bluuebunny/crossref_metadata_2025 huggingface dataset:
Standardization of Weightage Assigned to Different Segments of the Hand X-ray for Assessment of Bone Age by the Greulich–Pyle Method
Authors: Oza Chirantap , Khadilkar Anuradha V. , Goel Pranay , Aeppli Tim , Mondkar Shruti , Shah Nikhil , Lohiya Nikhil , Prasad Hemchand Krishna , Patil Prashant , More Chidvilas , Kajale Neha , Khadilkar Vaman , Sävendahl Lars
Published: April 2024

Introduction:

Bone age (BA) assessment is important in evaluating disorders of growth and puberty; the Greulich and Pyle atlas method (GP) is most used. We aimed to determine the weightage to be attributed by raters to various segments of the hand x-ray, namely, distal end of radius-ulna (RU), carpals, and short bones for rating bone age using the GP atlas method.

Methods:

692 deidentified x-rays from a previous study (PUNE-dataset) and 400 from the Radiological Society of North America (RSNA-dataset) were included in the study. Mean of BA assessed by experienced raters was termed reference rating. Linear regression was used to model reference age as function of age ratings of the three segments. The root-mean-square-error (RMSE) of segmental arithmetic mean and weighted mean with respect to reference rating were computed for both datasets.

Results:

Short bones were assigned the highest weightage. Carpals were assigned higher weightage in pre-pubertal PUNE participants as compared to RSNA, vice-versa in RU segment of post-pubertal participants. The RMSE of weighted mean ratings was significantly lower than for the arithmetic mean in the PUNE dataset.

Conclusion:

We thus determined weightage to be attributed by raters to segments of the hand x-ray for assessment of bone age by the GP method.
Pragmatic Evaluation of Growth Hormone Stimulation Tests in Short Stature
Authors: Gupta Rahul , Dabas Aashima , Kohli Shweta , Ramot Rekha , Jyotsna Viveka P. , Goyal Alpesh , Gupta Yashdeep , Khadgawat Rajesh
Published: April 2024

Introduction:

To assess the performance of growth hormone stimulation tests (GHSTs) in the evaluation of short stature.

Methods:

It was a single-centre retrospective study carried out in children evaluated for short stature between January 2005 to March 2020. The clonidine stimulation test (CST) and glucagon stimulation test (GST) were used to assess growth hormone (GH) reserve (GST was performed only when peak GH levels were between 5 to ≤10 ng/mL on CST). A GH level of <5 ng/mL on CST or ≤10 ng/ml on both was used to corroborate GH deficiency.

Results:

A total of 556 children were eligible for this study. The mean (SD) age was 12.9 (3.5) years, and 66.3% were male. The peak GH level [median (IQR)] was 5.50 ng/ml (1.90 – 7.50) on CST (at 60 minutes) and 7.45 ng/ml (2.15 – 10.77) on GST (at 120 minutes). On restricting sampling to two time points, the false positive rate was 13.6% on CST (60, 90 minutes) and 11.5% on GST (120, 150 minutes). Similarly, restricting to three time points was associated with a false positive rate of 8.5% on CST (60, 90, 120 minutes) and 3.8% on GST (90, 120, 150 minutes). Using the treating clinician-determined diagnosis of GHD as a reference standard, the optimal cut-off of peak GH on CST was 7.79 ng/ml (sensitivity: 83.8%; specificity: 89.4%).

Conclusion:

Restricting the GH sampling to fewer time points is associated with an increase in the false positivity rate (FPR).
Type 1 Diabetes in Singapore: Self-Care Challenges, Diabetes Technology Awareness, Current Use, and Satisfaction, an Online Survey
Authors: Chandran Suresh Rama , Ho Cindy , Yeoh Ester , Gardner Daphne
Published: April 2024

Introduction:

To describe the self-care challenges, diabetes technology awareness, current use, and satisfaction among adults with type 1 diabetes and parents of children with type 1 diabetes in Singapore.

Methods:

An anonymous online survey was administered between November 2020 and October 2021. Data are presented as mean (standard deviation) or count (percentages). Comparisons between groups were done using the independent samples T-test.

Results:

251 people (176 adults, 75 parents) participated. The most challenging self-care burdens were carbohydrate counting (24.4%) among adults and insulin dose calculations (28%) among parents. Nocturnal awakenings for diabetes care of their child were a common event (25.3%). Despite high awareness about continuous glucose monitoring devices (77.8% adults, 78.7% parents) the use (24.9% adults, 55% children) remained low. Both adults and parents of children with type 1 diabetes found continuous glucose monitoring to be liberating and less restrictive. Despite overall low insulin pump use (23.9% adults, 29.3% children); satisfaction scores were higher among insulin pump users than insulin pen users (P = 0.02).

Conclusion:

Carbohydrate counting and insulin dose calculations were the most challenging self-care tasks among people with type 1 diabetes in Singapore. Diabetes technology use was relatively low in Singapore. Continuous glucose monitoring and Insulin pump users found them to be beneficial.
Global Warming and Endocrinology: The Hyderabad Declaration of the South Asian Federation of Endocrine Societies
Authors: Bhattacharya Saptarshi , Sahay Rakesh , Afsana Faria , Sheikh Aisha , Widanage Niranjala Meegoda , Maskey Robin , Naseri Mohammad Wali , Murad Moosa , Harikumar K. V. S. , Selim Shahjada , Aamir Azizul Hasan , Muthukuda Dimuthu , Parajuli Naresh , Baheer Mohammed Daud , Latheef Ali , Nagendra Lakshmi , Mondal Sunetra , Kamrul-Hasan A. B. M. , Raza Syed Abbas , Somasundaram Noel , Shrestha Dina , Anne Beatrice , Ramakrishnan Santosh , Kalra Sanjay
Published: April 2024

Global warming and endocrine disorders are intertwined issues posing significant challenges. Greenhouse gases emanating from human activities drive global warming, leading to temperature rise and altered weather patterns. South Asia has experienced a noticeable temperature surge over the past century. The sizable population residing in the region heightens the susceptibility to the impact of global warming. In addition to affecting agriculture, water resources, and livelihood, environmental changes interfere with endocrine functioning. Resulting lifestyle changes increase the risk of metabolic and endocrine disorders. Individuals with diabetes face heightened vulnerability to extreme weather due to impaired thermoregulation. A high ambient temperature predisposes to heat-related illnesses, infertility, and nephropathy. Additionally, essential endocrine drugs and medical devices are susceptible to temperature fluctuations. The South Asian Federation of Endocrine Societies (SAFES) calls for collaboration among stakeholders to combat climate change and promote healthy living. Comprehensive approaches, including the establishment of sustainable food systems, promotion of physical activity, and raising awareness about environmental impacts, are imperative. SAFES recommends strategies such as prioritizing plant-based diets, reducing meat consumption, optimizing medical device usage, and enhancing accessibility to endocrine care. Raising awareness and educating caregivers and people living with diabetes on necessary precautions during extreme weather conditions are paramount. The heat sensitivity of insulin, blood glucose monitoring devices, and insulin pumps necessitates proper storage and consideration of environmental conditions for optimal efficacy. The inter-connectedness of global warming and endocrine disorders underscores the necessity of international collaboration guided by national endocrine societies. SAFES urges all stakeholders to actively implement sustainable practices to improve endocrine health in the face of climate change.
Cellular neurothekeoma of the eyelid: A rare tumor with a common clinical presentation
Authors: Ojha Hare Ram , Verma Neha , Srivastava Himanshu , Raguram Shubha
Published: April 2024

We report a case of cellular neurothekeoma (NTK) in a 4-year-old male boy, which presented as a painless, progressive, left upper lid mass of 6 months’ duration. The left upper lid mass was solitary and dome shaped, causing mechanical ptosis. A magnetic resonance imaging (MRI) was performed followed by surgical excision of the mass in two stages, which, after histopathology and immunohistochemistry, was confirmed to be cellular NTK with no recurrence reported so far. To our knowledge, cellular NTK (a variant of NTK), an uncommon benign skin neoplasm involving the ocular adnexa (eyelid), is extremely rare. It is important to differentiate it from other malignant lesions, so that aggressive treatment can be avoided. The treatment of choice in cellular NTK is complete excision with clear margins.
A rare case of conjunctival granuloma in Aurolab aqueous drainage implant (AADI) with supramid
Authors: Maheshwari Devendra , Tara Techi Dodum , Pillai Madhavi Ramanatha , Gupta Shivam , Nagdev Nimrita , Rengappa Ramakrishnan , Dodwad Rutusha
Published: April 2024

Conjunctival granuloma (CG) can be caused by a foreign body, surgically related inflammation, an allergen, an infectious organism, or as part of a systemic disease. We are reporting the first case of CG related to 5-0 prolene as supramid, which is used as an intraluminal stent in AADI to prevent hypotony. A 70-year-old female diagnosed with POAG in both eyes with posterior PCIOL on MMT with advanced disc damage and uncontrolled IOP in the right eye underwent AADI with supramid. The patient developed mild irritation and redness in RE in the fourth month of follow-up. On slit-lamp examination, there was localized CG at the end of the supramid tip. CG resolved with the removal of the supramid suture and medical treatment. Supramid-related CG is rare and generally causes non-fatal material-related hypersensitivity reactions that can be treated well with medications and removal of inciting factors.
Spontaneous expulsive choroidal hemorrhage: A rare ocular catastrophe - A case report
Authors: Girimallanavar Sheetal V , Kelagar Apoorva B , Chetty Sahana S
Published: April 2024

Spontaneous expulsive choroidal hemorrhage is described as a sudden accumulation of blood in the potential space between the choroid and sclera, with the source of the blood being the long or short posterior ciliary arteries. It is observed exclusively in the geriatric population with atherosclerotic vessels associated with hypertension.[4] Massive spontaneous choroidal hemorrhage in the absence of surgery or trauma is an infrequent event, described in isolated case reports, and it results in devastating vision loss.[8] We report a case of a 74-year-old patient with uncontrolled hypertension with a sudden loss of vision in the left eye, later diagnosed as spontaneous expulsive choroidal hemorrhage. The patient was treated conservatively with topical steroids, cycloplegics, antibiotics, antiglaucoma medications, and tight bandages with nil visual prognosis. The patient initially refused surgical management and got discharged against medical advice. However, having been mentally prepared, the patient underwent evisceration at a tertiary eye care center nearby.
A rare case of eyelid choriostoma in an adult male: A case report
Authors: Tripathi Anchal , Vats Sumedha , Goenka Ranjit , Dhiman Shrey , Pathak Lav
Published: April 2024

Choristomas are rare tumors, commonly occurring in the head and neck region. These are defined as the presence of normal tissues, such as muscle, bone, cartilage, dermal appendages, and epidermal components, in abnormal locations. They are mostly seen in the pediatric population. Occurrence in the adult population is fairly rare. Ocular choristomas comprise a substantial portion of all conjunctival and corneal tumors. These are the most common types of epibulbar and orbital tumors in children. Rarely, they may present as a growth in the eyelid region. The authors present one such rare case of eyelid choristoma masquerading as a chalazion, in an elderly patient. The patient presented with an eyelid mass, initially diagnosed as a Chalazion. The mass was excised and sent for histopathological evaluation, which revealed fibrocartilagenous tissue, suggesting a choristoma. The patient was followed up for a period of six months, without any recurrence.
Intravitreal foscarnet rescues vision in a psoriasis patient developing CMV retinitis – A case report
Authors: Bhatt Darshan , Shakeel Areeba , Mehta Parth , Biswas Jyotirmay
Published: April 2024

We present a case of CMV retinitis (CMVR) reactivation in a psoriasis patient on immunosuppressant therapy, which previously responded to intravitreal ganciclovir. However, upon reactivation, nonresponsiveness to the same drug was noticed and the patient was switched to intravitreal foscarnet treatment, resulting in complete resolution of retinitis and significant improvement in vision. This case emphasizes the efficacy of foscarnet as an alternative treatment for ganciclovir-resistant CMVR.
Binocular scleral cysts with calcification in an 86-year-old patient from China
Authors: Zhang Wanping , Hu Jun , Zhou Hezheng , Lei Qiong
Published: April 2024

We report a case of an 86-year-old woman from China who was admitted to the hospital for age-related cataracts in both eyes and presented binocularly light-colored, pitting, calcified lesions of the nasal sclera.
Rubinstein Taybi syndrome with secondary glaucoma: An unusual case report and review of literature
Authors: Angmo Dewang , Singhal Tavishi , Bukke Anand Naik
Published: April 2024

Rubinstein Taybi syndrome is a rare neurodevelopmental disorder characterized by broad thumbs and first toe, microcephaly, developmental delay, beaked nose, talon cusps, and various systemic abnormalities like cardiac defects, hearing loss, respiratory infections, and ocular abnormalities which are common with this syndrome. The various ocular abnormalities reported in the literature are corneal opacities, lacrimal gland abnormalities, strabismus, coloboma, retinal dysfunction, and congenital glaucoma. We hereby report the case of a 7-year-old boy who presented in the glaucoma clinic of a tertiary eye care center with large eyeballs and a typical dysmorphic face characterized by high-arched brows with a low-hanging columella, grimacing smile, talon cusps, diffuse corneal haze, and enlarged corneal diameters (12.5 mm) and who was subsequently diagnosed with congenital glaucoma after evaluation under anesthesia (EUA). EUA revealed raised intraocular pressure (IOP) of 22 mmHg, and optic never head cupping in the right eye (RE) was 0.8:1 the other eye had a total leucomatous corneal opacity. The child was started on topical antiglaucoma medication in RE, and subsequent evaluation revealed well-controlled IOP on these medications.
Descemet Stripping endothelial keratoplasty donor graft dissection following bowman-stromal Inlay preparation
Authors: Jain Neha , Shah Vishwa , Mittal Vikas
Published: April 2024

This article outlines the dissection of donor grafts in descemet’s stripping endothelial keratoplasty (DSEK) after Bowman–Stromal inlay (BSI) tissue preparation. Following the femtosecond (FS) laser-assisted BSI for stromal augmentation in keratoconus, the donor cornea is transitioned to an artificial anterior chamber. The dissection of the DSEK graft is meticulously performed using blunt dissectors, considering the varying tissue thickness (thinner at the center and gradually thickening toward the periphery). This approach was successfully employed in three corneal donor tissues, facilitating six surgeries—three BSI and three DSEK. The intraoperative and postoperative courses were uneventful. This technique demonstrates the feasibility of utilizing a single donor tissue for both stromal augmentation and posterior lamellar keratoplasty (DSEK). Notably, the endothelial integrity of the donor tissue appears to remain unaltered following FS laser and subsequent manipulation by blunt dissectors. This holds promise in optimizing the utility of donor corneas for multiple therapeutic interventions.
Multimodal imaging in iris retraction syndrome
Authors: Rangel Carlos M , Muñoz Juliana , Chaparro Tania , Tello Alejandro , Galvis Virgilio , Lizcano Karol Quintero , Arango Marcos Restrepo
Published: April 2024

Definition of iris retraction syndrome (IRS) has been changing over the years. The purpose of this article is to document through multimodal imaging the clinical signs found in two individuals who presented with IRS. This is a case series. Multimodal imaging was performed in a 34-year-old and a 57-year-old male patient with IRS. A literature search was conducted including the original articles that gave the concepts for the definition of IRS. IRS has been defined in the literature based on clinical and histological findings described in different case series. However, this is the first publication that documents through multimodal imaging the clinical signs found in two individuals who presented with IRS.
A rare case of choroidal melanoma in pregnant Indian female
Authors: Prabhu Sonali D , Arora Shivani , Shanmugam Mahesh , Javeri Henal J
Published: April 2024

Choroidal melanoma is a rare ocular malignancy in the Asian population but despite its rarity, it is the most common intraocular malignancy. In the Western population, it has been reported in younger men and females of childbearing age, particularly pregnant females. This is the first reported case of choroidal melanoma in pregnant Indian female in India, which reviews the imaging features of choroidal melanoma and emphasizes the need for further study to evaluate the causes of the increasing incidence of pregnancy-associated melanoma (PAM) in Indian females. We present a case of a 29-year-old pregnant female, diagnosed with choroidal melanoma in the right eye during the 7th month of pregnancy. Upon clinical and diagnostic imaging, the choroidal melanoma was treated by enucleation 20 days postpartum and the histopathology examination confirmed a mixed cell type choroidal melanoma. Systemic metastasis work-up was unremarkable both in the mother and the baby.
Devic’s disease: Neuromyelitis optica spectrum disorder – A case series
Authors: Shah Kannisha , Rasheed Rehna , Pillai Gopal S. , Radhakrishnan Natasha , Kandula Pooja
Published: April 2024

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that mainly involves the optic nerve and the spinal cord. Purpose of this case series is to better understand the clinical profile of patients with NMOSD, its treatment, and prognosis and to differentiate them from patients having other demyelinating disorders. Five patients (one male and four females) aged between 18 and 65 years were studied. All of them presented with severe vision loss. Bilateral optic nerve involvement was seen in four patients and unilateral involvement in one patient. One patient presented with only optic nerve involvement, two presented with initial optic nerve involvement followed by neurologic symptoms, while two patients presented with neurologic symptoms initially followed by optic nerve involvement. One patient was Neuromyelitis optica antibody negative and was diagnosed based on magnetic resonance imaging features. Two patients had optic atrophy at presentation itself, one had bilateral disc edema, and two had retrobulbar optic neuritis. All were treated with corticosteroids and immunosuppressants.
Spontaneous closure of macular hole following the development of raised multilobulated macular lesion
Authors: Chakraborty Debdulal , Das Sudipta , Chakraborty Somnath , Mondal Soumen
Published: April 2024

Spontaneous closure of stage 3 and 4 full-thickness macular holes (FTMHs) are unusual events. We present a case report of a patient with an idiopathic FTMH that closed spontaneously subsequent to the development of a raised macular lesion provisionally diagnosed as polypoidal choroidal vasculopathy and discuss the possible mechanisms leading to the closure.
The great escape- preserved cilioretinal artery with transient central retinal artery occlusion following snake bite
Authors: Singh Shivangi , Tagare Shivraj , Sinha Ayushi , Sonawane Nikita
Published: April 2024

A 24-year female sustained a snake bite on the lateral side of the left ankle, followed by localized pain and blurring of vision in right eye. Her best corrected visual acuity was 20/20 in the both eyes. Relative afferent pupillary defect was noted in right eye. Fundus examination of right eye showed clear media, normal optic disc and retinal whitening with sparing of small area on macula, temporal to disc with small cilioretinal artery, suggestive of central retinal artery occlusion (CRAO) with presence of cilioretinal artery sparing. Ophthalmic manifestations following a snake bite are uncommon and can arise through diverse mechanism such as hematotoxicity from the snake bite, resulting in CRAO. Although CRAO following snake bite has been reported, we present a very rare case of snake bite induced transient CRAO with presence of spared cilioretinal artery.
Bilateral acute anterior uveitis associated with MiraLAX bowel prep
Authors: Komalpreet Tur MD , Omari Amro , Tajran Jahan , Ali Dania , Hart John
Published: April 2024

Drug-induced uveitis is vision-threatening and has been associated with various bioactive molecules. Here, we discuss a potential association between a polyethylene glycol 3350-based osmotic laxative, also known as MiraLAX, and bilateral anterior uveitis. We present a case of a 52-year-old gentleman with no significant medical history and a past ocular history of dry eye syndrome, who developed an anaphylactic reaction and acute but mild bilateral anterior uveitis after recent MiraLAX bowel preparation for a screening colonoscopy. Screening for medical problems was otherwise unremarkable. The patient responded well to topical steroids. We aim to raise awareness of the potential association between MiraLAX and uveitis to prevent vision loss.
Scleral buckle infection due to Nocardia cyriacigeorgica
Authors: Kashyap Himanshu , Sreenivasan Janani , Anand Appakkudal R , Yasar Kasim
Published: April 2024

A 34-year-old male complained of pain, discharge, and foreign body sensation in the right eye (RE) for 1 week. On anterior segment examination, RE had conjunctival congestion with an exposed buckle at 12 o’clock and buckle sutures covered with thin conjunctiva in the other quadrants. A diagnosis of an exposed and infected scleral buckle in RE was made, and buckle explant removal was done. Culture isolated Nocardia cyriacigeorgica from the explant. This case highlights the importance of surgeons being aware of Nocardia’s potential to cause buckle infection, its delayed manifestation, the need for timely diagnosis using microbiology, appropriate treatment using sensitive antibiotics, and proper follow-up.
Nodular scleritis as the presenting feature in Takayasu arteritis – A case report and review of the literature
Authors: Patro Pradeepta S , Harish Buvanahalli V , Reddy Shilpa S , Samant Swati , Panigrahi Pradeep K
Published: April 2024

A 47-year-old female presented to Ophthalmology OPD with a history of redness in the right eye and pain for 3 days. Clinical examination revealed a temporal scleral nodule with congestion. Magnetic resonance aortogram revealed diffuse aortoarteritis involving the aortic arch and its major branches. We diagnosed the case as Takayasu arteritis presenting with anterior nodular scleritis. The patient was started on systemic steroids, immunosuppressives, and topical steroids. At the 8-week follow-up, there was a complete resolution of scleritis with reduced claudication symptoms. TA can rarely present with scleritis. Early diagnosis and appropriate treatment can be associated with a favorable prognosis.
Ophthalmıc fındıngs ın Joubert syndrome 25: A case report
Authors: Ogreden Tulin Aras , Büyüktiyaki Mehmet
Published: April 2024

Joubert syndrome (JBTS; OMIM PS213300) is a rare autosomal recessive disease classified as a ciliopathy. The diagnosis of JBTS is based on three criteria: a characteristic brain imaging finding known as the “molar tooth sign,” hypotonia, and developmental delays. There is a well-defined ocular feature, including oculomotor apraxia, nystagmus, and strabismus. Retinal and optic nerve abnormalities have been reported. In a few cases where the genetic result is not specified, a papilledema-like appearance has been observed. To date, 35 mutations have been reported, with JBTS-25 being associated with the CEP104 gene. This report presents rare ocular findings in individuals with JBTS-25.
Utility of multicolor imaging in endogenous endophthalmitis
Authors: Das Debmalya , Patnaik Gazal , Roy Rupak , Tripathi Abhishek K
Published: April 2024

The utility of multicolor imaging (MCI) has been well evaluated for various retinal disorders like age-related macular degeneration, retinal vascular occlusions, and central serous chorioretinopathy. However, the utility of MCI in endogenous endophthalmitis is very limited. We report a unique case of endogenous endophthalmitis showcasing the utility of MCI in monitoring the response of bacterial colonies to intravitreal antibiotic therapy.
Inverse Knapp procedure with double augmentation in inferior rectus palsy following blunt trauma
Authors: Pawar Neelam , Krishnan Aparna , Ravindran Meenakshi , Maheswari Devendra
Published: April 2024

This case highlights the management of inferior rectus palsy secondary to blunt trauma, which presented with diplopia after blunt injury to the right eye due to large hypertropia. This case was successfully managed using the Inverse Knapp procedure with double augmentation.
A pediatric case of two Nicolau syndrome lesions following leuprolide injection in the upper extremity
Authors: Menteşoğlu Dilek , Elkıran Laden , Kurmuş Gökçe Işıl , Kartal Selda Pelin
Published: April 2024

Nicolau syndrome (NS) is a rare and unpredictable adverse reaction that can occur after the administration of certain medications. A 9-year-old girl, accompanied by her father, visited the outpatient dermatology clinic with complaints of wounds on both upper arms. Upon reviewing her medical history, it was discovered that she had been receiving leuprolide for precocious puberty, and the symptoms began after the last two injections. The patient experienced pain during the leuprolide injection, and redness and swelling were noticed in the injection area on the same day. A few days later, the redness turned into ulcers. The fact that the development of NS cannot be detected in advance and the risk of rapid progression of tissue necrosis make disease management difficult. The prognosis of NS significantly depends on the patient, and when a developing lesion is noticed early, it is crucial to minimize the risk of complications.
Microwave ablation combined with percutaneous vertebroplasty for treating painful non-small cell lung cancer with spinal metastases under real-time temperature monitoring
Authors: Wu Linlin , Hu Miaomiao , Li Peishun , Man Qirong , Yuan Qianqian , Zhang Xusheng , Qiu Yuanyuan , Chen Lili , Fan Jing , Zhang Kaixian
Published: April 2024

Purpose:

To retrospectively study the therapeutic effect and safety performance of the combination strategies of the computed tomography (CT)-guided microwave ablation (MWA) and percutaneous vertebroplasty (PVP) as a treatment for painful non-small cell lung cancer (NSCLC) with spinal metastases.

Materials and Methods:

A retrospective review included 71 patients with 109 vertebral metastases who underwent microwave ablation combined with percutaneous vertebroplasty by the image-guided and real-time temperature monitoring. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry Disability Index (ODI) scores before treatment and during the follow-up period.

Results:

Technical success was achieved in all patients. The mean pre-procedure VAS score and morphine doses were 6.6 ± 1.8 (4–10) and 137.2 ± 38.7 (40–200) mg, respectively. The mean VAS scores and daily morphine doses at 24 h and 1, 4, 12, and 24 weeks postoperatively were 3.3 ± 1.9 and 73.5 ± 39.4 mg; 2.2 ± 1.5 and 40.2 ± 29.8 mg; 1.7 ± 1.2 and 31.3 ± 23.6 mg; 1.4 ± 1.1 and 27.3 ± 21.4 mg; and 1.3 ± 1.1 and 24.8 ± 21.0 mg, respectively (allP< 0.001). ODI scores significantly decreased (P< 0.05). Minor cement leakage occurred in 51 cases (46.8%), with one patient having a grade 3 neural injury. No local tumor progression was observed by follow-up imaging.

Conclusions:

MWA combined with PVP can significantly relieve pain and improve patients’ quality of life, which implied this is an effective treatment option for painful NSCLC with spinal metastases. Additionally, its efficacy should be further verified through the mid- and long-term studies.
Efficacy of microwave ablation with parallel acupuncture guided by ultrasound in treating single hepatocellular carcinoma in high-risk areas: A retrospective analysis of 155 patients
Authors: Liu Sheng , Zhou Pingsheng , Shen Qiang , Qian Guojun
Published: April 2024

Objective:

To investigate the safety and short- and long-term efficacy of ultrasound-guided microwave ablation (MWA) with parallel acupuncture for treating single hepatocellular carcinoma (HCC) in high-risk areas.

Methods:

Retrospective analysis was performed on 155 patients with single hepatocellular carcinoma who underwent microwave ablation in our hospital between December 2015 and September 2016. Patients with a tumor distance of ≤5 mm from the risk area were included in the observation group. Patients with a tumor distance of >5 mm from the risk area were placed in the control group. The patients’ preoperative general health status, tumor site, tumor size, follow-up data, disease-free survival rate, overall survival rates, local tumor progression, and intrahepatic distant recurrence rate were collected and analyzed.

Results:

The 1-, 3-, and 5-year overall survival rates for the observation group were 91.8%, 75.5%, and 59.2%, respectively. The 1-, 3-, and 5-year overall survival rates for the control group were 97.2%, 84.0%, and 66.0%, respectively. There were no significant differences between the two groups (P = 0.522). A tumor size of ≤20 mm (HR = 0.488, 95% CI = 0.254–0.940, P = 0.032) was an independent risk factor affecting the overall survival of patients with solitary HCC treated with MWA. The 1-, 3-, and 5-year recurrence-free survival rates for the observation group were 59.2%, 28.6%, and 18.4%, respectively, and those for the control group were 79.2%, 43.4%, and 31.1%, respectively. There was a statistical difference between the two groups (P = 0.007). Tumor size ≤20 mm (HR = 0.468, 95% CI = 0.303–0.723, P = 0.001), tumor location in a risk area (HR = 1.662, 95% CI = 1.121–2.465, P = 0.011), and an α-fetoprotein (AFP) level of <200 ug/L (HR = 0.612, 95% CI = 0.386–0.970, P = 0.036) are independent factors affecting the recurrence-free survival of MWA treatment for HCC.

Conclusion:

Microwave ablation with parallel acupuncture guided by ultrasound is a safe and effective treatment for single hepatocellular carcinoma in high-risk areas.
Evolution of neoadjuvant therapy for breast cancer regimens over 12 years and pathologic response rates according to tumor subtypes and clinical stage: A single-center retrospective study
Authors: Li Zhedong , Wang Yongsheng
Published: April 2024

Background and Purpose:

Given the evolution of neoadjuvant therapy (NAT) for breast cancer, this study aimed to analyze trends in NAT regimens over time and patients’ pathological responses, tumor stages, and subtypes.

Materials and Methods:

Data were analyzed for 548 patients with cT1-4N0-3M0 breast cancer who received NAT at Shandong Cancer Hospital between 2011 and 2022. The 12-year study period was divided into six 2-year periods termed P1 to P6.

Results:

From P1 to P6, the proportion of stage II patients treated with NAT increased from 6.4% to 33.8% compared with same-stage operable breast cancer (r = 0.228, P < 0.001), while the proportion of the full-course group increased from 50.0% to 99.0% (r = 0.354, P < 0.001). The pathologic complete remission (pCR) rate in the full-course group increased from 30.8% to 54.6% (r = 0.248, P < 0.001). In the full-course human epidermal growth factor receptor-2 positive (HER2+) group, the proportion of chemotherapy combined with inhibition therapy increased from 33.3% to 100% (r = 0.530, P < 0.001). Furthermore, dual inhibition therapy increased from 0 to 98.9%. The proportion of the nonanthracycline group (dual inhibition) increased from 56.0% at P5 to 76.6% at P6 (r = 0.190, P = 0.042). In the full-course Triple-Negative Breast Cancer (TNBC) group, the proportion of platinum therapy increased from 0 to 41.9% (r = 0.324, P < 0.001) and immune drugs increased from 0 to 53.2% (r = 0.500, P < 0.001).

Conclusion:

Overall, the results indicate an increasing proportion of patients receiving NAT therapy over time. Furthermore, there were increases in HER2 + patients receiving inhibition therapy (especially dual inhibition) and TNBC patients receiving platinum and immune therapy as part of NAT. Notably, these changes were associated with improved outcomes.
Non-mass-type ductal carcinoma in situ of the breast on ultrasound: Features and pathological analysis
Authors: Zhang Peipei , Kong Peng , Liu Dequan , He Shuqian , Zhang Xuping
Published: April 2024

Aims:

The aims of this study were to investigate the ultrasound features of non-mass-type ductal carcinoma in situ (DCIS) of the breast and conduct a pathological analysis.

Material and Methods:

Ultrasound images of 32 cases of non-mass-type DCIS of the breast, collected between September 2014 and June 2016, were analyzed. The characteristics of the lesions, including border, internal echogenicity, local glandular hyperplasia, micro-calcification, and intra-tumoral blood flow resistance index (RI), were analyzed, and a concurrent pathological analysis was conducted.

Results:

Obvious local glandular hyperplasia was commonly observed in the 32 cases of non-mass-type DCIS of the breast. The internal echogenicity varied in intensity, exhibiting a “leopard pattern” or “zebra pattern.” Color Doppler imaging revealed abundant blood flow signals within the lesion with an RI of >0.7. Isolated duct dilatation and micro-calcifications were occasionally observed within the lesions. High-grade DCIS was the predominant pathological type of non-mass-type DCIS.

Conclusions:

Non-mass-type DCIS of the breast often presents with obvious local glandular hyperplasia and varying internal echogenicity. High-grade DCIS is the frequent pathological type. Color Doppler imaging and RI measurement can assist in diagnosing non-mass-type DCIS of the breast.
Evaluation of stromal myofibroblasts in oral submucous fibrosis and its malignant transformation: An immunohistochemical study
Authors: Liu Ziyi , Hu Wenwu , Shan Zhongyan , Liu Sixuan , Yao Zhigang , Quan Hongzhi
Published: April 2024

Background:

Oral submucous fibrosis (OSF) is a precancerous lesion, with oral squamous cell carcinoma (OSCC) being the most prevalent malignancy affecting the oral mucosa. The malignant transformation of OSF into OSCC is estimated to occur in 7–13% of cases. Myofibroblasts (MFs) play pivotal roles in both physiological and pathological processes, such as wound healing and tumorigenesis, respectively. This study aimed to explore the involvement of MFs in the progression of OSF and its malignant transformation.

Materials and Methods:

In total, 94 formalin-fixed paraffin-embedded tissue blocks were collected, including normal oral mucosa (NOM; n = 10), early-moderate OSF (EMOSF; n = 29), advanced OSF (AOSF; n = 29), paracancerous OSF (POSF; n = 21), and OSCC (n = 5) samples. Alpha-smooth muscle actin was used for the immunohistochemical identification of MFs.

Results:

NOM exhibited infrequent expression of MFs. A higher staining index of MFs was found in AOSF, followed by EMOSF and NOM. Additionally, a significant increase in the staining index of MFs was found from EMOSF to POSF and OSCC. The staining index of MFs in NOM, EMOSF, AOSF, POSF, and OSCC was 0.14 ± 0.2, 1.69 ± 1.4, 2.47 ± 1.2, 3.57 ± 2.6, and 8.86 ± 1.4, respectively. All results were statistically significant (P < 0.05).

Conclusions:

The expression of MFs exhibited a gradual increase as the disease progressed from mild to malignant transformation, indicating the contributory role of MFs in the fibrogenesis and potential tumorigenesis associated with OSF.
Combination low-dose cyclophosphamide with check-point blockade and ionizing radiation promote an abscopal effect in mouse models of melanoma
Authors: Luo Xing , Zeng Ming
Published: April 2024

Purpose:

The complex strategy of hypo-fractionated radiotherapy (HFRT) in combination with an immune checkpoint inhibitor (ICI) can stimulate a potential systemic antitumor response; however, the abscopal effect is always precluded by the tumor microenvironment, which may limit sufficient T-cell infiltration of distant nonirradiated tumors for certain kinds of inhibitory factors, such as regulatory T-cells (Tregs). Additionally, low-dose cyclophosphamide (LD-CYC) can specifically kill regulatory Tregs and strongly synergize antigen-specific immune responses, which could promote an abscopal effect.

Materials and Methods:

We explored whether a triple regimen consisting of HFRT, ICI, and LD-CYC could achieve a better systemic antitumor response in bilateral mouse tumor models.

Result:

Our data demonstrate that LD-CYC combined with HFRT and antiprogrammed cell death ligand 1 (PDL-1) therapy could enhance the abscopal effect than only HFRT/antiPDL-1 or HFRT alone. Surprisingly, repeat CYC doses cannot further restrain tumor proliferation but can prolong murine overall survival, as revealed by the major pathologic responses. These results are associated with increased CD8 + effector T-cell infiltration, although LD-CYC did not upregulate PDL-1 expression in the tumor.

Conclusions:

Compared with traditional strategies, for the first time, we demonstrated that a triple treatment strategy remarkably increased the number of radiation-induced tumor-infiltrating CD8 + T-cells, effectively decreasing infiltrating Tregs, and promoting an abscopal effect. Thus, we describe a novel and effective therapeutic approach by combining multiple strategies to target several tumor-mediated immune inhibitory mechanisms.
A Retrospective Study of Clinical Profile, Management, and Evaluation of Early Outcomes in Endovascular Carotid Artery Stenting for Carotid Artery Stenosis: Our Institutional Experience
Authors: Patil Karansinh Raosaheb Parve , Nadkarni Trimurti D. , Dadla Murtaza Mustafa , Barve Pandurang S.
Published: April 2024

ABSTRACT

Objective:

The present study was undertaken to evaluate the clinical profile and management of carotid artery stenosis in the Indian population treated by endovascular modalities.

Materials and Methods:

This was a retrospective observational study of 54 patients with carotid artery stenosis treated at a tertiary care centre for 5 years between November 2018 and February 2023. Endovascular carotid artery stenting (CAS) was performed in all patients, and post-procedural imaging was done to assess the extent of restoration of blood flow through the stenosed segment and cerebral blood flow. Patients were followed up to 6 months post-procedure.

Results:

Fifty-four patients underwent carotid stenting. Four (7.4%) patients were asymptomatic and 50 (92.6%) were symptomatic. Total male patients were 39 (72.2%) and female patients were 15 (27.7%). Age of these patients ranged from 37 to 77 years, with the average age being 60.8 years. Hypertension was the most common comorbidity (88.88%), followed by diabetes mellitus (48.14%). Post-procedure brain and carotid angiogram showed no evidence of restenosis. Two patients had developed post-procedure haemorrhagic stroke, and one patient developed a pseudoaneurysm at the access site of the right femoral artery.

Conclusion:

Our study showed CAS is a safe and minimally invasive procedure in patients with severe carotid artery stenosis. Managing comorbidities is equally important. The procedure enabled the patients to have an early discharge and minimal limitation of daily activities.
Lamina Terminalis Fenestration: A Beneficial Approach to Reduce Shunt-dependent Hydrocephalus in Patients with Aneurysmal Subarachnoid Hemorrhage with a Review of Literature
Authors: Jadhav Anil , Katyal Abhishek , Jagetia Anita , Singh Hukum , Srivastava Arvind Kumar , Singh Daljit
Published: April 2024

ABSTRACT

Objective:

Hydrocephalus requiring shunt placement (12%–20%) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). Various studies suggest that fenestration of lamina terminalis (LT) during microsurgery for aSAH may be associated with a reduced rate of shunt-dependent hydrocephalus. We report a prospective analysis correlating fenestration of the LT with decreased shunt-dependent hydrocephalus after aSAH managed by microsurgical repair.

Methodology:

A total of 106 patients over a period of 1.5 years with aSAH treated by microsurgical aneurysm repair along with fenestration of LT were analyzed. Patients were treated by same surgical team and those patients where surgical clipping of anterior circulation aneurysms with LT fenestration was performed were included in the study. We compared the rate of shunting in patients operated on by routinely fenestration of the LT with that in cases where LT fenestration was not carried out (taking literature as control). This study design isolates the effect of fenestration of the LT on the incidence of shunt-dependent hydrocephalus.

Results:

There has been significantly lower rate of shunting (2.3%) in the patients where LT fenestration was done, versus 12%–20% in the cases where it was not preformed (P < 0.05). Furthermore, post-aSAH, hydrocephalus is associated with a higher grade of Fischer’s scale (Grade III and IV).

Conclusion:

Fenestration of the LT appears to be associated with a decreased incidence of shunt-dependent hydrocephalus of more than 80% after aSAH. This straightforward microsurgical maneuver should be performed whenever possible during aneurysm surgery.
Incidence and Surgical Outcomes of Intracranial Arachnoid Cysts: A Systematic Review Comparing Endoscopic Fenestration, Open Craniotomy and Cystoperitoneal Shunt Approaches
Authors: Encarnacion Daniel , Scalia Gianluca , Bozkurt Ismail , Wellington Jack , Kirilin Igor , Chaurasia Bipin , Garcia Mainer
Published: April 2024

ABSTRACT

Background:

Arachnoid cysts (ACs) are non-neoplastic collections of cerebrospinal fluid, often posing challenges in diagnosis and management due to their rarity and varied clinical presentations. This systematic review aims to investigate the frequency of ACs, analyse optimal intervention approaches and evaluate neurological complications postoperatively.

Materials and Methods:

A systematic search of Science Direct, PubMed and Cochrane databases was conducted using controlled vocabulary terms and keywords. Inclusion criteria encompassed studies focusing on adults with symptomatic ACs requiring surgical intervention. Data extraction involved factors influencing subdural haemorrhage, surgical techniques, drainage types and imaging approaches. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured methodological rigor and transparency.

Results:

The review identified multiple surgical approaches, including microsurgical fenestration, endoscopic fenestration and cystoperitoneal shunt, tailored to different cyst locations. Studies showed cystoperitoneal bypass as effective for supratentorial cysts, endoscopic fenestration for midline cysts and cystoperitoneal shunt for infratentorial cysts. Notably, endoscopic fenestration exhibited a 90% success rate, while cystoventricular drainage emerged as an alternative option. However, limitations in comparative studies and variations in follow-up durations hindered comprehensive analyses.

Conclusion:

Cystocysternostomy, preferably minimally invasive, showed promising outcomes in managing ACs. Wide endoscopic fenestration was recommended without causing damage to adjacent structures. Surgical adaptation for uncontrolled bleeding during procedures was suggested. Intracranial shunts were preferred due to lower infection risks. Postoperative care involving anticonvulsants and conservative antibiotic therapy exhibited low complication rates. Despite limitations in available evidence, this review highlights potential effective interventions for managing ACs, emphasising the need for further comprehensive studies.
The clarification of the concept of colostomy nursing care in ostomy care centers: A concept analysis through Walker and Avant’s method
Authors: Shoja Maryam , Arsalani Narges , Fallahi-Khoshknab Masoud , Mohammadi-Shahboulaghi Farahnaz , Shirozhan Shima
Published: April 2024

BACKGROUND:

Specialist nurses need to have an accurate understanding of colostomy care-related concepts to provide care. Although patients with different types of ostomy have different types of needs, terms such as ostomy care, colostomy care, and ileostomy nursing are interchangeably used. Moreover, there are limited concept analysis studies into the concept of colostomy nursing care (CNC) in ostomy care centers (OCCs). The aim of this study was to analyze and clarify the concept of CNC in outpatient OCCs.

METHODS AND MATERIAL:

This was a concept analysis study. This concept analysis was conducted using Walker and Avant’s eight-step method. The online databases were searched until 2022 to retrieve documents on CNC. Finally, 35 articles and four books were included in the analysis, the defining attributes, antecedents, and consequences of the concepts were determined, and model and additional cases as well as empirical referents were presented.

RESULTS:

The defining attributes of CNC in OCCs are the development of professional role, participatory practice and interdisciplinary care, selection of the best clinical procedures, care based on patient education, and patient rehabilitation. The antecedents of the concept are nurse-related antecedents, patient- and family-related antecedents, environmental antecedents, and professional rules and regulations. Its consequences are patients’ and families’ greater care-related knowledge, improvement of nurses’ care quality, patient autonomy, and self-efficacy.

CONCLUSION:

The concept of CNC in OCCs can be defined as “a continuous and coherent care based on knowledge, skill, expertise, experience, and colostomy type which uses interdisciplinary collaboration and the best available evidence in order to select and provide the best services according to patients’ and families’ culture and background, fulfill patients’ physical, mental, sexual, social, and spiritual needs, and timely refer patients to specialists, with the ultimate goal of improving patient autonomy and facilitating their return to normal life.”