bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid malignant transformation of mature ovarian cystic teratoma into undifferentiated carcinoma
Authors: Takasaki Kazuki , Ikeda Sayaka , Suminokura Jin , Kishimoto Naohisa , Takano Masashi , Ito Yuji , Kudoh Kazuya 
Published: April 2021

Abstract

Introduction:
Malignant transformation of mature cystic teratoma (MCT) is extremely rare and has poor prognosis. We report a case of malignant transformation of ovarian MCT into undifferentiated carcinoma, that showed extremely rapid progression after surgery.

Patient concerns:
A 51-year-old woman presented with complaints of abdominal swelling, pain and fever. Computed tomography (CT) and transvaginal ultrasonography revealed a cystic mass in the pelvis.

Diagnosis:
Based on the CT findings, ovarian tumor with possible rupture was provisionally diagnosed. However, post-operative histopathology showed malignant transformation of mature ovarian cystic teratoma into undifferentiated carcinoma.

Interventions:
Total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was performed.

Outcomes:
Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) after surgery showed multiple FDG uptake in liver, paraaortic lymph nodes and mesentery. Adjuvant chemotherapy was started, but the patient died 3 months after the surgery due to disease progression. Autopsy findings confirmed the metastases of undifferentiated carcinoma in liver, mesentery and left lung.

Conclusions:
Malignant transformation of MCT into undifferentiated carcinoma can be rapid and has poor outcomes. Pre-operative diagnosis is very difficult. Moreover, limited literature makes it difficult to establish the standardized treatment strategy for these patients. This case report shows that progression of this malignancy can be rapid despite surgery and chemotherapy.
A fatal case of severe pufferfish poisoning
Authors: Zhu Siqi , Yang Ying , Fan Zhao , Zhou Qidi , Fan Xiaoran 
Published: April 2021

Abstract

Introduction:
Pufferfish poisoning is the main cause of death due to food poisoning in China. No effective treatment has been proposed so far. The artificial airway and early mechanical ventilation are crucial for the prognosis, but the optimal time for these interventions remains unclear. Here we present an unsuccessful use of mechanical respiratory support in a patient with pufferfish poisoning.

Patient concerns:
A 62-year-old male patient presented to the emergency department with complaints of numbness around the mouth. He gave a history of eating pufferfish 3 hours before the coming to the hospital.

Diagnosis:
He was diagnosed as pufferfish poisoning based on the history of consuming pufferfish and the symptom of numbness.

Interventions:
Gastric lavage was performed in time, but he did not receive protective endotracheal intubation. His condition worsened rapidly with respiratory failure and cardiac arrest. He received active treatment in the intensive care unit with mechanical ventilation.

Outcomes:
Spontaneous breathing was not restored during the intensive care unit stay. He underwent treatment with hyperbaric oxygen in another hospital and died of respiratory failure eventually.

Conclusion:
The establishment of artificial airway and early implementation of mechanical ventilation are crucial for good prognosis. Our case report provides a valuable experience for implementing early endotracheal intubation intervention in patients with pufferfish poisoning.
Case report of surgically treated primary breast lymphoma in a very elderly patient
Authors: Yoneto Toshihiko , Hasumi Kenichiro , Takahashi Nobukazu , Takeda Yasutaka , Yoshimoto Takayuki 
Published: April 2021

Abstract

Introduction:
Primary malignant lymphoma of the breast (PBL) is a rare disease, and few cases have been reported in very elderly patients. Generally, first-line therapies for primary PBL are chemotherapy and radiation therapy. However, these invasive therapies may not always be the best choice, especially for very elderly patients who desire a better quality of life rather than improved prognosis over a long period of time. In addition, no studies have reported whether findings from preoperative imaging can be used to distinguish PBL from normal breast cancer and other malignant diseases.

Patient concerns:
A 91-year-old woman presented with an elastic, hard tumor in the upper lateral part of the right breast. The right axillary lymph node was palpable as an elastic hard mass of approximately 30 × 20 mm.

Diagnoses:
Needle biopsy of the breast strongly suggested malignant lymphoma. Ultrasonographic analysis revealed a maximal 90-mm hypoechoic area with hyperechoic margins. Thoracoabdominal computed tomography scanning revealed lesions only in the mammary gland and ipsilateral axillary lymph nodes. No other lymph node swelling was observed. Therefore, the patient was preoperatively diagnosed with PBL, stage II as per the Ann Arbor staging classification. After histopathological and immunohistochemical examinations, the patient was finally diagnosed with non-germinal center B-cell-like diffuse large B-cell lymphoma.

Interventions:
Right radical mastectomy and axillary lymph node dissection were performed in September 2019. Thereafter, the patient only received follow-up observation.

Outcomes:
Her postoperative progress was uneventful, and she was discharged 9 days post-surgery. She was followed-up for 1 year and there was no relapse.

Conclusion:
PBL should always be considered among other breast cancer diagnoses, although its incidence is very low. This is because PBL is highly malignant and frequently spreads to systemic lymph nodes, and its treatment differs from that of other breast cancers. Therefore, it should be definitively diagnosed preoperatively via histological analysis using adequate tissue obtained from either needle or open biopsies. Thus, surgical resection is a good choice, even for very elderly patients who wish to have a better quality of life.
Case report of a bilateral medial medullary infarct complicated with tetraplegia and respiratory failure
Authors: Nair Shaalina , Chai Low Soon 
Published: April 2021

Abstract

Rationale:
Medial medullary infarction is an uncommon stroke resulting from occlusion of a vertebral artery or its branch to the anterior spinal artery and it involves the pyramid, the medial lemniscus, and, sometimes, the hypoglossal nerve. As a result, it is usually described as a triad of ipsilateral hypoglossal paralysis, contralateral hemiparesis sparing the face and contralateral loss of deep sensation. Considering the rarity of the clinical diagnosis and paucity of case reports on this subject, we present a case of a successful detection of a bilateral medial medullary infarct in a patient which was later complicated with tetraplegia and respiratory failure.

Patient concerns:
This is a 62-year-old gentleman who presented to our center with sudden onset of left sided body weakness, slurring of speech and headache for 3 days. Past medical history includes smoking, hypertension and diabetes mellitus with poor glycemic control.

Diagnoses:
Subsequently, 3 days later, he developed right sided body weakness with power 0/5 (based on Medical Research Council scale for muscle power assessment) over the right upper and lower limbs with a right hemi sensory loss. Urgent Magnetic Resonance Imaging (MRI) of the brain revealed an acute ‘heart-shaped’ infarct of the bilateral medial medullary regions with a beaded appearance of V4 segment of right vertebral artery and M1 segment of left middle cerebral artery. A diagnosis of bilateral medial medullary infarct was made.

Interventions:
The patient was then started on oral Aspirin 100 mg once daily and his usual oral antihypertensive, Amlodipine 10 mg per day and oral hypoglycemic medication, Metformin 500 mg twice daily were continued as a part of the risk factor modification.

Outcomes:
He was tetraplegic and on day 4 post-infract, he developed acute respiratory failure requiring intubation and admission to the intensive care unit.

Lessons:
A bilateral medial medullary infarct is very rare and we believe that this patient's poorly controlled comorbid conditions have led to progressive atherosclerosis and thrombosis of the right vertebral and left middle cerebral arteries. This patient's respiratory failure is due to the involvement of the medulla oblongata that houses the respiratory center.
The FloTrac/VigileoTM system for continuous cardiac output monitoring in a paraplegic woman undergoing general anesthesia for cesarean section
Authors: Li Murong , Yao Qi , Wang Jinping 
Published: April 2021

Abstract

Rationale:
Paraplegic women requiring cesarean section present plenty of challenges for anesthesiologists. One of the most serious challenges is cardiovascular instability induced by autonomic hyperreflexia. The FloTrac/Vigileo TM system is a pulse contour analysis device for continuous hemodynamic index monitoring. Here, we present a case report of a paraplegic woman who underwent general anesthesia for cesarean section under FloTrac/VigileoTM monitoring.

Patient concerns:
A 33-year-old paraplegic woman was scheduled for cesarean section at the 38th week of gestation. The woman was completely paralyzed below T4 after a surgical treatment for a spinal cord bulge at the neck-chest junction.

Diagnoses:
A paraplegic G1 P0 patient at 38 week gestation following in-vitro fertilization and embryo transfer requiring elective cesarean section.

Interventions:
We chose general anesthesia for the patient under FloTrac/VigileoTM system monitoring. In accordance with the FloTrac/VigileoTM system monitoring, vasoactive drugs and liquid infusion were adjusted in real time.

Outcomes:
Autonomic hyperreflexia emerged during the surgery and the patient was treated in a timely manner because of the FloTrac/VigileoTM system. There were no complications, and the patient delivered a healthy baby girl.

Lessons:
Paraplegic women can be treated with general anesthesia under FloTrac/VigileoTM system monitoring. The FloTrac/VigileoTM system monitoring can be used to help monitor and maintain a paraplegic patient's hemodynamic stability.
A case report of isoniazid adverse drug reaction in a pediatric patient with defective NAT2 gene
Authors: Cocciadiferro Dario , Cursi Laura , Cairoli Sara , Agolini Emanuele , Simeoli Raffaele , Lancella Laura , Chiurchiu Sara , Novelli Antonio , Dionisi-Vici Carlo , Villani Alberto , Goffredo Bianca Maria 
Published: April 2021

Abstract

Rationale:
Adverse drug reactions (ADRs) represent a major health problem worldwide, with high morbidity and mortality rates, ranging from 0.5% to 16.8% in hospitalized children. One of the most effective and widely used drugs for anti-tuberculosis treatment is Isoniazid (INH). INH is a pro-drug and following oxidative activation, forms an adduct with NAD+ that inhibits NADH-dependent targets of Mycobacterium tuberculosis. Although this regimen is effective in treating active tuberculosis, it is associated with many ADRs considered as the main complication during therapy

Patient concerns:
The patient, a 14-year-old girl, presented with nodal tuberculosis exhibiting mobile laterocervical and angle-mandibular lymphadenopathy

Diagnoses:
INH plasmatic concentration levels above the therapeutic range and a custom NGS gene panel including NAT2 gene allowed the identification of the NAT2∗5C/∗6B slow metabolizer haplotype

Interventions:
The Patient was hospitalized and initially treated with quadruple antituberculosis therapy. After treatment, she was not able to continue the anti-tuberculosis treatment owing to ADR including overwhelming vomiting, nausea, worsening of clinical conditions, and hypertransaminasemia.

Outcomes:
Isoniazid and Rifampicin dosage was halved and then, because of the further increase of transaminases, anti-tuberculosis therapy was suspended. Clinical conditions and hematic parameters rapidly improved after suspension of anti-tuberculosis drugs

Lessons:
We report a 14-year-old girl with defective NAT2 that showed ADRs during anti-tuberculosis therapy. Combined strategy of therapeutic drug monitoring and pharmacogenetic analysis should be widely adopted during the routine clinical practice in order to optimize therapy and minimize ADRs
A case report of lymphoplasmacytic lymphoma with paraprotein IgA and IgM
Authors: Zheng Li , Guo Zhenxing 
Published: April 2021

Abstract

Introduction:
Lymphoplasmacytic lymphoma (LPL) is a rare indolent mature B-cell lymphoma and 90% to 95% LPL secrete monoclonal immunoglobulin M (IgM) protein. Only a small number of LPL secrete non-IgM monoclonal protein.

Patient concerns:
We report the case of an 86-year-old-male who was admitted to our hospital with a history of fatigue for 7 years and poor appetite for 3 months.

Diagnoses:
According to the M component IgA-κ and IgM-κ, plasmacytic differentiation lymphocytes in bone marrow biopsy and MYD88 mutation, the patient was diagnosed as LPL with paraprotein IgA and IgM.

Interventions:
Given the old age and expensive cost, the patient gave up chemotherapy and target therapy, and received only supportive treatment of intermittent transfusion.

Outcomes:
The patient has survived for more than 1 year with the supportive treatment.

Conclusion:
LPL with paraprotein IgA and IgM is a very rare indolent disease. Further studies with more patients are required to investigate the clinical outcomes.
Glisson pedicle ligation for unresectable hepatocellular carcinoma
Authors: Chen Qin-Qin , Yang Ling-Zhi , Yang Jian , Zhang Hong-Wei , Li Ke , Xiong Wei-Dong , Cheng Xiao , Bai Rong , Peng Xin-Yu 
Published: April 2021

Abstract

Introduction:
Hepatocellular carcinoma (HCC) is 1 of the most common malignant neoplasms worldwide. Surgical resection is the first choice of treatment. However, surgical resection is unsuitable for certain types of HCC.

Patient concerns:
A 47-years-old male patient presented with Child-Pugh class A liver function and the indocyanine green retention rate at 15 min effectively was 3.5%. Computed tomography and magnetic resonance imaging indicated that the tumors were distributed in the anterior segment of right lobe, and near the hepatic portal area. The maximum size of the tumor was approximately 86mm×82 mm.

Diagnosis:
The patient was diagnosed with hepatocellular carcinoma Stage IIIB. After pre-operative evaluation, hepatic segmentectomy by Glisson pedicle approach was recommended.

Interventions:
Hepatic segmentectomy by Glisson pedicle approach was recommended. But there was heavy bleeding during hepatic resection after the ligation of the Glisson pedicle on the right anterior branches. Hence only Glisson pedicle ligation was performed without hepatic segmentectomy.

Outcomes:
During 1 year of postoperative follow-up, the patient had no obvious complications. The computed tomography and magnetic resonance imaging indicated significant reduction in the size of tumor. The tumor was observed to have undergone liquefaction necrosis after 6 months. The serum a-fetoprotein also decreased significantly.

Conclusion:
The Glisson pedicle ligation may be an optional treatment in selected cases of unresectable HCC. However, further research is needed to understand the effectiveness of this treatment.
A study of 18F-FLT positron emission tomography/computed tomography imaging in pediatrics with myeloproliferative neoplasms
Authors: Yassin Mohamed A. , Ismail Omar M. , Soliman Dina S. , Nashwan Abdulqadir J. 
Published: April 2021

Abstract
Although Myeloproliferative Neoplasms (MPNs) are diseases of the elderly, MPNs are diagnosed in younger age groups in a considerable number of cases. Since most of the available data, as well as current WHO classification criteria, emphasize on the “average” patients with MPNs who range in age between 55 and 65 years. Less consistent data are available in the groups of patients presenting below this median age, such as children and younger adults which we’re planning to reveal.
The main purpose of this project to study the uptake pattern of 18FLT-Positron Emission Tomography (PET) and it is value in assessing the malignant hematopoiesis in MPNs within the pediatric age group in terms of diagnosis, staging and monitoring response to therapy. As well as evaluating 18FLT-PET as a novel non-invasive technique in cases with MPNs and its role in comparison to the standard bone marrow biopsy with regard to disease diagnosis, assessment of disease activity, detection of transformation, monitoring of treatment response and grading of fibrosis. Furthermore, we aim to study the association of 18FLT-PET uptake patterns with different genetic makeup (Janus kinase 2, Calreticulin positive, myeloproliferative leukemia protein, or Triple-negative disease) or allele burden in cases of Pre- prefibrotic/early primary myelofibrosis with the ability of FLT-PET to differentiate between Pre- prefibrotic/early primary myelofibrosis and essential thrombocythemia.
This trial is registered in ClinicalTrials.gov with number NCT03121599. Protocol version: June 2017
Dasatinib versus nilotinib as upfront therapy for treatment naïve chronic myeloid leukemia chronic phase
Authors: Yassin Mohamed A. , Hamad Anas A. , Hussein Radwa M. , Basha Ahmed M. , Adel Ahmad M. , Chandra Prem , Nashwan Abdulqadir J. 
Published: April 2021

Abstract
This is a randomized, phase 3 clinical trial comparing ’head to head’ nilotinib versus dasatinib as upfront therapy for patient with chronic myeloid leukemia. The efficacy of both drugs will be tested by measuring BCR/ABL using European LeukemiaNet recommendations. The study will be conducted in the National Center for Cancer Care & Research (NCCCR).
Adult patients will be eligible within 6 months after the diagnosis of Philadelphia chromosome positive Chronic Myeloid Leukemia in the chronic phase. Diagnosis will be determined by conventional cytogenetic analysis of bone marrow containing at least 1 Philadelphia chromosome–positive metaphase cell. The definition of chronic-phase Chronic Myeloid Leukemia as per WHO 2016. Patients will be recruited from hematology outpatient department or in-patient wards after confirmation of the diagnosis; vulnerable subjects will be excluded from the study.
The primary efficacy end point will be the rate of major molecular response at 12 months, defined as a BCR-ABL transcript level of 0.1% or less in peripheral blood on RQ-PCR assay, as expressed on the International Scale. This corresponds to a reduction of 3 log10 copies or more in BCR-ABL transcripts, as compared with the standardized baseline established in IRIS.
The key secondary end point will be a durable major molecular response by 24 months. Furthermore, for this study, the rate of complete cytogenetic response by 12 months will be the main secondary end point.
This trial is registered in ClinicalTrials.gov with number NCT03079505. Protocol version: August 2017
Complete recovery of delay of p13 latency in the cervical vestibular evoked myogenic potentials of a patient with earpick-induced inner ear injury
Authors: Takakura Hiromasa , Shojaku Hideo , Tsubota Masahito , Ito Shinsuke , Abe Hideharu 
Published: April 2021

Abstract

Introduction:
Cervical vestibular evoked myogenic potentials (cVEMP) testing is a vestibular function test for evaluating the saccular and inferior vestibular nerve function. The diagnostic value of p13 latency on the cVEMP in inner ear disorders is still unknown.

Patients concerns:
When a 21-year-old man was removing earwax from his right ear with an earpick, his girlfriend accidentally bumped against him. Immediately thereafter, he noticed right otalgia, right hearing loss and vertiginous attack with vomiting.

Diagnosis:
The patient showed a perforation in his right eardrum and spontaneous nystagmus directed to the left, indicating right perilymphatic fistula caused by the earpick injury.

Interventions:
cVEMP, caloric test and audiometry were repeated from 2 to 28 months after the injury.

Outcomes:
One month after the injury, the perforation of the tympanic membrane had closed, and the fistula test was negative. Two months after the injury, he had no spontaneous nystagmus. Four months after the injury, delay of p13 latency in the affected ear was observed on the cVEMP, but at 10 months after the injury, the p13 delay had disappeared and was normal. Although the patient's hearing level was normal at 2 months after the injury, severe semicircular canal dysfunction existed in the affected ear, and remained unchanged up to 28 months after the injury.

Conclusion:
We report the first case of a complete recovery of the delay of p13 latency in the cVEMP caused by an inner ear injury. Delay of p13 latency on the cVEMP has been used to diagnose retrolabyrinthine disorders. Not only asymmetric p13-n23 amplitude but also delay of p13 latency could be sensitive tools for diagnosing unilateral saccular dysfunction.
The effect of convalescent plasma therapy in treating severe coronvirus disease 2019
Authors: Wang Guangyao , Hong Xiaohua , Zhao Mei , Li Jiao , Li Guosheng , Yu Dan , Xu Guanglan 
Published: April 2021

Abstract

Background:
Since the outbreak globally of coronvirus disease 2019 (COVID-19), although active treatment has been taken, a large number of patients in severe condition have increased and clinical pressure is high. Convalescent plasma (CP) therapy is an important method of preventing and treating infectious diseases. antibody-rich blood is collected from recovered donors and then infused into other infected patients. So CP is a form of passive immunization. CP has been tried clinically and shown some effectiveness. Considering the absence of specific medicine for COVID-19, CP can be used as a potential therapy for COVID-19 patients. However, the curative effectiveness and safety of the CP for COVID-19 are still lacking evidence. Therefore, this systematic review and meta-analysis protocol is planned to evaluate the effectiveness and safety of the CP.

Methods:
This systematic search of articles will be indexed in nine databases: PubMed, Medline, Embase, Cochrane Library, World Health Organization International Clinical Trials Registry Platform, Wan-fang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database and Chinese Biomedical Literature Database. As well as the grey literature on other database for COVID-19 to evaluate the effectiveness and safety of the CP. Two reviewers will independently conduct the primary screening of the articles and data extraction. And then, they will select eligible sources after discussing non-conformities. Search keywords will include convalescent plasma therapy, COVID-19, severe condition. Survival, Mortality, Viral load, and antibody level will be used as the main outcome. Length of hospital stay, and adverse events as the secondary outcome. This protocol will use RevMan5.3.5.

Results:
The results of this systematic review will provide the curative effectiveness and safety of the CP for COVID-19 with high-quality evidence currently.

Conclusion:
The conclusion of this systematic review will provide for judging whether CP benefits the severe COVID-19 patients.

Ethics and dissemination:
Ethical approval are not required for systematic review. Externally peer reviewed.

PROSPERO registration number:
PROSPERO CRD42020215456