bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparisons of different general anesthetic techniques on immune function in patients undergoing flap reconstruction for oral cancer
Authors: Qin Chuanqi , Fan Guo , Huang Lili 
Published: July 2024

Background:
Anesthetic-induced immunosuppression is of particular interest in tumor surgery. This study aimed to investigate the influence of the 4 most common general anesthetic techniques on immune function in patients undergoing flap reconstruction for oral cancer.

Methods:
116 patients were randomly divided into 4 groups. Patients in group S were given sevoflurane-based anesthesia. Group P was administered propofol-based anesthesia. The SD group received sevoflurane combined with dexmedetomidine anesthesia. The propofol combined with dexmedetomidine anesthesia (PD) group received PD. Blood samples were obtained at 5 time points: baseline (T0), 1 hour after the start of the operation (T1), end of the operation (T2), 24 hours (T3), and 48 hours (T4) after the operation. Lymphocyte subsets (including CD3+, CD4+, CD8+, and B lymphocytes) and dendritic cells were analyzed by flow cytometry. Blood glucose, norepinephrine, and cortisol levels were measured using ELISA and a blood gas analyzer respectively.

Results:
In total, 107 patients were included in the final analysis. Immunological indicators, except CD8+ counts, were all decreased in groups S, P, and SD at T1-4 compared with the baseline value, and the counts of CD3+, CD4+, and dendritic cells, as well as CD4+/CD8+ ratios, were significantly higher in the PD group than in the S, P, and SD at T1-3 (P < .05). There were no significant differences between groups P and SD at any observation time point. Intraoperative stress indices, including norepinephrine and cortisol levels, were significantly lower in the PD group than in the other 3 groups at T1-2 (P < .05).

Conclusion:
These findings suggest that PD as a probably optimal choice can alleviate immunosuppression in patients undergoing flap reconstruction for oral cancer.
A meta-analysis supporting the superiority of staged carotid artery stenting and coronary artery bypass grafting in patients with concurrent severe coronary and carotid artery stenosis
Authors: Hao Dong , Jiang Yunshan , Wang Peijian , Mao Limei 
Published: July 2024

Background:
This study sought to ascertain whether a staged approach involving carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) holds superiority over the synchronous (Syn) strategy of CAS or carotid endarterectomy (CEA) and CABG in patients necessitating combined revascularization for concurrent carotid and coronary artery disease.

Method:
Studies were identified through 3 databases: PubMed, EMBASE, and the Cochrane Library. Statistical significance was defined as a P value of less than .05 for all analyses, conducted using STATA version 12.0.

Results:
In the comparison between staged versus Syn CAS and CABG for patients with concomitant severe coronary and carotid stenosis, 4 studies were analyzed. The staged procedure was associated with a lower rate of 30-day stroke (OR = 8.329, 95% CI = 1.017–69.229, P = .048) compared to Syn CAS and CABG. In the comparison between staged CAS and CABG versus Syn CEA and CABG for patients with concomitant severe coronary and carotid stenosis, 5 studies were examined. The staged CAS and CABG procedure was associated with a lower rate of mortality (OR = 2.046, 95% CI = 1.304–3.210, P = .002) compared to Syn CEA and CABG.

Conclusion:
The Syn CAS and CABG was linked to a higher risk of peri-operative stroke compared to staged CAS and CABG. Additionally, patients undergoing staged CAS and CABG exhibited a significantly decreased risk of 30-day mortality compared to Syn CEA and CABG. Future randomized trials or prospective cohorts are essential to confirm and validate these findings.
A case series of osseous metastases in patients with glioblastoma
Authors: Webb Lauren Michelle , Webb Mason J. , Campian Jian L. , Caron Samantha J. , Ruff Michael W. , Uhm Joon H. , Sener Ugur 
Published: July 2024

Background:
Extracranial metastases occur in <2% of cases of glioblastoma (GBM). When metastases do occur, bone is the most common destination. Herein, we review clinical characteristics of GBM patients with osseous metastases and evaluate both potential risk factors and prognostic significance.

Methods:
Using an institutional database, we identified and retrospectively analyzed 6 patients with both GBM and osseous metastases. We collected data on patient demographics, tumor genetics, clinical courses, and outcomes. Given the rarity of metastatic GBM, we conducted historical comparisons using previously published literature.

Results:
Five patients with osseous metastases (83%) were male, with a median age of 46 years at GBM diagnosis (range: 20–84). All patients had IDH-wildtype, MGMT promoter unmethylated GBM and 5 (83%) had alterations in TP53. All patients underwent surgical resection for GBM followed by radiation with concurrent and adjuvant temozolomide. Four patients (67%) received bevacizumab prior to bone metastasis diagnosis. Bone metastases were discovered at a median of 12.2 months (range: 5.3–35.2) after GBM diagnosis and 4.8 months after starting bevacizumab (range: 3.5–13.2). Three patients (50%) received immunotherapy. After osseous metastasis diagnosis, the median survival was 25 days (range: 13–225).

Conclusion:
In our cohort, most patients were male and young at the time of GBM diagnosis. All patients had IDH-wildtype, MGMT promoter unmethylated GBM, and most had alterations in TP53, which may be important for osseous metastasis. Most patients received bevacizumab, which has been associated with earlier metastasis. Osseous metastases of GBM occur and portend a dismal prognosis in an already aggressive malignancy.
Intralobar bronchopulmonary sequestration in an adult: a case report
Authors: Pandey Abhishek , Pandey Archana , Keshari Suraj , Dulal Aliza , Acharya Suyash , Chaudhary Aashutosh , Chaudhary Ashlesha , Pande Prasamsa , Bhardwaj Sushant 
Published: July 2024

Introduction:
Bronchopulmonary sequestration (BPS) is typically a rare congenital disorder characterized by the presence of non-functioning lung tissue. There are two types of BPS: intralobar and extralobar sequestration, where extralobar sequestration can either be intrathoracic or sub-diaphragmatic.

Case presentation:
In this case report, we present the case of a 70-year-old male with intralobar BPS who presented with recurrent chest infections, and a diagnosis of intralobar pulmonary sequestration was made based on a computed tomography (CT) scan.

Discussion:
The diagnosis of intralobar pulmonary sequestration can be delayed as the intralobar type can present with varying imaging findings. A diagnosis can be made based on CT or MRI findings. A CT scan or MRI can show mass or consolidation with or without a cyst. Both CT and MRI can be reliable modalities to identify the arterial supply of the sequestered lung tissue, which is commonly a branch of the descending aorta.

Conclusion:
Sequestration should be suspected when a posterobasal lung abnormality is supplied by an abnormal artery from the aorta or another systemic artery.
Transcutaneous oxygen tension-guided hyperbaric oxygen therapy for preventing skin necrosis after hyaluronic acid filler injections
Authors: Yang Qiqiong , Shi Zhiyuan , Pan Shuyi , Li Hang 
Published: July 2024

Introduction:
Hyaluronic acid (HA) fillers, popular for facial cosmetic enhancements, pose risks of vascular complications like skin necrosis due to arterial blockage, necessitating effective treatments such as hyperbaric oxygen therapy (HBOT).

Methodology:
This study presents a series of cases where measurements of transcutaneous oxygen pressure (TcPO2) informed the application of HBOT for skin necrosis induced by HA.

Clinical presentation and outcomes:
In cases 1 and 3, following the injection of HA, potential skin necrosis was observed. In addition to standard treatment, TcPO2 revealed values below 40 mmHg, indicating tissue hypoxia. Treatment with HBOT increased TcPO2 levels to above 200 mmHg, suggesting that HBOT could correct the hypoxia. Monitoring TcPO2 levels also aided in determining the optimal time to discontinue HBOT. In cases 2 and 4, patients received standard treatment, resulting in TcPO2 levels above 40 mmHg, indicating adequate tissue oxygenation, and no additional HBOT was administered. All four patients mentioned above showed good clinical recovery.

Conclusion:
This study investigates the application of TcPO2 measurement technology in aiding decisions on whether to utilize HBOT in the treatment of complications arising from HA fillers, as well as in optimizing HBOT protocols.
Artificial Intelligence or Nursing Student? Revisiting Clues in the Connectives
Authors: Abbott Miriam R. Bowers , Abbott Wyatt W. 
Published: July 2024

Background:
Recent research at a single-purpose nursing institution has suggested a means to authenticate student writing by distinguishing it from artificial intelligence (AI)-generated text through the detection of key terms.

Purpose:
The purpose was to replicate and expand the research that identified key terms present in student writing but absent from AI-generated text.

Methods:
A total of 5 generative AI writing tools were fed prompts to collect 14 787 words. Using the Search function on word processing software, the frequency of the terms, because, since, so, then, thing, think, and too, was measured and compared against earlier published findings from AI and students.

Results:
The replication study was successful for the terms since, then, thing, think, and too.

Conclusions:
Measuring key term frequency may be a path to authenticate student writing. While no tool can provide certainty of original authorship, the absence of key terms in a student submission may suggest AI authorship.
Long-Term Outcome of Secondary Cleft Rhinoplasty in Patients with Secondary Nasal Deformity: Optimal Indications for Tajima Technique
Authors: Liu Yingmeng , Zhang Chong , Yao Meilin , Wei Minxing , Long Yifei , Zheng Qian , Low David W. , Shi Bing , Li Chenghao 
Published: July 2024

Background:
The authors investigated the timing of and indications for the Tajima reverse-U incision for correcting secondary unilateral cleft nasal deformities.

Methods:
Nonsyndromic patients with secondary cleft lip and nasal deformity who received Tajima reverse-U incision rhinoplasty were grouped by age (4 to 13 years, n = 56; 13 to 18 years, n = 22; older than 18 years, n = 18) and severity of deformity (mild deformity, n = 7; moderate deformity = 22; severity deformity = 67) during 5-year follow-up. FACE-Q assessment and nasal symmetry measurements were used in this study.

Results:
Ninety-six patients completed the FACE-Q assessment for the nose and nostril. The results showed higher satisfaction with nostril appearance 1 week after surgery (85.95 ± 13.01) compared with before surgery (79.72 ± 11.89), maintained at the 5-year follow-up (82.61 ± 14.06). Significant differences were observed in 5 nasal parameters (nasal height ratio, one-fourth media part of nostril height ratio, nasal sill height ratio, columellar angle, and inner nostril height-to-width ratio [cleft]) at 1 week postoperatively, and the corrected outcome of the Tajima technique was maintained 5 years after surgery in the 4- to 13-year age group. The same statistically significant changes were found in nasal sill height ratio in the mild deformity group and nostril width ratio, one-fourth media part of nostril height ratio, columellar angle, and inner nostril height-to-width ratio (cleft) in the moderate deformity group.

Conclusion:
The Tajima procedure was beneficial for preadolescent children and children with mild to moderate unilateral cleft nasal deformities.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
What Computed Tomography Findings Are Predictive of Posttraumatic Enophthalmos in Orbital Fractures?
Authors: Lentskevich Marina A. , Nguyen Alvin , Choudhary Akriti , Obaid Oday , Purnell Chad A. 
Published: July 2024

Background:
Enophthalmos is a surgical indication for orbital fracture repair. However, guidelines to predict enophthalmos in orbital fractures are ambiguous. The authors systematically reviewed the existing literature on using computed tomographic findings to establish objective metrics to predict enophthalmos in asymptomatic patients during initial trauma work-up.

Methods:
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed and Embase were used to identify studies of interest. The Quality in Prognosis Studies tool was used for risk of bias assessment. Random-effects model meta-analyses of orbital volume change and fracture area values were completed. Regression analyses were performed to determine thresholds that predicted 2 mm of enophthalmos.

Results:
Of the initial 2236 abstracts, 36 met inclusion criteria. Thirty retrospective studies evaluated a total of 2851 patients, and 6 prospective studies evaluated 211 patients. All 36 studies had predominantly low risk of bias. Predictors of enophthalmos assessed were orbital volume change (21 articles), fracture surface area (13 articles), inferior rectus muscle displacements (7 articles), and fracture location (4 articles). Studies reporting on orbital volume change offered values ranging from 0.69 to 4.26 cm3. Fracture area predictor values ranged from 1.50 to 3.38 cm2. Meta-analyses confirmed the validity of both predictors. Pooled regression analyses demonstrated that 3.33 cm3 of orbital volume increase or fracture area of 3.12 cm2 were predictors of 2 mm of enophthalmos.

Conclusions:
Both orbital volume change and fracture area measured on computed tomographic scan are good predictors of late posttraumatic enophthalmos. Pooled data indicate that 3.12 cm2 of fracture area or 3.33 cm3 of orbital volume increase is predictive of enophthalmos.
The Contribution of Socioeconomic Factors to HIV RNA Suppression in Persons With HIV Engaged in Care in the NA-ACCORD
Authors: Chandran Aruna , Feng Xinyi , Coburn Sally B. , Kasaie Parastu , Malone Jowanna , Horberg Michael A. , Hogan Brenna , Rebeiro Peter F. , Gill M. John , McGinnis Kathleen A. , Silverberg Michael J. , Karris Maile Young , Napravnik Sonia , Konkle-Parker Deborah , Lee Jennifer , Freeman Aimee M. , Ghidey Ronel , Garza Venezia , Marconi Vincent C. , Kirk Gregory D. , Thorne Jennifer , Crane Heidi M. , Lang Raynell , Kitahata Mari M. , Moore Richard D. , Althoff Keri N. 
Published: July 2024

Introduction:
Socioeconomic status (SES) influences well-being among people living with HIV (people with HIV [PWH]); when individual-level SES information is not available, area-level SES indicators may be a suitable alternative. We hypothesized that (1) select ZIP code–level SES indicators would be associated with viral suppression and (2) accounting for ZIP code–level SES would attenuate racial disparities in viral suppression among PWH.

Setting:
The NA-ACCORD, a collaboration of clinical and interval cohorts of PWH, was used.

Methods:
Participants with ≥1 viral load measurement and ≥1 US residential 5-digit ZIP code(s) between 2010 and 2018 were included. In this serial cross-sectional analysis, multivariable logistic regression models were used to quantify the annual association of race and ethnicity with viral suppression, in the presence of SES indicators and sex, hepatitis C status, and age.

Results:
We observed a dose–response relationship between SES factors and viral suppression. Lower income and education were associated with 0.5–0.7-fold annual decreases in odds of viral suppression. We observed racial disparities of approximately 40% decreased odds of viral suppression among non-Hispanic Black compared with non-Hispanic White participants. The disparity persisted but narrowed by 3%–4% when including SES in the models.

Conclusions:
ZIP code–based SES was associated with viral suppression, and accounting for SES narrowed racial disparities in viral suppression among PWH in the NA-ACCORD. Inclusion of ZIP code–level indicators of SES as surrogates for individual-level SES should be considered to improve our understanding of the impact of social determinants of health and racial disparities on key outcomes among PWH in North America.
Radiogenomics of Intrahepatic Cholangiocarcinoma: Correlation of Imaging Features With BAP1 and FGFR Molecular Subtypes
Authors: Cox Veronica , Javle Milind , Sun Jia , Kang Hyunseon 
Published: July 2024

Purpose
Clinical research has shown unique tumor behavioral characteristics of BRCA-associated protein-1– (BAP1-) and fibroblast growth factor receptor (FGFR)–mutated intrahepatic cholangiocarcinomas (CCAs), with BAP1-mutated tumors demonstrating more aggressive forms of disease and FGFR-altered CCAs showing more indolent behavior. We performed a retrospective case-control study to evaluate for unique imaging features associated with BAP1 and FGFR genomic markers in intrahepatic CCA (iCCA).

Methods
Multiple imaging features of iCCA at first staging were analyzed by 2 abdominal radiologists blinded to genomic data. Growth and development of metastases at available follow-up imaging were also recorded, as were basic clinical cohort data. Types of iCCA analyzed included those with BAP1, FGFR, or both alterations, as well as cases with low mutational burden or mutations with low clinical impact, which served as a control or “wild-type” group. There were 18 cases in the FGFR group, 10 with BAP1 mutations, and 31 wild types (controls).

Results
Cases with BAP1 mutations showed significantly larger growth at first year of follow-up (P = 0.03) and more frequent tumor-associated biliary ductal dilatation (P = 0.04) compared with controls. FGFR-altered cases showed more infiltrative margins compared with controls (P = 0.047) and demonstrated less enhancement between arterial to portal venous phases (P = 0.02). BAP1 and FGFR groups had more cases with stage IV disease at presentation than controls (P = 0.025, P = 0.006).

Conclusion
Compared with wild-type iCCAs, FGFR-mutated tumors often demonstrate infiltrative margins, and BAP1 tumors show increased biliary ductal dilatation at presentation. BAP1-mutated cases had significantly larger growth at first-year restaging.
Incidental Breast Cancer Diagnosis From Lymphoscintography Using 99mTc-Labeled Nanocolloid for Cutaneous Melanoma of the Upper Arm
Authors: Chan Kayan , Chan James , Roshan Amit 
Published: July 2024

Abstract
A 51-year-old woman with a 2-mm-Breslow-thickness melanoma on her arm had 99mTc-nanocolloid lymphoscintigraphy to localize the associated sentinel lymph node. A single axillary node was identified, and histology confirmed a micrometastasis of breast tissue origin. Imaging of the patient’s breasts and subsequent biopsy confirmed ipsilateral stage III breast cancer, which was treated with lumpectomy and axillary node clearance. This is the first reported case of an incidental solid cancer diagnosis from a sentinel lymph node biopsy undertaken for a different tumor origin. This illustrates the importance of recognizing overlapping lymphatic distribution of sentinel lymph nodes, which can drain multiple organs.
FDG PET/CT in Staging and Response Evaluation of Primary Urothelial Carcinoma of the Urethra
Authors: Zhang Jun , Dong Aisheng , Wang Yang 
Published: July 2024

Abstract
Primary urethral urothelial carcinoma is a rare aggressive tumor with a high propensity for local invasion and regional and distal metastases. We describe the usefulness of FDG PET/CT in management of a patient with primary urethral urothelial carcinoma. FDG PET/CT at initial staging showed FDG-avid primary tumor and lymph node metastasis of the left groin, and mild or no activity of the lung metastases due to small size. FDG PET/CT after 4 cycles of chemotherapy showed progression of the primary tumor and lung metastases, partial response of the left inguinal lymphadenopathy, and multiple new sites of FDG-avid metastases.
Atypical Bone Involvement in Erdheim-Chester Disease Showing No or Subtle Structure Changes and Increased Activity on FDG PET/CT
Authors: Xiao Zhengguang , Dai Shun , Dong Aisheng , Bai Yushu 
Published: July 2024

Abstract
Bones are the most common sites involved in Erdheim-Chester disease. On imaging, the bone involvement in Erdheim-Chester disease typically presents as osteosclerotic lesions, and osteolytic lesions are unusual. Bone lesions showing no or subtle structure changes are rarely reported. We describe FDG PET/CT findings in a case of Erdheim-Chester disease with atypical bone involvement. The bone lesions showed no or subtle structure changes without obvious osteosclerosis or osteolysis on radiographs and CT, and increased FDG activity mimicking lymphoma. Familiarity with these atypical imaging findings of bone involvement in Erdheim-Chester disease is helpful for the diagnosis.
A Rare Case of Follicular Dendritic Cell Tumor of the Abdominal Cavity Visualized by 18F-AlF-NOTA-Octreotide PET/CT
Authors: Hou Guozhu , Cheng Xin , Sun Li , Wang Xuejuan , Zheng Rong 
Published: July 2024

Abstract
Positivity of follicular dendritic cell tumor in somatostatin receptor imaging is rare. A 68-year-old woman underwent ultrasound in health examination. The results showed abnormal echoes in the pancreatic head region, suggestive of a neuroendocrine tumor of the pancreatic head. 18F-AlF-NOTA-octreotide PET/CT was performed for staging. 18F-AlF-NOTA-octreotide PET/CT revealed an irregular mass between the caudate lobe of the liver and the pancreatic head with heterogeneously increased uptake, which was later confirmed as follicular dendritic cell tumor by pathological examination.
68Ga-FAPI PET/CT Visualized Benign Metastasizing Leiomyoma With Bone Invasion
Authors: Fang Tianxing , Li Chongjiao , Tian Yueli , Xiao Zhiwei , He Yong 
Published: July 2024

Abstract
Benign metastasizing leiomyoma (BML) is a rare disease associated with pelvic leiomyoma. We report 18F-FDG and 68Ga-FAPI PET/CT findings in a 51-year-old woman with multiple BMLs. The mass in the abdominopelvic cavity and other metastatic lesions showed highly increased 68Ga-FAPI uptake, whereas uptake of 18F-FDG in those lesions was low. Our report demonstrates that 68Ga-FAPI PET/CT showed a different result in detecting BML to 18F-FDG PET/CT, and 68Ga-FAPI PET/CT may be a promising method for whole-body evaluate metastases.
Establishment of Cephalic Index by Computed Tomography in Sampled Chinese Children
Authors: Liang Qin-Chuan , Chen Xi , Liu Hui-Qing , Xia Ze-Yang , Gao Ping-Ping , Bao Nan 
Published: July 2024

Objective:
Cephalic Index (CI), the ratio of head width to length, is one of the indexes reflecting cranial morphological characteristics. Current norms were established by European and American countries. The purpose of the study was to study anthropometry of cranial parameters using computed tomography scans to establish the CI of the sampled Chinese Children.

Methods:
The cross-sectional study was carried out on patients of age younger than 14 years old at Shanghai Children’s Medical Center. The measurement of maximum cranial breadth and maximum cranial length were taken on a computed tomography scan machine and recorded for analysis. Cephalic Index was calculated for each age and sex group and compared with previously established norms.

Results:
Five hundred eighteen patients met the inclusion criteria, including 301 males and 217 females. The means for boys and girls were 87.1 (SD: 4.3) and 85.8 (SD: 4.3), respectively. There was a significant difference between boys and girls (P < 0.01). Cephalic Index in different ages and on applying the 1-way analysis of variance association was statistically insignificant (P = 0.19).

Conclusions:
Chinese head shape was brachycephalic. A statistically significant correlation was seen between the CI and sex, while not age.