bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of multi-DAA resistance using a novel hepatitis C virus genotype 3a infectious culture system
Authors: Fernandez-Antunez Carlota , Wang Kuan , Fahnøe Ulrik , Mikkelsen Lotte S. , Gottwein Judith M. , Bukh Jens , Ramirez Santseharay 
Published: March 2023

Background and Aims:
The high HCV infection cure rates achieved with direct-acting antiviral (DAA) treatments could be compromised in the future by the emergence of antiviral resistance. Thus, it is essential to understand the viral determinants that influence DAA resistance, which is most prevalent in genotype 3. We aimed at studying how resistance to protease-, NS5A-, and NS5B-inhibitors influences the activities of glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, and sofosbuvir/velpatasvir/voxilaprevir in cell culture, and how the HCV genome adapts to selective pressure by successive rounds of treatment failure.

Approach and Results:
A previously developed in vivo infectious cDNA clone of strain S52 (genotype 3a) was adapted to efficiently replicate and propagate in human hepatoma cells (Huh7.5) using 31 adaptive substitutions. DAA escape experiments resulted in the selection of S52 variants with decreased drug susceptibility (resistance), which was linked to the emergence of known resistance-associated substitutions (RASs). NS5A-inhibitor resistance was sufficient to promote treatment failure with double-DAA but not triple-DAA regimens. Enhanced viral fitness associated with the selection of sofosbuvir resistance accelerated escape from DAAs. After serial DAA treatment failure, HCV genetic evolution led to a complex genome-wide network of substitutions, some of which coevolved with known RASs.

Conclusions:
Baseline NS5A-RAS can compromise the efficacy of double-DAA pangenotypic regimens for HCV genotype 3, and enhanced viral fitness can accelerate treatment failure. Persistence of RASs after successive treatment failure is facilitated by the remarkable evolutionary capacity and plasticity of the HCV genome. Proof-of-concept for the potential development of multi-DAA resistance is shown.
Rhinovirus, When Is It More Than Just a Cold? Rhinovirus as a Cause of Organizing Pneumonia in Two Patients With Hematological Cancer
Authors: Vasiloudes Kritos P. , Greene John N. 
Published: March 2023

Abstract
Human rhinoviruses are pathogens that cause significant morbidity and economic strain from upper respiratory infections. Rhinovirus has also been associated with exacerbations of chronic lung disease. Less understood is the role of rhinovirus in organizing pneumonia (OP). Organizing pneumonia is a certain lung pattern of injury that occurs after injury to the pulmonary parenchyma, with infection being the most studied etiology. It typically presents with similar symptoms to pneumonia, and patients are often treated with antibiotics to lack of improvement. However, OP is more subacute in presentation, and the treatment, systemic glucocorticoids, differs from bacterial pneumonia. Recognition of rhinovirus as a significant pathogen in immunocompromised patients is important because it tends to cause more severe disease in this group. Here, we present a case series of 2 hematological malignancy patients with a long-standing rhinovirus infection and lung disease unresponsive to antibiotics, later found on biopsy to be OP.
Both patients survived the infection, and both patients had documented rhinovirus shedding for greater than 9 months. Both patients had lymphoma and were being actively treated with a monoclonal antibody that targeted cluster of differentiation 20. Both patients reported fever and dyspnea. Both patients had multiple superimposed bacterial infections, with both patients eventually developing Pseudomonas aeruginosa pneumonia. In the immunocompromised, rhinovirus may cause morbidity through a primary infection, a secondary bacterial infection, or OP. Novel treatment strategies and increased awareness are needed not only for rhinovirus-induced OP but also for rhinovirus as an important pathogen in immunocompromised patients.
Cannabis update: Anxiety disorders and post-traumatic stress disorder
Authors: Haycraft Amy L. 
Published: March 2023

ABSTRACT
The development of anxiety disorders and post-traumatic stress disorder (PTSD) is complex. Both delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are of potential therapeutic use. Evidence suggests that cannabis has a beneficial effect on neural circuitry involved in fear regulation. In the United States, cannabis is considered either medical or recreational and can contain pure THC or CBD or any combination thereof. The numerous cannabis compounds of various administration routes, with variable pharmacokinetics, further affect the cannabis conundrum. Despite being federally unregulated, medical cannabis has received increased attention socially, and at present, 37 states, four territories, and the District of Columbia have legalized medical cannabis for use in specific health conditions. Patients are increasingly inquiring about cannabis, and clinicians must educate themselves with reliable cannabinoid information for patient education. In adults with anxiety disorders and PTSD, evidence supports a relatively safe profile for medical cannabis; however, conclusive scientific evidential support of its therapeutic properties is limited, resulting in a lack of standardization and Food and Drug Administration approval.
Imaging features of hyperacute intracerebral hemorrhage on multiple MRI sequences within 1 minute from onset during MRI examination: A case report
Authors: Bae Sang Bin , Kim Sanghyeon 
Published: March 2023

Rationale:
Acute stroke requires accurate imaging to ensure appropriate treatment decisions and favorable clinical outcomes. Computed tomography has long been used as an exclusive imaging technique to assess intracerebral hemorrhage, owing to its rapid scanning time and widespread availability. Several recent studies have reported the reliable detection of hyperacute hemorrhage using magnetic resonance imaging (MRI).

Patient concerns:
An 88-year-old woman with a history of hypertension presented with mild, acute dysarthria. The National Institutes of Health Stroke Scale score was 1.

Diagnoses:
Non contrast head computed tomography revealed the absence of acute cerebral hemorrhage. The patient underwent magnetic resonance, revealed hyperacute intracerebral hemorrhage within a few minutes of its occurrence on multiple MRI sequences.

Interventions and outcomes:
In this patient, hemorrhage developed during MRI for acute ischemic stroke. Hemorrhage was initially misdiagnosed, and inappropriate treatment severely affected the patient’s health.

Lessons:
Clinicians in the Department of Neurological Emergency should be familiar with imaging findings of hyperacute hemorrhage on multiple MRI sequences.
Bilateral medial medullary infarction with intravenous thrombolytic therapy: A case report
Authors: Fan Mingyue , Gao Junshu , Li Na , Jin Wei , Liu Yang , Zhang Xueqian , Lv Peiyuan 
Published: March 2023

Rationale:
Bilateral medial medullary infarction is a rare stroke subtype. To investigate its clinical manifestations, etiology, imaging features and thrombolytic effect, We here in reported a patient with acute ischemic stroke in the bilateral medial medullary and reviewed the related literatures.

Patients concern:
A 64-year-old female was taken to our hospital after 4.5 hours of dizziness in the morning, followed by somnolence and limb weakness. She gradually worsened into a rapidly progressive tetraparesis and slurred speech.

Diagnoses:
Diffusion weighted imaging exhibited a “heart appearance” sign in bilateral medial medulla oblongata, and high-resolution magnetic resonance imaging suggested the left vertebral artery-4 thromboembolism.

Interventions:
Timely intravenous thrombolysis was performed.

Outcome:
After intravenous thrombolysis, the patient’s symptoms did not worsen in a short time. Although the symptoms were aggravated in the later stage, they were alleviated after active treatment.

Lessons:
Diffusion weighted imaging can assist in the early diagnosis of bilateral medial medullary infarction, which will help in the decision to proceed with intravenous thrombolysis therapy. High-resolution magnetic resonance imaging should be improved as soon as possible, which can provide basis for the next intravascular interventional therapy.
Effectiveness of drug-coated balloon in acute myocardial infarction: A protocol for systematic review and meta-analysis
Authors: Yu Aili , Liu Hong , Yu Haiyan , Xiong Xue 
Published: March 2023

Background:
The management of acute myocardial infarction (AMI) has improved dramatically over the past 3 decades and is evolving. Percutaneous coronary intervention is an alternative means of achieving coronary revascularization. Previous studies comparing the published literature on drug-coated balloon (DCB) and drug-eluting stents have drawn divergent conclusions. We perform a protocol for systematic review and meta-analysis to compare the efficacy and safety of DCB and drug-eluting stent in the management of AMI.

Methods:
This systematic review was registered in the PROSPERO network (registration number: CRD42023397266). We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocol to accomplish the systematic review protocol. A systematic search will be conducted in PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, Wanfang Database, and Weipu Database without any language restrictions from their inception to February 2022. The risk of bias will be assessed independently by 2 authors using parameters defined in the Cochrane Handbook for Systematic Reviews of Interventions criteria. Statistical analysis will be performed using the STATA13.0 software (IBM, USA).

Results:
The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal.

Conclusion:
The results of the study will provide the evidence for the application of DCB in the treatment of AMI.
Extra-gastrointestinal stromal tumors (EGISTs): A case report for a mischief entity
Authors: El Charif Mohamad Hadi , Amro Sara , Boulos Fouad , Khalife Mohamad , Shamseddine Ali , Assi Hazem , Sbaity Eman 
Published: March 2023

Background:
Extra-gastrointestinal stromal tumor is a rare subtype of soft tissue sarcomas with significantly variable presentation, management, and prognosis. This makes it crucial to report the different institutional experiences of encountering extra-gastrointestinal stromal tumors (EGIST).

Case presentation:
We report 3 cases of EGIST diagnosis at American University of Beirut Medical Center for 2 males and 1 female in the 5th, 6th, and 7th decades of life, respectively. For the first case, the tumor was initially suspected to be ovarian cancer, but biopsy revealed a diagnosis of EGIST, and the patient was started on neoadjuvant therapy. In the second case, the tumor was retro-gastric and prelim diagnosis was gastric cancer but again biopsy revealed an EGIST histopathology, and the patient underwent surgery and adjuvant treatment. For the third case, a previous history of testicular cancer prompted an initial suspicion of recurrence with metastasis but biopsy and immunohistochemistry staining revealed EGIST with related markers. The patient underwent treatment at a different institution in his home country.

Conclusion:
This report sheds light on the importance of keeping EGIST amongst any differential list for abdominal and pelvic tumors. It also shows that EGIST-focused studies are needed to assess the effectiveness of the different treatment modalities available when utilized specifically for EGIST. This would allow for better oncological outcomes and improved quality of life.
Inferior ST segment elevation myocardial infarction combined with hyperextension cervical spine injury: A rare case report
Authors: Li Jiaying , Zhong Ping , Wang Zheng , Han Shufang 
Published: March 2023

Rationale:
Inferior ST-segment elevation myocardial infarction (STEMI) is usually caused by acute occlusion of the right coronary artery or left circumflex coronary artery (LCX). Inferior STEMI can cause a high-grade atrioventricular block, sinus bradycardia, and hypotension, leading to hemodynamic collapse, syncope, and disturbance of consciousness.

Patient concerns:
A case of a sudden disturbance of consciousness after chest tightness as the initial symptom, followed by incomplete paralysis and paresthesia of the extremities due to the collision of the face with the ground.

Diagnoses:
Coronary angiography showed about 99% of stenosis in the LCX. Cervical spine magnetic resonance imaging showed C2/3, C3/4, C4/5, and C5/6 intervertebral disc herniation with secondary spinal stenosis, spinal cord compression, and edema. The patient was diagnosed with inferior STEMI combined with hyperextension cervical spine injury.

Interventions and outcomes:
Bivalirudin was used for anticoagulation, the LCX lesion was pre-expanded with a balloon and the thrombus was removed, and anti-platelet aggregation therapy was given postoperatively. After rehabilitation therapy, hyperextension cervical spine injury improved. There was no recurrence of syncope and precordial pain during the 6-month follow-up.

Lessons:
Hyperextension cervical spine injury has unique hemodynamic features that mimic those associated with inferior STEMI, so a detailed medical history inquiry and physical examination should be carried out to avoid missed diagnoses.
Total tubeless percutaneous nephrolithotomy without artificial hydronephrosis in preschool children: Three case reports
Authors: Zhang Xicai , Zhang Yonghe , Li Fengyue , He Wenbo , Cao Xiande 
Published: March 2023

Rationale:
Indwelling ureteral catheter, double J tube, or nephrostomy tube are routine procedures for percutaneous nephrolithotomy (PCNL) in children. There are a few cases in which PCNL has been performed in children without any additional instruments being left in place.

Patient concerns:
In this study, 3 children were treated for hematuria and complicated with different degrees of urinary tract infection. All of them were diagnosed as upper urinary tract calculi by abdominal computed tomography.

Diagnosis:
Three preschoolers were diagnosed with upper urinary tract calculi before surgery, one with no hydronephrosis and the other 2 with different degrees of hydronephrosis.

Interventions:
After preoperative evaluation, all the children successfully completed PCNL without indwelling ureteral catheter, double J tube, or nephrostomy tube.

Outcomes:
The operation was successful and there were no residual stones observed during postoperative review. The operating times for the children were 33 minutes, 17 minutes, and 20 minutes, and the intraoperative bleeding volumes were 1 mL, 2 mL, and 2 mL. The catheter was removed on the second day after the operation, the postoperative review of the abdominal computed tomography or ultrasound did not indicate any stone residue, and there were no fever, bleeding, and other related complications after the operation.

Lessons:
We believe that total tubeless PCNL without artificial hydronephrosis can be achieved in the preschool population.
Impact of oral care modalities on the incidence of ventilator-associated pneumonia in the intensive care unit: A meta-analysis
Authors: Fu Li-Sang , Zhu Li-Mei , Yang Yuan-Ping , Lin Ling , Yao Li-Qun 
Published: March 2023

Background:
At present, evidence of the role of oral hygiene in ICU-related pneumonia is rare. The study aimed to evaluate the effectiveness of toothbrush-based oral care in preventing ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in the ICU.

Methods:
Ten databases were searched for randomized controlled trials (RCTs) evaluating toothbrush-based oral care for preventing VAP in patients with mechanical ventilation in ICU. Quality assessment and data extraction were independently performed by 2 researchers. The meta-analysis was performed using RevMan 5.3 software.

Results:
Thirteen RCTs with 657 patients were included. Tooth brushing + 0.2%/0.12% chlorhexidine was associated with reduced incidence of VAP compared to chlorhexidine (OR = 0.63, 95% confidence interval [CI]: 0.43–0.91, P = .01) or tooth brushing + placebo (OR = 0.47, 95% CI: 0.25–0.86, P = .02) in patients with mechanical ventilation in ICU, but was similar to cotton wipe with 0.2% or 0.12% chlorhexidine (OR = 1.33, 95% CI: 0.77–2.29, P = .31).

Conclusions:
Tooth brushing combined with chlorhexidine mouthwash can prevent VAP in patients with mechanical ventilation in ICU. There is no advantage of tooth brushing combined with chlorhexidine mouthwash over cotton wipe with chlorhexidine mouthwash for preventing VAP in these patients.
Efficacy of Epley’s maneuver plus betahistine in the management of PC-BPPV: A systematic review and meta-analysis
Authors: Li Wei , Sun Jinqiang , Zhao Zeqi , Xu Jifeng , Wang Hao , Ding Rui , Zhang Yanqiu 
Published: March 2023

Background:
To evaluate the efficacy of Epley’s maneuver plus betahistine in the management of patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV).

Methods:
Electronic databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang were searched from their inception to April, 2022. The effect size was analyzed by calculating the pooled risk ratio estimates of efficacy rate, recurrence rate, and standardized mean differences (SMD) of dizziness handicap inventory (DHI) score with a 95% confidence interval (CI). Sensitive analysis was performed simultaneously.

Results:
A total of 9 randomized controlled trials with 860 PC-BPPV patients were included in the meta-analysis, in which 432 were treated with Epley’s maneuver plus betahistine, and 428 received Epley’s maneuver alone. The meta-analysis revealed that Epley’s maneuver plus betahistine significantly improved DHI score than Epley’s maneuver alone (SMD = −0.61, 95% CI −0.96 to −0.26, P = .001). In addition, both Epley’s maneuver plus betahistine and Epley’s maneuver groups had comparable outcomes in efficacy rate and recurrence rate.

Conclusion:
This meta-analysis shows that Epley’s maneuver plus betahistine in PC-BPPV patients had favorable effects on DHI score.
The largest and heaviest giant juvenile fibroadenoma of the breast in the Chinese population: A case report
Authors: Zhang Yuanxin , Huang Junhua , Zhou Ling , Leng Ying 
Published: March 2023

Rationale:
Fibroadenoma is the most common benign tumor of the breast, but giant juvenile fibroadenoma exceeding 20 cm is much rare. This report presents the largest and heaviest giant juvenile fibroadenoma in an 18-year-old Chinese girl.

Diagnosis and interventions:
An 18-year-old adolescent girl with a 2-year history of a large left breast mass with progressive expansion over 11 months. A 28 × 21 cm soft swelling occupied the entire outer quadrants of the left breast. The huge mass sagged below the belly button, resulting in high asymmetry of the shoulders. Contralateral breast examination results were normal except for hypopigmentary detected on the nipple-areola complex. Under general anesthesia, the lump was completely excised along the outer envelope of the tumor, while reserving excessive resection of the skin. The patient’s postoperative recovery was uneventful, and the surgical wound healed well.

Outcomes:
A radial incision operation was finally performed to remove the huge mass and to preserve the normal breast tissue and the nipple-areolar complex, not only considering the aesthetics but also preserving the ability to lactate.

Lessons:
Currently, there is a lack of clear guidelines regarding the diagnostic and treatment modalities for a giant juvenile fibroadenoma. The principle of surgical choice is to balance aesthetics and function preservation.
Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) by endoscopic submucosal dissection: A case report
Authors: Han Yi-Ping , Min Cong-Cong , Li Yu-Bei , Chen Yun-Qing , Liu Hua , Tian Zi-Bin , Yin Xiao-Yan 
Published: March 2023

Rationale:
Gastric hamartomatous inverted polyps (GHIP) is not a common disease, and it has rarely been reported in the literature. Preoperative diagnosis is difficult due to the deep position and surface covered with normal gastric mucosa. However, with the progress of endoscopic technology, endoscopic submucosal dissection (ESD) can play a crucial role in the diagnosis and treatment of GHIP.

Patient concerns:
A 61-year-old Chinese man underwent gastroscopy due to abdominal pain 2 months prior that revealed chronic superficial nonatrophic gastritis with erosion and a submucosal tumor in the gastric body (an ultrasound gastroscopy was recommended). Therefore, he was admitted to our hospital for further diagnosis and treatment.

Diagnoses:
A hemispherical submucosal tumor was found in the middle segment of the stomach, with a size of approximately 30 mm × 35 mm and a smooth surface without central ulceration or mucosal bridge formation. Ultrasound gastroscopy showed that the lesion was a hypoechoic mass with uniform internal echo originating from the muscularis propria.

Interventions:
The tumor was completely removed by using ESD. The postoperative pathological results indicated a monocystic structure in the submucosa that was not connected with the surface mucosa. The surface of the cyst was covered with foveolar cells and mucous-neck cells (part of which had low-grade intraepithelial neoplasia), and GHIP was considered to be diagnosed.

Outcomes:
According to the abovementioned endoscopic and pathological features, the patient was finally diagnosed with GHIP. The patient was successfully discharged after surgery and received regular follow-up observations.

Lessons:
GHIP is located in the submucosa layer and has the potential risk of malignant transformation. However, it is not easy to diagnose by using gastroscopy and ultrasound gastroscopy. ESD can obtain complete specimens, which contributes to the diagnosis and treatment of GHIP.