bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pancreaticopleural fistula causing recurrent bilateral pleural effusions: A case report
Authors: Liu Rixiang , Su Ruolin , Yan Haiyu , Zhu Huangxin , Zhang Nuobei 
Published: December 2024

Rationale:
Pancreaticopleural fistula (PPF) is an infrequent etiology of pleural effusion, characterized by nonspecific thoracic symptoms, which often leads to misdiagnosis and subsequent severe complications. Consequently, early diagnosis is crucial for effective management and the prevention of adverse outcomes. This report presents a rare case of PPF causing bilateral pleural effusions, aiming to enhance clinical recognition of this condition.

Patient concerns:
A 51-year-old male with a history of hepatitis B, pulmonary tuberculosis, and chronic pancreatitis presented with recurrent chest tightness, dyspnea, and significant weight loss. He had undergone multiple hospitalizations for pleural effusions with no definitive diagnosis.

Diagnoses:
The patient exhibited a marked increase in amylase levels within the pleural effusion, and magnetic resonance cholangiopancreatography revealed a pancreatic pseudocyst herniating into the mediastinum. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated mild dilation of the pancreatic duct, leading to a definitive diagnosis of PPF.

Interventions:
Despite initial conservative measures, including thoracentesis, antimicrobial therapy, and somatostatin analogs, the patient continued to experience persistent pleural effusion. Ultimately, ERCP with pancreatic duct stent placement was performed, leading to a significant improvement in the patient’s condition.

Outcomes:
Re-evaluation 2 months postdischarge using a thoracoabdominal computed tomography scan confirmed near-complete resolution of the pancreatic pseudocyst, absence of pleural effusion, and normalization of pancreatic function.

Lessons:
This case underscores the importance of a multidisciplinary approach in diagnosing and managing PPF. It highlights the utility of ERCP in both diagnosing and treating PPF and the need for early recognition to prevent diagnostic delays and improve patient outcomes.
Immunochemotherapy for small cell lung cancer with paraneoplastic Cushing syndrome: A case report and literature review
Authors: Yu Ling , Li Yanlong , Li Caiyu , Qi Xiangjun , Lin Yeding , Li Yuanliang , Chen Hanrui , Lin Lizhu 
Published: December 2024

Rationale:
Paraneoplastic Cushing syndrome (PCS) is an adverse prognostic factor for small cell lung cancer (SCLC) patients. Retrospective studies have shown that the median survival of SCLC complicated with PCS was <7 months. No immunochemotherapy has been recorded in the treatment of SCLC with PCS. Previous preclinical and clinical studies have suggested glucocorticoid exposure may affect the efficacy of immunotherapy.

Patient concerns and diagnosis:
A 60-year-old man was admitted for his irritability and palpitation. During hospitalization, a chest computed tomography scan revealed a lobar soft tissue shadow in his left lower lung. He was diagnosed as limited-stage SCLC (T2bN1M0 IIB) with PCS, ultimately.

Interventions and outcome:
The patient received 4 courses of immunochemotherapy of etoposide plus platinum with durvalumab and 1 adjuvant radiotherapy alone in 2022 for his limited-stage SCLC, and underwent 5 courses of immunochemotherapy of irinotecan plus platinum with serplulimab in 2023 for his extensive-stage SCLC. The patient achieved a long survival of 20 months.

Lessons:
The case preliminarily demonstrated the efficacy of immunochemotherapy in the management of SCLC complicated with PCS. The regime of serplulimab with irinotecan-based chemotherapy also indicated its satisfactory efficacy as a second-line treatment for extensive-stage SCLC. Furthermore, the case has highlighted that the management of hypercortisolism, the improvement of myelosuppression, and the prophylaxis against infection were 3 hinges for the continuation of immunochemotherapy and the holistic management of SCLC with PCS.
A case report of adenomyosis-induced spontaneous rupture in an unscarred and unpregnant uterus
Authors: Liu Yan , Hu Xiaoling , Lv Wen , Xu Yingzi 
Published: December 2024

Rationale:
Spontaneous uterine rupture, although rare, is a life-threatening obstetric emergency with a high maternal and fetal mortality rate. It can occur without warning, leading to severe complications, including hemorrhage, shock, and fetal demise. The risk factors contributing to uterine rupture are diverse and include a history of uterine surgery (such as cesarean section), trauma to the uterus, abnormal uterine contractions during labor, and underlying conditions like adenomyosis. Identifying and understanding these risk factors are crucial for early detection, timely intervention, and improved outcomes in affected pregnancies.

Patient concerns:
Here, we report an exceptionally rare case of spontaneous uterine rupture triggered by adenomyosis in a 34-year-old unmarried and nulliparous woman with no prior scarring or pregnancy. Physical examination revealed abdominal distension, with the uterine fundus at the level of the umbilicus, exhibiting hardness, tenderness upon palpation, and rebound tenderness. Ultrasonography and computerized tomography scans suggested adenomyosis and uterine rupture. During surgery, a rupture was discovered in the left basal layer of the uterus, with a rupture diameter of approximately 3 cm. Additionally, there were multiple internal endometrial lesions in the uterorectal pouch.

Diagnoses:
Adenomyosis-induced spontaneous uterine rupture.

Interventions:
The procedures performed included excision of adenomyotic lesions, repair of the uterine rupture, and electrocoagulation of endometriotic lesions in the pelvic cavity.

Outcomes:
At the 1-month post-surgery follow-up examination, the patient showed good recovery, with no signs of complications. She was able to resume normal daily activities without difficulty. The surgical site was healing well, with no signs of infection or abnormal scarring. Ultrasound and clinical assessments confirmed the resolution of pelvic fluid accumulation, and uterine function appeared to be intact. The patient was advised to continue regular follow-up visits to monitor her recovery and ensure long-term well-being.

Lessons:
First, uterine rupture caused by adenomyosis in a nonpregnant, scarless uterus is extremely rare but still possible. When patients with severe adenomyosis present with abdominal pain and pelvic fluid, obstetricians and gynecologists should consider the possibility of uterine rupture. Second, ultrasound examination can quickly and accurately diagnose both adenomyosis and uterine rupture.
Surgical management of testicular cancer with limited retroperitoneal disease
Authors: Sigg Silvan , Rothermundt Christian , Fankhauser Christian Daniel 
Published: December 2024

Purpose of review
Chemotherapy offers excellent long-term survival rates for men with clinical stage II germ cell tumours. However, in this predominantly younger population, chemotherapy is associated with long-term adverse effects. Primary retroperitoneal lymph node dissection (RPLND) may serve as an alternative treatment option, preserving oncological safety while potentially reducing adverse effects in men with limited retroperitoneal disease.

Recent findings
The rate of negative surgical specimens (pN0) in primary RPLND series varies between 4% and 16% in seminoma and 12–29% in nonseminoma, respectively. This suggests that early restaging, novel biomarkers, and/or percutaneous biopsies should be considered to minimize overtreatment. In stage II seminoma, three prospective RPLND series with follow-up periods ranging from 22 to 51 months report recurrence rates between 6% and 30%. In contrast, only retrospective data are available for stage II nonseminoma, with follow-up periods and recurrence rates yet to be fully defined. Following primary RPLND with confirmed viable cancer, adjuvant chemotherapy reduces recurrence risk. In cases of recurrence after primary RPLND, first-line chemotherapy remains a highly effective salvage option. Ongoing research is needed to identify risk factors for contralateral retroperitoneal disease to refine surgical templates and to determine predictors of recurrence, allowing for more personalized decisions regarding the use of adjuvant chemotherapy and follow-up strategies.

Summary
Men with clinical stage II germ cell tumours may benefit from RPLND due to its lower risk of long-term side effects. Chemotherapy is an effective salvage treatment if needed. Although RPLND is a safe and promising option, further studies are required to better understand relapse risks and to tailor treatment plans based on individual patient factors.
Haemophilus influenzae-induced epididymitis: a rare case report
Authors: Patel Dev , Walker Luke , Patel Nalini , Patel Tirath , Kaithamanakallam Rajesh Perumbilavil 
Published: December 2024

Introduction and importance:
Epididymitis is a common urological condition typically caused by Chlamydia trachomatis or Neisseria gonorrhoeae, with rare complications like abscess formation. Haemophilus influenzae, usually linked to respiratory infections, is an uncommon cause. This report discusses a 33-year-old male with H. influenzae epididymitis, bacteremia, and a positive NAAT for Chlamydia, presenting a rare and complex clinical scenario. His history of vasectomy adds further intricacy to the case. This highlights the importance of recognizing atypical pathogens, conducting thorough diagnostic evaluations, and tailoring management strategies for unusual presentations of epididymitis.

Case presentation:
A 33-year-old male with GERD and a history of vasectomy presented with 1 day of fevers, chills, and worsening left-sided scrotal pain. Examination showed localized scrotal tenderness and a temperature of 100.9°F. Blood cultures revealed H. influenzae, and NAAT confirmed Chlamydia with negative Gonorrhea testing. Ultrasound suggested epididymitis with a possible abscess, while CT showed scrotal edema without a drainable collection. Follow-up imaging maintained concerns for an abscess. Treated with Rocephin and Doxycycline, the patient showed clinical improvement, with plans for serial imaging to monitor resolution and ensure full recovery.

Clinical discussion:
This case highlights the challenges of managing epididymitis caused by the atypical pathogen H. influenzae. Rare in genitourinary infections, its detection raises questions about pathogenesis, possibly linked to the patient’s vasectomy altering local immunity. Co-infection with Chlamydia may have exacerbated localized inflammation. Serial imaging, particularly ultrasound, proved critical in identifying an abscess overlooked by CT. Management involved targeted antibiotics, careful monitoring of blood cultures, and follow-up imaging to prevent complications. The case underscores the importance of a broad differential diagnosis and tailored treatment in managing rare presentations of epididymitis.

Conclusion:
This report highlights a rare case of H. influenzae-induced epididymitis with bacteremia and co-existing Chlamydia infection in a post-vasectomy patient. It underscores the importance of recognizing uncommon pathogens, especially in patients with unique risk factors like vasectomy. Serial imaging was crucial for identifying complications such as abscess formation. Early diagnosis and targeted therapy were essential in preventing serious outcomes like chronic inflammation or abscess rupture. This case contributes to the limited literature on atypical epididymitis, emphasizing the need for a multidisciplinary approach in managing complex infections effectively.
Short-term mortality and readmission rate prediction by the sequential organ failure assessment score in acute decompensated heart failure
Authors: Hoang Van , Tran Van Dong , Tran Thanh Hoa , Nguyen Van Dan , Nguyen Van Thuc , Vu Quynh Nga , Tran Tra Giang 
Published: December 2024

Background:
Data on the use of sequential organ failure assessment (SOFA) in patients with cardiovascular disease are increasing. Several studies demonstrated that the SOFA score can identify short-term mortality in patients with acute decompensated heart failure (ADHF). This study was conducted to determine the prognostic value of the admission SOFA score in patients hospitalized for ADHF and to assess its ability in predicting the 30-day readmission rate.

Materials and methods:
This study was conducted from July 2022 to August 2023 at our institution. A total of 216 patients were included in the study, and the SOFA score was calculated for all patients.

Results:
The average SOFA score is 3.14 ± 2.67, of which SOFA scores of ≤1, 2–3, and ≥4 account for 34.3%, 27.8%, and 37.9% of the total score, respectively. During the 30-day follow-up period, there were 22 cases of death from all causes (10.2%), of which in-hospital mortality accounted for 9.7%. Patients with all-cause mortality had higher SOFA scores than the survivors (7.32 ± 2.93 and 2.66 ± 2.12, respectively). The area under the receiver operating characteristic curve (AUC) for the SOFA score is 0.897 [95% confidence interval (CI) = 0.830–0.964] for 30-day mortality. The SOFA score was also compared with other validated risk scores, namely, the Get With the Guidelines-Heart Failure (GWTG-HF) risk score and the Acute Decompensated Heart Failure National Registry (ADHERE) score. In this study cohort, the SOFA score demonstrates superior predictive accuracy to the GWTG-HF and ADHERE scores [the AUCs when predicting 30-day mortality are 0.769 (95% CI = 0.676–0.862) and 0.789 (95% CI = 0.705–0.873), respectively].

Conclusion:
The SOFA score might be used to screen high-risk patients for optimization strategy in the treatment of ADHF.
A Randomized Controlled Feasibility Study to Evaluate the Online Delivery of Storytelling Through Music With Oncology Nurses
Authors: Phillips Carolyn S. , Morris Sue E. , Woods Heather , Mazzola Emanuele , Xiong Niya , Young Cara , Stuifbergen Alexa , Hammer Marilyn , Ligibel Jennifer 
Published: December 2024

Background
Oncology nurses frequently contend with intense work-related emotions stemming from their roles, which include bearing witness to suffering, managing end-of-life care, and navigating ethical dilemmas. These emotional challenges can lead to burnout, compassion fatigue, and overall psychological distress.

Objective
To determine the feasibility, acceptability, and preliminary effect of implementing Storytelling Through Music (STM) online with oncology nurses.

Intervention/Methods
This study (trial registration: NCT04775524) was a 2-group, randomized wait-list controlled trial, utilizing quantitative and qualitative methods. STM is a 6-week intervention that combines storytelling, reflective writing, songwriting, and psychoeducation. Data were collected in both groups at 3 timepoints and analyzed with descriptive statistics, conventional content analysis, and nonparametric tests.

Results
The oncology nurses (n = 24) were primarily female (96%) and White (79%), with an average of 15.98 (range, 2-51) years of nursing experience. All STM participants completed the intervention and found it acceptable. STM participants had greater improvements in burnout, secondary traumatic stress, anxiety, depression, and posttraumatic growth.

Conclusion
The online delivery of STM proved feasible and acceptable, demonstrating potential scalability across diverse geographic locations, and showed promise in reducing psychological distress and burnout. Future research should consider larger-scale studies with diverse participant demographics and settings to validate these findings further.

Implications for Practice
Results highlight the potential value of integrating expressive arts into comprehensive support programs for nurses. By implementing interventions that acknowledge and support the emotional demands of their work, healthcare organizations can better equip oncology nurses to navigate the complexities of their roles while maintaining their well-being.
Gastric cancer
Authors: Coffman Tammie J. 
Published: December 2024

Abstract:
Patients with gastric cancer experience symptoms that impact adequate nutritional intake. Delayed diagnosis may result in advanced disease. Surgery, chemotherapy, biologic therapy, and radiotherapy comprise interventions. This article discusses gastric cancer incidence and risks, treatment approaches, and nursing management of patients with gastric cancer, including advanced care planning for patients with terminal diagnoses.
When Auditing Is Not Enough: Analysis of a Central Line Bundle Audit Program
Authors: Linke Christopher A. , Hodges Paul , Edgerton Megan E. , Bjorgaard Johannah D. 
Published: December 2024

Background:
Bundled interventions and auditing have been recommended to reduce central line-associated bloodstream infection (CLABSI) events at acute care hospitals. We review the outcomes of a bundle audit program at an adult and pediatric academic medical center from April 1, 2021, to May 31, 2022.

Objectives:
To analyze the impact on CLABSI rates following the introduction of a central line maintenance bundle audit process.

Methods:
All audit survey data, CLABSI event rates, and line days were collected. Statistical relationships were evaluated for CLABSI bundle performance with CLABSI rates and audit volume with CLABSI rates. Analyses were conducted at the hospital and unit level.

Result:
No correlation is found between CLABSI rates and audit performance at the hospital level (adult units, P = .619, r-sq = 2.13%; peds/NICU, P = .825, r-sq = 0.43%) or at the unit level (n = 7; P = .8-.896, r-sq = 0.15%-18.2%). There was no correlation in CLABSI rates when reviewing performance by audit volume at the hospital level (adult, P = .65, r-sq = 1.7%; peds/NICU, P = .677, r-sq = 1.5%) or at the unit level (n = 7; P = .25-.8, r-sq = 1.2%-8.5%). By contrast, a single unit that did not participate in the audit program during the sample period reported a lower CLABSI rate than comparable participating units (P = .008).

Conclusion:
During the sample period, there was no relationship found between this CLABSI bundle audit program and improvement in CLABSI performance.
Do emergency Medicaid programs improve post-discharge health care access for trauma patients? A statewide mixed-methods study
Authors: Knowlton Lisa Marie , Arnow Katherine , Cosby Zaria , Davis Kristen , Hendricks Wesley D. , Gibson Alexander B. , Chen Peiqi , Morris Arden M. , Wagner Todd H. 
Published: December 2024

BACKGROUND
Hospital presumptive eligibility (HPE) emergency Medicaid programs offset patient bills at hospitalization and can provide long-term Medicaid coverage. We characterized postdischarge outpatient health care utilization among HPE Medicaid trauma patients and identified patient access facilitators and barriers once newly insured. We hypothesized utilization would be increased among HPE trauma patients compared with other HPE patients, but that challenges in access to care would remain.

METHODS
We performed a convergent mixed methods study of California HPE beneficiaries using a 2016 to 2021 customized statewide longitudinal claims dataset from the Department of Health Care Services. We compared adults 18 years and older with a diagnosis to other HPE patients. Patients were tracked for 2 months postdischarge to evaluate health care utilization: outpatient specialist visits, emergency room (ER) visits, readmissions, and mental health. Thematic analysis of semistructured interviews with HPE Medicaid patients aimed to understand facilitators and barriers to access to care (n = 20).

RESULTS
Among 199,885 HPE patients, 39,677 (19.8%) had a primary diagnosis of trauma. In the 2 months postdischarge, 40.8% of trauma vs. 36.6% of nontrauma accessed outpatient specialist services; 18.6% vs. 17.2% returned to ED, 8.4% vs. 10.2% were readmitted; and 1.4% vs. 1.8% accessed mental health services. In adjusted analyses, trauma HPE patients had 1.18 increased odds of accessing outpatient specialist services (p < 0.01). Patients cited HPE facilitators to accessing care: rapid insurance acquisition, outpatient follow-up, hospital staff support, as well as ongoing barriers to access (HPE program information recall, lack of hospital staff follow up postdischarge, and difficulty navigating a complex health care system).

CONCLUSION
Hospital presumptive eligibility Medicaid is associated with higher rates of outpatient specialist visits and fewer readmissions following injury, suggesting improved trauma patient access. Opportunities to improve appropriateness of health care utilization include more robust and longitudinal education and engagement with HPE Medicaid patients to help them navigate newfound access to services.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
Dynamic Preservation of Donation After Circulatory Death Liver Grafts From Donors Aged 60 y and Older
Authors: Blondeel Joris , van Leeuwen Otto B. , Schurink Ivo J. , Lantinga Veerle A. , Gilbo Nicholas , de Goeij Femke H.C. , Pirenne Jacques , Huurman Volkert A.L. , de Meijer Vincent E. , de Jonge Jeroen , Porte Robert J. , Monbaliu Diethard 
Published: December 2024

Background.
Donor livers from older donation after circulatory death (DCD) donors are frequently discarded for transplantation because of the high risk of graft failure. It is unknown whether DCD livers from older donors benefit from dynamic preservation.

Methods.
In a multicenter study, we retrospectively compared graft and patient outcomes after transplantation of livers from DCD donors older than 60 y, preserved with either static cold storage (SCS), ex situ sequential dual hypothermic perfusion, controlled oxygenated rewarming, and normothermic perfusion (DHOPE-COR-NMP), or in situ abdominal normothermic regional perfusion (aNRP).

Results.
Fifty-six liver transplants were included in the SCS cohort, 33 in the DHOPE-COR-NMP cohort, and 27 in the aNRP cohort. Donor warm ischemia time was significantly shorter in the SCS group than in DHOPE-COR-NMP (P < 0.001) and aNRP (P < 0.001) groups. Cold ischemia times were similar. One-year incidence of nonanastomotic biliary strictures was lower after DHOPE-COR-NMP (3%, P = 0.03) or aNRP (7%, P = 0.13), compared with SCS alone (21%). Anastomotic strictures were less frequent in aNRP (19%) compared with DHOPE-COR-NMP (52%; P = 0.015). One-year graft and patient survival were similar.

Conclusions.
Dynamic preservation allows safe transplantation of livers from DCD donors aged 60 y or older. The risk of nonanastomotic strictures was significantly lower after DHOPE-COR-NMP than after SCS, despite longer donor warm ischemia times.
Comparison of the virulence of community and hospital isolated Acinetobacter baumannii in HeLa cell line and insect model, Galleria mellonella
Authors: Muzahid Nazmul Hasan , Ramesh Aarthi , Siew Tan Hock , Hasan Md Zobaer , Narayanan Kumaran , Rahman Sadequr 
Published: December 2024

Acinetobacter baumannii is an important nosocomial pathogen causing high infections and morbidity among affected individuals and most studies focus on nosocomial strains. However, A. baumannii can also be isolated from community healthy individuals. This study compared the pathogenicity of hospital and community A. baumannii isolates using Galleria mellonella and human cell cultures. The insect model, G. mellonella and in vitro HeLa cell line were used with ten A. baumannii isolates (six community and four hospital isolates from Segamat, Malaysia). G. mellonella killing assays and HeLa cell adherence, invasion, and cytotoxicity assays were performed to investigate the virulence and invasion potential of the isolates. Out of the ten isolates investigated, three community and two hospital isolates were found to be highly virulent in G. mellonella infection model, killing 100 % larvae within 96 hours. These strains were also found to be invasive and have significant cytotoxicity in HeLa cells. Our study revealed that community and hospital isolated A. baumannii could be equally virulent judged by both model systems. Undoubtedly, besides hospital settings, the presence of highly virulent A. baumannii in community reservoirs poses a significant public health risk and requires additional investigation.