bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-Related Listening Performance Changes Across Adulthood
Authors: Lunardelo Pamela P. , Fukuda Marisa T. H. , Zanchetta Sthella 
Published: October 2024

Objectives:
This study compares auditory processing performance across different decades of adulthood, including young adults and middle-aged individuals with normal hearing and no spontaneous auditory complaints.

Design:
We assessed 80 participants with normal hearing, at least 10 years of education, and normal global cognition. The participants completed various auditory tests, including speech-in-noise, dichotic digits, duration, pitch pattern sequence, gap in noise, and masking level difference. In addition, we conducted working memory assessments and administered a questionnaire on self-perceived hearing difficulties.

Results:
Our findings revealed significant differences in auditory test performance across different age groups, except for the masking level difference. The youngest group outperformed all other age groups in the speech-in-noise test, while differences in dichotic listening and temporal resolution emerged from the age of 40 and in temporal ordering from the age of 50. Moreover, higher education levels and better working memory test scores were associated with better auditory performance as individuals aged. However, the influence of these factors varied across different auditory tests. It is interesting that we observed increased self-reported hearing difficulties with age, even in participants without spontaneous auditory complaints.

Conclusions:
Our study highlights significant variations in auditory test performance, with noticeable changes occurring from age 30 and becoming more pronounced from age 40 onward. As individuals grow older, they tend to perceive more hearing difficulties. Furthermore, the impact of age on auditory processing performance is influenced by factors such as education and working memory.
Patellar Tendon Reconstruction Using Quadriceps, Semitendinosus, and Gracilis Autografts With Ultra-high Molecular Weight Polyethylene Tape Augmentation: A Novel Technique
Authors: Goodwin Tyler M. , Hughes Austin G. , Pumphrey Conor M. , Smith Chadwick A. , Bruce Jeremy R. 
Published: October 2024

Background:
Chronic patellar tendon ruptures are challenging injuries to treat and can be debilitating to patients. Optimal treatment of these extensor mechanism injuries occurs in the acute postinjury period. When these injuries become chronic, they are increasingly difficult to treat effectively.

Purpose:
We present a case of chronic patellar tendon rupture in a young athletic male who was treated with quadriceps, semitendinosus, and gracilis autograft. To our knowledge, there have been no other reports of using a quadriceps autograft with a bone plug to reconstruct a chronic patellar tendon injury.

Patients and Methods:
A healthy male under the age of 18 presented in a delayed manner to our clinic with complaints of left knee pain and inability to straighten the knee. His imaging and clinical exam found that he had a patellar tendon rupture, ∼15-degree extensor lag, flexion to 140 degrees, and was unable to straight leg raise or perform any active extension of the knee. He had significant atrophy of his vastus musculature at the knee. The rupture was treated with quadriceps, semitendinosus, and gracilis autograft.

Results:
At 6 months follow-up, our patient had achieved full extension, flexion to 135 degrees, and 4 of 5 quadriceps strength. He returned to routine physical activity and was satisfied with his results to date. At 1 year’s follow-up, the patient had full extension and flexion to 140 degrees and had resumed playing recreational soccer.

Conclusion:
Treating chronic patellar tendon rupture with quadriceps, semitendinosus, and gracilis autograft resulted in a positive outcome for this difficult-to-treat injury.
Associations Between Physical Activity, Systemic Inflammation, and Hospital Admissions in Adults With Heart Failure
Authors: Gore Shweta , Beyer Victoria , Collelo Joseph , Melton Chloe 
Published: October 2024

Purpose:
Among individuals with diagnosed heart failure (HF), the impact of physical activity on systemic inflammation and risk of hospital admissions remains unclear. Therefore, the purpose of this study was to examine the associations between physical activity and (1) systemic inflammation measured through C-reactive protein (CRP) levels and (2) frequency of hospital admissions in those with HF.

Methods:
We used data from the National Health and Nutrition Evaluation Survey in this observational cross-sectional study to include 377 community-dwelling adults with HF. Demographic, clinical, and functional variables were extracted from the data and included in the regression models as covariates during analysis. Associations between activity and hospital admissions were examined using Poisson regression. Multivariable logistic regression analysis was used for association between CRP and physical activity.

Results:
We found a direct linear relationship between CRP levels and hospital admissions, with higher levels of CRP significantly associated with greater number of hospital admissions in HF (incidence rate ratio [IRR] = 1.18, P < .001). Similarly, participating in vigorous activity was significantly associated with decreased expected rate of hospital admissions (IRR = 0.38, P = .013 (C.I. = 0.18–0.80) and with a significant decrease in the CRP levels (B = −0.44, P = .018 (C.I. = −0.80 to −0.83).

Conclusion:
To the best of our knowledge, this is the first study using population-level data to examine the association between physical activity level, systemic inflammation, and hospitalizations in individuals with HF. The findings of this study demonstrate that irrespective of sex, engagement in physical activity at higher intensity levels is strongly associated with favorable health outcomes in older adults with HF.
Neonatal Bilirubin Assessment After Implementation of Enhanced Recovery After Caesarean Section
Authors: Resmi Dian C. , Ruswantriani  , Farhan Muhammad , Achmad Elsa Anjani , Handayani Nining , Wulandari Tri Aprilliana , Sundari Ayu Mulia , Sini Ivan 
Published: October 2024

Objective: The implementation of Enhanced Recovery After Cesarean (ERAC) is associated with significant improvement in maternal outcomes; however, its impact on neonatal outcomes remains limited. This study aims to evaluate the impact of ERAC protocol on neonatal outcomes. Methods: A retrospective cross-sectional study was conducted at Bunda Women and Children Hospital, Jakarta, Indonesia between 2021 and 2022 on women who performed cesarean delivery at 37 weeks and above. The primary outcome was neonatal bilirubin level and the secondary outcome was neonatal length of stay and breastfeeding rate. Results: Differences between outcomes were analyzed by comparing each parameter in non-ERAC (n = 356) and the ERAC groups (n = 331). The median bilirubin levels and neonatal length of stay did not exhibit significant differences between the non-ERAC and the ERAC group (9.5 mg/dL vs 9.5 mg/dL, P = .545, for bilirubin levels, and 3 days vs 3 days, P = .060 for neonatal length of stay). However, the ERAC group demonstrated a significantly higher breastfeeding rate compared to the non-ERAC group (3 hours vs 5 hours, P < .001, respectively). Conclusions: The implementation of the ERAC protocol does not influence neonatal bilirubin levels and the length of neonatal hospital stays but it increases breastfeeding rate.
Sutureless FOCUS harmonic scalpel versus clamp-and-tie techniques for thyroidectomy: a meta-analysis of 43 randomized controlled trials
Authors: Cirocchi Roberto , Matteucci Matteo , Lori Eleonora , D’Andrea Vito , Arezzo Alberto , Pironi Daniele , Avenia Stefano , Randolph Justus , Tiraboschi Ileana , Tebala Giovanni Domenico , Popivanov Georgi I. , Sorrenti Salvatore 
Published: October 2024

Background:
One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves’ injury. The “clamp and tie” technique was first introduced in the 19th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sectioning of thyroidal vessels; however, one of the most relevant advances is the introduction of energy-based devices (EBDs), which occurred three decades ago.

Purpose:
The aim of this systematic review and meta-analysis is to evaluate the safety and effectiveness of sutureless FOCUS harmonic scalpel (second-generation EBDs) versus conventional clamps-and-tie technique) in total thyroidectomy.

Results:
This systematic review and meta-analysis represent the largest comparison in the literature between the thyroidectomy procedure with the second-generation advanced harmonic scalpel ultrasonic focus (UAS FOCUS) versus the conventional clamp-and-tie (CT) technique: as a matter of fact, it includes 43 randomized controlled trials (RCTs) and a total of 10 361 patients. The incidence of transient recurrent laryngeal nerve palsy was statistically lower in patients undergoing UAS (3.99%) rather than CT (5.23%) (RR 0.79, 95% CI 0.63–0.99). The incidence of transient hypocalcemia was 11.3% in patients who underwent thyroidectomy with UAS FOCUS and 15.4% in those who underwent thyroidectomy with CT.

Conclusion:
Sutureless EBD is associated with a lower risk of damage to the laryngeal nerves and parathyroid glands. The rate of hypocalcemia and nerve paresis is indeed lower due to less thermic damage. Sutureless EBD can also diminish the rate of postoperative bleeding and cervical hematoma, a rare but potentially fatal complication.
Symmetrical peripheral gangrene caused by urosepsis: Case reports and literature review
Authors: Chen Yuanyuan , Liu Kai , Xu Xiujuan , Wu Gaofei , Zhu Lianghua , Zha Junjing , Cheng Chuji 
Published: October 2024

Rationale:
Symmetrical peripheral gangrene (SPG) is a serious and rare complication in patients with urosepsis, characterized by distal limb symmetry impairment.

Patient concerns:
In this study, 3 cases of SPG caused by urosepsis were reported, and the Chinese and English literature on SPG caused by urosepsis was reviewed. The demographic, clinicopathological, treatment, and follow-up data of the patients were summarized and analyzed.

Diagnosis:
SPG was diagnosed with clinical symptoms.

Interventions:
We conducted urological invasive surgery, administered anti-infective therapy, implemented fluid resuscitation and blood product transfusion, provided mechanical ventilation support, optimized myocardial contractility, administered heparin and B vitamins, utilized papaverine for vasodilation, performed hemodialysis and plasma exchange, peripheral skin warming along with other treatment modalities.

Outcomes:
Two patients died and 1 patient underwent autoamputation.

Lessons:
Our cases and literature review demonstrate that timely and accurate diagnosis, effective infection control, correction of hypoperfusion, organ function support, early management of disseminated intravascular coagulation, avoidance of premature amputation, and multidisciplinary comprehensive treatment are crucial for the successful treatment of SPG caused by urosepsis.
An unusual case of recurrent traumatic spinal epidural hematoma accompanied by osteoporotic vertebral compression fractures: Case report
Authors: Meng Yake , Su Kai , Dai Yaojun , Chang Xiaopan , Yang Yong , Mei Wei , Zhang Wei , Pan Hao 
Published: October 2024

Rationale:
Traumatic spinal epidural hematoma (SEH) is a rare clinical condition. Here, we present an extraordinary case of recurrent SEH accompanied by thoracolumbar spine fractures resulting from minor trauma, and provide evidence-based recommendations for the surgical management strategies in this unique scenario.

Patient concerns:
A 71-year-old female patient presented with back pain after a fall. Magnetic resonance imaging revealed an SEH with L2 vertebral compression fracture. Following unsuccessful conservative treatment, percutaneous vertebroplasty was performed at the 2nd lumbar vertebra under local anesthesia. Two years later, the patient experienced another fall and was diagnosed with spinal hematoma with L1 vertebral compression fractures.

Diagnoses:
The patient was diagnosed with recurrent osteoporotic vertebral compression fracture accompanying SEH.

Outcomes:
After 1 week of conservative treatment, notable improvement of limbs numbness was observed. The patient ultimately underwent L1 vertebroplasty surgery. The patient was discharged smoothly on the third postoperative day and made a full recovery after 4 months.

Lessons:
SEH is a rare clinical finding that can occur even after a minor trauma in the elderly. It is worth noting that osteoporotic vertebral compression fractures with asymptomatic or stable intraspinal hematoma, is not considered to be a contraindication for percutaneous vertebroplasty. And percutaneous vertebroplasty is a safe and effective treatment for osteoporotic compression fractures with asymptomatic SEH.
Transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty for corneal ulcer perforation in Graves’ ophthalmopathy: A case report
Authors: Wang Pei , Han Zijian , Li Xiuhong , Lin Ru , Yuan Hongfeng 
Published: October 2024

Rationale:
To report a unique case of corneal ulcer perforation associated with a severe manifestation of Graves’ ophthalmopathy that was treated with unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty.

Patient concerns:
A 66-year-old male with Graves’ disease experiencing unilateral corneal ulcer perforation, a rarity in medical literature. He presented with a 9-month history of bilateral exophthalmos accompanied by decreased vision, and over the past month, he experienced loss of vision and painful swelling in the right eye (RE).

Diagnoses:
After a series of examinations, he was diagnosed with Graves’ ophthalmopathy.

Interventions:
Through local anti-infective treatment, the RE corneal ulcer showed no signs of infection. Once the patient’s thyroid function and heart rate were stable and his overall condition was stable, he underwent RE unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty under general anesthesia.

Outcomes:
The patient underwent successful unilateral transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty, resulting in a significant 4 mm reduction in orbital proptosis and it improved the vision and saved the eyes.

Lessons:
Transnasal endoscopic orbital inner wall decompression combined with penetrating keratoplasty is an effective method for treating corneal ulcer perforation caused by Graves’ ophthalmopathy. This method can not only greatly improve the appearance but also save the patient’s eyeball and improve visual function.
Primary gastric epithelioid angiosarcoma: A case report of diagnostic biopsy pitfall
Authors: Zhou Ning , Yang Li , Li Tao , Chen Liqiao , Jia Ruiqi , Chen Ying 
Published: October 2024

Rationale:
Angiosarcoma is an aggressive neoplasm derived from endothelial cells that may develop anywhere within the body. Here, we report a case of primary gastric epithelioid angiosarcoma initially misdiagnosed as poorly differentiated adenocarcinoma from the preoperative biopsy.

Patient concerns:
The patient was a 60-year-old male admitted to the hospital due to abdominal discomfort. The gastroscopy examination suggested advanced gastric cardia carcinoma. Subsequent biopsy pathology examination confirmed the diagnosis of poorly differentiated adenocarcinoma. Therefore, the patient underwent radical resection for proximal gastric cancer. Histopathology showed that the tumor cells were epithelioid with rich, eosinophilic cytoplasm. Immunohistochemical examination indicated that the tumor cells were CD34, CD31, and ERG.

Diagnoses:
Based on clinical, morphological, and immunophenotypic evidence, primary gastric epithelioid angiosarcoma diagnosis was confirmed.

Interventions:
The postoperative Tumor Node Metastasis staging was considered T4aN1Mx. The patient did not receive chemotherapy.

Outcomes:
The patient died 3 months after the operation.

Lessons:
Primary gastric epithelioid angiosarcoma is a rare gastric tumor. Given the epithelioid cell features displayed by tumor cells and the high expression of epithelial markers in tumor cells (83%), preoperative diagnosis is difficult and should be differentiated from adenocarcinoma or gastrointestinal stromal tumor.
Proton pump inhibitor-induced hypomagnesemia, a rare cause of reversible delirium: A case report with literature review
Authors: Zhao Wanxia , Zhang Jing , Jia Hongwei , He Qing , Cui Jingqiu , Ding Li , Liu Ming 
Published: October 2024

Rationale:
Hypomagnesemia is associated with multiple electrolyte disturbances such as hypokalemia, hypocalcemia and hypoparathyroidism. Proton pump inhibitors (PPIs) are widely used in gastrointestinal disorders and are generally considered safe by clinicians. However, it is unusual side effect of hypomagnesemia is potentially under-recognized. Delirium is usually thought to be a clue of cerebrovascular disease, and the association between delirium and hypomagnesemia is unexpected. We describe a patient used PPI with hypomagnesemia showed normal parathyroid hormone (PTH) despite hypocalcemia and reversible delirium. To enhance clinicians’ vigilance, we performed a literature review on cerebellar syndromes due to hypomagnesemia.

Patient concerns:
A 74-year-old woman was admitted to our hospital with intermittent nausea, vomiting, hand tremors, and delirium.

Diagnosis:
Laboratory analysis showed hypokalemia, hypomagnesemia, and normal parathyroid hormone despite hypocalcemia, physical examination showed horizontal nystagmus and the brain MRI was negative. Surprising, detailed medical history revealed that the etiology was the usage of omeprazole.

Interventions:
Omeprazole was discontinued and oral supplementation with magnesium, calcium, and potassium was administered.

Outcomes:
Delirium quickly disappeared and the serum potassium, magnesium, and calcium levels gradually normalized; at discharge, nystagmus gradually disappeared, and plasma electrolyte levels were stable at follow-up.

Lessons:
Hypomagnesemia is associated with a variety of neurological symptoms up to life-threatening conditions if left untreated; as Mg is not present in routine electrolyte panels, hypoparathyroidism, hypokalemia, and delirium may be a clue, and physicians must be alert to consider PPI as a potential cause of unexplained hypomagnesemia, and timely treatment to avoid sequelae.
Uterine carcinosarcomas: A case series of 9 cases from a low-income country
Authors: Efared Boubacar , Koura Halidou Hamadou , Bako Aïchatou Balaraba Abani , Boubacar Idrissa , Boureima Habiba Salifou , Mahamadou Garba , Nouhou Hassan 
Published: October 2024

Rationale:
Uterine carcinosarcomas (UCS) are rare aggressive biphasic tumors classified as a subtype of high-grade uterine carcinomas. However, these tumors have particular histopathological features and clinical behavior with worse prognosis than high-grade uterine carcinomas.

Patient concerns:
The incidence of UCS is increasing and more studies are required to elucidate their clinical and histopathological characteristics. Herein, we report clinicopathological features of 9 cases of UCS in a low-income country.

Diagnoses:
We retrospectively collected all cases of UCS at our Pathology Department over a period of 4 years. The diagnosis was performed on formalin-fixed, paraffin-embedded and hematoxylin and eosin–stained surgical specimens.

Interventions:
Nine surgically treated cases of UCS have been registered, representing 12.67% of all uterine malignancies with a mean age of 58.88 years (range: 50–65 years). Abdominal pain and metrorrhagia were the main clinical presentations. The epithelial component of UCS was often a serous carcinoma (66.66%) and patients presented with large tumors (mean size of 9.24 cm, range of 5–19 cm), with advanced FIGO stages (stages III–IV) in 5/9 patients (55.55%).

Outcomes:
Follow-up data were available in 5/9 patients among which only 2 were alive 2 and 25 months after the surgical treatment (overall survival of 40%).

Lessons:
UCS are rare and aggressive uterine tumors with very poor prognosis especially in low-income countries.
Combined traditional Chinese medicine and anti-hypertensive treatments for renal hypertension: A network meta-analysis and systematic review
Authors: Guo Jinjing , Jiang Zhibing , Yang Siyu , Meng Bin , Tang Qun 
Published: October 2024

Background:
Traditional Chinese medicine (TCM) demonstrates significant effects on renal function, yet it remains unclear which TCM treatment yields the best clinical outcomes for renal hypertension (RH) management. This study aims to evaluate the safety and effectiveness of various TCM treatments for RH compared to conventional Western medicine (CWM).

Methods:
Randomized controlled trials (RCTs) of TCM for RH were screened from 9 databases, covering the period up to July 2023. The Cochrane Risk of Bias tool was utilized to assess the risk of bias in the included RCTs. Network meta-analysis was conducted using RevMan 5.3 and Stata 14.0 software. Sensitivity analyses and meta-regression were performed to identify sources of heterogeneity and assess result robustness.

Results:
This study encompassed 3879 patients from 44 investigations involving 29 TCM interventions. The quality of the studies ranged from moderate to excellent, with well-defined inclusion criteria and generally low potential for biases related to outcome data and selective reporting. Tianma Gouteng Yin combined with Qiju Dihuang Wan + CWM demonstrated the highest total effective rate (relative risk = 1.31, 95% confidence interval (CI): 1.03, 1.66) compared to CWM alone. Bailing capsule + CWM was optimal for improving serum creatinine (mean difference (MD) = −53.78, 95% CI: −96.59, −10.98). Ziyin Pinggan Huayu decoction + CWM had the highest likelihood (surface under the cumulative ranking curves = 56.2%) of improving blood urea nitrogen. Zishen Pinggan prescription + CWM showed the greatest improvement in systolic blood pressure (MD = −46.29, 95% CI: −73.19, −19.38), while Ye Ren Gao decoction + CWM demonstrated the best improvement in diastolic blood pressure (MD = −13.13, 95% CI: −20.12, −6.13). Xifeng Qingnao decoction + CWM achieved the best improvement in 24-hour urinary protein (MD = −2.00, 95% CI: −3.26, −0.74). The combination of TCM and CWM was associated with a lower incidence of adverse effects.

Conclusion:
Combination therapy of TCM with CWM surpasses CWM alone in treating renal hypertension. This study identifies the most effective combination treatment for RH, as well as optimal treatments for lowering blood pressure (Zishen Pinggan prescription + CWM) and improving renal function (Bailing capsule + CWM).