bluuebunny/crossref_metadata_2025_split huggingface dataset:
Two Hyperparasitaemic Plasmodium Falciparum Cases Successfully Treated with Artemisinin-based Combination Therapy
Authors: Mukhi Benudhar , Anvikar Anupkumar R. , Srivast Bina , Gupta Himanshu , Ghosh Susanta Kumar 
Published: December 2020

Abstract
BackgroundHyperparasitaemia is an important event in a cascade of Plasmodium falciparum severe malaria (SM) but requires host responses to cause cerebral malaria (CM) leading to death, if left untreated. Here, we report two hyperparasitaemic patients with no CM.MethodsMalaria diagnosis was performed based on thick and thin smears examination, and immunochromatographic-based rapid diagnostic test assay. Parasitaemia was calculated following World Health Organization (WHO) protocol. Haematological and biochemical investigations were also performed. Weekly follow-up of blood smear examination and temperature were recorded up to day 63.ResultsThe first patient had 42% parasitaemia (100% asexual parasites). The second one had 9.5% parasitaemia comprising 46% asexual, and 54% sexual stages with 1:1 male to female ratio. On the day of admission, both had presented abnormal haematological and biochemical parameters compared to the reference ranges. Remarkably, both the patients recovered successfully with oral artemisinin-based combination therapy (ACT) and a single dose of primaquine. Weekly follow-up did not show any parasite breakthrough except few drug-affected gametocytes in the second patient. This indicated successful treatment with ACT.ConclusionThe presence of hypergametocytaemia may hinder the elimination efforts, if not treated immediately. This report also signifies the need of accurately estimating the parasitaemia in malaria patients and their timely management to prevent complications and mortality.
Epidemiological feature, viral shedding, and antibody seroconversion among asymptomatic SARS-CoV-2 carriers and symptomatic/ presymptomatic COVID-19 patients
Authors: Chen Yi , Li Ping , Ding Yibo , Liu Miao , Liu Leijie , Yi Bo , Wu Ting , Dong Hongjun , Lao Xuying , Ding Keqing , Wang Haibo , Zhang Dongliang , Tan Xiaojie , Wang Zhongfa , Xu Guozhang , Cao Guangwen 
Published: December 2020

Abstract

Background
Novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is pandemic. However, data concerning the epidemiological features, viral shedding, and antibody dynamics between asymptomatic SARS-CoV-2 carriers and COVID-19 patients remain controversial.
Methods
A total of 193 subjects in Ningbo and Zhoushan, Zhejiang, China, were enrolled in this study from January 21 to March 6, 2020. All subjects were tested positive for SARS-CoV-2 genomic RNA by quantitative reverse transcription PCR and then followed up to monitor the dynamics of serum antibody immunoglobulin M (IgM) and immunoglobulin G (IgG) against SARS-CoV-2 using enzyme-linked immunosorbent assays. Scatter diagram to demonstrate the distribution of IgM and IgG among asymptomatic carriers and COVID-19 patients were generated by R.
Results
Of the 193 subjects, 31 were asymptomatic SARS-CoV-2 carriers, 149 were symptomatic COVID-19 patients, and 14 were COVID-19 patients during the incubation. Compared to symptomatic COVID-19 patients, asymptomatic SARS-CoV-2 carriers were younger and had higher levels of white blood cell and lymphocyte, lower levels of C-reactive protein (CRP) and viral load, and shorter viral shedding time. Seroconversion of IgM against SARS-CoV-2 from positive to negative in asymptomatic carriers took 7.50 (IQR, 4.75–11.50) days, which was significantly shorter than 25.50 (IQR, 6.75–56.75) days in COVID-19 patients (P = 0.030). The proportion of those persistently seropositive for IgG against SARS-CoV-2 was higher in COVID-19 patients than in asymptomatic carriers (66.1% vs. 33.3%, P = 0.037). Viral load was higher in symptomatic than presymptomatic COVID-19 patients. Viral shedding was longer in presymptomatic COVID-19 patients than in asymptomatic carriers. In 4 familial clusters of SARS-CoV-2 infection, asymptomatic carriers were mainly children and young adults while severe COVID-19 was mainly found in family members older than 60 years with underlying diseases. Asymptomatic carriers acquired infection more from intra-familial transmission than did COVID-19 patients (89% vs. 61%, P = 0.028).
Conclusion
Asymptomatic carriers might have a higher antiviral immunity to clear SARS-CoV-2 than symptomatic COVID-19 patients and this antiviral immunity might not be contributable to humoral immunity. The severity of COVID-19 is associated with older age and underlying diseases in familial clustering cases.
Changes in the epidemiology of fall-related injuries in a high-income developing country
Authors: Cevik Arif Alper , Alao David , Eid Hani O , Grivna Michal , Abu-Zidan Fikri 
Published: December 2020

Abstract
Background: Falls in the Gulf countries are the second most common cause of injuries. The United Arab Emirates government implemented various preventive measures to decrease injuries in the country. We aimed to evaluate the changes that occurred in the epidemiology of fall-related injuries in Al-Ain City that occurred over the last decade.Methods: Data of hospitalized patients who were presented with fall-related injuries to the Al-Ain Hospital during the two periods of March 2003 to March 2006 and January 2014 to December 2017 were compared. This included patients’ demographics, mechanism, location, anatomical distribution and parameters related to injury severity. Non-parametric tests were used for the statistical analysis.Results: Eight-hundred-eighty-two patients in the first period and 1358 patients in the second period were studied. The incidence of falls decreased by 30.5% over ten years. The number of elderly, female patients and UAE nationals increased, p < 0.001, p = 0.004, and p < 0.001, respectively. Falls from height decreased by 32.5% (p < 0.001) while fall on the same level increased by 22.5% (p < 0.001). Fall-related injuries at home has increased significantly by 22.6% (p <0.001) while falls in workplaces decreased by 24.4% (p <0.001). Conclusions: Our study showed that the overall incidence of falls decreased compared to a decade ago. The preventive measures were effective in reducing falls from height and workplace injuries. Current preventive measures should target falls at the same level and at homes.
Organisational Determinants and Consequences of Diagnostic Discrepancy in Emergency Departments: A National Study of Consecutive Episodes Between 2008-2016
Authors: Tipsmark Line Stjernholm , Obel Børge , Andersson Tommy , Søgaard Rikke 
Published: December 2020

Abstract
Background Diagnostic discrepancy (DD) is a common phenomenon in healthcare, but little is known about its organisational determinants and consequences. Thus, the aim of the study was to evaluate this among selected emergency department (ED) patients. Method We conducted an observational study including all consecutive ED patients (hip fracture or erysipelas) in the Danish healthcare sector admitted between 2008 and 2016. DD was defined as a discrepancy between discharge and admission diagnoses. Episode and department statistics were retrieved from Danish registers. We conducted a survey among all Danish EDs (m=21) to inform organisational determinants. To estimate the results while adjusting for episode- and department-level heterogeneity, we used mixed effect models of ED organisational determinants and 30-day readmission, 30-day mortality and episode costs (2018-DKK) of DDs. ResultsDD was observed in 2,308 (3.3%) of 69,928 hip fracture episodes and 3,206 (8.5%) of 37,558 erysipelas episodes. The main organisational determinant of DD was senior physicians being employed at the ED (hip fracture: odds ratio (OR) 2.74, 95% confidence interval (CI) 2.15-3.51; erysipelas: OR 3.29, 95% CI 2.65-4.07). However, 24-hour presence of senior physicians (hip fracture) and availability of external senior physicians (both groups) were negatively associated with DD. DD was associated with increased 30-day readmission (hip fracture, mean 9.45% vs 13.76%, OR 1.46, 95% CI 1.28-1.66, p<0.001) and episode costs (hip fracture, 61,681 DKK vs 109,860 DKK, log cost 0.58, 95% CI 0.53-0.63, p<0.001; erysipelas, mean 20,818 DKK vs 56,329 DKK, log cost 0.97, 95% CI 0.92-1.02, p<0.001) compared with episodes without DD. Conclusion DD affects outcomes, and particular organisational characteristics seem to be associated with DD. Yet, the complexity of organisations and settings warrant further studies into these associations.
White Matter Hyperintensity Load Drives Differential Grey Matter Changes in Mild Cognitive Impairment
Authors: Vipin Ashwati , Wong Benjamin Yi Xin , Kumar Dilip , Low Audrey , Ng Kok Pin , Kandiah Nagaendran 
Published: December 2020

Abstract
Background: Small-vessel cerebrovascular disease often represented as white matter hyperintensities on magnetic resonance imaging, is considered an important risk factor for progression to dementia. Grey matter volume alterations in Alzheimer’s disease-specific regions comprising the default mode network and executive control network are also key features of early Alzheimer’s disease. However, the relationship between increasing white matter hyperintensity load and grey matter volume needs further examination in the cognitively normal and mild cognitive impairment. Here, we examined the load-dependent influence of white matter hyperintensities on grey matter volume and cognition in the cognitively normal and mild cognitive impairment stages.Methods: Magnetic resonance imaging data from 93 mild cognitive impairment and 90 cognitively normal subjects were studied and white matter hyperintensity load was categorized into low, medium and high terciles. We examined how differing loads of white matter hyperintensities related to whole-brain voxel-wise and regional grey matter volume in the default mode network and executive control network. We further investigated how regional grey matter volume moderated the relationship between white matter hyperintensities and cognition at differing white matter hyperintensity loads.Results: We found differential load-dependent effects of white matter hyperintensity burden on voxel-wise and regional grey matter atrophy in only mild cognitive impairment subjects. At low load, white matter hyperintensity load was positively related to grey matter volume in the executive control network but at high load, white matter hyperintensity load was negatively related to grey matter volume across both the executive control and default mode networks and no relationship was observed at medium white matter hyperintensity load. Additionally, negative associations between white matter hyperintensities and domains of memory and executive function were moderated by regional grey matter volume. Conclusions: Our results demonstrate dynamic relationships between white matter hyperintensity load, grey matter volume and cognition in the mild cognitive impairment stage. Interventions to slow the progression of white matter hyperintensities, instituted when white matter hyperintensity load is low could potentially prevent further cognitive decline.
Interpret The&nbsp;Synergistic&nbsp;Mechanism of Shenfu Decoction in Treating Sick Sinus Syndrome From the Perspective of Systematic Pharmacology
Authors: Li Yihua , Luo Zhiyun , Chen Yupeng , Wang Kexin , Li Yi , Cai Jieqi , Zhao Xinjun , Chu Qingmin , Guan Daogang , Li Rong 
Published: December 2020

Abstract
Introduction: Sick sinus syndrome (SSS) is a common cardiovascular disease without available oral drugs for a long-term routine treatment, which can be treated by Shenfu Decoction (SFD) according to Traditional Chinese Medicine (TCM) clinical applications. The purpose of this research is to decode the therapeutic mechanisms of SFD in treating SSS as well as interpret the synergistic relationship of herbs in SFD through the method of systematic pharmacology.Methods: We established a novel systematic pharmacological model, which integrate pharmacokinetic parameters, pharmacological data and network topology analysis, to effectively screen the key components of SFD. Based on the key components, gene ontology, pathway enrichment and molecular docking were used to clarify and validate the therapeutic mechanisms of SFD in treating SSS and the synergistic relationship of herbs in SFD. Results: Through our proposed mathematical model, we retrieved 55 components which were defined as synergistic functional components group (SFCG) from 209 potential active components of SFD screened by ADME parameters. Pathway analysis of SFCG targets indicated that RS and FZ could synergistically target to neuroactive ligand-receptor reaction, cAMP signaling pathway, calcium signaling pathway, PI3K-Akt signaling pathway, Rap1 signaling pathway and other pathways to treat SSS. Additionally, molecular docking analysis showed that the average affinity of SFCG and targets involved in the key pathways reached -6.36 kcal/mmol, validating the synergistic effect of RS and FZ in treating SSS.Conclusions: The therapeutic effect of SFD on SSS may be due to its functions of regulating ion channel function, signal transduction and energy metabolism. Besides, we found that the synergistic relationship between RS and FZ can be described at the levels of target, function and pathway.
Epidemic Curves and COVID-19: How to Reduce The Confusion
Authors: Ost Katarina , Yuan Mengru , Carabin Hélène , Zinszer Kate 
Published: December 2020

Abstract
Introduction: Epidemic curves have played a central role in comparing COVID-19 burden and progression across cities, states, and countries. Methods: We created a series of epidemic curves for Québec and Ontario, comparing and contrasting different COVID-19 outcomes. Results: The different epidemic curves of COVID-19 revealed that crude incidence rates displayed larger differences between the two provinces compared to absolute counts. More notable differences between Ontario and Québec were demonstrated when comparing crude rates of hospitalizations to crude rates of confirmed cases in each province. Crude daily hospitalizations revealed twice the magnitude of hospitalizations for Québec from April to May when compared to Ontario. Conclusions: We recommend using crude rates of hospitalizations, intensive care unit admissions, and mortality for COVID-19 epidemic curve comparison as they reveal important patterns in disease trends, and are more easily comparable between health jurisdictions. A harmonized approach to data presentation is important to not only accurately compare the progression of the pandemic, but also for interpretation of the media and the general public.
The Safety and Efficacy of Transarterial Chemoembolization with Bleomycin for Hepatocellular Carcinoma Unresponsive to Doxorubicin:A Prospective Single-center Study
Authors: fu jinxin , wang yan , zhang jinlong , yuan kai , yan jieyu , yuan bing , guan yang , wang maoqiang 
Published: December 2020

Abstract
Purpose To investigate the safety and efficacy of transarterial chemoembolization (TACE) with bleomycin for hepatocellular carcinoma (HCC) unresponsive to doxorubicin.Methods We did a randomized controlled trial in HCC patients resistant to TACE with doxorubicin to assess the survival benefits of the experimental group (TACE with bleomycin) compared with the control group (TACE with doxorubicin). 170 patients were allocated randomly between December 2015 and December 2017 and 80 patients of each group were accomplished and analyzed finally. The modified response evaluation criteria in solid tumors (mRECIST) was used to evaluated the tumor response every 4-6 weeks. The primary endpoint was median progression-free survival (mPFS) and median overall survival (mOS). Safety was assessed by post-procedure complications.Results The study was stopped in October 2018. Objective response rate (ORR) of the experimental group was 27.5% (22/80) , mPFS and mOS was 5.8 and 8.1 months. ORR of the control group was 7.5% (6/80) , mPFS and mOS was 2.9 and 4.0 months. The ORR were significantly different between two grous ( χ²= 0.348, P＜0.05). The differences of mPFS and mOS between the two groups were statistically significant (χ² = 2.865, P＜0.05 and χ² = 0.926, P＜0.05, respectively). There were no significant difference in post-procedure complications (P＞0.05) and no major complications occurred.Conclusion It is suggested that TACE with bleomycin is a safe and effective method for HCC and bleomycin can be a second-line chemotherapeutic agent for the HCC patients unresponsive to TACE with doxorubicin.
PD-L1 on circulating tumor cells indicates poor prognosis in breast cancer
Authors: Wang Xuefei , Zhang Guochao , Wu Shafei , Li Jiaxin , sun qiang 
Published: December 2020

Abstract
Background

In breast cancer, circulating tumor cells (CTCs) are associated with a poor prognosis, but research concerning programmed cell death protein 1 ligand (PD-L1) on CTCs in breast cancer is limited. This study investigated an association between PD-L1 on CTCs, tumor cells (TCs), or tumor infiltrating immune cells (TIICs), respectively, and prognosis and clinicopathological features in breast cancer.
Methods

Twenty patients with breast cancer were recruited; one was excluded for confirmed lymphoma. The PD-L1 on TCs and TIICs was determined via immunohistochemistry (IHC); PD-L1 mRNA expression on CTCs was analyzed. The chi-squared test was used to determine associations between clinicopathological features and PD-L1 on TCs, TIICs, and CTCs. Kaplan-Meier and Cox proportional hazards model analyses were applied to compare the survival of patients and related factors.
Results

The follow-up time was 48 months. Of the 19 patients, 14 had > 1 CTC/10 mL peripheral blood. Among these, each had ≥ 1 CTC showing PD-L1. There was no association between the presence of PD-L1 on TCs, TIICs, and CTCs and pathology, nor between PD-L1 on TCs and TIICs and survival. Patients with high PD-L1 levels on CTCs or higher T status had poor overall survival (P = 0.034 and 0.003, respectively); and these were prognostic factors (P = 0.029, 0.010).
Conclusion

High levels of PD-L1 on CTCs may be a prognostic factor for shorter survival in breast cancer.
Clinical Characteristics and Prognosis of Ovarian Clear Cell Carcinoma: a Retrospective Study of 112 Patients in Beijing
Authors: Zhou Huimei , Liu Qian , Shi Xiaohua , Yang Jiaxin , Cao Dongyan , Wang Tao , Shen Keng 
Published: December 2020

Abstract
ObjectivesThis retrospective study aimed to evaluate the clinical characteristics and prognosis of ovarian clear cell carcinoma (OCCC) and to further explore the monitoring value of cancer antigen 125 (CA-125).MethodsThe medical records of 112 OCCC patients who were treated in Peking Union Medical College Hospital (PUMCH) between 2014 and 2019 were collected and reviewed, and data such as age, Federation of Gynecology and Obstetrics (FIGO) stage, CA-125 level, treatment, recurrence, and death were extracted.OutcomesThe median patient age was 50 (45, 57) years. Sixty (53.57%) patients were in stage I, 13 (11.61%) patients were in stage II, 22 (28.57%) patients were in stage III, and 7 (6.25%) patients were in stage IV. In total, 109 (97.32%) patients received adjuvant chemotherapy. The median chemotherapy cycles of CA-125 normalization was 2 (0, 3). The 1-year and 3-year progression-free survival (PFS) rates were 87.85% and 72.90%, respectively. The median PFS1 duration was 19 (11, 35) months, and the median overall survival (OS) duration was 24 (13, 40) months. Recurrence occurred in 32 patients, of whom 7 (21.88%) developed platinum-resistant recurrence. Fifty percent of relapsed patients had a CA-125 level<35 IU/ml at the time of relapse. Nine (28.13%) patients experienced a second recurrence. In the multivariate Cox regression analysis, the Chemotherapy cycles of CA-125 normalization remained nonsignificant for stage I (P=0.003, HR 4.287, 95% CI=1.632–11.258) and stage III (P=0.003, HR 4.287, 95% CI=1.632–11.258) disease. Multivariate Cox regression showed that platinum resistance was an independent factor for PFS2 (P=0.008, HR 11.562, 95% CI=1.873–71.353).ConclusionsFIGO stage and chemotherapy resistance are independent risk factors for prognosis. CA-125 levels following treatment are a valid indicator for treatment monitoring. Regardless of chemosensitivity to CA-125, CA-125 normalization before chemotherapy cycle 2 may not be a distinct inflection point for PFS and OS.
Emergency Laparoscopic Cholecystectomy with Low Pressure Pneumo-Peritoneum in Cardiopulmonary Risk Patients: Fundus-Calot Cholecystectomy VS Calot first Cholecystectomy. Randomized Controlled Trial.
Authors: Habeeb Tamer A.A.M , Osman Gamal , Ibrahim Amr , Riad Mohamed , Metwalli Abd-Elrahman M. , Khalil Osama M.H. , Mansour Mohamed Ibrahim , mohamed Ahmed Shafik , negm Said mohamed , Wasefy Tamer , Baghdadi Muhammad Ali , Sieda Bassem , elsayed Ashraf abdelmonem , Amin Mohamed Farouk , Abdalla Wael M , Elaidy Mostafa. M. , Mawla Walid A. , sharaf Khaled , Abdelhamid Mohamed I. 
Published: December 2020

Abstract
Background:The numbers of elderly persons have greatly increased worldwide due to improvement of medical health. Elderly complains of cardiopulmonary diseases and the incidence of emergent gall bladder diseases increase with age. Laparoscopic cholecystectomy is the usual approach in dealing with cholithiasis that greatly replace open approach even in acute emergency gall bladder diseases.Aim: compare between initial Fundus first cholecystectomy followed by Calot dissection VS Calot first cholecystectomy in Emergency laparoscopic cholecystectomy with low pressure pneumo-peritoneum in cardiopulmonary risk patients as regard intraoperative data and postoperative complications.Patients and methods:This prospective randomized controlled study was carried out in the Department of Emergency General Surgery on 470 cases with acute cholecystitis, biliary colic, mucocele and pyocele of gall bladder. The patients were divided into two groups, Group A: fundus-Calot group (235cases) and Group B (235cases): classical Calot first approach.ResultsIn most cases of group A, the operating time was up to 90 minutes, while in group B, most cases were more than 90 minutes. Intraoperative bleeding, visceral injury and biliary injury were higher in group B than in group A and therefore the conversion was higher in group B than in group A (14% vs. 4%). Postoperative sequelae were reported to be greater than in group B in regard to bleeding, biliary leakage and wound infections. Remote complications were more pronounced for biliary restrictions in Group B (14%) than in Group A (2%)Conclusion:Laparoscopic low-pressure pneumoperitoneum cholecystectomy with initial Fundus first method is an excellent and safe approach in treating acute gallbladder diseases in cardiopulmonary risk patients.