bluuebunny/crossref_metadata_2025_split huggingface dataset:
Orbital Cellulitis Secondary to Dacryocystitis: A Case Series and Literature Review
Authors: O’Rourke Michéal , Tang Yi Fan , Pick Zelda , Tan Jennifer S. , Tan Priscilla E. Z. , Athavale Dnyaneshwar D. , O’Donnell Brett , Selva Dinesh , Gajdatsy Adam , Hardy Thomas G. , McNab Alan , Khong Jwu Jin 
Published: December 2024

Purpose:
This study aimed to determine risk factors, and describe management and outcomes in patients who developed orbital cellulitis secondary to dacryocystitis.

Methods:
Multicenter retrospective case series with 18 patients and review of published cases.

Results:
The mean age was 62 years, 56% were female and 50% had recurrent dacryocystitis. Visual acuity was reduced in the affected eye with a mean of 0.27 logMAR (Snellen 20/40) which improved to 0.15 logMAR (Snellen 20/30) at final follow up. Two cases (12%) had dacryoliths and 1 patient had sarcoidosis within the lacrimal sac. Gram-positive bacteria were identified in 73% (11/15), gram-negative bacteria in 13% (2/15), and mixed infection in 13% (2/15), respectively. Cases who had dacryocystorhinostomy as definitive treatment, either acutely (n = 3) or electively (n = 10) had full resolution. Transcutaneous drainage of the medial wall abscess in 10 patients helped resolve acute cellulitis. Four patients declined dacryocystorhinostomy after transcutaneous drainage; 2 had repeated dacryocystitis and orbital cellulitis, while 2 had no further infective episodes. One immunosuppressed patient had rapid progression to non-perception-of-light vision due to fungal invasion. Forty-six published cases reported up to 28% permanent loss of vision (perception-of-light and non-perception-of-light). Dacryoliths were discovered in 17% of published cases.

Conclusions:
Orbital cellulitis complicating dacryocystitis appears to be related to recurrent dacryocystitis and possibly the presence of dacryoliths. Immunosuppression is identified as a poor prognostic factor in this series. While transcutaneous drainage works well as a temporizing measure, dacryocystorhinostomy either done acutely or deferred until resolution of orbital cellulitis is required for definitive cure.
Adalimumab Use in Severe Recalcitrant Vulval Lichen Sclerosus and Vulval Lichen Planus
Authors: Courtney Ashling , Adamson Sarah Rose , Veysey Emma 
Published: December 2024

Objectives
This case series aims to evaluate the demographic features, disease characteristics, and treatment outcomes of 8 patients receiving subcutaneous (SC) adalimumab for severe, refractory vulval lichen sclerosus (VLS) and/or vulval lichen planus (VLP). Both conditions are chronic inflammatory dermatoses that significantly impair quality of life, and although first-line treatment typically involves potent to ultrapotent topical corticosteroids, managing severe cases is challenging due to a lack of FDA-approved systemic therapies. Adalimumab, a TNF-α inhibitor, may offer a promising alternative by targeting the inflammatory cytokine implicated in the pathogenesis of both conditions.

Methods
Eight patients received SC adalimumab for VLS and/or VLP at a tertiary referral vulvar disorders clinic from September 2020 to June 2024. Among the 8 patients, 4 had VLS/VLP clinical overlap, 2 had VLP, and 2 had VLS. Evaluation included patient-reported outcome measures (PROMs) namely the vulval life quality index (VLQI) and numerical rating scales for itch and pain, and objective clinical severity was assessed by a vulvar dermatologist based on cutaneous signs and architectural features.

Results
Adalimumab was well tolerated by 6 of 8 patients who received treatment for at least 9 months. Varying degrees of clinical improvement were observed in cutaneous signs and PROMs, including significant reductions in vulval life quality index scores for 6 patients. Architectural changes remained stable throughout treatment for all patients.

Conclusion
This case series indicates that SC adalimumab may be a treatment option for patients with severe, refractory VLS and VLP, as demonstrated by significant improvements in PROMs. The observed clinical benefits suggest that adalimumab targets key inflammatory pathways in these conditions. Controlled trials are necessary to further validate these findings and define adalimumab's role in managing severe refractory VLS and VLP. Future research should also investigate long-term efficacy and safety, as well as potential predictors of treatment response, to optimize care for this challenging patient population.
Complete remission after pembrolizumab monotherapy in a non-small cell lung cancer patient with PD-L1 negative, high tumor mutational burden, and positive tumor-infiltrating lymphocytes: A case report
Authors: Li Suoni , Ma Jiequn , Bai Jie , Zhao Zheng 
Published: December 2024

Rationale:
Immune checkpoint inhibitors have been used to treat cancer patients. Non-small cell lung cancer (NSCLC) patients with a high expression level of programmed cell death ligand-1 (PD-L1) could benefit from immune checkpoint inhibitor monotherapy. However, treating NSCLC patients with PD-L1 negative is still a clinical challenge. The utilization of new-type tumor markers as predictive indicators of therapeutic efficacy, with the aim of guiding clinical medication strategies, has emerged as a paramount focus of clinical investigation and interest.

Patient concerns and diagnoses:
We reported a 72-year-old male with cough diagnosed as poorly differentiated metastatic lung adenocarcinoma (cT3N2M1, stage IV). He tested negative for driver gene mutations, and PD-L1 negative (＜1%), but a high tumor mutational burden (30.9 and 39.1 mutations/Mb in the lung tissue and blood, respectively), and positive tumor-infiltrating lymphocytes.

Interventions:
The patient received pembrolizumab monotherapy.

Outcomes:
After 8 treatment cycles over 5 months, repeat examinations showed significantly reduced lung mass and circulating tumor DNA abundance. The patient reached clinical complete remission and had long-term survival with no significant adverse events.

Lessons:
A comprehensive evaluation of multiple tumor biomarkers should be considered in NSCLC patients. Pembrolizumab monotherapy could benefit NSCLC patients with negative driver genes, PD-L1 negative, a high tumor mutational burden, and positive tumor-infiltrating lymphocytes.
Acute myeloid leukemia treatment outcomes with isocitrate dehydrogenase mutations: A systematic review and meta-analysis
Authors: Qin Han , Xu Rui , Yang Yingchao 
Published: December 2024

Background:
Isocitrate dehydrogenase (IDH) gene alterations and acute myeloid leukemia (AML) treatment results remain controversial. This study reviews the literature on IDH mutations in AML to determine the foundation of individualized therapy and improve effectiveness, survival time, and recurrence rate.

Methods:
Seven English and 2 Chinese databases were searched for literature on IDH mutations and AML outcomes. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated.

Results:
Twenty studies were included in this analysis. For the prognostic influence of IDH mutation on AML patients, the pooled HRs of overall survival in AML patients were 0.76 (95% CI, 0.63–0.93); the pooled HRs of event-free survival were 1.34 (95% CI, 1.15–1.57; heterogeneity: I
2 = 52.2%, P = .027 < 0.05); the pooled HRs of recurrence free survival were 0.79 (95% CI, 0.61–1.02). The pooled HRs of overall survival in AML patients with mutant IDH1 were 1.62 (95% CI, 1.42–1.86) and of mutant IDH2 were 1.07 (95% CI, 0.89–1.29). The pooled HRs for event-free survival in AML patients with mutant IDH1 were 1.71 (95% CI, 1.40–2.08) and of mutant IDH2 were 0.93 (95% CI, 0.65–1.34). No evidence of publication bias was observed.

Conclusions:
Different subtypes of IDH mutations may lead to different AML prognoses, suggesting the feasibility of personalized treatment for AML patients.
Heparin-induced thrombocytopenia during anticoagulation therapy for COVID-19-related pulmonary embolism: A case report
Authors: Zhang Yu , Chen Zhenling , Li Jianying , Wang Xuejing , Liu Yi 
Published: December 2024

Rationale:
One of the main characteristics of COVID-19 is the high incidence of venous thromboembolism, particularly pulmonary embolism. Anticoagulation therapy is the primary treatment for pulmonary embolism. Heparin-induced thrombocytopenia (HIT) is an antibody-mediated adverse reaction to heparin that occurs during its use of heparin drugs. The main clinical manifestation is a decrease in platelet count, which can lead to the formation of arterial and venous thrombosis and, in severe cases, even death. Herein, we present a case of HIT that occurred during anticoagulation therapy for COVID-19, complicated by pulmonary embolism.

Patient concerns:
An 86-year-old man with COVID-19 experienced a significant decrease in platelet count and progression of venous thrombosis in the lower extremities during anticoagulation therapy with nadroparin.

Diagnoses:
The 4T score was 6; therefore, HIT was considered.

Interventions and outcomes:
All heparin-based drugs were discontinued, and argatroban was administered as anticoagulation therapy. The patient’s platelet count was monitored, and it gradually returned to normal.

Lessons:
Clinicians should remain vigilant to venous thromboembolism for COVID-19 patients even after recovery. During anticoagulant therapy, if thrombocytopenia occurs, HIT should be considered due to its high mortality rate. The 4T scoring system was used for the initial assessment. HIT antibodies can be detected, if necessary, to assist in diagnosis and reduce the occurrence of severe HIT. In the future, by detecting certain biomarkers, we can screen out patients with HIT who are more prone to thrombotic events, thereby minimizing the risk of bleeding caused by anticoagulation.
Metastatic dedifferentiated liposarcoma of the mediastinum with osteosarcomatous differentiation: A case report
Authors: Hu Cong , Nong Shuxiong , Liu Aihua , Huang Weiling , Qi Yin , Wang Ying , Ye Yingfang , Jiang Yuancheng , Chen Yixin , Zhang Qi , Wu Meng 
Published: December 2024

Rationale:
Liposarcoma is a malignant tumor of adipocytic differentiation that rarely arises within the mediastinum. Most of the existing data available comes from scattered case reports and a few small series.

Patient concerns:
A 51-year-old man was admitted with cough and sputum accompanied by fever. X-ray and CT showed a bulky anterior mediastinal mass that was initially misdiagnosed as a teratoma. PET/CT demonstrated a lesion on that location showing a small area of moderately intense uptake. After surgical excision, histopathological examination via hematoxylin and eosin first revealed the diagnosis of malignant undifferentiated tumors. The results of immunohistochemical evaluations were as follows: P63 (scattered +), VIMENTIN (giant cell +), CD68 (KPI; giant cell +), SMA (−), and Ki-67 (Li: 50%). Molecular pathology: MDM2 gene status (+) with amplification.

Diagnoses:
The final histopathological diagnosis was dedifferentiated liposarcoma with osteosarcomatous differentiation.

Interventions:
The patient underwent left mediastinal tumor resection, left upper lobe wedge resection and postoperative chemotherapy.

Outcomes:
Mediastinal recurrences and chest wall metastases occurred quickly before the second round of chemotherapy 2 months later. Four months after surgery, the patient died.

Lessons:
This paper presents a case of dedifferentiated liposarcoma with osteosarcomatous differentiation in a rare location: the mediastinum. Correct diagnosis is of importance for appropriate choice of therapy. Clinicians should be aware of the presence of a dedifferentiated liposarcoma within a mass on the mediastinum and enhancing treatment and management strategies for affected patients.
Cutting-edge and topical issues in the treatment of breast cancer with traditional Chinese medicine based on CiteSpace bibliometric analysis
Authors: Chai Jiapeng , Zhang Nan , Li Tie , Jiang Hailin , Zhao Jinying , Li Xuefeng , Wang Heran , Zhang Jiaxun , Wang Lin , Zhang Qi , Jiang Yuxin , Wang Fuchun 
Published: December 2024

Background:
Breast cancer poses a significant health threat to women, marked by high incidence and mortality rates. Although modern treatment primarily involves surgery and chemotherapy, which may reduce quality of life, limited analysis exists on the effects of traditional Chinese medicine (TCM) on this aspect. In this paper, bibliometric software was used to study the literature related to TCM in the treatment of breast cancer to provide researchers with new insights and directions for development.

Methods:
By using CiteSpace and VOSviewer, we conducted an analysis of literature on TCM in breast cancer treatment from the Web of Science Core Collection (2013–2023). The assessment encompassed countries, institutions, journals, authors, keywords, and references, providing a comprehensive overview of developments in the field.

Results:
Analyzing 7419 articles, this study revealed an increasing trend in TCM research on breast cancer from 2013 to 2023. China and its institutions, particularly Beijing University of Chinese Medicine, made significant contributions. Liu Zhishun emerged as the most prolific author, while Y. Macpherson received the highest number of citations. The journal Evidence-Based Complementary and Alternative Medicine received the highest number of citations. Research primarily centers on TCM approaches for enhancing breast cancer patients’ quality of life and elucidating their underlying mechanisms.

Conclusion:
Numerous studies have investigated TCM in treating female breast cancer, revealing treatment trends, analyzing major research topics, currently focusing on acupuncture, breastfeeding, and TCM, which have a greater impact on positively ameliorating breast cancer. Influential authors and publications were also identified. These insights provide valuable guidance for future research, contributing to the foundation for developing effective TCM strategies for breast cancer.
Amoxicillin-associated hemorrhagic colitis: A case report and literature review
Authors: Xiong Yu-Ling , Peng Chao , Deng Ying-Jiang , Li Wei , Huang Yin , Tian Yue 
Published: December 2024

Rationale:
Antibiotic-associated hemorrhagic colitis (AAHC) is a special type of antibiotic-associated colitis. Due to the increased use of antibiotics, especially amoxicillin, which is commonly used in clinical practice, the incidence of antibiotic-associated hemorrhagic colitis has also increased. However, doctors have insufficient understanding of this disease, and patients may be missed or misdiagnosed.

Patient concerns:
A 71-year-old female patient was admitted to our hospital with abdominal pain, diarrhea, and bloody stools. There was a history of oral amoxicillin before the onset of the disease.

Diagnosis:
The final diagnosis of this patient was amoxicillin-associated hemorrhagic colitis.

Interventions:
The patient stopped using antibiotics and was given “Bifidobacterium quadruplex live bacterial tablets and L-glutamine sodium gualenate granules” orally.

Outcomes:
After oral administration, the patient’s symptom rapidly were completely alleviate. Follow-up colonoscopy revealed normal mucosal images.

Lesson:
Through this case report, doctors should increase their understanding of the disease, especially for patients with sudden abdominal pain accompanied by bloody stools as the main complaint, it is significant to attend to inquiries about the history of antibiotic use, such as amoxicillin, and pay attention to the discovery of acid-producing Klebsiella in the fecal microbiota.
Anti-NMDAR encephalitis presenting with persistent fever and meningitis and responding well to distinctive individualized first-line treatment: A case report
Authors: Jin Xin , Zhuang Jianhua , Xu Jin 
Published: December 2024

Rationale:
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis characterized by diverse neurological and psychiatric symptoms. It predominantly affects young women, particularly those with ovarian teratomas. However, cases without teratomas are also commonly reported, often exhibiting poorer treatment responses and higher relapse rates. Persistent fever and signs of meningitis are rare in such cases. Diagnosis is confirmed through the detection of anti-NMDAR antibodies.

Patient concerns:
A 15-year-old female presented with episodic loss of consciousness, fever, nuchal rigidity, limb convulsions, and psychiatric symptoms following a stressful exam period. Initial symptomatic treatments were ineffective.

Diagnosis:
The diagnosis of anti-NMDAR encephalitis was confirmed through lumbar puncture, brain imaging, and the detection of anti-NMDAR antibodies in cerebrospinal fluid and serum.

Interventions:
The patient received tailored first-line therapy, including high-dose methylprednisolone and 3 courses of intravenous immunoglobulin (IVIG).

Outcomes:
The patient exhibited significant clinical improvement, with a reduction in seizure frequency and eventual complete seizure control. Body temperature normalized, and follow-up showed progressive recovery in cognitive and motor functions.

Lessons:
This case highlights the importance of early diagnosis and individualized treatment in anti-NMDAR encephalitis. Repeated IVIG courses proved effective, underscoring the need for personalized treatment plans in managing this condition. Persistent fever and signs of meningitis were rare and contributed to the diagnostic challenge, highlighting the clinical complexity of this case.
Effectiveness of virtual reality in cardiac rehabilitation patients for exercise capacity and negative emotions: A systematic review and meta-analysis
Authors: Zhang Meijun , Liu Si , Xiong Xiaoyun , Liu Mengdie , Wang Ying , Yang Ying , Xiang Qin 
Published: December 2024

Background:
The significance of virtual reality (VR) technology as an alternative or complementary modality to traditional cardiac rehabilitation is of increasing interest. Numerous studies have examined the effects of virtual reality technology in cardiac rehabilitation patients, but the results have been inconsistent.

Methods:
We conducted a systematic search of the Cochrane Library, Web of Science, PubMed, Embase, Scopus, ProQuest, OVID, CINAHL, SinoMed, CNKI, WanFang, VIP Database, and ReadShow databases following the Program for Systematic Review and Meta-Analysis guidelines. The search included studies published up until June 30, 2024. The Cochrane Risk of Bias Tool was used to examine the methodological quality of the included randomized controlled studies. When feasible, a meta-analysis was performed to calculate the pooled effects using Review Manager (version 5.3). Otherwise, narrative summaries were performed.

Results:
A total of 11 studies with 1093 patients were included. The results of systematic review and meta-analysis showed that virtual reality technology improved patients’ exercise capacity (mean difference: 53.26, 95% confidence interval [CI]: 45.14–61.37; P < .00001); anxiety (standardized mean difference [SMD]: −0.39, 95% CI: −0.69, −0.08, P = .01); depression (SMD: −0.48, 95% CI: −0.79, −0.17; P = .003); stress (SMD: −0.72, 95% CI: −1.03, −0.40; P < .00001); emotional tension (SMD: −0.81, 95% CI: −1.15, −0.47; P < .00001); emotional tension (SMD: −0.64, 95% CI: −0.98, −0.30; P = .0002), and intrapsychic stress (SMD: −0.56, 95% CI: −0.90, −0.23; P = .0009).

Conclusion:
Virtual reality-based interventions can be effective in improving patients’ exercise capacity and negative emotions. However, further research is needed to determine the efficacy of VR for other clinical outcomes.
Large uterine fibroid causing DVT and PE: Successful management with mechanical aspiration thrombectomy and hysterectomy: A case report and literature review
Authors: Qammar Asfia , Raja Sandesh , Raja Adarsh , Chaulagain Aayush , Moshayedi Poupak , East Cara 
Published: December 2024

Rationale:
Uterine leiomyomas, though commonly benign, can occasionally lead to serious complications, including deep vein thrombosis (DVT) and pulmonary embolism (PE). This study aims to highlight the uncommon yet serious association between large uterine leiomyomas and thromboembolism, which is often overlooked in patients without traditional risk factors. It emphasizes the need for awareness, early diagnosis, and timely intervention to prevent complications in patients presenting with unexplained symptoms and pelvic masses.

Patient concern:
A 38-year-old gravida 5, para 2 woman presented to the emergency room with left lower extremity swelling, pain, and discoloration, accompanied by dyspnea. She had no prior history of DVT or PE and did not have any known risk factors for venous thromboembolism.

Diagnosis:
The patient was diagnosed with DVT and PE, confirmed by venous duplex ultrasound and abdominal and pelvic computed tomography, which revealed thrombus extension to the left iliac vein. Chest computed tomography angiography confirmed a partially occlusive thrombus in the pulmonary arteries.

Intervention:
The patient underwent mechanical aspiration thrombectomy, followed by placement of a left iliac stent. Anticoagulation therapy with heparin was initiated post-thrombectomy. On the third day, a right supracervical hysterectomy was successfully performed. After surgery, anticoagulation was continued with heparin, and the patient was later discharged on apixaban for ongoing therapy.

Outcomes:
The patient made full recovery with no recurrence of thromboembolic events at 11 months posttreatment.

Lessons:
This case highlights the rare but serious complication of DVT and PE in patients with uterine leiomyomas. Timely intervention with thrombectomy, stent placement, and hysterectomy was effective in resolving the thromboembolic events.
Therapeutic Efficacy of Tirofiban Combined With Thrombus Aspiration and Stent Thrombectomy in the Treatment of Large Vessel Occlusion Ischemic Stroke
Authors: Jiao Yang , Wang Xiaoli , Guan Yaxin , Wang Xinxin , Li Zhaosheng , Xiang Xiuzhi , Zhang Zhongmin 
Published: December 2024

Objective:
This research aimed to ascertain the effects of tirofiban combined with thrombus aspiration and stent thrombectomy on large vessel occlusion ischemic stroke (LVO-IS).

Methods:
Sixty patients with acute ischemic stroke (AIS) caused by LVO were randomized into the control group and the intervention group (n=30). Patients in the control group received thrombus aspiration combined with stent thrombectomy, while those in the intervention group were treated with tirofiban combined with thrombus aspiration and stent thrombectomy. General data, perioperative-related indicators, cerebral blood flow perfusion, coagulation function indicators, and neurological function indicators were collected, and the prognosis was observed after 3-month treatment.

Results:
A comparison of symptomatic cerebral hemorrhage rate and hospital mortality rate between the 2 groups displayed no significant difference (P>0.05). The rate of revascularization in the intervention group (90.00%) was higher versus the control group (66.67%). After treatment, the mean blood flow and cerebral blood volume of the intervention group were higher and the time to peak cerebral blood flow was less versus the control group. The prothrombin time, activated partial thromboplastin time, and prothrombinogen time of the intervention group were higher, and fibrinogen was lower versus the control group. A lower National Institutes of Health Stroke Scale score was observed in the intervention group versus the control group.

Conclusions:
Tirofiban combined with thrombus aspiration and stent thrombectomy has good efficacy in LVO-IS patients.