OpenMed/multicare-articles huggingface dataset:
A multi-case study of the vertically integrated health-care at county-level in rural China: towards holistic and dynamic governance
Authors: Wenhui Xu, Li Zhu, Zixuan Peng, Xu Chen
Journal: Front Public Health (2024)
Keywords: china, collaborations of multiple actors, health governance paradigm, multi-case study, vertically integrated health-care at county-level
MeSH terms: Delivery of Health Care, Health Care Reform, China, Government, Humans, Rural Population

Background:
In contrast to the Grading Diagnosis and Treatment System (GDTS), Vertically Integrated Health-care at County-level (VIHC) is a strategic policy in rural China. This research intends to analyze the shift in governance paradigm with regard to the adjustment of the power structure and interest relationships among various participants, using the building of VIHC as a cut-in point.
Methods:
We carry out a multi-case study to investigate the paradigms of health governance when building VIHC in three different rural counties in China.
Results:
There were exchanges between government and other participants, vertical and horizontal collaborations among government divisions, and prompt responses to public requirements. County C's local administration, in particular, placed a strong emphasis on bureaucratic power and collaboration between various departments both within and outside of administrative boundaries. In contrast, County B's local administration emphasized the independence of healthcare practitioners and worked to win their support. In contrast to the previous two governments, County A encouraged social actors to participate and saw a little improvement in performance.
Conclusion:
In examining the health reform in rural China, this study paints a picture of the development of the health governance paradigm. In rural China, a comprehensive and dynamic governance paradigm was created through the integration of the health decision-making process, which was driven by the public's health needs, the operation mechanism, which featured both competition and cooperation, and the action logic of sharing responsibility.
Successful treatment of acrodermatitis continua of Hallopeau coexisting with generalized pustular psoriasis with spesolimab: a case report
Authors: Pengfei Wen, Chuan Liu, Tingting Wang, Xian Jiang, Ping Wang, Sheng Wang
Journal: Front Immunol (2024)
Keywords: il-36, acrodermatitis continua of hallopeau, generalized pustular psoriasis, spesolimab, treatment
MeSH terms: Acrodermatitis / drug therapy, Acrodermatitis / pathology, Antibodies, Monoclonal, Humanized, Biological Products / therapeutic use, Psoriasis / complications, Psoriasis / drug therapy, Psoriasis / pathology, Case Reports, Humans, Male, Skin / pathology, spesolimab, Biological Products, Antibodies, Monoclonal, Humanized

Generalized pustular psoriasis (GPP) is a rare chronic inflammatory pustular dermatosis that presents as painful erythema with sterile pustules on nonacral skin. No unified standard and guideline for the treatment of GPP has been established. Several biologics have been tried for GPP, with varying success. Acrodermatitis continua of Hallopeau (ACH) is a very rare disabling variant of pustular psoriasis characterized by sterile pustules on the fingers and toes, including the nail bed. Comparatively, treating ACH is highly challenging due to its commonly therapy-resistant disease course. The pathogenic role of IL-36 signaling axis has been currently identified in GPP development. Spesolimab, the first anti-interleukin-36 receptor biologic, has been approved for treating GPP flares and shown promising results. In view of a shared pathogenesis between GPP and ACH, specolimab may be an effective treatment for ACH. Currently, there is no case and clinical trial data exist on this condition. Therefore, this case was aim to describe real-world experience of spesolimab use in ACH coexisting with GPP. We report an Asian patient with a 16-year-history of GPP and ACH with marked pustulosis on the nail bed and onychodystrophy. He received conventional systemic regimen acitretin, cyclosporine and biologics adalimumab and secukinumab, but experienced relapse for skin lesions and refractory for nail lesions. He was then treated with a single dose of spesolimab in combination with secukinumab, which resulted in skin clearance and nearly complete resolution of nail lesions over a 32-week period. Our observation suggests that spesolimab should be considered for the treatment of ACH, especially in the patients with intractable nail lesions and concomitant GPP.
Case report: Isolated eyelid metastasis of ccRCC 5 years after receiving radical nephrectomy
Authors: Huaqi Yin, Zheng Du, Jiuwen Zhang, Yongkang Ma, Shiming Zhao, Tiejun Yang
Journal: Front Oncol (2024)
Keywords: mri, eyelid metastasis, renal cell carcinoma, renal tumor, sunitinib
MeSH terms: Case Reports

Introduction:
The most common sites of clear cell renal cell carcinoma(ccRCC) metastasis are the lung, bones, liver and brain; eyelid metastasis is a rare occurrence.
Case presentation:
We report a case of ccRCC metastasis to the left eyelid after radical nephrectomy, and remission after sunitinib treatment.
Conclusions:
Although the probability of eyelid metastasis rate is very low, tumor metastasis to the eyelid skin is possible after radical nephrectomy. Therefore, any rash like changes on the skin during the review procedure cannot be ignored by the physician.
Langerhans Cell Histiocytosis of the Uvea with a Ciliochoroidal Mass: A Case Report of Management with Systemic Therapy
Authors: Fariba Ghassemi, Hamid Riazi-Esfahani, Nazanin Ebrahimiadib, Abdulrahim Amini, Zahra Mahdizad
Journal: Case Rep Ophthalmol Med (2023)
MeSH terms: Case Reports

Background:
This study is aimed at exploring a case of choroidal Langerhans cell histiocytosis (LCH) successfully treated with systemic corticosteroid and immunosuppressant. Case presentation. A 24-year-old man with known multisystem LCH developed loss of vision, ocular pain, conjunctival injection, panuveitis, and a ciliochoroidal mass. After receiving an intravenous methylprednisolone pulse, oral high-dose corticosteroids, and methotrexate, the mass resolved quickly and completely without flare-ups during 6 months of follow-up.
Conclusions:
Intraocular involvement of LCH is rare and can present with or without a history of multisystemic disease. The diagnosis is challenging, and the standard treatment is not established. Systemic anti-inflammatory and immunosuppressive therapy could be an effective treatment, as the LCH itself contains an essential element of inflammation and the symptoms may be mainly inflammatory.
Cutaneous metastasis of urothelial carcinoma
Authors: Alexandra Baczynski, Emily Medhus, Penelope Skopis, Aadil Ahmed
Journal: IJU Case Rep (2023)
Keywords: cutaneous metastasis, immunohistochemistry, prognosis, skin nodules, urothelial carcinoma
MeSH terms: Case Reports

Introduction:
Cutaneous metastasis of urothelial carcinoma is a rare occurrence, accounting for a small percentage of skin metastases in cancer patients. This case presentation highlights the importance of considering cutaneous metastasis in patients with a history of urologic malignancy presenting with new dermal nodules.
Case presentation:
A 79-year-old male with a history of papillary urothelial carcinoma of the bladder and metastasis to the rectum presented with a painful and pruritic rash in the right inguinal region. Physical examination revealed firm papulonodules forming confluent, hyperpigmented to violaceous plaques. A punch biopsy confirmed the diagnosis of cutaneous metastasis of urothelial carcinoma based on histopathological and immunohistochemical findings.
Conclusion:
While cutaneous metastasis is uncommon in urothelial carcinoma, early recognition and diagnosis are crucial in guiding patient management and setting realistic expectations regarding prognosis. Timely identification of cutaneous lesions can help facilitate appropriate treatment decisions and discussions of goals of care.
Case Report: foetal gastroschisis with ideal pregnancy outcomes under multidisciplinary treatment management
Authors: Shuhua Liu, Jingyu Qian, Qiuru Li, Dehong Liu, Bin Zhang, Xianxia Chen
Journal: Front Pediatr (2024)
Keywords: abdominal defect, foetal, gastroschisis, management, multidisciplinary treatment
MeSH terms: Case Reports

Background:
Gastroschisis has increased in recent years, however, complicated gastroschisis is associated with higher mortality, as well as higher health care costs and disease burdens from short- and long-term complications.
Case introduction:
A woman aged 25 years old at 37 + 1 weeks gestation (gravida 2; para 0) was admitted to the hospital because of foetal gastroschisis. Targeted quaternary ultrasound performed at our hospital showed that 34 mm of the abdominal wall was interrupted continuously, an intestinal echo with a range of approximately 88 × 50 mm was seen bulging outwards the local area close to the intestinal wall showed a 34 × 23 m anecho, and the foetus was measuring 2 weeks smaller than expected. After MDT including the maternal-foetal medicine, ultrasound, paediatric surgery, neonatal intensive care unit (NICU), and anaesthesiology departments, caesarean section was performed at 37 + 2 weeks. A baby boy was delivered, the small intestine, large intestine and stomach were seen outside of the abdomen, the abdominal cavity was excluded from the defect on the right side of the umbilical cord, the mesentery was shortened, and the intestinal tube had obvious oedema After paediatric surgical discussion, silo bag placement and delayed closure was performed, the placement process was smooth. One week following silo placement, the abdominal contents had been fully reduced below the fascia following daily partial reductions of the viscera,and the second stage of the operation was performed under general anaesthesia. The newborn was successfully discharged from the hospital 20 days after the operation and was followed up, with good growth, normal milk intake and smooth bowel movements.
Conclusions:
The diagnosis and treatment of complicated gastroschisis needs to be carried out under multidisciplinary team treatment. Delivery by cesarean section after 37 weeks is feasible.Immediate postpartum surgery is possible, and the choice of surgical modality is determined by the child's condition, emphasizing that it should be performed without adequate sedation under anaesthesia. A standardized postoperative care pathway appropriate to risk should be developed to optimize nutritional support and antibiotic use, and standardized enteral feeding practices should be sought with long-term follow-up.
A Case of Combination of IgA Nephropathy and Interstitial Nephritis After COVID-19 Vaccination
Authors: Yuki Yoshida, Kenta Torigoe, Ryosuke Sakamoto, Shinichi Abe, Kumiko Muta, Hiroshi Mukae, Tomoya Nishino
Journal: Cureus (2024)
Keywords: covid-19 vaccine, glomerular nephritis, iga nephropathy (igan), severe acute respiratory syndrome coronavirus 2, tubulointerstitial nephritis
MeSH terms: Case Reports

A 66-year-old male presented with renal dysfunction. At the time of presentation, his serum creatinine (sCr) was 2.55 mg/dL, estimated glomerular filtration rate (eGFR) was 20.93 ml/min/1.73 m2, urinary red blood cell (RBC) was 30-49/high power field, and urine protein-creatinine ratio was 0.43 g/gCr. The patient had no urinalysis abnormalities or renal dysfunction within the year prior to presentation but had gross hematuria after the third and fourth coronavirus disease 2019 (COVID-19) vaccinations. Therefore, immunoglobulin A nephropathy (IgAN) was suspected and a percutaneous renal biopsy was performed. Renal pathology confirmed IgAN and interstitial nephritis and glucocorticoid therapy was initiated. Glucocorticoids improved renal function, and microscopic hematuria resolved. Although previous reports have shown that the COVID-19 vaccine induces various renal diseases, complications associated with these two renal diseases are rare. In this case, while IgAN was suspected based on episodes of gross hematuria after vaccination, renal biopsy confirmed it and also revealed interstitial nephritis.
Case report: Remarkable response to a novel combination of mitotane, etoposide, paraplatin, and sintilimab in a patient with metastatic adrenocortical carcinoma
Authors: Yan Weng, Lin Wang, Xiao-Yi Wang, Xin-Xiang Fan, Li Yan, Zhi-Hua Li, Shao-Ling Zhang
Journal: Front Endocrinol (Lausanne) (2023)
Keywords: mlh1, msi-h, pd-1, adrenocortical carcinoma, tumor mutational burden
MeSH terms: Adrenal Cortex Neoplasms / drug therapy, Adrenal Cortex Neoplasms / genetics, Adrenocortical Carcinoma / drug therapy, Adrenocortical Carcinoma / genetics, Case Reports, Research Support, Non-U.S. Gov't, Adult, Carboplatin, Etoposide, Humans, Male, Mitotane, Mitotane, sintilimab, Carboplatin, Etoposide

Background:
Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis and limited treatment options for metastases. However, new effective regimens are emerging for specific conditions in metastatic ACC.
Case presentation:
We report a case of a 36-year-old man diagnosed with metastatic ACC who had a large left adrenal mass (158 mm × 112 mm) and multiple metastases in the liver and lungs. Genetic testing revealed a microsatellite instability-high (MSI-H) tumor, a splice mutation in MLH1, and a high tumor mutational burden (TMB). After the left adrenalectomy, he received sequential treatment with a combination of mitotane, etoposide, paraplatin (EP-M), and sintilimab. His condition has been assessed as a stable disease since the sixth cycle of the combined regimen.
Conclusion:
This case highlights the remarkable response of our patient's ACC with MSI-H tumor, MLH1 spice mutation, and high TMB to treatment with a novel combination of EP-M and sintilimab. Our findings suggest a promising therapeutic option for patients with similar molecular profiles.
Primary Staged Bilateral Total Hip Arthroplasty in a Patient With Short Stature and Hartofilakidis Type I Developmental Dysplasia of the Hip
Authors: Nikolaos Milonakis, Georgios Douvlis, Christothea-Alexandra Tsiridis, Zakareya Gamie, Eustathios Kenanidis, Eleftherios Tsiridis
Journal: Cureus (2024)
Keywords: bilateral total hip arthroplasty, developmental dysplasia of the hip, hybrid total hip arthroplasty, osteochondrodysplasia, osteotomy
MeSH terms: Case Reports

Syndromes associated with osteochondrodysplasia, short stature, and DDH are rarely reported in the literature. Total hip arthroplasty (THA) in such cases is a complex procedure with a high rate of complications and difficulties. In this case report, we describe the staged bilateral complex primary THA of a patient with the rare occurrence of a syndrome involving osteochondrodysplasia and DDH, highlighting the surgical challenges and importance of the right prosthesis selection.
Case report: Pathological differences in pulmonary arterial hypertension in long-term responders to calcium channel blockers
Authors: Yuichi Tamura, Sayamaa Lkhagvadorj, Yudai Tamura, Asuka Furukawa, Shinsuke Aida, Hirotoshi Ebinuma, Takayuki Shiomi
Journal: Front Cardiovasc Med (2023)
Keywords: calcium channel blockers, long term survivor, pathology, pathophysiology, pulmonary arterial hypertension
MeSH terms: Case Reports

Background:
This study investigates the pulmonary arterial histopathology in patients with idiopathic pulmonary arterial hypertension (IPAH) and acute vasoreactive phenotype, who demonstrated long-term survival (>30 years) and incidental death from causes other than PAH progression. The pathological changes observed in these patients were compared with those in patients with bone morphogenetic protein receptor type 2 (BMPR2) mutation.
Case presentation:
We present two cases of patients with pulmonary arterial hypertension (PAH) who died incidentally from causes unrelated to PAH progression. We report compares pulmonary arterial histopathology in long-term survivors of CCB-responsive PAH patient and a hereditary PAH patient with a BMPR2 mutation. Lung specimens were analyzed using the Heath and Edwards (HE) classification and percentage muscular wall thickness (%MWT) of pulmonary arterioles. A significant difference in the severity of grading (p = 0.0001) and distribution between grades 1-2, 4 (p = 0.001), and 5 (p = 0.014) was observed between both patients. These findings suggest differential vascular pathology between the two cases, with CCB responders displaying more mild illness lesions compared to BMPR2 mutant patients.
Conclusion:
The study revealed that CCB responders exhibit more mild illness vascular lesions than BMPR2 mutant patients despite their long-term survival, suggesting a difference in vascular pathology between the two phenotypes.
Steroid lifting method during endoscopic submucosal dissection: A novel strategy for stricture prevention
Authors: Masami Omae, Henrik Maltzman, Miroslav Vujasinovic, Naining Wang, Francisco Baldaque-Silva
Journal: DEN Open (2024)
Keywords: barrett's esophageal neoplasia, complete circumferential resection, endoscopic submucosal dissection, esophageal stricture, steroid lifting method
MeSH terms: Case Reports

A 73-year-old male patient was referred to us with a long Barrett's esophagus (BE). He had a history of pulmonary embolism under anticoagulant therapy. Esophagogastroduodenoscopy showed a C8M9 BE with no macroscopic lesions. Random biopsies from the BE revealed multifocal high-grade dysplasia. The case was discussed in a multidisciplinary team conference and the decision for full resection of BE with endoscopic submucosal dissection (ESD) was made. Considering the large ESD resection and the high risk of stricture, we developed a novel preventive technique: the "steroid lifting method" for submucosal injection during ESD. Complete circumferential ESD with en bloc resection was performed using the "steroid lifting method", without adverse events. Oral liquids were initiated on day 1 and the patient was discharged on day 4. Oral prednisolone (30 mg per day) was started and tapered for a total of 6 weeks. The pathological examination confirmed multifocal high-grade dysplasia, with radical and curative resection. The patient had neither stricture, dysphagia nor recurrence of Barrett's mucosa at the 2, 6, 12, and 24-month follow-up. International guidelines recommend oral prednisolone and triamcinolone injection to prevent stricture formation in large ESD of esophageal squamous cell carcinoma. However, there is no solid data on BE ESD. The risk factors for stricture formation and the optimal preventive management after large BE ESD is not known. The "steroid lifting method" might be an option in this context. Large prospective studies addressing stricture formation and preventive measures on BE ESD are necessary.
The enduring enigma of sporadic chorea: A single center case series
Authors: Pedro J Garcia Ruiz, Lola Diaz Feliz, Cici E Feliz, Isabel Lorda Sanchez, Almudena Avila Fernandez, Fiona Blanco Kelly, Maria Jose Trujillo Tiebas, Javier Del Val, Inma Navas Vinagre
Journal: Tremor Other Hyperkinet Mov (N Y) (2023)
Keywords: hereditary chorea, secondary chorea, sporadic chorea
MeSH terms: Chorea / diagnosis, Chorea / genetics, Huntington Disease / genetics, Research Support, Non-U.S. Gov't, Autoantibodies, Diagnosis, Differential, Humans, Autoantibodies

Chorea can have a wide variety of causes including neurodegenerative, pharmacological, structural, metabolic, infectious, immunologic and paraneoplastic processes. We reviewed the clinical records of patients with apparently sporadic choreic movements and no relevant family history, who presented to our neurology department (Hospital Fundación Jimenez Diaz) between 1991 and 2022. We detected 38 cases of apparent sporadic chorea (ASC); Our analysis revealed 5 cases of genetic chorea (including 3 cases with Huntington's disease) while 6 cases were autoimmune/hematological; 6 drug-related chorea, 5 metabolic-vascular, 5 due to miscellaneous conditions and 4 were of mixed etiology. No clear etiology was identified in 8 cases. The differential diagnosis of ASC is extensive and challenging.
Highlights:
Chorea can have a wide variety of genetic and sporadic causesWe reviewed the clinical records of patients with apparently sporadic chorea (ASC), who presented to our neurology department over the last 30 yearsWe detected 38 cases of apparent ASC; Our analysis revealed a wide array of different sporadic conditions and 5 cases of genetic choreaThe differential diagnosis of ASC is extensive and challenging.
Endodontic Retreatment of a Mandibular Second Molar With a C-shaped Root Canal Configuration: A Case Report
Authors: He Liu, Ya Shen
Journal: Cureus (2024)
Keywords: bioceramic sealer, c-shaped root canal configuration, dental operating microscope, mandibular second molar, root canal retreatment
MeSH terms: Case Reports

Root canal retreatment in mandibular second molars with C-shaped root canal configurations presents notable challenges. This article presents a case of successful root canal retreatment in a mandibular second molar exhibiting this complex configuration. Achieving a successful endodontic outcome in such cases necessitates a comprehensive understanding of the unique root canal anatomy. Moreover, the employment of advanced instruments and techniques is crucial to effectively address the intricacies of the C-shaped root canal system.
Successful excision of an inflammatory endobronchial polyp using biopsy forceps with improvement in FEV1 in a patient with allergic bronchopulmonary aspergillosis: A case report
Authors: Fumihiro Kashizaki, Kenji Konishi, Chihiro Yamada, Shunsuke Okazaki, Hao Chen, Atsushi Miyasaka, Nanami Tsuchiya, Akitomo Kikuchi, Kentaro Yumoto, Yui Kojima, Hiroyuki Osawa, Harumi Koizumi, Kenichi Takahashi, Takeshi Kaneko
Journal: Respir Med Case Rep (2024)
Keywords: allergic bronchopulmonary aspergillosis, biologic, biopsy forceps, flexible bronchoscopy, inflammatory endobronchial polyps, pulmonary function test
MeSH terms: Case Reports

Inflammatory endobronchial polyps (IEPs) are rare, benign bronchial tumors posing diagnostic and therapeutic challenges owing to limited data. A 55-year-old man, receiving treatment for allergic bronchopulmonary aspergillosis, presented with a one-week history of fever and purulent sputum. Diagnosed with pneumonia, he received antimicrobial treatment. However, because of persistent symptoms, an endobronchial tumor was suspected on computed tomography. IEP was confirmed through flexible bronchoscopy with forceps biopsy, and polyp removal improved symptoms, lung function, and imaging.