bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occult deterioration of an aortic annular abscess: how do we diagnose a pseudoaneurysm periaortic valve? A case report
Authors: Chen Tienan , Li Yinling , Qiao Shuai , Fu Huaying 
Published: August 2023

Abstract
Background
Infectious endocarditis (IE) is a disease caused by the colonization of toxic microorganisms on the endocardium of heart valves [1]. Although much progress has been made in the diagnosis and treatment of IE, its complications, such as annular abscesses [2], still have a high mortality rate. In this case, we describe a patient with infective endocarditis complicated by occult deteriorated aortic annular abscess.

Case presentation
A 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10 h. He had recurrent fevers for 1 month before admission. Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve, moderate aortic regurgitation and a possible aortic annular abscess. Blood cultures were negative and empiric antibiotic therapy was begun. The patient did not have fever again and seem to be clinically improved. However, follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm. The patient underwent mechanical prosthetic valve replacement and annulus reconstruction successfully. Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved, which requires us to pay more attention.

Discussion
Occult deterioration of an aortic annular abscess is rare and more attention should be paid. Re-evaluation of echocardiography is required even if the patient’s symptoms improve.
Application of enhanced recovery after surgery following liver transplantation
Authors: Jin Boxun , Gu Yanmei , Xi Shuangmei , Liu Xin , Wu Xiulian , Li Guangming 
Published: August 2023

Abstract
Objective
To investigate the effect of an enhanced recovery after surgery (ERAS) programme following liver transplantation and to further clarify the safety and clinical application value of an ERAS programme.

Methods
A retrospective analysis of 250 patients who underwent liver transplant at Beijing You’an Hospital affiliated to Capital Medical University between March 2019 and December 2021 was conducted. According to different perioperative management methods, patients were divided into a control group (120 cases) and an ERAS group (130 cases). Postoperative safety indicators, efficacy indicators and economic indicators were compared between the two groups.

Results
There was no significant difference in the safety indicators between the two groups. The ERAS group showed significantly lower results compared with the control group in terms of ventilator-associated pneumonia, urinary tract infection, pressure injury of oral and nasal mucosa, postoperative pain score 5 days after surgery and the incidence of delirium, whereas the Barthel score 10 days after surgery was significantly higher. There was no significant difference between the two groups in skin pressure injury or the Subjective Global Assessment grade 10 days after surgery. The length of intensive care unit stay, the total length of stay after surgery and the 10-day medical expenses after surgery were significantly lower in the ERAS group than in the control group.

Conclusion
The application of an ERAS programme after liver transplantation can effectively promote the postoperative recovery of patients and reduce medical costs. Studies have shown that the ERAS programme has important application value in improving the postoperative quality of life and reducing the economic burden of patients after liver transplantation. This programme provides a new concept for related clinical improvement and application.
Nitrous oxide-induced polyneuropathy, pancytopenia and pulmonary embolism: a case report
Authors: Parein Guillaume , Bollens Benjamin 
Published: August 2023

Abstract
Background
Nitrous oxide is a medical and household gas that has seen its use drift to recreational purpose among the young population in recent years. Significant neurological, hematological and psychiatric side effects, generally related to an induced functional vitamin B12 deficiency, have been described separately in the literature.

Case report
A 22-year-old woman of North African origin experienced an exceptional combination of polyneuropathy, bilateral pulmonary embolism and severe pancytopenia related to vitamin B12 deficiency and hyperhomocysteinemia induced by recreational nitrous oxide use. After treatment with vitamin B12 supplementation and intensive rehabilitative management, the patient progressively regained the ability to walk and her biological parameters gradually returned to normal. The pathophysiological mechanisms related to a decrease in vitamin B12 activity are the reduction of products needed for synthesis of deoxyribonucleic acid, carbohydrate or fatty acids, and the increase of hyperhomocysteinemia. Other mechanisms involving a direct action of N2O are also suspected.

Conclusion
This case report brings elements to support our knowledge about pathological pathway, recovery and prognosis of recreational N2O abuse complications. The general and medical population should be aware to the serious consequences of this type of consumption.
Improving inappropriate radiology referrals: a template for imaging requests in Saudi Arabia
Authors: Albahiti Sarah , Khafaji Mawya , Jamjoom Lamia , Badeeb Arwa 
Published: August 2023

Abstract
Background
Imaging requests are the first line of communication between the referring physician and the radiology department. The information provided allows the imaging team to choose the optimal examination for the clinical question. There are no imaging referral guidelines in Saudi Arabia. The Radiological Society of Saudi Arabia (RSSA) and Arabsafe have surveyed to develop an imaging referral tool in Saudi Arabia. This study aims to determine the most critical clinical information that should be included in an imaging request form in Saudi Arabia.

Methodology
A questionnaire was sent to the RSSA members to rank —using the Likert scale— the importance of 8 pieces of clinical information to discern what must be included in the imaging request form.

Results
The response rate was 80% of the RSSA members, which included 75 respondents, mostly Radiology consultants and residents in training. Radiologists carried different specialties and came from 4 main provinces in the Kingdom. 90.6% of Radiologists ranked the clinical question with relevant details as very important. The contact information of the requesting clinician came next in the ranking, with 82.3% scoring it as very important. The “very important” scores were 64.9% for the past medical history, 67.3% for past surgical history, 49.2% for laboratory, 38.3% for risk factors, and 56.7% for prior radiological studies. The RSSA-Arabsafe imaging request template was proposed because of the respondents’ votes to include all eight points: a clear clinical question relevant to the requested exam, the contact information of the referring physician, relevant surgical history, relevant medical history, past radiological tests if any, patient demographics, and relevant laboratory tests.

Conclusions
The RSSA-Arabsafe template is the first tool to improving imaging referrals and hence patients’ safety and services in Radiology departments in Saudi Arabia. It is crucial for healthcare institutions to actively implement standardized imaging request forms, such as the proposed RSSA-Arabsafe template, to reduce inappropriate referrals, enhance communications and optimize resource utilization.
Bioautography, synergistic effect and HPTLC-MS and SEM analysis of antimicrobial and antioxidant compounds of inflorescence extract of Sphaeranthus indicus
Authors: Tandon Dhananjay , Gupta Ashwini Kumar 
Published: August 2023

Abstract
Background
Sphaeranthus indicus L. is a well-known medicinal plant in folk medicine. A variety of biological activities and chemical substances in this plant have been reported. The phytochemical content and activity may vary according to geographic location. This study aims to determine the geographical significance, the analysis of the synergistic effect of phytochemicals, the identification of active compounds, and the determination of the action mechanism of S. indicus inflorescence methanolic extract against Staphylococcus aureus and Klebsiella pneumonia.

Results
The bands with Rf values of 0.92 and 1.0 showed antimicrobial activity, while all bands showed antioxidant activity. The first fraction showed the highest antimicrobial activity, and the pool of the second fraction showed the highest antioxidant activity. The kinetics of the antioxidants differed among the fractions. Analysis of synergistic effects showed that several compounds were involved in the activities. The bands with Rf 0.45, 0.55, 0.68, 0.79, and 0.85 were active components of the extract. Leakage of cell contents was detected at 260 and 280 nm wavelengths. Six different proteins and one nucleic acid band were detected after electrophoresis. The SEM analysis showed that the phytochemicals caused severe membrane damage.

Conclusion
The study revealed that the photochemical present in methanol extract of the inflorescence of S. indicus has a synergistic effect and acts on bacterial cell envelope. The five compounds were identified as active molecules belonging to the class of terpenoids. The result also signified the geographical area since thymol was identified for the first time in this plant at this location.

Graphical abstract
A LlMYB305-LlC3H18-LlWRKY33 module regulates thermotolerance in lily
Authors: Wu Ze , Liang Jiahui , Li Ting , Zhang Dehua , Teng Nianjun 
Published: August 2023

AbstractThe CCCH proteins play important roles in plant growth and development, hormone response, pathogen defense and abiotic stress tolerance. However, the knowledge of their roles in thermotolerance are scarce. Here, we identified a heat-inducible CCCH gene LlC3H18 from lily. LlC3H18 was localized in the cytoplasm and nucleus under normal conditions, while it translocated in the cytoplasmic foci and co-located with the markers of two messenger ribonucleoprotein (mRNP) granules, processing bodies (PBs) and stress granules (SGs) under heat stress conditions, and it also exhibited RNA-binding ability. In addition, LlC3H18 exhibited transactivation activity in both yeast and plant cells. In lily and Arabidopsis, overexpression of LlC3H18 damaged their thermotolerances, and silencing of LlC3H18 in lily also impaired its thermotolerance. Similarly, Arabidopsis atc3h18 mutant also showed decreased thermotolerance. These results indicated that the appropriate expression of C3H18 was crucial for establishing thermotolerance. Further analysis found that LlC3H18 directly bound to the promoter of LlWRKY33 and activated its expression. Besides, it was found that LlMYB305 acted as an upstream factor of LlC3H18 and activated its expression. In conclusion, we demonstrated that there may be a LlMYB305-LlC3H18-LlWRKY33 regulatory module in lily that is involved in the establishment of thermotolerance and finely regulates heat stress response.
Graphical Abstract
Peculiarities of neoplasms appeared after total body irradiation and homeostasis parameters in rats
Authors: Snezhkova Elisaveta , Voronina Olena , Zadvornyi Taras , Todor Igor , Lukianova Natalia , Melnyk Victor , Sakhno Laryssa , Bardakhivska Kvitoslava , Chekhun Vasyl , Nikolaev Vladimir 
Published: August 2023

Background: Tissue damage and disruption of metabolic processes as a result of total body irradiation (TBI) could lead to tumorigenesis. Methods: Female rats (25 of 32) were X-irradiated with a 6-Gy dose. On month 12±1 animals were sacrificed. The alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), amylase, lactate dehydrogenase (LDH), Ca 2+, creatinine, glucose, phosphorus, urea, uric acid, total protein, pO2, pCO2, pH, and blood cell count were evaluated in blood. Tumors were examinated histologically. Results: On 12±1 months after TBI, 76% of rats had visually detected tumors, histologically classified as benign fibro adenomas. Metabolic, hematological changes versus healthy control indicated disturbances in the homeostasis system. The blood lactate level was typically higher in animals with tumors than without. The ratio of tumor weight to lactate (or LDH) level in blood was 1±0.5 in the 63% of rats and histological analysis revealed the signs of biphasic hyperplasia of glandular lobes and connective tissue stroma, associated with secretory and proliferative activities in tumor. In animals with high values of this ratio (≥1.5) neoplasms were represented by fibrous and glandular tissues presenting a predominant stromal fibrous component, associated with the prevalence of high proliferation in tumor. While in 20% of tumor bearing rats with the low ratio (<0.5) predominated an epithelial structure with homogeneous basophilic content in the glandular lumens, suggesting the domination of secretory activity in tumor. Conclusions: TBI promoted the alterations of hematological and biochemical parameters of homeostasis in rats and provoked the appearance of benign tumors one year after. The ratio of tumor mass to lactate (or LDH) level in blood seems to be an informative indicator of the histological particularities of tumors, suggesting the prevalence of proliferative or secretory activity, or the balance between them.
BurkHostGEN: a study protocol for evaluating variations in the Burkholderia pseudomallei and host genomes associated with melioidosis infection
Authors: Angchagun Kesorn , Boonklang Phumrapee , Chomkatekaew Chalita , Pakdeerat Sukritpong , Wongsuwan Gumphol , Amornchai Premjit , Wuthiekanun Vanaporn , Panapipat Salwaluk , Ngernseng Thatsanun , Waithira Naomi , Walton Steve , Limmathurotsakul Direk , Surawong Anoree , Siriboon Suwatthiya , Chamnan Parinya , Chantratita Narisara , Dunachie Susie , Corander Jukka , Davenport Emma E. , Knight Julian , Parkhill Julian , Peacock Sharon J. , Thomson Nicholas R. , Day Nicholas P.J. , Chewapreecha Claire 
Published: August 2023

Background: Melioidosis is a frequently fatal disease caused by an environmental bacterium Burkholderia pseudomallei. The disease is prevalent in northeast Thailand, particularly among rice field farmers who are at risk of bacterial exposure through contact with contaminated soil and water. However, not all exposure results in disease, and infection can have different infection outcomes. Our hypothesis is that the acquisition and outcomes of melioidosis may be influenced by genetic factors of the bacterium, the host, or a combination of both. To address this hypothesis, we aim to collect, sequence, and analyse genetic data from melioidosis patients and controls, along with isolates of B. pseudomallei obtained from patients. Additionally, we will study the metagenomics of the household water supply for both patients and controls, including the presence of B. pseudomallei. Methods: BurkHostGEN is an ongoing observational study being conducted at Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand. Weare obtaining consent from 600 melioidosis patients and 700 controls, spanning both sexes, to collect 1 mL of blood for host DNA analysis, 3 mL of blood for RNA analysis, as well as 5 L of household water supply for metagenomic analysis. Additionally, we are isolating B. pseudomallei from the melioidosis patients to obtain bacterial DNA. This comprehensive approach will allow us to identify B. pseudomallei and their paired host genetic factors associated with disease acquisition and severity. Ethical approvals have been obtained for BurkHostGEN. Host and bacterial genetic data will be uploaded to European Genome-Phenome Archive (EGA) and European Nucleotide Archive (ENA), respectively. Conclusions: BurkHostGEN holds the potential to discover bacterial and host genetic factors associated with melioidosis infection and severity of illness. It can also support various study designs, including biomarker validation, disease pathogenesis, and epidemiological analysis not only for melioidosis but also for other infectious diseases.
Prospective randomised unblinded comparison of sputum viscosity for three methods of saline nebulisation in mechanically ventilated patients: A pilot study protocol
Authors: Arnott Andrew , Hart Robert , McQueen Scott , Watson Malcolm , Sim Malcolm 
Published: August 2023

Introduction
Heat and moisture exchanger (HME) filters are commonly used as passive circuit humidifiers during mechanical ventilation, however, are only ~80% efficient. As a result, patients that undergo mechanical ventilation in critical care with HME filter circuits will be exposed to partial airway humidification. This is associated with detrimental effects including increased secretion load which has been shown to be an independent predictor of failed extubation. Nebulised normal saline is commonly utilised to supplement circuit humidification in ventilated patients with high secretion loads, although there are no randomised control trials evaluating its use. Novel vibrating mesh nebulisers generate a fine aerosol resulting in deeper lung penetration, potentially offering a more effective means of nebulisation in comparison to jet nebulisers. The primary aim of this study is to compare the viscosity of respiratory secretions after treatment with nebulised normal saline administered via vibrating mesh nebuliser or jet nebuliser.

Methods and analysis
This randomised controlled trial is enrolling 60 mechanically ventilated adult critical care patients breathing on HME filter circuits with high secretion loads. Recruited patients will be randomised to receive nebulised saline via 3 modalities: 1) Continuous vibrating mesh nebuliser; 2) Intermittent vibrating mesh nebuliser or 3) Intermittent jet nebuliser. Over the 72-hr study period, the patients’ sputum viscosity (measured using a validated qualitative sputum assessment tool) and physiological parameters will be recorded by an unblinded assessor. A median reduction in secretion viscosity of ≥0.5 on the qualitative sputum assessment score will be deemed as a clinically significant improvement between treatment groups at analysis.

Discussion
At the conclusion of this trial, we will provisionally determine if nebulised normal saline administered via vibrating mesh nebulisation is superior to traditional jet nebulisation in terms of reduced respiratory secretion viscosity in intubated patients. Results from this pilot study will provide information to power a definitive clinical study.

Trial registration
ClinicalTrails.Gov Registry (NCT05635903).
Survey of clinicians on the use of adjuvant therapy for premenopausal women with breast cancer
Authors: Lee Young-Won , Ahn Sei-Hyun , Lee Young-jin , Yoo Tae-Kyung , Kim Jisun , Chung Il Yong , Kim Hee Jeong , Ko Beom Seok , Lee Jong Won , Son Byung Ho , Lee Sae Byul 
Published: August 2023

Purpose
Considering prognostic and anatomic stages in early-stage premenopausal patients with breast cancer, clinicians decide on performing the multigene assay, adjuvant chemotherapy, or ovarian function suppression (OFS). This decision is also based on genetic information related to hormone receptor-positive and human epidermal growth factor receptor 2 negative results. We aimed to determine the tendency to use adjuvant therapy in clinical practice.

Methods
From April to May 2022, clinicians of the Korean Breast Cancer Society responded to a web-based survey. The survey included 62 multiple-choice questions mainly on decision-making under different pathologic conditions.

Results
Among 92 responding clinicians, 91.3% were breast surgeons. For 35-year-old patients (pT2N0 and Ki-67 50% profile), 96.8% of clinicians selected chemotherapy, whereas 50.7% selected chemotherapy for patients with pT1N0, Ki-67 10%, and without Oncotype Dx (ODX). Only 35.6% selected chemotherapy for 47-year-old patients with the same profiles, while 84.3% and 49.1% chose chemotherapy with ODX recurrence score 21 and 16, respectively. More clinicians selected tamoxifen (TMX) plus OFS than aromatase inhibitor (AI) plus OFS for 5 years of endocrine therapy in patients with adjuvant chemotherapy regardless of genomic and clinical risks. However, for the same patients without adjuvant chemotherapy, more clinicians selected AI plus OFS. A longer duration of additional OFS and TMX was selected in patients with high clinical and genomic risks, and the duration of OFS was relatively shorter in older patients.

Conclusion
The decision regarding adjuvant therapy should be made considering clinical and genomic risks and age, and clinicians should consult with patients about adverse effects and compliance.
The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil
Authors: Brioschi dos Santos Ana Paula , Vicente Creuza Rachel , Cola João Paulo , Tanaka Luana Fiengo , Garbin Juliana Rodrigues Tovar , Dell’Antonio Larissa Soares , Dell’Antonio Cristiano Soares da Silva , Miranda Angelica Espinosa 
Published: August 2023

Objective
The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2.

Methods
This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (Sistema Nacional de Nascidos Vivos), National Mortality System (Sistema Nacional de Mortalidade), and e-SUS Health Surveillance System (Sistema e-SUS Vigilância em Saúde). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes.

Results
We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had ≥ 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73–95% confidence interval [95%CI] 11.07–31.69), fetal death/stillbirth (RR 1.96–95%CI 1.18–3.25), preterm birth [RR 1.18–95%CI 1.01–1.39], cesarean delivery (RR 1.07–95%CI 1.02–1.11), and cesarean delivery occurring before the onset of labor (RR 1.33–95%CI 1.23–1.44).

Conclusion
COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.