bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cold scissors versus electrosurgery for hysteroscopic adhesiolysis
Authors: Yang Liuqing , Wang Ling , Chen Yun , Guo Xiaoshi , Miao Chenyun , Zhao Ying , Li Lu , Zhang Qin 
Published: April 2021

Abstract

Background:
Intrauterine adhesion seriously affects reproductive health in women. Hysteroscopic adhesiolysis using cold scissors or electrosurgery is the main treatment, although there is no consensus on the preferable method. This review aimed to compare the efficacy and safety of these methods for treating moderate to severe intrauterine adhesion.

Methods:
PubMed, EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure were searched on April 30, 2020. Randomized controlled trials and observational studies that were published in all languages (must contain English abstracts) and compared hysteroscopic cold scissors with electrosurgery for the treatment of intrauterine adhesion were included. Mean differences, odds ratios, and 95% confidence intervals (CIs) were reported. Bias was evaluated using the Cochrane Risk of Bias assessment tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Data were analyzed using RevMan software (Review Manager version 5.3, The Cochrane Collaboration, 2014). Two researchers independently extracted data and assessed the quality of the included studies. If a consensus was not reached, a third researcher was consulted.

Results:
Nine studies (n = 761; 6 randomized controlled trials and 3 retrospective studies) were included. The intrauterine adhesion recurrence rate with second look hysteroscopy was significantly lower (odds ratio = 0.30, 95% CI = 0.16–0.56; P = .0002) with hysteroscopic cold scissors than with electrosurgery. The total operation time was significantly shorter (mean difference = –7.78, 95% confidence interval = –8.50 to –7.07; P < .00001), intraoperative blood loss was significantly lower (mean difference = –9.88, 95% CI = –11.25 to –8.51; P < .00001), and the menstrual flow rate was significantly higher (odds ratio = 4.36, 95% confidence interval = 2.56–7.43; P < .00001) with hysteroscopic cold scissors than with electrosurgery. There were no significant differences in the pregnancy rate. One complication (1 perforation case, hysteroscopic cold scissors group) was reported.

Conclusions:
Hysteroscopic cold scissors is more efficient in preventing intrauterine adhesion recurrence, increasing the menstrual flow, reducing intraoperative blood loss, and shortening the operation time.
Clinical therapeutic effects of trastuzumab in HER2-positive breast cancer patients
Authors: Tong Chuanming , Wang Chuan , Yang Kun 
Published: April 2021

Abstract

Background:
Despite the developments in diagnosis and treatment of HER2-positive metastatic breast cancer, there is a high likelihood in the development of resistance to trastuzumab. In general, HER2-positive patients with deteriorated health face negative clinical outcomes. The present study is conducted to systematically explore the medicinal properties of trastuzumab in HER2-positive breast cancer patients.

Methods:
Randomized controlled trials investigating the clinical properties of including trastuzumab to treat HER2-positive breast cancer cases will be sourced by exploring these online-based databases: MEDLINE, BIOSIS, China National Knowledge Infrastructure (CNKI), Cochrane Library, EMBASE, Central Register of Controlled Trials, and WanFang. Two independent authors will screen the literature, gather data, and assess the quality of selected studies. The significance of the relationship between the medical properties of trastuzumab when incorporated to treat HER2-positive breast cancer cases will be evaluated according to the relative risk, mean differences or standardized mean differences, and 95% confidence interval.

Results:
The outcomes from this review shall be issued in a journal that will be reviewed by peers.

Conclusion:
The conclusions presented in this review will serve as a reference for clinical practitioners and scholars to determine whether trastuzumab is an effective and safety intervention for treating HER2-positive breast cancer patients.

Ethics and dissemination:
Since this study is a systematic review of published studies, an ethical approval is not needed.

Systematic review registration number:
March 31, 2021.osf.io/wvqkf (https://osf.io/wvqkf/).
Primary vaginal malignant melanoma
Authors: Guo Na , Zhang Jiawen 
Published: April 2021

Abstract

Rationale:
Primary vaginal malignant melanoma is a sporadic and very aggressive tumor that is treated through surgery or radiotherapy combined with chemotherapy. Since most cases are diagnosed at an advanced stage, the operation range is extensive, the quality of life is poor, and the prognosis is gloomy.

Patient concerns:
A 58-year-old woman presented irregular water-like leukorrhea for 1 month after 6 years of menopause. Positron emission tomography-computed tomography revealed a 3.1 × 2.6 × 3.2 mass on the middle and lower part of the right vaginal wall. A gynecological examination revealed a 2 to 3 cm exophytic black mass in the lower-right part of the vaginal orifice. This mass was 2 cm from the urethral orifice. Furthermore, the mucosa of the anterior inferior vaginal wall had blackened and thickened, and there were some scattered black dots at the medial labia minora.

Diagnosis:
Due to the patient's symptoms with radiographic findings, the postmenopausal woman was diagnosed with primary vaginal malignant melanoma.

Interventions:
Surgery was done to remove the mass. The patient also underwent inguinal lymph node dissection, received immunotherapy, and was treated with nivolumab.

Outcomes:
After a 6-month follow-up period, the patient underwent a routine gynecological examination with negative radiological results. Moreover, no local recurrence or distant metastases were found.

Lessons:
This patient showed a good response to immunotherapy. With this treatment method, the prognosis is better for advanced-stage women, especially those who cannot endure the surgery. Local lesion resection and inguinal lymph node dissection combined with immunotherapy are recommended. The case reported here may help treat similar clinical cases.
Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor encephalitis
Authors: Yang Jing , Du Jichen , Zhao Jing , Liu Haichao , Zhang Lvming , Cai Lina , Wang Qi , Han Bailin , Cui Jiangbo 
Published: April 2021

Abstract

Introduction
: Anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) is a subtype of glutamate receptor that mediates most of the fast excitatory neurotransmission in the brain. Anti-AMPAR encephalitis is an autoimmune-mediated neurological disorder, frequently accompanied by the presence of neoplasms, comprising a spectrum of paraneoplastic syndrome.

Patient concerns:
A 56-year-old man was admitted for deterioration in memory and aberrant psychological behaviors, which lasted for at least 20 days

Diagnosis:
The patient was diagnosed as anti-AMPAR encephalitis and 4 months later, he was diagnosed with small cell lung cancer.

Interventions:
Once diagnosis for anti-AMPAR encephalitis was confirmed, methylprednisolone was prescribed with initial dose 500 mg/d for 14 days until the patient returned to pre-illness state. Then he was discharged with oral treatment with corticosteroids. Following the diagnosis of small cell lung cancer, he received 5 rounds of chemotherapy, including carboplatin and etoposide.

Outcomes:
After taken the prescription of Methylprednisolone for anti-AMPAR encephalitis, he returned to pre-illness state and was discharged. In April 21, 2017, after symptoms of respiratory system showed up, he was diagnosed with small cell lung cancer and he eventually died of respiratory failure.

Conclusion:
Though progress has been made in recent years in diagnosis and treatment for autoimmune encephalitis, it is challenging to diagnose due to the similarity in clinical findings with other autoimmune or infectious encephalitis. In addition, it is necessary for these patients to regularly have tumor screening, considering AMPAR antibody encephalitis is closely associated with neoplasm, and the incidence of paraneoplastic syndrome is 63% to 70%.
Transient infantile hypertriglyceridemia with jaundice
Authors: Wang Jun , Sun Fang , Xu Pengfei , Zhang Yufeng , Sun Xinrong , Deng Huiling 
Published: April 2021

Abstract

Rationale:
Transient infantile hypertriglyceridemia (HTGTI) is a rare autosomal recessive inherited disease caused by inactivating mutations in the glycerol-3-phosphate dehydrogenase 1 gene. To date, only a few patients have been reported worldwide. The symptoms of the affected individuals present a certain degree of transient hypertriglyceridemia, hepatomegaly, elevated liver enzymes, persistent fatty liver and hepatic fibrosis in early infancy. However, the clinical characteristics and pathogenesis of this disease are remain unclear.

Patient concerns:
A one month and twenty-five days old girl was admitted to hospital because of persisted jaundice and hepatomegaly for fifty days.

Diagnose:
The girl was diagnosed with HTGTI coincident with a noval mutation in glycerol-3-phosphate dehydrogenase 1.

Intervention:
She was advised to take low-fat diet and supplement of medium-chain fatty acids.

Outcomes:
Her jaundice was gradually normal at the age of 4 months without any treatment, and hypertriglyceridemia were normal at the age of 13 months, but still had elevated transaminases and hepatic steatosis.

Lessons:
Jaundice may be a novel phenotype in HTGTI. The report contributes to the expansion of HTGTI's gene mutation spectrum and its clinical manifestations.
Postoperative new-onset atrial fibrillation causing acute embolic occlusion of the superior mesenteric artery
Authors: Cho Jinbeom , Lee Dosang 
Published: April 2021

Abstract

Rationale:
Postoperative atrial fibrillation following noncardiac surgery increases mortality, length of hospital stay, and medical expenses; moreover, compared to nonvalvular atrial fibrillation, it poses a similar risk of thromboembolic complications. In this report, we discuss our decision-making process for diagnosis and treatment in case with unexpected postoperative new-onset atrial fibrillation causing acute mesenteric ischemia.

Patient concerns:
A 78-year-old male patient received varicose vein stripping and ligation in his right leg. The patient was previously healthy with no known comorbidities. The next day after surgery, he complained of sudden epigastric pain unresponsive to conservative treatment, and new-onset atrial fibrillation was observed on electrocardiography.

Diagnoses:
An abdominal computed tomography scan revealed acute embolic occlusion of the superior mesenteric artery

Interventions:
Emergent surgical embolectomy was performed successfully. The time to operation from the recognition of abdominal pain was 6 h. Surgical critical care was performed for life-threatening ischemic reperfusion injury.

Outcomes:
The patient was discharged from the hospital on the 40th postoperative day.

Lessons:
Atypical postoperative abdominal pain unresponsive to conservative treatment should be considered a surgical emergency, and a high level of clinical suspicion for acute mesenteric ischemia is required. Preoperative electrocardiography and postoperative telemetry might be helpful in some asymptomatic patients.
Dual-construct fixation is recommended in ipsilateral femoral neck fractures with infra-isthmus shaft fracture
Authors: Wei Yi Ping , Lin Kai Cheng 
Published: April 2021

Abstract
The aim of this study was to evaluate the risk factors related to osteosynthesis failure in patients with concomitant ipsilateral femoral neck and shaft fractures, including old age; smoking habit; comminuted fragments; infra-isthmus fracture; angular malreduction; unsatisfactory reduction (fracture gap >5 mm); and treatment with single construct.
Patients over the age of 20 with concomitant ipsilateral femoral neck and shaft fractures diagnosed at a level one medical center between 2003 and 2019 were included. Treatment modalities included single construct with/without an antirotational screw for the neck and dual constructs. Radiographic outcomes were assessed from anteroposterior and lateral hip radiographs at follow-up. Fisher exact test was used to analyze categorical variables. The presence of avascular necrosis of the femoral head, delayed union, atrophic or hypertrophic nonunion of the femoral shaft fracture, and loss of reduction were identified as factors related to treatment failure.
A total of 22 patients were included in this study. The average age was 58.5 years, and the majority was male (68.2%). The minimum radiographic follow-up duration was 12 months, and the median follow-up time was 12 (interquartile range 12–24) months.
Femoral neck osteosynthesis failed in 3 patients, whereas femoral shaft osteosynthesis failed in 12 patients. Fisher exact test demonstrated the failure of femoral shaft osteosynthesis was significantly more frequent in the single-construct cohort in 16 infra-isthmus femoral fracture cases (P = .034).
In ipsilateral femoral neck and infra-isthmus shaft fractures, it is better to treat the neck and shaft fractures with separate implants (dual constructs).
In a dual-construct cohort, separate plate fixation of the femoral shaft achieved a better result in terms of bone union than retrograde nailing of the shaft (bone union rate: 4/8 vs 0/2).
Stereo-EEG Evaluation and Surgical Treatment in Patients With Drug-Resistant Focal Epilepsy Associated With Nodular Heterotopia
Authors: Durica Sarah R. , Caruso James P. , Podkorytova Irina , Ding Kan , Hays Ryan , Lega Bradley , Perven Ghazala 
Published: April 2021

Purpose:
Nodular heterotopia (NH) is a common cause of drug-resistant epilepsy. Only limited studies detail the treatment of NH with laser interstitial thermal therapy and none analyze the relation between epileptogenicity and NH location.

Methods:
We retrospectively studied nine patients with drug-resistant epilepsy and NH who underwent stereoelectroencephalography and subsequent epilepsy surgery. Nodular heterotopia in the frontal lobes or along the bodies of the lateral ventricles was classified as anterior NH. Nodular heterotopia in the trigones, temporal or occipital horns, or temporal lobes was classified as posterior NH. Nodular heterotopia in both anterior and posterior locations was classified as diffuse NH. Interictal and ictal stereoelectroencephalography were analyzed, and patients were followed postoperatively to assess outcomes.

Results:
Of the six patients who underwent nine laser interstitial thermal therapy procedures either in isolation or in combination with other surgical therapies, four patients were Engel Ia, one was Engel IIb, and one was Engel IIIa, with an average follow-up of 22.8 months. All patients with posterior NH had interictal epileptiform abnormalities and seizures originating from the posterior NH. None of the patients with anterior NH had epileptiform activity recorded from their NH.

Conclusion:
Laser interstitial thermal therapy alone or in combination with other surgical therapies is an effective treatment in those with drug-resistant epilepsy because of NH, even in those with extensive NH and broad seizure onset. We observed a trend suggesting that posterior NH are more likely to be epileptogenic compared with anterior NH and recommend that in patients with anterior NH, alternative epilepsy etiologies and stereoelectroencephalography implantation strategies be considered.
Interleukin-6 receptor genetic variation and tocilizumab treatment response to COVID-19
Authors: Almarzooq Ammar Ali 
Published: April 2021

ABSTRACTInterleukin-6 receptor (IL6R) stimulates the inflammatory pathways as part of the acute-phase response to infection. Tocilizumab is a monoclonal antibody that inhibits both membrane-bound and soluble IL6R and is used to treat inflammatory conditions, including COVID-19. Despite the disproportionate incidence of COVID-19 among underserved, racial, and ethnic minority populations, the efficacy of tocilizumab in hospitalized COVID-19 patients from these populations is unclear. In this work, three genetic markers for the IL6R gene were analyzed across diverse ethnic backgrounds to identify population differences in response to tocilizumab treatment. Genetic structure analyses showed that African populations were significantly different from other described populations. In addition, mapped frequencies of these alleles showed that Sub-Saharan African populations were 3.4x more likely to show an impaired response to tocilizumab than East Asian populations, and 1.8x more likely than European ancestry populations. Existing IL6R genotype results may identify populations at increased therapeutic failure risk. As results from current clinical trials on the efficacy of tocilizumab treatment for extreme COVID-19 infections are conflicting, more studies are needed across diverse patient backgrounds to better understand the genetic factors necessary to predict treatment efficacy. This work demonstrates how pharmacogenomics studies can elucidate genetic variation on treatment efficacy on COVID-19.
Trends of SARS-CoV-2 antibody prevalence in selected regions across Ghana
Authors: Quashie Peter Kojo , Mutungi Joe Kimanthi , Dzabeng Francis , Oduro-Mensah Daniel , Opurum Precious C. , Tapela Kesego , Udoakang Aniefiok John ,   WACCBIP COVID-19 Team, Asante Ivy , Paemka Lily , Kumi-Ansah Frederick , Quaye Osbourne , Amoako Emmanuella , Armah Ralph , Kilba Charlyne , Boateng Nana Afia , Ofori Michael , Kyei George B. , Bediako Yaw , Ndam Nicaise , Abugri James , Ansah Patrick , Ampofo William K. , Mutapi Francisca , Awandare Gordon A. 
Published: April 2021

AbstractTo estimate the level of community exposure to SARS-CoV-2 in Ghana, we conducted phased seroprevalence studies of 2729 participants in selected locations across Ghana. Phase I screening (August 2020) covered a total of 1305 individuals screened at major markets/lorry stations, major shopping malls, hospitals and research institutions involved in COVID-19 work. The screening was performed using a strip-in-cassette lateral flow type Rapid Diagnostic Test (RDT) kit that simultaneously and separately detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. In Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure rate was significantly higher among individuals tested at markets/lorry stations (26.9%) compared to those at Shopping Malls (9.4%). The 41–60-years age group had the highest exposure rate (27.2%). People with only a basic level or no formal education had a higher exposure rate (26.2%) than those with tertiary level education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Phases II and III screening activities in October and December 2020, respectively, showed no evidence of increased seroprevalence, indicating either a reduced transmission rate or loss of antibody expression in a subset of the participants. The Upper East region has the lowest exposure rate, with only 4 of 200 participants (2%) seropositivity. Phase IV screening in February 2021 showed that exposure rates in the upper income earners (26.2%) had almost doubled since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases, which began in December 2020. The Phase IV results suggest that seroprevalence levels have become so high that the initial socioeconomic stratification of exposure has been lost. Overall, the data indicates a much higher COVID-19 seroprevalence in the Greater Accra Region than was officially acknowledged, likely implying a considerably lower case fatality rate than the current national figure of 0.84%. Additionally, the high exposure levels seen in the communities suggest that COVID-19 in Ghana still predominantly presents with none-to-mild symptoms. Our results lay the foundation for more extensive SARS-CoV-2 surveillance in Ghana and the West African sub-region, including deploying rapid antigen test kits in concert to determine the actual infection burden since antibody development lags infection.
Forecasting COVID-19 disease cases using the SARIMA-NNAR hybrid model
Authors: Demir İbrahim , Kirişci Murat 
Published: April 2021

AbstractBackgroundCOVID-19 is a new disease that is associated with high morbidity that has spread around the world. Credible estimating is crucial for control and prevention. Nowadays, hybrid models have become popular, and these models have been widely implemented. Better estimation accuracy may be attained using time-series models. Thus, our aim is to forecast the number of COVID-19 cases with time-series models.ObjectiveUsing time-series models to predict deaths due to COVID-19.DesignSARIMA, NNAR, and SARIMA-NNAR hybrid time series models were used using the COVID-19 information of the Republic of Turkey Health Ministry.ParticipantsWe analyzed data on COVID-19 in Turkey from March 11, 2020 to February 22, 2021.Main MeasuresDaily numbers of COVID-19 confirmed cases and deaths.Materials and methodsWe fitted a seasonal autoregressive integrated moving average (SARIMA)–neural network nonlinear autoregressive (NNAR) hybrid model with COVID-19 monthly cases from March 11, 2020, to February 22, 2021, in Turkey. Additionally, a SARIMA model, an NNAR model, and a SARIMA–NNAR hybrid model were established for comparison and estimation.ResultsThe RMSE, MAE, and MAPE values of the NNAR model were obtained the lowest in the training set and the validation set. Thus, the NNAR model demonstrates excellent performance whether in fitting or forecasting compared with other models.ConclusionsThe NNAR model that fits this study is the most suitable for estimating the number of deaths due to COVID-19. Hence, it will facilitate the prevention and control of COVID-19.
Atypical Resting State Functional Connectivity in Mild Traumatic Brain Injury
Authors: Amir Joelle , Raghavan Nair Jay Kumar , Del Carpio Raquel , Ptito Alain , Chen Jen-Kai , Chankowsky Jeffrey , Tinawi Simon , Lunkova Ekaterina , Saluja Rajeet Singh 
Published: April 2021

AbstractObjectivesThis study aimed to investigate changes in three intrinsic functional connectivity networks (IFCNs; default mode (DMN), salience (SN), and task-positive networks (TPN)) in individuals who had sustained a mild traumatic brain injury (mTBI).MethodsResting-state functional magnetic resonance imaging (rs-fMRI) data was acquired from 27 mTBI patients with persistent post-concussive symptoms (PCS), along with 26 age- and sex-matched controls. These individuals were recruited from a Level-1 trauma centre, at least three months after a traumatic episode. IFCNs were established based on seed-to-voxel, region-of-interest (ROI) to ROI, and independent component analyses (ICA). Subsequently, we analyzed the relationship between functional connectivity and PCS.ResultsSeed-to-voxel analysis of rs-fMRI demonstrated decreased functional connectivity in the right lateral parietal lobe, part of the DMN, and increased functional connectivity in the supramarginal gyrus, part of the SN. Our TPN showed both hypo- and hyperconnectivity, dependent on seed location. Within network hypoconnectivity was observed in the visual network, also using group comparison. Using an ICA, we identified altered network functional connectivity in regions within four IFCNs (sensorimotor, visual, DMN, and dorsal attentional). A significant negative correlation between dorsal attentional network connectivity and behavioural symptoms score was also found.ConclusionsOur findings indicate that rs-fMRI may be of use clinically, in order to assess disrupted functional connectivity among IFCNs in mTBI patients. Improved mTBI diagnostic and prognostic information could be especially relevant for athletes looking to safely return to play, as well for individuals from the general population with persistent post-concussive symptoms months after injury, who hope to resume activity.