bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catastrophic spontaneous spinal epidural hematoma following thrombolysis: An intersection of neurosurgical and cardiological challenges – An institutional experience
Authors: Soni Tushar V. , Patel Shreyansh J. , Shah Varshesh K. , Joshipura Kavan M. 
Published: September 2024

ABSTRACT
Catastrophic spontaneous spinal epidural hematoma (SSEH) following thrombolysis poses a complex intersection of neurosurgical and cardiological challenges. This case report presents the institutional experience of a 66-year-old female who developed rapid-onset compressive myelopathy after thrombolysis for inferior wall myocardial infarction with injection streptokinase. SSEH, although rare, demands prompt recognition due to its potential for permanent neurologic injury and mortality. The discussion highlights the clinical significance, anatomical considerations, and multidisciplinary approach requisite for accurate diagnosis and effective management of SSEH. The conclusion underscores the necessity for clinicians, particularly cardiologists administering thrombolytic therapies, to consider SSEH in postthrombolysis patients presenting with neurological deficits.
Odontoid remodeling with occipital condyle stabilization in patients with metastatic C2 involvement
Authors: Akgun Mehmet Yigit , Durmus Nazenin , Gunerbuyuk Caner , Gunara Sezer Onur , Oktenoglu Tunc , Sasani Mehdi , Ates Ozkan , Ozer Ali Fahir 
Published: September 2024

ABSTRACT
The occipitocervical junction (OCJ) is a complex anatomical region crucial for protecting the lower brain stem, upper spinal cord, and lower cranial nerves. Instability in this area can lead to severe outcomes such as chronic pain, neurological deficits, or death. Various surgical techniques have been developed for OCJ stabilization, particularly using occipital condyle screws, which have shown promise in providing stability and preserving neck rotation. This article presents two cases of OCJ instability caused by metastatic involvement of the C2 vertebra, managed successfully with occipital condyle screw fixation. The first case involved a 22-year-old female with Ewing sarcoma metastasis, and the second case involved a 62-year-old male with multiple myeloma. Both patients exhibited significant improvements in neurological function and cervical stability postoperatively, with observable den remodeling. Our findings suggest that occipital condyle screw fixation is not only feasible but also effective in managing OCJ instability due to metastatic disease. Detailed preoperative evaluation and the use of advanced intraoperative imaging technologies, such as the O-arm and neuronavigation, are essential for maximizing safety and ensuring optimal outcomes. This study underscores the potential of occipital condyle screw fixation as a primary surgical method for stabilizing the OCJ in appropriate cases.
Trends and epidemiology of spine fractures in the super-elderly population in the United States
Authors: Cush Charles T. , Stefko Joseph M. , Jaworski Hayden M. , Lyons Joseph G. 
Published: September 2024

ABSTRACT

Introduction:
Spine fractures occur commonly in the geriatric population. Super-elderly individuals (i.e., those 80 years of age and older) represent a growing segment of the population and are especially prone to these fractures. The contemporary epidemiology of spine fractures in the super-elderly population is incompletely described in the literature.

Materials and Methods:
This descriptive epidemiology study used the National Electronic Injury Surveillance System to examine the incidence and recent trends of spine fractures occurring among super-elderly individuals in the United States (US) from 2011 to 2020. Annual, overall, and age-/sex-specific incidence rates (IRs) were analyzed. Average annual percent change (AAPC) estimates were calculated to indicate the magnitude/direction of trends in annual injury rates.

Results:
An estimated n = 385,375 super-elderly patients sustained spine fractures over the 10-year study period for an overall IR of 31.5 per 10,000 person-years at-risk. Lumbar fractures (IR = 16.3) were the most common, followed by thoracic (IR = 9.4) and cervical (IR = 6.9) fractures. Incidence was significantly higher in super-elderly females (IR = 35.6) than in males (IR = 24.8). Incidence was significantly higher in nonagenarians (IR = 50.7) and centenarians (IR = 42.6) than in octogenarians (IR = 26.8). Accounting for population growth yielded a significantly increasing incidence over the study period from 20.8 in 2011 to 40.3 in 2020 (AAPC = 8, P < 0.0001).

Conclusions:
This study suggests that the annual incidence of spine fractures in the oldest cohort of patients in the US (80 + years of age) increased significantly during the recent decade from 2011 to 2020. Increased IRs highlight the need for future research aimed at optimizing outcomes and quality of life in this frail and ever-growing segment of the population.
Evaluating the Efficacy of Natural Language Processing Artificial Intelligence Models as a Patient Education Tool for Stature Lengthening Surgery and Reconstruction
Authors: Xavier Jorden L. , Khoury Joseph , Phen Huai Ming , Fragomen Austin T. , Rozbruch S. Robert , Kahn Mani 
Published: September 2024

Abstract

Introduction:
While traditionally a treatment for congenital deformities, limb-lengthening surgery has recently been utilized as a cosmetic solution for patients with less-than-desirable heights. Despite a growing rise in popularity, stature-lengthening surgery carries a host of social stigmas and ethical concerns. With the emergence of natural language processing artificial intelligence (NLP AI) models such as ChatGPT, patients interested in stature-lengthening surgery may turn to these chatbots for medical information instead of primary care providers. This study seeks to evaluate the quality and readability of NLP AI model responses to common questions regarding stature-lengthening surgery to ensure proper patient education and direction toward a licensed orthopedic surgeon.

Materials and Methods:
Eleven questions regarding limb-lengthening surgery were posed to ChatGPT version 3.5. All named authors reviewed the AI responses independently and utilized the following scoring systems to assess readability and quality: DISCERN, ChatGPT Response Accuracy Scoring (CRAS) developed by Mika et al., Flesch–Kincaid Reading Ease (FRES), and Flesch–Kincaid Grade Level (FKGL). Cohen’s kappa was utilized to determine the inter-rater reliability between each reviewer’s assigned DISCERN and CRAS scores.

Results:
The average DISCERN score across all independent reviewers was 55.2 ± 5.63, with an inter-rater reliability of 0.293, indicating good scores with fair agreement, respectively. The average CRAS score across all senior reviewers was 1.60 ± 0.63 with inter-rater reliability being 0.014, indicating none to slight agreement. The average FRES score was 14.8 ± 2.24, and the average FKGL score was 18.9 ± 11.0, indicating a required reading level of a college graduate.

Conclusions:
The results of our study show that NLP AI models provide generally high-quality responses to patient questions regarding stature-lengthening surgery. However, notable flaws were identified, including a high required education level for proper comprehension as well as an inability to cite source material used for each response.
The Effect of Ketorolac on Bone Healing Rate Following Osteotomy in Pediatric Patients with Deformity or Limb-length Discrepancy
Authors: Bafor Anirejuoritse , Yassall Anthony , Hatfield Danielle , Iobst Christopher 
Published: September 2024

Abstract

Background:
The mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs) and the results of testing in some animal fracture models have created concerns with bone healing when these drugs are used for perioperative orthopedic analgesia. Given that distraction osteogenesis patients require new bone to be formed, they would potentially be sensitive to the effects of NSAIDs such as Ketorolac. We sought to determine the relationship between the perioperative use of Ketorolac and the duration of healing in pediatric patients undergoing distraction osteogenesis for either limb lengthening or deformity correction surgery.

Materials and Methods:
A single-center retrospective chart review of 94 pediatric patients aged 17 years or younger who had undergone surgery for limb lengthening, deformity correction, or a combination of limb lengthening and deformity correction was carried out. We collected and analyzed patient demographics, details of surgery and pathology, perioperative pain management, duration of healing, and incidence of complications in this cohort of patients.

Results:
Patients were divided into three groups: a deformity correction group (n = 46), a limb lengthening group (n = 30), and a combined deformity correction and limb lengthening group (n = 18). The mean magnitude of deformity was 21°. Patients in the lengthening group had a mean lengthening of 4.1 cm. Patients in the combined group had a mean magnitude of deformity of 14.7° and a mean lengthening of 3.8 cm. Patients in all three groups received an average of 4 doses of ketorolac in the perioperative period. We found no correlation between the total amount of ketorolac used and the duration of healing among patients who had deformity correction, limb lengthening, or a combination of deformity correction and limb lengthening surgery (P = 0.82, 0.20, and 0.18, respectively). The correlation results also showed no sex variations in either group.

Conclusions:
Ketorolac can safely be used as an analgesic in pediatric patients undergoing distraction osteogenesis for limb lengthening, deformity correction, or a combination of both procedures.
Clinical, Demographic, Neuro Imaging Features, and Outcome of Subacute Sclerosing Pan Encephalitis in a Pediatric Cohort
Authors: Cornelius Leema P. , Venkateswaran K. J. , Jered Livinston K. , Neeraj E. , Surya Kumar S. 
Published: September 2024

Abstract

Background:
Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder in children and young adults due to persistent infection caused by the defective measles virus. It is still common in developing countries such as India.

Aim:
The aim of this study was to describe the clinical and demographic neuroimaging features, and outcomes of SSPE.

Materials and Methods:
A retrospective chart review of children diagnosed with SSPE during 2016–2020 was performed and the data were analyzed.

Results:
Of the 32 patients, 28 (87.5%) were men and four (12.5%) were women. The mean age of onset was 7.28 ± 2.19 years. The initial symptom was myoclonic and generalized seizures in eight (25%) each, behavioral problems in seven (21.9%), frequent falls in six (18.8%), and poor scholastic performance in three (9.4%). One-half of the cohorts had measles in the past and 91% had received the vaccine. Atypical presentations such as akinetic rigid syndrome, and acute disseminated encephalomyelitis (ADEM) like presentations can occur. Magnetic resonance imaging (MRI) brain showed abnormalities in 14 (43.8%) and was normal in 10 (31.3%). The most common abnormality noted was hyperintensities in the frontoparietal region in six (18.8%). Electroencephalogram showed long interval periodic complexes in 21 (65.6%), burst suppression pattern in 7 (22%), and was normal in 4 (12.5%). At the time of diagnosis, 25 (78%) patients were in stage II, 5 (15.6%) in stage III, and 1 (3.1%) child in stage IV and stage I each. Five patients (15.6%) died, 10 (31.3%) lost follow-up, 12 (37.5%) were bedridden, and the disease was static in 5 children (15.6%).

Conclusion:
Myoclonic seizures and cognitive decline are the most common symptoms in children with SSPE. Knowledge about atypical presentations is essential to avoid unnecessary investigations.
SLC25A19 Mutation-Related Bilateral Striatal Necrosis and Limbic System Involvement: A Case Report and Review of the Literature
Authors: Yüksel Merve Feyza , Bektas Ömer , Akıncı Göktas Özben , Sahin Süleyman , Teber Serap 
Published: September 2024

AbstractThiamine pyrophosphate is an activated form of thiamin and primary cofactor for a number of enzyme complexes. Several disorders have been identified so far, which are caused by abnormalities in thiamine transport and metabolism. Biotin–thiamine-responsive basal ganglia disease caused bySLC19A3mutation is the most commonly encountered disorder in the literature. Progressive polyneuropathy with bilateral striatal necrosis is a rarer entity associated withSLC25A19mutation and eight cases have been defined in the literature so far. TheSLC25A19differs fromSLC19A3by causing progressive neuropathy if not treated and lifelong thiamine replacement can slow progression of polyneuropathy. Here, we aimed to present a patient who presented with acute encephalopathy attacks triggered by infection and had bilateral strial necrosis and limbic system involvement in cerebral MR imaging,SLC25A19gene mutation in the genetic testing and neuropathy development during follow-up and to review patients withSLC25A19-related bilateral striatal necrosis in the literature.
Acute Leucoencephalopathy with Restricted Diffusion: A Novel Cause of Encephalopathy and Hypertension in Children
Authors: Kamate Mahesh , Detroja Mayank 
Published: September 2024

Abstract

Background:
Acute leucoencephalopathy with restricted diffusion is emerging as an important cause of acute encephalopathy in children. Recently, we found few children with his condition had associated refractory hypertension. This association has not been described in the past.

Method:
Retrospective chart review of patients with Acute leucoencephalopathy with restricted diffusion who also had documented hypertension was done and the clinical details, investigations done, course and outcome was analysed.

Result:
A total of 3 out of 21 children were found to have hypertension. Hypertension was recorded during first week of illness and lasted for 1-3 weeks. One child had refractory hypertension and required three antihypertensive drugs to control it. Detailed work up for other causes of hypertension was negative in all children.

Conclusion:
Acute leucoencephalopathy with restricted diffusion in children can present with hypertension. The hypertension can be refractory requiring multiple antihypertensive drugs but transient in nature.
Incidental Neuroendocrine Tumors of Appendix: Study from a Tertiary Care Hospital
Authors: Nazir Mir Wajahat Un , Shah Javid Rasool , Shah Khalid Manzoor , Bashir Nusrat , Bilal Sheikh 
Published: September 2024

ABSTRACT

Background:
Our aim is to study the data of patients who underwent appendectomy for clinically diagnosed acute appendicitis, and the neuroendocrine tumor was detected as an incidental finding.

Methods:
A retrospective Data of 1728 patients who underwent appendectomy for clinical diagnosis of appendicitis over a period of four years was evaluated in the department of pathology. The records of patients, who were reported as neuroendocrine tumors on histopathology, from those 1728 patients, were examined in detail in terms of demographic data, size of tumor, histopathological diagnosis and grading, status of margins, depth of invasion, lymphovascular emboli, perineural invasion, and immunohistochemical features. All the cases of neuroendocrine tumors were followed up for any recurrence or revised treatment.

Results:
Neuroendocrine tumors were detected incidentally in 8 (0.46%) out of 1728 appendectomy specimens. There was a male predominance, with 6 (75%) cases being males and 2 (25%) females. The clinical presentation in all cases was resembled acute appendicitis. The mean age was 18.25 (range: 3–31). The mean size was 8.75 mm (range: 6 mm–1 cm). Revised hemicolectomy was done in two patients. In both the reoperated cases, no residual tumor was detected.

Conclusion:
Neuroendocrine tumors of the appendix usually present as acute appendicitis and are detected incidentally on appendectomy specimens operated for acute appendicitis. Hence, careful and meticulous histopathological examination of all appendectomy specimens is mandatory to detect a hidden neuroendocrine tumor and to detect various adverse histopathological findings which will determine further treatment.
Initial Clinical Outcome of Breath-hold Stereotactic Body Radiation Therapy for Liver Tumors: A Single-Institutional Experience
Authors: Katano Atsuto , Noyama Tomoyuki , Morishima Kosuke , Yamashita Hideomi 
Published: September 2024

ABSTRACT

Objective:
This study aimed to evaluate the initial clinical outcomes of breath-hold stereotactic body radiation therapy (SBRT) for liver tumors based on the experience of a single institution. The study assessed treatment response, toxicity, and survival rates to determine the safety and efficacy of breath-hold SBRT in this patient population.

Methods:
A retrospective analysis was conducted on patients who underwent breath-hold SBRT as the primary treatment for liver tumors at a single institution between April 2020 and April 2021. Clinical characteristics, treatment parameters, and clinical outcomes, including local control (LC), overall survival (OS), toxicity, and patient-reported outcomes, were collected from electronic medical records. Statistical analyses were performed using the Kaplan–Meier method, Wilcoxon signed-rank tests, and multivariate analysis.

Results:
Sixteen patients were included in the study, with a median follow-up duration of 8.2 months. The OS rates at 6 and 12 months were 100% and 67.1%, respectively. No local relapses were observed during the follow-up period, and the intrahepatic control rate at 6 months was 50.0%. Grade 3 radiation-induced adverse events occurred in two patients, and Grade 2 events were observed in eight patients. No Grade 4 or higher adverse events were reported. Five patients experienced worsening Child–Pugh scores after treatment.

Conclusions:
The results indicate that breath-hold SBRT is a safe and effective treatment option for liver tumors, with comparable outcomes to recent studies. The study demonstrated acceptable LC and low toxicity rates. However, the median follow-up duration was relatively short, and further long-term studies are needed to assess the durability of LC and toxicity rates. In addition, larger-scale studies comparing breath-hold SBRT with other treatment modalities are necessary.
Medial End Clavicular Osteochondroma- An Unusual Case
Authors: Reddy G. Swetha , Reddy P. Amith , Adla Deepthi Nandan Reddy 
Published: September 2024

Abstract
Osteochondroma is the most common benign bone tumor, which could present as a sessile or pedunculated type and, in solitary or multiples, hereditary multiple exostoses (a genetic disorder, autosomal dominant inheritance). Clinical presentation is mostly asymptomatic, but if symptomatic, it presents in a wide spectrum, such as compression of adjacent vessels, nerves, deformities, fractures, bursa formation, and malignant transformation. Cancerous transformation is indicated by the thickness of the cartilage cap of >3 cm in children, >2 cm in adults, sudden onset of pain, and sudden/rapid growth of lesion (after growth plate closure). Surgical management is indicated for typical symptomatic lesions, complications, malignant transformation, and cosmetic reasons. The common treatment of choice is the excision of a tumor with a significant free margin.
Clinical, dermoscopic, and histopathological analysis of Becker’s nevus (BN): A case series in Indian skin
Authors: Mani Siddharth , Khandare Manish , Raut Aradhana , Paul Benjith 
Published: September 2024

Abstract

Introduction: Becker’s Nevus (BN) is a cutaneous hamartoma characterized by localized hyperpigmentation and hypertrichosis, primarily affecting adolescent males. The condition is associated with increased androgen receptor activity and may present with variations such as follicular BN and atypical site involvement. Despite its benign nature, accurate diagnosis through non-invasive methods like dermoscopy is crucial. Material and Methods: This study, conducted from September 2020 to January 2022, analyzed six male patients with clinically diagnosed BN. Dermoscopic examination using a non-contact polarized light dermatoscope was followed by punch biopsies. Four dermatologists independently evaluated the dermoscopic findings, which were then correlated with histopathological features. Results: All patients exhibited a prominent pigmentary network, with perifollicular hypopigmentation and terminal hair in the majority. Histopathology revealed acanthosis and increased basal layer pigmentation in all cases. Follicular BN variants were observed in two patients. Conclusion: Dermoscopy proved effective in identifying specific features of BN, reducing the need for invasive biopsies. This study enhances the understanding of BN's dermoscopic and histopathological characteristics, particularly in Indian patients.
Dowling-Degos disease: a classic presentation of a rare disease
Authors: Das Abhijit , Dhabal Arunima , Malakar Arpita , Kar Chinmay 
Published: September 2024

Abstract
Dowling-Degos disease (DDD) is an autosomal dominant disorder characterized by acquired, reticulate hyperpigmentation in flexural areas. It is a rare condition with very few cases reported in the literature. Although clinically similar to a number of other reticulate pigmentary disorders, it has some characteristic dermoscopic and histopathological features that aid in its diagnosis. We describe the case of an Indian female presenting with classical clinical, dermoscopic, and histological features of DDD.
Marketing information sources amongst oil palm fresh fruit bunch processors in Ovia Northeast Local Government Area, Edo State, Nigeria
Authors: S.O. Konkwo  , A.A. Dickson  
Published: September 2024

This study assessed marketing information sources among fresh fruit bunch (FFB) processors in Ovia North-East Local Government Area, Edo State, Nigeria. Multistage sampling procedure was used in selecting the respondents and data were analyzed using both descriptive and inferential statistics. Results showed that mean age, household size, farming experience and annual income were 47 years, 5 persons, 9 years, N 2,941,935.55 and 6 hectares respectively. Again, the study found that the most available marketing information to the respondents were information on where to sell FFB products, when to sell finished products and current market price of products based on the 97.5% respective response distribution on the variables. The major source of marketing information to the respondents was through phone calls (87.5%) while information from fellow dealers was the most preferred (ẍ = 4.30) source. Furthermore, there was significant relationship between age (r = -0.276; p = 0.013), farm size (r = 0.506; p = 0.000), annual income (r = 0.304; p = 0.006) and the available sources of marketing information to the respondents. The study concluded that the major source of marketing information to the respondents was through phone calls that were made directly to retailers/dealers of processed products. The need for initial identification of information sources available to end users was strongly recommended by this study before the actual dissemination of relevant information in order to ensure wider coverage and timely reception.