bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mixed adenoneuroendocrine carcinoma of the hepatic bile duct: a case report and review of the literature
Authors: Liu Sulai , Zhong Zhendong , Xiao Meng , Song Yinghui , Zhu Youye , Hu Bo , Sun Zengpeng , Yi Weimin , Peng Chuang 
Published: November 2020

Abstract
Background
The World Health Organization's updated classification of digestive system neuroendocrine tumors in 2010 first proposed the classification of mixed adenoneuroendocrine carcinoma (MANEC). The incidence of biliary malignant tumors with neuroendocrine tumors accounts for less than 1% of all neuroendocrine tumors. Moreover, the incidence of hilar bile duct with MANEC is very rare.

Case presentation
A 65-year-old female patient came to our hospital for repeated abdominal pain for more than 4 months and skin sclera yellow staining for 1 week. Contrast-enhanced computed tomography imaging and magnetic resonance results suggested a hilar tumor for Bismuth-Corlette Type II. The patient underwent radical surgery for hilar cholangiocarcinoma. Finally, the patient was diagnosed with hilar bile duct MANEC, staged 1 (pT1N0M0) based on the eighth edition of the AJCC. Histopathology showed that the tumor was a biliary tumor with both adenocarcinoma and neuroendocrine carcinoma. No evidence of recurrence and metastasis after 20 months of follow-up.

Conclusions
We first reported a MANEC that originated in the hilar bile duct. As far as we known, there were few reports of biliary MANEC, and the overall prognosis was poor. We also found that the higher the Ki-67 index, the worse the prognosis of this type of patient. Radical surgery is the most effective treatment.
Association between anorexia and hyposalivation in community-dwelling older adults in Japan: a 6-year longitudinal study
Authors: Ohara Yuki , Kawai Hisashi , Shirobe Maki , Motokawa Keiko , Fujiwara Yoshinori , Kim Hunkyung , Ihara Kazushige , Obuchi Shuichi , Edahiro Ayako , Iwasaki Masanori , Watanabe Yutaka , Hirano Hirohiko 
Published: November 2020

Abstract
Background
Hyposalivation is associated with the nutritional status. Anorexia of ageing, defined as an age-related decrease in appetite and food intake, presents even in healthy adults and is considered an independent predictor of malnutrition, frailty, and mortality. However, the relationship between anorexia and hyposalivation of ageing is unclear. Thus, the present longitudinal study aimed to investigate the incidence of hyposalivation and its relationship with anorexia in community-dwelling older people in Japan.

Methods
The study population comprised 220 individuals (80 men and 140 women) aged 65–86 years at baseline. The participants underwent comprehensive health check-ups, including dental examinations and anthropometry, and face-to-face interviews in 2013 and 2019. Hyposalivation was determined on the basis of the unstimulated salivary flow rate measured using the modified cotton roll method. Anorexia was defined as a score of ≤29 in the Japanese version of the Council on Nutrition Appetite Questionnaire. Logistic regression analyses were used to test whether the presence of anorexia at baseline was an independent predictor of hyposalivation.

Results
Hyposalivation developed at a rate of 19.5% during the 6-year observation period. Anorexia was observed in 95 (43.2%) participants at baseline. After adjusting for potential confounding factors, anorexia (adjusted odds ratio [AOR], 2.65; 95% confidence interval [CI], 1.26–5.57) and polypharmacy (AOR, 3.29; CI, 1.06–10.19) were significant predictors of hyposalivation.

Conclusion
Loss of appetite is independently correlated with and a risk factor for hyposalivation in older adults. Anorexia of ageing may have negative effects on the salivary flow rate in such settings. Salivation should be a standard feature in clinical assessments of the older adults.
Clinical characteristics of Epstein–Barr virus infection in the pediatric nervous system
Authors: Cheng Huan , Chen Doudou , Peng Xiaoling , Wu Peng , Jiang Li , Hu Yue 
Published: November 2020

Abstract
Background
To investigate the clinical characteristics of Epstein–Barr virus (EBV) infection in the pediatric nervous system (NS).

Methods
We retrospectively analyzed the clinical data and follow-up results of 89 children with neurological damage caused by EBV who were hospitalized in the children’s hospital of Chongqing Medical University from January 2008 to April 2019.

Results
EBV infection of the NS can occur at any time of the year. The highest incidence was seen in the age group of 0–4 years. Fever is the main clinical feature (74/89, 83.1%). The main clinical types were encephalitis/meningoencephalitis (64/89, 71.9%), acute myelitis (2/89, 2.2%), acute disseminated encephalomyelitis (ADEM) (3/89, 3.4%), Guillain–Barré Syndrome (GBS) (15/89, 16.9%), neurological damage caused by EBV-hemophagocytic lymphohistiocytosis (EBV-HLH) (4/89, 4.5%), and NS-post-transplant lymphoproliferative disorder (NS-PTLD) (1/89, 1.1%). Anti-N-methyl-D-aspartate receptor encephalitis was found during the convalescence of EBV encephalitis. EBV encephalitis/meningitis showed no symptoms of tonsillitis, lymph node enlargement, skin rash, hepatosplenomegaly. Acute motor axonal neuropathy is the chief complication in GBS caused by EBV.

Conclusion
There were significant differences in neurological complications caused by EBV. The prognosis of EBV infection in the NS is generally good. These illnesses are often self-limiting. A few cases may show residual sequelae.
Pulmonary disease caused by a newly identified mycobacterium: Mycolicibacterium toneyamachuris: a case report
Authors: Kuge Tomoki , Fukushima Kiyoharu , Matsumoto Yuki , Abe Yuko , Akiba Eri , Haduki Kako , Saito Haruko , Nitta Tadayoshi , Kawano Akira , Kawasaki Takahiro , Matsuki Takanori , Kagawa Hiroyuki , Motooka Daisuke , Tsujino Kazuyuki , Miki Mari , Miki Keisuke , Kitada Seigo , Nakamura Shota , Iida Tetsuya , Kida Hiroshi 
Published: November 2020

Abstract
Background
Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is becoming a significant health burden. Recent advances in analysis techniques have allowed the accurate identification of previously unknown NTM species. Here, we report a case of NTM-PD caused by a newly identified mycobacteria in an immunocompetent patient.

Case presentation
A 44-year-old woman was referred to our hospital due to the frequent aggravation of her chronic respiratory symptoms, with NTM-PD-compatible computed tomography findings. Unidentified mycobacterium was repeatedly isolated from respiratory specimens and we diagnosed her as NTM-PD of unidentified mycobacterium. Subsequent whole-genome analysis revealed that the unidentified mycobacterium was a novel mycobacterium genetically close to Mycolicibacterium mucogenicum. We started combination therapy with clarithromycin, moxifloxacin, amikacin, and imipenem/cilastatin, referring to drug sensitivity test results and observed its effect on M. mucogenicum infection. Her symptoms and radiological findings improved significantly.

Conclusion
We report a case of NTM-PD caused by a newly identified mycobacteria, Mycolicibacterium toneyamachuris, genetically close to M. mucogenicum. This pathogenic mycobacterium showed different characteristics from M. mucogenicum about clinical presentation and drug sensitivity. The clinical application of genomic sequencing will advance the identification and classification of pathogenic NTM species, and enhance our understanding of mycobacterial diseases.
Impact of water quality on Chronic Kidney Disease of unknown etiology (CKDu) in Thunukkai Division in Mullaitivu District, Sri Lanka
Authors: Gobalarajah Kalaivani , Subramaniam Prabagar , Jayawardena Uthpala Apekshani , Rasiah Gobalarajah , Rajendra Sittampalam , Prabagar Jasotha 
Published: November 2020

Abstract
Background
Increase in the number of cases in Chronic Kidney Disease of Unknown etiology (CKDu) in Sri Lanka has become a health issue of national concern. Even though, Northern Province is not identified as a high-risk province, there is an increasing trend of CKDu after the end of civil war in the Northern Province.

Methods
The present study was conducted in Thunukkai Division in Mullaitivu District to investigate the socio demographic and clinical pattern of CKDu patients and to evaluate the quality of their water sources. The samples were selected by using stratified purposive random sampling method which represented 29% of total CKDu patients in Thunukkai Division. Pretested structured questionnaire was administered to collect the data from the CKDu patients. The association between serum creatinine excreted by CKDu patients and the water quality parameters were determined by using linear regression model.

Results
Among the patients, 80% were male with over 68% falling in the age range of 50–70. Majority (90%) were involved in agriculture related occupation. Smoking and alcohol consumption were detected as common habits among 40% of the patients. Secondarily developed, hypertension (60%) and diabetes (34%) were reported as common diseases in the area. Dug wells served as the commonest source of drinking water in the area (90% households) together with few tube wells. Physicochemistry of more than 50% of the water samples revealed higher electric conductivity, salinity, total dissolved solids, total hardness and Na levels compared to drinking water standards in Sri Lanka.

Conclusions
Serum creatinine levels of the CKDu patients were significantly and negatively correlated with phosphate while positively correlated with total dissolved solids (TDS) and arsenic content of the drinking water. Geospatial mapping of TDS and arsenic in drinking water with the occurrence of higher serum creatinine levels confirmed the same trend. Thus, the total dissolved solids and arsenic in drinking water may have positive correlation with the occurrence of CKDu in Thunukkai region in the Mullaitivu District of Sri Lanka.
Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease (ESRD)
Authors: Li Peiyuan , Xia Chenqi , Liu Peng , Peng Zhong , Huang Hong , Wu Juan , He Zhangxiu 
Published: November 2020

Abstract
Background
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to be associated with inflammation in end-stage renal disease (ESRD) receiving dialysis. However, the value of NLR and PLR in non-dialysis patients with ESRD remains unclear.

Methods
Among 611 non-dialysis patients with ESRD in The First Affiliated Hospital of University of South China (2012–2018), we compared NLR and PLR in patients with high-sensitivity C-reactive protein (hs-CRP) levels of ≤3 mg/L vs. > 3 mg/L. Correlation of NLR and PLR to hs-CRP, PCT, ferritin were analyzed. Receiver operating characteristics (ROC) analysis was used for estimating sensitivity and specificity of NLR and PLR.

Results
NLR was higher in the patients with high hs-CRP levels (> 3 mg/L), compared to patients with low hs-CRP levels (≤ 3 mg/L) [5.74 (3.54–9.01) vs. 3.96 (2.86–5.85), p < 0.0001]. Additionally, PLR was higher in high hs-CRP group than in low group [175.28 (116.67–252.26) vs. 140.65 (110.51–235.17), p = 0.022]. In the current study, NLR and PLR were both positively correlated with hs-CRP (rs = 0.377, p = 0.000 for NLR; rs = 0.161, p = 0.001 for PLR), PCT, leukocytes, neutrophils, platelets, and age. NLR or PLR with a cut-off value of 5.07 or 163.80 indicated sensitivity and specificity were 65.67 and 66.37% (AUC = 0.69) or 57.21 and 57.52% (AUC = 0.55), respectively.

Conclusions
NLR or PLR was positively correlated with hs-CRP in non-dialysis patients with ESRD. NLR might be better for identifying inflammation than PLR in this population.
Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients
Authors: Dao Bui Quy Quyen , Pham Ngoc Huy Tuan , Nguyen Duc Loc , Pham Van My , Nguyen Huu Dung , Nguyen Duy Toan , Tran Viet Tien , Do Quyet , Le Viet Thang 
Published: November 2020

Abstract
Background
In this study, we focused on the role of overhydration (OH) and low serum prealbumin concentration in predicting peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients over a 3-year period.

Methods
We measured serum prealbumin concentration and OH by body composition monitor in 278 CAPD patients (159 males and 119 females) with a mean age of 46 years and a median peritoneal dialysis (PD) duration of 21 months. Cases of PD-related peritonitis were collected over 3 years.

Results
After the 3-year follow-up, 44 patients were diagnosed with PD-related peritonitis (15.8%). Low education, serum glucose, prealbumin, and OH were independent risk factors for predicting peritonitis over 36 months in CAPD patients. Based on the ROC curve model and Kaplan-Meier analysis, we realized that low prealbumin and high OH were independent predictors of 3-year peritonitis in CAPD patients (Prealbumin: AUC = 0.838, cut-off value = 32.5 mg/dL, Se = 90.9%, Sp = 32.9%; OH: AUC = 0.851, cut-off value = 1.33 L, Se = 79.5%, Sp = 85.5%; and log-rank test p <  0.001, respectively).

Conclusion
Overhydration and low serum prealbumin were the independent predictors of PD-related peritonitis in CAPD patients.
Cervical artery dissection—an easily neglected cause of stroke: a case report
Authors: Lian Ya -Hui , Chen Xin , Kong De- Rui , Chen Wei , Shi Ming-Chao , Zhou Hong-Wei 
Published: November 2020

Abstract
Background
In recent years, the incidence of stroke has gradually increased in young people. There are many reasons causing stroke, including atherosclerosis, artery embolization, and cervical artery dissection and so on. However, cervical artery dissection is a major cause of stroke in young people. We present a case of ischemic stroke caused by dissection, whose distal vascular occlusion due to detachment of the thrombosis in the right internal carotid artery.

Case presentation
A 33-year-old male patient was admitted to the hospital because of stroke. Imaging examination showed that there was no visualization of the right middle cerebral artery and there were a large number of mural thrombus in the C1 segment of the right internal carotid artery. After emergency surgery, the patient had vascular recanalization and the symptoms were significantly improved. Magnetic resonance imaging showed a high signal in the C1 segment of the right internal carotid artery, the abnormal signal disappeared after antiplatelet therapy.

Conclusions
When a patient has symptoms of stroke, we need to explore the root cause of stroke. Especially in young people, cervical artery dissection is an important reason that can’t be ignored. Through review and analysis of this case, we hope to improve the understanding of radiologists and clinicians about the cervical artery dissection, reduce the rate of misdiagnosis, and improve patients’ prognosis.
Benefit of dosimetry distribution for patients with multiple brain metastases from non-small cell lung cancer by a Cyberknife stereotactic radiosurgery (SRS) system
Authors: Yu Xuyao , Wang Yuwen , Yuan Zhiyong , Yu Hui , Song Yongchun , Zhao Lujun , Wang Ping 
Published: November 2020

Abstract
Background
In order to obtain a high dose conformal index of tumor and steep dose fall-off in healthy tissues for brain metastasis stereotactic radiosurgery (SRS), the aim of this study was to investigate SRS planning optimization by comparing one multiple-lesions plan (MLP) with multiple single-lesion plans (SLPs) for patients with multiple brain metastases using the Cyberknife (CK) system.

Methods
Fifty non-small cell lung cancer (NSCLC) patients (28 males and 22 females) with 2–4 brain metastases, inter-tumour distances less than 3 cm, were retrospectively replanned with the original prescription dose (12–32 Gy) in the original fractions (1–3). Two different clinical CK SRS plans (SLPs and MLP) were generated for the same patients with the same collimator and prescription isodose line (62–68%) by the CK Multiplan System. Both SLPs and MLP were able to achieve > 95% PTV volume covered prescription dose and met the Timmerman 2011 organs at risk (brainstem, optic nerve and pituitary) constraints.

Results
Compared with those in the SLPs, the maximum dose (Dmax) and mean dose (Dmean) of brainstem in the MLP were reduced 0.22–3.13% (2.62%) and 2.71–12.56% (5.57%), respectively, all P < 0.05. Meanwhile, the volumes of the whole brain minus the tumors that received a single dose equivalent of 8–16 Gy (V8Gy-V16Gy) were effectively reduced in the MLP. The treatment time parameters, the total number of beams and monitor units, of the MLP were reduced by 3.31 and 1.47% (P < 0.05), respectively. Although there were a few differences in the conformity index (CI) and homogeneity index (HI) between the two treatment plans, the differences were not statistically significant (P = 2.94 and 1.08 > 0.05).

Conclusion
One multiple-lesions plan for brain metastases could achieve higher precision in the target and lower doses in healthy tissue while shortening the treatment time and improving the treatment efficiency over multiple single-lesion plans.
Risk factors, prognostic factors, and nomograms for bone metastasis in patients with newly diagnosed infiltrating duct carcinoma of the breast: a population-based study
Authors: Huang Zhangheng , Hu Chuan , Liu Kewen , Yuan Luolin , Li Yinglun , Zhao Chengliang , Hu Chanchan 
Published: November 2020

Abstract
Background
Breast cancer is the most common malignancy in women, and it is also the leading cause of death in female patients; the most common pathological type of BC is infiltrating duct carcinoma (IDC). Some nomograms have been developed to predict bone metastasis (BM) in patients with breast cancer. However, there are no studies on diagnostic and prognostic nomograms for BM in newly diagnosed IDC patients.

Methods
IDC patients with newly diagnosed BM from 2010 to 2016 in the Surveillance, Epidemiology and End Results (SEER) database were reviewed. Multivariate logistic regression analysis was used to identify risk factors for BM in patients with IDC. Univariate and multivariate Cox proportional hazards regression analysis were used to explore the prognostic factors of BM in patients with IDC. We then constructed nomograms to predict the risk and prognosis of BM for patients with IDC. The results were validated using bootstrap resampling and retrospective research on 113 IDC patients with BM from 2015 to 2018 at the Affiliated Hospital of Chengde Medical University.

Results
This study included 141,959 patients diagnosed with IDC in the SEER database, of whom 2383 cases were IDC patients with BM. The risk factors for BM in patients with IDC included sex, primary site, grade, T stage, N stage, liver metastasis, race, brain metastasis, breast cancer subtype, lung metastasis, insurance status, and marital status. The independent prognostic factors were brain metastases, race, grade, surgery, chemotherapy, age, liver metastases, breast cancer subtype, insurance status, and marital status. Through calibration, receiver operating characteristic curve and decision curve analyses, we found that the nomogram for predicting the prognosis of IDC patients with BM displayed great performance both internally and externally.

Conclusion
These nomograms are expected to be a precise and personalized tool for predicting the risk and prognosis for BM in patients with IDC. This will help clinicians develop more rational and effective treatment strategies.
Predictive and prognostic role of tumour-infiltrating lymphocytes in breast cancer patients with different molecular subtypes: a meta-analysis
Authors: Gao Zhao-hua , Li Cun-xin , Liu Ming , Jiang Jia-yuan 
Published: November 2020

AbstractBackgroundWhether tumour-infiltrating lymphocytes (TILs) play different roles in different molecular subtypes of breast cancer remains unknown. Additionally, their prognostic and predictive value in different molecular subtypes of breast cancer is still controversial. The aim of our meta-analysis was to assess the prognostic and predictive value of TILs in different molecular subtypes of breast cancer by summarizing all relevant studies performing multivariate analysis.MethodsPubMed, Embase, EBSCO, ScienceDirect, the Cochrane Database and Web of Science were comprehensively searched (until March 2020). Hazard ratios (HRs), odds ratios (ORs) and their 95% confidence intervals (CIs) were used as effect measures to perform our meta-analysis. A random effect model was used. Stata software, version 15 (2017) (StataCorp, College Station, TX, USA) was used to perform the statistical analysis.ResultsThirty-three studies including 18,170 eligible breast cancer patients were analysed. The meta-analysis showed that high TIL expression was significantly associated with increased pathological complete response (pCR) rates after neoadjuvant chemotherapy in patients with the HER2-enriched molecular subtype (OR = 1.137, 95% CI [1.061 ~ 1.218],p < 0.001) and triple-negative breast cancer (TNBC) subtype (OR = 1.120, 95% CI [1.061 ~ 1.182],p < 0.001). However, high TIL expression was not significantly associated with high pCR rates after neoadjuvant chemotherapy in patients with the luminal molecular subtype of breast cancer (OR = 1.154, 95% CI [0.789 ~ 1.690],p = 0.460). We carried out a meta-analysis on the HRs of overall survival (OS) and disease-free survival (DFS) to assess the prognostic value of TILs in breast cancer with different molecular subtypes more deeply. Our meta-analysis confirmed that high TILs were associated with significantly improved DFS in patients with the HER2-enriched molecular subtype [HR = 0.940, 95% CI (0.903 ~ 0.979),p = 0.003] and TNBC molecular subtype [HR = 0.907, 95% CI (0.862 ~ 0.954),p < 0.001]. However, high TILs were not associated with significantly better DFS in patients with the luminal molecular subtype of breast cancer [HR = 0.998, 95% CI (0.977 ~ 1.019),p = 0.840]. Furthermore, the results confirmed that high TILs were significantly related to better OS in patients with the HER2-enriched molecular subtype [HR = 0.910, 95% CI (0.866 ~ 0.957),p < 0.001] and TNBC molecular subtype [HR = 0.869, 95% CI (0.836 ~ 0.904),p < 0.001]. Conversely, the summarized results indicated that high TILs were significantly associated with poor OS in patients with the luminal molecular subtype of breast cancer [HR = 1.077, 95% CI (1.016 ~ 1.141),p = 0.012].ConclusionsOur meta-analysis confirms that high TILs are associated with favourable survival and predicts pCR in breast cancer patients with the TNBC and HER2-enriched molecular subtypes.