bluuebunny/crossref_metadata_2025_split huggingface dataset:
Necrotizing fasciitis secondary to lake water inoculation with Aeromonas sobria
Authors: Hutchinson Lauren E. , Franke Jacob D. , Mailey Brian A. 
Published: March 2021

Abstract

Rationale:
Necrotizing fasciitis (NF) is a rapidly progressing bacterial soft tissue infection with a high mortality rate. It is characterized by significant soft tissue destruction with associated sepsis. The mainstay of treatment is coverage with appropriate broad-spectrum antibiotic therapy and emergent surgical debridement.

Patient concerns:
A previously healthy 66-year-old female presented with a deep laceration to her right, posterior calf with subsequent contamination with lake water. After the wound was irrigated and closed, the patient developed NF.

Diagnosis:
Laceration of the right lower extremity complicated by NF secondary to Aeromonas sobria.

Interventions:
The patient underwent emergent surgical debridements with intravenous broad-spectrum antibiotics and negative pressure wound therapy. The lower extremity was reconstructed with split-thickness skin grafts.

Outcomes:
The patient's initial penetrating trauma was closed in the emergency room, and the patient was discharged home with antibiotics. She returned the next day with unstable vitals and was admitted to the intensive care unit. Her condition continued to deteriorate, and she underwent serial surgical debridements. Her condition improved and was discharged home after 13 days in the hospital.

Lessons Learned:
Close monitoring for NF is important for tissue infections sustained in aquatic environments. Timely identification and surgical management of NF increases overall survival.
Dacryoendoscopy-guided re-canalization of canaliculops
Authors: Kitada Tomoko , Mimura Masashi , Takahashi Yasuhiro , Takagi Mai , Oku Hidehiro , Ikeda Tsunehiko 
Published: March 2021

Abstract

Rationale:
Canaliculops is a rare condition, and only 11 cases have been reported previously. We report 2 cases of canaliculops, which were successfully treated using the new recanalization technique under dacryoendoscopy followed by bicanalicular lacrimal intubation.

Patient concerns:
A 78-year-old man and a 76-year-old woman had 3- and 1-year histories of medial-upper eyelid swelling (left and right, respectively) without any inflammatory signs, history of periocular trauma, herpes infection, use of specific drugs, or ophthalmic diseases of note.

Diagnoses:
The cystic lesions were evaluated using ultrasound biometry or computed tomography to find the lumen of the horizontal canaliculus was exceedingly expanded, and to confirm the clinical diagnosis of canaliculops.

Interventions:
As the 2 cases of canaliculops were caused by upper puncta and common canaliculus obstructions, canaliculops of the upper eyelid were recanalized under dacryoendoscopic guidance, followed by bicanalicular intubation. The tubes were kept in situ involving bi-weekly irrigation and instillation of antibiotic and anti-inflammatory eye drops, and were removed after 2 to 3 months of follow-up.

Outcomes:
Epiphora, and eyelid swelling were completely resolved immediately after the procedure, and the lesions did not recur on follow-up after more than 6 months.

Lessons:
Eleven case series of canaliculops have been described previously, but this is the first report of this recanalization procedure offering a new, less invasive treatment option compared to complete or partial resection of the cystic lesion.
Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis
Authors: Bai Zixing , Yang Yanjun , Chen Si , Dong Yongli , Cao Xuhan , Qin Weikai , Sun Weidong 
Published: March 2021

Abstract

Background:
Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion.

Objective:
To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis.

Methods:
We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software.

Results:
A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = −2.31, 95% CI:−4.63, −2.21), intraoperative blood loss (MD = −43.37, 95%CI: −48.49, −38.25), hospital stay (MD = −1.80, 95%CI: −2.28, −1.33), and visual analog scale score (MD = −1.75, 95%CI: −2.04, −1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001).

Conclusion:
Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application.

PROSPERO registration number:
CRD42020195727.
Bivalirudin in patients undergoing percutaneous coronary intervention and independent predictors of postoperative adverse events in these patients
Authors: Hu Yue-cheng , Yao Wei-jie , Jin Dong-xia , Zhang Jing-xia , Wang Le , Zhang Rui , Xu Jing-han , Cong Hong-liang 
Published: March 2021

Abstract
The efficacy and safety of bivalirudin in percutaneous coronary intervention (PCI) has always been a hot topic in perioperative antithrombotic therapy, but there are still some controversies. So studies are needed to provide more evidence, especially the real world study which includes patients excluded from previous RCT studys. Our study aimed to investigate these information and analyze the independent predictors of postoperative adverse events.
A retrospective study enrolled 1416 patients underwent PCI in Tianjin Chest Hospital from May 2016 to October 2017. The incidence of stent-thrombosis and net clinical adverse events, including all-cause death, myocardial infarction, stroke, urgent target-vessel revascularization and bleeding, were followed up for 30 days and 1 year. Logistic regression and COX regression were respectively used to analyze independent predictors of bleeding events within 30-days, and independent predictors of Major adverse cardiovascular and cerebrovascular events (MACCE) in patients with stent implantation within 1-year.
Seven hundred six patients were treated with bivalirudin while 710 with unfractionated heparin (UFH). The proportions of diabetes, hypertension, anemia, myocardial-infarction history, PCI history, moderate-to-severe renal-impairment, gastrointestinal-bleeding history in the bivalirudin group were significantly higher (P < .05). Women, anemia were independent risk factors for bleeding within 30-days (P < .05). Among 682 patients with stent implantation in bivalirudin group, anemia, Body Mass Index (BMI) >25 kg/m2, KILLIP ≥2, ejection fraction (EF) <45%, eGFR <60 ml/minutes were independent risk factors for MACCE, while Statins, proton pump inhibitor (PPI) were independent protective factors for MACCE with-in 1-year (P < .05).
Bivalirudin have good anticoagulant effect and lower bleeding risk during PCI, especially in patients with higher bleeding risk. In patients treated with bivalirudin, female, anemia were independent predictors of bleeding within 30-days, BMI >25 kg/m2, anemia, KILLIP ≥2, EF <45%, eGFR <60 ml/minutes were independent risk factors and Statins, PPI were independent protective factors of MACCE within 1-year.
The value of repeated CT in monitoring the disease progression in moderate COVID-19 pneumonia
Authors: Gao Yang , Hu Yuxiong , Zhu Junteng , Liu Huan , Qiu Rongxian , Lin Qunying , He Xiongzhi , Lin Hai-Bin , Cheng Shiming , Li Guangxi 
Published: March 2021

Abstract
The role of thoracic CT (computerized tomography) in monitoring disease course of COVID-19 is controversial. The purpose of this study is to investigate the risk factors and predictive value of deterioration on repeatedly performed CT scan during hospitalization.
All COVID-19 patients treated in our isolation ward, from January 22, 2020 to February 7, 2020, were reviewed. Patients included were categorized into RD (Radiological Deterioration) group or NRD (No Radiological Deterioration) group according to the manifestation on the CT routinely performed during the hospitalization. All clinical data and CT images were analyzed.
Forty three patients were included in our study. All are moderate cases with at least 4 CT scans each. Eighteen (42.9%) patients had radiological deteriorations which were all identified in CT2 (the first CT after admission). Patients in RD group had lower leukocyte count (P = .003), lymphocyte count (P = .030), and higher prevalence (P = .012) of elevated C-reactive protein (CRP) at admission. NRD patients had a lower prevalence of reticulations (P = .034) on baseline CT (CT1, performed within 2 days before admission) and a longer duration between symptom onset and the time of CT2 (P < .01). There was no significant difference in hospital stay or fibrotic change on CT4 (follow-up CT scan performed 4 weeks after discharge) between 2 groups. Shorter duration between symptom onset and CT2 time (odds ratio [OR], 0.436; 95% confidence interval: 0.233–0.816; P < .01) and lower leukocyte count in baseline evaluation (OR, 0.316; 95% CI: 0.116–0.859; P < .05) were associated with increased odds of radiological deterioration on CT image during hospitalization.
For moderate COVID-19 patients, the value of routinely performed CT during the treatment is limited. We recommend avoiding using CT as a routine monitor in moderate COVID-19 patients.
The role of elevated red blood cell distribution width in the prognosis of AECOPD patients
Authors: Zhu Mengpei , Peng Hongxing , Wan Lei , Zhang Shuling , Zeng Yulan 
Published: March 2021

Abstract
Chronic obstructive pulmonary disease (COPD) is still a constant threat to people's health. We aimed to identify the relationship between increased red cell distribution width (RDW) on admission and length of hospitalization in acute exacerbation of chronic obstructive pulmonary disease patients (AECOPD).
Patients with AECOPD were recruited and divided into 3 groups based on RDW tertiles.
Two hundred eighty six patients with AECOPD admitted to our department during January 1, 2017 and June 30, 2019 were enrolled in the study. According to the RDW tertiles (≤12.8%, 12.9% to 13.6%, >13.6%), the patients were divided into 3 groups. Length of stay was significantly related to RDW (P < .001) in AECOPD patients. Correlation analysis indicated that RDW was negatively associated with FEV1% predicted (r = −0.142, P = .016). However, RDW was positively associated with prolonged of stay (r = 0.298, P < .001) in AECOPD patients. Multivariate regression analysis discovered that RDW was independently associated with the length of hospitalization (P = .001). Receiver operating characteristic (ROC) curve showed that RDW was a good predictor of prolonged hospital stay in AECOPD patients, and the area under the curve (AUC) was 0.818 (95% CI: 0.769–0.868). The highest sensitivity to predict prolonged hospital stay was 83.8% and the specificity was 71.6% with the cut-off 13.35%.
In conclusion, prolonged hospital stay in AECOPD patients was closely associated with increased RDW. Elevated RDW may be an independent predictor for prolonged hospitalization in AECOPD patients.
Suitability of h- and x-indices for evaluating authors’ individual research achievements in a given short period of years
Authors: Yie Kyent-Yon , Chien Tsair-Wei , Chen Chieh-Hsun , Yeh Yu-Tsen , Lin Jui-Chung John , Lai Feng-Jie 
Published: March 2021

Abstract

Background:
The h-index of a researcher refers to the maximum number h of his/her publications that has at least h citations via the concept of the square area. The x-index is determined by the maximum area of a rectangle under the curve to interpret authors’ individual research achievements (IRAs). However, the properties of both metrics have not been compared and discussed before. This study aimed to investigate whether both metrics of h- and x-index are suitable for evaluating IRAs in a short period of years.

Methods:
By searching the PubMed database (Pubmed.com), we used the keyword “PLoS One” (journal) and downloaded 50,000 articles published in 2015 and 2016. A total of 146,346 citations were listed in PubMed Central and 27,035 authors(with h-index ≥1) were divided into 3 parts. Correlation coefficients among metrics (ie, AIF, h, g, Ag, and x-index) were examined. The bootstrapping method used for estimating 95% confidence intervals was applied to compare differences in metrics among author groups. The most cited authors and topic burst were visualized by social network analysis. The most prominent countries/areas were highlighted by the x-index and displayed via choropleth maps.

Results:
Results demonstrated that, first, the h-index had the least relation to other metrics and failed to differentiate authors’ IRAs among groups, particularly in a short time period. Second, the top 3 highest x-index for countries were the United States, China, and the UK but with the productivity-oriented feature. Third, the most cited medical subject headings (ie, MeSH terms) were genome, metabolome, and microbiology, and the most cited author was Lori Newman (whose x-index = 13.52, and h = 2) from Switzerland with the article (PMID = 26646541) cited 291 times. The need for the x-index combined with a visual map for displaying authors’ IRAs was verified and recommended.

Conclusions:
We verified that the h-index failed to differentiate authors’ IRAs among author groups in a short time period. The x-index combined with the Kano map is recommended in research for a better understanding of the authors’ IRAs in other journals or disciplines, not just limited to the journal of PloS One as we did in this study.
Relationships between serum omentin-1 concentration, body composition and physical activity levels in older women
Authors: Li Shuo , Xue Jingjing , Hong Ping 
Published: March 2021

Abstract
This study aimed to investigate the relationships between omentin-1, body composition and physical activity (PA) levels in older women.
Eighty-one older women (age = 64 ± 6years; body mass index = 24.2 ± 3.2 kg/m2; body fat percentage = 36.1 ± 5.7%) participated in this study. We divided the subjects into overweight/obesity and normal weight group. Body composition was measured by dual energy X-ray absorptiometry. Serum omentin-1 concentration was measured using enzyme linked immunosorbent assay. PA levels were obtained by using accelerometers. In addition, anthropometric and insulin resistance values were determined.
Omentin-1 level in overweight/obesity group was significantly lower than in the normal weight group (P < .01). Analysis of all subjects showed that serum omentin-1 was negatively correlated with body weight, BMI (body mass index), waist circumference (WC), WHR (waist-to-hip ratio), percentage of body fat, total body fat mass (FM), fat-free mass (FFM) (r = −.571, −0.569, −0.546, −0.382, −0.394, −0.484, −0.524, all P < .01), respectively. We also found a negative correlation between moderate-to-vigorous physical activity (MVPA) and total body FM (r = −.233, P < .05). However, no significant correlation was found between omentin-1 and sedentary behavior and MVPA (both P > .05). Moreover, the relationship between omentin-1, body composition and PA was analyzed by using multiple linear stepwise regressions. The results showed that serum omentin-1 concentration was inversely correlated with total body FM (β = −0.334, P = .004) in multiple linear stepwise regression analysis.
We found that total body FM was inversely related to serum omentin-1 concentration and PA levels, but there was no correlation between omentin-1 and PA levels. These results showed that PA may participate in the regulation of body composition, which may be also affected by serum omentin-1. However, the mechanism by which PA affects body composition may not be through omentin-1 and was more likely through other metabolic pathways.
Transformation of NSCLC to SCLC after 1st- and 3rd-generation EGFR-TKI resistance and response to EP regimen and erlotinib
Authors: Lai Lin , Meng Wentao , Wei Jialiang , Zhang Xiaofei , Tan Zhiwei , Lu Yunxin , Hou Encun 
Published: March 2021

Abstract

Rationale:
Genotypic and histological evolution of non-small-cell lung cancer (NSCLC) into small-cell lung cancer (SCLC) has been described as a mechanism of acquired resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy. However, the number of clinical cases is rare.

Patient concerns:
Two lung adenocarcinoma patients with EGFR mutations who recurred after radical resection transformed into SCLC under treatment with the sequential first- and third-generation EGFR-TKIs.

Diagnosis:
The 2 cases were both confirmed as SCLC by pathological rebiopsy after EGFR-TKIs resistance.

Interventions:
Case 1 was treated with etoposide plus cisplatin (EP) regimen and erlotinib, while case 2 was treated with erlotinib and EP followed by oral etoposide.

Outcomes:
Case 1 treated with EP only achieved 3-month progression-free survival (PFS), which is the first case that reported T790 M/C797S cis-mutation for osimertinib resistance before the SCLC transformation. However, case 2 treated with erlotinib and EP followed by oral etoposide, PFS lasted for 8 months.

Lessons:
The cases highlighted the importance of rebiopsy that identified pathologically SCLC transformation after EGFR-TKI resistance, and suggested the treatment of erlotinib plus EP followed by etoposide, which could provide a reference for such phenotype.
A rare case of nevus sebaceous of the bilateral labia minora
Authors: Wen Qiao , Zhao Zhiwei , Yang Yanlin , Zhao Fengnian , Wang Ling , Cheng Juan , Wu Jiang , Miao Yali 
Published: March 2021

Abstract

Rationale:
Nevus sebaceous (NS) is a lesion caused by congenital hyperplastic disorder of the sebaceous glands. It commonly noted in the scalp and face and rarely in the trunk, neck, or oral mucosa. We present a rare case of a lesion arising in the genital region.

Patient concerns:
A 47-year-old woman complained of a gradual increase in the size of her bilateral labia minora over 2 years, which affected her sexual life and caused walking difficulty. She was admitted to the Department of Obstetrics and Gynecology. On physical examination, no ulcer, discharge, and vulval or vaginal bleeding were found. The bilateral inguinal lymph nodes were not palpable, bilateral labia minora were asymmetric, and the right side was evidently bigger than the left. The labia minora had serrated edges and numerous papillae with a maximum diameter of 0.5 cm. The vagina, cervix, and uterus with its attachments were normal. Blood samples tested negative for human immunodeficiency virus, human papilloma virus, hepatitis B virus, and hepatitis C virus.

Diagnosis:
A diagnosis of NS of the bilateral labia minora was made following histopathological examination of the resected specimen.

Intervention:
The bilateral labia minora lesions were resected general anesthesia on August 29, 2016. The operation was successful, and intraoperative blood loss was about 10 ml.

Outcomes:
After 40 months of postoperative follow-up, no recurrence or appearance of other tumors were noted.

Lessons:
We recommend surgical removal of lesions in the genital area during adolescence or before adulthood. Adolescence may be the best period for surgical intervention owing to a greater risk of malignant change in adulthood. On the other hand, surgical risk should be avoided in children considering the low incidence of malignant transformation.
Using human umbilical cord mesenchymal stem cells combined with allogenic platelet-rich fibrin membrane for the treatment of dual limb ischemia in an elderly patient
Authors: Ju Wendong , Fu Simao , Huang Jun , Li Bishuang , Wang Li , Zheng Minmin , Song Haojie , Li Quanyong , Zhou Qiaoyun , He Meixing 
Published: March 2021

Abstract

Rationale:
To describe the clinical effects of human umbilical cord mesenchymal stem cells (UCMSCs) combined with allogenic platelet-rich fibrin (PRF) for the treatment of lower limb ischemia in an elderly patient.

Patient concerns:
The patient was a 93-year-old Chinese woman with bilateral foot gangrene and ulcers lasting for 6 months. She had a prior history of Behcet's disease.

Diagnoses:
The admitting diagnosis for this episode was atherosclerosis bilateral limb ischemia.

Interventions:
First, treatment consisting of immunosuppressants, anticoagulation, antiplatelets, and anti-microbials were instituted. A UCMSC suspension was administered intravenously and injected into the lower limbs twice. An allogenic PRF membrane was externally applied 15 times over the lower limbs.

Outcomes:
The patient's pain improved and the 6 ulcers healed.

Lessons:
The combination of UCMSCs with a PRF membrane for the treatment of lower limb ischemia in an elderly patient is effective and safe. More and larger trials are needed before incorporating this therapy into mainstream treatment.
Randomized controlled trial comparing a conventional needle and a novel needle for endoscopic ultrasound (EUS)-guided histology of peripancreatic masses
Authors: Lee Hyoun Wook , Kim Kwang Min 
Published: March 2021

Abstract

Introduction:
Cytological study of samples obtained by Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) allows for recognition of clear signs of malignant transformation. However, certain neoplasms can be difficult to diagnose without histological analysis. Recently, a novel EUS-guided fine needle biopsy (EUS-FNB) needle was developed to increase tissue acquisition. This study set out to investigate the usefulness of this novel EUS-FNB needle (NEFN) in terms of obtaining a proper histology compared with a conventional EUS-FNA needle (CEFN).

Methods:
This investigation was a prospective, single-blind, randomized study in a single academic hospital. Primary outcome was the acquisition rate of an appropriate and sufficient specimen for histologic assessment. Secondary outcomes were diagnostic yield of peripancreatic masses using a CEFN and a NEFN. Furthermore, we assessed the feasibility of determining K-ras mutation status according to needle type.

Results:
The study enrolled 56 consecutive patients. Technical success rates were 96.6% (28/29) for the CEFN and 100% (27/27) for the NEFN (P = 1.000). No complications occurred during or after the procedure in either needle group. An adequate sample for cytologic diagnosis was obtained in 89.7% (26/29) of patients in the CEFN group vs 96.3% (26/27) of patients in the NEFN group (P = .612). For histologic diagnosis, a sample with a biopsy adequacy score of 2 or more was obtained in 41.4% (12/29) of CEFN-acquired samples vs 88.9% (24/27) of NEFN-acquired samples (P < .001). K-ras mutation analysis using histologic specimens was possible in 13 (44.8%) CEFN-acquired samples and 25 (92.6%) of NEFN-acquired samples. This difference was significant (P < .001).

Conclusions:
The present study suggests that the NEFN is an effective and reliable alternative compared to a CEFN in terms of tissue acquisition rate and quality of histologic sampling.