bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic full-thickness resection of a large gastric schwannoma and iatrogenic cervical esophageal perforations: A case report
Authors: Huang Siying , Huang Sifu , Fang Taiyong 
Published: July 2024

Introduction:
Gastrointestinal schwannomas are most commonly found in the stomach. Owing to their nonspecific clinical and endoscopic presentations, distinguishing gastric schwannomas (GS) from other gastric submucosal tumors based on typical symptoms and endoscopic features is challenging. Endoscopic full-thickness resection (EFTR) is safe and effective for GS management; however, no standard method exists for the extraction of large gastric specimens after endoscopic treatment.

Case presentation:
We report the case of a 72-year-old Chinese woman who presented with abdominal distension.

Diagnosis, interventions, and outcomes:
Gastroscopy revealed a submucosal bulge on the anterior wall of the lower stomach near the greater curvature. Endoscopic ultrasonography and computed tomography suggested a stromal tumor. The patient underwent EFTR of the stomach, and the tumor was successfully removed. The surgical specimen, with a long-axis diameter of approximately 5.5 cm in vitro, was extracted using a snare. Subsequent endoscopic examination revealed longitudinal, full-thickness perforations > 2 cm at the esophageal entrance. Over 10 metal clips were used to seal the mucosa, and a gastrointestinal decompression tube was placed. Follow-up radiography performed at 1 week postoperatively revealed an esophageal mediastinal fistula, which required subsequent endoscopic intervention to close the fistula using metal clips. The patient showed improvement and was discharged at 3 weeks postoperatively. Follow-up esophageal radiography revealed no abnormalities. Postoperative immunohistochemical analysis indicated CD34 (−), CD117 (−), DOG-1 (−), Ki67 (1%), S-100 (+), SDHB (+), SOX-10 (+), and Desmin (−), confirming the diagnosis of GS. Three months postoperatively, gastroscopy showed that the esophageal perforation healed well, a white ulcer scar had formed locally, metal clips were found in the stomach body, and no recurrence was found.

Conclusion:
EFTR is effective for removing giant schwannomas, although the extraction of large specimens may result in iatrogenic cervical esophageal perforations. Perforations > 2 cm can be managed using endoscopic metal clip closure.
DNA methylation analysis in plasma for early diagnosis in lung adenocarcinoma
Authors: Jin Yulin , Lu Rongguo , Liu Feng , Jiang Guanyu , Wang Ruixin , Zheng Mingfeng 
Published: July 2024

Background:
Lung adenocarcinoma (LUAD) represents the most prevalent type of lung cancer. SHOX2 and RASSF1A methylation have been identified as important biomarkers for diagnosis and prognosis of lung cancer. Bronchoalveolar lavage fluid (BALF) exhibits good specificity and sensitivity in diagnosing pulmonary diseases, but its acquisition is challenging and may cause discomfort to patients. In clinical, plasma samples are more convenient to obtain than BALF; however, there is little research on the concurrent detection of SHOX2 and RASSF1A methylation in plasma. This study aims to assess the diagnostic value of a combined promoter methylation assay for SHOX2 and RASSF1A in early-stage LUAD using plasma samples.

Methods:
BALF and blood samples were obtained from 36 early-stage LUAD patients, with a control group of nineteen non-tumor individuals. The promoter methylation levels of SHOX2 and RASSF1A in all subjects were assessed using the human SHOX2 and RASSF1A gene methylation kit.

Results:
The methylation detection rate of SHOX2 and RASSF1A in plasma was 61.11%, slightly lower than that in BALF (66.7%). The Chi-square test revealed no significant difference in the methylation rate between BALF and plasma (P > 0.05). The area under the receiver operating characteristic (ROC) curve analysis for blood was 0.806 (95% CI, 0.677 to 0.900), while for BALF it was 0.781 (95% CI, 0.649 to 0.881). Additionally, we conducted an analysis on the correlation between SHOX2 and RASSF1A methylation levels in plasma with gender, age, tumor differentiation, pathologic classification, and other clinicopathological variables; however, no significant correlations were observed.

Conclusions:
Measurement of SHOX2 and RASSF1A methylation for early diagnosis of LUAD can be achieved with high sensitivity and specificity by using plasma as a substitute for BALF samples.
Celiac trunk aortic dissection induced by bevacizumab therapy for rectal cancer: A case report
Authors: Su Mingming , Zhao Lili , Zhou Jing , Li Xuan , Ding Ning 
Published: July 2024

Rationale:
Bevacizumab (Bev) is a humanized monoclonal antibody that targets vascular endothelial growth factor A and is primarily used for the treatment of various solid tumors. Aortic dissection (AD) is a severe vascular disease caused by the tearing of the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of different layers of the aortic wall. However, the pathogenesis is not fully understood. Some studies have suggested that Bev treatment is associated with the occurrence of AD.

Patient concerns:
A 67-year-old Chinese male was diagnosed with rectal cancer accompanied by liver and lung metastasis. Three days after starting combined chemotherapy with Bev, the patient developed persistent abdominal pain. Abdominal CT scan revealed celiac trunk AD in the abdominal aorta.

Diagnoses:
The patient was diagnosed with rectal cancer accompanied by liver and lung metastases. Abdominal CT tomography revealed a celiac trunk AD.

Interventions:
Somatostatin combined with valsartan was used to control blood pressure. The patient was subsequently referred for vascular surgery and underwent an abdominal aortic angiography. Conservative treatment was continued.

Outcomes:
Three months after the initiation of treatment, follow-up abdominal CT scans showed stability in the condition of celiac trunk AD, with no abdominal pain or hypertension. There were no signs of worsening dissection, aneurysm formation, or inadequate perfusion of end organs.

Lessons:
There may be a connection between Bev and elevated blood pressure as well as celiac trunk AD.
Endovascular treatment for 2 types of subclavian artery injury: A case report
Authors: Kim Gun Woo , Hwang Suyeong , Lim Kyoung Hoon , Cho Sung Hoon 
Published: July 2024

Rationale:
Subclavian artery (SCA) injuries, though rare, carry significant morbidity and mortality risks due to significant blood loss causing hypovolemic shock. Early diagnosis and adequate treatment are crucial to minimize bleeding and associated morbidity. Recent advances in endovascular techniques offer faster and more accurate treatment options compared to traditional open surgical repair. This study demonstrates the efficacy of endovascular treatment in 2 cases of SCA injury and reviews its indications, limitations, and precautions.

Patient concerns:
A 69-year-old man presented with a penetrating SCA injury from a steel bar, and a 38-year-old woman presented with a blunt SCA injury caused by a fall. Both patients were hemodynamically unstable upon presentation.

Diagnoses:
Both patients were diagnosed with SCA injuries. The man had a penetrating injury, while the woman had a blunt injury, both resulting in hemodynamic instability and significant risk of hypovolemic shock.

Interventions:
Endovascular techniques, including the use of covered stent grafts, were employed to manage the injuries. These techniques allowed for rapid and efficient treatment, reducing the need for open surgical intervention.

Outcomes:
Both patients were successfully treated using endovascular methods and were discharged without any complications. The endovascular approach minimized blood loss, transfusion needs, and hospital stay.

Lessons:
This study demonstrates the effectiveness of endovascular techniques in rapidly diagnosing, bridging, and definitively treating SCA injuries, suggesting their use as a first-line therapy.
Enhancing treatment of lumbar disc herniation with Erxian decoction and auricular acupoint pressure: A randomized controlled trial
Authors: Feng Wei , Du Xixi , Zhao Yuxin 
Published: July 2024

Objective:
The incidence of lumbar disc herniation (LDH) is on the rise annually, with an emerging trend of affecting younger age groups. This study aims to investigate the clinical effectiveness of combining Erxian decoction with auricular acupoint pressure therapy in treating LDH. Our objective is to furnish evidence supporting the incorporation of traditional Chinese medicine (TCM) rehabilitation techniques in clinical settings.

Methods:
This randomized controlled trial enrolled 102 patients diagnosed with LDH and allocated them into Control and Intervention groups. The Control group underwent a 2-week rehabilitation regimen, whereas the Intervention group received an augmented treatment comprising Erxian decoction along with auricular acupoint pressure therapy based on the Control group. Main outcome measures included 3 scales – visual analog scale (VAS), Japanese Orthopedic Association (JOA), and Oswestry Disability Index – as well as 3 inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Additionally, pressure pain threshold and pain tolerance threshold values were evaluated. Participants were assessed at baseline, on 14-day, and on 28-day posttreatment.

Results:
After 2 weeks of treatment, both the Control and Intervention groups exhibited significant improvements in the VAS, JOA, ODI, CRP, IL-6, TNF-α, pressure pain threshold, and pain tolerance threshold (P < .05). These improvements persisted at the 28-day in the VAS, JOA, and ODI scores (P < .05). On 14-day, the Intervention group showed significantly better outcomes compared to the Control group in terms of the VAS, JOA, ODI, CRP, TNF-α, and pressure pain threshold (P < .05).

Conclusion:
Compared to conventional rehabilitation therapy, the combination of Erxian decoction and auricular acupoint pressure therapy demonstrates clear benefits in alleviating symptoms in patients with LDH. This approach offers fresh perspectives and substantiates evidence for future treatment strategies in managing LDH.
Efficacy and safety of resmetirom among patients with non-alcoholic steatohepatitis: a systematic review and meta-analysis
Authors: Mazhar Saad , Azhar Aima , Khan Ariba , Shakil Gulrukh , Kumari Sapna , Devi Deepa , Jawad Sayed 
Published: July 2024

Background:
Non-alcoholic steatohepatitis (NASH) is a severe medical illness that has few available therapeutic options. Resmetirom, a liver-targeting agonist of the thyroid hormone receptor (THR), has recently been licenced by the FDA. We assess the effectiveness and safety of resmetirom in patients with NASH.

Methods:
PubMed, SCOPUS and Cochrane Central were searched till March 2024 to find potential articles. Outcomes assessed included MRI-proton density fat fraction (MRI-PDFF), Fat Reduction, and NASH Resolution Without Fibrosis, changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), low-density lipoprotein (LDL), and triglyceride (TG) levels, along with diarrhoea, nausea, urinary tract infection (UTI), and headache. Subgroup analysis was performed between outcomes before and after 6 months. Outcomes were analyzed with a random-effects model and results presented as mean difference (MD) for continuous outcomes and odds ratios (OR) for safety analysis, along with their 95% confidence intervals. A risk of bias assessment was performed using Cochrane Risk of Bias tool.

Results:
Four randomized controlled trials (RCTs) were included in our analysis. Resmetirom shown a substantial improvement in MRI-PDFF with a MD of −19.23 (P<0.00001). Additionally, it resulted in a 30% reduction in fat (OR: 3.54, P=0.004) and resolution of NASH without fibrosis (OR: 2.41, P=0.04). There was no notable enhancement observed in AST levels, with a mean difference of −0.87 and a P value of 0.73. The usage of resmetirom resulted in significant improvement in ALT levels (MD: −4.36, P value: 0.32), GGT levels (MD: −17.87, P value: <0.00001), TG levels (MD: −23.48, P value: <0.00001), LDL levels (mean difference: −12.80, P value: <0.00001), and rT3 levels (MD: -2.08, P value: <0.00001). The use of Resmetirom was associated with a higher likelihood of experiencing diarrhoea (OR: 2.07, P<0.0001) and nausea (OR: 1.81, P=0.0003). However, there was no significant difference observed in the occurrence of UTI (OR: 1.04, P=0.85) or headaches (OR: 0.79, P=0.48).

Conclusion:
Resmetirom demonstrates efficacy in enhancing MRI-PDFF score, diminishing adipose tissue, resolving NASH without fibrosis, reducing GGT, TG, LDL, reverse triiodothyronine (rT3) levels in NASH patients. Nevertheless, there is also an observed heightened susceptibility to experiencing diarrhoea and nausea. Additional trials are necessary to further examine the efficacy and safety of this medication.
Predictors of quality of life, economic impact, and loss to follow-up after open tibial shaft fractures in Ghana
Authors: Ativor Vincent , Konadu-Yeboah Dominic , O'Marr Jamieson , Brown Kelsey , Rodarte Patricia , Kumah Ralph , Quartey Ralph , Awariyah Dominic , Konadu Peter , Baidoo Paa Kwesi , Okike Kanu , Morshed Saam , Shearer David , Roberts Heather 
Published: July 2024

Abstract

Objectives:
Open tibia fractures are associated with substantial morbidity and impact on quality of life. Despite increasing incidence in low-resource settings, most open tibia fracture research comes from high-resource settings. This study aimed to assess the impact of socioeconomic status on treatment modality and evaluate predictors of health-related quality of life following open tibia fractures in Ghana.

Design:
A single-center prospective observational study was conducted in Kumasi, Ghana, from May 2020 to April 2022. Adults with open tibial shaft fractures presenting within 2 weeks of injury were eligible. Demographics, comorbidities, socioeconomic factors, and hospital course were collected at enrollment. Follow-up was scheduled at 8, 12, 26, and 52 weeks. A telephone survey assessing reasons for loss to follow-up was initiated on enrollment completion.

Results:
A total of 180 patients were enrolled. Most patients were employed before injury (79.9%), had government insurance (67.2%), and were from rural areas (59.4%). Fracture classification was primarily Gustilo–Anderson type 3A (49.1%). No relationship between socioeconomic predictors and treatment modality was identified. The largest barriers to follow-up were preference for bonesetter treatment (63.1%), treatment cost (48.8%), and travel cost (29.8%). Of the lost to follow-up patients contacted, 67 (79.8%) reported receiving traditional bonesetter care. Reasons for seeking traditional bonesetter care included ease of access (83.6%), lower cost (77.6%), and familial influence (50.7%).

Conclusion:
No association was identified between socioeconomic predictors and choice of treatment. Bonesetter treatment plays a substantial role in the care of open tibia fractures in Ghana, largely because of ease of access and lower cost.
Analysis of Surgeon and Center Case Volume and Stroke or Death after Transcarotid Artery Revascularization
Authors: Elsayed Nadin , Khan Maryam Ali , Janssen Claire B , Lane John , Beckerman William E , Malas Mahmoud B 
Published: July 2024

BACKGROUND:
It has been suggested that the annual hospital volume of cases may affect the number of adverse events after carotid endarterectomy (CEA). We aim to study the associations between hospital as well as surgeon volume and the risk of stroke or death after transcarotid artery revascularization (TCAR).

STUDY DESIGN:
Retrospective review of the Vascular Quality Initiative data of patients undergoing TCAR from 2016 to 2021. Surgeon and center volume were calculated based on the mean number of cases (MNC) performed yearly by each surgeon and center. The primary outcome was a composite endpoint of in-hospital stroke or death.

RESULTS:
A total of 22,624 cases were included. Surgeon volume was divided into 3 quantiles: low (MNC = 4), medium (MNC = 10), and high (MNC = 26). Center volume was also divided into low (MNC = 14), medium (MNC = 32), and high (MNC = 64). After adjusting for potential confounders, and when compared with high-volume centers, low and medium center volumes were not associated with any increased odds of in-hospital stroke and death, stroke, death, or stroke with transient ischemic attack (TIA). Compared with high-volume surgeons, low surgeons’ volume was associated with a higher odd of stroke (odds ratio 1.5, 95% CI 1.1 to 2.04, p = 0.008), and stroke and TIA (OR 1.5, 95% CI 1.2 to 1.9, p = 0.002). However, medium surgeon volume was not associated with higher odds of stroke and death, stroke, and stroke with TIA. Neither low nor medium surgeon volume was associated with a difference in mortality compared with high surgeon volume.

CONCLUSIONS:
In this retrospective study, center volume was not associated with any differences in outcomes among patients undergoing TCAR. On the other hand, surgeons with low volume were associated with a higher risk of stroke, death, or MI and stroke or TIA when compared with high surgeon volume. There was no difference in outcomes between medium and high surgeon volume.
Spectral-switching analysis reveals real-time neuronal network representations of concurrent spontaneous naturalistic behaviors in human brain
Authors: Zhu Hongkun , Michalak Andrew J. , Merricks Edward M. , Agopyan-Miu Alexander H. C. W. , Jacobs Joshua , Hamberger Marla J. , Sheth Sameer A. , McKhann Guy M. , Feldstein Neil , Schevon Catherine A. , Hillman Elizabeth M. C. 
Published: July 2024

AbstractDespite abundant evidence of functional networks in the human brain, their neuronal underpinnings, and relationships to real-time behavior have been challenging to resolve. Analyzing brain-wide intracranial-EEG recordings with video monitoring, acquired in awake subjects during clinical epilepsy evaluation, we discovered the tendency of each brain region to switch back and forth between 2 distinct power spectral densities (PSDs 2-55Hz). We further recognized that this ‘spectral switching’ occurs synchronously between distant sites, even between regions with differing baseline PSDs, revealing long-range functional networks that would be obscured in analysis of individual frequency bands. Moreover, the real-time PSD-switching dynamics of specific networks exhibited striking alignment with activities such as conversation and hand movements, revealing a multi-threaded functional network representation of concurrent naturalistic behaviors. Network structures and their relationships to behaviors were stable across days, but were altered during N3 sleep. Our results provide a new framework for understanding real-time, brain-wide neural-network dynamics.
Translating human drug use patterns into rat models: exploring spontaneous interindividual differences via refined drug self-administration procedures
Authors: D’Ottavio Ginevra , Pezza Sara , Modoni Jacopo , Reverte Ingrid , Marchetti Claudia , Zenoni Soami F. , Termine Andrea , Fabrizio Carlo , Maftei Daniela , Lattanzi Roberta , Esposito Giuseppe , Ragozzino Davide , Merlo Emiliano , Milella Michele S. , Ciccocioppo Roberto , Fumagalli Fabio , Venniro Marco , Badiani Aldo , Boix Fernando , Caprioli Daniele 
Published: July 2024

AbstractHeroin and cocaine users tailor their dosage and frequency of use, as well as their method of administration, to maximize the drugs’ pleasurable effects and prevent withdrawal symptoms. On the other hand, many preclinical self-administration and choice experiments employ fixed unit doses and mandatory timeouts after doses (known as discrete dimension procedures). These restrictions fail to consider the distinct pharmacokinetic properties of heroin and cocaine, leading to uniform and comparable behaviors (including drug-taking patterns). This uniformity contrasts sharply with the significantly different ways humans use heroin and cocaine, which are characterized by highly individualized drug use behaviors. Here, we introduce a no-timeout procedure that overcomes this limitation (continuous dimension procedure).We analyzed the heroin and cocaine taking- and seeking-patterns and estimated drug-brain levels in the presence or absence of timeout between drug injections. We further assessed how absence of timeout and the availability of drug or social peer (access time to the two rewards) affect drug preference. Removing the timeout had a profound effect on pattern of heroin taking and seeking, promoting the emergence of burst-like drug intake and social withdrawal as revealed by a discrete choice procedure. On the other hand, timeout removal had a lesser impact on cocaine taking and seeking and did not impact social preference. By removing timeout during self-administration and increasing the access time during choice resulted in a self-administration procedure that more closely mimic human heroin intake, offering a platform to identify novel medications.
Parallel Sampling of Protein-Ligand Dynamics
Authors: Masters Matthew R. , Mahmoud Amr H. , Lill Markus A. 
Published: July 2024

AbstractMolecular dynamics (MD) simulations of protein-ligand complexes are essential for computer-aided drug design. In particular they enable the calculation of free energies and thus binding affinities. However, these simulations require significant computational resources and can take days to weeks to achieve relatively short timescales compared to biologically relevant timescales. To address this issue, we introduce a method for non-sequential generation of MD samples using a generative deep neural network trained on a large corpus of protein-ligand complex simulations. The method generates accurate protein-ligand complexes with full protein and ligand flexibility and is able to recapitulate the conformation space sampled by MD simulations with high coverage. This development is a step forward towards one-shot molecular sampling that can be utilized in the calculation of protein-ligand free energies.3
Proteins Derived From MRL/MpJ Tendon Provisional Extracellular Matrix and Secretome Promote Pro-Regenerative Tenocyte Behavior
Authors: Marvin Jason C. , Liu Ethan J. , Chen Hsin Huei , Shiovitz David A. , Andarawis-Puri Nelly 
Published: July 2024

AbstractTendinopathies are prevalent musculoskeletal conditions that have no effective therapies to attenuate scar formation. In contrast to other adult mammals, the tendons of Murphy Roths Large (MRL/MpJ) mice possess a superior healing capacity following acute and overuse injuries. Here, we hypothesized that the application of biological cues derived from the local MRL/MpJ tendon environment would direct otherwise scar-mediated tenocytes towards a pro-regenerative MRL/MpJ-like phenotype. We identified soluble factors enriched in the secretome of MRL/MpJ tenocytes using bioreactor systems and quantitative proteomics. We then demonstrated that the combined administration of structural and soluble constituents isolated from decellularized MRL/MpJ tendon provisional ECM (dPECM) and the secretome stimulate scar-mediated rodent tenocytes towards enhanced mechanosensitivity, proliferation, intercellular communication, and ECM deposition associated with MRL/MpJ cell behavior. Our findings highlight key biological mechanisms that drive MRL/MpJ tenocyte activity and their interspecies utility to be harnessed for therapeutic strategies that promote pro-regenerative healing outcomes.TeaserProteins enriched in a super-healer mouse strain elicit interspecies utility in promoting pro-regenerative tenocyte behavior.