bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total thyroidectomy for giant nodular goiter guided by pre-operative 3D computed tomography reconstruction and 3D printing: A case report
Authors: Zhang Jun , Liu Wanli , Zhang Qi , Zhao Chongru , Li Jie , Li Xing , Li Gezi , Chen Jiali , Peng Dawei , Wang Yifei , Yang Chang 
Published: December 2022

Background:
Nodular goiter is a common clinical problem, and thyroidectomy is preferred in patients with obstructive symptoms. Thyroidectomy is a complex procedure with some common complications. Three-dimensional (3D) computed tomography (CT) reconstruction and 3D printing provide visualized 3D anatomical structure, posing an enormously valuable potential in precise surgery with optimal efficacy and minimum complications. Here, we aimed to perform a precise thyroidectomy guided by this technology.

Methods:
The patient was an 80-year-old woman with 10 years of goiter, 1 year of labored dyspnea, and a history of thyroid surgery 62 years ago. In addition to ultrasonography examination, CT images were obtained to construct the 3D model to identify the 3D relationship between the lesion and adjacent structures, and a 3D model of the trachea was created and printed using a 3D printer.

Results:
The 3D model clearly presented the diffuse enlargement of the two lobes and isthmus and the compression of the goiter. Under the 3D guidance, the operative resection specimen of the right lobe and isthmus was 12 ´ 7 ´ 5 cm, whereas the left lobe specimen was 12 ´ 9 ´ 6 cm. Nodular goiter and lymphocytic thyroiditis were confirmed by postoperative histopathology. There were no complications after total thyroidectomy except for non-permanent hypocalcemia and hypoparathyroidism.

Conclusion:
Our results proved that total thyroidectomy for giant goiter is challenging, and 3D image-guided thyroidectomy facilitates precise and safe resection with fewer complications. 3D CT reconstruction and 3D printing can provide anatomical details and may be considered in thyroidectomy planning for patients with giant goiter.
Alteplase associated Orolingual angioedema: A case report and literature review
Authors: Qi Xiuyan , Lin Huiqian 
Published: December 2022

Objective:
Orolingual angioedema (OA) is a rare but life-threatening complication of intravenous thrombolysis using alteplase. Angioedema can be caused by almost any medication. Administration of recombinant tissue plasminogen activator causes atypical angioedema. This study aimed to investigate factors related to and treatment of OA after thrombolysis with alteplase.

Case report:
We describe the case of a 53-year-old man with a history of hypertension managed with enalapril, who presented with ischemic cerebrovascular stroke. Intravenous alteplase was administered, and within 54 minutes, the patient developed severe orolingual edema requiring emergent intubation. Subsequent imaging revealed an acute-to-subacute infarct in the left occipital lobe of the posterior cerebral artery.

Results:
The most common factor for increased risk of OA after recombinant tissue plasminogen activator was concomitant use of angiotensin-converting enzyme inhibitors (ACEI).

Conclusion:
Before intravenous thrombolytic therapy, patients should be asked if they have a history of allergies, are currently using ACEI, and try to avoid using ACEI antihypertensive drugs before and after thrombolytic therapy.
Gross hematuria and IgA nephropathy flare-up following the first dose of Moderna vaccine: A case report
Authors: Tseng Po-Hung , Chuang Shu-Han , Pan Yueh , Shih Hung-Jen , Chang Chin-Pao , Huang Sheng-Hsien 
Published: December 2022

Background:
Since the mass vaccination for COVID-19, several case reports indicated the risk of autoimmune disease flare-ups after the vaccination. Among them, COVID-19 vaccine-induced glomerular diseases have drawn attention worldwide. The cases demonstrating the association between the mRNA vaccine and IgA nephropathy (IgAN) exacerbation had been noticed. Mostly mentioned, the flare-ups usually occurred after the second dose.

Methods:
We present a Taiwanese female with IgAN who developed gross hematuria within only six hours after the first dose of the Moderna vaccine.

Results:
Six hours after the first dose of Moderna vaccine on 8 June 2021, the patient developed gross hematuria and significantly decreased urine output. All symptoms resolved spontaneously on the fifth day after the vaccination without any intervention. On the fourth day after the vaccination, the patient were able to back to her original condition.

Conclusion:
This was an intriguing case of IgAN flare-up following the first dose of mRNA-based COVID-19 vaccination.
Anticoagulation for mechanical heart valves during pregnancy: A case report and a literature review
Authors: Bai Chunqiang , Wu Haiying , Wu Wenying , Feng Peiming , Nie Minghui , Zhao Li , Meng Fanyue 
Published: December 2022

Rationale:
Most previous treatment guidelines for pregnant women with mechanical heart valves recommend that low molecular weight heparin (LMWH) should be applied once every 12 hours and only as required to reach peak anti-Xa levels of approximately 1.0 to 1.2 IU/mL, but it is commonly associated with subtherapeutic trough levels, consequently with an inadequate level of anticoagulation. Our case report here together with a literature review suggests that dose-adjusted (Target trough anti-Xa levels of 0.6 to 0.7 IU/mL and with peak anti-Xa levels of around 1.0 to 1.2 IU/mL or < 1.5 IU/mL) LMWH should be given thrice daily throughout pregnancy. In addition, the findings of this rare case indicate that a combination of LMWH and warfarin is effective in the treatment of small thromboses in pregnancy.

Patient concerns:
In the 1st trimester of pregnancy, a 28-year old pregnant female with a mechanical valve had a significant increase in the aortic valve flow rate and suspected mechanical valve thrombosis.

Diagnoses:
The peak velocity of the pregnant female aortic mechanical valve increased, and mechanical valve thrombosis was suspected.

Interventions:
We adjusted the enoxaparin sodium dose every 12 hours to 1 injection every 8 hours, with a total daily dose of 160 mL. Based on the original application of LMWH, warfarin (3 mg/day) was recommended.

Outcomes:
The pregnant woman delivered a live baby by cesarean section, and the peak flow velocity of the mechanical valve in the aortic position was reduced to nearly equivalent to the patient’s pre-pregnancy status. The mother and the baby were in good health at the time of discharge.

Lessons:
LMWH is administered twice daily, and anti-Xa trough levels are mostly in a subtherapeutic state, which may lead to insufficient anticoagulation and thrombosis. Dose-adjusted LMWH thrice daily throughout pregnancy is the recommended treatment for pregnant women with mechanical heart valves. The combination of LMWH and warfarin exhibited good efficacy for the treatment of small thromboses.
The mechanism of Bai He Gu Jin Tang against non-small cell lung cancer revealed by network pharmacology and molecular docking
Authors: Xie Rui-fei , Song Zi-yu , Xu-shao Lu-yao , Huang Jin-ge , Zhao Ting , Yang Zi 
Published: December 2022

Background:Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related burden and deaths, thus effective treatment strategies with lower side effects for NSCLC are urgently needed. To systematically analyze the mechanism of Bai He Gu Jin Tang (BHGJT) against NSCLC by network pharmacology and molecular docking.Methods:The active compounds of BHGJT were obtained by searching the Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine and Encyclopaedia of Traditional Chinese Medicine. Search tool for interactions of chemicals was used for acquiring the targets of BHGJT. The component-target network was mapped by Cytoscape. NSCLC-related genes were obtained by searching Genecards, DrugBank and Therapeutic Target Database. The protein-protein interaction network of intersection targets was established based on Search Tool for Recurring Instances of Neighboring Genes (STRING), and further, the therapeutic core targets were selected by topological parameters. The hub targets were transmitted to Database for Annotation, Visualization and Integrated Discovery for gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Finally, AutoDock Vina and MglTools were employed for molecular docking validation.Results:Two hundred fifty-six compounds and 237 putative targets of BHGJT-related active compounds as well as 1721potential targets of NSCLC were retrieved. Network analysis showed that 8 active compounds of BHGJT including kaempferol, quercetin, luteolin, isorhamnetin, beta-sitosterol, stigmasterol, mairin and liquiritigenin as well as 15 hub targets such as AKR1B10 and AKR1C2 contribute to the treatment of BHGJT against NSCLC. GO functional enrichment analysis shows that BHGJT could regulate many biological processes, such as apoptotic process. Three modules of the endocrine related pathways including the inflammation, hypoxia related pathways as well as the other cancer related pathways based on Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis might explain the biological mechanisms of BHGJT in treating BHGJT. The results of molecular docking verified that AKR1B10 and AKR1C2 had the strongest binding activity with the 8 key compounds of NSCLC.Conclusion:Our study reveals the mechanism of BHGJT in treating NSCLC involving multiple components, multiple targets and multiple pathways. The present study laid an initial foundation for the subsequent research and clinical application of BHGJT and its active compounds against NSCLC.
Femoral head fracture with large crushed defect in weight-bearing area treated with autologous osteochondral transplantation (repositionplasty): A case report
Authors: Shon Hyun-Chul , Lim Eic-Ju , Yang Jae-Young , Jeon Seung-Jun 
Published: December 2022

Rationale:
Femoral head fracture is a rare type of fracture commonly associated with hip dislocation. Femoral head fracture treatments include conservative treatment, fragment excision, open reduction, internal fixation, and arthroplasty. In cases of young patients, open reduction and internal fixation are preferred over arthroplasty. Pipkin type 2 fractures are treated with open reduction and internal fixation in most cases because the fracture line extends upward of the fovea and includes the femoral head-acetabular weight-bearing joint surface. However, if the fracture is severely comminuted or crushed, good results are difficult to obtain with open reduction and internal fixation.

Patient concerns:
A 23-years-old male patient presented to the emergency room with right hip pain after 4-m fall

Diagnosis:
In initial image work up, he was diagnosed with right posterior hip dislocation and a Pipkin type 2 femoral head fracture with an ipsilateral superior ramus fracture. After manual reduction, simple radiography and computed tomography showed reduction of the hip joint and a large osteochondral defect of approximately 6 cm2 in the weight-bearing area on the superomedial side of the femoral head

Interventions:
This was treated with a novel surgery named autologous osteochondral transplantation (repositionplasty), devised by the authors

Outcomes:
The congruent reduction was confirmed by radiography and computed tomography immediately after the surgery. At 5 years postoperatively, the Harris Hip Score was 100 points and no discomfort, femoral head collapse, osteonecrosis, or traumatic arthritis were observed on follow-up radiographs

Lessons:
We think this method “repositionplasty” will be a good treatment method for young patients with a large defect in the weight-bearing part of the femoral head who cannot undergo open reduction and internal fixation.
Making a move: Using simulation to identify latent safety threats before the care of injured patients in a new physical space
Authors: Kotagal Meera , Falcone Richard A. , Daugherty Margot , Merkt Brant , Klein Gina L. , McDonough Shawn , Boyd Stephanie D. , Geis Gary L. , Kerrey Benjamin T. 
Published: December 2022

BACKGROUND
In today's rapidly changing health care environment, hospitals are expanding into newly built spaces. Preserving patient safety by identifying latent safety threats (LSTs) in advance of opening a new physical space is key to continued excellent care. At our level 1 pediatric trauma center, the hospital undertook a 5-year project to build a critical care tower, including a new emergency department with five trauma bays. To allow for identification and mitigation of LSTs before opening, we performed simulation-based clinical systems testing.

METHODS
Eight simulation scenarios were developed, based on actual patient presentations, incorporating a variety of injury patterns. Scenarios included workflow and movement from the helipad and squad entrance as well as to radiology, the operating room, and the pediatric intensive care unit. A multiple resuscitation scenario was also designed to test the use of all five bays simultaneously. Multidisciplinary high-fidelity simulations were conducted in the new tower. Key trauma and emergency department stakeholders facilitated all sessions, using a structured framework for systems integration debriefing framework and failure mode and effect analysis to identify and prioritize LSTs, respectively.

RESULTS
Eight sessions were conducted for 2 months. A total of 201 staff participated, including trauma surgeons, respiratory therapists, nurses, emergency physicians, x-ray technicians, pharmacists, emergency medical services, and operating room staff. In total, 118 LSTs (average of 14.8/session) were identified. Latent safety threats were categorized. An action plan for mitigation was developed after applying failure mode and effects analysis prioritization scores (based on severity, probability, and ease of detection).

CONCLUSION
Systems-focused trauma simulations identified a large number of LSTs before the opening of a new critical care building. Identification of LSTs is feasible and facilitates mitigation before actual patient care begins, improving patient safety.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Dynamics of Humoral and Cellular Responses in Renal Transplant Recipients Receiving 3 Doses of SARS-CoV-2 mRNA Vaccine
Authors: Arias-Cabrales Carlos , Folgueiras Montserrat , Faura Anna , Eguia Jorge , Padilla Eduardo , Hurtado Sara , Ribera Laura , Echeverria-Esnal Daniel , Pérez-Sáez María José , Redondo-Pachón Dolores , Burballa Carla , Buxeda Anna , Llinàs-Mallol Laura , Cao Higini , Barbosa Francesc , Rovira Xavier , Cima Florencia , Pascual Julio , Crespo Marta 
Published: December 2022

Background.
The original SARS-CoV-2 vaccination regimen (2 doses) induces insufficient short-term response in kidney transplant (KT) recipients. This study assessed the response to a third dose and the long-term immunogenicity after 2 doses in KT.

Methods.
We analyzed the dynamics of the humoral and cellular response by monitoring SARS-CoV-2 IgG antibodies against the Spike-protein (IgG-Spike) and QuantiFERON SARS-CoV-2 IFN-γ release assay 6 mo after the second dose (T2) and 28 d after the third dose of mRNA vaccines (T3) to KT and controls (dialysis patients and healthy individuals).

Results.
At T2, the percentage of IgG-Spike+ KT and dialysis patients decreased (KT 65.8%–52.6%, hemodialysis 92.6–81.5%, and peritoneal dialysis 100%–90%), whereas 100% of healthy controls remained positive. About the cellular response, the percentage of responders decreased in all groups, especially in KT (22.4%–9.2%, P = 0.081). At T3, 92% of KT, 94%–98% of dialysis patients, and 100% of healthy controls were IgG-Spike+. In terms of antibody titers, patients and controls showed a reduction between T2 and T3 and about 80% of dialysis patients and 100% of controls achieved high titers after the third dose (>1479.5 Binding Antibody Units/mL), whereas this percentage was only 50% in KT. With respect to the cellular response, only KT displayed a significant rise after the third dose.

Conclusions.
The third dose of mRNA vaccine improves both humoral and cellular responses, but less effectively in KT compared with dialysis patients and healthy controls.
MicroRNA-4776-5p acts as a radiosensitizer and predicts the prognosis of patients with head and neck cancer receiving radiotherapy
Authors: Lai Yo-Liang , Wang Chun-Chieh , Lin Yung-Lun , Shen Pei-Chun , Tsai Meng-Hsin , Chen Fang-Hsin , Cheng Wei-Chung 
Published: December 2022

AbstractHead and neck cancer is the leading cancer worldwide. Radiation therapy plays important role of treatment for head and neck cancer. MicroRNAs have been shown to be related to tumor progression and radiosensitivity. However, the mechanisms are still largely unknown and evidence are still limited. In the current study, we sought to identify the miRNA related the radiosensitivity of head and neck tumor cell, which leading to the disappointed prognosis of patients with head and neck cancer receiving radiation therapy. The miRNA expression profiles and clinical information of patients with head and neck cancer were obtained from The Cancer Genome Atlas. The identification of miRNA was carried out through an integrated bioinformatics analysis. The miRNA identified in previous approach was validated throughin vitroandin vivostudies. MiR-4776-5p was finally identified as the role of radio-sensitizer and predicts the prognosis of patients with head and neck cancer receiving radiotherapy. 11 of 16 genes targeted by the miR-4776-5p have been discovered to regulate the mechanisms related to radiosensitivity using functional annotation.
Cohort study of fever neonates with confirmed community infection of SARS-CoV-2 Omicron: A study Protocol
Authors: Li Jicheng , He Wenwen , Qi Yujie , Meng Yao , Peng Xiaoxia , Hei Mingyan 
Published: December 2022

AbstractIntroductionReports on neonatal coronavirus disease (COVID) have been focused on vertical transmission. There was little information on prevalence of neonates with COVID till up to 18 months of age. It is well known that breastfeeding is beneficial for the growth and development of infants. We hypothesized that breastfeeding will be beneficial for a better prevalence of neonatal COVID. The objective of this study is to explore the prognosis of fever neonates with confirmed community infection of SARS-CoV-2 Omicron, and to clarify whether human milk breastfeeding is beneficial for reducing the rate of severe SARS-CoV-2 Omicron infection in neonates.Methods and analysisThis is a prospective single centre cohort study. Study period is from December, 2022 to December 2024. Inclusion criteria are: (1) Age ≤ 28 days or corrected age ≤ 44 weeks. (2) Fever. (3) Both tests (throat swab) of nucleic acid and antigen of SARS-CoV-2 Omicron were positive. (4) Parents signed the consents. Exclusion criteria is confirmed brain malformations. Patients will be classified into breastfeeding, mixed feeding, and formula feeding groups. The estimate sample size will be 200. The throat swab of infants will be collected for SARS-CoV-2 omicron nucleic acid ad antigen examination. Neonatal COIVD patients will be treated in the Out-Patient Department or admitted to Neonatal Intensive Care Unit according to the severity of infection. All patients will be followed at 3/6/12/18M of age. The endpoint to study was at 18 months of age. Data will be collected by Case Record Form and Electronic Data Capture from the History of In-hospital System. The primary outcome was the rate of severe SARS-CoV-2 infection.SPSS 20.0software will used for statistical analysis.Ethics and disseminationIt is approved by local Institute of Ethics Review Board (#[2022]-E-240-Y).RegistrationIt is registered in the Chinese Clinical Trail Registry (http://www.chictr.org.cn) (ChiCTR2200067148)Strengths and limitations of this studyThis is a prospective single centre cohort study for fever neonates with confirmed community infection of SARS-CoV-2 Omicron.Patients are categorized into breastfeeding group, mixed feeding group, and formula group.The primary outcome is rate of severe SARS-CoV-2 infection.The secondary outcomes include in-hospital outcomes and follow-up outcomes at 3M/6M/12//18M.Limitation are the observational nature and the single centre data.
Cytokine-expression patterns reveal coordinated immunological programs associated with persistent MRSA bacteremia
Authors: Chin Jackson L. , Tan Zhixin Cyrillus , Chan Liana C. , Ruffin Felicia , Parmar Rajesh , Ahn Richard , Taylor Scott , Bayer Arnold S. , Hoffmann Alexander , Fowler Vance G. , Reed Elaine F. , Yeaman Michael R. , Meyer Aaron S. ,   the MRSA Systems Immunobiology Group
Published: December 2022

AbstractMethicillin-resistantStaphylococcus aureus(MRSA) bacteremia is a common, life-threatening infection that imposes up to 30% mortality even when appropriate therapy is used. Despitein vitroefficacy, antibiotics often fail to resolve the infectionin vivo, resulting in persistent MRSA bacteremia. Recently, several genetic, epigenetic, and proteomic correlates of persistent outcomes have been identified. However, the extent to which single variables or composite patterns operate as independent predictors of outcome or reflect shared underlying mechanisms of persistence is unknown. To explore this question, we employed a tensor-based integration of host transcriptional and proteomic data across a well-characterized cohort of patients with persistent and resolving MRSA bacteremia outcomes. Tensor-based data integration yielded high correlative accuracy with persistence and revealed immunologic signatures shared across both the transcriptomic and proteomic datasets. We find that elevated proliferation of mature granulocytes associates with resolving bacteremia outcomes. In contrast, patients with persistent bacteremia heterogeneously exhibit correlates of granulocyte dysfunction or immature granulocyte proliferation. Collectively, these results suggest that transcriptional and proteomic correlates of persistent versus resolving bacteremia outcomes are complex and may not be disclosed by conventional modeling. However, a tensor-based integration approach can help to reveal consensus molecular mechanisms in an interpretable manner.Significance StatementWhile antibacterial therapies effectively resolve MRSAin vitro, these treatments often fail to clear MRSA bacteremiain vivo, suggesting that host-pathogen interactions are essential to persistent MRSA bacteremia. Recent studies have identified genetic, transcriptomic, and proteomic determinants of MRSA persistence. These determinants independently, however, provide insufficient mechanistic insight and it is unclear if they indicate unique or overlapping persistence mechanisms. Here, we use tensor-based decomposition to jointly analyze cytokine and transcriptomic measurements from patients with MRSA bacteremia. Results indicate that persistence mechanisms integrated across biological modalities reflect diverging mechanisms of persistent bacteremia. Ultimately, these results may help to identify future therapeutic targets for treating persistent MRSA bacteremia.