bluuebunny/crossref_metadata_2025_split huggingface dataset:
Etiology of serum vitamin B12 elevation 1 month after bariatric surgery
Authors: Guo Pengsen , Yang Huawu , Zhou Jinhua , Mao Rui , Zhan Dafang , Zhang Tongtong , Yuan Jiang , Ou Yanxi , Liu Yanjun 
Published: December 2021

Abstract
Few studies have reported an increase in vitamin B12 (VitB12) levels after bariatric surgery. This study reports the phenomenon and adverse reactions of serum VitB12 elevation 1 month after surgery and explores the possible etiologies.
Retrospective analysis was performed on VitB12 data for 112 patients from January 2018 to October 2019. Then, 87 patients were included between November 2019 and August 2020. They were divided into 2 groups according to the level of VitB12 after surgery, and the demographic and clinical data were analyzed. Then, LASSO regression model analysis and multiple logistic regression analysis were performed to explore the risk factors for VitB12 elevation after surgery.
Retrospective data showed that the VitB12 level was significantly increased 1 month after surgery. Comparison of data between the 2 groups found that more patients also had diabetes in the nonelevated group. The postoperative folic acid and VitB12 levels of the elevated group were significantly higher than those of the nonelevated group. More patients had concurrent constipation in the elevated group than in the nonelevated group. Two meaningful variables in LASSO regression analysis were incorporated into the multivariate logistic regression analysis, and constipation was found to be an independent risk factor for the increase in VitB12 after surgery. Of the 199 patients in this study, 111 patients had elevated VitB12 levels after surgery. Among them, 7 patients had peripheral nerve symptoms.
Constipation is an independent risk factor for increased VitB12 levels after surgery. High levels of VitB12 may cause some peripheral nerve symptoms. Therefore, it is necessary to pay attention to patients with postoperative constipation, monitor their VitB12 level as soon as possible, and take measures to improve constipation to avoid some adverse reactions caused by elevated VitB12 levels.
A patient with COVID-19 and bleeding complications due to neurofibromatosis type 1 during VV-ECMO
Authors: Shimoyama Keiichiro , Azuma Kazunari , Oda Jun 
Published: December 2021

Abstract

Rationale:
The many deaths from coronavirus disease (COVID-19) since 2019 have caused global concern. Effective treatment has not yet been established; supportive care is the main treatment. It has been suggested that veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be effective in severe cases that do not respond to ventilator management.

Patient concerns and diagnosis:
We report the case of a 68-year-old woman with severe respiratory failure due to COVID-19 who was treated with VV-ECMO but suffered from bleeding complications. She presented with multiple café-au-lait lesions and neurofibromas on her skin and was diagnosed pathologically as having neurofibromatosis type 1(NF1).

Interventions and outcomes:
Although she received appropriate anticoagulation therapy with heparin at the initiation of VV-ECMO, she had 5 episodes of severe bleeding, each requiring transcatheter arterial embolization and massive transfusion. In patients with NF1, vascular fragility has been noted due to vascular infiltration of neurofibromas and degeneration of vascular structures. Therefore, the causes of frequent bleeding complications may be related to the fragility of blood vessels in patients with NF1. VV-ECMO in patients with NF1 is likely to result in frequent bleeding complications and the need for massive transfusion.

Lesson:
We propose non-anticoagulation treatment strategy for the management of VV-ECMO in patients with NF1. Especially under the COVID-19 pandemic, more careful consideration should be given to the indications for VV-ECMO in patients with NF1.
Leave me out: Patients’ characteristics and reasons for opting out of a pragmatic clinical trial involving medication adherence
Authors: Sandy Lisa Caputo , Glorioso Thomas J. , Weinfurt Kevin , Sugarman Jeremy , Peterson Pamela N. , Glasgow Russell E. , Ho P. Michael 
Published: December 2021

Abstract
Opt-out procedures are sometimes used instead of standard consent practices to enable patients to exercise their autonomous preferences regarding research participation while reducing patient and researcher burden. However, little is known about the characteristics of patients who opt-out of research and their reasons for doing so. We gathered such information in a large pragmatic clinical trial (PCT) evaluating the effect of theory informed text messages on medication adherence.
Eligible patients, identified through electronic health records, were sent information about the study and provided with an opportunity to opt-out. Those opting out were asked to complete a voluntary survey regarding their reasons for doing so. Demographic data were compared among patients opting-out vs those included in the study using chi-squared tests and a log binomial regression model.
Of 9046 patients receiving study packets, 906 (10.0%) patients returned opt-out forms. Of those, 451 (49.8%) returned the opt-out survey. Patients who opted out were more likely to be older, white, and nonHispanic than those who were included in the PCT. Survey respondents expressed high levels of trust in their health care providers, research, and system. Nearly half (46.6%) reported concerns about time as a reason to opt-out.
In this PCT, 10% of patients receiving packets opted out, with significant differences in age, race, gender, and ethnicity compared to those included. Future trials should further investigate representativeness and reasons patients choose to opt-out of participating in research.
Ovarian high-grade serous carcinoma with elevated β-human chorionic gonadotropin
Authors: Zhong Yi , Chen Xing , Huang Yan , Jiang Yi , Chen Ting , Nie Xianglin , Cheng Wenjun 
Published: December 2021

Abstract

Rationale:
Human chorionic gonadotropin (hCG) is a glycoprotein hormone secreted by the syncytiotrophoblasts of the placenta. However, hCG (particularly β-hCG) is also expressed in many normal nontrophoblastic tissues. Here, we report the case of a 50-year-old woman diagnosed with ovarian high-grade serous carcinoma with elevated β-hCG, which was insensitive to chemotherapeutic drugs and had a poor prognosis.

Patient concerns:
A 50-year-old woman with abdominal distention was admitted to our hospital. Pelvic computed tomography and magnetic resonance imaging were highly suggestive of multiple metastases of ovarian cancer. Surprisingly, an elevation in β-hCG levels was also measured.

Diagnosis and interventions:
The patient underwent laparoscopic examination and was diagnosed with high-grade serous ovarian carcinoma. After 2 prior chemotherapies with paclitaxel and carboplatin, the patient underwent cytoreductive surgery and continued receiving chemotherapy. However, recurrent lesions were observed during the period of chemotherapy, and the level of β-hCG increased. Alternative chemotherapy with liposomal doxorubicin was administered, but it also had a poor therapeutic effect.

Outcomes:
The progression was rapid with a continuous increase in β-hCG levels, and the patient died 9 months after surgery.

Lessons:
Gynecologists should be aware of women with ovarian carcinoma with an elevated β-hCG level, which suggests a poor prognosis.
Early outcomes and long-term survival after kidney transplantation in elderly versus younger recipients from the same donor in a matched-pairs analysis
Authors: Jankowska Magdalena , Bzoma Beata , Małyszko Jolanta , Małyszko Jacek , Słupski Maciej , Kobus Grażyna , Włodarczyk Zbigniew , Rutkowski Bolesław , Dębska-Ślizień Alicja 
Published: December 2021

Abstract
The elderly are the fastest-growing population on waiting lists for kidney transplantation (KTx). Recognized barriers to KTx in the elderly is early post-transplant mortality and morbidity. To analyze the outcomes of KTx in recipients older than 60 years and, simultaneously, in their younger paired recipients, receiving a graft from the same donor.
We included 328 kidney transplant recipients in the study. The elderly kidney transplant recipients (EKT) group included 164 patients aged 65 standard deviation (SD4) years. They were paired with younger kidney transplant recipients (YKT) aged 45 (SD12) years.
The studied groups (EKT vs YKT) did not differ from the graft function estimated 1 year after the transplantation (50.7 mL/min vs 54.0 mL/min), while the estimated glomerular filtration rate decline was significantly faster in the YKT group. One-year patient survival (93.9% vs 97.0%), 1-year graft survival (90.4% vs 82.3%), and incidences of delayed graft function and acute rejection did not differ between the EKT and YKT groups. Significantly more cardiovascular complications and post-transplant diabetes mellitus were noticed in the EKT group. The long-term patient and graft survivals were poorer in the EKT group versus the YKT group, but death-censored graft survivals were the same. After having excluded donor-derived graft factors, there were no differences in the first-year outcome of KTx between recipients younger and older than 60 years. As life expectancy is lower in the EKT group, the probability of patient and graft survival was also significantly lower in this group. However, death-censored graft survival was not different in the EKT and YKT groups.
Comparison of concordance between chuna manual therapy diagnosis methods (palpation, X-ray, artificial intelligence program) in lumbar spine
Authors: Lee Jin-Hyun , Woo Hyeon-Jun , Lee Jung-Han , Kim Joong-Il , Jang Jun-Su , Na Young Cheol , Kim Kwang-Ryeol , Park Tae-Yong 
Published: December 2021

Abstract

Introduction:
Chuna manual therapy (CMT) is a type of manual medicine practiced by Korean medical doctors in South Korea. Spinal diagnosis in CMT uses a system that applies manual diagnostic and X-ray tests to detect specific vertebral malpositions, based on the relative alignment across vertebral bodies. Recently, artificial intelligence (AI) programs have been developed to assist in the radiological diagnosis of CMT using X-ray images. Nevertheless, a few clinical studies have reported on the concordance between diagnosticians, diagnostics methodologies, and the use of AI programs for diagnosing CMT. At present, the evidence to support CMT diagnosis is insufficient. This study thus aims to overcome such limitations by collecting and comparing CMT diagnostic data from experts and non-experts through manual diagnosis, X-ray test, and images obtained using an AI program. The study aims to search for CMT diagnosis methods with more outstanding rationality and consistency and to explore the potential use of AI-based CMT diagnosis programs.

Methods/design:
This study will be conducted as an exploratory, cross-sectional, prospective observational study that will recruit 100 non-specialist subjects. Each subject will submit a signed consent after the screening test and undergo L-spine standing AP & lateral X-ray imaging. Manual CMT diagnosis will be performed by 3 CMT experts according to the standard operation procedure (SOP). The X-ray images of the 100 subjects will subsequently be used to make the CMT radiological diagnoses according to the same SOP by the CMT expert group (n = 3) and CMT non-expert group (n = 3). Among the subjects, those in the non-expert group will receive another CMT radiological diagnosis with spinal data obtained using the AI program, approximately 1 month from after initial diagnosis.
Based on the collected diagnostic data, within- and between-group concordance levels will be assessed for each diagnostic method. The verified level of concordance will be used to test the potential use of CMT diagnostic method and CMT AI programs with high levels of rationality and consistency.

Ethics and dissemination:
This trial has received complete ethical approval from the Wonkwang University Korean Medicine Hospital (IRB 2021–8). We intend to submit the results of the trial to a peer-reviewed journal and/or conferences.

Trial registration:

https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&search_page=M&pageSize=10&page=undefined&seq=20613&status=5&seq_group=20613, Identifier: KCT0006707.
The effect of acupoint therapy on sleep quality of hemodialysis patients
Authors: Xiong Gang , Hu Lijun , Hu Chenglian , Yao Yunhua 
Published: December 2021

Abstract

Background:
Hemodialysis patients usually have sleep disturbance at varying degrees, which seriously affects the therapeutic efficacy and quality of life. Therefore, improving the sleep quality of hemodialysis patients is the key during treatment. Acupoint therapy can improve the sleep quality of patients. However, guidelines for improving sleep quality of hemodialysis patients by acupoint therapy are scant. This study aims to evaluate the effect of acupoint therapy on sleep quality in hemodialysis patients through a meta-analysis, providing clinical evidences.

Methods:
Randomized controlled trials (RCTs) reporting the effect of acupoint therapy on sleep quality in hemodialysis patients published before November 2021 will be searched in the China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang database, the Chinese Scientific Journal Database, PubMed, Embase, The Cochrane Library, and Web of Science databases. Eligible literatures will be screened according to inclusion and exclusion criteria and assessed for quality using the Cochrane Risk of Bias Assessment Tool. Meta-analysis will be performed using Revman 5.4 software.

Results:
This study will evaluate the effect of acupoint therapy on sleep quality in hemodialysis patients using the Pittsburgh Sleep Quality Index (PSQI).

Conclusion:
This study will provide a reliable evidence-based basis for conducting acupoint therapy to improve sleep quality in hemodialysis patients.
The effectiveness of Chinese herbal medicine for tic disorders in children and adolescents
Authors: Liu Li , Zhou Liang-An , Sun Ya-Lei 
Published: December 2021

Abstract

Background:
The tic disorders are common neuropsychiatric disorders that affects the growth and development of children and adolescents. Chinese herbal medicine is commonly used for the treatment of tic disorders. However, there is no consensus on the difference in clinical efficacy compared with routine treatment. Therefore, we plan to perform a systematic review and meta-analysis to review the clinical efficacy of Chinese herbal medicine for tic disorders.

Methods:
Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Bio-medical Database, and Wanfang database will be searched from their inception until March 31, 2021. The meta-analysis will be conducted with Review Manager 5.3 software to systematically review the clinical efficacy and safety of Chinese herbal medicine for tic disorders. The primary outcome will include the improvement rate (amount) of tic symptoms using related scales or methods, and the secondary outcome will include adverse events.

Results:
This analysis will provide useful information about clinical efficacy and safety of Chinese herbal medicine for tic disorders.

Conclusions:
Our study will generate strong evidence of Chinese herbal medicine for patients with tic disorders and provide suggestions for clinical practice.
MRI features of an atypical case of extraventricular neurocytoma
Authors: Liu Xiaoge , Yu Yaohan , Ma Liwei , Cheng Jingliang 
Published: December 2021

Abstract

Rationale:
Central neurocytoma occurring outside the ventricles is known as extraventricular neurocytoma (EVN). EVN is rare and its magnetic resonance imaging (MRI) findings vary greatly and overlap with the imaging features of other intracerebral primary tumors.

Patient concerns:
A 21-year-old woman with an intrauterine pregnancy of 18+2 weeks complained of dizziness and headache for 3 months.

Diagnosis:
A 8.6 cm × 5.8 cm × 3.7 cm space-occupying lesion was seen in the right frontal lobe on MRI, with mixed long signals on T1-weighted imaging and mixed slightly long signals on T2-weighted imaging, slightly hyperintense on T2-weighted imaging fluid attenuated inversion recovery images, and a large-scope long T1-weighted imaging and long T2-weighted imaging cystic component at the center of the lesion. A thick fence-like enhancement of the solid component at the periphery of the lesion was observed after injecting a contrast medium, while the internal cystic component was not enhanced. The MRI diagnosis was of glioma. The lesion was pathologically confirmed as an atypical central neurocytoma of the right frontal lobe.

Interventions:
Resection of the lesion and postoperative radiotherapy.

Outcomes:
The patient was lost to follow-up.

Lessons:
EVN can be considered as a differential diagnosis for lesions occurring in the cerebral hemispheres of young patients with cystic degeneration, thick fence-like enhancement, and peritumoral edema on MRI.
Early-stage serum Stanniocalcin 1 as a predictor of outcome in patients with aneurysmal subarachnoid hemorrhage
Authors: Jun Qin , Luo Weijian 
Published: December 2021

Abstract
Stanniocalcin-1 (STC1) takes part in anti-inflammatory and anti-oxidative processes, thus demonstrating neuroprotective properties. Early brain injuries associated with initial subarachnoid hemorrhage typically led to secondary cerebral infarction and poor outcomes. This retrospective study aimed to clarify the clinical significance of serum STC1 level in patients with subarachnoid hemorrhage.
We collected demographic information, comorbidities, neurological status in detail. All blood samples were collected on admission. Enzyme-linked immunosorbent assay kits were used to detect the serum level of STC1. Spearman analysis was used to explore the relationship between STC1 and clinical severity. Multivariate logistic regression was used to investigate the prognostic role of STC1 in patients with aneurysmal subarachnoid hemorrhage (aSAH). Receiver operating characteristic curve was performed to investigate the power of STC1 in predicting outcome in aSAH patients.
Serum STC1 concentration was significantly higher in aSAH patients than in healthy individuals. Serum concentration of STC1 positively correlated with Hunt-Hess grade (r = 0.62, P < .01) and Fisher grade (r = 0.48, P < .01), and negatively correlated with Glasgow Coma Scale on admission (r = −0.45, P < .01). Patients with delayed cerebral ischemia (DCI) had higher level of serum STC1 than those without DCI (13.12 ± 1.44 vs 8.56 ± 0.31, P < .01). Moreover, patients with poor outcome had higher concentration of STC1 than patients with good outcome (11.82 ± 0.62 vs 8.21 ± 0.35,P < 0.01). Results of univariate and multivariate logistic analysis revealed that Hunt-hess III–IV, DCI, and high STC1 level were independent risk factors associated with poor outcome of patients with aSAH. Further analysis revealed that combination of STC1 with Hunt-hess grade was more superior to 2 indicators alone in predicting clinical outcome of aSAH patients.
STC1 can be used as a novel biomarker in predicting outcome of patients with aSAH, especially when combined with Hunt-hess grade.
Giant mediastinal neuroendocrine tumor successfully resected after transarterial chemoembolization of drug-eluting embolic microspheres
Authors: Yu Qi , Li Zhen , Han Xinwei 
Published: December 2021

Abstract

Rationale:
Neuroendocrine tumors (NETs) in the mediastinum are extremely rare. No uniform solution currently exists for the treatment of mediastinal NETs.

Patient concerns:
We report the case of a 32-year-old man with symptoms of chest tightness, chest pain, cough, and panic.

Diagnoses:
Computed tomography showed that the mediastinum and right lung occupied a space with uneven enhancement. A needle biopsy revealed mediastinal NETs. An atypical carcinoid was diagnosed using immunohistochemistry.

Interventions:
The patient underwent 2 similar transarterial chemoembolizations of drug-eluting embolic microsphere procedures after 5 cycles of etoposide and cisplatin chemotherapy. The patient underwent successful surgical resection 2 months after the operation.

Outcomes:
The patient's quality of life was significantly improved, without chest tightness, chest pain, or other symptoms. At the 1-year follow-up, the patient had no tumor recurrence.

Lessons:
For large mediastinal NETs with poor chemotherapy effects, surgical resection is safe and feasible after down-staging treatment via arterial chemoembolization of drug-eluting embolic microspheres.
Febrile episode unmasking neuropsychiatric systemic lupus erythematosus with lytic lesions caused by secondary autoimmune myelofibrosis
Authors: Bratu Ionuţ-Flavius , Ribigan Athena Cristina , Mihailă-Bâldea Sorina , Badea Raluca , Stefan Daniela , Davidoiu Cristina , Casaru Bogdan , Antochi Florina 
Published: December 2021

Abstract

Rationale:
Systemic lupus erythematosus (SLE) is characterized by numerous immunological abnormalities that lead to multiorgan involvement. Central and peripheral nervous system manifestations are present in 8% to 92% of the cases of SLE. Furthermore, there have been reported cases of secondary autoimmune myelofibrosis associated with SLE.

Patient concerns:
We present the case of a 64-year-old female who was transferred from the Cardiology Department, where she was admitted for pericardial-pleural-peritoneal effusion after being discharged from another hospital following the resolution of a febrile episode. During hospitalization, she presented multiple oculomotor nerves palsies and weakness in the lower limbs. Serial cerebral magnetic resonance imaging (MRI) revealed extensive cerebral venous thrombosis. Nerve conduction studies showed sensory-motor axonal polyneuropathy. Thoracic MRI revealed a rare finding in patients with SLE – lytic lesions.

Diagnoses:
Extensive clinical, imaging, blood, and urine tests were performed. The patient exhibited pancytopenia, elevated inflammatory markers, hyperhomocysteinemia, mild hypoproteinemia, and severe proteinuria. The Hematology consultation ascertained that the peripheral blood smear and the bone marrow aspiration showed no alterations suggestive for a primary hematological disease and the thoracic vertebral-medullary MRI changes had a very low probability of representing osteolytic lesions in the context of plasma cells dyscrasia, but could not exclude their being result of a secondary autoimmune myelofibrosis. Immunology blood tests highlighted the presence of antinuclear antibodies and lupus anticoagulants. In this context, the Rheumatology consultation established the diagnosis of SLE with multiple complications.

Interventions:
The patient received treatment with cyclophosphamide.

Outcomes:
The ocular motricity problems and the paraparesis showed improvement. However, 1 week later, the patient developed weakness, dyspnea, and right lower quadrant abdominal pain. The abdominal-pelvic computed tomography scan indicated an acute right retroperitoneal hematoma with active bleeding for which she underwent arterial embolization of the spinal lumbar arteries with optimal result, but she died a few days later.

Lessons:
We chose to present this case in order to highlight the importance of interdisciplinarity in diagnosing and managing patients with SLE and multiorgan ailments, especially when faced with rare constellations of complications such as extensive cerebral venous thrombosis and osseous lytic lesions caused by secondary autoimmune myelofibrosis.