isolated from Tongji Hospital in Wuhan, China.
The data of 44 patients with P putida infections were retrospectively reviewed in this study. All cases of P putida strains were detected by the clinical laboratory of Tongji Hospital in the period of January 2010 to December 2017. Antimicrobial susceptibility testing was conducted using Kirby-Bauer method.
Forty-four effective strains of P putida were isolated, including 32 inpatients and 12 outpatients. The 32 inpatients cases were obtained from various departments, which were urosurgery wards (n = 5, 15.6%), pediatrics wards (n = 4, 12.5%), hepatic surgery wards (n = 4, 12.5%), among others. The isolates had been discovered from urine specimens (28.2%), blood specimens (21.9%), sputum specimens (12.5%), and so on. Twenty-five patients had histories of catheterization before the isolation of P putida. Twenty-four patients were in immunocompromised states, 5 patients had undergone surgery, catheterization and were taking immunosuppressive therapy simultaneously. Polymicrobial infections were found in some P putida cases, especially Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Escherichia coli. All the patients had treated by antimicrobial before culture. Multi-drug-resistant strains were detected in 75% of P putida isolates. The P putida strains were resistant to trimethoprim/sulfamethoxazole (97.7%), aztreonam (88.6%), minocyline (74.3%), ticarcillin/clavulanic acid (72.7%), and sensitive to amikacin (86.4%), imipenem (62.8%), gentamicin (56.8%).
Catheterization or other invasive procedures, immunocompromised states, and underlying diseases increased the risks of P putida infections. Moreover, the P putida strains were highly resistant to trimethoprim/sulfamethoxazole, aztreonam, minocyline, ticarcillin/clavulanic acid.
Efficacy of Shegan Mahuang Decoction for asthma
Authors: Zhao Yuhua , Pang Xiaoping 
Published: November 2019

Abstract

Background:
Shegan Mahuang Decoction (SMD) was used widely for treatment of asthma in China; however, the clinical effect of SMD on asthma was not well concluded.

Methods:
Seven electronic databases (Medline, Cochrane library, EMBASE database, Chinese National Knowledge Infrastructure, Wanfang database, Chongqing VIP database, and Chinese Biomedicine database) will be searched for randomized controlled trials which meet the eligible criteria. Two reviewers will select studies and extract data independently. Risk of bias will be evaluated using modified Jadad score. Data synthesis will be carried out using RevMan 5.3. Sensitivity analysis and publication bias will also be investigated.

Results:
This systematic review and meta-analysis will review and synthesis current clinical evidence of SMD for the treatment of asthma.

Conclusion:
This systematic review and meta-analysis will provide high quality evidence of SMD for the treatment of asthma.

Registration:
PROSPERO CRD42019141810.
Kambin triangle approach in percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures
Authors: Wang Ye-Feng , Shen Jun , Li Suo-Yuan , Yu Xiao , Zou Tian-Ming 
Published: November 2019

Abstract
The aim of this study was to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) in Kambin triangle approach for the treatment of osteoporotic vertebral compression fractures (OVCFs).
Between November 2017 and September 2018, 109 patients (144 vertebral bodies) with OVCFs, with a mean age of 76.7 ± 9.9 years (55–96 years), underwent PVP in Kambin triangle approach. The time of operation, the volume of bone cement, the incidence of complication, the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score, the position of puncture needles, and the spread of polymethylmethacrylate (PMMA) in vertebral body (VB) were recorded.
All patients had been completed the operation successfully and were followed up 9.1 ± 2.9 months. The average operation time of each VB was 24.0 ± 3.5 minutes. The average volume of cement was 4.8 ± 0.6 ml. The mean VAS scores were 8.4 ± 0.7 preoperatively, 1.6 ± 0.6 at the first day postoperatively, and 1.2 ± 0.6 at the last follow-up. The mean ODI scores were 70.97 ± 7.73 preoperatively, 27.99 ± 4.12 at the first day postoperatively, and 19.65 ± 3.49 at the last follow-up. The position of puncture needles in the VB was: 119 vertebral puncture needles reached the midline, 15 were close to the midline, and 10 exceeded the midline. The spread of PMMA in the VB was: type 1 in 81 levels (56.3%), type 2 in 37 (25.7%), type 3 in 18 (12.5%), type 5 in 8 (5.5%), and no case in type 4. One case developed pneumothorax after operation. No other complications (hematoma, cement embolism, spinal cord, and nerve injury) occurred.
Kambin triangle approach in PVP, which can deliver the puncture needle to the midline of VB easily and with excellent cement distribution, is a safe and effective method.
Distinct patterns of short-chain fatty acids during flare in patients with ulcerative colitis under treatment with mesalamine or a herbal combination of myrrh, chamomile flowers, and coffee charcoal: secondary analysis of a randomized controlled trial
Authors: Langhorst Jost , Koch Anna K. , Voiss Petra , Dobos Gustav J. , Rueffer Andreas 
Published: November 2019

Objectives:
Short-chain fatty acids are involved in the regulation of the gut immune system. In ulcerative colitis, short-chain fatty acids are often reduced, especially during flare. This study evaluated exploratively the pattern of butyrate and total short-chain fatty acids in patients with ulcerative colitis during flare treated either with mesalamine or a herbal preparation consisting of myrrh, chamomile flowers, and coffee charcoal which showed promising results in maintaining remission in a randomized double-blind, double-dummy, controlled clinical trial (EudraCT-Number 2007-007928-18).

Methods:
Patients were treated with the herbal preparation or mesalamine. Clinical activity was monitored by Clinical Colitis Activity Index. Using gas chromatography, we analyzed fecal samples of 38 patients who experienced a flare during treatment.

Results:
Paired t-test showed a significant decline of total short-chain fatty acids [M before = 66.12, SD = 39.59; M after = 29.83, SD = 15.05; 95% bootstrap confidence interval (20.53–55.30); P = 0.01) and of butyrate [M before 11.35, SD = 7.56; M after = 6.50, SD = 3.55; 95% bootstrap confidence interval (2.06–8.11); P = 0.02] in the event of a flare for patients treated with mesalamine but not for patients treated with the herbal preparation.

Conclusion:
Patients who received the herbal preparation did not show a significant decline of total short-chain fatty acids in the event of a flare. Since a decline of short-chain fatty acids might lead to unfavorable health impairments, a combination of the two treatments should be further investigated.