bluuebunny/crossref_metadata_2025_split huggingface dataset:
The combination of focal breast edema and adjacent vessel sign to assess the behavior of mass-type invasive ductal carcinoma
Authors: Hu Juanjuan , Ke Junli , Xu Shufeng , Pei Lei , Cao Lulu , Zhou Huanhao , Zhu Xisong 
Published: October 2024

Abstract

Objectives
To investigate whether the combination of focal breast edema (FBE) and adjacent vessel sign (AVS) can provide valuable biological information for personalized treatment of patients with mass-type invasive ductal carcinoma (M-IDC).
Methods
We retrospectively included patients with M-IDC between January 2016 and December 2021. FBE was evaluated using T2-weighted sequence. AVS was assessed using maximum-intensity projection images obtained using early dynamic contrast-enhanced magnetic resonance imaging. The breast peritumor score (BPS) was defined as follows: BPS 1, absence of both edema and AVS; BPS 2, AVS without edema; BPS 3, AVS with peritumoral edema; BPS 4, AVS with prepectoral edema; and BPS 5, AVS with subcutaneous edema. The correlation between different BPS scores and clinicopathological variables was examined using Kendall’s tau-b correlation coefficient. The DeLong test was used to compare the performances of three clinicopathological models combined with peritumoral features (FBE, AVS, and BPS) in predicting luminal A-like M-IDC.
Results
In 228 patients with M-IDC, BPS was positively correlated with tumor size, histologic grade, lymphovascular invasion, axillary lymph node status, and Ki-67 index, and negatively correlated with estrogen receptor expression (all P < 0.05). Furthermore, BPS 1 was more likely to be present in patients with luminal A-like breast cancer (P < 0.001). Among the three prediction models, the clinicopathological model combined with the BPS model demonstrated superior diagnostic performance for luminal A-like breast cancer.
Conclusions
The BPS is a valuable, non-invasive biomarker for assessing the aggressiveness of M-IDC and can facilitate treatment planning.
Unlocking Potential: Elevating Faculty Development in Liberia through a Localized Training-of-Trainers Model
Authors: Martin Marie , Kumeh Odell , Croly Megan , Goll Sydell , Enders Comfort , Brillant Barbara , Boiwu Grace Hawa , Pusah Hashmi , Beyan Edwin , Plyler Chelsea , Talbert-Slagle Kristina , Stober Chase , Dahn Bernice 
Published: October 2024

Abstract

Background
Over the past few decades, the University of Liberia College of Health Sciences (ULCHS) has faced increased challenges in providing high quality health education due to societal turmoil, disease outbreaks, and a critical lack of human resources. In 2018, ULCHS leadership identified the building of a faculty development program focused on pedagogy and teaching skills as a top priority to strengthen educational output.
Methods
This paper describes the creation and implementation of a pedagogical training program within the Center for Teaching, Learning, and Innovation (CTLI) at the University of Liberia College of Health Sciences (ULCHS). Using an innovative South-South Training-of-Trainers (ToT) model which leveraged local trained educators within the same city and country, the program aimed to bridge teaching and learning gaps among ULCHS faculty members.
Results
Surveys administered across three iterations of the program indicated a substantial improvement in participants' perceived knowledge in 11 competency domains related to teaching, learning, and assessment. Results demonstrated (1) the effectiveness of the pedagogy training program in building perceived skills, and (2) usage of a South-South ToT model to foster a supportive learning environment and promote systemic change.
Conclusions
This study highlights the potential of a three-phase ToT model for transforming pedagogical practices in low-resource settings and emphasizes the importance of peer instruction in creating effective, student-centered learning environments.
Trial registration:
Not applicable
Hematohidrosis – a clinical rarity
Authors: Birar Shreyash Narendra , Kadam Dileep Babasaheb , Kurundkar Gajanan Balaji 
Published: October 2024

Abstract

Hematohidrosis is indeed a rare and intriguing condition. It's thought to occur when the tiny blood vessels around the sweat glands rupture, leading to blood mixing with sweat. This phenomenon is often linked to severe stress or emotional trauma, though the precise pathophysiological mechanisms remain unclear. Diagnosing hematohidrosis involves ruling out other possible causes of blood in sweat such as bleeding disorders, vasculitis, or other dermatological conditions. Treatment typically focuses on addressing the underlying stressors, emotional factors and ensuring that any contributing medical conditions are managed.
Here, we present a case of hematohidrosis in a 17 year old male who had bleeding from several sites like forehead, face, scalp, eyes, nose and ears around six to seven times per day in the last 2 months . During hospitalization, the patient was thoroughly investigated but no clear cut etiology could be pointed out. Patient underwent skin biopsy and was diagnosed with hematohidrosis and treated with beta blockers and antidepressants. His condition had improved significantly on follow-up.
A novel model for predicting the risk of non-sentinel lymph node metastasis after positive sentinel lymph node biopsy in Chinese women diagnosed with early breast cancer
Authors: Zhang Qunchen , Fang Yutong , Chen Bingfeng , He Lifang , Chen Chunfa , Huang Guangshen , Guo Cuiping , Chen Zexiao , Zeng Huancheng , Zhang Yongqu , Wu Jundong 
Published: October 2024

Abstract

Background: 30 to 70% of patients with positive sentinel lymph nodes (SLNs) in early breast cancer do not develop non-SLN metastases. They are exposed to the potential complications and sequelae of axillary lymph node dissection (ALND) without gaining additional therapeutic benefit. Therefore, a prediction model for non-SLN metastasis for Chinese breast cancer patients is needed.
Methods:We enrolled 1717 patients with early breast cancer who underwent SLN biopsy, and 481 of these patients underwent further ALND. An additional 113 patients served as a validation cohort. A new predictive model was established using univariate and multivariate Logit regression. The Memorial Sloan Kettering Cancer Center (MSKCC) and Shanghai Cancer Hospital (SCH) models were used for comparison with our new model.
Results: Multivariate regression analysis showed that tumor size, multifocality, lymphovascular invasion, extracapsular extension, number of negative SLNs, number of positive SLNs, size of the SLN metastasis, and metastatic SLN locationwere independent indicators for non-SLN metastasis. The nomogram established based on these eight variables was well applied in the training cohort (AUC: 0.830) and validation cohort (AUC: 0.785). Moreover, the diagnostic value of our model was superior to that of the MSKCC and SCH models (both P = 0.000). Decision curve analysis showed that the net benefit of our model surpasses that of both the MSKCC and SCH models for the same risk threshold, resulting in greater benefits for patients. With a guaranteed false-negative rate, our model could accurately predict up to 24.5% of patients suitable for exemption from ALND. Meanwhile, our model evaluated the non-SLN status of patients with 3 or more positive SLNs (AUC: 0.843).
Conclusions: We developed a new model to predict non-SLN metastatic status in Chinese patients with early SLN-positive breast cancer. Our model showed good performance in both cohorts and significantly outperforms the MSKCC and SCH models.
Effects of Kidney Stone Prevention After ER intervention: Does rurality or comorbid conditions affect outcomes?
Authors: Summers Stephen , Pfeifer Zachary , Stern Joshua , Horn Joshua John 
Published: October 2024

Abstract

Introduction and Objective: The incidence of kidney stones is rising, particularly among diabetic and obese populations. Limited access to urologic care in rural US areas may predispose these patients to increased kidney stone-related visits. This study aims to determine if rural residency and comorbid conditions affect kidney stone-related healthcare visits and the effectiveness of medical prophylaxis.
Methods: Using Merative Marketscan data from 2008 to 2017, patients diagnosed with kidney or ureteral stones who underwent surgical intervention in emergency settings were identified. Patients were categorized by comorbidities, demographics, and rural vs. urban residency. Preventative treatments, including medication and 24-hour urine testing, were noted. All patients were followed for 365 days post initial encounter to track subsequent stone disease management and prevention encounters.
Results: Out of 1,030,512 patients, 17% were rural residents. Post-initial stone events, 19% engaged in medical treatment. Treatment engagement led to a 16% reduction in stone-related ED visits the following year. Diabetic and obese patients not engaged in treatment had an 11% and 20% increased risk of subsequent stone-related ED visits, respectively. Engagement reduced the risk of subsequent stone events by 34% in diabetic patients and 24.5% in obese patients compared to their unengaged counterparts.
Conclusions: Medical treatment engagement slightly reduced overall stone-related encounters and return rates in the general population, with a minor decrease in urban compared to rural populations. However, treatment engagement significantly lowered stone-related event rates in diabetic and obese patients, highlighting the need for focused and aggressive preventive medical treatment in these groups.
Anterior segmental osteomy versus orthodontic camouflage treatment decision: The importance of incisor mandibular plane angle
Authors: Hong Pureum , Song Seung Il , Choo Hyunhee , Choi Young-Jin , Kim Young Ho , Chae Hwa Sung 
Published: October 2024

Abstract

Objectives
Temporary anchorage devices (TADs) have reduced the need for anterior segmental ostomy (ASO) in Class I patients; however, ASO remains relevant in Class II patients. As previous studies were conducted before the usage of TADs, updated guidelines are required to determine the relationship between surgery and orthodontic treatment. This study aimed to evaluate the hard tissue changes following ASO versus non-ASO (NASO) orthodontic treatment utilizing TADs with premolar extraction.
Materials and Methods
This retrospective clinical study involved 67 patients (18 male, 49 female; mean age: 33.9 years) diagnosed with skeletal Class II malocclusion. The patients were categorized into the ASO (n = 31) and NASO (n = 36) groups. Cephalometric analyses were conducted to compare initial and final records to assess the treatment effects
Results
Pre-and post-treatment changes in the ASO and NASO groups exhibited significant differences in ΔSNA, ΔSNB, ΔANB, ΔA to N-perp, ΔB to N-perp, ΔPog to N-perp, and ΔA to FH (P < 0.05). While the reduction in ANB in the ASO group compared with that in the NASO group was clinically significant at 1.77, both groups demonstrated normalized ANB, indicating significant skeletal improvement in Class II malocclusion. Specifically, the change in FMIA (ΔL1 to FH [°]) was 4.98° greater in the NASO group than in the ASO group (P < 0.05).
Conclusions
Our findings revealed the importance of the incisor mandibular plane angle (IMPA) in treatment decision-making between ASO and NASO treatment.
Clinical Relevance:
This study highlights IMPA's importance in treatment planning and aids in selecting ASO and NASO treatments.
The risk factor and the impact on survival of pathological fractures in patients with humeral metastasis
Authors: Saito Shiro , Kimura Hiroaki , Aiba Hisaki , Kawaguchi Yohei , Murakami Hideki 
Published: October 2024

Abstract

Background
Bone metastases often cause pathological fractures, impair patients’ quality of life and survival. Although there are several studies on pathological fractures in femur and spine, currently, there is limited research pertaining to upper limbs. This study aimed to reveal the risk factor and how pathological fractures impact survival in patients with humeral metastasis.
Methods
This was a retrospective study, based on patients with humerus metastasis treated in Nagoya-City University hospital from 2010 to 2020. Patient characteristics, including sex, age at diagnosis of humeral metastasis, primary cancer, prior treatment, anatomical location and metastatic lesion size were retrieved from the medical records. The patients were divided into the pathological fracture and non-fracture groups, and their background and survival rates were compared.
Results
A total 31 patients with 32 metastatic lesions were included in this study. Nineteen patients had pathological fractures (one patient had bilateral fractures) and 12 patients had no fractures. The risk factor of pathological fracture was treatment without bone modifying agents in multivariate analysis. The median overall survival was 21 months, 1-year survival was 56% in non-fracture group, and 59% in fracture group. There was no significant difference in survival rate between the two groups, and only chemotherapy had correlation with longer survival in multivariate analysis.
Conclusion
Bone modifying agents have the benefit of preventing pathological fractures due to humeral metastases. The humeral pathological fracture did not affect patient's survival, and chemotherapy was the only prognostic factor that prolonged survival.
Characterization of erythrocyte parameters during twin pregnancy and risk associated with postpartum hemorrhage: a multicenter retrospective study
Authors: Liu Jingyi , Xie Fang , Liu Caixia , Wei Jun , Yin Shaowei , Li Jie , Yang Xue , Yu Wenqian , Chen Xi , Huang Hailong , Hou Jiayu , Zhao Yan 
Published: October 2024

Abstract

Introduction:
The twin pregnancy population is a high-risk group. Twin pregnancies are at higher risk of anemia due to increased fetal demand for maternal nutrients and oxygen. In addition, changes in erythrocyte parameters during pregnancy may be specific to twin pregnancy, and these changes may be closely associated with the risk of postpartum hemorrhage (PPH). Therefore, the aim of this study was to explore the specificity of twin pregnancies by comparing the changes in red blood cell (RBC), hemoglobin concentration (Hb), and hematocrit (Hct) at various stages of gestation and to further investigate the relationship between hemoglobin levels and the risk associated with PPH in twin pregnancies.
Material and methods:
Our study was a multicenter retrospective study involving 4569 twin pregnant women, conducted in 34 hospitals nationwide in China in 2020. First, the levels of RBC, Hb, and Hct were descriptively analyzed to compare whether there were any differences between singleton and twin pregnancies. Second, in twin cases, differences were compared between those at risk for PPH and those not at risk. The subject operating characteristic (ROC) curves and area under the curve (AUC) were calculated for Hb at each stage, and the Hb cutoff value that caused the risk associated with PPH was determined using the risk associated with PPH as the criterion. Finally, the relationship between the duration of low Hb status in twin pregnancies and the risk associated with PPH was explored.
Results:
(1) RBC, Hb, and Hct were low at all stages of twin pregnancies compared with singleton pregnancies. (2) In twin pregnancy, "low Hb status" at all stages of pregnancy was associated with the risk of PPH. We believe that Hb below 116.5 g/L in the third trimester should be considered a warning against the risk of PPH. (3) The duration of "low hemoglobin status" in twin pregnancy is associated with the risk of PPH.
Conclusions:
This study shows that the changes in erythrocyte parameters during twin pregnancies are more specific, and the proposed cut-off value of "low Hb status" in twin pregnancy may help to identify the risk of PPH.
Thrombotic Thrombocytopenic Purpura: A Trojan Horse of Acute Leukemia?
Authors: Nassani Bertha Maria , EID Hind , Mourad Denise , Riachy Moussa , Maalouly Georges 
Published: October 2024

Abstract

Backgroud
Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disorder. The severity of TTP is associated with high mortality in the absence of treatment. Acquired TTP can be indicative of various underlying conditions, including neoplasia. Its identification is crucial because prompt management is essential.
Case presentation
We report the case of a 66-year-old male, a heavy smoker, who presented with drowsiness and confusion. One month before his presentation he presented a pruritic ecchymosis skin lesions, initially misdiagnosed as superinfected fungal lesions. Laboratory tests at the emergency department revealed bicytopenia (hemoglobin at 5.2 g/dL, platelets at 16,000) renal failure, and liver dysfunction disturbances. Further investigations confirmed microangiopathic hemolytic anemia, with a peripheral blood smear showing 3% schistocytes, hepatosplenomegaly, leading to a diagnosis of TTP. Urgent treatment with plasmapheresis was initiated. A bone marrow revealed acute myeloblastic leukemia (AML) type 2. ADAMTS13 levels were severely reduced, confirming TTP. Despite transient neurological improvement, the patient showed no significant biological response and passed away five weeks after diagnosis, highlighting the complexity and severity of his condition.
Conclusion
This case presents a rare instance of TTP as an initial presentation of AML, highlights the need to maintain a high clinical suspicion for neoplastic causes in atypical TTP. Although the association between AML and TTP is anecdotal, the unusual clinical features, including atypical skin lesions in a 65-year-old with constitutional symptoms, led to the AML diagnosis. The pathophysiology may involve anti-ADAMTS13 antibodies or ADAMTS13 deficiency. Treatment is based on standard TTP therapy (corticosteroids, plasmapheresis, Rituximab) while treating the underlying AML. Aneoplasm, particularly a hematologic one, should be suspected in any elderly patient presenting with atypical TTP. Given the poor prognosis of both entities separately, their association remains fatal.
Comparison of the Effects of Sodium Bicarbonate Ringer's Solution and Normal Saline in the Prognosis and Endothelial Glycocalyx of Sepsis Patients: A Randomized Controlled Clinical Study
Authors: Zhang Ying , Gu Xue , Yu Lina , Yuan Jun , Yuan Zhou , Yang Penglei , Chen Qihong 
Published: October 2024

Abstract

Background
Although fluid resuscitation is an essential sepsis intervention, the optimal choice of fluid remains debatable. Herein, we aimed to compare the efficacy of sodium Bicarbonate Ringer's Solution (sBRS) to that of Normal Saline (NS) in the prognosis of sepsis patients.
Methods
This was a single-centre, Randomized Clinical Trial (RCT) that involved sepsis patients admitted to the Department of Critical Care Medicine of Jiangdu People's Hospital of Yangzhou between July 1, 2021, and June 30, 2023. Patients were randomly assigned to two groups to receive either sodium sBRS or NS for fluid resuscitation or maintenance therapy, respectively. The primary outcome was 30-day mortality. On the other hand, the secondary outcomes included Intensive Care Unit (ICU) mortality, occurrence of Major Adverse Renal Events within 30 days (MAKE30), duration of using vasoactive agents, sodium bicarbonate use, mechanical ventilation-free days, incidence of adverse events, and presence of endothelial glycocalyx degradation products in plasma or serum [including Syndecan-1 (SCD-1), Hyaluronan (HA), and Heparan Sulfate (HS)].
Results
Herein, 67 patients (32 and 35 patients in sBRS and NS groups, respectively) who met the inclusion criteria were included in the final analysis. The two groups showed no differences in 30-day mortality (28.1% vs. 40.0%), ICU mortality (15.6% vs 20.0%), and MAKE30 (31.2% vs. 42.9%) (P > 0.05). However, the sBRS group had a higher number of mechanical ventilation-free days than the NS group [12.9(2.5 18.9) d vs. 9.0(3.6 9.0) d] (P < 0.05). Furthermore, the sBRS group showed a significantly lower duration of using vasoactive agents [43.2(29.8 83.0) h vs. 46.3(23.5 104.3) h] and sodium bicarbonate [100(100 150) ml vs. 125(100 250) ml], as well as hyperchloremia incidence [18 (51.4%) vs. 6 (18.9%)], than the NS group (P < 0.05). Additionally, on the third day, the sBRS group exhibited significantly lower SCD-1 (1317.3 ± 206.9pg/ml vs. 1514.6 ± 264.9pg/ml), HA (75.1 ± 24.9ng/mL vs. 96.5 ± 25.4ng/mL), and HS (75.6 ± 13.8ng/mL vs. 85.8 ± 15.8ng/mL) levels than the NS group (P < 0.05).
Conclusion
Compared to NS, resuscitation using sBRS in sepsis patients could correct acidosis faster, reduce hyperchloremia incidence, shorten the mechanical ventilation time, and reduce the use of vasoactive drugs and glycocalyx degradation.
Trial registration
ChiCTR2100053514.Registered 23 November 2021(retrospectively registered)
Characteristics of Pseudomonas aeruginosa keratitis at Ho Chi Minh Eye Hospital
Authors: Nguyen Huynh Phuc , Nguyen Thi Truc Mai , Nguyen Thi Thanh Xuan , Ngo Tri Thuan , Vu Thi Viet Thu , Trinh Xuan Trang , Duong Nguyen Viet Huong 
Published: October 2024

Abstract

Background
The increasing drug resistance of Pseudomonas aeruginosa (PA) poses a serious challenge to the current treatment. Antibiograms of this pathogen often take 4–7 days, and treatment of Pseudomonas aeruginosa keratitis (PAK) is mainly based on preliminary physical examination, clinical experience, and medical guidelines. Pertinent clinical data on the causative agent and antibiotics for high efficacy are essential for early recognition and subsequent treatment.
Purpose
To report the etiology, risk factors, treatment outcomes, antibiotic susceptibilities, and trends of PAK.
Methods
This retrospective study included culture-proven PAK cases at the Ho Chi Minh City Eye Hospital Cornea Department between January 2018 and December 2022. Culture results showing coinfection were excluded from the study.
Results
Among 154 eyes infected by PA (n = 154) of 154 patients, ocular trauma was the leading risk factor (53.2%); only 16 patients had contact lenses (10.4%). Among the 154 eyes, 102/154 required surgical intervention (66.2%); and 31/154 eyes required evisceration (20.1%). PA was sensitive to tobramycin (95.9%), ciprofloxacin (91.9%), levofloxacin (91.9%), ofloxacin (87.4%), and moxifloxacin (20.0%). The prevalence of multidrug resistance (MDR) was 70.1%, and extensive drug resistance (XDR) was 6.5%. Poor outcomes (need for surgical intervention or final visual acuity ≤ CF 3m) included age > 50 years, ocular surface diseases, deep infiltrate, large infiltrate size ≥ 5mm, and ring infiltrate (p < 0.05).
Conclusion
PAK, which is associated with increasing drug resistance, poses significant challenges in terms of treatment, with 66.2% of patients requiring surgical intervention. With the rapid progression of PAK, early treatment with broad-spectrum and effective antibiotics is necessary. However, future research should focus on new methods to enhance treatment effectiveness.