bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapidly growing ovarian dysgerminoma during pregnancy: a case report and literature review
Authors: Awada Rim , Jlailati Alaa , Ahmad Heya , Hanna Majd , Martini Nafiza , Al-Mahasna Souheb 
Published: September 2024

Introduction and importance:
Ovarian dysgerminoma is a rare germ cell tumor comprising 1–2% of ovarian malignancies. It predominantly affects women aged 20–30 years old and has a favorable prognosis with nearly 100% 5-year survival for early-stage disease. However, its nonspecific symptoms often delay diagnosis, accentuating the need for timely identification and intervention to optimize outcomes.

Case presentation:
A 28-year-old pregnant woman presented with a complaint of a heavy sensation during her third month of pregnancy. An ultrasound scan detected a mass that was suspected to be a uterine fibroid tumor. The mass grew to a size of 20×20 cm, completely covering the fetus and causing significant discomfort. A cesarean section was performed at 37 weeks, delivering a healthy fetus. Intraoperatively, a necrotic dysgerminoma was unexpectedly discovered, leading to treatment with the BEP regimen, resulting in a complete response. The patient is currently under observation with favorable tumor marker levels and no abnormalities on imaging.

Clinical discussion:
The review of literature on 13 pregnant cases showed dysgerminoma can manifest with abdominal pain or distension, or incidentally. Unilateral tumors occurred more frequently on the right side. Imaging aids diagnosis but definitive classification requires immunohistochemistry. Treatment involves surgery with chemotherapy for advanced disease. Prognosis is favorable with appropriate management.

Conclusion:
Dysgerminoma during pregnancy poses diagnostic challenges due to nonspecific symptoms and physiological changes. A synergistic approach of imaging, histopathology, surgery, and chemotherapy enables accurate diagnosis and treatment. Further research on surgical strategies and patient-centered care is warranted for continued improvement.
Ramon syndrome: a rare case report of cherubism with gingival fibromatosis in an adult female
Authors: Assimi Sihame , Cherkaoui Amine 
Published: September 2024

Introduction and Importance:
Cherubism is a rare genetic disorder characterized by painless bilateral expansion of the mandible and maxilla.

Case Presentation:
The authors present an unusual case of a 50-year-old female patient with Ramon syndrome, a rare variant of cherubism accompanied by gingival fibromatosis. The patient exhibited symptoms such as short stature, mental retardation, rheumatoid arthritis, epilepsy, hirsutism, and gingival enlargement. Clinical examination revealed generalized gingival inflammation, plaque formation, and a loss of attachment. Radiographically, bilateral multilocular radiolucencies were observed in the mandibular body and the ramus. The patient underwent a nonsurgical phase, including oral hygiene motivation and periodontal debridement, followed by a surgical phase involving gingivoplasty and internal bevel gingivectomy with open flap debridement. Histopathological analysis confirmed the presence of fibroblasts, multinucleated giant cells, and fibrous connective tissues. The patient’s son also presented with bilateral facial swelling and similar radiographic findings, indicating familial inheritance of cherubism.

Clinical Discussion:
This case demonstrates the clinical, radiographic, and histopathological features of cherubism associated with gingival fibromatosis and highlights the challenges in its diagnosis and management. Regular follow-up and maintenance are essential for long-term stability and prevention of recurrence.

Conclusion:
This report contributes to the limited literature on cherubism in older patients and emphasizes the importance of early identification and intervention in affected individuals.
The sitting versus lateral position during induction of spinal anesthesia for elective cesarean delivery on block characteristics and severity of hypotension: a prospective randomized clinical trial, 2023
Authors: Befkadu Aynalem , Timerga Sara , Mihretu Fasil , Seyoum Fetene , Alimawu Agmuas A. 
Published: September 2024

Background:
Spinal anesthesia (SA) is the most preferred technique for cesarean delivery but is challenged by many adverse effects, mostly by maternal hypotension and bradycardia. Due to the high adversity effects of hypotension to mother and baby, prevention at any cost is much more advice. SA inductional positioning could be one of the preventive methods.

Objective:
To assess the effect of sitting and lateral SA induction positions on hemodynamic changes, severity of hypotension, and block characteristics in elective cesarean section.

Methodology:
A prospective double-blinded randomized control trial was conducted by recruiting 132 patients using a systematic random sampling technique. Patients were randomized into lateral position (n=66) and control group (sitting position) (n=66). Isobaric bupivacaine (0.5%) was injected into the spinal space at L3–L4 level in the lateral position for group 1 and in the sitting position for group 2. Afterward, the patient’s blood pressure was measured at first and third minute, then every 5 min until the 20th minute, and then every 10 min until the end of cesarean section. Data analysis was performed using SPSS (version 21) software, and continuous variables were analyzed by independent sample t test while categorical by Fisher exact and χ
2 test. An intention-to-treat analysis was applied for those who lost follow-up and P value <0.05 was considered statically significant.

Result:
There was a statistically significant difference in the incidence of hypotension between lateral and supine positions [50 (75.8%) in sitting and 31 (47.0% lateral), dep=0.002)]. The frequency of hypotension was more in the sitting position, and there were no significant differences in heart rate. Vasopressor consumption was 14.98±20.50 in the lateral group and 30.89±22.259 in the sitting group, P value <0.001. The onset of sensory block was faster in the lateral group (1.92±0.56 vs. 3.8±0.01, P<0.001), but it requires more time for identification of subarachnoid space (2.95±2.0 vs. 1.5±1.0, P=0.002).

Conclusion:
Lateral positioning was superior in view of better hemodynamic stability, early onset, low vasopressor consumption, and low incidence of hypotension for parturients undergoing elective cesarean section.
Endoscopic endonasal surgery for the complete removal of tuberculum sellae meningioma coexisting with craniopharyngioma: case report and literature review
Authors: Chen Yu Xing , Wan Xi Chen , Pan Lai Sheng , Peng Hao Yang , Hong Tao , Wu Xiao 
Published: September 2024

Introduction and importance:
Meningioma (MNG) is a common intracranial tumor, whereas craniopharyngioma (CPG) is relatively uncommon, and the combination of the two is extremely rare according to the currently published literature. Moreover, to date, most cases of CPG combined with MNG have been treated via surgical resection, particularly by craniotomy.

Case presentation:
A 59-year-old woman who presented with headache and vomiting and who was initially diagnosed with CPG combined with MNG underwent single-stage endoscopic endonasal surgery. The patient’s recovery was uneventful.

Clinical discussion:
A case of CPG combined with MNG was reported, and previously reported cases of CPG combined with MNG were systematically reviewed. Finally, the indications for and limitations of treatment with an endoscopic endonasal approach for CPG combined with MNG are discussed.

Conclusion:
The combination of CPG and MNG is rare. After comprehensive assessment, one-stage resection using endoscopic endonasal surgery is feasible. This approach can potentially reduce the duration of treatment and the risk of postoperative complications associated with multiple surgeries.
Interleukin-10: Genetic and biochemical prediction of sepsis-induced acute kidney injury in critically ill patients in intensive care unit: A cross-sectional study
Authors: Amin Amr A. , Ghonaim Aseel M. , Al-Amodi Hiba S. , Mukhtar Mohammed H. , Allam Reem M. , Dannoun Anas , Eldein Mohamed N. , Bogari Neda M. 
Published: September 2024

Background:
Sepsis is a potentially life-threatening condition that eventually causes multiorgan dysfunction in critically ill patients. Acute kidney injury (AKI) is a severe life-threatening complication of sepsis, a condition termed sepsis-induced AKI (S-AKI), with poor clinical outcomes and high mortality rates. Inflammatory and immunological responses are important variables in S-AKI. This study aimed to examine the relationship of rs1518111 polymorphism in the interleukin-10 (IL-10) gene and serum/urine IL-10 levels with sepsis-induced AKI in critically ill patients in the intensive care unit (ICU).

Methods:
In this cross-sectional study, 310 critically ill adult patients were recruited, of whom, 197 developed S-AKI. Real-time polymerase chain reaction was performed to detect the rs1518111 polymorphism. Circulating blood and urine IL-10 levels of IL-10 were measured.

Results:
For rs1518111 SNP, the presence of at least one T allele increased the risk of occurrence of S-AKI (odds ratio [OR]: 1.34, 95% CI: 1.07-3.17; p < 0.001), regardless of the type of infection and severity of sepsis. Blood and urine IL-10 levels were an excellent prediction of S-AKI (area under the receiver operating characteristic curve [AUC]: 0.881 and 0.953 and sensitivity: 90.2% and 97.6% at cutoff of 133.5 and 5.67 pg/mL, respectively). Regression analysis showed that white blood cell count and increased blood and urine IL-10 levels, in addition to the presence of TT genotype, are independent risk factors for S-AKI.

Conclusion:

rs1518111 polymorphism in the IL-10 gene is a risk factor for sepsis-induced AKI in the ICU. Serum/urine IL-10 levels may be used as predictors of S-AKI in critically ill patients with sepsis, thereby improving early management.
Diurnal variation of postoperative delirium in elderly patients undergoing esketamine anesthesia for elective noncardiac surgery: a randomized clinical trial
Authors: Zhang Yuan , Chen Rong , Tang Shan , Sun Tao , Yu Yanli , Shi Ruoshi , Wang Kai , Zeng Zi , Liu Xinhang , Meng Qingtao , Xia Zhongyuan 
Published: September 2024

Background:
Postoperative delirium (POD) is a serious and common complication. The aim of present study is to investigate the diurnal variation of POD and the effects of esketamine in elderly patients.

Methods:
A randomized, double-blind, placebo-controlled clinical trial with factorial design was conducted. Patients (aged 65 to 85 years) with normal Mini-Mental State Examination (MMSE) score were stratified by age (≤70 vs. >70) and American Society of Anesthesiologists physical status classification (Ⅱ vs. Ⅲ), then randomly assigned to either morning (08:00–12:00) or afternoon (14:00–18:00) noncardiac operation under general anesthesia with or without esketamine administration (0.2 mg/kg). The primary outcome was the incidence of POD (3-Minute Diagnostic Interview for Confusion Assessment Method-defined Delirium, 3D-CAM) on postoperative days 1, 3, and 7. The secondary outcomes were the scores of MMSE and Hospital Anxiety and Depression Scale. The intention-to-treat analysis of the outcomes were performed by generalized estimating equation.

Results:
Six patients who did not receive an intervention because of canceled operation were excluded after randomization. The datasets containing 426 cases were analyzed following the intention-to-treat principle after handling missing data via multiple imputation method. The incidence of POD declined from about 55% on postoperative day 1 to 31 and 18% on postoperative days 3 and 7, respectively. Afternoon operation [B=−0.583, OR (95% CI) 0.558 (0.319–0.976); P=0.041], but not esketamine, significantly decreased the incidence of POD. Both esketamine and operation time failed to significantly affect MMSE, HAD, and NRS score. There was no interaction among operation time, esketamine, and follow up time.

Conclusion:
Elderly patients undergoing elective noncardiac surgery in the afternoon displayed lower POD incidence than those operated in the morning. A single low-dose of esketamine before general anesthesia induction failed to significantly decrease the risk of POD but decrease the risk of intraoperative hypotension and emergence agitation.
Normal Saline Versus Hypertonic Saline for Airway STENT Maintenance
Authors: Salguero Bertin D. , Joy Greta , Lo Cascio Christian M. , Agrawal Abhinav , Chaddha Udit 
Published: September 2024

Background:
Mucus plugging is a common complication of airway stenting. There is no data or guidance on the best airway hygiene regimen and consequently wide practice variation exists.

Methods:
This single-center, nonblinded, randomized, pilot study aims to evaluate the effectiveness and safety of nebulized 3% saline (3%S) versus normal saline (NS) in reducing the incidence of mucus plugging in adult patients that undergo central airway stent placement. Patients were enrolled immediately after stent placement and randomized to nebulized 3%S or NS (3 mL) 3 times a day. Patients were scheduled for surveillance bronchoscopy in 4 to 6 weeks. Unscheduled bronchoscopies due to symptomatic mucus plugging were recorded.

Results:
From December 2022 to March 2024, 37 patients were screened, and 35 were enrolled. Four in the 3%S and 8 in the NS group did not undergo a surveillance bronchoscopy and were excluded from the final analysis. During surveillance bronchoscopy for the 3%S (n=13) and NS (n=10) groups, obstructive mucus plugging was noted in 7.7% versus 40%, granulation requiring intervention in 7.7% versus 10%, and >25% circumferential biofilm in 0% versus 30%, respectively. In the 3%S versus NS groups, 0% versus 20% of patients required an unscheduled bronchoscopy due to mucus plugging. There were no side effects reported with the daily use of 3%S or NS.

Conclusion:
Nebulized 3%S is safe and may be equally or more effective than NS in preventing obstructive mucus plugging in patients who undergo airway stenting. A larger blinded randomized controlled trial is necessary to confirm this finding.
Sclerosing Epithelioid Fibrosarcoma Harboring the EWSR1–CREB3L1 Gene Fusion: The Importance of Molecular Classification in Pediatric Sarcomas
Authors: Offenbacher Rachel , Kaswan Sara , Fabish Lara , Barron Carly , Fox Jana , Chin Steven , Snuderl Matija , Lee Alice , Loeb David M. , Baker Alissa 
Published: September 2024

Background:
Sclerosing epithelioid fibrosarcoma (SEF) is a very rare soft tissue sarcoma that most commonly presents in middle-aged and elderly adults but has been rarely seen in children. SEF is a very aggressive tumor with over 50% of patients experiencing local recurrence and 40% to 80% of patients experiencing distant metastatic spread. This disease has been shown to be resistant to chemotherapy and is classically treated with surgical excision.

Case:
We describe the case of a 10-year-old girl with Graves’ disease who presented with protruding eyes (to a greater extent on the left side) and was found to have a large mass in her left inferior rectus muscle that was diagnosed as SEF. After treatment with incomplete resection, due to the benign-appearing nature of the tumor on imaging, and proton radiation therapy, she remains disease-free at 18 months post-therapy.

Discussion:
SEF is typically identified via genetic testing and recognition of the EWSR1–CREB3L1 gene fusion as well as MUC4 expression via immunohistochemistry. DNA methylation profiling, which has traditionally been used in brain tumors, can also efficiently identify this tumor, and we recommend expanding the use of this technology for difficult to classify pediatric sarcomas.
Recent advances in acupuncture for pain relief
Authors: Niruthisard Supranee , Ma Qiufu , Napadow Vitaly 
Published: September 2024

Abstract

Introduction:
Acupuncture therapy has achieved global expansion and shown promise for health promotion and treatment of acute/chronic pain.

Objectives:
To present an update on the existing evidence base for research and clinical practice supporting acupuncture analgesia.

Methods:
This Clinical Update elaborates on the 2023 International Association for the Study of Pain Global Year for Integrative Pain Care “Factsheet Acupuncture for Pain Relief” and reviews best evidence and practice.

Results:
Acupuncture is supported by a large research evidence base and growing utilization. Mechanisms of acupuncture analgesia include local physiological response at the needling site, suppression of nociceptive signaling at spinal and supraspinal levels, and peripheral/central release of endogenous opioids and other biochemical mediators. Acupuncture also produces pain relief by modulating specific brain networks, integral for sensory, affective, and cognitive processing, as demonstrated by neuroimaging research. Importantly, acupuncture does not just manage pain symptoms but may target the sources that drive pain, such as inflammation, partially by modulating autonomic pathways. Contextual factors are important for acupuncture analgesia, which is a complex multifaceted intervention. In clinical practice, historical records and many providers believe that acupuncture efficacy depends on specific acupoints used, the technique of needle placement and stimulation, and the person who delivers the procedure. Clinical research has supported the safety and effectiveness of acupuncture for various pain disorders, including acupuncture as a complementary/integrative therapy with other pain interventions.

Conclusion:
Although the quality of supportive evidence is heterogeneous, acupuncture's potential cost-effectiveness and low risk profile under standardized techniques suggest consideration as a neuromodulatory and practical nonpharmacological pain therapy.
Species of Chinese materia medica resources based on the fourth national survey of Chinese materia medica resources
Authors: Huang Luqi , Guo Lanping , Zhang Xiaobo , Yu Liying , Sun Jiahui 
Published: September 2024

Abstract
This article outlines the composition and species characteristics of Chinese materia medica (CMM) resources identified in the fourth national survey of CMM resources. The survey was conducted based on field investigations and office collation, adhering to the “four principles” emphasizing the existence of survey records, voucher specimens, actual photographs, and evidence of medicinal use, to summarize the species of CMM resources and ensure the scientific integrity and accuracy of the results. According to the findings, China has 18,817 CMM resources, including 15,321 medicinal plants, 826 medicinal fungi, 2517 medicinal animals, and 153 medicinal minerals. Additionally, in the fourth national survey of CMM resources, 3151 species of unique medicinal plants, 464 species of rare and endangered medicinal plants, and 196 new species in China underwent specialized investigations. These latest statistics are expected to provide the most up-to-date foundational data for the protection, management, development, and utilization of these CMM resources over an extended period, offering scientific guidance for the development of the traditional Chinese medicine industry.
Whole blood to total transfusion volume ratio in injured children: A national database analysis
Authors: Campwala Insiyah , Dorken-Gallastegi Ander , Spinella Philip C. , Brown Joshua B. , Leeper Christine M. 
Published: September 2024

BACKGROUND
Whole blood (WB) resuscitation is increasingly common in adult trauma centers and some pediatric trauma centers, as studies have noted its safety and potential superiority to component therapy (CT). Previous analyses have evaluated WB as a binary variable (any versus none), and little is known regarding the “dose response” of WB in relation to total transfusion volume (TTV) (WB/TTV ratio).

METHODS
Injured children younger than 18 years who received any blood transfusion within 4 hours of hospital arrival across 456 US trauma centers were included from the American College of Surgeons Trauma Quality Improvement Program database. The primary outcome was 24-hour mortality, and the secondary outcome was 4-hour mortality. Multivariate analysis was used to evaluate associations between WB administration and mortality and WB/TTV ratio and mortality.

RESULTS
Of 4,323 pediatric patients included in final analysis, 88% (3,786) received CT only, and 12% (537) received WB with or without CT. Compared with the CT group, WB recipients were more likely to be in shock, according to pediatric age-adjusted shock index (71% vs. 60%) and had higher median (interquartile range) Injury Severity Score (26 [17–35] vs. 25 [16–24], p = 0.007). Any WB transfusion was associated with 42% decreased odds of mortality at 4 hours (adjusted odds ratio [aOR], 0.58 [95% confidence interval, 0.35–0.97]; p = 0.038) and 54% decreased odds of mortality at 24 hours (aOR, 0.46 [0.33–0.66]; p < 0.001). Each 10% increase in WB/TTV ratio was associated with a 9% decrease in 24-hour mortality (aOR, 0.91 [0.85–0.97]; p = 0.006). Subgroup analyses for age younger than 14 years and receipt of massive transfusion (>40 mL/kg) also showed statistically significant survival benefit for 24-hour mortality.

CONCLUSION
In this retrospective American College of Surgeons Trauma Quality Improvement Program analysis, use of WB was independently associated with reduced 24-hour mortality in children; further, higher proportions of WB used over the total resuscitation (WB/TTV ratio) were associated with a stepwise increase in survival.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Bleeding control methods for kids: A pediatric approach to the national education campaign—a pilot program
Authors: Anderson Melissa , Williams Renaldo 
Published: September 2024

BACKGROUND
The project purpose was to design and test an age-appropriate curriculum to train children aged 5 through 13 years on bleeding control methods based on the national Stop the Bleed initiative. Studies have shown that children as young as 5 years are able to perform first aid and cardiopulmonary resuscitation. The project aimed to demonstrate that children as young as 5 years can be taught bleeding control methods. Our hypothesis was that there would be a 60% retention rate on retesting of the children within 1 year across all age groups.

METHODS
The study design was an observational cohort study from February 2018 to January 2020. Participants (aged 5 through 13 years) were trained on bleeding control methods but using an age-based curriculum. The initial training included 500 children. The participants were taught tourniquet applications, wound packing, and direct pressure skills. The curriculum consisted of a 30-minute didactic portion with participant involvement and engagement followed by 30 minutes of hands-on skill training and demonstration. In addition, participants were required to be able to recite the “5 Rules” to helping hurt people. Descriptive statistics were performed.

RESULTS
Participants were retested approximately 1 year after the initial training. The retest group only consisted of 227 participants because of a multitude of reasons for the decrease in children. Children were tested in comprehension and application of each skill. Results indicated a greater than 70% retention for all skills across all participants for the retesting after 1 year.

CONCLUSION
The findings indicated that children as young as 5 years can be taught to perform bleeding control methods of tourniquet application, wound packing, and direct pressure. While the results indicate that the older the child, the better the retention, if children were provided multiple trainings over a 1-year period, the retention could be higher.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.