bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of cognitive behavioural play therapy on social anxiety among school children with stuttering deficit
Authors: Obiweluozo Patience Enuma , Ede Moses Onyemaechi , Onwurah Chimezie Nneka , Uzodinma Uchenna Eugenia , Dike Ibiwari Caroline , Ejiofor Juliana Ngozi 
Published: May 2021

Abstract

Background:
Stuttering is a speech deficit which is characterized by obstruction of speech eloquence and verbal expression in addition to involuntary flow of air during communication. School children with communication deficit often experience social anxiety in their immediate environment. Currently, reports show that a good number of children with communication deficits are prone to social maladjustment due to their being socially inept. And this has significantly affected their thought pattern, social behaviours and emotional responses. In view of this, we examined the impact of cognitive behavioural play therapy in reducing social anxiety among school children with stuttering.

Method:
This is a pretest-posttest randomized control group design. Participants were 178schoolchildren in inclusive schools in South east Nigeria. Participants in the intervention group were treated using cognitive behavioural play therapy programme (CBPT). Participants in the waitlist control group were only assessed at three points of assessment. Data analyses were completed using repeated measures ANOVA.

Results:
The results show that cognitive behavioural play therapy is beneficial in decreasing schoolchildren's social anxiety scores. The intervention equally showed the considerable impacts on the children when exposed to cognitive behavioural play programme at different times of assessment compared to waitlisted control group.

Conclusion:
It is concluded that CBPT is a long-term psychotherapeutic programme that has significant impacts in reducing social anxiety among children with stuttering. This study makes a leading contribution on the limited scholarship focusing on the impact of CBPT on social anxiety of special population with stuttering deficits in developing countries.
Xuefu Zhuyu decoction for nonalcoholic fatty liver disease
Authors: Liu Jiaxin , Dong Bo , Yang Lin , Huang Wei , Tang Songqi 
Published: May 2021

Abstract

Background:
Nonalcoholic fatty liver disease (NAFLD) includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH), which ranks only second to viral hepatitis and poses an increasingly serious challenge to global public health and economy. NAFLD has attracted more and more attention, but there is no drugs with exact curative effects are available. The commonly used drugs for the treatment of NAFLD in clinical practice are statins, such drugs, inevitably increase the burden on the live. Compared to statins, traditional Chinese medicines are believed to be “all natural” with fewer side effects, are associated with strong patient compliance. Accordingly, a great deal of clinical studies have shown that Xuefu Zhuyu decoction (XFZYD) can significantly improve the clinical symptoms and enhance the therapeutic effect. Meanwhile, a system review and meta-analysis are conducted by us to further clarify the effectiveness and safety of XFZYD for NAFLD.

Methods:
We will apply to database mainly range from the English literature searches Cochrane Library, PubMed, excerpt medica database, and Web of Science to the Chinese literature China national knowledge infrastructure, Chinese biomedical literature database, VIP, and Wanfang database, randomized controlled trials (RCTs) are enrolled to evaluate the effectiveness and safety of XFZYD in the treatment of NAFLD, the enrollment of RCTs is from the establishment of the database to February 01, 2021. Simultaneously we will retrieval clinical registration tests and grey literatures. The 2 researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is expressed in terms of relative risk, the continuous is represented by mean difference or standard mean difference, whether there is heterogeneity is the factor that determines the synthesis of data in fixed effect model or random effect model. Alanine aminotransferase (ALT) or Aspartic acid aminotransferase (AST) coupled with Glutamyltransferase (GGT) is considered as one of the main indicators of the NAFLD, while the pathology, imaging and diagnosis of metabolic syndrome are also auxiliary results. The last, meta-analysis was conducted by RevMan software version 5.3.

Results:
This study will provide evidence for treatment of NAFLD with XFZYD in terms of effectiveness and safety.

Conclusion:
This systematic review aims to confirm the efficacy and safety of XFZYD in the treatment of NAFLD.

OSF registration number:
DOI 10.17605/OSF.IO/7CWRK.
Is pre-operative axillary ultrasound alone sufficient to determine need for axillary dissection in early breast cancer patients?
Authors: Jamaris Suniza , Jamaluddin Jazree , Islam Tania , See Mee Hoong , Fadzli Farhana , Rahmat Kartini , Bhoo-Pathy Nirmala , Taib Nur Aishah Mohd 
Published: May 2021

Abstract
Pre-operative status of axillary lymph node (ALN) in early breast cancer is usually initially assessed by pre-operative ultrasound, followed by ultrasound-guided needle biopsy (UNB) confirmation. Patients with positive nodal status will undergo axillary lymph node dissection (ALND), while those with negative nodal status will have sentinel lymph node biopsy. ALND is associated with higher morbidity than Sentinel lymph node biopsy. The objective of this study is to determine if axillary ultrasound alone without UNB is predictive enough to assign patients to ALND and to identify ultrasound features that are significantly associated with pathologically positive ALN.
383 newly diagnosed primary breast cancer patients between 2012 and 2014, and who had undergone pre-operative axillary ultrasound in University Malaya Medical Centre with a complete histopathology report of the axillary surgery were retrospectively reviewed. ALN was considered positive if it had any of these features: cortical thickening > 3 mm, loss of fatty hilum, hypoechoic solid node, mass-like appearance, round shape and lymph node size > 5 mm. Post-operative histopathological reports were then analyzed for nodal involvement.
The overall sensitivity, specificity, and accuracy of pre-operative axillary ultrasound in detecting diseased nodes were 45.5%, 80.7%, and 60.3% respectively. The positive (PPV) and negative predictive values were 76.5% and 51.8%. Round shape, loss of fatty hilum and mass-like appearance had the highest PPVs of 87%, 83% and 81.6% respectively and significant odds ratios (ORs) of 5.22 (95% confidence interval [CI]: 1.52 - 17.86), ORs of 4.77 (95% CI: 2.62 - 8.70) and ORs of 4.26 (95% CI: 2.37 - 7.67) respectively (P-value < .05). Cortical thickness of > 3 mm was identified to have low PPV at 69.1%, ORs of 1.71 (95% CI: 0.86 - 3.41, P = .126).
There are features on axillary ultrasound that confer high PPV for axillary involvement i.e. round shape, loss of fatty hilum, and mass-like appearance. In a low resource setting, these features may benefit from ALND without further pre-operative biopsies. However, pre-operative UNB for features with low PPV that is, cortical thickness > 3 mm should be considered to obviate the unnecessary morbidity associated with ALND.
The efficacy and safety of combined methotrexate with anti-vascular endothelial growth factor therapy in treatment of diabetic macular edema
Authors: Bao Yuzhi , Lu Xiaolei , Zhou Yuwei 
Published: May 2021

Abstract

Objective:
There is no review or meta-analysis to compare the efficacy and safety of methotrexate plus anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with diabetic macular edema (DME). It is worthy to critically review the evidence of the assessment of combined therapies to inform clinical practice. Therefore, the purpose of this study was to compare the efficacy and safety of methotrexate plus anti-VEGF therapy in the treatment of DME and to provide evidence for clinical practice.

Methods:
The electronic databases of EMBASE, PubMed, Cochrane Library, and Web of Science were searched from the inception to April 2021 using the following key terms: “diabetic macular edema,” “methotrexate,” and “anti-vascular endothelial growth factor,” for all relevant studies. Additionally, the reference lists from published original articles and relevant reviews were assessed to identify more relevant studies. Only English publications were included. Data were extracted by review of each study for population, mean age, gender, follow-up duration, study design, publishing date, characteristics, and outcomes assessment. The present study was performed using Review Manager (RevMan Version 5.3, The Cochrane Collaboration, Copenhagen, Denmark).

Results:
We hypothesized that combined therapies would provide better therapeutic benefits compared to single method.

OSF registration number:
10.17605/OSF.IO/APD6 V.
Blastic plasmacytoid dendritic cell neoplasm of the breast
Authors: Lee Hyo-jae , Park Hye Mi , Ki So Yeon , Choi Yoo-Duk , Yun Sook Jung , Lim Hyo Soon 
Published: May 2021

Abstract

Rationale:
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon and aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions with or without involvement of lymph nodes, peripheral blood, or bone marrow. However, breast involvement of BPDCN is rare and there has been no report describing the radiologic features of BPDCN within breast parenchyma.

Patient concerns:
We report a case of a 47-year-old woman who presented with an incidentally detected hypermetabolic breast lesion on PET/CT with concurrent right cheek plaque.

Diagnoses:
Skin biopsy was performed for the right cheek plaque. Mammography and breast ultrasonography were performed to evaluate the breast lesion. The lesion was depicted as a 2.5 cm sized focal asymmetry on mammogram and an irregular heterogeneous echoic mass within the mammary zone of the right upper outer breast. Core needle biopsy was performed for the breast lesion. Histologic diagnosis of the two lesions was BPDCN.

Interventions:
The patient was treated with induction and consolidation chemotherapy and received allogenic peripheral blood stem cell transplantation.

Outcomes:
The patient remains in complete remission state without relapse at 34 months since initial diagnosis.

Lessons:
This is the first case of BPDCN manifested as a breast parenchymal mass and assessed by diagnostic breast imaging tools (mammography and ultrasonography). This case report is significant for BPDCN within the breast parenchyma and presenting rare radiologic description of BPDCN.
Efficacy and safety of Xihuang pill for gastric cancer
Authors: Wang Junwei , Hou Daorui , Peng Yahui , Xiong Jian , Xiong Lu , Tan Xin 
Published: May 2021

Abstract

Background:
Xihuang pill has been widely applied as a promising adjunctive drug for gastric cance. However, the exact effects and safety of Xihuang pill have yet to be systematically investigated. We aimed to summarize the effificacy and safety of Xihuang pill for the treatment of advanced GC through the meta-analysis, in order to provide scientific reference for the design of future clinical trials.

Methods:
The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant randomized controlled trials were searched from PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and echnology Periodical Database, and Chinese Biomedical Literature Database. Papers in English or Chinese published from their inception to October 2020 will be included without any restrictions. Cochrane Risk of Bias tool will be used to assess the risk of bias of included studies. The RevMan 5.4 and Stata 16.0 software will be applied for statistical analyses. Statistical heterogeneity will be computed by I
2 tests. Sensitivity analysis will be conducted to evaluate the stability of the results. The publication bias will be evaluated by funnel plots and Egger test. The quality of evidence will be assessed by the Grading of Recommendations Assessment, Development and Evaluate system.

Results:
The results of our research will be published in a peer-reviewed journal.

Conclusion:
The conclusion of this study will provide helpful evidence of the effect and safety of Xihuang pill for the treatment of GC in clinical practice.

OSF registration number:
10.17605/OSF.IO/VFJAK.
Durability of non-nucleotide reverse transcriptase inhibitor-based first-line ART regimens after 7 years of treatment in rural Uganda
Authors: Nanfuka Mastula , Forrest Jamie I. , Zhang Wendy , Okoboi Stephen , Birungi Josephine , Kaleebu Pontiano , Zhu Julia , Tibenganas Samuel , Moore David M. 
Published: May 2021

Abstract
Most antiretroviral therapy (ART) programs in resource-limited settings have historically used non-nucleotide reverse transcriptase inhibitor (NNRTI)-based regimens with limited access to routine viral load (VL) testing. We examined the long-term success of these regimens in rural Uganda among participants with 1 measured suppressed VL.
We conducted a prospective cohort study of participants who had been on NNRTI-based first-line regimens for ≥4 years and had a VL <1000 copies/mL at enrollment in Jinja, Uganda. We collected clinical and behavioral data every 6 months and measured VL again after 3 years. We quantified factors associated with virologic failure (VF) (VL ≥ 1000 copies/mL) using Wilcoxon Rank Sum, chi-square, and Fisher's Exact Tests.
We enrolled 503 participants; 75.9% were female, the median age was 45 years, and the median duration of time on ART was 6.8 years (IQR = 6.0–7.6 years). Sixty-nine percent of participants were receiving nevirapine, lamivudine, and zidovudine regimens; 22.5% were receiving efavirenz, lamivudine, and zidovudine; and 8.6% were receiving other regimens. Of the 479 with complete follow-up data, 12 (2.5%) had VL ≥ 1000 copies/mL. VF was inversely associated with reporting never missing pills (41.7% of VFs vs 72.8% non-VFs, P = .034). There were differences in distribution of the previous ART regimens (P = .005), but no clear associations with specific regimens. There was no association between having a VL of 50 to 999 copies/mL at enrollment and later VF (P = .160).
Incidence of VF among individuals receiving ART for nearly 7 years was very low in the subsequent 3 years. NNRTI-based regimens appear to be very durable among those with good initial adherence.
Gastrointestinal perforation secondary to COVID-19
Authors: Al Argan Reem J. , Alqatari Safi G. , Al Said Abir H. , Alsulaiman Raed M. , Noor Abdulsalam , Al Sheekh Lameyaa A. , Al Beladi Feda’a H. 
Published: May 2021

Abstract

Introduction:
Corona virus disease-2019 (COVID-19) presents primarily with respiratory symptoms. However, extra respiratory manifestations are being frequently recognized including gastrointestinal involvement. The most common gastrointestinal symptoms are nausea, vomiting, diarrhoea and abdominal pain. Gastrointestinal perforation in association with COVID-19 is rarely reported in the literature.

Patient concerns and diagnosis:
In this series, we are reporting 3 cases with different presentations of gastrointestinal perforation in the setting of COVID-19. Two patients were admitted with critical COVID-19 pneumonia, both required intensive care, intubation and mechanical ventilation. The first one was an elderly gentleman who had difficult weaning from mechanical ventilation and required tracheostomy. During his stay in intensive care unit, he developed Candidemia without clear source. After transfer to the ward, he developed lower gastrointestinal bleeding and found by imaging to have sealed perforated cecal mass with radiological signs of peritonitis. The second one was an obese young gentleman who was found incidentally to have air under diaphragm. Computed tomography showed severe pneumoperitoneum with cecal and gastric wall perforation. The third case was an elderly gentleman who presented with severe COVID-19 pneumonia along with symptoms and signs of acute abdomen who was confirmed by imaging to have sigmoid diverticulitis with perforation and abscess collection.

Interventions:
The first 2 cases were treated conservatively. The third one was treated surgically.

Outcome:
Our cases had a variable hospital course but fortunately all were discharged in a good clinical condition.

Conclusion:
Our aim from this series is to highlight this fatal complication to clinicians in order to enrich our understanding of this pandemic and as a result improve patients’ outcome.
Prominent PD-L1-positive M2 macrophage infiltration in gastric cancer with hyper-progression after anti-PD-1 therapy
Authors: Yamaguchi Kyoko , Tsuchihashi Kenji , Tsuji Kunihiro , Kito Yosuke , Tanoue Kenro , Ohmura Hirofumi , Ito Mamoru , Isobe Taichi , Ariyama Hiroshi , Kusaba Hitoshi , Akashi Koichi , Baba Eishi 
Published: May 2021

Abstract

Rationale:
Anti-PD-1 antibody is the standard therapy for treatment-resistant gastric cancer, but only a limited number of patients respond. Additionally, cases of hyper-progressive disease (HPD) in which tumor growth accelerates after anti-PD-1 antibody administration have been reported; however, the biological mechanism has not been elucidated.

Patient concerns:
In the present case, metastatic gastric cancer was treated with the anti-PD-1 antibody, nivolumab, as third-line treatment.

Diagnosis:
After the initiation of nivolumab therapy, a rapidly enlarging para-aortic lymph nodes were observed leading to the diagnosis of HPD.

Interventions:
Multiplex immunohistochemistry was used to examine immune cells infiltrating in the primary tumor and in liver metastasis which were obtained before nivolumab treatment, and in lymph node metastasis which presented with HPD after nivolumab therapy.

Outcomes:
In the primary tumor, helper T (Th) cells, cytotoxic T lymphocytes (CTLs), regulatory T (Treg) cells, and PD-L1-negative macrophages were observed. On the other hand, in metastatic lymph nodes presenting with HPD, PD-L1-positive macrophages prominently increased, while Treg cells, CTLs, and Th cells decreased. PD-L1 expression was not observed in gastric cancer cells among the three specimens.

Lessons:
The findings suggest the possibility that PD-L1-positive M2 macrophage might contribute to acceleration of tumor growth with anti-PD-1 therapy in the present case.
Atrial reconstruction, distal gastrectomy with Ante-situm liver resection and autotransplantation for hepatocellular carcinoma with atrial tumor thrombus
Authors: Tuxun Tuerhongjiang , Apaer Shadike , Yao Gang , Wang Zhipeng , Gu Shensen , Zeng Qi , Aizezijiang Aidan , Wu Jing , Anweier Nuerzhatijiang , Zhao Jinming , Li Tao 
Published: May 2021

Abstract

Rationale:
Hepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures.

Patient concerns:
We present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities.

Diagnoses:
Preoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium.

Interventions:
Distal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed.

Outcomes:
The operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence.

Lessons:
This case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.
Rescue balloon-assisted remodeling technique for protrusion of coil loop
Authors: Ko Hak Cheol 
Published: May 2021

Abstract

Rationale:
Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop.

Patient concerns:
A 53-year-old man was admitted to our hospital with severe bursting headache, nausea, and vomiting. Computed tomography showed subarachnoid hemorrhage and digital subtraction angiography revealed an anterior communicating artery aneurysm. We decided to obliterate the aneurysm with endovascular embolization using detachable coils

Diagnosis:
A small loop protruded into the parent artery during the removal of the microcatheter.

Interventions:
We performed successful repositioning of the protruded coil loop using balloon inflation.

Conclusion:
The rescue balloon-assisted remodeling technique was useful in the management of protrusion of a small coil loop into the parent artery during endovascular coil embolization of an intracranial aneurysm. The procedure was associated with minimal complications.
Using JAK inhibitor to treat cytokine release syndrome developed after chimeric antigen receptor T cell therapy for patients with refractory acute lymphoblastic leukemia
Authors: Zi Fu Ming , Ye Long Long , Zheng Ji Fu , Cheng Jing , Wang Qing Ming 
Published: May 2021

Abstract

Rationale:
Significant concerns about the adverse effects following chimeric antigen receptor T cell (CAR-T) therapy are still remained including cytokine release syndrome (CRS). In rare circumstances, CRS may be refractory to tocilizumab and/or corticosteroids, a new treatment is needed for the management of CRS.

Patient concerns:
We present a case of a 20-year-old male patient with acute lymphoblastic leukemia developed CRS after CD19/CD22 bispecific CAR-T treatment.

Diagnosis:
The patient was diagnosed with BCR-ABL(P210) positive B-ALL and developed CRS after CD19/CD22 bispecific CAR-T treatment.

Interventions:
Tocilizumab and methylprednisolone were administered, unfortunately the patient's symptoms of CRS were still not resolved. Another methylprednisolone and ruxolitinib were administered.

Outcomes:
The persistent fever and hypotension of this patient achieved a rapid clinical remission within hours after ruxolitinib administration.

Lessons:
Ruxolitinib can be used as an alternative therapeutic approach for severe and refractory CRS without impairing CAR-T amplification and anti-tumor effect.