bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP26 HIV infection masquerading as connective tissue disease
Authors: Javaid Zeeshan , Mekkayil Babitha , Paul Anupam 
Published: November 2020

Abstract

Case report - Introduction
Connective tissue diseases are multisystem disorders. Diagnosis and evaluation of suspected cases is not straight forward in most of the cases. This case describes the significance of considering a broader approach when evaluating a suspected case of connective tissue disease.

Case report - Case description
We describe a case of 58 years old non-smoker lady, presented with acute onset livedo reticularis rash on lower limbs and background of sicca symptoms, oral ulcers, fatigue, paraesthesias in feet and arthralgias without any systemic or inflammatory joint symptoms.
General examination showed livedo reticularis rash on both elbows and lower legs. There was no evidence of peripheral joint synovitis, but she had nodal osteoarthritis in her hands. Systemic examination was unremarkable.
Investigations revealed anaemia, pancytopenia, ESR of 77, low C4 and urine dipstick positive for leucocytes, nitrates, protein, and blood. Schirmer’s test, ANA and ENA screen was positive with positive RNP and SMdp antibody. She also had hypergammaglobulinemia in a polyclonal pattern. Nerve Conduction and EMG studies revealed mild axonal sensory neuropathy.

Case report - Discussion
This lady appeared to have mixed connective tissue disease with mixed features of Sjögren’s syndrome and systemic lupus erythematosus. She was started on Hydroxychloroquine but stopped it shortly after developing floaters in her eye. She had poor response to Depomedrone injection. She had ongoing symptoms of fatigue, weight-loss, loose stools, and abdominal pain, investigated further and CT scan showed hyperdense liver lesions and mesenteric lymphadenopathy. Esophagogastroduodenoscopy showed oesophageal candidiasis. She was admitted with progressive symptoms. Further investigations showed a positive HIV test and liver biopsy came back positive for anaplastic lymphoma, later she was diagnosed with advanced HIV disease, rapidly deteriorated with neutropenic sepsis and multi-organ failure, and unfortunately died.

Case report - Key learning points
This lady initially presented with symptoms of connective tissue disease and investigations in keeping with this diagnosis. Unfortunately, by the time she was tested for HIV infection, it was already too late. There could be overlap of symptoms of connective tissue disease and viral infections e.g. HIV infection. Autoantibodies may be falsely positive in infections e.g. HIV and in malignancy. Risk factors of HIV infection should be considered during assessment of multisystem diseases like connective tissue diseases particularly prior to immunosuppression. Viral screening including HIV test should be considered in all high-risk patients and particularly if the symptoms are atypical and do not quite fit well with the diagnosis.
Characteristics of Stillbirths Associated With Diabetes in a Diverse U.S. Cohort
Authors: Page Jessica M. , Allshouse Amanda A. , Cassimatis Irina , Smid Marcela C. , Arslan Erol , Thorsten Vanessa , Parker Corette , Varner Michael W. , Dudley Donald J. , Saade George R. , Goldenberg Robert L. , Stoll Barbara J. , Hogue Carol J. , Bukowski Radek , Conway Deborah , Pinar Halit , Reddy Uma M. , Silver Robert M. 
Published: November 2020

OBJECTIVE:
To characterize stillbirths associated with pregestational diabetes and gestational diabetes mellitus (GDM) in a large, prospective, U.S. case–control study.

METHODS:
A secondary analysis of stillbirths among patients enrolled in a prospective; multisite; geographically, racially, and ethnically diverse case–control study in the United States was performed. Singleton gestations with complete information regarding diabetes status and with a complete postmortem evaluation were included. A standard evaluation protocol for stillbirth cases included postmortem evaluation, placental pathology, clinical testing as performed at the discretion of the health care professional, and a recommended panel of tests. A potential cause of death was assigned to stillbirth cases using a standardized classification tool. Demographic and delivery characteristics among women with pregestational diabetes and GDM were compared with characteristics of women with no diabetes in pairwise comparisons using χ2 or two-sample t tests as appropriate. Sensitivity analysis was performed excluding pregnancies with genetic conditions or major fetal malformations.

RESULTS:
Of 455 stillbirth cases included in the primary analysis, women with stillbirth and diabetes were more likely to be older than 35 years and have a higher body mass index. They were also more likely to have a gestational hypertensive disorder than women without diabetes (28% vs 9.1%; P<.001). Women with pregestational diabetes had more large-for-gestational-age (LGA) neonates (26% vs 3.4%; P<.001). Stillbirths occurred more often at term in women with pregestational diabetes (36%) and those with GDM (52%). Maternal medical complications, including pregestational diabetes and others, were more often identified as a probable or possible cause of death among stillbirths with maternal diabetes (43% vs 4%, P<.001) as compared with stillbirths without diabetes.

CONCLUSION:
Compared with stillbirths in women with no diabetes, stillbirths among women with pregestational diabetes and GDM occur later in pregnancy and are associated with hypertensive disorders of pregnancy, maternal medical complications, and LGA.
Adherence to Oral Anticancer Therapeutics in the Gynecologic Oncology Population
Authors: Watson Catherine H. , Fish Laura J. , Falkovic Margaret , Monuszko Karen , Lorenzo Amelia , Havrilesky Laura J. , Secord Angeles Alvarez , Davidson Brittany A. 
Published: November 2020

INTRODUCTION:
To gain a better understanding of gynecologic oncology patient adherence to oral anticancer agents through both a cross-sectional survey of adherence and qualitative interviews with patients and clinicians regarding their experience with these medications.

METHODS:
Eligible participants completed a survey for this cross-sectional study that included an assessment of adherence, distress, quality of life, and health literacy. Any woman taking an oral anticancer agent for a gynecologic malignancy at a tertiary academic medical center for 30 days or more was eligible. Semi-structured qualitative interviews (n=14) were then conducted to explore experiences with oral anticancer agents. We also conducted a qualitative group interview with physicians and nurse practitioners.

RESULTS:
One hundred women taking oral anticancer agents were enrolled. Fifty-four percent reported perfect adherence to their medication, 21% reported equivocal adherence (demonstrating at least one nonadherent behavior in the previous 7 days), and 25% reported nonadherence (demonstrating more than one nonadherent behavior in the previous 7 days). Qualitative analysis identified five major themes: ease of use compared with traditional therapy; the mental burden of self-administrated medication; perceived importance of the medication; management of side effects; and the desire for consistent physician communication. Common misperceptions expressed in the health care professional interviews included high adherence to oral medications and a belief that cost was the biggest barrier to adherence.

CONCLUSION:
Almost half of the patients surveyed reported equivocal or nonadherence to their oral anticancer agent. The qualitative interviews identified several important themes, many of which were not recognized by physicians and nurse practitioners. These findings highlight the need for patient and health care professional interventions to improve patient adherence.
Circulating angiogenic factors are associated with progression to preeclampsia and the occurrence of adverse outcomes in women with gestational hypertension
Authors: Nolasco-Leaños Ana G. , Ramírez-Valenzuela Karla L. , Carrillo-Juárez Reyes I. , Molina-Pérez Carlos J. , Isordia-Salas Irma , Leaños-Miranda Alfredo 
Published: November 2020

Objective:
Gestational hypertension is characterized by an imbalance in angiogenic factors. The goal of the current study was to evaluate whether circulating concentrations of proangiogenic and antiangiogenic factors are associated with the risk of progression to preeclampsia and development of adverse outcomes in women with gestational hypertension.

Methods:
We studied 496 women with gestational hypertension. Patients were divided into three groups based on their degree of angiogenic imbalance, evaluated by the soluble fms-like tyrosine kinase-1/placental growth factor ratio: no angiogenic imbalance (≤38), mild angiogenic imbalance (>38–<85), and severe angiogenic imbalance (≥85) or stratified into tertiles according to soluble endoglin (sEng) levels.

Results:
The concentrations of all angiogenic factors were significantly different in patients with gestational hypertension than in healthy pregnancy. A significant trend towards higher serum sEng levels was observed as the degree of angiogenic imbalance increased. Patients with severe angiogenic imbalance had higher rates of adverse maternal and perinatal outcomes and progression to preeclampsia (P < 0.001) when compared with patients with no or mild angiogenic imbalance. The risk of combined adverse maternal outcomes and specific adverse outcomes (hemolysis, elevated liver enzymes, low platelet count syndrome, preterm delivery, small-for-gestational-age infant, perinatal death, and progression to preeclampsia within 7, 14, 28, and 56 days) was higher in patients with severe angiogenic imbalance or sEng values in the highest tertile (odds ratio ≥5.6 and ≥2.0, respectively), compared with no angiogenic imbalance or the lowest tertile.

Conclusion:
In women with gestational hypertension at the time of initial evaluation, circulating concentrations of the soluble fms-like tyrosine kinase-1/placental growth factor ratio and sEng appear to be suitable markers to assess the risk of adverse maternal and perinatal outcomes and progression to preeclampsia.
An Integrative Review of Cerebral Salt Wasting Syndrome
Authors: Oh HyunSoo , Seo WhaSook 
Published: November 2020

ABSTRACT

BACKGROUND: Although cerebral salt wasting syndrome (CSWS) is widely recognized, its clinical characteristics, diagnostic criteria, and management have not been clearly defined. This study was undertaken to comprehensively review current literature and provide a more complete picture of CSWS. This review also aimed to provide information for nurses on how to differentiate cerebral salt wasting syndrome from syndrome of inappropriate antidiuretic hormone secretion. METHODS: An integrative review was performed. Searches were conducted between May and July 2018. The primary information sources were CINAHL, Google Scholar, MEDLINE, PubMed, Scopus, and Web of Science. Included articles were published from 1954 to July 2018. RESULTS: The essential features of CSWS are hyponatremia, hypovolemia, and increased urine output. Treatment regimens may be determined based on the acuity and severity of hyponatremia and hypovolemia as well as evident symptoms and signs. CONCLUSION: This review may help neuroscience nurses become knowledgeable about CSWS for the drafting of appropriate nursing care plans and also be able to differentiate CSWS from syndrome of inappropriate antidiuretic hormone secretion as early as possible for timely and proper management.
Comparison of Q-value-guided laser-assisted in situ keratomileusis and standard laser in situ keratomileusis for myopia
Authors: Zhang Kai-Ping , Fang Xiang , Zhang Yin , Chao Min 
Published: November 2020

AbstractBackground:Previous studies examining the safety and efficacy ofQ-value-guided laser-assisted in situ keratomileusis (LASIK) for treating myopia have yielded inconsistent results. We, therefore, performed a meta-analysis to clarify this issueMethods:Various databases were conducted up to November 21, 2018. All randomized controlled trials and cohorts that comparedQ-value-guided LASIK with standard LASIK were selected. Mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to evaluate the strength of the correlations. Additionally, different subgroup analyses and publication bias tests were performed. Data were extracted including the number of postoperative uncorrected visual acuity (UCVA) of 20/20 or better, postoperative UCVA, preoperative and postoperativeQ-value, postoperative refractive spherical equivalent (SE), the number of postoperative SE within ±0.5D, higher order aberration (HOA), coma-like aberration and spherical-like aberration.Results:A total of seventeen studies with 2640 patients and 3,358 eyes were included. It has been shown that postoperativeQ-value (MD = -0.42; 95% CI: -0.64, -0.21;P < .001), HOA (MD = -0.14; 95% CI: -0.23, -0.06;P = .001), spherical-like aberration (MD = -0.19; 95% CI: -0.32, -0.06;P = .004) rather than postoperative UCVA (MD = 0.04; 95% CI: 0.01, 0.07;P = .012) were significantly better in theQ-value-guided LASIK than standard LASIK. However, the pooled results revealed that no significant differences were found between the 2 paired groups of postoperative UCVA of 20/20 or better (OR = 1.09; 95% CI: 0.62, 1.92;P = .763), preoperativeQ-value (MD = -0.00; 95% CI: -0.02, 0.02;P = .922), postoperative refractive SE (MD = 0.08; 95% CI: -0.09, 0.25;P = .336), coma-like aberration (horizontal: MD = -0.00; 95% CI: -0.03, 0.03;P = .966; vertical: MD = -0.01; 95% CI: -0.03, 0.01;P = .263) and postoperative SE within ±0.5 D (OR = 1.06; 95% CI: 0.48, 2.33;P = .886). Likewise, similar results were detected in some corresponding subgroups.Conclusion:Q-value-guided LASIK is a safe, effective and predictable surgical option for treating myopia, especially showing superiority over standard LASIK in postoperativeQ-value, HOA and spherical-like aberration. However, more detailed studies are required to confirm our conclusions in advanced researches.
The effect of preoperative degenerative spondylolisthesis on postoperative outcomes of degenerative lumbar spinal stenosis
Authors: Chang Yueliang , Zhou Fubiao , Fei Le , Wang Zili 
Published: November 2020

Abstract

Background:
Most degenerative lumbar spinal stenosis (DLSS) patients primitively received the conservative treatment to control symptoms. In order to develop an optimal surgical treatment strategy, it is very significant to understand how the degenerative lumbar spondylolisthesis (DS) affects the effect of decompression in the DLSS. Thus, the aim of this current study was to explore whether the concomitant DS would affect the effect of decompression alone in the patients with DLSS.

Methods:
The current study was carried out at our hospital and it was approved through our institutional review committee of General Hospital of Ningxia Medical University. During the period from January 2015 to December 2017, in our study, we identified consecutive patients who received the minimally invasive laminectomy to treat the DLSS. The inclusion criterion included radicular leg pain or neurogenic claudication with the neurological symptoms associated with DLSS syndrome, magnetic resonance imaging of the lumbar spine reveals at least 1 level of serious stenosis, the conservative treatment failed for at least 3 months, and patients agreed to provide the postoperative details. The major outcomes of this present research was Oswestry Disability Index. Secondary outcomes of this current study involved visual analog score, short form-36, surgical revision rate as well as complications.

Results:
We assumed that previous DS possessed a negative effect on the postoperative results of the DLSS patients.

Trial registration:
researchregistry5943.
Immunoglobulins concentration and B cell counts as severity markers in adult community-acquired pneumonia
Authors: Luchsinger Vivian , Lizama Luis , Garmendia María Luisa , Tempio Fabián , Ruiz Mauricio , Pizarro Rolando , Rossi Patricio , Huenchur Lucía , Moreno Cristian , López Mercedes , Ampuero Sandra , Larrañaga Carmen , Avendaño Luis Fidel 
Published: November 2020

Abstract
Community-acquired pneumonia (CAP) is a worldwide cause of morbidity and mortality. Immunoglobulins (Igs) and B cells quantification studies in CAP are few and show discrepancies. Serum IgA acts as a powerful natural anti-inflammatory factor, but its role in the CAP has not yet been defined. The highly sensitive xMAP Luminex technique allows better immunoglobulins quantification. The aim of this study was to analyze the relation between clinical severity and circulating Igs and B cells in adults with CAP.
Igs (M, A, G1, G2, G3, and G4) and B cells were quantified in peripheral blood of 190 Chilean patients ≥18 years old hospitalized for CAP and in 21 adults without respiratory disease, using xMAP Luminex and flow cytometry, respectively. Clinical history was recorded and PSI and CURB-65 scores were calculated for evaluation of clinical severity.
The total IgM, IgG2 and total IgG levels were lower in CAP than in asymptomatic adults (P < .05). No significant differences of Igs levels were found between patients classified as severe and mild by PSI and CURB-65 scores. Fatal cases had higher levels of IgA (P < .05). No differences in CD19+ B cells frequency was found between CAP and asymptomatic adults (P = .40). In PSI severe cases, CD19+ B cells were significantly lower than in mild cases (P = .008). No differences were found in CURB-65 severe and mild groups (P = .11). In fatal cases (11/82) group, CD19+ B cells frequency was lower than in 71 survivors (P = .2). No differences in memory B lymphocytes were detected between asymptomatic and CAP adults, severe and mild patients, survivors and fatal cases (P > .05).
Serum IgA levels were significantly higher in fatal CAP cases, raising it as a potential biomarker for severe disease considering its relatively universal availability. In PSI severe patients, B cells showed lower levels and could have a role on its physiopathology. Finding new markers rooted in physiopathology could improve the possibility of scoring severe CAP cases. Luminex technology showed promising quantification serum Igs.
A comparative study of the normal oesophageal wall thickness based on 3-dimensional, 4-dimensional, and cone beam computed tomography
Authors: Hu Chao Yue , Li Yan Kang , Li Jian Bin , Wang Jin Zhi , Shao Qian , Wang Wei , Guo Yan Luan , Xu Min , Li Wen Wu 
Published: November 2020

Abstract

Background:
The study aimed to compare normal oesophageal wall thickness based on 3-dimensional computed tomography (3DCT), 4-dimensional computed tomography (4DCT) and cone beam computed tomography (CBCT).

Methods:
Contrast-enhanced 3DCT, 4DCT, and CBCT scans were acquired from 50 patients with lung cancer or metastatic lung cancer. The outer oesophageal wall was manually contoured on each 3DCT, the maximum intensity projection of 4DCT (4DCTMIP) the end expiration phase of 4DCT (4DCT50) (the end expiration phase of 4DCT) and the CBCT data sets. The average wall thicknesses were measured (defined as R3DCT, R50, RMIP, and RCBCT).

Results:
Whether for thoracic or for intra-abdominal segments, there were no significant differences between R3DCT and R50, but significant differences between R3DCT and RMIP, R3DCT and RCBCT. For upper and middle oesophagus, RCBCT were larger than RMIP. There was no significant difference between upper and middle segments on 3DCT, 4DCT, and CBCT. Intra-abdominal oesophageal wall thickness was greater than that of thoracic oesophagus. There were no differences between upper and lower, and middle and lower oesophagus on CBCT.

Conclusion:
Our findings indicate normal oesophageal wall thickness differed along the length of oesophagus whatever it was delineated on 3DCT, 4DCT (4DCT50 and 4DCTMIP) or CBCT. It is reasonable to use uniform criterion to identify normal esophageal wall thickness when delineating gross tumor volume on 3DCT and 4DCT50, the same is true of delineating internal gross tumor volume on 4DCTMIP or CBCT images for lower and intra-abdominal oesophagus. But, in spite of using contrast-enhanced scanning, relatively blurred boundary on the CBCT images is noteworthy, especially for upper and middle thoracic esophagus.
A rare double ALK fusion variant EML4-ALK and CDK15-ALK in lung adenocarcinoma and response to crizotinib
Authors: Guo Jun , Shi Junping , Yao Ming , Jin Yi , Liu Dengxiang , Liu Weiling , Wang Kai , Jiang Da 
Published: November 2020

Abstract

Rationale:
The anaplastic lymphoma kinase (ALK) fusion has been identified to be a driver gene in lung cancer, and serves as important diagnostic and therapeutic targets. Owing to the advanced sequencing technologies, new partner genes of ALK have been constantly detected.

Patient concerns:
A 55-year-old Chinese woman went to our hospital because of cough and expectoration for 1 year. The patient had no fever, chest pain and hemoptysis.

Diagnoses:
She was diagnosed with lung adenocarcinoma. Because she had no operational condition, combination chemotherapy with docetaxel and cisplatin (CP) for 4 cycles was adopted. However, computed tomography (CT) scan indicated progression disease (PD). To explore possibility of targeted therapy, the tumor samples were subjected to next-generation sequencing (NGS), and a rare double ALK fusion variant EML4-ALK and CDK15-ALK was identified.

Interventions and outcomes:
The patient subsequently received crizotinib treatment, and achieved partial response (PR). No significant drug related adverse reactions were found during crizotinib treatment. The progression-free survival achieved 23 months.

Lessons:
Together, we identified a rare double ALK fusion variant, EML4-ALK and CDK15-ALK, in a patient with lung adenocarcinoma. The patient benefited from crizotinib treatment, which could provide a certain reference for the patients with such gene alteration.
Construction and analysis of an aberrant lncRNA-miRNA-mRNA network associated with papillary thyroid cancer
Authors: Jiang Yanxia , Wang Jiao , Chen Jian , Wang Jiancheng , Xu Jixiong 
Published: November 2020

Abstract
Accumulating evidence has indicated that long noncoding RNAs (lncRNAs) are the main constituents of competing endogenous RNA (ceRNA) networks. Nonetheless, in the lncRNA-related ceRNA network of papillary thyroid cancer (PTC), the function of cancer-specific lncRNAs, as well as their use for the potential prediction of PTC prognosis, remains unclear. In this study, 384 RNA sequencing (RNA-seq) profiles of PTC patients were attained from The Cancer Genome Atlas (TCGA), an open-source database that offers vast amounts of RNA-seq data, and 75 miRNAs, 495 lncRNAs, and 1099 mRNAs (P < .05 and |logFC| >2) were detected when compared with normal tissues. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were analyzed using the Cytoscape plug-in BinGo. An aberrant lncRNA-mRNA-miRNA ceRNA network consisting of 31 differentially expressed (DE)-lncRNAs, 13 DE-miRNAs, and 134 DE-mRNAs was built in TCGA. On the basis of overall survival (OS) analysis, 6 lncRNAs (CCAT1, SYNPR, SFTA1P, HOTAIR, HCG22, and CLDN10) were identified as prognostic biomarkers for patients in TCGA (P < .05). Through qRT-PCR, we designated 6 cancer-specific lncRNAs as having great significance for survival by verifying their expression in the 60 PTC patients who were diagnosed. The qRT-PCR and TCGA results were completely consistent. Our research provides data for further understanding the lncRNA-miRNA-mRNA ceRNA network and elucidating the molecular mechanisms of PTC.