bluuebunny/crossref_metadata_2025_split huggingface dataset:
A chronic EBV infection causing persistent facial erythema multiforme and a retrospective literature review: A case report
Authors: Fenfang Peng , Hui Guo 
Published: December 2022

Rationale:
Epstein-Barr virus (EBV) infection is associated with a variety of diseases and can involve multiple organs and systems, with complex and nonspecific clinical manifestations that are easily misdiagnosed. Chronic EBV infection with persistent erythema multiforme (EM) on the cheek as the main manifestation is very rare and has been reported rarely.

Patient Concerns:
This article reports a case of an adolescent female with chronic EBV infection who presented with chronic symmetrical erythema lesions on the face for 4 years, exacerbated with photophobia, lacrimation, Henoch-Schonlein purpura (HSP)-like rash, decline in granulocyte and erythrocyte lineages, hematuria, and proteinuria for 1 week.

Diagnoses:
The disease was initially misdiagnosed as systemic lupus erythematosus (SLE) and later confirmed as chronic EBV infection by skin biopsy. In the case, EBV infection not only caused chronic facial EM, but also induced acute HSP and purpura nephritis (hematuria and proteinuria type).

Interventions:
The child was treated with 1 week of glucocorticosteroids in adequate doses combined with acyclovir antiviral therapy and 3 sessions of hemoperfusion. After discharge, she took prednisone acetate (15 mg twice a day) orally for 1 month and then discontinued.

Outcomes:
She was discharged with her rash relieved and normal blood routine test and urine routine test. After 13 months of long-term follow-up, her facial erythema and hyperpigmentation became lighter, and there was no new rash on the whole body, and no abnormality in continuous monitoring of complete blood count and urine test.

Lessons:
This case suggests the need to be alert for chronic EBV infection in adolescent females with chronic facial EM rash and multiple organs and systems injury, in addition to connective tissue diseases such as SLE.
Chuna manual therapy in patients with functional dyspepsia: A protocol for systematic review and meta-analysis
Authors: Ha Na-Yeon , Keum Chang-Yul , Jeong Haein , Shin Ki-Seok , Kim Jinsung 
Published: December 2022

Background:
Functional dyspepsia (FD) is a functional gastrointestinal disease that occurs without any explanatory organic disease, involving discomforts in upper abdomen such as bloating or pain after eating food. Although there is a standard treatment for FD, the disease often recurs or develops into a chronic condition, resulting in poor quality of life for the patients and high socioeconomic burden. Chuna therapy is a manual treatment commonly used in traditional Korean medicine (TKM) for musculoskeletal diseases such as intervertebral disc disorders and spinal stenosis. Recent studies have shown that Chuna therapy can be applied for the treatment of FD and is helpful in symptom improvement; however, high-quality evidence is still lacking. Therefore, this systematic review protocol intends to analyze the efficacy and safety of Chuna manual therapy for FD.

Methods:
We will search 11 electronic databases, including the Embase and MEDLINE, from their inception to June 2022. Two reviewers will independently screen the relevant studies and determine their compatibility with the search eligibility of this review. The primary outcome is the total clinical effective rate, and other variables such as dyspepsia-related symptom score, quality of life score, and adverse events will be analyzed. We will evaluate the quality of the evidence and interpret the overall findings using the Cochrane risk-of-bias tool for randomized trials and the Grading of Recommendations Assessment, Development, and Evaluation tool. To reduce the heterogeneity of the included studies, subgroup analysis according to the subdivisions of FD will be conducted and operational methods of Chuna therapy will be recorded in detail.

Results:
This protocol describes the systematic review to establish scientific evidence of Chuna manual therapy in FD patients.

Conclusion:
We will categorize various types of Chuna therapy for providing guidelines that can be applied reproducibly in clinical practice.
An adult case of small bowel intussusception caused by hemangioma presenting with intestinal obstruction: A case report
Authors: Shi Chengyu , Yu Yangyang , Zhang Laixiang , Gao Cheng 
Published: December 2022

Introduction:
Both small bowel intussusception in adults and small bowel hemangioma are rare benign mass lesions. Moreover, a secondary effect of intussusception caused by hemangioma is extremely rare.

Patient concerns:
A 87-year-old female suffered from intussusception and intestinal obstruction caused by hemangioma located in the small bowel (February 14, 2020), reporting abdominal distention without nausea and vomiting.

Diagnosis:
Emergency abdominal and pelvic computed tomography showed an intussusception with the evidence of associated small bowel obstruction. Histological analysis revealed as small intestinal hemangioma accompanied by mesenteric ulcer.

Interventions:
The patient underwent segmental resection of intussusception of intestine instead of invalid conservative treatment.

Outcomes:
Although the postoperative pathological results were inconsistent with preoperative imaging examination, the old woman recovered well.

Conclusion:
The literature on intussusception of small intestine has described several possible causes including hemangioma, which more likely results in gastrointestinal bleeding or abdominal pain. Yet we experienced a rare case presenting as abdominal distention without nausea and vomiting, Therefore, preoperative diagnosis and localization of these lesions is of great importance. We recommend high resolution contrast-enhanced computed tomography and magnetic resonance imaging should be considered in diagnosis while capsule endoscopy is not available owing to the intestinal obstruction, as long as in facilitating surgical excision.
Construction of molecular subgroups in childhood systemic lupus erythematosus using bioinformatics
Authors: Ma Jianglei , Zhang Huijie , Chu Weijiang , Wang Pengyu , Chen Huaqiu , Zhang Yuanyuan , Wang Guangming 
Published: December 2022

Background:
Systemic lupus erythematosus (SLE) is a complex autoimmune disorder. In patients with childhood SLE (cSLE), the onset of the disease occurs before 18 years of age and accounts for a high proportion of childhood autoimmune diseases. Adult SLE and cSLE differ in terms of clinical manifestations, gene expression profiles, and treatment. Because current diagnostic methods do not meet clinical requirements, researchers currently use transcriptome analysis to investigate the characteristics of the cSLE genome. In the present study, we used bioinformatics methods to genotype cSLE and identify potential therapeutic targets.

Methods:
The transcriptomes of 952 patients with cSLE and 94 normal controls were obtained from the Gene Expression Omnibus using unsupervised class learning to determine the genotypes in the microarray dataset, and the clinical characteristics, differentially expressed genes, and biological characteristics of the subtypes were analyzed.

Results:
Patients with cSLE were accordingly classified into three subgroups. Subgroup I was associated with lupus nephritis, female patients, and a high SLE disease activity index, and the disease in this subgroup was more severe than that in other subgroups. The SLE disease activity index in subgroup II was low; this subgroup may be related to lupus vasculitis. Subgroup III mostly included male patients and was associated with neuropsychiatric manifestations of lupus.

Conclusion:
We divided patients with cSLE into three subgroups with different characteristics based on transcriptome data. Our findings provide molecular evidence for future diagnosis and individualized treatment of cSLE.
Effects of preoperative nasal spray esketamine on separation anxiety and emergence agitation in pediatric strabismus surgery: A randomized clinical trial
Authors: Liu Wei , Sun Ruiqiang , Gao Xuesong , Wang Shuzhen 
Published: December 2022

Objective:
To investigate the effects of preoperative nasal spray esketamine on separation anxiety and postoperative emergence agitation in pediatric strabismus surgery.

Method:
Ninety children aged 3 to 6 years who underwent elective strabismus surgery were randomly divided into 3 groups that received 0.5 mg/kg (group S
1), 1 mg/kg of esketamine (group S
2), and the same volume of normal saline (group C) by nasal spray 10 minutes before surgery. The observation indicators of this test include the Ramsay sedation score, separation anxiety score, mask induction score, and the incidences of postoperative emergence agitation. Patient’s heart rate, blood oxygen, post anesthesia care unit stay time, and any adverse events were recorded.

Results:
The Ramsay sedation score was significantly lower in group C than those in groups S
1 and S
2 (P < .001). The separation anxiety scores and the mask induction scores were significantly higher in group C than those in groups S
1 and S
2 (P < .001). The incidences of emergence agitation in groups S
1 and S
2 were significantly lower than that in C group (P < .001). No obvious clinical complication was observed.

Conclusion:
Preoperative nasal spray esketamine reduced the preoperative separation anxiety and decrease emergence agitation in pediatric strabismus surgery.
Efficacy and safety of single- and multiple-antenna microwave ablation for the treatment of hepatocellular carcinoma and liver metastases: A systematic review and network meta-analysis
Authors: Han Yi , Zhao Wangyang , Wu Min , Qian Yingjun 
Published: December 2022

Background:
There is a myriad of microwave ablation (MWA) systems used in clinical settings worldwide for the management of liver cancer that offer a variety of features and capabilities. However, an analysis on which features and capabilities result in the most favorable efficacy and safety results has never been completed due to a lack of head-to-head comparisons. The aim of this study is to compare single-antenna and multiple-antenna MWA using radiofrequency ablation (RFA) as a common comparator in the treatment of very-early, early hepatocellular carcinoma (HCC) and ≤5 cm liver metastases.

Methods:
This network meta-analysis was performed according to PRISMA guidelines. PubMed, Cochrane, and Web of Science databases were searched for comparative studies. Complete ablation (CA) rate, local tumor progression-free (LTPF) rate, overall survival (OS), and major complication rate were assessed. Subgroup analyses were further performed based on synchronous or asynchronous MWA generators and tumor size (<2 cm or ≥2 cm).

Results:
Twenty-one studies (3424 patients), including 3 randomized controlled trials (RCTs) and 18 observational studies, met eligibility criteria. For CA, LTPF and major complications, as compared to single-antenna MWA, multiple-antenna MWA had relative risks (RRs) of 1.051 (95% CI: 0.987–1.138), 1.099 (95% CI: 0.991–1.246), and 0.605 (95% CI: 0.193–1.628), respectively. For 1-year and 3-year OS, as compared to single-antenna MWA, multiple-antenna MWA had odds ratios (ORs) of 0.9803 (95% CI: 0.6772–1.449) and 1.046 (95% CI: 0.615–1.851), respectively. Subgroup analysis found synchronized multi-antenna MWA was associated with significantly better LTPF by 22% (RR: 1.22, 95% CI 1.068, 1.421), and 21.4% (RR: 1.214, 95% CI 1.035, 1.449) compared with single-antenna MWA, and asynchronous multiple-antenna MWA, respectively, with more evident differences in larger tumors (≥2 cm).

Conclusion:
Multi-antenna and single-antenna MWA showed similar effectiveness for local treatment of liver tumors, but synchronous multi-antenna MWA exhibited better LTPF compared to other MWA approaches, particularly for larger liver tumors (≥2 cm). Large-scale RCTs should be further conducted.
Pharmacological effects of statins in adult patients with type 2 diabetes mellitus: A protocol for systematic review and meta-analysis
Authors: Mokgalaboni Kabelo , Dludla Phiwayinkosi V. , Nkambule Bongani B. 
Published: December 2022

Background:
Due to contradicting findings on impact of statins on endothelial function in type 2 diabetes mellitus especially across the randomized controlled trials (RCTs). With this systematic review, we aim to evaluate whether the use of statins improves endothelial function in adults with type 2 diabetes. We will further highlight if these biomarkers are ideal therapeutic targets for risk for atherosclerosis and cardiovascular disease.

Methods:
This protocol was carried out according to the preferred reporting items for systematic review and meta-analysis protocols-2015 guideline. The online databases, such as MEDLINE, Scopus, and Web of Sciences, will be targeted using the medical subject heading terms (MeSH) and text words. The review will include clinical studies on the effect of statins on markers of endothelial function in type 2 diabetes. The Cochrane risk of bias guideline will be used to assess the quality and risk of bias. We are planning to use the grading of recommendation assessment, development, and evaluation approach to evaluate the strength and quality of evidence.

Results:
This study will not involve human samples and patient data; hence ethics approval will not be required. The findings will be presented in journal clubs and conferences and published in peer-reviewed journals.
Effects of acupuncture on sensory symptoms and motor signs in patients with restless legs syndrome: A crossover randomized controlled trial
Authors: Fukutome Takero , Murashima Koji 
Published: December 2022

Background:
Rapid effects of acupoint injection (acuinjection) at 4 acupoints (4P) (ST36, GB41, SP6, and BL60) on legs presenting sensory symptoms and motor signs in restless legs syndrome (RLS) were first described in a case report. This study aimed to confirm the beneficial effects of acuinjection.

Methods:
A randomized, controlled, single-blinded, prospective crossover study was conducted during 2018 to 2021. Adult volunteers (age ≥ 20 years) with RLS symptoms for > 2 weeks were included. Eight adults were enrolled and randomized to receive acuinjection (Verum group) or sham injection (Sham group). The effects of acuinjection on discomfort and periodic leg movement (PLM) were evaluated using the suggested immobilization test in a crossover design. The acupoint used was 4P, and normal saline solution (0.1–0.25 mL) was injected in both groups. Leg discomfort was measured using the visual analog scale (VAS), and PLM was measured using an electromyogram. To compare the VAS scores between the groups, repeated measures analysis of variance was used, and the Student t test was used to assess the mean discomfort score (MLDS: average of the 6 VAS scores) and PLM index (PLMI) (defined as the degree of PLM/hour).

Results:
A significant difference in the VAS score was observed; however, no significant difference was noted in the PLMI between the groups. The MLDS was significantly lower in the Verum group than in the Sham group.

Conclusion:
Acuinjection at 4P remarkably inhibited leg discomfort in patients with RLS. Despite the drastic PLM suppression in 1 patient by acuinjection, a statistically significant inhibition of PLM was not confirmed. The results of our study can be applied easily and safely in clinical situations where it is necessary to temporarily reduce or eliminate RLS symptoms.
Case report: One human Streptococcus suis occurred in Shandong Province, China
Authors: Chen Shuyu , Li Renpeng , Wang Xin , Liu Yuwei , Kou Zengqiang , Wang Qiang 
Published: December 2022

Background:

Streptococcus suis (S suis) is a major pathogen of bacterial infectious diseases, which can be transmitted to human beings through close contact with sick pigs or carriers, and can cause toxic shock, meningitis, septicemia, pneumonia, and other complications, with an extremely high mortality and disability rate. S suis is also an emerging zoonotic agent, mainly occurring in China, Thailand, and the Netherlands. This seriously threatens the health and family economy of patients.

Case presentation:
A 75-year-old man presented with a 1-day history of fever, vomiting, coughing, chills, and unconsciousness. He was admitted with the diagnosis sepsis and intracranial infection. At admission, hematologic studies showed a leukocyte count of 23.45 × 109/L with 91% neutrophils. Chest computed tomography revealed double pneumonia. Blood cultures grew small colonies, which were identified as S suis. Antibiotic susceptibility testing revealed that the pathogen was susceptible to levofloxacin. And then, treatment with levofloxacin was implemented. Epidemiological investigations showed that the patient had eaten pork from a sick pig. When a patient with bacterial infection has a history of eating pork from sick pigs, human S suis infection should be taken seriously.

Conclusion:
Although human S suis infection generally presents as a sporadic disease, its high burden highlights the importance of epidemiological surveillance and health education regarding human S suis infection.
Catecholamine crisis after endoscopic ultrasound-guided fine-needle biopsy: A case report
Authors: Lee Hyun Seok , Lee Eaum-Seok 
Published: December 2022

Rationale:
The function and use of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has developed in recent years, particularly in distinguishing malignant from benign masses. It is a generally safe method that can be completed without any uncommon complications. Here, although no complications from EUS-FNB were noted, we report about an unexpected catecholamine crisis that occurred after EUS-FNB.

Patient’s concerns:
A 60-year-old man visited an outpatient clinic with an incidental diagnosis of a retroperitoneal mass on his last abdominopelvic computed tomography (APCT) scan taken at the time of a previous liver abscess treatment. On presentation, the patient showed no symptoms.

Diagnoses:
A retroperitoneal mass was incidentally discovered on APCT, and risk for lymphoma, gastrointestinal tumor, or neuroendocrine tumor was noted on the APCT reading.

Interventions:
EUS-FNB was performed on retroperitoneal mass.

Outcomes:
The procedure was completed without any complications; however, the patient’s condition deteriorated due to hemodynamic instability and cardiovascular collapse. During intensive care unit (ICU) treatment, the biopsy results were found to be paraganglioma. Catecholamine crisis occurred after biopsy of paraganglioma.

Lessons:
The case presented here gives a caution of complication that may occur after EUS-FNB. Although EUS-FNB is known to be relatively safe, careful evaluation is required when performing biopsy of lesions around the aorta.
Childhood pheochromocytoma crisis complicated with brain stem infarction: A case report
Authors: Xie Fujing , Zhao Qingbing , Pan Wenwen , Zhang Anqi , Li Ke 
Published: December 2022

Rationale:
Pheochromocytoma crises are very rarely seen in children. In this report, we present a case of the death related to occult pheochromocytoma crisis combined cerebral infarction.

Patient concerns:
A 5-year-old boy has a 1-month history of polydipsia, polyuria, sweating, and weight loss of 2.5 kg. He was admitted to our hospital because of 1 week of anorexia, 2 days of vomiting, and 12 hours of convulsions and confusion. Magnetic resonance imaging of the brain and cervical spinal cord showed abnormal signals in the left parie-occipital lobe, medulla oblongata till C7 cervical vertebrae.

Diagnoses:
Based on patient’s complaints and clinical appearance, provisional diagnosis of pheochromocytoma crisis complicated brainstem infarction was considered.

Interventions:
Tracheal intubation, volume expansion, continuous infusion of dobutamine, and sedation reduce intracranial pressure. Chest compression was performed when the child suddenly developed sobbing respiration.

Outcomes:
The patient was dead. Congenital metabolic defects screening suggested mild ketonuria. Trio whole exon sequencing revealed a synonymous mutation of von Hippel–Lindau syndrome c.414 A > G in the decedent. Autopsy revealed pheochromocytoma, acute myocarditis, liquefaction necrosis of the medulla oblongata cerebral edema, and congestion.

Lessons:
Early clinical symptoms of pheochromocytoma in children are not typical. It may induce serious complications and develop into a pheochromocytoma crisis and cause death without proper treatment.
Clinical efficacy of SGLT2 inhibitors with different SGLT1/SGLT2 selectivity in cardiovascular outcomes among patients with and without heart failure: A systematic review and meta-analysis of randomized trials
Authors: Lee Mei-Chuan , Hua Yi-Ming , Yang Chun-Ting , Kuo Fang-Hsiu , Chang Wei-Ting , Tang Hsin-Ju , Siong Toh Han , Lin Yu-Min , Chen Sih-Yao , Chang Hung-Yu , Liao Chia-Te 
Published: December 2022

Background:
Some sodium-glucose co-transporter-2 (SGLT2) inhibitors showed benefits on heart failure (HF), but different SGLT2/SGLT1 selectivity might influence the treatment effect. This study aimed to meta-analyze the treatment effects of SGLT2 inhibitors and the diversity of receptor selectivity for patients with and without HF.

Methods:
Randomized controlled trials were searched in PubMed, Embase, Cochrane databases and ClinicalTrials.gov registry from inception to October 2020. The interest outcomes were analyzed with random-effects models and presented with a risk ratio (RR) and 95% confidence interval (CI). Subgroup analyses examined the treatment effects among SGLT2 inhibitors with different SGLT2/SGLT1 selectivity.

Results:
The final analyses included 10 trials and 52,607 patients. The RR of total cardiovascular (CV) death or hospitalization for HF (HHF) between SGLT2 inhibitors and placebo was 0.79 (95% CI 0.74–0.84, I
2 = 31%). With SGLT2 inhibitors, HF patients had reduced mortality risks (RR 0.89, 95% CI 0.80–0.99, I
2 = 0), and non-HF patients had lower risks of major adverse CV events (RR 0.92, 95% CI 0.85–0.99, I
2 = 0). The risk reduction of HHF was consistent in groups of HF (RR 0.72, 95% CI 0.64–0.80, I
2 = 8%) and non-HF (RR 0.74, 95% CI 0.61–0.89, I
2 = 0), but the effect of the low SGLT2/SGLT1 selectivity inhibitor was insignificant in non-HF patients.

Conclusion:
The efficacy of SGLT2 inhibitors on risk reduction of total CV death or HHF is consistent with the previous studies. The regimen is beneficial for reducing mortality in patients with HF and major adverse CV events in those without HF. Different SGLT2/SGLT1 selectivity may differ in the treatment effects in patients with and without HF.