bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of a uterine serosal heterotopic pregnancy after in vitro fertilization in a woman with bilateral salpingectomy: A case report and literature review
Authors: Sun Ping-Ping , Dong Shu-Yi , Xie Jin-Long , Liu Kun-Kun , Guo Ai-Ping 
Published: December 2022

Rationale:
Heterotopic pregnancy (HP) is defined as the simultaneous presence of intrauterine pregnancy and ectopic pregnancy (EP). HP after bilateral salpingectomy is extremely rare and may lead to serious complications if it is misdiagnosed and untreated timely. Here, we presented the first reported case of uterine serosal HP in a woman after assisted reproductive technology with bilateral salpingectomy because of bilateral tubal ectopic pregnancy.

Patient concerns:
A 27-years-old pregnant woman after in vitro fertilization with bilateral salpingectomy complained of a sudden onset of unprovoked abdominal pain, which was persistent and dull. She denied vaginal bleeding.

Diagnoses:
Serum beta-human chorionic gonadotropin levels are difficult to predict HP. Transvaginal ultrasonography demonstrated 1 gestational sac in the uterine cavity and 1 thick-walled cystic mass over the upper of the uterus, with a large amount of fluid in the Pouch of Douglas. Emergency laparotomy revealed a uterine serosal pregnancy combined with intrauterine pregnancy.

Interventions:
This patient was successfully managed via emergency laparotomy to remove residual tissue and repair the rupture of the uterine serosal pregnancy.

Outcomes:
At postoperative 4 days, repeat transvaginal ultrosonography presented 1 intrauterine gestational sac with a visible fetal bud and cardiac tube pulsation. Now the patient recover well and is in an ongoing pregnancy.

Lessons:
It is noteworthy that HP/ectopic pregnancy is still not prevented after bilateral salpingectomy. In cases of multiple embryo transfer, even if intrauterine pregnancy has been established, it is important to rule out HP/ectopic pregnancy in time. Early diagnosis and early management can significantly improve clinical outcomes.
Ultrasonographic evaluation of diaphragm function in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis
Authors: Hua-Rong Zeng , Liang Chen , Rong Liu , Yi-Fan Tu , Dou-Zi Shi , Yue Chen , Zu-Lin Liu 
Published: December 2022

Background:
Some studies have reported using ultrasonic evaluations to assess diaphragm function in patients with chronic obstructive pulmonary disease (COPD). However, they have limitations and thus cannot provide strong evidence to support ultrasound evaluations for diaphragm function and dysfunction severity assessments in this patient population. Additionally, quantitative studies on the relationship between ultrasound evaluations and diaphragm function do not exist. Therefore, we performed a systematic review and meta-analysis to explore the usefulness of ultrasonography for evaluating diaphragm function in patients with COPD.

Methods:
The Cochrane Library, PubMed, Embase, Web of Science, Chinese Biomedical Literature Database, Wanfang Data, China National Knowledge Network, and Chinese Scientific Journal Database (i.e., VIP) databases were searched for literature about ultrasonic evaluations of diaphragm function in patients with COPD for systematic review. We extracted patient demographic, diaphragm mobility, diaphragm thickness, diaphragm thickening score, and other related parameter data using RevMan 5.3 software for the meta-analysis.

Results:
We included 13 articles in the systematic review, 8 of which (494 participants) were included in the meta-analysis. The degree of diaphragm offset in patients with COPD was significantly lower than that in healthy controls (weighted mean difference [WMD] = –1.34; 95% confidence interval [CI]: –2.15, 0.53; P < .05). The diaphragm deviation was lower in the severe COPD group than in the mild-to-moderate COPD group (WMD = 0.50; 95% CI: –0.01, 1.01; P = .06), but the difference was not significant.

Conclusion:
Ultrasonography effectively evaluates diaphragm function in patients with COPD. The diaphragm offset can be used as an auxiliary diagnostic index for COPD, which is also related to disease severity.
Sorafenib versus nivolumab after lenvatinib treatment failure in patients with advanced hepatocellular carcinoma
Authors: Kim Yuna , Lee Jae Seung , Lee Hye Won , Kim Beom Kyung , Park Jun Yong , Kim Do Young , Ahn Sang Hoon , Goh Myung Ji , Kang Wonseok , Kim Seung Up 
Published: December 2022

Background and aim
An optimal sequential anti-hepatocellular carcinoma (HCC) agent that can be used after failed lenvatinib treatment has not been established. Here, we compared the outcomes of sorafenib and nivolumab as second-line agents after failed lenvatinib treatment in patients with advanced HCC.

Methods
Patients with advanced HCC who had received sorafenib or nivolumab as second-line agents after failed lenvatinib treatment were recruited from two Korean tertiary institutions between November 2018 and June 2020.

Results
The median age of the 60 participants (52 treated with sorafenib and eight treated with nivolumab) at baseline was 56.8 years. The demographic, laboratory and tumor variables, as well as lenvatinib treatment duration, were similar between the two groups. The median durations of sorafenib and nivolumab treatment were 1.2 and 2.6 months, respectively (P = 0.164). Twenty-four (40.0%) patients died during the follow-up period (median, 15.8 months). The median overall survival (OS) of the study population was 5.8 months. The median OS of patients treated with sorafenib was significantly longer than the median OS of patients treated with nivolumab (8.7 vs. 3.0 months; P = 0.046). Sorafenib treatment (vs. nivolumab) was independently associated with a lower risk of mortality (hazard ratio = 0.194; 95% confidence interval, 0.053–0.708; P = 0.013). Worse Eastern Cooperative Oncology Group performance status, larger maximal tumor size, lymph node metastases and higher total bilirubin levels were independently associated with increased mortality risk (all P < 0.05).

Conclusions
Lenvatinib-sorafenib sequential treatment resulted in significantly better survival did than lenvatinib-nivolumab sequential treatment in patients with advanced HCC. Larger studies are needed to validate our results.
Efficacy and safety of long-term postpartum antiviral therapy in hepatitis B virus-infected mothers receiving prophylactic tenofovir disoproxil fumarate treatment
Authors: Feng Yali , Yao Naijuan , Shi Lei , Zhu Yage , Liu Jinfeng , He Yingli , Zhao Yingren , Chen Tianyan 
Published: December 2022

Objectives
This study aimed to evaluate the efficacy and safety of long-term postpartum tenofovir disoproxil fumarate (TDF) therapy in hepatitis B virus (HBV)-infected mothers with high viral load.

Methods
In this retrospective cohort study, HBV-infected mothers with HBV DNA>2 × 105 IU/mL who initiated TDF prophylaxis treatment during pregnancy were divided into TDF continuation and discontinuation groups according to whether they stopped TDF treatment within 3 months after birth or not. Virological and biochemical markers were collected before TDF treatment, antepartum and postpartum.

Results
In 131 women followed for a median of 18 months postpartum, alanine aminotransferase (ALT) abnormality rate was significantly lower in TDF continuation group vs. discontinuation group (39.4% vs. 56.9%, P = 0.045), and continuous TDF therapy in postpartum was independently associated with lower risk of ALT flares [OR = 0.308, 95% confidence interval (CI), 0.128–0.742; P = 0.009]. Long-term postpartum TDF treatment can promote the decline of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) levels, but the HBeAg seroconversion rate in two groups was not significant (15.5% vs. 11.7%, P = 0.541). There were no statistical differences in bone metabolism markers between two groups (P > 0.05). Compared with the TDF discontinuation group, TDF continuation group had a significantly lower estimated glomerular filtration rate level and higher creatinine level in postpartum but within normal ranges (P < 0.05).

Conclusions
For pregnant women who received prophylactic TDF treatment, long-term TDF therapy continued in postpartum can reduce the risk of ALT flares and promote the rapid decline of HBeAg and HBsAg levels.
Humoral immunogenicity of COVID-19 vaccines in patients with coeliac disease and other noncoeliac enteropathies compared to healthy controls
Authors: Scalvini Davide , Schiepatti Annalisa , Maimaris Stiliano , Cosentini Emanuele , Muscia Roberta , Gregorio Virginia , Roda Elisa , Fassio Federico , Baiardi Paola , Locatelli Carlo Alessandro , Biagi Federico 
Published: December 2022

Objectives
Data are lacking on the immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients affected by coeliac disease, Whipple’s disease and other noncoeliac enteropathies (NCE), characterised by primary or drug-related immunosuppression. We aimed to assess humoral response to SARS-CoV-2 vaccination in these patients compared to controls.

Methods
Between December 2021 and January 2022, IgG anti-SARS-CoV-2 spike protein antibodies were measured in serum samples of coeliac disease, Whipple’s disease and NCE patients attending our gastroenterology outpatient clinic for follow-up, who had received their first SARS-CoV-2 vaccination dose 3-6-9 (±1) months prior. Humoral response was compared with healthy controls (vaccinated healthcare workers undergoing serological screening), matched for gender, age, and time from first vaccine dose at sample collection.

Results
A total of 120 patients [107 coeliac disease; 10 Whipple’s disease; 2 common-variable immunodeficiency (CVID); 1 idiopathic villous atrophy; 77 F, 42 ± 16 years] and 240 matched controls (154 F, 43 ± 14 years) were enrolled. At 3, 6 and 9 months, humoral response in coeliac patients was not impaired compared to controls. Inadequate humoral response to vaccination was significantly more common among Whipple’s disease patients than controls (P < 0.001). Patients on immunosuppressive therapy had markedly lower IgG anti-SARS-CoV-2 antibody titres (median 14 vs. 520 BAU/mL, P < 0.001). As expected, patients with CVID showed no humoral response to vaccination.

Conclusions
Humoral immunogenicity of SARS-CoV-2 vaccines was not reduced in coeliac disease patients compared to controls, although it was in Whipple’s disease and CVID patients. Post-vaccination humoral response should be monitored in patients with Whipple’s disease and chronic enteropathies on immunosuppressive therapy in order to schedule vaccine booster doses.
New management of surveillance in patients with baseline serrated polyps: a large single-center retrospective cohort study in China
Authors: Ye Xiangxi , Han Peiyi , Wu Zhijie , Cui Yun , Chen Yingxuan , Chen Zhaofei , Gao Qinyan 
Published: December 2022

Background
Serrate d polyps (SP) is associated with an increased risk of colorectal cancer. Patients with SP history tend to have SP recurrence. However, the risk factors for metachronous polyps (MP) in those patients are not well established.

Methods
Data of colonoscopy were retrospectively reviewed from October 2012 to October 2021. The pathology database, electronic medical records and telephone follow-up data were also observed.

Results
A total of 906 patients were studied including 278 patients with MPs and 628 patients without. The multiplicity of polyps (OR, 13.63; 95% CI, 8.80–21.75), older age (OR, 5.71; 95% CI, 1.87–20.63), abdominal obesity (OR, 2.46; 95% CI, 0.98–6.42), current smoker (OR, 2.93; 95% CI, 1.15–7.83) and sedentary lifestyle (OR, 1.41; 95% CI, 1.22–1.65) are significantly associated with the risk of MPs. Patients with baseline SP < 10 mm were more likely to develop higher or same risk-grade polyps (HSRGP) (P = 0.0014). Patients with non-clinically significant SPs whether coexisted with adenoma or not were more likely to develop HSRGPs when compared to others (P < 0.001).

Conclusion
Total number of polyps, older age, sedentary behavior, abdominal obesity and smoking status contributed to the risk of MPs at surveillance colonoscopy. Patients with grade 1 SPs might require closer surveillance. SPs coexisting with conventional adenoma did not increase the risk of MPs but may increase the risk of developing HSRGPs.
Plasma Biomarkers and Fractional Exhaled Nitric Oxide in the Diagnosis of Eosinophilic Esophagitis
Authors: Josyabhatla Rohit , Abrenica Cristoniel , Mai Tu , Hashmi Syed Shahrukh , Liu Yuying , Mosquera Ricardo , Van Arsdall Melissa , Navarro Fernando , Tchakarov Amanda , Tatevian Nina , Wu Guoyao , Rhoads Jon Marc 
Published: December 2022

Objectives:Eosinophilic esophagitis (EoE) is a chronic disease which requires endoscopy with biopsies for diagnosis and monitoring. We aimed to identify a panel of non‐invasive markers that could help identify patients with active EoE.Methods:In this prospective cohort study, we enrolled 128 children aged 5–18 years old, scheduled for endoscopy for suspected esophageal or peptic disease. On the day of the endoscopy, fractionated exhaled nitric oxide (FeNO) was measured; and blood was collected for peripheral absolute eosinophil count (AEC), plasma amino acids, and plasma polyamine analysis. Patients were grouped into controls (n = 91), EoE in remission (n = 16), or active EoE (n = 21), based on esophageal eosinophilia and history of EoE.Results:AEC was not statistically significant different among the groups compared (P = 0.056). Plasma amino acids: citrulline (CIT), β‐alanine (β‐ALA), and cysteine (CYS) were higher in active EoE compared to controls (P < 0.05). The polyamine spermine was lower in active EoE versus controls (P < 0.05). Receiver operator characteristic (ROC) curve to assess the predictive capability of a combined score made of FeNO, β‐ALA, CYS, and spermine had an area under curve (AUC) of 0.90 (95% CI: 0.80–0.96) in differentiating active EoE from controls and 0.87 (95% CI: 0.74–1.00) when differentiating active EoE from EoE in remission.Conclusion:A panel comprising FeNO, 2 plasma amino acids (β‐ALA, CYS) and the polyamine spermine can be used as a non‐invasive tool to differentiate active EoE patients from controls.
Physician Burnout in Pediatric Gastroenterology
Authors: Chien Kimberley A. , Thomas Charlene , Cooley Victoria , Weinstein Toba , Murray Karen F. , Muir Linda , Hayes Christopher , Gold Benjamin D. , Gerber Linda M. , Sauer Cary G. , Tomer Gitit 
Published: December 2022

Objectives:Physicians are prone to burnout which can negatively affect the quality of patient care and lead to medical errors. Burnout can also affect physicians by impacting their personal relationships, their sense of career fulfillment, and job satisfaction. The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) formed a taskforce to investigate burnout among pediatric gastroenterologists.Methods:A 35‐item electronic survey was developed to collect demographic and practice information and characterize the well‐being of pediatric gastroenterologists. Burnout was assessed employing 2 single‐item measures adapted from the Maslach Burnout Inventory. The survey was distributed to NASPGHAN members 3 times from February 2020 to March 2020. Descriptive statistics, Chi‐square, and Fisher exact tests were used.Results:One thousand seven hundred ninety‐one e‐mails were successfully sent and 408 participants (22.7%) returned surveys. A total of 28.8% reported high risk for emotional exhaustion, 17.5% reported high risk for depersonalization, and 33% reported overall burnout. Participants 44 years of age or younger reported significantly more burnout than those 45 years and older (P = 0.018). Contributors to high burnout identified included increased patient load/demands, insufficient nursing support, electronic health record (EHR) use, insufficient administrative staff, excessive on‐call coverage, and more complex patients. Forty‐four percent reported not having enough time for their personal life including family. A total of 16.2% of participants reported that they would not choose to be a pediatric gastroenterologist again.Conclusions:Pediatric gastroenterologists are at risk for emotional exhaustion, depersonalization, and overall burnout. Strategies to prevent physician burnout should be implemented as soon as feasibly possible to improve individual mental health and patient care.
Surgical modification of deep brain stimulation lead trajectories substantially reduces RF heating during MRI at 3 T: From phantom experiments to clinical applications
Authors: Vu Jasmine , Bhusal Bhumi , Rosenow Joshua , Pilitsis Julie , Golestanirad Laleh 
Published: December 2022

AbstractIntroductionRadiofrequency (RF) induced tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during magnetic resonance imaging (MRI), resulting in strict imaging guidelines and limited allowable protocols. The implanted lead’s trajectory and its orientation with respect to the MRI electric fields contribute to variations in the magnitude of RF heating across patients. Currently, there are no consistent requirements for surgically implanting the extracranial portion of the DBS lead. This produces substantial variations in clinical DBS lead trajectories and hinders RF heating predictions. Recent studies showed that incorporating concentric loops in the extracranial trajectory of the lead can reduce RF heating, but the optimal positioning of the loop remains unknown. In this study, we systematically evaluated the RF heating of 244 unique lead trajectories to elucidate the characteristics of the trajectory that minimize RF heating during MRI at 3 T. We also presented the first surgical implementation of these modified trajectories and compared their RF heating to the RF heating of unmodified trajectories.MethodsWe performed phantom experiments to assess the maximum temperature increase, ΔTmax, of 244 unique lead trajectories. We systematically interrogated the effect of three characteristics related to the extracranial portion of the lead trajectory, namely, the number of concentric loops, the size of the loops, and the position of the loops on the skull. Experiments were performed in an anthropomorphic phantom implanted with a commercial DBS system, and RF exposure was generated by applying a high-SAR sequence (T1-weighted turbo spin echo dark fluid pulse sequence, B1+rms= 2.7 μT). Test-retest experiments were conducted to assess the reliability of measurements. Additionally, we determined the effect of imaging landmark and perturbations to the DBS device configuration on the efficacy of low-heating lead trajectories. Finally, recommended modified trajectories were implanted in patients by two neurosurgeons and their RF heating was characterized in comparison with non-modified trajectories.ResultsOur search protocol elicited lead trajectories with ΔTmaxfrom 0.09 – 7.34 °C. Interestingly, increasing the number of loops and positioning them near the surgical burr hole—especially for the contralateral lead—substantially reduced RF heating. Trajectory specifications based on the results from the phantom experiments were easily adopted during the surgical procedure and generated nearly a 4-fold reduction in RF heating.Discussion/ConclusionSurgically modifying the extracranial portion of the DBS lead trajectory can substantially mitigate RF heating during MRI at 3 T. Simple adjustments to the lead’s configuration can be readily adopted during DBS lead implantation by implementing small concentric loops near the surgical burr hole.
Building Large-Scale Registries from Unstructured Clinical Notes using a Low-Resource Natural Language Processing Pipeline
Authors: Tavabi Nazgol , Pruneski James , Golchin Shahriar , Singh Mallika , Sanborn Ryan , Heyworth Benton , Kimia Amir , Kiapour Ata 
Published: December 2022

AbstractBuilding clinical registries is an important step in improving the quality and safety of patient care. With the growing size of medical records, manual abstraction becomes more and more infeasible and impractical. On the other hand, Natural Language Processing Techniques have shown promising results in extracting valuable information from unstructured clinical notes. However, the structure and nature of clinical notes are very different from regular text that state-of-the-art NLP models are trained and tested on and they have their own set of challenges. In this study, we propose SE-K, an efficient and interpretable classification approach for extracting information from clinical notes, and show that it outperforms current state-of-the-art models in text classification. We use this approach to generate a 20-year comprehensive registry of anterior cruciate ligament reconstruction operations, one of the most common orthopedics operations among children and young adults. This registry can help us better understand the outcomes of this surgery and identify potential areas for improvement which can ultimately lead to better treatment outcomes.
Epitopes- Based Vaccine Design Against Foot and Mouth DiseaseSAT2Serotype from Sudanese Isolate by Using Immunoinformatic Approaches
Authors: Habiballa Inas. I. , Raouf Y. A , Alhaj M , Mohamed Sana. I. , Elhassan Reham M. , Salim Oubi. O. , Mustafa Essra , Mohamed A. , Ahmed K , Mona M , Sirdar Mohamed. M. , Hassan Mohammed A. 
Published: December 2022

AbstractFoot and mouth disease (FMD) has been endemic in Sudan for decades and causes continuous outbreaks that have a direct negative impact on the animal population and prevent the exportation of animals from the country. The high diversity of FMD serotypes, especially SAT2 and A serotypes, hinders the development of effective vaccines since the most important component of vaccination is the degree of cross-protection provided by the vaccine against currently circulating field viruses. An immunoinformatic approach was utilized to predict a multi-epitope peptide vaccine design against theSAT2serotype from a Sudanese isolate targeting virus capsid regionP1. The virus capsid regionP1comprises the major immunogenic epitopes that confer protection against the FMD virus. Two predicted T-cell epitopes were identified that showed high binding affinity with MHC1 alleles (VQRSRQSTLandYHAEWDTGL) and high conservation with SAT2 African serotypes and were located within the VP1 and VP3 proteins, respectively. Only one epitope was predicted for B cells (LPATPEDAAH), which scored above the threshold in Bepipred linear epitope, Emini surface accessibility, and Kolaskar and Tongaonkar antigenicity and is located in VP3 protein. Molecular docking of the peptides (VQRSRQSTLandYHAEWDTGL) with the MHC1 allele showed satisfactory interaction with the binding sites of BoLA-HD6 using UCSF chimera 1.13.1 software. The peptideVQRSRQSTLshowed remarkable hydrophobic interaction with the BoLA-HD6 allele, which was superior to the other peptides. This study is the first to propose a peptide vaccine againstFMD SAT2serotypes from a Sudanese isolate.