bluuebunny/crossref_metadata_2025_split huggingface dataset:
Splenic rupture following endoscopic mucosal resection: A case report and literature review
Authors: Ye Yusong , Yang Rui , Peng Shicheng , Xiang Qilang , Chen Yuexi , Lü Muhan , Yang Weixing 
Published: October 2024

Rationale:
This study aims to highlight the rare but severe complication of splenic rupture following colorectal endoscopic mucosal resection (EMR), advocating for increased vigilance during procedures near the splenic flexure.

Patient concerns:
We present a case report of a 66-year-old woman who experienced persistent abdominal pain after undergoing EMR for an adenomatous lesion in the distal transverse colon.

Diagnoses:
The diagnosis of splenic rupture was established following her symptoms and clinical evaluation.

Interventions:
Active conservative management was implemented after diagnosis.

Outcomes:
The patient’s recovery underscores the importance of prompt diagnosis and careful monitoring.

Lessons:
Although splenic rupture after EMR is extremely rare, it is a serious and potentially life-threatening complication. When obtaining informed consent, it is important to emphasize not only common complications like bleeding and perforation but also the risk of splenic injury. Physicians should select appropriate instruments and carefully adjust the angle and force of needle insertion, avoiding excessively long needles and vertical insertion. The procedure should be performed gently to minimize the risk of splenic rupture. For lesions near the splenic flexure, if postoperative abdominal pain occurs, regardless of left shoulder pain, splenic rupture should be considered, and a computed tomography scan promptly performed. Postoperatively, physicians should closely monitor vital signs and repeatedly check blood counts and coagulation parameters. Treatment should be tailored to the splenic injury’s extent and the patient’s overall condition, with immediate surgery if necessary. High-risk patients should be regularly followed up and instructed to monitor for physical changes. Endoscopists should remain vigilant during procedures, fully understanding potential complications, and closely monitoring the patient’s condition postoperatively. This vigilance is key to preventing severe complications and ensuring optimal outcomes.
Cost-effectiveness analysis of anticoagulation, percutaneous mechanical thrombectomy, and catheter-directed thrombolysis treatments for acute lower extremity deep venous thrombosis
Authors: Zou Jun , Ye Qianling , Zhao Bin , Hu Chenming , Li Xiang , Wu Huaping 
Published: October 2024

Background:
There is a lack of health economics studies on the treatment of acute lower extremity deep venous thrombosis to measure the benefits to patients. The purpose of this study was to evaluate the cost-effectiveness of anticoagulation (AC), percutaneous mechanical thrombectomy (PMT), and catheter-directed thrombolysis (CDT).

Methods:
The above 3 methods were selected according to the patient’s treatment wishes. Related complications, clinical effective, occurrence of post-thrombotic syndrome (PTS) after 2 years, and total hospitalization costs of patients between the patients in these 3 treatment groups were analyzed. In the cost-effectiveness analysis, costs were expressed in monetary terms and the effect was expressed as the effective rate of clinical treatment. In addition, we used sensitivity analyses to validate the results.

Results:
The effective rate of clinical treatment for the AC, CDT, and PMT groups were 44.23%, 86.84%, and 92.59%, respectively. No serious complications occurred in any of the treated patients. There was no significant difference in the incidence of PTS among the 3 groups during the follow-up period. After 12 months, compared with the AC group, there were statistically significant differences in moderate-severe reduction in PMT group and CDT group separately. At 24 months, the incidence of moderate-severe disease in PMT group was significantly lower than that in CDT group.

Conclusion:
All 3 treatment methods have good safety. Compared with AC therapy alone, both PMT and CDT therapy resulted in a higher clinical efficacy rate, reduced the severity of PTS within 2 years, and reduced the cost of PTS. From the perspective of the cost-effectiveness ratio, within a certain range of treatment efficacy, AC therapy alone incurs the lowest cost per 1% improvement in therapeutic effect. The cost-effectiveness results show that if decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be lower than the ratio of incremental cost to effect, then AC therapy alone is chosen. If decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be higher than the ratio of incremental cost to effect, then the choice is AC plus CDT treatment.
Endoscopic ultrasound-guided gastroenterostomy versus duodenal stenting for gastric outlet obstruction: A systematic review, meta-analysis, and meta-regression
Authors: Jain Hritvik , Dey Debankur , Odat Ramez M. , Hussein Ayham Mohammad , Abbasi Haleema Qayyum , Madaan Hritik , Goyal Aman , Jain Jyoti , Ahmed Mushood , Marsool Mohammed Dheyaa Marsool , Yadav Rukesh 
Published: October 2024

Background:
Gastric outlet obstruction (GOO) refers to mechanical obstruction at the level of the gastric outlet and is associated with significantly impacted quality of life and mortality. Duodenal stenting (DS) offers a minimally invasive approach to managing GOO but is associated with a high risk of stent obstruction. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel intervention that uses lumen-apposing metal stents to open the restricted lumen. The current evidence comparing EUS-GE to DS is limited and inconsistent.

Methods:
We conducted a systematic literature search on PubMed, Embase, Cochrane, Scopus, and clinicaltrials.gov to retrieve studies comparing EUS-GE to DS for GOO. Odds ratios (OR) and mean differences (MD) with their 95% confidence intervals (CI) were pooled using the DerSimonian-Laird inverse variance random-effects model. Statistical significance was set at P < .05.

Results:
Ten studies with a total of 1275 GOO patients (585: EUS-GE and 690: DS) were included. EUS-GE was associated with statistically significant higher clinical success [OR: 2.52; 95% CI: 1.64, 3.86; P < .001], lower re-intervention rate [OR: 0.12; 95% CI: 0.06, 0.22; P < .00001], longer procedural time [MD: 20.91; 95% CI: 15.48, 26.35; P < .00001], and lower risk of adverse events [OR: 0.49; 95% CI: 0.29, 0.82; P = .007] than DS. Technical success [OR: 0.62; 95% CI: 0.31, 1.25] and the length of hospital stay [MD: −2.12; 95% CI: −5.23, 0.98] were comparable between the 2 groups.

Conclusion:
EUS-GE is associated with higher clinical success, longer total procedural time, lower re-intervention rate, and lower risk of adverse events than DS. Technical success and the length of hospital stay were comparable between the 2 groups. EUS-GE appears to be a safe and effective procedure for managing GOO. Further large, multicentric randomized controlled trials are warranted to investigate the safety and outcomes of EUS-GE in patients with malignant GOO.
Vibrio vulnificus infection complicated by acute-on-chronic liver failure: A case report
Authors: Wang Tingting , Huang Qifeng 
Published: October 2024

Rationale:

Vibrio vulnificus is a gram-negative bacterium that can cause 3 clinical syndromes: gastrointestinal symptoms, skin septicemia, and primary septicemia. V vulnificus infection can induce an exacerbation of liver disease, eventually requiring intensive care for multiorgan failure.

Patient concerns:
A 56-year-old Chinese male who was admitted for left lower limb swelling 5 days after sustaining an injury. His left lower leg was wounded with a machete used for cutting rubber. Notably, this machete had also been previously utilized for cutting seafood. Blood culture results indicated the presence of V vulnificus during the hospitalization. The patient’s condition deteriorated rapidly leading to acute liver failure. Over the ensuing days, the patient experienced separation of tendency of aminotransferase and bilirubin (bilirubin-aminotransferase dissociation), indicative of worsening liver function. Of note, the patient had a history of untreated hepatitis B virus infection and a long drinking history.

Diagnoses:
Acute-on-chronic liver failure following a V vulnificus infection.

Interventions:
We utilized double plasma molecular adsorption system (DPMAS) to address the deterioration of the patient’s liver function.

Outcomes:
After 2 DPMAS treatments, the patient’s liver function showed improvement.

Lessons:
This report underscores the importance of timely and repeated DPMAS treatment of patients with a drinking history or chronic liver disease when they present with V vulnificus septicemia.
A systematic review of case reports on mortality, modes of infection, diagnostic tests, and treatments for Nipah virus infection
Authors: Alla Deekshitha , Shah Dhruv Jayeshkumar , Adityaraj Navaneethan , Vagdevi Moparthi , Alla Sai Santhosha Mrudula , Sree Krithi , Aitha Praneeth , Bollampalli Ram Prasanjith Reddy , Pathinangil Antony Joseph , Patel Krupa , Issaka Yussif 
Published: October 2024

Background:
First identified in Malaysia in 1998, the Nipah virus is a paramyxovirus related to the Hendra virus. The clinical manifestation can vary from a silent infection to a life-threatening encephalitis. The World Health Organization (WHO) has documented 25 outbreaks in South Asia, resulting in 429 cases and 307 deaths to date. Currently, there are no approved treatments for the deadly Nipah virus infection, which is a serious threat to public health worldwide. Consequently, a review was conducted to examine the geographic distribution of the Nipah virus, mortality, transmission pathways, and available methods for diagnosis and treatment.

Methods:
PubMed, Scopus, Web of Science, and Google Scholar servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed.

Results:
A total of 12 studies (7 case series and 5 case reports) were included in the final analysis, and 92 cases were analyzed. The most frequent symptoms were fever (80%), myalgia (47%), headache (47%), shortness of breath/acute respiratory distress syndrome (n = 44.1%), altered sensorium (44.1%), and vomiting (42.6%). The most commonly used diagnostic test was RT-PCR (45.5%). The most common route of transmission reported is direct human contact with the infected patients. Treatment modalities include interventional procedures, antiviral drugs, and symptomatic treatment. The most common complications were seizures (39.2%) and altered sensorium (35.7%). The mortality rate was 73.9%.

Conclusion:
It is crucial to emphasize the importance of early Nipah virus infection diagnosis and treatment to prevent life-threatening consequences.
Staged angioplasty in 2 patients with severe carotid artery stenosis: A case report and literature review
Authors: Zhou Yong-Liang , Liu Shi-Min , Cao Wen-Feng , Cao Xian-Min , Wu Ling-Feng , Wen An 
Published: October 2024

Rationale:
Cerebral infarction is a common ischemic cerebrovascular disease, associated with high rates of morbidity, disability, and recurrence, that can seriously affect patient physical and mental health, as well as quality of life. Carotid artery stenosis is an independent risk factor of cerebral infarction. Following rapid developments in interventional technology and materials science, carotid artery stenting has arisen an important treatment option for carotid artery stenosis. However, surgery is associated with complications, such as postoperative hyperperfusion syndrome, which poses a serious threat to the life and health of patients. Staged angioplasty (SAP), that is, one-time revascularization of the carotid artery stenting, is divided into 2 stages. This method reduces the occurrence of hyperperfusion syndrome after stenting by increasing the ipsilateral cerebral blood flow in stages and gradually increasing the cerebral perfusion pressure.

Patient concerns:
Herein, we present 2 cases of elderly patients with severe carotid artery stenosis who underwent SAP to prevent hyperperfusion syndrome.

Diagnoses:
The final diagnosis was based on cervical vascular color Doppler ultrasonography, cervical vascular magnetic resonance angiography, and cerebral vascular digital subtraction angiography.

Intervention:
Both patients with severe carotid artery stenosis underwent a staged intravascular intervention.

Outcomes:
Both patients were followed up for 1 year, with neither developing any new cerebral infarction or recurrent stent restenosis.

Lessons:
When treating SAP, it is crucial to consider that patients with unstable carotid plaques may not be suitable for staging. Additionally, during phase II carotid stenting, it is important to assess any changes in the arterial morphology and select the appropriate device accordingly.
Optic nerve sheath diameters predict mortality and severity in hepatic encephalopathy
Authors: Kus Cumali , Acehan Selen , Satar Salim , Gulen Muge , Sevdimbas Sarper , Akdoganlar Ali İlker , Gorur Mehmet 
Published: October 2024

Objective:
The aim of this study was to compare the predictive power of optic nerve sheath diameter (ONSD) measured by brain computed tomography (CT) in patients diagnosed with hepatic encephalopathy (HE) in the emergency department, with other factors for mortality and disease severity.

Materials and methods:
A total of 217 patients aged 18 years and older with acute decompensation of cirrhosis diagnosed with HE in the emergency department were included in the study. To compare with patients diagnosed with HE, a total of 217 individuals were included in the study as the healthy control group. ONSD measurements were performed on both the HE patients and the healthy control group in the brain CT.

Results:
The mortality rate of HE patients was 32.7%. Regarding the severity of the disease, 53% of the patients had late-stage HE. The presence of acute-on-chronic liver failure was detected in 51.4% of patients. The mortality rate among acute-on-chronic liver failure patients was 56.6%. According to the study data, ONSD, creatinine, lactate, and procalcitonin were independent predictors of mortality. Meanwhile, Child-Pugh score, direct bilirubin, ONSD, ammonia, and total bilirubin were independent predictors of disease severity. In the receiver operating characteristic curve analysis, the ONSD had the highest predictive power for mortality and disease severity among the determined predictive values.

Conclusion:
The data from the study suggests that assessing the ONSD through brain CT scans in individuals diagnosed with HE in the emergency department may provide valuable insights for clinicians, aiding in the prediction of both mortality rates and the severity of the disease.
Interaction between trouble sleeping and diabetes on metabolic dysfunction-associated fatty liver disease and liver fibrosis in adults results from the National Health and Nutrition Examination Survey 2017–2018
Authors: Zhang Cui , Cao Lili , Xu Bo , Zhang Wei 
Published: October 2024

Background
Metabolic dysfunction-associated fatty liver disease (MAFLD), trouble sleeping, and diabetes, as major public health problems, were closely related. The study examined the interaction between trouble sleeping and diabetes on MAFLD and liver fibrosis in adults with MAFLD.

Methods
The data were obtained from the National Health and Nutrition Examination Survey 2017–2018. Multivariate logistic regression model and subgroup analyses were conducted to assess the relationship between either trouble sleeping or diabetes on MAFLD and liver fibrosis. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP), and synergy index (S) were utilized to assess the additive interaction.

Results
Ultimately, 3747 participants were included, with 2229 known MAFLD subjects. Compared with participants without diabetes, those with diabetes had a higher risk of MAFLD [odds ratio (OR) = 5.55; 95% confidence interval (CI) = 4.07–7.56] and liver fibrosis risk (OR = 3.61; 95% CI = 2.67–4.89). We also found a significant association of trouble sleeping with an increased risk of MAFLD (OR = 1.54; 95% CI = 1.17–2.02) and liver fibrosis risk (OR = 1.51; 95% CI = 1.06–2.16), compared with those without trouble sleeping. Moreover, there was a significant interaction between diabetes and trouble sleeping on MAFLD [RERI = 1.76 (95% CI: −0.22 to 3.73), AP = 0.35 (95% CI: 0.08–0.63), S = 1.80 (95% CI: 1.02–3.16)] and liver fibrosis risk [RERI = 1.79 (95% CI: 0.37–3.21), AP = 0.44 (95% CI: 0.20–0.69), S = 2.44 (95% CI: 1.18–5.08)].

Conclusion
The findings highlight that trouble sleeping and diabetes had a synergistic effect on MAFLD and liver cirrhosis. The study highlights the importance of addressing both trouble sleeping and diabetes management in adults to mitigate the risk of MAFLD and liver fibrosis.
Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting
Authors: Bettale Chiara M. , Pomales Melyrene , Boy Angie , Moran Tim , Agarwal Maneesha , Powers Abigail 
Published: October 2024

Background:
Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied.

Objectives:
To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening.

Research Design:
Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs.

Subjects:
Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic).

Measures:
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening.

Results:
Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21).

Conclusions:
Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.
Suicide Rates by Age and Time Among American Indian and Alaskan Native Veterans
Authors: Brenner Lisa A. , Miller Christin N. , Schneider Alexandra L. , Hoffmire Claire A. , McCloskey Charlotte , Forster Jeri E. 
Published: October 2024

Objective:
Although recent work has highlighted high rates of suicide among American Indian and Alaska Native individuals who served in the US military, to date, a comprehensive evaluation of age-specific suicide rates, over time, has yet to be conducted.

Methods:
Population-based retrospective cohort study. Average annual suicide rates (2005–2020) were computed. The cohort included 207,955 Native Veterans who were alive as of January 1, 2005, and separated from military service on or before December 31, 2020. Suicide was identified via National Death Index codes.

Results:
Between 2005 and 2020, average annual, age-specific suicide rates among Native Veterans ranged from 16.32/100,000 (55+ y) to 64.49/100,000 (18–34 y). Compared with other age-related cohorts, the rate among those in the youngest age cohort (18–34y) was the highest between 2005 and 2018. The 2019–2020 average annual rate for 18- to 34-year-olds (41.86/100,000) dropped below that of the middle-aged cohort (35–45 y; 44.66/100,000). Across all age cohorts, firearms were the most used method of suicide [57.2% (18–34 and 35–54 y) to 66.17% (55+y)]; however, a notable percentage of Veterans died by suffocation, 16.54% (55 y and older), 26.71% (35–54 y), and 33.21% (18–34 y).

Conclusions:
Findings highlight differences in suicide rates by age groups overtime for Native Veterans irrespective of Veterans Health Administration use and across service eras, as well as means of suicide, which also differed across groups. Increased efforts are needed to identify culturally and age-relevant intervention strategies, as well as factors associated with risk, to reduce deaths among Native Veterans.
Health Care Workers’ Perspectives on Collecting Sexual Orientation and Gender Identity in the Adult Primary Care Setting
Authors: LeClair Amy M. , Rose Raviv , Barker Olivia , Carpenter Eilish , Concannon Thomas W. , Boehmer Ulrike , Blazey-Martin Deborah , Bird Chloe E. , Freund Karen M. , Lemon Stephenie C. 
Published: October 2024

Background:
Despite numerous calls for standardized collection of sexual orientation and gender identity (SOGI) data in clinical settings, uptake of this practice still lags.

Objectives:
This study conducted a preimplementation assessment of staff attitudes toward SOGI data collection within an adult primary care practice in an urban academic medical center in the northeastern United States.

Research Design:
We created a process map of the flow of patient data from the point of registration to the clinical encounter to identify all staff roles associated with registration and patient demographic data collection. We purposively sampled staff members across these roles and conducted semistructured virtual interviews between November 2021 and February 2022. The research team used deductive and inductive coding and conducted a thematic analysis to identify barriers and facilitators to implementation.

Subjects:
Nine clinical staff and eleven nonclinical staff were interviewed.

Measures:
Participants were asked about their general experiences with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients, their perspectives on collecting this data, and potential barriers and facilitators to incorporating this into the workflow.

Results:
The main themes that emerged were the relevance of SOGI data to the clinical practice; concerns about patient acceptability; the prevalence of cis-gender, heteronormative assumptions; and concerns about linguistic, cultural, and generational differences. Differences were noted between clinical and nonclinical staff.

Conclusions:
Greater education is needed to help both clinical and nonclinical staff understand how patients’ SOGI demographics can be used to provide affirming, patient-centered care. Implementation strategies can be tailored to address specific barriers at the individual, organizational, and social levels.