bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Algorithms for Adnexal Masses in the Hands of a Novice Operator
Authors: De Vitis Luigi A. , Schivardi Gabriella , Grcevich Leah , Capasso Ilaria , Fumagalli Diletta , Dahal Sarju , Lembo Antonio , Breitkopf Daniel M. , Laughlin-Tommaso Shannon K. , Fought Angela J. , Johnson Noah E. , Caserta Melanie P. , Clingan Jennings J. , Aletti Giovanni D. , Mariani Andrea , Packard Annie T. , Langstraat Carrie L. 
Published: February 2025

OBJECTIVE:
To compare the performance of four commonly used algorithms to differentiate benign from malignant adnexal masses when used by a novice operator.

METHODS:
Women with adnexal masses treated at Mayo Clinic, Rochester, Minnesota, in 2019 were identified retrospectively. Patients were included if they underwent surgery within 3 months of diagnosis or had at least 10 months of follow-up. A nonexpert operator (European Federation of Societies for Ultrasound in Medicine and Biology level I) classified each lesion using ADNEX (Assessment of Different Neoplasias in the Adnexa), two-step strategy (benign descriptors followed by ADNEX), O-RADS (Ovarian-Adnexal Reporting and Data System) 2019, and O-RADS 2022. The primary outcome measure was the area under the receiver operating characteristic curve (AUC) compared across the four algorithms.

RESULTS:
A total of 556 women were included in the analyses: 452 with benign and 104 with malignant masses. The AUCs of ADNEX, the two-step strategy, O-RADS 2019, and O-RADS 2022 were 0.90 (95% CI, 0.87–0.94), 0.91 (95% CI,0.88–0.94), 0.88 (95% CI,0.84–0.91), and 0.88 95% CI, (0.84–0.91), respectively. The two-step strategy performed significantly better than the O-RADS algorithms (P=.005 and P=.002). With all the algorithms, the observed malignancy rate was 1.9–2.2% among lesions categorized as almost certainly benign, twofold higher than the expected less than 1.0%. Lesions wrongly classified as almost certainly benign were borderline tumors (n=4) and metastases (n=3).

CONCLUSION:
In the hands of a novice operator, all algorithms performed well and were able to distinguish benign from malignant lesions. Although the two-step strategy performed slightly better than the O-RADSs, the difference did not appear to be clinically meaningful. The malignancy rate among lesions classified as almost certainly benign was unexpectedly high at 1.9–2.3%, approximately double the expected rate of less than 1.0%.
Prenatal Cannabis Use and Depressive Symptoms
Authors: Pitt Taylor L. , Allshouse Amanda A. , Kim Pilyoung , McMillin Gwen , Silver Robert M. , Chung Judith H. , Grobman William A. , Haas David M. , Mercer Brian M. , Parry Samuel , Reddy Uma M. , Saade George R. , Simhan Hyagriv N. , Metz Torri D. 
Published: February 2025

OBJECTIVE:
To evaluate whether cannabis use during pregnancy was associated with depressive symptoms and whether ongoing use beyond the first trimester and higher amounts of cannabis use were associated with increased depressive symptoms.

METHODS:
This was a secondary analysis of the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be) study with participants enrolled from October 2010 to September 2013 at eight academic centers. Individuals with pregnancy outcome data who completed the EPDS (Edinburgh Postnatal Depression Scale) in the first and third trimesters and had available frozen stored urine samples were included. Cannabis exposure was ascertained by urine immunoassay for THC-COOH (11-nor-9-carboxy-delta-9-tetrahydrocannabinol); positive results were confirmed with liquid chromatography tandem mass spectrometry. Cannabis exposure groups for the primary analysis were classified as any exposure (positive urine assay at any of the three time points: 6 0/7–13 6/7 weeks of gestation, 16 0/7–21 6/7 weeks, and 22 0/7–29 6/7 weeks) or no exposure. In a secondary analysis, cannabis exposure was classified as no, only first trimester, or ongoing exposure beyond the first trimester. The primary outcome was depressive symptoms (EPDS score higher than 10) at 22–29 weeks of gestation. The association between cannabis exposure and later depressive symptoms was assessed with multivariable logistic. In an exploratory analysis, first-trimester urine THC-COOH was quantified to determine whether heavier use was associated with greater odds of depressive symptoms later in pregnancy.

RESULTS:
Of 10,038 nuMoM2b participants, 8,424 met the inclusion criteria, and 6.4% (n=535) were exposed to cannabis. Of those exposed, 32.1% (n=172) had only first-trimester exposure, and 67.9% (n=363) had ongoing exposure. Any cannabis use was not significantly associated with later depressive symptoms (adjusted odds ratio [aOR] 1.3, 95% CI, 0.97–1.6) compared with no exposure. However, ongoing exposure beyond the first trimester was associated with later depressive symptoms (aOR 1.6, 95% CI, 1.2–2.2). Higher levels of urine THC-COOH in the first trimester and across pregnancy were associated with increased odds of subsequent depressive symptoms.

CONCLUSION:
Any cannabis exposure was not associated with later-pregnancy increased depressive symptoms. However, ongoing use beyond the first trimester and higher levels of cannabis metabolite in first-trimester urine were associated with greater odds of depressive symptoms in later pregnancy. Directionality of this association cannot be determined given the study design.
Effect of Lumbar Erector Spinae Plane Blocks After Lumbar Fusion Surgery
Authors: Holderread Brendan , Syed Ishaq , Shin Caleb , Toussaint Leonide , Lewis Andrew , Botros David , Avramis Ioannis , Rizkalla James 
Published: February 2025

Study Design:
Randomized control trial.

Objective:
To examine erector spinae plane block on a large, comprehensive scale, and investigate the management of postoperative pain and recovery process after lumbar spine surgery using this block.

Summary of Background Data:
Pain management is a key aspect of a patient’s care and overall surgical outcome regarding spinal surgery. While most patients have no issues when undergoing spinal surgery, many have pain that will persist postoperation. Our goal was to evaluate the efficacy of erector spinae plane (ESP) blocks before lumbar arthrodesis in helping manage the persisting pains and opioid consumption postsurgery.

Methods:
A single-blinded randomized control trial was designed and executed on patients who were to undergo lumbar spine fusion. Before their surgical intervention, patients were randomly assigned to receive the erector spinae plane block or the normal anesthesia/pain management routine.

Results:
Of a total of 49 patients, 23 (47%) underwent a spinal block before their respective lumbar spine procedure. Patients with spinal block required fewer supplemental opioids postoperatively (69.9±6.66 vs. 71.7±5.70, P= 0.0002) while reporting less severe pain on VAS pain scoring throughout the first 3 postoperative days (P< 0.0001).

Conclusions:
The patient population that received the erector spinae block had significantly lower pain scores on days 1–3 postsurgery, showing that the spine block is effective in helping patients recover from spinal surgery quicker and with less persisting pain. In addition, the number of patients who filled their first opioid prescription was approaching significance, with the ESP block group filling those prescriptions less frequently. ESP blocks appear to be efficacious at reducing pain and opioid consumption in the immediate postoperative period. No additional complications or readmissions were apparent between subgroups.
Coupling Interval Ratio to Predict the Beta Blocker Response against Premature Ventricular Complexes
Authors: Atmaca Hasan , Yetkin Ertan 
Published: February 2025

Despite the wide-spread use of beta blockers, unpredictable response and overall low efficacy are the major pitfalls of beta blocker use for premature ventricular complexes (PVC). Accordingly, we aimed to reveal Holter-guided electrocardiographic criteria to predict the beta blocker responder ones of PVCs.
A total of 89 patients who had pre- and post- treatment Holter ECG recordings and fulfilled the inclusion criteria were retrospectively included in the study. Holter recordings were screened for heart rate variability (HRV), numbers of PVC, heart rate, pre and post coupling intervals (CI) in three different time intervals (24:00 to 08:00am, 08:00 am to 16:00 pm and 16:00pm to 24:00) .
Forty three patients were defined as beta blocker responder group in respect to 70% decrease in PVCs burden. HRV analysis revealed that there were not statistically significant differences between beta blocker responder and non-responder group. CI ratio ((post-PVC CI+ pre-PVC CI)/Pre-PVC CI) of responder and non-responder groups in 24.00 to 8.00 am time interval was statistically different (3.19 vs. 2.91, p=0.006 respectively). Logistic regression analysis revealed that CI ratios of the PVCs during the 24:00-08:00 am intervals have significantly associated with the beta blocker responsiveness for PVCs (Odds ratio: 9.54 95% CI: 1,89-48.7, P value: 0.006)
Night-time increased CI ratio i.e shorter CI time has been found to be an independent predictor of beta blocker response against PVCs. Therefore, beta blockers may be preferably recommended for PVCs, especially in those with shorter CI or increased CI ratio.
Danicopan’s FDA approval: a breakthrough in the treatment of paroxysmal nocturnal hemoglobinuria
Authors: Gul Muhammad Hamza , Mughal Muhammad Zain Ul Abideen , Fareed Ashan , Azad Shehryar , Khan Gulmeena Aziz , Shahid Minha , Noori Samim , Qayyum Sardar Noman 
Published: February 2025

The FDA’s approval of Danicopan (Vodeya) on 1 April 2024, represents a significant advancement in the treatment of Paroxysmal Nocturnal Hemoglobinuria (PNH). As the first oral serine protease factor D inhibitor, Danicopan complements existing C5 inhibitors by addressing both intravascular and extravascular hemolysis. In the phase 3 ALPHA trial, Danicopan as an add-on therapy to ravulizumab or eculizumab significantly improved hemoglobin levels, with a least squares mean difference of 2.44 g/dL compared to placebo (P < 0.0001). Key advancements include its ability to reduce transfusion dependency, improve patient quality of life, and its convenient oral administration compared to intravenous therapies. Potential side effects include severe headache, fever, blurred or tunnel vision, sudden dizziness, and an increased risk of infections by encapsulated organisms, along with rare adverse events such as elevated liver enzymes and neutropenia. Danicopan’s approval fills a critical therapeutic gap, offering a transformative approach to managing PNH.
Cholesterol Granuloma Mimicking CSF Otorrhea by beta-Trace-Protein Production
Authors: Radeloff Andreas , Radeloff Katrin , Henke Rolf-Peter , Hahnke Sarah , Loewenthal Maureen 
Published: February 2025

Objective
To report a patient who was misdiagnosed and operated on for cerebrospinal fluid (CSF) otorrhea and to demonstrate that cholesterol granulomas mimic CSF leakage by secreting beta-trace protein (BTP).

Patients
Eleven consecutive patients undergoing ear surgery in whom cholesterol granulomas were discovered intraoperatively.

Intervention
Biochemical and histologic analysis of liquid and solid fractions of cholesterol granulomas.

Main Outcome Measures
BTP and beta-2-transferrin concentrations and BTP mRNA levels in surgical specimens.

Results
Cholesterol granulomas produce BTP and express high levels of BTP mRNA, but do not produce beta-2-transferrin.

Conclusions
Beta-2 transferrin analysis is preferable to BTP analysis for the detection of CSF otorrhea because BTP may be false positive in the presence of cholesterol granulomas.
Efficacy of esketamine nasal spray for treatment-resistant depression: A meta-analysis of randomized controlled studies
Authors: Ouyang Yannan , Li Juan 
Published: February 2025

Background:
The efficacy of esketamine nasal spray for treatment-resistant depression remains controversial. This systematic review and meta-analysis was conducted to explore the influence of esketamine nasal spray on treatment efficacy for treatment-resistant depression.

Methods:
We conducted a comprehensive search across multiple databases, including PubMed, EMbase, Web of Science, EBSCO, and Cochrane library through March 2024 for randomized controlled trials (RCTs) assessing the effect of esketamine nasal spray on the treatment efficacy of depression. This meta-analysis was performed using the random-effect model.

Results:
Five RCTs are included in the meta-analysis. Overall, compared with control group treatment-resistant depression, esketamine nasal spray is associated with significantly reduced MADRS scores (SMD = −3.88; 95% confidence interval [CI] = −5.71 to −2.05; P < .0001), increased response rates (RR = 1.99; 95% CI = 1.28–3.10; P = .002), decreased Sheehan Disability Scale (SMD = −3.01; 95% CI = −4.39 to −1.64; P < .0001) and PHQ-9 scores (SMD = −2.32; 95% CI = −3.51 to −1.13; P = .0001), but leads to the increase in dizziness (RR = 3.55; 95% CI = 2.37–5.32; P < .00001) and nausea (RR = 3.88; 95% CI = 2.10–7.18; P < .0001).

Conclusion:
Esketamine nasal spray is beneficial to improve the efficacy of treatment-resistant depression.
A Prospective Study on Postmethylphenidate Treatment Changes in Premature Ejaculation Among Adults With Attention-Deficit/Hyperactivity Disorder
Authors: Takım Uğur , Gökçay Hasan 
Published: February 2025

Background:
Methylphenidate is widely used to treat attention-deficit/hyperactivity disorder (ADHD), but its impact on comorbid conditions such as premature ejaculation (PE) and impulsivity in adult patients with ADHD is underexplored.

Study Question:
How does methylphenidate treatment affect impulsivity and PE symptoms in adults with ADHD?

Study Design:
A prospective cohort study at Erzurum City Hospital included 53 adult patients with ADHD diagnosed through the Structured Clinical Interview for DSM-5 Disorders. Of these, 34 had comorbid PE and 19 did not.

Measures and Outcomes:
Primary outcomes were changes in ADHD symptoms, impulsivity, and PE, measured by the Adult ADHD Self-Report Scale (ASRS), Urgency, Premeditation, Perseverance, and Sensation Seeking Impulsive Behavior Scale, and the Arabic Index of Premature Ejaculation (AIPE). Secondary outcomes included the correlation between methylphenidate dosage and symptom improvement and predictors of changes in PE symptoms.

Results:
A significant reduction was observed in the ASRS total score, which decreased from 51.7 ± 9.0 (mean ± SD) to 32.5 ± 8.4 (P < 0.001). Urgency, Premeditation, Perseverance, and Sensation Seeking Impulsive Behavior Scale scores also showed a significant decrease from 125.1 ± 14.3 to 97.0 ± 5.0 (P < 0.001). The AIPE scores, measured in points, increased from 22.4 ± 9.3 to 32.5 ± 8.4 (P < 0.001), suggesting improved control over ejaculation. Correlation analysis revealed a significant positive correlation between the immediate-release methylphenidate dose and improvements in ASRS total scores (r = 0.485, P < 0.001). Regression analysis indicated that the pretreatment AIPE score (β = −0.529, P < 0.001) was a significant predictor of posttreatment changes.

Conclusions:
Treatment with methylphenidate was associated with a decrease in both impulsivity and PE symptoms in adults with ADHD, particularly with immediate-release formulations. These findings highlight the importance of considering comorbid conditions in ADHD treatment.
Zilucoplan: A Novel Strategy for Management of Myasthenia Gravis
Authors: Shah Veedhi , Quintana Marla , Steinberg Michael , Willett Kristine C. , Kakucs Cristian , Dima Lorena 
Published: February 2025

Background:
Generalized myasthenia gravis is an autoimmune disease that leads to eventual end-organ damage. Zilucoplan is a new agent for the treatment of generalized myasthenia gravis for patients who are acetylcholine receptor antibody positive.

Pharmacodynamics, And Pharmacokinetics:
It is the first in its class that exerts its effect by binding to complement protein C5 and inhibiting activation to C5a and C5b-9. Zilucoplan may increase the risk of bacterial infections in patients, as its mechanism does heavily rely on altering components of the immune system. Zilucoplan has a black box warning because of the risk of meningococcal infections. Zilucoplan is the first subcutaneous, at-home treatment for generalized myasthenia gravis, which may allow for increased adherence. It is supplied as a prefilled syringe and the dosing varies based on the bodyweight. Onset of action was seen as early as 1 week in clinical studies.
Clinical Trials: There were 2 major trials that led to Food and Drug Administration approval. A 12-week phase 2 study identified 0.3 mg/kg as the clinically efficacious dose for patients with generalized myasthenia gravis. A phase 3 trial (RAISE) showed clinical benefit in patients randomized to zilucoplan compared with placebo. There was a significant change in Myasthenia Gravis Activities of Daily Living score after 12 weeks of treatment. There was no difference in safety end points in both the phase 2 and phase 3 studies. Most patients experienced treatment-emergent adverse events, COVID-19 infections, and exacerbation of myasthenia gravis symptoms being among the most commonly reported.
Therapeutic Advance: Zilucoplan is a new agent with a novel mechanism of action and provides an additional treatment option for patients who do not respond to standard of care. Evidence from postmarketing studies assessing the benefit–risk profile of zilucoplan in real-world settings, in addition to randomized controled trials, as well as pharmacoeconomic studies, is necessary to establish its place in therapy.
Unusual radiographic appearance of fecalith leading to acute abdomen in a patient consuming iron: a case report
Authors: Pathak Niharika , Thapa Megha , Sah Sushil , Pandey Prakash , Joshi Padam Raj 
Published: February 2025

Background and importance:
Fecalith is common clinical condition, delay in diagnosis and management can lead to life threatening complications.

Case presentation:
We are reporting the case of an 18-year- old lady which have unusual radiographic appearance of fecalith which was diagnosed in rural emergency setting and managed with simple conservative approach.

Clinical discussion:
Fecalith can also be present in background of iron consumption without chronic constipation and anatomical abnormality. Large fecalith can have confusing radiographic picture.

Conclusion:
Fecalith can present with acute abdomen and confusing radiographic picture. It can lead to life-threatening bowel complications but can be managed conservatively with early diagnosis.
Treatment of JAK2 V617F-positive primary myelofibrosis and advanced chronic myelogenous leukemia with ruxolitinib and flumatinib: a case report
Authors: Zhu Feng , Wang Hui , Qiu Lei 
Published: February 2025

Introduction and importance:
Chronic myeloid leukemia (CML) is characterized by a BCR-ABL1 fusion gene of the Philadelphia chromosome, which is mutually exclusive of genetic abnormalities associated with the myeloproliferative neoplasms polycythemia vera, essential thrombocythemia, and primary myelofibrosis (PMF). These conditions are commonly linked to driver mutations in JAK2, CALR, and MPL. Rare cases with both BCR-ABL1 rearrangement and JAK2 V617F mutation have been reported. However, standardized and effective treatments are lacking.

Case presentation:
Herein, we report a patient with PMF who progressed to accelerated CML. Initially, molecular genetic analyses revealed a JAK2 V617F mutation but no BCR-ABL1 rearrangement and the patient was diagnosed with PMF. Nine years after the initial PMF diagnosis, the patient was diagnosed with accelerated CML. Next-generation sequencing confirmed the presence of a BCR-ABL fusion and JAK2 V617 mutation. A combination of 20 mg ruxolitinib twice daily and 0.6 g flumatinib daily was prescribed as treatment.

Discussion:
Serial quantitative measurements of the expression of BCR-ABL and JAK2 V617F following treatment with flumatinib demonstrated a marked reduction in the levels of the BCR-ABL transcripts, with a concomitant increase in the JAK2 V617F allele burden, suggesting that the two disorders arose from independent clones. The case presented suggests that the JAK2 V617F mutation and BCR-ABL fusion can coexist in early progenitor cells.

Conclusion:
In the current case, the BCR-ABL fusion was detected and CML was confirmed after the recurrence of splenomegaly. Subsequent treatment with a combination of flumatinib and ruxolitinib was demonstrated to be safe and effective.
Unnoticed for 14 years: an asymptomatic forgotten common bile duct stent – a case report
Authors: Elsharif Swsan A. , Elamin Mustafa A.M. , Rafei Ahmed , Abdelraheem Elaf M. , Abdo Abdelmounem E. 
Published: February 2025

Introduction:
Choledocholithiasis is the presence of gallstones within the common bile duct (CBD), affecting 10–20% of gallbladder stone patients. Endoscopic retrograde cholangiopancreatography (ERCP) with stent insertion is a common treatment of CBD obstruction and stenosis to maintain duct patency, with stents typically replaced within 3–6 months. However, prolonged stent presence can lead to complications such as pancreatitis and cholangitis. We report a rare case of a neglected CBD stent left in situ for 14 years without complications.

Case presentation:
A 77-year-old female with controlled hypertension and diabetes presented to the hospital for a routine check-up. Physical examination was unremarkable except for mild scleral jaundice. She had a history of obstructive jaundice treated with ERCP and stent placement in 2010 but missed follow-ups for stent replacement. Laboratory tests revealed mildly elevated total bilirubin and low serum albumin. An abdominal ultrasound showed gallbladder sludge and a mildly dilated CBD. ERCP confirmed a dilated CBD and common hepatic duct stricture. A new plastic stent was placed, with follow-up ERCP scheduled every 6 months.

Clinical discussion:
Forgotten biliary stents (FBS) are plastic stents left in place for more than a year. They can cause complications such as cholangitis, jaundice, stent migration, and pancreatitis. Elderly patients are more susceptible due to physical limitations and potentially inadequate follow-up. Our case highlights the unusual presentation of an asymptomatic FBS for 14 years.

Conclusion:
This case emphasizes the importance of regular monitoring and timely stent replacement to prevent complications. Effective patient education and adherence to follow-up protocols are crucial in managing biliary stents.