bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of Extracochlear Electrodes Using Electrical Field Imaging (EFI)
Authors: Saoji Aniket A. , Staricha Kelly L. , DeJong Melissa D. , Dornhoffer James R. , Neff Brian A. , Driscoll Colin L.W. , Koka Kanthaiah , Lane John I. , Carlson Matthew L.
Published: January 2025

Objective

To analyze the use of electrical field imaging (EFI) in the detection of extracochlear electrodes in cochlear implants (CI)

Study Design

Retrospective cohort study

Setting

Tertiary academic medical center

Methods

EFI patterns from 6 recipients with extracochlear electrodes were compared with 10 recipients with all intracochlear electrodes to identify differences in EFI patterns between these two groups. For the extracochlear group, EFI patterns were analyzed using two methods: visual inspection and calculation of the average impedance difference (AID) between specific EFI curves. These results were then compared with information from CT and plain film imaging, surgical notes, and audiology tests to confirm the placement of the electrodes in each recipient.

Results

An average AID of 0.06 kΩ was calculated from the EFI patterns for recipients with complete electrode insertion, whereas an average AID of 0.15 kΩ was calculated from the EFI curves measured for the extracochlear electrodes. Visual analysis of the EFI impedance curves for extracochlear electrodes showed a distinct separation from those measured for intracochlear electrodes. Based on AID analysis and visual inspection the EFI, patterns were in close agreement with the number of extracochlear electrodes detected based on either imaging, intraoperative surgical note, or audiological findings.

Conclusion

EFI is a noninvasive, inexpensive, and time-efficient measurement that can be used to detect extracochlear electrodes and monitor electrode migration from the cochlea.
Pöschl Reformations Created from High-Resolution Noncontrast Enhanced CT Head Exams Can Be Used to Detect and Classify Superior Semicircular Canal Abnormalities
Authors: Matari Nahill H. , Mingomataj Erli , Famuyide Akinrinola , Nguyen Pamela , Lalwani Anil K. , Garcon Ernst
Published: January 2025

Objective

To compare the diagnostic capability of Pöschl reformations created from temporal bone CT (TBCT) and high-resolution noncontrast CT head exams (HR-NECTH) to detect and classify superior semicircular canal (SSC) abnormalities.

Study Design

Retrospective case review.

Setting

Tertiary referral center.

Patients

Individuals with normal and abnormal SSC who received TBCT and HR-NECTH.

Interventions

Pöschl reformations of each patient’s temporal bones (TB) were created using TBCT and HR-NECTH. Screenshots displaying the SSC were randomized into an interpretation test sent to neuroradiologists who interpreted the SSC as normal/abnormal and classified abnormalities as thinning (SST)/dehiscence (SSD).

Main Outcome Measure

Analysis of responses to interpretation test, interrater reliability, and sensitivity, specificity, and positive/negative predictive values of Pöschl reformations from TBCT and HR-NECTH.

Results

Fourteen patients were enrolled, 28 TB were reviewed. Sixteen TB demonstrated SST/SDD and 12 were normal as per gold standard TBCT. Interpretation test displaying screenshots of the SSC, in a randomized, blinded fashion, was completed by four neuroradiologists. Analysis of TBCT and HR-NECTH Pöschl reformation interpretations yielded no statistically significant difference in proportion of true/false-positive/negative responses (χ
2 = 3.37, p = 0.83), similar and substantial interrater reliability (k = 0.78 vs. 0.73, respectively), and similar sensitivity, specificity, and positive/negative predictive values (0.86, 1, 1, 0.84 vs. 0.78, 0.96, 0.96, 0.77, respectively). Neuroradiologists also correctly classified SST/SSD on TBCT and HR-NECTH Pöschl reformations at a rate of 70.9% vs. 78.0%, respectively.

Conclusion

Pöschl reformations created from HR-NECTH demonstrated similar diagnostic capability as those created from TBCT to detect and classify SSC abnormalities.
The clinical effects of continuous nursing intervention combined with chronic disease management center in patients with severe hypertension
Authors: Zhang Hongqiang , Li Yongyan , Yang Xinmei , Zhou Tingting , Zhang Yanru , Yao Junru
Published: January 2025

The construction and application of chronic disease management centers are increasing. However, the effect of continuing nursing combined with intervention measures provided by chronic disease management centers in patients with severe hypertension is still unclear. To analyze the application effect of continuous nursing intervention combined with chronic disease management center in patients with severe hypertension. 240 patients with severe hypertension were randomly divided into control group (N = 120) and study group (N = 120). The study group adopted the intervention measures of continuous nursing combined with chronic disease management center, while the control group adopted routine nursing. The nursing effects of the 2 groups were compared. After nursing, the short form 36-item health survey, total satisfaction rate and medication compliance rate of the study group were higher than those of the control group (P < .001). Blood pressure, self-rating anxiety scale, and self-rating depression scale scores were lower than those of the control group (P < .05). Continuing nursing combined with the intervention of chronic disease management center can effectively reduce the blood pressure of patients with severe hypertension, and the overall nursing effect is remarkable.
Internal fixation vs manual reduction in the treatment of ankle fracture healing and inflammation: A case–control study
Authors: Wei Yaheng , Yang Zuoming
Published: January 2025

Ankle fractures are among the most common bone injuries, which are often accompanied by soft tissue injuries. Proper management of these fractures is crucial to promote healing and minimize complications. This study explores the effects of 2 treatment methods for ankle fractures: open reduction and internal fixation and manual reduction followed by plaster external fixation. A retrospective analysis was conducted on 124 patients with ankle fractures admitted between March 2020 and September 2022. Patients were divided into 2 groups: 62 received internal fixation and 62 received manual reduction with plaster external fixation. The study evaluated various clinical outcomes, including treatment effectiveness, recovery times, the incidence of nonunion, ankle joint function and inflammatory factors, and complication rates. The internal fixation group showed a significantly higher effective treatment rate (96.77%) compared to the non-internal fixation group (85.48%). After treatment, the internal fixation group had significantly lower medial malleolus space and talus tilt angles, indicating better fracture alignment. The internal fixation group also had shorter treatment, postoperative recovery, and functional recovery times. Furthermore, the incidence of nonunion and complications was lower in the internal fixation group. Inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), and interleukin-8 (IL-8) decreased significantly in the internal fixation group compared to the non-internal fixation group. Internal fixation is more effective than manual reduction and plaster external fixation for treating ankle fractures. It leads to better fracture healing, shorter recovery times, and fewer complications, including nonunion. Manual reduction with external fixation remains a viable option but may be associated with a higher risk of nonunion and delayed healing. Early and effective management of soft tissue injuries is crucial for improving treatment outcomes in ankle fractures.
Comparative effectiveness of massage combined with lifestyle intervention and lifestyle intervention alone for simple obesity: A systematic review and meta-analysis
Authors: Wang Gaofeng , Ju Hongyu , Zhang Zepeng , Wu Xingquan , Niu Heli , Zhang Lili , Chen Lili , Lou Huijuan , Yang Yonggang
Published: January 2025

Background:

This study aimed to assess the comparative effectiveness of massage combined with lifestyle intervention and lifestyle intervention alone in patients with simple obesity.

Methods:

The PubMed, Embase, Cochrane Library, CNKI, VIP Database, and Wanfang Data were searched. Meta-analysis was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Primary outcomes were body weight (BW) and body mass index (BMI). Secondary outcomes were waist circumference (WC), hip circumference (HC), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting insulin (FINS), and homeostasis model assessment–insulin resistance (HOMA-IR) and adverse events.

Results:

Thirteen randomized controlled trials were included. The meta-analysis showed that massage combined with lifestyle intervention significantly decreased BW (mean difference [MD]: −4.85; 95% confidence interval [CI]: −8.25 to −1.46; P = .005), BMI (MD: −2.65; 95% CI: −4.05 to −1.24; P = .0002), WC (MD: −3.63; 95% CI: −6.28 to −0.98; P = .007), TC (MD: −0.52; 95% CI: −0.84 to −0.20; P = .001), TG (MD: −0.23; 95% CI: −0.45 to −0.02; P = .003), LDL-C (MD: −0.48; 95% CI: −0.54 to −0.42; P < .00001), HDL-C (MD: −0.11; 95% CI: −0.17 to −0.05; P = .0004), FINS (MD: −1.64; 95% CI: −3.16 to −0.12; P = .03), and HOMA-IR (MD: −0.42; 95% CI: −0.65 to −0.18; P = .0005) compared with lifestyle intervention alone. In subgroup analyses, more obvious reduction in BMI (P = .02, I
2 = 80.3%) for the children and adolescents subgroup, more obvious reduction in HC (P = .04, I
2 = 76.1%) for the adults subgroup, more significant reduction in TC (P < .00001, I
2 = 98.3%), LDL-C (P < .00001, I
2 = 95.6%), and HDL-C (P < .0001, I
2 = 94.1%) for intermittent treatment subgroup and more significant reduction in TC (P < .00001, I
2 = 95.9%) and HDL-C (P < .0001, I
2 = 94.1%) for treatment times ≤30 subgroup were detected.

Conclusions:

Compared with lifestyle intervention alone, massage combined with lifestyle intervention significantly decreased BW, BMI, WC, TC, TG, LDL-C, FINS, and HOMA-IR, but produced less effect in increasing HDL-C. And different ages, treatment intervals, and treatment times can all affect treatment outcomes.
Spontaneous retroperitoneal hematoma after COVID-19 infection: A case report
Authors: Chen Xi , Li Zheng , Zou Liangping , Lan Yupin , Wu Xiaoling , Wang Hui
Published: January 2025

Rationale:

Spontaneous retroperitoneal hematoma (SRH) is a rare but potentially fatal condition, often associated with anticoagulation therapy. With the global prevalence of COVID-19 and the widespread use of anticoagulants in its management, there is an increasing need to recognize rare but serious complications like SRH. This case report aims to emphasize the importance of early recognition and intervention of SRH in patients with COVID-19 undergoing anticoagulation therapy, to improve patient outcomes and reduce mortality.

Diagnoses:

An 86-year-old male with a history of COVID-19 presented with recurrent cough, hemoptysis, and fever. Initial treatment included antiviral and anticoagulant therapy. The patient later developed abdominal distension, pain, and eventually hypovolemic shock, leading to the diagnosis of SRH confirmed by imaging and a significant drop in hemoglobin levels.

Interventions:

The patient received comprehensive supportive care, including noninvasive ventilation, antiviral therapy, and anticoagulants. Upon the onset of SRH, emergency interventions included fluid resuscitation, vasopressors, and interventional embolization of the bleeding vessels.

Outcomes:

The patient initially responded well to COVID-19 treatment but developed SRH, which was managed successfully with interventional embolization. Post-procedure, the patient’s vital signs stabilized, hemoglobin levels gradually increased without the need for further transfusions, and he regained full consciousness. Over the following weeks, the patient showed continuous improvement, with resolution of abdominal pain and a return to baseline mobility. He was discharged in stable condition with scheduled follow-ups.

Lessons:

This case underscores the critical need for vigilance in monitoring patients on anticoagulation therapy, particularly those with COVID-19, for signs of SRH. Early recognition and prompt intervention are essential to improve outcomes. Clinicians should maintain a high index of suspicion for SRH in patients presenting with unexplained abdominal pain and hypovolemic shock, even in the absence of typical risk factors.
Primary solitary fibrous tumor of the stomach: A case report and a review of literature
Authors: Dong Ling-Yun , Li Ying-Chun , Tong Hai-Chao , Guo Yao-xing , Li Le-Yao , Zhang Wan-Lin , Ma Shuang , Yang Lian-He , Petersen Philip , Wang Endi
Published: January 2025

Rationale:

Solitary fibrous tumors (SFTs) are spindle cell tumors that typically occur in the pleura and peritoneum, but very rarely in the stomach. To our best knowledge, there are only 10 cases reported in English literature. We reported a case of primary stomach SFT and summarized the characteristics of all previous cases, suggesting that pathologists and surgeons should include this disease in the differential diagnosis list of primary mesenchymal tumor of the stomach.

Patient concerns:

The patient suffered from epigastric pain for 5 months. Gastroscopy revealed a submucosa mass along the greater curvature centered on the gastric body. A repeat gastroscopy after 6 months showed a slight increase in mass size.

Diagnoses:

Endoscopic ultrasound showed the mass in the middle and lower portion of the stomach body, measuring 3.1cm in diameter, with a smooth surface. The patient was initially diagnosed with a gastrointestinal stromal tumor by gastroscopy. However, the pathologic morphology and immunohistochemical staining of resected specimens after surgery support a diagnosis of primary gastric SFT.

Interventions:

The patient underwent a laparoscopic gastric mass resection.

Outcomes:

The patient returned to hospital after 3 months with no recurrence or postoperative complications. During the 18-month follow-up period, the patient did not experience any tumor recurrence or metastasis.

Lessons:

This case teaches us that SFT should be included in the differential diagnoses of gastric primary spindle cell tumors, even though it is very rare in the stomach.
Blind nasoenteric tube placement risks: A case report of misplacement into the pleural cavity
Authors: Yuan You , Zhong Wei , Gao Huiming , Zhang Xia , Chen Junxi , Qing Yuanqin , Hu Rujun
Published: January 2025

Rationale:

Enteral nutrition is a critical component of care for critically ill patients. However, the blind insertion of a nasoenteric tube, despite being a simple procedure, carries inherent risks that necessitate a reevaluation of the technique.

Patient concerns:

A case of a 60-year-old female experienced the rare yet critical complication of a misplaced nasoenteric tube entering the thoracic cavity during a blind insertion procedure for enteral nutrition following a liver transplant.

Diagnosis:

Following liver transplantation, the patient was diagnosed with severe pneumonia, a right-sided hydropneumothorax, and severe malnutrition.

Interventions:

After the misplacement of the nasoenteric tube into the pleural cavity was detected from the chest X-ray, the tube was immediately removed, and the pneumothorax was actively managed. Subsequently, with the support of contrast radiography, the nasoenteric tube was successfully reinserted to provide the patient with nutritional support and promote rehabilitation.

Outcomes:

The patient responded well to the intervention and was discharged in stable condition following complete recovery.

Lessons:

The case prompts a reevaluation of blind placement techniques and calls for the adoption of more reliable technologies to prevent similar incidents and ensure patient safety, such as electromagnetic and visualized guided placement technique.
Public perceptions and attitudes of drive-through pharmacy services: Insights from a cross-sectional survey in Saudi Arabia
Authors: Bakarman Safiya Salem , Syed Wajid , Alharbi Mohammad K , Bashatah Adel , Al-Rawi Mahmood Basil A.
Published: January 2025

Disease-related fatalities in Saudi Arabia (SA) are on the rise, with 28% of all deaths attributed to cardiovascular diseases, followed by cancer, diabetes, and chronic respiratory disorders. In response to this issue, pharmacy dispensing practices have been significantly altered. One such innovative approach is the drive-through pharmacy service. This study aimed to assess the public perceptions and attitudes of drive-through pharmacy services living in Riyadh, SA. A cross-sectional, web-based study was conducted between October 2023 and December 2023 among adults living in Riyadh, SA to assess their perceptions and attitudes toward drive-through dispensing practice. A 19-item questionnaire, divided into 4 sections, was used to achieve the objectives. The first section focused on demographics and personal information. The second section included 3 questions about awareness, the population most benefited, and support. The final section assessed attitudes (5 items) of individuals toward drive-through pharmacy services. A response rate of 79.6% (n = 398) was achieved. A significantly high percentage of respondents, 86.2% (n = 343), reported being aware of drive-through pharmacy. Furthermore, 73.1% of them indicated that drive-through service benefits all populations, with 66.1% (n = 263) actually using the drive-through pharmacy service. In addition, 68.1% (n = 271) of individuals had positive perceptions. Positive perceptions were found to be higher among young adults aged 26 to 35 years compared with other age groups (P = .0001), among married individuals compared with unmarried individuals and others (P = .0001), as well as among housewives (P = .030). The results of the Student t test showed that males had a higher mean overall perception of drive-through pharmacy services (9.33) than females (9.26). Similarly, the analysis of variance analysis showed that individuals aged ≥46 years had a higher perception score (12.53) than other age groups. Furthermore, individuals with children had a lower perception (8.94) compared with those without children, indicating a statistically significant difference in mean perceptions of drive-through pharmacy based on gender (P = .002), age (P = .006), employment (P = .081), and presence of children (P = .001). Most respondents were aware of the drive-through pharmacy services and agreed that they would benefit the nation’s entire population. The majority of individuals also supported the expansion of drive-through pharmacy services.
Laparoscopic cholecystectomy for triple gallbladder malformation: A comprehensive case report and literature review
Authors: Zhou Shuang-hao , Li Zhen-hua , Wei Yao-chen , Wu Zhi-yu , Fu Qing-jiang , Cao Li-ying , Ma Xiang-ming
Published: January 2025

Rationale:

Triple gallbladder is a rare congenital anatomical abnormality because of the incomplete regression of rudimentary bile ducts and is often not found until it is accidentally detected during imaging research.

Patient concerns:

We report a rare case of triple gallbladder malformation and review the English literature on biliary tract variation caused by gallbladder malformation. The diagnosis, treatment, and postoperative situation of the patients were summarized and analyzed.

Diagnoses:

The patient was diagnosed with triple gallbladder malformation.

Interventions:

We conducted laparoscopic cholecystectomy for the patient.

Outcomes:

We successfully removed all 3 gallbladders by laparoscopic cholecystectomy, and the patient had no postoperative complications such as bleeding or bile leakage and recovered well.

Lessons:

At present, the best treatment for triple gallbladder malformation is to remove all 3 gallbladders by laparoscopic cholecystectomy, which can effectively prevent the occurrence of “postcholecystectomy syndrome” caused by individual gallbladder residue. However, the diagnosis of triple gallbladder is very challenging and often requires a combination of advanced imaging methods. However, sometimes preoperative imaging does not fully reveal biliary tract variation. Therefore, we need to rely on the guidance of evidence-based medicine before surgery and the accurate evaluation of surgical plans to complete the operation without risk.
Intradural extramedullary double primary ependymoma and meningioma rare condition: Case report and literature review
Authors: Yuan Xingyue , Li Ruibo , Liu Qian
Published: January 2025

Rationale:

Ependymomas are commonly prevalent intramedullary neoplasms in adults, with hardly any cases of exophytic extramedullary ependymoma being reported. Meningiomas, on the contrary, are one of the most common intradural extramedullary (IDEM) tumors. However, the occurrence of both IDEM tumors simultaneously is extremely rare.

Patient concerns:

A 63-year-old female who presented with pain and numbness in both lower limbs, and symptoms rapidly progressed over the past 5 months.

Diagnosis:

Based on the patient’s clinical symptoms and imaging features, we conducted pathological examination and genetic testing, ultimately confirming that the patient had IDEM double primary ependymoma and meningioma.

Interventions:

Surgery was performed to remove double spinal tumors, decompress spinal nerve roots, and perform laminectomy, and she was treated with electrocardiogram monitoring, antibiotics, hemostasis, and antiedema therapy.

Outcomes:

Histopathology confirmed World Health Organization grade II ependymoma at L2 and World Health Organization grade I meningioma at T12-L1. MYCN amplification and other genetic alterations were absent. Postoperative recovery was favorable, with no recurrence at 6-month follow-up.

Lessons:

This is the first reported case of IDEM double primary ependymoma and meningioma, highlighting the rarity of such cases and the importance of thorough diagnostic workup and surgical excision for IDEM tumors. Genetic analysis adds to the understanding of these rare tumors and guides management strategies.
Development and validation of a metabolic syndrome and its components to predict the efficacy of neoadjuvant chemotherapy in breast cancer: An observational, single-center, cohort study
Authors: Zhao Xingdong , Jia Chengfang , Ji Shuaichong , Lu Kewen , Yang Pei , Wang Yuexin
Published: January 2025

To assess whether metabolic syndrome can be used as a reference index to evaluate the efficacy of neoadjuvant chemotherapy treatment for breast cancer (BC). Seventy cases of female BC patients who received neoadjuvant chemotherapy treatment and surgical treatment at the Glandular Surgery Department of Hebei Provincial People’s Hospital from January 2021 to December 2023 were retrospectively collected, and clinical data such as puncture pathology were recorded. The clinical data were analyzed by 1-way analysis using the χ2 test, and further multifactorial logistic regression analysis was performed for statistically significant differences. The independent risk factor metabolic syndrome (MetS) and its components were plotted in the receiver operating characteristic curve (ROC) curve and baseline graph by R Studio 4.41 software, and the meaningful components were plotted in the column graph by lasso regression analysis for internal validation, and the quality of the model was evaluated by the ROC curve and calibration graph, and then the clinical decision curve analysis was used to evaluate the clinical effectiveness of the model. The neoadjuvant efficacy was statistically associated with whether the patient was first diagnosed between 45 and 55 years of age, estrogen receptors (ER), progesterone receptors (PR) expression status, Her-2 expression status, and whether the patient had MetS, as determined by univariate analysis through χ2 (P < .05). On multifactorial binary logistic regression analysis, ER, PR status, Her-2 status, and the presence of MetS were statistically significant (P < .05) for the efficacy of neoadjuvant chemotherapy. Patients with MetS were less likely to achieve complete pathological remission than those without MetS. MetS and its components were analyzed by lasso regression analysis with RStudio 4.41 software to conclude that hypertension, hyperglycemia, and high-density lipoprotein were all correlates affecting the pathologic complete response (pCR), and a column-line graph was plotted, with a C-index of 0.76, indicating a good predictive efficacy. ER, PR status, Her-2 status and the presence of MetS are independent predictors for assessing the efficacy of neoadjuvant chemotherapy in BC, and MetS can be used as a predictor of the efficacy of neoadjuvant chemotherapy. Clinical references are provided.
De novo KCNB1 missense variant causing developmental and epileptic encephalopathy: Two case reports
Authors: Ren Ying , Hu Wandong , Gao Zaifen , Shi Jianguo , Liu Yong , Zhang Hongwei
Published: January 2025

Rationale:

Developmental and epileptic encephalopathy (DEE) defines a group of severe and heterogeneous neurodevelopmental disorders. The voltage-gated potassium channel subfamily 2 voltage-gated potassium channel α subunit encoded by the KCNB1 gene is essential for neuronal excitability. Previous studies have shown that KCNB1 variants can cause DEE. Herein, we report the cases of 2 children with DEE caused by pathogenic variants in the KCNB1 gene. Trio whole-exome sequencing identified novel KCNB1 genotypes, c. 1160C > A and c.1012C > T, which had not been reported previously, in 2 unrelated patients.

Patient concerns:

Two children were admitted to our hospital for a detailed evaluation of frequent seizures. And both of these children have abnormal electroencephalogram and brain magnetic resonance imaging results, accompanied by developmental delay.

Diagnoses:

A genetic study using trio-whole-exome sequencing confirmed the diagnosis of KCNB1-related developmental and epileptic encephalopathy.

Interventions:

Both patients accepted the treatment of antiepileptic drugs. 1 patient had seizure remission with a combination of sodium valproate and lamotrigine, and the other was lost to follow-up.

Outcomes:

Trio-whole-exome sequencing technology was used to determine the etiology of the 2 children with DEE.

Lessons:

This study confirmed that genetic testing provides a basis for the diagnosis of children with abnormal electroencephalogram and brain magnetic resonance imaging findings and developmental delay, and provides data supporting a future phenotype–genotype correlation study.
Treatment of very high risk membranous nephropathy complicated by pulmonary embolism with glucocorticoids and rituximab: Case report
Authors: Khan Umer Farooq , Sia Charmaine , Thamboo Thomas Paulraj , Chua Horng Ruey , Chan Gek Cher
Published: January 2025

Rationale:

We report the efficacy of combination prednisolone and intravenous (IV) rituximab as an immunosuppressive regimen for a young male presenting with extensive venous thromboembolism including a submassive pulmonary embolism secondary to life-threatening nephrotic syndrome from very high risk anti-phospholipase-A2 receptor (PLA2R) positive membranous nephropathy. Initial treatment was with mechanical thrombectomy and anticoagulation. Thereafter, oral prednisolone was initiated to induce remission, during a period of uninterrupted anticoagulation. He subsequently underwent a kidney biopsy for histological confirmation and IV rituximab was administered as definitive treatment.

Patient concerns:

A 33-year-old Chinese male with no chronic conditions presented with shortness of breath and left-sided pleuritic chest pain.

Diagnoses:

He was diagnosed with a submassive pulmonary embolism which was confirmed on computer tomography imaging with additional extensive clot burden in the inferior vena cava and renal veins. Further workup revealed nephrotic syndrome, with proteinuria of 6.5g/day, and serum Albumin 26 g/L, associated with anti-PLA2R of 223 RU/ml. His presenting serum creatinine was 108 µmol/L (CKD-EPI eGFR 77ml/min/1.73m2). Additional workup for malignancy and infections were negative.

Interventions:

As part of acute management, immediate anticoagulation was initiated. The patient then underwent endovascular thrombectomy and inferior vena cava filter placement. Given the emergent indication for and need for 4 weeks of uninterrupted anticoagulation, his kidney biopsy had to be delayed. The patient was then preemptively treated with IV Methylprednisolone 500mg for 3 days followed by 0.5mg/kg of oral prednisolone after taking into consideration the specificity of PLA2R positivity for membranous nephrology.

Outcomes:

After 4 weeks of treatment, serum albumin improved to 32 g/L and anti-PLA2R levels improved significantly to 27 RU/ml. His subsequent kidney biopsy confirmed membranous nephropathy and 2 doses of IV rituximab 1g were administered 14 days apart. Six months after initial presentation, the patient is in partial remission. Albumin has improved to 41 g/L, Anti PLA2R < 2 RU/ml, and proteinuria is 1.18g/day.

Lessons:

This case demonstrates that preemptive treatment in patients with anti-PLA2R positive membranous nephropathy can initiated without a histological diagnosis when there are strong contraindications against a kidney biopsy. Treatment with a combination of steroids and IV rituximab could be a viable treatment option for patients with very high-risk membranous nephropathy over conventional therapy with cyclophosphamide.
Paraspinal synovial sarcoma mimicking tuberculosis: A case report and literature review
Authors: Liu Jie , Huang Xiajie , Liang Xinyun , Xian Xinhua , Mo Yangzhou , Wu Xiaomei , Lu William , Li Jian , Chen Yan
Published: January 2025

Rationale:

Synovial sarcoma (SS) is a rare and highly malignant soft tissue sarcoma. When SS occurs in atypical locations, it can present significant diagnostic challenges. We report a case of paraspinal SS initially misdiagnosed as spinal tuberculosis, highlighting the diagnostic difficulties and the importance of considering SS in the differential diagnosis.

Patient concerns:

A 23-year-old woman presented with progressively worsening lower left back pain over 3 weeks, accompanied by weakness and numbness in her left lower limb. She was initially misdiagnosed with spinal tuberculosis at 2 different hospitals based on weakly positive anti-tuberculosis antibodies and imaging findings. Despite ongoing anti-tuberculosis treatment, her condition continued to deteriorate.

Diagnoses:

The first surgery revealed findings inconsistent with spinal tuberculosis, but a tumor could not be excluded. However, the initial pathological biopsy was inconclusive. A second surgery confirmed the diagnosis of SS through histopathological examination.

Interventions:

The patient underwent a second surgery for mass resection and biopsy confirmation. Unfortunately, by the time the correct diagnosis was made, the disease had metastasized to her lungs, and the optimal window for surgical intervention had been missed.

Outcomes:

The patient’s delayed diagnosis resulted in extensive diffuse metastasis to both lungs, significantly impacting her survival.

Lessons:

This case underscores the need to consider malignancies such as SS in the differential diagnosis of spinal lesions, particularly when clinical response to treatment is poor. Early diagnosis and timely surgical intervention are critical to improving patient outcomes. Our literature review provides further insights into the characteristics of paraspinal SS and strategies to prevent misdiagnosis, emphasizing the importance of early and accurate diagnosis to enhance patient survival.
Primary malignant melanoma of the vagina: A case report of a rare disease that is difficult to diagnose
Authors: Park Soyoung , Park Jung-Woo , Rha Seo-Hee , Kim Sujin
Published: January 2025

Rationale:

Malignant melanoma is a rare cancer that accounts for approximately 1% of all cancers. Primary malignant melanoma of the female genital tract accounts for approximately 3% to 7% of all malignant melanomas, and 0.3% to 0.8% of all melanomas in women. It affects postmenopausal women ages 60 to 80 years. Various hormonal factors, including puberty, pregnancy, menopause, oral contraceptive use, and human papillomavirus infection are associated with primary malignant melanoma of the vagina.

Patient concerns:

Symptoms often include vaginal bleeding, discharge, and pain; however, it can also present as pigmented or nonpigmented lesions, making diagnosis challenging.

Diagnoses:

Diagnosis involves detailed history, physical examination, and imaging (CT, MRI, and positron emission tomography). Immunohistochemical staining for markers, such as human melanoma black-45 and Melan-A, is crucial for confirmation. The diagnosis was made through careful physical examination, imaging studies, and immunohistochemistry.

Interventions:

The treatment includes wide local excision, radical surgery, radiotherapy, chemotherapy, and immunotherapy. The prognosis of primary malignant melanoma of the vagina is usually poor owing to late diagnosis, and the 5-year survival rate is 5% to 25%.

Outcomes and lessons:

To consider the possibility of primary malignant melanoma of vagina, postmenopausal women, particularly those who with human papillomavirus infection, should be performed thorough examination regardless of symptoms of vaginal bleeding or discharge.
Predictive value of preoperative circulating tumor cells combined with hematological indexes for liver metastasis after radical resection of colorectal cancer
Authors: Zhu Tianyi , Li Yunsong , Li Rui , Zhang Jingjing , Zhang Wentao
Published: January 2025

Colorectal cancer is one of the most common malignant tumors in the world, and about 50% of its advanced patients will have liver metastasis. Preoperative assessment of the risk of liver metastasis in patients with colorectal cancer is of great significance for making individualized treatment plans. Traditional imaging examinations and tumor markers have some limitations in predicting the risk of liver metastasis. Therefore, it is of great clinical value to explore more sensitive and specific predictive indicators for improving early detection and treatment effect. In recent years, circulating tumor cells (CTCs), as a new biomarker, have attracted much attention because of their close relationship with tumor metastasis and prognosis. The purpose of this study is to collect and analyze the data of colorectal cancer patients treated in our hospital, so as to determine the predictive value of circulating tumor cells before operation and related hematological indexes for liver metastasis after radical resection of colorectal cancer, and to establish the corresponding prediction model to provide gastrointestinal surgeons with more accurate identification of high-risk patients and guidance for treatment. A total of 88 patients were included in this study, and 26 of whom developed liver metastasis after colorectal cancer surgery. The possible related factors are included in the single factor logistic regression, and the results are obtained after analysis. Body mass index, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9, tumor marker CA72-4 (CA72-4), cytokeratin-7 (CK-7), CTC count, and neutrophil-to-lymphocyte ratio (P < .2) are risk factors for liver metastasis after radical resection of colorectal cancer. Furthermore, the data obtained were included in multivariate regression analysis, and CEA, CA72-4, CK-7, and CTC counts were independent risk factors for liver metastasis after radical resection of colorectal cancer (P < .05). This study confirmed that CEA, CA72-4, CK-7, and CTC counts are independent risk factors for liver metastasis after radical resection of colorectal cancer. In addition, the prediction model of this study can help gastrointestinal surgeons accurately identify patients who are prone to liver metastasis after colorectal cancer surgery.
Reconfiguring Priorities: Breastfeeding Decision-making Among Young Breast Cancer Survivors
Authors: Huertas-Zurriaga Ariadna , Cabrera-Jaime Sandra , Navarri Isabel , Teruel-Garcia Iris , Leyva-Moral Juan Manuel
Published: January 2025

Background

Breast cancer survivors face unique challenges in breastfeeding decisions. Limited research exists on the experiences and decision-making processes of young women with breast cancer regarding breastfeeding.

Objective

To explain the decision-making processes of young women with breast cancer in relation to breastfeeding throughout the cancer trajectory.

Methods

A constructivist grounded theory approach was used. Semistructured interviews were conducted with 12 women diagnosed with breast cancer and 8 healthcare professionals. Data were analyzed using constant comparative analysis.

Results

The core category “Reconfiguring Priorities: The Secondary Role of Breastfeeding in the Context of Breast Cancer in Young Women” emerged, encompassing 3 subcategories: (1) scars over time, (2) omitting breastfeeding in oncological care, and (3) self-management of breastfeeding.

Conclusions

Breastfeeding decision-making among young breast cancer survivors is not driven by conscious will but by a constant struggle with the conditioning factors of the oncological process: mortality and toxicity of drugs to breast milk. The lack of professional support leads women to develop their own strategies for managing breastfeeding, marked by ambivalence between motivations and personal challenges.

Implications for Practice

Healthcare professionals should integrate breastfeeding discussions into oncological care for young breast cancer survivors. Specialized lactation consultants with oncology expertise should be incorporated into the care team. Peer support programs can provide valuable guidance based on lived experiences, empowering women to make informed decisions about breastfeeding after breast cancer.
Development and Effects of a Smartphone Application to Improve Self-Management in Workers Who Underwent Thyroid Cancer Surgery
Authors: Kim Myoyoun , Hwang Seon Young
Published: January 2025

Background

Although the survival rate for thyroid cancer is high, a nursing intervention that enhances autonomous motivation is needed for patients with jobs to improve their long-term self-management abilities in the early postoperative period.

Objectives

This study aims to develop a mobile application (app) based on the Self-Determination Theory for patients returning to work after thyroid cancer surgery and to verify its effectiveness.

Methods

We developed an app to promote self-management and verify its effectiveness after 12 weeks in early outpatients who underwent thyroid cancer surgery through a randomized controlled trial design. In addition to a subjective questionnaire, objective data on steps, stress, and sleep quality from a smartwatch are analyzed.

Results

Autonomous motivation (t = −2.11, P = .040), perceived health status (t = −2.05, P = .048), and perceived stress (t = 2.18, P = .039) show significant differences in the experimental group compared to the control group. Objective data collected using a smartwatch show that stress scores (t = 5.43, P = .006) and sleep quality scores (t = 3.83, P = .025) in the experimental group are significantly improved compared to those in the control group.

Conclusion

Among workers in the early stages after thyroid cancer surgery, using the smartphone app strengthens autonomous motivation and improves steps, stress levels, and sleep quality, making it an effective nursing intervention for self-management.

Implications for Practice

In outpatient nursing practice, self-management should be promoted using a smartphone app among adult patients returning to work soon after thyroid cancer surgery.
Neonatal and Home-Based PT Improves Neurodevelopmental Outcomes of Preterm Infants—A Randomized Clinical Trial
Authors: Khurana Sonia , Lewis Leslie E. , Russell Daniel M. , Dusing Stacey C. , Krishna Rao Bhamini
Published: January 2025

Purpose:

Investigate the effect of structured neonatal physical therapy program (SNP) on neurodevelopmental outcomes of moderate and late preterm (MLP) infants.

Methods:

Sixty MLP infants were randomly allocated to usual care (UC) or SNP. A previous publication reported the effect of neonatal component of SNP at hospital discharge. This paper examined SNP’s effect on motor, cognitive and language outcomes at 3 and 6 months using a 2-way mixed design ANOVA.

Results:

Both groups were similar at baseline for motor scores. Infants receiving SNP significantly outperformed UC at all subsequent time points. At 3 and 6 months, SNP significantly outscored UC in cognitive and language outcomes.

Conclusion:

SNP is effective in improving neurodevelopmental outcomes of MLP infants. However, caution is suggested in interpreting its effect on cognition and language as we lacked baseline scores to compare the longitudinal trajectory.
Medical Student Confidence in Meeting Disability Competencies: Results of a national survey-based study
Authors: Clarke Lauren , Dhanani Zainub , Tan Louis , Altamirano Jonathan , Fassiotto Magali , Poullos Peter
Published: January 2025

People with disabilities have recently been declared a population at increased risk of health disparities, and research has cited a lack of physician training as a cause of that increased risk. Prior studies demonstrate that physicians lack confidence in caring for people with disabilities, but there is little research on disability competency among medical students. This study assessed medical students’ confidence in six disability-related competencies and tested for associations between perceived confidence and students’ personal demographics and institutional characteristics. A cross-sectional survey was administered to measure student confidence, and students’ perceived confidence was calculated using a 5-point Likert scale. Mean confidence ranged from 2.35 – 3.43, suggesting that most students felt either “slightly confident” or “somewhat confident” in their ability to meet the selected competencies. Confidence did not differ based on disability exposure or level of training; however, there was a significant positive relationship between attending a public (state) medical school and students’ confidence in listing community-based services for people with disabilities. This study highlights that future physicians are not confident in their ability to meet the needs of people with disabilities. Additional training is needed to teach future physicians the skills necessary to provide this population with high-quality clinical care.
Plasma microRNA Levels After Electroconvulsive Therapy in Treatment-Resistant Depressed Patients
Authors: Galbiati Chiara , Dattilo Vincenzo , Bortolomasi Marco , Vitali Erika , Abate Maria , Menesello Valentina , Meattini Mattia , Carvalho Silva Rosana , Gennarelli Massimo , Bocchio Chiavetto Luisella , Minelli Alessandra
Published: January 2025

Objectives

Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD), even though the molecular mechanisms underlying its efficacy remain largely unclear. This study aimed, for the first time, to analyze plasma levels of miRNAs, key regulators of gene expression, in TRD patients undergoing ECT to investigate potential changes during treatment and their associations with symptom improvement.

Methods

The study involved 27 TRD patients who underwent ECT. Plasma samples were collected at baseline (T0) and 1 month after the last ECT session (T1), and miRNA analysis was conducted by qRT-PCR. We also performed gene prediction of miRNAs differentially expressed and KEGG pathway analysis.

Results

miR-95-3p, miR-194-5p, miR-324-3p, miR-195-5p, miR-19b-3p, miR-30c-5p, let-7i-5p, and miR-497-5p were nominally downregulated at T1. Changes in miR-324-3p and miR-30c-5p levels between T0 and T1 significantly correlated with symptom improvement. Among the predicted miRNA target genes of these 2 miRNAs, we noticed the presence of VEGF and SIRT1, whose expression regulation has been associated with the ECT mechanism of action in previous studies.

Conclusions

The study's most relevant results are related to the correlation between reductions in miR-30c-5p and miR-324-3p and the improvement of symptoms in response to ECT, positioning these miRNAs as promising candidates for further studies. These findings support and extend previous clinical and preclinical research indicating a role of miRNAs in ECT mechanism of action. However, no significant effects in ECT miRNA modulation were observed, highlighting the need for future replications in broader samples to confirm these results.
Pseudomonas spirodelae, sp. nov., a bacterium isolated from the roots of the aquatic plant Spirodela polyrhiza
Authors: Vandeborne Karlie , Guy Nathan , Lengyel George , Franks Jonathan , Maltman Chris
Published: January 2025

A polyphasic taxonomic study was carried out on strain T5W1T, isolated from the roots of the aquatic plant Spirodela polyrhiza. This isolate is Gram-negative, rod-shaped, motile, aerobic and non-pigmented. Nearly complete 16S rRNA gene sequence homology related the strain to Pseudomonas, with 98.4% similarity to P. guineae, P. peli and P. leptonychotis. Average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) with the closest phylogenetic neighbour of T5W1T showed differences at the species level, further confirmed by differences in several physiological characteristics. The main fatty acids are summed feature 3 (C16 : 1

 

ω7c and/or C16 : 1

 

ω6c), C18 : 1

 

ω7c, and C16 : 0. The DNA G+C content is 59.3 mol%. Q-9 is the primary ubiquinone found, and phosphatidylethanolamine is the dominant polar lipid, with lesser amounts of phosphatidylglycerol, diphosphatidylglycerol and phosphatidylserine. Based on the results obtained, this bacterium is assigned to the genus Pseudomonas as a new species with the name Pseudomonas spirodelae sp. nov., type strain T5W1T (=NRRL B-65714T =DSM 118085T).
An improved reverse genetics system for rotavirus vaccine strain LLR using five plasmid vectors
Authors: Liu Xiafei , Yu Junjie , Li Shan , Chai Pengdi , Xie Zhiping , Pang Lili , Li Jinsong , Zhu Wuyang , Ren Weihong , Duan Zhaojun
Published: January 2025

Species A rotaviruses (RVs), which belong to the family Sedoreoviridae and contain a genome of 11 segmented dsRNA segments, are a leading cause of severe acute gastroenteritis in infants and children younger than 5 years of age. We previously developed a strategy to recover rotavirus vaccine strain LLR from 11 cloned plasmids. Here, we report an improved reverse genetics system for LLR by combining two or three transcriptional cassettes in a single plasmid, which substantially enhances rescue efficiency from 66.7% (8/12) to 91.7 % (11/12). Furthermore, the recombinant LLR stably expressing NLuc was rescued based on the five-plasmid reverse genetics system. Improvements to the rotavirus reverse genetics system will enhance its applicability for studies of rotavirus biology and clinical use.