bluuebunny/crossref_metadata_2025 huggingface dataset:
Insight into the bacterial communities in the sediment–water interface across different salinities of Pacific White shrimp, Penaeus vannamei, by metabarcoding
Authors: Lalitha Natarajan , Katneni Vinaya Kumar , Jangam Ashok Kumar , Suganya Panjan Nathamuni , Sukumaran Suvana , Muralidhar Moturi
Published: February 2025

Microbes play an important role in the food chain by metabolizing organic matter, cycling nutrients, and maintaining a dynamic equilibrium among organisms in water and sediment. The objective is to study the fluctuating taxonomic microbial diversity profile in the sediment–water interface at different days of culture (DOC) of Penaeus vannamei in varying salinities using the Illumina MiSeq platform. Sediment samples were collected in Tamil Nadu, India, from low-saline, brackish water, and high-saline ponds at 30, 60, and 90 DOC. Bacterial richness and diversity in species were high in low-saline ponds. Beta-diversity variation indicated more differences in bacterial composition in high- and low-saline ponds. The predominant phyla observed were Proteobacteria, Actinobacteria, Chloroflexi, Bacteroidetes, Firmicutes, and Cyanobacteria. High-saline ponds accounted for more nitrification bacterial communities, sulfur-reducing bacterial communities, sulfur-oxidizing bacterial communities, and high redox potential, whereas denitrification bacterial communities were high in brackish water ponds.
Learn from AI: The pursuit of objectivity
Authors: Wang Fengyi , Marouli Angeliki , Charoenwongwatthana Pisit , Chang Chien-Yi
Published: February 2025

Humans continuously face threats from emerging novel pathogens and antimicrobial resistant bacteria or fungi, which requires urgently and efficient solutions. Alternatively, microbes also produce compounds or chemicals highly valuable to humans of which require continuous refinement and improvement of yields. Artificial intelligence (AI) is a promising tool to search for solutions combatting against diseases and facilitating productivity underpinned by robust research providing accurate information. However, the extent of AI credibility is yet to be fully understood. In terms of human bias, AI could arguably act as a means of ensuring scientific objectivity to increase accuracy and precision, however, whether this is possible or not has not been fully discussed. Human bias and error can be introduced at any step of the research process including conducting experiments and data processing, through to influencing clinical applications. Despite AI's contribution to advance knowledge, the question remains, is AI able to achieve objectivity in microbiological research? Here, the benefits, drawbacks and responsibilities of AI utilization in microbiological research and clinical applications were discussed.
A possible trail of dust from a young, highly extincted brown dwarf in the outskirts of the Trapezium Cluster
Authors: Haworth Thomas J , McCaughrean Mark J , Pearson Samuel G , Booth Richard A
Published: February 2025

We present the JWST discovery of a highly extincted ($A_V\sim 52$) candidate brown dwarf (${\sim} 0.018$ M$_\odot$) in the outskirts of the Trapezium Cluster that appears to be coincident with the end of a ${\sim} 1700$ au long, remarkably uniformly wide, dark trail that broadens only slightly at the end opposite the point source. We examine whether a dusty trail associated with a highly extincted brown dwarf could plausibly be detected with JWST and explore possible origins. We show that a dusty trail associated with the brown dwarf could be observable if dust within it is larger than that in the ambient molecular cloud. For example, if the ambient cloud has a standard ${\sim} 0.25$ $\mu$m maximum grain size and the trail contains micron-sized grains, then the trail will have a scattering opacity over an order of magnitude larger compared to the surroundings in NIRCam short-wavelength filters. We use a simple model to show that a change in maximum grain size can reproduce the high $A_V$ and the multifilter NIRCam contrast seen between the trail and its surroundings. We propose and explore two possible mechanisms that could be responsible for the trail: (i) a weak far ultraviolet radiation-driven wind from the circum-brown dwarf disc due to the O stars in the region and (ii) a Bondi–Hoyle–Lyttleton accretion wake. The former would be the most distant known case of the Trapezium stars’ radiation driving winds from a disc, and the latter would be the first known example of ‘late’ infall from the interstellar medium on to a low-mass object in a high-mass star-forming region.
Telemedicine as an alternative to in-person care in the field of rheumatic diseases: A systematic scoping review
Authors: Sada Ken-ei , Iwata Shigeru , Inoue Yuzaburo , Tanaka Eiichi , Nishida Keiichiro , Kawahito Yutaka , Abe Asami , Kawakami Atsushi , Miyamae Takako
Published: February 2025

Objective

The COVID-19 pandemic prompted the widespread adoption of telemedicine as an alternative to in-person care. This systematic scoping review evaluated the effectiveness, cost-efficiency, and challenges of telemedicine for patients with rheumatic diseases.

Methods

A comprehensive search of the MEDLINE database was conducted using specific terms related to rheumatoid or juvenile arthritis, and telemedicine. The literature search included studies published up to March, 2024. In this review, we only considered studies assessing telemedicine as an alternative to in-person care.

Results

The search, conducted on 15 March 2024, generated 258 references. Eight reports from three randomized controlled trials and three observational studies were included. Randomized controlled trials have shown that the outcomes of telemedicine intervention are comparable to those of in-person care in terms of disease activity, functional status, and quality of life, while enabling fewer outpatient visits and cost-effectiveness. However, the high dropout rates highlight the importance of patient preferences and comprehensive education. Observational studies revealed similar findings but were limited by a high confounding bias.

Conclusion

Telemedicine offers economic advantages and maintains clinical outcomes comparable to those of in-person care. Its success depends on structured patient education and alignment with patient preferences. Further research is required, particularly in the context of healthcare in Japan.
Endometrial zinc transporter Slc39a10/Zip10 is indispensable for progesterone responsiveness and successful pregnancy in mice
Authors: Kawata Yui , Terakawa Jumpei , Takeshita Ayuu , Namiki Takafumi , Kageyama Atsuko , Noguchi Michiko , Murakami Hironobu , Fukada Toshiyuki , Ito Junya , Kashiwazaki Naomi
Published: February 2025

Zinc is a critical trace element that is important for various biological functions including male and female reproductive systems, but the molecular mechanisms that underlie fertility have been unclear. We show here that zinc signaling in the endometrial tissue is indispensable for successful pregnancy in mice. We observed that a uterine-specific genetic deletion of Slc39a10/Zip10, which encodes one of the zinc transporters to elevate the cytoplasmic level of zinc, results in female infertility due to failure of embryo invasion into the endometrium and subsequent embryonic loss. Zip10 mRNA is expressed in uterine tissues, especially in the decidualizing stromal cells during embryo implantation. The absence of ZIP10 leads to attenuation of progesterone–progesterone receptor (PGR) signals between the epithelium and the stroma, including abnormal expression of the PGR and its target molecules in both the epithelium and stroma in vivo. We found that depletion of intracytoplasmic zinc ions due to loss of ZIP10 disrupts the change in nuclear-to-cytoplasmic localization of GLI1, which is critical for PGR signaling in the decidualizing stromal cells in vitro not only in mice but also in humans. Our findings (i) highlight a biological relevance of ZIP10-mediated zinc homeostatic regulation in the establishment of a successful pregnancy and (ii) will help to prevent infertility in humans.
Effect of Vitamin D Deficiency on Development of Slipped Capital Femoral Epiphysis
Authors: Torres-Izquierdo Beltran , Galan-Olleros Maria , Momtaz David , Mittal Mehul M. , Gonuguntla Rishi , Tippabhatla Abhishek , Hosseinzadeh Pooya
Published: February 2025

Objective:

Slipped capital femoral epiphysis (SCFE) is one of the most common hip disorders in adolescents, often linked to obesity. However, other factors, such as vitamin D deficiency, may also contribute to SCFE development. This study investigates the impact of vitamin D deficiency on SCFE development in a large cohort.

Methods:

We utilized the TriNetX national database to query pediatric patients with documented calcidiol levels. Patients with a recorded visit below the age of 9 and subsequent documented calcidiol levels were followed until SCFE occurrence or age 18. Patients were categorized into vitamin D adequate (≥ 30 ng/mL) and deficient (< 30 ng/mL) groups. Propensity score matching was performed using a multivariable logistic regression model to adjust for baseline characteristics, including age, sex, race, and body mass index percentile. Significance testing was conducted using the Fisher exact test and χ2 tests to compare SCFE risk between the cohorts, with a significance level set at P <0.05.

Results:

On preliminary analysis, 98,045 patients met the inclusion criteria. After matching, 34,552 individuals in both vitamin D deficient and adequate groups were included, with an average age of 8.4 years at the time of their first visit and 50% females. SCFE occurred in 136 (0.39%) and 48 (0.14%) patients in the vitamin D deficient and adequate groups, respectively (P < 0.0001). Vitamin D deficiency significantly increased SCFE risk, with a relative risk of 2.8 (95% CI: 2-3.9; P < 0.0001) and a hazard ratio of 1.6 (95% CI: 1.1-2.2; P < 0.0001).

Conclusion:

This study, one of the largest to date, establishes a significant association between vitamin D deficiency and SCFE development. After controlling for potential confounding variables, including body mass index, individuals with vitamin D deficiency were ∼2.83 times more likely to develop SCFE. The study findings highlight the need for further research to evaluate whether supplementation could mitigate this risk of developing SCFE.

Level of Evidence:

Level III.
Effect of Rectal Cancer Treatment Timing Standardization on Patient Outcomes
Authors: Sun James , Fredette Jordan D. , Hasler Jill S. , Vu Joceline V. , Philp Matthew , Poggio Juan L. , Porpiglia Andrea S. , Greco Stephanie H. , Reddy Sanjay S. , Farma Jeffrey M. , Villano Anthony M.
Published: February 2025

Objectives:

The National Accreditation Program for Rectal Cancer (NAPRC) was established in 2017 to decrease rectal cancer treatment variation and improve oncologic outcomes. Initiating curative intent treatment <60 days of first evaluation is one NAPRC standard. We evaluated whether oncologic outcomes improved with timely treatment and factors associated with its receipt.

Methods:

Using the NCDB, we identified stage I to III rectal cancer patients treated from 2004 to 2020 treated with curative-intent surgery. Patients were stratified into 2 cohorts (timely [<60 d], delayed [≥60 d]) for survival analysis and exploration of variables associated with timely treatment.

Results:

We included 117,459 patients with a median age of 61 years (interquartile range: 52 to 70 y). Most patients were male (61.1%), White (86.2%), Charlson 0 (77.1%) with stage II (33.5%) or III (44.3%) cancer treated with chemoradiation (58.1%), or surgery (27.0%) first. Timely treatment was associated with improved overall survival (OS; median OS: 153.26 vs. 128.59 m). Patients in the highest income bracket (odds ratio [OR] 1.30) with stage II (OR: 1.27) or III (OR: 1.50) cancer receiving neoadjuvant chemotherapy (OR: 2.24) or chemoradiation (OR: 1.73) as the first treatment received more timely treatment. Patients with Charlson ≥2 (OR: 0.83) of Black (OR: 0.56) or Hispanic (OR: 0.73) race received more delayed treatment (all P<0.01).

Conclusions:

Timely rectal cancer treatment is associated with improved survival. Socioeconomic disparities limit timely treatment with attendant worse survival, supporting national homogenization of care. As multimodal care for rectal cancer becomes increasingly complex, timely treatment remains paramount.
Racial residential segregation is associated with ambient air pollution exposure after adjustment for multilevel sociodemographic factors: Evidence from eight US-based cohorts
Authors: Zewdie Hiwot Y. , Fahey Carolyn A. , Harrington Anna L. , Hart Jaime E. , Biggs Mary L. , McClure Leslie A. , Whitsel Eric A. , Kaufman Joel D. , Hajat Anjum
Published: February 2025

Objective:

We examined if racial residential segregation (RRS) – a fundamental cause of disease – is independently associated with air pollution after accounting for other neighborhood and individual-level sociodemographic factors, to better understand its potential role as a confounder of air pollution-health studies.

Methods:

We compiled data from eight large cohorts, restricting to non-Hispanic Black and White urban-residing participants observed at least once between 1999 and 2005. We used 2000 decennial census data to derive a spatial RRS measure (divergence index) and neighborhood socioeconomic status (NSES) index for participants’ residing Census tracts, in addition to participant baseline data, to examine associations between RRS and sociodemographic factors (NSES, education, race) and residential exposure to spatiotemporal model-predicted PM2.5 and NO2 levels. We fit random-effects meta-analysis models to pool estimates across adjusted cohort-specific multilevel models.

Results:

Analytic sample included eligible participants in CHS (N = 3,605), MESA (4,785), REGARDS (22,649), NHS (90,415), NHSII (91,654), HPFS (32,625), WHI-OS (77,680), and WHI-CT (56,639). In adjusted univariate models, a quartile higher RRS was associated with 3.73% higher PM2.5 exposure (95% CI: 2.14%, 5.32%), and an 11.53% higher (95% CI: 10.83%, 12.22%) NO2 exposure on average. In fully adjusted models, higher RRS was associated with 3.25% higher PM2.5 exposure (95% CI: 1.45%, 5.05%; P < 0.05) and 10.22% higher NO2 exposure (95% CI: 6.69%, 13.74%; P < 0.001) on average.

Conclusions:

Our findings indicate that RRS is associated with the differential distribution of poor air quality independent of NSES or individual race, suggesting it may be a relevant confounder to be considered in future air pollution epidemiology studies.
Thromboelastometry and two activated clotting tests in detecting residual heparin after protamine in cardiac surgical patients
Authors: Moilanen Janne , Pada Marika , Ohtonen Pasi , Kaakinen Timo , Taskinen Panu , Savolainen Eeva-Riitta , Erkinaro Tiina
Published: February 2025

BACKGROUND

After cardiac surgery, complete heparin reversal with protamine is essential. Accordingly, there is a need for an accurate and precise point-of-care device to detect possible residual heparin after protamine administration.

OBJECTIVES

To compare two different activated clotting time (ACT) tests and thromboelastometry in detecting postprotamine heparin activity after cardiac surgery.

DESIGN

A single-centre prospective, observational study.

SETTING

University Hospital from September 2021 to February 2023.

PARTICIPANTS

Fifty-five adult, elective cardiac surgical patients.

INTERVENTIONS

The ACT-LR and ACT+ tests of Hemochron Signature Elite device, and the coagulation time (CT) ratio from INTEM and HEPTEM tests of ROTEM Sigma device, were analysed after protamine administration and compared to baseline values.

MAIN OUTCOME MEASURES

Based on postprotamine antifactor Xa (anti-fXa) activity, the patients were divided into heparin (anti-fXa ≥0.2 IU ml−1) and no heparin (anti-fXa ≤0.1 IU ml−1) groups.

RESULTS

There was a mean bias of 44 [95% confidence interval (CI) 40 to 47] celite seconds between ACT-LR and ACT+ measurements. The absolute changes in ACT-LR, ACT+ and INTEM:HEPTEM CT ratio were variable and did not differ between the groups. The mean ± SD percentage changes between postprotamine and baseline ACT-LR and ACT+ values were 5.9 ± 17.5 and 5.9 ± 16.9% in the no residual heparin group, compared to 1.4 ± 8.4 and 9.9 ± 12.5% in the residual heparin group. Receiver operator characteristic curves for postprotamine INTEM:HEPTEM CT ratio and for percentage changes in ACT-LR and ACT+ to detect an anti-fXa at least 0.2 IU ml−1 had areas under the curve of 0.496 (95% CI, 0.329 to 0.663), 0.425 (95% CI, 0.260 to 0.591) and 0.583 (95% CI, 0.417 to 0.749), respectively.

CONCLUSION

Both the ACT-LR and ACT+ tests of Hemochron Signature Elite device and the INTEM:HEPTEM CT ratio of ROTEM Sigma device have poor ability to detect residual heparin shortly after protamine administration.
Enhancing Acute Reconstructive Skills in Burn Surgery Through Virtual Simulation
Authors: Warner-Levy John , Sheikh Zeeshan , Dheansa Baljit , Walsh Karl
Published: February 2025

Medical simulation has progressed to using sophisticated computerized systems such as virtual and augmented reality. Despite its widespread adoption across various specialties, its adoption in burn surgery remains limited. Consequently, we wish to report on the “Excision of an Unhealed Burn Wound” module on the Touch Surgery mobile application that simulates the tangential excision and reconstruction of a burn wound with a split-thickness skin graft. To ascertain their knowledge of the surgical management of an unhealed burn wound, 38 regional senior house officer trainees currently on a plastic surgery placement completed a multiple-choice test. The trainees then viewed a full demonstration of the “Excision of an Unhealed Burn Wound” burn surgery module, before repeating the multiple-choice test after 1 hour. The self-assessed knowledge of participants regarding the excision of a burn and skin graft procedure improved in 90% of cases. Similarly, knowledge of the different types of equipment used for burn surgery saw an improvement in 89.5% of cases. Additionally, 84.3% of participants reported improvement in their understanding of the principles of preparing and applying a split-thickness skin graft. All but one participant agreed that simulation is beneficial in teaching surgical procedures, with the lone participant providing no rationale. Despite the relative inability to provide trainees with hands-on experience using surgical instruments and the risk of constraining the user to a single, preferred operating technique, we feel that digital simulation offers a novel tool for educating trainees in burn surgery.
Epigenomic landscape of the human dorsal root ganglion: sex differences and transcriptional regulation of nociceptive genes
Authors: Franco-Enzástiga Úrzula , Inturi Nikhil N. , Natarajan Keerthana , Mwirigi Juliet M. , Mazhar Khadijah , Schlachetzki Johannes C. M. , Schumacher Mark , Price Theodore J.
Published: February 2025

Cell states are influenced by the regulation of gene expression orchestrated by transcription factors capable of binding to accessible DNA regions. To uncover if sex differences exist in chromatin accessibility in the human dorsal root ganglion (hDRG), where nociceptive neurons innervating the body are found, we performed bulk and spatial assays for transposase-accessible chromatin technology followed by sequencing (ATAC-seq) from organ donors without a history of chronic pain. Using bulk ATAC-seq, we detected abundant sex differences in the hDRG. In women, differentially accessible regions (DARs) mapped mostly to the X chromosome, whereas in men, they mapped to autosomal genes. Hormone-responsive transcription factor binding motifs such as EGR1/3 were abundant within DARs in women, while JUN, FOS, and other activating protein 1 factor motifs were enriched in men, suggesting a higher activation state of cells compared with women. These observations were consistent with spatial ATAC-seq data. Furthermore, we validated that EGR1 expression is biased to female hDRG using RNAscope. In neurons, spatial ATAC-seq revealed higher chromatin accessibility in GABAergic, glutamatergic, and interferon-related genes in women and in Ca2+-signaling-related genes in men. Strikingly, XIST, responsible for inactivating 1 X chromosome by compacting it and maintaining at the periphery of the nucleus, was found to be highly dispersed in female neuronal nuclei. This is likely related to the higher chromatin accessibility in X in female hDRG neurons observed using both ATAC-seq approaches. We have documented baseline epigenomic sex differences in the hDRG which provide important descriptive information to test future hypotheses.
Challenges With Diagnosis of Labial Agglutination Due to Lichen Sclerosus
Authors: Ghosalkar Esha , Epstein Samantha , Epstein Allison , Mauskar Melissa , Pope Rachel
Published: February 2025

Objective

Labial adhesion (LA) lacks a clear etiology but is associated with low estrogen levels and lichen sclerosus (LS). Genitourinary Syndrome of Menopause is a contributor due to low estrogen, needing surgical resection if symptoms persist after topical estrogen use. Early diagnosis and treatment of LS can decrease the risk of development of LA. The objective is to investigate LS prevalence as an etiological factor and evaluate the necessity for enhanced biopsy rates in LA patients.

Methods

TrinetX provided data from 80 global health care centers, focusing on patients with LA using ICD-10-CM coding. The cohort was stratified based on vulva surgery 2 years post-LA diagnosis to establish a causal relationship.

Results

A total of 11,875 women over the age of 18 were diagnosed with LA from 2000 to 2023. Of those, 3,673 (30.93%) underwent a surgical procedure on the female genital system within 2 years. Demographic data included a mean age of 45 years, 67.9% identified as White, 6.53% as Black/African American, 20.52% unknown, and 2.45% other races. Of the 3,673 total women, 11% had a documented biopsy prior to or with the surgery, leading to 11% (395 women) being diagnosed with LS. Limitations include inconsistent medical coding, uncertain causality between conditions, and potential data inconsistencies from the national database.

Conclusions

Labial adhesion has a complex etiology, yet is associated with LS, emphasizing the need for biopsy in management when the first-line estrogen cream approach fails. Future studies on LA etiologies can improve approaches to female sexual health care disorders, enhancing patient care.
A Mixed-Methods Study Examining Guideline-Concordant Colposcopy Practices Among a National Cohort of US Colposcopists
Authors: Perkins Rebecca B. , Fuzzell Lindsay , Brownstein Naomi C. , Fontenot Holly B. , Michel Alexandra , Neggers Marena , Lake Paige , Vadaparampil Susan T.
Published: February 2025

Objectives

The 2017 ASCCP Colposcopy Standards guidelines were designed to maximize the diagnostic yield of colposcopy. However, guideline adoption is often slow, and few studies have examined management of patients undergoing colposcopy.

Methods

To elucidate factors associated with utilization of the 2017 ASCCP Colposcopy Standards guidelines for patients undergoing colposcopic cervical biopsy, we cross-sectionally surveyed and interviewed physicians and advanced practice providers who perform colposcopy. Clinicians responded to a clinical vignette describing a common colposcopy scenario. Clinicians were asked to describe where they would biopsy and why. Binomial logistic regression models determined factors associated with guideline concordance. Qualitative interviews further explored practice patterns.

Results

A total of 671 colposcopists participated from across the United States. A total of 541 (81%) participants reported colposcopy practice concordant with the 2017 ASCCP Colposcopy Standards guidelines. A total of 490 (73%) participants reported that they were using the 2017 ASCCP Colposcopy Standards guidelines. Male colposcopists and those who were internal and family medicine clinicians were less likely to report guideline-concordant management than females and obstetrician-gynecologists. Colposcopists discussed the rationale behind guideline-concordant aspects of care, including taking targeted biopsies and using excisional rather than ablation procedures.

Conclusions

Most colposcopists perform biopsies and treatment consistent with the 2017 ASCCP Colposcopy Standards guidelines and understand the rationale behind multiple targeted biopsies.
The modified lateral window technique for retrieving root stumps from the maxillary sinus: Case report
Authors: Liu Chongyuan , Cheng Lidi , Xu Qingying , Yang Fen , Liu Fengjia
Published: February 2025

Rationale:

Tooth extraction is a common surgical procedure in oral and maxillofacial surgery. Extraction of the upper molar teeth may result in root fracture for anatomical reasons, leading to the migration of fractured roots into the maxillary sinus. This can cause serious complications such as oroantral fistula, sinusitis, cellulitis, and subdural abscesses. To mitigate the risk of these complications, it is important to promptly remove the root stumps from the maxillary sinus and preserve alveolar bone for subsequent prosthetic rehabilitation.

Patient concerns:

A 30-year-old male patient presented for the removal of a root stump that had migrated into the maxillary sinus following the extraction of a right upper posterior tooth. A 28-year-old male patient sought dental implant restoration following the extraction of an upper left posterior tooth. Imaging revealed a residual root in the maxillary sinus, which could affect subsequent restoration.

Diagnoses:

Residual root in the maxillary sinus.

Interventions:

Two cases of root stumps displaced into the maxillary sinus were treated using the modified lateral window technique, with good recovery. Besides, the second patient underwent a successful implant placement 4 months postoperatively.

Outcomes:

Two cases of root stumps displaced into the maxillary sinus were removed though the modified lateral window technique, with good recovery. The second patient, who underwent implant restoration 4 months postoperatively, demonstrated good implant stability during subsequent follow-up assessments.

Lessons:

This paper presents a modified lateral window technique, which is used to remove the stump in the maxillary sinus, resulting in a good postoperative recovery and providing sufficient bone for implant placement. It should be noted that this surgical approach is not applicable to the scenario “the root is free within the sinus”, precise localization of the foreign body becomes challenging, and alternative surgical methods may need to be considered.
Granulocytic sarcoma as an initial manifestation of acute promyelocytic leukemia: A case report with literature review
Authors: Liu Yuyang , Huang Xiao
Published: February 2025

Rationale:

Granulocytic sarcoma (GS) is a rare tumor consisting of myeloid blasts with or without maturation and occurs in sites other than the bone marrow. Due to its low prevalence, clinical cases and pathogenesis need to be studied. Therefore, we present a rare case of humerus GS occurring simultaneously with acute promyelocytic leukemia (APL) and studied a retrospective analysis of clinical characteristics and related treatment strategies, hoping that it could help to standardize the early diagnosis and treatment of APL/GS.

Patient concerns:

We present a case of humerus GS complicated with APL in a 22-year-old woman who experienced pain in right clavicle and shoulder for 6 months without any cause. While the aggravated pain were persistent for 2 months, causing limited movement of her right upper arm.

Diagnoses:

The presence of tumor in her right proximal humerus and end of clavicle was revealed by positron emission tomography–computed tomography. Subsequently, the mass collected during the operation was confirmed to be GS by the pathological immunohistochemical examination. Further progression to APL was based on marrow smears, flow cytometry, fluorescence in situ hybridization, and PML/RARα gene detection.

Interventions and outcomes:

The patient underwent the tumorectomy, and then received 28-day induction therapy with all-trans retinoic acid (ATRA) (25 mg/m2/d) and arsenic trioxide. The posttreatment bone marrow smear and flow cytometry showed that she was in a complete remission. Consolidation treatment was performed with ATRA 25 mg/m2 PO BID for 2 weeks every 4 weeks and arsenic trioxide 0.16 mg/kg IV 5 days a week for 4 weeks every 8 weeks for a total of 6 cycles. Currently, the patient was routinely followed-up at an outpatient clinic, and has been maintained complete remission for 15 months.

Lessons:

We present an uncommon case of a humeral APL/GS, and conducted a comprehensive analysis of 28 cases of APL/GS. Despite the rarity of APL/GS, it should be diagnosed at an early stage. Furthermore, ATRA are recommended in the treatment plan of APL/GS.
An asymptomatic ectopic impacted tooth in the mandibular ramus region with congenital loss of the second lower right premolar: A rare case report
Authors: Xu Shencong , Ji Mingyi , Xu Chengrui , Xu Junfeng
Published: February 2025

Rationale:

Ectopic teeth may be supernumerary, deciduous, or permanent and rarely occur in the general population, with an incidence of ≈0.1% to 1% according to the literature. This report presents a rare case of an ectopic impacted tooth in the mandibular ramus region, aiming to enhance clinical recognition of this condition and explore the etiology of the ectopic tooth.

Patient concerns:

In a patient with an asymptomatic ectopic impacted tooth in the mandibular ramus region, accompanied by congenital loss of the second lower right premolar, we found an ectopic impacted tooth in the mandibular ramus region.

Diagnoses:

Ectopic teeth, impacted teeth, and congenital loss of the second lower right premolar.

Interventions:

The impacted tooth was not extracted, and regular oral radiographs were obtained every year. For congenital loss of the second lower right premolar, we recommend implant restoration in the position of the second right mandibular premolar.

Outcomes:

The patient accepted our recommendation and underwent implant restoration at the position of the second right mandibular premolar.

Lessons:

Asymptomatic ectopic impacted teeth in the mandibular ramus region are rare. Dental development is a complex process that is influenced by a variety of factors, including genetic or acquired factors, and is regulated at many levels and in different time periods; however, it is still not clear.
Clinical research progress of umbilical cord blood mesenchymal stem cells in Knee articular cartilage repair: A review
Authors: Liao ZhongKai
Published: February 2025

Umbilical cord blood mesenchymal stem cells (UCB-MSCs) are a type of adult stem cell with multipotent differentiation potential and immunoregulatory functions, primarily found in neonatal cord blood. Due to their noninvasive collection method, abundance, and ease of preservation, UCB-MSCs represent a promising biological material. This review examines the clinical research on UCB-MSCs in knee articular cartilage repair, highlighting their regenerative potential for treating knee joint cartilage defects. Our aim is to provide insights into current applications and propose directions for future research, focusing on optimizing clinical use and enhancing patient outcomes.
Hypercalcemia in children with APL caused by interactions between voriconazole and all-trans retinoic acid: A case report and literature review
Authors: Wu Namei , Lin Zhihang , Zhuang Shuquan , Wu Shuifa , Cai Zhiming , Wang Xiaofang
Published: February 2025

Rationale:

All-trans retinoic acid (ATRA) and voriconazole (VRZ) are pivotal drugs for the treatment of acute promyelocytic leukemia (APL) and invasive fungal infections, respectively. When ATRA is co-administered with VRZ, clinically significant drug interactions may occur due to alterations in drug metabolism and clearance.

Patient concerns:

We report a case of hypercalcemia caused by the interaction between ATRA and VRZ in a child with APL.

Diagnoses and interventions:

A 14-year-old boy received arsenictrioxide (ATO) for APL and VRZ for invasive fungal infections, followed by planned maintenance therapy with ATRA monotherapy and combination of ATRA and ATO. He experienced no adverse reactions during the concurrent use of ATO and VRZ, while on the 12th day of combined ATRA and VRZ administration, his blood calcium levels significantly increased, accompanied by a series of symptoms. Following the discontinuation of VRZ and continuation of ATRA monotherapy, and subsequent maintenance chemotherapy with ATRA and ATO, his blood calcium levels decreased and remained within the normal range.

Outcomes:

We reviewed the published literature and excluded primary hyperparathyroidism or ectopic parathyroid hormone secretion as the cause of hypercalcemia in the child. He did not use other cytochrome inhibitors that may affect ATRA metabolism other than VRZ. Multiple measurements of VRZ trough concentrations ranged from 1.2 to 3 μg/mL. According to the Drug Interaction Probability Scale (5 points) and Naranjo Probability Scale (4 points), the drug interaction between VRZ and ATRA is probable. The hypercalcemia and other clinical manifestations may be caused by the inhibition of ATRA metabolism by VRZ.

Lessons:

During clinical use of ATRA, it is necessary to closely monitor the adverse drug interactions such as hypercalcemia and limit the use of drugs that may affect cytochrome P450 enzyme such as VRZ.
Effect of radiation timing on the capsular contracture of implant-based breast reconstruction: A retrospective cohort study
Authors: Iwahira Yoshiko , Nakagami Gojiro , Morita Kojiro , Sanada Hiromi
Published: February 2025

Breast reconstruction using tissue expanders and silicone implants has become increasingly popular in Japan since health insurance began covering the procedure in 2013. Radiotherapy after mastectomy is recommended for certain patients and has been identified as a major risk factor for capsular contractures. However, the effect of radiation therapy timing on the development of capsular contracture has not yet been thoroughly studied. This study aimed to evaluate the effects of radiation therapy timing on the development of capsular contractures in patients who underwent implant-based breast reconstruction performed by a single expert plastic surgeon. This retrospective cohort study included 341 patients undergoing implant-based breast reconstruction and irradiation between April 2003 and March 2019. Patients were categorized based on radiation and operation types. Variables included postirradiation skin condition, implant mobility, and expander placement position. The outcome measure was the development of capsular contracture, assessed using the Baker Classification. Of 340 patients, 43 developed severe capsular contracture (Baker classification Grade III) within 2 years (cumulative incidence, 12.6 %). No significant relationship was found between the radiation or operation type and capsular contracture. Instead, postirradiation skin redness, implant mobility, skin pinchability after 1 year, and expander positioning were found to be significant factors affecting capsular contracture development. The timing of radiation therapy was not a determinant of capsular contracture development. Factors such as postirradiation skin inflammation, implant mobility, ability to pinch the skin, and expander position play pivotal roles in determining capsular contracture development.
Clinical outcomes of unilateral biportal endoscopic discectomy (UBE) compared with conventional open lumbar discectomy with 3D microscope (OLDM) assisted
Authors: Hao Jie , Chen Ruilin , Zheng Jian , Xu Shaohu , Xue Huawei , Yao Yu
Published: February 2025

The open lumbar discectomy with 3D microscope (OLDM) is considered the most common surgical procedure for herniated or ruptured discs of the lumbar spine, while unilateral biportal endoscopic (UBE) technique is a rapidly growing surgical treatment for spinal surgery. UBE as a new endoscopic technique has been applied to conventional arthroscopic systems for treating the spinal disease. In this research, we aimed to evaluate and compare the perioperative parameters and clinical outcomes, including operative time, intraoperative, blood loss, pain and modification, hospital stay, patient’s satisfaction, and complications, between OLDM and UBE for lumbar disc herniation. A total of 76 patients with lumbar disc herniation were included in this study from February 2019 to February 2022. All of them had received spinal surgery who underwent OLDM (42 cases) and UBE (34 cases) in Affiliated Hospital of Nantong University and Affiliated Nantong Hospital 3 of Nantong University. Respectively, all the patients had 1 level lumber disc herniation. Perioperative metrics were compared between the 2 groups: estimated blood loss, operation time, length of hospital stay, and complications of the patients. The visual analog scale (VAS) for back and leg pain, and Oswestry Disability Index (ODI) and modified MacNab criteria were tested before surgery and 3 days, 3 months and 12 months following surgery. Compared with the OLDM group, the UBE group had obviously shorter operative time, less intraoperative blood loss, and shorter hospital stay. In addition, the VAS and ODI scores had a significantly reduction in 2 groups after operation. There was no great difference of VAS and ODI scores in preoperative and 3 days, 3 months, and 12 months after operation between the 2 groups. Meanwhile, there was no significant difference in the rate of operational conversion and complications between the 2 groups. Application of OLDM yielded similar clinical outcomes to UBE for treatment of lumbar disc herniation containing pain control and patient satisfaction. Nevertheless, UBE was associated with several advantages relative to OLDM in terms of surgical time, intraoperative blood loss, short-term postoperative pain relief and postoperative hospitalization.
Sintilimab-induced photodistributed bullous pemphigoid: A case report
Authors: Cui Wenjuan , Wang Su , Xu Junzhu , Shen Xiaowei , Hu Murong
Published: February 2025

Rationale:

Immune-checkpoint inhibitors have emerged as a frontline treatment for a growing list of malignancies. Immunotherapy-induced bullous pemphigoid (BP) is a rare dermatological immune-related adverse event of immune-checkpoint inhibitor therapy immune-checkpoint inhibitor therapy. We report a case of immunotherapy-associated BP, with lesions presenting in a photodistribution. This case report aims to emphasize the early recognition of rare clinical manifestations induced by immunotherapy to improve patient prognosis.

Patient concerns:

The patient was a 77-year-old man with a history of right upper lung squamous cell carcinoma on sintilimab (anti-programmed cell death protein-1 [PD-1]) for over a year. After 12 months of initiation of PD-1 inhibitors, nonspecific cutaneous eruption appeared on his head, face, and extremities, mostly pruritic eczematous dermatitis with papules and plaques. The time to development of bullae after medication initiation was 16 months.

Diagnoses:

Sintilimab-induced BP.

Intervention:

Oral prednisone was gradually tapered to discontinuation following intravenous methylprednisolone; the skin lesions have basically recovered.

Outcomes:

Follow-up for 19 months showed no recurrence of the skin lesions.

Lessons:

This case report emphasizes that the clinical manifestations of BP induced by PD-1/programmed death ligand-1 inhibitors can be diverse. Dermatologists need to increase their awareness of BP caused by PD-1/programmed death ligand-1 inhibitors.
Refractory immune thrombocytopenia treated with low-dose decitabine combined with recombinant human thrombopoietin or eltrombopag: Two case reports
Authors: Jiang Yuxia , Xu Yani , Wu Haiying , He Minxia , Jiang Huifang , Xu Xiaofeng
Published: February 2025

Rationale:

Immune thrombocytopenia (ITP) is an autoimmune-mediated disorder caused by antibody-mediated platelet destruction and impaired platelet production by megakaryocytes. Treating refractory ITP remains a significant challenge.

Patient Concerns and Diagnoses:

We report 2 patients with refractory ITP.

Interventions and Outcomes:

Two patients received low-dose decitabine combined with recombinant human thrombopoietin or eltrombopag. Platelet counts in both patients increased to within the normal range.

Lessons:

Low-dose decitabine combined with recombinant human thrombopoietin or eltrombopag may exert a synergistic effect in the treatment of refractory ITP.
Hemosuccus pancreaticus post-EUS-FNA in multicystic pancreatic tail formation: A case report
Authors: Bokan Goran , Mislej Eva , Štabuc Borut , Siuka Darko
Published: February 2025

Rationale:

Hemosuccus pancreaticus (HP) is a rare but serious cause of gastrointestinal bleeding, characterized by hemorrhage from the papilla of Vater via the pancreatic duct. It is typically associated with vascular or pancreatic pathologies, including pancreatic cysts, tumors, or pseudoaneurysms involving adjacent arteries such as the splenic or gastric artery.

Patient concerns:

A 68-year-old male patient was evaluated for a pancreatic tail cyst detected on magnetic resonance cholangiopancreatography (MRCP). The lesion was described as a 20-mm multilocular cystic formation with septations, raising suspicion of malignancy.

Diagnosis:

HP was diagnosed following an episode of gastrointestinal bleeding after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the pancreatic tail cystic lesion.

Interventions:

The patient underwent EUS-FNA via a transgastric approach to obtain a tissue sample for further evaluation.

Outcomes:

The procedure was complicated by gastrointestinal bleeding and later confirmed to be HP. The bleeding was managed conservatively, and the patient remained hemodynamically stable with spontaneous resolution of symptoms.

Lessons:

This case underscores a rare but significant complication of EUS-FNA. Given the limited number of reported cases, further research is needed to establish the incidence, risk factors, and preventive measures for HP in similar clinical scenarios.
Causes of failed anterior cruciate ligament reconstruction: A retrospective case series
Authors: Jin Xiao , Lin Zihan , Yang Meiping , Zhao Jinlong , Zeng Lingfeng , Liu Jun , Liang Guihong , Yang Weiyi , Pan Jianke
Published: February 2025

Rationale:

The number of anterior cruciate ligament reconstruction (ACLR) surgeries in China is steadily increasing. To enhance the success rate of ACLR, it is crucial to understand the reasons for ACLR failure. The purpose of this study is to determine the primary reasons for ACLR failure and evaluate the technical skills associated with the revision procedure.

Patient concerns:

A retrospective clinical data analysis was performed for all patients who underwent anterior cruciate ligament revision surgery between January 2014 and September 2022. Each patient’s data set consisted of the 3 items listed below: standardized imaging data, medical records, and all arthroscopic images and recordings from the revision surgery.

Diagnoses:

A total of 65 patients underwent a failed ACLR surgery and then had to undergo revision surgery. Among these patients, the causes of revision were inappropriate tunnel placement (12, 18.75%), graft fixation problems (4, 6.25%), traumatic reinjury (35, 54.69%), graft failure (8, 12.5%), multiple ligament injuries (1, 1.56%), and infection (5, 7.81%).

Interventions and Outcomes:

In patients with inappropriate tunnel placement, the femoral canal deviated anteriorly in 6 cases, posteriorly in 4 cases, and the tibial canal deviated anteriorly in 2 cases. In patients with graft fixation failure, the loop plate was loose in 1 case, the screw was not screwed in 2 cases, and the metal guidewire was not pulled out in 1 case. Of patients who suffered traumatic reinjury, 24 suffered high-power trauma, whereas 11 suffered low-power trauma. Graft relaxation occurred in 3 cases, and absorption was noted in 5 cases among graft failure patients. Joint instability resulted from multiple knee ligament injuries, along with medial and lateral collateral ligament damage. In cases of infection, knee joint infection occurred in 3 cases, while 1 case involved wound infection combined with bone tunnel lysis, and another case involved a knee joint infection emerging after the revision procedure.

Lessons:

ACLR failure is associated with traumatic reinjury, inappropriate tunnel placement, graft failure, graft fixation problems, infection, and multiple ligament injuries. Particular emphasis should be placed on the precise positioning of bone tunnels during surgical procedures. Proper manipulation of the aforementioned influencing factors is crucial to the success rate and therapeutic efficacy of arthroscopic ACLR.
Clinical characteristics and risk factors of female precocious puberty
Authors: Qi Hongli , Pu Shanshan , Zhai Huibin
Published: February 2025

This study explores the clinical characteristics and risk factors of female precocious puberty. This retrospective study was conducted on 119 girls with precocious puberty admitted to Pu’er People’s Hospital from January 2022 to November 2023 (PP group) and 119 girls with normal sexual maturity during the same period (normal group). Clinical characteristics (including laboratory indicators) and general conditions of participants in both groups were collected and compared. The risk factors of female precocious puberty were analyzed using logistic analysis. There were statistically significant differences in axillary hair growth, early menarche, vaginal mucus appearance, pubic hair growth, breast development, areola diameter, ovarian volume, uterine volume, bone age, body mass index, height, prolactin, progesterone, estradiol, follicle stimulating hormone, and luteinizing hormone levels between the 2 groups (P < .05). There were statistically significant differences in frequent use of cosmetics, polluted living environment (chemical and pesticide detergents), sleeping with the light on at night, early exposure to sexual information, consumption of fried foods > 2 times/week, consumption of snacks > 2 times/week, parental discord, consumption of off-season fruits and vegetables, consumption of domestic poultry > 7 times/week, mother’s menarche < 12 years, and mother’s breast development age ≤ 10 years between the 2 groups (P < .05). Logistic analysis confirmed that frequent use of cosmetics, polluted living environment (chemical and pesticide detergents), sleeping with the light on at night, early exposure to sexual information, consumption of fried foods > 2 times/week, consumption of snacks > 2 times/week, parental discord, consumption of off-season fruits and vegetables, consumption of domestic poultry > 7 times/week, mother’s menarche < 12 years old, and mother’s breast development age ≤ 10 years old were risk factors of female precocious puberty (P < .05). In clinical practice, targeted prevention and control can be implemented based on relevant risk factors to improve the physical and mental health of children.