bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful concomitant therapy with tofacitinib for anti- melanoma differentiation associated gene 5 antibody-positive rapidly progressive interstitial lung disease with poor prognostic factors
Authors: Machiyama Tomoaki , Shirai Tsuyoshi , Fujita Yoko , Sato Hiroko , Fujii Hiroshi , Ishii Tomonori , Harigae Hideo 
Published: April 2021

Abstract

Rationale:
Rapidly progressive interstitial lung disease (RP-ILD) is a severe complication of anti- melanoma differentiation associated gene 5 (MDA5) antibody-positive dermatomyositis and has an extremely poor prognosis.

Patient concerns:
We describe the case of a 62-year-old Japanese male with progressive hypoxemia. Laboratory examinations revealed elevated levels of serum ferritin, KL-6, myogenic enzymes, liver enzyme, inflammatory markers and Anti-MDA5-antibody positivity. Chest computed tomography revealed consolidation along the bronchovascular bundle with air bronchograms, predominantly in the inferior lobe of both lungs.

Diagnosis:
The patient was diagnosed as anti-MDA5 antibody-positive RP-ILD.

Interventions:
Respiratory failure continued to worsen even after conventional therapy with glucocorticoids and intravenous cyclophosphamide. Due to the severity of his symptoms, tofacitinib was used in combination with tacrolimus, rituximab, and plasma exchange.

Outcomes:
The severity of his respiratory symptoms dramatically decreased and he was discharged without the need for supplemental oxygen.

Lessons:
This case suggests that multi-target immunosuppressive therapy including tofacitinib can be useful for anti-MDA5 antibody-positive RP-ILD in patients with poor prognostic factors.
Cerebral vasculopathy in systemic sclerosis
Authors: Iwata Mai , Nakai Noriyoshi , Kunitake Katsuhiko , Inagakai Ryosuke , Furukawa Soma , Suzuki Junichiro , Nishida Suguru , Itoh Takayuki , Ito Yasuhiro 
Published: April 2021

Abstract

Introduction:
Systemic sclerosis (SS) is 1 of the representative connective tissue diseases commonly affecting vascular endothelial cells and has an unknown pathogenesis. In comparison with other connective tissue diseases, vascular involvement in the brain is relatively rare in SS.

Patient concerns:
A 40-year-old woman developed neurological symptoms at 1 year after the diagnosis of SS. Head magnetic resonance imaging demonstrated diverse neuroradiologic abnormalities indicating brain edema, ischemic lesions and vasodilation or microbleeds from small vessels. 99mTc-ethyl cysteinate dimer-single photon emission computed tomography revealed decreased blood flow in both frontal lobes.

Diagnosis:
The patient was diagnosed with cerebral vasculopathy in SS.

Interventions:
Oral administration of prednisolone 50 mg/d was started and gradually tapered.

Outcomes:
Her neurologic symptoms improved, and most of the neuroradiologic abnormalities were also resolved.

Conclusions:
Our case sheds light on the rare cerebral vasculopathy associated with SS and the importance of head magnetic resonance images and single photon emission computed tomography in the diagnosis and assessment of therapeutic efficacy.
A large cervical lymphatic malformation in a neonate successfully treated with Kampo medicine
Authors: Nakahata Kengo , Ogawa-Ochiai Keiko , Yamanaka Hiroaki , Noguchi Yuki , Saka Ryuta , Takama Yuichi , Ueno Takehisa , Tazuke Yuko , Hidaka Kuniyuki , Osuga Keigo , Okuyama Hiroomi 
Published: April 2021

Abstract

Introduction:
Recently the application of Kampo, or Japanese traditional medicine, to lymphatic malformation (LM) has been reported, but there are no reports of its effects against neonatal LM. We herein report a case of a neonatal huge cervical LM successfully treated with eppikajutsuto and ogikenchuto without tracheostomy or sclerotherapy.

Patient concerns:
A baby boy with a huge cyst in his right neck was delivered by Caesarean section without a prenatal diagnosis. The cyst extended and slightly compressed the trachea on the 7th day after birth.

Diagnosis:
The patient was diagnosed with LM by ultrasonography.

Interventions:
Although we planned sclerotherapy with OK-432 followed by tracheostomy, his parents refused tracheostomy. Therefore, we started the administration of eppikajutsuto (0.5 g/kg/d) on the 26th day of life instead of sclerotherapy. As the cyst was slightly enlarged at the beginning of eppikajutsuto administration, we increased the dose of eppikajutsuto to 0.75 g/kg/d and added ogikenchuto (0.4 g/kg/d), expecting greater regression of the lesion than with the initial regimen.

Outcomes:
After a few days, the cyst started to diminish in size. Six months later, magnetic resonance imaging showed remarkable regression of the LM without tracheal compression.

Lessons:
The combination of eppikajutsuto and ogikenchuto was thus found to be effective in the treatment of a neonatal LM. This is the first report to demonstrate that the dose-escalation of eppikajutsuto may therefore be effective without any severe adverse effects, even in neonates.
Acute ischemic stroke due to posterior cerebral artery P2 segment occlusion treated with mechanical thrombectomy
Authors: Zhang Donghuan , Liu Yifeng , Gao Jun , Wang Ning , Zhang Baochao , Kang Meijuan , Yu Yang , Chen Di , Liu Shaozhe , Wang Jie , Wen Changming 
Published: April 2021

Abstract

Introduction:
Mechanical thrombectomy (MT) has become part of the standard treatment for patients who have acute ischemic stroke due to large-vessel occlusion in the anterior cerebral circulation. But the safety and effectiveness of MT for posterior cerebral artery (PCA) is still controversial.

Patient concerns:
We report a 40-year-old man with a medical history of hypertension who was non-compliant with the treatment. He presented to the hospital with right extremity paralysis, aphasia, and left gaze paralysis due to the occlusion of left PCA P2 segment (National Institutes of Health Stroke Scale Score 16). Head computed tomography showed infarction area of left temporal lobe and occipital lobe.

Diagnosis:
A head computed tomography angiography examination showed left PCA P2 segment occlusion.

Interventions:
The patient underwent MT and subsequent angiography showed left PCA P2 segment occlusion was recanalized after MT.

Outcomes:
The patient's symptoms improved completely after MT.

Conclusion:
The clinical symptoms due to PCA P2 segment occlusion may be mistaken clinically for MCA stroke syndrome, which may lead to severe functional deficit. MT seems to be safe and effective in treating PCA P2 segment occlusion.
Traditional Korean medicine as second-line treatment of metastatic colorectal cancer
Authors: Lee Dong-hyun , Seong Sin , Won Yunsik 
Published: April 2021

Abstract

Rationale:
As a standard chemotherapy treatment of colorectal cancer, 5-fluorouracil alone or in combination with capecitabine, irinotecan, and/or oxaliplatin has been used as the first-line treatment. However, the first-line treatment alone for colorectal cancer may not be effective for all patients. Moreover, interest among the colorectal patients towards Traditional Korean Medicine (TKM) as the second-line treatment is increasing.

Patient concerns:
We present a 69-year-old Korean male with lung metastasis from rectal adenocarcinoma who refused to receive further standard chemotherapy. After refusing further chemotherapy, the patient started TKM treatment.

Diagnoses:
The patient was diagnosed as colorectal cancer with multiple lymph nodes and lung metastases at our hospital in February 2016.

Interventions:
The patient was treated with Intravenous Wild Ginseng Pharmacopuncture, Hae, Soramdan, Gunchildan, SD nebulizer solution, and SSR.

Outcomes:
After 6 weeks of TKM treatment, there was clinical improvement, and the further spread of metastasis was reduced with diminished size of metastatic nodules throughout the treatment course and a six-month follow-up.

Lessons:
A definitive conclusion on the effectiveness of TKM treatment for colorectal cancer cannot be made based on the case report alone. However, TKM treatment may be considered as the second-line treatment for treating metastatic colorectal cancer in selected cases.
Non-functioning parathyroid cyst
Authors: Tsu-Hao Liu , Ming-Hong Yan 
Published: April 2021

Abstract

Rationale:
Parathyroid cysts are rare lesions which are classified as functioning and non-functioning, based on the hormone activity. We report an incidental finding of a non-functioning parathyroid cyst in a patient who showed good prognosis after surgery.

Patient concerns:
A 63-year-old female patient had a medical history of stage III chronic kidney disease, asthma, and idiopathic hypothyroidism. She underwent low-dose lung computed tomography and a suspected enlarged lymph node in the suprasternal region was identified.

Diagnoses:
The nodular site was considered relatively safe, thus, we did not arrange for further examinations and decided to perform a surgical biopsy intervention first. Consequently, immunohistological examination findings led to the diagnosis of parathyroid cyst. The patient's serum calcium level was normal. Thus, she was diagnosed with a non-functioning parathyroid cyst.

Interventions:
Surgery was performed with a 3-cm long incision on the midline of the upper chest wall for biopsy. A 19 mm × 15 mm × 7 mm cystic lesion was excised.

Outcomes:
No complications were observed after the surgical biopsy. The patient remains asymptomatic with no recurrence or serum biochemical abnormalities during the 1-year follow-up.

Lessons:
In cases of non-functioning parathyroid cysts, it is difficult to precisely diagnose it before surgery. We report a case of an incidental finding of a parathyroid cyst and the patient had a good prognosis after excision of the parathyroid cyst.
Treatment for a grade 4 diabetic foot patient with necrotizing fasciitis
Authors: Huang Renyan , Yang Xiao , Fan Weijing , Hu Xiaoming , Xv Feng , Liu Guobin 
Published: April 2021

Abstract

Rationale:
Grade 4 diabetic foot with necrotizing fasciitis is a severe infection that can cause septicemia, amputation and even death. Timely control of infection is the key measure in the treatment of diabetic foot with necrotizing fasciitis.

Patient concerns:
A 40-year-old male patient with long-term diabetes complicated with chronic renal insufficiency was admitted with grade 4 diabetic foot with necrotizing fasciitis. The patient had a concurrent nutritional deficiency and anemia.

Diagnoses:
The patient was diagnosed with type 2 diabetes mellitus, grade 4 diabetic foot with necrotizing fasciitis, chronic renal insufficiency, acute renal failure, hypoproteinemia, and moderate anemia.

Interventions:
Treatment with systemic antibiotics combined with dexamethasone was performed for eliminating systemic infection. Debridement was done to remove the devitalized tissues while preserving the skin of the ankle and calf.

Outcomes:
During the treatment procedure, the necrotic 2nd to 5th toe was removed. The infection gradually decreased after half a month of systemic treatment which included antibiotics combined with dexamethasone mainly, combined with local dressing of the wound. Hence high location amputation was avoided.

Lessons:
The application of antibiotics combined with dexamethasone in diabetic foot patient with necrotizing fasciitis can be an effective measure to reduce the risk of diabetic foot amputation and death.
Effects of Baduanjin qigong exercise in diabetes mellitus
Authors: Zhang Bei , Wang Zhe , Peng Fucong , Fang Jiaxin , Guo Liqun , Lu Chunli , Liu Hongxia 
Published: April 2021

Abstract

Objective:
To investigate the effects of Baduanjin exercise in diabetes mellitus.

Methods:
Literature retrieval will be performed in seven databases, including China National Knowledge Infrastructure, Wan Fang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, PubMed, The Cochrane Library, and Embase from inception to December 31, 2020. Systematic reviews of randomized controlled trials on investigating the effects of Baduanjin exercise in diabetic patients will be identified. To assess the reporting and methodological quality of the included systematic reviews by means of preferred reporting items for systematic review and meta-analysis statement and a measurement tool to assess systematic reviews -2 tool.

Results:
The umbrella review results will indicate the effects of Baduanjin exercise in diabetes mellitus, and these results will be disseminated through peer-reviewed journals and conferences.

Conclusion:
The study will provide more convincing evidence for the effects of Baduanjin exercise in diabetes mellitus. In addition, it might provide some specific suggestions for Chinese medical clinical practice or guideline.

Ethics and dissemination:
No ethical approval is required since the study data are sourced from published literature.

Protocol registration number:
PROSPERO CRD42020211398.
Efficacy and Safety of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombus: A Systematic Review and Meta-analysis
Authors: Burmeister Cameron , Beran Azizullah , Mhanna Mohammed , Ghazaleh Sami , Tomcho Jeremy C. , Maqsood Aadil , Sajdeya Omar , Assaly Ragheb 
Published: April 2021

Background:
Left ventricular thrombus (LVT) may develop in systolic heart failure or after acute myocardial infarction. The current recommendations support the use of vitamin K antagonists (VKAs) for the treatment of LVT. Limited data exist regarding the use of direct oral anticoagulants (DOACs) in patients with LVT. This meta-analysis aims to investigate the efficacy and safety of DOACs versus VKAs for LVT.

Methods:
We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases through November 2020 for all studies that evaluated the efficacy and safety of DOACs versus VKAs in patients with LVT. The primary outcomes were LVT resolution, overall thromboembolic events, and thromboembolic stroke. The secondary outcomes were major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel–Haenszel method within a random-effects model. Heterogeneity was assessed by I
2 statistic.

Results:
A total of 11 studies including 2153 patients with LVT on anticoagulation (570 on DOACs vs. 1583 on VKAs) were included. LVT resolution was significantly higher in DOACs compared with VKAs [RR: 1.18 (95% CI: 1.04–1.35); P = 0.01, I
2 = 25%]. However, no significant difference existed between DOACs and VKAs regarding overall thromboembolic events [RR: 1.10 (95% CI: 0.75–1.62); P = 0.61, I
2 = 0%] and thromboembolic stroke [RR: 0.63 (95% CI: 0.39–1.02); P = 0.06, I
2 = 0%]. Major bleeding [RR: 1.00 (95% CI: 0.66–1.51); P = 0.99, I
2 = 4%] and all-cause mortality [RR: 0.84 (95% CI: 0.50–1.43); P = 0.53, I
2 = 0%] were similar between the 2 groups.

Conclusions:
DOACs seem to be more efficacious in achieving LVT resolution compared with VKAs. However, there was no significant difference between the 2 groups in thromboembolic events, major bleeding, and all-cause mortality. Randomized controlled trials are needed to confirm our findings.
Impact of bariatric surgery on gastroesophageal reflux disease and esophageal motility
Authors: Nguyen Anh D. 
Published: April 2021

Purpose of review
Obesity is rapidly increasing in prevalence, and bariatric surgery has become a popular treatment option that can improve all-cause mortality in obese individuals. Gastroesophageal reflux disease (GERD) and esophageal motility disorders are common in the obese population, and the effects of bariatric surgery on these conditions differ depending on the type of bariatric surgery performed.

Recent findings
Laparoscopic adjustable gastric banding has declined in popularity due to its contributions to worsening GERD symptoms and the development of esophageal dysmotility. Although laparoscopic sleeve gastrectomy (LSG) is the most popular type of bariatric surgery, a comprehensive assessment for acid reflux should be performed as LSG has been linked with worsening GERD. Novel methods to address GERD due to LSG include magnetic sphincter augmentation and concomitant fundoplication. Due to the decreased incidence of postoperative GERD and dysmotility compared to other types of bariatric surgeries, Roux-en-Y gastric bypass should be considered for obese patients with GERD and esophageal dysmotility.

Summary
Bariatric surgery can affect esophageal motility and contribute to worsening or development of GERD. A thorough workup of gastrointestinal symptoms before bariatric surgery should be performed with consideration for formal testing with high-resolution manometry and pH testing. Based on these results, the choice of bariatric surgery technique should be tailored accordingly to improve clinical outcomes.
Supplementary Bovine Colostrum Feedings to Formula‐Fed Preterm Pigs Improve Gut Function and Reduce Necrotizing Enterocolitis
Authors: Yan Xudong , Sangild Per Torp , Peng Yueming , Li Yanqi , Bering Stine Brandt , Pan Xiaoyu 
Published: April 2021

ABSTRACTObjectives:Exclusive feeding with bovine colostrum (BC) protects preterm pigs against necrotizing enterocolitis (NEC) and BC has recently been tested as a supplement to a mother's own milk or formula (FOR) for very preterm infants. Using preterm pigs as a model for infants, we investigated if BC has gut‐ and NEC‐protective effects at different proportions of the daily enteral intake given as BC.Methods:Sixty‐eight caesarean‐delivered preterm piglets (90% gestation) were allocated into four groups with increasing proportions of eight daily bolus feedings as BC: BC00 (only FOR feeding), BC25 (25% BC), BC50 (50% BC), or BC75 (75% BC). On day 5, the gut was collected for biochemical analyses.Results:Body growth was increased in BC50 and BC75 piglets (2‐fold, P < 0.05 vs BC00). The incidence of mild NEC‐like lesions was similar among groups (67–86%), but BC75 reduced severe NEC‐like lesions (27% vs 79% in BC00, P < 0.05). BC50 and BC75 improved hexose absorption and mucosal structure and reduced gut permeability (P < 0.05 vs BC00), while enzyme activities (lactase, aminopeptidase N and A, dipeptidyl peptidase IV) were improved in all pigs fed BC (P < 0.05). Across the measured variables, beneficial effects were most clear for the BC75 group, including reductions in colon tissue cytokine levels (interleukin 8, interleukin 1β, tumor necrosis factor α) and expression of immune‐ and apoptosis‐related genes (LBP, TLR4, TLR2, IL8, STAT3, IL17, C3, all P < 0.05, relative to BC00).Conclusion:A proportion of 50–75% of daily enteral intake as BC is required to improve the intestinal structure, function, immunology, and NEC resistance in preterm piglets also fed formula. Further studies are required to show if and how supplementary BC may support gut development in preterm infants during the immediate postnatal period. It is challenging to translate results on optimal feeding regimens between species, and preterm infants would not receive a majority of their daily enteral intake as BC.
Transition Services for Paediatric Inflammatory Bowel Disease
Authors: Ashton James J. , Narula Priya , Kiparissi Fevronia , Spray Christine , Wilson David C. , Tayler Rachel , Howarth Lucy , Torrente Franco , Deb Protima , Cameron Fiona L. , Muhammed Rafeeq , Paul Thankam , Epstein Jenny , Lawson Maureen , Maginnis Janis , Zamvar Veena , Fagbemi Andrew , Devadason David , Bhavsar Hemant S. , Kammermeier Jochen , Beattie Robert M. 
Published: April 2021

ABSTRACTObjectives:Patients with paediatric inflammatory bowel disease (IBD) constitute one of the largest cohorts requiring transition from paediatric to adult services. Standardised transition care improves short and long‐term patient outcomes. This study aimed to detail the current state of transition services for IBD in the United Kingdom (UK).Methods:We performed a nationwide study to ascertain current practice, facilities and resources for children and young people with IBD. Specialist paediatric IBD centres were invited to contribute data on: timing of transition/transfer of care; transition resources available including clinics, staff and patient information; planning for future improvement.Results:Twenty of 21 (95%) of invited centres responded. Over 90% of centres began the transition process below 16 years of age and all had completed transfer to adult care at 18 years of age. The proportion of patients in the transition process at individual centres varied from 10% to 50%.Joint clinics were held in every centre, with a mean of 12.9 clinics per year. Adult and paediatric gastroenterologists attended at all sites. Availability of additional team members was patchy across the UK, with dietetic, psychological and surgical attendance available in <50% centres. A structured transition tool was used in 75% of centres. Sexual health, contraception and pregnancy were discussed by <60% of teams.Conclusions:This study provides real‐world clinical data on UK‐wide transition services. These data can be used to develop a national strategy to complement current transition guidelines, focused on standardising services whilst allowing for local implementation.
Integration of Lean Visual Management Tools Into Quality Improvement Practices in the Hospital Setting
Authors: Salinas Brianna , Villamin Colleen , Gallardo Luisa Dee 
Published: April 2021

Background:
Lean management tools have proven effective in achieving high reliability in health care.

Local Problem:
Unstructured leader rounds, decentralized prevention bundle repositories, and unfavorable patient experience outcomes prompted leaders on a thoracic and cardiovascular surgery unit to find other methods to address these issues and positively impact outcomes.

Methods:
Nurse sensitive indicator prevention bundles, root cause analysis tools, and best practices were used to develop Kamishibai Cards (K-Cards) for each measure targeted.

Interventions:
K-Cards were implemented to standardize processes, engage patients in their care, and promote staff identification of barriers and solutions.

Results:
Nurse-sensitive indicators and patient experience metrics were positively impacted by Kamishibai Rounding. K-Cards promote a state of continuous improvement, which supports sustainability of evidence-based practice and best practices that were implemented.

Conclusions:
K-Cards use high-reliability principles to standardize nursing practice to promote quality outcomes.
Early Life Stress and Chronobiological Rhythms Desynchronization
Authors: Caruso Danila , Palagini Laura , Miniati Mario , Massa Lucia , Marazziti Donatella , Geoffroy Pierre Alexis , Etain Bruno 
Published: April 2021

Abstract
The study aimed at investigating the potential impact of early stressful events on the clinical manifestations of bipolar disorder (BD). A sample of 162 adult individuals with BD was assessed using the Structural Clinical Interview for DSM-5, the Beck Depression Inventory-II, the Young Mania Rating Scale, the Early Trauma Inventory Self Report-Short Form, the Biological Rhythms Interview of Assessment in Neuropsychiatry, the Insomnia Severity Index, and the Scale for Suicide Ideation. A significant path coefficient indicated a direct effect of early life stressors on biological rhythms (coeff. = 0.26; p < 0.001) and of biological rhythms on depressive symptoms (coeff. = 0.5; p < 0.001), suicidal risk (coeff. = 0.3; p < 0.001), and insomnia (coeff. = 0.34; p < 0.001). Data suggested that the desynchronization of chronobiological rhythms might be one mediator of the association between early life stress and the severity of mood symptoms/suicidal ideation in BD. Addressing circadian rhythm alterations in subjects exposed to early stressors would help in preventing consequences of those stressors on BD.