bluuebunny/crossref_metadata_2025_split huggingface dataset:
Zolpidem-related euphoria, addiction and detoxification: A case report and review of the literature
Authors: Xie Fangfei , Liu Bo , Yang Liqiu , Huang Junqiang , Li Bin , Li Yuanyuan 
Published: November 2024

Rationale:
Zolpidem, a non-benzodiazepine sedative-hypnotic, is considered safer for the treatment of insomnia compared to benzodiazepines. However, in recent years, there have been growing reports of Zolpidem dependence, addiction, and withdrawal symptoms. We reported a case of Zolpidem addiction and successful detoxification, reviewed similar cases in the literature, and proposed a potential mechanism underlying Zolpidem addiction.

Patient concerns:
The patient was a 46-year-old Tibetan woman who had been using Zolpidem intermittently to treat insomnia for at least 8 years. She was overweight, with a BMI of 28.04 kg/m², and had hypertension, diabetes, a 20-year smoking history, and several years of alcohol abuse, often seeking instant gratification. She voluntarily increased both the dosage and frequency of Zolpidem, experiencing euphoria, anxiolysis, and increased appetite at higher doses, which led her to gradually escalate her dosage to 280 mg per day in divided doses. However, upon stopping Zolpidem, she experienced withdrawal symptoms, including insomnia, tension, and palpitations.

Diagnoses:
She was diagnosed with a combination of hypnotic use disorder, anxiety disorder, hypertension, and diabetes.

Interventions:
She underwent diazepam replacement therapy, along with antianxiety medications and mindfulness-based cognitive therapy, to address Zolpidem addiction.

Outcomes:
After 13 days of inpatient treatment, the patient successfully quit Zolpidem. During a 3-month follow-up, she returned to work and remained free from Zolpidem use.

Lessons:
We speculate that Zolpidem addiction is likely linked to the drug’s euphoric effects and certain patient characteristics, such as sensation-seeking behavior. A comprehensive approach, involving both pharmacological and psychological interventions, is essential for an effective detoxification strategy for Zolpidem addiction.
Rescue of a spontaneous subcapsular hepatic hematoma associated with HELLP syndrome: A case report
Authors: Yan Chenze , Jia Zhong , Liu Yuanwei , Zhou Weijiang , Zhou Heshan 
Published: November 2024

Rationale:
Spontaneous subcapsular hepatic hematoma (SSHH) is a rare yet severe complication of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome that can lead to life-threatening situations for both the mother and fetus. Determining an appropriate therapeutic strategy remains challenging, as it involves choosing between surgery, microinvasive percutaneous transhepatic drainage, or conservative treatment alone. Further successful cases are needed to support the optimal option. We retrospectively collected a patient’s clinical record and imaging data to elucidate the natural progression, response to noninvasive treatment, and outcome of SSHH associated with HELLP syndrome.

Patient concerns:
A 34-year-old woman, who underwent a cesarean section due to suspected fetal distress, developed SSHH accompanied by the potential risk of rupture and deteriorated serology within the first 24 hours after delivery.

Diagnoses:
Emergency blood routine examination, serum biochemistry analysis, and computed tomography of the abdomen revealed a SSHH associated with HELLP syndrome.

Interventions:
The main rescue measures included the use of corticosteroids, antihypertensive drugs, and platelet transfusion.

Outcomes:
A positive effect on the patient’s condition was exhibited within 24 to 48 hours. The majority of the subcapsular hepatic hematoma could be absorbed without any sequelae over a period of 7 months.

Lessons:
For patients with pregnancy-induced hypertension, there is a heightened risk of HELLP syndrome occurrence in subsequent pregnancies. The assessment and treatment of SSHH should be conducted by an experienced multidisciplinary team. In addition to timely delivery, the administration of corticosteroids, usage of antihypertensive medication, and platelet transfusion are necessary, particularly within the first 48 hours if the patient’s condition permits. This approach would provide valuable insights for further therapeutic decisions and facilitate a preliminary prognosis assessment.
Comparison of the effects of video conference and video-based home exercise on physical performance and body composition in older adult individuals
Authors: Elmas Özgün , Cemali Mustafa , Livanelioğlu Ayşe 
Published: November 2024

Background:
With the development of technology, remote access exercise interventions are frequently used in older adults. Although different technology methods are used in exercise, studies comparing these methods are limited. Based on this, the aim of the study is to compare the effect of exercise applied with video conference (VC) and video-based home exercise (VBHE) methods on physical performance, skeletal muscle mass, body fat percentage, and body mass index (BMI) in older adults.

Methods:
Thirty older adult individuals between the ages of 65 and 75 years participated in the study. Participants were divided into 2 groups by computer-generated randomization (allocation ratio of 1:1). VC group calisthenic exercises were performed online with the physiotherapist using the WhatsApp program. The VBHE group did the same exercises by watching videos at home. Both programs spanned 6 weeks, 3 times a week. Before and after the intervention, chair sit-stand, 6-minute walk, time up and go, single leg stance, hand grip strength, shoulder flexion strength, and knee extension strength tests were performed on older adults to evaluate their physical performance. For body composition, skeletal muscle mass, body fat percentage, and BMI were assessed using the Inbody device.

Results:
It was observed that in both VC and VBHE groups, physical performance improved statistically significantly compared to the preintervention period (P <.05), while skeletal muscle mass, body fat percentage, and BMI did not change (P ˃.05). When the groups were compared, it was concluded that the exercise program implemented with the VC method improved physical performance better than the VBHE method (P <.05), but there was no difference in skeletal muscle mass, body fat percentage and BMI values (P ˃.05).

Conclusion:
It has been observed that a 6-week calisthenic exercise intervention implemented through technology methods such as VC and VBHE is a useful method for the improvement of the physical performance of older adults. However, it was concluded that the VC method is a more effective method than the VBHE method. It is predicted that the lack of improvement in body composition is due to the intensity and duration of exercise.
Primary intracranial malignant melanomas: A case series with literature review
Authors: Chen Lifeng , Yang Yang , Li Dongmei , Bu Bo 
Published: November 2024

Rationale:
There is a high chance of misdiagnosis and limited knowledge regarding therapeutic strategies owing to the rarity of primary intracranial malignant melanoma (PIMM). The objective of the present study was to evaluate the clinical features, treatment modalities, and outcomes of patients with histologically proven PIMM.

Patient concerns:
Data of 15 patients with PIMM admitted to the Chinese People’s Liberation Army General Hospital in a 14-year period between January 2005 and January 2019 were collected. Clinical presentations, pathology, surgical strategies, adjuvant treatment, and prognosis were retrospectively analyzed.

Diagnoses:
CT showed iso- or high-density lesions in 12 cases (80%). MRI revealed short T1 and slightly short T2 in 14 cases (93.3%).The tumors showed mild or no enhancement on enhanced MRI. The patients were eventually diagnosed with PIMM through pathological examination.

Interventions:
The treatment modalities included radical resection followed by conventional radiotherapy (RT, n = 12) and subtotal resection followed by stereotactic radiosurgery (n = 3).

Outcomes:
All 15 patients had either recurrence or metastasis at an average of 14.7 months (range, 6–23 months) after surgery. In total, 14 patients (93.3%) succumbed to disease, with a mean overall survival of 22 months (range, 6–36 months). The median survival time was 23 months. The overall survival rates at 1, 2, and 3 years were 80, 47, and 13%, respectively. Radical resection with RT was associated with longer overall survival (log-rank, P < .05) than subtotal resection followed by stereotactic radiosurgery.

Lessons:
PIMM is an extremely rare tumor with a poor prognosis. Radical resection with RT may result in a longer overall survival rate. Targeted immunotherapy may be a promising treatment option for PIMM.
Day napping and metabolic-associated fatty liver disease: A systematic review and meta-analysis of observational studies
Authors: Gao Linxiao , Gong Jianping , Zhong Guochao , Qin Yajun 
Published: November 2024

Background:
Napping inevitably affects human health, and the association between napping and metabolism-related diseases is being more seriously considered. However, the conclusions of studies on the relationship between napping and fatty liver disease (NAFLD)/metabolic-associated fatty liver disease (MAFLD) remain controversial.

Methods:
We performed a systematical search to identify eligible studies up to July 31, 2024. The fixed effects model was used to calculate the pooled odds ratio (OR). Subgroup were performed. Sensitivity analyses and meta-regression analysis were carried to explore the heterogeneity. Publication bias was assessed by funnel plot and Egger’s test.

Results:
48,248 participants from 13 studies were included in this meta-analysis. The pooled analysis found napping to have an association between the incidence of NAFLD/MAFLD (OR, 1.13; 95% confidence interval (CI), 1.08–1.19; P < .001). The robustness of this study was confirmed using a sensitivity analysis. No apparent heterogeneity or publication bias was observed. Further meta-analysis revealed that short nap duration did not greatly affect the incidence of the disease (OR, 1.01; 95% CI, 0.91–1.12; P = .80). However, long nap duration was significantly linked to high risk of the disease (OR, 1.21; 95% CI, 1.02–1.44; P = .03).

Conclusion:
Patients with NAFLD/MAFLD may had higher prevalence of napping habit. Future research is warranted to conduct a dose-response analysis, measure the effects of confounding factors, and explore the causal relationships between NAFLD/MAFLD. The research protocol was registered and approved in PROSPERO (registration no: CRD42023439507).
Simultaneous clavicular hook plate fixation in bilateral distal clavicle fractures (Neer type II): A case report
Authors: Akar Bedrettin , Ugur Fatih 
Published: November 2024

Rationale:
Bilateral distal clavicle fractures (BDCF) are exceedingly rare types of fractures. This study aimed to evaluate the surgical treatment under a single anesthesia for trauma-induced BDCF (Neer type II) through a case report.

Patient concerns:
The patient brought to the emergency department due to a motor vehicle accident exhibited severe pain, tenderness, swelling, and deformity in both shoulder regions upon physical examination. No significant pain or tenderness was detected in other areas of the body. There were also no signs of additional neurological deficits or vascular pathology in the extremities.

Diagnoses:
Radiographic examinations led to a diagnosis of BDCF (Neer type II).

Interventions:
Surgical intervention involved the simultaneous application of a neutral-angled hook plate to both clavicles via open reduction.

Outcomes:
Postoperative radiographs taken at the 12th week demonstrated complete healing in both fractures and no functional limitations in shoulder movements.

Lessons:
BDCF can compromise the stability of the shoulder girdle, necessitating surgical intervention with anatomical reduction and rigid fixation.
The prevalence and associated factors of intraoperative hypotension following thoracic surgery in resources limited area, 2023: multicentre approach
Authors: Wolde Yisehak , Argawi Adugna , Alemayehu Yabtsega , Desalegn Mitiku , Samuel Sintayehu 
Published: November 2024

Background:
Hypotension is an independent predictor of long-term patient morbidity and duration of hospital stay. Multiple factors contribute to the development of intraoperative hypotension. Prevention and treatment of these factors may reduce patients’ hypotension and its associated morbidity and mortality. This study aimed to assess the prevalence and associated factors of intraoperative hypotension in patients undergoing elective thoracic surgery.

Methods:
This institution-based cross-sectional study was conducted among 174 adult patients who underwent elective thoracic surgery. A systematic random sampling technique was used, and quantitative data were collected through interviews and data retrieval from charts via a pretested questionnaire. Both bivariable and multivariable logistic regression analyses were performed to evaluate the associations between independent and dependent variables. The level of statistical significance was defined as a P-value less than 0.05. The data were entered into Info 7.2.1 and analyzed via SPSS version 26 software, which was used to calculate descriptive statistics, and bivariate and multivariate logistic regression were performed.

Results:
In general, information was collected from 174 patients during the study period. The results of the present study revealed that 65 (41%) patients developed intraoperative hypotension (95% CI: 36.43–48%). Intraoperative blood loss was significantly associated with intraoperative hypotension [AOR=9.58, 95% CI (2.57–35.8)] (P=0.001).

Conclusion and Recommendation:
The findings of this study revealed high rates of intraoperative hypotension episodes, which were 41%, in patients who underwent elective thoracic surgery. Age, ASA class, type of intraoperative blood loss, type of procedure pre-existence comorbidity, and duration of surgery were predictors of intraoperative hypotension in patients who underwent elective thoracic surgery. The anaesthetist’s, surgeon, and PACU staff’s understanding of these factors is very crucial for close follow-up of this group of patients.
Existential aspects of breathlessness in serious disease
Authors: Baglow David , Johnston Kylie , Williams Marie 
Published: November 2024

Purpose of the review
Breathlessness may evoke existential threat but may also affect the person with serious illness or their caregiver/s in other important ways which can be considered ‘existential’. This review explores existential aspects of breathlessness in people with serious illness and presents recent studies of assessment and management of associated distress and suffering.

Recent findings
Both existential distress and breathlessness are multidimensional and include a range of constructs, many of which have behavioural consequences. Existential distress tracks closely with distressing breathing potentially due to shared underlying neurobiological processing. Paradoxically ‘contagious’ and isolating effects of breathlessness and related distress have been recently highlighted. Approaches to screening and assessment vary. Preliminary studies have investigated novel approaches to breathing-related anxiety and existential distress.

Summary
Studies with existential constructs as outcome measures in people with breathlessness are scarce. Interventions for existential distress developed for those with malignant disease may be beneficial for those with non-malignant conditions, but adaptations may be required. Recently proposed taxonomies of existential distress/concerns may guide assessment and direct novel therapeutic interventions in people living with serious illness and breathlessness-related distress. Neglecting existential aspects of breathlessness represents a missed opportunity to support holistic well-being in people with serious illness.
Significant gaps in practise present despite higher level of public awareness in Antibiotic Use and Antimicrobial Resistance in the western province of Sri Lanka
Authors: Gunatilake Gayan Danushka , Anthony Conganige Hiranya Hansali , Hettiarachchige Done Anne Sithuvili , Hettige Sandani Kaveesha Dinudhya , Tennakoon Dinushi 
Published: November 2024

Background:
Antibiotic misuse, influenced by urbanization and limited healthcare access, has accelerated antibiotic resistance, impacting global health. Surveillance in Sri Lanka's National Strategic Plan for Combating Antimicrobial Resistance (2017-2022) shows significant multi-drug resistance in hospitals, with 12.7% of the health budget (3.3 billion) spent on antimicrobials. This resistance complicates treatment and increases patient management costs, particularly in the Western Province, a focal area for analyzing antibiotic misuse.

Objectives:
To assess public awareness of antibiotic misuse and antimicrobial resistance in the Western Province of Sri Lanka.
Methodology:
A cross-sectional study was conducted on 200 adults in the Western Province from December 23, 2023, to January 16, 2024, using in-person interviews and a Google form questionnaire. Descriptive statistics were applied to analyze the data.

Results:
Of the respondents, 83% knew antibiotics combat bacterial infections, while 71.5% adhered to completing antibiotic courses. However, 28.5% opposed doing so, with 65.5% stopping antibiotics once they felt better. Regarding antimicrobial resistance, 60.5% recognized the term, and 61% acknowledged that unnecessary antibiotic use could increase bacterial resistance.
Conclusion:
Most participants understood antibiotics' role, though gaps in correct use and awareness of misuse consequences persisted. While there was a positive attitude toward antimicrobial resistance, further educational efforts are essential to address knowledge gaps, as recent studies show high resistance levels and limited progress in awareness.
Keywords:
AMR; Antibiotic resistance; antimicrobial resistance; Knowledge; Awareness; Sri Lanka
Deep generative model for protein subcellular localization prediction
Authors: Yuan Guo-Hua , Li Jinzhe , Yang Zejun , Chen Yao-Qi , Yuan Zhonghang , Chen Tao , Ouyang Wanli , Dong Nanqing , Yang Li 
Published: November 2024

AbstractProtein sequence determines not only its structure but also its subcellular localization. Although a series of artificial intelligence models have been reported to predict protein subcellular localization, most of them provide only textual outputs. Here, we present deepGPS, adeepgenerative model forproteinsubcellular localization prediction. After trained with both protein primary sequences and protein subcellular localization fluorescence images, deepGPS shows the ability to predict cytoplasmic and nuclear localizations by reporting both textual labels and generative images as outputs. In addition, deepGPS shows potential to be further extended for other types of subcellular localization prediction, even with limited input data volumes for training. Finally, an openGPS website (https://bits.fudan.edu.cn/opengps) is constructed to provide a public and convenient platform for protein subcellular localization prediction with the scientific community.
Investigating a possible role ofR3HCC1Lin embryonic development and ocular disease
Authors: Fischer Megan C. , Reis Linda M. , Muheisen Sanaa , Seese Sarah E. , Semina Elena V. 
Published: November 2024

AbstractPeters anomaly (PA) is an anterior segment ocular disorder with wide phenotypic variability and genetic heterogeneity. Here we report a family consisting of a male with a diagnosis of syndromic PA and his unaffected parents, with no causative variants identified in known developmental ocular genes. Exome sequencing analysis identified compound heterozygous missense variants, c. 1022A>T p.(Asp341Val) and c.1457T>A p.(Phe486Tyr), inR3HCC1L. Both variants are ultra-rare in control populations and have CADD scores of 21.9 and 23.3, respectively, suggesting possible deleterious effects. TheR3HCC1Ltranscript variants encode three different protein isoforms all sharing two conserved C-terminal domains, an RNA recognition motif (RRM) and a coiled-coil domain (CCD), and likely represent an RNA-binding protein involved in post-transcriptional gene regulation; the identified patient variants are located within the N-terminal part of the protein shared by two of the three protein isoforms, upstream of the RRM and CCD domains. To investigate the possible role ofR3HCC1Lin embryonic development, the single zebrafish ortholog ofR3HCC1L, r3hcc1l, was examined for its expression and function.In situexpression studies showed that zebrafishr3hcc1lis expressed in the developing lens, cornea, retina and hyaloid vasculature, supporting its possible role in ocular development in vertebrates. CRISPR-Cas9 gene editing was used to generate a zebrafish line with a 4-bp deletion inr3hcc1l, c.623-626del, that is predicted to result in a nonsense-mediated decay and, if expressed, a nonfunctional truncated protein (p.Thr208fs*39) lacking 80% of the RRM and the entire CCD. The resultantr3hcc1lc.623-626delheterozygous and homozygous animals did not show any visible structural abnormalities in the eye or any other systems, with normal survival of all genotypes to adulthood, providing no support for its possible role in the congenital phenotype of interest. However, the function ofr3hcc1lmay not be completely conserved with humanR3HCC1L, and/or zebrafish may have compensatory mechanisms that are not present in humans. In addition, the engineered zebrafish variant disrupts the most conserved C-terminal region of R3HCC1L/r3hcc1l shared by all protein isoforms and likely leads to a complete loss-of-function of this gene, which may be different from the disease mechanism associated with the specific missense alleles identified in the patient. Finally, while it is important to consider the possible limitations of animal models, it is also necessary to highlight that the identifiedR3HCC1Lvariants may not have any role in the phenotype observed in this single patient. Identification of newR3HCC1Lvariants of interest in families affected with PA or other congenital phenotypes, if successful, will provide further support for the possible developmental function of this gene.
Spiders bring new insight into the eco-evolutionary drivers of body size variation and sexual size dimorphism in arthropods
Authors: Ameline Camille , Lafage Denis , Vernon Philippe , Hedde Mickaël , Pétillon Julien 
Published: November 2024

AbstractBody size has been used thoroughly in arthropod ecology as a reliable trait to assess fitness responses to changes in environmental factors. Among these, spiders represent a large and diverse group, colonizing almost all terrestrial habitats. Here, we propose a review on intraspecific body size variation in arthropods over two main macroecological spatial gradients—latitude and elevation—both of high interest in a global warming context. We found that more species with a direct than with an indirect development present a converse Bergmann cline along both gradients. Focusing on spiders, we propose that life history traits such as voltinism, mobility, and brood care influence intraspecific body size patterns—potentially hiding large-scale patterns. Further, we assessed interspecific sexual size dimorphism (SSD) in spider species. We found that extreme SSD—the most original feature in spider biometry—is influenced by hunting guild rather than phylogeny of spider families, suggesting that ecological factors prevail over evolutionary drivers in shaping SSD.