bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age and sex-specific associations of visit-to-visit variability of glycated hemoglobin A1c with all-cause mortality in patients with diabetes
Authors: Yeh Shu-Tin , Ooi Seng-Wei , Chang Ya-Hui , Li Chung-Yi , Chen Hua-Fen 
Published: August 2022

Background:
Visit-to-visit variability (VVV) of glycated hemoglobin (HbA1c) levels have been found to be associated with prognosis of diabetes. However, little is known about whether or to what extent sex and age may modify the effects of VVV.

Methods:
To investigate age- and sex-specific rates of mortality from all causes and relative hazards of mortality in association with VVV of HbA1c levels, 47,145 patients with diabetes and prescription of any antidiabetic agents >6 months were identified from outpatient visits of a tertiary medical center in northern Taiwan during 2003–2018. VVV of HbA1c was measured by quartiles of standard deviation (SD), coefficient of variation (CV), and average real variability (ARV), respectively. The study subjects were linked to Taiwan’s National Death Registry to identify all-cause mortality. The person-year approach with the Poisson assumption was used to assess the all-cause mortality rates, and Cox proportional hazard regression model was used to evaluate the relative hazards of all-cause mortality concerning various levels of VVV of HbA1c.

Results:
The lowest all-cause mortality rate was found in either the first or second quartile of various measures for VVV of HbA1c, but the highest mortality rate was consistently observed in the fourth quartile of VVV, regardless of SD, CV, or ARV across ages and sexes. Increased hazards of overall all-cause mortality were noticed from the second to fourth quartile of VVV of HbA1c. In detailed age- and sex-stratified analyses, elevated risk of mortality was seen in the fourth quartile of those aged <50 years while in those aged >69 years, increased risk of mortality was noticed in the third and fourth quartiles of any VVV of HbA1c irrespective of sex. In those aged 50–69 years, incremental increased hazards of mortality were consistently observed in the second to fourth quartiles of VVV of HbA1c.

Conclusion:
HbA1c variability whether it was SD, CV, or ARV could strongly predict the risks of all-cause mortality. The extent of the relationship between VVV of HbA1c and all-cause mortality in different age groups was comparable between both sexes. Given the importance of long-term glucose fluctuation, the inclusion of HbA1c variability calculated from the standardized method should be considered by clinical guideline policymakers as part of the biochemical panel in daily diabetes management.
Alopecia and colon ulcers following azathioprine use in a patient with myasthenia gravis: A case report
Authors: Hsu Wan-Yi , Lin Pei-Chin , Liu Yi-Ching , Lin Lung-Chang 
Published: August 2022

Rationale:
Azathioprine is a purine analog (PA) used to treat myasthenia gravis (MG). However, some patients are sensitive to azathioprine and develop severe side effects, such as leukopenia, alopecia, and diarrhea soon after using the medication. Pharmacogenetics plays a crucial role in such intolerance.

Patient concerns:
A 16-year-old woman with MG developed hair loss, pancytopenia, bloody diarrhea, and fever shortly after azathioprine treatment.

Diagnosis:
Pharmacogenetic analysis revealed compound heterozygosity of the nudix hydrolase 15 (NUDT15) gene, which led to suppressed NUDT15 function. Colonoscopy revealed large ulcers with polypoid lesions in the terminal ileum, cecum, ascending colon, and rectum. These are the characteristics of inflammatory bowel disease (IBD).

Interventions:
Sanger sequencing of NUDT15 gene and colonoscopy for bloody stool evaluation.

Outcomes:
The patient recovered completely from this acute episode after discontinuation of azathioprine treatment. Her hemogram turned back to normal range. There was also no blood in stool during follow-up.

Lessons:
Pharmacogenetic effects should be considered when prescribing PA medication. The possibility of secondary or concomitant autoimmune diseases must always be considered in patients with MG.
A bibliometric analysis of DNA methylation in cardiovascular diseases from 2001 to 2021
Authors: Zhang Yan , Jia Zijun , Zhou Qingbing , Zhang Ying , Li Dandan , Qi Yifei , Xu Fengqin 
Published: August 2022

Background:
DNA methylation is a dynamically reversible form of epigenetics. Dynamic regulation plays an important role in cardiovascular diseases (CVDs). However, there have been few bibliometric studies in this field. We aimed to visualize the research results and hotspots of DNA methylation in CVDs using a bibliometric analysis to provide a scientific direction for future research.

Methods:
Publications related to DNA methylation in CVDs from January 1, 2001, to September 15, 2021, were searched and confirmed from the Web of Science Core Collection. CiteSpace 5.7 and VOSviewer 1.6.15 were used for bibliometric and knowledge-map analyses.

Results:
A total of 2617 publications were included in 912 academic journals by 15,584 authors from 963 institutions from 85 countries/regions. Among them, the United States of America, China, and England were the top 3 countries contributing to the field of DNA methylation. Harvard University, Columbia University, and University of Cambridge were the top 3 contributing institutions in terms of publications and were closely linked. PLoS One was the most published and co-cited journal. Baccarelli Andrea A published the most content, while Barker DJP had the highest frequency of co-citations. The keyword cluster focused on the mechanism, methyl-containing substance, exposure/risk factor, and biomarker. In terms of research hotspots, references with strong bursts, which are still ongoing, recently included “epigenetic clock” (2017–2021), “obesity, smoking, aging, and DNA methylation” (2017–2021), and “biomarker and epigenome-wide association study” (2019–2021).

Conclusions:
We used bibliometric and visual methods to identify research hotspots and trends in DNA methylation in CVDs. Epigenetic clocks, biomarkers, environmental exposure, and lifestyle may become the focus and frontier of future research.
Ultrasound-guided screw fixation for patellar stress fracture in a female basketball player: A case report
Authors: Omodani Toru , Takahashi Kenji , Ueno Keishin 
Published: August 2022

Introduction:
Stress fracture of the patella is an overuse disorder that occurs in the lower extremity. Surgery may be considered if conservative treatment does not work or if a quicker and more reliable return to sports is expected. Surgery is usually performed under fluoroscopic guidance based on the premise that the proper placement of the internal fixation material can be determined on radiographic images.

Patient concerns:
A 16-year-old female basketball player gradually became aware of pain in the anterior aspect of her right knee during basketball, without any particular history of trauma. A computed tomography scan revealed a small bone fragment on the lateral side of the distal end of the patella.

Diagnosis:
Stress fracture of the patella.

Interventions:
Since it was difficult to determine the exact location of the bone fragment on radiographs, the surgery was performed under ultrasound guidance rather than fluoroscopy. While checking the bone fragment with ultrasound images, insertion of the guide pin, drilling, and screw fixation were performed under ultrasound guidance.

Outcomes:
Postoperative computed tomography showed accurate screw insertion into the bone fragment. Two months after surgery, bony fusion was confirmed, and the patient returned to her preinjury level of basketball.

Conclusion:
Ultrasound-guided screw fixation was useful in this case in which internal fixation of fractures is difficult under fluoroscopic guidance.
Drug hypersensitivity syndrome induced by sulfasalazine: A case report
Authors: Chen Dong-Hui , Zhou Hai-Rong , Zhang Yong-Gang , Shen Guan-Yuan , Xu Chong , Guan Chun-Li 
Published: August 2022

Introduction:
Drug hypersensitivity syndrome (DHS) induced by sulfasalazine is a serious systemic delayed adverse drug reaction, which is associated with significant morbidity and mortality.

Patient concerns:
A 52-year-old man was hospitalized for developing a rash after 3 weeks of sulfasalazine treatment for ulcerative colitis (UC).

Diagnosis:
The patient was diagnosed with DHS based on his drug history, clinical manifestations, and laboratory test results.

Interventions:
The patient was administered intravenous glucocorticoids. The patient’s condition improved after treatment with human immunoglobulin and antihistamines.

Outcomes:
Combination therapy of glucocorticoid and gamma globulin, the whole-body pruritus disappeared, and no new rash appeared. The whole-body rash subsided or turned dark red.

Conclusion:
This article describes the diagnosis and treatment process of a case of sulfasalazine-induced DHS and reviews the relevant literature to improve clinician understanding and avoid misdiagnosis and missed diagnosis.
Ecthyma gangrenosum caused by Staphylococcus aureus in hematological malignancies: Case reports and literature review
Authors: (Kudo) Nagata Yuka , Sekiya Noritaka , Fukushima Kazuaki , Horiuchi Masao , Doki Noriko 
Published: August 2022

Rationale:
Ecthyma gangrenosum (EG) is a potentially life-threatening, systemic infection generally caused by Pseudomonas aeruginosa. Data on EG caused by Staphylococcus aureus in patients with hematological malignancies are scarce. The present case report aimed to describe the clinical features of EG caused by S. aureus in patients with hematological malignancies and to provide a comprehensive review of previous studies on the topic.

Patient concerns:
The first patient was a 61-year-old man with acute myeloid leukemia who presented fever and multiple lesions during chemotherapy. The second patient was a 47-year-old man with myelodysplastic syndrome who developed progressive erythematous necrotic plaques on his extremities and face.

Diagnosis:
Both cases were diagnosed as EG caused by S. aureus. While the first patient had concurrent methicillin-resistant S. aureus (MRSA) bacteremia, the second patient had positive results only for tissue culture of the skin lesion isolated methicillin-sensitive S. aureus.

Interventions:
Vancomycin was initiated with critical care to the first patient. Cefazolin was administered to the second patient for 3 weeks, followed by cephalexin for 1 week.

Outcomes:
The first patient died of a brain hemorrhage and multiple organ failure. The second patient was cured without relapse.

Lessons:
Of 18 patients in the previous and current studies with EG caused by S. aureus, 6 (33%) had an underlying hematological malignancy, and 10 (56%) had EG caused by MRSA. While 28% of the patients had positive blood cultures, all tissue cultures were positive. All 3 fatalities had concurrent bacteremia (MRSA caused two). EG caused by MRSA with concurrent bacteremia can be fatal, especially in patients with hematological malignancies. Although S. aureus-associated EG in patients with hematological malignancies is relatively uncommon, tissue cultures with an initial gram stain smear are essential for selecting appropriate empirical antimicrobials, including the coverage of S. aureus.
A bibliometric analysis of neuroimaging biomarkers in Parkinson disease based on Web of Science
Authors: Li Xiao-Ling , Gao Rui-Xue , Zhang Qinhong , Li Ang , Cai Li-Na , Zhao Wei-Wei , Gao Sheng-Lan , Wang Yang , Yue Jinhuan 
Published: August 2022

Background:
This study aimed to analyze and summarize the research hotspots and trends in neuroimaging biomarkers (NMBM) in Parkinson disease (PD) based on the Web of Science core collection database and provide new references for future studies.

Methods:
Literature regarding NMBM in PD from 1998 to 2022 was analyzed using the Web of Science core collection database. We utilized CiteSpace software (6.1R2) for bibliometric analyses of countries/institutions/authors, keywords, keyword bursts, references, and their clusters.

Results:
A total of 339 studies were identified with a continually increasing annual trend. The most productive country and collaboration was the United States. The top research hotspot is PD cognitive disorder. NMBM and artificial intelligence medical imaging have been applied in the clinical diagnosis, differential diagnosis, treatment, and prognosis of PD. The trends in this field include research on T1 weighted structure magnetic resonance imaging in accordance with voxel-based morphometry, PD cognitive disorder, and neuroimaging features of Lewy body dementia and Alzheimer disease.

Conclusion:
The development of NMBM in PD will be effectively promoted by drawing on international research hotspots and cutting-edge technologies, emphasizing international collaboration and institutional cooperation at the national level, and strengthening interdisciplinary research.
Echocardiographic findings and associated factors in HIV-infected patients at a tertiary hospital in Ethiopia
Authors: Woldeyes Esubalew , Fisseha Henok , Mulatu Hailu Abera , Ephrem Abiy , Benti Henok , Alem Mehari Wale , Ahmed Ahmed Ibrahim 
Published: August 2022

Noncommunicable diseases including cardiovascular diseases are becoming an important part of human immunodeficiency virus (HIV) care. Echocardiography is a useful noninvasive tool to assess cardiac disease and different echocardiographic abnormalities have been seen previously. The aim of this study was to investigate the echocardiographic abnormalities in HIV-infected patients and factors associated with the findings.
A cross-sectional study was conducted on 285 patients with HIV infection including collection of clinical and echocardiographic data. Logistic regression was used to examine the association between echocardiographic abnormalities and associated factors with variables with a P value of <.05 in the multivariate model considered statistically significant.
Diastolic dysfunction was the most common abnormality seen in 30% of the participants followed by ischemic heart disease (19.3%), left ventricular hypertrophy (10.2%), enlarged left atrium (8.1%), pulmonary hypertension (3.6%), and pericardial effusion (2.1%). Diastolic dysfunction was independently associated with increasing age, elevated blood pressure, and left ventricular hypertrophy while ischemic heart disease was associated with male gender, increasing age, and abnormal fasting blood glucose. Left ventricular hypertrophy was associated with increasing age and blood pressure and the later was associated with left atrial enlargement. The level of immunosuppression did not affect echocardiography findings.
A high prevalence of echocardiographic abnormalities was found. Male gender, age >50 years, elevated blood pressure, and elevated fasting blood glucose were associated with echocardiographic abnormalities. Appropriate follow-up and treatment of echocardiographic abnormalities is needed.
Response to treatment with an ALK-TKI in a patient with advanced lung adenocarcinoma with concurrent ALK fusion and high PD-L1 expression: A case report
Authors: Zhang Yaping , Fang Hongming , Hong Jianfeng , Wang Xiaoyan , Wang Hui , Pan Guoqiang 
Published: August 2022

Rationale:
Previous studies have shown that PD-L1 TPS ≥50% in lung cancer rarely overlaps with driver oncogenes such as epidermal growth factor receptor and anaplastic lymphoma kinase (ALK). The initial gene detection of the patient in this study showed ALK fusion combined with high expression of PD-L1. We explored the treatment options for this patient.

Patient concerns:
A 34-year-old woman presented for the first time with “repeated fever and cough for 20 days.” The patient denied any underlying medical history.

Diagnosis:
After a series of imaging examinations and needle biopsy, the patient was diagnosed as stage IV lung adenocarcinoma with multiple liver and bone metastases (EML4-ALK fusion, PD-L1 TPS 80%).

Interventions:
The patient was initially given alectinib targeted therapy. After progression, a second round of genetic testing was performed and the patient was detected to have both ALK fusion and BRAF mutation. The patient was then successively changed to treatment with ensatinib combined with dabrafenib, and lorlatinib combined with dabrafenib.

Outcomes:
The initial efficacy evaluation of alectinib was PR, but its PFS was only 4 months. The patient only achieved an overall survival of 10 months.

Lessons:
Non–small cell lung cancer with an ALK fusion and high PD-L1 expression responds poorly to most current treatment options, with survival time after ALK-tyrosine kinase inhibitor treatment notably shorter than that of patients with an ALK fusion alone.
Application of network pharmacology and molecular docking approach to explore active compounds and potential pharmacological mechanisms of Aconiti Lateralis Radix Praeparata and Lepidii Semen Descurainiae Semen for treatment of heart failure
Authors: Yang Meng-Qi , Chen Cong , Mao Yi-Fei , Li Yan , Zhong Xia , Yu Yi-Ding , Xue Yi-Tao , Song Yong-Mei 
Published: August 2022

Background:
Heart failure (HF) is the end stage of the development of heart disease, whose prognosis is poor. The previous research of our team indicated that the formulae containing Aconiti Lateralis Radix Praeparata and Lepidii Semen Descurainiae Semen (ALRP-LSDS) could inhibit myocardial hypertrophy, inhibit cardiomyocyte apoptosis, delay myocardial remodeling (REM), and improve the prognosis of patients with HF effectively. In order to explore the mechanism of ALRP-LSDS for the treatment of HF, a combined approach of network pharmacology and molecular docking was conducted.

Methods:
Public database TCMSP was used to screen the active compounds of ALRP-LSDS. The targets of screened active compounds were obtained from the TCMSP database and predicted using the online analysis tool PharmMapper. The targets of HF were obtained from 6 databases including GeneCards, OMIM, DrugBank, TTD, PharmGKB, and DisGeNET. Protein–protein interaction and enrichment analysis were performed, respectively, by STRING and Metascape online tools after merging the targets of active compounds and HF. Cytoscape software was used to conduct networks. Finally, molecular docking was performed by Vina to verify the correlation between key targets and active compounds.

Results:
Final results indicated that the active compounds including β-sitosterol, isorhamnetin, quercetin, kaempferol, and (R)-norcoclaurine, the targets including AKT1, CASP3, and MAPK1 might be the main active compounds and key targets of ALRP-LSDS for the treatment of HF separately. The binding ability of AKT1 to the main active compounds was better compared with the other 2 key targets, which means it might be more critical. The pathways including AGE-RAGE signaling pathway in diabetic complications, Pathways in cancer, and Fluid shear stress and atherosclerosis might play important roles in the treatment of HF with ALRP-LSDS. In general, ALRP-LSDS could inhibit cardiomyocyte apoptosis, delay REM, and improve cardiac function through multicompound, multitarget, and multipathway, which contributes to the treatment of HF.

Conclusions:
Based on the combined approach of network pharmacology and molecular docking, this study screened out the main active compounds, key targets, and main pathways of ALRP-LSDS for the treatment of HF, and revealed its potential mechanisms, providing a theoretical basis for further research.
Single ultrasound-guided local high-dose thrombin injection in the treatment of giant brachial artery pseudoaneurysm: A case report
Authors: Li Liang , Xiu Junqing , Yuan Lian , Zhang Xing , Li Yue 
Published: August 2022

Rationale:
Pseudoaneurysm (PSA) is a common complication related to vascular intervention, and surgical therapy is the primary method. However, a giant brachial artery PSA over 2 weeks is rarely observed. Due to the adhesion of surrounding tissue, thrombus organization, the extensive injury, and the high expense of transluminal stent-graft placement, a single ultrasound-guided local high-dose thrombin injection can be a therapy option. Such cases are rarely reported.

Patient concerns:
A 71-year-old man with a history of left elbow fossa interventional puncture presented to our hospital with a pulsatile mass in the left elbow fossa. He had a history of cerebral infarction 32 years prior without sequelae, emphysema for more than 2 years, hyperlipidemia for 3 months, and prostatic hyperplasia for 8 months. After conservative therapy, the lumbar compression fracture produced by trauma 24 years ago healed, and the intracranial hematoma induced by trauma ten years ago was absorbed.

Diagnosis:
Ultrasound examination showed giant mixed echoes on the posterior medial side of the left brachial artery.

Interventions:
The patient underwent a single ultrasound-guided local high-dose thrombin injection to treat giant brachial artery PSA.

Outcomes:
Following therapy, the ultrasonography revealed that extensive thrombosis immediately formed in the cavity, and the internal blood flow signals had completely vanished. A week later, a physical examination showed that the PSA had shrunk with no apparent tenderness and that the texture had hardened. Pulsation and vascular murmurs disappeared. Ultrasound showed that the PSA was reduced, and no blood flow signals were found.

Lessons:
A single ultrasound-guided local high-dose thrombin injection had a considerable effect in curing large iatrogenic PSA. However, when deciding on the best therapy, specificity must be taken into account.
Protected carotid artery stenting in patients with severe stenosis
Authors: Jeon Seo-Young , Lee Jong-Myong 
Published: August 2022

Intraplaque hemorrhage (IPH) and ulcers are the major findings of unstable plaques. In addition, initial symptoms are associated with postprocedural complications after carotid artery stenting (CAS). The aim of this study was to determine the safety of CAS using an embolic protection device in symptomatic patients with severe carotid artery stenosis and unstable plaques such as IPH and ulcers.
This retrospective study included 140 consecutive patients with severe carotid stenosis. These patients underwent preprocedural carotid vessel wall imaging to evaluate the plaque status. We analyzed the incidence of initial clinical symptoms, such as headache, nausea, and vomiting, after CAS. The primary outcomes analyzed were the incidence of stroke, myocardial infarction, and death within 30 days of CAS.
Sixty-seven patients (47.9%) had IPH, and 53 (38.9%) had ulcers on carotid wall imaging/angiography. Sixty-three patients (45.0%) had acute neurological symptoms with positive diffusion-weighted image findings. Intraluminal thrombi on initial angiography and flow arrest during CAS were significantly higher in patients with IPH and symptomatic patients. Symptoms were significantly higher in patients with IPH than in those without (63.5% vs 35.1%, P < .001). There were no significant differences in clinical symptoms after stenting or in primary outcomes, regardless of IPH, ulcer, or initial symptoms.
IPH and plaque ulceration are risk factors in symptomatic carotid stenosis. However, IPH and plaque ulceration were not a significant risk factors for cerebral embolism during protected carotid artery stent placement in patients with carotid stenosis. Protected CAS might be feasible and safe despite the presence of unstable plaques.