bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrent neonatal sepsis and progressive white matter injury in a premature newborn culture-positive for group B Streptococcus
Authors: Moon Cheong-Jun , Kwon Tae Hee , Lee Kyung Sang , Lee Hyun-Seung 
Published: June 2021

Abstract

Rationale:
Group B Streptococcus (GBS) remains a principal pathogen causing neonatal sepsis and meningitis, particularly in premature infants with relatively insufficient immunity. Recurrence may occur uncommonly, largely associated with subclinical mucosal persistence or repetitive exposure to exogenous sources. White matter injury (WMI) including cystic periventricular leukomalacia (PVL) has been associated with intrauterine infection/inflammation, and neonatal infection as a more significant predictor including postnatal sepsis and recurrent infection, even without microbial neuroinvasion. Furthermore, clinical and experimental evidence of WMI by some bacteria other than GBS without central nervous system invasion has been reported. However, there is little evidence of WMI associated with neonatal GBS sepsis in the absence of meningitis in the literature.

Patient concerns:
A newborn at 30+4 weeks’ gestation with low birthweight presented with 2 episodes (with a 13-day interval with no antibiotic therapy) of neonatal sepsis culture-proven for GBS with early-onset presentation after clinical chorioamnionitis via vertical GBS transmission and the associated conditions including prematurity-related neonatal immunodeficiency and persistent mucosal GBS carriage after the first antibiotic treatment. The perinatal GBS infection was complicated by progressive WMI presenting with ventriculomegaly and cystic PVL without a definite evidence of meningitis, intraventricular hemorrhage, and documented cerebral hypoxia or hypoperfusion conditions including septic shock.

Diagnoses:
Recurrent group B streptococcal sepsis and cystic PVL with ventriculomegaly.

Interventions:
Two episodes of GBS sepsis were treated with 15-day parenteral antibiotic therapy, respectively.

Outcomes:
Resolution of the recurrent GBS sepsis without further relapses, however, complicated by WMI and subsequent about 6 months delay in motor development at 12 months’ corrected age.

Lessons:
This case suggests WMI associated with GBS bacteremia without central nervous system entry by viable GBS and also shows that in premature infants, intrauterine GBS infection with no interventions may lead to extensive and persistent GBS colonization, early-onset and recurrent GBS disease, and WMI. Postnatal as well as intrauterine infection/inflammation controls with maternal prophylaxis may be pivotal for prevention and limiting the magnitude of neurologic injury.
The impact of Covid-19 pandemic related lockdown on clubfoot practice
Authors: Özbay Hakan , Toy Serdar , Polat Oktay 
Published: June 2021

Abstract
We investigated whether the number of pediatric patients with congenital clubfoot treated with the Ponseti method decreased during the Covid-19 pandemic or not in a rural area. So we aimed to guide orthopedic surgeons and health infrastructure for future pandemics to be prepared in hospitals of rural areas for the treatment of children with congenital clubfoot.
One hundred and fifty-four patients with clubfoot who were admitted to our clinic were evaluated retrospectively from March 2017 to December 2020. Institutional hospital electronic database was used to detect the number of weeks between the birth and first cast performed in clinic and the number of casts been applied and unilaterality or bilaterality. Patients were divided into four groups, which included pandemic period and three previous years. Recorded data were analyzed statistically to detect if there is a difference between the numbers of the patients in pandemic period and three previous years.
The number of patients with clubfoot admitted to our hospital between March 2020 and December 2020 increased by 140% compared to previous year. There was a statistically significant difference between the average number of cast applications of Group 4 and other groups (P <.001). Achilles tenotomy was performed in 44 (61.1%) of 72 patients admitted during the pandemic period. Only 4 (13.3%) out of 30 patients admitted between March 2019 and December 2019 were performed Achilles tenotomy.
We detected an increase in the number of clubfoot cases admitted to our rural-based hospital during the Covid-19 pandemic, treated with casting or surgically. We think this is because of preventive measures during the pandemic, which caused parents could not reach urban for treatment.
The efficacy of ivabradine in the treatment of acute myocardial infarction
Authors: Zhang Yonggeng , Sun Shu , Yi Song 
Published: June 2021

Abstract

Background:
Cardiovascular diseases have become a prominent threat to public health and quality of life. In recent years, some studies have reported that ivabradine can improve the cardiac function and prognosis of patients with acute myocardial infarction (AMI). Therefore, we perform a protocol for systematic review and meta-analysis to evaluate the efficacy of ivabradine for treating AMI.

Methods:
This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. We will search PubMed, Cochrane Library, Embase, Web of Science, and Medline databases for relevant studies. In addition, we will also collect 4 databases of China: China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database. Risk of bias will be assessed using the Cochrane Handbook risk of bias assessment tool version (V.5.1.0). We will use STATA 16.0 software (Stata Corporation, College Station, TX) to perform data analysis.

Results:
The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:
We hypothesized that ivabradine can reduce the resting heart rate and improve heart function in patients with AMI.
Seroprevalence of SARS-CoV-2 antibodies among 925 staff members in an urban hospital accepting COVID-19 patients in Osaka prefecture, Japan
Authors: Nishida Tsutomu , Iwahashi Hiromi , Yamauchi Kazuhiro , Kinoshita Noriko , Okauchi Yukiyoshi , Suzuki Norihiro , Inada Masami , Abe Kinya 
Published: June 2021

Abstract
The subclinical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rate in hospitals during the pandemic remains unclear. To evaluate the effectiveness of our hospital's current nosocomial infection control measures, we conducted a serological survey of anti-SARS-CoV-2 antibodies (immunoglobulin [Ig] G) among the staff of our hospital, which is treating coronavirus disease 2019 (COVID-19) patients.
The study design was cross-sectional. We measured anti-SARS-CoV-2 IgG in the participants using a laboratory-based quantitative test (Abbott immunoassay), which has a sensitivity and specificity of 100% and 99.6%, respectively. To investigate the factors associated with seropositivity, we also obtained some information from the participants with an anonymous questionnaire. We invited 1133 staff members in our hospital, and 925 (82%) participated. The mean age of the participants was 40.0 ± 11.8 years, and most were women (80.0%). According to job title, there were 149 medical doctors or dentists (16.0%), 489 nurses (52.9%), 140 medical technologists (14.2%), 49 healthcare providers (5.3%), and 98 administrative staff (10.5%). The overall prevalence of seropositivity for anti-SARS-CoV-2 IgG was 0.43% (4/925), which was similar to the control seroprevalence of 0.54% (16/2970) in the general population in Osaka during the same period according to a government survey conducted with the same assay. Seropositive rates did not significantly differ according to job title, exposure to suspected or confirmed COVID-19 patients, or any other investigated factors.
The subclinical SARS-CoV-2 infection rate in our hospital was not higher than that in the general population under our nosocomial infection control measures.
The prognostic value of inflammation markers in postoperative gliomas with or without adjuvant treatments
Authors: Luo Yuanfu , Deng Renzhi , Zhong Qiulu , Luo Danjing , Li Xiangde , Chen Xueyuan , Tao Sha , Feng Zhoubin , Jiayi Liu , Huang Yiyun , Li Jian , Liu Wenqi 
Published: June 2021

Abstract
Recent studies have shown that some inflammatory markers are associated with the prognosis of solid tumors. This study aims to evaluate the prognosis of glioma patients with or without adjuvant treatment using the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR).
All patients who were diagnosed with gliomas at the first and second affiliated hospital of Guangxi Medical University between 2011 and 2020 were included in this study. The optimal cutoff value of SII, NLR, and PLR was determined by X-tile software program. We stratified patients into several groups and evaluated the progression-free survival (PFS) and overall survival (OS) of SII, NLR, and PLR during the period of pre-surgical, con-chemoradiotherapy, and post-treatments. Multivariate Cox regression analyses were performed to detect the relationships between OS, PFS, and prognostic variables.
A total of 67 gliomas patients were enrolled in the study. The cutoff values of SII, NLR, and PLR were 781.5 × 109/L, 2.9 × 109/L, and 123.2 × 109/L, respectively. Patients who are pre-SII < 781.5 × 109/L had better PFS (P = .027), but no difference in OS. In addition, patients who had low pre-NLR (<2.9 × 109/L) meant better OS and PFS. PLR after adjuvant treatments (post-PLR) was significantly higher than pre-PLR (P = .035). Multivariate analyses revealed that pre-SII, pre-NLR were independent prognostic factors for OS (pre-SII: HR 1.002, 95% CI: 1.000–1.005, P = .030 and pre-PLR: HR 0.983, 95% CI: 0.973–0.994, P = .001), while pre-PLR was an independent factor for PFS (HR 0.989, 95% CI: 0.979–1.000, P = .041).
High pre-SII or high pre-NLR could be prognostic markers to identify glioma patients who had a poor prognosis.
Diagnostic yields and clinical features of ocular myasthenia gravis
Authors: Kim Hyuna , Oh Shin Yeop 
Published: June 2021

Abstract
To investigate clinical features and diagnosis process of ocular myasthenia gravis (OMG) in ophthalmology department.
A total of 36 patients with ptosis or diplopia who had follow-up for at least 3 months between March 2016 and December 2019 were included in this study. Clinical symptoms of patients and the test results were analyzed. According to the positivity of serologic test, these patients were divided into 2 groups (confirmed OMG and possible OMG with relief of symptoms after antimyasthenic treatment) for comparison.
Ptosis was present in 12 (33.33%) patients, diplopia was present in 14 (38.89%) patients, and both ptosis and diplopia were present in 10 (27.78%) patients. Acetylcholine receptor auto-antibody (AchR Ab) was positive in 14 (38.89%) of 36 patients and ice test was positive in 15 (71.43%) of 21 patients with ptosis. Unequivocal response to pyridostigmine was observed in 31 (86.11%) patients. For seropositive cases, AchR Ab titer was significantly higher in the group with 2 clinical symptoms than that in the 1 clinical symptom (P = .011).
This study presents the usefulness and diagnostic validity of antimyasthenic treatment for OMG, especially seronegative OMG, with detailed symptom analysis.
Assessing dental students’ professional satisfaction with operative dentistry teaching and curriculum
Authors: Alqarni Mohammed A. 
Published: June 2021

Abstract
Evaluating students’ professional training satisfaction with operative dentistry teaching and curriculum can help identify their educational needs and improve the quality of the education imparted. This study aimed to assess the professional training satisfaction of senior undergraduate dental students in Saudi Arabia from the operative dentistry course teaching and its curriculum at different levels and among genders.
A total of 193 (109 male, 56.48%; and 84 female, 43.52%) students participated in the survey. The respondents were at the 10th, 11th, and 12th levels of the Operative Dentistry course in a ratio of 34.2%, 32.1%, and 33.7%, respectively. Data were collected from survey items (18 questions) covering 6 areas: learning objectives, course materials, content relevance, instructor knowledge, instructor delivery and style, and facility and environment. Descriptive and analytical tests were performed using SPSS Software 19, with the significance level set at 0.05.
A high level of satisfaction was seen among level 10 (68.18%), 11 (79.03%), and 12 (86.15%) students. A significant statistical difference was observed among level 10 students with a low level of satisfaction and a high level of satisfaction (P = .045). The percentage of satisfaction increased with the level. A high level of satisfaction was seen among male (78.90%) and female (76.19%) students, with a total satisfaction level of 77.72%.
Continuous evaluation and assessment of teaching and curriculum can be a tool to improve the quality of education imparted, especially in clinical courses such as operative dentistry. This helps to prepare students for their professional life as healthcare providers. The role of teaching skills related to amalgam must be re-evaluated. It is recommended to include student representation and participation in course development committees, as they are the final recipients of the educational process.
Acute hemorrhagic necrotizing enterocolitis caused by non-O1/non-O139 Vibrio cholerae infection
Authors: Wu Mingjie , Zhou Liangjing , Cao Liping 
Published: June 2021

Abstract

Rationale:
Acute hemorrhagic necrotizing enterocolitis (AHNE) is a rapidly progressive and extremely dangerous disease. Here we report a rare case caused by Vibrio cholerae (V cholerae).

Patient concerns:
A 70-year-old man was admitted to our emergency department because of a sudden loss of consciousness.

Diagnoses:
On admission with severe toxic shock, the patient presented with elevated body temperature, decreased blood pressure, abdominal tenderness and rebound pain, predominantly on the right side. Computed tomography showed swelling and thickening of the right colon and peritoneal effusion. Necrosis was found in the hepatic flexure of the colon. On the basis of these results, the patient was diagnosed with AHNE.

Interventions and outcomes:
After fluid resuscitation, an exploratory laparotomy was performed immediately. The procedure was successful. Despite antibiotic therapy, the patient's clinical condition progressively deteriorated and he died of multi-organ failure on day 3 after admission.

Lessons:
AHNE is a rapidly progressive and extremely dangerous disease. Here we report a case of AHNE caused by non-O1/non-O139 V cholerae infection. The clinical features, phenotypic analyses and the presence of a panel of known virulence genes in the isolated strain are described. To the best of our knowledge, this is the first report of V cholerae causing severe AHNE, which is of profound pedagogical significance.
Primary malignant melanoma of the esophagogastric junction
Authors: Chu Yu-Ming , Hung Chih-Sheng , Huang Ching-Shui 
Published: June 2021

Abstract

Rationale:
Most gastrointestinal melanomas are metastatic from an oculocutaneous primary lesion; however, primary gastrointestinal melanomas have been found in all levels of the gastrointestinal tract. We present the case of Primary malignant melanoma of the esophagus and discuss the diagnostic methods, differentiation from metastatic lesions and treatment options.

Patient concerns:
A 78-year-old male patient presented with fresh blood vomiting and tarry stools for 1 day.

Diagnoses:
Esophagogastroduodenoscopy of this patient revealed a tumor ∼4 cm in size at the cardia side of the esophagogastric junction with dark-red and gray pigmentation. Immunohistochemical stains of the biopsy specimens were positive for S-100 and HMB-45, which are specific markers of melanoma.

Interventions:
Laparotomy with proximal gastrectomy was performed by the surgeon. Histological examination of the surgical specimen revealed the tumor arose from the distal esophagus with invasion of the proximal stomach. Primary malignant melanoma of the esophagus was diagnosed after a full skin and ophthalmic examination and positron emission tomography, which revealed no lesions elsewhere in the body.

Outcomes:
No tumor recurrence was noted at the 1-year follow-up.

Lessons:
Primary malignant melanoma of the esophagus is an extremely rare but highly aggressive tumor. The special pattern of pigmentation should be recognized while performing endoscopy. Early detection and radical resection of the tumor are critical to ensure favorable outcomes.
Bilateral breast myxedema caused by Graves’ disease and responsive to multipoint subcutaneous injection of long-acting glucocorticoid
Authors: Du Tingting , Jiang Wangyan , Luo Hongchang , Chen Fuqiong , Yuan Gang , Zhang Muxun , Liu Zhelong 
Published: June 2021

Abstract

Rationale:
With the absence of ophthalmopathy, thyroid dermopathy especially lesions at atypical locations is a very rare presentation. We herein report an original case of bilateral breast myxedema caused by Grave's disease.

Patient concerns:
A 21-year-old unmarried woman presented with a 4-month history of Grave's disease and a 1-month history of progressive bilateral breast enlargement. She had symmetrical bilateral breast enlargement with redness and nonpitting thickening of the skin, diffusely enlarged thyroid glands, and no exophthalmos.

Diagnosis:
Ultrasonography, magnetic resonance imaging scan, and skin biopsy confirmed the diagnosis of bilateral breast myxedema.

Interventions:
The patient was treated with multipoint subcutaneous injections of triamcinolone acetonide in each breast every month.

Outcomes:
The bilateral breast returned approximately to its normal size after therapy for 6 months.

Conclusions:
Our case illustrates that multipoint subcutaneous injection of glucocorticoids is beneficial for bilateral breast myxedema.
Favorable response to second-line atezolizumab and bevacizumab following progression on nivolumab in advanced hepatocellular carcinoma
Authors: Swed Brandon , Ryan Kara , Gandarilla Omar , Shah Manish A. , Brar Gagandeep 
Published: June 2021

Abstract

Rationale:
Advanced hepatocellular carcinoma (HCC) remains a deadly disease in part due to decades of limited therapeutic options. With recent advances in our understanding of the tumor biology, several promising treatment strategies involving targeted and immunotherapies have emerged. However, enhancing their modest efficacy in HCC and other gastrointestinal malignancies is essential to improving survival.

Patient concerns:
A man in his late 50s with a history of type 2 diabetes mellitus and morbid obesity initially presented with progressive abdominal pain and anorexia prompting an abdominal computed tomography scan that revealed a large solitary liver mass with extensive local involvement.

Diagnoses:
Although there were features consistent with a primary gastric tumor on subsequent endoscopic evaluation leading to early diagnostic uncertainty, his clinical picture, including a dominant liver mass, immunohistochemical staining profile, and significantly elevated alpha fetoprotein ultimately favored HCC.

Interventions:
The patient received palliative systemic therapy with infusional fluorouracil for a presumed gastric primary, however restaging scans after 3 cycles demonstrated disease progression. The consensus from a multidisciplinary discussion was that his pathology was more consistent with primary HCC. He was subsequently started on nivolumab with a partial response, although after 5 months, he progressed prompting initiation of second-line atezolizumab and bevacizumab with a favorable response.

Outcomes:
The addition of atezolizumab and bevacizumab led to a sustained biochemical and radiographic response that appeared to overcome the resistance to nivolumab monotherapy. Aside from several mild immune-related adverse effects, his quality of life has greatly improved and he has tolerated treatment well to date.

Lessons:
Our findings suggest that vascular endothelial growth factor inhibition can overcome resistance to checkpoint inhibition in advanced HCC by resulting in a unique synergy that has never before been described in patients. The biological rationale for this response is likely attributable to the immunomodulatory effects of antiangiogenic agents, promoting an immunostimulatory microenvironment that can be exploited by immune checkpoint inhibitors for more effective antitumor activity. Given the considerable benefit patients may derive following progression on first-line treatment, it is important to consider this strategic combination of therapies which can ultimately lead to improved patient outcomes.
Meta-analysis of patent foramen ovale closure versus medical therapy for prevention of recurrent ischemic neurological events
Authors: Pan Xuemei , Xu Liang , Zhou Chang , Zhang Zhi , Sun Heng 
Published: June 2021

Abstract

Background
The optimal treatment strategy for patent foramen ovale (PFO) patients with cryptic stroke remains controversial. We performed this meta-analysis to evaluate the effect of PFO closure versus different types of medical therapy.

Methods
We searched PubMed, Embase, and Cochrane databases. The primary efficacy endpoints were the composite outcome of recurrent stroke and/or transient ischemic attack (TIA). Secondary efficacy endpoints included separate stroke and TIA. Safety endpoints included new-onset atrial fibrillation (AF)/atrial flutter and bleeding.

Results
Compared with antiplatelet therapy, PFO closure significantly reduced the risk of composite outcome (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.27–0.51), stroke (OR 0.22, 95% CI 0.13–0.36], and TIA (OR 0.57, 95% CI 0.34–0.98); Compared with the mixed medical therapy group (consist of antiplatelet therapy, anticoagulant therapy, or both), PFO closure still showed some benefits, but the effect was not as significant as that of antiplatelet therapy (composite outcome: OR 0.53, 95% CI 0.41–0.69; stroke: OR 0.48, 95% CI 0.34–0.68; TIA: OR 0.69, 95% CI 0.50–0.96); Compared with anticoagulant therapy, PFO closure showed no benefit (composite outcome: OR 0.77, 95% CI 0.46–1.28; stroke: OR 0.59, 95% CI 0.28–1.25; TIA: OR 1.01, 95% CI 0.50–2.04). In terms of safe endpoints, compared with antiplatelet therapy and anticoagulant therapy, PFO closure increased the risk of AF/atrial flutter (OR 9.56, 95% CI 2.85–32.06; OR 18.96, 95% CI 1.11–323.8, respectively) and reduced the risk of bleeding (OR 0.50, 95% CI 0.24–1.05; OR 0.13, 95% CI 0.04–0.46, respectively); compared with mixed medical therapy, PFO closure increased the risk of AF/atrial flutter (OR 4.40,95% CI 2.24–8.67), but there was no difference in bleeding (OR 0.97, 95% CI 0.56–1.68).

Conclusions
With the addition of anticoagulants, the benefit of PFO closure decreased gradually. Patient groups that adopt individualized medical therapy strategies may benefit more.