bluuebunny/crossref_metadata_2025_split huggingface dataset:
A New Twist on the Surgeon's Knot: Quantifying Suture Security
Authors: Modiri Omeed , Ebriani Joseph , Sauvageau Andrew , Davis Jeremy 
Published: November 2024

BACKGROUND
The reliability and security of surgical knots play a critical role in wound closure and healing. A surgeon's knot, created by a modification of the square knot in which an extra ‘twist’ is added to the initial throw, is often used to increase friction and provide stability of the tissue as the knot is completed.

OBJECTIVE
The purpose of this study was to quantify the security of sutures, as influenced by varying numbers of initial twists in a surgeon's knot.

MATERIALS AND METHODS
Using pig's feet for simulation, the study compared the security of knots tied with 2 types of sutures in 3 different sizes, examining the impact of 1 to 6 initial twists. Univariable linear regression was performed to evaluate the association between increased twists and the force required to loosen each knot.

RESULTS
These data showed that suture security generally improves with an increasing number of twists, up to 5, beyond which benefits diminish in certain suture sizes.

CONCLUSION
Increasing the number of twists in a surgeon's knot significantly enhances suture integrity, with optimal results in knot security observed between 3 to 5 twists, suggesting that a balance is necessary between knot security and ease of application.
Persistent visual field deficit after half-fluence photodynamic therapy for chronic central serous chorioretinopathy
Authors: Micevych Paul S. , Stewart Jay M. 
Published: November 2024

PURPOSE:
To report a rare case of a persistent paracentral scotoma after half-fluence photodynamic therapy for chronic central serous chorioretinopathy.

METHODS:
A 65-year-old man with a history of chronic central serous chorioretinopathy presented with a temporal paracentral visual distortion one week after undergoing repeat off-label treatment with half-fluence verteporfin photodynamic therapy for recurrent intraretinal fluid exudation in the right eye. Fundus photography, fundus autofluorescence, optical coherence tomography, fluorescein angiography, indocyanine green angiography, and automatic visual field testing were obtained.

RESULTS:
Humphrey visual field 10-2 demonstrated a focal temporal paracentral area of reduced sensitivity, which remained persistent on repeat testing up to 9 months. OCT macula and fluorescein angiography demonstrated subtle corresponding changes in the nasal macula, while indocyanine green angiography demonstrated no visible alteration in choroidal perfusion.

CONCLUSION:
Symptomatic scotoma in the location of laser treatment may be a rare complication of verteporfin photodynamic therapy even at reduced fluence, in the setting of repeat treatment in the same location, and may be identified and monitored with automated 10-2 visual field testing.
Simple Epithelial Transplantation for Ocular Surface Reconstruction After Severe Ocular Burn Injury
Authors: Bonacci Erika , Fasolo Adriano , Pagnacco Camilla , Bosello Francesca , Marchini Giorgio , Pedrotti Emilio 
Published: November 2024

Purpose:
To manage ocular surface complications and recover conjunctival and corneal epithelia after unilateral severe chemical burn.

Methods:
We performed simple conjunctival epithelial transplantation (SCET) to obtain renewal of fornix and bulbar-tarsal conjunctiva epithelium, followed by simple limbal epithelial transplantation (SLET) to recover limbal function and epithelial corneal surface. Slit-lamp examination, fluorescein staining, in vivo confocal microscopy, Kheirkhah grading system for symblepharon severity, Wong–Baker FACES Pain Rating Scale, and best-corrected visual acuity were assessed before surgery, at 1 to 3 months after SCET and SLET, and thereafter at 6 to 12 to 36 months.

Results:
Two patients with unilateral burn injuries underwent surgery. Eye mobility and fornix reconstruction were promptly achieved, and conjunctival epithelium with goblet cells was observed on the bulbar and tarsal conjunctiva 3 months after SCET. After SLET, corneal epithelium and cornea-conjunctiva transition zone were observed at 3 and 6 months, respectively. From before surgery to 6 months after SLET, symblepharon improved from grade IVa2 and IIIb2 to Ic0 and Ib0, the Wong–Baker FACES Pain Rating Scale changed from grade 6 and 4 to 0, and best-corrected visual acuity upgraded from 1.40 and 1.10 logarithm of the minimum angle of resolution to 0.5 logarithm of the minimum angle of resolution, in patient 1 and 2, respectively. After 3 years, results remained stable.

Conclusions:
SCET effectively healed the bare conjunctival area relieving subjective symptoms and discomfort. Sequential SCET and SLET showed to be feasible in restoring a normal ocular surface with long-lasting results suggesting the aim in patients with severe ocular burn is not merely corneal epithelium renewal but also the regeneration of ocular surface homeostasis.
Removal of Metallic Foreign Bodies with Complete Penetration of the Cornea: Introduction of a New Approach
Authors: Ucar Fikret , Sagdic Muhammed 
Published: November 2024

Purpose:
The purpose of this study was to present a new ab interno approach and relevant case series using a polymer-tipped cannula for the removal of metallic foreign bodies that penetrate the full thickness of the cornea and are located in the posterior corneal region.

Methods:
Corneal foreign bodies located on the posterior side of the cornea were gently pushed toward the epithelial side with a polymer-tipped cannula placed using a side-port incision, to be removed without damaging the corneal endothelial layer. The polymer-tipped cannula is specially angled to keep it at a distance from the corneal endothelial layer. In this way, unnecessary endothelial contact and the risk of possible endothelial loss are minimized. The foreign body was held by the epithelium with forceps and carefully removed along the corneal perforation line.

Results:
This technique was performed in 5 eyes of 5 patients. The mean patient age at the time of surgery was 38.0 ± 12.1 years (range, 28–59 years). Anterior segment optical coherence tomography showed a metallic foreign body and its shadow that completely penetrated the cornea with the deterioration of the endothelial layer in all cases. In all cases, the corneal foreign body was successfully removed. While preoperative corneal endothelial cell density was 3040.0 ± 512.8 cells/mm2, postoperative corneal endothelial cell density was 2927.2 ± 608.1 cells/mm2 at the third postoperative month, and there was no significant corneal endothelial cell loss in any of the cases (P = 0.31).

Conclusions:
The ab interno approach, performed with a polymer-tipped cannula for the removal of corneal foreign bodies that penetrate deeply, stands out as an important surgical method. This method offers a reliable and effective solution by preventing the foreign body from falling into the anterior chamber and minimizing endothelial damage.
Systemic immune inflammatory response index (SIIRI) in acute myocardial infarction
Authors: Muheeb Ghazi , Yusuf Jamal , Mehta Vimal , Faizuddin Md , Kurian Sumod , M. P. Girish , Gupta Mohit Dayal , Safal Safal , Gautam Ankur , Chauhan Narendra Kumar 
Published: November 2024

Background
Different treatment approaches exist for non-ST elevation acute coronary syndrome (ACS) patients. This study assessed the systemic immune inflammatory response index (SIIRI) for its prognostic value and incremental clinical utility in determining optimal timing for percutaneous coronary intervention (PCI) in non-ST elevation myocardial infarction (NSTEMI) patients, particularly when troponin levels are initially negative.

Methods
This study included 1270 ACS patients: 437 STEMI, 422 NSTEMI, and 411 unstable angina. Patients were stratified by SIIRI levels measured at admission, and coronary artery disease severity was evaluated using the SYNTAX score. The primary endpoint was major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, stroke, and revascularization. Secondary endpoints encompassed individual MACE components and heart failure hospitalisations.

Results
The mean age was 54.93 years (83% male). SIIRI levels were significantly higher in STEMI patients (6.83 ± 6.43 × 105) compared to NSTEMI (4.5 ± 5.39 × 105) and unstable angina (3.48 ± 2.83 × 105) (P < 0.001). Area under the curve for SIIRI distinguished NSTEMI and unstable angina from STEMI (0.81 and 0.80), with optimal cut-off points of 4.80 × 105 and 4.25 × 105. In NSTEMI, 24.6% presented within 2 h of symptom onset, were troponin-negative, yet had elevated SIIRI. Post-PCI, SIIRI > 4.93 × 105 correlated with increased MACE at 1 year (17.2% vs 5%).

Conclusion
NSTEMI and unstable angina patients with SIIRI values >4.80 × 105 and 4.25 × 105 respectively, may require urgent intervention (<2 h). SIIRI can be of significant utility in patients of NSTEMI who present earlier with negative troponins. SIIRI can also aid in identifying high-risk individuals post-PCI, providing a valuable tool for early and accurate assessment.
Network pharmacology-based study on the mechanism of action of Trollius chinensis capsule in the treatment of upper respiratory tract infection
Authors: Wu Jun , Zhang Hai-Ping , Gao Jing-Wen , Liu Zhi-Feng , Jin Lei 
Published: November 2024

Background:
Upper respiratory tract infection (URTI), one of the most common respiratory diseases, has a high annual incidence. Trollius chinensis capsule has been used to treat URTI in China. However, the underlying-mechanisms remain unclear.

Methods:
Network pharmacology was used to explore the potential mechanism of action of Trollius chinensis capsule in URTI treatment. The active compounds in Trollius chinensis were obtained from the TCMSP, SymMap, and ETCM databases. The TCMSP, PubChem, and SwissTargetPrediction databases were used to predict potential targets of Trollius chinensis. URTI-associated targets were gathered from GeneCards and DisGeNET databases. The key targets and signaling pathways associated with URTI were selected by network topology, GO, and KEGG pathway enrichment analysis. Molecular docking was used to verify the binding activity between active compounds and key targets.

Results:
Quercetin, pectolinarigenin, beta-sitosterol, acacetin and cirsimaritin are major active compounds in Trollius chinensis capsule. Eighty one candidate therapeutic targets were confirmed to be involved in protection of Trollius chinensis capsule against URTI. Among them, 7 key targets (TP53, IL6, AKT1, CASP3, CXCL8, MMP9, and EGFR) were verified to have good binding affinities to the main active compounds. Furthermore, enrichment analyses suggested that inflammatory response, virus infection and oxidative stress related biological processes and pathways were possibly the potential mechanism.

Conclusion:
Overall, the present study clarified that quercetin, pectolinarigenin, beta-sitosterol, acacetin and cirsimaritin are proved to be the main effective compounds of Trollius chinensis capsule treating URTI, possibly by acting on the targets of IL6, AKT1, CASP3, CXCL8, MMP9 and EGFR to play anti-infectious, anti-viral, and anti-oxidative effects. This study provides a new understanding of the active compounds and mechanisms of Trollius chinensis capsule in URTI treatment from the perspective of network pharmacology.
Ruptured coronary sinus aneurysm in pregnancy combined with cardiogenic shock and elevated V1 and aVR ST segments: Case report
Authors: Sun Yanhui , Lu Xing , Ma Honglan 
Published: November 2024

Introduction:
Sinus of Valsalva aneurysm (SOVA), a rare cardiac malformation, is usually congenital and rarely acquired and most commonly occurring in the right coronary sinus. The clinical presentation of patients with SOVA varies. It is usually asymptomatic when it has not ruptured, and when it compresses neighboring structures or ruptures, it can lead to heart failure or shock, at which point urgent surgical intervention is usually required. Rupture of the sinus of Valsalva aneurysm (RSOVA) during pregnancy is really hard to come by, especially if the clinical presentations resemble that of an acute myocardial infarction. This report describes a pregnant woman with severe chest pain and hypotension with aVR and V1 ST-segment elevation due to RSOVA.

Patient concerns:
Effects of RSOVA on the fetus, disease survival, and prognosis.

Diagnosis:
RSOVA.

Interventions:
Open SOVA repair.

Outcomes:
The patient’s blood pressure returned to normal range and clinical symptoms disappeared after the surgery. After 3 months of follow-up, the patient was hemodynamically stable without chest discomfort, and an echocardiogram showed a normal aortic sinus.

Conclusion:
Progressive aneurysm dilatation or rupture has a poor prognosis. A thorough history and physical examination are fundamental, with echocardiography being the initial diagnostic tool of choice, and other ancillary tests (e.g., computed tomography) being used to complement and confirm the diagnosis. Surgery remains the current treatment of choice for patients with RSOVA, while the continuation of pregnancy in pregnant patients with RSOVA remains a case-by-case measure.
Clinical and genetic features of Fanconi anemia associated with a variant of FANCA gene: Case report and literature review
Authors: Zhong Lin , Zhang Wenhua , Zhang Kaihui , Li Chan , Mu Xiao , Chu Yan , Gai Zhongtao , Wei Haiyun 
Published: November 2024

Rationale:
Fanconi anemia (FA) is a hereditary disease caused by mutations in the genes involved in the DNA damage repair pathway. The FANCA gene is the most commonly pathogenic gene, accounting for more than 60% of all causative genes.

Patient concerns:
The clinical case is a 3-year-old boy showed mild anemia and scattered bleeding spots the size of a needle tip all over his body.

Diagnoses:
Compound heterozygous mutation was identified in the FANCA gene in the FA case: c.1A > T from the father in exon 1; the deletion of chr16: 89857810-89858476 (exon13-14 del) from the mother; finally, the patient was diagnosed as Fanconi anemia.

Intervention:
After diagnosis, the child received chemotherapy (Ara-C + Flu + Cy + ATG). Then, the hematopoietic stem cell transplantation and unrelated umbilical cord blood transfusion were performed.

Outcomes:
The child is recovering well and is in regular follow-up.

Conclusion and Lessons:
The discovery of new mutations in the FANCA gene enriches the genetic profile of FA and helps clinicians to further understand this disease and guide genetic counseling and prenatal diagnosis. Whole-exome sequencing is a powerful tool for diagnosing FA.
Depression with comorbid juvenile-onset fibromyalgia syndrome novel treatment plan using interpersonal psychotherapy: A case report
Authors: Alkhawashki Samah H. , Algarzae Norah 
Published: November 2024

Background:
Fibromyalgia syndrome (FMS) affects 2% to 4% of people, with increasing prevalence in Saudi Arabia reaching 13.4%. FMS can occur in adolescents, known as juvenile-onset fibromyalgia (JFM) with comorbidities including depression, anxiety, and psychological stress. Our patient presented to the child and adolescent psychiatry clinic at King Saud University Hospital Medical City. A year before coming to our clinic, at the age of 15 she was initially diagnosed with JFM followed by a comorbid persistent depressive disorder.

Methods:
As a novel treatment method, a combination treatment approach was used, including a pharmacological intervention with Duloxetine, and a non-pharmacological intervention with interpersonal psychotherapy for adolescents. She completed 16 weeks of therapy while monitoring for duloxetine response and side effects.

Results:
Depressive symptoms were in remission by treatment’s end and continued to be in her first month posttreatment follow-up, and the FMS symptoms were also controlled.

Conclusion:
Our present case highlights a combined approach to treat depression and JFM in adolescents as a novel intervention method thus we strongly recommend utilizing it for similar cases.
A large forearm subcutaneous hematoma after contrast extravasation requires surgical managements: A case report
Authors: Wu Chunqiao , Jin Zhexia , Yang Yongmei 
Published: November 2024

Rationale:
Large extremity hematoma can rarely happen after contrast extravasation during a contrast-enhanced computed tomography scan. Some hematomas need prompt surgical managements.

Patient concerns:
A 77-year-old man had acute ischemic stroke and received the thrombolytic and antiplatelet therapies. He had a contrast extravasation during the computed tomography scan and developed a large hematoma in the right forearm, despite without evidence of compartment syndrome.

Diagnosis:
Right forearm hematoma, status post contrast extravasation.

Interventions:
The patient responded poorly to the routine care with arm elevation, cold pack, and wet dressing, and was finally treated by the surgical debridement, vacuum sealing drainage, fascioplasty, and skin flap repair.

Outcomes:
Right forearm wound healed with a scar.

Lessons:
Large extremity hematoma can happen after contrast extravasation during computed tomography scan, which may require surgical treatments. Careful preparation, close monitor, and prompt managements should be applied in high-risk patients.
Cognitive-behavioral therapy for negative symptoms of schizophrenia: A systematic review and meta-analysis
Authors: Xu Feifei , Xu Sheng 
Published: November 2024

Background:
Cognitive-behavioral intervention techniques are increasingly demonstrating their efficacy in preventing relapses and managing problems in patients with schizophrenia. There is still variation in its effectiveness for negative symptoms, such as mood-related symptoms and motivation to engage socially.

Methods:
A systematic search was conducted in PubMed, Web of Science for English literature on cognitive-behavioral therapy (CBT) interventions in patients with schizophrenia. The search included randomized controlled trials and nonrandomized controlled trials. The search period extended from the inception of the databases to September 30, 2022. Two researchers independently performed quality assessment and data extraction based on predefined inclusion and exclusion criteria.

Results:
Discrepancies were resolved through discussion or consultation with a third researcher. Initially, 169 articles were retrieved through database searches and other means. After applying the inclusion and exclusion criteria, 10 randomized controlled studies were included in the final analysis. The intervention group comprised a total of 680 patients with schizophrenia, while the control group included 686 patients with schizophrenia. Meta-analysis results demonstrated a statistically significant difference in negative symptom reduction between the CBT intervention group (WMD = −1.19, 95% CI [−1.73, −0.66], P < .0001) and the control group.

Conclusion:
We have analyzed the effectiveness of CBT based on our previous research, CBT was found to effectively improve negative symptoms in individuals diagnosed with schizophrenia.
Risk of malignancy in thyroid nodules with increased 11C-Choline uptake detected incidentally on PET/CT: A diagnostic accuracy study
Authors: Frota Lima Livia Maria , Bogsrud Trond Velde , Gharib Hossein , Ryder Mabel , Johnson Geoffrey , Durski Jolanta 
Published: November 2024

Purpose:
The purpose was to evaluate the pathological nature of focal thyroid uptake seen in 11C-Choline PET/CT performed for prostate cancer.

Material and methods:
The study was IRB-approved. All 11C-Choline PET/CT exam reports for studies performed between January 01, 2018, and July 30, 2021, in male patients with prostate cancer in our institution were retrospectively reviewed. Exams with “focal thyroid uptake” on their final report were selected. Patients with surgery or ablation in the thyroid prior to the PET/CT, proven parathyroid adenomas or absent thyroid ultrasound were excluded. Repeated PET/CT exams of same patient were excluded. PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax) of the focal thyroid uptake. Available thyroid ultrasound images, cytology and pathology reports were reviewed. Statistical analyses were performed.

Results:
Out of 10,047 sequential 11C-Choline PET/CT studies, 318 reports included “focal thyroid uptake.” About 128 of these studies were repeat exams and were excluded. Additional 87 patients were excluded, because the uptake was determined to be adjacent, rather than confined to the thyroid gland. Out of the remaining 103 patients, 74 patients had focal thyroid uptake and concurrent thyroid sonographic evaluation. Out of the 74 focal uptakes evaluated with ultrasound, 21 were presumed benign thyroid nodules based on the ultrasound and 53 had further evaluation with biopsy. Sixty three nodules were benign (21 presumed benign on ultrasound and 42 cytology or surgical pathology-proven), 9 nodules were malignant and 2 remained indeterminate. There was no significant difference between the SUVs of the benign and malignant groups (P > .3).

Conclusion:
In this retrospective study of patients with prostate cancer who underwent 11C-Choline PET/CT, we identified a group of patients who underwent thyroid ultrasound for incidental finding of focal 11C-Choline thyroid uptake. Incidence of malignancy in this group was 12%. Therefore, further investigation with ultrasound and possibly ultrasound-guided biopsy may be warranted when a choline avid thyroid nodule is found incidentally on choline PET.
Midline Catheter-Associated Thrombosis (MCAT)
Authors: Schechter Max S. , Baron Sarah W. , Gohari Arash , Southern William N. , Galen Benjamin T. 
Published: November 2024

Midline catheters, used for short- and intermediate-term venous access, are recommended to be placed with the tip in an upper arm vein rather than more proximally, in the axillary vein. Despite guidelines recommending against proximal location of the midline catheter tip, the impact of midline catheter tip location on midline catheter-associated thrombosis (MCAT) risk is unclear. Using a retrospective cohort of hospitalized patients who not only had a midline catheter but also had a chest x-ray and venous duplex performed, the authors evaluated whether axillary vein tip location increased the risk of MCAT. Of the 41 midline catheters with tips located in an arm vein, 17 (41.5%) resulted in a thrombus versus 7 (38.9%) of the 18 midline catheters with tips located in the axillary vein. When compared to midline catheter tips located in an arm vein, midline catheter tips located in the axillary vein were not significantly more likely to result in MCAT in unadjusted analysis (odds ratio [OR] = 0.90 [95% CI, 0.29–2.79], P = .85) or adjusted analysis (OR = 0.62 [95% CI, 0.18–2.12], P = .45). These findings support emerging evidence that there does not appear to be an increased risk of MCAT in midlines with an axillary vein tip location. The practice of avoiding the axillary vein for midline catheter tip placement should be reconsidered.