bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of an extensive odontogenic keratocyst
Authors: Khan Abdul Ahad , Qahtani Saad Al , Dawasaz Ali Azhar , Saquib Shahabe A. , Asif Shaik Mohammed , Ishfaq Mohammad , Kota Mohammad Zahir , Ibrahim Mohammed 
Published: December 2019

Abstract

Introduction:
The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. Despite the aggressive nature, previous literature as early as 1970s reported the fact that parakeratinized OKC can be treated by means of marsupialization alone.

Patients concerns:
The patient had reported with a complaint of pain and swelling in relation with a tooth in mandibular right quadrant.

Diagnosis:
This case report discusses features of a rare, extensive, panmandibular OKC that is only second of its kind mentioned in the literature.

Intervention:
As a usual treatment protocol, marsupialization was attempted first. Immunohistochemical analysis revealed reduced expression of Ki-67 and B cell lymphoma 2 (bcl-2) markers after marsupialization from 2 separate sites. However, due to incomplete resolution in the lower right anterior region, an aggressive approach was taken by curetting it out surgically along with associated teeth and cortical plate followed by application of Carnoy's solution.

Outcome:
Postsurgery uneventful healing of the lesion was noted on regular follow-up visits with complete resolution at 40 months. The case has been followed for 10 years with no sign of relapse and reoccurrence.

Conclusions:
Based on the expression of markers it can thus be concluded that Ki-67 and bcl-2 are site specific and bear strong relationship with the recurrence of OKCs.
A potential cause of adolescent onset Dyke-Davidoff-Masson syndrome
Authors: Li Yiyang , Zhang Tao , Li Bo , Li Jing , Wang Li , Jiang Zhibin 
Published: December 2019

Abstract

Rationale:
Dyke-Davidoff-Masson syndrome (DDMS) is a rare syndrome commonly occurring in children and characterized by cerebral hemiatrophy, hypertrophy of the skull, epilepsy, and mental retardation.
[1,2]
However, few have been reported in China, especially in teenagers. This case investigated its possible cause and explored a relative effective solution.

Patient concerns:
A 24-year-old female came to department having experienced recurrent seizures for 12 years.

Diagnosis:
DDMS was diagnosed from its manifestations, biochemistry indexes, and imaging (computed tomography angiography, magnetic resonance venography, and so on).

Interventions:
Several drugs are used to treat the disease, including valproate, carbamazepine, topiramate, and ginkgo biloba extract.

Outcomes:
Under the medicine treatment of magnesium valproate with carbamazepine, the patient experienced partial seizures approximately once per month that lasted 30 to 60 seconds each without any complications observed during a follow-up period of 24 months.

Conclusion:
The imaging and clinical features of DDMS in this teenager were similar to those in classic infantile-onset cases. A potential cause of the disease could be brain trauma, which impaired the middle cerebral artery and reduced cerebral blood supply, leading to epilepsy and hemiatrophy.

Lessons:
It was concluded early diagnosis and pharmacotherapy are the keys to preventing intellectual decline in DDMS patients. Moreover, the combination of magnesium valproate and carbamazepine could significantly reduce the frequency and duration of seizures, despite not eliminating them completely.
Concurrent treatment with rituximab and plasma exchange for severe refractory granulomatosis with polyangiitis
Authors: Song Ran , Chung Sang Wan , Lee Yeon-Ah 
Published: December 2019

Abstract

Rationale:
Rituximab is recommended to induce remission of severe granulomatosis with polyangiitis (GPA). Plasma exchange (PE) may be considered in the setting of rapidly progressive glomerulonephritis (RPGN) with a serum creatinine increase of more than 5.6 mg/dl or diffuse alveolar hemorrhage (DAH). However, there are no sufficient studies on combination therapy with rituximab and PE in GPA.

Patient concerns:
A 23-year-old woman was admitted with fever, abdominal pain, and diarrhea on suspicion of infectious colitis. Colonoscopy showed hemorrhagic colitis and antibiotic treatment was ineffective. Physical examination revealed episcleritis and skin lesions similar to Janeway lesions or Osler nodes on her palms and soles. Transesophageal echocardiogram (TEE) revealed mitral valve vegetation mimicking infective endocarditis. However, no pathogen was grown in the blood culture. Ten days after admission, blood-tinged sputum and respiratory distress developed. Imaging studies of lung, bronchoscopy, and bronchoalveolar lavage indicated DAH. Moreover, serum creatinine levels rapidly increased from 0.8 mg/dl to 6.1 mg/dl with proteinuria.

Diagnosis:
The patient was diagnosed with GPA and non-infectious endocarditis, DAH, and RPGN, based on a biopsy which revealed pauci-immune crescentic glomerulonephritis with granuloma and leukocytoclastic vasculitis and antineutrophil cytoplasmic antibodies against proteinase 3- positivity.

Interventions:
Initial methylprednisolone pulse therapy (1 g daily for 3 days) proved unsuccessful. After initiating PE, creatinine levels began to slowly decline, but DAH continued to deteriorate. Rituximab combined with PE therapy was considered. We performed PE every 2 to 3 days for 5 total treatments combined with rituximab (375 mg/m2, once weekly for 4 weeks).

Outcomes:
After the combination treatment of rituximab and PE, alveolar hemorrhage stopped. Chest X-ray and laboratory data, including serum creatinine and hemoglobin, notably improved. Mitral valve vegetation was no longer observed in follow-up TEE. GPA remained stable with low dose prednisolone and immunosuppressants over a follow-up period of 5 years.

Lessons:
This case suggests that the use of rituximab and concurrent PE may represent a promising combination for severe and refractory GPA.
Huge peliosis hepatis mimicking cystic echinococcosis
Authors: Liu JinHeng , Wang YanTin , Yin SiNeng , Ke NengWen , Liu XuBao 
Published: December 2019

Abstract

Rationale:
Peliosis hepatis (PH), which is characterized by blood-filled cavities in the liver, is a rare disease. Its diagnosis depends on postoperative pathological examinations and immunohistochemistry.

Patient concerns:
A 44-year-old female complained of right-middle upper abdominal pain and distension for 1 month, with occasional vomiting and fever.

Diagnosis:
Because of the similar imaging features, the patient was initially misdiagnosed as cystic echinococcosis (CE). The immunoassay of echinococcosis was negative. Irregular hepatectomy was performed. Eventually, the patient was diagnosed with PH based on postoperative histopathology and immunohistochemistry.

Interventions:
The patient underwent hepatectomy. Then, the cystic lesion was collected for intraoperative pathological examination. Thus, the blood liquid was extracted from the cystic lesion. Pringle maneuver was administered to prevent bleeding, and then the whole cystic lesion was removed.

Outcomes:
She recovered smoothly and there was no relapse occurred during 6 months’ follow-up.

Lessons:
It is difficult to differentiate PH from CE and other hepatic diseases due to the lack of special imaging features. Pathological examinations and immunohistochemistry can provide a confirmed diagnosis of PH.
Comparison of analgesic and anxiolytic effects of nitrous oxide in burn wound treatment
Authors: Li Lin , Pan Qiong , Xu Le , Lin Renqin , Dai Jiaxi , Chen Xinyan , Jiang Meiyun , Chen Zhaohong 
Published: December 2019

Abstract

Aim:
We compared the effects of 50% N2O and N2O titration in burn management to alleviate pain and anxiety associated with burn dressing.

Methods:
In this single-blind prospective randomized controlled trial, 70 stable adult burn patients were randomized to 2 groups during May 2015 to January 2016. The experimental group was titrated with N2O ranging from 30% to the ideal sedation concentration before dressing change until the end. The control group was treated with 50% N2O 2 minutes before dressing change until the end. Pain, anxiety, vital signs, and the highest concentrations of N2O inhaled were recorded at 1 minute before N2O inhalation (T0), dismantling of outer (T1), inner dressings (T2), debridement (T3), drug-smearing (T4), bandaging (T5), and 10 minutes after completion of the procedure (T6).

Results:
The pain and anxiety scores in the experimental group performed significantly less than the control group during T2-T6. The systolic blood pressure in T2 and the heart rate at T2 and T3 varied significantly between the 2 groups. The highest N2O concentrations of the experimental group were mainly 60% to 70% at T2 (87.9%), T3 (87.9%), and T4 (81.8%).

Conclusion:
N2O titration significantly reduced pain and anxiety in burn patients, with minimal side effects.
Efficacy of sodium-glucose co-transporter 2 inhibitors in patients with type II diabetes
Authors: Danjuma Mohammed Ibn-Mas’ud , Shokri Shaikha Al , Saud Arwa Ibrahim YA Al , Elshafei Mohamed Nabil Abdelsalam , Fatima Haajra , Doi Suhail , Bidmos Mubarak Ariyo 
Published: December 2019

Abstract

Background:
Recent systematic reviews have evaluated the efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT2) inhibitors (SGLT2I) in improving glycaemic control and mortality in patients with type II diabetes mellitus. None have incorporated the most recent study or utilized the generalized pairwise modeling methodology network meta-analysis (NMA), as well as a novel bias risk assessment approach.

Methods:
We propose to conduct literature search of all randomized controlled clinical trials published in English language evaluating the efficacy of (SGLT2I) versus placebo or usual standard of care from the inception of following databases to September 30, 2019: Controlled Clinical Trials Cochrane Controlled Trials Register (CCTR), Cochrane Database of Systematic Reviews (CDSR), EMBASE, Database of Abstracts of Reviews of Effectiveness (DARE), PubMed. Two reviewers will independently search these databases to identify studies that satisfy pre-specified eligibility criteria. Study bias risk assessment amongst other methodology quality evaluation of the studies will be carried out using a novel risk bias assessment tool.

Results:
We anticipate that the result of this review will provide additional insight into the ranking of the efficacy of various (SGLT2I) in type II diabetic patients especially as it relates to mortality, glycemic control, and body weight reduction.

Conclusion:
The result of this review will be useful informing therapeutic decisions by policy makers with regards to commissioning of diabetic care.

Prospero registration number: CRD42019139708
The role of hydroxyurea to prevent silent stroke in sickle cell disease
Authors: Hasson Carla , Veling Lisa , Rico Juan , Mhaskar Rahul 
Published: December 2019

Abstract

Background:
Chronic blood transfusions are standard of care for stroke prevention in sickle cell disease but is not cost effective and not without risks. Hydroxyurea has emerged as an option in the prevention of silent stroke in sickle cell disease.

Objective:
To evaluate the role of hydroxyurea in preventing silent strokes in a systematic review by adhering to the Cochrane guidelines.

Methods:
PubMed, EMBASE, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials were searched for the related articles. Eligibility criteria included randomized controlled trials (RCTs) comparing the use of hydroxyurea vs blood transfusions and observational studies evaluating the role of hydroxyurea to prevent stroke and silent stroke in patients with sickle cell anemia or sickle cell β thalassemia. The meta-analysis was conducted using STATA software version 13.

Results:
We included 10 single arm observational studies with 361 participants, and one RCT study with 60 participants receiving hydroxyurea, respectively. There were no deaths attributed to hydroxyurea. The results revealed that 1% (95% CIs 0.0 to 0.05) of patients receiving hydroxyurea had stroke. 18% (95% CIs 0.03 to 0.4) of the hydroxyurea patients had silent stroke. 24% (95% CIs 0.02 to 0.57) of the hydroxyurea patients had adverse events attributed to hydroxyurea.

Conclusion:
Our findings suggest that hydroxyurea is safe and may prevent silent stroke and stroke in sickle cell disease. More high-quality studies including RCTs are needed.
Management of infective corneal ulcers in a high-income developing country
Authors: AlMahmoud Tahra , Elhanan Mohamed , Elshamsy Mohamed H. , Alshamsi Hanan N. , Abu-Zidan Fikri M. 
Published: December 2019

Abstract
Microbial keratitis is a major risk for corneal blindness worldwide. We aimed to study the clinical presentation and outcome of hospitalized patients having infective corneal ulcers.
All patients who were diagnosed as microbial keratitis and were admitted to Al-Ain Hospital during the period July 2011-Dec 2016 were retrospectively studied. Patients’ demography, predisposing factors, symptoms and signs at presentation, time to presentation after onset of symptoms, microbial isolates, hospital stay, and visual acuity (VA) outcome were studied.
74 patients with corneal ulcers were hospitalized. 79.7% were males. The median (range) age was 44 years (1–91). 36.5% had trauma as a risk factor. The main presenting symptoms were pain (90.5%), red eye (79.7%), and decreased vision (63.5%). All patients had stromal infiltrate while 39.2% had hypopyon at presentation. The average time from the start of the symptoms to hospital presentation was 11 (1–90) days. The mean (range) hospital stay was 10.6 (1–60) days. Forty eyes were culture positive. Bacteria were identified in 27 eyes and fungus in 16. Pseudomonas aeruginosa (9 eyes) and Staphylococcus epidermis (5 eyes) were the most common bacterial islolates. Aspergillus (6 eyes) was the most common fungus species. 95.2% of the bacterial isolates were susceptible to the quinolone antibiotics group. Twenty eight (51.9%) patients had a vision worse than 6/60 in the affected eye.
Corneal ulcer poses a significant threat to the sight of an affected eye. Trauma was the most common risk factor for corneal ulcers. Usage of eyes personal protective equipment for high risk occupations and earlier accessibility to health care may reduce the impact of corneal ulcers in our community.
PMS2 germline mutation c.1577delA (p.Asp526Alafs∗69)-induced Lynch syndrome-associated endometrial cancer
Authors: Cui Man-Hua , Zhang Xi-Wen , Yu Tong , Huang Dong-Wei , Jia Yan 
Published: December 2019

Abstract

Rationale:
Lynch syndrome (LS) is an autosomal dominant cancer predisposition condition caused by germline heterozygous mutations in mismatch repair (MMR) genes. However, as one of the MMR genes, PMS2 mutation-induced LS-associated endometrial cancer (LSAEC) was rarely reported.

Patient concerns:
A 26-year-old female patient suffered from prolonged menstrual period and increased menstrual flow for 2 months.

Diagnoses:
The patient was diagnosed with cervix CIN III, endometrial cancer (EC), anemia, and LS.

Interventions:
Total hysterectomy, bilateral salpingectomy, pelvic lymphadenectomy were performed for treating EC, while ovariectomy was refused by the patient. The patient underwent postoperative chemotherapy with paclitaxel combined with carboplatin for 6 courses of treatment. Laparoscopic partial enterectomy was applied for treating colon cancer 5 years later after the surgery treatment for EC. Besides, Sanger sequencing and high-throughput genome sequencing were employed to detect the genetic status of the family that included two generations with four members. Immunohistochemistry (IHC) staining was used to identify the function of PMS2 mutation.

Outcomes:
The 26-year-old Chinese patient suffered from LSAEC and recovered well after surgery. A PMS2 germline heterozygous mutation (c.1577delA) was confirmed by gene sequencing 5 years later. In addition, PMS2 mutation was verified by IHC. The patient was followed up for 7 years.

Lessons:
Carrying PMS2 germline mutation (c.1577delA) confers an extremely high susceptibility of suffering from LS-associated cancers. Thus, close clinical monitoring and prophylactic surgery are highly recommended to reduce the morbidity and mortality of LS-associated cancers.
Multiple cerebral microbleeds and atypical β-amyloid deposits
Authors: Lee Jin San , Lee Kyung Mi , Kim Hyug-Gi , Hong Il Ki 
Published: December 2019

Abstract

Rationale:
Cerebral microbleeds are increasingly recognized in various neurological disorders such as cerebral amyloid angiopathy (CAA), Alzheimer disease, and stroke. The presence and number of cerebral microbleeds are known to be independent predictors of cognitive impairment.

Patient concerns:
A 73-year-old woman visited our memory disorder clinic complaining of progressive memory impairment, which started 2 years ago.

Diagnoses:
The patient had innumerable cortical/subcortical cerebral microbleeds in the entire brain. We diagnosed the patient with amnestic mild cognitive impairment due to CAA. Interestingly, only focal β-amyloid deposits at the bilateral parietal cortices were seen on amyloid positron emission tomography (PET) scan.

Interventions:
We have observed changes in her cognitive function without any medication.

Outcomes:
The cognitive function of the patient was unchanged during the follow-up period.

Lessons:
Our case was interesting in a few aspects, including the number of cerebral microbleeds and the atypical β-amyloid deposition pattern on amyloid PET scan. Further studies on more cases are needed to evaluate β-amyloid burden and distribution patterns in CAA.
Application of the healthcare failure mode and effects analysis system to reduce the incidence of posture syndrome of thyroid surgery
Authors: Zhang Li , Zeng Ling , Yan Yuanting , Hang Qinwen 
Published: December 2019

Abstract
This study aimed to investigate the application of the healthcare failure mode and effect analysis (HFMEA) to reduce the incidence of posture syndrome of thyroid surgery (PSTS).
Subjects before (n = 78, July 2017–December 2017) and after (n = 114, January 2018–June 2018) HFMEA implementation (The Second Hospital of Nanjing, Nanjing University of Chinese Medicine) were selected. The training for PSTS was optimized using HFMEA.
The occurrence of PSTS was reduced from 59% to 18% after HFMEA (P < .001). Symptoms of pain and nausea and vomiting were also decreased after HFMEA (all P < .001). The critical thinking ability of 34 medical personnel to evaluate the reduction of thyroid postoperative posture syndrome increased from 246 ± 19 to 301 ± 14 (P < .001) after HFMEA.
HFMEA was used to create preoperative posture training procedures for PSTS, bedside cards for training, innovative preoperative posture training equipment, and a diversified preoperative posture training health education model.
Gender- and age-dependent tongue features in a community-based population
Authors: Hsu Po-Chi , Wu Han-Kuei , Huang Yu-Chuen , Chang Hen-Hong , Chen Yi-Ping , Chiang John Y. , Lo Lun-Chien 
Published: December 2019

Abstract
This study, an important groundwork for clinical tongue diagnosis and future traditional Chinese medicine (TCM) research, tested the hypothesis that some tongue features vary significantly between different gender and age groups by utilizing an automatic tongue diagnosis system (ATDS).
A cross-sectional study of 1487 participants from a community-based population was performed. Study subjects with ages ranging from 20 to 92 were categorized into 3 groups: <40, 40 to 64, and ≥65 years old, and the subjects were also stratified according to gender. Tongue images were collected at the end of each normal health examination routine to further derive the relevant tongue features of every participant by using the ATDS developed by our team. There were a total of nine tongue features that were identified: tongue shape, tongue color, fur thickness, fur color, saliva, tongue fissure, ecchymosis, teeth mark, and red dot. The corresponding tongue features, demography, and physical/laboratory examination data were compared between different gender and age groups.
Our study showed that, compared to females, males had enlarged tongue shape, thicker fur, more fissures and fewer teeth marks (all P < .001), and also had more red tongue color (P = .019), normal saliva (P = .001), more red dots (P = .005) and yellower fur (P = .014). In females, increasing age was associated with more enlarged tongue shape, thicker fur, yellower fur, more saliva, fissures and fewer teeth marks (all P < .001), more ecchymoses (P = .009), and more red tongue color (P = .023). These associations of age with more fissures, fewer teeth marks, fewer red dots (P < .001), median tongue shape (P = .029), and wet saliva (P = .014) were also evident in males, but other relationships were not clearly evident.
Even though most of the common tongue features derived from a community-based population are consistent with TCM theory, yet some significantly gender- and age-dependent tongue characteristics were identified. These disparities in tongue features associated with gender or age shall be prudently taken into consideration in clinical tongue diagnosis and future TCM research.
Median sternotomy versus minimally invasive thymectomy for early-stage thymoma
Authors: Tianci Chai , Shen Zhimin , Chen Sui , Lin Yuhan , Gao Lei , Zhang Zhenyang , Kang Mingqiang , Lin Jiangbo 
Published: December 2019

Abstract

Background:
The completeness of resection is an important prognostic factor for early resectable thymoma. Since its inception 2 decades ago, median sternotomy has been recognized as the gold standard method for the treatment of all types and stages of thyomas. Minimally invasive surgical techniques, including video-assisted and robot-assisted surgery, have been rapidly developed as an alternative to traditional open approach surgery. Compared with traditional open approach surgery, minimally invasive approach has better cosmetic effect, faster improvement of lung function, reduction of surgical trauma, length of stay, and complications. We believe that this is an appropriate time and there is a need for a systematic, comprehensive, and objective assessment of the 2 surgical modalities in order to provide reliable evidence for clinicians to determine the best treatment for patients with early resectable thymoma.

Methods:
Pubmed (Medline), Web of Science, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomized controlled trials (RCTs), quasi-RCTs, and Hi-Q (high quality) prospective cohort trials published or unpublished in any language before March 1, 2020. Subgroup analysis will be performed in tumor pathological stage and ethnicity. PROSPERO registration number: CRD42019133724.

Results:
The results of this study will be published in a peer-reviewed journal.

Conclusion:
This study will be the first to assess the efficacy and safety of median sternotomy recognized as the gold standard method for the treatment of all types and stages of thyomas and minimally invasive thymectomy for patients with early-stage thymoma. This study will assess whether minimally invasive thoracoscopic and robotic assisted thymectomy can be used as an alternative to traditional median sternotomy for patients with early resectable thymoma and provide high-quality and reliable evidence for clinicians’ decision-making.